1.

varicella (chickenpox) requires use of airborne precautions and contact

precautions as well.
if a patient is on contact precautions, have family members and other
visitors wear a gown and gloves as outlined by your facility (hospital).
1) droplet room assignment: preferably private, if not available roomate with
same illness and same pathogen. and if thats not an option 3 feet away from
roomate with the curtain pulled.

2) when transporting a patient with airborne precautions (for essential
purposes only) they must wear a surgical mask.

for contact precautions
diseases/conditions include: c. diff, e. coli, scabies
room needs to be private unless room has another patient infected
with the same organism

for droplet precautions
diseases/conditions include: meningitis, pneumonia, pertussis
(whooping cough), rubella, mumps
room needs to be private unless room has another patient infected
with the same organism. maintain spacial distance of 3 feet when
near patient.

also remember standard precautions apply to all patients regardless
of diagnosis when in contact with any bodily fluid, blood,
secretions/excretions, nonintact skin, and mucous membranes

#1. when wearing gown and/or gloves, make sure to take them off and
properly dispose of them, before leaving the patien'ts room.

#2. pt's with herpes zooster (shingles) that is active should have the same
precautions as a patient with chicken pox---airborne and contact

#3. pt's on droplet precaution can have their room door left open.

#4. instruct visitors for pt's with droplet precautions to try to keep a
distance of three feet between them and the pt.

#5. pt's with croup should be on contact precautions

bacterial meningitis is transmitted via droplets, and when suctioning pt,
wear goggles, eyewear, mask, and gloves. pt should wear a face mask when
being transported.

cdc recommends airborne precautions against varicella/rubeola.

measles, chicken pox (varicella), disseminated varicella zoster, tuberculosis

barrrier protection: single room maintained under negative pressure
door kept closed except when someone is entering
exiting the room
negative airflow pressure used in room, (min of 6 - 12 air exchanges per
hour depending on the facility
ultraviolet germicide irradiation or high-efficiency
particulate air filter used in the room
mask or personal respiratory protection device used
mask placed on the client when client needs to
leave the room; client only leaves only if necessary!

rsv is contact precautions. so wear gloves and a gown. it is
a respiratory infection that is transmited through contact with the
secretions.


when you put your protective gear on start from top to bottom : mask->
gown-> and gloves. when you take them off start from bottom to top:
gloves->gown->mask. (i tried to research this part just to make sure it is
what i remember it to be, but found nothing so im not 100% certain)

wash hands between patients and whenever visibly soiled.

donning ppe (personal protective equipment)

gown
fully cover torso from neck to knees, arms to end of wrist, and wrap around
the back
fasten in back at neck and waist

mask or respirator
secure ties or elastic band at middle of head and neck
fit flexible band to nose bridge
fit snug to face and below chin
fit-check respirator

goggles/face shield
put on face and adjust to fit

gloves
use non-sterile for isolation
select according to hand size
extend to cover wrist of isolation gown

safe work practices
keep hands away from face
work from clean to dirty
limit surfaces touched
change when torn or heavily contaminated
perform hand hygiene

removing ppe

remove ppe at doorway before leaving patient room or in anteroom

gloves
outside of gloves are contaminated!
grasp outside of glove with opposite gloved hand; peel off
hold removed glove in gloved hand
slide fingers of ungloved hand under remaining glove at wrist

goggles/face shield
outside of goggles or face shield are contaminated!
to remove, handle by clean head band or ear pieces
place in designated receptacle for reprocessing or in waste container

gown
gown front and sleeves are contaminated!
unfasten neck, then waist ties
remove gown using a peeling motion; pull gown from each shoulder toward
the same hand
gown will turn inside out
hold removed gown away from body, roll into a bundle and discard into
waste or linen receptacle

mask or respirator
front of mask/respirator is contaminated do not touch!
grasp only bottom then top ties/elastics and remove
discard in waste container

hand hygiene
perform hand hygiene immediately after removing all ppe!


chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.

rash is pruritic, and starts out as a macule then papule then a vesicle.

spread by direct contact, droplet and contaminated object.

isolate till all vesicles are crusted; it can be spread from 2 days before the
rash begins.

avoid use of aspirin due to reye's syndrome, use tylenol.

airborn--door can be closed..measles (rubeola), m. tuberculosis,
disseminated zoster(shingles), varicella(chicken pox)--again can
cohort and place in same room with the same infective organism.
droplet--door may be open---streptococcus pharyngitis, meningitis,
pnemonia...private room or pt with same infection--involves contact with
mucous membranes of nose or mouth...happens during talking, coughing,
suctioning. maintain 3feet between infected patients and visitors.

rubella--there's a maculopapular rash on face and all over the body.
prodromal: malaise and fever which is followed by cough.
sread by droplets and contaminated objects. placed on contact
precautions, isolate child from pregnant women.

tuberculosis, pt is on isolation for 2-4 weeks (until there are 3 negative
sputum cultures.)

syphilis--painless chancre that fades within 6 weeks...on palms and soles
there is a copper colored rash...spread by contact with mucous membranes
and also congenitally...tx with penicillin g im


heres how i remember that rubella is droplet and rubeola is
airborne...rubella sounds like umbrella and umbrellas protect you from
raindrops...


transmission-based precautions: adc
a - airborne
d - droplet
c - contact

airborne precaution (credit goes to the one who posted this on april
thread, sorry can't remember your name)

my - measles
chicken - chickenpox
hez - herpes zoster (disseminated)
tb - tb

private room
negative pressure with 6-12 air exchanges per hour
uv
mask
n95 mask for tb

droplet precaution
think of spiderman!
s - sepsis
s - scarlet fever
s - streptococcal pharyngitis
p - parvovirus b19
p - pertussis
p - pneumonia
i - influenza
d - diptheria (pharyngeal)
e - epiglottitis
r - rubella
m - mumps
m - meningitis
m - mycoplasma or meningeal pneumonia
an - adenovirus

private room
mask


contact precaution
mrs.wee
m - multidrug resistant organism
r - respiratory infection - rsv
s - skin infections
w - wound infections
e - enteric infections - clostridium defficile
e - eye infections

skin infections:
v - varicella zoster
c - cutaneous diptheria
h - herpes simplex
i - impetigo
p - pediculosis
s - scabies, staphylococcus

private room
gloves
gown

wash your hands before patient care and after patient care.
when in doubt, wash your hands again.
gloves needed when passing meds to pt. with mrsa, if you'll be close to
patient need gown too.( just in case you touch anything that might be
contaminated )
my preceptor at work likes to say," better to have on too much ppe than not
enough."
ppe = personal protective equipment

in removing ppe:
1. gloves
2. goggles/face shield
3. gowns
4. last will be the mask

from: cdc
yes you are right!

