Ve yer a Cle EME Tricyclics Tremors Indigestion S voymown O cvovines seated Heoact Rate cowie Brand Names: @: Bein Guan GS ier @ui Ear an eet Sonat ree aad Ceters Prenat the typ ea Types of Antidepressants & Common Side Effects SSRIs Inigastion Nauces @ S ow mown O veces R seni! Side EMocts Common Brand Names: @&: @: Bor Newer e- ‘S acs S yew se cn a= Bie S vvrmouts D® siurerison ‘S Low Blood Pressure Increases Blood Pressure Sey ide eects eiects tran Cocoa Sncmstoshs oritns ‘Common Brand Names: Be For a compete Sst of antidepressants and site effects vst p/w ninh.nin gou heath pubicatons/ental. heath mecieaions/complete index shiCUSHING'S SYNDROME | SIDE EFFECTS OF GLUCOCORICOIDS insomria ~~ emotional instabity aches tendon rupture ‘eaing aby ADDIQON'S DISEANE | LACK OF CORTICOSTEROIDS hypoglycemia — weight oss —J GRAVES DISEASE | HYPERTHYROIDISM Insomnia sos syne reslessnessiitabiiy smoot, sky hi heat intolerance J exoptnalamos warm, damp shin goiter haphorwss tachycartiapapiations icume weightioss Hele — seant menses _— musde weakness and fatigue HYPOTHYROIDIM lethargy, slow mentation impated memory — eta cldintolrance —_ cool, ty skinEe KAWASAKI SYNDROME BB w FEVER > 1022°F CONJUNCTIVAL, REDNESS: STRAW BERRY TONGUE HE RED LIPS CARDIAC COMPLICATIONS. WN 520% YEPALLOR OF PROXIMAL Pinaeanal.s RASH OVER TRUNK Coens FPERINEAL AREA SUPERFICIAL ‘SKIN LAYERS OCCASIONAL Besouavave INTERM| TTENT east Couey gas aes ABD. PAIN @ PALMS: * may Last Bela WEEKS (Stage of Cervical Dilation) Begins with onset of reqular contr: and ends with complete dilation Latent-== Active=9 Transitional tions First Stage - (Stage of Expulsion) Begins with complete cervical dilation and ends with delivery of fetus = Second Stage (Placental Stage) Begins immediately after fetus is bon and ends when the placenta is delivered. - Third Stage - (Maternal Homeostatic Stabilization Stage) Begine after the delivery of the placenta and continues for one to four hours after delivery ~ Fourth Stage ~INCREASED INTRACRANIAL PRESSURE (lICP) (Symptoms OFIICP Are Opposite OF Shock) * ICP * * Shock » ter tere + Pulse t Pulse } Respirations Respirations (Cushings Tried) me Score 0 Scor Appearance Pulse No pulse < 100/min Grimace cy rN (Vv & ) oy Activity Respirations+ AORTIC = 2nd ICS PULMONIC = 2nd ICS : ERB'S POINT= 3rd ICS Ss TRICUSPID = 4 orSthiCs \ ANTRAL APEX= Sth 1 VANUMUEOM: 5 AREAS FOR LISTENING TO THE HEART ¢ PULMONIC Left 2nd Intercostal Space ¢ AORTIC Right 2nd Invercostal Space @ ERB’S POINT (SS) Left ora Intercostal Space ¢ TRICUSPID Lower Lefe Stermal Border 4th intercostal ¢ MITRAL Left 5th intercostal, Medial to Midelavicular Line All People Enjoy Time Magazine (62007 Nursing Education ConsltsrtSIGNS OF SHOCK 4 In MAP (Mean Arterial Pressure) . tren TAD As Vasoconsercwon —"F Pulse Pressure wap omentig trom }Maset Rae See eheticee etective Compensstion ee aie On Vital Organs "e aa MAPL 2OmmHg from Baseline sue f Organ Hyposia 4 Urine (Oliguris) Excessive CaliOran Damage Malt System Org pH BBB 022007 Nerves Eciucation Carematr, n(At NURSING TUTORIAL FOR NCLEX-AN MEDICAL-SURGICAL 7 ACID BASE MNEMONIC (ROME) R Respiratory 0 Opposite pH? PCO, Alkalosis pH PCO, T Acidosis M Metabolic E Equal pH? HCO, 7 Alkalosis pH +HCO,+ Acidosis AGE Prtesional Dewsioprert