Beruflich Dokumente
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Therapeutic Levels
Acetaminophen 5-20
Valpoic Acid 55 - 100
Digoxin 0.5 - 2. 0
Lithium 0.6 - 1.2
Phenytoin 10 - 20
Salicylate 15 - 30
Tegretol 8 - 12
Theophylline 10 - 20
MgSo4 4 - 7.5 /8
1cc 1ml
1cc 15gtt
30cc 1oz
5cc 1tsp
15cc 1Tbs
1mg 1000mcg
60mg 1 grain
bid 2x a day
tid 3x a day
qid 4x a day
every other day
qod
ac With each meal
hs At bedtime
BP HR
ICP
Shock
Bleeding
Cushings Triad (also widening pulse P)
Autonomic dysreflexia
Air embolus
Dehydration
ANTIDOTES
med/tx antidote for it.
MgSO4 (Tx for seizures & to contractions) calcium gluconate
benzodiazepine (Tx for seizures/anxiety) flumazenil
Heoin/opioids Naloxone/Narcan
anticholinergics (ex: antihistamine) physostigmine
beta blockers (tx for cardiac arrhythmias and to BP) Glucagon
warfarin (anticoag) vitamin K
digoxin (tx congest. HF, A.Fib) digonin immune Fab
Heparin (anticoag) Protamine Sulfate
Methatrexate (cancer tx) Leucavorin
cyanide/acrylonitrite (smoke inhalation: almond breath) sodium nitrate
acetominophen (tylenol) acetycysteine
possible liver failure with OD/poisoning possible for 4 days. close observation (Mucomyst)
required
MED SURG/DISEASES
Addisons Disease Cushings Disease
-think hyperthyroidism sx -think hypothyroidism sx
Hyposecretion of glucocorticoids Hypersecretion of glucocorticoids
-not enough aldosterone = lose water (think diuretics..some -too much aldosterone = water retention=
block aldosterone) ADH cushion ADH
Hypovolemia (Blood volume ) Hypervolemia (blood volume )
Hot Cold (Cushings = Cold)
K Ca Na (lose H2O, lose Na) K Ca Na (gain H2O, gain Na)
Hypoglycemia ( insulin production) Hyperglycemia ( insulin production) +
ketoacidosis
Wet skin Dry skin (hyper = dryer) hyperglycemia = dry
skin
Lethargy, fatigue, muscle weakness Generalized muscle wasting, weakness
Hypotension (Na) Hypertension ( Na)
Weight loss Weight gain / Slow healing
Decreased blood volume + shock Moon face, buffalo hump, obesity (trunk), thin
Hyperkalemia = meta acidosis + arrhythmias skin, reddish-purple striae, acne, menstraul
irreg., hirsutism
TREATMENT: hormone replacement, hydrocort. TREATMENT: hypophysectomy(pituitary),
during stress will need to increase hydocortisone adrenalectomy
Addisonian crisis = shock management. fluid
resuscitation/TX: 0.95NS, D5, hydrocort. IV push Osteoporosis (excess cortisol = Ca
-medical emergency reabsorption from bones)
-critical deficiency of glucocorticoids
-generally follows acute stress, sepsis, trauma, surgery, or
omission of steroid therapy
s/sx: N/V, hypotension, HR, confusion, severe abd pain,
sudden profound weakness, hyperpyrexia followed by
hypothermia, coma, renal failure
Hyperthyroidism Hypothyroidism
- fast (Hyper) sweating - slow(think lazy, slow, cold, overweight)
- metabolism metabolism
-sympathetic NS sx -parasympathetic NS sx
-nervousness, irritable, excitable, tachycardia, perspiration, -extreme fatigue, dry skin, coarse hair,
flushed face, exophthalmus, increased appetite, limp hair, wt numbness and tingling of fingers, alopecia,
loss, HTN wt gain
-heat intolerance -cold intolerance
Iodine uptake Iodine uptake
Graves disease Myxedema coma= medical emergency
Thyroid storm - mental status
-tachycardia - hyperthermia
-delirium - thickening & swelling of the
-coma skin
-pt with hyperthyroidism is typically nervous and has insomnia.
-don't place in same room with another pt with hyperthyroidism
because too much stimuli.
-place in private room.
