CramX Logo
RegisterLog in

NCLEX MARK Lecture Notes and link

Master acid-base imbalances with simple rules, not memorized lists. Includes key concepts like Rule of the B’s, ventilation alarms, metabolic vs. respiratory clues, and real-world nursing examples.

Alice Edwards
Contributor
4.3
42
9 months ago
Preview (12 of 38 Pages)
100%
Log in to unlock

Page 1

NCLEX MARK Lecture Notes and link - Page 1 preview image

Loading page ...

Etsy:1NURSING NOTES101** DON'T MIX UP S4S and CAUSATION- often what cajses someth ng is tne opposite of the SAS- ex. diarrhea will cause a metabolc ac dosis but onceyou are ac dotic yourbowel shuts down and you get aparalytic illeus- when you get scenarios:-> if it's a lung scenario = respiratory- then check if the client is Dver-i/enf'afp(alkalosis)orunder- ventilating (acidosis)- remember to look at the words (ex. over, under,ventilating) -> "as the pH goes so goes my PT"-> VENTILATING DOESN'T MEAN RESPIRATORYRATE; rasp, rale is inetevsrrfw/ acid-base,ventilationhas to co with gas excharge not resp.'ate (look at tie SaO2 -> if your resp. rale is fastbut EaO2 is low you are under-ventilating)-> ex. PCA pump - What acid-base disorderind cates they reed to come off of it? = respiratoryac cosis (resp. depression -> resp. arrest)—> if its not lung, its metabolic• metabolic alkalosis - really only one scenario = ifthe PT has prolonged gastric vomiting/suctioning- because you arelosing ACID"ex. Gl surgery w/ NG tube with suctioning for3 days; hyperemesis graviderum- otherwise everything else that isn't lung youpickmetabolic acidosis (DEFAULT)" ex. hyperemesis graviderum w/dehydrationacute renal failure, infantile diarrhea. remember, you only have 4 to pick from:- respiratory alkalosis- respiratory acidosis- metabolic alkalosis- metabolic acidosisRb6‘sYJERt NOTON UM *NCiexU*LECTURE 1ACID BASES• learn how to convert lab values to words- the rule of theBs= if the pH and the BiCarb are both in the samedirection -> metabolicHint:draw arrows beside each to see directions’ down = ac/cfos/s* up =alkalosis- respiratory -> hasnob init;if in other directions(or if bicarb is normal value)KNOW NORMAL pH, BiCarb, CO2- Hint:DON'T MEMORIZE LISTS...know principles(they test knowledge of principles by having you■generate lists..) -for "select all" questions- ex. in general/principle what do opioids/painmeds do? = sedate you, CNS depressorsFex. what does di audid do?dori I memorizespecificso.ra fefof dtlaudid, know principles of opioids(suchas sedation, CHS deppessian -> l&lhargy, flacc dity,reflex +1, hypo-reflex ia, -Dblunded)- boards don't test by lists because all books/classes have different lists■principles ofS4S acid bases:asthe pH goes sogoes my patient (except K+)- pH up = PT up -> body system gets moreirritable, hyper-excitable (EXCEPT K+)-> alkalosis -think ot a body system and gohigh,hyper-reflexive (+3, +4 [2 is normal]},tachypnea, tachycardia, borborygmi, seizure- pH down = PT down -> body systems shutdown (EXCEPT K+l-> acidosis -thwikof a system and go Sow.hypo-reflexive (+1, 0), bradycardia, lethargy,obtunded, paralytic illeus, respiratory arrest. ex. which acid-base disorders need an ambu-bag atthe bedside? = acidosis(resp. arrest)■ex.which acid-base disorders need suction at thebedside? = alkalosis(seize and aspirate)- Mac Kussmaul -Kussmaul s (compensatoryrespiratory mechanism) is only present inonly1 ofthe 4 metabolic (acid-base) disordersTM = metabolicAC = acidosis■pay more attention tc themodifying phrasesthanthe original noun- ex. personw/OCD whoisnow psychotic (psychotictrumps OCD); hyperemesis with dehydration (payattention to dehydration}VENTILATION- ventilators -> knowalarm systems(you set it upsothat the machine does nt useless thanormore thanspecific amounts of pressure)a} high pressure alarm =increased resistanceto airflow (the machine has to push too hard toget air into lungs)- from obstructions:i. kinks in tubing (unkink it)ii.water condensation in tube (empty it!)iii. mucous secretionsinthe airway (changepositions/turn, C&DB, andTHENsuction)suction is only PRNJII-> priority questions = you would checkkinks first, suction is not first. most common mistake with se ect all questions=selectingone more than you should(stop when you select the onesyou know! don't get caught up on the "could he's”)• Hint:don't select noneoraflonselect all that applyquestions (never only one and never all)- Causes of Acid- Base Imbalance:- scenarios and what acid-base disorder wouldresuttfwhat would cause an imbalance}

Page 2

NCLEX MARK Lecture Notes and link - Page 2 preview image

Loading page ...

b) low pressure alarm =decreased resistanceto airflow (the machine had to work too littleto push air into lungs)- from disconnections:i. main tubing (reconnect it duh!)ii. 02 sensor tubing (which senses FiO2 atthe airway/trach area; black coated wirecoming from machine right along thetubing - reconnect!)ventilators -> knowblood gases- resp. alkalosis = ventilation settings might beset too high (OVER-VENTILATING)- resp. acidosis = ventilation settings might be settoo low {UNDER-VENTILATING)ex. weaning a PT off ventilator -> should not beunder-ventilated, they need the ventilator; if they areover-ventilating then they can be weanednever pick an answer where you dont de somethingand someone else has to do something

Page 3

NCLEX MARK Lecture Notes and link - Page 3 preview image

Loading page ...

