RoadMap to Ara Aas A x Y y \ 5 yeT NTY vu Welcome to RoadMap to NCLEX®. A study guide that enables you to conquer your accomplishment as a nurse. In the next succeeding routes of this work are the vital parts towards passing the NCLEX®. It comprises high probability topics which are translated into easier comprehension such as highlighted “pinned facts” and images from various sources of learning in the nursing profession. Certainly, visual tool has an impact to effective learning to most nurses according to many studies, and ultimately headed for effective and safe nursing practice in the future. “Commit to the Lord whatever you do and all your plans will succeed” Proverbs 16:3i _ Know the NCLEX Computer Adaptive Testing ae Passing Level (line of minimum competency) Question Difficulty As you answer a question, the computer determines your competency based on the answer you selected. If you selected a correct answer, the computer scans the question bank and selects a more difficult question. If you selected an incorrect answer, the computer scans the question bank and selects an easier question until you meet the PASSING standard or otherwise a failing mark. There are 75 — 265 number of questions and as long as 6 hours to complete the exam.CSBN Test Plan Physiological Adaptation 0% Management af Care 20% Racuetian of isk Potential 12% Safety aod infection Cantal 2% Pharmacological and Parental Therapies Health Promotion and Maintenance: % Basie Care and Comfort. We Type of question . Multiple Choice . Ordered Response (Place the sequence in order) . Select all that apply (SATA) . Fill in the blank (usually computations) . Drag and drop . Hotspot (place the cursor over the area on the diagram that does the selected action) . Chart/Exhibit . Graphic Option . Audio The NCSBN provides specific directions for you to follow with all question types to guide you in your process of testing. Be sure to read these directions as they appear on the computer screen before you start answering the graded exam. tgsri | eee) a Pass with 75 questions as much as possible. To pass with 75 questions you will most likely need to answer more difficult and multiple response questions correctly like the BEAST “Select All That Apply.” The key to slay this is to be a master of the content! Don't panic if you exceeded the minimum 75 item. The goal is to pass the exam, so take a break and relax before you answer the next succeeding questions. In 2012, the average number of Items (questions) administered per candidate was around 119 on the NCLEX-RN and 117 on the NCLEX-PN. Gy se It's important to know your strong and weak concepts for you to’ focus on. Itis not good to hope that it would not come out during exam, the secret is focus on your weakness and maximize you strengths. NCLEX® knows how to target weak points by throwing more questions until you hit their standards.\_ Apply test strategies | ¥ Don't start being anxious and especially don't pani v You don't need to read extra meaning to the question. v Look for keywords and phrases to help you understand. ¥v Interpret the question correctly first before reading into the choices. v Read the stem correctly and notice, is it asking for the best response or the initial response ¥ Understand what the question is asking before considering the distracter. ¥ Rephrasing technique translates the question into your own words. Y lsolate choice that is relevant from what is not. ¥ Judge all four alternative choices/options against the stem and not against one another. v Use the process of elimination, cross out those variables that are incorrect.ri | eee) U vy When you come across a difficult question and you cannot immediately identify the answer, go back to your body of knowledge and draw all the information that you do know about the condition. Even though you do not know exactly what to do, you might know what not to do v fone is the exact opposite of another (e.g. complete bed rest is different from activity as tolerated; both cannot be correct since they are of opposites), choose the one that seems to be most logical. v_ lf you cannot choose an alternative, use your intuition. Let yourself feel which alternative might be right. Remember, it's better to choose one answer than none at all. Do we depend on this “hunch?" (Intuition). Current studies supports that hunches are often correct, for they are based on rapid subconscious connections in the brain.f eee rd Y So, if you have an initial hunch, go with it! Do not change the answer if and only if, upon reflection, it just doesn’t seem right. (If you are taking NCLEX®, you can take time as you want, but do not dwell too much.) v Remember, this is a nursing test and questions are designed to test your nursing competency and safety. ¥ It is unlikely that a question would require a medical action for the correct answer; it may, however offer these actions as distracter. v Beware of answers that contain specific qualifiers, such as “always’ and “never,” they rarely fit within a logical framework. ¥ Content is King: “Select all that Apply” (SATA) format questions are very much like a “T & F” quiz you may have taken during nursing school. Unfortunately, there is no short cut to preparing for the SATA questions, a candidate just has to have enough content.eee Wt Soon Heart rate: 80-100 bpm Respiratory rate: 12-20 rom Blood pressure: 110-120/60-70 mmHg Temperature: 37 °C (98.6 °F) T (°C) = (T (°F) - 32) x 5/9 T (°F) =T (°C) x 9/5 + 32 ml 1 tablespoon (T) = 3t=15 ml 1 gram (g) = 1,000 mg 1mg= 1000 mcg (Re RSSaRnER 1 kilogram (kg) = 2.2 Ibs 1 mg= 65 grain (gr) 1 lb = 16 oz 10z=30ml 1 cup = 240 ml 1 cup =8 oz 1 quart = 2 pints 1 pint = 2 cups imeter=3.28 tect Simmri | eee) Ww i Hematologic : RBCs: 4.5—5.0 million : WBCs: 5,000—10,000 ' Platelets: — 200,000—400,000 i Hemoglobin (Hgb): i 12—16 gm (f) 3 14—18 gm (m) j Hematocrit (Hct): j 37—47 (f) 40— 54 Never Let Monkeys Eat Bananas. Neutrophils: [ENE 54 - 62% Lymphocytes: 25 — 32% Monocytes: [JERS 3-7% Eosinophils: Ea 1-3% | Basophils: Bananas| <0.75%ri | eee) Ms Normal Values Serum Electrolytes Sodium: 135 -145 mEq/L Potassium: 3.5 - 5.5 mEq/L Calcium: 9 -10.5 mEq/L Chloride: 90 - 110 MEq/L Magnesium: 1.7 - 2.2 mEq/L Phosphorus: 3- 4.5 MEQ/L ABG Values pH: 7.35—7.45 HCO3: 22—26 mEq/L co2: 35—45 mEq/L PaO2: 80—100 mmhg Sa02: >95% Anticoagulant Therapy §§imusiBelmemonzedyy) £ Heparin aPTT: 30-40 sec (more sensitive) (1.5 - 2X is therapeutic) PTT: 25 — 35 sec (less sensitive) (1.5 - 2.5X is therapeutic) > Ezri | eee) ug Normal Values Warfarin (Coumadin) PT: 10—12 sec (1.5 - 2X is therapeutic) INR: 0.9—1.2 (upto 3X is therapeutic) : Chemistry Ammonia: 15-110 ug/dl AST (Aspartate Aminotranferase): 10—S50 IU/L ALT (Alanine Aminotransferase): 5—35 IU/L LDH: 100-190 U/L Albumin: 3.5—5.0 g/dL Total Protein: 6-8 g/dL Bilirubin: <1.0 mg/dL Total Cholesterol: <200 mg/dL Triglyceride: <150 mg/dL HDL (Good Cholesterol): >45 mg/gl (m) >50 mg/gl (f) LDL (Bad Cholesterol): 60—80 mg/dl Glucose: 70—110 mg/dL (+18 for mmol/L)ri | eee) Mo Normal Values HBAIC: < 7% Good control > 9% Poor Control > 12% Very Poor Control BUN: 10 - 20 mg/dL Serum creatinine: 0.5 - 1.5 mg/dL Specific Gravity: 1.010 - 1.030 Uric acid: 3.5 - 7.5 mg/dL Acute Coronary Syndrome (AMI) In order rising: Myoglobin: 0 - 85 ng/ml Troponin: <0.6ng/ml AST: 10 - 50 1U/L CPkK: 12-70 U/ML (m) 10 - 55 U/ml (f) LDH: 100 - 190 U/L Heart failure: B-Type Natriuretic Peptide (BNP): <125 pg/mL (0-74 YO) <450 pg/mL (75-99 YO)eT NTY 9 al Values Hemodynamics / Pressures (mmHg): 5 CVP: 6-12 mmHg PAP: 20 - 30 mmHg PCWP: 8-13mmHg : ICP: 0-10 mmHg «IOP: 12-15 mmHg Pulmonary Artery Catheter Thennistor Inocate KW PA Diatal Port RA Proximal Port <8 Thoristor Connectioneee Wt mal Values Drug Therapeutic Levels Carbamazepine (Tegretol): 4—10 mcg/ml Phenobarbital : 15—40 mcg/mL Digoxin (Lanoxin): 0.8—2.0 ng/ml Theophylline (Aminophylline): }—§ 10—20 mcg/dL Phenytoin (Dilantin): 10—20 mcg/dL Valproic Acid (Depakene): 50—100 mcg/ml Lithium (Eskalith): 0.5—1.5 mEq/L (Acute/Adult) 0.6—1.2 mEq/L (Maintenance) 0.4—1.0 mEq/L (>65 YO) $108 meq TESS Vancomycin: 20 -- 40 mcg/ml (peak) | amin afters dose 5-15 mco/ml trough) ITS aaa Magnesium Sulfate: 4 to 8 mg/dl 8-10 Absence of reflexes 10 - 12 Respiratory depression > 15 Respiratory depression | Mustbeintubated £ tgseee Wt 5 U- Safe Level 10 U-Toxic Level 70 - Medical Emergency Carbon Monoxide 10 to 20% (Headache) > 20 % (Generalized weakness) > 30% (Chest Pain) > 40% (Seizure, unconsciousness) > 60% (Coma - Death) 50 - 100 mg /ml : Infant - Choking | Toddler — Poisoning . Preschooler — Drowning School age - Vehicular Accidenteee Wt Child Safety The safest place for all children to ride, regardless of age, isin the back seat of the car. Lock the car doors; 4-door cars should be equipped with child safety locks on the back doors. Do not leave the infant unattended in the bath. Check for water temperature. Do not hold the infant near hot liquids or items. Use cool vaporizers instead of steam should if needed, to prevent burn injuries. Prevent choking by avoiding round shaped food or similar to the size of the airway. Toys must have no small parts. Toys hanging over the crib should be out of reach, to prevent strangulation. Avoid placing large toys in the crib because an older infant may use them as steps to climb. Cribs should be positioned away from curtains Cover electrical outlets. Remove chemicals such as cleaning or other household products, medications, poisons, and plants from the infant's reach. Toddlers need to be supervised at play to ensure safety. Keep all medicines, poisons, household plants, and toxic products in high areas and locked out of reach. Teach