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Comprehensive NCLEX Review

NCLEX review cheat sheet covering key conversions, dosage calculations, IV flow rate formulas, vital signs, and critical lab values for sodium and potassium. Includes clinical signs, symptoms, and nursing considerations for high/low levels.

Alice Edwards
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NCLEXREVIEWTOPICS1mg-l,OOOm eg1g=1 , EOOmgl o z=30rnLBoz=1c u pI t s p=5mLI t b s p=15mLI t b s p=3t s pI L=1 , 00OmLI m L=1 5g t t s( d r o p so rd r o pf a c t o r )1 k g=2 . 2 l b sl i b=I G c zFORMULA METHOD FOR VOLUME RELATEDDOSAGE ORDERS:D e s i r e d / D o s a g ec fmeda v a i l a b l ex'sV o l u m emedi sa v a i l a b l ei n=Amountmedr e q u i r e dt og i v eI VFLOW RATES:mLs o l u t i o n / t o t a lh r s=m L / h rI fq u e s t i o ng i v e ni nm i n u t e s ,mLo fs o l u t i o n / m i nx ' s6 0m i n=m L / h rI fq u e s t i o na s k sd r o pf a c t o rp e rm i n :MLo fs o l u t i o n / t c t a Lm i n u t e sxd r o pf a c t o r=g t t / m i nLABS:EP:1 2 0S y s t o l i c / 8 0D i a s t o l i cMAP:7 0 - 1 0 5 ,MAP<60=i n a d e q u a t et i s s u ep e r f u s i o nHR:6 0 - 1 0 0R e s p i r a t i o n s :1 2 - 2 00 2 :9 5 - 1 0 0 %Temp:9 7 . 3 - 9 9 F .9 7 - 9 9 Fi sn o r mt e m p e r a t u r er a n g e .Chemon e u t r o p e n i cp a t i e n t ss h o u l dn o t i f yd o c t o rw i t ht e r pa b o v e0 0 F .1 0 0 . 4F+f o rc h i l dg i v ea c e t a m i n o p h e n .101F+-f o ra d u l tt ogivea c e t a m i n o p h e n Z i b u p r o f e n .S o d i u m :1 3 5 - 1 4 5L o w :C r a m p i n g( h y p e r a c t i v eb o w e l s ) ,o r t h o s t a t i ch y p o t e n s i o n ,m u s c l ew e a k n e s s .SIADH,k i d n e yd i s e a s e ,r t r tf a i l u r e .4D's( D i a p h o r e s i s ,D i u r e t i c s ,D i a r r h e a ,D r a i n s(NGs u c t i o n ) .H i g h :B i ga n db l o a t e d ,f l u s h e ds k i n .R e s t l e s s ,p i t t i n gedema,d e c r e a s eu r i n eo u t p u t ,s k i nf l u s h e d / d r y ,t h i r s t.H e r o c c n c e n t r a t i o n=i n c r e a s e ds o d i u m .D i a b e t e si n s i p i d u s .K i d n e yp r o b l e m sa n dd e c r e a s e ds o d i u me x c r e t i o n .S o d i u ma n dP o t a s s i u ma r eo p p o s i t e s .Oneg o e su p ,o t h e rg o e sd o w n .K :3 . 5-5 .L o w :weaki r r e g u l a rp u l s e ,o r t h o s t a t i ch y p o t e n s i o n ,l e t h a r g y ,coma,l o wr e f l e x e s ,c o n s t i p a t i o n ,s h a l l o wb r e a t h i n g ,STd e p r e s s i o n ,P r o m i n e n tUwaveo nECG.NEVER g i v eKb yI Vp u s h ,I M ,o rs u b c u t a n e o u s .A l w a y sd i l u t e da n dv i ai n f u s i o nd e v i c e .H i g h :C r a m p s ,T i g h ta n dc o n t r a c t e dsoLowHR a n dlowBP,T a l lp e a k e dTw a v e s ,w i d e n e dQRS,F l a tPwaveso nECG.ACE i n h i b i t o r s / N S A I D s / S p i r o n c l a c t o n e ,t h o s eond i a l y s i s( d e c r e a s e dKe x c r e t i o n ) .C a l c i u m :9 - 1 1 .F o u n di nb o n e s / t e e t h .L o w :c o n v u l s i o n s ,t e t a n y( r i n g i n go fe a r s ) ,s t r i d e r ,numbnessi nf i n g e r s / t o e s /f a c e ,A r r h y t h m i a s( d i m i n i s h e dp u l s e s ) ,i n i t i a t es e i z u r ep r e c a u t i o n s .P o s i t i v eT r o u s s e a u( h a n dspasmp u m p i n gEPc u f f )a n dC h v o s t e k ' s{ f a c i a lm u s c l e sc o n t r a c twhenf a c i a ln e r v et a p p e do n ) .H i g h :Bonep a i n ,C a r d i a ca r r e s t( b o u n d i n gp u l s e s ) ,k i d n e ys t o n e s ,e x c e s s i v e

