Ncle x Study Guide Vm

7/25/2019 Ncle x Study Guide Vm

1/20

NCLEX study guide

Addisons Disease Cushings Disease

-think hyperthyroidism sx -think hypothyroidism sx

Hyposecretion of glucocorticoids

-not enough aldosterone = lose water (think

diuretics..some block aldosterone)

Hypersecretion of glucocorticoids

-too much aldosterone = water retention

Hypovolemia Hypervolemia

Hot Cold (Cushings = Cold)

K Ca Na (lose H!"# lose $a) K Ca Na (gain H!"# gain $a)Hypoglycemia (% insulin production) Hyperglycemia (& insulin production) ' ketoacidosis

et skin ry skin (hyper = dryer) hyperglycemia = dry skin

*ethargy# fatigue# muscle weakness +enerali,ed muscle wasting# weakness

Hypotension (&$a) Hypertension (% $a)

eight loss eight gain low healing

ecreased blood volume ' shock

Hyperkalemia = meta acidosis ' arrhythmias

/oon face# buffalo hump# obesity (trunk)# thin skin#

reddish-purple striae

01230/2$04 hormone replacement 01230/2$04 hypophysectomy# adrenalectomy

Addisonian crisis

-medical emergency

-critical deficiency of glucocorticoids

-generally follows acute stress# sepsis# trauma#

surgery# or omission of steroid therapy

s/sx:severe abd pain# sudden profound weakness#hyperpyrexia followed by hypothermia# coma#

renal failure

"steoporosis (excess cortisol = %Ca reabsorption from

bones)

Hyperthyroidis Hypothyroidis

- fast - slow

-% metabolism & metabolism

-sympathetic $ sx -parasympathetic $ sx

-nervousness# irritable# excitable# tachycardia#perspiration# flushed face# exophthalmus# increased

appetite# limp hair# wt loss# H0$

-extreme fatigue# dry skin# coarse hair# numbness andtingling of fingers# alopecia# wt gain

-heat intolerance -cold intolerance

5odine uptake % 5odine uptake &

!ra"es disease #yxedea coa

$hyroid stor

-tachycardia

-delirium

-coma

-pt with hyperthyroidism is typically nervous andhas insomnia.

-don6t place in same room with another pt withhyperthyroidism because too much stimuli.

-place in private room.

%eo"ing tu&es and things

Chest tubes Have pt perform valsalva maneuver# or take and hold deep

breath (have seen both in nclex books)

$+ tube Have pt take and hold a deep breath

75CC line Have pt perform valsalva maneuver

07$ line 8alsalva maneuver


2/20

Hyperg'yceia hyperoso'ar non(etotic

syndroe )HHNK*+

DKA

-occurs in people with /-! -occurs in peoplee with /-9

-glucose : ;


3/20

7arietal lobe = primary center for sensation

0emporal lobe = auditory reception areas

?rontal lobe = involved with personality# behavior# emotions# intellectual function# if inured may have difficulty

comprehending what is said

"ccipital lobe = primary visual receptor center

/3*"

La& "a'ues

> .D E D.9 (no pee# no >)

$a 9D E 9FD

/g 9.G E !.G

Cl ; E 9


4/20

3lbumin .F E D

?e GD-9ID

3*030 D-G en,ymes /B = cardiac muscle

BB = brain

// = skeletal

0roponins -better indicator of detecting /5 than C>s

Cl- levels in sweat test for

Cystic ?ibrosis

:Gorsakoff 7sychosis=

tyramine deficiency)

-avoid with #A53s# migraines

-figs# avocados# bananas# papaya# raisins

-aged cheese# yeast# yogurt# sour cream

-soybeans# beer# red wine

-beef# liver# sausage# bologna# deli meat

-chocolate

7urine -avoid with gout

-fish# sardines

-liver# beef# chicken# sausage# organ meats+luten -avoid with Celiacs disease

8itamin >

(antidote for Coumadin)

-broccoli# cabbage# turnips

-fish# liver-coffee# tea (caffeine)

8itamin B9! (thiamine) -found in animals# nuts# whole grain cereals

-pt with cirrhosis needs a diet high in B9!