TX:
Tensilon test = used to dx
-if pt shows improvement after tx = dx
TX: anticholinesterase drugs: pyridostigmine
Hirschsprings dz -mega-colon
hirschprung dz contd -results in mechanical obstruction b/c of inadequate motility
s/sx = failure to gain weight, abd distention, vomiting, ribbon-like and foul
smelling stools (not with newborns I think), constipation alternating with
diarrhea
B-thalassemia -too much Fe
-autosomal recessive disorder
-decreased production of 1 of the globin chains in the synthesis of Hgb
-chelation drug therapy (gets rid of Fe)
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 b/w legs to maintain abduction
Wernicke-Korsakoff -neuro disorder
syndrome -acute encephalopathy
-chronic psychosis
-caused by deficiency in Vit B / Tyramine deficiency
Multiple myeloma -Ca caused by bone destruction is the primary concern
-encourage fluids (dilutes Ca)
Pancreatitis -do not give morphine! (irritates pancreas)
-pain is severe and unrelenting in epigastric area and radiates to back
-observe for UO, HR
Hyperparathyroidism (Ca, P)
-increased sleeping - osteoporosis
-increased urination - nephrolithiasis (kidney stones)
-weakness - polydipsia - constipation
-bone pain - muscle pain - polyuria
-irritability
Hypoparathyroidism (Ca, P)
-increased urinary frequency
- trousseau sign
- muscle spasms
- tingling, numbness
chvostek sign
-seizures
SIADH (secretion of abnormal ADH production, common causes : CNS distrubtion (Stroke, trauma,
inapporpriate antidiuertic neuro. surgery), malgnancies( small lung carcinoma), pulmonary disorder
hormone (pneum)
-leads to excessive water absorption by kidneys
-decreased UO = fluid overload, HTN, HR
-water intoxication (retaining water)
- serum osmolality
-Na (dilutional hyponatremia)
-too much antidiuretic hormone (vasopressin)
TX:
TX:
1. fluid restriction <1000ml/day
2. oral salt tablets to Na
3. hypertonic saline: severe neuro problems can occur w/Na
4. vasopressin recept. antag: conivaptan
5. strict I and O & daily wts
6. monitor Neuro status
-treatment is effective if: UO, wt, urine osmolality
Diabetes insipidus -deficiency of ADH = ability of kidneys to concentrate urine
-give vasopressin
Intra
-damage to kidneys, nephrotoxic injury from contrast, antibiotics, corticosteroids
Post
-obstruction of urinary collecting system
Autonomic dysreflexia -hyperreflexia
-spinal cord injury T5 and above (I think)
-overactivity of autonomic NS
-kinked cath can cause it, constipation or full bladder (Incr ICP)
-pounding HA, HTN, sweating, bradycardia, restlessness
COPD -use a high-flow venture mask to deliver O2 b/c you are giving a controlled,
specified amount of O2
Sjogrens chronic autoimmune syndrome where moisture producing exocrine glands are attacked by WBC.
syndrome - dry salivary, lacrimal glands
- dry eyes, mouth, throat, bronchi
- skin rashes, dry vagina
- TX: no real treatment just OTC to help relieve the symptoms : eye drops, mouth
rinse, lube.
Medications and Insulin
Meds that Insulin requirements Meds that Insulin requirements
Glucocorticoids (cushings = hyperglycemia) Sulfonylrureas
Li Quinidine
Rifampin (TB) Quinine (malaria)
Progestins (oral contraceptives) ACE inhibitors
Nicotine Naproxen
Phenytoin Indomethacin (gout, RA, OA)
Ca-channel blockers Salicylates
Clonidine B-blockers
Morphine
Heparin
Diabetes - Insulin
Onset Peak Common types Misc.
Rapid 15min 1-2h Aspart (novalog) Clear, sliding scale, no IV, pump, can
Midmorn- Lispro (humalog) mix with I, L
trembling/wkness
Short 30- 2-4h Regular Only kind that can be given IV
Early evening wkness, 60min Clear
fatigue Can mix with I, L
Intermediate 1-2h 4-8h (4- NPH (Humalin R, Cloudy
Early evening wknes, 12h?) Novalin R) Can mix with R, S
fatigue Lente
Long 2-4h 8-14h Humalin U Cloudy
Can mix with R, S
Very Long-actig 1-2h None Glargine (Lantus) Clear
(ongoing) Never mix with others!
