Nclex Study Quick Stuff Future
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Transcript of Nclex Study Quick Stuff Future
8/3/2019 Nclex Study Quick Stuff Future
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Cardiac Rate- Peds
Remember: 311
(Fetal HR 120-160)
RR
-30 90-130 Infant 30-60
-10 80-120 Toddler 20-30
-10 70-110 Preschooler 16-22
Temperature
ºF = (1.8 * ºC) + 32
(Think of them as being ~ 2º apart)
37ºC = 98.6º F
38ºC=100.4º F
39ºC=102.2º F
40ºC =104 º F
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Labs
BUN/CR = Dehydration
BUN/CR = Overhydration
El : Na (135-145) K (3.5-5) Mg (1.5-2.5) Ca (9-11) Cl (96-106) Phos (3-4.5)
Endocr :
BUN (7-22 or to remember put the buns in the oven for 10-20 min)
Cr (0.5-1.5)
Urine Spec Gravity (1.005-1.030)
Glucose:
Nml 70-120
Fasting <110
Infant BG 50-90 (<45=hypoglycemia-high pitch cry)
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HgbA1c= 4-6% (or <7%)
Thyr oid:
T3 (60-180)
T4 (5-11)
TSH (0.5-5) or 0.5-2 for hypothyroid pts
Free T4: 0.8-2.7 ( I remember it .8-2.8 easier to memorize)
H ypot hyr oid: TSH ;q T3 & T4
H yper t hyr oid: q TSH ; T3 &T4
ABGs:
PH 7.35-7.45
pO2 80-100
pCO2 35-45
HCO3 22-26
ROME:
With Acidosis the PH is always q and PH is always in Alkalosis
Respiratory Opposite; Metabolic Equal
RESP OPP:
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PH q PCO2 = Resp Acidosis
PH PCO2 q = Resp Alkalosis
METABOLIC =
PH q HCO3 q= Metabolic Acidosis
PH HCO3 = Metabolic Alkalosis
Blood :
RBC 4.2-6.1 million WBC 5000-10000 (or 4500-11000) Plt 150,000 ± 450,000
Hgb F: 12-16 M: 14-18 Hct F: 37-47% M: 42-52%
Amylase: 53-123 Albumin: 3-4.3 Alk Phosphate: 14-100 NH3 (35-65)
Blood Osmol 280-300 Lipase 14-280
Bilirubin (Total: 0.3-1; Indirect: 0.2-0.8; Direct 0.1-0.3)
Phenylalanine: Newborn < 2 Adult < 6
Antidotes
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Digoxinp Digiband
TylenolpMucomist (17 doses + loading dose)
Heparinp Protamine Sulfate
Benzodiazepinep Flumzaemil (Romazicon)
CoumadinpVit K
DI pq ADH, u/o, q Urine Specific Gr, Na (think Na = urine spec gr)
SIADHp think syndrome of ed diuretic hormone ADH, q u/o, urine spec gr
Insulins
Rapid Reg Interm Very Long Long Acting
5-15m 30-60m 1-3h 1h 6-8h
1-2h 2-4h 6-12h peakless action 12-16h
4-6h 5-7h 16-20h 18-24h 20-30
Novolog Novolin R NPH Lantus Ultra Lente \
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Humalog Humulin R Lente
Vaccines
Hep B 0, 1-2, 6-18mo
Hib 2, 4, 6, 12-15
Pneumo 2, 4, 6,12-15
Dtap 2, 4, 6, 15-18, 4-6yrs; Td q 10 yrs
IPV 2, 4, 6-18, 4-6yr
Varicella 12-15, 4-6yr
MMR 12-15, 4-6yr
Hep A 12-23 mo (2 doses, 6 mo apart)
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Mening 9-11 yrs
Rota 2, 4, 6
Influenza at 6 mo and then yearly after
Random Stuff
Thiazides BG
Neupogen = Neutrophil
E pogen = RBC/Erythocyte
Lofenalac Formula = for PKU infants
Ototoxic drugs = loop diuretics (Lasix) and Platinol-AO
TB Meds (R ISE)
Rifampin
I NH
Streptomycin
Ethambutol
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GCS
Eyes (4 points)
Verbal (5 points)
Motor (6 points)
Max = 15 (<8=coma)
APGAR Score
At 1 and 5 min after birth
(1st score is the transitional score and 2nd is planning care of newborn)
8-10 = ok
2 1 0
Appearance [All pink, pink&blue, blue/pale]
Pulse [> 100, < 100, No Response]
Grimace [cough, grimace, no response]
Activity [flexed, flaccid, limp]
