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hyperthyroidism

Causes: Graves, Thyroiditis

Symptoms: Heat intolerance, tachycardia, weight loss, increased systolic BP, Goiter

Treatment: PTU, Methamazole (pregnant?), radioactive iodine therapy, thyroidectomy

thyroidectomy

keep trach at bedside (stridor, laryngeal spasms)

may experience hypocalcemia (Chevosteks and Trousseaus)

Calcium gluconate at the bedside

thyroid storm

Symptoms: fever (1 degree elevated is an emergency), Tachycardia, Systolic hypertension

Treatment: PTU and Methimazole, hydrocortisone, prednisone, cooling blankets

hypothyroidism

causes: autoimmune disease, medications, and thyroid surgery

symptoms: cold intolerance, weight gain, dry skin, brittle nails and hair, hair loss, constipation

treatment: levothyroxine (Synthroid) go low and slow, am in the morning 30 mins before meals, do not take fiber, monitor for chest pain

mxydema coma

Causes: stopping levothyroxine, surgery, chemo, acute illness

Symptoms: hypothermia, hypotension, high morbidity rate

treatment: Mechanical ventilation, warm blankets, IV levothyroxine, IV glucose

hyperparathyroidism

Causes: Primary (adenoma, hyperplasia, or cancerous tumor) Secondary (severe calcium deficit, vitamin D deficiency, Chronic kidney failure)

Symptoms: hypercalcemia, epigastric pain, bone weakness

Treatment: Diuretic and hydration (NS, Furosemide, Bumetanide) Calcitonin, oral phosphate

hypoparathyroidism

Causes: Neck surgery, cancer radiation to the neck, low magnesium

Symptoms: Hypocalcemia (CATS), Larynospasms, hypomagnesemia, hyperphosphatemia, seizures

Treatment: decrease stimuli, calcium gluconate, calcitriol, NO milk, yogurt, or processed cheese, ADD dark green leafy vegetables

SIADH

Causes: brain tumors, head trauma, meningitis, Gullian barre, encephalitis

Symptoms: ALOT of fluid, LOW sodium

Treatment: fluid restrictions, furosemide, 3% NS, IV Conivaptan, PO Tolvaptan

DI

Causes: craniotomy, falls/car accidents

Symptoms: ALOT of sodium, LOW fluids, increased thirst, up to 20L urine/day

Treatment: replace fluids, monitor output, vasopressin, desmopressin DDVAP (nasal spray)

Addison's disease

causes: TB, glucocorticosteroids, infections

symptoms: LOW bs and BP, HIGH HR, sodium, potassium, shock

Treatment: 3% hypertonic NS, replace hydrocortisone, solumedrol IS A PRIORITY

addisonian crisis

Causes: precipitated by physical or emotional stress, the sudden withdrawal of hormone.

Treatment: hyperkalemia replacement, hormone replacement

cushings syndrome

Causes: Corticosteroid therapy (COPD, asthma, RA, MS, Lupus), pituitary tumor

Symptoms: moon face, buffalo hump, thin skin, muscle atrophy

Treatment: Surgical removal of the adrenal gland, low sodium diet, decrease in corticosteroid use

phenochromocytoma

Causes: catecholamine-producing tumor

Symptoms: HTN, palpitation, diaphoresis, flushing, impending doom

Treatment: DO NOT PALPATE ABDOMEN, don't smoke or drink, avoid foods high in tyramine (red wine, dried meat, chocolate, and cheese)

dig toxicity

>2

halo vision, n/v, EKG change

digibind is the antidote

elderly pts (decreased renal and liver fxn) and CCBs

Burns

Rule of nines

foley (more than 30mL/hr)

IV meds only

Fluid resuscitation immediately

Parkland formula

4 X 100kg X 45% = 18000

1800/2 = 1125mL/hr for 8 hours

Acute Phase

Hgb and Hct are low

Low K and Low Na

Increase urine output

Emergent Phase

Dehydration

Decreased urine output

Hgb and Hct are elevated

BUN and Creatine are elevated

High K and Low Na

Compartment Syndrome

6 ps:

Pain

Pallor

Polar

Pulselessness

Paresthesia

Paralysis

social smile

6-8 weeks

head control

3-4 months

rolls

5-6 months

peek-a-boo

after 6 months

transfers objects from hand to hand

7 months

sits unsupported

8-9 months

crawls

10 months

anterior frontanel closes

12-18 months

throws ball overhand

18 months

kicks ball

24 months

day time toileting

starts at 2 years

Naegele's Rule

add 7 days to LMP, subtract 3 months, add 1 year

INR

0.8-1.9

Therapeutic 1.8-3.6

PT

11-12

therapeutic 16.5-30

PTT

20-30

therapeutic 30-75

aPTT

30-40

therapeutic 45-100

WBC

5,000-10,000

platelet

150,000-400,000

LDL

bad cholesterol, fatty buildup in arteries

should be <130

HDL

good cholesterol, carries LDL back to liver to break it down

males >45

females >55

removing PPE

1. gloves

2. goggles

3. gown

4. mask

5. wash hands

Airborne precautions

My (measles)

Chicken (chicken pox)

Has (herpes)

TB

Private negative pressure room an mask

Droplet precautions

SPIDERMAN

S=sepsis, scarlet fever, streptococcal pharyngitis,

P=parvovirus, pneumonia, pertussis,

I=influenza,

D=diphtheria,

E=epiglottitis,

R=rubella,

M=mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room or cohort mask!)

