Вы находитесь на странице: 1из 35

DO NOT delegate what you can EAT!

E - evaluate A - assess T - teach addisons= down, down down up down cushings= up up up down up addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia No Pee, no K (do not give potassium without adequate urine output) EleVate Veins dAngle Arteries !or better per!usion A= appearance (color all pink pink and !lue !lue "pale#$ %= pulse (&'(( ) '(( a!sent$ *= gri+ace (cough gri+ace no response$ A= activity (,le-ed ,laccid li+p$ .= respirations (strong cry weak cry a!sent$ T.AN/01//1ON-2A/ED %.E3A4T1ON/5 A1.2O.NE 0y - 0easles 3hicken - 3hicken %o-6Varicella 7e8 - 7erpe8 9oster6/hingles T2 or re+e+!er::: 0TV=Air!orne 0easles T2 Varicella-3hicken %o-67erpes 9oster-/hingles %rivate .oo+ - negative pressure with ;-'< air e-changes6hr 0ask N=> ,or T2 D.O%?ET think o, /%1DE.0AN! / - sepsis / - scarlet ,ever / - streptococcal pharyngitis % - parvovirus 2'= % - pneu+onia % - pertussis 1 - in,luen8a D - diptheria (pharyngeal$ E - epiglottitis . - ru!ella 0 - +u+ps 0 - +eningitis 0 - +ycoplas+a or +eningeal pneu+onia An - Adenovirus %rivate .oo+ or cohort 0ask

3ONTA3T %.E3A4T1ON 0./:@EE 0 - +ultidrug resistant organis+ . - respiratory in,ection / - skin in,ections A @ - wound in,-n E - enteric in,-n - clostridiu+ di,,icile E - eye in,-n - conBunctivitis /C1N 1NDE3T1ON/ V371%/ V - varicella 8oster 3 - cutaneous diphtheria 7 - herpe8 si+ple1 - i+petigo % - pediculosis / - sca!ies "# Air6%ul+onary E+!olis+ ($%$& chest pain, di!!iculty breathing, tachycardia, pale'cyanotic, sense o! impending doom) (() turn pt to le,t side and lower the head o! the bed# *# @o+an in ?a!or w6 4n-reassuring D7. (late decels, decreased variability, !etal bradycardia, etc) (() turn on le,t side (and give +*, stop Pitocin, increase ,- !luids) .# Tu!e Deeding w6 Decreased ?O3 (() position pt on right side (promotes emptying o! the stomach) with the 7O2 elevated (to prevent aspiration) /# During Epidural %uncture (() side-lying 0# A,ter ?u+!ar %uncture (and also oil(based 1yelogram)(() pt lies in ,lat supine (to prevent headache and leaking o! 2$3) 4# %t w6 7eat /troke (() lie ,lat w' legs elevated 5# During 3ontinuous 2ladder 1rrigation (26,) (() catheter is taped to thigh so leg should be kept straight# No other positioning restrictions# 7# A,ter 0yringoto+y (() position on side o! a,,ected ear a!ter surgery (allows drainage o! secretions) 8# A,ter 3ataract /urgery (() pt will sleep on una,,ected side with a night shield !or "(/ weeks# "9# A,ter Thyroidecto+y (() low or semi(3owler:s, support head, neck and shoulders# ""# 1n,ant w6 /pina 2i,ida (() position prone (on abdomen) so that sac does not rupture "*# 2uckEs Traction (skin traction) (() elevate !oot o! bed !or counter(traction ".# A,ter Total 7ip .eplace+ent (() don:t sleep on operated side, don:t !le; hip more than /0( 49 degrees, don:t elevate <+6 more than /0 degrees# 1aintain hip abduction by separating thighs with pillows# "/# %rolapsed 3ord (() knee(chest position or =rendelenburg

"0# 1n,ant w6 3le,t ?ip (() position on back or in in!ant seat to prevent trauma to suture line# >hile !eeding, hold in upright position# "4# To %revent Du+ping /yndro+e (post(operative ulcer'stomach surgeries) (() eat in reclining position, lie down a!ter meals !or *9(.9 minutes (also restrict !luids during meals, low 2<+ and !iber diet, small !requent meals) "5# A!ove Cnee A+putation (() elevate !or !irst */ hours on pillow, position prone daily to provide !or hip e;tension# "7# 2elow Cnee A+putation (() !oot o! bed elevated !or !irst */ hours, position prone daily to provide !or hip e;tension# "8# Detached .etina (() area o! detachment should be in the dependent position *9# Ad+inistration o, Ene+a (() position pt in le,t side-lying ($im:s) with knee !le;ed *"# A,ter /upratentorial /urgery (incision behind hairline) (() elevate <+6 .9(/0 degrees **# A,ter 1n,ratentorial /urgery (incision at nape o! neck)(() position pt ,lat and lateral on either side# *.# During 1nternal .adiation (() on !edrest while implant in place */# Autono+ic Dysre,le-ia67yperre,le-ia ($%$& pounding headache, pro!use sweating, nasal congestion, goose !lesh, bradycardia, hypertension) (() place client in sitting position (elevate 7O2$ ,irst !e,ore any other i+ple+entation: *0# /hock (() bedrest with e;tremities elevated *9 degrees, knees straight, head slightly elevated (modi!ied =rendelenburg) *4# 7ead 1nBury (() elevate <+6 .9 degrees to decrease intracranial pressure *5# %eritoneal Dialysis when Out,low is 1nadeFuate (() turn pt !rom side to side 6E3+?E checking !or kinks in tubing (according to Kaplan) *7# ?u+!ar puncture =) @3=E? the procedure, the client should be placed in the supine position !or / to "* hrs as prescribed# ($aunders .rd ed p# **8) Aemorol !or pancreatitis, N+= morphine sul!ate 1yasthenia Bravis& worsens with e;ercise and improves with rest# 1yasthenia 2risis& a positive reaction to =ensilon((will improve symptoms 2holinergic 2risis& caused by e;cessive medication(stop med(giving =ensilon will make it worse <ead inCury medication& 1annitol (osmotic diuretic)(crystalliDes at room temp so @E>@F$ use !ilter needle Prior to a liver biospy its important to be aware o! the lab result !or prothrombin time 3rom the aGG (diarrhea)= metabolic acidosis 3rom the mouth (vomitus)=metabolic alkalosis 0y-ede+a6hypothyroidis+& slowed physical and mental !unction, sensitivity to cold, dry skin and hair

*ravesG disease6hyperthyroidis+5 accelerated physical and mental !unction sensitivity to heat, !ine'so!t hair Thyroid stor+5 increased temp, pulse and <=N %ost-thyroidecto+y5 semi(3owlerHs, prevent ncek !le;ion'hypere;tension, trach at bedside 7ypo-parathyroid5 2@=$ I convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high 2a, low phosphorus diet 7yper-parathyroid& !atigue, muscle weakness, renal calculi, back and Coint pain (increased calcium), low 2a, high phosphorus diet 7ypovole+ia I incrased temp, rapid'weak pulse, increase respiration, hypotension, an;iety, urine speci!ic gravity )"#9.9 7ypervole+ia I bounding pulse, $+6, dyspnea, rares'crackles, peripheral edema, <=N, urine speci!ic gravity J"#9"9 $emi(3owlerHs Dia!etes 1nsipidus (decreased AD7$5 e;cessive urine output and thirst, dehydration, weakness, administer Pitressin /1AD7 (increased AD7$5 change in E+2, decreased deep tendon re!le;es, tachycardia, n'v'a, <@ administer Aeclomycin, diuretics 7ypokale+ia& muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery) 7yperkale+ia5 1K?AE? I muscle weakness, urine (oliguria'anuria), respiratory depression, decreased cardiac contractility, E2B changes, re!le;es 7yponatre+ia& nausea, muscle cramps, increased ,2P, muscular twitching, convulsion osmotic diuretics, !luids 7ypernatre+ia5 increased temp, weakness, disorientation'delusions, hypotension, tachycardia hypotonic solution 7ypocalce+ia5 2@=$ I convulsions, arrhythmias, tetany, spasms and stridor 7ypercalce+ia& muscle weakness, lack o! coordination, abdominal pain, con!usion, absent tendon re!le;es, sedative e!!ect on 2N$ 7ypo0g& tremors, tetany, seiDures, dyrshythmias, depression, con!usion, dysphagia dig to;icity 7yper0g5 depresses the 2N$, hypotension, !acial !lushing, muscle ewakness, absent deep tendon re!le;es, shallow respirations, emergency AddisonGs& hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, !ractures, alopecia, weight loss, B, distress 3ushings5 hyperNa, hypoK, hyperglycemia, prone to in!ection, muscle wasting, weakness, edema, <=N, hirsutism, moon!ace'bu!!alo hump Addisonian crisis5 n'v, con!usion, abdominal pain, e;treme weakness, hypoglycemia, dehydration, decreased 6P %heochro+ocyto+a& hypersecretion o! epi'norepi, persistent <=N, increased <?, hyperglycemia, diaphoresis, tremor, pounding <@ avoid stress, !requent bating and rest breaks, avoid cold and stimulating !oods, surgery to remove tumor "# Neuroleptic malignant syndrome (N1$)& (N1$ is like $%1 (you get hot (hyperpyre;ia) (sti!! (increased muscle tone) (sweaty (diaphoresis) (6P, pulse, and respirations go up % (you start to drool

*# , kept !orgetting which was dangerous when you:re pregnant regular measles (rubeola), or Berman measles (rubella), so remember& (never get pregnant with a Berman (rubella) .# >hen drawing up regular insulin % NP< together, remember& (?N (regular comes be!ore NP<) /# =etralogy o! !allot remember <+P$ =hink A?+P(child drops to !loor or squats) or P+$< Ae!ect, septal ?ight -entricular hypertrophy +verriding aorts Pulmonary stenosis 0# 1@+,:s that are used as antidepressants& weird way to remember, , know# pirates say arrrr, so think pirates take 1@+,:s when they:re depressed# ( e;planation 1@+,:s used !or depression all have an arrr sound in the middle (Parnate, 1arplan, Nardil) @utonomic dysre!le;ia& potentially li!e threatening emergency ( elevate head o! bed to 89 degree ( loosen constrictive clothing ( assess !or bladder distention and bowel impaction (triger) ( @dminister antihypertensive meds (may cause stroke, 1,, seisure ) easy way to re+e+!er 0AO1E/! think o, %ANA0A! %A - parnate NA - nardil 0A - +arplan metallic bitter taste# Aigo;in(check pulse, less than 49 hold, check dig levels and potassium levels# @mphoCel& t; o! BE?A and kidney stones####watch out !or contipation# -istaril& t; o! an;iety and also itching###watch !or dry mouth# given preop commonly -ersed& given !or conscious sedation###watch !or resp depression and hypotension P=K and =apaDole( prevention o! thyroid storm $inemet& t; o! parkinson###sweat, saliva, urine may turn reddish brown occassionally###causes drowsiness @rtane& t; o! parkinson##sedative e!!ect also 2ogentin& t; o! parkinson and e;trapyramidal e!!ects o! other drugs =igan& t; o! postop n'v and !or nausea associated with gastroenteritis =imolol (=imoptic)(t; o! gluacoma

