1

ADDISONS (TOO LITTLE

CORTISOL IN

THE BLOOD)==è

HYPERPIGMENT

SODIUM

DOWN

BP

DOWN

BLOOD VOLUME

DOWN

GLUCOSE

DOWN

POTASSIUM

UP

CUSHINGS (TOO MUCH

CORTISOL IN

THE BLOOD)

SODIUM

UP

BP

UP

BLOOD VOL

UP

GLUCOSE

UP

POTASSIUM

DOWN

MNEMONIC: RN DELEGATION==èDON’T DELEGATE WHAT YOU CAN TAPE

• T: TEACHING • A: ASSESSMENT • P: PLANNING • E: EVALUATE

RN DELEGATION TO LPN:

• M: MEDICATIONS (REGULAR) • R: RE-INFORCE TEACHING

• S: SPECIFIC ASSESSMENT (LUNGS, NEUROVASCULAR, VITAL SIGNS)

• M: MONITOR

• O: OSTOMIES

• R: ROUTINE PROCEDURES (FOLEY CATH) • T: TUBES (SUCTION, PENROSE, FEEDING, TPN)

RN DELEGATION TO CNA/UAP/HCA===èANY ROUTINE ADLS

• A: AMBULATE, ADLs • S: SHOWER OR BATHING

• S: SCALE (WEIGHING)

• I: INTAKE/OUTPUT RECORDING • S: SHEET OR LINEN CHANGES

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• T: TURNING & REPOSITION

• A: ANSWER CALL LIGHT/BELL • N: NUTRITION (FEEDING)

• T TAKING VITAL SIGNS (STABLE PATIENT) & RECORDING

TRANSMISSION-BASED PRECAUTIONS:

1. AIRBORNE PRECAUTION

MTV ON AIR– MEASLES, TB, VARICELLA

• PRIVATE ROOM - NEGATIVE PRESSURE, VARICELLA (GOWN, GLOVES, N95, GOGGLE.)

2. DROPLET PRECAUTION:

• D: DIPTHERIA • R: RUBELLA, RSV • O: OTHERS • P: PERTUSSUS • I: INFLUENZAS • N: NEISSERIA • S: STAPH & STREP

PRIVATE ROOM, SURGICAL MASK, FACE SHIELD, GOWN

3. CONTACT PRECAUTION===èALL OTHER (C-DIFF & MRSA OR VRSA, VRE)

1. AIR/PULMONARY EMBOLISM (S&S: ACUTE ONSET CHEST PAIN, SOB, TACHYCARDIA, TACHPNEA, IMPENDING DOOM) ==è PRIORITY==èTURN PT TO LEFT SIDE AND LOWER THE

HEAD OF THE BED.

4. FETAL HEART RATE PATTERNS: 3 KINDS OF RESPONSES TO UTERINE CONTRACTIONS.

DECELERATION:

• The FHR decreases in response to uterine contractions.

• Decelerations maybe Variable, Early or Late. • All are abnormal except early decelerations

WOMAN IN LABOR W/ UN-REASSURING FHR (LATE DECELS, DECREASED VARIABILITY, FETAL

BRADYCARDIA, ETC)====èMNEMONIC (LOINS)===è TURN ON LEFT SIDE (AND GIVE O2, STOP PITOCIN/OXTOCIN, INCREASE IV FLUIDS)====è

MNEMONIC:

3

NO CONCERNS. MONITOR, AND DOCUMENT

NOT GOOD

WHAT IS THE NURSING PRIORITY====THINK===èLOINS: Change mom’s position (moving her

around could help relieve cord compression), administer Oxygen usually 10 L (because cord is being compressed which in turn is causing the baby to not receive enough Oxygen), stop Picotin infusion if

running, and contact the doctor. Plus you may be asked on the exam what is causing this strip to look like

this and the answer would be cord compression.

4

Nothing to be alarmed about.

What is the Nursing Priority? Continue to monitor and document the process of the labor or no nursing interventions are required right now but continue to monitor.

NOT GOOD

NCLEX may ask what is causing this type of strip and the answer would be placental-uterine insufficiency. What is the nursing Priority?====èThink==èLOINS TURN MOM ONTO HER SIDE, STOP PITOCIN IF INFUSING, ADMINISTER 10 L OF O2, MAINTAIN IV ACCESS, DETERMINE THE FETAL HEART RATE VARIABILITY, AND CONTACT DOCTOR.

WHAT TYPES OF INJURIES WILL CAUSE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME?

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• BURN INJURY

• CRUAH INJURY • MAJOR SURGERY

• BOWEL ISCHEMIA

3. TUBE FEEDING W/ DECREASED LOC --> POSITION PT ON RIGHT SIDE (PROMOTES EMPTYING OF THE STOMACH) WITH THE HOB ELEVATED (TO PREVENT ASPIRATION)

4. DURING EPIDURAL PUNCTURE --> SIDE-LYING

5. AFTER LUMBAR PUNCTURE (AND ALSO OIL-BASED MYELOGRAM)--> PT LIES IN FLAT SUPINE (TO PREVENT HEADACHE AND LEAKING OF CSF)

6. PT W/ HEAT STROKE --> LIE FLAT W/ LEGS ELEVATED

7. DURING CONTINUOUS BLADDER IRRIGATION (CBI) --> CATHETER IS TAPED TO THIGH SO LEG SHOULD BE KEPT STRAIGHT. NO OTHER POSITIONING RESTRICTIONS.

