216277067 HAAD Reviewerhaad

8/18/2019 216277067 HAAD Reviewerhaad

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DO NOT delegate what you can EAT! E - evaluate A - assess T - teach addisons= down, down down up down cushings= up up up down up addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia No Pee, no K (do not give potassium without adequate urine output) EleVate Veins dAngle Arteries !or better per!usion A= appearance (color all pink pink and !lue !lue "pale#$ %= pulse (&'(( ) '(( a!sent$ *= gri+ace (cough gri+ace no response$ A= activity (,le-ed ,laccid li+p$ .= respirations (strong cry weak cry a!sent$ T.AN/01//1ON-2A/ED %.E3A4T1ON/5 A1.2O.NE 0y - 0easles 3hicken - 3hicken %o-6Varicella 7e8 - 7erpe8 9oster6/hingles T2 or re+e+!er::: 0TV=Air!orne 0easles T2 Varicella-3hicken %o-67erpes 9oster-/hingles %rivate .oo+ - negative pressure with ;-'< air e-changes6hr 0ask N=> ,or T2 D.O%?ET think o, /%1DE.0AN! / - sepsis / - scarlet ,ever / - streptococcal pharyngitis % - parvovirus 2'= % - pneu+onia % - pertussis 1 - in,luen8a D - diptheria (pharyngeal$ E - epiglottitis . - ru!ella 0 - +u+ps 0 - +eningitis 0 - +ycoplas+a or +eningeal pneu+onia An - Adenovirus %rivate .oo+ or cohort 0ask

1


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3ONTA3T %.E3A4T1ON 0./:@EE 0 - +ultidrug resistant organis+ . - respiratory in,ection / - skin in,ections A @ - wound in,-n E - enteric in,-n - clostridiu+ di,,icile E - eye in,-n - conBunctivitis /C1N 1NDE3T1ON/ V371%/ V - varicella 8oster 3 - cutaneous diphtheria 7 - herpe8 si+ple1 - i+petigo % - pediculosis / - sca!ies "# Air6%ul+onary E+!olis+ ($%$& chest pain, di!!iculty breathing, tachycardia, pale'cyanotic, sense o! impending doom) (() turn pt to le,t side and lower the head o! the bed# *# @o+an in ?a!or w6 4n-reassuring D7. (late decels, decreased variability, !etal bradycardia, etc) (() turn on le,t side (and give +*, stopPitocin, increase ,- !luids) .# Tu!e Deeding w6 Decreased ?O3 (() position pt on right side (promotes emptying o! the stomach) with the 7O2 elevated (to prevent aspiration) /# During Epidural %uncture (() side-lying 0# A,ter ?u+!ar %uncture (and also oil(based 1yelogram)(() pt lies in ,lat supine (to prevent headache and leaking o! 2$3) 4# %t w6 7eat /troke (() lie ,lat w' legs elevated 5# During3ontinuous 2ladder 1rrigation (26,) (() catheter is taped to thigh so leg should be kept straight# No other positioning restrictions# 7# A,ter 0yringoto+y (() position on side o! a,,ected ear a!ter surgery (allows drainage o! secretions) 8# A,ter 3ataract /urgery (() pt will sleep on una,,ected side with a night shield !or "(/ weeks# "9# A,ter Thyroidecto+y (() low or semi(3owler:s, support head,neck and shoulders# ""# 1n,ant w6 /pina 2i,ida (() position prone (on abdomen) so that sac does not rupture "*# 2uckEs Traction (skin traction) (() elevate !oot o! bed !or counter(traction ".# A,ter Total 7ip .eplace+ent (() don:t sleep onoperated side, don:t !le; hip more than /0( 49 degrees, don:t elevate


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"0# 1n,ant w6 3le,t ?ip (() position on back or in in!ant seat to prevent trauma to suture line# >hile !eeding, hold in upright position# "4# To %revent Du+ping /yndro+e (post(operative ulcer'stomach surgeries) (() eat in reclining position, lie down a!ter meals !or *9(.9 minutes (also restrict !luids during meals, low 2


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*ravesG disease6hyperthyroidis+5 accelerated physical and mental !unction sensitivity to heat, !ine'so!t hair Thyroid stor+5 increased temp, pulse and


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*# , kept !orgetting which was dangerous when you:re pregnant regular measles (rubeola), or Berman measles (rubella), so remember& (never get pregnant with a Berman (rubella) .# >hen drawing up regular insulin % NP< together, remember& (?N(regular comes be!ore NP


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6actrim& antibiotic##dont take i! allergic to sul!a drugs###diarrhea common side e!!ect###drink plenty o! !luids Bout 1eds& Probenecid (6enemid), 2olchicine, @llopurinol (Lyloprim) @presoline(hydralaDine)(t; o!


