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NCLEX study guide

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,
: 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 1.010 1.025
gravity > 1.030 dehydration
Glucose 70-110
Sedimentation -rate increases with more inflammation
rate (ESR) 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
ac With each meal
hs At bedtime

Cushings Triad (also widening pulse P)
Autonomic dysreflexia
Air embolus

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

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

Addisons Disease Cushings Disease
-think hyperthyroidism sx -think hypothyroidism sx
Hyposecretion of glucocorticoids Hypersecretion of glucocorticoids
-not enough aldosterone = lose water (think diuretics..some -too much aldosterone = water retention=
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) +
Wet skin Dry skin (hyper = dryer) hyperglycemia = dry
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, perspiration, -extreme fatigue, dry skin, coarse hair,
flushed face, exophthalmus, increased appetite, limp hair, wt numbness and tingling of fingers, alopecia,
loss, HTN wt gain
-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
-coma skin
-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 syndrome DKA

-occurs in people with DM-2 -occurs in peoplee with DM-1
-glucose > 800 ml/dL -glucose > 300-800 mg/dL
-gradual onset of sx -sudden onset of sx
No ketosis/acidosis Ketosis/acidosis / FRUITY breath odor Kussmaul
respirations (rapid and deep)
Polyuria, polydipsia, dehydration, mental status changes, Polyuria, dehydration, wt loss, dieresis
wt loss, weakness, headache BP BP / Tachycardia K
Tx = fluid replacement, correct electrolyte imbalance, give Tx = give vasopressin
insulin /Exercise 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

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
-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
-everything pretty much slows down and gets weak

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
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
Air embolus -chest pain
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
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
Hypoparathyroidism (Ca, P)
-increased urinary frequency
- trousseau sign
- muscle spasms
- tingling, numbness
chvostek sign

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)
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
-distended neck veins
Renal failure Pre
-poor perfusion to kidneys

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

-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.
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
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 shock/distributive T6 or higher vasodilation after spine injury

shock S/Sx:
- hypotension
- Hr
- pink dry skin
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 RUQ pain, referred pain to Rt shoulder and scapula a few hrs after eating fatty food,
cholecystitis 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 always secondary to something else (another disease process)
intravascular 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

Sjogrens chronic autoimmune syndrome where moisture producing exocrine glands are attacked by WBC.
syndrome - 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

*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, can
Midmorn- Lispro (humalog) mix with I, L
Short 30- 2-4h Regular Only kind that can be given IV
Early evening wkness, 60min Clear
fatigue Can mix with I, L
Intermediate 1-2h 4-8h (4- NPH (Humalin R, Cloudy
Early evening wknes, 12h?) Novalin R) Can mix with R, S
fatigue Lente
Long 2-4h 8-14h Humalin U Cloudy
Can mix with R, S
Very Long-actig 1-2h None Glargine (Lantus) Clear
(ongoing) 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
*Reduce your insulin needs during exercise (exercise lowers blood
*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

TENSION PNEUMOTHROAX: treatment: 1. emergency large bore needle decompression, 2. place
- trachea deviated chest tube
chest tube drainage >100ml/hr ***
call HCP
Breath sounds
Pneumonia crackles, bronchial breath sounds, tactile fermitus, percussion dull
Pleural diminished breath sounds, decreased tact. fermitus, percussion dull, mediastinal shift away from
effusion effusion
COPD diminished breath sounds, tactile ferm, hyperresonat percussion
Pneumothorax diminished breath sounds, tactile ferm, hyperrsonat. percussion, mediatal shift away from


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
-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
Macular -dry = nonexudative (slow)
degeneration -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 caused by activity) Pain = aching, heaviness
Warning signs of cancer CAUTION
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
abdominal distension: insert NG tube
vomitting - 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
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

Standard -uniform level of caution that should be used in all patients
-primary goal = prevent transmission of nosocomial infection
-hand hygiene
-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
-may place pt in private room
-masks are not needed, doors do not need to be closed

