COMMON BOARD TOPICS

COMMON BOARD TOPICS

Dilantin (Phenytoin) Detoxified by the liver Teach about side effects May cause bone marrow depression Taken with food

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PHLEBITIS Heat Redness Tenderness (-) swelling or edema INFILTRATION Pain Edema Cold

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Aminophylline (Truphylline; Theophylline Major side effects: palpitations, nervousness, rapid pulse, dysrhythmias, nausea, and vomiting. Check pulse!

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Morphine Sulfate Decreases preload and after load Decreases anxiety Not given to abdominal pain CNS depressant Constipating

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Total Parenteral Nutrition (TPN) Hang no longer than 24 hours Site of catheter changed every 4 weeks. Monitor for complications

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Fluoxetine (Prozac) (SSRI) for depression and OCD S/E: Postural hypotension, dry mouth, rapid heartbeat, insomnia If dose is missed, omit dose and instruct client to return to regular dosing schedule.

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Propanolol (Inderal) Beta-adrenergic blocker Antihypertensive Masks hypoglycemia S/E: Bronchospasm, bradycardia, depression. Take pulse before administration Do not give to asthmatic patients.

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Glipizide (Glucotrol) Oral hyoglycemic agent S/E:
Aplastic anemia and photosensitivity Hypoglycemia

Metformin (Glucophage)
Lactic acidosis

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Prednisone (Deltasone)
Corticosteroid causes hyperglycemia

Bethanechol (Urecholine)
Cholinergic drug for functional urinary retention Prevents urinary retention

Oxybutynin Cl (Ditropan)
Increases bladder capacity Not for glaucoma, Genitourinary obstruction

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1 grain=60mg 1 glass=240 cc 1 ounce=30 cc 1 kg=2.2 lbs 1 kg=1 liter 1 inch=2.54 cm 1 feet=12 inches 1 meter=36 inches

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Levothyroxine (Synthroid) Given in the morning on EMPTY STOMACH Report adverse reactions (hyperthyroidism) Carbamazepine (Tegretol) Interferes with action of hormonal contraceptives. S/E: photosensitivity.

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Treatment of tuberculosis Rifampicin Isoniazid (INH) Pyrazinamide (PZA) Ethambutol Streptomycin

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Carbidopa/Levodopa (Sinemet) Drug for PD Taken before meals avoid B6 and high-protein food Decreases the rigidity and bradykinesia . Albuterol (Proventil) Bronchodilator S/E: Tremors, headache, hyperactivity, tachycardia. Use bronchodilator first before steroid medication

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Insulin PEAK effect: Rapid-acting insulin: 1 hour Regular-acting insulin: 2-4 hours Intermediate/NPH insulin: 6-12 hours

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Regular insulin: Can be given IV Best site for insulin SQ: Abdomen SQ for chubby: 90 degree angle SQ for thin: 45-60 degree angle Dont massage/aspirate Dont inject on muscle area to be exercised Know the peak effect

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Topiramate (Topamax) Anticonvulsant Drink 2000-3000ml of fluid daily to prevent kidney stones. S/E: Orthostatic hypotension, ocular symptoms, blindness, and decrease effects of hormonal contraceptives.

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Phenazopyridine (Pyridium) Trimethoprim-sulfamethoxazole (Bactrim) Most common side effect mild to moderate rash (urticaria) Aminoglycosides are ototoxic. Butorphanol Tartrate (Stadol)
Analgesic S/E: Change in BP, bradycardia, respiratory depression.

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Infant normal resting heart rate: 120140 Fetal heart rate is 120-160 Herbs and spices are good to improve the taste of food Salt substitutes contain potassium Milk and dairy products are high in calcium and PHOSPHORUS

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Children with CELIAC DISEASE Should eat a gluten free diet. (No BR-O-W) Most concern is DEHYDRATION

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INFANT Stranger anxiety TODDLER Separation anxiety PRE-SCHOOLER Castration fear/body mutilation, fear of the dark SCHOOLER Fear of replacement/displacement in school, loss of privacy, fear of death

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Signs of TD include smacking lips, grinding of teeth and "fly catching" tongue movements.