8. AFTER MYRINGOTOMY --> POSITION ON SIDE OF AFFECTED EAR AFTER SURGERY (ALLOWS

DRAINAGE OF SECRETIONS)

9. AFTER CATARACT SURGERY --> PT WILL SLEEP ON UNAFFECTED SIDE WITH A NIGHT SHIELD

FOR 1-4 WEEKS.

10. AFTER THYROIDECTOMY --> LOW OR SEMI-FOWLER'S, SUPPORT HEAD, NECK AND SHOULDERS.

11. INFANT W/ SPINA BIFIDA --> POSITION PRONE (ON ABDOMEN) SO THAT SAC DOES NOT

RUPTURE

12. BUCK'S TRACTION (SKIN TRACTION) --> ELEVATE FOOT OF BED FOR COUNTER-TRACTION

13. AFTER TOTAL HIP REPLACEMENT --> DON'T SLEEP ON OPERATED SIDE, DON'T FLEX HIP

MORE THAN 45- 60 DEGREES, DON'T ELEVATE HOB MORE THAN 45 DEGREES. MAINTAIN HIP ABDUCTION BY SEPARATING THIGHS WITH PILLOWS.

14. PROLAPSED CORD --> KNEE-CHEST POSITION OR TRENDELENBURG

15. INFANT W/ CLEFT LIP --> POSITION ON BACK OR IN INFANT SEAT TO PREVENT TRAUMA TO SUTURE LINE. WHILE FEEDING, HOLD IN UPRIGHT POSITION.

16. TO PREVENT DUMPING SYNDROME (POST-OPERATIVE ULCER/STOMACH SURGERIES) --> EAT

IN RECLINING POSITION, LIE DOWN AFTER MEALS FOR 20-30 MINUTES (ALSO RESTRICT FLUIDS DURING MEALS, LOW CHO AND FIBER DIET, SMALL FREQUENT MEALS)

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17. ABOVE KNEE AMPUTATION --> ELEVATE FOR FIRST 24 HOURS ON PILLOW, POSITION PRONE

DAILY TO PROVIDE FOR HIP EXTENSION.

18. BELOW KNEE AMPUTATION --> FOOT OF BED ELEVATED FOR FIRST 24 HOURS, POSITION

PRONE DAILY TO PROVIDE FOR HIP EXTENSION.

19. DETACHED RETINA --> AREA OF DETACHMENT SHOULD BE IN THE DEPENDENT POSITION

20. ADMINISTRATION OF ENEMA --> POSITION PT IN LEFT SIDE-LYING (SIM'S) WITH KNEE FLEXED

21. AFTER SUPRATENTORIAL SURGERY (INCISION BEHIND HAIRLINE) --> ELEVATE HOB 30-45

DEGREES

22. AFTER INFRATENTORIAL SURGERY (INCISION AT NAPE OF NECK)--> POSITION PT FLAT AND

LATERAL ON EITHER SIDE.

23. DURING INTERNAL RADIATION --> ON BEDREST WHILE IMPLANT IN PLACE

24. AUTONOMIC DYSREFLEXIA/HYPERREFLEXIA (S&S: POUNDING HEADACHE, PROFUSE

SWEATING, NASAL CONGESTION, GOOSE FLESH, BRADYCARDIA, HYPERTENSION) --> NURSING

PRIORIY==èPLACE CLIENT IN SITTING POSITION (ELEVATE HOB) FIRST BEFORE ANY OTHER IMPLEMENTATION. OTHER PRIORITIES ARE===èCHECK FOR BLADDER DISTENTION; CHECK

BP; REMOVE CONSTRICTIVE CLOTHINGS; NOTIFY HCP.

25. SHOCK ===è BEDREST WITH EXTREMITIES ELEVATED 20 DEGREES, KNEES STRAIGHT, HEAD SLIGHTLY ELEVATED (MODIFIED TRENDELENBURG)

S/S OF SHOCK:

S: SOB H: HYPOTENSION, HIGH HR, HIGH RR O: OLIGURIA (LOW URINE OUTPUT) C: CONFUSION (ALTERED MENAL STATUS), COOL, CLAMMY SKIN K: KIDNEY FAILURE (HIGH SERUM CREATINE)

26. HEAD INJURY===è ELEVATE HOB 30 DEGREES TO DECREASE INTRACRANIAL PRESSURE 27. PERITONEAL DIALYSIS WHEN OUTFLOW IS INADEQUATE --> TURN PT FROM SIDE

TO SIDE BEFORE CHECKING FOR KINKS IN TUBING (ACCORDING TO KAPLAN)

28. LUMBAR PUNCTURE => AFTER THE PROCEDURE, THE CLIENT SHOULD BE PLACED IN THE SUPINE POSITION FOR 4 TO 12 HRS AS PRESCRIBED.

29. GIVE DEMOROL FOR PANCREATITIS, NOT MORPHINE SULFATE

30. MYASTHENIA GRAVIS=====AUTOIMMUNE===èEFFECT ON NEURO-MUSCULAR

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JUNCTION===èMUSCLE WEAKNESS FROM HEAD TO TOE. WORSENS WITH EXERCISE AND

IMPROVES WITH REST. NURSING PRIORTY====èMONITOR AIRWAY. OTHER PRIORITIES ARE==èADMINISTER ANTICHOLINESTERASE (PYRIDOSTIGMINE) BEFORE MEALS; ENCOURGE

SEMI-SOLID FOOD; TEACH THE IMPORTANCE OF THE NECESSARY VACCINATIONS (FLU &

PNEUMONIA SHOTS).

