NCLEX Study Guide 4

Munchausen Syndrome

a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care

Multiple Sclerosis

a chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord

Multiple Sclerosis: Motor S/S

limb weakness, paralysis, slow speech

Multiple Sclerosis: Sensory S/S

numbness, tingling, tinnitus (Ringing in ears)

Multiple Sclerosis: Cerebral S/S

nystagmus (eyes make repetitive, uncontrolled movements), ataxia (impaired coordination), dysphagia ( swallowing difficulties), dysarthria (Slurred speech)

Huntington's Chorea

50% genetic, autosomal dominant disorder S/S: chorea --\> writhing, twisting, movements of face, limbs and body -gait deteriorates to no ambulation -no cure, just palliative care

WBC shift to the left in a patient with pyelonephritis (A kidney infection)

neutrophils kick in to fight infection

Definitive diagnosis for abd. aortic aneurysm (AAA)

CT scan

Don't use Kayexalate if patient has

hypoactive bowel sounds

Uremic fetor

smell urine on the breath

Hirschsprung’s

bile is lower obstruction, no bile is upper obstruction; ribbon like stools

Pancreatic enzymes are taken with each meal!

Not before, not after, but WITH each meal

Hypospadias

abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under side)

Epispadias

opening of the urethra on the dorsal (front) surface of the penis

Priapism

painful erection lasting longer than 6 hrs

Anticholinergic effects--assessment

dry mouth\==can't spit urinary retention\=can't \**** constipated \=can't \**** blurred vision\=can't see

When you see Coffee-brown emesis, think

peptic ulcer

Anytime you see fluid retention. Think

heart problems first

For Peripheral vascular disease (PVD) remember DAVE

Legs are Dependent forArterial & for Venous Elevated

When choosing an answer, think in this manner… if you can only do ONLY one thing to help this patient what would it be?

Pick the most important intervention

If two of the answers are the exact opposite, like bradycardia or tachycardia

one is probably the answer

If 2 or 3 answers are similar or are alike...

none is correct

When asking patients’ questions NEVER use “why” questions

Eliminate all “why?” answer options.

If you have never heard of it…

please don't pick it

Never release traction UNLESS

you have an order from the MD to do so

Remember compartment  syndrome (A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues) is an emergency situation

Paresthesias and increased pain are classic symptoms. Neuromuscular damage is irreversible 4-6 hours after onset

Always deal with actual problems or harm before

potential problems

An answer option that states

probably wrong

Infancy 0-18 months

Behavior motivated by need to avoid anxiety and satisfy needs: others will satisy needs

childhood \>6yrs

Behavior motivated by need to avoid anxiety and satisfy needs:learn to delay need gratification

juvenile 6-9 years

Behavior motivated by need to avoid anxiety and satisfy needs:learn to relate to peers

preadolescence 9-12 yrs

Behavior motivated by need to avoid anxiety and satisfy needs:learns to relate to friends of of opposite sex

early adolescence 12-14yrs

Behavior motivated by need to avoid anxiety and satisfy needs:learn independence and how to relate to opposite sex

late adolecence 14-21yrs

Behavior motivated by need to avoid anxiety and satisfy needs:develop intimate relationship with person of opposite sex

Fetal alcohol syndrome

-upturned nose -flat nasal bridge -thin upper lip -SGA

vastus lateralis is IM administration site for

6 month infants

IM adminstartion for toddlers above 18 months (location?)

ventrogluteal

COAL (cane walking)

C - cane O - opposite A - affected L - leg

Traige: Red

Immediate: Injuries are life threatening but survivable with minimal intervention. Ex: hemothrax, tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fx's of long bones, and 2nd/3rd degree burn with 15%-40% of total body surface, etc.

Triage: Yellow

Delayed: Injuries are significant and require medical care, but can wait hrs without threat to life or limb. Ex: Stable abd wounds without evidence of hemorrhage, fx requiring open reduction, debridement, external fixation, most eye and CNS injuries, etc.

Triage: Green

Minimal: Injuries are minor and tx can be delayed to hrs or days . Individuals in this group should be moved away from the main triage area. Ex: upper extremity fx, minor burns, sprains, sm. lacerations, behavior disorders.

Triage: Black

Expectant: Injuries are extensive and chances of survival are unlikely. Seperate but dont abandoned, comfort measures if possible. Ex: Unresponsive, spinal cord injuries, woulds with anatomical organs, 2nd/3rd degree burn with 60% of body surface area , seizures, profound shock with multipe injuries, no pulse, b.p, pupils fixed or dilated.

Thoracentesis (a procedure that is performed to remove fluid or air from the thoracic cavity for both diagnostic and/or therapeutic purposes) prep

Take v.s., shave area around needle insertion, position patient with arms on pillow on over bed table or lying on side, no more than 1000cc at a one time. Post- listen for bilateral breath sounds, v.s., check leakage, sterile dressing.

