NCLEX Review Notes Mark Klimek Lectures

Preview (33 of 108 Pages)

100%

Purchase to unlock

Loading page image...

MARKKUAliKLECTURESNCLEXREVIEW NOTES

Loading page image...

Tzab’le of ContentsL e c t u r e 1 -Acid-ase Palance, VentilatorsLecture 2 - Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides,Peakand 1 roughL e c t u r e 3 -cardiac Medication, Calcium Channel plockers, Cardiac Arrhythmias,Chest 2 ubc, Congenital heart Pefects, Infectious Pisease, PTELecture 4- - Crutches, Canes, Walkers,Petusions,hallucinations, Psychosis,Psychoticand Non-Psythotic hallucination,Illusion, PelusionL e c t u r e 5 -Piabetes Mellitus, Piabetes Insipidus SlAPh, Insulin, PKA, h h N KL e c t u r e(a -Prug Toxicities (Lithium, Lanoxin,P itantin, pilirubin, AminophyIline),Kernic+eras, Pumping /Electrolytes: K+, LA, W£?|, and NA, Treatment for■hyperkalemia.L e c t u r e 7 -Thyroid (-hyper-, hyp*-), Adrenal Cortex (Addison Pisease, Cushing),Toys, LaminectomyL e c t u r eLabValues, five Voadty Ps, Keutropenif PreMU-tiovi.L e c t u r e-Psych Pru s, 7 ri, Peni o , WAAOI, Lithium, protac, hldol, Clotaril,£oloftL e c t u r e-Maternity and Neona tologyL e c t u r e H- petal Complications, Stages of Labor, Assessments, Variations forNp, Maternity Medications, Medication hints, Psych Tips, Operational Stages.L e c t u r e 1 2-Prioritisation,P elegation, Staff Management, guessing Stra tegies

Loading page image...

NURSINGE X A MSUCCESS

Loading page image...

K.J<?4 t?JldS3J S i 4-1'2SIAAJ3144-O9I | o q174-3 1 S I 37MV]t?£|Uil 3St?£J)-pi7k? 3144- 113144 ' l W i 4 - 3 3 J i p 3 H W S 34- I‘.I 144-03A0lU c5|Jk77l£L |?UP fjd} J:S<3. 9 L | 4} o3 ’ L ? >fp4 144-1:A 11914 J 3 J i p 9 4 lS<7d49 JO 3lAk?S 3 L- HI S 3 0 &J3I443I41A 3111LMJ 3 4-3'i? 'hjC?4-t7JldS3J JO 7l|<7<4t?4-3U1 S i 33llt?]K’tf|lUI 3S]4- } l3H11HIJ 34-33 04- 'MP|M4-d37X3 '6 lb] S I &Ull44-hj9A9 'I461I4 S i fri-}J-m w i S S P 4 a d 4-d37X3 'iAqSi GHib|4-hj3A3S i ffdJ-J -SMP3UA 4-L714.|_ "■U3MlSSt?+0j. JQJ. 4-437X3 '4-U3l-|-Vd hl*l S 3 9 & OS 'S3Cj6d3l|4- StfSIs o p pt? hjQ4-t?JldS3J -j-o 3 | d u i P X 3Ht? S I S1L|X "hjo+*7J»dS3y_ G'r £(Z?|d "SisopuyZ Z ' L-£ # 3|duit?xaSISQ|IZ4|17t?4-3H I J-0 3|dlUPX3Ht? S i SlLj J_ -71)0/5]t?4-9W7f+ -714-O]isqpy91-3 | d l M t ? X ' dSIS0WI717 7 i pt?4-3lM 4 0 3 | 4 m t ? X 3Ht? S i S1I4J_ -7lfOt?4-3O Et O O H ”S i s o p i j y£ ’ £ffd-V-# 3 | d H l t ? X ' i■-■?;.'■i■■.'■S I 37Ut7|l7i5|U4l 3St?3]-pi7t? 2I44-4 r £ <S i f-pi -J-J -7I4-Opi7t? S i 37Ut?|E?i l?JI 3St?iJ|-piJt7 3b|4 ' £ £ £ >S i f-|-i-3144-S l JSJUJQSlp 3St?- p i 7 V Ht? HI 4-t?OO] 04. 3W|t?A 4-SJL} 314J_,(i?4-i5rMcwyt77k4)£<X>ftput?ZCO'ffd-<o} S3W]t?A |t?u4jow 3144-iVLQtt04- 4-hP+Jodtwi Si 41. ' s j s p j o s i y ? 3S(7-ppt? 3A|0S <?_L3?Llt?Jl?<A. ?SL7. / p i 3S J 0 4 I?114 ?.3.A ' 3 JU1711?&3 S t ? < 4 . - p i 7 VVSVg p»3yPH:----------- 7.35 -7.45PACO; ---------- 35 -45HCOj ----------- 2 2 - 2 6PAO;----------- 8 0 -10002SAT-------- > 95%

Loading page image...

I fp Hoes over 7 . 4 5 , t h i s i s alkalosisTherefore, everything is IXF: tachycardia, tachypnea, f H N, seizures, irritability,spastic, diarrhea, borborygmi [increase bowel sounds), hyperreflexia (3+, 4+)However, potassium i s low (opposite). Therefore, Hypokalemia- What i s t h e nursing intervention?L- p t need suctioning because o f seizuresH■4.I fp H goes below 7 - 3 5 , t h i s i s acidosisTherefore,, everythi115 is PC*WN: bradycardia, constipation, absent bowel sounds,flaccid, obtunded, lethargy, coma hyporeflexia (0, V), bradypnea, low Pt.-flowever, potassium is h i g h . T h e r e f o r e , Hyperkalemia- What i s the nursing intervention?- patient needs t o be ventilated with an Ambu bag—respiratory arrest!So, remember that"MAC Kussmaul " jc.-phe only acid~base imbalance t o causeMetabolic ACidosis with Kussmaul respirations.Causes o f A c i d / l ase imbalance:f i r s t ask yourself, "Is it LU.N? . . . I f yes, then iti s respiratoryThen ask yourself, "Are they o v e r v e n t i l a t i n g o ru n d e r v e n t i l a t i n g ?- I fUHPffRventilating, then pick acidosis—pH i sunder 7 - 3 5- I fOVVentilating, t h e n i t i s alkalosis, p-H isover 7 . 4 5IF I T I S LUNGS* RESPIRATORYUNOERucntiloting* Ac idosisOVERuenukiting -What type of acid-base derangement is present in t h e following condition?I nl a b o r ?-"Respiratory alkalosisCverventilatincj—p7 increasesAlkalosisP r o w n i n?-"Respiratory acidosisUndervenHIatin—p H decreases... AcidosisP t is on P'CA (patient-controlled anesthesia) pump?- Ventilation is down ..."Respiratory acidosisI fit is n o t LUN61, t h e n i t is metabolic. I ft h e p a t i e n t h a s prolonged gastricVomiting or suction (sucking out acid), pick alkalosis.

