The HYPERKALEMIA "Machine" - Causes of Increased Serum K+

M - Medications - ACE inhibitors, NSAIDS

A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, hemolysis
I - Intake - Excesssive
N - Nephrons, renal failure
E - Excretion Impaired
MURDER
Signs and Symptoms of Increased Serum K+
M - Muscle weakness
U - Urine, oliguria, anuria
R- Respiratory distress
D - Decreased cardiac contractility
E - ECG changes
R - Reflexes, hyperreflexia, or areflexia (flaccid)
HYPONATREMIA
"You Are Fried"
F - Fever (low grade), flushed skin
R - Restless (irritable)
I - Increased fluid retention and increased BP
E - Edema (peripheral and pitting)
D - Decreased urinary output, dry mouth
Can also use this one:
SALT
S = Skin flushed
A = Agitation
L = Low-grade fever
T = Thirst

"CATS" of "HYPOCALCEMIA"
C - Convulsions
A- Arrhythmias
T - Tetany
S - Spasms and stridor
To remember which blood types are compatible, visualize the letter
O as an orb representing the universe, because type O blood is the
universal donor blood. Patients with any blood type can receive it. But
O also means odd man out: Patients with type O blood can receive
only type O blood. Think BEEP to remember the signs of minor
bleeding:
B: Bleeding gums
E: Ecchymoses (bruises)
E: Epistaxis (nosebleed)
P: Petechiae (tiny purplish spots)
Hypo/Hyperplasia
Having difficulty distinguishing hypoplasia from hyperplasia? When
you see plasia in any word, think of "plastic." Plastic, in turn, means
forming or developing. As for hypo and hyper, thats the easy part.
Hypo means under, or below normal. Hyper means excessive, or
above normal. Thus, hypoplasia means underdevelopment, and
hyperplasia means overdevelopment.
A stand-up comedian who gets no laughs might say his audience has
humoral immunity. But humor is the Latin word for liquid, and
humoral immunity comes from elements in the blood specifically,
antibodies. Contrast this with cellular immunity, which comes about
through the actions of T cells.

"FARM" for serum sickness Cholecystectomy

female
fair
fat
forty
fertile
R Respiratory
O Opposite
S Salivation
L Lacrimation
U Urination
D Defication
Memory Trick:Need to remember which kind of beta blocker has
which action?
B1 Blocks the heart (you have only one heart)
B2 Blocks the lungs (you have two lungs)
CRAINIAL NERVES. im pretty sure most of you heard of these.
Nerves Functions
I Olfactory -Oh -Sensory -Some
II Optic- Oh -Sensory -Say
III Occulomotor -Oh -Motor -Mary
IV Trochlear -To -Motor -Money
V Trigeminal -Touch -Both -But
VI Abducens -And -Motor -My
VII Facial -Feel -Both -Brother
VIII Acoustic (vestoblochlear) -A -Sensory -Says
IX Glosopharyngeal -Green -Both -Bad
X Vagus -Veggie -Both -Business

XI Spinal Accessory- Soon At -Motor -Mary

XII Hypoglosal -Harvest- Motor -Money
Oh oh oh to touch and feel a green veggie soon at harvest
EYES
Another way to remember the eyes is:
You look OUt with Both eyes.
Take the Right dose so you won't OD [overdose].
The only one that is Left is OS.
Both eyes=OU, Right eye=OD, Left eye=OS.
It is about fetal accelerations and decelerations!!!
Just remember VEAL CHOP
Variable Cord compression
Early Head compression
Accelerations OK
Late Placental insufficiency
Heart sounds:
S3= Heart fail-ure (3 syllables)
S4=Hy-per-ten-sion (4 syllables)
And the effects of anticholinergics:
Can't see
Can't pee
Can't spit
Can't --defecate
Nine-point Postpartum Assessment...
BUBBLEHER
B- Breasts
U- Uterus
B- Bladder
B- Bowel function
L- Lochia
E- Episiotomy
H- Homan's sign
E- Emotional Status

R- Respiratory System
LDL ("bad" cholesterol)
L=Lowdown
D=Dirty
L=lipoprotein
This one really helped me in the cardiac system when you need to
know when you hear a murmur like on Mitral regurgitation you hear it
on systole.
(H)ARD ASS MRS. MSD
ARD = Atrial regurgitation diastole
ASS = Atrial stenosis systole
MRS = Mitral regurgitation systole
MSD = Mitral stenosis diastole
The 5 P's of circulation loss in a limb.
Pain, Pallor, Pulselessness, Parasthesia, Poikilothermia
Heres one I learned about EKG
Snow over Grass- white over green
smoke over fire- black over red
and ground in the middle- brown
I finally know what METHODS mean on DISCHARGE PLANNING.
M-edicine
E-xercise
T-reatment
H-ealth Teaching
O-ut patient follow-up or check-up
D-iet
S-ex(sexual activity)
Side effects & adverse reactions to immunizations:
F- Fever
I- Itching
S- Stiffness
H- Headache
E- Edema
R- Redness

F- Fussy
L- Localized Tenderness
A- Appetite decrease
G- General Aches Pains
WHUTN- "Whutnthehell?"
W- Wheezing
H- Hypotension
U- Uticaria
T- Tachycardia
N- Nasal Decongestion
Assess for treatable causes of changes in cognition and behavior.
The mnemonic DEMENTIA can be used to remember potential
causes:
D: Drugs and alcoholincluding over-the-counter drugs
E: Eyes and earsdisorientation due to visual/auditory distortion
M: Medical disorderse.g., diabetes, hypothyroidism
E: Emotional and psychological disturbancese.g., mood or
paranoid disorders
N: Neurological disorderse.g., multiinfarct dementia
T: Tumors and trauma
I: Infectionse.g., urinary tract or upper respiratory tract
A: Arteriosclerosisleading to heart failure, insufficient blood supply
to heart and brain, and confusion
***GRANULOCYTES are Never Eat Bananas.
Normal (Neutrophils)
Monkeys (Monocytes)
Like to (Lymphocytes)
Eat (Eosinophils)
Bananas (Basophils)
Parkinson's Medications: "Ali Loves Boxing Matches"
A-Amantadine
L- Levodopa
B- Bromocriptine
M-MAO inhibitors

The 4 H's that invalidate a neuro exam:

Hypotension
Hpoxia
Hypoglycemia
Hypothermia*
3 ICP waveforms: A is awful, B is bad and C is common
Glasgow Coma Scale: #'s go low to high, with head to toe: eye,
mouth, motor
1. Eye opening (1-4)
2. Verbal response (1-5)
3. Best Motor response (1-6)
Glasgow Coma Scale: If they're <8, they intubate!
To remember DECEREBRATE posturing, it is abnormal extension.
Their hands look like the flippers of a seal - Think DESEALEBRATE!
Pinpoint pupils: Drugs, drops & nearly dead
Drugs: opiates
Drops: meds for glaucoma
Nearly dead: damage in the pons area of the brainstem
Dilated pupils: Fear, Fits & Fast Living
Fear: panic, extreme anxiety
Fits: seizures
Fast Living: cocaine, crack, phencyclidine (PCP)
The pathophysiology of ARDS:
Assault on the respiratory system
Respiratory distress
Decreased lung compliance
Severe respiratory failure
Diagnostic criteria of ARDS
Acute onset
Ratio (PaCO2/FiO2) <200
Diffuse infiltration
Swan-Ganz wedge pressure (PAWP) <18mm Hg

Acute respiratory failure (ARF) Type II (hypoventilation) criteria: 50/50

Rule
PaCO2 >50
PaO2 <50 (on >50% oxygen)
Alpha 1 Receptor stimulation: arteries & arterioles
Causes vasoconstriction when stimulated which increases afterload
dobutamine (Dobutrex) stimulates beta 1 receptors (increase
contractility & CO/CI)
Treatment of all acute coronary syndromes (unstable angina,
NSTEMI or STEMI): OADH
Open coronary arteries
Here, think MONA greets all MI's:
Morphine
Oxygen
Nitroglycerin
Aspirin (CHEWED)
Anticoagulate & antiplatelet
Destress the heart (with beta blockers; limited activity for 12h)
Hemodynamic stability
Complications of thrombolytic therapy: The 3 B's
Bleeding
Brady's (dysrhythmias)
Bloodclots (d/t excessive thrombin)
Complications of cardiopulmonary bypass (CPB): The 3 H's
Hypothermia (to decrease O2 consumption)...Effects SVR
(vasoconstriction) and causes myocardial depression (decreases
contractility)
Hemodilution (to improve macrocirculation)...fluid shifting (thirdspacing), e-lyte imbalances (K+, Mg+ & Ca++ often need replacing!)
Heparinzation (to prevent clots in circuit)...monitor aPTT.
Signs and symptoms of cardiac tamponade (Beck's Triad): The Three
D's
Distant heart sounds