Usually given at bedtime
*RN draw up Regular first and NPH second
*Oral hypoglycemics = stimulate pancreas to produce more insulin or
increase sensitivity to insulin already there,
only for DM-2
*DM-2 and insulin needs during surgery, stress, infection = need for
insulin
*Reduce your insulin needs during exercise (exercise lowers blood
glucose)
*Glucagon = prevents hypoglycemia, produced by the pancreas, action is
opposite of insulin
PNEUMO/TENSION THORAX
TENSION PNEUMOTHROAX: treatment: 1. emergency large bore needle decompression, 2. place
- trachea deviated chest tube
chest tube drainage >100ml/hr ***
call HCP
Breath sounds
Pneumonia crackles, bronchial breath sounds, tactile fermitus, percussion dull
Pleural diminished breath sounds, decreased tact. fermitus, percussion dull, mediastinal shift away from
effusion effusion
COPD diminished breath sounds, tactile ferm, hyperresonat percussion
Pneumothorax diminished breath sounds, tactile ferm, hyperrsonat. percussion, mediatal shift away from
pneumothorax.
Maslows
Eye stuff
Mydriatic eye drops Big word = big pupils
Dilates pupils
Miotic eye drops Little word = little pupils
Constricts pupils
Glaucoma -silent thief of vision
-optic nerve damage
-causes irreversible blindness
-blurred vision, halos, loss of peripheral vision
-risk factor = cardiovascular dz
-treat with meds to decrease IOP (B-blockers) and miotics (increase outflow of aq
humor)
-African Americans are at an increased risk at any age
-nursing goal: prevent further deterioration
Cataracts -lens opacity or cloudiness
-painless, blurry vision
-surroundings are dimmer
-diplopia
Macular -dry = nonexudative (slow)
degeneration -wet = exudative (fast)
-drusen = tiny yellow spots
Detached Retina - curtain over eyes, black spots,
- TX: cover both eyes call HCP
Cranial Nerves
I Olfactory Smell
II Optic Central/peripheral vision
III Oculomotor Pupil constriction
IV Trochlear Have pt follow tip of finger
V Trigeminal Jaw strength
VI Abducens 6 cardinal movements of eyes
VII Facial Facial symmetry
VIII Acoustic Ears hearing
IX Glossopharnygeal Taste, uvula midline, etc
X Vagus Taste, uvula midline, etc.
XI Accessory Neck, shoulder
XII Hypoglossal Midline tongue
Bells Palsy inflammation of VII
-facial muscle weakness
-inability to close eyelids
TX: eye care, patch @ night artifical tear, oral care often & after meals eat on unaffects side
Precautions
Standard -uniform level of caution that should be used in all patients
-primary goal = prevent transmission of nosocomial infection
-hand hygiene
-gloves
-misc barriers (mask, eye protection, face shield, gown)
Contact -in addition to standard
-used for organisms that are easily spread by skin-to-skin contact, or by contact with items in pts
environment
-may place pt in private room
-masks are not needed, doors do not need to be closed
Examples
-antibiotic-resistant organisms
-enteric infections with low infectious dose
-c-diff
-GI, respiratory, skin, wound infections or colonization with multidrug-resistant bacteria
-RSV
-highly infectious skin infections: diphtheria, herpes, impetigo, pressure ulcers, scabies, shingles
-conjunctivitis
-ebola
Airborne -in addition to standard
-for pt with serious illnesses transmitted by airborne droplet nuclei
Examples
-measles
-varicella (and disseminated zoster)
-TB
Droplet -in addition to standard
Examples
-flu -pertussis -adenovirus -mumps / rubella
Cardiovascular
Complications of mitral -thromboembolism
stenosis -rheumatic fever (common complication of CHF)
-endocarditis
-pulmonary HTN
-pulmonary edema
Hemolytic transfusion rxn -headache
-tachycardia
-HTN and Hypotension
-apprehension, sense of impending doom
-fever, chills
-DIC
-low back pain, chest pain
Autologous transfusion rxn - s/s of infestion ( greatest risk)
cor pulmonale right sided HF caused by left ventricular failure (so pick edema, JVD if they are a
