NCLEX RN Study Guide – 35 pg review from Allnurses.com – Part 1 – Flashcards

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question
addisons
answer
down, down down up down hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia
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cushings
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up up up down up hypernatremia, hypertension, increased blood vol, hypokalemia, hyperglycemia
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No Pee, no K
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do not give potassium without adequate urine output
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APGAR
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A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)
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AIRBORNE Precaustions MTV
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My - Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB or remember... MTV=Airborne Measles TB Varicella-Chicken Pox/Herpes Zoster-Shingles Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
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DROPLET Spiderman
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think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask
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Contact Mrs. Wee
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M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
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Skin infections VChips
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V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S - scabies
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Air/Pulmonary Embolism position
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S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left side and lower the head of the bed
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Woman in Labor w/ Un-reassuring FHR position
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late decels, decreased variability, fetal bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids
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Tube Feeding w/ Decreased LOC position
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position pt on right side (promotes emptying of the stomach) with the HOB elevated (to prevent aspiration
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During Epidural Puncture position
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side-lying
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After Lumbar Puncture (and also oil-based Myelogram) position
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pt lies in flat supine (to prevent headache and leaking of CSF)
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Pt w/ Heat Stroke
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lie flat w/ legs elevated
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During Continuous Bladder Irrigation (CBI)
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catheter is taped to thigh so leg should be kept straight. No other positioning restrictions.
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After Myringotomy
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position on side of affected ear after surgery (allows drainage of secretions)
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After Cataract Surgery
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pt will sleep on unaffected side with a night shield for 1-4 weeks.
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After Thyroidectomy
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low or semi-Fowler's, support head, neck and shoulders.
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Infant w/ Spina Bifida
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position prone (on abdomen) so that sac does not rupture
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Buck's Traction (skin traction)
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elevate foot of bed for counter-traction
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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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Prolapsed Cord
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knee-chest position or Trendelenburg
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Infant w/ Cleft Lip
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position on back or in infant seat to prevent trauma to suture line. While feeding, hold in upright position.
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To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries)
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eat in reclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small frequent meals)
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Above Knee Amputation
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elevate for first 24 hours on pillow, position prone daily to provide for hip extension.
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Below Knee Amputation
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foot of bed elevated for first 24 hours, position prone daily to provide for hip extension.
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Detached Retina
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area of detachment should be in the dependent position
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Administration of Enema
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position pt in left side-lying (Sim's) with knee flexed
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After Supratentorial Surgery (incision behind hairline)
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elevate HOB 30-45 degrees
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After Infratentorial Surgery (incision at nape of neck)
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position pt flat and lateral on either side.
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During Internal Radiation
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on bedrest while implant in place
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Autonomic Dysreflexia/Hyperreflexia
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S&S: pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB) first before any other implementation.
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Shock
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bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)
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Head Injury
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elevate HOB 30 degrees to decrease intracranial pressure
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Peritoneal Dialysis when Outflow is Inadequate
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turn pt from side to side BEFORE checking for kinks in tubing (according to Kaplan)
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Lumbar puncture
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AFTER the procedure, the client should be placed in the supine position for 4 to 12 hrs as prescribed. (Saunders 3rd ed p. 229)
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Pain med for pancreatitis
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Demorol
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Myasthenia Gravis
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worsens with exercise and improves with rest
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Myasthenia Crisis
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a positive reaction to Tensilon--will improve symptoms
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Cholinergic Crisis
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caused by excessive medication-stop med-giving Tensilon will make it worse
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Head injury medication
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Mannitol (osmotic diuretic)
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Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use ________ needle
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filter
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Prior to a liver biopspy
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its important to be aware of the lab result for prothrombin time
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From the a** (diarrhea)
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metabolic acidosis
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From the mouth (vomitus)
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metabolic alkalosis
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Myxedema/hypothyroidism
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slowed physical and mental function, sensitivity to cold, dry skin and hair
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Graves' disease/hyperthyroidism
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accelerated physical and mental function; sensitivity to heat, fine/soft hair
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Thyroid storm
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increased temp, pulse and HTN
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Post-thyroidectomy
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semi-Fowler's, prevent neck flexion/hyperextension, trach at bedside
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Hypo-parathyroid (CATS)
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CATS - convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca, low phosphorus diet
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Hyper-parathyroid
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fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low Ca, high phosphorus diet
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Hypovolemia
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increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific gravity >1.030
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Hypervolemia
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bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific gravity <1.010; Semi-Fowler's
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Diabetes Insipidus (decreased ADH)
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excessive urine output and thirst, dehydration, weakness, administer Pitressin/Vasopressin
