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Have trouble remembering fhr patterns in OB?
Think VEAL CHOP
A OL P
V = variable decels; C = cord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, not a problem!L = late decels P = placental insufficiency, can't fill
Positioning For late decels
turn the mother to her left side, to allow more blood flow to the placenta
For any kind of bad fetal heart rate pattern, what do you do?
When doing an epidural anesthesia, what is priority?
If the baby is anterior, where do you listen for FHR?
the sounds are heard closer to midline, between the umbilicus and where you would listen to a posterior presentation.
If the baby is breech, where do you listen for FHR?
the sounds are high up in the fundus near the umbilicus.
If the baby is vertex, where do you listen for FHR?
they are a little bit above the symphysis pubis.
to remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
ICP AND SHOCK HAVE OPPOSITE V/S, what are they?
ICP-increased BP, decreased pulse, decreased resp. (ICPIDD)shock- decreased BP, increased pulse, increased resp.
right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a choice.) caused by pulmonary disease, occurs with bronchitis or emphysema
Fluid may back up into your abdomen, legs and feet, causing swelling.
Left sided heart failure (Left=lungs)
Fluid may back up in your lungs, causing shortness of breath. Auscultate lungs.
no meat and milk together
pulse area cpr on an infant.
source of potassium
best way to warm a newborn
skin to skin contact covered with a blanket on mom
when a pt comes in and she is in active labor, what is priority for nurse?
nurse first action is to listen to fetal heart
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 patient’s body, not the machines/equipments.2. Key words are very important. Avoid answers with absolutes for example: always, never, must, etc.
with above the knee amputations, patient is placed in what position to prevent contracture?
patient is placed in prone (on stomach) position for 20 or 30 minutes a day to prevent contracture
What can’t be delegated to unlicensed assistive personnel
Assessment, teaching, meds, evaluation, unstable patient
LVN/LPN cannot handle blood.
Amynoglycosides (like vancomycin) cause:
nephrotoxicity and ototoxicity
IV push should go over at least...(how many minutes?)
In an emergency, what patients should be helped first?
patients with greater chance to live are treated first
Cardinal sign of ARDS (acute resp. distress syndrome)
hypoxemia (low oxygen level in tissues)
lungs and kidneys
Edema is in what space?
the interstitial space not in the cardiovascular space
What is the best indicator of dehydration?
wherever there is sugar (glucose), what follows?
What can cause Reyes Syndrome?
when aspirin is given once a day it acts as:
Cold vs. Heat for what types of pain?
use Cold for acute pain (eg. Sprain ankle) and Heat for chronic
What is great for chronic pain?
Guided imagery (the use of words and music to evoke positive imaginary scenarios in a subject with a view to bringing about some beneficial effect.)
Test tip: when patient is in distress, medication administration is ... (good or bad answer?)
rarely a good choice as an answer.
with pneumonia, what is usually present
fever and chills are usually present. For the elderly
confusion is often present.
COPD vs. Pneumonia
COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both a form of COPD (chronic obstructive pulmonary disease)
LPM of O2 for COPD
4 options for cancer management
chemo, radiation, surgery, allow to die with dignity.
neutropenic patients shouldn’t have what? (neutropenia is an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections, particularly those caused by bacteria and fungi.)
no live vaccines, no fresh fruits, no flowers
chest tubes are placed where?
Angina vs. MI (myocardial infarction)
angina (low oxygen to heart tissues) = no dead heart tissues.
MI = dead heart tissue present.
mevacor (anticholesterol med) must be given with:
evening meal if it is QD (per day).
Rules for nitroglycerin for chest pain
up to 3 times (every 5 minutes).
If chest pain does not stop go to hospital.
Do not give when BP is < 90/60.
unstable angina is not relieved by nitro
Preload vs. Afterload (concerning heart function)
Preload affects amount of blood that goes to the R ventricle.
Afterload is the resistance the blood has to overcome when leaving the heart.
Does calcium channel blockers affect afterload or preload?
1 T(tablespoon)= ___ t = ___ ml
1 cup= __ oz
1 quart= __ pints
1 gr (grain)= __ mg
1 g (gram)= ___mg
1 kg= ___ lbs
1 lb= __ oz
Antidote for heparin toxicity=
Antidote for coumadin=
Antidote for ammonia=
Antidote for acetaminophen=
Antidote for Iron=
Antidote for Digitoxin, digoxin=
Antidote for Alcohol withdraw=
What increases likelihood of Digitalis toxicity? (same as digoxin Used for heart failure)
Platelet aggregation (clotting)
when patient is on Coumadin, what tests are elevated?
