NCLEX study guide

LABS
K 3.5 5.1cardiac arrhythmias: possible met. acid.
if pt has K 1st hold diuretic/digoxin then assess with EKG, VS
I&O
:muscle weakness, dysrhythmias, to increase K in diet (raisins,
bananas,apricot)
: MURDER: muscle weakness, oliguria/anuria, respir.depression,
decreased cardiac contractility, ECG changes, reflexes
Na 135 145possible hypoT.&dehydration. HTN
: fever, weakness, disorientation, delusions,hypotension,
tachycardia tx:hypotonic 0.45NS, D5W
: n/a, muscle cramps, ICP, muscle twitching, convulsions, tx:
osmotic diuretics, fluids
Mg 1.6 2.6
: depresses CNS, hypotension, facial flushing, muscle
weakness, absent deep tendon reflexes, shallow respirations,
emergency
: tremors, tetany, seizures, dysrhythmias, depression,
confusion, dysphagia, dig toxicity
Cl 98 107
Ca 8.6 10 trousea (arm) & chovstek sign(cheek)
: muscle weakness, lack of coordination, abd pain, confusion,
absent tendon reflexes, sedative effecet on CNS
: CATS: convulsions, arrhythmias, tetany, spasms, stridor
Wbc 4500 11000
Phos. 2.2- 4.8 when this is high Ca is low etc
Hgb 14-16.5 m11-16 F:14-18
Hct 42-52% (3 x Hgb) M34-47 F:39-54
Mg. 1.5 - 2.5
Albumin 3.4 5: fluid overload, edema, ascites wt gain/liver dz
Fe 65-175
ALT/AST 5-60/5-43 (liver function tests)
Uric acid 4.5 8 (men)
2.5 6.2 (women)
with gout
Lipase 10 140
in liver dz (Lipase = Liver)
Serum osmolality 285 295
= dehydration
= overhydration
CK enzymes MB = cardiac muscle
BB = brain
MM = skeletal
Troponins -better indicator of detecting MI than CKs
Amylase 25-151
with pancreatitis (acute 5x nml, chronic 3x nml)
-aids in digestion
IOP/ICP 10-20
Urine specific gravity 1.010 1.025
> 1.030 dehydration
Glucose 70-110
Sedimentation rate (ESR) -rate increases with more inflammation
Men: 0-15mm/hr
Women: 0-20mm/hr
HCO3 22-26
PH 7.35 - 7.45
PaCO2 35-45
TSH 0.4-4.2
BNP < 100 ventricular
CKMB M: 0-4 F: 0- 4
Trop 1 0.0 - 0.1 ( heart attack/stroke)
Trop T 0.0 - 0.2
BUN 6-23
creat 0.2-1.0
Plate 140k-450k petechiae, spontaneous bleeding
APTT: 21 - 35
INR 2.0 - 3.0 bruising, bleeding and with liver dz
PTT 32 - 45 seconds
PT 10 - 14 seconds
D. Dimer <250
Tris 1: M: 25 -135 F 40- 170
total protein 6.0 - 9.0
RBC M: 3.8 - 5.1 F: 4.2 - 5.6 when polycemia
Neutr: 50- 81%
Lympho. 14 - 44%
Mono. 2 - 6%
EOS: 1 - 5%
Baso: 0-1%
HDL: 30 - 75
LDL < 130
Total Choles. <200
CVP 2-8 =right ventricular failure
or fluid overload S/S: perip.edema -UO accute rapid wt, JVD,
S3 heart sounds RR, dyspnea, crackles, bounding pulse
PCWP 8-13 readings 18-20 are HIGH

Therapeutic Levels
Acetaminophen 5-20
Valpoic Acid 55 - 100
Digoxin 0.5 - 2. 0
Lithium 0.6 - 1.2
Phenytoin 10 - 20
Salicylate 15 - 30
Tegretol 8 - 12
Theophylline 10 - 20
MgSo4 4 - 7.5 /8

1cc 1ml
1cc 15gtt
30cc 1oz
5cc 1tsp
15cc 1Tbs
1mg 1000mcg
60mg 1 grain
bid 2x a day
tid 3x a day
qid 4x a day
every other day
qod
ac With each meal
hs At bedtime
 BP HR
ICP
Shock
Bleeding
Cushings Triad (also widening
pulse P)
Autonomic dysreflexia
Air embolus
Dehydration

ANTIDOTES
med/tx antidote for it.
MgSO4 (Tx for calcium gluconate
seizures & to
contractions)
benzodiazepine (Tx for flumazenil
seizures/anxiety)
Heoin/opioids Naloxone/Narcan
anticholinergics (ex: physostigmine
antihistamine)
beta blockers (tx for Glucagon
cardiac arrhythmias
and to BP)
warfarin (anticoag) vitamin K
digoxin (tx congest. HF, digonin immune Fab
A.Fib)
Heparin (anticoag) Protamine Sulfate
Methatrexate (cancer tx) Leucavorin
cyanide/acrylonitrite sodium nitrate
(smoke inhalation: almond
breath)
acetominophen (tylenol) acetycysteine (Mucomyst)
possible liver failure with
OD/poisoning possible for
4 days. close observation
required

Removing tubes and things

Chest tubes Have pt perform valsalva maneuver, or take and hold deep
breath (have seen both in nclex books)
NG tube Have pt take and hold a deep breath
PICC line Have pt perform valsalva maneuver
TPN line Valsalva maneuver

Positions for Procedures

Parcentesis in cirrhosis Pt in High fowlers to remove air/fluid

During Liver Biopsy
After Liver biopsy
soap suds enema adm.
During Lumbar puncture
after lumbar puncture
after percutaneous coronary
intervention (PCI)
supine with R.arm above head
supine or right side 12-14 hrs
sims or left lateral recumben
fetal or bend over table
supine/prone 4-8 hrs
pt lay flat/supine for hours
prolapse cord
after thyroidectomy
after cataract surgery
pt with heat stroke
transferring WC bound pt
CANE walking
crutches and stairs
knee to chest
low or semi Fowler, support head, neck and
shoulders
pt will sleep on unaffected with a night sheild for
1-4wks
lie flat with legs elevated
place wheelchair parallel to bed on side of
weakness
COAL: cane opposite affected leg
step up 1. good leg goes up, then crutches 3. bad
leg.
going down: 1. crutches 2. good leg 3. bad leg

MED SURG/DISEASES
Addisons Disease Cushings Disease
-think hyperthyroidism sx -think hypothyroidism sx
Hyposecretion of glucocorticoids Hypersecretion of glucocorticoids
-not enough aldosterone = lose water (think -too much aldosterone = water retention=
diuretics..some block aldosterone) ADH cushion ADH
Hypovolemia (Blood volume ) Hypervolemia (blood volume )
Hot Cold (Cushings = Cold)
K Ca Na (lose H2O, lose Na) K Ca Na (gain H2O, gain Na)
Hypoglycemia ( insulin production) Hyperglycemia ( insulin production)
+ ketoacidosis
Wet skin Dry skin (hyper = dryer) hyperglycemia = dry
skin
Lethargy, fatigue, muscle weakness Generalized muscle wasting, weakness
Hypotension (Na) Hypertension ( Na)
Weight loss Weight gain / Slow healing
Decreased blood volume + shock Moon face, buffalo hump, obesity (trunk), thin
Hyperkalemia = meta acidosis + arrhythmias skin, reddish-purple striae, acne, menstraul irreg.,
hirsutism
TREATMENT: hormone replacement, hydrocort. TREATMENT: hypophysectomy(pituitary),
during stress will need to increase hydocortisone adrenalectomy
Addisonian crisis = shock management. fluid
resuscitation/TX: 0.95NS, D5, hydrocort. IV push Osteoporosis (excess cortisol = Ca
-medical emergency reabsorption from bones)
-critical deficiency of glucocorticoids
-generally follows acute stress, sepsis, trauma, surgery, or
omission of steroid therapy
s/sx: N/V, hypotension, HR, confusion, severe abd
pain, sudden profound weakness, hyperpyrexia followed by
hypothermia, coma, renal failure

Hyperthyroidism Hypothyroidism
- fast (Hyper) sweating - slow(think lazy, slow, cold, overweight)
- metabolism metabolism
-sympathetic NS sx -parasympathetic NS sx
-nervousness, irritable, excitable, tachycardia, -extreme fatigue, dry skin, coarse hair, numbness and
perspiration, flushed face, exophthalmus, increased tingling of fingers, alopecia, wt gain
appetite, limp hair, wt loss, HTN
-heat intolerance -cold intolerance
Iodine uptake Iodine uptake
Graves disease Myxedema coma= medical emergency
Thyroid storm - mental status
-tachycardia - hyperthermia
-delirium - thickening & swelling of the skin
-coma
-pt with hyperthyroidism is typically nervous and
has insomnia.
-don't place in same room with another pt with
hyperthyroidism because too much stimuli.
-place in private room.