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u r i n a t i c nC h l o r i d e :9 5 - 1 0 5Bun:7 - 2 0b l o o du r e an i t r o g e n .B r e a k d o w no fp r o t e i n sC r e a t i n e :0 . 6 - 1 . 2 .1 . 3=BADk i d n e y ,c r e a t i n ec h e c k sk i d n e yf u n c t i o n .Endp r o d u c to fm u s c l em e t a b o l i s m .B e t t e ri n d i c a t o rt h a nBUNA l b u m i n :3 . 4- 5 . 4 .P r o t e i nt h a th o l d sw a t e ri n s i d eb l o o dv e s s e l smadei nl i v e r .Lowi sf l u i dr e t e n t i o n( e d e m a / a s c i t e s ) ,h i g hi sd e h y d r a t i o n .Madei nl i v e r ,ap r o t e i ni nb l o o dp l a s r a .Keepsf l u i di nb l o o d s t r e a mandn o tl e a k i n gi n t ot i s s u e s .Lowa m o u n t si n d i c a t e sp o o rk i d n e y so rl i v e r .M a g n e s i u m :1 . 5 - 2 . 5 .Foundi nb o n e s .ToomuchMagnesiuma n dEVERYTHINGSEDATED.Coma,LowHR/BP/RR,l o wdeept e n d o nr e f l e x e s .Magnesiums u l f a t eg i v e nt op r e g n a n twomenw p r e e c l a m p s i a( h i g hBPa f t e r23w k sg e s t a t i o n )t os l o w / i n h i b i tc o n t r a c t i o n st od e l a yp r e t e r mb i r t h .Lowa m o u n t so fmagnesiumi ns y s t e m=t r e m o r s ,TORSADES DE POINTES,s e i z u r e s ,h y p e r a c t i v er e f l e x e s .U r i n es p e c i f i cg r a v i t y :1 . 0 1 3-1 . 0 3 0 .Low=c o n c e n t r a t i o no fu r i n ec l o s et ow a t e r ,v e r yh y d r a t e d .H i g hi n d i c a t e sc o n c e n t r a t e d u r i n e .D e h y d r a t e dn rs u b s t a n c e si nu r i n e .M e a s u r e sa b i l i t yf o rk i d n e y st oe x c r e t eo rc o n s e r v ew a t e r .GFR s h o u l d b e9 0 - 1 2 O m L / n i n .L e s st h a n30i sb a d .B l o o df l o wt h r o u g ht h ek i d n e y sL I V E R :A L T :7 - 5 6AST:5 - 4 0B i l i r u b i n :0 . 1 - 1 . 2 .H i g h=j a u n d i c e ,i t c h i n g .L I P I D S :T o t a lc h o l e s t e r o l :< 2 0 0T r i g l y c er i d e s :< 1 5 0LDL:< 1 6 0( b a dc h o l e s t e r o l )HDL:> 6 0( g o o dc h o l e s t e r o l )ABGs:PH:7 . 3 5t o7 . 4 5 .< 7 . 3 5=A c i d o s i s ,> 7 . 4 5A l k a l o s i sPaC02:3 5 - 4 5 .>45=A c i d o s i s ,< 3 5=A l k a l o s i sP a 0 2 :8 0 - 1 0 0HC03:2 2 - 2 6 .< 2 2=A c i d o s i s ,> 2 6=A l k a l o s i sR . O . M . E . :R e s p i r a t o r yO p p o s i t eM e t a b o l i cE q u a l .R e s p i r a t o r y :pHu p ,C02down=A l k a l o s i sO p p o s i t e :pHdown,C02up=A c i d o s i sM e t a b o l i c :pHu p ,HC03up=A l k a l o s i sE q u a l :pHdown,HC03down=A c i d o s i sI fpHo u to fr a n g eflC02o rHC03i si nr a n g e=u n c o m p e n s a t e dI fC02£HC03BOTH o u to fr a n g e£pHo u to fr a n g e=p a r t i a l l yc o m p e n s a t e dI fpH i si nr a n g e( 7 . 3 5 - 7 . 4 5 )=f u l l yc o m p e n s a t e dHOW DO ORGANS COMPENSATE? K i d n e y se x c r e t ea c i da n d b i c a r b o n a t e(HC03)o rr e t a i nh y d r o g e nS b i c a r b o n a t e .T a k eh o u r st od a y st oc o m p e n s a t e .LungsH Y P E R v e n t i l a t et or e d u c eCO2 c r e a t i n gALKALOSIS,o rHYPOVENTILATEt or a i s eC02c r e a t i n gACIDOSIS.F a s tc o m p e n s a t i o n .T h i n k" C a r b o nD i - A C I D " .R e s p i r a t o r yA c i d o s i s=L u n g sr e t a i n i n gt o omuchC02.K i d n e y sc o m p e n s a t eb ye x c r e t i n gh y d r o g e na n dr e t a i n i n gHC03.Causes=o p i o i d s ,s e d a t i v e s ,edema( f l u i di nl u n g s ) ,p n e u m o n i a ,a s t h m a ,COPD,emphysema,headi n j u r y ,p u l m o n a r ye m b c L i .S / S :r e d u c e dEP,I n c r e a s e dr e s p i r a t i o nr a t e ,h e a r tr a t e .R e s t l e s s ,c o n f u s e d ,s l e e p y ,coma.G i v e0 2 ,i fCO2>50,mayn e e de n d o t r a c h e a lt u b e .G i v eN a l o x o n e ,h y d r o m o r p h o n e .

