Ncle x Study Guide Vm
Transcript of Ncle x Study Guide Vm
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NCLEX study guide
Addisons Disease Cushings Disease
-think hyperthyroidism sx -think hypothyroidism sx
Hyposecretion of glucocorticoids
-not enough aldosterone = lose water (think
diuretics..some block aldosterone)
Hypersecretion of glucocorticoids
-too much aldosterone = water retention
Hypovolemia Hypervolemia
Hot Cold (Cushings = Cold)
K Ca Na (lose H!"# lose $a) K Ca Na (gain H!"# gain $a)Hypoglycemia (% insulin production) Hyperglycemia (& insulin production) ' ketoacidosis
et skin ry skin (hyper = dryer) hyperglycemia = dry skin
*ethargy# fatigue# muscle weakness +enerali,ed muscle wasting# weakness
Hypotension (&$a) Hypertension (% $a)
eight loss eight gain low healing
ecreased blood volume ' shock
Hyperkalemia = meta acidosis ' arrhythmias
/oon face# buffalo hump# obesity (trunk)# thin skin#
reddish-purple striae
01230/2$04 hormone replacement 01230/2$04 hypophysectomy# adrenalectomy
Addisonian crisis
-medical emergency
-critical deficiency of glucocorticoids
-generally follows acute stress# sepsis# trauma#
surgery# or omission of steroid therapy
s/sx:severe abd pain# sudden profound weakness#hyperpyrexia followed by hypothermia# coma#
renal failure
"steoporosis (excess cortisol = %Ca reabsorption from
bones)
Hyperthyroidis Hypothyroidis
- fast - slow
-% metabolism & metabolism
-sympathetic $ sx -parasympathetic $ sx
-nervousness# irritable# excitable# tachycardia#perspiration# flushed face# exophthalmus# increased
appetite# limp hair# wt loss# H0$
-extreme fatigue# dry skin# coarse hair# numbness andtingling of fingers# alopecia# wt gain
-heat intolerance -cold intolerance
5odine uptake % 5odine uptake &
!ra"es disease #yxedea coa
$hyroid stor
-tachycardia
-delirium
-coma
-pt with hyperthyroidism is typically nervous andhas insomnia.
-don6t place in same room with another pt withhyperthyroidism because too much stimuli.
-place in private room.
%eo"ing tu&es and things
Chest tubes Have pt perform valsalva maneuver# or take and hold deep
breath (have seen both in nclex books)
$+ tube Have pt take and hold a deep breath
75CC line Have pt perform valsalva maneuver
07$ line 8alsalva maneuver
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Hyperg'yceia hyperoso'ar non(etotic
syndroe )HHNK*+
DKA
-occurs in people with /-! -occurs in peoplee with /-9
-glucose : ;
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7arietal lobe = primary center for sensation
0emporal lobe = auditory reception areas
?rontal lobe = involved with personality# behavior# emotions# intellectual function# if inured may have difficulty
comprehending what is said
"ccipital lobe = primary visual receptor center
/3*"
La& "a'ues
> .D E D.9 (no pee# no >)
$a 9D E 9FD
/g 9.G E !.G
Cl ; E 9
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3lbumin .F E D
?e GD-9ID
3*030 D-G en,ymes /B = cardiac muscle
BB = brain
// = skeletal
0roponins -better indicator of detecting /5 than C>s
Cl- levels in sweat test for
Cystic ?ibrosis
:Gorsakoff 7sychosis=
tyramine deficiency)
-avoid with #A53s# migraines
-figs# avocados# bananas# papaya# raisins
-aged cheese# yeast# yogurt# sour cream
-soybeans# beer# red wine
-beef# liver# sausage# bologna# deli meat
-chocolate
7urine -avoid with gout
-fish# sardines
-liver# beef# chicken# sausage# organ meats+luten -avoid with Celiacs disease
8itamin >
(antidote for Coumadin)
-broccoli# cabbage# turnips
-fish# liver-coffee# tea (caffeine)
8itamin B9! (thiamine) -found in animals# nuts# whole grain cereals
-pt with cirrhosis needs a diet high in B9!
