ATI EXIT Study – Flashcards
396 test answers
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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:
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- 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
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- 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
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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
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- 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?
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- They also have an anticholinergic effect that can help control tremors in the early stages of Parkinson's.
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Agranulocytosis
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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?
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- 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?
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Neuroleptic malignant syndrome
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Clozapine (Clozaril) can cause?
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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
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- 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?
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- 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
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- Tachycardia - Moist clammy skin - Vertigo (dizzy) - Tremors
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Hyperglycemia Symptoms
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- Polydipsia (excessive thirst) - Polyuria (excessive urination) - Acetone breath
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Orlistat (Xenical)
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- 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
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- Relaxed uterus - Painless, vaginal bleeding - Fundal height > expected gestation age
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Pre-Eclampsia
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- Hyperactive deep-tendon reflexes - Hypertension
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Methycenedioxymethamphetamine (MDMA)
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- 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
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- 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
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- Back pain is an adverse reaction, hypotension, tachycardia
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Hypokalemia
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- Muscle weakness - Decreased in deep tendon reflexes - Decrease in bowel sounds * A SIC WALT*
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Hypocalcemia
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- 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?
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Hypocalcemia
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Tetany
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- 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
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- Acute - Subacute - Convalescent
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Acute phase of Kawasakis
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- Beginning stage - Starts with high fever uncontrolled by antipyretics - Tachycardia - Irritability - Strawberry tongue - Conjunctival redness
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Sub-acute phase of Kawasakis
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- Pain in childs weight bearing joints - Peeling of soles of feet and hands
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Post-op of Tonsillectomy
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- 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
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- 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
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- This can result in a false low prostrate specific antigen level
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Herbal supplement Valerian
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- Can lower BP
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Ginsing
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- Used to stimulate mental activity and increase appetite - This can interact with caffeine and cause irritability
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Flaxseed
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- 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
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-Stroke the infants check and the infant should turn to the side, stroked.
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Lithium expected side/adverse effects (non-urgent)
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- Headache - Polyuria - Hyperglycemia
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Signs of lithium toxicity (Urgent)
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- Confusion - Coarse hand tremors - ECG change - Sedation
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Macular Degeneration
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- Decrease in central vision
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Double vision
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- Can be a symptom of cataracts
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Floating dark spots
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- Retinal detachment
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Glaucoma
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ICP
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Misoprostol
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- 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
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- Bradypnea - Crackels
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Hypoxemia
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- Restless - Tachycardia
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Want lots of Vit A
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- 1 medium raw carrot
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Early Decels
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- Indicate progression of labor and are benign. - Nurses should continue to observe FHR.
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Prolapsed Cord
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- Knee-chest position
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Late Decels
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- Emergency cesarean
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Deficient Fluid Volume (DFV)
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- Not enough volume - Ortho hypotension - Increased BUN
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Fluid Volume Excess (FVE)
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- Too much volume - SOB - Blurred vision
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PACE
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- program that provides adult daycare services along with in home assessments and supportive services
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Chlorpromazine
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- 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
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- 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
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- 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
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- 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
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- Up & back
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True or False ? Methadone can be taken while pregnant?
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- True, it can be taken for opioid withdrawl
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Blood Transfusion
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- 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
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- 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
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1st: Remove inner cannula 2nd: Remove soiled dressing 3rd: Clean stoma 4th: Change collar
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Newborn Care
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- Pick dry newborn 1st unless suction mouth is there as AIRWAY is most important, then dry!
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Safety Teachings for parents
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- 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)
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- 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
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- 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)
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- Want to balance exercise/activity and rest - Pain, stiffness and swelling are worse in the morning
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BRAT diet
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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
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- Guided imagery
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Upper chest petechiae after a long bone fracture
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- 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
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- 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
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Life-threatening and requires immediate attention
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Pressure ulcer stage 2
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- Partial thickness (some skin loss or blistering)
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Pressure ulcer stage 3
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- Subcutaneous tissue visible
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Pressure ulcer stage 4
answer
- Muscle damage, tendon exposure
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Antisocial personality Disorder
answer
- Will show lack of remorse
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Narcissistic personality disorder
answer
- Is more likely to show sensitivity to rejection
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Bipolar
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Mood swings
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Borderline personality disorder
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Self-mutilation behaviors
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True Labor signs & symptoms
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- 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
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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.