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

-varicella (and disseminated zoster)
Droplet -in addition to standard
-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

Complications of mitral -thromboembolism
stenosis -rheumatic fever (common complication of CHF)
-pulmonary HTN
-pulmonary edema
Hemolytic transfusion rxn -headache
-HTN and Hypotension
-apprehension, sense of impending doom
-fever, chills
-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
Inotropic and Chronotropic Inotropics
Drugs -affect force of muscle ctx

(-) inotropic effects = myocardial contractile force

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

-affects HR

(-) chronotropic effects = HR (parasym NS, acetylcholine)

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

(+) inotropic
(-) chronotropic

Drugs for HTN

(-) inotropic
(-) chronotropic
Diagnostic tests 1. Troponins are more specific
2. CK-MB
Coronary arteriogram -femoral artery is used keep pt on bedrest with HOB slightly elevated for several
-HR in recovery may be a sign of hemorrhage (common complication)
Cardiac tamponade - 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
-muffled/distant heart tones
- pulsus pardoxus
TX: needs emergency pericardiocentesis
First priority of care for pt cardiac workload
with cardiovascular myocardial oxygenation
Aortic Dissection When arterial wall intimal layer tears. allows blood between inner and middle
S/S: abrupt, tearing, ripping back pain, HTN, can cause cardiac tamponade or
arterial rupture ermergcy Tx: surgery BP
Pulseless electrical activity occurs when cardiac monitor shows organized electrical activity but thers no
PEA adequate mechanial activity of the heart muscle, lack perfision and pt has no
-hydrogen ions (acidosis)
-hypo/hyper K
-tension pneumothorax
-tamponade (cardiac)
-toxins (narcs, benzos)
-thrombosis (pulmonary/coronary)
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 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. irregular rhythm, varying R-R intervals
Fib Fib waves present but no P wave
Premature ventrcular contractions early conduction of QRS. QRS wide & distorted shape. associated with
PVC stimulants, digoxin, heart dz, electrolyte imbalance, hypoxia,
emotional stress
Premature atrial conduction PAC contraction starting from an etopic focus in atrium and coming sooner
than next sinus beat. P wave has different shape than the original P

Supraventricular tachycardia SVT dysrhythmia orginates from etopic focus above the bundle of his. HR
150-220. 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
Tyramine -avoid with MAOIs, migraines
-figs, avocados, bananas, papaya, raisins
(Korsakoff Psychosis= tyramine -aged cheese, yeast, yogurt, sour cream
deficiency) -soybeans, beer, red wine
-beef, liver, sausage, bologna, deli meat
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
-dried apricots
Iron -can give with Vitamin C (tomato juice, OJ)
-liver, beef, shrimp
Folic acid -liver
-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
ulcerative colitis low residule diet
-high protien
- high calorie diet
- daily vitamins, minerals
- increase fluids 2000-3000 ml/day
- small frequent meals
Superficial partial thickness -first degree
-red, blanches with pressure
-possible blisters
Deep partial thickness -second degree
-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 ) = amount of mL in 24hrs
amount of fluid for a burn pt
*half of fluid amount given in 1st 8hrs
*burn pt at risk for K

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

Presence of glucose in nasal discharge = fluid is CSF
-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
- 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)
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
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

An unconscious pt with L sided tracheal The pt with L sided tracheal shift = airway
shift from midline or a pt clutching her
chest and c/o severe chest pain?
Priority interventions if pt has pulmonary 1. admin O2
edema 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 1. check blood glucose level
received NPH and regular insulin 2h ago 2. give pt 1/2c fruit juice
c/o hunger, weakness, shakiness 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