Mask, eye protection, gown, and gloves

Contact percautions

MRS. WEE

M=multidrug resistant

R= RSV

W= wound infection

E= enteric (c.diff)

E= eye infection

Skin infections

V CHIPS

V= Varicella

C= Cutaneous Diptheria

H= Herepes Zoster

I= Impetigo

P= Pediculosis

S= Scabies

nursing process

1. Assessment

2. Diagnosis

3. Planning/Outcomes

4. Implementation

5. Evaluation

incident report

med errors, needle sticks, falls, HAIs

DO NOT INCLUDE/MENTION IN CHART!

assess the pt and notify the provider

appendicitis

inflammation of the appendix

signs/symptoms: if pain goes away quickly (it ruptured), McBurneys point, RLQ pain, abdominal rigidity, N/V

pneumonia

Infection that inflames the air sacs in one or both lungs (may fill with fluid or pus)

NOT safe to send home (antibiotics for 48-72 hours)

Admission for 3 days

SOB, Cough, Chest pain

Ulcerative Colitis

2-3 stools a day is normal

10-20/day is an exacerbation

can lead to dehydration, anemia, low albumin

herpes zoster

Disseminated = airborne

prevented by shingles vaccine in 50 year olds

prevented by chicken pox vaccine in children

Mantoux testing

filgrastin

WBC will return to normal, specifically neutrophils

Flumazenil

GABA Receptor Antagonist

Antidote for benzodiazepine toxicity

Ex: Diazepam (Valium) Lorazepam (Ativan), Midazolam (Versed)

Administered IV

Expected outcomes: Reversal of benzodiazepine toxicity

Alert, increased level of consciousness, increased RR

furrous sulfate

Used to tx and prevent iron deficiency anemia

If PO drink through straw d/t staining of teeth

Avoid antacids, coffee, tea, dairy products, eggs, whole-grain bread within 1 hr after administration

Stools may be dark green/black

Educate foods that contain iron:

Cereals, clams, dried beans and peas, dried fruit, leafy green vegetables, lean red meats, molasses (blackstrap), and organ meats

Epoetin

increase in hematocrit or hemoglobin

Atropine

for sinus bradycardia

it increases heart rate

monitor in pts with GLUACOMA (elderly pts)

Carbamazepine

Anticonvulsant that works by reducing abnormal electrical activity in the brain

Uses:

To control seizures

To treat trigeminal neuralgia

To treat mania from Bipolar Disorder

Possible side effects:

Dizziness

Thinking abnormal

Difficulty speaking

Uncontrollable shaking of a part of the body

Constipation

Dry mouth

Oxytocin Drip

discontinued if uterine contraction frequency is less than 2 minutes, or duration is longer than 90 seconds, or if fetal distress is noted.

Increased risk for postpartum hemorrhage

Lorazepam

sedative

Uses:

epilepsy

relives anxiety

before and after surgeries

Side effects:

Drowsiness

poor coordination

confusion

hallucination

Sodium Polystrene sulfonate (Kayexalate)

removes potassium

Side effects:

loss os appetite

N/V

constipation

muscle weakness

broncial breath sounds

loud, high pitched and hollow, heard over the manubrium, prolonged in the expiratory phase

Bronchial vesicular sounds

Heard at first and second intercostal spaces and between scapula posterior, pitch is moderate amplitude is moderate, same inspiration and expiration

vesicular sounds

low-pitched, soft sounds heard over peripheral lung fields

elder abuse

dependent individuals are most at risk

physical, emotional, sexual, neglect, financial

treat injuries and separate individual

paranoid schizophrenia

They are fearful of harm

Do NOT respond well to stern nurses

NO group acitivties, better with individual activities

Manic depressive disorder (bipolar)

mood swings from depressive to manic highs

Lithium (routine labs, >2 is lithium toxicity)

safety is priority (SIGN A NO HARM CONTRACT

identify the need for suicide precautions, encourage patient to express feelings, provide activities that require minimal concentration (drawing, board games)

PEG tubes

surgically placed (do not check PH residual)

asess stoma

STOP infusion if acute abdominal pain, abdominal rigidity or vomiting

venous thrombosis prevention

drinking water and staying hydrated decreased clots and improves blood flow (6-8 8oz glasses a day)

compression stocking

ambulation

anticoagulants

skeletal traction

Weights should hang freely

Do not add or remove weights

Monitor for skin breakdown

Chlorhexidine or saline should be used to clean pin sites daily

Monitor pin sights for infection

TURP

CBI prevents clots continuous dripping for the first 24hrs

DO NOT DELEGATE

Pink urine outflow is normal, bleeding is common, monitor for hemorrhage (hemoglobin, hematocrit)

