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DO NOT delegate what you can EAT!

E - evaluate A - assess T - teach addisons= do


wn, down down up down cushings= up up up down up addisons= hyponatremia, hypoten
sion, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, h
ypertension, incrased blood vol, hypokalemia, hyperglycemia No Pee, no K (do not
give potassium without adequate urine output) EleVate Veins dAngle Arteries !or
better per!usion A= appearance (color all pink pink and !lue !lue "pale#$ %= pu
lse (&'(( ) '(( a!sent$ *= gri+ace (cough gri+ace no response$ A= activity (,leed ,laccid li+p$ .= respirations (strong cry weak cry a!sent$ T.AN/01//1ON-2A/ED
%.E3A4T1ON/5 A1.2O.NE 0y - 0easles 3hicken - 3hicken %o-6Varicella 7e8 - 7erpe8
9oster6/hingles T2 or re+e+!er::: 0TV=Air!orne 0easles T2 Varicella-3hicken %o67erpes 9oster-/hingles %rivate .oo+ - negative pressure with ;-'< air e-changes
6hr 0ask N=> ,or T2 D.O%?ET think o, /%1DE.0AN! / - sepsis / - scarlet ,ever / streptococcal pharyngitis % - parvovirus 2'= % - pneu+onia % - pertussis 1 - in
,luen8a D - diptheria (pharyngeal$ E - epiglottitis . - ru!ella 0 - +u+ps 0 - +e
ningitis 0 - +ycoplas+a or +eningeal pneu+onia An - Adenovirus %rivate .oo+ or c
ohort 0ask
1

3ONTA3T %.E3A4T1ON 0./:@EE 0 - +ultidrug resistant organis+ . - respiratory in,e


ction / - skin in,ections A @ - wound in,-n E - enteric in,-n - clostridiu+ di,,
icile E - eye in,-n - conBunctivitis /C1N 1NDE3T1ON/ V371%/ V - varicella 8oster
3 - cutaneous diphtheria 7 - herpe8 si+ple1 - i+petigo % - pediculosis / - sca!
ies "# Air6%ul+onary E+!olis+ ($%$& chest pain, di!!iculty breathing, tachycardi
a, pale'cyanotic, sense o! impending doom) (() turn pt to le,t side and lower th
e head o! the bed# *# @o+an in ?a!or w6 4n-reassuring D7. (late decels, decrease
d variability, !etal bradycardia, etc) (() turn on le,t side (and give +*, stop
Pitocin, increase ,- !luids) .# Tu!e Deeding w6 Decreased ?O3 (() position pt on
right side (promotes emptying o! the stomach) with the 7O2 elevated (to prevent
aspiration) /# During Epidural %uncture (() side-lying 0# A,ter ?u+!ar %uncture
(and also oil(based 1yelogram)(() pt lies in ,lat supine (to prevent headache a
nd leaking o! 2$3) 4# %t w6 7eat /troke (() lie ,lat w' legs elevated 5# During
3ontinuous 2ladder 1rrigation (26,) (() catheter is taped to thigh so leg should
be kept straight# No other positioning restrictions# 7# A,ter 0yringoto+y (() p
osition on side o! a,,ected ear a!ter surgery (allows drainage o! secretions) 8#
A,ter 3ataract /urgery (() pt will sleep on una,,ected side with a night shield
!or "(/ weeks# "9# A,ter Thyroidecto+y (() low or semi(3owler:s, support head,
neck and shoulders# ""# 1n,ant w6 /pina 2i,ida (() position prone (on abdomen) s
o that sac does not rupture "*# 2uckEs Traction (skin traction) (() elevate !oot
o! bed !or counter(traction ".# A,ter Total 7ip .eplace+ent (() don:t sleep on
operated side, don:t !le; hip more than /0( 49 degrees, don:t elevate <+6 more t
han /0 degrees# 1aintain hip abduction by separating thighs with pillows# "/# %r
olapsed 3ord (() knee(chest position or =rendelenburg
2

"0# 1n,ant w6 3le,t ?ip (() position on back or in in!ant seat to prevent trauma
to suture line# >hile !eeding, hold in upright position# "4# To %revent Du+ping
/yndro+e (post(operative ulcer'stomach surgeries) (() eat in reclining position
, lie down a!ter meals !or *9(.9 minutes (also restrict !luids during meals, low
2<+ and !iber diet, small !requent meals) "5# A!ove Cnee A+putation (() elevate
!or !irst */ hours on pillow, position prone daily to provide !or hip e;tension
# "7# 2elow Cnee A+putation (() !oot o! bed elevated !or !irst */ hours, positio
n prone daily to provide !or hip e;tension# "8# Detached .etina (() area o! deta
chment should be in the dependent position *9# Ad+inistration o, Ene+a (() posit
ion pt in le,t side-lying ($im:s) with knee !le;ed *"# A,ter /upratentorial /urg
ery (incision behind hairline) (() elevate <+6 .9(/0 degrees **# A,ter 1n,ratent
orial /urgery (incision at nape o! neck)(() position pt ,lat and lateral on eith
er side# *.# During 1nternal .adiation (() on !edrest while implant in place */#
Autono+ic Dysre,le-ia67yperre,le-ia ($%$& pounding headache, pro!use sweating,
nasal congestion, goose !lesh, bradycardia, hypertension) (() place client in si
tting position (elevate 7O2$ ,irst !e,ore any other i+ple+entation: *0# /hock ((
) bedrest with e;tremities elevated *9 degrees, knees straight, head slightly el
evated (modi!ied =rendelenburg) *4# 7ead 1nBury (() elevate <+6 .9 degrees to de
crease intracranial pressure *5# %eritoneal Dialysis when Out,low is 1nadeFuate
(() turn pt !rom side to side 6E3+?E checking !or kinks in tubing (according to
Kaplan) *7# ?u+!ar puncture =) @3=E? the procedure, the client should be placed
in the supine position !or / to "* hrs as prescribed# ($aunders .rd ed p# **8) A
emorol !or pancreatitis, N+= morphine sul!ate 1yasthenia Bravis& worsens with e;
ercise and improves with rest# 1yasthenia 2risis& a positive reaction to =ensilo
n((will improve symptoms 2holinergic 2risis& caused by e;cessive medication(stop
med(giving =ensilon will make it worse <ead inCury medication& 1annitol (osmoti
c diuretic)(crystalliDes at room temp so @E>@F$ use !ilter needle Prior to a liv
er biospy its important to be aware o! the lab result !or prothrombin time 3rom
the aGG (diarrhea)= metabolic acidosis 3rom the mouth (vomitus)=metabolic alkalo
sis 0y-ede+a6hypothyroidis+& slowed physical and mental !unction, sensitivity to
cold, dry skin and hair
3

*ravesG disease6hyperthyroidis+5 accelerated physical and mental !unction sensit


ivity to heat, !ine'so!t hair Thyroid stor+5 increased temp, pulse and <=N %ostthyroidecto+y5 semi(3owlerHs, prevent ncek !le;ion'hypere;tension, trach at beds
ide 7ypo-parathyroid5 2@=$ I convulsions, arrhythmias, tetany, spasms, stridor (
decreased calcium), high 2a, low phosphorus diet 7yper-parathyroid& !atigue, mus
cle weakness, renal calculi, back and Coint pain (increased calcium), low 2a, hi
gh phosphorus diet 7ypovole+ia I incrased temp, rapid'weak pulse, increase respi
ration, hypotension, an;iety, urine speci!ic gravity )"#9.9 7ypervole+ia I bound
ing pulse, $+6, dyspnea, rares'crackles, peripheral edema, <=N, urine speci!ic g
ravity J"#9"9 $emi(3owlerHs Dia!etes 1nsipidus (decreased AD7$5 e;cessive urine
output and thirst, dehydration, weakness, administer Pitressin /1AD7 (increased
AD7$5 change in E+2, decreased deep tendon re!le;es, tachycardia, n'v'a, <@ admi
nister Aeclomycin, diuretics 7ypokale+ia& muscle ewakness, dysrhythmias, increas
e K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery) 7ype
rkale+ia5 1K?AE? I muscle weakness, urine (oliguria'anuria), respiratory depress
ion, decreased cardiac contractility, E2B changes, re!le;es 7yponatre+ia& nausea
, muscle cramps, increased ,2P, muscular twitching, convulsion osmotic diuretics
, !luids 7ypernatre+ia5 increased temp, weakness, disorientation'delusions, hypo
tension, tachycardia hypotonic solution 7ypocalce+ia5 2@=$ I convulsions, arrhyt
hmias, tetany, spasms and stridor 7ypercalce+ia& muscle weakness, lack o! coordi
nation, abdominal pain, con!usion, absent tendon re!le;es, sedative e!!ect on 2N
$ 7ypo0g& tremors, tetany, seiDures, dyrshythmias, depression, con!usion, dyspha
gia dig to;icity 7yper0g5 depresses the 2N$, hypotension, !acial !lushing, muscl
e ewakness, absent deep tendon re!le;es, shallow respirations, emergency Addison
Gs& hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to str
ess, !ractures, alopecia, weight loss, B, distress 3ushings5 hyperNa, hypoK, hyp
erglycemia, prone to in!ection, muscle wasting, weakness, edema, <=N, hirsutism,
moon!ace'bu!!alo hump Addisonian crisis5 n'v, con!usion, abdominal pain, e;trem
e weakness, hypoglycemia, dehydration, decreased 6P %heochro+ocyto+a& hypersecre
tion o! epi'norepi, persistent <=N, increased <?, hyperglycemia, diaphoresis, tr
emor, pounding <@ avoid stress, !requent bating and rest breaks, avoid cold and
stimulating !oods, surgery to remove tumor "# Neuroleptic malignant syndrome (N1
$)& (N1$ is like $%1 (you get hot (hyperpyre;ia) (sti!! (increased muscle tone)
(sweaty (diaphoresis) (6P, pulse, and respirations go up % (you start to drool
4

*# , kept !orgetting which was dangerous when you:re pregnant regular measles (r
ubeola), or Berman measles (rubella), so remember& (never get pregnant with a Be
rman (rubella) .# >hen drawing up regular insulin % NP< together, remember& (?N
(regular comes be!ore NP<) /# =etralogy o! !allot remember <+P$ =hink A?+P(child
drops to !loor or squats) or P+$< Ae!ect, septal ?ight -entricular hypertrophy
+verriding aorts Pulmonary stenosis 0# 1@+,:s that are used as antidepressants&
weird way to remember, , know# pirates say arrrr, so think pirates take 1@+,:s w
hen they:re depressed# ( e;planation 1@+,:s used !or depression all have an arrr
sound in the middle (Parnate, 1arplan, Nardil) @utonomic dysre!le;ia& potential
ly li!e threatening emergency ( elevate head o! bed to 89 degree ( loosen constr
ictive clothing ( assess !or bladder distention and bowel impaction (triger) ( @
dminister antihypertensive meds (may cause stroke, 1,, seisure ) easy way to re+
e+!er 0AO1E/! think o, %ANA0A! %A - parnate NA - nardil 0A - +arplan metallic bi
tter taste# Aigo;in(check pulse, less than 49 hold, check dig levels and potassi
um levels# @mphoCel& t; o! BE?A and kidney stones####watch out !or contipation#
-istaril& t; o! an;iety and also itching###watch !or dry mouth# given preop comm
only -ersed& given !or conscious sedation###watch !or resp depression and hypote
nsion P=K and =apaDole( prevention o! thyroid storm $inemet& t; o! parkinson###s
weat, saliva, urine may turn reddish brown occassionally###causes drowsiness @rt
ane& t; o! parkinson##sedative e!!ect also 2ogentin& t; o! parkinson and e;trapy
ramidal e!!ects o! other drugs =igan& t; o! postop n'v and !or nausea associated
with gastroenteritis =imolol (=imoptic)(t; o! gluacoma
5

