Mark Klimek Yellow Book (KV)

25 July 2022
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893 test answers

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question
If the pH and the BiCarb are both in the same direction then it is?
answer
Metabolc
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If the pH is up it is?
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Alkalosis
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As the pH goes so goes my patient except for?
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Potassium
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If the pH is down it is?
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Acidosis
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If the pH is up my patient with show signs and symptoms of?
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Increase... like tachycardia,diarrhea and borborygmi
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If the pH is down my patient will show signs and symtoms of?
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Decrease... like decreased output, bradycardia and constipation
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If my pH is up my potassium (K+) is ?
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Down
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If my pH is down my potassium (K+) is?
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Up
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If my patient is overventilating I should choose?
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Respiratory Alkalosis
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If my patient is underventilating I should choose?
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Respiratory Acidosis
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If my patient has prolonged gastric vomiting or suction I choose?
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Metabolic Alkalosis
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If it is not lung or prolonged vomiting or suctioning I choose?
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Metabolic Acidosis
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Kussmal Respirations
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Metabolic Acidosis ( Remember MacKussmal
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Before measuing ABGs you should check what?
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Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's).
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Definition of Compensation
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PH is normal! It is never compensated if it is abnormal.
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If PH normal
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look in the direction it is going. Closer to Acidic? (7.35) acidosis. Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis. If C02 is abnormal, it's Respiratory Acidosis :)
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If your pt is acidotic and you need to pick a symptom
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Pick the symptom where everything is DOWN. ( And vice Versa) Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction
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If you don't know what causes an acid base balance, pick
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Metabolic Acidosis
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If in doubt in ABGs, always pick
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Headache, nausea, weakness & numbness+ tingling. It can be either up or down.
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High pressure alarms are triggered when?
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They cannot push air in
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High pressure alarms are caused by what three types of obstructions?
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Kinking, Water in dependant loops and mucus in the airway.
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If kinking in the tube is present you?
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Unkink
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If water is present in the dependant loops you?
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Open system and empty water.
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If mucus is present you?
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Turn them, cough and have them deeo breath first. If ineffective you then suction.
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Don't suction unless
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Coughing & deep breathing is deemed inappropriate.
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In order to suction, you must be able to hear
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Mucus in the lung
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Low pressure alarms are triggered when?
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It is to easy to push air in.
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Low pressure alarms are normally caused by?
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Disconnection
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If the tubing is disconnected you?
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Reconnect
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If O2 sensor line is disconnected you?
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Reconnect
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In a vented client respiratory alkalosis means the vent setting may be too?
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High
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In a vented client respiratory acidosis means the vent may be too?
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Low
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What do you do if the patients disconnected tube is on the floor?
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Bag them, (call for help) get new tube and then reconnect.
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First question to ask if the low pressure alarm sounds
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Where is the tubing?!
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HOLD
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H- High Pressure O- Obstruction L- Low D- Disconnections
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Never put anything in YOUR scope of practice
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On anyone else
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Make sure your answer is
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PATIENT FOCUSED. TAKE CARE OF YOUR PATIENT! Don't answer based on staff, building, machine, etc. PATIENT FIRST.
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What does wean mean?
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Decrease Gradually
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What do you do if the patients disconnected tube is on the chest?
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Reconnect ... if its above the waist its ok.
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Remember is PSYCH if you are asked to Prioritize, Don't forget
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MASLOW! 1. Physiological 2. Safety 3. Comfort - Includes pain 4. Psychological 5. Social 6. Spiritual
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When prioritizing, always use Maslow + ABCs
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For one patient. Don't if you have more than one patient.
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What is the biggest problem in abuse?
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Denial
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To treat denial you need to?
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Confront them.
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Definition of Denial
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Refusal to accept reality of their problem
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How do you confront?
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Point out the difference between what they say and what they do.
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What is the one circumstance that you as a nurse would support denial?
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Loss and Grief
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Always go
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Med surg first. Then Psych
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What is dependency?
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When the abuser gets a significant other so make decisions for them or do thing for them.
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What is codependency?
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When the significant other gets positive self esteem from doing things or making decisions for an abuser.
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To treat dependency/codependency you ?
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Set limits and enforce them. Say NO and follow through. Agree in advance on what requests are allowed, then enforce the agreement. Work on self esteem of the codependent.
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What is manipulation?
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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.
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How do you treat manipulation?
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Set limits and enforce.
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Why is manipulation easier to treat then dependency/codependency?
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Because no one likes being manipulated.
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DABDA
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D- Denial A- Anger B- Bargaining D- Depression A- Acceptance
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Psych Needs, In order
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Denial Depend Manipulation
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To address a patient's psychological needs, they must be:
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STABLE, safe, comfortable.
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Pain
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Never killed anyone. NOT the top priority, especially if there are physiological needs in the question that make the patient unstable.
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What is Wernickes (Korsakoffs) Syndrome?
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Psychosis induced by vitamin B1 (Thiamine) deficiency.
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Symptom of Wernickes Korsakoffs syndrome?
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Amnesia with confabulation. = Loss of memory with making up stories to fill in the gaps.
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Vitamin B1 helps breakdown?
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Alcohol
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So without B1 what happens?
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Alcohol isn't metabolized correctly goes to the brain and causes Wernickes
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Primary symptom of Wernickes?
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Amnesia with confabulation (making up stories).
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Is Wernickes preventable?
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Yes- Take Vitamin B1
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Is Wernickes arrestable?
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Yes- Take Vitamin B1
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Is Wernickes reversible?
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No
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What is the goal of patients dementia/organic brain syndrome?
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Maintain function, Never Improve.
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What is aversion therapy?
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When you try and make the patient hate something.
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Antabuse onset and duration is?
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2 weeks
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Teach a patient taking Antabuse to avoid what?
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Alochol
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On top of alcohol a patient taking Antabuse should also avoid what other 7 things?
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Alcohol Aftershave, Cologne, Perfumes Insect Repellent Elixirs Vanilla Extract Vinaigrettes Handsanitizer Alcohol Prep Pads Vanilla Icing
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How long does it take for Antabuse to get out of the system so they can drink Alcohol again?
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2 weeks
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What are Elixirs?
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95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse. This rule applies for diabetics too (elixers also have sugar).
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What happens if a person on Antabuse ingests alcohol?
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Nausea, Vomiting, & Possibly Death
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In Overdose VS Withdrawal, Ask yourself?
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Is this drug an upper or a downer?
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What are the five uppers?
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Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts
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Downers are?
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Everything other then the five uppers. Heroin Ativan Valiumn Fetanyl
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S/S of upper use?
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Everything goes up Tachycardia Increased BP Irritability Fever Diarrhea +4 Reflexes Pupil Dilation Excitability Seizures Borborygmi ETC.
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S/S of downer use?
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Everything goes down Bradycardia Lethargy Constricted Pupils Hyporeflexia Flaccidity Respiratory Depression
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Then ask yourself:
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Are they talking about Overdose or Withdrawal?
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Overdose/Intoxication:
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I have too much....
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Withdrawal:
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I don't have enough...
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Overdose of a downer causes everything to go?
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Down
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Overdose of an upper causes everything to go?
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Up
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Withdrawal of an upper causes everything to go?
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Down
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Withdrawal of a downer causes everything to go?
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Up
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Upper withdrawal looks like
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Downer Overdose
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Downer Withdrawal looks like
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Upper overdose
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At birth if the mother was addicted to a substance always assume the newborn is?
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Overdosed
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If 24 hours after birth assume the baby is in?
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Withdrawal
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Every alcoholic goes through what withing 24 hours after cessation?
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Alcohol Withdrawal syndrome
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What is Alcohol Withdrawal Syndrome?
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Hyper irritability state less than 24 hours after the first drink
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After 72 hours of alochol withdrawal a small minority may get?
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Delirium Tremens
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Can Delirium Tremens kill you?
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Yes
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Can Alcohol Withdrawal Syndrome kill you?
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No
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Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?
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No
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Are patients with Delirium Tremens a danger to themselves or others?
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Yes
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N/I for Delirium Tremens?
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Private room near nurses station NPO/Clear liquids Restricted bed rest Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine) Antihypertensive.
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N/I for Alcohol Withdrawal Syndrome?
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Semi-private room anywhere Regular diet Up and ad-lib, no restraint Tranquilizer Multivitamin (B1/Thiamine) Antihypertensive.
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A two point restraint is?
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One arm and the opposite leg.
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N/I for restraints?
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Check Q15min Rotate sites Q2H
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All aminoglycosides end in?
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"mycin" Vancomycin
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For Aminoglycosides, think:
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A Mean Old Mycin
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Aminoglycosides treat?
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Big gun antibiotics. Treat serious, life threatening, resistant infections
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If it has "thro" in it you?
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Throw it out...Zithromycin. It treats a minor infection
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Toxic effects of aminoglycosides?
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Ototoxicity Nephrotoxicity Cranial nerve 8 (vestibulocochlear nerve) which senses sound.
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The one Aminoglycoside that doesn't end in Mycin?
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Amikacin
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What is another word for aminoglycoside?
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Glycopeptide
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Monitor what with aminoglycoside use?
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Hearing, balance, tinnitus & creatinine (best indicator of renal function)
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Best indicator of aminoglycoside toxicity?
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Ototoxicity (Ears)
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Frequency of administration for aminoglycosides?
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Q8H
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Aminoglycoside route of administration?
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Im or IV
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Aminoglycosides are given PO for what two reasons?
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Hepatic Encephalopathy and Pre-op bowel surgery.
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What is Hepatic Encephalopathy also called?
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Liver Coma, Ammonia-Induced Encephalopathy
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If fluid resuscitation is used in shock, there will be
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Increased Urine Output
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Neomycin and Kanmycin are used for what?
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Bowel sterilzation? Can also be given for C.Diff
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Who can sterilize my bowel?
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"Neo" "Kan"
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If you give aminoglycosides PO, do you have to worry about side effects?
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No
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Hepatic Encephalopathy is caused by?
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High ammonia levels
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What raises ammonia levels the most?
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Ecoli in the gut
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Why do you draw TAP levels?
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Narrow therapeutic Window
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When do you draw a trough level?
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30 minutes before the next scheduled dose.
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When do you draw a sublingual peak level?
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5-10 minutes after it is dissolved.
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When do you draw a IV peak level?
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15-30 minutes after dose is finished.
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When do you draw a IM peak level?
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30-60 minutes after given
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If you must pick a time to draw the peak, pick the highest amount of time without going over the limits
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So for IV, Pick 30 Minutes, not 15.
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Category A Bio terrorism Agents
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Most Lethal
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What are the Category A Bio terrorism Agents?
