1.

varicella (chickenpox) requires use of airborne precautions and contact

precautions   as well.

if a patient is on contact precautions, have family members and other

visitors wear a gown and gloves as outlined by your facility (hospital).

1) droplet room assignment: preferably private, if not available roomate with

same illness and same pathogen. and if thats not an option 3 feet away from

roomate with the curtain pulled.

2) when transporting a patient with airborne precautions (for essential

purposes only) they must wear a surgical mask.

for contact precautions

diseases/conditions include: c. diff, e. coli, scabies

room needs to be private unless room has another patient infected

with the same organism 

for droplet precautions

diseases/conditions include: meningitis, pneumonia, pertussis

(whooping cough), rubella, mumps

room needs to be private unless room has another patient infected

with the same organism. maintain spacial distance of 3 feet when

near patient.

also remember standard precautions apply to all patients   regardless

of diagnosis when in contact with any bodily fluid, blood,

secretions/excretions, nonintact skin, and mucous membranes 

#1. when wearing gown and/or gloves, make sure to take them off and

properly dispose of them, before leaving the patien'ts room.

#2. pt's with herpes zooster (shingles) that is active should have the same

precautions as a patient with chicken pox---airborne and contact

#3. pt's on droplet precaution can have their room door left open.

#4. instruct visitors for pt's with droplet precautions to try to keep a distance

of three feet between them and the pt.

#5. pt's with croup should be on contact precautions 

bacterial meningitis is transmitted via droplets, and when suctioning pt, wear

goggles, eyewear, mask, and gloves. pt should wear a face mask when being

transported.

cdc recommends airborne precautions against varicella/rubeola.

measles, chicken pox (varicella), disseminated varicella zoster, tuberculosis

barrrier protection: single room maintained under negative pressure

door kept closed except when someone is entering 

exiting the room

negative airflow pressure used in room, (min of 6 - 12 air exchanges per hour

depending on the facility

ultraviolet germicide irradiation or high-efficiency 

particulate air filter used in the room

mask or personal respiratory protection device used

mask placed on the client when client needs to 

leave the room; client only leaves only if necessary! 

rsv is contact precautions. so wear gloves and a gown. it is

a respiratory infection that is transmited through contact with the

secretions. 

when you put your protective gear on start from top to bottom : mask->

gown-> and gloves. when you take them off start from bottom to top:

gloves->gown->mask. (i tried to research this part just to make sure it is

what i remember it to be, but found nothing so im not 100% certain)

wash hands between patients and whenever visibly soiled. 

donning ppe (personal protective equipment)

gown

fully cover torso from neck to knees, arms to end of wrist, and wrap around

the back

fasten in back at neck and waist

mask or respirator

secure ties or elastic band at middle of head and neck

fit flexible band to nose bridge

fit snug to face and below chin

fit-check respirator

goggles/face shield

put on face and adjust to fit

gloves

use non-sterile for isolation

select according to hand size

extend to cover wrist of isolation gown

safe work practices

keep hands away from face

work from clean to dirty

limit surfaces touched

change when torn or heavily contaminated

perform hand hygiene

removing ppe

remove ppe at doorway before leaving patient room or in anteroom

gloves

outside of gloves are contaminated!

grasp outside of glove with opposite gloved hand; peel off

hold removed glove in gloved hand

slide fingers of ungloved hand under remaining glove at wrist

goggles/face shield

outside of goggles or face shield are contaminated!

to remove, handle by “clean” head band or ear pieces

place in designated receptacle for reprocessing or in waste container

gown

gown front and sleeves are contaminated!

unfasten neck, then waist ties

remove gown using a peeling motion; pull gown from each shoulder toward

the same hand

gown will turn inside out

hold removed gown away from body, roll into a bundle and discard into

waste or linen receptacle

mask or respirator

front of mask/respirator is contaminated – do not touch!

grasp only bottom then top ties/elastics and remove

discard in waste container

hand hygiene

perform hand hygiene immediately after removing all ppe! 

chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.

rash is pruritic, and starts out as a macule then papule then a vesicle.

spread by direct contact, droplet and contaminated object.

isolate till all vesicles are crusted; it can be spread from 2 days before the

rash begins.

avoid use of aspirin due to reye's syndrome, use tylenol.

airborn--door can be closed..measles (rubeola), m. tuberculosis,

disseminated zoster(shingles), varicella(chicken pox)--again can

cohort and place in same room with the same infective organism.

droplet--door may be open---streptococcus pharyngitis, meningitis,

pnemonia...private room or pt with same infection--involves contact with

mucous membranes of nose or mouth...happens during talking, coughing,

suctioning. maintain 3feet between infected patients and visitors. 

rubella--there's a maculopapular rash on face and all over the body.

prodromal: malaise and fever which is followed by cough.

sread by droplets and contaminated objects. placed on contact

precautions, isolate child from pregnant women.

tuberculosis, pt is on isolation for 2-4 weeks (until there are 3 negative

sputum cultures.)

syphilis--painless chancre that fades within 6 weeks...on palms and soles

there is a copper colored rash...spread by contact with mucous membranes

and also congenitally...tx with penicillin g im 

heres how i remember that rubella is droplet and rubeola is airborne...rubella

sounds like umbrella and umbrellas protect you from raindrops... 

transmission-based precautions: adc

a - airborne

d - droplet

c - contact

airborne precaution (credit goes to the one who posted this on april

thread, sorry can't remember your name)

my - measles

chicken - chickenpox

hez - herpes zoster (disseminated)

tb - tb 

private room 

negative pressure with 6-12 air exchanges per hour

uv

mask

n95 mask for tb

droplet precaution

think of spiderman!

s - sepsis

s - scarlet fever

s - streptococcal pharyngitis

p - parvovirus b19

p - pertussis

p - pneumonia

i - influenza

d - diptheria (pharyngeal)

e - epiglottitis

r - rubella

m - mumps

m - meningitis

m - mycoplasma or meningeal pneumonia

an - adenovirus

private room

mask

contact precaution

mrs.wee

m - multidrug resistant organism

r - respiratory infection - rsv 

s - skin infections

w - wound infections

e - enteric infections - clostridium defficile

e - eye infections

skin infections:

v - varicella zoster

c - cutaneous diptheria

h - herpes simplex

i - impetigo

p - pediculosis

s - scabies, staphylococcus

private room

gloves 

gown 

 

wash your hands before patient care and after patient care.