6actrim& antibiotic##dont take i! allergic to sul!a drugs###diarrhea common side


e!!ect###drink plenty o! !luids Bout 1eds& Probenecid (6enemid), 2olchicine, @l
lopurinol (Lyloprim) @presoline(hydralaDine)(t; o! <=N or 2<3, ?eport !lu(like s
ymptoms, rise slowly !rom sitting'lying position take with meals# 6entyl& t; o!
irritable bowel####assess !or anticholinergic side e!!ects# 2alan (verapamil)& c
alcium channel blocker& t; o! <=N, angina###assess !or constipation 2ara!ate& t;
o! duodenal ulcers##coats the ulcer###so take be!ore meals# =heophylline& t; o!
asthma or 2+PA##therap drug level& "9(*9 1ucomyst is the antedote to tylenol an
d is administered orally Aiamo;& t; o! glaucoma, high altitude sickness###dont t
ake i! allergic to sul!a drugs ,ndocin& (nsaid) t; o! arthritis (osteo, rhematoi
d, gouty), bursitis, and tendonitis# $ynthroid& t; o! hypothyroidism##may take s
everal weeks to take e!!ect###noti!y doctor o! chest pain##take in the @1 on emp
ty stomach##could cause hyperthyroidism# Eibrium& t; o! alcohol w'd###dont take
alchol with this###very bad nausea and vomiting can occur# +ncovin (vincristine)
& t; o! leukemia##given ,- +NEF kwell& t; o! scabies and lice###(scabies)apply l
otion once and leave on !or 7("* hours###(lice) use the shampoo and leave on !or
/ minutes with hair uncovered then rinse with warm water and comb with a !ine t
ooth comb Premarin&t; a!ter menopause estrogen replacement Ailantin& t; o! seiDu
res# thera drug level& "9(*9 Navane& t; o! schiDophrenia##assess !or EP$ ?italin
& t; o! @A<A##assess !or heart related side e!!ects report immediately###child m
ay need a drug holiday b'c it stunts growth# dopamine (,ntropine)& t; o! hypoten
sion, shock, low cardiac output, poor per!usion to vital organs###monitor EKB !o
r arrhythmias, monitor 6P <ave trouble remembering !hr patterns in +6M =hink -E@
E 2<+P -2 E< @+ EP - = variable decels 2 = cord compression caused E = early dec
els < = head compression caused @ = accels + = okay, not a problemN E = late dec
els = placental insu!!iciency, can:t !ill
6

3or cord compression, place the mother in the =?ENAEEEN6E?B position because thi
s removes pressure o! the presenting part o!! the cord# (,! her head is down, th
e baby is no longer being pulled out o! hte body by gravity) ,! the cord is prol
apsed, cover it with sterile saline gauDe to prevent drying o! the cord and to m
inimiDe in!ection# 3or late decels, turn the mother to her le!t side, to allow m
ore blood !low to the placenta# 3or any kind o! bad !etal heart rate pattern, yo
u give +*, o!ten by mask### >hen doing an epidural anesthesia hydration be!ore h
and is a priority# <ypotension and bradypnea ' bradycardia are maCor risks and e
mergencies# NE-E? check the monitor or a machine as a !irst action# @lways asses
s the patient !irst !or e;maple listen to the !etal heart tones with a stethosco
pe in N2EEO land# $ometimes it:s hard to tell who to check on !irst, the mother
or the baby it:s usually easy to tell the right answer i! the mother or baby inv
olves a machine# ,! you:re not sure who to check !irst, and one o! the choices i
nvolves the machine, that:s the wrong answer# ,! the baby is a posterior present
ation, the sounds are heard at the sides# ,! the baby is anterior, the sounds ar
e heard closer to midline, between teh umbilicus and where you would listen to a
posterior presentation# ,! the baby is breech, the sounds are high up in the !u
ndus near the umbilicus# ,! the baby is verte;, they are a little bit above the
symphysis pubis# @lso !or ventilator alarms 7O?D 7igh alarm( Obstruction due to
incr# secretions, kink, pt# coughs, gag or bites ?ow press alarm( Disconnection
or leak in ventilatior or in pt# airway cu!!, pt# stops spontaneous breathing "#
to remember blood sugar& hot and dry(sugar high (hyperglycemia) cold and clammy
(need some candy (hypoglycemia) *# ,2P @NA $<+2K <@-E +PP+$,=E -'$ ,2P(increased
6P, decreased pulse, decreased resp# shock( decreased 6P, increased pulse, incr
eased resp# .# cor pulmonae& right sided heart !ailure caused by le!t ventricula
r !ailure (so pick edema, Cvd, i! it is a choice#) /# herion withdrawal neonate&
irratable poor sucking 0# Pews& no meat and milk together 4# 6rachial pulse& pu
lse area cpr on an in!ant# 5# =est child !or lead poisioning around "* months o!
age 7# bananas, potatoes, citrus !ruits source o! potassium ""# 2ultures are ob
tained be!ore starting ,- antibiotics
7

"*# a pt with leukemia may have epita;is b'c o! low platelets ".# best way to wa
rm a newborn& skin to skin contact covered with a blanket on mom# "/# when a pt
comes in and she is in active labor###nurse !irst action is to listen to !etal h
eart tone'rate "0# phobic disorders###use systematic desensitiDtion# N2EEO =,P$
"# >hen getting down to two answers, choose the assessment answer (assess, colle
ct, auscultate, monitor, palpate) over the intervention e;cept in an emergency o
r distress situation# ,! one answer has an absolute, discard it# Bive priority t
o answers that deal directly to the patientHs body, not the machines'equipments#
*# Key words are very important# @void answers with absolutes !or e;ample& alwa
ys, never, must, etc# .# with lower amputations patient is placed in prone posit
ion# /# small !requent !eedings are better than larger ones# 0# @ssessment, teac
hing, meds, evaluation, unstable patient cannot be delegated to an Knlicensed @s
sistive Personnel# 4# E-N'EPN cannot handle blood# 5# @mynoglycosides (like vanc
omycin) cause nephroto;icity and ototo;icity# 7# ,- push should go over at least
* minutes# 8# ,! the patient is not a child an answer with !amily option can be
ruled out easily# "9# ,n an emergency, patients with greater chance to live are
treated !irst ""# @?A$ (!luids in alveoli), A,2 (disseminated intravascular coa
gulaton) are always secondary to something else (another disease process)# "*# 2
ardinal sign o! @?A$ is hypo;emia (low o;ygen level in tissues)# ".# in p< regul
ation the * organs o! concern are lungs'kidneys# "/# edema is in the interstitia
l space not in the cardiovascular space# "0# weight is the best indicator o! deh
ydration "4# wherever there is sugar (glucose) water !ollows# "5# aspirin can ca
use ?eyeHs syndrome (encephalopathy) when given to children "7# when aspirin is
given once a day it acts as an antiplatelet# "8# use 2old !or acute pain (eg# $p
rain ankle) and <eat !or chronic ( rheumatoid arthritis) *9# guided imagery is g
reat !or chronic pain# *"# when patient is in distress, medication administratio
n is rarely a good choice# **# with pneumonia, !ever and chills are usually pres
ent# 3or the elderly con!usion is o!ten present# *.# @lways check !or allergies
be!ore administering antibiotics (especially P2N)# 1ake sure culture and sensiti
vity has been done be!ore adm# 3irst dose o! antibiotic# */# 2or pulmonale (s's
!luid overload) is ?ight sided heart !ailure caused by pulmonary disease, occurs
with bronchitis or emphysema# *0# 2+PA is chronic, pneumonia is acute# Emphysem
a and bronchitis are both 2+PA# *4# in 2+PA patients the baroreceptors that dete
ct the 2+* level are destroyed# =here!ore, +* level must be low because high +*
concentration
8

blows the patientHs stimulus !or breathing# *5# e;acerbation& acute, distress# *
7# epi always given in =6 syringe# *8# prednisone to;icity& cushingHs syndrome=
bu!!alo hump, moon !ace, high glucose, hypertension# .9# / options !or cancer ma
nagement& chemo, radiation, surgery, allow to die with dignity# ."# no live vacc
ines, no !resh !ruits, no !lowers should be used !or neutropenic patients# .*# c
hest tubes are placed in the pleural space# ..# angina (low o;ygen to heart tiss
ues) = no dead heart tissues# 1,= dead heart tissue present# ./# mevacor (antich
olesterol med) must be given with evening meal i! it is QA (per day)# .0# Nitrog
lycerine is administered up to . times (every 0 minutes)# ,! chest pain does not
stop go to hospital# Ao not give when 6P is J 89'49# .4# Preload a!!ects amount
o! blood that goes to the ? ventricle# @!terload is the resistance the blood ha
s to overcome when leaving the heart# .5# 2alcium channel blocker a!!ects the a!
terload# .7# !or a 2@6B operation when the great saphenous vein is taken it is t
urned inside out due to the valves that are inside# .8# unstable angina is not r
elieved by nitro# /9# dead tissues cannot have P-2Hs(premature ventricular contr
action# ,! le!t untreated pvcHs can lead to -3 (ventricular !ibrillation)# /"# "
t (teaspoon)= 0 ml " =(tablespoon)= . t = "0 ml " oD= .9 ml " cup= 7 oD " quart
= * pints " pint= * cups " gr (grain)= 49 mg " g (gram)= "999 mg " kg= *#* lbs "
lb= "4 oD G =o convert 2entigrade to 3# 3= 2R/9, multiply 8'0 and substract /9
G =o convert 3ahrenheit to 2# 2= 3R/9, multiply 0'8 and substract /9# /*# angiot
ensin ,, in the lungs= potent vasodialator# @ldosterone attracts sodium# /.# ?EE?$E @BEN=$ 3+? =+O,2,=F heparin= protamine sul!ate coumadin= vitamin k ammonia=
lactulose acetaminophen= n(@cetylcysteine# ,ron= de!ero;amine Aigito;in, digo;i
n= digibind# @lcohol withdraw= Eibrium# ( methadone is an opioid analgesic used
to deto;i!y'treat pain in narcotic addicts# ( Potassium potentiates dig to;icity
# //# heparin prevents platelet aggregation# /0# P='P== are elevated when patien
t is on coumadin /4# cardiac output decreases with dysrythmias# Aopamine increas
es 6P# /5# 1ed o! choice !or -tach is lidocaine /7# 1ed o! choice !or $-= is ade
nosine or adenocard /8# 1ed o! choice !or @systole (no heart beat) is atropine
9

