ATI Predictor Study Guide

PREDICTOR STUDY GUIDE TABLE OF CONTENTS: FUNDAMENTALS ANATOMY AND PHYSIOLOGY MEDSURG MENTAL HEALTH MATERNAL PEDIATRICS LEADERSHIP PHARMACOLOGY TEST TAKING SKILLS FUNDAMENTALS Ethical Principles of Nursing: ● Beneficence: Kindness and charity, nurse benefits others. EX: Holding dying PTs hand ● Autonomy: Ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge ● Justice: Being impartial and fair ● Veracity: Being truthful, not withholding information from patients ● Nonmaleficence: Do no harm ● Fidelity: Being faithful to the promises made as professionals ● QUIZLET ETHICAL PRINCIPALS OF NURSING Basic Skills: ● Denture cleaning ○ Soft bristle toothbrush, cleaning paste, towel, basin, denture cup, gloves ○ Place a towel at the bottom of the sink covering drain ○ Warm water (Not hot or cold), rinse and put in basin, then rinse denture cup (keep enough water to cover the dentures), then brush dentures in to out. ● Ambulating to chair ○ Gait belt (Should be able to fit 4 fingers)(below rib cage and above hips), lock brakes on chair/wheelchair, raise HOB, place foot in front of PTs feet, chair should be parallel to bed, PT hands should be on nurses shoulder and pivot PT into chair/wheelchair. ● Ambulating a PT with Hemiparesis the nurse always stands on the affected side and supports by holding the arm around the clients waist: EX: Right sided hemiparesis, stand on right side. ● Ambulation with assistive devices: ○ Up stairs (Good leg leads) Down stairs (Bad Leg leads) ○ With cane down stairs: cane first, then injured leg, then uninjured leg. Cane on the strong side. ○ Crutches, Canes, and Walkers Nursing NCLEX Assistive Devices Review Lab Levels: ● Digoxin 0.5 to 2.0ng/mL ● Lithium 0.8 to 1.4 mEq/L ● Dilantin 10-20 mcg/mL ● Theophylline 10 to 20mcg/mL Safety and Infection Control ● Standard & Isolation Precautions Nursing | Infection Control Contact, Droplet, Airborne PPE NCLEX ● Isolation Precautions QUIZLET ● Always dispose of needles immediately, never recap, put safety on needle up. ● Always wipe front to back, always clean clean to dirty ● Alcohol hand sanitizer does not work on C.Diff infections ● When PT with TB needs to go to another floor, the PT is the only one who needs to wear a mask ● Iatrogenic infection is caused by an intervention or physician (EX: Ventilator acquired pneumonia) ● Nosocomial is a term used to describe an infection that resulted from a hospital stay (Most common cause is infrequent hand washing) ● Pneumoconiosis is a respiratory disorder that occurs after particulate matter is inhaled and deposited into the lung tissue. Asbestosis and Silicosis are two forms of Pneumoconiosis. ● Standard Precautions: ○ CMV ○ HIV ○ Hepatitis B and C ○ Aspergillosis ● Contact Precautions ○ MRSA (Mask if respiratory infection) ○ VRE ○ Adenovirus ○ Diarrhea ○ C. Diff (alcohol is not effective, regular hand washing is effective) ○ Rotavirus ○ E. coli ○ Enterovirus ○ Hepatitis A (gloves when handling waste) ○ Lice ○ Scabies ○ Herpes Simplex ○ Herpes Zoster (Shingles, localized) ○ Chicken Pox (Symptomatic until lesions are crusted and dried over) ● Droplet Precautions ○ Pertussis (Whooping cough) ○ Influenza A and B ○ MRSA (Respiratory infection) ○ Neissera meningititis (Suspected or confirmed) ○ Bacterial meningitis (For 24hrs after elective antibiotic therapy) ○ Coxsackie ○ RSV (Droplet and contact) ○ Mumps ○ Rubella ● Airborne Precautions ○ Chicken Pox ○ Disseminated herpes zoster (Shingles) ○ Measles ○ N-95 Mask: ■ TB ■ SARS ■ Avian Influenza ANATOMY AND PHYSIOLOGY Systems: ● ● Introduction to Anatomy & Physiology: Crash Course Anatomy & Physiology #1 Integumentary: ● The Integumentary System, Part 1 - Skin Deep: Crash Course Anatomy & Physiology #6 ● The Integumentary System, Part 2 - Skin Deeper: Crash Course Anatomy & Physiology #7 Musculoskeletal: ● Muscles, Part 1 - Muscle Cells: Crash Course Anatomy & Physiology #21 ● Muscles, Part 2 - Organismal Level: Crash Course Anatomy & Physiology #22 ● The Skeletal System: Crash Course Anatomy & Physiology #19 ● Joints: Crash Course Anatomy & Physiology #20 ● Tissues, Part 1: Crash Course Anatomy & Physiology #2 Circulatory: ● The Heart, Part 1 - Under Pressure: Crash Course A&P #25 ● The Heart, Part 2 - Heart Throbs: Crash Course Anatomy & Physiology #26 ● Blood Vessels, Part 1 - Form and Function: Crash Course Anatomy & Physiology #27 ● Blood Vessels, Part 2: Crash Course Anatomy & Physiology #28 Respiratory: ● Respiratory System, Part 1: Crash Course Anatomy & Physiology #31 ● Respiratory System, Part 2: Crash Course Anatomy & Physiology #32 Gastrointestinal: ● Digestive System, Part 1: Crash Course Anatomy & Physiology #33 ● Digestive System, Part 2: Crash Course Anatomy & Physiology #34 ● Digestive System, Part 3: Crash Course Anatomy & Physiology #35 ● Metabolism & Nutrition, Part 1: Crash Course Anatomy & Physiology #36 Immune ● Immune System, Part 1: Crash Course Anatomy & Physiology #45 ● Immune System, Part 2: Crash Course Anatomy & Physiology #46 ● Immune System, Part 3: Crash Course Anatomy & Physiology #47 ● Lymphatic System: Crash Course Anatomy & Physiology #44 Nervous System: ● The Nervous System, Part 1: Crash Course Anatomy & Physiology #8 ● The Nervous System, Part 2 - Action! Potential!: Crash Course Anatomy & Physiology #9 ● The Nervous System, Part 3 - Synapses!: