Do a least one a day and LOOK AT THE RATIONALE WHETHER RIGHT OR WRONG

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Focus on your successes encouraging yourself to greater achievements in the future and Forget your past
mistakes.
Always do your best so you can be proud that you gave it your best shot.
Focus on your achievements rather than your failures. If you do find yourself thinking about how you
failed then look at what you managed to do right and how you could correct what you did next time.
A mind that is troubled with doubt won't be able to focus on the victory to be had.
Take time for yourself. A fried mind can't focus or learn.
Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily ascertain it has
something to do with muscle (myo) cancer (sarcoma). The same thing goes for drug names. For
example, if it ends in ide its probably a diuretic, as in Furosemide, and Amyloride.
When getting down to two answers, choose the assessment answer (assess, collect, auscultation,
monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has
an absolute, discard it. Give priority to answers that deal directly to the patients body, not the
machines/equipments.
Key words are very important. Avoid answers with absolutes for example: always, never, must, etc.
When choosing an answer, think in this manner if you can only do ONLY one thing to help this patient
what would it be? Pick the most important intervention.
If two of the answers are the exact opposite, like bradycardia or tachycardia... one is probably the
answer.
If two or three answers are similar or are alike, none is correct.
When asking patients questions NEVER use why questions. Eliminate all why? answer options.
If you have never heard of it please dont pick it!
Never release traction UNLESS you have an order from the MD to do so
Always deal with actual problems or harm before potential problems
Always select a patient focused answer.
An answer option that states "reassess in 15 minutes" is probably wrong.
An answer that delays care or treatment is ALWAYS wrong

DO NOT delegate what you can EAT! or PACET

P Planning
A Assess (Primary/Initial)
C Collaboration (with RT, OT, PT, ETC)
E Evaluate (for trends)
T Teach
* Assessment, teaching, i.v. meds, evaluation, unstable patient cannot be delegated to an Unlicensed
Assistive Personnel.
* LVN/LPN cannot handle blood.
Vit K is to coumadin as Protamine Sulfate is to Heparin as Ca Glu is to MgSo4 as Mucomyst is to
Acetominophen as Amicar is to TPAget it? Antidotes/treatments for overdose
REVERSE AGENTS FOR TOXICITY
ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine, Digitoxin/digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts.
- Potassium potentiates dig toxicity.
Order of assessment: Inspection, Palpation, Percussion and Ausculation. EXCEPT with abdomen cuz you dont
wanna mess with the bowels and their sounds so you Inspect, Auscultate, Percuss then Palpate (same with
kids, I suppose since you wanna go from least invasive to most invasive since they will cry! Gotta love them
kids!)
No Pee, no K (do not give potassium without adequate urine output)

EleVate Veins; dAngle Arteries for better perfusion

For PVD remember DAVE (Legs are Dependent for Arterial & for Venous Elevated)
Arterial PPP, Pain, paller, pulselessness. Stand up to reduce pain
Each worth 2 points:

>8 no interventions,

4-7 stimulate/rub back/give O2/rescore,

0-3 Full CPR/Rescore

Points:
2

0
A= appearance {skin colour} (color all pink pink and blue blue [pale])
P= pulse {HR}
(>100 < 100 absent)
G= grimace {reflex irritability} (cough/pulls away facial movement/grimace only with stimulation no response)
A= activity {muscle tone} (spontaneous activity arms/legs flexed with little movement limp/floppy tone)
R= respirations {effort} (30-60 bpm/strong cry irregular/slow breathing/weak cry absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE - Private Room - negative pressure with 6-12 air exchanges/hr, Mask, N95 for TB
My - Measles
or remember... MTV=Airborne
Chicken - Chicken Pox/Varicella
Measles
Hez - Herpez Zoster/Shingles
TB Varicella-Chicken Pox/Herpes ZosterTB
Shingles
DROPLET - Private Room or cohort Mask
think of SPIDERMAN!
S sepsis, S - scarlet fever, S - streptococcal pharyngitis
P - parvovirus B19, P - pneumonia P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R - rubella
M mumps, M meningitis, M - mycoplasma or meningeal pneumonia
An - Adenovirus
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *

W - wound infxn
E - enteric infxn - clostridium difficile
E - eye infxn - conjunctivitis

SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S - scabies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of
impending doom) turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc)
turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC position pt on right side (promotes emptying of the stomach) with
the HOB elevated (to prevent aspiration)
4. During Epidural Puncture side-lying

5. After Lumbar Puncture (and also oil-based Myelogram) pt lies in flat supine (to prevent headache
and leaking of CSF). AFTER the procedure, the client should be placed in the supine position for 4 to 12
hrs as prescribed. (Saunders 3rd ed p. 229)
6. Pt w/ Heat Stroke lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) catheter is taped to thigh so leg should be kept
straight. No other positioning restrictions.
8. After Myringotomy position on side of affected ear after surgery (allows drainage of secretions)
9. After Cataract Surgery pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) elevate foot of bed for counter-traction
13. After Total Hip Replacement don't sleep on operated side, don't flex hip more than 45-60 degrees,
don't elevate HOB > 45 degrees. Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip position on back or in infant seat to prevent trauma to suture line. While
feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) eat in reclining position,
lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small
frequent meals) and increase fat and protein, wait 1 hr after meals to drink. Unusual positional tip Low-fowlers recommended during meals to prevent dumping syndrome.
17. Above Knee Amputation elevate for first 24 hours on pillow, position prone daily to provide for hip
extension.
18. Below Knee Amputation foot of bed elevated for first 24 hours, position prone daily to provide for
hip extension.
19. Detached Retina area of detachment should be in the dependent position
20. Administration of Enema position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck) position pt flat and lateral on either side.
23. During Internal Radiation on bedrest while implant in place, treat pt as they are radioactive.

Tongs

24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal

congestion, goose flesh, bradycardia, hypertension) place client in sitting position (elevate HOB)
first before any other implementation.
25. Shock bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)
26. Head Injury elevate HOB 30 degrees to decrease intracranial pressure
27. Peritoneal Dialysis when Outflow is Inadequate turn pt from side to side BEFORE checking for
kinks in tubing (according to Kaplan)

Demorol for pancreatitis, NOT morphine sulfate. 1. Morphine is contraindicated in Pancreatitis. It causes
spasm of the Sphincter of Oddi. Therefore Demerol should be given.
Myasthenia Gravis: worsens with exercise and improves with rest caused by a disorder in the transmission of
impulses from nerve to muscle cell (does not affect the bladder & bowel). *Tensilon test given if muscle is tense in myasthenia gravis.
Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms and confirms the diagnosis
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
DUMBELLS A G: Defecation, Urination, Misosis, Bradycardia, Emesis, Lacrimation, Lethargy, Salivation,
Abdominal cramps G.I. upset
Give neostigmine to clients with Myesthenia Gravis about 45 min. before eating, so it will help with
chewing and swallowing.
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle
Prior to a liver biopsy its important to be aware of the lab result for prothrombin time
From the a$$ (diarrhea) = metabolic acidosis

From the mouth (vomitus) = metabolic alkalosis

Thyroid TSH test will differentiate btw primary and secondary

Thyroid scan no seafood, meds, or cough meds 7-10 days prior.

Myxedema/hypothyroidism: slowed physical and mental function, fatter, sensitivity to cold, dry skin and
hair. BMI. Give meds and correct hypothermia warming blanket).
* Anti-HTN and thyroid meds in the A.M. otherwise INSOMNIA.
Synthroid: TX of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in
the AM on empty stomach..could cause hyperthyroidism.
HYPERthyroidism think of MICHAEL JACKSON in THRILLER! Skinny, Nervous, Buldging Eyes, Up all
night, heart beating fast
Graves disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair, Goiter, Bulging eyes. Eating +++ but still thin. When giving meds watch for hypothyroidism.
Thyroid storm: increased temp, HR and HTN d/t: Surgery (Physical movement of thyroid), infection, stress
Post-thyroidectomy: semi-Fowlers, prevent neck flexion/hyperextension, trach at bedside, freq swallowing
is bad
Esophageal varices bleeding results in abdo distention not swallowing
Sengstaken blakemore tube used for TX of esophageal varices, keep scissors at bedside in case of shock.
Insomnia is a side effect of thyroid hormones. Increased met. rate, your body is "too busy to sleep" as
opposed to the folks with hypothyroidism who may report somnolence ( met rate, body is slow and sleepy).
Burning sensation in the mouth, and brassy taste are adverse reactions to Lugol solution (for
hyperthyroid). Report it to the doc.
Give synthroid on an empty stomach
PTU and Tapazole- prevention of thyroid storm
Hypovolemia increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific
gravity >1.030
Hypervolemia bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowlers
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics

3.5 5.0

Hypokalemia: dysrhythmias, increase K (raisins, bananas, apricots, citrus fruits, beans, potatoes, carrots,
celery). Caused by: Cushings/hyperaldosteronism, wound irrigation, vomiting/diarrhea/ G.I. suctioning,
diuretics, diaphoresis, kidney disease, alkalosis, in insulin.
Causes are a
GRAPHIC IDEA:
GI losses, Renal, Aldostrone, Periodic paralysis, Hypothermia, Insulin excess, Cushings
syndrome, Insufficient intake, Diuretics, Elevated beta adrenergic activity, Alkalosis.
SUCTION:

Skeletal Muscle Weakness, U-wave, Constipation, Toxicity to Digoxin (0.5-2.0),

Irregular/weak pulse, Orthostatic Hypotension, Numbness/Paresthesia

6Ls: Lethargy, Low/shallow respirations, Lethal cardiac arrhythmia, Leg cramps, Limp muscles, Less stool
(constipation)
Hyperkalemia: Caused by: Addisons, Acidosis, Trauma/Burn/Chemo, Kidney issue, K+ sparing diuretics,
when giving blood. * Lethal Injection is a high dose of K+ for the death penalty
MURDER:
Muscle weakness, Urine (oliguria/anuria), Respiratory depression,
Decreased cardiac contractility, ECG changes, Reflexes
MACHINE:
Meds NSAIDS and ACE inhibitors, Acidosis, Cell Damage (burns, chemo, crushing injury),
Hypoaldostronism, Intake excessive, Nephrons renal failure, Excretion impaired
When giving Kayexalate we need to worry about dehydration (K has an inverse relationship with Na)
-Don't use Kayexalate if patient has hypoactive bowel sounds.
K-BANK: K-sparing diuretic, Beta blocker, ACE inhibitor, NSAID, K supplement
135-145
Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics,
too much fluids
SALT: Stupor/coma, Anorexia, Lethargy/Lithium toxicity, Tendon reflexes
LOSS: Limp muscles, Ortho HTN, Stomach cramps ( G.I.), Seizures/headache
Hypernatremia: increased temp, weakness, disorientation/delusions, eventual hypotension, tachycardia;
hypotonic solution, thirst
Fried: Fever (low)/Flushed skin, Restless (irritable),
Increased fluids/BP, Edema, Decreased urine output/ Dry skin
8.5 10.9
Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes,
sedative effect on CNS. Caused by: in Phos, thiazide diuretics, glucocorticoids, adrenal insufficiency.
Groans (constipation), Moans (joint pain), Bones (d/t Ca), Stones (Kidney), Overtones (Depressed and
confusion). TX: Calcitonin, dialysis, dilute, diuretics
Thiazide diuretics elevated Ca+ lvls

Hypocalcemia: CATSS Convulsions, Arrhythmias, Tetany (Spasms), Stridor. + (Turning hand) Trousseau
sign and (Cheek) Chvostek's sign. Caused by C & C (Chrons and Celiac), kidney failure, alkalosis, pancreatitis
(steatorrhea)
, in Phos, PT issues. Long ST and QT intervals. TX: give Al-hydroxide to phos, Ca+ supplement after meal.
Hypo-parathyroid: CATSS Convulsions, Arrhythmias, Tetany, Spasms, Stridor (decreased calcium),
Diet: high Ca, low phosphorus
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium),
Diet: low Ca, high phosphorus diet
Polyuria is common with the hypercalcemia caused by hyperparathyroidism.
1.5- 2.5
HyperMg: depresses the CNS - confused, hypotension, facial flushing, muscle weakness, absent deep tendon
reflexes, shallow respirations, emergency. HR/BP, + Trousseau sign and Chvostek's sign. Caused by:
Laxatives, anatacids, renal insufficiency, Mg diet. TX: stop mg intake, diuretics, Calcium gluconate.