Calcium -eggs

-green leafy veggies

7otassium -potatoes

-bananas

-spinach

-raisins-dates

-oranges

-dried apricots

5ron -can give with 8itamin C (tomato uice# "S)

-clams

-liver# beef# shrimp

-turkey

-cereal

-pasta

?olic acid -liver

-papaya

-legumes# vegs# spinach-nuts# bran# cereal

-fruit# yeast# asparagus

3cid ash diet -avoid milk = makes urine alkaline

8itamin toxicity -+5 upset and metallic taste

-H3# weakness# renal insufficiency# renal calculi# H0$# arrhythmias# muscle

pain# conunctivitis

Crohns diet -*ow fat

-*ow residue (no popcorn)

-High protein

Calcium -take 9 hour after meals with full glass of water

3C2 inhibitors -take 9hour before meals

1hogam /om (-) Baby (')

urns

uperficial partial

thickness

-first degree

-sunburn

-epidermis

-red# blanches with pressure

-possible blisters


10/20

eep partial thickness -second degree

-scald

-epidermis# upper dermis# part of

deeper dermis

-blistered# mottled red base

-weeping# edema

?ull thickness -third degree

-flame# chemicals# electrical

current

-epidermis# entire dermis#musclebone

-dry# pale white

-leathery# fat exposed# edema

Pburn pt at risk for %>

#isc #ed/*urg diseases

+uillain-Barre yndrome -% weakness (ascending)

-neuro problem = acute infection of cranial and peripheral nerves

-pt co respiratory infection or +5 infection in past med hx

-immune system overreacts and destroys myelin sheath

-maor concern = problems breathing

ssx = paresthesis# lower extremity weakness# gradual progressive

weakness# possible resp failure# cardiac probs# high protein in C?

/yasthenia +ravis -eye problems

-sedatives make sx worse-neuro prob

-weakness and fatigue

-have pt do things in am

-defect in transmission of nerve impulses

-give meds before meals

ssx = weakness# fatigue# difficulty chewing# dysphagia# weakhoarse

voice# resp failure# ptosis# diplopia# decreased breath sounds-everything pretty much slows down and gets weak

$ensi'on test= used to dx

-if pt shows improvement after tx = dx


11/20

Hirschsprings d, -mega-colon

-results in mechanical obstruction bc of inadeKuate motility

ssx = failure to gain weight# abd distention# vomiting# ribbon-like and

foul smelling stools (not with newborns 5 thinkR)# constipation

alternating with diarrhea

B-thalassemia -too much ?e

-autosomal recessive disorder

-decreased production of 9 of the globin chains in the synthesis of Hgb

-chelation drug therapy (gets rid of ?e)Hip replacement -avoid extreme external# internal rotation

-avoid adduction

-no side-lying on operative side

-maintain abduction with pt in supine position or on non-operative side

-do not cross legs

-place pillow bw legs to maintain abduction

ernicke->orsakoff

syndrome

-neuro disorder

-acute encephalopathy

-chronic psychosis

-caused by deficiency in 8it B 0yramine deficiency

/ultiple myeloma -%Ca caused by bone destruction is the primary concern

-encourage fluids (dilutes Ca)7ancreatitis -do not give morphineO (irritates pancreas)

-pain is severe and unrelenting in epigastric area and radiates to back

-observe for &@"# %H1

-diet = &fat# &protein# %carbs# > supplements

-typically rest +5 by making pt $7" but give lots of 58 fluids

(') 0urners sign = bruiselike discoloration in flank

(') Cullens sign = bluish hemorrhage around umbilicus

umping syndrome -limit fluids with meals

-early sx = sweating and pallor

-D-< min after eating-also vertigo# tachycardia# desire to lie down

?at embolus -tachypnea

-tachycardia

-dyspnea

3ir embolus -chest pain

-dyspnea

-lightheadedness

-nausea

-di,,iness

-hypoxia

-anxiety

-%H1&B7

*iver biopsy -position pt on right side to help decrease risk of hemorrhage

-dont let pt cough = can cause bleeding

Dthd, -not contagious after rash

7eptic ulcer d, 7rimary sx of perforation = board-like abd and shoulder pain (blood)

Coffee ground emesis = slower internal bleeding

3sthma -diminished whee,ing in a child with asthma indicates possibleworsening of asthma

7osturing ecerebrate = cerebellum problem

ecorticate = cortex problem

-ecorticate is more favorable than decerebrate (thought it was other

way aroundQ)


12/20

7heochromocytoma -produces catecholamines (epi)

-tumor E adrenal medulla

-headache# diaphoresis# palpitations# H0$# tremor# hyperglycemia

-dont palpate abd = can cause more catecholamines (cells) to be released

and cause severe H0$

7arathyroid -monitor Ca and 7 (Ca% 7&)

