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"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, positio
n prone daily to provide !or hip e;tension# "8# Detached .etina (() area o! deta
chment should be in the dependent position *9# Ad+inistration o, Ene+a (() posit
ion pt in le,t side-lying ($im:s) with knee !le;ed *"# A,ter /upratentorial /urg
ery (incision behind hairline) (() elevate <+6 .9(/0 degrees **# A,ter 1n,ratent
orial /urgery (incision at nape o! neck)(() position pt ,lat and lateral on eith
er side# *.# During 1nternal .adiation (() on !edrest while implant in place */#
Autono+ic Dysre,le-ia67yperre,le-ia ($%$& pounding headache, pro!use sweating,
nasal congestion, goose !lesh, bradycardia, hypertension) (() place client in si
tting position (elevate 7O2$ ,irst !e,ore any other i+ple+entation: *0# /hock ((
) bedrest with e;tremities elevated *9 degrees, knees straight, head slightly el
evated (modi!ied =rendelenburg) *4# 7ead 1nBury (() elevate <+6 .9 degrees to de
crease 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# ($aunders .rd ed p# **8) A
emorol !or pancreatitis, N+= morphine sul!ate 1yasthenia Bravis& worsens with e;
ercise and improves with rest# 1yasthenia 2risis& a positive reaction to =ensilo
n((will improve symptoms 2holinergic 2risis& caused by e;cessive medication(stop
med(giving =ensilon will make it worse <ead inCury medication& 1annitol (osmoti
c diuretic)(crystalliDes at room temp so @E>@F$ use !ilter needle Prior to a liv
er biospy its important to be aware o! the lab result !or prothrombin time 3rom
the aGG (diarrhea)= metabolic acidosis 3rom the mouth (vomitus)=metabolic alkalo
sis 0y-ede+a6hypothyroidis+& slowed physical and mental !unction, sensitivity to
cold, dry skin and hair
3
*# , kept !orgetting which was dangerous when you:re pregnant regular measles (r
ubeola), or Berman measles (rubella), so remember& (never get pregnant with a Be
rman (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 w
hen 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& potential
ly li!e threatening emergency ( elevate head o! bed to 89 degree ( loosen constr
ictive 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 bi
tter taste# Aigo;in(check pulse, less than 49 hold, check dig levels and potassi
um 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 comm
only -ersed& given !or conscious sedation###watch !or resp depression and hypote
nsion P=K and =apaDole( prevention o! thyroid storm $inemet& t; o! parkinson###s
weat, saliva, urine may turn reddish brown occassionally###causes drowsiness @rt
ane& t; o! parkinson##sedative e!!ect also 2ogentin& t; o! parkinson and e;trapy
ramidal e!!ects o! other drugs =igan& t; o! postop n'v and !or nausea associated
with gastroenteritis =imolol (=imoptic)(t; o! gluacoma
5
3or cord compression, place the mother in the =?ENAEEEN6E?B position because thi
s removes pressure o! the presenting part o!! the cord# (,! her head is down, th
e baby is no longer being pulled out o! hte body by gravity) ,! the cord is prol
apsed, cover it with sterile saline gauDe to prevent drying o! the cord and to m
inimiDe in!ection# 3or late decels, turn the mother to her le!t side, to allow m
ore blood !low to the placenta# 3or any kind o! bad !etal heart rate pattern, yo
u give +*, o!ten by mask### >hen doing an epidural anesthesia hydration be!ore h
and is a priority# <ypotension and bradypnea ' bradycardia are maCor risks and e
mergencies# NE-E? check the monitor or a machine as a !irst action# @lways asses
s the patient !irst !or e;maple listen to the !etal heart tones with a stethosco
pe 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 inv
olves a machine# ,! you:re not sure who to check !irst, and one o! the choices i
nvolves the machine, that:s the wrong answer# ,! the baby is a posterior present
ation, the sounds are heard at the sides# ,! the baby is anterior, the sounds ar
e 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 !u
ndus 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, incr
eased resp# .# cor pulmonae& right sided heart !ailure caused by le!t ventricula
r !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& pu
lse 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 ob
tained be!ore starting ,- antibiotics
7
"*# a pt with leukemia may have epita;is b'c o! low platelets ".# best way to wa
rm 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 h
eart tone'rate "0# phobic disorders###use systematic desensitiDtion# N2EEO =,P$
"# >hen getting down to two answers, choose the assessment answer (assess, colle
ct, auscultate, monitor, palpate) over the intervention e;cept in an emergency o
r distress situation# ,! one answer has an absolute, discard it# Bive priority t
o answers that deal directly to the patientHs body, not the machines'equipments#
*# Key words are very important# @void answers with absolutes !or e;ample& alwa
