1.

A kid with Hepatitis A can return to school 1 week within the onset of
jaundice.
2. After a patient has dialysis they may have a slight fever...this is normal
due to the fact that the dialysis solution is warmed by the machine.

3. Hyperkalemia presents on an EKG as tall peaked T-waves

4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate

5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash

ALL linens and dishes seperate from the family. They also need to wash their
hands frequently and avoid contact.
Vasopressin think DIABETES INSIPIDUS!!!!
Vasopressin is also known as antidiuretic hormone
2. 1. dont give beta blockers to anyone with respiratory problems i.e asthma,
copd.
2. periorbital edema sign of complication with impetigo (indicate
glomernephritis)

3. Myocardial infaraction always relieve pain with morphine 1st. sometimes

the choice oxygen will be in the same question. choose morphine.

4. positive sweat test. indicative of cystic fibrosis

5. DKA-KETONES IN URINE, FRUITY BREATH, KUSSMAUL RESP DIABETES I,

HHNK-NO KETONES-SUGAR HIGH-DIABETES ii.
3. 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken
with an antihypertensive, it may cause hypotension. Licorice can increase
potassium loss and may cause dig toxicity.
2. With acute appendicitis, expect to see pain first then nausea and
vomiting. With gastroenitis, you will see nausea and vomiting first then pain.
3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes,
kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches.
4. Do not elevate the stump after an AKA after the first 24 hours, as this may
cause flexion contracture.
5. Beta Blockers and ACEI are less effective in African Americans than
Caucasians.
4. for the myelogram postop positions. water based dye (lighter) bed elevated.
oil based dye heavier bed flat.

2.autonomic dysreflexia- elevated bed first....then check foley or for

impaction

3. any of the mycin's..check for tinnitus or hearing loss

4. cloudy dialysate...always futher assess and call doctor

 5.osteoporosis prevention and mgt. choose weight bearing (walking) instead
of calcium if both are choices.
5. . Dilantin can cause gingival hypoplasia, advise good oral hygiene and freq.
dental visits, IVP 25-50 mg/min

2. Placentia Previa is painless, bright red bleed

3. Abruption is painful, board-like abdomen

4. Need MAP of 70-90 to perfuse organs

5. Vitamin C can cause false + occult blood

6. MAP= diastolic x 2 + systolic
___________________
divided by 3
7. . celiac disease cant have BROW! BARLEY RYE OAT WHEAT

2. any eye surgery place on pt on unaffected side

3. if pt has lung cancer, craniotomy, or some kinda pituitary surgery watch

for diabetes insipidus

4. sickle cell- hydration hydration important and treat pain if in crisis

5.dont palpate a wilm's tumor on the peds pt. can cause cancer cells to be
released!

oh one more:

6. terbutaline (Brethine) and mag sulfate- tx for preterm labor.

8. Here's some pharmacology:
Librium-antianxiety used to tx symptoms of acute alcohol withdrawal.
Cogentin-used to tx parkinsonian side effects of Thorazine (antipsychotic
med)
Methadone hydrochloride-opiod analgesic; tx for narcotic withdrawal
Procardia-antianginal med (CCB) decreases myocardial O2 demand.
Digoxin-strengthens myocardial contractio0n & slows conduction thru AV
node
Coumadin-inhiits prothrombin synthesis
Amicar-antifibrinolytic; prevents recurrence of subarachnoid hemorhage.
Lithium-tx manic phase of bipolar
Nimodipine-CCB; decreases spasm in cerebral blood vessels
diltiazem-CCB; inhibits Ca+ influx in vascular smooth muscle; reduces
myocardial O2 demand & decreases force of ventricular contraction
clotrimazole-antifungal; treats rashes.
9. NEVER NEVER NEVER administer KCl via IV push.
10. The level in the water seal chamber (chest tubes) fluctuates with respiration-
no fluctuation indicates an obstruction and excessive bubbling indicates an
air leak.

Stay with the client for 15 minutes at the start of a blood transfusion.

Nephrotic Syndrome leads to proteinuria while Glomerulonephritis leads to

hematuria.

Goodell's Sign is the softening of the cervix at the start of the 2nd month of
pregnancy

Nagele's Rule is First date of last menstrual period + 7 days - 3 months +

1year.

Vinca Alkaloids (Vincristine) lead to neurotoxicity and can present with

numbness and tingling in the legs or paralytic ileus.
11. Avoid herbal supps like ginsing, ginger, ginko, garlic (all the G's) if on any
clotting drugs/products (coumadin, platelets, ASA, Plavix)

High triglycerides may cause a false HIGH Hemoglobin A1C (normal is 2.6-6)

Deer ticks transmit Lyme Disease and it is most common in the NE Atlantic
states. (Go figure I thought it was down here in the South)

Think of pain last or as a psychosocial UNLESS: Burns, sickle cell crisis, or

kidney stones.

Anemia of pregnancy is common in the 2nd trimester due to rapid expanding

blood volume and is not a cause for concern. It can get as low as 10.5 and
still be OK. 1st and 3rd trimesters can go as low as 11 and still be ok

Preterm labor--after 20 weeks and before 37

true labor INCREASES with activity and usually moves from the back to the
front (according to our instructors but from personal experiance IT HURT ALL

OVER THE DANG PLACE AND INCREASED WITH EVERYTHING ).

Recommended weight gain for pregnancy 1.5-16 kg or 25-35 lbs

HAHAHAHAHAHAHAHAH yeah right. I myself classified as Shamu's little sister

by week 39 .

OK one more for 2nite....

 normal newborn jaundice-- AFTER 24 hours of life
pathologic jaundice-- BEFORE 24 hours of life
*feed orally ASAP because if it gets too high Kernicterus (brain damage that I

can't spell right now) .

12. Dilantin can cause gingival hypoplasia, advise good oral hygiene and freq.
dental visits, IVP 25-50 mg/min

2. Placentia Previa is painless, bright red bleed

3. Abruption is painful, board-like abdomen

4. Need MAP of 70-90 to perfuse organs

5. Vitamin C can cause false + occult blood

13. If it comes out your ass...its metabolic acidosis...
by vomitting...metabolic alkalosis...
14.
1. priority unstable pt- words to look for: cyanotic, sudden, increasing pain,
hypoxic, restlessness

2. when left with two choices pick the one thing you can do to make pt.
comfortable, safe, and more stable

3. no narcotics to any head injury..wont be able to accurately assess LOC. so

pick the narcotic if you have an order to question.

4. fluid resus. burn formula: kg X 4ml/kg X %(burn area)= total

give half of total in first 8 hours

5. after thyroid surgery-maintain airway-keep emergency trach set nearby,

check for blood at sides and back of dressing, teach pt to support neck

6. bucks traction-no pins tongs. skin traction

7. should not hear a bruit over anything except dialysis shunts. if so this is
the unstable pt

8. DVT- elevate extremity , bed rest, warm (not hot) compresses

15. Rubella- rash on face goes down to neck and arms then trunk and legs
pregnant women should avoid contact with any child who has Rubella or just
recieved the vaccine. if she does she has to get vaccine after she has
delivered

mmr #1 @ 12- 15 months mmr #2 4-6 years old.