Hyperparathyroidis )Ca6 -+

-increased sleeping

-increased urination-weakness

-bone pain

-irritability

Hypoparathyroidis )Ca6 -+

-increased urinary freKuency

53H -decreased @" = fluid overload# H0$# %H1

-water intoxication

-&$a (dilutional hyponatremia)

-too much antidiuretic hormone (vasopressin)

-treatment is effective if4 %@"# &wt# &urine osmolalityiabetes insipidus -deficiency of 3H = & ability of kidneys to concentrate urine

-give vasopressin

ssx = polyuria# polydipsia# fatigue# dilute urine# intense thirst#

dehydration# wt loss# H3# tachycardia# %$a in urine

0umor lysis syndrome -emergency of electrolyte imbalance

-potential renal failure

7ulmonary 2mbolism -blood tinged sputum

-chest pain

-cough

-cyanosis

-distended neck veins-dyspnea

-&B7# %H1

-whee,es

-tachypnea

1enal failure -re-poor perfusion to kidneys

3ntra

-damage to kidneys# nephrotoxic inury from contrast# antibiotics#

corticosteroids

-ost-obstruction of urinary collecting system

3utonomic dysreflexia -hyperreflexia

-spinal cord inury 0D and above (5 think)

-overactivity of autonomic $

-kinked cath can cause it# constipation or full bladder (5ncr 5C7)

-pounding H3# H0$# sweating# bradycardia# restlessness

C"7 -use a high-flow venture mask to deliver "!bc you are giving a

controlled# specified amount of "!

s/sx4 dyspnea on exertion# barrel chest# clubbed fingers and toes


13/20

Cardio"ascu'ar

Complications of mitral stenosis -thromboembolism

-rheumatic fever (common complication of CH?)

-endocarditis

-pulmonary H0$

-pulmonary edema

Hemolytic transfusion rxn -headache

-tachycardia

-H0$ and Hypotension

-apprehension# sense of impending doom-fever# chills

-5C

-'o7 &ac( pain6 chest pain

3utologous transfusion rxn - ss of infestion ( greatest risk)

5notropic and Chronotropic rugs 3notropics

-affect force of muscle ctx

(-) inotropic effects = % myocardial contractile force(') inotropic effects = & myocardial contractile force (b-blockers)

Chronotropics-affects H1

(-) chronotropic effects = & H1 (parasym $# acetylcholine)

(') chronotropic effects = % H1 (sym $)# epi# atropine)

igoxin

(') inotropic

(-) chronotropic

rugs for H0$

(-) inotropic

(-) chronotropiciagnostic tests 9. 0roponins are more specific

!. C>-/B

Coronary arteriogram -femoral artery is used E keep pt on bedrest with H"B slightly

elevated for several hours

-%H1 in recovery may be a sign of hemorrhage (common

complication)

Cardiac tamponade -fluid around heart-pt may co heavy fullness around heart

?irst priority of care for pt with

cardiovascular problem

& cardiac workload

% myocardial oxygenation

L.sided Heart 4ai'ure %.sided Heart 4ai'ure H4 in chi'dren

*eft = *ung Sugular vein distention - gallop rhythm

yspnea 2dema

0achypnea t. gain

+allop rhythm4 # F 3scites

?ine crackles Hepatomegaly

hee,ing# rhonchi 0achycardia

0achycardia ?atigue

"liguria (fluid retention)

Pacute pulmonary edema Pmitral stenosis


14/20

#edications and 3nsu'in

#eds that 3nsu'in re8uireents #eds that 3nsu'in re8uireents

+lucocorticoids (cushings = hyperglycemia) ulfonylrureas

*i Uuinidine

1ifampin (0B) Uuinine (malaria)

7rogestins (oral contraceptives) 3C2 inhibitors

$icotine $aproxen

7henytoin 5ndomethacin (gout# 13# "3)

Ca-channel blockers alicylates

Clonidine B-blockers

/orphine

Heparin

Pexercise = insulin needs increase

Pbaby born to diabetic mom is at risk for hypoglycemia (give extra feedings of formula)

Dia&etes . 3nsu'in

5nset -ea( Coon types #isc9

1apid

/idmorn-

tremblingwkness

9Dmin 9-!h 3spart (novalog)

*ispro (humalog)

Clear# sliding scale# no 58# pump#

can mix with 5# *

hort

2arly evening E

wkness# fatigue


15/20

32 *o'utions

3sotonic

D -dont use during fluid resuscitation

-used mainly to supply water and correct % serum osmolality


16/20

#3*C:

7resence of glucose in nasal discharge = fluid is C?

