Dyscrasia
any abnormal condition of the blood (anemia, leukopenia, etc.) that can result from carbamazepinethese exhibit flu-like symptoms such as sore throat, fever, fatigue, pallor
Diplopia
double visionA S/S of Multiple Sclerosis
Cullen's sign
ecchymosis in umbilical area, seen with pancreatitis
Common Niacin SE
flushing of the face and neck for about an hourTeach this SE to pt before they take it
Somatic Delusions
focus on preoccupations regarding health and organ function"The doctor said I'm fine, but I really have lung cancer."
When should the nurse follow up after administering morphine?
follow-up 30 minutes after the morphine is administered to assess the effectiveness of the pain medication
Loop Diuretics examples
furosemide - Lasixbumetanide - Bumex
Long acting insulin
glargine, detemir, degludecOnce/day
Acanthosis nigricans
is a skin condition that occurs with obesity and diabetes and appears as velvet-like patches of darkened, thick skinThese areas typically occur around the back of the neck and in the groin and armpits
Dextrose 5% in water (D5W) is an _________ fluid. It helps correct dehydration.
isotonic
Ataxia
lack of muscle coordinationa S/S of Multiple Sclerosis
Advanced directives are legal documents that include ________ & ___________.
living wills & health care proxies (durable powers of attorney for health care or medical power or attorney)
Glargine and detemir are ________ acting insulins
long
SE of loperamide
loperamide causes an anticholinergic effect of urinary retention
Statins do what?
lower cholesterol
Palivizumab
monoclonal antibody that binds to RSVProvides immunity in pediatric patients at high risk for RSV
after meals
pc
Low levels of ___________ increases risk for digitalis toxicity
potassium
How should oral potassium be taken?
potassium is an erosive substance that can cause esophagitistake with plenty of water and remain sitting upright for ≥30 minutes after ingestionpotassium should be taken during or immediately following meals to prevent gastric upset
Interventions to promote safety and reduce the risk of falling when using axillary crutches in the home
resting crutches upside down on the axilla pads when not in uselooking forward when walkingmaintaining a clutter-free environmentusing a small bag to hold personal itemswearing sturdy rubber-soled shoes
Symptoms of meperidine toxicity
restlessirritableconfusedhallucinations "bugs on walls"
MAOI examples
selegilineisocarboxazidphenelzinetranylcypromineIt's not PHENE (funny) but SELEne ISO TRANY. Oh Me, Oh My (MAOI)
Verapamil
calcium channel blockerSlows SA node -> delays AV node conductionSlows ventricular rate
Chlorthalidone
thiazide diuretic
Clinical manifestations of Cushings syndrome
thin fragile skinecchymosisweakness
Loop diuretics
FurosemideTorsemideBumetanide
What drug categories is diphenhydramine?
Anticholinergic!And antihistamine of course
What is an intervention for a pt with cariogenic shock and a PAWP of 24 mmHg?
Furosemide (Lasix) to decrease left ventricular preload
Patients with which allergy should not take celecoxib?
Sulfa allergyCelecoxib contains a sulfur molecule
COX-2 inhibitors are contraindicated in patients allergic to what?
Sulfa drugsAspirinNSAIDs
How do beta blockers work?
block Sympathetic NSreduce O2 demandslow HRlower BP
SE of thiazide diuretics
hyperkalemia - manifests as muscle cramps
How long does a pt need to take Warfarin after mechanical valve replacement?
Anticoagulant therapy (warfarin) will be needed for life after a mechanical valve replacement to prevent thromboembolic events (stroke) and valve thrombosis
PPIs
"-prazole"OmeprazolePantoprazoleEsomeprazoleWork better than H2 blockers
Chronic hyperglycemia can cause microvascular damage in the retina, leading to diabetic retinopathy, the most common cause of new blindness in adults. Which vision problem is an emergency?
"Half my vision looks like it is being blocked by a curtain!"This statement indicates a retinal detachment requiring emergency managementA partial retinal detachment may be painless and cause symptoms such as a curtain blocking part of the visual field, floaters or lines, and sudden flashes of lightAn unrepaired complete retinal detachment can cause blindness
Delusions of Grandeur
"I need to get to Washington for my meeting with the president."
Nihilistic Delusions
"It doesn't matter if I take my medicine. I'm already dead."Belief that a major catastrophe will occur
Trismus
"Lockjaw"
Superior mesenteric artery syndrome
"cast syndrome" A rare complication of an overly tight cast that involves compression of the duodenum by the SMAImmobilization of clients in body casts decreases peristalsis and may cause a paralytic ileus (bowel obstruction)
How do loop diuretics affect potassium?
"potassium-wasting" diureticsmay cause hypokalemia
Benztropine is used for
(Cogentin) is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide
Antifungals
-azoleKetoconazoleItraconazoleVoriconazole
Analgesics
-caineLidocaineBenzocaineBupivacaineNovocaineblocks sodium channels numb things (calm things down, reduce pain)
metabolic alkalosis compensation
-compensatory hypoventilation to retain CO2 and decrease pH-may cause hypoxemia
Protease Inhibitors
-navirRitonavirTreat HIV and Hep C
Macrolides
-thromycin"throw mice"Azithromycin - Zpack for URIClarithromycinErythromycin
H2 Receptor Blockers
-tidineCimetidineFamotidinereduce acid
Antivirals
-virAcyclovirValganciclovirCidofovirTenofovir
SSRIs
-xetineParoxetineFluoxetineSertralineCitalopram
Benzodiazepines
-zepam-zolamDiazepamAlprazolamMidazolamTriazolam
alpha blockers
-zosin
Digoxin therapeutic range
0.5 - 2.0 ng/mL
Normal Cr - NCLEX level
0.6 - 1.3
Normal Creatinine male
0.6 - 1.3 male
Normal Creatinine
0.6-1.3 mg/dL
Normal INR
0.75-1.25
When should calcium channel blockers be administered?
1 hour before mealsOR2 hours after meals
Healthy infants gain about ____ ounce(s) per day or _____ lb(s) per week for the first 3 months
1 ounce per day 0.5 lb per week
What should you do if a child collapses, is apneic, and has a pulse of 60 or less?
1) 2 rescue breaths2) If pulse still slow, begin compressions3) If pulse returns to > 60, go back to just breaths
Tx for Magnesium Toxicity
1) Immediately D/C magnesium infusion2) Administer antidote: IV Calcium Gluconate bolus3) Prepare for actions to prevent respiratory or cardiac arrest
You see VTach on the monitor. What 2 things do you need to assess about it to determine treatment?
1) Is there a pulse?2) If there is a pulse, is the pt stable or unstable? Signs of instability include hypotension, altered mental status, signs of shock, chest pain, and acute heart failure
Process of changing a negative-pressure wound therapy dressing
1) Medications are administered preprocedure to prevent discomfort - 30 mins prior2) After wound cleansing, a skin protectant is applied around the wound to prevent breakdown and promote an air-tight seal3) A sterile foam dressing is cut to fit the wound shape and size and is placed in the wound bed - edges should extend beyond the size of the wound - do not cut foam directly over wound site b/c pieces will fall into wound4) Then a vacuum-assisted closure (VAC) unit is connected to create negative pressure5) The foam dressing should compress when the device is turned on, indicating a proper seal and functioning equipment
Examples of pregnant clients who should NOT be given opioid agonist-antagonist medications
1) Mom at 3cm dilation who wants to ambulate - opioids could prolong her labor and make her dizzy during her walk2) Mom in active labor with recent heroin use - risk for maternal and/or fetal withdrawal symptoms3) Mom at 9cm with urge to push - opioids cross placenta and could cause respiratory depression in baby who will likely be born soon
Drugs that can cause orthostatic hypotension
1) Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (metoprolol) and alpha blockers (terazosin)2) Antipsychotic medications (olanzapine, risperidone) and antidepressants (SSRIs)3) Volume-depleting medications such as diuretics (furosemide, hydrochlorothiazide)4) Vasodilator medications (nitroglycerine, hydralazine)5) Narcotics (morphine)
Asthma exacerbation treatment:
1) O2 to maintain sat >90%2) High-dose inhaled short-acting beta agonist (SABA) (albuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes3) Systemic corticosteroids - IV methylprednisolone (Solu-Medrol)
How often should a rescue inhaler be taken apart and washed?
1-2 times/week
Dextrose 10% in water (D 10W), dextrose 5% in lactated Ringer's (D 5LR), and dextrose 5% in 0.9% sodium chloride (D 5NS; D 50.9% NaCl) are ____________ solutions.
hypertonic
Evaluation of kidney function is essential for clients taking medications that are excreted renally or can worsen renal injury. These include 3 major classes/drugs:
1. ACE inhibitors (lisinopril, enalapril)2. Aminoglycosides (gentamicin)3. Digoxin
Acceptable blood product alternatives for Jehovah's Witnesses include
Non-blood volume expanders (saline, lactated Ringer's, dextran, hetastarch)Albumin-free erythropoietin (epoetin alfa)
Treatment for an acute asthma attack:
1. Oxygen to maintain saturation >90%2. High-dose inhaled short-acting beta agonist (albuterol or levalbuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 mins3. Systemic corticosteroids (Solu-Medrol) to control the underlying inflammation - note that these will take some time to show an effect
Can children take fluoroquinolones?
Nope
Can LPNs administer blood?
Nope!
Normal magnesium levels
1.5 - 2.5
The ostomy bag is emptied when it becomes ____________ full.
1/3 fullLeaking and skin irritation may occur if the appliance becomes too heavy and pulls away from the skin
Children under the age of ____ should automatically be upgraded to 1 level higher than the triaged urgency of their medical issues.
10
Maximum infusion rate of KCl through a PIV is __ mEq/hr and the maximum concentration is __ mEq/L
1040
HR for 1-year-old
100 - 160
Normal newborn HR
110-160 when awake and calm80/min during rest180/min when crying or agitated
Normal Hgb
13.2 - 17.3
Normal Hgb for male and female
13.2-17.3 male11.7-15.5 female
Normal platelet count
150,000-400,000 cells/mm3
Houses built before ______ have a high probability of containing lead-based paint.
1978Active renovations can significantly increase the amount of lead released into the home environment, causing lead poisoning (neurological and motor impairment)
IV hydromorphone should be injected over how many minutes?
2 - 3 mins, either diluted with 5ml NS or undiluted
How many arteries and veins are in the umblical cord?
2 arteries and 1 vein
a normal umbilical cord has ___ arteries, ___ veins
2 arteries, 1 vein AVA
Normal CVP
2-8 mmHg
Why is it bad to give escitalopram to a pt who stopped phenelzine yesterday?
SSRIs (escitalopram) cannot be combined with (MAOIs) (phenelzine) as there is a risk of serotonin syndromeMAOI effects persist long after dosing stopsAn MAOI should be withdrawn at least 14 days before starting an SSRI
A pt with depression who takes herbal supplements should be educated about which supplement?
SSRIs and St John's wort increase serotonin levels in the brainPts taking both products concurrently are at risk for potentially life-threatening serotonin syndrome (agitation, confusion, tachycardia, diaphoresis, tremors, hyperreflexia)
Histrionic personality disorder
Self-dramatizing, exaggerated, shallowAttention-seeking, needs to be the center of attentionOverly friendly and seductive, attempts to keep others engagedDemands immediate gratification and has little tolerance for frustration
opioid-induced constipation is treated with simultaneous use of _______________ and ________________
Senna (stimulant)AND Docusate (stool softener)
Introjection
Taking in and "swallowing" the values and standards of othersSharing the political views of your favorite famous actor
Permanent effect of long-term phenothiazine administration?
Tardive dyskinesia is a permanent extrapyramidal symptom
Warfarin is usually administered for __ - __ months following PE to prevent further thrombus formation.
3 - 6 months
tPA must be administered within _____ of onset of clinical stroke symptoms.
3 to 4.5 hr window from onset
A common side effect of tiotropium and other anticholinergics (ipratropium, benztropine) is
Xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivationSugar-free candies or gum may be used to alleviate dry mouth and throat
Can a UAP provide perineal care around an indwelling urinary catheter and reapply SCDs?
Yes
Do you shake an albuterol canister prior to inhalation?
Yes
Does varicella zoster require use of an N95 respirator?
Yes
Is it ok to mix NPH with regular insulin or lispro?
Yes
Is it ok to administer Levofloxacin to a pt who has anaphylactic reactions to penicillins?
Yes!Levofloxacin, a fluoroquinolone antibiotic prescribed to treat UTIs, has no known cross-sensitivity to penicillin
Normal albumin levels
3.5-5
A normal respiratory rate for an infant
30-60/min
Normal Hct male
39% - 50% male
Undiluted morphine IV push should be administered slowly over how many minutes?
4 - 5 mins
A therapeutic magnesium level of ____ - ____ mEq/L is necessary to prevent seizures in a preeclamptic client.
4 - 7
How long until SSRIs start working?
4-6 weeks
Autonomic dysreflexia is an acute, life-threatening response to noxious stimuli, which clients with spinal cord injuries above _____ are unable to feel.
Above T6Signs and symptoms include hypertension, bradycardia, a pounding headache, diaphoresis, and nauseaIt is essential that the nurse assess for and remove noxious stimuli to prevent a strokeNoxious stimuli may include:Bladder distention (obstructed urinary catheter, neurogenic bladder)Fecal impactionTight clothing (shoelaces, waistbands)
Which drug is tPA?
Alteplase
Beta blockers can mask symptoms of ________________
hypoglycemia
Is it ok to administer IV morphine to a pt with who just underwent nephrolithotripsy who has not had a BM in 2 days?
Yes! Although opioids (morphine) can cause constipation, symptoms can be managed with pharmacologic (docusate sodium, sennoside) and nonpharmacologic interventions (increased activity, increased fiber and fluid intake)Percutaneous nephrolithotripsy breaks and removes kidney stones, and can lead to severe pain - therefore, pain medication is appropriate
The nurse should administer atenolol for any HR greater than _____.
60
A normal blood glucose range for an infant
40-60 mg/dL within the first 24 hours after deliveryA blood glucose level < 40 indicates hypoglycemia
Ketorolac (Toradol)
a highly potent NSAID
Phlebostatic axis is located where?
4th ICS, at the midway point of the AP diameter (½ AP) of the chest wall
Normal BUN
6 - 20 male
Stranger anxiety begins at what age?
6 months
How long does drug therapy last for a pt with TB?
6 months or longer
Normal PaO2
80-100
If pt is obese, administer SQ at a ____-degree angle!
90
Normal infant HR
90-160
A normal temperature range for an infant
97.7-99.7 F (36.5-37.6 C)
An individual with a CD4 lymphocyte percentage < ____% is considered to be severely immunocompromised.
< 15%
Low platelet count is not considered an urgent need until it is at < __________.
< 50,000
Secondary Postpartum Hemorrhage (PPH)
>24 hours but <6 weeks postpartumUsually results from uterine subinvolution (does not return to original size), retained placental fragments/membranes, or uterine infection(Option 1) Postpartum fatigue is common due to the adjustments needed to provide newborn care or may be related to postpartum anemia. Follow-up is necessary, but it is not the most concerning statement.(Option 2) Bright red bleeding with defecation is associated with hemorrhoids, a common finding in pregnancy. Hemorrhoids usually begin to shrink following birth.(Option 4) Physiologic fluid retention in pregnancy may cause medial nerve compression (ie, carpal tunnel syndrome), an expected discomfort of pregnancy marked by a tingling or burning sensation of the hands.Educational objective:Secondary or delayed postpartum hemorrhage (PPH) occurs >24 hours but <6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH.
When should children be screened for elevated blood lead levels?
A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened
What is a priority when caring a pt after a carotid endarterectomy?
A carotid endarterectomy is a surgical procedure that removes atherosclerotic plaque from the carotid arteryBlood pressure is closely monitored during the first 24 hrs postopHypertension may strain the surgical site and trigger hematoma formation, which can cause hemorrhage or airway obstruction*SBP is maintained at 100-150 mmHg to ensure adequate cerebral perfusion and avoidance of hemorrhage or strain
Misoprostol (Cytotec)
A cervical ripening agentIn addition to ripening the cervix, prostaglandins (misoprostol, dinoprostone) can stimulate frequent contractionsIt is given PO or vaginally, OR rectally in case of PPH
How should a parent handle a child with school phobia?
A child with school phobia needs to return to the classroom immediatelyInsisting on school attendance, along with other supportive interventions, will help the child make a faster adjustment
Solifenacin
A cholinergic antagonist prescribed to treat symptoms associated with an overactive bladder (urge incontinence, frequency)Common expected adverse effects include dry mouth and constipationCan cause dizziness and blurred vision
Expected lab finding in an infant with pyloric stenosis
A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydrationElevated BUN is also a sign of dehydration
Which diet should a patient follow when taking mebendazole?
A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms
Impetigo
A highly contagious bacterial skin infection, most commonly occurring in children during hot, humid weatherItchy, burning, red pustules that rupture to form honey-colored crustsWhen treated with antibiotic ointmentand/or oral antibiotics, lesions are no longer contagious after 24-48 hours and typically heal within a week
Fat embolism syndrome (FES)
A life-threatening condition that has no specific treatmentWhen a long bone is fractured, pressure within the bone marrow leads to release of fat globules into the bloodstreamThese combine with platelets (fat embolus) and can travel to the brain, lungs, and kidneys
Signs of bleeding into retroperitoneal space
A client who undergoes percutaneous coronary intervention (PCI) and intracoronary stent placement using the femoral approach is at increased risk for retroperitoneal hemorrhageAdministration of antithrombotic drugs before, during, and after PCI can exacerbate potentially life-threatening bleeding from the femoral arteryS/S:Hypotension, back pain, flank ecchymosis (Grey-Turner sign), hematoma formation, and diminished distal pulses can be early signs of bleeding into the retroperitoneal space and require immediate intervention/evaluation (notify health care provider, serial CBCs, abdominal CT)
Psychomotor retardation
A clinical finding in some pts diagnosed with major depressive disorderThe key features include:1) Decreased movement2) Inability or decreased ability to talk3) Impaired cognitive function4) Lack of facial expression5) Downcast gaze
Psychogenic dystonia
A psychogenic movement disorder characterized by involuntary muscle contractions that cause slow, repetitive movements such as twisting and abnormal postures
Carbidopa/levodopa can affect urine how?
A common medication used to manage symptoms of Parkinson disease, can cause a harmless darkening of urine color (brown, black)
Bronchiolitis
A common viral illness of childhood that is usually caused by RSVTreatment: supportive care; most children can be managed in the home environmentBreastfeeding should be continued and additional fluids offered if there is a risk of dehydration due to frequent coughing and vomitingParents should be instructed to use saline nose drops and then suction the nares with a bulb syringe to remove secretions prior to feedings and at bedtimeNO meds
Dextromethorphan
A cough suppressantAntitussive
Tetralogy of Fallot (TOF)
A cyanotic cardiac defect that causes chronic hypoxemia due to decreased pulmonary blood flow and circulation of poorly oxygenated bloodTo compensate for prolonged tissue hypoxia, erythropoietin production increases to produce additional oxygen-carrying RBCsIncreased RBCs result in increased circulatory viscosity or polycythemia (hgb >22 g/dL or hct >65%)Polycythemia increases the risk for blood clotting (thrombus formation), which can cause stroke
Cystic fibrosis (CF)
A defective protein responsible for transporting Na+ and Cl- causes exocrine gland secretions to be thicker and stickier than normalViscous respiratory secretions accumulate, resulting in impaired airway clearance and a chronic coughEventually develop chronic lung disease, which predisposes them to recurrent respiratory infectionPancreatic enzyme secretion, needed for digestion and absorption of nutrients, is also impaired because thick secretions block pancreatic ductsPt needs supplemental enzymes with all meals and snacksRequires multiple vitamins and a diet high in carbohydrates, protein, and fat to help meet nutritional requirements for growthSweat gland abnormalities prevent Na+ and Cl- reabsorption, causing increased salt loss, dehydration, and hyponatremia during times of significant perspiration - parents should increase the child's salt intake and fluids during hot weather, exercise, or feverPts should incorporate chest physiotherapy (percussion, vibration, postural drainage) into their daily routine to improve mucus clearance and lung functionEncourage physical activity as tolerated, which helps to thin secretions and remove them from airways and improves muscle strength and lung capacity
Atrial fibrillation
A disorganization of electrical activity in the atria due to multiple ectopic fociIt results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of bloodDuring atrial fibrillation, the atrial rate may be increased to 350-600/miThe ventricular response (pulse rate) can varyThe higher the ventricular rate, the more likely the client will have symptoms of decreased CO (hypotension)*Ventricular rate control is a priority in clients with atrial fibrillation
What needle is used to withdraw medication from a glass ampule?
