Etsy:1NURSING NOTES101
** DON'T MIX UP S4S and CAUSATION
- often what cajses someth ng is tne opposite of the SAS
- ex. diarrhea will cause a metabol c ac dosis but once
you are ac dotic your bowel shuts down and you get a
paralytic illeus
- when you get scenarios:
-> if it's a lung scenario = respiratory
- then check if the client is Dver-i/enf'af p
(alkalosis) or under- ventilating (acidosis)
- remember to look at the words (ex. over, under,
ventilating) -> "as the pH goes so goes my PT"
-> VENTILATING DOESN'T MEAN RESPIRATORY
RATE; rasp, rale is inetevsrrfw/ acid-base,
ventilation has to co with gas excharge not resp.
'ate (look at tie SaO2 -> if your resp. rale is fast
but EaO2 is low you are under-ventilating)
-> ex. PC A pump - What acid-base diso rder
ind cates they reed to come off of it? = respiratory
ac cosis (resp. depression -> resp. arrest)
—> if its not lung, its metabolic
• metabolic alkalosis - really only one scenario = if
the PT has prolonged gastric vomiting/suctioning
- because you are losing ACID
"ex. Gl surgery w/ NG tube with suctioning for
3 days; hyperemesis graviderum
- otherwise everything else that isn't lung you
pick metabolic acidosis (DEFAULT)
" ex. hyperemesis graviderum w/ dehydration
acute renal failure, infantile diarrhea
. remember, you only have 4 to pick from:
- respiratory alkalosis - respiratory acidosis
- metabolic alkalosis - metabolic acidosis
Rb6‘s YJERt NOT
ON UM *NCiexU *
LECTURE 1
ACID BASES
• learn how to convert lab values to words
- the rule of the Bs
= if the pH and the BiCarb are both in the same
direction -> metabolic
Hint: draw arrows beside each to see directions
’ down = ac/cfos/s
* up = alkalosis
- respiratory -> has no b in it; if in other directions
(or if bicarb is normal value)
KNOW NORMAL pH, BiCarb, CO2
- Hint: DON'T MEMORIZE LISTS...know principles
(they test knowledge of principles by having you
■generate lists..) - for "select all" questions
- ex. in general/principle what do opioid s/pain
meds do? = sedate you, CNS depressors
F ex. what does di audid do? dori I memorize specifics
o.r a fef of dtlaudid, know principles of opioids (such
as sedation, CHS dep pessian -> l&lhargy, flacc dity,
reflex +1, hypo-reflex ia, -Dblunded)
- boards don't test by lists because all books/
classes have different lists
■ principles of S4S acid bases: as the pH goes so
goes my patient (except K+)
- pH up = PT up -> body system gets more
irritable, hyper-excitable (EXCEPT K+)
-> alkalosis - think ot a body system and go
high, hyper-reflexive (+3, +4 [2 is normal]},
tachypnea, tachycardia, borborygmi, seizure
- pH down = PT down -> body systems shut
down (EXCEPT K+l
-> acidosis - thwik of a system and go Sow.
hypo-reflexive (+1, 0), bradycardia, lethargy,
obtunded, paralytic illeus, respiratory arrest
. ex. which acid-base disorders need an ambu-bag at
the bedside? = acidosis (resp. arrest)
■ ex. which acid-base disorders need suction at the
bedside? = alkalosis (seize and aspirate)
- Mac Kussmaul - Kussmaul s (compensatory
respiratory mechanism) is only present in only 1 of
the 4 metabolic (acid-base) disorders
T M = metabolic AC = acidosis
■ pay more attention tc the modifying phrases than
the original noun
- ex. person w/ OCD who is now psychotic (psychotic
trumps OCD); hyperemesis with dehydration (pay
attention to dehydration}
VENTILATION
- ventilators -> know alarm systems (you set it up so
that the machine does nt use less than or more than
specific amounts of pressure)
a} high pressure alarm = increased resistance
to airflow (the machine has to push too hard to
get air into lungs)
- from obstructions:
i. kinks in tubing (unkink it)
ii. water condensation in tube (empty it!)
iii. mucous secretions in the airway (change
positions/turn, C&DB, and THEN suction)
suction is only PRNJII
-> priority questions = you would check
kinks first, suction is not first
. most common mistake with se ect all questions = selecting
one more than you should (stop when you select the ones
you know! don't get caught up on the "could he's”)
• Hint: don't select noneor aflon select all that apply
questions (never only one and never all)
- Causes of Acid- Base Imbalance:
- scenarios and what acid-base disorder would
resuttfwhat would cause an imbalance}

b) low pressure alarm = decreased resistance
to airflow (the machine had to work too little
to push air into lungs)
- from disconnections:
i. main tubing (reconnect it duh!)
ii. 02 sensor tubing (which senses FiO2 at
the airway/trach area; black coated wire
coming from machine right along the
tubing - reconnect!)
