echocardiogram-used to assess heart valves. valve disorders require prophylactic antibiotics before invasive procedures. avoid IM injections when suspecting MI can affect CK levels hemodynamic measurements-transducer placed @ the midaxillary line at the fourth or fifth intercostal space phlebostatic axis. calcium channel blockers-assess for constipation 1. Neuroleptic malignant syndrome (NMS): -NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool 2.
I kept forgetting which was dangerous when you’re pregnant; regular measles (rubeola), or German measles (rubella), so remember: -never get pregnant with a German (rubella) 3. When drawing up regular insulin & NPH together, remember: -RN (regular comes before NPH) 4. Tetralogy of fallot; remember HOPS H- hypertrophy of right ventricle O- over-riding aorta P- pulmonary stenosis S- septal defect 5. MAOI’s that are used as antidepressants: weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI’s when they’re depressed. – explanation; MAOI’s used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)
Autonomic dysreflexia: potentially life threatening emergency – elevate head of bed to 90 degree – loosen constrictive clothing – assess for bladder distention and bowel impaction (triger) – Administer antihypertensive meds (may cause stroke, MI, seisure ) Normal ICP : 0 – 15mmHg Pulmonary embolus: S/S – pleuritic chest pain, dyspnea, low-grade fever, tachycardia, blood-tinged sputum. COPD : S/S – dyspnea on exertion, barrel chest, clubbed fingers and toes, tachypneic with prolonged expiratory phase. Tension pneumothorax – tracheal shift to opposite side, decreased venous return, neck vein bulge, tachycardia and tachypnea. -In complete heart block, the AV node blocks all impulses from the SA node, so the atria and ventricles beat independently, b/c Lidocaine suppresses ventricular irritability, it may diminish the existing ventricular response, cardiac depressant are contraindicated in the presence of complete heart block. –administrate Glucagon when pt is hypoglycemia and unresponsive –Bromocriptine (Parlodel) or Dantrolene (Dantrium) is used for CNS toxicity –Ibuprofen (Motrin) S/E includes epigastric distress, nausea, occult blood loss, peptic ulceration, use cautiously with history of previous gastrointestinal disorders. -Aminophylline (Truphylline) use with Propranolol (Inderal) may decrease metabolism and lead to toxicity –Antianxiety medication is pharmacologically similar to alcohol, is used effectively as a substitute for alcohol in decreasing doses to comfortably and safely withdraw a client from alcohol dependence — Tagamet decrease gastric secretion by inhibiting the actions of histamine at the H2-receptor site, constipation is a common side effect of this med, should increase fiber in diet. Take with meals and at bedtime. -elderly clients and clients with renal problems are most susceptible to CNS side effects (confusion, dizziness) of the medication 1st TRIMESTER (Chorionic villis sampling, US scan) 2nd TRIMESTER (AFP screening or Quad Screening,Amniocentesis) 3rd TRIMESTER (kick counts,Nonstress Test,Biophysical Profile, Percutaneous Umbilical Blood sampling, Contraction Stress Test ) Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill bladder) -Confirms viability -Indicates fetal presentation -Confirms multiple gestation -Identifies placental location Measurements can be taken to confirm/estimate gestational age -Identify morphologic anomalies Chorionic villis sampling 8-12 weeks for early diagnosis of genetic, metabolic problems Amniocentesis -13-14 weeks Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes, development, viability and lung maturity AFP 15-18 weeks-Maternal Blood Drawn AFP also called =Quad marker screening: -maternal serum alpha fetoprotein (MSAFP), -human chorionic gonadotropin (HcG), -unconjugated estriol (UE), -and inhibin A low AFP-Down syndrome high-Spina bifida t is not an absolute test if it is abnormal -further investigation is recommended Kick counts (tests Uretro placental capability) Same time every day mother records how often she feels the fetus move if mininum 3 movements are not noted within an hour’s time, the mother is encouraged to call her physician immediately! Nonstress Test checks FHR and mother detects Fetal movements. Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and CO2 exchange) -IV accessed and performed in a labor and deliver unit under electronic fetal monitoring contractions initiated by Pitocin or nipple stimulation he desired result is a “negative” test which consists of three contractions of moderate intensity in a 10 minute period without evidence of late decelerations the test is done to detect problems so if it is Positive (persistent late decelerations ) then-CS how is done: The electronic fetal monitor is placed on the maternal abdomen for 20-30 minutes Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15 seconds A reactive (good) test =>2 accelerations in FHR occur with associated fetal movement Biophysical Profile (BPP) dentification of a compromised fetus and consists of 5 components: -fetal breathing movement -fetal movement of the body or limbs -fetal tone (extension or flexion of the limbs) -amniotic fluid volume index (AFI) visualized as of fluid around the fetus -reactive non-stress test each component 0-2, 8-10-desirable. Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured -chromosomal anomalies, feta karyotyping, and blood disorders