09# 1ed o! choice !or 2<3 is @ce inhibitor# 0"# 1ed o! choice !or anaphylactic s
hock is Epinephrine 0*# 1ed o! choice !or $tatus Epilepticus is -alium# 0.# 1ed
o! choice !or bipolar is lithium# 0/# @miodorone is e!!ective in both ventricula
r and atrial complications# 00# $. sound is normal in 2<3, not normal in 1,# 04#
give cara!ate (B, med) be!ore meals to coat stomach 05# Protoni; is given proph
ylactically to prevent stress ulcers# 07# a!ter endoscopy check gag re!le;# 08#
=PN(total parenteral nutrition) given in subclavian line# 49# low residue diet m
eans low !iver 4"# diverticulitis (in!lammation o! the diverticulum in the colon
) pain is around EE quadrant# 4*# @ppendicitis (in!lammation o! the appendi;) pa
in is in ?E quadrant with rebound tenderness# 4.# portal hypotension R albuminem
ia= @scites# 4/# beta cells o! pancreas produce insulin 40# 1orphine is contrain
dicated in Pancreatitis# ,t causes spasm o! the $phincter o! +ddi# =here!ore Aem
erol should be given# 44# =rousseau and =chovoski signs observed in hypocalcemia
45# with chronic pancreatitis, pancreatic enDymes are given with meals# 47# Nev
er give KR in ,- push# 48# mineral corticoids are give in @ddisonHs disease# 59#
Aiabetic ketoacidosis (AK@)= when body is breaking down !at instead o! sugar !o
r energy# 3ats leave ketones (acids) that cause p< to decrease# 5"# AK@ is rare
in diabetes mellitus type ,, because there is enough insulin to prevent breakdow
n o! !ats# 5*# $ign o! !at embolism is petechiae# =reated with heparin# 5.# !or
knee replacement use continuous passive motion machine# 5/# give prophylactic an
tibiotic therapy be!ore any invasive procedure# 50# glaucoma patients lose perip
heral vision# =reated with meds 54# cataract= cloudy, blurry vision# =reated by
lens removal(surgery 55# 2o* causes vasoconstriction# 57# most spinal cord inCur
ies are at the cervical or lumbar regions 58# autonomic dysre!le;ia ( li!e threa
tening inhibited sympathetic response o! nervous system to a no;ious stimulus( p
atients with spinal cord inCuries at =(5 or above) is usually caused by a !ull b
ladder# 79# spinal shock occurs immediately a!ter spinal inCury 7"# 1ultiple scl
erosis= myelin sheat destruction, disruption in nerve impulse conduction# 7*# my
asthenia gravis= decrease in receptor sites !or acetylcholine# $ince smallest co
ncentration o! @2=< receptors are in cranial nerves, e;pect !atigue and weakness
in eye, mastication, pharyngeal muscles# 7.# =ensilon test given i! muscle is t
ense in myasthenia gravis# 7/# Buillain(6arre syndrome= ascending paralysis# Kee
p eye on respiratory system# 70# parkinsonHs = ?@=& rigidity, akinesia (loss o!
muscle mvt), tremors# =reat with levodopa# 74# =,@ (transient ischemic attack) m
ini stroke with no dead brain tissue 75# 2-@ (cerebrovascular accident) is with
dead brain tissue# 77# <odgkinHs disease= cancer o! lymph is very curable in ear
ly stage# 78# ?ule o! N,NE$ !or burns <ead and Neck= 8S Each upper e;t= 8S Each
lower e;t= "7S
10

3ront trunk= "7S 6ack trunk= "7S Benitalia= "S M 89# 6irth weight doubles by 4 m
onth and triple by " year o! age# 8"# i! <? is J"99 do not give dig to children#
8*# !irst sign o! cystic !ibrosis may be meconium ileus at birth# 6aby is incon
solable, do not eat, not passing meconium# 8.# heart de!ects# ?emember !or cyano
tic (.=Hs( =o!, =runcys arteriosus, =ransposition o! the great vessels)# Prevent
blood !rom going to heart# ,! problem does not !i; or cannot be corrected surgi
cally, 2<3 will occur !ollowing by death# 8/# with ? side cardiac cath=look !or
valve problems 80# with E side in adults look !or coronary complications# 84# rh
eumatic !ever can lead to cardiac valves mal!unctions# 85# cerebral palsy = poor
muscle control due to birth inCuries and'or decrease o;ygen to brain tissues# 8
7# ,2P (intracranial pressure) should be J*# measure head circon!erence# 88# dil
antin level ("9(*9)# 2an cause gingival hyperplasia "99# !or 1eningitis check !o
r KernigHs' 6rudDinskiHs signs# "9"# >ilmHs tumor is usually encapsulated above
the kidneys causing !lank pain# "9*# hemophilia is ;(linked# 1other passes disea
se to son# "9.# when phenylalanine increases, brain problems occur# "9/# 6uckHs
traction= knee immobility "90# ?ussell traction= !emur or lower leg "94# Aunlap
traction= skeletal or skin "95# 6ryantHs traction= children J.y, J.0 lbs with !e
mur !;# "97# place apparatus !irst then place the weight when putting traction "
98# placenta should be in upper part o! uterus ""9# eclampsia is seiDure# """# a
patient with a vertical c(section surgery will more likely have another c(secti
on# ""*# per!orm amniocentesis be!ore *9 weeks gestation to check !or cardiac an
d pulmonary abnormalities# "".# ?h( mothers receive rhogam to protect ne;t baby#
""/# anterior !ontanelle closes by "7 months# Posterior 4 to 7 weeks# ""0# capu
t succedaneum= di!!use edema o! the !etal scalp that crosses the suture lines# $
welling reabsorbs within " to . days# ""4# pathological Caundice= occurs be!ore
*/hrs and last5 days# Physiological Caundice occurs a!ter */ hours# ""5# placent
a previa = there is no pain, there is bleeding# Placenta abruption = pain, but n
o bleeding# ""7# bethamethasone (celestone)=sur!actant# 1ed !or lung e;pansion#
""8# dystocia= baby cannot make it down to canal "*9# pitocin med used !or uteri
ne stimulation "*"# 1agnesium sul!ate(used to halt preterm labor) is contraindic
ated i! deep tendon re!le;es are ine!!ective# ,! patient e;periences seiDure dur
ing magnesium adm# Bet the baby out stat (emergency)# "**# Ao not use why or , u
nderstand statement when dealing with patients "*.# milieu therapy= taking care
o! patient'environment "*/# cognitive therapy= counseling "*0# crisis interventi
on=short term# "*4# 3,-E ,N=E?-EN=,+N$ 3+? P$F2< P@=,EN=$ (sa!ety (setting limit
s
11

(establish trusting relationship (meds (leas restrictive methods'environment# "*


4# $$?,Hs (antidepressants) take about . weeks to work# "*5# +bsession is to tho
ught# 2ompulsion is to action "*7# i! patients have hallucinations redirect them
# ,n delusions distract them# "*8# =horaDine, haldol (antipsychotic) can lead to
EP$ (e;trapyramidal side e!!ects) ".9# @lDheimerHs disease is a chronic, progre
ssive, degenerative cognitive disorder that accounts !or more than 49S o! all de
mentias "# =o remember how to draw up ,N$KE,N think& Nicole .ichie .N (a teacher
taught us this is school, thought it was !unny and never !orgot itNNN) @ir into
NP<, then air into regular, draw up regular then draw up NP< *# <FPE?thyroidism
think o! 0137AE? HA3C/ON in T7.1??E.N /C1NNI NE.VO4/ 24?D*1N* EIE/, Kp all nigh
t, heart beating !ast @tropine used to decrease secretions Phenergan an antiemet
ic used to reduce nausea AiaDepam is a commonly used tranquiliDer given to reduc
e an;iety be!ore +? Aemerol is !or pain control Ao not give demerol to pts# with
sickle cell crisis# ,ron inCections should be given L(track so they don:t leak
into $Q tissues# All %hysicians Earn Too 0uch 0oney +r A%E To 0an 3ranial Nerves
& G, am sorry i! this vulgar !or some, but hey, it sticks $ensory=$ 1otor=1 6oth
=6 +h (+l!actory ,) +h (+ptic ,,) +h (+culomotor ,,,) =o (=rochlear ,-) =ouch (=
rigeminal -) @nd (@bducens -,) 3eel (3acial -,,) @ (@uditory -,,,) Birls (Blosso
pharyngeal ,O) -agina (-agus O) @nd (@ccessory O,) <ymen (<ypoglassal O,,) $ome
$ay 1arry 1oney 1y 6ig 6ras 1atter 1ore
6ut 6rother $ays
12

7yper natre+ia (greater than 'J>$ /kin !lushed Agitation ?ow grade !ever Thirst
Develop+ental *(. months& turns head side to side /(0 months& grasps, switch % r
oll 4(5 months& sit at 4 and waves bye(bye 7(8 months& stands straight at eight
"9("" months& belly to butt (phrase has "9 letters) "*(". months& twelve and up,
drink !rom a cup 7epatitis <epatitis& (ends in a VO@E?, comes !rom the 2O@E? (<
ep @) <epatitis 6=6lood and 6odily !luids <epatitis 2 is Cust like 6 Apgar measu
res 7. .. 0uscle tone .e,le-es /kin color each 9(* point# 7("9 +K# 9(. ?E$K$2,=@
=E# *?A/*O@ 3O0A /3A?E: EIE/ VE.2A? 0OTO.! ,t is similar to measuring dating ski
lls###+a- '> points (one can do it i! !elow K you are in 3o+a: $o, to start dati
ng you gotta open your EIE/ ,irst, i! you albe to do that spontaneously and use
them correctly to $EE whom you dating you earn /# 6ut i! she has to scream on yo
u to make you open them it is only .####and " you dont care to open even i! she
tries to hurt you# i! you get good EFE contact (/ points) then move to VE.2A?: t
alk to her' himN i! you can do that Fou are really +?,EN=EA in situation she'he
uncontiously gives you / pointsN i! you like her try not to be 2+N3K$EA (.), and
o! cause do not use ,N@PP?+P?,@=E >+?A$ (.), she will not like it)), try not to
?E$P+NA >,=< ,N2+1P?E<EN$,6EE $+KNA$ (*), i! you do not like her( Cust show no
-E?6@E ?E$P+N$E(") $ince you:ve got EFE and -E?6@E contact you can 0OVE now usin
g your 1otor ?esponse Points# =<is is -E?F important since Bood moves give you 4
N =he person who hyperventilates is most likely to e;perience respiratory alkalo
sis# avoid salt substitutes when taken dig and k(supplements because many are po
tassium based $igns o! hypo;ia& restless, an;ious, cyanotic tachycardia, increas
ed resps# (also monitor @6B:s) @ddison:s disease (need to LaddL hormone) 2ushing
:s syndrome (have e;tra LcushionL o! hormones) Aumping syndrome& increase !at an
d protein, small !requent meals, lie down a!ter meal to decrease peristalsis, wa
it " hr a!ter meals to drink#
13