when in doubt, wash your hands again.

gloves needed when passing meds to pt. with mrsa, if you'll be close to

patient need gown too.( just in case you touch anything that might be

contaminated )

my preceptor at work likes to say," better to have on too much ppe than not

enough."

ppe = personal protective equipment 

in removing ppe: 

1. gloves

2. goggles/face shield

3. gowns

4. last will be the mask

from: cdc

yes you are right!

donning ppe: 

-gown

-mask

-goggles

-gloves

removing ppe:

-gloves

-goggles

-gown

-mask 

for tb skin test, if client has 5mm induration, assess if patient is

immunocompromised, if yes, positive.

if not, 10mm/greater induration = positive

for treatment of tb and major side effects:

rifampicin (red-urine, tears, sweat)

inh (the n is for neurological

, h is for hepatic)

pyrazinamide (hyperurecimia)

ethambutol (optic neuritis)

[color=#444444]for hepatitis, you get the vowels from the bowels (hepa a

and e-"fecal-oral route)

[color=#444444]according to cdc, patients infected with anthrax do not

generally pose a transmission risk. standard (universal) precautions are

required though...

[color=#444444]vre = vancomycin resistant enterococcus 

[color=#444444]localized herpes zooster is also known as

a cold sore[color=#444444]. it's not airborne, and is not spread by touching,

so standard precautions is all that is needed. 

[color=#444444]mumps is respiratory precautions. 

rubella

[color=#444444]is keep away from pregnant women.

[color=#444444]scarlet fever is respiratory precautions till 24 hr after

therapy is started.

[color=#444444]german measles ( rubella ) requires standard precautions

and droplet precautions.

[color=#444444]rsv is contact precautions. so wear gloves and a gown. it is

a respiratory infection that is transmited through contact with the

secretions. 

[color=#444444]mmr immunization[color=#444444]: 

[color=#444444]1st vaccine dose given at age 12-15 mo.

[color=#444444]2nd dose at age 4-6 yrs 

[color=#444444]before administration; ask if allergic to eggs 

[color=#444444]mumps: incubation period 14-21 days

[color=#444444]communicable period, immediately before and after the

swelling begins

[color=#444444]transmitted via airborne droplets, saliva, and possibly by

contact with

[color=#444444]infected person's urine

[color=#444444]respiratory precaution; isolation for 9 days following the

onset of parotid swelling

[color=#444444]most common complication; aseptic meningitis, signs

include- nuchal rigidity, lathargy, & vomiting

[color=#444444]other complications; orchitis (red swollen tender testicles)

rubella[color=#444444] (german measles): hospitalized child-contact

isolation; mask, gown,and gloves

[color=#444444]incubation period: 14-21 days

[color=#444444]communicable period: 7 days before to ~ 5 days after rash

appears

[color=#444444]source: nasophryngeal secretions, virus present in blood,

stool, & urin

[color=#444444]transmission: airborne or direct contact with infectious

droplets,

[color=#444444]indirect via articles freshly contaminated with

nasopharyngeal secreations, feces, or urin

[color=#444444]assessment: low grade fever, malaise, pinkish-red

maculopapularrash[color=#444444] that begins on the face and spreads to

entire body, petecheae may occur on the soft palate

[color=#444444]implementation: supportive care

[color=#444444]transplacental: isolate from pregnant women

[color=#444444]rubeola (measles)

[color=#444444]koplik's spot (sm blue/white spots with a red base on the

buccal mucosa

[color=#444444]transmission: via airborne particles or contact with

infectious droplets

[color=#444444]precautions: mask and gloves 

[color=#444444]sars severe acute respiratory syndrome= it's droplet

precaution...so mask.

[color=#444444]-remember to tuck the gown cuffs inside each glove..and

not over the gloves

[color=#444444]-hiv/aids clients, you should always practice standard

precautions (on allpatients[color=#444444])...hiv/aids patients are not

required to state that they have hiv/aids and the healthcare providers will

not know which patient has what unless specify in their charts. 

[color=#444444]to those wondering about the n95 respirator with infectious

tb patient..

[color=#444444]-use n95 but during bronchoscopy on the same patient

(with infectious tb), use a stronger respirator such as a powered air-purifying

respirator or papr.

[color=#444444]-to do a respirator fit check: during inhalation, the

respirator should collapse, and during exhalation, check for leakage around

the face

[color=#444444]-removing the respirator, you will want to lift the bottom

elastic over your head prior to the top elastic. remember to do it slowly

because you don't want it to snap off your face. 

[color=#444444]-remember you would want to remove the respirator

outside the patient's room after the door has been closed. all other ppes

should be removed inside the patient's room at the doorway or in an

anteroom. but if the procedure only requires that you use gloves, then you

can remove your gloves in the patient room followed by hand hygiene

[color=#444444]-there are three types of respirator, n95, n99, n100 but the

n95 is used for infectious tb. 

[color=#444444]hepatitis b is something that if we are not careful, we can

make a mistake very easy, this is a standard precaution unless we are

suctioning the pt, then it becomes droplet

http://www.youtube.com/results?searc...rch_type=&aq=f

[color=#444444]keep those hands off that mouse!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[color=#444444]side note one: while you are practicing your nclex style questions, practice, practice, practice, critical thinking, by taking your time and trying to narrow down your answer and deciding between two possible correct answers. don’t get the quick mouse hand, take your hand off the mouse and don’t answer the question until you are confident that it’s the one you want to choose!!!!!!! i guarantee you that if your practice this you will become a better nclex test-taker. i personally like to keep my hand in my lap while deciding my answer. it kind of helps to keep you calm.

low ph, high co2, high hco3 = resp. acidosis

high ph, low co2, low hco3 = resp. alkalosis

low ph, low co2, low hco3 = metabolic acidosis 

high ph, high co2, high hco3= metabolic alkalosis

ph goes to the left= acid ph goes to the right=alkine

acid<<<<<7.35-7.45>>>>>>>alkine

hco3 22-26 co2 35-45

so if ph is 7.55(up)& hco3 is 28 (up) both are up = met alkalosis

ph hco3 both up = met alkalosis

ph hco3 both down = met acidosis

ph down co2 up = resp acidosis

ph up co2 down =resp alkalosis

rome:

respiratory= opposite:

· ph is high, pco2 is down (alkalosis).