donning ppe:

-gown
-mask
-goggles
-gloves

removing ppe:

-gloves
-goggles
-gown
-mask

for tb skin test, if client has 5mm induration, assess if patient is
immunocompromised, if yes, positive.
if not, 10mm/greater induration = positive

for treatment of tb and major side effects:
rifampicin (red-urine, tears, sweat)
inh (the n is for neurological


, h is for hepatic)
pyrazinamide (hyperurecimia)
ethambutol (optic neuritis)

[color=#444444]for hepatitis, you get the vowels from the bowels (hepa a
and e-"fecal-oral route)


[color=#444444]according to cdc, patients infected with anthrax do not
generally pose a transmission risk. standard (universal) precautions are
required though...



[color=#444444]vre = vancomycin resistant enterococcus

[color=#444444]localized herpes zooster is also known as
a cold sore[color=#444444]. it's not airborne, and is not spread by
touching, so standard precautions is all that is needed.

[color=#444444]mumps is respiratory precautions.
rubella


[color=#444444]is keep away from pregnant women.
[color=#444444]scarlet fever is respiratory precautions till 24 hr after
therapy is started.

[color=#444444]german measles ( rubella ) requires standard precautions
and droplet precautions.


[color=#444444]rsv is contact precautions. so wear gloves and a gown. it is
a respiratory infection that is transmited through contact with the
secretions.

[color=#444444]mmr immunization[color=#444444]:
[color=#444444]1st vaccine dose given at age 12-15 mo.
[color=#444444]2nd dose at age 4-6 yrs
[color=#444444]before administration; ask if allergic to eggs

[color=#444444]mumps: incubation period 14-21 days
[color=#444444]communicable period, immediately before and after the
swelling begins
[color=#444444]transmitted via airborne droplets, saliva, and possibly by
contact with
[color=#444444]infected person's urine
[color=#444444]respiratory precaution; isolation for 9 days following the
onset of parotid swelling
[color=#444444]most common complication; aseptic meningitis, signs
include- nuchal rigidity, lathargy, & vomiting
[color=#444444]other complications; orchitis (red swollen tender testicles)

rubella[color=#444444] (german measles): hospitalized child-contact
isolation; mask, gown,and gloves
[color=#444444]incubation period: 14-21 days
[color=#444444]communicable period: 7 days before to ~ 5 days after rash
appears
[color=#444444]source: nasophryngeal secretions, virus present in blood,
stool, & urin
[color=#444444]transmission: airborne or direct contact with infectious
droplets,
[color=#444444]indirect via articles freshly contaminated with
nasopharyngeal secreations, feces, or urin
[color=#444444]assessment: low grade fever, malaise, pinkish-red
maculopapularrash[color=#444444] that begins on the face and spreads to
entire body, petecheae may occur on the soft palate
[color=#444444]implementation: supportive care
[color=#444444]transplacental: isolate from pregnant women

[color=#444444]rubeola (measles)
[color=#444444]koplik's spot (sm blue/white spots with a red base on the
buccal mucosa
[color=#444444]transmission: via airborne particles or contact with
infectious droplets
[color=#444444]precautions: mask and gloves

[color=#444444]sars severe acute respiratory syndrome= it's droplet
precaution...so mask.

[color=#444444]-remember to tuck the gown cuffs inside each glove..and
not over the gloves

[color=#444444]-hiv/aids clients, you should always practice standard
precautions (on allpatients[color=#444444])...hiv/aids patients are not
required to state that they have hiv/aids and the healthcare providers will
not know which patient has what unless specify in their charts.


[color=#444444]to those wondering about the n95 respirator with infectious
tb patient..

[color=#444444]-use n95 but during bronchoscopy on the same patient
(with infectious tb), use a stronger respirator such as a powered air-
purifying respirator or papr.

[color=#444444]-to do a respirator fit check: during inhalation, the
respirator should collapse, and during exhalation, check for leakage around
the face

[color=#444444]-removing the respirator, you will want to lift the bottom
elastic over your head prior to the top elastic. remember to do it slowly
because you don't want it to snap off your face.

[color=#444444]-remember you would want to remove the respirator
outside the patient's room after the door has been closed. all other ppes
should be removed inside the patient's room at the doorway or in an
anteroom. but if the procedure only requires that you use gloves, then you
can remove your gloves in the patient room followed by hand hygiene

[color=#444444]-there are three types of respirator, n95, n99, n100 but the
n95 is used for infectious tb.


[color=#444444]hepatitis b is something that if we are not careful, we can
make a mistake very easy, this is a standard precaution unless we are
suctioning the pt, then it becomes droplet




http://www.youtube.com/results?searc...rch_type=&aq=f

[color=#444444]keep those hands off that mouse!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[color=#444444]side note one: while you are practicing your nclex style questions,
practice, practice, practice, critical thinking, by taking your time and trying to narrow down your
answer and deciding between two possible correct answers. dont get the quick mouse hand,
take your hand off the mouse and dont answer the question until you are confident that its
the one you want to choose!!!!!!! i guarantee you that if your practice this you will become a
better nclex test-taker. i personally like to keep my hand in my lap while deciding my answer. it
kind of helps to keep you calm.



low ph, high co2, high hco3 = resp. acidosis

high ph, low co2, low hco3 = resp. alkalosis

low ph, low co2, low hco3 = metabolic acidosis

high ph, high co2, high hco3= metabolic alkalosis








ph goes to the left= acid ph goes to the right=alkine
acid<<<<<7.35-7.45>>>>>>>alkine
hco3 22-26 co2 35-45
so if ph is 7.55(up)& hco3 is 28 (up) both are up = met alkalosis

ph hco3 both up = met alkalosis
ph hco3 both down = met acidosis
ph down co2 up = resp acidosis
ph up co2 down =resp alkalosis


rome:

respiratory= opposite:
ph is high, pco2 is down (alkalosis).
ph is low, pco2 is up (acidosis).