3or blood types& T+T is the universal donor (remember LoL in donor) T@6T is the
universal receipient Aisseminated <erpes Loster is @,?6+?NE P?E2@K=,+N$, as to E
ocaliDed <erpes Loster is 2+N=@2= P?E2@K=,+N$# @ nurse with a localiDed herpes D
oster 2@N care !or patients as long as the patients are N+= immunosuppressed and
the lesions must be coveredN 3at soluble vitamins are -itamins @, A, E, K Bive
N$@,A$, 2orticosteroids, drugs !or 6ipolar, 2ephalosporins, and $ul!anomides >,=
< !ood# @tivan is the treatment o! choice !or status epilepticus >hen using a br
onchodilator inhaler inconCuction with a glucocorticoid inhaler, administer the
bronchodilator !irst =heophylline increases the risk o! digo;in to;icity and dec
reases the e!!ects o! lithium and Ailantin 1Ntal, an inhaler used to treat aller
gy induced asthma may cause bronchospasm, thinkU 1Nto the asthmatic lung ,soniaD
id causes peripheral neuritis Peptic ulcers caused by <# pylori are treated with
3lagyl, Prilosec and 6ia;in# =his treatment kills bacteria and stops production
o! stomach acid, but does not heal ulcer# >eighted N, (Naso intestinal tubes) m
ust !loat !rom stomach to intestine# Aon:t tape the tube right away a!ter placem
ent, may leave coiled ne;t to pt on <+6# Position patient on ?,B<= to !acilitate
movement through pylorus# G Aiaphragm must stay in place 4 hours a!ter intercou
rse# =hey are also !itted so must be re( !itted i! you lose or gain a signi!ican
t amount o! weight# G 6est time to take Browth <ormone P1, $teroids @1, Aiuretic
s @1, @ricept @1# G 2ara!ate ($ulcra!ate) be!ore meals (mucosal barrier constipa
tion) G =agamet with !ood (<* messes with elderly ppl be care!ul N ,nteracts wit
h alot o! things) G@ntacids a!ter meals G Eong term use o! amphogel (binds to ph
osphates, increases 2a, robs the bones###leads to increased 2a resortion !rom bo
nes and >E@K 6+NE$) G2ushings ulcers r't 6?@,N inCury G2ushings triad r't ,2P in
6?@,N (htn, bradycard, irr# resp) G=hyroid storm is <+= (hyperthermia) G1y;edem
a coma is 2+EA (hypothermia) GBlaucoma intraocular pressure is greater than the
normal (** mm <g), give miotics to constrict (pilocarpine) N+ @=?+P,NE# G Non da
iry sources o! calcium include ?<K6@?6, $@?A,NE$, 2+EE@?A B?EEN$ G Fou can petal
the rough edges o! a plaster cast with tape to avoid skin irritation# G>ith low
back aches, bend knees to relieve G Push !luids with @llopurinol ( !lush the ur
ic acid out o! system G Koplick:s spots are red spots with blue center character
istic o! P?+A?+1@E stage o! 1easles# Ksually in mouth# G ,N< can cause periphera
l neuritis, take -it 64 to prevent also hepatoto;ic
14

G .i!ampin ( .ed orange tears and urine, also contraceptives don:t work as well
G Ethambutol ( messes with your Eyes G @pply eye drop to conCunctival sac and a!
ter wards apply pressure to nasolacrimal duct ' inner canthus G Pancreatitis pat
ients but them in !etal position, NP+, gut rest, prepare antecubital site !or P,
22 cuD they:ll probably be getting =PN'Eipids G =rendelenburg test ( !or varicos
e veins# ,! they !ill pro;imally = varicosity# ?ule o! nines, 8 = head, "7 = arm
s, .4 = torso, .4 =legs, and "= perineum = "99S @hen giving Caye-alate we need t
o worry a!out dehydration ( C ha ineverse relationship with Na$ Iogurt has live
cultures- dont give to i++unosuppressed pt 1tching under cast area- cool air via
!low dryer ice pack ,or '(- '> +inutes: NEVE. use Ftip or anything to scratch a
rea 1urphyHs sign I pain with palpation o! gall bladder area seen with cholecyst
itis 2ullenHs sign I ecchymosis in umbilical area, seen with pancreatitis =urner
Hs sign I !lank grayish blue (turn around to see your !lanks) pancreatitis 1c6ur
neyHs Point I pain in ?EQ indicative o! appendicitis EEQ I diverticulitis , low
residue, no seeds, nuts, peas ?EQ I appendicitis, watch !or peritonitis Buthrie
=est I =ests !or PKK, baby should have eaten source o! protein !irst $hilling =e
st I test !or pernicious anemia' how well one absorbs -it b"* @llenHs test I occ
lude both ulnar and radial artery until hand blanches then release ulnar# ,! the
hand pinks up, ulnar artery is good and you can carry on with @6B'radial stick
as planned# @6B$ must be put on ice and whisked to the lab# o,tHs ok to have abd
ominal craps, blood tinged out!low and leaking around site i! the Peritoneal Aia
lysis cath (tenkho!!) was placed in the last "(* wks# 2loudy out!low NE-E? N+?1@
E# o@mniotic !luid yellow with particles = meconium stained o<yper re!le;es (upp
er motor neuron issue Vyour re!le;es are over the topW) o@bsent re!le;es (lower
motor neuron issue) o?hogam & given at *7 weeks, 5* hours post partum, ,1# +nly
given to ?h NEB@=,-E mother# @lso i! indirect 2oombHs test is positive, donHt ne
ed to give ?hogam cuD she has antibody only give i! negative coombs o-it K is to
coumadin as Protamine $ul!ate is to <eparin as 2a Blu is to 1g$o/ as 1ucomyst i
s to @cetominophen as @micar is to =P@Uget itM @ntidotes'treatments !or overdose
+rder o! assessment& ,nspection, Palpation, Percussion and @usculation# EO2EP=
with abdomen cuD you donHt wanna mess with the bowels and their sounds so you ,n
spect, @uscultate, Percuss then Palpate (same with kids, , suppose since you wan
na go !rom least invasive to most invasive sine they will cry 6E++A 1K?AE? N Bot
ta love them kids N) Eate; allergies =) @ssess !or allergies to bananas, apricot
s, cherries, grapes, kiwis, passion !ruit, avocados, chestnuts, tomatoes, peache
s
15

=ensilon is used in myesthenia gravis to con!irm the diagnosis# 1yesthenia gravi


s is caused by a disorder in the transmission o! impulses !rom nerve to muscle c
ell# @myotrophic lateral sclerosis ( @E$ ) is a condition in which there is a de
generation o! motor neurons in both the upper % lower motor neuron systems# Tran
sesophageal Distula (TED$ ( esophagus doesn:t !ully develop (this is a surgical
emergency) =he M 3Es o, TED in the newborn& ") 2hoking *) 2oughing .) 2yanosis =
he 11? vaccine is given $Q not ,1# ?ed((unstable, ie, occluded airway, actively
bleeding, see !irst Fellow(((stable, can wait up to an hour !or treatment, ie bu
rns, see second Breen(((stable, can wait even longer to be seen, Twalking wounde
dT 6lack((unstable clients that will probably not make it, need com!ort measures
A+@(((dead on arrival Breek heritage ( they put an amulet or any other use o! p
rotective charms around their baby:s neck to avoid Tevil eyeT or envy o! others
4 year old kids cannot interpret TIME# Need to e;plain time in relationship to a
known 2+11+N E-EN= (eg& T1om will be back a!ter supperT)# GG @naphylactic react
ion to baker:s yeast is contraindication !or <ep 6 vaccine# GG @sk !or allergy t
o eggs be!ore 3lu shot GG @sk !or anaphylactic r;n to eggs or neomycin be!ore 11
? GG >hen on nitroprusside, monitor thiocynate (cyanide)# Normal value should be
", )" is heading toward to;icity GG,! kid has cold, can still give immuniDation
s GG$@?$ (severe acute resp syndrome) airborne R contact (Cust like varicella) G
G <epatitis @ is contact precautions GG =etanus, <epatitis 6, <,- are $=@NA@?A p
recautions GG >illiam:s position ( $emi 3owlers with knees !le;ed (inc# knee gat
ch) to relieve lower back pain# GG $,BN$ o! a 3ractured hip& EO=E?N@E ?+=@=,+N,
$<+?=EN,NB, @AAK2=,+N GG 3at Embolism& 6lood tinged sputum (r't in!lammation), i
nc E$?, respiratory alkalosis (not acidosis r't tachypnea), hypocalcemia,increas
ed serum lipids, Tsnow stormT e!!ect on 2O?# GG2omplications o! 1echanical -enti
lation& Pneumothora;, Klcers GG Paget:s Aisease ( tinnitus, bone pain, enlargeme
nt o! bone, thick bones# GG N+ -,=@1,N 2 with @llopurinol GG ,-P requires bowel
prep so they can visualiDe the bladder better GG@cid @sh diet ( cheese, corn, cr
anberries, plums, prunes, meat, poultry, pastry, bread GG @lk @sh diet( milk, ve
ggies, rhubarb, salmon GG +range tag in triage is non emergent Psych GG Breensti
ck !ractures, usually seen in kids bone breaks on one side and bends on the othe
r
16

,nsomnia is a side e!!ect o! thyroid hormones# $aunders con!irms it# 1akes sense
thoughN ,ncreased met# rate, your body is Ttoo busy to sleepT as opposed to the
!olks with hypothyroidism who may report somnolence (dec# met rate, body is slo
w and sleepy)# +k some more !acts# GG 6+=+O !or strabismus# Patch the B++A eye s
o that the weaker eye can get stronger# 3ound a cool link about its use in peds
pt with strabismus# , had to look it up cuD , heard it was important Gah hem ah
hemG GG =,A@E -+EK1E is 5 I "9ml ' kg GG 2+PA patients ?E1E16E?& *EN2 or less (h
ypo;ic N+= hypercapnic drive), Pa9* o! 49ish and $a9* 89S is normal !or them b'c
they are chronic 2+* retainers# ### GG Neostigmine'@tropine (anticholinergic) t
o reverse e!!ect o! pancuronium# GG@mpho 6 causes hypokalemia (amongst many othe
r things##gotta premedicate be!ore giving# Pts will most likely get a !ever) GG
=est / hypersensitivity be!ore the administration o! asparginase# GG =ake -ermo;
with high !at diet (increases absorption) GG Kidney Blucose threshold is "79 GG
@mphogel and ?enegal take with meals GG $tranger an;iety is greatest 5 ( 8 mont
hs, $eparation an;iety peaks in toddlerhood GG 11? is a $Q shot Eymes is !ound m
ostly in 2onneticut @sthma and @rthritis((swimming best @sthma has intercostal r
etractions((be concerned =ardive Ayskinesia ( irreversible ( involuntary movemen
ts o! the tongue, !ace and e;tremities, may happen a!ter prolonged use o! antips
ychotics @kathisia ( motor restlessness, need to keep going, t; with antiparkins
ons meds, can be mistaken !or agitation# >hen drawing an @6B, you need to put th
e blood in a hepariniDed tube, make sure there are no bubbles, put on ice immedi
ately a!ter drawing, with a lable indicating i! the pt was on room air or how ma
ny liters o! +*# ?emember to pre!orm the @llen:s =est prior to doing an @6B to c
heck !or su!!icient blood !low 6e!ore going !or Pulmonary 3uction =ests (P3=:s),
a pt:s bronchodilators will be with(held and they are not allowed to smoke !or
/ hrs prior 3or a lung biopsy, position pt lying on side o! bed or with arms rai
sed up on pillows over bedside table, have pt hold breath in mide;piration, ches
t ;(ray done immediately a!terwards to check !or complication o! pneumothora;, s
terile dressing applied 3or a lumbar puncture, pt is positioned in lateral recum
bent !etal position, keep pt !lat !or *(. hrs a!terwards, sterile dressing, !req
uent neuro assessments EEB, hold meds !or */(/7 hrs prior, no ca!!ine or cigaret
tes !or */ hrs prior, pt can eat, pt must stay awake night be!ore e;am, pt may b
e asked to hyperventilate and watch a bright !lashing light, a!ter EEB, assess p
t !or seiDures, pt:s will be at increased risk Aiamo;, used !or glaucoma, can ca
use hypokalemia
17