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3or cord compression, place the mother in the =?ENAEEEN6E?B position because this removes pressure o! the presenting part o!! the cord# (,! her head is down, the baby is no longer being pulled out o! hte body by gravity) ,! the cord is prolapsed, cover it with sterile saline gauDe to prevent drying o! the cord and to minimiDe in!ection# 3or late decels, turn the mother to her le!t side, to allow more blood !low to the placenta# 3or any kind o! bad !etal heart rate pattern, you give +*, o!ten by mask### >hen doing an epidural anesthesia hydration be!ore hand is a priority#


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"*# a pt with leukemia may have epita;is b'c o! low platelets ".# best way to warm a newborn& skin to skin contact covered with a blanket on mom# "/# when a ptcomes in and she is in active labor###nurse !irst action is to listen to !etal heart tone'rate "0# phobic disorders###use systematic desensitiDtion# N2EEO =,P$"# >hen getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor, palpate) over the intervention e;cept in an emergency or distress situation# ,! one answer has an absolute, discard it# Bive priority to answers that deal directly to the patientHs body, not the machines'equipments# *# Key words are very important# @void answers with absolutes !or e;ample& always, never, must, etc# .# with lower amputations patient is placed in prone position# /# small !requent !eedings are better than larger ones# 0# @ssessment, teaching, meds, evaluation, unstable patient cannot be delegated to an Knlicensed @ssistive Personnel# 4# E-N'EPN cannot handle blood# 5# @mynoglycosides (like vancomycin) cause nephroto;icity and ototo;icity# 7# ,- push should go over at least * minutes# 8# ,! the patient is not a child an answer with !amily option can be ruled out easily# "9# ,n an emergency, patients with greater chance to live are treated !irst ""# @?A$ (!luids in alveoli), A,2 (disseminated intravascular coagulaton) are always secondary to something else (another disease process)# "*# 2ardinal sign o! @?A$ is hypo;emia (low o;ygen level in tissues)# ".# in p< regulation the * organs o! concern are lungs'kidneys# "/# edema is in the interstitial space not in the cardiovascular space# "0# weight is the best indicator o! dehydration "4# wherever there is sugar (glucose) water !ollows# "5# aspirin can cause ?eyeHs syndrome (encephalopathy) when given to children "7# when aspirin isgiven once a day it acts as an antiplatelet# "8# use 2old !or acute pain (eg# $p

rain ankle) and


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blows the patientHs stimulus !or breathing# *5# e;acerbation& acute, distress# *7# epi always given in =6 syringe# *8# prednisone to;icity& cushingHs syndrome=bu!!alo hump, moon !ace, high glucose, hypertension# .9# / options !or cancer management& chemo, radiation, surgery, allow to die with dignity# ."# no live vaccines, no !resh !ruits, no !lowers should be used !or neutropenic patients# .*# chest tubes are placed in the pleural space# ..# angina (low o;ygen to heart tissues) = no dead heart tissues# 1,= dead heart tissue present# ./# mevacor (anticholesterol med) must be given with evening meal i! it is QA (per day)# .0# Nitroglycerine is administered up to . times (every 0 minutes)# ,! chest pain does not stop go to hospital# Ao not give when 6P is J 89'49# .4# Preload a!!ects amount o! blood that goes to the ? ventricle# @!terload is the resistance the blood has to overcome when leaving the heart# .5# 2alcium channel blocker a!!ects the a!terload# .7# !or a 2@6B operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside# .8# unstable angina is not relieved by nitro# /9# dead tissues cannot have P-2Hs(premature ventricular contraction# ,! le!t untreated pvcHs can lead to -3 (ventricular !ibrillation)# /"# " t (teaspoon)= 0 ml " =(tablespoon)= . t = "0 ml " oD= .9 ml " cup= 7 oD " quart= * pints " pint= * cups " gr (grain)= 49 mg " g (gram)= "999 mg " kg= *#* lbs " lb= "4 oD G =o convert 2entigrade to 3# 3= 2R/9, multiply 8'0 and substract /9G =o convert 3ahrenheit to 2# 2= 3R/9, multiply 0'8 and substract /9# /*# angiotensin ,, in the lungs= potent vasodialator# @ldosterone attracts sodium# /.# ?E-E?$E @BEN=$ 3+? =+O,2,=F heparin= protamine sul!ate coumadin= vitamin k ammonia= lactulose acetaminophen= n(@cetylcysteine# ,ron= de!ero;amine Aigito;in, digo;in= digibind# @lcohol withdraw= Eibrium# ( methadone is an opioid analgesic used

to deto;i!y'treat pain in narcotic addicts# ( Potassium potentiates dig to;icity# //# heparin prevents platelet aggregation# /0# P='P== are elevated when patient is on coumadin /4# cardiac output decreases with dysrythmias# Aopamine increases 6P# /5# 1ed o! choice !or -tach is lidocaine /7# 1ed o! choice !or $-= is adenosine or adenocard /8# 1ed o! choice !or @systole (no heart beat) is atropine

9


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09# 1ed o! choice !or 2


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3ront trunk= "7S 6ack trunk= "7S Benitalia= "S M 89# 6irth weight doubles by 4 month and triple by " year o! age# 8"# i!


