NCLEX Keypoints

Potassium

3.5-5.0

Chloride

95-105

Hemoglobin

Male: 14-18 g/dL

Female: 12-16 g/dL

Magnesium

1.5-2.5

BUN

10-20

Calcium

9-11: cardiac contraction, bones, nerves, muscles, clotting

o Hypercalcemia: d/t hyperparathyroidism, cancer, Paget's of bone, prolonged immobilization. s/s: weakness, paralysis, decreased DTR. Monitor for kidney stones

o Hypocalcemia: d/t rickets, vit D deficiency, renal failure, pancreatitis, chelation therapy, hypoparathyroidism.

• s/s: CATS: convulsions-arrhythmias-tetany-spasms/stridor, +Chvostek sign (cheek) Trousseau (BP arm)

• when administering IV, warm solution to body temp

Phosphate

2.5-4.5 mg/dL

Creatinine

0.5- 1.5

WBC

4-11K

Sodium

135-145

Critical Labs (remember 6's)

PH in the 6s, potassium in the 6s, CO2>60, O2 <60, plateletes <40,000

potassium over 6 they person will have

heart arrhythemias

Neutropenic precautions

WBC < 1000

Neutrophils<500

immunocompromised, strict hand washing, private room, no raw veggies/fruits, daily baths, visitors are restricted no sick visitors or personnel

ABGs Values

blood ph 7.35-7.45

Paco2(acid):35-45

HCO3 (basic): 22-26

SAO2 (oxygen sats):95-100

PAO2: 80-100

PaCO2, Acidosis

carbon dioxide 35-45

HCO3(basic) bicarbnate

22-26

SaO2 (Oxygen Saturation)

95 - 100% Normal

[> 90% is normal, < 86% is emergency; < 70% is life-threatening]

If Ph is high pt will be

very irratitable RR is high , BP is high , HR is high

if the ph ( acidoitic state) is low the pt will be

the body will be shutting down

Abnormal ABGs Causes (ALKALOSIS)

low HCO3, Ph is going to high

Vomiting

Suctioning

Hyperventilation Metabolic alkalosis or metabolic acidosis

Abnormal ABGs Causes (ACIDOSIS)

↑ PACO2, PH is going to be low

Diarrhea

Shock

Diabetic Ketoacidosis

Sign and symptoms when body is in Acidosis or shutting down

Bradycardia, lethargy ,hypotension , coma

Standard Precautions

gown

mask or respirator

googles or face shield

gloves

Droplet precautions PPE

gloves, gown, mask

droplet precaution

pertussis , pneumonia, influenza, rubella

Airbourne Precautions

-mask (N95)

-gloves

-negative pressure room private room

airbourne precaution sickness

measles, tb, varicella chickenpox

contact precaution

- C-Diff

-MRSA

-Wounds

contact precautions PPE

Standard precautions + gown and gloves

Donning PPE

1. gown

2. mask

3. goggles

4. gloves

Doffing PPE

1. gloves

2. goggles

3. gown

4. mask

potassium key points

Levels 3.5-5

critical level over 6

never do iv push

Antidote : kayexalate

if a pt has high potassium give them what antidote

Kayexalate

Low Calcium (hypocalcemia)

tetany ,abd pain

muscle spasms

Chvosteks-- facial n tingling when tapped

Trousseaus- bp cuff inflation causes carpal tunnel

high calcuim Hypercalemia

Hyperkalemia (high potassium)

everything is high except HR, urine output

hypokalemia (low potassium)

Everything is down except HR, Urine output

high calcium and magnasium

everything is up ( HR, BP,RR etc

low calcium and magnesuim

Everything is up

Hypernatremia (high sodium)

E= excessive thirst ,dehydration

Hyponatremia ( low sodium)

O is fluid overload

crutches have to be

2fingerbreaths under axilla

two point gait

matches the crutch to the opposite foot, moving them together ( always move the affected side first)

three point gait

both crutches forward with weak leg then move strong leg forward

four point gait

used when both legs can bear some weight; right foot, left crutch, left crutch, right foot

swing through gait

both crutches move forward than both legs swing forward ( one leg held up)

stairs

upstairs: use good leg first

downstairs : use weak leg first

Restraints used when:

pts is aggressive not on pt that has a past on aggression

restraints main points

less than 9 years old : 1 hours

9-17 yrs old : 2 hours

18+ : 4 hours

need md order within 1 hour of applying restraints on pt

medication admin

5 rights: patient, route, dose, time, medication, documentation

iv has onset of

5 to 15 minutes

subq and Im injection onset

35 to 45 min

ear antibotics or ointment on child 3+

pull ear up and back

type 1 diabetes ( remember K )

