NEXT GEN.

NCLEX
Comprehensive Study Guide

Ally, RN
 Table of Contents:
Adult Health Child Health
Cardiovascular...5 Cardiovascular...83
Respiratory... 16 Endocrine...84
Endocrine...21 Musculoskeletal...85
GI/Nutrition...26 Neuro...86
Hematological/ Oncological...35 Respiratory...87
Immunity...40 Renal...88
Infectious Disease...43 Integumentary...89
Integumentary...48 Infectious Disease...90
Musculoskeletal...50 GI/ Nutrition...91
Neuro...53 Immunity...93
Reproductive Organs...58 Growth/ Development...93
Urinary/ Renal...61
Visual/ Auditory...65 Leadership/ Management
Critical Care...67 Ethics and Legality...95
Delegation...96
Maternity Management...97
Antepartum...70 Prioritization...97
Labor and Delivery...75
Baby...78 Mental Health...98
Postpartum...80
 Table of Contents:
Pharmacology
Analgesics...101
Remember:
Cardiovascular...102
Stay consistent with your
Endocrine...105
studying!
Integumentary...107 Good luck, Future RN!
GI...109 You’re going to do great!
Musculoskeletal...110
Nuero...108
Hematological/ Oncological...109
Immunity...110
Infectious Disease...111
Mental Health...112
Maternity/ Newborn...114
Urinary/ Renal...114
Respiratory...115

Fundamental
Basic Care and Comfort...117
Medication Administration...118
Safety/ Infection Control...119
Skills/ Procedures...121
 Adult Health:
Cardiovascular
Cardiovascular topics you NEED to know!
Stress Test
What is it? Measures how well your heart works under stress, on treadmill or
stationary bike, professionals monitor hearts electrical activity
Adenosine is often the medication of choice to induce controlled stress on the heart.
Patient cannot eat, drink or smoke the day of the test! (including caffeinated OR
* decaffeinated products)
Do NOT give theophylline, nitrates or beta blockers before this exam
they interfere with the test results
You CAN give insulin!
be very careful with dosing because patient has not been eating. Glucose levels
may be lower than usual.
Coronary Arteriogram (Angiogram)
What is it? Study of the coronary arteries, heart chambers and function of the heart
Patient cannot eat or drink anything for 6-12 hours before test
Dye will be injected to highlight blood vessels
this dye can make patients flush > check for allergies
Patient may have to lay flat for hours after surgery to prevent bleeding at insertion
site
the access point is most commonly through the femoral artery
Central Venous Pressure (CVP)
What is it? Measures the preload of R ventricle
Normal ranges from 2 to 8
Elevated CVP means fluid overload
Mean Arterial Pressure (MAP)
What is it? Average blood pressure in your arteries during a cardiac cycle
Should be at least 70
Can be calculated... MAP = diastolic + 0.3 (pulse pressure)
pulse pressure = systolic pressure- diastolic pressure

5
Sinus Bradycardia
What is it? Pulse < 60 bpm
Treated with atropine
if that doesn’t work then transcutaneous pacing
if that doesn’t work then dopamine or epinephrine

Hyperkalemia
What is it? High level of potassium in blood- can cause arrhythmia
Can be treated with Albuterol or insulin which drives K into cells from blood
dextrose can be given with Insulin to prevent hypoglycemia and diuretic to excrete
Also give IV calcium gluconate to protect myocardium from dysrhythmias by reducing
irritability
Disseminated Intravascular Coagulation (DIC)
What is it? The body’s clotting cascade gets overreactive and creates lots of little clots
throughout the body, very very serious!! All of the blood clotting factors get used up
so then leads to hemorrhaging in other parts of body. Clotting cascade super messed
up!
Often caused by sepsis, trauma, cancer or placenta issues
Intervention: Norepinephrine to vasopress, give Heparin, closely watch coagulation
studies, give FFP and platelets, continue fixing underlying cause
Heparin > FFP = Fresh Frozen Plasma
What is it? Anticoagulant, treatment of choice for DIC
Therapeutic PTT is ~60-10 seconds or one that is 1.5-2.5x the normal range
PTT- partial thromboplastin time: measures how blood clots
high PTT means blood taking too long to clot
Antidote: protamine
Warfarin
What is it? Anticoagulant, works by blocking Vitamin K
Therapeutic INR is 2-3
INR is test to monitor warfarin treatment
Therapeutic PTT is 1.3-1.5x control
Crosses the placenta! not recommended for pregnant women
Antidote: Vitamin K/ Phytomenadione
Coronary Artery Bypass Graft (CABG)
What is it? Procedure that bypasses narrowed or blocked coronary arteries
Post procedure teachings: weight reduction, light exercise, no smoking, daily shower
but no soaking, no lifting anything heavier than 5 lbs, no driving for 4-6 weeks after

6
MIDCABG
What is it? Minimally invasive direct coronary artery bypass, they go in through the
ribs
More painful initially but shorter recovery time
Raynauds Syndrome
What is it? syndrome that causes blood vessels in fingers and toes to narrow in cold
Encouraged to wear gloves, dress warm, avoid extreme temperatures, avoid drugs,
caffeine and tobacco, avoid stress
Pulmonary Edema
What is it? excess fluid in the lungs
Causes dyspnea, pink frothy sputum and crackles in the base of the lungs
This often happens with patients with heart failure because the heart cannot pump
effectively so blood gets backed into the lungs
Treat initially with oxygen and diuretics
Aortic Stenosis
What is it? Narrowing of aorta
When active, these patients get syncope and angina
Avoid any strenuous activity till they can get it fixed
Thoracic Aortic Aneurysm
What is it? Bulge or ballooning of aortic wall
this puts pressure on the esophagus which can cause dysphagia
Hypertensive Crisis
What is it? Blood pressure so high that it damages the organs
It is important to prioritize neurological checks! If patient has a decreased level of
consciousness (LOC) it could mean hemorrhagic stroke
Treat with nitrates and antihypertensives, initial treatment goal is to lower MAP by no
more than 25%
If BP is lowered to quickly it can cause a stroke
Heart Transplants
What is it? you know what it is....
Patient will require lifelong immunosuppressants!

Cardiac Arrest
What is it? the heart suddenly and unexpectedly stops beating
Interventions: CPR first! then AED and medications
S/S: loss of consciousness, no pulse

7
Infective Endocarditis
What is it? Infection of the heart’s lining or valves, caused by fungus or bacteria, can
cause growths on the valves
Signs and Symptoms (S/S): fever, Arthralgia (joint pain), weakness and fatigue, splinter
hemorrhages
Pts with fake heart valves or any prosthetic material in their hearts can get this from
oral surgery, super important that they take antibiotics before
Growths on the valves can break off and embolize causing a stroke or ischemia to
extremities or organs
Permanent Pacemakers
What is it? device placed to help regulate bradycardia
As a nurse, you should assess for electrical capture and mechanical capture
electrical capture is checked by the cardiac monitor
mechanical capture is checked by auscultating the apical pulse
If the permanent pacemaker is not working, try transcutaneous pacing (converts
bradycardia to normal rate)
Education post placement: no MRIs, no security at airport, don’t linger around
antitheft devices by the doors at stores, keep your phone away from it, carry your
pacemaker ID card, don’t raise your arm above your head for a while, no hearing aids
Non Emergency Cardioversion
What is it? Converts tachyarrythmias (SVT and Vtach) back to normal
A defibrilator is used and shocks the patient only during the R wave!
Oxygen must be turned off and moved away
Congestive Heart Failure (CHF)
What is it? The heart cannot pump effectively to meet the body’s needs
A big concern with CHF is that they are retaining fluids in their lungs which causes
dyspnea
always auscultate lungs!
S3 heart sound is indicative of fluid build up
Weakened left ventricle causes lung build up and shortness of breath (SOB)
Weakened right ventricle causes jugular vein distention (JVD), lower limb edema,
increased abdominal girth, ascites, hepatomegaly and splenalomegaly
Pts with CHF may need to supplement with K
they usually take diuretics which often decrease K levels
watch for muscle cramps! this often means hypokalemia
BNP- Brain Natriuretic Peptide: hormone released when heart is not pumping well,
when BNP is above 100 then heart is struggling
Patient cannot take NSAIDS because they cause sodium retention
Patient should wear compression stockings to promote venous return and prevent
edema 8
Venous Vasculature Insufficiency
What is it? Veins in the legs (mostly) aren’t able to return blood to the heart
Legs appear warm, red and strong pulse, legs get painful after standing for a while due
to edema
Red blood cells get trapped and die in the legs causing a leathery appearance
Compression stockings encouraged, this skin is super prone to breakdown on the
inside of the ankle
Causes: excessive standing, thrombus, birth control makes the blood hypercoagulable
so possibly birth control
Arterial Vasculature Insufficiency
What is it? The heart is not able to pump blood to the legs
Legs have diminished pulses, ulcers and eschar on toes, shiny and hairless, toes are
blue
Patient may get intermittent claudication (cramping pain during exertion that is only
relieved by rest) and dependent rubor (discoloration of limbs when they are below the
heart)
Causes: smoking, HTN, DM, Hyperlipidemia, atherosclerosis
Intervention: Give antiplatelets, statins, and antihypertensives to vasodilate
make sure to check A1C because DM causes vascular inflammation so that could
be contributing
Myocardial Infarction (MI)
What is it? Blood flow to the heart is blocked leading to damage or death of the heart
tissue
Appears as crushing dull chest pain, shortness of breath (SOB), ST segment elevation,
elevated Troponin
Elderly females often have different presentation, they may have diaphoresis, nausea,
fatigue, Gerd women often present w/indigestion
if they have ST segment elevation then they're having a heart attack no matter the
atypical presentation
Initial treatment: Aspirin, Nitroglycerin, Clopidogrel, Beta, Statin and Anticoagulant
Make sure heart monitor is attached ASAP because dysrhythmias are very common
after MI, specifically VFib
Troponin is final indicator of MI, increases 4-6 hours after
Normal Troponin is 0.4
Post MI, patients are prescribed laxative so they don’t bear down and ACE Inhibitor to
prevent progression of HF
> Don't die like Elvis
Pulmonary Embolism
What is it? A blood clot has blocked off flow to the lungs and blood backs up in the R
Ventricle
S/S: chest pain worsening from breathing, dyspnea, hypoxia, DVT with peripheral
edema
9
If patient has DVT, sometimes an IVC filter will be placed to trap it in place, this
should be reported to docs before any scans, patient should not cross legs
Implantable Cardioverter Defibrilator (ICD)
What is it? A device that is often placed in patients with VTach to bring them back to a
normal rhythm
If ICD isn’t properly converting, then you have to do it manually with an external
defibrilator
Pericarditis
What is it? Inflammation of membranes surrounding the heart, often caused by viral
infections
S/S: sharp chest pain worsening with inspiration, pleural friction rub (high pitched
grating sound), ST segment elevation in all leads
Intervention: lean forward and sit up, give NSAIDS and colchicine to reduce
inflammation
Watch for signs of bleeding because of the NSAIDS and cardiac tamponade (muffled
heart sounds and narrowed pulse pressure and JVD)
Radio frequency Catheter Ablation
What is it? Catheter is inserted in femoral artery to burn the area of cardiac tissue
causing a dysrhythmia, this treats heart block and SVT
Mechanical Prosthetic Valves
What is it? Placed in heart to replaced damaged heart valve
Requires long term anticoagulant therapy
Aortic Dissection
What is it? A tear in the inner lining of the aorta that allows blood to collect between
the layers of the arterial wall
S/S: tearing pain, different blood pressures in each arm, pulse deficit, widening of
mediastinum on chest xray
Intervention: IV Opioids, IV Beta blockers, monitor for cardiac tamponade,
You really want to avoid aortic rupture, so it is very important to keep BP at a normal
level
Abdominal Aortic Aneurysm Repair
What is it? Surgery to treat a bulge or weakness in the aorta, two main way to do this
surgery...
Watch renal status very closely, this surgery often causes acute kidney injury
make sure patient is passing at least 30 mL/hr and watch BUN and Cr
Endovascular- 2 incisions in the groin area and they put stents grafts
watch for bleeding: ecchymosis in the testicles, penis or groin, increase in
abdominal girth, tachycardia, decreased peripheral pulses, decreased hematocrit
and hemoglobin (H&H), pain in the back or groin, decreased output
Open- large abdominal incision
make sure to check pulses on every limb because they clamp vasculature during
surgery so it important to make sure everything is still working 10
Deep Vein Thrombosis (DVT)
What is it? This is a blood clot in a vein usually in the lower extremity
S/S: calf pain, lower leg warmth and edema, pulmonary embolism, virchous triad,
vascular damage,
toes do not turn blue or cyanotic! this is a vein issue
Do NOT use SCDs, this may dislodge the clot
Warm compression, early ambulation and bedrest with elevation is fine
Post DVT recovery, encourage lots of fluids, avoid alcohol and caffeine, elevate legs
and dorsiflex often, exercise, avoid restrictive clothing, they dont have to avoid long
car ride or flights but make sure they use compression socks and dont cross legs
Risk factors: trauma (highest), major surgery, prolonged immobilization, pregnancy,
oral contraceptives, cancer, smoking, old age, obesity
Cardiac Tamponade
What is it? When pleural effusion (fluid surrounding the heart) gets so bad that it
compresses the heart and decreases its ability to fill and eject
S/S: hypotension, muffled heart sounds, jugular vein distension (JVD) (measure when
patient is sitting 45 degrees), becks triad, and narrowed pulse pressure
Central Venous Catheter < Hypotension , JVD , Muffled M sounds
What is it? thin, flexible tube inserted into a vein to aid in blood flow
Removal can cause an air embolism, patient would develop respiratory distress
Intervention: apply occlusive dressing, position patient in left lateral
trendelenburg, and give 100% oxygen
Non Emergency Cardioversion
What is it? Converts tachyarrythmias (SVT, Vtach or very tachy Afib) back to normal
A defibrilator is used and shocks the patient only during the R wave!
Oxygen must be turned off and moved away
Ventricular Tachycardia
May or may not produce a pulse, wide QRS, 150-250 bpm
Intervention: if patient is stable- give Amiodarone
Intervention: if patient is unstable (HOTN, altered mental status, shock, chest pain) -
treat with synchronized cardioversion

11
 Torsades de Pointes
What is it? type of Vtach caused by prolonged QT interval, occurs in patients
with hypomagnesia (1.7-2.2 is normal)
Treat with IV Magnesium

Paroxysmal Supraventricular Tachycardia (PSVT)

What is it? The heart is beating very quickly but with a regular rhythm
Intervention: Vagal maneuvers and Adenosine

Premature Ventricular Contracture (PVC)

What is it? Ventricle contracts too early, not too scary!
Can be caused by electrolyte imbalance, stimulants, stress

12
Ventricular Bigeminy
What is it? every other heartbeat is a premature
ventricular contraction (PVC)

Atrial Flutter
What is it? regular, sawtooth flutter patterns,
atrium going off 200-350 bpm

Atrial Pacing
What is it? A pacemaker sends out shock to the
atria first, you can see the spike before the P wave

13
Ventricular Pacing
What is it? A pacemaker sends out shock to the ventricle first, you can
see the spike before the QRS

Atrial Fibrillation
What is it? Atria beat irregularly and rapidly,
palpitations, tachycardia, irregular pulse

Supraventricular Tachycardia
What is it? Heart beats rapidly and irregularly, originates in
the bundle of His, P waves get hidden in the strip
Treated initially with vagal maneuvers
Adenosine is drug of choice if vagal not working

14
15
 Adult Health:
Respiratory
COPD
What is it? emphysema and chronic bronchitis
S/S: shortness of breath, fatigue, chronic cough with mucus, wheezing and chest
tightness
Often have issues with eating bc they get so out of breath
Teach: don't drink and eat at the same time, eat small frequent meals high in
protein and calories, oral hygiene before meals can help, avoid high fiber gas
forming foods and sodas, get flu and pneumococcal vaccines
Risk: smoking, fumes, air pollution, genetics
Venturi mask is best for COPD exacerbation
non rebreather is short term for asthma attacks, pneumonia trauma etc.
Even if patient is a hoarder, still teach them about O2 use at home
Causes polycythemia (too many RBCs) basically they have the opposite of anemia
During exacerbation, if Co2 levels super high, hook them up to BIPAP to decrease CO2
levels, they can also often administer nebulizer at the same times
Pursed Lip Breathing
What is it? inhale for 2 seconds with mouth closed, exhale for 4 seconds with pursed
lips
Promotes Co2 elimination and reduces air trapping, improves airflow and helps to
maintain open airways
Obstructive Sleep Apnea
What is it? episodes of hypopnea during sleep
S/S: sleep disturbances, snoring, headaches, depression
Teach: limit alcohol intake, lose weight, use a CPAP, avoid sedating medications

16
Pneumonia
What is it? lung inflammatory reaction to infection, production of secretions often
causing hypoxia
S/S in older adults: confusion, agitation, drowsy
General S/S: high fever, tachycardia, productive cough, weird breath sounds, dyspnea,
crackles, increased fremitus, unequal chest expansion, dullness, pleuritic chest pain,
leukocytosis
Cause: recent surgery, smoking, age,
Complications: ARDs, DVT, sepsis, pleurisy
pleurisy- stabbing pleuritic pain increases on inspiration caused by inflamed
parietal and visceral pleura rubbing together
Intervention: thoracentesis if pleural effusion, O2 and antibiotics
Position: good lung down to increase blood flow to good one
PE (Pulmonary Embolism)
What is it? blood clot blocking an artery in the lung
S/S: pain, dyspnea, hypoxemia, altered mental status, tachypnea, tachycardia, DVT
signs
Cause: surgery, DVT, smoking, aging
Intervention: Heparin drip
a decrease in platelet count is not what you want! this means too much heparin
has caused thrombocytopenia
Pulmonary Effusion
What is it? build up of fluid between the lungs and chest wall
S/S: decreased or absent breath sounds, chest pain during inhalation, dyspnea
Intervention: Thoracentesis
Tension Pneumothorax
What is it? air builds up in the chest cavity and presses on the heart and lungs
S/S: tracheal deviation, hypoxemia, unilateral chest wall expansion, diminished breath
sounds, hypotension, decreased cardiac output
This puts a lot of pressure on the heart, it can't fill and contract properly
Chest Tube
What is it? tube used to drain air, blood or fluid
You want to see intermittent bubbling and tidaling in water seal chamber and gentle
continuous bubbling in suction regulation
Make sure a sterile and occlusive gauze is taped on all four sides around tube
Disconnected chest tube with contamination, or drainage unit cracks/malfunctions?
First thing you do is put distal end in sterile water
Chest tube comes out of a person?
Apply occlusive dressing tapes on 3 sides to allow air to escape on exhalation
17
Asthma Exacerbation
What is it? narrowing of airway
S/S: accessory respiratory muscle use, chest tightness, diminished breath sounds,
high pitched expiratory wheezing, tachypnea
No breath sounds is an emergency!
Incentive Spirometer (ICS)
What is it? breathing device used to prevent atelectasis
Teach patient put mouth on mouth piece and to breathe in slowly and deeply till hit
the target, hold breath for 3 seconds and then exhale
Peak Flow Meter
What is it? measures a patients peak flow of air out of the lungs
Teach: exhale as fast and completely as you can, put indicator at base, breath in and
then exhale on the meter
Use 3 times in a row and record highest, use after bronchodilator to see if drug
worked
If it is red, green and yellow, yellow means caution you're getting worse and you
need more meds, red means emergency, green is good
Respiratory Failure
What is it? PaCO2 >45, PaO2 <60
S/S: paradoxical breathing, mental status changes, silent lung sounds, dyspnea, pH
<7.35
They will be in respiratory acidosis
Carbon Monoxide Poisoning
What is it? burning fuel in poorly ventilated setting
S/S: headache, dizziness, nausea
coO2 will displace SAo2 on Hgb so you can't trust pulse ox reading! will be falsely
high!
Intervention: 100% O2 on 15 L non rebreather
Tracheostomy
What is it? Incision made in the neck to create a separate airway to relieve an
obstruction
Immediate post op care priority is to prevent trach dislodgment, so check the
tightness of straps around the neck allowing for one finger underneath
if the patient gets a permanent tracheostomy it is placed in a neck stoma, if its tube
gets dislodged then you have to insert new tracheostomy tube with obturator
if you can't put a new one in, cover stoma with sterile occlusive dressing and
bag/valve mask

18
Ventilator Acquired Pneumonia (VAP)
What is it? infection patients can get when on ventilator, often critical care patients
S/S: purulent sputum, positive sputum culture, leukocytosis, fever, x ray showing
infiltrates
Bronchoscopy
What is it? doctor examines the bronchi by putting bronchoscope in either nose or
mouth
Post procedure: mildly sedated, gag reflex gone about 2 hours, respirations might be a
little low
Bright red blood with sputum means hemorrhage!
Respiratory Alkalosis
What is it? blood becomes to basic due to decrease in CO2 levels
Causes: hyperventilation
S/S: rapid, deep breathing, dizziness, confusion
Thoracentesis
What is it? inserting a needle into the pleural space to remove air or fluid
Complications: pneumothorax, hemothorax, infection
During procedure, patient sits up right and leans forward, doctor inserts needle in the
back
Acute Respiratory Distress Syndrome (ARDS)
What is it? Lung condition where fluid builds up in the lungs due to increased
permeability of vasculature leading to leaking, surfactant deficiency, collapsed alveoli
and decreased air exchange
Refractory hypoxemia- hallmark sign: inability to improve oxygen with increase in
oxygen concentration
S/S: SOB, shallow breathing, cough, chest pain, blueish tint to lips, confusion
Causes: acute pancreatitis, infection, pneumonia, aspiration, medications
Allergies
Before skin allergy test, avoid antihistamines (diphenhydramine, loratadine) and
corticosteroids
Most common site of dust mite allergen is bed linens- wash weekly in hot water
Elevated eosinophils are seen in allergic reaction results

19
Acute Respiratory Failure (ARF)
What is it? impairment of lungs ability to oxygenate blood and excrete CO2
S/S: altered mental status, paresthesia, dyspnea, tachypnea, hypoxemia
Rib Fracture
Intervention: pain management and preventing pneumonia etc.
Encourage coughing breathing and ambulating
Obstructive Sleep Apnea
S/S: loud snoring, apnea episodes, waking with choking sensation, excessive daytime
sleepiness, waking up alot while sleeping, morning headaches
Intervention: patient might need to loose weight, CPAP
Sleep with a CPAP to deliver pressure and air
If O2 drops while sleeping, always check mask fit first
Nasopharyngeal Airway
What is it? tube that goes in nose to maintain upper airway, great for conscious/semi
conscious patients
Never insert in patient with possible head trauma because could go into brain