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(establish trusting relationship (meds (leas restrictive methods'environment# "*4# $$?,Hs (antidepressants) take about . weeks to work# "*5# +bsession is to thought# 2ompulsion is to action "*7# i! patients have hallucinations redirect them# ,n delusions distract them# "*8# =horaDine, haldol (antipsychotic) can lead to EP$ (e;trapyramidal side e!!ects) ".9# @lDheimerHs disease is a chronic, progressive, degenerative cognitive disorder that accounts !or more than 49S o! all dementias "# =o remember how to draw up ,N$KE,N think& Nicole .ichie .N (a teacher taught us this is school, thought it was !unny and never !orgot itNNN) @ir into NP


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7yper natre+ia (greater than 'J>$ /kin !lushed Agitation ?ow grade !ever ThirstDevelop+ental *(. months& turns head side to side /(0 months& grasps, switch % roll 4(5 months& sit at 4 and waves bye(bye 7(8 months& stands straight at eight"9("" months& belly to butt (phrase has "9 letters) "*(". months& twelve and up, drink !rom a cup 7epatitis ,=< ,N2+1P?E


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3or blood types& T+T is the universal donor (remember LoL in donor) T@6T is theuniversal receipient Aisseminated hen using a bronchodilator inhaler inconCuction with a glucocorticoid inhaler, administer thebronchodilator !irst =heophylline increases the risk o! digo;in to;icity and decreases the e!!ects o! lithium and Ailantin 1Ntal, an inhaler used to treat allergy induced asthma may cause bronchospasm, thinkU 1Nto the asthmatic lung ,soniaDid causes peripheral neuritis Peptic ulcers caused by eighted N, (Naso intestinal tubes) must !loat !rom stomach to intestine# Aon:t tape the tube right away a!ter placement, may leave coiled ne;t to pt on


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G .i!ampin ( .ed orange tears and urine, also contraceptives don:t work as wellG Ethambutol ( messes with your Eyes G @pply eye drop to conCunctival sac and a!ter wards apply pressure to nasolacrimal duct ' inner canthus G Pancreatitis patients but them in !etal position, NP+, gut rest, prepare antecubital site !or P,22 cuD they:ll probably be getting =PN'Eipids G =rendelenburg test ( !or varicose veins# ,! they !ill pro;imally = varicosity# ?ule o! nines, 8 = head, "7 = arms, .4 = torso, .4 =legs, and "= perineum = "99S @hen giving Caye-alate we need to worry a!out dehydration ( C ha ineverse relationship with Na$ Iogurt has livecultures- dont give to i++unosuppressed pt 1tching under cast area- cool air via !low dryer ice pack ,or '(- '> +inutes: NEVE. use Ftip or anything to scratch area 1urphyHs sign I pain with palpation o! gall bladder area seen with cholecystitis 2ullenHs sign I ecchymosis in umbilical area, seen with pancreatitis =urnerHs sign I !lank grayish blue (turn around to see your !lanks) pancreatitis 1c6urneyHs Point I pain in ?EQ indicative o! appendicitis EEQ I diverticulitis , lowresidue, no seeds, nuts, peas ?EQ I appendicitis, watch !or peritonitis Buthrie=est I =ests !or PKK, baby should have eaten source o! protein !irst $hilling =est I test !or pernicious anemia' how well one absorbs -it b"* @llenHs test I occlude both ulnar and radial artery until hand blanches then release ulnar# ,! the hand pinks up, ulnar artery is good and you can carry on with @6B'radial stickas planned# @6B$ must be put on ice and whisked to the lab# o,tHs ok to have abdominal craps, blood tinged out!low and leaking around site i! the Peritoneal Aialysis cath (tenkho!!) was placed in the last "(* wks# 2loudy out!low NE-E? N+?1@E# o@mniotic !luid yellow with particles = meconium stained o


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=ensilon is used in myesthenia gravis to con!irm the diagnosis# 1yesthenia gravis is caused by a disorder in the transmission o! impulses !rom nerve to muscle cell# @myotrophic lateral sclerosis ( @E$ ) is a condition in which there is a degeneration o! motor neurons in both the upper % lower motor neuron systems# Transesophageal Distula (TED$ ( esophagus doesn:t !ully develop (this is a surgicalemergency) =he M 3Es o, TED in the newborn& ") 2hoking *) 2oughing .) 2yanosis =he 11? vaccine is given $Q not ,1# ?ed((unstable, ie, occluded airway, activelybleeding, see !irst Fellow(((stable, can wait up to an hour !or treatment, ie burns, see second Breen(((stable, can wait even longer to be seen, Twalking woundedT 6lack((unstable clients that will probably not make it, need com!ort measures A+@(((dead on arrival Breek heritage ( they put an amulet or any other use o! protective charms around their baby:s neck to avoid Tevil eyeT or envy o! others4 year old kids cannot interpret TIME# Need to e;plain time in relationship to a known 2+11+N E-EN= (eg& T1om will be back a!ter supperT)# GG @naphylactic reaction to baker:s yeast is contraindication !or hen on nitroprusside, monitor thiocynate (cyanide)# Normal value should be ", )" is heading toward to;icity GG,! kid has cold, can still give immuniDations GG$@?$ (severe acute resp syndrome) airborne R contact (Cust like varicella) GG