31. MYASTHENIA CRISIS===è A POSITIVE REACTION TO TENSILON===èWILL IMPROVE

SYMPTOMS

32. CHOLINERGIC CRISIS===è CAUSED BY EXCESSIVE MEDICATION==èSTOP MED-GIVING TENSILON WILL MAKE IT WORSE

33. HEAD INJURY MEDICATION==è MANNITOL (OSMOTIC DIURETIC)-CRYSTALLIZES AT

ROOM TEMP SO ALWAYS USE FILTER NEEDLE

34. PRIOR TO A LIVER BIOSPY ===èCHECK PROTHROMBIN TIME BEFORE THE PROCEDURE

35. FROM THE ASS (DIARRHEA)==è METABOLIC ACIDOSIS. FROM THE MOUTH

(VOMITUS)==èMETABOLIC ALKALOSIS

36. MYXEDEMA/HYPOTHYROIDISM==è SLOWED PHYSICAL AND MENTAL FUNCTION,

SENSITIVITY TO COLD, DRY SKIN AND HAIR.

37. GRAVES’ DISEASE/HYPERTHYROIDISM===è INCREASED T3 & T4. INCREASED DIFFUSED UPTAKE RAIU; BODY IS BURNING TOO MUCH ENERGY ===è S/S==èANXIETY, PALPITATION,

WEIGHT LOSS WITHOUT LOSS OF APPETITE, HEAT INTOLERANCE, SWEATING, TREMORS,

DIARRHEA, INSOMNIA, HTN, ATRIAL FIBRILLATION, LID LAG (SLOW EYE MOVEMENT), HYPER-REFLEXIA.

38. EXOPHALMOS===èCOMPLICATION OF GRAVES DISEASE. NURSING ACTION===èGIVE

ARTIFICIAL TEAR DROPS; TAPE EYELID DURING SLEEP IF EYELID CANNOT CLOSE; NEEDS EYE GLASSES TO PREVENT IRRITATION; ADVISE PT TO STOP SMOKING; RESTRICT SALT INTAKE TO

PREVENT EYE SWELLING.

39. GRAVES DISEASE TREATMENT===èBETA BLOCKER (PROPRANOLOL, ATENOLOL, METROPOLOL)==èTO CONTROL ADRENERGIC SYMPTOMS (ANXIETY, PALPITATION, TREMORS);

PTU/METHIMAZOLE===èPT TO REPORT ANY S/S OF INFECTION WHEN TAKING THIS

MEDICATION.

40. RADIOACTIVE IODINE UPTAKE (RAIU) TEST TEACHING ===èFEMALE SHOULD GET

PREGNANCY TEST BEFORE TEST; REMOVE ALL JEWELRY, DENTURE, METALS; DO NOT

BREASTFEED IMMEDIATELY AFTER THE TEST; HOLD ANTI-THYROID MEDICATIONS 5-7 DAYS BEFORE TEST; NOTIFY HCP IF PATIENT IS ALLERGIC TO IV CONTRAST.

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41. THYROID STORM/THYROTOXICOSIS===è LIFE THREATENING CONDITION. IT IS A

COMPLICATION OF UNCONTROLLED HYPERTHYROIDISM OR GRAVES DISEASE. IT IS PRECIPITATED BY STRESS, INFECTION, OR TRAUMA. PATIENT PRESENTS WITH ==èDECREASED

MENTAL STATUS, FEVER, HTN, AND TACHYCARDIA. NURSING PRIORITY===èRAPID TREATMENT

(IV FLUID, STERIODS, BETA BLOCKER); THEN PTU/METHIMAZOLE, AND IODINE.

39. POST-THYROIDECTOMY===èNURSING PRIORITY===èMONITOR FOR AIRWAY FOR

OBSTRUCTION. SIGNS===èSTRIDOR (HARSH, VIBRATING SOUND DURING INSPIRATION AND

EXPIRATION). POSITION SEMI-FOWLER’S; PREVENT NECK FLEXION/HYPEREXTENSION; MAKE AVAILABLE SUCTION DEVISE, OXYGEN, AND TRACHIOSTOMY TRAY AT BEDSIDE.

40. POST-THYROIDECTOMY==èPERSISTENT HOARSENESS (PATIENT CANNOT RAISE

VOICE)==èMORE THAN 24 HOURS AFTER SURGERY===èLARYNGEAL NERVE DAMAGE DURING THYROID SURGERY. NOTIFY HCP.

41. POST-THYROIDECTOMY===èA FEW HOURS LATER, PATIENT C/O TINGLING AROUND

MOUTH (+ CHOVSTEK SIGN) AND MUSCLE TWITCHING (+ TROUSSEAU SIGN)===èNURSING PRIORITY===èCHECK SERUM CALCIUM LEVEL.

42. GENERAL NURSING CARE PLAN POST-THYROIDECTOMY====èASSESS FOR NUMBNESS

AND TINGLING; HAVE EMEGENCY SUPPLIES AT BEDSIDE; MONITOR FOR STRIDOR; KEEP HEAD OF BED AT SEMI-FLOWER WITH HEAD & NECK IN NEUTRAL POSITION.

43. HYPO-PARATHYROID===èCAUSE BY PARATHYROIDECTOMY ===èLEADS TO

DECREASED SERUM CALCIUM (HYPOCALCEMIA)===èS/S===èCONVULSIONS, ARRHYTHMIAS, TETANY, SPASMS, STRIDOR (CATSS), DEPRESSION, ARRYTHMIAS (INCREASED QT INTERVAL);

REMEMBER THAT QT INTERVAL IS INVERSELY PROPORTIONAL TO CALCIUM. NURSING

PRIORITY===èCHECK SERUM CALCIUM LEVEL; TREATMENT====èGIVE ORAL CALCIUM; FOR VIT D DEFICIENCY===èGIVE VIT D + CALCIUM.