Etsy:lNURSINGNOTES101LECTURE 2ABUSE(Psych and Med-Surge)Psycfro/ogrcaMspect/Psycho-DynanNcs- # 1 psychological problem isthesameinany/allabusive situations =DENIAL- abusers have an infinite capacity for denial so thatthey can continue the behavior w/o answering for it- can use the alcoholism rules for any abuse- ex. # 1 peycn problem in child abuse, gambling orcocaine abuse ia aerae)- whyis denial the problem? HOW CAN YOU TREATSOMEONE WHO DEN1ES/DOESN T RECOGNIZETHE Y HAVE A PROBLEM- denial = refusal to accept the reality of a problem* treat denial by CONFRONTING the problem (it's notthe same as agpress/onwhichattacks the person, notthe problem) =they DENY you CONFRONT- pointing out to the person the difference betweenwhatthey say and what they do- Hintrever pick answers that attack the person-> ex. bad answers have bad pronouns - "you"-> ex. good answers have good pronouns - 'I", "we"-> ex. "youwrotethe order wrong" vs.'I'mhavingdifficulty interpreting what you want"- loss and grief -> for this denial you mustSUPPORTit- DABDA = cen al, arger, bargaining, depression, acceptance* Hint:for questions about denialyou must look to seeif itis LOSS or ABUSE- loss/grief = support- abuse = confront- #2 psychological problem in abuse =DEPENDENCY,CO-DEPENDENCY- dependency= whenthe abuser gets significant otherto do things for them or make decisions for them-> the dependent -abuser■c o - d e p e n d e n c y = when the significant other derivespositive self-esteem from making decisions for ordoingthings for the abuser-> the abuser gets a life w/o responsibilities->the sig. other gets positive self-esteem {which iswhy they can't get out of the relationship)* how do you treat it?- set limits and enforce them-> start teaching sig. other to say NO (and theyhave to keep doing it)- must also work on the self-esteem of the co-dependent(ex. I'm a good person because I'm saying "no')- manipulation = whenthe abuser gets the sig. otherto do things for them that are not in the best interest ofthe sig. other- the nature of the act is dancreroirs.'/Tarmfu/- how is manipulation like dependency?-> inboth the abuser is getting the other persontodo something for them-howdo you tellthe difference between manipulation& dependency?-> NEUTRAL vs. NEGATIVE (look at what they'rebeing asked to do)-> if the sig. other is being asked to do somethingneutral {no harm} its dependency/co-dependency-> if the sig. other is being asked to do somethingthat will harm them or is dangerous to them theyare manipulated- how do you treat manipulation?- set limits and enforce them ->'NO"-easier to treat than dependency/co-dependencybecause no one likes to be manipulated (no positiveself-esteem issue going on)■ex. how many P T s do you have w/ denial? =1ex. how many PT s do you have w/ dependency/co-dependency = 2ex. how many PT s do you have w/ manipulation = 1AlcoholismWernickes & Korsakoffs- typically separate BUT boards lumps them together- wemicke s = encephalopathy-korsakoff's = psychosis (lose touch with reality)-> tend to go together, find them in the same PT■WernickeK o r s a k o f f s s y n d r o m e :a} psychosis induced by Wf.Bl(Thiamine) deficiency■lose touch w/ reality, go insane because of no B1b} primary symptom ->amnesia w/ confabulation- significant memory loss w/ making up stories- they believe their stories■How do you deal w/ these PT's?- bad way = confrontation (because they believe whatthey are saying and can't see reality)- good way =redirection(take what the PT can't doand channel it into something they can do}■Characteristics of Wen ieke Korsakoff's:a} rtsprevejifabfe= take Vit. B1 (co-enzyme neededfor the metabolism of alcohol which keeps alcoholfrom accumulating and destroying brain cells)' PT doesn't have to stop drinkingb)it s arrestable =can stop it from getting worse bytaking Vit. B1ralso not necessary to stop drinkingc) rfsirreversible(70% of cases) -> Hint: On boards,answerw/ themajority (ex. if something is majorityof the time fatal, you say it’s fatal even if 5% of thetime if s not)- DrugsforAlcoholism:DISULFIRAM (Antabuse}= aversion therapy-> want PTs to develop a guthatred for alcohol-> interacts w/ alcohol in the blood to make you very ill-> works in theory better than in reality-> onset & duration: 2 weeks(soifyou want todrink again, wait 2 weeks}

Page 4

NCLEX MARK Lecture Notes and link - Page 4 preview image

Loading page ...