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,nsomnia is a side e!!ect o! thyroid hormones# $aunders con!irms it# 1akes sense thoughN ,ncreased met# rate, your body is Ttoo busy to sleepT as opposed to the !olks with hypothyroidism who may report somnolence (dec# met rate, body is slow and sleepy)# +k some more !acts# GG 6+=+O !or strabismus# Patch the B++A eye so that the weaker eye can get stronger# 3ound a cool link about its use in pedspt with strabismus# , had to look it up cuD , heard it was important Gah hem ahhemG GG =,A@E -+EK1E is 5 I "9ml ' kg GG 2+PA patients ?E1E16E?& *EN2 or less (hypo;ic N+= hypercapnic drive), Pa9* o! 49ish and $a9* 89S is normal !or them b'c they are chronic 2+* retainers# ### GG Neostigmine'@tropine (anticholinergic) to reverse e!!ect o! pancuronium# GG@mpho 6 causes hypokalemia (amongst many other things##gotta premedicate be!ore giving# Pts will most likely get a !ever) GG=est / hypersensitivity be!ore the administration o! asparginase# GG =ake -ermo; with high !at diet (increases absorption) GG Kidney Blucose threshold is "79 GG @mphogel and ?enegal take with meals GG $tranger an;iety is greatest 5 ( 8 months, $eparation an;iety peaks in toddlerhood GG 11? is a $Q shot Eymes is !ound mostly in 2onneticut @sthma and @rthritis((swimming best @sthma has intercostal retractions((be concerned =ardive Ayskinesia ( irreversible ( involuntary movements o! the tongue, !ace and e;tremities, may happen a!ter prolonged use o! antipsychotics @kathisia ( motor restlessness, need to keep going, t; with antiparkinsons meds, can be mistaken !or agitation# >hen drawing an @6B, you need to put the blood in a hepariniDed tube, make sure there are no bubbles, put on ice immediately a!ter drawing, with a lable indicating i! the pt was on room air or how many liters o! +*# ?emember to pre!orm the @llen:s =est prior to doing an @6B to check !or su!!icient blood !low 6e!ore going !or Pulmonary 3uction =ests (P3=:s),

a pt:s bronchodilators will be with(held and they are not allowed to smoke !or/ hrs prior 3or a lung biopsy, position pt lying on side o! bed or with arms raised up on pillows over bedside table, have pt hold breath in mide;piration, chest ;(ray done immediately a!terwards to check !or complication o! pneumothora;, sterile dressing applied 3or a lumbar puncture, pt is positioned in lateral recumbent !etal position, keep pt !lat !or *(. hrs a!terwards, sterile dressing, !requent neuro assessments EEB, hold meds !or */(/7 hrs prior, no ca!!ine or cigarettes !or */ hrs prior, pt can eat, pt must stay awake night be!ore e;am, pt may be asked to hyperventilate and watch a bright !lashing light, a!ter EEB, assess pt !or seiDures, pt:s will be at increased risk Aiamo;, used !or glaucoma, can cause hypokalemia

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Ae;edrine, used !or @A


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(0unchausen /yndro+e is a psychiatric disorder that causes an individual to sel!(in!lict inCury or illness or to !abricate symptoms o! physical or mental illness, in order to receive medical care or hospitaliDation# ,n a variation o! the disorder, 0unchausen !y pro-y (0/2%$, an individual, typically a mother, intentionally causes or !abricates illness in a child or other person under her care# (0ultiple /clerosis is a chronic, progressive disease with demyelinating lesions in the 2N$ which a!!ect the white matter o! the brain and spinal cord# 0otor /6/5limb weakness, paralysis, slow speech /ensory /6/5 numbness, tingling, tinnitus3ere!ral /6/5 nystagmus, ata;ia, dysphagia, dysarthria 7untingtonEs 3horea5 09Sgenetic, autosomal dominant disorder $'$& chorea (() writhing, twisting, movements o! !ace, limbs and body (gait deteriorates to no ambulation (no cure, Cust palliative care (>62 shi!t to the le!t in a patient with pyelonephritis (neutrophils kick in to !ight in!ection) (Ae!initive diagnosis !or abd# aortic aneurysm (@@@) --& 2= scan (Aon:t use Kaye;alate i! patient has hypoactive bowel sounds# (Kremic !etor --& smell urine on the breath (