Systems, be. 4 Jrdne Davies Bg 222 Son Gl Payal Ave. Maka Gly Tet B1R0G28 Fax no S1aNGe8As NURSING TUTORIAL FOR NCLEX-AN MEDICALSURGICAL 10 RESPIRATORY ALKALOSIS SYMPTOMS Tingling of extremities Confusion Deep, rapid breathing Seizures Reference: Memory Notebook ot ‘Aatrors. lohan Betuaby, 80), RN, FRB “eidttinos BBN RN Paes ‘1. €ttolClaborn NB, RN, AGE Prfensional Densopmert Sysies, x. 4F Jasin Daven Bg 222 Sen Gl Puy Ave: Maka iy Tal 6160028 Far no. 6163980As NURSING TUTORIAL FOR NCLEX-AN MEDICAL-SURGICAL 24 METABOLIC ALKALOSIS SYMPTOMS Nausea and vomiting Diarrhea Restle: ess Slow respirations Arrhythmias ACE Profeesonal Developme Syetens, “4 Jerdna Deion Big 222 Sen: Gi Paya Ave Maka iy "Te s18028 Fax. 616308(At NURSING TUTORIAL FOR NCLEX-AN MEDICAL-SURGICAL 8 RESPIRATORY ACIDOSIS SYMPTOMS Rapid, shallow respirations Dyspnea Disorientation Muscle weakness Reereree, ear Nebo Ware toann vawesn, ‘cil ier BSN. RN ACE Prefnzional Dovlopnart Syme, - Jeena Deion big 222Sar Gl Puja Ave Maka Cty Ta B180626 Pex no Siete‘A+ NURSING TUTORIAL FOR NCLEX-AN MEDICAL-SURGICAL 81 TYPES oF * Discotores + NO Pain) ACE Prtecsinal Dvaoprart Syatns e (6 Jardie Ova dg 222'San Puy Ave Maka CyA+ NURSING TUTORIAL FOR NCLEX.AN MEDICAL-SURGICAL 85 TETANUS # SPASMS OF HINTACT SENSORIUM FACIAL MUSCLES wneapacne 7 SERED Frcarons > # DIFFICULT # JAW STIFFNESS SWALLOWING ¥ SORE THROAT # RESTLESSNESS * IRRITABILITY * CHILLS # TONIC ) SPASMS (\ 2 EXAGGERATED ¥ REFLEXES PROFUSE }) SWEATING Devslopmant Stine. re ACE Petesions 4 Jenna sion dg 222an GI Puyel Ave. Ma ly Ta aveos Fax eo. e1600e8INCREASED INTRACRANIAL PRESSURE # Changes in LOC * Eyes +Fapiladema = Pupillary Changes lipsired Eye Movement + Fosturing * Deceretrate * Decortleste * laccid * Changes in Speech Infants: Headache * Seizures: ‘Impaired Sensory & Mator Function * Changes in Vital Signs: * Cushing's Tia ‘1 systolic BIP +1 Rise © lrrequiar Resp Pattern * vomiting “Bulging Fontanels “Cranial Suture Separation #f Head Circurnference High Pitched Cry4 AUTONOMIC DYSREFLEXIA. (Spinal Cond injury At F6 Or Higher) \ Triggered by sustained \ stimuli at T-6 or below from: @ayo = hey Full Baader estrictive un -— bs a 1BP » Sefore & Rapid es Aresis: shed Face endacke © Dietended Neck Vein Fecat Impaction Risk Factors: - Possibly Autoimmune ILL AL - Association with Immunizations: - Frequently preceded by mild repirstory or intestinal infection BARRE’ SYNDROME - Frogresses over hours te days Minimal Muscle frou Symmetrical Paralysis Causes Froblems With: ~ Respiration Talking SwallowingNeuro Baan it Cand Brain Son Me SEPNDRSING GOALS] % Alewaye- Onygeration ried * Nutetion ' Preserve Function ‘ Rehabication = Sie + Eaucation BRAIN ACCIDENT - Cv * Headache ‘* Hemiparesis or Hemiplegia * Mental Changes = Confusion = Disorientation + Memory Impairment. + Emotional Lability * Visual Changes Memeromove Hemiropes) 44... Pose opr Vomiting «Perceptual Defects {CA Righe Heriophere) © Aphaia (slersprce) * Resp Problems ( bNewremoveuar Corel) #4.Cough f Swallow Refiex * Agnosia (Aran ) *lecantinence = Seizures * Hypertension Apraxia Lencned Movement) WRB 22027 tr CeNewer" «Bulging Fomaneta Suture Separation #Thead Site | High Pitched Cry tin The Size OF Intracranial Convent ‘eae «Ra en Boma Coe SE yt Roece aoa pease