HypoMg: tremors/seizures, tetany, dyrshythmias, CNS depression, dysphagia; dig toxicity. HR/BP Caused
by: vomiting/diarrhea, C & C, diuretics, alcoholism. TX: greens, Ps, cauliflower.
Addisons=
Cushings=
Addisons=
Cushings=

Down
Down
Down
Up
Up
Up
Na
/ BP
/ Volume
hyponatremia, hypotension, decreased blood vol,
hypernatremia, hypertension, increased blood vol,

Up
Down
/ K+
hyperkalemia,
hypokalemia,

Down
Up
/ Blood Sugar
hypoglycemia
hyperglycemia

Addisons (need to "add" hormone): hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased
resistance to stress, fractures, alopecia, weight loss, sad (attitude), GI distress kind of like Golem
Mineral corticoids are given in Addisons disease.
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Managing stress in a patient with adrenal insufficiency (Addisons) is paramount, because if the adrenal
glands are stressed further it could result in Addisonian crisis. While were on Addisons, remember blood
pressure is the most important assessment parameter, as it causes severe hypotension.
Cushings (have extra "cushion" of hormones) : hyperNa, hypoK, hyperglycemia, prone to infection, muscle
wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump, happy (attitude) 3Ss - blood
Sugar, Na (Salt), Sex (androgens) kind of like a fat gamer playing SNES. Give a cal, protein diet.
Prednisone toxicity: Cushings syndrome= buffalo hump, moon face, high glucose, hypertension.
CUSHINGOID: Cataracts, Ulcers, Skin: striae/thinning/bruising, Hypertension/ hirsutism/ hyperglycemia,
Infections, Necrosis/avascular necrosis of the femoral head, Glycosuria, Osteoporosis, Obesity,
Immunosuppressant, and Diabetes

*Cushings ulcers r/t BRAIN injury

*Cushings triad r/t ICP in BRAIN (htn, bradycard, irr. resp)
*Thyroid storm is HOT (hyperthermia)
*Myxedema coma is COLD (hypothermia)
Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, hyperglycemia, tremor, pounding HA;
avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods, surgery to remove tumor.
5Ps: Pressure (HA d/t BP & HR), Palpitation, Pallor, Perspiration (diaphoresis), Pain
1. Neuroleptic Malignant Syndrome (NMS):
-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool

caused by an adverse reaction to neuroleptic or antipsychotic drugs.

FEVER: Fever , Encephalopathy, Vitals unstabile, Elevated WBC/CK, Rigidity,

WBC: white blood cell count, CPK: creatine phosphokinase
Serotonin syndrome - HARMED: Hyperthermia, Autonomic instability, Rigidity, Myoclonus,
Encephalopathy, Diaphoresis
2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German
measles (rubella), so remember: never get pregnant with a German (rubella)
3. When drawing up regular insulin & NPH together, remember: RN (regular comes before NPH).
4. To remember how to draw up INSULIN think:
Nicole Richie RN (a teacher taught us this is school, thought it was funny and never forgot it!!!)

Air into NPH, then air into regular, draw up regular then draw up NPH
5. Tetralogy of fallot; remember HOPS, Think

DROP (child drops to floor or squats) or POSH

Defect, septal
Right Ventricular hypertrophy
Overriding aortas
Pulmonary stenosis

6. MAOI's that are used as antidepressants:

Pirates say arrrr, so think; pirates take MAOI's when they're depressed alone at sea.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)
MAOI'S - Think of PANAMA: PA - Parnate NA - Nardil MA Marplan
NPM No Popular Meds NO barbs, tricyclic anti-deps, antihistamines/HTN, stimulants, CNS deps, OTC cold meds. Needs medialert bracelet,

H/A E.R. | low-tyramine diet (chocolate, cheese, pickled foods, wine, left out food, fig)

Autonomic dysreflexia: potentially life threatening emergency affects people with injuries at T-5 or
- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (trigger)
- Administer antihypertensive meds (may cause stroke, MI, seizure )
Metallic bitter taste.
Digoxin (0.5-2.0)-check pulse, less than 60 hold, check dig levels and potassium levels ( K+ = Dig Toxicity).
Avoid salt substitutes when taken digoxin and k-supplements because many are potassium based.
Amphojel: TX of GERD and kidney stones....watch out for constipation. Long term use of amphogel (binds to
phosphates, increases Ca, robs the bones...leads to increased Ca reabsorption from bones and WEAK
BONES). Amphogel and Renegal take with meals. Also Milk of Mag for GI upset. MOM in the AM for a BM in
the PM
Vistaril: TX of anxiety and also itching...watch for dry mouth. Given preop commonly
Versed: given for conscious sedation...watch for resp depression and hypotension
Tigan: TX of postop n/v and for nausea associated with gastroenteritis
Sinemet: TX of parkinson...sweat, saliva, urine may turn reddish brown occasionally...causes drowsiness
Artane: TX of Parkinson...Sedative effect also
Cogentin: TX of parkinson and extrapyramidal effects of other drugs
Timolol (Timoptic)-TX of glaucoma
Glaucoma pts gradually lose peripheral vision (Tunnel vision) and total vision and acuity painlessly. *Treated with meds
Glaucoma intraocular pressure is greater than the normal (22 mm Hg), give miotics to constrict (pilocarpine)
NO ATROPINE.
Bactrim: antibiotic...Dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of fluids
Gout Meds (+ uric acid): Probenecid (Benemid), Colchicine (cold), Allopurinol (Zyloprim)
Protect from trauma. No ASA, diuretics. Low purine diet (no red meat)

NO VITAMIN C with Allopurinol.

Apresoline(hydralazine)-TX of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying position;
take with meals.
Treating CHF
UNLOAD FAST: Upright position, Nitrates, Lasix, O2, ACE inhibitors, Digoxin
Fluids (decrease), Afterload (decrease), Sodium Restriction, Test (Dig lvl, ABGs, K+ lvl)
Bentyl: TX of irritable bowel....assess for anticholinergic side effects.
Calan (verapamil): calcium channel blocker: TX of HTN, angina...assess for constipation
Very Nice Drugs - Verapmil, Nifedipine, Diltiazem

Calcium channel blocker are not used for MI b/c of risk of heart block
SHED the GAPS (side effects): Stevens Johnson syndrome (life-threatening skin separating), H/A, Edema, Dizziness,
Gingival hyperplasia, Angina, Palpitations, Sleepiness
Carafate: TX of duodenal ulcers...coats the ulcer...so take before meals. Give before meals to coat stomach.
* anti-ulcer med
(mucosal barrier; constipation) Mylanta coats the whole stomach.
Tagamet: with food (H2; messes with elderly ppl be careful! Interacts with alot of things)
*Antacids after meals
Theophylline: TX of asthma or COPD...therap drug level: 10-20 Increases the risk of digoxin toxicity and
decreases the effects of lithium and Dilantin. Avoid coffee, cola, and chocolate.
Mucomyst is the antedote to tylenol and is administered orally.
Diamox: TX of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs, can cause hypokalemia
Indocin: (nsaid) TX of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.
Librium: TX of alcohol w/d...dont take alcohol with this...very bad nausea and vomiting can occur.
Oncovin (vincristine): TX of leukemia...given IV ONLY

causes a change in sensation, hair loss, constipation, difficulty walking, and

headaches

H-Awe is antidote. client may have epitaxis b/c of low platelets d/t the of dysfunctional WBC production

kwell: TX of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) use the shampoo
and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a fine tooth comb
Premarin: TX after menopause estrogen replacement
Dilantin (phenytoin) 10-20: TX of seizures. Can cause gingival hyperplasia. s/e rash (stop med), gingival
hyperplasia (good hygiene). Toxicity poor gait + coordination, slurred speech, nausea, lethargy, and diplopia.
S/E: PHENYTOIN: P-450 interactions, Hirsutism, Enlarged gums, Nystagmus, Yellow-browning of skin,
Teratogenicity, Osteomalacia, Interference with B12 metabolism (hence anemia), Neuropathies: vertigo,
ataxia, and headache
Navane: TX of schizophrenia...assess for EPS (4hrs Acute Dystonia {Disco}, 4 days AkINeasia, 4wks
AkaTHISia, 4 mths Tardive DyskINesia) Disco In This Inn for EPS
Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities, may happen
after prolonged use of antipsychotics. AIMS test used to assess for it.
Akathisia - motor restlessness, need to keep going, TX with antiparkinsons meds, can be mistaken for
agitation.
Thorazine (sedative effect, seizures, and EPS)/haldol (antipsychotic) can lead to EPS
Ritalin: TX of ADHD...assess for heart related side effects report immediately...child may need a drug holiday
b/c it stunts growth.
dopamine (Intropine): TX of hypotension, shock, low cardiac output, poor perfusion to vital organs...monitor
EKG for arrhythmias, monitor BP
Have trouble remembering
V = Variable decels;
E = Early decels;

A = Accelerations;
L = Late decels =

fetal heart rate patterns in OB? Think VEAL CHOP TOOL

C = Cord compression caused

T = place in TRENDELENBERG position

H = Head compression caused

O = Observe (monitor & document)

O = Okay, not a problem!

O = Observe (monitor & document)

P = Placental insufficiency, can't fill
L = turn the mother to her LEFT side

For cord compression, place the mother in the TRENDELENBERG position because this removes pressure of
the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of the body by
gravity). If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to
minimize infection.
For late decels, turn the mother to her left side, to allow more blood flow to the placenta. For any kind of bad
fetal heart rate pattern, you give O2, often by mask...
When doing an epidural anesthesia hydration before hand is a priority.
Hypotension and bradypnea / bradycardia are major risks and emergencies.
NEVER check the monitor or a machine as a first action. Always assess the patient first; for example
listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on
first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a
machine. If you're not sure who to check first and one of the choices involves the machine, that's the wrong
answer.
If the baby is a posterior presentation, the sounds are heard at the sides.
If the baby is anterior, the sounds are heard closer to midline, between the umbilicus and where you would
listen to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are
a little bit above the symphysis pubis.
B Bishop Score:
I Effacement
S Station
H Hard or soft (consistency)
O Opening (Dilation)
P Presenting part

0
0-30%
-3
Firm
closed
posterior

1
40-50%
-2
moderately firm
1-2cm
mid-line

2
60-70%
-1, 0
soft (ripe)
3-4cm
anterior

3
80%+
+1,+2
5+cm

* A score of 5 or less is unfavourable. Mother may need cervical ripening. >6 is good to induce since cervix is ripe and induction may be successful.

best way to warm a newborn: skin to skin contact covered with a blanket on mom.
when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart tone/rate

Ventilator alarms When in doubt BAG!

HOLD
High alarmObstruction due to secretions, kink, pt. coughs, gag or bites
Low press alarmDisconnection/leak in ventilator or in pt. airway cuff, pt. stops spontaneous breathing
Blood sugar:
Hot and Dry-sugar High (hyperglycemia)

Cold and Clammy-need some Candy (hypoglycemia)

1. ICP AND SHOCK HAVE OPPOSITE V/S

ICP BP, pulse, resp.
SHOCK BP, pulse, resp.
2.

cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a
choice.)

3.

heroin withdrawal neonate: irritable and poor sucking

4.

Muslims: allow time for prayer & fasting in Ramadhan. Jews: no meat & milk together.

5.

Brachial pulse: check pulse area cpr on an infant. BP cuff cover 75% of arm and 2cm above ac.

No blood for Jevo Witnes

6. Test child for lead poisoning (plumbism) around 12 months. * remove environmental source, start chelation therapy
Lead poisoning: ABCDEFG: Anemia, Basophilic stripping, Colicky pain, Diarrhea, Encephalopathy, Foot
drop, Gum (lead line)

7.

Cultures are obtained before starting IV antibiotics ALWAYS to see sensitiveness.

8.

Phobic disorders...use systematic desensitization.

1.
2.
3.
4.
5.
6.
7.

