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If the pH and the BiCarb are both in the same direction then it is? Metabolic If the pH is up it is? Alkalosis If the pH is down it is? Acidosis As the pH goes so goes my patient except for? P... otassium If the pH is UP my patient will show signs and symptoms of...? Increase... like tachycardia,diarrhea and borborygmi If the pH is down my patient will show signs and symtoms of? Decrease... like decreased output, bradycardia and constipation If my pH is up my potassium (K+) is ? Down If my pH is down my potassium (K+) is? Up If my patient is overventilating I should choose? Respiratory Alkalosis If my patient is underventilating I should choose? Respiratory Acidosis If my patient has prolonged gastric vomiting or suction I choose? Metabolic Alkalosis If it is not lung or prolonged vomiting or suctioning I choose? Metabolic Acidosis High pressure alarms are triggered when? They cannot push air in High pressure alarms are caused by what three types of obstructions? Kinking, Water in dependant loops and mucus in the airway.If kinking in the tube is present you? Unkink If water is present in the dependant loops you? Open system and empty water. If mucus is present you? Turn them, cough and have them deeo breath first. If ineffective you then suction. Low pressure alarms are triggered when? It is too easy to push air in. Low pressure alarms are normally caused by? Disconnection If the tubing is disconnected you? Reconnect If O2 sensor line is disconnected you? Reconnect In a vented client respiratory alkalosis means the vent setting may be too? High In a vented client respiratory acidosis means the vent may be too? Low What do you do if the patients disconnected tube is on the floor? Bag them, (call for help) get new tube and then reconnect. What do you do if the patients disconnected tube is on the chest? Reconnect ... if its above the waist its ok. What is the biggest problem in abuse? Denial applicable to all forms of abuse To treat denial you need to? Confront How do you confront?Point out the difference between what they say and what they do. What is the one circumstance that you as a nurse would support denial? Loss and Grief What is dependency? When the abuser gets a significant other to make decisions for them or do thing for them. the abuser is dependent What is codependency? When the significant other gets positive self esteem from doing things or making decisions for an abuser. To treat dependency/codependency you? Set limits and enforce them. You also need to work or the self estreem of the codependent. What is manipulation? When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other. How do you treat manipulation? Set limits and enforce. Why is manipulation easier to treat then dependency/codependency? Because no one likes being manipulated. What is Wernickes (Korsakoffs) Syndrome? Psychosis induced by vitamin B1 (Thiamine) deficiency. Vitamin B1 helps breakdown? Alcohol Primary symptom of Wernickes? Amnesia with confabulation (making up stories). Is Wernickes preventable? Yes Is Wernickes arrestable? Yes Is Wernickes reversible?No What is aversion therapy? When you try and make the patient hate something. Antabuse onset and duration is? 2 weeks Teach a patient taking Antabuse to avoid what? Alochol On top of alcohol a patient taking Antabuse should also avoid what other 7 things? Elixirs, Vanilla Extract, Aftershave/Perfumes, Alcohol based hand sanitizer, Insect repellant, Mouthwash and Vinagerette. What are the five uppers? Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds Downers are? Everything other then the five uppers. S/S of upper use? Everything goes up...Tachycardia, increased BP etc. S/S of downer use? Everything goes down...Bradycardia, decreased BP etc. Overdose of a downer causes everything to go? Down Overdose of an upper causes everything to go? Up Withdrawal of an upper causes everything to go? Down Withdrawal of a downer causes everything to go? Up At birth if the mother was addicted to a substance always assume the newborn is in? Intoxication If 24 hours after birth assume the baby is in? WithdrawalEvery alcoholic goes through what withing 24 hours after cessation? Withdrawal syndrome After 72 hours of alochol withdrawal a small minority may get? Delirium Tremens Can Delirium Tremens kill you? Yes Can Alcohol Withdrawal Syndrome kill you? No Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others? No Are patients with Delirium Tremens a danger to themselves or others? Yes N/I for Delirium Tremens? Private room near nurses station, NPO/Clear liquids, Restricted bed rest, restraints, tranquilizer, multivitamin (B1 vit.) and antihypertensive. N/I for Alcohol Withdrawal Syndrome? Semi-private room anywhere, regular diet, up and ad-lib, no restraint, tranquilizer, multivitamin (B1) and antihypertensive. A two point restraint is? One arm and the opposite leg. N/I for restraints? Check Q15min. and rotate sites Q2H All