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Addison's Disease

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- Is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone. - The disease is characterized by weight loss, muscle weakness, fatigue, low BP and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

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Common symptoms of Addison's Disease

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- Weight loss - Hyperpigmentation - Weakness/fatigue - Low BP - Loss of Body hair

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Cushing's Disease

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- S/S: Hirsutism (excessive hair), moon face, purple striatum (typically in the skin of the abdomen, thighs or breast), thin extremities, buffalo hump

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Testing for TB

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- A Mantoux skin test is the most accurate and valuable screening tool available for TB. A positive result means only that the client has been exposed to TB; it does not meant that the client has active TB. - A sputum culture for acid fast bacillus (AFB) is used to confirm the diagnosis of pulmonary TB after a screening test and chest x-ray come back positive.

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Teaching instructions for the use of a cane:

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(1) The cane is moved forward about 12 inches (2) Then, the weak leg is moved even with the cane. (3) Finally, the strong leg is brought forward and ahead of the cane and weak leg. - Canes are held on the strong side - The grip of the cane should be level with the trochanter of the femur

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Veracity

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- Is truthfulness. This is the value that requires the nurse to tell the truth to every client and to make sure that the client fully understands the message.

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Autonomy

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- Is the right to independence and personal freedom, which leads to the primacy of self-determination

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Fidelity

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- Is the duty to keep promises. It refers to the obligation to be faithful to agreements, commitments and responsibilities that are made.

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Nonmaleficence

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- Is the obligation and duty to do no harm.

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Meningococcal vaccine

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- Recommended that this vaccine be given to children who are 11 through 12 years of age and then given a booster dose at age 16.

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When should the single dose of Herpes zoster vaccine be given?

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- To adults 60 years or older whether or not they report a previous episode of herpes zoster.

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Rotavirus should be given at what age?

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- During the child's first year of life.

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Alendronate (Fosamax)

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- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease. - Alendronate must be taken first thing in the morning on an empty stomach. - The pt must be instructed to wait at least 30 minutes after taking Alendronate before eating, drinking, or taking other medications.

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What to expect with a pt having a chest tube?

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- Continuous gentle bubbling in the suction control chamber - Crepitus (with a pneumothorax, this will persist for several hours depending) - Oscillations or also called tidaling in the water seal chamber upon respiration are also expected.

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Symptoms of hypocalcemia

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- Numbness and tingling in the hands, soles of the feet and around the lips. - A nurse would assess the client for a positive reaction by eliciting the Chvostek's sign.

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What is a potential complication of a thyroidectomy?

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- Hypocalcemia, which can include numbness and tingling in the hands, soles of the feet and around the lips.

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What assessment tool would a nurse use to determine hypocalcemia?

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- Chvostek's sign

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What is Chvostek's sign? And how is it done?

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Tap on the pt's face at a point just anterior to the ear and just below the zygomatic bone. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia.

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Brudzinski's sign

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- Is an indication of meningeal irritation, which may be positive with pt's with meningitis. - To perform this, the client needs to be supine. The nurse places one hand behind the pt's head and places the other hand on the clients chest. The nurse then raises the clients head (with the hand behind the head) while the hand on the chest restrains the clients and prevents the client from rising. Flexion of the clients lower extremities constitutes a positive sign.

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Kernig's sign

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- Is an indication of meningeal irritation. The maneuver is usually performed with the client supine with hips and knees in flexion. Extension of the knees is attempted and the inability to extend the clients knee beyond 135 degrees w/out causing pain constitutes a positive test.

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Babinski sign

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- This is used to test for brain damage or upper motor neuron damage. It is considered positive if the toes flare up upon stroking the plantar aspect of the foot.

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Cataract surgery discharge instructions

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- Do not lift anything heavier than 10lbs for at least one week - Sleep on your back or unaffected side to lessen the pressure. - Need to report any pain, decrease in vision or increase in discharge in the eye. - It is normal to feel itching and mild discomfort after surgery, but the pt should be instructed not to rub or place pressure on the eye.

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Exposure or possible exposure to anthrax

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- Administer an antibiotic prophylaxis to all pt's newly exposed **Those exposed to anthrax do not require decontamination and are not considered contagious**

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Botulism treatment

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- Give an antitoxin

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Why would lidocaine (Xylocaine) be given to someone following cardiac arrest?

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- Lidocaine is an antiarrhythmic med that is commonly used to restore a regular heartbeat in a client who has arrhythmia. This effect is produced by delaying abnormal nerve pulses to the heart and reducing irritability of the heart tissue.

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Factors that can trigger an exacerbation of SLE?

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- Infection (especially a strep or viral infection. This can be a major stressor and can trigger an exacerbation) - Pregnancy (due to hormonal changes. The pt should be advised of the risks and must be monitored closely for effects on the renal and cardiovascular system if she decides to get pregnant) - Sunlight (Exposure to sunlight and artificial UV light is the leading cause of SLE exacerbation manifestations, especially the characteristic skin manifestations of lesions and butterfly rash)

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Hemoptysis

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Coughing up blood or bloody sputum

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Normal BUN value

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7-20 mg/dL

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Normal Hemoglobin levels

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Male: 13-18 g/100mL Female: 12-16 g/100mL

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Normal Hematocrit levels

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Male: 45%-52% Female: 37-48%

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Normal lactic acid levels

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0.5-1.5 mEq/L

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Normal creatinine levels

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0.8-1.4 mg/dL

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Defense mechanism: Conversion

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- Operating unconsciously, expresses emotional conflict via physical symptoms. EX: The pt converts repressed ideas or impulses into a variety of somatic (physical) symptoms that may include paralysis, pain or loss of sensory function.

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Defense Mechanism: Projection

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- In which the pt refused to acknowledge unacceptable personal characteristics and transfer feelings, thoughts or traits onto another person. EX: Projecting emotions about self onto something or someone else.

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Defense Mechanism Undoing

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- Is also known as reaction formation. It is a defense mechanism in which the pt, operating unconsciously, acts out of behavior or attitude in opposition to what he really believes.

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Defense Mechanism Idealization

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- Is when the positive attributes of another person are exaggerated in an effort to reduce related emotional conflicts. EX: Someone that got into a horrible car accident and had to go through rehab to walk again, now wants to be a physical therapist for a career.

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What diagnostic test would help the nurse monitor and evaluate the effectiveness of the aspirin medication for an Rhematoid arthritis patient?

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- Erythrocyte sedimentation rate (ESR) ** RA is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA.**

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Antinuclear antibody (ANA)

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- ANAs are frequently present in pts who have systemic lupus erythematosus and other autoimmune disorders such as RA and scleroderma.

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Rheumatoid factor (RF) diagnostic test

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This is helpful in diagnosing RA, but the levels do not always correlate with the severity of the disease activity.

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Cheyne-Stokes Respirations

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- Is characterized by a rhythmic increase (to the point of hyperventilation) and decrease (to the point of apnea) in the rate and depth of respirations. - It is commonly seen in pts who are unconscious, comatose or moribund (approaching death).

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Cryoprecipitate

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- Clients with hemophilia (deficiency of clotting factor), are given cryoprecipitate to replace the deficient factor as a prophylactic measure before any invasive procedure, surgery or when actively bleeding. - Cryoprecipitate provides therapeutic amounts of Facto 8, Factor 13, von Willebrand factor and fibrinogen. These concentrates are made with recombinant DNA technology and are the treatment of choice with hemophilic A and von Willebrands disease.