ys, never, must, etc# .# with lower amputations patient is placed in prone posit
ion# /# small !requent !eedings are better than larger ones# 0# @ssessment, teac
hing, meds, evaluation, unstable patient cannot be delegated to an Knlicensed @s
sistive Personnel# 4# E-N'EPN cannot handle blood# 5# @mynoglycosides (like vanc
omycin) 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 coa
gulaton) are always secondary to something else (another disease process)# "*# 2
ardinal sign o! @?A$ is hypo;emia (low o;ygen level in tissues)# ".# in p< regul
ation the * organs o! concern are lungs'kidneys# "/# edema is in the interstitia
l space not in the cardiovascular space# "0# weight is the best indicator o! deh
ydration "4# wherever there is sugar (glucose) water !ollows# "5# aspirin can ca
use ?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# $p
rain ankle) and <eat !or chronic ( rheumatoid arthritis) *9# guided imagery is g
reat !or chronic pain# *"# when patient is in distress, medication administratio
n is rarely a good choice# **# with pneumonia, !ever and chills are usually pres
ent# 3or the elderly con!usion is o!ten present# *.# @lways check !or allergies
be!ore administering antibiotics (especially P2N)# 1ake sure culture and sensiti
vity 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# Emphysem
a and bronchitis are both 2+PA# *4# in 2+PA patients the baroreceptors that dete
ct the 2+* level are destroyed# =here!ore, +* level must be low because high +*
concentration
8
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 ma
nagement& chemo, radiation, surgery, allow to die with dignity# ."# no live vacc
ines, no !resh !ruits, no !lowers should be used !or neutropenic patients# .*# c
hest tubes are placed in the pleural space# ..# angina (low o;ygen to heart tiss
ues) = no dead heart tissues# 1,= dead heart tissue present# ./# mevacor (antich
olesterol med) must be given with evening meal i! it is QA (per day)# .0# Nitrog
lycerine 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 ha
s 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 t
urned inside out due to the valves that are inside# .8# unstable angina is not r
elieved by nitro# /9# dead tissues cannot have P-2Hs(premature ventricular contr
action# ,! 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# /*# angiot
ensin ,, in the lungs= potent vasodialator# @ldosterone attracts sodium# /.# ?EE?$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;i
n= 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 patien
t is on coumadin /4# cardiac output decreases with dysrythmias# Aopamine increas
es 6P# /5# 1ed o! choice !or -tach is lidocaine /7# 1ed o! choice !or $-= is ade
nosine or adenocard /8# 1ed o! choice !or @systole (no heart beat) is atropine
9
09# 1ed o! choice !or 2<3 is @ce inhibitor# 0"# 1ed o! choice !or anaphylactic s
hock 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 ventricula
r 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 proph
ylactically 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 m
eans low !iver 4"# diverticulitis (in!lammation o! the diverticulum in the colon
) pain is around EE quadrant# 4*# @ppendicitis (in!lammation o! the appendi;) pa
in is in ?E quadrant with rebound tenderness# 4.# portal hypotension R albuminem
ia= @scites# 4/# beta cells o! pancreas produce insulin 40# 1orphine is contrain
dicated in Pancreatitis# ,t causes spasm o! the $phincter o! +ddi# =here!ore Aem
erol should be given# 44# =rousseau and =chovoski signs observed in hypocalcemia
45# with chronic pancreatitis, pancreatic enDymes are given with meals# 47# Nev
er 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 !o
r 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 breakdow
n o! !ats# 5*# $ign o! !at embolism is petechiae# =reated with heparin# 5.# !or
knee replacement use continuous passive motion machine# 5/# give prophylactic an
tibiotic therapy be!ore any invasive procedure# 50# glaucoma patients lose perip
heral vision# =reated with meds 54# cataract= cloudy, blurry vision# =reated by
lens removal(surgery 55# 2o* causes vasoconstriction# 57# most spinal cord inCur
ies are at the cervical or lumbar regions 58# autonomic dysre!le;ia ( li!e threa
tening inhibited sympathetic response o! nervous system to a no;ious stimulus( p
atients with spinal cord inCuries at =(5 or above) is usually caused by a !ull b
ladder# 79# spinal shock occurs immediately a!ter spinal inCury 7"# 1ultiple scl
erosis= myelin sheat destruction, disruption in nerve impulse conduction# 7*# my
asthenia gravis= decrease in receptor sites !or acetylcholine# $ince smallest co
ncentration o! @2=< receptors are in cranial nerves, e;pect !atigue and weakness
in eye, mastication, pharyngeal muscles# 7.# =ensilon test given i! muscle is t
ense in myasthenia gravis# 7/# Buillain(6arre syndrome= ascending paralysis# Kee
p eye on respiratory system# 70# parkinsonHs = ?@=& rigidity, akinesia (loss o!