metabolic= equal:
ph is high, hco3 is high (alkalosis).
ph is low, hco3 is low (acidosis).




acidosis alkalosis

ph <7.35 >7.45

pco2 >45 <35

co2 <18 >22

co2 might be hco3 in some labs and the 18 or 22 might be 1-2 numbers
different.

just write down this down and then circle which ones apply to your abg
results. then what it is called is the one that caused the acidosis or alkalosis.
pco is resp and co2 is metabolic

ex your pt abgs are ph 7.30, pco2, 40 co2 10 this is metabolic acidosis.





pharmacology - know indication/action/effect


prefix/suffix


-ase = thrombolytic
-azepam = benzodiazepine
-azine = antiemetic; phenothiazide
-azole = proton pump inhibitor, antifungal
-barbital = barbiturate
-coxib = cox 2 enzyme blockers
-cep/-cef = anti-infectives
-caine = anesthetics
-cillin = penicillin
-cycline = antibiotic
-dipine = calcium channel blocker
-floxacin = antibiotic
-ipramine = tricyclic antidepressant
-ine = reverse transcriptase inhibitors, antihistamines
-kinase = thrombolytics
-lone, pred- = corticosteroid
-mab = monoclonal antibiotics
-micin = antibiotic, aminoglycoside
-navir = protease inhibitor
nitr-, -nitr- = nitrate/vasodilator
-olol = beta antagonist
-oxin = cardiac glycoside
-osin = alpha blocker
-parin = anticoagulant
-prazole = ppis
-phylline = bronchodilator
-pril = ace inhibitor
-statin = cholesterol lowering agent
-sartan = angiotensin ii blocker
-sone = glucocorticoid, corticosteroid
-stigmine = cholinergics
-terol = beta 2 agonist
-thiazide = diuretic
-tidine = antiulcer
-trophin = pituitary hormone
-vir = anti-viral, protease inhibitors
-zosin = alpha 1 antagonist
-zolam = benzo/sedative
-zine = antihistamine




pharm facts


dont give non-selective beta-blockers to patients w/respiratory problems
vitamin c can cause false +ive occult blood
avoid the g herbs (ginsing, ginger, ginko, garlic) when on anti-clotting
drugs (coumadin, asa, plavix, etc)
asa toxicity can cause ringing of the ears
no narcotics to any head-injury victims
mg2+ toxicity is treated with calcium gluconate
do not give calcium-channel blockers with grapefruit juice
oxytocin is never administered through the primary iv
lithium patients must consume extra sodium to prevent toxicity
maoi patients should avoid tyramine:
oaacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese
(except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream.
dont give atropine for glaucoma it increases iop
dont give ant-acids with food -- b/c it delays gastric emptying.
dont give stadol to methadone/heroin preggos -- cause instant withdrawal
symptoms
insulin clear before cloudy
dont give meperidine (demerol) to pancreatitis patients
always verify bowel sounds when giving kayexelate
hypercalcemia = hypophosphatemia (and vice versa)
radioactive dye urine excretion
signs of toxic ammonia levels is asterixis (hands flapping)
d10w can be substituted for tpn (temporary use)
dopamine and lasix are incompatible
hypoglycemic shivers can be stopped by holding the limb, seizures cannot
(infants)
common symptom of aluminum hydroxide constipation
thiazide diuretics may induce hyperglycemia
take iron with vit c it enhances absorbtion do not take with milk
b1 - for alcoholic patients (to prevent wernickes encephalopathy &
korsakoffs synd)
b6 - for tb patients
b9 - for pregnant patients
b12 - pernicious anemia, vegetarians.
complications of coumadin - 3hs - hemorrhage, hematuria & hepatitis
ffp is administered to dic b/c of the clotting fx
mannitol (osmtic diuretic [head injury]) crystallizes at room temp use a
filter needle
antianxiety medication is pharmacologically similar to alcohol used for
weaning tx
administrate glucagon when pt is hypoglycemia and unresponsive
phenazopyridine ( pyridium)--urine will appear orange
rifampicin -- red-urine, tears, sweat)
hot and dry = sugar high (hyperglycemia)
cold and clammy = need some candy (hypoglycemia)
med of choice for v-tach is lidocaine
med of choice for svt = adenosine or adenocard
med of choice for asystole = atropine
med of choice for chf is ace inhibitor.
med of choice for anaphylactic shock is epinephrine
med of choice for status epilepticus is valium.
med of choice for bipolar is lithium.
give ace inhibitors w/food to prevent stomach upset
administer diuretics in the morning
give lipitor at 1700 since the enzymes work best during the evenin
common tricyclic meds - 3 syllabes (pamelor, elavil)
common maois - 2 syllables (nardil, marplan)
tpn has a dedicated line & cannot be mixed ahead of time
rhogam -- given at 28 weeks & 72 hrs postpartum
do not administer erythromycin to multiple sclerosis pt
benadryl and xanax taken together will cause additive effects.
can't take lasix if allergic to sulfa drugs.
acetaminophen can be used for headache when the client is using
nitroglycerin.
dilantin - can not give with dextrose. only give with ns.