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Smallpox Tularemia Anthrax Plague Hemorrhagic Fever, Such as Ebola Botulism
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Category B
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A big, long list.
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Category C. Not very Lethal
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Hanta Virus Nipeh Virus
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Small Pox Early Detection Symptom
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Rash that starts around the mouth
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Small pox
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Inhalation. Pt on AIRBORNE Precautions Dies from Septicemia. No treatment
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Tularemia
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Inhalation Chest Symptoms Dies from RESPIRATORY FAILURE Treat with Streptomycin
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Anthrax spreads by
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Inhalation (AIRBORNE PRECAUTIONS)
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Anthrax looks like
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Respiratory FLU
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Anthrax death occurs from?
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Respiratory Failure
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Treat Anthrax with
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Cipro, Penicillin, Streptomycin
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Plague spreads by
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Inhalation
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3 H's of Plague
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Blood Everywhere. H- emoptysis - Coughing up blood H-ematemesis - Blood in Vomitus H-ematochezia - Bright red blood in the diarrhea
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Plague patients die by
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DIC and respiratory Distress
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Hemorrhagic Illnesses (Like Ebola)
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Petechiae and ecchymoses = Pinpoint Hemorrhage, especially on Chest & Bruising
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Botulism is
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Ingested - Most Lethal Dies from Respiratory Arrest
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3 Major Symptoms of Botulism
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Descending Paralysis (Starts in face and goes down) Fever But is Alert
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Gullian Barre
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Ascending Paralysis
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Chemical Agents
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Mustard Gas, Cyanide, and Phosgine Chlorine
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Mustard Gas The Chemical Agent causes
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Blisters
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Cyanide The Chemical Agent Causes
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Respiratory Arrest.
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What do you use to treat Cyanide Poisoning?
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Sodium Thiosulfate IV
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What does Phosgine Chloride Cause
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Choking
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Sarin, the Nerve Agent, Causes
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Massive Cholinergic parasympathic response
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Cholinergic, Parasympathetic effects cause?
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B-ronchorrhea B-ronchospasm S-Salivation L-acrimating U-rinating Constantly D-iaphoretic + Diarrhea G-I distress E-mesis
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Ebola (Hemorrhagic Fever) Precautions
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Standard, Contact, and Droplet
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All chemical agents require only soap and water except for Sarin, which requires
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A WEAK Bleach
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What do you do in a Chemical Attack?
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Decontaminate + Treat
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What is the Nurse's role in Chemical Decontamination?
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Put clothes in Biohazard bag that gets burned Put them in a Government Issued suit They may need to be housed for a while
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Biochemical Attack, what do you do?
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Quarrentine
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Calcium Channel Blockers are like what for the heart?
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Valium
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Calcium Channel Blockers
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Negative Ino, Chrono, Dromo
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Calcium Channel Blockers treat what? (the 6 A's)
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Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS
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Calcium Channel Blocker side effects? (the 2 H's)
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Headache and Hypotension Also Bradycardia
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Calcium Channel Blockers treat what Arrhythmias starting with?
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A, as well as SVT
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What causes angina?
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Chest pain due to decreased O2 supply and demand issues.
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What do Anti-Anginal Medications do?
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Decrease O2 demand on the Heart, allowing more O2 to chest (dilate)
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90% of Calcium Channel Blockers end in?
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"dipine" and "zem"
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When giving a Calcium Channel Blocker you hold and notify if?
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Systolic is 100 or lower.
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"QRS" refers to?
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Ventricular
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"P" refers to?
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Atrail
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Asystole is?
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A lack of QRS repolarizations
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Asystole
Asystole
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TX: Epinephrine (Think Heart Stimulant)
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Atrail Flutter is?
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Rapid P-wave repolarizations in a saw tooth pattern.
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Atrial Flutter
Atrial Flutter
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Pharmacological therapy, such as beta blockers, antiarrhythmics, or calcium-channel blockers, need frequent monitoring of EKG rhythm strips, heart sounds, and apical pulse rate. (Unlikely to ask this)
question
Atrial- Fib is?
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Chaotic QRS depolarizations
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Atrial Fibrillation
Atrial Fibrillation
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Chaotic Between QRS, but QRS is still PRESENT. HR Has to be Irregular. Treatment: Heparin. IMMEDIATELY.
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What do you do if the A-fib is unwitnessed?
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1. Heparin First 2. Cardioversion 3. ADENOsine 8 second Push- Watch for the pt to go into Asystole BETA Blocker CALCIum Channel Blockers DIGitalis (Lanoxin)
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V-fib is?
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Chaotic QRS depolarizations
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Ventricular Fibrillation
Ventricular Fibrillation
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TX: Shock therapy. you DE-FIB.
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V-tach is?
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Wide bizarre QRS's
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Ventricular Tachycardia
Ventricular Tachycardia
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Treatment: Lidocaine & amniodarone
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SVT - Subventricular Tachycardia
SVT - Subventricular Tachycardia
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Narrow QRS. Treatment: A-denosine 8 second Push- Watch for the pt to go into Asystole B-eta Blocker C- Calcium Channel Blockers D- igitalis (Lanoxin)
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PVC is?
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Periodic wide, bizarre QRS's
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PVC
PVC
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PVC is the deviation in the picture from the normal QRS. Treatment is Lidocaine & Aminodorone
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Be concerned about PVC's if? ( rule of 6's)
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More then 6 per minute, 6 in a row
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What are the 2 lethal arrythmias?
What are the 2 lethal arrythmias?
answer
A-systole and V-Fib (Pic if V-Fib, Asystole is Flat Lining)
question
What are the 4 potentially life threatening arrythmias?
answer
V-tach, A-fib, A-flutter and PVC
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What are the 6 arrythmias you are tested over on the NCLEX?
answer
V-fib, A-fib, A-flutter, PVC, A-systole and V-tach
question
What are the 6 arrythmias for NCLEX in order for prioritization?
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A-systole, V-fib, V-tach, A-fib, A-flutter and PVC
question
When talking about arrythmias the word "chaotic" means?
answer
Fibrillation
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When talking about arrythmias the word 'bizarre" means?
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Tachy
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PVC's fall on what wave of the previous beat?
answer
T wave
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When prioritizing lethal arrhythmias, if one happened 6 minutes ago and the other happened 15 minutes ago, which do you choose?
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Always choose the closest to the 8 minute mark. After 8 minutes the survival rate is LOW.
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To treat PVC's you give?
answer
Lidocaine/Amnioderone
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To treat V-tach you give? (If it starts with V you use..)
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Lidocaine/Amnioderone
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To treat supraventricular arrythmias you give?
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Adeno Beta Calci Dig (Lonoxin)
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Supra means?
answer
Above
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To treat V-fib you ?
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Defibrillate ... For V-fib you D-fib
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To treat AsystolE you give?
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CPR Epinephrine (atropine no longer given) Oxygen
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If asked how to treat A-fib first you?
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Give Heparin then ABCD.... Heparin is instant Warfarin and Plavix take time.
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What is the purpose of Chest Tubes?
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To re-establish negative pressure in the pleural space
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Pneumothorax removes
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Air
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Hemothorax removes
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Blood
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Pneumohemothorax
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Air and Blood
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An Apical chest tube is placed?
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High (for air) A for air
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A Basilar chest tube is placed?
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Low (for blood) B for blood
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Chest tubes after a surgery or trauma assumes it's a?
answer
Unilateral Pneumohemothorax
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Does a pneumonectomy get a chest tube?
answer
No..removes the pleural space
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Patient Positioning after Chest Surgery
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Chest Tube Up, good side down
question
Patient Positioning after Chest Surgery
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Operative side (Good lung up) Or Back (Supine)
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What 4 things do you do if the water seal breaks on a chest tube?
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Clamp it 1st!! Cut broken device off of tube Put the tube in water (NS) Unclamp.
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What do you do if you kick over the collection bottle?
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Set it back up Tell the patient to take some deep breaths
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What is the BEST thing to do if the water seal breaks?
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Put it in water (NS). (the first= clamp it)
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What 4 things do you do if a chest tube comes out?
answer
Cover hole with a gloved hand Put on a vaseline gauze dressing, Put on sterile dressing and then tape on 3 sides.
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How many chest tubes (and where) for a Unilateral Pneumohemothorax ?
answer
2 chest tubes, One side (Unilateral) one apical (for air/pneumo) and one basal (for blood-hemo)
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How many chest tubes (and where) for bilateral Pneumothorax?
answer
Bilateral- chest tubes on both sides Pneumo- (air) Apical = 2 apical chest tubes (one on each side)
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How many chest tubes (And Where) for post-op chest surgery?
answer
Unilateral, pneumohemo (2 chest tubes, one side, apical and basal) Assume Chest trauma is a gunshot wound.
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Straight Catheter is to a foley catheter
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Like a Thoracentesis is to a Chest Tube :) (meaning less invasive, less infection risk)
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How long can you clamp a chest tube?
answer
No longer then 15 seconds without a doctors order.
question
What do you use to clamp a chest tube and why?
answer
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.
question
Is bubbling in the water seal continuously good?
answer
No it is bad. You need to find the air leak, tape it, report it and then record it.
question
Is bubbling in the water seal intermittently good?
answer
Yes it should tidal on inhalation
question
Is bubbling in the suction control chamber intermittently good?
answer
No it is bad. You need to dial up the suction, report and record.
question
Is bubbling in the suction control chanber continuously good?
answer
Yes
question
When picking answers, narrow it down to two, then ask yourself
answer
If i did this, but not this, what would be the outcome? Is it better?
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In routine care, do you ever clamp a chest tube?
answer
No. In an emergency, you can.
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When picking answers ask yourself ?
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Which one is MOST important to leave undone. More so than the others.
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All congenital heart defects that are trouble start with a ?
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"T"
question
Which exception to the rule of congenital heart defects doesn't start with a T?
answer
Left Ventricular Hypoplastic Syndrome
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What defects have right to left shunts and are cyanotic?
answer
Trouble defects
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What defects have left to right shunts and are acyanotic?
answer
Not trouble defects
question
All congenital heart defects have what?
answer
Murmur and an echocardiogram done
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What are the four defects of Tetrology of Fellot?
answer
Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy
question
What is the saying to help remember the four defects of Tetrology of Fellot?
answer
VarieD PictureS Of A RancH
question
1 fingerwidth is how many cm's?
answer
1
question
How to measure crutches
answer
2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot
question
When measuring crutches, don't pick
answer
any foot landmark like a "toe" or "heel"
question
When the handgrip of a crutch is properly in place the elbow felxion should be?
answer
30*
question
If crutch is not 30*, what will happen?
answer
Nerve Damage
question
Crutches should be how many fingerwidths below the armpit?
answer
2-3
question
Describe a 2 point gait?
answer
1. one crutch and opposite foot together 2. Other crutch and other foor together. 2 points 2gether and the same time.
question
Describe a 3 point gait?
