Hyperthyroidism is also called

Grave's disease or hypermetabolism

Tip to remember Grave's disease s/s's
"Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold
tolerance, hot intolerance
Treatment for Grave's disease
Radioactive Iodine, PTU (put thyroid under), surgically remove
Total thyroidectomy ... totals get
tetany, need lifelong hormone replacement
After thyroidectomy patients are at risk for
hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany,
parasthesia
parathesia
numbness and tingling, first sign of electrolyte imbalance
Subtotal thyroidectomy ... subs get
storm
S/S of thyroid storm
Extremely high vital signs, hyperpyrexia, psychotic delerium
How to treat thyroid storm
give o2, lower temp to spare brain
Risks post op for total thyroidectomy
airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany
Risks post op for sub total thyroidectomy
airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm
Hypothyroidism is also called
Myxedema or hypometabolism
S/S of mydexema
everything is down, constipation, heat tolerance, cold intolerance
Treatment for mydexema
give thyroid medications
Where to put the 5 ice packs to cool a thyroid storm patient
neck pits groin
If you cool a patient too fast what might happen?
Heart arrythmias
Never hold the hormone for what patient?
patient who is NPO with mydexema
Addison's disease easy way to remember
Add a Sone (sone = steroid)
Adrenal Cortex diseases easy way to remember
A in Adrenal stands for Addison's
C in Cortex stands for Cushing's
Addison's disease is
undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily.
STRESS can trigger.
Addison's disease treatment
give a steroid, chronic steroid therapy
Cushing's syndrome
Over secretion of adrenal cortex, too much hormone, too much steroid.
S/S of Cushing's syndrome
same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood
sugar, losing Potassium,
Treatment for Cushing's syndrome
Surgery, bi or uni lateral adrenalectomy (bilateral is worse)
Donning PPE's order
Gown, Mask, Goggles, Gloves
Removing PPE's order
alphabetically inside the room
For airborne precautions the mask is removed where?
outside of the room
Avoid answers with what words for children 9 months and younger?
build, sort, stack, construct, make
Toddlers (1-3) work on
their gross motor skills (jump, hop, throw), NO fine motor, parallel play
Preschoolers (3-6) work on
fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend
School age (7-11) work on
creative, collect, competitive
Best default order for click and drag order questions?
Hold ..... med
Assess ..... what med does
Prepare ...... the correction
Call ..... or notify
Rarely if ever answer ...
call Doctor, NCLEX wants you to think critically
Creatinine lab values
same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about
INR lab values
2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all
coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify
Potassium lab values
3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K
if high, hold all K, assess heart (EKG), give D5W and reg insulin, call
if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!!
pH lab values
7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the
patient
If bad vitals, call rapid response team
BUN lab values
8-30 check for dehydration if elevated not a big deal, just be concerned
If a deadly or dangerous lab value is discovered AND they have symptoms call the
rapid response team!
HgB lab values
12-18 check for bleeding if low or high, if low prepare for transfusion
HCO3 lab values
22-26 if it is abnormal so what!
CO2 lab values
35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's
considered deadly and respiratory failure, need intubated
Hct lab values
36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration
PO2 lab values
78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure
give O2, prepare for intubation, call resp therapy and call Dr
O2 sat lab values
93-100 pulse ox, if under 93 assess resp status and give O2
BNP lab value
less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF
NA lab values
135-145, if a change in LOC then evaluate for fall/safety risk
WBC lab values
5000-11000 if low assess for infection
CD4 count less than 200 equals
AIDS
Neutropenic precautions (low WBC)
strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no
water that has been standing longer than 15 min, vital signs Q4H
Platelets lab value
150000-400000 if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they
could die. Called thrombocytopenia
Bleeding precautions
no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use
drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods
RBC lab values
4-6 million abnormal doesn't really matter
Reason for laminectomy
treat nerve root compression
S/S of nerve root compression
Pain
Parasthesia (numbness & tingling)
Paresis (muscle weakness)
Cervical
Diaphram and Arms affected, breathing, respiratory pattern
Thoracic
Abd muscles and gut affected, ability to cough
Lumbar
Bladder and legs affected, when did they last void, are they distended
#1 post op answer for spinal problems is
log roll patient
Activity post op spinal issue
do not dangle
stand, walk, lie down w/o restricitons
limit sitting to 30 min at a time
Post op complications for cervical spinal surgery
pneumonia
Post op complications for thoracic spinal surgery
pneumonia (no cough), paralytic illeus (gut shuts down)
Post op complications for lumbar spinal surgery
urinary retention
How long does temporary restrictions usually mean?
6 weeks (driving, lifting, etc.)