Complications of a blood transfusion 1. Transfusion rxns
-weak pulse, fever,
brady/tachycardia, hypotension,
2. Circulatory overload
-cough, chest pain, wheezing, HA,
HTN, HR, distended neck veins
3. Septicemia
-chills, fever, vomiting, shock,
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 transfusion. What device -blood warming device
is used during blood transfusions to decrease risk of cardiac -rapid transfusions of cool blood puts pt at
dysrhythmias? risk for cardiac dysrhythmias
IV solution that can only be run with blood transfusions 0.9% NaCl
How long do you have to admin blood products once they are 15-30min
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 pt exhibit to show he is -decrease of bleeding from puncture sites
benefiting from the transfusion? and gums, etc.
What would you use to evaluate effectiveness of fresh frozen Coag studies (PT, PTT)
IV Solutions
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
0.45% NaCl -dehydration
D5W 0.9% NaCl
when drawing ABG, blood must go in heparinized tube, no bubbles, put
on ice, if pt was on O2 and how many liters
Respiratory opposite
Metabolic equal
PH 7.35-7.45
PaCo2 35-45
HCO3 22-26

Respiratory PH PaCO2 HCO3 s/s: headache, anxiety, blurred vision, restlessness, confusion,
Acidosis tremors, delirium, coma
uncompenstated < 7.35 > 45 normal D/t: asthma, COPD, Pulm. edema, MS, pneumonia,
Partially < > 45 > 26 obstructed airway, sedative OD, cardiac arrest
compen. 7.35 > 45 > 26
compensated Normal
Respiratory PH PaCO2 HCO3 s/s: hyperventilation, dizziness, bloating, light headed,
Alkalosis >7.45 <35 normal numbness/tingling in hands, discomfort in chest, dry mouth,
uncompensated >7.45 <35 < 22 palpitations, SOB
partially normal <35 < 22
compens. 7.41

Metabolic PH PaCO2 HCO3 s/s: (comes from the ass, must be acid) diarrhea, Kuss. resp.,
Acidosis < 7.35 normal < 22 jaundice, fruity breath
uncompensated < <35 < 22 D/t: DKA, hyperchloremic acidosis, lactic acidosis
partially 7.35 <35 < 22 acidosis starts in kidneys not lungs
compensa. Normal
compensated 7.39
Metabolic PH PaCo2 HCO3 S/S: vomitting,overuse of diuretics, adrenal disease, K&Na,
Alkalosis >7.45 normal > 26 antacids, laxatives, alcohol abuse
uncompensated >7.45 > 45 > 26
partially normal > 45 > 26
compens. 7.41
DKA metabolic acidosis or patially compensated
metabolic acidosis
COPD, obesity hypoventilation syndrome, respiratory respiratory acidosis
depression d/t narcotics
vomitting, aggressive diuresis metabolic alkalosis
hypotension and vasoconstricting meds alter the accuracy of O2 saturation

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
-pulmonary edema
Drugs that B1 = 1 heart (increase HR)
stimulate B1 and B2 = 2 lungs (dilate lungs)
Clozapine -antipsychotic
-risk for agranulocytosis
-give pt anticholinergic to help this (Benztropine Cogentin) also give this with
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 (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 -take on empty stomach!
Morphine Toxicity = pinpoint pupils, RR
Phenytion -causes urine to change colors
(dilantin) -only give with NS
Diuretics -some block aldosterone (Aldactone) = K sparing
-aldosterone retains H2O and Na, loses K
Infusion rate too 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, Antidote = protamine sulfate
enoxaparin, 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
Atropine tx for symptomatic bradycardia <60 s/s BP, chest pain, syncope
aripirazole atypical antipyscotic, acts as dopamine system stabilizer. helps stablize mood, control s/s:
(Abilify) agitation, hallucinations from dementia
promethazine antiemetic: NO IV
adalimumab tx for arthritis, plaqu psoriasis, crohns dz, ulcerative colitis,
(HUmira) immunosuppressant must test pt for TB. injectable protein that blocks inflammatory
Guaifenesin expectorant used to facilitate mobilization of mucus
lORATADINE 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 unless emergency situations
never go over 2
antibiotics used in STRIPE; STreptomycin, Rifampin, Isoniazid, Pyrazinamide, Ethambutol
sulfamethoxazole antibiotic, dont take if allergic to sulfa drugs, diarrhea common side effect, drink plenty of
hydralazine hx of HTN, CHF, report flu-like symptoms, rise slowly from sitting/laying take with
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 in
(synthroid) 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 holiday
(Ritalin) b/c it stunts growth.
dopamine tx of hypotension, shock, low cardiac output, poor perfusion to vital organs, moniotor
(Intropine) EKG for arrhythmias, monitor BP
Aluminum tx of GERD and kidney stones watch for constipation
hydroxyzine 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
hydrochlorothiazide -thiazide diuretic
-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 acid -Ca
Fosamax -take in morning on empty stomach
KCl -never give IV push
-use in pt with hypokalemia
Sodium -use in pt with hyperkalemia: must assess for normal bowel fx to avoid risk for intestinal
Polystyrene 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
Mannitol -osmotic diuretic
-renal failure