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=hank you, , !inally realiDe why a person shouldn:t have cantaloupe be!ore a occult stool test, because cantaloupe is high in vit c and vit c causes a !alse R !or occult blood# Now , Cust need to !igure out why they can:t have !ish# 7ypospadias5 abnormality in which urethral meatus is located on the ventral (back) sur!ace o! the penis anywhere !rom the corona to the perineum (re+e+!er hypo low (,or lower side or under side$ Epispadias5 opening o! the urethra on the dorsal (!ront) sur!ace o! the penis %riapis+5 pain!ul erection lasting longer than 4 hrs#@nticholinergic e!!ects((assessment dry mouth==can:t spit urinary retention=can:t GGGG constipated =can:t GGGG blurred vision=can:t see >hen you see 2o!!ee(brownemesis, think peptic ulcer *#@nytime you see !luid retention# =hink heart problems!irst# .#@n answer that delays care or treatment is @E>@F$wrong /#3or P-A remember A@-E (Eegs are Aependent !or@rterial % !or -enous Elevated) more to come########## ·

>hen choosing an answer, think in this mannerU i! you can only do +NEF one thing to help this patient what would it beM Pick the most important intervention#

,! two o! the answers are the e;act opposite, like bradycardia or tachycardia###one is probably the answer# ,! two or three answers are similar or are alike, none is correct# >hen asking patientsH questions NE-E? use VwhyW questions# Eliminateall VwhyMW answer options# ,! you have never heard o! itU please donHt pick itN Nevr release traction KNEE$$ you have an order !rom the 1A to do so Questions about a haloM ?emember sa!ety !irst, have a screwdriver nearby# ?emember compartment syndrome is an emergency situation# Paresthesias and increased pain are classic symp

toms# Neuromuscular damage is irreversible /(4 hours a!ter onset# @lways deal with actual problems or harm be!ore potential problems @lways select a Vpatient !ocusedW answer# @n answer option that states Treassess in "0 minutesT is probably wrong# ,nterpersonal model ($ullivan) 6ehavior motivated by need to avoid an;iety and satis!y needs "# ,n!ancy 9("7 months others will satisy needs *# childhood )4yrs learn to delay need grati!ication .# Cuvenile 4(8 years learn to relate to peers /# preadolescence 8("* yrs learns to relate to !riends o! o! opposite se; 0#early adolescence"*("/yrs&learn independence and how to relate to opposite se; 4# late adolecence "/(*"yrs& develop intimate relationship with person o! opposite se; is this not about communicationM####

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3etal alcohol syndrome (upturned nose (!lat nasal bridge (thin upper lip ($B@ vastus lateralis is ,1 administration site !or 4month in!ants 3or toddlers above "7 months ventrogluteal =he deltoid and gluteus ma;imus are appropriate sites !or children +K( both eyes +$( le!t eye +A( right eye ( dominent ?ight eye( Cust a tip to remember) "# 3OA? (cane walking)& 3 ( cane O ( opposite A ( a!!ected ? ( leg ?ed( ,mmediate& ,nCuries are li!e threatening but survivable with minimal intervention# E;& hemothra;, tension pneumothora;, unstable chest and abdominal wounds, ,N2+1PEE=E amputations, +PEN !;:s o! long bones, and *nd'.rd degree burn with "0S(/9S o! total body sur!ace, etc# Fellow( Aelayed& ,nCuries are signi!icant and require medical care, but can wait hrs without threat to li!e or limb# E;& $table abd wounds without evidence o! hemorrhage, !; requiring open reduction, debridement, e;ternal !i;ation, most eye and 2N$ inCuries, etc# Breen( 1inimal& ,nCuries are minor and t; can be delayed to hrs or days # ,ndividuals in this group should be moved away !rom the main triage area# E;& upper e;tremity !;, minor burns, sprains, sm# lacerations, behavior disorders# 6lack( E;pectant& ,nCuries are e;tensive and chances o! survival are unlikely# $eperate but dont abandoned,com!ort measures i! possible# E;& Knresponsive, spinal cord inCuries, woulds with anatomical organs, *nd'.rd degree burn with 49S o! body sur!ace area , seiDures, pro!ound shock with multipe inCuries, no pulse, b#p, pupils !i;ed or dilated# =horacentesis prep( =ake v#s#, shave area around needle insertion, position patient with ar+s on pillow on over !ed ta!le or lying on side no more than "999ccat a one time# Post( listen !or bilateral breath sounds, v#s#, check leakage, sterile dressing# 2=( assess allergies 1?,( claustrophobia, no metal, assess pacemaker 2ardiac cath( npo 7("*hr, empty bladder, pulses, tell pt may !eel heat palp

itations or desire to cough with dye inCection# Post( -ital signs keep leg straight bedrest 4(7hr# cerebral angio prep( well hydrated, lie !lat, sire shaved, pulses marked post( keep !lat "*("/hr, check site, pulses,!orce !luids# Eumbar puncture( !etal postion# post( nuero assess q"0(.9 until stable, !lat*(.hr, encourage !luids, oral anlgesics !or headache, observe dressing

