NCLEX lectures major takeaways

Hepatitis A

Transmission via food, all other hepatitis are blood and body fluid tranfer

ABG’s

ROME- respiratory opposite metabolic same.

If Ph low/high, everything low/high except potassium

Respiratory= underventilating- acidosis. overventilating- alkalosis

Default answer- metabolic acidosis

compensated- normal ph

uncompensated- normal pco2 or hco3

partial compensated- ph, paco2, hco3 all abnormal

Uppers- 5 & s/s, priority

• caffeine

• cocaine

• PCP/LSD

• Methamphetamines

• Adderall

S/s- overdose makes everything go up, withdrawal (24 hr) makes everything go down

Priority- suctioning

Aminoglycosides- IM or IV

A Mean old Mysin- old mean infections- all have THRO throw out.

mysin- mice- monitor hearing, balnce tinnitus

ear- kidney shaped- nephrotoxicity- creatinine

Oral mycin- sterilizes the bowel

Trough and Peak (SubL, IV, IM)

Trough- always drawn 30 min before next dose

peak: always go with highest answer within range

• subL- 5-10 min after dissolved

• IV-15-30 min after finished bag

• IM- 30-60 min

Calcium channel blockers/ Beta blockers: suffix, use, SE

end in “dipine” and “lol”

use: Antihypertensive, antianginal, antiatrialarrhythmia

SE: headache and hypotension (assess BP SBP >100)

Do not do any suctioning or clamping within an airway or chest tube for more then how many seconds

15-30

Congneital heart defects are Trouble

Trouble- all start with T

shunts blood R to L

B= blue cyanotic

Tet of fallot- remember PROVe

Transmission based precautions

Contact:

• Use: anything enteric (GI,fecal, oral)

• PPE: Private room, gown, gloves, disposable supply/ dedicated equipment

Droplet:

• large particles

• private room, mask, goggle, face shield, gloves, disposable supply/dedicated equipment

Airborne precautions: “Air MTV”

• MMR, TB, Varicella

• PPE: private room, goggle or face shield, respirator mask, gloves, door closed, negative airflow, disposable supply/dedicated equipment.

Order to take off- GGGM- alphabetical

Crutches, Canes

Crutches

• 6in away from foot, 2-3 finger from axillary fold, elbow 30 degrees

• 2 point gait- move crutch and opposite foot

• 3 point- two crutches and bad leg- 1 leg affected

• 4 point- everything separately

• swing through- non-weight baring/ amputees

• Up with the good down with the bad

Canes

• hold cane on strong/ unaffected side, advance cane with opposite side for wide base of support

Psychiatric questions

psychotic?

no= therapeutic communication

yes, acknowledge feelings/reassure= functional (present reality, limits, enforce) demented/brain damage (redirect) or delirious/episodic/sudden (reassurance)

• Give alone time to agitated patients

• Know what phase you are in: pre-interaction, orientation, working, or termination.

• Keep the patient talking and accept/ understand the patients feelings (scared, angry, sad, out of control) not what they said (don’t tell them how they should or shouldn’t feel)

• No advice, guarantees, gifts, referring, yes/ no questions, slang, personal stories/feelings

• If all else fails pick a question that examines your own feelings or establishs trust

Diabetes: types, insulin, hypoglycemia

S/S: PPP

DM1- lack of insulin

• treat: Diet, insulin, exercise

• DKA prone- Dehydration, ketones, kussmauls, high K, acidosis, acetone breath, anorexia. treat- insulin iv/ fluids

DM 2- insulin resistance- A1C >8

• Treat:diet, oral hypoglycemic, activity

• HHS/ HHNK prone: dehydration. insulin iv/fluids

Diabetes insipidus- not DM, brain injury low ADH> dehydration. Opposite= SIADH

Insulin: Onset, peak, duration

• R= Regular- 1,2,4

• N= Intermediate- 6,8,10,12

• Lispro- 15,30,3

• Glargine- long-acting insulin, 12 to 24hrs

• Excercise=insulin

• Regular insulin drawn into needle before intermediate

Hypoglycemia= drunk patient in shock

• give carb, starch, protein, sugar

Drug toxicities toxic and normal value ranges

Values almost always toxic: >2 or >20

Normal values usually fall: .6-1.2 (lithium), 1-2 (dig) or 10-20 (theophylline, phenitoin)

Electrolytes

1. Kalemias do the same as the prefix (hypo or hyper), except for HR and urine output which go opposite

2. Calcemias do the opposite as the prefix (sedative)

3. Magnesemias do the opposite as the prefix (sedative)

4. hyponatremia= volume overload, hypernatremia= dehydration

Thyroids

Hyperthyroidism= hypermetabolism- weightloss, HR BP up, heat interolence

Hypothyroidism= hypometabolism- obesity, HR BP down, flat, cold intolerance.

Adrenal cortex disease

addisons disease= adrenal insufficiency= hyperpigmented= not adapt to stress (go into hypoglycemic shock). Treatment= ADD- a- SONE/ steroid.