Distended jugular veins

Decreased pulse pressure (think of a narrow pulse pressure as
opposed to a wide one)
Atrial Arrhythmias: ABCDE
Adenosine/amiodorone or anticoagulate (if Afib/Flutter has been
present >48h)
Beta blockers
Calcium channel blockers
Digoxin
Electrocardiovert (if <48h)
For ventricular arrhythmias: AL
Amiodorone
Lidocaine
8 A's for Hepatotoxic Drugs (Check SGPT/SGOT)
Antituberculosi
Anticonvulsant
S - sodium Luminal
G - gabapentin
P - phenytoin
T - tegretol
Anticancer
Aspirin
Alcohol
Antifamily (contraceptice pills)
Acetaminophen
Aflatoxins
Breast self examination (i made a song out of this)
1 little 2, little 3 little fingers
Do BSE 7 days after menses
Press nipple once check for discharge
Call your doctor
I'm sure you will do it more...
STANDARD ROOM PRECAUTION
A -irborne (PTB, SARS, Antrax)
B -lood and body fluids - AIDS, Hepa B

C -ontact - open wounds, lesions

D - roplet - Diphtheria, Pneumonia, Pertussis
E - nteric - GIT infections
RIGHT SIDED HEART FAILURE
A norexia and ascites
B loating and indigestion
C ardiomegaly
D istended neck vein
E dema-peripheral
F acial puffiness
G allop
H epatomegaly
I tchiness
J aundice
HYPERTHYROIDISM (GRAVE'S)
G oiter
R avenous appetite
A gitation and nervousness
V S increased
E xophthalmos
S kin is moist & heat intolerance:)
- See more at: http://allfornursing.blogspot.com/2012/05/nursingmnemonics-everything-madeeasy_27.html#sthash.LHn0aGec.dpuf

Functions of Frontal Lobe = PIMS (thank you sir john teodoro)

P - personality
I - intelligence
M - memory
S - speech
Errors of Refraction = My Cave is Far from Vex
MYopia, conCAVE lens; FAR sightedness (hyperopia), conVEX lens
Eye Accommodation = FaD Flat NeC Bulge
FAr Vision -- ciliary muscle Dilates; lens FLATtens
NEar Vision -- ciliary muscle Constricts; lens BULGEs
Warning Signs of Cancer = CAUTION

C - change in bowel/bladder patterns

A - a sore that doesn't heal
U - unexplained weight loss, anemia, bleeding
T - thickening of lump
I - indigestion
O - obvious change in wart/mole
N - nagging cough
Sickle Cell Anemia Management = HOP
H - hydration
O - oxygen
P - pain medications
Blood Transfusion Problems = HAPCATCH (thank you sir john teodoro)
H - hemolytic reaction
A - allergic reaction
P - pyrogenic reaction
C - citrate reaction
A - air embolism
T - thrombocytopenia
C - circulatory overload
H - hyperkalemia
# of Bones and Muscles = #s 2, 0 6 (thank you sir john teodoro)
# of Muscles - 620
# of Bones (Child) - 260
# of Bones (Adult) - 206
Femoral Fracture = TENI - Trochanter Extracapsular, Neck Intracapsular
CPR Priority = CAB - Compression, Airway, Breathing
Celiac Disease Contraindications = BROW - Barley, Rye, Oat, Wheat
Glaucoma = AICO - Acute Imbalance Chronic Obstruction
Cellular Ions = PISO - Potassium Inside Sodium Outside (thank you jb
abad)

Heart Valves = LABRAT - Left Atrium Bicuspid, Right Atrium Tricuspid

Levels of Consciousness
= ACLOSC - Alert, Confused, Lethargic, Obtunded,Stuporous, Comatose

Hypoglycemia & Hyperglycemia Skin

Cold and clammy need some candy, Warm and dry sugar high
PLANTar flexion occurs when you squash a PLANT
SOUPination (supination) is holding the SOUP up with your
palm; POURnation (pronation) is POURing the bowl of soup with your palm

Stages of Grief
= DABDA - Denial, Anger, Bargaining, Depression, Acceptance

ADEK - four fat-soluble vitains

Drugs contraindicated for G6PD Deficiency
= AAA - Antibiotics, Antimalarials,Antipyretics

Cardinal signs for tetralogy of fallot = DROP - ventricular

septal Defect, Right ventricular hypertrophy, Overriding aorta, Pulmonary
stenosis

Cell Cycle Stages (for cancer drugs) = "Go Sally Go! Make Children!" G1
phase, SG2 phase, Mitosis, Cytokinesis

phase,

Hypersensitivity Reactions = ACID - Anaphylactic (Type I), Cytotoxic

(Type II),Immune complex (Type III), Delayed (Type IV)

Pain Assessment
= OLDCART - Onset, Location, Duration, Characteristic,Aggravating
factor, Relieving factor, Treatment

CVS (Chorionic Villi Sampling) - "Chorionic" has 9 letters and is measured

during 9th week

Amniocentesis - measures alphafetoprotein - "alphafetoprotein" has 16

letters and is measures during the 16th week

Blue Bloater Bronchitis; Pink Puffer emPhysema

Congenital CYANOTIC Heart Diseases = 4 T's - Truncus
arteriosus, Tricuspid atresia,Transposition of great arteries, Tetralogy of fallot

Pediatric Milestones = 1234

1 year - 1 word said
2 years - 2 step commands
3 years - rides TRIcycle
4 years - draws SQUARE

drugs ending with "olol" are Beta Blockers - stick "o" and "l" together to
make an inverted "b", flip them together to get "bb" which stands for Beta
Blockers

Anti-TB drugs
= RIPES - Rifampicin, Isoniazid, Pyrazinamide, Ethambutol,Streptomycin

"You have 1 HEART and 2 LUNGS" - Beta 1 receptors affect the heart,
Beta 2 affect the lungs

"You have 1 NOSE and 2 EYES" - Cranial Nerve 1 Olfactory, Cranial Nerve
2 Optic

Heart Conduction Pathway = "SAVe HIS KIN" - SA node, AV node, bundle

of HIS, purKINje fibers

Pituitary Hormones
= FLAGTOP - FSH, LH, ADH, GH, TSH, Oxytocin, Prolactin

Compartment Syndrome = 5 P's

- Pain, Palor, Pulselessness, Paresthesia, Pressure

Language Areas: language IN, letter "I", wernIcke's area; language OUT,
letter "O", brOca's area

http://24nurse.tumblr.com/post/35423030606/mnemonics-nclexstudy-guide

DO NOT delegate what you can EAT!

E - evaluate
A - assess
T - teach
addisons= down, down down up down
cushings= up up up down up
addisons= hyponatremia, hypotension, decreased blood
vol, hyperkalemia, hypoglycemia
cushings= hypernatremia, hypertension, incrased blood
vol, hypokalemia, hyperglycemia

No Pee, no K (do not give potassium without adequate

urine output)
EleVate Veins; dAngle Arteries for better perfusion
A= appearance (color all pink, pink and blue, blue [pale])
P= pulse (>100, < 100, absent)
G= grimace (cough, grimace, no response)
A= activity (flexed, flaccid, limp)
R= respirations (strong cry, weak cry, absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE
My - Measles
Chicken - Chicken Pox/Varicella
Hez - Herpez Zoster/Shingles
TB - Tuberculosis)
or remember
MTV=Airborne
Measles
TB
Varicella-Chicken Pox/Herpes Zoster-Shingles
Private Room - negative pressure with 6-12 air
exchanges/hr Mask, N95 for TB
DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diptheria (pharyngeal) E - epiglottitis

R - rubella
M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia
An - Adenovirus
Private Room or cohort Mask
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *
W - wound infxn
E - enteric infxn - clostridium difficile E - eye infxn conjunctivitis
SKIN INFECTIONS VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpes simplex
I - impetigo
P - pediculosis
S - scabies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty
breathing, tachycardia, pale/cyanotic, sense of impending
doom) > turn pt to left side and lower the head of the
bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels,
decreased variability, fetal bradycardia, etc) > turn
on left side (and give O2, stop Pitocin, increase IV fluids)

