Archer Rationales

Safety & Infection

Infectious Diseases
• Impetigo → contagious bacterial infection of the skin
▪ S/S: lesions (on face), erythema (redness of skin), pruritus (itchy skin), burning,
lymph node
▪ Contact precautions
• Increased susceptibility to illness → increases autoimmune responses
• Hep A → infection via consumption of raw or undercooked food, fecal-oral,
contaminated water
▪ S/S: N/V, abdominal pain, fever, anorexia, dark urine, scleral icterus (yellowish
pigmentation of sclera), pale stools, jaundice, pruritus
Preventing aspiration
• Chin-down position (tilt head forward, with chin down), provide rest periods during
meals, position upright 30-60 minutes after a meal, position upright 90 degrees in a
chair or HOB, oral hygiene after meals to reduce plaque secretions to decrease
pneumonia, minimize distractions – do not talk – do not rush client, alternate liquids
and bites of food, avoid mixing foods of different textures in the same mouthful,
observe for signs of aspiration (coughing, choking, gagging, drooling of food) – if noted
then suction airway
Preventing falls
• Ensuring call button is accessible and within easy reach of the client; the call light can be
clipped or secured when the client is in bed
• Completing fall risk assessment at admission or within 2 hours of admission
• Setting the bed to the lowest position
• Avoid administering diuretics and laxatives before clients sleep to reduce urgent
bathroom needs
Restraints
• Assess q 2 hours, behavioral status, skin integrity, neurovascular status (pulse, capillary
refill), continued need for restraint, can be placed without physician’s order but has one
hour to inform provider and obtain an order, should be removed via quick release
buckle
CPR
• Compress rate of 100-120 bpm
• Utilize early defib for vfib
• Carotid pulse should not exceed ten seconds
• Compression rate of 30 to 2 rescue breaths in kids its 15 to 2 if there are two people
• Should be 2 inches on the center breastbone
Miscellaneous
• Water temperature → maximum of 49 C (120 F)

Pharmacology
 • Risperidone, Lurasidone, Ziprasidone, Olanzapine, Quetiapine, Clozapine, Lurasidone,
Ziprasidone, Aripiprazole, Brexpiprazole → atypical (second generation) antipsychotic
▪ Indication: treats schizophrenia
▪ Preferred because of decreased risk of movement disorders
▪ Therapeutic response: decreased thoughts of persecution, increased mood
stability
▪ Adverse effects: extrapyramidal effects (tremors, stiff muscles, involuntary
muscle contractions (dystonia), and facial movements) especially gait
disturbances, (shuffling gait), raises glucose, weight, and cholesterol levels,
akathisia (inability to sit still), bradykinesia (slow movement)
▪ Nursing considerations: NMS (neuroleptic malignant syndrome)
▪ S/S: fever, ALOC, muscle rigidity, autonomic dysfunction
• Labs to be monitored during regular insulin IV → hourly glucose and potassium (via q4-6
hrs BMP)
▪ Insulin can cause hypoglycemia and hypokalemia
▪ Stop infusion if potassium is low and/or UOP is less than 30 mL/hr
• Tizanidine, baclofen, carisoprodol, cyclobenzaprine, methocarbamol → muscle relaxants
▪ Indication: muscle relaxant for treating of multiple sclerosis
▪ S/S: CNS depressants, drowsiness
▪ Considerations: avoid driving & don’t take with alcohol
• Mannitol → treats cerebral edema & given via filtered IV tubing
• Side effects of levothyroxine → S/S of hyperthyroidism like high intolerance, weight
loss, insomnia
• Medications used to treat opioid use disorder → naltrexone, methadone,
buprenorphine
▪ Considerations: methadone and buprenorphine may cause respiratory
depression when combined with other CNS depressants
• Rapid-acting insulin (lispro, aspart, glulisine) are given when → 10-15 mins before a
meal or with meals

Growth & Development

Hospital considerations
• Adolescents → facilitating independence in decision making by including the patient in
their care
• School-age clients → facilitating interaction among peers & emphasizing importance of
education & remaining in school
• Early teens → emphasize importance of education & remaining in school