Evrywhere where woman’s abdomen is punctured informed consent is needed, and risks like amnionitis spontaneous abortion, preterm labor/delivery, and premature rupture of membranes must be explained. If she Rh–she may be RHoGAM given. compartment syndrome… significant increase in pain not responsive to pain meds. Plaquenil-tx of Rhem Arthritis… recommend eye exam every 3 mo. Statins- tx of high cholesterol… ASSESS FOR MUSCLE PAIN… moniter liver enzymes. Nicotinic Acid (Niacin)-tx of high cholesterol- flushing occurs in most pt. will diminish over several weeks. tages of shock (its more but i made it simple “KISS” keep it simple stupid lol! ) early- increase in pulse… normal urine output intermediate-RAS (renin-angioten system), low urine output, cool skin, pallor late-no urine output, low BP irreversible stage! Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and hair Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft hair Thyroid storm: increased temp, pulse and HTN Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca, low phosphorus diet Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low Ca, high phosphorus diet Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific gravity >1. 030 Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific gravity Drooling, Dysphagia, Dysphonia and Distress inspiratory efforts 9. Niacin (Vit B) is a lipid lowering agent.
Foods high in Niacin are meats, eggs, milk, dairy products 10. Child with 3 C’s (Cough-Choke-Cyanosis) should be assessed for tracheoesophagial fistula 11. Gastric lavage is a priority for an infant who has been identified as suffering from botulism 12. Viral meningitis usually does not require protective measures 13. [pic] 14. Myasthenia gravis–muscle weakness that occurs mostly in the throat and face as results from the deficits of the nerve impulses conducting at the myoneural junction. Pancuronium and succinylcholine are neromuscular agents that should be used with caution because of the chance of prolonging recovery.
Clients with CRF are to be on a high carbohydrate diet to prevent protein metabolism. Pt’s must limit protein, sodium and potassium and fluids because the kidneys cannot excrete an adequate amount of urine. ABG’s is the best way to monitor pulmonary status by analyzing the level of hypoxia caused by pulmonary edema and for monitoring effects of treatment. Cardiogenic shock–there is low cardiac output from heart pump failure such as in heart failure, sever cardiomyopathy, acute MI. Pancreatitis-high carb, low fat diet. IV cimetidine(Tagamant) given as treatment for a bleeding peptic ulcer may experience hyptotention if given too rapidly.
If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the hematocrit reaches normal levels (30% to 33%) in 2 to 3 months. Clients with oxalate stones should avoid foods high in oxalate such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine
Clients who form uric acid calculi should be placed on a low-purine diet. The intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on physician prescription, the urine may be either alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice. Controlling edema is a critical aspect of therapeutic management of the client with nephrotic syndrome. A diet high in protein may help the body restore normal plasma oncotic pressure, thus decreasing edema.
Dietary modifications may include salt restrictions and fluid restriction and is based on the client’s symptoms. Bed rest is prescribed to promote diuresis when edema is severe Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased excretion of protein in the urine, decreased serum albumin levels, increased serum lipids, and edema.
In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky During the oliguric phase of acute renal failure, urine output is less than 100 mL in a 24-hour period. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client’s serum level, or about 300 mOsm/L. The diuretic phase of acute renal failure develops about 14 days after the initial insult and lasts about 10 days.
It is characterized by an increase in urine output of more than 1000 mL in a 24-hour period In an alkaline ash diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine.
The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH The client must produce increased ADH, which will increase reabsorption of water in the renal tubules and increase circulating volume Diabetes insipidus results from insufficient ADH production, which causes the kidneys to excrete large volumes of urine. Water intoxication represents the opposite problem of that experienced with diabetes insipidus. Clients in renal failure do not manufacture adequate amounts of erythropoietin, which is a glycoprotein needed to synthesize red blood cells.