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Cisplatin (Platinol)

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- Treatment for cancer. - If a client has reported fatigue it is important to check the pts most recent CBC. The client I likely to be anemic as a result of myelosuppression (bone marrow suppression) from the chem. The pt may require tx for the anemia (transfusion, medications) and further chemo may be need to be delayed until the blood counts are higher.

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Jerking movements of the extremities

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- Such as ataxia, may be seen with many neurologic conditions affecting the clients ability to produce a smooth movement.

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Ataxia

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Jerky movements of the extremities

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Spasm of the extremities

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- Involuntary spasms may be found with such conditions as cerebral palsy, trauma, cerebral infection and certain degenerative disorders.

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Peripheral neuropathy

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- Is a neurological disorder resulting from damage to the peripheral nerves. It may be caused by diseases of the nerves, systemic illness or a side-effect from chemo. If sensory nerve is damaged, the client is likely to experience pain, numbness, tingling, burning or a loss of feeling in the extremities.

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RAST testing

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- Involves measuring the quantity of IgE present in the serum after exposure to specific antigens that are selected based on the pts symptom hx. An elevated IgE indicates a positive response to RAST testing and is seen in pts who have a hx of allergic manifestations, anaphylaxis and asthma.

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Immunoglobulin G (IgG)

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An elevation of this indicates the production of antibodies to all types of infections

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Immunoglobulin A (IgA)

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An elevation in this is associated with several autoimmune diseases and chronic infections

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Immunoglobulin M (IgM)

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IgM produces antibodies against the ABO blood groups and gram-negative.

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If clear drainage is coming out of a patient and you suspect that it could be CSF, first action is to?

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- Test it for glucose, then notify doctor

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What is a complication that you should frequently assess if a patient is suspected of having diabetes insipidus?

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- Hypotension **A pt who has diabetes insipidus will continue to excrete urine even though there is no intake. Hypovolemia, with resulting hypotension is possible.**

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Active TB treatment duration?

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- Active TB is usually treated with the simultaneous administration of a combo of meds to which the organisms are susceptible. Such therapy is continued until the disease is controlled. A 6-9 month regimen consisting of two meds is frequently used.

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Chlorpromazine (Thorazine)

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- Chlorpromazine is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12. Chlorpromazine is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus. - This medication can cause photophobic skin reactions and damage to the retina of the eye if exposed to direct sunlight. PTs taking this should be reminded to wear protective clothing, apply sunscreen and wear sunglasses when they are outside.

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Ileal conduit

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- It is used to divert urine outside of the body when the urinary bladder has been removed. The conduit cannot store urine the way the bladder did; therefore, urine will be flowing continuously and an appliance must be worn as a collection device. The bag should be emptied approx. every 2 hours to prevent leakage, skin irritation and infection.

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Manifestations of tardive dyskinesia

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- Tongue thrusting and lip smacking - Facial grimacing and eye blinking - Repetitive involuntary movements

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Ulcerative Colitis

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- Is a chronic, episodic, inflammatory disease of the large intestines and rectum characterized by bloody diarrhea. - Maintaining fluids and electrolyte balance is one of the most important nursing goals.

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To assess for cyanosis in a pt with dark skin where is the most appropriate areas to assess for this?

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- Examine body areas with the least melanin, such as the underarm, soles of the feet, conjunctiva and mucous membranes.

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Panic level of anxiety

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- Pt is highly disorganized and may appear either paralyzed (unable to act) or hyperactive and agitated because the client is not able to focus on anything except the anxiety itself. - Inability to concentrate and feelings of impending doom, as well as possible delusional statements such as "my dad can read my thoughts".

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Sever anxiety

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- Pt's perceptual field is scattered and the pt is unable to focus on anything except relieving the anxiety.

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Moderate anxiety

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- The pt's perceptual field narrows, but with assistance the pt is able to cope

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Mild

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- Mild anxiety is associated with the stress of daily living, the client has a heightened sense of alertness and is able to concentrate closely on the task at hand.

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Post operative tx of arthroscopy

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- This is used to visualize, diagnose and treat problems inside a joint. Applying ice to the affected area in the immediate postop period reduces pain and swelling. Pt may be allowed to walk as tolerated, but joint used should be minimizes for the first few days to reduces pain and swelling.

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Patient with Gout

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- Gout is a painful and potentially disabling form of arthritis that is caused by an excess of uric acid in the body. - Pt should remain well hydrated (this will minimize uric acid stones) - Should avoid foods high in purines - Should limit alcohol consumption (too much alcohol can inhibit excretion of uric acid, leading to its build up and causes an onset of gout. - Pt's should not take aspirin and/or salicylates (this can interfere with uric acid excretion and may precipitate an acute onset

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Hyperthyroid s/s:

answer

- Frequent mood changes - Nervousness - Hand tremors - Rapid, pounding irregular heartbeat - heat intolerance - Diarrhea - Weight loss

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Colostrum

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Colostrum is secreted from the mother's breasts during postpartum days 1 to 3. It contains the IgA immunoglobulin that provides passive immunity to the newborn.

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Breastfeeding schedule

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- Newborns should be breastfed every 2 to 3 hr. Parents should awaken the newborn to feed at least every 3 hr during the day and at least every 4 hr during the night until the newborn is feeding well and gaining weight adequately. Breastfeeding should occur 8 to 12 times within a 24-hr window. Then, a feed-on-demand schedule may be followed. - Tell the mother how to tell if her newborn is receiving adequate feeding (gaining weight, voiding 6 to 8 diapers a day, and contentedness between feedings).

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Two components of Advanced Directives

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-Living will - Durable Power of Attorney for Health Care

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Living Will

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- A living will is a legal document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. Types of treatments that are often addressed in a living will are those that have the capacity to prolong life. Examples of treatments that are addressed are cardiopulmonary resuscitation, mechanical ventilation, and feeding by artificial means. Living wills are legal in all states.

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Durable Power of Attorney for Health Care

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- A durable power of attorney for health care is a legal document that designates a health care proxy, who is an individual authorized to make health care decisions for a client who is unable. The person who serves in the role of health care proxy to make decisions for the client should be very familiar with the client's wishes. Living wills may be difficult to interpret, especially in the face of unexpected circumstances. A durable power of attorney for health care, as an adjunct to a living will, may be a more effective way of ensuring that the client's decisions about health care are honored

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Verapamil (Calan)

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- Calcium channel blocker - Used to Tx angina, hypertension & arrhythmias

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Left Hemisphere

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- Dominant for language

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Left-sided CVA

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- Could have some aphasia and would need speech therapy - Will also demonstrate hemiplegia of the right side

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Right-sided Lesion (CVA)

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- Most likely to have impulsive like behaviors

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Late signs of ICP

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- Alterations in VS (Including increased systolic pressure) - Widening pulse pressures - Bradycardia

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Early signs of ICP

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- Lethargy - Headache - Neck pain - Generalized muscle aches

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Pediculosis Capitis

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- Head lice ** Nits shed into the environment and are able to hatch up to 7-10 days**

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Scabies

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- Appear as grayish brown, threadlike burrows on the skin

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Cocaine intoxication

answer

- Dilated pupils

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EKG strip of hypokalemia

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- A prominent U wave - Prolonged P-R interval - ST segment is depressed - T wave is flattened

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EKG strip of hyperkalemia

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- Wide PQR

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Hemianopsia

answer

Blindness in one half of the field, a functional defect that can affect the right or left side.