Crash Course Anatomy & Physiology #10 ● Central Nervous System: Crash Course Anatomy & Physiology #11 ● Peripheral Nervous System: Crash Course Anatomy & Physiology #12 ● Autonomic Nervous System: Crash Course Anatomy & Physiology #13 ● Sympathetic Nervous System: Crash Course Anatomy & Physiology #14 ● Parasympathetic Nervous System: Crash Course Anatomy & Physiology #15 Urinary: ● Urinary System, Part 1: Crash Course Anatomy & Physiology #38 ● Urinary System, Part 2: Crash Course Anatomy & Physiology #39 Reproductive system: ● Reproductive System, Part 1 - Female Reproductive System: Crash Course Anatomy & Physiol… ● Reproductive System, Part 2 - Male Reproductive System: Crash Course Anatomy & Physiolo… ● Reproductive System, Part 3 - Sex & Fertilization: Crash Course Anatomy & Physiology #42 MEDSURG Cardiology ● Congestive Heart Failure (CHF) for Nursing & NCLEX ● Myocardial Infarction (Heart Attack) for Nursing & NCLEX ● https://www.osmosis.org/learn/Heart_failure:_Pathology_review Heart Failure: ○ Left= Lung Symptoms ○ Right= Body Symptoms ○ Red flag weight gain is 2-3 Lbs a day of 5Lbs in 7 days (Daily weights) ○ Decrease sodium (2Gs or less) and fluid (2L of fluid) ○ Worsening HF NCLEX tips: ■ How does a nurse know if treatment is successful? Clearer lung sounds with decreased HR ■ Question any order with fluids ■ When transferring HF pt reassess heart and lung sounds ■ Sodium swells the body (Nothing from a package) and no OTC drugs (aspirin contains sodium) MI ● Risk factors: BMI over 25, smoking, diet, HTN, over 50, men, african american, Atherosclerosis- Due to lifestyle choices ● Labs: Troponin is #1 indicator for MI, over 0.5 = trauma to heart ● S/S: Jaw pain, substernal chest pain, left arm, epigastric pain, mid back pain, heartburn, abdominal pain and diaphoresis ● Treatment for MI: Angioplasty, bypass, and Cut out fat (endarterectomy), TPA for clot buster (within 2-6 hrs), Stress test to pinpoint potential blockages, exercise or chemical stress test. Stop stress tests with ST changes or chest pain. ○ Before chemical stress tests, avoid meds and stimulants that will alter the test. 24-48 hrs before avoid caffeine, avoid nitro, beta blockers, and theophylline. NPO 4 hrs before chemical stress test. ○ OANM (Oxygen, aspirin, nitro, morphine) NO viagra with Nitro (Both are vasodilators) ○ Any new chest pain requires EKG first, ST elevation= no O2 or hyperkalemia, ST low= Low O2 or hypokalemia. Types of Angina ● Stable Angina: (Most common), Regular pattern, rest and medicine helps to relieve ● Unstable Angina: Unstable angina is unrelieved with rest and unpredictable , does not go away with rest and or medicine, red flag for MI (PRIORITY) ● Variant Angina: Happens when resting, medicine can help Renal/ABGs AKI ● Patho: Sudden episode of renal failure ○ Acute Renal Failure (Acute Kidney Injury) for Nursing NCLEX RN & LPN ● S/S: Sudden onset of symptoms, oliguria, swelling around legs and eyes, SOB, confusion, nausea, seizures ● Treatment: Insulin and D50, osmotic diuretics (mannitol), albuterol, loop diuretic (spironolactone), strict I&O’s ● Diet: Low sodium, low potassium, low phosphate ● Labs: Low urine specific gravity: 1.005-1.015 (Normal is 1.005-1.030), Low urine osmolarity CKD ● CKD Patho: Progressive, irreversible loss of kidney function. Can be caused by HTN, diabetes, obesity, exc. ○ Renal Failure, Chronic Kidney Disease l End Stage Renal Disease for Nursing Exams, NCLEX R… ○ Chronic Renal Failure (Chronic Kidney Disease) ESRD l Nursing NCLEX RN & LPN ● CKD Stages: ○ ● CKD S/S: Oliguria (Less than 400ml a day) (Expected) HTN (Fluid retention) (Priority: headache, N/V, & change in mental status = HTN crisis) HTN Can be a cause and consequence of CKD, Fluid volume overload (Bounding pulse, crackles in lungs, JVD, tachycardia), Anemia (Due to lack of erythropoietin) ● CKD Labs: ● Complications of CKD: ○ ○ Uremic pericarditis can progress to effusion and tamponade (Friction rub, chest pain, and fever), Hypertensive crisis (Fluid retention), Dysrhythmias (Potassium), Infection (Pruritus, skin breakdown) Dialysis ○ Kidney Failure - Hemodialysis & Peritoneal Dialysis, Nursing Care NCLEX RN & LPN ○ Dialysis Education Video ○ QUIZLET RENAL ABG ● Dialysis Complications: ○ Infection (Peritonitis EMERGENCY w/ peritoneal dialysis) (S/S: Fever, cloudy drainage, tachycardia) ○ Respiratory distress due to rapid infusion (S/S of fluid volume overload) (#1 priority raise HOB) (Slow infusion rate if dyspnea is present) ○ Insufficient outflow (Assess PT first, then assess device, then reposition side lying) UTI ○ DDS ● Patho: Infection of urinary tract ○ UTI l Urinary Tract Infection & Pyelonephritis Treatment for NCLEX RN & LPN ○ Incontinence, Urinary Tract Infection & Pyelonephritis - Medical-Surgical - Renal: | @LevelU… ● Causes: Poor hygiene (Wiping back to front), Urinary stasis , Reflux of urine (Catheter above patient instead of being below) ● S/S: Confusion in older adults, Burning with urination, Feeling of incomplete bladder emptying, Frequency/urgency ● Treatment: Antibiotics, culture and sensitivity Respiratory COPD ● Umbrella term for diseases: Emphysema (Pink puffer) and Chronic Bronchitis (Blue Bloater) ● Nutrition: Dry mouth leads to poor nutritional intake (Small frequent meals high in protein and calories), oral hygiene before meals, avoid activity