PMI for heart sounds on an adult= Left 5th ICS lateral to the Left nipple. If
you get the diagram don't put the X on a rib.

Angle of Louis- manubrial-sternal junction at the 2nd inter costal space.

Don't forget>>> if you are adding up I&O and it says the patient had 8 oz
of water.....multiply 8 by 30 to get ML.

before checking or measuring fundal height have the patient empty her
bladder! A full bladder can throw off the measurement by 3cm.

Fetal Fibronectin (FFN) Test helps determine >>pre-term labor

Draw regular CLEAR insulin FIRST.

Meniers disease= ringing in the ears and hearing damage cause from HIGH
sodium levels. Need diuretics. Avoid caffeine, nicotine, and ETOH

Meningitis= look for nuchal rigidity, Kernigs sign(can't extend knee when
hip is flexed) and Brudinskis sign (flex neck and knee flexes too) petichial
rash. People who have been in close contact may need Rifampin as a
prevention. Vaccine for meningitis after 65 years of age and every 5 years

MI=#1 pain relief, helps decrease 02 demand

Acute Asthma = diffuse expiratory wheezes

Cessation of wheeze omnimous

Infective endocarditis = murmur

Fluid overload = auscultate lungs 1st

3. Hyperkalemia presents on an EKG as tall peaked T-waves

This is only true if the tall peaked T-waves are universal (ie, on every lead). If
you see tall, peaked T-waves on one subset of leads, such as the inferior
leads (II, III, and AVF), it could actually indicate the onset of an acute MI.

Also, hyperkalemia doesn't always produce T wave changes. I routinely have

patients with K+ levels above 6 with no noticable EKG changes.

4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate

Calcium isn't an antidote for hypermagnesemia. Renal filtration is how

excess Mg is removed-- that or of course dialysis.
 Instead, calcium helps to stabilize the electrical gradients of muscle and
nerve cells, which helps to prevent dysryhthmias.

Also, Calcium gluconate is only one available form. Calcium chloride is much
more potent.
1. dont give beta blockers to anyone with respiratory problems i.e asthma,
copd.

Actually, don't give non-selective beta blockers to anyone with respiratory

problems. The B1 selective blockers such as metoprolol don't cause
respiratory complications, as they don't antagonize the B2 receptors in the
smooth muscle of the respiratory tree. MI Treatment
MONA

M-Morphine pain reduce O2 consumption

0-Oxygen
N-Nitroglycerin
A-Aspirin

24 hours after thyroidectomy, watch for s/s of thyroid storm not for
decreased levels of thyroid hormones.

1. HYPOGLYCEMIA= T.I.R.E.D

T-tachycardia
I- irritability
R- restless
E- excessive hunger
D- diaphoresis

2.posturing- deceberate(brainstem problem)- hands like an "e", decorticate

(cord problem)- hands pulled in toward the cord

3.tetralogy of fallot- have child squat to increase return to heart. just

remember fallot=squat

4. cant sign consent after preop meds are given...call doctor if not signed

5. rubella (german measles)-airbone contact precautions, 3 day rash

6. rubeola (red measles)- droplet contact precautions, koplik spots in mouth.

2. Withdrawl Symptoms:

Amphetamine= Depression , disturbed sleep, restlessness ,

 disorientation

Barbituates= nausea & vomiting, seizures, course tremors,

tachy

Cocaine= Sever cravings, drpression , hypersomnia, fatigue

Heroin= Runny nose, Yawning , fever, muscle & joint pain, diarrhea
(Remember Flu like symptoms).
3. When using a cane to aid ambulation: Step up on the good extremity then
place the can and affected extremity on the step. Reverse when coming
down. (Up with the good, down with the bad)

2. In infants, pyloric stenosis = projectile vomiting

3. Croup: seal-bark cough, dyspnea, inspiratory stridor, irritable. In children

considered a medical emergency due to narrowed airway

4. Skull fracture: Battle's sign (bruising over mastoid bone) and raccoon eyes

5. Pheochromocytoma: catecholamine secreting tumor. Look for persistent

hypertension, pounding headache.
4. peritoneal dialysis- if outflow slow check tube for patency, turn pt side to side

2. pts with the same infection can room together or two clean non
contagious disorders can room together.

3. pulse parodoxus- pulse is weak on inspiration and strong on

expiration...could be a sign of CARDIAC TAMPONADE

4. fat embolism- high risk pt...fracture of long bone..greatest risk in first 48

hrs.

5. pancreatitis-elevated amylase (cardinal lab value)

6. JP DRAIN- SQUEEZE=SUCK... squeeze the bottle to let air out then repalce
cap.

7.lymphocytic leukemia causes a decrease in all blood cells...hmmm i got

this wrong on a test once...i didnt know it causes rbcs to be low also!

8. mannitol for ICP.

5. PERSONAL PROTECTIVE EQUIPMENT

DONNING
Wash hands first!
Gown
Mask
Eyewear
Gloves

REMOVING
Gloves
Wash hands
Mask
Gown
Eyewear.
6. when patient is on a vent or intubated NEVER give a paralytic agent without
a sedative!.
7. Oxytocin is always given via an infusion pump and and can never be
administered through the primary IV.

One of the first signs of ICP (increased intracranial pressure) in infants is a

high pitched cry.

Regarding blood transfusions, a hemolytic reaction is the most dangerous

kind of reaction...S & S include
NAUSEA
VOMITING
PAIN IN LOWER BSCK
HEMATURIA Treatment is to STOP blood, get a urine specimen and maintain
perfusion and blood volume.

Febrile reaction S&S

FEVER
CHILLS
NAUSEA
HEADACHE

Narcan is given for to reverse respiratory depression...a rate of 8 or less is

too low and requires nursing action.

Miller abbott tube is used for decompressing intestine, which relieves the
small intestine by removing fluid and gas from small intestine.

If a client takes lithium the nurse should instruct the client to take in a good
amount of sodium, without it causes retention of lithium and in turn leads to
toxicity.
 Rinne test- a vibrating tuning fork is held against the mastoid bone till pt
can't hear sound...then moved to ear.
8. A subarachnoid (spinal block) for labor may cause a headache, a lumbar
epidrual will not since the dura mater is not penetrated

2) Tracheoesophageal fistula: 3 C's: coughing, choking, & cyanosis

3) Hypothyroidism: Decreased T3 +T4, but increased TSH

Hypertyroidism: Increased T3 + T4, but decreased TSH

4) NO tyramine containing foods if taking and MAO inhibitor ( smoked meat,

brewer's yeast, aged cheese, red wine)

5)Regular insulin is the only type that can be given IV.