Check before CT scan?

assess allergies

Check before MRI?

claustrophobia, no metal, assess pacemaker

Cardiac cath

npo 8-12hr, empty bladder, pulses, tell pt may feel heat palpitations or desire to cough with dye injection. Post- Vital signs keep leg straight bedrest 6-8hr

cerebral angio prep

well hydrated, lie flat, sire shaved, pulses marked post- keep flat 12-14hr, check site, pulses,force fluids

Lumbar puncture (check the fluid that circulates around the brain and spinal cord)

fetal postion. post- nuero assess q15-30 until stable, flat2-3hr, encourage fluids, oral anlgesics for headache, observe dressing

EEG (a test that detects abnormalities in your brain waves, or in the electrical activity of your brain)

no sleep the night before, meals not withheld, no stimulants for 24hr before, tranquilizer/stimulant meds held 24-48hr before, may be asked to hyperventilate 3-4min and watch a bright flashing light.

Myelogram (It uses a contrast dye and X-rays (fluoroscopy) or computed tomography (CT) to look for problems in the spinal canal)

Npo 4-6hr, allergy hx, phenothiazines, cns depressants, and stimulants withheld 48hr prior, table will be moved to various postions during test. Post- neuro q2-4, water soluble HOB up, oil soluble HOB down, oral analgesics for h/a, encourage po fluids, assess for distended bladder, inspect site.

Liver biopsy

Adm vit k , npo morning of exam 6hr, give sedative, Teach pt that he will be asked to hold breath for 5-10sec, supine postion, lateral with upper arms elevated. Post- postion on right side, frequent v.s., report severe ab pain stat, no heavy lifting 1wk.

Paracentesis (needle or catheter is inserted into the peritoneal cavity and ascitic fluid is removed for diagnostic or therapeutic purposes)

semi fowlers or upright on edge of bed, empty bladder. Post- v.s., report elevated temp, observe for signs of hypovolemia

Laparoscopy (a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin)

CO2 used to enhances visual, general anesthesia, foley. Post- walk patient to decrease CO2 build up used for procedure

Pyelogram (uses x-rays to take pictures of the organs of your urinary tract)

Check for allergies before pyelogram

Sengstaken blakemore tube

used for tx of esophageal varices, keep scissors at bedside

Hemovac (a type of drain that is put into a wound during surgery to help remove blood and fluid)

used after mastectomy, empty when full or q8hr, remove plug, empty contents, place on flat surface, cleanse opening and plug with alcohol sponge, compress evacuator completely to remove air, release plug, check system for operation

Common Signs and Symptoms: pulmonary tb (PTB)-an infectious disease caused by Mycobacterium tuberculosis. This microorganism not only infects the lung but also other organs such as brain, kidneys and lymph nodes

low grade afternoon fever

Common Signs and Symptoms: pneumonia-an infection that affects one or both lungs. It causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Bacteria, viruses, or fungi may cause pneumonia

rusty sputum

Common Signs and Symptoms: asthma-a disease that affects your lungs

wheezing on expiration

Common Signs and Symptoms: emphysema-Type of COPD, air sacs in the lungs (alveoli) are damaged

barrel chest

Common Signs and Symptoms: kawasaki syndrome-acute febrile illness of unknown cause that primarily affects children younger than 5 years of age

strawberry tongue

Common Signs and Symptoms: pernicious anemia-a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12

red beefy tongue

Common Signs and Symptoms: down syndrome-a condition in which a person has an extra chromosome (mental retardation, distrinctive facial charc., increase risk for heart defects and digetsive problems)

protruding tongue

Common Signs and Symptoms: cholera-an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria. People can get sick when they swallow food or water contaminated with cholera bacteria

watery stool

Common Signs and Symptoms: malaria-a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans

stepladder like fever w/ chills

Common Signs and Symptoms: typhoid-similar diseases caused by bacteria. Salmonella Typhi bacteria cause typhoid fever. Salmonella Paratyphi bacteria cause paratyphoid fever. People infected with these bacteria can spread them to others

rose spots in abdomen

Common Signs and Symptoms: diptheria-a serious infection caused by strains of bacteria called Corynebacterium diphtheriae that make toxin. It can lead to difficulty breathing, heart rhythm problems, and even death

pseudo membrane formation

Common Signs and Symptoms: measles-caused by a single-stranded, enveloped RNA virus with 1 serotype. It is classified as a member of the genus Morbillivirus in the Paramyxoviridae family. Humans are the only natural hosts

koplik's spots

Common Signs and Symptoms: systemic lupus erythematosus (SLE)-the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.

butterfly rashes

Common Signs and Symptoms: liver cirrhosis-a condition in which your liver is scarred and permanently damaged

spider like varices

Common Signs and Symptoms: leprosy-an infection caused by slow-growing bacteria called Mycobacterium leprae. It can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa)

lion face

Common Signs and Symptoms: bulimia-A serious eating disorder marked by binging, followed by methods to avoid weight gain

chipmunk face

Common Signs and Symptoms: appendicitis-when your appendix becomes sore, swollen, and diseased

rebound tenderness

Common Signs and Symptoms: dengue-a viral infection that spreads from mosquitoes to people

petechiae (pinpoint, round spots that appear on the skin as a result of bleeding) or (+) Herman's sign (erythematous maculopapular or morbilliform eruptions that develop three to six days from fever onset)

