Dilantin - detoxified by liver.

The nurse cares for a client receiving IV antibiotics every 8 hours for the past 4 days. The antibiotic is mixed in D5W. The nurse
determines that a post-infusion phlebitis has occurred if which of the following is observed?
1. Tenderness at the IV site.
2. Increased swelling at the insertion site.
3. Area around the IV site is reddened with red streaks.
4. Fluid is leaking around the IV catheter.
a. Tenderness occurs with phlebitis but is not specific to it.
b. May indicate either infiltration or phlebitis
c. CORRECT—reddened, warm area noted around insertion site or on path of vein; discontinue IV, apply warm, moist
compresses, restart IV at new site
d. Not indicative of phlebitis

Ethacrynic Acid (Edecrin)—are considered loop diuretics and are potassium wasting; encourage client to increase intake of
potassium-rich foods. Orange juice/Bananas, etc.

Aminophylline (Truphylline)—is a xanthine bronchodilator;

major side effects: palpitations, nervousness, rapid pulse, dysrhythmias, nausea, and vomiting.
Toxic effects: confusion, headache, flushing, tachycardia, and seizure.

Morphine Sulfate—decreases blood return to the right side of the heart, and decrease peripheral resistance. In other words, decreases
preload and afterload pressures and cardiac workload; causes vasodilation and pooling of fluid in extremities; provides relief from
anxiety.

Intropin (Dopamine)—vasoactive medication are given IV to restore BP in hypotensive states; Increases blood return to the right
side of the heart, and increase peripheral resistance;
side effects: headache, severe hypertension, dysrhythmias; check BP q2 minutes until stabilized, then q5 minutes

TPN—hang no longer than 24 hours; IV tubing and filters every 24 hours; site of catheter changed every 4 weeks.

Fluoxetine (Prozac)—a selective serotonin reuptake inhibitor (SSRI) used to treat depression and obsessive compulsive disorder.
Side effects: postural hypotension, dry mouth, rapid heartbeat, anorexia, weight loss, severe headache. If dose is missed, omit dose
and instruct client to return to regular dosing schedule.

Propanolol (inderal)—a beta-adrenergic blocker used as antihypertensive;

Side effects: bronchospasm, bradycardia, depression. Take pulse before administration and gradually decrease when discontinuing.
Do not give to asthmatic patients.

Glipizide (Glucotrol)—an oral hypoglycemic that decreases blood sugar by stimulating insulin release from the beta cells of the
pancreas; may cause aplastic anemia and photosensitivity.

Prednisone (Deltasone)—a corticosteroid. Side effects: hyperglycemia

Bethanechol (Urecholine)—a cholinergic or parasympathomimetic used to treat functional urinary retention; mimics action of
acetylcholine.

Ventricular Tachycardia—causes chest pain, dizziness, and fainting.

1 grain = 60mg

Levothyroxine (Synthroid)—thyroid preparation should be administered at breakfast to prevent insomnia.

Carbamazepine (Tegretol)—interferes with action of hormonal contraceptives. Side effects: photosensitivity; prevention of seizures
and relief of pain in trigeminal neuralgia. Trigeminal neuralgia (Tic douloureux) is an agonizing pain that may result in severe
depression and suicide.
Aluminum Hydroxide (Amphojel)—an antacid; neutralizes hydrochloric acid and reduces pepsin activity; take one hour before and
hour of sleep. Antacids most effective after digestion has started, but prior to the emptying of the stomach.

1
Isoniazid (INH)—Side effects: peripheral neuropathy (administer pyridoxine), rash, urticaria, and swelling of the face, lips, and
eyelids.

Pyridoxine (Vitamin B6, Beesix, Doxine)—required for amino acid, carbohydrate, and lipid metabolism. Used in the transport of
amino acids, formation of neurotransmitters, and sythesis of heme. Prevention of neuropathy.

Clonidine (Catapres-TTS)—is a centrally acting alpha-adrenergic used to treat hypertension; Side effects: drowsiness, sedation,
orthostatic hypotension, heart failure. If patch used, be cautious around microwaves, results in burns, dispose of carefully, and heat
will increase medication absorption leading to toxicity.

Phlebitis—tenderness, redness; remove iv, apply warm soaks to decrease inflammation, swelling, and discomfort.

Autologous blood—may give blood 5 weeks before surgery; can give 2 to 4 units of blood; may have to take iron pills

Partial-thickness burn; only part of skin is damaged or destroyed; large, thick-walled blisters develop; underlying tissue is deep red,
appears wet and shiny; painful with increased sensitivity to heat; healing occurs by evolution of undamaged basal cells, takes about
21-22 days. I.E., Redness and swelling with fluid-filled vesicles noted on right arm or Blistering and blanching of the skin noted on
the back.

Full-thickness burn; all skin is destroyed and muscle and bone may be involved; substance that remains is called eschar, dry to touch,
doesn’t heal spontaneously, requires grafting. I.E., Charred, waxy, white appearance of skin on left leg.

Superficial burn; skin appears pink, increased sensitivity to heat, some swelling, healing occurs without treatment. I.E., Reddened
blotchy painful areas noted on the face.

Carbidopa/Levodopa (Sinemet)—used to treat symptoms of Parkinson’s disease. Take immediately before meals and high-protein
meals may impair effectiveness of medication. Reduces rigidity and bradykinesis and facilitates client’s mobility.

Doxycycline (Vibramycin)—a tetracycline that is taken at regular intervals but not within 1 hour of bedtime because it may cause
esophageal irritation. Use another method of birth control, do not take antacids within 1-3 hours of taking medication, and may cause
photosensitivity.

Albuterol (Proventil)—a bronchodilator. Side effects: tremors, headache, hyperactivity, tachycardia. Use first before steroid
medication so opens up bronchioles for steroid to get in. Wait one minute between puffs of the inhalers for best effect.

Beclomethasone (Vanceril)—a steroid medication. Side effect: fungal infections, dry mouth, throat infections.

Insulin—NPH Onset: 1.5 hours Peak: 4-12 hours Regular Onset: 0.5 hours Peak: 2.5-5 hours

Topiramate (Topamax)—is an anticonvulsant. Should drink 2000-3000ml of fluid daily to prevent kidney stones. Side effects:
orthostatic hypotension, ocular symptoms, blindness, and decrease effects of hormonal contraceptives.

Propranolol (Inderal)—a beta-blocker that takes up beta-adrenergic receptor sites, which prevents adrenaline from causing
symptoms and glycogenolysis. Inderal may mask symptoms of hypoglycemia, removing the body’s early warning system.

Phenazopyridine (Pyridium)—acts on urinary tract mucosa to produce analgesic or local anesthetic effects. Side effects: bright
orange urine, yellowish discoloration of skin or sclera indicates drug accumulation due to renal impairment.

Trimethoprim-sulfamethoxazole (Bactrim)—most common side effect mild to moderate rash (urticaria)

Aminoglycosides are ototoxic.

Butorphanol Tartrate (Stadol)—analgesic used for moderate to severe pain; Side effects include change in BP, bradycardia,
respiratory depression.

Infant normal resting heart rate: 120-140

Salt substitutes contain potassium

2
When directing a UAP, the nurse must communicate clearly about each delegated task with specific instructions on what must be
reported. Because the RN is responsible for all care-related decisions, only implementation tasks should be assigned because they do
not require independent judgment.

When applying the nursing process, assessment is the first step in providing care. The 5 "Ps" of vascular impairment can be used as a
guide (pain, pulselessness, pallor, paresthesia, paralysis)

READ THE QUESTIONS FIRST!!!!!

READ THE QUESTIONS FIRST!!!!!
DETERMINE THE QUESTION!!!!!!

Rash and blood dyscrasias are side effects of anti-psychotic drugs. A history of severe depression is a contraindication to the use of
neuroleptics.

Children with celiac disease should eat a gluten free diet. Gluten is found mainly in grains of wheat and rye and in smaller quantities
in barley and oats. Corn, rice, soybeans and potatoes are digestible in persons with celiac disease.

The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk because Decadron increases the
production of hydrochloric acid, which may cause gastrointestinal ulcers.

The protest phase of separation anxiety is a normal response for a child this age (2 year-old hospitalized child). In toddlers, ages 1 to
3, separation anxiety is at its peak

Signs of tardive dyskinesia include smacking lips, grinding of teeth and "fly catching" tongue movements.

Verapamil, Bretylium, and Amiodarone increases serum dig levels, possibly causing Digitalis Toxicity

Signs/Symptoms of Digital Toxicity: first signs include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia,
and other arrhythmias. In infants and small children, the first symptoms of overdose are usually cardiac arrhythmias.

Restlessness, confusion, irritability and disorientation may be the first signs of fat embolism syndrome followed by a very high
temperature.

A Neologism is a new word self invented by a person and not readily understood by another that is often associated with a thought
disorder.

Pancreatic enzymes give before meals.

Clinical features of delusional disorder include extreme suspiciousness, jealousy, distrust, and belief that others intend to harm.

The UAP can be assigned to care for a client with a chronic condition after an initial assessment by the nurse. This client has no risk of
instability of condition.

Never leave your patient. For example, Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders
from the physician.

Tips for charting: don’t use inflammatory words, no nurse judgments, be as specific as possible. I.E., “Vital signs stable” is incorrect
for of charting.

Restraint: frame of bed, quick release ties, document need for restraint Q4 hours

Never ask “WHY” questions in the NCLEX!

Gag Reflex: don’t assess gag reflex to a client that has an absent swallow reflex

Nifedipine (Procardia XL): do not crush

An RN that is not assigned to a patient does not have the authority to tell a nurse what to do. Refer it to nursing supervisor.

3
If doctor has orders it should carried out unless contraindicated in nurse’s decision.

Physical assessment: Inspection, Percussion, Palpation, Auscultation (Except for abdomen: Inspection, Auscultation, Percussion,
Palpation)

Coronary artery bypass graft (CABG)—halt medications before surgery, can do 5 at a time; will be on mechanical ventilations after
surgery; chest tubes

Acromegaly—monitor blood sugar, atrium—90 implant care (radioactive, nasally implanted, monitor vision)

Bone marrow Aspiration---done at iliac crest; painful

Postoperative care after Supratentorial surgery: maintain airway, elevate head 30-45

Position care after Infratentorial surgery: flat and lateral

Orange juice does not help acidify urine it makes it more alkaline.

Myelogram
• Water-soluble dye—elevate head of bed 30 degrees (not removed)
• Oil based dye—flat in bed (removed)

Fractures:
ü Immobilize joint above and below fracture
ü Cover open fracture with cleanest material available
ü Check temperature, color, sensation, capillary refill distal to fracture
ü Close reduction—manually manipulate bone or use traction

Buck’s Traction
ü Use to relieve muscle spasm of leg and back
ü If used for muscles spasms only, they can turn to either side.
ü If used for fracture treatment, only can turn to unaffected side.
ü Use 8-20 lbs of weight, if used for scoliosis will use 40 lbs of weight.
ü Elevate head of bed for countertraction or foot bed
ü Place pillow below leg not under heel or behind knee.

Russell’s Traction
ü Sling is used
ü Check for popliteal pulse
ü Place pillow below lower leg and heel off the bed
ü Don’t turn from waist down
ü Lift patient, not the leg

Cervical Tongs
ü Never lift the weights
ü No pillow under head during feedings

Balanced Suspension Traction

ü For femur realignment
ü Maintain weights hanging free and not on floor
ü Maintain continuous pull

Halo Jacket
ü Maintain pin cleansing

Casts
ü Don’t rest on hard surface
ü Don’t cover until dry 48+ hours

4
 ü Handle with palms of hands not with fingers
ü Keep above level of heart
ü Check for CSM

Fractured Hip
• Assessments
§ Leg shortened
§ Adducted
§ Externally rotated
• Implementation
§ Care after a total hip replacement
• Abduction pillows
• Crutch walking with 3-point gait
• Don’t sleep on operated side
• Don’t flex hip more than 45-60 degrees
• Don’t elevate head of the bed more than 45 degrees

Amputations
• Guillotine (open)
• Flap (closed)
• Delayed prosthesis fitting
§ Residual limb covered with dressing and elastic bandage (figure eight)
• Figure-8 doesn’t restrict blood flow, shaped to reduce edema
§ Check for bleeding
§ Elevated 24 hours (AKA-pillow, BKA-foot of bed elevated)
§ Position prone daily
§ Exercises, crutch walking
§ Phantom Pain: acknowledge feelings, that pain is real for them.

Thiamin (Vit. B1)—carbohydrate metabolism; deficiency will cause Beri-Beri

Pyridoxine (Vit. B6)—amino acid metabolism; deficiency will cause anemia, seizures

Folic acid—RBC formation; deficiency will cause anemia

Cyanocobalamin (B12)—nerve function; deficiency cause pernicious anemia

Calcium deficiency causes Rickett’s

Cultural Food Pattern’s

ü Orthodox Jewish (Kosher)—milk and meat cannot be eaten at same meal
ü Muslin—30 day fast during Ramadan
ü Japanese—rice is basic food, tea is main beverage
ü Greek—bread is served with every meal

Enteral feeding held if: 150 or > cc’s aspirated or 50% given in the hour is aspirated
ü If cramping, vomiting occurs decrease rate of enteral feeding or keep it warm.

TPN—supply nutritions via intravenous route

ü Peripherally or centrally
ü Initial rate 50/hour and can be increased to 100-125ml/hour.
ü A pump must be used to keep rate constant
ü Prevent sepsis: maintain closed system,, don’t draw blood/infuse anything in line, dry sterile dressing
ü Verify placement of line
ü Monitor Glucose, acetone
ü Change IV tubing/Filter Q24 hours
ü Solution refrigerated then warmed
ü If solution not available, start 10% in water.
ü 3/week check BUN, electrolytes (ca, mg)
5
 ü When TPN Dc’d taper patient off or else will get rebound hypoglycemia (use hypotonic to do this)

Specific gravity 1.010-1.030

Ph 4.5-8
1,000-1,500cc/day

Crede’s Maneuver—push urine out

Pernicious Anemia
- monthly Vitamin B12 IM injections

Metered dose inhaler

- Beclomethasone (Vanceril)
- Albuterol (Proventil)

Guillain-Barre Syndrome
- GBS often preceded by a viral infection as well as immunizations/vaccinations
- Intervention is symptomatic
- Acute phase: Steroids, plasmapheresis, aggressive respiratory care; prevent hazards of immobility, maintain adequate
nutrition; physical therapy; pain-reducing measures; eye care, prevention of complications (UTI, aspiration); psychosocial
support

Organ Donation Criteria

- No history of significant, disease, process in organ/tissue to be donated
- No untreated sepsis
- Brain death of donor
- No history of extracranial malignancy
- Relative hemodynamic stability
- Blood group compatibility
- Newborn donors must be full term (more than 200g)
- Only absolute restriction to organ donation is documented case of HIV infection
- Family members can give consent
- Nurse can discuss organ donation with other death-related topics (funeral home to be used, autopsy request)

Accurate way to verify NG tube position is to aspirate for gastric contents and check pH.

Parkinson’s disease
- Activities should be scheduled for late morning when energy level is highest and patient won’t be rushed
- Symptoms: tremors, akinesia, rigidity, weakness, “motorized propulsive gait, slurred monotonous speech, dysphagia,
drooling, mask-like expression.
- Nursing care: encourage finger exercises. Administer Artane, Congentin, L-Dopa, Parlodel, Sinemet, Symmetrel.
- Teach: ambulation modification
- Promote family understanding of disease intellect/sight/hearing not impaired, disease progressive but slow, doesn’t lead to
paralysis

Normal urine output (1200-1500 cc’s/day or 50-63 cc/hr, normal voiding pattern 5-6 times/day.

Green leafy vegetables contain vitamin K.

Labs

HbA1c (4.5-7.6%)
- indicates overall glucose control for the previous 120 days

Serum Amylase / Somogyl (60-160 u/dL)

6
 - elevated in acute pancreatitis

Erythrocyte Sedimentation Rate (ESR)

- Men (1-15)
- Women (1-20)
- Rate at which RBC’s settle out of unclotted blood in one hour
- Indicates inflammation/neurosis

Hematocrit (Hct)
- Men (40-45) u/mL
- Women (37-45) u/mL
- Relative volume of plasma to RBC
- Increased with dehydration
- Decreased with volume excess

Creatine Kinase (CK)

- Men (12-70)
- Women (10-55)
- Enzyme specific to brain, myocardium, and skeletal muscles
- Indicates tissue necrosis or injury

Serum Glucose
- 60-110 mg/dL

Sodium (Na+)
- 135-145 mEq/L
- Hypernatremia
o Dehydration and insufficient water intake

Chloride (Cl-)
- 95-105 mEq/L

Potassium (K+)
- 3.5-5.0 mEq/L

Bicarbonate (HCO3)
- 22-26 mEq/L
- Decreased levels seen with starvation, renal failure, diarrhea.

Blood, Urea, Nitrogen (BUN)

- 6-20 mg
- Elevated levels indicate rapid protein catabolism, kidney dysfunction, dehydration

Creatinine Clearance Test

- normal 125 ml/min.
- Lower levels reflect renal insufficiency and may influence the excretion of many drugs and toxins from the body.

Lithium
- targeted blood level: (1-1.5 mEq/L)

Tofranil and Anafranil—OCD medications

Pick physical needs over psychosocial needs!!!!!!!!!!!!!!!

Focus on here and now!!!!!!!!!!!!!!!!!

Oculogyric crisis: uncontrollable rolling back of eyes: side effect of Phenothiazines

Moribund means dying patient.

7
Don’t leave your patients. Stay with your patients.

Assess before implementation.

Manic patient: decrease stimuli and increase rest period and no competition.

Lithium helps control impulsive behaviors.

Fluphenazine (Prolixin): antipsychotic medication

Thiamine sources: organ meats, liver, whole grain, nuts, legume, egg, and milk.

Don’t document abuse. Report suspected abuse to nursing supervisor.

Never promise a patient “Not to tell.”