9. ESSR method of feeding (cleft palate)

ENLARGE nipple

STIMULATE sucking
SWALLOW
REST.
1)Immunizations
Before 1 years old:

Hep B 3x):Only one that is given at birth and one month (3rd dose at 6
months)

IPV(4x), DTaP(5x), Hib(4x), PCV(4x): all given at 2, 4, & 6 months

Hib, PCV: again at 12-15month

DTaP: again at 12-18months
DTaP, IPV: last doses are given 4-6yrs

1yrs old and older:

MMR: (2x) 12-15months, then at 4-6 years* *if dose not given from 4-6 give
from 11-12yrs old

Varicella Zoster: (1x) 12-18months

Td: (1x): 11-12yrs old

2)Fundal height: pt supine, measure from symphysis pubis to top of fundus,

if patients is 18+ wks pregnant the height in cm will be same as weeks
pregnant give or take 2 cm
 3)Isolation**:

STRICT Contact: use universal precautions, gown when contact with pt.,
single pt. room in most situations

Used with: Any colonizing infections, MSRV, Fifths disease, RSV, infected
wounds, skin, or eyes

STRICTER Droplet: include all universal precautions, gown, goggles, masks

on you, on pt. if leaving room, single pt. rooms

Used with: Majority of infectious diseases

STRICTEST Airborne: include all universal precautions and negative pressure

single patient rooms, gown, goggles, mask on you, mask on pt. if leaving
room which should only be done if absolutely necessary

Used with:
Measles
Varicella
Disseminated Varicella Zoster
Tuberculosis

**Always check facilities policies when following isolation

precautions/procedures

4) Self breast exams: do monthly, 7-10 days after menses

5) Pt's taking Monoamine Oxidase inhibitors (for depression usually) should

avoid foods containing tyramine which include
10.Avocados, bananas
11.Beef/chicken liver
12.Caffeine
13.Red wine, Beer
14.Cheese (except cottage cheese)
15.Raisins
16.Sausages, pepperoni
17.Yogurt, sour cream
18. 1. dumping syndrome-tx no fluids with meals /no high carbs /lie down after
eating. they need a high fat high protien diet

2. multiple sclerosis- avoid hot showers and baths

 3. parial thickness burns=blisters...... full thickness-charred, waxy

4 PKU- no nuts, meats, dry beans, eggs, dairy (basically no protein stuff) give
specially prepared formula to baby because they can digest this protein well

5. introduce rice cereal to infant at 6 mos and strained veggies one at a time

6. pt must keep taking prescribed insulin on sick days, drink plenty of fluids
and notify doctor. also insulin is also given when pt comes from surgery on
NPO status because trauma and infection makes sugar go up!.
19. In an infant of a diabetic mom, hypoglycemia 30-90 min after birth...then
look for them to also have hypocalcemia after 24 hours

Non Stress Test on a preggo....should be REACTIVE (rise of 15 bpm above

baseline for 15 sec) if it's NOT reactive they need a contraction stress test
and the result that you want from it is NEGATIVE

With Diabetic Ketoacidosis don't give K+ until the patient has been hydrated
and urine output is adequate.

Post-op Total Hip replacement-- abduction (toes pointing in) or patient laying
on non-operative hip. Avoid adduction (letting the foot turn out).
20. mother/baby stuff

1. Rh negative mom gets Rhogam if baby Rh positive. Mom also gets

Rhogam after aminocentesis, ectopic preganancy, or miscarriages.

2. fetus L/S Ratio less than 2= immature lungs......2-3=borderline....greater

than 3=good lung maturity dude!! may give dexamethasone to speed up
maturity if baby needs to be delivered soon.

3. prolasped cord position knee chest or trend..call for help!! GET THAT

BOTTOM OFF THE CORD! SUPPORT CORD WITH YA HAND

4. decelerations early vs late----always good to be early but dont ever show

up late. early mirrors the contraction, late comes after the contraction

5. LOCHIA SEQUENCE...lochia rubra- red, clotty....lochia serosa...pink,

brown....lochia alba..white.........SHOULD NEVER HAVE A FOUL ODOR!.
21. . In prioritizing cardiac patients, check the pt with INDIGESTION first because
that could be a sign of MI.

2. ABG's need to be placed on ice and sent to the lab ASAP.

3. If active TB is suspected, a sputum culture for acid-fast bacillus is the only

 metod to actually confirm active TB (NOT a mantoux skin test!)

4. Celebrex is contraindicted in pts with a history of cirrhosis.

5. In psych pts, the client most at risk for self-harm is always the pt that has
stopped taking their meds.

One more!
6. Change in resp rate in a pt receiving mag sulfate could indicate toxicity.
22. 1. Cushing's Triad = HTN (widening pulse pressure, systolic rises),
Bradycardia, irregular resp.

2. Tx of DIC = Heparin

3. Assessment for Cancer =

C: Change in bowel or bladder habits
A: A sore throat or sore that doesn’t heal
U: Unusual bleeding or discharge
T: Thickening or lump
I: Indigestion or difficulty swallowing
O: Obvious changes in a wart or mole
N: Nagging cough or hoarseness.

4. Acid Base =
Respiratory
Opposite
Metabolic
Equal

5. For Injuries such as twisted ankles use RICE acronym

Rest
Ice
Compress
Elevate.
23. 1. dont give atropine for glaucoma. it increases intraocular pressure!

2. drug abusers at risk for heart valve disease.

3. after a liver biopsy place pt. on right side to put pressure on site.

4. end stage cirrhosis the ammonia level is elevated. doctor may order
lactoluse to decrease levels.

5. dont do a vaginal exam on a pregnant cliet thats bleeding .

24. Ulcerative colitis...3-30 stools per day WITH blood and mucus.

Pain in LLQ: relieved by defecation.

Crohns disease-NO obvious blood or mucus in stool.

Pain: Right lower quadrant pain that is steady or cramping...or pain could be
in periumbilical area, tenderness and mass in the RLQ.

Rheumatoid arthritis: Pain and stiffness is on arising, lasting less than an

hour...can also occur after long periods of inactivity. Joints red, hot swollen,
boggy, and decreased ROM.

Osteoarthritis: Pain and stiffness occurs during activity. Joints may appear
swollen, cool, and bony hard.

Hemodialysis: disequilibrium syndrome- N&V, headache, decreased LOC,

rapid changes in PH, bun...

Transfusion reaction: Chills, dyspnea, itching, uticaria, back or arm pain,

fever.

Peritoneal dialysis: When more dialysate drains than has been given, more
fluid has been lost(output). If less is returned than given, a fluid gain has
occured.

Slow dialysate instillation- increase height of container, reposition client.

Poor dialysate drainage-Lower the drainage, reposition.

25. INSULIN:

Rapid: (Lispro) Onset: <15min Peak: 1hr Duration : 3hr

Short: (Regular) Onset: 1/2hr-1hr Peak: 2-3 hr Duration: 4-6 hr

Intermediate: (NPH or Lente) Onset: 2hr Peak: 6-12 Duration: 16-24

Long Acting: (Ultralente) Onse:t 4-6 hr Peak: 12-16hr Duration: >24 hrs

Very Long: (Lantus) Onset: 1 hr Peak: NONE Duration: 24 hr continuous.

