Irritable Bowel Syndrome Hesi Case Study

  • 1. 

    Which of the following is not an education tool required prior to an endoscopic procedure?

    • A. 

      The purpose of the procedure

    • B. 

      What to expect during the procedure

    • C. 

      How long the procedure will take

    • D. 

      Preparation required prior to the surgery

  • 2. 

    Which patient is most susceptible for acquiring secondary stomatitis?

    • A. 

      An AIDs patient suffering from pneumonia

    • B. 

    • C. 

      A 45 y/o male suffering from colon cancer

    • D. 

  • 3. 

    When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as:

    • A. 

      A canker sore of the oral soft tissues

    • B. 

      An acute stomach infection

    • C. 

    • D. 

      An early sign of peptic ulcer disease

  • 4. 

    Which item is unneccessary when examing the oral cavity of a patient with candidiasis?

    • A. 

    • B. 

    • C. 

    • D. 

  • 5. 

    Which of the following is an inappropriate nursing diagnosis for a client with malignant tumors of the oral cavity?

    • A. 

      Impaired oral mucous membranes

    • B. 

    • C. 

    • D. 

      Risk for ineffective airway clearance

  • 6. 

    The graduate nurse and her preceptor are establishing priorities for their morning assessments. Which client should they assess first?

    • A. 

      The newly admitted client with acute abdominal pain

    • B. 

      The client who needs an abdominal dressing changed (POD 3)

    • C. 

      The client receiving continuous tube feedings who needs the tube-feeding residual checked

    • D. 

      The sleeping client who received pain medication 1 hour ago

  • 7. 

    Which foods should a patient with GERD stay away from (multiple answers)?

    • A. 

      Burger King double cheeseburger

    • B. 

    • C. 

    • D. 

    • E. 

  • 8. 

    To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

    • A. 

      Lie down after meals to promote digestion

    • B. 

      Avoid coffee and alcoholic beverages

    • C. 

    • D. 

      Limit fluid intake with meals

  • 9. 

    Which of the following is not a common symptom of GERD?

    • A. 

    • B. 

    • C. 

    • D. 

  • 10. 

    Which drug class isn't used to treat GERD?

    • A. 

    • B. 

      Histamine receptor antagonists

    • C. 

    • D. 

  • 11. 

    Which of the following has the least important role in terms of peptic ulcer formation?

    • A. 

    • B. 

    • C. 

    • D. 

  • 12. 

    A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be:

    • A. 

    • B. 

    • C. 

    • D. 

  • 13. 

    Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

    • A. 

    • B. 

    • C. 

      Hemoglobin (Hb) levels and hematocrit (HCT

    • D. 

  • 14. 

    Which of the following isn't a complication of peptic ulcer disease?

    • A. 

    • B. 

    • C. 

    • D. 

  • 15. 

    Which of the following are goals of drug therapy in the treatment of PUD (multiple answers)?

    • A. 

    • B. 

    • C. 

    • D. 

      Eradicate H. pylori infection

  • 16. 

    An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse should be concerned most with the potential for:

    • A. 

    • B. 

    • C. 

    • D. 

  • 17. 

    A client who underwent abdominal surgery who has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first?

    • A. 

    • B. 

    • C. 

      Assess patency of the NG tube

    • D. 

  • 18. 

    To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. Which is another test method?

    • A. 

      Aspiration of gastric contents and testing for a pH less than 6

    • B. 

      Instillation of 30 ml of water while listening with a stethoscope

    • C. 

      Cessation of reflex gagging

    • D. 

      Ensuring proper measurement of the tube before insertion

  • 19. 

    Which of the following would you NOT teach a patient recently diagnosed with irritable bowel syndrome?

    • A. 

      Identifying food intolerances and needed dietary modifications

    • B. 

    • C. 

      Avoiding coffee and and limiting alcohol intake

    • D. 

  • 20. 

    Which of the following are appropriate nursing diagnoses for patients with colorectal cancer (multiple answers)?

    • A. 

      Altered level of consciousness

    • B. 

    • C. 

    • D. 

  • 21. 

    Which foods should patients with colorectal cancer avoid (multiple answers)?

    • A. 

    • B. 

      Boiled carrots and broccoli

    • C. 

    • D. 

    • E. 

  • 22. 

    A client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to:

    • A. 

    • B. 

      Place saline-soaked sterile dressings on the wound

    • C. 

      Take a blood pressure and pulse

    • D. 

      Take a blood pressure and pulse

  • 23. 

    Which is the least likely to cause constipation?

    • A. 

    • B. 

    • C. 

    • D. 

  • 24. 

    A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which is one such factor?  

    • A. 

      Increased intestinal motility

    • B. 

      Decreased abdominal strength

    • C. 

      Increased gastric aid production

    • D. 

  • 25. 

    Which outcome indicates effective client teaching to prevent constipation?

    • A. 

      The client verbalizes consumption of low-fiber foods

    • B. 

      The client maintains a sedentary lifestyle

    • C. 

      The client limits water intake to three glasses per day

    • D. 

      The client reports engaging in a regular exercise regimen

  • 26. 

    In regards to appendicitis, the location of pain in the lower, right abdominal quadrant is called:

    • A. 

    • B. 

    • C. 

    • D. 

  • 27. 

    When preparing a client, age 50, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

    • A. 

      The appendectomy surgery is very invasive and it puts the client at a risk for infection

    • B. 

      Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

    • C. 

      Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage

    • D. 

      The appendix may develop gangrene and rupture, especially in a middle-aged client

  • 28. 

    Which of the following assessment findings suggests early appendicitis?

    • A. 

    • B. 

    • C. 

    • D. 

  • 29. 

    Which of the following is not an appropriate nursing diagnosis related to appendicitis?

    • A. 

    • B. 

    • C. 

      Risk for infection r/t rupture

    • D. 

  • 30. 

    While preparing a client for cholecystectomy, the nurse explains that incentive spirometry will be used after surgery primarily to:

    • A. 

      Increase respiratory effectiveness.

    • B. 

      Eliminate the need for nasogastric intubation.

    • C. 

      Improve nutritional status during recovery.

    • D. 

      Decrease the amount of postoperative analgesia needed.

  • 31. 

    Which task can the nurse delegate to a nursing assistant?

    • A. 

      Irrigating a nasogastric (NG) tube

    • B. 

      Assisting a client who had surgery three days ago walk down the hallway

    • C. 

      Helping a client who just returned from surgery to the bathroom

    • D. 

      Administering an antacid to a client complaining of heartburn

  • 32. 

    How are ulcerative colitis and Chron's disease definitively diagnosed?

    • A. 

    • B. 

    • C. 

    • D. 

  • 33. 

    What is toxic megacolon (mulitple answers)?

    • A. 

      A complication of ulcerative colitis

    • B. 

      Dilation and paralysis of the colon

    • C. 

    • D. 

      A risk factor for pancreatitis

  • 34. 

    A 28-year-old client is admitted with inflammatory bowel syndrome (Crohn's disease). Which therapies should the nurse expect to be part of the care plan? Check all that apply 

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

      Antidiarrheal medications

  • 35. 