- PT teaching = avoid ALL formsofalcohol to avoidnausea, vomiting & possibly death-> including mouthwash, aftershaves/colognes/perfumes(topical stuff will make tnem nauseous), insectrepel ants, any OTC that ends with "-elixer", alcohol-based hard sanitizers, uncooked (no-ba<el icingswhich havevanillaextract, 'ed wine vinaigrette- Overdoses & Withdrawals:- everyabuseddrug is either anUPPERorDOWNER-> the other drugs don't do anything-> £1 abused class of drug that is not an upper ordowner = laxatives in the elderlyal first establishif thedrug is anupperor downer- uppers(5) = caffeine, coca ne, PCP/LSD (psychedelichallucinogens}, methsmphsfaiTwrws. adderoi {ADD drug?T5&S -> make you go up: euphoria, tachycardia,restlessness, irritability, diarrhea, oorborygmi.hyper-reflexia, spastic, seze (need suction)- downers= don't memorize names -> anything thatis not an upper is a downer! if you don't know whatthe med is, you have a high chance that its adowner if its not part of the uppers list’ S&S -> make you go cown; letnargy. resp ratorydepression (&.arrest)- ex. The PT is high on cocaine. What is critical to assess?-> NOT resps below 12 because they will be high-> maybe check reflexesbl are they talking aboutoverdoseorwithdrawsI- overdose/intoxication =toomuch- withdrawal =not enough- ex. the PT has overdosed on an upper -> pick theS&S of too much upper- ex. the PT has overdosed on a downer -> pick theS&S of too much dowrer- ex. the PT is withdrawing from an uppep-> notenough uopermakes everytning go down- ex. the PT is withdrawing from a cowner -> notenough downer makes eveyth ng go up■upper overdose looks tike - downer withdrawal• downer overdose looks like = upper withdrawal- In what 2 situations would resp. depression & arrestbe your highest priority:- downer overdose- upper withdrawal• In what 2 situations would seizure be the biggest risk:- upper overdose- downer withdrawal.■AlcoholWithdrawal Syndromevs.Delirium Tremens- they are both different! not the samea)everyalcoholic goes through withdrawal 24hrs.after they stop drinking- only a mmor/tyget delirium tremens- timeframe -> 72 hrs. (alcohol withdrawal comes 1st)- alcohol withdrawal syndrome ALWAYS precedesdelirium tremens, BUT delirium tremens does notalways follow alcohol withdrawal syndromeb) AWS is not life-threatening; DTs can kill youc) PT's w/ AWS are not a danger to sellf/others; PT'sw/ DT's are dangerous to self/others- they are withdrawing from a downer so they willbe exhibiting upper S&S- DTs are dangerousDiflsrsncesAWSDTin CansDietRegu lar c etNPCWclear lieuids(because a1 risk for seizures whichcan cause -isk ci asp ration)RoomSemi-prvatePrivatenearnurses stationanywhere on (dangerous A unstable)the unitAmbulation Up ad libRest-kited bed rest -> no balh-oomprivileges (use bedpans'urinals)RestraintsNorestrants Restraints (because dangerous)(because not - not soft wrist or 4 point softdangerous)because tney'll gel out- need to be in vest or 2-pt. lockedleathers (opposite 1 arm 8. leg,rotate Q2hrs, lock 1he f-eeI mbs 1st before releasing thelocked ones)Thevboth get ANTI-HYPERTENSIVES &TRANQUILIZERS- becajse eve-ylhing is up (downer withdrawal)They both gel MULTIVITAMIN w,' Bl■RN's can accept but RPN's can't (because PT is unstable)- on med-surge, the RN who takes :hem must decreasetheir workload (i.e. reduce PT load if they take a DT PT)-> Hint:on boards, the setting is always perfect(i.e. enough staff/time/resources on the unit etc.)• Drug Abuse in the Newborn:- always assume intoxication. NOT withdrawal at birth- after24 hrs-> withdrawal- ex. caring for infant of a Quaalude addicted mom 24hrs. after birth, select all that apply:-> downer withdrawal so everything is up = exaggeratedstartle, seizing, high ptched'Shrill cry

Page 5

NCLEX MARK Lecture Notes and link - Page 5 preview image

Loading page ...

DRUGSAMINOGLYCOC1DES- powerful class ofantibiotics(when nothing elseworks pull these outs, the big guns)- don't use unless anything else works■boards /oue fo test fhese drugs because theyredangerous and are a test of safety- think: A MEAN OLD MYCIN-> a mean o.'d= they treat serious, life-threatening,resistant, Gram-neg bacteria infections (i.e. a meano/d antibiotic for a mean oj'd intectionj-> mycto = what they end with(allendw/-mycin}”not all -mycin's are aminoglycosides BUT mostare (the 3 that are not are erythromycinazihromycin, clarithromycin = torow if off toe tist.i)- 2 toxic effectsi) when you see -mycin. thinkmice- mice ->ears -> otto toxic-monitor hearing, tinnitus, vertgo/dizzinessii) the humanear is shapedlike akidneyso nexteffect isnephrotoxicity- monitortreat'.nine(not BUN output, daily weight)'creatinine= the best indicator of kidney/renalfunction(pick 24 hrcreatinine clearance overserum creatinine if both available)■#8 (fits nicely in the kidney) reminds you about 2things about these drugs- toxic to cranial nerve 8 = ear nerve- administer Q8- route:- IM or IV- do notgive PO-> theyarenot absorbed- if you give an oral -mycin' it will go into gut, dissolve,go through and come out as expensive stool (won thave any systemic effect)- EXCEPT i- 2 case .= bowel sterilizers:Thepatic encephalopathy (hepatic coma} =to getammonia down, cral ’-mycin's' will sterilize thebowel by killing Gram-neg bacteria (E. coli) to helpbring down ammonia and wont harm thedamaged liver because it doesn't go through theliver (also gives diarrhea, more poop out is good.)rpre-op bowei surgery =it sterilizes the gut bykilling the E coli bacteria■if oral, no otto or nephro toxicity because not absorbed- these are neomycin & kanamycin’ Who can sterilize my bowels? NEO KAN■Why draw levels? =narrow therapeutic window- small difference between what works and what kills- if the drug has a wide range then you wouldn'tneed to draw TAP levelsTex. Lasix doses range from 5-80mg thus a widerange so you wont need TAP levels" ex. Dig doses range from 0.125 - 0.25 so thisnarrow range needs TAPS levels- A MEAN OLD MYCIN3 = major class that reedsTAPs drawn because of narrow window- When do you draw TAPS?-> depends on theroute(don't focus on the med)a} Trough Levels”doesn’t matter which route or medalways20 mins.- sublingual = 30 mins, before next dose- IV = 30 mins, before next dose- IM = 30 mins, before next dose- Sub-Q = 30 mins, before next dose- PO = 30 mins, before next doseb)Peak Levelsdifferent but depends on the route mot the med)- Sublingual = 5-10 mins after drug is dissolved- IV = 15-30 mins after drugs is finished tofesingrTHint:if you get two values 'hat are correct (i.e. a15 minanswer and a 30 min. one)pick the highestwithout going overso 30 mins.- IM = 30-60 mins, after administration- Sub-Q = SEE (see diabetes lecture -> because theonly Sub-Q peaks are Insulins)- PO = forget about it, too variable so not testedThe BIG 10 Drugs to Know:1.psych drugs2. insulins3 anti -coagulants4. digitalis5. aminoglycosides6. steroids7. caldum-channel blockers8beta-blockers9. pain meds10. OB drugs■Trough and Peak levels:- trough = drug at /owesf- peak = drug at highest*' MP.'evefc -trough administer peak-> draw trough levels first-> administer your drug-> draw peak levels after drug administration

Page 6

NCLEX MARK Lecture Notes and link - Page 6 preview image

Loading page ...