one hour before and after meals, avoid carbonated drinks or high fiber fluids. Increase fluid intake, avoid fluids while eating. ● Vaccines: Pneumococcal every 5 years, influenza annually. ● Irreversible damage to alveoli and bronchi, typically due to smoking, can also be environmental. ● Decreased O2 level 88-93% for late or end stage COPD ● Normal signs: Clubbed fingers (Mainly emphysema), increased RBC, low O2 high CO2, Low PaO2= Hypoxemia (Below 80) (Normal range 80-100), respiratory acidosis. ● No Opioids or “-Pam” Or “-Lam” ending drugs, these suppress respirations ● Before going to sleep: Cool mist humidifier, and guaifenesin (Mucinex) ● BiPap machine 1st (To expel CO2), Venturi oxygen mask. Steroids and albuterol (Can use albuterol if PT is SOB) won’t work effectively because lungs aren't able to deeply inhale the meds. ● Never increase O2; it can kill PT. ● Huff coughing helps to cough out thick mucus, ○ Correct order: Sit upright and lean forward, deep slow inhalation, hold breath for 2-3 seconds, then exhale, avoid normal coughing, rest for 5-10 seconds between breaths. ● Monitor: mental status change: Restlessness, decreased LOC, and confusion ● Emphysema: ○ Well perfused (Pink), but they have difficulty breathing which leads to Air trapping, ○ Pursed lip breathing (In nose for 2sec then blow out the candle for 4sec), Barrel chest, minimal cough, tripod position for breathing ● Chronic Bronchitis: ○ Cyanotic (Blue), inflammation of bronchi. Excessive mucus production (Recurrent infections) ○ Weight gain from water, long term chronic cough, sputum, crackles and wheezes, peripheral edema, R sided heart failure which leads to pulmonary HTN, JVD. Asthma ● Bronchodilators (Inhalers) Short acting Beta2 agonists. Albuterol, terbutaline provide rapid relief for acute asthma attacks. ● Cholinergic Antagonists (anticholinergic medications) such as ipratropium, block the parasympathetic nervous system, providing relief of acute bronchospasms. ● Anti-Inflammatory Agents decrease airway inflammation for long-term management. ○ Corticosteroids (fluticasone, prednisone) ○ Leukotriene modifiers (montelukast) mast cell stabilizers (cromolyn sodium) ● Retractions are a priority ● Pharmacology for Asthma - Albuterol, Bronchodilators, Steroids for NURSING, NCLEX RN & LPN ARDS ● Pneumonia ● ● ● Pneumonia symptoms, patho, nursing interventions for NCLEX RN & LPN GASTROINTESTINAL Stomas ● Should be pink and not prolapsed outward, Blue/dusky/pale color is an emergency. Stoma color should be checked every shift. Pouch should be emptied when it is no more than half full ● Bowel function (3-4th day post op) ● Ileostomy: Loose liquid stool is normal, since it is early in the GI tract, it hasn't had a chance to form. ● Colostomy: Formed stool ● Cleaning: https://youtu.be/h8CtsPAaa5Y ○ Clean w/H20 the stoma, cover w/ointment or paste: Cleanse skin around stoma with soap and water, rinse, and pat dry. Apply a protective skin barrier before replacing the pouch. If wafers or wafers are used, make an opening not more than 1/8th inch larger than the stoma. Cirrhosis ● Signs & Symptoms ○ Early Signs and symptoms: ■ Weight loss, fever, fatigue, heaviness in RUQ, Impaired metabolism, GI disturbances, congestion of blood flow which causes increased pressure of intestines, stomach, esophag. ○ Later signs and symptoms ■ Jaundice (can go away if liver recovery is successful) From > high Bilirubin ■ Ascites, Abdominal pain, Peripheral neuropathy, clay colored stool, confusion, pruritus. ● Complications for cirrhosis ○ Portal hypertension- changes in the liver causes a backup of blood, straining should be avoided because this may cause bleeding. ○ Esophageal varices ○ Hepatic encephalopathy ● Nursing Interventions for cirrhosis: ○ Emollient baths (oatmeal or baking soda ), Blood transfusions due to bleeding varices, Low Na, high vitamin diet, Small frequent meals, No ETOH, Diuretics, Vitamin K, Daily weight, daily abdominal girth measurements ● Cirrhosis of the Liver | Signs, Symptoms, Interventions & Nursing Care Pancreatitis ● Pathology: May be acute or chronic, inflammation of pancreas ● Causes: backflow of bile into the pancreas, gallstones or tumors, ETOH: trauma or alcohol ● Diagnostic test: elevated amylase and lipase (Pancreatic enzymes) ● Monitor for: DM bc of insulin secreting cells may be damaged. Monitor glucose ● Signs and symptoms: Severe, sudden onset abdominal pain in ULQ, Vomiting, Fever, jaundice, Tachycardia, stratoherra, Tender, distended abdomen, Bowel sounds may be absent, Elevated serum amylase ● Medical Management: Pain control- Demerol: first then morphine if it doesn't help, anticholinergic reduce spasms and pain, nitroglycerin is always used, NPO; TPN, Pancrease- to reduce steatorrhea ● Nursing interventions: NGT, NPO, IV, no caffeine or alcohol, small frequent meals, no spicy foods ● Hepatitis ● ● Pathology: Inflammation & swelling of the liver, Bile channels are compressed, Blood flow through liver is impaired ● Signs and Symptoms: Jaundice, purisis- treat by emollient baths, ● Complications: Liver problems or decreased liver function, fatigue, lethargy, joint pain, dark urine, hepatomegaly, fever, decreased appetite, abdominal pain. ● Treatment: Allow liver to regenerate, Prevent transmission, hep B is treated for a 4-12 months course of interferrion, High calorie