    A client is diagnosed with Crohn's disease after undergoing two weeks of testing. The client's boss calls the medical-surgical floor requesting to speak with the nurse manager. He expresses concern over the client and explains that he must know the client's diagnosis for insurance purposes. Which response by the nurse is best?

    • A. 

      "Sure, I understand how demanding insurance companies can be."

    • B. 

      "I appreciate your concern, but I can't give out any information."

    • C. 

      "Why don't you come in, and we can further discuss this issue."

    • D. 

      "He has been diagnosed with Crohn's Disease."

  • 36. 

    A client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?

    • A. 

      Lying on the right side with legs straight

    • B. 

      Lying on the left side with knees bent

    • C. 

      Prone with the torso elevated

    • D. 

      Bent over with hands touching the floor

  • 37. 

    A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image?

    • A. 

      The client asks his wife to leave the room

    • B. 

      The client closes the eyes when the abdomen is exposed

    • C. 

      The client avoids talking about the recent surgery

    • D. 

      The client touches the altered body part

  • 84 Here is a study guide composed by 3 students to help us pass the HESI exit and NCLEX exams.
    All three of us passed the first time with 75 questions.
    If you know everything on this guide you will do well.
    Kind of long but worth studying.
    Best of luck to you
    Please give me feedback

    Jay BSN



    HESI Hints & NCLEX Gems

    * Answering NCLEX Questions
    o Maslow's Hierarchy of Needs
    * Physiologic
    * Safety
    * Love and Belonging
    * Esteem
    * Self-actualization
    o Nursing Process
    * Assessment
    * Diagnosis (Analysis)
    * Planning
    * Implementation (treatment)
    * Evaluation
    o ABCs
    * Airway
    * Breathing
    * Circulation

    * Normal Values
    o Hgb
    * Males 14-18
    * Females 12-16
    o Hct
    * Males 42-52
    * Females 37-47
    o RBCs
    * Males 4.7-6.1 million
    * Females 4.2-5.4 million
    o WBCs
    * 4.5-11k
    o Platelets
    * 150-400k
    o PT (Coumadin/Warfarin)
    * 11-12.5 sec (INR and PT TR = 1.5-2 times normal)
    o APTT (Heparin)
    * 60-70 sec (APTT and PTT TR = 1.5-2.5 times normal)
    o BUN 10-20
    o Creatinine 0.5-1.2
    o Glucose 70-110
    o Cholesterol < 200
    o Bilirubin Newborn 1-12
    o Phenylalanine Newborn < 2, Adult < 6
    o Na+ 136-145
    o K+ 3.5-5
    * HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves
    * HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS
    o Ca++ 9-10.5
    * Hypocalcemia ... muscle spasms, convulsions, cramps/tetany, + Trousseau's, + Chvostek's, prolonged ST interval, prolonged QT segment
    o Mg+ 1.5-2.5
    o Cl- 96-106
    o Phos 3-4.5
    o Albumin 3.5-5
    o Spec Gravity 1.005-1.030
    o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
    o Dilantin TR = 10-20
    o Lithium TR = 0.5-1.5
    o Arterial Blood Gases ... Used for Acidosis vs. Alkalosis
    * PH 7.35-7.45
    * CO2 35-45 (Respiratory driver) ... High = Acidosis
    * HCO3 21-28 (Metabolic driver) ... High = Alkalosis
    * O2 80-100
    * O2 Sat 95-100%

    * Antidotes
    o Digoxin ... Digiband
    o Coumadin ... Vitamin K (Keep PT and INR @ 1-1.5 X normal)
    o Benzodiazapines ... Flumzaemil (Tomazicon)
    o Magnesium Sulfate ... Calcium Gluconate?
    o Heparin ... Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal)
    o Tylenol ... Mucomist (17 doses + loading dose)
    o Opiates (narcotic analgesics, heroin, morphine) ... Narcan (Naloxone)
    o Cholinergic Meds (Myesthenic Bradycardia) ... Atropine
    o Methotrexate ... Leucovorin

    * Delegation
    o RN Only
    * Blood Products (2 RNs must check)
    * Clotting Factors
    * Sterile dressing changes and procedures
    * Assessments that require clinical judgment
    * Ultimately responsible for all delegated duties
    o Unlicensed Assistive Personnel
    * Non-sterile procedures

    * Precautions & Room Assignments
    o Universal (Standard) Precautions ... HIV initiated
    * Wash hands
    * Wear Gloves
    * Gowns for splashes
    * Masks and Eye Protection for splashes and droplets
    * Don't recap needles
    * Mouthpiece or Ambu-bag for resuscitation
    * Refrain from giving care if you have skin lesion
    o Droplet (Respiratory) Precautions (Wear Mask)
    * Sepsis, Scarlet Fever, Strep, Fifth Disease (Parvo B19), Pertussis, Pneumonia, Influenza, Diptheria, Epiglottitis, Rubella, Rubeola, Meningitis, Mycoplasma, Adenovirus, Rhinovirus
    * RSV (needs contact precautions too)
    * TB ... Respiratory Isolation
    o Contact Precautions = Universal + Goggles, Mask and Gown
    o No infection patients with immunosuppressed patients

    * Weird Miscellaneous Stuff
    o Rifampin (for TB) ... Rust/orange/red urine and body fluids
    o Pyridium (for bladder infection) ... Orange/red/pink urine
    o Glasgow Coma Scale ... < 8 = coma
    o Myesthenia Gravis
    * Myesthenic Crisis = Weakness with change in vitals (give more meds)
    * Cholinergic Crisis = Weakness with no change in vitals (reduce meds)
    o Diabetic Coma vs. Insulin Shock ... Give glucose first - If no help, give insulin
    o Fruity Breath = Diabetic Ketoacidosis
    o Acid-Base Balance
    * If it comes out of your ass, it's Acidosis.
    * Vomiting = Alkalosis
    o Skin Tastes Salty = Cystic Fibrosis
    o Lipitor (statins) in PMs only - No grapefruit juice
    o Stroke ... Tongue points toward side of lesion (paralysis), Uvula deviates away from the side of lesion (paralysis)
    o Hold Digoxin if HR < 60
    o Stay in bed for 3 hours after first ACE Inhibitor dose
    o Avoid Grapefruit juice with Ca++ Channel Blockers
    o Anthrax = Multi-vector biohazard
    o Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side (to trap air in right side of heart)
    o Head Trauma and Seizures ... Maintain airway = primary concern
    o Peptic Ulcers ... Feed a Duodenal Ulcer (pain relieved by food) ... Starve a gastric ulcer
    o Acute Pancreatitis ... Fetal position, Bluish discoloration of flanks (Turner's Sign), Bluish discoloration of pericumbelical region (Cullen's Sign), Board like abdomen with guarding ... Self digestion of pancreas by trypsin.
    o Hold tube feeding if residual > 100mL
    o In case of Fire ... RACE and PASS
    o Check Restraints every 30 minutes ... 2 fingers room underneath
    o Gullain-Barre Syndrome ... Weakness progresses from legs upward - Resp arrest
    o Trough draw = ~30 min before scheduled administration ... Peak Draw = 30-60 min after drug administration.