LECTURE 3£ ) O N EOCAR DI AC- AR R Y T H Ml AS- Interpreting Rhythm Strips(4 that need to be knownby sight):a} Normal Sinus Rhythm= P wave before every QRS & followed by a Twave for every single c o m p l e x-> all P wave peaks are e q u a l l y distant from eachother. QRS evenly spacedb).'-jib = chaotic squiggly line, no patternc) '.'-Tach = sharp peaks, has a patternd} - -Systole = flat-fine-Terminology:- if QRS d e p o l a r i z a t on, it's talking aboutventricular(so rule out anything atrial)- if it says P-wave then it s t a l k i n g aboutatrialCardiacD R U G SC A L C E U M - C H A N N E L B L O C K E R SCS/c/um-C/ianne/ B/ocxe/s are M eVa/rum for your heart•Valium -> calm's you down; so C C 8 s calm your heartdown(ex. if tachycardic, give CCB s but not in shock)- to R E S TYOUR HEART- not stimulants• calcium-channei b l o c k e r s arenegative i n o t r o p i cc h r o n o t r o p i c , S. d r o m o t r o p i c o r u g s- fancy way of saying that they calm the heart downPOSITIVENEGATIVEinotropesCardiac StimulantsCardiac Depressants*- stimulate, speec- caTmtne near! cown.bnronotropesu othe heartweaken & slow cownDromotopes-6 Rhythms most tested on N - C L E X :1a lack of QRS's" = A-systole- flat-line, no QRS2. " P - w a v e " = Atrial- if its asawtooth wave, always pickafoa)flutter3. " c h a o t i c ' - A-tib if w/ P-wave4. "chaotic" - V-fib if w/ QRSL !I- H i n t :the worechaosis used tor>'t •-..'.aifor5bizarre" = atrial t a c h y c a r d i a if w/ P - w a v e6.bizarre" = ventricular tachycardia if w/ Q R S- Hint,the work 'b zarre' is usee forfoc.iyca/'oras-P V C s(premature ventricular contractions)= a.k.a. periodic wide bizarre Q R S- ventricular because Q P S'W h e n do youwant io ' d e p r e s s " theheart?WhatdoCCS's treat?At anti- h y p e r t e n s i v e s- relax heart & blood vessels to bring down BPAA: anti-anginas4CUT VtP ftlN- relax heart to use less 0 2to makea n g i n a go away- treats a n g i n a by addressing oxygen d e m a n dAAA; anti-atrial arrhythmia- ex. atrial flutter, A-fib. premature atrial contractions- never ventricularmwhat aboutsupra-ventricular tachycardia??-> because it means 'above the ventricles' (whichare theatria)- Side-Effects:H & H = headache & h y p o t e n s i o n-> hypoTN - from relaxed heart & v e s s e l s■> h e a d a c h e - vasodilation to brain”Hint:h e a d a c h e is a good thing tc se set for'select ail that apply' questions(®t.low Na & nignNa = headache, hign & low g ucoae = headache, high &low BP = headache)- N a m e s of C a l c i u m - C h a n n e l B l o c k e r s :- anything e n d i n g in- d i p i n e1- ex. a m l o d i p i n enifedipine■N O T just '-pine'- also i n c l u d e s ' VERAPAMIL & C ARD1ZEM- which can be given as continuous IV drip??= Cardizem*bVhaf 1/Sneeds to be assessed before giving a C C B ?- BP = because of risk ofhypoTN-> parameters/guidelines - hold CCB ifsystolicisunder 1 00-> so you need to monitor BPif PTis on a Cardizemc o n t i n u o u s drip (if it's under 1 00 then you mayhave to stop or changethedrip rate}- bizarre -> tachycardia-you can call a group of P V C sa short run of V-tach- d oPhysician's care about PT's having P V C s ?->NO, not a high priority = low priority-> 3 circumstances when you could elevate theseP T s t omoderatepriority (re -ereac- high)i. if there are more than 6 PVC's in a minuteii. if there are more than 6 PVC's in a rowiii. if the PVC tall on the T-wave of the previousbeat ( R o n T phenomenon)-> most common order if you call the MO about aPT w/ P V C s = D/C monitor (Decause then youcan t see the PVCs and then you won t call them)-LethalArrhythmia s:- HIGH PRIORITY 2 main oneswill - ill you in 8 m nsjiess-> these P T swill p r o b a b l y be top prioritiesa} A - S y s t o l eb) V-Fifa”both have in common = no cardiac output-> no brain perfusion (and you II be dead in8 mins)-. -tach = potenf/a/jyHte-th reate ning (but not actuallylife-threatening), but still m a k e s it a fairly high priority- difference is that these PT's have c a r d i a c output- in c o d e s , even rf the rhythm c h a n g e sif there is nocardiac output it's ju st as cad as the p r e v i o u s rhythm

Page 7

NCLEX MARK Lecture Notes and link - Page 7 preview image

Loading page ...