20
 Adult Health:
Endocrine
Metabolic System
What is it? A combination of conditions that increase the risk for DM1, stroke and
heart disease.
Patient must have 3 of these conditions to be diagnosed: increased waist
circumference >35 (women) or 40 (men), increased triglycerides >150, decreased HDL
<50 (women) or 40 (men), elevated BP over 130/80, or fasting glucose of 100 or higher
Acromegaly
What is it? A condition causing over production of the growth hormone causing
overgrowth of soft tissues in face, hands, feet, organs
This usually causes joint pain, skin issues and hyperglycemia
SIADH (Syndrome of Inapropriate Antidiuretic Hormone)
What is it? Too much antidiuretic hormone is released
Signs & Symptoms: water retentions, dilutional hyponatremia (can cause seizures and
neuro issues)
in labs you will see low serum osmolality, low serum sodium, high specific gravity
because fluid in urine is retained
Intervention: fluid restriction, oral salt tablets, hypertonic saline to fix the
hyponatremia in first few hours, vasopressin, strict I&O monitoring, monitor neuro
status, daily weighing, high sodium diet
Most common cause is small cell lung cancer
Hyperparathyroidism
What is it? Parathyroid glands produces too much parathyroid hormone (PTH)
S/S: High calcium, excessive urination, increased risk of osteoporosis or broken bones
Treatment: calcitonin and bisphosphonates given to decrease calcium level

21
Hypoparathyroidism
What is it? Parathyroid glands produces not enough parathyroid hormone (PTH)
S/S: Low calcium and high phosphorus, tingling, muscle cramps, Trosseau and
Chvosteks sign, prolonged QT interval, tetany and seizure
Treatment: calcitonin and bisphosphonates given to decrease calcium level
This can be caused by surgery to the neck or any trauma to neck
Treatment: mild (Ca >7.5) oral calcium and calcitriol
Treatment: Severe (Ca < 7.5) IV calcium gluconate, Calcitriol
watch Mg levels, sometimes they drop with the calcium
IV calcium should be administered push over 10-15 minutes to prevent HOTN and
dysrhythmias and make sure to flush before and after because it is a vesicant!
Acanthosis Nigricans
What is it? condition that causes symmetric, hyperpigmented velvet plaque in armpit
or neck, usually has skin tags
This indicates insulin resistance.
Hyperosmolar Hyperglycemic State
What is it? Severely high blood glucose levels, extreme dehydration and altered
consciousness
Occurs in patients with DM2, BG >600, usually takes a while for symptoms to kick in
but super dehydrated for a long time
S/S: altered mental status, blurry vision, lethargy, obtunded, coma
Because insulin is still being produced, symptoms that occur with DKA don't
happen with HHS like kussmaul respirations, acidosis or ketones in the urine

DKA (Diabetic Keto Acidosis)

What is it? Occurs in patients with DM1, not enough insulin in the body so it cannot
breakdown glucose, body turns to fat instead which produces ketones causing acidic
blood
S/S: blood glucose 250-500, profound dehydration, polyuria, polydipsia, nausea and
vomiting, tachypnea, tachycardia, hyperglycemia, abdominal pain, fruity breath,
altered mental state, ketones in urine, metabolic acidosis, Kussmaul respirations
Treatment: 1st is fluid (NaCl to start), give IV insulin, hourly BG monitoring, when
glucose drops below 250 then switch fluid to D5 to prevent hypoglycemia
insulin causes hypokalemia so K is often given even if K levels are normal to
prevent any arrhythmias, frequent ABG checks, continuous cardiac monitoring,
isotonic fluid with strict I&Os

22
Sick Day Rules for Diabetics
When sick, resistance to insulin increases and leads the body to ketosis (breaking
down fats for energy)
Patient should increase fluid intake, check blood glucose (BG) q4hr, monitor urine for
ketones, they should NOT discontinue insulin or food intake, they should try to eat the
normal amount of food for them
Diabetes Foot Care
Foot care is very important for diabetics, they have poor blood flow meaning any
wound is very slow to heal
They must cut their toenails straight across, use mild powder on sweaty feet, use
cotton to separate overlapping toes, wash feet daily, check water with thermometer,
use lanolin to prevent dry skin (never between the toes!), no barefoot or open toed
shoes, do not sit with legs crossed
Hypoglycemia
What is it? BG are too low, BG <70
S/S: shakiness, palpitations, pallor, cold and sweaty
if left unTreatmented can lead to decreased level of consciousness, seizure or
coma
Treatment: 1 mg glucagon IM into deltoid muscle, recheck BG every 15 min
Graves Disease
What is it? Overproduction of the thyroid hormone leading to hypermetabolic state
S/S: tachycardia, weight loss, exopthalmos
Treatment: radioactive iodine therapy- destroys thyroid gland tissue resulting in
decrease in T3 and T4, the low thyroid levels cause pituitary gland to release more TSH
but cannot attach to anything anymore so they just circulate
teratogenic! no pregnancies while doing this!
must watch out for thyroid storm!
Cushing Disease
What is it? hormonal disease in pituitary gland causing too much cortisol
S/S: androgen excess causing acne, hirsutism and period issues, truncated obesity,
HTN, moon face, hyperglycemia, bruising, muscle weakness
Treatment: surgical removal of pituitary gland (transphenoidal hypophysectomy)

23
Addisons Disease
What is it? chronic adrenal insufficiency causing low levels of
cortisol,aldosterone and androgens
diagnosed with ACTH test
S/S: hypotension, low CO2, hypoglycemia, muscle weakness, fatigue, salt
cravings, hyperpigmentation (bronze patchy skin parts), depressed mood,
anorexia, decreased body hair, hyponatremia
Treatment: hormone replacement, increase sodium intake (because
aldosterone deficiency increase sodium and water loss in urine), and monitor
orthostatic blood pressure
Addisonian Crisis:
triggers: illness, injury, stress
s/s: HOTN, tachy, hyperkalemia, hypoglycemia
Treatment: fluid resuscitation, IM hydrocortisone shot
Hypothyroidism
What is it? decrease in thyroid hormones
S/S: bradycardia, HOTN, cold intolerance, constipation, weight gain, facial
puffiness, periorbital edema
Treatmentment: lifelong thyroid hormone replacement- Levothyroxine
Myxedema Coma-
What is it? severe hypothyroidism
hypothyroid patient not adhering to hormone replacement
S/S: altered mental status, hypothermia, hypoventilation
Treatment: give levothyroxine IV, warm blankets, possible endo tube bc not
ventilating, cardiac monitor
Hyperthyroidism
What is it? The thyroid produces too much thyroid hormone
Diagnosed with Radioactive Iodine Uptake Test (RAIU) - low dose RAI given
to see if thyroid picks it up and how much- positive patients pick up too
much RAI
Isolation post test is not needed, cannot be pregnant! Remove all metal
objects around neck, drink lots of fluids after
s/s: weight loss, heat intolerance
Treatment: Iodine Solutions rapidly lower thyroid hormones (T3 and T4)
Teach patient to eat 4000-5000 calories a day, avoid caffeine and spicy foods,
and eat high protein meals

24
Thyroid Storm (Thyrotoxosis)
What is it? an increase in thyroid hormone resulting in hypermetabolic state,
usually happens as a exacerbation of hyperthyroidism
S/S: high fever, tachycardia, HTN, arrhythmias, agitation, anxiety, seizure,
nausea and vomiting, diarrhea, jaundice, goiter (swollen thyroid), lid lag, tremor,
agitation and confusion
Causes: thyroid surgery, any surgery, acute illness, childbirth, acute iodine load
(contrast solution)
Without treatment, this can turn into hyperthermia, malignant hypertension
and V Tach
Treatment: Beta blockers, antithyroid medications, corticosteroids, cooling
measures, rehydrate
Thyroidectomy
What is it? partial or total removal of the thyroid, can be done to treat
hyperthyroidism or cancer
Expected findings post surgery: pain, slight bleeding, sore throat
Monitor for any signs of thyroid storm post surgery (especially in patients with
hyperthyroidism) because after surgery, thyroid levels can maintain elevated
or even increase, monitor for hoarse voice or inspiratory stridor (could mean
airway compromise), dysphagia or frequent swallowing (could mean bleeding),
hypocalcemia or tingling/numbness which can be occur bc parathyroid got
damaged- assess using Trousseae or Chvostek
Maintain HOB 30-45 degrees (semi fowler) to promote drainage, and have
airway equipment nearby (tracheostomy, suction, oxygen)

25
 Adult Health:
GI/ Nutrition
Benefits of High Fiber Diet
helps prevent colorectal cancer, improves glycemic control, promotes weight
loss, reduces risk of vascular disease, regulates bowel movements
Nasogastric Tubes
What is it? A tube inserted through the nose into the stomach used for feeding,
decompressing and providing medications
Salem Sump- continuous suction with air vent to remain open to prevent
excess suction
If suction! no residual to check
Semi fowler, mouth care q4hr, turn off suction for auscultation
Peritonitis
What is it? Complication of peritoneal dialysis, contamination during infusion
S/S: cloudy peritoneal effluent, rebound tenderness, fever, chills, abdominal
pain
Treatment: collect peritoneal effluent from drainage bag for culture and
sensitivity
Colostomy
What is it? A piece of the colon is diverted to an artificial opening in the abdomen
Stoma- should be pink/red and moist- if dusky, pale or dark colored- means
vascular compromise!
Ascending colostomy- ask doctor about enteric coated meds before taking, cut
back on foods that cause odor and gas (broccoli, cauliflower, beans), semiliquid
so does not require irrigation, increased fluid, empty pouch when 1/3 full
Ileostomy- small intestine, avoids colon, low residue diet when healing
avoid anything high fiber, stringy veggies, seeds or pits, edible peels
Irrigation- for descending or sigmoid only, irrigate with 500-1000 ml tap water,
hang container on hook or pole, sit on toilet, lubricate tip and insert and hold in
place, irrigate, clamp if cramping---never use enema set! this is not a rectum!
it's a stoma-- requires a special cone tip applicator
26
Refeeding Syndrome
What is it? Life threatening condition due to electrolyte and fluid shifts that occur when
malnourished patient eats too much (mainly carbohydrates)
S/S: rapid decline in phosphorus (2.4-4.4), potassium (3.5-5), magnesium(1.3-2.1), fluid
overload, sodium retention, hyperglycemia, thiamine deficiency
GERD
What is it? The sphincter in esophagus has decreased tone causing food to come back
up (baby barf)
Teaching: foods low in fat, no tobacco, alcohol, caffeine, chocolate or peppermint,
lose weight, small frequent meals, chew gum, HOB elevated, no eating before bed
Ulcerative Colitis
What is it? chronic IBS causing sores in the colon
S/S: frequent bloody diarrhea, anorexia and anemia, fluid loss, malabsorption, skin
breakdown, fatigue
Treatment: avoid triggers (caffeine, fatty food, alcohol) drink at least 2-3 L of water,
take vitamins to make up for fluid loss (containing calcium), take Sulfasalazine every
day even if symptoms gone, use zinc cream or witch hazel for rectal break down, eat
high protein foods
Megacolon- can happen with any IBD but more common with ulcerative colitis, colon
super inflamed,
S/S: abdominal pain, bloody diarrhea, fever and signs of shock
Albumin vs. Prealbumin
Albumin looks at long term malnutrition, normal levels are 3.5-5, wont show any
recent changes
IV albumin is a colloid, often given after paracentesis to prevent hypotension
PreAlbumin (normal level is 15-35) is a more reliable indicator for acute change in
nutritional status
Dumping Syndrome
What is it? Food is passed too quickly from the stomach to the small intestine, typically
caused by gastric surgery
S/S: HOTN, abd pain, NV, dizzy, sweating, tachycardia
Teach: eat foods high in fat, protein and fiber because they take a while to digest,
don't drink while eating, small frequent meals, avoid simple carbs, lay down after
meals

27
Celiac Disease
What is it? the body cannot properly digest gluten (barley, rye, oats, wheat)
Patients usually experience relief in a few days after going gluten free
Most common reason for continuation of symptoms is that they aren't properly
following the diet
Stool Guaiac Test
What is it? A test that looks for hidden occult blood in a stool sample
Recent ingestion of red meat or medications (vitamin C, anticoagulants, aspirin, iron,
ibuprofen, steroids) may interfere with results and get false negative
To take the test, take two samples of feces first and let dry few minutes, then two
drops of provided solution and wait 30-60 sec, positive will turn the sample blue
meaning presence of blood
Colonoscopy
What is it? procedure that examines the large intestine
Teach: clear liquid diet the day before, NPO 8-12 hr prior, polyethylene glycol is used
to cleanse bowel
Risk for perforation (this is true for any rectal or oral surgery)
Signs are rebound tenderness, guarding, and abd distention
Enteral Feedings
What is it? Method of providing nutrition through a tube directly into the GI tract
This is the preferred route of feeding compared to TPN, enteral has a lower risk of
infectious complications, helps to preserve function of gut and prevent stress ulcers
Total Parenteral Feedings
What is it? Providing nutrition through central venous access device
Never stop abruptly! If has to be stopped, give 10% dextrose in water at TPN rate to
prevent hypoglycemia, check BG q4-6, record daily weight and IO
Complications: hyperglycemia due to excessive dextrose in the infusion
Lower GI Bleed
What is it? bleeding from the anus, rectum or large intestines
This most often occurs in patients with chrons, ulcerative colitis, hemorrhoids,
diverticulitis
S/S: bright red blood in stool

28
Upper GI Bleed
What is it? Bleeding that occurs in the esophagus, stomach or duodenum
May be caused by gastroesophageal varices- distended fragile blood vessels in
the stomach or esophagus that often occur due to cirrhosis
watch them closely for variceal rupture! this can cause massive
hemorrhage, variceal rupture can occur due to sudden increase portal
venous pressure or NG tube insertion causing trauma, also associated with
chronic NSAID use, hx of H. Pylori infection, Peptic ulcer disease
S/S: HOTN, Tachycardia, syncope, tarry/black stools, hematemesis,
Intervention: Pantoprazole to reduce gastric acid secretion , Octreotide to
reduce portal venous pressure which reduces bleeding,
Peptic Ulcer Disease
What is it? ulcers in the lining of the stomach
Teach: avoid spicy foods, acidic food, pepper, no NSAIDS, drugs, alcohol,
caffeine, chocolate, tobacco, reduce stress
Complications: bowel perforation, abd bleeding
Risk Factors:PUD can develop from H. Pylori infection, NSAID use, smoking and
drinking
treatment: antibiotics and PPI for 7-14 days
Esophagogastroduodenoscopy (EGD)
What is it? medical procedure to study the lining of the upper GI tract, endoscope
goes down esophagus
Watch for signs of perforation- temp spike, increasing pain, tachycardia and
tachypnea
Irritable Bowel Syndrome
What is it? chronic digestive system dysfunction causing diarrhea and constipation
S/S: abdominal pain, loose stools and constipation
Often exacerbations caused by stress, depression, anxiety

29
Acute Diverticulitis
What is it? diverticula become inflamed and infected because trapped food particles
in diverticula
diverticula are hernia pouches in digestive tract cause by stretching from
constipation
S/S: fever, loose stools, abdominal pain, occult blood in stool, leukocytosis, hx of
chronic constipation
Complications: fistula formation- often between colon and bladder, bowel
perforation, abscess formation
Intervention: uncomplicated: treated at home with NPO, fluids, antibiotics, exercise,
high fiber diet, 2-3 L of water a day, DON'T need a low residue diet but decrease
fats/red meat/// complicated: IV fluids, IV antibiotics, NPO, abdominal surgery
Goal of treatment: give bowel a rest, no enema or laxatives or anything
Cholecystitis
What is it? Inflammation of the gallbladder by gallstones or other obstruction
S/S: vague pain or RUQ radiating to R shoulder, pain and NV after high fat meal, fever,
tachycardia, diaphoresis
Intervention: NPO high priority if vomiting, cholecystectomy, IV antiemetics
(promethazine), IV fluids, semi fowler, abd ultrasound
NG tube not high priority
Post procedure- early ambulation is priority! they pump abd with CO2 to expand,
walking helps get that out
Constipation
What is it? condition causing infrequent bowel movements
Intervention: stool softener, warm fluids with breakfast, increase fruit and veg,
increase fluid intake, exercise
Dont eat a lot of dairy
Bariatric Surgery
What is it? various surgeries done to help people loose weight
Sleeve Gastrectomy- most of stomach is removed
Complications: Anastomic Leak- gastric contents leaking into abd space
S/S: severe abd pain radiating to back or shoulder, developing sepsis (restless,
tachy, oliguria)
NG tube is often used after surgery to prevent anastromic leak, If the NG tube is
blocked after surgery, call the doctor!
Post op diet: while healing, clear liquid diet then full liquid then low in carbs and high
in protein to prevent dumping syndrome

30
Colorectal Cancer
Occurs with adults over 50, hx of colon polyps, family hx, IBD
S/S: blood in stool, abd discomfort, change in bowel habits, unexplained weight loss,
anemia
clients should have colonoscopy at age 50 if they have any signs: fatigue, weight loss,
anemia
Esophageal Cancer
Squamous cell carcinoma- cancer in the upper esophagus
Adenocarcinoma- lower esophageal cancer
Causes: smoking any kind of tobacco, alcohol, GERD, obesity, Barrett Esophagus, prior
esophagus issues, Nitrous containing foods (pickled food, beer)
Hiatal Hernia
What is it? hernia right above stomach on esophagus
S/S: heartburn, chest pain, dysphagia, SOB,
Intervention: avoid high fat, small frequent meals, decrease fluid while eating, dont eat
before bed, no chocolate, peppermint, tomatoes or caffeine, lose weight if obese with
light training, avoid lifting or straining, sit up after meals, elevate HOB 6 inch, if
symptoms uncontrolled then surgery needed
Gastroenteritis
What is it? inflammation of gastric and intestinal mucosa
S/S:NV, diarrhea and abdominal pain, fever, diarrhea, occult blood in stool
Pancreatitis
What is it? Inflammation of the pancreas, which produces digestive enzymes and hormones
like insulin
acute- risk for pancreatic abscess development
S/S: high fever, leukocytosis and increasing abd pain, treat abscess ASAP or sepsis
S/S: hyperglycemia, left upper quadrant radiating to the back pain, knee chest
position, steatorrhea (fatty yellow bowel movements)
Intervention: FLUIDS 1ST! NPO, Opioids, Fluids, lean forward
Patient can develop respiratory complications so watch out for signs, it can easily get
infected so watch for signs of infection, also watch BG due to the impaired insulin
production!

31
Appendicitis
What is it? inflammation of appendix, usually from a blockage of feces
S/S: abd pain beginning in umbilical area but moves to RL quadrant (McBurney point) ,
rebound tenderness, leukocytosis, fever, NV, anorexia
Intervention: IV fluids 1st! prepare patient for surgery, NPO, watch for pain to
disappear or abd perforation because that means perforation and that is BAD
Avoid putting the pts head over appendix, increases risk for perforation due to
increased circulation
Postoperative Ileus
What is it? normal bowel movements are significantly slowed down, often after
abdominal surgery
S/S: NV, abd pain, distension, absent bowel sounds, imbalanced nutrition
Diagnosed: abdominal and pelvic x ray used to rule out bowel obstruction, for ileus-
bowel is diffusely dilated
Intervention: monitor abd girth often, non opioid pain meds, cold packs for pain, IV
fluids, ambulation, watch for electrolyte changes
Small Bowel Obstruction
What is it? obstruction in the small intestine
S/S: colickly abd pain, N&V, cant have a bowel movements or pass gas, hyperactive
bowel sounds (borborygmi), distended abd
Diagnose: CT or X Ray
Causes: surgery, paralytic ileus, hernias
Treatment: NG tube, IV antiemetics, abdominal CT scan, IV fluids, NPO
Large Bowel Obstruction
What is it? obstruction in the large intestine (colon)
Gradual onset of symptoms: cramping, abd pain, distension, absolute constipation, no
flatus- constipation an earlier finding
Often occurs due to diverticulitis or colon cancer

32
Cirrhosis
What is it? chronic inflammation and scar development of liver
S/S: pruritus, abdominal ascites, issues with coagulation, esophageal varices, hepatic
encephalopathy, malnutrition, ecchymosis, edema, jaundice, distended veins around
umbilicus
Intervention: Cholestyramine- bile acid sequestrant used to block reabsorption of bile
and decreases itching -take 1 hour after other meds bc decreases absorption, use
lotion and cut nails short
Often have hypoalbuminemia bc liver produces albumin, albumin helps to keep liquid
in vasculature, when low then it seeps out and you get edema and ascites, you also
can't produce any clotting factors so easy bleeding is an issue and elevated ammonia
levels cause HE
Hepatic Encephalopathy
What is it? liver is no longer able to detox blood, causing toxins to build up and affect the brain
Intervention: Lactulose given to decrease ammonia levels, increased bowel
movements, 3 times a day is good! keep going, for faster results give on an empty
stomach, you can mix with juice,
S/S: Altered mental status, sleep disturbances, lethargy, AOX 1 maybe, asterixis
(flapping tremors of hands), hepaticus (musty sweet breath)
Esophageal Varices
What is it? enlarged and swollen veins in the esophagus
often happens in patients with cirrhosis
If ruptured: IV fluid bolus, NPO, endogastroduodenoscopy to find bleeding, octreotide
infusion to decrease bleeding, RBCs
Balloon tamponade tube- controls bleeding by compression, can cause airway
obstruction if displaced- scissors must be kept at bedside incase of obstruction and
nurse has to cut the tube for rapid blood deflation and removal
Hemorrhoidectomy
What is it? removal of hemorrhoids
A minor procedure but very very painful
Pain is main concern but also stool softeners should be taken
Small Bowel Follow Through
What is it? Xray images taken every 15-60 minutes to watch barium as it passes
through small intestine
NPO 8 hours before
Chalky stools 24-72 hours after is common

33
Barium Enema
What is it? imaging done to visualize the colon with contrast
DO NOT do with diverticulitis patients
Clear liquid diet day before, NPO 8 hrs before, stool chalky white after, take a laxative
to expel barium
Lactase Deficiency
What is it? Lactose intolerance
Patient should restrict lactase containing foods
they can take lactase enzyme replacements and should supplement with calcium
and vitamin D
some yogurt and cheese actually have no lactose so those can be okay, but no milk
or cream
Abdominal Wound Dehiscince
Medical emergency, remain with client while someone gets help, cover wound with
sterile saline dressing, keep patient in low fowler position with knees bent
Vegan Diet
What is it? Diet containing no animal products
These patients are at risk for B12 deficiency which can cause megaloblastic anemia
and/or neuro symptoms
S/S: peripheral neuropathy, poor balance, gait problems, memory loss, dementia
Teach patient to eat B12 fortified foods

34
 Adult Health:
Hematology/ Oncology

Thrombotic Thrombocytopenia Purpura

What is it? hemolytic anemia with fragmentation of erythrocytes (formation of tiny
clots in small blood vessels)
Thrombocytopenia - low platelets
S/S: hemolytic anemia (jaundice and pallor), thrombocytopenia (petechiae, purpura),
decreased renal function, fever, very low platelet count (below 10,000), neuro issues
(seizures, confusion)
Change in LOC is what to watch out for- brain bleed!
Intervention: plasmapheresis (plasma exchange)
Heparin Induced Thrombocytopenia
What is it? immune reaction to heparin based anticoagulants causing decrease in
platelet counts
Switch patient to non heparin anticoagulant - Rivaroxaban
Purpura
What is it? reddish purple blotches that don't blanch, indicates bleeding under the
skin
Neutropenia
What is it? low white blood cells, ANC < 1000
Reduced WBC count
Absolute neutrophil count (ANC) = WBC x neutropenia
Neutropenic Precautions
private room with HEPA filtration
avoid raw fruits/vegetables, standing water or undercooked meat
Nobody sick around here!
Virchows Triad
What is it? three factors that increase the risk of blood clot
1) altered blood flow (stasis), 2) endothelial damage, 3) hypercoagulable state

35
Polycythemia Vera
What is it? the bone marrow produces super high amount of RBCs causing the blood
to become sluggish and decreases perfusion, often too many WBC and platelets too,
super increased risk for DVT and PE
Intervention: phlebotomy- removal of blood 300-500 mL at a time
teach: measure to prevent thrombus (compression stockings, elevate legs, fluids,
monitor for any redness, tenderness and swelling)
super common in people with COPD because chronic super low O2 levels so body
thinks it needs more RBC
Megaloblastic Anemia
What is it? B12/ folic acid deficiency
B12 only found in animal food, vegans are often deficient
Encourage supplementation
Anemia
What is it? low Hgb
S/S: severe- tachycardia, SOB, pallor, confusion ; mild - fatigue, headache,
dizziness
Iron Deficiency Anemia
What is it? low iron
Encourage patient to eat meat, shellfish, eggs, green leafy vegetables, dried fruits,
dried beans, brown rice, oatmeal
Eating vitamin c rich foods with iron rich foods increases absorption
Sickle Cell Anemia
What is it? genetic disorder causes red blood cells to change shape which causes them
to stick together
Vaso Occlusive crisis- large number of sickle RBCs clump together and obstruct small
blood vessels leading to ischemia and its very painful- can lead to MI or limb necrosis
Splenic Sequestration Crisis: Rbcs get trapped in spleen and causes splenomegaly and
HOTN
Intervention: opioid analgesics, IV fluids, watch Hgb levels
Teach: avoid extreme temps, stay hydrated,
Blood Transfusion
Make sure patient pees before transfusing blood! incase of reaction you need fresh
pee sample post blood
20 gauge is good for PRBCs,initiate transfusion within 30 min of obtaining blood
When treating any reaction: stop transfusion, disconnect tubing and give NS!