26. Mydriatic: with a D= Dilate pupils
Miotic:with an O= cOnstrict pupils

aniticholinergic SE:
can't see
 can't pee
can't spit
can't sh*t

Hyperkalemia "MACHINE"- causes of incr serup K+

M-medications (ace inhibitors, Nsaids)
A-acidosis (Metabolic and respiratory)
C-cellular destrx-burns, traumatic injury
H-hypoaldosteronism, hemolysis
N-nephrons, renal failure
E- excretion-impaired

Signs and symptoms of incr serum K+= MURDER

M-muscle weakness
U-urine, oliguria, anuria
R-respiratory distress
D-decr cardiac contractility
E-ECG changes
R- reflexes, hyperreflexia, or flaccid

HYPERNATREMIA-you are fried

F-fever (low grade), flushed skin
R-restless (irritable)
I-incr fluid retention and incr BP
E-edema ( peripheral and pitting)
D-decr urinary output, dry mouth

Hypocalcemia-"CATS"
C-convulsions
A-arrythmias
T-tetany
S-spasms and stridor.
27. For those of you who have trouble with mcg/kg/min problems.
try this solution.

Exp: 7mg of dopamine in 500ml in NS ; pt is 110lbs

first convert 110lbsto kg =110lbs/2.2 kg=50kg

then change 7 mg to mcg =7000 mcg

Now plug in the numbers. 7000* 50kg*60mins

------------------
500ml

answer is 16.8 mcg/kg/min.

28. V-FIB=DEFIB
DONT SHOCK ASYSTOLE!

EEG- MUST BE SLEEP DEPRIVED FOR THE PROCEDURE

Albumin best indicator of nutrition normal range 3.5 - 5.5

altered LOC- earliest sign of ICP

to check dehydration in an infant (inner thigh)...elderly (on top of forehead or

sternum)

shift to the left when number of immature cells are increasing in the
bloodstream to fight an infection.
29. Insulin- Clear before cloudy.
& you are an RN so draw up Regular before ....Nph.
Only insulin that can be given IV- Regular.

Administering ear medication... pull the ear UP and back for OLD, and down
for young (<3 yo)

Fill for a thrill, listen for a bruit.

Assess your patient. not the monitor.... So, If a question asks what you do
FIRST.... always, always go with assess the patient. Beta Blockers are contra-
indicated in patients with Resp problems are easy....
Contra-Indicated- so think.... Coreg, Corgard, Inderal.
30. Carbamazepine therapeutic serum level is 4 - 12 mcg/dL

Cycloserine is an antituburculan and needs weekly drug levels

foscarnet (Foscavir) can be toxic to kidneys so creatinine is monitored.

Android Pelvis is wedge shaped, narrow and unfavorable for birth

Therapeutic serum digoxin is 0.5 - 2 mg/dL

No meperidine (Demerol)to pancreatitis pt. b/c is causes spasms in the

Sphincter of Oddi

Hyperkalemia = narrow, peaked T waves on cardiac monitor

Hypokalemia = Peaked P, Flat T, Depressed ST and Prominent U

p24 Antigen Assay confirms HIV in an infant

31. MORPHINE IS CONTRAINDICATED IN ACUTE PANCREATITIS BECAUSE IS
CAUSES THE SPASMS BUT THE DEMEROL IS THE DRUG OF CHOICE. AT LEAST
THATS HOW I LEARNED IT.
32. if you see Mg/Ca, think MUSCLE first. Mg and Ca act like SEDATIVES.

HYPOCALCEMIA (not enough sedatives)

+ trouseau and + chovstek's sign
incr DTR
stridor, laryngospasm
swallowing problem=aspiration

BURN pt.
Carbon monoxide poisoning is the MOST COMMON airway injury.
Carboxyhemoglobin : blood test to determine carbon monoxide poisoning.

Treat burn pt with fluid replacement therapy;Check hourly to make sure you
are not overloading them with CVP= measures the right atrial pressure.

use the PARKLAND FORMULA with fluid replacement thx for the first 24
hours.To calculate fluid replacement properly you also need to know the pts
wt and TBSA affected.
1st 8 hr= 1/2 total volume
2nd 8 hr= 1/4 total volume
3rd 8 hr= 1/4 total volume
33. Rubella is spread by droplets....

The benefit of a venturi mask- oxygen can be regulated to deliver between

24 and 50%.

Shilling test is done to detect pernicious anemia.

Shift to the left in WBC differential – reflects bacterial infection

Pneumocystis carinii pneumonia is caused by – Protozoal infection.

Open-angle glaucoma is characterized by Halo and blurred vision

Detached retina- floater or sensation of a curtain or veil over the visual field

Good lung down- position a patient with right side pneumonia , with the left
side dependent

Atrial fibrillation might require synchronized cardioversion

 Ventricular tachycardia require defribillation

Second degree heart block- needs a pace maker

34. Respiratory syncytial virus- contact precautions

systemic lupus erythematosus- butterfly rash on nose and cheek. avoid

sunlight

with DIC...get worried if you see blood oooze from the IV line. notify doctor

Tegratol- tx for seizures..watch for drowsiness, n/v, blurred vision, h/a.

kayexalate- may be ordered for a high potassium level

35. Diabetes insipidus - Dries you out (high urine output ---> leads to
hypernatremia and Dehydration)

SIADH (syndrome of inappropriate diuretic hormone) - makes you Soaking

wet (fluid retention ---> leads to hyponatremia and Cerebral edema)
36. nebulizers used by HIV patients are cleansed with warm water after each
treatment and allow it to air dry. soaked in wht vinegar and water for 30f min
at the end of the day
2.SHARE support group for parents who have experienced misscarriage
3. RESOLVE support grp for infertile clients
4. CANDLELIGHTERS families who have lost child to cancer
5 FETAL ALCOHOL SYNDROME child small head circumferance, low birth wt,
underdeveloped cheeks. Ruebella is DROPLET
37. PARATHYROID PROBLEMS
hyperparathyroidism= hypercalcemia=hypophosphatemia

hypoparathyroidism=hypocalcemia=hyperphosphatemia

**calcium and phosphorus are inversely related**

THYROID PROBLEMS
hypothyroid (myxedema):no energy, depress pt. everything is slow

hyperthyroid (grave's): very ENERGETIC, manic pt., everything is high

**watch out for heart problems, rhythm changes**

Physician's order: add 60 mEq KCl to 1000 mL D5/W and infuse at a rate of
2.5 mEq/hr.
Available: KCl 40 mEq=20 ml
The infusion set has a drop factor of 60

How much KCl should be added to the IV?

 How many mL/hr should the patient receive?

How many gtts/min need to infuse to deliver the required amount of drug
per hour?

