DO NOT delegate what you can EAT!

E - evaluate
A - assess
T – teach

Addison’s= Everything is DOWN except Potassium… Mineral corticoids are give in Addison’s
disease.
hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia

cushings= Everything is UP except Potassium

hypernatremia, hypertension, increased blood vol, hypokalemia, hyperglycemia

No Pee, no K (do not give potassium without adequate urine output)

EleVate Veins
DAngle Arteries ….for better perfusion

A= appearance (color all pink, pink and blue, blue [pale])

P= pulse (>100, < 100, absent)
G= grimace (cough, grimace, no response)
A= activity (flexed, flaccid, limp)
R= respirations (strong cry, weak cry, absent)

TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE
Measles
Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB
TB… N95 MASK
SARS
Private Room - negative pressure, Exchange air 6-12 hrs - DOOR CLOSED
Mask, N95 for TB
Gloves
Gown
Handwashing
Disposable supplies

DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diptheria (pharyngeal) E - epiglottitis
R - rubella
M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia An - Adenovirus
Private Room
cohort Mask – Pt wears mask when leaving the room
Disposable supplies

CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *
W - wound infxn
E - enteric infxn - clostridium difficile E - eye infxn – conjunctivitis

SKIN INFECTIONS VCHIPS

V - varicella zoster
C - cutaneous diphtheria H - herpez simplex
I - impetigo
P - pediculosis S – scabies
Private Room- Door Open
Gloves
Gown ONLY worn when in Direct Contact
Disposable supplies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense
of impending doom) --> turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc)
--> turn on left side (and give O2, stop Pitocin, increase IV fluids)

3. Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the stomach)
with the HOB elevated (to prevent aspiration)

4. During Epidural Puncture --> side-lying

5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent
headache and leaking of CSF)

6. Pt w/ Heat Stroke --> lie flat w/ legs elevated

7. During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept
straight. No other positioning restrictions.

8. After Myringotomy --> position on side of affected ear after surgery (allows drainage of
secretions)

9. After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1-4 weeks.

10. After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.

11. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture

12. Buck's Traction (skin traction) --> elevate foot of bed for counter-traction

13. After 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. hip abduction by
separating thighs with pillows.

14. Prolapsed Cord --> knee-chest position or Trendelenburg

15. Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line. While
feeding, hold in upright position.

16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) -->

eat in reclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals,
low CHO and fiber diet, small frequent meals)

17. Above Knee Amputation --> elevate for first 24 hours on pillow, position prone daily to provide
for hip extension.

18. Below Knee Amputation --> foot of bed elevated for first 24 hours, position prone daily to
provide for hip extension.

19. Detached Retina --> area of detachment should be in the dependent position
20. Administration of Enema --> left side-lying (Sim's) with knee flexed

21. After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees

22. After Infratentorial Surgery (incision at nape of neck)--> position pt flat and lateral on either
side.

23. During Internal Radiation --> on bedrest while implant in place

24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal

congestion, goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB)
first before any other implementation.

25. Shock --> bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)

26. Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure

27. Peritoneal Dialysis when Outflow is Inadequate --> turn pt from side to side BEFORE checking
for kinks in tubing

28. Lumbar puncture => AFTER the procedure, the client should be placed in the supine position for
4 to 12 hrs as prescribed.

Demorol for pancreatitis, NOT morphine sulfate

Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore
Demerol should be given.

Myasthenia Gravis: worsens with exercise and improves with rest.

Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use
filter needle

Prior to a liver biospy its important to be aware of the lab result for prothrombin time (10-13
seconds)

Diarrhea)= metabolic acidosis

Vomitus)=metabolic alkalosis

Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and
hair


Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat,
fine/soft hair

Thyroid storm: increased temp, pulse and HTN

Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside

Hypo-parathyroid: – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca,
low phosphorus diet

Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium),
low Ca, high phosphorus diet

Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine
specific gravity >1.030

Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine
specific gravity <1.010; Semi-Fowler’s

Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin

SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics

Hypokalemia: muscle wakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression,
decreased cardiac contractility, ECG changes, reflexes

Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic
diuretics, fluids

Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia;

hypotonic solution

Hypocalcemia: convulsions, arrhythmias, tetany, spasms and stridor

Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, sedative effect on CNS

HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity

HyperMg: depresses the CNS, hypotension, facial flushing, muscle weakness, absent deep tendon
reflexes, shallow respirations, emergency

Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia,

diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and
stimulating foods, surgery to remove tumor

1. Neuroleptic malignant syndrome (NMS): -NMS is like S&M;

-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up
-you start to drool


2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubella), or
German measles (rubella), so remember:
-Never get pregnant with a German (rubella)

3. When drawing up regular insulin & NPH together, remember: -RN (regular comes before NPH)
4. Tetralogy of fallot; child drops to floor or squats…. TET SPELLS

5. MAOI's that are used as antidepressants:

Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.

