NCLEX

digoxin therapeutic levels

0.8-2 ng/L

>2 is toxic

toxic effects of digoxin more likely to occur in clients with

hypokalemia

hypomagnesemia

hypoxia

hypercalcemia

heart disease

signs of digoxin toxicity

“A Nasty View Has Dangerous Side-effects”

• a nasty view = digoxin toxicity causes vision changes (yellow-green halo or blurred vision)

Arrhythmia

Nausea

Vomiting

Headaches

Disorientation

Seizures

droplet precautions

• mask within 3-6ft of pt

• gloves

• gown

• flu, pertussis, rubella, mumps, streptococcal pharyngitis, meningococcal meningitis, pna, scarlet fever,

• RSV = contact and droplet

• can be in same room if same culture and s/s, private room preffered

• dedicated equipment

• Fans should be removed from a room for a client with droplet or airborne precautions. Fans may propel the transmission of a pathogen

airborne precautions

• N95

• gloves and gowns

• Negative pressure room

• surgical mask on pt if must be transported

• visitors need to wear PPE and masks

• measles (rubeola), TB, varicella, covid, sars, ebola

• can be in same room if same culture and s/s

• Fans should be removed from a room for a client with droplet or airborne precautions. Fans may propel the transmission of a pathogen

contact precautions

• gloves, gown

• gloves ane gowns worn by caregivers and visitors

• dispose dressing material into nonporous bag

• dedicated equipment or disinfect after each use

• client leave room only for essential reasons

• ex:

  • c.diff

  • hep A (A for Anus) if incontinent until 7 days after onset of jaundice

  • herpes until lesions crust over

  • MRSA

  • RSV = contact and droplet

  • salmonellosis, shigellosis

  • staph aureus

  • VRE (vanc. resistant enterococci) until 3 neg cultures from infectious site (1 week apart)

• can cohort if have same CULTURE

don and doff order

don (up the body then hands)

• hand hygiene

• gown

• mask must extend below and under chin

• eye protection

• gloves- cover wrist portion of gown

doff (in alphabetical order)

• gloves

• goggles/face shield

• gown

• mask

• HH

vancomycin adverse effects

• ototoxicity

• red man syndrome

• thrombophlebitis

• thrombocytopenia

• allergy

• nephrotoxic

vancomycin trough and peak and toxic levels

• trough = one hour before next dose / just before 4th dose (5-10mcg)

• peak = 2hr after completion of 3rd dose (25-40 mcg)

• toxic > 80 mcg/mL

what to monitor for heparin

PTT, aPTT

PTT should be 1.5-2.5 baseline

prolonged PTT → liver damage, vitamin K deficiency, DIC

what to monitor for warfarin

INR, PT
PT: (2-2.5 base)

INR: (2-3.5 base)

meds to avoid when taking lithium

NSAIDS (naproxen) : reduce renal blood flow, can cause lithium levels to rise to toxicity

ACE inhibitors: promote sodium wasting, low sodium can precipitate lithium toxicity

diuretics

diet for CKD and AKI

renal diet CKD

• dec protein, inc carbs, vitamins, Ca replacement, dec sodium and phosphate

AKI

• oliguric phase: dec protein,inc carbs, restrict K

• diuresis phase: dec protein, inc cals, rest. fluids.

phospahte binder names

sevelamer hydrochloride

calcium acetate

aluminum hydroxide

2 month dev milestones

• follow object w eyes

• able to pick up head on tummy

• head side to side

• verbal noises/coos

• smiles

4 month dev milestones

• lower central incisors

• rolls over

• babbles (copying noises)

• begins to like play

• holds and reaches for toys

• starts to remember faces

6 month dev milestones

• scared of strangers

• sit up w support

• double weight

• responds to name

• babbles w vowels

• looks at self in mirror

8-9 month dev milestones

• sits w/o support

• crawls

• stand by grippng something

• pincer grasp

• objects from hand to hand

• object permanence

10-12 month dev milestones

• cruising/walking

• walk alone mastered by 12-14m

• follows simple commands

• put objects in container

• say simple words

• separation anxiety

order of developmental stage

• trust v mistrust 0-1

• autonomy vs shame and doubt 2-3

• initiative v guilt 4-6

• industry v inferiority school age 6-11

• identity v role confusion 11-18

by 4 years old child can

• speak 4+ words in a sentence and use 4 sentences to tell a story

• understand how and why

• talk enough for parent to understand most of time

• express feelings n ideas

• identify colors

• group objects by categories (like food)

what age do baby reflexes dissapear?

• moro

• tonic neck

• rooting

• palmar

• plantar

• sucking

• moro 3-4m

• rooting 3-4m

• tonic neck 4m

• palmar 5-6m

• plantar (babinski) 12m - pos = toes fan ouft

• sucking 12m

peaks for diff administration routes

• SL: 5-10min after dissolved

• IV: 15-30 min after bag finished

• IM: 30-60min

• SQ: depends on insulin

if get 2 answers in same range (correct) choose higher one (price is right)

The nurse is obtaining vital signs for a client who has acquired immune deficiency syndrome (AIDS). Prior to entering the room, the nurse should do which of the following?