6actrim& antibiotic##dont take i! allergic to sul!a drugs###diarrhea common side e!!ect###drink plenty o! !luids Bout 1eds& Probenecid (6enemid), 2olchicine, @llopurinol (Lyloprim) @presoline(hydralaDine)(t; o! <=N or 2<3, ?eport !lu(like symptoms, rise slowly !rom sitting'lying position take with meals# 6entyl& t; o! irritable bowel####assess !or anticholinergic side e!!ects# 2alan (verapamil)& calcium channel blocker& t; o! <=N, angina###assess !or constipation 2ara!ate& t; o! duodenal ulcers##coats the ulcer###so take be!ore meals# =heophylline& t; o! asthma or 2+PA##therap drug level& "9(*9 1ucomyst is the antedote to tylenol and is administered orally Aiamo;& t; o! glaucoma, high altitude sickness###dont take i! allergic to sul!a drugs ,ndocin& (nsaid) t; o! arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis# $ynthroid& t; o! hypothyroidism##may take several weeks to take e!!ect###noti!y doctor o! chest pain##take in the @1 on empty stomach##could cause hyperthyroidism# Eibrium& t; o! alcohol w'd###dont take alchol with this###very bad nausea and vomiting can occur# +ncovin (vincristine)& t; o! leukemia##given ,- +NEF kwell& t; o! scabies and lice###(scabies)apply lotion once and leave on !or 7("* hours###(lice) use the shampoo and leave on !or / minutes with hair uncovered then rinse with warm water and comb with a !ine tooth comb Premarin&t; a!ter menopause estrogen replacement Ailantin& t; o! seiDures# thera drug level& "9(*9 Navane& t; o! schiDophrenia##assess !or EP$ ?italin& t; o! @A<A##assess !or heart related side e!!ects report immediately###child may need a drug holiday b'c it stunts growth# dopamine (,ntropine)& t; o! hypotension, shock, low cardiac output, poor per!usion to vital organs###monitor EKB !or arrhythmias, monitor 6P <ave trouble remembering !hr patterns in +6M =hink -E@E 2<+P -2 E< @+ EP - = variable decels 2 = cord compression caused E = early decels < = head compression caused @ = accels + = okay, not a problemN E = late decels = placental insu!!iciency, can:t !ill

3or cord compression, place the mother in the =?ENAEEEN6E?B position because this removes pressure o! the presenting part o!! the cord# (,! her head is down, the baby is no longer being pulled out o! hte body by gravity) ,! the cord is prolapsed, cover it with sterile saline gauDe to prevent drying o! the cord and to minimiDe in!ection# 3or late decels, turn the mother to her le!t side, to allow more blood !low to the placenta# 3or any kind o! bad !etal heart rate pattern, you give +*, o!ten by mask### >hen doing an epidural anesthesia hydration be!ore hand is a priority# <ypotension and bradypnea ' bradycardia are maCor risks and emergencies# NE-E? check the monitor or a machine as a !irst action# @lways assess the patient !irst !or e;maple listen to the !etal heart tones with a stethoscope in N2EEO land# $ometimes it:s hard to tell who to check on !irst, the mother or the baby it:s usually easy to tell the right answer i! the mother or baby involves a machine# ,! you:re not sure who to check !irst, and one o! the choices involves the machine, that:s the wrong answer# ,! the baby is a posterior presentation, the sounds are heard at the sides# ,! the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and where you would listen to a posterior presentation# ,! the baby is breech, the sounds are high up in the !undus near the umbilicus# ,! the baby is verte;, they are a little bit above the symphysis pubis# @lso !or ventilator alarms 7O?D 7igh alarm( Obstruction due to incr# secretions, kink, pt# coughs, gag or bites ?ow press alarm( Disconnection or leak in ventilatior or in pt# airway cu!!, pt# stops spontaneous breathing "# to remember blood sugar& hot and dry(sugar high (hyperglycemia) cold and clammy(need some candy (hypoglycemia) *# ,2P @NA $<+2K <@-E +PP+$,=E -'$ ,2P(increased 6P, decreased pulse, decreased resp# shock( decreased 6P, increased pulse, increased resp# .# cor pulmonae& right sided heart !ailure caused by le!t ventricular !ailure (so pick edema, Cvd, i! it is a choice#) /# herion withdrawal neonate& irratable poor sucking 0# Pews& no meat and milk together 4# 6rachial pulse& pulse area cpr on an in!ant# 5# =est child !or lead poisioning around "* months o! age 7# bananas, potatoes, citrus !ruits source o! potassium ""# 2ultures are obtained be!ore starting ,- antibiotics

"*# a pt with leukemia may have epita;is b'c o! low platelets ".# best way to warm a newborn& skin to skin contact covered with a blanket on mom# "/# when a pt comes in and she is in active labor###nurse !irst action is to listen to !etal heart tone'rate "0# phobic disorders###use systematic desensitiDtion# N2EEO =,P$ "# >hen getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor, palpate) over the intervention e;cept in an emergency or distress situation# ,! one answer has an absolute, discard it# Bive priority to answers that deal directly to the patientHs body, not the machines'equipments# *# Key words are very important# @void answers with absolutes !or e;ample& always, never, must, etc# .# with lower amputations patient is placed in prone position# /# small !requent !eedings are better than larger ones# 0# @ssessment, teaching, meds, evaluation, unstable patient cannot be delegated to an Knlicensed @ssistive Personnel# 4# E-N'EPN cannot handle blood# 5# @mynoglycosides (like vancomycin) cause nephroto;icity and ototo;icity# 7# ,- push should go over at least * minutes# 8# ,! the patient is not a child an answer with !amily option can be ruled out easily# "9# ,n an emergency, patients with greater chance to live are treated !irst ""# @?A$ (!luids in alveoli), A,2 (disseminated intravascular coagulaton) are always secondary to something else (another disease process)# "*# 2ardinal sign o! @?A$ is hypo;emia (low o;ygen level in tissues)# ".# in p< regulation the * organs o! concern are lungs'kidneys# "/# edema is in the interstitial space not in the cardiovascular space# "0# weight is the best indicator o! dehydration "4# wherever there is sugar (glucose) water !ollows# "5# aspirin can cause ?eyeHs syndrome (encephalopathy) when given to children "7# when aspirin is given once a day it acts as an antiplatelet# "8# use 2old !or acute pain (eg# $prain ankle) and <eat !or chronic ( rheumatoid arthritis) *9# guided imagery is great !or chronic pain# *"# when patient is in distress, medication administration is rarely a good choice# **# with pneumonia, !ever and chills are usually present# 3or the elderly con!usion is o!ten present# *.# @lways check !or allergies be!ore administering antibiotics (especially P2N)# 1ake sure culture and sensitivity has been done be!ore adm# 3irst dose o! antibiotic# */# 2or pulmonale (s's !luid overload) is ?ight sided heart !ailure caused by pulmonary disease, occurs with bronchitis or emphysema# *0# 2+PA is chronic, pneumonia is acute# Emphysema and bronchitis are both 2+PA# *4# in 2+PA patients the baroreceptors that detect the 2+* level are destroyed# =here!ore, +* level must be low because high +* concentration

blows the patientHs stimulus !or breathing# *5# e;acerbation& acute, distress# *7# epi always given in =6 syringe# *8# prednisone to;icity& cushingHs syndrome= bu!!alo hump, moon !ace, high glucose, hypertension# .9# / options !or cancer management& chemo, radiation, surgery, allow to die with dignity# ."# no live vaccines, no !resh !ruits, no !lowers should be used !or neutropenic patients# .*# chest tubes are placed in the pleural space# ..# angina (low o;ygen to heart tissues) = no dead heart tissues# 1,= dead heart tissue present# ./# mevacor (anticholesterol med) must be given with evening meal i! it is QA (per day)# .0# Nitroglycerine is administered up to . times (every 0 minutes)# ,! chest pain does not stop go to hospital# Ao not give when 6P is J 89'49# .4# Preload a!!ects amount o! blood that goes to the ? ventricle# @!terload is the resistance the blood has to overcome when leaving the heart# .5# 2alcium channel blocker a!!ects the a!terload# .7# !or a 2@6B operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside# .8# unstable angina is not relieved by nitro# /9# dead tissues cannot have P-2Hs(premature ventricular contraction# ,! le!t untreated pvcHs can lead to -3 (ventricular !ibrillation)# /"# " t (teaspoon)= 0 ml " =(tablespoon)= . t = "0 ml " oD= .9 ml " cup= 7 oD " quart= * pints " pint= * cups " gr (grain)= 49 mg " g (gram)= "999 mg " kg= *#* lbs " lb= "4 oD G =o convert 2entigrade to 3# 3= 2R/9, multiply 8'0 and substract /9 G =o convert 3ahrenheit to 2# 2= 3R/9, multiply 0'8 and substract /9# /*# angiotensin ,, in the lungs= potent vasodialator# @ldosterone attracts sodium# /.# ?E-E?$E @BEN=$ 3+? =+O,2,=F heparin= protamine sul!ate coumadin= vitamin k ammonia= lactulose acetaminophen= n(@cetylcysteine# ,ron= de!ero;amine Aigito;in, digo;in= digibind# @lcohol withdraw= Eibrium# ( methadone is an opioid analgesic used to deto;i!y'treat pain in narcotic addicts# ( Potassium potentiates dig to;icity# //# heparin prevents platelet aggregation# /0# P='P== are elevated when patient is on coumadin /4# cardiac output decreases with dysrythmias# Aopamine increases 6P# /5# 1ed o! choice !or -tach is lidocaine /7# 1ed o! choice !or $-= is adenosine or adenocard /8# 1ed o! choice !or @systole (no heart beat) is atropine