Hyperglycemia hyperosmolar nonketotic DKA

syndrome (HHNKS)
-occurs in people with DM-2
-glucose > 800 ml/dL
-gradual onset of sx
No ketosis/acidosis
Polyuria, polydipsia, dehydration, mental status
changes, wt loss, weakness, headache BP
Tx = fluid replacement, correct electrolyte
imbalance, give insulin /Exercise
-occurs in peoplee with DM-1
-glucose > 300-800 mg/dL
-sudden onset of sx
Ketosis/acidosis / FRUITY breath odor Kussmaul
respirations (rapid and deep)
Polyuria, dehydration, wt loss, dieresis
BP / Tachycardia K
Tx = give vasopressin
IV Fluids / Reg. Insulin
-expected outcome = responsiveness
TX: 1. rehydrate to glucose, K will go
2. supplement with K to prevent hypkalemia
3. hourly fingersticks
4. D5W with IVwhen glucose<200
5. insulin infusion titrated to get glucose lower

Nursing Process Info

nursing Process/Plan 1. Assess

2. Diagnosis
3. Plan
4. Implement
5. Evaluate

head to toe 1. inspect 2. palpate 3. perucss 4.

ausculate

Abdomen Stand @right of Pt. 1. inspect, 2. ausculate 3.

percuss 4. palpate
Child inspect, auscultate, percuss, then palpate

Guillain-Barre Syndrome - weakness (ascending)

-neuro problem = acute infection of cranial and peripheral nerves
-pt c/o respiratory infection or GI infection in past med hx
-immune system overreacts and destroys myelin sheath
-major concern = problems breathing

s/sx = paresthesis, lower extremity weakness, gradual progressive weakness,

possible resp failure, cardiac probs, high protein in CSF
Myasthenia Gravis autoimmune dz
acetychol.
-eye problems
-sedatives make sx worse
-neuro prob
-weakness and fatigue
 -have pt do things in am
-defect in transmission of nerve impulses
-give meds before meals
- semi solid foods

s/sx = fluctuating weakness of smooth muscle, fatigue, difficulty chewing,

dysphagia, weak/hoarse voice, resp failure, ptosis, diplopia, decreased breath
sounds
-everything pretty much slows down and gets weak

TX:
Tensilon test = used to dx
-if pt shows improvement after tx = dx
TX: anticholinesterase drugs: pyridostigmine
Hirschsprings dz -mega-colon
hirschprung dz contd -results in mechanical obstruction b/c of inadequate motility

s/sx = failure to gain weight, abd distention, vomiting, ribbon-like and foul
smelling stools (not with newborns I think), constipation alternating with
diarrhea
B-thalassemia -too much Fe
-autosomal recessive disorder
-decreased production of 1 of the globin chains in the synthesis of Hgb
-chelation drug therapy (gets rid of Fe)
Hip replacement -avoid extreme external, internal rotation
-avoid adduction
-no side-lying on operative side
-maintain abduction with pt in supine position or on non-operative side
-do not cross legs
-place pillow b/w legs to maintain abduction
Wernicke-Korsakoff -neuro disorder
syndrome -acute encephalopathy
-chronic psychosis
-caused by deficiency in Vit B / Tyramine deficiency
Multiple myeloma -Ca caused by bone destruction is the primary concern
-encourage fluids (dilutes Ca)
Pancreatitis -do not give morphine! (irritates pancreas)
-pain is severe and unrelenting in epigastric area and radiates to back
-observe for UO, HR

-diet = fat, protein, carbs, K supplements

-typically rest GI by making pt NPO but give lots of IV fluids

(+) Turners sign = bruiselike discoloration in flank

(+) Cullens sign = bluish hemorrhage around umbilicus
Dumping syndrome -limit fluids with meals
-early sx = sweating and pallor
-5-30 min after eating
-also vertigo, tachycardia, desire to lie down
Fat embolus -tachypnea
-tachycardia
-dyspnea
Air embolus -chest pain
-dyspnea
-lightheadedness
-nausea
-dizziness
-hypoxia
 -anxiety
-HR
BP
Liver Failure serum albumin (causes ascites), INR( risk of
bruising/bleeding), ammonia (causes lethargy & confusion),
bilirubin (causes jaundice & itching)
5th dz -not contagious after rash
Peptic ulcer dz Primary sx of perforation = board-like abd and shoulder pain (blood)
Coffee ground emesis = slower internal bleeding
Asthma -diminished wheezing in a child with asthma indicates possible worsening of
asthma
Posturing Decerebrate = cerebellum problem
Decorticate = cortex problem
-Decorticate is more favorable than decerebrate
Pheochromocytoma -produces catecholamines (epi)
-tumor adrenal medulla
-headache, diaphoresis, palpitations, HTN, tremor, hyperglycemia
-dont palpate abd = can cause more catecholamines (cells) to be released and
cause severe HTN
Parathyroid -monitor Ca and P (Ca P)

Hyperparathyroidism (Ca, P)
-increased sleeping - osteoporosis
-increased urination - nephrolithiasis (kidney stones)
-weakness - polydipsia - constipation
-bone pain - muscle pain - polyuria
-irritability
Hypoparathyroidism (Ca, P)
-increased urinary frequency
- trousseau sign
- muscle spasms
- tingling, numbness
chvostek sign
-seizures

SIADH (secretion of abnormal ADH production, common causes : CNS distrubtion (Stroke, trauma,
inapporpriate antidiuertic neuro. surgery), malgnancies( small lung carcinoma), pulmonary disorder
hormone (pneum)
-leads to excessive water absorption by kidneys
-decreased UO = fluid overload, HTN, HR
-water intoxication (retaining water)
- serum osmolality
-Na (dilutional hyponatremia)
-too much antidiuretic hormone (vasopressin)
TX:
1. fluid restriction <1000ml/day
2. oral salt tablets to Na
3. hypertonic saline: severe neuro problems can
occur w/Na
4. vasopressin recept. antag: conivaptan
5. strict I and O & daily wts
6. monitor Neuro status
-treatment is effective if: UO, wt, urine osmolality
Diabetes insipidus -deficiency of ADH = ability of kidneys to concentrate urine
-give vasopressin

s/sx = polyuria, polydipsia, fatigue, dilute urine, intense thirst,

dehydration, wt loss, HA, tachycardia, Na in urine
Tumor lysis syndrome -emergency of electrolyte imbalance
-potential renal failure
Pulmonary Embolism -blood tinged sputum
-chest pain
-cough
-cyanosis
-distended neck veins
-dyspnea
-BP, HR
-wheezes
-tachypnea
Renal failure Pre
-poor perfusion to kidneys

Intra
-damage to kidneys, nephrotoxic injury from contrast, antibiotics,
corticosteroids