3. Tube Feeding w/ Decreased LOC > position pt

on right side (promotes emptying of the stomach) with
the HOB elevated (to prevent aspiration)
4. During Epidural Puncture > side-lying
5. After Lumbar Puncture (and also oil-based Myelogram)
> pt lies in flat supine (to prevent headache and leaking of
CSF)
6. Pt w/ Heat Stroke > lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) > catheter
is taped to thigh so leg should be kept straight. No other
positioning restrictions.
8. After Myringotomy > position on side of affected
ear after surgery (allows drainage of secretions)
9. After Cataract Surgery > pt will sleep on unaffected
side with a night shield for 1-4 weeks.
10. After Thyroidectomy > low or semi-Fowlers, support
head, neck and shoulders.
11. Infant w/ Spina Bifida > position prone (on abdomen)
so that sac does not rupture 12. Bucks Traction (skin
traction) > elevate foot of bed for counter-traction
13. After Total Hip Replacement > dont sleep on
operated side, dont flex hip more than 45- 60 degrees,
dont elevate HOB more than 45 degrees. Maintain hip
abduction by separating thighs with pillows.
14. Prolapsed Cord > knee-chest position or
Trendelenburg
15. Infant w/ Cleft Lip > position on back or in infant seat
to prevent trauma to suture line. While feeding, hold in
upright position.

16. To Prevent Dumping Syndrome (post-operative

ulcer/stomach surgeries) > eat in reclining position, lie
down after meals for 20-30 minutes (also restrict fluids
during meals, low CHO and fiber diet, small frequent
meals)
17. Above Knee Amputation > elevate for first 24 hours
on pillow, position prone daily to provide for hip extension.
18. Below Knee Amputation > foot of bed elevated for
first 24 hours, position prone daily to provide for hip
extension.
19. Detached Retina > area of detachment should be in
the dependent position
20. Administration of Enema > position pt in left sidelying (Sims) with knee flexed
21. After Supratentorial Surgery (incision behind hairline)
> elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)
> position pt flatand lateral on either side.
23. During Internal Radiation > on bedrest while implant
in place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding
headache, profuse sweating, nasal congestion, goose
flesh, bradycardia, hypertension) > place client in sitting
position (elevate HOB) first before any other
implementation.
25. Shock > bedrest with extremities elevated 20
degrees, knees straight, head slightly elevated (modified
Trendelenburg)
26. Head Injury > elevate HOB 30 degrees to decrease
intracranial pressure

27. Peritoneal Dialysis when Outflow is Inadequate >

turn pt from side to side BEFORE
checking for kinks in tubing (according to Kaplan)
28. Lumbar puncture => AFTER the procedure, the client
should be placed in the supine position for 4 to 12 hrs as
prescribed. (Saunders 3rd ed p. 229)
Demorol for pancreatitis, NOT morphine sulfate
Myasthenia Gravis: worsens with exercise and improves
with rest.
Myasthenia Crisis: a positive reaction to Tensilonwill
improve symptoms
Cholinergic Crisis: caused by excessive medication-stop
med-giving Tensilon will make it worse
Head injury medication: Mannitol (osmotic diuretic)crystallizes at room temp so ALWAYS use filter needle
Prior to a liver biospy its important to be aware of the lab
result for prothrombin time
From the a** (diarrhea)= metabolic acidosis From the
mouth (vomitus)=metabolic alkalosis
Myxedema/hypothyroidism: slowed physical and mental
function, sensitivity to cold, dry skin and hair
Graves disease/hyperthyroidism: accelerated physical and
mental function; sensitivity to heat, fine/soft hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowlers, prevent ncek
flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS convulsions, arrhythmias,
tetany, spasms, stridor (decreased calcium), high Ca, low
phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi,

back and joint pain (increased calcium), low Ca, high

phosphorus diet
Hypovolemia incrased temp, rapid/weak pulse,
increase respiration,hypotension, anxiety, urine specific
gravity >1.030
Hypervolemia bounding pulse, SOB, dyspnea,
rares/crackles, peripheraledema, HTN, urine specific
gravity <1.010; Semi-Fowlers
Diabetes Insipidus (decreased ADH): excessive urine
output and thirst, dehydration, weakness, administer
Pitressin
SIADH (increased ADH): change in LOC, decreased deep
tendon reflexes, tachycardia, n/v/a, HA; administer
Declomycin, diuretics
Hypokalemia: muscle ewakness, dysrhythmias, increase K
(raisins, bananas, apricots, oranges, beans, potatoes,
carrots, celery)
Hyperkalemia: MURDER muscle weakness, urine
(oliguria/anuria), respiratory depression, decreased cardiac
contractility, ECG changes, reflexes
Hyponatremia: nausea, muscle cramps, increased ICP,
muscular twitching, convulsion; osmotic diuretics, fluids
Hypernatremia: increased temp, weakness,
disorientation/delusions, hypotension, tachycardia;
hypotonic solution
Hypocalcemia: CATS convulsions, arrhythmias, tetany,
spasms and stridorHypercalcemia: muscle weakness, lack
of coordination, abdominal pain, confusion, absent tendon
reflexes, sedative effect on CNS

HypoMg: tremors, tetany, seizures, dyrshythmias,

depression, confusion, dysphagia; dig
toxicity HyperMg: depresses the CNS, hypotension, facial
flushing, muscle ewakness, absent deep tendon reflexes,
shallow respirations, emergency
Addisons: hypoNa, hyperK, hypoglycemia, dark
pigmentation, decreased resistance to stress, fractures,
alopecia, weight loss, GI distress
Cushings: hyperNa, hypoK, hyperglycemia, prone to
infection, muscle wasting, weakness, edema, HTN,
hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme
weakness, hypoglycemia, dehydration, decreased BP
Pheochromocytoma: hypersecretion of epi/norepi,
persistent HTN, increased HR, hyperglycemia, diaphoresis,
tremor, pounding HA; avoid stress, frequent bating and
rest breaks, avoid cold and stimulating foods, surgery to
remove tumor
1. Neuroleptic malignant syndrome (NMS): -NMS is like
S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up & -you start to drool
2. I kept forgetting which was dangerous when
youre pregnant; regular measles (rubeola), or German
measles (rubella), so remember:
-never get pregnant with a German (rubella)
3. When drawing up regular insulin & NPH together,
remember: -RN (regular comes before NPH)

4. Tetralogy of fallot; remember HOPS

Think DROP(child drops to floor or squats) or POSH
Defect, septal
Right Ventricular hypertrophy Overriding aorts
Pulmonary stenosis
5. MAOIs that are used as antidepressants:
weird way to remember, I know. pirates say arrrr, so think;
pirates take MAOIs when theyre depressed.
- explanation; MAOIs used for depression all have an arrr
sound in the middle (Parnate, Marplan, Nardil)
Autonomic dysreflexia: potentially life threatening
emergency - elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (triger)
- Administer antihypertensive meds (may cause stroke, MI,
seisure )
easy way to remember MAOIS! think of PANAMA!
PA - parnate
NA - nardil
MA - marplan
Digoxin-check pulse, less than 60 hold, check dig levels
and potassium levels.
Amphojel: tx of GERD and kidney stones.watch out for
contipation.
Vistaril: tx of anxiety and also itchingwatch for dry
mouth. given preop commonly
Versed: given for conscious sedationwatch for resp
depression and hypotension
PTU and Tapazole- prevention of thyroid storm

Sinemet: tx of parkinsonsweat, saliva, urine may turn

reddish brown occassionallycauses drowsiness
Artane: tx of parkinson..sedative effect also
Cogentin: tx of parkinson and extrapyramidal effects of
other drugs Tigan: tx of postop n/v and for nausea
associated with gastroenteritis Timolol (Timoptic)-tx of
gluacoma
Bactrim: antibiotic..dont take if allergic to sulfa drugs
diarrhea common side effectdrink plenty of fluids
Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol
(Zyloprim)
Apresoline(hydralazine)-tx of HTN or CHF, Report flulike symptoms, rise slowly from sitting/lying position; take
with meals.
Bentyl: tx of irritable bowel.assess for anticholinergic
side effects.
Calan (verapamil): calcium channel blocker: tx of HTN,
anginaassess for constipation Carafate: tx of duodenal
ulcers..coats the ulcerso take before meals.
Theophylline: tx of asthma or COPD..therap drug level: 1020
Mucomyst is the antedote to tylenol and is administered
orally
Diamox: tx of glaucoma, high altitude sicknessdont take
if allergic to sulfa drugs
Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty),
bursitis, and tendonitis.
Synthroid: tx of hypothyroidism..may take several weeks
to take effectnotify doctor of chest pain..take in the AM
on empty stomach..could cause hyperthyroidism.