· ph is low, pco2 is up (acidosis).

metabolic= equal:

· ph is high, hco3 is high (alkalosis).

· ph is low, hco3 is low (acidosis).

acidosis alkalosis

ph <7.35 >7.45

pco2 >45 <35

co2 <18 >22

co2 might be hco3 in some labs and the 18 or 22 might be 1-2 numbers

different.

just write down this down and then circle which ones apply to your abg

results. then what it is called is the one that caused the acidosis or alkalosis.

pco is resp and co2 is metabolic

ex your pt abgs are ph 7.30, pco2, 40 co2 10 this is metabolic acidosis. 

pharmacology - know indication/action/effect

prefix/suffix

-ase = thrombolytic

-azepam = benzodiazepine

-azine = antiemetic; phenothiazide

-azole = proton pump inhibitor, antifungal

-barbital = barbiturate

-coxib = cox 2 enzyme blockers

-cep/-cef = anti-infectives

-caine = anesthetics

-cillin = penicillin

-cycline = antibiotic

-dipine = calcium channel blocker

-floxacin = antibiotic

-ipramine = tricyclic antidepressant

-ine = reverse transcriptase inhibitors, antihistamines

-kinase = thrombolytics

-lone, pred- = corticosteroid

-mab = monoclonal antibiotics

-micin = antibiotic, aminoglycoside

-navir = protease inhibitor

nitr-, -nitr- = nitrate/vasodilator

-olol = beta antagonist

-oxin = cardiac glycoside

-osin = alpha blocker

-parin = anticoagulant

-prazole = ppi’s

-phylline = bronchodilator

-pril = ace inhibitor

-statin = cholesterol lowering agent

-sartan = angiotensin ii blocker

-sone = glucocorticoid, corticosteroid

-stigmine = cholinergics

-terol = beta 2 agonist

-thiazide = diuretic

-tidine = antiulcer 

-trophin = pituitary hormone

-vir = anti-viral, protease inhibitors

-zosin = alpha 1 antagonist

-zolam = benzo/sedative

-zine = antihistamine

pharm facts

·don’t give non-selective beta-blockers to patients w/respiratory problems 

·vitamin c can cause false +ive occult blood

·avoid the ‘g’ herbs (ginsing, ginger, ginko, garlic) when on anti-clotting

drugs (coumadin, asa, plavix, etc)

·asa toxicity can cause ringing of the ears 

·no narcotics to any head-injury victims

·mg2+ toxicity is treated with calcium gluconate

·do not give calcium-channel blockers with grapefruit juice

·oxytocin is never administered through the primary iv

·lithium patients must consume extra sodium to prevent toxicity

·maoi patients should avoid tyramine:

oaacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese

(except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream.

·don’t give atropine for glaucoma – it increases iop

·don’t give ant-acids with food -- b/c it delays gastric emptying. 

·don’t give stadol to methadone/heroin preggo’s -- cause instant withdrawal

symptoms

·insulin – clear before cloudy

·don’t give meperidine (demerol) to pancreatitis patients

·always verify bowel sounds when giving kayexelate

·hypercalcemia = hypophosphatemia (and vice versa)

·radioactive dye – urine excretion

·signs of toxic ammonia levels is asterixis (hands flapping)

·d10w can be substituted for tpn (temporary use)

·dopamine and lasix are incompatible

·hypoglycemic shivers can be stopped by holding the limb, seizures cannot

(infants)

·common symptom of aluminum hydroxide – constipation

·thiazide diuretics may induce hyperglycemia

·take iron with vit c – it enhances absorbtion – do not take with milk

·b1 - for alcoholic patients (to prevent wernicke’s encephalopathy &

korsakoff’s synd)

·b6 - for tb patients 

·b9 - for pregnant patients

·b12 - pernicious anemia, vegetarians. 

·complications of coumadin - 3h’s - hemorrhage, hematuria & hepatitis

·ffp is administered to dic b/c of the clotting fx

·mannitol (osmtic diuretic [head injury]) crystallizes at room temp – use a

filter needle

·antianxiety medication is pharmacologically similar to alcohol –used for

weaning tx

·administrate glucagon when pt is hypoglycemia and unresponsive

·phenazopyridine ( pyridium)--urine will appear orange

·rifampicin -- red-urine, tears, sweat)

·hot and dry = sugar high (hyperglycemia)

·cold and clammy = need some candy (hypoglycemia)

·med of choice for v-tach is lidocaine

·med of choice for svt = adenosine or adenocard

·med of choice for asystole = atropine

·med of choice for chf is ace inhibitor.

·med of choice for anaphylactic shock is epinephrine

·med of choice for status epilepticus is valium.

·med of choice for bipolar is lithium.

·give ace inhibitors w/food to prevent stomach upset

·administer diuretics in the morning

·give lipitor at 1700 since the enzymes work best during the evenin

·common tricyclic meds - 3 syllabes (pamelor, elavil)

·common maoi’s - 2 syllables (nardil, marplan)

·tpn has a dedicated line & cannot be mixed ahead of time

·rhogam -- given at 28 weeks & 72 hrs postpartum

·do not administer erythromycin to multiple sclerosis pt

·benadryl and xanax taken together will cause additive effects.

·can't take lasix if allergic to sulfa drugs.

·acetaminophen can be used for headache when the client is using

nitroglycerin.