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SIADH (increased ADH)
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change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA; administer Declomycin, diuretics
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Declomycin
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tx for SIADH
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Hypokalemia
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muscle weakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)
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Hyperkalemia: MURDER
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muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
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Hyponatremia
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nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics, fluids
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Hypernatremia
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increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic solution
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Hypocalcemia: CATS
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convulsions, arrhythmias, tetany, spasms and stridor
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Hypercalcemia
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muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS
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HypoMg
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tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
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HyperMg
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depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon reflexes, shallow respirations, emergency
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Addison's
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hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress
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Cushings
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hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
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Addisonian crisis
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n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
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Pheochromocytoma
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hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
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Neuroleptic malignant syndrome (NMS)
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-NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool
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never get pregnant with a German (rubella)
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I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles (rubella), so remember: -never get pregnant with a German (rubella)
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When drawing up regular insulin & NPH together, remember: RN
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RN (regular comes before NPH)
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Tetralogy of fallot; remember DROP
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Think DROP(child drops to floor or squats) or POSH Defect, septal Right Ventricular hypertrophy Overriding aorta Pulmonary stenosis
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MAOI's that are used as antidepressants pirates take MAOI's when they're depressed
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weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're depressed. - explanation; MAOI's used for depression all have an arrr sound in the middle (pARnate, mARplan, nARdil)
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Autonomic dysreflexia
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potentially life threatening emergency - elevate head of bed to 90 degree - loosen constrictive clothing - assess for bladder distention and bowel impaction (triger) - Administer antihypertensive meds (may cause stroke, MI, seisure )
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MAOI'S! think of PANAMA! what type of taste do they have?
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PA - parnate NA - nardil MA - marplan metallic bitter taste.
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Digoxin
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check pulse, less than 60 hold, check dig levels and potassium levels
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Amphojel:
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tx of GERD and kidney stones....watch out for contipation
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Vistaril
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tx of anxiety and also itching...watch for dry mouth. given preop commonly
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Versed
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given for conscious sedation...watch for resp depression and hypotension
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PTU and Tapazole
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prevention of thyroid storm
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Sinemet (what color are secretions)
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tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causes drowsiness
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Artane
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tx of parkinson..sedative effect also
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Cogentin
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tx of parkinson and extrapyramidal effects of other drugs
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Tigan
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tx of postop n/v and for nausea associated with gastroenteritis
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Timolol (Timoptic)
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tx of gluacoma
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Bactrim
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antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of fluids
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Bactrim shouldn't be taken if allergy to
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sulfa drugs
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Apresoline(hydralazine) tx of ___ or ___, Report _____ symptoms, rise slowly from sitting/lying position; take with ____
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HTN CHF flu-like meals
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Bentyl: tx of ________....assess for ______ side effects
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irritable bowel; anticholinergic
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Calan (verapamil)
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calcium channel blocker: tx of HTN, angina...assess for constipation
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Carafate
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tx of duodenal ulcers..coats the ulcer...so take before meals
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Theophylline
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tx of asthma or COPD..therap drug level: 10-20
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Mucomyst
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antedote to tylenol and is administered orally
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Diamox
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tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs
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Indocin
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(nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis
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Synthroid
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tx of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in the AM on empty stomach..could cause hyperthyroidism.
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Librium: tx of _____ withdrawal...dont take alchol with this...very bad nausea and vomiting can occur
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alcohol
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Oncovin (vincristine) tx
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tx of leukemia..given IV ONLY
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kwell tx
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tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(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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Premarin tx
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tx after menopause estrogen replacement
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Dilantin
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tx of seizures. thera drug level: 10-20
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Navane: tx of _____..assess for EPS
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schizophrenia
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Ritalin
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tx of ADHD..assess for heart related side effects report immediately...child may need a drug holiday b/c it stunts growth.
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dopamine (Intropine)
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tx of hypotension, shock, low cardiac output, poor perfusion to vital organs...monitor EKG for arrhythmias, monitor BP
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Have trouble remembering fhr patterns in OB? Think VEAL CHOP
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V = variable decels; C = cord compression caused E = early decels; H = head compression caused A = accels; O = okay, not a problem! L = late decels = Placental insufficiency, can't fill
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what to do for cord compression
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place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
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what you should do For late decels
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turn the mother to her left side, to allow more blood flow to the placenta
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For any kind of bad fetal heart rate pattern
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you give O2, often by mask...
