NCLEX Review Notes Mark Klimek Lectures
Lecture on acid-base balance and ventilator interpretation for NCLEX prep. Covers pH, CO₂, HCO₃ values, metabolic vs. respiratory disorders, and the "Rule of the Bs" to simplify diagnosis—ideal for nursing students and critical care review.
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MARKKUAliK
LECTURES
NCLEX
REVIEW NOTES
LECTURES
NCLEX
REVIEW NOTES
MARKKUAliK
LECTURES
NCLEX
REVIEW NOTES
LECTURES
NCLEX
REVIEW NOTES
Tzab’le of Contents
L e c t u r e 1 - Acid- ase Palance, Ventilators
Lecture 2 - Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Peak
and 1 rough
L e c t u r e 3 - cardiac Medication, Calcium Channel plockers, Cardiac Arrhythmias,
Chest 2 ubc, Congenital heart Pefects, Infectious Pisease, PTE
Lecture 4- - Crutches, Canes, Walkers, Petusions, h allucinations, Psychosis, Psychotic
and Non-Psythotic hallucination, Illusion, Pelusion
L e c t u r e 5 - Piabetes Mellitus, Piabetes Insipidus SlAPh, Insulin, PKA, h h N K
L e c t u r e (a - Prug Toxicities (Lithium, Lanoxin, P i tantin, 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, Laminectomy
L e c t u r e Lab Values, five Voadty Ps, Keutropenif PreMU-tiovi.
L e c t u r e - Psych Pru s, 7 ri, Peni o , WAAOI, Lithium, protac, h ldol, Clotaril,
£oloft
L e c t u r e - Maternity and Neona tology
L e c t u r e H - petal Complications, Stages of Labor, Assessments, Variations for
Np, 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
L e c t u r e 1 - Acid- ase Palance, Ventilators
Lecture 2 - Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Peak
and 1 rough
L e c t u r e 3 - cardiac Medication, Calcium Channel plockers, Cardiac Arrhythmias,
Chest 2 ubc, Congenital heart Pefects, Infectious Pisease, PTE
Lecture 4- - Crutches, Canes, Walkers, Petusions, h allucinations, Psychosis, Psychotic
and Non-Psythotic hallucination, Illusion, Pelusion
L e c t u r e 5 - Piabetes Mellitus, Piabetes Insipidus SlAPh, Insulin, PKA, h h N K
L e c t u r e (a - Prug Toxicities (Lithium, Lanoxin, P i tantin, 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, Laminectomy
L e c t u r e Lab Values, five Voadty Ps, Keutropenif PreMU-tiovi.
L e c t u r e - Psych Pru s, 7 ri, Peni o , WAAOI, Lithium, protac, h ldol, Clotaril,
£oloft
L e c t u r e - Maternity and Neona tology
L e c t u r e H - petal Complications, Stages of Labor, Assessments, Variations for
Np, 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
Tzab’le of Contents
L e c t u r e 1 - Acid- ase Palance, Ventilators
Lecture 2 - Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Peak
and 1 rough
L e c t u r e 3 - cardiac Medication, Calcium Channel plockers, Cardiac Arrhythmias,
Chest 2 ubc, Congenital heart Pefects, Infectious Pisease, PTE
Lecture 4- - Crutches, Canes, Walkers, Petusions, h allucinations, Psychosis, Psychotic
and Non-Psythotic hallucination, Illusion, Pelusion
L e c t u r e 5 - Piabetes Mellitus, Piabetes Insipidus SlAPh, Insulin, PKA, h h N K
L e c t u r e (a - Prug Toxicities (Lithium, Lanoxin, P i tantin, 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, Laminectomy
L e c t u r e Lab Values, five Voadty Ps, Keutropenif PreMU-tiovi.
L e c t u r e - Psych Pru s, 7 ri, Peni o , WAAOI, Lithium, protac, h ldol, Clotaril,
£oloft
L e c t u r e - Maternity and Neona tology
L e c t u r e H - petal Complications, Stages of Labor, Assessments, Variations for
Np, 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
L e c t u r e 1 - Acid- ase Palance, Ventilators
Lecture 2 - Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Peak
and 1 rough
L e c t u r e 3 - cardiac Medication, Calcium Channel plockers, Cardiac Arrhythmias,
Chest 2 ubc, Congenital heart Pefects, Infectious Pisease, PTE
Lecture 4- - Crutches, Canes, Walkers, Petusions, h allucinations, Psychosis, Psychotic
and Non-Psythotic hallucination, Illusion, Pelusion
L e c t u r e 5 - Piabetes Mellitus, Piabetes Insipidus SlAPh, Insulin, PKA, h h N K
L e c t u r e (a - Prug Toxicities (Lithium, Lanoxin, P i tantin, 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, Laminectomy
L e c t u r e Lab Values, five Voadty Ps, Keutropenif PreMU-tiovi.
L e c t u r e - Psych Pru s, 7 ri, Peni o , WAAOI, Lithium, protac, h ldol, Clotaril,
£oloft
L e c t u r e - Maternity and Neona tology
L e c t u r e H - petal Complications, Stages of Labor, Assessments, Variations for
Np, 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
NURSING
E X A M
SUCCESS
E X A M
SUCCESS
NURSING
E X A M
SUCCESS
E X A M
SUCCESS
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VSVg p»3y
PH: ----------- 7.35 - 7.45
PACO; ---------- 35 - 45
HCOj ----------- 2 2 - 2 6
PAO; ----------- 8 0 - 100
02 SAT -------- > 95%
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VSVg p»3y
PH: ----------- 7.35 - 7.45
PACO; ---------- 35 - 45
HCOj ----------- 2 2 - 2 6
PAO; ----------- 8 0 - 100
02 SAT -------- > 95%
I f p H oes over 7 . 4 5 , t h i s i s alkalosis
Therefore, 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 seizures H ■ 4.
I f p H goes below 7 - 3 5 , t h i s i s acidosis
Therefore,, 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 cause
Metabolic 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 it
i s respiratory
Then ask yourself, "Are they o v e r v e n t i l a t i n g o r
u n d e r v e n t i l a t i n g ?
- I f UHPffRventilating, then pick acidosis— pH i s
under 7 - 3 5
- I f OV Ventilating, t h e n i t i s alkalosis, p-H is
over 7 . 4 5
IF I T I S LUNGS* RESPIRATORY
UNOERucntiloting * Ac idosis
OVERuenukiting -
What type of acid-base derangement is present in t h e following condition?
I n l a b o r ?
-"Respiratory alkalosis Cverventilatincj—p7 increases Alkalosis
P r o w n i n ?
-"Respiratory acidosis UndervenHIatin —p H decreases... Acidosis
P t is on P'CA (patient -controlled anesthesia) pump?
- Ventilation is down ..."Respiratory acidosis
I f it is n o t LUN61, t h e n i t is metabolic. I f t h e p a t i e n t h a s prolonged gastric
Vomiting or suction (sucking out acid), pick alkalosis.
Therefore, 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 seizures H ■ 4.
I f p H goes below 7 - 3 5 , t h i s i s acidosis
Therefore,, 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 cause
Metabolic 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 it
i s respiratory
Then ask yourself, "Are they o v e r v e n t i l a t i n g o r
u n d e r v e n t i l a t i n g ?
- I f UHPffRventilating, then pick acidosis— pH i s
under 7 - 3 5
- I f OV Ventilating, t h e n i t i s alkalosis, p-H is
over 7 . 4 5
IF I T I S LUNGS* RESPIRATORY
UNOERucntiloting * Ac idosis
OVERuenukiting -
What type of acid-base derangement is present in t h e following condition?
I n l a b o r ?
-"Respiratory alkalosis Cverventilatincj—p7 increases Alkalosis
P r o w n i n ?