Ae;edrine, used !or @A<A, may alter insulin needs, avoid taking with 1@+,:s, tak
e in morning (insomnia possible side e!!ect) 2ytovene, used !or retinitis caused
by cytomegalovirus, pt will need regular eye e;ams, report diDDiness, con!usion
, or seiDures immediately ,N<, used to treat and prevent =6, do not give with di
lantin, can cause phenytonin to;icity, monitor E3=:s, give 64 along with, hypote
nsion will occur initially, then resolve ?i!ampin, !or =6, dyes bodily !luids or
ange ,! mi;ing antipsychotics (ie <aldol, =hroaDine, Proli;in) with !luids, med
is incompatible with ca!!ine and apple Cuice <aldol pre!erred anti(psychotic in
elderly, but high risk e;trapyramidal side e!!ects (dystonia, tarditive dyskines
ia, tightening o! Caw, sti!! neck, swollen tongue, later on swollen airway), mon
itor !or early signs o! reaction and give ,1 6enadryl ?isperdal, antipsychotic,
doses over 4mg can cause tarditive dyskinesia, !irst line antipsychotic in child
ren Eevodopa, !or parkinsons, contraindicated in pts with glaucoma, avoid 64 $in
emet, !or parkinsons, contraindicated with 1@+,:s <ydro;yurea, !or sickle cell,
report B, symptoms immediately, could be sign o! to;icity Locor, !or hyperlipide
mia, take on empty stomach to enhance absorption, report any une;plained musle p
ain, especially i! !ever Aecorticate is toward the :cord:# Aecerebrit is the oth
er way (out) GG 6+=+O GG (6otulin =o;in) can be used with strabismus also to rel
a; vocal cords in spasmodic dysphonia#
18

(0unchausen /yndro+e is a psychiatric disorder that causes an individual to sel!


(in!lict inCury or illness or to !abricate symptoms o! physical or mental illnes
s, in order to receive medical care or hospitaliDation# ,n a variation o! the di
sorder, 0unchausen !y pro-y (0/2%$, an individual, typically a mother, intention
ally causes or !abricates illness in a child or other person under her care# (0u
ltiple /clerosis is a chronic, progressive disease with demyelinating lesions in
the 2N$ which a!!ect the white matter o! the brain and spinal cord# 0otor /6/5
limb weakness, paralysis, slow speech /ensory /6/5 numbness, tingling, tinnitus
3ere!ral /6/5 nystagmus, ata;ia, dysphagia, dysarthria 7untingtonEs 3horea5 09S
genetic, autosomal dominant disorder $'$& chorea (() writhing, twisting, movemen
ts o! !ace, limbs and body (gait deteriorates to no ambulation (no cure, Cust pa
lliative care (>62 shi!t to the le!t in a patient with pyelonephritis (neutrophi
ls kick in to !ight in!ection) (Ae!initive diagnosis !or abd# aortic aneurysm (@
@@) --& 2= scan (Aon:t use Kaye;alate i! patient has hypoactive bowel sounds# (K
remic !etor --& smell urine on the breath (<irschsprungHs --& bile is lower obst
ruction, no bile is upper obstruction ribbon like stools# (Pancreatic enDymes ar
e taken with each mealN Not be!ore, not a!ter, but @1T7 each meal#
19

=hank you, , !inally realiDe why a person shouldn:t have cantaloupe be!ore a occ
ult stool test, because cantaloupe is high in vit c and vit c causes a !alse R !
or occult blood# Now , Cust need to !igure out why they can:t have !ish# 7ypospa
dias5 abnormality in which urethral meatus is located on the ventral (back) sur!
ace o! the penis anywhere !rom the corona to the perineum (re+e+!er hypo low (,o
r lower side or under side$ Epispadias5 opening o! the urethra on the dorsal (!r
ont) sur!ace o! the penis %riapis+5 pain!ul erection lasting longer than 4 hrs#
@nticholinergic e!!ects((assessment dry mouth==can:t spit urinary retention=can:
t GGGG constipated =can:t GGGG blurred vision=can:t see
>hen you see 2o!!ee(brown
emesis, think peptic ulcer *#@nytime you see !luid retention# =hink heart proble
ms!irst# .#@n answer that delays care or treatment is @E>@F$wrong /#3or P-A reme
mber A@-E (Eegs are Aependent !or@rterial % !or -enous Elevated) more to come###
#######
>hen choosing an answer, think in this mannerU i! you can only do +NEF one thing
to help this patient what would it beM Pick the most important intervention#
,!
two o! the answers are the e;act opposite, like bradycardia or tachycardia###
one is probably the answer#
,! two or three answers are similar or are alike, none
is correct#
>hen asking patientsH questions NE-E? use VwhyW questions# Eliminate
all VwhyMW answer options#
,! you have never heard o! itU please donHt pick itN Neve
r release traction KNEE$$ you have an order !rom the 1A to do so
Questions about a
haloM ?emember sa!ety !irst, have a screwdriver nearby# ?emember compartment synd
rome is an emergency situation# Paresthesias and increased pain are classic symp
toms# Neuromuscular damage is irreversible /(4 hours a!ter onset# @lways deal with
actual problems or harm be!ore potential problems
@lways select a Vpatient !ocuse
dW answer# @n answer option that states Treassess in "0 minutesT is probably wrong
# ,nterpersonal model ($ullivan) 6ehavior motivated by need to avoid an;iety and
satis!y needs "# ,n!ancy 9("7 months others will satisy needs *# childhood )4yr
s learn to delay need grati!ication .# Cuvenile 4(8 years learn to relate to pee
rs /# preadolescence 8("* yrs learns to relate to !riends o! o! opposite se; 0#
early adolescence"*("/yrs&learn independence and how to relate to opposite se; 4
# late adolecence "/(*"yrs& develop intimate relationship with person o! opposit
e se; is this not about communicationM####
20

3etal alcohol syndrome (upturned nose (!lat nasal bridge (thin upper lip ($B@ va
stus lateralis is ,1 administration site !or 4month in!ants 3or toddlers above "7
months ventrogluteal =he deltoid and gluteus ma;imus are appropriate sites !or ch
ildren +K( both eyes +$( le!t eye +A( right eye ( dominent ?ight eye( Cust a tip
to remember) "# 3OA? (cane walking)& 3 ( cane O ( opposite A ( a!!ected ? ( leg
?ed( ,mmediate& ,nCuries are li!e threatening but survivable with minimal inter
vention# E;& hemothra;, tension pneumothora;, unstable chest and abdominal wound
s, ,N2+1PEE=E amputations, +PEN !;:s o! long bones, and *nd'.rd degree burn with
"0S(/9S o! total body sur!ace, etc# Fellow( Aelayed& ,nCuries are signi!icant a
nd require medical care, but can wait hrs without threat to li!e or limb# E;& $t
able abd wounds without evidence o! hemorrhage, !; requiring open reduction, deb
ridement, e;ternal !i;ation, most eye and 2N$ inCuries, etc# Breen( 1inimal& ,nC
uries are minor and t; can be delayed to hrs or days # ,ndividuals in this group
should be moved away !rom the main triage area# E;& upper e;tremity !;, minor b
urns, sprains, sm# lacerations, behavior disorders# 6lack( E;pectant& ,nCuries a
re e;tensive and chances o! survival are unlikely# $eperate but dont abandoned,
com!ort measures i! possible# E;& Knresponsive, spinal cord inCuries, woulds wit
h anatomical organs, *nd'.rd degree burn with 49S o! body sur!ace area , seiDure
s, pro!ound shock with multipe inCuries, no pulse, b#p, pupils !i;ed or dilated#
=horacentesis prep( =ake v#s#, shave area around needle insertion, position pat
ient with ar+s on pillow on over !ed ta!le or lying on side no more than "999cc
at a one time# Post( listen !or bilateral breath sounds, v#s#, check leakage, st
erile dressing# 2=( assess allergies 1?,( claustrophobia, no metal, assess pacem
aker 2ardiac cath( npo 7("*hr, empty bladder, pulses, tell pt may !eel heat palp
itations or desire to cough with dye inCection# Post( -ital signs keep leg strai
ght bedrest 4(7hr# cerebral angio prep( well hydrated, lie !lat, sire shaved, pu
lses marked post( keep !lat "*("/hr, check site, pulses,!orce !luids# Eumbar pun
cture( !etal postion# post( nuero assess q"0(.9 until stable, !lat*(.hr, encoura
ge !luids, oral anlgesics !or headache, observe dressing
21

EEB( no sleep the night be!ore, meals not withheld, no stimulants !or */hr be!or
e, tranquiliDer'stimulant meds held */(/7hr be!ore, may be asked to hyperventila
te .(/min and watch a bright !lashing light# 1yelogram( Npo /(4hr, allergy h;, p
henothiaDines, cns depressants, and stimulants withheld /7hr prior, table will b
e moved to various postions during test# Post( neuro q*(/, water solu!le 7O2 up
oil solu!le 7O2 down oral analgesics !or h'a, encourage po !luids, assess !or di
stended bladder, inspect site# Eiver biopsy( @dm vit k , npo morning o! e;am 4hr
, give sedative, Teach pt that he will !e asked to hold !reath ,or >-'(sec supin
e postion lateral with upper ar+s elevated: %ost- postion on right side ,reFuent
v:s: report severe a! pain stat no heavy li!ting "wk# Paracentesis( semi !owler
s or upright on edge o! bed, empty bladder# Post( v#s#, report elevated temp, ob
serve !or signs o! hypovolemia# Eaparoscopy( 2+* used to enhances visual, genera
l anesthesia, !oley# %ost- walk patient to decrease 3O< !uild up used ,or proced
ure: Pyelogram( assess allergies $engstaken blakemore tube used !or t; o! esopha
geal varices, keep scissors at !edside: <emovac( used a!ter mastectomy, empty wh
en !ull or q7hr, remove plug, empty contents, place on !lat sur!ace, cleanse ope
ning and plug with alcohol sponge, co+press evacuator co+pletely to re+ove air,
release plug, check system !or operation# 2ommon $igns and $ymptoms 9"# P=6 I lo
w(grade a!ternoon !ever# 9*# PNEK1+N,@ I rusty sputum# 9.# @$=<1@ I wheeDing on
e;piration# 9/# E1P<F$E1@ I barrel chest# 90# K@>@$@K, $FNA?+1E I strawberry ton
gue# 94# PE?N,2,+K$ @NE1,@ I red bee!y tongue# 95# A+>N $FNA?+1E I protruding to
ngue# 97# 2<+EE?@ I rice watery stool# 98# 1@E@?,@ I stepladder like !ever with
chills# "9# =FP<+,A I rose spots in abdomen# ""# A,P=<E?,@ I pseudo membrane !or
mation "*# 1E@$EE$ I koplikHs spots# ".# $EE I butter!ly rashes#
22