Loading page image...

- Tor everything else that isn't lung <pick metabolic acidosis- So, when youdon't know what t o pick. pick metabolic acidosisT i p- Set your default setting t o Metabolic ftcidosis- Always pay attention t o modifying phrase rather than original noumV e n t i l a t o rft Ventilator is a machine designed t o movebreathable air into and out of t h e kings,aids patients who are physically unable t obreathe, or breathing insufficiently t obreatheft Ventilator is equipped with ahigh and a low-pressure alarm,■High pressures alarms are always triggeredby increased resistance t o air flow. Look forobstructions:- Kinks in tubing ...Solution: unkink the tube- Condensed water in the dependent tube...Solution: empty it- Mucus plugs ...Solution: Ask patient t oturn, tough, deep breathe; or suction t h etubing TRNWhat is the appropriate order t o address high pressure alarm in a mechanicalVentilator?Cl) Unkink.(2.jEmpbJ water out of tubing. ( 3 ) turn pt, ask p t t o cough or deeplybreathe, and f4) suctionLow pressures alarms are always triggered bdecrease in resistance. This can becaused b

Loading page image...

- Main tubing disconnection- 0 2 . sensor tube disconnection- I n both cases, reconnect the disconnected twbing unless tube is on floor „.t>ag p +and call'Respiratory TherapistThe ven tilator may be set too high or too lowSetting is too high ... Tatient is over -ventilated-’Respiratory Alkalosis ... TankingSetting is too low ... Tatient i s tinder -Ventilated-’Respiratory Acidosis ... "Patient i s retaining 0 0 2QuestionThe physician wants t o wean patient off v e n t in the morning. A t G>am, the A’ (5|Ssay respiratory acidosis. What would you do next?Notify the physician thatthe patient is not ready t o be weaned off the respirator- T t is in respiratory acidosis, which means that he is underventilatedTherefore,not ready t o be weaned off t h e ventilator.- I fpatient were in respiratory alkalosis (overventilated), he should be ready t o beweaned off,

Loading page image...

Lecture 2Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Teak and 7 roughAlcoholismNo be: T h e title o f t h i s section is alcoholism. -However, thisrule can be used for any abuse situation- So, w h a t it the number 1 psychological problem in childabuse? ... Tn gambling?... I ncocaine abuse? ...I n spou salabuse? ... I n elder abuse?T h e a n s w e r i s denialT h e # 1 psychological problem is P EM l AL■How do you respond/treat t o pts in denial?- Confront them by pointing out the difference b/w what they say and what they do- for instance, say something like:,rOk, you say you're not an alcoholic, but it is 1 0a.m. and you've already had a(ppack" ...I tis not the same as aggression.Pon'tattack t h e person- (Stood answer has " I " ...Pad answer has "VOU"- One place where denial is ok—foss and grief S tages o f grief are " P A P PA " - Penial,a n g e r , b a r g a i n i n g , depression, acceptance- So when the question is about patient in denial, pay attention t o whether you aredealing with loss or abusive situationS u p p o r t - L o s sC o n f r o n t -Abuse4t !P ependency v s Co-dependencyT h e # 2 psychological problem is Pependency or Co-PependencyPependency; when the g e t the significant o t h e r t o do things or make decisions forthem- T h e abuser is dependentCo-dependency: when t h e significant other derive self-esteem for doing things ormaking decisions for the abuser- The significant other is the co-dependentPependency and co-dependency have a symbiotic, yet a pathological relationship- T h e dependent patient gets a free ride on the co-dependent- T h e co-defendant patient feels good from "doing stuff" for the abuser

Loading page image...

-Mow do you treatdependency/codependency?- dependent pts are "abusers"Confront them- Co-depe»ident pts have self-esteem issues „. Teach pts how t o set limits andenforce them- flgree in advance on what requests are allowed -then enforce- Teach significant other t o say N O- Work on self-esteem on the co-dependent personM a n i p u l a t i o nManipulation is when the abuser gets the significant other t o do things or makedecisions thatare not in the best interests o f the significant other- The nature o f the act is dangerous and harmful t o the significant otherMow i s manipulation like dependency?- I n both situations the dependent person gets the co-dependent person t o dothings or make decisions- I fwhat the significant o t h e r is being asked t o do i s not inherently dangerous andharmful, t h e n this is dependency/co-dependency- Mowever, i f the significant other i s being asked t o do something inherentlydangerous and harmful, then this i s manipulationManipulation? Set LIMITSand Enforce themExamplesPetermine i f either one of these situations is dependent/co-dependent problem or amanipulation problem* 4-year-old alcoholic gets her 17-year-old son t o go t o the store and buy alcoholfor her.- The mother is manipulating the son- This is an illegal act - harmful- dependency ... There are 2 patients- T h e dependent has a denial issue- The co-dependent has a self-esteem issue• ft 4-year-old alcoholic asks her 60-year-old husband t o go t o the store and buyalcohol for her.- This is not illegal for the husband t o buy alcohol- T h i s a dependency/co-dependency situation- Manipulation ... There i s 1 patient— no self-esteem issues

Loading page image...