Librium: tx of alcohol w/ddont take alchol with thisvery

bad nausea and vomiting can occur. Oncovin (vincristine):
tx of leukemia..given IV ONLY
kwell: tx of scabies and lice(scabies)apply lotion once
and leave on for 8-12 hours(lice) use the shampoo and
leave on for 4 minutes with hair uncovered then rinse with
warm water and comb with a fine tooth comb
Premarin:tx after menopause estrogen replacement
Dilantin: tx of seizures. thera drug level: 10-20
Navane: tx of schizophrenia..assess for EPS
Ritalin: tx of ADHD..assess for heart related side effects
report immediatelychild may need a drug holiday b/c it
stunts growth.
dopamine (Intropine): tx of hypotension, shock, low
cardiac output, poor perfusion to vital organsmonitor
EKG for arrhythmias, monitor BP
Have trouble remembering fhr patterns in OB? Think VEAL
CHOP
VC
EH
AO
LP
V = variable decels; C = cord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels = Placental insufficiency, cant fill
For cord compression, place the mother in the
TRENDELENBERG position because this removes pressure
of the presenting part off the cord. (If her head is down,
the baby is no longer being pulled out of hte body by

gravity)
If the cord is prolapsed, cover it with sterile saline gauze to
prevent drying of the cord and to minimize infection.
For late decels, turn the mother to her left side, to allow
more blood flow to the placenta. For any kind of bad
fetal heart rate pattern, you give O2, often by mask
When doing an epidural anesthesia hydration before hand
is a priority.
Hypotension and bradypnea / bradycardia are major risks
and emergencies.
NEVER check the monitor or a machine as a first action.
Always assess the patient first; for exmaple listen to
the fetal heart tones with a stethoscope in NCLEX land.
Sometimes its hard to tell who to check on first, the
mother or the baby; its usually easy to tell the right
answer if the mother or baby involves a machine. If youre
not sure who to check first, and one of the choices involves
the machine, thats the wrong answer.
If the baby is a posterior presentation, the sounds are
heard at the sides.
If the baby is anterior, the sounds are heard closer to
midline, between teh umbilicus and where you would listen
to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus
near the umbilicus. If the baby is vertex, they are a little
bit above the symphysis pubis.
Also for ventilator alarms
HOLD
High alarm- Obstruction due to incr. secretions, kink, pt.
coughs, gag or bites

Low press alarm- Disconnection or leak in ventilatior or in

pt. airway cuff, pt. stops spontaneous breathing
1. to remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
2. ICP AND SHOCK HAVE OPPOSITE V/S ICP-increased BP,
decreased pulse, decreased resp. shock- decreased BP,
increased pulse, increased resp.
3. cor pulmonae: right sided heart failure caused by left
ventricular failure (so pick edema, jvd, if it is a choice.)
4. herion withdrawal neonate: irratable poor sucking
5. Jews: no meat and milk together
6. Brachial pulse: pulse area cpr on an infant.
7. Test child for lead poisioning around 12 months of age 8.
bananas, potatoes, citrus fruits source of potassium 1
11. Cultures are obtained before starting IV antibiotics
12. a pt with leukemia may have epitaxis b/c of low
platelets
13. best way to warm a newborn: skin to skin contact
covered with a blanket on mom.
14. when a pt comes in and she is in active labornurse
first action is to listen to fetal heart tone/rate
15. phobic disordersuse systematic desensitiztion.
NCLEX TIPS
1. When getting down to two answers, choose the
assessment answer (assess, collect, auscultate, monitor,
palpate) over the intervention except in an emergency or
distress situation. If one answer has an absolute, discard it.
Give priority to answers that deal directly to the patients
body, not the machines/equipments.

2. Key words are very important. Avoid answers with

absolutes for example: always, never, must, etc.
3. with lower amputations patient is placed in prone
position.
4. small frequent feedings are better than larger ones.
5. Assessment, teaching, meds, evaluation, unstable
patient cannot be delegated to an Unlicensed Assistive
Personnel.
6. LVN/LPN cannot handle blood.
7. Amynoglycosides (like vancomycin) cause
nephrotoxicity and ototoxicity. 8. IV push should go over at
least 2 minutes.
9. If the patient is not a child an answer with family option
can be ruled out easily.
10. In an emergency, patients with greater chance to live
are treated first 11. ARDS (fluids in alveoli), DIC
(disseminated intravascular coagulaton) are always
secondary to something else (another disease process).
12. Cardinal sign of ARDS is hypoxemia (low oxygen level
in tissues). 13. in pH regulation the 2 organs of concern
are lungs/kidneys.
14. edema is in the interstitial space not in the
cardiovascular space. 15. weight is the best indicator of
dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reyes syndrome (encephalopathy)
when given to children
18. when aspirin is given once a day it acts as an
antiplatelet.
19. use Cold for acute pain (eg. Sprain ankle) and Heat for

chronic ( rheumatoid arthritis)

20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration
is rarely a good choice.
22. with pneumonia, fever and chills are usually present.
For the elderly confusion is often present.
23. Always check for allergies before administering
antibiotics (especially PCN). Make sure culture and
sensitivity has been done before adm. First dose of
antibiotic.
24. Cor pulmonale (s/s fluid overload) is Right sided heart
failure caused
by pulmonary disease, occurs with bronchitis or
emphysema.
25. COPD is chronic, pneumonia is acute. Emphysema and
bronchitis are both COPD.
26. in COPD patients the baroreceptors that detect the
CO2 level are destroyed. Therefore, O2 level must be low
because high O2 concentration blows the patients
stimulus for breathing.
27. exacerbation: acute, distress.
28. epi always given in TB syringe.
29. prednisone toxicity: cushings syndrome= buffalo
hump, moon face, high glucose, hypertension.
30. 4 options for cancer management: chemo, radiation,
surgery, allow to die with dignity.
31. no live vaccines, no fresh fruits, no flowers should be
used for neutropenic patients.
32. chest tubes are placed in the pleural space.
33. angina (low oxygen to heart tissues) = no dead heart

tissues. MI=
dead heart tissue present.
34. mevacor (anticholesterol med) must be given with
evening meal if it is QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5
minutes). If
chest pain does not stop go to hospital. Do not give when
BP is < 90/60.
36. Preload affects amount of blood that goes to the R
ventricle.
Afterload is the resistance the blood has to overcome
when leaving the heart. 37. Calcium channel blocker
affects the afterload.
38. for a CABG operation when the great saphenous vein is
taken it is
turned inside out due to the valves that are inside.
39. unstable angina is not relieved by nitro.
40. dead tissues cannot have PVCs(premature ventricular
contraction. If
left untreated pvcs can lead to VF (ventricular fibrillation).
41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz

* To convert Centigrade to F. F= C+40, multiply 9/5 and

substract 40
* To convert Fahrenheit to C. C= F+40, multiply 5/9 and
substract 40.
42. angiotensin II in the lungs= potent vasodialator.
Aldosterone attracts sodium.
43. REVERSE AGENTS FOR TOXICITY
heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat
pain in
narcotic addicts.
- Potassium potentiates dig toxicity.
44. heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on coumadin
46. cardiac output decreases with dysrythmias. Dopamine
increases BP.
47. Med of choice for Vtach is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heart beat) is atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodorone is effective in both ventricular and atrial

complications.
55. S3 sound is normal in CHF, not normal in MI.
56. give carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress
ulcers.
58. after endoscopy check gag reflex.
59. TPN(total parenteral nutrition) given in subclavian line.
60. low residue diet means low fiver
61. diverticulitis (inflammation of the diverticulum in the
colon) pain is around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in
RL quadrant with rebound tenderness.
63. portal hypotension + albuminemia= Ascites.
64. beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes
spasm of the Sphincter of Oddi. Therefore Demerol should
be given.
66. Trousseau and Tchovoski signs observed in
hypocalcemia
67. with chronic pancreatitis, pancreatic enzymes are
given with meals.
68. Never give K+ in IV push.
69. mineral corticoids are give in Addisons disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking
down fat instead of sugar for energy. Fats leave ketones
(acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is
enough
insulin to prevent breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with

heparin.
73. for knee replacement use continuous passive motion
machine.
74. give prophylactic antibiotic therapy before any
invasive procedure.
75. glaucoma patients lose peripheral vision. Treated with
meds
76. cataract= cloudy, blurry vision. Treated by lens
removal-surgery
77. Co2 causes vasoconstriction.
78. most spinal cord injuries are at the cervical or lumbar
regions
79. autonomic dysreflexia ( life threatening inhibited
sympathetic response
of nervous system to a noxious stimulus- patients with
spinal cord injuries
at T-7 or above) is usually caused by a full bladder.
80. spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheath destruction,
disruption in nerve
impulse conduction.
82. myasthenia gravis= decrease in receptor sites for
acetylcholine. Since smallest concentration of ACTH
receptors are in cranial nerves, expect fatigue and
weakness in eye, mastication, pharyngeal muscles.
83. Tensilon test given if muscle is tense in myasthenia
gravis.
84. Guillain-Barre syndrome= ascending paralysis. Keep
eye on respiratory system.
85. parkinsons = RAT: rigidity, akinesia (loss of muscle

mvt), tremors.
Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no
dead brain tissue
87. CVA (cerebrovascular accident) is with dead brain
tissue.
88. Hodgkins disease= cancer of lymph is very curable in
early stage.
89. Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?
90. Birth weight doubles by 6 month and triple by 1 year of
age. 91. if HR is <100 do not give dig to children.
92. first sign of cystic fibrosis may be meconium ileus at
birth. Baby is inconsolable, do not eat, not passing
meconium.
93. heart defects. Remember for cyanotic -3Ts( Tof,
Truncys arteriosus, Transposition of the great vessels).
Prevent blood from going to heart. If problem does not fix
or cannot be corrected surgically, CHF will occur following
by death.
94. with R side cardiac cath=look for valve problems
95. with L side in adults look for coronary complications.
96. rheumatic fever can lead to cardiac valves
malfunctions.

97. cerebral palsy = poor muscle control due to birth

injuries and/or decrease oxygen to brain tissues.
98. ICP (intracranial pressure) should be <2. measure head
circonference. 99. dilantin level (10-20). Can cause
gingival hyperplasia
100. for Meningitis check for Kernigs/ Brudzinskis signs.
101. Wilms tumor is usually encapsulated above the
kidneys causing flank pain.
102. hemophilia is x-linked. Mother passes disease to son.
103. when phenylalanine increases, brain problems occur.
104. Bucks traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryants traction= children <3y, <35 lbs with femur
fx.
108. place apparatus first then place the weight when
putting traction
109. placenta should be in upper part of uterus
110. eclampsia is seizure.
111. a patient with a vertical c-section surgery will more
likely have another c-section.
112. perform amniocentesis before 20 weeks gestation to
check for cardiac and pulmonary abnormalities.
113. Rh- mothers receive rhogam to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6
to 8 weeks.
115. caput succedaneum= diffuse edema of the fetal scalp
that crosses the suture lines. Swelling reabsorbs within 1
to 3 days.
116. pathological jaundice= occurs before 24hrs and last7

days. Physiological jaundice occurs after 24 hours.

117. placenta previa = there is no pain, there is bleeding.
Placenta abruption = pain, but no bleeding.
118. bethamethasone (celestone)=surfactant. Med for
lung expansion. 119. dystocia= baby cannot make it down
to canal
120. pitocin med used for uterine stimulation
121. Magnesium sulfate(used to halt preterm labor) is
contraindicated if deep tendon reflexes are ineffective. If
patient experiences seizure during magnesium adm. Get
the baby out stat (emergency).
122. Do not use why or I understand statement when
dealing with patients 123. milieu therapy= taking care of
patient/environment
124. cognitive therapy= counseling
125. crisis intervention=short term.
126. FIVE INTERVENTIONS FOR PSYCH PATIENTS
-safety
-setting limits
-establish trusting relationship
-meds
-leas restrictive methods/environment.
126. SSRIs (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. if patients have hallucinations redirect them. In
delusions distract them.
129. Thorazine, haldol (antipsychotic) can lead to EPS
(extrapyramidal side effects)
130. Alzheimers disease is a chronic, progressive,

degenerative cognitive disorder that accounts for more

than 60% of all dementias
1. To remember how to draw up INSULIN think:
Nicole Richie RN (a teacher taught us this is school,
thought it was funny and never forgot it!!!)
Air into NPH, then air into regular, draw up regular then
draw up NPH
2. HYPERthyroidism think of MICHAEL JACKSON in
THRILLER! SKINNY, NERVOUS, BULDGING EYES, Up all
night, heart beating fast
Atropine used to decrease secretions
Phenergan an antiemetic used to reduce nausea
Diazepam is a commonly used tranquilizer given to reduce
anxiety before OR Demerol is for pain control
Do not give demerol to pts. with sickle cell crisis.
Iron injections should be given Z-track so they dont leak
into SQ tissues.
Cranial Nerves: *I am sorry if this vulgar for some, but hey,
it sticks
Sensory=S Motor=M Both=B
Oh (Olfactory I)
Oh (Optic II)
Oh (Oculomotor III)
To (Trochlear IV)
Touch (Trigeminal V)
And (Abducens VI)
Feel (Facial VII)
A (Auditory VIII)
Girls (Glossopharyngeal IX) Vagina (Vagus X)

And (Accessory XI)

Hymen (Hypoglassal XII)
Hyper natremia (greater than 145) Skin flushed
Agitation
Low grade fever
Thirst
Developmental
2-3 months: turns head side to side
4-5 months: grasps, switch & roll
6-7 months: sit at 6 and waves bye-bye
8-9 months: stands straight at eight
10-11 months: belly to butt (phrase has 10 letters) 12-13
months: twelve andup, drink from a cup
Hepatitis
Hepatitis: -ends in a VOWEL, comes from the BOWEL (Hep
A) Hepatitis B=Blood and Bodily fluids
Hepatitis C is just like B
Apgar measures HR,RR,Muscle tone, Reflexes,Skin
color each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!
It is similar to measuring dating skillsmax 15 points -one
can do it if below 8 you are in Coma.
So, to start dating you gotta open your EYES first, if you
albe to do
that spontaneously and use them correctly to SEE whom
you dating you earn 4. But if she has to scream on you to
make you
open them it is only 3.and 1 you dont care to open even
if she tries to hurt you.

if you get good EYE contact (4 points) then move

to VERBAL.
talk to her/ him! if you can do that You are really ORIENTED
in
situation she/he uncontiously gives you 4 points! if you like
her try not to be CONFUSED (3), and of cause do not use
INAPPROPRIATE WORDS (3), she will not like it)), try not to
RESPOND WITH INCOMPREHENSIBLE SOUNDS (2), if you do
not like herjust show no VERBAL RESPONSE(1)
Since youve got EYE and VERBAL contact you
can MOVE now using your Motor Response Points. THis is
VERY important since Good moves give you 6!
The person who hyperventilates is most likely to
experience respiratory alkalosis.
avoid salt substitutes when taken dig and k-supplements
because many are potassium based
Signs of hypoxia: restless, anxious, cyanotic tachycardia,
increased resps. (also monitor ABGs)
Addisons disease (need to "add" hormone)
Cushings syndrome (have extra "cushion" of hormones)
Dumping syndrome: increase fat and protein, small
frequent meals, lie down after meal to decrease peristalsis,
wait 1 hr after meals to drink.
For blood types: O is the universal donor
(remember "o" in donor)
AB is the universal receipient
Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS,
as to Localized Herpes Zoster is CONTACT PRECAUTIONS. A
nurse with a localized herpes zoster CAN care for patients

as long as the patients are NOT immunosuppressed and

the lesions must be covered!
Fat soluble vitamins are Vitamins A, D, E, K
Give NSAIDS, Corticosteroids, drugs
for Bipolar, Cephalosporins, and Sulfanomides WITH food.
Ativan is the treatment of choice for status epilepticus
When using a bronchodilator inhaler inconjuction with a
glucocorticoid inhaler, administer the bronchodilator first
Theophylline increases the risk of digoxin toxicity and
decreases the effects of lithium and Dilantin
INtal, an inhaler used to treat allergy induced asthma may
cause bronchospasm, think INto the asthmatic lung
Isoniazid causes peripheral neuritis
Peptic ulcers caused by H. pylori are treated with Flagyl,
Prilosec and Biaxin. This treatment kills bacteria and stops
production of stomach acid, but does not heal ulcer.
Weighted NI (Naso intestinal tubes) must float from
stomach to intestine. Dont tape the tube right away after
placement, may leave coiled next to pt on HOB. Position
patient on RIGHT to facilitate movement through pylorus.
* Diaphragm must stay in place 6 hours after intercourse.
They are also fitted so must be re- fitted if you lose or gain
a significant amount of weight.
* Best time to take Growth Hormone PM, Steroids AM,
Diuretics AM, Aricept AM.
* Carafate (Sulcrafate) before meals (mucosal
barrier; constipation)
* Tagamet with food (H2; messes with elderly ppl be
careful ! Interacts with alot of things) *Antacids after meals