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Restlessness, confusion, irritability and disorientation may be the first signs of fat embolism syndrome Restraint: frame of bed, quick release ties, document need for restraint Q4 hours IPPA for Physical Assessment IAPerPal

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Never ask WHY questions in the care of patients with psychiatric problem Gag Reflex: dont assess gag reflex to a client that has an absent swallow reflex

 Bone marrow Aspiration

Site: iliac crest; painful

 Myelogram Water-soluble dye: Elevate head of bed 30 degrees Oil based dye: Flat in bed (removed)

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Fractured Hip Assessments Leg shortened Adducted Externally rotated Implementation Abduction pillows Crutch walking with 3-point gait Dont sleep on operated side Dont flex hip more than 45-60 degrees Dont elevate head of the bed more than 45 degrees

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AMPUTATIONS Residual limb covered with dressing and elastic bandage (figure eight) Figure-8 doesnt restrict blood flow, shaped to reduce edema Elevated 24 hours (AKA-pillow, BKA-foot of bed elevated) Position prone daily Phantom Pain: acknowledge feelings, that pain is real for them.

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Proper positioning on NGT/enteral feeding Enteral feeding held if: >150 ccs aspirated or 50% given in the hour is aspirated If cramping, vomiting occurs decrease rate of enteral feeding or keep it warm.

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Specific gravity of urine: 1.010-1.030 pH: 4.5-8(Slightly acidic) UO: 1,000-1,500cc/day Credes Maneuver: Push urine out Displaced uterus in a postpartum mother: Check for distention Throbbing headache after SCI: Check bladder or fecal impaction

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Normal urine output (1200-1500 ccday or 50-63 cc/hr) Normal voiding pattern 5-6 times/day.` Infants: 6-8 times Green leafy vegetables contain vitamin K.

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Glucose Na K Cl Bicarbonate BUN Creatinine clearance Serum Creatinine

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Oculogyric crisis: uncontrollable rolling back of eyes: side effect of Phenothiazines Lithium helps control impulsive behaviors. Fluphenazine (Prolixin): antipsychotic medication

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Thiamine sources: organ meats, liver, whole grain, nuts, legume, egg, and milk. Dont document abuse. Report suspected abuse to nursing supervisor. Tonometry: measures intraocular pressure; to rule out glaucoma

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Blind client: address by name Introduce self Keep furniture arrangement consistent, open or close doors Walk step ahead Instilling ear drops lie patient on unaffected ear to absorb drops. Position patient on affected ear to promote drainage.

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Sick day rules: take insulin as ordered, check blood glucose q3-4 hours, soft foods, liquids

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Phenylketonuria (PKU) High blood phenylalanine (no enzyme) Results in mental retardation Provide milk substitutes, low-protein diet

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Hepatobiliary disease Decrease in ability of bile to absorb fat Cystic fibrosis: Absence of pancreatic enzymes; malabsorption of fat Lung disease Pancreatic enzyme replacement High-protein, high-calorie diet, respiratory care/suction

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Position right side to promote gastric emptying. Dumping syndrome prevention: Teaching on prevention of signs and symptoms Sengstaken-Blakemore Tube Treat patient with bleeding esophageal varices.