09# 1ed o! choice !or 2<3 is @ce inhibitor# 0"# 1ed o! choice !or anaphylactic shock is Epinephrine 0*# 1ed o! choice !or $tatus Epilepticus is -alium# 0.# 1ed o! choice !or bipolar is lithium# 0/# @miodorone is e!!ective in both ventricular and atrial complications# 00# $. sound is normal in 2<3, not normal in 1,# 04# give cara!ate (B, med) be!ore meals to coat stomach 05# Protoni; is given prophylactically to prevent stress ulcers# 07# a!ter endoscopy check gag re!le;# 08# =PN(total parenteral nutrition) given in subclavian line# 49# low residue diet means low !iver 4"# diverticulitis (in!lammation o! the diverticulum in the colon) pain is around EE quadrant# 4*# @ppendicitis (in!lammation o! the appendi;) pain is in ?E quadrant with rebound tenderness# 4.# portal hypotension R albuminemia= @scites# 4/# beta cells o! pancreas produce insulin 40# 1orphine is contraindicated in Pancreatitis# ,t causes spasm o! the $phincter o! +ddi# =here!ore Aemerol should be given# 44# =rousseau and =chovoski signs observed in hypocalcemia 45# with chronic pancreatitis, pancreatic enDymes are given with meals# 47# Never give KR in ,- push# 48# mineral corticoids are give in @ddisonHs disease# 59# Aiabetic ketoacidosis (AK@)= when body is breaking down !at instead o! sugar !or energy# 3ats leave ketones (acids) that cause p< to decrease# 5"# AK@ is rare in diabetes mellitus type ,, because there is enough insulin to prevent breakdown o! !ats# 5*# $ign o! !at embolism is petechiae# =reated with heparin# 5.# !or knee replacement use continuous passive motion machine# 5/# give prophylactic antibiotic therapy be!ore any invasive procedure# 50# glaucoma patients lose peripheral vision# =reated with meds 54# cataract= cloudy, blurry vision# =reated by lens removal(surgery 55# 2o* causes vasoconstriction# 57# most spinal cord inCuries are at the cervical or lumbar regions 58# autonomic dysre!le;ia ( li!e threatening inhibited sympathetic response o! nervous system to a no;ious stimulus( patients with spinal cord inCuries at =(5 or above) is usually caused by a !ull bladder# 79# spinal shock occurs immediately a!ter spinal inCury 7"# 1ultiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction# 7*# myasthenia gravis= decrease in receptor sites !or acetylcholine# $ince smallest concentration o! @2=< receptors are in cranial nerves, e;pect !atigue and weakness in eye, mastication, pharyngeal muscles# 7.# =ensilon test given i! muscle is tense in myasthenia gravis# 7/# Buillain(6arre syndrome= ascending paralysis# Keep eye on respiratory system# 70# parkinsonHs = ?@=& rigidity, akinesia (loss o! muscle mvt), tremors# =reat with levodopa# 74# =,@ (transient ischemic attack) mini stroke with no dead brain tissue 75# 2-@ (cerebrovascular accident) is with dead brain tissue# 77# <odgkinHs disease= cancer o! lymph is very curable in early stage# 78# ?ule o! N,NE$ !or burns <ead and Neck= 8S Each upper e;t= 8S Each lower e;t= "7S

10

3ront trunk= "7S 6ack trunk= "7S Benitalia= "S M 89# 6irth weight doubles by 4 month and triple by " year o! age# 8"# i! <? is J"99 do not give dig to children# 8*# !irst sign o! cystic !ibrosis may be meconium ileus at birth# 6aby is inconsolable, do not eat, not passing meconium# 8.# heart de!ects# ?emember !or cyanotic (.=Hs( =o!, =runcys arteriosus, =ransposition o! the great vessels)# Prevent blood !rom going to heart# ,! problem does not !i; or cannot be corrected surgically, 2<3 will occur !ollowing by death# 8/# with ? side cardiac cath=look !or valve problems 80# with E side in adults look !or coronary complications# 84# rheumatic !ever can lead to cardiac valves mal!unctions# 85# cerebral palsy = poor muscle control due to birth inCuries and'or decrease o;ygen to brain tissues# 87# ,2P (intracranial pressure) should be J*# measure head circon!erence# 88# dilantin level ("9(*9)# 2an cause gingival hyperplasia "99# !or 1eningitis check !or KernigHs' 6rudDinskiHs signs# "9"# >ilmHs tumor is usually encapsulated above the kidneys causing !lank pain# "9*# hemophilia is ;(linked# 1other passes disease to son# "9.# when phenylalanine increases, brain problems occur# "9/# 6uckHs traction= knee immobility "90# ?ussell traction= !emur or lower leg "94# Aunlap traction= skeletal or skin "95# 6ryantHs traction= children J.y, J.0 lbs with !emur !;# "97# place apparatus !irst then place the weight when putting traction "98# placenta should be in upper part o! uterus ""9# eclampsia is seiDure# """# a patient with a vertical c(section surgery will more likely have another c(section# ""*# per!orm amniocentesis be!ore *9 weeks gestation to check !or cardiac and pulmonary abnormalities# "".# ?h( mothers receive rhogam to protect ne;t baby# ""/# anterior !ontanelle closes by "7 months# Posterior 4 to 7 weeks# ""0# caput succedaneum= di!!use edema o! the !etal scalp that crosses the suture lines# $welling reabsorbs within " to . days# ""4# pathological Caundice= occurs be!ore */hrs and last5 days# Physiological Caundice occurs a!ter */ hours# ""5# placenta previa = there is no pain, there is bleeding# Placenta abruption = pain, but no bleeding# ""7# bethamethasone (celestone)=sur!actant# 1ed !or lung e;pansion# ""8# dystocia= baby cannot make it down to canal "*9# pitocin med used !or uterine stimulation "*"# 1agnesium sul!ate(used to halt preterm labor) is contraindicated i! deep tendon re!le;es are ine!!ective# ,! patient e;periences seiDure during magnesium adm# Bet the baby out stat (emergency)# "**# Ao not use why or , understand statement when dealing with patients "*.# milieu therapy= taking care o! patient'environment "*/# cognitive therapy= counseling "*0# crisis intervention=short term# "*4# 3,-E ,N=E?-EN=,+N$ 3+? P$F2< P@=,EN=$ (sa!ety (setting limits

11

(establish trusting relationship (meds (leas restrictive methods'environment# "*4# $$?,Hs (antidepressants) take about . weeks to work# "*5# +bsession is to thought# 2ompulsion is to action "*7# i! patients have hallucinations redirect them# ,n delusions distract them# "*8# =horaDine, haldol (antipsychotic) can lead to EP$ (e;trapyramidal side e!!ects) ".9# @lDheimerHs disease is a chronic, progressive, degenerative cognitive disorder that accounts !or more than 49S o! all dementias "# =o remember how to draw up ,N$KE,N think& Nicole .ichie .N (a teacher taught us this is school, thought it was !unny and never !orgot itNNN) @ir into NP<, then air into regular, draw up regular then draw up NP< *# <FPE?thyroidism think o! 0137AE? HA3C/ON in T7.1??E.N /C1NNI NE.VO4/ 24?D*1N* EIE/, Kp all night, heart beating !ast @tropine used to decrease secretions Phenergan an antiemetic used to reduce nausea AiaDepam is a commonly used tranquiliDer given to reduce an;iety be!ore +? Aemerol is !or pain control Ao not give demerol to pts# with sickle cell crisis# ,ron inCections should be given L(track so they don:t leak into $Q tissues# All %hysicians Earn Too 0uch 0oney +r A%E To 0an 3ranial Nerves& G, am sorry i! this vulgar !or some, but hey, it sticks $ensory=$ 1otor=1 6oth=6 +h (+l!actory ,) +h (+ptic ,,) +h (+culomotor ,,,) =o (=rochlear ,-) =ouch (=rigeminal -) @nd (@bducens -,) 3eel (3acial -,,) @ (@uditory -,,,) Birls (Blossopharyngeal ,O) -agina (-agus O) @nd (@ccessory O,) <ymen (<ypoglassal O,,) $ome $ay 1arry 1oney 1y 6ig 6ras 1atter 1ore

6ut 6rother $ays

12

7yper natre+ia (greater than 'J>$ /kin !lushed Agitation ?ow grade !ever Thirst Develop+ental *(. months& turns head side to side /(0 months& grasps, switch % roll 4(5 months& sit at 4 and waves bye(bye 7(8 months& stands straight at eight "9("" months& belly to butt (phrase has "9 letters) "*(". months& twelve and up, drink !rom a cup 7epatitis <epatitis& (ends in a VO@E?, comes !rom the 2O@E? (<ep @) <epatitis 6=6lood and 6odily !luids <epatitis 2 is Cust like 6 Apgar measures 7. .. 0uscle tone .e,le-es /kin color each 9(* point# 7("9 +K# 9(. ?E$K$2,=@=E# *?A/*O@ 3O0A /3A?E: EIE/ VE.2A? 0OTO.! ,t is similar to measuring dating skills###+a- '> points (one can do it i! !elow K you are in 3o+a: $o, to start dating you gotta open your EIE/ ,irst, i! you albe to do that spontaneously and use them correctly to $EE whom you dating you earn /# 6ut i! she has to scream on you to make you open them it is only .####and " you dont care to open even i! she tries to hurt you# i! you get good EFE contact (/ points) then move to VE.2A?: talk to her' himN i! you can do that Fou are really +?,EN=EA in situation she'he uncontiously gives you / pointsN i! you like her try not to be 2+N3K$EA (.), and o! cause do not use ,N@PP?+P?,@=E >+?A$ (.), she will not like it)), try not to ?E$P+NA >,=< ,N2+1P?E<EN$,6EE $+KNA$ (*), i! you do not like her( Cust show no -E?6@E ?E$P+N$E(") $ince you:ve got EFE and -E?6@E contact you can 0OVE now using your 1otor ?esponse Points# =<is is -E?F important since Bood moves give you 4N =he person who hyperventilates is most likely to e;perience respiratory alkalosis# avoid salt substitutes when taken dig and k(supplements because many are potassium based $igns o! hypo;ia& restless, an;ious, cyanotic tachycardia, increased resps# (also monitor @6B:s) @ddison:s disease (need to LaddL hormone) 2ushing:s syndrome (have e;tra LcushionL o! hormones) Aumping syndrome& increase !at and protein, small !requent meals, lie down a!ter meal to decrease peristalsis, wait " hr a!ter meals to drink#