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R e s p i r a t o r yA l k a l o s i s=l u n g sl o s i n gt omuchCOZ.K i d n e y sc o m p e n s a t eb ye x c r e t i n gb i c a r b o n a t ea n dr e t a i n i n gh y d r o g e n .C a u s e s=T a c h y p n e a .H y p e r v e n t i l a t i n g ,I n c r e a s et e m p e r a t u r e ,a s p i r i nt o x i c i t y .S / S :RR>20,i n c r e a s e dHR,c o n f u s e d / t i r e d ,t e t a n y ,EKG c h a n g e s ,-C h v o s t e ks i g n .G i v ee r o t i o n a ls u p p o r t ,r e b r e a t hi n t op a p e rb a g ,a n t ia n x i e t ym e d s ,h y d r o m o r p h c n e .M e t a b o l i cA c i d o s i s=K i d n e y sh o l d i n gt o omuchh y d r o g e n ,t o ol i t t l eB i c a r b o n a t e .L u n g sc o m p e n s a t eb yb l o w i n go f fC02.C a u s e s=DKA,k i d n e yi n j u r y ,s e v e r ed i a r r h e a( b e l o wt h ew a i s tl o s et h eb a s e ) ,d e h y d r a t i o n .S / S :K u s s m a u lb r e a t h i n g ,HYPERkalemia,l o w e r e dBP,C o n f u s i o n .G i v eI Vs o l u t i o nt or a i s eb a s e sa n dl o w s ’-a c i d s ,s e i z u r ep r e c a u t i o n s .G i v eI n s u l i nf o rDKA.I fk i d n e yd i s e a s ei sc a u s e ,d i a l y s i sw i t hi n c r e a s e dc a l o r i ci n t a k ea n dl e s sp r o t e i n .M i g h tg i v ea f o p i n e .M e t a b o l i cA l k a l o s i s=K i d n e y sh o l d i n go n t ot o omuchHCO3,t o ol i t t l eH y d r o g e n .L u n g sc o m p e n s a t eb yr e t a i n i n g0 0 2 .C a u s e s :E x c e s sv o r i t i n gd e p l e t e sa c i df r o ms t o m a c h ,t o omanya n t ia c i d s( w h i c hi sb i c a r b o n a t eH C 0 3 ) ,d i u r e t i c s .S / S :h y p o v e n t i l a t i o n< 1 2B r e a t h s / r i n ,LowK .G i v eI Vf l u i d st og e tr i do fHC03.R e p l a c eK ,g i v ea n t i e r e t i c sf o rv o m i t i n g( O n d a n s e t r o no rP h e n e r g a n ) .P a n c r e a sA m y l a s e :3G-113L i p a s e :0 - 1 5 0H B l a c( b l o o dg l u c o s ef o *-l a s t3m o n t h s )D i a b e t i c :< 6 . 5Randomb l o o dg l u c o s et h a ti sn o r m a l :< 2 0 0F a s t i n gb l o o dg l u c o s e :<125Rangef o *-p a t i e n t sr e c e i v i n gn u t r i t i o n a ls u p p o r t :1 4 3 - 1 8 0Rangef o ri n f a n twithin1 s t2 4 h r so fd e l i v e r y :2 4 - 6 0 .C o l dandclammy?Needsomec a n d y .H o ta n dd r y ?S u g a rh i g h .DKA.B l o w i n go f fk e t o n e s .Redi nc h e e k s ,warmt ot o u c h .WBC's:5 - 1 0 KRBC :4 - Gm i l l i o nP l a t e l e t :1 5 O - 4 5 0 KH e m o g l o b i n :1 2 - 1 8 .I ti sap r o t e i ni nRBC c a r r y i n go x y g e na n dt r a n s p o r t i n gawayC02H e m a t o c r i t :3 6 - 5 4 %( t h i n k3x ' sH e m o g l o b i n ) .I ti s% o fRBC'si nav o l u m eo fw h o l eb l o o d .H i g h ?D e h y d r a t e d ,h e a r td i s e a s e ,s c a r r e dl u n g s ,l a c ko f0 2i nb l o o d ,P o l y c y t h e r i aV e r a( i n c r e a s ei nb l o o dc e l l s=t h i c kb l o o d ) .H e p a r i naPTTi s3G-4Gs e c .A n t i d o t eP r o t a m i n es u l f a t e .W a r f a r i n :I N Ri s2 - 3s e c .A n t i d o t eV i t a m i nK .W a r f a r i nCANNOT beg i v e nt op r e g n a n twomen .B l o o dt y p eAB:U n i v e r s a lr e c i p i e n tB l o o dt y p e0 :U n i v e r s a lD O n o r .I fy o u rh a v eRH f a c t o r ,y o uc a nr e c e i v e+o r-b l o o d .Don'th a v eRH f a c t o r ?O n l yr e c e i v e s-b l o o d .I C P :5 - 1 5BMI :1 8 . 5t o2 4 . 9 .O v e r w e i g h t> 2 5 ,Obese> 3 0 ,M o r b i d l yo b e s e> 3 5G l a s g o wcoma:3 - 1 5 .L e s st h a n8=i n t u b a t e .FUNDAMENTALSNURSINGPROCESS:A .D . E L I C I O U SP . I . E .A s s e s sD i a g n o s eP l a nI m p l e m e n tE v a l u a t eSMART g o a l s :s p e c i f i cm e a s u r a b l ea c h i e v a b l er e l e v a n ttime