Post
-obstruction of urinary collecting system
Autonomic dysreflexia -hyperreflexia
-spinal cord injury T5 and above (I think)
-overactivity of autonomic NS
-kinked cath can cause it, constipation or full bladder (Incr ICP)
-pounding HA, HTN, sweating, bradycardia, restlessness
COPD -use a high-flow venture mask to deliver O2 b/c you are giving a controlled,
specified amount of O2

s/sx: dyspnea on exertion, barrel chest, clubbed fingers and toes

hypovolemic shock inadequate tissue perfusion.
change in mental status = brain is dry
tachycardia and thready pulse
olguria: peeing out all liquid
tachypnea: breathing so fast have dry mouth
cool clamy skin, body trying to find fluids
Parietal lobe in an acute injury pt, if they cannot identify sensation felt when nurse touches
skin with paperclip/qtip the deficit reflects injury to parietal lobe
ulcers starve a gastric ulcer with emptying stomache, feed a duodenal
meningitis CSF will have high protein and low glucose
pernicious anemia red beefy tongue, will take B12 for life
menieres dz admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affted
ear when in med.
vertigo
tinnitus
N/V
glumerulonephritis check BP. BP most important assessent parameter.
stomas dusky stoma means poor blood supply, protruding means prolapsed, shar pain +
rigidity means peritonitis, mucus in ileal conduit is expected
lymes dz bulls eye rash
BPH reduced size and force of urine
parkinsons pill rolling tremors
infectious monoucleosis hallmark: sore throat, cervical lymph adenopathy, fever, compromised liver and
spleen
liver cirrhosis spider like varices
lephrosy lion face
bulima chipmunk face
tetnus risus sardonicus (face/smile like joker)
pyloric stenosis olive like mass
PDA machine like murmur
emphysema barrel chest
cholera rice watery stool
typhoid rose spots on abdomen
multiple sclerosis chronic progressive dz with demyelination lessions in CNS which affect white
matter in brain/spinal cord.
motor s/s: limb weakness, paralysis, slow speech
sensory s/s: numbness, tingling, tinnitus
cerebral s/s: nystagmus, ataxia, dysphagia, dyarthria
Huntingtons chorea 50% genetic, autosomal dominant
s/s: writhing, twisting, movements of face, limbs and body , gait deteriorates to
no abulation, no cure just palliative care
pyelonephritis WBC shift to left

Neurogenic T6 or higher vasodilation after spine injury

shock/distributive shock S/Sx:
- hypotension
- Hr
- pink dry skin
TX:
isotonic fluids to increase BP (NS), systolic BP needs to be at least 80 to perfuse
the kidneys
polycythemia Vera disorder where bone marrow produces RBC
TX: periodic phlebotomy to remove 300 - 500ml to RBC and
Hct to 45%
Nrs: fluid intake and avoid dehydration
hemorroidectomy severe pt after surgery top priority is pain management
ICP NURSING 1. HOB 30 in neutral position
2. adm stool softeners (no vals. )
3. manage pain
4. tx fever (but avoid shivers)
5. stimulation
6. adequate oxygenation
7. hyperventilate before suctioning
8. suction no longer than 10 seconds
9. adm mannitol, corticosteriods
abdominal pain
acute caculous cholecystitis RUQ pain, referred pain to Rt shoulder and scapula a few hrs after eating fatty
food, fever, chills, N/V/A
appendicitis pain at umbilcus progress to RLQ, rebound tenderness, MCburry point
Kidney stones left flank pain radiationg to L groin
pancreatitis sudden, severe LUQ or midepigastric area readiating to back
diverticulitis LLQ abdm pian progress to LUQ

ARDS FLUID in alveoli: secondary to something else. cardinal signs are hypoxemia
(low oxygen level in tissues)
DIC disseminated intravascular always secondary to something else (another disease process)
coagulations
copd is chronic. emphysema and bronchitis are both COPD
signs of fractured hip external rotation, shortening, adduction
fat embolism blood tinged sputum, increase ESR, respiratory alkalosis, hypocalemia,
increased serum lipids, snow storm effect on CXR
complication of mech. pneumothorax, ulcers, hypotension
ventilation

Sjogrens syndrome chronic autoimmune syndrome where moisture producing exocrine glands are
 attacked by WBC.
- dry salivary, lacrimal glands
- dry eyes, mouth, throat, bronchi
- skin rashes, dry vagina
- TX: no real treatment just OTC to help relieve the symptoms :
eye drops, mouth rinse, lube.
Medications and Insulin
Meds that Insulin requirements Meds that Insulin requirements
Glucocorticoids (cushings = hyperglycemia) Sulfonylrureas
Li Quinidine
Rifampin (TB) Quinine (malaria)
Progestins (oral contraceptives) ACE inhibitors
Nicotine Naproxen
Phenytoin Indomethacin (gout, RA, OA)
Ca-channel blockers Salicylates
Clonidine B-blockers
Morphine
Heparin

*exercise = insulin needs increase

*baby born to diabetic mom is at risk for hypoglycemia (give extra feedings of formula)

Diabetes - Insulin
Onset Peak Common types Misc.
Rapid 15min 1-2h Aspart (novalog) Clear, sliding scale, no IV, pump,
Midmorn- Lispro (humalog) can mix with I, L
trembling/wknes
s
Short 30-60min 2-4h Regular Only kind that can be given IV
Early evening Clear
wkness, fatigue Can mix with I, L
Intermediate 1-2h 4-8h (4-12h?) NPH (Humalin R, Cloudy
Early evening Novalin R) Can mix with R, S
wknes, fatigue Lente
Long 2-4h 8-14h Humalin U Cloudy
Can mix with R, S
Very Long-actig 1-2h None (ongoing) Glargine (Lantus) Clear
Never mix with others!
Usually given at bedtime
*RN draw up Regular first and NPH second
*Oral hypoglycemics = stimulate pancreas to produce more insulin or increase sensitivity to insulin already there,
only for DM-2
*DM-2 and insulin needs during surgery, stress, infection = need for insulin
*Reduce your insulin needs during exercise (exercise lowers blood glucose)
*Glucagon = prevents hypoglycemia, produced by the pancreas, action is opposite of insulin

Metabolic Syndrome We Better Think High Glucose

Waste: men >40 women >35
BP: > 130/85
Triglycerides: <150
HDL: <40 men <50 women
Glucose: fasting >100
increases the risk for DM and cardiac dzs
Sepsis: complication of another illness (pneuomonia)
HR >90
temp >100.9
 systolic BP <90
altered mental status
glucose >140 (no DM)
absent bowel sounds
cap refill >4 seconds

Sympathetic NS (fight/flight) Parasympathetic NS

-anticholinergic drugs -B blockers
-vasoconstriction -vasodilation
Tachycardia Bradycardia
Dilated pupils Constricted pupils
Inhibits digestion Stimulates digestion
-constipation -diarrhea
Inhibits nasal secretions Stimulates nasal secretions
Inhibits saliva production
Inhibits liver, kidneys, gallbladder
Stimulates sweating Stimulates liver, kidneys, gallbladder
Lungs dilate Constricts lungs
Increases muscle strength

PNEUMO/TENSION THORAX
TENSION PNEUMOTHROAX: treatment: 1. emergency large bore needle
- trachea deviated decompression, 2. place chest tube

chest tube drainage >100ml/hr *** call HCP

Breath sounds
Pneumonia crackles, bronchial breath sounds, tactile fermitus,
percussion dull
Pleural effusion diminished breath sounds, decreased tact. fermitus, percussion dull,
mediastinal shift away from effusion
COPD diminished breath sounds, tactile ferm, hyperresonat
percussion
Pneumothorax diminished breath sounds, tactile ferm, hyperrsonat.
percussion, mediatal shift away from pneumothorax.

Maslows
 Eye stuff
Mydriatic eye drops Big word = big pupils
Dilates pupils
Miotic eye drops Little word = little pupils
Constricts pupils
Glaucoma -silent thief of vision
-optic nerve damage
-causes irreversible blindness
-blurred vision, halos, loss of peripheral vision
-risk factor = cardiovascular dz
-treat with meds to decrease IOP (B-blockers) and miotics (increase
outflow of aq humor)
-African Americans are at an increased risk at any age
-nursing goal: prevent further deterioration
Cataracts -lens opacity or cloudiness
-painless, blurry vision
-surroundings are dimmer
-diplopia
Macular degeneration -dry = nonexudative (slow)
-wet = exudative (fast)
-drusen = tiny yellow spots
Detached Retina - curtain over eyes, black spots,
- TX: cover both eyes call HCP

Arterial leg ulcers Venous leg ulcers

-small -large
-circular -irregular
-deep -superficial
-granulation tissue
-highly exudative
Pain = intermittent claudication (pain Pain = aching, heaviness
caused by activity)

Warning signs of cancer CAUTION

abdominal distension: vomitting
C changes in bowel bladder habits (black stool, painless hematurai)
A a sore that doesnt heal
U unusual bleeding/discharge (vag)
T thickening/Lump in breast or elsewhere
I indigestion or difficulty swallowing that doesnt go away
O obvious changes in wort or mole (color, shape, size)
N nagging cough or hoarseness
insert NG tube
- decompression : removal of air/secretions from stomach
after NG tube in checks
1. connect main lumen of NG using a small white tear drop
adapter to suction apparatus
2. blue pigtail lumin is air vent, NEVER connect it to
suction. use it for flusing or clamp/plug it
3. regularly flush NG with water to clear pathway

