Important nursing Points
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| Normal Red Blood Cell Level? | 4.2-6.1 million/mm3
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| Normal White Blood Cell Level? | 5,000-10,000 mm3
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| Normal Hemoglobin Level? | 12-18 g/100mL
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| Normal Hematocrit Level? | 37-52%
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| Normal Sodium (Na) Level? | 135-145 mEq/L
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| Normal Potassium (K) Level? | 3.5-5 mEq/L
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| Normal Chlorine Level? | 98-106 mEq/L
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| Normal Bicarb (HCO3) Level? | 22-26 mEq/L
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| Normal Calcium (Ca) Level? | 4.5-5.5 mEq/L
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| Normal Magnesium (Mg) Level? | 1.5-2.5 mEq/L
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| Normal pH Level? | 7.35-7.45
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| Normal PaCO2 Level? | 35-45 mmhg
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| Normal PaO2 Level? | 80-100 mm
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| Normal O2 Saturation Level? | 96-100%
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| Normal PT Level? | 11-12.5 seconds
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| Normal INR Level? | 0.76-1.27
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| Normal APTT Level? | 30-40 seconds
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| Normal Serum Creatinine Level? | 0.5-1.2 mg/100mL
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| Normal BUN Level? | 10-20mg/100mL
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| How much Oxygen and Liters can Nasal Cannula offer? | up to 44% @ 6L/min
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| How much Oxygen and Liters can a Simple Mask offer? | up to 60% @ 7-8L/min
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| How much Oxygen and Liters can a Venturi Mask offer? | up to 55% @ 14L/min
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| Convert Farenheit to Celsius? | *F = 1.8 x *C + 32
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| Convert Celsius to Farenheit? | *C = *F -32/1.8
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| What happens in Respiratory Acidosis? | Incr. PCO2 Decr. pH
*Hypoventilation
*Hyperkalemia, hyperrelexia, muscle weakness
*drowsiness, dizziness, disorientation
*decreased BP with vasodilation
*Causes: decreased respiratory stimuli, COPD, Pneumonia, Atelectasis
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| What happens in Respiratory Alkalosis? | Decr. PCO2 Incr. pH
*Seizures, deep rapid breathing
*tachycardia, hypokalemia, hyperventilation
* lethargy, confusion, N/V, light headed
* decreased or normal BP
* numbness & tingling of extremities
Causes: hyperventilation, mechanical ventilation
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| What happens in Metabolic Acidosis? | Decr. pH Dec HCO3
* HA, hyperkalemia, muscle twitching, N/V/D
* decr. BP, vasodilation
* Change in LOC, kussmal repirations
* decr. ability of kidney to excrete acid or conserve base
Causes: DKA, severe diarrhea, renal failure, shock
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| What happens in Metabolic Alkalosis? | Incr. pH Incr. HCO3
*restlessness followed by lethargy
*dysrhytmias, tachycardia, confusion, N/V/D
*tremors, muscle cramps, tingling of fingers & toes
*hypokalemia
Causes: severe vomitting, excessive GI suctioning, diuretics, excessive NaHCO3
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| Name some hypotonic solutions. What does it do? | 0.45% NS, D5W
*Fluid shifts out of vessels into the cells.
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| Name some isotonic solutions. What do they do? | 0.9% NS, LR
*No major shifts
*Vascular expansion
*Electrolyte replacement
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| Name some hypertonic solutions. What do they do? | D5 1/2 NS, D5 NS, hypertonic saline 3%
*Shifts fluid back into the circulation.
*Vascular expansion
*Replaces electrolytes.
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| COPD clinical findings? | (Inspection) Barrel chest, cyanosis, tripod position, use of accessory muscles.
(Palpation) decr. movement
*(percussion)hyperresonant or dull if consolidation
*(Aucultation)crackles, rhonci, wheezes, distant breath sounds
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| Asthma clinical findings? | (Inspection)prolonged expiration, tripod position, pursed lips
(Palpation) decr. movement
(Percussion) hyperresonance
(Auscultation)wheezes, decr. breath sounds ominous sign if no improvement
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| Pneumonia clinical findings? | (Inspection)tachypnea, use of accessory muscles, duskiness or cyanosis
(Palpation)incr. fremitus over affected area
(Percussion)dull over affected area
(Auscultation)early: bronchial sounds, later: crackles, rhonci, egophany, whispered pectoriloquy
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| Atelectasis clinical findings? | (Inspection)no change unless involves entire segment, lobe.