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Ulcerative Colitis medications
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- Pts with this should take glucocorticoids such as prednisone to decrease the inflammation
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Caution with a pt that has an ileostomy
answer
- Should avoid taking enteric-coated medications
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RACE acronym for fire
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R= Retreat pts and self A= Activate alarm C= Contain fire (turn off O2, close doors & windows) E= Extengish
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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
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Thrombocytopenia
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- Decrease amt of platelets
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Neutropenia
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- 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)
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Ice is contraindicated with what disease?
answer
Type 1 DM
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Signs of Stevens-Johnson Syndrome
answer
- A vesicular crusty rash - This should be reported - Sulfamethazazole can cause this as well as many others
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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
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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
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Clonidine may be prescribed for some experiencing?
answer
- Alcohol withdrawal, this will help diaphoresis
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Chlordiazepoxide
answer
- This med is used to prevent delirium tremens for someone experiencing alcohol withdrawal
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Acetazolamide
answer
- This is a med used for open angle glaucoma - Adverse effect of this med is tingling of fingers and hyperglycemia
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Donepezil
answer
- Used for Alzheimer's - Side Effects: Dyspepsia, diarrhea, dizziness - Adverse effect: Dyspnea (NEED TO REPORT TO PROVIDER)
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Furosemide
answer
- Puts pt at risk for hypokalemia, dizziness (can cause drop in BP which leads to the dizziness) & urinary frequency
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Decreased LOC signs
answer
- Depressed deep tendon reflexes - Decreased BP - Lethargy
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Methotrexate
answer
- This med is an immune suppressant and can cause bone marrow suppression. Should advised pt about monitoring for fever or sore throat.
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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
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Flumazenil
answer
- Used for Benzo reversal (antidote)
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Albuterol
answer
- Used for acute asthma attacks
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Long-term tx of asthma
answer
- Montelukast (Leukotine) - Beclomethasone (corticoseteriod) - Nedocromil (Mast-cell)
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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.
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Enalapril
answer
(ACE Inhibitor) - Should monitor for hyperkalemia (due to potassium retention by the kidneys)
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Insulin glargine
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- 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
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Salmeterol
answer
- Bronchodilator that is used to tx exercise induced bronchospasm, prevention of asthma attacks, COPD and chronic bronchitis & emphysema *Helps improve breathing*
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Oxybutynin
answer
- Med is used for tx of urinary incontinence - Can expect these common side effects: Tachycardia, constipation, dry mouth, blurred vision, photophobia
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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.
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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.
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Medication used for Diabetes Insipidus
answer
- Vasopression
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Rhogam is given when mom and baby are what?
answer
- Mom is negative and baby is positive
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Medication to induce labor?
answer
- Oxytocin - Misoprostol suppositories
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Used to stop labor
answer
- Tocolytic medication = Terbutaline
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Med for osteoporosis
answer
Alendondrate
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Antiepileptic (seizure) medications
answer
- Phenobarbital - Phenytoin - Carbamazepine - Valproic acid - Iamotrigine - Gabapentin **For status epilepticus (Diazepam, Lorazepam)**
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Rheumatoid arthritis meds
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- Prednisone (Glucocorticoid) - Adalimumab (DMARD)
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Alzheimer meds
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- Memantine - Donazepril
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Med to tx Mysathena gravis
answer
- Neostigmine (its a anticholinesterase)
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Liver failure medication (to eliminate ammonia levels)
answer
- Lactulose (causes diarrhea)
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Medication specifically for migraines
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Sumatriptan
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Antifungals
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- End in "zole" - Also nystatin (used for mouth)
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Azithromycin
answer
- Antibiotic: Macrolide - No cross allergy with penicillins
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Medication for UTI's that causes urine and contacts to turn orange?
answer
- Phenazopyridie
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Medications prescribed for UTI's:
answer
- Sufamethoxazole-trimethoprim - Ciprofloxacin - Phenazopyridine
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Medications to fight bone marrow suppression (typically due to cancer treatment)
answer
- Erthropoietin - Filgrastim **Growth factors**
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Atorvastatin
answer
- Watch for muscle pain (stop med & contact provider) - Watch liver enzymes
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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
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Digoxin Toxicity manifestations
answer
- Anorexia - N/V - Blurred vision - Yellow haze - Fatigue/weakness - Normal Dig levels: 0.5-0.8
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Reasons to hold BP meds
answer
- HR <60 bpm - Systolic BP <90
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Ace Inhibitors
answer
- Watch for dry cough (discontinue and report) - Hypotension - Increased K+ levels (can cause hyperkalemia) - Common meds: Captopril, Enalapril (Ends in "pril")
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Beta- Blockers
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- 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)
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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
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Carbamazepine
answer
- This medication can be used to treat bipolar as well as seizures - This med can affect oral contraceptives
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Neostigmine
answer
- This medication is used to treat myasthenia gravis - An adverse effect of this med is nausea, bradycardia, and salvation at the mouth.