Incorrect

Correct Answer(s): B

A. Wear gloves and a gown.

B. Perform hand hygiene.

C. Review the client’s viral load.

D. Obtain a disposable stethoscope.

right answer

performing hand hygiene before entering roomn

A disposable stethoscope and blood pressure cuff may be useful for a client with contact precautions, but it would not be necessary for a client with AIDS.

Placing the client in a high Fowler’s position may be helpful for comfort, but it is not a priority unless the client is experiencing respiratory distress

foods high in calcium

• broccoli

• milk

• seafood (high in vit D)

s/s hypoglycemia

• sleepiness

• cold and clammy

• pallor

• paresthesias

• lack coordination

• irritability

• hunger

• palpitations

• blurry vision

• tachycardia

clozapine

• used in treatment resistant schizophrenia

• c/i in pt with seizures bc lowers seizure threshold !!! (dont give to pt w DT)

hyponatremia

confusion, lethargy, and stupor as well as seizures and cerebral edema.

Abdominal cramps are another symptom of hyponatremia. Since water follows sodium, there are decreased levels of sodium in the blood and decreased fluid. This creates a fluid volume deficit, decreased urine output, muscle spasms, and abdominal cramping.

Nausea and vomiting are common signs of hyponatremia

2nd generation antipsychotics

quetiapine, cariprazine, and risperidone

bipolar meds

• 2nd gen AP not 1st gen

• lamotrigine

lamotrgine

• mood stabilizer

• bipolar disorder & anticonvulsant. Lamotrigine is efficacious for both bipolar mania and depression.

• titrated slowly because of the risk of the benign rash that may occur.

• Lamotrigine is notorious for a client developing a rash. Two rashes may occur with lamotrigine.

  • One rash is painful, tender, and blistery, affecting the upper trunk and possibly involving the eyes, lips, and mouth. This is suggestive of Steven Johnson's Syndrome (SJS). This type of rash should be reported immediately, and the client should seek emergency care.

  • A second benign rash (non-tender, has no systemic features) is common and may occur if the client is rapidly titrated upward.

first gen antipsychotics

• haloperidol

donezepil

• acetylcholinesterase inhibitor

• Alzheimer's disease and dementia

• major adverse reaction of this medication is bradycardia, which may cause syncope. The nurse should monitor the client's pulse.

• may cause hyperlipidemia

rx hypercalcemia

• phosphorus

• Calcitonin is a thyroid hormone that decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

• Bisphosphonates are intravenous osteoporosis drugs that can quickly lower calcium levels and are often used to treat hypercalcemia due to cancer

abduction

legs separated

hip arthroplasty

• keep abduction

• abductor pillow

• no bending 90º

• high seated toilet

all psych drugs cause

low bp and weight changes

usually weight gain

Phenothiazines

• first gen AP / typical

• all end in -ZINE (thorazine, compazine, promethazine)

• dont cure, just reduce s/s

• big doses “we only use zines for the zany (cuckoos)

• small doses: antiemetics

• major tranquilizes

• aminoglycosudes are to abx as phenothiazines are to antipsychotics

• ap s/e = ABCDEFG

  • anticho; (dry mouth, urinary retention)

  • blurry vision

  • constipo
    drowsy

  • EPS (tremors, parkinsons, shuffling)

  • Foto sensitivity

  • aGranulocytosis (low WBC, immunosuppressed) → report s/s pf infection to hcp

• nursing teaching for all other s//e: safety teaching. dec risk for injury

what is nursing action presents w s/e ?

educate them

what is nursing action presents w toxic effect

hold drug and notify hcp

deconate or caprate form of medication

sometimes is a med denoted wit letter D (med-D)

LONG ACTING FORM OF DRUG

IM form given for non-compliance

often court ordered

TCAs

• most grandfathered into NNSRI category

• mood elevators

• Elavil (elevates), Trofranil, Aventyl, Desyrel (ALL RHYME)

• S/E

  • Antichol rdp dry mouth

  • blurred vision

  • constip

  • drowsy

  • euphoria

• must take for 2-4 weeks for benefits to start (teach pt this or will complain)

benzodiazapines

• anti-anxiety, minor tranquilizers

• ZEP in the name

• many end in -pam or -lam

• Remember zzzzz’s for falling/going to sleep

• prototype: valium, induction of anesthetic, muscle relaxant, alcohol

• work quickly but don’t take longer than 2-4weeks

• zepplin concert has minors on tranquilizers

• used as

  • sz meds

  • preop induction of anesthesia

  • muscle relaxants

  • etoh withdrawal meds

  • ventilation, to relx and calm pts on vent down

• s/e ABCD

  • Antichol

  • blurred vision

  • constipation

  • drowsiness

give major and minor tranquilizers at same time, why?