(Palpation)If small, no change. If large, decr. movement, incr. fremitus
(Percussion)dull over affected area
(Auscultation)crackles,(may disappear with deep breaths), absent sound if large
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| Pulmonary edema clinical findings? | (Inspection)tachypnea, labored respirations,cyanosis
(Paplation)decr. movement or normal mvt
(Percussion)dull or normal depending on amt of fluid
(Inspection)fine or coarse crackles at bases moving upward as condition worsens
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| Pleural effusion clinical findings? | (Inspection)tachypnea, use of accessory muscles
(Palpation)incr. movement, incr. fremitus above effusion, none over effusion
(Percussion)dull
(Inspection)diminished or absent over effusion, egophany over effusion
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| Pulmonary fibrosis clinical findings? | (Inspection)tachypnea
(Palpation)incr. movement
(Percussion)normal
(Inspection)crackles or "velcro" rales
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| Indications of hypercalcemia? | N/V, change in mental status, constipation, weakness and vague muscle/joint aches, HA, polyuria, ab or flank pain (due to renal calculi)
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| Indications of hypocalcemia? | Tetany, Chvostek's, Trousseau's signs, muscle twitching, CNS changes, ECG changes
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| Indications of hypermagnesemia? | Loss of deep tendon reflexes, depression of CNS, depression of neuromuscular function
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| Indications of hypomagnesemia? | Hyperactive deep tendon reflexes, CNS changes
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| Indications of hypernatremia? | thirst, CNS deterioration, increased interstitial fluid, dehydration, elevated temp, flushed skin, dry mucous membranes
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| Indications of hyponatremia? | CNS deterioration, anorexia, N/V, confusion, agitation, HA, seizures, decreased urinary output, muscle weakness, abdominal cramps,
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| Indications of hyperkalemia? | Ventricular fibrillation, ECG changes, CNS changes, tall peaked T waves, abdominal cramps, muscle weakness
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| Indications of hypokalmeia? | Bradycardia, ECG changes, CNS changes, flat T & ST wave, hyotension, dizziness, lethargy/confusion
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| What are some possible side effects of tricyclic antidepressants? | sore throat, fever, increased fatigue, vomiting, diarrhea
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| What are the five P's of neurovascular status? | Pain, pallor, paralysis, parasthesia, pulselessness
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| What is a neonate most at risk for with a diabetic mother? | hypoglycemia
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| What type of diet would you prescribe for a cystic-fibrosis patient? | high calorie, high protein, low fat
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| What does the cerebellum maintain? | motor function, balance,
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| What needs to be done prior to a IV pyelogram? | cleansing enemas the evening before to provide adequate visulatization.
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| What is an IV pyelogram used for? | visualization of the ureters, kidney and bladder with iodine contrast
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| Under what conditions is the RhoGAM or Rh immune globulin administered? | Rh negative mother, Rh positive baby and negative Coombs test
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| How do you instruct a patient to go up and down stairs with a cane? | Up with the good, down with the bad. Up - Advance the cane and the good leg together the bad leg. Reverse for down.
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| What test do you use for tardive dyskinesia? | (AIMS) Abnormal Involuntary Movement Scale
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| What are some compensatory mechanisms for a fever? | increased respiratory rate and tachycardia
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| What precautions should you note in a care plan for a patient taking tetracycline? | Sun protection due to increased photosensitivity, don't take with milk or antacids
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| What are some symptoms of Cushing syndrome? | Buffalo hump, hyperglycemia, hypernatremia
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| Describe the defense mechanism conversion | Patient's congnitive tensions manifest as physical symptoms. Suddenly can't walk, move arms...