    * Mental Health & Psychiatry
    o Most suicides occur after beginning of improvement with increase in energy levels
    o MAOIs ... Hypertensive Crisis with Tyramine foods
    * Nardil, Marplan, Parnate
    * Need 2 wk gap from SSRIs and TCAs to admin MAOIs
    o Lithium Therapeutic Range = 0.5-1.5
    o Phenothiazines (typical antipsychotics) - EPS, Photosensitivity
    o Atypical Antipsychotics - work on positive and negative symptoms, less EPS
    o Benzos (Ativan, Lorazepam, etc) good for Alcohol withdrawal and Status Epilepticus
    o Antabuse for Alcohol deterrence - Makes you sick with OH intake
    o Alcohol Withdrawal = Delerium Tremens - Tachycardia, tachypnea, anxiety, nausea, shakes, hallucinations, paranoia ... (DTs start 12-36 hrs after last drink)
    o Opiate (Heroin, Morphine, etc.) Withdrawal = Watery eyes, runny nose, dilated pupils, NVD, cramps
    o Stimulants Withdrawal = Depression, fatigue, anxiety, disturbed sleep

    * Medical-Surgical
    o Hypoventilation = Acidosis (too much CO2)
    o Hyperventilation = Alkalosis (low CO2)
    o No BP or IV on side of Mastectomy
    o Opiate OD = Pinpoint Pupils
    o Lesions of Midbrain = Decerebrate Posturing (Extended elbows, head arched back)
    o Lesions of Cortex = Decorticate Posturing (Flexion of elbows, wrists, fingers, straight legs, mummy position)
    o Urine Output of 30 mL/hr = minimal competency of heart and kidney function
    o Kidney Stone = Cholelithiasis
    * Flank pain = stone in kidney or upper ureter
    * Abdominal/scrotal pain = stone in mid/lower ureter or bladder
    o Renal Failure ... Restrict protein intake
    * Fluid and electrolyte problems ... Watch for HyperK+ (dizzy, wk, nausea, cramps, arhythmias)
    * Pre-renal Problem = Interference with renal perfusion
    * Intra-renal Problem= Damage to renal parenchyma
    * Post-renal Problem = Obstruction in UT anywhere from tubules to urethral meatus.
    * Usually 3 phases (Oligouric, Diuretic, Recovery)
    * Monitor Body Wt and I&Os
    o Steroid Effects = Moon face, hyperglycemia, acne, hirsutism, buffalo hump, mood swings, weight gain - Spindle shape, osteoporosis, adrenal suppression (delayed growth in kids) . . . (Cushing's Syndrome symptoms)
    o Addison's' Crisis = medical emergency (vascular collapse, hypoglycemia, tachycardia ... Admin IV glucose + corticosteroids) ... No PO corticosteroids on empty stomach
    o Potassium sparing diuretic = Aldactone (Spironolactone) ... Watch for hyperK+ with this and ACE Inhibitors.
    o Cardiac Enzymes ... Troponin (1 hr), CKMB (2-4 hr), Myoglobin (1-4 hr), LDH1 (12-24 hr)
    o MI Tx ... Nitro - Yes ... NO Digoxin, Betablockers, Atropine
    o Fibrinolytics = Streptokinase, Tenecteplase (TNKase)
    o CABG = Coronary Artery Bypass Graft
    o PTCA = Percutaneous Transluminal Coronary Angioplasty
    o Sex after MI okay when able to climb 2 slights of stairs without exertion (Take nitro prophylactically before sex)
    o BPH Tx = TURP (Transurethral Resection of Prostate) ... some blood for 4 days, and burning for 7 days post-TURP.
    o Only isotonic sterile saline for Bladder Irrigation
    o Post Thyroidectomy - Keep tracheostomy set by the bed with O2, suction and Calcium gluconate
    o Pericarditis ... Pericardial Friction Rub, Pain relieved by leaning forward
    o Post Strep URI Diseases and Conditions:
    * Acute Glomerulonephritis
    * Rheumatic Fever ... Valve Disease
    * Scarlet Fever
    o If a chest-tube becomes disconnected, do not clamp ... Put end in sterile water
    o Chest Tube drainage system should show bubbling and water level fluctuations (tidaling with breathing)
    o TB ... Treatment with multidrug regimen for 9 months ... Rifampin reduces effectiveness of OCs and turns pee orange ... Isoniazide (INH) increases Dilantin blood levels
    o Use bronchodilators before steroids for asthma ... Exhale completely, Inhale deeply, Hold breath for 10 seconds
    o Ventilators ... Make sure alarms are on ... Check every 4 hours minimum
    o Suctioning ... Pre and Post oxygenate with 100% O2 ... No more than 3 passes ... No longer than 15 seconds ... Suction on withdrawal with rotation
    o COPD:
    * Emphysema = Pink Puffer
    * Chronic Bronchitis = Blue Bloater (Cyanosis, Rt sided heart failure = bloating/edema)
    o O2 Administration
    * Never more than 6L/min by cannula
    * Must humidify with more than 4L/hr
    * No more than 2L/min with COPD ... (CO2 Narcosis)
    * In ascending order of delivery potency: Nasal Cannula, Simple Face Mask, Nonrebreather Mask, Partial Rebreather Mask, Venturi Mask
    * Restlessness and Irritability = Early signs of cerebral hypoxia
    IVs and Blood Product Administration
    o 18-19 gauge needle for blood with filter in tubing
    o Run blood with NS only and within 30 minutes of hanging
    o Vitals and Breath Sounds ... before, during and after infusion (15 min after start, then 30 min later, then hourly up to 1 hr after)
    o Check Blood: Exp Date, clots, color, air bubbles, leaks
    o 2 RNs must check order, pt, blood product ... Ask Pt about previous transfusion Hx
    o Stay with Pt for first 15 minutes ... If transfusion rxn ... Stop and KVO with NS
    o Pre-medicate with Benadryl prn for previous urticaria rxns
    o Isotonic Solutions
    * D5W
    * NS (0.9% NaCl)
    * Ringers Lactate
    * NS only with blood products and Dilantin
    Diabetes and Insulin
    o When in doubt - Treat for Hypoglycemia first
    o First IV for DKA = NS, then infuse regular insulin IV as Rx'd
    o Hypoglycemia ... confusion, HA, irritable, nausea, sweating, tremors, hunger, slurring
    o Hyperglycemia ... weakness, syncope, polydipsia, polyuria, blurred vision, fruity breath
    o Insulin may be kept at room T for 28 days
    o Draw Regular (Clear) insulin into syringe first when mixing insulins
    o Rotate Injection Sites (Rotate in 1 region, then move to new region)
    o Rapid Acting Insulins ... Lispro (Humalog) and Aspart (Novolog) ... O: 5-15 min, P: .75-1.5 hrs
    o Short Acting Insulin ... Regular (human) ... O: 30-60 min, P: 2-3 hrs (IV Okay)
    o Intermediate Acting Insulin ... Isophane Insulin (NPH) ... O: 1-2 hrs, P: 6-12 hrs
    o Long Acting Insulin ... Insulin Glargine (Lantus) ... O: 1.1 hr, P: 14-20 hrs (Don't Mix)
    o Oral Hypoglycemics decrease glucose levels by stimulating insulin production by beta cells of pancreas, increasing insulin sensitivity and decreasing hepatic glucose production
    * Glyburide, Metformin (Glucophage), Avandia, Actos
    * Acarbose blunts sugar levels after meals
    Oncology
    o Leukemia ... Anemia (reduced RBC production), Immunosuppression (neutropenia and immature WBCs), Hemorrhage and bleeding tendencies (thrombocytopenia)
    * Acute Lymphocytic = most common type, kids, best prognosis
    o Testicular Cancer ... Painless lump or swelling testicle ... STE in shower > 14 yrs ... 15-35 = Age
    o Prostate Cancer ... > 40 = Age
    * PSA elevation
    * DRE
    * Mets to spine, hips, legs
    * Elevated PAP (prostate acid phosphatase)
    * TRUS = Transurethral US
    * Post Op ... Monitor of hemorrhage and cardiovascular complication
    o Cervical and Uterine Cancer
    * Laser, cryotherapy, radiation, conization, hysterectomy, exenteration ... Chemotherapy = No help
    * PAP smears should start within 3 years of intercourse or by age 21
    o Ovarian Cancer = leading cause of death from gynecological cancer
    o Breast Cancer = Leading cause of cancer in women
    * Upper outer quadrant, left > right
    * Monthly SBE
    * Mammography ... Baseline @ 35, Annually after age 50
    * Mets to lymph nodes, then lungs, liver, brain, spine
    * Mastectomy ... Radical Mastectomy = Lymph nodes too (but no mm resected)
    * Avoid BP measurements, injections and venipuncture on surgical side
    o Anti-emetics given with Chemotherapy Agents (Cytoxan, Methotrexate, Interferon, etc.)
    * Phenergan (Promethazine HCl)
    * Compazine (Prochlorperazine)
    * Reglan (Metocolpramide)
    * Benadryl (Diphenhydramine)
    * Zofran (Ondansetron HCl)
    * Kytril (Granisetron)
    Sexually Transmitted Diseases
    o Syphilis (Treponema pallidum) ... Chancre + red painless lesion (Primary Stage, 90 days) ... Secondary Stage (up to 6 mo) = Rash on palms and soles + Flu-like symptoms ... Tertiary Stage = Neurologic and Cardiac destruction (10-30 yrs) ... Treated with Penicillin G IM.
    o Gonorrhea (Neisseria Gonorrhea) ... Yellow green urethral discharge (The Clap)
    o Chlamydia (Chlamydia Trachomatis) ... Mild vaginal discharge or urethritis ... Doxycyclin, Tetracycline
    o Trichomoniasis (Trichomonas Vaginalis) ... Frothy foul-smelling vaginal discharge ... Flagyl
    o Candidiasis (Candida Albicans) ... Yellow, cheesy discharge with itching ... Miconazole, Nystatin, Clomitrazole (Gyne-Lotrimin)
    o Herpes Simplex 2 ... Acyclovir
    o HPV (Human Pappilovirus) ... Acid, Laser, Cryotherapy
    o HIV ... Cocktails