With lower amputations patient is placed in prone position but elevate for first 24 hours.
Small frequent feedings are better than larger ones.
Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
IV push should go over at least 2 minutes. Never push K+
If the patient is not a child an answer with family option can be ruled out easily.
In an emergency/crisis, patients with greater chance to live are treated first, so they can help others.
ARDS (fluids in alveoli), DIC (disseminated intravascular coagulation) are always secondary to
something else (another disease process).
8. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
9. In pH regulation the 2 organs of concern are lungs/kidneys. Resp Opposite, Metabolic Equal, red for
acidic, blue for alkaline
pH 7.35-7.45
|
pCO2 >45 -<35
|
HCO3 <22 - >26
10. Edema is in the interstitial space not in the cardiovascular space.
11. Weight is the best indicator of dehydration therefore to see fluid changes weight the client.
12. Wherever there is sugar (glucose) water follows.
13. Aspirin can cause Reyes syndrome (encephalopathy) when given to children
S/E: ASPIRIN: Asthma, Salicyalism, Peptic ulcer disease/ Platelet disaggregation, Intestinal blood loss,
Reye's syndrome, Idiosyncracy, Noise (tinnitus)
14. When aspirin is given once a day it acts as an antiplatelet.
15. Use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (rheumatoid arthritis)
16. Guided imagery is great for chronic pain.
17. When patient is in distress, medication administration is rarely a good choice.
18. With pneumonia, fever and chills are usually present. For the elderly confusion is often present.
19. Always check for allergies before administering antibiotics (especially PCN). Make sure culture and
sensitivity has been done before adm. First dose of antibiotic.
20. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused by pulmonary disease, occurs with
bronchitis or emphysema (d/t to the difficulty of the blood to be push through lungs).
21. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both COPD.
22. COPD patients the baroreceptors that detect the CO 2 level are destroyed. Therefore, O2 level must be
low because high O2 concentration blows the patients stimulus for breathing.
23. Remember that leaving chest tube clamped caused a tension pneumothorax and mediastinal shift
24. Exacerbation: acute, distress.
25. Epi is always given in TB syringe.
26. 4 options for cancer management: chemo, radiation, surgery, allow to die with dignity.
27. No live vaccines, no fresh fruits, no flowers should be used for neutropenic (-pena, "deficiency") patients.
28. Chest tubes are placed in the pleural space. Bubbling in the water seal chamber is normal and is caused
by air passing out of the pleural space into the fluid chamber. Intermittent bubbling is normal. It
indicates that the system is accomplishing a purpose which is to remove air from the pleural space.
Continuous bubbling during inspiration and expiration indicates that there is an air leak.
29. Angina (low oxygen to heart tissues) = no dead heart tissues. MI= dead heart tissue present.
Precipitating factors for Angina"4E's": Eating, Emotion, Exertion (Exercise), Extreme Temperatures
(Hot or Cold weather), usually relieved by rest/nitro.
30. For a CABG, they are vented, restrained (d/t temporary psychosis), and chest tubed. Get consent before.
For a CABG operation when the great saphenous vein is taken it is turned inside out due to the valves
that are inside.
31. Nitroglycerine is administered up to 3 times (every 5 minutes). If chest pain (even if a 1) does not stop
go to hospital. Do not give when BP is < 90/60. Unstable angina is not relieved by nitro.
32. M.I. long and expansive pain. Denial of heart attack. 12 lead shows live changes. give O2, give nirates
then aspirin then morphine, monitor ECG and lytes, Mona: Morphine, Oxygen, Nitrates, & Aspirin.
33. Preload affects amount of blood that goes to the R ventricle. Afterload is the resistance the blood has to
overcome when leaving the heart.
34. Calcium channel blocker affects the afterload. relax blood vessels and increase the supply of blood and oxygen to the heart while also
reducing the heart's workload.
-ipine, diltiazem, verapamil
35. Mevacor (anticholesterol med) must be given with evening meal if it is Qday (per day).
36. Raynaud's phenomenon/disease is excessively reduced blood flow in response to cold or emotional

stress. Caused by Smoking, Stress, and Severe weather. SSS - Red white and blue
37. Dead tissues cannot have PVCs (premature ventricular contraction. If left untreated pvcs can lead to
VF (ventricular fibrillation).
38. 1 t (teaspoon)= 5 ml
1 quart= 2 pints
1 kg= 2.2 lbs
1 Tsp (tablespoon) =3 t (15ml)
1 pint= 2 cups
1 lb= 16 oz
1 oz= 30 ml
1 gr (grain) = 60 mg
1 cup= 8 oz
1 g (gram) = 1000 mg
*
To convert Centigrade to F. F= C+40, multiply 9/5 and subtract 40
*
To convert Fahrenheit to C. C= F+40, multiply 5/9 and subtract 40.
39. Angiotensin II in the lungs= potent vasodialator. Aldosterone attracts sodium.
40. heparin prevents platelet aggregation.
41. PT/PTT are elevated when patient is on Coumadin (INR should be 2-3 for therapeutic effect)
42. Cardiac output decreases with dysrythmias. Dopamine increases BP.
43. Med of choice for Vtach is lidocaine * local anesthetic and class-1b antiarrhythmic drug Lidocaine toxicity SAMS:
Slurred or difficult speech (numbness in tongue/lips), Altered CNS (drowsy,confused, arrythmias),
Muscle twitching (tremors), Seizures (convulsions, \/ RR and HR)
44. Med of choice for SVT (supraventricular tachycardia) is adenosine (adenocard) *If Vagal maneuvers do not work.
45. Med of choice for Asystole (no heart beat) is atropine

46. Med of choice for CHF is Ace inhibitor (-pril). * BV, BP, vasodilates and heart demands
CAPTOPRIL
Cough
Angioedema / Agranulocystosis
Proteinuria / Potassium excess
Taste changes
Orthostatic hypotension
Pregnancy contraindication / Pancreatitis/ Pressure drop (first dose hypertension)
Renal failure (and renal artery stenosis contraindication) / Rash
Inflammation-related pain
Lower GFR / Liver toxicity
47. Med of choice for anaphylactic shock is Epinephrine
IDEA meds for \/HR and \/BP: Isoproterenol, Dopamine, Epinephrine, Atropine
Emerg drugs to LEAN on: Lidocaine, Epinephrine, Atropine, Narcan
48. Med of choice for Status Epilepticus is Ativan (Lorazepam), Valium (diazepam). Also treats anxiety disorders, alcohol
withdrawal symptoms, or muscle spasms.

49. Ativan and Thorazine calms pt down in the short term before other meds kick in.
50. Med of choice for bipolar is lithium (is a salt) 0.8 to 1.2 mEq/L. * If hyponatremia occurs, lithium reabsorption is increased and
toxicity results | NO DIURETICS. Give lytes and fluids ESP IN EXERCISE. NEED TO HAVE GOOD KIDNEYS AND THYROID. Watch for imbalances.

L- Level of therapeutic affect is 0.5-1.5

I- indicate mania
T- toxic level is 2-3 - N/V, diarrhea, tremors
H- Hydrate 2-3L of water/day
I- increased UO and dry mouth
U - Uh oh; give Mannitol and Diamox if toxic s/s are present
M- maintain Na intake of 2-3g/day
Symptoms of acute lithium toxicity
"CAN HAM SUCS"
Confusion, An increase of urine and thirst, Nausea
Hand tremors, Ataxia (in coordination of arms and legs), Muscle twitches
Seizures, Uncontrollable eye movement, Coma, Slurred Speech
*All psych meds' (except Lithium) side effects are the same as SNS but the BP is decreased.
*SNS- Increase in BP, HR and RR (dilated bronchioles), dilated pupils (blurred vision), Decreased GUT
(urinary retention), GIT (constipation), Constricted blood vessels and Dry mouth.
51. Amiodorone is effective in both ventricular and atrial complications.
52. S3 sound is normal in CHF, not normal in MI.
53. Protonix (pantoprazole) is given prophylactically to prevent stress ulcers.

54.
55.
56.
57.
58.
59.
60.
61.
62.
63.

After endoscopy check gag reflex.

TPN (total parenteral nutrition) given in subclavian line.*BS q 2hr-4hrs, never catch-up, watch for infection/weight gain, transition to food gradually.
Low residue diet means low fiber/milk. Use for abdo pre & post op to relieve pressure, crohn's, ulcerative colitis, and diverticulitis
Diverticulitis pain is around LL quadrant. Food gets stuck in pouches along intestine therefore no high residue foods.
With Chrons and Colitus carb and protein diet. Give anti diarrheal and anti cholinergic meds.
Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness.
Liver issues = Portal hypertension + hypoalbuminemia (liver makes albumin so) = Ascites.
Low albumin indicates malnutrition
Beta cells of pancreas produce insulin ( BS) and Glucagon ( BS).
With chronic pancreatitis and Cystic fibrosis, pancreatic enzymes are given with meals.*Bad if Steatorrhea (fatty
stool)

64. Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.
65. Never give K+ in IV push/SC/IM, always dilute. That is the DEATH penalty * Too much of the King Kills the heart.
66. Diabetic ketoacidosis (DKA) = when body is breaking down fat instead of sugar for energy. Fats leave
ketones (acids) that cause pH to decrease. Very rare in DM type II b/c there is enough insulin to
prevent breakdown of fats.
67. DKA Mangt KING UFC: K+ reduction, Insulin, Nasogastic tube (if patient comatose), Glucose (once serum levels
drop to 12), Urea (check it), Fluids (crystalloids/NaCl), Creatinine (check it)/ Catheterize

68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.

Sign of fat embolism is petechiae. Treated with heparin.

For knee replacement use continuous passive motion machine.
Give prophylactic antibiotic therapy before any invasive procedure.
Cataract= cloudy, blurry vision. Treated by lens removal-surgery
Co2 causes vasoconstriction.
Most spinal cord injuries are at the cervical or lumbar regions
Spinal shock occurs immediately after spinal injury
Multiple sclerosis= myelin sheath destruction, disruption in nerve impulse conduction.
Myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH
receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles.
Guillain-Barre syndrome (going up losing nerves) = ascending paralysis. Keep eye on respiratory system.
Parkinsons = RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa.
TIA (transient ischemic attack) mini stroke with no dead brain tissue
CVA (cerebrovascular accident) is with dead brain tissue.
Hodgkins disease= cancer of lymph is very curable in early stage.
Rule of NINES for burns | Head and Neck= 9% | Each Upper Ext= 9% | Each Lower Ext= 18% |
Abdomen = 9% | Chest= 9% | Upper Back = 9% | Lower Back = 9% |Genitalia= 1% = 100%

83. Birth weight doubles by 6 month and triple by 1 year of age.

84. If HR is <100 do not give digoxin to children.
85. First sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing
meconium. Cystic Fibrosis give diet low fat, high sodium, fat soluble vitamins ADEK. Aerosal
bronchodilators, mucolytics and pancreatic enzymes.
86. Heart defects. Remember for cyanotic -3Ts (ToF, Truncys arteriosus, Transposition of the great
vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically,
CHF will occur following by death.
87. with R side cardiac cath=look for valve problems | with L side in adults look for coronary complications.
88. Rheumatic fever can lead to cardiac valves malfunctions.*Inflammatory disease that can develop as a complication of inadequately treated strep throat
or scarlet fever.

89. Cerebral palsy = poor muscle control d/t birth injuries and/or decrease oxygen to brain tissues.

90.
91.
92.
93.
94.

ICP (intracranial pressure) should be <2. Measure head circumference.

Meningitis check for Kernigs/ Brudzinskis signs and stiff neck.
Wilms tumor is usually encapsulated above the kidneys causing flank pain. * DO NOT PALPATE IT MAY DISLODGE
Hemophilia is x-linked. Only mother passes disease to son.
When phenylalanine increases, brain problems occur.*depression, ADHD, Parkinson's disease, chronic pain, arthritis, alcohol
withdrawal

95. Bucks traction= knee immobility

Russell traction= femur or lower leg

Dunlop traction= skeletal or skin

Bryants traction= children <3y, <35 lbs with
femur fx.
96. place apparatus first then place the weight when putting traction
97. placenta should be in upper part of uterus and if it ruptures it is painful.
98. eclampsia is seizure.
99. Vertical c-section surgery will more likely have another c-section. Very high chance of another C.
100. Perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities.
101. Rh- mothers receive Rhogam to protect next baby. *negative ppl cant accept positive but positive accept all
102. Rhogam : given at 28 weeks, 72 hours post partum, IM. Only given to Rh NEGATIVE mother. Also if
indirect Coombs test is positive, dont need to give Rhogam cuz she has antibody only give if negative
coombs
103. Anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
104. Caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs
within 1 to 3 days.
105. Pathological jaundice= occurs before 24hrs and last7 days. *the path last 7 days
106. Physiological jaundice occurs after 24 hours.
107. Placenta previa = painless, there is bleeding. Placenta abruption = pain, but no bleeding.
108. Bethamethasone (celestone)=surfactant. Med for lung expansion.
109. Dystocia= baby cannot make it down to canal
110. pitocin med used for uterine stimulation
111. Magnesium sulfate (used to halt preterm labor) is contraindicated if deep tendon reflexes are
ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat (emergency).
112. Do not use why or I understand statement when dealing with patients
113. milieu therapy= taking care of patient/environment
114. Cognitive therapy= counseling
|
Crisis intervention=short term.
115. FIVE INTERVENTIONS FOR PSYCH PATIENTS: safety | setting limits | establish trusting relationship
|medications | least restrictive methods/environment.
126. SSRIs (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. If patients have hallucinations (sensory) redirect them. In delusions (false beliefs) distract them.
129. Alzheimers disease is a chronic, progressive, degenerative cognitive disorder that accounts for more
than 60% of all dementias
Atropine used to decrease secretions
Phenergan an antiemetic used to reduce nausea
Diazepam is a commonly used tranquilizer given to reduce anxiety before O.R.
Demerol is for pain control, Do not give demerol to pts with sickle cell crisis.
Iron injections should be given Z-track so they don't leak into SQ tissues.
All Physicians Earn Too Much Money/APE To Man: aortic, pulmonic, erbs point, tricuspid, and mitral areas
Cranial Nerves:

*I am sorry if this vulgar for some, but hey, it sticks

Oh
Oh
Oh
To
Touch
And
Feel
A
Girls
Velvet

|
Sensory=S
|
(Olfactory I)
Some
(Optic II)
Say
(Oculomotor III)
Marry
(Trochlear IV)
Money
(Trigeminal V)
But
(Abducens VI)
My
(Facial VII)
Brother
(Auditory VIII)
Says
(Glossopharyngeal IX) Big
(Vagus X)
Bras

Motor=M

Both=B

And
Hair

(Accessory XI)
(Hypoglassal XII)

Matter
Most

Developmental
2-3 months: turns head side to side
4-5 months: grasps, switch & roll
6-7 months: sit at 6 and waves bye-bye
8-9 months: stands straight at eight
10-11 months: belly to butt (phrase has 10 letters)*crawl 12-13 months: twelve and up, drink from a cup
Hepatitis
Hepatitis: -ends in a VOWEL, comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids
Hepatitis C is just like B
GLASGOW COMA SCALE. 4 EYES, VOCAL (Jackson 5), 6 Cylinder MOTOR/ENGINE!
EYE RESPONSE
1
2
3
4
5
6

E Does not open eyes

Y Opens eyes in response to painful stimuli
E Opens eyes in response to voice
S Opens eyes spontaneously
-------------------------------------------------------------------------------

VERBAL RESPONSE

MOTOR RESPONSE

V Makes no sounds
O Incomprehensible sounds
C Utters inappropriate words
A Confused, disoriented
L Oriented, converses normally
-----------------------------------

M Makes no movements
O Extension to painful stimuli
T Abnormal flexion to painful stimuli
O Flexion/Withdrawal to painful stimuli
R Localizes painful stimuli
S Obeys commands

The person who hyperventilates is most likely to experience respiratory alkalosis.