Chere +r Rieu FecdngeSystolic and Diastolic Blood Pressure Systolic blood pressure: Diastolic blood pressure: The pressure of blood The pressure between in the vessels when beats when the the heart beats (SPB) heart relaxes (DBP) 120/89 mmig millimeters of mercury Blood Pressure Ranges ‘SBP DBP Blood Pressure Category mre rai Hypotension <90 or <60 Normal Blood Pressure 90-119 |or| 60-79 High Blood Pressure Stage 1 Lifestyle Modifications to Manage High Blood Pressure ‘Approximate Ee SBP Reduction ‘Maintain normal body weight 520 mmHG/I0KG (body mass index 185-24.9 ka/m2). ‘Consumes diet rich in fruits, vegetables, and lowfat dairy products with areduced content 814mmHg, (of saturated and total fat. weightloss Reduce dietary sodium intake to ‘no more than 100 mmol per day 28mmHg (24 g sodium or 6g sodium chloride). Engage in regular aerobic physical activity such as brisk walking (at east 30 min per 4.9mmig day, most days ofthe week). Limit consumption to no more than 2 drinks (1.020730 mLethanol;e, 24 oz bees, 24mmig 10 ozwine, or3 02 80-proof whiskey! wwnwarhealth-blog.compo PSVchon, 9 epressan ts Suenw? aly ucinoge™—.. KIDNEY DISEASE ores ase heathy tency Karey dese ay ADAM (CKD USUALLY HAS NO SYMPTOMS UNTIL THE DISEASE HAS ADVANCED (GFR 25%). BLOOD & URINE TESTS ARE THE QUICKEST WAYS TO DX THE. DISEASE. MOST COMMON CAUSES Diabetes Mellitus Uncouttoled Hypenension Glomerwionepintis ‘WHAT HAPPENS? ‘The kidaeys are unable to filter S get rid of ‘vastes ftom the blood, concentate urine, regu- late BP & acid-base balance, & produce erytaro- poietn (ihe hormone needed for RBC production ‘and survival). The waste and ext fits build 1p inthe blood & body furemia) & cate elec tuolyte imbalmees (Ja, 1H, 1P. Stage l: GER 90 >= slight ladaey damage, Stage 2: GFR 60.90 = mild | in faction ‘Stage 3: GFR 30-60 = a moderate | in furction, Stage 4: GFR 15.30 a severe | in function Stage §: GFRIS <= ESRD. Tet needed to sustain Lie, Physical ndings: description of wine, ‘put, ad balance, VS, findings it complications of CRF presence of pain for pruritus, LOC, GI tans, sin integrity, condition of dialysis cass ste Natition: Response 10 dietary oid ee ktice Lott of gs, cht toperform ADLs, mobility Bron Unea Nrmoczx/BUN (6.26 mg/aL.) indicates the renal clearaace of waste products (9) indicates the tuabiy to excrete wares. ‘Sexvw Cxrarmenve (06.1.3 mgidL) is 0d prodoct of protes& sncecle etabotina (Gd) with renal diceace & when $076> of renal function soit 2m lParam Ym eee ewe (GLOMERULAR FILTRATION RATE/GFE (125 mL/min) the amount of fltrate formed by the Kidneys each minute. Soestages ‘CoupLere aLoop couxr/cac RBCs, WECs & platelets 1) function is reduced ASSESSMENT CNS: impaired decision making, impaired judgment, vtatibity, decreased alertaess, insomnia, loss of conscionsness & seizures, ‘blurred vision, electrelyte imbalance, met ‘bolic acidosis CARDIOVASC: Uremia, CHF, HTN, rapid, inzepularheat rates: JVD: a pericardial frc- ‘ion rob & distant heart sonnde (ifportcardi fi prevent), anemia [RESP: hyperveatilation, Kussmaul treath- ing, dyspnea, orthopnea, pulnoaaty conges- ‘ion, rales (tid overload), pulmonary edema (roth sputim & SOB) GUGU: ure tke odor on the breath, dite ‘rine with cass or crystals presen, cliguria (Lurine