- Easier t o treatno one like -to tee man!pulatedWernicke ( K o r s a k o f f ) SyndromeTypically, Wernicke and Korsakoff are 2 separate disorders. T h e NCLEX howeverbundles the 2 a s 1 CondiHon- Wernicke is an encephalopathy- Korsakoff is a psychosis- Wernicke and Korsakoff tend -to go togetherWernicke and Korsafoff- Psychosis induced by Vitamin th, thiamine deficiency- T h i s is a situation the patient loses touch with reality due t o vit T h deficiency- The primary S/Sx are amnesia (memory loss) and confabulation (making u p stories)Confabulation—T h e lies for this pts are just as real as realityvJow do deal with a patient w i t h Wernicke and Korsakoff who is confabulating aboutgoing t o a meeting with T arack Obama this morning?-'Redirect the patient t o something he can do- for instance, tel! patient something along that line: "Why can we go watch T V t osee what is on the news today”Characteristics of Wernicke and Korsakoff syndrome1. Preventable ... Take T h2 .Arrestable (stop i t from getting worseJ ... Take PT3 . Irreversible (70o)Will kill brain cellsA n t a b u s e and R e v i a (Pis u l f i r a m )A n t a b u s e —Alcohol deterrent"Revi a —Aliti dote-Aversion (strong hatred) Therapy —a type of behavior therapydesigned t o make a patient give u p an cmdesirable habit bycausing t h e m t o associate it with an unpleasant effect- Works in theory better t h a n in realityOnset (how long it takes t o startworking) and duration (how< long it lasts) ofeffectiveness of A tabuse/Revia i s 2 weeks- for instance, i f patient will be a t a function and would like t o drink, t h e p t must beon Antabuse /Revia a t least 2 weeks prior t o the event

Loading page image...

p a t i e n t t e a c h i n g- Teach patient t o avoid all forms o f EtO{4. Mot doing so malead t o symptoms ofvi!\fteven death- Teach them t o avoidkhe followings items a s theu contain alcohol ... Mouth wash,cologne,perfume, aftershave, elixir, most O T C liguid medicine, insect repellavit, handsanitizer, vanilla extract (can't have cupcake with unbaked icing)- On t h e exam, do not pick the"Red Wine Vinaigrettes . . . I t does not have alcohol in i tOverdose and W i t h d r a w a l"First thing <(ou ask in an overdose guestion is: I sit an Upper or a Powner?- 7 his is because everq abuse drug is either an Upper or a "Uowner- 7Jowever, laxative abuse ivi the elderly is neither an Upper nor a Vowner* CaFTlrt- _ocaii t■I'/LSP (psi cdc iws/halktfinogenrtV. KL-.r; p r h ibniwc..- Pddc'at o r <r.t h f j f".Vr ’-v' "lirNi'Li. XUPPERDOWNER- 'Hficr'c Art oVCt 1 3 5 dr<*g$ thai- are swwrtr'S- ZT't--1a n >. - p a .-. . a div. iLi. i.’.ipt"■- T , - i n g :j PCv. I1_ r thfl<" r " . ]■. I T M 4 Jr r lt . ./' I I • . r.ccHStiprt+tsl, etc‘in. -1’ J+rn'r..- '"I-’ ngs go u -■Euphoria, seixitres,IrritaWftty.1-1pcrrc fit :«J.a7 - . 4 4 . rac'.T •■. r dia, 1. cre■£<■?.■ewerorbo'■■-i.r■. . r •-!-€.•What is the highest nursing priority t o anticipate in an Upper or downer?- Upper; T h e highest priority t o anticipate in an Upper is suctioning due t o seizures.- 'Powner: The highest priority t o anticipate in a 'Powner is intubation/ventilationdue t o respiratory arrest.ExampleOne of t|our patients is "high on cocaine." what is critical'important t o assess?

Loading page image...

- fjavina T R o f 1 2 is notacritical measurement t o assess for that patient- {Jowever. assessing for reflexes ( 3 + or 4+j, irritability borborycjmi increased bowelsounds), or increased temperature wowId be more appropriate- T h e W Crale" does not apply hereI n fact, the patient's ACin cocaine toxicityis unremarkableft-fter you know -that -the druin question i s an Upper or a Powner, -the secondquestion you should ask yourself i s whether i t i s an Overdose or a Withdrawal?- Overdose and withdrawal have the opposite effectsOVERDOSEOventMOverdose o*i a n UpperCVercose on a TownerTooinuctToo I'H-rle'/■Jit.vrav,/Wit, arawon a> Uopei- Tool i t t l e.■jitkvi .:wa. on a p o wa- T o o ' r n c hQuestionThe driver of a squad car calls the P T and says he is brinejinej a p t who in Oped oncocaine. What do you expect t o see? ... Select all -that applypatient OPed on Upper O P ... Expert -to see T 00 much- firstquestion: Upper or a Powner?- Second question: Overdose or Withdrawal?- S/SX would be: Irritability4 + reflexes, borborvfcjmi, increased temperature, etc.QuestionThe same patient is withdrawing from cocaineSame question- This patient is an Upper in Withdrawal - Too little- Therefore, respiratory is under 1 2 , patient is difficult t o arouse, cjive t h e m Marcan

Loading page image...