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R esp [strong cry, weak cry, no cry]
INFECTION CONTR OL
C ontact P r ecautions:
MRS WEE
VCHIPS
Alex Hez 5 Coins HeRe
M-MRSA
R -Resp Infections (those not listed in other categories below)
S-Skin Infections
W-Wound Infections
E-Enteric Infections (C.Diff, Shigella)
E-Eye Infections (Conjunctivitis)
SK IN INFECTIONS:
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V-Varicella
C-Cutaneous Diptheria
H-Herpes Simplex
I- Impetigo
P- Pediculosis (lice)
S-Scabies
Alex = AIDS
Hez= Herpes Zoster
5=5th Dx
Coins=Croup
HeRe= Hepatitis and RSV
Dr o plet P r ecautions:
SPIDERMAN
Sepsis
Scarlet Fever
Streptococcal Pharyngitis
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Parovirus B19 (virus that causes 5th dx)
Pertussis
Pneumonia
Influenza
Diptheria
Epiglottidis
Rubella (Measles)
Measles
Meningitis
Mycoplasma
AdeNovirus
Also Rhinovirus and RSV
FETAL k Strips
REMEMBER: VEAL CHOP
Variable is Cord
Early is Head
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Acceleration is Ok
Late is Placental Insufficiency
Hypoventilation => Resp Acidosis ( CO2) ³Retain CO2´
Hyperventilation=> Resp Alk alosis (q CO2) ³Blow off CO2´ (think of preg breathing)
Lasix/Bumex = K+ Wasting (can cause hypok alemia)
Aldactone = K+ Sparing (can cause hyperk alemia)
Tx of DIC = Heparin (safe during preg)
Post Masectomy Care: BREAST
BP NOT on affected side
Reach Recovery
Elevate affected side
Abduction and external rotation ± no initial exercise (initial is extension/flexion)
Self Breast Exam (1x mon
th ± 7 day after period)
Try to promote a (+) self-image
Autosomal Recessive: Cystic Fibrosis, PKU, Tay-Sachs, Albinism, Sick le Cell Dx, Alpha
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Anti-Trypsin Deficiency, Galactetsemia
Autosomal Dominant: Huntington¶s Disease, Marfan¶s, Polydactly, Achandrophic
Dwarfism, Polycystic KidneyDisease
X-Link ed Recessive: Duchenne¶s Muscle Dystrophy, Hemophilia A (Females are carriers in
these diseases and males are affected by the disease)
At Term:
Nml = wt: 6-9lbs, head circumference: ¼ body length, 13-14 in, chest: 12-13in
Umbilical cord falls off in 1-2 week s
Stool: 1st stool (Mecconium) ± black + tarry (passes w/in 12-24 hrs), thin/green/brown day
3, formula feedings (1-2 pale yellow/light brown stools) or breast feeding (loose golden
yellow stools with sour milk odor)
Hypok alemia: Flat T wave, Depressed ST, and Prominent U wave
Hyperk alemia: Tall T wave, Wide QRS, Long PR Wave
5 P¶s of Fracture: Pain, pallor, pulseless, paresthesia, paralysis
Cushing¶s Triad: (Indicates ed ICP) q HR , qRR , BP
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CONVERSIONS:
1 lb = 16 oz 1 T = 3 tsp = 15 mL
1c = 8 oz = 240 mL 1 t = 5 mL 1 lb = 454 g = 16 oz
2 c = 1 pt = 16 oz 1 oz = 30 mL= 8 drams 1 mg = 1000 mcg
2 pt = 1 qt= 32 oz 1 g = 15 gr
4 qt =1 gal=128 oz 1 gr = 60 mg
Med Trivia
Talwan and Stadol=> Avoid (opoid agonist antagonists) ± much less effective then opoid
agonists
No Tagamet with Warfarin
Erogostat => For Migraine
No Quinolones/Tetracyclines with pregnancy
No ASA/NSAIDS in Hemophilia A patients
Lipitor = PM ONLY, no grapefruit juice
tPA= dissolves clots (heparin does not)
SLE Tx
o Cytotax, Imuran (Immunosupressants)
o NSAIDs
o Plaquinil (also an anit-malarial drug)
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More Maternity