13

3or blood types& T+T is the universal donor (remember LoL in donor) T@6T is the universal receipient Aisseminated <erpes Loster is @,?6+?NE P?E2@K=,+N$, as to EocaliDed <erpes Loster is 2+N=@2= P?E2@K=,+N$# @ nurse with a localiDed herpes Doster 2@N care !or patients as long as the patients are N+= immunosuppressed and the lesions must be coveredN 3at soluble vitamins are -itamins @, A, E, K Bive N$@,A$, 2orticosteroids, drugs !or 6ipolar, 2ephalosporins, and $ul!anomides >,=< !ood# @tivan is the treatment o! choice !or status epilepticus >hen using a bronchodilator inhaler inconCuction with a glucocorticoid inhaler, administer the bronchodilator !irst =heophylline increases the risk o! digo;in to;icity and decreases the e!!ects o! lithium and Ailantin 1Ntal, an inhaler used to treat allergy induced asthma may cause bronchospasm, thinkU 1Nto the asthmatic lung ,soniaDid causes peripheral neuritis Peptic ulcers caused by <# pylori are treated with 3lagyl, Prilosec and 6ia;in# =his treatment kills bacteria and stops production o! stomach acid, but does not heal ulcer# >eighted N, (Naso intestinal tubes) must !loat !rom stomach to intestine# Aon:t tape the tube right away a!ter placement, may leave coiled ne;t to pt on <+6# Position patient on ?,B<= to !acilitate movement through pylorus# G Aiaphragm must stay in place 4 hours a!ter intercourse# =hey are also !itted so must be re( !itted i! you lose or gain a signi!icant amount o! weight# G 6est time to take Browth <ormone P1, $teroids @1, Aiuretics @1, @ricept @1# G 2ara!ate ($ulcra!ate) be!ore meals (mucosal barrier constipation) G =agamet with !ood (<* messes with elderly ppl be care!ul N ,nteracts with alot o! things) G@ntacids a!ter meals G Eong term use o! amphogel (binds to phosphates, increases 2a, robs the bones###leads to increased 2a resortion !rom bones and >E@K 6+NE$) G2ushings ulcers r't 6?@,N inCury G2ushings triad r't ,2P in 6?@,N (htn, bradycard, irr# resp) G=hyroid storm is <+= (hyperthermia) G1y;edema coma is 2+EA (hypothermia) GBlaucoma intraocular pressure is greater than the normal (** mm <g), give miotics to constrict (pilocarpine) N+ @=?+P,NE# G Non dairy sources o! calcium include ?<K6@?6, $@?A,NE$, 2+EE@?A B?EEN$ G Fou can petal the rough edges o! a plaster cast with tape to avoid skin irritation# G>ith low back aches, bend knees to relieve G Push !luids with @llopurinol ( !lush the uric acid out o! system G Koplick:s spots are red spots with blue center characteristic o! P?+A?+1@E stage o! 1easles# Ksually in mouth# G ,N< can cause peripheral neuritis, take -it 64 to prevent also hepatoto;ic

14

G .i!ampin ( .ed orange tears and urine, also contraceptives don:t work as well G Ethambutol ( messes with your Eyes G @pply eye drop to conCunctival sac and a!ter wards apply pressure to nasolacrimal duct ' inner canthus G Pancreatitis patients but them in !etal position, NP+, gut rest, prepare antecubital site !or P,22 cuD they:ll probably be getting =PN'Eipids G =rendelenburg test ( !or varicose veins# ,! they !ill pro;imally = varicosity# ?ule o! nines, 8 = head, "7 = arms, .4 = torso, .4 =legs, and "= perineum = "99S @hen giving Caye-alate we need to worry a!out dehydration ( C ha ineverse relationship with Na$ Iogurt has live cultures- dont give to i++unosuppressed pt 1tching under cast area- cool air via !low dryer ice pack ,or '(- '> +inutes: NEVE. use Ftip or anything to scratch area 1urphyHs sign I pain with palpation o! gall bladder area seen with cholecystitis 2ullenHs sign I ecchymosis in umbilical area, seen with pancreatitis =urnerHs sign I !lank grayish blue (turn around to see your !lanks) pancreatitis 1c6urneyHs Point I pain in ?EQ indicative o! appendicitis EEQ I diverticulitis , low residue, no seeds, nuts, peas ?EQ I appendicitis, watch !or peritonitis Buthrie =est I =ests !or PKK, baby should have eaten source o! protein !irst $hilling =est I test !or pernicious anemia' how well one absorbs -it b"* @llenHs test I occlude both ulnar and radial artery until hand blanches then release ulnar# ,! the hand pinks up, ulnar artery is good and you can carry on with @6B'radial stick as planned# @6B$ must be put on ice and whisked to the lab# o,tHs ok to have abdominal craps, blood tinged out!low and leaking around site i! the Peritoneal Aialysis cath (tenkho!!) was placed in the last "(* wks# 2loudy out!low NE-E? N+?1@E# o@mniotic !luid yellow with particles = meconium stained o<yper re!le;es (upper motor neuron issue Vyour re!le;es are over the topW) o@bsent re!le;es (lower motor neuron issue) o?hogam & given at *7 weeks, 5* hours post partum, ,1# +nly given to ?h NEB@=,-E mother# @lso i! indirect 2oombHs test is positive, donHt need to give ?hogam cuD she has antibody only give i! negative coombs o-it K is to coumadin as Protamine $ul!ate is to <eparin as 2a Blu is to 1g$o/ as 1ucomyst is to @cetominophen as @micar is to =P@Uget itM @ntidotes'treatments !or overdose +rder o! assessment& ,nspection, Palpation, Percussion and @usculation# EO2EP= with abdomen cuD you donHt wanna mess with the bowels and their sounds so you ,nspect, @uscultate, Percuss then Palpate (same with kids, , suppose since you wanna go !rom least invasive to most invasive sine they will cry 6E++A 1K?AE? N Botta love them kids N) Eate; allergies =) @ssess !or allergies to bananas, apricots, cherries, grapes, kiwis, passion !ruit, avocados, chestnuts, tomatoes, peaches

15

=ensilon is used in myesthenia gravis to con!irm the diagnosis# 1yesthenia gravis is caused by a disorder in the transmission o! impulses !rom nerve to muscle cell# @myotrophic lateral sclerosis ( @E$ ) is a condition in which there is a degeneration o! motor neurons in both the upper % lower motor neuron systems# Transesophageal Distula (TED$ ( esophagus doesn:t !ully develop (this is a surgical emergency) =he M 3Es o, TED in the newborn& ") 2hoking *) 2oughing .) 2yanosis =he 11? vaccine is given $Q not ,1# ?ed((unstable, ie, occluded airway, actively bleeding, see !irst Fellow(((stable, can wait up to an hour !or treatment, ie burns, see second Breen(((stable, can wait even longer to be seen, Twalking woundedT 6lack((unstable clients that will probably not make it, need com!ort measures A+@(((dead on arrival Breek heritage ( they put an amulet or any other use o! protective charms around their baby:s neck to avoid Tevil eyeT or envy o! others 4 year old kids cannot interpret TIME# Need to e;plain time in relationship to a known 2+11+N E-EN= (eg& T1om will be back a!ter supperT)# GG @naphylactic reaction to baker:s yeast is contraindication !or <ep 6 vaccine# GG @sk !or allergy to eggs be!ore 3lu shot GG @sk !or anaphylactic r;n to eggs or neomycin be!ore 11? GG >hen on nitroprusside, monitor thiocynate (cyanide)# Normal value should be ", )" is heading toward to;icity GG,! kid has cold, can still give immuniDations GG$@?$ (severe acute resp syndrome) airborne R contact (Cust like varicella) GG <epatitis @ is contact precautions GG =etanus, <epatitis 6, <,- are $=@NA@?A precautions GG >illiam:s position ( $emi 3owlers with knees !le;ed (inc# knee gatch) to relieve lower back pain# GG $,BN$ o! a 3ractured hip& EO=E?N@E ?+=@=,+N, $<+?=EN,NB, @AAK2=,+N GG 3at Embolism& 6lood tinged sputum (r't in!lammation), inc E$?, respiratory alkalosis (not acidosis r't tachypnea), hypocalcemia,increased serum lipids, Tsnow stormT e!!ect on 2O?# GG2omplications o! 1echanical -entilation& Pneumothora;, Klcers GG Paget:s Aisease ( tinnitus, bone pain, enlargement o! bone, thick bones# GG N+ -,=@1,N 2 with @llopurinol GG ,-P requires bowel prep so they can visualiDe the bladder better GG@cid @sh diet ( cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread GG @lk @sh diet( milk, veggies, rhubarb, salmon GG +range tag in triage is non emergent Psych GG Breenstick !ractures, usually seen in kids bone breaks on one side and bends on the other

16

,nsomnia is a side e!!ect o! thyroid hormones# $aunders con!irms it# 1akes sense thoughN ,ncreased met# rate, your body is Ttoo busy to sleepT as opposed to the !olks with hypothyroidism who may report somnolence (dec# met rate, body is slow and sleepy)# +k some more !acts# GG 6+=+O !or strabismus# Patch the B++A eye so that the weaker eye can get stronger# 3ound a cool link about its use in peds pt with strabismus# , had to look it up cuD , heard it was important Gah hem ah hemG GG =,A@E -+EK1E is 5 I "9ml ' kg GG 2+PA patients ?E1E16E?& *EN2 or less (hypo;ic N+= hypercapnic drive), Pa9* o! 49ish and $a9* 89S is normal !or them b'c they are chronic 2+* retainers# ### GG Neostigmine'@tropine (anticholinergic) to reverse e!!ect o! pancuronium# GG@mpho 6 causes hypokalemia (amongst many other things##gotta premedicate be!ore giving# Pts will most likely get a !ever) GG =est / hypersensitivity be!ore the administration o! asparginase# GG =ake -ermo; with high !at diet (increases absorption) GG Kidney Blucose threshold is "79 GG @mphogel and ?enegal take with meals GG $tranger an;iety is greatest 5 ( 8 months, $eparation an;iety peaks in toddlerhood GG 11? is a $Q shot Eymes is !ound mostly in 2onneticut @sthma and @rthritis((swimming best @sthma has intercostal retractions((be concerned =ardive Ayskinesia ( irreversible ( involuntary movements o! the tongue, !ace and e;tremities, may happen a!ter prolonged use o! antipsychotics @kathisia ( motor restlessness, need to keep going, t; with antiparkinsons meds, can be mistaken !or agitation# >hen drawing an @6B, you need to put the blood in a hepariniDed tube, make sure there are no bubbles, put on ice immediately a!ter drawing, with a lable indicating i! the pt was on room air or how many liters o! +*# ?emember to pre!orm the @llen:s =est prior to doing an @6B to check !or su!!icient blood !low 6e!ore going !or Pulmonary 3uction =ests (P3=:s), a pt:s bronchodilators will be with(held and they are not allowed to smoke !or / hrs prior 3or a lung biopsy, position pt lying on side o! bed or with arms raised up on pillows over bedside table, have pt hold breath in mide;piration, chest ;(ray done immediately a!terwards to check !or complication o! pneumothora;, sterile dressing applied 3or a lumbar puncture, pt is positioned in lateral recumbent !etal position, keep pt !lat !or *(. hrs a!terwards, sterile dressing, !requent neuro assessments EEB, hold meds !or */(/7 hrs prior, no ca!!ine or cigarettes !or */ hrs prior, pt can eat, pt must stay awake night be!ore e;am, pt may be asked to hyperventilate and watch a bright !lashing light, a!ter EEB, assess pt !or seiDures, pt:s will be at increased risk Aiamo;, used !or glaucoma, can cause hypokalemia