"/# E,-E? 2,??<+$,$ I spider like varices# "0# EEP?+$F I lioning !ace# "4# 6KE,1
,@ I chipmunk !ace# "5# @PPENA,2,=,$ I rebound tenderness# "7# AENBKE I petechia
e or (R) <ermanHs sign# "8# 1EN,NB,=,$ I KernigHs sign (leg !le; then leg pain o
n e;tension), 6rudDinski sign (neck !le; = lower leg !le;)# *9# =E=@NF I hypocal
cemia (R) =rousseauHs sign'carpopedal spasm 2hvostek sign (!acial spasm)# *"# =E
=@NK$ I risus sardonicus# **# P@N2?E@=,=,$ I 2ullenHs sign (ecchymosis o! umbili
cus) (R) Brey turners spots# *.# PFE+?,2 $=EN+$,$ I olive like mass# */# PA@ I m
achine like murmur# *0# @AA,$+NH$ A,$E@$E I bronDe like skin pigmentation# *4# 2
K$<,NBH$ $FNA?+1E I moon !ace appearance and bu!!alo hump# *5# <FPE?=<F?+,A,$1'B
?@-EH$ A,$E@$E I e;opthalmus# *7# ,N=K$$K$2EP=,+N I sausage shaped mass, Aance $
ign (empty portion o! ?EQ) *8# 1$ I 2harcotHs =riad (,@N) .9# 1B I descending mu
scle weakness ."# Buillain 6arre $yndrome I ascending muscle weakness .*# A-= I
<omanHs $ign ..# 2<,2KEN P+O I -esicular ?ash (central to distal) dew drop on ro
se petal ./# @NB,N@ I 2rushing stubbing pain relieved by N=B .0# 1, I 2rushing s
tubbing pain which radiates to le!t shoulder, neck, arms, unrelieved by N=B .4#
E=6 I inspiratory stridor .5# =E3 I /2sH 2oughing, 2hoking, 2yanosis, 2ontinous
Arooling .7# EP,BE+=,=,$ I .AsH Arooling, Aysphonia, Aysphagia .8# <+ABEK,NH$ A$
E'EF1P<+1@ I painless, progressive enlargement o! spleen % lymph tissues, ?eedst
enberg 2ells
23

/9# ,N3E2=,+K$ 1+N+NK2EE+$,$ I <allmark& sore throat, cervical lymph adenopathy,


!ever /"# P@?K,N$+NH$ I Pill(rolling tremors /*# 3,6?,N <F@E,N I E;piratory Bru
nt /.# 2F$=,2 3,6?+$,$ I $alty skin //# A1 I polyuria, polydypsia, polyphagia /0
# AK@ I Kussmauls breathing (Aeep ?apid ??) /4# 6E@AAE? 2@ I painless hematuria
/5# 6P< I reduced siDe % !orce o! urine /7# PE1P<,BK$ -KEB@?,$ I NikolskyHs sign
(separation o! epidermis caused by rubbing o! the skin) /8# ?E=,N@E AE=@2<1EN=
I -isual 3loaters, !lashes o! light, curtain vision 09# BE@K2+1@ I Pain!ull visi
on loss, tunnel'gun barrel'halo vision (Peripheral -ision Eoss) 0"# 2@=@?@2= I P
ainless vision loss, +pacity o! the lens, blurring o! vision 0*# ?E=,N+ 6E@$=+1@
I 2atHs eye re!le; (grayish discoloration o! pupils) 0.# @2?+1EB@EF I 2oarse !a
cial !eature 0/# AK2<ENNEH$ 1K$2KE@? AF$=?+P<F I BowersH sign (use o! hands to p
ush oneHs sel! !rom the !loor) 00# BE?A I 6arretts esophagus (erosion o! the low
er portion o! the esophageal mucosa) 04# <EP@=,2 EN2EP<@E+P@=<F I 3lapping tremo
rs 05# <FA?+2EP<@EK$ I 6ossing sign (prominent !orehead) 07# ,N2?E@$E ,2P I <FPE
?tension 6?@AFpnea 6?@AFcardia (2ushingHs =riad) 08# $<+2K I <FP+tension =@2<Fpn
ea =@2<Fcardia 49# 1EN,E?EH$ A$E I -ertigo, =innitus 4"# 2F$=,=,$ I burning on u
rination 4*# <FP+2@E2E1,@ I 2hvostek % =rosseaus sign 4.# KE2E?@=,-E 2+E,=,$ I r
ecurrent bloody diarrhea 4/# EF1EH$ A$E I 6ullHs eye rash +ttorhea s's o! basila
r !racture 6attles sign and racoons eyes s's o! orbital !racture
24

=ake iron eli;ir with Cuice or water#### never with milk Kawasaki:s leads to Ail
antin "9(*9 =heophyline "9(*9 @cetaminophen "9(*9 Eithium 9#0("#0 Aigo;in 9#0(*#
9 +steomyletitis is an in!ectious bone dD# Bive blood cultures and antibiotics,
then i! necessary surgery to drain abscess# Nephrotic syndrome s's edema R hypot
ension# =urn and reposition (risk !or impaired skin integrity) =o access role re
lationship pattern !ocus on image and relationships with others# ?enal impairmen
t& serum creatinine elevated and urine clearance decreased cardiac problems
Norm# $erum creatinine 9#7("#7 (men), 9#0("#0 (women) Norm# Krine clearance 70("
.0 @tropine +verdose <ot as a <are (=emp), 1ad as a <atter 6one (=hirsty) <emogl
obin Neonates "7(*5 . mos "9#4("4#0 . yrs 8#/("0#0 "9 yrs "9#5("0#0 Blomerulonep
hritis& take vs q / hrs R daily weights @ge / to 0 yrs child needs AP='11?'+P2ys
tic 3ibrosis give diet low !at, high sodium, !at soluble vitamins @AEK# @erosal
bronchodilators, mucolytics and pancreatic enDymes# @irborne Precautions& measel
s, chicken po; and =6# private room, negatvie pressure w' 4("* air e;changes, 1a
sk N80# Aroplet Precautions&sepsis, scarlet !ever, streptococcal pharyngitis, pa
rovirus 6"8, pnuemonia, pertusis, in!luenDa, diptheria, epiglottis, rubella, mum
ps, meningitis, mycoplasma and adenovirus# Aoor open, . !t distance, private roo
m or cohort, mask 2ontact Precautions& multidrug resistant organism respiratory,
skin, wound enteric and eye ,N3E2=,+N$ Lolo!t s'e agitation, sleep disturb, and
dry mouth 2loDapine s'e agranulocytosis, tachycardia and sieDures 6lood tests !
or 1,& 1yoglobin, 2K and =roponin (E+2), ?ed as a 6eet (!lushed !ace) and Ary as
a
25

$alt substitutes may contain pottasium Placental abruptio& bleeding with pain, d
on:t !orget to monitor volume status (,%+) @n ill child regresses in behaviors 1
eningeal irritation $'s nuchal rigidity, positive 6rudDinski R Kernig signs and
P<+=+P<+6,@ tooN
6abinski sign ( toes curl
greatN toes !an
bad
Blucose =olerance =est !or preggies result o! "/9 or highter needs !urther evalu
ation# @ssessing e;traocular eye movements check cranial nerves ., /, and 4# $to
mas dusky stoma means poor blood supply, protruding means prolapsed, sharp pain
R rigidity means peritonitis, mucus in ileal conduit is e;pected# Ailantin s'e r
ash (stop med), gingival hyperplasia (good hygiene) to;icity(()poor gait R coord
ination, slurred speech, nausea, lethargy, and diplopia# Phenobarbital can be ta
ken during pregnancy but Ailatin is contraindicated# =ension pneumothora; trache
a shi!ts to opposite side# =his is B?E@=N <ere:s some , got !rom a review class
, went to several months ago### A3hange in color is always a E@=E signN G1ncenti
ve /piro+etry steps&") $it upright *) E;hale .) ,nsert mouthpiece /) ,nhale !or
. seconds, and then <+EA !or "9 seconds AA+inoglycocide (XX1ycin e;cept erythrom
ycine) @dverse E!!ects are bean shaped ( Nephroto;ic to Kidneys and +toto;ic to
Ears A0./A ( 2ontact precaution +NEF AV./A ( 2ontact @NA airborne precaution (Pr
ivate room, door closed, negative pressure) A?1T7140 L-level of therapeutic affe
ct is 0.5-1.5 I-indicate mania T-to ic level is !-" - #$%& diarrhea& tremors '-h
yrdrate !-"L of (ater$day I-increased )* and dry mouth )-uh oh+ ,ive Mannitol an
d -iamo if to ic s$s are present M-maintain #a intake of !-",$day AAll psych +ed
sE (e-cept ?ithiu+$ side e,,ects are the sa+e as /N/ !ut the 2% is decreased: A/
N/( ,ncrease in 6P, <? and ?? (dilated bronchioled), dilated pupils (blurred vis
ion), Aecreased BK= (urniary retention), B,= (constipation), 2onstricted blood v
essels and Ary mouth# A2lood trans,usion- sign o! allergies in order& ")3lank pa
in *)3requent swallowing .)?ashes /)3ever 0)2hills AThro+!ocytopenia (6leeding p
recautionsN ")$o!t bristled toothbrush *)No insertion o! anythingN (c'i supposit
ories, douche)
26

