Kaplan Bullets

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when turning,coughing, and deep breathing a patient that purpose is to promote ventalation and prevent respiratory acidosis bec. you are removing carbon dioxide inorder to prevent respiratory acidosis

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The preschoold child see's death as gradual and temporary, by age 7, death is punishment, by age 9 (Shandon) develop an adult concept that death is irreversible.

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when the child is REstless and Overactive, it indicate that the child maybe in pain, so check if he have receive the last pain medication or rather assess.

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when a pt. receiving aminophylline IV and it infiltrates and has an assessment of clear lung sounds and unlabored breathing, there's no need to continue Iv it should be referred to the physician and request for P.O medication

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a pt. in manic phase in combative behavior, the initial strategy is to give sedative medecation rather than decreasing environmental stimuli bec. decreasing env. stimuli will not decrease internal aggresiveness although it's one strategy.

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Irritable bowel syndrome is rather known as spastic bowel disease, no inflammation occur. Unlike Ulcerative colitis which is bloody diaarhea and Chron's non-bloody

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The toy for a five year's old boy is a telephone who imitates his father.

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Dpt is given around 2 mos. and again on 4 mos. Measles Mumps and Rubella (MMR, LIve vaccine), given at 15 mos. Polio, given at 2 mos, 4mos, 12 and 18 mos. Smallchicken pox is no longer given

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pain is characteristic of inflammation and infection

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When using gravity drip, piggybank fluid should be higher than primary infusion

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Calan (Cal-(calcium), Calcium channel blocker, it decreases work load of ventricles therefore can cause hypotension and heartfailure, if there's HF there's peripheral edema

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In early fetal deceleration(head compression) this is normal, no intervention needed, in late fetal deceleration (difficient placental perfusion) sign of hypoxia you should position the mother to the left side, if no change, move to other side and trendelenburg or kneechest position. Variable deceleration is chord compression relieve by change in position.

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Hypoparathyroidism need tracheostomy set because of risk for laryngospasm

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The live attenuated rubella virus is not communicable in breast milk; therefore, breast-feeding does not need to be stopped.

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Avoiding high-carbohydrate food sources also will assist in minimizing dumping syndrome.

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Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis,check for pulyuria.

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The normal albumin level ranges from 3.4 to 5 g/dL. The albumin level is decreased in many conditions such as acute infection, ascites, alcoholism, burns, and cirrhosis. If increased, dehydration, diarrhea, multiple myeloma.

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Albumin is responsible for maintaining the osmolality of the blood. When the albumin level is low, osmotic pressure is decreased, which in turn can lead to peripheral edema.

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Clinical manifestations of respiratory alkalosis include a decrease in the respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesias such as tingling of the fingers and toes, hypokalemia, hypocalcemia, tetany, and convulsions.

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Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain.

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An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow

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Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis.

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Adequate dietary iodine is needed to produce T3 and T4. The other requirements for adequate T3 and T4 production are an intact thyroid gland and a functional hypothalamic-pituitarythyroid feedback system

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The indirect Coombs’ test detects circulating antibodies against RBCs.

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A blood glucose lower that 50 mg/dL is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Glyburide is an oral hypoglycemic agent used to treat diabetes mellitus type 2 and would not be given to a client with hypoglycemia.

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Regular insulin, NPH insulin, and glyburide are used to treat hyperglycemia

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In mucomyst if it's used it's given as inhalation as mucolytic, but if it's used as antidote for tylenol overdose make sure the stomach is empty from emesis or lavage and then dilute the mucomyst with juice and administer orally or ngt!

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Signs and symptoms of hypoglycemia include hunger, nervousness, anxiety, dizziness, blurred vision, sweaty palms, confusion, and tingling and numbness around the mouth. Polydipsia (thirst) and increased urine output are noted in the client with hyperglycemia.

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Dexamethasone (decadron) - corticosteriods, decreases inflammation, mainly by stabilizing membranes.. use for CErebral Edema. may be given by direct intravenous injection or intravenous infusion.

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These days, when dr's ask me for B/P, they normally want the systolic. Ex: 'What's her b/p?", "110".

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MAP - Mean Arterial Pressure" You want to see better than 60.

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Less than 60 is an indication that vital organs aren't being adequately perfused. This can lead to 'multi-organ failure' - a significant cause of the leading cause of death in critical care units.

death,

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In 10 yrs, we'll all be using mean arterial pressure (MAP). The Mean is the 'average' pressure of the system as opposed to sys/dia, which are the high and low of the system.

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Hint: I'm using the terms MAP and 'Mean' interchangeably.

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MAP = Sys +(Dia x2)/3 or also, Dia + (Sys-Dia/3).

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Or, to use both formulas:

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Ex 120/80 = Sys 120 + (Dia x2) 160 = 280/3 = 93.3

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or

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120/80 = 80 + (120-80 = 40/3) = 13.3 +80 = 93.3

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A mean is a better indicator than the high and low. But that being the case, anaccurate diastolic is even MORE important, because it will affect the mean.

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In an emergency department, triage involves brief client assessment to classify clients according to their need for care and includes establishing priorities of care. The type of illness or injury, the severity of the problem, and the resources available govern the process. Clients with trauma, chest pain, severe respiratory distress or cardiac arrest, limb amputation, acute neurological deficits, and those who have sustained chemical splashes to the eyes are classified as emergent and are the number 1 priority. Clients with conditions such as a simple fracture, asthma without respiratory distress, fever, hypertension, abdominal pain, or a renal stone have urgent needs and are classified as number 2 priority. Clients with conditions such as a minor laceration, sprain, or cold symptoms are classified as nonurgent and are the number 3 priority.