1.
HOW MUCH KCL TO PUT IN THE BAG:
do this like your standard problem. I ALWAYS use the same formula even if it
is pills:

want (order)
------ X available form
have (available)

so...... 60 mEq
-------- x 20 ml = so you would put 30 cc's in the bag
40 mEq

HOW MANY ML PER HOUR?

then you would look at your order. You have 60 mEq added to a 1000 cc bag
right? So you would divide 60 into 1000 to tell you how many mEq per cc of
fluid... 60 / 1000= 0.06 mEq per cc

so then you go back to that original order. Doc want you to run 2.5 mEq per
hour so...

you want 2.5

------------- x 1 cc = 41.66 or 42 ml per hour
you have 0.06

HOW MANY GTT PER MINUTE?

so I would use my regular iv formula

volume to be infused X drip factor

_____________________________
time in minutes

42 x 60
-------- = 42 ggt/ min
60
2. dont give methotrexate in the first trimester of pregnancy.

radioactive iodine- excreted in urine

sealed source implant- body fluids not radioactive- nursing care-limit total
 time care provider with pt. limit distance around pt. no pregnant women in
room or children. keep forceps and lead container in room.

chemo drugs: in case of extravasation...stop infusion...remove any remaining

drug from tubing and aspirate the infiltrated area...do not remove
needle...notify doctor.
3. Prenatal Visits
q 4 weeks -28-32 weeks
q 2 weeks -32-36 weeks
q1 week -36-40 weeks

care of the NEWBORN

term infant -38-42 weeks

L-45-55 cm =18-22inches
W-2500-4300 kg=5.5-9.5lb

in males prepuce retractable on about 3 y.o. dont do that before->Adhesions

Normal Hyper- Bi-emia after 24 hr, if before pathological. (in premature it
appears after 48 hr, if before Report)
Hyperbilirubinemia- DO normal Breast feeding,q2-4hr.

RDS-basically bcoz infant cant expand lungs->cant breath normally, because

of luck of surfactant in lungs.
s/s:cyanosis,increased RR, nasal flaring, grunting.
treatment-intratracheal surfactant, and supportive -O2-if on O2 worry about
retinal damage.

if Mother-DRUGS: NEWBORN -Irritable->Swaddle&reduce stimulation aside

from abcd.

FAS(fetal alcohol syndrome)-craniofascial abnormalities, growth retarded,,

palmar creases. IRRITABILITY.RNs goal-nutritional balance.
When BATHIN Newborn go from CLEAN to DIRTY -eyes, face...diaper area the
last.

in Diabetic mother the newborn at risk for hypoglycemia, RDS, hypo Ca emia,
congenital anomal.
Diabetic mother during pregnancy-1st trimester insulin DECREASE. 2 and 3rd
Trimester INCREASE INSULIN (placental hormones produce insulin resistance)
BUT after PLACENTAL DELIVERY INSULIN REQUIREMENTS DECREASE.
4. Metylergonovine-to contract uterus. before giving check BP. dont give if
vascular diseases are present.

MgSo4-CNS Deppressant and Anticonvulsant

= normal range 4-7.5, effective if no seizures. Adverse reactions: Flushing,
decrease in RR, Muscle weakness

..and fontanels Posterior close Previously (2-3mo)

Anterior close After (12-18 mo)
Apgar measures HR,RR,Muscle tone, Reflexes,Skin color
each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.

GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!

It is similar to measuring dating skills...max 15 points -one can do it

if below 8 you are in Coma.

So, to start dating you gotta open your EYES first, if you albe to do
that spontaneously and use them correctly to SEE whom you dating you earn
4. But if she has to scream on you to make you
open them it is only 3....and 1 you dont care to open even if she tries to hurt
you.

if you get good EYE contact (4 points) then move to VERBAL.

talk to her/ him! if you can do that You are really ORIENTED in
situation she/he uncontiously gives you 4 points! if you like her try not to be
CONFUSED (3), and of cause do not use
INAPPROPRIATE WORDS (3), she will not like it)), try not to RESPOND WITH
INCOMPREHENSIBLE SOUNDS (2), if you do not like her-
just show no VERBAL RESPONSE(1)

Since you've got EYE and VERBAL contact you can MOVE now using your
Motor Response Points.

THis is VERY important since Good moves give you 6!

filgrastim (Neupogen) - increase NEUtrophil count

epoietin alfa (Epogen) - increase RBC/erythrocytes

Cholecystectomy due to cholelithiasis and colesysthitis, WATCH for
BLEEDING problems, because vit K FAT soulble, is poorly absorbed in the
absence of bile. by the way T-tube used for drainage-Reason for T tube to
maintain patency of common bile duct.

Chronic RF the best way to asses fluid status-WEIGHT the PATIENT daily

When NGT present mouth care ICE CHIPS but be aware not give that too
much-> it becames water->stomach->NGT suck it with K and other
electrolites present in stomach. LOST K
 Heat cramps in hot weather-Sodium (Na) loses

Following Gastrectomy NGT drainage should NOT be BLOODY after 12 hr

Thyroid storm's main sign is FEVER

ALDOSTERONE insufficiency -Hypo-Na-emia, Hyper-K-emia, hypo-Volemia.

WHEN Na decrease, K increase

addisons= down, down down up down

cushings= up up up down up

addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia,

hypoglycemia
cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia,
hyperglycemia

everything else wouldnt be hard to remmenber> moon face, hirsutism,

buffalo hump, obesity
. prozac, zoloft, paxil- tx of depression.

2. sodium nitroprusside- sheild from light. wrap in foil

3. cephalosporins- CHECK FOR ALLERGIES TO PENICILLINS. pt could be

hypersensitive.

4. pts recieving Lasix should be assessed for tinnitus and hearing loss

5. anticoagulants cant dissolve a formed thrombus but tPAs can.

1. Shock: BP <90/60 Pulse > 100

2. Fluid of choice in pt in shock are isotonic: NS, LR

3. PVCs: Always treat: >6 UNIFOCAL and/or >3 MULTIFOCAL with

LIDOCDAINE 75mg 4:1 drip

4. SIADH
Na <120
Hx of lung cancer
Specific gravity > 1.035

Diabetes Insipidus
Na> 160
 head injury
Specific gravity <1.005

5. Pt with radium implants you can only stand at the head of their bed. When

performing bath remember: 'pits and crotch' ONLY

2. Verapamil (calan) - treatment of supraventricular tachycardias, check heart
rate
2. clomid - inducesovulation by changing hormonal effect on the ovary
3. phobias include projection and displacement
4. blood glucose monitoring of glucose preferred over urine because the
level of glucose starts to appear in the urine increases, leading to false
negative readings
5. corneal abrasion - unable to close the eye voluntarily, cranial nerve VII
affected, secretions unable to protect the eye, complication of CVA,
prevented with RN care

other randoms

- when the lungs re-expanded, the fluid in the water seal does not fluctuate
with respirations

- pacemaker- increases cardiac output, acts to regulate cardiac rhythm

3. KVO rate is 20ml/hr

MAOIs: Nardil, Marplan, Parnate

Of course, no tyramine because of hypertensive crisis, which is treated with
Procardia.