ventilators -> know blood gases
- resp. alkalosis = ventilation settings might be
set too high (OVER-VENTILATING)
- resp. acidosis = ventilation settings might be set
too low {UNDER-VENTILATING)
ex. weaning a PT off ventilator -> should not be
under-ventilated, they need the ventilator; if they are
over-ventilating then they can be weaned
never pick an answer where you dont de something
and someone else has to do something

Etsy:lNURSINGNOTES101
LECTURE 2
ABUSE (Psych and Med-Surge)
Psycfro/ogrcaMspect/Psycho-DynanNcs
- # 1 psychological problem is the same in any/all
abusive situations = DENIAL
- abusers have an infinite capacity for denial so that
they can continue the behavior w/o answering for it
- can use the alcoholism rules for any abuse
- ex. # 1 peycn problem in child abuse, gambling or
cocaine abuse ia aerae)
- why is denial the problem? HOW CAN YOU TREAT
SOMEONE WHO DEN1ES/DOESN T RECOGNIZE
THE Y HAVE A PROBLEM
- denial = refusal to accept the reality of a problem
* treat denial by CONFRONTING the problem (it's not
the same as agpress/on which attacks the person, not
the problem) = they DENY you CONFRONT
- pointing out to the person the difference between
what they say and what they do
- Hint rever pick answers that attack the person
-> ex. bad answers have bad pronouns - "you"
-> ex. good answers have good pronouns - 'I", "we"
-> ex. "you wrote the order wrong" vs. 'I'm having
difficulty interpreting what you want"
- loss and grief -> for this denial you must SUPPORT it
- DABDA = cen al, arger, ba rgaining, depression, acceptance
* Hint: for questions about denial you must look to see
if it is LOSS or ABUSE
- loss/grief = support
- abuse = confront
- #2 psychological problem in abuse = DEPENDENCY,
CO-DEPENDENCY
- dependency= when the abuser gets significant other
to do things for them or make decisions for them
-> the dependent - abuser
■ c o - d e p e n d e n c y = when the significant other derives
positive self-esteem from making decisions for or
doing things for the abuser
-> the abuser gets a life w/o responsibilities
->the sig. other gets positive self-esteem {which is
why they can't get out of the relationship)
* how do you treat it?
- set limits and enforce them
-> start teaching sig. other to say NO (and they
have to keep doing it)
- must also work on the self-esteem of the co-dependent
(ex. I'm a good person because I'm saying "no')
- manipulation = when the abuser gets the sig. other
to do things for them that are not in the best interest of
the sig. other
- the nature of the act is dancreroirs.'/Tarmfu/
- how is manipulation like dependency?
-> in both the abuser is getting the other person to
do something for them
-how do you tell the difference between manipulation
& dependency?
-> NEUTRAL vs. NEGATIVE (look at what they're
being asked to do)
-> if the sig. other is being asked to do something
neutral {no harm} its dependency/co-dependency
-> if the sig. other is being asked to do something
that will harm them or is dangerous to them they
are manipulated
- how do you treat manipulation?
- set limits and enforce them -> 'NO"
-easier to treat than dependency/co-dependency
because no one likes to be manipulated (no positive
self-esteem issue going on)
■ ex. how many P T s do you have w/ denial? = 1
ex. how many PT s do you have w/ dependency/co-
dependency = 2
ex. how many PT s do you have w/ manipulation = 1
Alcoholism
Wernickes & Korsakoff s
- typically separate BUT boards lumps them together
- wemicke s = encephalopathy
-korsakoff's = psychosis (lose touch with reality)
-> tend to go together, find them in the same PT
■ Wernicke K o r s a k o f f s s y n d r o m e :
a} psychosis induced by Wf. Bl (Thiamine) deficiency
■ lose touch w/ reality, go insane because of no B1
b} primary symptom -> amnesia w/ confabulation
- significant memory loss w/ making up stories
- they believe their stories
■ How do you deal w/ these PT's?
- bad way = confrontation (because they believe what
they are saying and can't see reality)
- good way = redirection (take what the PT can't do
and channel it into something they can do}
■ Characteristics of Wen i eke Korsakoff's:
a} rtsprevejifabfe= take Vit. B1 (co-enzyme needed
for the metabolism of alcohol which keeps alcohol
from accumulating and destroying brain cells)
' PT doesn't have to stop drinking
b) it s arrestable = can stop it from getting worse by
taking Vit. B1
r also not necessary to stop drinking
c) rfs irreversible (70% of cases) -> Hint: On boards,
answer w/ the majority (ex. if something is majority
of the time fatal, you say it’s fatal even if 5% of the
time if s not)
- Drugs for Alcoholism:
DISULFIRAM (Antabuse}
= aversion therapy -> want PTs to develop a gut
hatred for alcohol
-> interacts w/ alcohol in the blood to make you very ill
-> works in theory better than in reality
-> onset & duration: 2 weeks (so if you want to
drink again, wait 2 weeks}

- PT teaching = avoid ALL forms of alcohol to avoid
nausea, vomiting & possibly death
-> including mouthwash, aftershaves/colognes/perfumes
(topical stuff will make tnem nauseous), insect
repel ants, any OTC that ends with "-elixer", alcohol-
based hard sanitizers, uncooked (no-ba<el icings
which have vanilla extract, 'ed wine vinaigrette
- Overdoses & Withdrawals:
- every abused drug is either an UPPER or DOWNER
-> the other drugs don't do anything
-> £1 abused class of drug that is not an upper or
downer = laxatives in the elderly
al first establish if the drug is an upperor downer
- uppers (5) = caffeine, coca ne, PCP/LSD (psychedelic
hallucinogens}, methsmphsfaiTwrws. adderoi {ADD drug?
T 5&S -> make you go up: euphoria, tachycardia,
restlessness, irritability, diarrhea, oorborygmi.
hyper-reflexia, spastic, seze (need suction)
- downers = don't memorize names -> anything that
is not an upper is a downer! if you don't know what
the med is, you have a high chance that its a
downer if its not part of the uppers list
’ S&S -> make you go cown; letnargy. resp ratory
depression (&. arrest)
- ex. The PT is high on cocaine. What is critical to assess?