b) Basilar= at thebottomof the lungs, thusitisremovingbfoodlliquid (because of gravity)-ex. its bad if your basilar tube is bubbling or notdraining any mL■ax. Howmany chest tubes & where would you place themfor s unilateral pneumohemothorax?- 2 chest tubes (apical for preumo. basilar for nemo)■ax. Howmany chest tubes S where would you place themfor a bi-lateral pneumothorax?- 2 tubes (apicalonleft,apical on right)* ax. Howmany chest tubes & where would place them forpost-op chest surgery?- 2 tubes (apical & basilar on the side of the surgery)"you are to assume that chest surgery/trauma isunilateral uni'ess otherwise specified(they willsay bilateral)- Trick Question:How many chest tubes would youneed and where would you place them for a post-opright pneumonectomy?- NONE! because you are removing the lung so youdon't need to re-establish any pressure (there is notpleural space)!Troubleshooting Chest Tubes:- What do you do it you knock over the plasticcontainers that certain tubes are attached to?-> set it back up & have PT take some deep breaths-> NOT a medical emergency!(don't call ND)- What do you do if the water seal breaks (theactual device breaks?)-> first =CLAMP it!!!because now positive pressurecan get in! don't let anything get in-> 2nd= cutthe tube away from the broken device-> 3rd = stick that open end into sterile water->then unclamp it because you've re-established thewater seal (doesn't need clams if its under water™ better for the tube to be under water thanclamped! -> alir can t goinand stuff can still keepcoming out (if clamped nothing can come outwhich is what the tube is for)- Ex.Ifthey ask what thefirstthing is to do if the sealbreaks -> Clamp! BUT, if they ask what's the bestthing to do -> put end of tube under water! (because itactually solves the problem, cfamping is a tempfix)- Hint: 'BESTvs. FIRST questions- first questions = areabout what order- testquestions =what's the one thing you would doifyou couldonly doI cf the options-> ex. You notice the FT has V-fib on the monitor. Yourunto the room and they are non-responsive withnopulse. What is thefirstthing you do?A) place a backboard?B) begin chest compressions?- "first”is about order so = pick A (because youwouldn't start chest compressions first)- BUT. if the question ask "What s thebestthing todo?" -> you only get to do 1 thing not the other soyou would pick B- Treatment (more drugs):a) PVC sb) V-tach= forventricularuse LIDOCAINE/AMIODARONE' in rural areas mare Liaocaine use (cheaper Alange- ahelf-He)c) Supra-Ventricular Arrhythmia's= atrial arrhythmia's use ABCUs■A->ADENOCARO (Adenosine)- have to push in less than 8 seconds {FAST IVpush)-> Siam tnis drjg;followed by a flush; use abig vein: BUT the prob em w/ slamming it fast isthe risk of PT going into A-Systo e (for 30 secondsbut theywillcome out of it so don't worry [unlesslorger than 30 sec...])”for IV pushes: whenyou don t know you go slow■B -> BETA- BLOCKERS- aiiend .in '-lol- every-lol'is a BB & every BBisa '-lol'- are negative inotropes, chronotropes, &dromotropes like calcium-channel blockers {a.k.a.valium for your heart so they treat A, AA, AAA &have same side-effects)”generally speaking don't make a big differencebetween Beta- & Calcium channel blockers;except that CCB are better for PT's w/ asthmaor COPD -> Beta-B's bronchoconstrict■C ->CALCIUM-CHANNEL BLOCKERS- see Beta-Blockers & CCB's earlier■D -> DIGITALIS (DIGOXIN, LANOXIN)d) V-Fib= forV-L't ycoD-fib(shock them!)elA-Systole= use EPINEPHRINE & ATROPINE {in this order!)-> if epinephrine doesn't work then use atropineCHEST TUBES• purpose is to re-estab/rs/r nerjafrVepressurein thepleural space (so that the lung expands when thechest wall moves)- pleural space -> rregabveis good(negative pressuremakes things stick together)- ex. gun shot to the lung add positive pressure- Hint:when you get a chest tube question look at thereason for which it was placed(will tell you what toexpect & what not to expect)- ex. pneumothorax = to remove air (because aircreated the positive pressure)- ex. hemothorax = to remove blood- ex. pneumohemothorax = to remove blood & air- Hint:Also, payattention tothe tacatronot the tubes.a)Apical =the chest tube is wayuphigh, thusit isremovingair(because air rises)- ex. its bad if you re apical tube is draining 200 mL oritisnotbubbling

Page 8

NCLEX MARK Lecture Notes and link - Page 8 preview image

Loading page ...

-What do you do if the chest tube gets pulled out?- firef = take a gloved hand and cover the hole- best=cover the hole with vaseline gauze- B u b b l i n g chesttubes:(ask yourself 2 questions)a) Where is it bubbling?b) When is it bubbling?= the answer will depend on these 2 questions(sometimes bubbling is good, sometimes bad butdepends on where & when)- ex. /nfemfffenfbubbling in the water seal -> GOOD(document it, neverbadfl- ex.Continuous bubbling in the water seal -> BAD(you don't want this, means a leak in the system thatyou need to find and tapeituntil it stops leaking)”in RPN scope- ex. Infermjftent insuction control chamber -> BAD(means suction is not high enough, turn it up on thewall until bubblingiscontinuous)- ex.Continuous in suction control chamber -> GOOD(document it)- Hint:both locations are opposites of each other(memorize one & deduce the others)—> if there is a seal it should not be continuous(ex. a sealed bottle of pop continuouslybubbling means it's leaking!)- A straight catheter is to a foley catheter as athoracentesis is to a chest tube.- in-&-out vs. continuous secured-thoracentesis -> also helps re-establish neg.pressure (in-S.-out chest tube)- higher risk for infections are continuousRules for Clamping Tubes:- a) Never clamp a tube for more than15 secondswithout a doctors order.- so if you break the water seal -> you have 15seconds to get that tube under water- b) Userubber-tippeddoubledclamps.- the teeth of the damp need to be covered w/rubber so that you don't puncture the tubeCONGENITAL HEART DEFECTS■every congenital heart defect is either TROUBLE orNO TROUBLE (ALL BAD or NO BAD)- either causes a lot of problems or its no Dig deal (noin-between defect)- memorizeone word: TRouBLeHeart DelectaTRp uBLe (95% ofall heart defects}No TroubleSu rgeryNED surgery now- don't need surgery-igrt away; possitn'jneed it years late- if itcausea 'aTrouble(butwe do n'1 expect it to)Growth & Dev.alow, delayedno-malLife Expectancy shortnormalParentsExperiencinggrief, stress.,ffnanc el seuea, lotsof ca'egvng issuesregular average personiBffjesGoing Homeapnea monitorno apnea monitort c o i t a l Stoy at weeks24-40 houraWho Follow®Your CarePaediatricCard ologistPaediatrician,oaediat-ic NPShuntingR_to L(TRouBLe)L t o RCyanosisCyanotic -> Blue(TTtouBLe)Acyanotic- ex. You are teaching the parents about a heart defect:- pick alltheoptionsthatcausetrouble• Hint:Boards will not give pictures of defects and askyou what they are.- not ou r job, we don't diag nose-our role is teaching parents the implications-> so f ts troube = leach them things that ts goingto be a lot ol trousle-> il it's not rouble = pick the things saying it's notgoing to be troube■Thepe are 40+ congenital heart defects so just rememberTRouBLe (don't memorize all of them!):- Hint: all congenitalheartdefects that startw/theletter T are Troubte Defects- we con fcare about the defect, we care about whatwere teaching the parents-All congenital heart defect kids (trouble or no trouble)will have 2 things:a)Murmur- why? = because of the shunting of the blood(regardless of direction of shunt)b) all have anEchocardiogramdone (to find outwhat the defect is or why there's amurmur)- 4 Defects of Tetralogy of Fallout:-VarieD Pictures Of A R a n c H (cr Valentines Day=lc<Someone Out A Red Heart)1. VD= ventricular defect2. PS = pulmonary stenosis3. O A = overriding aorta4. RH = right hypertrophy• dont have torecallthese. RECOGNIZE them- recall -> remember from nothing- RECOGNIZE -> spot it when you see it (use theinitials to recognize them in questions)- ONLY DEFECT where they ask youwhatit is