A filter needle must be used when withdrawing medication from a glass ampule to prevent aspiration and injection of glass shardsAfter the medication is withdrawn, the filter needle is discarded and an injection needle (eg, 20-gauge, 1-in [2.5-cm] needle) is attached to the syringe
Methotrexate
A folate antimetabolite, antineoplastic, immunosuppressant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug used to treat rheumatoid arthritis and psoriasisPt education:Obtain routine killed (inactivated) vaccines (influenza, pneumococcal) and avoiding crowds and persons with known infectionsLive vaccines (herpes zoster) are contraindicatedAlcohol should be avoided in clients taking methotrexate as it is hepatotoxicPhotosensitivity (tetracycline, thiazide diuretics, and sulfonamides) and nephrotoxicity (common with aminoglycosides, vancomycin, and nonsteroidal anti-inflammatory drugs) can occur
What should you do if the patient's ventilator is alarming, you have check all the connections, and the O2 sat is dropping?
A low tidal volume alarm indicates that the volume of air the ventilator is delivering is lower than the set volume. This is most often due to a disconnection, loose connection, or leak in the circuit. The nurse should troubleshoot the most common causes of the alarm, but if the client's condition is deteriorating clinically (eg, decreasing oxygen saturation), then the nurse should:Disconnect the ventilator and manually ventilate the client's lungs with a resuscitation bag device at 10-15 L/min oxygen until the ventilator alarm state can be resolved. Then call the RT!
Autonomic dysreflexia (autonomic hyperreflexia)
A massive, uncompensated cardiovascular reaction by the sympathetic nervous system (SNS) in a spinal injury at T6 or higherDue to the injury, the parasympathetic nervous system cannot counteract the SNS stimulation below the injuryClassic triggers are distended bladder or rectum
Which pt should be seen first?1) Cancer pt on chemo with new onset back pain and weak legs2) Cancer pt on chemo with persistent vomiting and K+ of 3.4
A new-onset finding is more concerning than chronic or expected findingsThere is a risk of spinal cord compression from a metastatic tumor in the epidural spaceThe classic symptoms are localized, persistent back pain; motor weakness; and sensory changes (numbness, paresthesia)Neurologic changes are a priority because the symptoms are subtle and time sensitive for permanent negative outcomesBone is a common site for metastasis due to its vascularity(The 3.4 K+ is barely low and vomiting is expected for a chemo pt)
Albuterol (Proventil)
a short-acting beta agonist a rescue drug to relieve symptoms (eg, wheezing, breathlessness, chest tightness) associated with asthma
Functional nursing
A nursing care pattern focusing on tasks and jobs; each nursing team member has certain tasks and jobs to do
McBurney point
A point halfway between the anterior superior iliac spine and the umbilicus on the pt's right sideThe area of pain and rebound tenderness in patients suffering from acute appendicitis
Hirschsprung's disease
A portion of the colon has no innervation and must be removed. Some children require a temporary colostomy.
Nicardipine
A prototype of nifedipine and is a potent calcium channel blocking vasodilatorIt takes effect within 1 minute of IV administrationIt is essential to monitor that the BP is not being lowered too quickly or too slowlyMust be discontinued if hypotension or reflex tachycardia occurs
What do you do if a chest tube becomes dislodged?
A sterile occlusive dressing (petrolatum gauze) must immediately be placed over the insertion site until the HCP can assess the client and insert a new chest tube*If such dressings are not immediately available, the nurse should cover the insertion site with something clean and occlusive gloved hand) to prevent air from entering the pleural cavityAfter the chest tube insertion site is covered, the client should be assessed
Nitrazine pH test strip
A strip inserted into the vagina that can differentiate between amniotic fluid, which is alkaline, and vaginal fluid, which is acidicA blue-green, blue-gray, or deep blue color indicates a positive result and probable rupture of membranesA yellow, olive-yellow, or olive green color indicates a negative result and suggests that membranes are intact
Bishop score
A system for the assessment and rating of cervical favorability and readiness for induction of laborThe cervix is scored (0-3) on consistency, position, dilation, effacement, and station of the fetal presenting partA higher Bishop score indicates an increased likelihood of successful induction that results in vaginal birthFor nulliparous women, a score ≥6-8 usually indicates that induction will be successful
Systolic murmur in a pregnant woman
A systolic murmur (swooshing sound heard during S1) is a common finding in pregnancyIt results from increased total body volume (flow murmur) and usually resolves after birth
Middle East respiratory syndrome (MERS)
A viral respiratory illness caused by the coronavirus (MERS-CoV)Symptoms include fever, cough, and SOB that often worsen and cause death in many of those afflictedHow the virus spreads is not fully understood, but it is thought to spread via respiratory secretionsPPE: standard, contact, and airborne precautions with eye protection when caring for clients with MERS - includes an N95 respirator
Regular insulin
best for IV use for diabetic ketoacidosisShort-actingPeak: 2-5 hours
Which antihypertensive medication class is helpful in diabetics?
ACE Inhibitors
Captopril is an ___________ that also causes ______________.
ACE inhibitorhyperkalemia
Angioedema and dry, hacking cough are adverse effects of which class of medications?
ACE inhibitors (enalapril, lisinopril, captopril) and occurs more commonly in African American clients
Which antihypertensives can worsen hyperkalemia?
ACEs and ARBs
Desmopressin
ADH agonist used to treat Diabetes InsipidusMonitored for UO, urine specific gravity, and serum Na+ (to avoid hyponatremia due to excess DDAVP)
Losartan is an ____________ that causes _____________.
ARBhyperkalemia
Behavioral management for agitated clients with Alzheimer disease includes:
Acknowledging client feelingsReassuring safetyDistractingRedirecting to other activities
Colchicine is used to treat
Acute attack of gout because it decreases the inflammation and pain associated with deposition of uric acid crystals in the joints
Pain and tenderness in the epigastric or right upper quadrant of the abdomen that is referred to the right scapula is associated with
Acute cholecystitisMay also experience indigestion, nausea, vomiting, restlessness, and diaphoresis
Sucralfate
An oral medication that forms a protective layer in the GI mucosa, which provides a physical barrier against stomach acids and enzymesIt does not neutralize or reduce acid production but is prescribed to treat and prevent both stomach and duodenal ulcersSucralfate is generally prescribed 1 hour before meals and at bedtime and, for effective results, is taken on an empty stomach with a glass of waterSucralfate forms a better protective layer at a low pH level - therefore, antacids or other acid-reducing medications (PPIs, H2 blockers) should be avoided within 30 minutes of taking sucralfateSucralfate should be taken 1 hour before meals to protect the stomachSucralfate binds with many medications (digoxin, warfarin, phenytoin), reducing their bioavailability and effectiveness - therefore, all other medications are generally taken ≥ 1-2 hours before or after taking sucralfateConstipation is a common side effect of sucralfate
NPH insulin is ____ acting
intermediate
Adalimumab
Adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) are common tumor necrosis factor inhibitor, biologic disease-modifying antirheumatic drugsMajor adverse effects include immunosuppression and infection
Which medication is administered for SVT and how is it administered?
Adenosine!Rapid IV push!The half-life is <5 seconds, so adenosine should be administered rapidly as a 6-mg bolus IV over 1-2 seconds followed by a 20-mL saline flush.Repeat boluses of 12 mg may be given twice if the rapid rhythm persistsThe injection site should be as close to the heart as possible (antecubital area)
The nurse should anticipate the following interventions for clients in Preterm Labor before 34 weeks gestation:
Administer IM antenatal glucocorticoids (betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development Administering IVantibiotics (penicillin) to prevent group B Streptococcus infection in the newborn if preterm birth occursInitiating an IV magnesium sulfate infusion for fetal neuroprotection if at <32 weeks gestationGiving tocolytic medications (nifedipine, indomethacin) to suppress uterine activity, which allows antenatal glucocorticoids time to have a therapeutic effectMonitoring pertinent laboratory results, including cultures for vaginal or urinary tract infection and group B Streptococcus, if obtainedPlace on continuous fetal monitoring
Amnioinfusion
Administered through an intrauterine pressure catheter to relieve variable decelerations, not late decelerationsVariable decelerations are usually caused by cord compression secondary to loss of amniotic fluid (after rupture of membranes, because of oligohydramnios)
The priority in treatment of hyperkalemia with ECG changes (peaked T waves) is
Administration of IV calcium gluconate to immediately prevent life-threatening dysrhythmiasThen IV regular insulin with dextrose, sodium polystyrene sulfonate, and/or hemodialysis may be implementedIV regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells - dextrose is administered concurrently to prevent hypoglycemia
Mannitol
An osmotic diuretic used to treat cerebral edema (increased ICP) and acute glaucomaWhen administered, mannitol causes an increase in plasma oncotic pressure (similar to excess glucose) that draws free water from the extravascular space into the intravascular space, creating a volume expansionThis fluid, along with the drug, is excreted through the kidneys, thereby reducing cerebral edema and intracranial pressureHowever, if a higher dose of mannitol is given or it accumulates (as in kidney disease), fluid overload that may cause life-threatening pulmonary edema resultsAn early sensitive indicator of fluid overload is new onset of crackles auscultated in the lungs
When should infants no longer have head lag?
After age 4-6 monthsHead lag remaining after age 6 months is an abnormal finding often associated with cerebral palsy or autism
Beta agonists
AlbuterolTerbutaline
Rapid-acting asthma medications
Albuterol and Ipratropium
Who should get the influenza vaccination?
All pts age ≥6 months should receive the influenza vaccine annually unless the client has a life-threatening allergy to the vaccine or one of its ingredientsEspecially vaccinate the following people:- Clients with chronic conditions (asthma, HF, cancer) may experience exacerbation of symptoms if infected- Immunocompromised clients (HIV) have decreased ability to fight infection- Health care workers and caretakers are at greater risk for acquiring and transmitting infection to other clients- Healthy children age 6-23 months and clients age ≥65 are at greatest risk for serious, flu-related complications (pneumonia, dehydration)- Pregnant clients are at increased risk for premature labor/delivery or influenza complications due to pregnancy-related physiologic changes
Benzodiazepines for acute anxiety include
AlprazolamLorazepam
Buretrol
Also known as a volume control device, may be used to reduce risk for fluid overload or medication overdoseMay also be used for intermittent medications that need to be further diluted and given over a specific time.
In children with cystic fibrosis, which medications may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction?
Aluminum hydroxide and magnesium hydroxide
How does Amantadine work for pts with Parkinson's?
Amantadine is a dopamine-releasing agentIt increases the amount of dopamine present in the CNS
Zolpidem
AmbienInsomnia Hypnotic
Tricyclic antidepressants
Amitriptylinenortriptylinemoxapine
Which medication is prescribed for neuropathic pain to reduce opioid use?
Amitriptylinetricyclic antidepressant
ALS
Amyotrophic lateral sclerosis, also known as Lou Gehrig disease, is a debilitating, progressive neurodegenerative disease with no cureClients develop fatigue and muscle weakness that progresses to paralysis, dysphagia, difficulty speaking, and respiratory failureMost clients diagnosed with ALS survive only 3-5 years
Suspect a chest tube air leak when ...
An air leak would cause bubbling in the air leak gauge or water seal chamber NOT in the suction control chamberGentle, continuous bubbling in the suction control chamber of a chest tube drainage unit indicates the presence of suction in the system and is an expected finding
Unilateral neglect
An alteration in sensory perception that causes clients to ignore input from the affected side, leading to performing actions only on one side (eg, eating food on only the right side of the plate)Teaching clients to turn the head to fully scan the environment reduces the tendency to neglect one side
Tobramycin
An aminoglycoside antibiotic drug used to treat serious gram-negative bacterial infections
Amphotericin B
An antifungal used to treat systemic fungal infectionsCommonly associated with severe adverse effects, including hypotension, fever, chills, and nephrotoxicityDo not administer at the same time as blood products
Signs of child abuse
Shaken baby syndrome (irritability or lethargy, poor feeding, emesis, seizures)Burns in the shape of household items (iron, spatula), from cigarettes, or from immersion in scalding liquidRepeated injuries in varied stages of healing (bruises, burns, fractures)Injuries to genitaliaLapsed time between the injury and the time when care is soughtInconsistency between the injury and the caregiver's explanation of the injury (client's developmental age, mechanism of injury)
Myasthenia gravis
An autoimmune disease manifesting mainly as muscle weakness and ptosisThe muscle weakness increases with activity, and by the end of the day, ptosis is presentPts with myasthenia crisis can have respiratory failure
Benztropine
Anticholinergic Medicationtreats the extrapyramidal symptoms associated with chlorpromazine
Postpartum endometritis
An infection of the endometriumCharacterized by fever, chills, tachycardia, uterine tenderness, and purulent lochia
Dopamine
An inotrope used to treat hypotension due to bradycardia
Radiofrequency catheter ablation
An invasive procedure that may be used to treat clients with recurrent episodes of SVTA catheter is inserted through a large artery or vein (femoral) and threaded to the heartAfter cardiac catheterization, clients must remain supine with the head of the bed at ≤30 degrees and the affected extremity straight to prevent bleeding from the catheter insertion siteAny level of chest pain after ablation should be reported immediately to the health care provider (even 2/10 pain)
Nursing care for Renal Calculi
Analgesics administered at regularly scheduled intervalsRehydration of up to 3 L/day unless contraindicated by other comorbiditiesAmbulation to facilitate the passage of calculiStrain all urine obtained - stones are analyzed for composition in labMonitored heat therapy on flank is ok but no massage
At what Hgb level is epoetin administered to a pt with CKD?
Anemia associated with chronic kidney disease is treated with recombinant human erythropoietin (Epogen/Procrit, epoetin)Therapy is initiated when Hgb is < 10 g/dLTherapy should be discontinued or the dose reduced for hemoglobin >11 g/dL to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs
MRI is contraindicated in pts with:
Aneurysm clipsMetallic implants such as Implantable Cardioverter Defibrillators (ICDs)Pacemakers, electronic devicesHearing aidsShrapnel
What is the difference between antacids and H2 antagonists?
Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief
Difference between H2 blockers and antacids
Antacids neutralize gastric acid to keep pH at 3.5 or aboveH2 Blockers decrease the production of gastric secretions (-tidines)
Tamoxifen
Anti-estrogenic drug used to decrease the occurrence of certain breast cancers
How do you treat stable VTach with a pulse?
Antiarrhythmic medications (amiodarone, procainamide, sotalol)
Adenosine
Antiarrhythmic used to treat supraventricular tachycardia (SVT)
Should you administer pain meds/antipyretics or antibiotics first?
Antibiotics
Ezetimibe
Antihyperlipidemic
Clonidine class
Antihypertensive(and analgesic)
Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?
Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication.
Cisplatin
Antineoplastic medication that can cause renal toxicityCheck UO, BUN, and Cr
Carbidopa/levodopa
Antiparkinson medicationMay cause dizziness, involuntary movements, and orthostatic hypotension, further increasing the risk for falls
Clopidogrel (Plavix)
Antiplatelet agent
Phenytoin
Antiseizure medication
Baclofen
Antispasmodic drug commonly prescribed to clients with multiple sclerosis to relieve uncomfortable spasms and muscular painDizziness when attempting to stand or changing positions (orthostatic hypotension) is a common adverse effect
What could trigger a low-pressure limit alarm in a pt with a ventilator?
Any condition that decreases airway resistance (tubing disconnect, extubation, endotracheal or tracheostomy tube cuff leak) can trigger the low-pressure limit alarm
What do you do if a 5 minute APGAR is <7?
Apgar scoring is repeated every 5 minutes for up to 20 minutes if the 5-minute Apgar score is <7Scores <7 indicate difficulty transitioning and may require further interventions (oxygen, suctioning) in addition to typical supportive measures (stimulating, drying, warming)
Interventions for a client with a suspected cervical spine injury are ...
Application of a rigid hard collarPlacing the client on a firm surfaceLogrolling the client during movement and transfersContinued assessment of need for an advanced airway
Labor Pain intervention for fetus in Right Occiput Posterior (ROP) position
Applying counter-pressure to the sacrum during contractions
What should you check before giving a patient a cephalosporin?
Are they allergic to penicillin??
Why is careful handling required for hypothermic pts?
As the core temperature decreases, the cold myocardium becomes extremely irritableFrequent turning could cause spontaneous VFib and should not be performed during the acute stage of hypothermiaContinuous cardiac monitoring should be initiated
ADHD medications
Stimulants such as methylphenidate (Ritalin) and amphetamines (dextroamphetamine, lisdexamfetamine)
Priority assessment prior to administering Kayexalate
Assess abdomen and review EMR for frequency of stoolsIn clients without normal bowel function (post surgery, constipation, fecal impaction), there is a risk for intestinal necrosisDuring sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy, cramping) can develop - frequent monitoring of electrolyte status is requiredBecause potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium) - the client should be monitored for signs of fluid overload (crackles, JVD, edema) and have daily weights and I&O assessment
Hypercyanotic episodes occur in infants with which disease?
Associated with Tetralogy of FallotThe knee-chest position increases systemic vascular resistance in the lower extremities and can help
How long must a patient remain at the healthcare center after receiving an allergy shot?
At least 30 mins to assess for anaphylaxis
Is it ok to apply a heating pad on a pts abdomen if they have appendicitis?
Avoid applying heat to the abdomen as this increases appendiceal swelling and the risk of appendix perforation
Teaching plan for isoniazid (INH)
Avoid intake of alcohol and limit use of other hepatotoxic agents (acetaminophen)Take pyridoxine (vitamin B6) if prescribed to prevent neuropathyAvoid aluminum-containing antacids (aluminum hydroxide (Maalox)) within 1 hour of taking INHReport changes in vision (blurred vision, vision loss)Report scleral and skin jaundice, vomiting, dark urine, fatigue, numbness, tingling of extremities
What type of diet is required for a patient taking MAOIs? Why?
Avoid tyramine-containing foods (eg, cheese, overripe fruit, liquor, beef/chicken liver, fermented products) due to risk of hypertensive crisis
At what platelet count should you avoid IM injections and venipuncture?
Avoiding intramuscular injections and minimizing venipunctures is most important when the platelet count is below 50,000/mm3, as these can cause prolonged bleeding
Expected SE of methotrexate
Stomatitis
When a foreign body becomes accidentally embedded in a pt's eye, what should the nurse do?
BOTH eyes should be shielded to prevent eye movement and additional injuryThe nurse should immediately refer the client to an ophthalmologist for further evaluation and treatment
Which 4 proteins have gluten in them?
BarleyRyeOatsWheatmnemonic: BROW
Which medication class should the nurse monitor apical rate and assess for decreased BP?
Beta Blockers
Carvedilol
Beta blocker used to improve cardiac output and slow the progression of heart failure
Why is wheezing a bad sign after a pt receives a beta blocker?
Beta blockers cause P to decrease secondary to a decrease in HR. Bronchoconstriction may occur due to the effect on the beta2 receptors. The presence of wheezing in a client taking propranolol may indicate that bronchoconstriction or bronchospasm is occurring. The nurse should assess for any history of asthma or respiratory problems with this client and notify the health care provider (HCP).
Hirschsprung Disease s/s
Bilious green vomitingAbdominal distensionFailure to pass meconium Tight anal sphincter
Potential complications for a pt with a total thyroidectomy
Bleeding (throat compression)Hypocalcemia (if parathyroids were removed inadvertently)
Where should you check the pulse of an unresponsive infant <1 year old?
Brachial artery
Adverse effects of beta-blockers include
BradycardiaBronchospasmDepressionDecreased libido with erectile dysfunction
Abciximab
Glycoprotein (GP) IIb/IIIa receptor inhibitors (abciximab, eptifibatide, tirofiban) are used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complicationsGP IIb/IIIa receptor inhibitors can cause serious bleedingGlycoprotein IIb/IIIa receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) inhibit platelet aggregation and increase bleeding riskSerious thrombocytopenia can occur within few hours, further increasing bleeding risk
Why are H2 antagonists taken at bedtime?