Nephritis Nephrotic Syndrome (Nephrosis)

Think I (thin kid) Think O (round kid)
Periorbital edema, facial edema edema (ascites), periorbital edema
High BP Low BP
Anorexia Lethargy, pallor, anorexia
UO UO
Hematuria Swollen abd, labia, scrotum
Pallor, irritability, lethargy
Proteinuria Massive proteinuria
BUN, creatitine, ASO titer (pt reports
strep infection before)
Treatment: antibiotics, antiHTN Treatment: steroids

Cranial Nerves
I Olfactory Smell
II Optic Central/peripheral vision
III Oculomotor Pupil constriction
IV Trochlear Have pt follow tip of finger
V Trigeminal Jaw strength
VI Abducens 6 cardinal movements of eyes
VII Facial Facial symmetry
VIII Acoustic Ears hearing
IX Glossopharnygeal Taste, uvula midline, etc
X Vagus Taste, uvula midline, etc.
XI Accessory Neck, shoulder
XII Hypoglossal Midline tongue

Bells Palsy inflammation of VII

-facial muscle weakness
-inability to close eyelids
TX: eye care, patch @ night artifical tear, oral care often & after meals eat
on unaffects side

Precautions
Standard -uniform level of caution that should be used in all patients
-primary goal = prevent transmission of nosocomial infection
-hand hygiene
-gloves
-misc barriers (mask, eye protection, face shield, gown)
Contact -in addition to standard
-used for organisms that are easily spread by skin-to-skin contact, or by contact with items in pts
environment
-may place pt in private room
-masks are not needed, doors do not need to be closed

Examples
-antibiotic-resistant organisms
-enteric infections with low infectious dose
-c-diff
-GI, respiratory, skin, wound infections or colonization with multidrug-resistant bacteria
-RSV
-highly infectious skin infections: diphtheria, herpes, impetigo, pressure ulcers, scabies, shingles
 -conjunctivitis
-ebola
Airborne -in addition to standard
-for pt with serious illnesses transmitted by airborne droplet nuclei

Examples
-measles
-varicella (and disseminated zoster)
-TB
Droplet -in addition to standard
Examples
-flu -pertussis -adenovirus -mumps / rubella

Putting on PPE 1mask,2. goggles, 3.gown, 4gloves

taking off 1.gloves, 2. goggles, 3. gown, 4. mask 5 hand washing

Cardiovascular
Complications of mitral stenosis -thromboembolism
-rheumatic fever (common complication of CHF)
-endocarditis
-pulmonary HTN
-pulmonary edema
Hemolytic transfusion rxn -headache
-tachycardia
-HTN and Hypotension
-apprehension, sense of impending doom
-fever, chills
-DIC
-low back pain, chest pain
Autologous transfusion rxn - s/s of infestion ( greatest risk)
cor pulmonale right sided HF caused by left ventricular failure (so pick edema,
JVD if they are a choice)
Inotropic and Chronotropic Drugs Inotropics
-affect force of muscle ctx

(-) inotropic effects = myocardial contractile force

(+) inotropic effects = myocardial contractile force
(b-blockers)

Chronotropics
-affects HR

(-) chronotropic effects = HR (parasym NS,

acetylcholine)
(+) chronotropic effects = HR (sym NS), epi,
atropine)

Digoxin
(+) inotropic
(-) chronotropic

Drugs for HTN

(-) inotropic
(-) chronotropic
Diagnostic tests 1. Troponins are more specific
2. CK-MB
Coronary arteriogram
Cardiac tamponade
First priority of care for pt with
cardiovascular problem
Aortic Dissection
Pulseless electrical activity PEA
-femoral artery is used keep pt on bedrest with HOB slightly
elevated for several hours
-HR in recovery may be a sign of hemorrhage
(common complication)
- fluid builds up in the pericardial sac and
compresses against the heart. heart unable to
contract causing C
-pt may c/o heavy / fullness around heart
-narrowing pulse pressure
-hypotension
-JVD
-muffled/distant heart tones
- pulsus pardoxus
-tachypnea
-tachycardia
-dyspnea
TX: needs emergency pericardiocentesis
cardiac workload
myocardial oxygenation
When arterial wall intimal layer tears. allows blood between inner
and middle layer
S/S: abrupt, tearing, ripping back pain, HTN, can
cause cardiac tamponade or arterial rupture
ermergcy Tx: surgery BP
occurs when cardiac monitor shows organized electrical activity but
thers no adequate mechanial activity of the heart muscle, lack
perfision and pt has no pulse.
5Hs:
-hypovolemia
-hypoxia
-hydrogen ions (acidosis)
-hypo/hyper K
-hypothermia
5Ts:
-tension pneumothorax
-tamponade (cardiac)
-toxins (narcs, benzos)
-thrombosis (pulmonary/coronary)
-trauma

L-sided Heart Failure R-sided Heart Failure HF in children

Left = Lung Jugular vein distention - gallop rhythm
Dyspnea Edema
Tachypnea Wt. gain
Gallop rhythm: S3, S4 Ascites
Fine crackles Hepatomegaly
Wheezing, rhonchi Tachycardia
Tachycardia Fatigue
Oliguria (fluid retention)

*acute pulmonary edema *mitral stenosis

EKG

EKG info 5 little boxes = 0.2 sec

3-4 big boxes = 0.6 sec
p wave always before QRS
PR interval = 0.12 - 0.20 (3-5 little boxes)
 QRS width = 2-3 little boxes
Q - T interval = 8-11 little boxes
1st degree block -P present and before QRS
-R-R regular
-PR bigger than 5 little boxes
2nd AV Block -P wave present
-sometimes p wave r/t QRS
3rd AV block -P wave present
-never r/t QRS
ventricular standstill -pwave present
no QRS
A.Flutter p wave present but abnoral
saw tooth shape flutter
A. Fib irregular rhythm, varying R-R intervals
Fib waves present but no P wave
tachycardia
Premature ventrcular early conduction of QRS. QRS wide & distorted shape. associated with
contractions PVC stimulants, digoxin, heart dz, electrolyte imbalance, hypoxia, emotional
stress
Premature atrial conduction contraction starting from an etopic focus in atrium and coming sooner than
PAC next sinus beat. P wave has different shape than the original P wave

Supraventricular tachycardia dysrhythmia orginates from etopic focus above the bundle of his. HR 150-
SVT 220. rhythm usually regular, P wave often hidden/abnormal shape PR
interval short, QRS narrow <2 little boxes
TX: vagal stimulation (Cough, Valsalva) drugs: adenosine or synchronize
cardoversion
Ventricular Tachycardia rate 150-250 firing repeatedly in ventricle. P wave not visible, PR interval
not measurable QRS wide >4 + boxes
Food
Tyramine -avoid with MAOIs, migraines
-figs, avocados, bananas, papaya, raisins
(Korsakoff Psychosis= -aged cheese, yeast, yogurt, sour cream
tyramine deficiency) -soybeans, beer, red wine
-beef, liver, sausage, bologna, deli meat
-chocolate
Purine -avoid with gout
-fish, sardines
-liver, beef, chicken, sausage, organ meats
Gluten -avoid with Celiacs disease
Vitamin K -broccoli, cabbage, turnips
(antidote for Coumadin) -fish, liver
-coffee, tea (caffeine)
Vitamin B12 (thiamine) -found in animals, nuts, whole grain cereals
-pt with cirrhosis needs a diet high in B12
Calcium -eggs
-green leafy veggies
Potassium -potatoes -dairy products
-bananas -avocados
-spinach
-raisins
-dates
-oranges
-dried apricots
Iron -can give with Vitamin C (tomato juice, OJ)
-clams
-liver, beef, shrimp
 -turkey
-cereal
-pasta
Folic acid -liver
-papaya
-legumes, vegs, spinach
-nuts, bran, cereal
-fruit, yeast, asparagus
Acid ash diet -avoid milk = makes urine alkaline
Vitamin D toxicity -GI upset and metallic taste
-HA, weakness, renal insufficiency, renal calculi, HTN, arrhythmias, muscle
pain, conjunctivitis
Crohns diet -Low fat
-Low residue (no popcorn)
-High protein
Calcium -take 1 hour after meals with full glass of water
ACE inhibitors -take 1hour before meals
CKD -apples
-pears
grapes
pineapple
blackberry
blueberry
plums
ulcerative colitis low residule diet
-high protien
- high calorie diet
- daily vitamins, minerals
- increase fluids 2000-3000 ml/day
- small frequent meals