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When doing an epidural anesthesia
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hydration before hand is a priority
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NEVER check the monitor or a machine as a first action
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Always assess the patient first; for exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to check first, and one of the choices involves the machine, that's the wrong answer
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If the baby is a posterior presentation
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the sounds are heard at the sides. If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and whereyou would listen to a posterior presentation
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If the baby is breech
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the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are a little bit above the symphysis pubis
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Also for ventilator alarms HOLD
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High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites Low press alarm- Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous Breathing
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hyperglycemia
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hot and dry-sugar high
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hypoglycemia
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cold and clammy-need some candy
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ICP
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increased BP, decreased pulse, decreased resp
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shock
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decreased BP, increased pulse, increased resp
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cor pulmonae
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right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a choice.)
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herion withdrawal neonate
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irratable poor sucking
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Jews
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no meat and milk together
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Brachial pulse
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pulse area cpr on an infant
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Test child for lead poisoning
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around 12 months of age
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bananas, potatoes, citrus fruits
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source of potassium
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Cultures are obtained
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before starting IV antibiotics
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a pt with leukemia may have epitaxis
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b/c of low platelets
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best way to warm a newborn
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skin to skin contact covered with a blanket on mom
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when a pt comes in and she is in active labor
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nurse first action is to listen to fetal heart tone/rate
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phobic disorders
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use systematic desensitiztion
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with lower amputations patient position
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placed in prone position
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LVN/LPN
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cannot handle blood
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Amynoglycosides (like vancomycin)
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cause nephrotoxicity and ototoxicity
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If the patient is not a child
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an answer with family option can be ruled out easily.
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ARDS
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fluids in alveoli
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DIC disseminated intravascular coagulaton
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are always secondary to something else (another disease process).
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Cardinal sign of ARDS
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hypoxemia (low oxygen level in tissues).
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edema location
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in the interstitial space not in the cardiovascular space
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weight is best indicator of
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dehydration
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aspirin can cause
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Reye's syndrome (encephalopathy) when given to children
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when aspirin is given once a day
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it acts as an antiplatelet
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use Cold compression (ice)
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for acute pain (eg. Sprain ankle)
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use Heat compression
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for chronic (rheumatoid arthritis)
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guided imagery
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great for chronic pain
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when patient is in distress
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medication administration is rarely a good choice.
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pneumonia
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fever and chills are usually present. For the elderly confusion is often present.
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Always check for allergies before administering
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antibiotics (especially PCN). Make sure culture and sensitivity has been done before adm. First dose of antibiotic.
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Cor pulmonale
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(s/s fluid overload) is Right sided heart failure caused by pulmonary disease, occurs with bronchitis or emphysema
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in COPD patients the baroreceptors
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that detect the CO2 level are destroyed. Therefore, O2 level must be low because high O2 concentration drops the patient's stimulus for breathing.
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epi is always given in
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TB syringe
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prednisone toxicity
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cushing's syndrome= buffalo hump, moon face, high glucose, hypertension.
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4 options for cancer management
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chemo, radiation, surgery, allow to die with dignity.
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neutropenic pts
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no live vaccines, no fresh fruits, no flowers should be used
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chest tubes are placed in the
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pleural space
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angina
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(low oxygen to heart tissues) = no dead heart tissues
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MI=
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dead heart tissue present
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mevacor
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(anticholesterol med) must be given with evening meal if it is QD (per day).
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Preload
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affects amount of blood that goes to the R ventricle
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Afterload
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is the resistance the blood has to overcome when leaving the heart
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Calcium channel blocker
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affects the afterload
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for a CABG operation
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when the great saphenous vein is taken it is turned inside out due to the valves that are inside
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measurements
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1 t (teaspoon)= 5 ml 1 T(tablespoon)= 3 t = 15 ml 1 oz= 30 ml 1 cup= 8 oz 1 quart= 2 pints 1 pint= 2 cups 1 gr (grain)= 60 mg 1 g (gram)= 1000 mg 1 kg= 2.2 lbs 1 lb= 16 oz
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To convert Centigrade to F
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F= C+40, multiply 9/5 and substract 40
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To convert Fahrenheit to C
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C= F+40, multiply 5/9 and substract 40
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angiotensin II in the lungs
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potent vasodialator
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heparin antidote
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protamine sulfate
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coumadin antidote
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vitamin k
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ammonia antidote
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lactulose
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acetaminophen antidote
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n-Acetylcysteine
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Iron antidote
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deferoxamine
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Digitoxin, digoxin antidote
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digibind
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Alcohol withdraw antidote
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Librium
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methadone
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is an opioid analgesic used to detoxify/treat pain in narcotic addicts.
