NICE TO KNOW

1. Prednisone– tx of inflammatory and immunologic conditions.

o S.E.- hyperglycemia, gastric and duodenal ulcers, muscle wasting, fluid retention, potassium
excretion, and moon face.
o Nursing responsibilities include assessing for diabetes and ulcers, monitoring blood pressure and
laboratory values, and checking for infections.
2. Infant dx with PKU- offer Lofenalac
o Lack enzyme to convert phenylalanine to tyrosine, accumulates in tissues, leads to mental
retardation
o Autosomal recessive
3. Therapeutic Serum Lithium Lvl- Less than 1.5 mEq/L
o Signs of lithium toxicity- diarrhea, over-sedation, ataxia, tinnitus, slurred speech, muscle weakness
o EARLY SIGN TOXICITY- fine tremors of fingers, wrist, hands, N/V
o SEVERE SIGNS- ataxia, confusion, seizures
4. Raynaud’s phenomenon - cold temperatures or strong emotions cause blood vessel spasms that
block blood flow to the fingers, toes, ears, and nose, tingling numbness
5. Inderal (propanalol) contraindicated in pts with uncompensated Heart Failure and pulmonary
edema
o Proper meds- Digoxin, Lasix, O2 nasal cannula
6. Range for IOP (intraocular pressure) 10-21 mmHg
7. Postmortemcare- wash the client, place pad under perineum
o Don’t pass buck to chaplain or supervisor
8. Signs of hypoxia- increased RR, restlessness, cyanosis, anxiety, tachycardia
9. Pt with Bell’s Palsy- protect face from cold and drafts bc trigeminal hyperesthesia. Heat on
affected side
10. Acute Renal Failure (ARF)- inability of kidneys to concentrate urine
o Check urine specific gravity
11. Repair of detached retina- if gas or oil used to reattach, sleep on stomach for several days
o Avoid jarring motion of head- increases ICP
o Resume work after 3 weeks, avoid strenuous activity for 3 months
12. Evisceration- happens after surgery, underlying bowel visible, shiny pink area
o Cover area with sterile gauze and soak in NS
13. Glaucoma- IOP is higher during the morning- early morning assessments more accurate in the
morning
o Lifelong eyedrop treatment needed to prevent blindness
o Decreased visual acuity not corrected with glasses
14. Acute phase of CVA- HOB at 15-30 degrees, facilitates venous drainage from brain
15. Pleur-Evac Drainage System
o Suction control chamber- water bubbles constantly
o Water seal chamber- bubbles when pt exhales and when coughing or sneezing
 Amount of fluid should fluctuate with respirations, rising with inspiration and falling with expiration
 If not fluctuating, either lung is expanded (desired) or obstruction of chest tube- kinked, looped,
clots
o First 24 hrs after surgery- 500-1,00mL drainage
16. Continuous Ambulatory Peritoneal Dialysis (CAPD)
o Constipation common problem- stool softeners and high fiber diet
o Cloudy dialysate output is first sign of peritonitis
o Normal- clear and yellow
17. Ketonuria during pregnancy- ketoacidosis which contributes to intrauterine death
18. JVD is symptom of cardiac tamponade, a complication after CABG from bleeding around the
heart
19. Hypoparathyroidism- diet high in CALCIUM and low in PHOSPEROUS
20. Clomid (clomiphene citrate) works by inducing ovulation by altering estrogen and stimulating
follicular growth to produce a mature ovum- used for women having trouble conceiving
21. Erikson’s stages:
o Newborn-2: Trust vs. mistrust
 Feeding, attention, care lead to trust
o Age 2-3: Autonomy vs. Shame and Doubt
 Toilet training leads to independence, personal control
o Preschool 3-5: Initiative vs. Guilt
 Assert power and control over environment to gain initiative
o School-age 6-11: Industry vs. Inferiority
 School provides social and academic demands
o Adolescence 12-18: identity vs. Role Confusion
 Developing sense of self
o Young Adulthood 19-40: Intimacy vs. Isolation
 Forming intimate, loving relationships
o Middle Adulthood 40-65: Generativity vs. Stagnation
 Having children or legacy to leave behind, usefulness and accomplishment vs. shallow