Burns
Superficial partial -first degree
thickness -sunburn
-epidermis
-red, blanches with pressure
-possible blisters
Deep partial -second degree
thickness -scald
-epidermis, upper dermis, part of deeper dermis
-blistered, mottled red base
-weeping, edema
Full thickness -third degree
-flame, chemicals, electrical current
-epidermis, entire dermis, muscle/bone
-dry, pale white
-leathery, fat exposed, edema
parkland formula %of body burned
amount of fluid for a ) = amount of mL in 24hrs
4 ml x(wt kg) x
burn pt
*half of fluid amount given in 1st 8hrs
*burn pt at risk for K
 MISC
Fire in patients room? PACE / RACE

P = get patient out / R = Rescue patients

A = activate fire alarm, rescue other patients
C = close door to confine fire
E = extinguish fire

MISC:
Presence of glucose in nasal discharge = fluid is CSF
Catecholamines
-dopamine, epi
-released during times of stress
Thyroidectomy monitor Ca and P

Chemo treatment
- uric acid levels in blood d/t massive cell destruction
Calmette-guerin vacc = vacc for TB
-mantoux test will always be positive
CO2 in blood = vasodilation
Allergy to bananas/kiwis = allergy to latex
Acute pain sx = BP, HR, RR, perspiration, body T, dilated pupils (wide
eyed with fear)
If a question asks you to select a goal for a pt, make sure the answer you pick is an actual goal!
1. maintain O2 Sats above 90% throughout shift = yes, this is a goal
2. keep HOB elevated to promote proper ventilation = no, this is an intervention
Allergy to eggs = no flu shot
Dx test to confirm TB = sputum culture
Infiltration = cool to touch, swelling, tenderness, decreased rate, blanching of skin
Phlebitis = inflammation, redness, heat, swelling, tenderness
HTN-crisis
- give phentolamine: vasodilates
Best area to check a dark-skinned patient for:
Petechiae = oral mucosa, conjuntivae
Cyanosis = palms/soles of hands and feet
Jaundice = sclera

Nclex Strategies
Look for umbrella answer if all the answers are correct, does one contain the others?
Which one is not like the other?
Look for opposites, look for similar answers to find the one that isnt the same (rapid pulse, tachycardia)
ABCs
Like dz can room with like dz . (Clean pt with Clean pt / Dirty with Dirty)
Assess before you implement! - Unless no further assessment is needed
Safety 1st
Maslows - IMPORTANT
Avoid key words always, never, only - Throw these out
Look for words like pt suddenly developed chills the suddenly means new and serious! Priority!
do not use I understand or why
when two answers are the exact opposite like bradycardia and tachycardia one is the answer
if two or three answers are similiar/alike none is correct
never release traction unless it is a dr. order
question about a halo? remember safety 1st have a screwdriver nearby
always deal with actual problems or harm before potential problems
anytime you see fluid retention, think heart problems

Priority
An unconscious pt with L sided tracheal shift from The pt with L sided tracheal shift = airway
midline or a pt clutching her chest and c/o severe chest
pain?
Priority interventions if pt has pulmonary edema 1. admin O2
2. foley cath (to monitor I/O since giving
diuretics)
3. Lasix
4. Morphine - work of breathing
and anxiety
Priority of actions if pt with DM-1 who received NPH and 1. check blood glucose level
regular insulin 2h ago c/o hunger, weakness, shakiness 2. give pt 1/2c fruit juice
3. take vital signs
4. retest blood glucose
5. give pt small snack of carbs/protein
6. document
TRIAGE T = trauma
R = respiratory
I = ICP and mental status
A = an infection
G = GI , upper
E = elimination, lower
Priority of care 1st level: -airway - breathing -circulation & cardiac
(become 1st in cardiac arrest) - Vital Signs
2nd level: altered mental status - acute pain - untreated
medical problem (hyperglycemia in pt with DM) - chronic
pain - acute elimination issues - abnormal labs - risk for
infection/saftey

Types of play
Parallel -toddlers
-side by side
-rarely interact
Associative -preschoolers
-all engaged I similar activity, but little organization
Cooperative -school-age
-organized and goal-directed
Therapeutic -technique used to help understand a childs feelings
Play Therapy - Allow the child the express themselves easier

Blood
Complications of a blood transfusion 1. Transfusion rxns
-weak pulse, fever, brady/tachycardia, hypotension, oliguria
2. Circulatory overload
-cough, chest pain, wheezing, HA, HTN, HR,
distended neck veins
3. Septicemia
-chills, fever, vomiting, shock, hypotension
4. Fluid overload
5. Dz transmission
-Hep B, for example
6. Hypocalcemia
-citrate in transfused blood binds with Ca and is excreted
-hypereflexia, paresthesia, tetany, muscle cramps, +Trousseaus
sign, +Chvosteks sign
7. Hyperkalemia
-stored blood liberates K+
Pt with severe blood loss requires rapid -blood warming device
transfusion. What device is used during -rapid transfusions of cool blood puts pt at risk for cardiac dysrhythmias
blood transfusions to decrease risk of
cardiac dysrhythmias?
IV solution that can only be run with 0.9% NaCl
blood transfusions
How long do you have to admin blood 15-30min
products once they are picked up from
blood bank?
Reason to delay a blood transfusion Fever hold and notify dr
Special about blood transfusion tubing Has a built-in filter
Pt is receiving plateletswhat might the -decrease of bleeding from puncture sites and gums, etc.
pt exhibit to show he is benefiting from
the transfusion?
What would you use to evaluate Coag studies (PT, PTT)
effectiveness of fresh frozen plasma
IV Solutions
Isotonic
D5W -dont use during fluid resuscitation
-used mainly to supply water and correct serum
osmolality
0.9% NaCl (NS) -used with blood transfusions
-used with Dilantin
-used to replace Na losses
-burn injuries
-doesnt supply calories
-not for: HF, pulmonary edema, renal impairment, Na retention
LR -corrects dehydration, Na depletion
-replace GI losses
Hypotonic
0.45% NaCl -dehydration
Hypertonic
D5W 0.9% NaCl
ABGs
when drawing ABG, blood must go in heparinized tube, no bubbles, put on ice, if pt was on O2 and how many liters
ACID / BASE BALANCE
ROME
Respiratory opposite
 Metabolic equal
PH 7.35-7.45
PaCo2 35-45
HCO3 22-26

Respiratory Acidosis PH PaCO2 HCO3 s/s: headache,

uncompenstated anxiety, blurred
Partially compen. < 7.35 > 45 normal vision, restlessness,
compensated < 7.35 > 45 > 26 confusion, tremors,
Normal 7.39 > 45 > 26 delirium, coma
D/t: asthma, COPD,
Pulm. edema, MS,
pneumonia,
obstructed airway,
sedative OD, cardiac
arrest

Respiratory PH PaCO2 HCO3 s/s: hyperventilation,

Alkalosis >7.45 <35 normal dizziness, bloating,
uncompensated >7.45 <35 < 22 light headed,
partially compens. normal 7.41 <35 < 22 numbness/tingling in
compensated hands, discomfort in
chest, dry mouth,
palpitations, SOB

Metabolic Acidosis PH PaCO2 HCO3 s/s: (comes from the

uncompensated < 7.35 normal < 22 ass, must be acid)
partially compensa. < 7.35 <35 < 22 diarrhea, Kuss. resp.,
compensated Normal 7.39 <35 < 22 jaundice, fruity breath
D/t: DKA,
hyperchloremic
acidosis, lactic
acidosis
acidosis starts in
kidneys not lungs

Metabolic Alkalosis PH PaCo2 HCO3 S/S:

uncompensated >7.45 normal > 26 vomitting,overus
partially compens. >7.45 > 45 > 26 e of diuretics,
compensated normal 7.41 > 45 > 26 adrenal disease,
K&Na,
antacids,
laxatives, alcohol
abuse

DKA metabolic acidosis or patially compensated metabolic acidosis

COPD, obesity respiratory acidosis
hypoventilation
syndrome, respiratory
depression d/t narcotics
vomitting, aggressive metabolic alkalosis
diuresis
hypotension and alter the accuracy of O2 saturation
vasoconstricting meds

Important Drugs
-olol = B-blocker (HR, BP)
 -pine = Ca channel blocker (HR, BP)
-pril = ACE inhibitor (BP) vasodilate
-sartan (similar to ACE inhib) for pt allergic to ACE inhib.