Amphojel: tx of GERD and kidney stones....watch out for contipation.

Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonly
Versed: given for conscious sedation...watch for resp depression and hypotension

PTU and Tapazole- prevention of thyroid storm

Sinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causes

drowsiness

Cogentin: tx of parkinson and extrapyramidal effects of other drugs

Tigan: tx of postop n/v and for nausea associated with gastroenteritis

Timolol (Timoptic)-tx of gluacoma


Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of
fluids

Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)

Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying
position; take with meals.

Bentyl: tx of irritable bowel....assess for anticholinergic side effects.

verapamil: calcium channel blocker: tx of HTN, angina...assess for constipation

Carafate: tx of duodenal ulcers..coats the ulcer...so take before meals.

Theophylline: tx of asthma or COPD..therap drug level: 10-20

Mucomyst is the antedote to tylenol and is administered orally

Diamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs

Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.

Librium: tx of alcohol w/d...dont take alchol with this...very bad nausea and vomiting can occur.

vincristine): tx of leukemia..given IV ONLY

kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) use the
shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb
with a fine tooth comb

Premarin:tx after menopause estrogen replacement

Dilantin: tx of seizures. thera drug level: 10-20

Navane: tx of schizophrenia..assess for EPS

Ritalin: tx of ADHD..assess for heart related side effects report immediately...child may need a drug
holiday b/c it stunts growth.

dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital
organs...monitor EKG for arrhythmias, monitor BP

Have trouble remembering fhr patterns in OB? Think VEAL CHOP VC

V = variable decels;… C = cord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels = P= placental insufficiency, can't fill

For cord compression, place the mother in the TRENDELENBERG position because this removes
pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled
out of the body by gravity)

If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to
minimize infection.

For late decels, turn the mother to her left side, to allow more blood flow to the placenta.

For any kind of bad fetal heart rate pattern, you give O2, often by mask...

When doing an epidural anesthesia hydration before is a priority.

Hypotension and bradypnea / bradycardia are major risks and emergencies.

Always assess the patient first; for exmaple listen to the fetal heart tones with a stethoscope in
NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually
easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to
check first, and one of the choices involves the machine, that's the wrong answer.

HEAR HEART SOUNDS

If the baby is a posterior presentation, the sounds are heard at the sides.

If the baby is anterior, the sounds are heard closer to midline, between the umbilicus and where you
would listen to a posterior presentation.

If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex,
they are a little bit above the symphysis pubis.

ventilator alarms
High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites
Low press alarm- Disconnection or leak in ventilator or in pt. airway cuff, pt. stops

spontaneous breathing
1. remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)

2. ICP AND SHOCK HAVE OPPOSITE V/S

3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is
a choice.)
4. herion withdrawal neonate: irratable poor sucking

5. Jews: no meat and milk together

6. Brachial pulse: pulse area cpr on an infant.

7. Test child for lead poisioning around 12 months of age

8. bananas, potatoes, citrus fruits source of potassium

11. Cultures are obtained before starting IV antibiotics


12. a pt with leukemia may have epitaxis b/c of low platelets

13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.

14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart
tone/rate

15. phobic disorders...use systematic desensitiztion.

Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.

IV push should go over at least 2 minutes.

If the patient is not a child an answer with family option can be ruled out easily

In an emergency, patients with greater chance to live are treated first

ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton) are always secondary to
something else (another disease process).

Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).

In pH regulation the 2 organs of concern are lungs/kidneys.

Edema is in the interstitial space not in the cardiovascular space.

 Weight is the best indicator of dehydration

Wherever there is sugar (glucose) water follows

Aspirin can cause Reye’s syndrome (encephalopathy) when given to children

Use Cold for acute pain (eg. Sprain ankle)

Heat for chronic (rheumatoid arthritis)

Guided imagery is great for chronic pain

When patient is in distress, medication administration is rarely a good choice.

With pneumonia, fever and chills are usually present. For the elderly confusion is often present.

Cor pulmonale (s/s fluid overload) is Right sided heart failure caused
by pulmonary disease, occurs with bronchitis or emphysema.

COPD is chronic,
Pneumonia is acute.
Emphysema and bronchitis are both COPD.

In COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2 level must be low for
pt with COPD

Prednisone toxicity: cushing’s syndrome= buffalo hump, moon face, high glucose, hypertension.

4 options for cancer management: chemo, radiation, surgery, allow to die with dignity.

no live vaccines, no fresh fruits, no flowers should be used for neutropenia patients.

chest tubes are placed in the pleural space.

angina (low oxygen to heart tissues) = no dead heart tissues.
MI=dead heart tissue present.

mevacor (anticholesterol med) must be given with evening meal if it is QD (per day).