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Hypothyrdoism expected lab results

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- Elevated TSH levels - Decreased T4, T3 & free thyroxine

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Specific & Sensitive indicator for renal function

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- Creatnine

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Emphysema expected findings

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- Dyspnea - Tachycardia - Barrel chested - Clubbing of the fingers - Shallow respirations

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Rescue breathing

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- When someone is not breathing but has a pulse **Deliver a breath every 5 seconds for a adult**

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Addison's Disease Treatment:

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- High protein, high carb diet - Weigh daily - Injectable IV fast acting steroid may be ordered or indicated for a pt experiencing an Addisonian crisis until the pt is no longer at risk for dehydration, hypotension and shock.

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SSRIs

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- Citalopram (Celexa) an example of an SSRI - Used to treat depression - Can take 3-4 weeks before pt starts to experience signs of improvement and in some cases up to 8 weeks.

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Agoraphobia

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- Fear of being in places in which help may not be available

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Pernicious anemia

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- Caused by a lack of intrinsic factor, a substance needed to absorb Vit B12 from the GI tract. - Often has a red beefy looking tongue - Vit B12 is needed for the formation of RBCs.

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Iron deficiency Anemia

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- Is a condition in which RBCs contain decreased level of hemoglobin

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Aplastic Anemia

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- Caused by a failure of the bone marrow to produce sufficient number of RBC's.

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Hemolytic Anemia

answer

- Hemolytic anemia involves erythrocyte destruction and maybe medication induced or caused by sickle cell disease, transfusion reaction or kidney disease. **Hematuria (blood in the urine) or hemoglobin present in the urine may indicate hemolytic anemia**

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Diphenhydramine's such as Benadryl can also be given to treat what?

answer

- They also have an anticholinergic effect that can help control tremors in the early stages of Parkinson's.

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Agranulocytosis

answer

Is a rare adverse reaction to Clozapine (Clozaril) in which WBC's drop causing pt to become susceptible to acute infections.

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Haloperidol (Haldol) can cause what?

answer

- This med can cause neuroleptic malignant syndrome which is a rare and potentially fatal adverse effect that requires emergency medical intervention. - Other manifestations associated with NMS are sudden onset of rigidity, tremor, stupor, incontinence, elevated serum enzymes, hyperkalemia, renal failure, elevated temp, BP & HR.

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Haloperidol (Haldol) adverse effect?

answer

Neuroleptic malignant syndrome

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Clozapine (Clozaril) can cause?

answer

Agranulocytosis

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Utilitarianism

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Refers to the actions that are right when they contribute to the greatest good.

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Malpractice

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Negligence

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Assault

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- An intention tort Ex: Is a threat to touch a person without consent

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Battery

answer

- An intentional tort Ex: Touching someone without consent

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Isometrics

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- Is a form of exercise involving static (no movement) contractions of a muscle w/out any movement of the joint. Isometrics may help to prevent muscle atrophy in pts who are on complete bedrest. EX: Instruct the pt to hold a muscle tight for approx. 5 seconds then relax

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Clozapine can cause?

answer

- Agranulocytosis, therefore WBC count of < 3000 is contraindicated.

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Clang association

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- Words that sound the same

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Echolalia

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- Repeats back what others say **Think echo**

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Neologisms

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- Made u words that have meaning to the patient with schizo

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Word Salad

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- Jumbles words, disorganized speech

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Hypoglycemia symptoms

answer

- Tachycardia - Moist clammy skin - Vertigo (dizzy) - Tremors

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Hyperglycemia Symptoms

answer

- Polydipsia (excessive thirst) - Polyuria (excessive urination) - Acetone breath

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Orlistat (Xenical)

answer

- Is prescribed to morbidly obese pts to lose weight. It prevents absorption of some of the fat in the pts diet. - The med should be taken 3 times/day within 1 hour of a meal - Its a lipase inhibitor, not an appetite suppressor.

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Placenta previa

answer

- Relaxed uterus - Painless, vaginal bleeding - Fundal height > expected gestation age

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Pre-Eclampsia

answer

- Hyperactive deep-tendon reflexes - Hypertension

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Methycenedioxymethamphetamine (MDMA)

answer

- Also referred to as Molly or Ecstasy - Should expect diaphoresis - Also might experience increased tactile sensitivity, lowered inhibition, chills, muscle cramping, teeth clenching & mild hallucinations.

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Mechanical restraints

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- Pt needs to be assessed q15-30 minutes and document findings, check for a new prescription q4h for clients >18 years, q2h for children 9-17 & q1h for children younger than 9 years.

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Pulse paradoxus

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- A finding in which systolic BP is 10 mmHg or greater on expiration than inspiration. Pt also may present with JVD, bradycardia & hypotension. **A symptom of cardiac tapenade**

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Estradiol

answer

- Estradiol is used to treat symptoms of menopause such as hot flashes, and vaginal dryness, burning, and irritation. Other uses include prevention of osteoporosis in postmenopausal women, and replacement of estrogen in women with ovarian failure or other conditions that cause a lack of natural estrogen in the body.Estradiol is sometimes used as part of cancer treatment in women and men. - Adverse effect of a headache needs to be reported as medication can cause thromboembolism. Monitor for swelling & tenderness of the calf, monitor for hypertension and report as well.

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Hemolytic transfusion reaction

answer

- Back pain is an adverse reaction, hypotension, tachycardia

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Hypokalemia

answer

- Muscle weakness - Decreased in deep tendon reflexes - Decrease in bowel sounds * A SIC WALT*

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Hypocalcemia

answer

- Would expect numbness and tingling of the extremities and around the mouth. - Need to watch for tetany

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Tetany symptom is linked to what?

answer

Hypocalcemia

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Tetany

answer

- A condition marked by intermittent muscular spasms, caused by malfunction of the parathyroid glands and a consequent deficiency of calcium

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Stages of Kawasakis Disease

answer

- Acute - Subacute - Convalescent

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Acute phase of Kawasakis

answer

- Beginning stage - Starts with high fever uncontrolled by antipyretics - Tachycardia - Irritability - Strawberry tongue - Conjunctival redness

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Sub-acute phase of Kawasakis

answer

- Pain in childs weight bearing joints - Peeling of soles of feet and hands

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Post-op of Tonsillectomy

answer

- Should position pt so that the head is lower than the chest. - Avoid having pt cough & clear throat, avoid using straw in the first 24-48 hours. - Administer analgesics q4hours for the first 24-48 hours. - No red liquids (including red-popsicles) - No diary products

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Abruptio placentae

answer

- Persistent uterine contractions - Painful - Placenta separates from the uterus - Bleeding inside the uterus - Life-threatening to the fetus

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Herbal supplement Saw Palmetto

answer

- This can result in a false low prostrate specific antigen level

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Herbal supplement Valerian

answer

- Can lower BP

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Ginsing

answer

- Used to stimulate mental activity and increase appetite - This can interact with caffeine and cause irritability

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Flaxseed

answer

- This can be used for migraine prophylaxis can lead to GI symptoms such as bloating, abd pain and flatulence

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Rooting reflex

answer

-Stroke the infants check and the infant should turn to the side, stroked.