44. OTHER CAUSES OF LOW CALCIUM

• RENAL FAILURE===èDECREASED CALCIUM & INCREASED PHOSPHORUS • VIT D DEFICIENCY====èDECREASED CALCIUM & DECREASED PHOSPHORUS

• LOW SERUM MAGNESIUM===èHAS THE SAME S/S AS LOW CALCIUM

45. PRIMARY HYPER-PARATHYROID====è MOST COMMON CAUSE OF INCREASED SERUM CALCIUM (HYPERCALCEMIA WITH SERUM Ca >10.5)===èS/S===èFATIGUE, MUSCLE WEAKNESS,

CONSTIPATION, DECREASED MENTAL ACTIVITY, KIDNEY STONE, BACK AND JOINT PAIN,

ARRTHYMIA (DECREASED QT INTERVAL). NURSING PRIORITY====èCHECK SERUM CALCIUM LEVEL.

9

46. TREATMENT OF HYPERCALCEMIA

• STABLE PATIENT OR ASYMPTOMATIC (NO S/S)====èHIGH PHOSPHORUS DIET; ORAL BISPHOSPHONATES (ALENDRONATE, PAMIDRONATE)

• STABLE PATIENT WITH GRANULOMATOUS DISEASE (SARCOIDOSIS)===èGIVE

STEROIDS • UNSTABLE OR SYMPTOMATIC OR CALCIUM >14===è IV FLUID, FOLLOWED BY

FUROSEMIDE

• IF IV FLUID AND FUROSEMIDE DON’T WORK====èGIVE CALCITONIN

47. HYPOVOLEMIA – INCRASED TEMP, RAPID/WEAK PULSE, INCREASE RESPIRATION,

HYPOTENSION, ANXIETY, URINE SPECIFIC GRAVITY >1.030

48. HYPERVOLEMIA – BOUNDING PULSE, SOB, DYSPNEA, RARES/CRACKLES, PERIPHERAL EDEMA, HTN, URINE SPECIFIC GRAVITY <1.010; SEMI-FOWLER’S

49. DIABETES INSIPIDUS (DUE TO DECREASED ADH)===è S/S===èPOLYURIA (EXCESSIVE,

DILUTED URINE OUTPUT), POLYDIPSIA (THIRST), DEHYDRATION, WEAKNESS. PATIENT WILL HAVE INCREASED SERUM SODIUM (INCREASE BLOOD SODIUM CONCENTRATION/OSMOLARITY),

DECREASED URINE SODIUM (DECREASED URINE SPECIFIC GRAVITY), THIRSTY AND WEIGHT

LOSS. NURSING PRIORITY===èREHYDRATION (FLUID REPLACEMENT TO PREVENT DEHYDRATION) AND IV DDAVP (DESMOPRESSIN). NURSING CARE PLAN====èMONITOR===è

INTAKE/OUTPUT, SPECIFIC GRAVITY WILL BE LOW, SERUM SODIUM WILL BE HIGH.

50. SIADH (INCREASED ADH)===èPATIENT WILL BE RETAINING FLUID. SIGNS====èPATIENT WILL HAVE DECREASED SERUM SODIUM, WEIGHT GAIN, DECREASE URINARY OUTPUT,

INCREASED URINE CONCENTRATION/OSMOLARITY/SPECIFIC GRAVITY. NURSING

PRIORITY=====èFLUID RESTRICTION. NURSING CARE PLAN=====èMONITOR FOR SEIZURES (COMPLICATION OF LOW SERUM SODIUM). IF PATIENT HAS SEVERE SYMPTOMS

(SEIZURE/COMA)====èTREATMENT===è3° HYPERTONIC SALINE

51. HYPOKALEMIA (K<3.5)====èMUSCLE EWAKNESS, DYSRHYTHMIAS, INCREASE K (RAISINS, BANANAS, APRICOTS, ORANGES, BEANS, POTATOES, CARROTS, CELERY) .

COMPLICATION===èARRHTHYMIA==è T-WAVE DEPRESSION

52. HYPERKALEMIA (K>5.6)=====èPOTENTIALLY LIFE THREATENING===èS/S===èDYSRRHYTHMIA (TENTED T-WAVE), MUSCLE WEAKNESS, URINE

(OLIGURIA/ANURIA), RESPIRATORY DEPRESSION. TREATMENT PRIORITY IF EKG IS

NORMAL===è IV INSULIN (DRIVES K+ INTO THE CELL) + GLUCOSE (TO PREVENT HYPOGLYCEMIA). NURSING PRIORITY ==è GET EKG===èEKG CHANGES===èDECREASED

CARDIAC CONTRACTILITY (TALL TENTED T-WAVE)===èTREATMENT PRIORITY IF EKG SHOWS

TALL, PEAK T-WAVE ====è1ST STEP ===èGIVE CALCIUM GLUCONATE (TO STABILIZE THE

10

CARDIAC CELL MEMBRANE); FOLLOWED BY INSULIN + GLUCOSE (TO PREVENT HYPOGLYCEMIA).