a preschooler and school-age child to leave an area immediately if a gun is visible and to tell an adult. Children should always wear a helmet when riding a bike or using in-line skates or skateboards. Teach the child water safety rules.ri — eee) 1 Maternity se jotic fluid: 500—1000 ml > 1500 ml Polyhydramnios < 500 ml! Oligohydramnios Additional calorie intake: Pregnancy- 300 kcal/day Lactating - 500 kcal/day Weight gain: First trimester— 1 lb/month 2nd Trimester— 1 lb/week 3rd Trimester- 1 Ib/week Protein Intake 65 g/dl (Pre-pregnant) 45 — 50 g/dl (Female) 65-70 g/dl (Male)eT NTY ed Maternity Stages of Labor 1. Cervical Dilatation (Dilatation - Duration - Interval) Latent: 0-3 cm - 20-40 secs - 5— 10 mins Active: 4-7cm- 40 - 60 secs - 3-5 mins Transitional: 8 — 10 cm — 60 - 90 secs — 1-3 mins 2. Expulsion of baby Hallmark: = Crowning RBOW: Primi 10 cm Multi 7-8 cm 3. Placental Separation Calkin’s sign (Globular shape of abdomen) Sudden gush of blood Lengthening of cord Schultz Mechanism — shiny inverted umbrella Duncan Mechanism - Raw red umbrella 4. Immediate post-partum (1 - 4 hrs) Lochia — Psychological Task Rubra: 1-3 days - Taking In - physiologic need Serosa: 4-10 days Taking Hold - accepting status Alba: 11-20 days Letting Go - adapted to roles tgseT NTY ral Maternity Fetal Heart Monitoring: IVEAL CHOP| Variable deceleration Cord compression Early deceleration Head compression Acceleration Okay! Late deceleration Poor placental perfusion 2 ero : ld a a A Lee Br Aes Variable ine fabasib wont fu H Le oa LE nn» ES Early onoat i- @f | eee Wt Maternity Fetal Heart Rate Heaby acnleaton eA. Normal Range: 120-160 bpm Contractions Late reconery ** ae 825 gaeee Wt Maternity STOP — Treatment for (STEVENS * — Stop infusion of Pitocin. * Turn the client on her left side. | ¢ Administer Oxygen. * — If hypovolemia is present, Push IV fluids | Pregnancy Categories of Digs $E Category A: No risk in controlled human studies Category B: No risk in other studies. Examples: Amoxicillin, Cefotaxime. Category C:Risk not ruled out. Examples: Rifampicin, Theophylline Category D: Positive evidence of risk. Examples: Phenytoin, Tetracycline. Category X: Contraindicated in Pregnancy. Examples: Isotretinoin (Accutane) Category N: Not yet classified tgseT NTY re} Acute Glomerulonephritis: Low Na, low protein Addison's disease: High Na, low potassium ADHD: High-calorie, finger foods Bedsore: High Protein, High Vitamin C Bipolar Disorder: Finger foods Burns: High protein, high caloric, high Vitamin C. Cancer: High-calorie, high-protein. Celiac Disease: Gluten-free diet (no BRW: barley, rye, and wheat) Cholecystitis: High protein, High carb, Low fat Chronic Renal Disease: Low protein, low Na & K, Low Phosphate, fluid-restricted Cirrhosis (stable): Normal protein Cirrhosis with hepatic insufficiency: Low protein, Low Sodium Constipation: High-fiber, increased fluids COPD: Soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings Crohn's disease: High protein, High Carb, low fat Cushing's disease: High potassium, Low NaPry eee Wt ystic Fibrosis: High fluids & Na, High Calorie Cystitis (Stones): Acid ash for alkaline stones (Uric, Cystine), Alkaline ash for acid stones (Calcium, Struvite), Increase OFI Diarrhea: Liquid, low-fiber, regular, fluid & electrolyte replacement Diabetes Mellitus: Balanced Diverticulitis: Low residue Diverticulosis: High Residue Dumping Syndrome: High Fat, High Protein, Drink 30 - 60 minutes before or after meals (No fluids with meals) Gallbladder diseases: Low fat, Low Calorie, regular Gastritis: Low-fiber, bland diet Gouty Arthritis: Low purine Hepatitis: regular, high-calorie, high-protein Hirschprung’s: High Calorie, high protein, low residue Hyperlipidemias: Fat-controlled, Low calorie perparathyroidism: Low calciumeT NTY ms Hypertension, CHF, CAI tt controlled Hyperthyroidism: High calorie, High protein Hypoparathyroidism: High Calcium, Low Phosphate Hypothyroidism: Low calorie, low fat Kawasaki disease: Clear Liquid Meniere's disease: Low Na Nephrotic Syndrome: Low Na & Potassium, high calorie & protein Osteoporosis: High Calcium, High Vitamin D Pancreatitis: Low-fat, regular, small frequent feedings; tube feeding or TPN Peptic ulcer: Bland, High Carb, Low protein Phenylketonuria: Low Phenylalanine protein Pregnancy Induced Hypertension (PIH): High Protein Pernicious Anemia: High Vitamin B12 (Cobalamin), (shellfish, beef liver, and fish) Renal Failure (Acute): High Protein, high-calorie, fluid-controlled, sodium and potassium controlled. Low Na, Low-calorie,fa:Py eee Wt ow Na & Potassium, Low f Renal Failure (Chronic i protein Sickle Cell Anemia: Increase fluids to maintain hydration Stroke (CVA): Mechanical soft, regular, or tube- feeding Abdominal Aortic Aneurysm (AAA): Increased BUN, Creatinine Acoustic Neuroma: Caloric Stimulation (-) Nystagmus Acromegaly: Increased HGH Acute Glomerulonephritis: Increased BUN, Creatinine, ASO Titer Acute Pancreatitis: Increased WBC, amylase, lipase, decreased calcium and Mg Acute Renal Failure: Increased BUN, Creatinine tgseT NTY ms Laboratory & Diagnostic abnormalities Addison's disease: HyperK, HypoNa, Hypoglycemia AIDS: (+) ELISA, Western Blot Allergic Reaction: IgE, increased eosinophils, decreased basophils Anemia (Pernicious): Increased LDH Anemia (Sickle Cell): Decreased RBC, dec. ESR, decreased or normal HgB, Increased WBC Anorexia Nervosa: HypoK, Hypoglycemia Appendicitis: Slightly Increased WBC Arthritis (Gouty): Increased Uric acid Arthritis (Rheumatoid): Increased ESR, ANA (+) Aspirin Toxicity: Respiratory Alkalosis - Meta Acidosis Asthma: Increased IgE, Respiratory Acidosis Bipolar Disorder: Increased Norepinephrine & Serotonin(Mania), decreased in (depression) Bulimia: Hypokalemia, Hypoglycemia Burns: Hyperglycemia, Hyperk, anemia Cancer (Bladder): Increased Serum acid phosphatase Cancer (Colon): Carcinoembryonic Ag — Tumor marker Cancer (Prostate): Increased acid phosphatase & PSA Cancer (Testicular): Increased HCG, AFP tgseT NTY rad Laboratory & Diagnostic abnormalities Cardiogenic Shock: Increased BUN, Creatinine, Liver enzymes Chronic Renal Failure: Increased Creatinine Congestive Heart Failure: Increased CVP (Right Sided Failure), Increased PAP, PCWP (Left Sided) Increased B-Type Natriuretic Peptide (BNP) Cretinism (Hypothyroid in Children): Decreased 1314, Increased TSH Cushing’s syndrome: Increased Cortisol, HyperNa, HypoK, HPN, Hyperglycemia Cystic Fibrosis: Increased Sweat Chloride Cystitis: C/S E. Coli Delirium Tremens: >2% alcohol level Diabetes Insipidus: HyperNa, HypoK, Decreased Urine Specific Gravity, Decreased Urine concentration Disseminated Intravascular Coagulation (DIC): Prolonged PT, PTT Down Syndrome: Decreased AFP (Amniocentesis) Endocarditis: Increased ESR Gestational DM: Increased GTT, FBS Guillain Barre Syndrome: Increased Protein (CSF) Hemophilia: Prolonged PTT Hepatitis: Increased AST, ALT tgs30 eee Wt Laboratory & Diagnostic abnormalities Hepatic Encephalopathy: Increased Ammonia Hodgkin's disease: (+) Reed Sternberg Hyperparathyroidism: Increased serum calcium Hyperthyroidism: Increased 1314, decreased TSH Hypoparathyroidism: decreased Ca, increased Phos. Hypothyroidism: Decreased 1314, Increased TSH Kawasaki Disease: Increased ESR (acute) Liver Cirrhosis: Increased AST, ALT Lyme disease: Increased IgM, increased ESR Meniere's disease: Caloric Stimulation (+) moderate Nystagmus Meningitis: CSF Bacterial —- decreased glucose, increased protein, CSF Viral — Normal glucose, increased protein Meningomyelocele (Spina Bifida): Increased AFP Multiple Myeloma: (+) Bence Jones protein, hypercalcemia Myasthenia Gravis: Tensilon test (+) increased strength Myocardial Infarction: Increased cardiac enzymes, Infarction-ST elevation Ischemia — ST depression, T wave inversion Necrosis — Pathologic Q wave tgseT NTY oy Laboratory & Diagnostic abnormalities Nephrotic Syndrome: (+) Urine protein Phenylketonuria: Guthrie test - increased phenylalanine Pregnancy induced HPN (PIH): (+) Urine protein Rheumatic Heart Disease (RHD): increased ASO titer Reye Syndrome: Increased ALT, AST, prolonged PTT, PT Syndrome of Inappropriate ADH (SIADH): HypoNa, Increased Urine Specific Gravity, Increased urine conc.Ey eee Wt Common Diseases and “Memory” Signs Aphasia: Wernickes (Temporal) - Receptive Brockas (Frontal) - Expressive Ascites: fluid shifting waves Bacterial Pneumonia: rust-colored sputum. Cardiac Tamponade: Beck's Triad Hypotension Muffled Heart Sound Engorged Neck Veins Cholera: rice-watery stool and washer woman's hands (wrinkled hands from dehydration). Cytomegalovirus (CMV): Owl's eye appearance of cells (huge nucleus in cells). Diabetic Ketoacidosis: acetone breathe Diabetes Mellitus: Dawn Phenomenon (5-6am) increased glucose r/t increased Growth Hormone) Somogyi Phenomenon: Rebound hyperglycemia Diphtheria: pseudo membrane formation Harlequin Syndrome: Unilateral flushing and sweating HELLP Syndrome: Hemolysis, elevated liver enzymes, low platelet Increase ICP: Cushing's Reflex (Triad) Systolic Hypertension (Widened Pulse pressure} Bradycardia, Irregular Breathing Klinefelter syndrome: Men with XXyY, instead of XY, taller than normal : Lyme disease: Bull's Eye rash: Rounded ring Malaria: stepladder like fever with chillseee Wt Obstructive Sleep Apnea (OSA): (5-30x/hour) relaxed back throat muscle Pernicious Anemia: red beefy tongue Pregnancy Induced Hypertension (PIH): proteinuria, hypertension, edema. Pulmonary TB (PTB): low-grade afternoon fever Purple Glove syndrome: Inflammation r/t IV Phenytoin Red man syndrome: Hypersensitivity r/t fast infusion of Vancomycin Reye Syndrome: Degeneration of liver, brain and kidneys R/t intake of aspirin Sjogren's syndrome: dry eyes and a dry mouth r/t SLE and rheumatoid arthritis Steven Johnson Syndrome: Mucuos membrane and skin inflammation r/t anticonvulsants. Superior Vena Cava Syndrome: Compression of SVC, lung CA- common cause, $/S blood shot eyes Subclavian Steal Syndrome: retrograde (reversed) blood flow in the vertebral artery, decreased blood supply to brain Supine Hypotensive Syndrome: occurs when a pregnant woman lies on her back, resolves when on left side Systemic Lupus Erythematosus: butterfly rash. Tetanus: Risus sardonicus or rictus grin. Tumor Lysis Syndrome: (r/t Chemotherapy) Hyperphosphatemia, Hypocalcemia, Hyperuricemia, Hyperkalemia Turner Syndrome: Women with XO Chromosome, instead of XX - Absence of 2° sex char. webbed neck Typhoid: rose spots in the abdomen Virchow's Triad: Thrombophlebitis - Hypercoagulabllity, Vein trauma, venous stasis Von Willebrand's Disease: (-) Von Willebrand Factor EKEY eee Appendicitis: Rouvsing — RLQ Pain (Post palpation of LLQ) Blumberg — Rebound Tenderness Psoas = Hip Flexion irritation Obturator -Hip Flexion Abduction irritation pact Sere met | lliopsoas test Obturator test Abdominal Aortic Aneurysm: (AAA) Tender pulsatile abdominal mass a Arthritis (Gout): Tophi Arthritis (Osteo): Heberden’s Node — Distal joint of fingers Bouchard's Node - Proximal joint of finger \ Bouchard’s “ node tgs35 NT Arthritis (Rheumatoid): aye Swan Neck Deformity, Boutonniere’s - Both distal and proximal swan nck deformity Basilar Skull Fracture: Raccoon eyes (periorbital ecchymosis) Battle's sign (mastoid ecchymosis). es Bulimia: Chipmunk facies (parotid gland swelling) Carpal Tunnel Syndrome: Tinel’s Sign (Tapping the wrist) Phalen's Sign (Hold both wrist in flexion for 60 sec) } Cat's eye reflex: r/t Retinoblastoma Grayish pupileer eS Cholecystitis: Murphy's sign (Pain on deep palpation of liver while deep breathing) i Congenital Hip Dysplasia: Barlow's sign — out (Abduct hip joint) Ortolani's sign — in (Adduct hip joint) after barlow Trendelenburg sign - standing on one leg, the pelvis drops on the side opposite to the stance leg / Barlow j Ortolani A Papatle Disloation F ci] Down Syndrome: Goldstein Sign: space between big toe and 2nd toe Brushfield spot: White spot on the iris, Protruding tongue Simean Creaseeer wy Duchenne's muscular dystrophy: Gower's Sign: (Use of hands to push oneself to stand) FQ A = Ectopic pregnancy: Cullen's sign - Periumbilical bruising Emphysema: barrel chest Fetal alcohol syndrome (FAS) Microcephaly, short palpebral fissures, Smooth philtrum, thin upper lip Grave's Disease (Hyperthyroidism): Exophthalmos (Bulging of the eye out of the orbit).38 eee Wt Hydrocephalus: Sunset Eyes (eyes downward) Bossing sign (Prominent Forehead) Hypocalcemia: Chvostek sign — Overstimulation of facial nerve ‘> Trousseau sign - Carpopedal spasm. Kawasaki Syndrome: strawberry tongue and Scarlet Fever Loss of eyebrows: Leprosy: Leonine facies —. (Thickened folded facial skin). he Nasal collapse Lumpy earlobe “Leonine tacies" of lepromatous leprosy Measles: Koplik’s spots (Clustered white lesions on buccal mucosa)eres Se Meningitis: Brudzinski Sign - neck stiffnes upon flexion, Kernig Sign - inability to straighten the leg Upon 90°hip flexion Pancreatitis: Grey-Turner's sign — hemorrhagic discoloration of the flank Cullen's sign - hemorrhagic discoloration of the umbilicus Gillen's'and Grey Turaer's Signs in Acute Pancreatitis Patent Ductus Arteriosus: Machinery - like murmureer 0, Compare & Contrast Enlarged colon of ‘Nownal colon Hirselsprung’s Diseaseeee Wt ro) Compare & C GUILLAIN-BARRE oso on Pep Benes SYNDROME \ soe uaa an Pounce ay Guillain-Barre al ay Syndrome rman reraeer Ascending mam muscle % scours : et cn weakness ces a Poon a ae ome Myasthenia Gravis Descending muscle weakness, ptosis (drooping of eyelids)eee Wt Compare & Contrast MULTIPLE SCLEROSIS * Autoimmune «Urinary v. “ * Nystagmus Oe * Spastic Bladder + DIPL@BIA * Constipation »BLURRED VISION * Dysarthria . ‘7, may rm reso to vara * Dysphagia * . Spastcty a * Ataxia *Vertigo « & * Onset 206 to 406 Multiple Sclerosis (Neurologic) Nystagmus, intentional tremors, scanning speech ry)eer a Compare & Contrast Typical appearance of Parkinson disease zy — Masked facial 7 expression Rigidity Forward tilt of trunk Flexed elbows AMES Reduced arm yy swinging Slightly flexed hips & knees D Trembling of —//f extremities “/ rr ‘Shuffling, short- \ stepped gait Parkinson's disease Pill - rolling tremors, rigidity, bradykinesiarr eee Wt Compare & Contrast Chronic Open Angle Acute Closed Angle Glaucoma Glaucoma Trabecular meshaiork Trabecular \. meshwork Schiemm’s canal wv \ . Ssep ANGLE Giliery Aqueous ANGLE: i bod’ How GLAUCOMA Per ADVANCED GLAUCOMA Tunnel vision, Loss of peripheral visioneT NTY 5 Compare & Contrast What It's Like Macular degeneration Loss of central vision This is how a streetscene Example of a Macular looks with normal vision. Degeneration What It’s Like Cataract Blurring of vision Thisis howe street scene This is how the same looks with normal vision. scene looks with Retinal Detachment Flashes of light, shadow with curtain across vision Vision in retinal Normal detachment _ Moritorfor eve pain after eye surgeries oft 2eer nS Compare & Contrast Buerger's Disease (Arterial and Venous) — intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking) Reynaud's Disease f (Arterial) - Numbness, 1 cold, or painful fingers/toes Qo aac © rege rayeee Wt (Col anlolel—m sm Oxo MiKelyi Deep vein Thrombo: Virchow’s triad Venous stasis Hypercoagulability Vein Trauma Pulmonary Embolism Caused by dislodged clot from DVTeee Cs oo Compare & Co Arterial insufficiency Venous insufficiency ascoos vein rae, ck ‘nda sin ronzesrowa Insrmitent laseaton| plarentaton Large, nepal, Superical eer ‘sth sanage ‘hie, rete tema ‘Sil cicular, Seep leers # tgseee Compare & Co face Supracaviclar — ~sutalo humo usolo. Peds ‘wasting Cushing's syndrome Conti ~| Moon face, buffalo hump Bronz Pigmentation of kin —| Hypoglycemia Changes in —S )— Fostural Distribution Hypotension of Body Hair 8 Addison's Weight: Looe ee Gl Disturbances Weakness Bronzelike skin pigmentation Adrenal Crisis: Profound Fatigue Dehydration Vascular Collapse @BP) Renal Shut Dawn Seerum NA Serum KeT NTY 0 SIADH (Increased ADH) - Dilutional Hyponatremia, Hypokalemia, increased urine specific gravity, increased urine concentration (Decreased ADH) - Hypernatremia, Hypokalemia, Decreased urine specific gravity, decreased Urine concentration \ fe TWeai nuscae | |rtyportensin *E2eom SS | | Dry mucus membranes (tHomestotin aryekn TV) rite DICompare & Contrast Ulcerative Colitis €} Crohn's Disease Ulcerative Cots affects the Gras Disease cn ai = F entire large intestine (colon), any partof the digest —=eT NTY os Compare & Contrast DIVERTICULOSIS and DIVERTICULITIS Colon > _ e poy ~tntsmmation Diverticulosis —— Bleeding Divericla A nestines Diverticla — ‘Transverse Ostomy Locations Ascending ‘colostomy Sigmoid colostomy | Eesti tgseee Wt ¢ (40) cree oning ® Kee Above Knee Amputation: elevate for first 24 hours on pillow, position on prone daily for hip extension. Air/Pulmonary embolism: turn to left side and lower HOB Asthma: Orthopneic position, patient sitting up and bent forward with arms supported on a table or chair Autonomic Dysreflexia: sitting position (elevate HOB) first before any other implementation Below Knee Amputation: foot of bed elevated for first 24 hours, position prone daily for hip extension. Bronchiolitis: Tripod position Buck's Traction: elevate foot of bed for counter-traction. Cardiac Catheterization: keep site extended Cast: Elevate extremity to prevent edema Cerebral Aneurysm: high Fowler's Cleft-lip: position on back or in infant seat to prevent trauma_ to the suture line. While feeding, hold in upright position. Cleft-palate: prone Cleft Lip and Palate: Supine or side to prevent rubbing Detached retina: area of detachment should be in the dependent position. Dumping Syndrome: eat in reclining position, lie down after meals for 20-30 minutes tgseT NTY CS Disequilibrium Syndrome: cerebral edema, during or following shortly post intermittent hemodialysis Enema Administration: left-side lying (Sim's position) with knees flexed. Epistaxis: Lean forward Failed back syndrome or post-laminectomy syndrome: characterized by chronic pain after back surgeries Flail Chest: affected side, to facilitate expansion of unaffected lung Fracture of the neck of femur: Internal rotation of the leg with extension of the knee to promote alignment Head Injury: HOB 30° Hemorrhoidectomy: assist to lateral position. Hemorrhagic Stroke: HOB elevated 30 degrees to reduce ICP and facilitate venous drainage. Hiatal Hernia: upright position to prevent reflux Increased ICP: high Fowler's Internal radiation implant: Complete bed rest while implant is in place Intestinal Tubes: right side lying to facilitate passage into duodenum Ischemic Stroke: HOB flat. tgseT NTY es Laminectomy: back as straight as possible; log roll to move and sand bag on sides Liver Biopsy: Right side lying with pillow, or small towel under puncture site for at least 3 hours. Lobectomy: Semi fowlers to promote breathing Mastectomy: Elevate affected side with pillow Myelogram: (Water-based dye) semi Fowler's for at least 8 hours. (Oil-based dye) flat on bed for at least 6-8 hours to prevent leakage of CSF, {Air dye)Trendelenburg. Nasogastric Tubes: elevate HOB 30°, Maintain elevation for continuous feeding or lhour after intermittent feedings. Paracentesis: flat on bed or sitting. Peritoneal Dialysis: when outflow is inadequate—turn patient side to side before checking for tube kinks Post abdominal aneurysm surgery: Fowler's position Post