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Lithium expected side/adverse effects (non-urgent)

answer

- Headache - Polyuria - Hyperglycemia

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Signs of lithium toxicity (Urgent)

answer

- Confusion - Coarse hand tremors - ECG change - Sedation

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Macular Degeneration

answer

- Decrease in central vision

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Double vision

answer

- Can be a symptom of cataracts

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Floating dark spots

answer

- Retinal detachment

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Glaucoma

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ICP

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Misoprostol

answer

- This med reduces gastric acid secretions so that ulcers can heal. - Pt's taking this should avoid taking magnesium containing antacids as this will increase the risk of diarrhea. - Misoprostol tends to cause diarrhea. - This can induce uterine contractions, so women of childbearing age must r/o pregnancy.

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Oxygen toxicity

answer

- Bradypnea - Crackels

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Hypoxemia

answer

- Restless - Tachycardia

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Want lots of Vit A

answer

- 1 medium raw carrot

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Early Decels

answer

- Indicate progression of labor and are benign. - Nurses should continue to observe FHR.

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Prolapsed Cord

answer

- Knee-chest position

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Late Decels

answer

- Emergency cesarean

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Deficient Fluid Volume (DFV)

answer

- Not enough volume - Ortho hypotension - Increased BUN

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Fluid Volume Excess (FVE)

answer

- Too much volume - SOB - Blurred vision

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PACE

answer

- program that provides adult daycare services along with in home assessments and supportive services

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Chlorpromazine

answer

- Schizophrenia medication - One of the greatest risks for a pt taking this is neuroleptic syndrome. It is a potentially life threatening adverse effect of this medication, which can show symptoms of a high fever, dysrhymias, decreased LOC and labile BP. - Headaches, constipation & vomiting are common side effects of this medication.

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Hemoptysis

answer

- Coughing up blood - If the amount is greater than 275 mL/24 hours this indicates a risk for hemorrhage and needs to be reported.

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Sickle cell anemia

answer

- A common manifestation of a vaso-occlusion in a sickle cell crisis can be hematuria (blood in the urine) resulting from ischemia of the kidneys

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Autonomic dysreflexia

answer

- Potentially life threatening emergency - Spinal cord injury @ T6 or higher - Facial flushing, nasal congestion, severe headache Tx: Elevate head of bed to 90 degrees, loosen constrictive clothing, assess for bladder distention and bowel impaction, administer antihypertensive meds (as this may cause stroke, MI, seizures)

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Obtaining temp or giving ear drops to a child

answer

- Up & back

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True or False ? Methadone can be taken while pregnant?

answer

- True, it can be taken for opioid withdrawl

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Blood Transfusion

answer

- Normal Saline ONLY! - Only collect one unit of blood @ a time. - Want a 20 gauge needle or larger. - Initiate blood transfusion 30 minutes or less after obtaining blood.

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Warfarin

answer

- Daily blood draws are needed for the 1st 5 days of starting this medication. - Pt should not take calcium supplements - Do not take acetaminophen for headaches (increases risk for bleeding)

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Permanent Trach Care Steps

answer

1st: Remove inner cannula 2nd: Remove soiled dressing 3rd: Clean stoma 4th: Change collar

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Newborn Care

answer

- Pick dry newborn 1st unless suction mouth is there as AIRWAY is most important, then dry!

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Safety Teachings for parents

answer

- No more than 120 degrees for water heater - Crib slates should be no more than 2.25 in apart - Car seat should face the rear until 2 years of age - Newborn car seat should be at 45 degree angle.

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Myasthenia gravis care (with attention to improving nutrition)

answer

- Monitor weight each week - Take your anticholinesterase medications 45-60 minutes before meals to prevent aspiration - Cut food into small bites & eat slowly - Choose snacks that are high in calorie

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Acupressure band

answer

- These bands can be worn on the wrists and can help alleviate nausea and vomiting. - An alternative therapy option for pregnancy n/v.

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Rheumatoid Arthritis (RA)

answer

- Want to balance exercise/activity and rest - Pain, stiffness and swelling are worse in the morning

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BRAT diet

answer

B = Bananas R = Rice A = Applesauce T = Toast **This may be suggested if the child is having a hard time keeping things down from vomiting or GI upset. This is high in carbs but has little nutritional value**

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Infectious Gastroenteritis (Diarrhea) rehydration

answer

- Should initiate oral rehydration therapy that should contain sodium, potassium, chloride, citrate or bicarb and glucose.

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With PTSD, type of alternative therapy

answer

- Guided imagery

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Upper chest petechiae after a long bone fracture

answer

- Purple/red small dots that are caused by minor bleeding from capillary blood vessels. - This indicates that the pt is at great risk for a fat emboli a life-threatening complication of fractures.

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Diabetes Insipidus

answer

- A deficiency in antidiuretic hormone - Increase in urine output (polyuria)

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If a pt has a hx of a stroke and we want to decrease risk of ICP while caring for them, what are some interventions to reduce the risk?

answer

- Keep the bed no more than 25 degrees - Place pt in a quiet room

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Fluoxetine

answer

- This can cause serotonin syndrome within 2-72 hours of starting treatment. - Pt could experience tremors, agitation, confusion, anxiety and hallucinations and need to be reported. - Educate pt to monitor and report any black tarry stools. - Weight gain is an adverse effect and can cause a rash.

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Yellow tag

answer

Major injury & should be given attention within 30 minutes to 2 hours.

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Red tag

answer

Life-threatening and requires immediate attention

question

Pressure ulcer stage 2

answer

- Partial thickness (some skin loss or blistering)

question

Pressure ulcer stage 3

answer

- Subcutaneous tissue visible

question

Pressure ulcer stage 4

answer

- Muscle damage, tendon exposure

question

Antisocial personality Disorder

answer

- Will show lack of remorse

question

Narcissistic personality disorder

answer

- Is more likely to show sensitivity to rejection

question

Bipolar

answer

Mood swings

question

Borderline personality disorder

answer

Self-mutilation behaviors

question

True Labor signs & symptoms

answer

- The cervix transitions to the anterior position - Contractions increase with ambulation - Contractions in true labor should be felt in the lower abdomen and back - Cervix shortens and thins

question

Amitriptyline

answer

- Medication for tx of depression - Pts should watch out for reactions like dry mouth & constipation - Pts should avoid overheating because of the lack of an ability to sweat while taking this med. - Should take at night before bedtime.

question

Ulcerative Colitis medications

answer

- Pts with this should take glucocorticoids such as prednisone to decrease the inflammation

question

Caution with a pt that has an ileostomy

answer

- Should avoid taking enteric-coated medications

question

RACE acronym for fire

answer

R= Retreat pts and self A= Activate alarm C= Contain fire (turn off O2, close doors & windows) E= Extengish

question

Implementing an emergency preparedness plan, what do you need to do FIRST?

answer

- FIRST you want to notify the incident commander to initiate the command hierarchy and maintain order

question

Thrombocytopenia

answer

- Decrease amt of platelets

question

Neutropenia

answer

- Decreased amount of WBC's ( <4000) - Initiate precaution for infection (wear masks when going in patients room, limit visitors, no flowers & no fresh veggies or fruit)

question

Ice is contraindicated with what disease?