Page 9

NCLEX MARK Lecture Notes and link - Page 9 preview image

Loading page ...

INFECTIOUS DISEASE and TRANSMISSION BASEDPRECAUTIONS (Isolations)- Standard- Universal- Contact- for anythingenteric =can be caught from fnfestfne-> fecaloral- C-Diff, Hep. A, Cholera, Dysenteryrthings with bugs in diarrheaTHint for Hep A & B: Hep A -> think anus. Hep B ->think blood (anything from the iwn'&|starts w? a vowel)- Staph infections- RSV = respiratory syncytia/ virus (what babies, 1 -2yr. old s get that is not dangerous to adults but canbe fatal for them)rtransmitted by droplet BUTstill putthem oncontactprecautions because little kids catchitfrom touching Wringsthat other sick kids touched- Herpes infections(includes Shingles-> HerpesZoster virus even though caused by varicella)- What's involved in contact precautions?-> private room ispreferred(but not required)Tor 2 RSV kids in the same roomrkeep RSV kid & suspected RSV separatebecause you need positive cultures (not basedon symptoms)->NO:maskeye/face shield (unless for universal),special filter mask, PT mask, neg. air flow->YES: gloves. gown, hand-washing, specialsupplies & dedicated equipment (includes toys)”disposable supply vs. dedicated equipment:- thermometer cover- BP cuff that stays in room- Droplet- for bugs that travel 3 feet on large particles due tcsneezing/ccughing- allmeningitis’ cultured through lumbar puncture- H Flu (haemophilus influenzaB)-> commonlycausesepiglottis’ never stick something down throat because it willcause obstruction- What’s involved in droplet precautions?-> private room is preferred (but not required)ron boards select pr vatercan also cohort based on positive cultures->NO:gowneye/face shield, special filter mask,neg. air flow->YES: mask, gloves, hand-washing, PT wornmask (when leaving room), disposable supplies& dedicated equipment-Airborne- M-M-R;TB: varicella (chicken pox)- W h a t s involved in airborne precautions?-> private room isrequiredrunless co-horting-> NO: gown (mostiyfor contact), eye/face shields-> YES: mask, gloveshand-washingspecial-filtermask ONLY for TB. PT mask for leaving room(but really shouldn't be leaving), neg. air flow"disposable supplies & dedicated equipment is agood thing but not really as essential as in theother 2 (can let this one slide)-> TB: technically transmitted via droplet BUT puton airbornePPE = Personal Protective Equipment- boards Eke to test how you put on or take off-alwaystake it offin alphabetical cider-> ex. gloves, goggles, gown, mask- p u t t i n g on is reverse alphabetically for theg s' &mask comes 2nd-> gown. mask, goggles, glovesI N FECUOhl , ,CONSOLMRWRMEPRECAUTIONH>-s.jMiftuesL<JMEZHECTfS ZWCR -r C W f t UCONTACT PEKAUTi*MUSR T MRERSEHeSWfHOfliJ INFECTIONVIIUWOW C C T I O NENTEKU.'j tSft(<H i n n ss»Mpitx>I M P H I W?PtOiCulOSVS&SCOPES tMOCCUStSTfiPHtlUTilPEMC PRCCtAVTlbNS?7 ’

Page 10

NCLEX MARK Lecture Notes and link - Page 10 preview image

Loading page ...