36
Acute Hemolytic Transfusion Reaction
What is it? reaction when incompatible blood is given
S/S: fever with chills, flank/ back pain, dark red urine, tachycardia, HOTN, dyspnea
Complications: AKI, DIC, shock
Intervention: stop infusion, remain with client and give vitals, new tubing, give NS,
send blood and tubing to blood bank, get blood and urine sample, aggressive fluid
hydration!
Anaphylactic Transfusion Reaction
What is it? Life threatening allergic reaction that occurs right after transfusion starts
S/S: respiratory distress, skin changes, abd pain, angioedema, HOTN, wheezing
Intervention: epinephrine
Febrile Nonhemolytic Transfusion Reaction
What is it? most common reaction, fever and chills during transfusion
Intervention: stop transfusion, replace tubing, give NS, acetaminophen to reduce
fever
Hemophilia
What is it? deficiency in coagulation proteins resulting in issues with clotting and
increase risk of uncontrolled bleeding
Hemophilia A lacks FCTOR VIII, Hemophilia B lacks Factor IX
S/S: severe bleeding, excessive bleeding, hemarthrosis (joint bleeding)
Intervention: IV clotting factors, treat hemarthrosis with RICE- rest ice compression
elevation
NO NSAIDS
Von Wildebrand
What is it? deficiency of von Willebrand factor (vWR) causing bleeding disorder, issues
with coagulation
Intervention: Desmopressin stimulates body to produce more VW factors
Teletherapy
What is it? External beam radiation therapy
During treatment, focus on preventing infection and promoting healing
avoid extremes in temp, no sun, only lotions and creams approved by physician,
shower daily, no scratching or rubbing
Cancer
What is it? abnormal growth of cells
S/S: change in bowel or bladder habits, sore that doesn't heal, unusual bleeding or
discharge, lump, indigestion or dysphagia, mole or wart is weird, nagging cough

37
Colorectal Cancer
S/S: rectal bleeding, changes in bowel habits, and pain, screening is key!
Super high risk if family has it or IBD; if increased risk, get a colonoscopy when turning
50
Lesser risks: red meat, not enough fiber, alcohol, obesity, stationary, smoking
Prostate Cancer
Super slow growing cancer, diagnosed with PSA (prostate specific antigen)
High risk: black men with family hx, >50 yo, lots of red meat and high fat diet, simple
carbs and being obese
S/S: urinating issues, ED, fatigue
Often metastasizes to the bones- causes severe pain, fractures and spinal cord
compression
Cervical Cancer
Causes: HPV!!!, or anything that increases chances of getting HPV like multiple
partners, sex before 18, Hx of STDs, immunosuppression, oral contraceptives, living in
poverty, tobacco
Endometrial Cancer
What is it? unregulated endometrial growth- inner lining of uterus
S/S: abnormal uterine bleeding, lower back and abd pain
Causes: family hx, prolonged estrogen exposure without progesterone, PCOS,
infertility, early menarche, obesity, tamoxifen (estrogen chemo drug)
Lymphoma
What is it? cancer of the lymph
S/S: drenching night sweats, weight loss, pruritus, enlarged lymph nodes, fever, weight
loss, severe pain after alcohol
Hodgkin lymphoma- reed sternberg cells found in lymphatic tissue , usually one node
involved
Non Hodgkin Lymphoma- multiple lymph nodes involved, much more common
Tumor Lysis Syndrome
What is it? after chemo or immunotherapy, mass cancer cells die and release of
intracellular components causing hyperkalemia, hyperphosphatemia, hyperuricemia,
hypocalcemia and cause AKI
Cancers with tumors or hematological cancers are at risk
Complications: AKI, arrhythmias, seizure
Intervention: hypouricemic meds (allopurinol, rasburicase), seizure precautions,
Sevelamer for high levels of phosphorus in the blood, cardiac monitoring, IV insulin
and dextrose to lower levels of K in the blood, watch serum uric levels, IV fluids

38
Lymph Nodes
Usually you cant feel them, but recent surgery sometimes brings them out
normal: soft, mobile, <2 cm, localized
abnormal: firm, immobile, > 2 cm, generalized
Chemotherapy
Causes neutropenia, thrombocytopenia and anemia
Oral Mucositis
What is it? inflammation of the mouth caused by radiation to head or neck,
chemotherapy
S/S: dry mouth, no taste, hurts to swallow
Teach: mouth lube, soft toothbrush, wash mouth out with saline, no spicy foods,
remove dentures every meal, apply lidocaine
Radiation
affects all areas with rapidly proliferating cells
oral mucosa, GI, bone marrow
causes nausea and vomiting, diarrhea, low WBC
Mastectomy
What is it? surgical procedure to remove a breast
When recovering from procedure, elevate arm to heart level! crucial to reduce fluid
retention and prevent lymphedema, encourage hand and arm exercises, no trauma to
arm (BP cuff)

39
 Adult Health:
Immunity
Sjorgrens Syndrome
What is it? A chronic autoimmune disorder where moisture producing glands are
attacked by WBC causing dry mouth, eyes, vagina, skin, throat
S/S: dry skin, rash, chronic dry cough, vaginal dryness
Treatment: treating symptoms, sugarless gum, regular dental appointments, lube for
sex, lukewarm water and mild soap when showering, avoid decongestants and oral
irritants (caffeine, alcohol,nicotine)
Scleroderma
What is it? overproduction of collagen causing tightening and hardening of
skin/connective tissue
Complications: renal crisis, malignant hypertension- watch out for abrupt HTN and
headache, causes Raynaud's, pulmonary fibrosis (scarred lung tissue), heartburn and
dysphagia
Systemic Lupus Erythemathosus (SLE)
What is it? The bodies immune system produces autoantibodes that attack the body’s
tissue and cells, causes flares and remission
S/S: butterfly rash on face- usually related to sun exposure, oral ulcers, can affect skin,
muscle, joints to kidneys, heart, lungs, blood vessels and CNS, chest pain on
inspiration, photosensitivity, pancytopenia
Complications:
Lupus nephritis- inflammation of kidneys because of vascular inflammation
watch BUN, Cr and abnormal urinalysis
Pleural Effusion- inflammation of pleural tissue causes buildup of fluid between
visceral and parietal pleura
watch for dyspnea, diminished breath sounds
Vasculitis and presence of procoagulant antibodies in blood increases risk for DVT
greatly- must watch for signs
Treatment: NSAIDS (give at night for joint relief next day), Prednisone for short term
symptoms, Hydroxychloroquine- antimalarial agent that reduces immune activity
without inducing immunosuppression, ROM after waking up
Teach: Hydroxychloroquine causes retinal toxicity- see eye doctor 2x year, reduce
stress bc will cause flare up, limit sun exposure, avoid large crowds, must be symptom
free for 6 mo before getting pregnant, routinely screen urine for proteins to watch for
KI, watch stool for blood bc NSAIDS, it is safe to get inactivated vaccines (influenza IM)

40
Anaphylactic Shock
What is it? systemic IgE mediated hypersensitivity allergic reaction
S/S: urticaria, hypotension, SOB; and if not treated, circulatory failure, laryngeal
edema, severe bronchoconstriction
Drug caused anaphylaxis treatment: stop the infusion, call for help, IM epinephrine,
asses airway and give O2, Iv fluids
General treatment: call for help (1st action), maintain airway and breathing, IM
epinephrine, elevate legs, IV fluids, bronchodilator (albuterol), antihistamine,
corticosteroids (methylprednisolone)
Tuberculosis
What is it? Infectious disease primarily affecting the lungs
Active Tuberculosis: positive Tuberculin skin test, has symptoms- cough, fever,
malaise, anorexia, fatigue
Airborne precautions
Latent Tuberculosis: positive TST test, negative chest x ray, asymptomatic, negative
sputum smear
Cannot transmit disease to others
Latent can become active from malignancy, immunosuppressive meds, chronic
diseases, corticosteroids
HIV
What is it? Disease that attacks the CD4 cells causing immune impairment
Transmitted via blood, sex, shared needles, mother to child
PrEP- preventative strategy where antiretroviral therapy given to people who are high
risk : Emtricitabine/Tenofovir very common
Acute phase- flu like symptoms, rash and GI issues, CD4 count doesn't go down yet,
HIV testing may be negative
Treatment: Antiretroviral therapy- decreases viral load and increases CD4 counts,
early initiation is good, this should be continued even through pregnancy, treatment is
lifelong- you cannot stop taking these meds
Rheumatoid Arthritis
What is it? chronic autoimmune disease that causes inflammation and damage to
synovial joints
S/S: progressive fibrosis of joints resulting in stiffness in the morning and deformities
Treatment: immunosuppressants are taken to improve long term joint function:
Methotrexate usually, NSAIDS and glucocorticoids (Prednisone) are also given

41
Osteoarthritis
What is it? degradation of cartilage of joints that worsens over time- usually due to
aging, overuse, excess weight or trauma
Treatment: weight control, muscle building, NSAIDS
Fibromyalgia
What is it? widespread burning painful sensation of muscles associated with fatigue
and sleep issues, abnormal pain processing by the brain
Treatment: Tricyclic antidepressants (amitriptyline)
Immune Thrombocytopenic Purpura (ITP)
What is it? Immune system attacks and destroys platelets causing low platelet count
and increased risk for bleeding
Teach: soft bristle toothbrush, nonalcoholic mouthwash, low impact activity, non skid
footwear, stool softeners to prevent straining, electric razors, avoid NSAIDS

42
 Adult Health:
Infectious Disease
Post Surgical Infections
Pneumonia: cough, tachypnea, SOB, atelectasis (alveolar collapse) prevents clearing
of secretions so patient gets pneumonia
Surgical site infection: redness, warmth, purulent drainage
UTIs
Peritonitis- rebound tenderness, abdominal rigidity, abd distension
Impetigo
What is it? super contagious skin infection from Staph
Occurs often in young kids and hot weather
S/S: itchy red blister lesion that burst and forms yellow brown crust
Hepatitis A
What is it? highly infectious liver infection causing inflammation caused by HepA
Fecal oral transmission, standard precautions
S/S: fever, nausea, RUQ pain, jaundice, dark urine, pale stools,
Encourage pts to get Hep A vaccine!
Especially homosexual men
Hepatitis B
What is it? highly infectious liver infection causing inflammation caused by HepB
Transmission through blood, semen and vaginal fluids
S/S: jaundice, weight loss, clay stool, thrombocytopenia in late stages
Intervention: alternate rest and activity, avoid alcohol or acetaminophen, watch out
for meds, low fat small frequent meals, lots of water
Herpes Simplex
What is it? common viral infection causing sores
S/S: cold sores, genital sores, primary infection comes with fever, malaise and
lymphadenopathy
Acyclovir, Famciclovir, Valacyclovir used to treat herpes infection
No cure, just symptom treatment
Teach: Lesions should be kept dry and clean, no bandages, during active lesions no
sex, use gloves when applying meds to lesions

43
Herpes Zoster (Shingles)
What is it? acute viral infection after chickenpox, it presents with immune system is
weaker
S/S: fever, malaise, tingling and burning pain, small erythematous macules forming
into vesicular lesions in linear pattern form yellow brown crusts
If reactivated in trigeminal ganglion then usually affects the eye part of cranial nerve
V, which causes vesicular rash to be around the eye, this can cause corneal scarring
and blindness
Intervention: airborne precautions, antiviral meds (-clovir), analgesic meds, eye doc
Complications: bell's palsy, postherpetic neuralgia (pain lasting longer than 3 mo after
healing)- neuropathic pain like tingling or burning triggered by light touch- may take
years to go away
Influenza
What is it? contagious respiratory illness
S/S: fever, chills, muscle aches. headache, cough, sore throat, nasal congestion,
malaise
Intervention: Oseltamivir is given to pts with symptom onset within last 48-72 hours to
reduce duration
Teach: annual vaccination, droplet precaution, wear a mask when leaving room,
incubation period 1-4 days with symptoms lasting up to 7 days, stay alone for about a
week
Lyme Disease
What is it? bacterial infection spread from the bite of an infected tick
Initially patient gets flu like symptoms and a bullseye rash
Intervention: antibiotics
Complications: carditis, chronic arthritis, meningitis, facial paralysis
West Nile Virus
What is it? mosquito borne disease, usually in hot humid weather
Teach: use mosquito spray, long sleeves and light colors
S/S: fever, headache, body aches, vomiting, diarrhea, rash
No treatment
Urinary Tract Infection
What is it? infection often caused by E. Coli
bladder infection (cystitis)
most common, burning with peeing, frequency and urgency
can lead to a kidney infection
kidney infection (pyelonephritis)
flank pain, NV, fever

44
Tuberculosis (TB)
What is it? highly contagious bacterial respiratory infection caused by M, tuberculosis
Risk factors: working in health care facility, immunosuppression, homelessness
Intervention: multidrug therapy- Isoniazid, Rifampin
Rifampin- reduces effectiveness of oral contraceptives for 1 month even after drugs,
turns body fluids orange
Directly Observed Therapy
created by WHO to prevent reinfection with TB bc no one is compliant due to time of
drug therapy (6mo), nurse watches client swallow each medication for at least two
months
Diagnosing TB
Interferon Y release assay- blood draw used to diagnose latent TB, cannot differentiate
latent from active
3 Sterile Sputum Culture- gold standard for diagnosing active TB, takes 3-8 weeks
Smear Microscopy- can determine active or latent, not the most accurate
Mantoux test or PPD test
Screens for TB, forearm injected, patient returns in 48-72 hours and site assessed for
induration,
>15 mm is considered positive in general population- doesn't mean active! just
means you have an immune response to it
in high risk pts (immunosuppressed) , >5 mm is considered positive
in moderate risk (healthcare employees), >10 mm is positive
redness with no induration is negative
If positive results, chest x rays and symptoms determine if active
Latent TB
Asymptomatic, no transmission, only induration, everything else negative, just positive
Mantoux test but negative xray results
Just standard precaution
Antibiotics given to prevent progression to active - Rifamycin daily for 4 months
Active TB
Cough, fever, SOB, chills, malaise, weight loss, night sweats, anorexia, fatigue,
transmission, purulent or blood tinged sputum
Positive Mantoux test, abnormal chest x ray, positive sputum smear
Airborne precautions but is spread by droplet, must wear N95s
Intervention: multiple chest x rays, long term antibiotics, 3 sputum cultures at timed
intervals, blood specimen to determine baseline liver function because TB antibiotics are
hepatotoxic
Rheumatic Fever
What is it? acute inflammatory disease of heart, complication that happens 2-3 weeks after
strep, delayed autoimmune reaction
S/S: joint pain, carditis, nodules, erythema, fever, arthralgia, elevated ESR, prolonged PR
interval
45
Infective Endocarditis
What is it? infection of the endocardium and heart valves
Infectious organism sneaks inside heart and forms vegetation on heart valves
Dental work increases risk for this! must get antibiotics anytime they are getting
dental work
S/S: fever, erythematous lesions on hands and feet bc of microemboli, splinter
hemorrhages, new or worsening cardiac murmurs due to growths , flu like
symptoms
Increased risk for emboli!
Intervention: IV antibiotics in central cath bc long term meds, echocardiography,
blood sample to identify pathogen
Septic Shock
What is it? widespread infection causing low blood pressure that can lead to organ
failure
S/S: fever or hypothermia, HOTN, tachycardia, prolonged cap refill, increased WBC,
decreased urine output
Treatment: aggressive antibiotics and IV fluids
Bacterial Meningitis
What is it? infection of the membranes surrounding brain and spinal cord
S/S: headache, neck stiffness, nausea and vomiting, photophobia, fever, altered
mental status, hugely at risk for seizures
Intervention: droplet precautions, reduced stimulus, bed rest with HOB 10-30 to
reduce ICP, seizure precautions
HIV
What is it? a virus that attacks the immune system that eventually leads to AIDS
Acute: flu like symptoms, lymphadenopathy, maculopapular rash
Teach: Use condoms in every sexual encounter if HIV positive, they are super at risk
for infection so don't eat any undercooked meats or eggs, get flu shot every year, only
good bottled water, no changing litter boxes!
Histoplasmosis
What is it? opportunistic fungal infection occurring in clients with compromised
immunity
Usually spreads from soil containing bird or bat dropping
S/S: asymptomatic or pneumonia like symptoms, if frequent exposure may develop
chronic pulmonary infection
STIs
Factors increasing risk: <25 years old, multiple partners, previous STIs, drug abuse, no
sexual barrier use
Common S/S: erythematous pharynx (oral), LQ abdominal pain, dysuria, changes in
urinary frequency, green discharge, bleeding after sex
46
Syphilis
What is it? bacterial infection spread often through sex
Primary stage: chancre - painless genital ulcer
Secondary stage: systemic symptoms (fever, malaise), diffuse rash, lymphadenopathy, oral
lesions, hepatitis, condyloma latum (gray genital papules)- highly contagious
Latent: asymptomatic
Tertiary: if left untreated can cause formation of destructive systemic lesions effecting the
central nervous system, heart blood vessels and more
Treatment: get a pregnancy test, give penicillin IM, notify public health department
Chlamydia
What is it? common STI
S/S: urethritis- urinary pain and frequency, bleeding during sex, vaginal discharge, rectal or
oral pain (if infection is in anus or mouth)
Treatment: antibiotics
if left untreated, can cause pelvic inflammatory disease (PID)
Gonorrhea
What is it? STI that infects the cervix and urethra
S/S: large amounts of yellow green discharge, bleeding during sex, pain when peeing
Complications -PID, bacteria infects upper genital tract
can causes infertility, ectopic pregnancy
treat PID: antibiotics, report infection to WHO
Disseminated gonococcal infection is where it infects blood and causes septic arthritis
Intervention: evaluating effectiveness of treatment within 72 hours of starting antibiotics are
crucial because gonorrhea becomes super resistant to antibiotics- if symptoms not improving
then gotta change it up fast
Trichomoniasis
What is it? most common STI
S/S: thin frothy yellow green discharge, vulvovaginal erythema, inflammation, pruritus, pain
and bleeding during sex, urethritis
Treatment: antibiotics
Jarisch Herxheimer Reaction
What is it? systemic inflammatory response to antibiotic therapy- rapid lysis of large amount
of bacteria cause release of intracellular components in blood which trigger immune
response
S/S: fever, myalgia, sweating, rigors, HOTN, rash even worse than before, lasts 12-24 hours
Occurs after treatment of syphilis
C. Difficile
What is it? bacteria that causes widespread inflammation of the colon and severe diarrhea
S/S: profuse watery diarrhea, abd pain and cramping, fever, nausea
Intervention: contact precaution, antibiotics, watch electrolytes, watch for abd distension-
this could mean toxic megacolon, watch for hypovolemia and elevated BUN
47
 Adult Health:
Integumentary

Tinea Corporis (Ringworm)

What is it? fungal infection causing scaly pruritic patch in a circle
Transmitted from person to person or animal, highly contagious
Treated with antifungals
Psoriasis
What is it? autoimmune disorder affecting the skin
S/S: silver plaques on reddened skin
Intervention: moisturizers, corticosteroids, avoidance of triggers (stress, alcohol), UV
light exposure actually improves psoriasis! get in the sun!
Skin Cancer
Risk factors: family hx, lots of moles, immunosuppressive meds, outdoor occupation,
aging
Look for asymmetry, border irregularity, color changes and variation, diameter of 6
mm or larger, evolving
purulent drainage is not consistent with cancer- thats infection
Burns
LR is solution of choice for acute burns to prevent hypovolemia
Intervention: IV analgesics, Tetanus shot, insert Foley bc strict IOs, debride wounds,
blood specimen for carboxyhemoglobin levels, enteral nutrition
Complications: compartment syndrome, hypovolemic shock, malnutrition, respiratory
failure, sepsis
Signs of burn sepsis: enteral feeding intolerance (paralytic ileus bc stomach not
being perfused), tachycardia, tachypnea, hyperglycemia, HOTN, fever or
hypothermia
Emergent phase: (24-72hrs) cause massive fluid shifts, cells all dead and release fluids,
Hyperkalemia!! patient will have muscle weakness, peaked T waves, arrhythmias, H&H
will be high, hyponatremia
Rehabilitation phase- wounds have fully healed, lasts about 12 mo
use lotion and massage, pressure garments, ROM, avoid direct sun for at least 3 mo
and lots of sunscreen!