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1. Move two crutches and bad leg together. 2. Move good foot. Move all three together and then the good leg.
question
Describe a 4 point gait?
answer
NOTHING moves together 1. Right crutch 2. Left foot. 3. Left crutch. 4. Right foot. It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4
question
Describe swing through?
answer
Traditional crutching
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Who uses Swing Through?
answer
Amputees, non weight bearing (sprain/break)
question
Use the even numbered gaits when weakness is?
answer
Evenly distributed (bilateral) Remember, Even for Even, Odd for Odd
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When using the even gaits what one is for severe and what one for mild problems?
answer
2 point gait for mild 4 point gait for severe.
question
4 point gait for what?
answer
Fresh Post Op
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If the question says "systemic disease" when it comes to crutches
answer
Assume it impacts both legs
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Use the odd numbered gait when?
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The problem is affecting one leg (unilateral)
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When going up the stairs or down the stairs with crutched remember?
answer
UP with the GOOD and DOWN with the BAD
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Crutches always move with what leg?
answer
The bad leg.
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What side do you hold the cane?
answer
Strong side.
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What side do you advance the cane with?
answer
The weak side for a wide base support. *Step with opposites*
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For walkers remember you?
answer
Pick it up, set it down and walk to it.
question
Remember for walkers that you
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Always push, never pull NO tennis balls on legs If you put something on the walker, make it the side not front
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A non psychotic person has
answer
insight and is reality based
question
A psychotic person has
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No Insight and is Not reality based
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Not all psych patients are
answer
Psychotic. Show this in your answers!
question
7 Hallucinatory Words
answer
Look See Listen Hear Feel Taste Smell
question
If the question has "appear" in psych, it is
answer
A delusion ( a belief)
question
What is a delusion?
answer
A false fixed belief, idea or thought. This has no sensory component.
question
What are the three types of delusions?
answer
Paranoid or Persecutory, Grandiose and Somatic
question
What is a paranoid delusion?
answer
False fixed belief that people are out to harm you (CIA, FBI).
question
What is a grandiose delusion?
answer
False fixed belief that you are superior (God, the Pope).
question
What is a somatic delusion?
answer
False fixed belief about a body part (X-ray vision).
question
What is a hallucination?
answer
False, fixed sensory experience.
question
Five types of hallucinations?
answer
Auditory, visual, tactile (feel) olfactory gustatory (taste)
question
Most common type of hallucination?
answer
Auditory (Especially Command)
question
What is an illusion?
answer
Misinterpretation of reality. It is a sensory experience.
question
How can you diffirentiate between illusions and hallucinations?
answer
Illusion: Sensory response to something in reality [the news (reality) is talking TO them (illusion)] Hallucination: Sensory response but nothing in reality pertains
question
Don't treat all Psych patients
answer
The same/like they are psychotic
question
Example of an illusion?
answer
The clock on the wall is a bomb (the clock is real, but the belief isn't)
question
What are the four types of functional psychosis?
answer
Schizophrenia Schizoaffective disorder, Major depression/mania (bipolar). (SCHIZO SCHIZO MAJOR MANIC)
question
Functional Psychotics have WHAT
answer
The potential to learn reality
question
If a functional psychotic is having a delusion or illusion you?
answer
Acknowledge the feeling ( I see you are upset), Present reality (but we have no spiders in the room) Set a limit ( we're not going to talk about that lets talk about something else) Enforce the limit ( I see you're to ill to talk about reality). Follow with : We have medication to treat those symptoms
question
NEVER set limits on
answer
Feelings
question
Present reality
answer
Positively
question
Example of presenting reality positively:
answer
Tell them what they CAN do instead of what they CAN'T do.
question
5 examples of psychosis of dementia?
answer
Alzheimers, dementia, organic brain syndrome, wernickes seniality.
question
When deciding whether to redirect or reassure
answer
Functional Psychotic (Schizophrenia) or Non Functional (Dementia)
question
Re directing is NOT
answer
Orders Distraction Doing a physical action
question
Re-direction IS
answer
Taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately
question
For patients with OCD, you
answer
Negotiate a balance
question
If a patient has psychotic depression
answer
No reality. Won't get dressed because they believe they are a prisoner in Iran.
question
What do you do if a patient with psychosis of dementia is having a hallucination or illusion?
answer
Acknowledge their feelings Redirect them. DON'T Challenge them.
question
Examples of Psychosis of dementia:
answer
Alzheimer's Disease, Senility, Organic Brain Syndrome/Post Stroke Dementia, Lewy Body Disease, Parkinson's, Wereneke's
question
Patients with Psychosis of Dementia
answer
Cannot learn reality because they have brain damage
question
What causes Psychotic Delirium?
answer
Chemical Imbalance (electrolyte Imbalance), Sepsis, UTI.
question
Is Psychotic Delirium permanent?
answer
No. Assure them its temporary. A dramatic, episodic onset of skewed reality d/t acute illness.
question
What is flight of ideas?
answer
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).
question
What is word salad?
answer
Jump from word to word. Bob, Car, Sleep, Foot etc..
question
What is neologisms?
answer
Make up new words.
question
If a patient is psychotic, should you force them to do things?
answer
NO. They will become violent.
question
What is a narrowed self concept?
answer
When they refuse to leave the room or get dressed. (DON'T force them to do it) Respond by saying " I see you are uncomfortable, when you are ready, you can do it"
question
What is ideas of reference?
answer
When they think everything is about them. (Everyone is talking about me)
question
Type I diabetes (IJK)?
answer
Insulin dependant Juvenile onset Ketosis prone ( makes ketones)
question
Type II diabetes?
answer
Non insulin dependant Adult onset Non ketosis prone
question
Diabetes S/S?
answer
Polyuria, Polydypsia and polyphagia (hunger)
question
What is diabetes mellitus ?
answer
An error in glucose metabolism
question
What is diabetes Insipidus?
answer
Not enough ADH, pituitary gland
question
How do you treat type I diabetes? (DIE)
answer
Diet 3 Insulin 1 Exercise 2
question
How do you treat type II diabetes? (DOA)
answer
Diet 1 Oral hypoglycemic 3 Activity 2 (Obesity Reduction)
question
In a tonsellectomy, what days are most important post op?
answer
Days 6-8, biggest risk for bleeding.
question
Diabetes is also what?
answer
Dehydration
question
AC
answer
Before Meals
question
TID
answer
3 times a day
question
QD
answer
Every day/daily
question
OD
answer
Once a day
question
QOD
answer
Every other day
question
QID/QDS
answer
4 times daily
question
SIADH is
answer
fluid overload. (crackles, Edema, etc.) DO: Fluid restrictions + sodium supplements
question
Type II diabetics need how many calories a day?
answer
1,200-1,800
question
#1 Priority in Type 1 diabetes
answer
Medication (insulin)
question
#1 Priority in type 2 =
answer
Diet + Exercise (NEED TO LOSE WEIGHT)
question
Type II diabetics need how many feedings a day?
answer
6 small meals
question
Type 2 diabetes will do what when in acute illness?
answer
Go to type 1 and need insulin
question
The peak in insulin is a risk for what?
answer
Biggest risk for HYPOGLYCEMIA
question
Which Insulins and peaks for hypoglycemia?
answer
Humalog: 30 minutes after dose Regular: 2 hours after dose NPH: 6 hours after dose
question
Freezing insulin does what?
answer
De natures it
question
What two drugs can increase blood sugar?
answer
Glucagon and Epinephrine
question
If client exercises more they need?
answer
Less insulin and a snack
question
Replace the word exercise with?
answer
Another shot of insulin
question
Best answer for a type 2 diabetic?
answer
Calorie Restriction
question
If client exercises less they need?
answer
More insulin
question
As a rule in shock
answer
Anything that is a pressure goes down Anything that is a RATE goes up
question
When a client is sick what does it do to there blood sugar?
answer
It increases d/t stress
question
Teach diabetics who are sick to?
answer
Take insulin, Stay hydrated Stay as active as possible.
question
What are the 4 types of insulin?
answer
Humalog (log rolls down hill FAST) Regular, (RN, R then N) NPH (iNNNtermediate) Lantus/Levemir (glargine) L for LOONG
question
Regular insulins all have what in them?
answer
R
question
Regular insulin onset?
answer
1 hour
question
Regular insulin peak?
answer
2 hours
question
Regular insulin duration?
answer
4 hours
question
NPH insulin all have a what in them?
answer
N
question
NPH onset?
answer
6 hours
question
NPH peak?
answer
8-10 hours
question
NPH duration?
answer
12 hours
question
NPH is not so fast and
answer
...not in the bag (IV)
question
Regular insulin is
answer
...rapid and runs IV
question
With humalog when do you give it?
answer
With meals
question
Humalog onset?
answer
15 minutes
question
Humalog peak?
answer
30 minutes
question
Humalog duration?
answer
3 hours
question
What is the only insulin safe to give at bedtime?
answer
Lantus/Glargine Duration 12-24hrs No peak
question
Which insulin works the fastest?
answer
Humalog
question
What are the three reasons that cause low blood sugar in type I diabetes?
answer
too much insulin (#1) too much exercise not enough food
question
What is the biggest danger with low blood sugar?
answer
Brain damage
question
S/S of low blood sugar are?
answer
S/S of shock and being drunk... clammy, weak, slurred speech, poor gait etc.
question
For Hypoglycemia, Pick signs and symptoms of
answer
1. Cerebral impairment (drunk) - slurred speech, judgement changes, staggering gait If it makes you look drunk, pick it. 2. Shock symptom = pale, cold, rapid + thready pulses, etc.
question
If ICP is increased
answer
Pressure goes UP Rate goes DOWN (Opposite of hypoglycemia)
question
Treatment for low blood sugar in type I diabetes?
answer
Rapidly metabolizable carb (Juice, Pop, chewed candy) or carb and protein/carb and starch. (MILK, or jam + crackers)
question
If a diabetic is unconscious
answer
NPO give Glucagon IM or Dextrose IV.
question
Examples of rapidly metabolizing carbs?
answer
Juice, hard candy, icing, honey, syrup
question
Diabetic Ketoacidosis (AKA high blood sugar in Type I diabetes) is caused by what 3 things?
answer
Too much food Not enough insulin Not enough exercise
question
What is the #1 cause of DKA?
answer
Viral upper respiratory infection within last 2 weeks.
question
So if you suspect DKA, what should you ask?
answer
Have you had a cold lately?
question
DKA S/S?