Prue) flbwse i n t h e NewbornAlways assume intoxication, not withdrawal a t birth, in a newborn less than 2 4hours after birth, 2.4 hours or 'more after birth, youn assume the newborn is inwithdrawalQuestion7ou are caring for an infant born -to Quaaiude addicted mother 2 4 hours after bir th.Select all -tha t applyOverdose/withdrawal condition ,.. Ask t h e following 2 questions- I s it an Upper or a Powner?We don't what i t is because i t is a "Quaaiude" (it islikely a Towner)- I si t Overdose or withdrawal? ... 2 4 hours a f t e r birth (Withdrawal)- fl Towner in Withdrawal - Too much- S/Sx - Pifficult t o console, seizure risk, shrill, hi h-pitched cry, exaggerated startlereflexAlcohol W i t h d r a w a l Syndrome v s . P e l i r i u m T r e m e n sAlcohol Withdrawal Syndrome and Pelirium 1 remens are not the same- Every alcoholic cjoes through alcohol withdrawal approximately 2.4 hours after theperson stops drinking- however, less than 2 0of alcoholics in alcohol withdrawal syndrome progress t odelirium tremens...Pelirium tremens occurs about 72. hours after the person stopdrinking,- Alcohol withdrawal syndrome always precedes delirium tremens; however, deliriumtremens does not always follow alcohol withdrawal syndromeAlcohol Withdrawal Syndrom*. n■. , -+ti. -4 iDiir. iHc- /1idH*)MOMI *'< i H ' c m v r i i Q i tjs’iidotirttnL'JlAti'J!TJ. L _- Flcu;<'.*r J'bM- Sr'iTi'T- r /i-lv I■"JL (HVIJ A Z l c T f .‘-u t/|c, u>-•i ;i ;i dilu■ii :n■■i .■,. ' K - ' .. i ..'.iJ e tCt'Jfjrio rr-:.*rdintsDelirium Trem«n«■O f f :■. . A c r, I t -■' . . T i t . T.■■itT.. -'i ici ' . r c f i t f. ]t o>xl‘. m J oT. : « i 'r.iI I . _■- J / i L!.1,Nr'l?i l i iC .C-ff . l■hl'..!J t-f_ - c v \ ..r w >| T.|,-Ifr-rlfj,■r+1H-llT,l-141■1i i d i■'.. i tI • ’'i i Mt r Ct1 ”■IOVC fMrlUfl.■s J f:i L ' —■■.6 i - r r i1Foer.u H-. |\Y". h o f2M f L l *lifter)

Loading page image...

N o t e :- "Up ad lib" or "up a d liberum" means pat ient may have activity or free t o movearound as desired any time- 2-point lock le-tters restraints:Restraints. in 1 upper and the contrala-teral lowerextremit'es.Release and secure upper arm first, and then release and secure thefoot. Switch extremities every 2 hours- ffve both a n t i - f j T N medication, tran uiliter, multivitamin containing V'ffriQuestionSo w h a t two situations would respiratory arrest be a priority?- Overdose o f a Vowner- withdrawal of an UpperQuestionWhich pts would secure be a risk for?- Overdose o f an Upper- Withdrawal of a Pownersinc;!■<:L, es (Top 5 most t e s t e d d r u g s )Aminoglycosides are t h e big guns o f AbXs (antibiotics) —use them, when nothing elseworks. Aminoglycosides are unsafe a t toxic levels and safe ty then becomes an issue.7 hey are t h e 5th most tested drugs on the NCL£X“3 he m o s t t e s t e d d r u g s on t h e NCLfiX a r e ;T o p 5- Psychiatric- I nsulin- Anticoagulant- Pigitalis- AminoglycosidesO t h e r s- Steroids- "beta-blockers- Calcium channel blockers- pain medications- Obstetrics medications" A Mean Old Wlycin" - AminoglycosidesAMINOGLYCOSIPE TCJXKJTY

Loading page image...

Would be used t o treat serious, resistant, life-threatening, ( ram negativesinfections.- So, treata mean old infection with a "Mean O l d Mycin"Examples are: TB, septic peritonitis, fulminating pyelonephritis, septic shock,infection from third degree wound covering >60of the body- fj owever, sinusitis, otitis media, bladder infection, viral pharyngitis, and strepthroat are not old mean infections and are not treated with a mean old mycinAll Aminoglycosides end in Mycin- ftentamycin, Vancomycin, and Clindamycin, Streptomycin, Cleomycin, Tobramycin- N o t all drags ending in mycin are aminoglycosides- Azithromycin, Clarithromycin, ErythromycinAll have TffRO in the middle ... So.TffRO t h e m o f f the " M e a n Old Mycin" list.W h a t a r e toxic e f f e c t s ?- Mycin—Sounds like Mice ( 7 hink ears) ... Monitorhearing (#7), balance, tinnitus (ringing of the ear,CN& toxicity)- T h e human ears are shaped like a kidney, so another<*#toxic effect of aminoglycosides is nephrotoxicity (Toxic t o the kidneys)Therefore, monitor Creatinine'What would be your answer i f in a guestion, you have t o choose which i s t h e bestbetween 2 4 - h o u r creatinine and serum creatinine?1. Creatinine - Best indicator of kidney function2 . 24-hour creatinine clearance is better t h a n Serum creatinineT h e figure 6 drawn inside t h e ear should remind you of 2 things:- They are toxic t o CNft- Administer them gft hourB o not give Mean Old Mycins TO because t h e y are not absorbed., and therefore wouldnot have any systemic effectsThere are 2 cases where Mean Old Mycins are given TO- hepatic encephalopathy (or hepatic coma) where ammonia level gets too h i g h- Tre-op bowel surgery: t o sterilise t h e bowel before surgery

Loading page image...

I n both cases, the ftf&X stays in t h e gutno-t absorbed), sterilises the bowel.would not be -toxicandT h e # 1 a c t i o n o f a n " o r a l mycin" ,.. S t e r i l i s e -the bowel- Who can s t e r i l i s e my bowel?Neo Kan- Neomycin and Kanamycin'7": Mean Old V4ycin" is given I Mor I V because i t is excre ted in feces and n o tabsorbed in the 6|I tract. I tis used in hepa tic encephalopathy -to kill €. coli,.andbowel surgery (to sterilise -the bowel).No-tefL coli in -the gut is the # 1 producer o f ammonia, which a t -toxic levels,leads -to encephalopathyT r o u g h s and p e a k s- 7 r o u g h s is when drugs are a t their lowest concentration in the patient's blood- peaks is when drugs are a t t h e i r highest concentration in a patient's blood"Tft?"Levelsft method t o remember what is done before or after, when dealing with a medicationwith troughs and peaks, rf ftp " _ T rough, ftdminister, Peak- Trough before drug administration- Peak after drug administration- T rough and peak levels are drawn because o f a drug's narrow therapeutic windowor index- Narrow therapeutic window or index means that t h e r e is a small difference inw h a t works and what killsWhich one o f t h e following medications would "-trough and peak" important?* Lasix (furosemide)- Smaller dose: 5 or 1 0- Larger dose; ftO or 1 2 0* Pigitalis (digoxin)- Smaller dose; 0.12.6- Larger dose; 0-26

Loading page image...