addison is skinny ( hypoglycemic, you get weight loss, you got weakness,
and you get postural hypotn) cushing is fat ( hyperglycemic, you get moon
face big cheeks, and you retain a lot of na and fluid)
never give via ivp:
okcl
oheparin
oibuprofen
oinsulin
odobutamine
oasa
oalbumin
oacetaminophen

insulin:
orapid: lispro onset <15 min. peak: 1 hr. duration 3hr
oshort: regular onset - 1 hr. peak: 2-3hr. duration: 4-6 hr
oint: nph or lente onset: 2 hr. peak 6-12 hr. duration: 16-24hr
olong: ultralente onset 4-6 hr. peak: 12-16 hr. duration: >24hr
ov.long: lantus onset 1 hr. peak: none. duration: 24 hr continuous



anticholergic side effects:
ocant see
ocant pee
ocant spit
ocant sh*t
hypocalcemia cats
oconvulsions
oarrythmias
otetany
ospasms & stridor





hyper kalemia causes: machine
omedicationa (ace inhibitors, nsaids)
oacidosis (metabolic & repiratory)
ocellular destruction (burns, traumatic injuy)
ohypoaldosteronism, hemolysis
onephrons, renal failure
oexcretion (impaired)

signs of increased k murder
omuscle weaknes
ourine olyguria, anuria
orespiratory distress
odecreaed cardiac contractility
oecg changes
oreflexes hyperreflexia, or flaccid

substance poisoning and antidotes
omethanol -- ethanol
oco2 -- oxygen
odopamine -- phentolamine
obenzos (versed) -- flumazenil
olead -- succimer, calcium disodium
oiron -- deferoxamine
ocoumadin -- vitamin k
oheparin -- protamine sulfate
othorazine -- cogentine
owild mushrooms - atropine
orat poison - vit k

parkland formula: 4cc * kg * bsa burned = total volume necessary
o1st 8hrs total volume
o2nd 8hrs total volume
o3rd 8 hrs total volumes



nclex drugs??? most-prescribed meds in the us!


generic name (trade name) major concerns
analgesic
acetaminophen (tylenol) watch for liver and kidney problems
hydrocodone with acetaminophen addictive
(lortab)
ibuprofen (motrin) can lead to hpn and kidney disease
naproxen (aleve) can lead to hpn and kidney disease

antianxiety
alprazolam (xanax) this drug can be addictive
diazepam (valium) watch for allergies, *also anticonvulsant*
lorazepam (antivan) sedation
promethazine hci (phenergan) *also antiemetic*

antibiotic
amoxicilline (augmentin) watch for allergic reactions
azithromycin (zithromax z-pak) watch for allergies
cephalexin (keflex) if you are allergic to cephalosporins, you might also be allergic to penicillin
doxycycline hyclate (vibramycin) avoid for pregnant clients
penicillin v potassium (penicillin) watch for allergies
sulfamethoxazole (septra, bactrim) can cause gi diturbance

anticoagulant
warfarin sodium (coumadin) teach the client to limit the intake of green leafy vegetables
watch for signs of bleeding
anticonvulsant
clonazepam (klonopin) should not be stoppe abruptly
diazepam (valium) watch for allergies, also antianxiety
lorazepam (antivan) sedation

antidepressant
sertraline (zoloft) sedation
amitriptyline hci (elavil)
trazodone hci (desyrel)

antidiabetic
glipizide (glucotrol) watch for hypoglycemia
metformin (glucophage) thi drug should be stopped prior to a dye study such as cardiac
catheterization

antihistamine
cetirizine (zyrtec)
fexofenadine (allegra) dry mouth

antihypertensive
amiodipine (norvasc) hypertension
atenolol (tenormin) cause drop in pulse rate, check pr daily
doxazosin mesylate (cardura)
lisinopril (zestril) cause postural hpn, remain supine for at least 30mins
metoprolol succinate (toprol xl) teach the client to check his pulse rate
metoprolol tartrate (lopressor,toprol) teach the client to check his pulse rate

antihypertensive/antianginal
verapamil hci (calan)

anti-inflammatory
ibuprofen (motrin) can lead to hypertension and kidney disease
prednisone (deltasone) can cause cushings syndrome and gi problems

antigout
allopurinol (zyloprim) drink a least 8 glasses of water per day


antilipidemic usually ends in statin
simvastatin (zocor) can cause liver problems & muscle soreness
do not take this drug with grape-fruit juice
antiulcer/histamine blocker
ranitidine hci (zantac) best to take this drug with meals

antiulcer/proton pump inhibitor
lansoprazole (prevacid) take this drug prior to meals
omeprazole (prilosec)

bronchodilator
albuterol (proventil) tachycardia, md check blood levels for toxicity

diuretic
furosemide (lasix) hypokalemia
hydrochlorothiazide (hctz) hypokalemia

hormone replacement
estrogen (premarin) can blood clots
levothyroxine (levoxyl) can blood clots
levothyroxin (synthyroid) teach the clients to check his pulse rate

muscle relaxant
cyclobenzaprine hci (flexeril) sedation

oral contraceptive
necon (ortho-novum 7/7/7) can blood clots
trinessa (ortho triclen) can blood clots

osteoporosis
alendronate (fosamax) remain upright for at least 30mins after taking to prevent gerd.
take wit water

potassium supplement
potassium chloride (k-lyte) check for renal function before giving this drug

sleep aid
zolpidem (ambien) allow at least 8hrs of sleep time to prevent daytime drowsiness


i highly recomend this link it is organized and less confusing and not over done as cdc website
which can be over whelming:

http://info.med.yale.edu/ynhh/infection


this is sir silas he kept me company during this long journey. he wants
me to find a job now. yet another hurdle


hope it helps!!! good luck!
Last edit by UNIVERSAL NURSE on Mar 31, '10
gyuzeel, stacievlz, kaila731, and 1 other like this.
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8 Comments so far...
5.
0
Mar 31, '10 by goodstudentnowRN
Thanks! This will help those who are still studying for the NCLEX.
6.
0
Mar 31, '10 by caliotter3
and many thanks for consolidating a lot of useful info!
7.
2
Mar 31, '10 by Gold2010
Quote from universal nurse
i passed after taking nclex this past monday/ pearson trick
immediately after getting home. kaplan takes months to fully
get all out of it. not weeks, it works. review all content review
and write it all out. takes months. it took many 7 months to
fully absorb all of kaplan and i kept changing my class in order
to get more time. i highly recomend th live on line course, not
the in person course. you must cover all the course content
review which is huge. do all the q-trainers and know all the
rationales, i never got to the q-bank and still passed. write it
all out if you are slow like me.

priority and delegation by charity is a must.

i get tired very easily. i ate breakfast, went back to bed for 3
hours. got ready downed a red bull ate chocolate and was fully
charged for the nclex. the brain uses lots of sugar when you
are concentrating this kept me going.

below are also a must know that i had copied pasted from
different posts. i must emphasize this is a must know:
varicella (chickenpox) requires use of airborne
precautions and contact precautions as well.
if a patient is on contact precautions, have family
members and other visitors wear a gown and gloves as
outlined by your facility (hospital).
1) droplet room assignment: preferably private, if not available roomate with
same illness and same pathogen. and if thats not an option 3 feet away from
roomate with the curtain pulled.