Common Signs and Symptoms: meningitis-an inflammation (swelling) of the protective membranes covering the brain and spinal cord

Kernig’s sign (leg flex then leg pain on extension), Brudzinski sign (neck flex \= lower leg flex)

Common Signs and Symptoms: tetany-a condition marked by intermittent muscular spasms, caused by malfunction of the parathyroid glands and a consequent deficiency of calcium

hypocalcemia (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm)

Common Signs and Symptoms: tetanus-fixed contraction of the facial muscles resulting in a peculiar distorted grin

risus sardonicus (fixed contraction of the facial muscles resulting in a peculiar distorted grin)

Common Signs and Symptoms: pancreatitis-inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself.

Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots

Common Signs and Symptoms: pyloric stenosis-a thickening or swelling of the pylorus — the muscle between the stomach and the intestines — that causes severe and forceful vomiting in the first few months of life

olive like mass

Common Signs and Symptoms: patent ductus arteriosus (PDA)-a condition in which the ductus arteriosus does not close. The word

machine like murmur

Common Signs and Symptoms: addison's disease-adrenal insufficiency, is an uncommon illness that occurs when the body doesn't make enough of certain hormones. In Addison's disease, the adrenal glands make too little cortisol and, often, too little of another hormone, aldosterone

bronze like skin pigmentation

Common Signs and Symptoms: cushing's syndrome-ccurs when your body makes too much cortisol, a hormone related to the body's stress response

moon face appearance and buffalo hump

Common Signs and Symptoms: hyperthyroidism/grave's disease-Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).

exopthalmus

Common Signs and Symptoms: intussusception-a life-threatening illness and occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. This causes an obstruction, preventing the passage of food that is being digested through the intestine.

sausage shaped mass, Dance Sign (empty portion of RLQ)

Common Signs and Symptoms: multiple scleroris (MS)-a potentially disabling disease of the brain and spinal cord (central nervous system). In MS , the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.

Charcot’s Triad (IAN)-nystagmus, intention tremors, and scanning or staccato speech

Common Signs and Symptoms:Common Signs and Symptoms: myasthenia gravis (MG)-a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles.

descending muscle weakness (Upper to lower limb)

Common Signs and Symptoms: Gullian Barre syndrome-A condition in which the immune system attacks the nerves

ascending muscle weakness (feet to upper)

Common Signs and Symptoms: deep vein thrombosis (DVT)-occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs

Homan’s Sign-orced dorsiflexion of the respective ankle in the suspected limb

Common Signs and Symptoms: chicken pox-a highly contagious disease caused by the varicella-zoster virus (VZV)

Vesicular Rash (central to distal) dew drop on rose petal

Common Signs and Symptoms: angina-chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest.

Crushing stubbing pain relieved by NTG (nitroglycerin)

Common Signs and Symptoms: Myocaridal infarction (MI)-

Crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG (nitroglycerin)

Common Signs and Symptoms: lupus band test (LBT)-a diagnostic procedure that is used to detect deposits of immunoglobulins and complement components along the dermoepidermal junction in patients with lupus erythematosus (LE)

inspiratory stridor

Common Signs and Symptoms: tracheoesophageal fistula (TEF)-Normally, the esophagus (the tube that connects the throat to the stomach) and the trachea (the tube connecting the throat to the windpipe and lungs) are separate. A tracheoesophageal fistula (TEF) is an abnormal connection between these two tubes. As a result, swallowed liquids or food can be aspirated (inhaled) into your child's lungs. Feeding into the stomach directly can also lead to reflux and aspiration of stomach acid and food.

4Cs’ Coughing, Choking, Cyanosis, Continous Drooling

Common Signs and Symptoms: epiglotitis-happens when the epiglottis — a small cartilage

3Ds’ Drooling, Dysphonia, Dysphagia

Common Signs and Symptoms: hodgekin's disease/lymphoma-a type of cancer that develops in the lymph system. Your lymph system is part of your immune system. It helps protect your body from infection and disease. The lymph system is made up of tissues and organs that produce, store, and carry white blood cells.

painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells

Common Signs and Symptoms: infectious mononucleosis-a contagious disease. Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis

Hallmark: sore throat, cervical lymph adenopathy, fever

Common Signs and Symptoms: parkinson's-a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination

Pill-rolling tremors

Common Signs and Symptoms: fibrin hyalin-A breathing disorder in newborns caused by immature lungs.

Expiratory Grunt

Common Signs and Symptoms: cystic fibrosis-a genetic condition that affects a protein in the body. People who have cystic fibrosis have a faulty protein that affects the body's cells, tissues, and the glands that make mucus and sweat.

Salty skin

Common Signs and Symptoms: diabetes mellitus (DM)-a disease of inadequate control of blood levels of glucose

3 Ps: polyuria, polydypsia, polyphagia