Kaplan Decision Tree and All Nurses Notes

Ok for those of you who did not take Kaplan, this is their infamous Decision Tree
(Can't say I use it a lot, but some swear by it)
1. Can you identify the Topic?

Yes= proceed to step 2
No= read answers for clues, read stem, re word question
identify and proceed to step 2
2. Are all answers Assessments or Implementations?

Yes= proceed to step 3
No= determine from stem if assessment needed, validation needed; if so assess
*if no assess in stem then you need to assess
*if assess in stem, do you need validation?
*if assess or validation required and there are no right assess answers, then implement
3. Does Maslows fit?

Yes= Do they make sense? Apply ABC's.
*eliminate psychosocial/pain (consider pain psychosocial for nclex)
*don't always pick airway
No= are all physical? yes..then proceed to step 4
are all psychosocial? yes..then proceed to step 5
4. Are all answers physical?

Yes= apply ABC's
No= proceed to step 5
5. What is outcome of each?

do they make sense?
why?
and yes folks then you should have your answer!!!!
During peritoneal dialysis- client suddenly begins to breathe more rapidly, what do you do? Elevate the
HOB! Will decrease the pressure fo the dialysate on the diaphragm and increase the vital capacity of
the lungs, draining the cavity will further decrease the pressure.
Normal platelet = 150,000- 400,000. Decreased platelet= increase risk for bleeding. No IM injections,
use sm. gauge needle to prevent trauma, apply firm pressure to needlestick site for 10 min, soft
bristled toothbrush , do not floss, and no hard fards
Femoral to popliteal bypass graft= report if client becomes clammy. Hypovolemic shock is caused by
an inadequate volume of blood caused by hemorrhage, severe dehyradtion, or burns. skin will be cold
and clammy b/c the body redirects blood from the skin, kidneys, and GI tract to the brain and heart.
Urine output and B/P decreases and pulse increase
Pre-op teaching of extracapsular cataract removal -post-op- activites and restrictions needs to be
taught. Protect eye from ICP that will cause the suture line to rupture. To bend at the knees, avoid
sneezing, coughing, blowing nose, not to strain during a BM, to avoid vomiting, and do not lie down in
an dependent position
Hepatic encaphalopathy occurs with profound liver disease and results from the accumulation of
ammonia in the blood. Low protein and high calorie diet.
mother receiving DES is at risk for development of vag. cancer
cervical cancer risk factor= sex at early age
WHIPPLE PROCEDURE- for pancreatic cancer= removal of head of pancreas, distal portion of common
bile duct, the duodenum, and part of the stomach for tx of cancer. NG tube is connected to
intermittent low suction, assess tub for kinking. Postion client in semi-fowlers. Drainage should be
serosanguineous- pinkish
Post-op radical neck dissectino, detect the presence of stirdor, most probable cause is laryngeal
obstruction! Is identified upon auscultation of the trachea with a stethoscope. A coarse- high pitched
sound can be heard on inspiration d/t edema of the larynx.
Re: Anyoone up for random FACT THROWING??

PRAYERS BEFORE YOU TAKE THE EXAM
Dear God,
Today I will have my examinations. You know how important they are to me. So I am humbly asking
Your gracious help and divine assitance. I pray to you, my dear God, please neve rlet me be at ease
and give my very best. Please never let me guess nor rely on pure luck, but enlighten my mind and let
me think clearly. Please never let me resort to chances nor to dishonesty, but let me work to the
fullest of my ability. I pray for Your guidance that i as i think, I may find the right solutions, I may be
able to correctly answer the questions, I may solve those difficult problems. I ask, O God, Your
intercession, that as I write, I may not be careless nor overconfident, I may not be distracted but be
more concentrated, I may not be in a hurry nor take the exams too lightly. Today, O my Lord, I will
take my examinations Let me, with Your help, give my best effort. Let me, because of You, receive the
best and fruitful results. This I pray in Jesus name. Amen.
My tips:
Stages of Dying:
DABDA
Denial
Anger
Bargaining
Depression
Acceptance
Normal growth and development

Most People Can Get Stuff
BIRTH to 1 year- Mobiles

1-3 years- Push and pull toys
3-5 years - Coloring
6-12 years- Board Games
12-19 years- own Stuff
Diabetic KetoAcidosis (DKA): (5-10% mortality)

Almost exclusively in Type 1 diabetics
S/S: Polyuria, dehydration, ab pain, fruity breath, AMS, Na/Mg/Phos, K ( total body), +
following:
Hyperglycemia (>250)
Metabolic acidosis (pH <7.3,> 20)
Ketonuria/Ketonemia
TX:
IV insulin bolus (0.1 unit/kg) then IV infusion with same amount per hr AFTER making sure pt is
not K
Continue until acidosis corrects then taper
NS immediately upon diagnosis
Switch to D5NS when glucose < 250
Why in the world would I give D5NS when a patient still has high glucose levels? The most important
problem is the acidosis that is occurring. To reverse this we give insulin to drive glucose into the cell.
Remember that K rushes into the cell along with the glucose, and wherever K can go, H+ can go.
Since high levels of H+ in the blood is the cause of the acidosis, we give insulin to drive this H+
intercellularly, thereby reversing acidosis. We can't give insulin if the level of glucose is too low, so we
give D5NS to keep levels around 250 so we can give insulin until the acidosis is gone.
Add KCl to IV fluids once K < 5; replenish other electrolytes as necessary; Even though K usually
appears high, it most often is total body low and when you give glucose, the K is driven into the cell,
and hypokalemia can develop rapidly.
Hyperosmolar Hyperglycemic nonketotic syndrome (HHNS):

Severe Glucose, almost exclusively in Type 2 diabetics
Similar to DKA but usually have much higher glucose (>600) and NO acidosis or
ketonuria/ketonemia
Treat with fluids and low dose Insulin infusion
An important distinction is that DKA usually occurs in Type 1 Diabetics, while HHNS most often
occurs in Type 2 Diabetics. Remember this as it is a common question in the NCLEX world.
Hypoglycemia:
Patho: When glucose drops to 80 = insulin levels ; 70 = Glucagon ; 50 = epinephrine along with
s/s such as sweaty, BP, HR, tremors; Also around 50 CNS s/s (drowsy, h/a, confused) begin
Note: S/S from epinephrine release are absent if pt is on a BB
TX: If pt is alcoholic give Thiamine before any other treatment to prevent encephalopathy
Can eat = sugar food;
Can Not eat = - 2 amps D50 IV push; (Glucagon alternative option if no IV access is available,
however is of no use in prolonged hypoglycemia because stores of glycogen are depleted)
Points to remember:
For high sugar (DKA, HHNS) most of the signs and symptoms are from polyuria, so look for
dehydration and electrolyte imbalances...remember High and Dry
For low sugar most of the signs and symptoms are from the release of epinephrine, so look for
things that would happen when someone was high on adrenaline, such as hypertension, sweating,
tachycardia and tremors.
Imperative that you can recognize the difference between these two, as you are almost guaranteed
to see a question relating to this difference!

PULMONARY EDEMA:TX "MAD DOG"
Morphine
Aminophylline
Digitalis
Diuretics
Oxygen
Gases in blood(ABG'S)
drugs to treat viral respiratory infections

"you'd get a respiratory infection if you shoot an ARO (arrow)
laced with viruses into the lungs
ARO

d1206,thanks for the correction
back to facts:
Pnuemothorax symptoms
P-THORAX
Pleuritic pain
Trachea deviation
Hyper resonance
Onset sudden
Reduced breath sounds(dyspnea)
Absent Fremitus
X-ray shows collapse
Hi everyone my simple "PHARMA" facts for today from COMMERCIALS:
1)Sumatriptan (IMITREX)---an NSAID for MIGRAINE

2)Alleve---for muscle pain
3)Advair---COPD, bronchitis, emphysema
4)Lipitor--- to decrease BP, and for CAD
5)Mucinex--- expectorant, can last for 12 hours
6)Zopidem (AMBIEN)---anti-insomnia, taken at bedtime with full glass of water in an empty
stomach (seen this at Saunders Q & A too)
7) Enbrel---for Rheumatoid Arthitis SE: immunosuppression, fever and bruising
Oh and GLUCERNA diet for people with DM.. So far those are the drugs that Ive seen on TV ads. and
1 came up on Saunders Q &A the ambienCR.
ABCDE mnemonic --CAUSE of secondary hypertension

A: Accuracy, Apnea, Aldosteronism
B: Bruits, Bad Kidney
C: Catecholamines, Coarctation of the Aorta, Cushing's Syndrome
D: Drugs, Diet
E: Erythropoietin, Endocrine Disorders
MASLOW'S HIERARCHY examples and
contraindications
by vadee
Updated Oct 08, 2008 at 04:18 PM by vadee
Registered User Join Date: Oct 2008
Received 162 Kudos from 39 posts Posts: 70
As we all know, Maslow's hierarchy is important to know and understand. Yet there are examples
where Maslow's hierarchy is contraindicated. With that being said, here is to refresh your memory
on Maslow's hierarchy. PLEASE HELP GIVE EXAMPLES.
---------------------------------------------------------------------------------
IMAGINE that this is the pyramid:
1st (most) important (located at the bottom of the pyramid): BASIC PHYISIOLOGICAL NEEDS:
airway, respiratory effort, heart rate, rhythm, and strength of contraction, nutrition, elimination
2nd most important (located above physiological on the pyramid): SAFETY AND SECURITY:
protection from injury, promote feeling of security, trust in nurse-client relationship
PSYCHOSOCIAL NEEDS
3rd most important: LOVE and BELONGING: maintain support systems, protect from isolation, fear
4th: SELF ESTEEM: control, competence, positive regard, acceptance/worthiness
5th (top of the pyramid): SELF ACTUALIZATION: hope, spiritual well-being, enhanced growth.
-----------------------------------------------------------------
example of when it is contraindicated:
-a dehydrated and extremely suicidal client: safety comes before hydration
------------------------------------------------------------
example of when physiological is more important than safety
-cataract client: disturbed sensory perception (visual) is more important than risk of injury related to
decreased vision
)In myocardial infarction...MORPHINE first BEFORE OXYGEN...

2) In sickle cell crisis...TREAT HYDRATION FIRST BEFORE OXYGEN
in nclex,common sense is a key factor. you always think for the safety of the patient.I choose the
extremely suicidal.For the other one,it only says "dehydrated". Offer some fluids.hehe
apology..i meant to say this CLIENT was dehydrated plus suicidal....you would want to provide safety
first before hydration. i reread my posting and realized that I made it sound like there were two clients
involved rather than one.
thanks and lets keep them coming. =)
cataract client: disturbed sensory perception (visual) is more important than risk of injury
related to decreased vision
hhmmm physiologic need IS more important than safety/security.
that being said, i believe if you can't see, (physiologic) then it'll probably lead you busting your butt
along the way (safety/security)
phyisiologic needs always come before safety, except in psy. When you think about these needs, you
need O2, water, food. Also, think about ABC's then safety
example of when oxygen is not administered first....
a client receiving parenteral nutrition with suspected air embolism.
1. First CLAMP the intravenous catheter (prevents the embolism from going through the heart to the
pulmonary system).
2. Position the client to a LEFT trendelenburg position with the HOB lower (this will trap the air in the
right side of the heart)
3. CONTACT the physician
4. Administer OXYGEN as prescribed
5. Take the VITALS frequently
6. document the occurrence
so what i got from this is that you save the documentation for last. Before administering oxygen, you
need to contact the Physician (remember that administration of oxygen requires Physician's order).
usually you would want to do all that you can first before contacting the Physician. In this case which
is considered an emergency, the vitals is taken after the physician is contacted and oxygen is
administered.
that being said, i believe if you can't see, (physiologic) then it'll probably lead you busting
your butt along the way (safety/security)
yes but risk for is a potential diagnosis and altered sensory perception is an actual diagnosis. Priority
would be a diagnosis that is present not one that has the potential to be.
Just remember that underneath that Maslow's triangle there is an imaginary "additional" line below
the whole thing that is LIFE or DEATH.
In other words, if the "safety" factor is a life or death issue, that takes priority over every other need.
A client being hydrated isn't going to mean a hill of beans if he's dead.
always draw up clear to cloudy when mixing insulin.

2. do not add potassium to the diet of someone who is taking potassium sparing diretics.
3. Give diretics in the am to avoid nocturia.
4. always check for tube placement with 10 cc of air before instilling ANYTHING in an NG tube.
5. An infant should double there birth weight by 6 months old.
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!
VEAL CHOP
Variable deceleration -Cord compression
Early deceleration - Head ompression
Acceleration - O.k
Late deceleration - Position change
Pt with asthma - FIRST give bronchodilators (opens airways) and then stuff them with steroids
2. Antepartum client c/o leg cramps - teach client to dorsiflex foot
3. Pt who had thyroidectomy - assess for signs of hypocalcemia (muscle twitching: positive
Chvostek's/Trousseau's sign, tetany)
4. NORMAL FINDINGS for a 6 month old child - sits up without support

5. DELEGATION/SUPERVISION
RN's can assess (initial for sure, MOST IMPORTANTLY), teach, administer blood products, planning,
evaluation, infusion of IV meds,
LVN's can do dressing changes, administer enemas/antibiotics, oral care and routine observation, perform
fingerstick glucose readings, gathering data and observations: breath sounds and pulse oximetry, set up
equipment for oxygen and suctioning, checking and observing client for signs of infection, irrigating the ear,
reminding client about post-op instructions given by RN, assisting with procedures in stable clients with
predictable outcomes
Nursing assistant's can do VS's, baths, ambulate client, brush/floss client's teeth, record intake and output,
can remind client to perform actions that are already part of the plan of care, weighing the client, taking pulse
and blood pressure, reinforce dietary and fluid restrictions after the RN has explained them to the client
Remember that long-term corticosteroid use causes adrenal atrophy, which will decrease the ability of
the body to withstand stress. Therefore, when a pt is made NPO before surgery, check with the MD
because this medication may still need to be given. Sometimes you may also see the the dosage of a
corticosteroid increased before surgery

Burns
Priority = 1-airway (ABCs),

2-Circulation (Fluids & E-lytes)= IV LR
3-Pain,
4-Infection
Percaution= Cap, Gown, Mask, Gloves (use by nurse to infection.
Wound Care= at least 1/day with carful Aseptic (sterile) techinique if pt with 50% burned.
Meds= Morphine IV (monitor VS)

Analgesic 30 min before wound care
Tx= Silvadene (monitor urine for sulfa crystals) (Tx for psudomonas)
Monitor= adequate fluid replacement check urinary output of 30ml/hr
Lab= Hematocrit male 40-50, female 37-47
Diet= Calorie Carb protein / TPN may be used monitor BS / Sliding Scale for insulin
supplments: Vit B, Vit C, Iron
FyI: Most concern is a burn that does not blanch.
Degree of Burns
1 = Pink to red; epidermis damage (superfical) ;uncontrollable painful
2 = red to white with blisters and edema; epidermis and dermis (partial thickness) ;
painful
= charred, waxy white and edema; damage skin, nerves, muscle, bones(called deep
thickness burn), painless
3 = usually dry darkbrown or has a leathery appearence.

;damage to all the Epidermis and Dermis Skin grafting is recommended.( Full Thickness
Burn)
4= The tissue beneath the skin is burned/destroyed. includes the muscles, tendons,
ligaments and bones. Skin grafting is usually needed to close up the areas.
Endocrine Glands
Hypothalamus (Regulator)
Pituitary Gland (Growth, Reproduction, Melanin, F&E)
Pineal Gland (Melatonin, Circadan Rhythms)
Thyroid (Metabolism, Energy, Growth)
Parathyroid (Calcium Regulation)
Thymus (Immune Response)
Adrenal Glands (Stress Response, Metabolism, F&E)
Pancreas (Fat, Protein, Carb Metabolism)
Ovaries (Reproductive System, Sex Organs)
Testes (Reproduction, Muscles, Bones, Skin, Hair)
Hormones
Hypothalmus (Releasing/Inhibiting Hormones)

Ant. Pituitary (TSH, Growth Hormone, LH, FSH, ACTH)
Posterior Pituitary (ADH, MSH, Oxytocin)
Pineal (Melantonin)
Thymus (Thymopoietin)
Thyroid (T4, T3, Calcitonin)
Parathyroids ( PTH)
Adrenal Medulla (Epi, Norepi)
Adrenal Cortex ( Glucocorticoids, Mineralocorticoids)
Pancreas (Insulin, Glucagon)
Addissons Disease Assessments

Fatigue
Weakness
Dehydration
Eternal tan
Decreased resistance to stress
Low Sodium
Low Blood Sugar
High Potassium Addissons Disease
Implementations
High protein, High carbohydrate, high Sodium, Low potassium diet
Teach life-long hormone replacement
Addisonian Crisis Assessments

Hypotension
Extreme weakness
Nausea vomiting
Abdominal pain
Severe hypoglycemia
Dehydration Addisonian Crisis Implementations
Administer NaCl IV, vasopressors, hydrocortisone
Monitor vital signs
Absolute bedrest
Cushings Syndrome Assessments

Osteoporosis
Muscle wasting
Hypertension
Purple skin striations
Moon face
Truncal obesity
Decreased resistance to infection Cushings Syndrome Implementations
Low Carbohydrate, Low Calorie, High Protein, High Potassium, Low sodium diet
Monitor glucose level
Postop care after adrenalectomy or hypophysectomy
Buck's traction is used to immobilize and reduce spasms in a fractured hip.
Prioritizing
Anyone threatening suicide/self-harm should be seen first, followed by anyone hearing
command hallucinations to harm others.
An infant experiencing vomiting and/or diarrhea should be seen before an older child, young
adult, or adult experiencing vomiting/diarrhea.
IRON-DEFICIENCY ANEMIA (IDA)
* Anemia that results when iron supply is inadequate for optimal RBC formation because of excessive
iron loss from bleeding, decreased dietary intake, or malabsorption
Nursing assessment
* Fatigue and weakness

* Shortness of breath
* Pallor (ear lobes, palms, and conjunctiva)
* Brittle spoonlike nails
* Cheilosis (cracks in the corners of the mouth)
* Smooth, sore tongue
* Dizziness
* Pica (craving to eat unusual substances such as clay or starch)
* Blood sample shows microcytic and hypochromic anemia (small RBC diameter with decreased
pigmentation) and an increase in red cell size distribution width (RDW)
* Decreased MCV, MCH, and MCHC; analyzed only when hemoglobin is low
* Low serum iron level and elevated serum iron-binding capacity or low serum ferritin levels
Therapeutic management
* Examine stools for occult blood; endoscopic examination and other diagnostic procedures may be
performed to detect possible sources of bleeding
* Increase intake of iron-rich foods, such as organ meats, meat, beans, green leafy vegetables,
molasses, and raisins
* Administer iron supplements
* Administer parenteral iron dextran (InFed) by deep IM route via Z-track method
* Determine stool color, consistency, frequency, and amount; may appear greenish black and tarry;
caution client that iron supplements usually cause constipation and client should take preventive
measures (fluids, fiber)
Client teaching
* Take iron on an empty stomach; absorption of iron is decreased with food; ab*sorption may be
enhanced when taken with an acidic beverage (such as one with vitamin C), but avoid grapefruit Mice
* Foods high in iron include organ meats (beef or calf liver, chicken liver), other meats, beans (black,
pinto, and garbanzo), leafy green vegetables, raisins, and molasses
MEGALOBLASTIC ANEMIA
* Vitamin B12, deficiency anemia

* A type of anemia characterized by macrocytic RBCs
Nursing assessment
* Pallor or slight jaundice with a complaint of weakness

* Smooth, sore, beefy red tongue (glossitis), and cheilosis (cracking of lips)
* Diarrhea
* Paresthesias (numbness or tingling in extremities)
* Impaired proprioception (difficulty identifying one's position in space. which may progress to
difficulty with balance)
* Clients with this anemia tend to be fair-haired or prematurely gray Macrocytic (megaloblastic)
anemia (RBC diameter >8) with increase in MCV and MCHC
* Gastric secretion analysis reveals achlorhydria: absence of free hydrochloric acid in a pH maintained
at 3.5
* Twenty-four-hour urine for Schilling test (a vitamin B12 absorption test th indicates if client lacks
intrinsic factor by measuring excretion of orally ad-ministered radionuclide-labeled B12) confirms
diagnosis of pernicious anemia
* Medication therapy: parenteral vitamin B12,100 to 1000 mcg subcutaneously daily for 7 days, then
once a week for 1 month, then monthly for lifetime is usually prescribed; a nasal form is now available
also
Client teaching
* Dietary sources of vitamin B12 include dairy products, animal proteins
Folic aciddeficiency anemia

Nursing assessment
* Pallor, progressive weakness, fatigue

* Shortness of breath
* Cardiac palpitations
* GI symptoms are similar to B12 deficiency but usually more severe (glossitis, cheilosis, and
diarrhea)
* Neurological symptoms seen in B12 deficiency are not seen in folic acid deficiency and therefore
assist in differentiating these two types of anemia
* RBC analysis shows macrocytic (megaloblastic) anemia (RBC diameter, high MCV with low
hemoglobin, low serum folate level
* Includes dietary counseling and administration of folic acid
Client teaching
* Dietary sources of folic acid such as green leafy vegetables, fish, citrus yeast, dried beans, grains,
nuts, and liver
APLASTIC ANEMIA
Nursing assessment
* Pallor and fatigue

* Palpitations and exertional dyspnea
* Infections of the skin and mucous membranes
* Bleeding from gums, nose, vagina, or rectum
* Purpura (bruising)
* Retinal hemorrhage
* Blood counts reveal pancytopenia (decreased RBC, WBC, and platelets)
* Decreased reticulocyte count
* Bone marrow examination reveals decrease in activity of bone marrow or no cell activity
* Institute reverse isolation to protect client from infection