Blocks hydrochloric acid secreted at timeH2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action
Guillan-Barre Syndrome
Body produces auto-antibodies that cause demyelination of nerves leading to muscle paralysis and weaknessS/S: ascending muscle paralysis and absence of reflexes
The major adverse effects associated with methotrexate include
Bone marrow suppressionHepatotoxicityCongenital abnormalities and fetal deathSo get flu shot, don't drink alcohol, and don't get pregnant
Peak of NPH
Both insulin NPH, an intermediate-acting insulin, and insulin detemir, a long-acting insulin, have peak effect timesthat may cause hypoglycemia at 5-6 hours later
What should the nurse assess before administering atropine?
Bowel sounds (should have 3 - 35 sounds/min)Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony
Which type of inhaler is used first?
Bronchodilator before corticosteroid
Theophylline
Bronchodilator used to treat asthma and COPD
Battle sign
Bruising behind an ear over the mastoid process that may indicate a basilar skull fracture
Dehiscence
Bursting open of a wound, especially a surgical abdominal wound
Which analgesic should the nurse anticipate administering for a patient with pain during the active stage of labor?
Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics
Opioid agonist-antagonist medications used in labor include:
Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain)Maternal adverse effects include sedation, dizziness, and nauseaButorphanol tartrate crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hoursIf given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects
Can a 3-month old recognize faces?
By age 3 months, the infant recognizes familiar items and faces Any 3-month-old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (eg, autism)
Pt education for carbamazepine
Carbamazepine is associated with agranulocytosis (leukopenia) and infection riskClients should be advised to report any fever or sore throat
NPH
intermediate acting insulinDuration: 12-18 hoursTwice a day
Labetalol and Carvedilol are contraindicated in which 4 patients?
COPDAsthmaHFHeart Block
Gerd triggers
Caffeine, alcohol, nicotine, high-fat foods, chocolate, spicy foods, peppermint, and carbonated beverages
Avoid grapefruit juice with this class of antihypertensive medication
Calcium Channel Blocker
Amlodipine
Calcium channel blocker commonly used to treat hypertension
Potential complications of alcohol withdrawal
Can develop into delirium tremens or seizuresIf this happens, pts need frequent doses of benzodiazepines (lorazepam, diazepam) and aggressive supportive care
Why is widening of the QT interval dangerous and which medications can cause this to happen?
Can increase the risk of life-threatening Torsades de PointesMost commonly seen with:Haloperidol (Haldol)MethadoneZiprasidone (Geodon)Erythromycin
Isoniazid interacts with which drugs?
alcoholAntabusephenytoin - increases levels
Pacemaker failure to capture
Causes bradycardia and hypotensionPacemaker malfunction may be caused by a failing battery, malpositioned lead wires, or fibrosis at the tip of lead wire(s) preventing adequate voltage for depolarizationIf this happens and the pt is symptomatic, the nurse's priority is to use transcutaneous pacemaker pads to normalize the HR, stabilize BP, and adequately perfuse organs until the permanent pacemaker is repaired or replacedAdminister analgesia and/or sedation as prescribed as transcutaneous pacing is very uncomfortable for the clientThe health care provider needs to be notified, but the nurse should first use the transcutaneous pacemaker to stabilize the client
When the mechanical ventilator high-pressure limit alarm sounds (high PIP), the nurse should assess for ...
Causes of increased airway resistance in the:1) Patient (bronchospasm)2) Artificial airway (excessive secretions, biting the endotracheal tube)AND/OR3) Ventilator system (eg, kinked tubing)Also check for causes of decreased lung compliance (pneumothorax)
What is the black box warning for Celecoxib?
Celecoxib (Celebrex), a COX-2 inhibitor, has a black box warning for increased risk of cardiovascular complications. MI symptoms!!
Amyotrophic lateral sclerosis (ALS) becomes emergent at which point?
Characterized by the progressive loss of motor neurons in the brainstem and spinal cordClients have spasticity, muscle weakness, and atrophy*Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure, and deathCare of clients with ALS focuses on maintaining respiratory function, adequate nutrition, and quality of lifeThere is no cure, and death usually occurs within 5 years of diagnosisThe client with ALS and worsening ability to speak (dysarthria) may also have dysphagia and respiratory distress - seeing this pt first is a priority!
Nursing Implications for Calcium Channel Blockers
Check BP and pulse routinelyLimit caffeine consumptionTake medications before mealsNo grapefruit juice! It causes hypotensionHigh fat meals elevate serum levels - cause hypotension
In which room should a child with autism be placed on the unit?
Children with autism spectrum disorder (ASD) often exhibit sensory processing problems; they may be hyper- or hypo-sensitive to sounds, lights, movement, touch, taste, and smellsA calming environment with minimal stimulation should be provided; a private room away from the nurses' station is the best locationThe nurse can also facilitate a calming environment by:Using a quiet or monotone voice when speaking to the childUsing eye contact and gestures carefullyMoving slowlyLimiting visual clutterMaintaining minimal lightingProviding the child with a single object to focus on
Addison's disease
Chronic adrenal insufficiency occurs when the adrenal glands do not produce adequate amounts of steroid hormones (mineralocorticoids, glucocorticoids, androgens)S/S:- Weight loss- Muscle weakness- Low BP- Hypoglycemia- Hyperpigmented skin (skin folds, buccal area, palmar crease)- Loss of libido- Decreased axillary and pubic hair are common due to lower levels of androgensHyperpigmented skin is a characteristic universal finding; this results from increased adrenocorticotropic hormone which is due to a decrease in cortisol negative feedbackTx:- Replacement therapy with oral mineralocorticoids and corticosteroids
Fibromyalgia
Chronic, nonspecific pain disorderCauses fatigue, sleep disturbances, emotional distress (eg, anxiety, depression), and even mild cognitive impairments (eg, forgetfulness, difficulty concentrating)
neurogenic shock
Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilationA form of distributive shockCauses a disruption in the function of the sympathetic, but not parasympathetic, nervous systemBradycardia, a characteristic manifestation of neurogenic shock, occurs as a result of this alteration in neural activity between the 2 systemsWarm dry skin is present (not cool, clammy)
Loratadine
Claritin is an antihistamine
When cleanse a female pt with iodine swabs prior to insertion of a Foley, do you clean the meatus or labia first?
Cleanse the labia majora first, then the labia minora, and lastly the urinary meatus
phenothiazines
all end in 'zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety
Pt education to prevent SE of codeine
Codeine is both an opioid for pain and an antitussive.SE:- Constipation- N/V- Orthostatic hypotension- DizzinessInterventions:- Increasing fluid intake and bulk in the diet- Laxatives- Taking the medication with food- Changing position slowly
Avoid giving Methylergonovine [Methergine] to which pts?
Contraindicated for clients with high BP such as preeclampsia or preexisting hypertensionWhy? Because Methergine acts by vasoconstrictionCould lead to stroke or seizure if given to pt with high BP!
Guaifenesin is prescribed for which pts?
Clients with acute URIs or chronic bronchitis (inflammation of the upper airways) may be prescribed guaifenesin (Musinex) to loosen and improve the expectoration of mucusClients with chronic bronchitis typically develop rhonchi (sonorous wheezes), which are continuous, low-pitched adventitious breath sounds that resemble moaning or snoring
What should you do if a pt with an allergy to amoxicillin, ciprofloxacin, and sulfa drugs is prescribed IV cefazolin?
Clients with an allergy to penicillin antibiotics (amoxicillin, ampicillin) can possibly experience a cross-sensitivity reaction to cephalosporin antibiotics (cefazolin, cephalexin, ceftriaxone)The nurse should obtain more information about this client's reported allergies, as reactions range from mild to severeThe nurse should then clarify the prescription with the health care provider (HCP) prior to administration
What should you do if a pt with borderline personality disorder ask for you to be their only nurse?
Clients with borderline personality disorder, in an attempt to prevent abandonment and control their environment, may flatter and cling to one staff member while making derogatory remarks about othersThe best nursing action is to rotate staff members assigned to care for the client
Phosphodiesterase inhibitors used in erectile dysfunction (tadalafil, sildenafil, vardenafil)
Contraindicated with the use of nitratesBoth have similar mechanisms and cause vascular smooth muscle dilationCombined use can result in severe hypotension
What age group partakes in cooperative play?
Cooperative play is common in school-age children (age 6-12) These children play with one another with a specific goal , often within a rigid set of rules
Hypothermia treatment
Core temp <95 F (35 C) and the body is unable to compensate for heat lossCold myocardium --> extremely irritable --> prone to dysrhythmiasThe client should be handled gently as spontaneous VFib could develop when moved or touchedTherefore, placing the client on a cardiac monitor is a high priorityThe nurse should anticipate defibrillation in these clients
Why would a pt with liver disease need albumin?
Clients with severe liver disease can develop hypoalbuminemia because the liver manufactures albumin, and damaged hepatocytes are unable to synthesize it
RN Scope of Practice
Clinical assessmentInitial client educationDischarge educationClinical judgmentInitiating blood transfusion
RN scope of practice
Clinical assessmentInitial client educationDischarge educationClinical judgmentInitiating blood transfusion
Escitalopram
LexaproSSRI Antidepressant
What type of drug is isocarboxazid?
Commonly used MAOIs include isocarboxazid, phenelzine, and tranylcypromineThese first-generation antidepressants are used only for resistant depression due to serious adverse affects
3rd degree Heart Block
Complete heart block occurs when electrical conduction from the atria to the ventricles is blocked, causing decreased CO (dizziness, syncope, mental status changes, heart failure, hypotension, bradycardia)The client with third-degree AV block is a high priority, as the client may decompensate to cardiogenic shock and even periods of asystoleTreatment: atropine and temporary pacing (transcutaneous) until a permanent pacemaker can be placedClients with third-degree atrioventricular (AV) block should be assessed immediately due to the potential for life-threatening consequences (eg, shock, syncope, asystole) caused by decreased CO and severe bradycardiaThe client with third-degree AV block requires a permanent pacemaker
Common SE of famotidine
Confusion"I haven't been thinking clearly"
Hypospadias
Congenital defect in which the urethral opening is on the underside of the penisTypically corrected around age 6-12 months by surgically redirecting the urethra to the penis tipCircumcision is delayed so the foreskin can be used to reconstruct the urethraPostoperatively, absence of UO for over an hour indicates that a kink or obstruction may have occurred and requires immediate follow-up
Important age-related considerations for the older adult receiving IV therapy include:
Consideration of renal and cardiac function to prevent hypervolemiaUse of an infusion pump for controlClose monitoring of the site for infiltration and infectionMeasures to prevent skin tearsUse of small-bore (24-26 gauge) IV catheters and correct technique (5-15-degree angle) for insertion of an IV into fragile veins
Hemolytic uremic syndrome
Life-threatening complication of E. coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury (low UO)Hemolysis results in anemia (pallor), and low platelets manifest as petechiae or purpura
What question do you ask patients taking SSRIs when they are new to taking them?
Do you have suicidal thoughts?SSRIs can give them enough energy to carry out their plan
Oxybutynin (Ditropan)
an anticholinergicused to treat overactive bladder
Elevated hct can indicate
Dehydration - thicker blood
Which foods should a pregnant woman avoid consuming?
Deli meats and hot dogs (unless steaming hot) - risk for listeriosis Liver - too much Vitamin AUnpasteurized milk productsUnwashed fruits and vegetablesRaw fishFish high in mercury such as swordfish
What do Benzos do?
Depress respirationsDepress CNS - sleep, sedation (Versed - midazolam)
How can the RN help a patient with myasthenia gravis respond to their symptoms?
Develop a teaching plan for the client to self-adjust the dose of medication in response to symptomsPatients should be taught to recognize signs of overmedication and undermedication with cholinesterase inhibitors so that they can modify the dosage themselves based on a prescribed sliding scale
Which drug is used as a palliative treatment to manage symptoms of compression from tumor growth?
Dexamethasone
Nursing care when administering IV vancomycin
Draw the prescribed trough level prior to administration - therapeutic vancomycin levels range from 10-20 mg/L for hemodynamically stable clientsAdverse effects of vancomycin toxicity include nephrotoxicity (elevated creatinine levels) and ototoxicity (hearing loss, vertigo, tinnitus)Infuse medication over at least 60 minutes (≤10 mg/min) - faster rates increase the likelihood of complicationsMonitor blood pressure during the infusion - hypotension is a possible adverse effectRed man syndrome is a nonallergic histamine reaction characterized by sudden onset of severe hypotension, flushing, and/or maculopapular rash of the face, neck, chest, and upper extremitiesMonitor for anaphylaxisObserve IV site every 30 minutes for pain, redness, or swelling - Vancomycin is a vesicant and may cause thrombophlebitis or, if extravasation occurs, tissue necrosisAdministration using a central venous catheter is preferred; however, a peripheral IV may be used for short-term therapy
Mixing regular and NPH insulin
Draw up regular insulin firstRN- regular before NPH
High doses of Vitamin C can cause what?
Diarrhea
Most common side effect of Quinidine
Diarrhea
Which drug is used in the ED to treat status epilepticus?
Diazepam
Dicyclomine
Dicyclomine (Bentyl) is an anticholinergic/antispasmodic drug prescribed to manage symptoms of intestinal hypermotility in clients with irritable bowel syndrome (IBS)Dicyclomine is contraindicated in clients with paralytic ileus as it decreases intestinal motility and would exacerbate the condition
How does nitroglycerine work?
Dilates coronary arteries so more O2 can get to heart
Which medication would you give to a pt with Afib, a HR of 140, and a BP of 120/80?
Diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/minOther medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rateAnticoagulants (rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin) are used for long-term prevention of atrial thrombus and embolic complications
Medications used for AFib
Diltiazem (calcium channel blockers)MetoprololDigoxinGoal of meds: reduction in ventricular rateORAntiarrhythmic medications such as amiodarone or ibutilide will be used for conversion to sinus rhythm ANDAnticoagulants are used to prevent embolic complications
Babinski reflex disappears at what age?
Disappears between ages 1 - 2
Diverticulitis
Diverticula are saclike protrusions or outpouchings of the intestinal mucosa of the large intestine caused by increased intraluminal pressure (chronic constipation)The left (descending, sigmoid) colon is the most common area for diverticula to developWhen these diverticula become inflamed (diverticulitis), the client may experience acute pain (usually in the left lower quadrant) and systemic signs of infection (eg, fever, tachycardia, nausea, leukocytosis)
Pain in the left lower quadrant is associated with
Diverticulitis (often in the sigmoid colon)Other signs and symptoms include a palpable, tender abdominal mass and systemic symptoms of infection (fever, increased C-reactive protein, and leukocytosis with a left shift)
Pancreatic enzymes for CF education
Do NOT give with milkIt is ok to open capsule and sprinkle on applesauce for childrenDo NOT chew capsule though
Is loss of mucous plug a sign of true labor?
During pregnancy, a collection of secretions forms a "mucous plug" in the cervical canal, acting as a protective barrierAlthough the client may notice expulsion of the mucous plug in the days preceding labor, it is not necessarily a sign of labor
CPR in Pregnancy, 3rd trimester
During pregnancy, the heart is displaced toward the left because the growing uterus pushes upward on the diaphragm, particularly in the third trimesterTo accommodate this displacement, the hands should be placed on the sternum slightly higher than usual for chest compressionsIn addition, a gravid uterus can significantly compress the client's vena cava and aorta - the uterus should be manually displaced to the client's left to reduce this pressure - the nurse can also place a rolled blanket or wedge under the right hip to displace the uterus - pt should NOT be fully supineIf ROSC does not occur after 4 minutes of CPR, emergency cesarean section is usually initiated - delivery should occur within 5 minutes of initiating CPR
How fast should infants grow per week during the first 6 months? During age 6-12 months?
During the first 6 months, infants should grow 5-7 oz a weekFrom age 6-12 months, infants should grow 3-5 oz a week
What should you do if you suspect a PE?
Elevate the head of the bedAdminister oxygenAssess the ptNotify HCP
What type of BUN/Cr values would you expect for a dehydrated pt?
Elevated BUN (eg: 40) and normal Cr (eg: 1)
Nursing interventions to control ICP include:
Elevating the head of the bed to 30 degrees with the head/neck in a neutral position to reduce venous congestionAdministering stool softeners to reduce the risk of straining (Valsalva maneuver)Managing pain well while monitoring sedationManaging fever (cool sponges, ice, antipyretics) while preventing shiveringMaintaining a calm environment with minimal noise (alarms, television, hall noise)Ensuring adequate oxygenationHyperventilating and preoxygenating the client before suctioning - reducing CO2 (a potent cerebral vasodilator) by hyperventilation induces vasoconstriction and reduces ICPLimit performing interventions unless absolutely necessary and AVOID performing interventions in clusters The nurse should suction a maximum of 10 seconds and only as necessary to remove secretions. Prolonged suctioning increases ICP
Hyperresonance to percussion should make you think of what diagnosis?
Emphysema floppy lung, distended alveoli
Should PPIs be given on an empty or full stomach?
Empty
LMWHs
EnoxaparinDalteparinTinzaparin
What lab value can you assess for therapeutic affect of corticosteroids used to treat RA?
Erythrocyte sedimentation rate (ESR)This is indicative of active inflammation
Why does positive pressure ventilation lead to fluid/Na+ retention?
Fluid and/or Na+ retention usually occurs about 48-72 hours after initiation of PPV due to: (1) increased intrathoracic pressure and decreased CO that stimulate the kidneys to release renin(2) physiologic stress that leads to the release of ADH and cortisol(3) breathing through the ventilator's closed circuitry, which decreases insensible loss associated with respiration
Benzo reversal agent
Flumazenil (Romazicon)
Scleroderma
an autoimmune disorder in which the connective tissues become thickened and hardened, causing the skin to become hard and swollen
Schizoid personality disorder
Exhibit social detachment and an inability to express emotionDo not enjoy close relationships and prefer to be aloof and isolated
Phlebostatic axis
External anatomical point on the chest at the level of the atria of the heart (fourth intercostal space at the midaxillary line or midway point of the anterior posterior diameter of the chest) It is used as a reference point for correct placement of the zeroing point of the transducer when measuring continual arterial BP, CVP using a central line, and/or cardiopulmonary pressures via a pulmonary artery (Swan-Ganz) catheterIf the zeroing stopcock is placed below this level, falsely high readings occur; if it is too high, falsely low readings are obtained
Stage 4 pressure ulcer
Full-thickness skin loss with visible tendon, muscle, or boneSlough or eschar (scabbing, dead tissue) may be presentUndermining and tunneling may be present
4 loop diuretics
FurosemideEthacrynic acidBumetanideTorsemide
FLACC scale
Face, Legs, Activity, Cry, and ConsolabilityCan be used to assess pain in the child who is nonverbalThis includes assessment for:Facial grimacingLeg movement, tension, or bending up toward the chestActivity, including squirming, arching, jerkingCrying or moaningDifficulty consoling or comforting the child
Rivaroxaban
Factor Xa inhibitors (rivaroxaban [Xarelto], edoxaban, apixaban) are anticoagulants used to prevent and treat venous thromboembolismThey have a lower risk of bleeding and require less ongoing monitoring than Warfarin does (eg, PT/INR)Education:- Avoid taking over-the-counter medications or supplements that increase bleeding risk, such as NSAIDs (aspirin), garlic, and ginger- Unlike warfarin, factor Xa inhibitors are not affected by vitamin K, which is found in many green, leafy vegetables- Routine monitoring of clotting times (PT/INR, PTT) is unnecessary for clients prescribed factor Xa inhibitors
Is fentanyl safe for a pt with a codeine allergy?
Fentanyl is appropriate in postoperative clients with moderate to severe pain, even those with a history of allergies to codeineBoth drugs have opiate agonist effects but are chemically different - Codeine is a derivative of natural opiates (morphine), whereas fentanyl is completely synthetic
S/S of Neuroleptic Malignant Syndrome (NMS)
FeverMuscular rigidityAltered mental statusAutonomic dysfunction (sweating, hypertension, tachycardia)
Clinical manifestations of bacterial meningitis in infants age < 2 include:
Fever or possible hypothermiaIrritability, frequent seizuresHigh-pitched cryPoor feeding and vomitingNuchal rigidity (stiff neck)Bulging fontanelle is possibleOne of the most common acute complications of bacterial meningitis in children is hydrocephalus
Filgrastim
Filgrastim (Neupogen) and pegfilgrastim (Neulasta) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it
Factor Xa Inhibitor
Fondaparinux
If your pt who overdosed on cocaine has a creatine kinase level of 30,000, what would you recommend to the HCP?