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PRIORITIZATION:ABC'sI st h e r ea no p e nAIRWAYs oa i rc a ng e ti n ?Cang a se x c h a n g eo c c u rs cp a t i e n tc a nBREATHE?Cano x y g e n a t e db l o o dCIRCULATEt ot h ea r g a n sandt i s s u e s ?* P a i nr a r e l yk i l l sp e a p l erd o e sn o tt a k ep r i o r i t yo nNCLEXNURSINCETHICS:A u t o n o m y :Makey o u rownd e c i s i o n sN o n m a l e f i c e n c e :Causench a r mB e n e f i c e n c e :dag o o dJ u s t i c e :e q u a ld i s t r i b u t i o no fb e n e f i t s / s e r v i c e sV e r a c i t y :T e l lt h et r u t hF i d e l i t y :K e e p i n gp r o m i s e s .I ne m e r g e n c ywhenc l i e n tc a n ' tg i v ec o n s e n t ,c o n s e n ti si m p l i e dv i ae m e r g e n c yl a w s .I m p l i e dc o n s e n t :Trauma,e m e r g e n c y ,g e t t i n gi n t oa na m b u l a n c e ,u n c o n s c i o u sI n f o r m e dc o n s e n t :y o uh a v et og i v eb e n e f i t s / r i s k s / a l t e r n a t i v e s / w h oi sd o i n gp r o c e d u r e / w r i t t e na n dp r o v i d e rh a st adai t /w h a tc o u l dh a p p e ni fy o ue l e c tn e tt oh a v ep r o c e d u r e .M i n o r su n d e rI Em u s tg e tc o n s e n tf r o mp a r e n t / l e g a lg u a r d i a nI t ' st h eDOCTOR'S r e s p o n s i b i l i t yt oi n f o r mp a t i e n ta b o u tr e dp r o c e d u r e .N u r s eo n l yh a st aw i t n e s s / o b t a i nc o n s e n tp r i o rt ap r o c e d u r e .INFECTIONCONTROL:DONNING:h a n dh y g i e n e ,gewn,m a s k / r e s p i r a t o r ,g c g g l e s / f a c es h i e I d / g l a v e sl a s t .DOFFING:g l o v e sf i r s t ,g c g g l e s / f a c es h i e l d ,gown,THEN m a s k / r e s p i r a t o r ,handh y g i e n e .AIRBORNE:"MTV' . . . Meas L e s ,TB,V a r i c e l l a( c h i c k e n p o xa n ds h i n g l e s ) .Ream i su n d e rNEGATIVEp r e s s u r e ,d o o r sc l o s e d ,h e a l t hc a r ew o r k e rn e e d sN95.Nol o n g e ra i r b o r n ewhenl e s i o n sc r u s t e do v e r .D r o p l e t :s u r g i c a lmask.F l u ,m e n i n g i t i s ,mumps,p e r t u s s i s ,p n e u m o n i a ,r u b e l l a ,s c a r l e tf e v e r ,s e p s i s ,S t r e pt h r o a t .C o n t a c t :G l o v e s / g o w n .C D i f f ,c o n j u n c t i v i t i s ,i m p e t i g o ,h e r p e s ,s c a b i e sI VSOLUTIONS:I n t r a c e l l u l a r :f l u i di n s i d et h ec e l lE x t r a c e l l u l a r :c u t s i d ec e l l ,i n t e r s t i t i a l( s u r r o u n d sc e l l ) ,i n t r a v a s c u l a r( p l a s m ai nb l o o dv e s s e l s ) .H y p E r t o n i c :ENTERv e s s e l sf r o mt h ec e l l s .M o r ec o n c e n t r a t e d / i n c r e a s e do s m o l a l i t y .F o rC e r e b r a lEdema,m e t a b o l i ca l k a l o s i s ,h y p o v o l e m i a .5% D e x t r c s ei n0 . 9 %s a l i n e / 0 . 4 5 %s a l i n e / L R .H y p e r=G e ti tm o v i n g .Youmoveb yb e i n gi nt h eb l o o d ,n o tt h ec e l I s .I s o t o n i c :S t a y sw h e r eIp u ti t .Sameo s m o l a l i t ya sb o d yf l u i d sE x p a n d si n t r a v a s c u l a rf l u i dv o l u m ea n dr e p l a c e sf l u i dl o s sf r o mB u r n s / s u r g e r y / d e h y d r a t i c n / h e m o r r h a g e .0 . 9 % s a l i n e f u s e dw b l o o dp r o d u c t s ) / L R / D 5 WH y p O t o n i c :OUTo ft h ev e s s e landi n t ot h ec e l lt omakei ts w e l l .M o r ed i l u t e da n dl o w e ro s m o l a l i t y( l e s ss a l t / n o r ew a t e r ) .F o ri n t r a c e l l u l a rd e h y d r a t i o nl i k eDKA,h e l p sk i d n e y sexcretee x c e s sf l u i d s .NEVER GIVEFOR BURN PATIENTSOR THOSE W LIVERDISEASE.Q.45%s a l i n e / 2 . 5 %Dextrose/fl. 3 3S a l i n e .BLOOD TRANSFUSIONS:I SOR 1 9gaugen e e d l e .Runw i t hn o r m a ls a l i n e .T r a n s f u s es l o w l y .F I R S T1 5MINV I T A Lf o ra d v e r s er e a c t i o n s .V i t a l sm o n i t o r e de v e r y3Bm i n - l h r .A f t e r1 5f l e wc a nbe

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i n c r e a s e d .B l e e ds h o u l db ei n f u s e dw i t h i n3 0m i ny o ur e c e i v e di t .B l e e dm u s tbet r a n s f u s e di nu n d e r4h r s .I ft h e r ei sa d v e r s er e a c t i o n :S t o pt r a n s f u s i o n .ChangeI Vt u b i n g .KeepI Vo p e nwn o r r a ls a l i n eC o n t a c tp r o v i d e r / b l o o db l a n k ,STAYWITHCLIENTAND MONITOR.6RIGHTSOF MEDICATIONADMINISTRATION:RIGHTPATIENTXMED/TINEZ ROUTEZDOSE/ DOCUMENTATIONWHEN GIVINGMEDS I NTHEEARS:ADULTSSHOULD BE ABLETODO PULL-UPSSO EAR EARUPAND OUT.KIDS< 3 :PULLEAR DOWN AND BACK.PRESSURE I N J U R I E S :STAGE 1 - 4 ,THEN UNSTAGEABLE.SEEBONE AND MUSCLE?L e v e l4 .L e v e l1 :J u s tr e da n ds w o l l e n ,nob r o k e ns k i n .T y p e3 :c a nseef a t .BRADEN SCALE:fi-23.6i ss e v e r e ,2 3i sp e r f e c ts k i n .Alwaysl i f t ,n e v e rp u l l ,r e p o s i t i o ne v e r y2 h r sHYPO VSHYPER VOLEMIA.Hypo=Low.D e h y d r a t i o n ,F l u i dv o l u m ed e f i c i t ,h y p o v o l e m i cs h o c k .P o l y u r i a ,3 r ds p a c i n g=f l u i d ss h i f tf r o mi n t r a v a s c u l a r( v e i n )t oi n t e r s t i t i a l( c e l l s )s u c ha