NCLEX HIGH YIELD TOPICS

polyuria

fluid volume deficit---> shock

heart failure

pump not moving blood forward---> decreased blood to kidneys---> decreased UOP----> fluid retention

hypoxia

not enough oxygen to the tissues----> not enough oxygen to the brain---> anxious patient/change in LOC

QRST

- AV node

- ventricle

- controlled by potassium

P wave

- SA node

- atrial depolarization

- calcium

calculation of HR on ECG estimation

measure big boxes between R-R

300/# of big boxes between R-R

normal sinus rhythm

heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute

sinus bradycardia

<60

normal sinus rhythm

give atropine (don't give to pt with glaucoma)

sinus tachycardia

>100 (100-150)

normal sinus rhythm

caused by:

- excessive caffeine

- anxiety

- dehydration

- hyperthyroidism

give beta blockers, be aware of bronchoconstriction and bronchospasm, contraindicated in asthma

atrial fibrillation

- SA node not firing properly

- absence of P wave, quivering P wave

- AV node fires irregularly because its waiting for SA node to work

- worried about clots

- calcium channel blockers work for a-fib because the atrium uses calcium to work (diltiazem, verapamil)

INR & warfarin

want it to be 2-3x the normal value except for when there is a valve replacement

heparin & warfarin homegoing

- don't go home on this, usually gradually introduce warfarin simultaneously so that they can go home on it instead (called bridging)

- wait for INR to get to 2-3, then d/c heparin and continue warfarin

potassium sparing diuretics and cardio

aldosterone antagonists

examples

- spironolactone

- eplerinone

aldosterone increases sodium--->decreases potassium

leads to decreased sodium and water, keeps potassium same

ACE inhibitors pneumonic

ACE-I

Angioedema

Cough

Excess K+

Instead, ARB's (still increased K+)

ACEs and ARBs are both

Teratogens

agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm

priority what am I freaking out about?? ASK GRAPH

A- airway

S- sepsis

K- potassium

G- glucose below 70

R- child with lethargy

A- altered mental status suddenly

P- peritonitis

H- hemorrhage

cushings vs addisons

Cushing is gushing cortisol.

Addison's patient's cortisol doesn't add up.

cushing's syndrome

A- increased appetite

B- increased blood pressure

I- increased insulin resistance

G- increased gluconeogenesis

F- decreased fibroblasts (healing factors)-->striae

I- decreased inflammatory process/immune system

B- decreased bone formation (osteoblasts)

physical symptoms

- buffalo hump

- moon face

- abdominal striae

- hirsutism ("hairy suit-ism")

- weight gain

- truncal obesity

causes of cushing's disease

- steroids (long term therapy

- tumor (pituitary, adrenal)

- small cell lung cancer

treatment for cushings

cut out tumor or steroids (slowly decrease)

cortisol increased by ______

4 S's

Surgery

Stress

Sepsis

Strenuous activity

adrenal gland monitors ________

salt: regulates aldosterone

sugar: cortisol

sex: sex and hair

all increased in cushings, all decreased in addison's

addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

aldosterone knocked out:

- low salt and water---> low BP

- increased potassium--->hyperkalemia

cortisol knocked out:

- increased ACTH---> increased melanin production (bronze skin, hyperpigmentation)

androgens knocked out:

- decreased libido

- low sex drive

- erectile dysfunction

- infertility

nursing considerations

- monitor Na and H20

- monitor fluid volume

- give them cortisol

- give them estrogen and testosterone (these thicken the blood and makes person hyper-coagulable, monitor for clots to prevent DVTs and PE)

increased estrogen caused by:

- birth control

- obesity

- patient taking tamoxifin

causes of addison's disease

A- autoimmune (body kills adrenals or pituitary

D- diseases (cancer, infections (TB/HIV)

D- damage (adrenal hemorrhage, trauma)

most common cause of addison's disease

tuberculosis

treat with RIPE

R- Rifampin (red expected)

I- Isoniazid (this is very hepatotoxic)

P- Pyozinimide

E- Ethambutol (E for eye, look for vision issues like diplopia, blurred vision)

addison's treatment

- add "-sones"

- diet high in protein, carbs, sodium

- dont abruptly stop steroids

- dont believe this medication will cure you

- lifelong hormone replacement

cushings sydrome

increased cortisol

- primary tumor (high cortisol, low ACTH)

- secondary tumor (high ACTH, high cortisol)

- exogenous (high cortisol, low ACTH)

infant growth

- rapid growth

- birth weight should double by 6 months and triple by 12 months

fontanelles

- posterior closes first - between 1 and 2 months

- anterior closes between 9 and 18 months

infant gross motor skills

- sitting up without support: 6-8 months

- rolling over: 6 months

- standing without support: 10-12 months

- first steps: 12 months

infant fine motor skills

- palmar grasp: 6 months

- pincer grasp: 9 months

- brings objects to mouth: 4 months

- transfers objects from hand to hand: 6-8 months

infant language

- first words: 12 months

- can understand "no": 11 months

- following simple directions: 12 months

infant psychosocial development

- trust vs mistrust

- sensorimotor ("taking it all in")

