IMPORTANT FOR EXAM

GTPAL stands for

Gravidity: number of times the woman has been pregnant (THIS INCLUDES CURRENT
PREGNANCY, MISCARRIAGES, ABORTIONS and *twins/triplets count as one).

Term Births: number born (alive or stillborn) at 37 weeks gestation onward (*twins/triplets count
as one)

Preterm births: number born 20-37 weeks (alive or stillborn) (*twins/triplets counts as one)

Abortion: pregnancy losses before 20 weeks (counts as a pregnancy…so would put in gravidity as
well)** if baby died after 20 weeks it is added under preterm or term not abortion.

Living children: number of children living (NOTE: twin/triplets counts individually)

GTPAL Practice Questions

Question 1: A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks
gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL?

Answer: G=3, T=1, P=0, A=1, L=1

Question 2: A 35 year old female is currently pregnant with twins. She has 10 year old triplets who
were born at 32 weeks gestation, and 16 years old who was born at 41 week gestation. Twelve years
ago she had a miscarriage at 8 weeks gestation. What is her GTPAL?

Answer: G=4, T=1, P=1, A=1, L=4

Naegele’s Rule Nursing NCLEX Review

Key Points about Naegele’s Rule:

 It is used for estimating an expected due date based on the woman’s last menstrual period
(LMP).
 It bases it calculation that the woman has a 28 day menstrual cycle (many woman
vary)AND that it will be a gestation period of 280 days (40 weeks)… again this varies because
gestation is slightly longer for first time mothers. Hence, Naegele’s Rule calculation in JUST an
estimation!
 Always give February 28 days (regardless of a leap year…to keep things simple).
  Know which months have 30 days vs 31 days (September, April, June & November have 30
days)

Calculation Formula for Naegele’s Rule

LMP Date

1. Subtract 3 months from the LMP

2. Add 7 Days to the LMP
3. Add 1 Year
(use this calculation formula for patients whose LMP falls between April-Dec)

OR

LMP Date

1. Add 7 Days to LMP

2. Then add 9 months
(use this calculation formula for patients whose LMP falls between January-March rather than
the other formula)

*Please watch the lecture video above for why it is best to use these different calculations based on
when the LMP falls to prevent errors.

What is the Rule of Nines? Burns

Lactated Ringer’s (an isotonic solution) is most commonly used to help expand the
intravascular compartment. To determine how much fluid a patient will need 24 hours after a severe
burn, the Parkland Burn Formula is used (please see the next review for how to calculate the amount of
fluid a patient needs after a severe burn).

Burns
 Rule of nines, 9 = head, 18 = arms, 36 = torso, 36 =legs, and
1= perineum = 100%

The Parkland formula is a formula used for

calculation the total fluid requirement in 24 hours for a
burn patient

4ml x TBSA % (Total Burn Surface Area) x body

weight (kg) = Total amount of fluid the patient will
receive in 24 hrs

50% given in first eight hours

50% given in next 16 hours.

The Number #1 Priority for Burn Patients is maintaining a

patent airway

1st Degree – Red and Painful


2nd Degree – Blisters


3rd Degree – No Pain because of blocked and burned

nerves

Rule of Nines for Burns

Now, let’s look at the Rule of Nines!

Each area of the body is broken down by nines (hence makes it easier to remember). I like to
start my way from the top and work downward:

NOTE: Remember that there is a FRONT AND BACK percentage value assigned to EACH

AREA (many people forget this and get their

calculation wrong).

Adult:

Head and Neck: 9% (4.5% anterior and posterior)

Right Arm: 9% (4.5% anterior and posterior)

Left Arm: 9% (4.5% anterior and posterior)

Trunk: 36% (18% anterior and posterior)

Perineum: 1%

Right Leg: 18% (9% anterior and posterior)

Left Leg: 18% (9% anterior and posterior)

Total: 100%

Rule of Nines Practice Problem:

 A 35 year old female patient has deep partial-thickness burns on the front and back of both
arms, anterior trunk, back of left leg, anterior and posterior sides of the right leg, posterior head
and neck, and perineum. What is the total body surface area percentage that is burned?

FRONT and BACK of both arms: 18%

ANTERIOR trunk: 18%

BACK of left leg: 9%

ANTERIOR and POSTERIOR of right leg: 18%

POSTERIOR head and neck: 4.5%

Perineum: 1%

Total: 68.5%

What is the Parkland Burn Formula?