sb u r n sanda s c i t e s .URINESPECIFICGRAVITY/HEMATOCRIT/BUNGOES UP.Lows k i nt u r g o r ,t h i r s t y ,LowBP.RISKFOR FALLSORTHOSTATICHYPOTENSION.D i a b e t e s .H y p e r=o v e rh y d r a t i o n .H e a r t / k i d n e yf a i l u r e .I fb l o o dc a n ' tb ef i l t e r e db yk i d n e y si tb a c k su p .I n c r e a s e ds o d i u mi n t a k ec a u s e st h i sb e c a u s ew h e r es o d i u mg o e s ,w a t e rf l o w s .J u g u l a rd i s t e n d e dv e i n s ,I n c r e a s e dB P / H R / W e i g h t .Edema.WetL u n g s .Lowu r i n eg r a v i t y / h e m a t t i c r i t / b u n.P l a c ei nH i g hF o w l e r ' s ,d a i l yIfiffs,DIURETICS.SCOPE OFPRACTICE:RN's:A s s e s st e a c h ,s t a r tb l o o dp r o d u c t s ,s t e r i l ep r o c e d u r e s ,I V s ,d i s c h a r g ee d u c a t i o n .U n s t a b l ep a t i e n t sLPN :S t a b l ec l i e n t s ,r e i n f o r c et e a c h i n g ,r o u t i n ep r o c e d u r e s( c a t h e t e r i s a t i o n ,o s t o m i e s ,woundc a r e ) ,I n j e c t e dd r u g s( n oI V ' s ) ,H o s tm e d i c a t i o na d m i n i s t r a t i o n s ,Ostomyc a r e .Tubep o t e n c ya n de n t e r a lf e e d i n g s ,s p e c i f i ca s s e s s m e n t so n l yl i k el u n gs o u n d s / b c w e ls o u n d s / n e u r oc h e c k s .UAP:R o u t i n es t a b l ev i t a l s ,d o c u m e n t i n gI & O ' s ,c a ng e tb l o o df r o mb l o o db a n k ,ADL'sl i k ef e e d i n g( n o tw i t ha s p i r a t i o nr i s k ) ,p o s i t i o n i n g ,a m b u l a t i n g ,c l e a n i n g ,l i n e nc h a n g e s ,h y g i e n ec a r e ,Rangeo fm o t i o ne x e r c i s e s .I nab l o o dt r a n s f u s i o n ,aUAPc a ng e tb l o o d ,t a k ev i t a l sBEFORE t r a n s f u s i o n ,a n da n yv i t a l s1 5m i nAFTERt r a n s f u s i o nhass t a r t e d .CLIENTW LEFTSIDEDWEAKNESS,HOLD CANE ON *RIGHT*S I D EADVANCE LEFTFOOT FORWARD.STRONG LEG( R )STAYSBEHINDTO FORM TRIPOD.WEAK LEG AND CANE MORE ATSAME T I M E .UP STAIRS:R A I L ,STRONG LEG,CRUTCH AND WEAK LEG ATSAME TIME,REPEAT.DOWN STAIRS:R A I L ,WEAK LEGAND CRUTCH,THEN STRONG LEG.REPEAT.'Goodt oh e a v e n ,downt oh e l l "PHARMACOLOGY:ANTIOB I O T I C / ANTIBACTERIALS :B r o a ds p e c t r u ma n t i b i o t i c s :- o x a c i n( L e v o f l o x a c i nf o re x a m p l e .T h i sd r u gn e e d st ob em o n i t o r e df o ”n a u s e a / c o n s t i p a t i o n / d i a r r h e a )T e t r a c y c l i n e s :- e y el i n eS uI f o namides :s u l f -C e p h a l o s p o r i n s :- c e fP e n i c i l l i n s :- c i l l i nA m i n o g l y c o s i d e s /mac r o l i d e s :- m y c i nF L u o r o q i n o l o n e s :- f l o x a c i n

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ANTIVIRALS:END I N- v i rH I V / A I D S :- v u d i n eANTIFUNGAL:- a z o l eCARDIACANTIHYPERTENSIVESACE i n h i b i t o r s( v a s o d i l a t i o n ) :- p r i lB e t ab l o c k e r s( s l o wH R ) ) :- o l o lA n g i o t e n s i n2B l o c k e r s(ARBS.,a c tL i k eACE i n h i b i t o r s ) :- s a r t a n( c a u s eh y p e r k a l e m i a )C a l c i u mC h a n n e lb l o c k e r s( C a i n sh e a r tv a s o d i l a t i o n ) :- p i n eo r- m a i lV a s o p r e s s i nr e c e p t o ra n t a g o n i s t s( b l a c kADH,g i v ef o rSIADH) :- v a p t a nA l p h a 1b l o c k e r s( f o rBPH e n l a r g e dp r o s t a t e ) :- c s i nL o o pd i u r e t i c s :- i d ea r- s e m i d eT h i a z i d ed i u r e c t i c s :- t h i a z i d eP o t a s s i u ms p a r r i n gd i u r e c t i c s :- a c t o n eA n t i h y p e r L i p i d e m i c s :- s t a t i nA n t i c o a g u l a n t s :- x a b a n ,- a r o l ,- i r u d i n( a l s oc l o p i d o g r e l / P l a v i x ).Don e tt a k eG i n k oB i l o b a .Lowm o l e c u l a rw e i g h th e p a r i n :- p a r i nT h r o m b o l y t i c s :- t e p l a s eo r- a s eA n t i a r r h y t h m i c s( s u p p r e s sa b n o r m a lh e a r tr h y t h m s ) :- a r o n e( a m i o d a r o n e )M o n i t o rP o t a s s i u mi nd i g o x i n ,h o l di fHR<60RESPIRATORYDRUGS.U p p e rR e s p i r a t o r y :A n t i h i s t a m i n e s :- a d i n e ,- t i r i z i n e ,- t i c i n eN a s a ld e c o n g e s t a n t :- e p h r i n e ,- z o l i n eL o w e rR e s p i r a t o r y :B r o n c h o d i l a t o r :- t y r o lX a n t h i n ed e r i v a t i v e s ;- p h y l l i n eC h o l i n e r g i cb l o c k e r s :- t r o p i u no r- c l i n d i d i u nI m m u n o r c d u l a t o r s&l e u k o t r i e n