·dilantin - can not give with dextrose. only give with ns.

addison is skinny ( hypoglycemic, you get weight loss, you got weakness,

and you get postural hypotn) cushing is fat ( hyperglycemic, you get moon

face big cheeks, and you retain a lot of na and fluid)

·never give via ivp:

okcl

oheparin

oibuprofen

oinsulin

odobutamine

oasa

oalbumin

oacetaminophen

·insulin: 

orapid: lispro – onset <15 min. peak: 1 hr. duration 3hr

oshort: regular – onset ½ - 1 hr. peak: 2-3hr. duration: 4-6 hr

oint: nph or lente – onset: 2 hr. peak 6-12 hr. duration: 16-24hr

olong: ultralente – onset 4-6 hr. peak: 12-16 hr. duration: >24hr

ov.long: lantus – onset 1 hr. peak: none. duration: 24 hr continuous

·anticholergic side effects:

ocan’t see

ocan’t pee

ocan’t spit

ocan’t sh*t

·hypocalcemia – cats

oconvulsions

oarrythmias

otetany

ospasms & stridor

·hyper kalemia causes: ‘machine’

omedicationa (ace inhibitors, nsaids)

oacidosis (metabolic & repiratory)

ocellular destruction (burns, traumatic injuy)

ohypoaldosteronism, hemolysis

onephrons, renal failure

oexcretion (impaired)

·signs of increased k ‘ murder’

omuscle weaknes

ourine – olyguria, anuria

orespiratory distress

odecreaed cardiac contractility

oecg changes

oreflexes – hyperreflexia, or flaccid

·substance poisoning and antidotes

omethanol -- ethanol

oco2 -- oxygen

odopamine -- phentolamine

obenzo’s (versed) -- flumazenil

olead -- succimer, calcium disodium 

oiron -- deferoxamine

ocoumadin -- vitamin k

oheparin -- protamine sulfate

othorazine -- cogentine

owild mushrooms - atropine

orat poison - vit k

·parkland formula: 4cc * kg * bsa burned = total volume necessary

o1st 8hrs – ½ total volume

o2nd 8hrs – ¼ total volume

o3rd 8 hrs – ¼ total volumes

nclex drugs??? most-prescribed meds in the us!

generic name (trade name) major concernsanalgesicacetaminophen (tylenol) watch for liver and kidney problemshydrocodone with acetaminophen addictive(lortab)ibuprofen (motrin) can lead to hpn and kidney diseasenaproxen (aleve) can lead to hpn and kidney disease

antianxietyalprazolam (xanax) this drug can be addictivediazepam (valium) watch for allergies, *also anticonvulsant*lorazepam (antivan) sedationpromethazine hci (phenergan) *also antiemetic*

antibioticamoxicilline (augmentin) watch for allergic reactionsazithromycin (zithromax z-pak) watch for allergiescephalexin (keflex) if you are allergic to cephalosporins, you might also be allergic to penicillindoxycycline hyclate (vibramycin) avoid for pregnant clientspenicillin v potassium (penicillin) watch for allergiessulfamethoxazole (septra, bactrim) can cause gi diturbance

anticoagulantwarfarin sodium (coumadin) teach the client to limit the intake of green leafy vegetableswatch for signs of bleedinganticonvulsantclonazepam (klonopin) should not be stoppe abruptlydiazepam (valium) watch for allergies, also antianxietylorazepam (antivan) sedation

antidepressantsertraline (zoloft) sedation

amitriptyline hci (elavil) trazodone hci (desyrel)

antidiabeticglipizide (glucotrol) watch for hypoglycemiametformin (glucophage) thi drug should be stopped prior to a dye study such as cardiac catheterization

antihistaminecetirizine (zyrtec)fexofenadine (allegra) dry mouth

antihypertensiveamiodipine (norvasc) hypertensionatenolol (tenormin) cause drop in pulse rate, check pr dailydoxazosin mesylate (cardura)lisinopril (zestril) cause postural hpn, remain supine for at least 30mins

metoprolol succinate (toprol xl) teach the client to check his pulse rate

metoprolol tartrate (lopressor,toprol) teach the client to check his pulse rate

antihypertensive/antianginalverapamil hci (calan)

anti-inflammatoryibuprofen (motrin) can lead to hypertension and kidney diseaseprednisone (deltasone) can cause cushing’s syndrome and gi problems

antigoutallopurinol (zyloprim) drink a least 8 glasses of water per day

antilipidemic – usually ends in statinsimvastatin (zocor) can cause liver problems & muscle sorenessdo not take this drug with grape-fruit juiceantiulcer/histamine blocker

ranitidine hci (zantac) best to take this drug with meals

antiulcer/proton pump inhibitorlansoprazole (prevacid) take this drug prior to mealsomeprazole (prilosec)

bronchodilatoralbuterol (proventil) tachycardia, md check blood levels for toxicity

diuretic furosemide (lasix) hypokalemiahydrochlorothiazide (hctz) hypokalemia

hormone replacementestrogen (premarin) can ↑ blood clotslevothyroxine (levoxyl) can ↑ blood clots

levothyroxin (synthyroid) teach the clients to check his pulse rate

muscle relaxant cyclobenzaprine hci (flexeril) sedation

oral contraceptivenecon (ortho-novum 7/7/7) can ↑ blood clotstrinessa (ortho triclen) can ↑ blood clots

osteoporosisalendronate (fosamax) remain upright for at least 30mins after taking to prevent gerd.take wit water

potassium supplementpotassium chloride (k-lyte) check for renal function before giving this drug

sleep aidzolpidem (ambien) allow at least 8hrs of sleep time to prevent daytime drowsiness

i highly recomend this link it is organized and less confusing and not over done as cdc website which can be over whelming:

http://info.med.yale.edu/ynhh/infection

 this is sir silas he kept me company during this long journey. he

wants me to find a job now. yet another hurdle

hope it helps!!! good luck!

Last edit by UNIVERSAL NURSE on Mar 31, '10

gyuzeel, stacievlz, kaila731, and 1 other like this.

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8 Comments so far...

4.

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0Mar 31, '10 by goodstudentnowRN

Thanks! This will help those who are still studying for the NCLEX.

5.

0Mar 31, '10 by caliotter3

 and many thanks for consolidating a lot of useful info!

6.