-"Respiratory acidosis UndervenHIatin —p H decreases... Acidosis
P t is on P'CA (patient -controlled anesthesia) pump?
- Ventilation is down ..."Respiratory acidosis
I f it is n o t LUN61, t h e n i t is metabolic. I f t h e p a t i e n t h a s prolonged gastric
Vomiting or suction (sucking out acid), pick alkalosis.
- Tor everything else that isn't lung < pick metabolic acidosis
- So, when you don't know what t o pick. pick metabolic acidosis
T i p
- Set your default setting t o Metabolic ftcidosis
- Always pay attention t o modifying phrase rather than original noum
V e n t i l a t o r
ft Ventilator is a machine designed t o move
breathable air into and out of t h e kings,
aids patients who are physically unable t o
breathe, or breathing insufficiently t o
breathe ft Ventilator is equipped with a
high and a low-pressure alarm,
■High pressures alarms are always triggered
by increased resistance t o air flow. Look for
obstructions:
- Kinks in tubing ...Solution: unkink the tube
- Condensed water in the dependent tube
...Solution: empty it
- Mucus plugs ... Solution: Ask patient t o
turn, tough, deep breathe; or suction t h e
tubing TRN
What is the appropriate order t o address high pressure alarm in a mechanical
Ventilator?
Cl) Unkink. (2.j EmpbJ water out of tubing. ( 3 ) turn pt, ask p t t o cough or deeply
breathe, and f4) suction
Low pressures alarms are always triggered b decrease in resistance. This can be
caused b
- So, when you don't know what t o pick. pick metabolic acidosis
T i p
- Set your default setting t o Metabolic ftcidosis
- Always pay attention t o modifying phrase rather than original noum
V e n t i l a t o r
ft Ventilator is a machine designed t o move
breathable air into and out of t h e kings,
aids patients who are physically unable t o
breathe, or breathing insufficiently t o
breathe ft Ventilator is equipped with a
high and a low-pressure alarm,
■High pressures alarms are always triggered
by increased resistance t o air flow. Look for
obstructions:
- Kinks in tubing ...Solution: unkink the tube
- Condensed water in the dependent tube
...Solution: empty it
- Mucus plugs ... Solution: Ask patient t o
turn, tough, deep breathe; or suction t h e
tubing TRN
What is the appropriate order t o address high pressure alarm in a mechanical
Ventilator?
Cl) Unkink. (2.j EmpbJ water out of tubing. ( 3 ) turn pt, ask p t t o cough or deeply
breathe, and f4) suction
Low pressures alarms are always triggered b decrease in resistance. This can be
caused b
Loading page 6...
- 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 Therapist
The ven tilator may be set too high or too low
Setting is too high ... Tatient is over -ventilated
-’Respiratory Alkalosis ... Tanking
Setting is too low ... Tatient i s tinder -Ventilated
-’Respiratory Acidosis ... "Patient i s retaining 0 0 2
Question
The physician wants t o wean patient off v e n t in the morning. A t G> am, the A’ (5|S
say respiratory acidosis. What would you do next?
Notify the physician that the patient is not ready t o be weaned off the respirator
- T t is in respiratory acidosis, which means that he is underventilated Therefore,
not ready t o be weaned off t h e ventilator.
- I f patient were in respiratory alkalosis (overventilated), he should be ready t o be
weaned off,
- 0 2 . sensor tube disconnection
- I n both cases, reconnect the disconnected twbing unless tube is on floor „.t>ag p +
and call'Respiratory Therapist
The ven tilator may be set too high or too low
Setting is too high ... Tatient is over -ventilated
-’Respiratory Alkalosis ... Tanking
Setting is too low ... Tatient i s tinder -Ventilated
-’Respiratory Acidosis ... "Patient i s retaining 0 0 2
Question
The physician wants t o wean patient off v e n t in the morning. A t G> am, the A’ (5|S
say respiratory acidosis. What would you do next?
Notify the physician that the patient is not ready t o be weaned off the respirator
- T t is in respiratory acidosis, which means that he is underventilated Therefore,
not ready t o be weaned off t h e ventilator.
- I f patient were in respiratory alkalosis (overventilated), he should be ready t o be
weaned off,
Loading page 7...
Lecture 2
Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Teak and 7 rough
Alcoholism
No be: T h e title o f t h i s section is alcoholism. -However, this
rule can be used for any abuse situation
- So, w h a t it the number 1 psychological problem in child
abuse? ... Tn gambling?... I n cocaine abuse? ... I n spou sal
abuse? ... I n elder abuse?
T h e a n s w e r i s denial
T 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 0
a.m. and you've already had a (p pack" ... I t is not the same as aggression. Pon't
attack 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 are
dealing with loss or abusive situation
S u p p o r t - L o s s
C o n f r o n t - Abuse
4t !
P e pendency v s Co -de pendency
T h e # 2 psychological problem is Pependency or Co-Pependency
Pependency; when the g e t the significant o t h e r t o do things or make decisions for
them
- T h e abuser is dependent
Co- dependency: when t h e significant other derive self-esteem for doing things or
making decisions for the abuser
- The significant other is the co-dependent
Pependency 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
Alcohol, Wernicke, Overdose and Withdrawal S/Sx, Aminoglycosides, Teak and 7 rough
Alcoholism
No be: T h e title o f t h i s section is alcoholism. -However, this
rule can be used for any abuse situation
- So, w h a t it the number 1 psychological problem in child
abuse? ... Tn gambling?... I n cocaine abuse? ... I n spou sal
abuse? ... I n elder abuse?
T h e a n s w e r i s denial
T 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 0
a.m. and you've already had a (p pack" ... I t is not the same as aggression. Pon't
attack 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 are
dealing with loss or abusive situation
S u p p o r t - L o s s
C o n f r o n t - Abuse
4t !
P e pendency v s Co -de pendency
T h e # 2 psychological problem is Pependency or Co-Pependency
Pependency; when the g e t the significant o t h e r t o do things or make decisions for
them
- T h e abuser is dependent
Co- dependency: when t h e significant other derive self-esteem for doing things or
making decisions for the abuser
- The significant other is the co-dependent
Pependency 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 8...
-Mow do you treat dependency /codependency?
- dependent pts are "abusers" Confront them
- Co-depe»ident pts have self-esteem issues „. Teach pts how t o set limits and
enforce 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 person
M a n i p u l a t i o n
Manipulation is when the abuser gets the significant other t o do things or make
decisions that are not in the best interests o f the significant other
- The nature o f the act is dangerous and harmful t o the significant other
Mow i s manipulation like dependency?
- I n both situations the dependent person gets the co-dependent person t o do
things or make decisions
- I f what the significant o t h e r is being asked t o do i s not inherently dangerous and
harmful, t h e n this is dependency/co-dependency
- Mowever, i f the significant other i s being asked t o do something inherently
dangerous and harmful, then this i s manipulation
Manipulation? Set LIMITS and Enforce them
Examples
Petermine i f either one of these situations is dependent/co-dependent problem or a
manipulation problem
* 4 -year-old alcoholic gets her 17 -year-old son t o go t o the store and buy alcohol
for 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 buy
alcohol 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
- dependent pts are "abusers" Confront them
- Co-depe»ident pts have self-esteem issues „. Teach pts how t o set limits and
enforce 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 person
M a n i p u l a t i o n
Manipulation is when the abuser gets the significant other t o do things or make
decisions that are not in the best interests o f the significant other
- The nature o f the act is dangerous and harmful t o the significant other
Mow i s manipulation like dependency?