choice)
Inotropic and Chronotropic Inotropics
Drugs -affect force of muscle ctx
Chronotropics
-affects HR
Digoxin
(+) inotropic
(-) chronotropic
Supraventricular tachycardia SVT dysrhythmia orginates from etopic focus above the bundle of his. HR
150-220. rhythm usually regular, P wave often hidden/abnormal shape
PR interval short, QRS narrow <2 little boxes
TX: vagal stimulation (Cough, Valsalva) drugs: adenosine or
synchronize cardoversion
Ventricular Tachycardia rate 150-250 firing repeatedly in ventricle. P wave not visible, PR
interval not measurable QRS wide >4 + boxes
Food
Tyramine -avoid with MAOIs, migraines
-figs, avocados, bananas, papaya, raisins
(Korsakoff Psychosis= tyramine -aged cheese, yeast, yogurt, sour cream
deficiency) -soybeans, beer, red wine
-beef, liver, sausage, bologna, deli meat
-chocolate
Purine -avoid with gout
-fish, sardines
-liver, beef, chicken, sausage, organ meats
Gluten -avoid with Celiacs disease
Vitamin K -broccoli, cabbage, turnips
(antidote for Coumadin) -fish, liver
-coffee, tea (caffeine)
Vitamin B12 (thiamine) -found in animals, nuts, whole grain cereals
-pt with cirrhosis needs a diet high in B12
Calcium -eggs
-green leafy veggies
Potassium -potatoes -dairy products
-bananas -avocados
-spinach
-raisins
-dates
-oranges
-dried apricots
Iron -can give with Vitamin C (tomato juice, OJ)
-clams
-liver, beef, shrimp
-turkey
-cereal
-pasta
Folic acid -liver
-papaya
-legumes, vegs, spinach
-nuts, bran, cereal
-fruit, yeast, asparagus
Acid ash diet -avoid milk = makes urine alkaline
Vitamin D toxicity -GI upset and metallic taste
-HA, weakness, renal insufficiency, renal calculi, HTN, arrhythmias,
muscle pain, conjunctivitis
Crohns diet -Low fat
-Low residue (no popcorn)
-High protein
Calcium -take 1 hour after meals with full glass of water
ACE inhibitors -take 1hour before meals
CKD -apples
-pears
grapes
pineapple
blackberry
blueberry
plums
ulcerative colitis low residule diet
-high protien
- high calorie diet
- daily vitamins, minerals
- increase fluids 2000-3000 ml/day
- small frequent meals
Burns
Superficial partial thickness -first degree
-sunburn
-epidermis
-red, blanches with pressure
-possible blisters
Deep partial thickness -second degree
-scald
-epidermis, upper dermis, part of deeper dermis
-blistered, mottled red base
-weeping, edema
Full thickness -third degree
-flame, chemicals, electrical current
-epidermis, entire dermis, muscle/bone
-dry, pale white
-leathery, fat exposed, edema
parkland formula ) = amount of mL in 24hrs
amount of fluid for a burn pt
*half of fluid amount given in 1st 8hrs
*burn pt at risk for K
MISC
Fire in patients room? PACE / RACE
MISC:
Presence of glucose in nasal discharge = fluid is CSF
Catecholamines
-dopamine, epi
-released during times of stress
Thyroidectomy monitor Ca and P
Chemo treatment
- uric acid levels in blood d/t massive cell destruction
Calmette-guerin vacc = vacc for TB
-mantoux test will always be positive
CO2 in blood = vasodilation
Allergy to bananas/kiwis = allergy to latex
Acute pain sx = BP, HR, RR, perspiration, body T, dilated pupils (wide eyed with fear)
If a question asks you to select a goal for a pt, make sure the answer you pick is an actual goal!
1. maintain O2 Sats above 90% throughout shift = yes, this is a goal
2. keep HOB elevated to promote proper ventilation = no, this is an intervention
Allergy to eggs = no flu shot
Dx test to confirm TB = sputum culture
Infiltration = cool to touch, swelling, tenderness, decreased rate, blanching of skin
Phlebitis = inflammation, redness, heat, swelling, tenderness
HTN-crisis
- give phentolamine: vasodilates
Best area to check a dark-skinned patient for:
Petechiae = oral mucosa, conjuntivae
Cyanosis = palms/soles of hands and feet
Jaundice = sclera
Nclex Strategies
Look for umbrella answer if all the answers are correct, does one contain the others?