answer
D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea
question
DKA treatment?
answer
High IV flow rate (150-200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate)
question
Treatment for low blood sugar in Type II is the same as Type I low blood sugar treatment.
answer
...
question
High blood sugar in type II aka hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) is the same as?
answer
Dehydration
question
HHNK S/S?
answer
Same as dehydration
question
Treatment for HHNK is?
answer
Rehydrate but no insulin in the bag (type II has insulin still) Insulin in the bag with type I diabetes d/t burned fat = ketones=acidic
question
Diabetes complications, in order of priority:
answer
1.Hypoglycemia 2.DKA 3.HHNC
question
If you don't know if a blood glucose is high or low, pick
answer
Low If you give candy to a hyperglycaemic they're condition won't change If you give candy to hypoglycaemic you'll save their life
question
What are the two long term problems from diabetes?
answer
Peripheral neuropathy Poor tissue perfusion.
question
What lab is the best indicator for long term blood sugar maintenance?
answer
HGBA1C (glycosated hemoglobin) <7 is an ideal sign of CONTROLLED diabetes
question
What is the H1AC diagnosis level?
answer
Greater to or equal to 6.5
question
Lithium therapeutic level?
answer
0.6-1.2
question
Lithium toxic level?
answer
over 2.0
question
Lanoxin (digoxin) therapeutic level?
answer
1-2
question
Lanoxin (digoxin) toxic level?
answer
Over 2.0
question
Aminophylline therapeutic level? (Antispasmotic)
answer
10-20
question
Aminophylline toxic level?
answer
Over 20
question
Dilantin therapeutic level?
answer
10-20
question
Dilantin toxic level?
answer
Over 20
question
Elevated bilirubin level?
answer
10-20 neonate only
question
Toxic bilirubin level?
answer
Over 20 neonate only
question
Dilantin is an?
answer
Anticonvulsant
question
Aminophylline is an?
answer
Airway antispasmotic
question
Lanoxin(digoxin) is for?
answer
CHF, Atrial arrhythmia
question
Lithium decreases?
answer
Mania
question
What is Kernicterus?
answer
When bilirubin is over 20 and in the CSF(cerebrospinal fluid) and brain Assessment: hyperextension d/t menigial irritation
question
What is Opisthotonos?
answer
POSITION of hyperextension seen with kernicterus. ANY EXTENSION, Even slight extension of the neck! DO: Place on there side if present.
question
If kernicterus and opisthotonos are occuring you?
answer
Turn baby on their side Call doctor Draw bilirubin level Increase the IV rate and start billirubin lights.
question
Hiatal hernia is?
answer
Stomach herniates into esophagus Gastric contents move in WRONG DIRECTION at the CORRECT RATE.
question
Definition of Hiatal Hernia?
answer
Reguritation of acid into the esophagus, because upper stomach herniates upward through the diaphragm
question
Definition of dumping syndrome?
answer
Post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum
question
Dumping syndrome is?
answer
Gastric contents moving in the RIGHT DIRECTION and the INCORRECT RATE.
question
S/S of hiatal hernia are?
answer
GERD upon lying after meals
question
S/S of dumping syndrome are?
answer
DRUNK + SHOCK + ABD DISTRESS Acute abdominal distress= gas, ^bs, cramping, bloat Drunk=staggered gait, slurred speech Shock= cold, pale, hypotension, tachy
question
3 treatments for hiatal hernia is?
answer
High fowlers during and 1hr after meals Increase fluids with meals Increased carbs
question
3 treatments for dumping syndrome?
answer
Lay flat on side during and 1hr after meals Decrease fluids during meals(drink between meals) Decrease carbs (aka ^ protein diet)
question
Kalemias do the same as the prefix except for the what?
answer
The HR and urine output. (opposite) eg HyperK= BRADY, tachypnea, diarrhea HypoK= TACHY, lethargy, POLYurea, ilius
question
Calcemias do the opposite of the prefix plus all what?
answer
BP changes eg: Hypocalcemia FAST everything (Low bp) Hypercalcemia: SLOW everything (high BP)
question
So hypocalemia.. pick symptoms consistent with what?
answer
UP... Plus BP changes
question
So hypokalemia... pick symptoms consistent with what?
answer
Down... and UP HR and UP Urine Output
question
What is Chvosteks sign?
answer
Push the cheek and it spasms (low calcium)
question
What is Trousseaus sign?
answer
BP cuff inflated and causes a carpal spasm. (Low calcium)
question
Magnesemias do the opposite of the prefix plus all what?
answer
BP changes Calcium and Mag have inverse relationship
question
Calcium below what is a medical emergency?
answer
6.0 N=8.2-10.3?
question
In a tie never pick ___________ If the symptom involves nerve or skeletal pick__________ For any other symptom pick___________
answer
...magnesium ....calcemia. ....potassium.
question
What is the rule for Natremias?
answer
The one with the E =dehydration HypErnatremia has s/s of dehydration the one with the O = overload HypOnatremia has s/s of fluid overload.
question
Earliest sign of an electrolyte overload is?
answer
Numbnesss and tingling (AKA parasthesia)
question
Universal s/s of an electrolyte imbalance is?
answer
Muscle weakness (AKA paresis)
question
Nere push what electrolyte?
answer
K+
question
To decrease K+ you give?
answer
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)
question
Kayexelate does what?
answer
Gets rid of K+ slow and late= K-exits-late
question
How much K+ can you have per liter of IV fluid?
answer
40 mEq If higher, clarify order.
question
In electrolyte questions, pay attention to:
answer
Cause & effect questions. WHICH one are they asking?
question
What two words mean the same thing as immunosuppresion?
answer
Agranulocytosis and neutropenia.
question
Hyperthyroidism (AKA graves disease) is the same as saying?
answer
Hypermetabolism
question
Anesthesia (total loss) is to paresthesia (partial loss) as
answer
Paralysis (total loss) is to paresis (partial loss)
question
S/S of Hyperthyroidism?
answer
Same as hypermetabolism... agitated, nervous, diarrhea, heat Intolerant, ^HR, ^BP, thin, hyperactive etc.
question
Remember RUN yourself in the GRAVE
answer
...
question
Graves disease treatment options are? (3)
answer
1.Radiation with I131 (radioactive iodine) (1st 24hrs be alone and flush the toilet alot. Urine is very dangerous/radioactive) 2. PTU(drug- Puts Thyroid Under) worry about immunosuppresion. 3. Surgical removal.
question
What are the two types of Thyroidectomys?
answer
Total and Sub-total.
question
With a Total Thyroidectomy what do they need for life?
answer
Hormone replacement (Synthroid)
question
What are you at risk for following a Total Thyroidectomy?
answer
Hypocalcemia- taking parathyroid with sx (parathyroid regulates calcium)
question
For a Sub-total Thyroidectomy you are at risk for what?
answer
Thyroid storm
question
S/S of a Thyroid storm are?
answer
The same as graves disease but incredibly higher. Exp: HR 180, Temp 108*, psychotic delirium.
question
Thyroid storm treatment?
answer
High flow O2, 5 ice packs= 2 under each arm, 2 groin, 1 back of neck. OR cooling blanket
question
First thing to do in thyroid storm is?
answer
Ice pack Then cooling blanket
question
Post Op Thyroidectomy risks 1st 12 hrs?
answer
Hemorrhage and airway. After 1st 12hrs assume they are stable.
question
Never pick infection within
answer
48 hours after surgery
question
Get cooling blankets to shut off
answer
One degree higher than what the doctor wants
question
Post Op thyroidectomy risks 12-48 hrs for Total Thyroidectomy?
answer
Tetany ( they are stable at this point so don't pick airway or hemorrhage)
question
Post Op thyroidectomy risks 12-48 hrs for Sub-total Thyroidectomy?
answer
Thyroid storm (this can cause brain damage ..too febrile)
question
Hypothyroidism is the same as saying?
answer
Hypometabolism
question
Hypothyroidism S/S?
answer
Same as hypometabolism ie, tired, sluggish Cold intolerant obese decreased hr, p, rr
question
What is the name of the disease for hypothyroidism?
answer
Myexedema
question
Treatment for hypothyroidism?
answer
Hormone supplement
question
If asked a question and your patient is critical remember to always STAY with the patient!!
answer
...
question
Do you sedate a patient with hypothyroidism?
answer
No you could put them into a coma.
question
If a patient with hypothyroidism is NPO for surgery you still give them what?
answer
Hormone replacement medication.
question
What is Addison's Disease?
answer
Under secretion of the adrenal hormones ( Normal- Stress= ^glucose, ^BP= perfusion Addison's-No adrenaline + stress= v glucose, v bp=shock)
question
S/S of Addison's Disease?
answer
Hyperpigmentation Do not adapt to stress. Also becomes dehydrated easily
question
Addisons Disease treatment?
answer
glucocorticoids - think blood sugar monitoring and immunosuppression
question
With Addison's Disease you ADD what?
answer
ADD-A-SONE
question
Cushing Syndrome is the oversecretion of?
answer
The adrenal cortex.
question
S/S of Cushing's Syndrome?
answer
Think of the Cush Man... Moon face-steroids buffalo hump thin legs and bones striae (stretch marks), male breasts, hirstusism high glucose Immunosuppressed/infection bruising
question
CUSHMAN!
draw him!