* Long term use of amphogel (binds to phosphates,

increases Ca, robs the bonesleads to increased Ca
resortion from bones and WEAK BONES)
*Cushings ulcers r/t BRAIN injury
*Cushings triad r/t ICP in BRAIN (htn, bradycard, irr. resp)
*Thyroid storm is HOT (hyperthermia)
*Myxedema coma is COLD (hypothermia)
*Glaucoma intraocular pressure is greater than the normal
(22 mm Hg), give miotics to constrict (pilocarpine) NO
ATROPINE.
* Non dairy sources of calcium include RHUBARB,
SARDINES, COLLARD GREENS
* You can petal the rough edges of a plaster cast with tape
to avoid skin irritation.
*With low back aches, bend knees to relieve
* Push fluids with Allopurinol - flush the uric acid out of
system
* Koplicks spots are red spots with blue center
characteristic of PRODROMAL stage of Measles. Usually in
mouth.
* INH can cause peripheral neuritis, take Vit B6 to prevent
also hepatotoxic
* Rifampin - Red orange tears and urine, also
contraceptives dont work as well
* Ethambutol - messes with your Eyes
* Apply eye drop to conjunctival sac and after wards apply
pressure to nasolacrimal duct / inner canthus
* Pancreatitis patients but them in fetal position, NPO, gut
rest, prepare antecubital site for PICC cuz theyll probably
be getting TPN/Lipids

* Trendelenburg test - for varicose veins. If they fill

proximally = varicosity.
Rule of nines, 9 = head, 18 = arms, 36 = torso, 36 =legs,
and 1= perineum = 100%
When giving Kayexalate we need to worry about
dehydration ( K ha ineverse relationship with Na)
Yogurt has live cultures- dont give to immunosuppressed
pt
Itching under cast area- cool air via blow dryer, ice pack
for 10- 15 minutes. NEVER use qtip or anything to scratch
area
Murphys sign pain with palpation of gall bladder area
seen with cholecystitis Cullens sign ecchymosis in
umbilical area, seen with pancreatitis
Turners sign flank grayish blue (turn around to see your
flanks) pancreatitis McBurneys Point pain in RLQ
indicative of appendicitis
LLQ diverticulitis , low residue, no seeds, nuts, peas
RLQ appendicitis, watch for peritonitis
Guthrie Test Tests for PKU, baby should have eaten
source of protein first Shilling Test test for pernicious
anemia/ how well one absorbs Vit b12
Allens test occlude both ulnar and radial artery until
hand blanches then release ulnar. If the hand pinks up,
ulnar artery is good and you can carry on with ABG/radial
stick as planned. ABGS must be put on ice and whisked to
the lab.
oIts ok to have abdominal craps, blood tinged outflow and
leaking around site if the Peritoneal Dialysis cath (tenkhoff)
was placed in the last 1-2 wks. Cloudy outflow NEVER

NORMAL. oAmniotic fluid yellow with particles = meconium

stained
oHyper reflexes (upper motor neuron issue your reflexes
are over the top)
oAbsent reflexes (lower motor neuron issue)
oRhogam : given at 28 weeks, 72 hours post partum, IM.
Only given to Rh NEGATIVE mother. Also if indirect
Coombs test is positive, dont need to give Rhogam cuz
she has antibody only give if negative coombs
oVit K is to coumadin as Protamine Sulfate is to Heparin as
Ca Glu is to MgSo4 as Mucomyst is to Acetominophen as
Amicar is to TPAget it? Antidotes/treatments for
overdose
Order of assessment: Inspection, Palpation, Percussion and
Ausculation. EXCEPT with abdomen cuz you dont wanna
mess with the bowels and their sounds so you Inspect,
Auscultate, Percuss then Palpate (same with kids, I
suppose since you wanna go from least invasive to most
invasive sine they will cry BLOOD MURDER ! Gotta love
them kids !)
Latex allergies => Assess for allergies to bananas,
apricots, cherries, grapes, kiwis, passion fruit, avocados,
chestnuts, tomatoes, peaches
Tensilon is used in myesthenia gravis to confirm the
diagnosis.
Myesthenia gravis is caused by a disorder in the
transmission of impulses from nerve to muscle cell.
Amyotrophic lateral sclerosis ( ALS ) is a condition in which
there is a degeneration of motor neurons in both the upper
& lower motor neuron systems.

Transesophageal Fistula (TEF) - esophagus doesnt fully

develop (this is a surgical emergency) The 3 Cs of TEF in
the newborn:
1) Choking
2) Coughing
3) Cyanosis
The MMR vaccine is given SQ not IM.
Redunstable, ie, occluded airway, actively bleeding, see
first
Yellow-stable, can wait up to an hour for treatment, ie
burns, see second
Green-stable, can wait even longer to be seen, walking
wounded
Blackunstable clients that will probably not make it, need
comfort measures
DOA-dead on arrival
Greek heritage - they put an amulet or any other use of
protective charms around their babys neck to avoid evil
eye or envy of others
4 year old kids cannot interpret TIME. Need to explain time
in relationship to a known COMMON EVENT (eg: Mom will
be back after supper).
** Anaphylactic reaction to bakers yeast is
contraindication for Hep B vaccine.
** Ask for allergy to eggs before Flu shot
** Ask for anaphylactic rxn to eggs or neomycin before
MMR
** When on nitroprusside, monitor thiocynate (cyanide).
Normal value should be 1, >1 is heading toward toxicity

**If kid has cold, can still give immunizations

**SARS (severe acute resp syndrome) airborne + contact
(just like varicella)
** Hepatitis A is contact precautions
** Tetanus, Hepatitis B, HIV are STANDARD precautions
** Williams position - Semi Fowlers with knees flexed (inc.
knee gatch) to relieve lower back pain.
** SIGNS of a Fractured hip: EXTERNAL ROTATION,
SHORTENING, ADDUCTION
** Fat Embolism: Blood tinged sputum (r/t inflammation),
inc ESR, respiratory alkalosis (not acidosis r/t tachypnea),
hypocalcemia,increased serum lipids,"snow storm" effect
on CXR. **Complications of Mechanical Ventilation:
Pneumothorax, Ulcers
** Pagets Disease - tinnitus, bone pain, enlargement of
bone, thick bones.
** NO VITAMIN C with Allopurinol
** IVP requires bowel prep so they can visualize the
bladder better
**Acid Ash diet - cheese, corn, cranberries, plums, prunes,
meat, poultry, pastry, bread
** Alk Ash diet- milk, veggies, rhubarb, salmon
** Orange tag in triage is non emergent Psych
** Greenstick fractures, usually seen in kids bone breaks
on one side and bends on the other
Insomnia is a side effect of thyroid hormones. Saunders
confirms it. Makes sense though! Increased met. rate, your
body is too busy to sleep as opposed to the folks with
hypothyroidism who may report somnolence (dec. met
rate, body is slow and sleepy). Ok some more facts.