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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
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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**
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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
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Metronidazole
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- 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
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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
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Doxycycline
answer
- An antibiotic - This should NOT be given to someone who is pregnant, due to the adverse effects on developing bones and teeth)
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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!
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Adverse effects of glucocorticoids are?
answer
- Osteoporosis, which needs to be monitored regularly w/bone density scans
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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.
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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.
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Ferrous sulfate
answer
- Iron - Want to take on an empty stomach
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Metoclopramide
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- This is a medication given for nausea - It increases gastric motility and can cause sedation
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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.
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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)
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Aminoglycosides (Gentamycin and Tobramycin)
answer
- Want to watch for nephron & Otto toxicities - They also interfere with diuretics, skeletal muscle relaxants and anticoagulant meds.
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Amoxicillin
answer
- Watch for renal insufficiency - Decreases contraceptives, warfarin
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Better perfusion: EleVate
answer
Veins
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Better perfusion: DAngle
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Anteries
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Airborne Precaution
answer
**Think MTV** M= Measles T= TB V= Varicella-Chicken pox/herpes Zoster-Shingles
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Droplet Precautions
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**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**
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Contact Precaution
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**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**
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Air/Pulmonary Embolism
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S/S: Chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom, bloody sputum Tx: Heaprin, d-dimer lab, O2
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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
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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)
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Myringotomy
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- 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)
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After cataract surgery
answer
- Pt will sleep on UNAFFECTED side with a night shield for 1-4 weeks
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Positioning of a pt after total hip replacement
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- 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.
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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
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With peritoneal dialysis outflow is inadequate
answer
- Turn pt from side to side BEFORE checking kinks in tubing (according to Kaplan)
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Before a liver biopsy it is important to check what lab?
answer
- Lab results for prothrombin time
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Hypo-parathyroid
answer
** Think CATS** C= Convulsions A= Arrhythmias T= Tetany S= Spasms, stridor - Decreased calcium - Want to have high Calcium, low phosphorus diet
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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
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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
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Hypermagnesmeia
answer
- Depresses the CNS - Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations - Emergency
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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
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Rubella
answer
- Dangerous when you are pregnant - German measles (rubella)....Never get pregnant with a German (rubella)
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Tetralogy of fallot
answer
**Think of DROP** D= Defect, septal R= Right ventricular hypertrophy O= Overriding aorta P= Pulmonary stenosis
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Amphojel
answer
- Tx of GERD and kidney stones - Watch out for constipation
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Vistaril
answer
- Tx of anxiety and also itching - Watch out for dry mouth, given preop commonly
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PTU and Tapazole
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Prevention of thyroid storm
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Sinemet
answer
- Used for tx of parkinsons - Sweat, saliva, urine may turn reddish brown occasionally - Causes drowsiness
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Artane
answer
- A med used for Prkinsons - Sedative effect
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Cogentin
answer
- Tx of parkinsons and extrapyramidal effects of other drugs
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Timolol (Timoptic)
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Tx of glaucoma
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Bactrim
answer
- Antibiotic - Don't take if allergic to sulfas - Diarrhea is a common side effect - Drink plenty of fluids
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Antidote for Tylenol
answer
Mucomyst
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Librium
answer
- Used for tx of alcohol w/d - Don't drink alcohol with this as very bad n/v can occur
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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.
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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
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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.
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To test lead poisoning in a child?
answer
- Around 12 months of age
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High in potassium
answer
- Bananas - Potatoes - Citrus fruits
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Aspirin can cause what in children?
answer
- Reye's Syndrome
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Morphine is contraindicated in what?
answer
- Pancreatitis - It causes spasms of the sphincter of Oddi, therefore Demerol should be given
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Hodgkin's disease
answer
- Cancer of the lymph and is very curable in early stages
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Birth weight
answer
- Doubles by 6 months - Triples by 1 year
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First sign of cystic fibrosis
answer
- May be meconium ileus at birth - Baby is inconsolable, do not eat, not passing meconium
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Rheumatic fever
answer
Can lead to cardiac valve lafunctions
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Hemophilia
answer
- A blood disorder. Is x-linked. Mother passes disease onto son.