phenytoin -antiepileptic
(Dilantin) -only give with NS
-s/e = blurred vision, diplopia
Sinemet (levodopa/carbidopa) -parkinsons dz
somatriptan -HA
donepezil -alzheimers
nalbophine -opioid
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
Epi -sympathetic
-inhalation = fastest route
Atropine -sympathetic
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)
-loss of job
-death of loved one
-severe physical, mental illness

Maturational (occurs at a developmental stage)

-birth of child

Adventitious (crisis of disaster)

-not part of everyday life
-flood, fire
Manic pt -have them reorganize something
Akathisia Restlessness, pacing, inability to sit still
Dystonia -tonic contractures of muscles in the neck, mouth, tongue
Parkinsonism -muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors,
What factor has the most influence -previous coping skills
on the outcome of the a crisis
In extreme stress dont do what? -teach, educationlearning is limited at this point
Serotonin syndrome -diarrhea
-irritability, restlessness
-tremors, delirium
-tachycardia, HTN
Double bind communication -pt says I love you but has a grimace on face
RESTRAIN Answer is always least restrictive intervention (this include meds)
Histrionic Personality Disorder self-dramatizing (shallow emotion expression) attention seeking, overly
friendly, seductive, demands immediate gratification little tolerance for
Alzhemier dz memantime used to ease s/s of moderate to severe
PTSD 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
3. increased anxiety, emotional arousal, insomnia, irritability, outburst of
anger, restlessness, diff. concentrating
Heroin withdrawal: generalized myalgias, diarrhea, pupil dilation, N/V, abdom. cramps, goose
bumps (pilerection), rhinorrhea, frequent yawning, restlessness increased
alcohol withdrawal Give chlordiazepoxide (Librium): dont take with alcohol very bad N/V can
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
96 hrs
child abuser/perpetration -unrealistic expectations of child
characteristics -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
neuroleptic malignant syndrome rare but potentially fatal reaction most often seen with typical
NPS antipyschotics (haloperidol, fluphenazine)
characterized by:
-fever - muscular rigidity - altered mental status - autonomic
dysfunction (sweating, HTN, tachycardia)
immediately DC drug, notify HCP, and treat symptoms : decrease fever,
decrease muscle rigidity & preventing complications.