Calcium -eggs
-green leafy veggies
7otassium -potatoes
-bananas
-spinach
-raisins-dates
-oranges
-dried apricots
5ron -can give with 8itamin C (tomato uice# "S)
-clams
-liver# beef# shrimp
-turkey
-cereal
-pasta
?olic acid -liver
-papaya
-legumes# vegs# spinach-nuts# bran# cereal
-fruit# yeast# asparagus
3cid ash diet -avoid milk = makes urine alkaline
8itamin toxicity -+5 upset and metallic taste
-H3# weakness# renal insufficiency# renal calculi# H0$# arrhythmias# muscle
pain# conunctivitis
Crohns diet -*ow fat
-*ow residue (no popcorn)
-High protein
Calcium -take 9 hour after meals with full glass of water
3C2 inhibitors -take 9hour before meals
1hogam /om (-) Baby (')
urns
uperficial partial
thickness
-first degree
-sunburn
-epidermis
-red# blanches with pressure
-possible blisters
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eep partial thickness -second degree
-scald
-epidermis# upper dermis# part of
deeper dermis
-blistered# mottled red base
-weeping# edema
?ull thickness -third degree
-flame# chemicals# electrical
current
-epidermis# entire dermis#musclebone
-dry# pale white
-leathery# fat exposed# edema
Pburn pt at risk for %>
#isc #ed/*urg diseases
+uillain-Barre yndrome -% weakness (ascending)
-neuro problem = acute infection of cranial and peripheral nerves
-pt co respiratory infection or +5 infection in past med hx
-immune system overreacts and destroys myelin sheath
-maor concern = problems breathing
ssx = paresthesis# lower extremity weakness# gradual progressive
weakness# possible resp failure# cardiac probs# high protein in C?
/yasthenia +ravis -eye problems
-sedatives make sx worse-neuro prob
-weakness and fatigue
-have pt do things in am
-defect in transmission of nerve impulses
-give meds before meals
ssx = weakness# fatigue# difficulty chewing# dysphagia# weakhoarse
voice# resp failure# ptosis# diplopia# decreased breath sounds-everything pretty much slows down and gets weak
$ensi'on test= used to dx
-if pt shows improvement after tx = dx
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Hirschsprings d, -mega-colon
-results in mechanical obstruction bc of inadeKuate motility
ssx = failure to gain weight# abd distention# vomiting# ribbon-like and
foul smelling stools (not with newborns 5 thinkR)# constipation
alternating with diarrhea
B-thalassemia -too much ?e
-autosomal recessive disorder
-decreased production of 9 of the globin chains in the synthesis of Hgb
-chelation drug therapy (gets rid of ?e)Hip replacement -avoid extreme external# internal rotation
-avoid adduction
-no side-lying on operative side
-maintain abduction with pt in supine position or on non-operative side
-do not cross legs
-place pillow bw legs to maintain abduction
ernicke->orsakoff
syndrome
-neuro disorder
-acute encephalopathy
-chronic psychosis
-caused by deficiency in 8it B 0yramine deficiency
/ultiple myeloma -%Ca caused by bone destruction is the primary concern
-encourage fluids (dilutes Ca)7ancreatitis -do not give morphineO (irritates pancreas)
-pain is severe and unrelenting in epigastric area and radiates to back
-observe for &@"# %H1
-diet = &fat# &protein# %carbs# > supplements
-typically rest +5 by making pt $7" but give lots of 58 fluids
(') 0urners sign = bruiselike discoloration in flank
(') Cullens sign = bluish hemorrhage around umbilicus
umping syndrome -limit fluids with meals
-early sx = sweating and pallor
-D-< min after eating-also vertigo# tachycardia# desire to lie down
?at embolus -tachypnea
-tachycardia
-dyspnea
3ir embolus -chest pain
-dyspnea
-lightheadedness
-nausea
-di,,iness
-hypoxia
-anxiety
-%H1&B7
*iver biopsy -position pt on right side to help decrease risk of hemorrhage
-dont let pt cough = can cause bleeding
Dthd, -not contagious after rash
7eptic ulcer d, 7rimary sx of perforation = board-like abd and shoulder pain (blood)
Coffee ground emesis = slower internal bleeding
3sthma -diminished whee,ing in a child with asthma indicates possibleworsening of asthma
7osturing ecerebrate = cerebellum problem
ecorticate = cortex problem
-ecorticate is more favorable than decerebrate (thought it was other
way aroundQ)
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7heochromocytoma -produces catecholamines (epi)