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Obese person choking: use Chest Thrusts. Care for patient first, equipment second Signs for hypoxia: restlessness, tachycardia

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Defibrillation Start CPR first 1st attempt 200 joules 2nd attempt 200 to 300 joules 3rd attempt 360 joules Check monitor between shocks for rhythm

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Cardioversion Elective procedure, Informed Consent Valium IV Synchronizer on 25-360 joules Check monitor between rhythm

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Hypovolemic: Decreased in intravascular volume Cardiogenic: Decreased cardiac output Septic shock Anaphylactic shock Neurogenic shock

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Shock Signs and Symptoms of SHOCK Cool, clammy skin Cyanosis Decreased alertness Tachycardia Hypotension Shallow, rapid respirations Oliguria Decreased CVP

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Increased ICP Assessments Altered LOC (Earliest Sign) Restlessness Glasgow coma scale <7 indicates coma

Confusion VS changes Unequal pupil

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Implementations for IICP Elevate head 30-45 degrees Avoid neck flexion and head rotation Reduce environmental stimuli Prevent Valsalva maneuver Restrict fluids to 1200-1500 cc/day Medications: Osmotic diuretics, corticosteroids

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Seizures: Do not restrain! Do not insert anything in mouth! No oral thermometer Protect airway during and after seizure Orient the client

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ELECTROLYTES Potassium :3.5-5.0 mEq/L Sodium :135-145 mEq/L Calcium :4.5-5.5 mEq/L or 9-11 Chloride :96-106 mEq/L Magnesium :1.5-2.5 mEq/L Phosphorus :1.2-3 mEq/L

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HYPOKALEMIA Assessments K+ < 3.5 mEq/L Muscle weakness Paresthesias Dysrhythmias Increased sensitivity to digitalis

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HYPOKALEMIA Implementations Potassium Supplements Dont give > 40 mEq/L into peripheral IV or without cardiac monitor Check URINE OUTPUT For infants not more than 1 cc! Increase dietary intake of K

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Hyperkalemia Assessments K+ >5.0 mEq/L ECG changes Paralysis Diarrhea Nausea

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Hyperkalemia Implementations K-I-D Restrict intake of K Calcium Gluconate and Na HCO3 Diuretics

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Hyponatremia Assessments Na+ < 135 mEq/L Nausea Muscle cramps Confusion

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Hyponatremia Implementations I & O Daily weight Increase oral intake of sodium rich foods Water restriction IV Lactated Ringers or 0.9% NaCL

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Hypernatremia Assessments Na+ >145 mEq/L Disorientation, delusion, hallucinations Thirsty, dry, swollen tongue Sticky mucous membranes

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Hypernatremia Assessments I & O Daily Weight Give hypotonic solutions: 0.45% NaCl or 5% Dextrose in water IV

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Hypercalcemia Assessments Ca+> 5.5 mEq/L Muscle weakness, lack of coordination Constipation, abdominal pain Depressed deep tendon reflexes

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Hypercalcemia Implementations 0.4% NaCl or 0.9% NaCl IV Encourage fluids (acidic drinks: cranberry juice) Diuretics Calcitonin Mobilize patient Surgery for hyperparathyroidism

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Hypocalcemia Assessments Ca+ < 4.5 mEq/L Tetany Positive Trousseaus sign Positive Chvosteks sign Seizures Confusion Irritability, paresthesias

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Hypocalcemia Implementations Oral calcium supplements Calcium gluconate IV Seizure precautions Meet safety needs

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Wound Care for Burns Pain, hyperkalemia, and shock are problems Isotonic fluids (Lactated Ringers) Closed method (Silvadene) Open method (Sulfamylon) IV pain medication initially: not PO takes too long, not IM circulation impaired

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Medicate patient before wound care Silver nitrate (warn patient skin will turn black) High calorie, High carbohydrate, High protein diet Vitamin B,C, and Iron TPN maybe used Prevent contractures

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Pheochromocytoma Assessment Increase in catecholamines Hypertension Collect urine for VMA Avoid abdominal palpation Prepare to give P medications

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COPD Assessments Blue Bloaters Pink Puffers Assume ORTHOPNEIC POSITION Barrel-chest Dyspnea Cough Adventitious breath sounds Clubbing

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COPD Implementations Assess airway clearance Listen to breath sounds Administer low-flow oxygen (1-2 LPM) Encourage fluids Small frequent feedings Humidify oxygen Use metered dose inhalers (MDI)