Which one is not like the other?
Look for opposites, look for similar answers to find the one that isnt the same (rapid pulse, tachycardia)
ABCs
Like dz can room with like dz . (Clean pt with Clean pt / Dirty with Dirty)
Assess before you implement! - Unless no further assessment is needed
Safety 1st
Maslows - IMPORTANT
Avoid key words always, never, only - Throw these out
Look for words like pt suddenly developed chills the suddenly means new and serious! Priority!
do not use I understand or why
when two answers are the exact opposite like bradycardia and tachycardia one is the answer
if two or three answers are similiar/alike none is correct
never release traction unless it is a dr. order
question about a halo? remember safety 1st have a screwdriver nearby
always deal with actual problems or harm before potential problems
anytime you see fluid retention, think heart problems
Priority
An unconscious pt with L sided tracheal The pt with L sided tracheal shift = airway
shift from midline or a pt clutching her
chest and c/o severe chest pain?
Priority interventions if pt has pulmonary 1. admin O2
edema 2. foley cath (to monitor I/O since giving diuretics)
3. Lasix
4. Morphine - work of breathing and anxiety
Priority of actions if pt with DM-1 who 1. check blood glucose level
received NPH and regular insulin 2h ago 2. give pt 1/2c fruit juice
c/o hunger, weakness, shakiness 3. take vital signs
4. retest blood glucose
5. give pt small snack of carbs/protein
6. document
TRIAGE T = trauma
R = respiratory
I = ICP and mental status
A = an infection
G = GI , upper
E = elimination, lower
Priority of care 1st level: -airway - breathing -circulation & cardiac (become 1st in
cardiac arrest) - Vital Signs
2nd level: altered mental status - acute pain - untreated medical
problem (hyperglycemia in pt with DM) - chronic pain - acute
elimination issues - abnormal labs - risk for infection/saftey
Types of play
Parallel -toddlers
-side by side
-rarely interact
Associative -preschoolers
-all engaged I similar activity, but little organization
Cooperative -school-age
-organized and goal-directed
Therapeutic -technique used to help understand a childs feelings
Play Therapy - Allow the child the express themselves easier
Blood
Complications of a blood transfusion 1. Transfusion rxns
-weak pulse, fever,
brady/tachycardia, hypotension,
oliguria
2. Circulatory overload
-cough, chest pain, wheezing, HA,
HTN, HR, distended neck veins
3. Septicemia
-chills, fever, vomiting, shock,
hypotension
4. Fluid overload
5. Dz transmission
-Hep B, for example
6. Hypocalcemia
-citrate in transfused blood binds
with Ca and is excreted
-hypereflexia, paresthesia, tetany,
muscle cramps, +Trousseaus sign,
+Chvosteks sign
7. Hyperkalemia
-stored blood liberates K+
Pt with severe blood loss requires rapid transfusion. What device -blood warming device
is used during blood transfusions to decrease risk of cardiac -rapid transfusions of cool blood puts pt at
dysrhythmias? risk for cardiac dysrhythmias
IV solution that can only be run with blood transfusions 0.9% NaCl
How long do you have to admin blood products once they are 15-30min
picked up from blood bank?
Reason to delay a blood transfusion Fever hold and notify dr
Special about blood transfusion tubing Has a built-in filter
Pt is receiving plateletswhat might the pt exhibit to show he is -decrease of bleeding from puncture sites
benefiting from the transfusion? and gums, etc.