* Monitor for evidence of bleeding
* Avoid invasive procedures including rectal temperatures
Client teaching
* Methods to prevent infection such as avoiding crowds, maintaining good hygiene, hand washing, and
elimination of uncooked foods from the diet
* Methods to prevent hemorrhage such as using a soft toothbrush, avoiding contact sports, and use of
an electric razor
* Avoid drugs that increase bleeding tendency, such as aspirin
Sickle Cell Disease

Nursing assessment
* Pallor and jaundice

* Fatigue and possible irritability
* Large joints and surrounding tissue may become swollen during crisis
* Priapism (abnormal, painful, continuous erection of penis) may occur if penile veins are obstructed
* Severe pain
* Anemia with sickle cells noted on a peripheral smear
* Hemoglobin electrophoresis to detect presence and percentage of hemoglobin is used for a definitive
diagnosis
* Elevated serum bilrubin levels
* Elevated reticulocyte count
* Care of client in sickle cell crisis

o Recognize that client may have severe pain and medicate accordingly, usually with opioid analgesics
o Administer 02 to increase oxygenation to cells
o Promote hydration to decrease blood viscosity; provide oral intake of at 6 to 8 quarts daily or IV
fluids of 3 liters daily
o Monitor for complications such as vaso-occlusive disease (thrombosis), hy*poxia, CVA, renal
dysfunction, priapism leading to impotence, acute chest syndrome (fever, chest pain, cough,
pulmonary infiltrates, and dyspnea), an substance abuse
o Manage infection if appropriate
Medication therapy
* Narcotic (opioid) analgesics during the acute phase of sickle cell crisis, often at large doses
Client teaching
* Ways to prevent sickle cell crisis

* Maintain an oral intake of at least 4 to 6 quarts a day; avoid conditions that might predispose to
dehydration
* Avoid high altitudes
* Prevent and promptly treat infections
* Use stress-reduction strategies
* Avoid exposure to cold
* Avoid overexertion
Anemia
* Children with persistent anemia might experience frequent bouts of otitis media and upper
respiratory infections.
Pernicious Anemia
* For the exam, you should know the names for the various B vitamins and realize that they can be
used interchangeably in test items;
* B1 (Thiamine)
* B2 (riboflavin)
* B3 (niancin)
* B6 (pyridoxine)
* B9 (folic acid)
* B12 (cyanocobalamin)
Sikle Cell Anemia
* When multiple transfusions are given, reduce iron overload and hemosiderosis with subcutaneous
chelating injections of deferoxamine (Desferal)
* Morphine is the drug of choice for acute pain in sickle cell anemia. Meperidine is contraindicated due
to the possibility of central nervous system stimulation in these clients that could lead to seizure
activity.
* An easy to remember general nursing care for clients with sickle cell anemia is to remember the
following
* H - heat
* H hydration
* O oxygen
* P pain relief
Polycythemia Vera
This disorder is characterized by thicker than normal blood. There is an increase in the clients
hemoglobin to levels of 18 g/dL, RBC of 6 million/mm or hematocrit at 55% or greater and increased
platelets)
* With polycythemia, the client is at risk for cerebrovascular accident (CVA), myocardial infarction,
(MI) and bleeding due to dysfunctional platelets.
Hemophilia
* Intracranial bleeding is the major cause of death in clients with hemophilia
* Cryoprecipitates are no longer used for treatment of hemophilia because HIV and hepatitis cannot
be removed.
Transfusion Therapy
* Severe reactions occur during the first 50mL of blood transfused. Stay with the patient for the initial
15-30 min of infusion
Client with Burns
BURN INJURY
* An alteration in skin integrity resulting in tissue loss or injury caused by heat, chemicals, electricity,
or radiation
* There are several types of burn injury: thermal, chemical, electrical, and radiation
* Thermal burn: results from dry heat (flames) or moist heat (steam or hot liq*uids); is most common
type; causes cellular destruction that results in vascu*lar, bony, muscle, or nerve complications;
thermal burns can also lead to inhalation injury if head and neck area is affected
* Chemical burn: caused by direct contact with either acidic or alkaline agents; alters tissue perfusion
and leads to necrosis
* Electrical burn: severity depends on type and duration of current and amount of voltage; electricity
follows path of least resistance (muscles, bone, blood vessels. and nerves); sources of electrical injury
include direct current, alter*nating current, and lightning
* Radiation burn: usually associated with sunburn or radiation treatment for cancer; usually
superficial; extensive exposure to radiation may lead to tissue damage and multisystem injury
o Nursing assessment: history of injury, estimate burn extent and depth, obtain past medical history
and medication history including date of last tetanus pro*phylaxis; assess for other concurrent injuries
o Systemic effects of severe burns include asphyxia from smoke inhalation that causes edema of
respiratory passages; shock from fluid shifts; renal failure from shock; protein loss from open wound;
potassium excess from tissue destruction and renal failure
o Diagnostic and laboratory test findings: may have elevated hematocrit (Hct) and decreased
hemoglobin (Hgb) caused by fluid shift, decreased sodium (Nat) and increased potassium (K+) caused
by damage to capillary and cell mem*branes, elevated BUN and creatinine caused by dehydration,
myoglobin in urine, and possible deterioration of arterial blood gases (ABGs) and oxygen (02)
saturation readings depending on respiratory status
o Therapeutic management
* First aid: douse flames with water or smother them with a blanket, coat, or other similar object; cool
a scald burn with cool water; flush chemical burns copiously with water or other appropriate irrigant
after dusting away any dry powder if present; remove client from contact with an electrical source
only after current has been shut off
* Priority care is on ABCs: airway, breathing, and circulation; assess for smoke inhalation injury
(singed nares, eyebrows or lashes; burns on face or neck; stridor, increasing dyspnea) and give 02
(up to 100% as prescribed), being prepared for possible intubation and mechanical ventilation if
severe inhala*tion injury or carbon monoxide inhalation has occurred; assess for signs of shock
caused by fluid shifts (increased pulse, falling BP and urine output, pal*lor, cool clammy skin,
deteriorating level of consciousness [LOC])
* Fluid resuscitation: Brooke formula uses 2 mL/kg/% TBSA burned (3/4 crys*talloid plus 1/4 colloid)
plus maintenance fluid of 2,000 mL D5W per
o Medication therapy: analgesicsusually morphine sulfate IV, tetanus booster (> 5-10 years since
last dose), topical antimicrobials, systemic antibiotics
o Acute phase of burn management: begins with start of diuresis (usually 48 to 72 hours postburn)
and ends with closure of burn wound
o Therapeutic management
+ Wound care management includes debridement, dressing changes, hydrother*apy, and possible
escharotomy,
+ Mafenide (Sulfamylon) may be applied in thin layer over open wound and covered with dressing
+ Sulfadiazine (Silvadene) may applied in thin layer over open wound and cov*ered with dressing; use
with caution when impaired renal function exists; must be washed off and reapplied every 8 to 12
hours
+ Skin grafting may need to be done to achieve healing in full-thickness and large, deep partial-
thickness burns
+ Nutritional therapies (high-calorie, high-protein diet with vitamins and min*erals) and continue to
maintain hydration status
+ Infection control with strict sterile technique
+ Maintain heated environment to prevent chilling
+ Physical therapy as needed
+ Psychosocial support
# Rehabilitative phase of burn management: begins with wound closure and ends when client returns
to highest level of health restoration
# Therapeutic management
* Prevent immobility contractures with exercises or ongoing physical therapy
* Assist in returning to work. family, and social life
* Client education
* Environmental safety: use low temperature setting for hot water heater, en*sure access to and
adequate number of electrical cords/outlets, isolate house*hold chemicals, avoid smoking in bed
* Use of sunscreen to protect healing tissue and other protective skin; measures soft tissue injuries;
or deep chemical or electrical
+ To prevent burns, hot water heaters should be set no higher that 120 Fahrenheit.
Burn Classifications
+ Pain medication is given intravenously to provide quick, optimal relief and to prevent overmedication
as edema subsides and fluid shift is resolving.
+ The cardiac status of a client with electrical burns should be closely monitored for at least 24 hours
following the injury to detect changes in electrical conduction of the heart.
+ Full thickness burns can damage muscles, leading to the development of myoglobinuria in which
urinary output becomes burgundy in color. The client with myoglobinuria require hemodialysis to
prevent tubular necrosis and acute renal failure.
Burn Measurement with TBSA
+ It will be beneficial to review your nursing textbooks for local and systematic reactions to burns
because these injuries affect all body systems and cardiovascular and renal functions in particular.
Nursing Care for Burn Victims
+ The eyes should be irrigated with water immediately if a chemical burn occurs. Follow-up care with
an ophthalmologists is important because burns of the eyes can result in corneal ulceration and
blindness.
+ Important Steps in treating a burn client include the following:

* Treat airway and breathing Traces of carbon around the mouth or nose, blisters in the roof of the
mouth, or the presence of respiratory stridor, indicate the client has respiratory damage
* Ensure proper circulation Compromised circulation is evident by a drop in normal blood pressure,
slowed capillary refill, and decreased urinary output. These symptoms signal impending burn shock.
o It is important to remember that the actual burns might not be the biggest survival issue facing burn
clients. Carbon monoxide from inhaled smoke can develop into a critical problem as well. Carbon
monoxide combines with hemoglobin to form carboxyhemoglobin which binds to available hemoglobin
200 times more readily than with oxygen. Carbon monoxide poisoning causes a vasolidating effect
causing the client to have a characteristic cherry red appearance. Interventions for carbon monoxide
poisoning focus on early intubation and mechanical ventilation with 100% oxygen.
The Consensus Formula
o Fluid replacement formulas are calculated from the time of injury rather than from the time of arrival
in the emergency room.
The Intermediate Phase
o Infections represent a major threat to the post-burn client. Bacterial infections (Staphylococcus,
Proteus, pseudomonas, eshcerichia coil, and Klebsiella) are common due to optimal growth conditions
posed by the burn wound; however, the primary source of infection appears to be the clients own
intestinal tract. As a rule, systemic antibiotics are avoided unless an actual infection exists,
o Enzymatic debridement should not be used for burns greater thatn 10% TBSA, for burns near the
eyes, or for burns involving muscle.
Dressing for Burns
o Dressing for burns include standard wound dressings (sterile gauze) and biologic or biosynthetic
dressings (grafts, amniotic membranes, cultured skin, and artificial skin)
o Biologic dressings are obtained from either human tissue (homograft or allograft) pr animal tissue
(heterograft or xenograft). These dressing which are temporary are used for clients with partial
thickness or granulating full thickness injuries.
o Hemografts and allografts are taken from cadaver donors and obtained through a skin bank. These
grafts are expensive and there is a risk of blood-borne infection. Heterografts and xenografts are
taken from animal sources. The most common heterograft is pig skin (porcine) because of its
compatibility with human skin.
o Muslims and Orthodox Jews are two religious/ethnic groups who might be offended by the use of
porcine grafts since the pig is considered an unclean animal. Christian groups such as Seventh Day
Adventists might also reject the use of procine grafts.
DIAGNOSTIC TEST AND ASSESSMENT

Pulse oximetry
* Monitors arterial or venous oxygen saturation ([percentage of 02] bound to he*moglobin [Hgb]
compared to volume that Hgb is capable of binding); normal is usually 95% or greater in a client with
no lung disease; in clients with lung dis*ease, target oxygen saturation is 90% or greater; may be
measured intermit*tently (such as with vital signs or ambulation) or continuously
* Uses a light spectroscopy probe attached to a finger, earlobe, or nose
* Accuracy is lower with diminished peripheral perfusion, brightly lit environ*ment, acrylic fingernails,
and dark skin color
Laboratory
Sputum analysis: specimen obtained for microbiology (Gram stain, culture and sensitivity) or cytology
* Specimens for acid-fast bacilli (mycobacterium tuberculosis) may be collected

* on three different days; specimen collection following a long sleep period (early morning) is
desirable because of greater concentration; if unable to ob*tain a sputum specimen for acid-fast
bacilli, gastric specimen may be obtained because mycobacterium tuberculosis is not altered by acidic
gastric contents
* Specimen processing: collect specimens in appropriate container and send to laboratory promptly
Skin testing: assesses for allergic reactions to specified antigens (type I hypersensitivity), exposure
to tuberculosis-causing organisms (type IV hypersensiti vity), or fungi
* Measure area of induration (if present), not reddened area; read result 48 to 72 hrs after
placement; an uncertain reading at 48 hrs may be reread at 72
* Positive result: individual has been exposed to antigen; does not mean that individual currently has
active disease, only that there has been exposure/ infection
* When performing skin tests to assess for type I allergies, ensure that antihict*amines, which could
interfere with test results, are discontinued 72 hours prior to testing
COMMON NURSING TECHNIQUES AND PROCEDURES

Airway management: goal is to maintain patent airway
1. Head and jaw position
* Open airway by head tilt and anterior chin lift maneuver

* In individuals with suspected neck injury, open airway by anterior chin dis*placement and/or jaw
thrust; do not perform head tilt
* Limit suctioning to 10 seconds per catheter pass (5 in children) to reduce risk of inadequate
oxygenation and cardiac dysrhythmias from hypoxia
Body positioning
* Acute respiratory failure

a. Elevate head at least 45 decrees to increase chest exnansion
* Unilateral lung disease a. Position with unaffected lung in dependent position ("good lung down")
Oxygen (02) administration

Nasal cannula
* Typical 02 flow of 1 to 6 L/min will provide 02 concentrations of 24% to 44%

* Individuals with chronic obstructive pulmonary disease (COPD) should re*ceive low flow oxygen,
about 1 to 2 L/min, to prevent respiratory depression; these clients are used to high CO2 levels and
low 02 levels, so increased 02 (greater than 2 L/min) can cause a loss of respiratory drive
Key ventilator settings
* Rate: number of breaths per minute delivered by ventilator; is a number that is combined with the
mode often in clinical practice (e.g., SIMV of 6/min)
* FiO2: fraction of inspired 02 or 02%; amount of 02 in air inhaled via ventilator; is expressed as a
decimal instead of a percentage (e.g., Fi02 of .40 versus 40%)
* Tidal volume (VT): amount of air delivered with each breath; often expressed in milliliters or liters
(e.g., 700 mL or 0.7 L)
* PEEP: abbreviation for positive end-expiratory pressure; the amount of posi*tive-pressure set in
system at end of exhalation; keeps alveoli open during ex*halation to increase gas exchange; is
expressed in terms of centimeters of pressure (e.g., 5 cm)
Nursing management
* Position client for maximum alveolar ventilation and comfort; maintain soft restraints to avoid
accidental extubation
* Monitor for any changes in respiratory status or effort
* Maintain ventilator settings as ordered and remain knowledgeable about how to troubleshoot
ventilator alarms (high pressure frequently indicates need for suctioning or kinking/compression of ET
tube; low pressure indi*cates leak or disconnection); manually ventilate client if alarms sound
with*out apparent cause
* Monitor arterial blood gases (ABGs) and maintain continuous 02 satura*tion monitoring
* Complete a thorough physical assessment with emphasis on cardiac, neuro*logical, and respiratory
areas
* Administer antibiotics, neuromuscular blocking agents, and sedatives as ordered
* Maintain nasogastric suction to prevent aspiration
* Supply nutritional support as ordered
* Perform frequent oral care and suctioning to maintain airway patency
* Provide emotional support to client and family as well as alternative commu*nication method
Potential complications: pneumothorax, GI stress ulcers, hypotension caused by decreased venous

return from increased intrathoracic pressure, increased in*tracranial pressure, infection
Laryngectomy
Postoperative care
* Maintain patent airway

* Provide pain management
* Provide appropriate nutritional support
* Teach client and family how to care for tracheostomy and feeding tube (if applicable)
* Provide access to communication devices, such as writing supplies, picture or word board, speaking
tracheostomy valve
* Provide emotional sunnort to client and family: make annronriate referrals
Respiratory Isolation
* Droplet precautions (transmission-based precautions)

* In addition to standard precautions, persons should wear mask when near client who has known or
suspected pathogen transmitted by droplet route
* Limit client transport within facility; when transport is necessary, place mask on client
* Limit contamination of equipment and/or environment
* Place client in private room or with a cohort (client with same diagnosis)
NURSING MANAGEMENT OF CLIENT HAVING THORACIC SURGERY

Preoperative period
* Reduce anxiety through preoperative teaching about procedure and postopera*tive course and care
* Assess client's support systems and ability to care for self after surgery
* Administer preoperative medications, such as antibiotics, opioid analgesics, and anti-anxiety agents,
as ordered
* Obtain baseline vital signs, oxygenation status, and cognitive status for compari*son postoperatively
Postoperative period
* Maintain patent airway

* Position client for optimal ventilation and perfusion; note any specific surgeon-s orders for
positioning; be prepared to initiate respiratory support (intubation. emergency tracheostomy,
mechanical ventilation) as needed
* Maintain client safety
* Assess for and report possible surgical complications to maintain oxygenation
* Change in level of consciousness (LOC) ranging from restlessness and agitation to lethargy or
unresponsiveness
* Increase in respiratory rate, unequal chest expansion, decreased breath sounds, and/or use of
accessory muscles for breathing
* Loss of water seal drainage in closed chest drainage system
* Greater than desired volume of chest drainage (75-100 mL drainage over 1 hour is an average
acceptable upper limit); orders should specify volume acceptable chest tube drainage; should
decrease over first 24 hours
Positioning client after lung surgery: orders should specify turning parameters for indvidual client
* Lobectomy: positioning includes lying on back or turned to either side

* Segmental resection: positioning includes lying on back and turned onto nonl erative side;
positioning on operative side may place tension on sutures and mote bleeding
* Pneumonectomy
* Positioning includes lying on back and turned toward operative side
* Avoid complete lateral turning to either side, which changes pressure dynam*ics within chest and
could lead to mediastinal shift
OBSTRUCTIVE PULMONARY DISEASES

Emphysema
a. Progressive destruction of alveoli related to chronic inflammation
Assessment
* "Pink puffer" is a classic clinical description characterized by barrel chest, pursed-lip breathing
(caused by forced exhalation), obvious use of accessory muscles when breathing, and underweight
appearance
* Exertional dyspnea progresses with advancing disease
* Persistent tachycardia is related to inadequate oxygenation
* Overall diminished breath sounds, and possible wheezes or crackles
* ABGs: slightly decreased P02; PCO2 is not elevated until later stages
* Chest x-ray: hyperinflated lungs with a flattened diaphragm; heart size is nor*mal or small
* Pulmonary function tests: low vital capacity and forced expiratory volume (FEVi)
* Goals are to improve ventilation and promote patent airway by removing se*cretions
* Remove environmental pollutants and encourage smoking cessation
* Prescribed treatments include bronchodilator therapy, beta-adrenergic ago*nists, corticosteroid
therapy, oxygen and nebulization therapy, chest physio*therapy, intermittent positive-pressure
breathing (IPPB), possibly mechanical ventilation, and possible surgical procedures such as
bullectomy, lung volume reduction surgery, or lung transplantation
* Provide education and referrals for clients with behaviors (such as smoking) that increase risk for
COPD
* Refer clients to a structured pulmonary conditioning program and provide reinforcement as
appropriate
* Teach clients to avoid pulmonary irritants
* Assist clients to develop appropriate nutritional plans to provide ade*quate calories
Chronic bronchitis
A disorder of chronic airway inflammation with a chronic productive cough lasting at least 3 months
during 2 years; is a form of COPD
Assessment
* Frequent cough, occurring during winter season, with foul-smelling sputum

* Frequent pulmonary infections
* Classic appearance of "blue bloater" includes tendency for obesity and bluish-red skin discoloration
from cyanosis and polycythemia
* Dyspnea and activity intolerance occurs as disease progresses
* Increased anteriorposterior chest diameter
* Elevated red blood cell count; hemoglobin and hematocrit elevated in later stages
* Chest x-ray reveals enlarged heart, congested lung fields, and normal or flattened diaphragm
* Pulmonary function indicates increased residual volume, decreased vital capacity, FEVi, and
FEVi/FVC ratio
* Includes measures previously described in section on emphysema

* Provide education or referrals to clients with behaviors that increase the risk of developing COPD
* Refer clients to a structured pulmonary conditioning program and provide reinforcement as
appropriate
* Teach clients how to avoid pulmonary irritants
* Assist clients to develop appropriate nutritional plans that provide adequate calories but maintain
ideal weight
* Administer supplemental low-flow 02 as necessary; be prepared to initiate mechanical ventilation
* Surgical interventions include bullectomy, lung volume reduction surgery, lung transplantation
* Medication therapy includes immunization against pneumonia and influenza antibiotics, possible
bronchodilators (beta-adrenergic agonists, anticholiner-minimal client symptoms; air leak may
progress until pressure between thoracic cavity and atmosphere equalizes and client is symptomatic.
* Tension: disruption of chest wall or lungs causes air accumulation in pleural space; pressure on
mediastinum causes pressure on other lung and interrupts venous return to heart; is a medical
emergency that requires emergency placement of chest tube to relieve increasing pressure in thoracic
cavity and restore adequate cardiac output
PNEUMOTHORAX AND HEMOTHORAX