Nitroglycerine is administered up to 3 times (every 5 minutes). If chest pain does not stop go to
hospital. Do not give when BP is < 90/60.
Unstable angina is not relieved by nitro.

Preload affects amount of blood that goes to the R ventricle.

Afterload is the resistance the blood has to overcome when leaving the heart.
Calcium channel blocker affects the afterload.

For a CABG operation when the great saphenous vein is taken it is turned inside out due to the
valves that are inside.

Dead tissues cannot have PVC’s (premature ventricular contraction. If left untreated pvc’s can lead
to VF (ventricular fibrillation).

1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz

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

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

Angiotensin II in the lungs= potent vasodialator. Aldosterone attracts sodium.

REVERSE AGENTS FOR TOXICITY

heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.

- methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts.

heparin prevents platelet aggregation.

PT/PTT are elevated when patient is on Coumadin

cardiac output decreases with dysrythmias.

Dopamine increases BP.

Med of choice for Vtach is lidocaine
Med of choice for SVT is adenosine or adenocard

Med of choice for Asystole (no heart beat) is atropine


Med of choice for CHF is Ace inhibitor.

Med of choice for anaphylactic shock is Epinephrine

Med of choice for Status Epilepticus is Valium.

Med of choice for bipolar is lithium. Get levels checked… OVER 2.0 TOXIC

Amiodorone is effective in both ventricular and atrial complications.

S3 sound is normal in CHF, not normal in MI.

Protonix is given prophylactically to prevent stress ulcers.

after endoscopy check gag reflex.

TPN(total parenteral nutrition) given in subclavian line.

low residue diet means low fiver

Diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant.

Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness

portal hypotension + albuminemia= Ascites.

Beta cells of pancreas produce insulin

Trousseau and Tchovoski signs observed in hypocalcemia

With chronic pancreatitis, pancreatic enzymes are given with meals.

Never give K+ in IV push

Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy. Fats leave
ketones (acids) that cause pH to decrease. DKA is rare in diabetes mellitus type II because there is
enough insulin to prevent breakdown of fats.

Sign of fat embolism is petechiae. Treated with heparin.

For knee replacement use continuous passive motion

Glaucoma patients lose peripheral vision. Treated with meds

Cataract= cloudy, blurry vision. Treated by lens removal-surgery

Spinal shock occurs immediately after spinal injury

Multiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction.

Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system.

Parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), and tremors. Treat with levodopa.

TIA (transient ischemic attack) mini stroke with no dead brain tissue

CVA (cerebrovascular accident) is with dead brain tissue.

Hodgkin’s disease= cancer of lymph is very curable in early stage.

Rule of NINES for burns

Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?

Birth weight doubles by 6 month and triple by 1 year of age. 91. if HR is <100 do not give dig to
children.

First sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable; do not eat, not
passing meconium.
Heart defects. Remember for cyanotic -3T’s(TOF, Truncys arteriosus, Transposition of the great
vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected
surgically, CHF will occur following by death.

with R side cardiac cath=look for valve problems

with L side in adults look for coronary complications.

rheumatic fever can lead to cardiac valves malfunctions.

cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain tissues.

ICP (intracranial pressure) should be <2. measure head circonference.

dilantin level (10-20). Can cause gingival hyperplasia

For Meningitis check for Kernig’s/ Brudzinski’s signs.

Wilm’s tumor is usually encapsulated above the kidneys causing flank pain

hemophilia is x-linked. Mother passes disease to son.

Buck’s traction= knee immobility

Russell traction= femur or lower leg

Dunlap traction= skeletal or skin

Bryant’s traction= children <3y, <35 lbs with femur fx.

place apparatus first then place the weight when putting traction

placenta should be in upper part of uterus

a patient with a vertical c-section surgery will more likely have another c-section.

Perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities.

Rh- mothers receive rhogam to protect next baby.

anterior fontanelle closes by 18 months.

Posterior 6 to 8 weeks.

caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs
within 1 to 3 days.

Pathological jaundice= occurs before 24hrs and last7 days.

Physiological jaundice occurs after 24 hours.

Placenta previa = there is no pain, there is bleeding.

Placenta abruption = pain, but no bleeding.

bethamethasone (celestone)=surfactant. Med for lung expansion.

dystocia= baby cannot make it down to canal

 Pitocin med used for uterine stimulation
Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective.
If patient experiences seizure during magnesium adm. Get the baby out stat (emergency).

FIVE INTERVENTIONS FOR PSYCH PATIENTS

-safety
-setting limits
-establish trusting relationship
-meds
-leas restrictive methods/environment.

SSRI’s (antidepressants) take about 3 weeks to work.

Obsession is to thought.
Compulsion is to action

If patients have hallucinations redirect them.

In delusions distract them.

Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side effects)

Alzheimer’s disease is a chronic, progressive, degenerative cognitive disorder that accounts for more
than 60% of all dementias

Iron injections should be given Z-track so they don't leak into SQ tissues.
Developmental
2-3 months: turns head side to side
4-5 months: grasps, switch & roll
6-7 months: sit at 6 and waves bye-bye
8-9 months: stands straight at eight
10-11 months: belly to butt (phrase has 10 letters)
12-13 months: twelve and up, drink from a cup

Hepatitis
Hepatitis: -ends in a VOWEL, comes from the BOWEL
(Hep A) Hepatitis B=Blood and Bodily fluids
Hepatitis C is just like B

Apgar measures HR,RR,Muscle tone, Reflexes, Skin color each 0-2 point.
8-10 OK. 0-3 RESUSCITATE.

GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!

It is similar to measuring dating skills...max 15 points -one can do it if below 8 you are in Coma.

The person who hyperventilates is most likely to experience respiratory alkalosis.

avoid salt substitutes when taken dig and k-supplements many are potassium based
Signs of hypoxia: restless, anxious, cyanotic tachycardia, increased resps. (also monitor ABG's)

Dumping syndrome: increase fat and protein, small frequent meals, lie down after meal to decrease
peristalsis, wait 1 hr after meals to drink.

For blood types: "O" is the universal donor (remember "o" in donor)
"AB" is the universal receipient

Fat soluble vitamins are Vitamins A, D, E, K

Give NSAIDS, Corticosteroids, drugs for Bipolar, Cephalosporins, and Sulfanomides WITH food.

Ativan is the treatment of choice for status epilepticus

When using a bronchodilator inhaler inconjuction with a glucocorticoid inhaler, administer the
bronchodilator first

Theophylline increases the risk of digoxin toxicity and decreases the effects of lithium and Dilantin

INtal, an inhaler used to treat allergy induced asthma may cause bronchospasm, think... INto the
asthmatic lung

Isoniazid causes peripheral neuritis

Peptic ulcers caused by H. pylori are treated with Flagyl, Prilosec and Biaxin. This treatment kills
bacteria and stops production of stomach acid, but does not heal ulcer.

Weighted NI (Naso intestinal tubes) must float from stomach to intestine. Don't tape the tube right
away after placement, may leave coiled next to pt on HOB. Position patient on RIGHT to facilitate
movement through pylorus.

* Diaphragm must stay in place 6 hours after intercourse. They are also fitted so must be re- fitted if
you lose or gain a significant amount of weight.

 Best time to take Growth Hormone PM,

 Steroids AM,
 Diuretics AM,
 Aricept AM.

* Tagamet with food (H2; messes with elderly ppl be careful ! Interacts with alot of things)
*Antacids after meals

Long term use of amphogel (binds to phosphates, increases Ca, robs the bones...leads to increased
Ca resortion from bones and WEAK BONES)

*Glaucoma intraocular pressure is greater than the normal (22 mm Hg), give miotics to constrict
(pilocarpine) NO ATROPINE.

Non dairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS

You can petal the rough edges of a plaster cast with tape to avoid skin irritation.

* Push fluids with Allopurinol - flush the uric acid out of system

* Koplick's spots are red spots with blue center characteristic of PRODROMAL stage of Measles.
Usually in mouth.

* INH can cause peripheral neuritis, take Vit B6 to prevent also hepatotoxic
14

* Rifampin - Red orange tears and urine, also contraceptives don't work as well

* Ethambutol - messes with your Eyes

* Apply eye drop to conjunctival sac and after wards apply pressure to nasolacrimal duct / inner
canthus

* Pancreatitis patients but them in fetal position, NPO, gut rest, prepare antecubital site for PICC cuz
they'll probably be getting TPN/Lipids

When giving Kayexalate we need to worry about dehydration ( K ha ineverse relationship with Na)

Yogurt has live cultures- dont give to immunosuppressed pt

Itching under cast area- cool air via blow dryer, ice pack for 10- 15 minutes. NEVER use qtip or
anything to scratch area

Murphy’s sign – pain with palpation of gall bladder area seen with cholecystitis

Cullen’s sign – ecchymosis in umbilical area, seen with pancreatitis

Turner’s sign – flank grayish blue (turn around to see your flanks) pancreatitis

McBurney’s Point – pain in RLQ indicative of appendicitis

LLQ – diverticulitis , low residue, no seeds, nuts, peas

RLQ – appendicitis, watch for peritonitis

Guthrie Test – Tests for PKU, baby should have eaten source of protein first Shilling Test – test for
pernicious anemia/ how well one absorbs Vit b12

Allen’s test – occlude both ulnar and radial artery until hand blanches then release ulnar. If the hand
pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned. ABGS must be
put on ice and whisked to the lab.