    * Perioperative Care
    o Breathing Es taught in advance (before or early in pre-op)
    o Remove nail polish (need to see cap refill)
    o Pre Op ... Meds as ordered, NPO X 8 hrs, Incentive Spirometry & Breathing Es taught in advance, Void, No NSAIDS X 48 hrs
    o Increased corticosteroids for surgery (stress) ... May need to increase insulin too
    o Post Op restlessness may = hemorrhage, hypoxia
    o Wound dehiscence or extravisation ... Wet sterile NS dressing + Call Dr.
    o Call Dr. post op if ... < 30 mL/hr urine, Sys BP < 90, T > 100 or < 96
    o Post Op Monitoring VS and BS ... Every 15 minutes the first hour, Every 30 min next 2 hours, Every hour the next 4 hours, then Every 4 hours prn
    o 1-4 hrs Post Op = Immediate Stage ... 2-24 hrs Post Op = Intermediate Stage ... 1-4 days Post Op = Extended Stage
    o Post Op Positioning
    * THR ... No Adduction past midline, No hip flexion past 90 degrees
    * Supratentorial Sx ... HOB 30-45 degrees (Semi-Fowler)
    * Infrantentorial Sx ... Flat
    * Phlebitis ... Supine, elevate involved leg
    * Harris Tube ... Rt/back/Lt - to advance tube in GI
    * Miller Abbott Tube ... Right side for GI advancement into small intestine
    * Thoracocentesis ... Unaffected side, HOB 30-45 degrees
    * Enema ... Left Sims (flow into sigmoid)
    * Liver Biopsy ... Right side with pillow/towel against puncture site
    * Cataract Sx ... Opp side - Semi-Fowler
    * Cardiac Catheterization ... Flat (HOB no more than 30 degrees), Leg straight 4-6 hrs, bed rest 6-12 hrs
    * Burn Autograph ... Elevated and Immob 3-7 days
    * Amputation ... Supine, elevate stump for 48 hrs
    * Large Brain Tumor Resection ... On non-operative side
    o Incentive Spirometry ... Inhale slowly and completely to keep flow at 600-900, Hold breath 5 seconds, 10 times per hr
    o Post Op Breathing Exercises ... Every 2 hours
    * Sit up straight
    * Breath in deeply thru nose and out slowly thru pursed lips
    * Hold last breath 3 seconds
    * Then cough 3 times (unless abd wound - reinforce/splint if cough)
    o Watch for Stridor after any neck/throat Sx ... Keep Trach kit at bed side
    o Staples and sutures removed in 7-14 days - Keep dry until then
    o No lifting over 10 lbs for 6 weeks (in general)
    o If chest tube comes disconnected, put free end in container of sterile water
    o Removing Chest Tube ... Valsalvas, or Deep breath and hold
    o If chest tube drain stops fluctuating, the lung has re-inflated (or there is a problem)
    o Keep scissors by bed if pt has S. Blakemore Tube (for esoph varices)... Sudden respiratory distress - Cut inflation tubes and remove
    o Tracheostomy patients ... Keep Kelly clamp and Obturator (used to insert into trachea then removed leaving cannula) at bed side
    o Turn off NG suction for 30 min after PO meds
    o NG Tube Removal ... Take a deep breath and hold it
    o Stomach contents pH = < 4 (gastric juices aspirated)
    o NG Tube Insertion ... If cough and gag, back off a little, let calm, advance again with pt sipping water from straw
    o NG Tube Length ... End of nose, to era lobe, to xyphoid (~22-26 inches)
    o Decubitus (pressure) Ulcer Staging
    * Stage 1 = Erythema only
    * Stage 2 = Partial thickness
    * Stage 3 = Full thickness to SQ
    * Stage 4 = Full thickness + involving mm /bone