muscle mvt), tremors# =reat with levodopa# 74# =,@ (transient ischemic attack) m
ini stroke with no dead brain tissue 75# 2-@ (cerebrovascular accident) is with
dead brain tissue# 77# <odgkinHs disease= cancer o! lymph is very curable in ear
ly stage# 78# ?ule o! N,NE$ !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 m
onth 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 incon
solable, do not eat, not passing meconium# 8.# heart de!ects# ?emember !or cyano
tic (.=Hs( =o!, =runcys arteriosus, =ransposition o! the great vessels)# Prevent
blood !rom going to heart# ,! problem does not !i; or cannot be corrected surgi
cally, 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# rh
eumatic !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# 8
7# ,2P (intracranial pressure) should be J*# measure head circon!erence# 88# dil
antin level ("9(*9)# 2an cause gingival hyperplasia "99# !or 1eningitis check !o
r KernigHs' 6rudDinskiHs signs# "9"# >ilmHs tumor is usually encapsulated above
the kidneys causing !lank pain# "9*# hemophilia is ;(linked# 1other passes disea
se 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 !e
mur !;# "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(secti
on# ""*# per!orm amniocentesis be!ore *9 weeks gestation to check !or cardiac an
d pulmonary abnormalities# "".# ?h( mothers receive rhogam to protect ne;t baby#
""/# anterior !ontanelle closes by "7 months# Posterior 4 to 7 weeks# ""0# capu
t 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# placent
a previa = there is no pain, there is bleeding# Placenta abruption = pain, but n
o 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 uteri
ne stimulation "*"# 1agnesium sul!ate(used to halt preterm labor) is contraindic
ated i! deep tendon re!le;es are ine!!ective# ,! patient e;periences seiDure dur
ing magnesium adm# Bet the baby out stat (emergency)# "**# Ao not use why or , u
nderstand statement when dealing with patients "*.# milieu therapy= taking care
o! patient'environment "*/# cognitive therapy= counseling "*0# crisis interventi
on=short term# "*4# 3,-E ,N=E?-EN=,+N$ 3+? P$F2< P@=,EN=$ (sa!ety (setting limit
s
11
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 % r
oll 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 measu
res 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 ski
lls###+a- '> points (one can do it i! !elow K you are in 3o+a: $o, to start dati
ng you gotta open your EIE/ ,irst, i! you albe to do that spontaneously and use
them correctly to $EE whom you dating you earn /# 6ut i! she has to scream on yo
u to make you open them it is only .####and " you dont care to open even i! she
tries to hurt you# i! you get good EFE contact (/ points) then move to VE.2A?: t
alk to her' himN i! you can do that Fou are really +?,EN=EA in situation she'he
uncontiously gives you / pointsN i! you like her try not to be 2+N3K$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 usin
g your 1otor ?esponse Points# =<is is -E?F important since Bood moves give you 4
N =he person who hyperventilates is most likely to e;perience respiratory alkalo
sis# avoid salt substitutes when taken dig and k(supplements because many are po
tassium based $igns o! hypo;ia& restless, an;ious, cyanotic tachycardia, increas
ed resps# (also monitor @6B:s) @ddison:s disease (need to LaddL hormone) 2ushing
:s syndrome (have e;tra LcushionL o! hormones) Aumping syndrome& increase !at an
d protein, small !requent meals, lie down a!ter meal to decrease peristalsis, wa
it " hr a!ter meals to drink#
13
3or blood types& T+T is the universal donor (remember LoL in donor) T@6T is the
universal receipient Aisseminated <erpes Loster is @,?6+?NE P?E2@K=,+N$, as to E
ocaliDed <erpes Loster is 2+N=@2= P?E2@K=,+N$# @ nurse with a localiDed herpes D
oster 2@N care !or patients as long as the patients are N+= immunosuppressed and
the lesions must be coveredN 3at soluble vitamins are -itamins @, A, E, K Bive
N$@,A$, 2orticosteroids, drugs !or 6ipolar, 2ephalosporins, and $ul!anomides >,=
< !ood# @tivan is the treatment o! choice !or status epilepticus >hen using a br
onchodilator inhaler inconCuction with a glucocorticoid inhaler, administer the
bronchodilator !irst =heophylline increases the risk o! digo;in to;icity and dec
reases the e!!ects o! lithium and Ailantin 1Ntal, an inhaler used to treat aller
gy induced asthma may cause bronchospasm, thinkU 1Nto the asthmatic lung ,soniaD
id 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) m
ust !loat !rom stomach to intestine# Aon:t tape the tube right away a!ter placem
ent, 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 intercou
rse# =hey are also !itted so must be re( !itted i! you lose or gain a signi!ican
t amount o! weight# G 6est time to take Browth <ormone P1, $teroids @1, Aiuretic
s @1, @ricept @1# G 2ara!ate ($ulcra!ate) be!ore meals (mucosal barrier constipa
tion) G =agamet with !ood (<* messes with elderly ppl be care!ul N ,nteracts wit
h alot o! things) G@ntacids a!ter meals G Eong term use o! amphogel (binds to ph
osphates, increases 2a, robs the bones###leads to increased 2a resortion !rom bo