TREATMENT OF HYPERKALEMIA

• C===èCALCIUM GLUCONATE

• B====èBETA BLOCKER

• I=====èINSULIN • G=====èGLUCOSE

• K=====èKAYEXELATE (REMOVES K+ FROM THE BODY)

****IF ALL OF THE ABOVE MEASURES FAIL====èDIALYSIS

53. CAUSES OF HYPERKALEMIA

• A==èACIDOSIS, ALDOSTERONE DECREASE, ACEI, ARBS

• B==èBETA BLOCKERS • C==èCRUSHING INJURIES, KIDNEY FAILURE

• D==èDIGITALIS, DEFICIENCY OF INSULIN

54. HYPONATREMIA: NAUSEA, MUSCLE CRAMPS, INCREASED ICP, MUSCULAR TWITCHING, CONVULSION; OSMOTIC DIURETICS, FLUIDS

55. HYPERNATREMIA: INCREASED TEMP, WEAKNESS, DISORIENTATION/DELUSIONS,

HYPOTENSION, TACHYCARDIA; HYPOTONIC SOLUTION

56. HYPOCALCEMIA====èCATSS===è CONVULSIONS, ARRHYTHMIAS (INCREASED QT

INTERVAL), TETANY, SPASMS AND STRIDOR

57. HYPERCALCEMIA====èMUSCLE WEAKNESS, LACK OF COORDINATION, ABDOMINAL PAIN, CONFUSION, ABSENT TENDON REFLEXES, SEDATIVE EFFECT ON CNS

58. HYPOMAGNESIUM=====èSIMILAR TO HYPOCALCEMIA====èCATSS TREMORS, TETANY,

SEIZURES, DYRSHYTHMIAS, DEPRESSION, CONFUSION, DYSPHAGIA; DIG TOXICITY HYPERMAGNESIUM: DEPRESSES THE CNS, HYPOTENSION, FACIAL FLUSHING, MUSCLE

EWAKNESS, ABSENT DEEP TENDON REFLEXES, SHALLOW RESPIRATIONS, AND EMERGENCY

59. ADDISONS DISEASE (PRIMARY ADRENO-CORTICAL INSUFFICIENCY)====è CAUSE BY ADRENO-CORTICAL DYSFUNCTION===èLEADING TO LOW LEVELS OF CORTICO-

STEROIDS====è(LOW MINERALOCORTICOID, LOW ANDROGEN, LOW GLUCOCORTICOID).

S/S===èHYPONA, HYPERK, HYPOGLYCEMIA, DARK PIGMENTATION (BRONZE SKIN PIGMENTATION, VITILIGO), DECREASED RESISTANCE TO STRESS, FRACTURES, ALOPECIA,

WEIGHT LOSS, GI DISTRESS. NURSING PRIORITY====èGIVE HYDROCORTICOIDS.

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60. WHAT IS THE NURSING TEACHING PLAN FOR ADDISONS DISEASE?=====èREPORT LOW

GRADE FEVER; YEARLY EYE DOCTOR VISIT TO ASSESS FOR CATARACT; REPORT S/S OF HYPERGLYCEMIA; PATIENT SHOULD WATCH OUT FOR S/S OF STRESS; TEACH S/S OF

OSTEOPOROSIS WHEN TAKING STEROIDS AND MUSCLE WEAKNESS; DO NOT TAKE STERIODS IN

AN EMPTY STOMACH TO PREVENT GASTRIC IRRITATION; REGULAR EXERCISE SHOULD BE APPROVED BY HCP.

61. ADDISONIAN CRISIS====è IS THE POTENTIALLY LIFE THREATENING COMPLICATION OF

ADDISON DISEASE. PATIENT PRESENTS WITH====èFEVER, N/V, CONFUSION, ABDOMINAL PAIN, EXTREME WEAKNESS, HYPOGLYCEMIA, DEHYDRATION, DECREASED BP , TACHYCARDIA, AND

TACHPNEA. NURSING PRIORITY=====èNOTIFY HCP IMMEDIATELY, IV FLUID, DEXTROSE, IV

HYDROCORTISONE.

62. CUSHINGS====èEXCESS STEROID LEVEL=====èHYPERNATREMIA, HTN,

HYPERGLYCEMIA, HYPOKALEMIA, PRONE TO INFECTION, MUSCLE WASTING, WEAKNESS, EDEMA,

HIRSUTISM, MOONFACE/BUFFALO HUMP, OSTEOPOROSIS, PURPLE STRIAE, ACNE, IRREGULAR MENSES.

63. PHEOCHROMOCYTOMA====èADDRENAL MEDULLA TUMOR===èLEAD

TO==èHYPERSECRETION OF CATECHOLAMINES (EPINEPHRINE/NOREPINORPHRINE)===èS/S===è PERSISTENT HTN (BP >180/100), INCREASED

HR, PALPITATION, HYPERGLYCEMIA, DIAPHORESIS, TREMOR, POUNDING HEADACHE; WHAT IS

THE IMMEDIATE NURSING ACTION?=====èSTART NITROPRUSSIDE OR LABATELOL IV STAT.

64. PHEOCHROMOCYTOMA====èWHAT IS IMPORTANT TO NOTE WHEN CARE FOR

PATIENT===èAVOID HYPERTENSIVE CRISIS TRIGGERS (VALSALVA MANEUVERS, LIFTING AND

BENDING); AVOID ABDOMINAL PALPATION

65. NEUROLEPTIC MALIGNANT SYNDROME (NMS)===èPOTENTIALLY LIFE

THREATENING===èCAUSE BY THE USE OF TYPICAL ANTIPSYCHOTICS (EG. HALOPERIDOL AND

SOME ATYPICAL ANTIPSYCHOTICS SUCH AS CLOZAPINE, RESPERIDOL, OLANZAPINE); S/S NMS==èFEVER, MUSCLE STIFFNESS/RIGIDITY (INCREASED MUSCLE TONE), ALTERED MENTAL

STATUS (CONFUSION), AUTONOMIC DYSFUNCTION (SWEATING, TACHYCARDIA, TACHYPNEA,

HYPERTENSION); NURSING PRIORITY===èSTOP MEDICATION; NOTIFY HCP.