2Mar 31, '10 by Gold2010

Quote from universal nurse

 i passed after taking nclex this past monday/ pearson trick immediately after getting home. kaplan takes months to fully get all out of it. not weeks, it works. review all content review and write it all out. takes months. it took many 7 months to fully absorb all of kaplan and i kept changing my class in order to get more time. i highly recomend th live on line course, not the in person course. you must cover all the course content review which is huge. do all the q-trainers and know all the rationales, i never got to the q-bank and still passed. write it all out if you are slow like me.

priority and delegation by charity is a must.

i get tired very easily. i ate breakfast, went back to bed for 3 hours. got ready downed a red bull ate chocolate and was fully charged for the nclex. the brain uses lots of sugar when you are concentrating this kept me going.

below are also a must know that i had copied pasted from different posts. i must emphasize this is a must know:

varicella (chickenpox) requires use of airborne precautions and contact precautions   as well.

if a patient is on contact precautions, have family members and other visitors wear a gown and gloves as outlined by your facility (hospital).

1) droplet room assignment: preferably private, if not available roomate with same illness and same pathogen. and if thats not an option 3 feet away from roomate with the curtain pulled.

2) when transporting a patient with airborne precautions (for essential purposes only) they must wear a surgical mask.

for contact precautionsdiseases/conditions include: c. diff, e. coli, scabiesroom needs to be private unless room has another patient infected with the same organism 

for droplet precautionsdiseases/conditions include: meningitis, pneumonia, pertussis (whooping cough), rubella, mumpsroom needs to be private unless room has another patient infected with the same organism. maintain spacial distance of 3 feet when near patient.

also remember standard precautions apply to all patients   regardless of diagnosis when in contact with any bodily fluid, blood, secretions/excretions, nonintact skin, and mucous membranes 

#1. when wearing gown and/or gloves, make sure to take them off and properly dispose of them, before leaving the patien'ts room.

#2. pt's with herpes zooster (shingles) that is active should have the

same precautions as a patient with chicken pox---airborne and contact

#3. pt's on droplet precaution can have their room door left open.

#4. instruct visitors for pt's with droplet precautions to try to keep a distance of three feet between them and the pt.

#5. pt's with croup should be on contact precautions 

bacterial meningitis is transmitted via droplets, and when suctioning pt, wear goggles, eyewear, mask, and gloves. pt should wear a face mask when being transported.

cdc recommends airborne precautions against varicella/rubeola.

measles, chicken pox (varicella), disseminated varicella zoster, tuberculosis

barrrier protection: single room maintained under negative pressuredoor kept closed except when someone is entering exiting the roomnegative airflow pressure used in room, (min of 6 - 12 air exchanges per hour depending on the facilityultraviolet germicide irradiation or high-efficiency particulate air filter used in the roommask or personal respiratory protection device usedmask placed on the client when client needs to leave the room; client only leaves only if necessary! 

rsv is contact precautions. so wear gloves and a gown. it is a respiratory infectionthat is transmited through contact with the secretions. 

when you put your protective gear on start from top to bottom : mask-> gown-> and gloves. when you take them off start from bottom to top: gloves->gown->mask. (i tried to research this part just to make sure it is what i remember it to be, but found nothing so im not 100% certain)

wash hands between patients and whenever visibly soiled. 

donning ppe (personal protective equipment)

gownfully cover torso from neck to knees, arms to end of wrist, and wrap around the backfasten in back at neck and waist

mask or respiratorsecure ties or elastic band at middle of head and neckfit flexible band to nose bridgefit snug to face and below chinfit-check respirator

goggles/face shieldput on face and adjust to fit

glovesuse non-sterile for isolationselect according to hand sizeextend to cover wrist of isolation gown

safe work practiceskeep hands away from facework from clean to dirtylimit surfaces touchedchange when torn or heavily contaminatedperform hand hygiene

removing ppe

remove ppe at doorway before leaving patient room or in anteroom

glovesoutside of gloves are contaminated!grasp outside of glove with opposite gloved hand; peel offhold removed glove in gloved handslide fingers of ungloved hand under remaining glove at wrist

goggles/face shieldoutside of goggles or face shield are contaminated!to remove, handle by “clean” head band or ear piecesplace in designated receptacle for reprocessing or in waste container

gowngown front and sleeves are contaminated!unfasten neck, then waist tiesremove gown using a peeling motion; pull gown from each shoulder toward the same handgown will turn inside outhold removed gown away from body, roll into a bundle and discard into waste or linen receptacle

mask or respiratorfront of mask/respirator is contaminated – do not touch!grasp only bottom then top ties/elastics and removediscard in waste container

hand hygieneperform hand hygiene immediately after removing all ppe! 

chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.

rash is pruritic, and starts out as a macule then papule then a vesicle.

spread by direct contact, droplet and contaminated object.

isolate till all vesicles are crusted; it can be spread from 2 days before the rash begins.

avoid use of aspirin due to reye's syndrome, use tylenol.

airborn--door can be closed..measles (rubeola), m. tuberculosis, disseminated zoster(shingles), varicella(chicken pox)--again can cohort and place in same room with the same infective organism.droplet--door may be open---streptococcus pharyngitis, meningitis, pnemonia...private room or pt with same infection--involves contact with mucous membranes of nose or mouth...happens during talking, coughing, suctioning.maintain 3feet between infected patients and visitors. 

rubella--there's a maculopapular rash on face and all over the body. prodromal: malaise and fever which is followed by cough.

sread by droplets and contaminated objects. placed on contact precautions, isolate child from pregnant women.

tuberculosis, pt is on isolation for 2-4 weeks (until there are 3 negative sputum cultures.)

syphilis--painless chancre that fades within 6 weeks...on palms and soles there is a copper colored rash...spread by contact with mucous membranes and also congenitally...tx with penicillin g im 

heres how i remember that rubella is droplet and rubeola is airborne...rubella sounds like umbrella and umbrellas protect you from raindrops... 