Would draw " T At" (Trough, Administer, peak) on digitalisN o t e : 'Draw T A T on Mean Old Mucins because o f t h e i r narrow therapeutic indejc.When t o P r a w a T h r o u g h and a P e a kToth Trough and Teak are not medication-dependentT h e trough, it is always drawn 3 0 minutes before next dosefor the peak, it depends on the route5 t o 1 0 minutes after drug is dissolved15 t o 3 D minutes after drug is finished (bag evnphjj3 D t o G?Dminutesi/ epends on insulin (See diabetes lecture)N o t necessary, not tested- teak Subb- teak I V- teak I M- teak SubQ- teak for TOQuestionVou give 1DD m b of a drug a t 2 00 m b per hour (the drug takes 3 0 minutes t o runJ.I fuou hang the drug a t 1 0 a.m., it will finish running a t 10:30 a.m. When will t h edrug peak?1. 10:15 a.m.2 . 1 0 : 3 0 a.m.3 - 1 0 : 4 5 a.m.4 . 11:00 a.m.Answer: T w o right answers—pick 11:00 a.m.I n this ease, platf the "trice IsT-ight" — go with the highest time w/o going overN o t eT h e same drug, given bn 2 different routes a t the same time will have differentpeaks- Morphinehowever, 2 different drugs given a t the same time and route (IV) will peaktogether- Morphine and amphetamine

Loading page image...

N e g a t i v e chronotropydecrease rate of impulse formation a t theSA node -> decelerate heart rateN e g a t i v e dromotropydecrease speed that impulses from SAnode travel t o AV node (decreaseconduction velocity;( + } I n o t r o p y , Chronotropy, Promotropy (_ J Inotropy, Chronotropy, PromotropyP o s i t i v e i n o t r o p yIncrease cardiac contractile force ->Ventricles empty more completelyN e g a t i v e i n o t r o p yWeaken/decrease the force o f myocardialcontractionL e c t u r e3Cardiac Medication, Calcium Channel blockers, Cardiac Arrhythmias, Chest Tube,Congenital -f-fc r tPefects, I n f e c t i o u s Pisease, P P ECalcium Channel b l o c k e r sCCPs (Calcium channel blockers) are tike- Valium for the heart- They relax and slows down the heart- I no t h e r words, CCPs have negative inotropic, chronotropic, dromotropic effects ont h e heartWhen do you want t o relax and slows down the heart?T o treat"A, AA. AAA1'- Antihypertensive- AntiAnginal drugs (decreasin.- AntiA+rialA rrhyt h miaSide Effects-headache and hypotensionName: ends in "dipine"- Ate-D;Verapamil(What are t h e parameters t o assess before putting a p t on CCBs?- Assess for P P- ytald if SPP <1DD- Cardi t e m (diltiatem) i s given continuous I VdripPositive chronotropyIncrease rate o f impulse formation a tSA node -> Accelerate heart rateP o s i t i v e dromotropyIncrease speed that impulses from SAnode travel t o AV node (increaseconduction velocity)Cardiac output improved

Loading page image...

Cdr didc Ar r+hmi d s- Xhowivihow +o ivrterprei- rkitffrhvn.- Wl«s+ know -the follow, 4 cdrdidc- r h +hvns bu sigkri'N o r m a l Sii-iiis Vkut-kiiM- 7 Here isAP wdVe, followed by d QRS, followed be d 7wave for evercomplex- Pedks of +Vie P VedVe i s e Mdll dis+dn+ +o r'/ie Q?S, did fdl! wi tViin 5 swidll boxesExtras:VenPri6«tdr f i b r i l l d Kon- Mo pM+ernVen+r icMtdr “I dr k uc Ar di d- Skidrp pedks wi+h d pdt rerviwyvw.wvvvwMnfiSMsrole

Loading page image...

Thoro df£ "S loyols CTHcirsi'ri knowledge1. Shiftneod +o Ictoy.12 . Shift H'kJ.I-is nice tc blow3- Shift H'ldt i$ wt+s +c blowI ft h e question mentions- QP-.S depolarization - Ventricular- T wave - AtrialT h e C r h y t h m s m o s t t e s t e d on t h e NCLEXT A lack of QBS complexes is asystole—a flat line2 . T waves (atria!) in the form o f saw tooth wave - atrial flutter3 . Chaotic T wave patterns - atrial ftbriNation (a-fi.b) (Chaotic: word used t odescribe fibrillation)4 . Chaotic QBS complexes - ventricular fibrillation (v-fib)6. "bizarre QRS complexes - Ventricular tachycardia (v-tach) ("bizarre: word used t odescribe tachycardia)(p.Teriodic wide bizarre QBS complexes - TVCs (Salvos of TVCs - A short runs o f v-tach)TVCs (premature ventricular contractions) are usually low priority* flow:ever, elevate t h e m t o moderate priority i funder t h e following 3 circumstances- There are(por more TVCs in a minute- More than(pTVCs in a row- V on T phenomenon (a TVC falls on a T wave)* TVCs after an M I is common and is a low priorityLethal arrhythmias are high priority and wnll kill a patient in ft minutes or less. Theyare;« Asystole and V-fib (ventricular fibrillation)♦3oth rhythms produce low or no cardiac output (CO), without which there isinadequate or no brain perfusion. This may lead t o confusion and deathT o t e n t i a l l y L e t h a l Cardiac A r r h y t h m i aV-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm, but it has aCOfjow would a patient with or without CO presents?- CO is absent - there is no pulse- CO i s present - there is a pulse

Loading page image...