-> NOT resps below 12 because they will be high
-> maybe check reflexes
bl are they talking about overdose or withdrawsI
- overdose/intoxi cation = too much
- withdrawal = not enough
- ex. the PT has overdosed on an upper -> pick the
S&S of too much upper
- ex. the PT has overdosed on a downer -> pick the
S&S of too much dowrer
- ex. the PT is withdrawing from an uppe p -> not
enough uope r makes everytning go down
- ex. the PT is withdrawing from a cowner -> not
enough downer makes eveyth ng go up
■ upper overdose looks tike - downer withdrawal
• downer overdose looks like = upper withdrawal
- In what 2 situations would resp. depression & arrest
be your highest priority:
- downer overdose
- upper withdrawal
• In what 2 situations would seizure be the biggest risk:
- upper overdose
- downer withdrawal.
■ Alcohol Withdrawal Syndrome vs. Delirium Tremens
- they are both different! not the same
a) every alcoholic goes through withdrawal 24 hrs.
after they stop drinking
- only a mmor/tyget delirium tremens
- timeframe -> 72 hrs. (alcohol withdrawal comes 1st)
- alcohol withdrawal syndrome ALWAYS precedes
delirium tremens, BUT delirium tremens does not
always follow alcohol withdrawal syndrome
b) AWS is not life-threatening; DTs can kill you
c) PT's w/ AWS are not a danger to sellf/others; PT's
w/ DT's are dangerous to self/others
- they are withdrawing from a downer so they will
be exhibiting upper S&S
- DTs are dangerous
Diflsrsnces AWS DT
in Cans
Diet Regu lar c et NPCWclear lie uids
(because a1 risk for seizures which
can cause -isk ci asp ration)
Room Semi-prvate Private near nurses station
anywhere on (dangerous A unstable)
the unit
Ambulation Up ad lib Rest-kited bed rest -> no balh-oom
privileges (use bedpans'urinals)
Restraints Norestrants Restraints (because dangerous)
(because not - not soft wrist or 4 point soft
dangerous) because tney'll gel out
- need to be in vest or 2-pt. locked
leathers (opposite 1 arm 8. leg,
rotate Q2hrs, lock 1he f-ee
I mbs 1st before releasing the
locked ones)
Thev both get ANTI- HYPERTENSIVES &
TRANQUILIZERS
- becajse eve-ylhing is up (downer withdrawal)
They both gel MULTIVITAMIN w,' Bl
■ RN's can accept but RPN's can't (because PT is unstable)
- on med-surge, the RN who takes :hem must decrease
their workload (i.e. reduce PT load if they take a DT PT)
-> Hint: on boards, the setting is always perfect
(i.e. enough staff/time/resources on the unit etc.)
• Drug Abuse in the Newborn:
- always assume intoxication. NOT withdrawal at birth
- after 24 hrs -> withdrawal
- ex. caring for infant of a Quaalude addicted mom 24
hrs. after birth, select all that apply:
-> downer withdrawal so everything is up = exaggerated
startle, seizing, high ptched'Shrill cry

DRUGS
AMINOGLYCOC1DES
- powerful class of antibiotics (when nothing else
works pull these outs, the big guns)
- don't use unless anything else works
■ boards /oue fo test fhese drugs because theyre
dangerous and are a test of safety
- think: A MEAN OLD MYCIN
-> a mean o.'d = they treat serious, life-threatening,
resistant, Gram-neg bacteria infections (i.e. a mean
o/d antibiotic for a mean oj'd intectionj
-> mycto = what they end with (all end w/ -mycin}
” not all -mycin's are aminoglycosides BUT most
are (the 3 that are not are erythromycin
azihromycin, clarithromycin = torow if off toe tist.i)
- 2 toxic effects
i) when you see -mycin. think mice
- mice ->ears -> otto toxic
-monitor hearing, tinnitus, vertgo/dizziness
ii) the human ear is shaped like a kidney so next
effect is nephrotoxicity
- monitor treat'.nine (not BUN output, daily weight)
'creatinine = the best indicator of kidney/renal
function (pick 24 hr creatinine clearance over
serum creatinine if both available)
■ #8 (fits nicely in the kidney) reminds you about 2
things about these drugs
- toxic to cranial nerve 8 = ear nerve
- administer Q8
- route:
- IM or IV
- do not give PO -> they are not absorbed
- if you give an oral -mycin' it will go into gut, dissolve,
go through and come out as expensive stool (won t
have any systemic effect)
- EXCEPT i- 2 case . = bowel sterilizers:
T hepatic encephalopathy (hepatic coma} = to get
ammonia down, cral ’-mycin's' will sterilize the
bowel by killing Gram-neg bacteria (E. coli) to help
bring down ammonia and wont harm the
damaged liver because it doesn't go through the
liver (also gives diarrhea, more poop out is good.)
r pre-op bowei surgery = it sterilizes the gut by
killing the E coli bacteria
■ if oral, no otto or nephro toxicity because not absorbed
- these are neomycin & kanamycin
’ Who can sterilize my bowels? NEO KAN
■ Why draw levels? = narrow therapeutic window
- small difference between what works and what kills
- if the drug has a wide range then you wouldn't
need to draw TAP levels
T ex. Lasix doses range from 5-80mg thus a wide
range so you wont need TAP levels
" ex. Dig doses range from 0.125 - 0.25 so this
narrow range needs TAPS levels
- A MEAN OLD MYCIN3 = major class that reeds
TAPs drawn because of narrow window
- When do you draw TAPS?
-> depends on the route (don't focus on the med)
a} Trough Levels
” doesn’t matter which route or med always 2 0 mins.