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Buck’s extension traction is a type of skin traction in which the legs are in an extended position. It is used primarily for short-term immobilization, such as in preoperative management of a child with a dislocated hip. A 90- to 90-degree femoral traction (option 2) is used for femur fractures. In this type of traction, the lower leg is put in a boot cast or supported in a sling, and a skeletal Steinmann pin or Kirschner wire is placed in the distal fragment of the fracture. Russell’s traction (option 3) is used for fractures of the femur or for hip and knee contractures. It uses skin traction on the lower leg with a padded sling under the knee. Balanced suspension (option 4) may be used with or without skin or skeletal traction. It is used for femur, hip, or

tibial fractures. The balanced suspension suspends the leg in a desired flexed position to relax the hip and hamstring muscles and does not exert any traction directly on a body part. In balanced suspension, a Thomas splint extends from the groin to midair above the foot, and a Pearson attachment supports the lower leg. ● ● ●

the normal CSF pressure is 5 to 10 mm Hg Normal ICP readings range from 5 to 15 mm Hg pressure. Pressures greater than 20 mm Hg are considered to represent increased ICP, which seriously impairs cerebral perfusion.

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A cooing begins at birth to 2 mos., monosyllabic begins 3 to 6 mos, linking syllables begins 6 to 9 mos, and "mama and dada" 9 to 12 mos.

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_____________________________________________________________________________ _____________ The Parkland (Baxter) formula for estimating fluid requirements is 4 mL × 90 × 83 = 29,880 mL, divided by 2 = 14,940 mL.

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Clinical manifestations associated with ARF occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul’s respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide.

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Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.

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Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler’s position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client’s response to treatment is successful.

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Characteristic behaviors of the newborn infant with fetal alcohol syndrome (FAS) are not unlike behaviors similar to those of the drug-exposed newborn infant. These behaviors include irritability, tremors, poor feeding, and hypersensitivity to stimuli. Newborn infants with FAS are smaller at birth and present with failure to thrive.

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Mastitis - In most cases, the mother can continue to breast-feed with both breasts. If the affected breast is too sore, the mother can pump the breast gently. Regular emptying of the breast is important to prevent abscess formation. Antibiotic therapy assists in resolving the mastitis within 24 to 48 hours. Additional supportive measures include ice packs, breast supports, and analgesics

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Colchicine is classified as an antigout agent that interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client

should report a decrease in pain and inflammation in the affected joints, as well as a decrease in number of gout attacks. ● ●

Ribavirin (Virazole) is active against RSV, influenza virus types A and B, and herpes simplex virus. It is administered by oral inhalation

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Nephrotic syndrome is a kidney disorder. Clinical manifestations of nephrotic syndrome include edema, proteinuria, hypoalbuminemia, and hypercholesterolemia in the absence of hematuria and hypertension

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Albuterol is a sympathomimetic bronchodilator. Side effects that can occur from the use of this medication include tremors, nausea, nervousness, palpitations, tachycardia, and dryness of the mouth or throat.

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Black cohosh produces estrogen-like effects. Zinc stimulates the immune system and is used for its antiviral properties. Echinacea stimulates the immune system and ginger is used for nausea and vomiting

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Avoid herbal supps like ginsing, ginger, ginko, garlic (all the G's) if on any clotting drugs/products (coumadin, platelets, ASA, Plavix)

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MI Treatment MONA

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M-Morphine pain reduce O2 consumption 0-Oxygen N-Nitroglycerin A-Aspirin

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Pt's taking Monoamine Oxidase inhibitors (for depression usually) should avoid foods containing tyramine which include

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* Avocados, bananas * Beef/chicken liver * Caffeine * Red wine, Beer * Cheese (except cottage cheese) * Raisins * Sausages, pepperoni * Yogurt, sour cream PKU- no nuts, meats, dry beans, eggs, dairy (basically no protein stuff) give specially prepared formula to baby because they can digest this protein well

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In anosognosia, the client exhibits neglect of the affected side of the body. The nurse will plan care activities that remind the client to perform actions that require looking at the affected arm or leg, as well as activities that will increase the client’s awareness of the affected side. In brain stroke

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The normal hematocrit level is approximately 40% to 50% in the adult male and 37% to 47% in

the adult female. The hematocrit level measures the percentage of red blood cells in whole blood. Elevated hematocrit levels are seen in persons with dehydration, pernicious anemia, or polycythemia. ● ●

Recognition that the therapeutic ranges for phenytoin, acetaminophen, and theophylline are the same 10 - 20mcg/dl

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At lithium levels of 2.0 to 2.5 mEq/L, the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2.0 mEq/L, the client experiences vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3.0 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

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One of the earliest indicators of successful adaptation of the newborn is the Apgar score. Scores range from 0 to 10. Five criteria are used to measure the infant’s adaptation. Heart rate: absent = 0; less than 100 = 1; greater than 100 = 2. Respiratory effort: absent = 0; slow or irregular weak cry = 1; good, crying lustily = 2. Muscle tone: limp or hypotonic = 0; some extremity flexion = 1; active, moving, and well flexed = 2. Irritability or reflexes (measured by bulb suctioning): no response = 0; grimace = 1; cough, sneeze, or vigorous cry = 2. Color: cyanotic or pale = 0; acrocyanotic, cyanosis of extremities = 1; pink = 2.

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Double vision, loss of appetite, and nausea are early signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence.

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Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis,

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Hypertension, cardiovascular disease, diabetes mellitus, and obesity are associated with the development of glaucoma.

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Assessment of a client with Hodgkin’s disease most often reveals enlarged, painless lymph nodes along with fever, malaise, and night sweats