- I n both situations the dependent person gets the co-dependent person t o do
things or make decisions
- I f what the significant o t h e r is being asked t o do i s not inherently dangerous and
harmful, t h e n this is dependency/co-dependency
- Mowever, i f the significant other i s being asked t o do something inherently
dangerous and harmful, then this i s manipulation
Manipulation? Set LIMITS and Enforce them
Examples
Petermine i f either one of these situations is dependent/co-dependent problem or a
manipulation problem
* 4 -year-old alcoholic gets her 17 -year-old son t o go t o the store and buy alcohol
for 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 buy
alcohol 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 9...
- Easier t o treat no one like -to tee man!pulated
Wernicke ( K o r s a k o f f ) Syndrome
Typically, Wernicke and Korsakoff are 2 separate disorders. T h e NCLEX however
bundles the 2 a s 1 Condi Hon
- Wernicke is an encephalopathy
- Korsakoff is a psychosis
- Wernicke and Korsakoff tend -to go together
Wernicke 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 reality
vJow do deal with a patient w i t h Wernicke and Korsakoff who is confabulating about
going 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 o
see what is on the news today”
Characteristics of Wernicke and Korsakoff syndrome
1. Preventable ... Take T h
2 . Arrestable (stop i t from getting worse J ... Take PT
3 . Irreversible (70 o) Will kill brain cells
A n t a b u s e and R e v i a (Pi s 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 therapy
designed t o make a patient give u p an cmdesirable habit by
causing t h e m t o associate it with an unpleasant effect
- Works in theory better t h a n in reality
Onset (how long it takes t o start working) and duration (how< long it lasts) of
effectiveness 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 be
on Antabuse /Re via a t least 2 weeks prior t o the event
Wernicke ( K o r s a k o f f ) Syndrome
Typically, Wernicke and Korsakoff are 2 separate disorders. T h e NCLEX however
bundles the 2 a s 1 Condi Hon
- Wernicke is an encephalopathy
- Korsakoff is a psychosis
- Wernicke and Korsakoff tend -to go together
Wernicke 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 reality
vJow do deal with a patient w i t h Wernicke and Korsakoff who is confabulating about
going 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 o
see what is on the news today”
Characteristics of Wernicke and Korsakoff syndrome
1. Preventable ... Take T h
2 . Arrestable (stop i t from getting worse J ... Take PT
3 . Irreversible (70 o) Will kill brain cells
A n t a b u s e and R e v i a (Pi s 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 therapy
designed t o make a patient give u p an cmdesirable habit by
causing t h e m t o associate it with an unpleasant effect
- Works in theory better t h a n in reality
Onset (how long it takes t o start working) and duration (how< long it lasts) of
effectiveness 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 be
on Antabuse /Re via a t least 2 weeks prior t o the event
Loading page 10...
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 ma lead t o symptoms of
vi!\ ft even death
- Teach them t o avoid khe followings items a s theu contain alcohol ... Mouth wash,
cologne, perfume, aftershave, elixir, most O T C liguid medicine, insect repellavit, hand
sanitizer, 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 t
Overdose and W i t h d r a w a l
"First thing <(ou ask in an overdose guestion is: I s it 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 (ps i cdc iws/halktfinogen
rtV. KL-.r; p r h ibniwc..
- Pddc'a
t o r < r. t h f j f ".Vr ’-v' "lir Ni'Li. X
UPPER DOWNER
- 'Hficr'c Art oVCt 1 3 5 dr<*g$ thai- are swwrtr'S
- Z T' t --1 a n >. - p a . - . . a div. iLi
. i.’.ipt "■
- T , - i n g : j PCv. I1
_ r thfl< " r " . ] ■ . I T M 4 Jr r l t . . / ' I I • . r.
ccHStiprt+tsl, etc
‘in. -1’ J +rn'r..
- '"I-’ ngs go u -
■ Euphoria, seixitres, IrritaWftty
.1-1pcrrc fit :«J.a 7 - . 4 4 . rac'.T •■ . r dia, 1. c re ■£<■?
.■ewe rorbo' ■■ -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/ventilation
due t o respiratory arrest.
Example
One of t|our patients is "high on cocaine." what is critical' important t o assess?
- Teach patient t o avoid all forms o f EtO{4. Mot doing so ma lead t o symptoms of
vi!\ ft even death
- Teach them t o avoid khe followings items a s theu contain alcohol ... Mouth wash,
cologne, perfume, aftershave, elixir, most O T C liguid medicine, insect repellavit, hand
sanitizer, 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 t
Overdose and W i t h d r a w a l
"First thing <(ou ask in an overdose guestion is: I s it 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 (ps i cdc iws/halktfinogen
rtV. KL-.r; p r h ibniwc..
- Pddc'a
t o r < r. t h f j f ".Vr ’-v' "lir Ni'Li. X
UPPER DOWNER
- 'Hficr'c Art oVCt 1 3 5 dr<*g$ thai- are swwrtr'S
- Z T' t --1 a n >. - p a . - . . a div. iLi
. i.’.ipt "■
- T , - i n g : j PCv. I1
_ r thfl< " r " . ] ■ . I T M 4 Jr r l t . . / ' I I • . r.
ccHStiprt+tsl, etc
‘in. -1’ J +rn'r..
- '"I-’ ngs go u -
■ Euphoria, seixitres, IrritaWftty
.1-1pcrrc fit :«J.a 7 - . 4 4 . rac'.T •■ . r dia, 1. c re ■£<■?
.■ewe rorbo' ■■ -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/ventilation
due t o respiratory arrest.
Example
One of t|our patients is "high on cocaine." what is critical' important t o assess?
Loading page 11...
- fjavin a T R o f 1 2 is not a critical measurement t o assess for that patient
- {Jowever. assessing for reflexes ( 3 + or 4+j, irritability borborycjmi increased bowel
sounds), or increased temperature wowId be more appropriate
- T h e W C rale" does not apply here I n fact, the patient's A Cin cocaine toxicity
is unremarkable
ft-fter you know -that -the dru in question i s an Upper or a Powner, -the second
question you should ask yourself i s whether i t i s an Overdose or a Withdrawal?
- Overdose and withdrawal have the opposite effects
OVERDOSE
OventM
Overdose o*i a n Upper CVercose on a Towner
Too inuct Too I'H-rle
'/■Jit.vrav,/
Wit, araw on a> Uopei
- Too l i t t l e
.■jitkvi .:wa. on a p o w a
- T o o ' r n c h
Question
The driver of a squad car calls the P T and says he is brinejinej a p t who in Oped on
cocaine. What do you expect t o see? ... Select all -that apply
patient OPed on Upper O P ... Expert -to see T 00 much
- first question: Upper or a Powner?
- Second question: Overdose or Withdrawal?
- S/SX would be: Irritability 4 + reflexes, borborvfcjmi, increased temperature, etc.
Question
The same patient is withdrawing from cocaine Same 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
- {Jowever. assessing for reflexes ( 3 + or 4+j, irritability borborycjmi increased bowel
sounds), or increased temperature wowId be more appropriate
- T h e W C rale" does not apply here I n fact, the patient's A Cin cocaine toxicity
is unremarkable
ft-fter you know -that -the dru in question i s an Upper or a Powner, -the second
question you should ask yourself i s whether i t i s an Overdose or a Withdrawal?
- Overdose and withdrawal have the opposite effects
OVERDOSE
OventM
Overdose o*i a n Upper CVercose on a Towner
Too inuct Too I'H-rle
'/■Jit.vrav,/
Wit, araw on a> Uopei
- Too l i t t l e
.■jitkvi .:wa. on a p o w a
- T o o ' r n c h
Question
The driver of a squad car calls the P T and says he is brinejinej a p t who in Oped on
cocaine. What do you expect t o see? ... Select all -that apply
patient OPed on Upper O P ... Expert -to see T 00 much
- first question: Upper or a Powner?