Fundal Height
o Top of Symphis Pubis to top of fundus
o Gross estimate of dates
o Use a non-stretchable tape measure
o 12-14 wk s (at level of symphis)
o show after week 14 (can tell preg)
o 20 wk s (~ 20cm) at level of umbilicus
o rises 1 cm/wk till 36 week s then varies
Quick ening = fetal movement; 16-20 week s
Fetal Heartbeat = 8-12 week s (by Doppler) and 18-20 week s by auscultating with
stethoscope
Preterm: 20-37 week s
Term: 38-42 week s
Post-term: 42 week s plus
Total preg weight gain: 11-14 k g (25-35 lb)
300 cal during preg (DAILY) and 200-500 cal during breastfeeding (DAILY)
Caffeine < 300 mg/day (500-750 mL/day => risk of spontaneous abortion or fetal
intrauterine growth restriction
Uterine contractions can be felt after 4th month = Braxton Hick s Contractions facilitate
uterine blood flow through placenta and promote O2 delivery to fetus
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Amniotic Fluid:
o Nml: 800-1200 mL (transparent/clear, no odor)
o <300 mL = Olighydrimanos (low amniotic fluid)
Kidney problems
o Polyhydrimanos (too much amniotic fluid)
Umbilical Cord: 2 arteries and 1 vein
Placenta: Fetal lungs in utero
Alcohol, caffeine, nicotine, meds = easily cross placenta (viruses can cross, bacteria
cannot; exs of viruses (HIV, AIDS, Herpes, Measles, Toxoplasmosis, Hep)
AFP Test: measured at 16-18 week s
o ed Levels = risk of neural tube/abd wall defects (ex. spina bifida)
o qed Levels: risk of Down Syndrome
Fetal Distress
o HR < 110 or > 160
o Fetal hyperactivity or no activity
o Fetal Blood pH < 7.2
Other Stuff
Immed after put pt on a Mech Vent check BP (hypotension)
Lesions of midbrain = decerebrate positioning
Morphine Toxicity = Pinpoint pupils
Corticosteroid Effects: Acne, Hirituism, Mood Swings, ostoporosis and adrenal
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suppression (in k ids = delayed growth)
No Paxil with MAOI)
Beta Block ers = Mask Effect Of Hypoglycemia
SOMogyi Effect = BG sometimes up and sometimes down
Dawn Phenomenon = high BG in DAWN hrs (5-8am)
AFTER
o Post tracheostomy: k eep O2 and Suction at bedside
o Post pleural biopsy: chest tube and drainage system at bedside
o Post parathyroidectomy: tracheostomy at bedside
o Tonic Clonic Seizures: Suction apparatus at bedside
o Paracentesis: BP Cuff at Bedside
R ACE-Priority in a fire
o R-Rescue
o A-Alarm
o C-Confine
o E-Extinguish
PASS ± To use a fire extinguisher
o P-Pull Pin
o A-Aim at Base Fire
o S-Squeeze Handle
o S-Sweep fire from side to side
Folic Acid Rich Foods (FOL)
o F= Fish
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o O=Organ Meats, Oranges
o L=Leafy green veggies
K+ Foods (R OYGBIV-Rainbow colors)
o Red= Strawberries, Tomatoes (not apples)
o Orange= Oranges
o Yellow=Banana
o Green= Avocado, green veggies
o Blue= Fish from the BLUE sea
o Indigo/Violet= Raisins
Cretenism = Congential Hypothyroidism (appears 3-6 mo in bottlefed infants and later
in breastfed infants)
Hepatitis: low fat, high cal/carbs/protein, no alcohol
Hypothryoid: High Protein, low cal diet
Cystic Fibrosis: High Protein Diet and Pancr enzyme replacement
Hital Hernia: Fundopliction (tighten cardiac sphincter on stomach) don¶t lie down for 1
hr after meals, HOB 4-8 in when sleepy, no food before bed
Papable olive shaped tumor in epigastrim = pyloric stenosis (projectile vomiting)