LECTURE 4y\JCRUTCHES, CANES, WALKERS■major area of human function islocomotionso they testthese even though not a major emphasis in school- area to test PT teaching & risk reductionCrutches:* How do you measure crutches?”need to know for risk reduction -> so you don'tcause nerve damaget.a)lengthofcrutch =2-3 finger-widths below antedoraxillary folc to a point lateral to & si ghtly in front of the foot-> many questions ask where you measure fromfto (so forcrutches, if they ask anything measuring from ax Ila tofoot -> rule out, they re wrong instructions for length)blhand grip =can be adjusted up & down; when properlyplaced,shouldbeapx. 30 dagraas elbow Haxion■Howto teachcrutch gaits(4 kinds}:”names are pretty obvious w/ a few exceptionsa) 2-point- move acrutch and opposite foottogether followedby other crutch & opposite foot- moving 2 things togetherb) 3-point- moving2 crutches5the bad legtogether- moving 3 things togetherc) 4-point- movingeverything separately■move any crutch, then opposite foot, followed bynext crutch then other foot- very slow but very stabled) Swing-through- fornon-v,eight bearinginjuries (ex. amputations)- plant crutches and swing the injured limb through(never touches down)-When do they use them?- ask yourself "how many legs are affected?'- even for even, odd for oddreven point gaits when a weakness is evenlydistributed (i.e. even # of legs messed up)- 2-point = mjfcf problems (bilateralj■4-point = severe problems (severe, bilateralweaknesses)- 3-point = chmy odd one, when only 1 leg is affected.Ex.Eady stages of rheumatoid arthritis =2-pointEx. LaS, atove- the knee ampufatio.? = ewing-througriEx. Firstday post-op right knee replacement. partial weight-bearing allowed =3-pointEx.Advanced stages of ALS =4-pointEx.Left hip replacement, 2nd day post-op, non weight-bearing= swing-throughEx. BWsieraitotalkneereplacement, 1st day post-op. weight-bearing a'lcwed =4-pointEx. BWsierai tatai knee reptacsmert', 3 weekspost-op =2 point■Going up & down stairs:- up with the good, down with bad- crutches move with the bad legGains:* hold the cain onthestrong side- a lot of people use it the wrong wayWalkers:- pick it up, set it down, walk to it- if they must tie their belongings tothewalker,tieit atthe sides, not the front■ever tic mostpeop e do that anyways; they don't like wheels or tennisball on the bottom either)

Page 11

NCLEX MARK Lecture Notes and link - Page 11 preview image

Loading page ...

DELUSIONS, HALLUCINATIONS, 4 ILLUSIONS (Psych)Neurosis Non- Psychotic vs. Psychosis- Hint:thefirst thingyou have to do to get a psychex. person sianngst a waH&says: "J see abomtf ->hallucinationBX- person .toks st fireextinguishes on thev/ai"sndsays: '7 seesbomb' ->illusion {refereci)■Hint:On the test, they will tell you that there issomething there thus, you can differentiate between ahallucination & an illusion.questions correct is decide: 'Ismy PT non-psychoticor psychotic?"= this will determine treatment, goals, prognosis,medication, length of stay, legalities., .everythingNON-PSYCHOTICD e f i n i t i o nHas i n a i g h l & iersalrty-bSsed- eyen w/ emotionaldistreaa.'illTesB,mentabbenavioraldisorder- racoon ize what tneproblem a and howrt affectB their liteTreatment/- good thejapputicTechniquesfiommunicaucn (likeany PT that d splaysacbd comm, ski He jthere e noth ngspec al that you Tieecto do/know comparedto any med-surge,paeca , or C B PTSymptomsrjont have delusions,hallucinations, orillusionsPSYCHOTICHas noinsight &i s n o lreality-based- cpnit th 'nk.'knovj the.rsck- think everyone e ae naathe problem but not them(blae anyone else)- even if they say i h e y - esick but then they aay themartiana made them sickthey con*1! have insight- good therapeuticcom "'un caton coea network because the? are- R M R Ble. spec f cstrategiesHow do you deal with these Psychotic Symptoms?- first thing you ask after determining iFPT is psychotic:What is their problem?—>what kind of psychosis do they have?- 3TypesofPsychosis:1. Functional Psychosis- can function in everyday life(i.e. have jobs, amarriage, etc.)-4 diseases:Schizo Schizo Major Manicsi.Schizophreniaii.Schizoaffective Disorderiii. Major Depression (if its majortest will say)iv. Manic (Acute)-> so bi-polar is functional, only psychoticduring manic phase-these PT s have the potential tolearnreality(because no damage)-> may need meds or set boundaries for structure-> nurse role = teach reality {4 steps}a) acknowledge feef/og -> "|s e eyou're angry;'You seem upset', "Tell me how you are feeling',often uses the word feeling or shows a feelingb)PRESENT REALITY-> "I know that those voicesare real to you but I don’t hear them" or tellingthem what is real ("I’m a nurse & this is a hospital")c)setalimit"That topic/behavior is off-limits',’Weare not going to talk about that right now",'Stop talking about that"d)enforce the limit-> "| see you're too ill to stayreality based so our convo is over" (ending theconversation NOT taking away a privilege [i.e.punishment]: continuing to talk may enforce thenon-reality)™ on the test, they won't ask these specific stepsbutinstead, will ask "how should the nurse respond...'T”try to pick the morepositive statements(i.e. whatthev can have/do. not what they cant); if between2 statements go w/ the positive oneDELUSIONS,- only in pavchotc p-'s- as scon as they get anyof these they've crossed,thene to Being psycnoticPsychotic Symptoms:- alDelusions= false, fixed, idea o<belief;no sensory component(all in the brainTthinking it)i. ParanoidDelusions-> people are out to harm me■ex. the mafia are out to get meii. GrandioseDelusions-> you are superior or youare the world s smartest/greatest person- ex. thinking you are Christ, Genghis Khaniii.Somatic Delusions-> about a body part- ex. x-ray vision; there are worms in my body- b)Hallucinations= a false,fixed,sensory experience (purely sensory);5 senses so 5 for (1 for each sense)i. Auditory _>heading things that aren't there (primarilyvoices teFing you to hurt yourself); most commonii. Visual -> seeing; 2nd most commoniii. Tactile -> feeling tilings: 3rd most commoniv.Gustatory ->tasting things that are not therev. Olfactory -> smel ing things that are not there”Tlast 2 are relatively rare- c)Illusions= .nr/srnferpreLaf/on of reafffy; sensory experience- difference from hallucination ->with an illusion thereis areferentinreality-> referent= something in reality to which a personrefers when they say something (theyjustmisinterpret it}■ex. PT says:"/ near detrain nc.ted -> haikucinationex. pm ovemears rarses £ ,’,fi7s Aauphing £ raiVnnp ar the nurse'ssiatran £ says: 'Listen,I.hear demon voices' ->IILs-or(therea a referent)- 2. Psychosis of Dementia-psychosis because ofactual damage to the brainrin Functional Dementia, there is no brain damage;its just messed up chemicals- include PT s w/ Alzeimer's, psychosis after a stroke,organic brain syndrome; anything w/ "senile" or"dementia"-cannot Learnreality-> major difference from functional (which is whyyou have to determine type of psychosis)

Page 12

NCLEX MARK Lecture Notes and link - Page 12 preview image

Loading page ...