diet, High protein diet, High carb diet, no ETOH, immunosuppressants and corticosteroids for life. ● Hepatitis ABCDE Nursing | Patho, Causes, Symptoms, Diagnostics, Treatments Musculoskeletal Traction Devices provide alignment ● Application of pulling forces to ● Counter traction pulls in other direction (muscles / body weight) ● Purposes of Traction ○ Reduce fracture / dislocation to maintain alignment ○ ↓ muscle spasm and relieve pain ○ Correct, lessen or prevent deformities ○ Promote rest of injured body part ○ Promote exercise ■ Basic Principles of Traction ● Proper body alignment ○ Should be 1st initial assessment if PT is reporting pain ● Amount of weight should be correct as ordered, All weights hanging free ● Skin Traction (Bucks Traction): ○ Attaches to skin ○ Provides a light pull ○ May be removed and reapplied, if ordered ○ Usually 5 - 10 pounds ○ Buck’s, cervical, pelvic ○ Traction Classifications ● Skeletal Traction (Halo Device): ○ Attaches directly to bone ○ Strong, steady, continuous pull ○ Wt. to wires, pins, or tongs ○ Pin Care important ○ Don’t remove without order ○ Usually 15 - 30 pounds Fractures ○ Halo, Skull Tongs, etc. ● Bone Fractures in Pediatrics | Nursing and NCLEX Review ● Spiral Fracture: Cause is abuse, mandate report. ● Complete: entire cross-section ● Incomplete: part of cross-section ● Greenstick: incomplete ● Closed / Simple: skin intact ● Open / Compound: fragments of bone break through skin. 3 grades of severity ● Complications of fractures: ○ Infection ○ Fat Embolism (Especially with femur fracture) ○ DVT ○ Compartment Syndrome ○ Shock ○ Joint Stiffness/Contractures ● Sprain: Surrounding ligament fibers are damaged by excessive stretching or exertion ○ Treatment: ■ R = Rest ■ I = Ice ■ C = Compression ■ E = Elevation Arthritis (Rheumatoid and Osteoarthritis) ● Treatment/Management: Heat and cold application, weight loss, acetaminophen, smoking increases risk for osteoarthritis ● Joint replacement Hip Replacement: ● Anterior ○ No crossing legs ○ Avoid hyperextension ○ No bedpans ○ Don’t turn leg outward ○ Ortho Post-op Care: ■ Abduction pillow or wedge to maintain abduction/prevent injury ● Posterior: ○ No bending forward more than 90 degrees ○ No crossing the legs ○ No turning toes inward ■ No pigeon toes Endocrine ○ Cushings ● Patho: Excess levels of circulating corticosteroids will affect every body system. ● Causes: Internal (tumor) and external (prolonged admin of high dosage steroids) production of corticosteroids, particularly glucocorticoids. ● Risk Factors: Asthma, rheumatoid arthritis, or any other disease where long term steroid use is required. ● S/S: Hirsutism, menstrual disorder, mood changes, obesity, facial redness, delayed wound healing, insomnia, irrational behavior, truncal obesity, thin limbs, “moon face”, osteoporosis, hypokalemia of uncertain cause, increased BP, easy bruising. ● Labs: low potassium, high sodium, high glucose. ● Diagnosed: S/S, 24h urine collection to look for cortisol, low dose dexamethasone suppression test (should show a drop of cortisol and steroid levels when compared to baseline), Radiographic studies (CT & MRI are done if tumor is suspected) ● Medical treatment: Drug therapy, surgical treatment, or radiation. ● Addisons vs Cushing's Disease for NCLEX RN Addisons ● Cause: Autoimmune diseases that affect the (low function) adrenal glands; results in deficiencies. Decreased ACTH production, TB and fungal infections, abrupt withdrawal of exogenous steroids. ● S/S: increased potassium and decreased sodium causes salt cravings weakness lethargy and malaise, skin hyperpigmentation, lightheadedness upon rising from hypovolemia, decreased tolerance to minor stress. ● Acute adrenal crisis: Fluid and electrolytes become imbalanced which is life threatening. Cause from abrupt withdrawal of steroid therapy. Stress can cause it, as well as adrenal surgery or pituitary destruction. Same S/S as adrenal hypofunction but they are more severe and onset much quicker. If untreated can lead to circulatory collapse. ● Diagnosis: by S/S, EKG (electrolyte imbalance can cause irregular HR), Xray ● Labs: low glucose, low serum cortisol levels, low sodium, high potassium, ACTH level (Cannot be diagnosed without this, If high= adrenals are the issue, if low= pituitary is at fault) ● Treatment: Replacement therapy with glucocorticoids and mineralocorticoids. hydrocortisone is the best drug because it contains both. Diabetes Insipidus ● Replace any question with DI with dehydration SIADH ● Holding onto fluids Neurological Parkinsons Medical diagnosis ● From health history and physical examination ● MRI to rule out other causes of the symptoms Signs and symptoms ● Major triad of symptoms: ○ Tremor ○ Rigidity ○ Bradykinesia (Extremely slow movements) Drug therapy ● L-dopa (L-dihydroxyphenylalanine); carbidopa/levodopa (Sinemet) ● https://www.osmosis.org/learn/Anti-parkinson_medications Nursing Care ● As disease progresses, the patient becomes more immobilized ● “Protein effect” - dietary protein can interfere with absorption of levodopa. This is why herbal supplements should be avoided ● Nursing Diagnosis/Interventions ○ Impaired Physical Mobility ■ Independence ■ Assistive devices ■ Active & Passive ROM ○ Risk for Injury ■ Room safety ■ Supportive shoes Head Trauma Basilar Skull Fracture - S/S: Battle's sign - bruising