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| How do you draw up a Regular and NPH insulin injection? | Clear before cloudy, regular before NPH
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| What is a pt with obsessive compulsive order ritual trying to achieve? | To avoid or alleviate severe anxiety
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| What may happen when a calcium channel blocker is combined with other antihypertensives? | Hypotension and heart failure, monitor for peripheral edeam
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| What is the normal KVO rate? | 20cc/hr
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| What is a adverse side effects of beta blockers? | bronchospasm, increased airway resistance (except for cardio-selective BB)
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| What is a myelogram? | lumbar puncture with the injection of a contrast medium (or air) into spinal subarachnoid space, allowing x-ray visualization of the spinal canal
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| What is the positioning for a patient with hip replacement? | side lying with the affected hip in a position in abduction
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| What is the purpose of cuff in a cuffed tracheostomy? | to seal the trachea and prevent aspiration
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| Till how old is the Babinski reflex supposed to be present? | 12 months
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| What can precipitate digoxin toxicity? | hypokalemia
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| What are normal lithium levels? | 0.6-0.12
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| What is the risk involved with hypoparathroidism? | laryngospasm
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| How do you calculate the estimated date of confinement? | add 7 days to the first day of last menstrual period and subtract 3 months
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| What is the appropriate care for around the clock feedings? | Rinse the bag and change the formula every 4 hours
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| How does pregnancy affect a type I diabetic? | Insulin demands increase during pregnancy and decrease afterwards
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| What are some signs of hypoglycemia? | irritability, tachycardia, diaphoresis
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| What are the isotonic, hypertonic and hypotonic fluids? | Iso: D5 1/4 NS, NS, LR
Hypertonic: D5 1/2 NS, D5 in LR
Hypotonic: water
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| What are some airborne precaution diseases? | TB, measles (rubeola virus), chickenpox, mycobacterium, possibly SARS
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| What are some droplet precaution diseases? | pertussis, influenza, adenovirus, rhinovirus, group A strep, meningitis, pneumonia, sepsis, scarlet fever, streptococcal pharyngitis, parvovirus B19, mumps, rubella, diptheria
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| What are some contact precaution diseases? | MRSA, VRE, c. difficle, norovirus, RSV, impetigo, scabies, ebola, viral conjunctivitis
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| What is the therapeutic range for Digoxin? | 0.5-2 ng/mL
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| How is a patient positioned for a liver biopsy? | supine with right arm over head
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| What types of foods should you avoid with hyperparathyroidism? | high calcium foods
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| What are some medications for the treatment of Tuberculosis? | Isoniazid and Rifampin
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| What are some symptoms of hypoglycemia. | hunger, shakiness, nervousness, sweating, dizziness, light headedness, confusion, difficulty speaking, anxiety
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| What are some DKA symptoms. | glucose 300, bicarb <15, acidosis ,7.3, ketonuria, confusion, abdominal tenderness, tachypnea, hypotension, acetone odor breath, tachycardia
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| What is the best way to access edema on a daily basis? | daily weights
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| What can a bile obstrution cause? | bleeding tendencies since Vit K can't be absorbed properly
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| What physical assessment finding many indicate Down Syndrome in a newborn? | Simian line on hand
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| Leg cramping in a person taking steroids may indicate? | hypokalemia
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| What may be a unique manifestation of juvenile rheumtaoid arthritis? | inflammation of the eyes
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| What is stomatitis? | inflammation of the mucosa of the mouth, tongue, cheek...
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| What is a major side effect of radiation therapy? | fatigue
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| What is rationalization? | Rationalization is offering a socially acceptable or logical explanation to justify an unacceptable feeling or behavior.
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| What are some signs of a hemolytic transfusion response? | fever, chills, flank pain, hematuria
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| What is an early sign of digitalis toxicity? | nausea
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| Where is the best location for an IM injection in a newborn? | vastus lateralis
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| What are some signs of hypokalemia? | muscle weakness and dysrhythmias
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| What is Cheynes-Stokes breathing? | periods of apnea followed by periods of rapid breathing
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| What are some signs of diabetic ketoacidosis? | fruity acetone breath, kussmal respirations, decreased alertness, circulatory volume, dry hot flushed skin, metabolic acidosis,
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| What is an early sign of cystic fibrosis the may be seen in newborns? | meconium ileus
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| Describe kussmaul respirations. | deep, rapid breathing in diabetic ketoacidosis
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| What is displacement? | unconscious redirecting of emotion from a threatening source to a non-threatening source
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| What other physical finding would you expect to find in glomerulonephritis? | periorbital edema
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| 1 gram of carbs = how many calories? | 4 calories
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| What is a sign of necrotizing enterocolitis in a preterm infant? | increasing NG tube residuals from prior feedings
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| What happens to cardiac output in the postpartum period? | it increases due to the rapid shift in fluids
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| When does acute glomerulonephritis occur and what is priority in treatment? | a noninfectious, immune-complex renal disease that occurs 10 to 21 days after a strep infection. Rest and symptomatic care
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| What happens to insulin requirements in a pregnant type 1 diabetic? | Usually first trimester: decreased insulin needs, second and third: there is a resistance to insulin so increased insulin needs
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| What serious condition may occur in a patient with an ileostomy? | dehyrdration, because it bypasses the large intestine where water is reabsorped
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| A mediolateral episiotomy is associated with? | more infections
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| Which hormones are secreted during dehydration? | ADH and Aldosterone
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| What does ADH do? | causes the renal tubules of the kidney to reabsorp water
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| What does Aldosterone do? | causes the reabsorption of sodium and excretion of potassium
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| What electrolyte parallels chlorine? | sodium
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