Forced saline diuresis with IV fluids (to prevent blockage of the renal tubules with myoglobin) is necessary to prevent permanent kidney damage
Where should you place the pulse ox in a pt with decreased peripheral tissue perfusion who is also receiving vasopressors?
Forehead
Vaginal hematoma
Formed when trauma to the tissues of the perineum occurs during deliveryMore likely to occur following a forceps- or vacuum-assisted birth or an episiotomyS/S:- Persistent, severe vaginal pain or a feeling of fullness- Uterus is firm and at the midline on palpation- If the hematoma is large, the hemoglobin level and vital signs can change significantly
How is Alendronate best absorbed?
Fosamax is best absorbed when taken 30 mins before breakfast. Patient should remain upright for these 30 mins.
Stage 3 pressure ulcer
Full-thickness skin lossSQ fat is visible but not tendon, muscle, or boneTunneling may be present
Which type of contrast is used for MRIs?
Gadolinium contrastNOT providing-iodine (Betadine)
Which oral supplements cause an increased risk of bleeding and should be discontinued prior to surgery?
GarlicGingerGinkgo bilobaGinsengFeverfew
Burning pain in the upper abdomen can be due to
Gastric or duodenal ulcersIf the ulcers are located posteriorly, the client may experience back pain
Complications of alcoholic cirrhosis
GastritisClotting abnormalities (thrombocytopenia, coagulation disorders)Esophageal varices that increase the risk for hemorrhage (coffee ground emesis from oxidized blood)
Blood transfusion tubing
Gauge 20 or bigger (18 is preferred)
Aminoglycosides
GentamicinNeomycinAmikacinTobramycinStreptomycinGNATS
LGA risk factors
Gestational diabetesExcessive gestational weight gain or elevated prepregnancy BMIHistory of a prior newborn who was LGAPostterm gestationGenetics (male sex, maternal birth weight, ethnicity)
PPE removal order
GlovesEyesGownMask
Patient education for HIV antiviral medication zidovudine
Go to clinic for blood counts every 2 weeksBone marrow depression with granulocytopenia is a severe and common adverse effect of zidovudine
PPE donning order
GownMaskGogglesGloves
Adverse reactions to Nitroglycerine or Isosorbide
HADizziness, weaknessHypotensionNausea
digoxin uses
HFAfib
What should you do before splitting a medication in half?
Hand hygieneDo not need gloves though
Antisocial personality disorder
Have a pattern of disregard for and violation of the rights of othersManipulate others for personal gain and lack empathy
S/S of myopia in children
Headaches, dizziness, and the need to squint the eyes to see clearly Fften need to hold objects near their face or sit near objects to see clearlyDecreased school performance from eye strain"nearsightedness"
Beta agonists are usually prescribed for which condition?
Heart failureThey increase CO by increasing HR and BP
Dobutamine is used for which condition?
Heart failure - emergency cardiac decompensation
Leopold maneuvers
Help determine fetal presentation and involve systematic palpation of the client's abdomenThese maneuvers assist the nurse in locating the fetal back for optimal placement of the ultrasound transducer for external fetal heart monitoring
What is an adverse effect of erythropoietin administration and what should the nurse do to prevent this from occurring?
Hypertension is a major adverse effect of erythropoietin administrationTherefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapyBP should be well controlled prior to administering erythropoietin - the nurse should always check BP prior to administrationErythropoietin is administered intravenously or in any SQ area, NOT IMAdequate stores of iron, vitamin B12, and folic acid are required for the erythropoietin to work
Initial goal during management of hypertensive crisis
Hypertensive crisis may require continuous infusion of an IV vasodilator (nitroprusside sodium)BP should be lowered slowly to prevent organ damage*The initial goal is to lower MAP by 25% or less or to maintain MAP of 110-115 mm HgMAP = (2 x DBP + SBP) / 3
Common adverse reaction of cyclophosphamide
Hemorrhagic cystitisTeach patient to assess urine for hematuria (chemotherapy drug)
Your PACU pt who just had surgery under anesthesia has a temp of 94F (34.4C). Should you notify the provider?
Hypothermia (<95 F [35 C]) is common in the immediate postoperative period due to anesthetic-induced vasodilation, decreased basal metabolic rate, and a cool environmentThis can be managed by the nurseHyperthermia (fever) is also common due to the blood products and trauma from surgeryHowever, stiffness/rigidity in the presence of elevated temperature is more concerning and could be malignant hyperthermia
Beclomethasone (Beconase)
an inhaled corticosteroidnormally used as a long-term, first-line drug to control chronic airway inflammationfluticasone is also an inhaled corticosteroid
Two serious adverse effects of INH use are ____________ and _________________.
Hepatotoxicity and peripheral neuropathy
When obtaining blood from a client for labs, follow these rules:
Insert the needle at 15-degree angleLimit attempts to 2Avoid the side of a mastectomyA capillary specimen should be obtained at the side of the finger padNever draw a specimen above an IV infusion
How are glaucoma eye drops administered?
Instruct client to close the eyelid and move the eye aroundThen apply pressure to the lacrimal duct for 30-60 seconds if medication has systemic effects (beta blocker, timolol maleate - this will distribute the medication, prevent overflow into the lacrimal duct, and reduce possible systemic absorption
Clients with hypertension should be instructed not to take potentially high-risk over-the-counter (OTC) medications such as:
High-sodium antacidsAppetite suppressantsCold and sinus preparationsMany cold and sinus medications contain phenylephrine or pseudoephedrineThese sympathomimetic decongestants activate alpha-1 adrenergic receptors, producing vasoconstrictionThe resulting decreased nasal blood flow relieves nasal congestionThese agents can cause dangerous hypertensive crisis!!!
Clonidine
Highly potent antihypertensive
Developmental dysplasia of the hip (DDH)
Hip abnormalities ranging from mild dysplasia of the hip joint to full dislocation of the femoral headManifestations in infants age <2-3 months include:- Extra inguinal or thigh folds- Laxity of the hip joint on the affected sideIf DDH is not treated, these signs disappear after age 2-3 months due to the development of muscle contracturesAfter age 3 months, limited hip abduction and limb shortening on the affected side are evidentA pelvic tilt is noted once the child learns to walk
Food choices for infants nearing 1 year of age
Honey should not be offered to children age <12 months because their immature gut systems are susceptible to Clostridium botulinum (botulism) infectionCommon allergenic foods (eggs, fish, peanuts) may be introduced along with other foods starting at age 4-6 monthsInfants should be transitioned to whole milk, not low-fat milk, at age 12 monthsAt age 8-10 months, start offering small finger foods, such as crackers or cut-up pieces of nutritious foods
Insulin aspart onset
Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes
Which vasodilator is used to treat HTN?
Hydralazine
___________________ is administered in the setting of critically elevated blood pressure.
Hydralazine (Apresoline)
At what maternal BP would you anticipate intervening with a BP medication and which medications would you recommend?
Hydralazine (Apresoline) and/or labetalol are used to lower blood pressure if needed when > 160/110 mm HgRemember, HTN is a sign of preeclampsia!
Thiazide diuretics
Hydrochlorothiazide (HCTZ)Chlorthalidone Metolazone
_________________- may develop when a potassium-sparing diuretic or angiotensin-converting enzyme inhibitor increases the ___________ level.
Hyperkalemiapotassium
Stage 1 pressure ulcer
Intact skin with nonblanchable redness
Potential complications for a pt with acute pancreatitis
HypocalcemiaARDSMay need aggressive supportive care (pain management, IV fluids)
What is a side effect of terbutaline?
Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is increased maternal serum glucose levels
Adverse effects of Thiazides and Loop diuretics
HypokalemiaHyperuricemiaGlucose intolerance
Which lab value would cause you to hold bumetanide?
HypokalemiaLoop diuretics (eg, bumetanide, furosemide, torsemide) can cause hypokalemia (K < 3.5)
_____________ can be caused by antidepressants and NSAIDs.
Hyponatremia
What electrolyte imbalance are infants at risk for if their formula is diluted with excess water?
Hyponatremia secondary to water intoxication, which can present with neurological symptoms (eg, lethargy, irritability, seizures)
Adverse reactions of Calcium Channel Blockers
HypotensionHA, dizzinessEdemaNauseaConstipationTachycardiaHFDry cough
What should you do if your pt with alcoholic cirrhosis has hypotension, tachycardia, and coffee ground emesis?
Hypotension and tachycardia in the presence of blood loss can indicate hypovolemiaAssess for signs of hypovolemia and call HCP to report changes in baselineEsophagogastroduodenoscopy is necessary to determine the bleeding site
SE of Calcium Channel Blockers
Hypotension, syncope, dizziness, fatigueHypokalemia
Serious adverse effect of ticarcillin
Hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae
Swelling around the eyes and face occurs in which 3 conditions?
HypothyroidismCushings diseasenephrotic syndrome
What does a paCO2 > 45 and normal paO2 indicate?
HypoventilationInstruct pt to use incentive spirometer
A pt undergoing ET intubation received IV sedation and succinylcholine. Pt becomes flushed and profusely diaphoretic and has a rigid jaw. Which medication should the nurse prepare to administer?
IV dantrolene
IV morphine peaks in ___ minutes and has a duration of ___ - ____ hours.
IV morphine peaks in 20 minutes and has a duration of 3-4 hours.
How should you administer IV pain meds to a pt in labor?
IV narcotics administered to laboring women can cause fetal sedation and subsequent respiratory depression at birthAdministering IV narcotics at the PEAK OF CONTRACTIONS reduces the amount of narcotic that crosses the placental barrier and affects the fetus
IV opioids are safest for clients who will give birth in ______ hours
IV opioids are safest for clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth - could cause respiratory depression in baby at birthIV opioids are also best for clients in active labor or those with a well-established contraction pattern because opioid administration may slow labor progression in the latent phase
Is ibuprofen or acetaminophen an NSAID?
Ibuprofen (Advil)Acetaminophen (Tylenol) is an analgesic and antipyretic
Agoraphobia
Intense anxiety about being in a situation from which there may be difficulty escaping in the event of a panic attackMay avoid open spaces, closed spaces, riding in public or private transportation, going outside the home, bridges/tunnels, and crowds
How serious is it if a pt with a PCA reports burning at the IV site?
If the IV line infiltrates the SQ tissue or the catheter becomes occluded, the PCA drug can back up into the primary tubing each time a dose is administered, resulting in inadequate pain controlIn addition, burning can indicate phlebitis, which causes vessel wall injury and can lead to thrombophlebitis
"Unstageable" pressure ulcer
If the base is covered by necrotic tissue or eschar
Pt gave birth by c-section 5 hours ago and is requesting pain meds. The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety. What do you suspect?
If unrecognized, DVT may progress to pulmonary embolism (PE), often characterized by:Anxiety/restlessnessPleuritic chest pain/tightnessShortness of breathTachycardiaHypoxemiaHemoptysis
Ectopic pregnancy
If untreated, continued growth can lead to fallopian tube rupture, resulting in hemorrhage and hemodynamic compromiseIntra-abdominal bleeding can lead to referred shoulder pain, a classic sign of diaphragm irritationRuptured ectopic pregnancy requires emergency surgical intervention and hemodynamic support (eg, IV fluids, blood transfusion)
Infective Endocarditis compilations
In IE, the vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications - stroke, loss of limb, infarction IE clients typically require intravenous antibiotics for 4-6 weeksSplinter hemorrhages can occur and may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli)
"mal de ojo"
In Latin American culture, an illness called "mal de ojo" ("evil eye") is believed to be caused when a stranger or someone perceived as powerful admires or compliments a childThe mal de ojo curse can be broken if the admirer touches the child while speaking to the child or immediately afterwardMexican American mothers may worry when strangers compliment their babies without touching them
Important patient teaching for Acyclovir for herpes
Increase daily fluids to 2000 to 4000 mL/dayIncreasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney functionAcute glomerulonephritis is a possible complication of acyclovir therapy
What diet change should you recommend in a pt taking antipsychotic medications?
Increase intake of raw fruits and vegetables to prevent constipation
How do cholinesterase inhibitors work?
Increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation
Vaginal bBirth after Cesarean (VBAC) - potential complications
Increased risk for uterine ruptureThe first sign of uterine rupture is usually abnormal fetal heart rate (FHR) patterns - usually decelerations followed by fetal bradycardia with decreased variability Constant abdominal painLoss of fetal stationSudden cessation of uterine contractionsHemorrhage, hypovolemic shock, and maternal tachycardia may occur if severe rupture occurs unrecognized
ECT patient education
Induces a generalized seizure in an anesthetized clientPrior to the procedure, the client should be NPO and not take anticonvulsant medications (such as valproic acid - Depakote)Temporary confusion and memory loss are common after the procedureClients should be instructed not to drive during the course of ECT treatment
What intervention is indicated in all pts who are comatose or do not follow commands after cardiac arrest resuscitation?
Inducing therapeutic hypothermia within 6 hrs of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes89.6-93.2 F (32-34 C) for 24 hrs before rewarmingThe nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, BP (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injuryThe nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees
Infants should double in birth weight by age ____ months and triple in birth weight by age ____ months.
Infants should double in birth weight by age 6 months and triple in birth weight by age 12 monthsAt birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months
Lactational mastitis
Infection and inflammation of breast tissue may result from inadequate milk duct drainage or poor breastfeeding techniquManifestations include fever, muscle aches, and breast pain and inflammation (warmth, redness, edema)
S/S of infection in neonates
Infectious manifestations are often subtle in neonates (fever can be the only symptom)May have hypothermia, lethargy, poor feeding, or decreased UO*Rectal temperature >100.4 F (38.0 C) or <96.8 F (36.0 C) is a "red flag" in a neonate
Pudendal nerve block
Infiltrates local anesthesia (lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulvaWhen birth is imminent, a pudendal block provides the best pain relief with the least maternal/newborn side effects and could be administered quickly by the HCPIt does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor
Extravasation
Infiltration of a drug into the tissue surrounding the veinNorepinephrine (Levophed) is a vasoconstrictor and vesicant that can cause skin breakdown and/or necrosis if absorbed into the tissuePain, blanching, swelling, and redness are signs of extravasationNorepinephrine should be infused through a central line when possible
Epiglottitis
Inflammation of the epiglottis that may result in life-threatening airway obstructionSymptoms begin with abrupt onset of high-grade fever and a severe sore throat, followed by the 4 Ds: drooling, dysphonia, dysphagia, and distressed airway (inspiratory stridor)Children are typically toxic-appearing and may be "tripoding" (sitting up and leaning forward) with inspiratory stridor
Inflizimab, adalimumab, & etanercept
Infliximab, adalimumab, and etanercept are tumor necrosis factor (TNF) inhibitors that suppress the inflammatory response in autoimmune diseases such as RA, Crohn disease, and psoriasisDue to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection - a client with current, recent, or chronic infection should not take a TNF inhibitor
Rifampin
Inhibits RNA polymerase of tubercle bacillus
Ethambutol
Inhibits RNA synthesis of tubercle bacillusBacteriostatic for tubercle bacillusUsed as a substitute for Rifampin or Isoniazid if toxicity occurs
Patients with an allergy to Atropine may also be allergic to which medication?
Ipratropium
What is the drug of choice for treatment of patients with a positive skin test for tuberculosis?
Isoniazid
24-hr urine collection procedure
It is common practice to start a 24-hour urine collection test at the time of the client's first voiding in the morningTo start the collection period, the nurse asks the client to void and discards this specimen (it is not added to the collection container)If any urine is discarded by accident during the test period, the procedure must be restartedAll produced urine should be placed in the same container and kept cool (on ice)
What is the difference between pathological jaundice and physiological jaundice?
Jaundice within the first 24 hours is pathological - it is usually related to problems of the liverJaundice after 24 hours is referred to as physiological jaundice and is related to the increased amount of unconjugated bilirubin in the system
Which lab should be monitored in pts taking calcium channel blockers?
K+
Which lab should the nurse assess before administering a neuromuscular blocking agent?
K+Low potassium levels enhance the effects of neuromuscular blocking agents
Which vaccines should be delayed for a 12-month-old child being treated for Kawasaki disease with IV immunoglobulin?
Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysmsAntibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccinesTherefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunityHib, Hep B, and PVC are NOT live vaccines
Levetiracetam
Keppra is often used to treat seizuresIt has minimal drug-drug interactions compared to phenytoin and is often the preferred antiepileptic medication
Combined Alpha/Beta Blockers
LabetalolCarvedilol
Which hair abnormality is seen in extreme cases of anorexia?
Lanugo (fine terminal hair) can be seen in extreme cases
What would an increased CVP, increased PAWP, and coarse crackles indicate?
Left-sided heart failuretreat with loop diuretic - furosemide
SE of Beta Blockers
LethargyImpotenceHFBradycardiaHallucinationsWheezing
Guidelines for Pt Care during Brachytherapy
Limit staff time spent in the room to 30 minutes per shift - cluster careInstruct the client to remain on bedrest to prevent dislodgement of the implantStaff must wear a dosimeter film badgeNo individuals who are pregnant or under age 18 may be in the roomAll staff and visitors must maintaining a distance of at least 6 feetAssign the client to a private room with a private bathKeep the door to the room closedEnsure that a sign stating, "Caution, Radioactive Material" is affixed to the doorAll staff providing nursing care that requires physical contact must wear a lead apron
Short-acting insulin
Lispro AspartGlulisineBest for post-meal hyperglycemiaPeak: 0.5-3 hours
Glipizide
oral hypoglycemicenhances pancreatic production of insulin as long as there is some beta cell function present
When you give statins, what should we monitor?
Liver function tests!
Chronic pain treatment
Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. Immediate-release opioids may be required for breakthrough pain. Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect.
Cor pulmonale is treated with...
Long-term, low-flow oxygenBronchodilatorsDiuretics
Bumetanide
Loop diureticPrescribed for clients with HF to promote diuresis
ARBs
LosartanValsartan
SE of methylphenidate in children
Loss of appetite with resulting weight lossParents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and developmentIt is very important to compare weight/height measures from one well-child checkup to the nextIf weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferableAnother SE is increased BP and tachycardia - these should be monitored before and after starting tx
Enoxaparin
LovenoxLow molecular weight heparinAdminister at least 2 inches to the left or right of the umbilicus - pinch skin - 90 degree angle injection
If a pt has a temp of 100.4 F (38 C) and cough, should you report this to the surgeon before the pts procedure?
Low-grade temperature and cough could indicate the presence of an infection, and the nurse should report these findings to the HCP as soon as possible before surgeryThe administration of anesthesia in a client with a fever and cough can exacerbate an unknown viral or bacterial condition, increase the risk for postoperative pneumonia, and interfere with the postoperative healing process
Clinical manifestations of ectopic pregnancy
Lower-quadrant abdominal pain on one sideMild to moderate vaginal bleedingMissed or delayed mensesSigns of subsequent hypovolemic (hemorrhagic) shock from ruptured ectopic pregnancy:Dizziness, hypotension, and tachycardiFree intraperitoneal blood pooling under the diaphragm can cause referred shoulder painPeritoneal signs (eg, tenderness, rigidity, low-grade fever) may develop subsequently
What is the main side effect for a patient staring to take an MAOI?
MAOIs and other antidepressants are associated with increased risk of suicidal ideation during the first few weeks of treatmentClients taking MAOIs need to avoid tyramine-containing foods due to risk of hypertensive crisis
Neomycin enema
Medicated enema that reduces the number of bacteria in the intestine in preparation for colon surgery
Atypical (second-generation) antipsychotic medications
PisperidoneQuetiapineOlanzapineUsed in the treatment of schizophrenia, bipolar disorder, and other mental health disordersSE:- Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait)- Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention- Clients may experience anticholinergic effects (dry mouth, constipation- Clients should change positions slowly to prevent orthostatic hypotension- Sedating effects (drowsiness, hypersomnia) are common*The HCP may prescribe medications to treat EPS (benzodiazepines, diphenhydramine)
Interventions for Malignant Hyperthermia
MH requires emergent treatment with IV dantrolene to reverse the process by slowing metabolismApply cooling blankets to reduce temperatureTreat high potassium levels
Magnesium toxicity occurs at what level?