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Eclampsia
answer
Seizure
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Fontanelle closure timeframe
answer
- Anterior (front) fontanelle closed by 18 months - Posterior (back) close within 6-8 weeks.
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Caput succedaneum
answer
- Diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1-3 days
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Bethamethasone (Celestone)
answer
- Surfactant. Med for lung expansion
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Dystocia
answer
Baby cannot make it down to canal
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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!
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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)
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Glasgow Scale
answer
-15 max points - 8 and below you are in a coma
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When taking Dig and k-supplements avoid this?
answer
- Salt substitutes because many are potassium based
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Addisons Disease
answer
- Think of ADD as needs to add hormones
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Universal donor blood
answer
Type O
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Universal recipient
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AB
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Bronchodilator inhaler before glucocorticoid inhaler. True or False?
answer
True, you want to open up the alveoli to maximize the medications.
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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.
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Murphys sign
answer
- Pain with palpation of gall bladder area. Seen with cholecystitis
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Cullen's sign
answer
- Ecchymosis in umbilical area, seen with pancreatitis
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Turner's sign
answer
- Flank grayish blue (turn around to see your flanks) - Indicates pancreatitis
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Shillings Test
answer
- This is a test for pernicious anemia, to see how well one absorbs Vit B12
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Guthrie Test
answer
- This tests for PKU. The baby should have eaten source of protein first
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Diverticulitis
answer
- Pockets within the intestine. Low residue, no seeds, nuts or peas
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Rhogam is given when?
answer
- Given at weeks, & 72 hours post partum, IM. - Only needs to be given to Rh NEGATIVE mother
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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
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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**
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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
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MMR vaccines is given
answer
- Subcut **Also ask about anaphylactic reaction to eggs or neomycin before MMR**
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Strabismus
answer
- Botox may be given for this. - Patch the GOOD eye so that the weaker eye can get stronger.
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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)
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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.
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Stranger anxiety
answer
- Is greatest in ages 7-9 months
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Separation anxiety
answer
- Peaks in toddlerhood
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Akathisia
answer
- Motor restlessness, person needs to keep going - Tx with antiparkinsons meds - Can be mistaken for agitation
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Before a Pulmonary Function Test (PFT)
answer
- A pt's bronchodilator will be withheld - And not allowed to smoke 4 hours before the test
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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
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Rifampin
answer
- Is used to tx TB, dyes bodily fluids orange
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INH
answer
- Is used to treat and prevent TB
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Antipsychotics are incompatible with
answer
- Caffeine and apple juice
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Extrapyramidal effects
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- Adverse effects of anti-psychotic meds - Dystonia - Tarditive dyskinesia - Tightening of the jaw - Stiff neck - Swollen tongue - Later on swollen airway
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Risperdal
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- Is an anti-psychotic med - Doses over 6mg can cause tarditive dyskinesia - This is the first line anti-psychotic for children
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Hydroxyurea
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- This is used for sickle cell - Report GI symptoms immediately this could be a sign of toxicity
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Zocor
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- Tx of hyperlipidemia - Should be taken on an empty stomach to enhance absorption, report any unexplained muscle pain, especially fever
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Decorticate
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- Is pointing toward the "cord"
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Decerebrit
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- Hands are pointing out. - To "celebrate"
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Hirschsprungs
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- Ribbon like stools - Enlarged colon
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IM administration site for an infant-6 months
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- Vastus lateralis
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IM administration site for a toddler above 18 months of age?
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- Ventrogluteal
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IM site for children above 18 months
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- Deltoid and gluteus maximus are appropriate sites
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Cane walking
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** Think COAL** C= Cane O= Opposite A= Affected L= Leg
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What is the max amount that can be taken out at one time with a thoracentesis?
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- 1000cc
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Preparation for cardiac cath:
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- 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.
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Post cardiac cath:
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- 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.
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Paracentesis
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- Semi fowlers or upright on edge of bed - Empty bladder - Post procedure: VS, report elevated temp, observe for signs of hypovolemia
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Hemovac
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- 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.