Mental Health
Drug intoxications
• Alcohol overdose → lack of balance, nystagmus, flushed face, sedation, impaired
judgment, uninhibited behavior, talkativeness, slurred speech, impaired memory,
irritability
 • Cannabis overdose → reddened eyes, increased HR, dry mouth, hunger, loss of
coordination/balance, relaxed mood, increased perceptions, social withdrawal, paranoia
• Cocaine overdose → pupil dilation, increased or decreased in HR or BP, chills, N/V,
sweating, pacing, visual or tactile hallucinations, hyper-vigilance, agitation
Miscellaneous
• Therapeutic communication → avoid answer choices that includes “why”
• S/S of opiates overdose → pinpoint pupils, slurred speech, inattention, lethargy,
hypotension, decreased HR, reduced temp, lower respiratory rate

Fundamentals
Delegation
• UAP cannot → collect urine specimen from an indwelling catheter because it’s a sterile
procedure
• LPN can → trach suctioning, insertion of an indwelling urinary catheter, insert NG tube,
irrigation of an ostomy, tube feedings
Assistive devices
• Canes → cane should be placed on the stronger side (unaffected) side of the body
Mobility
• Active range of motion exercise →
• Passive range of motion exercise → flexing and extending client’s elbow
Non-pharmacological
• Contralateral stimulation → stimulating the skin in an area opposite to the painful site
▪ Can be in the form of scratching, rubbing, applying heat or cold
▪ Helpful if the affected area is painful to touch, under bandages, or in a cast
▪ Massage is a type of cutaneous stimulation by relaxing the muscles to reduce
pain
• TENS (transcutaneous electrical nerve stimulator) → externally worn battery-powered
device consisting of electrode pads, connecting wire, and a stimulator, pads are applied
to the affected painful area
▪ Contraindicated: burn clients
• Acupuncture → applying needles on pressure points
▪ Contraindicated: burn clients
• Acupressure → applying firm gentle pressure using fingertips on various pressure points
▪ Contraindicated: burn clients
Miscellaneous
• Orthostatic VS → supine – sitting – standing
• Indwelling catheter → irrigated with sterile water or sterile NS not top water
• Chest tube → never be clamped due to risk of increase in intrathoracic pressure which
may cause tension pneumothorax
• Log rolling → requires more than one staff and a transfer sheet
• Gait belt → used when pt. is ambulating
Maternity
Weight Gain
• First trimester → 3 to 6 lbs for three months
• Second & third trimester → ½ to 1 lb weekly
• Report weight loss to HCP
• Weight gain of 2 or more lbs each week is HIGH
• Limit weight gain to ¾ of a lb each week (3 lbs per month) to reduce maternal
hyperglycemia
Miscellaneous
• Reassuring FM → increased variability, mild variable decelerations, early decelerations
• Non-reassuring FM → FHR less than 110 or greater than 160, late decelerations, severe
variable decelerations
• Diagnostic test for ectopic pregnancy → transvaginal ultrasound
▪ S/S: unilateral abdominal pelvic pain, vaginal bleeding, positive pregnancy test
▪ Tx: unruptured is given methotrexate and ruptured is surgery
• Risk factors for breast cancer → white woman, early menarche (period before 12 years),
late menopause (greater than 55 years), nulliparity or first pregnancy after 30 years,
gene mutations, birth control, atypical hyperplasia, fibrocystic changes
▪ Primary prevention: normal BMI, exercise regularly, smoking cessation,
moderation of alcohol intake
▪ Secondary prevention: mammography beginning yearly at age 45
• Group more likely to die from breast cancer → black woman younger than 40 years
• S/S of preeclampsia → hyperreflexia, HA, epigastric pain