Bronchoscopy: flat on bed with head hyperextended. Post cataract surgery: Sleep on unaffected side with a night shield for 1-4 weeks. Post infratentorial surgery (incision at nape of neck): Flat and lateral on either side. tgseT NTY eS Post Lumbar puncture: Flat for 2-3 hrs. to prevent headache and leaking of CSF. Post myringotomy: On the side of affected ear post-surgery (allows drainage of secretion). Post Supratentorial surgery (incision behind hairline): Elevate HOB 30-45 degrees. Post Total Hip Replacement: don't sleep on operated side, don't flex hip more than 45-60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separating thighs with pillows Postural Drainage: Lung segment to be drained should be in the uppermost position to allow gravity Prolapsed cord: knee-chest position or Trendelenburg. Pyloric stenosis: Right side lying after meals, to facilitate entry of stomach contents into intestines Rectal Exam: knee-chest position, Sim's, or dorsal recumbent Seizure: Side lying Shock: bed rest with extremities elevated 20°, knees straight, head slightly elevated (modified Trendelenburg). Spina Bifida: infant on prone to prevent sac rupture. tgseT NTY w Spinal Cord Injury: immobilize on spine board, with head in neutral position. Immobilize head with padded C- collar, maintain traction and alignment of head manually. Log roll client, don't allow to twist or bend Thoracentesis: sitting on the side of the bed and leaning over the table (during procedure); affected side up (after procedure). Thyroidectomy: Semi fowlers, avoid hyperflexion & hyperextension of neck to prevent tension of suture Tonsillectomy: Side lying or prone, pro mote drainage Total Parenteral Nutrition (TPN): Trendelenburg during insertion to prevent air embolism Tracheoesophageal fistula (TEF): Supine with HOB elevated 30° to minimize reflux Tube feeding for patients with decreased LOC: position patient on right side to promote emptying of the stomach with HOB elevated to prevent aspiration.eee Wt must bedside equipment Regs Amputation — Tourniquet Autonomic Dysreflexia — Urinary Catheter Chest Tube Drainage - Extra sterile bottle with sterile H20, clamp/forceps, vaselinized gauze Cholinergic crisis — Tracheostomy/ET tube Hydrocephalus — Tape measure Laryngotracheobronchitis — Tracheostomy Myasthenic Crisis - Tracheostomy/ET tube Parkinson's Disease - Suction equipment Radium Implant — Lead container, long handled forcep Seizure— Suction equipment Spinal Cord Injury - Tracheostomy Tamponade tube (Sengstaken-Blakemore)- Scissors Thyroidectomy — Tracheostomy Tonsillectomy — Flashlight Tracheostomized Patient — obturator, hemostat (Dilator), one size smaller tracheostomy tube, Ambu bag Wired Jaw - wire cutter tgseee Wt =x Central Lines Triple lumen catheter ), Tunneled Central Lines Le trl hie (pp A2°5= ee For central line insertion, tubing che ni r ao aA) Cred eceteted eee aR Ree Endot Endof Cater ~g Peripherally Inserted Central Catheter (PICC) & Midline Catheter {poster cm (Cater Tal wth Cap PICC Catheter Midline Catheter tgsN'study guide eee Wt Nasogastric Tubes Lurgetunen Avent feeseconig of ast contnt — Levine F a amen torsucton - Salem Sump = Intestinal Tubes -Cantor § — Miller Abott =eee ubes and Lines Other tubes: (for esophageal varices) Esophageal balloon ination Gasivic aspiration Weighted tension Gasticbatoon fal Cole ereial leh aiv ol) Sengstaken Blakemore Minnesota Tubeeer 2 bes and Lines Chest Tube — Drainage System Air and fluid wall suction ‘from patient ‘Atmospheric Lie eerie Amount of suction ‘applied Continuous bubbling is iareliaslel gauge 3 Suction Water seal Collection regulation chamber chamber chambereee Wt BMI: Wt. (kg) + Ht (m2) -—> Tracheal tube size: internal dm. ETT size (mm) = (Age [yr] +16)/4 Suction Catheter size: = 2 X (Tracheal tube size - 2) Parkland (Burns): Volume to be infused in 24 hours ___ % (TBSA) x Wt. (Kg) x 4 = __ml/day (24hrs) 1 foot = 12 inches ~ 1 meter = 3.28 feet £ Adults: Asize 7.5-mm cuffed ETT is well tolerated by most = adult female patients. A size 8.0-mm cuffed ETT is well tolerated by most = adult male patients. Pediatrics: An uncuffed ETT should be used for children under the age of 8 years. = 11 (f11) £ After getting the volume, divide: -> 1% 8 hours is 507% 2n9 8 hours is 257% 39 8 hours is 25% tgseT NTY CH Formulas & Calculat SF £ Fluids in children — —p 11-20kg = 1000 ml + SOmi/kg/day 21-30 kg = 1500 ml + 20 mi/kg/day Naegel’s Rule £ Expected Day of Get first day of a woman's LMP (M/D/Y) Confinement ~~ - 3(M) +7(D) +1(¥) (EDC) 1, Calculate the concentration of nad insulin solution Ex: 50 units + 100 mL = 0.5 units/mL Insulin Infusion — —p ¥ 2. Calculate the dose in mL/hr Desired x Quantity Available 5S units x 1mL=10mL/hr 0.5 units 1. 1 ampule: 25,000 IU / 5 mi £ Prep: 45 ml NSS + 25,000 (5m!) Heparin I £ v 2. Calculate the dose in mL/hr Desired x Quantity Available 100 units x 50 mL=0.2 mL/hr 25,000 units tgs Heparin Infusion — —»Ce ormulas & Calculation > Dopamine Dobutamine infusion is Infusion the same process, (If asked — > differs only according to stock dose!! mcg/kg/ml) + £ 7 = 1,meg/min = Stock dose in mg (1000) Volume (Convert - in 1 mg there are 1000 mcg) Ex: ordered dose — 10 microdrops/min Stock dose — 500 mg dilute in 250 ml Weight - 60 kg = 500 mg X 1000 250 ml = 2,000 mca/ml ! ' £ 2. Drops/min (ordered dose) X meg/min Weight (kg) X 60 mins = 10 microdrops/min (given order) X 2,000 mcg/ml 60 kg X 60 mins Answer: 5.55 mcg/kg/ml tgs77 eee Wt SF Formulas & Calcula Dobutamine infusion Dopamine Infusion — up» 19s the same process, differs only according i asked to stock dosel! microdrops/min) I ' ¢ 2 dered dose (mcg/kg/min) X wi(kg) X 60min X volume Stock in mg x 1000 (in 1 mg there are 1000 mcg) Ex: ordered dose - 10 mcg/kg/min Stock dose — 500 mg dilute in 250 mI Weight - 60 kg ! ‘ £ 2. = 10 mceg/kg/min X 60kg X 60min X 250 ml 500 mg X 1000 = 36,000 X 250 ml 500,000 Answer: 18 microdrops/min tgseer wy Respiratory Bronchial Bronchovesicular Vesicular Normal Lung Sounds Adventitious Lung Sounds i 51 BERTON eR MSry} eee Wt Respiratory ‘Tripod position &epiglotiis Stridor High-pitched breath sound resulting from turbulent air flow in the larynx or lower in the: bronchial tree £ Breathing Patterns Kussmaul— deep labored, Kusemaul - WWW = = Meta, Acidosis, ketoacidosis J. Cheyne-Stokes Pate Near Ceath Bred@pigg Pattorn ~ Cheyne Stoke — Waxing and waning, "TARR = WWW AU eVV EN deeper & sometimes faster ee Face acidosis, brain trauma Bradypnea - @— Be 2 Biots --/\wW\ 4. wor — Biot’s — shallow with periods of roger apnea, CVA, pons trauma tgsad | eee Wt or RIPES: (UPTO 12 MONTHS) Rifampicin Red orange secretions, hepatotoxic Isoniazid (+ VitBé) Peripheral Neuritis, hepatotoxic Pyrazinamide Increase Uric acid, hepatotoxic Ethambutol Optic neuritis Streptomycin Ototoxic, neurotoxic, nephrotoxiceee Wt 7.40 (7.35 — 7.45) 35 — 45 mmHg 22 — 26 mmoV/L. . Determine if the deviation/problem is Acidosis or Alkalosis Note: Use 7.40 (mean) instead of the range (7.35-7.45) <7.40 - Acidosis >7.40 - Alkalosis . Identify which is responsible for the deviation. PCO2 - Respiratory (Respiratory System) <35 — Alkalosis >45 - Acidosis HCO3 - Metabolic (Renal System) <22 - Acidosis >26 — Alkalosis . After identifying, you need to know if there is compensation. Remember, ABG is about buffer system. If there is deviation then the other one must compensate. How do you know if it is COMPENSATED? If the other value opposes and attempts to neutralize (buffer) - Compensated If not - Uncompensated |. If compensated, determine if full or partial. Note: This time, refer to the range (7.35-7.45) If within 7.35 — 7.45 then it's FULL If not within 7.35 - 7.45 then it’s only PARTIAL 70eT NTY a Application Example: pH 7.39 PCO2 49 mmHg HCO3 28 meqs/L 1, Determine if the deviation/problem is Acidosis or Alkalosis Note: Use 7.40 (mean) instead of the range (7.35-7.45) <7.40 - Acidosis >7.40 - Alkalosis Ex: pH 7.39 - ACIDOSIS (<7.40 - Acidosis) 2. Identify which is responsible for the deviation. PCO2 - Respiratory (Respiratory System) <35 - Alkalosis >45 - Acidosis HCO3 - Metabolic (Renal System) <22 - Acidosis >26 - Alkalosis PCO2 49 mmHg (ACIDOSIS) - RESPIRATORY HCO3 28 megqs/L (ALKALOSIS) - METABOLIC Problem: RESPIRATORY ACIDOSIS 3. After identifying, you need to know if there is compensation. Remember, ABG is about buffer system. If there is deviation then the other one must compensate. How do you know if it is COMPENSATED?eT NTY 72 Application « Ifthe other value opposes and attempts to neutralize (buffer) - Compensated « If not-Uncompensated HCO3 28 meqs/L (ALKALOSIS) OPPOSES? YES - COMPENSATED Problem: RESPIRATORY ACIDOSIS COMPENSATED. 