Magnesium toxicity may occur when magnesium levels are > 7 mEq/L.Causes CNS depression and blocks neuromuscular transmission
Nursing interventions after Extubation
Place pt immediately on warm humidified oxygenHigh Fowler positionMonitored for aspiration, airway obstruction, and respiratory distressNPO until swallowing function has been evaluateRoutine oral careCoughing, deep breathing, and use of incentive spirometry to prevent atelectasis
Expected (normal) findings for a term newborn include
Plantar creases up the sole of the footBabinski reflex - disappears at 1 year old - the toes hyperextend and fan out when the lateral surface of the sole is stroked in an upward motionEpstein's pearls - white, pearl-like epithelial cysts on gum margins and the palate - they are benign and usually disappear within a few weeksCord with 2 arteries and 1 vein
Frequent eye exams are required for pts taking which two medications?
PlaquenilEthambutol
What can trismus indicate in children with tonsillitis?
May indicate a serious complication of tonsillitis, a peritonsillar or retropharyngeal abscessOther features of the abscess include a "hot potato" or muffled voice, pooling of saliva, and deviation of the uvula to one sideThis abscess can occlude the airway, making it a medical emergencySurgical intervention (tonsillectomy or incision and drainage) is often requiredIn the meantime, maintaining an adequate airway is essential
Which infections require airborne precautions with negative pressure isolation?
MeaslesTuberculosisVaricella zoster (chicken pox) infections (airing MTV)
Preschoolers partake in what type of play?
Preschoolers (age 3-6) enjoy associative play, in which they engage in similar activities or play with the same or similar items, but the play is unorganized without specific goals or rulesThey often borrow items from each other without directing each other's playPreschoolers also enjoy play involving motor activities and imaginative, pretend play
IV loop diuretic SE
ototoxicity
When is LMWH indicated?
Prevention of DVT
Which drug should not be given on the day a pt receives IV contrast with iodine?
MetforminCan resume 48 hrs after iodine contrast
How is muscle strength graded?
Normal muscle strength is 5 on a scale of 0-5Weakened muscle strength would be a 2+ and means only able to move laterally, not able to lift up against gravity)
Which beta blocker is appropriate for a pt with asthma?
MetoprololOther beta blockers cause bronchoconstriction
What is the first line drug to treat C. diff?
Metronidazole (Flagyl) is the first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficileNote: Leukocytosis is expected with this bacterial infection
Discharge teaching for pt taking enoxaparin after ortho surgery
Mild pain, bruising, irritation, or redness of the skin at the injection site is common - do NOT rub the site with the handUsing an ice cube on the injection site can provide reliefAvoid taking ASA, NSAIDs, and herbal supplements (Ginkgo biloba, vitamin E) without HCP approval as these can increase the risk of bleedingMonitor complete blood count to assess for thrombocytopenia (NO need for regular coag studies - PT, INR)
Head injury classification based on GCS
Mild: GCS 13-15Moderate: GCS 9-12Severe: GCS ≤8 (coma)
What happens if your patient takes flouroquinolones and drinks milk or takes antacids?
Milk or antacids inactivate flouroquinolones
LPN/LVN Scope of Practice
Monitoring RN findingsReinforcing educationRoutine procedures (catheterization)Most medication administrationsOstomy careTube patency & enteral feedingSpecific assessments* (lung sounds, bowel sounds, neurovascular checks)
A patient with Inflammatory Bowel Disease is at risk for which adverse reaction if taking morphine?
Morphine slows peristalsisTherefore, the patient is at risk for:Toxic megacolon & paralytic ileus
Why would an Orthodox Jew not want to take a medication in capsule form?
Most capsules are coated in gelatin, a substance made from the collagen of animals, which is generally considered nonkosher. The nurse should first ask the pharmacist if an equivalent, gelatin-free form of the medication (tablets) is available
Are penicillin derivates and cephalosporins safe for pregnant and breastfeeding women?
Most penicillin derivates (ampicillin, amoxicillin) and cephalosporins (cephalexin, ceftriaxone) are generally considered safe for use by women who are pregnant or lactating
What should you do if you suspect heat exhaustion?
Move pt to cooler temperatures and provided a cool sports drink, a electrolyte-containing beverage (Gatorade), or waterThe priority is to lower the body temperature to prevent heat stroke, a potentially fatal condition associated with mental status changes (indicating brain damage) and additional organ damage (kidney injury, rhabdomyolysis)If the temp continues to rise after moving to cooler temperatures, ice packs placed on the axilla and groin may help to dissipate heat; further medical help may be necessaryAssessment can be continued once the pt has been moved to a cooler environment and provided with hydration - alcohol consumption may compound heat exhaustion but does not change initial management of the client
Guaifenesin
Mucinex is an expectorant used to facilitate mobilization of mucus
Cyclobenzaprine
Muscle relaxant given to treat pain associated with muscle spasmCommonly given for a pt with an open fractureCarisoprodol or methocarbamol can also be prescribed
Why do patients taking carbamazepine for seizures need weekly blood tests?
Myelosuppression is a risk factor
S/S of emergent bowel obstruction
N/VAbdominal painBloatingDecreased stool outputIf left untreated, bowel obstruction can lead to electrolyte disturbances, dehydration, bowel perforation and infection (peritonitis), and/or tissue necrosis
SE of Isoniazid
N/Vabdominal painhepatotoxicity - metabolized by liver, excreted by kidneysneurotoxicity - crosses blood-brain barrier
Colchicine toxicity
N/V/Dabdominal pain
Does Digoxin help with angina?
NODigoxin increases the strength and contraction of the heart
Patient education for metronidazole
NO alcohol - causes a disulfiram-like reaction (like Antabuse)Treat partner concurrently Use a barrier method for sex or abstinence during treatment
Can kids take tetracyclines?
NO!Prevents calcium absorption
Does tPA (Alteplase) cause a bleeding risk?
NO, only alters coagulation at the site of the thrombus, NOT systemically
Kosher laws
No pork, shellfish, or fish without scalesSeparation of meat/poultry from dairyWhen meat or poultry is consumed, at least 3-6 hours must pass before a dairy product is consumedCertain foods, including fresh fruits and vegetables, grains, tea, and coffee, are considered neutral and can be consumed at any time
In an emergent situation, is a 22 gauge IV sufficient?
No probably need a 16 or 18 gauge incase bolus IV or blood products are needed
Celecoxib
NSAID
Ketorolac
NSAID that is administered PO, IV, or IM for short-term relief of mild to moderate pain
Which 2 classes of medications can cause problems for pts with asthma?
NSAIDs and beta blockers have the potential to cause problems for clients with asthmaAbout 10%-20% of asthmatics are sensitive to Ibuprofen (Motrin) and aspirin and can experience severe bronchospasm after ingestion
Acronym to determine the need for spinal immobilization during triage
NSAIDs:N - Neurological examination. Focal deficits include numbness and decreased strengthS - Significant traumatic mechanism of injuryA - Alertness. The client may be disoriented or have an altered level of consciousnessI - Intoxication. The client could have impaired decision-making ability or lack awareness of painD - Distracting injury. Another significant injury could distract the client from spinal painS - Spinal examination. Point tenderness over the spine or neck pain on movement (if there is no midline tenderness) may be presentNote: there is no direct correlation of multiple sclerosis (autoimmune progressive nerve demyelinization) with the need for spinal immobilization
A pt with CKD should restrict intake of which electrolytes?
Na and KAvoid salt substitutes (they contain K)Likely should take Ca supplements due to hypocalcemia
Should you hold Warfarin in a pt with a PE and an INR of 2.5?
No! Give it!The effect of warfarin (Coumadin) is monitored by the INRThe therapeutic range of INR is 2 - 3
Your pt has a STAT order for an anticoagulant and has an epidural for continuous anesthesia. Do you give the anticoagulant?
No, anticoagulants are not given while an epidural catheter is in place
Should a pt with asthma be on a beta blocker?
No, contraindicated
Should you report bilateral crackles in an infant born 30 mins ago?
No, it is normal to auscultate crackles in an infant during the first hour of lifeThis is because fluid is still being pushed out of and absorbed by the lungs
Should you remove dentures during postmortem care?
No, leave them in to maintain face shapeIf not in at death, put them in
Which drugs reverse the effect of pancuronium bromide?
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide
The nurse is caring for a client who was just resuscitated following an out-of-hospital cardiac arrest. The client does not follow commands and remains comatose. What intervention does the nurse anticipate being added to the client's plan of care?
Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly VFib or pulseless VTach*Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomesIt is indicated in all clients who are comatose or do not follow commands after resuscitation
Most serious complication of Guillan-Barre syndrome
Neuromuscular respiratory failureThe rate and depth of the respirations should be monitored
Risk factors for suicide
Never married, divorced, separatedElderly white manPsychiatric disorders, prior suicide attemptsHopelessnessLiving aloneUnemployed or unskilledPhysical illnessFamily history of suicide, family discordAccess to firearmsSubstance abuse, impulsivity
Preeclampsia definition
New-onset hypertension (≥140/90 mmHg) PLUS proteinuria and/or signs of end-organ damage after 20 weeks gestationAlthough edema is not a diagnostic criterion for preeclampsia, it is a common manifestation of the disease process
Which MI medication decreases preload and afterload?
Nitroglycerin The vasodilation reduces preload and the reduced contractility reduces afterload
Can you mix long acting insulin with other insulins?
NoNo mixing glargine or detemir
Should a sexually active woman < age 21 have a Pap smear?
NoNot until 21, regardless of sexual activity
Would you be concerned about a pt with WBC of 12,000 2 days postop ortho surgery?
NoPostoperative leukocytosis (>11,000) is common in the first 48 hours after orthopedic surgery from normal inflammatory immune responses
Is it concerning for a pregnant woman at 39 weeks to have brown mucoid vaginal discharge?
NoVaginal discharge increases at the end of pregnancy and may become mucoid and blood-tinged (pink/brownish) in the days preceding laborThis assessment finding may be a sign of approaching labor
Serum carboxyhemoglobin
Normal values are <5% in nonsmokers and slightly higher (<10%) in smokersThe diagnosis of CO poisoning is often missed in the emergency department because symptoms are nonspecific (HA, dizziness, fatigue, nausea, dyspnea) with a normal O2 satTx:Immediate administration of 100% oxygen to correct hypoxemia and eliminate toxic CO from the blood
At what age do infants begin playing interactive games such as peek-a-boo?
Not until age 10-12 months
Concerning SE in pts taking furosemide
Nurses caring for clients receiving potassium-wasting diuretics (eg, furosemide) should monitor for and report signs of hypokalemia (eg, muscle cramps), as unmanaged hypokalemia may result in lethal complications
OD on tricyclic antidepressants (TCAs) effects
OD is especially concerning for a tricyclic antidepressant (TCA) due to the effect this can have on the cardiovascular and central nervous systems (eg, dysrhythmias, seizures)TCA use for depression is an uncommon second-line treatment, but the drug class is used for neuropathic pain and sometimes enuresis
Otitis media vs otitis externa
OM typically occurs in infants and children under age 2, sometimes following a respiratory tract infectionInfants with exposure to tobacco smoke are at risk for OMOM risk is also higher with activities such as using a pacifier or drinking from a bottle when lying down as these allow fluid to pool in the mouth and then reach the eustachian tubesKey preventive measures include eliminating exposure to smoke, obtaining routine immunizations to prevent infection, and reducing or eliminating use of a pacifier after age 6 monthsvs.Otitis externa is "swimmers ear" and can be caused by water in the ears
Which medication is given to children with cystic fibrosis to help with nutrition requirements?
Pancreatic enzyme replacement with pancrelipase
When are PVCs considered dangerous?
Occasional PVCs in the normal heart are not significantPVCs in the client with CAD or MI indicate ventricular irritability and may lead to life-threatening dysrhythmia such as VTach!!!
Late decelerations
Occur after the onset of a uterine contraction and continue beyond its endThe lowest point (nadir) occurs near the end of the contraction before the fetal heart rate gradually returns to baselineLate decelerations occur when fetal oxygenation is compromised (uteroplacental insufficiency, uterine tachysystole, hypotension)
Diabetes insipidus
Occurs due to insufficient production/suppression of antidiuretic hormone (ADH)Tx:Fuids should be replaced orally/intravenously to prevent dehydrationADH replacement with vasopressin can be used to treat DI, however, it also has vasoconstrictive properties so desmopressin (DDAVP), an analog without vasopressor activity, is preferred
Sickle cell crisis
Occurs when inadequate oxygenation or hydration exacerbates sickling and causes RBCs to clump together in the capillaries (vasoocclusion)Adequate oxygenation and hydration may reverse the acute sickling responseThe priority intervention is the administration of IV fluids to reduce blood viscosity and restore perfusion to the areas previously affected by vasoocclusion
Rhabdomyolysis
Occurs when muscle tissue is damaged and myoglobin is released into the blood, usually after an injury from overexertion, dehydration, severe vasoconstriction (eg, cocaine use), heat stroke, or traumaAKI can occur when myoglobin overwhelms the kidneys' filtration abilityAs myoglobin is excreted, the urine becomes very dark and is described as being a cola-brown colorSeverely elevated creatine kinase levels, typically >15,000 U/L (>250 µkat/L), are observed with severe muscle damage and can be a precursor to kidney injury
Placental abruption
Occurs when the placenta separates prematurely from the uterine wall, causing hemorrhage beneath the placentaAbruptions are classified as partial, complete, or marginal and may be overt (visible vaginal bleeding) or concealed (bleeding behind placenta)Risk factors include abdominal trauma, hypertension, cocaine use, history of previous abruption, and PPROMNursing Interventions:Tachysystole, with or without fetal distress, is often present, and continuous fetal monitoring is necessaryA type and crossmatch should be drawn as treatment may include blood transfusionIn severe cases, emergent cesarean birth is indicated Maternal vital signs should be assessed frequently for signs of shockAbruption may require rapid volume replacement with IV fluid and blood products, requiring large-bore IV access - peripheral IV access with a 16- or 18-gauge catheter should be initiated
How should a post-op pneumonectomy client be positioned in bed?
On the affected sideWith the complete removal of the lung in a pneumonectomy, the client should be positioned on the surgical side to promote adequate expansion and ventilation of the remaining lung
Antiemetics
OndansetronGranisetronProchlorperazinePromethazineMetoclopramideHaloperidolDiphenhydramine
2 things about Oral Care for ventilated pts on the NCLEX that differs from how you normally do it
Oral care is every 2 hrsOnly suction ETT when indicated, not every time you do oral care
Oral iron should be taken how?
Oral iron is better absorbed on an empty stomach and with vitamin C
SE of Rifampin
Orange urine, stains contact lenseshepatitisfeverGI disturbanceperipheral neuropathysuppresses effect of birth control pills
Bisthmuth Subsalicylate should not be combined with
Other salicylates, such as AspirinBisthmuth subsalicylate is Pepto Bismol
Anticholinergic drugs
Oxybutynin (Ditropan)Tiotropium Ipratropium (Atrovent)Benztropine (Cogentin)ScopolamineDiphenhydramine
High PEEP is dangerous because
PEEP of 10 - 20 can cause overdistension of the alveoli and cause them to rupture --> barotrauma of the lung --> air can escape and cause pneumothorax or subcutaneous emphysema
Proton pump inhibitors side effects
PPIs like omeprazole, are associated with increased risk of pneumonia, Cdiff, and calcium malabsorption (osteoporosis)
Warfarin therapeutic range
PT 1.5 - 2.5 x normalINR 2:3
Vitamin K foods should be reduced when taking which medication?
PT and INR are decreased when a vitamin K antagonist warfarin (Coumadin) is taken with vitamin K-rich foods such as green, leafy veggies
Warfarin labs
PT/INR
What labs do you assess in a pt on heparin?
PTTHgb, HctPlatelets
Heparin therapeutic range
PTT 1.5 - 2.5 x normal
How does Propylthiouracil work?
PTU inhibits synthesis of T3 and T4 by the thyroid
Factors to prevent SIDS
Pacifier useRoom sharing without bed sharingSmoking cessationBreastfeedingUp-to-date immunizationsFirm sleep surface
How is Pancuronium eliminated?
Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation
A full bladder is a concern with which procedure?
Paracentesis when a trocar needle is inserted into the abdomen to drain ascites
What age group partakes in parallel play?
Parallel play is more common in toddlersDuring parallel play, these children play next to each other and are happy to be in the presence of peers, but they do not play directly with one another
Carbidopa-levodopa
Parkinson disease is characterized by decreased dopamine levels, uncontrolled acetylcholine, and formation of abnormal protein clusters (Lewy bodies) in the brainCarbidopa-levodopa is a combination antiparkinsonian medication used to reduce physical symptoms by increasing dopamine levels in the brain
Stage 2 pressure ulcer
Partial-thickness skin loss (abrasion, blister, or shallow crater) involving the dermis or epidermisThe wound bed is red or pink and may be shiny or dry
When should the peak level be drawn for Gentamicin?
Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides
Famotidine
PepcidH2 antagonist
Preventing VAP in sedated pts
Performing scheduled daily sedation vacations and maintaining appropriate client sedation levelsElevating the head of the bed 30-45 degrees (ie, semi-Fowler position)Providing oral care with antiseptic solutions (eg, chlorhexidine mouthwash) and suctioning subglottic secretionsPracticing strict hand hygiene
Is prophylactic treatment of family members recommended for pertussis or RSV bronchiolitis?
Pertussis
SE of griseofulvin
PhotosensitivityTeach to wear sunscreen
What is a common adverse effect of haloperidol?
Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client
Somatization
Physical symptoms that cannot be explained by a medical condition or disease
Priority before administering radioactive iodine to a female adult patient with Grave's disease
RAI destroys the thyroid gland, making clients permanently hypothyroid and requiring life-long thyroid supplementsIn female clients, a non-pregnant status should be confirmed with a valid pregnancy test prior to administering RAIRAI is contraindicated in pregnancy and may cause harm to a fetusAt some point, educate about S/S of hypothyroidism
Where is the gallbladder located?
RUQ
Causes of hirsutism
Polycystic ovary syndromeCushing's syndrome
Would oligohydramnios or polyhydramnios pose a risk for postpartum hemorrhage?
Polyhydramnios is a risk factor for postpartum hemorrhage due to overdistension of the uterus
Torsades de pointes
Polymorphic VTach characterized by QRS complexes that change size and shape in a characteristic twisting pattern
PEEP
Positive end-expiratory pressure - pressure given at the end of expiration during mechanical ventilation Keeps alveoli open so they can participate in gas exchange Usually PEEP is kept at 5High PEEP is used in pts with ARDS
What type of change in VS when standing would indicate a risk for falls?
Positive orthostatic vital signs (eg, rise in pulse of ≥20/min) indicate increased risk of syncope and falls
Adverse effect associated with positive pressure ventilation (via facemask, ETT, NC, etc)
Positive pressure applied to the lungs compresses the thoracic vessels and increases intrathoracic pressure during inspirationThis leads to reduced venous return, ventricular preload, and CO, which results in HYPOTENSION
Your post cholecystectomy pt reports increased nausea. What do you do?
Postoperative pts are at an increased risk for vomit aspiration due to nausea and an altered LOC (caused by anesthesia)These pts should be placed on their side and should receive antiemetics to prevent potential airway and breathing complications
Postpartum vaginal bleeding that saturates a perineal pad in < ____ hr(s) is considered excessive.
Postpartum vaginal bleeding that saturates a perineal pad in <1 hour is considered excessive.
What is the purpose of combining spironolactone with HCTZ?
Potassium-sparing diuretics (spironolactone, amiloride, triamterene eplerenone) are generally very weak diuretics and antihypertensives*However, they are useful when combined with thiazide diuretics to reduce potassium (K+) lossThiazide diuretics can cause hypokalemia when used as monotherapy
Addisonian crisis
Precipitated by physical or emotional stress, or sudden withdrawal of hormoneS/S:N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Factors that protect against suicide
PregnancyParenthoodReligion & participation in religious activitiesSocial support/family connectedness
A BMI of 25 to 29.9 is considered
overweight
Allen's test
Prior to drawing an ABG from the radial artery, you must occlude both ulnar and radial artery until hand blanches - then release ulnar - if thehand pinks up in <15 secs, ulnar artery is good and you can carry on with ABG/radial stick as planned
Should you flush an NG tube with 30 ml of water prior to or after administering enteral feeding?