Tonometry—measures intraocular pressure; to rule out glaucoma

Myopia—nearsightedness (near clear, distance clear)

Hyperopia—farsightedness (distance is clear, near vision blurry)

Presbyopia—changes with aging

Blind client: address by name, introduce self, keep furniture arrangement consistent, open or close doors walk ½ step ahead, identify
food location on tray.

Instilling ear drops lie patient on unaffected ear to absorb drops.

Position patient on affected ear to promote drainage.

Regular Insulin only given IV.

Sick day rules: take insulin as ordered, check blood glucose q3-4 hours, soft foods, liquids

Phenylketonuria—high blood phenylalanine (no enzyme), results in mental retardation; milk substitutes, low-protein diet

Celiac Disease (SPrue)—intestinal malabsorption, malnutrition (unable to digest wheat/rye/oats/barley); gluten-free diet

Hepatobiliary disease—decrease in ability of bile to absorb fat, fat malabsorption; low-fat high-protein diet, vitamins

Cystic fibrosis—absence of pancreatic enzymes, malabsorption of fat, lung disease, pancreatic enzyme replacement, high-protein,
high-calorie diet, respiratory care/suction

Position right side to promote gastric emptying.

Dumping syndrome prevention: restrict fluid with meals, lie down after eating, small, frequent meals, low-carbohydrate, low-fiber diet

Sengstaken-Blakemore Tube—to treat pt. with esophageal varices.

8
Hepatitis B Vaccine MMR (Mumps, Measles, and Rubella)
Given IM to vastus lateralis or deltoid Given SC anterior or lateral thigh
Side effects: mild tenderness at site Side effects: rash, fever, arthritis in 10 days to 2 weeks.
• 1st shot – Birth to 3 months • 1st shot – 12 to 18 months
• 2nd shot – 1 to 4 months • 2nd shot – 4 to 6 years
• 3rd shot – 6 to 18 months
Varicella (Chickenpox)
DTaP (Diptheria, Tetanus, and Pertussis) • 12 to 18 months
Given IM anterior or lateral thigh
Side effects: fever within 24-48 hours, swelling, PCV (Pneumococcal)
redness, soreness • 1st shot – 2 months
Don’t treat with aspirin, use other antipyretic. • 2nd shot – 4 months
• 1st shot – 2 months • 3rd shot – 6 months
• 2nd shot – 4 months • 4th shot – 12 to 18 months
• 3rd shot – 6 months
• 4th shot – 15 to 18 months TB
• 5th shot – 4 to 6 years Given intradermal
• Only TD shot – 11 to 16 years Evaluated in 48 to 72 hours

Hib (Influenza) TD
• 1st shot – 2months Given IM into anterior or lateral thigh
• 2nd shot – 4months Repeated every 10 years
• 3rd shot – 6 months
Live attenuated Rubella
• 4th shot – 12 to 18 months
Given once SC into anterior or lateral thigh
Given to antibody-negative women
IPV (Inactive Polio Vaccine)
Prevent pregnancy for 3 months after receiving immunization
Given PO, Few side effects
• 1st shot – 2 months Live attenuated mumps
• 2nd shot – 4 months Given once SC
• 3rd shot – 6 to 18 months Prevents orchitis
• 4th shot – 4 to 6 years

Normal Vital Signs

Newborn
• Pulse 120-140 bpm, increases with crying
• Respirations 30-50/min, diaphgramatic (abdomen moves), can be irregular
• BP 60/40 – 80/50 mmHg

1-4 year old

• Pulse: 80-140
• Resp: 20-40
• BP: 90-60 – 99/65

5-12 year old

• Pulse: 70-115
• Resp: 15-25
• BP: 100/56 – 110/60

Adult
• Pulse: 60-100
• Resp: 12-20
• BP: 90/60-140/90

Aortic Valve: Right of Sternum at the 2nd intercostal space

Pulmonic Valve: Left of Sternum at the 2nd intercostal space

9
Tricuspid Valve: Immediately left of sternal border at the 5th Intercostal Space

Mitral Valve (Point of Maximal Impulse): Left of Sternum Mid-Clavicular Line at the 5th Intercostal Space

Erb’s Point: Left of Sternum at the 3rd intercostal space

Infant (Point of Maximal Impulse): Lateral to sternum 4th intercostal space

Obese person choking use Chest Thrusts.

Tracheostomy tube placement of cuff maintained to prevent aspiration

Care for patient first, equipment second

Signs for hypoxia: restlessness, tachycardia

CPR: Shake, shout, summon help, open airway, look, listen, feel for signs of breathing, pinch nose, give 2 full breaths (if no rise,
reposition)

Adults 12/min check carotid, chest compressions 80-100/min 1.5 inches

Infants 20/min check brachial pulse, chest compression 100/min ½ - 1 inch

15:2 Adult 4 cycles

Infant 20 cycles
Reassess pulse and breathing
Continue CPR until:
• Victim responds
• Someone else takes over
• Victim is transferred
• Rescuer is unable to continue

MI Implementation for MI
• Chest pain radiating to arms, jaw, neck
(which is unrelieved by rest or • Thrombolytic therapy-streptokinase, t-PA
nitroglycerin) • Bedrest
• Dyspnea • Beta-blockers, morphine sulfate,
• Indigestion dysrhythmics, anticoagulants
• Apprehension • Do not force fluids (will give heart more to
• Low grade fever work with)
• Elevated WBC (5-10, ESR, CK-MB, LDH)

Defibrillation
• Start CPR first
• 1st attempt – 200 joules
• 2nd attempt – 200 to 300 joules
• 3rd attempt – 360 joules
• Check monitor between shocks for rhythm

Cardioversion
• Elective procedure, Informed Consent
• Valium IV
• Synchronizer on
• 25-360 joules
• Check monitor between rhythm

Epidural hematoma – short period of unconsciousness, ipsilateral papillary dilation, contralateral weakness of extremities

Subdural hematoma – decreased LOC, ipsilateral papillary dilation, contralateral weakness of extremities, personality changes
10
CSF leakage – good place to look is behind the ears.

Head Injury – elevate bed 30 degrees, barbiturate therapy, hypothermia, glucocorticoids (Decadron)

Flail Chest Sucking Chest Wound Pneumothorax Implementation

Affected side goes (Sucking Open Collapse of lung due to alteration Monitor for
down during Pneumothorax) of air in intrapleural space shock
inspiration and up • Sucking sound with • Dyspnea Humidified
during expiration respiration • Pleuritic pain oxygen
• Pain • Restricted movement on Thoracentesis
• Decreased breath affected side (aspiration of
sounds • Decreased/absent breath fluid from
• Anxiety sounds pleural space)
• Cough Chest Tubes
• Hypotension

Cullen’s Sign – ecchymosis around umbilicus

Turner’s Sign – ecchymosis around either flank

Balance’s sign – resonance over spleen (+) means rupture of spleen

Shock Signs and Symptoms

• Cool, clammy skin
• Cyanosis
• Decreased alertness
• Tachycardia
• Hypotension
• Shallow, rapid respirations
• Oliguria

Hypovolemic Cardiogenic Distributive

Decreased in intravascular volume Decreased cardiac output Problem with blood flow to cells

Implementation for shock

• Monitor CVP: <3 inadequate fluid; >11 too much fluid

Increased ICP Implementations

Assessments • Monitor vital signs
• Altered LOC (Earliest Sign) • Monitor Glasgow Coma Scale
• Glasgow coma scale <7 indicates coma • Elevate head 30-45 degrees
• Confusion • Avoid neck flexion and head rotation
• Restlessness • Reduce environmental stimuli
• Pupillary changes • Prevent Valsalva maneuver
• Vital sign changes – WIDENING PULSE • Restrict fluids to 1200-1500 cc/day
PRESSURE • Medications – Osmotic diuretics, corticosteroids

Seizures:
ü do not restrain
ü do not insert anything in mouth

Electrolytes
Potassium: 3.5-5.0 mEq/L
Sodium: 135-145 mEq/L

11
 Calcium: 4.5-5.2 mEq/L
Magnesium: 1.5-2.5 mEq/L

Hypokalemia Assessments Hypokalemia Implementations

• K+ < 3.5 mEq/L • Potassium Supplements
• Muscle weakness • Don’t give > 40 mEq/L into peripheral IV or without cardiac
• Paresthesias monitor
• Dysrhythmias • Increase dietary intake – oranges, apricots, beans, potatoes,
• Increased sensitivity to digitalis carrots, celery, raisins

Hyperkalemia Assessments Hyperkalemia Implementations

• K+ >5.0 mEq/L • Restrict oral intake
• EKG changes • Kayexalate
• Paralysis • Calcium Gluconate and Sodium Bircarbonate IV
• Diarrhea • Peritoneal or hemodialysis
• Nausea • Diuretics

Hyponatremia Assessments Hyponatremia Implementations

• Na+ < 135 mEq/L • I&O
• Nausea • Daily weight
• Muscle cramps • Increase oral intake of sodium rich foods
• Confusion • Water restriction
• Increased ICP • IV Lactated Ringer’s or 0.9% NaCL

Hypernatremia Assessments Hypernatremia Assessments

• Na+ >145 mEq/L • I&O
• Disorientation, delusion, hallucinations • Daily Weight
• Thirsty, dry, swollen tongue • Give hypotonic solutions: 0.45% NaCl or 5% Dextrose
• Sticky mucous membranes in water IV
• Hypotension
• Tachycardia

Hypocalcemia Assessments Hypocalcemia Implementations

• Ca+ < 4.5 mEq/L • Oral calcium supplements with orange (maximizes
• Tetany absorption)
• Positive Trousseau’s sign • Calcium gluconate IV
• Positive Chvostek’s sign • Seizure precautions
• Seizures • Meet safety needs
• Confusion
• Irritability, paresthesias

Hypercalcemia Assessments Hypercalcemia Implementations

• Ca+> 5.2 mEq/L • 0.4% NaCl or 0.9% NaCl IV
• Sedative effects on CNS • Encourage fluids (acidic drinks: cranberry juice)
• Muscle weakness, lack of coordination • Diuretics
• Constipation, abdominal pain • Calcitonin
• Depressed deep tendon reflexes • Mobilize patient
• Dysrhythmias • Surgery for hyperparathyroidism

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Hypomagnesemia Assessments Hypomagnesemia Implementations
Ø Mg+< 1.5 mEq/L Ø Monitor cardiac rhythm and reflexes
Ø Neuromuscular irritability Ø Test ability to swallow
Ø Tremors Ø Seizure precautions
Ø Seizures Ø Increase oral intake—green vegetables, nuts, bananas,
Ø Tetany oranges, peanut butter, chocolate
Ø Confusion
Ø Dysphagia

Hypermagnesemia Assessments Hypermagnesemia Implementations

Ø Mg + > 2.5 mEq/L Ø Discontinue oral and IV magnesium
Ø Hypotension Ø Monitor respirations, cardiac rhythm, reflexes
Ø Depressed cardiac impulse transmission Ø IV Calcium to antagonize cardiac depressant activity
Ø Absent deep tendon reflexes (helps to stimulate heart)
Ø Shallow respirations

Burns Assessments
• Superficial partial thickness—pink to red, painful
• Deep partial thickness—red to white, blisters, painful
• Full thickness—charred, waxy, white, painless

Wound Care for Burns ü Medicate patient before wound care

ü Never break blisters ü Silver nitrate (warn patient skin will turn black)
ü Isotonic fluids (Lactated Ringer’s) ü High calorie, High carbohydrate, High protein diet
ü Closed method (Silvadene) covered with ü Vitamin B,C, and Iron
dressings ü TPN maybe
ü Open method (Sulfamylon) that are not covered ü Prevent contractures
with dressings
ü IV pain medication initially: not PO takes too
long, not IM circulation impaired

Addisson’s Disease Assessments Addisson’s Disease Implementations

ü Fatigue ü High protein, High carbohydrate, high Sodium, Low
ü Weakness potassium diet
ü Dehydration ü Teach life-long hormone replacement
ü Eternal tan
ü Decreased resistance to stress
ü Low Sodium
ü Low Blood Sugar
ü High Potassium
Addisonian Crisis Assessments Addisonian Crisis Implementations
• Hypotension • Administer NaCl IV, vasopressors, hydrocortisone
• Extreme weakness • Monitor vital signs
• Nausea vomiting • Absolute bedrest
• Abdominal pain
• Severe hypoglycemia
• Dehydration

Cushing’s Syndrome Assessments Cushing’s Syndrome Implementations

• Osteoporosis • Low Carbohydrate, Low Calorie, High Protein, High
• Muscle wasting Potassium, Low sodium diet
• Hypertension • Monitor glucose level
• Purple skin striations • Postop care after adrenalectomy or hypophysectomy
• Moon face
• Truncal obesity
• Decreased resistance to infection
13
Pheochromocytoma Assessments—hypersecretions of the Pheochromocytoma Implementations
catecholamines (epinephrine/norepinephrine) • Histamine Test, Regitine Test, 24- hour urine VMA test
• Persistent hypertension • Avoid emotional and physical stress
• Hyperglycemia • Encourage rest
• Pounding headache • Avoid coffee and stimulating foods
• Palpitations • Postop care after adrenalectomy and medullectomy
• Visual disturbances

COPD Assessments COPD Implementations

• “Blue Bloaters” • Assess airway clearance
• “Pink Puffers” • Listen to breath sounds
• Weakness • Administer low-flow oxygen (1-2 L, not too much
• Change in postured day and hs (don’t sleep laying because your trying to prevent CO2 narcosis)
down, have to stay erect) • Encourage fluids
• Use of accessory muscles of breathing • Small frequent feedings
• Dyspnea • Use metered dose inhalers (MDI)
• Cough
• Adventitious breath sounds

Pneumonia Assessments Pneumonia Implementations

• Fever • Check breath sounds
• Leukocytosis • Cough and deep breath q 2 hours
• Productive Cough (rust, green, yellow) • Chest physiotherapy
• Dyspnea • Antibiotics
• Pleuritic pain • Incentive spirometer
• Tachycardia • Encourage fluids
• Suction PRN
• Provide oxygen
• Semi-Fowler’s position
• Bedrest
• Medications—mucolytics (Mucomyst), expectorants
(Robitussin), Bronchodilators (Aminophylline),
Antibiotics (Bacterim)

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Acyanotic Congenital Heart Anomalies Assessments Cyanotic Congenital Heart Anomalies Assessments
• Normal Color • Cyanosis
• Possible exercise intolerance • Clubbing of fingers
• Small stature • Seizures
• Failure to thrive • Marked exercise intolerance
• Heart murmur • Difficulty eating
• Frequent respiratory Infections • Squat to decrease respiratory distress
• Small stature
• Failure to thrive
• Characteristic murmur
• Frequent respiratory infection

Cyanotic Congenital Heart Anomalies Types:

• Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee chest position
to help breath; surgery needed
• Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle; oxygenated blood
not going into systemic circulation
• Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and aorta; rather than
two distinctly different vessels there is a single vessel that overrides both ventricles and gives rise to both pulmonary and
systemic circulation; blood enters from both common artery and either goes to the lungs or to the body; cyanosis,
murmur, difficult intolerance
• Total anomalous venous return—absence of direct communication between pulmonary veins and left atria; pulmonary
veins attach directly to right atria or drains to right atria

Congenital Heart Anomalies Compensatory Mechanisms

• Tachycardia
• Polycythemia (increase formation of RBC’s)
• Posturing—squatting, knee-chest position

Congenital Heart Anomalies Implementations

• Prevention
• Recognize early symptoms
• Monitor vital signs and heart rhythms
• Medications—digoxin, iron, diuretics, potassium
• Change feeding pattern

Left-Side CHF Right-Side CHF

• Dyspnea, orthopnea • Dependent edema
• Cough • Liver enlargement
• Pulmonary edema • Abdominal pain/Nausea/Bloating
• Weakness/Changes in mental status • Coolness of extremities

15
CHF Implementations
• Administer digoxin, diuretics
• Low-sodium, low-calorie, low-residue diet
• Oxygen therapy
• Daily weight
• Teach about medications and diet

Arterial Peripheral Vascular Disease Arterial Peripheral Vascular Disease

Assessments Implementations
• Rubor • Monitor Peripheral pulses
• Cool shiny skin • Good foot care
• Ulcers • Stop smoking
• Gangrene • Regular exercise
• Intermittent Claudication (pain with exercise/walking • Medications—vasodilators, anticoagulants
relieved with rest)
• Impaired sensation
• Decreased peripheral pulses

Venous Peripheral Vascular Disease Venous Peripheral Vascular Disease

Assessments Implementations
• Cool, brown skin • Monitor peripheral pulses
• Edema • Elastic stockings
• Normal or decreased pulses • Medications—anticoagulants
• Positive Homan’s sign • Elevate legs
• Warm, moist packs
• Bedrest 4-7 days (acute phase)

Anemia Assessments (reduction in hemoglobin Anemia Implementations

amount/erythrocytes) • Identify cause
• Palpitations • Frequent rest periods
• Dyspnea • High protein, high iron, high vitamin diet
• Diaphoresis • Protect from infection
• Chronic fatigue
• Sensitivity to cold

Iron Deficiency Anemia Assessments Iron Deficiency Anemia Implementations

• Fatigue • Increase iron-rich foods (liver, green leafy vegetables)
• Glossitis • Iron supplements (stains teeth)
• Spoon fingernails
• Impaired cognition
Pernicious Anemia Assessments (gastric mucosa fail to Pernicious Anemia Assessments
secrete enough intrinsic factor for stomach to absorb) • Vitamin B12—IM
• Schilling’s Test • Rest of life can’t be absorbed PO
• Fatigue
• Sore, red tongue
• Paresthesia in hands and feet

Sickle Cell Anemia Assessments Sickle Cell Anemia Implementations

• Pain /Swelling/Fever • Check for signs of infection (prevent crisis)
• Schlerae jaundiced • Check joint areas for pain and swelling
• Cardiac murmurs • Encourage fluids
• Tachycardia • Provide analgesics with PCA pump c crisis