Signs of hypoxia: restless, anxious, cyanotic, tachycardia, increased resps. (Also monitor ABG's)
For blood types: "O" is the universal donor (remember "o" in donor) "AB" is the universal recipient
Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS, as to Localized Herpes Zoster is CONTACT
PRECAUTIONS.
A nurse with a localized herpes zoster CAN care for patients as long as the patients are NOT
immunosuppressed and the lesions must be covered!
Fat soluble vitamins are Vitamins A, D, E, K

ADEK is a fat so

Give NSAIDS, Corticosteroids, drugs for Bipolar,

Cephalosporins, and Sulfanomides WITH food. - antibiotics
When using a bronchodilator inhaler inconjuction with a glucocorticoid inhaler, administer the bronchodilator
first
INtal, an inhaler used to treat allergy induced asthma may cause bronchospasm, think INto the asthmatic
lung+
* Isoniazid of TX of TB can cause peripheral neuritis. do not give with dilantin, can cause phenytonin toxicity,
monitor LFT's, take Vit B6 to prevent also hepatotoxic, hypotension will occur initially, then resolve
Peptic ulcers caused by H. pylori are treated with Flagyl, Prilosec and Biaxin. This treatment kills bacteria and
stops production of stomach acid, but does not heal ulcer.
Weighted NI (Naso intestinal tubes) must float from stomach to intestine. Don't tape the tube right away
after placement, may leave coiled next to pt on HOB. Position patient on RIGHT to facilitate movement
through pylorus.
* Diaphragm must stay in place 6 hours after intercourse. They are also fitted so must be re-fitted if you
lose or gain a significant amount of weight.
* Best time to take Growth Hormone PM, Steroids AM, Diuretics AM, Aricept For Alzheimer AM.
* Non dairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS
* You can petal the rough edges of a plaster cast with tape to avoid skin irritation.
* With low back aches, bend knees to relieve
* Push fluids with Allopurinol - flush the uric acid out of system
* Nasuea and vomiting with all TB drugs.

*
*
*
*

Rifampin (antibiotic) - Red orange tears and urine, also contraceptives don't work as well. * For TB and infections
Ethambutol - messes with your Eyes * For TB and infections
Apply eye drop to conjunctival sac and after wards apply pressure to nasolacrimal duct / inner canthus
Pancreatitis patients but them in fetal position, NPO, gut rest, prepare antecubital site for PICC cuz they'll
probably be getting TPN & Lipids (hang higher). Issues with alcohol, gallstones, infections ( WBC), steroids. If
no TPN then fat and carb diet. These pts may have steatorrhea and hypoglycemia.
Trendelenburg test - for varicose veins. If they fill proximally = varicosity.

Yogurt has live cultures- dont give to immunosuppressed pt

Itching under cast area- cool air via blow dryer, ice pack for 10- 15 minutes.

NEVER use qtip or anything to scratch area

Murphys sign pain with palpation of gall bladder area seen with cholecystitis
Cullens sign (coloured umbilicus) ecchymosis in umbilical area, seen with pancreatitis
Turners sign flank grayish blue (turn around to see your flanks) pancreatitis
McBurneys Point pain in RLQ indicative of appendicitis |
RLQ appendicitis, watch for peritonitis
LLQ diverticulitis , low residue, no seeds, nuts, peas
Guthrie Test Tests for PKU, baby should have eaten source of protein first
Remember to perform the Allen's Test prior to doing an ABG to check for sufficient blood flow
Allens test occlude both ulnar and radial artery until hand blanches then release ulnar. If the hand pinks
up, ulnar artery is good and you can carry on with ABG/radial stick as planned. ABGS must be put on ice and
whisked to the lab. Testing for abnormal circulation, if color fails to return, the test is considered "Positive" (abnormal circulation is present) and the ulnar
artery supply to the hand is not sufficient. The radial artery therefore cannot be safely pricked/ cannulated.

When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles, put
on ice immediately after drawing, with a label indicating if the pt was on room air or how many liters of O2.
Its ok to have abdominal cramps, blood tinged outflow and leaking around site if the Peritoneal Dialysis cath
(tenkhoff) was placed in the last 1-2 wks. Cloudy outflow NEVER NORMAL.
Amniotic fluid yellow with particles = meconium stained
Hyper reflexes (upper motor neuron issue your reflexes are over the top)
Absent reflexes (lower motor neuron issue)
Latex allergies Assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados,
chestnuts, tomatoes, peaches
Amyotrophic lateral sclerosis (ALS) is a condition in which there is a degeneration of motor neurons in both
the upper & lower motor neuron systems.
Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical emergency). The 3 C's
of TEF in the newborn:
1) Choking
2) Coughing
3) Cyanosis
The MMR vaccine is given SQ not IM and at 12 months.
Red- Immediate: Injuries are life threatening but survivable with minimal intervention. Ex: hemothrax,
tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fx's of long
bones, and 2nd/3rd degree burn with 15%-40% of total body surface, etc.
Yellow- Delayed: Injuries are significant and require medical care, but can wait hrs without threat to life or
limb. Ex: Stable abdomen wounds without evidence of hemorrhage, fx requiring open reduction,
debridement, external fixation, most eye and CNS injuries, etc.
Green- Minimal: Injuries are minor and TX can be delayed to hrs or days . Individuals in this group should be
moved away from the main triage area. Ex: upper extremity fx, minor burns, sprains, sm. lacerations,
behavior disorders.
Black- Expectant: Injuries are extensive and chances of survival are unlikely. Separate but dont abandoned,

comfort measures if possible. Ex: Unresponsive, spinal cord injuries, woulds with anatomical organs, 2nd/3rd
degree burn with 60% of body surface area , seizures, profound shock with multipe injuries, no pulse, b.p,
pupils fixed or dilated.
Red--unstable, ie, occluded airway, actively bleeding, see first
Yellow---stable, can wait up to an hour for treatment, ie burns, see second
Green---stable, can wait even longer to be seen, "walking wounded"
Black--unstable clients that will probably not make it, need comfort measures DOA---dead on arrival
Orange - tag in triage is non emergent Psych
Greek heritage - they put an amulet or any other use of protective charms around their baby's neck to avoid
"evil eye" or envy of others
4 year old kids cannot interpret TIME. Need to explain time in relationship to a known COMMON EVENT (eg:
"Mom will be back after supper").
** Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine.
** Ask for allergy to eggs before Flu shot
** Ask for anaphylactic rxn to eggs or neomycin before MMR
** When on nitroprusside, monitor thiocynate (cyanide). Normal value should be 1, >1 is heading toward
toxicity
**If kid has cold, can still give immunizations
**SARS (severe acute resp syndrome) airborne + contact (just like varicella)
** Hepatitis A is contact precautions
** Tetanus, Hepatitis B, HIV are STANDARD precautions
** William's position - Semi Fowlers with knees flexed (inc. knee gatch) to relieve lower back pain.
** SIGNS of a Fractured hip SERA: SHORTENING, EXTERNAL ROTATION, ADDUCTION
** Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not acidosis r/t
tachypnea), hypocalcemia, increased serum lipids, "snow storm" effect on CXR.
**Complications of Mechanical Ventilation: Pneumothorax, Ulcers
** Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones.
** IVP (intravenous pyelogram) requires bowel prep so they can visualize the bladder better
**Acid Ash diet primarily protein and starch diets- cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
** Alk Ash diet- milk, veggies, rhubarb, salmon
** Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other
** BOTOX for strabismus. Patch the GOOD eye so that the weaker eye can get stronger.
** BOTOX ** (Botulin Toxin) can be used with strabismus also to relax vocal cords in spasmodic dysphonia.
** TIDAL VOLUME is 7 10ml / kg
** COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive), Pa0 2 of 60ish and Sa02 90% is
normal for them b/c they are chronic CO2 retainers.
** Neostigmine/Atropine (anticholinergic) to reverse effect of pancuronium. Wake up medications.
**Ampho B causes hypokalemia (gotta pre-medicate before giving. Pts will most likely get a fever). *antifungal
** Test for hypersensitivity before the administration of asparaginase. *used for acute lymphocytic leukemia
** Take (mebendazole) Vermox with high fat diet (increases absorption). Used to treat worm infections
** Kidney Glucose threshold is 180
** Stranger anxiety is greatest 7 - 9 months, Separation anxiety peaks in toddlerhood.
Asthma and Arthritis--swimming best

Asthma has intercostal retractions--be concerned

Before going for Pulmonary Function Tests (PFT's), a pt's bronchodilators will be with-held and they are not
allowed to smoke for 4 hrs prior
For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table, have
pt hold breath in mid-expiration, chest x-ray done immediately afterwards to check for complication of
pneumothorax, sterile dressing applied
Thoracentesis prep- Take VS, shave area around needle insertion, position patient with arms on pillow
on over bed table or lying on side, no more than 1000cc at a one time. Post- listen for bilateral breath

sounds, v.s., check leakage, sterile dressing.

For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards,
sterile dressing, and frequent neuro assessments
EEG, hold meds for 24-48 hrs prior, no caffeine or cigarettes for 24 hrs prior, pt can eat, pt must stay awake
night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG, assess pt
for seizures, pt's will be at increased risk
Dexedrine, used for ADHD, may alter insulin needs; avoid taking with MAOI's, take in morning (insomnia
possible side effect)
Cytovene, used for retinitis caused by cytomegalovirus, pt will need regular eye exams, report dizziness,
confusion, or seizures immediately
If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with fluids, med is incompatible with caffeine and
apple juice
Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia, tarditive
dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway), monitor for early signs of
reaction and give IM Benadryl. It has low incidence of hypotension and anticholingeric properties.
First line: Risperdal/Risperedone, antipsychotic, doses over 6mg can cause tarditive dyskinesia, first line
antipsychotic in children. Low EPS s/e and low dosages.
Clozapine/ Clozaril: needs a long term commitment works well. atypical antipsychotic medication used in the
treatment of schizophrenia. Chance of agranulocytosis therefore weekly cbcs. s/e tachycardia and seizures
Clonidine: D for drug withdrawal. HTN, and anxiety.
Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6,
Sinemet, for parkinsons, contraindicated with MAOI's
Hydroxyurea, for sickle cell, report GI symptoms immediately, could be sign of toxicity
Zocor, for hyperlipidemia, take on empty stomach to enhance absorption, report any unexplained muscle
pain, especially if fever
Decorticate is toward the 'cord'. Decerebrit is the other way (out)
-Munchausen Syndrome (M for medical care and S for self inflicted) is a psychiatric disorder that causes an
individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to
receive medical care or hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP), an
individual, typically a mother intentionally causes or fabricates illness in a child or other person under her
care.
-Multiple Sclerosis is a chronic, progressive disease with demyelinating lesions in the CNS which affect the
white matter of the brain and spinal cord.
Motor S/S: limb weakness, paralysis, slow speech
Sensory S/S: numbness, tingling, tinnitus
Cerebral S/S: nystagmus, ataxia, dysphagia, dysarthria
Huntington's Chorea: 50% genetic, autosomal dominant disorder S/S: chorea writhing, twisting,
movements of face, limbs and body
-gait deteriorates to no ambulation
-no cure, just palliative care
-WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)

-Definitive diagnosis for abd. aortic aneurysm (AAA) CT scan

-Uremic fetor smell urine on the breath
-Hirschsprungs

blockage large intestine

bile is lower obstruction, no bile is upper obstruction; ribbon like stools.