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Potassium in relation to digoxin
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potentiates dig toxicity
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heparin prevents
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platelet aggregation
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Dopamine increases
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BP
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Vtach med
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lidocaine
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SVT med
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adenosine or adenocard
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Asystole or Bradycardia med
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atropine
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CHF med
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Ace inhibitor "pril"
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anaphylactic shock med
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Epinephrine
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Status Epilepticus med
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Valium
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bipolar med
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lithium
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S3 sound is normal in CHF
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not normal in MI
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carafate
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(GI med) before meals to coat stomach
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Protonix prophylactically
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given prophylactically to prevent stress ulcers
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TPN(total parenteral nutrition)
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given in subclavian line
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diverticulitis
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(inflammation of the diverticulum in the colon) pain is around LL quadrant.
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Appendicitis
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(inflammation of the appendix) pain is in RL quadrant with rebound tenderness.
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portal hypotension + albuminemia =
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ascites
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beta cells of pancreas produce
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insulin
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Morphine is contraindicated
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in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given.
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mineral corticoids are given in
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Addison's disease
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Sign of fat embolism
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petechiae Treated with heparin
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for knee replacement use
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continuous passive motion machine
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give prophylactic antibiotic therapy before
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any invasive procedure
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glaucoma patients lose
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peripheral vision Treated with meds
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cataract
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cloudy, blurry vision Treated by lens removal-surgery
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Co2 causes
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vasoconstriction
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most spinal cord injuries are at the
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cervical or lumbar regions
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autonomic dysreflexia
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( life threatening inhibited sympathetic response of nervous system to a noxious stimulus- patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder.
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spinal shock occurs
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immediately after spinal injury
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Multiple sclerosis
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myelin sheat destruction, disruption in nerve impulse conduction.
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myasthenia gravis
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decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles
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Tensilon test
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given if muscle is tense in myasthenia gravis
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Guillain-Barre syndrome
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ascending paralysis. Keep eye on respiratory system.
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parkinson's (RAT)
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RAT: rigidity, akinesia (loss of muscle mvt), tremors Treat with levodopa.
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TIA (transient ischemic attack)
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mini stroke with no dead brain tissue
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CVA (cerebrovascular accident)
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is with dead brain tissue
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Hodgkin's disease
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cancer of lymph is very curable in early stage
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Rule of NINES for burns
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Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1%
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Birth weight
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doubles by 6 month triple by 1 year of age
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first sign of cystic fibrosis
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may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium
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heart defects. Remember for cyanotic -3T's
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( Tof, Truncys arteriosus, Transposition of the great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically, CHF will occur following by death.
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with R side cardiac cath
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look for valve problems
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with L side in adults
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look for coronary complications
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rheumatic fever can lead to
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cardiac valves malfunctions
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cerebral palsy
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poor muscle control due to birth injuries and/or decrease oxygen to brain tissues
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ICP (intracranial pressure) should be
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<2. measure head circonference
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dilantin level
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(10-20). Can cause gingival hyperplasia
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for Meningitis check for
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Kernig's/ Brudzinski's signs
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Wilm's tumor
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usually encapsulated above the kidneys causing flank pain.
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hemophilia
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x-linked. Mother passes disease to son
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when phenylalanine increases
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brain problems occur
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Buck's traction
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knee immobility
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Russell traction
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femur or lower leg
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Dunlap traction
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skeletal or skin
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Bryant's traction
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children <3y, <35 lbs with femur fx
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placenta location
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upper part of uterus
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a patient with a vertical c-section
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more likely have another c-section.
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amniocentesis
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performed before 20 weeks gestation to check for cardiac and pulmonary abnormalities.
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Rh negative mothers
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receive rhogam to protect next baby
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anterior fontanelle closes
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by 18 months
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Posterior fontanelle closes by
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6 to 8 weeks
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caput succedaneum
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diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days
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pathological jaundice
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occurs before 24hrs and last 7 days. Physiological jaundice occurs after 24 hours
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bethamethasone (celestone)
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surfactant. Med for lung expansion
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Magnesium sulfate
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(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat (emergency).
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milieu therapy
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taking care of patient/environment
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FIVE INTERVENTIONS FOR PSYCH PATIENTS
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-safety -setting limits -establish trusting relationship -meds -least restrictive methods/environment.
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SSRI's
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(antidepressants) take about 3 weeks to work
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if patients have hallucinations
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redirect them
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if patients have delusions
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distract them.
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Thorazine, haldol
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(antipsychotic) can lead to EPS (extrapyramidal side effects)
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Alzheimer's disease
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is a chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias
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Contact Mrs. Wee
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M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
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Skin infections VChips
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V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S - scabies
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Air/Pulmonary Embolism
answer
...
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Contact Mrs. Wee
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M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
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Skin infections VChips
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V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S - scabies
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Contact Mrs. Wee
answer
M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
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Contact Mrs. Wee
answer
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