16
Hemophilia Assessments (female to male gene Hemophilia Implementations
transmission) • Administer plasma or factor VIII
• Easy bruising • Analgesics
• Joint pain • Cryoprecipitated antihemophilic factor (AHF)
• Prolonged bleeding • Teach about lifestyle changes
• Non contact sports

Cancer Implementation: External Radiotherapy

• Leave markings on skin
• Avoid use of creams, lotions (only vitamin A&D ointment)
• Check for redness, cracking
• Wear cotton clothing
• Administer antiemetics

Cancer Implementation: Internal radiation sealed source Cancer Implementation: Internal Radiation
• Lead container and long-handled forceps in room • Time and distance important
• Save all dressings, bed linen until source removed • Private room sign on door
• Urine and feces not radioactive • Nurse wears dosimeter at all times
• Don’t stand close or in line with source • Limit visitors and time spent in room
• Patient on bed rest • Rotate staff
• Self-care when can do
Cancer Implementation: Internal radiation unsealed source
• All body fluids contaminated
• Greatest danger first 24-96 hours

Leukemia Assessments Leukemia Implementations

• Ulcerations of mouth • Monitor for signs of bleeding: petechiae, ecchymosis,
• Anemia thrombocytopenia
• Fatigue • Infections
• Weakness • Neutropenia (private room/limit # people, wbc done daily, no fruit,
• Pallor no flowers/plotted plants, clean toothbrush with weak bleach
solution
• Good mouth care
• High calorie, high Vitamin diet (avoid salads/raw fruit/pepper/don’t
reuse cup/don’t change litter box/digging in garden

Intracranial Tumors Assessments Intracranial Tumors Implementations

• Motor deficits • Preoperative: do neurological assessment, patient head shaved
• Hearing or visual disturbances • Postoperative: maintain airway, elevate head 30-45 after
• Dizziness supratentorial surgery
• Paresthesia • Flat and lateral after infratentorial surgery
• Seizures • Monitor vital and neurological signs
• Personality disturbances • Glascow coma scale
• Changes in LOC
Therapeutic Positions
Ø Supine—avoids hip flexion
Ø Dorsal recumbent—supine with knees flexed
Ø Prone—extension of hip joint(after amputation)
Ø Side lateral—drainage of oral secretions
Ø Knee-chest—visualization of rectal area
Ø Sim’s—decreases abdominal tension (side lying with legs bent)
Ø Fowler’s—increases venous return, lung expansion
Ø High Fowler’s—60-90
Ø Fowler’s—45-60
Ø Semi-Fowler’s—30-45
17
 Ø Low Fowler’s—15-30
Ø Modified Trendelenburg—used for shock;Feet elevated 20 degrees, knees straight, trunk flat, head slightly
elevated
Ø Elevation of extremity—increases blood to extremity and venous return
Ø Lithotomy—used for vaginal exam

4 point Gait 2 point Gait 3 point Gait Swing-to-swing

Weight bearing Bearing both legs Bearing one leg through
both legs RC/LF, LC/RF Weaker leg both crutches, then stronger Partial weight
RC, LF, LC, RF leg bearing both legs
Both crutches, one
or two legs
Stairs
Ø Going up—“good” leg first, crutches, “bad” leg
Ø Going down—crutches with “bad” leg, then “good” leg
Ø “Up with the good, down with the bad”
Walker
• Flex elbows 20-30 degrees when hands are on grips
• Lift and move walker forward 8-10 inches
• Step forward with “bad” leg, support self on arms, follow with “good” leg
• Stand behind client holding onto gait belt

Myelogram—x-ray visualization of the spinal canal by injection Post-procedure

of radiopaque dye. • Water-soluble dye—elevate head of bed 30 degrees
• Hydration done 12 hours before procedure (not removed)
• Cleansing enemas • Oil based dye—flat in bed (removed)
• Avoid seizure-promoting medications • Bedrest 24 hours encourage fluids

Laminectomy—excision portion of lamina to expose area of Postoperative care:

affected disc • Assess circulation and sensation
• Preopcare: moist heat • Log roll Q2 hours with pillow between leg
• Fowler’s position • Calf exercises, assist with ambulation keeping back
• Isometric exercises for abdominal muscles straight
• Muscle relaxants, NSAIDs, Analgesics • Muscle relaxants, NSAIDS, analgesics, Teaching—
• Traction, TENS daily exercises, firm mattress, avoid prone position
and heavy lifting
• Avoid sitting long time

Dysplasia of the Hip Assessment Dysplasia of the Hip Implementations

• Uneven gluteal folds and thigh creases Newborn to 6 months
• Limited abduction of hip • Reduced by manipulation
• Ortolani’s sign—place infant on back with legs flexed, • Pavlik harness for 3 to 6 months
clicking sound with abduction of legs 6 to 18 months
• Shortened limb on affected side • Bilateral Bryant’s traction
• Hip spica cast
Older child
• Open reduction
• Hip Spica cast

Scoliosis Assessments—lateral deviation of one or more of Scoliosis Implementations

vertebrae accompanied by rotary motion of spine
• Uneven hips or scapulae
• Kyphosis lump on back
• Bend at waist to visualize deformity
• Structural (flexible deviation corrected with bending)
or functional (permanent heredirary that is seen)
18
• Exercises to strengthen abdominal muscles (if
functional)
• Surgery: spinal fusion insertion of Herrington Rod
• Milwaukee brace: used with curves 30-40 degrees
• Wear 4-6 years, worn 23 hours of the day, wear
undershirt to prevent irritation, teach isometric
exercises
Cerebral Palsy Assessments Cerebral Palsy Implementations
• Voluntary muscles poorly controlled due to brain • Ambulation devices, PT and OT
damage • Muscle relaxants and anticonvulsants
• Spasticity, rigidity, ataxia, repetitive involuntary gross • Feeding: place food at back of mouth with slight
motor movements downward pressure. Never tilt head backward.
• High calorie diet

Muscular Dystrophy Assessments Braces to help ambulation

Atrophy of voluntary muscles Balance activity and rest
Muscle weakness, lordosis, falls

Parkinson’s Disease Assessments Parkinson’s Disease Implementations

• Deficiency of dopamine • Teach ambulation modification: goose stepping walk
• Tremors, rigidity, propulsive gait (marching), ROM exercises
• Monotonous speech • Medications—Artane, Cogentin, L-Dopa, Parlodel,
• Mask like expression Sinemet, Symmetrel

Myasthenia Gravis Assessments Myasthenia Gravis Implementations

• Deficiency of acetylcholine • Good eye care, restful environment
• Muscular weakness produced by repeated • Medications—anticholinesterases, corticosteroids,
movement immunosuppressants
• Dysphagia • Avoid crisis: infection
• Respiratory distress • Symptoms: sudden ability to swallow

Clear liquid Full liquid Low-fat cholesterol Sodium High roughage, Low-residue
No milk No jam restricted restricted high fiber Minimize intestinal
No juice with No fruit Can eat No cheese No white activity
pulp No nuts lean meat bread Buttered rice white
No without fiber processed food, no
avocado, whole wheat corn
milk, bran
bacon, egg
yolks butter
High protein diet Renal Low-phenylalanine
Restablish Keeps diet
anabolism protein, Prevents
to raise potassium brain
albumin and sodium damage
levels low from
Egg, roast No beans, imbalance
beef no cereals, of amino
sandwich, no citrus acids
No junk fruits Fats, fruits,
food jams
allowed
No meats
eggs bread

19
Glomerulonephritis Assessment Glomerulonephritis Implementation
• Fever, Chills • Antibiotics, corticosteroids
• Hematuria • Antihypertensives, immunosuppressive agents
• Proteinuria • Restrict sodium and water intake
• Edema • Bedrest
• Hypertension • I&O
• Abdominal or flank pain • Daily weight
• Occurs 10 days after beta hemolytic • High Calorie, Low protein
streptococcal throat infection

Urinary Diversion: Assessments Urinary Diversion Implementations

• Done for: Bladder t umors, birth defects,
neurogenic bladder, interstitial cystitis
• Ileal Conduit
• Koch Pouch
• Nephrostomy: flank incision and insertion of nephrostomy tube into renal
pelvis; penrose drain after surgery; surgical dressing
• Ureterosigmoidostomy: urters detached from bladder and anastomosed to
sigmoid colon; encourage voiding via rectum q 2-4 hours;no enemas or
cathartics; complications—electrolyte imbalance, infection, obstruction; urine
and stool evacuated towards anus.
• Cutaneous Ureterostomy: Stoma formed from ureters excised from bladder and
brought to abdominal wall; stoma on right side below waist; assist with
alteration in body image
• Illeal Conduit: Ureters replanted into portion of terminal ileum and brought to
abdominal wall; check for obstruction; mucous threads in urine normal
• Koch Pouch (Continent Illeal Conduit): Ureters transplanted into pouch made
from ileum with one-way valve; drainage of pouch by catheter under control of
client; drain pouch at regular intervals

Acute Renal Failure
Assessments: Oliguric
Phase
• Output <400 cc/day
• Hypertension
• Anemia
• CHF
• Confusion
• Increased K+, Ca+,
Na+, BUN, Creatinine
Acute Renal Failure Acute Renal Failure Acute Renal Failure
Assessments: Diuretic Implementations:
Phase Causes • Low-output stage: Limit fluids,
• Output 4-5 L/day • Prerenal—reduced blood Kayexalate, Dialysis
• Increased BUN volume • High-output stage: Fluids as
• Na+, K+ lost in • Renal—nephrotoxic drugs, needed, K+ replacement, Dialysis
urine glomerulonephritis • I&O
• Increased mental • Postrenal--obstruction • Daily Weight
and physical • Monitor Electrolytes
activity • Bedrest during acute phase
• IV fluids
• Diet restrictions
• Oliguric phase: limit fluids, TPN
maybe
• After Diuretic phase: high
protein, high calorie diet

Hemodialysis Implementation Peritoneal Dialysis Types of Peritoneal

• Check for thrill and bruit q 8 • Weight before and after Dialysis
hours treatment • Continuous ambulatory
• Don’t use extremity for BP, • Monitor BP (CAPD)
finger stick • Monitor breath sounds • Automated
• Monitor vital signs, weight, • Use sterile technique • Intermittent
breath sounds • If problem with outflow, • Continuous
• Monitor for hemorrhage reposition client
• Side effects: constipation

20
Ego Defense Mechanisms
ü Denial—failure to acknowledge thought
ü Displacement—redirect feelings to more acceptable subject
ü Projection—attributing your feelings to someone else
ü Undoing—attempt to erase an act, thought or feeling
ü Compensation—attempt to overcome shortcoming
ü Symbolization—less threatening object used to represent another
ü Substitution—replacing unacceptable or unobtainable object to one that is acceptable or attainable
ü Introjection—symbolic taking into oneself the characteristics of another
ü Repression—unacceptable thoughts kept from awareness
ü Reaction formation—expressing attitude opposite of unconscious wish or fear
ü Regression—returning to an earlier developmental phase
ü Dissociation—detachment of painful emotional conflicts from consciousness
ü Suppression—consciously putting thought out of awareness

Dying patient: Denial, Anger, Bargaining, Depression, Acceptance

Bipolar Disorder Assessments Bipolar Disorder Implementations

• Disoriented, flight of ideas
• Lacks inhibitions, agitated
• Easily stimulated by environment
• Sexually indiscreet
• Affective disorder
• Maintain contact with reality
• Elation is defense against underlying
depression
• Manipulative behavior results from
poor self-esteem
• Meet physical needs first
• Simplify environment
• Distract and redirect energy
• Provide external controls
• Set limits: escalating hyperactivity
• Use consistent approach
• Administer Lithium (help Manic
Phase of Bipolar, keep hydrated)
• Increase awareness of feelings through
reflection

Schizophrenia Assessments Schizophrenia Types Schizophrenia Implementations

• Withdrawal from relationships
and world
• Inappropriate display of feelings
• Hypochondriasis
• Suspiciousness
• Inability to test reality, regression
• Hallucinations—false sensory
perceptions
• Delusions—persistent false
beliefs; grandeur (feel higher
rank); persecutory (beliefs to be a
victim); ideas of reference (see
people talking think talking about
them)
• Loose associations
• Short attention span
• Inability to meet basic needs:
nutrition, hygiene
• Regression
• Disorganized—inappropriate
behavior, transient hallucinations
• Catatonic—sudden onset mutism,
stereotyped position, periods of
agitation
• Paranoid—late onset in life,
suspiciousness, ideas of
persecution and delusions
• Maintain safety—protect from erratic
behavior
• With hallucination—do not argue, validate
reality, respond to feeling tone, never
further discuss voices (don’t ask to tell
more about voices)
• With delusions—do not argue, point out
feeling tone, provide diversional activities
• Meet physical needs
• Establish therapeutic relationship
• Institute measures to promote trust
• Engage in individual, group, or family
therapy
• Encourage client’s affect
• Accept nonverbal behavior
• Accept regression
• Provide simple activities or tasks

Paranoid Assessments Paranoid Implementations

Suspiciousness Establish trust
Cold, blunted affect Low doses phenothiazines for anxiety
Quick response with anger or rage Structured social situations

21
Schizoid Assessments Schizoid Implementations
Shy and introverted Establish trust
Little verbal interaction Low doses phenothiazines for anxiety
Few friends Structured social situations
Uses intellectualization

Schizotypal Assessments Schizotypal Interventions

Eccentric Establish trust
Suspicious of others Low doses neuroleptics to decrease psychotic symptoms
Blunted affect Structured social situations
Problems with perceiving, communicating

Antisocial Assessments Antisocial Implementations

Disregards rights of others Firm limit-setting
Lying, cheating, stealing, promiscuous Confront behaviors consistently
Lack of guilt Enforce consequences
Immature Group therapy
Irresponsible
Associated with substance abuse

Borderline Assessments Borderline implementations

Brief and intense relationships Identify and verbalize feelings
Blames others for own problems Use empathy
Impulsive, manipulative Behavioral contract
Self-mutilation Journaling
Women who have been sexually abused Consistent limit-setting
Suicidal when frustrated, stressed Group therapy

Narcissistic Assessments Narcissistic Implementations

Arrogant lack of feelings and empathy for Mirror what client sounds like
others Limit-setting
Sense of entitlement Consistency
Uses others to meet own needs Teach that mistakes are acceptable
Shallow relationships
Views self as superior to others

Histrionic Assessments Histrionic Implementations

Draws attention to self Positive reinforcement for other centered
Somatic complaints behaviors
Temper tantrums, outbursts Clarify feelings
Shallow, shifting emotions Facilitate expression of feelings
Cannot deal with feelings
Easily influenced by others

Dependent Assessments Dependent Implementations

Passive Emphasize decision-making
Problem working independently Teach assertiveness
Helpless when alone Assist to clarify feelings and needs
Dependent on others for decisions
Fears loss of support and approval

Avoidant Assessments Avoidant Implementations

Socially uncomfortable Gradually confront fears
Hypersensitive to criticism, Lacks self- Discuss feelings
confidence Teach assertiveness
Fears intimate relationships Increase exposure to small groups

22
Obssessive-compulsive Assessments
High personal standards for self and others
Preoccupied with rules, lists, organized
Perfectionists
Intellectualize
Obssessive-compulsive Implementations
Explore feelings
Help with decision-making
Confront procrastination
Teach that mistakes are acceptable

Manipulative behavior Assessments Manipulative Behavior Implementations

Unreasonable requests for time, attention,
favors
Divides staff against each other
Intimidates others
Use seductive or disingenuous approach
Use consistent undivided staff approach
Set limits
Be alert for manipulation
Check for destructive behavior
Help client to see consequences of
behavior

Acute Alcohol Intoxication Acute Alcohol Implementations

Drowsiness Protect airway
Slurred speech Assess for injuries
Tremors Withdrawal assess
Impaired thinking IV glucose
Belligerence Counsel about alcohol use
Loss of inhibitions

Alcohol Withdrawal Assessments After WithdrawalàDelirium Alcohol Withdrawal Implementations

Tremors Tremens Assessments Monitor vital signs, especially pulse
insomnia Disorientation Administer sedation, anticonvulsants,
anxiety Paranoia thiamine (IM or IV), glucose (IV)
hallucinations Ideas of reference Seizure precautions
Suicide attempts Quiet, well-lighted environment
Grand mal convulsions Stay with patient

Chronic Alcohol Dependence Assessments Chronic Alcohol Dependence Implementations

• Persistent incapacitation
• Cyclic drinking or “binges”
• Others in family take over client’s role
• Family violence
• Identify problems related to drinking
• Help client see problem
• Establish control of problem
• Alcoholics anonymous
• Antabuse
• Counsel spouse and children

Wernicke’s Syndrome Assessments Wernicke’s Syndrome Implementations

• Confusion • Thiamine (IM or IV)
• Diplopia, nystagmus • Abstinence from alcohol
• Ataxia
• Apathy

Korsakoff’s Psychosis Assessments Korsakoff’s Psychosis Implementations

• Memory disturbances with confabulation • Balanced diet
• Learning problems • Thiamine
• Altered taste and smell • Abstinence from alcohol
• Loss of reality testing

23
Retinopathy of Prematurity Assessment Retinopathy of Prematurity Implementations
Demarcation line with ridge Prevent by using minimum oxygen concentrations
Retinal detachment Monitor PO2
Eye exam (premature infants)

Strabismus (cross-eyed) Assessments Corrective lenses Implementations

Deviation of eye Eye exercises
Diplopia surgery
Tilts head or squints

Detached Retina Assessments Detached Retina Implementations

Flashes of light Bedrest, affected eye in dependent position
Loss of vision Eye patched (one or both)
Particles moving in line of vision Surgery
confusion Sedatives and tranquilizers
Avoid stooping, straining at stool,
strenuous activity 3 months

Cataracts Assessments Cataracts Implementations

Distorted, blurred vision Postop: check for hemorrhage
Milky white pupil Check pupil—constricted with lens implanted, dilated without lens
Eye drops
Night shield
Sleep on unaffected side

Glaucoma Assessments Glaucoma Implementations

Abnormal increase in intraocular pressure Administer miotics (constrict pupil, allows more area for aqueous humor
that leads to blindness to flow), carbonic anhydrase inhibitors
Blurred vision Surgery
Lights with halos Avoid heavy lifting, straining of stool
Decreased peripheral vision Mydriatics (dilates pupil, makes angle smaller and constrict aqueous
Pain flow) are contraindicated with glaucoma.
Headache

Trigeminal Neuralgia Assessments Trigeminal Neuralgia Implementations

• Stabbing, burning facial pain
• Twitching of facial muscles
Bell’s Palsy Assessments
• Inability to close eye
• Increased lacrimation
• Distorted side of face
Guillain-Barre Syndrome Assessments
• Paresthesia
• Motor losses beginning in lower
extremities
• Altered autonomic function
• Medications—analgesics, Tegretol
• Surgery
Bell’s Palsy Implementations
• Isometric exercises for face
• Prevent corneal abrasions
Guillain-Barre Syndrome Implementations
• Medications—steroids
• Aggressive respiratory care
• Physical therapy
• Eye care
• Prevent complications: respiratory and aspiration

Meningitis Assessments Meningitis Implementations

• Nuchal rigidity • Medications—antibiotics, antifungals
• Kerning’s sign • Prevent complications: droplet precautions, contagious
• Brudzinski’s sign
• Seizures
• Bulging fontanels
• High-pitched cry
24
Thoracentesis: no more than 1000cc taken at one time.