** BOTOX for strabismus. Patch the GOOD eye so that the

weaker eye can get stronger. Found a cool link about its
use in peds pt with strabismus. I had to look it up cuz I
heard it was important *ah hem ah hem*
** TIDAL VOLUME is 7 10ml / kg
** COPD patients REMEMBER: 2LNC or less (hypoxic NOT
hypercapnic drive), Pa02 of 60ish and Sa02 90% is normal
for them b/c they are chronic CO2 retainers.
** Neostigmine/Atropine (anticholinergic) to reverse effect
of pancuronium.
**Ampho B causes hypokalemia (amongst many other
things..gotta premedicate before giving. Pts will most likely
get a fever)
** Test 4 hypersensitivity before the administration of
asparginase.
** Take Vermox with high fat diet (increases absorption)
** Kidney Glucose threshold is 180
** Amphogel and Renegal take with meals
** Stranger anxiety is greatest 7 - 9 months, Separation
anxiety peaks in toddlerhood
** MMR is a SQ shot
Lymes is found mostly in Conneticut
Asthma and Arthritisswimming best
Asthma has intercostal retractionsbe concerned
Tardive Dyskinesia - irreversible - involuntary movements
of the tongue, face and extremities, may happen after
prolonged use of antipsychotics
Akathisia - motor restlessness, need to keep going, tx with
antiparkinsons meds, can be mistaken for agitation.

When drawing an ABG, you need to put the blood in a

heparinized tube, make sure there are no bubbles, put on
ice immediately after drawing, with a lable indicating if the
pt was on room air or how many liters of O2.
Remember to preform the Allens Test prior to doing an
ABG to check for sufficient blood flow
Before going for Pulmonary Fuction Tests (PFTs), a pts
bronchodilators will be with-held and they are not allowed
to smoke for 4 hrs prior
For a lung biopsy, position pt lying on side of bed or with
arms raised up on pillows over bedside table, have pt hold
breath in midexpiration, chest x-ray done immediately
afterwards to check for complication of pneumothorax,
sterile dressing applied
For a lumbar puncture, pt is positioned in lateral
recumbent fetal position, keep pt flat for 2-3 hrs
afterwards, sterile dressing, frequent neuro assessments
EEG, hold meds for 24-48 hrs prior, no caffine or cigarettes
for 24 hrs prior, pt can eat, pt must stay awake night
before exam, pt may be asked to hyperventilate and watch
a bright flashing light, after EEG, assess pt for seizures,
pts will be at increased risk
Diamox, used for glaucoma, can cause hypokalemia
Dexedrine, used for ADHD, may alter insulin needs, avoid
taking with MAOIs, take in morning (insomnia possible
side effect)
Cytovene, used for retinitis caused by cytomegalovirus, pt
will need regular eye exams, report dizziness, confusion, or
seizures immediately

INH, used to treat and prevent TB, do not give with

dilantin, can cause phenytonin toxicity, monitor LFTs, give
B6 along with, hypotension will occur initially, then resolve
Rifampin, for TB, dyes bodily fluids orange
If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with
fluids, med is incompatible with caffine and apple juice
Haldol preferred anti-psychotic in elderly, but high risk
extrapyramidal side effects (dystonia, tarditive dyskinesia,
tightening of jaw, stiff neck, swollen tongue, later on
swollen airway), monitor for early signs of reaction and
give IM Benadryl
Risperdal, antipsychotic, doses over 6mg can cause
tarditive dyskinesia, first line antipsychotic in children
Levodopa, for parkinsons, contraindicated in pts with
glaucoma, avoid B6
Sinemet, for parkinsons, contraindicated with MAOIs
Hydroxyurea, for sickle cell, report
GI symptoms immediately, could be sign of toxicity
Zocor, for hyperlipidemia, take on empty stomach to
enhance absorption, report any unexplained musle pain,
especially if fever
Decorticate is toward the cord. Decerebrit is the other
way (out)
** BOTOX ** (Botulin Toxin) can be used with strabismus
also to relax vocal cords in spasmodic dysphonia.
-Munchausen Syndrome is a psychiatric disorder that
causes an individual to self-inflict injury or illness or to
fabricate symptoms of physical or mental illness, in order
to receive medical care or hospitalization. In a variation of
the disorder, Munchausen by proxy (MSBP), an individual,

typically a mother, intentionally causes or fabricates

illness in a child or other person under her care.
-Multiple Sclerosis is a chronic, progressive disease with
demyelinating lesions in the CNS which affect the white
matter of the brain and spinal cord.
Motor S/S: limb weakness, paralysis, slow speech
Sensory S/S: numbness, tingling, tinnitus
Cerebral S/S: nystagmus, ataxia, dysphagia, dysarthria
Huntingtons Chorea: 50% genetic, autosomal dominant
disorder S/S: chorea > writhing, twisting, movements of
face, limbs and body -gait deteriorates to no ambulation
-no cure, just palliative care
-WBC shift to the left in a patient with pyelonephritis
(neutrophils kick in to fight infection) -Definitive diagnosis
for abd. aortic aneurysm (AAA) > CT scan
-Dont use Kayexalate if patient has hypoactive bowel
sounds.
-Uremic fetor > smell urine on the breath
-Hirschsprungs > bile is lower obstruction, no bile is
upper obstruction; ribbon like stools. -Pancreatic enzymes
are taken with each meal! Not before, not after,
but WITH each meal.
Thank you, I finally realize why a person shouldnt have
cantaloupe before a occult stool test, because cantaloupe
is high in vit c and vit c causes a false + for occult blood.
Now I just need to figure out why they cant have fish.
Hypospadias: abnormality in which urethral meatus is
located on the ventral (back) surface of the penis
anywhere from the corona to the perineum(remember
hypo, low (for lower side or under side)

Epispadias: opening of the urethra on the dorsal (front)

surface of the penis
Priapism: painful erection lasting longer than 6 hrs.
Anticholinergic effectsassessment dry mouth==cant
spit
urinary retention=cant **** constipated =cant ****
blurred vision=cant see
When you see Coffee-brown emesis, think peptic ulcer
2.Anytime you see fluid retention. Think heart
problemsfirst.
3.An answer that delays care or treatment is ALWAYSwrong
4.For PVD remember DAVE (Legs are Dependent forArterial
& for Venous Elevated) more to come.
Interpersonal model (Sullivan)
Behavior motivated by need to avoid anxiety and satisfy
needs
1. Infancy 0-18 months others will satisy needs
2. childhood >6yrs learn to delay need gratification
3. juvenile 6-9 years learn to relate to peers
4. preadolescence 9-12 yrs learns to relate to friends of of
opposite sex
5. early adolescence12-14yrs:learn independence and how
to relate to opposite sex
6. late adolecence 14-21yrs: develop intimate relationship
with person of opposite sex
is this not about communication?.
When choosing an answer, think in this manner if you
can only do ONLY one thing to help this patient what would
it be? Pick the most important intervention.

Fetal alcohol syndrome -upturned nose

-flat nasal bridge
-thin upper lip
-SGA
vastus lateralis is IM administration site for 6month infants
For toddlers above 18 months ventrogluteal
The deltoid and gluteus maximus are appropriate sites for
children
OU- both eyes
OS- left eye
OD- right eye ( dominent Right eye- just a tip to
remember)
1. COAL (cane walking):
C - cane
O - opposite
A - affected
L - leg
Red- Immediate: Injuries are life threatening but survivable
with minimal intervention. Ex: hemothrax, tension
pneumothorax, unstable chest and abdominal wounds,
INCOMPLETE amputations, OPEN fxs of long bones, and
2nd/3rd degree burn with 15%-40% of total body surface,
etc.
Yellow- Delayed: Injuries are significant and require
medical care, but can wait hrs without threat to life or
limb. Ex: Stable abd wounds without evidence of
hemorrhage, fx requiring open reduction, debridement,
external fixation, most eye and CNS injuries, etc.
Green- Minimal: Injuries are minor and tx can be delayed
to hrs or days . Individuals in this group should be moved

away from the main triage area. Ex: upper extremity fx,
minor burns, sprains, sm. lacerations, behavior disorders.
Black- Expectant: Injuries are extensive and chances of
survival are unlikely. Seperate but dont abandoned,
comfort measures if possible. Ex: Unresponsive,spinal cord
injuries, woulds with anatomical organs, 2nd/3rd degree
burn with 60% of body surface area , seizures, profound
shock with multipe injuries, no pulse, b.p, pupils fixed or
dilated.
Thoracentesis prep- Take v.s., shave area around needle
insertion, position patient with arms on pillow on over bed
table or lying on side, no more than 1000cc at a one time.
Post- listen for bilateral breath sounds, v.s., check leakage,
sterile dressing.
CT- assess allergies
MRI- claustrophobia, no metal, assess pacemaker
Cardiac cath- npo 8-12hr, empty bladder, pulses, tell pt
may feel heat palpitations or desire to cough with dye
injection. Post- Vital signs keep leg straight bedrest 6-8hr.
cerebral angio prep- well hydrated, lie flat, sire shaved,
pulses marked post- keep flat 12-14hr, check site,
pulses,force fluids.
Lumbar puncture- fetal postion. post- nuero assess q15-30
until stable, flat2-3hr, encourage fluids, oral anlgesics for
headache, observe dressing
EEG- no sleep the night before, meals not withheld, no
stimulants for 24hr before, tranquilizer/stimulant meds
held 24-48hr before, may be asked to hyperventilate 34min and watch a bright flashing light.