4, If compensated, determine if full or partial. Note: This time, refer to the range (7.35-7.45) If within 7.35 - 7.45 then it's FULL If not within 7.35 - 7.45 then it’s only PARTIAL pH 7.39 Within normal range? Yes Problem: RESPIRATORY ACIDOSIS (FULLY COMPENSATED)eee Wt Common Tumor Markers Colon - Carcinoembryonic antigen (CEA) Prostate - Prostate Specific Antigen (PSA) Liver - Aloha-fetoprotein (AFP) Multiple Myeloma - Bence-Jones Proteins Bladder — Bladder Tumor Antigen (BTA) Cancer screening Breast: Annual Mammography - after 40 YO BSE — Monthly after 20 YO Prostate: Prostate Specific Antigen (PSA) & Rectal Exam — Annual after 50 YO Testicular: Testicular Self-exam (TSE) — Monthly (15-35YO) Colon: (after 50 YO) Colonoscopy — every 10 years Ba Enema - every 5 years Occult blood — every year + colonoscopy if (+) Cervical: Pap Smear - Women 21 to 65 YO Pap smear does not detect ovarian cancer rE}74 Immunology immu Birth | Tmonth | months | months | months | months | months HepB | HepB Hep 6 DTaP DTaP DTaP DTaP RY Hib. Hib Ipv pev Pov MMR vz HepA HepB. DTaP = diphithvi,totarus toxoids, aco potusss RV = rotavirus Hib = Hoemophitusinftuenzae type b conjugate vacene CV = pouinocotea! conjugate vaccine Hop A™hopatits A "Note: The infer vaccine is cecammanded yearly beginning at age 6 moths, Esse) tgseee Wt Immunology a! Common misperceptions of contraindications to immunization Penicilin allergy Mild iliness (with or without an elevated temperature) Mild site reactions (eg, swelling, erythema, soreness) Recent infection exposure Current course of antibiotics + IPV (Inactivated Polio Vaccine) - a new form of polio vaccine because OPV (Oral) had caused incidences of vaccine-associated paralytic poliomyelitis (VAPP). * Rotavirus — not given with immunodeficiency or intussusception * Newborns at risk for HIV infection need to receive all recommended immunizations at the regular schedule; live vaccines are not administered until HIV status is determined * Infants with (+) HepB mothers should receive HepB vaccine and hepatitis B immunoglobulin {HBIG) within 12 hours of birth.eT NTY Ww Immunology | KeyFoint immunization Hepa B Vaccines — can be given to MS, GBS, autoimmune, autoimmune diseases, and pregnant women except allergy to baker's yeast. Cervical Cancer: Cervarix, Gardasil - 3 IM Injections (6 months period) before becoming sexually active In HIV (CD4 <200, <15%): Varicella, MMR cannot be given MMR & Varicella if not administered on the same day, must be separated by 28 days Hepa B Vaccines should not be given if infant weighs <2000gms. DTaP cannot be given to patients with seizure d/o ei fore) Routinely recommended during pregnancy * Flu (influenza) shot, flu season (November-March). Avoid influenza nasal spray vaccine, which is made from alive virus. * Tetanus toxoid, diphtheria and pertussis (Tdap) vaccine - aiven between 27 and 36 weeks AOG <= * Varicella Zoster (VZV) + Measles-mumps-rubella (MMR) + Inf |eee Wt STANDARD PRECAUTION * If suspected or determined that a patient has an infectious disease we add on TRANSMISSION-BASED PRECAUTIONS - CONTACT, DROPLET, and AIRBORNE. * Hand hygiene: performed before and after patient contact, after wearing gloves, touching surfaces in a patient's room * Perform hand hygiene by using soap and water or hand sanitizer. * PPE: gloves, gown, mask, goggles or face shield. (see part 18 - common multiple response questions) * Select PPE wisely! - with AIRBORNE precautions, use N95 mask during patient contact, BUT if you are going to be inserting an NG tube or doing a procedure that will have the potential for splashes of body fluids, you will need a gown, googles or face shield, gloves.eee Wt Infectious Disease Transmission Based Precaution DROPLET PRECAUTION Rubella (German Measles) Diphtheria Whooping Cough (pertussis) Mumps Parvovirus B19 (erythema infectiosum or 5th disease) Mycoplasmal Pneumonia Epiglottitis (Haemophilus influenza type b) Flu (contact and droplet) Meningococcal Disease: Sepsis, Pneumonia, meningitis Pneumonia Adenovirus (contact and droplet) Streptococcal pharyngitis Scarlet fever Key Points: Transmitted via droplets expelled by the person during sneezing, coughing, talking etc. Droplets are large and travel less distance (3 feet and then fall) Wear a surgical mask during patient contact at all times and follow standard precautions. Keep a distance of 3 feet or more from other patients and visitors. Patient must wear a surgical mask if being transported. Patient's door can stay open. No special ventilation is required.eT NTY Ww Infectious Disease Transmission Based Precaution AIRBORNE PRECAUTION MTV Measles (Rubeola) Tuberculosis Chicken Pox (Varicella) (Airborne and Contact) Herpes Zoster /Varicella Zoster (disseminated) Shingles {Airborne and Contact) Key Points: Transmitted when the infected person coughs, sneezes etc. which produces respiratory droplets With airborne diseases these droplets SURVIVE the drying out process and turn into droplet nuclei and SUSPENDS and suspends in the air These particles INFECT a person when the person INHALES. THE INFECTIOUS DISEASE into their lungs (different than droplet where it enters into the mucous membranes). Must wear an N95 mask (blocks very small particles) while in the room at all times PLUS follow standard precautions like hand hygiene and use other types of PPE as needed depending on the type of care you will be providing. Single room (negative pressure room). Suction effect The room will have 6-12 air changes an hour to decrease infectious particles in the room. Keep room door closed at ALL TIMES! Limit transport unless necessary Have procedures performed at the bedside as much as possible. If patient has to leave the room, the patient must wear a surgical mask aeT NTY ty Infectious Disease Transmission Based Precaution CONTACT PRECAUTION Medication-Resistant Organisms: MRSA, VRE, extended spectrum beta lactamase producers (ESBLs), Klebsiella Pheumoniae Carbapenemase (KPC) Diarrhea infections or of unknown origin: C.difficille noravirus, rotavirus.....USE SOAP AND WATER FOR HAND WASHING NOT hand-sanitizer. NOTE: Hepatitis A. (if patient is diapered or incontinent) remember it is soread through stool Skin infection: impetigo, lice, scabies, herpes simplex, chickenpox (airborne and contact), skin diphtheria, shingles (airborne and contact) * Wound infections with excessive drainage - staphylococci * RSV, parainfluenza * Conjunctivitis Key Points: * Transmitted from direct or indirect contact + Must at always wear a gown and gloves PLUS follow standard precautions like hand hygiene and use other types of PPE as needed depending on the type of care you will be providing. * Single room the best or group patients together with same infectioneT NTY ul Infectious Disease RESERVED T- Toxoplamosis, O - Others (syphilis, varicella-zoster, parvovirus B19) R - Rubella (German measles) C - Cytomegalovirus H- Herpes Animal Associated Infections Histoplasmosis Lyme disease — —Fungal— —> (borreliosis) Birds/bats Bacteria - Deer ticks Rabies raccoon, dog, = —> rat bites ieee ! Viral Encephalitis Toxoplasmosis — - West Nile Virus - Protozoa - Cat mosquito bites littereee Wt Hearing loss and paralysis of face Deer tick Muscl Heart uscle complications | soreness \ —— Nausea Enjthetna —— and vomiting migrans Pathogen Fever we Chills Fatigue Weakness Bacteria Borrelia Use tweezer - YOM ol eet fo] olyeT NTY eS Infectious Disease Caan ¥ AIDS Sexually Associated Infections Ke yy Herpes Simplex Type II - painful vesicles on genitalia Genital Warts - 1-2 mm in diameter Syphilis - painless chancres Chancroid - painful chancres Gonorrhea - green, creamy discharges & painful urination Moniliasis/Candidiasis — Fungal, curdlike vaginal discharge Trichomoniasis - Protozoa, yellow, itchy, frothy, and foul- smelling vaginal discharges. Chlamydia - Bacteria, malodorous, mucopurulent yellow discharge Diarrheal Infections Norwalk Virus (Norovirus) - "stomach flu" or "Winter Vomiting Disease". Salmonella - Bacterial, eggs, turtle pets Cryptosporidiosis — parasite, swimming in public pools Giardiasis — parasite, from contaminated food and water Shigellosis (dysentery) — Shigella bacteria, “bloody stool” Rotavirus — most common to cause of diarrheain children, the only diarrheal infection with vaccines, — non-foul smelling, common in wintereer 4 Infectious Disease Long-Term Care Infections Clostridium Dificille - contact precautions/ Spore precautions Norwalk Virus (Norovirus) - "stomach flu" or "Winter Vomiting Disease". Itch related Infections Pediculosis — “occipital itchiness" Scabies — characterized by “burrowing tracts" Mites burrow under the skin and lay eggs tgseT NTY ts Infect Disease Other Infections Infectious Mononucleosis (Kissing's) — Epstein Virus Legionnaire’s Disease (pneumonia) — Bacterial, severe Respiratory Syncytial Virus (RSV) — bronchiolitis in babies (2nd bday) Meningitis - Aseptic/Viral (Standard Prec.), Bacterial (droplet) Encephalitis — (Viral) - sequelae of rabies, Herpes, poliovirus, measles (Bacterial) - caused by bacterial meningitis Measles (Rubeola) - white Koplik’s spot, airborne prec. German Measles (Rubella) — red Forcheimer's spot, droplet precaution Pertussis — “whopping cough”, bacteria, droplet precaution ry i "Slapped cheek" rasheee Wt lealth Care Associated Infections (HCAI) Bundles of Care Keep the head of the patient's bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur. Assessment of readiness to extubate Hand hygiene before and after touching the patient or the ventilator. Oral care - chlorhexidine (minimizes microaspiration) Peptic ulcer prophylaxis - PPls (minimizes complications and length of stay) Venous Thromboembolism (VTE) prevention - (minimizes complications and length of stay) Comply hand hygiene religiously Avoid femoral site in obese adult patients. Prepare the insertion site with >0.5% chlorhexidine with alcohol. Immediately replace dressings that are wet, soiled, or dislodged — NO WET DRESSING If blood or blood products or fat emulsions are administered change tubing every 24 hours. * Promptly remove unnecessary central lines * Perform daily audits to assess whether each central line is still neededeT NTY ws Health Care Associated Infections (HCAI) Bundles of Care © CATHETERIZE patient only when necessary * Perform daily assessment of the need for catheter * Secure catheter properly * Ensure that urine bag is below bladder, not touching the floor * Perform catheter care daily * Empty drainage regularlyri | ees td Common Multiple Response Subjects Donning PPE 3.Gogales or face shield 4. Gloves Removing PPE 3.Gown 4. Mask or respirator89 eee Wt Comr Multiple Response Subjects ¢ Needlestick injury: 1. Remove