Electroencephalogram (EEG) Electroencephalogram (EEG)

Preparation Post-test
• Test brains waves; seizure disorders • Remove paste from hair
• Tranquilizer and stimulant meds withheld for 24-48 hours • Administer medications withheld before test
• Stimulants (caffeine, cigarettes) withheld for 24 hours • Observe for seizure activity
• May be asked to hyperventilate during test • Seizure prodromal signs; epigastric distress,
• Meals not withheld lights before the eyes
• Kept awake night before test; want them to lie still

CAT Scan—dye gives flushed, warm face and metallic taste during injection (if contrast dye is used)

Myelogram: Post-test
• Supine 8-24 hours (Pantopaque oil-based dye used)
• Head raised 30-45degrees 8-16 hours(metrizamide water-soluble dye used)
Liver Biopsy Preparation Liver Biopsy Post-Test
• Administer vitamin K IM (decrease risk of • Position on operative side for 1-2 hours
hemorrhage) • Gradually elevate head of bed 30 degrees (1st hour) and then 45
• NPO 6 hours degrees (2nd 2 hours)
• Given sedative • Bedrest for 24 hours
• Position supine, lateral with upper arms • Check Vital signs
elevated • Check clotting time, platelets, hematocrit
• Asked to hold breath for 5-10 seconds • Report severe abdominal pain

Upper GI Series Barium Swallow: stool white from barium

Tracheostomy Tube Cuff

• Purpose—prevents aspiration of fluids
• Inflated
o During continuous mechanical ventilation
o During and after eating
o During and 1 hour after tube feeding
o When patient cannot handle oral secretions

Oxygen Administration: assess patency of nostril, apply jelly

• Face mask: 5-10 l/min (40-60%)
• Partial rebreather mask: 6-15 l/min (70-90%); keep reservoir bag 2/3 full during inspiration
• Non-rebreather mask: (60-100%); keep reservoir bag 2/3 full during inspiration
• Venturi mask: 4-10 l/min (20-50%); provides high humidity and fixed concentrations, keep tubing free of kinks
• Tracheostomy collar or T-piece: (20-100%); assess for fine mist; empty condensation from tubing’ keep water container full
• Croupette or oxygen tent:
o Difficulty to measure amount of oxygen delivered
o Provides cooled, humidified air
o Check oxygen concentration with oxygen analyzer q4 hours
o Clean humidity jar and fill with distilled water daily
o Cover patient with light blanket and cap for head
o Raise side rails completely
o Change linen frequently
o Monitor patient’s temperature

25
Chest Tubes Implementations
• Use to utilize negative pressure in lungs
• Fill water-seal chamber with sterile
water to 2 cm
• Fill suction control chamber with sterile
water to 20 cm
• Maintain system below level of
insertion
• Clamp only momentarily to check for
air leaks
• Ok to milk tubing towards drainage
• Observe for fluctuation in water-seal
chamber
• Encourage patient to change position
frequently
Chest Tube Removal:
• Instruct patient to do
valsalva maneuver
• Clamp chest tube
• Remove quickly
• Occlusive dressing applied
Complications of Chest Tubes:
• Constant bubbling in water-seal chamber=air
leak
• Tube becomes dislodged from patient, apply
dressing tented on one side
• Tube becomes disconnected from drainage
system, cut off contaminated tip, insert sterile
connector and reinsert
• Tube becomes disconnected from drainage
system, immerse end in 2 cm of sterile water

CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid
• “0” on mamometer at level of right atrium at midaxilliary line
• Measure with patient flat in bed
• Open stopcock and fill manometer to 18-20 cm
• Turn stopcock, fluid goes to patient
• Level of fluid fluctuates with respirations
• Measure at highest level of fluctuation
• After insertion
o Dry, sterile dressing
o Change dressing, IV fluids, manometer, tubing q24 hours
o Instruct patient to hold breath when inserted, withdrawn, tubing changed
o Check and secure all connections
• Normal reading—3-11 cm water
• Elevatedà>11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician)
• Loweredà<3, hypovolemia
• Chest tray at bedside

Eye irrigation: tilt head back and toward affected side

Eye drops: drop in center of conjunctival sac; prevent systemic absorption, press on inner angle of eye; don’t allow drops to go from
one eye to the other; don’t squeeze eyes

Nasogastric Tubes:
• Levin-single—single-lumen, used for decompression or tube feeding
• Salem sump—double-lumen, used for decompression or tube feeding
• Sengstaken-Blakemore—triple-lumen, used for bleeding esophageal varices
• Linton-Nachlas—4-lumen, used for bleeding esophageal varices
• Keofeed/Dobhoff—soft silicone, used for long-term feedings
• Cantor—single lumen with mercury-filled balloon and suction port
• Miller-Abbott—double-lumen with mercury-filled balloon and suction port
• Harris—single lumen with mercury-filled balloon and suction port

NG tube placement:
“BEST WAY” to check is to aspirate for gastric contents and check for pH of aspirate <4

Implementation of feeding:
• Check residual before intermittent feeding, reinstall residual
• Check residual Q4 hours with continuous feeding, reinstall residual
• Hold feeding if >50% residual from previous hour (adults) or >25% (children)
• Flush tube with water before and after feeding
• Use pump to control rate of tube feeding
26
 • Administer fluid at room temperature
• Change bag Q8 hours for continuous feeding
• Elevate head of bed while feeding is running
• Check patency Q4 hours
• Good mouth care

NG Irrigation Tubing:
• Verify placement of tube
• Insert 30-50 cc of normal saline into tube
• If feel resistance, change patient position, check for kinks
• Withdraw solution or record amount as input
NG removal:
• Clamp tube
• Remove tape
• Instruct patient to exhale
• Remove tube with smooth, continuous pull

Intestinal Tubes (Cantor, Mill-Abbott, Harris)

• Implementations
o After tube is in stomach, have patient lie on right side, then back in Fowler’s position, then left side
o Gravity helps to position tube
o Coil excess tube loosely on bed, do not tape
o Position of tube verified by x-ray
o Measure drainage QShift
• Removal
o Clamp tube
o Remove tape
o Deflate balloon or aspirate contents of intestinal tube balloon
o Instruct patient to exhale
o Remove 6” every 10 min. until reaches the stomach, then remove completely with smooth, continuous pull

T-Tube: 500-1000 cc/day, bloody first 2 hours

Penrose: expect drainage on dressing

Enema Implementation
• Position on left side
• Use tepid solution
• Hold irrigation set no more than 18” above rectum
• Insert tube no more than 4”
• Do not use if abdominal pain, nausea, vomiting, suspected appendicitis

Catheter insertion: 2-3” into urethra then 1” after urine flows

Male catheter: insert 6-7”

Catheter Urine Drainage bag: do not remove more than 700 cc at one time, clamp prior to removal

Ileostomy: post-op has loose, dark green, liquid drainage from stoma

Tonsillectomy: post-op frequently swallowing indicates hemorrhage

External contact lenses: need fine motor movements (rheumatoid arthritis prevents this).

Object in eye: never remove visible glass; apply loose cover and remain quiet.

Retina detached: sleep prone with affected side down; avoid jarring movements; avoid pin point movement with eye (sewing); high
fluid and roughage (prevents constipation=no straining); make light sufficient for needs (75watt+); no hairwashing
27
Glaucoma medications: Epinephrine hydrochloride (Adrenalin Chloride) and Pilocarpine Hydrochloride (Pilocar): give Pilocar
(therapeutic) first then wait 2-10minutes and instill adrenalin to increase absorption of adrenalin).

Tympanoplasty: remain in bed 24 hours position flat in bed with the affected ear up (helps to promote insertion).

Triglycerides elevation can falsely elevate glycosalated hemoglobin test.

Laparoscopic Cholecystectomy post: encourage to walk to eliminate acute right shoulder pain.

Impetigo: 2 year old; honey-colored crusts, vesicles, and reddish macules around mouth; don’t need to isolate; watch contact
precautions.

Only patient we use distractions on the NCLEX are manic patients and toddlers not for pain.

Rhinoplasty (nose surgery) position post-op: want to promote drainage of oral secretions is to position on her right side.

1 cup= 240cc
Pregnancy is a contraindication to an MRI.

Raynaud’s disease have decreased vascularity in the extremities.

Post-Parecentesis most important assessment is to obtain the blood pressure, weight the client, measure the client’s abdominal girth,
and check dressing in that order.

Tracheostomy tube: use pre-cut/pre-made gauze pads.

Suction is always intermittent never continuous.

O universal donor/AB universal recipient.

ABO BLOOD TYPE

COMPATIBILITY
Blood Type Can Receive from: Can donate to:
O O O,A,B,AB
A A,O A,AB
B B,O B,AB
AB O,A,B,AB AB

Autologous Transfusion:
• Collected 4-6 weeks before surgery
• Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular
disease

Hypotonic Solution Isotonic Solution Hypertonic Solution

• ½ NS (0.45% • 0.9% NaCl (Normal Saline) • 10% D/W (10% Dextrose in water)
Saline) • 5% D/W (Dextrose in Water) • D15W
• Lactated Ringer’s • 5% D/NS (5% Dextrose in 0.9% Saline)
• 5% D/ ¼ NS (5% Dextrose in • 5% D/ ½ NS (5% Dextrose in 0.45% Saline)
0.225% Saline ) • 3% NaCl
• 5% Sodium Bicarbonate

Change tubing Q72 hours

Change bottle Q24 hours

Infiltration
• Assessment: cool skin, swelling, pain, decrease in flow rate
• Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site

28
 IV Phlebitis, Thrmobophlebitis
• Assessment—redness, warm, tender, swelling, leukocytosis
• Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity
Hematoma
• Assessment—ecchymosis, swelling, leakage of blood
• Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity

IV Clotting
• Assessment—decreased flow rate, back flow of blood into tubing
• Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not
aspirate cannula, inject Urokinase, D/C and start on other site.

Insertion of Percutaneous Central Catheters:

• Placed supine in head-low position
• Turn head away from procedure
• Perform Valsalva maneuver
• Antibiotic ointment and transparent sterile dressing
• Verify position with x-ray
• Change tubing Q24 hours
• Nurse/patient both wear mask when dressing change 2-3x/week

Adrenergics Adrenergic Medications Adrenergics Side effects:

Actions: Levophed • Dysrhythmias
• Stimulate the sympathetic nervous system: Dopamine • Tremors
increase in peripheral resistance, increase blood flow to Adrenalin • Anticholinergic effects
heart, bronchodilation, increase blood flow to skeletal Dobutrex Adrenergics Nursing Considerations:
muscle, increase blood flow to uterus • Monitor BP
• Stimulate beta-2 receptors in lungs • Monitor peripheral pulses
• Use for cardiac arrest and COPD • Check output

Anti-Anxiety Anti-Anxiety Anti-Anxiety

Action: Medications: Side effects:
• Affect neurotransmitters • Librium, Xanax, • Sedation
Used for: Ativan, Vistaril, • Confusion
• Anxiety disorders, manic Equanil • Hepatic dysfunction
episodes, panic attacks Anti-Anxiety
Nursing Considerations:
• Potention for addiction/overdose
• Avoid alcohol
• Monitor Liver Function AST/ALT
• Don’t discontinue abruptly, wean off
• Smoking/caffeine decreases effectiveness

Antacids Antacids Medications Antacids

Actions: • Amphojel Side effects:
• Neutralize gastric acids • Milk of Magnesia • Constipation
Used for: • Maalox • Diarrhea
• Peptic ulcer • Acid rebound
• Indigestion, reflex Antacids
esophagitis Nursing Considerations:
• Interferes with absorption of antibiotics, iron preps,
INH, Oral contraceptives
• Monitor bowel function
• Give 1-2 hours after other medications
• 1-3 hours after meals and at HS
• Take with fluids

29
 Antiarrhythmics Antiarrhythmics Antiarrhythmics
Action: Medications: Side effects:
• Interfere with electrical • Atropine sulfate • Lightheadedness
excitability of heart • Lidocaine • Hypotension
Used for: • Pronestyl • Urinary retention
• Atrial fibrillation and • Quinidine Antiarrhythmics
flutter • Isuprel Nursing Considerations:
• Tachycardia • Monitor vital signs
• PVCs • Monitor cardiac rhythm

Aminoglycosides Aminoglycosides Aminoglycosides (Antibiotics)

(Antibiotics) (Antibiotics) Side effects:
Action: Medications: • Ototoxicity and Nephrotoxicity
• Inhibits protein • Gentamycin • Anorexia
synthesis in gram- • Neomycin • Nausea
negative bacteria • Streptomycin • Vomiting
Used for: • Tobramycin • Diarrhea
• Pseudomonas, Aminoglycosides (Antibiotics)
E.Coli Nursing Considerations:
• Harmful to liver and kidneys
• Check 8th cranial nerve (hearing)
• Check renal function
• Take for 7-10 days
• Encourage fluids
• Check peak/trough level

Allergy: 1st symptom SOB

Cephalosporins Cephalosporins Cephalosporins (Antibiotics)
(Antibiotics) (Antibiotics) Side effects:
Action: Medications: • Bone marrow depression: caution with anemic, thrombocytopenic
• Inhibits synthesis • Ceclor patients
of bacterial cell wall • Ancef • Superinfections
Used for: • Keflex • Rash
• Tonsillitis, otitis • Rocephin Nursing Considerations:
media, peri-operative • Cefoxitin • Take with food
prophylaxis • Cross allergy with PCN
• Meningitis • Avoid alcohol
• Obtain C&S before first dose: to make sure medication is
effective against disease/bacteria
• Can cause false-positive for proteinuria/glycosuria

Fluoroquinolones Fluoroquinolones Fluroquinolones

(Antibiotics) (Antibiotics) (Antibiotics)
Action: Medications: Side effects:
• Interferes with DNA • Cipro • Diarrhea
replication in gram- • Decreased WBC and Hematocrit
negative bacteria • Elevated liver enzymes (AST, ALT)
Used for: • Elevated alkaline phosphatase
• E.Coli, Nursing Considerations:
Pseudomonas, S. • C&S before starting therapy
Aureus • Encourage fluids
• Take 1 hour ac or 2 hour pc (food slows absorption)
• Don’t give with antacids or iron preparation
• Maybe given with other medications (Probenicid: for gout)

30
Macrolide (Antibiotics)
Action:
• Binds to cell membrane and
changes protein function
Used for:
• Acute infections
• Acne
• URI
• Prophylaxis before dental
procedures if allergic to PCN
Macrolide (Antibiotics) Macrolide (Antibiotics)
Medications: Side effects:
• Erythromycin • Diarrhea
• Clindamycin • Confusion
• Hepatotoxicity
• Superinfections
Nursing Considerations:
• Take 1hr ac or 2-3 hr pc
• Monitor liver function
• Take with water (no fruit juice)
• May increase effectiveness of: Coumadin and
Theophylline (bronchodilator)

Penicillin Penicillin Penicillin

Action: Medications: Side effects:
• Inhibits synthesis of cell • Amoxicillin • Stomatitis
wall • Ampicillin • Diarrhea
Used for: • Augmentin • Allergic reactions
• Moderate to severe • Renal and Hepatic changes
infections Nursing Considerations:
• Syphilis • Check for hypersensitivity
• Gonococcal infections • Give 1-2 hr ac or 2-3 hr pc
• Lyme disease • Cross allergy with cephalosporins

Sulfonamides (Antibiotics) Sulfonamides (Antibiotics) Sulfonamides (Antibiotics)

Action: Medications: Side effects:
• Antagonize essential component • Gantrisin • Peripheral Neuropathy
of folic acid synthesis • Bactrim • Crystalluria
Used for: • Septra • Photosensitivity
• Ulcerative colitis • Azulfidine • GI upset
• Crohn’s disease • Stomatitis
• Otitis media Nursing Considerations:
• UTIs • Take with meals or foods
• Encourage fluids
• Good mouth care
• Antacids will interfere with absorption

31
Tetracyclines TEtracyclines Tetracyclines (Antibiotics)
(Antibiotics) (Antibiotics) Side effects:
Action: Medications: • Discoloration of primary teeth if taken during
• Inhibits protein sythesis • Vibramycin pregnancy or if child takes at young age
Used for: • Panmycin • Glossitis
• Infections • Rash
• Acne • Phototoxic reactions
• Prophylaxis for Nursing considerations:
opthalmia neonatorum • Take 1 hr ac or 2-3 hr pc
• Do not take with antacids, milk, iron
• Note expiration date
• Monitor renal function
• Avoid sunlight