Aminoglycosides (gentamycin, etc.) affect 8th cranial nerve function

(hearing) and are nephrotoxic.

Hyperparathyroid states can cause renal stones which can present with
hematuria.

Bell's Palsy- facial paralysis, prevent corneal abrasions.

4. macular degeneration: mac is in the middle (central vision loss)

digoxin toxicity: halos, nausea, vomiting

Fractured hip: shorter extremity and external rotation

hip replacement: teach pt not to cross legs; keep leg abducted to avoid
dislocation of hip
 Schillings test: measures % of B12 excreted in 24hr used to diagnose
pernicious anemia
5. Dopamine and Lasix are incompatible

2 - Hypoglycemic jitters can be stopped by holding the limb, seizure clonus

can't

3 - Normal urine output in an infant is at least 1cc/kg/hr

4 - Septic babies will often DROP their temp

5 - SE of PGE1, used to keep the ductus arteriosus open, are hypotension,

fever, and apnea. The therapeutic effect is not necessarily dose-dependent,
but the severity of SE is.
6. The adverse effects of Anti psychotics can be remembered using this:
SHANCE
S-SUNLIGHT SENSITIVITY( Use hats and sunscreen)
H-HEPATOTOXICITY( Monitor LFT)
A-AGRANULOCYTOSIS( Characterised by fever and sore throat)
N-NEUROLEPTIC MALIGNANT SYNDROME( Characterised by fever and
muscular rigidity)
C-CIRCULATORY PROBLEMS( Leukopenia and orthostatic hypotension)
E-EXTRA PYRAMIDAL SYMPTOMS( Administer anticholinergics and anti
parkinsonian agents)
7. acute renal failure-abrupt loss of kidney function, usually reversible, with
minor functioning loss

prerenal (renal ischemia)

intrarenal (any kidney tissue disease)
postrenal (obstruction...i.e calculi, prostatic hypertrophy)
chronic renal failure- progressive, irreversible loss of renal function.
8. Antidote for Coumadin- Aquamephyton same as Vitamin K given to children
after they are born.
Side effect of Aminophylline-head and irregular pulse
Treatment for Angina-sublingual nitro (given q5min X3)and rest
Anterior fontanel closes at-12-18mon
Posterior fontanel closes at-birth to 3mon
Classic sign of Diabetes-3 "p"s (polyuria, polydysia, polyphasia)
CVA pt with hemianopsia-approach from unaffected side
Discharge teaching after cataract surgery-avoid sneezing, coughing,
straining or bending
Lyme disease-wear long sleeves clothing
Post laminectomy -flat position
Diet for cirrhosis-low protein, high calorie
Fundus displaced to right side-ask pt to void
fundus is boggy-message fundus
 Self breast exam-done 5-7 days after menses
SandS of Pyloric Stenosis-projectile vomit, metabolic alkalosis,olive size
bulge unger the ribcage
Position for Meneries-affected side
Raynards disease-wear gloves, keep hands warm
9. ABCDEs of malignant melanoma:

A = Asymmetry;
B = Border;
C = Color;
D = Diameter;
E = Elevation
Assessment of any kind of discharge is COCA
C=color
O=odor
C=consistency
A=amount

and assessment of an incision is LEADERS

L=location
E=edema
A=approximation
D=drainage
E=ecchymosis
R=redness
S=sutures/staples, count them

Trigeminal neuralgia (tic douloureax) - eat warm, soft foods

Preparing to breast feed - wash braest with water and rub with a towel
everyday

Ventricular gallop is the earliest sign of heart failure

Levin tube - feedings at room temperature, do not clamp between feedings

position for liver biopsy - supine with arms raised above head

rheumatoid arthritis - heat, ROM, weight reduction

statin = lipid lowering agents
-mycin= antibiotics; watch for oto and nephrotoxicity
-vir=antivirals
-zine=can be antipsycotics or antiemtics; watch for agranulocytosis and eps
effects
-tidine=H2 blockers
-prazole=proton pump inhibitors.
Bells Palsy: avoid cold temperatures: make sure pt. closes windows when
they are sleeping. Some even take eyes shut.

Nurses' priority intervention after a patient receives a skin graft is to prevent

movement of the graft.

Greatest risk for postpartum hemorrhage is from distended bladder.

Herpes zoster (shingles) is from reactivation of the varicella virus.

1 grain = 60mg (I always forget this one)

Risk factors for legionnaires disease: advanced age, immunosuppression,

end stage renal disease, and diabetes.
EleVate Veins; dAngle Arteries for better perfusion
Peds - kids are 1/2 their adult height by age 5!
Post-partum - cabbage leaves help with discomfort of engorged breasts --
they don't know why.
Respiratory: pink puffers - emphysema
blue bloaters – bronchitis.
Heart Arrythmias:
SVT - Adenosine
Atrial Flutter - Anticoagulants
Atrial Fibrillation - Beta Blockers, Digoxin
PVC - Amiodarone
Ventricular Tachycardia - Amiodarone
Ventricular Fibrillation - Defibrillation
Torsades de Pointes - Magnesium Sulfate
1st Degree AV Block - No treatment usually
2nd Degree AV Block Type I - Atropine
2nd Degree AV Block Type II - Pacemaker
3rd Degree AV Block Complete - Emergent Pacemaker, Atropine,
Epinephrine, Dopamine
Sinus Bradycardia - Atropine or Epinephrine
Sinus Tachycardia - Beta Adrenergic or Calcium Channel Blocker.

Hepatitis
5 types
A,B, C, D, and E
Hep A-spread by drinking unsanitary water and uncooked foods
Hep B-spread by contact with blood or bodily fluids and is an STD
Hep C-spread by contact the same way as Hep B, can lead to cirrhosis
(mostly seen with alcoholism)
Hep D-only contracted if you already have Hep B
Hep E-usually spread by contact with contaminated water
In nursing school, my instructor taught us to remember the different types
like this:

VOWEL = BOWEL

Hep A and E---if your infected you will have problems with bowels...

Some Therapeutic Drug Levels

Digoxin 05-2.0 ng/ml
Lithium 0.6-1.5 mEq/L
Dilantin 10-20 mcg/dl
Theophylline 10-20 mcg/dl
Lithium 0.5-1.5 mEq/L
Coumadin PT: 12-20 sec....therapeutic range 1.5-2 times the control
INR: 2-3
Heparin PTT: 30-60 sec...therapeutic range 1.5-2 times the control
CREATININE AND CREATININE CLEARANCE
With renal impairment, serum creatinine goes up,urinary clearance goes
down.
Serum Creatinine-men 0.8-1.8mg/dl
women-0.5-1.5mg/dl
Urinary creatinine clearance-85-135ml/min--requires a 24 hour urine
specimine. Decreases with renal malfunction.
With a unilateral kidney disease, if one of the kidneys is healthy, a decrease
in the creatinine clearance is not to be expected.