48
Toxic Epidermal Necrosis (TEN)
What is it? rare, severe skin reaction causing blistering often caused by medications
S/S: starts with flu like symptoms, then rash then lesions then epidermal shedding
Severe form of Stevens Johnson Syndrome- causes sepsis!
Intervention: sterile wound care, reverse isolation, fluids and nutrition, hypothermia
prevention, pain management, eye care- eye lube bc eyes get really dry
Pressure Ulcers
Stage 1- erythema
Stage 2- shallow open wound, red or pink
Stage 3 - subcutaneous fat may be visible
Stage 4- muscle or bone is visible
Unstageable- eschar in the way

49
 Adult Health:
Musculoskeletal

Ankylosing Spondylitis
What is it? inflammation of the spine
Teach: spine stretching exercises, proper posture, stop smoking, moist heat and
NSAIDS for pain, take anti inflammatory and immunosuppressants, rest during flare up
and sleep on firm mattress
Compartment Syndrome
What is it? Pain caused by decreased blood flood to distal tissue
S/S: pain, numbness, absent pulse, pallor, coolness!!, swelling, decreased movement,
cyanosis
coolness and pallor is where it differs from DVT
Intervention: assess vascular status asap and remove dressing, position extremity at
level of the heart
Can cause Volkman’s contracture- deformity of wrist, making the hand have a claw like
appearance
Osteomalacia
What is it? vitamin d deficiency causing weak soft bones that fracture easily
Teach: mobility devices, light to moderate activity, increase diet of calcium (leafy
greens and dairy), phosphorus (milk,organ meat, nuts, fish, poultry, egg yolks),
vitaminD (cereal, egg yolks, saltwater fish and liver) and sunshine, OTC vitamin D
Skeletal Traction
What is it? used to stabilize fractures and breaks, uses wires and pins
Bucks traction treats the lower leg with weights and straps
never sit them up more than 30 degrees, elevated leg may be a littler cooler than
the other but not worrisome
Assess neurovascular very often and skin integrity, lay only in straight supine position,
no side to side repositioning
Weight must be freely hanging, never resting on anything, elevating FOB 15 degrees is
good
Severe pain is not good! means that traction is not working properly or compartment
syndrome
Improperly maintained traction can caused severe pain, bone malpositioning, and
muscle spasms 50
Complications: atelectasis, compartment syndrome, constipation, DVT, osteomyelitis
Carpal Tunnel
What is it? caused by nerve compression
Treat with wrist immobilization splint especially at night
Mandibular Fracture
Maintain patent airway!!
Ensure that there are wire cutters by the bed, jaw may be wired shut and patient may
require suction
Hip Fracture
S/S: one leg shorter, rotated externally, can't bear any weight, bruising on hip, muscle
spasms in area, groin pain,
Complications: pneumonia, hemorrhage, neurovascular impairment, avascular
necrosis, VTE
Canes
The cane goes on stronger side, elbow flexed around 30 degrees, cane goes in front
and side of strong side, move weaker leg forward after cane, then stronger leg, (cane,
weak, strong) , cane should be length from greater trochanter to floor
Knee Arthroplasty (Replacement)
Fully weight bearing by the time they are leaving, around day 5
Knee immobilizer is used to maintain extension for about 4 weeks, anti DVT drugs
given 2 weeks after
Long Bone Fracture
What is it? fracture of humerus, radius, ulna, femur, tibia or fibula
Increased risk for fat emboli, can travel to the brain or lungs or kidneys-- this is not a
DVT!
S/S: confusion and restlessness, hypoxemia, petechiae on neck and chest, neuro
changes, respiratory distress
Minimize movement of limb ASAP
Osteoporosis
What is it? rate of bone breakdown exceeds bone formation resulting in porous fragile
bones
Often get compression fractures in spine, loss of height, musculoskeletal fractures,
kyphosis
Risk factors: age, postmenopausal, low body weight <18.5, white/asian, smoking,
alcohol, sedentary lifestyle, hyperthyroidism, liver or renal disease, female, steroids,
vitamin D or calcium deficiency, estrogen deficiency, family hx
Intervention: vitamin D supplement, Biphosphonate (Alendronate), calcium carbonate
Biphosphonate- allows bone mineralization to occur more quickly, take with a full
glass of water empty stomach and stay upright for 30-60 min after, don't take with
calcium supplement! these drugs cause esophageal issues if taken wrong
51
Osteoarthritis
What is it? degenerative disorder of synovial joints, causes erosion of cartilage in
joints, bone spurs develop, gets worse over time and throughout day, joint deformity
S/S: pain made worse by exercises, crepitus (grating noise with movement), morning
stiffness, decreased joint mobility, atrophy of muscles
Hip Arthroplasty (Replacement)
Teach: avoid hip flexion >90 degrees, isometric exercises 2-3x a day, use toilet riser
Amputation
Teach: above the knee amputations- no elevation bc causes contractures in the hip!
just lay prone for 30 min 3-4x a day and use compression bandages to decrease
edema
Scoliosis
Teach: wear a cotton tshirt under the brace, the brace does not cure! it just keeps it
from progressing, can be removed for bathing and exercise
Shoulder Dislocation
This can become an emergency because the bone may compress vasculature and
cause ischemia- signs are pins and needles in limb
Rhabdomyolysis
What is it? after muscle injury, myoglobin are released in blood and can cause AKI
Cause: injury, heat, stroke, prolonged muscle exertion
Intervention: rapid IV fluid resuscitation to flush out myoglobin
S/S: dark bloody urine, fatigue, oliguria
Fiber Glass Cast
Avoid getting wet, elevate extremity above heart level for first 48 hours, ROM, report
foul odors or hot areas which may mean infection
External Fixation Device
What is it? frame used to stabilize fractures
Intervention: clean pin sites with sterile solution, keep vest clean and dry (blow dryer
on cool), use foam inserts to prevent ulcers, small pillow under client's head, keep
correct size wrench available at all times in case of emergency
Don't mess with pins and avoid touching the device frame
They can walk with these on! they aren't on bed rest!

52
 Adult Health:
Neuro

Wernickes Encephalopathy
What is it? neurological condition caused by B-1 (thiamine) deficiency
Complication of chronic alcohol abuse, malnutrition, surgery, head injuries
give thiamine alcoholics to prevent
S/S: confusion, vision problems, lack of muscle coordination, low blood pressure
Intervention: B1 tablets or infusion
Facial Nerves
Olfactory (I): sense of smell
Optic (II): Carries visual information from the eyes to the brain.
Oculomotor (III): Controls eye movements and pupil dilation.
Trochlear (IV): helps with eye movements.
Trigeminal (V): sensation in the face and jaw, and controls chewing muscles.
Abducens (VI): Controls lateral eye movements.
Facial (VII): taste, facial expressions, and tear production.
Vestibulocochlear (VIII): hearing and balance.
Glossopharyngeal (IX): taste, swallowing, and the gag reflex.
Vagus (X): motor control of the heart, lungs, and digestive system, and sensory
information from the throat and internal organs.
Accessory (XI): head and neck movements.
Hypoglossal (XII): tongue movements.
Lobes of the Brain
Parietal: somatic and sensory input- sensations
Frontal: high order processing- executive function and personality
Temporal: visual and auditory input- verbal and written language
Occipital: visual images- vision

53
Stroke
What is it? lack of blood flow in the brain, either hemorrhagic or ischemic
S/S: facial drooping, arm weakness, speech difficulties, time to call (FAST)
Get CT scan ASAP or MRI to see if hemorrhagic , standardized stroke assessment,
always check BG bc sometimes hypoglycemia can mimic stroke symptoms
Intervention: tPA and alteplase - given 4.5 hours from onset of symptoms
Hemorrhagic Stroke
What is it? ruptured blood vessel in brain
May cause seizures due to ICP
Intervention: reduce stimulation, stool softeners, bed rest, head in midline, frequent
neuro checks, NPO till can swallow again
Ischemic Stroke
What is it? loss of brain tissue perfusion due to blockage in blood flow
Causes permissive HTN- bodies compensatory reaction to maintain blood flow in
brain, usually corrects itself in 24-48 hours
Intervention: get EKG, fall precautions, frequent neuro checks, give tPA, SCDs to lower
extremities to prevent more DVT
Afib increases risk for thrombus formation is L atrium which can cause stroke- they
may require long term anticoagulant meds
tPA
What is it? clot dissolving medication used in ischemic strokes or heart attacks
Must be given within 4.5 hours of symptom onset
Contraindicated: recent surgery within 2 weeks, BP > 185/110, already on
anticoagulants
Closely watch for any bleeding, brain bleed is possible so watch for any change in
LOC, projectile vomiting or severe HT
Aphasia
What is it? impaired communication,
Receptive (wernicke's) aphasia- impaired comprehension of speech and writing
Expressive (broca )aphasia- impaired speech and writing
Apraxia
What is it? loss of ability to perform a learned movement
Dysarthria
What is it? weakness of muscles used for speech

54
Supraglottic Swallow
What is it? swallowing technique to prevent food from entering the airway
patients with effected cranial nerve IX, altered ability to swallow and taste, are taught
to use this
Ruptured Cerebral Aneurysm
What is it? area of blood vessel in brain that is ballooned out and eventually bursts
Usually asymptomatic until ruptured, onset is usually worst headache ever felt,
excruciating
Substance Overdose
Priority is treating CNS depression- promote adequate ventilation and oxygenation -
ABCs
Respiratory depression- treat with Naloxone which quickly reverses depressant
effects of opioids
Meningitis
What is it? inflammation of meninges
S/S: fever, headache, NV, nuchal rigidity, ICP
Epilepsy
What is it? chronic seizures, require lifelong anticonvulsants
Avoid triggers- alcohol, sleep deprivation, stress
Phenytoin- common anti seizure drug
must use non hormonal birth control and not get pregnant
med cannot be stopped abruptly! no anticonvulsants can
Lamotrigine- epilepsy med that can be taken by pregnant women
Status Epilepticus
What is it? seize for 5 min or longer, grunting and dazed appearance
Intervention: give IV or rectal benzodiazepine
Can results in brain damage or death
Seizures
Prodromal phase- warning signs preceding a seizure
Aural phase - visual and sensory changes
Ictal phase - active seizure
Postictal phase- confusion, recovering from seizure
Electroencephalography - diagnostic tool used for seizures
ICP (Increased Cranial Pressure)
What is it? increase of pressure inside the skull, can be due to fluid or swelling
S/S: Cushing's triad: bradycardia, widening pulse pressure, cheyne strokes respirations
(periods of apnea and rapid breathing)
Keep HOB 30 degrees
55
Concussion
S/S: brief period of confusion, headache, retrograde amnesia- if more than this, then
more severe brain injury!
Teach: abstain from alcohol, have responsible adult stay with you and watch for
change in LOC, vision changes, motor problems, seizures, NV
Epidural Hematoma
What is it? collection of blood that forms between the skull and the dura mater
Usually pts head gets hit, they lose consciousness and wake up just fine! then after a
little bit they decline and coma
Guillain Barre Syndrome
What is it? autoimmune disorder that attacks the peripheral nervous system
Patient usually recovers in 4-6 months but have some chronic neuro issues
Often triggered from infection or vaccination
Complications: pneumonia, pressure sores, respiratory failure, DVT
S/S: abdominal distension from constipation, labile BP, decreased RR, difficulty
swallowing, urinary retention
Intervention: IV immunoglobulin
Myasthenia Gravis
What is it? chronic autoimmune disorder affecting the neuromuscular junction causing
muscle weakness
Infection, under medication and stress (deficiency in anti cholinesterase) can cause a
myasthenic crisis- respiratory failure!
to prevent: eating easily chewed foods to avoid aspiration, get flu shot, take meds
before meals to you can chew and swallow easier
S/S: visual changes, slurred speech, dysphagia and respiratory depression ( no sensory
or motor neurons)
Intervention: anticholinerase inhibitors
Pyridostigmine is common option
Multiple Sclerosis
What is it? autoimmune disorder affecting brain and spinal cord due to the breakdown
of myelin sheath,
often in young woman
S/S: eye pain and burning, electric shock sensation in neck, extreme fatigue, gets
worse in heat, numbness and paresthesia, motor issues, bowel/bladder issues, muscle
weakness, spasms
Intervention: corticosteroids
Tonic Clonic Seizures
What to do? Call for help, turn Patient to side, prepare for suctioning after seizure

56
Parkinsons Disease
What is it? neurological disorder affecting movement and coordination
S/S: delay in movement (bradykinesia) and rigidity, resting tremor and shuffling gait,
often affects speech so encourage them to speak slowly and take breaks, make sure
food is cut into bite sized pieces bc they often choke on their food
Don't encourage naps throughout the day! they have insomnia so naps make that
worse
Huntingtons Disease
What is it? dominant genetic disease causing progressive nerve degeneration
S/S: onset 30-50 years old, impaired movement, swallowing, speech and cognitive
abilities
Botulism
What is it? toxin that attacks the nervous system
Causes descending muscle paralysis
Main source is improperly canned food- watch for a bulging end of can
Babies can get this from honey
ALS (Amyotrophic Lateral Sclerosis)
What is it? neurodegenerative disease
S/S: muscle weakness, twitching and muscle spasms, issues swallowing, speaking and
respiratory failure, most only survive 3-5 years
Transsphenoidal Hypophysectomy
What is it? removal of pituitary gland through incision in the nose
Complications: diabetes insipidus (insatiable thirst)
S/S: polydipsia, polyuria, hypernatremia, elevated serum osmolality, decreased urine
specific gravity, hypovolemia

57
 Adult Health:
Reproductive Organs

Priapism
What is it? sustained painful erection for longer than 2 hours, often associated with
sickle cell anemia
Causes: spinal cord injury, meds, drugs
Monitor urine output and look for color changes!
If penis turns blue then ischemia
Selective Estrogen Receptor Modulator
What is it? Clomiphene- treats infertility by stimulating ovulation
Take 5 days early in period and then ovulation occurs 5-9 days after completing med,
Teach: try to have sex often 5 days after completing medication!
this drug also increases chances of having twins or triplets
S/S: mood swings, nausea, hot flashes, headaches
Vasectomy
What is it? male sterilization
Takes several months for sperm count to be zero so use alternative birth control until
cleared by doc
Pelvic Inflammatory Disease
What is it? infection of fallopian tubes and uterus that can eventually cause infertility
Risk factors:multiple partners, not using contraception, age 15-25, Gonorrhea and
chlamydia both can cause PID
yearly testing for these two STDS are encouraged for all women having sex
Chlamydia
What is it? most common STD,
S/S: can be asymptomatic, should get screened annually
Treatment: azithromycin- abstain from sex 7 days after starting
Breast Cancer
Risk factors: relative hx, mutation of breast cancer 1 or 2 genes, excessive weight in
postmenopausal years, menopausal hormone therapy >5 years, beginning period
super early or late
S/S: enlarged lymph nodes, breast tissue is warm, red, pitting appearance
58
Fibrocystic Breast Changes
What is it? benign breast disorder, correlates to estrogen progesterone fluctuations
during cycle
If breast changes occur non cycle related- call doc!
Ovarian Cancer
S/S: often subtle, abd bloating, pelvic pain or pressure, abd back or leg pain, urinary
urgency
Peri Menopause
What is it? ovarian function declines and estrogen levels decrease
Patient can still get pregnant at this point
S/S: hair loss, vaginal dryness, breast tenderness, weight gain
Treatment: Vitamin D and calcium supplement, avoid spicy foods to decrease
vasomotor symptoms (hot flashes), use lube, estrogen/progesterone therapy, SSRI,
SNRI for vasomotor (fluoxetine and venlafaxine)
if no uterus, can get estrogen therapy
Menopause
What is it? last period was 3 months ago, night sweats, hot flashes, pain during sex,
depression
Post Menopause
Increased risk for osteoporosis and CAD
to prevent osteoporosis make sure you take your calcium and vitamin D,
biphonsphonates- take them correctly!
Watch cholesterol, eat lots of calcium (green leafy vegetables and dairy), exercise,
maybe see a dietician
Human Chorionic Gonadotropin (hCG)
What is it? hormone produced by placenta during pregnancy,
this is what pregnancy tests look for
Oral Contraceptives
What is it? pill taken daily to prevent pregnancy
Back up contraceptive needed for 7 days after starting pill unless pack started right
after period starts
Prostatectomy
What is it? surgery to remove all or part of the prostate gland
Don't use any suppositories or enemas! too much pressure on suture line
Teach: drink lots of fluids, walk a lot, clean catheter

59
Prostatitis
What is it? inflammation of prostate usually from bacterial infection
S/S: fever, pain, urinary hesitancy, urgency
Intervention: ciprofloxacin, ibuprofen, tamsulosin, take stool softeners, sitz baths,
ejaculate often, avoid coffee tea etc.
Infertility
What is it? Inability to conceive after 12 mo <35, or 6 mo >35
Risk factors: endometriosis, older than 35, PCOS, recurrent chlamydial infections, very
low or high BMI
Pap Screen
What is it? test for early detection of cervical dysplasia which may indicate cervical
cancer
HPV causes almost all cases of cervical cancer
Starts age 21 and screened every 3 years till you're 29 whether you have sex or not
Testicular Self Examination
Teach: monthly on same day, in warm shower, use both hands to feel each testical
Cervical Cap
What is it? barrier method of contraception used with spermicide, leave in place for 6
hours or more after sex but not more than 48 hours
Teach: dont use when you're on your period

60
 Adult Health:
Urinary/ Renal

Acute Pyelonephritis
What is it? kidney infection caused by UTI traveling up
S/S: chills, fever, vomiting, flank pain, costovertebral angle tenderness
Intervention: blood and urine cultures and then antibiotic therapy
Urinary Tract Infection
What is it? infection of the bladder, urethra, ureter
S/S: pain during urination, increased urinary frequency, cloudy foul smelling urine
Intervention: urine cultures and then antibiotic therapy
Kidney Labs
BUN and Creatinine (0.6-1.2) are usually measured every 24 hours, rarely every 12,
they don't change quickly
Creatinine clearance test requires 24 hours urine collection, first urine is discarded of
the test
Kidney Biopsy
What is it? small sample of kidney removed to study
Bleeding is major possible complication
discontinue all anticoagulants (heparin, warfarin, rivaroxaban) and antiplatelets
(aspirin, NSAIDS, clopidogrel) for one week prior
Peritoneal Dialysis
What is it? form of dialysis that uses abdominal lining as semipermeable membrane to
filter blood
Catheter placed in peritoneal cavity and dialysis fluid infused, sterile technique when
spiking and attaching bags of dialysate,
drainage bag should always be below abdomen
Insufficient outflow- usually from constipation, assess bowel patterns and give stool
softeners, also check for tubing kinks and reposition to side lying position
Complications: watch for signs of respiratory distress (due to fluid overload); bacterial
peritonitis- infection of peritoneum that can lead to sepsis (cloudy outflow,
tachycardia, fever, pain, NV)
Self administered peritoneal dialysis: sit at 20 degree angle to reduce abdominal
pressure and leakage, wear sterile gloves when accessing catheter, do not microwave
dialysate and do everything else the same 61
Hemodialysis
What is it? filtering blood to remove excess fluid, electrolytes and waste
Pre dialysis: get full set of vitals, pts current weight and pts last dialysis post weight,
palpate fistula for thrill (vibration) and auscultate for bruit (whooshing),
IV heparin is added to the blood after patient connected to machine, vitals taken
often, BP cannot be taken on fistula arm, hold antiHTN meds, often required to
follow special fluid and dietary restrictions
Arteriovenous fistula- surgical connection of artery to vein, it gets huge to sustain two
large bore needles, encouraged to squeeze a rubber ball to assist in blood flow
Monitor for patency, should feel a bruit, don't sleep on that arm
Complication: arterial steal syndrome- vein takes too much arterial blood causing
distal extremity ischemia- pallor, pain, decreased pulses
Complication:
Dialysis Disequilibrium Syndrome
after or during initials session, when dialysate removed causes a concentration
gradient
S/S: NV, headache, restlessness
Hemodialysis induced HOTN
S/S: NV, chest pain
Dialysis increases risk for infection
Do not place immunocompromised patient with dialysis patient
Urge Incontinence
What is it? patient feels sudden strong urge to urinate and cannot hold it
Teach: empty bladder every two hours, lose weight, anticholinergic meds
(oxybutonine, tolterodine), avoid bladder irritants (caffeine, citrus, alcohol, nicotine,
sodas), kegels, bladder training
Overflow Incontinence
What is it? patient is unable to empty bladder when urinating and leaks small amounts
throughout the day
Teach: fixed voiding schedule, valsalva maneuver when peeing, crede maneuver
(pushing on abd), measure postpee volumes, double void (wait 20-30 seconds
between pees)
Potassium
Impaired kidney function increases risk for hyperkalemia bc K is excreted by the
kidneys- too high can cause Vfib and Vtach
Calcium gluconate IV is given to protect the heart from hyperkalemia!
It raises the threshold needed for dysrhythmias- if you see EKG changes, give this
first
IV insulin and dextrose are given to sends K back into cells and then give Furosemide
62
Cytoscopy
What is it? scope inserted to visualize the urinary system
Teach: pink tinged urine, frequency and dysuria expected for up to 48 hrs post, drink
lots of water!
Complications: urinary retention, hemorrhage and infection
Notify doc if any right red blood when urinating, blood clots, can't pee, fever
Percutaneous Nephrolithotripsy
What is it? surgery involving nephroscope inserted into kidney to break up and remove
kidney stone that it too large to treat other ways
Nephrostomy tube placed after to prevent obstruction by stone, you can irrigate it
with sterile NS to maintain potency
Extracorporeal Shock Wave Lithotripsy
What is it? shock waves used to break up kidneys stones and easier to pee out,
Teach: drink lots of fluids, bruising and pain over kidneys is normal, blood in urine, lots
of ambulation
Benign Prostatic Hyperplasia
What is it? enlargement of the prostate
Usually occurs in men older than 50
S/S: urinary urgency, frequency and hesitancy, nocturia and urinary retention
Prostatectomy
What is it? removal of prostate
Up to 36 hours after surgery, small blood clots are normal, but should continue after
that
Let doctor know if you have blood clots after 36 hours, reduced urine stream,
bleeding, retention, fever, dysuria
Ileal Conduit
What is it? incontinent urinary diversion, ureters are connected to ileal conduit to
create stoma

63
Bladder Cancer
S/S: hematuria, pain during urination, lower back pain
Primary cause: cigarette smoking or tobacco use
Urinary Retention
Common after surgeries, should void 6-8 hours post op
Treat post op: ambulate, encourage fluids, straight cath, bladder scan, running water
Pessary
What is it? removable vaginal device that provides support for the bladder that is
replaced every 3-6 months
Recommended for pelvic organ prolapse
increases vaginal discharge
CKD Diet
What is it? diet recommended for patients with CKD because they are at risk for fluid
overload and hyperkalemia
Sodium restriction, potassium restriction (avoid raw carrots, tomatoes, OJ, dairy
products, bananas, coconuts, watermelons, avocados), fluid intake monitoring, low
protein diet, low phosphorus diet (avoid chicken, turkey, diary)
3 Way Foley Catheter
What is it? catheter providing continuous bladder irrigation
Urine should be pink during first 24 hours, clots up to 36 hours after
Nurse can adjusts flow rate till urine is pink with no clots

