Nurse Study Guide

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  • Topic: Mantoux test, Universal precautions, Intracranial pressure
  • Pages : 21 (3620 words )
  • Download(s) : 31
  • Published : March 20, 2013
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Chest Tubes
-continuous bubbling= air leak
-bubbling with inspiration= okay
-continuous bubbling in suction chamber= okay
-up and down in water seal= okay
Types of Insulin
-Rapid Acting (lispro, humalog)
-Onset= 5 minutes
-Peak= 30 minutes
-Short Acting (novolog, regular)
-Onset= 30 minutes
-Peak= 2 hours
-Intermediate Acting (NPH)
-Onset= 1 hour
-Peak= 6-12 hours
-Long Acting (Humulin)
-Onset= 4 hours
-Peak= 16-18 hours
-Maslows= PhysiologicSafetyLove & BelongingEsteem & RecognitionSelf Actualization -Piaget= Sensorimotor (birth-2)Preoperational(2-7)Concrete operational(7-11)Formal operations(11-death) -Eriksons=Trust vs. Mistrust(birth-1)Autonomy vs. shame and doubt(1-3)Initiative vs. guilt(3-6)Industry vs. inferiority(6-12)Identity vs. role confusion(12-18)Intimacy vs. isolation(early adulthood)Genrativity vs. stagnation(middle adult)Ego integrity vs. despair(older adult) AIRBORNE PRECAUTION (SARS is airborne/contact)

My - Measles
Chicken - Chickenpox
Hez - Herpes Zoster (Disseminated)
TB - TB
-Private room
-Negative pressure with 6-12 air exchanges per hour
-UV
-Mask, standard precautions (gown,gloves)
-N95 Mask for TB
-put own eyewear-->mask-->gown-->gloves and take off in opposite order (this applies to all infection control)

DROPLET PRECAUTION
think of SPIDERMAN!
S - Sepsis
S - Scarlet fever
S - Streptococcal pharyngitis
P - Parvovirus B19
P - Pertussis
P - Pneumonia
I - Influenza
D - Diptheria (Pharyngeal)
E - Epiglottitis
R - Rubella
M - Mumps
M - Meningitis
M - Mycoplasma or meningeal pneumonia
An - Adenovirus
-Private room
-Mask and standard precautions

CONTACT PRECAUTION- standard precautions
MRS.WEE
M - Multidrug resistant organism
R - Respiratory infection - RSV
S - Skin infections
W - Wound infections
E - Enteric infections - clostridium defficile
E - Eye infections

Skin Infections private room, gloves, gown
V - Varicella zoster
C - Cutaneous diptheria
H - Herpes simplex
I - Impetigo
P - Pediculosis
S - Scabies, Staphylococcus

Cranial Nerves
1) Olfactory
2) Optic
3) Oculomotor
4) Trochlear
5) Trigeminal
6) Abduchens
7) Facial
8) Acoustic
9) Glossopharyngeal
10) Vagus
11) Spinal Accessory
12) Hypoglossal
Triage
Red-unstable, but fixable, see first
Yellow-stable, can wait for up to an hour for treatment, see second Green- stable, can wait for a while, “walking wounded”
Black- unstable clients that probably won’t make it, comfort measures DOA- dead on arrival
Antidotes
-Heparin- protamine sulfate
-Coumadin- vitamin K
-Meg sulfate- calcium gluconate
-Morphine- Narcan
-Anaphylaxis- epinephrine
-Tensilon-atropine sulfate
-Tylenol= mucomist
-Benzodiazapines= romazicon
Lab Values
Coagulation
-PT = 10-13 seconds, 1.5-2 times the control for Coumadin therapy -aPTT= 20-35 seconds, 1.5-2.5 times the control for heparin therapy -PTT = 60-70, 1.5-2.5 times control in anticoagulant therapy -INR= 2-3

Electrolytes
-Na+ = 135-145
-K+ = 3.5-5.0
-Cl- = 95-105
-Ca+ = 8-10
-Mg+ = 1.5-2.0
-Protein = 3.5-5.5
Hematology
-WBC = 5000-11000
-Neutrophils = 45-75%
-RBC = 4.5-6 million
-Hgb = 12-16 (women), 13-18 (men)
-Hct- 36-46%
-Platelet = 150000-400000
Renal Function
-BUN= 7-20
-Creatinine= 0.5-1.5
-Urine specific gravity= 1.010-1.030
Cholesterol
-Total= <200
-LDL = <139
Liver
-AST = 10-40
-ALT= 5-35
Electrolytes
-Hyponatremia- hypervolemia, edema, increased urine output, lethargy, dizziness, diarrhea, use isotonic solutions, give loop diuretics(excess water) -Hypernatremia- tachycardia, hypertension, hypovolemia, seizures, decrease Na+ intake, assess I&O, loop diuretics( excess sodium) Hypokalemia- flattened T wave, U wave appearance, weak shallow respiratations, paresthesias, give K+ Hyperkalemia-bradycardia, narrow/peaked T waves, widened QRS, flattened P waves, muscle cramps, diarrhea, give K+ wasting diuretics Hypocalcemia-Chvostek’s sign (cheek twitching),...
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