transmission-based precautions: adca - airborned - dropletc - contact

airborne precaution (credit goes to the one who posted this on april thread, sorry can't remember your name)

my - measleschicken - chickenpoxhez - herpes zoster (disseminated)tb - tb 

private room negative pressure with 6-12 air exchanges per houruvmaskn95 mask for tb

droplet precautionthink of spiderman!s - sepsiss - scarlet fevers - streptococcal pharyngitisp - parvovirus b19p - pertussis

p - pneumoniai - influenzad - diptheria (pharyngeal)e - epiglottitisr - rubellam - mumpsm - meningitism - mycoplasma or meningeal pneumoniaan - adenovirus

private roommask

contact precautionmrs.weem - multidrug resistant organismr - respiratory infection - rsv s - skin infectionsw - wound infectionse - enteric infections - clostridium defficilee - eye infections

skin infections:v - varicella zosterc - cutaneous diptheriah - herpes simplexi - impetigop - pediculosiss - scabies, staphylococcus

private roomgloves gown 

 wash your hands before patient care and after patient care.when in doubt, wash your hands again.gloves needed when passing meds to pt. with mrsa, if you'll be close to patient need gown too.( just in case you touch anything that might be contaminated )my preceptor at work likes to say," better to have on too much ppe

than not enough."ppe = personal protective equipment 

in removing ppe: 1. gloves2. goggles/face shield3. gowns4. last will be the mask

from: cdcyes you are right!

donning ppe: 

-gown-mask-goggles-gloves

removing ppe:

-gloves-goggles-gown-mask 

for tb skin test, if client has 5mm induration, assess if patient is immunocompromised, if yes, positive.if not, 10mm/greater induration = positive

for treatment of tb and major side effects:rifampicin (red-urine, tears, sweat)

inh (the n is for neurological

, h is for hepatic)

pyrazinamide (hyperurecimia)

ethambutol (optic neuritis)

[color=#444444]for hepatitis, you get the vowels from the bowels (hepa a and e-"fecal-oral route)

[color=#444444]according to cdc, patients infected with anthrax do not generally pose a transmission risk. standard (universal) precautions are required though...

[color=#444444]vre = vancomycin resistant enterococcus 

[color=#444444]localized herpes zooster is also known as a cold sore[color=#444444]. it's not airborne, and is not spread by touching, so standard precautions is all that is needed. 

[color=#444444]mumps is respiratory precautions. rubella

[color=#444444]is keep away from pregnant women.[color=#444444]scarlet fever is respiratory precautions till 24 hr after therapy is started.

[color=#444444]german measles ( rubella ) requires standard precautions and droplet precautions.

[color=#444444]rsv is contact precautions. so wear gloves and a gown. it is a respiratory infection that is transmited through contact with the secretions. 

[color=#444444]mmr immunization[color=#444444]: [color=#444444]1st vaccine dose given at age 12-15 mo.[color=#444444]2nd dose at age 4-6 yrs [color=#444444]before administration; ask if allergic to eggs 

[color=#444444]mumps: incubation period 14-21 days[color=#444444]communicable period, immediately before and after the swelling begins[color=#444444]transmitted via airborne droplets, saliva, and possibly by contact with[color=#444444]infected person's urine[color=#444444]respiratory precaution; isolation for 9 days following the onset of parotid swelling

[color=#444444]most common complication; aseptic meningitis, signs include- nuchal rigidity, lathargy, & vomiting[color=#444444]other complications; orchitis (red swollen tender testicles)

rubella[color=#444444] (german measles): hospitalized child-contact isolation; mask, gown,and gloves[color=#444444]incubation period: 14-21 days[color=#444444]communicable period: 7 days before to ~ 5 days after rash appears[color=#444444]source: nasophryngeal secretions, virus present in blood, stool, & urin[color=#444444]transmission: airborne or direct contact with infectious droplets,[color=#444444]indirect via articles freshly contaminated with nasopharyngeal secreations, feces, or urin[color=#444444]assessment: low grade fever, malaise, pinkish-red maculopapularrash[color=#444444] that begins on the face and spreads to entire body, petecheae may occur on the soft palate[color=#444444]implementation: supportive care[color=#444444]transplacental: isolate from pregnant women

[color=#444444]rubeola (measles)[color=#444444]koplik's spot (sm blue/white spots with a red base on the buccal mucosa[color=#444444]transmission: via airborne particles or contact with infectious droplets[color=#444444]precautions: mask and gloves 

[color=#444444]sars severe acute respiratory syndrome= it's droplet precaution...so mask.

[color=#444444]-remember to tuck the gown cuffs inside each glove..and not over the gloves

[color=#444444]-hiv/aids clients, you should always practice standard precautions (on all patients[color=#444444])...hiv/aids patients are not required to state that they have hiv/aids and the healthcare providers will not know which patient has what unless specify in their charts. 

[color=#444444]to those wondering about the n95 respirator with infectious tb patient..

[color=#444444]-use n95 but during bronchoscopy on the same patient (with infectious tb), use a stronger respirator such as a powered air-purifying respirator or papr.

[color=#444444]-to do a respirator fit check: during inhalation, the respirator should collapse, and during exhalation, check for leakage around the face

[color=#444444]-removing the respirator, you will want to lift the bottom elastic over your head prior to the top elastic. remember to do it slowly because you don't want it to snap off your face. 

[color=#444444]-remember you would want to remove the respirator outside the patient's room after the door has been closed. all other ppes should be removed inside the patient's room at the doorway or in an anteroom. but if the procedure only requires that you use gloves, then you can remove your gloves in the patient room followed by hand hygiene

[color=#444444]-there are three types of respirator, n95, n99, n100 but the n95 is used for infectious tb. 

[color=#444444]hepatitis b is something that if we are not careful, we can make a mistake very easy, this is a standard precaution unless we are suctioning the pt, then it becomes droplet

http://www.youtube.com/results?searc...rch_type=&aq=f

[color=#444444]keep those hands off that mouse!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[color=#444444]side note one: while you are practicing your nclex style questions, practice, practice, practice, critical thinking, by taking your time and trying to narrow down your answer and deciding between two possible correct answers. don’t get the quick mouse hand, take your hand off the mouse and don’t answer the question until you are confident that it’s

the one you want to choose!!!!!!! i guarantee you that if your practice this you will become a better nclex test-taker. i personally like to keep my hand in my lap while deciding my answer. it kind of helps to keep you calm.