involvement in the world
o Maturity 65-Death: Ego integrity vs. Despair
 Look back and feel sense of fulfillment
22. Pt with CVA- nursing care can PREVENT corneal abrasion- eye can no longer close voluntarily
and produce moisture
23. Tracheal tube suctioning- insert suction tube until resistance is met, then withdraw tube 1-2cm.
Apply suction intermittently while withdrawing in twirling motion. Never suction longer than 10-15
seconds
24. Naproxen Sodium – NSAID used as analgesic
o SE- HA, dizziness, GI distress, pruritus, rash
25. Thorazine- antipsych med
o SE- akathesia (restlessness), dystonia (tongue protrusion), pseudoparkinsonian (tremors, rigid),
dyskinesia (difficulity swallowing)
 Cogentin may be ordered for antiparkinsonian symptoms
 Dosage may be decreased if extrapyramidal symptoms
26. Post op cataract client- avoiding bending over, sudden movements, vomiting, constipation
o Increase IOP- pressure on ocular suture line
27. Blood transfusion reactions
o Circulatory overload- bounding peripheral pulses
o Febrile- chills
o Allergic- wheezing, hives, facial flushing, itching
o Hemolytic- lower back pain
28. Process of adjustment
o 1. Denial, isolation
o 2. Anger
o 3. Bargaining
o 4. Depression
o 5. Acceptance
29. Defense mechanisms used in phobias
o Projection- attributing thoughts and impluses to something else
o Displacement- shifting emotion concerning something to something else less dangerous
o Symbolization- something representing something else
30. Other defense mechanisms
o Reaction formation- ex: treating someone you hate excessively nice in order to hide true feelings
o Intellectualization- avoiding disturbing feelings with the use of logic or over-thinking
o Sublimation- channeling unacceptable impulses into acceptable ones ex: anger to kick boxing
o Internalization- using someone else’s opinion as your own
31. Infant barium swallow study- make NPO 3 hours prior
32. Colostomy care
o Irrigated at the same time every day
o Once per day
o Catheter inserted no more than 4 inches
o Solution at body temperature
33. Purpose of Digoxin- increase force of myocardial contraction
34. During 4th stage of labor- uterus palpable at umbilicus
35. SHARE- organization for parents who lost newborn
36. Position of fractured hip- shortened, adducted, internally rotated
37. Milestones for children
o Posterior fontanelle closed at 2-3 months
o Solid food (rice cereal) 4-5 months
o Sitting with assist at 6 months
o Pincer grasp at 9 months
o Eating using fingers at 10-12 months
o Tripling birth weight at 1 year
o Anterior fontanelle closed at 1.5 years
o Builds tower of blocks at 16-18 months
o Discriminates between pictures of objects at 2 years
38. Musculoskeletal milestones for children
o Child stands without support – 15 months
o Child runs after ball- age 2
o Child climbs up and down stairs- age 2-4
o Child hops and skips- age 6
o Child neatly ties laces- above age 6
39. LTB- larygnotracheobronchitis – edema and inflammation of upper airways, inspiratory stridor
and restlessness
40. Kussmaul respirations assoc. with DKA
41. Hemophilia is SEX-LINKED- transmitted by mother to son
42. IVP – intravenous pyleogram
o Looks at urinary tract by X-ray
43. Cytoscopy
o Looks at renal pelvis
44. Lead Poisoning- increase calcium bc it binds to lead and inhibits absorption
45. Rinne test- tuning fork held on mastoid until no longer heard then moved in front of the auditory
canal. Air conduction should be better than bone conduction
46. Osmitrol used in increased ICP bc it is osmotic diuretic and decreases ICP- UO will increase
47. Hypothyroidism
o Cannot tolerate cold temps
o Sensitive to narcotics, barbiturates and anesthetics
o Require high fiber high cellulose diet
48. Cortisol- converts proteins and fats into glucose
49. Amniocentesis indicates- spinal cord problems, blood problems, lung function
50. US determines gestational age
51. Addison’s disease
o Muscle weakness, fatigue, dark pigmentation of skin, GI disturbances, and anorexia
o Addisonian crisis- restlessness, rapid and weak pulse
52. Triad of preeclampsia
o HTN
o Edema
o Proteinuria
53. Eclampsia- blurred vision, oliguria, epigastric pain and HA are signs of seizure
54. Prolixin (fluphenazine decanoate) used in psychotic disorders, given IM or SQ every 1-6 weeks