It’s a formula used to calculate the amount of fluids a patient needs throughout a 24 hour period after
sustaining a severe burn.
Total Amount of Lactated Ringer’s Needed

= 4 mL x body surface area % burned x patient’s weight in kg

As we learned in the last review on burns, patients who’ve experienced 15% or more of a total body
surface area that is burned will have an increase in capillary permeability and will most likely need fluid
replacement. (Diver, 2008). This calculation helps determine that total amount.

Why Lactated Ringer’s? It’s an isotonic solution that will help expand the intravascular compartment,
which is essential with this type of injury because the fluid in the intravascular compartment is moving
into the interstitial tissues……leading to a risk of hypovolemic shock.

Note: To use the Parkland Burn Formula, you must know how to calculate the total body surface area
that is burned. If you don’t know how to do this, check out my review on the Rule of Nines (it makes
calculating TBSA so easy).

How is the total amount of fluid administered? 1/2 during the first 8 hours and then the other 1/2
over the next 16 hours to equal 24 hours

Let’s do a practice problem:

A 46 year old male patient has partial-thickness burns on:

 Anterior head and neck

 Front and back of left arm
 Front of right arm
 Posterior Trunk
 Front and back of right leg
 Back of left leg
The patient weighs 180 lbs. Using the Parkland’s Burn Formula to calculate fluid replacement, calculate
the hourly fluid rate (mL/hr) for this patient over the next 24 hours?

Answer: 1st 8 hours: 1,292 mL/hr and next 16 hours: 646 mL/hr (total amount: 20,664 mL)

Rationale:

63% TBSA burned

180 lb….divide by 2.2= 81.8….82 kg

4 mL x 63 x 82 = 20,664 mL of LR total

1st 8 hours: 20,664 divided by 2 = 10,332 mL…hourly rate (divide by 8): 1,291.5…..1,292 mL/hr

Next 16 hours: 20,664 divided by 2 = 10,332 mL….hourly rate (divide by 16): 645.75……646 mL/hr

More Parkland Formula Practice Questions

Useful Conversion Table for Nurses & Nursing Students

19. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml

1 cup= 8 oz


1 quart= 2 pints


1 pint= 2 cups


1 gr (grain)= 60 mg


1 g (gram)= 1000 mg


1 kg= 2.2 lbs


1 lb= 16 oz

 1 milliliter (mL)=1 cubic centimeter (cc)

 1 teaspoon (tsp)= 5 milliliters (mL)

 1000 (mL)= 1 Liter (L)

 3 teaspoon (tsp)= 1 tablespoon (Tbsp)

 1000 (mcg)= 1 (mg)

 2 tablespoons (Tbsp)= 1 ounce (oz)

 1000 Grams (G)= 1 Kilogram (Kg)

 30 milliliters (mL)= 1 ounce (oz)

 1000 (mg)= 1 Gram (G)

 2.2 pounds (lb)= 1 Kilogram (Kg)

 1 tablespoon (Tbsp)= 15 (ml)