- Second question: Overdose or Withdrawal?
- S/SX would be: Irritability 4 + reflexes, borborvfcjmi, increased temperature, etc.
Question
The same patient is withdrawing from cocaine Same 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 12...
Prue) flbwse i n t h e Newborn
Always assume intoxication, not withdrawal a t birth, in a newborn less than 2 4
hours after birth, 2.4 hours or 'more after birth, you n assume the newborn is in
withdrawal
Question
7ou are caring for an infant born -to Quaaiude addicted mother 2 4 hours after bir th.
Select all -tha t apply
Overdose/ withdrawal condi tion ,.. 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 is
likely a Towner)
- I s i 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 startle
reflex
Alcohol 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 s
Alcohol Withdrawal Syndrome and Pelirium 1 remens are not the same
- Every alcoholic cjoes through alcohol withdrawal approximately 2.4 hours after the
person stops drinking
- however, less than 2 0 of alcoholics in alcohol withdrawal syndrome progress t o
delirium tremens... Pelirium tremens occurs about 72. hours after the person stop
drinking,
- Alcohol withdrawal syndrome always precedes delirium tremens; however, delirium
tremens does not always follow alcohol withdrawal syndrome
Alcohol Withdrawal Syndrom*
. n ■ . , -+ti . -4 iDiir . iHc- / 1 idH*)
MOM I *'< i H ' c m v r i i Q i t js’iidotirttn
L'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 d ilu ■ i i : n ■■ i . ■, . ' K - ' . . i ..'.i
J e t Ct'Jfj
rio rr-:.*rdints
Delirium Trem«n«
■ O f f : ■ . . A c r , I t -■ ' . . T i t . T . ■ ■itT.. -'
i i c i ' . r c f i t f . ] t o >xl‘ . m J o T . : « i 'r.
i I I . _■ - J / i L ! .1,
N r 'l? i l i i C . C- f f . l ■ hl'..! J t-f
_ - c v \ . . r w > | T .|, -If r-rlfj, ■r+1H-llT,l
- 141 ■ 1 i i d i ■ ' .. i t I • ’ ' i i M t r Ct 1 ”■ I OVC fM r lUfl
.■ s J f : i L ' — ■■.6 i - r r i1 Foer.
u H-. |\Y". h o f 2 M f L l * lifter)
Always assume intoxication, not withdrawal a t birth, in a newborn less than 2 4
hours after birth, 2.4 hours or 'more after birth, you n assume the newborn is in
withdrawal
Question
7ou are caring for an infant born -to Quaaiude addicted mother 2 4 hours after bir th.
Select all -tha t apply
Overdose/ withdrawal condi tion ,.. 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 is
likely a Towner)
- I s i 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 startle
reflex
Alcohol 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 s
Alcohol Withdrawal Syndrome and Pelirium 1 remens are not the same
- Every alcoholic cjoes through alcohol withdrawal approximately 2.4 hours after the
person stops drinking
- however, less than 2 0 of alcoholics in alcohol withdrawal syndrome progress t o
delirium tremens... Pelirium tremens occurs about 72. hours after the person stop
drinking,
- Alcohol withdrawal syndrome always precedes delirium tremens; however, delirium
tremens does not always follow alcohol withdrawal syndrome
Alcohol Withdrawal Syndrom*
. n ■ . , -+ti . -4 iDiir . iHc- / 1 idH*)
MOM I *'< i H ' c m v r i i Q i t js’iidotirttn
L'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 d ilu ■ i i : n ■■ i . ■, . ' K - ' . . i ..'.i
J e t Ct'Jfj
rio rr-:.*rdints
Delirium Trem«n«
■ O f f : ■ . . A c r , I t -■ ' . . T i t . T . ■ ■itT.. -'
i i c i ' . r c f i t f . ] t o >xl‘ . m J o T . : « i 'r.
i I I . _■ - J / i L ! .1,
N r 'l? i l i i C . C- f f . l ■ hl'..! J t-f
_ - c v \ . . r w > | T .|, -If r-rlfj, ■r+1H-llT,l
- 141 ■ 1 i i d i ■ ' .. i t I • ’ ' i i M t r Ct 1 ”■ I OVC fM r lUfl
.■ s J f : i L ' — ■■.6 i - r r i1 Foer.
u H-. |\Y". h o f 2 M f L l * lifter)
Loading page 13...
N o t e :
- "Up ad lib" or "up a d liberum" means pat ient may have activity or free t o move
around as desired any time
- 2 -point lock le-tters restraints:Restraints. in 1 upper and the contrala-teral lower
extremit'es.Release and secure upper arm first, and then release and secure the
foot. Switch extremities every 2 hours
- ffve both a n t i - f j T N medication, tran uiliter, multivitamin containing V'ffri
Question
So w h a t two situations would respiratory arrest be a priority?
- Overdose o f a Vowner
- withdrawal of an Upper
Question
Which pts would secure be a risk for?
- Overdose o f an Upper
- Withdrawal of a Powners
inc ;!■<: 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 else
works. 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
- Aminoglycosides
O t h e r s
- Steroids
- "be ta-blockers
- Calcium channel blockers
- pain medications
- Obstetrics medications
" A Mean Old Wlycin" - Aminoglycosides
AMINOGLYCOSIPE TCJXKJTY
- "Up ad lib" or "up a d liberum" means pat ient may have activity or free t o move
around as desired any time
- 2 -point lock le-tters restraints:Restraints. in 1 upper and the contrala-teral lower
extremit'es.Release and secure upper arm first, and then release and secure the
foot. Switch extremities every 2 hours
- ffve both a n t i - f j T N medication, tran uiliter, multivitamin containing V'ffri
Question
So w h a t two situations would respiratory arrest be a priority?
- Overdose o f a Vowner
- withdrawal of an Upper
Question
Which pts would secure be a risk for?
- Overdose o f an Upper
- Withdrawal of a Powners
inc ;!■<: 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 else
works. 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
- Aminoglycosides
O t h e r s
- Steroids
- "be ta-blockers
- Calcium channel blockers
- pain medications
- Obstetrics medications
" A Mean Old Wlycin" - Aminoglycosides
AMINOGLYCOSIPE TCJXKJTY
Loading page 14...
Would be used t o treat serious, resistant, life -threatening, ( ram negatives
infections.
- So, treat a 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 >60 of the body
- fj owever, sinusitis, otitis media, bladder infection, viral pharyngitis, and strep
throat are not old mean infections and are not treated with a mean old mycin
All Aminoglycosides end in Mycin
- ftentamycin, Vancomycin, and Clindamycin, Streptomycin, Cleomycin, Tobramycin
- N o t all drags ending in mycin are aminoglycosides
- Azithromycin, Clarithromycin, Erythromycin All 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) ... Monitor
hearing (#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 best
between 2 4 - h o u r creatinine and serum creatinine?
1. Creatinine - Best indicator of kidney function
2 . 24-hour creatinine clearance is better t h a n Serum creatinine
T 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 hour
B o not give Mean Old Mycins TO because t h e y are not absorbed., and therefore would
not have any systemic effects
There are 2 cases where Mean Old Mycins are given TO
- hepatic encephalopathy (or hepatic coma) where ammonia level gets too h i g h
- T re-op bowel surgery: t o sterilise t h e bowel before surgery
infections.
- So, treat a 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 >60 of the body
- fj owever, sinusitis, otitis media, bladder infection, viral pharyngitis, and strep
throat are not old mean infections and are not treated with a mean old mycin
All Aminoglycosides end in Mycin
- ftentamycin, Vancomycin, and Clindamycin, Streptomycin, Cleomycin, Tobramycin
- N o t all drags ending in mycin are aminoglycosides
- Azithromycin, Clarithromycin, Erythromycin All 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) ... Monitor
hearing (#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 best
between 2 4 - h o u r creatinine and serum creatinine?