Thank you, I finally realize why a person shouldn't have cantaloupe before a occult stool test, because
cantaloupe is high in vit c and vit c causes a false + for occult blood. Now I just need to figure out why they
can't have fish.
Hypospadias: abnormality in which urethral meatus is located on the ventral (back) surface of the penis
anywhere from the corona to the perineum (remember hypo, low (for lower side or under side)
Epispadias: opening of the urethra on the dorsal (front) surface of the penis
Priapism: painful erection lasting longer than 6 hrs.
Anticholinergic effects- secretions-assessment dry mouth==can't spit, urinary retention=can't Pi$$ constipated
=can't $h!t blurred vision=can't see
Anticholinergic toxidrome: mad as a hatter (confused), hot as hell, red as a beat (redman syndrome), dry as
a bone, and blind as a bat.
Atropine Overdose
When you see Coffee-brown emesis, think peptic ulcer
Anytime you see fluid retention. Think heart problems first.
Questions about a halo? Remember safety first, have a screwdriver nearby.
Remember compartment syndrome is an emergency situation. Paresthesias and increased pain are classic
symptoms
Neuromuscular damage is irreversible 4-6 hours after onset.
Interpersonal model (Sullivan)
Behavior motivated by need to avoid anxiety and satisfy needs
1. Infancy 0-18 months others will satisfy needs
2. childhood >6yrs learn to delay need gratification
3. juvenile 6-9 years learn to relate to peers
4. preadolescence 9-12 yrs learns to relate to friends of opposite sex
5. early adolescence12-14yrs:learn independence and how to relate to opposite sex
6. late adolescence 14-21yrs: develop intimate relationship with person of opposite sex is this not about
communication?....
-upturned nose

-flat nasal bridge

Fetal alcohol syndrome

-thin upper lip

-SGA

vastus lateralis is IM administration site for 6month infants

for toddlers above 18 months: ventrogluteal
the deltoid and gluteus maximus are appropriate sites for children
OU- both eyes OS- left eye

OD- right eye (dominant Right eye- just a tip to remember)

1. COAL (cane walking): C cane O - opposite A - affected L - leg

CT- assess allergies
MRI- claustrophobia, no metal, assess pacemaker
Cardiac catheter- NPO 8-12hr, empty bladder, pulses, tell pt may feel heart palpitations or desire to cough
with dye injection.
Post- Vital signs keep leg straight bedrest 6-8hr.
Cerebral angio prep- well hydrated, lie flat, sire shaved, pulses marked

Post - keep flat 12-14hr, check site, pulses, force fluids.

Lumbar puncture - fetal position.
Post - neuro assess q15-30 until stable, flat 2-3hr, encourage fluids, oral analgesics for headache, observe
dressing
EEG- no sleep the night before, meals not withheld, no stimulants for 24hr before, tranquilizer/stimulant
meds held 24-48hr before, may be asked to hyperventilate 3-4min and watch a bright flashing light.
Myelogram- Npo 4-6hr, allergy hx, phenothiazines, cns depressants, and stimulants withheld 48hr prior, table
will be moved to various positions during test.
Post- neuro q2-4, water soluble HOB up, oil soluble HOB down, oral analgesics for h/a, encourage po
fluids, assess for distended bladder, inspect site.
Liver biopsy- Adm vit k , npo morning of exam 6hr, give sedative, Teach pt that he will be asked to hold
breath for 5-10sec, supine position, lateral with upper arms elevated.
Post - position on right side, frequent VS, report severe ab pain stat, no heavy lifting 1wk.
Liver issue leads to HTN, albumin, PLT, HCT, Hgb, but in ammonia (neuro issues results). Give protein diet
since albumin is produced there. Skin may turn orange and in gas with sour smell.
Paracentesis- semi fowlers or upright on edge of bed, empty bladder.
Post- VS, report elevated temp, observe for signs of hypovolemia.
Laparoscopy- CO2 used to enhances visual, general anesthesia, Foley.
Post- walk patient to decrease CO2 build up used for procedure.
Pyelogram- assess allergies
Hemovac- used after mastectomy, empty when full or q8hr, remove plug, empty contents, place on flat
surface, cleanse opening and plug with alcohol sponge, compress evacuator completely to remove air,
release plug, check system for operation.
http://www.currentpsychiatry.com/home/article/mnemonics-in-a-mnutshell-32-aids-to-psychiatricdiagnosis/ce6ce4b6b4429382a239bf4db99000c2.html

Common Signs and Symptoms

1.
Pulmonary tuberculosis low-grade afternoon fever.
2.
PNEUMONIA rusty sputum.
3.
ASTHMA wheezing on expiration.
4.
EMPHYSEMA barrel chest.
5.
KAWASAKI SYNDROME strawberry tongue.
6.
PERNICIOUS ANEMIA Red, Beffy tongue; will take Vit.B12 for life!

Cant absorb enough vitamin B12 from food. This

is because they lack intrinsic factor, a protein made in the stomach. A lack of this protein leads to vitamin B12 deficiency. Shilling Test test for
pernicious anemia/ how well one absorbs Vit B12. Any intestine surgery will affect b12 absorption therefore may need b12 shots as well.

7.
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DOWN SYNDROME protruding tongue.

CHOLERA rice watery stool.
MALARIA stepladder like fever with chills.
TYPHOID rose spots in abdomen.
DIPTHERIA pseudo membrane formation
MEASLES Koplick's spots: red spots with blue center - PRODROMAL stage of Measles. Usually in mouth.
SLE butterfly rashes. Affects minorities, reduce stress/infection/injury, there are remissions, joint pain and cardiac. serum comp test. nsaids, quilinlone, steroids.
LIVER CIRRHOSIS spider like varices.
LEPROSY lioning face.
BULIMIA chipmunk face.
APPENDICITIS rebound tenderness.
DENGUE petechiae or (+) Hermans sign.
MENINGITIS Kernigs sign (leg flex then leg pain on extension), Brudzinski sign (neck flex = lower leg flex).
TETANY hypocalcemia (+) Trousseaus sign/carpopedal spasm; Chvostek sign (facial spasm).
TETANUS risus sardonicus. - lockjaw

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PANCREATITIS Cullens sign (ecchymosis of umbilicus); (+) Grey turners spots.

PYLORIC STENOSIS olive like mass. Exceedingly volatile vomiting.
PDA machine like murmur.
ADDISONS DISEASE bronze like skin pigmentation.
CUSHINGS SYNDROME moon face appearance and buffalo hump.
HYPERTHYROIDISM/GRAVES DISEASE exopthalmus.
INTUSSUSCEPTION sausage shaped mass, Dance Sign (empty portion of RLQ)
MS Charcots Triad (IAN)
MG descending muscle weakness
Guillain Barre Syndrome ascending muscle weakness
DVT Homans Sign
CHICKEN POX Vesicular Rash (central to distal) dew drop on rose petal
ANGINA Crushing stubbing pain relieved by NTG
MI Crushing stabbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG
LTB inspiratory stridor
TEF 4Cs Coughing, Choking, Cyanosis, Continuous Drooling
EPIGLOTITIS 3Ds Drooling, Dysphonia, Dysphagia
HODGEKINS DSE/LYMPHOMA painless, progressive enlargement of spleen & lymph tissues,
Reedstenberg Cells
INFECTIOUS MONONUCLEOSIS Hallmark: sore throat, cervical lymph adenopathy, fever
PARKINSONS Pill-rolling tremors
FIBRIN HYALIN Expiratory Grunt
CYSTIC FIBROSIS Salty skin
DM polyuria, polydypsia, polyphagia
DKA Kussmauls breathing (Deep Rapid RR)
BLADDER CA painless hematuria
BPH reduced size & force of urine
PEMPHIGUS VULGARIS Nikolskys sign (separation of epidermis caused by rubbing of the skin)
RETINAL DETACHMENT Visual Floaters, flashes of light, curtain vision
GLAUCOMA Painless vision loss, tunnel/gun barrel/halo vision (Peripheral Vision Loss)
CATARACT Painless vision loss, Opacity of the lens, blurring of vision
RETINO BLASTOMA Cats eye reflex (grayish discoloration of pupils)
ACROMEGALY Coarse facial feature
DUCHENNES MUSCULAR DYSTROPHY Gowers sign (use of hands to push ones self from the floor)
GERD Barretts esophagus (erosion of the lower portion of the esophageal mucosa)
HEPATIC ENCEPHALOPATHY Flapping tremors
HYDROCEPHALUS Bossing sign (prominent forehead)
INCREASE ICP HYPERtension BRADYpnea BRADYcardia (Cushings Triad)
SHOCK HYPOtension TACHYpnea TACHYcardia
MENIERES DSE Vertigo, Tinnitus
CYSTITIS burning on urination
ULCERATIVE COLITIS recurrent bloody diarrhea
LYMES DSE Bulls eye rash

Ottorhea s/s of basilar fracture

Battles sign and racoons eyes s/s of orbital fracture
Take iron elixir with juice or water.... never with milk
Kawasaki's leads to
cardiac problems
Osteomyletitis is an infectious bone dz. Give blood cultures and antibiotics, then if necessary surgery to drain
abscess.
Nephrotic syndrome s/s edema + hypotension (d/t proteinuria, hypoalbuminemia)
Glomerulonephritis: take VS q 4 hrs + daily weights.
Turn and reposition (risk for impaired skin integrity)
To access role relationship pattern focus on image and relationships with others.

Age 4 to 5 yrs child needs DPT/MMR/OPV

Zoloft s/e agitation, sleep disturb, and dry mouth
Blood tests for MI: Myoglobin, CK-MB (sign of M.I. MB-myocardial breakdown) and Troponin.
CK-MM (M for all muscles). Thalium imaging for viewing heart and determine function.
2 types: stress no substances, NPO after 12 am, radioactive tracker, activity cloths, any pain needs to be
expressed immediately.
Resting first few hours after M.I.
Placental abruptio: bleeding with pain, don't forget to monitor volume status (I&O)
An ill child regresses in behaviors
Babinski sign - toes curl great! toes fan bad
Glucose Tolerance Test for preggies result of 140 or higher needs further evaluation.
Assessing extraocular eye movements check cranial nerves 3, 4, and 6.
Stomas dusky stoma means poor blood supply, protruding means prolapsed, sharp pain + rigidity means
peritonitis, mucus in ileal conduit is expected.
Phenobarbital can be taken during pregnancy but Dilatin is contraindicated.
Tension pneumothorax trachea shifts to opposite side.
*Change in color is always a LATE sign!
*Incentive Spirometry steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds, and
then HOLD for 10 seconds
*Aminoglycocide (Mycin ; except erythromycine) Adverse Effects are bean shaped
Nephrotoxic to Kidneys and Ototoxic to Ears
*MRSA - Contact precaution ONLY
*VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure)
*Blood transfusion- sign of allergies in order: 1) Flank pain 2) Frequent swallowing 3) Rashes 4) Fever 5)
Chills
*Thrombocytopenia -Bleeding precautions! Soft bristled toothbrush, No insertion of anything! (c/i
suppositories, douche)
Know IM meds as much as possible!
*Iron deficiency anemia - easily fatigued
1) Fe PO - give with Vitamin C or on an empty stomach 2) Fe via IM- Inferon via Z-track
*BURNS
1st Degree - Red and Painful
2nd Degree - Blisters
3rd Degree - No Pain because of blocked and burned nerves
*Meniere's Disease - Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear
when in bed. Triad: 1)Vertigo 2)Tinnitus 3)N/V
*Gastric Ulcer pain occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away with
food
Pediatric Tips:
What is an intraosseous infusion? In pediatric life-threatening emergencies, when IV access cannot be
obtained, an osseous (bone) needle is hand-drilled into a bone (usually the tibia), where crystalloids,
colloids, blood products and drugs can be administered into the marrow. It is a temporary, life-saving
measure, and I have seen it once! When venous access is achieved it can be d/cd. One medication that
cannot be administered by intraosseous infusion is isoproterenol, a beta agonist. (I dont know more about
that drug; it was just pointed out on a practice exam.)
During sickle cell crisis there are two interventions to prioritize: fluids and pain relief. Give O2
With glomerulonephritis you should consider blood pressure to be your most important assessment

