common board topics

8/4/2019 Common Board Topics

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COMMON BOARD TOPICS


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COMMON BOARD TOPICS

Dilantin (Phenytoin)

Detoxified by the liver

Teach about side effects

May cause bone marrow

depressionTaken with food


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COMMON BOARD TOPICS

PHLEBITIS

Heat

Redness

Tenderness

(-) swelling or edema

INFILTRATION

Pain

Edema

Cold


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COMMON BOARD TOPICS

Aminophylline (Truphylline;Theophylline

Major side effects: palpitations,nervousness, rapid pulse,dysrhythmias, nausea, and

vomiting.Check pulse!


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COMMON BOARD TOPICS

Morphine Sulfate

Decreases preload and after

load

Decreases anxiety

Not given to abdominal painCNS depressant

Constipating


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COMMON BOARD TOPICS

Total Parenteral Nutrition (TPN)

Hang no longer than 24 hours

Site of catheter changed every

4 weeks.

Monitor for complications


7/65

COMMON BOARD TOPICS

Fluoxetine (Prozac)

(SSRI) for depression and OCD

S/E: Postural hypotension, dry mouth,rapid heartbeat, insomnia

If dose is missed, omit dose and

instruct client to return to regular

dosing schedule.


8/65

COMMON BOARD TOPICS

Propanolol (Inderal)

Beta-adrenergic blocker

Antihypertensive Masks hypoglycemia

S/E: Bronchospasm, bradycardia,

depression. Take pulse beforeadministration

Do not give to asthmatic patients.


9/65

COMMON BOARD TOPICS

Glipizide (Glucotrol)

Oral hyoglycemic agent

S/E: Aplastic anemia and photosensitivity

Hypoglycemia

Metformin (Glucophage)

Lactic acidosis


10/65

COMMON BOARD TOPICS

Prednisone (Deltasone)

Corticosteroid causes hyperglycemia

Bethanechol (Urecholine) Cholinergic drug for functional urinary

retention

Prevents urinary retention

Oxybutynin Cl (Ditropan)

Increases bladder capacity

Not forglaucoma, Genitourinary

obstruction


11/65

COMMON BOARD TOPICS

1 grain=60mg

1 glass=240 cc

1 ounce=30 cc

1 kg=2.2 lbs

1 kg=1 liter

1 inch=2.54 cm

1 feet=12 inches

1 meter=36 inches


12/65

COMMON BOARD TOPICS

Levothyroxine (Synthroid)

Given in the morning on EMPTY

STOMACH

Report adverse reactions

(hyperthyroidism)

Carbamazepine (Tegretol) Interferes with action of hormonal

contraceptives.

S/E: photosensitivity.


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COMMON BOARD TOPICS

Treatment of tuberculosis

Rifampicin

Isoniazid (INH)Pyrazinamide (PZA)

Ethambutol

Streptomycin


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COMMON BOARD TOPICS

Carbidopa/Levodopa (Sinemet)

Drug for PD

Taken before meals avoid B6 and high-protein

food Decreases the rigidity and bradykinesia

. Albuterol (Proventil)

Bronchodilator

S/E: Tremors, headache, hyperactivity,tachycardia.

Use bronchodilator first before steroid medication


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COMMON BOARD TOPICS

Insulin PEAK effect:

Rapid-acting insulin: 1 hour

Regular-acting insulin: 2-4 hours

Intermediate/NPH insulin: 6-12

hours


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COMMON BOARD TOPICS

Phenazopyridine (Pyridium)

Trimethoprim-sulfamethoxazole(Bactrim)

Most common side effect mild to moderaterash (urticaria)

Aminoglycosides are ototoxic.

Butorphanol Tartrate (Stadol)Analgesic

S/E: Change in BP, bradycardia, respiratory

depression.


19/65

COMMON BOARD TOPICS

Infant normal resting heart rate: 120-

140

Fetal heart rate is 120-160 Herbs and spices are good to improve

the taste of food

Salt substitutes contain potassium

Milk and dairy products are high in

calcium and PHOSPHORUS


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COMMON BOARD TOPICS

Children with CELIAC DISEASE

Should eat a gluten free diet. (No B-

R-O-W)Most concern is DEHYDRATION


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COMMON BOARD TOPICS

INFANT

Stranger anxiety

TODDLER

Separation anxiety

PRE-SCHOOLER

Castration fear/body mutilation, fear ofthe dark

SCHOOLER

Fear of replacement/displacement in

school, loss of privacy, fear of death


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COMMON BOARD TOPICS

Signs ofTD include smacking

lips, grinding of teeth and "fly

catching" tongue movements.