- sublingual = 30 mins, before next dose
- IV = 30 mins, before next dose
- IM = 30 mins, before next dose
- Sub-Q = 30 mins, before next dose
- PO = 30 mins, before next dose
b) Peak Levels
different but depends on the route mot the med)
- Sublingual = 5-10 mins after drug is dissolved
- IV = 15-30 mins after drugs is finished tofesingr
T Hint: if you get two values 'hat are correct (i.e. a
15 min answer and a 30 min. one) pick the highest
without going over so 30 mins.
- IM = 30-60 mins, after administration
- Sub-Q = SEE (see diabetes lecture -> because the
only Sub-Q peaks are Insulins)
- PO = forget about it, too variable so not tested
The BIG 10 Drugs to Know:
1. psych drugs
2. insulins
3 anti -coagulants
4. digitalis
5. aminoglycosides
6. steroids
7. caldum-channel blockers
8 beta-blockers
9. pain meds
10. OB drugs
■ Trough and Peak levels:
- trough = drug at /owesf
- peak = drug at highest
*' MP.'evefc -trough administer peak
-> draw trough levels first
-> administer your drug
-> draw peak levels after drug administration

LECTURE 3 £ ) O N E O CAR DI AC- AR R Y T H Ml AS
- Interpreting Rhythm Strips (4 that need to be known
by sight):
a} Normal Sinus Rhythm
= P wave before every QRS & followed by a T
wave for every single c o m p l e x
-> all P wave peaks are e q u a l l y distant from each
other. QRS evenly spaced
b) .'-jib = chaotic squiggly line, no pattern
c) '.'-Tach = sharp peaks, has a pattern
d} - -Systole = flat-fine
- Terminology:
- if QRS d e p o l a r i z a t on, it's talking about ventricular
(so rule out anything atrial)
- if it says P-wave then it s t a l k i n g about atrial
Cardiac D R U G S
C A L C E U M - C H A N N E L B L O C K E R S
CS/c/um-C/ianne/ B/ocxe/s are M e Va/rum for your heart
• Valium -> calm's you down; so C C 8 s calm your heart
down (ex. if tachycardic, give CCB s but not in shock)
- to R E S T YOUR HEART
- not stimulants
• calcium-channei b l o c k e r s are negative i n o t r o p i c
c h r o n o t r o p i c , S. d r o m o t r o p i c o r u g s
- fancy way of saying that they calm the heart down
POSITIVE NEGATIVE
inotropes Cardiac Stimulants Cardiac Depressants
* - stimulate, speec - caTmtne near! cown.
bnronotropes u o the heart weaken & slow cown
Dromotopes
- 6 Rhythms most tested on N - C L E X :
1 a lack of QRS's" = A-systole
- flat-line, no QRS
2. " P - w a v e " = Atrial
- if its a sawtooth wave, always pick afoa) flutter
3. " c h a o t i c ' - A-tib if w/ P-wave
4. "chaotic" - V-fib if w/ QRS L ! I
- H i n t : the wore chaos is used tor >'t •-..'.aifor
5 bizarre" = atrial t a c h y c a r d i a if w/ P - w a v e
6. bizarre" = ventricular tachycardia if w/ Q R S
- Hint, the work 'b zarre' is usee for foc.iyca/'oras
- P V C s (premature ventricular contractions)
= a.k.a. periodic wide bizarre Q R S
- ventricular because Q P S
' W h e n do you want io ' d e p r e s s " the heart? What do
CCS's treat?
At anti- h y p e r t e n s i v e s
- relax heart & blood vessels to bring down BP
AA: anti-angina s 4 CUT Vt P ftlN
- relax heart to use less 0 2 to make a n g i n a go away
- treats a n g i n a by addressing oxygen d e m a n d
AAA; anti-atrial arrhythmia
- ex. atrial flutter, A-fib. premature atrial contractions
- never ventricular
m what about supra-ventricular tachycardia??
-> because it means 'above the ventricles' (which
are the atria)
- Side-Effects:
H & H = headache & h y p o t e n s i o n
-> hypoTN - from relaxed heart & v e s s e l s
■> h e a d a c h e - vasodilation to brain
” Hint: h e a d a c h e is a good thing tc se set for
'select ail that apply' questions (®t. low Na & nign
Na = headache, hign & low g ucoae = headache, high &
low BP = headache)
- N a m e s of C a l c i u m - C h a n n e l B l o c k e r s :
- anything e n d i n g in - d i p i n e1
- ex. a m l o d i p i n e nifedipine
■ N O T just '-pine'
- also i n c l u d e s ' VERAPAMIL & C ARD1ZEM
- which can be given as continuous IV drip??
= Cardizem
* bVhaf 1/S needs to be assessed before giving a C C B ?
- BP = because of risk of hypoTN
-> parameters/guide lines - hold CCB if systolic is
under 1 00
-> so you need to monitor BP if PT is on a Cardizem
c o n t i n u o u s drip (if it's under 1 00 then you may
have to stop or change the drip rate}
- bizarre -> tachycardia
-you can call a group of P V C s a short run of V-tach
- d o Physician's care about PT's having P V C s ?