nes 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;edem
a 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 da
iry 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 ur
ic acid out o! system G Koplick:s spots are red spots with blue center character
istic o! P?+A?+1@E stage o! 1easles# Ksually in mouth# G ,N< can cause periphera
l 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 pat
ients 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 varicos
e veins# ,! they !ill pro;imally = varicosity# ?ule o! nines, 8 = head, "7 = arm
s, .4 = torso, .4 =legs, and "= perineum = "99S @hen giving Caye-alate we need t
o 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 a
rea 1urphyHs sign I pain with palpation o! gall bladder area seen with cholecyst
itis 2ullenHs sign I ecchymosis in umbilical area, seen with pancreatitis =urner
Hs sign I !lank grayish blue (turn around to see your !lanks) pancreatitis 1c6ur
neyHs 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 $hilling =e
st I test !or pernicious anemia' how well one absorbs -it b"* @llenHs test I occ
lude both ulnar and radial artery until hand blanches then release ulnar# ,! the
hand pinks up, ulnar artery is good and you can carry on with @6B'radial stick
as planned# @6B$ must be put on ice and whisked to the lab# o,tHs ok to have abd
ominal craps, blood tinged out!low and leaking around site i! the Peritoneal Aia
lysis 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 (upp
er 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 ne
ed 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 i
s 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 ,n
spect, @uscultate, Percuss then Palpate (same with kids, , suppose since you wan
na go !rom least invasive to most invasive sine they will cry 6E++A 1K?AE? N Bot
ta love them kids N) Eate; allergies =) @ssess !or allergies to bananas, apricot
s, cherries, grapes, kiwis, passion !ruit, avocados, chestnuts, tomatoes, peache
s
15
,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 slo
w and sleepy)# +k some more !acts# GG 6+=+O !or strabismus# Patch the B++A eye s
o 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 (h
ypo;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) t
o reverse e!!ect o! pancuronium# GG@mpho 6 causes hypokalemia (amongst many othe
r 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 mont
hs, $eparation an;iety peaks in toddlerhood GG 11? is a $Q shot Eymes is !ound m
ostly in 2onneticut @sthma and @rthritis((swimming best @sthma has intercostal r
etractions((be concerned =ardive Ayskinesia ( irreversible ( involuntary movemen
ts o! the tongue, !ace and e;tremities, may happen a!ter prolonged use o! antips
ychotics @kathisia ( motor restlessness, need to keep going, t; with antiparkins
ons meds, can be mistaken !or agitation# >hen drawing an @6B, you need to put th
e blood in a hepariniDed tube, make sure there are no bubbles, put on ice immedi
ately a!ter drawing, with a lable indicating i! the pt was on room air or how ma
ny liters o! +*# ?emember to pre!orm the @llen:s =est prior to doing an @6B to c
heck !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 rai
sed up on pillows over bedside table, have pt hold breath in mide;piration, ches
t ;(ray done immediately a!terwards to check !or complication o! pneumothora;, s
terile dressing applied 3or a lumbar puncture, pt is positioned in lateral recum
bent !etal position, keep pt !lat !or *(. hrs a!terwards, sterile dressing, !req
uent neuro assessments EEB, hold meds !or */(/7 hrs prior, no ca!!ine or cigaret
tes !or */ hrs prior, pt can eat, pt must stay awake night be!ore e;am, pt may b
e asked to hyperventilate and watch a bright !lashing light, a!ter EEB, assess p
t !or seiDures, pt:s will be at increased risk Aiamo;, used !or glaucoma, can ca
use hypokalemia
17
Ae;edrine, used !or @A<A, may alter insulin needs, avoid taking with 1@+,:s, tak
e 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 di
lantin, can cause phenytonin to;icity, monitor E3=:s, give 64 along with, hypote
nsion will occur initially, then resolve ?i!ampin, !or =6, dyes bodily !luids or
ange ,! 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 dyskines
ia, tightening o! Caw, sti!! neck, swollen tongue, later on swollen airway), mon
itor !or early signs o! reaction and give ,1 6enadryl ?isperdal, antipsychotic,
doses over 4mg can cause tarditive dyskinesia, !irst line antipsychotic in child
ren Eevodopa, !or parkinsons, contraindicated in pts with glaucoma, avoid 64 $in
emet, !or parkinsons, contraindicated with 1@+,:s <ydro;yurea, !or sickle cell,
report B, symptoms immediately, could be sign o! to;icity Locor, !or hyperlipide
mia, take on empty stomach to enhance absorption, report any une;plained musle p
ain, especially i! !ever Aecorticate is toward the :cord:# Aecerebrit is the oth
er way (out) GG 6+=+O GG (6otulin =o;in) can be used with strabismus also to rel
a; vocal cords in spasmodic dysphonia#
18
=hank you, , !inally realiDe why a person shouldn:t have cantaloupe be!ore a occ
ult stool test, because cantaloupe is high in vit c and vit c causes a !alse R !