parameter. Dietary restrictions you can expect include fluids, protein, sodium, and potassium.
Congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature
rbcs) Labs supporting this would show increased hematocrit, hemoglobin, and rbc count.
Did you know there is an association between low-set ears and renal anomalies? Now you know what to
look for if downs isnt there to choose. (the kidneys and ears develop around the same time in utero. Hence,
they're shaped similarly. Which is why when doing an assessment of a neonate, if the nurse notices low set
or asymmetrical ears; there is good reason to investigate renal functioning. Knowing that the kidneys and
ears are similar shapes helped me remember this).
School-age kids (5 and up) are old enough, and should have an explanation of what will happen a week
before surgery such as tonsillectomy.
If you gave a toddler a choice about taking medicine and he says no, you should leave the room and come
back in five minutes, because to a toddler it is another episode. Next time, dont ask.
The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. Later
you may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings.
We know Kawasaki disease causes a heart problem, but what specifically? Coronary artery aneurysms
d/t the inflammation of blood vessels.
A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is where the
shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles. You should watch
for abdominal distention, since fluid from the ventricles will be re- directed to the peritoneum. You should
also watch for signs of increasing intracranial pressure, such as irritability, bulging fontanels, and highpitched cry in an infant. In a toddler watch lack of appetite and headache. Careful on a bed position question!
Bed-position after shunt placement is flat, so fluid doesnt reduce too rapidly. If you see s/s of increasing
icp, then raise the hob to 15-30 degrees.
What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. Mechanical
ventilation can cause it. Premature newborns with immature lungs are ventilated and over time it damages
the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or
scarring.
It is essential to maintain nasal patency with children < 1 yr. because they are obligatory nasal
breathers.
Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good, right?)
Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia with milkaholics. And dont let that mother put anything but water in that kids bottle during naps/over-night. Juice or
milk will rott that kids teeth right out of his head.
What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage?
Ninety, ninety. Huh? I never heard of it either. The name refers to the angles of the joints. A pin is placed
in the distal part of the broken bone, and the lower extremity is in a boot cast. The rest is the normal pulleys
and ropes youre used to visualizing with balanced suspension. While were talking about traction, a kids
hinder should clear the bed when in Bryants traction (also used for femurs and congenial hip for young
kids).
TRACTION: Temperate, Ropes hang freely, Alignment, Circulation check (5Ps), Type & location of fracture,
Increase fluid intake, Overhead trapeze, No weights on bed or floor
If you can remove the white patches from the mouth of a baby it is just formula. If you cant, its
candidiasis.
Just know the MMR and Varicella immunizations come later (12-15 months).
Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start
teaching boys testicular self exam around 12 (in bath or shower), because most cases occur during

adolescence.
A guy loses his house in a fire. Priority is using community resources to find shelter, before assisting with
feelings about the tremendous loss. (Maslow).
No aspirin with kids b/c it is associated with Reyes Syndrome, and also no NSAIDS such as ibuprofen. Give
Tylenol.
CSF in meningitis high protein, and low glucose. Usually CSF is /\ in glucose, \/ in protein and clear.
It is always the correct answer to report suspected cases of child abuse.
No nasotracheal suctioning with head injury or skull fracture.
Feed upright to avoid otitis media.
Position prone w hob elevated with gerd. In almost every other case, though, you better lay that kid on his
back (Back To Sleep - SIDS).
Pull pinna down and back for kids < 3 yrs. when instilling eardrops.
Kids with RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being administered by
hoot, tent, etc.
Positioning with pneumonia lay on the affected side to splint and reduce pain. But if you are trying to
reduce congestion the sick lung goes up. (Ever had a stuffy nose, and you lay with the stuff side up and it
clears?)
A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease.
Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer stops
wheezing. It could mean he is worsening.
You better pick do vitals before administering that dig. (apical pulse for one full minute).
Tet spells treated with morphine.
Morphine: side-effects MORPHINE: Myosis, Out of it (sedation), Respiratory depression, Pneumonia
(aspiration), Hypotension, Infrequency (constipation, urinary retention), Nausea, Emesis

Group-A strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body
movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to
be elevated. Penicillin!
Dont pick cough over tachycardia for signs of chf in an infant.
Random Tips:
No milk (as well as fresh fruit or veggies) on neutropenic precautions.
Tylenol poisoning liver failure possible for about 4 days. Close observation required during this timeframe, as well as TX with Mucomyst.
Radioactive iodine The key word here is flush. Flush substance out of body w/3-4 liters/day for 2 days,
and flush the toilet twice after using for 2 days. Limit contact w/patient to 30 minutes/day. No pregnant
visitors/nurses, and no kids.
The main hypersensitivity reaction seen with antiplatelet drugs is bronchospasm (anaphylaxis).
Common sites for metastasis include the liver, brain, lung, bone, and lymph.
Orthostasis is verified by a drop in pressure with increasing heart rate.

Bence Jones protein in the urine confirms multiple myeloma.

Dont fall for reestablishing a normal bowel pattern as a priority with small bowel obstruction. Because the
patient cant take in oral fluids maintaining fluid balance comes first.
Pernicious anemia s/s include pallor, tachycardia, and sore red tongue.
With flecainide (Tambocor), an antiarrythmic, limit fluids and sodium intake, because sodium increases
water retention which could lead to heart failure.
Basophils release histamine during an allergic response.
Adenosine is the treatment of choice for paroxysmal atrial tachycardia.
Iatragenic means it was caused by treatment, procedure, or medication.
Other than initially to test tolerance, G-tube and J-tube feedings are usually given as continuous feedings.
Four side-rails up can be considered a form of restraint. Even in LTC facility when a client is a fall risk,
keep lower rails down, and one side of bed against the wall, lowest position, wheels locked.
Your cancer patient is getting radiation. What should you be most concerned about? Skin irritation? No.
Infection kills cancer patients most because of the leukopenia caused by radiation.
A breast cancer patient treated with Tamoxifen should report changes in visual acuity, because the adverse
effect could be irreversible.
Pneumovax 23 gets administered post splenectomy to prevent pneumococcal sepsis.
Lets say every answer in front of you is an abnormal value. If potassium is there you can bet it is a
problem they want you to identify, because values outside of normal can be life threatening. Normal
potassium is 3.5-5.0. Even a bun of 50 doesnt override a potassium of 3.0 in a renal patient in priority.
You better be making sure that patient on Dig and Lasix is getting enough potassium, because low
potassium potentiates Dig and can cause dysrrhythmias.
You will ask every new admission if he has an advance directive and if not you will explain it, and he will
speak with physician and have the option to sign or not.
An example of when you would implement before going through a bunch of assessments is when someone is
experiencing anaphylaxis. Get the ordered epinephrine in them stat, especially if it clearly states the s/s
(difficulty breathing, increasing anxiety, etc.)
In a disaster you should triage the person who is most likely to not survive last.
A little trick regarding potassium:
ALKALOSIS: K is LOW
Acidosis is just the opposite: K is High
The vital sign you should check first with high potassium is pulse (due to dysrhythmias).
Anectine is used for short-term neuromuscular blocking agent for procedures like intubation and ECT.
Norcuron is for intermediate or long-term.
The parathyroid gland relies on the presence of vitamin D to work.
Glucagon increases the effects of oral anticoagulants.
Bleeding is part of the circulation assessment of the ABCDs in an emergent situation. Therefore, if airway
and breathing are accounted for, a compound fracture requires assessment before Glasgow coma scale and a
neuro check (D=disability, or neuro check)
The immediate intervention after a sucking stab wound is to dress the wound and tape it on three sides

which allows air to escape. Do not use an occlusive dressing, which could convert the wound from open
pneumo to closed one, and a tension pneumothorax is worse situation. After that get your chest tube tray,
labs, iv.
An occlusive dressing is used if a chest tube is accidentally pulled out of the patient.
When o2 deprived, as with a PE, the body compensates by causing hyperventilation (resp alkalosis). Should
the patient breathe into a paper bag? No. If the pao2 is well below 80 they need oxygen. Look at all your
abg values. As soon as you see the words PE you should think oxygen first.
A typical adverse reaction to oral hypoglycemics is rash, photosensitivity.
Serum acetone and serum ketones rise in DKA. As you treat the acidosis and dehydration expect the
potassium to drop rapidly, so be ready, with potassium replacement.
Fluids are the most important intervention with HHNS as well as DKA, so get fluids going first. With HHNS
there is no ketosis, and no acidosis. Potassium is low in HHNS (d/t diuresis).
Atropine blocks acetylcholine (remember it reduces secretions).
Decorticate positioning in response to pain = Cortex involvement. Decerebrate in response to pain =
Cerebellar, brain stem involvement
Dantrium, for spasticity

muscles are continuously tight or stiff

, may take a week or more to be effective.

Decreased acetylcholine is related to senile dementia.

Hyperactive deep tendon reflexes, vision changes, fatigue and spasticity are all symptoms of MS
After removal of the pituitary gland you must watch for hypocortisolism and temporary diabetes
insipidus.
Position on right side with legs flexed after appendectomy.
Hirschsprungs diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in
infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.
IntussusCeption common in kids with Cystic Fibrosis. Obstruction may cause fecal emesis, Currant jellylike stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping.
Resolution is obvious, with onset of bowel movements.
With omphalocele infant's intestine or other abdominal organs are outside of the body because of a hole in the belly button and gastroschisis (herniation of abdominal contents)
dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat
quickly.
After a hydrocele repair provide ice bags and scrotal support.
No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame). Baby is born without the
ability to properly break down an amino acid called phenylalanine
Second voided urine most accurate when testing for ketones and glucose.
Never give potassium if the patient is oliguric or anuric.
Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular
damage. Corticosteroids are the mainstay. Generalized edema common.
A PCR in a child <18 months (presence of HIV antibodies) indicates only that child is infected. Serological
assays are used to test adults now.

For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is
avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on
the mouth, and not share eating utensils.
Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.
An antacid should be given to a mechanically ventilated patient w/ an NG tube if the ph of the
aspirate is <5.0. Aspirate should be checked at least every 12 hrs.
Ambient air (room air) contains 21% oxygen.
The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis.
Normal PCWP (pulm capillary wedge pressure) is 8-13. Readings of 18-20 are considered high.
First sign of PE is sudden chest pain, followed by dyspnea and tachypnea.
High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium
out). Carbon dioxide narcosis causes increased intracranial pressure.
Pulmonary sarcoidosis leads to right sided heart failure.
An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an
NG tube.
Digitalis increases ventricular irritability, and could convert a rhythm to v-fib following cardioversion.
If your normally lucid patient starts seeing bugs you better check his respiratory status first. The first sign
of hypoxia is restlessness, followed by agitation, and things go downhill from there all the way to delirium,
hallucinations, and coma. So check the o2 stat, and get abgs if possible.
The biggest concern with cold stress and the newborn is respiratory distress.
Lasix can cause a patient to lose his appetite (anorexia) due to reduced potassium.
If your laboring moms water breaks and she is any minus station you better know there is a risk of
prolapsed cord.
In a five-year old breathe once for every 5 compressions doing cpr.
After g-tube placement the stomach contents are drained by gravity for 24 hours before it can be used for
feedings.
Cephalhematoma (caput succinidanium) resolves on its own in a few days. This is the type of edema that
crosses the suture lines.
During the acute stage of Hep-A gown and gloves are required. In the convalescent stage it is no longer
contagious.
Low magnesium and high creatinine signal renal failure. Pain is usually the highest priority with RA
If a TB patient is unable/unwilling to comply with TX they may need supervision (direct observation). TB is a
public health risk.
Level of consciousness is the most important assessment parameter with status epilepticus.
Crackles suggest pneumonia, which is likely to be accompanied by hypoxia, which would manifest itself as
mental confusion, etc.
Cant cough=ineffective airway clearance
Absence of menstruation leads to osteoporosis in the anorexic.

Toddlers need to express autonomy (independence)

A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as
dark stools.
A laxative is given the night before an IVP in order to better visualize the organs.
A patient with liver cirrhosis and edema may ambulate, then sit with legs elevated to try to mobilize the
edema.
After pain relief, cough and deep breathe is important in pancreatitis, because of fluid pushing up in the
diaphragm.
Safety over Nutrition with a severely depressed client.
Prolonged hypoxemia is a likely cause of cardiac arrest in a child.
Fluid volume overload caused by IVC fluids infusing too quickly (or whatever reason) and CHF can cause
an S3
Coarctation of the aorta causes increased blood flow and bounding pulses in the arms
A newly diagnosed hypertension patient should have BP assessed in both arms
Depression often manifests itself in somatic ways, such as psychomotor retardation, GI complaints, and
pain.
Respiratory problems are the chief concern with CF
speaking of TB... PPD is positive if area of induration is:
>5 mm in an immunocompromised patient
>10 mm in a normal patient
>15 mm in a patient who lives in an area where TB is very rare.
HbA1c - test to assess how well blood sugars have been controlled over the past 90-120 days. 4- 6
corresponds to a blood sugar of 70-110; 7 is ideal for a diabetic and corresponds to a blood sugar of 130.
BSA is considered the most accurate method for medication dosing with kids. (I thought it was weight, but
apparently not)
Place a wheelchair parallel to the bed on the side of weakness
If one nurse discovers another nurse has made a mistake it is always appropriate to speak to her before
going to management. If the situation persists, then take it higher.
Sepsis and anaphylaxis (along with the obvious hemorrhaging) reduce circulating volume by way of
increased capillary permeability, which leads to reduced preload (volume in the left ventricle at the end of
diastole). This is a toughiethink about it.
Amniotic fluid is alkaline, and turns nitrazine paper blue. Urine and normal vaginal discharge are acidic,
and turn it pink.
Gonorrhea is a reportable disease
Remember the phrase step up when picturing a person going up stairs with crutches. The good leg goes
up first, followed by the crutches and the bad leg. The opposite happens going down. The crutches go first,
followed by the good leg.
While treating DKA, bringing the glucose down too far and too fast can result in increased intracranial

pressure d/t water being pulled into the CSF.