Prior!
A pt is 2 days post-op gastric bypass surgery. The pt is experiencing nausea and is dry heaving. Is this pt's condition a priority and what should you do?
Priority because vomiting/dry heaving increase the risk for wound dehiscence and eviscerating - Obese clients who have undergone extensive abdominal surgery are especially vulnerable!!Administer an antiemetic medication as soon as possible to prevent wound dehiscence and evisceration, which would be a medical emergency!
Shock continuum
Progressive stage of shockInitial --> Compensatory --> Progressive --> Irreversible
____________, used for anesthesia and sedation, includes egg lecithin and soybean oil as inactive ingredients. Therefore, patients who have an egg or soy allergy should not receive this medication.
Propofol
Beta Blockers
PropranololMetoprololAtenolol
Certain individuals should receive prophylactic antibiotics prior to dental procedures to prevent infective endocarditis (IE). These include the following:
Prosthetic heart valve or prosthetic material used to repair heart valvePrevious history of IESome forms of congenital heart diseaseCardiac transplantation recipients who develop heart valve disease
Heparin antagonist
Protamine sulfate
Administration of misoprostol is contraindicated if:
Pt is receiving another uterotonic simultaneously (oxytocin)Pt has a history of uterine surgery (cesarean birth)Pt has an abnormal fetal heart rate pattern or uterine tachysystole (>5 contractions in 10 min)
Risperidone
Pts with bipolar disorder often need antipsychotic medication (risperidone, haloperidol) to control acute psychosis and lithium for long-term maintenance therapy
Who should NOT take anticholinergics (antihistamines included!)?
Pts with urinary retention, such as BPH diagnosisBowel obstruction ptsGlaucoma pts
How do you administer ear drops to a child <3 years old?
Pull the pinna downward and straight back
A child with tonisllitis is pulling at his ears. Is this a serious finding?
Pulling at the ears is a common symptom in children with otitis mediaAn ear infection frequently accompanies tonsillitis in children and is easily treated with antibioticsThis is not a serious finding
Complications of Oligohydramnios
Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluidUmbilical cord compression - continuous fetal monitoring should be applied to monitor for variable decelerations
Abdominal aortic aneurysm S/S
Pulsatile mass in the periumbilical area slightly to the left of the midlineBruit may be auscultated over the siteBack/abdominal pain due to compression of nearby anatomical sites or nerve compression from an expanding/rupturing AAARupture of an abdominal aneurysm can quickly cause exsanguination and death
When should Levothyroxine be held?
Pulse > 100bpm
Adverse effect of Erythromycin
QT prolongation (over 0.4 sec)
Scopolamine
anticholinergicused to prevent nausea and vomiting from motion sickness used as an adjunct to anesthesia to control secretions
Nursing care for suspected Autonomic Dysreflexia
Raise the HOBTreat the cause - such as a kink in the Foley (bladder or rectal distension is a common cause)
Peak of Lispro
Rapid-acting insulins (lispro, aspart) take peak effect in 30 minutes to 3 hoursE.g.: Pts who receive rapid-acting insulin at 11:30 AM would be most at risk for hypoglycemia from 12:00-2:30 PM
Most common adverse effect of penicillins
Rash - indicates potentially impending anaphylaxis
Cardiogenic shock s/s
Reduced CO (hypotension, narrow pulse pressure), Pulmonary edema (tachypnea, bibasilar crackles, decreased O2 sat) caused by blood "backing up" into the pulmonary capillariesTo compensate, catecholamines (epinephrine) and vasopressin are released by the adrenal glands to increase COIV fluids should not be bolused in cardiogenic shock as this will suddenly increase circulating volume and cardiac workload, which may precipitate pulmonary edemaNitroglycerin can worsen hypotension and should not be given either - other pain medications (morphine) may be given for chest pain if blood pressure is low
Peak of Regular Insulin
Regular insulin is a short-acting insulin that reaches the peak effect within 2-5 hours after SQ administrationE.g.: Pts who receive regular insulin subcutaneously at 11:30 AM are at highest risk for hypoglycemia between 1:30 PM and 4:30 PM
Which type of insulin can be administered IVP?
Regular insulin is the only insulin that can be administered via IV pushSQ injection is the indicated route for NPH insulin administration; it should never be administered via IV push
Fleet enema
Relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon and causing distention and then defecation
Neck dissection
Removal of cancerous lymph nodes around the neck
Which antitubercular drug often causes red-orange urine?
Rifampin often causes a red-orange discoloration of body fluids (urine, sweat, saliva, tears)
Where are defibrillator pads placed?
Right upper chest, just below the clavicleLeft lateral chest, near the anterior axillary line below the nipple line
Is left or right sided heart failure more critical?
Right-sided heart failure (peripheral edema) is not as dangerous as left-sided heart failure (pulmonary edema)
ALS medical management
Riluzole (Rilutek) is the only medication approved for ALS treatmenRiluzole, a glutamate antagonist, is thought to slow neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and spinal corIn some clients, riluzole may slow disease progression and prolong survival by 3-6 months
Methylphenidate
Ritalin is a CNS stimulant used to treat ADHD and narcolepsy
New Oral Anticoagulants (NOACs)
Rivaroxaban (Xaralto)DabigatranApixaban
How does Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion affect Na+ levels? What is an appropriate IV solution for this pt?
SIADH secretion results in water retention and dilutional hyponatremiaPts with SIADH often require hypertonic saline 3% for sodium repletion to increase serum sodium levels
Heparin route
SQ or IV
MAOIs should not be combined with
SSRIsConcurrent use of MAOIs with SSRIs (escitalopram, citalopram, sertraline) may precipitate life-threatening adverse reactions (serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis)If a client's prescribed medication regimen will change to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2-week "washout" period without either medication
What is a good activity for a hospitalized 10-year-old child to promote growth and development?
School-age children deal with the conflict of industry versus inferiorityLearning is a priority and completing school work provides a sense of accomplishment and satisfactionParents should provide hospitalized school-age children with missed school work on a regular basis
What type of drainage is expected 2 hours post-op?
Serosanguineous (pink) drainage is expected after a surgical procedure, but a dressing saturated with sanguineous (bright red) drainage indicates excessive blood loss with possible hemorrhage; it should be reported immediately to the health care provider for evaluationTreatment with a pressure dressing to provide hemostasis, cauterization of a bleeding vessel, or fluid replacement may be necessary
Patient education for Levothyroxine
Several medications impair the absorption of levothyroxine (Synthroid): antacids, calcium, and iron preparationsPts with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medicationsLevothyroxine dosing is adjusted based on blood tests for thyroid-stimulating hormone or other thyroid hormone levelsThyroid supplementation with levothyroxine usually requires lifelong therapyLevothyroxine has a long half-life, so dosing is once daily
S/S of Autonomic Dysreflexia
Severe hypertensionThrobbing headacheMarked diaphoresis above the level of injuryBradycardiaPiloerection (goose bumps)FlushingThis is an emergency condition requiring immediate intervention
Myxedema coma
Severe hypothyroidism causing decreased LOC (lethargy, stupor) that may progress to a comaS/S:HypothermiaBradycardiaHypotensionHypoventilationWill likely require emergency endotracheal intubation and mechanical ventilationClients with myxedema coma require thyroid hormone replacement with IV levothyroxine to correct the hypothyroid state but only after respiratory status is secured
SE of SSRIs
Sexual SE - Zoloft (sertraline) = No LoftSerotonin syndrome
Hepatitis B is transmitted through
Sexual contact and infected blood (drug use, accidental needle stick, perinatal mother-to-child infection)
How is nystatin administered for oral candidiasis?
Shake suspension well before dosingAssist the client in removing and soaking denturesAssess the affected area frequentlyEducate the client to swish the medication in the mouth before swallowing
Epstein pearls
Small, white cysts found on the hard palate of newbornsThese cysts are considered common findings, and they disappear a few weeks after birth
Burn care at home
Soak area briefly in cool water to stop the burning processRemove any clothing or jewelry around the burn to avoid constriction as edema develops - only a HCP may remove clothing that is stuck to the burned area Cover with a clean, dry cloth to prevent contamination, further trauma, and hypothermiaMedications should not be applied to a burn until prescribedNo ice, ointments, creams, or butter should be placed on the open skin
Which medication is administered to reverse QRS prolongation from a tricyclic antidepressant overdose?
Sodium bicarbonate
Which medication is used to treat mild to moderate hyperkalemia?
Sodium polystyrene sulfonate (Kayexalate)Potassium is exchanged for sodium in the intestines and excreted in the stool, thereby lowering the serum potassium
What medication should not be taken with tetracycline?
Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption
When suctioning a newborn, should you suction the pharynx or nasal passages first?
Suction the pharynx first followed by the nasal passages to prevent aspiration if the newborn gasps with nasal suctioning
What age group partakes in solitary play?
Solitary play is common in infantsChildren at this stage are focused on their own activity and will play alone in the presence of others
What is the priority action for a pt that has been impaled with a sharp object?
Stabilization of the object is the first priority to prevent it from moving during initial client assessmentException to the rule: First responders may remove the impaled object if it obstructs the airway and prevents effective cardiopulmonary resuscitation
Scarlet Fever
Streptococcus pyogenesS/S:FeverSoar throat and erythemaStrawberry tongueSandpaper rash - red sunburn-like rash with small bumpy feelingDx:Rapid streptococcal antigen testThroat culture may be neededTx:Penicillin such as amoxicillin
Does Streptokinase or Urokinase have a side effect of allergic reactions?
Streptokinase
Which fibrinolytic drugs can cause bleeding complications?
StreptokinaseUrokinaseAssess for bleeding at puncture sitesDo not administer heparin or anticoagulants with these drugs!
Fibrinolytic agents
StreptokinaseUrokinaseAlteplase
Contraindications for tPA
Stroke or head trauma within the past 3 monthsThrombocytopenia (platelet count < 100,000 and/or coagulation disordersUncontrolled hypertensionMajor surgery in past 2 weeksOnset of symptoms > 4.5 hrs ago
Calculating EDB
Subtract 3 months and add 7 days from LMP
Rhythms that are ideal for synchronized cardioversion are:
Supraventricular tachycardia (SVT)Ventricular tachycardia with a pulseAtrial fibrillation with rapid ventricular responseIf the defibrillator is not synchronized with the R wave in a client with a pulse, the shock may be delivered on the T wave and can cause a lethal arrhythmia (Vfib)
Dopamine (Intropin)
Sympathomimetic inotropic medication used to improve hemodynamic status in clients with shock and heart failureEnhances CO by increasing myocardial contractility, increasing HR, and elevating BP through vasoconstrictionRenal perfusion is also improved, resulting in increased UO
Fibromyalgia treatment
Symptom management:Muscle relaxers (cyclobenzaprine)Narcotic analgesics (tramadol, hydrocodone)NSAIDs (ibuprofen, naproxen, celecoxib)Neuropathic pain relievers (pregabalin, gabapentin)Antidepressants such as SSRIs (fluoxetine, duloxetine) and tricyclic antidepressants (amitriptyline).
Major side effects of angiotensin-converting enzyme (ACE) inhibitors include:
Symptomatic hypotensionIntractable coughHyperkalemiaAngioedema (allergic reaction involving edema of the face and airways)Temporary increase in serum creatinine
How do you treat unstable VTach with a pulse?
Synchronized cardioversion
Instructions for proper NTG administration include:
Tablets are heat and light sensitive: They should be kept in a dark bottle and capped tightlyTake up to 3 pills in a 15-minute period: Take 1 pill every 5 minutes (up to 3 doses)EMS should be called if pain does not improve or worsens 5 minutes after the first tablet has been takenAvoid fatal drug interactions: concurrent use of erectile dysfunction drugs (sildenafil, tadalafil, vardenafil) or alpha blockers (terazosin, tamsulosin) is contraindicated due to potentially fatal hypotensionHeadache may occur: headache and flushing are common side effects of NTG due to systemic vasodilation and do not warrant medication discontinuation
Symptoms of hypokalemia
TachycardiaDry mouth, thirstWeakness, drowsiness, lethargyMuscle aches
Signs of malignant hyperthermia
Tachypnea, tachycardia, and a rigid jaw or generalized rigidityAs the condition progresses, the client develops a high feverMuscle tissue is broken down, leading to hyperkalemia, cardiac dysrhythmias, and myoglobinuria
Dabigatran
anticoagulant, thrombin inhibitorrisk for bleeding
Which vaccines can a pregnant woman received at 30 weeks gestation?
Tdap, influenza vaccine (NOT nasal spray)Pregnant women have suppressed immune systems and are at increased risk for illness and subsequent complicationsSome viruses (eg, rubella, varicella) can cause severe birth defectsInactivated vaccines contain a "killed" version of the virus and pose no risk of causing illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and pose a slight theoretical risk of contracting the illness from the vaccine. For this reason, women should not receive live virus vaccines during pregnancy or become pregnant within 4 weeks of receiving such a vaccineThe tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all pregnant women between the beginning of the 27th and the end of the 36th week of gestation as it provides the newborn with passive immunity against pertussis (whooping cough)During influenza season (October-March), it is safe and recommended for pregnant women to receive the injectable inactivated influenza vaccine regardless of trimesterThe influenza nasal spray; measles, mumps, and rubella (MMR) vaccine; and varicella vaccine contain live viruses and are contraindicated in pregnancy
COX-2 inhibitors are not safe for which patient populations?
Teenagers3rd trimester of Pregnancy - premature closure of ductus arteriosus
Right sided stroke
Tend to be impulsive and unaware of deficitsTeaching the client's family to expect disinhibition and emotional outbursts helps family members cope with the behavioral changes and reduces frustration during interactions
What is the first sign of puberty in boys?
Testicular enlargement, including scrotal changesThis typically occurs at age 9½-14
Common SEs of Clonidine
The 3 Ds:DizzinessDrowsinessDry mouth
Fluoxetine is an ________________ that leads to _______________.
antidepressanthyponatremia
Negative-pressure wound therapy
The application of negative pressure to a wound to enhance bacteria and exudate removalNegative pressure promotes healing by stimulating cell growth and vessel perfusion in the wound bed
A child with tonsillitis develops a sandpaper-like rash. Is this a serious finding?
The most common bacterial cause of tonsillitis is group A streptococcal infectionGroup A strep can also result in scarlet fever, which manifests as fine sandpaper-like skin rash and feverAntibiotics will effectively treat this condition, and it is not life-threatening
Ethambutol adverse effect
The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effectThe client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination
Monitor these labs when a pt is taking Isoniazid
The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored
What should the nurse do to help a pt who gave birth vaginally 2 hrs ago, has a boggy fundus deviated to the right, and has saturated a pad in 20 mins?
The client should be assisted to void to correct the bladder distensionThe nurse should then perform fundal massageAn oxytocin infusion should be initiated if initial attempts to control postpartum bleeding (relief of bladder distention and fundal massage) have failed - the usual postpartum oxytocin IV dosage is 125-200 milliunits/minA complete blood count is needed to determine hematocrit and hemoglobin levels following excessive postpartum bleedingOxygen delivery at 10 L/min via a nonrebreather facemask may be initiated if the client becomes symptomatic following excessive blood loss - however, the first priority is to control the bleeding
A pt with COPD and worsening leg edema likely has which heart condition?
The client with COPD and peripheral edema may have cor pulmonale, or right-sided heart failure, from vasoconstriction of the pulmonary vessels
Which client should be seen first?1. Asthma, SOB, high-pitched expiratory wheezing2. HF, SOB, pink frothy sputum
The client with HF who is SOB and coughing up pink frothy sputum has developed acute pulmonary edema (fluid filling the alveoli), a potentially life-threatening condition - this client's status has deteriorated from baseline, is potentially the most hemodynamically unstable, and should be assessed firstThis client with shortness of breath and high-pitched expiratory wheezing is experiencing expected clinical manifestations of asthma and is the second most unstable client at this time
What color should the stoma be post-op?
The colostomy stoma should be beefy red in the immediate postoperative period. Any discoloration to the stoma could indicate decreased blood supply to the area; the nurse should notify the HCP. Any paleness or graying of the stoma indicates decreased blood supply to that area.
When is a toddler ready for toilet training?
The degree of readiness progresses relative to development of neuromuscular maturity with voluntary control of the anal and urethral sphincters occurring at age 18-24 monthsBowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years
When should Lovastatin be taken
The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal
In a pt with autonomic dysreflexia with symptoms of HTN, bradycardia, and HA, should you lower or raise the HOB?
The head of the bed should be raised to lower the blood pressure
How fast can IVPB KCL be administered?
The infusion rate should not exceed 10 mEq/hr. Therefore, IVPB KCL must be given via an infusion pump so the rate can be regulated. IV KCL should be diluted and never given in a concentrated amount. Furthermore, too rapid infusion can cause cardiac arrest. The charge nurse would need to intervene if the new nurse was attempting to administer IVPB KCL via gravity infusion instead of a pump.
Placenta accreta
direct implantation into myometrium without intervening decidua -> will need a C-section, high risk for bleeding, may need hysterectomy
Glyburide pt education
The major adverse effects of sulfonylurea medications (glyburide, glipizide, glimepiride) are:Hypoglycemia & Weight gainPts taking glyburide should be taught to use sunscreen and protective clothing as serious sunburns can occurAvoid alcohol because it lower blood sugar and can cause hypoglycemia
If parents of a child with epiglottis are wondering how they could have prevented this from happening, what should you say?
The majority of cases of epiglottitis are caused by Haemophilus influenza type B (HiB), which is covered under the standard vaccinations given during the 2- and 4-month visitsEpiglottitis is rarely seen in vaccinated children
Characteristics of an Extreme Preemie around 28 weeks
The newborn at 28 weeks gestation has:Abundant lanugo - fine hair on back that disappears at 36 weeksFlat areolae without palpable breast budsSmooth, pink skin with visible veins
How can the nurse prevent fat emboli from forming in a pt with a fractured femur?
The nurse should minimize movement of the injured extremity to reduce the risk for fat emboli
Plan of Care for LGA baby
The nurse should prioritize assessment of birth injuries and hypoglycemia!!!- Assess the newborn for birth-related injuries (eg, cephalohematoma, clavicular fracture, lacerations) and review the birth record to determine if an operative vaginal birth occurred (eg, forceps)- Discuss the need for possible feeding supplementation (eg, breastmilk, formula) if the newborn is hypoglycemic- Assist the mother to feed the newborn soon after birth and every 2-3 hours thereafter to prevent hypoglycemia - Obtain a capillary blood glucose before feeding to assess for hypoglycemia, and notify the health care provider when a capillary BG reading is <40-45 mg/dL
Postoperative cognitive dysfunction (POCD)
The nurse should teach the client that possible memory impairment and problems with concentration, language comprehension, social integration, and emotional lability are common following major surgerySymptoms typically resolve after 4-6 weeks or when healing is complete
Which meds should not be combined with Lithium?
Thiazide diureticsNSAIDsAntidepressants They can all cause elevated lithium levels, which increases the risk of toxicityRemember Lithium range: 0.6-1.2
What adverse effect should a patient taking hydrochlorothiazide report?
Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia
How do administer ear drops to an adult or child years or older?
The pinna is pulled upward and back to straighten the external ear canal
When does the posterior fontanel close?
The posterior fontanel is a membrane-filled space between the parietal and occipital bones and normally closes by age 2 months
The posterior fontanelle fuses by age ____ months, and the anterior fontanelle fuses by age ____ months.
The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months.
How should you position a patient after a liver biopsy? How long should they stay in the position?
The pt must lie on the right side for a minimum of 2-4 hours to splint the incision site (the liver is on the right side of the body)The liver is a "heavy" organ and can "fall on itself" to tamponade any bleedingThe client stays on bed rest for 12-14 hours
Category X drugs
There is a risk for teratogenesis in the first trimesterMust use reliable birth control if taking a drug in this category (e.g. Accutane)
Why is it important to drink plenty of water when taking sulfa drugs?
They can crystalize in the urine
What should you educate your pt about drowsiness related to clonidine?
