ATI - Predictor Study Notes (updated 2020) – Rasmussen College | ATI - Predictor Study Notes (updated 2020)

ATI - Predictor Study Notes (updated 2020) – Rasmussen College 120+ pages of questions and answers ATI – NCLEX Predictor Remediation Study Notes Renal Calculi - Pain: Flank pain → Kidney or Ureter (if pain radiates → stones in ureter or bladder) Performing Ear Irrigation: Sterile technique, warm meds, pull up & back, tilt toward affected ear Thrombolytic Therapy (Stroke): Reteplase recombinant (rTPA – clot buster) w/ in 4.5 hours of initial symptoms Trach care: Dressing ∆, inner cannula ½ hydrogen peroxide, & stoma □ knot Head injury (changes in LOC): Length of time unconscious & GCS General anesthesia (post-op): ABC’s – full body assessment, Vitals every 15 minutes, Lateral position (if unresponsive or unconscious - monitor LOC), Fluids/Electrolytes Superficial Burns: Painful, pink, red, mild edema (3-6 day healing), damage to epidermis2 Dialysis (reporting unexpected findings): Temp of 100 degrees, ↓ BP, bleeding, 1 L of fluid = 1Kg, clotting, H/A, Nausea, Disequilibrium syndrome (rapid ↓ BUN & Fluid volume), anemia, peritonitis, ↑ BG, ↑ cholesterol Pacemaker (complications): Infection, hematoma, pneumothorax, hemo-thorax, arrhythmias, pacer spikes before P or QRS, hiccups / muscle twitching Magnesium (Mg) Sulfate → Increase Mg+ 1.3 Mg/dL ↑ Mg foods = (Dairy, dark leafy greens veges) ↓ Mg causes → Hyperactive deep tendon reflexes * Paresthesia’s, muscle tetany, positive chvostek’s & Trousseau’s sign, hypoactive bowels, constipation, abdominal distention, paralytic Ileus. TPN Admin: (Total parenteral nutrition) -feeding that bypasses the GI tract. Fluids are given into a vein to provide most of the nutrients the body needs. Given when person cannot/ should not receive feedings or fluids by mouth. Hypertonic (20-50% dextrose), Used in chronic pain, peritonitis, burns, Infection, etc No more than 10% hourly, ↑ in rate for body adjustment, check BG Hyperglycemia, hypoglycemia, vitamin deficiencies, air embolism (clamp, place in Trendelenburg pos., O2) Fluid imbalance → Fluid volume excess Wound Culture specimen: Sterile field, press / rotate over wound surface inside the wound (center) in drainage3 Diabetes Mellitus (Nephropathy): Kidney damage d/t prolonged ↑ BG & dehydration Monitor I & O, Creatinine, BP Avoid Soda, alcohol, acetaminophen/NSAIDS / 2 – 3 L fluid from food / beverages Kidney Biopsy (Post op): Monitor VS → Client receives sedation Assess dressings & urinary output (hematuria-blood in urine) Labs: HgB & Hct values, Admin PRN pain meds, Complications hemorrhage / infection Thyroidectomy (Post Op): Needs Thyroid hormone replacement Client in high fowler’s position, Respiratory (trach supplies) present, Check for laryngeal nerve damage Pain management, Hypocalcemia / Tetany can occur Prioritization: Apply knowledge to Standards to determine priority action Systemic before Local – “Life before Limb” Acute before Chronic Actual Problems before Potential Future Listen carefully to clients & Don’t Assume Recognize & Respond - Trends vs. Transient findings Recognize indications - Emergencies vs. Expected Delegate to LPN: Monitoring Findings, Reinforcing teaching, performing trach care, suctioning, checking NG tube patency, administer tube feedings, inserting urinary catheter, administering meds (No IV)4 Delegate to AP: ADLs, Bathing, Grooming, Dressing, toileting, Ambulating, feeding w/out swallowing precautions, positioning, routine tasks, bed making, specimen collection, I & O, VS for stable clients, monitoring clinical manifestations after initial RN assess/eval. Paracentesis (prep) - take out fluid from belly (peritoneal fluid) Have client VOID Bariatric Surgery: (weight loss surgery) – Semi fowlers, 6 small meals/day, liquid/pureed food for first 6 weeks (not to exceed 1cup), Vitamin / mineral supplements, & 2 servings of protein daily. Ostomy (in small intestine) Avoid odorous & gas foods (dark green veges, dairy, fish, eggs, beans, corn), yogurt ↓ gas Avoid ↑ fiber foods for first 2 months, ↑ fluid intake Dumping Syndrome: Happens within 15mins of eating. Sx: cramps, diarrhea, tachycardia, dizziness, fatigue, hypoglycemia Interventions: small frequent meals, drink liquids 1hr b4/after Parkinson’s disease: Tremor, muscle rigidity, bradykinesia (slowness in movement), postural instability Stages: 1. Unilateral shaking / tremor of one limb 2. Bilateral limb involvement, difficulty walking/balance 3. Slowed physical movements 4. Akinesia & Rigidity make ADL’s difficult 5. Unable to stand/walk, dependent of cares, dementia5 Assault: threat Battery: touching Hypoglycemia Sx: Shakiness, confusion, sweating, tachycardia, diaphoresis, palpitations, H/A, lack of coordination, blurred vision, seizures, coma Oral Hypoglycemic Agents: promote insulin release from pancreas (Type2 DM) Glipizide (Glucotrol), Chlorpropamide (Diabines), Glyburide (Diabinese), Metformin (Glucophage). * Med for insulin overdose = Glucagon Radiation Adverse Effects: Skin changes, hair loss, debilitating fatigue, 30 minute visits / stays 6ft away / private room Infection control in clients home: good hygiene, avoid crowded areas, avoid raw foods (veges/meats), avoid cleaning litter boxes, clean home and avoid sick family. Client evacuation in response to fire: greatest good for the greatest amount of people Client in seclusion: 18 yo+ → 4 hours, 9 – 17 yo →2 hours, 8 yo & younger →1 hour Conduct Disorders: lack of remorse, bullies, threatens, low self-esteem, tempers, physical cruelty, destroys property, truant, and shoplifts Manic Phase: ↑ mood, irritable, lasts at least a week, euphoria, agitation, restless, ↑ in talking, flight of ideas, grandiose view of self, impulsive, manipulative, poor judgement, attention seeking.6 Paranoid: distrust / suspiciousness Schizoid: emotional detachment, disinterest in relationships, indifferent to praise/criticism, uncooperative Schizotypal: odd beliefs, eccentric appearance, magical thinking, perceptual distortions Antisocial: disregard for others, lack of empathy, unlawful, failure to accept responsibility, manipulative, impulsive, seductive Borderline: instability of affect, identity & relationships, splitting behaviors, fear of abandonment, self-injurious, impulsive Histrionic: attention seeking, seductive, flirtatious Narcissist: arrogant, constant admiration, lack of empathy Avoidant: anxious, wants close relationships, fear of rejection Dependent: dependency on another individual OCD: perfectionist, orderly, and control Clozapine (Anti-psychotic Atypical ) Adverse effects: metabolic syndrome, orthostatic hypotension, anticholinergic effects, agitation, dizziness, sedation, mild EPS, ↑ prolactin levels(galactorrhea, amenorrhea, gynecomastia), & sexual dysfunction Anti-lipemic Agents: (Statins) – treats high levels of fats/cholesterol in blood - called lipid-lowering drugs Monitor liver enzyme levels (hepatotoxicity) and muscles – monitor CK levels (myopathy & peripheral neuropathy)7 Med interactions: Fibrates (Genfibrozil) - ↑ myopathy risk, Erythroycin & Ketoconazole, Amiodarone, & Cyclosprine = Grapefruit juice can ↑ statin levels Gentamicin (effects urine output) -causes ototoxicity w/ diuretics, digoxin, lithium, ototoxic meds, NSAIDs, & anti-hypertensives Long term therapy for RA: DMARDs (methotrexate, etanercept, infliximab, adalimubrab, Azathioprine, Cyclosporine) ** Slow joint degradation Glucocorticoids (Prednisone) & NSAIDs provide symptom relief from inflammation & pain Bulb Syringe (for babies): Mouth first, then nose, depress. Then insert into mouth, avoid center of mouth- may stim. gag reflex. Priority action to an allergic response: Mild rashes/hives – Benadryl Anaphylaxis - treat with epi, bronchodilators, and anti-histamines Provide respiratory support & notify HCP Losartan (ARBs -Anti-Hypertensive (HTN) & kidney disease) - Cough & hyperkalemia are for ace inhibitors. Side Effects: Angioedema, hypotension, dizziness Tracheostomy Care: 2 xtra tubes, adequate humidification, oral care every 2 hours, trach care every 8 hours, sterile suctioning, surgical asepsis to remove / clean inner8 cannula, secure trach ties before removing old, square knot, clean from stoma outward Appropriate Doc.: Subjective/objective data, Accurate/concise, Complete/current, Organized/ date/ time/ blk ink Crutch safety: Support bodyweight at hand grips with elbows at 30 degrees, Position crutches on unaffected side when sitting or rising from a chair Varicella (chicken pox) Transmission: Direct contact, droplet, from person with shingles, 10-21 days, 1-2 days before lesions appear and all lesions have sabs Scoliosis: Lateral curvature of spine & spinal/truncal rotation that causes ribs asymmetry. Curve needs to be at least 10 degrees One leg shorter than the other. Asymmetry in scapula, ribs, flanks, shoulders, hips. Screening for Idiopathic Scoliosis: During pre-adolescence - Observe child from back Bend at waist with arms handing down & observe for asymmetry of ribs and flank Measure truncal rotation with a scolio-meter Use Cobb technique to determine degree of curvature Use riser scale to determine skeletal maturity ↓ Cardiac output (interventions): Maintain bedrest, Semi fowler’s/ fowler’s position while awake, Sleep w/ pillows Cardiac output positioning for optimal output: Left lateral side, Semi fowlers, Supine with wedge under one hip9 Infant car seat: Position infant in car seat at 45 degree angle, Safety restraints loose and low on abdomen Correct use of Condoms: On erect penis, empty space at tip for sperm reservoir (May be used with spermicidal gel to ↑ effectiveness), Protects against STI’s, only water soluble lube with latex condoms Amnio-infusion for Oligohydramnios: (not enough amniotic fluid around fetus) Infusion or NS or LR into amniotic cavity to reduce severity of variable decelerations caused by cord compression Scant amount or absence of amniotic fluid, Membranes must have ruptured to perform - Warm fluid Rhogam for Clients who are RH-Negative: (Antibodies from human plasma injected into RH+ mother to protect fetus) Chadwick’s sign – violet/blue color or cervix & vaginal mucosa Goodell’s sign – softening of cervical tip HSV (Herpes simplex virus): direct contact transmission to fetus is greatest during vaginal birth if woman has active lesions, Lesions & tender lymph nodes, Obtain cultures from women who have HSV or are at or near term Urinary frequency Interventions: ↓ fluid intake b-4 bed, Use perineal pads, and Kegel exercises ↓ stress incontinence Buddhist Dietary practices: vegetarian, nuts, legumes (dried peas/cooked beans), No eggs, no milk products10 Notifiable Communicable diseases: anthrax, botulism, cholera, diphtheria, gonorrhea, hep A/B/C, HIV, legionaries, lymes, malaria, mumps, pertussis, polio, syphilis, tetanus, TSS, TB, Typhoid fever, VRSA, At risk populations, transmissions routes Anterior Pituitary Hormones: Stimulate growth - Caution in DM patients – can cause hyperglycemia (Somatropin) Anti-Convulsants: Tx- seizures (caphe) Petit Mal (Valet) Carbamazepine, valproic acid, ethosuximide, Phenytoin/phenobarbital – adverse effects = yellowing of skin, nystagmus, teratogenicity, osteomalacia, H/A, vertigo, ataxia Ophthalmic Agents: Beta Blockers: ↓ aqueous humor production (betotopic, betaxon, betagan, betimol) Prostaglandin Analogs: ↑ aqueous humor outflow (xalantan, travatan) Alpha Adrenergic Agonists: ↓ aqueous humor & ↑ outflow (Alphagan) Direct Acting Cholinergic Agonist: ↓IOP & ↑ outflow of AH (Pilocarpine) Side effects for Ophthalmic Agents: Blurred vision, angle closure glaucoma, dry eyes, photophobia, ocular pressure, can cause systemic effects, ciliary muscle constriction Mixing Insulin: (Clear before Cloudy) Air into NPH (Cloudy), Air into Regular (Clear), Draw up Regular (Clear), Draw up NPH (Cloudy) * Hypoglycemia is most likely to occur during peak.11 Obstetric History: (GTPAL) Gravida, Term, Preterm, Abortions, Living Children Pre-Term Infant: Anticipated Problems (TRIES) Temperature regulation (poor), Resistance to infections (poor), Immature Liver, Elimination problems (Necrotizing Enterocolitis), Sensory-Perceptual Functions (Retinopathy) Fetal Heart Rate: (VEAL CHOP) Variable Decels Cord Compression Early Decels Head Compression Accelerations O2 (Baby is well-oxygenated) Late Decels Placental Utero Insufficiency Pregnant Client - Med. Surg Floor: (FETUS) Fetal heart tones (document every shift) Emotional Support Temperature (Measure maternal) Uterine Activity/Contractions (early-low back pain) Sensations of fetal movement Placenta Previa: low implantation of the placenta / Bright red bleeding present that is painless. Place mother on bedrest in side lying position / Weigh perineal pads Abuptio Placenta: Premature separation of the placenta - Dark red bleeding may or may not be present with sharp stabbing pain Start fluid replacement, oxygen by mask, monitor FHR, keep in lateral position, pregnancy must be terminated - birth or C-Section12 Endocrine Agents: Thyroid Hormones (Hypothyroidism) Synthetic form of thyroxine (T4), ↑ metabolic rate, body temp, oxygen use, renal perfusion, blood volume, & growth processes. (Levothyroxine, Thyroid, Liothronien, Anti-thyroid meds (hyperthyroidism), graves, thyrotoxicosis, propythiouracil (PTU) Cholecystitis: (Inflammation of Gall Bladder) ↓ fat intake, NO - coffee, broccoli, cauliflower, cabbage, onions/ legumes Compartment Syndrome: Sx: (5 Ps) Pain, Pallor, Pulse ↓ or absent, ↑ BP, Paresthesia (tingling hands, feet) Acute Renal Failure: Can cause HypoNatremia, HyperKalemia, HypoCalcemia, & HyperPhosphatemia Shock Sx: (Chord Item) Anti-Platelets: Aspirin, Plavix (clopidogrel) Cold, clammy skin, Hypotension, Oliguria, Drowsiness, ↑bleeding risk, prevent MI/stroke, taken PO Rapid/shallow breathing, Irritability, Tachycardia Watch for hemorrhagic stroke (weakness, Dizziness, H/A) Elevated or reduced CVP, Multi-Organ damage Avoid NSAIDs, Heparin, warfarin, corticosteroids Anti-Platelets: Aspirin, Plavix (clopidogrel) ↑bleeding risk, prevent MI/stroke, taken PO Herb/Botanical Therapy Watch for hemorrhagic stroke (weakness, Dizziness, H/A) Echinacea (common cold), Ginger root (↓ nausea, RA)13 Avoid NSAIDs, Heparin, warfarin, corticosteroids Ginko Biloba (↑ vasodialation, dementia, alzheimers) HypoCalcemia Sx: (CATS) Valarian (↑ GABA to prevent insomnia) – don’t use in MH, Convulsions, Arrhythmias, Tetany, Stridor / Spasms Or pregnancy. Black cohosh (estrogen sub)-↑ anti HTN Nephrotic Syndrome meds& hypoglycemia Serum Proteins in urine, Diet with sufficient protein Peptic Ulcer Disease Diet low in sodium Avoid frequent meals/snacks, alcohol, smoking, NSAIDs, Nephrolithiasis (kidney