Remember the action of vasopressin because it sounds like press in, or vasoconstrict.
Water intoxication will be evidenced by drowsiness and altered mental status in a patient with TUR
syndrome, or as an adverse reaction to desmopressin (for diabetes insipidus).
Extra insulin may be needed for a patient taking Prednisone (remember, steroids cause increased
glucose).
Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure
Patients with GERD should lay on their left side with the HOB elevated 30 degrees. Lying on Your Left Side Eases Heartburn
In emphysema the stimulus to breathe is low PO2, not increased PCO2 like the rest of us, so dont slam
them with oxygen. Encourage pursed-lip breathing which promotes CO2 elimination, encourage up to
3000mL/day fluids, high-fowlers and leaning forward.
Theophylline

(10-20)

causes GI upset, give with food.

TB drugs are liver toxic. (Does your patient have hepB?) An adverse reaction is peripheral neuropathy
give b vit.

blockers-(olols) (propranolol):
Pharmacodynamics (Action): Antagonists of sympathetic system receptors PVR and rate resulting in BP
Indication: hypertension, angina, Hf, M.I.
Contraindications: block (obstruction in the conduction system of the heart), bradycardia (<60bpm), CHF, COPD, diabetes
Adverse Effects: bradycardia, bronchospasm, hypoglycaemia
Check blood glucose lvl, heart rate (apical only for a full min, should be >60), BP, lung sounds
D.A.S.H diet (dietary approaches to stop hypertension) Lower sodium intake and increase K
Morphine Sulfate, Haldol, Thorazine, Fluoxetine, Lithium, Digoxin, Atropine, and Phenobarbital are a few.
Know what toxicity looks like and know the top side effects for certain groups of drugs. For example, all of
the drugs that treat TB can cause drug-induced hepatotoxicity. So, if a question states that a patient is being
treated for TB and asks what labs to monitor, you know to monitor AST and ALT.

Just remember that Nephrotic syndrome involves the loss of a lot of protein, whereas Nephritic
syndrome involves the loss of a lot of blood.
Nephritic Syndrome: PHARAOH: Proteinuria & Edema, Hematuria, Azotemia (nitrogen), RBC casts, AntiStrep titres (if post strep), Oliguria, Hypertension
Nephrotic Syndrome: People Have Endless Appetites - Protienuria, Hyperlipidemia, Edema, Albuminuria &
hypoalbuminemia
Endocarditis: FROM JANE: Fever, Roths spots, Oslers nodes, Murmur, Janeway lesions, Anemia, Nail
hemorrhage (splinter hemorrhages), Emboli
Limited Scleroderma: CREST: Calcinosis, Raynauds syndrome, Esophageal motility disorder, Sclerodactyly,
Telangiectasia
Hypothalamus Functions: TAN HATS: Thirsts & water balance, Adenohypophysis, Neurohypophysis, Hunger
and satiety, Autonomic regulation, Temperature regulation, Sexual urges and emotions
Think of Hal and Amus as the 2 directors of the sensations.
Streptococcus causes: GET NIPPLES: Glomerulonephritis, Endocarditis (Heart valves), Toxic shock
syndrome, Necrotizing fasciitis and myositits, Impetigo, Pharyngitis, Pneumonia, Lymphangitis, Erysipelas
and cellulitis, Scarlet fever/Rheumatic fever
Bartholomew's rule of fourths: A rule for determining the duration of pregnancy by measuring the height of
the fundus of the uterus above the pubic symphysis. 12 wks symphisis, 16 wks midway btw symphyisis
& umbilicus, 20 wks Umbilicus, 36 wks Xiphoid process
Primary Syphilis: PRESS: Painless lesion, Regional lymphadenopathy, Exudate, Single lesion, Sexual contact
can cause
Secondary Syphilis: CAMP: Condyloma lata, Acute infection symptoms (fever, sore throat, malaise, weight
loss), Mucocutaneous lesion, Mucous patches, Papules & pustules
Tertiary Syphilis: CLASS: Cardiovascular disorder, Latebenign syphilis (gumma), Asymptomatic
Neurosyphilis, Symptomatic Neurosyphilis, Seizures and apathy (signs of meningeal involvement)
Attenuated Vaccines: ROME, Is My Best Place To Yell!
Rubella, OPV, Measles, Epidemic typhus, Influenza, Mumps, BCG, Plague, Typhoid oral vaccine, Yellow fever
Stages of Shock: CPR: Compensatory, Progressive, Refractory
Causes of Shock: HAVANA: Hypovolemia, Adrenal crisis, Vascular stasis, Acute respiratory obstruction,
Neurogenic, Anaphylaxis
Secondary causes of HTN: A Aldosterone/apnea, B Bad Kidney/Bruits, C Catecholamines/cushings
syndrome, D Drugs/diet, E Endocrine
Hormones that /\ Glucose: STENGG: Somatotropin (growth hormone), Thyroid hormones (Throxine and
triiodothyronine), Epinephrine, Norepinephrine, Glucagon, Glucocorticosteroids
Ecoli causes: DUNG Diarrhe, UTI, Neonatal meningitis, Gram negative sepsis
Liver Functions: PUSH DoG: Protein synthesis, Ureas synthesis, Storage, Hormone synthesis,
Detoxification, Glucose and fat metabolism
Compensation RUB MUB Respiratory uses Bicarb, Metabolic uses breathing
- Respiratory Uses Bicarb, Metabolic Uses Breathing
- Respiratory Acidosis: Retain Bicarb

- Respiratory Alkalosis: Excrete Bicarb

- Metabolic Acidosis: Increase Ventilation
Hypoglycemia: TIRED: Tachycardia, Irritability, Restlessness, Excessive hunger, Diaphoresis
CAPTOPRIL: Cough, Angioedema/Agranulocystosis, Proteinuria / Potassium excess, Taste changes,
Orthostatic hypotension, Pregnancy contraindication / Pancreatitis/ Pressure drop (first dose hypertension),
Renal failure (and renal artery stenosis contraindication) / Rash, Indomethacin inhibition, Leukopenia /Liver
toxicity

Lantus
Lasix
Levadopa
Lithium
Marplan (MAOI)
Nardil (MAOI)
Neoral
Parnate (MAOI)
Remeron
Tegretal
Theo-Dur

Ancef
Cialis
Calan
Catapress
Desmopressin
Digoxin
Dopamine
Flagyl
Fluticasone

Tridil
Vasotec
Viagra
Zoloft
Zrytec
Rispiredone
Clonazapam
Tagamet and Zantac H2
Antgonist for GI upset.

Common Drug Name Stems Cheat Sheet

Below is a cheat sheet table that has three columns: Drug Stem, Drug Class, and an Example. Each stem has hyphens
at one or both ends of its text to show that it is found at the beginning, end, or in the middle of the generic name.

Drug
Stem

Drug Class and/or Stem Explanation

Examples

alol

Combined alpha and beta blockers

labetalol, medroxalol

andr

Androgens

nandrolone

anserin

Serotonin 5HT(sub)2 receptor antagonists

altanserin, tropanserin, altanserin

arabine

Antineoplastics (arabinofuranosyl derivatives)

fludarabine

ase

Enzymes

alglucerase, dornase alfa

azepam

Antianxiety agents (diazepam type)

lorazepam

azosin

Antihypertensives (prazosin type)

doxazosin

bactam

Betalactamase inhibitors (antibiotic)

sulbactam

bamate

Tranquilizers/antiepileptics

meprobamate, felbamate

barb

Barbituric acid derivatives (CNS depressant)

phenobarbital

butazone

Antiinflammatory analgesics (phenylbutazone type)

mofebutazone

caine

Local anesthetics

dibucaine

cef

Cephalosporins (antibiotic)

cefazolin

cillin

Penicillins (antibiotic)

ampicillin

conazole

Antifungals (miconazole type)

fluconazole, oxiconazole

cort

Cortisone derivatives (from adrenal cortex)

Hydrocortisone,

curium

Neuromuscular blocking agents

atracurium

cycline

Antibiotics (tetracycline type)

minocycline

dralazine

Antihypertensives (hydrazinephthalazines)

hydralazine

glucocorticoids, minerialcorticoids

erg

Ergot alkaloid derivatives (for migraines & muscles)

pergolide

estr

Estrogens

estrone

fibrate

Antihyperlipidemics

bezafibrate

flurane

Inhalation anesthetics

enflurane, isoflurane

gest

Progestins

megestrol

irudin

Anticoagulants

desirudin

leukin

Interleukin2 derivatives (simulate WBC growth)

teceleukin, aldesleukin

lukast

Leukotriene antagonists (Bronchospasms)

montelukast, zafirlukast

mab

Monoclonal antibodies

capromab, daclizumab, detumomab,

mantadine Antivirals

rimantadine

monam

Monobactam antibiotics

gloximonam

mustine

Antineoplastics

carmustine

mycin

Antibiotics (streptomyces strains)

lincomycin

olol

Betablockers (propranolol type)

timolol, atenolol

olone

Steroids (no prednisone derivatives)

minaxolone

oxacin

Antibiotics (quinolone derivatives)

difloxacin, ciprofloxacin

pamide

Diuretics (sulfamoylbenzoic acid derivatives)

adipamide

pamil

Coronary vasodilators

tiapamil

parin

Heparin derivatives and low molecular weight (or

depolymerized) heparins

heparin, tinzaparin, dalteparin

peridol

Antipsychotics (haloperidol type)

haloperidol

poetin

Erythropoietins

epoetin alfa, epoetin beta

pramine

Antidepressants (imipramine type)

lofepramine

pred

Prednisone derivatives

prednicarbate, cloprednol

pril

Antihypertensives (ACE inhibitors)

enalapril, temocapril, spirapril

profen

Antiinflammatory/analgesic agents (ibuprofen type)

flurbiprofen

rubicin

Antineoplastic antibiotics (daunorubicin type)

epirubicin, idarubicin

sartan

Angiotensin II receptor antagonists

losartan, eprosartan

sulfa

Antibiotics (sulfonamide derivatives)

sulfasalazine

thiazide

Diuretics (thiazide derivatives)

chlorothiazide

tocin

Oxytocin derivatives

oxytocin, pitocin

trexate

Antimetabolites (folic acid derivatives)

(chemo & abortions)

methotrexate

triptyline
-uracil

vastatin
vir-, -viror -vir

amitriptyline

Antidepressants
Uracil derivatives used as thyroid antagonists and
as antineoplastics
Antihyperlipidemics (HMGCoA inhibitors)
H
Antiviral substances (undefined group)

fluorouracil
lovastatin, simvastatin
viroxime, envirodyne, ganciclovir

More cheat sheets at Nurseslabs.com

Prefix or
Suffix

Likely Drug
Classification

Example of a
Medication in
This Classification

Precautions/Information to Know

Cef- or
ceph-

Cephalosporin
antibiotic

cefazolin, cephalexin
ceftin

5% cross sensitivity with penicillin

Can cause GI distress

-cillin

penicillin
antibiotic

bicillin
penicillin G

Common allergy
GI distress

-mycin

aminoglycoside or
macrolide antibiotic

gentamycin, tobramycin Renal toxicity , ototoxicity with

erythromycin
aminoglycosides

-cycline

tetracycline

doxycycline
minocycline

Dental problems (enamel discoloration) for

fetus if taken in pregnancy or before age 8
Interferes with oral contraceptives

-gliptin

DDP-4 inhibitor for

treating diabetes

vildagliptin (Galvus)
sitagliptin (Januvia)

watch for respiratory infections, headaches

-oxacin

a fluoroquinolone
antibiotic

Ciprofloxacin
levofloxacin

photosensitivity reactions

indicates an antifungal

Itraconazole
fluconazole
(Diflucan)
clotrimazole
ketoconazole
miconazole
daclizumab
(Lotrimin)

very liver toxic, many drug-drug interactions

-azoles

-mab

-pine

indicates a
monoclonal antibody
indicates a calcium
channel blocker

amlodipine
Very

Nice

injected, flu-like symptoms

monitor BP, rhythm, Calcium channel blocker are not used for MI
Drugs b/c of risk of heart block

Verapmil, Nifedipine, Diltiazem

-pril

indicates an ACE
inhibitor

captopril

monitor cough

-sartan

indicates an
angiotensin receptor
blocker(ARB)

valsartan

not to be used during pregnancy

-olol

indicates a beta
blocker

propranolol
acebutolol

Monitor cardiovascular effects (bradycardia and

bronchospasms), caution with diabetics
(hypoglycemia)