1. Creatinine - Best indicator of kidney function
2 . 24-hour creatinine clearance is better t h a n Serum creatinine
T 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 hour
B o not give Mean Old Mycins TO because t h e y are not absorbed., and therefore would
not have any systemic effects
There are 2 cases where Mean Old Mycins are given TO
- hepatic encephalopathy (or hepatic coma) where ammonia level gets too h i g h
- T re-op bowel surgery: t o sterilise t h e bowel before surgery
Loading page 15...
I n both cases, the ftf&X stays in t h e gut no-t absorbed), sterilises the bowel.
would not be -toxic
and
T 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 M or I V because i t is excre ted in feces and n o t
absorbed in the 6|I tract. I t is used in hepa tic encephalopathy -to kill €. coli,. and
bowel surgery (to sterilise -the bowel).
No-te
fL coli in -the gut is the # 1 producer o f ammonia, which a t -toxic levels,
leads -to encephalopathy
T 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?" Levels
ft method t o remember what is done before or after, when dealing with a medication
with troughs and peaks
, r f 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 window
or index
- Narrow therapeutic window or index means that t h e r e is a small difference in
w h a t works and what kills
Which 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
would not be -toxic
and
T 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 M or I V because i t is excre ted in feces and n o t
absorbed in the 6|I tract. I t is used in hepa tic encephalopathy -to kill €. coli,. and
bowel surgery (to sterilise -the bowel).
No-te
fL coli in -the gut is the # 1 producer o f ammonia, which a t -toxic levels,
leads -to encephalopathy
T 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?" Levels
ft method t o remember what is done before or after, when dealing with a medication
with troughs and peaks
, r f 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 window
or index
- Narrow therapeutic window or index means that t h e r e is a small difference in
w h a t works and what kills
Which 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 16...
Would draw " T At" (Trough, Administer, peak) on digitalis
N 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 k
Toth Trough and Teak are not medication-dependent
T h e trough, it is always drawn 3 0 minutes before next dose
for the peak, it depends on the route
5 t o 1 0 minutes after drug is dissolved
15 t o 3 D minutes after drug is finished (bag evnphjj
3 D t o G?D minutes
i/ epends on insulin (See diabetes lecture)
N o t necessary, not tested
- teak Subb
- teak I V
- teak I M
- teak SubQ
- teak for TO
Question
Vou give 1DD m b of a drug a t 2 0 0 m b per hour (the drug takes 3 0 minutes t o run J.
I f uou hang the drug a t 1 0 a.m., it will finish running a t 10:30 a.m. When will t h e
drug 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 over
N o t e
T h e same drug, given bn 2 different routes a t the same time will have different
peaks
- Morphine
however, 2 different drugs given a t the same time and route (IV) will peak
together
- Morphine and amphetamine
N 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 k
Toth Trough and Teak are not medication-dependent
T h e trough, it is always drawn 3 0 minutes before next dose
for the peak, it depends on the route
5 t o 1 0 minutes after drug is dissolved
15 t o 3 D minutes after drug is finished (bag evnphjj
3 D t o G?D minutes
i/ epends on insulin (See diabetes lecture)
N o t necessary, not tested
- teak Subb
- teak I V
- teak I M
- teak SubQ
- teak for TO
Question
Vou give 1DD m b of a drug a t 2 0 0 m b per hour (the drug takes 3 0 minutes t o run J.
I f uou hang the drug a t 1 0 a.m., it will finish running a t 10:30 a.m. When will t h e
drug 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 over
N o t e
T h e same drug, given bn 2 different routes a t the same time will have different
peaks
- Morphine
however, 2 different drugs given a t the same time and route (IV) will peak
together
- Morphine and amphetamine
Loading page 17...
N e g a t i v e chronotropy
decrease rate of impulse formation a t the
SA node -> decelerate heart rate
N e g a t i v e dromotropy
decrease speed that impulses from SA
node travel t o AV node (decrease
conduction velocity;
( + } I n o t r o p y , Chronotropy, Promotropy (_ J Inotropy, Chronotropy, Promotropy
P o s i t i v e i n o t r o p y
Increase cardiac contractile force ->
Ventricles empty more completely
N e g a t i v e i n o t r o p y
Weaken/dec rease the force o f myocardial
contraction
L e c t u r e 3
Cardiac Medication, Calcium Channel blockers, Cardiac Arrhythmias, Chest Tube,
Congenital -f-fc r t Pefects, I n f e c t i o u s Pisease, P P E
Calcium Channel b l o c k e r s
CCPs (Calcium channel blockers) are tike- Valium for the heart
- They relax and slows down the heart
- I n o t h e r words, CCPs have negative inotropic, chronotropic, dromotropic effects on
t h e heart
When do you want t o relax and slows down the heart? T o treat "A, A A. AAA1
'
- Antihypertensive
- AntiAnginal drugs (decreasin.
- AntiA+rialA r rhyt h mia
Side Effects
-headache and hypotension
Name: 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 V drip
Positive chronotropy
Increase rate o f impulse formation a t
SA node -> Accelerate heart rate
P o s i t i v e dromotropy
Increase speed that impulses from SA
node travel t o AV node (increase
conduction velocity)
Cardiac output improved
decrease rate of impulse formation a t the
SA node -> decelerate heart rate
N e g a t i v e dromotropy
decrease speed that impulses from SA
node travel t o AV node (decrease
conduction velocity;
( + } I n o t r o p y , Chronotropy, Promotropy (_ J Inotropy, Chronotropy, Promotropy
P o s i t i v e i n o t r o p y
Increase cardiac contractile force ->
Ventricles empty more completely
N e g a t i v e i n o t r o p y
Weaken/dec rease the force o f myocardial
contraction
L e c t u r e 3
Cardiac Medication, Calcium Channel blockers, Cardiac Arrhythmias, Chest Tube,
Congenital -f-fc r t Pefects, I n f e c t i o u s Pisease, P P E
Calcium Channel b l o c k e r s
CCPs (Calcium channel blockers) are tike- Valium for the heart
- They relax and slows down the heart
- I n o t h e r words, CCPs have negative inotropic, chronotropic, dromotropic effects on
t h e heart
When do you want t o relax and slows down the heart? T o treat "A, A A. AAA1
'
- Antihypertensive
- AntiAnginal drugs (decreasin.
- AntiA+rialA r rhyt h mia
Side Effects
-headache and hypotension
Name: 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 V drip
Positive chronotropy
Increase rate o f impulse formation a t
SA node -> Accelerate heart rate
P o s i t i v e dromotropy
Increase speed that impulses from SA
node travel t o AV node (increase
conduction velocity)
Cardiac output improved
Loading page 18...
Cdr didc Ar r +h mi d s
- Xhowivi how +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 is A P wdVe, followed by d QRS, followed be d 7 wave for ever complex
- Pedks of +Vie P VedVe i s e Mdll dis+dn+ +o r'/ie Q?S, did fdl! wi tViin 5 swidll boxes
Extras:
VenPri6«tdr f i b r i l l d Kon
- Mo pM+ern
V en+r ic Mtdr “I dr k uc Ar di d
- Skidrp pedks wi+h d pdt rervi
wyvw.wvvvwMn
fiSMsrole
- Xhowivi how +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 is A P wdVe, followed by d QRS, followed be d 7 wave for ever complex
- Pedks of +Vie P VedVe i s e Mdll dis+dn+ +o r'/ie Q?S, did fdl! wi tViin 5 swidll boxes
Extras:
VenPri6«tdr f i b r i l l d Kon
- Mo pM+ern
V en+r ic Mtdr “I dr k uc Ar di d
- Skidrp pedks wi+h d pdt rervi
wyvw.wvvvwMn
fiSMsrole
Loading page 19...