UTIs
• Medication:
o Furadantin
• Action:
o Anti-infective
• Side effects:
o Asthma attacks
o Diarrhea
• Nursing Considerations:
o Give with food or milk
o Monitor pulmonary status

UTIs
• Medication
o Mandelamine
• Action:
o Anti-infective
• Side effects:
o Elevated liver enzymes
• Nursing Considerations:
o Give with cranberry juice to acidify urine
o Limit alkaline foods: vegetables, milk, almonds, coconut

UTIs
• Medication
o Pyridium
• Side effects:
o Headache
o Vertigo
• Action
o Urinary tract analgesic
• Nursing Consideration
o Tell patient urine will be orange

32
Anticholinergics Anticholinergic Medications: Anticholinergic
Action: • Pro-Banthine Side Effects:
• Inhibits action of acethylcholine • Atropine • Blurred vision
and blocks parasympathetic nerves • Scopolamine • Dry mouth
(affects heart, eyes, respiratory • Urinary retention
tract, GI tract and the bladder) • Chage in heart rate
• Dilates pupil, causes Nursing Consideration:
bronchodilation and decreased • Monitor output
secretions • Contraindicated with glaucoma
• Decrease GI motility secretions • Give 30 min ac, hs, or 2hr pc
Used for:
• Contraindicated: paralytic ileus,
• Opthalmic exam BPH
• Motion sickness
• Pre-operative

Anticoagulants Anticoagulants Anticoagulants (Heparin)

Action:
• Blocks conversion of
prothrombin to thrombin
Used for:
• Pulmonary embolism
• Venous thrombosis
• Prophylaxis after acute MI
Medications: Side Effects:
• Heparin • Hematuria
• Tissue irritation
Nursing Considerations:
• Monitor clotting time or Partial Thromboplastin Time
(PTT)
• Normal 20-45 sec
• Therapeutic level 1.5-2.5 times control
• Antagonist—Protamine Sulfate
• Give SC or IV

Anticoagulant Anticoagulant Anticoagulant (Coumadin)

Action:
• Interferes with synthesis of
vitamin K-dependent clotting
factors
Used for:
• Pulmonary embolism
• Venous thrombosis
• Prophylaxis after acute MI
Medication: Side Effects:
• Coumadin • Hemorrhage, Alopecia
Nursing Considerations:
• Monitor Prothrombin Test (PT)
• Normal 9-12 sec
• Therapeutic level 1.5 times control
• Antagonist—Vitamin K
(AquaMEPHYTON)
• Monitor for bleeding
• Give PO

Anticonvulsants Anticonvulsant Anticonvulsant

Action: Medications: Side effects:
• Decreases flow of calcium • Dilantin • Respiratory depression
and sodium across neuronal • Luminal • Aplastic anemia
membranes • Depakote • Gingival hypertrophy
Used for: • Tegretol • Ataxia
• Seizures • Klonopin Nursing Considerations:
• Don’t discontinue abruptly
• Monitor I&O
• Caution with use of medications that lower
seizure threshold: MAO inhibitors & anti-
psychotics
• Good mouth care
• Take with food
• May turn urine pinkish-red/pinkish-brown
33
Anti-Depressants Monoamine
Oxidase Inhibitors (MAO)
Action:
• Causes increases
concentration of
neurotransmitters
Used for:
• Depression
• Chronic pain
Anti-Depressants Anti-Depressants
(Monoamine Oxidase (Monoamine Oxidase Inhibitors)
Inhibitors) Side effects:
Medications: • Hypertensive Crisis (Sudden headache, diaphoretic,
• Marplan palpitations, stiff neck, intracranial hemorrhage) with
• Nardil food that contain Tyramine
• Parnate Nursing Considerations:
• Avoid foods containing Tyramine: Aged cheese,
liver, yogurt, herring, beer and wine, sour cream,
bologna, pepperoni, salami, bananas, raisins, and
pickled products
• Monitor output
• Takes 4 weeks to work
• Don’t combine with sympathomometics
vasoconstrictors, and cold medications

Anti-Depressants Anti-Depressants Anti-Depressants

Selective Serontonin Reuptake Selective Serontonin Selective Serontonin Reuptake Inhibitors (SSRI)
Inhibitors (SSRI) Reuptake Inhibitors Side effects:
Action: (SSRI) • Anxiety
• Inhibits CNS uptake of Medications: • GI upset
serotonin • Paxil • Change in appetite and bowel function
Used for: • Prozac • Urinary retention
• Depression • Zoloft Nursing Considerations:
• Obsessive-Compulsive • Suicide precautions
Disorder • Takes 4 weeks for full effect
• Bulimia • Take in a.m.
• May urine to pinkish-red or Pinkish-brown
• Can be taken with meals
Anti-Depressants (Tricyclics) Anti-Depressants (Tricyclics) Anti-Depressants (Tricyclics)
Action: Medications: Side Effects:
• Inhibits reuptake of • Norpramin • Sedation/Confusion
neurotransmitters • Elavil • Anticholinergics affects
Used for: • Tofranil • Postural Hypotension
• Depression • Urinary retention
• Sleep apnea Nursing Considerations:
• Suicide precautions/2-6 weeks to work
• Take at hs/Don’t abruptly halt
• Avoid alcohol/OTC /Photosensitivity

Insulin Insulin Insulin Insulin

(Regular, Humulin R)
Type: Fast acting
Onset: ½ -1 hr
Peak: 2-4 hr
Duration: 6-8 hr
(NPH, Humulin N) (Ultralente, Humulin U) (Humulin 70/30)
Type: Intermediate acting Type: Slow acting Type: Combination
Onset: 2hr Onset: 4hr Onset: ½ hr
Peak: 6-12hr Peak: 8-20hr Peak: 2-12hr
Duration 18-26hr Duration: 24-36hr Duration: 24hr

34
Antidiabetic Agents Antidiabetic Agents Antidiabetic Agents
Action: Medications: Side Effects:
• Stimulates insulin • Diabinese • Hypoglycemia
release from beta cells in • Orinase • Allergic skin reactions
pancreas • Dymelor • GI upset
Used for: • Micronase Nursing Considerations:
• Type 2 diabetes • Take before breakfast
(NIDDM) • Monitor glucose levels
• Avoid alcohol, sulfonamides, Oral Contraceptives, (MAO),
aspirin because they help to make drug work better

Hypoglycemic Agent Hypoglycemic Agent Hypoglycemic Agent

Action: Medication: Side Effects:
• Stimulates liver to change • Glucagon • Hypotension
glycogen to glucose • Bronchospasm
Used for: Nursing Considerations:
• Hypoglycemia • May repeat in 15min
• Give carbohydrates orally to prevent secondary
hypoglycemic reactions

Antidiarrheals Antidiarrheals Antidiarrheals

Action: Medications: Side Effects:
• Slows peristalsis • Kaopectate • Constipation
• Increases tone of • Lomotil • Anticholinergic effects (urinary retention, dry
sphincters • Imodium mouth)
Used for: • Paregoric Nursing Considerations:
• Diarrhea • Do not use with abdominal pain
• Monitor for urinary retention
• Give 2hr before or 3 hr after other meds

Antiemetics Antiemetics Antiemetics

Action: Medications: Side Effects:
• Increases GI motility • Tigan • Sedation
• Blocks effect of • Compazine • Anticholinergic effects
dopamine in • Torecan Nursing Considerations:
chemoreceptor trigger • Reglan • Used before chemotherapy
zone • Antivert • When used with viral infections may cause Reye’s
Used for: • Dramamine syndrome (Toxic Encephalopathy)
• Vomiting

Antifungals Antifungals Antifungals

Action: Medications: Side Effects:
• Impairs cell membrane • Amphotericin B • Hepatotoxicity
Used for: • Nystatin • Thrombocytopenia
• Candidiasis • Leukopenia
• Oral thrush • Pruritis
• Histoplasmosis Nursing Considerations:
• Give with food
• Monitor liver function
• Good oral hygiene

35
Antigout Agents Antigout Agents Antigout Agents
Action: Medications: Side Effects:
• Decreases production • Colchicine • Agranulocytosis
and resorption of uric • Probenecid • GI upset
acid • Zyloprim • Renal calculi
Used for: Nursing Considerations:
• Gout • Monitor for renal calculi
• Give with food, milk, antacids

Antihistamines Antihistamines Antihistamines

Action: Medications: Side Effects:
• Block effects of histamine • Chlor-Trimeton • Drowsiness
Used for: • Benadryl • Dry mouth
• Allergic rhinitis • Phenergan • Photosensitivity
• Allergic reactions to blood Nursing Considerations:
• Give with food
• Use sunscreen
• Avoid alcohol

Antihyperlipidemic Agents Antihyperlipidemic Agents Antihyperlipidemic Agents

Action: Medications: Side Effects:
• Inhibits cholesterol and triglyceride • Questran • Constipation
synthesis • Lipid • Fat-soluble vitamin deficiency
Used For: Nursing Considerations:
• Elevated cholesterol • Take at hs or 30 min ac
• Reduce incidence of cardiovascular • Administer 1hr before or 4-6 hr after
disease other meds

Antihypertensives Antihypertensives Antihypertensives

Types: ACE Inhibitors (ACE Inhibitors) (ACE Inhibitors)
Action: Medications: Side Effects:
• Blocks ACE in lungs • Capoten • GI upset
Used for: • Vasotec • Orthostatic hypotension
• Hypertension • Dizziness
• CHF Nursing Considerations:
• Give 1hr ac or 3hr pc
• Change position slowly

Antihypertensives Antihypertensives Antihypertensives

Type: Beta-Adrenergic Blockers Type: Beta-Adrenergic Type: Beta-Adrenergic
Action: Medications; Side Effects:
• Blocks Beta-Adrenergic Receptors • Nadolol • Changes in heart rate
• Decrease excitability/workload of heart, • Propranolol • Hypotension
oxygen consumption • Tenormin • Bronchospasm
• Decrease • Timoptic Nursing Considerations:
Used for: • Masks signs of shock and
• Hypertension hypoglycemia
• Angina • Take with meals
• SVT • Do not discontinue abruptly

36
Antihypertensives Antihypertensives Antihypertensives
Type: Centrally acting alpha- Type: Centrally acting alpha-adrenergics Type: Centrally acting alpha-adrenergics
adrenergics Medications: Side Effects:
Action: • Aldomet • Sedation
• Stimulates alpha receptors • Catapres • Orthostatic Hypotension
in medulla which causes a Nursing Considerations:
reduction in sympathetic • Don’t discontinue abruptly
in the heart • Monitor for fluid retention
Used for: • Change position slowly
• Hypertension
Antihypertensives Antihypertensives Antihypertensives
Type: Direct-acting vasodilators Medications Side Effects:
Action: • Hydralazine • Tachycardia
• Relaxes smooth muscle • Minoxidil • Increase in body hair
Used for: Nursing Considerations:
• Hypertension • Teach patient to check pulse
Antihypertensives Antihypertensives Antihypertensives
Type: Calcium Channel Blockers Type: Calcium Channel Type: Calcium Channel Blockers
Action: Blockers Side Effects:
• Inhibits movement of calcium across cell membranes Medications: • Hypotension
• Slow impulse conduction and depresses myocardial • Procardia • Dizziness
contractility • Calan • GI distress
• Causes dilation of coronary arteries and decreases • Cardizem Nursing Consideration:
cardiac workload and energy consumption • Monitor vital signs
Used for: • Do not chew or divide
• Angina sustained-release tablets
• Hypertension
• Interstitial cystitis

Antihypertensives Antihypertensives Antihypertensives

Type: Peripheral-acting alpha-adrenergic blockers Medications: Side Effects:
Action: • Reserpine • Depression
• Depletes stores of norepinephrine in • Orthostatic Hypotension
sympathetic nerve endings • Brachycardia
Used for: Nursing Considerations:
• Hypertension • Give with meals or milk
• Change position slowly

Bipolar Disorder Bipolar Disorder Medications: Bipolar Disorder

Action: • Lithium (1-1.5meq/L) Side Effects:
• Reduces catecholamine • Tegretol • GI upset
release • Depakote • Tremors
Used for: • Polydipsia
• Manic episodes • Polyuria
Nursing Considerations:
• Monitor serum levels
• Give with meals
• Increase fluid intake

37
Antineoplastic Agents Antineoplastic Agents Antineoplastic Agents
Type: Alkylating Agents Medications: Side Effects:
Action: • Cisplatin • Hepatotoxicity
• Interferes with rapidly • Myleran • Ecchymosis
reproducing DNA • Cytoxan • Alopecia
Used for: • Epitaxis
• Leukemia • Infertility
• Multiple myeloma • Bone Marrow Suppression
• Stomatitis
• GI disturbances: Anorexic, N/V, diarrhea
Nursing Considerations:
• Check hematopoietic (reproduction of
RBC’s by bone marrow) function
• Force fluids
• Good mouth care

Antineoplastic Agents Antineoplastic Agents Antineoplastic Agents

Type: Antimetabolites Antimetabolites Medications: Antimetabolites
Action: • 5-FU Side Effects:
• Inhibits DNA • Methotrexate • Nausea
polymerase • Hydrea • Vomiting
Used for: • Oral ulceration
• Acute lymphatic • Bone marrow
leukemia suppression
• Cancer of colon, breast, • Alopecia
pancreas Nursing Considerations:
• Monitor hematopoietic
function
• Good mouth care
• Discuss body image
changes

Antineoplastic Agents Antineoplastic Agents Antineoplastic Agents

Type: Antitumor Antibiotics Antitumor Antibiotics Antitumor Antibiotics
Action: Medications: Side Effects:
• Interferes with DNA and • Adriamycin • Bone marrow suppression
RNA synthesis • Actinomycin D • Alopecia
Used for: • Bleomycin • Stomatitis
• Cancer Nursing Considerations:
• Monitor vital signs
• Give antiemetic medications before therapy

Antineoplastic Agents Antineoplastic Agents Antineoplastic Agents

Type: Hormonal Agents Type: Hormonal Agents Type: Hormonal Agents
Action: Medications: Side Effects:
• Changes hormone input • Diethylstilbestrol • Leukpenia
into sensitive cells • Tamoxifen • Bone pain
Used for: • Testosterone • Hypercalcemia
• Cancer Nursing Considerations:
• Check CBC
• Monitor serum calcium

38
Antineoplastic Agents Antineoplastic Agents Antineoplastic Agents
Type: Vinca Alkaloids Type: Vinca Alkaloids Type: Vinca Alkaloids
Action: Medications: Side Effects:
• Interferes with cell • Oncovin • Stomatitis
division • Velban • Alopecia
Used for: • Loss of reflexes
• Cancer • Bone marrow suppression
Nursing Considerations:
• Give antiemetic before administration
• Check reflexes
• Given with Zyloprim to decrease uric acid

Antiparkinson Agents Antiparkinson Agents Antiparkinson Agents

Action: Medications: Side Effects:
• Converted to • Artane • Dizziness
Dopamine • Cogentin • Ataxia
• Stimulates • L-Dopa • Atropine-like effects: dry mouth, urinary retention
postsynaptic Dopamine • Parlodel Nursing Considerations:
receptors • Sinemet • Monitor for urinary retention
Used for: • Symmetrel • Large doses of vitamin B6 reverse effects
• Parkinson’s disease • Avoid use of CNS depressants
Antiplatelet Agents Antiplatelet Agents Antiplatelet Agents
Action: Medications: Side Effects:
• Interferes with platelet • Aspirin • Hemorrhage
aggregation • Persantine • Thrombocytopenia
Used for: Nursing Considerations:
• Venous thrombosis • Check for signs of bleeding
• Pulmonary embolism • Give with food or milk

Antipsychotic Agents Antipsychotic Agents Antipsychotic Agents

Action: Medications: Side Effects:
• Blocks dopamine • Haldol • Akathisia (inability to sit
receptors in basal • Thorazine still)
ganglia • Mellaril • Dyskinesia
Used for: • Stelazine • Dystonias
• Acute and Chronic • Parkinson’s syndrome
psychoses • Tardive dyskinesias
• Leukopenia
Nursing Considerations:
• Check CBC
• Monitor vital signs
• Avoid alcohol and
caffeine

Atypical Antipsychotic Agents Atypical Antipsychotic Atypical Antipsychotic

Action: Medications: Side Effects:
• Interferes with binding • Clozaril • Extrapyramidal effects
of dopamine in the brain • Risperdal • Anticholinergic
Used for: • Sedative
• Acute and Chronic • Orthostatic hypotension
psychoses Nursing Considerations:
• Monitor blood
• Change positions slowly
• Use sunscreen

39
Antipyretic Agents Antipyretic Agents Antipyretic Agents
Action: Medications: Side Effects:
• Antiprostaglandin • Tylenol • GI irritation
activity in hypothalamus (Acetaminophen) Nursing Considerations:
Used for: • Monitor liver function
• Fever • Aspirin contraindicated
for younger than 21
years old due to risk of
Reye’s syndrome

Antithyroid Agents Antithyroid Agents Antithyroid Agents

Action: Medications: Side Effects:
• Reduce vascularity of • Tapazole • Leukopenia
thyroid • SSKI • Rash
• Inhibits release of • Thrombocytopenia
thyroid into circulation Nursing Considerations:
Used for: • Bitter taste
• Hyperthyroidism • May cause burning in
mouth
• Give with meals
• Check CBC

Thyroid Replacement Agents Thyroid Replacement Thyroid Replacement

Action: Medications Side Effects:
• Increases metabolic rate • Synthroid • Nervousness
Used for: • Cytomel • Tachycardia
• Hypothyroidism • Weight loss
Nursing Considerations:
• Monitor pulse and BP
• Monitor weight
• Take in a.m.
• Enhance action of
anticoagulants,
antidepressants, decrease
action of insulin and
digitalis

Antitubercular Agents Antitubercular Agents Antitubercular Agents

Action: Medications: Side Effects:
• Inhibits cell and protein • INH • Hepatitis
synthesis • Ethambutol • Peripheral Neuritis
Used for: • Streptomycin Nursing Considerations:
• Tuberculosis • PAS • Check liver function tests
• To prevent disease in • PYZ • Vitamin B6 given for peripheral
person exposed to neuritis (Pyridoxine)
organism • Used in combination

Antivirals Antivirals Antivirals

Action: Medications: Side Effects:
• Inhibits DNA and RNA • Zovirax • Headache
replication • AZT • Dizziness
Used for: • Videx • GI symptoms
• Recurrent HSV • Famvir Nursing Considerations:
• HIV infection • Cytovene • Encourage fluids
• Not a cure, but relieves
symptoms

40
Attention Disorder Agents Attention Disorder Agents Attention Disorder Agents
Action: Medications: Side Effects:
• Increases level of • Ritalin • Restlessness
catecholamines • Cylert • Insomnia
Used for: • Dexedrine • Tachycardia
• ADDH • Palpitations
• Narcolepsy Nursing Considerations:
• Monitor growth rate
• Monitor liver enzymes
• Give in A.M.