or occult blood# Now , Cust need to !igure out why they can:t have !ish# 7ypospa
dias5 abnormality in which urethral meatus is located on the ventral (back) sur!
ace o! the penis anywhere !rom the corona to the perineum (re+e+!er hypo low (,o
r lower side or under side$ Epispadias5 opening o! the urethra on the dorsal (!r
ont) 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 proble
ms!irst# .#@n answer that delays care or treatment is @E>@F$wrong /#3or P-A reme
mber 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 Neve
r 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 synd
rome is an emergency situation# Paresthesias and increased pain are classic symp
toms# Neuromuscular damage is irreversible /(4 hours a!ter onset# @lways deal with
actual problems or harm be!ore potential problems
@lways select a Vpatient !ocuse
dW 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 )4yr
s learn to delay need grati!ication .# Cuvenile 4(8 years learn to relate to pee
rs /# 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! opposit
e se; is this not about communicationM####
20
3etal alcohol syndrome (upturned nose (!lat nasal bridge (thin upper lip ($B@ va
stus 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 ch
ildren +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 inter
vention# E;& hemothra;, tension pneumothora;, unstable chest and abdominal wound
s, ,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 a
nd require medical care, but can wait hrs without threat to li!e or limb# E;& $t
able abd wounds without evidence o! hemorrhage, !; requiring open reduction, deb
ridement, e;ternal !i;ation, most eye and 2N$ inCuries, etc# Breen( 1inimal& ,nC
uries 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 b
urns, sprains, sm# lacerations, behavior disorders# 6lack( E;pectant& ,nCuries a
re e;tensive and chances o! survival are unlikely# $eperate but dont abandoned,
com!ort measures i! possible# E;& Knresponsive, spinal cord inCuries, woulds wit
h anatomical organs, *nd'.rd degree burn with 49S o! body sur!ace area , seiDure
s, 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 pat
ient 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, st
erile dressing# 2=( assess allergies 1?,( claustrophobia, no metal, assess pacem
aker 2ardiac cath( npo 7("*hr, empty bladder, pulses, tell pt may !eel heat palp
itations or desire to cough with dye inCection# Post( -ital signs keep leg strai
ght bedrest 4(7hr# cerebral angio prep( well hydrated, lie !lat, sire shaved, pu
lses marked post( keep !lat "*("/hr, check site, pulses,!orce !luids# Eumbar pun
cture( !etal postion# post( nuero assess q"0(.9 until stable, !lat*(.hr, encoura
ge !luids, oral anlgesics !or headache, observe dressing
21
EEB( no sleep the night be!ore, meals not withheld, no stimulants !or */hr be!or
e, tranquiliDer'stimulant meds held */(/7hr be!ore, may be asked to hyperventila
te .(/min and watch a bright !lashing light# 1yelogram( Npo /(4hr, allergy h;, p
henothiaDines, cns depressants, and stimulants withheld /7hr prior, table will b
e 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 di
stended 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 supin
e 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 !owler
s or upright on edge o! bed, empty bladder# Post( v#s#, report elevated temp, ob
serve !or signs o! hypovolemia# Eaparoscopy( 2+* used to enhances visual, genera
l anesthesia, !oley# %ost- walk patient to decrease 3O< !uild up used ,or proced
ure: Pyelogram( assess allergies $engstaken blakemore tube used !or t; o! esopha
geal varices, keep scissors at !edside: <emovac( used a!ter mastectomy, empty wh
en !ull or q7hr, remove plug, empty contents, place on !lat sur!ace, cleanse ope
ning 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 lo
w(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 ton
gue# 94# PE?N,2,+K$ @NE1,@ I red bee!y tongue# 95# A+>N $FNA?+1E I protruding to
ngue# 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 !or
mation "*# 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 petechia
e or (R) <ermanHs sign# "8# 1EN,NB,=,$ I KernigHs sign (leg !le; then leg pain o
n e;tension), 6rudDinski sign (neck !le; = lower leg !le;)# *9# =E=@NF I hypocal
cemia (R) =rousseauHs sign'carpopedal spasm 2hvostek sign (!acial spasm)# *"# =E
=@NK$ I risus sardonicus# **# P@N2?E@=,=,$ I 2ullenHs sign (ecchymosis o! umbili
cus) (R) Brey turners spots# *.# PFE+?,2 $=EN+$,$ I olive like mass# */# PA@ I m
achine like murmur# *0# @AA,$+NH$ A,$E@$E I bronDe like skin pigmentation# *4# 2
K$<,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 mu