.)No ,1 meds as much as possibleN G,ron de!iciency anemia ( easily !atigued ")3e
P+ ( give with -itamin 2 or on an empty stomach *)3e via ,1( ,n!eron via Ltrack
A%ernicious Ane+ia ( ?ed, 6e!!y tongue will take -it#6"* !or li!eN A24.N/ "st A
egree ( ?ed and Pain!ul *nd Aegree ( 6listers .rd Aegree ( No Pain because o! bl
ocked and burned nerves A0eniereEs Disease ( @dmin diuretics to decrease endolym
ph in the cochlea, restrict Na, lay on a!!ected ear when in bed# =riad& ")-ertig
o *)=innitus .)N'A*astric 4lcer pain occurs .9 minutes to 89 minutes a!ter eatin
g, not at night, and doesn:t go away with !ood G=hink positive and you can achie
ve great things# =hink o! present and !uture, the past is gone# ./or,et your pas
t mistakes and focus on your successes encoura,in, yourself to ,reater achieveme
nts in the future. .0l(ays do your 1est so you can 1e proud that you ,ave it you
r 1est shot. ./ocus on your achievements rather than your failures. If you do fi
nd yourself thinkin, a1out ho( you failed then look at (hat you mana,ed to do ri
,ht and ho( you could correct (hat you did ne t time. .0 mind that is trou1led (
ith dou1t (on2t 1e a1le to focus on the victory to 1e had. G=ake it one day at a
time# G=ake time !or yoursel!# @ !ried mind can:t !ocus or learn# Pediatric =ip
s& >hat is an intraosseous in,usionM ,n pediatric li!e(threatening emergencies,
when iv access cannot be obtained, an osseous (bone) needle is hand(drilled into
a bone (usually the tibia), where crystalloids, colloids, blood products and dr
ugs can !e ad+inistered into the +arrow# ,t is a temporary, li!e(saving measure,
and , have seen it onceN (Bruesome#) >hen venous access is achieved it can be d
'cHd# +ne medication that cannot be administered by intraosseous in!usion is iso
proterenol, a beta agonist# (, donHt know more about that drug it was Cust point
ed out on a practice e;am#) Auring sickle cell crisis there are two intervention
s to prioritiDe& ,luids and pain relie!# >ith glo+erulonephritis you should cons
ider !lood pressure to be your most important assessment parameter# Aietary rest
rictions you can e;pect include !luids, protein, sodium, and potassium# ?emember
yesterday when , mentioned how congenital cardiac de!ects result in hypo-ia whi
ch the body attempts to compensate !or (in!lu; o! immature rbcHs)M Eabs supporti
ng this would show increased he+atocrit he+oglo!in and r!c count# Aid you know t
here is an association between low-set ears and renal ano+aliesM Now you know wh
at to look !or i! downHs isnHt there to choose# (Cust to e;pand on it a little,
the kidneys and ears develop around the same time in utero# <ence, they:re shape
d similarly# >hich is why when doing an assessment o! a neonate, i! the nurse no
tices low set or asymmetrical ears, there is good reason to investigate renal !u
nctioning# Knowing that the kidneys and ears are similar shapes helped me rememb
er this)#
27

$chool(age kids (> and up) are old enough, and should have an e-planation o! wha
t will happen a week be!ore surgery such as tonsillectomy# ,! you gave a toddler
a choice about taking medicine and he says no, you should leave the room and co
+e !ack in !ive minutes, because to a toddler it is another episode# Ne;t time,
donHt ask# =he ,irst sign o! pyloric stenosis in a baby is +ild vo+iting that pr
ogresses to proBectile vo+iting# Eater you may be able to palpate a mass, the ba
by will seem hungry o!ten, and may spit up a!ter !eedings# >e know Cawasaki dise
ase causes a heart problem, but what speci!icallyM 3oronary artery aneurys+s d't
the in!lammation o! blood vessels# @ child with a ventriculoperitoneal shunt wi
ll have a small upper(a!do+inal incision# =his is where the shunt is guided into
the abdominal cavity, and tunneled under the skin up to the ventricles# Fou sho
uld watch !or a!do+inal distention, since !luid !rom the ventricles will be re(
directed to the peritoneum# Fou should also watch !or signs o! increasing intrac
ranial pressure, such as irritability, bulging !ontanels, and high(pitched cry i
n an in!ant# ,n a toddler watch lack o! appetite and headache# 2are!ul on a bed
position questionN 6ed(position a,ter shunt place+ent is ,lat, so !luid doesnHt
reduce too rapidly# ,! you see s's o! increasing icp, then raise the hob to "0(.
9 degrees# >hat could cause !ronchopul+onary dysplasiaM Aysplasia means abnormal
ity or alteration# 0echanical ventilation can cause it# Premature newborns with
immature lungs are ventilated and over time it damages the lungs# +ther causes c
ould be in!ection, pneumonia, or other conditions that cause in!lammation or sca
rring# ,t is essential to +aintain nasal patency with children ) ' yr# because t
hey are obligatory nasal breathers# >atch out !or questions suggesting a child d
rinks more than .(/ cups o! milk each day# (1ilks good, rightM) =oo much milk re
duces intake o! other essential nutrients, especially iron# >atch !or ane+ia wit
h +ilk-aholics# @nd donHt let that mother put anything but water in that kidHs b
ottle during naps'over(night# Puice or milk will rott that kids teeth right out
o! his head# >hat traction is used in a school(age kid with a !emur or tibial !r
acture with e;tensive skin da+ageM Ninety ninety# <uhM , never heard o! it eithe
r# =he name re!ers to the angles o! the Coints# @ pin is placed in the distal pa
rt o! the broken bone, and the lower e;tremity is in a boot cast# =he rest is th
e normal pulleys and ropes youHre used to visualiDing with balanced suspension#
>hile weHre talking about traction, a kidHs hinder should clear the !ed when in
2ryantGs traction (also used !or !emurs and congenial hip !or young kids)# ,! yo
u can remove the white patches !rom the mouth o! a baby it is Cust !ormula# ,! y
ou canGt its candidiasis# Pust know the 00. and Varicella i++uni8ations co+e lat
er ("0 months)# Kndescended testis or cryptorchidis+ is a known risk !actor !or
testicular cancer later in li!e# $tart teaching boys testicular sel, e-a+ around
'<, because most cases occur during adolescence# Not pediatrics but have to thr
ow it in I @ guy loses his house in a !ire# Priority is using community resource
s to !ind shelter, be!ore assisting with !eelings about the tremendous loss# (1a
slow)# No aspirin with kids b'c it is associated with ?eyeHs $yndrome, and also
no nsaids such as ibupro!en# *ive Tylenol#
28

3/D in +eningitis will have high protein, and low glucose# ,t is always the corr
ect answer to report suspected cases o, child a!use# No nasotracheal suctioning
with head inBury or skull ,racture# Deed upright to avoid otitis media# Position
prone w hob elevated with gerd# ,n almost every other case, though, you better
lay that kid on his back (6ack =o $leep ( $,A$)# Pull pinna down and !ack ,or ki
ds ) M yrs# when instilling eardrops# Kids with ?$- no contact lenses or pregnan
t nurses in rooms where ri!avirin is being administered by hoot, tent, etc# Posi
tioning with pneumonia I lay on the a,,ected side to splint and reduce pain# 6ut
i! you are trying to reduce congestion the sick lung goes up# (Ever had a stu!!
y nose, and you lay with the stu!! side up and it clearsM) @ positive ppd con!ir
ms in,ection, not Cust e;posure# @ sputu+ test will con!irm active disease# 3oug
hing w'o other s's is suggestive o! asth+a# $peaking o! asthma, watch out i! you
r whee8er stops whee8ing# ,t could mean he is worsening# Fou better pick Ndo vit
alsG be!ore administering that dig# (apical pulse !or one !ull minute)# Tet spel
ls treated with +orphine# *roup-a strep precedes rheu+atic ,ever# 3horea is part
o! this sickness (grimacing, sudden body movements, etc#) and it e+!arrasses ki
ds# =hey have Boint pain# >atch !or elevated antistreptolysin + to be elevated#
PenicillinN AonHt pick cough over tachycardia !or signs o! ch, in an in!ant# ?an
dom =ips& No +ilk (as well as !resh !ruit or veggies) on neutropenic precautions
# Tylenol poisoning I liver !ailure possible !or about J days# 2lose observation
required during this time(!rame, as well as t; with 1ucomyst# .adioactive iodin
e I =he key word here is ,lush# 3lush substance out o! body w'.(/ liters'day !or
* days, and !lush the toilet twice a!ter using !or * days# Eimit contact w'pati
ent to .9 minutes'day# No pregnant visitors'nurses, and no kids# =he main hypers
ensitivity reaction seen with antiplatelet drugs is !ronchospas+ (anaphyla;is)#
2ommon sites !or +etastasis include the liver, brain, lung, bone, and lymph# Ort
hostasis is veri!ied by a drop in pressure with increasing heart rate# 2ence Hon
es protein in the urine con!irms +ultiple +yelo+a#
29

AonHt !all !or Yreestablishing a normal bowel patternH as a priority with small
!owel o!struction# 6ecause the patient canHt take in oral !luids Ymaintaining ,l
uid !alanceG comes !irst# %ernicious ane+ia s's include pallor, tachycardia, and
sore red tongue# >ith !lecainide (Ta+!ocor), an antiarrythmic, li+it ,luids and
sodium intake, because sodium increases water retention which could lead to hea
rt !ailure# 2asophils release hista+ine during an allergic response# Adenosine i
s the treatment o! choice !or paro;ysmal atrial tachycardia# 1atragenic means it
was caused by treatment, procedure, or medication# +ther than initially to test
tolerance, *-tu!e and H-tu!e !eedings are usually given as continuous !eedings#
Dour side-rails up can be considered a !orm o! restraint# Even in E=2 !acility
when a client is a !all risk, keep lower rails down, and one side o! bed against
the wall, lowest position, wheels locked# Four cancer patient is getting radiat
ion# >hat should you be most concerned aboutM $kin irritationM No# ,n!ection kil
ls cancer patients most because o! the leukopenia caused by radiation# @ breast
cancer patient treated with Ta+o-i,en should report changes in visual acuity, be
cause the adverse e!!ect could be irreversible# %neu+ova- <M gets administered p
ost splenecto+y to prevent pneumococcal sepsis# EetHs say every answer in !ront
o! you is an a!nor+al value# ,! potassiu+ is there you can bet it is a problem t
hey want you to identi!y, because values outside o! normal can be li,e threateni
ng# Normal potassium is .#0(0#9# Even a bun o! 09 doesnHt override a potassium o
! .#9 in a renal patient in priority# Fou better be making sure that patient on
Dig and ?asi- is getting enough potassiu+, because low potassium potentiates Aig
and can cause dysrrhythmias# Fou will ask every new ad+ission i! he has an adva
nce directive, and i! not you will e;plain it, and he will have the option to si
gn or not# @n e;ample o! when you would implement be!ore going through a bunch o
! assessments is when someone is e;periencing anaphyla-is# Bet the ordered epine
phrine in them stat, especially i! they stem clearly states the s's (di!!iculty
breathing, increasing an;iety, etc#) ,n a disaster you should triage the person
who is most likely to not survive last# @ little trick regarding potassium& @EC@
?O$,$& K is E+> @cidosis is Cust the opposite& K is <igh =he vital sign you shou
ld check !irst with high potassiu+ is pulse (due to dysrhythmias)# Bive neostig+
ine to clients with 1yesthenia Bravis about /0 min# be!ore eating, so it will he
lp with chewing and swallowing#
30