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COMMON BOARD TOPICS

Restlessness, confusion, irritabilityand disorientation may be the firstsigns offat embolism syndrome

Restraint: frame of bed, quick releaseties, document need for restraint Q4hours

IPPA for Physical Assessment

IAPerPal


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COMMON BOARD TOPICS

Never ask WHY questions in the

care of patients with psychiatric

problem Gag Reflex: dont assess gag reflex to

a client that has an absent swallow

reflex


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Bone marrow Aspiration

Site: iliac crest; painful


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Myelogram

Water-soluble dye: Elevate head

of bed 30 degrees Oil based dye: Flat in bed

(removed)


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COMMON BOARD TOPICS

Fractured Hip Assessments

Leg shortened

Adducted Externally rotated Implementation

Abduction pillows

Crutch walking with 3-point gait Dont sleep on operated side Dont flex hip more than 45-60 degrees Dont elevate head of the bed more than 45

degrees


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COMMON BOARD TOPICS

AMPUTATIONS Residual limb covered with dressing andelastic bandage (figure eight)

Figure-8 doesnt restrict blood flow, shapedto reduce edema

Elevated 24 hours (AKA-pillow, BKA-foot ofbed elevated)

Position prone daily Phantom Pain: acknowledge feelings, that

pain is real for them.


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COMMON BOARD TOPICS

Proper positioning on NGT/enteral

feeding

Enteral feeding held if: >150 ccsaspirated or 50% given in the

hour is aspirated

If cramping, vomiting occurs

decrease rate of enteral feeding

or keep it warm.


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COMMON BOARD TOPICS

Specific gravity of urine: 1.010-1.030

pH: 4.5-8(Slightly acidic)

UO: 1,000-1,500cc/day Credes Maneuver: Push urine out

Displaced uterus in a postpartum

mother: Check for distention Throbbing headache after SCI: Check

bladder or fecal impaction


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COMMON BOARD TOPICS

Normal urine output (1200-1500

ccday or 50-63 cc/hr)

Normal voiding pattern 5-6times/day.`

Infants: 6-8 times Green leafy vegetables contain

vitamin K.


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COMMON BOARD TOPICS

Glucose

Na

K Cl

Bicarbonate

BUN Creatinine clearance

Serum Creatinine


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COMMON BOARD TOPICS

Oculogyric crisis: uncontrollable

rolling back of eyes: side effect of

Phenothiazines Lithium helps control impulsive

behaviors.

Fluphenazine (Prolixin):antipsychotic medication


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COMMON BOARD TOPICS

Thiamine sources: organ meats,

liver, whole grain, nuts, legume, egg,

and milk. Dont document abuse. Report

suspected abuse to nursing

supervisor. Tonometry: measures intraocular

pressure; to rule out glaucoma


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COMMON BOARD TOPICS

Blind client:

address by name

Introduce self

Keep furniture arrangement consistent, open

or close doors

Walk step ahead

Instilling ear drops lie patient on unaffected earto absorb drops.

Position patient on affected ear to promote

drainage.


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COMMON BOARD TOPICS

Sick day rules: take insulin as ordered,

check blood glucose q3-4 hours, soft

foods, liquids


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COMMON BOARD TOPICS

Hepatobiliary disease

Decrease in ability of bile to absorb fat

Cystic fibrosis:

Absence of pancreatic enzymes;malabsorption of fat

Lung disease

Pancreatic enzyme replacement High-protein, high-calorie diet,

respiratory care/suction


39/65

COMMON BOARD TOPICS

Position right side to promote gastric

emptying.

Dumping syndrome prevention:Teaching on prevention of signs and

symptoms

Sengstaken-Blakemore Tube

Treat patient with bleeding

esophageal varices.


40/65

COMMON BOARD TOPICS

Obese person choking: use Chest

Thrusts.

Care for patient first, equipmentsecond

Signs for hypoxia: restlessness,

tachycardia


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COMMON BOARD TOPICS

Defibrillation

Start CPR first

1st attempt 200 joules

2nd attempt 200 to 300 joules

3rd attempt 360 joules Check monitor between shocks

for rhythm


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COMMON BOARD TOPICS

Cardioversion

Elective procedure, Informed Consent

Valium IV Synchronizer on

25-360 joules

Check monitor between rhythm


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COMMON BOARD TOPICS

Hypovolemic: Decreased in

intravascular volume

Cardiogenic: Decreased cardiacoutput

Septic shock

Anaphylactic shock

Neurogenic shock


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COMMON BOARD TOPICS

Shock Signs

and Symptoms

of SHOCK Cool, clammy

skin

Cyanosis Decreased

alertness

Tachycardia

Hypotension

Shallow, rapidrespirations

Oliguria

Decreased CVP


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COMMON BOARD TOPICS

Increased ICP

Assessments

Altered LOC(Earliest Sign)

Restlessness

Glasgow comascale


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COMMON BOARD TOPICS

Implementations for IICP

Elevate head 30-45 degrees

Avoid neck flexion and head rotationReduce environmental stimuli

Prevent Valsalva maneuver

Restrict fluids to 1200-1500 cc/dayMedications: Osmotic diuretics,

corticosteroids


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COMMON BOARD TOPICS

Seizures:Do not restrain!