CUSHMAN! draw him!
answer
Gaining h20 Infection Irritability Weak bones Wasting, thin extremities Bruises Easily Moon Face Acne Losing K Buffalo Hump Striae/Stretch Marks Breasts in Men Trunkal Obesity Hair on face
question
Cushings Syndrome treatment?
answer
Adrenalectomy Biliateral Adrenectomy is always worse
question
Hep A
answer
Anus to mouth
question
Hep B
answer
Blood
question
Pts with Adrenal cortex diseases must have
answer
Med alert bracelet
question
Symptoms of cushings are side effects of what?
answer
SONES.
question
Contact precautions are used for what 4 types of diseases?
answer
RSV (babies) Herpies zoster, Staph infections and Enteric (bowel) infections (cdiff, collera)
question
RSV
answer
Spread by droplet, but they are on contact precautions (Only affect infants)
question
Contact precautions have what 5 things?
answer
Private room - door can be open Gloves Gown- if giving direct care Handwashing Disposable supplies Dedicated equipment
question
Droplet precautions are for what 2 diseases?
answer
All meningitis and all influenza Pertusis, Diptheria, Mumps, All Meningitis
question
Droplet precations have what 6 things?
answer
Private room- door can be open Gloves Mask- #1 in this group Handwashing Pt wears mask when leaving room Disposable/dedicated equipment
question
Airborne precautions are for what 4 diseases?
answer
SARS (Severe Acute Respiratory Syndrome), TB, Measles and Varicella
question
Airborne precautions have what 9 things?
answer
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
question
PPE contains?
answer
Gloves, gown, gogles and mask unless told otherwise.
question
Proper order for donning PPE?
answer
1. gown 2. mask 3. goggles 4. gloves
question
Where do you remove PPE?
answer
In the room.
question
Where do you put on PPE?
answer
Outside the room.
question
Proper order for removing PPE?
answer
1. gloves 2. goggles 3. gown 4. mask
question
In airborne precautions it is ok to remove what piece of PPE outside of the room?
answer
Mask
question
What position are your hands for handwashing?
answer
Hands below elbow
question
How long do you wash for handwashing?
answer
15 seconds
question
Can the faucet have handles for handwashing?
answer
Yes
question
What do you use in handwashing?
answer
Soap and water
question
When do you wash your hands?
answer
Before and after gloves, entering and exiting a room and after you soil your hands.
question
What position are your hands in for scrubbing?
answer
Elbows below hands.
question
What is the length for hand scrubbing?
answer
3-7 minutes
question
What do you use for hand scrubbing?
answer
Cleaning agent must have the prefix "chlor"
question
Can the sink have handles for scrubbing?
answer
No
question
When do you use scrubbing?
answer
Immunosuppresion, surgery, transplant, chemo, HIV
question
Dry yours hands from...?
answer
Cleanest to least clean
question
You can use alcohol based solution when?
answer
Before and after gloves, entering and leaving a room
question
how to sterile glove
answer
Glove Dominant Hand First Grasp Outside of the cuff Touch only the inside of the glove surface Do not roll the cuff Fingers inside of the second glove cuff Only touch the outside of the glove with your first gloved hand
question
Remember with sterile gloving
answer
Only touch the OUTSIDE of the surface glove Glove to Glove Skin to Skin
question
On nclex, when drying hands
answer
Swipe ONE swipe per paper towel then throw it away and get another one
question
What can't children under four have?
answer
Small toys
question
If a child has O2 is use what type of toys can't be used?
answer
Metal
question
Beware of Foamites
answer
Nonliving object that harbors microorganisms
question
What is the best toy for a 0-6 month old?
answer
Musical mobile (get rid of this at 6 months or when the child is sitting up)
question
What toy is good for an immunosuppressed patient?
answer
Action figure. Can't harbor microorganisms
question
What three things should you ask yourself when choosing appropriate toys for kids?
answer
Is it safe Is it appropriate Is it feasible
question
Remember: 9 Months in the womb
answer
9 months until purposeful activity
question
What is the 2nd best toy for a 0-6 month old?
answer
Anything soft and large
question
What is the best toy for a 6-9 month old?
answer
Cover/uncover toy eg. jack in box
question
What is the second best toy for a 6-9 month old?
answer
Anything large that they can't swallow.
question
What is the best toy for a 9-12 month old?
answer
Talking toy.
question
What is the second best toy for a 9-12 month old?
answer
Anything that is purposeful (play with blocks)
question
What 5 words should you avoid when answering a question about toys for a child under 9 months old?
answer
Build Make Construct Sort Stack
question
What is the best toy for a toddler (1-3 yr.)?
answer
Push/pull toy wagon, stroller
question
What should you work on with a toddler (1-3 yr.) ?
answer
Gross motor eg. run, jump NOT finger dexterity <- fine motor
question
What is toddler (1-3 yr.) play characterized by?
answer
Parallel play (with another child but alone)
question
What two things should you work on with a preschooler (3-6 yr.) ?
answer
Fine motor (fingers) Balance (dance, gymnastics)
question
What sort of play do preschoolers (3-6 yr.) prefer?
answer
Pretend play
question
What is preschooler (3-6 yr.) play characterized by?
answer
Co-operative play (together) Everybody wins
question
School age (7-11 yr.) is characterized by the 3 C's, what are they?
answer
Creative (no coloring book, use blank paper) Collecting Competitive
question
Adolescents (12-18 yr.) "play" is?
answer
Peer associated
question
Allow adolescents to be in each others rooms unless?
answer
Contagious Immunosupressed Fresh post-op <12 hr
question
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.
answer
...
question
Best indicator of kidney function?
answer
Creatnine
question
Creatinine norm?
answer
0.6-1.2
question
INR monitors?
answer
Coumadin/Warafin therapy
question
INR therapeutic level?
answer
2-3
question
If the INR is over 4 you?
answer
Hold all Coumadin/Warafin Assess bleeding Prepare to give K+ Call doctor
question
Potassium norm?
answer
3.5-5.3
question
If the potassium is below 3.5 you?
answer
Assess the heart Prepare to give potassium Call the doctor
question
If the potassium is high (5.4-5.9 high but still within the 5's) you?
answer
Hold potassium if in the IV Assess the heart Prepare to give D5W with insulin Call the doctor
question
If the potassium is over 6 you?
answer
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)
question
pH norm?
answer
7.35-7.45
question
If the pH is under 6 you?
answer
Assess vital signs Call the doctor ASAP
question
BUN norm?
answer
8-30
question
If the BUN is elevated check for?
answer
Dehydration
question
How should you prioritize labs?
answer
Which level will do the most harm to the body and NOT the disease it's associated with.
question
If you have a lab thats high and you don't know why pick?
answer
Dehydration
question
Hgb norm?
answer
12-18
question
Hgb under 8 you?
answer
Assess bleeding Prepare blood Call doctor
question
Elevated Hemoglobin?
answer
Dehydration
question
Bicarb (HCO3) norm?
answer
22-26
question
CO2 norm?
answer
35-45
question
CO2 is the 50's you?
answer
Assess respiratory status Do pursed lip breathing ^ exhale time DON't give O2 if the above isn't working call the doctor!
question
Severe Acidosis means what?
answer
Hyperkalemia! Biggest priority
question
CO2 in the 60's (respiratory failure) you?
answer
Assess respiratory status Do pursed lip breathing Prepare for intubation Call respiratory therapy Call the doctor
question
Hct norm?
answer
36-54
question
PO2 norm?
answer
78-100
question
PO2 70-77 you?
answer
Assess respiratory status Give O2
question
PO2 below 60 you?
answer
Assess respiratory status Give O2 Prepare for intubation Call respiratory therapy Call the doctor
question
O2 sat norm?
answer
93-100
question
O2 sat below 93 you?
answer
Assess respiratory status Give O2
question
BNP norm?
answer
<100
question
BNP is a good indicator of what?
answer
CHF
question
What is the best indicator of CHF?
answer
ANF
question
ANF and BNP=
answer
CHF
question
Sodium norm?
answer
135-145
question
Sodium is ok if abnormal unless what occurs?
answer
Change in LOC
question
WBC norm?
answer
5,000-11,000
question
Absolute neutrophil count (ANC) norm?
answer
500
question
CD4 norm?
answer
>200 (below that=aids)
question
If the WBC count is high this is called?
answer
Leukocytosis
question
If the WBC is low it is called?
answer
Leukopenia Neutropenia Agranulocytosis Immunosupression Bone marrow supression
question
If the WBC is low you should?
answer
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,
question
Platelets norm?
answer
150,000-400,000
question
If platelets are below 90,000 you?
answer
Check for bleeding Place on bleeding precautions (thrombolytic precautions)
question
If platelets are below 40,000 you?
answer
Prepare platelet transfusion Call the doctor
question
RBC norm?
answer
4-6
question
What is a lamina? Reason for laminectomy?
answer
Vertebral spins process (bumpy bones at back of neck) To treat nerve root compression.
question
3 P's of nerve root compression (S/S) ?
answer
Pain Paresis= muscle weakness Parasthesia
question
Knowing the location of a laminectomy is key to getting the ? right.
answer
...
question
Cervical =
answer
Neck
question
Thoracic =
answer
Upper back
question
Lumbar =
answer
Lower back
question
Pre-op cervical laminectomy's most important assessment is?
answer
1st breathing (rate and rhythm) 2nd arm and motor sensory
question
Pre-op thoracic laminectomy's most important assessment is?
answer
1st cough (uses abdominal muscles) 2nd bowel sounds (If you can't contract these muscles, you can't cough)
question
Pre-op lumbar laminectomy's most important assessment is?
answer
1st voiding ( when was last time, can they) 2nd leg motor and sensory.
question
The rule of ABC"s doesnt work in what area of health?
answer
Neuro
question
What is the #1 post-op answer for the NCLEX?
answer
Log roll the patient
question
Activity requirements/restrictions Q8H after laminectomy surgery?
answer
Do NOT dangle (AKA sit on the side of bed) May stand, walk and lay without restrictions Don't sit longer than 30 minutes
question
What post-op complication do you watch for with a cervical laminectomy?
answer
Pneumonia/Atelectesis (breathing issues)
question
What post-op complication do you watch for with a thoracic laminectomy?
answer
Decreased cough= Aspiration > pneumonia Decreased GI= ilius
question
What post-op complication do you watch for with a lumbar laminectomy?
answer
Urinary retention
question
For a laminectomy what incision site is more painful?
answer
Hip site
question
For a laminectomy what incision has the most drainage/bleeding?
answer
Hip site
question
For a laminectomy what incision site has the highest risk for infection?
answer
50/50 equal
question
If being asked about a surgery and the length of time for restrictions your default answer should be?
answer
6 weeks
question
Surgeons are using cadaver from bone banks. Why?
answer
Because they only do one incision Quicker heel time
question
Discharge teaching for a laminectomy?
answer
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
question
Permanent restrictions for a laminectomy?
answer
Do not lift by bending at the waist No crazy activities... jerky rides, horseback riding
question
For a cervical laminectomy they can never?
answer
Lift objects above the head.
question
Nageles rule for calculating a due date is?
answer
1st day of the last menstrual period Add 7 days Subtract 3 months
question
Normal weight gain for pregnancy?
answer
28 + or - 3 lb
question
1st trimester weight gain?
answer
1 lb a month x 3 months
question
2nd/3rd trimester weight gain?
answer
1 lb a week x 6 months
question
After week 12 you can subtract 9 to get appropriate weight gain. (Think 9months)
answer
Week 12 = 3 lbs 13 = 4 lbs 14 = 5 lbs 15 = 6 lbs 16 = 7 lbs 17 = 8 lbs eg. week 14-9= 5lbs 28-9= 23 lbs
question
Fundal height is not palpable until week?
answer
12
question
The fundus is palpable at the naval at week?
answer
20-22
question
If the fundus is not above the naval the baby is not?
answer
Viable
question
Positive signs of pregnancy?