low ph, high co2, high hco3 = resp. acidosis

high ph, low co2, low hco3 = resp. alkalosis

low ph, low co2, low hco3 = metabolic acidosis 

high ph, high co2, high hco3= metabolic alkalosis

ph goes to the left= acid ph goes to the right=alkineacid<<<<<7.35-7.45>>>>>>>alkinehco3 22-26 co2 35-45so if ph is 7.55(up)& hco3 is 28 (up) both are up = met alkalosis

ph hco3 both up = met alkalosisph hco3 both down = met acidosisph down co2 up = resp acidosisph up co2 down =resp alkalosis

rome:

respiratory= opposite:· ph is high, pco2 is down (alkalosis).· ph is low, pco2 is up (acidosis).

metabolic= equal:· ph is high, hco3 is high (alkalosis).· ph is low, hco3 is low (acidosis).

acidosis alkalosis

ph <7.35 >7.45

pco2 >45 <35

co2 <18 >22

co2 might be hco3 in some labs and the 18 or 22 might be 1-2 numbers different.

just write down this down and then circle which ones apply to your abg results. then what it is called is the one that caused the acidosis or alkalosis. pco is resp and co2 is metabolic

ex your pt abgs are ph 7.30, pco2, 40 co2 10 this is metabolic acidosis. 

pharmacology - know indication/action/effect

prefix/suffix

-ase = thrombolytic-azepam = benzodiazepine-azine = antiemetic; phenothiazide-azole = proton pump inhibitor, antifungal-barbital = barbiturate-coxib = cox 2 enzyme blockers-cep/-cef = anti-infectives-caine = anesthetics-cillin = penicillin-cycline = antibiotic

-dipine = calcium channel blocker-floxacin = antibiotic-ipramine = tricyclic antidepressant-ine = reverse transcriptase inhibitors, antihistamines-kinase = thrombolytics-lone, pred- = corticosteroid-mab = monoclonal antibiotics-micin = antibiotic, aminoglycoside-navir = protease inhibitornitr-, -nitr- = nitrate/vasodilator-olol = beta antagonist-oxin = cardiac glycoside-osin = alpha blocker-parin = anticoagulant-prazole = ppi’s-phylline = bronchodilator-pril = ace inhibitor-statin = cholesterol lowering agent-sartan = angiotensin ii blocker-sone = glucocorticoid, corticosteroid-stigmine = cholinergics-terol = beta 2 agonist-thiazide = diuretic-tidine = antiulcer -trophin = pituitary hormone-vir = anti-viral, protease inhibitors-zosin = alpha 1 antagonist-zolam = benzo/sedative-zine = antihistamine

pharm facts

·don’t give non-selective beta-blockers to patients w/respiratory problems ·vitamin c can cause false +ive occult blood·avoid the ‘g’ herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs (coumadin, asa, plavix, etc)

·asa toxicity can cause ringing of the ears ·no narcotics to any head-injury victims·mg2+ toxicity is treated with calcium gluconate·do not give calcium-channel blockers with grapefruit juice·oxytocin is never administered through the primary iv·lithium patients must consume extra sodium to prevent toxicity·maoi patients should avoid tyramine:oaacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream.·don’t give atropine for glaucoma – it increases iop·don’t give ant-acids with food -- b/c it delays gastric emptying. ·don’t give stadol to methadone/heroin preggo’s -- cause instant withdrawal symptoms·insulin – clear before cloudy·don’t give meperidine (demerol) to pancreatitis patients·always verify bowel sounds when giving kayexelate·hypercalcemia = hypophosphatemia (and vice versa)·radioactive dye – urine excretion·signs of toxic ammonia levels is asterixis (hands flapping)·d10w can be substituted for tpn (temporary use)·dopamine and lasix are incompatible·hypoglycemic shivers can be stopped by holding the limb, seizures cannot (infants)·common symptom of aluminum hydroxide – constipation·thiazide diuretics may induce hyperglycemia·take iron with vit c – it enhances absorbtion – do not take with milk·b1 - for alcoholic patients (to prevent wernicke’s encephalopathy & korsakoff’s synd)·b6 - for tb patients ·b9 - for pregnant patients·b12 - pernicious anemia, vegetarians. ·complications of coumadin - 3h’s - hemorrhage, hematuria & hepatitis·ffp is administered to dic b/c of the clotting fx·mannitol (osmtic diuretic [head injury]) crystallizes at room temp – use a filter needle·antianxiety medication is pharmacologically similar to alcohol –used for weaning tx·administrate glucagon when pt is hypoglycemia and unresponsive·phenazopyridine ( pyridium)--urine will appear orange·rifampicin -- red-urine, tears, sweat)·hot and dry = sugar high (hyperglycemia)

·cold and clammy = need some candy (hypoglycemia)·med of choice for v-tach is lidocaine·med of choice for svt = adenosine or adenocard·med of choice for asystole = atropine·med of choice for chf is ace inhibitor.·med of choice for anaphylactic shock is epinephrine·med of choice for status epilepticus is valium.·med of choice for bipolar is lithium.·give ace inhibitors w/food to prevent stomach upset·administer diuretics in the morning·give lipitor at 1700 since the enzymes work best during the evenin·common tricyclic meds - 3 syllabes (pamelor, elavil)·common maoi’s - 2 syllables (nardil, marplan)·tpn has a dedicated line & cannot be mixed ahead of time·rhogam -- given at 28 weeks & 72 hrs postpartum·do not administer erythromycin to multiple sclerosis pt·benadryl and xanax taken together will cause additive effects.·can't take lasix if allergic to sulfa drugs.·acetaminophen can be used for headache when the client is using nitroglycerin.·dilantin - can not give with dextrose. only give with ns.

addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and you get postural hypotn) cushing is fat ( hyperglycemic, you get moon face big cheeks, and you retain a lot of na and fluid)·never give via ivp:okcloheparinoibuprofenoinsulinodobutamineoasaoalbuminoacetaminophen

·insulin: orapid: lispro – onset <15 min. peak: 1 hr. duration 3hroshort: regular – onset ½ - 1 hr. peak: 2-3hr. duration: 4-6 hroint: nph or lente – onset: 2 hr. peak 6-12 hr. duration: 16-24hrolong: ultralente – onset 4-6 hr. peak: 12-16 hr. duration: >24hr

ov.long: lantus – onset 1 hr. peak: none. duration: 24 hr continuous

·anticholergic side effects:ocan’t seeocan’t peeocan’t spitocan’t sh*t·hypocalcemia – catsoconvulsionsoarrythmiasotetanyospasms & stridor