scle weakness ."# Buillain 6arre $yndrome I ascending muscle weakness .*# A-= I
<omanHs $ign ..# 2<,2KEN P+O I -esicular ?ash (central to distal) dew drop on ro
se petal ./# @NB,N@ I 2rushing stubbing pain relieved by N=B .0# 1, I 2rushing s
tubbing pain which radiates to le!t shoulder, neck, arms, unrelieved by N=B .4#
E=6 I inspiratory stridor .5# =E3 I /2sH 2oughing, 2hoking, 2yanosis, 2ontinous
Arooling .7# EP,BE+=,=,$ I .AsH Arooling, Aysphonia, Aysphagia .8# <+ABEK,NH$ A$
E'EF1P<+1@ I painless, progressive enlargement o! spleen % lymph tissues, ?eedst
enberg 2ells
23
=ake iron eli;ir with Cuice or water#### never with milk Kawasaki:s leads to Ail
antin "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 hypot
ension# =urn and reposition (risk !or impaired skin integrity) =o access role re
lationship pattern !ocus on image and relationships with others# ?enal impairmen
t& serum creatinine elevated and urine clearance decreased cardiac problems
Norm# $erum creatinine 9#7("#7 (men), 9#0("#0 (women) Norm# Krine clearance 70("
.0 @tropine +verdose <ot as a <are (=emp), 1ad as a <atter 6one (=hirsty) <emogl
obin Neonates "7(*5 . mos "9#4("4#0 . yrs 8#/("0#0 "9 yrs "9#5("0#0 Blomerulonep
hritis& take vs q / hrs R daily weights @ge / to 0 yrs child needs AP='11?'+P2ys
tic 3ibrosis give diet low !at, high sodium, !at soluble vitamins @AEK# @erosal
bronchodilators, mucolytics and pancreatic enDymes# @irborne Precautions& measel
s, chicken po; and =6# private room, negatvie pressure w' 4("* air e;changes, 1a
sk N80# Aroplet Precautions&sepsis, scarlet !ever, streptococcal pharyngitis, pa
rovirus 6"8, pnuemonia, pertusis, in!luenDa, diptheria, epiglottis, rubella, mum
ps, meningitis, mycoplasma and adenovirus# Aoor open, . !t distance, private roo
m or cohort, mask 2ontact Precautions& multidrug resistant organism respiratory,
skin, wound enteric and eye ,N3E2=,+N$ 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, d
on:t !orget to monitor volume status (,%+) @n ill child regresses in behaviors 1
eningeal 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 evalu
ation# @ssessing e;traocular eye movements check cranial nerves ., /, and 4# $to
mas 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 r
ash (stop med), gingival hyperplasia (good hygiene) to;icity(()poor gait R coord
ination, slurred speech, nausea, lethargy, and diplopia# Phenobarbital can be ta
ken during pregnancy but Ailatin is contraindicated# =ension pneumothora; trache
a 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 G1ncenti
ve /piro+etry steps&") $it upright *) E;hale .) ,nsert mouthpiece /) ,nhale !or
. seconds, and then <+EA !or "9 seconds AA+inoglycocide (XX1ycin e;cept erythrom
ycine) @dverse E!!ects are bean shaped ( Nephroto;ic to Kidneys and +toto;ic to
Ears A0./A ( 2ontact precaution +NEF AV./A ( 2ontact @NA airborne precaution (Pr
ivate room, door closed, negative pressure) A?1T7140 L-level of therapeutic affe
ct is 0.5-1.5 I-indicate mania T-to ic level is !-" - #$%& diarrhea& tremors '-h
yrdrate !-"L of (ater$day I-increased )* and dry mouth )-uh oh+ ,ive Mannitol an
d -iamo if to ic s$s are present M-maintain #a intake of !-",$day AAll psych +ed
sE (e-cept ?ithiu+$ 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 vis
ion), Aecreased BK= (urniary retention), B,= (constipation), 2onstricted blood v
essels and Ary mouth# A2lood trans,usion- sign o! allergies in order& ")3lank pa
in *)3requent swallowing .)?ashes /)3ever 0)2hills AThro+!ocytopenia (6leeding p
recautionsN ")$o!t bristled toothbrush *)No insertion o! anythingN (c'i supposit
ories, 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 A
egree ( ?ed and Pain!ul *nd Aegree ( 6listers .rd Aegree ( No Pain because o! bl
ocked and burned nerves A0eniereEs Disease ( @dmin diuretics to decrease endolym
ph in the cochlea, restrict Na, lay on a!!ected ear when in bed# =riad& ")-ertig
o *)=innitus .)N'A*astric 4lcer pain occurs .9 minutes to 89 minutes a!ter eatin
g, not at night, and doesn:t go away with !ood G=hink positive and you can achie
ve great things# =hink o! present and !uture, the past is gone# ./or,et your pas
t mistakes and focus on your successes encoura,in, yourself to ,reater achieveme
nts in the future. .0l(ays do your 1est so you can 1e proud that you ,ave it you
r 1est shot. ./ocus on your achievements rather than your failures. If you do fi
nd 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 =ip
s& >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 dr
ugs 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 iso
proterenol, a beta agonist# (, donHt know more about that drug it was Cust point