64
 Adult Health:
Visual/ Auditory

Intraocular Pressure
What is it? pressure of the fluid inside the eye
Oost surgery; keep IOP low, which means no vomiting, coughing, straining, bending at
waist, lifting anything more than 5 lbs
Diabetic Retinopathy
What is it? microvascular damage due to the hyperglycemia
This can cause retinal detachment and blindness if untreated
Retinal Detachment
What is it? light sensitive tissue at the back of the eye separates from the underlying
tissue
S/S: flashes of light, floaters, blackspots, curtain being drawn over eye, can lead to
blindness if not treated
Can be treated! Hurry to the doctor, this is not something to leave untreated
Glaucoma
What is it? compression of the optic nerve
Acute angle closure glaucoma - emergency! IOP increases quickly causing severe pain,
reduced central vision, blurry vision, ocular redness and halos, unilateral headache,
mid dilated pupils (4-6mm) nonreactive to light
due to impaired aqueous humor drainage
Intervention:ophthalmic beta blockers (-lol) to decrease IOP, diuretics to reduce
IOP (mannitol), antiemetic meds, fall precautions, no straining
teach: talk to doctor about OTC meds because can precipitate another ACG attack
Chronic open angle glaucoma- gradual loss of peripheral vision and difficulty adjusting
to lighting
S/S: gradual patchy blind spots in vision, halos of light

65
Cataracts
What is it? cloudy areas in lenses causing blurred vision
S/S: opaque lenses, blurred vision, halos around lights, reduced color clarity
Macular Degeneration
What is it? deterioration of central portion of retina
S/S: you lose the central tunnel of your vision
Meniere Disease
What is it? excess fluid in the inner ear
Episodic attacks- vertigo, tinnitus, hearing loss, usually affects one ear and can lead to
permanent hearing loss,
Teach: low sodium diet, avoid aggravating substances (nicotine, caffeine, alcohol) and
stimuli, fall precautions
Blunt Force Trauma
Can cause retinal detachment- S/S: lightning flashes, floaters, gnats/hairnet/cobweb
effect
Can cause permanent blindness
Hearing Aids
To put on, pull ear up and back
If whistling is heard, turn volume down
Clean hearing aid with soft dry cloth or alcohol wipe

66
 Adult Health:
Critical Care

Reduce ICP
How to: elevate HOB, stool softeners, manage pain and fever, calm environment,
adequate O2, hyperventilate and hyperoxygenate to reduce Co2 which reduces ICP,
do not cluster care
Asystole
What is it? there is no electrical activity in the heart, no pulse
Don’t shock/AED! It will do nothing
Intervention: CPR and breaths and epinephrine
Third Spacing
What is it? fluid is accumulating in spaces it does not usually like body cavities and
tissues
Common 24-72 hrs after abdominal surgery, if urine output starts to decrease- check
vitals! You will see tachycardia and HOTN bc they're hypovolemic- all the fluid is in the
tissue
Neurogenic Shock
What is it? autonomic nervous system is impaired
S/S: low blood pressure, bradycardia, warm and dry, massive vasodilation
Causes: spinal cord injury, brain injury, spinal anesthesia, certain medications
occurs usually T6 or higher
Intervention: isotonic fluids to maintain organ perfusion
Cardiogenic Shock
What is it? heart is unable to pump enough blood for the bodys needs
S/S: elevated pulmonary artery wedge (6-12), low BP, tachycardia, tachypnea,
confusion
Intervention: vasopressors, Inotropes, diuretics if fluid overload
Causes: MI, Heart failure, PE
Hypovolemic Shock
What is it? loss of fluid leading to inadequate blood circulating the vasculature
Positioning: elevate legs, HOB less than 30 to help perfuse vital organs
rapid heart rate, low blood pressure, rapid breathing,

67
Basilar Skull Fracture
What is it? break of the bones at the base of the skull
S/S: CSF in snot or out of ears, dextrose test to check if CSF (blood messes the test
results, needs to be just CSF), bruises raccoon eyes or behind ears (battles sign)
No NG tubes!! you could just go right into brain
Phlebostatic Axis
What is it? 4th intercostal space under armpit, used for continuous BP, CVP
monitoring
Allen’s Test
What is it? checks for patency of radial and ulnar arteries
Pt makes a fist, you occlude ulnar with thumbs till the palm is pale, then release and
hand should go back to pink in 15 seconds (positive), then repeat the test occluding
the radial
If positive, ABG can be drawn
Mechanical Ventilation
You must monitor respiratory status, HOB 30-45 always, use minimum amount of
sedation, pause sedation daily for evaluation of breathing, oral care with chlorhexidine
q2hrs, suctioning prn, watch insertion depth of trach tube to see if placement is good,
always have manual resuscitation bag nearby
A drop in oxygenation could mean improper tube placement, first thing you wanna do
is listen to the lungs
Low tidal alarm- low volume of air being delivered maybe from disconnection or leak
If O2 starts dropping then you need to manually ventilate with bag valve mask
connected to tube--- nonrebreather doesn't work because it is not connected to
ventilation tube
Positive End Expiratory Pressure (PEEP)
What is it? the positive pressure in the airway that remains even after an exhale, used
during mechanical ventilation to keep the alveoli open
High pressure prevents airway collapse, but if levels are too high (normal levels are 5-
8) then can cause barotrauma resulting in pneumothorax and eventually hypotension
Positive Pressure Ventiliation (PPV)
What is it? ventilation that pushes air into the lungs
Can be through tracheostomy or mask, usually given to people with respiratory failure
The pressure compresses the thoracic vessels which leads to reduced CO which
causes HOTN- so watch BP!

68
Deceberate Posture
What is it? a sign of severe brain damage
Legs straight out, toes pointed down and head arched back
Extubation
What is it? removal of endotracheal tube
Super high risk for aspiration, kept NPO, high fowler, warmed humidified oxygen given,
oral care, cough deep breathe and use ICS
Gastric Lavage
What is it? pumping out the contents of the stomach
This can cause some complications- perforation or aspiration
Only done with certain things like consumption of lithium and alcohol poisoning
Intubation and suction supplies should always be available at bedside during GL
Frostbite
Intervention: remove clothing and jewelry, do not massage or rub tissue, put affected
tissue in warm bath, lots of pain meds bc super painful;, elevate after warming to
prevent edema, apply loose non sticky sterile dressings and watch for compartment
syndrome
Therapeutic Hypothermia
What is it? the patient is cooled to 89-93 F for 24 hours to reduce damage from
various life threatening circumstances
Great for patients who have cardiac, are comatose and do not follow commands, if
done within 6 hours of arrest, this lowers mortality rate
Closely watch cardiac monitor and all vitals for 24 hours then slowly rewarm
Malignant Hyperthermia
What is it? inherited disorder that causes a reaction to anesthetic medications
S/S: hypercapnia, muscle rigidity, hyperthermia, tachypnea, tachycardia, rigid jaw
Intervention: IV Dantrolene
Drowning
Intervention: mechanically ventilate, rewarm, and give warm fluids and watch for
cardiac issues
Blunt Head Force
Intervention: assess for carotid pulse and airway (DON'T do the head tilt chin lift
maneuver bc moves neck, just jaw thrust), place rigid cervical collar, backboard,
perform GCS

69
 Adult Health:
Maternity

Antepartum
Constipation
Often caused by progesterone levels and iron supplementation
Treat: moderate intensity exercise, high fiber foods, drink 2-3L of water
Stimulant laxatives should not be taken during pregnancy, only stool softeners or bulk
laxatives
Syphilis
STI that crosses placenta, everyone is screened at initial prenatal visit and screened
again 3rd trimester
Treatment: prenatal IM Penicillin, if allergic to penicillin then initiate penicillin
desensitization
Manifestations
Primary- Painless genital ulcer (chancre)
Secondary- Diffuse rash (palms & soles), lymphadenopathy (epitrochlear),
condyloma latum, oral lesions, hepatitis
Latent- asymptomatic
Tertiary- CNS (dementia), aortic aneurysm
Signs of Pregnancy
Positive: fetal heartbeat felt, fetal movement felt by health care provider, visualization
of fetus by ultrasound
Presumptive: self reported by client: amenorrhea etc.
Probably: pregnancy test
Pregnancy and Travels
Avoid anywhere with Zika outbreak!
This is spread by mosquitoes and sex and causes microcephaly and encephalitis
Lab Values while Pregnant
Hemoglobin and hematocrit decrease
if super low then will supplement with iron
WBC increases
Naegele Rule 70
Estimated date of birth= (first day of period +7)- 3 months
Preconception Care
400 mg folic acid at least 3 mo before conceiving, regular dental care, updated
vaccines, no alcohol or smoking, normal BMI, check for rubella immunity
give rubella vaccine if they don't have it and then wait 4 weeks to start trying again
Eat fortified grains with folic acid to prevent NTD,
First Trimester
Weeks 1 -14
At 10-12 weeks, fetal heart rate can be felt
Urinary frequency, fatigue, nausea, breast tenderness, mood swings, heart burn
Second Trimester
Weeks 14-27
After week 20, fundal height correlates with number of weeks pregnant
Quickening starts around weeks 16-20, should be gaining around 1 lb a week,
Increase iron rich food intake and iron supplement
Ultrasound around 18-20 weeks
Screening for gestational diabetes happens at the end of this trimester
Glucose Challenge test- drink glucose solution and get blood 1 hr later, does not
require fasting, less than 140 is passing, if results are higher then do 2 or 3 hr
glucose test which require fasting and more blood
Third Trimester
Weeks 28-40
Expect shortness of breath, false contractions
Tdap vaccine given in 3rd trimester because it gives baby passive immunity
Vaccines
Pregnant woman cannot get live vaccines!
Recommended: Tdap, inactivated influenza, Rho(D) immunoglobulin
Indicated for high risk patients: Hepatitis B, Hepatitis B, Pneumococcus, Haemophilus
influenzae, meningococcus, varicella zoster immunoglobulin
Contraindicated: HPV, MMIR, live influenza

Nitrazine pH test
What is it? tests to see if patients water broke
Yellowish or green result means negative
Blue result it positive
Blood or semen results in false positive
Ectopic Pregnancy
What is it? fertilized egg in fallopian tube that can rupture causing hemorrhage
S/S: should pain, severe abdominal pain, HOTN, tachycardia
71
GTPAL
What is it? acronym used to record obstetric history
Gravida - number of times been pregnant
Term - delivered 37 weeks and beyond
Preterm- from wk 20-27
Abortion- pregnancies ending before wk 20
Living
Cervical Cerclage
What is it? placed to prevent preterm delivery, mostly for women with history of
preterm
Cervix is stitched up around 12-23 wks, removed weeks 36-37
Patient is placed on activity restriction and watched for signs of labor!- low back
aches, contractions, pelvic pressure
Teratogenic Medications
What is it? medications that cannot be taken while pregnant!
Ace Inhibitors (-pril)
ARBs (-sartan)
Pica
What is it? compulsive craving for non edible items- chalk, dirt
Usually means iron deficiency anemia
Check hemoglobin and hematocrit levels
Placenta Previa
What is it? placenta implants too low and blocks the opening of the cervix
Blood flow disruption happens during growing of baby and labor which can cause
hemorrhage
If no active bleeding, patient can go home and closely monitored, C section is planned,
modified bed rest, extra ultrasound done around 36 weeks to see where placenta is
Often these patients come in with painless vaginal bleeding after 20 wks- they are very
high risk for hemorrhage!
Placenta Abruption
What is it? the placenta separates from the uterine wall, causes hemorrhage
S/S: abdominal and back pain, uterine contractions, uterine rigidity, dark red vagina
bleeding
if severe, patient will be taken to emergency C- section
Spontaneous Abortion
What is it? miscarriage before 20 wks
Avoid sex for 2 weeks, report any bad smells or pain or lots of bleeding, continue
prenatal vitamins, no baths!
RhoGAM indicated for all Rh negative clients even if miscarriage
Recommend support groups and communication- don't suggest trying again yet! It is 72
too soon.
Morning Sickness
1st trimester, can happen at any point of day
Treat: eat dry high carb and low fat protein, many small meals throughout day, drink
cold drinks between meals, ginger, eat foods with vitamin B6 (nuts, seeds, legumes)
Preeclampsia
What is it? HT and proteinuria after 20th week, delivery is only cure
monitor BP at home, report any changes, monitor fetal kick counts, anticipate
labor induction at 37 weeks
Severe features: very high BP, thrombocytopenia, increased creatinine, pulmonary
edema and visual issues- get baby out at 34 weeks
Magnesium sulfate is given as depressant to prevent seizure activity
watch vitals, I and O, and any signs of Mg toxicity, therapeutic level is 4-7 to
prevent seizures, assess DTR hourly, ensure calcium gluconate available, no bright
lights, O2 ready, limit stimulations to prevent seizing
HELLP- hemolysis, elevated liver enzymes, low platelet: form of preeclampsia usually
in 3rd trimester-- emergency!!! get the baby out now!
S/S: NV, malaise, RUQ pain or epigastric pain
Fetal Tachycardia
What is it? >160 bpm
Causes: maternal fever, infection, dehydration, fetal anemia and maternal
hyperthyroidism
you need fetal monitoring
Herpes Simplex
This is deadly for babies! Mother should start acyclovir asap!
Vaginal birth is not recommended in presence of active lesions
Acyclovir usually prescribed at 36 weeks to prevent outbreak before labor
Oligohydramnios
What is it? baby did not produce enough amniotic fluid
S/S: cord compression, decreased fundal height, irregular tummy contour,
Complications: pulmonary hypoplasia in baby, umbilical cord compressed
there will be extra people in room to help baby in delivery
Molar Pregnancy
What is it? egg is fertilized and grows abnormally
Most of the pregnancies are benign but they can develop into type of
choriocarcinoma
The hCG hormones are too high so it is super important to not get pregnant for 6-12
mo after evacuation, hCG watched closely to ensure it didn't turn into cancer
Treat: uterine evacuation,
Interhepatic Cholastasis of Pregnancy
What is it? liver disorder that causes a build up of bile acids in the blood
73
S/S; itching of hands and feet but no rash
Treat: watch baby closely, medication and labor induction at 37 weeks
Hyperemesis Gravidarum
What is it? persistent nausea and vomiting causing weight loss, fluid imbalance and
deficiencies
S/S: ketonuria (bc body breaking down fat for energy), increased urine gravity
Preterm Birth
What is it? birth before 37 wks
risk: hx of preterm birth, cervical surgeries, tobacco, drug use, any kind of infection,
black woman, malnourished, under 17 or over 35 years old
Toxoplasmosis
What is it? infection from feces,
Often comes from gardening or not washing your vegetables and fruits
This can kill your baby!
Supine Hypotension
What is it? the enlarged uterus compresses the vena cava causing hypotension and
fetal distress
Intervention: lay the patient on her left side
General Changes During Pregnancy
Bleeding gums when brushing teeth, BP decreases slightly in beginning, occasional
headaches are normal
Avoid eating: unpasteurized milk products, unwashed fruits and veg, deli meat, hot
dogs, raw fish/meat, fish high in mercury (shark, swordfish, mackerel)
No amount of alcohol during pregnancy is safe! can cause miscarriage, preterm birth,
low birth weight and fetal alcohol syndrome
Antepartum Bleeding
Normal : small amount of blood, pain with contractions
Placental abruption: sudden bleeding, pain, tender uterus, frequent contractions
Placenta previa: painless vagina bleeding
Uterine rupture: sudden bleeding, constant pain, no more contractions, you cant find
fetal station and fetus is VERY unwell

74
Labor and Delivery
Preterm Labor
What is it? birth before 34 weeks
Intervention: administer IM glucocorticoids to stimulate fetal lung maturation
(betamethasone), administer antibiotics (penicillin) to prevent any infections, IV
Magnesium sulfate for fetal neuroprotection
If less than 32 weeks old, give tocolytic med (nifedipine, indomethacin) to suppress uterine
activity so that steroids can kick in
Epidural Block
What is it? numbs the lower half of the body
Inhibits the SNS and causes peripheral vasodilation- may cause HOTN- check BP regularly
IV fluid bolus and left lateral position
Variable Deceleration
What is it? caused by umbilical cord compression
Treat with amnioinfusion- transvaginal infusion of isotonic fluids through intrauterine
pressure catheter to compensate for low amniotic fluid
Uterine overdistension- complication due to infusing too much fluid
if baseline uterine resting tone is elevated (>20) and minimal absent fluid return
then pause the infusion and call doc!

Late Deceleration
What is it? this happens when fetal oxygenation is compromised
Stop oxytocin asap, reposition client, give O2, IV fluid bolus

Sinusoidal Fetal Heart Rate

75
DIC in Pregnancy
What is it? widespread clotting throughout the body
Pregnant women with placental abruption or intrauterine fetal demise are super high
risk for DIC
For these patients, it is super important to get baseline lab tests of coagulation
factors, fibrinogen and complete blood count with platelets before labor so it's easy
to assess for signs of DIC
Opioids During Labor
Drugs given are Butorphanol Tartrate and Nalbuphine Hydrochloride
these can cause maternal sedation and nausea, crosses placenta and peaks in 30-
60 min, if given too close to birth may cause fetal respiratory depression
Give these drugs during peak of contractions because it can decrease sedation effects
of fetus
Best patient would be a nullipara 6 cm dilation with regular contractions
Best to give at least 2-4 hours before birth but still in active labor
Pudenal Nerve Block
What is it? local anesthetic (lidocaine) into areas around pudendal nerve
Least side effects of all the blocks, doesn't do anything to contraction pain but
relieves perineal pressure and good for forcep birth or laceration repair
Umbilical Cord Prolapse
What is it? The umbilical cord comes out before the baby
Causes fetal HR deceleration, fetal bradycardia, low fetal O2
Intervention: Get patient on elbows and knees asap or trendelenburg
Amniotomy
What is it? doctor breaks the amniotic sac to induce labor
There is a risk for umbilical cord prolapse so watch fetal HR
Increased risk for infection so monitor patients temp
Uterine Atony
What is it? uterus fails to contract and stop the bleeding leading excessive blood loss
and clots
After birth, uterus should be firmly contracted, midline and slightly below or at
umbilicus
Intervention: fundal massage which stimulate contraction- if this works then monitor
every 15 min/ if doesnt work then give oxytocin
Leopold Maneuver
What is it? determines fetal position, palpitations and helps determine where to put
the fetal heart monitor
Cephalic Presenting 76
What is it? the head is the first part of the baby to exit the mother, this is the preferred
way
Breeching
What is it? The babies feet or legs come out first
Fetal Occiput Posterior
What is it? malposition, baby facing moms posterior
causes back pain "back labor"
helps to apply counterpressure to clients sacrum during contractions
Bishop Score
What is it? measure readiness for labor
6-8 means induction of labor will be successful, 10 means super ready
Anencephaly
What is it? severe birth defect causing neural tube defect and missing brain tissue
These babies usually go into comfort care straight from birth
Uterine Rupture
Client trying vaginal birth after having a previous c-section have an increased risk of
this, scar bursts open inside them
S/S: abnormal fetal heart rate, constant abd pain, sudden stop of contractions,
hemorrhage, hypovolemic shock
Uterine Tachysystole
What is it? >5 contractions in 10 min
Decrease oxytocin infusion!!
Oxytocin
What is it? uterine drug promotes uterine contractions, we want contraction every 2-3
minutes
Delivered through secondary line with IV fluid NS usually in primary,
Forcep/ Vacuum Birth
What is it? the doctor applies blades to side of baby's head and locks handles in place,
applies traction to forceps during contractions to help rotation and descent of fetal
head
During 2nd phase (pushing phase) if mother has contraindications to pushing
Never apply pressure to fundus during this! may cause rupture!
Placenta Accreta
What is it? placenta implant directly in myometrium- adheres too deep into uterus
Super high risk for hemorrhage
During birth- make sure blood is ready!!
Shoulder Dystocia
What is it? the fetal head comes out but is stuck at the shoulders! head retracts
backwards
Occurs more often in moms with gestational diabetes 77
Perform McRoberts maneuver and apply suprapubic pressure
Baby
1 hr post Birth
Baby glucose levels low and will stabilize 2-3 hours later (>40 is normal) optimal is 70-100
later on
RR is 30-60 and irregular, shallow, diaphragm
Milia (white papules) on nose and chin
Poorly Controlled Maternal Diabetes
Fetus usually will have hyperglycemia so produces too much insulin and then the body
increases O2 consumption which increases RBC production (polycythemia)-- this is bad
because clots and stroke!
Hypoglycemia
If under 45 and asymptomatic- feed the baby!
Symptomatic (poor feeding, jittery)- IV glucose
Cleft Palate
What is it? birth defect causing an opening in the roof of the mouth
Can't create a suction and will easily aspirate
Feed in upright position, tilt bottle so nipple always filled, point down and away from cleft,
use special bottles, burp them more often, feed slowly 20-30 min at a time, more frequent
feedings
Post op- pain management, upright supine position, use elbow restraints to prevent them
from touching the site
General Newborn Information
Decreased muscle tone, single line on palm- Down Syndrome
Sacral dimple- spina bifida occulta
Single umbilical artery- usually has 2 and a vein
Girl infants often have swollen labia and discharge
Lanugo- fine hair, disappears around wk 32
Newborns vomit a lot, sometimes out of their nose, can be bloody too- only emergency is if
it's green!
Watch for respiratory distress- nasal flaring, chest wall retractions, grunting, crackles are
okay for the first couple hours but no longer
Check for jaundice on forehead or nose
Desquamation is peeling of skin- normal
During the first 3-4 days of life, baby loses 5-6% of body weight but then returns by 14 days,
anything more than 7% means look into it!
Babies who are large for gestational age are higher risk for becoming hypoglycemic- watch
the BG, and also can get birthing injuries
Hepatitis B- prevent maternal to newborn transmission during birth by giving baby Hepatitis
B vaccine and immune globulin within 12 hours of birth, they are still good to breastfeed!
In first 48 hours of life, 2-6 wet diapers is normal
Candida Albicans 78
What is it? oral candidiasis
Babies can get it too, white patches on tongue and palate, have a hard time feeding
Hydrocephalus
What is it? buildup of CSF
S/S: large fontanelles, widened sutures and head circumference >90% on growth
chart, if head > 0.8 inches larger than chest then call doc!
Neonatal Resuscitation
Assessed every 3 seconds, positive pressure ventilation (PPV) is started if heart rate
<100/min, compression started if HR stays <60/min after at least 30 seconds of PPV
Resuscitating a newborn- sniffing position- small blanket under shoulders, neck very
slightly back- not hyperextended because that cuts off airway too
Post Term Baby
Born at >42 weeks
Deep plantar creases, dry cracked skin, a lot of hair and long nails, minimal to absent
vernix
Imperforate Anus
What is it? birth defect blocking the anus that prevents normal stool passage
No meconium passed by 48 hours then call doc
This rule applies to all babies
Vitamin K
Newborns are vitamin K deficient
Increases risk for bleeding
IM vitamin K given at birth
Gastroschisis and Omphalocele
What is it? Omphalocele is when bowel herniates through abdominal wall via umbilical
opening and has a protective sac, Gastroschisis- comes out of abdominal wall but with
no sac
Intervention: cover the bowel with a non adherent dressing, sterile and soaked,
monitor for temp, infection, fluid loss and get IV access, keep NPO bc surgery
Necrotizing Enterocolitis
What is it? bacteria gets into bowels and gets congested and gas collects bc of
underdeveloped GI systems, usually occurs with premies
Interventions: measure abdominal girth daily, NPO and NG suction
Take temp but not rectal bc risk of bowel friction, keep them supine un-diapered
Hirschsprung Disease
What is it? congenital disease that prevents colon from contracting and moving stool
S/S: vomiting, abdominal distension, failure to pass meconium, can't relax sphincter,
no peristalsis