    * Acute Care
    o CVA ... Hemorrhagic or Embolic
    * A-fib and A-flutter = thrombus formation
    * Dysarthria (verbal enunciation/articulation), Apraxia (perform purposeful movements), Dysphasia (speech and verbal comprehension), Aphasia (speaking), Agraphia (writing), Alexia (reading), Dysphagia (swallowing)
    * Left Hemisphere Lesion ... aphasia, agraphia, slow, cautious, anxious, memory okay
    * Right Hemisphere Lesion ... can't recognize faces, loss of depth perception, impulsive behavior, confabulates, poor judgment, constantly smiles, denies illness, loss of tonal hearing
    o Head Injuries ...
    * Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP
    * Change in level of responsiveness = Most important indicator of increased ICP
    * Watch for CSF leaks from nose or ears - Leakage can lead to meningitis and mask intracranial injury since usual increased ICP symps may be absent.
    o Spinal Cord Injuries
    * Respiratory status paramount ... C3-C5 innervates diaphragm
    * 1 wk to know ultimate prognosis
    * Spinal Shock = Complete loss of all reflex, motor, sensory and autonomic activity below the lesion = Medical emergency
    * Permanent paralysis if spinal cord in compressed for 12-24 hrs
    * Hypotension and Bradycardia with any injury above T6
    * Bladder Infection = Common cause of death (try to keep urine acidic)
    o Burns
    * Infection = Primary concern
    * HyperK+ due to cell damage and release of intracellular K+
    * Give meds before dressing changes - Painful
    * Massive volumes of IV fluid given, due to fluid shift to interstitial spaces and resultant shock
    * First Degree = Epidermis (superficial partial thickness)
    * Second Degree = Epidermis and Dermis (deep partial thickness)
    * Third Degree = Epidermis, Dermis, and SQ (full thickness)
    * Rule of 9s ... Head and neck = 9%, UE = 9% each, LE = 18% each, Front trunk = 18%, Back Trunk = 18%
    * Singed nasal hair and circumoral soot/burns = Smoke inhalation burns
    o Fractures
    * Report abnormal assessment findings promptly ... Compartment Syndrome may occur = Permanent damage to nerves and vessels
    * 5 P's of neurovascular status (important with fractures)
    * Pain, Pallor, Pulse, Paresthesia, Paralysis
    * Provide age-appropriate toys for kids in traction

    * Special Tests and Pathognomonic Signs
    o Tensilon Test ... Myesthenia Gravis (+ in Myesthenic crisis, - in Cholinergic crisis)
    o ELISA and Western Blot ... HIV
    o Sweat Test ... Cystic Fibrosis
    o Cheilosis = Sores on sides of mouth ... Riboflavin deficiency (B2)
    o Trousseau's Sign (Carpal spasm induced by BP cuff) ... Hypocalcemia (hypoparathyroidism)
    o Chvostek's Sign (Facial spasm after facial nerve tap) ... Hypocalcemia (hypoparathyroidism)
    o Bloody Diarrhea = Ulcerative Colitis
    o Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pyloric Stenosis
    o Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RUQ = Intussiception
    o Mantoux Test for TB is + if 10 mm induration 48 hrs post admin (previous BCG vaccine recipients will test +)
    o Butterfly Rash = SLE ... Avoid direct sunlight
    o 5 Ps of NV functioning ... Pain, paresthesia, pulse, pallor, paralysis
    o Cullen's Sign (periumbelical discoloration) and Turner's Sign (blue flank) = Acute Pancreatitis
    o Murphy's Sign (Rt. costal margin pain on palp with inspiration) = GB or Liver disease
    o HA more severe on wakening = Brain Tumor (remove benign and malignant)
    o Vomiting not associated with nausea = Brain Tumor
    o Elevated ICP = Increased BP, widened pulse pressure, increased Temp
    o Pill-Rolling Tremor = Parkinson's (Tx with Levodopa, Cardidopa) - Fall precautions, rigid, stooped, shuffling
    o IG Bands on Electrophoresis = MS ... Weakness starts in upper extremities - bowel/bladder affected in 90% ... Demyelination - Tx with ACTH, corticosteroids, Cytoxan and other immunosuppressants
    o Reed-Sternberg Cells = Hodgkin's
    o Koplik Spots = Rubeola (Measles)
    o Erythema Marginatum = Rash of Rheumatic Fever
    o Gower's Sign = Muscular Dystrophy ... Like Minor's sign (walks up legs with hands)