-> NO, not a high priority = low priority
-> 3 circumstances when you could elevate these
P T s t o moderate priority (re -er eac- high)
i. if there are more than 6 PVC's in a minute
ii. if there are more than 6 PVC's in a row
iii. if the PVC tall on the T-wave of the previous
beat ( R o n T phenomenon)
-> most common order if you call the MO about a
PT w/ P V C s = D/C monitor ( Decause then you
can t see the PVCs and then you won t call them)
- Lethal Arrhythmia s:
- HIGH PRIORITY 2 main ones will - ill you in 8 m ns
ji ess -> these P T s will p r o b a b l y be top priorities
a} A - S y s t o l e
b) V-Fifa
” both have in common = no cardiac output
-> no brain perfusion (and you II be dead in 8 mins)
- . -tach = potenf/a/jyHte-th reate ning (but not actually
life-threatening), but still m a k e s it a fairly high priority
- difference is that these PT's have c a r d i a c output
- in c o d e s , even rf the rhythm c h a n g e s if there is no
cardiac output it's ju st as cad as the p r e v i o u s rhythm

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b) Basilar= at the bottom of the lungs, thus it is
removing bfoodlliquid (because of gravity)
-ex. its bad if your basilar tube is bubbling or not
draining any mL
■ ax. How many chest tubes & where would you place them
for s unilateral pneumohemothorax?
- 2 chest tubes (apical for preumo. basilar for nemo)
■ ax. How many chest tubes S where would you place them
for a bi-lateral pneumothorax?
- 2 tubes (apical on left, apical on right)
* ax. How many chest tubes & where would place them for
post-op chest surgery?
- 2 tubes (apical & basilar on the side of the surgery)
" you are to assume that chest surgery /trauma is
unilateral uni'ess otherwise specified (they will
say bilateral)
- Trick Question: How many chest tubes would you
need and where would you place them for a post-op
right pneumonectomy?
- NONE! because you are removing the lung so you
don't need to re-establish any pressure (there is not
pleural space)!
Troubleshooting Chest Tubes:
- What do you do it you knock over the plastic
containers that certain tubes are attached to?
-> set it back up & have PT take some deep breaths
-> NOT a medical emergency! (don't call ND)
- What do you do if the water seal breaks (the
actual device breaks?)
-> first = CLAMP it!!! because now positive pressure
can get in! don't let anything get in
-> 2nd = cut the tube away from the broken device
-> 3rd = stick that open end into sterile water
->then unclamp it because you've re-established the
water seal (doesn't need clams if its under water
™ better for the tube to be under water than
clamped! -> alir can t go in and stuff can still keep
coming out (if clamped nothing can come out
which is what the tube is for)
- Ex. If they ask what the first thing is to do if the seal
breaks -> Clamp! BUT, if they ask what's the best
thing to do -> put end of tube under water! (because it
actually solves the problem, cfamping is a temp fix)
- Hint: 'BEST vs. FIRST questions
- first questions = are about what order
- test questions = what's the one thing you would do if
you could only do I cf the options
-> ex. You notice the FT has V-fib on the monitor. You
run to the room and they are non -responsive with
no pulse. What is the first thing you do?
A) place a backboard?
B) begin chest compressions?
- "first” is about order so = pick A (because you
wouldn't start chest compressions first)
- BUT. if the question ask "What s the best thing to
do?" -> you only get to do 1 thing not the other so
you would pick B
- Treatment (more drugs):
a) PVC s b) V-tach
= for ventricular use LIDOC AINE/AMIODARONE
' in rural areas mare Liaocaine use (cheaper A
lange- ahelf-He)
c) Supra-Ventricular Arrhythmia's
= atrial arrhythmia's use ABCUs
■ A->ADENOCARO (Adenosine)
- have to push in less than 8 seconds {FAST IV
push)-> Siam tnis drjg ; followed by a flush; use a
bi g vein: BU T the prob e m w/ slamming it fast is
the risk of PT going into A-Systo e (for 30 seconds
but they will come out of it so don't worry [unless
lorger than 30 sec...])
” for IV pushes: when you don t know you go slow
■ B -> BETA- BLOCKERS
- a ii end .in '-lol
- every -lol' is a BB & every BB is a '-lol'
- are negative inotropes, chronotropes, &
dromotropes like calcium-channel blockers {a.k.a.
valium for your heart so they treat A, AA, AAA &
have same side-effects)
” generally speaking don't make a big difference
between Beta- & Calcium channel blockers;
except that CCB are better for PT's w/ asthma
or COPD -> Beta-B's bronchoconstrict
■ C ->CALCIUM-CHANNEL BLOCKERS
- see Beta-Blockers & CCB's earlier
■ D -> DIGITALIS (DIGOXIN, LANOXIN)
d) V-Fib
= for V-L't yco D-fib (shock them!)
el A-Systo le
= use EPINEPHRINE & ATROPINE {in this order!)
-> if epinephrine doesn't work then use atropine
CHEST TUBES
• purpose is to re-estab/rs/r nerjafrVe pressure in the
pleural space (so that the lung expands when the
chest wall moves)
- pleural space -> rregabve is good (negative pressure
makes things stick together)
- ex. gun shot to the lung add positive pressure
- Hint: when you get a chest tube question look at the
reason for which it was placed (will tell you what to
expect & what not to expect)
- ex. pneumothorax = to remove air (because air
created the positive pressure)
- ex. hemothorax = to remove blood
- ex. pneumohemothorax = to remove blood & air
- Hint: Also, pay attention to the tacatron ot the tubes.
a) Apical = the chest tube is way up high, thus it is
removing air(because air rises)
- ex. its bad if you re apical tube is draining 200 mL or
it is not bubbling

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- What do you do if the chest tube gets pulled out?
- firef = take a gloved hand and cover the hole
- best= cover the hole with vaseline gauze
- B u b b l i n g chest tubes: (ask yourself 2 questions)
a) Where is it bubbling?
b) When is it bubbling?