 Hallmark Signs of Symptoms
1. PTB( pulmonary tuberculosis)– low-grade
afternoon fever.
 (facial spasm).
2. PNEUMONIA – rusty sputum.
3. ASTHMA – wheezing on expiration.
4. EMPHYSEMA – barrel chest.
5. KAWASAKI SYNDROME – strawberry tongue.
6. PERNICIOUS ANEMIA – red beefy tongue.
7. DOWN SYNDROME – protruding tongue.
8. CHOLERA – rice watery stool.
9. MALARIA – stepladder like fever with chills.
10. TYPHOID – rose spots in abdomen.
11. DIPTHERIA – pseudo membrane formation
12. MEASLES – Koplick’s spots are red spots with
blue center, usually in the mouth
13. SLE – butterfly rashes.
14. LIVER CIRRHOSIS – spider like varices.
15. LEPROSY – lioning face.
16. BULIMIA – chipmunk face.
17. APPENDICITIS – rebound tenderness.
18. DENGUE – petechiae or (+) Herman’s sign.
19. MENINGITIS – Kernig’s sign (leg flex then
leg pain on extension), Brudzinski sign (neck
flex = lower leg flex).
20. TETANY – hypocalcemia (+) Trousseau’s
sign/carpopedal spasm; Chvostek sign
21. TETANUS – risus sardonicus.
22. PANCREATITIS – Cullen’s sign (ecchymosis of
umbilicus); (+) Grey turners spots.
23. PYLORIC STENOSIS – olive like mass.
24. PDA – machine like murmur.
25. ADDISON’S DISEASE – bronze like skin
pigmentation.
26. CUSHING’S SYNDROME – moon
face appearance and buffalo hump.
27. HYPERTHYROIDISM/GRAVE’S DISEASE –
exopthalmus.
28. INTUSSUSCEPTION – sausage shaped
mass, Dance Sign (empty portion of RLQ)
29. MS – Charcot’s Triad (IAN)
30. MG – descending muscle weakness
31. Guillain Barre Syndrome – ascending muscle
weakness
32. DVT – Homan’s Sign
33. CHICKEN POX – Vesicular Rash (central to distal)
dew drop on rose petal
34. ANGINA – Crushing stubbing pain relieved by
NTG
35. MI – Crushing stubbing pain which radiates to
left shoulder, neck, arms, unrelieved by NTG
36. LTB – inspiratory stridor
37. TEF – 4Cs’ Coughing, Choking,
Cyanosis, Continous Drooling
38. EPIGLOTITIS – 3Ds’ Drooling, Dysphonia,
Dysphagia
39. HODGEKIN’S DSE/LYMPHOMA – painless,
progressive enlargement of spleen & lymph tissues,
Reedstenberg Cells
40. INFECTIOUS MONONUCLEOSIS – Hallmark: sore
throat, cervical lymph adenopathy, fever
41. PARKINSON’S – Pill-rolling tremors
42. FIBRIN HYALIN – Expiratory Grunt
43. CYSTIC FIBROSIS – Salty skin
44. DM – polyuria, polydypsia, polyphagia
45. DKA – Kussmauls breathing (Deep Rapid RR)
46. BLADDER CA – painless hematuria
47. BPH – reduced size & force of urine
48. PEMPHIGUS VULGARIS – Nikolsky’s sign
(separation of epidermis caused by rubbing of
the skin)
49. GERD – Barretts esophagus (erosion of
the lower portion of the esophageal mucosa)
50. HEPATIC ENCEPHALOPATHY – Flapping tremors
51. HYDROCEPHALUS – Bossing sign (prominent
forehead)
52. INCREASE ICP – HYPERtension BRADYpnea
BRADYcardia (Cushing’s Triad)
53. SHOCK – HYPOtension TACHYpnea
TACHYcardia
54. MENIERE’S Disease – Vertigo,
Tinnitus
55. CYSTITIS – burning on urination
56. HYPOCALCEMIA – Chvostek &
Trosseaus sign
57. RETINAL DETACHMENT –
Visual Floaters, flashes of light,
curtain vision
58. GLAUCOMA – Painfull vision loss,
tunnel/gun barrel/halo vision
(Peripheral Vision Loss)
59. CATARACT – Painless vision loss,
Opacity of the lens, blurring of vision
60. RETINO BLASTOMA – Cat’s eye
reflex (grayish discoloration of pupils)
61. ACROMEGALY – Coarse facial
feature
62. DUCHENNE’S MUSCULAR
DYSTROPHY – Gowers’ sign (use of
hands to push one’s self from the
floor)
3. ULCERATIVE COLITIS – recurrent bloody
diarrhea
6
4. LYME’S DSE – Bull’s eye rash
Basillar Fracture – Ottorhea
Orbital Fracture – Battle signs & Raccoon’s Eye
 19
Injection Sites
IM
• Vastus Lateralis for 6 months infants
• Ventrogluteal for Toddlers above 18 months
• Deltoid & Gluteus Maximus for Children

Tuberculosis
• If a TB patient is unable/unwilling to comply with tx they may need supervision (direct
observation).

• TB is a public health risk.

PPD is positive if area of induration is:

>5 mm in an immunocompromised patient

>10 mm in a normal patient

>15 mm in a patient who lives in an area where TB is very rare.

A positive ppd confirms infection, not just exposure. A sputum test will confirm active
disease.

Ventilators

• Complications of Mechanical Ventilation: Pneumothorax, Ulcers

HOLD

High alarm – Obstruction due to incr. secretions, kink, pt. coughs, gag, or bites the tubing

Low press alarm – Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops
spontaneous breathing

Thoracentesis:

• Pre Op – Take V/S, shave area around needle insertion, move the patient into tripod
position over a bed table, while holding a pillow
• During – Withdra w no more than 1000cc at one time
• Post Op – Listen for bilateral breath sounds, V/S, check leakage, sterile dressing.

* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40


* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.


119. Milieu therapy= taking care of patient/environment

120. cognitive therapy= counseling
Crisis intervention=short term
Brompton’s cocktail is prescribed to help relieve pain in
patients who have terminal cancer

For nasotracheal suctioning, the nurse should set wall suction for an
infant, at 50 to 95
for a child 95 to 115 mm ,
for an adult. or 80 to 120 mm Hg