Nagele's Rule
1st day of last period + 7 days - 3 months
Weight gain during pregnancy
28 lbs plus or minus 3 lbs
1st trimester weight gain
1 lb/month or 3 lbs for 1st trimester
2nd/3rd trimester weight gain
1 lb/week
Easy way to calculate appropriate weight gain during pregnancy
The week number minus 9 so if 12 weeks pregnant 12-9=3 lbs. not allowed to be off by more
than 2 lbs.
Fundal Height
not palpable until 12 weeks, 2nd and 3rd trimesters week gestation 20-22 in cm so at the navel
is 20 weeks
Positive signs of pregnancy
xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother)
palpates fetal movement
Probable signs of pregnancy
blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign
Chadwick's sign
Cervical color changes to Cyanosis See all the CCCCCC's!
Goodell's sign
Cervical softening
Hegar's sign
Uterine softening
All changes in cervix and vagina occur in what order?
alphabetical order
Pattern of Office Visits for prenatal care
once a month until 28 weeks, once every 2 weeks until week 36, once a week until delivery or
week 42 when induction is scheduled
Pregnancy hemoglobin
normal is 12-18, first trimester falls to 11 which is okay, second trimester falls to 10.5 which is
okay and then third trimester falls to 10 also okay
Easy way to remember station
has it made it through the "tight squeeze" (ischial spine) no then its a negative, yes then its a
positive, 0 station is when it's at the ischial spine
Presenting part is 99% of the time the
head
What is bad as far as Lie?
Transverse is bad, vertical is good, parallel is good
Stage 1 of L&D
Labor - thinning and opening, has 3 phases, Latent, Active, Transitional, nothing to do with the
baby just the cervix, no baby at the end of labor
Stage 2 of L&D
Delivery - pushing the baby out
Stage 3 of L&D
Placenta delivery
Stage 4 of L&D
Recovery (1st 2 hrs after delivery of placenta), considered unstable patient, stop the bleeding in
stage 4
Memorize 1st stage 2nd phase of L&D then you know the rest
Active phase
CM dilated 5-7 cm
CXN Freq 3-5 min
Duration 30-60 sec
Intensity moderate
Contractions should not be longer than ____ seconds or closer than every _____ minutes.
90, 2
Prolapsed cord
OB emergency, baby will die if you don't do something
What to do with prolapsed cord
Push then position! Push head off cord then position in knee/chest of trendelenburg (head
down)
Lithotomy position
on back with knees drawn up
Easy to remember interventions for complications of L&D
LIONPit
L left side, I increase IV, O oxygenate, N notify Dr, Pitocin
If question says there is pitocin running and there are complications
stop pit first then LIONpit
Pain meds in labor
know your peaks for IV, IM, PO, Subling. If baby is likely to be born when the pain med is
peaking don't give! Why? Respiratory depression in baby
Fetal monitor patterns
if it starts with L it's bad so do LIONPit, ex; low fetal heart rate, low baseline variability, late
decels
VC
EH
AO
LP
Variable Decels Cord Compression (bad)
Early Decels Head (bad)
Acels Okay (good)
Late Decels Placenta (bad)
Best answer for what to check first in fetal monitoring is
fetal heart rate, it's the ace of spades!
During the 2nd stage (delivery of baby), order of actions.
Deliver the head then stop pushing, suction the mouth first then the nose, check for nuchal cord,
deliver shoulders and body, ID band
If the baby has to leave the delivery area, the priority is
the ID band
Umbilical cord has what in it
AVA 2 arteries and a vein
4th stage of L&D recovery stage, what do do?
4 things you do 4 times an hour in 4th stage
Vitals (assess for s/s of shock)
Fundus (want midline and firm, if boggy, massage, if displaced void/cath)
Pads (check and replace)
Roll on side (check for bleeding under patient)
Excessive Lochia is
a pad saturated in less than or equal to 15 minutes
Postpartum Uterus Tone
Firm NOT boggy
Postpartum Fundal Height
Fundal height should equal day post partum, day 5 = 5 cm below navel
Postpartum Uterus location
midline, if not void/cath
Postpartum Lochia color
Rubra - Red (ruby red)
Serosa - Pink (rosa pink)
Alba - whitish (albino white)
Postpartum Lochia amount
Moderage 4-6 inches on pad in one hour
Excessive pad saturated in 15 min
Best way to measure DVT is
calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's
sign
Postpartum assessment of extremities
Pulses, Edema, S&S of Thrombophlebitis
Postpartum assessment includes assessment of
Uterus, Lochia and Extremities
Way to remember difference between Cephalohematoma and Caput Succedaneum
C S in Caput Succedaneum = Crosses suture lines, both are swelling on scalp caused by
bleeding and both are normal or okay.