K: keep insulin nearby Insulin dependent

K: kids, Adolescent Onset

K: ketosis, DKA in Type 1

type 1 diabetes symptoms

polyuria (excessive urination), polydipsia(excessive thirst), polyphagia(excessive appetite)

type 1 Diabetes treatment is

D: diet

I: insulin

E: excerise

type 2 diabetes (remeber your A's)

A: adult onset

A: absent ketones. no ketosis

A: Avoid excess carbs and calories ( develop from unhealthy lifestyle)

always continue to take insulin even when they feel sick

type 2 treatment (dream)

D: diet avoid excess carbs /cals

R:resources

E: excerise 30 mins/ 5 days a week

A: additional insulin if needed

M: metformin Oral hypoglycemic med

diabetes inspidus (DI)

decreased ADH

polyuria ( excessive urination) , polydipsia (excessive thirst) = dehydration

diabetes mellitus

insulin is not secreted adequately or tissues are resistant to its effects

urine specific gravity

1.005-1.030

high urine output

low specific gravity

low urine output

high specific gravity

Diabetes Ketoacidosis (DKA) type 1 diabetics causes

acute infection, not to much caloric intake or not enough excerise

Diabetes Ketoacidosis (DKA) symptoms

D: dehydration

K: ketones , kussmaul breathing , High K (potassium)

A: acidosis , Acetone breath (fruity breath), anoerexia

traetments for DKA

IV fluids and regular insluin

Hypoglycemia

blood glucose less than 70

hypoglycemia causes

pt not having to much food or to much insulin

hypoglycemia (remember the D's)

D: decreased BG <70

D: drunk symptoms (slurred speech, delayed reaction, increased HR,RR,decreased BP, cold)

D: drink juice , rapid carbs like juice or crackers first

D: drug injection of glucagon

HHS / HHNK (hyperosmolar hyperglycemic nonketotic syndrome) only in type 2 diabetes

H: high BG of >600

H: hot, flushed dry skin due dehydration

H: hand the client water , iv fluids with insulin is treatment

Insulin (rapid acting lispro, aspart, and glulisine)

onset: 15min

Peak: 30 min

Duration: 3 hrs

timed with meals

insulin short acting regular, humulin

Onset: 1 hr

Peak: 2hrs

Duration:4hrs

timed with meals . only insulin type that can be run through IV

insulin intermediate acting nph

Onset: 6hrs

peak:8hrs

duration:12hrs

cloudy not fast and usually used for noncompliant clients

Long acting insulin lantus (glargine)

no Peak

Duration: 12-24hrs

given 1-2x per day also can be given at night

normal blood glucose

70-110 mg/dL

a1c test

A test for checking the sugar on red blood cells to get an average glucose level in your bloodstream over several months.

estimated delivery date

LMP - 3 months + 7 days

average BMI weight gain for pregnancy is

18.5-24.99

would have 30lb gain

maybe sign of pregnancy

breast enlarge

urinary frequecency

quickening

probable signs of pregnancy

blood and urine tests, Chadwick's sign(cynosis of cervix), Goodell's sign(softening of cervix)

postive signs of pregnancy

fetal heart tones

fetal skeleton

pregnant women shouldn't take

ibuprofen as it increases a chance of autism

pregnant women should take

acetaminophen

stages of labor

Stage 1: Cervix dilates from 0-10 cm

Stage 2: Delivery of baby

lat is when the cervix

Stage 3: Delivery of placenta

Stage 4: Postpartum

Latent phase of labor (stage 1)

Cervix 1-3 cm contractions 5- 30 mins apart

active phase of labor Stage 1

4-7 cm, moderate to strong contractions q3-5 min lasting 40-70 seconds

transition phase of labor Stage 1

8-10 cm dilation contractions 2-3 min apart

fetal hypoxia

if mom contracting more that 90 secs or less than two minutes apart

pt comes in preterm and is contracting what med is given to slow down progression of labor

Terbutaline

induces labor and used to control postpartum hemorrhage

oxytocin or pitocin

placenta previa

bright red painless vaginal bleeding attaches to part of the uterus instead of the fundus

to treat placenta previa

give fluids , blood and might have to deliver the baby

Abruptio placentae

premature separation of the placenta from the uterine wall (dark vaginal bleeding very painful)

treatment of abruptio placentae

oxygen , bed rest , will have to deliver baby

Preeclampsia

protein in urine, rising blood pressure , edema

eclampsia

seizures , put them on seizure precautions make sure to have oxygen and suction on the bed side

Ob maternity complication remember Lion

L: lie on side

I: increase IV fluids

O: oxygen

N: Nofity MD

fetal heart rate

110-160

fetal bradycardia heart less than 100 you are going to

stop Pitocin and do Lion

Fetal Accelerations (remember Veal Chop)

V: variable (very bad )

E: early

A: accelerations

L: late (not good use Lion)

C: cord compression

H: head compression

O: Okay

P: Uteroplacental insufficiency