It’s ok to have abdominal craps, blood tinged outflow and leaking around site if the Peritoneal
Dialysis cath (tenkhoff) was placed in the last 1-2 wks. Cloudy outflow NEVER NORMAL.
Amniotic fluid yellow with particles = meconium stained

Hyper reflexes (upper motor neuron issue “your reflexes are over the top”)

Rhogam : given at 28 weeks, 72 hours post partum, IM. Only given to Rh NEGATIVE mother. Also if
indirect Coomb’s test is positive, don’t need to give Rhogam cuz she has antibody only give if
negative coombs

Order of assessment:
Inspection,
Palpation,
Percussion
Ausculation.

EXCEPT with abdomen cuz you don’t wanna mess with the bowels and their sounds so you Inspect,
Auscultate,
Percuss then
Palpate (same with kids, I suppose since you wanna go from least invasive

Latex allergies => Assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit,
avocados, chestnuts, tomatoes, peaches

Amyotrophic lateral sclerosis ( ALS ) is a condition in which there is a degeneration of motor
neurons in both the upper & lower motor neuron systems.

Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical emergency)
The 3 C's of TEF in the newborn:
1) Choking
2) Coughing
3) Cyanosis

The MMR vaccine is given SQ not IM.

Red--unstable, ie, occluded airway, actively bleeding, see first

Yellow---stable, can wait up to an hour for treatment, ie burns, see second
Green---stable, can wait even longer to be seen, "walking wounded"
Black--unstable clients that will probably not make it, need comfort measures
Greek heritage - they put an amulet or any other use of protective charms around their baby's neck
to avoid "evil eye" or envy of others

4 year old kids cannot interpret TIME. Need to explain time in relationship to a known COMMON
EVENT (eg: "Mom will be back after supper").

** Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine.

** Ask for allergy to eggs before Flu shot

** Ask for anaphylactic rxn to eggs or neomycin before MMR

** When on nitroprusside, monitor thiocynate (cyanide). Normal value should be 1, >1 is heading
toward toxicity

**If kid has cold, you can still give immunizations

** SIGNS of a Fractured hip: EXTERNAL ROTATION, SHORTENING, ADDUCTION

** Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not
acidosis r/t tachypnea), hypocalcemia, increased serum lipids, "snow storm" effect on CXR.

**Complications of Mechanical Ventilation: Pneumothorax, Ulcers

** Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones.

** NO VITAMIN C with Allopurinol

** IVP requires bowel prep so they can visualize the bladder better

**Acid Ash diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread

** Alk Ash diet- milk, veggies, rhubarb, salmon

** Orange tag in triage is non emergent Psych

** Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other


** BOTOX for strabismus. Patch the GOOD eye so that the weaker eye can get stronger. Found a cool
link about its use in peds pt with strabismus. I had to look it up cuz I heard it was important *ah hem
ah hem*

** TIDAL VOLUME is 7 – 10ml / kg

** COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive), Pa02 of 60ish and
Sa02 90% is normal for them b/c they are chronic CO2 retainers. ...

** Neostigmine/Atropine (anticholinergic) to reverse effect of pancuronium.

**Ampho B causes hypokalemia (amongst many other things..gotta premedicate before giving. Pts
will most likely get a fever)

** Test 4 hypersensitivity before the administration of asparginase.

** Take Vermox with high fat diet (increases absorption)

** Kidney Glucose threshold is 180

** Amphogel and Renegal take with meals

** Stranger anxiety is greatest 7 - 9 months,

Separation anxiety peaks in toddlerhood

Asthma and Arthritis--swimming best

Asthma has intercostal retractions--be concerned

Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities, may
happen after prolonged use of antipsychotics

Akathisia - motor restlessness, need to keep going, tx with antiparkinsons meds, can be mistaken for
agitation.

When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no
bubbles, put on ice immediately after drawing, with a lable indicating if the pt was on room air or
how many liters of O2.

Remember to preform the Allen's Test prior to doing an ABG to check for sufficient blood flow

Before going for Pulmonary Fuction Tests (PFT's), a pt's bronchodilators will be with-held and they
are not allowed to smoke for 4 hrs prior

For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside
table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for
complication of pneumothorax, sterile dressing applied

For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs
afterwards, sterile dressing, frequent neuro assessments
EEG, hold meds for 24-48 hrs prior, no caffeine or cigarettes for 24 hrs prior, pt can eat, pt must
stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing
light, after EEG, assess pt for seizures, pt's will be at increased risk
Diamox, used for glaucoma, can cause hypokalemia


Dexedrine, used for ADHD, may alter insulin needs, avoid taking with MAOI's, take in morning
(insomnia possible side effect)

Cytovene, used for retinitis caused by cytomegalovirus, pt will need regular eye exams, report
dizziness, confusion, or seizures immediately

INH, used to treat and prevent TB, do not give with dilantin, can cause phenytonin toxicity, monitor
LFT's, give B6 along with, hypotension will occur initially, then resolve