= the answer will depend on these 2 questions
(sometimes bubbling is good, sometimes bad but
depends on where & when)
- ex. /nfemfffenf bubbling in the water seal -> GOOD
(document it, never badfl
- ex. Continuous bubbling in the water seal -> BAD
(you don't want this, means a leak in the system that
you need to find and tape it until it stops leaking)
” in RPN scope
- ex. Infermjftent in suction control chamber -> BAD
(means suction is not high enough, turn it up on the
wall until bubbling is continuous)
- ex. Continuous in suction control chamber -> GOOD
(document it)
- Hint: both locations are opposites of each other
(memorize one & deduce the others)
—> if there is a seal it should not be continuous
(ex. a sealed bottle of pop continuously
bubbling means it's leaking!)
- A straight catheter is to a foley catheter as a
thoracentesis is to a chest tube.
- in-&-out vs. continuous secured
-thoracentesis -> also helps re-establish neg.
pressure (in-S.-out chest tube)
- higher risk for infections are continuous
Rules for Clamping Tubes:
- a) Never clamp a tube for more than 15 seconds
without a doctors order.
- so if you break the water seal -> you have 15
seconds to get that tube under water
- b) Use rubber-tipped doubled clam ps.
- the teeth of the damp need to be covered w/
rubber so that you don't puncture the tube
CONGENITAL HEART DEFECTS
■ every congenital heart defect is either TROUBLE or
NO TROUBLE (ALL BAD or NO BAD)
- either causes a lot of problems or its no Dig deal (no
in-between defect)
- memorize one word: TRouBLe
Heart Delecta TRp uBLe (95% of
all heart defects} No Trouble
Su rgery N ED surgery now - don't need surgery
-igrt away; possitn'j
need it years late - if it
causea 'a Trouble (but
we do n'1 expect it to)
Growth & Dev. alow, delayed no-mal
Life Expectancy short normal
Parents
Experiencing grief, stress.,
ffnanc el seuea, lots
of ca'egvng issues
regular average person
iBffjes
Going Home apnea monitor no apnea monitor
t c o i t a l Stoy at weeks 24-40 houra
Who Follow®
Your Care Paediatric
Card ologist Paediatrician,
oaediat-ic NP
Shunting R_to L
(TRouBLe) L t o R
Cyanosis Cyanotic -> Blue
(TTtou BLe) Acyanotic
- ex. You are teaching the parents about a heart defect:
- pick all the options that cause trouble
• Hint: Boards will not give pictures of defects and ask
you what they are.
- not ou r job, we don't diag nose
-our role is teaching parents the implications
-> so f ts troube = leach them things that ts going
to be a lot ol trousle
-> il it's not rouble = pick the things saying it's not
going to be troube
■ The pe are 40+ congenital heart defects so just remember
TRouBLe (don't memorize all of them!):
- Hint: all congenital heart defects that start w/ the
letter T are Troubte Defects
- we con f care about the defect, we care about what
were teaching the parents
- All congenital heart defect kids (trouble or no trouble)
will have 2 things:
a) Murmur
- why? = because of the shunting of the blood
(regardless of direction of shunt)
b) all have an Echocardiogram done (to find out
what the defect is or why there's a murmur)
- 4 Defects of Tetralogy of Fallout:
-VarieD Pictures Of A R a n c H (cr Valentines Day =l c<
Someone Out A Red Heart)
1. VD= ventricular defect
2. PS = pulmonary stenosis
3. O A = over riding aorta
4. RH = right hypertrophy
• dont have to recall these. RECOGNIZE them
- recall -> remember from nothing
- RECOGNIZE -> spot it when you see it (use the
initials to recognize them in questions)
- ONLY DEFECT where they ask you what it is

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INFECTIOUS DISEASE and TRANSMISSION BASED
PRECAUTIONS (Isolations)
- Standard
- Universal
- Contact
- for anything enteric = can be caught from fnfestfne
-> fecal oral
- C-Diff, Hep. A, Cholera, Dysentery
r things with bugs in diarrhea
T Hint for Hep A & B: Hep A -> think anus. Hep B ->
think blood (anything from the iwn'&| starts w? a vowel)
- Staph infections
- RSV = respiratory syncytia/ virus (what babies, 1 -2
yr. old s get that is not dangerous to adults but can
be fatal for them)
r transmitted by droplet BUT still put them on
contact precautions because little kids catch it
from touching Wrings that other sick kids touched
- Herpes infections (includes Shingles -> Herpes
Zoster virus even though caused by varicella)
- What's involved in contact precautions?
-> private room is preferred (but not required)
T or 2 RSV kids in the same room
r keep RSV kid & suspected RSV separate
because you need positive cultures (not based
on symptoms)
->NO: mask eye/face shield (unless for universal),
special filter mask, PT mask, neg. air flow
->YES: gloves. gown, hand-washing, special
supplies & dedicated equipment (includes toys)
” disposable supply vs. dedicated equipment:
- thermometer cover - BP cuff that stays in room
- Droplet
- for bugs that travel 3 feet on large particles due tc
sneezing/ccughing
- all meningitis
’ cultured through lumbar puncture
- H Flu (haemophilus influenza B)-> commonly
causes epiglottis
’ never stick something down throat because it will
cause obstruction
- What’s involved in droplet precautions?
-> private room is preferred (but not required)
r on boards select pr vate
r can also cohort based on positive cultures
->NO: gown eye/face shield, special filter mask,
neg. air flow
->YES: mask, gloves, hand-washing, PT worn
mask (when leaving room), disposable supplies
& dedicated equipment
- Airborne
- M-M-R; TB: varicella (chicken pox)
- W h a t s involved in airborne precautions?