Assessment
* Dyspnea
* Tracheal deviation toward unaffected side
* Diminished breath sounds on affected side
* Percussion dullness on affected side
* Unequal chest expansion (reduced on affected side)
* Crepitus over chest
* Chest x-ray reveals pneumothorax
* ABG shows decreased P02
* In mild cases, no chest tube is required; if pneumothorax is significant, a chest tube is inserted and
attached to water seal drainage
* Spontaneous pneumothorax: in otherwise healthy client, may resolve without in*vasive treatment
* If spontaneous pneumothorax occurs repeatedly, may require pleurodesis, an in*stillation of an
agent (such as talc or tetracycline) in pleural spaces to allow pleura to adhere together; other
procedures include partial pleurectomy, sta*pling, or laser pleurodesis for pleural sealing
* Care of client with a chest tube:
* Monitor respiratory and oxygenation status
* Provide supplemental oxygen as indicated
* Maintain infection control practices
* Medication therapy: analgesics and antibiotics
ATELECTASIS
* Incomplete expansion or collapse of the lung resulting from obstruction of air*way by secretions or a
foreign body
Assessment
* Low-grade fever
* Breath sounds diminished or absent in affected area
* Diminished rate and depth of respiration
PULMONARY TUBERCULOSIS
* Lung infection caused by Mycobacterium tuberculosis
Assessment
* Frequent cough with copious frothy pink sputum; nonproductive cough devel*ops first as an early
symptom (especially in early morning)
* Night sweats
* Anorexia
* Weight loss
* History may indicate recent exposure to infected individual
* Positive tuberculin skin test (indicates exposure)
* Appearance of characteristic Ghon tubercle on chest x-ray
* Positive acid-fast bacillus sputum cultures (provides definitive diagnosis of infection)

* Provide adequate nutrition and hydration
* Institute standard precautions (Centers for Disease Control [CDC] Tier 1) and airborne precautions
(Tier 2, transmission-based precautions
* Use a private room with negative air pressure that has 6 to 12 full air exchanges per hour and is
vented to the outside or has its own air filtration system
* Wear specially fitted mask (N95 respirator) whenever entering client's room; fit-test the mask with
each use
* Provide visitors with appropriate masks
* Wear gown and masks if client does not reliably cover mouth during cough*ing or sneezing to
reduce risk of transmission to others
* Provide client with a surgical mask if it is necessary to bring client to another department; choose
shortest and least busy route and alert that department ahead of time about client's status; schedule
tests for least busy times of day
* Administer antimicrobial therapy as prescribed
* Provide supplemental oxygen as indicated
* Obtain periodic sputum cultures following onset of antimicrobial therapy
Client education
* Infection control measures, including handwashing, coughing into tissues disposing of them in a
closed bag
* Teach client, family, and close contacts about mechanisms of transmission antimicrobial therapy,
including need to take medication for full course of apy to prevent recurrence and/or development of
drug-resistant organisrm
PULMONARY EMBOLISM
* Emboli lodge in pulmonary vasculature and impede blood flow through pulmonary capillaries
Assessment
* Restlessness, anxiety, agitation
* Vital signs: tachycardia, tachypnea, hypotension, fever
* Chest pain
* Hemoptysis
* Mental status changes with possible decreasing level of consciousness
* Cyanosis
* Recent history of thromboembolism and/or long bone fractures
* Lung crackles upon auscultation
* Atrial fibrillation
* Chest x-ray may be normal
* Supplemental oxygen therapy; maintain patent airway

* Be prepared to initiate mechanical ventilation
* Maintain IV access and provide circulatory support as needed
* Anticoagulant and/or thrombolytic therapy
* Opioid analgesies and anti-anxiety agents as needed
* Embolectomy
* To prevent future pulmonary emboli, a vena cava filter may be inserted to trap emboli from a known
source
BRONCHOGENIC CARCINOMA
* Lung cancer is leading cause of death from malignancy
Assessment
* Symptom onset is often late in course of disease

* Persistent cough with or without hemoptysis
* Localized chest pain
* Dyspnea
* Unilateral wheeze upon auscultation
* Swallowing difficulty
* Anorexia and weight loss
* Enlarged neck lymph nodes
* Mass visible on chest x-ray
* CT scan or MRI of chest may better differentiate mass
* Sputum for cytology reveals tumor cells
* Bronchoscopy for direct biopsy or washings for cytology reveal tumor cells
* Surgical resection
o Pneumonectomy: removal of entire lung
o Lobectomy: removal of a lobe of lung
o Segmentectomy (segmental resection): removal of a segment or segments of a lung
o Wedge resection: dissection and removal of a defined area in lung
* Chemotherapy
* Radiation therapy
* Laser therapy
* Immunotherapy
CANCER OF THE LARYNX
* Most laryngeal tumors are benign
Assessment
* Hoarseness and/or change in voice characteristics

* Palpable jugular nodes
* Pain when swallowing
* Unexplained earache
* Diagnostic test results: laryngeal biopsy findings, x-ray visualization, MRI findings, barium swallow
visualization
* Depends on stage of disease and general condition of client

* Radiation therapy or brachytherapy (placement of a radioactive sow next to tumor)
* Chemotherapy
* Laryngectomy
* Radical neck dissection
* Maintain patent airway (tracheostomy performed with laryngectomy)
* Pain management
* Provide adequate hydration and nutrition (temporary or permanent alter route for nutrition)
* Provide alternate means for communication and plan for permanent mea communication (artificial
larynx or esophageal speech)
* Provide oxygen supplementation as indicated
* Medication therapy: opioid analgesics and antipyretics
THORACIC TRAUMA
* Alteration of breathing mechanics and/or gas exchange caused by respiratory. system trauma
Assessment
* Chest pain, may be severe such as with flail chest

* Shallow breathing with splinting
* Possible unequal chest expansion
* Tachycardia, tachypnea, hypotension
* Crepitus over chest
* Chest x-ray findings show white opacifications
* ABGs reveal hypoxemia
Therapeutic management: same as pneumothorax and hemothorax
* Ventilation support
* Be prepared to initiate mechanical ventilation
* Maintain IV access
* Possible placement of chest tube with water seal drainage
* Medication therapy: opioid analgesics, patient-controlled or epidural analgesia may be appropriate
CYSTIC FIBROSIS (CF)
* Multisystem disorder of exocrine glands, leading to increased production of

thick mucus in bronchioles, small intestines, and pancreatic and bile ducts
Assessment
* Sweat test (pilocarpine iontophoresis) analyzes Na+ and C1-- content in sw e chloride concentration
greater than 60 meq/L is diagnostic of cystic fibrosis.. ents often report that infants taste salty when
kissed
* Respiratory: ensure pulmonary hygiene is performed; auscultate breath sounds before and after
treatments; encourage coughing and deep breath exercises and physical activity as tolerated;
administer prescribed antibiotics and bronchodilator(s)
* Digestive: provide high-calorie (150% above normal recommendations). high protein diet and
snacks; give infants a predigested formula such as pregestnutramigen; administer pancreatic enzymes
with all meals and snacks; indi ize to achieve stools as near normal as possible; administer fat-soluble
vitamins determine food preferences to encourage acceptance of diet; weigh daily: avoid pulmonary
treatments immediately after meals to decrease risk of vomiting
* Medications: antibiotics for treatment of pulmonary infection and purulent cretions, pancreatic
enzymes for fat absorption, vitamin supplementation. immucolytics to decrease viscosity of sputum,
bronchodilators to improve lung function; see Chapter 37 for overview of commonly ordered
respiratory cardiac medications
* High-calorie, high-protein diet is essential; give pancreatic enzymes with all meals and snacks; may
need extra salt in hot weather
BRONCHOPULMONARY DYSPLASIA (BPD)
* A chronic obstructive pulmonary disorder occurring in infants as a sequela to prolonged 02 therapy

and mechanical ventilation
Assessment
* Diagnosed by chest x-ray, which reveals lung changes and air trapping with or without hyperinflation
* Blood gases reveal hypercapnia (increased CO2) and respiratory acidosis
* Respiratory observations include tachypnea (rapid respirations), tachycardia, in*creased work of
breathing, retractions, wheezing, and barrel chest (rounding of chest caused by trapped air)
* Pallor, activity intolerance, and poor feeding result from chronic hypoxia
* Infants with BPD are cared for in intensive care units and require an artificial airway; avoid pressure
or trauma to ET tube and infant's airway
* Suctioning, turning, and weighing is done carefully to ensure adequate 02 sat*uration levels are
maintained
* Monitor respiratory status continuously; infant's condition can worsen in a short period of time
* Monitor for fluid overload; infants are at increased risk for pulmonary edema; weigh daily; maintain
strict I & 0
* Strict handwashing; avoid exposure to respiratory infections
* Cluster nursing care to minimize 02 requirements and caloric expenditure
* Plan quiet stimulation and activities to foster normal infant development and parental bonding with
extended and often repeated hospitalizations of in*fants with BPD
Medications
* Bronchodilators open airways and increase lung compliance

* Corticosteroids reduce airway edema and inflammation
* Diuretics remove excess fluid from lungs and help prevent pulmonary edema
* Antibiotics may be given prophylactically
LARYNGOTRACHEOBRONCHITIS (LTB)
* Viral infection that causes inflammation, edema, and narrowing of chea, and bronchi; usually LTB is
preceded by a recent upper respira% fection (URI)
Assessment
* Onset is gradual after URI

* Child awakens with low-grade fever, barking cough, and acute stridor; noisy breathing and use of
accessory muscles increase
* Child is agitated, restless, has a frightened appearance, sore throat, and rhinorrhea
* Pulse oximetry is used to detect hypoxemia; anteroposterior (AP) and lateral upper airway x-rays
are ordered
* Monitor child's respiratory effort continuously to ensure a patent airway; ob*serve for diminished
breath sounds, circumoral cyanosis, diminishing noisy breathing, and drooling
* Quiet respiratory effort is a sign of physical exhaustion and impending respira*tory failure
* Provide humidity and supplemental 02; IV fluids prevent dehydration and help liquefy secretions
* Assist child to assume upright position or any position of comfort; promote a calm, quiet
environment; keep parents nearby to decrease child's stress and to lessen crying
* Keep emergency intubation equipment available at bedside; readily respond to call bell or requests
for assistance
* Assess parental and child's anxiety level; provide emotional support
* Medications
* Bronchodilators decrease mucosal constriction and laryngeal edema; nebu*lized racemic epinephrine
has a rapid onset with improvement of symptoms, although relapse may occur within 2 hours
* Corticosteroids decrease inflammation and edema
Child and family education
* Cool mist humidifier and parental presence can be initial treatment of crisis; comforting measures
include cuddling, rocking, singing, and any calming mea*sures until breathing becomes easier
* Instruct parents to seek medical attention immediately if breathing becomes la*bored, child seems
exhausted or very agitated, or if symptoms do not improve after cool air humidity treatment
EPIGLOTTITIS
Inflammation and swelling of epiglottis. primarily affecting children ages 2 to 8
Assessments
* Child awakens with sudden onset of high fever (102F), extremely sore and pain on swallowing
* Child is very anxious, restless, looks ill, and insists on sitting upright legs and arms, with chin thrust
out and mouth open (tripod position)
* Dysphonia (muffled voice), dysphagia (difficulty swallowing), drooling and distressed respiratory
effort are classic signs
* Edematous, cherry-red epiglottis is most reliable diagnostic sign
* Examination of throat is contraindicated, however, unless emergency equipment and trained
personnel are available; physical manipulation of hypersensitive and irritated airway muscles may
result in spasm and a obstruction
* Lateral neck-x-ray confirms an enlarged epiglottis; portable x-rays are completed in examination
room with child on parent's lap to minimize stress maximize child's comfort and calm behavior
* Complete blood count (CBC) and blood cultures are taken once child is - stabilized
* Assess continuously for respiratory distress and decrease in respiratory report changes in status
* Never leave child unattended; support child in position of comfort; encourage parents to hug and
cuddle their child
* Keep ET and tracheotomy tubes and suction equipment at bedside; assist emergency ventilation if
needed before child is taken to operating room for airway insertion
* Child is usually intubated for 24 hours; restraints may be necessary to prevent tube dislodgment,
because swelling of epiglottis may prohibit reintubation
* Provide support for child and family and alleviate anxiety; explain all procedures clearly and calmly
* All invasive procedures, including starting an IV infusion, ABGs, and blot surtures are performed in
OR
* Keep child NPO; IV fluids provide hydration; administer antipyretics and antibotics as prescribed
* After extubation, monitor child closely in intensive care unit to ensure ir*ate assessment if
respiratory effort is compromised
* Medications
* Antibiotics treat bacterial infection (usually given for 7 to 10 days); discharged in about 3 days with
oral antibiotics
* Antipyretics treat fever and manage pain of sore throat
* Corticosteroids may be given for 24 hours before extubation
Assessment
* Clinical manifestations include worsening of URI with tachypnea, retractions, low-grade fever,
anorexia, thick nasal secretions, and increasingly labored breathing; older infants may have a
frequent, dry cough
* Auscultation of lungs reveal wheezing or crackles
* Nasopharyngeal washing to obtain respiratory secretions identifies causative virus; chest x-ray may
be normal or indicate hyperinflation or nonspecific inflammation
* Assess respiratory status hourly; provide humidified 02 to ease respiratory ef*fort; use pulse
oximetry to assess 02 saturation
* Clear nasal passages with bulb syringe; elevate head of bed
* Cluster nursing care to allow for rest; assess anxiety level of parents and provide support; maintain
a calm environment
* IV fluids may be needed if oral intake is compromised; monitor strict I & 0; weigh daily to assess
fluid loss
* Maintain strict handwashing and contact precautions; caregivers should not care for other high-risk
children
* Medications: bronchodilators and steroids are sometimes used; prevention of bronchiolitis in high-
risk children under age 2 may be achieved with use of palivizumab (Synagis) or IV RSV
immunoglobulin
FOREIGN BODY ASPIRATION
* Inhalation of an object into respiratory tract, intentional or otherwise

* The type and shape of object, as well as small diameter of an infant's airway, de*termines severity
of problem; round objects such as hot dogs, round candy, nuts, and grapes do not break apart and are
more likely to occlude airway; latex bal*loons are particularly hazardous; objects with irregular shapes
may irritate air*way and partially obstruct airflow
Assessment
* Sudden coughing and gagging is first sign, and objects in upper airway may be expelled by coughing
* Partial obstruction may cause symptoms of respiratory infection for days or even weeks; child may
have hoarseness, croupy cough, wheezing, and dyspnea
* Assess respiratory status to determine severity of problem and degree of ob*struction; continuously
monitor and provide assistance if obstruction worse
* If total airway obstruction occurs, perform back blows and chest thrusts for infants and Heimlich
maneuver in children older than 1 year
* Keep NPO; foreign body is usually removed in surgery
* Position for comfort and to optimize airway; provide emotional support to parents and child and
alleviate anxiety
* After removal of object, assess for additional obstruction that may result from laryngeal edema and
tissue swelling
Asthma
* When both antibiotics and aminophylline are administered intravenously, the nurse should check for
compatibility. If only one IV site is used, the nurse should use the SAS procedure (saline, administer
medication, saline) for administering medications. Administer IV doses using a controller.
* Clinets receiving aminophylline should be maintained or cardiorespiratory monitoring because
aminophylline affects cardia and respiratory rates as well as blood pressure. Because toxicity can
occur rapidly the nurse should monitor the clients aminophylline level. Symptoms of toxicity are
nausea, vomiting, tachycardia, palpitations, hypotension. In extreme cases, the client could progress
to shock, coma and death.
* The therapeutic range for aminophylline is 10-20 mcg/mL.
Pneumonia
* Some medications used in the treatment of pneumonia require special attention:
* Tetracycline should not be given to women who are pregnant or to small children because of the
damage it can cause to developing teeth and bones
* Garamycin, an aminoglycoside, is both ototoxic and nephrotoxic. It is important to monitor the client
for signs of toxicity. Serum peak and trough levels are obtained according to hospital protocol. Peak
levels for Garamycin are drawn 30 minutes after the third or fourth IV or IM dose. Trough levels for
Garamycin are drawn 30 minutes before the third or fourth IV dose. The therapeutic range for
Garamycin is 4-10mcg/mL.
Pulmonary Embolus
* Remember the three Fs of fat emboli:

o Fat
o Femur
o Football player
* Most fat emboli come from fractured femurs; most fractured femurs occur in young men 18-25, the
age of most football players.
* Streptokinase is made from beta strep; therefore, clients with a history of strep infections might
respond poorly to anticoagulant therapy with streptokinase because they might have formed
antibodies.
* Streptokinase is not clot specific; therefore, the client might develop a tendency to bleed from
incision of injection sites.
addison - bronze like skin

angina- levines sign
apendicitis- reboundtenderness
asthma- wheezing
bulimia-chipmunk face
catarct-hazy vision
cholecystitis- murphys sign
cholera-rice watery stool
cushing- moon face
dengue- petechiae
diptheria-pseudomembrane
down syndrome-protrusion of tongue/simean creases on palms
empysema-barrel chest
glaucoma-tunnel like vision
graves dse- exopthalmos
hepatitis-jaundice
kawasaki-strawberry tongue
leprosy-leoning face
liver cirrhosis-spider angioma
malaria-chills
measles- koplik spots
meningitis-brudzinski/kernigs
m gravis-ptosis
pancreatitis/ectopic pregnncy- cullens sign /grey turners sign
parkinson-pill rolling tremor
pda-machine like murmur
pernicious-red beefy tongue
pneumonia-rusty sputum
ptb-low grade fever
pyloric stenosis-olive shape mass
retina detachment-curtain like vision
sle- butterfly rash
tetanus-risus sardonicus
tetralogy of fallot-clubbing of fingers
icp- hyperbradybrady
shock-hypotachytachy
cushing- 3 S are up ( sugar salt sex)

adisons-3 S are down ( sugar salt sex)
more to come ^^
I would just like to say thanks to everyone who has posted here. I take my NCLEX on September 10 and I have
gotten alot of great info! It is amazing how much you sort of forget once you have gotten past them ...so I
just wanted to add
delegation..
RN is the only one that can EAT- evaluation, assessment and teach- any patient that says, recently admitted,
to be discharged, or change in clinical status!
LPN- stable pts with predictable outcomes (do not go by equipment)
CNA- standard UNCHANGING procedures (remember that in some areas, CNA's are permitted to do things
like tube feedings, dressing changes, foley insertions- as long as it is UNCHANGING procedure)
For the test remember- this is the NCLEX world, not real life....you always have time, always have an order and
always have availible resources.
When a questions asks about who to report to, always follow the chain of command... first your supervisor, then
hosp admin
When it gives you a question like..the ventilator oxygen alarm sounds what do you do FIRST- always check your
patient...patient first, equipment next
THIS IS THE BIG ONE THAT I WAS TOLD
always remember Maslow....physiological before pyschosocial and then go by ABC's
hope the tips help..
Akathsia- restless movements, pacing

anhedonia- inability to experience pleasure
apraxia- loss of purposeful motor movements
clang association- meaningless rhyming of words
echolalia- repitition by a person what is said to another person
echopraxia- meaningless imitation of movement
Labile- rapidly shifting emotions
somatization- the expression of a psychological stress through
physical symptoms
word salad- spoken words wth no meaning like someone saying
(dog, foil, house, sing, lake)
neologism- coined word with special meaning to the user
mania- unstable elevated mood
flight of ideas- rapid flow of speech in which the person jumps
from one idea to another without finishing the first idea
premorbid- occuring before the development of the disease
waxy flexibility- the extremities remain in a fixed position for a
long period of time (like that guy on patch adams that holds his
arm up constantly)
Re: Quick Facts/nclex Infecton Control

Transmission-based Precautions: ADC
A - Airborne
D - Droplet
C - Contact
AIRBORNE PRECAUTION (credit goes to the one who posted this on April thread, sorry can't
remember your name)
My - Measles
Chicken - Chickenpox
Hez - Herpes Zoster (Disseminated)
TB - TB
Private room
Negative pressure with 6-12 air exchanges per hour
UV
Mask
N95 Mask for TB
DROPLET PRECAUTION
think of SPIDERMAN!
S - Sepsis
S - Scarlet fever
S - Streptococcal pharyngitis
P - Parvovirus B19
P - Pertussis
P - Pneumonia
I - Influenza
D - Diptheria (Pharyngeal)
E - Epiglottitis
R - Rubella
M - Mumps
M - Meningitis
M - Mycoplasma or meningeal pneumonia
An - Adenovirus
Private room
Mask
CONTACT PRECAUTION
MRS.WEE
M - Multidrug resistant organism
R - Respiratory infection - RSV
S - Skin infections
W - Wound infections
E - Enteric infections - clostridium defficile
E - Eye infections
Skin Infections:
V - Varicella zoster
C - Cutaneous diptheria
H - Herpes simplex
I - Impetigo
P - Pediculosis
S - Scabies, Staphylococcus
Private room
Gloves
Gown
Someone mention in another thread of having a

Botox question on the nclex, so Botox it is:
Botulinum Toxin (Botox)

Produced by the Clostridium Botulinum bacteria,
which temporarily weakens/paralyzes facial muscles.
Used to reduce wrinkles (facial lines), last 90-120 days.
It is also used to TX strabismus (cross eye), abnormal neck
and shoulder contraction and vocal spasm.
May relieve migrane and tension H/A symtoms.
Most common SE: H/A, nausea, brusing, flu like symtoms,
ptosis (eye drooping),
other SE: Temporary facial pain, redness at injection site,
reduced blinking, and weakness in facial muscles.
Extreme cases: muscle weakness can limit facial expressions
Rare occasions: sore may develope on the white of the eye (corneal ulceration)
This is GREAT! Here's some I got from a review class I went to several months ago...
*Change in color is always a LATE sign!