79
Postpartum

Pregnancy is a hypercoagulable state.

watch for signs of PE and DVT
preventing DVT: early and frequent ambulation, leg exercises, SCDs
Postpartum Endometriosis
What is it? endometrium (uterine lining) becomes infected after birth
S/S: uterine tenderness, foul smelling and purulent lochia, fever, tachy, chill, fever
Interventions: Aminoglycosides, antibiotics, antipyretics, fluids
Complications: abscess and peritonitis
Rh Alloimmunization
What is it? condition where pregnant patient with Rh- blood type is exposed to Rh+ fetal rbcs,
after exposure the moms body produces antibodies that will cause serious issues next
pregnancies
This is also called Rh Incompatibility
Rh Immune Globulin (RhoGAM
What is it? medication given postpartum who are Rh negative to prevent Rh antibodies
from developing
This is effective only if client has never developed the antibodies
Verify that client is not Rh sensitized by checking indirect Coombs test
Should be administered within 72 hours of birth to ensure effectiveness
If newborn is Rh negative, RhoGAM is not needed postpartum
Postpartum Urinary Retention
S/S: bladder distension, displaced and boggy uterus, palpable bladder
If client unable to ambulate, hasn't voided in 6-8 hrs and cant empty bladder then
monitor I&O with catheter
Postpartum Distended Bladder
S/S: boggy fundus, uterine atony, bladder is elevated above the umbilicus and
deviated to the right
This prevents the uterus from contracting sufficiently to control the bleeding after
giving birth
If pt is postpartum hemorrhaging with distended bladder symptoms, then they
need to pee!
Breastfeeding
every 2-3 hours, position tummy to tummy, ensure proper latch, feed 15-20 min per
breast, insert finger in gum to break latch
When patient wants to to stop breastfeeding, supportive bra, NSAIDS and ice packs on
80
breasts are recommended
Mastitis
What is it? inadequate milk duct drainage, bacteria enters the nipple and grow in
stagnant milk
Interventions: antibiotics, continue breastfeeding, warm compresses, give analgesics
(acetaminophen, ibuprofen), wash hands before and after feeding
S/S: breast pain, swelling, redness, nipple discharge,fever
Postpartum Hemorrhage
What is it? mother bleeding out after birth
Risk factors: more than 5 births, prolonged labor, use of oxytocin or Mg sulfate during
labor, hemorrhage in prior birth, big baby over 8 lbs, uterine fatigue, super fast labor
(less than 3 hrs)
S/S: perineal pad saturated in less than or equal to an hour
Can be due to uterine atony which means overdistension of uterus
Treat: Methylergonovine (methergine)- causes vasoconstriction for hemorrhage but
cant give if pt has HTN or preeclampsia,
Vaginal Hematoma
What is it? from trauma to the tissue of the perineum that occurs during delivery
More likely to occur with forcep or vacuum assisted birth or episiotomy
S/S: severe vaginal pain or feeling fullness, firm uterus in midline
Sex After Giving Birth
Patient can resume once bleeding and lacerations are healed, vaginal dryness may be
an issue especially if breastfeeding, feed newborn before sex
Postpartum Blues
What is it? very common feelings of sadness a few days after birth that usually goes
away within two weeks
Postpartum Depression
What is it? mental health condition after pregnancy
S/S: crying, irritability, can't sleep, anxiety, guilt, extreme sadness
Usually occurs within 4 weeks of delivery and lasts longer than the blues
Postpartum Psychosis
What is it? onset of psychotic symptoms post pregnancy
S/S: hallucinations, delusions, mood swings, paranoia
Cervical Lacerations
What is it? tear in the cervix during delivery causing significant blood loss
S/S: fundus firm and midline, increased bleeding
Inversion of Uterus
What is it? uterus turns inside out and the fundus protrudes from the cervix
81
Lochia Rubra
What is it? bleeding from birth to 3/4 days postpartum
Dark or bright red blood, occasional clots, decreasing in quantity
Lochia Serosa
What is it? bleeding from day 4 to 10/11 day,
Pink serosanguineous, brownish
If the patient is day 4 and still reporting heavy period bleeding, this is bad!
Lochia Alba
What is it? fluids from 11 days-6 weeks
White yellow discharge
Eclampsia
What is it? a combination of preecamplsia and seizures that occur while the mother is
pregnant or shortly after birth
S/S: HTN, proteinuria, bad headaches, visual issues, RUQ pain, seizures, edema

82
 Child Health

Cardiovascular
Kawasaki Disease
What is it? systemic inflammation of arterial walls
Acute phase: high fever not responding to anything, rash, strawberry tongue,
conjunctivitis
Subacute: skin peel on palms and soles
Convalescent: symptoms go away
Interventions: administer aspirin to help vasculitis, IV immunoglobulin (pulls fluid into
vasculature) , prepare for echocardiography to see if any damage
Ventricular Septal Defect (VSD)
What is it? a hole in the wall between left and right ventricles
Risk for CHF and pulmonary HTN
Watch for signs of CHF: diaphoresis, tachypnea, dyspnea, grunting when feeding,
increased respiratory exertion
Tetralogy of Fallot
What is it? VSD, pulmonic stenosis, overarching aorta, right ventricular hypertrophy
S/S: hypoxemia made worse with exertion (feeding), systolic ejection murmur, heart
failure, failure to thrive, infective endocarditis, thromboembolic events- increased
viscosity of blood increase this risk
infective endocarditis is complication of ventricular defect bc of high velocity
shunting of blood, injured cardiac tissue
Hypercyanotic episodes (Tet spells)- too much unoxygenated blood goes through
circulation
S/S: rapid deep breathing and cyanosis on lips and tongue
Teach: dont wake them up when asleep, small frequent feedings, very calm
environment, offer comfort as soon as baby cries- basically try to avoid them
crying or any stress
place in the knee chest position to relieve cyanosis
Complications: heart failure (diaphoresis, decreased output, fluid overload - edema),
poor weight gain, cool and pale extremities

83
General Baby Cardiac Information
Infant pulse- <1 yr old, palpate brachial artery by placing 2/3 fingers halfway between
shoulder and elbow
Infant CPR: <1 yr old, check brachial pulse for 12 seconds, if by yourself- perform CPR
for 2 min before getting AED, use two fingers or two thumbs just below sternum, 30:2
compression to breath ratio
If two rescuers then do 15:2 ratio, compress 1/3 chest diameter at 100-120 rate
SVT is most common childhood arrhythmia- rapid HR of 200-300, first do vagal
maneuvers-- if ineffective, try adenosine or synchronized cardioversion
Coarctation of Aorta
What is it? narrowing of aorta resulting in decreased CO2
Shows high pulse pressure in upper extremities and diminished pressure in lower
extremities
Patent Ductus Arteriosus
What is it? congenital heart defect where a vessel connecting the aorta to the
pulmonary artery remains open
Usually resolves itself in 48 hours
Makes a machine sound murmur
Heart Defects
Left to Right Acyanotic Heart Defect: blood flows from left side of the heart to the
right side due a deformity
S/S: pulmonary congestion, tachypnea, tachycardia, diaphoresis during exertion,
heart murmur, CHF, poor weight gain
Right to Left cyanotic HD: blood flows from right to left (bypassing the lungs) so there
is not enough oxygenated blood in the body
S/S: chronic hypoxia, clubbing of fingers
Endocrine
DM1 (Type 1 Diabetes)
S/S: polyuria, nocturnal enuresis, polydipsia, dry mucous membranes, weight loss,
fatigue, irritable
Teach: track carb intake, rotate insulin injections, wear med bracelet, show injections
on a doll first, store unopened insulin in fridge then when open you can leave them
out
Congenital Hypothyroidism
What is it? abnormal development of thyroid gland causing decreased secretion of
thyroid hormone
S/S: lethargy, dry skin, hoarse cry, constipation, bradycardia
Treat: levothyroxine
84
Musculoskeletal
Juvenile Idiopathic Arthritis (Juvenile Rheumatoid Arthritis)
What is it? RA in children under the age of 16
Child has a risk for becoming deconditioned, tire quickly, encourage low impact,
weight bearing - yoga, cycling, swimming
Developmental Dysplasia of the Hip
What is it? the hip joint socket did not develop properly
Pavlik Harness- nonsurgical correction must be done within 6 mo of birth, maintains
infants hips slightly flexed and abducted, worn for 3-5 months, straps assessed by doc
every week and changed by doc- parents shouldn't touch straps! leave harness on at
all times, lightly massage skin under straps, no lotions, shirt and knee socks to protect
skin
Infants, S/S: extra inguinal or thigh fold, laxity of hip joint
Older than 2-3 mo S/S: limited hip abduction, limp, walking on toes, pelvic tilt
Make sure baby swaddled with legs bent and abducted to prevent DDH
Osteomyelitis
What is it? bone infection, causes bone necrosis or sepsis
S/S: fever, pain, erythema, swelling
Treat: blood culture and sensitivity and antibiotics
Duchenne Muscular Dystrophy
What is it? childhood form of muscular dystrophy, x linked recessive (carried by
females given to males),
No cure, usually pass away by 30 years old, onset 2-5 yo, lower extremity weakness,
important to eliminate clutter on floors to prevent falls, encouraged to take part in
gentle exercises likes swimming
S/S: Gower sign- using hands to push on thighs to stand up), enlarged calves, tiptoe
walking, frequent tripping and falling
Osteogenesis Imperfecta
What is it? brittle bone disease, impaired collagen, frequent fractures
Be very careful when moving, touching, taking blood pressure
Dental Avulsion
What is it? an adult tooth gets knocked out
Clean it with sterile water and reinsert it back into the socket and go see a dentist
Clubfoot
What is it? feet have developed to turn inward

85
Neuro
Hydrocephalus
What is it? increased ICP from obstruction of cerebrospinal fluid
S/S: bulging fontanelle, increase head circumference, sunset eyes (sclera visible above
iris)
Complications: hearing loss, learning disabilities, brain damage
Treat: ventriculoperitoneal shunt: placed 3-4 mo old
Can get blocked and cause increased ICP
S/S: bradycardia, vomiting, headaches, vision changes, mental status changes
Cushing's triad (late signs)- systolic HTN with widened pulse pressure,
bradycardia, respiratory depression
Febrile Seizures
What is it? seizures in 6 mo- 6 yo stemming from high temperature
Interventions at home: use acetaminophen and ibuprofen (>6mo) to reduce fever, cool
damp compresses to head, if seizure longer than 5 min then call 911
Interventions if seizing in hospital: turn client to side, ensure rails are padded, provide
oxygen and suction prn, nothing in mouth or restraining
Bacterial Meningitis
What is it? inflammation of meninges
S/S: fever, seizures, high pitched cry, poor feeding and vomiting, nuchal rigidity,
bulging fontanelle
Complication: hydrocephalus
Myelomeningocele
What is it? a birth defect where the spinal cord and the meninges never close fully
Interventions: cover area with sterile, moist dressing, prone position, risk for infection,
get ready for surgery
Auditory/ Visual
Acute Otitis Media
What is it? middle ear infection
S/S: pulling at ear, red and bulging tympanic membrane, restless, refusal to eat
Treat with antibiotics, if not better in 2-3 days then go back to doc, avoid
decongestants, and always finish meds!
To prevent: reduce exposure to tobacco, no bottle while lying down or pacifier
Otitis externa- swimmer's ear
Retinoblastoma
What is it? retinal tumor
S/S: white glow of pupil with no red reflex, usually under 2 yo, strabismus
Treat: radiation, or removal of eye (enucleation) 86
Strabismus
What is it? ocular misalignment, lazy eye
Intervention: patch the good eye and force bad eye to work
General Information
Snellen chart is used for kids 6 and over to test vision, they must stand 10 ft away
Hearing impairment- child may seem withdrawn, inattentive, monotone speech, very
loud,
Respiratory
Cystic Fibrosis
What is it? genetic disorder causing the body to produce thick secretions and have
issues with absorption of nutrients
Pulmonary issues- chronic hypoxemia, no pancreatic enzymes so malabsorption of
vitamins and nutritional deficiencies, infertility
Chest physiotherapy- percussion or HFCWO vest- may cause nausea or vomiting so
avoid food 1 hr before and 2 hrs after
Exacerbation: hypoxia, respiratory distress, signs of pulmonary infection, blood tinged
sputum, greasy bulky stool, paroxysmal cough, fever
treat: give antibiotics for infection, chest physio, bronchodilator, administer
nebulized hypertonic saline to loosen thick mucus
Teach: regular exercise, annual flu vaccine, lifelong vitamins, pancrelipase capsules
can be sprinkled on food if they can't be swallowed whole, high protein calorie fat diet,
can't chew capsules!!
Pulse Oximeter Pleth
What is it? shows the pulse wave, helps to assess perfusion levels on pulse ox
Normal should have a regular wave formation, if low perfusion, then more of a wavy
straight line, but if there is no pattern- check to make sure that the pulse ox is on the
right way
Tonsillectomy
What is it? surgery to remove the tonsils
Post op bleeding is the priority concern- watch for frequent swallowing, vomiting
blood
Normal to have fever, ear and throat pain and halitosis (bad breath) for 5-10 days post
op.
Can cause trismus- inability to open mouth due to tonic contraction of muscles which
means there may be an abscess which can occlude the airway
Bronchiolitis
What is it? viral infection of the bronchioles caused by RSV
Nasal saline drops and bulb suctions are encouraged to remove secretions for babies
87
Asthma Exacerbation
What is it? hyperreactive airway and chronic airway inflammation
S/S: tripod positioning, intercostal retractions, expiratory wheezing, tachypnea,
Complications: respiratory acidosis
Treat: corticosteroids, nebulizers (albuterol), anticholinergics (ipratropium bromide),
give O2, pulse ox, high fowlers
If wheezing stops "silent chest" very bad! no air moving!
Epiglottitis
What is it? infection of the epiglottis
S/S: high grade fever, lethargic, severe sore throat, dysphonia (muffled voice),
dysphagia, drooling and respiratory distress
Usually caused by HiB (droplet), which kids should be getting that vaccine during 2
and 4 mo visits
Treat: endotracheal intubation with tracheostomy kit standing by in case airway
already closed
RSV
What is it? respiratory tract infection
Contact precautions, commonly causes bronchiolitis and respiratory distress
S/S: fever, cough, tachypnea, rhinorrhea, adventitious lung sounds
Treat: give O2, IV fluids
Increased risk for otitis media, cough may continue for weeks after virus gone,
symptoms most severe days 3-6
General Information
Can't give infants <6 mo ibuprofen! acetaminophen can be given for fever reduction
Any child under 12 years old needs to use a spacer for their inhaler
When living with a tracheostomy tube, very important you care two spare tubes, one
same size and one smaller incase tube gets dislodged

Renal
Postinfectious Glomerulonephritis
What is it? excessive Na and water retention which causes HTN and edema
S/S: edema, HTN, decreased output, dark cola urine and untreated sore throat blood
and protein in urinalysis, increased BUN and Cr
Complications: hypertensive encephalopathy, pulmonary edema, permanent kidney
damage, cerebral edema
Interventions: daily weights, fluid and salt restriction, loop diuretics, low sodium foods
Teach: watch for any changes in vision due to HTN, dark urine and output, hematuria
may persist for months after its resolved, avoid anyone with upper respiratory
infection
Hypospadias
What is it? urethral opening is on underside of penis 88
Surgery fixes it with foreskin and stent placed while healing
Urinary output must be monitored
Wilms Tumor
What is it? kidney tumor in a child less than 5 years old
DO NOT PALPATE ABDOMEN! can cause tumor to burst
Hemolytic Uremic Syndrome
What is it? complication of E. Coli diarrhea,
Can cause RBC hemolysis, low platelets and AKI
S/S: petechiae, purpura, pallor, low urine output
Nephrotic Syndrome
What is it? kidney disorder causing excessive loss of protein in the urine
4 class signs: massive proteinuria, hypoalbuminemia, edema, hyperlipidemia
In kids ages 2-7, there is a huge loss of albumin in urine- their body retains sodium and
water
S/S: edema, weight gain, loss of appetite, decreased urine output
Teach: infection prevention, corticosteroids, low salt diet, test urine daily for protein,
fluid restriction
Integumentary
Pediculosis Capitis
What is it? Lice
Teach: use hot water to wash all sheets and clothing, things that can't be washed can
be sealed in bag for 14 days to kill lice
Impetigo
What is it? highly infectious skin infection caused by staph. or strep.
Decrease transmission by keeps clients nails short, keep their laundry separate, avoid
close contact with others for 24-48 hours after antibiotics start, impetigo should be
covered to avoid spread
Can be caused by Strep so watch for Acute poststreptococcal glomerulonephritis
Tinea Capitis
What is it? Ringworm on head
Treat: 1% selenium sulfide shampoo, antifungal meds (griseofulvin) they take for weeks
to months- take with high fat foods
Atopic Dermatitis
What is it? Eczema
S/S: pruritus, erythema and dry skin
Treatment goal is to alleviate itching and keep skin hydrated

89
Infectious Disease
Infectious Mononucleosis
What is it? viral infection from sharing drinks or kissing
S/S: fatigue, fever, sore throat, splenomegaly, hepatomegaly, swollen lymph nodes
Treat: hydration, rest and pain control
MMR Vaccine
After the first dose, some kids have fever, rash and swelling
If fever is high- need to give antifebrile med to prevent febrile seizures
Given 12-15 mo, but if baby exposed to measles, then give it early bc if given 72 hours
within exposure it may prevent spread
Live vaccine! Don't give to immunocompromised
UTI
Very common in little girls!
Teach them not to hold their urine in and no bubble baths
Botulism
What is it? food poisoning after eating contaminated foods, often raw honey or milk
S/S: constipation, difficulty feeding, no head control and diminished DTR- eventually
leads to respiratory failure and arrest
Pinworm Infection
What is it? Pinworms living in the stomach from eating contaminated foods
The pinworms leave the anus and lay eggs causing intense itching
Pertussis
What is it? whooping cough
Very contagious!
S/S: at first like a common cold but then violent cough often causing puking and huge
amounts of phlegm
Treat: humidified O2, fluids, vaccination, antibiotics
Fifth Disease
What is it? viral illness
S/S: rash on face that spreads, general malaise and joint pain
Treat: give ibuprofen, usually fine in 7-10 days, once symptoms appear they are not
contagious anymore
Reye Syndrome
What is it? rare condition that develops from viral infection and/or aspirin use
S/S: fever, acute encephalopathy, altered hepatic function, vomiting, confusion
Usually happens after viral infection, aspirin increases the risks of this
Scarlet Fever
What is it? infectious disease 90
S/S: red rash neck and chest and spread- looks like sunburn feels like sandpaper and
sore throat
Scabies
What is it? very contagious skin infestation by mites, spread skin to skin
S/S: intense itching and papules
Treat: scabicide cream to all surfaces except eyes, avoid all close contact for 30-60
day period, wash everything with hot water
Rotavirus
What is it? very contagious virus causing diarrhea
Leading cause of diarrhea in children under 5, spread fecal oral route, watch for any
signs of dehydration
S/S: watery stinky diarrhea lasting 5-7 days, fever, vomiting
Encourage meticulous hand washing
Varicella (Chickenpox)
What is it? highly contagious viral infection
Begins as rash then turns into weeping lesions then crusts over, fever
Treat: cool oatmeal baths, topical antihistamines, acetaminophen
Infectious till lesions crust over
Immunocompromised kids should not get Varicella vaccine bc its live and also if they
get varicella they need strong antiviral agents (acyclovir)
Strep Throat
Teach: give cold liquids and soft food, replace toothbrush 24 hrs after starting
antibiotics and go back to school
No throat drops for kids! This is a choking hazard!
Measles
What is it? viral infection, easy to prevent, very serious for children
S/S: conjunctivitis, snotty, coughing, koplik spots, red rash everywhere
Super contagious, airborne- N95 and negative air pressure room
Teach: everyone in family should get MMR vaccine
Treat: give vitamin A to prevent vitamin A deficiency which can cause blindness

GI/ Nutrition
Hirschsprung Disease
What is it? congenital birth defect causing distal intestinal obstruction
S/S: distended abdomen, don't pass meconium within 48 hours, can't feed, vomit
green bile
Complication: enterocolitis which can lead to sepsis
S/S: fever, lethargy, explosive stinky diarrhea and abdominal distension getting
worse and worse

91
Pyloric Stenosis
What is it? lower part of the stomach becomes narrowed preventing food from being
passed
S/S: projectile vomit, very hungry, poor weight gain, dehydrated (which causes
hematocrit to be elevated), olive shaped mass in RUQ
Infant Anemia
Iron deficiency causes decrease in Hgb causing anemia
Preterm babies run out of iron stores by 2-3 mo and require iron supplementation-
they save up their iron while in uterus- if come out early then they dont have alot
stored up
Causes: delayed introduction to solid food, consumption of cow's milk before 1 yo,
excessive cows milk intake (over 24 oz)
Intussusception
What is it? intestine prolapses into other part of intestine, common in infancy
S/S: abdominal pain, super bloody jelly poop, palpable sausage mass, screaming and
drawing up of knees
Air enema used for diagnosis and treats it a little too- if bowel movements are normal
after enema then no surgery needed!
Complications: peritonitis: infection of abdomen, fever, rigid, guarding and rebound
tenderness
Dental Cavities
Avoid sweet sticky foods like candy, dried fruit and sodas, brush teeth after meal ,
floss 2x a day, rinse mouth out with water after eating, drink tap water, eat dairy and
sugar free gum-its prevents cavities,
Don't let kids have bottles of milk in bed with them at night!
Infant Formula
Wash the tops of formula cans, refrigerate any unused formula (opened but not in
bottle) for only 24 hrs, then throw it away
If its leftovers in bottle after feeding, throw excess away
Never warm in microwave
Physiologic Anorexia
Toddlers eat a lot less because they are way pickier, it may seem like they aren't eating
enough but they are usually fine if growth is good
Teach: set and enforce schedule, offer choices, no forcing, portions small, avoid tv or
games while eating
Water Intoxication
What is it? hyponatremia in infants bc formula has been watered down
S/S: irritability, lethargy, hypothermia, seizures
PKU
What is it? phenylalanine enzyme deficiency 92
Low phenylalanine diet- no meat, eggs, milk/ special formula for infants
Lead Poisoning
Wash hands before eating to wash off lead residue! cold tap water should be used,
floors mopped weekly
Affects neurological system- mild: hyperactivity, impulsiveness// prolonged:
developmental delays, reading issues, visual motor issues/// severe: permanent
cognitive issues, seizures, blindness, death
Immunity
IV Immunoglobin (IVIG)
Live vaccines should be delayed for 11 mo after getting IVIG bc mildly
immunocompromised
Live Vaccines: Polio (oral), MMR, Rotavirus, Yellow Fever, Varicella
Hemophilia
To give vaccinations: SubQ, smallest needle, apply pressure for 5 min after- no
rubbing!
Bonus: If fever after vaccines is greater than 100.4 and lasts 1-2 days then call doc!
Growth and Development
Marfan Syndrome
What is it? genetic disorder effecting connective tissue
S/S: very tall and thin with super long arms legs and fingers, abnormalities with aorta,
aneurysms, dissection, scoliosis, ocular issues
Teach: avoid contact and competitive sports because their heart can't handle it
Infant Assessment Order
Observe anything, auscultation, palpate and percuss, traumatic procedures (anything
with moving baby around like checking pupils or mouth), then moro reflex
Growth Hormone Replacement Therapy
What is it? given if child isn't growing due to deficiency
Starts early in child life, stopped around 16 yo, they'll still usually be smaller
Given via subq injections
Play
Infants- solitary
Toddlers- parallel, next to each other
Preschool- associative play, similar activities but play is unorganized- kinda almost
playing together
School age- specific goal to game with rules