Bronchodilators Bronchodilators Bronchodilators

Action: Medications: Side Effects:
• Decreases activity of • Aminophylline • Tachcyardia
phosphodiesterase • Atrovent • Dysrhythmias
Used for: • Brethine • Palpitations
• COPD • Proventil • Anticholinergic effects
• Preterm labor (Terbutaline) • Primatene Nursing Considerations:
• Monitor BP and HR
• When used with steroid
inhaler, use
bronchodilator first
• May aggravate diabetes

Cardiac Glycosides Cardiac Glycosides Cardiac Glycosides

Action: Medication: Side Effects:
• Increases force of • Lanoxin • Bradycardia
myocardial contraction, (Digoxin) • Nausea
slows rate • Vomiting
Used for: • Visual disturbances
• Left-sided CHF Nursing Considerations:
• Take apical pulse
• Notify physician if adult <60,
child <90-110, <70 in older
children
• Monitor potassium level
• Dose: 0.5-1 milligram IV or
PO over 24 hr period
• Average: 0.25 mg
Cholinergics Cholinergics Cholinergics
Action: Medications: Side Effects:
• Inhibits destruction of • Tensilon • Bronchoconstriction
acetylcholine • Prostigmin • Respiratory paralysis
• Stimulate parasympathetic • Hypotension
nervous system (increase Nursing Considerations:
bowel tone, increase • Give with food or milk
bladder tone, constrict • Monitor vital signs, especially
pupil) respirations
Used for: • Antidote: Atropine Sulfate
• Myasthenia gravis • Toxicity: excessive salivation,
• Post-operative excessive sweating, abdominal
• Postpartum urinary cramps, flushing
retention

41
 Diuretics Diuretics Diuretics
Action: Medications: Side Effects:
• Inhibits reabsorption of • HydroDIURIL • Dizziness
sodium and water • Diamox • Orthostatic Hypotension
• Blocks effects of • Aldactone • Leukopenia
aldosterone • Lasix Nursing Considerations:
Used for: • Hygroton • Take with food or milk
• CHF • Take in a.m.
• Renal disease • Monitor fluid and
electrolytes

Iron: Imferon/Feosol, use straw if liquid form, no milk/antacids, take on empty stomach, tachycardi
Glucocorticoids Glucocorticoids Glucocorticoids
Action: Medications: Side Effects:
• Stimulates formation of • Solu-Cortef • Psychoses
glucose • Decadron • Depression
• Alters immune response • Deltasone • Hypokalemia
Used for: • Stunted growth
• Addison’s disease • Buffalo Hump
• Crohn’s disease Nursing Considerations:
• COPD • Monitor fluid and
• Leukemias electrolyte balance
• Don’t discontinue
abruptly
• Monitor for signs of
infection

Mineralocorticoids Mineralocorticoids Mineralocorticoids

Action: Medications: Side Effects:
• Increases sodium • Florinef • Hypertension
reabsorption • Edema
• Potassium and hydrogen • Hypokalemia
ion secretion in kidney Nursing Considerations:
Used for: • Monitor BP, I&O, Weight, and Electrolytes
• Adrenal insufficiency • Give with food
• Low-sodium, High-protein, High-potassium
diet

Heavy Metal Antagonists Heavy Metal Antagonists Heavy Metal Antagonists

Action: Medications: Side Effects:
• Forms stable complexes • Desferal mesylate • Tachycardia
with metals • BAL in Oil • Pain and induration at
Used for: • EDTA injection site (conjunct with
• Gold and arsenic Procaine in syringe)
poisoning Nursing Considerations:
• Acute lead • Monitor I&O and kidney
encephalopathy function
• Administered with local
anesthetic
• Seizure precautions

42
H2 Receptor Blockers H2 Receptor Blockers H2 Receptor Blockers
Action: Medications: Side Effects:
• Inhibits action of • Tagamet • Dizziness
histamine and gastric • Zantac • Confusion
acid secretion • Hypotension
Used for: • Impotence
• Ulcers Nursing Considerations:
• Gastroesophageal reflux • Take with meals and hs
• Smoking decreases
effectiveness
• Monitor liver function
and CBC

Immunosuppressants Immunosuppressants Immunosuppressants

Action: Medications: Side Effects:
• Prevents production of T • Sandimmune • Hepatotoxicity
cells and their response • Nephrotoxicity
to interleukin-2 • LeuKopenia
Used for: • Thrombocytopenia
• Prevents rejection for Nursing Considerations:
transplanted organs • Take once daily in a.m.
• Used with adrenal
corticosteroids
• Monitor renal and liver
function tests

Miotics (Constricts Pupil) Miotics Miotics

Action: Medications: Side Effects:
• Causes constriction of • Isopto-Carpine • Headache
sphincter muscles of iris • Eserine • Photophobia
Used for: • Carbacel • Hypotension
• Ocular surgery • Bronchoconstriction
• Open-angle glaucoma Nursing Considerations:
• Apply pressure on
lacrimal sac for 1min
• Avoid sunlight
• May experience
transient brow pain and
myopia

Mydriatics (Dilates Pupil) Mydriatics Mydriatics

Action: Medications: Side Effects:
• Anticholinergic actions • Atropine sulfate • Tachycardia
leaves pupil under • Cyclogyl • Blurred vision
unopposed adrenergic • Photophobia
influence • Dry mouth
Used for: Nursing Considerations:
• Diagnostic procedures • Contraindicated with glaucoma
• Acute iritis • Apply pressure on lacrimal sac
• Uveitis for 1min.
• Wear dark glasses

43
 Narcotics Narcotics Narcotics
Action: Medications: Side Effects:
• Acts on CNS receptor • Morphine Sulfate • Dizziness
cells • Codeine • Sedation
Used for: • Demerol • Respiratory depression
• Moderate to severe pain • Dilaudid • Hypotension
• Preoperative • Percodan • Constipation
• Postoperative Nursing Considerations:
• Safety precautions
• Avoid alcohol
• Monitor vital signs
• Use narcotic antagonist if
necessary (Narcan)

Antianginals Antianginals Antianginals

Action: Medications: Side Effects:
• Relaxes smooth muscle • Nitroglycerine • Hypotension
• Decreases venous return • Isosorbide • Tachycardia
Used for: • Headache
• Angina • Dizziness
• Peri-operative Nursing Considerations:
hypertension • Check expiration date
• CHF • Teach when to take medication
• May take Q5min x3 doses
• Wet with saliva and place under tongue

NSAIDS NSAIDS NSAIDS

Action: Medications: Side Effects:
• Inhibits prostaglandin • Motrin • GI upset
synthesis • Indocin • Dizziness
Used for: • Naprosyn • Headache
• Arthritis • Bleeding
• Mild to moderate pain • Fluid retention
• Fever Nursing Considerations:
• Take with food or after meals
• Monitor liver and renal function
• Use cautiously with aspirin allergy
• Check for bleeding

Thrombolytics Thrombolytics Thrombolytics

Action: Medications: Side Effects:
• Dissolves or lyses blood clots • Streptokinase • Bleeding
Used for: • Urokinase • Bradycardia
• Acute Pulmonary Emboli • Tissue Plasminogen • Dysrhythmias
• Thrombosis Activator Nursing Considerations:
• MI • Monitor for bleeding
• Contraindicated in: hemophilia, CVA, • Have Amino Caproic Acid
Trauma, not used in patients over 75 Available
years old, not used in patients taking • Check pulse, color, sensation
anticoagulants of extremities
• Monitor EKG

44
Anaphylaxis
• Symptoms
o Hives
o Rash
o Difficulty breathing (first sign)
o Diaphoresis
• Nursing care
o Epinephrine 0.3 ml of 1:1000 solution SQ
o Massage site
o May repeat in 15-20 min.

Delayed Allergic Reaction

• Symptoms:
o Rash, Hives, Swollen Joints
• Nursing Care
o Discontinue medication
o Topical Antihistamines
o Corticosteroids
o Comfort measures

Bone Marrow Depression

Symptoms:
Fever, Chills, Sore Throat
Back pain, Dark urine
Anemia, Thrombocytopenia, Leukopenia
Nursing Care:
Monitor CBC
Protect from infections
Avoid injury
Liver impairment: light stools and dark urine

Renal Impairment: decrease Hematocrit

Anticholinergic Effects
• Symptoms:
o Dry mouth, Dysphagia, Nasal Congestion
o Urinary retention, Impotence
• Nursing Care:
o Sugarless lozenges
o Good mouth care
o Void before taking medication

Parkinson’s-like effects
• Symptoms:
o Akinesia (temporarily paralysis of muscles)
o Tremors
o Drooling
o Changes in gait
o Rigidity
o Akathisia (Extreme restlessness)
o Dyskinesia (Spasms)
• Nursing Care:
o Anticholinergic and Antiparkinsonian medications
o Safety measures for gait

45
How long should a client with tuberculosis be on
medication?
What are symptoms of hepatitis?
What is the transmission of Hepatitis A?
What is the transmission of Hepatitis B?
What is the transmission of Hepatitis C?
What is the transmission of Delta Hepatitis?
What nursing care are recommended for
Hepatitis?
What is Lyme’s Disease?
What is Stage 1 of Lyme’s Disease?
What is Stage 2 of Lyme’s Disease?
What is Stage 3 of Lyme’s Disease?
What are some Lyme’s Disease teaching?
What are some Lyme’s Disease nursing care?
What are the treatment, mode of transmission,
care, signs and symptoms of syphillis?
6-9 Months
Inflammation of Liver
Jaundice
Anorexia
RUQ pain
Clay-colored stools, tea-colored urine
Pruritis (bile salts eliminated through skin)
Elevated ALT, AST
Prolonged PT (liver involvement with clotting factor)
Fecal/Oral
Consume contaminated food or water
Travelers to developing countries at risk
Clients with hepatitis A should not prepare food for others
Parenteral/Sexual contact
Blood or body fluids
At risk individuals are the one’s that abuse IV drugs, dialysis, healthcare
workers
Vaccine developed
Blood or body fluids
Can become chronic disease
Seen in patients with hemophilia (unable to clot)
Co-infects with hepatitis B
Rest (mainly for liver)
Contact and standard precautions
Low-fat, High-Calorie, and High Protein diet (needed for organ healing)
No alcoholic beverages
Medications (Vitamin K, Aqua-Mephyton for bleeding problems, Anti-emetic –
no compazine, use Tigan or (Dramamine). Corticosteroids to decrease
inflammatory response, and anti-histamines, will use lotions or baths than
systemic ones.
Multi-system infection caused by a tick bite. There are three stages.
Erythematous papule develops into lesion with clear center (Bull’s-eye)
Regional lymphadenopathy
Flu-like symptoms (fever, headache, conjunctivitis)
Can develop over 1 to several months
Develop after 1 to 6 months if disease untreated.
Cardiac conduction defects
Neurologic disorders (Bell’s palsy, temporary paralysis)
Develops after 1 to several months, if reached at this stage may persist for
several years.
Arthralgias
Enlarged, inflamed joints
Cover exposed areas when in wooded areas
Check exposed areas for presence of ticks
Antibiotics 3-4 weeks
Stage 1 use Doxicillin
IV penicillin with later stages
Painless chancre fades after 6 weeks
Low grade fever
Copper-colored rash on palms and soles of feet
Spread by contact of mucous membranes, congent
Treat with Penicillin G IM
If patient has penicillin allergy, will use erythromycin for 10-15 days.
After treatment, patient must be retested to make sure disease is gone.
46
What are the treatment, mode of transmission,
care, signs and symptoms of gonorrhea?
What are the treatment, mode of transmission,
care, signs and symptoms of genital herpes?
What are the treatment, mode of transmission,
care, signs and symptoms of Chlamydia?
What are the treatment, mode of transmission,
care, signs and symptoms of Venereal Warts?
What is the difference between AIDS and HIV
+?
What are some opportunistic infections of AIDS?
How is AIDS transmitted?
What are diagnostics test associated with AIDS?
What are some nursing cares for AIDS?
If female maybe asymptomatic and will be unaware of having disease.
Males may have thick discharge from urethra.
Some females from vagina.
Spread mucous membranes, congenital
IM Rocephin with Doxycycline PO, IM Aqueous Penicillin with PO Probenecid
(used for gout, used with Penicillin because it delays the urinary excretion of it,
makes it more effective)
Complication: Pelvis Inflammatory Disease
Most often affected with Chlamydia also, then treatment with PO Tetracycline
No cure.
Painful vesicular genital lesions
Problem is exacerbations/remissions
Reoccurs with stress, infection, menses
Spread by contact of mucous membranes, congenital
Treatment: Acyclovir, sitz bath
Monitor pap smears regularly because of higher incidence of cervical cancer.
Emotional support of client/significant others important because of no cure.
Pregnant women with active disease will have C-section.
Men: urethritis, dysuria
Women: thick vaginal discharge with acrid odor
Spread by mucous membranes, congenital
Treatment with Tetracycline or Doxycycline PO
Will cause sterility if left untreated.
Important to notify sexually contacted.
Single, small papillary lesion spreads into large cauliflower cluster on perineum,
vagina, penis.
May itch or burn.
Spread by mucous membranes, congenital
Treatment: Curettage, cryotherapy with liquid nitrogen, kerotolytic agents
Avoid intimate contact until lesions heal
Complication: Genital Dysplasia Cancer
HIV Positive—presence of HIV in blood
AIDS—has significant defects in immune function associated with positive HIV
evidenced by development of opportunistic infections
Syndrome where CD4 counts are below 200
P. Carinii Pneumonia: sob/dry-nonproductive cough
C. Albicans stomatitis: will have difficulty swalling and white exudates in back
of throat
C. Neoformans: debilitating form of meningitis that may suffer seizures.
Cytomegalovirus (CMV): will experience lymphadenopathy and may have
visual impairment and can affect any organ.
Kaposi’s Sarcoma: most common malignancy experience with AIDS, small
purplish brown, nonpainful, nonpuriitc palpable lesions on the body.
Contaminated blood or body fluids
Sharing IV needles
Sexual contact
Transplacental: across placenta
Possibly by breast milk
ELISA test, if positive will be confirmed by Western Blot test
HIV Viral culture: Leukopenia, Thrombocytopenia, Decrease CD4 counts
Prevention: avoid IV drug use, precautions regarding sexual patterns, use
standard precautions
Contact and standard precautions
High-protein and high-calorie diet, small frequent meals rather than 3 large
meals
Symptomatic relief
Support
Don’t share toothbrush/shavers
47
What are treatments, care, prevention of poison
control?
What should happen when someone is poisoned?
Why should vomit not be induced?
What medication treatment is used to induce
vomiting and what other factors need to be
implemented?
What should happen to poison control in
emergency care?
What are signs and symptoms, treatments, care,
prevention of aspirin poisoning?
What are signs and symptoms, treatments, care,
prevention of tylenol poisoning?
What are signs and symptoms, treatments, care,
prevention of lead toxicity?
What are nursing care goals for Hazardous
wastes?
What are nursing care for Hazardous wastes?
What type of play do infants (0-12months) use?
What type of play do toddlers (1-3years) use?
What type of play do pre-schoolers (3-6years)
use?
Prevention most important.
Treat patient first, and then the poison.
Recognize signs of symptoms of accidental poison: changes in appearance,
behavior, substances around mouth, empty containers, vomitous.
Call poison control center.
Tell them: substance, time, amount and route of ingestion, child’s condition,
age, weight, save vomitus, stool, urine.
Don’t induce if:
Danger of aspiration, decrease LOC, Ingested petroleum distillate (lighter fluid,
kerosene, paint remover)
Ingested corrosive (Draino)
Syrup of Ipecac with small amount of water. Don’t give large amount of fluid
after Ipecac, will increase gastric emptying.
Don’t use milk.
Position with head lower then chest.
No universal antidote.
Intubated if comatose
Run blood gases
IV fluids
Cardiac Monitor
Gastric Lavage (NG down to flush with NS to remove rest in stomach)
Activated Charcoal
May use cathartics, diuretics
Tinnitus, change in mental status, Increased temperature, hyperventilation,
bleeding, nausea and vomiting.
Nursing care: induce vomiting, maintain hydration, reduce temperature (sponge
baths), monitor for bleeding.
Symptoms: nausea/vomiting, hypothermia, If no treatment, hepatic/liver
involvement.
If liver gets involved patient may have RUQ pain, jaundice, confusion, and
coagulation abnormalities.
Nursing care: induce vomiting, maintain hydration, monitor liver and kidney
function with labs such as AST/ALT enzymes.
Tylenol (Acetaminophen) overdosage:
Antidote N-acetylcysteine (Mucomyst)
Symptoms: Irritability, decreased activity, abdominal pain, Increased ICP
Diagnostic tests: Blood lead levels (>9micrograms = toxic), Erythrocyte
protoporphyrin (EP), X-ray long bones (lead deposits in long bones)
Children engage in PICA (ingesting nonfood substances)
Lead blocks formation of hemogloblin and toxic to kidneys.
Nursing care: identify source, chelating agents, teaching parents
Decontaminate individual
Prevent spread of contamination
Clean and remove contaminuated source
Monitor personnel exposed
If chemical poses threat to caregiver, decontaminate patient first.
If chemical poses no threat or patient has been decontaminated, begin care.
If immediate threat to life, put on protective garments and provide care to
stabilize patient.
Solitary play. Game is one sided. Like to play with body parts.
Birth-3months: smile/squeal
3-6months: rattles/soft stuff toys
6-12 months: begin imitation, peek-a-boo, patty-cake
Parallel play.
Associative play. Dress up/imitating play. Talking on telephone/kitchen/tool
belt
48
What type of play do school age (6-12years) use?
According to Erikson’s Developmental Task,
explain the Infancy stage.
According to Erikson’s Developmental Task,
explain the Toddler stage.
According to Erikson’s Developmental Task,
explain the Preschool stage.
According to Erikson’s Developmental Task,
explain the School age stage.
According to Erikson’s Developmental Task,
explain the Adolescence stage.
According to Erikson’s Developmental Task,
explain the young adult stage.
According to Erikson’s Developmental Task,
explain the middle adulthood stage.
According to Erikson’s Developmental Task,
explain the Late adulthood stage.
At what month does the head sag?
At what month do you see closing of posterior
fontanelle, turn from side to back, and see a
social smile?
What toys do you give for a 2 month old?
At what month does a child bring objects to
mouth and head erect?
What toys do you give for a 4 month old?
Which age does birth weight double?
At what age does teething occur?
What toys do you give for a 6 month old?
What age for fears of strangers? When is fear
strongest?
Which month able to play peek-a-boo?
What toys do you give for 7-8months?
What month can a child say “DADA?
What month can a child crawl well?
What month can a child stand erect with
support?
Cooperative play. Conformed/organized play.
Birth-18 months.
Trust vs. Mistrust
Positive outcome---trusts self
Negative outcome---withdrawn
18months – 3 years
Autonomy vs. Shame and Doubt
Positive outcome---exercise self-control
Negative outcome---defiant and negative
3-6 years
Initiative vs. Guilt
Children develop conscience at this age.
Positive Outcome---learns limits
Negative Outcome---fearful, pessimistic
6-12years
Industry vs. Inferiority
Positive---sense of confidence
Negative---self doubt, inadequate
12-20 years
Identity vs. Role diffusion
Positive outcome---coherent sense of self
Negative outcome---lack of identity
20-45 years
Intimacy vs. Isolation
Positive outcome---intimate relationships/careers formed
Negative outcome---avoidance of intimacy
45-65 years
Generativity vs. Stagnation
Positive Outcome---creative and productive
Negative Outcome---self centered
65+ years
Integrity vs. Despair
No regrets in life or Regrets
Positive outcome---seems life as meaningful
Negative outcome---life lacks meaning
1 month
2 months
Mobiles, wind up infant swings, soft clothes, and blankets.
3 months
Rattles, cradle gym, and stuffed animals
5 months
6 months
Brightly colored, small enough to grasp, large enough for safety, teething toys
7 months
8 months is stronger
7 months
Large colored, bricks, jack in the box
9 month
10 months
11 months
49
What happens in the 12th month of the child? Birth weight triples.
Eats with fingers.
Anterior Fontanelle almost close.
Babinski reflex disappears.
Toys: books with large pictures, push pull toys, teddy bears, a large ball, or
sponge toys.