Renin, angiotensin, and aldosterone are substances that assist in maintaining blood pressure. With increased potassium retention, the kidneys excrete more sodium. Sodium is a cation. With increased retention of sodium, the kidneys also increase reabsorption of chloride and bicarbonate, which are anions. The stimuli for ADH release are increased serum osmolality and decreased blood volume. Physiological stress, alcohol intake, and a cold environment all can cause the release of ADH Using the process of filtration, creatinine is removed from the body in the glomerulus.
Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle. Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and hypocalcemia, they are the most relevant to nursing management of the client with chronic renal failure CRF is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. The typical signs and symptoms of CRF include proteinuria or hematuria
Urge incontinence occurs when the client experiences involuntary loss of urine soon after experiencing urgency. Reflex incontinence occurs when incontinence occurs at rather predictable times that correspond to when a certain bladder volume is attained. Stress incontinence occurs when the client voids in increments of less than 50 mL under conditions of increased abdominal pressure Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
The parietal lobe of the brain is responsible for spatial orientation and awareness of sizes and shapes. The ability to distinguish an object by touch is called stereognosis, which is a function of the right parietal area. The left parietal area is responsible for mathematics and right-left orientation The occipital lobe is responsible for reception of vision and contains visual association areas. This area of the brain helps the individual to visually recognize and understand the surroundings
Broca’s area in the brain is responsible for the motor aspects of speech, by coordinating the muscular activity of the tongue, mouth, and larynx. The term assigned to damage in this area is called aphasia. Carbon dioxide is one of the metabolic end products that can alter the tone of the blood vessels in the brain. High carbon dioxide levels cause vasodilation, whereas low carbon dioxide levels cause vasoconstriction. As a result, the client may experience headache and lightheadedness, respectively The vagus nerve is responsible for sensations in the thoracic and abdominal viscera.
It also is responsible for the decrease in heart rate because approximately 75% of all parasympathetic stimulation is carried by the vagus nerve. After supratentorial surgery (surgery above the tentorium of the brain), the head of the client’s bed usually is elevated 30 degrees to promote venous outflow through the jugular veins. Epidural hematomas frequently are characterized by a “lucid interval” that lasts for minutes, during which the client is awake and talking. After this lucid interval, signs and symptoms progress rapidly, with potentially catastophic intracranial pressure increase.
Epidural hematomas are medical emergencies. Brown-Sequard syndrome results from hemisection of the spinal cord, resulting in ipsilateral paralysis and loss of touch, pressure, vibration, and proprioception. Contralaterally, pain and temperature sensation is lost because these fibers decussate after entering the cord. Clients with Guillain-Barre syndrome have dysphagia. Clients with dysphagia are more likely to aspirate clear liquids than thick or semisolid food Clients with cholinergic crisis have experienced overdosage of medication.
Tensilon will exacerbate symptoms in cholinergic crisis to the point at which the client may need intubation and mechanical ventilation. Intravenous atropine sulfate is used to reverse the effects of these anticholinesterase medications Buck’s extension traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture Following pin insertion for skeletal traction, a small amount of bleeding is expected. This can be controlled with small pressure dressings; A small amount of serous oozing is expected at pin insertion sites.
Signs of infection such as inflammation, purulent drainage, and pain at the pin site are not expected findings and should be reported to the physician. A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and promote venous drainage. The client is taught to hold the cane on the side opposite from the weakness. The reason is that with normal walking, the opposite arm and leg move together (called reciprocal motion). The cane is placed 4 to 6 inches lateral to the fifth toe. 1. Larngotracheobronchitis: inspiratory stridor and restlessness 2.