production). esophagitis. Tight NV D, hematomosis, constipation, enstite (MS: osteopenia (1 bone sue), pathological fractures, ambulatry dysfonction ered ‘motor function, git abnormalities, bone! joint pain, muscle crap, and titebing, & peripheral aewopathy, {extremity weakness, ‘diopaic bone’ joint pain, anscle mass, soctunal leg cramping INTEG: yellow gaay cat, igile & dey, ‘wemie fos, proite, bruising; petechie; ‘eile mais ky, bite mir; gum wlers; or bleeding ‘REPRO: gynecomastia (mer). amenorhea (eomen), sexual dysfonction, | bids TEACHING ‘Menncanons (Qur Swoxne ‘Conran DM. ‘Treat HIN ‘Trem ANIMA Regus DET fd restriction (ice chips, hard candy) “high calories, high carbohydrates tow protein, tow sodium, “reduce intake of beans, slmoa, dark leafy greens (dietary potasium) - reduce intake of chicken. milk, ccatbonated drinks (dietary phosphors) Duras when indicated = signs ofan infected access ste “cary clamp should shan become discomested "Feel the Thi NO BPs or blcod draws oa limb “protect site during bathing - do not ‘apply creams or lotions on access site “TeasooLawamos when available = risk infection, rejection & skin CA (Gerosr cuNces To PCP noventarety) ~ svoid large groups for 3-4mos after - avoid stong sunlight for duration "NO contact sports & heavy lifing MEDICATIONS BRMeds (on 4CE [Lisinopail or 4RB {Losartan lpr protec ines & lower haar disease risk) Diuretics (conol fue overload (Lass) ‘Supplements (Vit D, Ca, Paosphoms Binder, Sodism Bicab, Kayeneate)- tak with uals or enacks Medi to 1 RBCs (Exytiopoictin FeSO4) Immmuromppresanis Corticesteroids | inflammation & pain Ant lla Seltzer or baking soda; TNs — TBP esta Miko Mag ocother antacid "Mig cas ‘buldup inthe bod & ene arco problems (Gateure, ‘Acid: Bets the coreng stem -may ‘ans bleding (tae prescribed. ‘NSAIDS. (40, Nuprin, Monin I & dlove Aattslammatary meds ou ‘mere damaze ‘Enemasor laxatives: ‘Supplements! may coats t K & Mg. Conslt PCP hefre using ‘OTCameds:Consul PCP before wsirg Hechal meds: Cone PCPif wing crueHeart Disease Heart disease includes any lisorder of the heart and affects millions of Americans every year, yet itis highly preventable by following a healthy lifestyle. Itisthenumber one ‘atte of death inthe US, accounting for 3605 of deaths annually. ‘TYPES OF HEART DISEASE. = Seon ‘nate reas nly |n2010, heart diceasewillcost an estimated $316.4 ion in health Heart taure eter ump Srderty spy fe body th medicine and lost peodacteiy: ‘fe feartmustes over rt nee ‘cOMMON mUsK FACTORS al FoR WeART DISEASE eee opin tnd out the heat wo comers Sere mina Sherasrectons” ee fearon rt, ean x ferme Ses oat pricy iy elias rpscepnrorse BES NASEtote Soe 2 rretraene Sor, seeeatecen! ing oe oes =o --Computaiidiicuss your Sree blood disorders Soucasic HOWTO LOWERYOURRISK FAST FACTS Hear lssase death rtesin the US. onrelny Serceciimmay Meneceanuens es inst deme eee) ve ieuuieyies Naa wins clan, ae SES ‘Separeeaiane napintas Sorular acai eamoeeeen een SOE! worm nain Moweryoctootioe — Nomuneraete tanFoods to Avoi ACE inhibitors With Certa’ Potassium-containing salt substitute Ampicillin Carbonated beverages, acidic juices Aspirin Feverfew, ginkgo, green tea Barbiturates Valerian Calcium-channel blockers Grapefruit juice Cloxacillin ‘Carbonated beverages, acidic juices Cyclosporine