Must have an order to irrigate to remove clot

Kegel exercises

birth control

oral contraceptives is not a good form if you miss

not good for women older than 35 who smoke, htn, heart disease, stroke, breast cancer

take missed dose ASAP

use with second form of birth control

decreases effectiveness:

antibiotics

herbs

sedatives/anticonvulsants (Carbamazepine)

antacids

Wasting narcotics

must have a RN witness

waste before administering

TPN

Aseptic technique

d10/20 if you run out of TPN

hangs for 10-12 hours

change tubing every 24 hours

BG checks

monitor renal status

Type 1 diabetic exercise

Should aim for at least 150 minutes of moderate-vigorous intensity aerobic exercise per week (may have to gradually work up to this amount)(swimming, cycling, walking, weight lifting)

Take BS before

100-250 is good

stop exercise if shaky, weak, or confused

eat a small snack with carbs after

Do not exercise if there are ketones in your urine or you took insulin within the hour

external radiation

Avoid direct sunlight on the radiation area

No PERCAUTIONS

Protect skin from heat or cold

Do not remove the radiation markings unless instructed to by their physician

Wear loose, soft clothing

When washing the radiation site, do it with water. no lotions and pat dry

DKA

Type 1

BG 350-500 mg/dL

Metabolic acidosis b/c of ketone production

Fruity breath odor

Kussmaul respirations

HHS

Type 2

BG >800 mg/dL

No metabolic acidosis

No ketones

Altered mental status, significant dehydration

laproscopic surgery

Low fowlers post op

right shoulder or chest pain from gas used during procedure, patient may think they are having MI- educate patient

AMBULATE ASAP

liver cirrhosis

Main cause is DRINKING

Complication is esophageal varices, ascites, coffee ground emesis

may have petechiae or spider angiomas

pancreatitis

Upper admonial pain that radiates to the back

Can lad to diabetes and will need to be treated with insulin

ERCP

NPO 8 hours before

Monitor gag reflex to make sure it comes back

lozenges, saline gargle, and oral analgesics for discomfort

DO NOT DELEGATE

glomerulonephritis

Acute- occurs 2-3 weeks after a streptococcal infection

Chronic- may occur after the acute phase or slowly over time

low sodium and low potassium diet

diuretics

Hemophilia

Abnormal bleeding response

Easy bruising

Joint bleeding-pain, tenderness, swelling, decrease ROM

Replacement of specific clotting factors (factor VIII), analgesics, corticosteroids

DDAVP (Vasopressin)-increases plasma factor VIII

Monitor for joint pain-if present, immobilize affect extremity.Control joint bleeding by immobilization, elevation, ice, and pressure

sickle cell anemia

episodes of pain, swelling in hands and feet, frequent infections

During a crisis, 1st priority is administering IV bolus of fluids. Regular pain medications(Narcotics) needed to help with pain

Hirschsprung disease

missing nerve cells in the large intestine, which causes difficulty passing stool

Delayed meconium stool (after 48hrs), chronic constipation, abdominal bloating, vomiting, diarrhea

Surgery to bypass or remove section of colon without nerve cells

High-fiber diet, increased fluids, and laxatives as rxn for those who still experience symptoms

STAGE 1 Early

0-5cm

Early contractions, initial labor is usually 6-8 hrs but can last longer

Intensity is mild to moderate, duration is 30-40 seconds, frequency is q2-30 minutes, very irregular

STAGE 1 Active

6-10cm

Cervix fully dilated, regular contractions, more efficient faster progression, takes about 3-6 hours

Intensity is moderate to strong, last longer 40-90 seconds, more frequent 1 ½ to every 5 minutes

STAGE 2 Latent

Uterus contracts to allow baby to come to birth canal

STAGE 3 Active

Urge to bear down happens in stage 2, anal pressure,

Phototherapy

Cover infants eyes and genital area

increase fluids

monitor skin temperature

avoid stimulation

reposition q2hrs

Consents

Nurse is just a witness

They do not educate or make sure the patient understands the procedure

VEAL CHOP

V- Variable C- Cord Comphression

E- Early Decels H- Head Compression

A- Accelerations O - OK

L-Late Decels P - Placenta

Heart Transplant

INR of 2.4 is normal (on warafin)

BP drop in 20 is PRIORITY

respiratory acidosis

low PH, High CO2

hypoventilation, COPD, overdose, PE, trauma

respiratory alkalosis

high PH, Low CO2

hyperventilation, high altitude, hypoxia, anxiety YOURE BREATHING IT OUT

metabolic acidosis

low pH, low HCO3

DKA, Sepsis, Diarrhea, Renal issue

metabolic alkalosis

high pH, high HCO3

Loss of GI secretions, potassium wasting diuretic, antacids

A. Fib

cardioversion

V. Tach

cardioversion

defib

amioderone

intubate

V. Fib

Defib

CPR