Thorazine: antidote cogentine SE: akathisia(motor restlessness) dystonia(tongue protrusion, abnormal posture) and diskinesia(stiff neck, difficulty swallowing) 3. Toddlers- parrallel play; infants enjoy company but self play. 4. IV infiltraton D/C IV and apply warm compress. 5. Urticaria= hives. 6. Graves disease: enlarged thyroid, increased metoblism and of course weight loss. 7. The goal for COPD is to improve ventilation. 8. From birth to 18 months Trust vs Mistrust 9 HbA1C- indicates BS for past 6-8 weeks(time varies with source) 2. 5-6% normal. 10. myasthemia gravis: autoimmune disease of neuro jnx. estroys Acetylecholine receptors. 11. Meniere’s: Inner ear disease: vertigo, tinnitus, sensorineuro hearing loss, N/V 12. Use play therapy for children d/t inability to verbalize emotions. 13. Phenergan: Check vein patency (very important) 14. Visine: contraindicated in glaucoma d/t vasoconstriction DONNING PPE (Personal Protective Equipment) GOWN Fully cover torso from neck to knees, arms to end of wrist, and wrap around the back Fasten in back at neck and waist MASK OR RESPIRATOR Secure ties or elastic band at middle of head and neck Fit flexible band to nose bridge
Fit snug to face and below chin Fit-check respirator GOGGLES/FACE SHIELD Put on face and adjust to fit GLOVES Use non-sterile for isolation Select according to hand size Extend to cover wrist of isolation gown SAFE WORK PRACTICES Keep hands away from face Work from clean to dirty Limit surfaces touched Change when torn or heavily contaminated Perform hand hygiene REMOVING PPE Remove PPE at doorway before leaving patient room or in anteroom GLOVES Outside of gloves are contaminated! Grasp outside of glove with opposite gloved hand; peel off Hold removed glove in gloved hand
Slide fingers of ungloved hand under remaining glove at wrist GOGGLES/FACE SHIELD Outside of goggles or face shield are contaminated! To remove, handle by “clean” head band or ear pieces Place in designated receptacle for reprocessing or in waste container GOWN Gown front and sleeves are contaminated! Unfasten neck, then waist ties Remove gown using a peeling motion; pull gown from each shoulder toward the same hand Gown will turn inside out Hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle MASK OR RESPIRATOR
Front of mask/respirator is contaminated – DO NOT TOUCH! Grasp ONLY bottom then top ties/elastics and remove Discard in waste container HAND HYGIENE Perform hand hygiene immediately after removing all PPE! Chicken pox(13-17 days)–prodromal, child have malaise, fever, anorexia. Rash is pruritic, and starts out as a macule then papule then a vesicle. Spread by direct contact, droplet and contaminated object. ISOLATE till all vesicles are crusted; it can be spread from 2 days before the rash begins. Avoid use of aspirin due to Reye’s syndrome, use tylenol. Airborne–door can be closed.. easles (RUBEOLA), M. tuberculosis, disseminated zoster(shingles), varicella(chicken pox)–again can cohort and place in same room with the same infective organism. Droplet–door may be open—Streptococcus pharyngitis, meningitis, pneumonia, adeno virus, epiglottitis, influenza, mumps, mycoplasma pneumonia, or meningococcal, parvovirus, pertussis, pneumonia,rubella, scarlet fever, sepsis… private room or pt with same infection–involves contact with mucous membranes of nose or mouth… happens during talking, coughing, suctioning. MAINTAIN 3FEET between infected patients and visitors.
Rubella–there’s a maculopapular rash on face and all over the body. Prodromal: malaise and fever which is followed by cough. Spread by droplets and contaminated objects. placed on contact precautions, isolate child from pregnant women. Contact- c-diff, RSV, mrsa, wound infections,skin infections, diarrhea stuff-enteric infections The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by narcotics, pain that increases with limb elevation, and pallor and coolness to the distal limb.
Cyanosis is a late sign To achieve proper traction, weights need to be free-hanging, with knots kept away from the pulleys When going down the stairs with crutches, the client should be instructed to move the crutches and the affected leg, then move the unaffected leg down. To go up the stairs, the client should first move up the unaffected leg and then move up the affected leg and crutches. In a three-point gait, the client is instructed to simultaneously move both crutches and the affected leg forward and then to move the unaffected leg forward.
Edema in the extremity indicates impaired venous return. Signs of impaired arterial circulation in the limb include coolness and pallor of the skin and a diminished arterial pulse. A gallium scan is similar to a bone scan, but with injection of gallium isotope instead of technetium Tc 99m. Gallium is injected 2 to 3 hours before the procedure. The procedure takes 30 to 60 minutes to perform. The client must lie still during the procedure. There is no special aftercare. A straight leg cane is useful for the client with slight weakness in one leg.
A walker is beneficial to the client with greater or bilateral weakness, or the client who is at risk for falls. Wooden crutches often are used by clients with a leg cast. Lofstrand crutches aid clients who need crutches but have limited arm strength. Clients with low back pain often are more comfortable when placed in William’s position. The bed is placed in semi-Fowler’s position with the knee gatch raised sufficiently to flex the knees. This relaxes the muscles of the lower back and relieves pressure on the spinal nerve root.