17

Ae;edrine, used !or @A<A, may alter insulin needs, avoid taking with 1@+,:s, take in morning (insomnia possible side e!!ect) 2ytovene, used !or retinitis caused by cytomegalovirus, pt will need regular eye e;ams, report diDDiness, con!usion, or seiDures immediately ,N<, used to treat and prevent =6, do not give with dilantin, can cause phenytonin to;icity, monitor E3=:s, give 64 along with, hypotension will occur initially, then resolve ?i!ampin, !or =6, dyes bodily !luids orange ,! mi;ing antipsychotics (ie <aldol, =hroaDine, Proli;in) with !luids, med is incompatible with ca!!ine and apple Cuice <aldol pre!erred anti(psychotic in elderly, but high risk e;trapyramidal side e!!ects (dystonia, tarditive dyskinesia, tightening o! Caw, sti!! neck, swollen tongue, later on swollen airway), monitor !or early signs o! reaction and give ,1 6enadryl ?isperdal, antipsychotic, doses over 4mg can cause tarditive dyskinesia, !irst line antipsychotic in children Eevodopa, !or parkinsons, contraindicated in pts with glaucoma, avoid 64 $inemet, !or parkinsons, contraindicated with 1@+,:s <ydro;yurea, !or sickle cell, report B, symptoms immediately, could be sign o! to;icity Locor, !or hyperlipidemia, take on empty stomach to enhance absorption, report any une;plained musle pain, especially i! !ever Aecorticate is toward the :cord:# Aecerebrit is the other way (out) GG 6+=+O GG (6otulin =o;in) can be used with strabismus also to rela; vocal cords in spasmodic dysphonia#

18

(0unchausen /yndro+e is a psychiatric disorder that causes an individual to sel!(in!lict inCury or illness or to !abricate symptoms o! physical or mental illness, in order to receive medical care or hospitaliDation# ,n a variation o! the disorder, 0unchausen !y pro-y (0/2%$, an individual, typically a mother, intentionally causes or !abricates illness in a child or other person under her care# (0ultiple /clerosis is a chronic, progressive disease with demyelinating lesions in the 2N$ which a!!ect the white matter o! the brain and spinal cord# 0otor /6/5 limb weakness, paralysis, slow speech /ensory /6/5 numbness, tingling, tinnitus 3ere!ral /6/5 nystagmus, ata;ia, dysphagia, dysarthria 7untingtonEs 3horea5 09S genetic, autosomal dominant disorder $'$& chorea (() writhing, twisting, movements o! !ace, limbs and body (gait deteriorates to no ambulation (no cure, Cust palliative care (>62 shi!t to the le!t in a patient with pyelonephritis (neutrophils kick in to !ight in!ection) (Ae!initive diagnosis !or abd# aortic aneurysm (@@@) --& 2= scan (Aon:t use Kaye;alate i! patient has hypoactive bowel sounds# (Kremic !etor --& smell urine on the breath (<irschsprungHs --& bile is lower obstruction, no bile is upper obstruction ribbon like stools# (Pancreatic enDymes are taken with each mealN Not be!ore, not a!ter, but @1T7 each meal#

19

=hank you, , !inally realiDe why a person shouldn:t have cantaloupe be!ore a occult stool test, because cantaloupe is high in vit c and vit c causes a !alse R !or occult blood# Now , Cust need to !igure out why they can:t have !ish# 7ypospadias5 abnormality in which urethral meatus is located on the ventral (back) sur!ace o! the penis anywhere !rom the corona to the perineum (re+e+!er hypo low (,or lower side or under side$ Epispadias5 opening o! the urethra on the dorsal (!ront) sur!ace o! the penis %riapis+5 pain!ul erection lasting longer than 4 hrs# @nticholinergic e!!ects((assessment dry mouth==can:t spit urinary retention=can:t GGGG constipated =can:t GGGG blurred vision=can:t see >hen you see 2o!!ee(brown emesis, think peptic ulcer *#@nytime you see !luid retention# =hink heart problems!irst# .#@n answer that delays care or treatment is @E>@F$wrong /#3or P-A remember A@-E (Eegs are Aependent !or@rterial % !or -enous Elevated) more to come##########

>hen choosing an answer, think in this mannerU i! you can only do +NEF one thing to help this patient what would it beM Pick the most important intervention#

,! two o! the answers are the e;act opposite, like bradycardia or tachycardia### one is probably the answer# ,! two or three answers are similar or are alike, none is correct# >hen asking patientsH questions NE-E? use VwhyW questions# Eliminate all VwhyMW answer options# ,! you have never heard o! itU please donHt pick itN Never release traction KNEE$$ you have an order !rom the 1A to do so Questions about a haloM ?emember sa!ety !irst, have a screwdriver nearby# ?emember compartment syndrome is an emergency situation# Paresthesias and increased pain are classic symptoms# Neuromuscular damage is irreversible /(4 hours a!ter onset# @lways deal with actual problems or harm be!ore potential problems @lways select a Vpatient !ocusedW answer# @n answer option that states Treassess in "0 minutesT is probably wrong# ,nterpersonal model ($ullivan) 6ehavior motivated by need to avoid an;iety and satis!y needs "# ,n!ancy 9("7 months others will satisy needs *# childhood )4yrs learn to delay need grati!ication .# Cuvenile 4(8 years learn to relate to peers /# preadolescence 8("* yrs learns to relate to !riends o! o! opposite se; 0# early adolescence"*("/yrs&learn independence and how to relate to opposite se; 4# late adolecence "/(*"yrs& develop intimate relationship with person o! opposite se; is this not about communicationM####

20

3etal alcohol syndrome (upturned nose (!lat nasal bridge (thin upper lip ($B@ vastus lateralis is ,1 administration site !or 4month in!ants 3or toddlers above "7 months ventrogluteal =he deltoid and gluteus ma;imus are appropriate sites !or children +K( both eyes +$( le!t eye +A( right eye ( dominent ?ight eye( Cust a tip to remember) "# 3OA? (cane walking)& 3 ( cane O ( opposite A ( a!!ected ? ( leg ?ed( ,mmediate& ,nCuries are li!e threatening but survivable with minimal intervention# E;& hemothra;, tension pneumothora;, unstable chest and abdominal wounds, ,N2+1PEE=E amputations, +PEN !;:s o! long bones, and *nd'.rd degree burn with "0S(/9S o! total body sur!ace, etc# Fellow( Aelayed& ,nCuries are signi!icant and require medical care, but can wait hrs without threat to li!e or limb# E;& $table abd wounds without evidence o! hemorrhage, !; requiring open reduction, debridement, e;ternal !i;ation, most eye and 2N$ inCuries, etc# Breen( 1inimal& ,nCuries are minor and t; can be delayed to hrs or days # ,ndividuals in this group should be moved away !rom the main triage area# E;& upper e;tremity !;, minor burns, sprains, sm# lacerations, behavior disorders# 6lack( E;pectant& ,nCuries are e;tensive and chances o! survival are unlikely# $eperate but dont abandoned, com!ort measures i! possible# E;& Knresponsive, spinal cord inCuries, woulds with anatomical organs, *nd'.rd degree burn with 49S o! body sur!ace area , seiDures, pro!ound shock with multipe inCuries, no pulse, b#p, pupils !i;ed or dilated# =horacentesis prep( =ake v#s#, shave area around needle insertion, position patient with ar+s on pillow on over !ed ta!le or lying on side no more than "999cc at a one time# Post( listen !or bilateral breath sounds, v#s#, check leakage, sterile dressing# 2=( assess allergies 1?,( claustrophobia, no metal, assess pacemaker 2ardiac cath( npo 7("*hr, empty bladder, pulses, tell pt may !eel heat palpitations or desire to cough with dye inCection# Post( -ital signs keep leg straight bedrest 4(7hr# cerebral angio prep( well hydrated, lie !lat, sire shaved, pulses marked post( keep !lat "*("/hr, check site, pulses,!orce !luids# Eumbar puncture( !etal postion# post( nuero assess q"0(.9 until stable, !lat*(.hr, encourage !luids, oral anlgesics !or headache, observe dressing

21

EEB( no sleep the night be!ore, meals not withheld, no stimulants !or */hr be!ore, tranquiliDer'stimulant meds held */(/7hr be!ore, may be asked to hyperventilate .(/min and watch a bright !lashing light# 1yelogram( Npo /(4hr, allergy h;, phenothiaDines, cns depressants, and stimulants withheld /7hr prior, table will be moved to various postions during test# Post( neuro q*(/, water solu!le 7O2 up oil solu!le 7O2 down oral analgesics !or h'a, encourage po !luids, assess !or distended bladder, inspect site# Eiver biopsy( @dm vit k , npo morning o! e;am 4hr, give sedative, Teach pt that he will !e asked to hold !reath ,or >-'(sec supine postion lateral with upper ar+s elevated: %ost- postion on right side ,reFuent v:s: report severe a! pain stat no heavy li!ting "wk# Paracentesis( semi !owlers or upright on edge o! bed, empty bladder# Post( v#s#, report elevated temp, observe !or signs o! hypovolemia# Eaparoscopy( 2+* used to enhances visual, general anesthesia, !oley# %ost- walk patient to decrease 3O< !uild up used ,or procedure: Pyelogram( assess allergies $engstaken blakemore tube used !or t; o! esophageal varices, keep scissors at !edside: <emovac( used a!ter mastectomy, empty when !ull or q7hr, remove plug, empty contents, place on !lat sur!ace, cleanse opening and plug with alcohol sponge, co+press evacuator co+pletely to re+ove air, release plug, check system !or operation# 2ommon $igns and $ymptoms 9"# P=6 I low(grade a!ternoon !ever# 9*# PNEK1+N,@ I rusty sputum# 9.# @$=<1@ I wheeDing on e;piration# 9/# E1P<F$E1@ I barrel chest# 90# K@>@$@K, $FNA?+1E I strawberry tongue# 94# PE?N,2,+K$ @NE1,@ I red bee!y tongue# 95# A+>N $FNA?+1E I protruding tongue# 97# 2<+EE?@ I rice watery stool# 98# 1@E@?,@ I stepladder like !ever with chills# "9# =FP<+,A I rose spots in abdomen# ""# A,P=<E?,@ I pseudo membrane !ormation "*# 1E@$EE$ I koplikHs spots# ".# $EE I butter!ly rashes#