*Incentive Spirometry steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds,
and then HOLD for 10 seconds
*Aminoglycocide (__Mycin ; except erythromycine) Adverse Effects are bean shaped - Nephrotoxic
to Kidneys and Ototoxic to Ears
*MRSA - Contact precaution ONLY
*VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure)
*LITHIUM
L-level of therapeutic affect is 0.5-1.5
I-indicate mania
T-toxic level is 2-3 - N/V, diarrhea, tremors
H-hyrdrate 2-3L of water/day
I-increased UO and dry mouth
U-uh oh; give Mannitol and Diamox if toxic s/s are present
M-maintain Na intake of 2-3g/day
*All psych meds' (except Lithium) side effects are the same as SNS but the BP is decreased.
*SNS- Increase in BP, HR and RR (dilated bronchioled), dilated pupils (blurred vision), Decreased GUT
(urniary retention), GIT (constipation), Constricted blood vessels and Dry mouth.
*Blood transfusion- sign of allergies in order:
1)Flank pain
2)Frequent swallowing
3)Rashes
4)Fever
5)Chills
*Thrombocytopenia -Bleeding precautions!
1)Soft bristled toothbrush
2)No insertion of anything! (c/i suppositories, douche)
3)No IM meds as much as possible!
*Iron deficiency anemia - easily fatigued
1)Fe PO - give with Vitamin C or on an empty stomach
2)Fe via IM- Inferon via Ztrack
*Pernicious Anemia - Red, Beffy tongue; will take Vit.B12 for life!
*BURNS
1st Degree - Red and Painful
2nd Degree - Blisters
3rd Degree - No Pain because of blocked and burned nerves
*Meniere's Disease - Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on
affected ear when in bed. Triad:
1)Vertigo
2)Tinnitus
3)N/V
*Gastric Ulcer pain occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away
with food
CHEST TUBE DRAINAGE SYSTEM:

( I decided posting this since I tend to forget it sometimes, hope this can help someone1)
Collection Chamber- This is the patient fluid Collection Chamber. Located on the Right
Side.
(2 things to Know): Notify Physician IF:
1. ABOVE 100 ML/Hr drainage

2. BRIGHT-RED drainage color.
Water Seal- This is the Middle Chamber.
Fluctuation Fluid inside chamber, indicates that client is breathing. (respirations) This is
NORMAL.
If the Fluid inside chamber stops fluctuating (moving up and down) this can mean 2 things:
- Lung Reexpansion
- Blocked Occluded Tube.
PRIORITY: Always check for KINKS in the tubing BEFORE notifying the physician.
- Intermittent Bubbling (On and Off) is Normal
Suction Control Chamber- Left Chamber
- Intermittent Bubbling (on and Off) is Normal especially for Pneumothorax patients.
- Notify Physician for Continuous Bubbling.
* Note: all drainage systems shouldn't have Continuous Bubbling. Notify physician if you
notice this.
Antacid that contains magnesium may cause diarrhea

Antacid that contains aluminum may cause constipation
During colostomy irrigation bag should be hung 18 inches (45 cm) above the stoma
stress incontinence = involuntary leakage that is triggered by a sudden physical strain such as cough,
sneeze or quick movement
urge incontinence = inability to suppress a sudden urge to urinate
total incontinence = continuous leakage resulting from the bladder's inability to retain urine.
Right sided failure:

Edema (peripheral)
Liver /spleen enlargement
jugular vein distention
bounding pulses
decrease or absent of urinary output
Left Sided Failure:

Cyanosis
Wheezes
anxiety
pulmonary crackes
apical murmurs
decrease BP/periheral pulses
increase res.p. rate
s3/s4 gallop
Schizophrenia
Positive symptoms:
1. hallucinations
2. delusions
3. loose associations
4. agitated or bizarre behavior
Negative symptoms:
1. apathy
2. anhedonia
3. poverty of speech
4. poor social functioning
5. social withdrawal
Treament:
Typical and atypical meds
Antiparkinsonian meds
Nursing Care:
- protect client and other from harm including suicide prec.

-administer meds as ordered
-monitor s/e
-establish trust and reduce anxiety
-encourage or reinfore
* clients sense of control
* reality orientation
*self care
-help clients set realistic goals
-provide safe environment
do not.... with them....
Not sure if this stuff was allready addressed but things I learned that helped me pass in July were:
In NCLEX hospital (the imaginary hospital where you pretend you are when you take your test) you
HAVE:
1 AN UNLIMITED BUDGET
2 AN UNLIMITED AMMOUNT OF TIME TO SPEND WITH EACH PATIENT
3 UNLIMITED STAFFING
If you have a answer as an option, YOU HAVE

1 the order to do it
2 the option to use it (Family to stay all night or delegating a person to do it)
3 the time to quietly sit with a patient for 12 hours holding their hand
You CANNOT
1 Delegate upward or horizontally, you cannot have your boss start an IV. You cannot delegate a fellow
nurse to do this either.
2 treat the machinery! STAY WITH THE PATIENT and treat THEM!
3 delegate aides or lpn's to ASSESS or TEACH
thoracentesis- a needle inserted through the chest wall to remove

air or fluid, observe for possible pneumothorax, increased pulse,
pallor, chest pain, dypsnea and tachycardia
legionnaires' disease- acute respiratory infection caused by gram

neg. bacteria, primary entry is through the lungs, usually through
air conditioners, not transmitted by person to person
symptoms- fatigue, HA, dry cough, fever and chills,
erythromycin drug of choice
nursing care same as pneumonia
Ebola virus- acute infection linked to monkeys in africa or the

philippines that produces a severe illness mortality rate 25-
90% (not good odds)
skin and mucous membrane contact transmission
fever, myalgia, HA, upper res. symptoms
then hemorrhagic symptoms begin a few days later
mask, gown, glove precautions
there is no vaccine or effective antiviral therapy

Severe acute respiratory syndrome (SARS)
1st detected in china in 2003
spread by close contact and droplet
dry non-productive cough and dypsnea, hypoxemia may
develop and sometimes respiratory distress syndrome, the last
stage of SARS is classified as atypical pneumonia
put client in a neg. pressure isolation room, use airborne and
contact protection
there is no accepted medical treatment for SARS, but
Ribavirin can be used in clients under 40, do not give ribavirin
to the elderly
mechanical ventilation may be necessary
Colmplications of thyroid surgery: (4H)

Hemmorrhage
Hypothyroidism
Hypoparathyroidism
Hypocalcemia
**
Danger signs of Pregnancy: ABCDEFGH

Abdominal or chest pain
Bleeding
Chills and fever
Decrease in fetal movement
Escape of clear fluid from vagina that suddenly occur
Frequent and persistent vomiting
Gain in weight of over 2 lbs/week in 2nd trimeester and 1.6 lbs/week in 3rd trimester
Hypertension
PRIORITY: Report to physician immediately

cushings syndrome- overactivity of adrenal cortex, tumor of adrenal gland
moon face, buffalo hump, obese trunk with thin arms and legs
fragile skin, they easily bruise
assess for osteoporosis, fractures, renal stones
hyperglycemia, may develop DM
mood swings
get infections easily
muscle weakness
masculine characteristics in females (facial hair)
hypertension
potassium depletion, sodium and water retention, metabolic alkalosis
Ok my points are Priority points that i have learned over the months.
Tricky points if you see a pat with blood sugar or 222 and K+ of 59 WHO do you see first. ?
Also you have a patient going into a seizure do you move all the furniture away first of do you put the
patient on its side First these the things and points you need to know. What do you do first.
if you see a pregnant woman come into the Er with a umbilical cord protruding out the belly wht
position do you put her in
Just incase anyone else was as confused about triage systems as I was...
listed by prioritization
1. Immediate (emergent) - seriously injured but have a reasonable chance for survival once in stable
condition
2. Delayed (nonemergent) - can wait for 1-2 hours after recieving simple first aid
3. Expectant - extremely critical or dying

4. Minimal (nonemergent) - no impairment of function; can treat on their own or recieve treatment
from a non-professional
I hope this helps!
hate to say this, but in working on Suzanne's Tip #1, I saved lab values until close to the
end, as I did not do well the first time I took the practice test. In fact, I had to take it
five times before I was finally able to pass the chapter test! Here are some things that
helped me remember some lab values:
BUN: Normal 8-25 I pictured 8 buns on one cookie sheet. For the upper limit of 25, I
picture three times that many on three pans and an extra bun squeezed on the third pan,
making a total of 25 buns.
Calcium: Normal 8.6 - 10. I picture 8-10 cups of milk to provide calcium instead of drinking
8-10 cups of water. (We DO need our water!)
Chloride: Normal 98-107 mEq/L: I picture 10 rows of 10 bottles of bleach, or Chlorox,

making a total of 100 gallon jugs, making a total of 100, which is about the norm for
chloride.
DigOXin: Normal 0.5 - 2 ng/L: I picture half of a pair of oxen up to one pair of oxen pulling
a cart (The ox is from the "ox" in Digoxin).
Iron ranges from 50 to 175 in males & females, so I picture an athlete pumping from 50
pounds to 175 pounds of iron weights
I haven't thought of a good way to remember lithium, but the low range is the same as for
digoxin.
Magnesium: 1.6 to 2.6 mg/dL (Think magnesium1.6 2.6 si in magnesium stands for
six)
Phosphorus: Normal value: 2.7 to 4.5 mg/dL (little higher than magnesium)
Serum AMylase: Normal = 25 - 151 units/L (remember 25-150 yards of AMber lace)
Serum creatinine: 0.6 1.3 mg/dL (A specific indicator of renal function). (Think
creatinine1.6, higher level about double the lower normal level)
Serum Lipase: 10 -140 units/L (Lipase LIES all over the place from 10 to 140)
Serum potassium: 3.5 5.1 (major intracellular cation) (higher than magnesium &
phosphorus)
Serum protein: 6-8 g/dL (think of 6-8 protein bars = enough for just over or under a
weeks supply)
The following medications have normals values of 10-20.
Dilantin
Theophylline
Acetaminophen
Phenytoin
Chloramphenicol
Hope this helps some of you who are visual learners! Blood transfusions should not exceed 4
hours.
2. with infections the prodromal stage is the onset of the first symptoms and the Most contagious.
3. With Chronic Renal Failure diet is high in Carbohydrates.
4. with Cholecystitis pain starts in RUQ and radiates to right shoulder and scapula.
5.The 3 signs of pregnancy induced hypertension(PIH) 1. Edema above waiste. Proteinuria. BP

increase of 3ommhg systolic and 15 mmhg diastolic above the basline BP..
ok hope these are helpful!!
Otoscopic examination in a client with mastoiditis reveals a red, dull,

thick, and immobile tympanic membrane, with or without
perforation
Activities that increase intrathoracic and intraabdominal
pressures cause an indirect elevation of the intracranial pressure
Polyuria occurs early in chronic renal failure and, if untreated, can
cause severe dehydration.
Clients on potassium-wasting diuretics are at high risk for
hypokalemia.
The most common initial symptom in pulmonary embolism is
chest pain that is sudden in onset.
The principle manifestations of Crohns disease are diarrhea and
abdominal pain.
A hypoglycemic reaction may occur in response to increased
exercise. Patients should avoid exercise during the peak hours of
insulin.
A side effect specific to vincristine is peripheral neuropathy, which
occurs in almost every client
Special Considerations
Infants
Greatest risk for fluid and electrolyte imbalance
Hypothermia and infections
Approach them in non-threatening manner
Toddler
Increased separation anxiety
Briefly prepare them for procedures due to short attention span
Describe sensation that they may feel during procedure
Preschooler
Fear of physical harm
Believe that illnesses is a form of punishment
Explanations must be brief, honest and in natural terms
Use demonstrations and play in providing health teaching
Can use adult seatbelt if 40lbs or 40 inches tall, also if he could look at the window in sitting position
School Age
Realistic understanding of death = 9 -10
Needs more detailed teachings
Allow them to make some choices
Adolescence
Developed abstract thinking and ability to problem solve
Logic and reasoning
Full and honest explanation
Primary concern are with the present time
Focus on appearance
Elderly
Nutrition is a primary concern
Muscle atrophy
Dec body water, BMR
Dec renal, CV, GIT function
Dec taste, smell, visual acuity (cataract, arcuc senilis = fatty deposits around pupil_)
With multiple medications due to chronic diseases
More legalese
Nurse practice act: Authority is given to state boards of nursing to define the practice of nursing
within broad parameters that are specified by the legislature, mandate the requisite preparation
for the practice of nursing & discipline members of the profession who deviate from the rules
governing the practice of nursing.
Malpractice refers to a professional's wrongful conduct while performing his/her professional

duties or failure to meet standards of care for the profession, which results in harm (physical,
emotional or financial) to an individual entrusted to the professional's care. Example: Not giving
medications properly
(Liability has to be proven)
Negligence is failure to provide care that a reasonable person would ordinarily provide in a similar
situation.
Assault: Threat to touch another in an offensive manner without having that person's permission.
Battery: Actual touching of a person without that person's consent.
Libel is something that was said
Slander is something that is written
G = patient's stated pain goal

L = location
A = aggravating factors
D = duration of pain
A = alleviating factors
I = intensity on a scale from 0 - 10
D = description of pain per the patient
The patient will be Glad for some Aid in pain relief!
Another diagnosis
Cretenism
Patho: Congenital condition due to thyroid hormone deficiency due to defective physical
development or mental retardation. Appears at 3-6 months of age in bottle-fed babies. Delayed in
breast-fed infants.
Symptoms: Large puffy eyes, thick protruding tongue, dry skin, lack of coordination
If left untreated, permanently dwarfed, could be extremely mentally retarded, sterile
Pericarditis position in leaning forward while sitting
Jaundice in neonate blanch tip of nose or area above umbilicus
Dehydration in adult assess by skin turgor on the sternum
Early s/s of aspirin toxicity rapid deep breathing
Jaundice in dark skinned sclera
Cyanosis in dark skinned nail beds, palms, soles
Skin turgor in adult below clavicle, or on abdomen
Skin turgor in children fleshy part of legs, arms
Nail clubbing - angle of the nail beds should form a diamond when the nail beds
are approximated
hypoglossal nerve - tested by the client sticking out his tongue
glossopharyngeal nerve - tested by taste, gag reflex, and giving the client a
drink and asking him to swallow.
Phalen's maneuver - used to detect carpal tunnel syndrome

Hemoglobin S - specific for sickle cell disease
physical dependence occurs with opiod use
Clients with inflammatory bowel disease - more susceptible to having a

complication of toxic megacolon or paralytic ileus from morphine.
Opiod antagonist Narcan (naloxone)
Pheochromocytoma - catecholamine-producing tumor that arises from the cells of

the adrenal medulla and sympathetic ganglia; causes increased blood pressure by
releasing excessive amounts of norepinephrine; therefore this client would have the
highest priority for blood pressure readings.
Cushing's Triad = Late signs of Increased ICP
I - rregular RR
C ardiac Rate Decreases
P ulse pressure widens.
* Tip, Notice that 1 is irregular, 1 is increased and 1 is decreased.
Cardiac Rate of peds (the only thing you have to remember is 311 and fetal cardiac rate of 120-160)
From that baseline rate; SUbtract 30-10-10 311
-30 = 90-130 Infant
-10 = 80-120 Toddler
-10 = 70-110 PreSchool.
*The lower limits of these are when you will hold the dose of Digoxin
Foods rich in Folic Acid:

F ish
O rgan Meats, Oranges
L eafy green vegetables.
Foods rich in potassium are very colorful, therefore remember the Colors of the Rainbow, ROYGBIV
Red - Strawberries, Tomatoes NOT APPLE

Orange - Orange
Yellow - Banana
Green - Avocados, Green Veggies
Blue - (there arent really lots of blue foods out there, so remember the fish that came from the blue
sea)
Indigo and Violet (not much foods of these colors either but remember RAISINS)
Disequilibrium Syndrome:
(complication of hemodialysis)
s/s:
nausea
vomiting
headache
hypertension
restlessness and agitation
confusion
seizures
notify Doc
reduce environmental stimuli
dialyze pt for a shorter period at reduced blood flow rates to
prevent occurrence

Biological warfare agent:
Botulism- serious paralytic illness caused by clostridium botulinum (death can

occur within 24 hours).
-spread thru air or food (improper food canning) or via a contaminated wound.
-CAN'T spread person to person
-s/s abd. cramps, diarrhea, n/v, double vision, blurred vision, drooping eyelids, hard time swallowing
or speaking, dry mouth and muscle weakness.
-if dx is early, food- borne and wound borne can be trx with an antitoxin that blocks the action of the
toxin circulating in the blood.
-other trx= induce vomitting, enemas, penicillin
-no vaccine avail.
Anyoone up for random FACT THROWING??

Cardiovascular Disorders
* The cardiovascular comprises the heart and the blood vessels and is responsible for the transport of
oxygen and nutrients to organ systems of the body.
Managing the Client with Hypertension
* Calcium channel blockers are more effective for the elderly and African American because they
provide a better control blood pressure without many of the side effects associated with other
categories of drug.
Management of a Client with Myocardial Infarction
* Anticoagulants such as heparin are used to decrease the potential for clothing. The nurse should
check the partial thromboplastin time (PTT). The therapeutic bleeding time should be from one and a
half to two times the control. The medication should be injected in the abdomen 2 from the umbilicus
using a tuberculin syringe. Do not aspirate or massage. The antidote for heparin derivatives is
protamine sulfate. Anticoagulants should be stopped at least 24 hours prior to surgery and are usually
restarted 12-24 hours following surgery.
* If Coumadin (sodium warfarin ) is ordered, the nurse should check or prothrombin time (PT). The
control level for a prothrombin time is 10-12 seconds. The therapeutic level for Coumadin should be
from one and a half to two times the control. The antidote for Coumadin is Vitamin K. The
international normalizing ration (INR) is done for oral anticoagulants. The therapeutic range is 2-3. If
the level exceeds 7, watch for spontaneous bleeding.
Echocardiography
* The gag reflex is stimulated by placing a tongue blade on the back of the throat. Absence of the gag
reflex increases the chances of aspirating liquids.
Endocrine Disorders
Diabetes Mellitus
* Regular insulin is the only insulin that can be administered intravenously
Genitourinary Disorders
Cystitis
* Although the client with interstitial cystitis experiences the same symptoms of cystitis as the client
with other forms, the uterine is negative for bacteria.
Back to Top...
Integumentary Disorders
* Remember the alphabet ABCD- to remember the adverse changes in skin lesions that need to be
reported: asymmetry, border, color and diameter
Sensory Disorders
Intraocular Disorders
* The normal intraocular pressure ranges from 10-21mm Hg.
Disorder of the Ears
* Hearing loss of 50 decibels affects the clients ability to distinguish parts of speech. Presbycusis
affects the ability to hear high-frequency, soft consonant sounds (t,s, th, ch, sh, b,f, and pa)
Gastrointestinal Disorders
Peptic Ulcer Disease
* Administer NSAIDs with food, milk or antacids to reduce the likelihood of GI upset
Treatment of Ulcer
* Aciphex and Protonex are enteric-coated and cannot be crushed for administration
Inflammatory Bowel Disorders
* Clients learn to control crampy abdominal pain (which usually occurs with food intake) associated
with Chrons disease by not eating.
Management of the Client with Diverticulitis

* A low-fiber diet is recommended during the acute stage of diverticulitis.
* Morphine is contraindicated due to the increase in intraluminal pressure caused by this drug.
Appendicitis
* Rebounded tenderness can occur upon release of pressure in the epigastric or periumbilical area and
indicates peritoneal inflammation.
* A positive Rovsings sign can also occur. This happens when the client experiences pain on the right
lower quadrant of the abdomen when the examiner palpates the left lower quadrant.
Intestinal Obstruction
* Pain medications might be withheld initially to determine the clients problem.
GERD
* Due to the surgical procedures, the stomach size is smaller and cannot accommodate large meals.
Caffeine and alcohol might need to be restricted or eliminated from the diet.
Disease of the Liver
* Remember that hepatitis A has no long term effects and is not chronic
* Symptoms of hepatitis C are similar to those of hepatitis B. Some say the symptoms are mild and
variable. The reason so many people are predicted to have hepatitis C is because of the lack of
symptoms and vagueness. Consequently, those infected often do not seek assistance. A great deal of
people with hepatitis C are carriers of the disease but do not know they have it.
Treatment of Hepatitis
* Not all hepatitis are reported. Hepatitis A is widespread with approximately 250,000 occurring in the
US annually. Hepatitis C causes much concern because it can lead to cirrhosis and liver cancer. Due to
the increased number of clients with hepatitis C, the most common type of hepatitis in the US, the
need for liver transplants is increasing, as is the number of deaths from liver disease.
Treatment of Cirrhosis
* If the client has advanced liver disease or portal-systemic encephalopathy (PSE), protein sources are
restricted due to the livers inability to convert protein to urea for excretion.
Acute Pancreatitis
* Cullens sign is recognized as periumbilical bluish discoloration of the skin. When the ecchymosis is
noted on the flank area it called Turners sign. These signs may indicate intraperitoneal hemorrhage.
Diagnosis of Pancreatitis
* Amylase levels elevate in 12-24 hours after inflammation and stay elevated for 3-4 days. Lipase
levels are more specific for pancreatitis and remain elevated for up to 2 weeks.
* Hypocalcemia and hypomagnesia indicate that fat necrosis has occurred.
Cholecystitis
* An easy way to remember who usually develops gallstones is to remember these four Fs of
gallbladder disease:
o Female (sex)
o Forty (normal age)
o Fat (usually obese)
o Fertile (usually have children)
Treatment of Cholecystitis
* Morphine is not given for pain because it can cause spasms of the sphincter of Oddi.
* Clients with colostomies will have formed stool because the water is absorbed in the colon, whereas,
ileostomy clients have liquid stools because the water has not been absorbed in this area.
Hematological Disorders
* The hematologic system consists of blood, blood cells, and blood forming organs. Because circulation
of blood provides oxygen and nutrients to all body systems, a functioning hematological system is
essential to health and well being. A disorder in the system might result from a lack of function, a
reduction in production or an increase in the destruction of blood cells.
Sikle Cell Anemia
* The vaso-occlusive crisis is the primary crisis type that causes the client to have pain.
Iron Deficiency Anemia
* Intramuscular iron (Imferon) is given through the IM Z track method.
Polycythemia Vera
* This disorder is characterized by thicker than normal blood. There is an increase in the clients
hemoglobin to levels of 18 g/dL, RBC of 6 million/mm or hematocrit at 55% or greater and increased
platelets)
Transfusion Therapy
* If a client is receiving blood components, assess the chart for a physician order, identify the patient
by armband numbers, blood bag label, attached tag, requisition slip, and blood expiration date. Each
identification should be checked by two registered nurses with documented signatures of the
assessment by both.
Neurological Disorders
* Remember the mnemonic APQRST to trigger recall of all import points to access whenever the client
has an acute onset symptom
o A any associated symptoms with chief compliant
o P what provokes (makes worse) or palliates (makes better) symptoms
o Q- quality of pain
o R region and radiation
o S- severity of pain on a scale of 1 to 10
o T- timing: when it stops and starts, whether it is intermittent or constant its duration
* Recall that the words Kernigs and knee both begin with K while Brudzinkis and brain both begin
with B. This will aid in recalling how to conduct each test.
Neoplastic Disorders
* Remember to use CAUTION to recall risk factors for cancer