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EEB( no sleep the night be!ore, meals not withheld, no stimulants !or */hr be!ore, tranquiliDer'stimulant meds held */(/7hr be!ore, may be asked to hyperventilate .(/min and watch a bright !lashing light# 1yelogram( Npo /(4hr, allergy h;, phenothiaDines, cns depressants, and stimulants withheld /7hr prior, table will be moved to various postions during test# Post( neuro q*(/, water solu!le 7O2 upoil solu!le 7O2 down oral analgesics !or h'a, encourage po !luids, assess !or distended bladder, inspect site# Eiver biopsy( @dm vit k , npo morning o! e;am 4hr, give sedative, Teach pt that he will !e asked to hold !reath ,or >-'(sec supine postion lateral with upper ar+s elevated: %ost- postion on right side ,reFuent v:s: report severe a! pain stat no heavy li!ting "wk# Paracentesis( semi !owlers or upright on edge o! bed, empty bladder# Post( v#s#, report elevated temp, observe !or signs o! hypovolemia# Eaparoscopy( 2+* used to enhances visual, general anesthesia, !oley# %ost- walk patient to decrease 3O< !uild up used ,or procedure: Pyelogram( assess allergies $engstaken blakemore tube used !or t; o! esophageal varices, keep scissors at !edside:


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"/# E,-E? 2,??


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/9# ,N3E2=,+K$ 1+N+NK2EE+$,$ I


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=ake iron eli;ir with Cuice or water#### never with milk Kawasaki:s leads to Ailantin "9(*9 =heophyline "9(*9 @cetaminophen "9(*9 Eithium 9#0("#0 Aigo;in 9#0(*#9 +steomyletitis is an in!ectious bone dD# Bive blood cultures and antibiotics,then i! necessary surgery to drain abscess# Nephrotic syndrome s's edema R hypotension# =urn and reposition (risk !or impaired skin integrity) =o access role relationship pattern !ocus on image and relationships with others# ?enal impairment& serum creatinine elevated and urine clearance decreased cardiac problems

Norm# $erum creatinine 9#7("#7 (men), 9#0("#0 (women) Norm# Krine clearance 70(".0 @tropine +verdose


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$alt substitutes may contain pottasium Placental abruptio& bleeding with pain, don:t !orget to monitor volume status (,%+) @n ill child regresses in behaviors 1eningeal irritation $'s nuchal rigidity, positive 6rudDinski R Kernig signs andP


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.)No ,1 meds as much as possibleN G,ron de!iciency anemia ( easily !atigued ")3e P+ ( give with -itamin 2 or on an empty stomach *)3e via ,1( ,n!eron via Ltrack A%ernicious Ane+ia ( ?ed, 6e!!y tongue will take -it#6"* !or li!eN A24.N/ "st Aegree ( ?ed and Pain!ul *nd Aegree ( 6listers .rd Aegree ( No Pain because o! blocked and burned nerves A0eniereEs Disease ( @dmin diuretics to decrease endolymph in the cochlea, restrict Na, lay on a!!ected ear when in bed# =riad& ")-ertigo *)=innitus .)N'A*astric 4lcer pain occurs .9 minutes to 89 minutes a!ter eating, not at night, and doesn:t go away with !ood G=hink positive and you can achieve great things# =hink o! present and !uture, the past is gone# ./or,et your past mistakes and focus on your successes encoura,in, yourself to ,reater achievements in the future. .0l(ays do your 1est so you can 1e proud that you ,ave it your 1est shot. ./ocus on your achievements rather than your failures. If you do find yourself thinkin, a1out ho( you failed then look at (hat you mana,ed to do ri,ht and ho( you could correct (hat you did ne t time. .0 mind that is trou1led (ith dou1t (on2t 1e a1le to focus on the victory to 1e had. G=ake it one day at a time# G=ake time !or yoursel!# @ !ried mind can:t !ocus or learn# Pediatric =ips& >hat is an intraosseous in,usionM ,n pediatric li!e(threatening emergencies,when iv access cannot be obtained, an osseous (bone) needle is hand(drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can !e ad+inistered into the +arrow# ,t is a temporary, li!e(saving measure, and , have seen it onceN (Bruesome#) >hen venous access is achieved it can be d'cHd# +ne medication that cannot be administered by intraosseous in!usion is isoproterenol, a beta agonist# (, donHt know more about that drug it was Cust pointed out on a practice e;am#) Auring sickle cell crisis there are two intervention

s to prioritiDe& ,luids and pain relie!# >ith glo+erulonephritis you should consider !lood pressure to be your most important assessment parameter# Aietary restrictions you can e;pect include !luids, protein, sodium, and potassium# ?emember yesterday when , mentioned how congenital cardiac de!ects result in hypo-ia which the body attempts to compensate !or (in!lu; o! immature rbcHs)M Eabs supporting this would show increased he+atocrit he+oglo!in and r!c count# Aid you know there is an association between low-set ears and renal ano+aliesM Now you know what to look !or i! downHs isnHt there to choose# (Cust to e;pand on it a little,the kidneys and ears develop around the same time in utero# hich is why when doing an assessment o! a neonate, i! the nurse notices low set or asymmetrical ears, there is good reason to investigate renal !unctioning# Knowing that the kidneys and ears are similar shapes helped me remember this)#