22

"/# E,-E? 2,??<+$,$ I spider like varices# "0# EEP?+$F I lioning !ace# "4# 6KE,1,@ I chipmunk !ace# "5# @PPENA,2,=,$ I rebound tenderness# "7# AENBKE I petechiae or (R) <ermanHs sign# "8# 1EN,NB,=,$ I KernigHs sign (leg !le; then leg pain on e;tension), 6rudDinski sign (neck !le; = lower leg !le;)# *9# =E=@NF I hypocalcemia (R) =rousseauHs sign'carpopedal spasm 2hvostek sign (!acial spasm)# *"# =E=@NK$ I risus sardonicus# **# P@N2?E@=,=,$ I 2ullenHs sign (ecchymosis o! umbilicus) (R) Brey turners spots# *.# PFE+?,2 $=EN+$,$ I olive like mass# */# PA@ I machine like murmur# *0# @AA,$+NH$ A,$E@$E I bronDe like skin pigmentation# *4# 2K$<,NBH$ $FNA?+1E I moon !ace appearance and bu!!alo hump# *5# <FPE?=<F?+,A,$1'B?@-EH$ A,$E@$E I e;opthalmus# *7# ,N=K$$K$2EP=,+N I sausage shaped mass, Aance $ign (empty portion o! ?EQ) *8# 1$ I 2harcotHs =riad (,@N) .9# 1B I descending muscle weakness ."# Buillain 6arre $yndrome I ascending muscle weakness .*# A-= I <omanHs $ign ..# 2<,2KEN P+O I -esicular ?ash (central to distal) dew drop on rose petal ./# @NB,N@ I 2rushing stubbing pain relieved by N=B .0# 1, I 2rushing stubbing pain which radiates to le!t shoulder, neck, arms, unrelieved by N=B .4# E=6 I inspiratory stridor .5# =E3 I /2sH 2oughing, 2hoking, 2yanosis, 2ontinous Arooling .7# EP,BE+=,=,$ I .AsH Arooling, Aysphonia, Aysphagia .8# <+ABEK,NH$ A$E'EF1P<+1@ I painless, progressive enlargement o! spleen % lymph tissues, ?eedstenberg 2ells

23

/9# ,N3E2=,+K$ 1+N+NK2EE+$,$ I <allmark& sore throat, cervical lymph adenopathy, !ever /"# P@?K,N$+NH$ I Pill(rolling tremors /*# 3,6?,N <F@E,N I E;piratory Brunt /.# 2F$=,2 3,6?+$,$ I $alty skin //# A1 I polyuria, polydypsia, polyphagia /0# AK@ I Kussmauls breathing (Aeep ?apid ??) /4# 6E@AAE? 2@ I painless hematuria /5# 6P< I reduced siDe % !orce o! urine /7# PE1P<,BK$ -KEB@?,$ I NikolskyHs sign (separation o! epidermis caused by rubbing o! the skin) /8# ?E=,N@E AE=@2<1EN= I -isual 3loaters, !lashes o! light, curtain vision 09# BE@K2+1@ I Pain!ull vision loss, tunnel'gun barrel'halo vision (Peripheral -ision Eoss) 0"# 2@=@?@2= I Painless vision loss, +pacity o! the lens, blurring o! vision 0*# ?E=,N+ 6E@$=+1@ I 2atHs eye re!le; (grayish discoloration o! pupils) 0.# @2?+1EB@EF I 2oarse !acial !eature 0/# AK2<ENNEH$ 1K$2KE@? AF$=?+P<F I BowersH sign (use o! hands to push oneHs sel! !rom the !loor) 00# BE?A I 6arretts esophagus (erosion o! the lower portion o! the esophageal mucosa) 04# <EP@=,2 EN2EP<@E+P@=<F I 3lapping tremors 05# <FA?+2EP<@EK$ I 6ossing sign (prominent !orehead) 07# ,N2?E@$E ,2P I <FPE?tension 6?@AFpnea 6?@AFcardia (2ushingHs =riad) 08# $<+2K I <FP+tension =@2<Fpnea =@2<Fcardia 49# 1EN,E?EH$ A$E I -ertigo, =innitus 4"# 2F$=,=,$ I burning on urination 4*# <FP+2@E2E1,@ I 2hvostek % =rosseaus sign 4.# KE2E?@=,-E 2+E,=,$ I recurrent bloody diarrhea 4/# EF1EH$ A$E I 6ullHs eye rash +ttorhea s's o! basilar !racture 6attles sign and racoons eyes s's o! orbital !racture

24

=ake iron eli;ir with Cuice or water#### never with milk Kawasaki:s leads to Ailantin "9(*9 =heophyline "9(*9 @cetaminophen "9(*9 Eithium 9#0("#0 Aigo;in 9#0(*#9 +steomyletitis is an in!ectious bone dD# Bive blood cultures and antibiotics, then i! necessary surgery to drain abscess# Nephrotic syndrome s's edema R hypotension# =urn and reposition (risk !or impaired skin integrity) =o access role relationship pattern !ocus on image and relationships with others# ?enal impairment& serum creatinine elevated and urine clearance decreased cardiac problems

Norm# $erum creatinine 9#7("#7 (men), 9#0("#0 (women) Norm# Krine clearance 70(".0 @tropine +verdose <ot as a <are (=emp), 1ad as a <atter 6one (=hirsty) <emoglobin Neonates "7(*5 . mos "9#4("4#0 . yrs 8#/("0#0 "9 yrs "9#5("0#0 Blomerulonephritis& take vs q / hrs R daily weights @ge / to 0 yrs child needs AP='11?'+P2ystic 3ibrosis give diet low !at, high sodium, !at soluble vitamins @AEK# @erosal bronchodilators, mucolytics and pancreatic enDymes# @irborne Precautions& measels, chicken po; and =6# private room, negatvie pressure w' 4("* air e;changes, 1ask N80# Aroplet Precautions&sepsis, scarlet !ever, streptococcal pharyngitis, parovirus 6"8, pnuemonia, pertusis, in!luenDa, diptheria, epiglottis, rubella, mumps, meningitis, mycoplasma and adenovirus# Aoor open, . !t distance, private room or cohort, mask 2ontact Precautions& multidrug resistant organism respiratory, skin, wound enteric and eye ,N3E2=,+N$ Lolo!t s'e agitation, sleep disturb, and dry mouth 2loDapine s'e agranulocytosis, tachycardia and sieDures 6lood tests !or 1,& 1yoglobin, 2K and =roponin (E+2), ?ed as a 6eet (!lushed !ace) and Ary as a

25

$alt substitutes may contain pottasium Placental abruptio& bleeding with pain, don:t !orget to monitor volume status (,%+) @n ill child regresses in behaviors 1eningeal irritation $'s nuchal rigidity, positive 6rudDinski R Kernig signs and P<+=+P<+6,@ tooN

6abinski sign ( toes curl

greatN toes !an

bad

Blucose =olerance =est !or preggies result o! "/9 or highter needs !urther evaluation# @ssessing e;traocular eye movements check cranial nerves ., /, and 4# $tomas dusky stoma means poor blood supply, protruding means prolapsed, sharp pain R rigidity means peritonitis, mucus in ileal conduit is e;pected# Ailantin s'e rash (stop med), gingival hyperplasia (good hygiene) to;icity(()poor gait R coordination, slurred speech, nausea, lethargy, and diplopia# Phenobarbital can be taken during pregnancy but Ailatin is contraindicated# =ension pneumothora; trachea shi!ts to opposite side# =his is B?E@=N <ere:s some , got !rom a review class , went to several months ago### A3hange in color is always a E@=E signN G1ncentive /piro+etry steps&") $it upright *) E;hale .) ,nsert mouthpiece /) ,nhale !or . seconds, and then <+EA !or "9 seconds AA+inoglycocide (XX1ycin e;cept erythromycine) @dverse E!!ects are bean shaped ( Nephroto;ic to Kidneys and +toto;ic to Ears A0./A ( 2ontact precaution +NEF AV./A ( 2ontact @NA airborne precaution (Private room, door closed, negative pressure) A?1T7140 L-level of therapeutic affect is 0.5-1.5 I-indicate mania T-to ic level is !-" - #$%& diarrhea& tremors '-hyrdrate !-"L of (ater$day I-increased )* and dry mouth )-uh oh+ ,ive Mannitol and -iamo if to ic s$s are present M-maintain #a intake of !-",$day AAll psych +edsE (e-cept ?ithiu+$ side e,,ects are the sa+e as /N/ !ut the 2% is decreased: A/N/( ,ncrease in 6P, <? and ?? (dilated bronchioled), dilated pupils (blurred vision), Aecreased BK= (urniary retention), B,= (constipation), 2onstricted blood vessels and Ary mouth# A2lood trans,usion- sign o! allergies in order& ")3lank pain *)3requent swallowing .)?ashes /)3ever 0)2hills AThro+!ocytopenia (6leeding precautionsN ")$o!t bristled toothbrush *)No insertion o! anythingN (c'i suppositories, douche)