-ol

indicates a beta agonist

(bronchodilator)
indicates an alpha
blocker (HTN & BPH)

albuterol

rapid heart rate, sympathetic reaction

doxazosin, prazosin

first dose reaction; monitor for CHF

-osin

-parin

indicates an
anti clotting agent

heparin, dalteparin

Injected; monitor for excessive bruising or

Bleeding (ptt - 45 100 seconds)

-thiazide

indicates a diuretic

polythiazide,
hydrochlorothiazide

weight loss, fluid & electrolyte balance, increase in

Ca+

-ase

indicates an enzyme,
usually used with
thrombolytics

urokinase,
streptokinase

Monitor for bleeding

-statin

indicates an HMG CoA

inhibitor

lovastatin, pravastatin

pregnancy category X, with diet and exercises,. S/E: HMG-CoA:

-triptan

indicates and
antimigraine drug

zolmitriptan

monitor BP, cardiac effects

-enafil

indicates an
impotence drug

sildenafil

not with nitrates (can cause fatal hypotension) oral

alpha blockers; must be used with sexual
stimulation

-barbital

indicates a barbiturate

phenobarbital

CNS depressant, stimulates liver enzymes to

metabolize drugs

-pam

indicates a
benzodiazepine

diazepam
(exception:
chlordiazepoxide does
not end in pam)

liver and renal toxic

-lukast

indicates a
leukotrience receptor
antagonist

zafirlukast

Asthma maintenance drug

Not for use in acute asthma attack

-stim

indicates a colony
stimulating agent

filgrastim

injected; check bone marrow

-prazole

indicates an
antisecretory agent
(GERD and peptic ulcer)

omeprazole (Prilosec)
Proton Pump Inhibitors (PPIs) are not for
esomeprazole (Nexium) prolonged use: can cause hip fractures
(exception
aripiprazole ends in
prazole and is an
antipsychoticagent not
in this classification)

-setron

indicates a centrally
acting antiemetic

ondansetron,
granisetron

-azine

indicates a phenothiazine promethazine

CNS depressant

-sone

indicates a
corticosteroid

cortisone, prednisone

timing of dose, risk of infection

-esterone

indicates a progestin

progesterone

annual pap smear

-dronate

indicates a calcium
regulator

etidronate

dosing details, monitor calcium

-olone

indicates an anabolic
steroid

androlone

Liver and heart toxicity

-asteride

indicates an androgen
inhibitor

dutasteride

Monitor urinary output

-profen

Indicates an NSAID

ibuprofen

Monitoring GI bleeding

Hepatotoxicity/HA, Myopathy, GI symptoms, CK increased, Atrial fib

injected, CNS depression

Common Drugs and Antidotes

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Antidote

Indication

Mode of Action

acetylcysteine (Mucomyst)

Acetaminophen/ Tylenol/
Paracetamol

Restores depleted glutathione stores and protects

against renal and hepatic failure.

Activated charcoal

Non-specific poisons except

cyanide, iron, lithium, caustics
and alcohol.

Absorption of drug in the gastric and intestinal tracts.

Interrupts the entero-hepatic cycle with multiple dose.

albuterol inhaler, insulin &

glucose, NaHCO3, kayexalate

Potassium

anticholinesterase agents

Neuromuscular blockade
(paralytics)

atropine sulfate or pralidoxime

Anticholinesterase

Competitive inhibition of muscarinic receptors.

Benzylpenicillin

Amanita phalloides (Death cap

mushroom)

Not known; partial protection against acute hepatic

failure; may displace amatoxin from protein-binding
sites allowing increased renal excretion; may also
inhibit penetration of amatoxin to hepatocytes.

Calcium salts

Fluoride ingestion

Rapidly complexes with fluoride ion.

deferoxamine

Iron

Deferoxamine acts by binding free iron in the

bloodstream and enhancing its elimination in the
urine.

digibind
digoxine immune fab

Digoxin

dimercapol, edetate calcium,

disodium,

Lead

Chelation of lead ions and endogenous metals (e.g.,

zinc, manganese, iron, copper).

diphenhydramine (Benadryl)

Extrapyramidal symptoms
(EPS)

A potent antagonist to acetylcholine in muscarinic

receptors.

flumazenil

Benzodiazepines

Reverses the effects of benzodiazepines by

competitive inhibition at the benzodiazepine binding
site on the GABAA receptor.

fomepizole

Ethylene glycol

A competitive inhibitor of the enzyme alcohol

dehydrogenase found in the liver. This enzyme plays a
key role in the metabolism of ethylene glycol and
methanol.

glucagon

Beta blockers and calcium

channel blockers

Stimulates the formation of adenyl cyclase causing

intracellular increase in cycling AMP and enhanced
glycogenolysis and elevated serum glucose
concentration.

Insulin reaction

Dextrose (the monosaccharide glucose) is used,

distributed and stored by body tissues and is
metabolized to carbon dioxide and water with the
release of energy.

Heparin

Ergotamine

Reverses hypercoagulable state by interacting with

antithrombin III. Used in combination with vasodilator
phentolamine or nitroprusside to prevent local
thrombosis and ischemia.

Hydroxocobalamin

Cyanide

Forms cyanocobalamin, a non-toxic metabolite that is

easily excreted through the kidneys.

Glucose (Dextrose 50%)

Binds molecules of digoxin, making them unavailable

for binding at their site of action on cells in the body.

Fluorouracil
leucovorin calcium

Magnesium sulfate

Methotrexate
calcium gluconate

Protects the healthy cells from the effects of

methotrexate while allowing methotrexate to enter
and kill cancer cells.

A chemoprotectant drug that reduces the undesired

effects of certain chemotherapy drugs.

mesna

Cyclophosphamide

Methylene blue

Chemical producing severe

methemoglobinemia.
Ifosamide-induced
encephalopathy.

nalmefene or naloxone

Opioid analgesics

Prevents or reverses the effects of opioids including

respiratory depression, sedation and hypotension.

naloxone (Narcan)

Narcotics

Naloxone is believed to antagonize opioid effects by

competing for the , and opiate receptor sites in
the CNS, with the greatest affinity for the receptor.

Neostigmine

Anticholinergics

Anticholinesterase which causes accumulation of

acetylcholine at cholinergic receptor sites.

Nitrite, sodium and

glycerytrinitrate

Cyanide

Oxidizes hemoglobin to methemoglobin which binds

the free cyanide and can enhance endothelial cyanide
detoxification by producing vasodilation.

Penicillamine

Copper, gold, lead, mercury,

zinc, arsenic

Reduces methemoglobin to hemoglobin.

Chelation of metal ions.

phentolamine (Regitine)

Dopamine

Regitine produces an alpha-adrenergic block of

relatively short duration. It also has direct, but less
marked, positive inotropic and chronotropic effects on
cardiac muscle and vasodilator effects on vascular
smooth muscle.

phyostigmine or NaHCO3

Tricyclic antidepressants

A reversible anticholinesterase which effectively

increases the concentration of acetylcholine at the
sites of cholinergic transmission.

Phytomenadione (Vitamin K.)

Coumadin/Warfarin

Bypasses inhibition of Vitamin K epoxide reductase

enzyme.

protamine sulfate

Heparin

Protamine that is strongly basic combines with acidic

heparin forming a stable complex and neutralizes the
anticoagulant activity of both drugs.

Pyridoxine

Isoniazid, theophylline,
monomethyl hydrazine.
Adjunctive therapy in ethylene
glycol poisoning.

Snake anti-venin

Cobra bite

Neutralizes venom by binding with circulating venom

components and with locally deposited venom by
accumulating at the bite site.

Iron

Prevents convertion of ferrous to ferric.

Sodium Bicarbonate

Sodium thiosulphate

Thiamine

Vitamin C

Reverses acute pyridoxine deficiency by promoting

GABA synthesis. Promotes the conversion of toxic
metabolite glycolic acid to glycine.

Cardiotoxic drug affecting fast Decreases affinity of cardiotoxic drugs to the fast
sodium channel (TCA, cocaine) sodium channel.
Weak acids

Promotes ionization of weak acids.

Chlorine gas inhalational

poisoning

Neutralization of hydrochloric acid formed when

chlorine gas reacts with water in the airways.

Cyanide

Replenishes depleted thiosulphate stores by acting as

sulfur donor necessary for the conversion of CN-O to
thiocyanate through the action of sulfur transferase
enzyme rhodanese.

Alcohol, Wernicke-Korsakoff
Syndrome

Reverses acute thiamine deficiency

Adjunctive in ethylene glycol

Enhances detoxification of glyoxylic acid.

Chemicals causing
Reduces methemoglobin to hemoglobin.
methemoglobinemia in patients
with G6PD deficiency

Common Laboratory Values Cheat Sheet

Diagnostic tests are crucial in any aspect of clinical practice since they assist clinicians in establishing and determining the
particular condition of the patient. Nurses are often tasked of patient preparation and specimen collection during these
diagnostic procedures. It is of utmost importance that nurses are knowledgeable about the different procedures and their values
and results to make informed clinical decisions. To assist nurses, here are the common laboratory values listed in an organized
and easy-to-understand table.
ARTERIAL BLOOD GAS (cont.)
Base Excess (BE)

-2+2

THERAPEUTIC SERUM DRUG LEVELS

mEq/L

THYROID FUNCTION STUDIES

Thyroid-Stimulating
Hormone (TSH)

Thyroxine (Total T4)

Triiodothyronine (Total T3)

Adults:
0.25.4
Neonate:
320

mU/L

Adult: 5.4
11.5
Child: 6.4
13.3

mcg/dL

75200

ng/dL

Carbamazepine (Tegretol)

410

mcg/mL

Digoxin (Lanoxin)

0.82.0

ng/mL

Lithium (Eskalith)

0.81.5

mEq/L

Phenobarbital (Solfoton)

1540

mcg/mL

Theophylline (Aminophylline)

1020

mcg/mL

Valproic Acid (Depakene)

50100

mcg/mL

Value

Normal Range

Unit

M: 4.55.5
F: 4.04.9

x105/ml

White Blood Cell (WBC) 4,50010,000

cells/mcL

Platelets

cells/mcL

Hemoglobin (Hgb)

Hematocrit (Hct)

100,000450,
000
M: 13.516.5
F: 12.015.0
Pregnant: 015

g/dL

DIFFERENTIAL COUNT
5462%

Eosinophils

13%

Basophils

00.75%

Lymphocytes

2533%

Monocytes

37%

Unit

Creatine phosphokinase (CPK)

21198

units/L

Creatinine Clearance (CrCl)

F: 85132
M: 90138

mL/min

Albumin

3.45.0

g/dL

Bilirubin

<1.0

mg/dL

Uric Acid

3.57.5

mg/dL

Prothrombin Time (PT)

1114

seconds

Partial Thromboplastin Time

(PTT)

2535

seconds

International Normalized Ratio

(INR)

0.81.2

Activated Partial Thromboplastin

Time (aPTT)

1.52.5

Fibrinogen

203377

mg/dL

Bleeding time

16

mins

COAGULATION STUDIES

M: 4150%
F: 3644%

Neutrophils

Normal Range

CHEMISTRY VALUES (cont.)

COMPLETE BLOOD COUNT

Red Blood Cell (RBC)

Value

LIPOPROTEINS AND TRIGLYCERIDES

SERUM ELECTROLYTES
Sodium (Na+)

135145

mEq/L

Potassium (K+)

3.55.0

mEq/L

Chloride (Cl-)

95105

mEq/L

Calcium

8.510.9

mEq/L

Calcium, ionized

2.242.46

mEq/L

Magnesium (Mg)

1.52.5

mEq/L

Phosphorus (P)

2.54.5

mEq/L

1,0002,000

mL/day

30

mL/hour

Total Cholesterol

Ideal: below 200 mg/dL

Borderline:
200240
High: above 240

Low Density Lipoprotein (LDL)

<70

mg/dL

High Density Lipoprotein (HDL)

<60

mg/dL

Triglycerides

Normal: below
150
Borderline
high: 150199
High:
200499
Very high:
above 500

mg/dL

SGOT (AST)

<35

IU/L

SGPT (ALT)

<35

IU/L

Troponin (CTN-1 or CTN-T)

Normal I: 0.03
Critical level I:
above 1.5
Critical level T:
0.2

ng/L

C-reactive protein

Below 0.8

mg/dL

Creatinine Kinase (CK-MB)

03

mcg/L

URINALYSIS
Volume

Specific Gravity

1.0101.030

pH

4.58

Uric Acid

F: 3.57.2
M: 2.66.0

mg/dL

CHEMISTRY VALUES
Glucose

Adults: 70110

mg/dL

Blood Urea Nitrogen

Adults: 718
Child: 520
Infant: 515

mg/dL

0.61.35

mg/dL

(BUN)
Serum Creatinine

CARDIAC MARKERS

ARTERIAL BLOOD GAS

pH

7.357.45

Partial Pressure of CO2 (pCO2)

3545

mmHg

Partial Pressure of O2 (pO2)

80100

mmHg

Bicarbonate (HCO3)

2226

mEq/L