• major AP take long time to start working

• minor AP start working right away

• ex: valium and elavil given at same tume, valium d/c once elavil kicks in

monoamine oxidase inhibitors

• names of MAOIs rhyme at beginning

  • MARpln, NARdil, PARnate

• s/e

  • anticholinergic

  • blurred vision

  • constipation

  • drowsiness

• AVOID TYRAMINE

  • avoid salad “BAR” - bananas, avocados, raisins (dried fruit)

  • grains okay exxcept yeast

  • no organs liver, kidney, tripe, heart, no preserved meats (smoked, dried, pickled, hot dogs)

  • dairy, no cheese except mozzerla, cottage cheese (aka no aged cheese)

  • no etoh, exlixirs, tinctires (iodine/betadine). caffiene, chocolate, licorice, soy sauce

• Teach not to take OTC DRugs

lithium

• bipolar (treats mania)

• s/e: think lithium. 3 Ps of s/e

  • Peeing (polyuria)

  • Pooping (diarrhea)

  • Paresthesia (earliest s/s of e- imbal)

• toxic effects

  • tremors

  • metallic taste

  • severe diarrhea

  • if experiencing. give fluids and notify hcp

#1 rx for lithium pt presenting w peeing n pooping all the times

• give pt fluids bc are s/e

MONITOR SODIUM

• low sodium makes lithium toxic

• high Na makes lithium ineffective

• sodium needs to be normal

prozac/fluoxetine

• SSRI

• s/e ABCDE

• e = euphoria

• causes insommnia so give before noon if bid give 6am and noon

• when changing dose in adolescenrs and YA watch fpr suicide risk. must be recently changed dose and adolecent or young adult

haldol

• basically same as thorazil

• first gen just like zines

• ABCDEFG

• E = EPS

• G= teach pt to report sore throat and s/s of infection

• may develop NMS from tm haldol

  • seen in eldery and young white schizophrenics

  • high fever over 102 - is differentiating factor

  • their dose should be ½ usual adult dose

• EPS = s/e
  NMS = emergency

Clozaril / Clozapine

• atypical AP

• DONT CONFUSE ZAP FOR ZEP

• doesn’t have A-F s/e

• s'/e is aGranulocytosis

  • worse than in cancer meds, trashes bm

• monitor WBC is #1 nursing intervention

geodon/ ziprasidone

• black box

• do not use in pts w cardiac conditions bc prolongs QT and could cause sudden cardiac arrest

second gen AP ends in -apine

zoloft/setraline

• antidepp

• can cause insomnia

• interacts w following bc not metabolized in liver:

  • st johns - can cause serotonin syndrome

  • warfarin - can cause bleeding

• s/e = SAD Head

  • sweating

  • apprehensive (doom)

  • dizziness

  • HA

• nurse should anticipate lowering dose of zoloft for pt on st johns or warfarin

rubella (german measles) v pertussis (whooping cough) v measles

• rubella (german measles)

  • fever'

  • droplet

  • rash starts at face and spreads

  • swollen lymph nodes.

  • joint pain

  • rx: hydration and antipyretics

  • dont let pregnanr women around bc can lead to birth defects

• measles (rubeola)

  • virus

  • airborne

  • kolpik spots (tiny white spots inside mouth)

  • conjuctivitis

  • maculopapular rash at hairline and goes down

  • fever and runny nose

  • rx: vitamin A, hydration, antipyretics

• pertussis

  • flu like symptoms runny nose, fever, cough

  • bacterial

  • droplet

  • cx pneumonia

  • rx: abx

meds taken without food

• Penicillin (and derivatives): Best absorbed without food.

• Azithromycin (Zithromax): Typically recommended without food to enhance absorption.

• Tetracyclines:

  • Doxycycline and Minocycline: Avoid dairy and antacids as they inhibit absorption.

• Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin):

  • Take at least 2 hours before or 6 hours after antacids, dairy, or calcium-enriched products.

• biphosphonates

  • w water, stay uprighft to prevent esophageal irritation

• levothyroxine

• PPIs

• iron

  • avoid calcium and antacids bc dec absorption

  • can take w foods if causes GI upset

• sucraflate

• carbidopa-levodopa

meds that can caus SJS

• Monitor for Early Symptoms:

  • Flu-like symptoms (fever, sore throat, malaise) can precede the skin rash.

  • Rash: Painful, red/purple macules that blister and may peel.

• sulfamethoxazole-trimethoprim

• levoflaxin

• cefs

• penicillin

• -mycins

• allopurinol

• nsaids

• phenytoin

• phenobarbitral

• carbamezapine

• lamotrigine

isonazid and rifampin

• both hepatotoxic (monitor LFTs)

• inonazid need to take w B6 bc will deplete

• rifampin will stain secretion orange (wear glasses instead of contacts)

• emphasize adherance to prevent resistance

. Any drainage exceeding 70 mL would concern the nurse and require investigation for potential hemorrhage

contractions should be no longer than 90 seconds and no closer than 2 min