answer

Type 1 DM

question

Signs of Stevens-Johnson Syndrome

answer

- A vesicular crusty rash - This should be reported - Sulfamethazazole can cause this as well as many others

question

Indomethacin

answer

- Is a nonsteroidal anti-inflammatory that reduces pain and inflammation - Adverse effects of this med: Dizziness, vertigo, muscle weakness, n/v, anorexia that leads to weight loss

question

OTC decongestants

answer

- Can constrict blood vessels causing an increase in BP & HR, so want to caution anyone that has hypertension or on cardiac meds

question

Clonidine may be prescribed for some experiencing?

answer

- Alcohol withdrawal, this will help diaphoresis

question

Chlordiazepoxide

answer

- This med is used to prevent delirium tremens for someone experiencing alcohol withdrawal

question

Acetazolamide

answer

- This is a med used for open angle glaucoma - Adverse effect of this med is tingling of fingers and hyperglycemia

question

Donepezil

answer

- Used for Alzheimer's - Side Effects: Dyspepsia, diarrhea, dizziness - Adverse effect: Dyspnea (NEED TO REPORT TO PROVIDER)

question

Furosemide

answer

- Puts pt at risk for hypokalemia, dizziness (can cause drop in BP which leads to the dizziness) & urinary frequency

question

Decreased LOC signs

answer

- Depressed deep tendon reflexes - Decreased BP - Lethargy

question

Methotrexate

answer

- This med is an immune suppressant and can cause bone marrow suppression. Should advised pt about monitoring for fever or sore throat.

question

Tetracycline

answer

- Can cause GI upset, suggest to take with applesauce. - Should advise pt to take med in the morning to prevent esophageal ulceration. - Do not take with antacids, will alter absorption

question

Flumazenil

answer

- Used for Benzo reversal (antidote)

question

Albuterol

answer

- Used for acute asthma attacks

question

Long-term tx of asthma

answer

- Montelukast (Leukotine) - Beclomethasone (corticoseteriod) - Nedocromil (Mast-cell)

question

Phenytoin

answer

- Medication for seizures (anticonvulsant) - Should not take with other calcium containing foods - Commonly causes gingival hyperplasia - Nystagmus us a serious reaction and should be reported - Levels less than 10 mcg/mL are sub therapeutic and can result in seizure activity. Levels more than 20 mcg/mL can produce toxic effects.

question

Enalapril

answer

(ACE Inhibitor) - Should monitor for hyperkalemia (due to potassium retention by the kidneys)

question

Insulin glargine

answer

- This should NOT be mixed in a syringe with any other insulins - This med should be injected once a day and does not cause peaks, instead it maintains a steady blood level for 24 hours, which reduces the risk of hypoglycemia

question

Salmeterol

answer

- Bronchodilator that is used to tx exercise induced bronchospasm, prevention of asthma attacks, COPD and chronic bronchitis & emphysema *Helps improve breathing*

question

Oxybutynin

answer

- Med is used for tx of urinary incontinence - Can expect these common side effects: Tachycardia, constipation, dry mouth, blurred vision, photophobia

question

Common medication given for Graves Disease

answer

- Propylthiouracil - This medication increases the ability to focus which is a symptom of graves disease (inability to focus). - An increase in ability to focus would indicate that this medication is working.

question

Propylthiouracil

answer

- This medication is used to tx of Graves Disease (hyperthyroidism), but should not be of first choice with this disease. (In patients with Graves' disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option) - Should not be used if pt has liver failure, or pregnant - Watch out for and report : Black tarry stools, chills, chest pain, fever, cough, sore throat or SOB.

question

Medication used for Diabetes Insipidus

answer

- Vasopression

question

Rhogam is given when mom and baby are what?

answer

- Mom is negative and baby is positive

question

Medication to induce labor?

answer

- Oxytocin - Misoprostol suppositories

question

Used to stop labor

answer

- Tocolytic medication = Terbutaline

question

Med for osteoporosis

answer

Alendondrate

question

Antiepileptic (seizure) medications

answer

- Phenobarbital - Phenytoin - Carbamazepine - Valproic acid - Iamotrigine - Gabapentin **For status epilepticus (Diazepam, Lorazepam)**

question

Rheumatoid arthritis meds

answer

- Prednisone (Glucocorticoid) - Adalimumab (DMARD)

question

Alzheimer meds

answer

- Memantine - Donazepril

question

Med to tx Mysathena gravis

answer

- Neostigmine (its a anticholinesterase)

question

Liver failure medication (to eliminate ammonia levels)

answer

- Lactulose (causes diarrhea)

question

Medication specifically for migraines

answer

Sumatriptan

question

Antifungals

answer

- End in "zole" - Also nystatin (used for mouth)

question

Azithromycin

answer

- Antibiotic: Macrolide - No cross allergy with penicillins

question

Medication for UTI's that causes urine and contacts to turn orange?

answer

- Phenazopyridie

question

Medications prescribed for UTI's:

answer

- Sufamethoxazole-trimethoprim - Ciprofloxacin - Phenazopyridine

question

Medications to fight bone marrow suppression (typically due to cancer treatment)

answer

- Erthropoietin - Filgrastim **Growth factors**

question

Atorvastatin

answer

- Watch for muscle pain (stop med & contact provider) - Watch liver enzymes

question

Digoxin

answer

- Cardiac glycoside - Common side effect: Bradycardia - Watch Potassium levels (if too low=toxicity) - Check HR & hold if under 60 bpm - Toxicity symptoms: Anorexia, N/V, blurred/yellow haze vision - Normal Dig levels: 0.5-0.8

question

Digoxin Toxicity manifestations

answer

- Anorexia - N/V - Blurred vision - Yellow haze - Fatigue/weakness - Normal Dig levels: 0.5-0.8

question

Reasons to hold BP meds

answer

- HR <60 bpm - Systolic BP <90

question

Ace Inhibitors

answer

- Watch for dry cough (discontinue and report) - Hypotension - Increased K+ levels (can cause hyperkalemia) - Common meds: Captopril, Enalapril (Ends in "pril")

question

Beta- Blockers

answer

- End in "olol" - Metoprolol, propranolol - Watch for bradycardia & hypotension - Metroprolol can decrease cardiac output and needs to be cautioned with CHF. No grapefruit. - Propranolol can cause bronchoconstriction (so don't want to give to someone with asthmatics)

question

Oprelevekin

answer

- This med is used to tx adverse effect of chemo ( low platelet count) - This med is a thrombopoletic growth factor and therefore a platelet count within the expected range would mean it is therapeutic

question

Carbamazepine

answer

- This medication can be used to treat bipolar as well as seizures - This med can affect oral contraceptives

question

Neostigmine

answer

- This medication is used to treat myasthenia gravis - An adverse effect of this med is nausea, bradycardia, and salvation at the mouth.

question

Valproic Acid

answer

- Valproic acid is used to treat various types of seizure disorders. It is also used to treat manic episodes related to bipolar disorder (manic depression), and to prevent migraine headaches. - This medication can cause liver failure so watch for jaundice

question

Side effects of inhaled corticosteroids

answer

- Dysphonia - Oral candidiasis **Pt will need spacer and need to rinse the mouth after inhalation, this will help reduce the risk**

question

Verapamil

answer

- This is a calcium channel blocker used to decrease workload and lower BP. So changing positions slowly will prevent orthostatic hypotension and dizziness. - Should take with food - Palpitations should be discussed with pcp but not stopped w/out addressing with doc first

question

Metronidazole

answer

- Metronidazole is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will NOT treat a vaginal yeast infection. - This should not be taken with alcohol

question

When a pt is taking epoetin alfa, what should you watch for?