93
Prep-Op Teaching
Toddler- teach simply right before procedure
School age- concrete explanation
Adolescents- talk about thoughts and feelings
Growth
Weight should double by 6 mo and triple by 12 mo
Toddler- by 30 mo, 4x greater than birth weight
Chest circumference exceeds tummy by age 2
Gross Motor Skills
18 mo- walk up stairs with help, turn 2 pages in a book at a time, can use a spoon
24 mo- call self by name, stack 6 blocks, open doorknobs, draws lines, kicks a ball
Fetal Alcohol Syndrome
What is it? occurs when a women consumes alcohol during her pregnancy
S/S: intellectual disability, growth deficiency, microcephaly, indistinct philtrum, thin
upper lip, flat face, short eyes
Sudden Infant Death Syndrome
What is it? death before 1 yo, usually while sleeping
To prevent, ensure baby sleeps on back on hard surface with no loose items, smoke
free home and breastfeed and keep up to date on vaccinations
Shaken Baby Syndrome
What is it? occurs when an infant is shaken causing brain injury
Causes head injury, bleeding in brain and eyes- vomiting, irritability, lethargy, seizures,
nonstop crying, dyspnea, won't eat
Marfan Syndrome
What is it? genetic disorder effecting connective tissue
S/S: very t
Separation Anxiety
Toddlers , 10 mo - 3 yo
Interventions: adhere to home routine, give favorite toy, quiet environment, give
familiar object (moms tshirt) while stressed
Fine Motor Skills
3 mo- grasp something put in hand
5 mo- voluntarily grasp
7 mo- transfer from hand to hand
8-10 mo- basic pincer grasp
11 mo- neat pincer grasp- finger and thumb
General
Child is ready for potty training when they can follow commands and communicate
94
Children walkers are very dangerous! Never encourage use!
 Leadership &
Management
Ethics and Legality
Informed Consent
Consent is required for any nonemergency procedure
If they find something mid surgery that wasn't discussed prior, then call the patients
POA or guardian to provide consent
Fidelity
What is it? fulfilling commitments made and taking responsibilities for your actions
Nonmaleficence
What is it? do no harm, protect patients who can protect themselves
Autonomy
What is it? freedom for clients to make decisions themselves
Veracity
What is it? duty to tell the truth
Good Samaritan Law
What is it? prevents any civil action against nurses who help injured people outside of
work, this doesn’t apply to you if you receive payment from the person or if you do
something a reasonable, prudent nurse would never do
For example, if person is bleeding out and you do CPR instead of occluding artery
Advanced Directive
What is it? legal document outlining persons preferences if they are ever unable to
make the decisions for themselves
This can be completed in hospital with two witnesses (can't be healthcare providers)
Two forms: livings wills and healthcare proxy (durable power of attorney)
Health care proxy- person appointed by client to make decisions on their half
Living will- describes type of treatments they can do to you
Becomes of use when pt can't comprehend or speak (GCS <7) or aphasia
Medical Battery
What is it? intentional touching of person that is legally defined as unacceptable or
occurs without consent
Assault 95
What is it? deliberate threat with power to carry it out
HIPAA
Transporting employee doesn't need to know anything about the patient
It is not a violation to call clients their full names, have information overheard
inadvertently (through curtains) or indicate well wishes
Violations: you take your pt handoff sheet home
General
Parents may not refuse life, limb or organ saving treatment on behalf of any minor
If someone newly diagnosed with Alzheimers - get them to fill out Advance Directive!
A nurse should never document that an incident report has been filed in the EMR! This
should never be mentioned in the medical record!!
If a nurse is impaired (drunk or high) don't confront them! Go to charge nurse and
document incident
For the NCLEX, wake the Dr up in the middle of the night! for falls, deteriorations, lab
values, need clarification for a prescription, pt leaves AMA, refuses key treatments
etc.
This is obviously not how it goes in the real world, but in the NCLEX its a perfect
world
Documenting tips: do not write "will continue to monitor". It's too vague!
Assignment and Delegation
LPNs
They can take care of stable clients with expected outcomes
They can collect data but they cannot evaluate/assess it, they can monitor for
changes
For example, LPN can assess the changes in color of the stoma but cannot assess
the stoma for perfusion
If the task is something a UAP can do, then give it to the UAP (unlicensed assistive
personnel)
They can't review EKG monitors for dysrhythmias
They can't do any drug IV titrations
Unlicensed Assistive Personnel (UAP)
UAP cannot monitor anything, cannot assess anything, can't do anything sterile (urine
culture)
Blood: they can take vitals before and after 15 min of starting blood transfusion, they
can also pick up the blood from the bank, they can transport body to the morgue, they
can take unused blood back to bank
They can reapply SCDs
They can help assisting with positioning, reporting changes in clients condition,
toileting
They can empty, measure and record output from a surgical drain
They can remind patients to use things if teaching has already been done
96
General
Nurses from different department: give them easiest patient that they may know skills
never give them discharge or new patients
Pregnant nurses can take care of patients who are receiving chemo outpatient, they
just can't handle the chemo agents
Management
Physical Therapy
What is it? focuses on mobility, ambulation, ability to transfer and use of related
equipment (below the waist)
Occupational Therapy
What is it? skills necessary for daily living, dressing bathing (above the waist)
Palliative Care
What is it? for clients who wish to focus on quality of life and symptom management -
great for chronic terminal diseases
Sentinel Event
What is it? patient safety failure that results in death
Case Manager
What is it? facilitate communication between patients doctors, obtain health info,
assess clients needs, make referrals for home health, arranges placement after
discharge
Prioritization
Radiation Exposure
Assess patient farthest radiation source first because most salvageable
Mass Disaster
Priority is to treat the people who have a chance surviving
If severe neurological damage, pulseless, apnea, full burns then probably gonna
die and do not treat first
Priorities
1st priority: airway, breathing, circulation and cardiac
2nd priority: mental status, pain, untreated problems, cant pee, weird labs, infection

97
 Mental Health
PTSD
What is it? mental health disorder that occurs after a traumatic event
S/S: intrusive memories, avoidance, alterations in emotions
Bipolar Disorder
What is it? mental disorder causing intense emotional instability and impulsive
behaviors
Splitting- pt thinks something is all good or all bad, no in between
When manic, pt needs high calorie, protein and fluid intake
Acute manic episode interventions: reduce environmental stimuli, quiet calm
environment, one on one interactions, structured schedule, physical activity, private
room, very structured and limit their interactions with others
Schizophrenia
What is it? mental illness that causes a variety of symptoms such as hallucinations,
delusions, disorganized thoughts, flat affect, apathy, social withdrawal, and cognitive
impairments
If the patient has anxiety and delusions- don't challenge belief, go along with it but try
to change it subtly
If pt having hallucination, acknowledge and reinforce reality
If pt not social, you as a nurse can hang out with him to help him with his social
communication- play a board game for example
Don't force these patients to do anything
If pt starts hallucinating- first focus on nature of hallucination
Auditory hallucinations - giving them earphones and music sometimes helps them go
away
Persecutory delusions- focus on reality and reinforce it, try to understand
Don't attempt to understand or control or present an explanation- they aren't
going to change
Sundowning
What is it? behavior changes that occur in evening or late afternoon particularly in
patients with dementia
Reorient the patient and make sure they are safe
Catatonia
What is it? psychomotor disorder that affect movement, speech and behavior
Withdrawn phase- patient remains in fixed position for days to months
Excited phase: hyperactivity 98
They are almost always unable to meet their own needs and cause a self care deficit
Partner Violence
Assess for any harm, document injuries
Don't tell pt to avoid triggers because it places the blame on them
When assessing a patient, have partner leave room
Occurs equally in all races and levels of income
Abuse often gets worse when they're pregnant
Major Depressive Disorder
What is it? to be diagnosed must feel either depressed mood or loss of interest
everyday for 2 weeks plus 5 other symptoms: sleep, anhedonia, guilt, tired, cant
concentrate, appetite changes, agitation, suicide ideation
These patients need direction and structure
Assist them with ADLs
They don't want to eat breakfast? help them get up and walk with them to meal
room
Alcohol Recovery
These patients need total abstinence from alcohol
Alcohol withdrawal kicks in 8 hours after last drink and peaks at 24-72 hours
Delirium Tremons
What is it? severe alcohol withdrawal symptoms
Occurs 48-96 hours after drink
S/S: agitation, HTN, diaphoresis, hallucinations, tachycardia
Delirium
What is it? impaired cognition, disorientation, confusion, altered consciousness
Often from mechanical ventilation, infection, medications, dehydration
requires one on one supervision
Conversion Disorder
What is it? presence of neurological symptoms from psychological stress, medically
unexplainable symptoms- could be paralysis or even blindness
Antisocial Personality Disorder
What is it? mental condition that characterized as disregard for others
S/S: often disregard rules, irresponsible, blame others, impulsive and fight a lot
Set firm limits and rules with these patients
Agoraphobia
What is it? fear of being in situations that might cause helplessness, panic or
embarrassment
These patients often have difficulty leaving the house

99
Anorexia
What is it? mental disorder that prevents patients from eating due to an intense fear
of gaining weight
Complications: lanugo, amenorrhea, fluid and electrolyte imbalances, decreased
metabolic rate, cold intolerance, osteoporosis, HOTN and bradycardia, low WBC and
RBC, metabolic alkalosis
Don't let these patients do their usual exercise
Strict documentation of calories and protein, weight gain goal, weigh them every
morning, sit with them while they eat and after
Histrionic Personality Disorder
What is it? health condition characterized by excessive emotion and attention seeking
behaviors
S/S: self dramatizing, attention seeking, overly friendly and seductive, demands
immediate gratification, little tolerance for frustration
Electroconvulsive Therapy (ECT)
What is it? medical treatment where electrical current is run through brain causing a
seizure
NPO for 6-8 hours prior
Clients given anesthesia and muscle relaxant
No driving
Muscle loss and confusion normal
Do not give anti seizure meds (valproic acid)!! This would prevent ECT from working

100
 Pharmacology

Analgesics
Morphine Sulfate
Can occasionally cause nausea and vomiting
Tolerance develops very quickly
Epidural morphine often causes itching
Methadone
Treats moderate to severe pain, also given to help narcotic drug addiction
Potent narcotic, very high risk for overdose due to a long half life
Signs of toxicity: NV and lethargy
NSAIDS
What is it? Ibuprofen, Naproxen, Ketorolac, Indomethacin, Aspirin, Meloxicam
Can cause cardio side effects like MI or stroke, decrease effectiveness of BP meds and
diuretics, causes peptic ulcers and chronic kidney disease
Contraindicated for people with HTN or heart failure
GI- report any signs of bleeding- tarry stools
Eat with food to reduce risk of ulcers
Do not give to anyone with injured kidneys or asthma!
Hydromorphone (Dilaudid)
What is it? very strong analgesic, treats moderate to severe pain, narcotic
Duration of action is 3-4 hours
Naloxone (Narcan)
What is it? used to reverse an overdose
Duration of action is 40 min, may need to give multiple doses
If pt overdoses and this is given, the drug usually has a longer duration, so check them
again in an hour and see if they need more
If given post surgery- use does not warrant a rapid response
Opioids
What is it? Morphine, Fentanyl, Hydrocodone
Causes constipation! give stimulant or stool softener
Cause pruritus and flushing and HOTN, fall risk!
Risk for respiratory depression: use of other sedating meds (antihistamines), hx of
smoking, obesity, opioid naive, >65 yo, hx of pulmonary disease, recent surgery
Give slowly over 2-3 min
101
Reassess pt 15-30 min after giving drug because that's when it hits
Capsaicin Topical
What is it? OTC minor pain cream
Great for osteoarthritis or neuralgia
May cause some stinging
Cardiovascular
ACE Inhibitors (-pril)
Lowers BP and treats HF, does not decrease HR
Can cause dry cough that won't go away, angioedema (more common in patients with African
descent), hyperkalemia
Patients cannot take this while pregnant
Don't give to patients with kidney issues
Alpha Agonists
Clonidine, Methyldopa
Anti HTN med, very strong
Cannot just abruptly stop these, will get intense rebound HTN, taper over 2-4 days
S/S: drowsiness, dizziness, dry mouth
Beta Blockers (-lol)
Reduces BP and HR
Contraindicated in patients with acute decompensated heart failure
Can cause bronchospasms, don't give to anyone with hx of asthma or respiratory issues
Calcium Channel Blockers (-dipine, Diltiazem, Verapamil)
Reduces BP and HR and chronic stable angina,
Diltiazem great for Afib- monitor the ventricular rate, ventricular rate control is priority
S/S: orthostatic hypotenson, dizziness, headache, edema, constipation
No grapefruit juice!
ARBs (-sartan)
Treats HTN
Can't take while pregnant!!
When a patient cant take an ACE inhibitor, take an ARB instead
Can cause hyperkalemia
Anticoagulants
Fondaparinux - anticoagulant used to prevent DVT, not administered until more than 6 hours
after surgery
Does not dissolve clots! just keeps it from growing and prevents new ones
t-PA is used to break down clots in emergencies, usually we just let body break it down
Heparin- monitor apTT- 46-70 seconds therapeutic, reversal agent is protamine
Warfarin- usually given with heparin for a few days. until therapeutic INR is reached, then
usually taken 3-6 mo, take same time daily
avoid excessive vitamin K intake- broccoli, spinach, liver 102
No anticoagulants can be given with an epidural catheter in place! will cause a hematoma
Antiplatelet
Clopidogrel, Aspirin
Prevents platelet aggregation, increases bleeding risk
Monitor for signs of bleeding and decrease platelet counts
Contraindicated: peptic ulcer, recent stroke, active bleeding, recent surgery,
pregnancy
Nitrates
Nitrate Isosorbide Mononitrate- long acting, helps pt live daily life and do activities
without angina attack
Nitroglycerin
Increases cardiac blood flow and relieve pain, massive vasodilator
Infusion titrated every 3-5 min, if Systolic BP is less than 90 then too low and slow
infusion rate
Oral- heat and light sensitive, up to 3 pills in 15 min, headache will occur, can't take
with ED drugs (-fil) or alpha blockers (-osin)
EMS should be called if pain is unimproved or worsening 5 min after the first tablet
Must be kept in room temp area light resistant bottle, keep in original packaging
Statins
Lower LDL, cholesterol, triglycerides, and increase HDL
Massively increases chances of rhabdomyolysis!! (causes massive kidney damage)
Report any signs like muscle aches or weakness or dark urine
Can cause myopathy, check creatine kinase levels
No grapefruit juice! take with evening meal
Adenosine
Drug of choice for SVT (rhythm >150 bpm)
Administered over 1-2 seconds with 20 mL flush
Chose IV closest to the heart, watch EKG, may cause brief asystole
Digoxin
Treats HF and Afib, positive inotropic effect (increased CO2) and decreases HR
Toxicity is an issue, good range is 0.5-2
S/S of toxicity: cardiac arrhythmias, bradycardia, heart block, dizzy and light headed,
visual symptoms, NV, abdominal pain, confusion, lethargy-- GI symptoms usually first
Check pulse before taking this med! very important
Check K levels because hypokalemia can cause dig toxicity
For children, hold if HR less than 90-110, if vomits don’t give a second dose
Don't give to pt with renal issues

103
Amiodarone
Antiarrhythmic med used for arrhythmias that can't be controlled with any other
meds
Really awful toxic side effects: pulmonary toxicity, thyroid issues, peripheral
neuropathy, eye problems, make your skin gray, bradycardia and heart block, hepatitis
Fall Risk Drugs
Most antiHTN meds, antipsychotics, antidepressants, vasodilators, narcotics, diuretics
Thrombolytic Agents
Examples: tPA (Alteplase), Streptokinase, Urokinase,
Dissolves blood clots, bleeding is a huge risk!
Treats MI, PE and DVT
tPA absolute contraindications: prior intracranial hemorrhage, cerebral structural
issues, stroke within 3 months, aortic dissection, active bleeding, head trauma in last 3
months
Thrombin Inhibitors
Examples: Dabigatran
Reduces risk of clot formation in stroke clients with Afib
Place patient on bleeding precautions!
This drug must be kept in original container!!
Do not stop taking no matter what unless you've spoken to doc
Factor Xa Inhibitor
Examples: Apixaban, Edoxaban, Fondaparinux, Ribaboxaban
Prevents blood clots by inhibiting activity of factor Xa
Taken orally
Increased risk for bleeding
Potassium Sparing Diuretic
Examples: Spironolactone
Often used in combination with other drugs to treat heart failure and HTN
Loop Diuretics
Examples: Furosemide, Torsemide, Bumetanide
Treats HF
Watch for hypokalemia
IV furosemide in high doses >120 mg can cause ototoxicity, rate of administration
should not go faster than 4 mcg/min

104
Thiazide Diuretics
Examples: hydrochlorothiazide, chlorthalidone
Treats HTN and edema
These drugs can cause hypokalemia and hyponatremia, hyperuricemia, hyperglycemia
Teach: Don’t eat licorice root!! can cause cardiac issues, take in the morning
Milrinone
This drug increase contractility of the heart and promotes vasodilation, often given
when HF is not responding to anything else
Palliative drug for end stage HF
Requires CVA or PICC line
General
Patients with HTN should not take OTC cold and flu meds bc they are vasoconstrictors
and make HTN worse
Sodium replacements are high in potassium, don't use if taking Ace or ARB

Endocrine
Desmopressin
Synthetic form of ADH, treats diabetes insipidus by decreasing urine output which
increases specific gravity
Complications: water intoxication, hyponatremia - headaches, mental status changes,
seizures
Sulfonylurea Medications
Examples: Glyburide, Glipizide, Glimepiride
Treats Tye 2 diabetes
Can cause hypoglycemia and weight gain
Glyburide makes you sunburn super easily
Radioactive Iodine Therapy
Treats hyperthyroid disorders
Destroys thyroid tissue so patient will have to take levothyroxine forever
Patient will emit radiation for up to a week after treatment
No pregnant people!!
Teach: limit close contact with children and pregnant women, use separate toilet and
flush 2 or 3 times, use disposable cups and plates, don't share anything, sleep in
separate bed, don't sit near people for too long (flying), no breastfeeding
Glucocorticoid Replacement (steroids)
Examples: Prednisone, Hydrocortisone
Treats inflammatory disorders
Addison’s disease, lupus, asthma, multiple sclerosis
Teach: report any signs of infection bc these cause immunosuppression, report
increase in thirst, hunger and urination because can cause hyperglycemia, increase 105
dose during times of stress, take with food
Insulin
Insulin reduces serum Potassium levels
when giving Insulin, check K+ to ensure wont worsen hypokalemia
Regular insulin is the only insulin that can be administered IV push! The rest are subQ
Only R and NPH can be mixed in a syringe
Clear before cloudy!
Draw up short acting insulin before longer acting insulin
Rapid Acting
Lispro, Aspart, Glulisine
Onset: 15-30 min; Peak 1-3 hours; Duration 2-5 hours
Short Acting
Regular
Onset: 30-60 min; Peak 2-4 hours; Duration 4-8 hours
Intermediate Acting
NPH
Onset: 1.5- 2 hours; Peak 4-10 hours; Duration 12-24 hours
Long Acting
Glargine, Detemir, Degludec
Onset: 1-2 hours ; No Peak; Duration 24-48 hours
Levothyroxine
Treats hypothyroidism
Teach: can't take with antacids, calcium or iron, take on empty stomach in the
morning, may take 8 weeks to see full effect, maybe a little better in 3-4 weeks
Requires TSH testing, lifelong treatment- if TSH levels are too high it means that drug
isn't working and dose should be increased
TSH getting lower is the goal when taking this drug
This is fine to take while pregnant, may need to be increased
Beers Criteria List
Elderly patients cannot take: sulfonylureas (glyburide), tricyclic antidepressants,
antipsychotics, barbiturates, benzodiazepines, sliding scale insulin, NSAIDS, muscle
relaxants, anti HTN, drowsy antihistamines
Thiazolidinediones (TZDs)
Examples: rosiglitazone, pioglitazone, -glitazone drugs
Treats type 2 diabetes
Side effects: fluid retention, increased risk of heart failure, weight gain
Metformin
Oral anti-diabetic, increases sensitivity of insulin receptors and reduces glucose
production by liver
Prevents a huge glucose rise after eating
Metformin does not pose risk a for hypoglycemia like other DM2 drugs
106
GI
Proton Pump Inhibitors (PPIs) (-prazoles)
Examples: Pantoprazole, Omeprazole
Suppress gastric acid secretions, great for peptic ulcer disease and GERD
Increase risk for C. Diff for reasons unknown, also fractures from decreased bone
density, pneumonia, and hypomagnesemia
Sulfasalazine
Treats IBD, Ulcerative Colitis and Crohn’s Disease
Risk for dehydration and can cause kidney injury, watch urine specific gravity for
dehydration (it will be elevated0
normal gravity (1.002-1.030)
Sucralfate
Treats and prevents ulcers
Oral med that forms protective layer over GI
Take 1 hour before meals with glass of water
Metoclopramide
Treats GERD by increasing gastric motility
Relieves nausea, heartburn and feeling of fullness
Can cause tardive dyskinesia (sucking smacking of life is common, uncontrollable
motions in face, puffing of cheeks)

