Test 1 Review

-Putting Pieces together only

-only understand insulin why and when we give it

Nutrition

-BMI Levels and what is a healthy BMI vs. not healthy

Ex: BMI 38: what interventions? No sweets, exercise, be more mobile, because it will play into heart
problems and heart is trying to pump higher, much know HDL and LDL numbers!!!!

Heart Healthy Diet: heart patients, cardiac.

-know that sodium isn’t their friend

-no processed food, canned goods are bad, eat fresh veggies!

Lasik, furosemide: know when you give it – IV is instant, PO is more for heart failure patient and at home

-promotes faster urination

-watch that they are okay, especially their electrolytes!

Diabetes: have it in metabolism and nutrition! Must know

-sliding scale

-how to draw up NPH and regular together: air into NPH and then Regular, then draw up

-know the peaks for the insulin types (when to watch for hypoglycemia)

-signs of hypo: drenched in sweat

-signs of hyper:

Sweaty/thirsty: get blood sugar and see if that is the problem.

-what can make a person who’s not a diabetic and diabetic: certain meds

-due to steroids blood sugars can spike!!

TPN or a Tube: exemplar – know about the skill itself, as well as why they are having it

-check residuals

-when and why do we hold it

-know how to give meds through tube

Infant: how do we know they are getting enough nutrition

How many diapers in 1 hour? 4 wet diapers, we know that they are eating and functioning.

If not, they are in failure to thrive

Bottle feeders’ vomit: slow down the feeding, and burp baby more.

-eating too fast and getting too much air and cause malabsorption.

PUD: antiacids (omeprazole), Protonix (PPI – pantoprazole), PPI (IV calculations)

-make sure to give before they eat, so it works on the stomach acid (patient education)

Read through

Your patient has been taking aspirin, and they have a peptic ulcer, so you educate patient on why they
need to stop.

NG Tubes: are for bowl obstruction or pancreatitis, where you need to keep everything out of the
stomach, know how to put NG tube in, know that it’s to keep stomach empty.

-semi fowlers, on aspiration precautions, have suction in case they are aspirating

How to know if hemorrhaging: low BP, tachycardia

-Give bolus of fluid to increase BP fast, turn then Trendelenburg (want to flow to heart)

Hypovolemia: dehydration

-give IV line, strict I/O

-perforation in bowel? Stomach is rigid, red flag call HCP!

-know the emergencies and know what to do!

-which patients to see first and which to see last!

GERD: picking up stomach acid

-need to be sitting up right 4 hours after they eat so stomach has time to settle and not come up.

-no alcohol and carb beverages

-lose weight if overweight

-can put bed on blocks, increase incline of head

-eat small frequent meals throughout day

-similar interventions for any gastric issues.

-no spicy food or chocolate!

-know the patho behind each disease.

Do know what the weight gain difference is between the bottle- and breast-fed baby

-not okay for mom to add water to pre-made formula!

-breast milk is best because “immunity”

-don’t put them down for not wanting to breast feed, just encourage and teach them, and let them let
them make that decision.

Nutrition: don’t spend too much time on it

Metabolism: spend a lot of time on it!

Gestational diabetes: when we test 24-28 weeks, glucose to drink to see if you are GD

Which insulin will we give on insulin drip, regular only!!!!!

If BS drops to 60, give fast acting carbs or OJ, re-check BS 15 min, always re-assess after intervention.

-check BS before meals to know where they are at as far as level

Type 2: just found out, what is the teaching

-lose weight

-diet and exercise

-change your lifestyle

-or congratulations you get insulin the rest of your life

#1 teaching: will have to see podiatrist, check feet daily to make sure no ulcers or breakdown

-avoid injury, because wound healing is a lot longer for them

Thyroid Gland: memorize 1 of them and the other side is exact opposite

-hyper: everything is hyper, tachycardia, sweaty, increases temp, Graves’ disease: running into the grave

-skinny, crack cocaine, high HR, low BP, irritable, eyeballs bulging out of head (graves)

-hypo: fat, obese, dull personality, tolerate heat but not cold, BP and pulse is low, HR low and Synthroid
(antithyroid), will have surgery, give or not give if NPO: give it or myxedema coma will happen!

Take Synthroid for rest of life!

-thyroid storm: after taking out thyroid gland probably, S&S (on HESI too)

-lights are dim, keep visitors away, don’t keep closer to nursing station because loud, keep environment
very cool, and make sure they eat more than 6 time high calorie meals.

-what after thyroidectomy: monitor if they can still swallow and no swelling or airway is not closing.

-check for dressing, no infection or bleeding.

-iodine: need it in table salt and why

(don’t go to concept on prep you, do the chapters that pertain to what you are doing. do questions on
drugs from pharm book) They will be on lecture exams!!
(go back to raise the bar, look after exam if wasn’t tests on exam, then be prepared for it to be on
comprehensive)

Comfort:

Sickle Cell: pt in ER, we are nurse, they have sickle cell crisis, what to do first: give fluids first by bolus,
then pain meds. We need to get fluids moving and increase hydration***

Post Op Pain: acute pain, try non-pharm pain management as well.

-opioids: look out for sedation, constipating, breathing

Make sure to re-assess constantly.

-always order things for constipation, polyglycol or stool softener

PCA Pump: have some constipation remedy for that patient

-need patients out of bed to prevent DVT, skin breakdown

Distraction, ice, imagery.

Renal Calculi: painful, need to pee it out (ACUTE)

-lithotripsy: go in and laser stones and break down but still pain. We have to strain their urine because
the stones are big (are they made from calcium or uric acid)

-antiemetic (Zofran) prior to pain med

-pain management 101: needs pain meds around the clock until passes.

Pain scale: 0-10 or FACES; always re-assess pain after medications

PVD: (CHRONIC) neuropathic pain, diabetic patient has neuropathy

-gabapentin: for neuropathy, blocks transmission through nerves

Acute pain before chronic patient! When read questions…. Which issue is it?

-opioids and non-opioids, gabapentin, non-pharm.

NIPS, FLACC, FACES, 0-10: which one we use when because they will test us on

You cannot tell patient they are not in pain; go with number and document pain level they say.

Hemophilia: injury prevention

-put bumpers on every edge

-non-contact sports – swimming, chess, piano, golf

-if injured, you as the parent bring the factor 8 or 9 with you to the hospital (clotting factor)

-all about safety

-male gender, mom is usually the carrier

Clotting: PTT value should be at and INR value

-when they go into for dental doctor needs to know

-can’t take aspirin, before after and during procedures

-medical bracelet to be aware of medical clotting problem

-elevate and mobilize joints!!! (bleeding can be in joints)

-how to give shot of clotting factor with children (self-administer)

-RICE: when joints are sore.

DVT: #1 is ambulation; lovenox (LMW heparin, pre-filled syringes)

-given daily to patients usually during the day

-early ambulation to prevent

-if suspect, do not massage leg at all or move

-S&S: notify doctor to do ultrasound, decreases pulse in leg, swelling.

-after 1 hour after hit floor up and moving!

Therapeutic ranges heparin: 2-3

Interventions: TED hose, elevate legs every 4-5 hours, mobility

-Desk job walk every 1-2 hours

-Walk in airplane if going far away

-Don’t wear restrictive clothing

-Don’t cross legs