behind ear, bruising around eyes, Unwanted halo or ring sign, Injury can lead to death, Signs of Rhinorrhea, Otorrhea, Early halo or ring sign - Interventions: Nero exam frequently, Offer low dose codeine to avoid cough, No sneezing or blowing nose, Offer antiemetics to avoid N/V, No NG tubes, Offer gauze over ear or nose to catch CSF, - If CSF leak is suspected, test fluid for glucose. CSF is high in glucose. ICP ● Normal ICP is 0-15 ● Keep PT cool and calm, elevate HOB, avoid flexing hips, Neuro checks as ordered, any change in GCS by 3 points, HCP needs to be notified. ● Immunological HIV/AIDS ● Opportunistic Infections: Candidiasis, Herpes Simplex (more than a month), Encephalopathy (Coma), Kaposi’s sarcoma, Mycobacterium tuberculosis of any site, Pneumonia, Salmonella septicemia (Salmonella affects every organ), Wasting syndrome ● Labs: ○ Enzyme-linked immunosorbent assay (ELISA) ■ HIV antibody test ○ Confirmed by another antibody test called the Western blot or immunofluorescence assay (IFA) ○ Viral load measures HIV RNA in plasma (DOne with positive IFA) ■ Before treatment and throughout to evaluate effectiveness ○ CD4+ (Good is above 200) (Less than 200 = AIDS) ● MENTAL HEALTH Alcohol Abuse ● Death could occur from acute toxicity in levels greater than 0.4% ● Effects of Intoxication: ○ Effects of excess: Slurred speech, nystagmus, memory impairment, altered judgment, decreased ○ motor skills, decreased LOC (stupor, coma), respiratory arrest, peripheral collapse and death. ○ Chronic use: cardiovascular damage, liver damage (fatty liver, cirrhosis) erosive gastritis and GI bleeding, acute pancreatitis, sexual dysfunction ● Withdrawal: abdominal cramping, vomiting, tremors, restlessness, insomnia, tachycardia, transient hallucinations or illusions, anxiety, hypertension, tachypnea, increased temperature, and tonic-clonic seizures. ● Alcohol withdrawal delirium: can occur 2 to 3 days after cessation of alcohol, this is a Medical Emergency: severe disorientation, psychotic manifestations (hallucinations) severe hypertension, cardiac dysrhythmias, and delirium. Alcohol withdrawal delirium can progress to death. ● Mental Health Medications SSRI: ● Side Effects: : Sexual dysfunction, nausea, decreased appetite, weight loss, excessive sweating, insomnia, jitteriness, sedation, dizziness. ● Safety Issue: Serotonin Syndrome, this is a medical emergency!, Occurs when two medications that raise serotonin are combined such as another antidepressant, some pain/headache medications or St. John's Wort. ● Mechanism of action: Take 2-4 weeks to be totally effective, Increase serotonin reuptake MAOI: ● Safety Issue: Hypertension crisis with wine and aged cheeses and proteins, decongestants like Sudafed, contraindicated with SSRI’s and other antidepressants. Antipsychotics: ● Side effects: TD, blurred vision, nausea, vomiting, sexual dysfunction. ● Pharmacology - Antipsychotics - Haloperidol, Clozapine, ● Pharmacology - Psychiatric Medications for nursing RN PN (MADE EASY) ● Pharmacology - Anxiety Medication ● Schizophrenia | What is Schizophrenia? Therapeutic Communication Nursing ● Pharmacology Antidepressants - SSRI, MAOI, TCA, SNRIs) nursing RN PN (MADE EASY) ● Pharmacology - Bipolar Drugs - Lithium, Valproic Acid, Carbamazepine nursing RN PN NCLEX Tardive dyskinesia: Bipolar disorder: - Mania: An abnormally elevated mood, which can also be described as expansive or irritable; usually requires Hospitalization. Manic episodes last at least 1 week - Hypomania: A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania. Hospitalization is not required, and the client who has hypomania is less impaired. Hypomania can progress to mania. - Nursing Interventions: - Decrease stimulation without isolating the client if possible. Beware of noise, music, television, and other clients, all of which can lead to an escalation of behavior - Follow agency protocols for providing client protection (restraints, seclusion, one to one observation) if threat of self injury or injury to others exists. - Implement frequent rest periods. MATERNAL Signs of Pregnancy Hyperemesis Gravidarum ● IV fluids as needed ● Bland diet, eat crackers before getting out of bed in the morning ● Severe cases may require TPN ● Monitor weight, Promote bed rest ● Electrolyte replacement as needed Identify and avoid triggers (smells) ● Monitor fluid and electrolytes (risk for dysrhythmias) Preeclampsia/Eclampsia Gestational Hypertension: ● Edema, HTN (If BP is too high, baby will have insufficient blood flow), proteinuria, Signs generally occurs after 20 weeks gestation Mild Preeclampsia ● PT 140/90, generalized edema of hands, face, lower extremities, look for sudden weight gain (2.2lb a day) ● Protein in urine (1+ or 2+), bed rest is typically ordered Severe Preeclampsia ● Symptoms appear suddenly ● BP of 160/110 or greater ● Increased edema (Places to look: face, hands, sacral area, abdomen, and lower extremities. 