answer
Fetal skeleton on X-ray Fetal presence on ultrasound Auscultation of FHR (heart at week 8, most likely at 10 and should be heard by 12) Examiner palpates fetal movement
question
Probable/presumptive signs of pregnancy are?
answer
All urine and blood tests
question
What is Chadwicks sign?
answer
Cervical change to cyanosis (blue hue)
question
What is Goodells sign?
answer
Cervical softening
question
What is Hegars sign?
answer
Softening moves from the cervix to the uterus.
question
Good prenatal care = dr apt _______ times a month until week 28
answer
once a month
question
Good prenatal care= dr apt ________ a month weeks 28-36
answer
Twice a month
question
Good prenatal care= dr apt ______ times a month weeks 36 to birth
answer
4 times a month
question
Is it normal to be slightly anemic during pregnancy?
answer
Yes
question
Normal Hgb level in women is?
answer
12-16
question
Hgb level in first trimester?
answer
Can fall to 11 and it is normal.
question
Hgb level in second trimester?
answer
Can fall to 10.5 and is normal.
question
Hgb level in the third trimester?
answer
Can fall to 10 and is normal.
question
How do you treat morning sickness? (1st trimester)
answer
Dry carb
question
How do you treat urninary incontinence during pregnancy? (1st and 3rd trimester)
answer
Void Q2H
question
How do you treat dyspnea during pregnancy? (2nd and 3rd trimester)
answer
Tri-pod position (sit, lean forward, elbows on knees)
question
How do you treat back pain in pregnancy? (2nd and 3rd trimester)
answer
Pelvic tilt exercise
question
Always teach a pregnant women to pee how often from day of pregnancy to 6 weeks post partum?
answer
Q2H
question
Truest most valid sign of labor is?
answer
Regular contractions
question
Dilation is?
answer
Opening of the cervix (0-10)
question
Effacement is?
answer
Thinning of the cervix (0-100%)
question
Station is?
answer
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 - numbers are negative news.
question
Engagement is?
answer
Station 0
question
Lie is?
answer
Relationship between the spine of the baby and the spine of the mom. Vertical (parallel) is ok, Tranverse (perpindicular) is bad.
question
Transverse Lie?
answer
C- Section!
question
Presentation is?
answer
The part of the body that enters the birth canal first.
question
The first stage of labor is?
answer
The labor part.
question
The second stage of labor is?
answer
Delivery of the baby.
question
The third stage of labor is?
answer
Delivery of the placenta.
question
The fourth stage of labor is?
answer
Recovery (1st 2 hours after the placenta is delivered)
question
How often do you monitor during labor?
answer
Q15min until the 2hr mark after placental delivery. Then Q1H.
question
The first stage of labor has how many phases?
answer
3
question
What are the three phases of labor?
answer
Latent, Active and Transition
question
Latent phase is?
answer
0-4 cm dilated Contractions are 5-30min apart Lasting 15-30 sec. They are mild
question
Active phase is? ONLY MEMORIZE THIS (The other phases can be figured out)
answer
5-7 cm dilated Contractions are 3-5 min apart Lasting 30-60 sec. They are moderate
question
Transition phase is?
answer
8-10 cm dilated Contractions are 2-3 min apart Lasting 60-90 seconds They are strong
question
Contractions should be no longer then ____ and no closer then_____.
answer
90 sec and 2 minutes > = uterine tetany & hyperstimulation =decreased 02 to baby
question
How do you assess frequency of contractions?
answer
Beginning of one contraction to the beginning of another.
question
How do you assess duration of a contraction?
answer
Beginning to end of contraction
question
How do you assess the intensity of a contraction?
answer
Palpate with one hand over fundus and with the fingertips.
question
How do you treat painful back labor?
answer
Knee to chest position You use your fist and press on the patients sacrum.
question
How do you treat prolapsed cord? 911!! OB emergency
answer
Push head back in knee-chest (hands and knees) or Trendelenburg Or elevate hips on pillows Don't put the patient on their left side. Cover the cord in moist saline
question
What interventions do you do for all other OB complications? (LION)
answer
If Pitosin is running stop this first then LION L-eft side position I-ncrease IV O-2 N-otify doctor
question
VEAL CHOP
answer
V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placenta
question
Do not give what type of pain medication to a women in labor if the medication is likely to peak when the baby is born?
answer
Systemic- AKA IV, IM and oral
question
Low fetal heart rate is ?
answer
Bad LION if hr under 110
question
High fetal heart rate?
answer
160 This is ok Take mom's temp
question
Low baseline variability? (aka heart rate not changing)
answer
Bad LION
question
High baseline variability?
answer
HR changing a lot. This is ok.
question
Late decelerations?
answer
Bad (placental insufficiency) LION
question
Early decelerations?
answer
Head pressed on. This is ok.
question
Variable decelerations?
answer
HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position
question
ACE of spades answer for OB?
answer
Check fetal HR
question
If in OB its low or late you?
answer
LION
question
If variable its?
answer
Very bad and you push and position.
question
The second stage of labor and delivery is all about?
answer
Order
question
So what do you do and in what order for the second stage?
answer
Deliver the head Suction 1st the mouth then the nose Check for nuchle cord (cord around neck) Deliver shoulders and body ID band
question
During the third stage of labor and delivery (placental delivery) you do what two things?
answer
Make sure it's intact( can 1)hemorrhage 2) infection) Check for three vessels (2 arteries, 1 vein)AVA
question
What are the 4 things you do 4 times an hour for the 4th stage of labor?
answer
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.
question
The uterus should be like what after delivery?
answer
Firm not boggy Fundal height= days postpartum (3days= 3cm below naval) Midline- if not catheterize
question
Lochia color rubra?
answer
Red- rub it red
question
Lochia color serosa?
answer
pink- rose pink
question
Lochia color alba?
answer
White- albino white
question
Moderate lochia is?
answer
4-6 inches on pad in one hour
question
Excessive lochia is?
answer
Saturated pad in 15 minutes
question
Extremity assessment post partum should check?
answer
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)
question
Post partum assessment should include what?
answer
Uterus Lochia Extremities
question
Milia is?
answer
Distended sebacious glands which appear as tiny white spots on babys face.
question
Epsteins pearls are?
answer
Small,white epithelial cysts on babys gums.
question
Mongolian spots are?
answer
Bluish/black macules appearing over the buttocks and or thighs of darker skinned neonates.
question
Erythema toxicum neonatorum is?
answer
Red papular rash on babys torso which is benign and disappears after a few days.
question
Hemangiomas is?
answer
Benign tumor of the capillaries.
question
Cephalohematoma is?
answer
Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.
question
Caput Succedaneum is?
answer
Edematous swelling on the scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day.
question
Hyperbilirubinemia is?
answer
Normal, physiologic jaundice appears after 24 hours of age and disappears at about one week.
question
Vernix caseosa is?
answer
Whitish, cheese like substance which covers the skin on an unborn baby.
question
Acrocyanosis is?
answer
Normal cyanosis of the babys hands and feet which appears intermittently over the 1st 7-10 days.
question
Nevus/Nevi is?
answer
The generic term for a birthmark.
question
What 2 newborn variations are you most likely to be tested on for the NCLEX?
answer
Cephalohematoma and Caput Succedaneum
question
Tocolytics do what to labor?
answer
Stop it
question
What are the two tocolytics?
answer
Trobutaline= increases moms hr Nifediopine= ccb= decreases hr bp Magsulfate= decreases hr, bp, refleces, rr, loc (watch RR and watch Reflexes)
question
SE for Terbutaline?
answer
Maternal tachycardia This drug is not good if a heart issue is already present.
question
SE of Nifedipine?
answer
Headache and Hypotension (H)
question
Oxytocics do what to labor?
answer
Start it
question
What are the two oxytocic's?
answer
Pitocin=Oxytocin Cervidil= Prostaglandin Methergine
question
Oxytocics used for PP Hemorrhage:
answer
Pitocin, Methergine
question
SE of Pitocin?
answer
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.
question
With an Epidural, give what after delivery?
answer
Fluid Bolus to combat hypotension because they are a FALL RISK
question
Liquid meds in math calculations
answer
Round
question
SE of Cervidil?
answer
Effacement which leads to contractions.
question
What are the two neonatal lung medications?
answer
Betamethasone Survanta
question
How do you give Betamethasone?
answer
To the mom Before delivery IM
question
SE of Betamethasone?
answer
^ in glucose so monitor blood sugar
question
How do you give Survanta?
answer
To the baby After delivery By inhalation
question
Humulin 70/30 is what?
answer
70% N insulin (intermediate) 30% R insulin (short rapid)
question
When drawing up insulins its?
answer
RN (regular then N) draw what you are RN)
question
If your are pressurizing for drawing up insulin you?
answer
Draw what you are backwards. NR----> RN
question
For injections an IM needle must be?
answer
A 1 in both gauge and length. If not, pick the CLOSEST.
question
For injections SUBQ needles must have?
answer
A 5 in both gauge and length.
question
What routes can you give Heparin?
answer
IV or SUBQ
question
How quickly does Heparin work?
answer
ASAP
question
Heparin does not
answer
Thin blood/dissolve clots. It prevents clots from happening
question
What do you monitor if on Heparin?
answer
PTT
question
Antidote for Heparin is?
answer
Protamine Sulfate
question
Heparin is what pregnancy class?
answer
C
question
How can Coumadin be given?
answer
Oral only
question
For Heparin, Ask:
answer
How long have they been on it?
question
How long does it take for Coumadin to work?
answer
3-5 days
question
What do you monitor in Coumadin?
answer
Pt-INR(this is only for Coumadin)q
question
What is the antidote for Coumadin?
answer
Vitamin K
question
What pregnancy class is Coumadin?
answer
X
question
Switching from Heparin to Coumadin must?
answer
Be 14 days after heparin (5 days before coumadin) or there is a risk for DIC.
question
Clot busters end in what?
answer
Ase
question
All K+ wasting diuretics end in?
answer
X... If it ends in X its X's out K+ everything else it K+ sparing diuretics.
question
Generic for Baclofen(this will be on the NCLEX)
answer
Lioresil or Flexeril -muscle relaxant/antispasmotic
question
What is Baclofen(Lioresil, Flexeril)?
answer
Muscle relaxer
question
Baclofen(Lioresil, Flexeril) SE?
answer
Muscle weakness and drowsiness
question
What should you teach a patient taking Baclofen(Lioresil, Flexeril)?
answer
Don't drive/ operate machinery Don't drink alcohol Don't care for children under 12 Causes muscle weakness Causes Drowsiness
question
What is the saying that can be used to help remember Baclofen(Lioresil,Flexiril)?
answer
When you're on Baclofen you're on your back loafin.