-> private room is required
r unless co-horting
-> NO: gown (mostiyfor contact), eye/face shields
-> YES: mask, gloves hand-washing special-filter
mask ONLY for TB. PT mask for leaving room
(but really shouldn't be leaving), neg. air flow
" disposable supplies & dedicated equipment is a
good thing but not really as essential as in the
other 2 (can let this one slide)
-> TB: technically transmitted via droplet BUT put
on airborne
PPE = Personal Protective Equipment
- boards Eke to test how you put on or take off
-always take it off in alphabetical cider
-> ex. gloves, goggles, gown, mask
- p u t t i n g on is reverse alphabetically for the g s' &
mask comes 2nd
-> gown. mask, goggles, gloves
I N FECUOhl , ,
CONSOL
MRWRME PRECAUTION H>-
s.j Miftues L<J
MEZ HECTfS ZWCR -r C W f t U
CONTACT PEKAUTi
* MUSR T MRE
R
S
E
HeSWfHOfliJ INFECTION
VIIUWO W C C T I O N
ENTEKU. 'j tSft (<
H i n n s s»Mpitx
> I M P H I W
? PtOiCulOSVS
& SCOPES t MOCCUS t STfiPH
tlUTilPEMC PRC CtAVTlbNS ? 7 ’

Loading page 9...

LECTURE 4 y\J
CRUTCHES, CANES, WALKERS
■ major area of human function is locomotion so they test
these even though not a major emphasis in school
- area to test PT teaching & risk reduction
Crutches:
* How do you measure crutches?
” need to know for risk reduction -> so you don't
cause nerve damage
t.a) length of crutch = 2-3 finger-widths below anted or
axillary folc to a point lateral to & si ghtly in front of the foot
-> many questions ask where you measure fromfto (so for
crutches, if they ask anything measuring from ax Ila to
foot -> rule out, they re wrong instructions for length)
bl hand grip = can be adjusted up & down; when properly
placed, should be apx. 30 dagraas elbow Haxion
■ How to teach crutch gaits (4 kinds}:
” names are pretty obvious w/ a few exceptions
a) 2-point
- move a crutch and opposite foot together followed
by other crutch & opposite foot
- moving 2 things together
b) 3-point
- moving 2 crutches 5 the bad leg together
- moving 3 things together
c) 4-point
- moving everything separately
■ move any crutch, then opposite foot, followed by
next crutch then other foot
- very slow but very stable
d) Swing-through
- for non-v,eight bearing injuries (ex. amputations)
- plant crutches and swing the injured limb through
(never touches down)
- When do they use them?
- ask yourself "how many legs are affected?'
- even for even, odd for odd
r even point gaits when a weakness is evenly
distributed (i.e. even # of legs messed up)
- 2-point = mjfcf problems (bilateral j
■ 4-point = severe problems (severe, bilateral
weaknesses)
- 3-point = chmy odd one, when only 1 leg is affected
. Ex. Eady stages of rheumatoid arthritis = 2-point
Ex. LaS, atove- the knee ampufatio.? = ewing-througri
Ex. First day post-op right knee replacement. partial weight-
bearing allowed = 3-point
Ex. Advanced stages of ALS = 4-point
Ex. Left hip replacement, 2nd day post-op, non weight-bearing
= swing-through
Ex. BWsierai total knee replacement, 1st day post-op. weight-
bearing a'lcwed = 4-point
Ex. BWsierai tatai knee reptacsmert', 3 weeks post-op = 2 point
■ Going up & down stairs:
- up with the good, down with bad
- crutches move with the bad leg
Gains:
* hold the cain on the strong side
- a lot of people use it the wrong way
Walkers:
- pick it up, set it down, walk to it
- if they must tie their belongings to the walker, tie it at
the sides, not the front
■ ever tic most
peop e do that anyways; they don't like wheels or tennis
ball on the bottom either)

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DELUSIONS, HALLUCINATIONS, 4 ILLUSIONS (Psych)
Neurosis Non- Psychotic vs. Psychosis
- Hint: the first thing you have to do to get a psych
ex. person sianng st a waH& says: "J see a bomtf -> hallucination
BX- person .toks st fire extinguishes on the v/ai" snd says: '7 see s
bomb' -> illusion {refereci)
■ Hint: On the test, they will tell you that there is
something there thus, you can differentiate between a
hallucination & an illusion.
questions correct is decide: 'Is my PT non-psychotic
or psychotic?"
= this will determine treatment, goals, prognosis,
medication, length of stay, legalities., .everything
NON-PSYCHOTIC
D e f i n i t i o n Has i n a i g h l & ie
rsalrty-bSsed
- eyen w/ emotional
distreaa.'illTesB,
mentabbenavioral
disorder
- racoon ize what tne
problem a and how
rt affectB their lite
Treatment/ - good thejapputic
Techniques fiommunicaucn (like
any PT that d splays
acbd comm, ski He j
there e noth ng
spec al that you Tieec
to do/know compared
to any med-surge,
paeca , or C B PT
Symptoms rjont have delusions,
hallucinations, or
illusions
PSYCHOTIC
Has no insight & i s n o l
reality-based
- cpnit th 'nk.'knovj the.r sck
- think everyone e ae naa
the problem but not them
(bla e anyone else)
- even if they say i h e y - e
sick but then they aay the
martiana made them sick
they con* 1
! have insight
- good therapeutic
com "'un caton coea net
work because the? are
- R M R B le. spec f c
strategies
How do you deal with these Psychotic Symptoms?
- first thing you ask after determining iF PT is psychotic:
What is their problem?
—>what kind of psychosis do they have?
- 3 Types of Psychosis:
1. Functional Psychosis
- can function in everyday life (i.e. have jobs, a
marriage, etc.)