gloves 2. Wash area with soap and water 3. Notify the nurse's supervisor 4, Go to employee health clinic 5. Take post-exposure prophylaxis Assisting a falling client Fall Incident ¢ , 1. Assess for presence of adequate pulse Ne 2. Inspect the client for 4, injuries { br — — 3. Gethelp and move the A client to the bed XK RN ‘ 4, 5. Notify the client's health & ‘Ne i we care provider (HCP) we 5. Complete an incident ‘Step behind cient with Move one foot back, extend front leg, Lower client to report ‘etapa lel ide efor Healthcare Fire Safety Fire Incident: RACE protocol 1. Rescue/remove any clients in immediate danger 2. Pull the fire alarm / activate Code system 3. Close the door to the area of fire 4, Aitempt to put out the fire with a fire extinguisher - evacuate as needed 5. Discourage visitors from using the elevatorsf eee rd cr} Common Multiple Response Subjects Goal marker Ce How to Use an Incentive Spirometer Peak flow meter ‘A measure of air way obstruction is the peak rate of flow of air out of the lung. Record is make using peak flow meter, ‘Normally 300-600 L/min Moutn piece 2, Volume Oriented Incentive Spirometer . Exhale normally and place the mouthpiece in the mouth .. Seal lips tightly on mouthpiece . Inhale deeply, until piston is elevated to predetermined level Hold breath for at least 2-3, seconds . Exhale slowly around the mouthpiece Measuring peak expiratory flow: peak flow meter Slide the indicator on the numbered scale on the flow meter fo the 0 or lowest number and instruct the client to stand or sit as upright as possible Instruct the client fo breathe in deeply, place the mouthpiece in the mouth, and close the lips tightly ‘around it to form a seal Instruct the client fo exhale as quickly and forcibly as possible and note the reading on the numbered scale Repeat the procedure 2 more times with a 5-10-second rest period belween exhalations Record the highest reading achieved (personal best) tgsf eee rd Common Multiple Response Subjects ‘Techie for using How to Use a Metered-Dose Inhaler with ‘@ Spacer 7 teed dose tae (MD) wut spacer 1 a=<— — Metered Dose Inhaler (MDI) 1. Shake canister well for 3-5 seconds Tilt head back slightly and exhale slowly for 3-5 seconds Place mouthpiece between teeth and wrap lips around mouthpiece Compress canister while inhaling slowly through the mouth for about 3-5 seconds Hold breath for 10 seconds, if possible, before exhaling 6. Wail al least 1-2 minutes before taking a second puff, if prescribed Metered Dose Inhaler (MDI) With Spacer 1. Shake the medicine 2. Insert the mouthpiece of the inhaler into the rubber sealed end of the spacer 3. Breathe all air out of your lungs. Then put the spacer into mouth between teeth. Make a tight seal ‘around the mouth piece with your lips. 4, Press the metered dose inhaler down the medicine. The medicine will be trapped in the spacer. Breathe in slowly and deeply. 5. Hold your breath for at least 5-10 seconds. Breathe out slowly. Ohf eee rd cP} Common Multiple Response Subjects Huff Coughing: to decrease lung“ secretion 1. Position upright 2. Inhale through the nose using abdominal breathing and prolong the exhalation through pursed lips for 3 breaths 3. Hold breath for 2-3 seconds following an inhalation while keeping the throat open, then exhale 4, Deeply inhale and, while leaning forward, force the breath out gently using the abdominal muscles while making a ha’ sound (huff cough}; repeat 2 more times 5. Inhale deeply using abdominal breathing and give one forced huff cough £ Tracheostomy Care / Dressing: 1. Gather supplies and position client 2. Don mask, goggles, and clean gloves 3. Remove soiled dressing Don sterile gloves; remove old disposable cannula and replace with a new one 5. Clean around stoma with sterile water or saline; dry and replace sterile gauze pad =eT NTY wd Comm ultiple Response Subjects Lumbar Puncture Lumbar Puncture (Prep): | AS f y parental consent 2. Gather the lumbar puncture tray and supplies 3. Have the child empty the —_ bladder 4. Assist the child into the side- lying position with the knees drawn up 5. Label specimen vials as they 1. Check the medical record for b ~w are collected Lying Position Sitting Position 6. Place a bandage on the insertion site < Central line tubing change (client suddenly begins gasping for air and writhing): 1. Clamp the catheter tubing 2. Place the client in Trendelenburg position on the left side 3. Administer oxygen as needed . Notify the health care provider (HCP) . Stay with the client and provide reassurance s 2 tgsry eee Wt Common Multiple Response Subjects Renal Assessment (Sequence): 1. Advise client to empty the bladder completely 2. Observe skin and contour of abdomen and lower back 3. Auscultate the renal arteries in right and left upper quadrants 4, Percuss and palpate both the right and left kidneys 5. Document the assessment of renal system function Assessment sequence for 2 YO child: 1. Interact with the parent in a friendly manner Play with the child using a finger puppet . Measure the child's height and weight . Auscultate the child's heart and lungs . Take the child's vital signs x o » a tgseee Wt cy Common Multiple Response Subjects Upper chest -- Upper outer arm Z-Track technique: IM Injection: 1. Pull the skin 1-1 14" (2.5-3.5 cm) laterally and away from the injection site 2. Hold the skin taut with non- dominant hand and insert needle at a 90-degree angle 3. Inject medication slowly with dominant hand while maintaining traction 4, Wait 10 seconds after injecting the medication and withdraw the needle 5. Release the hold on the skin, allowing the layers to slide back to their original position 6. Apply gentle pressure at the injection site but do not massage Client teaching: CLONIDINE Patch 1. Apply patch to a dry hairless area on the upper arm or chest 2. Wash hands before and after application 3. Rotate sites with each new patch application 4, Discard patch away from children or pets with sticky sides folded together 5. Never wear more than I patch at atime 6. Never stop using the patch abruptly tgseee Wt Common Administration of nasal spray: 1 1. 2 77 ultiple Response Subjects Assume a high Fowler's position with head slightly tited forward Insert the nasal spray nozzle into an open nostri, occluding the other nostri with a finger Point the nasal spray tip toward the side and away from the center of the nose Spray the medication into the nose while inhaling deeply Remove the nozdle from the nose and breathe through the mouth Repeat the above steps for the other nostri Blot a runny nose with a facial tissue, but avoid blowing the nose for several minutes after instillation ¢ Ear Irrigation (Adult): Assess the client for fever, ear infection, or tympanic membrane injury Place the client in a sitting position with the head tilted toward the affected ear Place a towel and an emesis basin under the ear Straighten the ear canal by pulling the pinna up and back (down & back - < 3¥0) Gently irigate the ear canal with a slow, steady flow of solution tgs7 ¢ eee Wt Common Multiple Response Subjects Administration of suppositories: 1. Apply clean gloves and position the client appropriately based on age and size (eg, infant supine with knees and feet raised, older child side-lying with knees bent) Lubricate the tip of the suppository with water-soluble jelly. Insert the suppository past the intemal sphincter using the fifth finger if the child is under 3 years. Use of the index finger may cause injury to the colon or sphincters in chidren younger than age 3 years. Angle suppository and guide it along the rectal wall. Hold the buttocks together for several minutes, or until the urge to defecate has passed, to prevent immediate expulsion ¢ Handling Evisceration: Stay calm and stay with the client. Put the client into semi-Fowler position with knees slightly flexed. Check the vital signs, especially blood pressure and pulse. Have a colleague gather sterile supplies and contact the physician Cover the intestine with sterile } moistened gauze. Oshiecence Evecoron 6. Prepare the client for surgery as ordered. tgseee Common A ew X cr ultiple Response Subjects ee NGT for gastric Assess and select naris 2 Measure, mark, and lubricate tube 3. Instruct client to extend neck back slightly 4, Gently insert tube just past nasopharynx 5. Ask client to flex head forward and swallow 6. Advance tube to the marked point 7. Verify tube placement and anchor Inserting Urinary Catheter: ‘ 1. Perform hand hygiene 2. Apply sterile gloves 3. Use non-dominant hand to spread the labia 4, Cleanse labial fold with antiseptic swab 5. Wipe meatus with antiseptic swab 6. Insert catheter until urine is visualized7) Common Multiple Response Subjects ¢ Bowel Irrigation: 1. Fill the irrigation container with 500- 1000 mL of lukewarm water, flush inigation tubing, and reclamp and hung. . Instruct the client to sit on the toilet, place the irigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma Lubricate cone-tipped irrigator, insert cone and attached catheter gently into the stoma, and hold in place . Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes . Clamp the tubing if cramping occurs, until it subsides . Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet Drugs for Constipation (stepwise progression): 1. Bulk forming - Metamucil 2. Stimulating - Dolculax, Senokot 3. Stool softeners - Colace 4, Osmotics - Mik of magnesia 5. Enemas — Fleet enema tgseee Wt Comm y ‘a. a Check for changes with hands on hips and chest muscles flexed. While ying down, use the three middle fingers and apply three levels of pressure Examine underarm ina circular mation. Follow ite upright, with ‘anup and down pattern. arm slightly raised. Testicular SelfExamination Exam Yourself Every Month TO Check For Abnormalities w. ple Response Subjec 100 BSE: Breast Self-examination 1. Place arm behind the head and lie down 2. Use the left hand to palpate the tight breast and right hand for the left breast. 