Thoro df£ "S loyols CT Hcirsi'ri knowledge
1. Shift neod +o Ictoy.1
2 . Shift H'kJ.I- is nice tc blow
3- Shift H'ldt i$ wt+s +c blow
I f t h e question mentions
- QP-.S depolarization - Ventricular
- T wave - Atrial
T h e C r h y t h m s m o s t t e s t e d on t h e NCLEX
T A lack of QBS complexes is asystole—a flat line
2 . T waves (atria!) in the form o f saw tooth wave - atrial flutter
3 . Chaotic T wave patterns - atrial ftbriNation (a-fi.b) (Chaotic: word used t o
describe fibrillation)
4 . Chaotic QBS complexes - ventricular fibrillation (v-fib)
6. "bizarre QRS complexes - Ventricular tachycardia (v-tach) ("bizarre: word used t o
describe 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 f under t h e following 3 circumstances
- There are (p or more TVCs in a minute
- More than (p TVCs 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 priority
Lethal arrhythmias are high priority and wnll kill a patient in ft minutes or less. They
are;
« Asystole and V-fib (ventricular fibrillation)
♦ 3oth rhythms produce low or no cardiac output (CO), without which there is
inadequate or no brain perfusion. This may lead t o confusion and death
T 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 a
V-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm, but it has a
CO
fjow would a patient with or without CO presents?
- CO is absent - there is no pulse
- CO i s present - there is a pulse
1. Shift neod +o Ictoy.1
2 . Shift H'kJ.I- is nice tc blow
3- Shift H'ldt i$ wt+s +c blow
I f t h e question mentions
- QP-.S depolarization - Ventricular
- T wave - Atrial
T h e C r h y t h m s m o s t t e s t e d on t h e NCLEX
T A lack of QBS complexes is asystole—a flat line
2 . T waves (atria!) in the form o f saw tooth wave - atrial flutter
3 . Chaotic T wave patterns - atrial ftbriNation (a-fi.b) (Chaotic: word used t o
describe fibrillation)
4 . Chaotic QBS complexes - ventricular fibrillation (v-fib)
6. "bizarre QRS complexes - Ventricular tachycardia (v-tach) ("bizarre: word used t o
describe 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 f under t h e following 3 circumstances
- There are (p or more TVCs in a minute
- More than (p TVCs 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 priority
Lethal arrhythmias are high priority and wnll kill a patient in ft minutes or less. They
are;
« Asystole and V-fib (ventricular fibrillation)
♦ 3oth rhythms produce low or no cardiac output (CO), without which there is
inadequate or no brain perfusion. This may lead t o confusion and death
T 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 a
V-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm, but it has a
CO
fjow 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 20...
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 hoard will want as answer
Supraventricular arrhythmias are Atrial arrhythmias (supra - above) T reatvnents
are W C P s "
- Adenocard (Adenosine) . . u f a s t I V push [push in less than ft seconds and 2.D vnL MS
flush right after) These pts will go into asystole for about ftD seconds and out o f
it
- I eta-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 treat r'A, A A, AAA"
- Antihypertensive
- AntiAnginal drugs (decreasing oxygen demand)
- Anti AtrialArythmia
- Side Effects - fleadache and hypotension
T 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 Asystole
T)t: A + r i d l drrkiH't'V'ntids
- Adfivid
- l?€+d
- CdkiMrti
- Pig
T x: VOn+r’iCHIrif dt’r’klnHl Hiid$
- LiJofd.Hd
- Ventricular - Lidocaine
- t>oth tare ventricular rhythms
- Treat with Lidocaine
- Amiodarone is eventually the MCLEX hoard will want as answer
Supraventricular arrhythmias are Atrial arrhythmias (supra - above) T reatvnents
are W C P s "
- Adenocard (Adenosine) . . u f a s t I V push [push in less than ft seconds and 2.D vnL MS
flush right after) These pts will go into asystole for about ftD seconds and out o f
it
- I eta-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 treat r'A, A A, AAA"
- Antihypertensive
- AntiAnginal drugs (decreasing oxygen demand)
- Anti AtrialArythmia
- Side Effects - fleadache and hypotension
T 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 Asystole
T)t: A + r i d l drrkiH't'V'ntids
- Adfivid
- l?€+d
- CdkiMrti
- Pig
T x: VOn+r’iCHIrif dt’r’klnHl Hiid$
- LiJofd.Hd
Loading page 21...
C h e s t T u b e s
Purpose: t o reestablish negative pressure
in the pleural space ... Negative pressure in
■rhe pleural space makes thing stick so
that the lung expands when the chest wall
expands
- Pleural space i s t h e space between the
lung (visceral pleura j and t h e chest wall
(parietal pleura}
- T n a pneumothorax, chest t u b e removes
air
- T n a hemothorax, chest tube removes
blood
- T n a hemopneumothorax, c h e s t t u b e
removes air and blood
Question
fi chest tube is placed in a p t for a
hemothorax (blood). What would \fou (the L ? N ) report t o t h e nurse? O r , w h a t would
40H (thc'RN) report physician?
a. Chest t u b e is n o t bubbling
b . Chest tube drains ftDO m L in the first I D hours
c. Chest t u b e i s not draining
d. Chest tube is intermittent bubbling
What is the chest tube not supposed t o do? 1 he chest tube is supposed t o drain
instead o f bubbling
Therefore answer (c) is the right answer.
Question
fi 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 bubbling
b . Chest tube drains ft 0 0 m L in the first 1.0 hours
c. Chest t u b e i s not draining
d. Chest tube is intermittent bubbling
Purpose: t o reestablish negative pressure
in the pleural space ... Negative pressure in
■rhe pleural space makes thing stick so
that the lung expands when the chest wall
expands
- Pleural space i s t h e space between the
lung (visceral pleura j and t h e chest wall
(parietal pleura}
- T n a pneumothorax, chest t u b e removes
air
- T n a hemothorax, chest tube removes
blood
- T n a hemopneumothorax, c h e s t t u b e
removes air and blood
Question
fi chest tube is placed in a p t for a
hemothorax (blood). What would \fou (the L ? N ) report t o t h e nurse? O r , w h a t would
40H (thc'RN) report physician?
a. Chest t u b e is n o t bubbling
b . Chest tube drains ftDO m L in the first I D hours
c. Chest t u b e i s not draining
d. Chest tube is intermittent bubbling
What is the chest tube not supposed t o do? 1 he chest tube is supposed t o drain
instead o f bubbling
Therefore answer (c) is the right answer.
Question
fi 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 bubbling
b . Chest tube drains ft 0 0 m L in the first 1.0 hours
c. Chest t u b e i s not draining
d. Chest tube is intermittent bubbling
Loading page 22...
With a pneumothorax, bubbling is expected
Therefore, (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 bleed
and needs -to be reported t o -the nurse er the physician
Also, 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) is
expected
- 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) is
expected
- A basilar chest tube is not bubbling ... This is a good sign because bubbling (air) is
not expected
Example
Patient presents w i t h a unilateral hemopneumothorax. flow t o care for -this
patient?
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 left
Air tube - Apical - Top, on both sides
P 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 this
patient? ...place an apical and a basilarchesttube on the side of -the problem ...
Always assume trauma and surgery is unilateral unless otherwise specified
T r i c k guestion
Where 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 was
removed, there is no need for a chest tube
Therefore, (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 bleed
and needs -to be reported t o -the nurse er the physician
Also, 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) is
expected
- 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) is
expected
- A basilar chest tube is not bubbling ... This is a good sign because bubbling (air) is
not expected
Example
Patient presents w i t h a unilateral hemopneumothorax. flow t o care for -this
patient?