- social smile: 6-8 weeks

- object permanence: 9 months

- stranger anxiety: 9 months

therapeutic communication with infants

- speak in a soft voice

- warm hands before touching baby

always involve caregivers

- explain everything you are doing to them

- have them hold infant

- parents are your best team member. they know how to keep their child happy and calm.. it is hard to assess a screaming baby!

toddler growth

ages 1 to 3 years old

- growth slows

- language develops quickly

- height increases by 3 inches per year

- weight increases by 4-6 pounds per year

- head does not grow as rapidly as the body; head circumference should equal chest circumference by 1-2 years

- anterior fontanelle closes between 9 and 18 months

toddler fine and gross motor development

should be able to:

- hold crayons or pencils to color and draw

- copy a circle on paper

- build a tower of blocks 8-10 blocks high

- clap their hands

- button and unbutton

- work a zipper

- ride a tricycle - 3 years

- jump - 2 years

toddler language

should be able to:

- follow simple directions

- link words together: 2 years

- vocabulary of 300 words: 2 years

- identify objects

- identify body parts

toddler social and cognitive development

erikson stage:

- autonomy vs shame and doubt

- children seek to develop a sense of personal control over physical skills and a sense of independence

- when they are successful they feel independent and it leads to a sense of autonomy. when they are not successful, they feel they are a failure and it results in shame and self doubt

- task= toilet training- toddlers want to accomplish this to attain autonomy

parallel play

- children play adjacent to each other, but do not try to influence on another's behavior

symbolic play

- ability of children to use objects, actions or ideas to represent other objects, actions, or ideas as play

toddler toilet training

- important not to start before the child is ready - control of the sphincters does not happen until 18-24 months old

signs that child is ready

- wake up from nap dry

- tell you they need to go potty

- can stay dry for 2 hours during the day

during toilet training

- never leave the child on the toilet alone

- only sit on the toilet for 5-8 minutes at a time

- get their own toilet or a stool that will be the right size, their feet should be able to sit on the floor or a stool

- teach hand hygiene!!

toddler injury

common injuries at this age

- falls

- burns

- drowning

- poisoning

ways to help prevent injuries

- lock up dangerous substances: medications, cleaning supplies, laundry detergent, etc.

- put gates at the top and bottom of the stairs

- never leave a bathtub unsupervised- even if there is only a little bit of water in it!

- toddlers can drown in less than 2 inches of water

toddler nutrition

- toddlers are the classic "picky eaters"

- iron deficiency anemia is common due to a lack of iron rich foods

iron rich foods to offer

- iron-fortified cereals

- leafy greens

- red meats

- fish

- beans

- use full fat milk until 2 years old

- do not use food as a reward

preschoolers

ages 3-5 years old

- rapid social development

- rapid fine motor skills

- improving coordination

- getting ready for school

preschool growth

- height: increases 2-3 inches every year

- weight increases about 5 pounds every year

preschool gross motor development

- hops on one foot

- runs

- skips

- ride tricycle: 3 years

- ride bicycle: 5 years

preschool fine motor development

- pastes things onto paper

- complete puzzles with 5 or more pieces

- copy a circle onto a piece of paper

- cut out simple shapes with scissors

- uses spoon and fork

- can dress self

- brushes teeth

preschool language

- at 5 years age should have vocabulary of about 2,100 words

- speak in complete sentences (4-5 words at a minimum)

- can correctly name colors, objects, people

- tell stories and use fantasy

- know their name and address

preschool psychosocial and cognitive development

erikson stage: initiative vs guilt

- children start to assert control and power over their environment. success leads to initiative when they feel a sense of purpose, but children who try to exert too much power and experience disapproval end up feeling guilt

- important to involve the child when possible, such as giving them options, which helps develop initiative

cooperative play

- play that involves the division of efforts among children in order to reach a common goal

magical thinking

- the belief that one's own thoughts, wishes, or desires can influence the external world.

- do not yet have a concept of time

preschool therapeutic communication

poor concept of time

- avoid delays with treatment

fear bodily harm

- use bandages over any puncture sites

- bandages help them feel secure

magical thinking

- they may think that their actions or misbehaving caused them to become sick

- view sickness as a punishment

- help them understand this is not their fault

language

- their developing language skills make your word choice very important

- use simple, non-threatening terms

school age

- 6-12 years old

- physical growth gets slower

- social development is pronounced (friend groups, personal accomplishments)

school age growth

- gain 5-7 pounds each year

- grow about 2 inches per year

- begin to lose baby teeth

- brain will reach full adult size by 9-10 years old

school age motor development

- write in cursive

- ride a bike

- plays games

- swim

- roller skate

- jump rope

school age psychosocial and cognitive development

erikson stage: industry vs inferiority

- in this stage, children need to cope with new social and academic demands. when they are successful with this, they feel competency and achieve industry. when they are not successful they feel failure and it results in inferiority