Catecho'aines

-dopamine# epi

-released during times of stress

0hyroidectomy E monitor Ca and 7

Cheo treatent

-% uric acid levels in blood dt massive cell destruction

Ca'ette.guerin "acc= vacc for 0B-mantoux test will always be positive

C"!in blood = vasodilation

3llergy to bananaskiwis = allergy to latex

3cute pain sx = %B7# %H1# %11# %perspiration# &body 0# %dilated pupils (wide eyed with fear)

5f a Kuestion asks you to select a goal for a pt# make sure the answer you pick is an actual goalO

9. maintain "!ats above


17/20

0153+2 0 = trauma

1 = respiratory

5 = 5C7 and mental status

3 = an infection

+ = +5 # upper

2 = elimination# lower

$ypes o, p'ay

7arallel -toddlers

-side by side

-rarely interact

3ssociative -preschoolers

-all engaged 5 similar activity# but little organi,ation

Cooperative -school-age

-organi,ed and goal-directed

0herapeutic -techniKue used to help understand a childs feelings

7lay 0herapy - 3llow the child the express themselves easier

'ood

Complications of a blood transfusion ;9 $rans,usion rxns-weak pulse# fever# bradytachycardia# hypotension# oliguria

9 4'uid o"er'oad

?9 D@ transission

-Hep B# for example

9 Hypoca'ceia

-citrate in transfused blood binds with Ca and is excreted-hypereflexia# paresthesia# tetany# muscle cramps# '0rousseaus

sign# 'Chvosteks sign

09 Hyper(a'eia

-stored blood liberates >'

7t with severe blood loss reKuires rapid

transfusion. hat device is used during

blood transfusions to decrease risk of

cardiac dysrhythmiasQ

-blood warming device

-rapid transfusions of cool blood puts pt at risk for cardiac dysrhythmias

58 solution that can only be run with blood

transfusions


18/20

-ediatric/Boens Hea'th *tu,,

Ne7&orn Apgars );in6 ?in+

Heartrate (N or : 9.

-re'iinary signs o, 'a&or

-Braxton hicks ctx

-dropping (lightening)

-nesting

-lose 9-!lb

-bloody show

tages of *abor

*tage ;E ctx to complete dilation)

-*atent ( stimulates liver to produce

clotting factors

4eta' onitoring

$ormal = 99


19/20

7rimary intervention with a pediatric

burn pt = remove blisters

Centration= tendency to center

attention on 9 feature of something and

be unable to see its other Kualities

0each a pt with sickle cell how to

prevent sickling4 maintain hydration#

promote oxygenation# avoid strenuousactivity

7>@ = autosomal recessive

/ost important newborn reflex =

#5%5 (determines neuro dev)

7lacenta previa vs placenta abruptoQ

-A3N

+7073*

-'acenta pre"ia

-after !


20/20

Diuretics6 N*A3Ds6 drugs a,,ecting e'ectro'ytes

*asix -loop diuretic

-&>

HC0X -thia,ide diuretic

-&>

-exacerbates gout

3spirin -$35-& inflammation

-1eyes syndrome in kids

5ron sulfate -?e deficiency anemia-take with vitamin C

-best taken bw meals

-no antacids-make cause black stools

?osamax -%Ca

-take in morning on empty stomach

>Cl -never give 58 push

-use in pt with hypokalemia

>ayexalate -use in pt with hyperkalemia

0ylenol -not anti-inflammatory

-pain relief# fever

B9! -&> -for vit B9! deficiency

3ldactone -> sparing diuretic

/annitol -osmotic diuretic

-&5"75C7

-renal failure

CN* drugs

ilantin -antiepileptic

-only give with $

-se = blurred vision# diplopia

inemet

(levodopacarbidopa)

-parkinsons d,

5mitrex -H3

3ricept -al,heimers

$ubain -opioid

$arcan -opioid antagonist

/orphine -opioid-toxicity = pinpoint pupils# decreased 11# increased 5C7

7ro,ac -antidepressant# 15

2lavil -antidepressant# tricyclic

-anti-chol se

Autonoic drugsBethanechol -parasympathetic

-for urinary retention

-cholinergic

2pi -sympathetic

-inhalation = fastest route

3tropine -sympathetic

-anti-cholinergic

opamine -sympathetic

Documents

Ncle x Study Guide Vm