ATROPINE OVERDOSE
Hot as a Hare(temperature)
Mad as a hatter(confusion, delirium)
Red as a Beet(flushed face)
Dry as a bone(decreased secretions, thirsty)
CYSTIC FIBROSIS
Diet: Low in fat and high in sodium
Meds: Antibiotics, liposoluable vitamins(A D E K) Aerosol Bronchodialators,
mucolytics, pancreatic enzymes.
5 A's to alzheimers
Anomia-unable to remember things
Apraxia-failure to identify objects
Agonsia-can't recognize sounds, tastes and other sensations, familiar
objects.
Amnesia-memory loss
Aphasia-can't express SELF through speech.
GLOMEULONEPHRITIS-it's an antigen antibody complex from a recent strep
infection which causes inflammation/ decreased glomerular filtration rate.
BETA BLOCKERS
B1-affects the heart
B2-affects lungs
EMERGENCY DRUGS TO LEAN ON
Lidocain
Epinephrine
Atropine
Narcan
AUTONOMIC DYSREFLEXIA-triggered by sustained stimuli at T6 or below.
Vasodialation above injury,(flushed face, increased bp etc) vasoconstriction
below injury(pale, cool, no sweating.)
. Widening pulse pressure is a sign of increased ICP
2.Pt taking Digoxin should eat a diet high in potassium (hypokalemia-> dig
toxicity)
3.Key sign of PUD... hematemesis which can be bright red or dark red with
the consistency of coffee grounds
4.Common symptom of Aluminium hydroxyde: constipation
5.In a child anemia is a the first sign of lead poisoning
6.Diuretic used for intracranial bleeding, hydrocephalus (Increased ICP,...)
MANNITOL (osmotic diuretic)
7.Treatment of celiac disease: gluten free diet
8.cystis fibrosis==> excessive mucus production, respiratory infection
complications,...
9.Cholelithiasis causes enlarged edematous gallbladder with multiple stones
and an elevated bilirubin level.
10.Fat embolism is mostly seen in LONG BONES (femur,...)
TRANSMISSION-BASED PRECAUTIONS:
Remember ADC - airborne, droplet, contact
AIRBORNE
My - Measles
Chicken - Chicken Pox
Hez - Herpez Zoster
TB
Private Room - negative pressure with 6-12 air exchanges/hr
Mask, N95 for TB
DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis
P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R - rubella
 M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia
An - Adenovirus

Private Room or cohort

Mask
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *
W - wound infxn
E - enteric infxn - clostridium difficile
E - eye infxn - conjunctivitis
SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S - scabies
Private room or cohort
Gloves
Gown
Abruptio placentae may be a complication of severe preeclampsia
1. Syrup if ipecac is not administered when the ingested substance is corrosive
in nature
2. Pt before liver biopsy is NPO 4-6 hours
3. Assess renal fct before giving an osmotic diuretic (mannitol)

4. Patient in addisonian crisis ecreased BP, Na, Blood glucose, Increased K

5. Amniocentesis is done as early as 14 weeks of gestation
6. Chorionic villi sampling is done as early as 10 weeks of gestation
7. Increased level of alpha fetoprotein in pregnant woman => neural tube
defects
8. Insulin is safely given throughout pregnancy; oral hypoglycemic agents are
contraindicated
9. Phenobarbital (Luminal) is commonly used to treat and prevent recurrent
seizures in infants and young children
10.Aspirin is associated with Reye's syndrome in children with fever or viral
infection
11.Glycerin suppositories are preferred agents to treat constipation in children
12.Corticosteroids may produce an altered effect of a vaccine
13. Thiazide diuretics (HCTZ,...) may induce hyperglycemia
14.Anticonvulsants INCREASE the seizures THRESHOLD!!!!
15. Hyperbilirubinemia in newborn: bilirubin levels are greater than 13-15 mg/dl .
16. Postpartum period: circulating hcG disappears within 8-24 hours
17. S/S opioid withdrawl: rhinorrhea, dilated pupils, abdominal cramps
18. S/S sedative withdrawl: Increased motor activity, tachycardia
19. S/S alcohol withdrawl: tremors, N/V, diaphoresis
20. S/S stimulant withdrawl: CNS depression, fatigue, depression, confusion,...
21. Hb values: neonates have Hb higher than those of older children to sustain
them until active erythropoiesis begins
22. Toclytic therapy: to arrest preterm labor
23.Child with chickenpox can be treated with oatmeal preparation baths and
calamine lotion at home to relieve the itching...
24. child with rheumatoid arthritis should sleep in bag to keep joints warm and
promote flexibility!!!! Wow...
25.When an eye patch is used to correct strabismus, the normal eye is patched.
That forces the child to use the "lazy" eye, thereby increasing that eye's
muscle strengths
26.If a chest tube accidently get disconnected, clamp it or place the open end of
the tube in a container of sterile water or saline solution
27.Women should avoid pregnancy for at least 3 months after a rubella vaccine
28.Most accurate method to detect TB: sputum culture!!!
29.some respiratory
30. 1. RSV- child in private room...CONTACT PRECAUTIONS..not droplet or
airbone. (sometimes i get this mixed up because its called respiratory
synctical virus..i used to pick droplet precautions but i have down now lol!
2. Elderly adults generally present with confusion rather than S/S of an
illness.

3. pneumonia- droplet precautions

4. COPD pts should get low flow Oxygen b/c of the hypoxic drive. (1-3L/min)
teach pursed lip breathing.5. ARDS- this pt doesnt respond to even 100%
FiO2
6. TB- hemotysis (advanced stage) v/s pulmonary edema- frothy blood tinged
 sputum
7. Allen's test- done b/f an ABG by applying pressure to the radial artery to
determine if adequate blood flow is present.
8. INH (Isoniazid)- tx of TB. give vit B6 to prevent peripheral neuritis
9. SIMV mode on vents commonly used for weaning pt off ventilator.
10. vent alarms: high alarm (increased secretions then suction......, biting
tube-need an oral airway,...... or coughing and anxiety- need a sedative)
low alarm- there is a leak or break in system...check all connectors and cuff.

11. if a trach becomes accidently dislodged try to replace it with an

obturator..if no luck keep the hole open with hemostats until physician
arrives.
31.Profile of gallbladder disease: 5Fs: fair, fat, forty, five pregnancies,
flatulent(disease can occur in all ages and both sexes)
32.Hip fractures commonly hemorrhage, whereas femur fractures are at risk for
fat emboli
33.Religious beliefs: Hindu- No beef or items containing gelatin
34.Renal diet- High calorie, high carbohydrate, low protein, low K, low Na, and
fluid restricted to intake = output +500 ml
35.Treatment for sickle cell crises- HHOP: Heat, hydration, oxygen, pain meds
36.RN and MD institute seclusion protection
37.MD or hospice RN can pronounce the client dead
38.For hospital triage, care for the client with a life-threatening illness or injury
first
39.For disaster triage, choose to triage first those clients who can be saved with
the least use of resources!
40.It is contraindicated to induce vomiting if the patient has ingested gasoline,
acid and alkaline!!!
41. MAOIs
Non-Popular Meds
Nardil
Parnate
Marplan

avoid Tyramine 1. teach a pt with GERD after meals to remain upright for
at least 20 min.