What would you use to evaluate effectiveness of fresh frozen Coag studies (PT, PTT)
plasma
IV Solutions
Isotonic
D5W -dont use during fluid resuscitation
-used mainly to supply water and correct serum osmolality
0.9% NaCl (NS) -used with blood transfusions
-used with Dilantin
-used to replace Na losses
-burn injuries
-doesnt supply calories
-not for: HF, pulmonary edema, renal impairment, Na retention
LR -corrects dehydration, Na depletion
-replace GI losses
Hypotonic
0.45% NaCl -dehydration
Hypertonic
D5W 0.9% NaCl
ABGs
when drawing ABG, blood must go in heparinized tube, no bubbles, put
on ice, if pt was on O2 and how many liters
ACID / BASE BALANCE
ROME
Respiratory opposite
Metabolic equal
PH 7.35-7.45
PaCo2 35-45
HCO3 22-26
Respiratory PH PaCO2 HCO3 s/s: headache, anxiety, blurred vision, restlessness, confusion,
Acidosis tremors, delirium, coma
uncompenstated < 7.35 > 45 normal D/t: asthma, COPD, Pulm. edema, MS, pneumonia,
Partially < > 45 > 26 obstructed airway, sedative OD, cardiac arrest
compen. 7.35 > 45 > 26
compensated Normal
7.39
Respiratory PH PaCO2 HCO3 s/s: hyperventilation, dizziness, bloating, light headed,
Alkalosis >7.45 <35 normal numbness/tingling in hands, discomfort in chest, dry mouth,
uncompensated >7.45 <35 < 22 palpitations, SOB
partially normal <35 < 22
compens. 7.41
compensated
Metabolic PH PaCO2 HCO3 s/s: (comes from the ass, must be acid) diarrhea, Kuss. resp.,
Acidosis < 7.35 normal < 22 jaundice, fruity breath
uncompensated < <35 < 22 D/t: DKA, hyperchloremic acidosis, lactic acidosis
partially 7.35 <35 < 22 acidosis starts in kidneys not lungs
compensa. Normal
compensated 7.39
Metabolic PH PaCo2 HCO3 S/S: vomitting,overuse of diuretics, adrenal disease, K&Na,
Alkalosis >7.45 normal > 26 antacids, laxatives, alcohol abuse
uncompensated >7.45 > 45 > 26
partially normal > 45 > 26
compens. 7.41
compensated
DKA metabolic acidosis or patially compensated
metabolic acidosis
COPD, obesity hypoventilation syndrome, respiratory respiratory acidosis
depression d/t narcotics
vomitting, aggressive diuresis metabolic alkalosis
hypotension and vasoconstricting meds alter the accuracy of O2 saturation
Important Drugs
-olol = B-blocker (HR, BP)
-pine = Ca channel blocker (HR, BP)
-pril = ACE inhibitor (BP) vasodilate
-sartan (similar to ACE inhib) for pt allergic to ACE inhib.
phenytoin -antiepileptic
(Dilantin) -only give with NS
-s/e = blurred vision, diplopia
Sinemet (levodopa/carbidopa) -parkinsons dz
somatriptan -HA
(Imitrex)
donepezil -alzheimers
(Aricept)
nalbophine -opioid
(Nubain)
naloxone (Narcan) -opioid antagonist
Morphine -opioid
-toxicity = pinpoint pupils, decreased RR, increased ICP
Fluoxetine (Prozac) -antidepressant, SSRI
amitriptyline (Elavi)l -antidepressant, tricyclic
-anti-chol s/e
Bethanechol -parasympathetic
-for urinary retention
-cholinergic
Epi -sympathetic
-inhalation = fastest route
Atropine -sympathetic
-anti-cholinergic
Dopamine -sympathetic
Mental Health
Schizophrenic patients Remember SDS to remember major needs:
S = structure: because they tend to have too little in their lives
D = diversion: to distract them from disturbing thoughts
S = stress reduction: to minimize the severity of the disorder
Paranoid pt dont encourage , dont support their coping mechanisms
infant 1. auscultate 2. percuss 3. palpate in head to toe direction 4. traumatic (eyes, ears,
assessment: mouth) 5. reflexes Moro
ICP/hydrocephalus sclera visible above the iris (sunset eyes). 6th cranial nerve palsy. late sign of
(6th cranial nerve ICP/Hydrocephalus
palsey)
juvenile idiopathic high risk for becoming deconditioned d/t muscle strength & endurance: overall capacity
arthritis (JIA) for exercise. good activities: swim, stationary bike, yoga, low impact, low wt bearing - non
wt bearing & rom
Kawaski disease inflammation of arterial walls, some develop coronary aneurysm
3 phases: 1. acute: sudden fever, doesnt respond to meds, irritable, swollen red hands/feet
lips swollen/cracked, strawberry red tongue
2. subacute: skin peeling from hands and feet, very irritable
3. convalscent: symptoms disappear slowly temp. returns to normal
TX: IV gamma globulin (IVIG) & aspirin. IVIG creates oncotic pressure causing signs of
fluid overload, pulmonary edema make sure to monitor for s/s of HF, UO, extra heart
sounds HR, diff. breathing
infant botulism generalized weakness, diminished deep tendon reflexes, can cause respiratory failure S/S
constipation, difficulty feeding
hemolytic uremic life-threatening complication of E.coli results in red cell hemolysis, low platelet, acute
syndrome (HUS) kidney injury, hemolysis results in anemiaa & low platelets manifests as petechia or pupura
Cystic Fibrosis thick mucus plugs ducts, impairs Cl transport & Na absorption resulting in thickened
secretions
manifestations: -recurrent sinus & pulmonary infections
pancreatic insufficiency & diffic. with adequate wt & growth (given -pacreatic enzymes
with meals)
-infertility
-deficiency of fat soluble vitamins
epiglottis inflammation of the epiglottis : life threatening airway obstruction. most common cause H.