Med-Surg
Neuro
Lobes of the Brain
• Frontal lobe → cognitive function (thinking, planning, organizing, problem solving,
emotions, behavioral control, personality)
• Parietal lobe → perception, math, spelling, logic
• Occipital lobe → vision
• Temporal lobe → memory & understanding language
• Cerebellum → balance
• Broca’s area → expressive language (unable to express self & answer correctly)
• Wernicke’s area → receptive language (can’t understand words)
Miscellaneous
• S/S of sudden-onset HA described as the “worst HA of my life” → confusion, nuchal
rigidity (neck stiffness), age greater 50 years or younger than 5 years, HTN, fever
▪ Indicates bacterial meningitis
• Stereognosis → test to see if pt. can recognize the size, shape, and texture of an
object by close their eyes, place, and object in their hand, and ask them to identify it
without using their vision
 ▪ Example: having pt. close their eyes and place a toothbrush in their hand to
see if they can state that it is a toothbrush
▪ Nursing considerations: in clients with dementia, they would fail due to the
inability to recognize (or use) the object called agnosia (inability to interpret
sensations and recognize things)
• Romberg test → determines if the client can maintain balance with closed eyes by
having the client walk on their tiptoes and heels for at least ten feet with touching
the tip of their nose with their right index finger and return the arm to an extended
position
• Most probable cause of sepsis in a paraplegic who is wheelchair bound → pressure
ulcers due to wheelchair use
• Assessment findings following cervical spinal surgery → client will be placed in a c-
collar
▪ Expected: active range of motion in both arms, scant drainage on the
dressing, soreness at the operative site
▪ Unexpected: numbness and tingling in upper extremities, diminished
sensations, difficulty swallowing, decreased motor strength, respiratory
depression, reduced active range of motion (REPORT TO HCP)
• S/S migraine HA → unilateral frontotemporal pain, N/V, photophobia, phonophobia,
ALOC, dizziness, numbness, tingling sensations
• Myasthenia gravis → impairs facial and eye muscles
▪ S/S: diplopia, ptosis, facial muscle weakness
▪ Complications: respiratory failure
Respiratory
• Priority nursing diagnosis for impaired oxygenation because of asbestos fibers →
impaired gas exchange because the fibers move into the alveolar space causing fibrosis
leading to increased production of secretions thus impairing gas exchange so nurse
would need to suction
Cardiac
• Complication of rheumatic fever during pregnancy → can lead to cardiac stress can
cause formation of valvular lesions
• Nurse first action if unable to palpate clients pulse following cardiac catheterization →
recheck pedal pulse with doppler
• Interventions for post-op cardiac cath → assess pulse distal to puncture site, monitor for
hematoma formation at the puncture site, position HOB flat or no more than 30
degrees, hold metformin for 48 hrs post-op
Nutrition
• Foods high in iron → roast beef, egg yolks, wheat bread, carrots, green leafy vegetables,
raisins, chicken, pork chops
Endocrine
• IV fluid tx for Addison crisis → NS or D5NS
Miscellaneous
• Common areas of metastasis in bladder cancer → lung, liver, bone, pelvic structures
 • Common areas of metastasis in breast & lung cancer → brain

Children
• Encopresis → voluntary or involuntary fecal incontinence in children over the age of 4
who were previously toilet trained
• Intussusception → one part of intestine goes into the other part S/S: abdominal pain
• Hirschsprung disease → not passing meconium within the first 48 hrs of life can indicate
this, caused by inadequate motility
• cystic fibrosis → meconium ileus presents within few hours of birth with bilious emesis
after the first feeding, thick mucus in lungs & pancreas S/S: lung issues

Elderly Client
• Polypharmacy → check for duplication in medication before checking for drug
interactions and side effects from medications

Critical Care
• NG tube placement → secure tube before sending client to x-ray
▪ Explain produce to client, place client in a high-Fowler’s position and place
pillows behind the shoulders, measure the tube length from the nose to the
earlobe to the xiphoid process, insert lubed nasogastric tube into the clients
nostril, once the tube enters the back of the throat then the client should take a
few sips of water to, then tube is advanced into the stomach, once it is inserted
it should be secured to the patient’s nose with tape

Dosage-calculations
• 1 mL= 30 oz
• 1 cup= 8 oz or 240 mL

Fluid & Electrolytes

• Insensible fluid loss → client unaware (ex: sweating & tachypnea)
• Sensible fluid loss → client is aware (ex: V/D, urination, wound drainage)