3. Palpate the breast with the use of finger pads of the three middle fingers 4, Using circular motion, palpate the breast tissue progressing from light, medium and firm pressure 5. Palpate each breast from top to bottom and then by going across the breast from side to side ¢ TSE: Testicular Self-examination 1. Examine testicles while taking a warm bath 2. Use the thumb, and first two. fingers to palpate each testes. The normal testes is oval shape, smooth and about 4-5 cm in length 3. Note for abnormalities like spongy consistency 4, Stand in front of the mirror and look for the change in size and shape Report for abnormalities. 2eer va) Common iple Response Subjects Guaiac Fecal Occult blood test: S Fecal occutt blood test 1. Obtain supplies, wash hands, and apply nonsterile gloves. 2. Open the slide’s flap and apply 2 separate stool samples to the boxes on the slide. 3. Open the back of the slide and apply 2 drops of developing solution to each box. 4. Wait 30-60 seconds. Document the results Anaphylactic shock due to IV ¢ Antibiotics: . Stop the infusion and call for help Assess airway and place client on we oxygen I corsa tae 3. Give IM epinephrine and start IV J) veaction that involves normal saline |||) two or more body systems 4, Administer diphenhydramine IV Re er ee ay . Monitor vital signs for changes 2eee Wt Common 2 Blood Transfusion Administration 1 » eo Always verify blood products, type and crossmatch results, and client identifiers with another nurse prior fo transfusion. Obtain vital signs before, during, and after blood administration. Use Y tubing primed with NS and an IV pump for administration. |. Watch for transfusion reaction . Stop the transfusion immediately if areaction occurs. Ww \ 8 Recipient --> 102 Itiple Response Subjects 3 Blood Transfusion Reaction . Stop the blood transfusion Using new tubing, infuse normal saline into the vein ‘Administer prescribed vasopressor Collect urine specimen Document the occurrence pe ae s Ae ABE ABS ooe6 e o o 6 o 6 e 6 o 6ri | ees weg Common Multiple Response Subjectsri | ees ues Common Multiple Response SubjectseT NTY 10s ; Drug of Choice &) * Acromegaly — Sandostatin, Parlodel Acute Gout - Colchicine Acute Pancreatitis pain - Demerol, any anticholinergic Addison's Disease - Hydrocortisone + NaCl IV fluids ADHD - Ritalin (Methylphenidate) Alcohol Withdrawal - Antabuse, Librium Amoebiasis - Flagyl (Metronidazole), Emetin HC Autism - Thorazine (Chlorpromazine) Bell's Palsy — Prednisolone Burn pain - Morphine |M or lV. Chlamydia - Tetracycline Cholera - Tetracycline + Rehydration + K supplement Chronic Gout - Allopurinol, Probenecid Cushing's Syndrome - Mitotane Diabetes Insipidus — Desmopressin Diphtheria - Erythromycin, Penicillin, Diptheria antitoxin Eclampsia - Magnesium Sulfate Glaucoma - Miotics Gonorrhea - Penicillin Heart Block (AV block) - Atropine Sulfate, Isuprel Heroin withdrawal of neonate - Thorazine, Valium Hyperkalemia - Insulin, glucose, Diamox, NAHCO3, Kayexalate Hyperthyroidism (toxic goiter)/ Thyroid Storm — PTU, Tapazole, Lugol's solutioneee Wt Drug of Choic Hypocalcemia — Calcium Gluconate Hypothyroidism — Synthroid, L-thyroxine Impetigo — Penicillin Increased ICP - Mannitol, Lasix, Decadron Iron Deficiency Anemia (IDA) — Iron Sulfate, Iron Dextran Kawasaki Disease - Aspirin Leg cramps - Amphogel Leptospirosis - Penicillin, Tetracycline Leukemia — VAMP (vincristine, adriamycin, methotrexate, prednisone), MOP (methotrexate, oncovin, prednisone) Lyme disease - Doxycycline Malignant Hyperthermia - Parlodel Manic (Bipolar Disorder) - Lithium carbonate, Lithane, Monolith Metabolic Acidosis - Sodium Bicarbonate Metabolic Alkalosis - Diamox, Ammonium Chloride MRSA - Aminoglycosides, Vancomycin Multiple Sclerosis — Corticosteroid Myasthenia Gravis — Cholinergic, Prostigmin, Tensilon Oral thrush/Monoliasis - Monistat, Fungizole Osteoarthritis - ASA, NSAIDS, Brufen, Voltaren Osteoporosis - Estrogen, DES, TACE, calcium 106eT NTY wey Drug of Choice Paget's disease - Fosamax (Alendonate) Patent Ductus Arteriosus (PDA) — Indomethacin (Prostaglandin Inhibitor) Parkinson's disease — Carvidopa, Levodopa Pediculosis capitis/pubis, scabies - Kwell/Lindane Shampoo Peptic Ulcer Disease (PUD) - Cimetidine, Ranitidine, famotidine (Tagamet) Pneumocystis Carinii Pneumonia (in AIDS) - Tetracycline Prostate Cancer (control) - DES, TACE, estrogen preparation Prosthetic heart valves - Anticoagulants, Penicillin Renal colic pain — Morphine Respiratory Distress Syndrome — Cellestone (Betamethasone) Rheumatic Heart Disease prevention (RF) — Penicillin Scarlet Fever - Erythromycin, Penicillin Shigellosis (Bacillary Dysentery) — Ampicilliin, Chloramphenicol, Tetracycline Sinus Bradycardia - Atropine Sulfate, Isuprel Spinal shock - Prednisone Status Asthmaticus — Epinephrine Suicide - Venlafaxine (SNR!) Syp! - Penicillin Thalassemia - Deferoxamine Thrombosis - Heparin, Warfarin, ASA Toxic Shock Syndrome (TSS) - Cloxacillin, Oxacillin, Toxoplasmosis - Sulfonamides, Pyrimethamine Trichomoniasis - Flagy! (Metronidazole) Vaginal moniliasis - Ketoconazole, Co-trimoxazole, MycostatineT NTY wed Drugs Causing Urine Discolorati { Se £ Amitriptyline — Blue or blue green Daunorubicin or Doxorubicin - Red/Pink Ferrous / iron dextran - Dark / Brown Heparin - Orange/yellow, Red/Pink Ibuprofen - Red/Pink Levodopa - Dark / Brown Methyldopa - Dark / Brown, Red/Pink Metronidazole - Dark / Brown, Yellow-brown Nitrates - Dark / Brown Nitrofurantoin - Dark / Brown, Yellow-brown Phenazopyridine - Orange/yellow Phenothiazines - Red/Pink Phenytoin - Red/Pink Rifampin - Orange/yellow, Red/Pink Salicylates - Red/Pink Sulfasalazine - Orange/yellow Sulfonamides - Dark / Brown, Yellow-brown Triamterene - Blue or blue green Warfarin - Orange/yelloweT NTY ue Di Huang - Diabetes Mellitus Ma Huang - Weight Loss Echinacea - Immune booster Black Cohosh - Flushing in menopause Blue Cohosh — Uterine tonic Saw Palmetto — BPH Arnica - Post operative bruising Ginger - Anti emetic, anti-inflammatory - Bleeding risk Ginkgo Biloba - Memory enhancement - Bleeding risk Ginseng — Improve mental performance - Bleeding risk Garlic - HPN, cholesterol — Bleeding risk St. John’s wort — Depression, Insomnia Kava — Anxiety, Insomnia Valerian - Insomnia Licorice — Bronchitis, anti-ulcer Ephedra — Colds & flu, weight loss, improve athletic performanceeT NTY LL « All Psychotropic medications should be given after meals except anti-Anxiety * Do not give anti-anxiety with anti-ulcer * “2-31ule” All psych meds effects 2-3 Weeks, alll anti- anxiety in 2-3 minutes, all anti-Parkinson in 2-3 days * Don't give non-selective beta-blockers to patients w/respiratory problems * Typical antipsychotics (+) symptoms - “azine” “dol” * Atypical antipsychotics (-)&(+) symptoms - “apine” “done” + Adverse effects of anti-psychotics: report to HCP NMS - rigidity, fever Malignant Hyperthermia — only fever Tardive dyskinesia — irreversible muscle rigidity, tongue protrusion Pseudo Parkinsonism — muscle rigidity, tremors ¢ Vitamin C can cause false (+) occult blood + ASA toxicity can cause ringing of the ears * No narcotics to any head-injury victims + Do not give Calcium-Channel Blockers with Grapefruit Juice + Oxytocin is never administered through the primary IV ¢ Lithium patients must consume extra sodium to prevent toxicity * MAOI Patients should avoid tyramine: Avocados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream Pharmacology Fact: ©eee Wt ee ee ewe . eee Pharmacology Facts Selegeline Patch (MAOI) — no restrictions to food Tricyclic anti-depressants (TCAs) causes urine retention and arrhythmias Don't give atropine for glaucoma - it increases IOP Don't give ant-acids with food -- b/c it delays gastric emptying. Always verify bowel sounds when giving Kayexelate D10W can be substituted for TPN (temporary use) Dopamine and Lasix are incompatible Aluminum hydroxide - constipation Magnesium Hydroxide — Diarrhea Thiazide diuretics may induce hyperglycemia Take iron with Vit. C —it ennances absorbtion — Do not take with milk B1 (Thiamine) - For Alcoholic Patients (to prevent Wernicke's encephalopathy & Korsakoff's syndrome) Bé - For TB Patients taking INH B9 - For Pregnant Patients B12 - Pernicious anemia, Vegetarians. Complications of Coumadin - 3H's - Hemorrhage, hematuria & hepatitis Mannitol (Osmotic diuretic [Head injury]) crystallizes at room temp - use a filter needle Administer Glucagon only when patient is hypoglycemia and unresponsive anhee ee oe eee Wt iF] acology Facts Phenazopyridine ( Pyridium)--Urine will appear orange Rifampicin -- Red-urine, tears, sweat Give ACE inhibitors w/food to prevent stomach upset Administer diuretics in the morning Never give potassium (K+) in IV push. A significant toxic risk associated with clozapine (Clozaril) administration is blood dyscrasia. Narcotics causes urinary retention and constipation Opioids (Depressants): heroin, codeine, morphine Stimulants: Cocaine, amphetamine, marijuana Anti-depressants — avoid citrus fruits Anti-Parkinson — avoid milk shakes Lithium — avoid caffeine Ranitidine (Zantac) - causes hallucination in elderly Streptokinase may cause bronchospasm Cyclophosphamide - Hemorrhagic cystitis Oncovin, Adriamycin - Hyperuricemia NADIR - when bone marrow and WBC are its lowest Oprelvekine — to increase platelet Neupogen - to increase WBC Epogen - to increase RBC Metochlopramide (Reglan) may cause EPS such