T r e a t m e n t o f ?VCs and V-tach- Ventricular - Lidocaine- t>oth tare ventricular rhythms- Treat with Lidocaine- Amiodarone is eventually the MCLEX hoardwillwant as answerSupraventricular arrhythmias are Atrial arrhythmias (supra - above) T reatvnentsare W C P s "- Adenocard (Adenosine) . . u f a s t I V push [push in less than ft seconds and 2.D vnL MSflush right after)These pts will go into asystole for about ftD seconds and out o fit- Ieta-hlockers (end in -olol)- CCBs- Vigitalis (digoxin), Lanoxin (another digitalis analog)■eta-blockers have negative inotropic, chronotropic,dromotropic effects on t h e heart. They treatr'A, AA, AAA"- Antihypertensive- AntiAnginal drugs (decreasing oxygen demand)- AntiAtrialArythmia- Side Effects - fleadache and hypotensionT r e a t m e n t o f V - f i b and Asystole- Pefil? for V-fih (’Pefih - defihrillate - Shock eml)- Epinephrine and ATopine for AsystoleT)t: A + r i d l drrkiH't'V'ntids- Adfivid- l?€+d- CdkiMrti- PigT x: VOn+r’iCHIrif dt’r’klnHlHiid$- LiJofd.Hd

Loading page image...

C h e s t T u b e sPurpose: t o reestablish negative pressurein the pleural space ... Negative pressure in■rhe pleural space makes thing stick sothat the lung expands when the chest wallexpands- Pleural space i s t h e space between thelung (visceral pleura j and t h e chest wall(parietal pleura}- T n a pneumothorax, chest t u b e removesair- T n a hemothorax, chest tube removesblood- T n a hemopneumothorax, c h e s t t u b eremoves air and bloodQuestionfi chest tube is placed in a p t for ahemothorax (blood). What would \fou (the L ? N ) report t o t h e nurse? O r , w h a t would40H (thc'RN) report physician?a. Chest t u b e is n o t bubblingb .Chest tube drains ftDO m L in the first I D hoursc. Chest t u b e i s not drainingd.Chest tube is intermittentbubblingWhat is the chest tube not supposed t o do? 1 he chest tube is supposed t o draininstead o f bubblingTherefore answer (c) is the right answer.Questionfi chest tube is placed in a p t for a pneumothorax (air). What would uou (the LPN)report t o the nurse? Dr, what would 40U (the'P.Mj report physician?a. Chest t u b e is n o t bubblingb .Chest tube drains ft 0 0 m L in the first 1.0 hoursc. Chest t u b e i s not drainingd.Chest tube is intermittentbubbling

Loading page image...

With a pneumothorax, bubbling is expectedTherefore, (a) is a good answer choice- Since this is a pneumothorax, not -toe much blood is expec ted- Consequently, g»DD m b of blood over AD hours (60 m L per hour) i s toe much bleedand needs -to be reported t o -the nurse er the physicianAlso, pay attention to the location the -tube is placed- Apical (+*p) *>r 'basilar (base)- Apical ches t tube removes Air- "basilar chest tube removes 'blood or fluid (due t o gravity)Examples- An apical chest tube is draining 3DD m b t h e first hour is bad ..."bubbling (air) isexpected- A basilar chest tube i s draining 2 0 0 m L -the first hour is expected- An apical chest tube is not bubbling ....This i s a bad sign because bubbling (air) isexpected- A basilar chest tube is not bubbling ... This is a good sign because bubbling (air) isnot expectedExamplePatient presents w i t h a unilateral hemopneumothorax. flow t o care for -thispatient?Place an apical chest -tube for -the pneumothorax and a basilar for the hemothorax'bilateral pneumothorax needs apical chest -tube one on t h e right and one on -the leftAir tube - Apical - Top, on both sidesP o s t - t r a u m a or p o s t s u r g i c a l p a t i e n t needs- Patient presents with a unilateral hemopneumothorax. -Mow t o care for thispatient? ...place an apical and a basilarchesttube on the side of -the problem ...Always assume trauma and surgery is unilateral unless otherwise specifiedT r i c k guestionWhere would you place a chest tube for a postop r i g h t pneumonectomy?- postop right pneumonectomy does not need a chest -tube ...Since the right lung wasremoved, there is no need for a chest tube

Loading page image...

- Chest tube will however be used for lobectomn (removal o falobe of t h e lang), orwedge resectionClosed c h e s t drainage devicesTpes: Jackson-vratt, Emtsson,pneumovac, hemovac, e tc.What happens i f one of thosedrainage devices i s blocked over?- /Vsk patient t o -take a deepbreath and set the device back up- Motmedical emergency ... Noneed t o ceill -the physician’Knock someone or something over; to push or strike someone or something, causing■the person or -the thing to fall.T ft h e w a t e r seal o f -the c h e s t t u b e b r e a k sClamp- Clamping, unclamping, and placing the tube under water must be done in 1 6 secondsor lessCut t h e tube awauSubmerge (stick) the end of t h e tube under sterile water- The most important stepUnclamp t h e tube if it was initially clamped, (clamping t h e tube preven t a i r t o getinto the chest but does not alloy.' anything from -the chest t o get out)N o t eT f for whatever reason the chest tube breaks, clamp, unclamping -to placing thetube under w a t e r must be done in 1 6 seconds or lessQuestionT h e water sea' chamber of the chest -tube in a patient with apneumo-thorax/hemothorax breaks. What is the first course o f action for the nurse?a. Clamp -the tubeb. Cut t h e tube awac. Submerge (or stick) -the end o f -the tube under sterile waterd. Unclamp the t u b e i f it was initially clamped

Loading page image...