influ type B (HIB)
s/s: abrupt onset high fever, severe sore throat, followed by 4Ds: Drooling, Dysphonic (diff.
speaking), Dysphagia, Distress airway (stridor). child may be tripoding with stridor
a postive western <18 monhts (presence of HIV antibodies) indicates only that the mother is infected.
blot test
2 or more positive will confirm HIV in kids <18months. p24 can be used @ any time
p24 antigen tests
HIV kids avoid OPV and Varicella vacinations bc they are live. but give pneumoccocal and
influenza. MMR is only avoided if the kid is severely immunocompromised. parents should
wear gloves for car, no kissing on mouth/near, and dont share forks/spoons.
for digoxin in if HR is <100bpm hold
PEDS
wt birth wt doubles by 6 months, triples by 1 year
hemophilia x- linked mother passes disease to son
pyloric stenosis first sign in baby is mild vomitting that progresses to projectile vomitting. later maybe able
to palpate mass, baby will seem hungry often and may spit up after feedings.
VP Shunt will have small upper-abdomen incision. this is where shunt is guided into the abdominal
cavity, and tunneled under the skin up to ventricles.
watch for abdominal distention, since fluid from the ventricles will be redirected to
peritoneum. watch for signs of ICP such as irritability, bulging fontanels, and high
pitched cry in infants. in toddlers watch for lack of appetite and headache. careful on bed
position questions. after shunt placement keep pt flat, so fluid doesnt reduce too rapidly. if
you s/s of ICP, then raise HOB to 15-30 degrees.
vacinations MMR and varicella immunizations come later (15 m)
Maternal OB
preeclampsia: therapeutic MgSO4 4-8 to prevent seizures
when it increases more than 8=toxicity.
toxicity s/s: CNS depressant blocking neuro transmitters. loss of deep tendon reflexes
(earliest sign) 9-11
-respiratory depression 12-18 and decreased UO
PICA often accompanied by iron defciency anemia: check HCT & Hgb
trisomy 18 severe cardiac defects, multiple muscko.deformities, life expectancy few weeks after birth.
(edward provide end of life care
syndrome)
anecephaly neural tube defect results in little to no brain tissue, most are stillborn, those born alive will
not surive. provide end of life care
subjective -amenorrhea -quickening -NV -breast tenderness -excessive fatigue
(presumptive) for
pregnancy
objective uterine/cervical changes (goodell sign, hegar sign, chadwick sign, uterine enlargement) -
(probable) for braxton hicks, ballotment - fetal outline palpation - uterine softens - skin pigmentation
pregnancy changes -positive preg test
positive -fetal heartbeat with doppler - fetal movement palpated - visualization fetus by US
pregnancy dx
fetus bones fully developed @32wk
development lanugo begins to disappear @ 36
lungs & respir. system fully developed @40
28wk newborn/permie should have eyes open, adipose tissue developed & ability to perform
gas exchange
VEAL CHOP V:variable decels C:chord compression/prolapse: oligohydraminos
E:early decels H:head compression
A: accelerations O: OK normal
L: late decelerations P: placental insufficiency