    * Pediatrics
    o Bench Marks
    * Birth wt doubles at 6 months and triples at 12 months
    * Birth length increases by 50% at 12 months
    * Post fontanel closes by 8 wks
    * Ant fontanel closes by 12-18 months
    * Moro reflex disappears at 4 months
    * Steady head control achieved at 4 months
    * Turns over at 5-6 months
    * Hand to hand transfers at 7 months
    * Sits unsupported at 8 months
    * Crawls at 10 months
    * Walks at 10-12 months
    * Cooing at 2 months
    * Monosyllabic Babbling at 3-6 months, Links syllables 6-9 mo
    * Mama, Dada + a few words at 9-12 months
    * Throws a ball overhand at 18 months
    * Daytime toilet training at 18 mo - 2 years
    * 2-3 word sentences at 2 years
    * 50% of adult Ht at 2 years
    * Birth Length doubles at 4 years
    * Uses scissors at 4 years
    * Ties shoes at 5 years
    * Girls' growth spurt as early at 10 years ... Boys catch up ~ Age 14
    * Girls finish growing at ~15 ... Boys ~ 17
    o Autosomal Recessive Diseases
    * CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism,
    * 25% chance if: AS (trait only) X AS (trait only)
    * 50% chance if: AS (trait only) X SS (disease)
    o Autosomal Dominant Diseases
    * Huntington's, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease
    * 50% if one parent has the disease/trait (trait = disease in autosomal dominant)
    o X-Linked Recessive Diseases
    * Muscular Dystrophy, Hemophilia A
    * Females are carriers (never have the disease)
    * Males have the disease (but can't pass it on)
    * 50% chance daughters will be carriers (can't have disease)
    * 50% chance sons will have the disease (not a carrier = can't pass it on)
    * This translates to an overall 25% chance that each pregnancy will result in a child that has the disease
    o Scoliosis ... Milwaukee Brace - 23 hrs/day, Log rolling after Sx
    o Down Syndrome = Trisomy 21 ... Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes
    o Cerebral Palsy ... Scissoring = legs extended, crossed, feet plantar-flexed
    o PKU ... leads to MR ... Guthrie Test ...Aspartame (NutraSweet) has phenylalanine in it and should not be given to PKU patient
    o Hypothyroidism ... Leads to MR
    o Prevent Neural tube disorders with Folic Acid during PG
    o Myelomeningocele ... Cover with moist sterile water dressing and keep pressure off
    o Hydrocephalus ... Signs of increased ICP are opposite of shock ...
    * Shock = Increased pulse and decreased BP
    * IICP = Decreased pulse and increased BP ... (+ Altered LOC = Most sensitive sign)
    * Infants ... IICP = Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy ... Treat with peritoneal shunt - don't pump shunt. Older kids IIPC = Widened pulse pressure
    * IICP caused by suctioning, coughing, straining, and turning - Try to avoid
    o Muscular Dystrophy ... X-linked Recessive, waddling gait, hyper lordosis, Gower's Sign = difficulty rising walks up legs (like Minor's sign), fat pseudohypertrophy of calves.
    o Seizures ... Nothing in mouth, turn hd to side, maintain airway, don't restrain, keep safe ... Treat with Phenobarbitol (Luminol), Phenytoin (Dilantin: TR = 10-20 ... Gingival Hyperplasia), Fosphenytoin (Cerebyx), Valproic Acid (Depakene), Carbamazepine (Tegritol)
    o Meningitis (Bacterial) ... Lumbar puncture shows Increased WBC, protein, IICP and decreased glucose
    * May lead to SIADH (Too much ADH) ... Water retention, fluid overload, dilutional hyponatremia
    o CF Kids taste salty and need enzymes sprinkled on their food
    o Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during PG)
    o Pain in young children measured with Faces pain scale
    o No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin
    o Immunization Side Effects ... T < 102, redness and soreness at injection site for 3 days ... give Tylenol and bike pedal legs (passively) for child.
    o Call Physician if seizures, high fever, or high-pitched cry after immunization
    o All cases of poisoning ... Call Poison Control Center ... No Ipecac!
    o Epiglottitis = H. influenza B ... Child sits upright with chin out and tongue protruding (maybe Tripod position) ... Prepare for intubation or trach ... DO NOT put anything into kid's mouth
    o Isolate RSV patient with Contact Precautions ... Private room is best ... Use Mist Tent to provide O2 and Ribavirin - Flood tent with O2 first and wipe down inside of tent periodically so you can see patient
    o Acute Glomerulonephritis ... After B strep - Antigen-Antibody complexes clog up glomeruli and reduce GFR = Dark urine, proteinuria
    o Wilm's Tumor = Large kidney tumor ... Don't palpate
    o TEF = Tracheoesophageal Atresia ... 3 C's of TEF = Coughing, Choking, Cyanosis
    o Cleft Lip and Palate ... Post-Op - Place on side, maintain Logan Bow, elbow restraints
    o Congenital Megacolon = Hirschsprung's Disease ... Lack of peristalsis due to absence of ganglionic cells in colon ... Suspect if no meconium w/in 24 hrs or ribbon-like foul smelling stools
    o Iron Deficiency Anemia ... Give Iron on empty stomach with citrus juice (vitamin C enhances absorption), Use straw or dropper to avoid staining teeth, Tarry stools, limit milk intake < 32 oz/day
    o Sickle Cell Disease ...Hydration most important ...SC Crisis = fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia ...Tx + rest, hydration ... Avoid high altitude and strenuous activities
    o Tonsillitis ... usually Strep ... Get PT and PTT Pre-Op (ask about Hx of bleeding) ... Suspect Bleeding Post-Op if frequent swallowing, vomiting blood, or clearing throat ... No red liquids, no straws, ice collar, soft foods ... Highest risk of hemorrhage = first 24 hrs and 5-10 days post-op (with sloughing of scabs)
    o Primary meds for ER for respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) ... Bronchodilators
    o Must know normal respiratory rates for kids ... Respiratory disorders = Primary reason for most medical/ER visits for kids ...
    * Newborn ... 30-60
    * 1-11 mo ... 25-35
    * 1-3 years ... 20-30
    * 3-5 years ... 20-25
    * 6-10 years ... 18-22
    * 11-16 years ...16-20
    Cardiovascular Disorders
    o Acyanotic = VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis
    * Antiprostaglandins cause closure of PDA (aorta - pulmonary artery)
    o Cyanotic = Tetralogy of Fallot, Truncus Arteriosis (one main vessel gets mixed blood), TVG (Transposition of Great Vessels) ... Polycythemia common in Cyanotic disorders
    * 3 T's of Cyanotic Heart Disease (Tetralogy, Truncus, Transposition)
    o Tetralogy of Fallot ... Unoxygenated blood pumped into aorta
    * Pulmonary Stenosis
    * VSD
    * Overiding Aorta
    * Right Ventricular Hypertrophy
    * TET Spells ...Hypoxic episodes that are relieved by squatting or knee chest position
    o CHF can result ... Use Digoxin ... TR = 0.8-2.0 for kids
    o Ductus Venosus = Umbelical Vein to Inferior Vena Cava
    o Ductus Arteriosus = Aorta to Pulmonary Artery
    o Rheumatic Fever ... Acquired Heart Disease ... Affects aortic and mitral valves
    * Preceded by beta hemolytic strep infection
    * Erythema Marginatum = Rash
    * Elevated ASO titer and ESR
    * Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep)
    * Treat with Penicillin G = Prophylaxis for recurrence of RF