question
Pregnancy Categories
answer
A- Safe B- Problems in Animals, Not Humans C- Caution, if benefits outweigh the risks you can use it X- NEVER.
question
A 0-2 yr old is in what Paiget stage?
answer
Sensory motor total present thinking Only teach what you do, while you do it Tell them directly
question
A 3-6 yr old is in what Piaget stage?
answer
Pre-operational Fantasy based teach just before (morning of) Teach what you are going to do Learn through play
question
A 7-11 yr old is in what Piaget stage?
answer
Concrete operation (think of a 7-11 with concrete around it) Rule oriented (can't abstract) teach days ahead Teach what to do +skills Be age appropriate, use demonstrations
question
A 12-15 yr old is in what Piaget stage?
answer
Formal operations Can abstract Can be taught like adults can manage their own care
question
Piagets sensory motor stage is characterized by?
answer
Present oriented Only think about what they SENSE or are DOING now.
question
As a nurse when, what and how do you teach a child in sensorimotor stage?
answer
Teach when you're doing it What you're doing to them Do it verbally
question
Piagets pre-operational stage is characterized by?
answer
Fantasy oriented Illogical No rules
question
Teaching 0-2 years old?
answer
Teach them as it happens, verbally tell them what you're doing as you do it
question
Teaching 3-6 year olds?
answer
Teach them the day of, Don't let them sleep on it. Tell them what you're going to do - future tense. USE PLAY. Picture book, dolls, play with equipment
question
Teaching, 7-11 year olds?
answer
Teach days before. Teach them what you're going to plus skills (they can draw up insulin) Don't use play. Use Age Appropriate audio + visual materials
question
Teaching 12-15 year olds?
answer
Teach them like an adult! They can think abstractly.
question
As a nurse when, what and how do you teach a child in the pre-operational stage?
answer
Teach the day of- to avoid nightmares What you're going to do Do this through play
question
Piagets concrete operations stage is characterized by?
answer
Rule oriented Live and die by the rules Cannot abstract
question
As a nurse when, what and how do you teach a child in the concrete operations stage?
answer
Teach them ahead of time What you're going to do Use visual and audio and use age appropriate reading
question
At what Piaget stage can you teach a skill like how to draw up insulin?
answer
Concrete operations
question
Piagets formal operations stage can be taught like?
answer
An adult
question
Stage 1 Pressure Ulcer
Stage 1 Pressure Ulcer
answer
Non Blanching Redness
question
Stage 2 Pressure Ulcer
Stage 2 Pressure Ulcer
answer
Skin no longer intact, fleshy pink base with a break in skin integrity This is where Blistering is
question
Stage 3 Pressure Ulcer
Stage 3 Pressure Ulcer
answer
Yellow fatty tissue seen at the base
question
Stage 4 Pressure Ulcer
Stage 4 Pressure Ulcer
answer
Bright Red Muscle or Bone is seen
question
Milia
Milia
answer
Distended sebaceous glands which appear as tiny white spots on the baby's face. NORMAL.
question
Epstein's Pearls
Epstein's Pearls
answer
Small, white epithelial cysts on the baby's spots
question
Mongolian Spots
Mongolian Spots
answer
Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates
question
Erhythema Toxicum Neonatorum
Erhythema Toxicum Neonatorum
answer
Red papular rash on the baby's torso which is benign and disappears after a few days
question
Hemangiomas
Hemangiomas
answer
Benign tumor of the capillaries
question
Cephalohematoma
Cephalohematoma
answer
Swelling caused by bleeding between the osteum and the periosteum of the skull. This swelling does not cross the suture lines.
question
Caput Succedaneum
Caput Succedaneum
answer
Crosses the suture lines
question
Hyperbilirubinemia
Hyperbilirubinemia
answer
Normal, Physiologic Jaundice
question
Vernix Caseosa
Vernix Caseosa
answer
White wax like substance that covers the skin of an unborn baby
question
Acrocyanosis
Acrocyanosis
answer
normal cyanosis of the baby's hands and feet. Appears intermittently over the first 7-10 days
question
Nevus/Nevi
Nevus/Nevi
answer
Normal Birthmark
question
If S1 is louder in a heart sound
answer
It's in the tricuspid
question
If S2 is louder is the heart sound
answer
It's Aortic
question
For prioritization the question will give what 4 pieces of information?
answer
Age Gender Disease Modifying phrase
question
For a prioritization question the most important information is?
answer
The modifying phrase
question
For a prioritization question what 2 pieces of information do not matter?
answer
Age and gender
question
What are the four rules of prioritization?
answer
Acute < chronic Fresh post-op(12hr.) < medical or other surgical. Unstable < stable The more vital the organ the higher the priority(use only as a tie breaker)
question
What is the best rule out of all 4 for prioritization?
answer
#4
question
What makes a patient stable? (7)
answer
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.
question
What makes a patient unstable? (7)
answer
Acute illness Post-op less than 12 hr General anesthesia Changed assessment Phrase "newly admitted" or "newly diagnosed" Labs C & D Unexpected S/S
question
What 4 things are always considered unstable?
answer
Hemorrhage Hypoglycemia Fevers over 104* Pulselessness and breathlessness
question
The more VITAL the ORGAN
answer
The HIGHER the priority
question
What are the main 6 organs in prioritized order?
answer
1. Brain 2. Lung 3. Heart 4. Liver 5. Kidney 6. Pancreas
question
What do you not delegate to a family member?
answer
Safety responsibilities-" can you watch your dad really fast while I grab something."
question
Family can only do what you ____ them for the patient?
answer
Teach
question
ONLY RN SCOPE (Don't delegate to LPN)
answer
Starting an IV Hanging of mixing IV Meds Evaluating IV Site or anything Giving IV Push Meds Giving an Blood Transfusion Preforming Admission, discharge, transfer assessment, or any UNSTABLE patient Plan of Care Developing or Preforming Teaching Taking Verbal Orders from MD
question
Do not Delegate to an UAP
answer
Chart about a Patient (They may document what they DID) Assessment Meds/IV. They MAY apply topical lotions/creams Treatments, except for Soap Suds Enema You MAY delegate ADLs.
question
Perfect Glasgow Coma Score?
answer
15
question
If another staff member is doing something illegal you?
answer
Tell the supervisor.
question
What do you do if another staff member is placing the patient in physical or psychological harm?
answer
Intervene and take over.
question
What do you do if a staff members behavior is legal, not harmful but just inappropriate?
answer
Counsel them later at a better time.
question
PSYCH do not receive______ do not give _______ keep the pt ________ about it Use _______ when communicating Put self in client's _______ choose answer that reflects
answer
gifts advise talking the feelings of the client shoes Don't fucus on words said, but feelings (empathy questions have a quote in them)
question
All psych medications cause what?
answer
Weight changes and low BP.
question
What group of drugs is the most commonly tested on the NCLEX?
answer
Psychotropic
question
What are phenothiazines?
answer
Psychotropic drugs
question
Phenothiazines end in?
answer
"zine"
question
Large doses of phenothiazines are ?
answer
Anti-psychotic
question
Small doses of phenothiazines are?
answer
Antiemetics
question
Major doses of phenothiazines are?
answer
Tranquilizers..... BIG GUNS.
question
The SE for phenothiazines are? (ABCDEFG)
answer
A-nticholinergic SE B-lurred vision C-onstipation D-rowsiness E-xtra paramital syndrome F-otosensitivity aG-granulocytosis
question
What do you teach patients taking phenothiazines?
answer
Report sore throat and any signs of infection. Keep medicating, tell dr of SE If toxic effect hold drug, tell dr
question
What is the #1 nursing diagnosis for a patient taking phenothiazines?
answer
Risk for injury --- Keep pt Safe
question
If a drug has the word _____ behind it, it means long IM form for noncompliance?
answer
Deconoate
question
Deconoate means?
answer
Long IM form given to noncompliant patients.
question
Tranquilizers work?
answer
ASAP
question
Antidepressants work?
answer
In 2-4 weeks
question
Tranquilizers shouldn't be taken?
answer
Long
question
Antidepressants can be taken?
answer
Long
question
What are the four Tricyclic antidepressants you need to know?
answer
Elavil Tofranil Aventyl Desyrel
question
Tricyclic SE? (Elavil starts with E so they go through E ABCDE)
answer
A-nticholinergic effects B-lured vision C-onstipation D-rowsiness E-uphoria (happy)
question
Tricyclic's do what to the mood?
answer
Elevates it elavil- elevates
question
Benzodiazepines are ?
answer
Antianxiety meds.
question
Benzodiazepines are considered minor __________?
answer
Tranquilizers
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Benzo's have what in the name?
answer
"zep"
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Must not take Benzo's for longer than?
answer
6 weeks
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Benzo's can also be used for what 5 other reasons?
answer
1. Anesthesia induction 2. Muscle relaxant 3. Alcohol withdrawal 4. Seizures 5. Facilitates mechanical ventilation
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Benzo SE? (ABCD)
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A-nticholinergic effects B-lured vision C-onstipation D-rowsiness
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What is the #1 nursing diagnosis for Benzo's?
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Safety
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MAOI's treat?
answer
Depression
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MAOI's are the?
answer
Mar-plan Nar-dil Par-nate
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MAOI SE?
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A-nticholinergic effects B-lured vision C-onstipation Drowsiness
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To avoid a severe hypertensive crisis patients taking MAOI's must avoid all foods with?
answer
Tyramine
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a list of Tyramine foods
answer
AGED & FERMENTED Cheese Sour cream Yogart Soy sause cured meats beer/wine smoked fish
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Lithium SE? (The 3 P's)
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Peeing Pooping Parasthesia
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Lithium toxic SE?
answer
Metallic taste Severe diarrhea
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Number 1 intervention for Lithium toxicity?
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Keep them hydrated If sweating give sodium as well as fluids
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While on Lithium you must monitor the level as well as what?
answer
Sodium
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Prozac is?
answer
An SSRI
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Prozac has the same side effects as Elavil?
answer
ABCDE
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Prozac causes what?
answer
Insomnia
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When should you give Prozac?
answer
Before 12 noon.
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If Prozac is BID give at what times?
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6A and 12N
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When changing the dose of Prozac for a young adult you must monitor for?
answer
Suicide
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If you don't know what a drug is and you are being asked which lab is important.... you need to remember?
answer
ALT A L-iver T-est
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What is the average dose of Haldol?
answer
5 mg
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Haldol has the SE?
answer
ABCDEFG
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Elderly patients need to take what amount of Haldol?
answer
Half the regular amount.