Digoxin 0.5-2 -Toxicity = nausea/anorexia (early signs), green halos, UO

-monitor K and Mg (low levels and increase toxicity)
-therapeutic level < 2 (0.8 1.5)
-If given with lasix, monitor K!
-pt with hypothyroidism is more sensitive to dig (K)
-Ca can make toxicity worse (Ca = K)
-usual dose = 0.25mg/day
- workload of heart and myocardial function
- intracellular Ca
-assess apical pulse before admin
Theophylline 10-20 -for asthma or COPD
-dont give with food/drinks that contain caffeine
MgSO4 -therapeutic level = 4-7.5

*for eclampsia Toxicity

*tocolytic -flushing
-RR, DTR, BP, UO
-pulmonary edema
Drugs that stimulate B1 B1 = 1 heart (increase HR)
and B2 B2 = 2 lungs (dilate lungs)
Clozapine -antipsychotic
-risk for agranulocytosis
-give pt anticholinergic to help this (Benztropine Cogentin) also give this with
Thorazine
Tetracycline -take on empty stomach
-dairy can bind with it and prevent absorption
-no Ca, Mg, Al, Fe (prevent absorption)
Li toxicity -therapeutic level = 0.5 1.2
Toxicity = N/V, muscle weakness, severe diarrhea, tinnitus, blurred vision
Lidocaine toxicity -drowsiness and CNS disturbances
Lasix toxicity -renal failure (OU), blood dyscrasias, hearing loss
Methylergonvine ctx (methergine = more)
(prevent postpart bleed) (increase contractions, prevent postpart bleed, subinvolution)
Terbutaline ctx (stop contractions/ preterm labor)
Bethanechol -cholinergic med
-10-50mg 3-4x/day
-tx for urinary retention
Alendronate (fosamax) -take on empty stomach!
Morphine Toxicity = pinpoint pupils, RR
Phenytion (dilantin) -causes urine to change colors
-only give with NS
Diuretics -some block aldosterone (Aldactone) = K sparing
-aldosterone retains H2O and Na, loses K
Infusion rate too fast? Hypotension
Clomipramine Ana is depressed because of her OCD
(Anafranil) -tricyclic antidepressant
-can also be used for OCD
Clonidine -HTN and opiate w/d
Coumadin Monitor PT
Antidote = vitamin K
Heparin Monitor aPTT goal to be 1.5-2 times normal or control value (46-70 seconds)
fondaprinux, enoxaparin, Antidote = protamine sulfate
dalteparin short duration so PT can go back within 2-6 hrs (IV)
vancomycin IV: monitor creatinine can cause nephrotoxicity
hydrochloroquine antimalarial but commonly used for tx of systemic lupus erythem.
Sulfa drugs Tx for RA & ulcercolitis
duloxetine cymbalta
meformin tx for DM2
azithromycin, may cause prolonged QT intervals sudden cardiac death d/t tordes de point
erythromycin,
clarithromycin
Atropine tx for symptomatic bradycardia <60 s/s BP, chest pain, syncope
aripirazole (Abilify) atypical antipyscotic, acts as dopamine system stabilizer. helps stablize mood, control
s/s: agitation, hallucinations from dementia
promethazine antiemetic: NO IV
(Phenergan)
adalimumab (HUmira) tx for arthritis, plaqu psoriasis, crohns dz, ulcerative colitis,
immunosuppressant must test pt for TB. injectable protein that blocks inflammatory
effects
Guaifenesin (mucinex) expectorant used to facilitate mobilization of mucus
lORATADINE (Claritan) antihistamine
ibuprofen & AMA can cause bronchospasms in asthma pt
metoclopromide antiemetic promotes motlilty/gastic emptying tx for N/V & gastroparesis
can cause tardiv dyskinsesia : unusal movements (like psych drugs)
aynoglycosides cause nephrotoxicity and ototoxicity
IV push should never go unless emergency situations
over 2 minutes
antibiotics used in TB STRIPE; STreptomycin, Rifampin, Isoniazid, Pyrazinamide, Ethambutol
sulfamethoxazole antibiotic, dont take if allergic to sulfa drugs, diarrhea common side effect, drink plenty
of fluids.
hydralazine hx of HTN, CHF, report flu-like symptoms, rise slowly from sitting/laying take with
meals
dicyclomin tx of irritable bowel, assess for cholinergic SE
verapamil calcium channel blocker: tx of HTN, angina, assess for constipation
sucralfate (carafate) tx of duodenal ulcer, coats the ulcer, so take before meals
theophylline tx of asthma or COPD therap. level 10-20
levothyroxine tx of hypothyroidism may take several weeks to take effect, call HCP if chest pain, take
(synthroid) in AM on empty stomach, could cause hyperthyroidism
vincristine tx of leukemia give IV only
kwellada tx of scabies and lice
thiothixene tx of schizophrenia, assess for EPS (acute/tardive symptoms)
methylphendate tx of ADHD assess for heart related SE report immediately. child may need a drug
(Ritalin) holiday b/c it stunts growth.
dopamine (Intropine) tx of hypotension, shock, low cardiac output, poor perfusion to vital organs, moniotor
EKG for arrhythmias, monitor BP
Aluminum hydroxide tx of GERD and kidney stones watch for constipation
(Amphojel)
hydroxyzine (vistaril) tx of anxiety and also itching, watch for dry mouth, given preop commonly
midazalam (versed) given for conscious sedation, watch for resp. depression, and hypotension
dextroamphetamine used for ADHD may alter insulin needs, avoid taking with MAOIs take in morning
(dexedrine) (insomnia possible SE)
haloperidol (haldol) anti-psychotic preferred in elderly but high risk of EPS (dystonia, tardive dyskinesia,
tightening of jaw, swollen tongue risk of airway obstr.) monitor for early signs of
reaction and give IM diphenhydramine (Benadryl)
simvastatin (Zocor) for hyperlipidemia, take on empty stomach to enhance absorption
levastation for hyperlipidema must be given with evening meal
lidocaine med of choice of Vtach
adenosine med of choice of SVT
atropine med of choice for asystole
Ace Inhibitors med of choice for CHF
epinephrine med of choice for anaphylactic shock
diazepam (valium) med of choice for status epilipticus
lithium med of choice for bipolar
TPA (alteplase) med given for acute ischemic stroke must be given within 3 hrs of onset

Furosemide -loop diuretic

Lasix -K
hydrochlorothi -thiazide diuretic
azide : HCTZ -K
-exacerbates gout
Aspirin -NSAID
- inflammation
-Reyes syndrome in kids
Iron sulfate -Fe deficiency anemia
-take with vitamin C
-best taken b/w meals
-no antacids
-may cause black stools
alendronic -Ca
acid -take in morning on empty stomach
Fosamax
KCl -never give IV push
-use in pt with hypokalemia
Sodium -use in pt with hyperkalemia: must
Polystyrene assess for normal bowel fx to avoid
(Kayexalate) risk for intestinal necrosis. assess for
constipation, S/S of impaction, recent
bowel patterns
Tylenol -not anti-inflammatory
-pain relief, fever
B12 -K
-for vit B12 deficiency
spironalactone -K sparing diuretic
(Aldactone)
Mannitol -osmotic diuretic
-IOP/ICP
-renal failure

phenytoin -antiepileptic
(Dilantin) -only give with NS
-s/e = blurred vision, diplopia
Sinemet -parkinsons dz
(levodopa/carbidopa
)
somatriptan -HA
(Imitrex)
donepezil -alzheimers
(Aricept)
nalbophine -opioid
(Nubain)
naloxone (Narcan) -opioid antagonist
Morphine -opioid
-toxicity = pinpoint pupils, decreased RR, increased ICP
Fluoxetine (Prozac) -antidepressant, SSRI
amitriptyline (Elavi)l -antidepressant, tricyclic
-anti-chol s/e
Bethanechol -parasympathetic
-for urinary retention
-cholinergic
Epi -sympathetic
-inhalation = fastest route
Atropine -sympathetic
-anti-cholinergic
Dopamine -sympathetic

Mental Health
Schizophrenic patients Remember SDS to remember major needs:
S = structure: because they tend to have too little in their lives
D = diversion: to distract them from disturbing thoughts
S = stress reduction: to minimize the severity of the disorder
Paranoid pt dont encourage , dont support their coping mechanisms

Ask direct questions: do you hear voices?