Explain introduction of solid foods. One food at a time.

Begin with least allergenic foods first.
• Cereal is usually first. (Do not use cow’s milk/whole milk. After six
months of age cereal can be mixed with fruit juices. Fruit juices
should be offered in a cup to prevent dental carries.)
• Vegetables
• Fruits
• Potatoes
• Meats
• Eggs
• Orange Juice
• By 12 months children should be eating table food. Don’t give honey
under 12 because of botulism.
What does a toddler do at 15 months? Walks alone.
Throws object.
Holds spoon.
Say 4-6 words. Understand simple commands.
What does a toddler do at 18 months? Anterior fontanelle closes.
Climbs stairs.
Sucks thumb.
Say 10 + words.
Temper Tantrums.
What does a toddler do at 24 months? 300 world vocabulary.
Obeys easy commands.
Go up/down stairs alone.
Build towers.
Turn doorknobs/unscrew lids.
Increase independence.
What does a toddler do at 30 months? Walk tip toe.
Stand on one foot balance.
Has control for sphincter training.
Birth weight quadrupled.
State first/last name.
Give simple commands.
What type of toys are included for Toddlers? Cooking utensils, Dress-up clothes, rocking horses, finger paints, phonographs,
cd players.
How do you avoid negativism during toddler Don’t ask no/yes questions.
ages? Offer them choices.
Make a game out of the tasks.
What can a 3 year old do? Rides tricycle.
Undresses without help.
May invent imaginary friend.
Vocabulary 900 words.
Egocentric in thoughts/behaviors.
What can a 4 year old do? Laces shoes
Brushes teeth

50

What can a 5 year old do?
What toys are used for preschool (3-5)?
Which age groups has greatest number of fears?
What would you expect with a 6 year old?
What would you expect with a 7 year old?
What would you expect with a 8 year old?
What would you expect with a 9 year old?
What toys are used for school age child?
School age potential problems include:
What are symptoms/indications of a fetal alcohol
syndrome in a child?
What happens with amniocentesis? What does it
do?
What happens with an ultrasound?
What happens with a non-stress test?
What happens with a contraction stress test?
What does Torch stand for? And their
importance?
What concerns for clients that have UTI,
Throws overhand
Uses sentences.
Independent
Runs well/Dresses without help.
Beginning cooperative play.
Gender-specific behavior.
Playground materials, Housekeeping toys, Coloring books, tricycle with helmet.
Preschool age children.
Self-centered, show off, rude
Sensitive to criticism
Begins loosing temporary teeth
Tends to lie.
Team games/sports.
Concept of time.
Playing with same sex child.
Seeks out friends.
Writing replaces printing.
Conflicts between peer groups and parents.
Conflicts between independence and dependence.
Likes school.
Able to take on job duties (housework).
Construction toys, Pets, Games, Electronic games, reading, books, bicycles with
helmets.
Anuresis (encourage before bed time)
Encopresis
Head lice
Thin upper lip, vertical ridge in upper lip, short up turned nose, mental
retardation, motor retardation, hearing disorders, microcephaly.
Avoid alcohol 3 months before conception and throughout pregnancy.
16th week detects genetic abnormality
30th week detects L/S ratio: lung maturity
Void before procedure
Ultrasound given to determine position of placenta and fetus.
Complications: premature labor, infection, Rh isommunization (if client Rh
negative, will be given Rhogam)
5th week confirms pregnancy
Determines position of fetus, placenta, and # of fetuses.
Client must drink a lot of fluid before procedure for full bladder to have a clear
image.
At 28th week records FHR and fetal movement.
Favorable result: 2+ FHR accelerates by 15bpm and last 15seconds in 20
minutes.
Determines placenta’s response to labor.
Done after 28th week.
Fowler/Semi-Fowler.
Given Oxytocin or Pitocin.
Results:
• Positive: Late decelerations indicates potential risk to fetus.
• Negative: No late decelerations.
Diseases that cross placenta or other events. Produce significant deformities or
infant born with infectious process.
Toxoplasmosis: no litter box changed, no gardening, no under cooked meats.
Rubella: 1-16 titer immune for rubella, titer <1-8 susceptible.
Cytomegalovirus: transmitted in body fluids.
Herpes Simplex: Ascending infection. During pregnancy get treated with
acyclovir. Delivery through c-section.
UTI: may lead to pylonephritis, increase risk of premature birth.
51
Syphilis, Gonorrhea?
What are the danger signs of pregnancy?
What are the events in the onset of labor?
How does prolapsed umbilical cords happen?
What do you do when a client has a prolapsed
cord?
What is a early/sign of fetal hypoxia?
What things should you know about the
Informed Consent form?
What is early deceleration?
What are interventions for late decelerations?
What do variable decelerations indicate?
What are signs of “True Labor”?
What are characteristics of a “False Labor”?
Prior to Lumbar Epidural block what should the
patient do?
What should be implemented during the delivery
of a newborn?
Syphillis: passes through placenta, causes 2nd trimester abortions, still birth, and
congenital infection, may receive medication for her and her baby.
Gonorrhea: baby gets prophylactic eydrops.
• Gush or fluid bleeding from vagina
• Regular uterine contractions
• Severe headaches, visual disturbances, abdominal pain, persistent
vomiting (symptoms of PIH)
• Fever or chills (symptoms of infection)
• Swelling in face or fingers (symptoms of PIH)
Lightening: (when baby drops to pelvis)
• Primipara: occurs 2 weeks before delivery
• Multipara: occurs during labor
Softening of cervix
Expulsion of mucus plug (bloody show) – pink tinged mucus secretion
Uterine contractions: regular/progressive not Braxton-Hick’s type.
Premature rupture of membranes.
Presenting part not engaged.
Fetal distress.
Protruding cord.
Call for help.
Push up against presenting part off of the cord.
Place in trendenlenberg position or knee chest position.
Successful if FHT left unchanged.
Early sign: fetal tachycardia >160 in >10minutes
Late sign: fetal bradycardia <110 in > 10 minutes
Nurse can witness patient sign form.
Patient has to be age of capacity/adult and confident. No confused
patient/drinking/already received preoperative medications.
Consent must be given voluntarily and information understandable. Nurse must
make sure questions are answered and form is attached to chart.
Decrease in HR before peak of contraction. Indication of head compression.
Position mother left side/trendenlenberg/knee chest
Increase rate of IV
Administer Oxygen 7-10 l/min
DC Oxytocin
Cord compression.
Change maternal position.
Administer oxygen.
DC Oyxtocin/Pitocin
Regular contractions increasing in frequency, duration, intensity
Discomfort radiates from back
Contractions do not decrease with rest
Cervix progressively effaced and dilated.
Irregular contractions, no change in frequency, duration, intesityDiscomfort is
abdominal
Contractions decrease with rest or activity
No cervical changes
Void
Establish airway
Check Apgar at 1 and 5 minutes
Clamp umbilical cord
Maintain Warmth
Place ID band on mother and infant
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What are the types of Lochia?
If fundus is displaced not centrally and off to the
sides means?
If client soaks pad in 15 minutes or pooling of
blood?
What are assessments and implementations for
an “Ectopic Pregnancy”?
What are assessments and implementations for
“Placenta Previa”?
What are the assessments and implementation
for “Abruptio Placentae”?
What are assessments and implementations for
Gestational Diabetes Mellitus (GDM)?
What are assessments and implementation for a
Hydatidiform Mole?
What are the newborn vital signs?
Rubra-bloody, day 1-3
Serosa-pink-brown, day 4-9
Alba-yellow-white, 10+ days
Bladder distended.
Check for hemorrhage
Unilateral lower quadrant pain.
Rigid, tender abdomen
Low Hct and hCG levels
Bleeding
Monitor for shock
Administer RhoGAM
Provide support
A placenta that’s implanted in the lower uterine segment near cervical os,
during pregnancy placenta is torn away causing:
First and second trimester spotting
Third and trimester painless, profuse bleeding
Bedrest side-lying or trendelenburg position, ultrasound to locate placenta, no
vaginal or rectal exams, amniocentesis for lung maturity, daily Hgb, Hct,
Monitor bleeding
The premature separation of a placenta that is implanted in a correct position.
Painful vaginal bleeding
Abdomen tender, painful, tense
Possible fetal distress/Contractions
Monitor for maternal and fetal distress
Prepare for immediate delivery
Monitor for complications: DIC, pulmonary emboli
Hyperglycemia after 20 weeks
Usually controlled by diet
Oral hypoglycemic medications contraindicated
Test for diabetes at 24-28 weeks on all women with average risk 20.
Frequent monitoring of mother/fetus during pregnancy.
Teach to eat prescribed amount of food daily at same times
Home glucose monitoring
Teach about change in insulin requirements
Elevated hCG
Uterine size larger than expected for dates
No FHT
Minimal dark red/brown vaginal bleeding with grape like clusters
Nausea and vomiting
Associated with PIH
Curettage to remove tissue
Pregnancy discouraged for 1 year
Do not use IUD
hCG levels monitored for 1 year
Temp. 97.7-99.7
HR sleep 100, awake 120-140, 180 crying
Resp 30-60
BP arm/calf 65/41
53
What are assessments and implementation for Caused by immature hepatic function
Hyperbilirubinemia? Physiological Jaundice (No treatment required)
• Seen after 24 hours
• Peaks at 72 hours
• Lasts 5-7 days
Breast-Feeding Associated Jaundice (Frequent breast feeding)
• Caused by poor milk intake
• Onset 2-3 days
• Peaks 2-3 days
Breast Milk Jaundice (discontinue breast feeding for 24 hours)
• Caused by factor in breast milk
• Onset 4-5 days
• Peak 10-15 days
Hemolytic Disease (Phototherapy then exchange transfusion)
Caused by blood antigen incompatibility (Rh or ABO incompatibility)
Onset first 24 hours
Peak variable

What are assessments and implementations for a Assessments

Narcotic-Addicted infant? • High-pitched cry (Hallmark sign)
• Hyperreflexia
• Decreased sleep
• Tachypnea (>60/min)
• Frequent sneezing and yawning
• Seen at 12-24 hours of age, up to 7-10 days
Implementation
• Reduce environmental stimuli
• Administer Phenobarbital, chlorpromazine, diazepam, paregoric
• Wrap snugly, rock, and hold tightly
• Assess muscle tone, irritability, vital signs.
What are the assessments and implementations Sudden-onset fever
of Toxic Shock Syndrome? Vomiting, diarrhea
Hypotension
Erythematous rash on palms and soles
Administer antibiotics
Educate about use of tampons (change tampon Q3-Q6 hours)
What are contraindications to Immunizations? Immunization is a primary prevention
Severe febrile illness
Altered immune system
Previous allergic response
Recently acquired passive immunity
What are assessments and implementations for a Assessment
“Latex Allergy”? Urticaria, rash
Wheezing, Rhinitis, Conjunctivitis, Bronchospasms
Anaphylactic shock
Implementation
Screen for sensitivity
Avoid latex products: gloves, catheters, brown ace bandages, band aid dressing,
elastic pressure stockings, balloons, condoms
What are implementations for Croup syndromes Steamy shower
at home? Exposure to cold air
Cool, humidified air

54
Universal Donor Blood: Packed red blood cells (help oxygen deliver to tissue, if you use whole blood there will be a risk for fluid
overload), type O, Rh-negative

5% Sodium Bicarbonate—metabolic alkalosis solution

Older adults are asymptomatic when they have an infection and can lead to confusion.

Mononucleosis: complication enlarged spleen; concerned for trauma if child plays dangerous sport.

Lyme disease:found mainly in mid alantic states (Connecticut)

Pottery is unglazed can lead to “Lead Toxicity”

Apgar Score: normal 7-10

WBC after pregnancy?

Ampicillin decreases oral contraceptives efficiency.

Tricuspid area: 5th intercostals space in the left sternum area

Tracheostomy care: no powder, suction trachea first then mouth, use pre-cut gauze.

Hip-Flexion: causes increased intra-abdominal/thoracic pressure.

Injury C3 and above need respiratory ventilation.

SIADH causes: lung cancer, Cisplatin (Platinol)

Chest Tubes
Fill water-seal chamber with sterile water to 2 cm (middle chamber)
Fill suction control chamber with sterile water to 20 cm (chamber all the way to the right)
Air-leak if bubbling in water-seal chamber (middle chamber)
Obstruction: “milk” tube in direction of drainage
Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly, apply
occlusive dressing
Dislodged: apply tented dressing
Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile
connector and reinsert
Tube becomes disconnected from drainage system, immerse in 2cm of water

Jackson-prat: Notify physician if drainage increases or becomes bright red

Penrose: Expect drainage on dressing

Tracheostomy Tube Cuff

Prevents aspiration of fluids/separates upper and lower airways
Inflated during continuous mechanical ventilation
Inflated during and after eating
Inflated during and 1 hour after tube feeding
Inflated when patient cannot handle oral secretions

• NCLEX-RN exam is a “here and now” test; take care of problem now to prevent harm to client.
• Do not ask “why” on the licensure exam
• Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi; Meperidine is drug of choice.
• Normal Intraocular Pressure is 10-21 mm Hg
• Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates retroperitoneal bleeding

The parenteral form of Chlorpheniramine Maleate is use to relieve symptoms of anaphylaxis allergic reactions to blood or plasma.
55
Herbs: Toxicities and Drug Interactions

Chamomile
Uses: Chamomile is often used in the form of a tea as a sedative.
Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps,
tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the
breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting
(anticoagulants) such as warfarin.

Echinacea
Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to
boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in
combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex),
isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as
Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these
different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are
in progress.
Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair-
skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb
should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa-
containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used
in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic
Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence
to recommend its routine use in clinical practice.")
Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment.
Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should
be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin.

Feverfew
Uses: Most commonly used for migraine headaches.
Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow.
Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of
feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain,
tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in
patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba
Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking.
Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not
recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to
prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure
medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital.

Ginseng
Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on
reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical
components of substances branded as "Ginseng.")
Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause
falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not
56
recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking
aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood
clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It
should be avoided in persons with manic disorder and psychosis.

Ginger
Uses: Ginger has been used as a treatment for nausea and bowel spasms.
Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting
(anticoagulants) such as warfarin (Coumadin).

Saw Palmetto
Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies
verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder
infections.
Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller
states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other
hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")

Black Cohosh
Claims, Benefits: A natural way to treat menopausal symptoms.
Bottom Line: Little is known about its benefits and its risks.
A child with celiac disease mustn’t consume foods containing gluten and therefore should avoid prepared puddings, commercially
prepared ice cream, malted milk, and all food and beverages containing wheat, rye, oats, or barley.
The infant of a diabetic mother may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the
placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increases
glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin
production in the newborn coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with
formula can prevent hypoglycemia

Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous
pooling at the distal portion of the extremity.