-tumor E adrenal medulla
-headache# diaphoresis# palpitations# H0$# tremor# hyperglycemia
-dont palpate abd = can cause more catecholamines (cells) to be released
and cause severe H0$
7arathyroid -monitor Ca and 7 (Ca% 7&)
Hyperparathyroidis )Ca6 -+
-increased sleeping
-increased urination-weakness
-bone pain
-irritability
Hypoparathyroidis )Ca6 -+
-increased urinary freKuency
53H -decreased @" = fluid overload# H0$# %H1
-water intoxication
-&$a (dilutional hyponatremia)
-too much antidiuretic hormone (vasopressin)
-treatment is effective if4 %@"# &wt# &urine osmolalityiabetes insipidus -deficiency of 3H = & ability of kidneys to concentrate urine
-give vasopressin
ssx = polyuria# polydipsia# fatigue# dilute urine# intense thirst#
dehydration# wt loss# H3# tachycardia# %$a in urine
0umor lysis syndrome -emergency of electrolyte imbalance
-potential renal failure
7ulmonary 2mbolism -blood tinged sputum
-chest pain
-cough
-cyanosis
-distended neck veins-dyspnea
-&B7# %H1
-whee,es
-tachypnea
1enal failure -re-poor perfusion to kidneys
3ntra
-damage to kidneys# nephrotoxic inury from contrast# antibiotics#
corticosteroids
-ost-obstruction of urinary collecting system
3utonomic dysreflexia -hyperreflexia
-spinal cord inury 0D and above (5 think)
-overactivity of autonomic $
-kinked cath can cause it# constipation or full bladder (5ncr 5C7)
-pounding H3# H0$# sweating# bradycardia# restlessness
C"7 -use a high-flow venture mask to deliver "!bc you are giving a
controlled# specified amount of "!
s/sx4 dyspnea on exertion# barrel chest# clubbed fingers and toes
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Cardio"ascu'ar
Complications of mitral stenosis -thromboembolism
-rheumatic fever (common complication of CH?)
-endocarditis
-pulmonary H0$
-pulmonary edema
Hemolytic transfusion rxn -headache
-tachycardia
-H0$ and Hypotension
-apprehension# sense of impending doom-fever# chills
-5C
-'o7 &ac( pain6 chest pain
3utologous transfusion rxn - ss of infestion ( greatest risk)
5notropic and Chronotropic rugs 3notropics
-affect force of muscle ctx
(-) inotropic effects = % myocardial contractile force(') inotropic effects = & myocardial contractile force (b-blockers)
Chronotropics-affects H1
(-) chronotropic effects = & H1 (parasym $# acetylcholine)
(') chronotropic effects = % H1 (sym $)# epi# atropine)
igoxin
(') inotropic
(-) chronotropic
rugs for H0$
(-) inotropic
(-) chronotropiciagnostic tests 9. 0roponins are more specific
!. C>-/B
Coronary arteriogram -femoral artery is used E keep pt on bedrest with H"B slightly
elevated for several hours
-%H1 in recovery may be a sign of hemorrhage (common
complication)
Cardiac tamponade -fluid around heart-pt may co heavy fullness around heart
?irst priority of care for pt with
cardiovascular problem
& cardiac workload
% myocardial oxygenation
L.sided Heart 4ai'ure %.sided Heart 4ai'ure H4 in chi'dren
*eft = *ung Sugular vein distention - gallop rhythm
yspnea 2dema
0achypnea t. gain
+allop rhythm4 # F 3scites
?ine crackles Hepatomegaly
hee,ing# rhonchi 0achycardia
0achycardia ?atigue
"liguria (fluid retention)
Pacute pulmonary edema Pmitral stenosis
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#edications and 3nsu'in
#eds that 3nsu'in re8uireents #eds that 3nsu'in re8uireents
+lucocorticoids (cushings = hyperglycemia) ulfonylrureas
*i Uuinidine
1ifampin (0B) Uuinine (malaria)
7rogestins (oral contraceptives) 3C2 inhibitors
$icotine $aproxen
7henytoin 5ndomethacin (gout# 13# "3)
Ca-channel blockers alicylates
Clonidine B-blockers
/orphine
Heparin
Pexercise = insulin needs increase
Pbaby born to diabetic mom is at risk for hypoglycemia (give extra feedings of formula)
Dia&etes . 3nsu'in
5nset -ea( Coon types #isc9
1apid
/idmorn-
tremblingwkness
9Dmin 9-!h 3spart (novalog)
*ispro (humalog)
Clear# sliding scale# no 58# pump#
can mix with 5# *
hort
2arly evening E
wkness# fatigue
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32 *o'utions
3sotonic
D -dont use during fluid resuscitation
-used mainly to supply water and correct % serum osmolality
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#3*C:
7resence of glucose in nasal discharge = fluid is C?