Panic attacks -sympathetic NS sx
-HTN, HR, alertness, SOB, trembling
Alcohol w/d sx -DT -give Librium
Types of crisis Situational (external source, unanticipated)
-divorce
-loss of job
-death of loved one
-abortion
-severe physical, mental illness

Maturational (occurs at a developmental stage)

-marriage
-birth of child
-retirement

Adventitious (crisis of disaster)

Manic pt
Akathisia
Dystonia
Parkinsonism
What factor has the most
influence on the outcome of the
a crisis situation?
In extreme stress dont do
what?
Serotonin syndrome
Double bind communication
RESTRAIN
Histrionic Personality Disorder
-not part of everyday life
-flood, fire
-9/11
-rape
-have them reorganize something
Restlessness, pacing, inability to sit still
-tonic contractures of muscles in the neck, mouth, tongue
-muscle rigidity, shuffling gait, stooped posture, flat-faced affect,
tremors, drooling
-previous coping skills
-teach, educationlearning is limited at this point
-diarrhea
-irritability, restlessness
-tremors, delirium
-fever
-tachycardia, HTN
-apnea
-death
-pt says I love you but has a grimace on face
Answer is always least restrictive intervention (this include meds)
self-dramatizing (shallow emotion expression) attention seeking,

Alzhemier dz
PTSD
Heroin withdrawal:
alcohol withdrawal
child abuser/perpetration
characteristics
neuroleptic malignant syndrome
NPS
Pediatric/Womens Health Stuff
infant assessment:
Newborn VS
Infant VS 1-12m
Preschool 3-5 VS
School age 6 - 12 VS
overly friendly, seductive, demands immediate gratification little
tolerance for frustrations.
memantime used to ease s/s of moderate to severe
3 categories: 1. re-experience of traumatic even recurring, instrusive
memories, flashbacks and nightmares
2. avoiding reminders of trauma. avoid activities, places, feeling
attached, numb, lack interest. inability to set goals, amnesia of
important details/events
3. increased anxiety, emotional arousal, insomnia, irritability, outburst
of anger, restlessness, diff. concentrating
generalized myalgias, diarrhea, pupil dilation, N/V, abdom. cramps,
goose bumps (pilerection), rhinorrhea, frequent yawning, restlessness
increased lacrimation
Give chlordiazepoxide (Librium): dont take with alcohol very bad N/V
can occur.
mild: anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset,
intact orientation. 6-24hrs
seizures: single or multiple tonic-clonic 12-48hrs
alcohol. hallucinations: visual, auditory, tactile, stable VS, intact
orientation 48hrs
delirium tremors: confusion, agitation, tachycardia, HTN, diaphoresis
48-96 hrs
-unrealistic expectations of child
-confusion b/w punishment & discipline. stern authorative
- having to cope with ongoing stress
- crisis: poverty, violence, illness,
- low self-esteem
-history of sub. abuse, alcohol
- punitive tx/abuse as a child
- lack parenting skills
-resentment/rejection of child
- low tolerance/poor impulse control
- attempt to conseal the injuries
rare but potentially fatal reaction most often seen with typical
antipyschotics (haloperidol, fluphenazine)
characterized by:
-fever - muscular rigidity - altered mental status - autonomic
dysfunction (sweating, HTN, tachycardia)
TX:
immediately DC drug, notify HCP, and treat symptoms : decrease
fever, decrease muscle rigidity & preventing complications.
1. auscultate 2. percuss 3. palpate in head to toe direction
4. traumatic (eyes, ears, mouth) 5. reflexes Moro
HR: 110-160
RR: 30-60
BP 60-80 / 40-50
HR 80-140
RR 20-30
BP 70-100 / 45 - 65
HR 80- 120
RR 20 - 30
BP 90 - 105 / 55- 70
HR 70-110
RR 20 - 30
 BP 90 - 120 / 60-75
adolescent VS HR 55-105
RR 12-20
BP 110 - 125 / 65-85
Hbg neonates: 18-27
3 mon 10.6 - 16.5
3 yrs 9.4 - 15.5
10 yrs 10.7 - 15.5

vaccinations 4-5 child needs DPT/MMR/OPV

FETAL alocohol syndrome -upturned nose
-flat nasal bridge
-thin upper lip
-SGA
Transesophageal Fistula (TEF) esophagus doesnt fully develop (this is a surgical emergency) the 3
Cs in newborns
1.Choking
2.Coughing
3.Cyanosis
PEds med surg/dz

ICP/hydrocephalus sclera visible above the iris (sunset eyes). 6th cranial nerve palsy. late
(6th cranial nerve palsey) sign of ICP/Hydrocephalus
juvenile idiopathic arthritis high risk for becoming deconditioned d/t muscle
(JIA) strength & endurance: overall capacity for exercise.
good activities: swim, stationary bike, yoga, low impact,
low wt bearing - non wt bearing & rom
Kawaski disease inflammation of arterial walls, some develop coronary aneurysm
3 phases: 1. acute: sudden fever, doesnt respond to meds, irritable,
swollen red hands/feet lips swollen/cracked, strawberry red tongue
2. subacute: skin peeling from hands and feet, very irritable
3. convalscent: symptoms disappear slowly temp. returns to normal
TX: IV gamma globulin (IVIG) & aspirin. IVIG creates
oncotic pressure causing signs of fluid overload,
pulmonary edema make sure to monitor for s/s of HF,
UO, extra heart sounds HR, diff. breathing
infant botulism generalized weakness, diminished deep tendon reflexes, can cause
respiratory failure S/S constipation, difficulty feeding
hemolytic uremic syndrome life-threatening complication of E.coli results in red cell hemolysis,
(HUS) low platelet, acute kidney injury, hemolysis results in anemiaa & low
platelets manifests as petechia or pupura
Cystic Fibrosis thick mucus plugs ducts, impairs Cl transport & Na absorption
resulting in thickened secretions
manifestations: -recurrent sinus & pulmonary infections
pancreatic insufficiency & diffic. with adequate wt & growth (given
-pacreatic enzymes with meals)
-infertility
-deficiency of fat soluble vitamins
epiglottis inflammation of the epiglottis : life threatening airway obstruction.
most common cause H. influ type B (HIB)
s/s: abrupt onset high fever, severe sore throat, followed by 4Ds:
Drooling, Dysphonic (diff. speaking), Dysphagia, Distress airway
(stridor). child may be tripoding with stridor
a postive western blot test <18 monhts (presence of HIV antibodies) indicates only that the
mother is infected.
2 or more positive p24 antigen will confirm HIV in kids <18months. p24 can be used @ any time
tests
 HIV kids avoid OPV and Varicella vacinations bc they are live. but give
pneumoccocal and influenza. MMR is only avoided if the kid is
severely immunocompromised. parents should wear gloves for car, no
kissing on mouth/near, and dont share forks/spoons.
for digoxin in PEDS if HR is <100bpm hold
wt birth wt doubles by 6 months, triples by 1 year
hemophilia x- linked mother passes disease to son
pyloric stenosis first sign in baby is mild vomitting that progresses to projectile
vomitting. later maybe able to palpate mass, baby will seem hungry
often and may spit up after feedings.
VP Shunt will have small upper-abdomen incision. this is where shunt is guided
into the abdominal cavity, and tunneled under the skin up to ventricles.
watch for abdominal distention, since fluid from the ventricles will
be redirected to peritoneum. watch for signs of ICP such as
irritability, bulging fontanels, and high pitched cry in infants. in
toddlers watch for lack of appetite and headache. careful on bed
position questions. after shunt placement keep pt flat, so fluid doesnt
reduce too rapidly. if you s/s of ICP, then raise HOB to 15-30 degrees.
vacinations MMR and varicella immunizations come later (15 m)
Maternal OB
preeclampsia: therapeutic MgSO4 4-8 to prevent seizures
when it increases more than 8=toxicity.
toxicity s/s: CNS depressant blocking neuro transmitters. loss of deep
tendon reflexes (earliest sign) 9-11
-respiratory depression 12-18 and decreased UO
PICA often accompanied by iron defciency anemia: check HCT & Hgb
trisomy 18 (edward syndrome) severe cardiac defects, multiple muscko.deformities, life expectancy
few weeks after birth. provide end of life care
anecephaly neural tube defect results in little to no brain tissue, most are stillborn,
those born alive will not surive. provide end of life care
subjective (presumptive) for -amenorrhea -quickening -NV -breast tenderness -excessive fatigue
pregnancy
objective (probable) for uterine/cervical changes (goodell sign, hegar sign, chadwick sign,
pregnancy uterine enlargement) -braxton hicks, ballotment - fetal outline
palpation - uterine softens - skin pigmentation changes -positive preg
test
positive pregnancy dx -fetal heartbeat with doppler - fetal movement palpated - visualization
fetus by US
fetus development bones fully developed @32wk
lanugo begins to disappear @ 36
lungs & respir. system fully developed @40
28wk newborn/permie should have eyes open, adipose tissue
developed & ability to perform gas exchange
VEAL CHOP V:variable decels C:chord compression/prolapse: oligohydraminos
E:early decels H:head compression
A: accelerations O: OK normal
L: late decelerations P: placental insufficiency