2.levodopa toxicity- notify physician if twitching develops.

3. Curling's ulcers or stress ulcers can cause sudden massive hemmorage.

4. 5 mm induration positive reaction (mantoux test) for HIV or

 immunosuppressd pts
5. Schilling test done to see how well a pt can absorb vit b12. checking to
see if they have pernicious anemia.
6. Prednisone, Prograf, and Cellcept helps to prevent kidney rejection.
42. Positioning Facts:
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing,
tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left side
and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability,
fetal bradycardia, etc) --> turn on left side (and give O2, stop Pitocin,
increase IV fluids)
3. Tube Feeding w/ Decreased LOC --> position pt on right side (promotes
emptying of the stomach) with the HOB elevated (to prevent aspiration)
4. During Epidural Puncture --> side-lying

5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat

supine (to prevent headache and leaking of CSF)
6. Pt w/ Heat Stroke --> lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so
leg should be kept straight. No other positioning restrictions.
8. After Myringotomy --> position on side of affected ear after surgery
(allows drainage of secretions)
9. After Cataract Surgery --> pt will sleep on unaffected side with a night
shield for 1-4 weeks.
10. After Thyroidectomy --> low or semi-Fowler's, support head, neck and
shoulders.
11. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does
not rupture
12. Buck's Traction (skin traction) --> elevate foot of bed for counter-traction
13. After Total Hip Replacement --> don't sleep on operated side, don't flex
hip more than 45-60 degrees, don't elevate HOB more than 45 degrees.
Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord --> knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma
to suture line. While feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries)
--> eat in reclining position, lie down after meals for 20-30 minutes (also
restrict fluids during meals, low CHO and fiber diet, small frequent meals)
17. Above Knee Amputation --> elevate for first 24 hours on pillow, position
prone daily to provide for hip extension.
18. Below Knee Amputation --> foot of bed elevated for first 24 hours,
position prone daily to provide for hip extension.
19. Detached Retina --> area of detachment should be in the dependent
position
20. Administration of Enema --> position pt in left side-lying (Sim's) with
 knee flexed
21. After Supratentorial Surgery (incision behind hairline) --> elevate HOB
30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)--> position pt flat
and lateral on either side.
23. During Internal Radiation --> on bedrest while implant in place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse
sweating, nasal congestion, goose flesh, bradycardia, hypertension) -->
place client in sitting position (elevate HOB) first before any other
implementation.
25. Shock --> bedrest with extremities elevated 20 degrees, knees straight,
head slightly elevated (modified Trendelenburg)
26. Head Injury --> elevate HOB 30 degrees to decrease intracranial
pressure.
43. some GI/hepatic
hepatitis--all forms standard precautions
s/s of bowel perforation--sudden diffuse abdominal pain, no bowel sounds,
resp. rapid and shallow, rigid abdomen.
nursing care for undiagnosed abdominal pain--npo, no heat on stomach, no
enemas, no narcotics, no laxatives.
crohns-small intestine vs ulcerative colitis-large intestine..sulfasalzine used
to treat both.

pyloric stenosis- olive shaped mass felt in R. epigastric area, projectile

vomiting
if a pt requires TPN and it is temp. unavailable then give D10W OR 20% DW
until available.

before a Dx test of after 3 enemas, returns are not clear, notify physician
if diarrhea occurs with a colostomy. check meds (some cause diarrhea)..dont
irrigate
as a general rule antacids should be taken 1-2 hours after other oral meds.
44. Symptothermal method of birth control - combines cervical mucus evaluation
and basal body temperature evaluation, non-prescription/drug
percipitus/rapid labor - risk factor for early postpartum hemmorhage and
amniotic fluid embolism.
In elderly, change in mental status and confusion are often the presenting
symptoms of infection.
antiseizure meds - notify anesthesia prior to surgery, may need to decrease
the amount of anesthetic given.
neuroleptic malignant syndrome - increased temp, severe rigidity, oculogyric
crises, HTN, complication of antipsychotic meds, notify MD
Dilantin - pregnancy risk category D, should investigate possibility of
pregnancy (LMP) prior to administering
Transcutaneous electrical nerve stimulation (TENS) - used for localized pain
 (back pain, sciatica) - use gel, place electrodes over, above or below painful
area, adjust voltage until pain relief/prickly "pins and needles".
45.S/S delusional thought patterns => suspiciousness and resistance to therapy
46.Use of neologism (new word self invented by a person and not readily
understood by another) =>associated with thought disorders
47.Age and weight are VERY important to know after a child has ingested a
toxic substance
48. Child with celiac disease can eat corn, rice, soybeans and patatoes (gluten
free)
49. Anaphylactic rx => administer epinephrine first, then maintain an open

airway. (Not the other way around )

50. Client with asthma => monitor peak of airflow volumes daily. Pulse ox

after!!!!
51.DKA pt => a HCT of 60 (way high...) (extreme dehydration) would be more
critical than a pH less than 3! (Fluids first...)
52. Assess for abdominal distention after placement of a VP shunt! (You know

why right? )
53. GFR is decreased in the initial response to severe burns, with fluid shift
occuring. Kidney fct must be monitored closely or renal failure may follow in
a few days
54.Vomiting => metabolic alkalosis (loss of stomach acid content)
55.Diarrhea => metabolic acidosis (loss of bicarbonate)
56.COPD => respiratory acidosis (CO2 retention)
57. Anxious client => hyperventilation can cause respiratory alkalosis. A paper

bag will help. (Increase CO2) Right?

58. Client with low H&H after splenectomy => the initial priority is REST due to
the inability of RBCs to carry O2
59. Mild to moderate diarrhea in a child => maintain a NORMAL diet with fluids

to rehydrate the poor child

60. Peripheral vascular disease - patient should sit with feet flat on floor to
prevent hypereflexion of the knee
Myelominigocele - baby should like on abdomen with head to the side

Tegretol - interferes with actino of hormonal contraceptives, should use

alternate type of birth control
Clozapine (Clozaril) - antipsychotic, treats schizophrenia, potential to
suppress bone marrow and cause agranulocytosis (look for sore throat and
fever)
Bucks traction - remove foam boots 3x/day to inspect skin, turn client to
unaffected side, dorsiflex foot on affected side, elevate foot of bed
phlebitis - tenderness and redness at IV insertion site and redness proximally
along the vein. Remove the IV adn apply warm soaks