em o d i f i e r s :- z u r a bo r- l u k a s tANESTHETICS/ANTIANXIETYL o c a la n e s t h e t i c :- c a i n eB a r b i t u r a t e s(CNSd e p r e s s a n t ) :- b a r b i t a lB e n z o d i a z e p i n e s :- z o l a mo r- z e p a mANTIDEPRESSANTSS S R I ' s :- o x e t i n e( l i k ef l u o x e t i n e / P r o z a c ) ,- t a l a p r a m ,- z e d o n eS N R I ' s :- f a x i n e ,- z o d o n e ,- n a c i p r a mT r i c y c l i cA n t i d e p r e s s a n t :- t r i p t y L i n eo r- p r a r i n e( h a sa n t i c h o l i n e r g i ce f f e c t sl i k ec o n s t i p a t i o n ,d r ym o u t h ,d y s r h y t h m i a s ,b l u r r e dv i s i o n )3S'so fS S R I s :s e x u a ld i s f u n c t i o n / s t o m a c hi s s u e s / s e r o t o n i ns y n d r o m e :t a c h y c a r d i a / d i f f i c u l t yw a l k i n g / e l e v a t e dtempandEPrr e n t a lc h a n g e s ,m u s c l et i g h t n e s s .T a k ei nm o r n i n gDon o tm i xSNRI'sw i t hTCA'so rMAOI'sMAOI's:- g i l i n e ,- z i n e ,- m i n e ,i s o c a r b o x a z i d ,not y r a m i n ef o o d s( f e r m e n t e ds t u f fl i k ec h e e s ec h o c o l a t e sj e r k y )B e n z o d i a z e p i n e sm u s tbet a p e r e d ,r i s kf o rd e p e n d a n c e .Canc a u s el i g h t h e a d e d n e s s / d r o w s i n e s s / f a t i g u es ot a k ea tn i g h t .A n t i p s y c h o t i c smayt a k e6 - I Dw e e k st ow o r k .H a l o p e r i d o l ,r i s p e r i d o n e ,c l o z a p i n ecommonb r a n d s .T* * C l o z a p i n ea s s o c i a t e dw i t ha g r a n u l o c y t o s i s( f a t a lb l o o dd i s o r d e rw i t hs u p e rLowWBC c o u n t ) * * *F o rs c h i z o p h r e n i a .S i d ee f f e c t sT a r d i v ed y s k n e s i a ,e x t r a p y r a r i d a lsymptoms

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ANALGESICS/OPIDIDSO p i o i d s :- d o n en r- o n eNSAIDs:- o l a co r- p r o f e nS a l i c y l a t e s :A s p i r i nN o n s a l i c y L a t e s :a c e t a m i n o p h e nM o n i t o rr e s p i r a t o r yr a t ei nM o r p h i n eGASTROINTESTINAL:H2B l o c k e r s :- t i d i n eo r- d i n eP P I s :- p r a z o l eL a x a t i v e s :- l a xANTIDIABETICS:O r a lh y p o g l y c e m i c :- i d e ,- t i d e ,L i n i d e( g l i p i z i d e ,g l y b u r i d e )A l s o- g l i p t i n ,- g l i t a z o n e ,m e t f o r m i nM o n i t o rb l o o dg l u c o s ei ng l i p i z i d eMISCELLANEOUSDRUGSC o r t i c o s t e r o i d s:- a s o n e ,- c l o n e ,- i n i d e( c a u s ei m m u n o s u p p r e s s i o na n dmasks i g n so fi n f e c t i o n( i n f l a m m a t i o n ,r e d n e s s ,edema,f e v e r )T r i p t a n s( a n t im i g r a i n e ) :- t r i p t a nTBd r u g s :r i f a -B i s p h o s p h a t e s :- d r o n a t e( a l e n d r o n a t ef o ro s t e o p o r o s i s )A t y p i c a la n t i p s y c h o t i c s :- r i d a n eP r o g e s t i n( f e m a l eh o r m o n e ) :- t r e lP o t a s s i u mNEVER GIVENI VPUSH,ALWAYS DILUTEDAND ON APUMP.W a t c hf o re x t r a v a s a t i o nb e c a u s ei tc a nl e a dt on e c r o s i s .I VINFUSIONOF NO MORE THAN 1 0inEqo v e ranh o u rv i ap e r i p h e r a ll i n eo rn o tg r e a t e rt h a n4 6t h r o u g hc e n t r a ll i n e .P r e d n i s o n e( as t e r o i d )l o w e r simmunes y s t e mt or e d u c ei n f l a m r a t i o na n ds w e l l i n gb u tw a t c hf o rd e l a y e dwoundh e a l i n g .Z o l p i d e mb o o s t sGABA t oh e l pc a l mt h eb r a i nsoy o uc a ns l e e pb u tm o n i t o rs l e e pp a t t e r n s .Causest i r e d n e s sa n dd r o w s i n e s s .O l a n z a p i n ei sana n t i p s y c h o t i cS S R It h a tc a nf e a tb i p o l a ra n ds c h i z o p h r e n i ah u tm o n i t o rf o rmoodc h a n g e s .A L L o p u r i n o lf o rg o u t ?W a t c hp u r i n ei n t a k e( a l c o h o lm e a tf i s hm u s h r o o m s )N e r v ep a i n ?E p i l e p s y ?G a b a p e n t i nM o d e r a t et os e v e r ep a i n ?H y d r o n e r p h o n eR h e u m a t o i d( a u t o i m m u n e ,swann e c kf i n g e r s ,b i l a t e r a lu n i f o r mi n f l a m m a t i o n )a r t h r i t i s :m e t h o t r e x a t eP o s tb i r t hb l e e d i n g ?M e t h y l e r g c n o v i n eI n d u c el a b o r ?O x y t o c i nH a l l u c i n a t i o n s ?R i s p e r i d o n eE p i l e p s y ?P h e n y t o i n( k e e pb l o o dl e v e l s1 0 - 2 0 r c g / m L .MONITOR FOR GINGIVALHYPERPLASIA)F u r o s e r i d ec a u s e sh y p o k a l e m i aa n do t o t o x i