Newborn Apgars (1min, 5min) 0,1,2 Stages of Labor Fetal monitoring

Heartrate (< or > 100) Stage 1 ctx to complete dilation) Normal = 110-160
Respiratory effort -Latent (0-3cm) Usual tone of uterine activity = 10-12
Muscle tone -Active (4-7cm) Bradycardia < 110 @ least 10min
Reflex irritability -Transition (8-10cm) Tachycardia > 160 @ least 10min
Skin color Stage 2 delivery of baby
Stage 3 delivery of placenta Treatment of maternal hypotension
Fontanels Stage 4 post partum, 1-4hrs after STOP
Anterior = diamond (closes 18mon)
Posterior = triangle (closes 6mon)
Pregnancy T to watch out for = greater
than 100.4
Postpartum changes
- Hct, hunger, UO
- blood vol, progesterone
production
Fundus
-descends 1cm/day below umbilicus
postpartum
After breaking water = assess FHR!
systemic alagesia can be admn. to pt in S = stop pitocin
Active phase T = turn pt on L side
7 Cardinal Movements (edfieee) O = administer O2 (6-10L)
Engagement P = push IV fluids if hypovolemic
Descent
Flexion Placenta Previa
Internal rotation -when the placenta implants in the
Extension lower uterine segment where it
External rotation encroaches on the internal cervical os
Expulsion -one of the most common causes of
bleeding during 2nd half of pg
Bracton Hicks ctx = 23-27w -painless bright red bleeding after 20th
week (no warning, stops suddenly)
Quickening = 18-22w (13-25w)
*risk factors: multigestation, multi
Fetal heartbeat = 18-22w pregnancies

5 Ps of labor Lochia Low: placenta implants in lower

Passage Rubra - red uterine segment
Passenger Serosa - pink Partial: placenta partially occludes
Power Alba - yellow cervical os
Psyche Total: placenta totally occludes
Position Sources of folic acid cervical os
-liver, papaya, legumes, vegs, spinach,
Plantar creases breakfast cereal Causes of postpartum hemorrhage
Preterm = red creases, not very -uterine atony
distinguished Decelerations (fetal heart) -risk increases with increased # of pg
Term =2/3 of foot Early: head compression (normal) -lacerations of birth canal
Postterm = entire sole -formation of a hematoma
Late: uteroplacento insufficiency
Layers of placenta = amnion (inner), Variable: cord compression Risk:
chorion (outer) Interventions: -large infant
-turn pt -time of labor (fast/slow)
Shiny = baby -increase primary IV -retained placenta
Serum glucose 40-60 -d/c pitocin -# of pg
-amnioinfusion -trauma
Preliminary signs of labor -elevate legs
-Braxton hicks ctx -call dr Chadwicks sign: blue
-dropping (lightening) Goodells sign: cervical softening
-nesting Why give neonate vit K? Hegars sign: softening of lower
-lose 1-2lb -neonate lacks intestinal flora to make it uterine segment
-bloody show -at risk for bleeding disorders
-necessary for blood coag 5 year old should be able to
-vit K stimulates liver to produce memorize their phone #
clotting factors
Primary intervention with a pediatric Ectopic pregnancy BPP
burn pt = remove blisters -implantation of fertilized ovum outside -determines fetal demise
uterine cavity -fetal apgar score
Centration = tendency to center -no vag bleeding -use u/s
attention on 1 feature of something and -common site: fallopian tube -fetal muscle tone
be unable to see its other qualities -methotrexate: inhibits growth -fetal activity
-HCG, cullens sign -fetal breathing motions
Teach a pt with sickle cell how to s/s: LQ abd pain on 1 side, mild-mod -look at fluid pocket
prevent sickling: maintain hydration, bleeding, missed/delayed menses -NST
promote oxygenation, avoid strenuous hypovolemic shock: from tubal rupture
activity can occur s/s: dizziness, hypoT, Incompetent cervix
tachycardia, low UO, referred shoulder -premature cervical dilation
PKU = autosomal recessive pain. -painless
 -around 20w
Most important newborn reflex = HTN disorders -d/t AMA, trauma
MORO (determines neuro dev) Chronic HTN -cerclage
-present before/during/after pg
Placenta previa vs placenta abrupto? -before 20w Maternal death
PAIN! Gestational HTN (PIH) 1. Hemorrhage
GTPAL: g: # of times she has -after 20w 2. Infection
conceived/#pregnancies. T: term births -no proteinuria 3. HTN
P: Preterm births, A: abortions (before -resolves after pg
20 wks) L:living/live births ->140/90 NST
Placenta previa Preeclampsia -assesses fetal well-being
-after 20weeks -HTN and proteinuria -FHR accels in response to fetal
-painless -low platelets movement
-no vag exam ->140/90
-BP -after 20w Menorrhagia
-low/partial/total -prefer vag delivery -heavier than normal menstrual
Chronic HTN w/ preeclampsia bleeding
Placenta abruption -new onset proteinuria
-after 20weeks -sudden BP Dysmenorrhea
-painful Severe preeclampsia -painful menstrual bleeding
-d/t trauma/cocaine/HTN -clonus
-BP -need 1 of 9 sx: When are fetal movements palpable on
-Kleihauer-bette test/FDP ->160/110, pulmonary edema abd? 28 weeks!
-mild/mod/strong ->5g/24h proteinuria
-abnl LFTs, oliguria, IUGR Transition phase of labor
Hyperemesis gravidarum -RUQ/epigastric pain -breathing should be pant/blow to
-d/t HCG -thrombocytopenia resist urge to push
-severe N/V -visual/cerebral disturbances
-+ ketones BUN, HR, BP Eclampsia Pediatric stuff
wt UOspecific gravity -seizures
-MgSO4 Burn pt priority intervention is to
Hydatidiform mole -proteinuria remove blisters
-exaggerated sx of pg
-complete (grapes, empty egg, no HELLP Myelomeningocele pt priority
fetus/placenta/etc parts) -complication of preeclamsia intervention is to measure head
-partial (2 sperm/1egg, abnl -hemolysis, elevated liver enzymes, low circumference
fetus/placenta, baby dies in utero) platelets
Promote motor dev in preterm infant
Spontaneous abortion Diabetes prevent grasping
-bleeding after 20w 1st trimester: hypoglycemia, insulin
-threatened needs Do NOT give pregnant pt diuretics!
-inevitable 2nd trimester: hyperglycemia, -Can cause ctx!
-complete insulin begin to
-incomplete 3rd trimester: hyperglycemia,
-missed\ insulin and taper off at 37w

Preterm Labor 21-37wks

TX: 1 antenatal gluccorticoids
(bethnathasone, dexmethasone)
stimulate fetal lung maturity, promote
release of surfacate up to
2. fetal fibronectin test: predict if labor
will progress to delivery
3. tocolytics (MgSO4, terbutaline,
indomethacin, nifedipine, stop
contractions up to 48hrs