2 pounds can be gained in a few days) ● Increase urine albumin (protein in urine, 3+ to 4+ readings. Kidney filtration is affected because of high BP) & decrease in urine amount (Less than 500 mL/24 hours) ECLAMPSIA ● Most severe form of PIH/GH ● Characterized by seizures & coma ● Elevated BP, albuminuria and oliguria (kidneys are shut down) are common also NURSING INTERVENTIONS ● I & O (Monitor fluids very carefully to prevent fluid overload from IV infusions) and daily weights at the same time, wearing the same clothes, before breakfast. ● Monitor BP every 4 hrs. Quiet environment & bedrest ● Magnesium Sulfate-> used to prevent convulsions, & lower BP ○ Main purpose for treatment is to prevent convulsions (Initiate seizure precautions) ○ Decreases acetylcholine in motor nerve terminals, which is responsible for seizure prevention in preeclampsia and eclampsia. Anecdote is CALCIUM GLUCONATE HELLP Interventions for HELLP: ● Padded side rails ● Make sure the call button is within reach. ● Keep the environment quiet and non stimulating. ● Emergency medication: ○ Hydralazine- antihypertensive vasodilator and magnesium sulfate are in or adjacent to the women's room. ○ Calcium gluconate- immediately available in a labeled syringe at the bedside as an antidote to magnesium sulfate toxicity. Abruptio Placenta Symptoms: ● Painfull, dark red blood, tender uterus usually in last trimester ● Strong, consistent contractions ● Rising fundus (uterine rigidity) may indicate retroplacental hemorrhage ● Check for amount, color, and onset of bleeding Treatment: ● Continuous fetal monitoring ● Monitor fundal height (marking to check for upward movement) ● Frequent VS ● If no fetal distress- vaginal delivery ● If s/s of fetal distress- C/S Placenta Previa Umbilical Prolapse ● Priority action is to insert a gloved hand and relieve pressure off the cord and call for help. Do not move until c-section is done. ● Requires emergency c-section ● Transdelenburg position for gravity or knee to chest Stages of Labor: 1: Latent: 0-3 cm Talkative, irregular contractions (Contractions 5-30 min) Active: 4-7cm Walking/Squatting/Breathing (Contractions 3-5 min) Transition: 8-10cm Shortest phase, emotional (Contractions 2-3 min) 2: Push & Birth: OA- Prefered OP = Back pain, counterpressure Contractions 1-2min 3: Placenta (5-30 min) - Sunny side up/Schultz preferred Dull side up/ Duncan = Increased risk for bleeding 4: Recover: VS Q15 min x 2 hrs Fundal assessment Q15 min x 1 Hr ● Sedatives (Analgesia): Early and latent phase. Watch for neonatal respiratory depression, do not use it if labor is expected within 12-24 hrs, and require walking assistance. ● Opioids (Analgesia): Active labor. Butorphanol and nalbuphine do not cause significant respiratory depression, Continuous FHR monitoring. Naloxone for antidote. Walking assistance. ● Epidural analgesia (Analgesia): Produce regional pain relief, allows the client to sense contractions. Walking assistance. Continue FHR monitoring. ● Pudendal Blocks (Anesthesia): Second and third stage. Transvaginal ingestion, compromised bearing down, Local anesthesia to perineum/vulva. No systemic effects. ● Epidural block (Anesthesia): Suitable for all stages of labor (4cm min.). Monitor BP (IV bolus), PT can not get up. Contraindication: Increased WBC (More than 10,000), Low PLT (Below 100,000). Continue FHR monitoring. ● Spinal block (Anesthesia): Late second stage or before C-Section. Eliminates all sensation from nipple down. VS Q10 min (BP), leakage of CSF. Bear down, contractions will not be felt. ● General Anesthesia: Rarely used when no complications are present. Verify NPO, Continue FHR monitoring, Wedge under PTs hip, Assess for uterine tone and hemorrhage. PT will be unconscious. VEAL CHOP: L.I.O.N: Left side Lying, IV access, O2, Notify provider ● Category 1 (Normal): Accelerations, Early decelerations, Moderate variability ● Category 2: Tachycardia, Bradycardia, minimal variability, absent baseline variability, Marked baseline variability, absent accelerations, episodic/periodic decelerations ● Category 3: Sinusoidal pattern, absent baseline , late decelerations, Postpartum Care: ● Taking in stage: Provides supportive care, primary focus may be herself, may rely on nurses to take care of baby ● Taking hold stage: Mom is now ready to assume greater authority for herself and baby, the nurse should explain mood fluctuations are normal. This is the stage where a mother is ready to learn how to care for baby. ● Letting Go: Letting go of past like (EX: Girls nights/going out) PEDIATRICS Vaccine Schedule for Children: ● 2&4 Months old: Pediarix #1 (DTaP-HepB-IPV/Polio), Hiberix (Haemophilus influenzae type B) #1, PVC13 (Pneumococcal) #1, Rotarix (Rotavirus) #1 ○ Vaxelis (DTaP-HepB-IPV/Polio, & HIB) ○ Vaxneuvance (Pneumococcal 15) ● 6 months old: Pediarix #3, Hiberix #3, PVC13 #3 (Vaxelis (DTaP-HepB-IPV/Polio, & HIB)) ● 12 months old: MMR (Measles, Mumps, Rubella) #1, Varivax (Varicella), PVC13 #4, Havrix (Hepatitis A) #1 ○ MMR and Varicella given separately with the first dose due to possible seizures. ● 15 Months: Infanrix (DTaP #4), Hiberix #4 ● 18 Months: Havrix (Hepatitis A) #2 ● 4 Years: MMRV (MMR-VZV), Kinrix (DTaP-IPV/AKA Polio) ● 11 years old: Menveo (Meningitis) #1, boostrix (Tdap), HPV9 #1 ○ HPV9 booster @ 6 months ● 16 Years old: Menveo #2 ● 16-18 Years old: Bexsero (Meningococcal Group B) (booster @ 1 month) Meningitis ● Complications: ○ Seizure, Sepsis, Vasomotor collapse, Increased ICP ● Signs and symptoms ○ Headache (r/t inflammation of meninges), Nuchal rigidity (stiff neck, PT cannot put chin to chest.), Irritability, Diminished level of consciousness, Fever, Photophobia (sensitivity to light.), Hypersensitivity, Seizure activity, Positive Kernig sign