Orlistat
Weight loss medication
Prevents the breakdown and absorption of fats
Interferes with fat soluble vitamin uptake
take a multivitamin with A,D,E and K at least 2 hours after the orlistat
Integumentary
Cyclines
Examples: Tetracycline, Doxycycline, Minocycline
Taken for acne or various bacterial skin infections
Teach: take on empty stomach an hour before meals, avoid antacids and dairy, causes
photosensitivity, decreases effectiveness of oral contraceptives, can cause gingival
hyperplasia
Isotretinoin (Accutane)
Oral retinoid taken for acne
Make sure patient isn’t pregnant!! Pt must use two forms of BC
Made up of vitamin A, so don't take even more vitamin A supplements
107
Neuro
Anticonvulsants
Depresses CNS causing drowsiness and fatigue (goes away in 4-6 weeks),
Can cause SJS, so watch for rashes
Levetiracetam
Watch for suicidal ideation! big issue!
Phenytoin
Causes gingival hyperplasia, folic acid depletion and osteoporosis
Narrow therapeutic range (10-20)
Toxicity signs: nystagmus, balance troubles, ataxia, slurred speech
If getting it through tube feeding, pause the feeding for 1-2 hours while giving this
Metabolized in liver
Carbamazepine
Great for neuropathic pain like trigeminal neuralgia
Causes leukocytosis and infection risk
If on these drugs, it is very difficult to get driving allowance
Triptan Drugs
Examples: Sumatriptan, Naratriptan
Treats migraines or cluster headaches
constricts blood vessels in bad
Don't give to anyone with CAD or HTN
If taking SSRI or SNRI then monitor for serotonin syndrome
Benztropine
Anticholinergic medication
Great for parkinson's disease, improves muscle control and reduces stiffness
Watch for glaucoma, urinary retention
Carbidopa and Levodopa
Combination of drugs used to treat Parkinsons
Increases dopamine levels, helps the bradykinesia in parkinsons, reduces tremor and
rigidity, never ever stop suddenly
Takes several weeks to kick in, changes color of secretions, avoid high protein meals,
Overdose signs: dyskinesia
Riluzole
Slows down ALS- progressive terminal disease
3-5 yr life expectancy

108
Scopolamine
Anticholinergic
Prevents nausea and vomiting from motion sickness
Place clean dry hairless area behind ear, apply patch >4 hrs before traveling, replace
every 72 hrs, throw away patch far away from kids and pets, wash hands after touching
Benzodiazepines
Examples: Midazolam
Great for conscious sedation
Can cause respiratory arrest
Antidote: Flumazenil

Hematological/ Oncological
Herbal Supplements
Increased risk for bleeding: garlic, ginkgo, ginger, ginseng, feverfew
Ferrous Sulfate
Oral iron supplement
Treats iron deficiency anemia
Don't give with calcium or antacids!
Taking with vitamin C increases absorption
Tamoxifen
Estrogen modulator- prevents breast cancer recurrence, blocks estrogen
Can cause thromboembolic events and endometrial cancer (increase in vaginal
bleeding)
Brachytherapy
Pt placed in a lead room and lead shields, limit time of exposure, staff involved with pt
must wear dosimeter badge, avoid device dislodgement by bedrest, visitors must stay
at least 6 ft away from them
Tumor Lysis Syndrome
Rapidly dividing cancer cells break down
Causes hypocalcemia, hyperuricemia, hyperkalemia and hyperphosphatemia (2.4-4.4)
Allopurinol is given to decrease hyperuricemia and keep it normal (4.4-7.6)
Filgrastim
Often given to chemo patients to stimulate neutrophil count

109
Immunity
TNF Inhibitors
Examples: Etanercept, Infliximab, Adalimumab
Reduce RA and slow progression of joint damage
Causes major immunosuppression
This is a big issue is if pt has latent TB then it will become active on these drugs!
must get a TB test
Azathiopine
Immunosupressant
Causes bone marrow depression , increased risk for infection, watch for leukopenia
Treats IBDs and prevents organ transplant rejections
Methotrexate
Drug for rheumatoid arthritis that causes immunosupression
S/S: bone marrow suppression, hepatotoxicity, GI issues, thrombocytopenia- so watch
for bleeding
Anaphylaxis
Treat with epinephrine, may have to give again in 5-10 minutes
Give bronchodilators and steroids later
Isoniazid
Antitubercular drug for latent or active Tb
Interferes with vitamin B6 and causes peripheral neuropathy- take with B6
supplements
Contraindicated in patients with any liver issues
Sulfa Drugs
Sulfasalazine, Sulfa antibiotics, Glyburide, Lasix
Treat a variety of issues from edema to UTIs
Can cause KI, drink a lot of water, photosensitivity, folic acid deficiency, leukopenia,
SJS

110
Infectious Disease
Metronidazole (Flagyl)
Treats C. Diff
Teach: no alcohol, can cause SJS
Vancomycin
Very strong antibiotic
Must draw trough serum concentrations to monitor, want to avoid oto and
nephrotoxic effects
Therapeutic range (10-20)
Vesicant- watch IV site, watch BP, any reactions, infuse over at least 60 min
Penicillin Allergy
Clients with penicillin allergies might also be allergic to cephalosporins (cefazolin,
cephalexin, ceftriaxone)
Nystatin
Antifungal for oral candidiasis
Teach: if wear denture, soak them in it, check mouth first for any ulcers, swish for a
few minutes then swallow, shake med well first
Linezolid
Antibiotic for bacterial infections
Given for vanco,methicillin resistant infections
Similar to an MAOI so dont give with SSRIs and avoid foods with tyramine
Macrolide Antibiotics (-thromycins)
Examples: Erythromycin, Azithromycin
Causes prolonged QT intervals, hepatotoxicity and hearing loss
watch EKG and liver values
Aminoglycosides (-cin)
Examples: Gentamicin, Tobramycin, Neomycin
Treats serious bacterial infections
Closely monitor kidney function and hearing

111
Mental Health
Selective Serotonin Reuptake Inhibitors (SSRI)
Examples: Sertraline, Escitalopram, Fluoxetine, Paroxetine, Citalopram
Treats major depression and anxiety disorders- cause increased serotonin in the brain,
takes 4-6 weeks to kick in
S/S: sexual dysfunction, hyponatremia, weight gain
Teach: report any suicidal thoughts
Do not take with MAOIs
Serotonin- Norepinephrin Reuptake Inhibitors (SNRI)
Examples: Venlafaxine, Duloxetine
Treats depression and anxiety
Do not take with MAOIs
Methylphenidate
Taken for ADHD symptoms
Can cause weight loss, tachycardia and hypertension
Buspirone
Treats generalized anxiety disorder
Lacks any CNS effects, does not cause withdrawal dependence or anything
Benzodiazepine
Examples: Lorazepam, Alprazolam
Taken for anxiety, insomnia, seizures
CNS depressant, don't drive after taking
Taken daily but only before bed, never stop abruptly
Neuroleptic Malignant Syndrome
Reaction to antipsychotics
S/S: mental status changes hyperthermia, muscle rigidity, tachycardia, diaphoresis
Hold psychotic drugs and call doc!
Benztropine
Anticholinergic/antiparkinson drug used to treat extrapyramidal symptoms from
psych medications such as acute dystonia, akathisia, tardive dyskinesia,
pseudoparkinsonism
Trazadone
Treats major depressive disorders
Side effects: orthostatic hypotension, sedation, priapisms
Teach: no drinking while on this drug

112
MAOIs
Examples: isocarboxazid, phenelzine, tranylcypromine, selegiline
Treats major depressive disorder
Avoid tyramine containing foods
Tyramines will cause HTN crisis
foods high in tyramine
cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine,
chocolate, avocados, soy sauce and raisins
Side Effects: stimulation of CNS, insomnia, agitation, manic symptoms, anxiety
Cannot give with SSRIs or SNRIs!
Lithium
Used to treat mania
Do not give if patient is dehydrated
Sodium levels must be adequate
Teach: drink lots of water, report any diarrhea or vomiting
Routine blood tests- monitor kidney and thyroid function
Can't take with NSAIDS
Takes 1 week for mania to decrease
SE: dry mouth, weight gain, drowsiness
Antipsychotics
Clozapine
Treats schizophrenia
Side effects: neutropenia, weight gain, cardiac disease, seizure, sedation
Atypical antipsychotic, not used often
Can cause agranulocytosis (super low WBC count)
Must have routine blood work and ANC and WBC, must have WBC >3500 and ANC
>2000 to start
Ziprasidone
Treats acute bipolar mania and agitation
Can cause prolonged QT interval, watch for HOTN and seizures
Risperidone
Treats schizophrenia or bipolar disorder
Haloperidol
Treats schizophrenia
anticholinergic side effects, can be sedating
Tricyclic Antidepressants
Examples: Amitriptyline, Imipramine, Nortriptyline, Desipramine
Side effects: anticholinergic effects, orthostatic hypotension, drowsy, photosensitive
St. Johns Wort
Can help depression but interacts with most other antidepressants and causes
serotonin syndrome
Signs of Serotonin Syndrome: agitation, sweating, tachycardia, diarrhea, clonus, 113
hyperreflexia, mydriasis (eyes super dilated)
Teach: do not take if also taking other anti depressants
Maternity/Newborn
Copper IUD
Works immediately, check strings every month, causes heavier bleeding
Misoprostol
Cervix softens for birth
Contraindications: pt already getting oxytocin, hx of uterine surgery (c section) or
abnormal fetal HR
Teratogenic Drugs
Cannot take while pregnant
Examples: Doxycycline, ARBS, ACE, Warfarin, Methotrexate, Isotretinoin
Don’t take NSAIDs especially during third trimester
Urinary/ Renal
Anticholinergics
Examples: Tolterodine, Oxybutynin, Solifenacin
Used for overactive bladder, should decrease amount you have to pee to a normal
amount
often causes heat intolerance and hyperthermia
Alpha Adrenergic Antagonists
Examples: Terazosin, Doxazosin, Tamsulosin, Alfuzosin
Treats BPH (benign prostatic hyperplasia (enlgared prostate)), relaxes smooth muscle
causes orthostatic hypotension
Saw Palmetto
Herbal treatment for BPH
Increases risk for bleeding
Drugs for CKD Patients
Sodium Polystyrene sulfonate
Works in GI to decrease potassium by pooping it out
Often given to people with CKD bc they often deal with hyperkalemia
Erythropoietin
anemia is big issue with CKD, this drug often given to CKD patients, give only if Hgb
<10,
Causes HTN so closely watch BP
Allopurinol
Treats gout by preventing uric acid deposits and preventing kidney stones
This med can cause Stevens Johnson syndrome so if you see any kind of rash of any
kind then call doc asap
Takes several months to become effective, take with a full glass of water and increase
fluid intake bc the uric acid comes out in your urine
114
Respiratory
Beclomethasone
Inhaled corticosteroid, long term, helps control chronic airway inflammation
Teach: rinse mouth out well after, wash inhaler every day
Short Acting Beta Antagonist (SABA)
Examples: Albuterol
Rescue drug
Only take when wheezing and breathless, treats or prevents bronchospasm
Long Acting Beta Antagonist (LABA)
Examples: Salmeterol
Often taken daily for those with asthma or COPD, causes bronchodilation
Theophylline
Bronchodilator, treats symptoms of asthma, bronchitis emphysema and COPD
Low therapeutic window (10-20)
Can cause seizures and arrhythmias
contraindicated in patients with cardiovascular disease
Teach: avoid caffeine, this drug is an upper
Do not take with cimetidine and ciprofloxacin! will become toxic asap
Ipratropium
Immediate acting bronchodilator for rescue
Anticholinergic. causes dry mouth
Tiotropium
Long acting medication for those with COPD
Sometimes comes in capsules that you place in the inhaler
Montelukast
Oral drug combined with corticosteroids to control asthma long term
Asthma Attack
Drugs given: Albuterol, Ipratropium, Methylprednisolone
Codeine
Opioid, cough suppressant
Not recommended for patients with COPD or asthma because these patients need to
have productive coughs and it causes respiratory depression due to its sedating effect
S/S: orthostatic hypotension, constipation, nausea and vomiting, fatigue

115
Death Rattle
Rattle breathing sound when patient is close to death
Give Atropine or Scopolamine patch
Will dry up the secretions due to anticholinergic properties
Acetylcysteine
Loosens respiratory secretions, great for cystic fibrosis
Can also worsen a bronchospasm, not recommended for asthmatic patients

116
 Fundamentals

Basic Care and Comfort Information

Hearing impaired patients - do not raise your voice!
Any surgery with femoral access- no baths, wash daily, no lotions, wear ted hose and
elevate legs
NG and nasoenteric (goes into intestine) can get dislodged and cause aspiration
pneumonia- watch for any signs of dyspnea
Neutrophil normal is (2200-7700)
Post mastectomy- position is semi fowler with arm elevated
HOTN can mess up the O2 sensor due to low perfusion
Preventing pressure injuries
moisture barrier cream, use turn sheet to turn q2h
Enteral Feedings
Usually the feedings are hypertonic- they can sometimes cause nausea and
vomiting and diarrhea (similar to dumping syndrome)- just slow the rate down
If tube gets clogged- flush and aspirate with warm water in large barrel syringe
Postmortem care
Close their eyes, remove tubes and dressings, wash the body and change the
linens, pad under anus in case of leakage, pillow under head and towel under chin
if jaw won't close, give belongings to family members, leave dentures in mouth!
Religions
Orthodox Jewish- can't eat gelatin because it is not kosher- most capsules are
coated in gelatin
Jehovah's Witness- no blood products (including WBCs), give them IV iron and
erythropoietin instead
Alternative medicine
Cupping- suction from cup is created on skin
Coining- coin dragged on back, can make bruises
Moxibustion- small craters in skin
Stroke education
Dressing- first clothe the affected side
Right sided stroke often causes pt to be impulsive and emotionally labile
Receptive aphasia- affects verbal and written language
Dysphagia is common issue- don't let them use straws! increases chance of
choking

117
Medication Administration
To administer ear drops, pull ear up and back for anyone over the age of 3/// pull ear
down and back for 3 and under only
TB test: bevel should still be visible under skin when inserted, 25-27 gauge syringe,
insert needle 5-15 degree, come back in 72 hours to check skin
Ketorolac- NSAID that can be administered PO, IV, or IM- give with 1-1.5 in deep
muscle using z track method
Nasal spray- lean forward a little, spray tip should be pointed away from septum,
avoid blowing nose after
Clonidine patch- dont shave area before putting on patch! chose a dry hairless area on
arm or chest, never stop abruptly
Suppositories
Under 3 years old- lift legs and use pinkie to insert
Over 3 years old- side lying
Hold cheeks together for a few min after insertion, insert past external and internal
sphincter
Isotonic fluids- given for dehydration and fix decreased circulation, clients in labor
usually get 500-1000 mL of isotonic fluids before epidural to help prevent HOTN
Tiotropium- inhaled medication in a little pill form you put in this special inhaler- do
not swallow capsule!! long acting anticholinergic for COPD
Ipratropium- short acting rescue med
Glass ampule- flick upper neck to make sure no meds up there, break ampule away
from body with gauze, withdraw med with filter needle, replace filter needle with
injection needle, put glass in sharps
Eye lube- tilt head back, pull down lower eyelid, squeeze thin strip on lower eyelid
from inner to outer and then close eyes for 2-3 min after, can make eyesight blurry so
a lot of people just use at bedtime
Injections- infants <7mo : anterolateral middle portion of thigh with 5/8 or 1 inch
needle for vaccinations/ can place them supine, prone or side lying, 22-25 gauge
glute muscle isn't developed yet from crawling
PCA pumps require continuous IV solution to keep the vein open and flush the meds
through
Fentanyl patches changed every 72 hours
Prefilled Enoxaparin syringes come with bubbles, leave the bubble! it's there on
purpose, do not rub injection site

118
Safety and Infection Control
Nosocomial Infection- a healthcare setting acquired infection occurring 48 hrs or
more after admission
most common is UTI
IV care- clean site with chlorhexidine before placing, scrub the hub
Droplet precuations- for routine care- just mask required/ but if doing wound care or
suctioning etc. then face shield, gloves, gown required// when pt leaves room, they
must wear mask
If pt allergic to penicillin then avoid cephalosporins (cephalexin)
Incident reports are written for poor hand off reports!
Infected wounds- remove dressing with gloves, change to sterile gloves when
redressing
Pertussis- super contagious, paroxysms of rapid coughing that lead to vomiting -
isolate ASAP!
Romberg Test- test to see if patient can stand straight with eyes closed; if pt fails then
they have tested positive- fall precautions!
Restraints
Tied in quick release!
In semi fowler or side lying position, supine can cause aspiration
Normal INR 0.75-1.25,, therapeutic for warfarin is 2-3
Crutches
When sitting or standing, you put both crutches in the hand of the affected side to
get up/down and the armrest for the unaffected side
Pregnant workers should not be exposed to TORCH: toxoplasmosis, Other (varicella),
Rubella, Cytomegalovirus, Herpes Simplex) because can cause fetal issues
Middle East Respiratory Syndrome
standard, contact and airborne used for these patients- gown, gloves, N95 and
goggles
Form of Coronavirus
Brachytherapy
If radiation implant comes out of patient, you use long handled forceps to put it in
lead container
Airborne precautions- patient leaves room, must wear a surgical mask! also has
dedicated equipment!
If routine care- just N95,, if close contact then throw on everything!
Shingles is airborne but if lesions are open then its contact too
Best way to reduce falls in home: no rugs and install grab bars!
Preventing UTIs
Clean perineal area with soap and water, use sterile technique when collecting
urine sample
People with latex allergies are often allergic to bananas, kiwis, avocados, tomatoes,
peaches and grapes 119
Cellulitis
warm compress can help relieve some of the pain, always ensuring the affected
extremity is elevated!
Medications that increase risk for bleeding need to be stopped 5-7 days before
surgery (aspirin, nsaids, antiplatelets (prasugrel, clopidogrel(Plavix), or anticoagulants
Staph infections: opportunistic bacteria causing infection through opening in skin,
methicillin resistant is antibiotic resistant strain (MRSA)
MRSA risks: recent hospitalization, long term care facility, advanced age,
immunosuppressed, frequent antibiotics use, invasive tubes or lines
Transfers
Partial weight bearing: cooperative (1 person assist) uncooperative (2 person)
Full weight bearing- no help or 1 person if high fall risk
None - 2 person assist or motorized
Generalized weakness and can't follow instructions
Household wound care- you wrap the soiled dressing in glove or plastic bag before
throwing away in household trash
Central Venous Catheters
Require heparin flush(usually 10-100 units)
10,000-100,000 used to treat VTE
Change occlusive dressing every 7 days
Scrub the hub for 10-15 seconds
If dressing ever gets torn or soiled- change it!
Distal port of CVC is used to measure CVP
If patient is awake and fully oriented with a trach tube- you can actually deflate the
cuff and that decreases the chances of the aspirating
Cuff only helps to prevent aspiration if the pt is unconscious/ but if they are
conscious then it increases chances bc it is really uncomfortable and harder to
swallow
Ebola
Standard, droplet and airborne precautions
Wear all the PPE plus double gloves with long arms, boot covers, impermeable
coveralls
Maintain log of everyone in the room
No meds to treat this exist
If pt is leaving AMA, most important thing you must do is remove IV!!
If trying to avoid infection of the IV site, use upper extremities and hand is best!
Antecubital fossa is best for emergency situations bc of large veins but can get
irritated from moving arm
Tricyclic antidepressants are super toxic to kids- even one pill can cause major issues-
go to ED!! (amitriptyline)

120
Skills and Procedures
Irrigating wound- give pain meds 30 min before, don gown, face shield, gloves, fill 30-
60 mL syringe and attach 18 gauge needle, then irrigate starting with least dirty then
going to most dirty
NG tube insertion- if pt starts to cough or gag while inserting then pull back a little bit
and let them breathe for a second, then ask them to take some sips of water and
advance
NaCl is the only fluid that can run with a blood transfusion
Patient choking? Do the Heimlich! blind sweep of the mouth can make it worse!
If infant- back blows or chest thrusts
PICC line- dressing change is sterile, pt should do valsalva when changing caps or
tubing, pt should turn head away from picc line when changing dressing, supine
position
CVC occlusion? - first try to reposition client, the catheter tip may be resting against
vessel wall
Removal- pt bears down, supine position, occlusive dressing
They can run incompatible drugs at the same time- multiple lumens in body
Always flush with 10 mL
Always draw Regular before NPH, clear then cloudy
When calculating fluid for weight and %body burned- you keep the percentage a
percent!!
Parkland Formula= 4 mL x kg x TBSA%
Blood draw for specimens
Do not use veins on the ventral side of the wrist, tourniquet shouldnt stay on
longer than 1 min, gently invert tube 5-10 times to mix with heparin in tube, if you
insert and bright red blood starts pulsating then you've hit an artery! pull out asap
and hold pressure for 5 min
Air embolism
Clamp tubing, position in left lateral trendelenburg, give O2, tell doc, stay with
patient!
Positioning
After liver biopsy- lay on right side for 2 hours to apply pressure to liver
Suspected air embolism- lay left side trendelenburg
Chest tube insertion- semi fowler with arm raised
Pneumonectomy- position on affected side
Reaction to blood? stop the transfusion, replace tubing and THEN start NaCl again
Magnetic Resonance Cholangiopancreatography (MRCP)
MRI for biliary, hepatic and pancreatic ducts
Uses IV gadolinium - IV contrast material
Normal MRI contraindications + pregnancy! gadolinium dangerous for fetus

121
Norepinephrine is vesicant! if extravasation occurs (pain, blanching, swelling and
redness) then stop the infusion, use syringe to aspirate drug, elevate arm, tell doc to
get prescription for phentolamine (vasodilator than is sub q inj- great for dopamine
extravasation too)
Sling teaching
Keep elbow flexed 90 degrees, hand should be above level of elbow, sling should
end mid palm with fingers sticking out
Potassium shouldn't be given faster than 10mEq over 1 hour for the peripheral! or
40/hr if CVC
Orthostatic Hypotension vitals: take when lying down, then sitting, then standing
Liver Biopsy
Pre- check PT and INR, blood type and crossmatch and have pt lay on right side
and wash for any signs of shock
GI assessment order: inspect, auscultate, percussion, palpation
Non sterile urine collection on diaper child- place cotton balls in child diaper and
squeeze out urine on dipstick
Trach suctioning- pt usually coughs when you suction them- that's good! it helps
loosen up secretions- keep suctioning
Pulsus Paradoxus- sign of cardiac tamponade
measured korotkoff sounds auscultated throughout respirations while looking at
BP
Checking NG tube residuals for enteral feeding
check every 4-6 hours, if GRV is >500 then hold feeding, check pH (should be less
than 5), then RETURN GRV, flush before and after feeding
4 pt gait with crutches it the closest you can go to walking, then 2 pt gait then 3 pt gait
Nasoenteric tubes- placed using a stylet (metal wire)
you should get xray before removing stylet
Proteinuria- this is albumin in your pee, normally there is none, but if there is any kind
of kidney dysfunction then albumin is the first to show
18 gauge needle is best for blood draw, 14 is for extreme emergencies, 20-22 is for
normal procedures, although you can give blood through 20 it's just not best
Things affecting O2 sensor: HOTN, dark fingernail polish, any kind of vasoconstriction,
PAD

122