2) when transporting a patient with airborne precautions (for essential
purposes only) they must wear a surgical mask.

for contact precautions
diseases/conditions include: c. diff, e. coli, scabies
room needs to be private unless room has another patient infected with the
same organism

for droplet precautions
diseases/conditions include: meningitis, pneumonia, pertussis (whooping
cough), rubella, mumps
room needs to be private unless room has another patient infected with the
same organism. maintain spacial distance of 3 feet when near patient.

also remember standard precautions apply to all patients regardless of
diagnosis when in contact with any bodily fluid, blood,
secretions/excretions, nonintact skin, and mucous membranes

#1. when wearing gown and/or gloves, make sure to take them off and properly
dispose of them, before leaving the patien'ts room.

#2. pt's with herpes zooster (shingles) that is active should have the same
precautions as a patient with chicken pox---airborne and contact

#3. pt's on droplet precaution can have their room door left open.

#4. instruct visitors for pt's with droplet precautions to try to keep a distance
of three feet between them and the pt.

#5. pt's with croup should be on contact precautions

bacterial meningitis is transmitted via droplets, and when suctioning pt, wear
goggles, eyewear, mask, and gloves. pt should wear a face mask when being
transported.

cdc recommends airborne precautions against varicella/rubeola.

measles, chicken pox (varicella), disseminated varicella zoster, tuberculosis

barrrier protection: single room maintained under negative pressure
door kept closed except when someone is entering
exiting the room
negative airflow pressure used in room, (min of 6 - 12 air exchanges per hour
depending on the facility
ultraviolet germicide irradiation or high-efficiency
particulate air filter used in the room
mask or personal respiratory protection device used
mask placed on the client when client needs to
leave the room; client only leaves only if necessary!

rsv is contact precautions. so wear gloves and a gown. it is
a respiratory infectionthat is transmited through contact with the
secretions.


when you put your protective gear on start from top to bottom : mask-> gown->
and gloves. when you take them off start from bottom to top: gloves->gown-
>mask. (i tried to research this part just to make sure it is what i remember it
to be, but found nothing so im not 100% certain)

wash hands between patients and whenever visibly soiled.

donning ppe (personal protective equipment)

gown
fully cover torso from neck to knees, arms to end of wrist, and wrap around the
back
fasten in back at neck and waist

mask or respirator
secure ties or elastic band at middle of head and neck
fit flexible band to nose bridge
fit snug to face and below chin
fit-check respirator

goggles/face shield
put on face and adjust to fit

gloves
use non-sterile for isolation
select according to hand size
extend to cover wrist of isolation gown

safe work practices
keep hands away from face
work from clean to dirty
limit surfaces touched
change when torn or heavily contaminated
perform hand hygiene

removing ppe

remove ppe at doorway before leaving patient room or in anteroom

gloves
outside of gloves are contaminated!
grasp outside of glove with opposite gloved hand; peel off
hold removed glove in gloved hand
slide fingers of ungloved hand under remaining glove at wrist

goggles/face shield
outside of goggles or face shield are contaminated!
to remove, handle by clean head band or ear pieces
place in designated receptacle for reprocessing or in waste container

gown
gown front and sleeves are contaminated!
unfasten neck, then waist ties
remove gown using a peeling motion; pull gown from each shoulder toward the
same hand
gown will turn inside out
hold removed gown away from body, roll into a bundle and discard into waste
or linen receptacle

mask or respirator
front of mask/respirator is contaminated do not touch!
grasp only bottom then top ties/elastics and remove
discard in waste container

hand hygiene
perform hand hygiene immediately after removing all ppe!


chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.

rash is pruritic, and starts out as a macule then papule then a vesicle.

spread by direct contact, droplet and contaminated object.

isolate till all vesicles are crusted; it can be spread from 2 days before the rash
begins.

avoid use of aspirin due to reye's syndrome, use tylenol.

airborn--door can be closed..measles (rubeola), m. tuberculosis,
disseminated zoster(shingles), varicella(chicken pox)--again can cohort and
place in same room with the same infective organism.
droplet--door may be open---streptococcus pharyngitis, meningitis,
pnemonia...private room or pt with same infection--involves contact with
mucous membranes of nose or mouth...happens during talking, coughing,
suctioning.maintain 3feet between infected patients and visitors.

rubella--there's a maculopapular rash on face and all over the body.
prodromal: malaise and fever which is followed by cough.
sread by droplets and contaminated objects. placed on contact
precautions, isolate child from pregnant women.

tuberculosis, pt is on isolation for 2-4 weeks (until there are 3 negative sputum
cultures.)

syphilis--painless chancre that fades within 6 weeks...on palms and soles there
is a copper colored rash...spread by contact with mucous membranes and also
congenitally...tx with penicillin g im


heres how i remember that rubella is droplet and rubeola is airborne...rubella
sounds like umbrella and umbrellas protect you from raindrops...


transmission-based precautions: adc
a - airborne
d - droplet
c - contact

airborne precaution (credit goes to the one who posted this on april thread,
sorry can't remember your name)

my - measles
chicken - chickenpox
hez - herpes zoster (disseminated)
tb - tb

private room
negative pressure with 6-12 air exchanges per hour
uv
mask
n95 mask for tb

droplet precaution
think of spiderman!
s - sepsis
s - scarlet fever
s - streptococcal pharyngitis
p - parvovirus b19
p - pertussis
p - pneumonia
i - influenza
d - diptheria (pharyngeal)
e - epiglottitis
r - rubella
m - mumps
m - meningitis
m - mycoplasma or meningeal pneumonia
an - adenovirus

private room
mask


contact precaution
mrs.wee
m - multidrug resistant organism
r - respiratory infection - rsv
s - skin infections
w - wound infections
e - enteric infections - clostridium defficile
e - eye infections

skin infections:
v - varicella zoster
c - cutaneous diptheria
h - herpes simplex
i - impetigo
p - pediculosis
s - scabies, staphylococcus

private room
gloves
gown

wash your hands before patient care and after patient care.
when in doubt, wash your hands again.
gloves needed when passing meds to pt. with mrsa, if you'll be close to patient
need gown too.( just in case you touch anything that might be contaminated )
my preceptor at work likes to say," better to have on too much ppe than not
enough."
ppe = personal protective equipment
in removing ppe:
1. gloves
2. goggles/face shield
3. gowns
4. last will be the mask

from: cdc
yes you are right!