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 left
Air tube - Apical - Top, on both sides
P 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 this
patient? ...place an apical and a basilarchesttube on the side of -the problem ...
Always assume trauma and surgery is unilateral unless otherwise specified
T r i c k guestion
Where 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 was
removed, there is no need for a chest tube
Loading page 23...
- Chest tube will however be used for lobectomn (removal o f a lobe of t h e lang), or
wedge resection
Closed c h e s t drainage devices
T pes: Jackson-vratt, Emtsson,
pneumovac, hemovac, e tc.
What happens i f one of those
drainage devices i s blocked over?
- /Vsk patient t o -take a deep
breath and set the device back up
- Mot medical emergency ... No
need 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 f t 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 s
Clamp
- Clamping, unclamping, and placing the tube under water must be done in 1 6 seconds
or less
Cut t h e tube awau
Submerge (stick) the end of t h e tube under sterile water
- The most important step
Unclamp t h e tube if it was initially clamped, (clamping t h e tube preven t a i r t o get
into the chest but does not alloy.' anything from -the chest t o get out)
N o t e
T f for whatever reason the chest tube breaks, clamp, unclamping -to placing the
tube under w a t e r must be done in 1 6 seconds or less
Question
T h e water sea' chamber of the chest -tube in a patient with a
pneumo-thorax/hemothorax breaks. What is the first course o f action for the nurse?
a. Clamp -the tube
b. Cut t h e tube awa
c. Submerge (or stick) -the end o f -the tube under sterile water
d. Unclamp the t u b e i f it was initially clamped
wedge resection
Closed c h e s t drainage devices
T pes: Jackson-vratt, Emtsson,
pneumovac, hemovac, e tc.
What happens i f one of those
drainage devices i s blocked over?
- /Vsk patient t o -take a deep
breath and set the device back up
- Mot medical emergency ... No
need 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 f t 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 s
Clamp
- Clamping, unclamping, and placing the tube under water must be done in 1 6 seconds
or less
Cut t h e tube awau
Submerge (stick) the end of t h e tube under sterile water
- The most important step
Unclamp t h e tube if it was initially clamped, (clamping t h e tube preven t a i r t o get
into the chest but does not alloy.' anything from -the chest t o get out)
N o t e
T f for whatever reason the chest tube breaks, clamp, unclamping -to placing the
tube under w a t e r must be done in 1 6 seconds or less
Question
T h e water sea' chamber of the chest -tube in a patient with a
pneumo-thorax/hemothorax breaks. What is the first course o f action for the nurse?
a. Clamp -the tube
b. Cut t h e tube awa
c. Submerge (or stick) -the end o f -the tube under sterile water
d. Unclamp the t u b e i f it was initially clamped
Loading page 24...
- I n this case, the first course of action is the clamp the tube
Question
The water seal chamber o f the chest tube in a patient with a
pneumothorax/hemothorax breaks, What is the priority (best) action of t h e nurse?
a. Clamp the tube
b. Cut the tube awa
c. Submerge (or stick) the end of t h e tube under sterile water
d. 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 the
tube 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)
Note
Clamping, unclamping, and placing the tube under water- must be done in 15 seconds
or less
Question
Vou notice on t h e monitor that a patient has V-fb. p t is unresponsive and there is
no 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 supine
b. Start chest compression
*H?estn is about what is the priori-fry. Chest compression i s the priority action.
I f a 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 f it i s intermittent, i t is good (document i t )
- I f it is continuous, it is bad and indicates a break/leak in the system (find it and
tape it)
♦ bubbling ...Where? I n the suction control chamber
Question
The water seal chamber o f the chest tube in a patient with a
pneumothorax/hemothorax breaks, What is the priority (best) action of t h e nurse?
a. Clamp the tube
b. Cut the tube awa
c. Submerge (or stick) the end of t h e tube under sterile water
d. 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 the
tube 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)
Note
Clamping, unclamping, and placing the tube under water- must be done in 15 seconds
or less
Question
Vou notice on t h e monitor that a patient has V-fb. p t is unresponsive and there is
no 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 supine
b. Start chest compression
*H?estn is about what is the priori-fry. Chest compression i s the priority action.
I f a 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 f it i s intermittent, i t is good (document i t )
- I f it is continuous, it is bad and indicates a break/leak in the system (find it and
tape it)
♦ bubbling ...Where? I n the suction control chamber
Loading page 25...
- I f it is intermittent, suction pressure is too low (increase it a t the wall until it i s
continuous)
- I f it 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 continuous
drainage
- Thoracocentesis - go in and o u t w Chest tubes - g o in, secure it, and [eave it in
ptace
• 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 o
clamp, cut the tube, submerge it under sterile water, and then unclamp it
Congenital J-leart pefects
I t is 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 congenital
heart defects are either:
"TBou&Le" o r Nothing t o worry about
ft pediatric p a t i e n t w i t h "TRou Le" 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
continuous)
- I f it 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 continuous
drainage
- Thoracocentesis - go in and o u t w Chest tubes - g o in, secure it, and [eave it in
ptace
• 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 o
clamp, cut the tube, submerge it under sterile water, and then unclamp it
Congenital J-leart pefects
I t is 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 congenital
heart defects are either:
"TBou&Le" o r Nothing t o worry about
ft pediatric p a t i e n t w i t h "TRou Le" 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
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Question
7 h e nurse is teaching the parent o f a n infant l?orvi with “I etralogy o f Eallot. Which
of t h e following should the nurse talked t o t h e parents about in the teaching
session?
- T h e nurse should teach the newborn's parents all of the choices listed above
fl "TRotfBLe" congenital heart defect
♦ "TRou L e " shunts blood Ticjht t o Left
♦ "TRouS Le" is lwe (cyanotic)
♦ AH "TRou Le" 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 t v e n t r i c u l a r hypoplastic syndrome
7 h e s e a r e examples i f Mo 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 stenosis
flII children with a congenital heart defect, whether TRou le defect or No TRou'&le
defect, have
- fl Murmur
- fln echocardiogram need t o be done t o find out the cause o f the murmur
4 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 the
board
7 h e nurse is teaching the parent o f a n infant l?orvi with “I etralogy o f Eallot. Which
of t h e following should the nurse talked t o t h e parents about in the teaching
session?
- T h e nurse should teach the newborn's parents all of the choices listed above
fl "TRotfBLe" congenital heart defect
♦ "TRou L e " shunts blood Ticjht t o Left
♦ "TRouS Le" is lwe (cyanotic)
♦ AH "TRou Le" 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 t v e n t r i c u l a r hypoplastic syndrome
7 h e s e a r e examples i f Mo 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 stenosis
flII children with a congenital heart defect, whether TRou le defect or No TRou'&le
defect, have
- fl Murmur
- fln echocardiogram need t o be done t o find out the cause o f the murmur
4 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 the
board
Loading page 27...
I n f e c t i o n s P i sea sc and Transmission-Pased Precautions
RFtfHXO*
- UH. I
C 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 the
same disease
• ■Herpes
Til ere are 4 transmission-based precautions
- Standard or universal
- Contact
- Proplet
- Airborne precaution
PPE (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 room
P r o p1st prec aerbions
- for b«gs -travelling on large par+ieles -through Coughing, Sneering -to less than 3
fee-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 washing Mask - > froggle or face shield - > frloves
- Pisposable supply
- Pedica-ted e wipment
a i r b o r n e p r e c a u t i o n s "ftir M T V
RFtfHXO*
- UH. I
C 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 the
same disease
• ■Herpes
Til ere are 4 transmission-based precautions
- Standard or universal
- Contact
- Proplet
- Airborne precaution
PPE (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 room
P r o p1st prec aerbions
- for b«gs -travelling on large par+ieles -through Coughing, Sneering -to less than 3
fee-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 washing Mask - > froggle or face shield - > frloves
- Pisposable supply
- Pedica-ted e wipment
a i r b o r n e p r e c a u t i o n s "ftir M T V
Loading page 28...