Does cardiac output decrease or increase with
Dopamine increases what VS
Med of choice for Vtach is (ventricular tachycardia)
Med of choice for SVT (Supraventricular tachycardia)
Med of choice for Asystole (no heart beat)
Med of choice for CHF (congestive heart failure)
Med of choice for anaphylactic shock
Med of choice for Status Epilepticus is
Med of choice for bipolar is
What med is effective in both ventricular and atrial complications
give carafate (GI med) when?
before meals to coat stomach
Protonix is given prophylactically to prevent what?
after endoscopy check what?
TPN(total parenteral nutrition) given in what line?
low residue diet means
diverticulitis (inflammation of the diverticulum in the colon) pain is in what quadrant
Appendicitis (inflammation of the appendix) pain is in what quadrant?
RL quadrant with rebound tenderness.
portal hypotension + albuminemia=.
beta cells of pancreas produce
What medication is contraindicated in Pancreatitis.
Morphine. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given.
signs observed in hypocalcemia
What is Diabetic ketoacidosis (DKA)=
when body is breaking down fat instead of sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
DKA is rare in diabetes mellitus type II because:
there is enough insulin to prevent breakdown of fats.
Sign of fat embolism is
petechiae. Treated with heparin.
for knee replacement use what type of machine
continuous passive motion machine.
give prophylactic antibiotic therapy when?
before any invasive procedure, such as surgery.
glaucoma patients lose what type of vision.
Peripheral. Treated with meds
Cataract is associated with what type of vision
cloudy, blurry vision. Treated by lens removal-surgery
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
spinal shock occurs when
Multiple sclerosis is =
myelin sheath destruction, disruption in nerve impulse conduction.
myasthenia gravis is =
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.
Tensilon test given if
muscle is tense in myasthenia gravis.
ascending (moving from bottom to top of body) paralysis. Keep eye on respiratory system.
RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa.
TIA (transient ischemic attack)
mini stroke with no dead brain tissue
CVA (cerebrovascular accident) is
cancer of lymph is very curable in early stage.
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% ?
Birth weight doubles by __ month and triple by __ year of age.
do not give dig to children when?
first sign of cystic fibrosis may be
meconium ileus at birth. (Baby is inconsolable, do not eat, not passing meconium.)
rheumatic fever can lead to.
cerebral palsy =
poor muscle control due to birth injuries and/or
decrease oxygen to brain tissues.
ICP (intracranial pressure) should be <
2; measure head circonference.
dilantin level (10-20)
for Meningitis check for ____________ signs.
hemophilia is passed on by who?
Buck’s traction immobilizes what part of body?
Russell traction involves what part of body?
Bryant’s traction is used for what=
perform amniocentesis before ___ weeks gestation to check for cardiac and pulmonary abnormalities.
Rh- mothers receive ______ to protect next baby.
anterior fontanelle closes by __ months. Posterior ____ weeks.
diffuse edema of the fetal scalp that crosses the
suture lines. Swelling reabsorbs within 1 to 3 days.
placenta previa vs placenta abruption
placenta previa = there is no pain, there is bleeding.
Placenta abruption = pain, but no bleeding.
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).
Do not use why or I understand statement when dealing with patients.
FIVE INTERVENTIONS FOR PSYCH PATIENTS
-estsablish trusting relationship
-least restrictive methods/environment.
SSRI’s (antidepressants) take about ___ weeks to work.
Obsession vs compulsion
Obsession is to thought.
Compulsion is to action.
High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites
Low press alarm- Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous
What syringe is used for epinephrine?
F= C+40, multiply 9/5 and substract 40
* To convert Fahrenheit to C. C=
Thorazine, haldol (antipsychotic) can lead to
HYPERthyroidism think of MICHAEL JACKSON in THRILLER!
SKINNY, NERVOUS, BULDGING EYES, Up all night, heart beating fast
Atropine used to
Phenergan an antiemetic used to
Diazepam is a commonly used
tranquilizer given to reduce anxiety before OR (surgergy)
Demerol is for
Do not give demerol to pts. with sickle cell crisis.
Iron injections should be given by what injection method?