Catecho'aines
-dopamine# epi
-released during times of stress
0hyroidectomy E monitor Ca and 7
Cheo treatent
-% uric acid levels in blood dt massive cell destruction
Ca'ette.guerin "acc= vacc for 0B-mantoux test will always be positive
C"!in blood = vasodilation
3llergy to bananaskiwis = allergy to latex
3cute pain sx = %B7# %H1# %11# %perspiration# &body 0# %dilated pupils (wide eyed with fear)
5f a Kuestion asks you to select a goal for a pt# make sure the answer you pick is an actual goalO
9. maintain "!ats above
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0153+2 0 = trauma
1 = respiratory
5 = 5C7 and mental status
3 = an infection
+ = +5 # upper
2 = elimination# lower
$ypes o, p'ay
7arallel -toddlers
-side by side
-rarely interact
3ssociative -preschoolers
-all engaged 5 similar activity# but little organi,ation
Cooperative -school-age
-organi,ed and goal-directed
0herapeutic -techniKue used to help understand a childs feelings
7lay 0herapy - 3llow the child the express themselves easier
'ood
Complications of a blood transfusion ;9 $rans,usion rxns-weak pulse# fever# bradytachycardia# hypotension# oliguria
9 4'uid o"er'oad
?9 D@ transission
-Hep B# for example
9 Hypoca'ceia
-citrate in transfused blood binds with Ca and is excreted-hypereflexia# paresthesia# tetany# muscle cramps# '0rousseaus
sign# 'Chvosteks sign
09 Hyper(a'eia
-stored blood liberates >'
7t with severe blood loss reKuires rapid
transfusion. hat device is used during
blood transfusions to decrease risk of
cardiac dysrhythmiasQ
-blood warming device
-rapid transfusions of cool blood puts pt at risk for cardiac dysrhythmias
58 solution that can only be run with blood
transfusions
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-ediatric/Boens Hea'th *tu,,
Ne7&orn Apgars );in6 ?in+
Heartrate (N or : 9.
-re'iinary signs o, 'a&or
-Braxton hicks ctx
-dropping (lightening)
-nesting
-lose 9-!lb
-bloody show
tages of *abor
*tage ;E ctx to complete dilation)
-*atent ( stimulates liver to produce
clotting factors
4eta' onitoring
$ormal = 99
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7rimary intervention with a pediatric
burn pt = remove blisters
Centration= tendency to center
attention on 9 feature of something and
be unable to see its other Kualities
0each a pt with sickle cell how to
prevent sickling4 maintain hydration#
promote oxygenation# avoid strenuousactivity
7>@ = autosomal recessive
/ost important newborn reflex =
#5%5 (determines neuro dev)
7lacenta previa vs placenta abruptoQ
-A3N
+7073*
-'acenta pre"ia
-after !
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Diuretics6 N*A3Ds6 drugs a,,ecting e'ectro'ytes
*asix -loop diuretic
-&>
HC0X -thia,ide diuretic
-&>
-exacerbates gout
3spirin -$35-& inflammation
-1eyes syndrome in kids
5ron sulfate -?e deficiency anemia-take with vitamin C
-best taken bw meals
-no antacids-make cause black stools
?osamax -%Ca
-take in morning on empty stomach
>Cl -never give 58 push
-use in pt with hypokalemia
>ayexalate -use in pt with hyperkalemia
0ylenol -not anti-inflammatory
-pain relief# fever
B9! -&> -for vit B9! deficiency
3ldactone -> sparing diuretic
/annitol -osmotic diuretic
-&5"75C7
-renal failure
CN* drugs
ilantin -antiepileptic
-only give with $
-se = blurred vision# diplopia
inemet
(levodopacarbidopa)
-parkinsons d,
5mitrex -H3
3ricept -al,heimers
$ubain -opioid
$arcan -opioid antagonist
/orphine -opioid-toxicity = pinpoint pupils# decreased 11# increased 5C7
7ro,ac -antidepressant# 15
2lavil -antidepressant# tricyclic
-anti-chol se
Autonoic drugsBethanechol -parasympathetic
-for urinary retention
-cholinergic
2pi -sympathetic
-inhalation = fastest route
3tropine -sympathetic
-anti-cholinergic
opamine -sympathetic