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Downs syndrome
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Protruding tongue
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SLE
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- Butterfly rash
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Pyloric stenosis
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- Projectile vomiting - Olive like mass
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Hepatic Encephalopathy
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- Flapping tremors of the hands - Caused by an increased amount of toxins in the blood stream (ammonia)
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Lyme Disease
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- Bulls eye rash
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Iron elixir
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- NEVER take with milk - Take with juice or water
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Kawasakis Disease
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Leads to cardiac problems
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Lithium levels
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- 0.5-1.5
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Nephrotic syndrome
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- Edema (begins in the face) - Hypotension - Fatigue/malaise - Weight gain, edema in the face and limbs - Foamy/frothy urine - Protein in the urine - Hyperlipidemia
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Glomerulonephritis
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- 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)
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DPT/MMR/OPV
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- Vaccines needed for ages 4-5 years
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Cystic Fibrosis
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- 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**
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Treatment for Cystic Fibrosis
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- "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
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Common symptoms of a cystic fibrosis pt:
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- Large, bulky, frothy, foul-smelling stools - Barrel chest - Life expectancy is 30-40's - Cough - Respiratory distress - Thick secretions
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Zoloft (Sertraline)
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- SSRI - Side effects are agitation, sleep disturbances and dry mouth, constipation, ortho hypotension, possible urinary retention, blurred vision
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Clozapine (Clozaril)
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- Antipsychotic medication - Want to watch for tachycardia and seizures - May cause severe agranulocytosis (weekly blood draws)
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Glucose Tolerance Test while pregnant
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- A result of 140 or higher needs further evaluation
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When assessing extra ocular eye movement what cranial nerves are you assessing?
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- 3,4 &6
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Tension pneumothorax
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- Trachea shifts to opposite side
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With Lithium
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- Hydrate, drinking 2-3 L of water/day - Maintain sodium intake of 2-3g/day - Toxic level is 2-3 (n/v, diarrhea, tremors)
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Burns:
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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?
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- Flat (so fluid doesn't reduce too rapidly) - If you see signs of increasing ICP, then raise the HOB to 15-30 degrees.
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Bence Jones
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- Specific protein in the urine that confirms multiple myeloma
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Anectine
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- Is used for short-term neuromuscular blocking agents for procedures like intubation and ECT
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Glucagon increases the effects of what?
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- Oral anticoagulants
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Intussusception
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- 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.
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Positive for PKU
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- No phenylalanine (no meat, no diary, no aspartame)
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Antacids should be given ?
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- When mechanically ventilated - With an NG tube if the pH of the aspirate is <5.0. Aspirate should be checked every 12 hrs.
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Amniotic fluid is?
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- Alkaline, it will turn nitrazine paper blue. Urine and normal vaginal discharge are acidic and turn it pink.
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Nitrazine paper
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- Blue is positive for amniotic fluid
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Using crutches while going up stairs
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**GCB (Good leg, crutches, Bad leg)** - Good leg goes up first - Crutches next - Bad leg
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Using crutches going down stairs
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** CGB (Crutches, Good leg, bad leg)** - Crutches - Good leg - Bad leg
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Steroids such as Prednisone can increase what?
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- Increase glucose, so monitor blood sugar levels
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A big cue with lithium toxicity is what?
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- If a pt complains of metallic taste in mouth.
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Croup
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- Barking cough - Difficulty breathing, fast breathing, noisy breathing, SOB or wheezing - Fatigue or fever - Hoarseness or impaired voice
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Antidote for Magnesium Toxicity
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- Calcium Gluconate
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Magnesium Sulfate Toxicity S/S:
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- Hyporefexia (absence of deep tendon reflexes) - Respiratory depression - Decrease in LOC - Hypotension - Urine output is decreased
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Compensation : Defense Mechanism
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- 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.
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Denial: Defense Mechanism
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- 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.
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Displacement: Defense Mechanism
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- 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.
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Rationalization: Defense Mechanism
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- 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."
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Reaction Formation: Defense Mechanism
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- 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.
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Regression: Defense Mechanism
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- 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.
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Identification: Defense Mechanism
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- An attempt to increase self worth by acquiring certain attributes and characteristics of an individual one admires.
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Repression: Defense Mechanism
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- Involuntary blocking of unpleasant feelings and experiences from ones awareness. EX: An accident victim can remember nothing about the accident
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Intellectualization Defense Mechanism
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- An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis.
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Sublimation: Defense Mechanism
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- 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.
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Introjection: Defense Mechanism
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- 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
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- 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
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- 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.
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Undoing: Defense Mechanism
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- 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.
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Projection: Defense Mechanism
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- 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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