ed out on a practice e;am#) Auring sickle cell crisis there are two intervention
s to prioritiDe& ,luids and pain relie!# >ith glo+erulonephritis you should cons
ider !lood pressure to be your most important assessment parameter# Aietary rest
rictions you can e;pect include !luids, protein, sodium, and potassium# ?emember
yesterday when , mentioned how congenital cardiac de!ects result in hypo-ia whi
ch the body attempts to compensate !or (in!lu; o! immature rbcHs)M Eabs supporti
ng this would show increased he+atocrit he+oglo!in and r!c count# Aid you know t
here is an association between low-set ears and renal ano+aliesM Now you know wh
at 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 shape
d similarly# >hich is why when doing an assessment o! a neonate, i! the nurse no
tices low set or asymmetrical ears, there is good reason to investigate renal !u
nctioning# Knowing that the kidneys and ears are similar shapes helped me rememb
er this)#
27
$chool(age kids (> and up) are old enough, and should have an e-planation o! wha
t 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 pr
ogresses to proBectile vo+iting# Eater you may be able to palpate a mass, the ba
by will seem hungry o!ten, and may spit up a!ter !eedings# >e know Cawasaki dise
ase 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 wi
ll 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 sho
uld 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 intrac
ranial pressure, such as irritability, bulging !ontanels, and high(pitched cry i
n 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 abnormal
ity or alteration# 0echanical ventilation can cause it# Premature newborns with
immature lungs are ventilated and over time it damages the lungs# +ther causes c
ould be in!ection, pneumonia, or other conditions that cause in!lammation or sca
rring# ,t is essential to +aintain nasal patency with children ) ' yr# because t
hey are obligatory nasal breathers# >atch out !or questions suggesting a child d
rinks more than .(/ cups o! milk each day# (1ilks good, rightM) =oo much milk re
duces intake o! other essential nutrients, especially iron# >atch !or ane+ia wit
h +ilk-aholics# @nd donHt let that mother put anything but water in that kidHs b
ottle 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 !r
acture with e;tensive skin da+ageM Ninety ninety# <uhM , never heard o! it eithe
r# =he name re!ers to the angles o! the Coints# @ pin is placed in the distal pa
rt o! the broken bone, and the lower e;tremity is in a boot cast# =he rest is th
e 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)# ,! yo
u can remove the white patches !rom the mouth o! a baby it is Cust !ormula# ,! y
ou canGt its candidiasis# Pust know the 00. and Varicella i++uni8ations co+e lat
er ("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 thr
ow it in I @ guy loses his house in a !ire# Priority is using community resource
s to !ind shelter, be!ore assisting with !eelings about the tremendous loss# (1a
slow)# 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 corr
ect 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 ki
ds ) M yrs# when instilling eardrops# Kids with ?$- no contact lenses or pregnan
t nurses in rooms where ri!avirin is being administered by hoot, tent, etc# Posi
tioning 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!ir
ms in,ection, not Cust e;posure# @ sputu+ test will con!irm active disease# 3oug
hing w'o other s's is suggestive o! asth+a# $peaking o! asthma, watch out i! you
r whee8er stops whee8ing# ,t could mean he is worsening# Fou better pick Ndo vit
alsG be!ore administering that dig# (apical pulse !or one !ull minute)# Tet spel
ls 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 ki
ds# =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# ?an
dom =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 iodin
e 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'pati
ent to .9 minutes'day# No pregnant visitors'nurses, and no kids# =he main hypers
ensitivity reaction seen with antiplatelet drugs is !ronchospas+ (anaphyla;is)#
2ommon sites !or +etastasis include the liver, brain, lung, bone, and lymph# Ort
hostasis is veri!ied by a drop in pressure with increasing heart rate# 2ence Hon
es 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 ,l
uid !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 hea
rt !ailure# 2asophils release hista+ine during an allergic response# Adenosine i
s 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 radiat
ion# >hat should you be most concerned aboutM $kin irritationM No# ,n!ection kil
ls cancer patients most because o! the leukopenia caused by radiation# @ breast