donning ppe:

-gown
-mask
-goggles
-gloves

removing ppe:

-gloves
-goggles
-gown
-mask

for tb skin test, if client has 5mm induration, assess if patient is
immunocompromised, if yes, positive.
if not, 10mm/greater induration = positive

for treatment of tb and major side effects:
rifampicin (red-urine, tears, sweat)
inh (the n is for neurological


, h is for hepatic)
pyrazinamide (hyperurecimia)
ethambutol (optic neuritis)

[color=#444444]for hepatitis, you get the vowels from the bowels (hepa a and
e-"fecal-oral route)


[color=#444444]according to cdc, patients infected with anthrax do not
generally pose a transmission risk. standard (universal) precautions are
required though...



[color=#444444]vre = vancomycin resistant enterococcus

[color=#444444]localized herpes zooster is also known as
a cold sore[color=#444444]. it's not airborne, and is not spread by touching, so
standard precautions is all that is needed.

[color=#444444]mumps is respiratory precautions.
rubella


[color=#444444]is keep away from pregnant women.
[color=#444444]scarlet fever is respiratory precautions till 24 hr after therapy
is started.

[color=#444444]german measles ( rubella ) requires standard precautions and
droplet precautions.


[color=#444444]rsv is contact precautions. so wear gloves and a gown. it is a
respiratory infection that is transmited through contact with the secretions.

[color=#444444]mmr immunization[color=#444444]:
[color=#444444]1st vaccine dose given at age 12-15 mo.
[color=#444444]2nd dose at age 4-6 yrs
[color=#444444]before administration; ask if allergic to eggs

[color=#444444]mumps: incubation period 14-21 days
[color=#444444]communicable period, immediately before and after the
swelling begins
[color=#444444]transmitted via airborne droplets, saliva, and possibly by
contact with
[color=#444444]infected person's urine
[color=#444444]respiratory precaution; isolation for 9 days following the onset
of parotid swelling
[color=#444444]most common complication; aseptic meningitis, signs include-
nuchal rigidity, lathargy, & vomiting
[color=#444444]other complications; orchitis (red swollen tender testicles)

rubella[color=#444444] (german measles): hospitalized child-contact isolation;
mask, gown,and gloves
[color=#444444]incubation period: 14-21 days
[color=#444444]communicable period: 7 days before to ~ 5 days after rash
appears
[color=#444444]source: nasophryngeal secretions, virus present in blood, stool,
& urin
[color=#444444]transmission: airborne or direct contact with infectious
droplets,
[color=#444444]indirect via articles freshly contaminated with nasopharyngeal
secreations, feces, or urin
[color=#444444]assessment: low grade fever, malaise, pinkish-red
maculopapularrash[color=#444444] that begins on the face and spreads to
entire body, petecheae may occur on the soft palate
[color=#444444]implementation: supportive care
[color=#444444]transplacental: isolate from pregnant women

[color=#444444]rubeola (measles)
[color=#444444]koplik's spot (sm blue/white spots with a red base on the
buccal mucosa
[color=#444444]transmission: via airborne particles or contact with infectious
droplets
[color=#444444]precautions: mask and gloves

[color=#444444]sars severe acute respiratory syndrome= it's droplet
precaution...so mask.

[color=#444444]-remember to tuck the gown cuffs inside each glove..and not
over the gloves

[color=#444444]-hiv/aids clients, you should always practice standard
precautions (on all patients[color=#444444])...hiv/aids patients are not
required to state that they have hiv/aids and the healthcare providers will not
know which patient has what unless specify in their charts.


[color=#444444]to those wondering about the n95 respirator with infectious tb
patient..

[color=#444444]-use n95 but during bronchoscopy on the same patient (with
infectious tb), use a stronger respirator such as a powered air-purifying
respirator or papr.

[color=#444444]-to do a respirator fit check: during inhalation, the respirator
should collapse, and during exhalation, check for leakage around the face

[color=#444444]-removing the respirator, you will want to lift the bottom
elastic over your head prior to the top elastic. remember to do it slowly
because you don't want it to snap off your face.

[color=#444444]-remember you would want to remove the respirator outside
the patient's room after the door has been closed. all other ppes should be
removed inside the patient's room at the doorway or in an anteroom. but if the
procedure only requires that you use gloves, then you can remove your gloves
in the patient room followed by hand hygiene

[color=#444444]-there are three types of respirator, n95, n99, n100 but the n95
is used for infectious tb.


[color=#444444]hepatitis b is something that if we are not careful, we can
make a mistake very easy, this is a standard precaution unless we are
suctioning the pt, then it becomes droplet




http://www.youtube.com/results?searc...rch_type=&aq=f

[color=#444444]keep those hands off that mouse!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[color=#444444]side note one: while you are practicing your nclex style questions, practice,
practice, practice, critical thinking, by taking your time and trying to narrow down your answer
and deciding between two possible correct answers. dont get the quick mouse hand, take your
hand off the mouse and dont answer the question until you are confident that its the one you
want to choose!!!!!!! i guarantee you that if your practice this you will become a better nclex
test-taker. i personally like to keep my hand in my lap while deciding my answer. it kind of helps
to keep you calm.