stones) Coffee, spicy foods, & caffeine ↑ Fluid Consumption is primary intervention Lactose Intolerance HypoKalemia Sx: (6 L’s) Distention, Cramps, Flatus, Diarrhea Lethargy, Leg Cramps, Limp Muscles HypoGlycemia Sx: (TIRED) Low Shallow Respirations Tachycardia, Irritability, Restlessness, Excessive Hunger Lethal Cardiac Dysrhythmias Depression / Diaphoresis Lots of urine (polyuria) End Stage Renal Disease: GFR 25mL/min Pre-End Stage Renal Disease Serum creatinine rises, dialysis or transplant required ↑ in serum creatinine ↑ protein, ↓phosphorus, ↓potassium, ↓sodium Limit protein & phosphorous (meat, dairy, pb, dried peas, Fluid restricted diet Beans, cola, chocolate beer)14 Protein needs ↑ once dialysis begins Restrict sodium to maintain BP Vitamin D deficiency occurs Arterial occlusion (4 P’s) HTN Care: (Diuretic) Pain, Pulselessness, Pallor, Paresthesia Daily weight, I&O’s, urine output, response of BP, CHF Treatment: (MADD DOG) Electrolytes, take pulse, Ischemic Episodes (TIA’s) Morphine, Aminophylline, Digoxin, Diuretics, Oxygen Complications (CVA, CAD, CHR, CRF) Gases (ABG’s) Labs: Normal Values: Normal Values: Creatinine 0.6-1.2 Males 0.5-1.1 Females RBC 4.7-6.1 Males 4.2-5.4 Females Hematocrit 42-52 Males 37-47 Females Urine Specific Gravity 1.0-1.030 APTT 40 Sec. Digoxin 0.5-2.0 Lithium 0.8-1.4 Anti-Emetics (-tron, -zine): Can cause sedation. Metoclopramide (Reglan)- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- Instruct the client to fast 2 to 4 hr before the procedure according to facility policy and to avoid tobacco, alcohol, and caffeine before the test. Chest Tube Inserting and Monitoring: Monitoring a Water Seal Drainage System- • Water seals are created by adding sterile fluid to a chamber up to the 2 cm line. The water seal allows air to exit from the pleural space on exhalation and stops air from entering with inhalation. • To maintain the water seal, the chamber must be kept upright and below the chest tube insertion site at all times. • The height of the sterile fluid in the suction control chamber determines the amount of suction transmitted to the pleural space. The application of suction results in continuous bubbling in the suction chamber. • Tidaling (movement of the fluid level with respiration) is expected in the water seal chamber. Monitor the water seal chamber for continuous bubbling (air leak finding). • If the chest tube drainage system is compromised, the nurse immerses the end of the tube in sterile water to restore the water seal.114 Hematologic Disorders: Preventing Sickle Cell Crisis- • Promote rest to decrease oxygen consumption. Administer oxygen as prescribed if hypoxia is present. • Maintain fluid and electrolyte balance. • Pain management: Treat mild to moderate pain with Tylenol or ibuprofen. Manage severe pain with opioid analgesics (codeine, morphine sulfate, oxycodone, Dilaudid, and methadone). • Administer blood products (packed RBCs). • Treat and prevent infection. • Monitor and report laboratory results. Renal Disorders: Risk Factors for Glomerular Disease- • Risk Factors - APSGN: streptococcal infection with a specific strain of group A ß- hemolytic streptococcus. • Subjective Data -Recent upper respiratory infection or streptococcal infection. • Objective Data -Cloudy, tea-colored urine , ↓urine output , Irritability, Ill appearance, Lethargy , Anorexia, discomfort (headache, abdominal pain, dysuria) ,Periorbital/facial edema , that is worse in the morning but then spreads to extremities and abdomen with progression of the day, mild to severe hypertension. Fluid Imbalances: Clinical Manifestations of Hypervolemia- • Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure. • Confusion, muscle