answer

- Increase in BP (if the pt hematocrit levels rise too rapidly, hypertension and seizures could result

question

Doxycycline

answer

- An antibiotic - This should NOT be given to someone who is pregnant, due to the adverse effects on developing bones and teeth)

question

What is the greatest risk for someone receiving mannitol IV?

answer

- Developing HF, so the nurse should watch for peripheral edema and report any findings of this STAT!

question

Adverse effects of glucocorticoids are?

answer

- Osteoporosis, which needs to be monitored regularly w/bone density scans

question

Sucralfate

answer

- It is a mucous protectant that forms a gel-like substance coating the ulcer, creating a barrier. - It works mainly in the lining of the stomach by adhering to ulcer sites and protecting them from acids, enzymes, and bile salts. - Sucralfate is used to treat an active duodenal ulcer. Sucralfate can heal an active ulcer, but it will not prevent future ulcers from occurring.

question

Fluoxetine

answer

- Is an SSRI and used to Tx depression - This medication suppresses platelet aggregation which increases risk for bleeding when used with NSAIDs & anticoagulants. Want to advise pt to use Tylenol instead of ibuprofen for headaches.

question

Ferrous sulfate

answer

- Iron - Want to take on an empty stomach

question

Metoclopramide

answer

- This is a medication given for nausea - It increases gastric motility and can cause sedation

question

Ergotamine

answer

- Medication that should be taken on onset of a migraine - It should be taken upon aura of headache and a max of 3 tablets should be taken in a 24 hour period.

question

Allupurinol

answer

- Inhibits production of uric acid - Used to treat gout and/or kidney stones of that nature - Watch for kidney toxicity - Contraindicated with Warfarin & oral hypoglycemic (increases effects of meds)

question

Aminoglycosides (Gentamycin and Tobramycin)

answer

- Want to watch for nephron & Otto toxicities - They also interfere with diuretics, skeletal muscle relaxants and anticoagulant meds.

question

Amoxicillin

answer

- Watch for renal insufficiency - Decreases contraceptives, warfarin

question

Better perfusion: EleVate

answer

Veins

question

Better perfusion: DAngle

answer

Anteries

question

Airborne Precaution

answer

**Think MTV** M= Measles T= TB V= Varicella-Chicken pox/herpes Zoster-Shingles

question

Droplet Precautions

answer

**Think SPIDERMAN** S = Sepsis, scarlet fever, streptococcal pharyngitis P = Parvovirus B19, pneumonia, pertussis I = Influenza D = Diptheria E = Epiglottitis R= Rubella M = Mumps, meningitis, mycoplasma or meningeal pneu. AN= Adenovirus (private room, mask) **Droplet requires mask, gown, gloves, mask & goggles**

question

Contact Precaution

answer

**Think MRS.WEE** M= Multidrug resistant organism R= Respiratory infection S= Skin infections W= Wound infection E= Enteric infection (C.diff) E= Eye infection (conjunctivitis) **Gloves and gown**

question

Air/Pulmonary Embolism

answer

S/S: Chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom, bloody sputum Tx: Heaprin, d-dimer lab, O2

question

Women in labor with un-reassuring FHR

answer

- This would include late decels, decreased variability, fetal bradycardia. - Turn pt on left side, give O2, stop Pitocin (if running) and increase fluids

question

Tube feedings with decreased LOC

answer

- Position pt on right side (this promotes emptying of the stomach) and head of bed elevated (to prevent aspiration)

question

Myringotomy

answer

- Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. - Pt should be positioned on affected ear after surgery (this allows drainage of secretions)

question

After cataract surgery

answer

- Pt will sleep on UNAFFECTED side with a night shield for 1-4 weeks

question

Positioning of a pt after total hip replacement

answer

- Don't sleep on operated side - Don't flex hip more than 45-60 degrees - Don't elevate HOB more than 45 degrees - Maintain hip abduction by separating thighs with pillows.

question

Prevention of dumping syndrome

answer

- Eat in reclining position - Lie down after meals for 20-30 minutes - Restrict fluids during meals - Low carb and fiber diet - Small frequent meals

question

With peritoneal dialysis outflow is inadequate

answer

- Turn pt from side to side BEFORE checking kinks in tubing (according to Kaplan)

question

Before a liver biopsy it is important to check what lab?

answer

- Lab results for prothrombin time

question

Hypo-parathyroid

answer

** Think CATS** C= Convulsions A= Arrhythmias T= Tetany S= Spasms, stridor - Decreased calcium - Want to have high Calcium, low phosphorus diet

question

Hyper-parathyroid

answer

- Fatigue - Muscle weakness - Renal calculi - Back and joint pain - High levels of calcium - Want pt to have a diet high in phosphorus and low in Calcium

question

SIADH (Increased ADH)

answer

- Holding on to fluids and not releasing (little output) - Change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, headache - Administer Declomycin, diuretics

question

Hypermagnesmeia

answer

- Depresses the CNS - Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations - Emergency

question

Neuroleptic malignant syndrome (NMS)

answer

- NMS is like S & M - You get hot (hyperpyrexia) - stiff (increased muscle tone) - Sweaty (diaphoresis) - BP, pulse and resp go up - Start to drool

question

Rubella

answer

- Dangerous when you are pregnant - German measles (rubella)....Never get pregnant with a German (rubella)

question

Tetralogy of fallot

answer

**Think of DROP** D= Defect, septal R= Right ventricular hypertrophy O= Overriding aorta P= Pulmonary stenosis

question

Amphojel

answer

- Tx of GERD and kidney stones - Watch out for constipation

question

Vistaril

answer

- Tx of anxiety and also itching - Watch out for dry mouth, given preop commonly

question

PTU and Tapazole

answer

Prevention of thyroid storm

question

Sinemet

answer

- Used for tx of parkinsons - Sweat, saliva, urine may turn reddish brown occasionally - Causes drowsiness

question

Artane

answer

- A med used for Prkinsons - Sedative effect

question

Cogentin

answer

- Tx of parkinsons and extrapyramidal effects of other drugs

question

Timolol (Timoptic)

answer

Tx of glaucoma

question

Bactrim

answer

- Antibiotic - Don't take if allergic to sulfas - Diarrhea is a common side effect - Drink plenty of fluids

question

Antidote for Tylenol

answer

Mucomyst

question

Librium

answer

- Used for tx of alcohol w/d - Don't drink alcohol with this as very bad n/v can occur

question

Kwell

answer

- This is used for the tx of scabies and lice - For scabies: apply lotion once and leave on for 8-12 hours - For lice: Use the shampoo and leave on for 4 minutes with hair uncovered, then rinse with warm water and comb with a fine tooth comb.

question

OB Patterns

answer

**Think VEAL CHOP** V= Variable decels; C= Cord Compression E= Early decels; H= Head compression caused A= Accels; O= Okay, not a problem L= Late decels; P= Placental insufficiency

question

For cord compression

answer

- Trendelenberg position (this removes pressure off the cord) - If the cord is prolapsed, knee to chest, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.

question

To test lead poisoning in a child?

answer

- Around 12 months of age

question

High in potassium

answer

- Bananas - Potatoes - Citrus fruits

question

Aspirin can cause what in children?