-4 diseases: Schizo Schizo Major Manics
i. Schizophrenia
ii. Schizoaffective Disorder
iii. Major Depression (if its major test will say)
iv. Manic (Acute)
-> so bi-polar is functional, only psychotic
during manic phase
-these PT s have the potential to learn reality
(because no damage)
-> may need meds or set boundaries for structure
-> nurse role = teach reality {4 steps}
a) acknowledge feef/og -> "| s e e you're angry;
'You seem upset', "Tell me how you are feeling',
often uses the word feeling or shows a feeling
b) PRESENT REALITY -> "I know that those voices
are real to you but I don’t hear them" or telling
them what is real ("I’m a nurse & this is a hospital")
c) set a limit "That topic/behavior is off-limits',
’We are not going to talk about that right now",
'Stop talking about that"
d) enforce the limit -> "| see you're too ill to stay
reality based so our convo is over" (ending the
conversation NOT taking away a privilege [i.e.
punishment]: continuing to talk may enforce the
non-reality)
™ on the test, they won't ask these specific steps but
instead, will ask "how should the nurse respond...'T” try to pick the more positive statements (i.e. what
thev can have/do. not what they cant); if between
2 statements go w/ the positive one
DELUSIONS,
- only in pavchotc p-'s
- as scon as they get any
of these they've crossed,
the ne to Being psycnotic
Psychotic Symptoms:
- al Delusions
= false, fixed, idea o< belief; no sensory component
(all in the brainTthinking it)
i. Paranoid Delusions -> people are out to harm me
■ ex. the mafia are out to get me
ii. Grandiose Delusions -> you are superior or you
are the world s smartest/greatest person
- ex. thinking you are Christ, Genghis Khan
iii. Somatic Delusions -> about a body part
- ex. x-ray vision; there are worms in my body
- b) Hallucinations
= a false, fixed, sensory experience (purely sensory);
5 senses so 5 for (1 for each sense)
i. Auditory _> heading things that aren't there (primarily
voices teFing you to hurt yourself); most common
ii. Visual -> seeing; 2nd most common
iii. Tactile -> feeling tilings: 3rd most common
iv. Gustatory -> tasting things that are not the re
v. Olfactory -> smel ing things that are not there
” T last 2 are relatively rare
- c) Illusions
= .nr/srnferpreLaf/on of reafffy; sensory experience
- difference from hallucination ->with an illusion there
is a referent in reality
-> referent = something in reality to which a person
refers when they say something (they just
misinterpret it}
■ ex. PT says:"/ near detrain nc.ted -> haiku ci nation
ex. pm ovemears rarses £ ,’,fi7s Aauphing £ raiVnnp ar the nurse's
siatran £ says: 'Listen, I .hear demon voices' -> IILs-or (there
a a referent)
- 2. Psychosis of Dementia
-psychosis because of actual damage to the brain
r in Functional Dementia, there is no brain damage;
its just messed up chemicals
- include PT s w/ Alzeimer's, psychosis after a stroke,
organic brain syndrome; anything w/ "senile" or
"dementia"
-cannot Learn reality
-> major difference from functional (which is why
you have to determine type of psychosis)

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-> nurse role:
al acknowledge feeling
bl REDIRECT them -> from something they can t
do to something they can do
” you dont set-limits because its mean
” NOT APPROPRIATE to present reality to these
PT's when they are experiencing psychotic
symptoms (BUT don't confuse this w/ reality
orientation}
-> important to remember that forgetting things (like
where they are or what room they're in - PTs w/
dementi a/Alzheimers) is NOT psychosis
" when they start having delusions, hallucinations or
illusions, then they are psychotic
-> reality orientation = telling them person, place,
and time (ALWAYS APPROPRIATE w/
DEMENTIA) - this deals w/ memory
■ Narrowed Self Concept
= when a psychotic refuses to leave their room or
change their clothes
-functional psychotic
- #1 reason is because their definition of self is
narrowed -> defined self based on 2 things:
i. Where they are
ii. What they are wearing
" T so they dodt know who they are unless they are
wearing those exact clothes in that exact room
- as the nurse, don't make them change or leave the
room (will cause escalating panic because they will
lose their concept of self}
r use the Functional Psychosis techniques
- Ideas of Reference
= ■ ■< e veryone is la k ng about you
- ex. see someone on the news and get upset
because you think they are talking about you
- can have both paranoia & ideas of reference
(paranoia if also think they are going to harm you)
3. P s y c h o t i c D e l i r i u m
= a temporary, sudden, dramatic, episodic,
secondary loss of reality; usually due to some
chemical imbalance in the body
r different because its temporary and very acute
-> include PT's that are short-term psychotic because
of something else causing the psychosis
- ex. a crug reaction, high on uppers or withdrawing
from cowners (delirium tremens), cocaine overdose.,
post-op psychosis (withdrawing from a downer). ICU
psychosis (sensory deprivation), UTi (or any occult
infection), thyroid storm, adrenal crisis
- good thing is its temporary so focus is removing
the u n d e r l y i n g cause & k e e p i n g them safe
-> nurse role:
al acknowledge feeling
bl REASSURE them: it's temp. & they'll be safe
" don't present reality -> they won't get it
” don't redirect -> not going to work
- Personality Disorders are different
A = antisocial
B = bopcerline
N = narcissistic
” very sick personality disorders
” may be good to use Functional Psychosis
techniques because you set im its
Other Psychotic Symptoms:
■ L o o s e n i n g of A s s o c i a t i o n
= your thoughts aren't wrapped too tight, all over tine map
al Flight of Ideas
- coherent phrases but the phrases are not
connected (not coherent together)
b} Word Salad
- sicker, can t even make a coherent phrase
-> babble random words
c) Neologism
- making up imaginary words

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