Cushings= adrenal oversecretion= cushy touchie= drawing of cushy man

Ericksons stages of development

Trust vs mistrust (birth- 1yr)- (piaget sensorimotor/ think present tense)

• no small toys

• rolling, smile, teeth, sitting

• Reflexes (in order)= rooting/ sucking, pupillary, palmar, plantar, tonic neck, moro, supporting, stepping, babinski

Autonomy vs shame and doubt (1-3yr) (piaget sensorimotor/ present tense)

• no small toys, can begin purposeful play

• walking, running, playing

• Gross motor skills- running, jumping, imitation play, parallel play

Initiative vs guilt (3-6yr) (piagets preoperational/ future tense)

• fine motor- finger dexterity, drawing, dancing, cooperative play, highly imaginative, fantasy oriented

Industry vs inferiority (6-12yr) (piagets concrete operational/ cause and effect thinking)

• concrete (3 C’s)= Creative, collective, compettive

identity vs Confusion (12-18yr) (piagets formal operational/ like an adult)

• Peer group association

Intimacy vs isolation (18-40yr)

Generativity vs stagnation (40-65yr)

Integrity vs dispair (65<)

Hint: go with the answer that is normal, easier, and older child because growth and development is not standardized allow the child more time.

Vertebra

• lowest vertibra at which sensory or motor function are intact, above injured vertibra. Below the neurologic level there may be partial or complete loss of function or sensation.

• S/S: conscious= acute pain to back or neck that may radiate along the injured nerve. Important to remember the absence of pain does not rule out a spinal cord injury. Respiratory dysfunction can be seen at multiple injury sites.

• C1 & C2- Death

• C4= diaphragm

• >C4 = ventilator support

• C5-C7= Arms

• T1= Hands

• T1-T6 = intercostal (pneumonia/ atelectsis risk)

• T6-T12 = abdominal muscles

• Anything >T12 = some impact on respiratory function

• >L1= Spastic hypertonic bladder/bowel

• <L1= lower legs/feet/ bowel bladder hypotonic

Med Calc values to remember

1kg=1000g

1g=1000mg

1mg=1000mcg

60mg=1grain

1kg=2.2lbs

1L=1000ml

30ml= 1oz

1lb=16oz

1cc=1ml

1tsp=5ml

1tbsp=15ml

1cup=8oz

BSA(m2)= √lbs x inches/ 3131

BSA (m2)= √kg X cm/ 3600

Pump rate=ml/hr

Due date= First day of last menstural period, add 7 days subtract 3 months

Ideal pregnancy weight gain= week gestation -9

ECG rate calculation= number of QRS x 10

Labs to remember

Creatinine/ BUN= 1 to 20 = Kidney function= Level A

Bicarb= 22-26= alk= level A

Hematocrit= 36-54= dehydration= level B

BNP= <100= CHF indicator= Level B

RBC= 4-6 million= level B

INR= 2-3 = Bleeding/warfarin= Level C

Hemoglobin= 12-18= bleeding/anemia= Level C (think puberty)

o2 sat= 93-100= level C if <90

Sodium= 135-145= Fluid indicator= level C if LOC change

WBC= 4,000-11,000= infection= level C (kids 4-11 always getting sick)

ANC= >500 = level C

CD4= >200= HIV AIDs indicator= Level C

pH= 7.35-7.45 = Acid or Alk= Level D

Co2= 45-35= Level D if 60

o2/ pao2= 78-100= oxygenation= level D if 60

Potassium= 3.5-5.3 = assess heart= Level D (number of bananas you buy from the store)

Platelet= 150,000-450,000= level D

Psych drugs

all cause low BP and weight changes

phenothiozines: Typical antipsychotics “zine”= Zany, major tranqulizers

S/S

• A- anticholinergic (dry mouth)

• B- blurred vision

• C- constipation

• D- drowsy

• E- EPS (parkinson)

• F-foto sensitivity

• G- aGranulocytosis (low WBC)

Haloperidol: tranquilizers, first gen antipsychotic. only one can be given to pregnant women

• A- anticholinergic

• B- blurred vision

• C- constipation

• D- drowsiness

• E- EPS

• Foto sensitivity

• aGranulocytosis

Fluoxetine: SSRI

• A- anticholinergic

• B- blurred vision

• C- constipation

• D- drowsiness

• E- euphoria

• I- insomnia

Tricyclic antidepressants- elavil, trofranil, aventyol, desyrel (they rhyme)

• elavil mood

• S/S:

  • A: antichholiinergic

  • B: blurred vision

  • C: constipation

  • D: drowsiness

  • E: euphoria

Benzodiazepines: minor tranquilizers “ZEP”

S/S

• A- anticholinergic

• B- blurred vision

• C- constipation

• D- drowsiness

Monamine Oxidase Inhibibitors: antidepresant- start with MAR,PAR, NAR. No foods with tyramine= hypertensive crisis