o In adults from peptic ulcers; in infants from hypertrophy of pylorous (symp 2nd-4th wk
after birth)
Toddler: Fear of separation (give simple directions)
Preschooler: Fear mutilation (Allow to play with equipment)
School Agers: Fear loss of control (allow to play with equipment)
Adol: Fear loss of independence
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Pneumothorax Symp (P-Thorax)
o P-Pleurtic Pain
o T-Trachea Deviation
o H-Hyperresonance
o O-Onset Sudden
o R-Reduced breath sounds (dyspnea)
o A-Absent Fremitus
o X-X-Rays show collapse
Pul Edema Tx (MAD DOG)
o M-Morphine
o A-Aminophylline
o D-Digitalis
o D-Diuretics
o O-O2
o G-Gasses in blood (ABGs)
Cholecystisis: Gallbladder inflammation (RUQ pain)
Cholelithiasis: Gall Stones
Pancreatitis
o TURNER ¶S SIGN: Flank echymosis
o CULLAN¶s SIGN: Bluish periumbical (around the belly button)
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Who needs Dialysis?
Vowels: AEIOU
A: Acid/Base Problems
E: Electrolyte Problems
I: Intoxications
O: Overload of fluids
U: Uremic Symptoms
Cushing¶s Dx
o (Cushion ± too much Cortisone)
o (3 S¶s = high Steriods, high Sugars (hyperglycemia), high Sodium
o Moon Face, Buffalo Hump, Trunkal obesity, thin skinny extremities, slow wound healing,
osteoporosis, HTN, muscle wasting
o q K+
Addison¶s Dx
o Need to ADD steroids
o (3 S¶s = Low Steroids, Low Sugars, Low Sodium)
o Low vascular volume (Not holding salt and H20 like in Cushing¶s), low BP
o Hyperkalemia ( K+)
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o Bronze Skin, Hyperpigmentation
ALLEN TEST
o B4 drawing ABGs do an Allen¶s Test
o Compress both radial and ulnar arties (wrist) at same time on 1 hand
o Release the ULNAR side (pinky side) and hand should turn discolored and should be able to
see blood flow back into it
(Radial ± is located on the thumb side and ulnar is on the pinky side)
o Minutes of press on the ABG site after drawing blood?
5-10 min or 15-20 min if on anti-coagulants
After a liver biopsy place patient on the RIGHT Side
Mobility
o Cane
COAL = Cane Opp Affected Leg
o 2 point gait
One leg and 1 crutch touch ground at same time
Weight bearing
o 3 point gait
Both crutches and 1 foot are on the ground
N on-weig ht bear ing
o 4 point gait
Both legs and both crutches touch the ground
Weight bearing
o Swing through gait
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Advancing both crutches, then both legs, and requires weight bearing
Not as stable as other gaits
Laminectomy = removal of 1 or more vertebral laminae ± need straight back after =
LOGROLL and KEEP BACK STRAIGHT (so flat bed)
Intussceptation
o Seen in Non-Hodgkin¶s Lymphoma
o Hot dog mass in RUQ
o Red Currant Jelly Like mucous and bloody stool
Sweat Chol
o > 60 = CF
o 40-60 = Borderline CF
Ostomy = pouch opening 1/8 in larger than stoma
Macule = flat and round
Papule = rounded and red
Vesicle = filled with fluid
Impetigo = 1:20 Burrow¶s Soln, honey colored crusts
Permethrin [NIX] => 10% for lice tx and 5% for Scabies tx
o (Scabies = mites bury under skin)
RUQ: Right upper quadrant
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Cholelithiasis (gallstones)
Cholecystitis (inflamm of gallbladder)
Hepatitis
Pancreatitis (severe knifelike pain; worse with eating/lying down; some relief with fetal
position)
RLQ:
Crohn¶s Dx (Ileum, Rt Colon; pain after meals)
Appendicitis
o Pain at McBurney¶s Point