as tardive dyskinesia Maalox may cause akathisia unr}aT} eee Wt eee Considerations African a * May believe that illness is caused by supernatural causes and seek advice and remedies form faith healers « Family oriented; e Higher incidence of HPN and obesity; « High incidence of lactose intolerance £ Latino Americans © May view illness as a sign of weakness, punishment for evil doing; © May consult with a curandero or voodoo priest * Family members are typically involved in all aspects of decision making such as terminal illness * May see no reason to submit to mammograms or vaccinations. tgseee Wt Native Americans May tum to a medicine man to determine the true cause of an illness; May value the ability to endure pain or grief with silent stoicism; Diet may be deficient in vitamin D and calcium because many suffer from lactose intolerance or don't drink milk; Obesity and diabetes are major health concerns; May divert eyes to the floor when they are praying or paying attention. -=> Asian Americans * May value ability to endure pain and grief with silent stoicis * Typically family oriented; extended family should be involved in care of dying patient; * Believes in “hot-cold” yin/yang often involved * Sodium intake is generally high because of salted and dried foods; * May believe prolonged eye contact is rude and an invasion of privacy; * May prefer to maintain a comfortable physical distance between the patient and the health care provider.ane eee Wt Transcultural Considerations g Arab Americans *May remain silent about health problems such as STIs, substance abuse, and mental illness *A devout Muslim may interpret illness as the wil of Allah, a test of t= = faith; *May rely on ritual cures or altemative therapies before seeking help from health care provider *After death, the family may want to prepare the body by washing and wrapping the body in unsewn white cloth *Postmortem examinations are discouraged unless required by law. *People suffering from chronic Western Culture illnesses, pregnant women, breast- « May value technology feeding, or menstruating don't fast. almost exclusively in the *Females avoid eye contact with struggle to conquer mes fami 7 diseases: *Use same-sex family members as interpreters. * Health is understood to be the absence, minimization, or control of disease process; « Eating utensils usually consists of knife, fork, and spoon; « Three daily meals is typical.eT NTY uo Developmental Milesto! \ . « Turns head side to side ¢ Birth — > « Keeps hands tightly fisted ¢ Lifts head when lying prone 2 Months —~— . Head lags when pulled fromm, supine position ¢ Rolls over 4 Months “> « No head lag when pulled from supine ¢ « Pushes chest up with arms = « Brings hands together to midline, to mouth e Reaches for objects Sits alone Leads with head when pulled from supine + Rakes objects with whole hand i, « Transfers object from hand to hand * Babbling (mixing vowels with mixed consonants) fe.a. ba-ba-bal a 6 Months --)eT NTY UW Developmental Milestone 9 Months -— Pulls to stand, Cruises £ Uses immature pincer (ability to hold small object between thumb and index finger) Begins using mama, dada (nonspecific) Object permanence (people and objects continue to exist even when an infant cannot see them). This ability to maintain an image of a person is the reason why separation anxiety (6-18 months) develops when a loved one leaves the room. Walks 5 12 Months — >. Uses mature pincer (ability to hold small object between thumb and the index finger) * Begins using mama, dada (nonspecific) * 1-3 words, mama and dada (specific) * Magical thinking * Social play (exhibit parallel play during the first 2 years of life). tgseT NTY uw Developmental Milestone © 20-50 words ~ 18 Months => + Beginning to use two-word phrases * Magical thinking * Social play (exhibit parallel play during the first 2 years of life). ¢ 2 Years ——> «+ 25-50% of child’s speech should be intelligible * Magical thinking * Social play (exhibit parallel play during the first 2 years of life). ¢ 3 Years ——> « Three-word sentences ¢ More than 75% of the child's speech should be intelligible * Magical thinking tgsant eee Wt ad Miscellaneous - Bullets &) Delegate sterile skills (¢.g., dressing change) to the RN or LPN. * Where non-skilled care is required, delegate the stable client to the UAP * Assign the most critical client to the RN * Clients who are being discharged should have final assessments done by the RN. * The Licensed Practical Nurse (LPN) can monitor clients with IV therapy, insert urinary catheters, feeding tubes, and apply restraints * Assessment, teaching, medication administration, evaluation, unstable patients cannot be delegated to an UAP Veracity is truththfulness Beneficence is duty to do good that “benefits the others” Nonmaleficence is the duty to “do no harm". Fidelity — doing what is expected and promised by a nurse Autonomy - individual's right to determination Assault — threatening person Battery — touching patient without permission Slander — oral defamation « False imprisonment - Limiting patient to move, illegal detention * Negligence — act of omission or commission Omission — unable to do what is right for pt. Commission — able to do but wrongly done * Malpractice - Instance of negligence or incompetence by a “professional”. ee ee eeeeee Wt Miscellaneous - Bullets Emancipated minors: minors who can decide on their own, martied minors, military service, living alone, had a child, any minor emancipated by law, seeking management for STD, contraception. Restraint patient must be assessed every hour - peripheral circulation Sudden cheerfulness and giving away valuable things are signs of suicide — promote safety Kosher Diet (Jewish) - Do not combine milk and meat. At least 4 hours apart Mongolian spots (Bluish discoloration in the lower back) is common to hispanics, Asians, native americans Predisposed fo Cancer: Breast Ca — Jewish, Testicular Ca - Whites, Cervical & Testicular Ca ~ African Americans Anorexia nervosa — Suppression, Bulimia Nervosa — Compulsiveness ADHD can be initially found during the early entry to school loss of things, crayons, pencils etc. Honey (especially raw or wild) is not recommended for children under age 1 due to the risk for infant botulism. Withheld Metformin prior to cardiac catheterization - can cause increase lactic acid. ARF can happen "Permissive hypertension’ is allowed within the first 24-48 hours of an acute ischemic stroke provided that the blood pressure is <220/120 mm Hg. Allows adequate cerebral perfusion to keep the stroke from extending. 120ri | eee) ua) Ga & The RIGHT Way On the day of exam make sure you avoid the things that you think might affect your performance. You have spent a lot of hours and sacrifices to achieve your goals, only to be crumbled by things you can easily avoid. For instance, anxiety might be a reason to lose what you have mastered. A day before the exam you must have turned your worrisome to confidence. Following are the habits on your way to success.eee Wt The RIGHT Way 1. Get plenty of sleep not only a night before the exam but starting from the days ahead before the exam. Hydrate adequately. 2. Avoid distractions the day before exam. You may have some relaxation activities. 3. Don't isolate yourself, get out of your room and have some light exercise 4. Don't cram, but you need to calibrate your level of confidence, too much is dangerous. 5. Plan to dress comfortably 6. Plan to arrive at least 30 minutes early in your testing center. If the Test Center is in a busy district, you may come visit days ahead of the exam. 7. Take along with you a high-energy snack, a chocolate bar for instance. iPr}123 eee Wt The RIGHT Way 8. Try not to focus on the length of your exam. Your goal is passing at 75 items but it might be a little longer. That is where your good sleep a night before will take its job. 9. Plan something fun to do after the exam. You'll need at least a reward after a series of hardwork on studying. 10. Above all, don’t forget to put your faith into action. Pray hard, claim your success and give back the glory.Uy Sen Absolutely itis OK to be anxious at this moment of waiting for the result. This might be the longest 48 hours of your life waiting for the quick results. If you_are to inflict more anxiety to yourself then wait for 6 weeks for NCSBN to release your result. Then came the SUCCESS. Passing NCLEX® is not easy, itis a culmination of hardwork and a result.of free will to welcome a future made by the-almighty. Get going, be NICE and be a NURSE.eT NTY Te References “ Gapuz, Ray. (2010). The ABC of Passing NCLEX-RN Exam. Singapore, Singapore: Elsevier. Kallen and Patel. (2016). Healthcare associated infections (HAI): Retrieved from hitps://www.cdc.gov/hai/index.html. La Charity, Kumagai, Bartz, and Hansten. (2014). Prioritization, Delegation & Assignment: Practice Exercises for the NCLEX Examination 3rd Edition. St. Louis, Missouri: Elsevier. Sarah, (January 23, 2017). Standard and Isolation Precautions NCLEX Review. Retrieved form hitp://www.registerednursern.com/standard- and-isolation-precautions-nclex-review/ Silvestri, Linda Anne. (2014). Saunders Comprehensive Review for the NCLEX-RN Examination. St. Louis, Missouri: Elsevier. Shelov and Tanya (2009). Milestone Moments, Learn the Signs and Act Early. Retrieved from www.cdc.gov/milestones. Vera, Matt. (2017). NCLEX Exam Cramsheet. Retrieved from hitps://nurseslabs.com/nclex-cram-sheet/ Wyatt, Kendall. (2017). Picmonic Visual Learning Community. The NCLEX Study Plan. https://www.picmonic.com/pages/picmonic-nclex- study-plan/ Created by: Jay Padong, RN, USRN Powered By: IPASS Nursing Exams Processing tgs