Grapefruit juice, potassium-containing salt substitute Digoxin High-fiber foods and meals Enteric-coated pills Excess milk, hot beverages, alcohol Fluoroquinolones Foods high in calcium, iron, or zinc (dairy and red meat) Hemorrhoid medications Saw palmetto Indomethacin Potassium-containing salt substitute Isoniazid High-carbohydrate foods Levodopa Excess protein Lithium Significant increase or decrease In sodium intake MAO inhibitors Foods containing tyramine Methyldopa Excess protein NSAIDs Asian ginseng, ginkgo Penicillin G Carbonated beverages, acidic juices Phenytoin Excess protein Potassium-sparing diuretics Potassium-containing salt substitute “Statin” drugs Grapefruit and grapefruit juice Tetracycline lron-rich food or supplements, calcium Theophylline Excess protein Warfarin (Coumadin) Vitamin K-rich foods and supplements, Asian ginseng, feverfew, garlic, ginger, ginkgo, St. John’s wort, green tea Zidovudine Excess fat1 Normal We Gain ~ 20-30 to. $ Bataniaa Det Treas ee eet 30 ca eg atheea orn peace oun 2 Bases aaprate fi 2 sea Sate ieee + LLumtoeactl Gaye Mes Coreen ct Smeg One Wag Gat Beret Size ‘Hencrees ce ey ‘iarenac ee | ae tom olay ed HEE cee domeneae Het ents ice iiesec Pypertrophy PRES ang [Prous Conmactive Thesae Braran Hiei =P Thick white secretions Conca Softening = Mucus Pg Sain Phgmaneation wenn 5 Fea) * Facial Mask ood Aone Hagar = Dermat Se A 1 Vagcular Spider Net Banal ater 9 ABD - Sereech Marke "Forma acter tees, es BB 22007 sarang Edecatien Comutanta ee:ns Sie i Supine og Prone Right ff SSS Recumbent Left Lateral Recumbent Fowler's 7 i TrendelenbergIsa RSA g ROP 3 LOA ROAGENERAL HYGIENE Showersibed baths, Jacuzzi bath | Perineum Oral hygiene Handwashing Face Gownsilinens NURSING ACTIONS: Assess for progress in labor ‘Supervise showers closely if woman is in true labor Suggest allowing warm water to flow over back Cleanse frequently, especially after rupture of ‘membranes and when show Increases Offer toothbrush or mouthwash of wash the ‘teeth with an ice-cold, wet washcloth as, needed Brush, braid per woman's wishes Offer washcloths before and after voiding and a8 needed Offer cool washcloth Change prn; fluff pillows NUTRIENT AND FLUID INTAKE Oral wv ELIMINATION Voiding Ambulatory woman | Woman on bed rest Catheterization Bowel elimination— sensation of rectal pressure Offer fluids and solid foods, following orders of primary health care provider and desires of laboring woman Establish and maintain lV as ordered Encourage voiding at least every 2 hours Allow ambulation to bathroom according to orders of primary health care provider, if The presenting part is engaged The membranies are not ruptured The woman is not medicated Offer bedpan Allow tap water to fun; pour warm water over the vulva: give positive suggestion Provide privacy Put up side rails on bed Place call bell within reach Offer washcloth for hands ‘Wash vulvar area Catheterize according to orders of primary health care provider or hospital protocol if ‘measures to facilitate voiding are ineffective Insert catheter between contractions Avoid force if obstacle to insertion is noted Help the woman ambulate to bathraom or offer bedpan, efter careful assessment Perform vaginal examination Cleanse perineum immediately after passage of