- I nthis case, the first course of action is the clamp the tubeQuestionThe water seal chamber o f the chest tube in a patient with apneumothorax/hemothorax breaks, What is the priority (best) action of t h e nurse?a. Clamp the tubeb. Cut the tube awac. Submerge (or stick) the end of t h e tube under sterile waterd. Unclamp the tube if it was initially clamped- I n this guestion, the priory action for the nurse is t o submerge the end of thetube under sterile water because doing so prevents air from getting into the chest.A t the same time, t h i s allows air or blood from t h e chest to get out(This -solves the problem ky reestablishing t h e water seal)NoteClamping, unclamping, and placing the tube under water- must be done in 15 secondsor lessQuestionVou notice on t h e monitor that a patient has V-fb. p t is unresponsive and there isno pulse. What is t h e first step in t h e management of this patient?a. place a backboard under patient's backwhile patient is supineb. Start chest compression*H?estnis about what is the priori-fry. Chest compressioni s the priority action.I fa c h e s t t u b e g e t s pulled o u t ...1. Take a gloved hand and cover t h e opening (first step)2 . Take a sterile Vaseline gaute and tape 3 sides (best step)Chest tube is bubbling ... Ask (1) where it is bubbling, and ( 2 ) when it is bubbling?Ask the following 2. guestions♦bubbling ... Where?I n the w a t e r seal chamber- I fit i s intermittent, i t is good (document i t )- I fit is continuous, it is bad and indicates a break/leak in the system (find it andtape it)♦bubbling ...Where? I n the suction control chamber

Loading page image...

- I fit is intermittent, suction pressure is too low (increase it a t the wall until it i scontinuous)- I fit i s continuous, i t is good (document it)ftnalogies* ft straight catheter is t o a fotey catheter, as a thoracentesis i s t o a chest tube.- ft straight catheter goes in and out ... ft poley goes in,secure it, and continuousdrainage- Thoracocentesis - go in and o u twChest tubes - g o in, secure it, and [eave it inptace• ft foley has a higher risk o f infection than a straight Cath* ft chest tube has a higher risk o f infection than thoracocentesis"Bules f o r clamping t u b e s- Po not clamp a tube for more than 15 seconds without a physician's order- Use rubber tooth (will not puncture tubing), double clamps- Therefore, when the water seat breaks, the nurse has no more than 15 seconds t oclamp, cut the tube, submerge it under sterile water, and then unclamp itCongenital J-leart pefectsI tis either they cause a lot of trouble or no trouble- E>ut nothing in between♦Memorise one word:,rTRou"HLe" with the lower-case vowels because congenitalheart defects are either:"TBou&Le"o rNothing t o worry aboutft pediatric p a t i e n t w i t h "TRouLe" as congenita! h e a r t defect- Needs surgery now/soon t o live- -Jjas slowed/delayed growth and development (failure t o thrive)- fjas a shortened life expectancy- Parents will experience a tot of grief, financial and emotional stress- Patient is likely t o be discharge home on a cardiac monitor- ftfter, birth, patient will be in the hospital for weeks- Pediatrician or pediatric nurse will likely refer patient t o a pediatric cardiologist

Loading page image...

Question7 h e nurse is teaching the parent o f a n infant l?orvi with “I etralogy o f Eallot. Whichof t h e following should the nurse talked t o t h e parents about in the teachingsession?- T h e nurse should teach the newborn's parents all of the choices listed abovefl "TRotfBLe" congenital heart defect♦"TRouL e " shunts bloodTicjht t o Left♦"TRouS Le" islwe (cyanotic)♦AH "TRouLe" starts with the letter " 7 "- 7 etralocjy o f Eallot- 7runcus arteriosus- 7 ransposition of the- cjreat vessels- 7 ricuspid a t resia- 7 otally anomalous of pulmonary vasculature (7 flTV)- Except, L e f tv e n t r i c u l a r hypoplastic syndrome7 h e s e a r e examples i fMo TRouULe congenital h e a r t d e f e c t s- Ventricular septal defect (VSP)- patent ductus arteriosus (?Pfl)- patent foramen ovale- fltrial septal defect- pulmonic stenosisflII children with a congenital heart defect, whether TRoule defect or No TRou'&ledefect, have- fl Murmur- fln echocardiogram need t o be done t o find out the cause o f the murmur4 d e f e c t s o f T e t r a l o g y o f f a l l o t — "ERDVe"- Pulmonary artery stenosis-TV-H (ricjht ventricular hypertrophy)- Overriding aorta- VSP i Ventricular septal defect)No need t o know w h a t they are ... Just need t o spot them as answer choices on theboard

Loading page image...

I n f e c t i o n s P i seasc and Transmission-Pased PrecautionsRFtfHXO*-UH. IC o n t a c t precautions• Anything enteric (frl,or fecal/oral)- C. diff, -Hepatitis A. E. coli, cholera, Afsentery• Staph•“RSV (droplets fa!! onto object t h e n patient touches object or put it in mouth)- P o net cohort 2.VSV patievtts unless culture and symptoms saif that have thesame disease•■HerpesTil ere are 4 transmission-based precautions- Standard or universal- Contact- Proplet- Airborne precautionPPE (persona! protective equipment) for contact precaution- Private room is preferred- Can be in t h e same room i f cohort based on culture and not symptoms- -Hand washing -> frown - > frloves- Pisposable SKppfy fgloves, paper pla+es, plas+ie wtensits]- Pedicaied e4uiptnen+ (s+e-bkioseope,l£p ewff) and f o s s+aij in +he roomP r o p1st prec aerbions- for b«gs -travelling on large par+ieles -through Coughing, Sneering -to less than 3fee-t- Meningitis- -H. inflwenia b [Example: epiglottitis (nothing in t h e throat)]PPE (persona! protective E iiipment)- private room is preferred- Can be in the same room if cohort based on culture and symptoms- -Hand washingMask - > froggle or face shield - > frloves- Pisposable supply- Pedica-ted e wipmenta i r b o r n e p r e c a u t i o n s "ftirM T V

Loading page image...

- M WTfc- Varicella (chickenpox)P P £Private room is preferredCan be in the same room i f cohort based on culture and symptoms{Jand washing■> ( oa.a.le or Face shield -> gloves- Wear mask when living the room- Keep door closed- disposable suppKf (not essentialJ- dedicated equipment (not essential)- Negative airflowr D O N N I N GP P € (Personal p r o t e c t i v e e q u i p m e n t )* Order t o put in on:- 6pwn- Mask- fto.e- glovesrD O F F I N G* Order t o take i t off ... d o so in alphabetical order- gloves- Ciole- f own- MaskM a t h Problemsdosage calculationI V drip rates - Volume * drop factor / Time- Micro/Mini drip -(pC‘drops per vnL- Macro drip - W drops per m LPediatric dose (2.2. 1'as - 1 kej)

Loading page image...