Rifampin, for TB, dyes bodily fluids orange

If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with fluids, med is incompatible with
caffeine and apple juice

Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia,
tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway), monitor
for early signs of reaction and give IM Benadryl
Risperdal, antipsychotic, doses over 6mg can cause tarditive dyskinesia, first line antipsychotic in
children

Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6

Sinemet, for parkinsons, contraindicated with MAOI's

Hydroxyurea, for sickle cell, report GI symptoms immediately, could be sign of toxicity

Zocor, for hyperlipidemia, take on empty stomach to enhance absorption, report any unexplained
musle pain, especially if fever

Decorticate is toward the 'cord'. Decerebrit is the other way (out)

-Munchausen Syndrome is a psychiatric disorder that causes an individual to self-inflict injury

or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or
hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically
a mother, intentionally causes or fabricates illness in a child or other person under her care.
Huntington's Chorea: 50% genetic, autosomal dominant disorder S/S: chorea --> writhing, twisting,
movements of face, limbs and body -gait deteriorates to no ambulation
-no cure, just palliative care

-Don't use Kayexalate if patient has hypoactive bowel sounds.

-Uremic fetor --> smell urine on the breath

-Hirschsprung’s --> bile is lower obstruction, no bile is upper obstruction; ribbon like stools. -
Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.

a person shouldn't have cantaloupe before a occult stool test, because cantaloupe is high in vit c and
vit c causes a false + for occult blood. They can’t have FISH either
Hypospadias: abnormality in which urethral meatus is located on the ventral (back) surface of the
penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under
side)

Epispadias: opening of the urethra on the dorsal (front) surface of the penis

Priapism: painful erection lasting longer than 6 hrs.

Anticholinergic effects--assessment dry mouth==can't spit

urinary retention=can't **** constipated =can't ****
blurred vision=can't see

When you see Coffee-brown emesis, think peptic ulcer

2.Anytime you see fluid retention. Think heart problems first.

3.An answer that delays care or treatment  ALWAYS wrong

When asking patients’ questions NEVER use “why”

Never release traction UNLESS you have an orderfrom the MD to do so

Questions about a halo? Remember safety first, havea screwdriver nearby.

Remember compartment syndrome is an emergency situation. Paresthesias and increased pain

are classic symptoms. Neuromuscular damage is irreversible 4-6
hours after onset.

Behavior motivated by need to avoid anxiety and satisfy needs

1. Infancy 0-18 months others will satisy needs
2. childhood >6yrs learn to delay need gratification
3. juvenile 6-9 years learn to relate to peers
4. preadolescence 9-12 yrs learns to relate to friends of of opposite sex
5. early adolescence12-14yrs:learn independence and how to relate to opposite sex
6. late adolecence 14-21yrs: develop intimate relationship with person of opposite sex

Fetal alcohol syndrome -upturned nose

-flat nasal bridge
-thin upper lip
-SGA

vastus lateralis is IM administration site for 6month infants

For toddlers above 18 months ventrogluteal

The deltoid and gluteus maximus are appropriate sites for children

Thoracentesis prep- Take v.s., shave area around needle insertion, position patient with arms on
pillow on over bed table or lying on side, no more than 1000cc at a one time. Post- listen for bilateral
breath sounds, v.s., check leakage, sterile dressing.

CT- assess allergies

MRI- claustrophobia, no metal, assess pacemaker

Cardiac cath- npo 8-12hr, empty bladder, pulses, tell pt may feel heat palpitations or desire to cough
with dye injection. Post- Vital signs keep leg straight bedrest 6-8hr.
cerebral angio prep- well hydrated, lie flat, sire shaved, pulses marked post- keep flat 12-14hr,
check site, pulses,force fluids.

Lumbar puncture- fetal postion. post- nuero assess q15-30 until stable, flat2-3hr, encourage fluids,
oral anlgesics for headache, observe dressing

EEG- no sleep the night before, meals not withheld, no stimulants for 24hr before,
tranquilizer/stimulant meds held 24-48hr before, may be asked to hyperventilate 3-4min and watch
a bright flashing light.

Myelogram- Npo 4-6hr, allergy hx, phenothiazines, cns depressants, and stimulants withheld 48hr
prior, table will be moved to various postions during test. Post- neuro q2-4, water soluble HOB up,
oil soluble HOB down, oral analgesics for h/a, encourage po fluids, assess for distended bladder,
inspect site.

Liver biopsy- Adm vit k , npo morning of exam 6hr, give sedative, Teach pt that he will be asked to
hold breath for 5-10sec, supine postion, lateral with upper arms elevated. Post- postion on right
side, frequent v.s., report severe ab pain stat, no heavy lifting 1wk.
Paracentesis- semi fowlers or upright on edge of bed, empty bladder. Post- v.s., report elevated
temp, observe for signs of hypovolemia.
Laparoscopy- CO2 used to enhances visual, general anesthesia, foley. Post- walk patient to decrease
CO2 build up used for procedure.