* American Cancer Societys Seven Warning Signs of Cancer
o Changes in a wart or mole
o A sore that does not heal
o Changes in bowel or bladder habits
o A new lump or the thickening of an existing lump
o A persistent cough
o Indigestion or difficulty in swallowing
o Unusual bleeding or discharge
The Four Major Categories of Cancer
* The different types of cancers are classified according to the tissue from which they originate. The
following list identifies the major cancer groups:
o Carcinoma cancer arising from epithelial tissue (for example, basal cell carcinoma)
o Sarcoma cancer arising from connective tissue, muscle or bone (for example, osteosarcoma)
o Lymphoma cancer arising from lymphoid tissue (for example, Burkitts lymphoma)
o Leukemia cancer of the blood-forming cells in the bone marrow (for example, acute lymphocytic
leukemia
Risk Factors for Specific Cancers
o Bladder- Risk factors include smoking and environmental carcinogens such as dyes, paint, rubber,
ink and leather
o Breast Risk factors include a family history in first-degree relatives, the birth of the first child after
age 30, abnormality in genes BRCA-1 and BRCA-2, menarche before age 12 and menopause after age
55, obesity, the use of birth control pills and hormonal replacement, alcohol intake, and a diet high in
fat.
o Cervical Risk factors include early sexual activity, early childbearing, multiple partners, human
papillomavirus (HPV) or human immunodeficiency virus (HIV) infection, smoking, using of DES by the
mother during pregnancy and chronic cervical infections.
Risk Factors for Specific Cancers
* The FDA has licensed a vaccine (Gardasil) for use in girls/women ages 9-26 that protects against
four HPV types responsible for 70% of all cervical cancers and 90% of genital warts. Three shots are
administered over a six-month period.
* Cancer of the colon is the second most common form of cancer in the United States.
Breast Cancer
* The TNM classification system is commonly used cancer staging system that allows description of
the severity of the cancer based on the T (description of the extent of the tumor), N (the spread to
lymph nodes) and M (the spread beyond the area to the other parts of the body).
* It is normal for the patient to have post-surgical transient edema. This is not lymphedema.
Radiation
* While the implant is in place, the client emits radiation but the clients body fluids are not radioactive
Total Parenteral Nutrition
* A central line is required for TPN administration

* If the TPN is not immediately available and the infusion is empty, the nurse should give D10W until
the solution is obtained
Musculoskeletal Disorders
* Use the phrase good leg up; bad leg down to help remember which leg to place first when going
up and down stairs with crutches
* Use the 5 Ps to remember the neurovascular assessment findings; pain, pallor, paresthesia,
pulselessness (or decreased pulses) and paralysis
* Use RICE for musculoskeletal injuries (rest, ice, compression, and elevation)
Maternal and Neonatal Client
* Remember to protect the head during the precipitous birth. Apply enough pressure to guide the
descent and prevent rapid intracranial pressure changes within the infants molded skull
* Remember that the umbilical cord could choke the fetus and is dangerous. If during delivery the
umbilical cord cant be loosened and slipped away from the infants neck, two clamps should be
applied to the cord and the cord should be cut between the clamps.
Burns
The Consensus Formula
* Enteral feedings help meet the clients increased caloric needs and maintains the integrity of the
intestinal mucosa, thereby minimizing systemic sepsis.
The Intermediate Phase
* The normal central venous pressure (CVP) is 4-12 mm H20. Increased CVP indicates fluid volume
overload; decreased CVP indicates fluid volume deficit.
Immunological Disorders
* Human Immunodeficiency Virus (HIV) leads to depletion of the CD4 +T4 helper cells. This depletion
causes an inability to fight off opportunistic infections. Infected CD4 + (T4) helper cells are targeted
by Human Immunodeficiency Virus CD8+ killer cells. Acquired immune deficiency syndrome (AIDS) is
caused by the HIV virus. AIDS was first identified in the 1980s, and is believed to derive from
infections found in the green monkey of Africa. It is thought that some reason the virus mutated and
became a virus that affects human beings. There are 2 types of HIV:
o Type 1 (HIV-1) found in Western Europe and Asia
o Type 2 (HIV-2) found in West Africa
* HIV results in an abnormal cell that cannot fight infection. That abnormal cell duplicates producing
more of the virus. The result is a decrease in the helper cells and an increase in the suppressor cells.
HIV Prevention
* Body fluids likely to transmit blood-borne disease include blood, semen and vaginal/cervical
secretions, tissues, cerebral spinal fluid, amniotic fluid, synovial fluid, pleural fluid, peritoneal fluid,
pericardial fluid, and breast milk.
* Body fluids not likely to transmit blood-borne disease unless blood is visible include feces, nasal
secretions, sputum, vomitus, sweat, tears, urine, and saliva (with the exception of during oral surgery
or dentistry)
Legal and Ethical Nursing Practices

Managing Client Care
* Nursing Practice Acts varies from state to state. The nurse is responsible for knowing the laws in
which he/she will practice. It is the responsibility of the nurse to contact the board of nursing to obtain
a copy of the Nursing Practice Act. The state board of nursing has been authorized to take action
against a nurse found guilty of failure to comply with rules and regulations set forth by the law. These
examples are not a comprehensive list of all the skills registered nurses/licensed practical nurse can
do.
Psychiatric Disorders
Dissociative Identity Disorder
* The following films offer good depictions of dissociative identity disorder: the Three Faces of Eve,
Sybil, and Identity.
Obsessive Compulsive Disorder
* The main character in the movie As Good As It Gets is an excellent example of the client with OCD
Schizophrenia
* This disorder is most often diagnosed in late adolescence or early adulthood, although symptoms
might have been present at a much earlier age. The disorder equally affects both males and females;
however, males seem to have an earlier onset of symptoms. Theories offered regarding the cause of
schizophrenia include genetics, environmental factors, and biological alterations in the
neurotransmitters serotonin and dopamine.
* Clients with schizophrenia are best known for their odd appearance and behavior, which sometimes
summarized by the 4 A's. The 4 A's include
o AffectDescribed as flat, blunted, or inappropriate
o AutismPreoccupation with self and a retreat into fantasy
o AssociationLoosely joined unrelated topics
o Ambivalence Having simultaneous opposing feelings
Memory Support
* It is best to avoid challenging activities that can confuse and overwhelm the client.
* The mainstay in the management of the client with schizophrenia is medication.
* Unlike the EPSE of akathisia, akinesia and dystentonias, tardive dyskinesia is not caused by a
dopamine
Anxiety
* Anxiety-related disorders are sometimes referred to as neurotic disorders and include the following
categories:
o Generalized anxiety disorder
o Post-traumatic stress disorder
o Dissociative identity disorder
o Somatoform disorder
o Panic disorder
o Phobic disorder
o Obsessive-compulsive disorder
* Anxiety disorders are characterized by feelings of fear and apprehension accompanied by a sense of
powerlessness. Anxiety-related disorders are listed on Axis I of the DSM-IV-TR.
Substance Abuse
* When a client has a problem with substance abuse or addiction, carefully screen for other mental
health disorders as well which may be comorbidities
* Use the initials of the CAGE questionnaire to trigger the memory of what each question refers to
* It is just as important to screen for psychosocial data as for physical assessment data during
admission for treatment for addiction
* Development of an emergency plan is high priority before discharge to home so that the client is
better empowered to act on own behalf when the urge to abuse occurs Thank you everyone for all
of your valuable information, it has been wonderful!! We graduated in Aug. and I will be
taking my NCLEX-RN on October 6th!
Here are a couple of ways I remember things
* To increase Venous blood flow legs up- act like the lines from the V are legs they are
going up.
* To increase blood flow to the Arteries- legs down- act like the long lines from the A are
the legs pointing down
* Never Let Monkeys Eat Bananas

Neutrophils 50-60%.
Lymphocytes 20-40%.
Monocytes 2-6%.
Eosinophils 1-4%.
Basophils 0.5-1%
OR
Never let people between 50-70 have kids

Let people between 20-40 have kids
Kids act like Monkeys between 2-6
Kids learn to Eat well between 1-4
We usually eat .5-1 Banana
Na Salt is expensive now a days, it costs 135-148 per kilo. (135-148

mEq/L)
K A bananas cost 3.50 to 5.50 a bunch (3.5-5.5 mEq/L)
Chloride Since Chloride regulates BP, here it goes

Chloride said his BP is 108/98. (98-108 mEq/L)
HCO3 (bicarbonate) Bicarbonate said ten years ago he was 22 now how
old is he? 32. (22-32 mEq/L)
Ca My bones started to become strong when I was about 8-10 years old.
(8.5-10.3 mEq/L)
Mg Magnesium is always exercising his muscles every 1 1/2 2 hours.

(1.4-2
I found lots of Nclex information from Skatebetty, so all of this is her work and all credit goes to her. I just
happened to be skimming the NCLEX forum pages going back to 2006 and found these tips from her. So I am posting
them here for us to study from. All of the credit goes to her, it is all her work. Thanks Skatebetty!!!
Agnosia - I don't know what it is (when an object is placed in hand)
Apraxia - My practiced skills are lost (can't carry out a purposeful activity)
Procainamide - For dysrhythmias unresponsive to Lidocaine
Ridaura - Gold, for arthritis (think shiny, aura)
Tessalon - Anti-tussive (sounds like tuss)
Cognex - for Alzheimer's (sounds like cognition)
Calcium Carbonate has the most calcium of oral types

Neupogen - sounds like "generates neutrophils"
Epogen - sounds like "erythropoetein generator"
Flomax - Improves urinary flow with BPH (urine flows)
Dimetane - An antihistimine (Dimetapp)
Which anti-coagulant is safe in pregnancy? Heparin is! It does not cross the placenta, so when it is
ordered, give it, and when you do it is sub-q.
What is a t-tube? I'd never heard of one. It drains bile from the bile duct after gallbladder sx, and
there could be a lot of drainage, up to 400 cc's/day. It should be bloody initially, and then green.
Count it as output.
Why does skin temperature drop when someone is experiencing acute pain? Because they are
sweating (diaphoretic).
What's a ureteral catheter? It may be placed to drain urine from the ureter along with a foley.
The foley gets d/c'd first, the ureteral one can be clamped so your patient can pee normally, and then
you unclamp it to see how much residual there is! Once there is no residual it is also d/c'd. Who knew?
What if you find your TURP patient in a wet bed? The catheter is either too small, or the patient is
having bladder spasms, causing leakage.
What's given for alcohol withdrawl? Librium. Narcotic withdrawl? Methadone. Narcotic
withdrawl with respiratory depression? There you go...Narcan.
Who get's c-diff? Hospitalized patients, that's who. Almost half of your patients who get diarrhea in
the hospital have c-diff, and got it from somebody who works there.
You've run out of tube feeding. Which solution is most like TPN while you're waiting for the
pharmacy? D10W.
What is the solution of choice for volume replacement in the ER? Lactated Ringers.
How does acute renal failure differ in s/s from chronic? With acute there is an oliguric phase when
the kidney is really sick, followed by a diuretic phase when the kidney is starting to get better and
urine starts to flow again. With chronic, the kidney slowly deteriorates, and output decreases.
With portal hypertension or cirrhosis think bleeder because of esophageal varices, and also
reduced or no clotting factors being produced by the sick liver. While were talking about the liver,
remember it is highly vascular, which means when it is injured by trauma, or even a needle biopsy it
will bleed right out. Position a patient on the right side after a liver biopsy to help splint the injury.
For everybody wanting to Maslow nutrition ahead of safety with a depressed client, just toss your
pyramid right out the window, and choose safety first. Suicide precautions.
While were talking about priorities dont think you must always choose an assessment over an
intervention if both are options. Use your instincts and your logic! If the options are listed to suction
copious secretions" or "monitor O2sat" you better get the secretions out, especially if the stem says
youve assessed the patient already and what is the next nursing action.
Dont push all those dangerous objects out of the way first when your kid is on the floor seizing. Turn
him on his side. Airway first, then remove hazardous objects.
Prolonged hypoxia in kids, like with tetralogy of fallot, does bad stuff. For starters the body tries to
compensate for low O2 by pushing out more immature rbcs, which hypercoagulates the blood
increasing the kids risk of seizures and CVAs. The kid is also at risk for cardiac arrest and
respiratory failure. Remember, nothings getting oxygen.
Dont you schedule frequent rest periods for that kid newly diagnosed with CF. He needs exercise,
which is a good adjunct to the chest physiotherapy in keeping his lungs clear. Now if your CF kid is
exercising with a sickle cell kid, make sure that one doesnt get over-heated. Dehydration triggers
sc crisis. Keep his fluids up. No demerol with sickle cell either.
Steroids complicate things while they're reducing inflammation. They increase the risk for
osteoporosis, increase glucose, and delay wound healing. They also cause weight gain (have
yall seen Tonya Harding lately? She says its the prednisone) and increase the risk of infection.
Watch sore throats and fevers for pts. on steroids.
Ever touched a colostomy bag? Me either. Just know to remove flatus by opening the bottom of the
bag, and to empty it when it is approximately 1/3 to full.
These are 3 days of her tips...she has tips for another 4-5 days, so I will copy and paste them in the next few
posts. Happy studying! I test this month! Yikes!!!!
What is an intraosseous infusion? In pediatric life-threatening emergencies, when iv access cannot
be obtained, an osseous (bone) needle is hand-drilled into a bone (usually the tibia), where
crystalloids, colloids, blood products and drugs can be administered into the marrow. It is a
temporary, life-saving measure, and I have seen it once! (Gruesome.) When venous access is
achieved it can be d/cd. One medication that cannot be administered by intraosseous infusion is
isoproterenol, a beta agonist. (I dont know more about that drug; it was just pointed out on a
practice exam.)
During sickle cell crisis there are two interventions to prioritize: fluids and pain relief.
With glomerulonephritis you should consider blood pressure to be your most important
assessment parameter. Dietary restrictions you can expect include fluids, protein, sodium, and
potassium.
Remember yesterday when I mentioned how congenital cardiac defects result in hypoxia which the
body attempts to compensate for (influx of immature rbcs)? Labs supporting this would show
increased hematocrit, hemoglobin, and rbc count.
Did you know there is an association between low-set ears and renal anomalies? Now you know
what to look for if downs isnt there to choose. (just to expand on it a little, the kidneys and ears
develop around the same time in utero. Hence, they're shaped similarly. Which is why when doing an
assessment of a neonate, if the nurse notices low set or asymmetrical ears, there is good reason to
investigate renal functioning. Knowing that the kidneys and ears are similar shapes helped me
remember this).
School-age kids (5 and up) are old enough, and should have an explanation of what will happen a
week before surgery such as tonsillectomy.
If you gave a toddler a choice about taking medicine and he says no, you should leave the room and
come back in five minutes, because to a toddler it is another episode. Next time, dont ask.
The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile
vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, and may spit
up after feedings.
We know Kawasaki disease causes a heart problem, but what specifically? Coronary artery
aneurysms d/t the inflammation of blood vessels.
A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is
where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles.
You should watch for abdominal distention, since fluid from the ventricles will be re-directed to the
peritoneum. You should also watch for signs of increasing intracranial pressure, such as irritability,
bulging fontanels, and high-pitched cry in an infant. In a toddler watch lack of appetite and headache.
Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesnt
reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees.
What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration.

Mechanical ventilation can cause it. Premature newborns with immature lungs are ventilated and
over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that
cause inflammation or scarring.
It is essential to maintain nasal patency with children < 1 yr. because they are obligatory nasal
breathers.
Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good,
right?) Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia
with milk-aholics. And dont let that mother put anything but water in that kids bottle during
naps/over-night. Juice or milk will rott that kids teeth right out of his head.
What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage?
Ninety, ninety. Huh? I never heard of it either. The name refers to the angles of the joints. A pin is
placed in the distal part of the broken bone, and the lower extremity is in a boot cast. The rest is the
normal pulleys and ropes youre used to visualizing with balanced suspension. While were talking
about traction, a kids hinder should clear the bed when in Bryants traction (also used for femurs
and congenial hip for young kids).
If you can remove the white patches from the mouth of a baby it is just formula. If you cant, its
candidiasis.
Just know the MMR and Varicella immunizations come later (15 months).
Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start
teaching boys testicular self exam around 12, because most cases occur during adolescence.
Not pediatrics but have to throw it in A guy loses his house in a fire. Priority is using community
resources to find shelter, before assisting with feelings about the tremendous loss. (Maslow).
No aspirin with kids b/c it is associated with Reyes Syndrome, and also no nsaids such as ibuprofen.
Give Tylenol.
CSF in meningitis will have high protein, and low glucose.
It is always the correct answer to report suspected cases of child abuse.
No nasotracheal suctioning with head injury or skull fracture.
Feed upright to avoid otitis media.
Position prone w hob elevated with gerd. In almost every other case, though, you better lay that kid
on his back (Back To Sleep - SIDS).
Pull pinna down and back for kids < 3 yrs. when instilling eardrops.
Kids with RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being
administered by hoot, tent, etc.
Positioning with pneumonia lay on the affected side to splint and reduce pain. But if you are
trying to reduce congestion the sick lung goes up. (Ever had a stuffy nose, and you lay with the stuff
side up and it clears?)
A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease.
Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer
stops wheezing. It could mean he is worsening.
You better pick do vitals before administering that dig. (apical pulse for one full minute).
Tet spells treated with morphine.
Group-a strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body
movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated
antistreptolysin O to be elevated. Penicillin!
Dont pick cough over tachycardia for signs of chf in an infant.
Random Tips:
No milk (as well as fresh fruit or veggies) on neutropenic precautions.
Tylenol poisoning liver failure possible for about 4 days. Close observation required during this
time-frame, as well as tx with Mucomyst.
Radioactive iodine The key word here is flush. Flush substance out of body w/3-4 liters/day for 2
days, and flush the toilet twice after using for 2 days. Limit contact w/patient to 30 minutes/day. No
pregnant visitors/nurses, and no kids.
The main hypersensitivity reaction seen with antiplatelet drugs is bronchospasm (anaphylaxis).
Common sites for metastasis include the liver, brain, lung, bone, and lymph.
Orthostasis is verified by a drop in pressure with increasing heart rate.
Bence Jones protein in the urine confirms multiple myeloma.
Dont fall for reestablishing a normal bowel pattern as a priority with small bowel obstruction.
Because the patient cant take in oral fluids maintaining fluid balance comes first.
Pernicious anemia s/s include pallor, tachycardia, and sore red tongue.
With flecainide (Tambocor), an antiarrythmic, limit fluids and sodium intake, because sodium
increases water retention which could lead to heart failure.
Basophils release histamine during an allergic response.
Adenosine is the treatment of choice for paroxysmal atrial tachycardia.
Iatragenic means it was caused by treatment, procedure, or medication.
Other than initially to test tolerance, G-tube and J-tube feedings are usually given as continuous
feedings.
Four side-rails up can be considered a form of restraint. Even in LTC facility when a client is a fall
risk, keep lower rails down, and one side of bed against the wall, lowest position, wheels locked.
Your cancer patient is getting radiation. What should you be most concerned about? Skin irritation?
No. Infection kills cancer patients most because of the leukopenia caused by radiation.
A breast cancer patient treated with Tamoxifen should report changes in visual acuity, because the
adverse effect could be irreversible.
Pneumovax 23 gets administered post splenectomy to prevent pneumococcal sepsis.
Lets say every answer in front of you is an abnormal value. If potassium is there you can bet it is a
problem they want you to identify, because values outside of normal can be life threatening. Normal
potassium is 3.5-5.0. Even a bun of 50 doesnt override a potassium of 3.0 in a renal patient in
priority.
You better be making sure that patient on Dig and Lasix is getting enough potassium, because low
potassium potentiates Dig and can cause dysrrhythmias.
You will ask every new admission if he has an advance directive, and if not you will explain it, and
he will have the option to sign or not.
An example of when you would implement before going through a bunch of assessments is when
someone is experiencing anaphylaxis. Get the ordered epinephrine in them stat, especially if they
stem clearly states the s/s (difficulty breathing, increasing anxiety, etc.)
In a disaster you should triage the person who is most likely to not survive last.
A little trick regarding potassium:

ALKALOSIS: K is LOW
Acidosis is just the opposite: K is High
The vital sign you should check first with high potassium is pulse (due to dysrhythmias).
Give neostigmine to clients with Myesthenia Gravis about 45 min. before eating, so it will help with
chewing and swallowing.
Anectine is used for short-term neuromuscular blocking agent for procedures like intubation and
ECT. Norcuron is for intermediate or long-term.
The parathyroid gland relies on the presence of vitamin D to work.
Glucagon increases the effects of oral anticoagulants.
Bleeding is part of the circulation assessment of the ABCDs in an emergent situation. Therefore, if
airway and breathing are accounted for, a compound fracture requires assessment before Glasgow
coma scale and a neuro check (D=disability, or neuro check)
The immediate intervention after a sucking stab wound is to dress the wound and tape it on three
sides which allows air to escape. Do not use an occlusive dressing, which could convert the wound
from open pneumo to closed one, and a tension pneumothorax is worse situation. After that get your
chest tube tray, labs, iv.
An occlusive dressing is used if a chest tube is accidentally pulled out of the patient.
When o2 deprived, as with a PE, the body compensates by causing hyperventilation (resp alkalosis).
Should the patient breathe into a paper bag? No. If the pao2 is well below 80 they need oxygen. Look
at all your abg values. As soon as you see the words PE you should think oxygen first.
A typical adverse reaction to oral hypoglycemics is rash, photosensitivity.
Serum acetone and serum ketones rise in DKA. As you treat the acidosis and dehydration expect
the potassium to drop rapidly, so be ready, with potassium replacement.
Fluids are the most important intervention with HHNS as well as DKA, so get fluids going first. With
HHNS there is no ketosis, and no acidosis. Potassium is low in HHNS (d/t diuresis).
Atropine blocks acetylcholine (remember it reduces secretions).