26

.)No ,1 meds as much as possibleN G,ron de!iciency anemia ( easily !atigued ")3e P+ ( give with -itamin 2 or on an empty stomach *)3e via ,1( ,n!eron via Ltrack A%ernicious Ane+ia ( ?ed, 6e!!y tongue will take -it#6"* !or li!eN A24.N/ "st Aegree ( ?ed and Pain!ul *nd Aegree ( 6listers .rd Aegree ( No Pain because o! blocked and burned nerves A0eniereEs Disease ( @dmin diuretics to decrease endolymph in the cochlea, restrict Na, lay on a!!ected ear when in bed# =riad& ")-ertigo *)=innitus .)N'A*astric 4lcer pain occurs .9 minutes to 89 minutes a!ter eating, not at night, and doesn:t go away with !ood G=hink positive and you can achieve great things# =hink o! present and !uture, the past is gone# ./or,et your past mistakes and focus on your successes encoura,in, yourself to ,reater achievements in the future. .0l(ays do your 1est so you can 1e proud that you ,ave it your 1est shot. ./ocus on your achievements rather than your failures. If you do find yourself thinkin, a1out ho( you failed then look at (hat you mana,ed to do ri,ht and ho( you could correct (hat you did ne t time. .0 mind that is trou1led (ith dou1t (on2t 1e a1le to focus on the victory to 1e had. G=ake it one day at a time# G=ake time !or yoursel!# @ !ried mind can:t !ocus or learn# Pediatric =ips& >hat is an intraosseous in,usionM ,n pediatric li!e(threatening emergencies, when iv access cannot be obtained, an osseous (bone) needle is hand(drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can !e ad+inistered into the +arrow# ,t is a temporary, li!e(saving measure, and , have seen it onceN (Bruesome#) >hen venous access is achieved it can be d'cHd# +ne medication that cannot be administered by intraosseous in!usion is isoproterenol, a beta agonist# (, donHt know more about that drug it was Cust pointed out on a practice e;am#) Auring sickle cell crisis there are two interventions to prioritiDe& ,luids and pain relie!# >ith glo+erulonephritis you should consider !lood pressure to be your most important assessment parameter# Aietary restrictions you can e;pect include !luids, protein, sodium, and potassium# ?emember yesterday when , mentioned how congenital cardiac de!ects result in hypo-ia which the body attempts to compensate !or (in!lu; o! immature rbcHs)M Eabs supporting this would show increased he+atocrit he+oglo!in and r!c count# Aid you know there is an association between low-set ears and renal ano+aliesM Now you know what to look !or i! downHs isnHt there to choose# (Cust to e;pand on it a little, the kidneys and ears develop around the same time in utero# <ence, they:re shaped similarly# >hich is why when doing an assessment o! a neonate, i! the nurse notices low set or asymmetrical ears, there is good reason to investigate renal !unctioning# Knowing that the kidneys and ears are similar shapes helped me remember this)#

27

$chool(age kids (> and up) are old enough, and should have an e-planation o! what will happen a week be!ore surgery such as tonsillectomy# ,! you gave a toddler a choice about taking medicine and he says no, you should leave the room and co+e !ack in !ive minutes, because to a toddler it is another episode# Ne;t time, donHt ask# =he ,irst sign o! pyloric stenosis in a baby is +ild vo+iting that progresses to proBectile vo+iting# Eater you may be able to palpate a mass, the baby will seem hungry o!ten, and may spit up a!ter !eedings# >e know Cawasaki disease causes a heart problem, but what speci!icallyM 3oronary artery aneurys+s d't the in!lammation o! blood vessels# @ child with a ventriculoperitoneal shunt will have a small upper(a!do+inal incision# =his is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles# Fou should watch !or a!do+inal distention, since !luid !rom the ventricles will be re( directed to the peritoneum# Fou should also watch !or signs o! increasing intracranial pressure, such as irritability, bulging !ontanels, and high(pitched cry in an in!ant# ,n a toddler watch lack o! appetite and headache# 2are!ul on a bed position questionN 6ed(position a,ter shunt place+ent is ,lat, so !luid doesnHt reduce too rapidly# ,! you see s's o! increasing icp, then raise the hob to "0(.9 degrees# >hat could cause !ronchopul+onary dysplasiaM Aysplasia means abnormality or alteration# 0echanical ventilation can cause it# Premature newborns with immature lungs are ventilated and over time it damages the lungs# +ther causes could be in!ection, pneumonia, or other conditions that cause in!lammation or scarring# ,t is essential to +aintain nasal patency with children ) ' yr# because they are obligatory nasal breathers# >atch out !or questions suggesting a child drinks more than .(/ cups o! milk each day# (1ilks good, rightM) =oo much milk reduces intake o! other essential nutrients, especially iron# >atch !or ane+ia with +ilk-aholics# @nd donHt let that mother put anything but water in that kidHs bottle during naps'over(night# Puice or milk will rott that kids teeth right out o! his head# >hat traction is used in a school(age kid with a !emur or tibial !racture with e;tensive skin da+ageM Ninety ninety# <uhM , never heard o! it either# =he name re!ers to the angles o! the Coints# @ pin is placed in the distal part o! the broken bone, and the lower e;tremity is in a boot cast# =he rest is the normal pulleys and ropes youHre used to visualiDing with balanced suspension# >hile weHre talking about traction, a kidHs hinder should clear the !ed when in 2ryantGs traction (also used !or !emurs and congenial hip !or young kids)# ,! you can remove the white patches !rom the mouth o! a baby it is Cust !ormula# ,! you canGt its candidiasis# Pust know the 00. and Varicella i++uni8ations co+e later ("0 months)# Kndescended testis or cryptorchidis+ is a known risk !actor !or testicular cancer later in li!e# $tart teaching boys testicular sel, e-a+ around '<, because most cases occur during adolescence# Not pediatrics but have to throw it in I @ guy loses his house in a !ire# Priority is using community resources to !ind shelter, be!ore assisting with !eelings about the tremendous loss# (1aslow)# No aspirin with kids b'c it is associated with ?eyeHs $yndrome, and also no nsaids such as ibupro!en# *ive Tylenol#

28

3/D in +eningitis will have high protein, and low glucose# ,t is always the correct answer to report suspected cases o, child a!use# No nasotracheal suctioning with head inBury or skull ,racture# Deed upright to avoid otitis media# Position prone w hob elevated with gerd# ,n almost every other case, though, you better lay that kid on his back (6ack =o $leep ( $,A$)# Pull pinna down and !ack ,or kids ) M yrs# when instilling eardrops# Kids with ?$- no contact lenses or pregnant nurses in rooms where ri!avirin is being administered by hoot, tent, etc# Positioning with pneumonia I lay on the a,,ected side to splint and reduce pain# 6ut i! you are trying to reduce congestion the sick lung goes up# (Ever had a stu!!y nose, and you lay with the stu!! side up and it clearsM) @ positive ppd con!irms in,ection, not Cust e;posure# @ sputu+ test will con!irm active disease# 3oughing w'o other s's is suggestive o! asth+a# $peaking o! asthma, watch out i! your whee8er stops whee8ing# ,t could mean he is worsening# Fou better pick Ndo vitalsG be!ore administering that dig# (apical pulse !or one !ull minute)# Tet spells treated with +orphine# *roup-a strep precedes rheu+atic ,ever# 3horea is part o! this sickness (grimacing, sudden body movements, etc#) and it e+!arrasses kids# =hey have Boint pain# >atch !or elevated antistreptolysin + to be elevated# PenicillinN AonHt pick cough over tachycardia !or signs o! ch, in an in!ant# ?andom =ips& No +ilk (as well as !resh !ruit or veggies) on neutropenic precautions# Tylenol poisoning I liver !ailure possible !or about J days# 2lose observation required during this time(!rame, as well as t; with 1ucomyst# .adioactive iodine I =he key word here is ,lush# 3lush substance out o! body w'.(/ liters'day !or * days, and !lush the toilet twice a!ter using !or * days# Eimit contact w'patient to .9 minutes'day# No pregnant visitors'nurses, and no kids# =he main hypersensitivity reaction seen with antiplatelet drugs is !ronchospas+ (anaphyla;is)# 2ommon sites !or +etastasis include the liver, brain, lung, bone, and lymph# Orthostasis is veri!ied by a drop in pressure with increasing heart rate# 2ence Hones protein in the urine con!irms +ultiple +yelo+a#

29

AonHt !all !or Yreestablishing a normal bowel patternH as a priority with small !owel o!struction# 6ecause the patient canHt take in oral !luids Ymaintaining ,luid !alanceG comes !irst# %ernicious ane+ia s's include pallor, tachycardia, and sore red tongue# >ith !lecainide (Ta+!ocor), an antiarrythmic, li+it ,luids and sodium intake, because sodium increases water retention which could lead to heart !ailure# 2asophils release hista+ine during an allergic response# Adenosine is the treatment o! choice !or paro;ysmal atrial tachycardia# 1atragenic means it was caused by treatment, procedure, or medication# +ther than initially to test tolerance, *-tu!e and H-tu!e !eedings are usually given as continuous !eedings# Dour side-rails up can be considered a !orm o! restraint# Even in E=2 !acility when a client is a !all risk, keep lower rails down, and one side o! bed against the wall, lowest position, wheels locked# Four cancer patient is getting radiation# >hat should you be most concerned aboutM $kin irritationM No# ,n!ection kills cancer patients most because o! the leukopenia caused by radiation# @ breast cancer patient treated with Ta+o-i,en should report changes in visual acuity, because the adverse e!!ect could be irreversible# %neu+ova- <M gets administered post splenecto+y to prevent pneumococcal sepsis# EetHs say every answer in !ront o! you is an a!nor+al value# ,! potassiu+ is there you can bet it is a problem they want you to identi!y, because values outside o! normal can be li,e threatening# Normal potassium is .#0(0#9# Even a bun o! 09 doesnHt override a potassium o! .#9 in a renal patient in priority# Fou better be making sure that patient on Dig and ?asi- is getting enough potassiu+, because low potassium potentiates Aig and can cause dysrrhythmias# Fou will ask every new ad+ission i! he has an advance directive, and i! not you will e;plain it, and he will have the option to sign or not# @n e;ample o! when you would implement be!ore going through a bunch o! assessments is when someone is e;periencing anaphyla-is# Bet the ordered epinephrine in them stat, especially i! they stem clearly states the s's (di!!iculty breathing, increasing an;iety, etc#) ,n a disaster you should triage the person who is most likely to not survive last# @ little trick regarding potassium& @EC@?O$,$& K is E+> @cidosis is Cust the opposite& K is <igh =he vital sign you should check !irst with high potassiu+ is pulse (due to dysrhythmias)# Bive neostig+ine to clients with 1yesthenia Bravis about /0 min# be!ore eating, so it will help with chewing and swallowing#