answer

- Reye's Syndrome

question

Morphine is contraindicated in what?

answer

- Pancreatitis - It causes spasms of the sphincter of Oddi, therefore Demerol should be given

question

Hodgkin's disease

answer

- Cancer of the lymph and is very curable in early stages

question

Birth weight

answer

- Doubles by 6 months - Triples by 1 year

question

First sign of cystic fibrosis

answer

- May be meconium ileus at birth - Baby is inconsolable, do not eat, not passing meconium

question

Rheumatic fever

answer

Can lead to cardiac valve lafunctions

question

Hemophilia

answer

- A blood disorder. Is x-linked. Mother passes disease onto son.

question

Eclampsia

answer

Seizure

question

Fontanelle closure timeframe

answer

- Anterior (front) fontanelle closed by 18 months - Posterior (back) close within 6-8 weeks.

question

Caput succedaneum

answer

- Diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1-3 days

question

Bethamethasone (Celestone)

answer

- Surfactant. Med for lung expansion

question

Dystocia

answer

Baby cannot make it down to canal

question

Magnesium sulfate

answer

- Used to halt preterm labor - Is contraindicated if deep tendon reflexes are ineffective - If the pt experiences a seizure during Mg admission, get the baby out STAT! It's an emergency!

question

Cranial Nerves

answer

Oh, Oh, Oh, To, Touch, And, Feel, A, Girls, Vagina, And, Hymen Oh= Olfactory #1 (Smell) Oh= Optic #2 (Vision) Oh= Oculomotor #3 (Motor control of some eye muscles and eyelid) To= Trochlear #4 (motor control of some eye muscles) Touch= Trigeminal #5 (Chewing & facial sensation) And= Abducens #6 (Motor control of some eye muscles) Feel= Facial #7 ( Motor control of facial muscles, salivation, tastes and cutaneous sensations) A= Auditory #8 (Hearing, equilibrium) Girls= Glossopharyngeal #9 (Salivation, sensations of skin, taste) Vagina= Vagus #10 (Motor control of the heart, sensation from the thorax) And= Accessory #11 (Motor impulses to pharynx and shoulder) Hymen= Hypoglassal #12 (Motor control of the tongue, some skeletal muscles, some viscera, sensation from skin and viscera)

question

Glasgow Scale

answer

-15 max points - 8 and below you are in a coma

question

When taking Dig and k-supplements avoid this?

answer

- Salt substitutes because many are potassium based

question

Addisons Disease

answer

- Think of ADD as needs to add hormones

question

Universal donor blood

answer

Type O

question

Universal recipient

answer

AB

question

Bronchodilator inhaler before glucocorticoid inhaler. True or False?

answer

True, you want to open up the alveoli to maximize the medications.

question

Diaphragms must stay in place for how long after intercourse?

answer

- 6 hours - In addition these contraceptive devices are also fitted so must be refitted if you lose weight or gain a significant amount of weight.

question

Murphys sign

answer

- Pain with palpation of gall bladder area. Seen with cholecystitis

question

Cullen's sign

answer

- Ecchymosis in umbilical area, seen with pancreatitis

question

Turner's sign

answer

- Flank grayish blue (turn around to see your flanks) - Indicates pancreatitis

question

Shillings Test

answer

- This is a test for pernicious anemia, to see how well one absorbs Vit B12

question

Guthrie Test

answer

- This tests for PKU. The baby should have eaten source of protein first

question

Diverticulitis

answer

- Pockets within the intestine. Low residue, no seeds, nuts or peas

question

Rhogam is given when?

answer

- Given at weeks, & 72 hours post partum, IM. - Only needs to be given to Rh NEGATIVE mother

question

If someone has a latex allergy, you should also assess if the patient is allergic to what?

answer

- Bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes and peaches

question

Tensilon

answer

- This is used in myasthenia gravis to confirm the diagnosis. **Myasthenia gravis is caused by a disorder in the transmission of impulses from nerve to muscle cell**

question

Transesophageal Fistula (TEF)

answer

- Esophagus doesn't fully develop and is a surgical emergency - The 3 C's of TEF in the newborn are: Choking, Coughing, Cyanosis

question

MMR vaccines is given

answer

- Subcut **Also ask about anaphylactic reaction to eggs or neomycin before MMR**

question

Strabismus

answer

- Botox may be given for this. - Patch the GOOD eye so that the weaker eye can get stronger.

question

A 12 month old infant recently had a fever, runny nose, cough and white spots in the mouth for 3 days. A rash developed that started on the face and spread to the whole body. What should you suspect that the child has?

answer

- Rubeola (Measles)

question

Rubeola

answer

- Measles is a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40 °C, cough, runny nose, and inflamed eyes. Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik's spots. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Symptoms usually develop 10-12 days after exposure to an infected person and last 7-10 days.

question

Stranger anxiety

answer

- Is greatest in ages 7-9 months

question

Separation anxiety

answer

- Peaks in toddlerhood

question

Akathisia

answer

- Motor restlessness, person needs to keep going - Tx with antiparkinsons meds - Can be mistaken for agitation

question

Before a Pulmonary Function Test (PFT)

answer

- A pt's bronchodilator will be withheld - And not allowed to smoke 4 hours before the test

question

EEG test

answer

- This is to assess a pt for seizure activity - Need to hold meds for 24-48 hours - No caffine or cigarettes for 24 hrs prior. - Pt is able to eat - Pt must stay awake the night before the exam, pt may be asked to hyperventilate and watch a bright flashing light. - After EEG, assess pt for seizures, pt will be at increased risk

question

Rifampin

answer

- Is used to tx TB, dyes bodily fluids orange

question

INH

answer

- Is used to treat and prevent TB

question

Antipsychotics are incompatible with

answer

- Caffeine and apple juice

question

Extrapyramidal effects

answer

- Adverse effects of anti-psychotic meds - Dystonia - Tarditive dyskinesia - Tightening of the jaw - Stiff neck - Swollen tongue - Later on swollen airway

question

Risperdal

answer

- Is an anti-psychotic med - Doses over 6mg can cause tarditive dyskinesia - This is the first line anti-psychotic for children

question

Hydroxyurea

answer

- This is used for sickle cell - Report GI symptoms immediately this could be a sign of toxicity

question

Zocor

answer

- Tx of hyperlipidemia - Should be taken on an empty stomach to enhance absorption, report any unexplained muscle pain, especially fever

question

Decorticate

answer

- Is pointing toward the "cord"

question

Decerebrit

answer

- Hands are pointing out. - To "celebrate"

question

Hirschsprungs

answer

- Ribbon like stools - Enlarged colon

question

IM administration site for an infant-6 months

answer

- Vastus lateralis

question

IM administration site for a toddler above 18 months of age?

answer

- Ventrogluteal

question

IM site for children above 18 months

answer

- Deltoid and gluteus maximus are appropriate sites

question

Cane walking

answer

** Think COAL** C= Cane O= Opposite A= Affected L= Leg

question

What is the max amount that can be taken out at one time with a thoracentesis?

answer

- 1000cc

question

Preparation for cardiac cath:

answer

- NPO 8-12 hours (incase surgery is needed) - Empty bladder, pulses - Tell pt that they may feel heat palpitations or desire to cough with dye injection.