low ph, high co2, high hco3 = resp. acidosis

high ph, low co2, low hco3 = resp. alkalosis

low ph, low co2, low hco3 = metabolic acidosis

high ph, high co2, high hco3= metabolic alkalosis








ph goes to the left= acid ph goes to the right=alkine
acid<<<<<7.35-7.45>>>>>>>alkine
hco3 22-26 co2 35-45
so if ph is 7.55(up)& hco3 is 28 (up) both are up = met alkalosis

ph hco3 both up = met alkalosis
ph hco3 both down = met acidosis
ph down co2 up = resp acidosis
ph up co2 down =resp alkalosis


rome:

respiratory= opposite:
ph is high, pco2 is down (alkalosis).
ph is low, pco2 is up (acidosis).

metabolic= equal:
ph is high, hco3 is high (alkalosis).
ph is low, hco3 is low (acidosis).




acidosis alkalosis

ph <7.35 >7.45

pco2 >45 <35

co2 <18 >22

co2 might be hco3 in some labs and the 18 or 22 might be 1-2 numbers
different.

just write down this down and then circle which ones apply to your abg results.
then what it is called is the one that caused the acidosis or alkalosis. pco is
resp and co2 is metabolic

ex your pt abgs are ph 7.30, pco2, 40 co2 10 this is metabolic acidosis.





pharmacology - know indication/action/effect


prefix/suffix


-ase = thrombolytic
-azepam = benzodiazepine
-azine = antiemetic; phenothiazide
-azole = proton pump inhibitor, antifungal
-barbital = barbiturate
-coxib = cox 2 enzyme blockers
-cep/-cef = anti-infectives
-caine = anesthetics
-cillin = penicillin
-cycline = antibiotic
-dipine = calcium channel blocker
-floxacin = antibiotic
-ipramine = tricyclic antidepressant
-ine = reverse transcriptase inhibitors, antihistamines
-kinase = thrombolytics
-lone, pred- = corticosteroid
-mab = monoclonal antibiotics
-micin = antibiotic, aminoglycoside
-navir = protease inhibitor
nitr-, -nitr- = nitrate/vasodilator
-olol = beta antagonist
-oxin = cardiac glycoside
-osin = alpha blocker
-parin = anticoagulant
-prazole = ppis
-phylline = bronchodilator
-pril = ace inhibitor
-statin = cholesterol lowering agent
-sartan = angiotensin ii blocker
-sone = glucocorticoid, corticosteroid
-stigmine = cholinergics
-terol = beta 2 agonist
-thiazide = diuretic
-tidine = antiulcer
-trophin = pituitary hormone
-vir = anti-viral, protease inhibitors
-zosin = alpha 1 antagonist
-zolam = benzo/sedative
-zine = antihistamine




pharm facts


dont give non-selective beta-blockers to patients w/respiratory problems
vitamin c can cause false +ive occult blood
avoid the g herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs
(coumadin, asa, plavix, etc)
asa toxicity can cause ringing of the ears
no narcotics to any head-injury victims
mg2+ toxicity is treated with calcium gluconate
do not give calcium-channel blockers with grapefruit juice
oxytocin is never administered through the primary iv
lithium patients must consume extra sodium to prevent toxicity
maoi patients should avoid tyramine:
oaacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese
(except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream.
dont give atropine for glaucoma it increases iop
dont give ant-acids with food -- b/c it delays gastric emptying.
dont give stadol to methadone/heroin preggos -- cause instant withdrawal
symptoms
insulin clear before cloudy
dont give meperidine (demerol) to pancreatitis patients
always verify bowel sounds when giving kayexelate
hypercalcemia = hypophosphatemia (and vice versa)
radioactive dye urine excretion
signs of toxic ammonia levels is asterixis (hands flapping)
d10w can be substituted for tpn (temporary use)
dopamine and lasix are incompatible
hypoglycemic shivers can be stopped by holding the limb, seizures cannot
(infants)
common symptom of aluminum hydroxide constipation
thiazide diuretics may induce hyperglycemia
take iron with vit c it enhances absorbtion do not take with milk
b1 - for alcoholic patients (to prevent wernickes encephalopathy &
korsakoffs synd)
b6 - for tb patients
b9 - for pregnant patients
b12 - pernicious anemia, vegetarians.
complications of coumadin - 3hs - hemorrhage, hematuria & hepatitis
ffp is administered to dic b/c of the clotting fx
mannitol (osmtic diuretic [head injury]) crystallizes at room temp use a filter
needle
antianxiety medication is pharmacologically similar to alcohol used for
weaning tx
administrate glucagon when pt is hypoglycemia and unresponsive
phenazopyridine ( pyridium)--urine will appear orange
rifampicin -- red-urine, tears, sweat)
hot and dry = sugar high (hyperglycemia)
cold and clammy = need some candy (hypoglycemia)
med of choice for v-tach is lidocaine
med of choice for svt = adenosine or adenocard
med of choice for asystole = atropine
med of choice for chf is ace inhibitor.
med of choice for anaphylactic shock is epinephrine
med of choice for status epilepticus is valium.
med of choice for bipolar is lithium.
give ace inhibitors w/food to prevent stomach upset
administer diuretics in the morning
give lipitor at 1700 since the enzymes work best during the evenin
common tricyclic meds - 3 syllabes (pamelor, elavil)
common maois - 2 syllables (nardil, marplan)
tpn has a dedicated line & cannot be mixed ahead of time
rhogam -- given at 28 weeks & 72 hrs postpartum
do not administer erythromycin to multiple sclerosis pt
benadryl and xanax taken together will cause additive effects.
can't take lasix if allergic to sulfa drugs.
acetaminophen can be used for headache when the client is using
nitroglycerin.
dilantin - can not give with dextrose. only give with ns.



addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and
you get postural hypotn) cushing is fat ( hyperglycemic, you get moon face big
cheeks, and you retain a lot of na and fluid)
never give via ivp:
okcl
oheparin
oibuprofen
oinsulin
odobutamine
oasa
oalbumin
oacetaminophen

insulin:
orapid: lispro onset <15 min. peak: 1 hr. duration 3hr
oshort: regular onset - 1 hr. peak: 2-3hr. duration: 4-6 hr
oint: nph or lente onset: 2 hr. peak 6-12 hr. duration: 16-24hr
olong: ultralente onset 4-6 hr. peak: 12-16 hr. duration: >24hr
ov.long: lantus onset 1 hr. peak: none. duration: 24 hr continuous



anticholergic side effects:
ocant see
ocant pee
ocant spit
ocant sh*t
hypocalcemia cats
oconvulsions
oarrythmias
otetany
ospasms & stridor





hyper kalemia causes: machine
omedicationa (ace inhibitors, nsaids)
oacidosis (metabolic & repiratory)
ocellular destruction (burns, traumatic injuy)
ohypoaldosteronism, hemolysis
onephrons, renal failure
oexcretion (impaired)

signs of increased k murder
omuscle weaknes
ourine olyguria, anuria
orespiratory distress
odecreaed cardiac contractility
oecg changes
oreflexes hyperreflexia, or flaccid

substance poisoning and antidotes
omethanol -- ethanol
oco2 -- oxygen
odopamine -- phentolamine
obenzos (versed) -- flumazenil
olead -- succimer, calcium disodium
oiron -- deferoxamine
ocoumadin -- vitamin k
oheparin -- protamine sulfate
othorazine -- cogentine
owild mushrooms - atropine
orat poison - vit k

parkland formula: 4cc * kg * bsa burned = total volume necessary
o1st 8hrs total volume
o2nd 8hrs total volume
o3rd 8 hrs total volumes



nclex drugs??? most-prescribed meds in the us!


generic name (trade name) major concerns
analgesic
acetaminophen (tylenol) watch for liver and kidney problems
hydrocodone with acetaminophen addictive
(lortab)
ibuprofen (motrin) can lead to hpn and kidney disease
naproxen (aleve) can lead to hpn and kidney disease

antianxiety
alprazolam (xanax) this drug can be addictive
diazepam (valium) watch for allergies, *also anticonvulsant*
lorazepam (antivan) sedation
promethazine hci (phenergan) *also antiemetic*

antibiotic
amoxicilline (augmentin) watch for allergic reactions
azithromycin (zithromax z-pak) watch for allergies
cephalexin (keflex) if you are allergic to cephalosporins, you might also be allergic to penicillin
doxycycline hyclate (vibramycin) avoid for pregnant clients
penicillin v potassium (penicillin) watch for allergies
sulfamethoxazole (septra, bactrim) can cause gi diturbance

anticoagulant
warfarin sodium (coumadin) teach the client to limit the intake of green leafy vegetables
watch for signs of bleeding
anticonvulsant
clonazepam (klonopin) should not be stoppe abruptly
diazepam (valium) watch for allergies, also antianxiety
lorazepam (antivan) sedation

antidepressant
sertraline (zoloft) sedation
amitriptyline hci (elavil)
trazodone hci (desyrel)

antidiabetic
glipizide (glucotrol) watch for hypoglycemia
metformin (glucophage) thi drug should be stopped prior to a dye study such as cardiac
catheterization

antihistamine
cetirizine (zyrtec)
fexofenadine (allegra) dry mouth

antihypertensive
amiodipine (norvasc) hypertension
atenolol (tenormin) cause drop in pulse rate, check pr daily
doxazosin mesylate (cardura)
lisinopril (zestril) cause postural hpn, remain supine for at least 30mins
metoprolol succinate (toprol xl) teach the client to check his pulse rate
metoprolol tartrate (lopressor,toprol) teach the client to check his pulse rate

antihypertensive/antianginal
verapamil hci (calan)

anti-inflammatory
ibuprofen (motrin) can lead to hypertension and kidney disease
prednisone (deltasone) can cause cushings syndrome and gi problems

antigout
allopurinol (zyloprim) drink a least 8 glasses of water per day


antilipidemic usually ends in statin
simvastatin (zocor) can cause liver problems & muscle soreness
do not take this drug with grape-fruit juice
antiulcer/histamine blocker
ranitidine hci (zantac) best to take this drug with meals

antiulcer/proton pump inhibitor
lansoprazole (prevacid) take this drug prior to meals
omeprazole (prilosec)

bronchodilator
albuterol (proventil) tachycardia, md check blood levels for toxicity

diuretic
furosemide (lasix) hypokalemia
hydrochlorothiazide (hctz) hypokalemia

hormone replacement
estrogen (premarin) can blood clots
levothyroxine (levoxyl) can blood clots
levothyroxin (synthyroid) teach the clients to check his pulse rate

muscle relaxant
cyclobenzaprine hci (flexeril) sedation

oral contraceptive
necon (ortho-novum 7/7/7) can blood clots
trinessa (ortho triclen) can blood clots

osteoporosis
alendronate (fosamax) remain upright for at least 30mins after taking to prevent gerd.
take wit water

potassium supplement
potassium chloride (k-lyte) check for renal function before giving this drug

sleep aid
zolpidem (ambien) allow at least 8hrs of sleep time to prevent daytime drowsiness


i highly recomend this link it is organized and less confusing and not over done as cdc website
which can be over whelming:

http://info.med.yale.edu/ynhh/infection


this is sir silas he kept me company during this long journey. he wants me
to find a job now. yet another hurdle


hope it helps!!! good luck!
thx for sharing this information. i too took exam today not good pop up but
lolts of prioritization and infection control . congrates. i will pass too soonnnn
kaila731 and StarMatrix17 like this.
8.
0
Mar 31, '10 by Lmcgrady
Hello Everyone , I took my NCLEX today and I was wondering if anyone
knows how long it takes before the unofficial results are posted on Pearson
Vue?

Thanks
9.
0
Mar 31, '10 by Hopscotch81
Good info!
10.
0
Apr 4, '10 by missaphrodite
thank you for sharing this.. im gonna copy this now on my notes.. thank you
so much!!1
11.
0
Apr 4, '10 by Brenda101
Thank You so much for sharing your info with us, Congrats on your passing
nclex. I will ve attempting for the third time at the end of may. Going to
byuy the Charity book tomorrow...
12.
0
Apr 5, '10 by mariyahsmommy
Universal Nurse--

All I can say is THANK YOU! You obviously put alot of time and effort into
posting all of this very valuable info on to us. I graduate in May 5 more
weeks and then am planning on taking a Review Course. This is AMAZING
stuff! I will pass it on to my buddies as well. Congratulations to you on
passing! Woo-Hoo!