Pyelogram- assess allergies

Sengstaken blakemore tube used for tx of esophageal varices, keep scissors at bedside.

Hemovac- used after mastectomy, empty when full or q8hr, remove plug, empty contents, place on
flat surface, cleanse opening and plug with alcohol sponge, compress evacuator completely to
remove air, release plug, check system for operation.
 Common Signs and Symptoms

01. PTB – low-grade afternoon fever.

02. PNEUMONIA – rusty sputum.

03. ASTHMA – wheezing on expiration.

04. EMPHYSEMA – barrel chest.

05. KAWASAKI SYNDROME – strawberry tongue.

06. PERNICIOUS ANEMIA – red beefy tongue.

07. DOWN SYNDROME – protruding tongue.

08. CHOLERA – rice watery stool.

09. MALARIA – stepladder like fever with chills.

10. TYPHOID – rose spots in abdomen.

11. DIPTHERIA – pseudo membrane formation

12. MEASLES – koplik’s spots.

13. SLE – butterfly rashes.

14. LIVER CIRRHOSIS – spider like varices.

15. LEPROSY – lioning face.

16. BULIMIA – chipmunk face.

17. APPENDICITIS – rebound tenderness.

18. DENGUE – petechiae or (+) Herman’s sign.

19. MENINGITIS – Kernig’s sign (leg flex then leg pain on extension), Brudzinski sign (neck flex =

lower leg flex).

20. TETANY – hypocalcemia (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm).

21. TETANUS – risus sardonicus.

22. PANCREATITIS – Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots.

23. PYLORIC STENOSIS – olive like mass.

24. PDA – machine like murmur.

25. ADDISON’S DISEASE – bronze like skin pigmentation.

26. CUSHING’S SYNDROME – moon face appearance and buffalo hump.

27. HYPERTHYROIDISM/GRAVE’S DISEASE – exopthalmus.

28. INTUSSUSCEPTION – sausage shaped mass, Dance Sign (empty portion of RLQ)

29. MS – Charcot’s Triad (IAN)

30. MG – descending muscle weakness

31. Guillain Barre Syndrome – ascending muscle weakness

32. DVT – Homan’s Sign

33. CHICKEN POX – Vesicular Rash (central to distal) dew drop on rose petal

34. ANGINA – Crushing stubbing pain relieved by NTG

35. MI – Crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG

36. LTB – inspiratory stridor

37. TEF – 4Cs’ Coughing, Choking, Cyanosis, Continous Drooling

38. EPIGLOTITIS – 3Ds’ Drooling, Dysphonia, Dysphagia

39. HODGEKIN’S DSE/LYMPHOMA – painless, progressive enlargement of spleen & lymph tissues,

Reedstenberg Cells

40. INFECTIOUS MONONUCLEOSIS – Hallmark: sore throat, cervical lymph adenopathy, fever

41. PARKINSON’S – Pill-rolling tremors

42. FIBRIN HYALIN – Expiratory Grunt

43. CYSTIC FIBROSIS – Salty skin

44. DM – polyuria, polydypsia, polyphagia

45. DKA – Kussmauls breathing (Deep Rapid RR)

46. BLADDER CA – painless hematuria

47. BPH – reduced size & force of urine

48. PEMPHIGUS VULGARIS – Nikolsky’s sign (separation of epidermis caused by rubbing of the skin)

49. RETINAL DETACHMENT – Visual Floaters, flashes of light, curtain vision

50. GLAUCOMA – Painfull vision loss, tunnel/gun barrel/halo vision (Peripheral Vision Loss)

51. CATARACT – Painless vision loss, Opacity of the lens, blurring of vision

52. RETINO BLASTOMA – Cat’s eye reflex (grayish discoloration of pupils)

53. ACROMEGALY – Coarse facial feature

54. DUCHENNE’S MUSCULAR DYSTROPHY – Gowers’ sign (use of hands to push one’s self from the

floor)

55. GERD – Barretts esophagus (erosion of the lower portion of the esophageal mucosa) 56.

HEPATIC ENCEPHALOPATHY – Flapping tremors

57. HYDROCEPHALUS – Bossing sign (prominent forehead)

58. INCREASE ICP – HYPERtension BRADYpnea BRADYcardia (Cushing’s Triad)

59. SHOCK – HYPOtension TACHYpnea TACHYcardia

60. MENIERE’S DSE – Vertigo, Tinnitus

61. CYSTITIS – burning on urination

62. HYPOCALCEMIA – Chvostek & Trosseaus sign

63. ULCERATIVE COLITIS – recurrent bloody diarrhea 64. LYME’S DSE – Bull’s eye rash

Ottorhea s/s of basilar fracture

Battles sign and racoons eyes s/s of orbital fracture

Take iron elixir with juice or water.... never with milk

Dilantin 10-20
Theophyline 10-20
Acetaminophen 10-20
Lithium 0.5-1.5
Digoxin 0.5-2.0

Osteomyletitis is an infectious bone dz. Give blood cultures and antibiotics, then if necessary surgery
to drain abscess.