- M W
Tfc
- Varicella (chickenpox)
P P £
Private room is preferred
Can 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 airflow
r D O N N I N G
P 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
- gloves
r D O F F I N G
* Order t o take i t off ... d o so in alphabetical order
- gloves
- Cio le
- f own
- Mask
M a t h Problems
dosage calculation
I V drip rates - Volume * drop factor / Time
- Micro/Mini drip - (pC‘ drops per vnL
- Macro drip - W drops per m L
Pediatric dose (2.2. 1'as - 1 kej)
Tfc
- Varicella (chickenpox)
P P £
Private room is preferred
Can 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 airflow
r D O N N I N G
P 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
- gloves
r D O F F I N G
* Order t o take i t off ... d o so in alphabetical order
- gloves
- Cio le
- f own
- Mask
M a t h Problems
dosage calculation
I V drip rates - Volume * drop factor / Time
- Micro/Mini drip - (pC‘ drops per vnL
- Macro drip - W drops per m L
Pediatric dose (2.2. 1'as - 1 kej)
Loading page 29...
Lecture 4
Crutches, Canes, Walkers, 'Pe fusions, -Hallucinations, Psychosis, Psychotic and Mon -
psychotic Hallucination, I l l u s i o n , Pelusion
C r u t c h e s , Canes, Walkers Cruich walking gaH*
One of the major human functions is 1 P0 1 2 P0* 1 9311 4 s»«
locomotion. Therefore, crutches, canes
and walkers are tested on the NCLEX
exam even though they are n o t really
emphasised in school, ffso, such
knowledge is good -for patient teaching.
With that said, crutches, canes and
walkers are devices used t o help pts a
with an unstable gait, whose musses
are weak or who require a reduction in
the load on weight-bearing structures
2
f j o w do you measure t h e l e n g t h o f
c r u t c h e s ?
♦ Measuring crutches is important for
risk reduction when ambulating and t o
avoid nen/e problems
♦ T h e length of a crutch i s measured by
- Holding it vertically and placing t h e t i p
on t h e ground
- Having 2 t o 3 finger widths between
t 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 ( 6
inches) and slightly in f r o n t o f foot inches)
♦ "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
Crutches, Canes, Walkers, 'Pe fusions, -Hallucinations, Psychosis, Psychotic and Mon -
psychotic Hallucination, I l l u s i o n , Pelusion
C r u t c h e s , Canes, Walkers Cruich walking gaH*
One of the major human functions is 1 P0 1 2 P0* 1 9311 4 s»«
locomotion. Therefore, crutches, canes
and walkers are tested on the NCLEX
exam even though they are n o t really
emphasised in school, ffso, such
knowledge is good -for patient teaching.
With that said, crutches, canes and
walkers are devices used t o help pts a
with an unstable gait, whose musses
are weak or who require a reduction in
the load on weight-bearing structures
2
f j o w do you measure t h e l e n g t h o f
c r u t c h e s ?
♦ Measuring crutches is important for
risk reduction when ambulating and t o
avoid nen/e problems
♦ T h e length of a crutch i s measured by
- Holding it vertically and placing t h e t i p
on t h e ground
- Having 2 t o 3 finger widths between
t 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 ( 6
inches) and slightly in f r o n t o f foot inches)
♦ "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 30...
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 crutch
with other foo t together
* Together (Right leg & Left crutch) “• ogether (Left leg <£."Right crutch)
* for mild bilateral leg weaknesses
3 -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 ground
4 -point g a i t —move everything separately
- 'Move c rutch -> Move opposite foo-t - > followed by other crutch -> followed by
opposite foo-t
-"Right crutch -> Left foot Left crutch -> 'Right foot
- 4-poin-t gait is Very slow but very stable
Swing-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 weight
on -the leg a t al!
- 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 f patient cannot bear weight or amputation
- Swing-through
Example
patient affec ted wi th early s tages of rheumatoid arthritis. What gai I- should -the
patient use?
- "Ho th legs affected (because it is a systemic disease)
2 -point g a i t —move a crutch and opposite foot together, then the other crutch
with other foo t together
* Together (Right leg & Left crutch) “• ogether (Left leg <£."Right crutch)
* for mild bilateral leg weaknesses
3 -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 ground
4 -point g a i t —move everything separately
- 'Move c rutch -> Move opposite foo-t - > followed by other crutch -> followed by
opposite foo-t
-"Right crutch -> Left foot Left crutch -> 'Right foot
- 4-poin-t gait is Very slow but very stable
Swing-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 weight
on -the leg a t al!
- 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 f patient cannot bear weight or amputation
- Swing-through
Example
patient affec ted wi th early s tages of rheumatoid arthritis. What gai I- should -the
patient use?
- "Ho th legs affected (because it is a systemic disease)
Loading page 31...
- Eariij stage— mild
- 2 -point gait
Exa mple
A patient has left ATk. (above the knee) amputation 2 da s ago. What gait should
the patient use?
- Mon-weight bearing
- Swing-through
Example
patient i s first da postop, right knee, partial weight
bearing allowed. What gait should the patient use?
- One leg affected
- Odd-numbered gait
- 3-p*int gait
Example ——- *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 gait
Example
Patient 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 gait
Example
Patient with bilateral (E / L ) total knee replacement first dat{ postop, weight
bearing is allowed. What gait should the patient use?
- Even-numbered gait - Trilateral
- Weight bearing
- first dafrf postop - Severe
- 4-point gait
- 2 -point gait
Exa mple
A patient has left ATk. (above the knee) amputation 2 da s ago. What gait should
the patient use?
- Mon-weight bearing
- Swing-through
Example
patient i s first da postop, right knee, partial weight
bearing allowed. What gait should the patient use?
- One leg affected
- Odd-numbered gait
- 3-p*int gait
Example ——- *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 gait
Example
Patient 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 gait
Example
Patient with bilateral (E / L ) total knee replacement first dat{ postop, weight
bearing is allowed. What gait should the patient use?
- Even-numbered gait - Trilateral
- Weight bearing
- first dafrf postop - Severe
- 4-point gait
Loading page 32...
Example
patient with bila-teraI total knee replacement 3 weeks postop. What gait should the
patient use?
- €Ven-numbered gait - Pilateral
- Weight bearing
- 3 weeks postop - mild
- Z-point
ftoing 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 last
P u t , . o m a t t e r w h a t : P o t h crutches always move w i t h the bad leg
Cane
- -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 wrist
Walker
• 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 tands
u 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 — "I t h e m t o either side so it
won't tip over
• T h e NCLTX board does no t like tennis balls or wheels on walker can create problem
PSH h i a t r q
F i r s t t h i n g t o a s k in a p s ch guestion i s ; " i s t 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.
patient with bila-teraI total knee replacement 3 weeks postop. What gait should the
patient use?
- €Ven-numbered gait - Pilateral
- Weight bearing
- 3 weeks postop - mild
- Z-point
ftoing 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 last
P u t , . o m a t t e r w h a t : P o t h crutches always move w i t h the bad leg
Cane
- -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 wrist
Walker
• 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 tands
u 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 — "I t h e m t o either side so it
won't tip over
• T h e NCLTX board does no t like tennis balls or wheels on walker can create problem
PSH h i a t r q
F i r s t t h i n g t o a s k in a p s ch guestion i s ; " i s t 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.
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