Pediatric/Womens Health Stuff

infant 1. auscultate 2. percuss 3. palpate in head to toe direction 4. traumatic (eyes, ears,
assessment: mouth) 5. reflexes Moro

Newborn VS HR: 110-160

RR: 30-60
BP 60-80 / 40-50
Infant VS 1-12m HR 80-140
RR 20-30
BP 70-100 / 45 - 65
Preschool 3-5 VS HR 80- 120
RR 20 - 30
BP 90 - 105 / 55- 70
School age 6 - 12 VS 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
Transesophageal Fistula esophagus doesnt fully develop (this is a surgical emergency) the 3 Cs in
(TEF) newborns
PEds med surg/dz

ICP/hydrocephalus sclera visible above the iris (sunset eyes). 6th cranial nerve palsy. late sign of
(6th cranial nerve ICP/Hydrocephalus
juvenile idiopathic high risk for becoming deconditioned d/t muscle strength & endurance: overall capacity
arthritis (JIA) 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 life-threatening complication of E.coli results in red cell hemolysis, low platelet, acute
syndrome (HUS) 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
manifestations: -recurrent sinus & pulmonary infections
pancreatic insufficiency & diffic. with adequate wt & growth (given -pacreatic enzymes
with meals)
-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 <18 monhts (presence of HIV antibodies) indicates only that the mother is infected.
blot test
2 or more positive will confirm HIV in kids <18months. p24 can be used @ any time
p24 antigen 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 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 severe cardiac defects, multiple muscko.deformities, life expectancy few weeks after birth.
(edward 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 -amenorrhea -quickening -NV -breast tenderness -excessive fatigue
(presumptive) for
objective uterine/cervical changes (goodell sign, hegar sign, chadwick sign, uterine enlargement) -
(probable) for braxton hicks, ballotment - fetal outline palpation - uterine softens - skin pigmentation
pregnancy changes -positive preg test
positive -fetal heartbeat with doppler - fetal movement palpated - visualization fetus by US
pregnancy dx
fetus bones fully developed @32wk
development 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 =
Muscle tone -Active (4-7cm) 10-12
Reflex irritability -Transition (8-10cm) Bradycardia < 110 @ least
Skin color Stage 2 delivery of baby 10min
Stage 3 delivery of placenta Tachycardia > 160 @ least
Fontanels Stage 4 post partum, 1-4hrs after 10min
Anterior = diamond (closes 18mon) systemic alagesia can be admn. to
Posterior = triangle (closes 6mon) pt in Active phase Treatment of maternal
7 Cardinal Movements (edfieee) hypotension
Pregnancy T to watch out for = greater Engagement STOP
than 100.4 Descent S = stop pitocin
Flexion T = turn pt on L side
Postpartum changes Internal rotation O = administer O2 (6-10L)
- Hct, hunger, UO Extension P = push IV fluids if
- blood vol, progesterone production External rotation hypovolemic
Fundus Placenta Previa
-descends 1cm/day below umbilicus Bracton Hicks ctx = 23-27w -when the placenta implants in
postpartum the lower uterine segment
Quickening = 18-22w (13-25w) where it encroaches on the
After breaking water = assess FHR! internal cervical os
Fetal heartbeat = 18-22w -one of the most common
5 Ps of labor causes of bleeding during 2nd
Passage Lochia half of pg
Passenger Rubra - red -painless bright red bleeding
Power Serosa - pink after 20th week (no warning,
Psyche Alba - yellow stops suddenly)
Sources of folic acid *risk factors: multigestation,
Plantar creases -liver, papaya, legumes, vegs, multi pregnancies
Preterm = red creases, not very spinach, breakfast cereal
distinguished Low: placenta implants in
Term =2/3 of foot Decelerations (fetal heart) lower uterine segment
Postterm = entire sole Early: head compression (normal) Partial: placenta partially
occludes cervical os
Layers of placenta = amnion (inner), Late: uteroplacento insufficiency Total: placenta totally occludes
chorion (outer) Variable: cord compression cervical os
Shiny = baby -turn pt Causes of postpartum
Serum glucose 40-60 -increase primary IV hemorrhage
-d/c pitocin -uterine atony
Preliminary signs of labor -amnioinfusion -risk increases with increased #
-Braxton hicks ctx -elevate legs of pg
-dropping (lightening) -call dr -lacerations of birth canal
-nesting -formation of a hematoma
-lose 1-2lb Why give neonate vit K?
-bloody show -neonate lacks intestinal flora to Risk:
make it -large infant
-at risk for bleeding disorders -time of labor (fast/slow)
-necessary for blood coag -retained placenta
-vit K stimulates liver to produce -# of pg
clotting factors -trauma

