NCLEX study from Mark Klimek

NCLEX study from Mark Klimek Hyperthyroidism is also called Ans- Grave's disease or hypermetabolism Tip to remember Grave's disease s/s's Ans- "Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance Treatment for Grave's disease Ans- Radioactive Iodine, PTU (put thyroid under), surgically remove Total thyroidectomy ... totals get Ans- tetany, need lifelong hormone replacement After thyroidectomy patients are at risk for Ans- hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia parathesia Ans- numbness and tingling, first sign of electrolyte imbalance Subtotal thyroidectomy ... subs get Ans- storm S/S of thyroid storm Ans- Extremely high vital signs, hyperpyrexia, psychotic delerium How to treat thyroid storm Ans- give o2, lower temp to spare brain Risks post op for total thyroidectomy Ans- airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany Risks post op for sub total thyroidectomy Ans- airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm Hypothyroidism is also called Ans- Myxedema or hypometabolism S/S of mydexema Ans- everything is down, constipation, heat tolerance, cold intolerance Treatment for mydexema Ans- give thyroid medications Where to put the 5 ice packs to cool a thyroid storm patient Ans- neck pits groin If you cool a patient too fast what might happen? Ans- Heart arrythmias Never hold the hormone for what patient? Ans- patient who is NPO with mydexema Addison's disease easy way to remember Ans- Add a Sone (sone = steroid) Adrenal Cortex diseases easy way to remember Ans- A in Adrenal stands for Addison's C in Cortex stands for Cushing's Addison's disease is Ans- undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger. Addison's disease treatment Ans- give a steroid, chronic steroid therapy Cushing's syndrome Ans- Over secretion of adrenal cortex, too much hormone, too much steroid. S/S of Cushing's syndrome Ans- 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 Ans- Surgery, bi or uni lateral adrenalectomy (bilateral is worse) Donning PPE's order Ans- Gown, Mask, Goggles, Gloves Removing PPE's order Ans- alphabetically inside the room For airborne precautions the mask is removed where? Ans- outside of the room Avoid answers with what words for children 9 mths and younger? Ans- build, sort, stack, construct, make Toddlers (1-3) work on Ans- their gross motor skills (jump, hop, throw), NO fine motor, parallel play Preschoolers (3-6) work on Ans- fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend School age (7-11) work on Ans- creative, collect, competitive Best default order for click and drag order questions? Ans- Hold ..... med Assess ..... what med does Prepare ...... the correction Call ..... or notify Rarely if ever answer ... Ans- call Doctor, NCLEX wants you to think critically Creatinine lab values Ans- same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about INR lab values Ans- 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 Ans- 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 Ans- 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 Ans- 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 Ans- rapid response team! HgB lab values Ans- 12-18 check for bleeding if low or high, if low prepare for tranfussion HCO3 lab values Ans- 22-26 if it is abnormal so what! CO2 lab values Ans- 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 Ans- 36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration PO2 lab values Ans- 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 Ans- 93-100 pulse ox, if under 93 assess resp status and give O2 BNP lab value Ans- less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF NA lab values Ans- 135-145, if a change in LOC then evaluate for fall/safety risk WBC lab values Ans- if low assess for infection CD4 count less than 200 equals Ans- AIDS Neutropenic precautions (low WBC) Ans- 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 Ans- - if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia Bleeding precautions Ans- 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 Ans- 4-6 million abnormal doesn't really matter Reason for laminectomy Ans- treat nerve root compression S/S of nerve root compression Ans- Pain Parasthesia (numbness & tingling) Paresis (muscle weakness) Cervical Ans- Diaphram and Arms affected, breathing, respiratory pattern Thoracic Ans- Abd muscles and gut affected, ability to cough Lumbar Ans- Bladder and legs affected, when did they last void, are they distended #1 post op answer for spinal problems is Ans- log roll patient Activity post op spinal issue Ans- 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 Ans- pneumonia Post op complications for thoracic spinal surgery Ans- pneumonia (no cough), paralytic illeus (gut shuts down) Post op complications for lumbar spinal surgery Ans- urinary retention How long does temporary restrictions usually mean? Ans- 6 weeks (driving, lifting, etc.) Nagele's Rule Ans- 1st day of last period + 7 days - 3 months Weight gain during pregnancy Ans- 28 lbs plus or minus 3 lbs 1st trimester weight gain Ans- 1 lb/month or 3 lbs for 1st trimester 2nd/3rd trimester weight gain Ans- 1 lb/week Easy way to calculate appropriate weight gain during pregnancy Ans- 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 Ans- 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 Ans- xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movemen