Decorticate positioning in response to pain = Cortex involvement. Decerebrate in response to pain
= Cerebellar, brain stem involvement
Dantrium, for spasticity, may take a week or more to be effective.
Decreased acetylcholine is related to senile dementia.
Hyperactive deep tendon reflexes, vision changes, fatigue and spasticity are all symptoms of MS
After removal of the pituitary gland you must watch for hypocortisolism and temporary diabetes
insipidus.
Position on right side with legs flexed after appendectomy.
Hirschsprungs diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign
in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.
Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like
stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping.
Resolution is obvious, with onset of bowel movements.
With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline
dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.
After a hydrocele repair provide ice bags and scrotal support.
No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).
Second voided urine most accurate when testing for ketones and glucose.
Never give potassium if the patient is oliguric or anuric.
Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by
glomerular damage. Corticosteroids are the mainstay. Generalized edema common.
A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the
mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The
p24 can be used at any age.
For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza.
MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care,
not kiss kids on the mouth, and not share eating utensils.
Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.
An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the

aspirate is <5.0. Aspirate should be checked at least every 12 hrs.
Ambient air (room air) contains 21% oxygen.
The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger,
cyanosis.
Normal PCWP (pulm capillary wedge pressure) is 8-13. Readings of 18-20 are considered high.
First sign of PE is sudden chest pain, followed by dyspnea and tachypnea.
High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing
potassium out). Carbon dioxide narcosis causes increased intracranial pressure.
Pulmonary sarcoidosis leads to right sided heart failure.
An NG tube can be irrigated with cola, and should be taught to family when a client is going home
with an NG tube.
Happy Studying! I test soon.....yikes!!! Question is....am I ready to test or not to test?
Digitalis increases ventricular irritability, and could convert a rhythm to v-fib following
cardioversion.
If your normally lucid patient starts seeing bugs you better check his respiratory status first. The
first sign of hypoxia is restlessness, followed by agitation, and things go downhill from there all the
way to delirium, hallucinations, and coma. So check the o2 stat, and get abgs if possible.
The biggest concern with cold stress and the newborn is respiratory distress.
Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily ascertain it
has something to do with muscle (myo) cancer (sarcoma). The same thing goes for drug names. For
example, if it ends in ide its probably a diuretic, as in Furosemide, and Amyloride.
Lasix can cause a patient to lose his appetite (anorexia) due to reduced potassium.
If your laboring moms water breaks and she is any minus station you better know there is a risk of
prolapsed cord.
In a five-year old breathe once for every 5 compressions doing cpr.
After g-tube placement the stomach contents are drained by gravity for 24 hours before it can be
used for feedings.
Cephalhematoma (caput succinidanium) resolves on its own in a few days. This is the type of
edema that crosses the suture lines.
During the acute stage of Hep-A gown and gloves are required. In the convalescent stage it is no
longer contagious.
Low magnesium and high creatinine signal renal failure.
Pain is usually the highest priority with RA
If a TB patient is unable/unwilling to comply with tx they may need supervision (direct observation).
TB is a public health risk.
Level of consciousness is the most important assessment parameter with status epilepticus.
Crackles suggest pneumonia, which is likely to be accompanied by hypoxia, which would manifest
itself as mental confusion, etc.
Cant cough=ineffective airway clearance
Absence of menstruation leads to osteoporosis in the anorexic.
Toddlers need to express autonomy (independence)
A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding,
such as dark stools.
A laxative is given the night before an IVP in order to better visualize the organs.
A patient with liver cirrhosis and edema may ambulate, then sit with legs elevated to try to
mobilize the edema.
Managing stress in a patient with adrenal insufficiency (Addisons) is paramount, because if the
adrenal glands are stressed further it could result in Addisonian crisis. While were on Addisons,
remember blood pressure is the most important assessment parameter, as it causes severe
hypotension.
After pain relief, cough and deep breathe is important in pancreatitis, because of fluid pushing up
in the diaphragm.
Safety over Nutrition with a severely depressed client.
Prolonged hypoxemia is a likely cause of cardiac arrest in a child.
Fluid volume overload caused by IVC fluids infusing too quickly (or whatever reason) and CHF can
cause an S3
Coarctation of the aorta causes increased blood flow and bounding pulses in the arms
A newly diagnosed hypertension patient should have BP assessed in both arms
Depression often manifests itself in somatic ways, such as psychomotor retardation, gi complaints,
and pain.
Respiratory problems are the chief concern with CF
speaking of TB... PPD is positive if area of induration is:
>5 mm in an immunocompromised patient

>10 mm in a normal patient
>15 mm in a patient who lives in an area where TB is very rare.
another tiP:
HbA1c - test to assess how well blood sugars have been controlled over the past 90-120 days. 4-6
corresponds to a blood sugar of 70-110; 7 is ideal for a diabetic and corresponds to a blood sugar of
130.
BSA is considered the most accurate method for medication dosing with kids. (I though it was
weight, but apparently not)
Place a wheelchair parallel to the bed on the side of weakness
If one nurse discovers another nurse has made a mistake it is always appropriate to speak to her
before going to management. If the situation persists, then take it higher.
Sepsis and anaphylaxis (along with the obvious hemorrhaging) reduce circulating volume by way of
increased capillary permeability, which leads to reduced preload (volume in the left ventricle at the
end of diastole). This is a toughiethink about it.
Amniotic fluid is alkaline, and turns nitrazine paper blue. Urine and normal vaginal discharge are
acidic, and turn it pink.
Gonorrhea is a reportable disease

Remember the phrase step up when picturing a person going up stairs with crutches. The good leg
goes up first, followed by the crutches and the bad leg. The opposite happens going down. The
crutches go first, followed by the good leg.
While treating DKA, bringing the glucose down too far and too fast can result in increased
intracranial pressure d/t water being pulled into the CSF.
Polyuria is common with the hypercalcemia caused by hyperparathyroidism.
Remember the action of vasopressin because it sounds like press in, or vasoconstrict.
Water intoxication will be evidenced by drowsiness and altered mental status in a patient with TUR
syndrome, or as an adverse reaction to desmopressin (for diabetes insipidus).
Burning sensation in the mouth, and brassy taste are adverse reactions to Lugol solution (for
hyperthyroid). Report it to the doc.
Give synthroid on an empty stomach
Extra insulin may be needed for a patient taking Prednisone (remember, steroids cause increased
glucose).
Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure
Patients with GERD should lay on their left side with the HOB elevated 30 degrees.
Unusual positional tip - Low-fowlers recommended during meals to prevent dumping syndrome.
Limit fluids while eating.
In emphysema the stimulus to breathe is low PO2, not increased PCO2 like the rest of us, so dont
slam them with oxygen. Encourage pursed-lip breathing which promotes CO2 elimination,
encourage up to 3000mL/day fluids, high-fowlers and leaning forward.
Theophylline causes GI upset, give with food
TB drugs are liver toxic. (Does your patient have hepB?) An adverse reaction is peripheral
neuropathy.
Thats the end of her tips everyone! Happy Studying! I wish everyone taking it soon the very best of luck!
One cause of testicular cancer... undescended testes aka cryptorchidism
Bottlefed neonate's FIRST feed is with sterile water than formula
Multiple Myeloma- condition in which neoplastic plasma cells infiltrate the

bone marrow resulting in osteoporosis, high risk for fractures so we need
to install precautions with position changes
With cardiac tamponade, venous pressure rises and neck veins become
distended
For chest physiotherapy, percussion should only be done in the area of the
rib cage
Evaluation of HTN is a key assessment in the course acute

glomerulonephritis
Post-procedure nursing interventions for electroconvulsive therapy
includes remaining with the client until he/she is oriented and able to
engage in self care because when they awaken they appear groggy and
confused
Best method for assessing BP is in both arms
Recommended age for switiching from formula to whole milk is 12 months

to prevent allergies and lactose intolerance
Chronic, under treated asthma can lead to lung remodeling and

permanent changes in lung function
If a nurse suspects domestic violence as a cause of a client's injuries, the

RN should interview the client without the persons who came with the
client
Wish me luck this week that I pass and can move forward with my career
Delegations
CNAs
-skin care, feeding, toileting, vital signs (not initials), height, weight, IOs, ROM exercises, ambulation,
transporting, grooming, and hygiene meaures of stable clients.
LPNs/LVNs
-physiologically stable clients with predictable outcomes
-dressings, suctionings, urinary catheterization, med administrations (only oral, subcutaneous, and
intramuscular), no rectal or IV meds
RN associated:
-care for individual in a structured health care environment
RN BSN:
-care for individuals, families, groups, and communities in both structured and unstructured health
settings.
RN (all):
-assessment/planning care, initiating teaching, IV meds
RN can not delegate these tasks:

-initial assessments of clients
-evaluation of client data
-nursing judgement
-client/family educatoin/evaluation
-nsg diagnosis
cushing's (HYPERSECRETION OF ADRENAL CORTEX)

Check vital signs esp BP
Urinary output and weight monitoring
Stress management
High chon diet
Infection precaution
Na restriction
Glucose And electrolytes monitoring
Spousal support
ADDISON'S (hyposecretion of adrenal cortex hormone)
6 A's of addison
1. avoid stress
2. avoisd strenous activity
3.avoid individuals with infection
4.avoid otc meds
5.a lifelong glucocorticoids therapy
6.always wear medic alert bracelet
Parents with a child that has sickle cell disease need to be taught that the child needs to AVOID
OVERHEATING during physical activities because fluid loss caused by overheating and dehydration can
trigger a crisis
In developmental dysplasia, it produces a CHARACTERISTIC LIMP in children who are walking
Clients with BPH have overflow incontinence with FREQUENT URINATION in small amounts day and
night
Pneumonia causes a marked increase in interstitial & alveolar fluid, therefore, consolidated lung tissue
transmits BRONCHIAL BREATH SOUNDS to OUTER LUNG FIELDS
During seizure activity, it is a PRIORITY to note, and then record, WHAT MOVEMENTS are seen because
the diagnosis and treatment often rests solely on the seizure description
PERSISTENT COUGHING in a child discharged after a tonsillectomy should BE REPORTED to the primary
care provider because it may indicate BLEEDING ( don't just think frequent swallowing)
Process of dying w/ a client that is Hindu: RN should plan that after death, a Hindu priest will pour
water into the mouth of the client and tie a thread around the client's wrist, family is particular about
who touches the body, cremation preferred, last rites carefully prescribed
Process of dying w/ a client that is Mormon: Cremation discouraged, elders may be w/ the client during
process of dying and no last rites are given
Process of dying w/ a client that is Islamic: family must be w/ client during process of dying and family
must be the only ones to wash the body after death
Process of dying w/ a client that practices Judaism: body is ritually cleansed and burial occurs as soon
as possible after death
RNs should limit visitors with a client that has decreased adrenal function because any exertion,
physical or emotional places additional stress on the adrenal glands, which could bring on an
Addisonian crisis
Client with trigeminal neuralgia, the RN should offer small meals of high calorie soft food to promote
more nourishment and less chewing
Separation anxiety is most evident from 6 months to 30 months of age
Fluorosis, a condition in which teeth have a chalky white to yellowish staining with pitting of enamel d/t
repeated swallowing of toothpaste with fluoride or drinking water with high levels of fluoride
Breast engorgement in newborns occurs in both sexes as a result of withdrawal of maternal hormones
after birth (normal occurence)
Glaucoma and prostatic hypertrophy are contraindications to use Congentin because it is an

anticholinergic drug
Clients taking Thorazine should avoid direct sunglight d/t sensitivity

Scenario- If RN is working for a Poison Control Center and parents say that their child has drunk drain
cleaner (alkaline), the RN would suggest parents to have child drink orange juice (acidic) to neutralize
the substance
Facts for the day...
A child with t-tubes can only swim if he/she wears earplugs, water should
not enter the ears and the child should not put their heads under the
water
Fosomax should be taken 1st thing in the morning with 6-8 oz of PLAIN
water at least 30 min before other foods or meds. Client needs to be
instructed to remain in an upright position for 30 min following the dose
to facilitate passage into the stomach and minimize irritation of the
esophagus
Cyclosporin (Neoral) inhibits normal immune responses. Clients receiving

this are at risk for infection.
INH (isoniazid) can also cause peripheral neuropathy (extremity tingling

and numbness)
Contraindication to cardioversion is digoxin use 24 hrs beforehand
Wellbutrin should be started at 100mg BID for 3 days and then increased
to 150mg BID, if used to treat depression, can take up to 4 weeks to see
results, doses should be administered in equally spaced time increments
throughout the day to minimize risk of seizures
SE of Clozaril is extreme salivation
Elderly clients are at risk for developing confusion when taking Tagament,
a drug that interacts with many other meds
1st step in delegation is to DETERMINE the QUALIFICATIONS of the person

to WHOM ONE IS DELEGATING, so ASK about PRIOR EXPERIENCE w/ similar
clients
Xanax is a short-acting benzodiazepine useful in controlling panic

symptoms quickly, therefore short-term relief can be expected
NSAIDs for arthritic use should be taken 1 hour before or 2 hours after
meals, it results in a more rapid effect of the med
Oral anticoagulation agents (Coumadin) are contraindicated in pregnancy
SE of Prozac are diarrhea, dry mouth, weight loss, and decreased libido
SE of aminophylline are restlessness and palpitations, nurse needs to

intervene
Clients with GERD need to avoid eating 2 hours before going to sleep and
an upright posture should be maintained for 2 hours after eating to allow
for stomach emptying
Hospitalized patients, especially those on antibiotic therapy are at high

risk for getting C. difficile
Remember pain is whatever the client says it is
Autonomy- individuals must be free to make independent decisions about

participation in research without coercion from others
While assessing the vitals in a child, the RN should know the apical HR is
preferred until the radial pulse can be accurately assessed at 2 years of
age
A newborn is expected to lose 5-10% of birth wt in 1st few days post-

partum d/t changes in elimination and feeding
Blood sugars...
premature neonate= 20-60mg/dl
neonate= 30-60mg/dl
infant= 40-90mg/dl
Here's my facts for the day
a.INTEGUMENTARY SYSTEM
1.autograph: after the surgery the site is immobilized for 3-7 days
2.burns on the face and head: elevate the head of the bed
3.burns on the extremities: elevate the extremities above the level of the heart
4.Skin graft: elevate and immobilize the graft site
B.REPRODUCTIVE
1.Mastectomy-semi fowler's 30* with the affected arm elevated on a pillow,turn only on the unaffected
side and back
C.ENDOCRINE SYSTEM
1.Hypophysectomy-elevate head of the bed
2.Thyroidectomy-semi fowler's- sandbags/pillows support head and neck
D.GASTROINTESTINAL
1.HEMORRHOIDECTOMY-lateral side lying
2.GERD-reverse trendelenberg
3.LIVER BIOPSY-during procedure:supine right side right arm extended on the left shoulder
after procedure:right lateral(side lying)place small pillow or folded towel under the punctured site
4.NG TUBE-
a)insertion-high fowler's
b)irrigation/feeding-semi fowler's head of bed 30*
5.Rectal enemas-left sim's position
E. RESPIRATORY
1.COPD-sitting position,leaning forward with clients arms over several pillows

2.Laryngectomy-semi fowler's to fowlers
3.Bronchoscopy-semi fowler's
4.Postural drainage-the lung segment should be in the uppermost position
5.Thoracentesis-during procedure:sitting the edge of the bed
after procedure: fowler's position
F.CARDIOVASCULAR
1.ABDOMINAL RESECTION(ANEURISM)
LIMIT TO 45*(FOWLER'S)
2.Amputtion of the lower limbs-elevate foot of the bed;prone 20-30 mins
3.Arterial vascular Grafting
a)bedrest 24* with extremities straight
b)limit movement
4.Cardiac catherization
a)bedrest 3-4 hrs,side to side after
b)keep straight ang head of bed elevated no more than 30*
5.Congestive heart failure with pulmonary edema
high fowler's position
6.Perpheral arterial disease-Keep legs dependent do not elevate
7.Deep vein thrombosis
bed rest with leg elevation,out of bed after 24*
8.Varicose veins-leg elevation above heart level
9. Venous leg ulcers-leg elevated
H.NEUROLOGICAL SYSTEM
1.Autonomic dysreflexia-elevate head of bed to fowlers
2.Cerebral aneurism-semi fowler's
3.cerebral angiography-bed rest
1. What is the most important intervention for someone with

Respiratory Acidosis?
2. What is the best diet for someone with Metabolic Acidosis?
3. A Client with Respiratory Alkalosis may also experienced _______
and calcium gluconate should be prescribed.....
4. Nausea, Vomiting, and Diarrhea are signs and symptoms of
________________
5. What test should be performed prior to obtaining an arterial
speciment for ABG?
CAN YOU PLEASE HELP ME ANSWER THE TWO QUESTIONS I HAVE IN RED
FONTS BELOW? THANK YOU.
ACID/BASE BALANCE
pH- 7.35-7.45
PCO2- 35-45 mmHg
PO2- 80-100 mmHg
HCO3 22-27 mEq/L
ACIDOSIS
-decrease pH
-Potassium increases
AKALOSIS
-increase pH
-Potassium decreases
ROME
respiratory oppossite metabolic equals
-----------------------------------------------------------------------
RESPIRATORY ACIDOSIS
Causes of Respiratory Acidosis (mostly airways/lungs related)

-Asthma: spasms causing the brochioles to constrict
-Atelectasis: excess mucus collection
-Brain trauma: excessive pressure on the respirtory center
-Bronchiectasis: bronchi become dilated as a result of inflammation
-COPD
-Emphysema: loss of elasticity of alveolar sacs, restricting airflow
-Hypoventilation: Carbon dioxide is retained
-Pulmonary Edema: accumulation of fluid in acute CHF
-Medications
Assessment for Respiratory Acidosis

-headache
-restlessness
-drowiness/confusion
-visual disturbances
-diaphoresis
-cyanosis as the hypoxia become acute
-hyperkalemia
-rapid, irregular pulse
-dysrhythmias leading to VFib.
Interventions for Respiratory Acidosis

-monitor signs of respiratory distress
-administer oxygen as prescribed
-semi-fowler
-encourage and assist the client to turn, cough, and breathe deeply
-hydration to thin secretions unless contraindicated
-suction airway if necessary
-monitor for potassium (because it is high in acidosis already)
-administer meds (antibiotics) and NOT meds that would place the client in more respiratory
depression
-----------------------------------------------------------------------
RESPIRATORY ALKALOSIS
Causes of Respiratory Alkalosis

-Fever (increases metabolism)
-Hyperventilation
-Hypoxia
-Hysteria
-Overventilation by mechanical ventilators
-Pain
-Aspirin
Clinical Manifestations of Respiratory Alkalosis/Assessment
-headache
-tachypnea (initial but decreases) (abnormal rapid respiration)
-paresthesias (tingling of fingers and toes)
-tetany
-vertigo
-convulsions
-hypokalemia
-hypocalcemia
Interventions for Respiratory Alkalosis

-encourage appropriate breathing patterns
-assist with breathing techniques and breathing aids as prescribed (voluntary holding of breath, use of
rebreathing mask, carbon dioxide breaths)
-no deep breathing???? (not sure but please look it up in your book and let me know)
-administer calicum gluconate for tetany as prescribed.
-----------------------------------------------------------------------
METABOLIC ACIDOSIS
Causes of Metabolic Acidosis

-Diabetes Mellitus or Diabetic Ketoacidosis
-Excessive ingestion of acetylsalicylic (aspirin)
-High-fat diet (a high intake of fat causes a much too rapid accumulation of the waste products of fat
metabolism, leading to a buildup of ketones and acids.
-insufficient metabolism of carbohydrates
-malnutrition
-renal insufficiency or renal failure
-severe diarrhea
-enteric dranage tubes/ileostomy
-gastrointestinal disorder
Clinical manifestations of metabolic acidosis/ assessments

-hyperpnea with kussmaul's repirations
-headache
-nausea/vomitting/ diarrhea
-fruitty smelling breath resulting from improper fat metabolism
-CNS depression (mental dullness, drowiness, stupor, and coma)
-twitching and convulsions
-hyperkalemia
Interventions for Metabolic Acidosis

-give insulin as precribed
-dialysis as prescribed
-Diet: low in protein and high in calories will decrease the amouth of protien waste products (which
will lessen the acidosis)
-----------------------------------------------------------------------
METABOLIC ALKALOSIS
Causes of Metabolic Alkalosis

-diuretics
-excessive vomitting or gastrointestinal suctioning
-hyperaldosteronism: increased rental tubular reabsorption of sodium occurs, with the resultant loss of
hydrogen ions.
-ingestion of excess sodium bicarbonate/antacids
-massive transfusion of whole blood
Assessment of Metabolic Alkalosis