This SE will go away after a few weeks of taking the drug
Techniques for feeding pts with dysphagia
Tilting the neck slightly to assist with laryngeal elevation and closure of the epiglottisModification of food consistency (pureed, mechanically altered, soft) - don't want it too thinThickened liquidsHaving the client sit upright at a 90-degree angle Placing food on the stronger side of the mouth to aid in bolus formationAvoid straws for drinking liquids - might cause increased swallowing difficulty and choking
Prior to oral surgery, it is necessary to report findings such as
Those that will place a client at risk for the development of endocarditis (presence of prosthetic valves, history of congenital heart disease) and bleeding (elevated INR)
Is it ok for a pt with glaucoma to take diphenhydramine?
Those with glaucoma or urinary retention should avoid anticholinergic drugs
Alteplase
Thrombolytic agents (alteplase, tenecteplase, reteplase) place clients at risk for bleedingTherefore, they are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertensionThey are often prescribed to resolve acute thrombotic events (ischemic stroke, myocardial infarction, massive pulmonary embolism)BP must be below 180/110 mm Hg !!!!
NSAIDs increase the risk of
Thrombotic events (MI, stroke), especially in clients with cardiovascular disease (coronary artery disease)
Lyme disease
Tick-borne disease caused by Borreliaring-shaped rashtx: antibiotics
What is a S/S of aminoglycoside toxicity?
Tinnitis - ring of the earsBecause aminoglycosides are ototoxic(and nephrotoxic!)
Tinnitus is a SE of which drugs
Tinnitus (ringing in the ears) is an uncommon SE of NSAID (naproxen) useTinnitus is commonly associated with toxicity related to salicylate-containing NSAIDs (aspirin) or aminoglycosides (gentamicin, neomycin, tobramycin)
What is atropine used for in the OR?
To decrease oral secretions
A pt is receiving a heparin infusion and you have orders to administer Warfarin at the same time. Why? What do you do?
Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effectTherefore, an overlap of a parenteral anticoagulant like heparin with warfarin is requiredThe typical overlap is 5 days or until the INR reaches the therapeutic levelWarfarin requires an overlap of therapy with unfractionated heparin infusion or low-molecular-weight heparin (eg, enoxaparin, dalteparin) for several days until the INR is in the therapeutic range for the client's condition.Remember: Anticoagulants like heparin and warfarin will not break down or dissolve clots. They inhibit any further clot formation and keep the current clot from getting larger. Thrombolytics, such as tissue plasminogen activator, do break down clots.
When are NOACs used?
To prevent stroke/embolism in patients with atrial fibrillation Prevent VTE in orthopedic surgery
Which medication is administered for AFib?
To slow the heart rate, an IV infusion of the calcium channel blocker diltiazem is prescribedThis requires continual cardiac monitoring!!
Topical capsaicin cream
Topical capsaicin cream (Zostrix) is an over-the-counter analgesic that effectively relieves minor pain (osteoarthritis, neuralgia)
First line medication for Torsades de pointes
Torsades de pointes is usually due to a prolonged QT interval (more than half the RR interval), which is the result of electrolyte imbalances, especially hypomagnesemia, or some medicationsThe first-line treatment is IV magnesiumTreatment may also include defibrillation and discontinuation of any QT-prolonging medications
TORCH infections
ToxoplasmosisOther (parvovirus B19/varicella-zoster virus)RubellaCytomegalovirusHerpes
Which route provides the most continuous analgesia for cancer pain?
Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief
Justice
Treating every pt equally regardless of gender, sexual orientation, religion, ethnicity, disease, or social standing
Position Air Embolism
Trendelenburg on the Left Side!
Oral Metronidazole pt education
Trichomoniasis is a sexually transmitted infection that may cause a frothy, malodorous, yellow-green vaginal dischargeAppropriate teaching for clients undergoing treatment with oral metronidazole includes:- Avoidance of alcohol- Treatment of sexual partners- Abstinence from sexual activity until the symptoms resolve (about 1 week after treatment)- Awareness of possible side effects (dark-colored urine, metallic taste, GI upset)
Amitriptyline
Tricyclic antidepressantAlso treats nerve pain, so may be used to treat fibromyalgia
Medication for Trigeminal Neuralgia
Trigeminal neuralgia is sudden, sharp pain along the distribution of the trigeminal nerveThe symptoms are usually unilateral and primarily in the maxillary and mandibular branchesClients may experience chronic pain with periods of less severe pain, or "cluster attacks" of pain between long periods without pain - pain is severe, intense, burning, or electric shock-likeTriggers can include washing the face, chewing food, brushing teeth, yawning, or talking*The drug of choice is carbamazepine - it is a seizure medication but is highly effective for neuropathic pain
Tumor lysis syndrome (TLS)
Tumor lysis syndrome occurs due to rapid lysis of cells and the resulting release of intracellular potassium and phosphorus into serumPhosphorus binds to calcium, leading to hypocalcemiaThe breakdown of cellular nucleic acids causes severe hyperuricemiaIV hydration and hypouricemic medications (allopurinol) are prescribed to promote purine excretion and prevent acute kidney injury
A pt with a goiter should avoid which food?
Turnips
Who can witness an advance directive?
Two witnesses are required for completion of the advance directive formThe witnesses canNOT be health care providers involved in the care of the client OR individuals named as health care proxies in the document
Subdural hematoma
Typically is a slow venous bleed so symptoms appear 24-48 hours after head trauma occursS/S: similar to those of increased ICP, including change in LOC, projectile vomiting, ataxia, ipsilateral (unilateral) pupil dilation, & seizuresBrain herniation can occur if the condition is not recognized and treated
When should you hold erythropoietin?
Uncontrolled HTN Hgb > 11
Fondaparinux
Unfractionated heparinAnticoagulant commonly used for DVT and PE prophylaxis after hip/knee replacement or abdominal surgeryFondaparinux is not administered until MORE THAN 6 hrs after any surgeryAnticoagulants are NOT given while an epidural catheter is in place
Typical characteristics of child abusers
Unrealistic expectations of the child's performance, behavior, and/or accomplishments; overly critical of the childConfusion between punishment and discipline; having a stern, authoritative approach to disciplineHaving to cope with ongoing stress and crises such as poverty, violence, illness, lack of social support, and isolationLow self-esteemA history of substance abusePunitive treatment and/or abuse as a childLack of parenting skills, inexperience, minimal knowledge about child care and child development, and young parental ageResentment or rejection of the childLow tolerance for frustration and poor impulse controlAttempts to conceal the child's injury or being evasive about an injury; shows little concern about the child's injury
UAPs cannot reposition which pts?
Unstable clients and spinal cord stabilization require the presence of a nurse for repositioning or moving - includes pts with cervical collar or a recent hip replacementOther repositioning info:Use a gait/transfer belt to transfer a partially weight-bearing client to a chairUse 2 or more caregivers to reposition clients who are uncooperative or unable to assist (comatose, medicated)Use a full-body sling lift to move/transfer nonparticipating clientsUse 2-3 caregivers to move cooperative clients weighing less than 200 lbUse 3 or more caregivers to move cooperative clients weighing more than 200 lb
How to care for a newly circumcised baby
Use only warm water for cleaning and avoid soap and alcohol-based wipesAfter 24 hours, a yellow exudate forms as part of the normal healing process; it should not be removedPain is expectedDiapers should be changed when soiled or at least every 4 hours to keep the area clean and assess for evidence of infection or bleedingPetroleum gauze or ointment should be applied at every diaper change (unless Plastibell used) to prevent sticking
Black cohosh
Used for treatment of menopausal symptomsThe main side effect is liver injury
Memantine
Used to ease the symptoms of moderate to severe Alzheimer disease, thereby improving the quality of life for clients and caregiversIt may improve:Cognition - memory, thinking, languageADLsBehavioral problems - agitation, depression, hallucinations
Lithium is used to treat which conditions and what range is therapeutic?
Used to treat bipolar affective disordersTherapeutic serum range of 0.6-1.2 mEq/L Levels >1.5 mEq/L are considered toxic
Barium enema
Uses contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray
Ways to prevent lead exposure in the home
Vacuuming spreads lead dust in the air, which increases inhalation exposure, so instead hard surfaces should be wet-dusted or mopped at least weeklyHot tap water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present - taps should be flushed for several minutes to clear out contaminated water before useThe home environment should be assessed for lead sourcesHand-washing, especially before eating, is important to remove lead residue
What should a pt practice before a cardiac catheterization?
Valsalva's maneuver and coughingThese tasks will need to be performed during the procedure
Live vaccines
Varicella-zoster vaccine (chicken pox)Measles-mumps-rubella (MMR)RotavirusYellow feverInfluenza if administered intranasal
Vesicular skin lesions on an infant could be which 2 things?
Varicella-zoster virus (chickenpox)ORStaphylococcus aureus (impetigo)These lesions are not associated with a fungal infection
Calcium Channel Blockers
VerapamilNifedipineDiltiazemAmlodipine
Warfarin antagonist
Vitamin K
Normal WBC and neutrophil count
WBC 4,000 - 11,000Neutrophils 2,200 - 7,700
Capasaicin cream pt education
Wait at least 30 mins after massaging the cream into the hands before washing to ensure adequate absorption The client should avoid contact with mucous membranes (eg, nose, mouth, eyes) or skin that is not intact, as capsaicin is a component of hot peppers and can cause burningThe application of heat with capsaicin is contraindicated as heat causes vasodilation, which increases medication absorption and can possibly lead to a chemical burnLocal irritation (burning, stinging, erythema) is quite common and usually subsides within the first week of regular use - if the client experiences persistent pain, redness, or blistering, the cream should be discontinued and the HCP notifiedTopical capsaicin is often used concurrently with acetaminophen or NSAIDs (naproxen, celecoxib) to effectively treat osteoarthritis pain.Capsaicin should be used regularly (3-4 times daily) for long periods (weeks to months) to achieve the desired effect
Which foods should pts starting to take Warfarin not eat too much of eat inconsistent amounts of?
Warfarin (Coumadin) is a vitamin K antagonist used to prevent blood clots in clients with atrial fibrillation, artificial heart valves, or a history of thrombosis*Excessive intake of vitamin K-rich foods (broccoli, spinach, liver) can decrease the anticoagulant effects of warfarin therapy
Furosemide is a _____________ that causes _____________ and ______________
diuretichypokalemia and hypomagnesemia
Pertussis
Whooping cough is a very contagious communicable disease caused by the Bordetella pertussis bacteriaDroplet isolationTx:AntibioticsHumidified oxygenAdequate fluids will help loosen the thick mucusSuction as needed is important in infantsRespiratory status should be monitored for obstructionPosition pt on the left side to prevent aspiration if vomiting occursNo cough suppressants
What is the priority treatment for an injured child with hemophilia A who hit their head?
When intracranial or another form of bleeding is suspected, administration of factor VIII is a priority as the client's body cannot form a clot without it. Then after this, you can get a CT scan.
When should isosorbide or nitroglycerine be held?
When the SBP < 90 mmHg
Shoulder dystocia
When the fetal head delivers but the anterior (top) shoulder becomes wedged behind or under the mother's symphysis pubisShoulder dystocia lasting ≥5 minutes is correlated with almost certain fetal asphyxia resulting from prolonged compression of the umbilical cord
SE of Phenazopyridine to tell your pts
Will turn urine an orange-red color
When should a parent take their child for their first dental visit?
Within 6 months of first tooth eruption OR by the first birthday
Recent major surgery within the past ___ days is a contraindication as tPA dissolves all clots in the body and may therefore disrupt the surgical site
Within the past 14 days
Evisceration
Wound separation with protrusion of organs
Alprazolam
XanaxAn anxiolytic
What are some important preconception education topics?
achieving a normal weight (BMI 18.5-24.9)check rubella immunity & get updated vaccinationsfolic acid supplementationregular dental careavoidance of alcohol, smoking, and illicit drugs
ac
before meals
How could ACE inhibitors affect potassium levels?
cause hyperkalemia
Psoriasis
chronic skin condition producing red lesions covered with silvery scalesautoimmunetx: corticosteroids, methotrexate, phototherapy, avoid stress triggers
Signs of TRUE labor
contractions are regular with increasing frequency, duration, and intensitydiscomfort radiates from back to abdomencontractions do not decrease with restcervix progressively effaces and dilates
Acyclovir SE
crystalline neuropathy in kidneys
Corticosteroids ___________ the potassium level.
decrease
What is the benefit of combined alpha/beta blockers?
decrease BP without affecting HR
How do Calcium Channel Blockers work?
decreases SA/AV node conduction
PO Penicillin G should be taken when?
empty stomach
Which Loop diuretic is NOT a sulfa drug?
ethacrynic acid
How often should a corticosteroid inhaler be taken apart and washed?
every day
Pediculosis capitis
head lice
HHNK
hyperglycemic hyperosmolar non ketotic coma - essentially DKA without the ketoacidosis - blood gluclose levels rise without the right amount of insulin
Anticholinergic Pt Education
increase intake of fluids and bulk-forming foods to prevent dry mouth and constipationavoid locations/activities that may lead to hyperthermiado not drive until you know how the medication affects you (commonly causes sedation)
How do renal labs change in older age (age 80)?
increased protein in urine is expectedserum glucose increase is expectedspecific gravity declines
NSAIDs examples
indomethacinibuprofennaproxenketorolac
Patients with myxedema are dangerously hypersensitive to which classes of medications?
narcoticsbarbiturates (phenobarbital for sleep)anestheticsthese meds are contraindicated in this patient!
Pyloric stenosis S/S
narrowing of the opening of the stomach to the duodenumS/S:Projectile nonbilious vomiting followed by hunger - "hungry vomiter"An olive-shaped RUQ massWeight lossDehydrationElectrolyte imbalance (metabolic alkalosis)
isosorbide dinitrate (Imdur) can cause which SE?
nitrates cause vasodilation which can cause HAsAcetaminophen can be administered prn to control the HAs
1st degree heart block
prolonged PR intervalusually asymptomatic
A diet rich in ____________ and vitamin ___ helps with calcium-supplement absorption
protein vitamin D
Adverse reactions of ACE Inhibitors
proteinurianeutropeniacough
Cushing's triad
r/t increased ICP1) Systolic HTN with widening pulse pressure2) Bradycardia3) Bradypnea
Lispro and aspart insulins are _________ acting
rapid
McRoberts maneuver
sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter of the free anterior shoulderUsed for shoulder dystocia
Herpes zoster
shingles
Manifestations of Addisonian Crisis are similar to s/s of what condition?
shockHypotension, rapid weak pulse, rapid RR
Regular insulin is _________ acting
short
edrophonium
temporarily reduces muscle weakness to test for myasthenia gravis
Which medications can cause pill-induced esophagitis?
tetracyclines (eg, doxycycline) bisphosphonates ("dronates": alendronate, ibandronate, pamidronate, risedronate)potassium
Dysarthria
the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system
Imipramine
tricyclic antidepressant
Eardrops are administered with the ear positioned ____________ and ___________ for patients > 3 years.
upward and outward
Acyclovir is used to treat which two conditions?
varicella zoster - shinglesherpes
Nitroprusside sodium
vasodilatorused to decrease BP in HTN
Signs of digitalis toxicity
vomiting!!!anorexiaabdominal painLipitor can cause digitalis toxicity!
Transverse myelitis
(Spinal cord inflammation) usually results from a recent viral infectionClassic symptoms include paralysis, urinary retention, and bowel incontinence
Delusions of Control
"Don't drink the tap water. That's how the government controls us."
Persecutory (paranoid) delusion
"Those martians are trying to poison me with that tap water."
Drugs that can cause Neuroleptic Malignant Syndrome (NMS)
"Typical" antipsychotics:haloperidol, fluphenazineNewer "atypical" antipsychotic drugs:clozapine, risperidone, olanzapine
Rosuvastatin
(Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglyceridesA serious complication associated with statin medication is rhabdomyolysisThe client should immediately report any signs of muscle aches or weakness to the HCPOther SE: insomnia, headache, abdominal discomfort
Phentolamine
(Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation
Tinea capitis
(Ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair lossTreatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungalmedication (griseofulvin oral suspension) that the client must take for several weeks to monthsThe client will best absorb griseofulvin (suspension, microsized tablets) when taken after/with high-fat foods (ice cream)Photosensitivity is a common SE of griseofulvin
Colchicine
antiinflammatory to treat acute gouty arthritisTake WITHOUT food
A white pupil
(leukocoria, or cat's-eye reflex) is one of the first signs of retinoblastoma, an intraocular malignancy of the retinaOther symptoms include an absent red reflex, asymmetric or of a differing color in the affected eye, and fixed strabismus (constant deviation of one eye from the other)
Tricyclic antidepressants side effects
*TCAs*T - ThrombocytopeniaC - Cardiac [arrhythmia, MI, stroke]A - Anticholinergic [urinary retention, constipation]S - Seizures*TEACHING*-take at bedtime because of sedative effect-stay out of sun
S/S of colorectal cancer
- Blood in the stool (positive occult blood, melena)- Abdominal discomfort and/or mass (not common)- Anemia due to intestinal bleeding- Change in bowel habits (diarrhea, constipation)- Unexplained weight loss due to impaired nutrition from altered intestinal absorption
Epinephrine auto-injectors patient education
- Administer injection at a 90-degree angle into the outer thigh- Hold the auto-injector in place for 10 seconds to ensure delivery of the entire dose- Seek immediate medical care after an injection because anaphylactic reactions may resume when the effects of the epinephrine subside (ie, 10-20 minutes)- Expect to experience tachycardia, palpitations, and/or dizziness after administration- Store EAIs at room temperature in a dark place to prevent inactivation by heat or light, or device failure from cold
Nursing interventions for clients with acute viral hepatitis include:
- Alternate periods of rest and activity to reduce metabolic demands and avoid fatigue- Avoid hepatotoxins (alcohol, acetaminophen)- Medications metabolized in the liver (appetite stimulants, antipruritics, analgesics, sedatives) should be used cautiously to allow hepatocytes to heal- Encourage low fat, small, frequent meals to decrease nausea and promote intake in clients with anorexia - anorexia is lowest in the morning - promote eating a larger breakfast- Provide oral care and avoid extremes in food temperature to increase appetite- Promote water consumption (3L/day) and diets adequate in carbohydrates and caloriesDiets high in fat should be avoided as liver bile production, which is needed for fat digestion, may be impaired - encourage protein and carbohydrate intake to assist with liver healing
Causes of lithium toxicity
- Dehydration- Diet low in Na+- Drug-drug interactions (NSAIDs and thiazide diuretics)- Decreased renal function (elderly clients)Lithium is cleared renally. Even a mild change in kidney function can cause serious lithium toxicity - therefore, drugs that decrease renal blood flow (NSAIDs) should be avoided. Acetaminophen would be a better choice for pain reliefPts should NEVER restrict their Na+ or H2O intake while taking lithium
Clients taking long-term corticosteroid replacement should be taught the following:
- Do not discontinue glucocorticoid therapy abruptly- Report any signs and symptoms of infection to the HCP immediately- Stay attuned to signs and symptoms of stress and increase dose of corticosteroid during times of stress- A side effect of corticosteroid therapy is hyperglycemia- Corticosteroids are catabolic to bone (osteoporosis) and muscle (muscle weakness - a diet high in calcium (at least 1500 mg/day) and protein (1.5 g/kg/day) but low in fat and simple carbohydrates is recommended- Cataracts are a side effect of corticosteroids, particularly glucocorticoid therapy. - make an appointment with an optometrist yearly to assess for cataracts- Corticosteroid medications can cause gastric irritation and should not be taken on an empty stomach
Nursing interventions for shoulder dystocia
- Documenting the exact time of events (birth of fetal head, shoulder dystocia maneuvers)- Verbalizing passing time to guide decision-making by the HCP ("two minutes have passed")- Performing maneuvers to relieve shoulder impaction (McRoberts maneuver, suprapubic pressure)- Requesting additional help from staffNO forceps
Pts classified as "Expectant" during disaster triage
- Full-thickness burns over > 60% BSA- Severe neuro trauma- Apnea- Pulsenesses
When reconstituting a powdered medication for parenteral administration, the nurse should follow these steps in this order:
- Perform hand hygiene and don clean gloves prior to handling medication- Cleanse the vial top with alcohol and let it dry to prevent possible microbial contamination- Withdraw an amount of air from the vial equal to the prescribed amount of diluent to create negative pressure that will be equalized when the diluent is injected into the vial- Inject the appropriate diluent (sterile saline, sterile water) into the vial- Roll the vial between the palms of the hands to gently mix the solution- Withdraw the reconstituted medication from the vial into a sterile syringe for administration- Verify the dosage by checking the prepared medication against the medication administration record and medication label- Label the syringe with the medication name and dose
Mastitis tx
- Staphylococcus aureus is the most common causative organism and requires antibiotic treatment (dicloxacillin, cephalexin)- Continue breastfeeding frequently (every 2-3 hr) to ensure adequate milk drainage- Ensure proper breastfeeding technique (alternate newborn feeding positions, proper latch)- Apply warm compresses and massage the breast to facilitate complete emptying- Cool compresses can also be used between breastfeeding as needed for comfort- Ensure adequate rest, nutrition, and hydration- Relieve pain and inflammation with analgesics compatible with breastfeeding (acetaminophen, ibuprofen)- Wash hands before and after feeding
How should you manage norepinephrine extravasation through a peripheral IV?