weakness, H/A. • Weight gain, ascites. • Dyspnea, orthopnea, crackles, diminished breath sounds. • Edema, distended neck veins, pale and cool skin. Cardiovascular Disorders: Nursing Interventions to Decrease Cardiac Demands115 • Remain calm when providing care. • Conserve the child’s energy by providing frequent rest periods, clustering cares, providing small, frequent meals, bathing PRN, and keeping crying to a minimum in cyanotic children. • Maintain bedrest. • Position the infant in a car seat or hold at a 45◦ angle. Keep safety restraints low and loose on the abdomen. • Allow the child to sleep with several pillows and encourage a semi-Fowler’s or Fowler’s position while awake. • Medications: Digoxin (improves myocardial contractility); Captopril and enalapril (reduce afterload by causing vasodilation, resulting in decreased pulmonary and systemic vascular resistance); Metoprolol or carvedilol (decrease HR and BP, and promote vasodilation). Furosemide or chlorothiazide (rid the body of excess fluid and sodium). Cystic Fibrosis: Illness Management at Home- • Chest Physiotherapy – 2x/day – not immediately before or after meals. • Drink fluids, exercise, vitamins A, D, E, K, eat 3 meals /day w/ snacks, eat high protein/calorie meals. • Pancreatic Enzymes – taken 30 min. within eating. • Clubbing fingers is a late manifestation of CF. Hyperthyroidism: Assessment Findings- • Nervousness, irritability, hyperactivity, emotional lability, decreased attention span. • Weakness, easy fatigability, exercise intolerance. • Heat intolerance, weight loss, increased appetite. • Insomnia and interrupted sleep. • Frequent stools and diarrhea.116 • Menstrual irregularities. • Warm, sweaty, flushed skin with velvety-smooth texture. • Tremor, hyperkinesia, hyperreflexia. • Vision changes, hair loss, goiter, bruit over the thyroid gland. • Elevated systolic BP and widened pulse pressure, tachycardia, and dysrhythmias. Cardiovascular Disorders: Laboratory Results Indicating Rheumatic Fever- • Throat culture for GABHS. • Serum antistreptolysin-O (ASO) titer – elevated or rising titer, most reliable diagnostic test. • C-reactive protein (CRP) – elevated in response to an inflammatory reaction. • Erythrocyte sedimentation rate – elevated in response to an inflammatory reaction. Disorders of the Eye: Manifestations of Acute Glaucoma- • H/A, mild eye pain, loss of peripheral vision, decreased accommodation, and elevated IOP; (Open-angle Glaucoma). • Rapid onset of elevated IOP, decreased or blurred vision, seeing halos around lights, pupils are nonreactive to light, severe pain and nausea, and photophobia; (Angle-closure Glaucoma). Heart Failure and Pulmonary Edema: Complications of Atrial Fibrillation- • Stroke and HF. Pulmonary Embolism: Expected Manifestations- • SOB, sudden/sharp chest pain, ↑HR, ↑breathing, sweating, anxiety, coughing up blood or pink/frothy mucous, fainting. Expected Findings for Retinoblastoma- • Cancer of the Retina. • Most common: White pupillary reflex.117 • Less Common: Lazy eye, vision problems, eye pain, redness of the white part of the eye, bleeding in the front part of the eye, bulging of the eye, a pupil that doesn’t get smaller when exposed to bright light, and a different color in each iris (the colored part of the eye). Allergies to medications * latex related to sensitivity to bananas and other fruits * betadine related to an allergen to shellfish * propofol related to an allergy to eggs or soybean oil. Diagnostic Procedures Summary: * Urinalysis – ruling out of infection * Blood type and cross match – transfusion readiness * CBC – infection/immune status * Hgb and Hct – fluid status, anemia * Pregnancy test – fetal risk of anesthesia * Clotting studies (PT, INR, aPTT, platelet count) * Electrolyte levels – electrolyte imbalances * Serum creatinine and BUN – renal status * ABGs – oxygenation status * Chest x-ray – heart and lung status * 12-lead ECG – baseline heart rhythm, dysrhythmias, history of cardiac disease, performed on all clients older than 40 years Rheumatic fever – Lab results: * Throat culture for GABHS * Serum antistreptolysin-O (ASO) titer – elevated or rising titer, most reliable diagnostic test118 * C-reactive protein (CRP) – elevated in response to an inflammatory reaction * Erythrocyte sedimentation rate – elevated in response to an inflammatory reaction Gross Motor Skills: * 3 year-olds: Rides a tricycle › Jumps off bottom step › Stands on one foot for a few seconds * 4 year-olds: Skips and hops on one foot › Throws ball overhead * 5 year-olds: Jumps rope › Walks backward with heel to toe › Throws and catches a ball with ease Signs of infiltration -Edema, pallor, decreased skin temperature around the site, and pain Signs of phlebitis - Pain, increased skin temperature, and redness along the vein Signs of extravasation (infiltration w/ dislodged IV catheter) - Pain, stinging or burning at the site, swelling, and redness Tunneled catheter - A catheter surgically inserted into a trench Cystic Fibrosis: * Chest Physiotherapy – 2x/day – not immediately before or after meals. * Drink fluids, exercise, vitamins A, D, E, K, eat 3 meals /day w/ snacks, eat high protein/calorie meals * Pancreatic Enzymes – taken 30 min. within eating. * Clubbing fingers is a late manifestation of CF119 Vision: Hardy-Rand-Rittler Test – person should be able to identify number in confusion of colors Glaucoma: Loss of peripheral vision Phenelzine (Nardil): (MAOI) –increases dopamine, serotonin, and norepinephrine (CNS Stimulation) * Depression & bulimia * don’t use if pregnant & avoid OTC decongestants AVOID – foods with Tyramine: aged cheese, peperoni, salami, avocados, figs, bananas, smoked fish, protein, beers, red wine, caffeine, chocolate, fava beans, ginseng. Schizophrenia: Med for Tx: Chlorpromazine (Thorazine): * chew sugarless gum, sip on water, and wear sunglasses when outdoors * Constipation, blurred vision, photophobia, tachycardia Depressive disorders: 1st line of therapy = Medications, but may take 2-3 weeks for therapeutic effects to be noticed * Hospitalization may be necessary, close supervision, suicide prevention * provide a safe/structured environment to distract the client from thinking about hallucinations * promote therapeutic communication to lower anxiety, decrease defensive patterns, encourage structured participation socially, encourage friendships, establish trust. * ask client directly about hallucinations. Don’t agree or disagree with clients views, but respond with comments like, “I don’t hear anything, but you sound frightened” * do not argue, be genuine, be empathetic Parkinson’s disease - EPS Sx:120 * Drooling, Involuntary arm movements (tardive dyskinesia), pacing (akathisia) Sustained Release Tabs: swallow whole (do not chew/crush), stay on regular schedule Transdermal Patches: place on one hip daily and alternate hips. Leave on for 9 hours. ADHD med evaluation of effectiveness: improved ability to focus, complete tasks, interacts with peers, & manages impulsivity. * Monitor BP, chew sugarless gum, sip water, and watch for orthostatic hypotension, monitor weight Nurses: responsible for understanding and protecting client rights. Pre-Procedure Nurse Responsibilities: * signed consent form (after demonstrating thorough understanding of procedure) * Client to FAST 2-4 hours prior to procedure