    * Maternity
    o Day 1 of cycle = First day of menses (bleeding) ... Ovulation on Day 14 ... 28 days total ... Sperm 3-5 days, Eggs 24 hrs ... Fertilization in Fallopian Tube
    o Chadwick's Sign = Bluing of Vagina (early as 4 weeks)
    o Hegar's Sign = Softening of isthmus of cervix (8 weeks)
    o Goodell's Sign = Softening of Cervix (8 weeks)
    o Pregnancy Total wt gain = 25-30 lbs (11-14 kg)
    o Increase calorie intake by 300 calories/day during PG ... Increase protein 30 g/day ... Increase iron, Ca++, Folic Acid, A & C
    o Dangerous Infections with PG ... TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV
    o Braxton Hicks common throughout PG
    o Amniotic fluid = 800-1200 mL (< 300 mL = Oligohydramnios = fetal kidney problems)
    o Polyhydramnios and Macrosomia (large fetus) with Diabetes
    o Umbelical cord: 2 arteries, 1 vein ... Vein carries oxygenated blood to fetus (opposite of normal)
    o FHR = 120-160
    o Folic Acid Deficiency = Neural tube defects
    o Pre-term = 20-37 weeks
    o Term = 38-42 weeks
    o Post-term = 42 weeks+
    o TPAL = Term births, Pre-term births, Abortions, Living children
    o Gravida = # of Pregnancies regardless of outcome
    o Para = # of Deliveries (not kids) after 20 wks gestation
    o Nagale's Rule ... Add 7 days to first day of last period, subtract 3 months, add 12 months = EDC
    o Hgb and Hct a bit lower during PG due to hyperhydration
    o Side-lying is best position for uteroplacental perfusion (either side tho left is traditional )
    o 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature
    o AFP in amniotic fluid = possible neural tube defect
    o Need a full bladder for Amniocentesis early in PG (but not in later PG)
    o Lightening = Fetus drops into true pelvis
    o Nesting Instinct = Burst of Energy just before labor
    o True Labor = Regular contractions that intensify with ambulation, LBP that radiates to abdomen, progressive dilation and effacement
    o Station = Negative above ischial spines, Positive below
    o Leopold Maneuver tries to reposition fetus for delivery
    o Laboring Maternal Vitals ... Pulse < 100 (usually a little higher than normal with PG - BP is unchanged in PG). T < 100.4
    o NON-Stress Test ... Reactive = Healthy (FHR goes up with movements)
    o Contraction Stress Test (Ocytocin Challenge Test)... Unhealthy = Late decels noted (positive result) indicative of UPI ... "Negative" result = No late decels noted (good result)
    o Watch for hyporeflexia with Mag Sulfate admin . . . Diaphragmatic Inhibition
    * Keep Calcium gluconate by the bed (antidote)
    o Firsts
    * Fetal HB ... 8-12 weeks by Doppler, 15-20 weeks by fetoscope
    * Fetal movement = Quickening, 14-20 weeks
    * Showing = 14 weeks
    * Braxton Hicks - 4 months and onward
    o Early Decels = Head compression = OK
    o Variable Decels = Cord compression = Not Good
    o Late Decels = Utero-placental insufficiency = BAD!
    o If Variable or Late Decels ... Change maternal position, Stop Pitocin, Administer O2, Notify Physician
    o DIC ... Tx is with Heparin (safe in PG) ... Fetal Demise, Abruptio Placenta, Infection
    o Fundal Heights
    * 12-14 wks ... At level of symphysis
    * 20 weeks ... 20 cm = Level of umbilicus
    * Rises ~ 1 cm per week
    o Stages of Labor
    * Stage 1 = Beginning of Regular contraction to full dilation and effacement
    * Stage 2 = 10 cm dilation to delivery
    * Stage 3 = Delivery of Placenta
    * Stage 4 = 1-4 Hrs following delivery
    o Placenta Separation ... Lengthening of cord outside vagina, gush of blood, full feeling in vagina ... Give oxytocin after placenta is out - Not before.
    o Schultz Presentation = Shiny side out (fetal side of placenta)
    o Postpartum VS Schedule
    * Every 15 min X 1 hr
    * Every 30 min X next 2 hours
    * Every Hour X next 2-6 hours
    * Then every 4 hours
    o Normal BM for mom within 3 days = Normal
    o Lochia ... no more than 4-8 pads/day and no clots > 1 cm ... Fleshy smell is normal, Foul smell = infection
    o Massage boggy uterus to encourage involution ... empty bladder ASAP - may need to catheterize ... Full bladder can lead to uterine atony and hemorrhage
    o Tears ...1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal sphincter, 4th Degree = rectum
    o APGAR = HR, R, mm tone, Reflex irritability, Color ... 1 and 5 minutes ...7-10 = Good, 4-6 = moderate resuscitative efforts, 1-3 = mostly dead
    o Eye care = E-mycin + Silver Nitrate ... for gonorrhea
    o Pudendal Block = decreases pain in perineum and vagina - No help with contraction pain
    o Epidural Block = T10-S5 ... Blocks all pain ... First sign = warmth or tingling in ball of foot or big toe
    o Regional Blocks often result in forceps or vacuum assisted births because they affect the mother's ability to push effectively
    o WBC counts are elevated up to 25,000 for ~10 days post partum
    o Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver Rh+ kids... Not given if mom has a +Coombs Test ... She already has developed antibodies (too late)
    o Caput Succedaneum = edema under scalp, crosses suture lines
    o Cephalhematoma = blood under periosteum, does not cross suture lines
    o Suction Mouth first - then nostrils
    o Moro Reflex = Startle reflex (abduction of all extremities) - up to 4 months
    o Rooting Reflex ... up to 4 months
    o Babinski Reflex ... up to18 months
    o Palmar Grasp Reflex ...Lessens by 4 months
    o Ballard Scale used to estimate gestational age
    o Heel Stick = lateral surface of heel
    o Physiologic Jaundice is normal at 2-3 days ... Abnormal if before 24 hours or lasting longer than 7 days ... Unconjugated bilirubin is the culprit.
    o Vitamin K given to help with formation of clotting factors due to fact that the newborn gut lacks the bacteria necessary for vitamin K synthesis initially ... Vastus lateralis mm IM
    o Abrutio Placenta = Dark red bleeding with rigid board like abdomen
    o Placenta Previa = Painless bright red bleeding
    o DIC = Disseminated Intravascular Coagulation ... clotting factors used up by intravascular clotting - Hemorrhage and increased bleeding times result ... Associated with fetal demise, infection and abruptio placenta.
    o Magnesium Sulfate used to reduce preterm labor contractions and prevent seizures in Pre-Eclampsia ... Mg replaces Ca++ in the smooth mm cells resulting relaxation ... Can lead to hyporeflexia and respiratory depression - Must keep Calcium Gluconate by bed when administering during labor = Antidote ... Monitor for:
    * Absent DTR's
    * Respirations < 12
    * Urinary Output < 30/hr
    * Fetal Bradycardia
    o Pitocin (Oxytocin) use for Dystocia... If uterine tetany develops, turn off Pitocin, admin O2 by face mask, turn pt on side. Pitocin can cause water intoxication owing to ADH effects.
    o Suspect uterine rupture if woman complains of a sharp pain followed by cessation of contractions
    o Pre-Eclampsia = Htn + Edema + Proteinuria
    o Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma ... Suspect if Severe HA + visual disturbances
    o No Coumadin during PG (Heparin is OK)
    o Hyperemesis Gravidarum = uncontrollable nausea and vomiting ... May be related to H. pyolori ... Reglan (metaclopromide)
    o Insulin demands drop precipitously after delivery
    o No oral hypoglycemics during PG - Teratogenic ... Insulin only for control of DM
    o Babies born without vaginal squeeze more likely to have respiratory difficulty initially
    o C-Section can lead to Paralytic Ileus ... Early ambulation helps
    o Postpartum Infection common in problem pregnancies (anemia, diabetes, traumatic birth)
    o Postpartum Hemorrhage = Leading cause of maternal death ... Risk factors include:
    * Dystocia, prolonged labor, overdistended uterus, abrutio placenta, infection
    Tx includes ... Fundal massage, count pads, VS, IV fluids, Oxytocin, notify physician
    o Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn
    o Hypoglycemia ... tremors, high pitched cry, seizures
    o High pitched cry + bulging fontanels = IICP
    o Hypothermia can lead to Hypoxia and acidoisis ... Keep warm and use bicarbonate prn to treat acidosis in newborn.
    o Lay on right side after feeding ... Move stomach contents into small intestine
    o Jaundice and High bilirubin can cause encephalopathy ... < 12 = normal ... Phototherapy decomposes bilirubin via oxidation ... Protect eyes, turn every 2 hours and watch for dehydration ... The dangerous bilirubin is the unconjugated indirect type.