-> nurse role:alacknowledge feelingblREDIRECT them ->from something they can tdo to something they can do”you dont set-limits because its mean”NOT APPROPRIATE to present reality to thesePT's when they are experiencing psychoticsymptoms (BUT don't confuse thisw/ realityorientation}-> important to remember that forgetting things (likewhere they are or what room they're in - PTs w/dementia/Alzheimers) is NOT psychosis"when they start having delusions, hallucinations orillusions, then they are psychotic-> realityorientation= telling them person, place,and time (ALWAYS APPROPRIATE w/DEMENTIA) - this deals w/ memory■NarrowedSelf Concept= when apsychoticrefuses to leave their room orchange their clothes-functional psychotic- #1 reason is because their definition of self isnarrowed -> defined self based on 2 things:i.Where they areii. What they are wearing"Tsothey dodt know who they are unless they arewearing those exact clothes in that exact room- as the nurse, don't make them change or leave theroom (will cause escalating panic because they willlose their concept of self}ruse the Functional Psychosis techniques- IdeasofReference=■■<e veryone is la k ng about you- ex. see someone on the news and get upsetbecause you think they are talking about you- can have bothparanoia& ideas of reference(paranoia if also think they are going to harm you)3. P s y c h o t i c D e l i r i u m= atemporary,sudden, dramatic, episodic,secondary loss of reality; usually due to somechemical imbalance in the bodyrdifferent because its temporary and very acute-> include PT's that are short-term psychotic becauseof something else causing the psychosis- ex. a crug reaction, high on uppers or withdrawingfromcowners (delirium tremens), cocaine overdose.,post-op psychosis (withdrawing from a downer). ICUpsychosis (sensory deprivation), UTi (or any occultinfection), thyroid storm, adrenal crisis- good thing is its temporary so focus isremovingthe u n d e r l y i n g cause & k e e p i n g them safe-> nurse role:alacknowledge feelingblREASSURE them:it's temp. & they'll be safe"don't present reality -> they won't get it”don't redirect -> not going to work- Personality Disorders are differentA = antisocialB = bopcerlineN = narcissistic”very sick personality disorders”may be good to use Functional Psychosistechniques because you set imitsOther Psychotic Symptoms:■L o o s e n i n g of A s s o c i a t i o n= your thoughts aren't wrapped too tight, all over tine mapalFlightof Ideas- coherent phrases but the phrases are notconnected (not coherent together)b} Word Salad- sicker, can t even make a coherent phrase-> babble random wordsc)Neologism- making up imaginary words
Preview Mode

This document has 38 pages. Sign in to access the full document!

Study Now!

X-Copilot AI
Unlimited Access
Secure Payment
Instant Access
24/7 Support
Document Chat

Document Details

Subject
National Council Licensure Examination

Related Documents

View all
Past Exams

NSG 3160 NCLEX Review Chapter 15

This NCLEX-style quiz focuses on eye anatomy, function, cranial nerves, and visual pathways—essential content for nursing students reviewing ophthalmologic assessment and preparing for the NCLEX-RN exam.

Past Exams

NSG 3160 NCLEX Review Chapter 14

This NCLEX-style quiz reviews head, neck, and cranial nerve anatomy, focusing on landmarks, nerve function, and physical assessment—ideal for nursing students preparing for neuro and head-to-toe assessments on the NCLEX-RN exam.

Past Exams

NSG 3160 NCLEX Review Chapter 24

This NCLEX-style quiz focuses on the neurological system, covering brain structure, reflexes, sensory pathways, and pain interpretation—ideal for nursing students reviewing neuroanatomy and preparing for the NCLEX-RN exam.

Past Exams

Lippincott Style NCLEX Questions

Lippincott-style NCLEX practice questions with rationales covering critical nursing priorities like medication safety, lab interpretation, and patient education. Ideal for NCLEX-RN/PN prep with select-all-that-apply and scenario-based formats.

Past Exams

NCLEX PN Test Practice Questions

NCLEX-PN 2023 practice questions with verified answers, covering stress ulcer prevention, immunosuppressant use post-transplant, and postpartum hemorrhage management. Ideal for nursing students preparing for clinical scenario-based NCLEX questions.

Class Notes

Lecture Notes NCLEX

Comprehensive NCLEX acid-base balance study guide covering principles over memorization, identifying respiratory vs. metabolic imbalances, interpreting patient symptoms, and ventilator alarms.

Past Exams

NCLEX Study Guide

NCLEX study guide highlighting delegation rules (EAT: Evaluate, Assess, Teach), Addison's vs. Cushing's signs, perfusion tips, APGAR scoring, and transmission-based precautions (Airborne, Droplet) with key mnemonics for easy recall.

Past Exams

Comprehensive NCLEX Review

NCLEX review cheat sheet covering key conversions, dosage calculations, IV flow rate formulas, vital signs, and critical lab values for sodium and potassium. Includes clinical signs, symptoms, and nursing considerations for high/low levels.

Past Exams

NCLEX Style Questions Nutrition

A secure and easy-to-use file sharing platform that lets you upload, store, and share documents, images, and videos. Access files anywhere, collaborate in real time, and manage content with full privacy and control.

Solved Assignments

Key Concepts for NCLEX

This document provides essential nursing care notes on Continuous Bladder Irrigation (CBI) post-TURP, including expected outcomes, troubleshooting, complications, and patient instructions.