66. SEROTONIN SYNDROME===èPOTENTIALLY LIFE THREATENING====èCAUSE BY

ADMINISTERING TWO DRUGS THAT AFFECT SEROTONIN LEVELS SIMULTANEOUSLY WITHOUT A

WASHOUT PERIOD. EXCESSIVE SYMPATHETIC NERVOUS SYSTEM STIMULATION. DRUGS THAT CAN TRIGGER SEROTONIN SYNDROME (SSRIs, MAOIs, ONDANSETRON, TRAMADOL,

DEXTROMETHORPHAN, ST. JOHN’S WART). S/S===èAUTONOMIC DYSFUNCTION

(HYPERTENSION, TACHYCARDIA, SWEATING); MENTAL STATUS CHANGES (ANXIETY, AGITATION, CONFUSION); NEUROMUSCULAR HYPERACTIVITY (CLONUS, HYPER-REFLEXIA, MUSCLE RIGIDITY,

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TREMORS, DIARRHEA). NURSING PRIORITY====èSTOP MEDICATION; NOTIFY THE HCP.

67. NEVER GET PREGNANT WOMAN MEASLE, MUMP, RUBELLA, VARICELLA (MMRV) IMMUNIZATION. THEY ARE LIVE VIRUS.

68. TERATOGENIC DRUGS TO AVOID DURING PREGNANCY (MNEMONIC: With TERATO)

DRUGS ADVRESED EFFECTS W: WARFARIN NASAL HYPOPLASIS,

STIPPLED EPIPHYSIS T: TETRACYCLINES IMPAIRED BONE

MINERALIZATION; STAINING OF THE TEETH

E: EPILEPTIC DRUGS (VALPROATE, CARBAMAZEPINE, PHENYTOIN)

NEURAL TUBE DEFECT

R: RETINOIDS (ISOTRETENOIN) SEVERE BIRTH DEFECTS A: ACEI, ARBS RENAL DEFECT, DECREASED

AMNIOTIC FLUID (OLIGOHYROMNIUM)

T: THIRD ELEMENT (LITHIUM) EBSTEIN ANOMALY,

HYPOTHROIDISM, RENAL DEFECT

O: OCP BIRTH DEFECT METHOTREXATE TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM)

69. WHEN MIXING UP NPH & REGULAR INSULIN TOGETHER===èMNEMONIC====èNEWLY

REGISTERED-RN===èNR-RN==èINJECT AIR INTO NPH, INJECT AIR INTO REGULAR; DRAW REGULAR, DRAW NPH.

70. TETRALOGY OF FALLOT===èMURMUR IS EXPECTED====è4 DEFECTS IN THE

HEART===èMNEMONIC====èPROV.

• P==èPULMONARY STENOSIS

• R==èRIGHT VENTRICULAR HYPERTROPHY

• O==èOVERIDING OF THE AORTA • V==èVENTRICULAR SEPTAL DEFECT (VSD)

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71. TETRALOGY OF FALLOT====èIS THE MOST COMMON CYANOTIC CONGENITAL HEART

DEFECT IN CHILDREN. LOOK FOR A CHILD WITH IRRITABILITY, EXTREMELY CYANOSIS (TET SPELL) WITH EXERTION (WHEN CRYING, UPSET OR FEEDING). NURSES FIRST

ACTION===èPLACE CHILD IN KNEEL TO CHEST POSITION OR SQUATTING POSITION TO FEEL

BETTER.

72. TETRALOGY OF FALLOT====èWHAT SHOULD THE NURSE TEACH THE PARENTS TO

REPORT? =èNURSING PRIORITY TO REPORT==èELEVATED HEMOGLOBIN LEVEL HgB

>25=èPOLYCETHEMIA; REDUCTION OF NUMBER OF WET DIAPERS; PUFFINESS AROUND THE EYES; COOL EXTREMITIES; WEAK PULSES, ACTIVITY INTOLERANCE (INABILITY TO FEED), PALE

AND IRRITABLE, HYPOTENSION, TACHCARDIA, TACHYPNEA, WEIGHT GAIN, ELEVATED JVD.

73. MONOAMINE OXIDASE INHIBITORS===èMAOI'S====èARE USED AS ANTIDEPRESSANTS. NURSING PRIORITY====èPREVENT HYPERTENSIVE CRISIS====èAVOID

FOOD HIGH IN TYRAMINE (OLD CHEESE, RED WINE, BEER, CHOCOLATE, AVOCADOS, CURED

MEAT).

EASY WAY TO REMEMBER MAOI'S DRUGS===èPANAMA!

• PA - PARNATE (Tranylcypromine) • NA - NARDIL (PHENELZINE)

• MA - MARPLAN (Isocarboxazid)

74. MIXING MAOIS WITH SSRIS, TRAMADOL, ODANSETRON, DEXTROMETHORPHAN, ST JOHNS WORT====èLEAD TO====èSEROTONIN SYNDROME.

75. MAOIS====èINCREASES SUICIDAL RISK====èIN CHILDREN, ADOLESANTS AND THE

ELDERLY. NURSING PRIORITY=====èASSESS SUICIDAL RISK (FEELINGS OF HOPELESSNESS, SELF HARM).

76. WHEN SWITCHING FROM MAOI TO ANOTHER ANTIDEPRESSANT MEDICATION===èSSRI;

TRICYCLIC ANTIDEPRESSANTS (NORTRIPTYLINE, IMAPRAMINE, AMITRYPTYLINE)====èALLOW 2 WEEKS WASHOUT TIME====èTO PREVENT HYPERTENSIVE CRISIS.