Anectine is used !or short-ter+ neuro+uscular blocking agent !or procedures like
intubation and E2=# Norcuron is !or intermediate or long(term# =he parathyroid
gland relies on the presence o! vita+in D to work# *lucagon increases the e!!ect
s o! oral anticoagulants# 2leeding is part o! the YcirculationH assessment o! th
e A23DHs in an emergent situation# =here!ore, i! airway and breathing are accoun
ted !or, a compound !racture requires assessment be!ore Blasgow coma scale and a
neuro check (A=disability, or neuro check) =he immediate intervention a!ter a s
ucking sta! wound is to dress the wound and tape it on three sides which allows
air to escape# Ao not use an occlusive dressing, which could convert the wound !
rom open pneumo to closed one, and a tension pneumothora; is worse situation# @!
ter that get your chest tube tray, labs, iv# @n occlusive dressing is used i! a
chest tu!e is accidentally pulled out o! the patient# >hen o* deprived, as with
a %E, the body compensates by causing hyperventilation (resp alkalosis)# $hould
the patient breathe into a paper bagM No# ,! the pao* is well below 79 they need
o-ygen# Eook at all your abg values# @s soon as you see the words PE you should
think o;ygen !irst# @ typical adverse reaction to oral hypoglyce+ics is rash, p
hotosensitivity# /eru+ acetone and seru+ ketones rise in DCA# @s you treat the a
cidosis and dehydration e;pect the potassiu+ to drop rapidly, so be ready, with
potassium replacement# Dluids are the most important intervention with 77N/ as w
ell as DCA, so get !luids going !irst# >ith <<N$ there is no ketosis, and no aci
dosis# Potassium is low in <<N$ (d't diuresis)# Atropine !locks acetylcholine (r
emember it reduces secretions)# Aecorticate positioning in response to pain = 3o
rte; involvement# Decere!rate in response to pain = 2erebellar, !rain ste+ invol
vement Dantriu+, !or spasticity, may take a week or more to be e!!ective# Decrea
sed acetylcholine is related to senile de+entia# <yperactive deep tendon re!le;e
s, vision changes, !atigue and spasticity are all symptoms o! 0/ @!ter removal o
! the pituitary gland you must watch !or hypocortisolis+ and temporary diabetes
insipidus# Position on right side with legs !le;ed a!ter appendecto+y# 7irschspr
ungGs diagnosed with rectal biopsy looking !or a!sence o, ganglionic cells# 2ard
inal sign in in!ants is !ailure to pass meconium, and later the classic ribbon(l
ike and !oul smelling stools# 1ntussusception common in kids with 3D# +bstructio
n may cause !ecal emesis, currant Bellylike stools (blood and mucus)# @ barium e
nema may be used to hydrostatically reduce the telescoping# ?esolution is obviou
s, with onset o! bowel movements#
31

>ith o+phalocele and gastroschisis (herniation o! abdominal contents) dress with


loose saline dressing covered with plastic wrap, and keep eye on temp# Kid can
lose heat quickly# @!ter a hydrocele repair provide ice !ags and scrotal support
# No phenylalanine with a kid positive !or %C4 (no meat, no dairy, no aspartame)
# /econd voided urine most accurate when testing !or ketones and glucose# Never
give potassiu+ i! the patient is oliguric or anuric# Nephrotic syndro+e is chara
cteriDed by massive proteinuria (looks dark and !rothy) caused by glomerular dam
age# 2orticosteroids are the mainstay# BeneraliDed edema common# @ positive @est
ern !lot in a child J"7 months (presence o! <,- antibodies) indicates only that
the +other is in!ected# =wo or more positive p<J antigen tests will con!irm <,in kids J"7 months# =he p*/ can be used at any age# 3or 71V kids avoid O%V and V
aricella vaccinations (live), but give Pneumococcal and in!luenDa# 11? is avoide
d only i! the kid is severely immunocompromised# Parents should wear gloves !or
care, not kiss kids on the mouth, and not share eating utensils# 7ypotension and
vasoconstricting meds may alter the accuracy o! o< sats# @n antacid should be g
iven to a mechanically ventilated patient w' an ng tube i! the ph o! the aspirat
e is )>:(# @spirate should be checked at least every "* hrs# @mbient air (roo+ a
ir) contains <'O o;ygen# =he !irst sign o! A.D/ is increased respirations# Eater
comes dyspnea, retractions, air hunger, cyanosis# Normal %3@% (pul+ capillary w
edge pressure$ is K-'M# ?eadings o! "7(*9 are considered high# 3irst sign o! %E
is sudden chest pain, !ollowed by dyspnea and tachypnea# 7igh potassiu+ is e;pec
ted with car!on dio-ide narcosis (hydrogen !loods the cell !orcing potassium out
)# 2arbon dio;ide narcosis causes increased intracranial pressure# Pulmonary sar
coidosis leads to right sided heart !ailure# @n N* tu!e can be irrigated with co
la, and should be taught to !amily when a client is going home with an NB tube#
Digitalis increases ventricular irrita!ility, and could convert a rhythm to v(!i
b !ollowing cardioversion# ,! your normally lucid patient starts seeing !ugs you
better check his respiratory status !irst# =he !irst sign o! hypo;ia is restles
sness, !ollowed by agitation, and things go downhill !rom there all the way to d
elirium, hallucinations, and coma# $o check the o* stat, and get abgHs i! possib
le# =he biggest concern with cold stress and the newborn is respiratory distress
# Eook care!ully when you have no idea# ,n a word like rhabdomyosarcoma you can
easily ascertain
32

it has something to do with muscle (myo) cancer (sarcoma)# =he same thing goes !
or drug names# 3or e;ample, i! it ends in Iide itHs probably a diuretic, as in 3
urosemide, and @myloride# ?asi- can cause a patient to lose his appetite (anoreia) due to reduced potassium# ,! your laboring momHs water breaks and she is any
+inus station you better know there is a risk o! prolapsed cord# ,n a ,ive-year
old !reathe once ,or every > compressions doing cpr# @!ter g-tu!e place+ent the
stomach contents are drained by gravity !or <J hours be!ore it can be used !or
!eedings# 2ephalhematoma (caput succinidaniu+) resolves on its own in a !ew days
# =his is the type o! edema that crosses the suture lines# Auring the acute stag
e o! 7ep-A gown and gloves are required# ,n the convalescent stage it is no long
er contagious# ?ow +agnesiu+ and high creatinine signal renal ,ailure: %ain is u
sually the highest priority with .A ,! a T2 patient is unable'unwilling to co+pl
y with t; they may need supervision (direct observation)# =6 is a public health
risk# Eevel o! consciousness is the most important assessment parameter with sta
tus epilepticus# 3rackles suggest pneumonia, which is likely to be accompanied b
y hypo-ia, which would mani!est itsel! as mental con!usion, etc# 3anGt cough=ine
,,ective airway clearance A!sence o, +enstruation leads to osteoporosis in the a
nore;ic# Toddlers need to e;press autonomy (independence) @ patient with a low h
e+oglo!in and6or he+atocrit should be evaluated !or signs o! !leeding, such as d
ark stools# @ la-ative is given the night be!ore an 1V% in order to better visua
liDe the organs# @ patient with liver cirrhosis and ede+a may a+!ulate, then sit
with legs elevated to try to mobiliDe the edema# 0anaging stress in a patient w
ith adrenal insu!!iciency (AddisonGs) is paramount, because i! the adrenal gland
s are stressed !urther it could result in @ddisonian crisis# >hile weHre on @ddi
sonHs, remember blood pressure is the most important assessment parameter, as it
causes severe hypotension: @!ter pain relie!, cough and deep !reathe is importa
nt in pancreatitis, because o! !luid pushing up in the diaphragm# /a,ety over Nu
trition with a severely depressed client#
33

%rolonged hypo-e+ia is a likely cause o! cardiac arrest in a child# Dluid volu+e


overload caused by ,-2 !luids in!using too quickly (or whatever reason) and 2<3
can cause an /M 3oarctation o, the aorta causes increased blood !low and !oundi
ng pulses in the ar+s @ newly diagnosed hypertension patient should have 6P asse
ssed in !oth ar+s Depression o!ten mani!ests itsel! in so+atic ways, such as psy
chomotor retardation, gi complaints, and pain# .espiratory problems are the chie
! concern with 3D speaking o! =6### PPA is positive i! area o! induration is& )0
mm in an immunocompromised patient )"9 mm in a normal patient )"0 mm in a patie
nt who lives in an area where =6 is very rare# another tiP& <b@"c ( test to asse
ss how well blood sugars have been controlled over the past 89("*9 days# /( 4 co
rresponds to a blood sugar o! 59(""9 5 is ideal !or a diabetic and corresponds t
o a blood sugar o! ".9# 2/A is considered the +ost accurate method !or medicatio
n dosing with kids# (, though it was weight, but apparently not) Place a wheelch
air parallel to the bed on the side o, weakness ,! one nurse discovers another n
urse has made a +istake it is always appropriate to speak to her be!ore going to
management# ,! the situation persists, then take it higher# /epsis and anaphyla
-is (along with the obvious hemorrhaging) reduce circulating volume by way o! in
creased capillary permeability, which leads to reduced preload (volume in the le
!t ventricle at the end o! diastole)# =his is a toughieUthink about it# A+niotic
,luid is alkaline, and turns nitraDine paper !lue: Krine and normal vaginal dis
charge are acidic, and turn it pink# *onorrhea is a reporta!le disease ?emember
the phrase Pstep upQ when picturing a person going up stairs with crutches# =he
good leg goes up !irst, !ollowed by the crutches and the bad leg# =he opposite h
appens going down# =he crutches go !irst, !ollowed by the good leg# >hile treati
ng DCA, bringing the glucose down too ,ar and too ,ast can result in increased i
ntracranial pressure d't water being pulled into the 2$3# %olyuria is common wit
h the hypercalce+ia caused by hyperparathyroidism# ?emember the action o! vasopr
essin because it sounds like Vpress inW, or vasoconstrict# @ater into-ication wi
ll be evidenced by drowsiness and altered mental status in a patient with =K? sy
ndrome, or as an adverse reaction to desmopressin (!or diabetes insipidus)# 2urn
ing sensation in the mouth, and brassy taste are adverse reactions to ?ugol solu
tion (!or
34

hyperthyroid)# ?eport it to the doc# Bive synthroid on an e+pty stomach E-tra in


sulin may be needed !or a patient taking %rednisone (remember, steroids cause in
creased glucose)# Non,at +ilk reduces re,lu- by increasing lower esophageal sphi
ncter pressure Patients with *E.D should lay on their le,t side with the <+6 ele
vated .9 degrees# Knusual positional tip ( ?ow-,owlers recommended during +eals
to prevent du+ping syndro+e# Eimit !luids while eating# ,n e+physe+a the sti+ulu
s to breathe is low %O<, not increased P2+* like the rest o! us, so donHt slam t
hem with o;ygen# Encourage pursed-lip !reathing which promotes 3O< eli+ination,
encourage up to .999mE'day !luids, high(!owlers and leaning !orward# Theophyllin
e causes *1 upset, give with !ood T2 drugs are liver to;ic# (Aoes your patient h
ave hep6M) @n adverse reaction is peripheral neuropathy#
35