-nausea, vomiting, diarrhea
-restlessness
-numbness and tingling in the extremities
-twitching in the extremities
-hypokalemia
-hypocalcemia
-dysrhythmias: tachycarida
Interventions for Metabolic Alkalosis

-monitor potassium and calcium
-institute safety precautions (not sure of the safety precautions, please look this up in your book and
let me know)
-prepare to administer medications as prescribed to promote the kidney excretion of bicarbonate.
-replace potassium chloride
-----------------------------------------------------------------------
OTHERS
-Kussmaul's respirations (found in DKA): abnormally deep, regular, increase in rate

-bradypnea respirations: regular but abnormally slow
-hyperpnea respirations: labored and increased in depth and rate
-apnea respirations: cease for several seconds
-Make sure you do an Allen's test prior to drawing blood for the arterial blood gases. The purpose of
this procedure is to assess the adequacy of the ulnar circulation.
-ALLEN's Test: explain procedure, apply pressure over the ulnar and radial arteries, ask client to open
and close hand repeatedly, release pressure from ulnar artery, assess the color of the extremity distal
to the pressure point.
1. When getting down to two answers, choose the assessment answer (assess,
collect, auscultate, monitor, palpate) over the intervention except in an
emergency or distress situation. If one answer has an absolute, discard it.
Give priority to answers that deal directly to the patients body, not the
machines/equipments.
2. Key words are very important. Avoid answers with absolutes for example:
always, never, must, etc.
3. with lower amputations patient is placed in prone position.
4. small frequent feedings are better than larger ones.
5. Assessment, teaching, meds, evaluation, unstable patient cannot be
delegated to an Unlicensed Assistive Personnel.
6. LVN/LPN cannot handle blood.
7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
8. IV push should go over at least 2 minutes.
9. If the patient is not a child an answer with family option can be ruled
out easily.
10. In an emergency, patients with greater chance to live are treated first
.
11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton)
are always secondary to something else (another disease process).
12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
13. in pH regulation the 2 organs of concern are lungs/kidneys.
14. edema is in the interstitial space not in the cardiovascular space.
15. weight is the best indicator of dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reyes syndrome (encephalopathy) when given to
children
18. when aspirin is given once a day it acts as an antiplatelet.
19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (
rheumatoid arthritis)
20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration is rarely a good
choice.
22. with pneumonia, fever and chills are usually present. For the elderly
confusion is often present.
23. Always check for allergies before administering antibiotics (especially
PCN). Make sure culture and sensitivity has been done before adm. First dose
of antibiotic.
24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused
by pulmonary disease, occurs with bronchitis or emphysema.
25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are
both COPD.
26. in COPD patients the baroreceptors that detect the CO2 level are
destroyed. Therefore, O2 level must be low because high O2 concentration
blows the patients stimulus for breathing.
27. exacerbation: acute, distress.
28. epi always given in TB syringe.
29. prednisone toxicity: cushings syndrome= buffalo hump, moon face, high
glucose, hypertension.
30. 4 options for cancer management: chemo, radiation, surgery, allow to
die with dignity.
31. no live vaccines, no fresh fruits, no flowers should be used for
neutropenic patients.
32. chest tubes are placed in the pleural space.
33. angina (low oxygen to heart tissues) = no dead heart tissues. MI=
dead heart tissue present.
34. mevacor (anticholesterol med) must be given with evening meal if it is
QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5 minutes). If
chest pain does not stop go to hospital. Do not give when BP is < 90/60.
36. Preload affects amount of blood that goes to the R ventricle.
Afterload is the resistance the blood has to overcome when leaving the heart.
37. Calcium channel blocker affects the afterload.

38. for a CABG operation when the great saphenous vein is taken it is
turned inside out due to the valves that are inside.
39. unstable angina is not relieved by nitro.
40. dead tissues cannot have PVCs(premature ventricular contraction. If
left untreated pvcs can lead to VF (ventricular fibrillation).
41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz
* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40
* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.
42. angiotensin II in the lungs= potent vasodialator. Aldosterone attracts
sodium.
43. REVERSE AGENTS FOR TOXICITY
heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in
narcotic addicts.
- Potassium potentiates dig toxicity.
44. heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on coumadin
46. cardiac output decreases with dysrythmias. Dopamine increases BP.
47. Med of choice for Vtach is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heart beat) is atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodorone is effective in both ventricular and atrial complications.
55. S3 sound is normal in CHF, not normal in MI.
56. give carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress ulcers.
58. after endoscopy check gag reflex.
59. TPN(total parenteral nutrition) given in subclavian line.
60. low residue diet means low fiver
61. diverticulitis (inflammation of the diverticulum in the colon) pain is
around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with
rebound tenderness.
63. portal hypotension + albuminemia= Ascites.
64. beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes spasm of the
Sphincter of Oddi. Therefore Demerol should be given.
66. Trousseau and Tchovoski signs observed in hypocalcemia
67. with chronic pancreatitis, pancreatic enzymes are given with meals.
68. Never give K+ in IV push.
69. mineral corticoids are give in Addisons disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of
sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is enough
insulin to prevent breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with heparin.
73. for knee replacement use continuous passive motion machine.
74. give prophylactic antibiotic therapy before any invasive procedure.
75. glaucoma patients lose peripheral vision. Treated with meds
76. cataract= cloudy, blurry vision. Treated by lens removal-surgery
77. Co2 causes vasoconstriction.
78. most spinal cord injuries are at the cervical or lumbar regions
79. autonomic dysreflexia ( life threatening inhibited sympathetic response
of nervous system to a noxious stimulus- patients with spinal cord injuries
at T-7 or above) is usually caused by a full bladder.
80. spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheat destruction, disruption in nerve
impulse conduction.
82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since
smallest concentration of ACTH receptors are in cranial nerves, expect fatigue
and weakness in eye, mastication, pharyngeal muscles.
83. Tensilon test given if muscle is tense in myasthenia gravis.
84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory
system.
85. parkinsons = RAT: rigidity, akinesia (loss of muscle mvt), tremors.
Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no dead brain tissue
87. CVA (cerebrovascular accident) is with dead brain tissue.
88. Hodgkins disease= cancer of lymph is very curable in early stage.
89. Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?
90. Birth weight doubles by 6 month and triple by 1 year of age.

91. if HR is <100 do not give dig to children.
92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is
inconsolable, do not eat, not passing meconium.
93. heart defects. Remember for cyanotic -3Ts( Tof, Truncys arteriosus,
Transposition of the great vessels). Prevent blood from going to heart. If
problem does not fix or cannot be corrected surgically, CHF will occur
following by death.
94. with R side cardiac cath=look for valve problems
95. with L side in adults look for coronary complications.
96. rheumatic fever can lead to cardiac valves malfunctions.
97. cerebral palsy = poor muscle control due to birth injuries and/or
decrease oxygen to brain tissues.
98. ICP (intracranial pressure) should be <2. measure head circonference.
99. dilantin level (10-20). Can cause gingival hyperplasia
100. for Meningitis check for Kernigs/ Brudzinskis signs.
101. Wilms tumor is usually encapsulated above the kidneys causing flank
pain.
102. hemophilia is x-linked. Mother passes disease to son.
103. when phenylalanine increases, brain problems occur.
104. Bucks traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryants traction= children <3y, <35 lbs with femur fx.
108. place apparatus first then place the weight when putting traction
109. placenta should be in upper part of uterus
110. eclampsia is seizure.
111. a patient with a vertical c-section surgery will more likely have
another c-section.
112. perform amniocentesis before 20 weeks gestation to check for cardiac
and pulmonary abnormalities.
113. Rh- mothers receive rhogam to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
115. caput succedaneum= diffuse edema of the fetal scalp that crosses the
suture lines. Swelling reabsorbs within 1 to 3 days.
116. pathological jaundice= occurs before 24hrs and last7 days.
Physiological jaundice occurs after 24 hours.
117. placenta previa = there is no pain, there is bleeding. Placenta
abruption = pain, but no bleeding.
118. bethamethasone (celestone)=surfactant. Med for lung expansion.
119. dystocia= baby cannot make it down to canal
120. pitocin med used for uterine stimulation
121. Magnesium sulfate(used to halt preterm labor) is contraindicated if
deep tendon reflexes are ineffective. If patient experiences seizure during
magnesium adm. Get the baby out stat (emergency).
122. Do not use why or I understand statement when dealing with patients
123. milieu therapy= taking care of patient/environment
124. cognitive therapy= counseling
125. crisis intervention=short term.
126. FIVE INTERVENTIONS FOR PSYCH PATIENTS
-safety
-setting limits
-establish trusting relationship
-meds
-leas restrictive methods/environment.
126. SSRIs (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. if patients have hallucinations redirect them. In delusions distract
them.
129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side
effects)
130. Alzheimers disease is a chronic, progressive, degenerative cognitive
disorder that accounts for more than 60% of all dementias
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Jul 06, 2008, 11:28 AM

Updated Jul 06, 2008 at 11:32 AM by Joiex

I found this thread last night and read until I couldn't keep my eyes open. Got

Originally Posted by pretty_nurse1028
hi. for those who passed the nclex rn exam? how did u make it? i mean how u review in
preparing for test? also what materials did u use before u take the test? how many months
u prepare for the test? hope for a reply soon...
thanks
I used the Random Facts Thread, Infection Control Thread, Obscure Diseases Thread, Read the
Pathophysiology Sticky in the Nursing Student Assistance Forum as well as that same forums
Pharmacology & Nursing Math Stickies. I watched the Drexel DVD's and sort of read Lippincott's
NCLEX Reveiw book. I used NCLEX 3000 to practice questions but got such bad scores I gave up on
practicing questions ( and still passed NCLEX ).
GOOD LUCK!!!! Biggest help for me was AllNurses.com and their many resources in Sticky
Threads!!!!
Here's my tip: Look through Sticky Threads here and you'll find a wealth of valuable information,
facts, tips, and memory joggers. There are lots of great educational resources here.
Second fact/tip: Give yourself breaks when studying so your mind can rest and be fresh to learn and
retain more info.
Third: Take care of yourself, eat well, get plenty of rest and exercise, destress. This is only a test and
you took lots of tests in nursing school.
I wanted to stop by and give you few "ideas" that may help you for your incoming
test! I hope I don't get in trouble for this. I am not discussing test questions, I am
just relaying few facts regarding the general consensus out there on the NCLEX.
1. It is not a secret that NCLEX is now focusing on infection control and

prioritization/delagation (For high level questions). Make sure that you
know what kind of precautions (Contact, droplets, airborne) used for any
specific disease. You should check my thread on infection control:
http://allnurses.com/forums/f197/qui...ol-314902.html
2. Know the major drug classes. At least 5 drugs from each class. Focus on the
patient teaching section.
3. Spend time (if you can) learning some rare diseases such as Kawasaki
disease, Fifth disease,... Know the major signs and symptoms and how you
treat them.
4. Review the acid/base imbalance content.
5. Many people reported having questions on Diabetes insipidus, SIADH,

Cushing's and Addison disease. Study THOROUGHLY those diseases!!!
6. Review the nursing interventions of internal and external radiations.

(Oncology...)
7. Do as many questions as you can (60-100/day), always making sure that

you review the rationales of missed questions. Also you should know your
weak areas and focus on them when you study the content.
8. Have time to relax
Good luck to all of you and if I did it, you can also do it!
Value Normal Range
BUN 10 25 or 5 - 25
Kaplan
Creatinine 1.2 1.5 or 0.5 1.5

Kap
Creatinine Clearance 85 135
Albumin, serum 3.5 5.0
Potassium 3.5 5.0
Specific Gravity 1.010 1.030
Sodium, serum 135 145
Calcium 9 - 11
Magnesium 1.3 2.1 Critical < 0.5 or >3
Chloride 95 105
Phosphate 3.0 4.5
Serum Osmolarity 285 - 295
Glycosylated Hemoglobin 4 6% 3 month review of

Glucose
pH 7.35 7.45 Acid Alkaline
HCO3 22 26 Acid Alkaline
PCO2 35 45 Acid Alkaline
PO2 80 100
O2 saturation 96 - 100
Metabolic Alkalosis pH , PCO2 , HCO3
Metabolic Acidosis pH , PCO2 , HCO3
Respiratory Alkalosis pH , PCO2 , HCO3

Respiratory Acidosis pH , PCO2 , HCO3
Phosphate 3.0 4.5
CVP 3 11 or 2 8
HGB, hemoglobin 12 15
HCT, hemocrit 36 45
Platelets 150,000 450,000
Neutrophils 2500 8000
Lymphocytes 1000 4000
RBC 3.2 5.2
WBC 5000 10,000
ESR 0 20
PTT 20 45 sec. Max 112 Therapeutic. 1.5 2.5

sec. times
PT/INR 10 14 seconds
Bilirubin 0.1 1.0
ALT/AST 8 - 20
Digoxin 0.5 2 Toxic > 2.5
Dilantin 10 20 Toxic > 30
Theophylline 10 - 20 Toxic > 20
Lithium 0.5 1.2
Tylenol Toxic > 4000 mg/day
Hey guys. I just passed the NCLEX and I can give you few ideas
about preparing for NCLEX
1. Be familiar with the NCLEX test.
2. Know your NCLEX weak areas and focus on them
3. Maintain a consistent study habit. Study at least 2-3 hours a

day EVERY DAY!
4. Focus on nursing interventions. Most NCLEX questions are

about what you can do for the patient
5. Do at least 60-100 questions a day. Make sure you review the
rationales of missed questions and do as many questions as
you can! Believe me it worked for me...
6. Focus also on the prioritization/delegation and infection

control contents
7. Know the major drugs classes and at least 3-5 drugs in each
class. Focus on patient teaching
8. Include Saunders in your study books. Saunders book is best

to teach you what you need to know in simple and concise
terms
9. Improve your critical thinking skills. NCLEX is about critical

thinking
10. Develop a winning strategy and be confident
11. Do not study the night before the test
12. Make sure you breathe...
This thread is a very good idea. I learnt so much from it. But the
"random facts" should help you to be familiar with the content.
Don't just focus on memorizing them. Make sure that you know how
you can "apply" those facts to any given scenario regarding patient
care. NCLEX is about critical thinking...
Good luck to all of you!
Can anyone add to this and/or correct me if I am wrong??

Seems like these are pretty important to know, everyone seems to get a good amount of
questions on this..
INFECTION CONTROL
Airborne Precautions:
Varicella
TB
Rubeola
pt must wear mask when transporting

what else?!?
Droplet Precautions:
Mennigittis
Pneumonia
Pertussis
Rubella
Mumps
private room unless other pt has same organism

maintain 3 feet distance unless giving care
anything else??
Contact Precautions:
RSV
Synctial virus
C Diff
MRSA
Ecoli
Scabies
Impetigo
Room needs to be private unless same organism
gloves/gown when in contact with secretions
anything else??
Standard Precautions:
CF
Bronchitis
Hantavirus
Tonsillitis
Cutaneous Anthrax
Hey Kristina,
This is good, thanks for posting it.
For airborne, make sure the patient is in a room that has negative air pressure with at least 6-12 exchanges an
hour, and N95 mask for TB.
Also remember MTV Cd for airborne: Measles (Rubeola), TB, Varicella (Shingles), Chickenpox,
Disseminated varicella zoster.
Here are 2 links I have been using regarding infection control. Hope you find them useful.
http://allnurses.com/forums/f197/qui...-314902-4.html
http://allnurses.com/forums/f197/isolation-precautions-316743.html

You have to know these common disease in NCLEX:
hypertension
provide for physical and emotional rest
provide for special safety needs
health teaching (client and family)
dysrhythmias
provide for emotional and safety needs
prevent thromboemboli
prepare for cardioversion with atrial fibrillation if indiated
provide for physical and emotional needs with pacemaker insertion
cardiac arrest
prevent irreversible cerebral anoxic damage
establish effective circulatio n, respiration
angina pectoris
provide relief from pain
provide emotional support
health teaching
myocardial infarction
reduce pain, discomfort
maintain adequate circulation, stabilize heart rhythm
decrease oxygen demand/promote oxygenation, reduce cardiac workload
maintain fluid electrolyte, nutritional status
facilitate fecal elimination
promote sexual functioning
health teaching
cardiac valvular defects

reduce cardiac workload
promote physical comfort and psychological support
prevent complications
prepare for surgery
cardiac catheterization & percutaneous transluminal coronary angioplasty

precatheterization:
provide for safety, comfort
health teaching
postcatheterization:
health teaching
cardiac surgery
cardiopulmonary bypass
preoperative:
provide emotional and spiritual support
health teaching
postoperative:
provide constant monitoring to prevent complications
promote comfort, pain relief
maintain fluid, electrolyte, nutritional balance
promote emotional adjustment
promote early mobilization
health teaching
heart failure (HF)

provide physical rest / reduce emotional stimuli
provide for relief of respiratory distress; reduce cardiac workload
maintain fluid and electrolyte balance, nutritional status
health teaching
pulmonary edema
promote physical, psychological relaxation measures to relieve anxiety
improve cardiac function, reduce venous return, relieve hypoxia
health teaching (include family or significant other)
shock
promote venous return, circulatory perfusion
disseminated intravascular coagulation (DIC)

prevent and detect further bleeding
pericarditis
promote physical and emotionl comfort
maintain fluid, electrolyte balance
chronic arterial occlusive disease

promote circulation; decrease discomfort
prevent infection, injury
aneurysms
provide emergency care before surgery for dissection or rupture
prevent complications postoperatively
promote comfort
health teaching
Raynauds phenomenon
Maintain warmth in extremities
Increase hydrostatic pressure, and therefore circulation
Health teaching
Varicose veins
Promote venous return from lower extremities
Provide for safety
Health teaching
Vein ligation and stripping
Prevent complications after discharge
Health teaching to prevent recurrence
Deep vein thrombosis (thrombophlebitis)

Provide rest, comfort, and relief from pain
Prevent complications
Health teaching
Iron deficiency anemia & Hemolytic anemia

Promote physical and mental equilibrium
Health teaching
Pernicious anemia
Promote physical and emotional comfort
Health teaching
Polycythemia vera
promote comfort and prevent complications
health teaching
leukemia (acute and chronic)

prevent, control, and treat infection
assess and control bleeding, anemia
provide rest, comfort, nutrition
reduce side effects from therapeutic regimen
provide emotional/spiritual support
health teaching
idiopathic thrombocytopenic purpura (ITP)

prevent complications from bleeding tendencies
health teaching
splenectomy
prepare for surgery
prevent postoperative complications
health teaching
fluid volume deficit

restore fluid and electrolyte balance-increase fluid intake to hydrate client
promote comfort
prevent physical injury
fluid volume excess

maintain oxygen to all cells
promote excretion of excess fluid
obtain/ maintain fluid balance
prevent tissue injury
health teaching
common electrolyte imbalances

hyponatremia
obtain normal sodium level
prevent further sodium loss
prevent injury
hypernatremia
obtain normal sodium level
hypokalemia
replace lost potassium: increase potassium in diet
prevent injury to tissues
prevent potassium loss
hyperkalemia
decrease amount of potassium in body
hypocalcemia
prevent tetany
prevent tissue injury
prevent injury related to mediction administration
in less acute condition
hypercalcemia
reduce calcium intake: decrease foods high in calcium
prevent injury
hypomagnesemia
provide safety
health teaching
hypermagnesemia
obtain normal magnesium level
respiratory adidosis
assist with normal breathing
protect from injury
health teaching
metabolic acidosis
restore normal metabolism
health teaching
respiratory alkalosis
increase carbon dioxide level
prevent injury
health teaching
metabolic alkalosis
obtain, maintin acid-base blance
prevent physical injury
health teaching
pneumonia
promote adequate ventilation
control infection
provide rest and comfort
prevent potential complications
health teaching
severe acute respiratory syndrome (SARS)

infection control
supportive care
atelectasis
relieve hypoxia
health teaching
pulmonary embolism
monitor for signs of respiratory distress
health teaching
histoplasmosis
relieve symptoms of the disease
health teaching
tuberculosis
reduce spread of disease
promote nutrition
promote increased self-esteem
health teaching
emphysema
promote optimal ventilation
employ comfort measures and support other body systems
improve nutritional intake
provide emotional support for client and fmily
health teaching
asthma
promote pulmonary ventilation
facilite expectoration
health teaching to prevent further attacks
bronchitis
assist in optimal respirations
minimize bronchial irritation
improve nutritional status
acute adult respiratory distress syndrome (ARDS)

assist in respirations
health teaching
pneumothorax & hemothorax

prevent damage until medical intervention available
protect against injury during thoracentesis
promote respirations
prepare client for closed chest drainage, physically and psychologically
prevent complications with chest tubes
health teaching
chest trauma
Flail chest
restore adequate ventilation and prevent further air from entering pleural cavity
thoracic surgery
preoperative care:
minimize pulmonary secretions
preoperative teaching
postoperative care:
maintain patent airway
promote gas exchange
reduce incisional stress and discomfort
prevent complications related to respiratory function
maintain fluid and electrolyte balance
postoperative teaching
tracheostomy
preoperative care
relieve anxitety and fear
postoperative care
alleviate apprehension
improve nutritional status
health teaching
burns
alleviate pain, relieve shock, and maintain fluid and electrolyte balance
prevent physicl complications
promote emotional adjustment and provide supportive therapy
promote wound healing wound care
health teaching
rheumatoid arthritis
prevent or correct deformities
health teaching
lupus erythematosus
minimize or limit immune response and complications
health teaching
infectious diseases
Lyme disease
minimize irreversible tissue damage and complications
alleviate pin, promote comfort
maintain physical and psychological well-being
health teaching
acquired immunodeficiency syndrome (AIDS)

reduce risk of infection; slow disease progression
prevent the spread of disease
provide physical and psychological support
health teaching
The perioperative experience