30

Anectine is used !or short-ter+ neuro+uscular blocking agent !or procedures like intubation and E2=# Norcuron is !or intermediate or long(term# =he parathyroid gland relies on the presence o! vita+in D to work# *lucagon increases the e!!ects o! oral anticoagulants# 2leeding is part o! the YcirculationH assessment o! the A23DHs in an emergent situation# =here!ore, i! airway and breathing are accounted !or, a compound !racture requires assessment be!ore Blasgow coma scale and a neuro check (A=disability, or neuro check) =he immediate intervention a!ter a sucking sta! wound is to dress the wound and tape it on three sides which allows air to escape# Ao not use an occlusive dressing, which could convert the wound !rom open pneumo to closed one, and a tension pneumothora; is worse situation# @!ter that get your chest tube tray, labs, iv# @n occlusive dressing is used i! a chest tu!e is accidentally pulled out o! the patient# >hen o* deprived, as with a %E, the body compensates by causing hyperventilation (resp alkalosis)# $hould the patient breathe into a paper bagM No# ,! the pao* is well below 79 they need o-ygen# Eook at all your abg values# @s soon as you see the words PE you should think o;ygen !irst# @ typical adverse reaction to oral hypoglyce+ics is rash, photosensitivity# /eru+ acetone and seru+ ketones rise in DCA# @s you treat the acidosis and dehydration e;pect the potassiu+ to drop rapidly, so be ready, with potassium replacement# Dluids are the most important intervention with 77N/ as well as DCA, so get !luids going !irst# >ith <<N$ there is no ketosis, and no acidosis# Potassium is low in <<N$ (d't diuresis)# Atropine !locks acetylcholine (remember it reduces secretions)# Aecorticate positioning in response to pain = 3orte; involvement# Decere!rate in response to pain = 2erebellar, !rain ste+ involvement Dantriu+, !or spasticity, may take a week or more to be e!!ective# Decreased acetylcholine is related to senile de+entia# <yperactive deep tendon re!le;es, vision changes, !atigue and spasticity are all symptoms o! 0/ @!ter removal o! the pituitary gland you must watch !or hypocortisolis+ and temporary diabetes insipidus# Position on right side with legs !le;ed a!ter appendecto+y# 7irschsprungGs diagnosed with rectal biopsy looking !or a!sence o, ganglionic cells# 2ardinal sign in in!ants is !ailure to pass meconium, and later the classic ribbon(like and !oul smelling stools# 1ntussusception common in kids with 3D# +bstruction may cause !ecal emesis, currant Bellylike stools (blood and mucus)# @ barium enema may be used to hydrostatically reduce the telescoping# ?esolution is obvious, with onset o! bowel movements#

31

>ith o+phalocele and gastroschisis (herniation o! abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp# Kid can lose heat quickly# @!ter a hydrocele repair provide ice !ags and scrotal support# No phenylalanine with a kid positive !or %C4 (no meat, no dairy, no aspartame)# /econd voided urine most accurate when testing !or ketones and glucose# Never give potassiu+ i! the patient is oliguric or anuric# Nephrotic syndro+e is characteriDed by massive proteinuria (looks dark and !rothy) caused by glomerular damage# 2orticosteroids are the mainstay# BeneraliDed edema common# @ positive @estern !lot in a child J"7 months (presence o! <,- antibodies) indicates only that the +other is in!ected# =wo or more positive p<J antigen tests will con!irm <,- in kids J"7 months# =he p*/ can be used at any age# 3or 71V kids avoid O%V and Varicella vaccinations (live), but give Pneumococcal and in!luenDa# 11? is avoided only i! the kid is severely immunocompromised# Parents should wear gloves !or care, not kiss kids on the mouth, and not share eating utensils# 7ypotension and vasoconstricting meds may alter the accuracy o! o< sats# @n antacid should be given to a mechanically ventilated patient w' an ng tube i! the ph o! the aspirate is )>:(# @spirate should be checked at least every "* hrs# @mbient air (roo+ air) contains <'O o;ygen# =he !irst sign o! A.D/ is increased respirations# Eater comes dyspnea, retractions, air hunger, cyanosis# Normal %3@% (pul+ capillary wedge pressure$ is K-'M# ?eadings o! "7(*9 are considered high# 3irst sign o! %E is sudden chest pain, !ollowed by dyspnea and tachypnea# 7igh potassiu+ is e;pected with car!on dio-ide narcosis (hydrogen !loods the cell !orcing potassium out)# 2arbon dio;ide narcosis causes increased intracranial pressure# Pulmonary sarcoidosis leads to right sided heart !ailure# @n N* tu!e can be irrigated with cola, and should be taught to !amily when a client is going home with an NB tube# Digitalis increases ventricular irrita!ility, and could convert a rhythm to v(!ib !ollowing cardioversion# ,! your normally lucid patient starts seeing !ugs you better check his respiratory status !irst# =he !irst sign o! hypo;ia is restlessness, !ollowed by agitation, and things go downhill !rom there all the way to delirium, hallucinations, and coma# $o check the o* stat, and get abgHs i! possible# =he biggest concern with cold stress and the newborn is respiratory distress# Eook care!ully when you have no idea# ,n a word like rhabdomyosarcoma you can easily ascertain

32

it has something to do with muscle (myo) cancer (sarcoma)# =he same thing goes !or drug names# 3or e;ample, i! it ends in Iide itHs probably a diuretic, as in 3urosemide, and @myloride# ?asi- can cause a patient to lose his appetite (anore-ia) due to reduced potassium# ,! your laboring momHs water breaks and she is any +inus station you better know there is a risk o! prolapsed cord# ,n a ,ive-year old !reathe once ,or every > compressions doing cpr# @!ter g-tu!e place+ent the stomach contents are drained by gravity !or <J hours be!ore it can be used !or !eedings# 2ephalhematoma (caput succinidaniu+) resolves on its own in a !ew days# =his is the type o! edema that crosses the suture lines# Auring the acute stage o! 7ep-A gown and gloves are required# ,n the convalescent stage it is no longer contagious# ?ow +agnesiu+ and high creatinine signal renal ,ailure: %ain is usually the highest priority with .A ,! a T2 patient is unable'unwilling to co+ply with t; they may need supervision (direct observation)# =6 is a public health risk# Eevel o! consciousness is the most important assessment parameter with status epilepticus# 3rackles suggest pneumonia, which is likely to be accompanied by hypo-ia, which would mani!est itsel! as mental con!usion, etc# 3anGt cough=ine,,ective airway clearance A!sence o, +enstruation leads to osteoporosis in the anore;ic# Toddlers need to e;press autonomy (independence) @ patient with a low he+oglo!in and6or he+atocrit should be evaluated !or signs o! !leeding, such as dark stools# @ la-ative is given the night be!ore an 1V% in order to better visualiDe the organs# @ patient with liver cirrhosis and ede+a may a+!ulate, then sit with legs elevated to try to mobiliDe the edema# 0anaging stress in a patient with adrenal insu!!iciency (AddisonGs) is paramount, because i! the adrenal glands are stressed !urther it could result in @ddisonian crisis# >hile weHre on @ddisonHs, remember blood pressure is the most important assessment parameter, as it causes severe hypotension: @!ter pain relie!, cough and deep !reathe is important in pancreatitis, because o! !luid pushing up in the diaphragm# /a,ety over Nutrition with a severely depressed client#

33

%rolonged hypo-e+ia is a likely cause o! cardiac arrest in a child# Dluid volu+e overload caused by ,-2 !luids in!using too quickly (or whatever reason) and 2<3 can cause an /M 3oarctation o, the aorta causes increased blood !low and !ounding pulses in the ar+s @ newly diagnosed hypertension patient should have 6P assessed in !oth ar+s Depression o!ten mani!ests itsel! in so+atic ways, such as psychomotor retardation, gi complaints, and pain# .espiratory problems are the chie! concern with 3D speaking o! =6### PPA is positive i! area o! induration is& )0 mm in an immunocompromised patient )"9 mm in a normal patient )"0 mm in a patient who lives in an area where =6 is very rare# another tiP& <b@"c ( test to assess how well blood sugars have been controlled over the past 89("*9 days# /( 4 corresponds to a blood sugar o! 59(""9 5 is ideal !or a diabetic and corresponds to a blood sugar o! ".9# 2/A is considered the +ost accurate method !or medication dosing with kids# (, though it was weight, but apparently not) Place a wheelchair parallel to the bed on the side o, weakness ,! one nurse discovers another nurse has made a +istake it is always appropriate to speak to her be!ore going to management# ,! the situation persists, then take it higher# /epsis and anaphyla-is (along with the obvious hemorrhaging) reduce circulating volume by way o! increased capillary permeability, which leads to reduced preload (volume in the le!t ventricle at the end o! diastole)# =his is a toughieUthink about it# A+niotic ,luid is alkaline, and turns nitraDine paper !lue: Krine and normal vaginal discharge are acidic, and turn it pink# *onorrhea is a reporta!le disease ?emember the phrase Pstep upQ when picturing a person going up stairs with crutches# =he good leg goes up !irst, !ollowed by the crutches and the bad leg# =he opposite happens going down# =he crutches go !irst, !ollowed by the good leg# >hile treating DCA, bringing the glucose down too ,ar and too ,ast can result in increased intracranial pressure d't water being pulled into the 2$3# %olyuria is common with the hypercalce+ia caused by hyperparathyroidism# ?emember the action o! vasopressin because it sounds like Vpress inW, or vasoconstrict# @ater into-ication will be evidenced by drowsiness and altered mental status in a patient with =K? syndrome, or as an adverse reaction to desmopressin (!or diabetes insipidus)# 2urning sensation in the mouth, and brassy taste are adverse reactions to ?ugol solution (!or

34

hyperthyroid)# ?eport it to the doc# Bive synthroid on an e+pty stomach E-tra insulin may be needed !or a patient taking %rednisone (remember, steroids cause increased glucose)# Non,at +ilk reduces re,lu- by increasing lower esophageal sphincter pressure Patients with *E.D should lay on their le,t side with the <+6 elevated .9 degrees# Knusual positional tip ( ?ow-,owlers recommended during +eals to prevent du+ping syndro+e# Eimit !luids while eating# ,n e+physe+a the sti+ulus to breathe is low %O<, not increased P2+* like the rest o! us, so donHt slam them with o;ygen# Encourage pursed-lip !reathing which promotes 3O< eli+ination, encourage up to .999mE'day !luids, high(!owlers and leaning !orward# Theophylline causes *1 upset, give with !ood T2 drugs are liver to;ic# (Aoes your patient have hep6M) @n adverse reaction is peripheral neuropathy#

35