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$chool(age kids (> and up) are old enough, and should have an e-planation o! what will happen a week be!ore surgery such as tonsillectomy# ,! you gave a toddler a choice about taking medicine and he says no, you should leave the room and co+e !ack in !ive minutes, because to a toddler it is another episode# Ne;t time,donHt ask# =he ,irst sign o! pyloric stenosis in a baby is +ild vo+iting that progresses to proBectile vo+iting# Eater you may be able to palpate a mass, the baby will seem hungry o!ten, and may spit up a!ter !eedings# >e know Cawasaki disease causes a heart problem, but what speci!icallyM 3oronary artery aneurys+s d't the in!lammation o! blood vessels# @ child with a ventriculoperitoneal shunt will have a small upper(a!do+inal incision# =his is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles# Fou should watch !or a!do+inal distention, since !luid !rom the ventricles will be re(directed to the peritoneum# Fou should also watch !or signs o! increasing intracranial pressure, such as irritability, bulging !ontanels, and high(pitched cry in an in!ant# ,n a toddler watch lack o! appetite and headache# 2are!ul on a bedposition questionN 6ed(position a,ter shunt place+ent is ,lat, so !luid doesnHtreduce too rapidly# ,! you see s's o! increasing icp, then raise the hob to "0(.9 degrees# >hat could cause !ronchopul+onary dysplasiaM Aysplasia means abnormality or alteration# 0echanical ventilation can cause it# Premature newborns withimmature lungs are ventilated and over time it damages the lungs# +ther causes could be in!ection, pneumonia, or other conditions that cause in!lammation or scarring# ,t is essential to +aintain nasal patency with children ) ' yr# because they are obligatory nasal breathers# >atch out !or questions suggesting a child drinks more than .(/ cups o! milk each day# (1ilks good, rightM) =oo much milk re

duces intake o! other essential nutrients, especially iron# >atch !or ane+ia with +ilk-aholics# @nd donHt let that mother put anything but water in that kidHs bottle during naps'over(night# Puice or milk will rott that kids teeth right outo! his head# >hat traction is used in a school(age kid with a !emur or tibial !racture with e;tensive skin da+ageM Ninety ninety# hile weHre talking about traction, a kidHs hinder should clear the !ed when in2ryantGs traction (also used !or !emurs and congenial hip !or young kids)# ,! you can remove the white patches !rom the mouth o! a baby it is Cust !ormula# ,! you canGt its candidiasis# Pust know the 00. and Varicella i++uni8ations co+e later ("0 months)# Kndescended testis or cryptorchidis+ is a known risk !actor !or

testicular cancer later in li!e# $tart teaching boys testicular sel, e-a+ around '


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3/D in +eningitis will have high protein, and low glucose# ,t is always the correct answer to report suspected cases o, child a!use# No nasotracheal suctioningwith head inBury or skull ,racture# Deed upright to avoid otitis media# Position prone w hob elevated with gerd# ,n almost every other case, though, you betterlay that kid on his back (6ack =o $leep ( $,A$)# Pull pinna down and !ack ,or kids ) M yrs# when instilling eardrops# Kids with ?$- no contact lenses or pregnant nurses in rooms where ri!avirin is being administered by hoot, tent, etc# Positioning with pneumonia I lay on the a,,ected side to splint and reduce pain# 6ut i! you are trying to reduce congestion the sick lung goes up# (Ever had a stu!!y nose, and you lay with the stu!! side up and it clearsM) @ positive ppd con!irms in,ection, not Cust e;posure# @ sputu+ test will con!irm active disease# 3oughing w'o other s's is suggestive o! asth+a# $peaking o! asthma, watch out i! your whee8er stops whee8ing# ,t could mean he is worsening# Fou better pick Ndo vitalsG be!ore administering that dig# (apical pulse !or one !ull minute)# Tet spells treated with +orphine# *roup-a strep precedes rheu+atic ,ever# 3horea is part o! this sickness (grimacing, sudden body movements, etc#) and it e+!arrasses kids# =hey have Boint pain# >atch !or elevated antistreptolysin + to be elevated#PenicillinN AonHt pick cough over tachycardia !or signs o! ch, in an in!ant# ?andom =ips& No +ilk (as well as !resh !ruit or veggies) on neutropenic precautions# Tylenol poisoning I liver !ailure possible !or about J days# 2lose observation required during this time(!rame, as well as t; with 1ucomyst# .adioactive iodine I =he key word here is ,lush# 3lush substance out o! body w'.(/ liters'day !or * days, and !lush the toilet twice a!ter using !or * days# Eimit contact w'patient to .9 minutes'day# No pregnant visitors'nurses, and no kids# =he main hypers

ensitivity reaction seen with antiplatelet drugs is !ronchospas+ (anaphyla;is)#2ommon sites !or +etastasis include the liver, brain, lung, bone, and lymph# Orthostasis is veri!ied by a drop in pressure with increasing heart rate# 2ence Hones protein in the urine con!irms +ultiple +yelo+a#