cancer patient treated with Ta+o-i,en should report changes in visual acuity, be
cause the adverse e!!ect could be irreversible# %neu+ova- <M gets administered p
ost splenecto+y to prevent pneumococcal sepsis# EetHs say every answer in !ront
o! you is an a!nor+al value# ,! potassiu+ is there you can bet it is a problem t
hey want you to identi!y, because values outside o! normal can be li,e threateni
ng# Normal potassium is .#0(0#9# Even a bun o! 09 doesnHt override a potassium o
! .#9 in a renal patient in priority# Fou better be making sure that patient on
Dig and ?asi- is getting enough potassiu+, because low potassium potentiates Aig
and can cause dysrrhythmias# Fou will ask every new ad+ission i! he has an adva
nce directive, and i! not you will e;plain it, and he will have the option to si
gn or not# @n e;ample o! when you would implement be!ore going through a bunch o
! assessments is when someone is e;periencing anaphyla-is# Bet the ordered epine
phrine in them stat, especially i! they stem clearly states the s's (di!!iculty
breathing, increasing an;iety, etc#) ,n a disaster you should triage the person
who is most likely to not survive last# @ little trick regarding potassium& @EC@
?O$,$& K is E+> @cidosis is Cust the opposite& K is <igh =he vital sign you shou
ld 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 he
lp 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!!ect
s o! oral anticoagulants# 2leeding is part o! the YcirculationH assessment o! th
e A23DHs in an emergent situation# =here!ore, i! airway and breathing are accoun
ted !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 s
ucking 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)# $hould
the patient breathe into a paper bagM No# ,! the pao* is well below 79 they need
o-ygen# Eook at all your abg values# @s soon as you see the words PE you should
think o;ygen !irst# @ typical adverse reaction to oral hypoglyce+ics is rash, p
hotosensitivity# /eru+ acetone and seru+ ketones rise in DCA# @s you treat the a
cidosis and dehydration e;pect the potassiu+ to drop rapidly, so be ready, with
potassium replacement# Dluids are the most important intervention with 77N/ as w
ell as DCA, so get !luids going !irst# >ith <<N$ there is no ketosis, and no aci
dosis# Potassium is low in <<N$ (d't diuresis)# Atropine !locks acetylcholine (r
emember it reduces secretions)# Aecorticate positioning in response to pain = 3o
rte; involvement# Decere!rate in response to pain = 2erebellar, !rain ste+ invol
vement Dantriu+, !or spasticity, may take a week or more to be e!!ective# Decrea
sed acetylcholine is related to senile de+entia# <yperactive deep tendon re!le;e
s, 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# 7irschspr
ungGs diagnosed with rectal biopsy looking !or a!sence o, ganglionic cells# 2ard
inal sign in in!ants is !ailure to pass meconium, and later the classic ribbon(l
ike and !oul smelling stools# 1ntussusception common in kids with 3D# +bstructio
n may cause !ecal emesis, currant Bellylike stools (blood and mucus)# @ barium e
nema may be used to hydrostatically reduce the telescoping# ?esolution is obviou
s, with onset o! bowel movements#
31
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 3
urosemide, and @myloride# ?asi- can cause a patient to lose his appetite (anoreia) 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 stag
e o! 7ep-A gown and gloves are required# ,n the convalescent stage it is no long
er contagious# ?ow +agnesiu+ and high creatinine signal renal ,ailure: %ain is u
sually the highest priority with .A ,! a T2 patient is unable'unwilling to co+pl
y with t; they may need supervision (direct observation)# =6 is a public health
risk# Eevel o! consciousness is the most important assessment parameter with sta
tus epilepticus# 3rackles suggest pneumonia, which is likely to be accompanied b
y 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 a
nore;ic# Toddlers need to e;press autonomy (independence) @ patient with a low h
e+oglo!in and6or he+atocrit should be evaluated !or signs o! !leeding, such as d
ark stools# @ la-ative is given the night be!ore an 1V% in order to better visua
liDe 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 w
ith adrenal insu!!iciency (AddisonGs) is paramount, because i! the adrenal gland
s are stressed !urther it could result in @ddisonian crisis# >hile weHre on @ddi
sonHs, remember blood pressure is the most important assessment parameter, as it
causes severe hypotension: @!ter pain relie!, cough and deep !reathe is importa
nt in pancreatitis, because o! !luid pushing up in the diaphragm# /a,ety over Nu
trition with a severely depressed client#
33