Do not insert anything in mouth!No oral thermometerProtect airway during and after

seizureOrient the client


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COMMON BOARD TOPICS

ELECTROLYTES

Potassium :3.5-5.0 mEq/L

Sodium :135-145 mEq/L

Calcium :4.5-5.5 mEq/L or 9-11

Chloride :96-106 mEq/L

Magnesium :1.5-2.5 mEq/L Phosphorus :1.2-3 mEq/L


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COMMON BOARD TOPICS

HYPOKALEMIA

Assessments

K+ < 3.5 mEq/LMuscle weakness

Paresthesias

DysrhythmiasIncreased sensitivity to digitalis


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COMMON BOARD TOPICS

HYPOKALEMIA

Implementations

Potassium Supplements

Dont give > 40 mEq/L into peripheral IVor without cardiac monitor

Check URINE OUTPUT

For infants not more than 1 cc! Increase dietary intake of K


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COMMON BOARD TOPICS

Hyperkalemia

Assessments

K+ >5.0 mEq/LECG changes

Paralysis

Diarrhea

Nausea


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COMMON BOARD TOPICS

Hyperkalemia Implementations

K-I-D

Restrict intake of K

Calcium Gluconate and Na HCO3

Diuretics


53/65

COMMON BOARD TOPICS

Hyponatremia

Assessments

Na+ < 135 mEq/L

Nausea

Muscle crampsConfusion


54/65

COMMON BOARD TOPICS

Hyponatremia

Implementations

I & ODaily weight

Increase oral intake of sodium rich

foods

Water restriction

IV Lactated Ringers or 0.9% NaCL


55/65

COMMON BOARD TOPICS

Hypernatremia Assessments

Na+ >145 mEq/L

Disorientation, delusion, hallucinations

Thirsty, dry, swollen tongue

Sticky mucous membranes


56/65

COMMON BOARD TOPICS

Hypernatremia

Assessments

I & ODaily Weight

Give hypotonic solutions: 0.45%

NaCl or 5% Dextrose in water IV


57/65

COMMON BOARD TOPICS

Hypercalcemia

Assessments

Ca+> 5.5 mEq/LMuscle weakness, lack of

coordination

Constipation, abdominal pain

Depressed deep tendon reflexes


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COMMON BOARD TOPICS

Hypercalcemia

Implementations

0.4% NaCl or 0.9% NaCl IV

Encourage fluids (acidic drinks:

cranberry juice)

Diuretics Calcitonin

Mobilize patient

Surgery for hyperparathyroidism


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COMMON BOARD TOPICS

Hypocalcemia

Assessments

Ca+ < 4.5mEq/L

Tetany

Positive

Trousseaus

sign

Positive

Chvosteks

sign

Seizures

Confusion

Irritability,paresthesias


60/65

COMMON BOARD TOPICS

Hypocalcemia

Implementations

Oral calcium supplementsCalcium gluconate IV

Seizure precautions

Meet safety needs


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COMMON BOARD TOPICS

Wound Care for Burns

Pain, hyperkalemia, and shock are

problems

Isotonic fluids (Lactated Ringers)

Closed method (Silvadene)

Open method (Sulfamylon) IV painmedication initially: not PO takes too

long, not IM circulation impaired


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COMMON BOARD TOPICS

Medicate patient before wound care

Silver nitrate (warn patient skin will

turn black)High calorie, High carbohydrate,

High protein diet

Vitamin B,C, and Iron

TPN maybe used

Prevent contractures


63/65

COMMON BOARD TOPICS

Pheochromocytoma

Assessment

Increase in catecholaminesHypertension

Collect urine for VMA

Avoid abdominal palpationPrepare to give P medications


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COMMON BOARD TOPICS

COPD Assessments

Blue Bloaters

Pink Puffers

Assume ORTHOPNEIC POSITION

Barrel-chest

Dyspnea

CoughAdventitious breath sounds

Clubbing


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COMMON BOARD TOPICS

COPD Implementations

Assess airway clearance

Listen to breath sounds

Administer low-flow oxygen (1-2 LPM)

Encourage fluids

Small frequent feedings

Humidify oxygen

Use metered dose inhalers (MDI)

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