·hyper kalemia causes: ‘machine’omedicationa (ace inhibitors, nsaids)oacidosis (metabolic & repiratory)ocellular destruction (burns, traumatic injuy)ohypoaldosteronism, hemolysisonephrons, renal failureoexcretion (impaired)

·signs of increased k ‘ murder’omuscle weaknesourine – olyguria, anuriaorespiratory distressodecreaed cardiac contractilityoecg changesoreflexes – hyperreflexia, or flaccid

·substance poisoning and antidotesomethanol -- ethanoloco2 -- oxygenodopamine -- phentolamineobenzo’s (versed) -- flumazenilolead -- succimer, calcium disodium oiron -- deferoxamine

ocoumadin -- vitamin koheparin -- protamine sulfateothorazine -- cogentineowild mushrooms - atropineorat poison - vit k

·parkland formula: 4cc * kg * bsa burned = total volume necessaryo1st 8hrs – ½ total volumeo2nd 8hrs – ¼ total volumeo3rd 8 hrs – ¼ total volumes

nclex drugs??? most-prescribed meds in the us!

generic name (trade name) major concernsanalgesicacetaminophen (tylenol) watch for liver and kidney problemshydrocodone with acetaminophen addictive(lortab)ibuprofen (motrin) can lead to hpn and kidney diseasenaproxen (aleve) can lead to hpn and kidney disease

antianxietyalprazolam (xanax) this drug can be addictivediazepam (valium) watch for allergies, *also anticonvulsant*lorazepam (antivan) sedationpromethazine hci (phenergan) *also antiemetic*

antibioticamoxicilline (augmentin) watch for allergic reactionsazithromycin (zithromax z-pak) watch for allergiescephalexin (keflex) if you are allergic to cephalosporins, you might also be allergic to penicillindoxycycline hyclate (vibramycin) avoid for pregnant clientspenicillin v potassium (penicillin) watch for allergiessulfamethoxazole (septra, bactrim) can cause gi diturbance

anticoagulantwarfarin sodium (coumadin) teach the client to limit the intake of green leafy vegetableswatch for signs of bleedinganticonvulsant

clonazepam (klonopin) should not be stoppe abruptlydiazepam (valium) watch for allergies, also antianxietylorazepam (antivan) sedation

antidepressantsertraline (zoloft) sedation amitriptyline hci (elavil) trazodone hci (desyrel)

antidiabeticglipizide (glucotrol) watch for hypoglycemiametformin (glucophage) thi drug should be stopped prior to a dye study such as cardiac catheterization

antihistaminecetirizine (zyrtec)fexofenadine (allegra) dry mouth

antihypertensiveamiodipine (norvasc) hypertensionatenolol (tenormin) cause drop in pulse rate, check pr dailydoxazosin mesylate (cardura)lisinopril (zestril) cause postural hpn, remain supine for at least 30mins metoprolol succinate (toprol xl) teach the client to check his pulse ratemetoprolol tartrate (lopressor,toprol) teach the client to check his pulse rate

antihypertensive/antianginalverapamil hci (calan)

anti-inflammatoryibuprofen (motrin) can lead to hypertension and kidney diseaseprednisone (deltasone) can cause cushing’s syndrome and gi problems

antigoutallopurinol (zyloprim) drink a least 8 glasses of water per day

antilipidemic – usually ends in statinsimvastatin (zocor) can cause liver problems & muscle sorenessdo not take this drug with grape-fruit juiceantiulcer/histamine blockerranitidine hci (zantac) best to take this drug with meals

antiulcer/proton pump inhibitorlansoprazole (prevacid) take this drug prior to mealsomeprazole (prilosec)

bronchodilatoralbuterol (proventil) tachycardia, md check blood levels for toxicity

diuretic furosemide (lasix) hypokalemiahydrochlorothiazide (hctz) hypokalemia

hormone replacementestrogen (premarin) can ↑ blood clotslevothyroxine (levoxyl) can ↑ blood clotslevothyroxin (synthyroid) teach the clients to check his pulse rate

muscle relaxant cyclobenzaprine hci (flexeril) sedation

oral contraceptivenecon (ortho-novum 7/7/7) can ↑ blood clotstrinessa (ortho triclen) can ↑ blood clots

osteoporosisalendronate (fosamax) remain upright for at least 30mins after taking to prevent gerd.take wit water

potassium supplementpotassium chloride (k-lyte) check for renal function before giving this drug

sleep aidzolpidem (ambien) allow at least 8hrs of sleep time to prevent daytime drowsiness

i highly recomend this link it is organized and less confusing and not over done as cdc website which can be over whelming:

http://info.med.yale.edu/ynhh/infection

 this is sir silas he kept me company during this long journey.

he wants me to find a job now. yet another hurdle

hope it helps!!! good luck!

thx for sharing this information. i too took exam today not good pop up but

lolts of prioritization and infection control . congrates. i will pass too soonnnn

kaila731 and StarMatrix17 like this.

7.

0Mar 31, '10 by Lmcgrady

Hello Everyone , I took my NCLEX today and I was wondering if anyone

knows how long it takes before the unofficial results are posted on Pearson

Vue?

Thanks

8.

0Mar 31, '10 by Hopscotch81

Good info!

9.

0Apr 4, '10 by missaphrodite

thank you for sharing this.. im gonna copy this now on my notes.. thank you

so much!!1

10.

0Apr 4, '10 by Brenda101

Thank You so much for sharing your info with us, Congrats on your passing

nclex. I will ve attempting for the third time at the end of may. Going to byuy

the Charity book tomorrow...

11.

0Apr 5, '10 by mariyahsmommy

Universal Nurse--

All I can say is THANK YOU! You obviously put alot of time and effort into

posting all of this very valuable info on to us. I graduate in May 5 more

weeks and then am planning on taking a Review Course. This is AMAZING

stuff! I will pass it on to my buddies as well. Congratulations to you on

passing! Woo-Hoo!