Nephrotic syndrome s/s edema + hypotension. Turn and reposition (risk for impaired skin
integrity)
Renal impairment: serum creatinine  elevated and urine clearance  decreased
Norm. Serum creatinine 0.8-1.8 (men), 0.5-1.5 (women) Norm. Urine clearance 85-135

Blood tests for MI: Myoglobin, CK and Troponin


*Change in color is always a LATE sign!

*Incentive Spirometry steps:

1) Sit upright
2) Exhale
3) Insert mouthpiece
4) Inhale for 3 seconds, and then HOLD for 10 seconds

*Aminoglycocide (Mycin ; except erythromycine) Adverse Effects are bean shaped - Nephrotoxic to
Kidneys and Ototoxic to Ears

*MRSA - Contact precaution ONLY

*VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure)

*LITHIUM
L-level of therapeutic affect is 0.5-1.5
I-indicate mania
T-toxic level is 2-3 - N/V, diarrhea, tremors
H-hyrdrate 2-3L of water/day
I-increased UO and dry mouth
U-uh oh; give Mannitol and Diamox if toxic s/s are present
M-maintain Na intake of 2-3g/day
*All psych meds' (except Lithium) side effects are the same as SNS but the BP is decreased.

*SNS- Increase in BP, HR and RR (dilated bronchioled), dilated pupils (blurred vision), Decreased
GUT (urniary retention), GIT (constipation), Constricted blood vessels and Dry mouth.

*Blood transfusion- sign of allergies in order:

1)Flank pain
2)Frequent swallowing
3)Rashes
4)Fever
5)Chills

*Thrombocytopenia -Bleeding precautions!

1)Soft bristled toothbrush
2)No insertion of anything! (c/i suppositories, douche)
3)No IM meds as much as possible!

*Iron deficiency anemia - easily fatigued

1)Fe PO - give with Vitamin C or on an empty stomach
2)Fe via IM- Inferon via Ztrack

*Pernicious Anemia - Red, Beffy tongue; will take Vit.B12 for life!
*BURNS
1st Degree - Red and Painful
2nd Degree - Blisters
3rd Degree - No Pain because of blocked and burned nerves

*Meniere's Disease - Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on
affected ear when in bed. Triad:

*Gastric Ulcer pain occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away
with food

Knee to chest
Calm pt
Give o2
Give morphine
BNP level should be <100

If a patient can’t take Ace inhibitor … give SARTEN…

Furosemide is a “potassium- wasting” diuretic…. TAKE WITH WATER and sit up because can cause
heart dysthymias

Calcium channel blocker “PINE” causes DIZZINESS, change positions slowly

Pericarditis is aggravated during inspiration and coughing and relieved by LEANING FORWARD

Raynaud disease: wear gloves when handeling cold objects, stop smoking, avoid caffine, practice
yoga,

Sildenafil is VIAGRA… DO NOT USE with NITRO and Nitro is used to treat unstable angina so
always question this medication
Any time there is a risk of DVT always do a complete neurovascular assessment

When a child has Kawasaki disease always monitor for a gallop heart rhythm and decreased urine
output… this is the ONLY time a child can have aspirin
 When a person has PVD or
PAD … Elevating their legs
causes pain to them

BLUEISH COLOR
HAIRLESS, SHINY

CALF PAIN
EDEMA
WARM AND RED

MURMUR ARE BEST HEARD OVER 5TH INTERCOSTAL SPACE

CALCIUM SCORING CT SCAN = NO SPECIAL PREP NEEDED

Isotretinoin… need two forms of birth control

CHEST TUBE Drainage more then 3ml and hr or 5-10 ml/hr REPORT ASAP think hemorrhage

An ICD can defib patients but cannot sense pulselessness… so CPR should still be initiated if the patient is
pulseless.
Hypomagnesemia < 1.5 can lead to Torsades de pointes ( heart rhythm)
If a pt is prescribed clopidogel and antiplatelet be concerned about ULCERS and don’t take GINKO

IF bleeding occurs after a cardiac cath.. apply pressure ABOVE the site

STATINS (cholesterol drugs) monitor for MUSCLE WEAKNESS.. Rhabdomyolysis ( break down of muscle)

Adenosine is the drug of choice for PSVT

Contraindications to thrombolytic
Any intracranial hemorrhage
Stroke within 3 months
Active bleeding
Head trauma (cerebral aneurysm)

Any time a pt comes into the ER with chest pains they should be seen first
A FIB- beat can be 300-600 NO P waves,