o Good for pts with poor med compliance
55. Dilantin – seizure med
o SE- reddish-brown urine, constipation; longterm- acne, hirsutism (hairiness), gingival hyperplasia
o Interferes with normal vit D metabolism= need supplement or osteomalacia may occur
o Overdose/toxicity- ataxia, slurred speech, nystagmus
56. Hemophiliac- at risk for crippling knee and joint deformities bc repeated bleeding episodes into
joints
57. Granular casts in UA = renal disease
58. Hydralazine hydrochloride (Apresoline)-direct vasodilator, lowers BP and decreases peripheral
resistence
59. Atenolol (Tenormin)- beta blocker, slows HR and decreases cardiac contractility and CO, lowers
BP
o Less effective on blacks (also ACEs)
60. Chlorothiazide (Diuril)- thiazide diuretic, sodium and water excretion, lowers BP
o Especially effective in blacks
61. Nifedipine (Procardia)- CCB, stops calcium from moving into cells, relaxes smooth muscles,
causes vasodilation
o Especially effective in elderly and blacks
62. When angle between nail plate and proximal nail fold is straightened to 180 degrees, spongy on
palpation= early clubbing= hypoxia
63. Spoon nails (koilonychias)- iron deficiency anemia
64. Small pits in nail plate seen in psoriasis
65. Horizontal depressions in nail plate- infection or severe malnutrition
66. Signs and symptoms of air embolism- restless, complains of difficulty breathing
o Place pt on left side in Trendeleberg position and initiate O2 therapy, contact physician
o Increases likelihood air will pass into right atrium and dispersed by pulmonary artery
67. Fainting episode may be due to cardiac arrhythmia
68. Sign patient is developing shock (could be from burns)- cool, clammy skin, and tachypnea
o Body responds to early hypovolemic shock by adregnic stimulation
o Vasoconstriction compensates for loss of fluid
69. Identifying PMI for fetal heart tone
o If baby is BREECH (left/right sacrum anterior) it will be at or above the umbilicus
70. Rapid labor is risk factor for early postpartum hemorrhage and amniotic fluid embolism- labor
pattern that progresses quickly ends in less than 3 hours
71. Hantavirus Pulmonary Syndrome (HPS) caused by rodent droppings
o Symptoms- fever, aching, nausea
o Can cause severe cardiopulmonary disease
o Can cause thrombocytopenia
 Observe for hematuria, hematemesis, bleeding gums and melena
72. Polyarteritis nodosa- inflammation of the small arteries causing diminished blood
o 90% remission rate with cortisone
73. Immunizations
o DtaP- 2 months, 4 months, 6 months
o Inactivated polio- 2 mo, 4 mo
o MMR- 15 months
o TB skin testing- 12 months
74. Pain in lower extremities not relieved by rest= peripheral artery disease
o Numbness, burning, skin is dry, scaly, dusky, pale, mottled, cold
o Pulses may be weak or absent
75. Signs of HF- fatigue, SOB, tachycardia, edema, weight gain
76. Left sided HF
o Dyspnea
o Orthopnea
o Cough
o Crackles
o Tachycardia
o Fatigue
o Anxiety
o Restlessness
77. Right sided HF
o JVD
o Dependent edema
o Hepatomegaly
o Right upper quandrant tenderness
o Ascities
o Anorexia
o Nausea
o Weight gain
o Weakness
o GI distress
78. Tx for Heart Failure
o Oxygen therapy
o Digoxin
o Diuretics
o Vasodilators
o Potassium supplements
o Low sodium diet
o High fowler’s position
79. Thiazide diuretics block reabsorption of sodium and increase excretion of water and potassium
from body= can lead to hypokalemia
80. After aortofemoral bypass keep pt in full supine position, bending of hip and knee contraindicated
81. Digoxin increases the strength of the heart’s contractions by slowing the HR and conduction
through AV node
o SE- bradycardia, anorexia, N/V, fatigue, dysrhythmias, diaphoresis
o S&S of toxicity- N/V, diarrhea, confusion, visual disturbances
o Hold med if HR below 60
82. Nitroglycerin dilates coronary arteries, decreases preload
83. Lidocaine prevents premature ventricular contractions
84. Atropine increases heart rate
85. Dopamine used for hypotension and increases CO and urine output
o SE- nausea, tachycardia, angina, dysrhythmias, increased IOP
o Headache- early symptom of drug excess
86. Propanolol (Inderal)- beta blocker used for HTN, dysrhythmias, angina, and MI
o SE- bronchospasm, weakness, fatigue, CHF
o Blocks signs of hypoglycemia