NCLEX STUDY

LECTURE 1: ACID BASES

  • Learning Lab Values:
      - Importance of converting lab values into words for understanding and communication.
      - The Rule of B's: If both pH and bicarbonate (BiCarb) move in the same direction, it indicates metabolic origin of the acid-base disorder.
        - Down = Acidosis
        - Up = Alkalosis
      - Use arrows to visualize the directions of change.

  • Normal Values:
      - Know normal pH, Bicarbonate (HCO3), and CO2 levels.

  • Study Tips:
      - Principles Over Lists:
        - Understand that tests assess principles rather than memorization of facts or lists.
        - For select-all-that-apply questions:
          - Example: Opioids (e.g., dilaudid) as CNS depressants causing sedation, lethargy, and reflex issues.

  • Signs & Symptoms (S&S) of Acid-Base Imbalances:
      - As pH increases, the patient's condition becomes more irritable and excitable.
        - Alkalosis: High pH leads to symptoms like hyper-reflexivity (+3, +4), tachypnea, tachycardia, borborygmi, seizures.
      - As pH decreases, the patient's systems shut down.
        - Acidosis: Low pH leads to symptoms like hypo-reflexive (+1, 0), bradycardia, lethargy, respiratory arrest.

  • Practical Applications:
      - Acidosis requires ambu-bag at bedside due to respiratory arrest risks.
      - Alkalosis requires suction at bedside due to seizure risk.

  • Kussmaul's Breathing:
      - A compensatory respiratory mechanism seen only in metabolic acidosis.

  • Common Errors in Select-All Questions:
      - Avoid selecting none or all options, and be cautious of over-selecting.

  • Causes of Acid-Base Imbalance:
      - Scenarios leading to acid-base disorders must be understood:
        - Scenarios such as lung issues lead to respiratory conditions (over-ventilation = alkalosis, under-ventilation = acidosis).
        - Do not confuse S&S with causation; e.g., diarrhea leads to metabolic acidosis but causes paralytic ileus once acidotic.
        - Functionality: If lungs are involved, assess ventilation not rate (SaO2 is more critical).

  • Examples of Disturbances:
      - Metabolic Alkalosis mainly through prolonged gastric suctioning/vomiting; losing acid.
      - Commonly seen scenarios like GI surgery with an NG tube or hyperemesis gravidarum.

  • Disorder Selection:
      - From the four listed options (respiratory acidosis, respiratory alkalosis, metabolic alkalosis, metabolic acidosis), assess based on clues in scenarios.

  • Modifying Phrases:
      - Focus on modifying phrases over the main diagnosis for prioritization (e.g., OCD patient becoming psychotic).

VENTILATION

  • Ventilator alarms:
      - High-pressure alarms indicate increased resistance; investigate for kinks, water in tubing, or mucous.
        - Prioritization: Kinks should be addressed first, suctioning is only PRN.
      - Low-pressure alarms indicate decreased resistance due to disconnection.
        - Check reconnection of tubing or sensors.

  • Blood Gases and Ventilation Settings:
      - Respiratory alkalosis = potentially over-ventilating; respiratory acidosis = likely under-ventilating.
      - When weaning patients from ventilators, ensure they're not under-ventilated.

  • Know delegation rules and nursing responsibilities.

LECTURE 2: ABUSE (Psych and Med-Surge)

  • Denial in Abuse Situations:
      - Denial is the most significant psychological problem in abuse, enabling the abuser to avoid accountability.
      - Treatment involves confronting the problem and distinguishing it from aggression.

  • Dependency and Co-dependency:
      - Dependency involves the partner making decisions for the abuser, while co-dependency involves the abuser gaining self-esteem from making decisions for the abuser.
      - Address through setting limits and helping the co-dependent build self-esteem.

  • Manipulation:
      - Distinguishing manipulation from dependency involves assessing if the request is harmful.
      - Treatment involves setting limits and enforcing them.

  • Alcoholism and Wernicke-Korsakoff Syndrome:
      - Wernicke = encephalopathy; Korsakoff = psychosis due to vitamin B1 deficiency.
      - Symptoms include significant memory loss with confabulation.
      - Treatment: Avoid confrontation; use redirection instead.
     

  • Drug Abuse:
      - Differentiate between uppers and downers, identifying withdrawal symptoms specific to each.
      - Handle overdoses and withdrawals by recognizing the type and adjusting care.

  • Alcohol Withdrawal Syndrome vs. Delirium Tremens:
      - AWS occurs 24 hours after alcohol cessation, while DT's occurs after 72 hours.
      - AWS is not life-threatening; DT's can be.

  • Differences in Care:
      - AWS is more centered around regular diet and unilateral personal care, DT's require more stringent monitoring and protective measures.

LECTURE 3: DRUGS

AMINOGLYCOSIDES

  • Powerful antibiotics used in serious infections; known for safety testing.

  • Names typically end in -mycin except for erythromycin, azithromycin, and clarithromycin.

  • Monitor ototoxicity (hearing) and nephrotoxicity (kidney function) via creatinine levels.

CALCIUM-CHANNEL BLOCKERS

  • Calms the heart (negative inotropic, chronotropic, and dromotropic effects).

  • Indications include hypertension, angina, and atrial arrhythmias.

  • Side effects noted with headaches and hypotension.

CARDIAC ARRHYTHMIAS

  • Interpretation of Rhythms:
      - Identify normal sinus rhythm, V-Fib, V-Tach, and A-Systolic rhythms by their characteristics.

TREATMENT INTERVENTIONS

  • Treatments for PVC's and V-tach include drugs like Lidocaine or Amiodarone, while for A-systole Epinephrine and Atropine are indicated.

  • Nursing Focus: Knowledge of vital signs and patient status should inform timely intervention and care.

LECTURE 4: CRUTCHES, CANES, WALKERS

-Crutch Measurements:
  - Correct measuring involves the length being 2-3 finger widths below the anterior axillary fold to a point lateral to the foot.

LECTURE 5: DRUG TOXICITY

  • Five key drugs to monitor:
      - Lithium
      - Digoxin
      - Aminophylline
      - Dilantin
      - Bilirubin

  • Monitor therapeutic vs. toxic levels.

LECTURE 6: MATERNAL AND POSTPARTUM CARE

  • Proper prenatal care includes regular assessments and education to encourage healthy outcomes for both mother and child.

  • Care focuses on minimizing complications during labor and birth and ensuring postpartum wellness through monitoring and education.

LECTURE 7: ENDORCRINE DISORDERS

  • Understand significance of thyroid and adrenal disorders in relation to metabolic processes, management options, and patient education for safety.

LECTURE 8: LAB VALUES

  • Differences in normal ranges versus priority impacts on patient care understanding and intervention methods.

LECTURE 9: PRIORITIZATION & DELEGATION

  • Focus on effective prioritization strategies in care settings, understanding delegation rules, and addressing medical emergencies efficiently.

  • This comprehensive guide covers essential knowledge areas for nursing students in preparation for examinations and clinical practices. Topics span from foundation to specialized knowledge necessary for effective patient care and safety management in medical scenarios.