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AonHt !all !or Yreestablishing a normal bowel patternH as a priority with small!owel o!struction# 6ecause the patient canHt take in oral !luids Ymaintaining ,luid !alanceG comes !irst# %ernicious ane+ia s's include pallor, tachycardia, and sore red tongue# >ith !lecainide (Ta+!ocor), an antiarrythmic, li+it ,luids and sodium intake, because sodium increases water retention which could lead to heart !ailure# 2asophils release hista+ine during an allergic response# Adenosine is the treatment o! choice !or paro;ysmal atrial tachycardia# 1atragenic means it was caused by treatment, procedure, or medication# +ther than initially to test tolerance, *-tu!e and H-tu!e !eedings are usually given as continuous !eedings# Dour side-rails up can be considered a !orm o! restraint# Even in E=2 !acilitywhen a client is a !all risk, keep lower rails down, and one side o! bed against the wall, lowest position, wheels locked# Four cancer patient is getting radiation# >hat should you be most concerned aboutM $kin irritationM No# ,n!ection kills cancer patients most because o! the leukopenia caused by radiation# @ breastcancer patient treated with Ta+o-i,en should report changes in visual acuity, because the adverse e!!ect could be irreversible# %neu+ova-


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Anectine is used !or short-ter+ neuro+uscular blocking agent !or procedures like intubation and E2=# Norcuron is !or intermediate or long(term# =he parathyroidgland relies on the presence o! vita+in D to work# *lucagon increases the e!!ects o! oral anticoagulants# 2leeding is part o! the YcirculationH assessment o! the A23DHs in an emergent situation# =here!ore, i! airway and breathing are accounted !or, a compound !racture requires assessment be!ore Blasgow coma scale and a neuro check (A=disability, or neuro check) =he immediate intervention a!ter a sucking sta! wound is to dress the wound and tape it on three sides which allowsair to escape# Ao not use an occlusive dressing, which could convert the wound !rom open pneumo to closed one, and a tension pneumothora; is worse situation# @!ter that get your chest tube tray, labs, iv# @n occlusive dressing is used i! achest tu!e is accidentally pulled out o! the patient# >hen o* deprived, as witha %E, the body compensates by causing hyperventilation (resp alkalosis)# $houldthe patient breathe into a paper bagM No# ,! the pao* is well below 79 they need o-ygen# Eook at all your abg values# @s soon as you see the words PE you should think o;ygen !irst# @ typical adverse reaction to oral hypoglyce+ics is rash, photosensitivity# /eru+ acetone and seru+ ketones rise in DCA# @s you treat the acidosis and dehydration e;pect the potassiu+ to drop rapidly, so be ready, withpotassium replacement# Dluids are the most important intervention with 77N/ as well as DCA, so get !luids going !irst# >ith


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>ith o+phalocele and gastroschisis (herniation o! abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp# Kid canlose heat quickly# @!ter a hydrocele repair provide ice !ags and scrotal support# No phenylalanine with a kid positive !or %C4 (no meat, no dairy, no aspartame)# /econd voided urine most accurate when testing !or ketones and glucose# Nevergive potassiu+ i! the patient is oliguric or anuric# Nephrotic syndro+e is characteriDed by massive proteinuria (looks dark and !rothy) caused by glomerular damage# 2orticosteroids are the mainstay# BeneraliDed edema common# @ positive @estern !lot in a child J"7 months (presence o!


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it has something to do with muscle (myo) cancer (sarcoma)# =he same thing goes !or drug names# 3or e;ample, i! it ends in Iide itHs probably a diuretic, as in 3urosemide, and @myloride# ?asi- can cause a patient to lose his appetite (anore-ia) due to reduced potassium# ,! your laboring momHs water breaks and she is any +inus station you better know there is a risk o! prolapsed cord# ,n a ,ive-year old !reathe once ,or every > compressions doing cpr# @!ter g-tu!e place+ent the stomach contents are drained by gravity !or


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%rolonged hypo-e+ia is a likely cause o! cardiac arrest in a child# Dluid volu+e overload caused by ,-2 !luids in!using too quickly (or whatever reason) and 2


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hyperthyroid)# ?eport it to the doc# Bive synthroid on an e+pty stomach E-tra insulin may be needed !or a patient taking %rednisone (remember, steroids cause increased glucose)# Non,at +ilk reduces re,lu- by increasing lower esophageal sphincter pressure Patients with *E.D should lay on their le,t side with the


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216277067 HAAD Reviewerhaad

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