stool RATIONALE Determines appropriateness of the activity Prevents injury from fall; labor may be acvel- erated ‘Aids relaxation; increases comfort Enhances comfort and reduces risk of infection Refreshes mouth; improves morale; helps ‘counteract dry, thirsty feeling Improves morale; increases comfort Maintains cfeanliness; improves morale and ‘comfort Improves morale: provides relief from diaphoresis Improves morale and comfort Provides hydration and calories; enhances positive emotional experience and maternal control Maintains hydration; provides venous access for medications ‘A {ull bladder may impede descent of present- ing part; everdistention may cause bladder atony and injury, as well as postpartum voiding difficulty Reinforces normal process of urination Precautionary measure to protect against pro- lapse of umbilical cord Precautionary measure to protect against injury Prevents complications of bladder distention and ambulation Encourages voiding Shows respect for woman Prevents injury from fall Reinforces safe caro Maintains cleanliness and comfort Maintains standard of care Prevents complications of bladder distention Minimizes discomfort “Obstacle” may be caused by compression on Urethra by presenting part Prevents misinterpretation of rectal pressure from the presenting part as the need to defecate Determine degree of descent of presenting part Reduces risk of infection and sense of ‘embarrassmentDYSRHYTHMIA CHEAT SHEET Ce others Sow auchage toms. | sleep, hypother- ‘nus requir mia hypothyroid Granda |erygey | Ervaptsiras | Nomal | nemal | Nema cree See smens | increased CP Tago stargesfom | Hypotension, . Moretien | ypovoleria, Iodbpmeow- | fever, anemia, | Normal | Normal | Normal Tachycardia | urine | hyposia heart moyease | allure a Troan peas | May prelude su- focvvily | praventcular Premature | winners | tachycardia. Atrial: ‘conduction, Stimulants, hy- ‘regu ‘Abnormal | Variable | Normal Convacton | 82 | perthyroidism, {PAQ) pulse may be | COPD, infection eyeder | and heat diseas- nr es scope oe Paroxysmal | Soove me Exerion, Emo- Suprovenarce | tune s ap reenty rae | tion, Stimulants, | Abnormal | Vacate | — Nermal fromito:o | Rheumatic Heart | or Hidden Tachycar 30/mnute, Diceaces sv iepuar tytn sy cece CO ope aa fear rary stal__| CAD, Valve Prob- Aviat otter [2528 | lem Hyperthy- | S222! | Variable | Normal ally with slow roidism semen reparse Tia deer gentaton avial electrical | Usually heart dis. May cause Atrial saciviywith- | eases, also hy- Can'tbe Fibifation | M8 | certnycia infec: | SMHS | measured | NOFA ton tion ‘i R300%0 coynnte First Degree | AB 5.0 mEq/L - Calcium citrate (Citrical ‘Calcium carbonate or calcium acetate ‘Oral or IV administration Implemant seizure precautions during administration andhave emergency equisment on hand Magnesium sulfate Magnesium gluconate or magnesium hydroxide Monitor BP, pulse and respirations with IV administration Decreased/absent deep tendon reflexes. indicates toxicity Have injectable calcium gluconate on hand to counteract toxicity when giving magnesium sulfate: | Bicarbonate HCO) «Normal pH range: 7.35-7.45 » Sodium bicarbonate # Maintains blood pH to prevent Given orally as an antacid or via IV metabolic acidosis Numerous incompatibilities with IV form