- egocentrism decreases and importance of relationships increases

school age therapeutic communication

- asks lots of questions

- peer support

- allow time for discussion

- give them privacy when able

adolescents

- ages 13 to 18 years old

- puberty begins

- development of personal identity (peer groups, risky behavior)

adolescent puberty

female

- thelarche: breast development 11 years

- menarche: first menstruation 2 years after thelarche

male

- begins between 9-13 years

- period of rapid growth

- testicles enlarge

- voice deepens

adolescent motor development

- increased coordination

- prolonged endurance

- better distance judgement

- increased hand-eye coordination

adolescent psychosocial and cognitive development

erikson stage: identity vs role confusion

- adolescents develop a sense of personal identity. when they are successful it leads them to the ability to be true to themselves and have an identity they are proud of. when they are not successful there is role confusion and a weak sense of self

- risk behavior increases

- social interaction with peers prioritized over family

adolescent therapeutic communication

- give them as much privacy as possible

- peer support groups

- allow for free time

- support socializing when possible

- encourage questions and taking part in their own care

acting out

temper tantrum

projection

disguising one's own threatening impulses by attributing them to others

A-B

displacement

nurse johnny yells at nurse Meredith and then nurse Meredith yells at nurse Matthew

regression

A reversion to immature patterns of behavior

splitting

borderline disorder

extreme happy or extreme sad, no middle ground

ADHD (Attention-Deficit Hyperactivity Disorder)

usually noticed by teacher first

- identify low self esteem

- try behavioral therapy

treatment

- D-amphetamine/ methylphenidate

side effects of medication

- insomnia (take before 6 pm)

- weight loss (take after meals)

- hypertension

- tachycardia

autism spectrum disorder

- do not like change

- do not like stimulation

- keep furthest away from nurses station, noise can trigger

paranoid patients

- give packaged or sealed meals so they can open themselves

- let them get their food

borderline personality disorder

splitting ego defense

antisocial personality disorder

against society

- criminals, rapists

- no rules

- above 18 years old (less than 18 is conduct disorder)

asocial

dont want to hang out

histrionic personality disorder

- provocative

- attention seeking

- think instagram models

narcissistic personality disorder

- grandiose

- always has to be right

- will argue their point and think they're right all the time

dependent personality disorder

stage 5 clingers

- cant function without you

key words indicative of respiratory compromise

- stridor

- drooling

- accessory muscles

- grunting

epiglottitis

inflammation of the epiglottis

- inspiratory stridor

- drooling

- tripod positioning (hunched over, hands on knees)

- most often caused by H. influenza type 3 (HIB)

treatment

- intubate

- bedside trach kit

pulmonary embolism

developed by:

F- fat (long bone fx, liposuction)

A- air embolism (starting a line)

T- thrombus (DVT)

B- bacteria (IV drug use)

A- amniotic fluid (during delivery)

T- tumor

- impaired gas exchange (increased CO2, decreased O2)

- pH acidic

- respiratory acidosis

risk factors of DVT's

- post-op (use incentive spirometry, get them to walk up)

- obesity

- smoking

- long trips

- contraceptives

- pregnancy

obstructive sleep apnea

causes

- typically seen in obese patients

- anatomical defects

education

- no drinking before sleep

- no napping before daytime

- avoid sleep aids or sleep meds

- educate on weight loss and how to eat

- don't smoke

treatment

- CPAP

negele's Rule

first day of last menstrual period - 3 months + 7 days

maternal weight gain during pregnancy

total weight gain is 28 lbs plus or minus 3

- first trimester 1 lb each month

- second trimester 1 lb a week

to calculate ideal pregnancy weight gain

week of gestation minus 9 = ideal weight gain in lbs

Fundus is not palpable until week?

12

thus, cannot palpate fundus in first trimester

when is fundus at umbilicus?

20-22 weeks of gestation

mother is priority until fundal height is

at or above the umbilicus

fetal heartbeat can be auscultated by

8 weeks (first)

10 weeks (most likely)

12 weeks (should)

when they say first, pick lowest part of range, most likely is middle of range, should is end of range

baby kicks by (quickening)

16 weeks

Chadwick, goodell and hegar signs occur in ____ order

alphabetical

chadwick sign

cervical color change to cyanosis

goodell sign

cervical softening

hegar sign

uterine softening

positive pregnancy test

not a positive sign of pregnancy, only probable

prenatal care visits

- once a month until week 28

- then, once every two weeks until week 36

- then, once every week until delivery or week 42

- at week 42, c-section or induction

maternal pregnancy hemoglobin

can drop to 11 hgb and be normal

how do you treat morning sickness?

first trimester

dry carbohydrates before getting out of bed

how do you deal with urinary incontinence in pregnancy?

1st and 3rd trimesters

void every 2 hours all the way all through pregnancy

how do you deal with difficulty breathing in pregnancy?

tripod position

how do you deal with back pain in pregnancy?

second and third trimester

pelvic tilt exercises

most valid sign that a woman is in labor

onset of regular progressive contractions

dilation

opening of the cervix

0-10 centimeters

effacement

thinning of the cervix during labor

ischial spines

smallest diameter in which the baby has to fit in order to be born vaginally

vertical lie

GOOD