S/S

• A- Anticholinergic

• B- Blurred vision

• C- constipation

• D- drowsiness

Clozapine- atypical antipsychotic

• Agranulocytosis= monitor WBC

Sertraline- SSRI antidepressant, no warfarin or st johns

• I- insomnia

• S- sweating

• A- apprehensive

• D- dizzyness

• Headache

Lithium: Bipolar

• 3 P’s: peeing (polyuria), pooping (diarrhea), paresthesia (electrolyte imbalance)

Labor and delivery

Normal fetal heart rate= 120-160

Late & variable decelerations= very bad

Fundus (height should= day postpartum): boggy= massage. displaced= catheterize it

Lochia- Rubra, serosa, alba. Excessive is peripad compeletely saturated in 15 minutes

baby heads (non-issues)= Cephlaohematoma (C) vs caput succedaneum (CS)- CS crosses sutures caput symmetrical

Hint: Always pick check fetal heart rate when in doubt

needles for injection

IM= 21 guage 1 inch long needle, 90 degree angle

SubQ= 25 guage, 0.5 inche needle, 45 degree angle

Heparin vs warfarin

• Heparin= IV subQ. works immediately. cannot be given for more then 3 weeks. Antidote protamine sulfate. Labs: PTT. can be used during pregnancy

• Warfarin= PO. takes a few days to work. given life long. antidote= vitamin K (no leafy greens). labs: PT/INR

Muscle relaxants

Baclofen and cyclobenzaparine

S/E= fatigue and drowsiness, muscle weakness. No operating machinery.

Priority questions mark K: 4 questions

• Diagnosis: high/low priority. Acute?

• Modifying phrase:  high/low priority, expected/ unexpected?

• Stable or unstable? <12 hours post op/anesthesia, new s/s/ diagnosis, 24hr since admit or hemorrhage, fever >105, hypoglycemia, and pulseless or breathless.

• Organ of modifying phrase: Brain, lungs, heart, liver, kidney, pancreas

LPN Jobs

Take care of stable patients and perform routine tasks, administer IM meds.

Can not: IV meds/ transfusions/ lines, no care planning or teaching. Can’t do any first and lasts in patient care.

CANNOT DO ASSESSMENTS/ interpret data

UAP jobs

Can: vitals, creams, I&O’s, Accu-checks,
ADLs, reinforce teaching for stable patients

Can’t: meds, assessments

RN jobs

Do: always do first and last in patient care, IV meds/lines/ transfusions, teaching, discharge, meds, assessments, unstable patients

Don’ts: educate on surgical procedure/ give results of procedure outside of RN duties without prompt by doctor, give/ do orders

auscultation over heart valves

A- aortic valve- 2nd intercostal right sternal border

P- Pulmonic valve- 2nd intercostal left sternal border

E- Erb point- 3rd intercostal left sternal border

T- Tricuspid valve- 4th intercostal space left sternal border

M- mitral valve- 5th intercostal space midclavicular line

Meds & SE to know

Amlodipine- CCC, antihypertensive, SE: edema

Furosemide- diuretic, Monitor BP and K+

Albuterol- bronchodialator, SE: tachycardia

Lisinopril/ losartan- ACE and ARB, used HF HTN, SE: cough

Pantoprazole- PPI, Gerd, take first thing in the morning, long term increases fracture risk

Levothyroxine- hypothyroidism, give first thing in morning

If allergic to pennicilin don’t give a cephlasporin

Hint: if you don’t know the SE pick a SE in the same body system as where the med is working, or PO pick GI side effect.

Rights to med admin

My- Medication

Parents- Patient

Drove- Dose

Right- route

To- time

DQ- documentation

Gillian barre & ALS

both cause muscle weakness and paralysis

ALS- Attacks upper and lower nervous system

GBS- attacks the peripheral nervous system

swallowing, drooling, difficulty chewing is always a red flag sign

Vaccines

there are no vaccines given under a month appart except for the hep b booster

if a diagnostic test ends in -gram

It is a dye test

Meaning no metformin

need an empty bowel

client may feel hot flushed and nauseas from the dye

encourage fluids after

Health promotion and maintence must knows

menarche- first menstrual period

Fundal height/ listening for baby: 20 weeks= at the umbilicus+ 1cm per week. >20 symphysis pubis.

Always go with autosomal recessive (25%)

TORCH (toxoplasmosis other= syphilis varicella/shingles Group b strep, hep A & B, AIDS, Rubella, ytomegalovirus, herpes2)- diseases that transfer to baby C section necessary

Remember LOA and ROA- for baby heart sounds pre-birth

Birthing plan: airway, Apgar, clamp cord, warmth, id band, medication (eye drops and K+).

Orange juice with prenatal vitamins/iron

Early decels: uniform, onset begins before/ during peak of contraction, quick to baseline

Late decels: begins at after peak of the contraction, slow return to baseline

Variable decels- transient all over the place at anytime, slow/ low baseline