question

Post cardiac cath:

answer

- Monitor vital signs, pulses distal to site - Apply pressure to cath site for at least 15 minutes - Keep leg straight, bedrest for 6-8 hrs.

question

Paracentesis

answer

- Semi fowlers or upright on edge of bed - Empty bladder - Post procedure: VS, report elevated temp, observe for signs of hypovolemia

question

Hemovac

answer

- Used after a mastectomy - Empty when full or q8h, remove plug, empty contents, place on flat surface, cleanse opening and plug with alcohol sponge. - Compress evacuator completely to remove air, release plug, check system for operation.

question

Downs syndrome

answer

Protruding tongue

question

SLE

answer

- Butterfly rash

question

Pyloric stenosis

answer

- Projectile vomiting - Olive like mass

question

Hepatic Encephalopathy

answer

- Flapping tremors of the hands - Caused by an increased amount of toxins in the blood stream (ammonia)

question

Lyme Disease

answer

- Bulls eye rash

question

Iron elixir

answer

- NEVER take with milk - Take with juice or water

question

Kawasakis Disease

answer

Leads to cardiac problems

question

Lithium levels

answer

- 0.5-1.5

question

Nephrotic syndrome

answer

- Edema (begins in the face) - Hypotension - Fatigue/malaise - Weight gain, edema in the face and limbs - Foamy/frothy urine - Protein in the urine - Hyperlipidemia

question

Glomerulonephritis

answer

- R/t recent strep infection - Headache - Elevated BP - Lethargic - Preorbital edema - Decreased GFR - Protein & blood in urine (cola-colored urine) - Painful (dysuria) & oliguria (little urine)

question

DPT/MMR/OPV

answer

- Vaccines needed for ages 4-5 years

question

Cystic Fibrosis

answer

- Is an inherited autosomal recessive trait that involves exocrine (non hormonal) gland dysfunction. - Increased viscosity of secretions - Increased electrolyte levels in sweat - Lungs become filled with mucus that is thick like glue - A sweat test is used to diagnose **It "gums up" the ducts: spleen, gall bladder and lungs**

question

Treatment for Cystic Fibrosis

answer

- "CF cleanout" medications to clean ducts, suction them out. - Helrom vest: Shakes them to knock secretions loose - Enzymes, insulin if glucose is high, antibiotics (antibiotics may seem high, but this is typical for a child with CF) - CF pt's don't absorb nutrients well, so they will be given AQUADEX, fat soluble vitamins A,D,E, & K. - Diet consists of high fats, high calorie/low sugar diet

question

Common symptoms of a cystic fibrosis pt:

answer

- Large, bulky, frothy, foul-smelling stools - Barrel chest - Life expectancy is 30-40's - Cough - Respiratory distress - Thick secretions

question

Zoloft (Sertraline)

answer

- SSRI - Side effects are agitation, sleep disturbances and dry mouth, constipation, ortho hypotension, possible urinary retention, blurred vision

question

Clozapine (Clozaril)

answer

- Antipsychotic medication - Want to watch for tachycardia and seizures - May cause severe agranulocytosis (weekly blood draws)

question

Glucose Tolerance Test while pregnant

answer

- A result of 140 or higher needs further evaluation

question

When assessing extra ocular eye movement what cranial nerves are you assessing?

answer

- 3,4 &6

question

Tension pneumothorax

answer

- Trachea shifts to opposite side

question

With Lithium

answer

- Hydrate, drinking 2-3 L of water/day - Maintain sodium intake of 2-3g/day - Toxic level is 2-3 (n/v, diarrhea, tremors)

question

Burns:

answer

1st degree: Red and painful 2nd degree: Blisters 3rd degree: No pain because of blocked and burned nerves

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After a shunt placement, what is the bed position?

answer

- Flat (so fluid doesn't reduce too rapidly) - If you see signs of increasing ICP, then raise the HOB to 15-30 degrees.

question

Bence Jones

answer

- Specific protein in the urine that confirms multiple myeloma

question

Anectine

answer

- Is used for short-term neuromuscular blocking agents for procedures like intubation and ECT

question

Glucagon increases the effects of what?

answer

- Oral anticoagulants

question

Intussusception

answer

- 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.

question

Positive for PKU

answer

- No phenylalanine (no meat, no diary, no aspartame)

question

Antacids should be given ?

answer

- When mechanically ventilated - With an NG tube if the pH of the aspirate is <5.0. Aspirate should be checked every 12 hrs.

question

Amniotic fluid is?

answer

- Alkaline, it will turn nitrazine paper blue. Urine and normal vaginal discharge are acidic and turn it pink.

question

Nitrazine paper

answer

- Blue is positive for amniotic fluid

question

Using crutches while going up stairs

answer

**GCB (Good leg, crutches, Bad leg)** - Good leg goes up first - Crutches next - Bad leg

question

Using crutches going down stairs

answer

** CGB (Crutches, Good leg, bad leg)** - Crutches - Good leg - Bad leg

question

Steroids such as Prednisone can increase what?

answer

- Increase glucose, so monitor blood sugar levels

question

A big cue with lithium toxicity is what?

answer

- If a pt complains of metallic taste in mouth.

question

Croup

answer

- Barking cough - Difficulty breathing, fast breathing, noisy breathing, SOB or wheezing - Fatigue or fever - Hoarseness or impaired voice

question

Antidote for Magnesium Toxicity

answer

- Calcium Gluconate

question

Magnesium Sulfate Toxicity S/S:

answer

- Hyporefexia (absence of deep tendon reflexes) - Respiratory depression - Decrease in LOC - Hypotension - Urine output is decreased

question

Compensation : Defense Mechanism

answer

- Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. EX: A handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

question

Denial: Defense Mechanism

answer

- Refusing to acknowledge the existence of a real situation or the feelings associated with it. EX: A women drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.

question

Displacement: Defense Mechanism

answer

- The transfer of feelings from one target to another that is considered less threatening or that is neutral. EX: A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

question

Rationalization: Defense Mechanism

answer

- Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors. EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job."

question

Reaction Formation: Defense Mechanism

answer

- Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.

question

Regression: Defense Mechanism

answer

- Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning. EX: When 2 year old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for over 6 months.

question

Identification: Defense Mechanism

answer

- An attempt to increase self worth by acquiring certain attributes and characteristics of an individual one admires.

question

Repression: Defense Mechanism

answer

- Involuntary blocking of unpleasant feelings and experiences from ones awareness. EX: An accident victim can remember nothing about the accident

question

Intellectualization Defense Mechanism

answer

- An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis.

question

Sublimation: Defense Mechanism

answer

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD.

question

Introjection: Defense Mechanism

answer

- Integrating the beliefs and values of another individual into ones own ego structure. EX: Children integrate their parents value system into the process of conscience formation.

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Suppression: Defense Mechanism

answer

- The voluntary blocking of unpleasant feelings and experiences from ones awareness. EX: "I don't want to think about that now. I'll think about that tomorrow."

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Isolation: Defense Mechanism

answer

- Separate a thought or memory from the feeling tone or emotion associated with it. EX: Without showing any emotion, a young women describes being attacked and raped.

question

Undoing: Defense Mechanism

answer

- Symbolically negating or canceling out an experience that one finds intolerable. EX: Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her flowers.

question

Projection: Defense Mechanism

answer

- Attributing feelings or impulses unacceptable to ones self to another person. EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!"

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