A platypelloid pelvis has a flat shape. A gynecoid pelvis is a normal female pelvis. An anthropoid pelvis has an oval shape, and an
android pelvis has a heart shape.

The pulse is the earliest indicator of new decreases in fluid volume.

Adult Rickets: deficiency in vitamin D.

Chronic Pain: normal blood pressure, heart rate, and respiratory rate. Normal pupils and dry skin.

Acute pain: causes increased blood pressure, increased pulse, and respiratory rate, dilated pupils, and perspiration.

The tip of the endotracheal tube lies 1 cm above the carina. This is positioned above the bifurcation of the right and left mainstem
bronchi.

Creatine Phosphokinase (CPK) is a cellular enzyme that can be fractionated into three isoenzymes.

Ø MB band reflects CPK from CARDIAC MUSCLE (This is the level that elevates with an MI.)
Ø MM band reflects CPK from SKELETAL MUSCLE
Ø BB band reflects CPK from the BRAIN

ALKYLATING AGENTS: affect ALL PHASES of the reproductive cell cycle (i.e., Cyclophosphamide
[Cytoxan])

ANTIMETABOLITES: are cell cycle phase-specific and affect the S PHASE (i.e., Cytarabine [Cytosar])

57
VINCA ALKALOIDS: are cell cycle phase-specific and act on the M PHASE

Bell’s Palsy: is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown. Possible causes
include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a
combination of these items.

McBURNEY’S POINT: is midway between the right anterior superior iliac crest and the umbilicus. This is usually the location
of greatest pain in the child with appendicitis.

MMR: administered SQ in the outer aspect of the upper arm.

Watch for absolute words “NOT” and “ONLY”

AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg position. Lying on the left side may prevent
air from flowing into the pulmonary veins. The trendelenburg position increases intrathoracic pressure, which decreases the amount
of blood pulled into the vena cava during inspiration.

Trigeminal neuralgia pain medication: Use Carbamazepine (Tegretol) and Phenytoin (Dilantin). Narcotic analgesics (Meperidine
Hydrochloride [Demerol], Codeine Sulfate , and Oxycodone) are not effective in controlling pain caused by trigeminal neuralgia.

Grapefruit juice can raise cyclosporine (Sandimmune) levels by 50% to 100%, risk for toxicity.

Fomepizole (Antizol): an antidote given IV to a client with Ethylene Glycol (Antifreeze) intoxication

Phenotolamine (Regitine): antidote for hypertensive crisis

Bromocriptine (Parlodel): an antiparkinsonian prolactin inhibitor, is used to treat NMS.

Biophysical profile: assesses five parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal
tone, and amniotic fluid volume. In a biophysical profile, each of the five parameters contributes 0 to 2 points with a score of 8 being
considered normal and a score of 10 perfect.

G T P A L
Gravidity, the Term births, the Preterm births, the Abortions/miscarriages Live births, the
number of number born at number born number of live
pregnancies. term (40 weeks). before 40 weeks’ • Included in births or living
gestation. gravida if before children
20 weeks’
gestation
• Included in parity
if past 20 weeks’
gestation

Therefore a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was
delivered at 38 weeks, the number of preterm births is 1, and the number of term births is 0. The number of
abortions is 0, and the number of live births is 1.

Probable signs of pregnancy:

• Uterine enlargement
• Hegar’s sign (Softening and thinning of the lower uterine segment that occurs about week 6)
• Goodell’s sign (softening of the cervix that occurs at the beginning of the second month)
• Chadwick’s sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs about week 6)
• Ballottement (rebounding of the fetus against the examiner’s fingers on palpation)
• Braxton Hicks contractions

58
 • A positive pregnancy test measuring for human chorionic gonadotropin

Positive signs of pregnancy:

• Fetal heart rate detected by electronic device (Doppler transducer) at 8-12 weeks and by nonelectronic device (Fetoscope) at
20 weeks of gestation
• Active fetal movements palpable by examiner
• An outline of fetus via radiography or ultrasound

Acetazolamide (Diamox): used for management of glaucoma is a carbonic anyhdrase inhibitor that has sulfonamide properties.

Watch out for absolute words “ALL” and “ALWAYS”

Before NG removal: bowel sounds have to be present.

Hyperkalemia on Electrocardiogram: Tall, peaked T waves; prolonged PR interval; widening QRS complex

Hypokalemia on Electrocardiogram: ST segment depression; Flat T wave

First-Degree Heart Block: Prolonged P-R interval

Bundle Branch Block: Widened QRS complex

Myocardial Necrosis in Area: Q waves present

Ventricular Fibrillation: No visible P waves or QRS complexes, no measurable rate. Irregular, chaotic undulations of varying
amplitudes.

HypoCalcemia: Prolonged Q-T interval

Myocardial Ischemia: ST segment elevation or depression

Premature Ventricular Contractions: absence of P waves, wide and bizarre QRS complexes, and premature beats followed by
a compensatory pause

Ventricular Tachycardia: absence of P waves, wide QRS complexes, rate between 100 and 250 impulses per minute. Regular
rhythm

Atrial Fibrillation: no P waves; instead there are wavy lines, no PR interval. QRS duration is WNL and irregular ventricular
rate can range from 60-160 beats/minute.

ANGINA
Stable Unstable Variant Intractable
Triggered by a Triggered by an Triggered by coronary Chronic and
predictable amount of unpredictable amount of artery spasm; the attacks incapacitating and is
effort or emotion. exertion or emotion and tend to occur early in the refractory to medical
may occur at night; the day and at rest. therapy.
attacks increase in
number, duration, and
severity over time.

Cardiac Conduction System: Sinoatrial NodeàInternodal/Interatrial pathwaysàAV nodeàBundle of HisàR/L Bundle

BranchesàPurkinje fibers

Pulse rate is the earliest indicator of decrease in fluid volume.

59
A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated

A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation.

B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction, and contractility.

B2: Arterial and bronchial walls and cause vasodilation and bronchodilation.

PULSE PRESENT = NO DEFIBRILLATION

Myxedema (a.ka. Hypothyroidism)

Suggested toys

a. birth to six months - mobiles, unbreakable mirrors, music boxes, rattles

b. six to 12 months - blocks, nesting boxes or cups, simple take apart toys, large ball, large puzzles, jack in the box, floating
toys, teething toys, activity box, push-pull toys
c. Solitary play

Toddlerhood (one year to three years)

Play is parallel

• Suggested toys: push-pull toys, finger paints, thick crayons, riding toys, balls, blocks, puzzles, simple tape recorder,
housekeeping toys, puppets, cloth picture books, large beads to string, toy telephone, water toys, sand box, play dough or
clay, chalk and chalkboard

Preschool age (three years to six years)

• Preschool play is associative and cooperative.

• dress-up
• fantasy play
• imaginary playmates
• Suggested toys: tricycle, gym and sports equipment, sandboxes, blocks, books, puzzles, computer games, dress-up clothes,
blunt scissors, picture games, construction sets, musical instruments, cash registers, simple carpentry tools

School age (six years to 12 years)

Play is cooperative.

1. sports and games with rules

2. fantasy play in early years
3. clubs
4. hero worship
5. cheating
6. Suggested toys/activities: board or computer games, books, collections, scrapbooks, sewing, cooking, carpentry, gardening,
painting

Tympany: Drumlike, loud, high pitch, moderate duration; usually found over spaces containing air such as the stomach

Resonance:Hollow sound of moderate to loud intensity; low pitch, long duration; Usually heard over lungs

Hyperresonance: Booming sound of very loud intensity; very low pitch, long duration; Usually heard in the presence of trapped air
(such as emphysematous lung)Flatness:

Flat sound of soft intensity; high pitch; short duration; Usually heard over muscle

60
Dullness:Thud-like sound of soft intensity; high pitch; moderate duration; Usually heard over solid organs (such as heart, liver)

body temperature

o range: 36 to 38 degrees Celsius (98.6 to 100.4 degrees Fahrenheit)

St. John's wort - antidepressant

Garlic - antihypertensive
Ginseng - Anti stress
Green tea - antioxidant
Echinacea - immune stimulant (6-8 weeks only)
Licorice - cough and cold
Ginger root - antinausea
Ginkgo - improves circulation
Ma huang - bronchodilator, stimulant

Anatomical Landmarks of the HEART

i. second right intercostal space - aortic area

ii. second left intercostal space - pulmonic area
iii. third left intercostal space - Erb's point
iv. fourth left intercostal space - tricuspid area
v. fifth left intercostal space - mitral (apical) area
vi. epigastric area at tip of sternum

Range of Normal Blood Pressure

i. child under age two weighing at least 2700g: use flush technique,30-60mg Hg
ii. child over age two: 85-95/50-65 mm Hg
iii. school age: 100-110/50-65 mm Hg
iv. adolescent: 110-120/65-85 mm Hg
v. adult: <130 mm Hg Systolic / <85 mm Hg diastolic

Normal Range of Peripheral Pulses

• infants: 120 to 160 beats/minutes

• toddlers: 90 to 140 beats/minutes
• preschool/school-age: 75 to 110 beats/ minute
• adolescent/adult: 60 to 100 beats/minute

Normal Rates of Respirations

• newborn: 35 to 40 breaths/minute
• infant: 30 to 50 breaths/minute
• toddler: 25 to 35 breaths/minute
• school age: 20 to 30 breaths/minute
• adolescent/adult: 14 to 20 breaths/minute
• adult: 12 to 20 breaths/minute

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 CRANIAL NERVE FUNCTION

1. Olfactory (CN I)

• Can identify variety of smells

• Deviation: Inability to identify aroma
2. Optic (CN II)
• Has visual acuity and full visual fields
• Fundoscopic exam reveals no pathology
• Deviation: Inability to identify full visual fields - total or partial blindness of one or both eyes

3, 4, 6. Oculomotor (CN III), trochlear (CN IV), and abducens (CN VI)

• Follows up to six cardinal positions of gaze

• Pupils are unremarkable
• Exhibits no nystagmus and no ptosis
• Deviation: one or both eyes will deviate from its normal position

5. Trigeminal (CN V)

• Clenches teeth with firm bilateral pressure

• Has no lateral jaw deviation with mouth open
• Feels a cotton wisp touched to forehead, cheek and chin
• Differentiates sharp and dull sensations on face
• Corneal reflex; blinks when cotton is touched to each cornea
• Deviation: Absent or one-sided blinking of eyelids

7. Facial (CN VII)

• Has facial symmetry with and without a smile

• Can raise the eyebrows symmetrically and grimace
• Can shut eyes tightly
• Can identify sweet, sour, salt or bitter on the anterior tongue
• Deviation: Irregular and unequal facial movements
• Deviation: Inability to taste or identify taste
• Deviation: Inability to taste or identify salt, sweet, sour, or bitter substances on the anterior two-thirds of the tongue
• Deviation: Inability to smile symmetrically

8. Acoustic (CN VIII)

• Can hear a whisper at 1-2 feet

• Can hear a watch tick at 1-2 feet
• Does not lateralize the Weber test
• Can hear AC (air conduction) better than BC (bone conduction) in the Rinne test
• Deviation: Inability to hear spoken word

9, 10. Glossopharyngeal (CN IX) and Vagus (CN X)

• Swallows and speaks without hoarseness

• Palate and uvula rise symmetrically when patient says "ah"
• Bilateral gag reflex
• Can identify taste on the posterior tongue
• Deviation: Unequal or absent rise of uvula and soft palate as the client says, "ah"
• Deviation: Absent gag reflex
62
 • Deviation: inability to taste or identify taste on the posterior tongue

11. Spinal accessory (CN XI)

• Resists head turning

• Can shrug against resistance
• Deviation: Weak or absent shoulder and neck movement

12. Hypoglossal (CN XII)

• Can stick tongue out and move it from side to side

• Can push tongue strongly against resistance
• Deviation: Tongue deviates to side

Types of Coping Mechanisms

1. Compensation - extra effort in one area to offset real or imagined lack in another area
o Example: Short man becomes assertively verbal and excels in business.
2. Conversion - A mental conflict is expressed through physical symptoms
o Example: Woman becomes blind after seeing her husband with another woman.
3. Denial - treating obvious reality factors as though they do not exist because they are consciously intolerable
o Example: Mother refuses to believe her child has been diagnosed with leukemia. "She just has the flu."
4. Displacement - transferring unacceptable feelings aroused by one object to another, more acceptable substitute
o Example: Adolescent lashes out at parents after not being invited to party.
5. Dissociation - walling off specific areas of the personality from consciousness
o Example: Adolescent talks about failing grades as if they belong to someone else; jokes about them.
6. Fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction
o Example: A student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest.
7. Fixation - becoming stagnated in a level of emotional development in which one is comfortable
o Example: A sixty year old man who dresses and acts as if he were still in the 1960's.
8. Identification - subconsciously attributing to oneself qualities of others
o Example: Elvis impersonators.
9. Intellectualization - use of thinking, ideas, or intellect to avoid emotions
o Example: Parent becomes extremely knowledgeable about child's diabetes.
10. Introjection - incorporating the traits of others
o Example: Husband's symptoms mimic wife's before she died.
11. Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others
o Example: Woman who is jealous of another woman's wealth accuses her of being a gold-digger.
12. Rationalization - justifying behaviors, emotions, motives, considered intolerable through acceptable excuses
o Example: "I didn't get chosen for the team because the coach plays favorites."
13. Reaction Formation - expressing unacceptable wishes or behavior by opposite overt behavior
o Example: Recovered smoker preaches about the dangers of second hand smoke.
14. Regression - retreating to an earlier and more comfortable emotional level of development
o Example: Four year old insists on climbing into crib with younger sibling.
15. Repression - unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts
o Example: Adolescent "forgets" appointment with counselor to discuss final grades.
16. Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable areas.
o Example: Young woman who hated school becomes a teacher.

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Elizabeth Kubler-Ross: Five Stages

1. Denial
a. Unconscious avoidance which varies from a brief period to the remainder of life
b. Allows one to mobilize defenses to cope
c. Positive adaptive responses - verbal denial; crying
d. Maladaptive responses - no crying, no acknowledgement of loss
2. Anger
a. Expresses the realization of loss
b. May be overt or covert
c. Positive adaptive responses - verbal expressions of anger
d. Maladaptive responses - persistent guilt or low self esteem, aggression, self destructive ideation or behavior
3. Bargaining
a. An attempt to change reality of loss; person bargains for treatment control, expresses wish to be alive for specific
events in near future
b. Maladaptive responses - bargains for unrealistic activities or events in distant future
4. Depression and Withdrawal
a. Sadness resulting from actual and/or anticipated loss
b. Positive adaptive response - crying, social withdrawal
c. Maladaptive responses - self-destructive actions, despair
5. Acceptance
a. Resolution of feelings about death or other loss, resulting in peaceful feelings
b. Positive adaptive behaviors - may wish to be alone, limit social contacts, complete personal business

FOODS HIGH IN WATER-SOLUBLE VITAMINS

A. Vitamin C - citrus fruits, cabbage, tomatoes, strawberries, broccoli

B. Thiamine (B1) - lean meat, legumes,unrefined or enriched grains and cereals
C. Riboflavin (B2) - enriched grains, milk, organ meats, poultry, fish
D. Niacin - peanuts, peas, beans, meat, poultry
E. Pyridoxine (B6) - kidneys, liver, meats, corn, wheat, eggs, poultry, fish
F. Cyanocobalamin (B12) - kidneys, lean meats,liver, dairy products, egs
G. Folic acid - liver, eggs, leafy green vegetables, fruits, enriched grain products

FOODS CONTAINING FAT-SOLUBLE VITAMINS

A. Vitamin A - fruits, green and yellow vegetables, butter, milk, eggs, liver
B. Vitamin D - milk, fish
C. Vitamin E - green vegetables, vegetables oils, wheat germ, nuts
D. Vitamin K - liver, cheese, leafy green vegetables, milk, green tea

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mucomyst: acetaminophen toxicity

65
66
Medication
-azepam (benzodiazepine)
-azine (antiemetic; phenothiazide)
-azole (proton pump inhibitor)
-barbital (barbiturate)
-cillin (penicillin)
-cycline (antibiotic)
-ipramine (Tricyclic antidepressant)
-navir (protease inhibitor)
-olol (beta antagonist)
-oxin (cardiac glycoside)
-phylline (bronchodilator)
-pril (ACE inhibitor)
-terol (Beta 2 Agonist)
-tidine (H2 Antagonist)
-trophin (Pituitary Hormone)
-zosin (alpha 1 Antagonist)
-statin (cholesterol lowering agent)
-sartan (angiotensin receptor blocker)
-sone (glucocorticoid)
-mycin (anti-infective, aminoglycosides)
-vir (anti-viral)
-coxib (cox 2 enzyme blockers)
-caine (anesthetics)
-mab (monoclonal antibiotics)
-stigmine (cholinergics)
-thiazide (diuretic)
-ase (thrombolytic)

and one prefix

ceph or cef- (cephalosporins)

-ase = thrombolytic
-coxib = cox 2 enzyme blocker
-caine = anesthetics
-dipine = CCB
-floxacin = antibiotic
-ine = reverse transcriptase inhibitors, antihistamines
-kinase = thrombolytics
-lone, pred = corticosteroid
-mab = monoclonal antibiotics
-micin = antibiotic, aminoglycoside
-navir = protease inhibitor
-nitr = nitrate/vasodilator
-olol = beta blocker
-oxin = cardiac glycoside
-osin = alpha blocker
-parin = anticoagulant
-prazole = PPI
-stigmine = colinergics
-terol = beta 2 agonist
-thiazide = diuretic
-tidine = antiulcer
-trophin = pituitary hormone
-vir = anti-viral, protease inhibitor
-zozin = alpha 1 antagonist
-zolam = benzodiazapine, sedative
-zine = antihistamine

1 heart, 2 lungs = beta 1 for cardiac, beta 2 for respiatory

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