Developmental stages for children
2-3 months: turns head side to side
4-5 months: grasps, switch & roll
6-7 months: sit at 6 and waves bye-bye
8-9 months: stands straight at eight
10-11 months: belly to butt (phrase has 10 letters)
12-13 months: twelve and up, drink from a cup
Hepatitis A cause:
-ends in a VOWEL, comes from the BOWEL
Hepatitis B cause=
Hepatitis C is
Apgar measures HR,RR,Muscle tone, Reflexes,Skin color. What is the numbers used?
each 0-2 point.
The person who hyperventilates is most likely to experience
Addison's disease treatment vs
Addison's:(need to "add" hormone)
Cushing's: (have extra "cushion" of hormones)
increase fat and protein,
small frequent meals,
lie down after meal to decrease peristalsis,
wait 1 hr after meals to drink.
universal donor (remember "o" in donor)
"AB" is the
Give NSAIDS, Corticosteroids, drugs for Bipolar, Cephalosporins, and Sulfanomides WITH what?
When using a bronchodilator inhaler in conjuction with a glucocorticoid inhaler, which do you administer first?
Theophylline increases the risk of
Theophylline decreases the effects of
Peptic ulcers caused by H. pylori are treated with
Flagyl, Prilosec and Biaxin. This treatment kills bacteria and stops production of stomach acid, but does not heal ulcer.
Best time to take Growth Hormone
Best time to take steroids, diuretics and aricept
Thyroid storm is
Myxedema coma is
Glaucoma intraocular pressure is greater than the normal (22 mm Hg). What medication is used?
(pilocarpine) NO ATROPINE.
RHUBARB, SARDINES, COLLARD GREENS
Apply eye drop to conjunctival sac and after wards apply pressure to nasolacrimal duct / inner
Yogurt has live cultures-
dont give to immunosuppressed pt
pain with palpation of gall bladder area seen with cholecystitis
Cullen’s sign –
ecchymosis in umbilical area, seen with pancreatitis
Turner’s sign –
flank grayish blue (turn around to see your flanks) pancreatitis
McBurney’s Point –
Guthrie Test –
Tests for PKU, baby should have eaten source of protein first.
PKU is rare inherited disorder that causes an amino acid called phenylalanine to build up in your body
Shilling Test –
Only given to Rh NEGATIVE mother.
if positive, don’t need to give Rhogam cuz she has antibody only give
if negative coombs
a condition in which there is a degeneration of motor
neurons in both the upper & lower motor neuron systems.
Transesophageal Fistula (TEF) -
esophagus doesn't fully develop (this is a surgical emergency)
The 3 C's of TEF in the newborn:
Yellow---stable, can wait up to an hour for treatment, ie burns, see second
stable, can wait even longer to be seen, "walking wounded"
unstable clients that will probably not make it, need comfort measures
What is a contraindication for Hep B vaccine.
Ask for allergy to eggs before what kind of shot?
before MMR check for what allergies?
Ask for anaphylactic rxn to eggs or neomycin
EXTERNAL ROTATION, SHORTENING, ADDUCTION
TIDAL VOLUME should be
7 – 10ml / kg
Separation anxiety peaks when?
- irreversible - involuntary movements of the tongue, face and extremities,
may happen after prolonged use of antipsychotics
a pt's bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior
For a lung biopsy,
table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for
complication of pneumothorax, sterile dressing applied
For a lumbar puncture, pt is positioned
afterwards, sterile dressing, frequent neuro assessments
What to do before EEG,
stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing
light, after EEG, assess pt for seizures, pt's will be at increased risk
INH, used to treat and prevent TB, do not give with dilantin, can cause phenytonin toxicity,
monitor LFT's, give B6 along with, hypotension will occur initially, then resolve
Rifampin, for TB, dyes bodily fluids orange
Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia,
tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway),
monitor for early signs of reaction and give IM Benadryl
first line antipsychotic in
Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6
Decorticate is toward the 'cord'. Decerebrit is the other way (out)
strabismus and also to relax vocal cords in spasmodic dysphonia.
psychiatric disorder that causes an individual to self-inflict injury
or illness or to fabricate symptoms of physical or mental illness, in order to receive medical careor hospitalization. In a variation of the disorder
Munchausen by proxy (MSBP),
typically a mother, intentionally causes or fabricates illness in a child or other person under her
is a chronic, progressive disease with demyelinating lesions in the CNS which
affect the white matter of the brain and spinal cord.
limb weakness, paralysis, slow speech
nystagmus, ataxia, dysphagia, dysarthria
50% genetic, autosomal dominant disorder
S/S: chorea --> writhing, twisting, movements of face, limbs and body
-gait deteriorates to no ambulation
-no cure, just palliative care
-Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.
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