OB medications tocolytics
stop contractions, Brethine causes maternal tachycardia, Nifedipine (dipine - CCB) causes
Hypotension and headache
OB medications oxytocics
makes labor more intense, Pitocin, Methergine, Cervidil
Uterine Hyperstimulation
contractions longer than 90 seconds or closer than 2 minutes
OB medications Fetal/Neonatal Lung meds
Betamethasone, speeds the development of the baby's lungs, given to Mom before baby is
born, given IM, will increase the blood sugar of Mom
Survanta (surfactant)
given to baby after baby is born given trastracheal through the airway develops lungs
Med hints for IM injections
Look for 1's in both parts (the 1 looks like an I), guage and length, 21 g, 1 inch means IM
Med hints for SQ injections
look for 5's in both parts (the 5 looks like an S), guage and length, 25 g, 5/8 inch means SQ
Drawing up Insulin rules
R then N, Draw up R then N, NRRN the whole process
Pressurizing Insulin rule 2
put air into N then R , NRRN the whole process
If 70/30 insulin it is
70% N and 30% R, may have to make your own on boards, no 70/30 on the floor
Heparin is given IV or SQ NOT PO, info re: Heparin
works immediately, labs Ptt or any clotting or bleeding time, antidote: protamine sulfate, course:
21 days, pregnancy: YES (Class C pregnancy drug, use caution)
Coumadin is given PO, info re: Coumadin
takes days to work, labs ONLY PT-INR, antidote: Vit K (think Koumadin), course: forever,
pregnancy: NO (never use)
If a diuretic ends in the letter X it is a potassium
wasting drug plus Diurel
Baclofen/ Flexoril
muscle relaxant, think on your back loafin'! makes a patient drowsy, weak muscles, don't drink,
don't drive, don't care of kids under 12
Piaget's stage Sensorimotor
age 0-2, totally present oriented, only think about what they sense or what they are doing NOW.
tell them what you are doing as you are doing it
Piaget's stage Pre-Poperational
age 3-6, fantasy oriented, illogical, no rules, if they can think it it can happen, play with them, tell
them what you are going to do the day of the event.
Piaget's stage Concrete Operations
age 7-11, rule oriented, live and die by the rules,only 1 way to do things, everything different is
wrong, tell them days ahead what you are going to do plus skills, reading and visual tools
Piaget's stage Formal Operations
age 12-15, able to think abstractly, understand cause and effect, tell them like an adult
Child has to be at least what age for PRE op teaching?:
3
When can a child give themselves their own insulin shot?
7
What 2 parts are always irrelevant in a prioritization question?
age and gender (NCLEX is testing discrimination against ageism)
If it is a pediatric question the age is critical but if it is a prioritization question ...
age is not critical
In prioritization questions decide which patient is _________ or ____________
sickest, healthiest
Rule #1 for prioritization
Acute beats Chronic, unstable beats stable. Ex: COPD, CHF, CRF and acute appendicitis, who
wins? Acute appendicitis. No ABC's, an acute gut beats a chronic COPD all day long
ABC's don't count for
acuity
Prioritize patients at this very moment, not
3 seconds later or 10 minutes ago, Right NOW, right HERE, as they say it!
Rule #2 for prioritization
Fresh post op (12 hours out) beats medical or other surgical, Ex: 2 hr post op cholesysectomy
beats acute appendicitis and post op one day CABG and COPD, CHF, CRF (then do ABC's)
Rule #3 for prioritization
Unstable beats stable
Things that make a patient stable
the word stable, chronic, post op greater than 12 hours, local or regional anesthesia, unchanged
assessment, to be discharged, lab values that aren't urgent
Stable patients are experiencing the ___________ or __________ s/s's of the disease with
which they have been diagnosed and for which they are receiving treatment
Typical, expected
Things that make a patient unstable
the word unstable, acute, post op less than 12 hours, general anesthesia, changing
assessment, newly, recently admitted or diagnosed, lab values that are critical or deadly
Unstable patients are experiencing _________ or ____________ s/s's, complications
unexpected, atypical
Patients who are always unstable
hypoglycemia, hemorrhaging clients, fevers over 104, pulselessness, breathlessness
Faulty reasoning, prioritizing by symptom severity
It is not how severe the symptom is, its if the symptom has changed or if its typical or expected.
Rule #4 for prioritization
Tie-breaker, ONLY use for a tie breaker, the more Vital the organ the higher the priority.
Vital organ priority list
brain
lung
heart
liver
kidney
pancreas
LPN's can't do
IV anything (don't assume they have IV cert unless it says so), assessments, planning,
admission, discharge, transfer, teaching, taking verbal orders or 1st of anything
AID's can't do
charting (only document what they did), assess, meds, IV, treatments, fleet enemas
AIDS can do
Soap suds enema, beds, bath, ADL's VS (not the first set), Accu check (not the first one)