    * Nutrition
    o K+ ... Bananas, dried fruits, citrus, potatoes, legumes, tea, peanut butter
    o Vitamin C ... Citrus, potatoes, cantaloupe
    o Ca++ ... Milk, cheese, green leafy veggies, legumes
    o Na+ ... Salt, processed foods, seafood
    o Folic Acid ... Green leafy veggies, liver, citrus
    o Fe++ ... Green leafy veggies, red meat, organ meat, eggs, whole wheat, carrots
    * Use Z-track for injections to avoid skin staining
    o Mg+ ... Whole grains, green leafy veggies, nuts
    o Thiamine (B1) ... Pork, beef, liver, whole grains
    o B12 ... Organ meats, green leafy veggies, yeast, milk, cheese, shellfish
    * Deficiency = Big red beefy tongue, Anemia
    o Vitamin K ... Green leafy veggies, milk, meat, soy
    o Vitamin A ... Liver, orange and dark green fruits and veggies
    o Vitamin D ... Dairy, fish oil, sunlight
    o Vitamin E ... Veggie oils, avocados, nuts, seeds
    o BMI ... 18.5-24.9 = Normal (Higher = Obese)

    * Gerontology
    o Essentially everyone goes to Hell in a progressively degenerative hand-basket
    * Thin skin, bad sleep, mm wasting, memory loss, bladder shrinks, incontinence, delayed gastric emptying, COPD, Hypothyroidism, Diabetes

    o Common Ailments:
    * Delerium and Dementia
    * Cardiac Dysrhythmias
    * Cataracts and Glaucoma
    * CVA (usually thrombotic, TIAs common)
    * Decubitus Ulcers
    * Hypothyroidism
    * Thyrotoxicosis (Grave's Disease)
    * COPD (usually combination of emphysema and CB)
    * UTIs and Pneumonia ... Can cause confusion and delerium
    o Memory loss starts with recent - progresses to full
    o Dementia = Irreversible (Alzheimer's) ... Depression, Sundowning, Loss of family recognition
    o Delerium = Secondary to another problem = Reversible (infections common cause)
    o Medication Alert! ... Due to decreased renal function, drugs metabolized by the kidneys may persist to toxic levels
    o When in doubt on NCLEX ... Answer should contain something about exercise and nutrition.

    * Advanced Clinical Concepts
    o Erickson ... Psycho-Social Development
    * 0-1 yr (Newborn) ... Trust vs. Mistrust
    * 1-3 yrs (Toddler)... Autonomy vs. Doubt and Shame ... Fear intrusive procedures - Security objects good (Blankies, stuffed animals)
    * 3-6 yrs (Pre-school) ... Initiative vs. Guilt ... Fear mutilation - Band-Aids good
    * 6-12 yrs (School Age) ... Industry vs. Inferiority... Games good, Peers important ... Fear loss of control of their bodies
    * 12-19 yrs (Adolescent) ... Identity vs. Role Confusion ... Fear Body Image Distortion
    * 20-35 yrs (Early Adulthood) ... Intimacy vs. Isolation
    * 35-65 yrs (Middle Adulthood) ... Generativity vs. Stagnation
    * Over 65 (Older Adulthood) ... Integrity vs. Despair
    o Piaget ... Cognitive Development
    * Sensorimotor Stage (0-2) ... Learns about reality and object permanence
    * Preoperational Stage (2-7) ... Concrete thinking
    * Concrete Operational Stage (7-11) ... Abstract thinking
    * Formal Operational Stage (11-adult) ... Abstract and logical thinking
    o Freud ... Psycho-Sexual Development
    * Oral Stage (Birth -1 year) ... Self gratification, Id is in control and running wild
    * Anal Stage (1-3) ... Control and pleasure wrt retention and pooping - Toilet training in this stage
    * Phallic Stage (3-6) ... Pleasure with genitals, Oedipus complex, SuperEgo develops
    * Latency Stage (6-12) ... Sex urges channeled to culturally acceptable level, Growth of Ego
    * Genital Stage (12 up) ... Gratification and satisfying sexual relations, Ego rules
    o Kohlberg ... Moral Development
    * Moral development is sequential but people do not aromatically go from one stage to the next as they mature
    * Level 1 = Pre-conventional ... Reward vs. Punishment Orientation
    * Level 2 = Conventional Morality ... Conforms to rules to please others
    * Level 3 = Post- Conventional ... Rights, Principles and Conscience (Best for All is a concern)

    * Calculations Rules & Formulas
    o Round final answer to tenths place
    o Round drops to nearest drop
    o When calculating mL/hr, round to nearest full mL
    o Must include 0 in front of values < 1
    o Pediatric doses rounded to nearest 100th. Round down for peds
    o Calculating IV Flow Rates
    * Total mL X Drop Factor / 60 X #Hrs = Flow Rate in gtts/min
    o Calculating Infusion Times
    * Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse

    * Conversions
    o 1 t = 5mL
    o 1 T = 3 t = 15 mL
    o 1 oz = 30 cc = 30 mL = 2 T
    o 1 gr = 60 mg
    o 1 mg = 1000 ug (or mcg)
    o 1 kg = 2.2 lbs
    o 1 cup = 8 oz = 240 mL
    o 1 pint = 16 oz
    o 1 quart = 32 oz
    o Degrees F = (1.8 X C) + 32
    o Degrees C = (F - 32) / 1.8
    * 37 C = 98.6 F
    * 38 C = 100.4 F
    * 39 C = 102.2 F
    * 40 C = 104 F

    * Fall Precautions
    o Room close to nurses station
    o Assessment and orientation to room
    o Get help to stand (dangle feet if light headed)
    o Bed low with side rails up
    o Good lighting and reduce clutter in room
    o Keep consistent toileting schedule
    o Wear proper non-slip footwear
    o At home ...
    * Paint edges of stairs bright color
    * Bell on cats and dogs

    * Neutropenic (Immunosuppressed) Precautions
    o No plants or flowers in room
    o No fresh veggies ... Cooked foods only
    o Avoid crowds and infectious persons
    o Meticulous hand washing and hygiene to prevent infection
    o Report fever > 100.5 (immunosuppressed pts may not manifest fever with infection)

    * Bleeding Precautions (Anticoagulants, etc.)
    o Soft bristled tooth brush
    o Electric razor only (no safety razors)
    o Handle gently, Limit contact sports
    o Rotate injection sites with small bore needles for blood thinners
    o Limit needle sticks, Use small bore needles, Maintain pressure for 5 minutes on venipuncture sites
    o No straining at stool - Check stools for occult blood (Stool softeners prn)
    o No salicylates, NSAIDs, or suppositories
    o Avoid blowing or picking nose
    o Do not change Vitamin K intake if on Coumadin

    0 Replies to “Irritable Bowel Syndrome Hesi Case Study”

    Lascia un Commento

    L'indirizzo email non verrĂ  pubblicato. I campi obbligatori sono contrassegnati *