77. DIGOXIN===èCHECK PULSE BEFORE STARTING; LESS THAN 60 HOLD; NOTIFY HCP;

CHECK DIG LEVELS AND POTASSIUM LEVELS.

78. DIGOXIN TOXICITY====èMNEMONIC===èHAD NAUSEA/VOMITING==è (HALO AROUND OBJECT, BLINDNESS); GI SYMPTOMS (ABD PAIN, ANOREXIA, DIARRHEA, NAUSEA/VOMITING); NEUROLOGICAL SYMPTOMS (ALTERED MENTAL STATUS, WEAKNESS, LETHARGY)====èREPORT TO HCP. What is the normal digoxin level?===è 0.5-0.8 ug/ml 79. When on digoxin, too low of K+ can lead to? ===èDigoxin toxicity

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80. When on digoxin too high K+ can lead to? ===èLower therapeutic level 81. MONITOR SERUM CREATININE WHEN PATIENT IS ON DIGOXIN====èDIGOXIN IS

EXCREATED ALMOST EXCLUSIVELY BY THE KIDNEY

81. AMPHOJEL (Aluminum hydroxide)===è TX OF GERD AND KIDNEY STONES===èWATCH OUT FOR CONSTIPATION. 82. VISTARIL (HYDROXYZINE)===èANTI-HISTAMINE====èTX OF ANXIETY AND ALSO

ITCHING====èWATCH FOR DRY MOUTH.

83. VERSED===èGIVEN FOR CONSCIOUS SEDATION===èWATCH FOR RESP DEPRESSION AND HYPOTENSION

84. PTU AND METHIMAZOLE===èPREVENTION OF THYROID STORM====èREPORT S/S OF

INFECTION (AGGRANULOCYTOSIS)

85. SINEMET===èTX OF PARKINSON===èWATCH OUT FOR====èRISK FOR

FALL====èMAY CAUSE ORTHOSTATIC HYPOTENSION, DIZZINESS, INVOLUNTARY MOVEMENTS.

PATIENT SHOULD NEVER STOP MEDICATION SUDDENLY

86. ARTANE====èANTI-SPASMODIC===èTX OF PARKINSON AND ANTIPSYCHOTIC

EXTRAPYRAMIDAL EFFECT; CONTRA-INDICATION===èPARALYTIC ILEUS; NARROW ANGLE

GLAUCOMA.

87. COGENTIN====èTX OF PARKINSON AND EXTRAPYRAMIDAL EFFECTS OF OTHER DRUGS.

88. TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM)====èANTIBIOTIC====èDON’T TAKE

IF ALLERGIC TO SULFA DRUGS (SULFANYLUREAS). DIARRHEA COMMON SIDE EFFECT====èDRINK PLENTY OF FLUIDS. MAY CAUSE FOLIC ACID DEFICIENCY;

PHOTOSENSITIVITY REACTION; KIDNEY INJURY. TEACH PATIENT TO EAT FOLIC ACID REACH

FOOD AND FOLIC ACID SUPPLEMENT.

89. GOUT MEDS: PROBENECID (BENEMID), COLCHICINE, ALLOPURINOL (ZYLOPRIM)

90. APRESOLINE (HYDRALAZINE)===èTX OF HTN OR CHF====èREPORT FLU-LIKE

SYMPTOM. VASODILATOR===èRISE SLOWLY FROM SITTING/LYING POSITION; TAKE WITH MEALS.

91. BENTYL====èTX OF IRRITABLE BOWEL====èASSESS FOR ANTICHOLINERGIC SIDE

EFFECTS. CONTRA-INDICATION=====èPATIENT WITH PARALYTIC ILEU.

92. CALAN (VERAPAMIL)====èCALCIUM CHANNEL BLOCKER: TX OF HTN===èASSESS FOR

CONSTIPATION. TEACH PATIENT TO REPORT DIZZINESS; GET UP SLOWLY TO PREVENT FALL DUE

TO ORTHOSTATIC HYPOTENSION.

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93. CARAFATE===èTX OF DUODENAL ULCERS===èCOATS THE ULCER====èTAKE BEFORE

MEALS.

94. THEOPHYLLINE/AMINOPHYLLINE====è TX OF ASTHMA OR COPD===è BRONCHODILATOR===èTHERAP DRUG LEVEL: 10-20 ====èMONITOR THEOPHYLLINE TOXICITY INCLUDING===è ABDOMINAL PAIN, SEIZURES, CONFUSION, TREMORS, CHANGE IN BEHAVIOR, CONVULSIONS, DARK OR BLOODY VOMIT, DIZZINESS, DIARRHEA, ARRHYTHMIAS, HYPOTENSION, TACHYPNEA, TACHYCARDIA, NERVOUSNESS, AND RESTLESSNESS ====èNURSING PRIORITY FOR THEOPHYLINE TOXICITY====èMONITOR ====è AIRWAY, BREATHING, CIRCULATION, AND HEMODYNAMIC. OVERDOSE OF THEOPHYLLINE CAN CAUSE DEVELOPMENT OF HYPOKALEMIA. HYPERGLYCEMIA IS FOUND IN THE MAJORITY OF PATIENTS WITH ACUTE THEOPHYLLINE TOXICITY.

95. ACETYLCYSTEINE/MUCOMYST====è ANTIDOTE TO TYLENOL TOXICITY AND IS ADMINISTERED ORALLY. THE INHALER===èTO LIQUIFY SECRETION FROM THE LUNGS.