(1/2 b/w umbilicus and right iliac crest)
LLQ:
Ulcerative Colitis (Rectum, left colon; pain pre-defecation)
Diverticulitis
o Relieved by passage of stool/flatulus
Duodenal U lcer : Pain 2-3 hrs after meals and nighttime (relieve pain with FOOD INTAKE)
Gast r ic U lcer : Pain 1 hr after meal/when fasting; relieve pain with vomiting, not with food
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intake
(S tarve t he gast r ic ulcer and feed t he duodenal)
Di ver ticular Dx : Cramping in LLQ relived by passage of stool and flatus (constipation alternates
with diarrhea (from def in diet fiber) high fiber diet
Meckel¶s Di ver ticulum: congen sac or pouch in ileum, symp seen by age 2; painless rectal
bleeding, abd, hematechezia, (currant jelly like stool), s/s of appendicitis (tx = remove
diverticulum)
C i rrhosis:
Biliary obstruction, alcohol, Hepatitis
Early stage: high protein/carbs and Vit B
Adv stage: low fiber/salt/fat/protein, high cal, fluid restriction
Esophageal Varices
o Sengstaken Blakemore Tube or Minnesota Tube
Balloon on Esophagus and stomach to apply direct press on bleeding veins
o TIPS (transesophegal intrahepatic post systemic shunt)
Balloon Catheter inserted via jugular vein with angiography to create a metal stent b.w portal
vein to vena cava channel (provides a pathway for blood b/w portal vein and hepatic vein =
bypasses cirrhotic liver) and relieves press on esoph varicies
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Jaundice (Icterus)
Hemolytic
o RBCs are destroyed (release bilirubin)
Hemolytic transfusion rxn
Hemolytic Anemia
Sickle Cell Crisis
Hepatocellular
o
The impaired liver cell (hepatocyte) doesn¶t allow bilirubin to convert from the unconjugated
to the conjugated form
Obstructive
o Bile flow is obstructed
Cholelithias (Gall Stones)
Tumors
EK GS
Nml Sinus
o 60-100
o PQRST nml EKG Strip
Sinus Brady
o < 60
o Tx: Atropine
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o (can be nml in physically fit/trainer person = then no tx needed)
1st degree AV k Block
o Prolonged PR interval
o Nml PR interval: 0.12-0.20
o Conduction Problem
o Drugs (Dig, Beta Blockers, Ca Channel Blockers) can cause by slowing conduction system
(slows conduction from SA node to AV node to Purnjee Fibers = see slowed PR (Atrial
Response)
o Usu don¶t see symp, so usu not treated
Atrial Flutter
o Saw Tooth Appearance
o Atrium racing away, blood pools and can throw a clot => stroke
o Treat with Cardioversion 20-50 Jules (NURSE must hit Synchronize button)
o Ventricle beats are regular
Atrial Fib
o Ventricle beats are irregular
o Atrium quivers, not good pump
o Cardiovert 50-100 Jules
o If in hospital and were stable b4 going into a fib = give cardizem drip and beta blockers b4
cardioversion
V-Tach
o Wide QRS complexes
o V Tach and awake drugs I must take (Amiodarone or Lidocaine)
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o V Tach and a nap (unconscious) zap zap zap (defibrillate)
o Can only stay in for 2-3 min (can die)
V Fib
o Irreg makes no sense
o Only way to tx = defribillate start at 360 Jules
o Epi (to HR)
Strok e
Rig ht S ided: Impatient, easily distracted, impulsive, less concerned about life events, safety is a
big issue (impulse)
Left S ided: Slow, cautious, particular, very aware of deficits, greater depression/anxiety
(Think rt brain = creative, left brain = logical, math, science)