aminoglycosides end in? "mycin" Vancomycin If it has "thro" in it you? Throw it out...Zithromycin Toxic effects of aminoglycosides? Ototoxicity, nephrotoxicity and cranial nerve 8 (vestibulocochlear nerve) which senses sound.In aminoglycoside use monitor? Hearing, balance, tinnitus & creatinine (best indicator of renal function) Frequency of administration for aminoglycosides? Q8H Aminoglycoside route of administration? Im or IV Aminoglycosides are given PO for what two reasons? Hepatic Encephalopathy and Pre-op bowel surgery. Neomycin and Kanmycin are used for what? Bowel sterilzation? Who can sterilize my bowel? "Neo" "Kan" Hepatic Encephalopathy is caused by? High ammonia levels What raises ammonia levels the most? Ecoli in the gut When do you draw a trough level? 30 minutes before the next scheduled dose. When do you draw a sublingual peak level? 5-10 minutes after it is dissolved. When do you draw a IV peak level? 15-30 minutes after dose is finished. When do you draw a IM peak level? 30-60 minutes after given Drugs DON't determine peak and trough times, the ROUTE does. ... Calcium Channel Blockers are like what for the heart? Valium Calcium Channel Blockers treat what? (the 6 A's) Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTSCalcium Channel Blocker side effects? (the 2 H's) Headache and Hypotension What causes angina? Chest pain due to O2 supply and demand issues. 90% of Calcium Channel Blockers end in? "dipine" and "zem" When giving a Calcium Channel Blocker you hold and notify if? Systolic is 100 or lower. "QRS" refers to? Ventricular "P" refers to? Atrail Asystole is? A lack of QRS repolarizations Atrail Flutter is? Rapid P-wave repolarizations in a saw tooth pattern. A-Fib is? Chaotic QRS depolarizations V-fib is? Chaotic QRS depolarizations V-tach is? Wide bizarre QRS's PVC is? Periodic wide, bizarre QRS's Be concerned about PVC's if? ( the 6, 6 T's of PVC's) More then 6 per minute, 6 in a row What are the 2 lethal arrythmias? A-systole and V-Fib What are the 4 potentially life threatening arrythmias? V-tach, A-fib, A-flutter and PVC What are the 6 arrythmias you are tested over on the NCLEX?V-fib, A-fib, A-flutter, PVC, A-systole and V-tach What are the 6 arrythmias for NCLEX in order for prioritization? A-systole, V-fib, V-tach, A-fib, A-flutter and PVC When talking about arrythmias the word "chaotic" means? Fibrillation When talking about arrythmias the word 'bizarre" means? Tachy PVC's fall on what wave of the previous beat? T wave When given a prioritization question for lethal arrythmias if you are asked to prioritize and one say it happened 6 minutes ago and the other says 15 minutes ago which do you choose? Always the one closest to the 8 minute mark. After 8 minutes the survival rate is LOW. To treat PVC's you give? Lidocaine/Amnioderone To treat V-tach you give? (If it start with a V you use..) Lidocaine/Amnioderone To treat supraventricular arrythmias you give? Adenocard, Beta-blocker (end in "lol'), Calcium Channel Blocker and Digitalis or Lonoxin. Supra means? Above To treat V-fib you ? Defibrillate ... For V-fib you D-fib To treat AsystolE you give? Atropine and Epinephrine but give it in reverse. If asked how to treat A-fib first you? Give Heparin then ABCD.... Heparin is instant Coumadin and Plavix take time. An Apical chest tube is placed? High (for air) A for airA Basilar chest tube is placed? Low (for blood) B for blood If you are asked about chest tubes after a surgery or trauma you can assumes it's a? Unilateral Pneumohemothorax Does a pneumonectomy get a chest tube? No What 4 things do you do if the water seal breaks on a chest tube? Clamp it 1st!! Cut broken device off of tube, put the tube in water (NS), unclamp. If asked about the best thing to di if the water seal breaks and not asking the first thing to do you? Put it in water (NS). What 4 things do you do if a chest tube comes out? Cover hole with a gloved hand, put on a vaseline gauze dressing, put on sterile dressing ands then tape on 3 sides. How long can you clamp a chest tube? No longer then 15 seconds without a doctors order. What do you use to clamp a chest tube and why? Rubber tipped double clamps. Rubber because it won't pierce the tube and double because were nurses and if one is good two is better. Is bubbling in the water seal continuously good? No it is bad. You need to find the air leak, tape it, report it and then record it. Is bubbling in the water seal intermittently good? Yes it should tidal on inhale. Is bubbling in the suction control chamber intermittently good? No it is bad. You need to dial up the suction, report and record. Is bubbling in the suction control chanber continuously good? Yes All congenital heart defects that are trouble start with a ?"T" What defects have right to left shunts and are cyanotic? Trouble defects What defects have left to right shunts and are acyanotic? Not trouble defects All congenital heart defects have what? Murmurs and Echocardiogram What are the four defects of Tetrology of Fellot? Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy What is the saying to help remember the four defects of Tetrology of Fellot? VarieD PictureS Of A RancH 1 fingerwidth is how many cm's? 1 W hen the handgrip of a crutch is properly in place the elbow felxion should be? 30* Crutches should be how many fingerwidths below the armpit? 2-3 Describe a 2 point gait? 1. one crutch and opposite foot together 2. Other crutch and other foor together. 2 points 2gether and the same time. Describe a 3 point gait? 1. Move two crutches and bad leg together. 2. Move good foot. Move all three together and then the good leg. Describe a 4 point gait? 1. One crutch 2. Opposite foot. 3. Other crutch. 4. Other foot. It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4 so crutch, foot, other crutch, other foot, and crutch,foot, other foot, other crutch etc, Describe swing through?Used for two braced extremeties 1. Crutches 2. Legs... they kind of hop. Use the even numbered gaits when weakness is? Evenly distributed (bilateral) When using the even gaits what one is for severe and what one for mild problems? 2 point gait for mild 4 point gait for severe. Use the odd numbered gait when? The problem is affecting one leg (unilateral) Going up the stairs or down the stairs with crutches patient must remember... UP with the GOOD and DOWN with the BAD Crutches always move with what leg? The bad leg. What side do you hold the cane? Strong side. What side do you advance the cane with? The weak side for a wide base support. Step with opposites For walkers remember you? Pick it up, set it down and walk to it. What is a delusion? A false fixed belief, idea or thought. This has no sensory component. What are the three types of delusions? Paranoid or Persecutory, Grandiose and Somatic What is a paranoid delusion? False fixed belief that people are out to harm you (CIA, FBI). What is a grandiose delusion? False fixed belief that you are superior (God, the Pope). What is a somatic delusion? False fixed belief about a body part (X-ray vision). What is a hallucination? False, fixed sensory experience.Five types of hallucinations? Auditory, visual, tactile, olfactory and gustatory. What is an illusion? Misinterpretation of reality. It is a sensory experience. How can you diffirentiate between illusions and hallucinations? There is a referent ( something to which they refer). So the patient takes something from reality and has a sensory response. What are the four types of functional psychosis? Schizophrenia, Schizoaffective disorder, Major depression/mania (bipolar). If a functional psychotic is having a delusion or illusion you? Acknowledge the feeling ( that sound horrible), present reality (but we have no spiders in the room), set a limit ( were not going to talk about that lets talk about something else), enforce the limit ( I see you're to ill to talk about reality). 5 examples of psychosis of dementia? Alzheimers, dementia, organic brain syndrome, wernickesand seniality. What do you do if a patient with psychosis of dementia is having a hallucination or illusion? Acknowledge and Redirect. What is flight of ideas? Jump from word to word. (This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano). What is word salad? Jump from word to word. Bob, Car, Sleep, Foot etc.. What is neologisms? Make up new words. What is a narrowed self concept? When they refuse to leave the room or get dressed. (DON'T force them to do it)What is ideas of reference? When they think everything is about them. (Everyone is talking about me) Type I Diabetes (IJK)? Insulin dependent Juvenile onset Ketosis prone (makes ketones) Type II diabetes? (non all of the above) Non insulin dependant Adult onset Non ketosis prone Diabetes S/S? Polyuria, Polydypsia and polyphagia (hunger) How do you treat type I diabetes? (DIE) Diet 3 Insulin 1 Exercise 2 How do you treat type II diabetes? (DOA) Diet 1 Oral hypoglycemic 3 Activity 2 Type II diabetics need how many calories a day? 1,200-1,800 Type II diabetics need how many feedings a day? 6 W hat two drugs can increase blood sugar? Glucagon and Epinephrine If client exercises more they need? Less insulin If client exercises less they need? More insulin When a client is sick what does it do to there blood sugar? It increases it. Teach diabetics who are sick to? Take insulin, take sips of water to stay hydrated and stay as active as possible.What are the 4 types of insulin? Regular, NPH, Humalog and Lantus Regualr insulins all have what in them? R R egular insulin onset? 1 hour Regular insulin peak 2 hours Regular insulin duration? 4 hours NPH insulin all have a what in them? N N PH onset? 6 hours NPH peak? 8-10 hours NPH duration? 12 hours NPH is not so fast and not in the bag (IV) ... Regualr insulin is rapid and run ... With humalog when do you give it? With meals Humalog onset? 15 minutes Humalog peak? 30 minutes Humalog duration? [Show More]

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