96. DIAMOX====è TX OF GLAUCOMA, HIGH ALTITUDE SICKNESS. DONT TAKE IF ALLERGIC

TO SULFA DRUGS

97. INDOCIN===è(NSAID) TX OF ARTHRITIS (OSTEO, RHEMATOID, GOUTY), BURSITIS, AND

TENDONITIS.

98. SYNTHROID/LEVOTHYROXINE====èTX OF HYPOTHYROIDISM. MAY TAKE SEVERAL WEEKS TO TAKE EFFECT. NOTIFY DOCTOR OF CHEST PAIN. TAKE IN THE AM ON EMPTY

STOMACH. COULD CAUSE HYPERTHYROIDISM.

99. LIBRIUM====è TX OF ALCOHOL W/D...DONT TAKE ALCHOL WITH THIS...VERY BAD NAUSEA AND VOMITING CAN OCCUR.

100. ONCOVIN (VINCRISTINE)===è TX OF LEUKEMIA..GIVEN IV ONLY

101. KWELL===èTX OF SCABIES AND LICE====è(SCABIES) APPLY LOTION ONCE AND LEAVE ON FOR 8-12 HOURS===è(LICE) USE THE SHAMPOO AND LEAVE ON FOR 4 MINUTES WITH HAIR

UNCOVERED THEN RINSE WITH WARM WATER AND COMB WITH A FINE TOOTH COMB

102. PREMARIN====èTX AFTER MENOPAUSE ESTROGEN REPLACEMENT

103. DILANTIN====èTX OF SEIZURES. THERA DRUG LEVEL: 10-20

104. NAVANE====è TX OF SCHIZOPHRENIA===èASSESS FOR EPS.

105. RITALIN/CONCERTA/ADDERALL===èSTIMULANT===èTX OF ADHD===èWHAT IS THE NURSING PRIORITY ACTION? ====èCHECK BP BEFORE STARTING THESE MEDICATIONS. WHAT

DO YOU TEACH THE PATIENT/PARENTS? =====èREPORT HEART RELATED SIDE EFFECTS

IMMEDIATELY; CHILD MAY NEED A DRUG HOLIDAY BECAUSE IT STUNTS GROWTH. MAJOR PROBLEMS WITH STIMULANT MEDICATIONS====èLOSS OF APPETITE, WEIGHT LOSS, ELEVATED

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BP, TACHYCARDIA, INSOMNIA, RESTLESSNESS, MOTOR/VOCAL TICS, AND ABUSE POTENTIAL.

106. CHILD WITH ADHD====èPRIORITY ASSESSMENT DURING VISIT ====èWEIGHT/HEIGHT AND BP.

107. DOPAMINE (INTROPINE)====è TX OF HYPOTENSION, SHOCK, LOW CARDIAC OUTPUT,

POOR PERFUSION TO VITAL ORGANS====èMONITOR EKG FOR ARRHYTHMIAS, MONITOR BP

108. STATINS ====èEXAMPLES====èSIMVASTATIN, ATORVASTATIN, ROSUVASTATIN, ETC. 109. WHAT ARE THE STATINS PRESCRIBED FOR?

• LOWER CHOLESTEROL 110. HOW DO THE STATINS WORK?

• HMG-COA REDUCTASE INHIBITOR (STATIN) 111. WHAT ARE THE AE OF STATINS?

• MUSCLE PAIN • RHABDOMYOLYSIS • LIVER FAILURE • GI MUSCLE CRAMPS • CATARACTS • NAUSEA/VIMITING • CONSTIPATION • WEAKNESS

112. WHAT IS NURSING IMPLICATIONS FOR STATINS?

• ASSESS FOR MUSCLE PAIN, TENDERNESS, OR WEAKNESS. IF URINE IS DARK BROWN, IT MAY INDICATE RHABDOMYOLYSIS. NOTIFY HCP.

• LAB VALUES TO MONITOR- CHECK LIVER (AST, ALT) AND KIDNEY (BUN, CREATININE) FUNCTION TESTS; CPK LEVELS; HDL, CHOLESTEROL, AND TRIGLYCERIDE LEVELS

• GIVE MEDICATION ON A FULL STOMACH 113. WHAT DO YOU TEACH YOU PATIENT?

• REPORT UNEXPLAINED MUSCLE PAIN, TENDERNESS, WEAKNESS, AND BROWN URINE TO DOCTOR IMMEDIATELY.

• DO NOT DRINK ALCOHOL BECAUSE IT CAN CAUSE LIVER DAMAGE. • AVOID DRINKING GRAPEFRUIT BECAUSE IT WILL SLOW DOWN THE

EFFECTIVENESS OF THE MEDICATION. • TAKE MEDICATION AT NIGHT TO INCREASE EFFECTIVENESS OF DRUG. • FOLLOW LOW CHOLESTEROL AND A LOW SATURATED FAT DIET.

114. TUBES AND DRAINAGES DEVICES NOT DRAINING? WHAT DO YOU DO FIRST? =====èCHECK PATENCY/KINK. 115. PICC LINE IS DISCONNECTED. PATIENT IS DYSPNIC, TACHYCARDIAC, AND CHEST PAIN. WHAT DO YOU DO FIRST? ======èLEFT LYING. TENDELENBERG POSITION. 116. YOUR PATIENT RECEIVES ORGAN TRANSPLANT. WHAT ARE NURSING CONCERNS?

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• INFECTION (DUE TO IMMUNOSUPRESSANTS=====èSTEROIDS) • REJECTION (ITCHING or painful rash on the palms and soles of the feet. • AVOID ANTACID. • HYPERTENSION • KIDNEY PROBLEM • HEPATITIS (NO ALCOHOL)