c i t yL e v o f l o x a c i n :m o n i t o rf o rp h o t e s e n s i t i v i t y / t e n d o nr u p t u r eS e r t r a l i n ei sanSSRIt ot r e a td e p r e s s i o nb u tg i v e sy o ui n s o m n i a ,s e x u a ld i s f u n c t i o n ,w e i g h tg a i n ,d r o w s i n e s sP r o p r a n o l o lc a ng i v ey o uh y p o t e n s i o nandb r a d y c a r d i aL i s i n o p r i lg i v e sa n g i o e d e m ao ff a c eandp e r s i s t e n tc o u g hR i f a m p i nc a u s e so r a n g eb o d yf l u i d sa n dl i v e rh e p a t o t o x i c i t yC l o p i d o ge Li sana n t i p l a t e l e tb u tw a t c hf o rb l e e d i n ga n dh e m o r r h a g eL i t h i u mf o rb i p o l a rb u tw a t c hf o rt r e m o r s ,c o n v u l s i o n s ,coma,G Iu p s e t ,p o l y u r i a .T i n n i t u s .Rangei s0 . 6t o1 . 2 .YOU WANT TO INGESTSALT.DROP I NSALTINTAKERAISESLITHIUMLEVELS.H a l o p e r i d o lf u rs c h i z o p h r e n i ab u tw a t c hf o re x t r a p y r a m i d a lsymptomsl i k el i ps m a c k i n gE p o e t i nt r e a t sa n e m i ab ys t i m u l a t i n gr e db l o o dc e l lp r o d u c t i o nb u tw a t c hf o rc l o t s

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R i s e n d r c n a t ef a ro s t e o p o r o s i sb u tw a t c hf o rp a i ni nbone s / m u s c l e s / j o i n t sa n dj a wp a i nD i l t i a z e mi sa C a l c i u mC h a n n e lb L o c k e rf o rHTN A F i bA F l u t t e rSVTb u tw a t c hf o rh e a r tf a i l u r eandp e r i p h e r a ledemaA n t i b i o t i c sh a v ep e a k sa n dt r o u g h s .M u s tb et a k e na ts c h e d u l e dt i m e s .Soi fp r e s e n t e dw i t hw h i c hmedt ogivef i r s t ,g ow i t ht h ea n t i b i o t i c .O m e p r a z o l ei saP P I .S h o u l dbet a k e nw EMPTY s t o m a c h .Canc a u s ep n e u m o n i as oNCLEX’wet"c o u g h .A v o i di b u p r o f e n .Reducesb o n ed e n s i t ys ot a k eWITHc a l c i u m .S t a t i n sknownf o rm u s c l ep a i n .Rhabdomyo l o i si sb r e a k d o w no fm u s c l et i s s u er e l e a s i n gm u s c l ef i b e r si n t ob l o o d .T a m o x i f e nf o rb r e a s tc a n c e r :w a t c hf o rh e a v yp e r i o d s / s f o k e / p u l m o n a r ye m b o l i s m / D V Td u et ot h r o m b o e m b o l i cp r o p e r t i e s .T o l t e r o d i n ei sa n t i c h o l i n e r g i cg i v e nf o ro v e r a c t i v eb l a d d e randu r g eu r i n a r yi n c o n t i n e n c e .L a c t u l o s er e d u c e sammoniai nt h el i v e ra n di sal a x a t i v e.P e o p l ew i t hH I Vt a k ea n t i r e t r o v i r a lt h e r a p yl i k eE m t r i c i t a b i n e / t e n o fo v i r .Emptys t o m a c hd r u g s :P r o t o npumpi n h i b i t o r s ,m u c o s a lp r o t e c t a n t s[ s u c r a l f a t e s ) ,I b a n d r o n i ca c i d( b i o p h o s p h a n a t e sf o ro s t e o p o r o s i s )t a k ew 8o u n c et a pw a t e r ,r e m a i nu p r i g h t3 0 - 6 0r i nt of i g h te s o p h a g i t i s .P r i l sd r u g sneedt obeg i v e nanh rb e f o r e .NO GRAPEFRUITDRUGS:STATINS,CALCIUMCHANNEL BLOCKERS,CERTAINPSYCH DRUGS L I K EVALIUMTEGRETOL,ZOLOFT,ANTIHISTAMINES.DRUGS AFFECTINGBALANCE:BPP I L L S ,NARCOTICS,ALLPSYCHDRUGS,L A S I X ,DIURECTICS,MEDS.CARDIACDRUGS,SLEEPINGHERBAL SUPPLEMENTS:Sawp a l m e t t of o rd e c r e a s e dp r o s t a t e .P r e g n a n twomens h o u l d n o tt a k e .V a l e r i a nr o o tp r e v e n t si n s o m n i a .A d d i t i v ee f f e c twhenu s e dw i t hb a r b i t u r a t e sa n db e n z o d i a z e p i n e sG a r l i cB l o c k sLDLc h o l e s t e r o l ,r a i s e sHDLl o w e r st r i g l y c e r i d e s ,r i s kf o rb l e e d i n gG i n g k ob i l o b aI n c r e a s e sb l o o dflowt ob r a i n ,i m p r o v e smemory,d e c r e a s e dp a i nw i t hw a l k i n gS tJ o h n ' sW o r tT r e a t sm i l dd e p r e s s i o n ,c a nc a u s es e r o t o n i ns y n d r o m ewhenc o m b i n e dw i t ha n t i d e p r e s s a n t sB l a c kc o h o s hE s t r o g e ns u b s t i t u t e ,s i m i l a rt os o y ,t r e a t smenopause,d o n ' tt a k ef o rm o r et h a n6m o n t h sG i n g e r ,g a r l i c ,g i n k g ob a l b o a ,G i n s e n gI n t e r f e r ew i t ha n t i c o a g u l a n t s ,c o n s u l tw i t hp r o v i d e rb e f o r et a k i n gw i t hNSAIDSK a v aR e l i e v e sa n x i e t yp r o m o t e ss l e e p ,s e v e r el i v e ri n j u r yANTIDOTESO p i o i d s :N a l o x o n e( N a r c a n )W a r f a r i n :V i t a m i nKH e p a r i n :P r o t a m i n es u l f a t eD i g o x i n :D i g i b i n dB e n z o d i a z e p i n e s :F l u m a z e n i lC h o l i n e r g i cc r i s i s :A t r o p i n eA c e t a m i n o p h e n( T y l e n o l ) :A c e t y l c y s t e i n eMagnesiumS u l f a t e :C a l c i u mg l u c o n a t eL e a d :C h e l a t i o na g e n t sA l c o h o lw i t h d r a w a l :c hl o r d i a z e p o x i d e( L i b r i u m )B e t ab l o c k e r s :G l u c a g o nC a l c i u m C h a n n e l B l o c k e r s :G l u c a g o n ,i n s u l i n ,c a l c i u mA s p i r i n / T r i c y c l i ca n t i d e p r e s s a n t s:S o d i u mb i c a r b o n a t eI n s u l i n :g l u c o s e