Preoperative preparation
reduce preoperative and intraoperative anxiety and prevent postoperative complications
instruct in exercises to reduce complications
reduce the number of bacteria on the skin to eliminate incision contamination
reduce the risk of vomiting and aspiration during anesthesia; prevent contamination of
abdominal operative sites by fecal material
promote rest and facilitate reduction of apprehension
protect from injury;ensure final preparation for surgery
intraoperative preparation
promote comfort
observe for indications of malignant hyperthermia
postoperative experience
promote a safe, quiet, nonstressful environment
promote lung expansion and gss exchange
prevent aspiration and atelectasis
promote and maintain cardiovascular function
promote psychological equilibrium
maintain proper function of tubes and appatatus
general postoperative nursing care

promote lung expansion
provide relief of pain
promote adequate nutrition and fluid and electrolyte balance
assist client with elimination
facilitate wound and prevent infection
promote comfort and rest
encourage early movement and ambulation to prevent complications of immobilization
general nutritional deficiencies

prevent complications of specific deficiency
health teaching
celiac disease
altered nutrition, less than body requirements
diarrhea
fluid volume deficit related to loss through excessive diarrhea
knowledge deficit
hepatitis
prevent spread of infection to others
promote comfort
pancreatitis
control pain
rest injured pancreas
prevent fluid and electrolyte imbalance
prevent respirtory and metabolic complications
provide adequate nutrition
health teaching
cirrhosis
relieve discomfort caused by complications
improve fluid and electrolyte balance
promote optimum nutrition within dietary restrictions
health teaching
esophageal varices: life-threatening hemorrhage

provide safety measures related to hemorrhage
promote fluid balance
prevent complications of hepatic coma
health teaching
diaphragmatic (hiatal) hernia

presurgical: promote relief of symptoms
postsurgical:
provide for postoperative safety needs
promote comfort and maintain nutrition
health teaching
gastroesophgel reflux disease(GERD)
promote comfort and reduce reflux episodes
health teaching
peptic ulcer disease

promote comfort
prevent/ recognize signs of complications
health teaching
gastric surgery
promote comfort in the postoperative period
promote wound healing
promote adequate nutrition and hydration
dumping syndrome
health teaching
total parenteral nutrition

prevent infection
preent fluid and eclectrolyte imbalance
diabetes
obtain and maintain normal sugar balance
health teaching
nonketotic hyperglycemic hyperosolar coma (NKHHC)

promote fluid and electrolyte balance
cholecystits/ cholelithiasis
nonsurgical interventions romote comfort
preoperative: prevent injury
postoperative romote comfort
health teaching
obesity
decrease weight, initially 10% from baseline
appendicitis
promote comfort
hernia
health teaching
diverticulosis
bowel rest during acute episodes
promote normal bowel elimination
health teaching
ulcerative colitis & Crohns disease

prevent disease progression and complications
reduce psychological stress
health teaching
intestinal obstruction
obtain and maintain fluid balance
relieve pain and nausea
prevent respiratory complications
postoperative nursing care
fecal diversion-stomas
preoperative period:
prepare bowel for surgery
relieve anxiety and assist in adjustment to surgery
postoperative period:
maintain fluid balance
prevent other postoperative complications
initiate ostomy care
promote psychological comfort
hemorrhoids
reduce anal discomfort
prevent complications related to surgery
health teaching-avoid constipation
pyelonephritis (PN)
combat infection, prevent recurrence, alleviate symptoms
promote physical and emotional rest
acute glomerulonephritis
monitor fluid balance, observing carefully for complications
provide adequate nutrition
provide reasonable measure of comfort
prevent further infection & health teaching
acute renal failure (ARF)
maintain fluid and electrolyte balance and nutrition
use assessment and comfort measures to reduce occurrence of complications
maintain continual emotional support
health teaching
chronic renal failure

maintain fluid/ electrolyte balance and nutrition
employ comfort measures that reduce distress and support physical function
health teaching
dialysis
reduce level of nitrogenous waste
correct acidosis, reverse electrolyte imbalances, remove excess fluid
kidney transplantation
preoperative:
promoe physical and emotional adjustment
encourage expression of feelings
health teching
postoperative:
promote uncomplicated recovery of recipient
observe for signs of rejection-most dangerous complication
maintain immunosuppressive therapy
nephrectomy
preoperative ptimize physical and psychological functioning
postoperative
promote comfort and prevent complications
renal calculi (urolithiasis)

reduce pain and prevent complications
health teaching
lithotripsy
enourage ambulation and promote diuresis through forcing fluids
benign prostatic hyperplasia

relieve urinary retention
health teaching
prostatectomy
promote optimal bladder function and comfort
assist in rehabilitation
urinary diversion
prevent complications and promote comfort
health teaching
laryngectomy
preoperative care: provide emotional support and optimal physical preparation
health teaching
postoperative care
maintain patent airway and prevent aspiration
promote optimal physical and psychological function
health teaching
aphasia
assist with communication
Menieres disease
provide safety and comfort during attacks
minimize occurrence of attacks
health teaching
otosclerosis & stapedectomy

preoperative health teaching
postoperative
promote physical and psychological equilibrium
health teaching
deafnessmaximize hearing ability and provide emotional support.health teaching

glaucoma
reduce intraocular pressure
health teaching
cataract & cataract removal

preoperative
prepare for surgery
postoperative
reduce stress on the sutures and prevent hemorrhage
promote psychological well-being
health teaching
retinal detachment
preoperative:
reduce anxiety and prevent further detachment
health teaching
postoperative
reduce intraocular stress and prevent hemorrhage
support coping mechanisms
health teaching
blindness
promote independence and provide emotional support
health teaching
traumatic injuries to the brain

sustain vital functions and minimize or prevent complications
provide emotional support and use comfort measures
increased inrcranial pressure

promote adequate oxygenation and limit further impairment
craniotomy
preoperative btain baseline measures
provide psychological support
prepare for surgery
postoperative
prevent complications and limit further impairment
epilepsy
prevent injury during seizure
postseizure care
prevent or reduce recurrences of seizure activity
health teaching
transient ischemic attacks

reduce cerebral anoxia
promote cerebrovascular function and maintain cerebral perfusion
provide for emotional relaxation
client safety
health teaching
pain
immobility
complications of fractures
types of traction
teaching crutch walking
compartment syndrome
recognizes early indications of ischemia
osteoarthritis
promote comfort: reduce pain, spasms, inflammation, swelling
health teaching to promote independence
total hip replacement

preoperative:
prevent deep vein thrombosis or pulmonary emboli
prevent infection: antibiotics
health teaching
postoperative
prevent respiratory complications
prevent complications of shock or infection
prevent contractures, muscle atrophy
promote early ambulation and movement
prevent constipation
prevent dislocation of prosthesis
promote comfort
health teaching
total knee replacement

achieve active flexion beyond 70 degrees
amputation
prepare for surgery,physically and emotionlly
promote healing postoperatively
gout
decrease discomfort
prevent kidney damage
health teaching
primary hip arthroplasty
herniated/ reptured disk

relieve pain and promote comfort
health teaching
laminectomy
relieve anxiety
prevent injury postoperatively
promote comfort
prepare for early discharge
health teaching
spinal cord injuries

prevent further damage
relieve edema:anti-inflammatory medications,corticosteroids
relieve discomfort,analgesics,sedatives,muscle relaxants
promote comfort
health teaching
posterior spinal fusion (PSF)
spinal shock
prevent injury related to shock
autonomic dysreflexia
decrease symptoms to prevent serious side effects
maintain patency of catheter
promote regular bowel elimination
prevent decubitus ulcers
hyperthyroidism
protect from stress
promote physical and emotional equilibrium
health teaching
thyroid storm
thyroidectomy
promote physical and emotional equilibrium
prevent complications of hypocalcemia and tetany
promote comfort measures
hypothyroidism
provide for comfort and safety
health teaching
cushings disease
promote comfort
health teaching
pheochromocytoma
prevent paroxysmal hypertension
prepare for surgical removal of tumor
adrenalectomy
preoperative:reduce risk of postoperative complications
postoperative promoe hormonal balance
health teaching
Addisons disease
decrease stress
promote adequate nutrition
Health teaching
Multiple sclerosis
maintain normal routine as long as possible
decrease symptoms-medications as ordered
Myasthenia gravis
promote comfort
decrease symptoms
promote increased self-concept
health teaching
Parkinsons disease
promote maintenance of daily activities
protect from injury
Amyotrophic lateral sclerosis (ALS)

maintain independence as long as possible
health teaching
Guillain-Barre syndrome
prevent complications during recovery from paralysis
monitor for signs of autoimmune dysfunction
prevent tachycardia
assess cranial nerve function
maintain adequate ventilation
in acute phase:check for progression of muscular weakness
maintain nutrition
prevent injury and complications
support communication
Chemotherapy
assist with treatment of specific side effect
health teaching
Radiationtherapy
External radiation:
prevent tissue breakdown
decrease side effects of therapy
health teaching
internal radiation : sealed
assist with cervical radium implantation
health teaching
internal radiation: unsealed
reduce radiation exposure of others
Immunotherapy
decrease discomfort associated with side effects of therapy
health teaching
Palliative care
make client as comfortable as possible
assist client to maintain self-esteem and identity
assist client with psychological adjustment
Types of cancer:
Lung cancer
Make client aware of diagnosis and treatment options
Prevent complications related to surgery
Assist client to cope with alternative therapies
colon and rectal cancer
assist through treatment protocol
surgery reoperative
preparefor surgery
promote comfort
postoperative :
facilitate healing
facilitate rehabilitation
health teaching
breast cancer
assist client through treatment protocol
prepare client for surgery
reduce anxiety and depression
support coping mechanisms
health teaching
uterine cancer
prostate cancer
assist client through treatment protocol
prepare client for surgery
assist with acceptance diagnosis and treatment
prevent complication during postoperative period
bladder cancer
laryngeal cancer
additional typers of cancer,etc.
18 Readers Gave Kudos

alienRNwannabe charming7680 CrystalClear75 debi23 december2905 folashade 37 fortheloveofnursing
hase2000 Jack_ICU jadu1106 JoanieDee, LPN Lil'mama Martina1120 Melinurse nursy2008 pink_girl
SWEETDREAMERINSOCAL unadunad
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No. 581
from jadu1106
Registered User Join Date: Dec 2007

Years Exp: 8--Will the next attempt at the NCLEX-RN be successful?? Posts: 687
Nursing Specialty: Postpartum/Nursery
Received 699 Kudos from 337 posts
Jul 11, 2008, 11:34 AM

Wow thanks NY2008....Thank you so much for posting this information and for posting the info about
shigella!!
Good luck to you!!
Report
No. 582
from Melinurse
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Nursing Specialty: LTC, case mgmt, agency
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Jul 11, 2008, 01:01 PM
Drugs with these endings........ usually are in this class

-caine ;local anesthetics
-cillin; antibiotic
-dine ;anti-ulcer ( H2 blocker )
-done; opioid analgesic
-ide; oral hypoglycemics
-lam; antianxiety
-mide ;diuretic
-mycin ;antibiotic
-nium; neuromuscular blocking
-olol; beta blocker
-oxacin ;antibiotic
-pam ;antianxiety
-pril ;ACE inhibitor
-sone ;steroids
-statin ;cholesterol
-vir; antiviral
-zide; diuretic
. When getting down to two answers, choose the assessment answer (assess,
collect, auscultate, monitor, palpate) over the intervention except in an

emergency or distress situation. If one answer has an absolute, discard it.
Give priority to answers that deal directly to the patients body, not the
machines/equipments.
2. Key words are very important. Avoid answers with absolutes for example:
always, never, must, etc.
3. with lower amputations patient is placed in prone position.
4. small frequent feedings are better than larger ones.
5. Assessment, teaching, meds, evaluation, unstable patient cannot be
delegated to an Unlicensed Assistive Personnel.
6. LVN/LPN cannot handle blood.
7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
8. IV push should go over at least 2 minutes.
9. If the patient is not a child an answer with family option can be ruled
out easily.
10. In an emergency, patients with greater chance to live are treated first
.
11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton)
are always secondary to something else (another disease process).
12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
13. in pH regulation the 2 organs of concern are lungs/kidneys.
14. edema is in the interstitial space not in the cardiovascular space.
15. weight is the best indicator of dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reyes syndrome (encephalopathy) when given to
children
18. when aspirin is given once a day it acts as an antiplatelet.
19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (
rheumatoid arthritis)
20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration is rarely a good
choice.
22. with pneumonia, fever and chills are usually present. For the elderly
confusion is often present.
23. Always check for allergies before administering antibiotics (especially
PCN). Make sure culture and sensitivity has been done before adm. First dose
of antibiotic.
24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused
by pulmonary disease, occurs with bronchitis or emphysema.
25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are
both COPD.
26. in COPD patients the baroreceptors that detect the CO2 level are
destroyed. Therefore, O2 level must be low because high O2 concentration
blows the patients stimulus for breathing.
27. exacerbation: acute, distress.
28. epi always given in TB syringe.
29. prednisone toxicity: cushings syndrome= buffalo hump, moon face, high
glucose, hypertension.
30. 4 options for cancer management: chemo, radiation, surgery, allow to
die with dignity.
31. no live vaccines, no fresh fruits, no flowers should be used for
neutropenic patients.
32. chest tubes are placed in the pleural space.
33. angina (low oxygen to heart tissues) = no dead heart tissues. MI=
dead heart tissue present.
34. mevacor (anticholesterol med) must be given with evening meal if it is
QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5 minutes). If
chest pain does not stop go to hospital. Do not give when BP is < 90/60.
36. Preload affects amount of blood that goes to the R ventricle.
Afterload is the resistance the blood has to overcome when leaving the
heart.
37. Calcium channel blocker affects the afterload.

38. for a CABG operation when the great saphenous vein is taken it is
turned inside out due to the valves that are inside.
39. unstable angina is not relieved by nitro.
40. dead tissues cannot have PVCs(premature ventricular contraction. If
left untreated pvcs can lead to VF (ventricular fibrillation).
41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz
* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40
* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.
42. angiotensin II in the lungs= potent vasodialator. Aldosterone attracts
sodium.
43. REVERSE AGENTS FOR TOXICITY
heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in
narcotic addicts.
- Potassium potentiates dig toxicity.
44. heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on coumadin
46. cardiac output decreases with dysrythmias. Dopamine increases BP.
47. Med of choice for Vtach is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heart beat) is atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodorone is effective in both ventricular and atrial complications.
55. S3 sound is normal in CHF, not normal in MI.
56. give carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress ulcers.
58. after endoscopy check gag reflex.
59. TPN(total parenteral nutrition) given in subclavian line.
60. low residue diet means low fiver
61. diverticulitis (inflammation of the diverticulum in the colon) pain is
around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with
rebound tenderness.
63. portal hypotension + albuminemia= Ascites.
64. beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes spasm of the
Sphincter of Oddi. Therefore Demerol should be given.
66. Trousseau and Tchovoski signs observed in hypocalcemia
67. with chronic pancreatitis, pancreatic enzymes are given with meals.
68. Never give K+ in IV push.
69. mineral corticoids are give in Addisons disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of
sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is enough
insulin to prevent breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with heparin.
73. for knee replacement use continuous passive motion machine.
74. give prophylactic antibiotic therapy before any invasive procedure.
75. glaucoma patients lose peripheral vision. Treated with meds
76. cataract= cloudy, blurry vision. Treated by lens removal-surgery
77. Co2 causes vasoconstriction.
78. most spinal cord injuries are at the cervical or lumbar regions
79. autonomic dysreflexia ( life threatening inhibited sympathetic response
of nervous system to a noxious stimulus- patients with spinal cord injuries
at T-7 or above) is usually caused by a full bladder.
80. spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheat destruction, disruption in nerve
impulse conduction.
82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since
smallest concentration of ACTH receptors are in cranial nerves, expect
fatigue
and weakness in eye, mastication, pharyngeal muscles.
83. Tensilon test given if muscle is tense in myasthenia gravis.
84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory
system.
85. parkinsons = RAT: rigidity, akinesia (loss of muscle mvt), tremors.
Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no dead brain tissue
87. CVA (cerebrovascular accident) is with dead brain tissue.
88. Hodgkins disease= cancer of lymph is very curable in early stage.
89. Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?
90. Birth weight doubles by 6 month and triple by 1 year of age.

91. if HR is <100 do not give dig to children.
92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is
inconsolable, do not eat, not passing meconium.
93. heart defects. Remember for cyanotic -3Ts( Tof, Truncys arteriosus,
Transposition of the great vessels). Prevent blood from going to heart. If
problem does not fix or cannot be corrected surgically, CHF will occur
following by death.
94. with R side cardiac cath=look for valve problems
95. with L side in adults look for coronary complications.
96. rheumatic fever can lead to cardiac valves malfunctions.
97. cerebral palsy = poor muscle control due to birth injuries and/or
decrease oxygen to brain tissues.
98. ICP (intracranial pressure) should be <2. measure head circonference.
99. dilantin level (10-20). Can cause gingival hyperplasia
100. for Meningitis check for Kernigs/ Brudzinskis signs.
101. Wilms tumor is usually encapsulated above the kidneys causing flank
pain.
102. hemophilia is x-linked. Mother passes disease to son.
103. when phenylalanine increases, brain problems occur.
104. Bucks traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryants traction= children <3y, <35 lbs with femur fx.
108. place apparatus first then place the weight when putting traction
109. placenta should be in upper part of uterus
110. eclampsia is seizure.
111. a patient with a vertical c-section surgery will more likely have
another c-section.
112. perform amniocentesis before 20 weeks gestation to check for cardiac
and pulmonary abnormalities.
113. Rh- mothers receive rhogam to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
115. caput succedaneum= diffuse edema of the fetal scalp that crosses the
suture lines. Swelling reabsorbs within 1 to 3 days.
116. pathological jaundice= occurs before 24hrs and last7 days.
Physiological jaundice occurs after 24 hours.
117. placenta previa = there is no pain, there is bleeding. Placenta
abruption = pain, but no bleeding.
118. bethamethasone (celestone)=surfactant. Med for lung expansion.
119. dystocia= baby cannot make it down to canal
120. pitocin med used for uterine stimulation
121. Magnesium sulfate(used to halt preterm labor) is contraindicated if
deep tendon reflexes are ineffective. If patient experiences seizure during
magnesium adm. Get the baby out stat (emergency).
122. Do not use why or I understand statement when dealing with patients
123. milieu therapy= taking care of patient/environment
124. cognitive therapy= counseling
125. crisis intervention=short term.
126. FIVE INTERVENTIONS FOR PSYCH PATIENTS
-safety
-setting limits
-establish trusting relationship
-meds
-leas restrictive methods/environment.
126. SSRIs (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. if patients have hallucinations redirect them. In delusions distract
them.
129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side
effects)
130. Alzheimers disease is a chronic, progressive, degenerative cognitive
disorder that accounts for more than 60% of all dementias

Kaplan Decision Tree and All Nurses Notes

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Kaplan Decision Tree and All Nurses Notes

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Ok for those of you who did not take Kaplan, this is their infamous Decision Tree

(Can't say I use it a lot, but some swear by it)

1. Can you identify the Topic?

2. Are all answers Assessments or Implementations?

3. Does Maslows fit?

4. Are all answers physical?

5. What is outcome of each?

and yes folks then you should have your answer!!!!

mother receiving DES is at risk for development of vag. cancer

cervical cancer risk factor= sex at early age

Re: Anyoone up for random FACT THROWING??

Normal growth and development

BIRTH to 1 year- Mobiles

Diabetic KetoAcidosis (DKA): (5-10% mortality)

Hyperosmolar Hyperglycemic nonketotic syndrome (HHNS):

Re: Anyoone up for random FACT THROWING??

drugs to treat viral respiratory infections

Re: Anyoone up for random FACT THROWING??

Hi everyone my simple "PHARMA" facts for today from COMMERCIALS:

1)Sumatriptan (IMITREX)---an NSAID for MIGRAINE

ABCDE mnemonic --CAUSE of secondary hypertension

4th: SELF ESTEEM: control, competence, positive regard, acceptance/worthiness

-a dehydrated and extremely suicidal client: safety comes before hydration

)In myocardial infarction...MORPHINE first BEFORE OXYGEN...

thanks and lets keep them coming. =)

hhmmm physiologic need IS more important than safety/security.

example of when oxygen is not administered first....

a client receiving parenteral nutrition with suspected air embolism.

always draw up clear to cloudy when mixing insulin.

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

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

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

2. Antepartum client c/o leg cramps - teach client to dorsiflex foot

4. NORMAL FINDINGS for a 6 month old child - sits up without support

Re: Anyoone up for random FACT THROWING??

Priority = 1-airway (ABCs),

Meds= Morphine IV (monitor VS)

Monitor= adequate fluid replacement check urinary output of 30ml/hr

Lab= Hematocrit male 40-50, female 37-47

FyI: Most concern is a burn that does not blanch.

3 = usually dry darkbrown or has a leathery appearence.

Hypothalmus (Releasing/Inhibiting Hormones)

Addissons Disease Assessments

Addisonian Crisis Assessments

Cushings Syndrome Assessments

Buck's traction is used to immobilize and reduce spasms in a fractured hip.

IRON-DEFICIENCY ANEMIA (IDA)

* Fatigue and weakness

* Vitamin B12, deficiency anemia

* Pallor or slight jaundice with a complaint of weakness

* Dietary sources of vitamin B12 include dairy products, animal proteins

Folic aciddeficiency anemia

* Pallor, progressive weakness, fatigue

* Includes dietary counseling and administration of folic acid

* Pallor and fatigue

* Institute reverse isolation to protect client from infection

Sickle Cell Disease

* Pallor and jaundice

* Care of client in sickle cell crisis

* Ways to prevent sickle cell crisis

Sikle Cell Anemia

* Intracranial bleeding is the major cause of death in clients with hemophilia