- Stop the infusion immediately and disconnect the IV tubing- Use a syringe to aspirate the drug from the IV catheter; remove the IV catheter while aspirating- Elevate the extremity above the heart to reduce edema- Notify the health care provider and obtain a prescription for the antidote phentolamine (Regitine), a vasodilator that is injected subcutaneously to counteract the effects of some adrenergic agonists (eg, norepinephrine, dopamine)
Cervical lacerations should be suspected if
- The uterine fundus is firm and midline on palpation despite continued vaginal bleeding- The bleeding can be minimal to frank hemorrhage- Severe pain or a feeling of fullness is not associated with cervical lacerations
To care for and decrease transmission of impetigo, interventions include:
- Wash hands before and after touching the infected area- Isolating the infected person's clothing and linens and washing them in hot water- Keeping the infected person's fingernails short and clean to prevent bacteria from collecting under them and to deter scratching- Avoiding close contact with others for 24-48 hours after initiation of antibiotic therapy- Keeping the infected area covered with gauze when in contact with others
S/S of third spacing
- decreased UO with adequate intake- tachycardia- hypovolemia- increased weight- pitting edema, ascites
Fluoroquinolones
- floxacinCiprofloxacinLevofloxacinMoxifloxacin
Common side effects of anticholinergics
- new-onset constipation- dry mouth- flushing- heat intolerance- blurred vision- drowsiness
Pt Education for Transdermal Scopolamine
- placed on a hairless, clean, dry area behind the ear - apply patch ≥4 hours before starting travel- replace patch q72 hours- remove and discard old patch before placing a new one- dispose of the old patch out of reach of children and pets- wash hands with soap and water after handling patch
What size needle is used for IM injections?
1 to 1.5 in
The maximum rate for infusion of IV potassium chloride through a peripheral vein is ____ mEq/hr, and the maximum rate through a central vein is ____ mEq/hr.
10 mEq/hr40 mEq/hr
Theophyline therapeutic range
10 to 20 mcg/mLHold dose and call provider if higher than 20
Withhold digoxin in an infant with a HR less than _______ bpm.
100And contact HCP
A neonate's resting pulse is _____ /min
110-160/min
Ovulation begins ____ days before the start of the menstrual period
14
1 tbsp = ? mL
15 mL
A client with an acute stroke presentation requires "permissive hypertension" during the first 24-48 hours to allow for adequate perfusion through the damaged cerebral tissues. However, the blood-brain barrier is no longer intact once the blood pressure is > _____/_____ mm Hg. Therefore, "mild" lowering is required, usually to a systolic pressure that is not below _____ mm Hg.
220/120170
Normal aPTT
25-35 seconds
Therapeutic aPTT
46-70 seconds1.5-2 times normal aPTT value
Colostomies appliance should be changed every __ - __ days.
5 - 10
Normal BUN in children
5-18 mg/dL
Normal pulmonary artery wedge pressure
6-12 mmHg
Asymptomatic hypoglycemia in newborns with blood glucose (BG) <____ mg/dL if age 4-24 hours or <____ mg/dL if age < 4 hours should be initially treated with ____________.
< 35<25Feeding !!!Feeding the newborn is a simple, noninvasive method of increasing and stabilizing BG
Low CD4 counts are defined as:
< 750 for infants 12 months or younger<500 for children between age 1-5 years<200 for children age >5 years and adults
Oliguria is defined as < _____ mL/kg/hr
<0.5 mL/kg/hr
Normal BNP
<100 pg/mLBNP is secreted from the ventricles in response to the increased ventricular stretchElevated BNP is expected in a client with heart failure
What is SVT?
> 150 bpm
After how many days postpartum should lochia change from rubra to serosa?
> 3-4 days postpartum - progressive change in lochia from lochia rubra (dark-red vaginal bleeding) to lochia serosa (pink or brown discharge)
Facility policy may advise holding enteral feeding for high GRVs > ____ mL to minimize aspiration risk.
> 500 ml
Newborns who are large for gestational age (LGA) are diagnosed after birth by plotting their birth weight and gestational age on a growth chart; weight must be at least ____ percentile and is commonly > _______.
> 90th percentile> 8lbs 13oz (4000g)
What is considered a severely high creatine kinase level?
>15,000 U/L
UAP Scope of Practice
ADLsHygieneLinen changeRoutine, stable VSDocumenting I&OPositioning
UAP Scope of practice
ADLsHygieneLinen changeRoutine, stable VSDocumenting input/outputPositioning
Which antihypertensive medication class can cause hepatitis and renal failure?
ARBs - Losartan
What class of medication is recommended for a pt who has a reaction to ACE inhibitors?
ARBs such as valsartan or losartan
Phenazopyridine
AZOUTI pain relief
Insulin is absorbed more quickly when injected into the ______________.
Abdomen
Pica
Abnormal, compulsive craving for and consumption of substances normally not considered nutritionally valuable or edibleCommon substances include ice, cornstarch, chalk, clay, dirt, and paperMany women only have pica when they are pregnantOften accompanied by iron deficiency anemia due to insufficient nutritional intake or impaired iron absorption
Most important pt teaching about Clonidine
Abrupt discontinuation can result in serious rebound hypertension due to the rapid surge of catecholamine secretion that was suppressed during therapyClonidine should be tapered over 2-4 daysAbrupt withdrawal of beta blockers can also result in rebound hypertension and in precipitation of angina, myocardial infarction, or sudden death
Tolterodine and Oxybutynin
Anticholinergic meds to treat overreactive bladderreduce bladder spasms
When should a vaccine be held in children?
Assess for allergies to vaccine components (neomycin, gelatin, yeast)Screen for an allergy to latex (lips swelling from contact with bananas, kiwis, or latex balloons)Severely immunocompromised children (corticosteroid therapy, chemotherapy, AIDS) generally should not receive live vaccines (varicella-zoster vaccine, measles-mumps-rubella, rotavirus, yellow fever)Passive immunization may be the only option for children with severe immunosuppression or those unable to mount an antibody immune responseIt is OK to give vaccines to kids with a cold (even with a fever), hx of local swelling/erythema from previous vaccination, current antibiotics
What should you do first if an intubated pt has a drop in O2 sat?
Auscultate breath sounds bilaterallyIf the tube becomes displaced in the hypopharynx, hypoxemia can resultConfirming the presence of equal breath sounds bilaterally via auscultation is an important initial nursing interventionOnce placement is confirmed, you can give 100% O2 and suction tube
Which vitamin should be given along with isoniazid (INH) therapy?
B6 (pyridoxine) INH interferes with the action of vitamin B6 resulting in peripheral neuropathy; it manifests as ataxia and paresthesiaIndividuals who are most predisposed to becoming neurotoxic from taking INH include older adults, those who are malnourished, diabetic clients, pregnant or breastfeeding clients, alcoholics, children, those with liver or renal disease, and HIV-positive individuals
Nurses should screen clients for and immediately report warning signs of cancer, which can be remembered with the mnemonic CAUTION:
Change in bowel or bladder habitsA sore that does not healUnusual bleeding or discharge from a body orificeThickening or a lump in the breast or elsewhereIndigestion or difficulty in swallowing that does not go awayObvious change in a wart or moleNagging cough or hoarseness
sublimation (defense mechanism)
Channeling socially unacceptable impulses into constructive, even admirable, behaviorUsing boxing to channel aggression
What time of day should a patient take corticosteroids?
Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisolPatients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy productsCorticosteroids can often cause GI distress and should be administered with meals
What should you monitor in a pt on hydralazine?
Daily weights, I&OsBP, pulseAdverse reactions: fluid retention, tachycardia
What could cause a false low on a pulse ox?
Dark fingernail polish or artificial acrylic nailsHypotension and low cardiac output (HF)Vasoconstriction (hypothermia, vasopressor medications)Peripheral arterial disease
Vitamin K foods
Dark green vegetables ( Spinach, Brussels sprouts, broccoli)Green tea
Side effects of ADHD medications (stimulants)
Decreased appetite and weight loss - can lead to growth delaysCardiovascular effects - hypertension and tachycardiaAppearance of new or exacerbation of vocal/motor ticsExcess brain stimulation - restlessness, insomniaAbuse potential - misuse, diversion, addiction
Reaction formation
Defense mechanism by which people behave in a way opposite to what their true but anxiety-provoking feelings would dictate
How should pts with Type 1 diabetes change their disease management when they are sick?
Do NOT discontinue insulin usage during an illness, even if unable to eatEncouraging fluidsMonitoring glucose more frequently Check ketone levels in urine
What is a benefit of oral anticoagulants, such as Rivaroxaban?
Do not require monitoring like Warfarin does
Cholinesterase inhibitors
DonepezilRivastigmineGalantamine
Methotrexate - always do this before administering to a patient with RA
Double-checking the prescription with another RN because death can occur from an overdoseIt is administered weekly and in low doses for RA and should not be confused with administration of the drug as a chemotherapeutic agent
Priority intervention during a "Tet Spell"
During a hypercyanotic episode, or "tet spell," which is an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding, the child should first be placed in a KNEE-TO-CHEST positionFlexion of the legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defectAfter placing infant in knee-to-chest position, check VS. Morphine or O2 can be administered if this does not help
Dependent personality disorder
Fear separation and tend to be indecisive and unable to take the initiativeThey are often preoccupied with the thought of being left to fend for themselves and want others to assume responsibility for all major decision making
Erythema toxicum neonatarum
Firm, white or yellow papules or pustules surrounded by erythemaThis idiopathic rash, which closely resembles flea bites, appears in the first few days after birth and resolves within 5-7 daysThe rash requires no treatment
What should you do if a feeding tube becomes clogged?
First attempt to unclog the tube by using a large-barrel syringe to flush and aspirate warm water in a back-and-forth motion through the tubeA digestive enzyme solution may help if warm water flushing is not effective
SE of taking glucocorticoids with NSAIDs or ASA
Glucocorticoids (prednisone), when taken in combination with aspirin or NSAIDs such as naproxen, can increase the risk of GI ulceration and bleeding
Education for a new mom who choses NOT to breastfeed
Ice packs to breasts for 15-20 minutes every 3-4 hours to reduce blood flow and swellingApplying chilled, fresh cabbage leaves to breastsTaking an anti-inflammatory analgesic (eg, ibuprofen) as directed to reduce painMaintaining firm breast support (eg, supportive bra, breast binder)
Herpes simplex virus in a pregnant woman
Immediate antiviral therapy (acyclovir) should be initiated to treat the active infectionVaginal birth is not recommended in the presence of active lesions
Your patient's baby is having late decelerations. What do you do?
Immediate steps to correct late decelerations include:1) Stop oxytocin if it is being administered2) Reposition the client to the left/right side3) Administer O2 by face mask4) Administer an IV bolus of isotonic fluid (LR, NS) as needed5) If late decelerations persist or variability is absent or minimal, the nurse should prepare for emergency delivery
Azathioprine
Immunosuppressant drug that can cause bone marrow depression and increase the risk for infectionIt is prescribed to treat autoimmune conditions such as inflammatory bowel diseases (Crohn disease) and to prevent organ transplant rejection
receptive aphasia (Wernicke's aphasia)
Impairment of verbal and written language comprehensionVisual aids and hand gestures may be more effective means of communication
Pt education about Carbidopa-levodopa
Implement fall precautions (changing positions slowly, removing rugs), as orthostatic hypotension is a common side effectCarbidopa-levodopa takes several weeks to reach its maximum effectivenessHarmless discoloration (red, brown, black) of secretions (urine, perspiration, saliva) may occurAvoid high-protein meals, which interfere with the absorptionDyskinesia (facial or eyelid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicity of carbidopa-levodopa and should be reported immediately to the health care providerCarbidopa-levodopa often decreases, but does not eliminate, tremor and rigidity
Isoniazid (INH)
Interferes with DNA metabolism of tubercle bacillus
Sodium polystyrene sulfonate retention enema
KayexalateRetention enema administered to clients with high serum K+ levelsKayexalate can also be given orally and is much more effective
What do you do if while changing the tubing of your pts central line, he starts gasping for air and writhing?
Likely an Air Embolism!Leakage of more than 500 mL of air into a central venous catheter is potentially fatalAn air embolism in the small pulmonary capillaries obstructs blood circulationA central venous catheter leaks air rapidly at 100 mL/secThis client requires immediate intervention to prevent further complications (cardiac arrest, death)Priority interventions for active or suspected air embolism are as follows:1) Clamp the catheter to prevent more air from embolizing into the venous circulation2) Place the pt in Trendelenburg position on the left side, causing any existing air to rise and become trapped in the right atrium3) Administer oxygen if necessary to relieve dyspnea4) Notify the HCP or call an RRT to provide further resuscitation measures5) Stay with the pt to provide reassurance and monitoring as the air trapped in the right atrium is slowly absorbed into the bloodstream over the course of a few hours
S/S of Magnesium Toxicity
Mild: nausea, flushing, HA, hyporeflexiaModerate: areflexia (patella reflex 0/4), hypocalcemia, somnolenceSevere: respiratory paralysis, cardiac arrestAbsent or decreased deep tendon reflexes (DTRs) are the earliest sign of magnesium toxicityDTRs, scored on a scale of 0 to 4+, should be frequently assessed during magnesium sulfate infusionNormal findings are 2+ Also, UO < 30 mL/hr is a sign that magnesium toxicity may be likely, as magnesium is excreted through the urine
Milrinone
Milrinone (Primacor) is a phosphodiesterase-3 inhibitor given via IV infusion to increase contractility and promote vasodilation. Milrinone, an inotropic agent, is often prescribed to clients with heart failure unresponsive to other pharmacologic therapies. The medication is usually infused over 48-72 hours in a hospital setting; however, home infusion through a central line is becoming more common as a palliative measure for end-stage heart failure. Milrinone infusion requires central venous access (eg, peripherally inserted central catheter) as the medication is a vesicant and can cause extravasation if infused through a peripheral IV line.
Meperidine use during labor can result in
Minimal variability FHR - but this is ok as long as accelerations/early decelerations are present and HR is not bradycardic - continue to monitor to see if FHR will return to moderate variability after the opioid wears off in 2-4hrsOpioid medications administered during pregnancy cross the placenta, resulting in minimal variability FHR patterns and neonatal respiratory depression after birth
LPN/LVN Scope of practice
Monitoring RN findingsReinforcing educationRoutine procedures (eg, catheterization)Most medication administrationsOstomy careTube patency & enteral feedingSpecific assessments* - lung sounds, bowel sounds, neurovascular checks
2nd degree type 2 AV block
More P waves than QRS complexesCan rapidly deteriorate to complete heart block (third-degree AV block), which is life-threateningThe nurse should quickly obtain a transcutaneous pacemaker, assess the client for symptoms (bradycardia, hypotension, syncope), and be prepared to pace the client if symptoms occur
Can calcium channel blockers be crushed?
No, swallow whole
When should methylphenidate (Ritalin) be administered to a child diagnosed with ADHD?
Offer the child the medication with breakfast and after the child eats lunch. This helps prevent the effects of appetite suppression (a SE of methylphenidate)Doses should be spaced at 6-hour intervals
Pavlik harness education
Regularly assess skin for redness or breakdown under the strapsDress the child in a shirt and knee socks under the harness to protect the skinAvoid lotions and powders to prevent irritation and excess moisture Lightly massage the skin under the straps every day to promote circulationOnly apply 1 diaper at a time as wearing ≥2 diapers increases risk of incorrect hip placementApply diapers underneath the straps to keep harness clean and dry
How should you care for a pt with frostbite?
Remove items that can cause constriction or sloughingDo NOT massage or rub the injured areaProvide warm water soaks and analgesiaElevating injured areas to prevent edema as blood returns to extremitiesApply loose, nonadherent, sterile dressings - NOT occlusive dressingsMonitor for compartment syndrome.
What type of labs would you expect to see in a pt with renal failure and osteodystrophy?
Renal failure -> kidneys fail to activate Vitamin D -> impaired calcium absorption -> serum calcium decreases -> stimulates release of PTH -> resorption of calcium and phosphate from the bones -> hypocalcemia, hyperphosphatemia, & hyperkalemiaRenal failure also causes anemia
What labs should you check in a pt on an ACE inhibitor?
Renal tests
if a nurse suspects child abuse, is it a priority to document or report first?
Report
Pt teaching for Ethambutol
Requires monthly vision checkMay have to take for 1-2 years
PKU screening
Requires that the newborn has ingested adequate amounts (2-3 days) of milk proteins to detect metabolism errors, which result in abnormal phenyaline in the newborns blood and predisposes the infant to mental retardation
What are we concerned about with Benzos?
Respiratory depression!
Theophylline toxicity S/S
RestlessnessAnorexiaN/VInsomniaTachycardia, arrhythmiasSeizures
Signs of antimetabolite toxicity
Stomatitis Mucosal ulcerationsOccurs because chemo affects all rapidly growing cells
S/S of a moderate to severe asthma exacerbation
Tachycardia (>120/min)Tachypnea (>30/min)Saturation <90% on RAUse of accessory muscles to breathemoderate to severe asthma exacerbations
How to perform a testicular self-exam
Testicular cancer is the most common form of cancer in men age 15-35When diagnosed early, it is highly curableClients at high risk for developing a tumor (history of undescended testis) are encouraged to perform a monthly TSEInstructions for a TSE include:Perform TSE monthly on the same day (easy to remember)Perform TSE while taking a warm shower or bath as warm temperatures will relax the scrotal tissue and make the testis hang lower in the scrotumUse both hands to feel each testis separatelyPalpate each testicle gently, using the thumb and first 2 fingersCheck that the testicle is normally egg-shaped and movable with a smooth surfaceReport these findings to HCP:Painless, hardened lump on testesScrotal swelling or heavinessDull ache in pelvis or scrotum*Note: It is normal for one testicle to be slightly larger or hang lower than the other
What is oxytocin used for?
Uterotonic drugs (oxytocin [Pitocin]) are used to induce or augment labor and to stop postpartum hemorrhage by promoting uterine contractionsOxytocin must be administered via infusion pump and requires continuous electronic fetal monitoring as it is a high-alert medicationThe nurse assesses and documents the fetal heart rate and contraction pattern every 15 minutes during the first stage of labor with oxytocinMost oxytocin protocols dictate gradual titration to achieve contractions every 2-3 minutesTachysystole (ie, ≥5 contractions in 10 minutes) is a potential adverse effect of oxytocinTreatment of tachysystole may include decreasing or stopping oxytocin infusion and administering IV fluid bolus and/or tocolytic drugs (terbutaline)
Is a bite block used during ECT?
Yes, the jaw muscles can contract when the current is applied
Can as UAP collect a urine specimen?
Yes, unless the pt has a Foley catheter because this is a sterile procedureThe UAP and even pts themselves may collect a clean-catch or midstream urine specimen
Calcium acetate (PhosLo)
a phosphate binder used to treat hyperphosphatemia (normal phosphorous: 2.4-4.4 mg/dL) in clients with chronic kidney diseaseCalcium acetate lowers the serum phosphorous level by binding to dietary phosphate and excreting it in feces
A pt who is experiencing asthma should administer inhalers in which order?
albuterol first to open the airways and then the corticosteroid to provide better delivery of the medication
What happens after administering adenosine rapid IVP?
brief period of asystole due to adenosine slowing impulse conduction through the AV nodeThe pt should be monitored for flushing, dizziness, chest pain, or palpitations during and after administration
What color is it ok for dobutamine solution to be?
brown
Pts should not eat grapefruit or drink grapefruit juice while taking _________________ due to the possible development of severe _____________.
calcium channel blockerssevere hypotension