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MENTAL HEALTHG i v ef i n g e rf o o d sf o rp a t i e n t sw i t hm a n i awhoc a n ' ts i ts t i l lS tJ o h n ' sW o r tf o rd e p r e s s i o nD e l i r i u ns h o r tt e r mw i t ha nu n d e r l y i n gc a u s eandam e d i c a le m e r g e n c yD o n e p e z i lf o rd e m e n t i aa n dA l z h e i m e r ' sC a r b i d o p a - L e v o d o p af o rP a r k i n s e n ' sRESTRAINTS:TAKEOFFEVERY 2HRS.CHECK FOR CIRCULATION,SKININTEGRITY,RANGE OFNOTION,AND OBSERVE EVERY 1 5 .HAVE TOHAVE HARN TO SELFOR OTHERS I NORDER GETANORDER FOR RESTRAINTS.MUST DESCRIBEOTHER ATTEMPTS TO PACIFY.P h o b i a s-d e s e n s i t i z eOCD -allowr i t u a l sP a n i c-i n s t r u c tt ot a k es l o wdeepb r e a t h e sG e n e r a l i z e dA n x i e t yD i s o r d e r-r e f r a m es i t u a t i o ni nap o s i t i v ewayS c h i z o p h r e n i a-R e a s s u r et h e nd e l u s i o n sn o tr e a l ,b u ti fp a t i e n ts a y sv o i c e st e l l i n gt h e mt oh a r mo t h e r s ,a s kt h e m w h a tv o i c e sa r es a y i n gP r o d r o m e :g r a d u a lo n s e t ,m i l dsymptoms,o c c u r sm o n t h so ry e a r sb e f o r ea c u t ep h a s eA c u t e :d e l u s i o n sa n dh a l l u c i n a t i o n s ,a l t e r a t i o n si ns p e e c h ,a l t e r e db e h a v i o r .S t a b i l i z a t i o n :p s y c h os o c i a lt r e a t m e n t ,i m p r o v e dc o p i n g ,medsN a i n t en a n c e :q u a l i t yo fl i f eS c h i z o p h r e n i a :don o tc o n f r o n t ,a r g u e ,d e n y .A v o i dp h y s i c a lt o u c h i n g .ADHD:d i f f i c u l t yf o l l o w i n gt h r o u g ho nt a s k s .C o g n i t i v eb e h a v i o r a la n df a m i l yt h e r a p y .S t i m u l a n t sA u t i s m :f i x a t e di n t e r e s t s ,i n s i s t e n c eonr o u t i n e .E a r l yi n t e r v e n t i o n .R e w a r d s ,s t r u c t u r e ,c o n s i s t e n c y .ADHD medsw i l lc a u s ew e i g h tl o s ss om o n i t o rw e i g h tasp r i o r i t yd u r i n gc h e c k u p sI n t e l l e c t u a ld i s a b i l i t y :d e f i c i t si nr e a s o n i n g / p r o b l e n - s o l v i n gL e a r n i n gd i s o r d e r :d i f f i c u l t yi nr e a d i n g / m a t hNon e e dt om o n i t o rl e v e lo fa t t e n t i o ns p a ni nA u t i s m .N a j o rd e p r e s s i v e2wkst o6m o n t h sP e r s i s t e n td e p r e s s i v el o wl e v e lmoret h a n2y r sP o s t p a r t u m4wksp o s tb i r t hS e a s o n a ll e s sd a y l i g h tD i s r u p t i v emoodd y s r e g u l a t i o n :o c c u r si nc h i l d r e n ,t a n t r u m s ,i r r i t a b i l i t y .A n h e d o n i a :l o s so fp l e a s u r e .M a i n t a i na d l ' sS l e e pa l t e r a t i o n :r o u t i n e sA n e r g i a :n oe n e r g y .E x e r c i s eS o c i a li s o l a t i o n :a t t e n dg r o u ps e s s i o nA n o r e x i c :s m a l lh i g hc a l o r i em e a l s .L i t h i u m :s l u rs p e e c h ,l e t h a r g y ,d e h y d r a t i o n ,n a u s e a ,v o m i t i n gs i g n so ft o x i c i t yA n o r e x i a :f i n g e rf o o d sF r a g m e n t e dt h o u g h t s :r e d i r e c tL a c ki m p u l s ec o n t r o l :m o n i t o rs a f e t yI n a b i l i t yt os l e e p :a d a p ts l e e pwakec y c l eB e n z o s :s h o r tt em.H i g h l yd e p e n d e n tA n t ie p i l e p t i c s :r e d u c eb i r t hc o n t r o lA n t ip s y c h o t i c s :h y p e r l i p i d e m i aa n dh y p e r g l y c e m i aL i t h i u m :a d v e r s er e a c t i o nw i t hDIURECTICS/NSAIDSDELUSIONS( P O S I T I V ESYMPTOMS OFSCHIZOPHRENIA)Gr a n d e u rC o n t r o l :a f r a i do fo u t s i d es o u r c e sc o n t r o l l i n gt h e mN i h i l i s t i c :g l a s sa l w a y se m p t yS o m a t i c :a l w a y st h i n k i n gh e a l t hi so f f
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