Lecture 4Crutches, Canes, Walkers, 'Pefusions, -Hallucinations, Psychosis, Psychotic and Mon -psychotic Hallucination, I l l u s i o n , PelusionC r u t c h e s , Canes, WalkersCruich walking gaH*One of the major human functions is1P012P0*193114s»«locomotion. Therefore, crutches, canesand walkers are tested on the NCLEXexam even though they are n o t reallyemphasised in school, ffso, suchknowledge is good -for patient teaching.With that said, crutches, canes andwalkers are devices used t o help ptsawith an unstable gait, whose mussesare weak or who require a reduction inthe load on weight-bearing structures2f j o w do you measure t h e l e n g t h o fc r u t c h e s ?♦Measuring crutches is important forrisk reduction when ambulating and t oavoid nen/e problems♦T h e length of a crutch i s measured by- Holding it vertically and placing t h e t i pon t h e ground- Having 2 t o 3 finger widths betweent h e pad and t h e a n t e r i o r axillary fold- T h e tip i s located t o a point lateral ( 6inches) and slightly in f r o n t o f footinches)♦"Rule o u t l a n d m a r k s on f o o t o r say axilla!♦fjandgrip measurement- T h e angle of elbow flexion i s 3 0 degrees- T h e wrists should be a t the level o f t h e handgrip

Loading page image...

f l o w t o Teach Crutch traits?2 -point g a i t —move a crutch and opposite foot together, then the other crutchwith other foo t together* Together (Right leg & Left crutch)“• ogether (Left leg <£."Right crutch)* for mild bilateral leg weaknesses3 -point g a i t —move ( 2 crutches <£.bad leg) -together -> followed by unaffected leg- The gait goes 3-1, 3 -A/ 3-1- The affected (bad) leg is not on the ground- The unaffected (good) leg is on the ground4 -point g a i t—move everything separately- 'Movecrutch -> Move opposite foo-t - > followed by other crutch -> followed byopposite foo-t-"Right crutch -> Left footLeft crutch -> 'Right foot- 4-poin-t gait is Very slow but very stableSwing-th rough is for non- w e i g h t bearing [amputees)- Similar-to 3-point gait- The unaffected foot gets pass the tip of both cru tches- The person may be an ampu tee or does not bear weighton -the leg a tal!- Can move really fast.When do you use t h e s e g a i t s ?♦Use EVen-point g a i t f o r even, odd-point gait f o r odd♦Use the even numbered gaits when weakness in -the feet is evenly distributed- 2-point for mild problems- 4-point for severe♦Use -the odd numbered gait when one leg is affec-ted- 3-point for one leg♦T fpatient cannot bear weight or amputation- Swing-throughExamplepatient affec ted wi th early s tages of rheumatoid arthritis. What gai I- should -thepatient use?- "Hoth legs affected (because it is a systemic disease)

Loading page image...

- Eariij stage—mild- 2 -point gaitExampleA patient has left ATk. (above the knee) amputation 2 da s ago. What gait shouldthe patient use?- Mon-weight bearing- Swing-throughExamplepatient i s first dapostop, right knee, partial weightbearing allowed. What gait should the patient use?- One leg affected- Odd-numbered gait- 3-p*int gaitExample——-*r=Patient is in advanced stages o f ALS. What gait should the patient use?- Trilateral leg weakness (because it is a systemic disease)- Even-numbered gait- Advanced stages - Severe- 4-point gaitExamplePatient with [eft h i p replacement, 2nd daq postop on non-weight bearing instruction.What gait should the patient use?- Non-weight bearing o f 1 leg- Swing-through gaitExamplePatient with bilateral (E / L ) total knee replacement first dat{ postop, weightbearing is allowed. What gait should the patient use?- Even-numbered gait - Trilateral- Weight bearing- firstdafrf postop - Severe- 4-point gait

Loading page image...

Examplepatient with bila-teraI total knee replacement 3 weeks postop. What gait should thepatient use?- €Ven-numbered gait - Pilateral- Weight bearing- 3 weeks postop - mild- Z-pointftoing U p and Pown -the S t a i r s w i t h Crutches-"Remember this phrase: " u p w i t h -the C ood, and Pown w i t h -the P a d "- When 40a <50 u p -the stairs, the good foot moves u p first- When 40M go down the stairs, the bad foo t moves down lastP u t , . o m a t t e rw h a t : P o t h crutches always move w i t h the bad legCane- -Hold cane on -the anaffected (strong) side- advance cane wi-th the opposite side for a wide base o f support- -handgrip should be a t -the level -the wristWalker• Correc t wai| -to use a walker- The walker is on -the side o f -the p a tient, -the patient "picks it u p ...Se ts it down ...Walks -to i t "- Once -the walker is in front o f -the p a tient, the patient "- olds on t o c h a i r , S tandsu p , T h e n g r a b s w a l k e r "• Pon't tie belongings t o -the front of -the walker — "It h e m t o either side so itwon't tip over• T h e NCLTX board does no t like tennis balls or wheels on walker can create problemPSH h i a t r qF i r s t t h i n g t o a s k in a p s ch guestion i s ; " i st h e p a t i e n t psychotic or non -psychotic?"T h e answer -to this guestion will determine care plan, treatment, length of stavf,legality, etc.

Preview Mode

This document has 108 pages. Sign in to access the full document!

Report

Study Now!

Document Details

Related Documents

NSG 3160 NCLEX Review Chapter 15

NSG 3160 NCLEX Review Chapter 14

NSG 3160 NCLEX Review Chapter 24

Lippincott Style NCLEX Questions

NCLEX PN Test Practice Questions

Lecture Notes NCLEX

NCLEX Study Guide

Comprehensive NCLEX Review

NCLEX Style Questions Nutrition

Key Concepts for NCLEX

Company

Explore

Study Tools