Chadwicks sign: blue

Goodells sign: cervical
Hegars sign: softening of
lower uterine segment

5 year old should be able to

memorize their phone #

Primary intervention with a pediatric Ectopic pregnancy BPP

burn pt = remove blisters -implantation of fertilized ovum -determines fetal demise
outside uterine cavity -fetal apgar score
Centration = tendency to center attention -no vag bleeding -use u/s
on 1 feature of something and be unable -common site: fallopian tube -fetal muscle tone
to see its other qualities -methotrexate: inhibits growth -fetal activity
-HCG, cullens sign -fetal breathing motions
Teach a pt with sickle cell how to prevent s/s: LQ abd pain on 1 side, mild- -look at fluid pocket
sickling: maintain hydration, promote mod bleeding, missed/delayed -NST
oxygenation, avoid strenuous activity menses
hypovolemic shock: from tubal Incompetent cervix
PKU = autosomal recessive rupture can occur s/s: dizziness, -premature cervical dilation
hypoT, tachycardia, low UO, -painless
Most important newborn reflex = MORO referred shoulder pain. -around 20w
(determines neuro dev) -d/t AMA, trauma
HTN disorders -cerclage
Placenta previa vs placenta abrupto? Chronic HTN
PAIN! -present before/during/after pg Maternal death
GTPAL: g: # of times she has -before 20w 1. Hemorrhage
conceived/#pregnancies. T: term births P: Gestational HTN (PIH) 2. Infection
Preterm births, A: abortions (before 20 -after 20w 3. HTN
wks) L:living/live births -no proteinuria
Placenta previa -resolves after pg NST
-after 20weeks ->140/90 -assesses fetal well-being
-painless Preeclampsia -FHR accels in response to fetal
-no vag exam -HTN and proteinuria movement
-BP -low platelets
-low/partial/total ->140/90 Menorrhagia
-after 20w -heavier than normal menstrual
Placenta abruption -prefer vag delivery bleeding
-after 20weeks Chronic HTN w/ preeclampsia
-painful -new onset proteinuria Dysmenorrhea
-d/t trauma/cocaine/HTN -sudden BP -painful menstrual bleeding
-BP Severe preeclampsia
-Kleihauer-bette test/FDP -clonus When are fetal movements
-mild/mod/strong -need 1 of 9 sx: palpable on abd? 28 weeks!
->160/110, pulmonary edema
Hyperemesis gravidarum ->5g/24h proteinuria Transition phase of labor
-d/t HCG -abnl LFTs, oliguria, IUGR -breathing should be pant/blow
-severe N/V -RUQ/epigastric pain to resist urge to push
-+ ketones BUN, HR, BP wt -thrombocytopenia
UOspecific gravity -visual/cerebral disturbances Pediatric stuff
Hydatidiform mole -seizures Burn pt priority intervention
-exaggerated sx of pg -MgSO4 is to remove blisters
-complete (grapes, empty egg, no -proteinuria
fetus/placenta/etc parts) Myelomeningocele pt priority
-partial (2 sperm/1egg, abnl HELLP intervention is to measure head
fetus/placenta, baby dies in utero) -complication of preeclamsia circumference
-hemolysis, elevated liver enzymes,
Spontaneous abortion low platelets Promote motor dev in preterm
-bleeding after 20w infant prevent grasping
-threatened Diabetes
-inevitable 1st trimester: hypoglycemia, insulin Do NOT give pregnant pt
-complete needs diuretics! -Can cause ctx!
-incomplete 2nd trimester: hyperglycemia,
-missed\ insulin begin to
3rd trimester: hyperglycemia,
Preterm Labor 21-37wks insulin and taper off at 37w
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