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If an elderly patient OD's on Haldol what are they at risk for?
answer
NMS -Neuroleptic Malignant Syndrome
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Hyperprexia is?
answer
Fever- really bad fever
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NMS has what associated with it?
answer
Hyperprexia
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Clozaril(Clozapine) is what?
answer
A second generation tranquilizer
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Most second generation tranquilizers have what in them?
answer
"zap"
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How often do you have to draw a WBC for a patient taking a second generation tranquilizer?
answer
1 a week for 1 month 1 a month for 6 months 1Q6 months for life
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Clozaril(Clozapine) is used to treat?
answer
Severe schizophrenia
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If a question has a drug with "zap " in it, the answer is probably?
answer
Infection related
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Clozaril(Clozapine) has what SE?
answer
Agranulocytosis
question
Zoloft(Sertraline) is a?
answer
SSRI
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Can Zoloft be taken in the evening?
answer
Yes
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Does Zoloft cause insomnia?
answer
Yes
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Zoloft decreases metabolism and can cause?
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Toxic drug levels
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What should you monitor with Zoloft use?
answer
Other drugs levels
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Patients taking Zoloft should NOT take what?
answer
St. John's wort
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St. John's wort and Zoloft use can cause?
answer
Serotonin Syndrome
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What are the S/S of serotonin syndrome?
answer
S-weating A-pprehension (sense of doom) D-izziness H-eadache
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If a patient is on drug A for 10 yrs. and the doctor adds drug B which drug dose needs to be lowered?
answer
Drug A
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Tx Protocol for Depression
answer
High Calorie, FIBER FOODS. Activities that are with others, but not interactive. Like Parallel Play. Dangers: Suicide. If They suggest it, be direct and ask them if they have a plan
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Tx Protocol for Schizophrenia
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Obvious Foods. They are suspicious. If they are on antipsychotics, think FIBER. Activity- With people to reinforce reality Huge homicide/suicide risk. They are the biggest risk for other-direct violence
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Tx Protocol for Bipolar
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Mania - Very high calorie, Finger Foods (on the go) Needs Gross Motor Activity Let them sleep whenever they can Not usually self destructive
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Tx Protocol for Anxiety Disorder
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No special diet, more anxious = more allergies Activity absorbs anxiety Self destructive behavior is not an issue.
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Hypomania
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Manic but can function
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Manic
answer
Can't function in society
question
Stages of desensitization
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Talk about it Look At Pictures Be Environment with it Interact/Experience it
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For a phobia, the first thing you do is
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Let them avoid it for now.
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Violent Clients
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Goal is to de-escalate. Walk with a pacing patient. Say "I see you are upset" Need 5 people to control a person. 1 person charge.
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For Empathy Questions
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Always pick the answer that reflects the patient's FEELINGS, *Not* Actions, or the nurses feelings.
question
The ACE of spades answer for nutrition is to either pick ____ or _____.
answer
Chicken Fish
question
Never choose _______ as a food for children.
answer
Casserol
question
For a toddler pick ______ food.
answer
Finger
question
For a preschooler ____ meal a day is ok!!!
answer
1 (they aren't growing as fast)
question
If you know what a particular drug does pick a SE in the ______ body system.
answer
Same
question
If you have no idea what a drug is check to see if it is ___. If it is, pick a _______ SE.
answer
PO GI
question
Ace of Spades answer for OB?
answer
Check the FHR.
question
What is the first thing you assess in a Med-Surg situation?
answer
L.O.C. = Bob, Bob, Bob are you ok????
question
What is the first thing you do in a Med-Surg situation?
answer
Airway
question
For Peds when in doubt call it?
answer
Normal
question
For Peds when in doubt pick?
answer
The older age.
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For Peds when in doubt pick the?
answer
Easier task for the child.
question
In Peds always give?
answer
More time
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Empathy question have?
answer
A quote in the question and a quote in the answer.
question
In psych choose the answer that reflects the _______ and not the _______ they said.
answer
Feelings Words
question
Warfarin, watch for?
answer
Bleeding
question
When you get a select all that apply question, do NOT ask
answer
What list do I remember?
question
When you get a select all that apply question, ask yourself:
answer
What principle do I know that could guide me to make my selection?
question
When you get a select-all that apply question, ask yourself:
answer
What does this disease/drug/procedure do to the BODY? For example, hypocalcemia makes the body responses go UP.
question
Do not use the following words in your thought process:
answer
Maybe, If, Possibly, Might, Could. They lead to OVERSELECTION!
question
Boards love to make an answer
answer
Right, but in the wrong direction. For example, Hyperkalemia when it should be HypOkalemia
question
Never select an answer on a SATA
answer
Based on another answer you chose. Base it on the QUESTION.
question
Watch for opposite answers...The list will often contain a __ concept going in the ___direction.
answer
Correct Concept in the Wrong Direction. READ CAREFULLY!
question
Make sure to decide if the question is asking what ___ the phenomenon OR what ___ from it.
answer
Causes the phenomenon or results from it. These are often the totally opposite answer.
question
Rule out
answer
Absolutes. Like "Always" or "Never"
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If two answers say the same thing
answer
Neither is right "tachycardia", "racing heart"
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If two answers are opposite
answer
One of them is probably right
question
Pick the answer that is more
answer
Global. (Umbrella Answer) For example, "Initiate suicide precautions" instead of "Remove belt", "medicate", "supervision", ect.
question
Don't be tempted to answer a question based on your ___ instead of your____
answer
Ignorance instead Knowledge (if you've never heard of it, DON'T PICK IT)
question
If you don't know a drug in the question...
answer
Cross it out, ignore it. Look at the route or other info about it. Like "IVPB" and base your answer on what you DO know about THAT!
question
If you don't know an answer
answer
You do know the answer. Use your common sense!
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If an answer seems right
answer
It probably is. Right answers are different from wrong answers just because they are right!
question
Only change an answer
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If you have a rationale and can answer as to why THAT answer is superior to one you originally chose
question
Every psych patient is a
answer
Med-surg patient first
question
In order to pick a psych answer, the patient must be
answer
Stable, Safe, and comfortable
question
Priorities, in Order
answer
Physiological, Safety, Comfort(Includes Pain), Psychological, Social, Spiritual (Maslow's)
question
Boards try to trick you with the words
answer
"bile stained " and "vomitus" in acid base. It is NOT from the stomach, it is from the intestine, so it means metabolic acidosis.
question
Patients that do NOT need interdisciplinary care
answer
Pt with multiple med surg diagnoses. Not the sickest or the most unstable people!
question
Patients that do need interdisciplinary care
answer
Patients with multidimensional needs. For example, physical, intellectual, psychological, emotional, spiritual.
question
Patients who need rehabilitation
answer
Needs interdisciplinary Care Automatically
question
Tie breakers when deciding which patient needs interdisciplinary care more
answer
Patient who's current treatment is ineffective, or the patient who is preparing for discharge
question
Best indicator of CHF
answer
ANF (ANF+BNP=CHF)
question
Plague is not longer commutable when?
answer
After 48 hours of treatment
question
Stop beta blockers & calcium channel blockers if
answer
Patient had MI or suspected MI
question
If a diabetic is unconscious
answer
If in hospital, give dextrose IV If at home, give Glucagon
question
Pt just had gastric surgery...acting drunk and in shock with ABDOMINAL distress... Think?
answer
Dumping syndrome! Low everything!
question
Pt has chest pain when lying down and indigestion
answer
Hiatal Hernia
question
Cushing's patients with an adrenalectomy need what?
answer
A "SONE" because they are more like an addison's pt now
question
All adrenal cortex disorders start with?
answer
A or C
question
Prolapsed cord / Variable decelerations, do you turn them on their left side?
answer
NO! Knee to chest position, tredelenburg, or elevate hips on pillows. Also cover chord in moist saline
question
Pressurizing insulin
answer
Draw up whole dose of air Put air into N (equal to liquid amount ordered) Put air into R Draw up R Draw up N
question
Wheezes are heard, what would you give?
answer
Bronchodilator
question
Theophylline
answer
Long acting bronchodilator
question
Should you massage a pressure sore if it won't blanch?
answer
NO
question
Lithium toxicity
answer
Tremors, Metallic taste, neuro symptoms besides parenthesia
question
High sodium levels in lithium
answer
Decrease the effectiveness
question
Low sodium levels in lithium
answer
Prolong lithiums half life
question
If you don't know the drug, monitor
answer
Liver Enzymes Then Creatinine Then WBC
question
Elderly patients on Haldol
answer
Should be 2.5 mg (half of the regular dose of 5)
question
In a patient with suspected shock, how should you position them?
answer
Legs elevated
question
Nursing diagnoses must
answer
Support the assessment data in the question
question
When intervening in daycare, look for task that is
answer
Unsuitable for age group
question
Low bowel surgery
answer
Low residue diet
question
Ruptured membranes
answer
Check for prolapsed cord
question
Antacids should not be given?
answer
With meals. They interfere with absorption With other meds. They stop other med absorption
question
After an amputation, for the first 24 hours, don't
answer
Put the leg under s pillow, might cause contractures
question
Whenever a time is mentioned after a medication is given, like "a pt received morphine. One half hour later, the patient wants to ambulate"
answer
Think about the peak times of the medication and if there are any safety risks involved! Don't ambulate if a medication is likely to peak!
question
In the pre interaction phase the nurse will?
answer
Explore his/own feelings about...
question
If you see the words "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"
answer
Correct answers should be: Tolerant Accepting Explorative Probing "Nosy" Be warm and fuzzy This is the introductory phase. You would not set limits
question
If you see the words "During the therapeutic interview" "While implementing the care plan" "While working on the care plan goals" "During treatment sessions" "During therapy" "In your weekly session" "Three days after admission"
answer
You are in the working phase, also known as the "therapeutic phase" Do: Be very focused, directive, "tough" In some ways these answers will seem stern and slightly unfriendly. Enforce proper communication.
question
Gift giving in psych
answer
Do not gift give in psych
question
What shouldn't you give in psych?
answer
Hugs, kisses, compliments, opinions, holding hands, placing arm around, etc. NO ADVICE/recommendations
question
Do you give advice in psych?
answer
NO.
question
Rule out these words in psych
answer
"Suggest that" "Advise the patient to" "Tell the patient to" "If I were you, I would..." "You should do" "You ought to" "You should NOT do" "Don't do" "Recommend that"
question
In psych should you give guarantees?
answer
NO
question
Don't pass the buck
answer
Don't tell a patient "refer patient to" or "have you spoken to your doctor about this?"
question
The best psych answers
answer
Reflect the feelings the patient feels and not the words they said Reflect Are open ended (not yes/no questions ) Don't have "I, me, we, us" Shortest answers are better Why questions are not as good
question
This test is not about you.
answer
It's about the PATIENT.
question
Take care of your
answer
PATIENT Not the machine