and Brudzinski sign ● Kernig sign and Brudzinski sign ● Testing for Kernig Sign (Positive kernig sign: PT is supine (on the back), when the PT’s leg is flexed, the patient is unable to completely extend the leg. Indicates meningeal irritation.) ○ ● Testing for Brudzinski Sign (When the nurse flexes the PT’s neck, hip flexion occurs. The examiner cradles the neck, bringing it towards the chest, attempting a chin to chest. When they bring the head up, to try to create a chin to chest, both knees are going to come up, this is a positive brudzinski's. Also indicates meningeal irritation.) ○ Meningitis Medical diagnosis: ● Lumbar puncture to obtain CSF for lab analysis (#1 test.) ● Nursing consideration: ○ Have PT lie flat (b/c of fluid imbalance and spinal headache caused by unequal pressure.) ○ Check the site of the dressing (L3, L4, L5, because the spinal cord ends at L2). Monitor dressing, it should have no stain, not a good sign. Check for CSF (appears as pink, with yellow halo) ○ CSF will appear purulent in bacterial meningitis Meningitis Medical treatment: ● Bacterial infections usually respond to antimicrobial therapy, but no specific drugs are effective against most viral infections. ● Both conditions, viral or bacterial isolation precautions will have to be initiated. ● Meningococcal meningitis is spread via droplet. ● Anticonvulsants are used to control seizure activity if necessary and prevent a seizure from happening (prophylactic), and place the PT on broad spectrum antibiotic (Must obtain the C&S FIRST to identify organisms) Epiglottis ● ● A nurse in an emergency department is caring for a toddler who is in acute respiratory distress. Which of the following should alert the nurse to the possibility of epiglottis? ○ Drooling ○ Rational: children with epiglottitis typically present with drooling, restlessness, and leaned over position with chin out. ● A nurse is caring for a preschool age child who has epiglottitis with a barking cough. Which of the following actions should the nurse take? ○ Monitor O2 sat Growth and Development ● ● 1MO: demonstrates head lag, has grasp reflex ● 2MO: lifts head off mattress when prone, holds hands in open position ● 3MO: slight head lag; raises head and shoulders off mattress when prone, no more grasp reflex, hands loosely open ● 4MO: rolls from back to side, places objects in mouth ● 5MO: palmar grasp dominant ● 6MO: holds bottle ● 7MO: bears full weight on feet, moves objects from hand to hand ● 8MO: sits unsupported, begins pincer grasp ● 9MO: pulls to stand; creeps on hands and knees instead of crawling, crude pincer grasp ● 10MO: changes from prone to sitting, grasps rattle by handle ● 11MO: walks while holding onto something, neat pincer grasp; places objects in container ● 12MO: sits down from a standing position without assistance, tries to build a 2 block tower without success ● 18MO: Should be able to remove shoes ● 2YO: Stacking blocks, jump in place ● 3YO: Ride tricycle, cutting with scissors, coloring, push pull toys ● 4YO: Jump on one foot, Draw stick figure ● 5YO: Skip on alternate feet Parenting Styles: ● Dictatorial or authoritarian parenting style: ○ Parents try to control the child's behaviors & attitudes through unquestioned rules & expectations *Example: The child is never allowed to watch TV on school nights ● Permissive parenting style: ○ Parents exert little or no control over the child's behavior and consult them when making decisions *Example: The child assists with deciding if they can watch TV or not ● Democratic or authoritative parenting style: ○ Parents direct the child's behavior by setting rules & explaining the reason for each rule *Example: The child can watch TV for 1 hr. on school nights if homework & chores are done *Example: The privilege is taken away but later reinstated based on new guidelines ● Passive parenting style: ○ Parents are uninvolved, indifferent, and emotionally removed *EX: The child may watch TV whenever they want Pain Scales NIPS for neonates: ● FLACC for 2mo-7 years: ● FACES for ages 3 years or older: ● Numeric pain scale for ages 5 years and older Tetralogy of Fallots ● ● If baby begins to have a tet spell, priority is to place the baby in a knee to chest position ● Any activity (especially feeding or crying) can trigger a tet spell Hirschsprung's Disease ● Congenital Varicella ● LEADERSHIP QUIZLET LEADERSHIP ATI N430: ATI Leadership Ch 1 Overview Quality Planning PHARMACOLOGY Quick tips ● “Mycin” drugs can cause ototoxicity (tinnitus), ACE can puff the tongue and add potassium. ● Pharmacology - GI, Vitamin, Herbs & Nutrition drugs ● Tyramines (Cheese, nuts, alcohol) are contraindicated in MAOIs (Leads to HTN crisis) ● SSRI’s should avoid sunlight, serotonin syndrome (Monitor for fever) ● Antacids should not be taken at the same time as other drugs (Inhibits drug absorption) ● Potassium should be given with 4oz of fruit juice to prevent GI upset ● PT with peptic ulcers should avoid Naproxen and Prednisone (GI irritation) ● St. John's Wort is avoided with SSRI’s ● Donepezil slows progression of Alzheimers ● Do not give metformin to someone having a procedure with contrast dye (acute renal failure) ● Inject air into NPH, then regular, then flip regular to draw insulin then draw NPH insulin ● Carbamazepine is contraindicated within 14 days of MAOI administration ● Anticholinergic effect: won't be able to spit, see, pee, or shit. ● Carafate: Before meals, Tagamet: With food, Antacids: After meals ● Heparin: Given IV or SQ, monitor aPTT (60-100 sec) Warfarin: monitor INR 2-3, vitamin K ● “-Line” And “-Mine” ending drugs are for neuropathic pain, common side effect is orthostatic hypotension. ● Nitroglycerin: Can give up to 3 tablets in 15 min, PT can use aspirin or acetaminophen to offset headache, Nitroglycerin can cause large bruising, PT should take tablet 5-10 min before an activity that trigger angina. ● Mannitol: Monitor for S/S of circulatory overload ● Pharmacology Made Easy - Drug Endings (Part 1) | Picmonic Nursing Webinar ● Pharmacology Made Easy - Drug Endings (Part 2) - Antibiotics | Picmonic Nursing Webinar ● Pharmacology Made Easy - Drug Endings (Part 3) | Picmonic Nursing Webinar ● Fluid & Hormones | IV Fluids (Isotonic, Hypotonic, & Hypertonic) Pharmacology Reversals ● Coumadin = Vitamin K ● Benzodiazepines = Romazicon (Flumazenil) ● Magnesium Sulfate (Used to prevent preterm birth)= Calcium Gluconate ● Heparin= Protamine Sulfate ● Tylenol= Mucomyst ● Digoxin= Digiband ● Alcohol withdrawal= Librium ● Aspirin= Sodium bicarbonate ● Insulin= glucose Gastric Lavage Brachytherapy (Internal Radiation) ● Organize care so that nurse/ staff exposure is kept to a minimum ● Limit time in the room to max. of 30 minutes/ 8 hr. shift ● Perform non-direct care outside of room (opening up meds) ● Rotate assignments to minimize exposure, provide care on opposite side of implant ● Never care for more than 1-2 radiation implant patients at a time. ● No pregnant women or children under age of 18 y.o. limit visitors to 30-60 minutes/ day. visitors should stay at least 6 feet from the source. ● Inspect all linens before discarding to make sure implant/ seeds have not been released, only change when soiled. save all linens, gowns, dressings, equipment, trash in the patient's room until the patient is discharged. ● Staff must wear an individual dosimeter (film) badge (no sharing) when in the room. post signage on the patient's door. lead shield or apron if close contact ● If the implant falls out: call the hazardous waste team if available. if not available, use long- handled forceps (lead gloves) and place in lead container ● HOB no higher than 20-30 degrees with cervical implant ● Avoid complete baths/ complete linen change (unless soiled, may change under pad) TEST TAKING SKILLS Determine type of question: ● Safety/risk reduction ● Effective Care Environment ● Health Promotion and maintenance ● Priority ● Psychosocial Integrity ● Physiological Integrity Priority Question Tips: ● Airway, breathing, Circulation (Assessment before Intervention) ● Physical comes before physiological (Maslow) ● Acute patients comes before chronic ○ EX: Asthma before COPD ● Survival Potential: ○ Expectant: Fatal injury, Comfort measures ○ Non-Urgent: Class 3, minimal injury ○ Emergent. Class I, life threatening Injury but survival is possible with intervention ● least restrictive before restrictive ● least Invasive before invasive ○ Ex: SOB: Position change before tracheostomy Select all that apply ● Answer as a tRUe or false ● Be wary of selecting possible answers that are not immediately necessary, relevant, or specific to the problem or issue you are addressing. ● Ask yourself “ Would this help, harm, or do nothing?” Safety/risk reduction tips: ● Major contributors to client injury: ○ In health care: ■ Medication Errors ■ Falls ■ Incorrectly preformed or timed procedures ○ At home: ■ Motor Vehicle Accidents ■ Drowning ■ Fires (R.A.C.E) ■ Poisoning (Almond Breath) ■ Inhalation + Ingestion of Foreign Materials ■ Firearms ● Assess risk for injury then report to charge nurse/provider ● Disease specific Isolation recommendations ○ Standard: CMV, HIV, Hepatitis B+ C, aspergillosis. ○ Contact: MESA (mask if respiratory), diarrhea, C. diff, Hepatitis A, lice, parainfluenza, rotavirus, E. Coli, salmonella, Herpes Zoster. ○ Droplet: Pertussis, Influenza ArB, MRSA (respiratory), Rubella, Mumps, Bacterial meningitis ○ Airborne: Chicken Pox, disseminated herpes Zoster,measles. ■ N-95 Mask for: TB, SARS, Avian influenza Test Taking Skills: ● New, sudden, worsening, or rapid are all words that typically describe a priority PT ● NCLEX only uses Generic names for meds ● Situational questions remember there's plenty of staff and resources ● RNs: Don't delegate what you can EAT: Evaluate, Assess, Teach. Develop a care plan, first assessment, evaluate outcomes of nursing interventions, unstable PTs, blood transfusions. ● UAPs: perform ADLs, DOES NOT give Meds, does not feed PTs with risk of aspiration ● LPNs: Mostly stable PTs, gather data, fresh post-OP, No new admissions, No education/teaching, only reinforcement. ● Nurses responsibility with informed consent: ○ Witness signature, ask if PT understands procedure ● Subject of Question: This Can effect answer choice ○ Adult (generic PT) ○ Gender specific ○ Child ○ Older adult Client ● key words ○ First (Airway, Breathing, Circulation) ○ Priority (Airway, Breathing, Circulation) ○ After- Check to see what has already been Done ● Teaching CLient ○ “Need for further teaching” questions (which question is the wrong answer) ○ “Indicates understanding Questions” (correct answer) ● When drawing up regular insulin and NPH: N-R-R-N ○