Myelogram- Npo 4-6hr, allergy hx, phenothiazines, cns

depressants, and stimulants withheld 48hr prior, table will
be moved to various postions during test. Post- neuro q24, water soluble HOB up, oil soluble HOB down, oral
analgesics for h/a, encourage po fluids, assess for
distended bladder, inspect site.
Liver biopsy- Adm vit k , npo morning of exam 6hr, give
sedative, Teach pt that he will be asked to hold breath for
5-10sec, supine postion, lateral with upper arms elevated.
Post- postion on right side, frequent v.s., report severe ab
pain stat, no heavy lifting 1wk.
Paracentesis- semi fowlers or upright on edge of bed,
empty bladder. Post- v.s., report elevated temp, observe
for signs of hypovolemia.
Laparoscopy- CO2 used to enhances visual,
general anesthesia, foley. Post- walk patient to decrease
CO2 build up used for procedure.
Pyelogram- assess allergies
Sengstaken blakemore tube used for tx of esophageal
varices, keep scissors at bedside.
Hemovac- used after mastectomy, empty when full or
q8hr, remove plug, empty contents, place on flat surface,
cleanse opening and plug with alcohol sponge, compress
evacuator completely to remove air, release plug, check
system for operation.
Common Signs and Symptoms
01. PTB low-grade afternoon fever.
02. PNEUMONIA rusty sputum.
03. ASTHMA wheezing on expiration.
04. EMPHYSEMA barrel chest.

05. KAWASAKI SYNDROME strawberry tongue. 06.

PERNICIOUS ANEMIA red beefy tongue. 07. DOWN
SYNDROME protruding tongue.
08. CHOLERA rice watery stool.
09. MALARIA stepladder like fever with chills. 10.
TYPHOID rose spots in abdomen.
11. DIPTHERIA pseudo membrane formation 12.
MEASLES kopliks spots.
13. SLE butterfly rashes.
14. LIVER CIRRHOSIS spider like varices.
15. LEPROSY lioning face.
16. BULIMIA chipmunk face.
17. APPENDICITIS rebound tenderness.
18. DENGUE petechiae or (+) Hermans sign.
19. MENINGITIS Kernigs sign (leg flex then leg pain on
extension), Brudzinski sign (neck flex = lower leg flex).
20. TETANY hypocalcemia (+) Trousseaus
sign/carpopedal spasm; Chvostek sign (facial spasm).
21. TETANUS risus sardonicus.
22. PANCREATITIS Cullens sign (ecchymosis of
umbilicus); (+) Grey turners spots.
23. PYLORIC STENOSIS olive like mass.
24. PDA machine like murmur.
25. ADDISONS DISEASE bronze like skin pigmentation.
26. CUSHINGS SYNDROME moon face appearance and
buffalo hump.
27. HYPERTHYROIDISM/GRAVES DISEASE exopthalmus.
28. INTUSSUSCEPTION sausage shaped mass, Dance
Sign (empty portion of RLQ)
29. MS Charcots Triad (IAN)

30. MG descending muscle weakness

31. Guillain Barre Syndrome ascending muscle weakness
32. DVT Homans Sign
33. CHICKEN POX Vesicular Rash (central to distal) dew
drop on rose petal
34. ANGINA Crushing stubbing pain relieved by NTG
35. MI Crushing stubbing pain which radiates to left
shoulder, neck, arms, unrelieved by NTG 36. LTB
inspiratory stridor
37. TEF 4Cs Coughing, Choking, Cyanosis, Continous
Drooling
38. EPIGLOTITIS 3Ds Drooling, Dysphonia, Dysphagia
39. HODGKINS DSE/LYMPHOMA painless, progressive
enlargement of spleen & lymph tissues, Reedstenberg
Cells
40. INFECTIOUS MONONUCLEOSIS Hallmark: sore
throat, cervical lymph adenopathy, fever 41. PARKINSONS
Pill-rolling tremors
42. FIBRIN HYALIN Expiratory Grunt
43. CYSTIC FIBROSIS Salty skin
44. DM polyuria, polydypsia, polyphagia
45. DKA Kussmauls breathing (Deep Rapid RR)
46. BLADDER CA painless hematuria
47. BPH reduced size & force of urine
48. PEMPHIGUS VULGARIS Nikolskys sign (separation of
epidermis caused by rubbing of the skin)
49. RETINAL DETACHMENT Visual Floaters, flashes of
light, curtain vision
50. GLAUCOMA Painfull vision loss, tunnel/gun barrel/halo
vision (Peripheral Vision Loss)

51. CATARACT Painless vision loss, Opacity of the lens,

blurring of vision
52. RETINO BLASTOMA Cats eye reflex (grayish
discoloration of pupils)
53. ACROMEGALY Coarse facial feature
54. DUCHENNES MUSCULAR DYSTROPHY Gowers sign
(use of hands to push ones self from the floor)
55. GERD Barretts esophagus (erosion of the lower
portion of the esophageal mucosa) 56. HEPATIC
ENCEPHALOPATHY Flapping tremors
57. HYDROCEPHALUS Bossing sign (prominent forehead)
58. INCREASE ICP HYPERtension BRADYpnea
BRADYcardia (Cushings Triad)
59. SHOCK HYPOtension TACHYpnea TACHYcardia 60.
MENIERES DSE Vertigo, Tinnitus
61. CYSTITIS burning on urination
62. HYPOCALCEMIA Chvostek & Trosseaus sign
63. ULCERATIVE COLITIS recurrent bloody diarrhea 64.
LYMES DSE Bulls eye rash
Ottorhea s/s of basilar fracture
Battles sign and racoons eyes s/s of orbital fracture
Take iron elixir with juice or water. never with milk
Dilantin 10-20 Theophyline 10-20 Acetaminophen 10-20
Lithium 0.5-1.5 Digoxin 0.5-2.0
Osteomyletitis is an infectious bone dz. Give blood cultures
and antibiotics, then if necessary surgery to drain abscess.
Nephrotic syndrome s/s edema + hypotension. Turn and
reposition (risk for impaired skin integrity)

To access role relationship pattern focus on image and

relationships with others. Renal impairment: serum
creatinine elevated and urine clearance decreased
Norm. Serum creatinine 0.8-1.8 (men), 0.5-1.5 (women)
Norm. Urine clearance 85-135
Atropine Overdose
Hot as a Hare (Temp), Mad as a Hatter (LOC), Red as a
Beet (flushed face) and Dry as a Bone (Thirsty)
Hemoglobin Neonates 18-27 3 mos 10.6-16.5 3 yrs 9.415.5 10 yrs 10.7-15.5
Glomerulonephritis: take vs q 4 hrs + daily weights Age 4
to 5 yrs child needs DPT/MMR/OPV
Cystic Fibrosis give diet low fat, high sodium, fat soluble
vitamins ADEK. Aerosal bronchodilators, mucolytics and
pancreatic enzymes.
Airborne Precautions: measels, chicken pox and TB.
private room, negatvie pressure w/ 6-12 air exchanges,
Mask N95.
Droplet Precautions:sepsis, scarlet fever, streptococcal
pharyngitis, parovirus B19, pnuemonia, pertusis, influenza,
diptheria, epiglottis, rubella,
mumps,meningitis, mycoplasma and adenovirus. Door
open, 3 ft distance, private room or cohort, mask
Contact Precautions: multidrug resistant organism;
respiratory, skin, wound enteric and eye INFECTIONS
Zoloft s/e agitation, sleep disturb, and dry mouth
Clozapine s/e agranulocytosis, tachycardia and siezures
Blood tests for MI: Myoglobin, CK and Troponin
Salt substitutes may contain pottasium
Placental abruptio: bleeding with pain, dont forget to

monitor volume status (I&O)

An ill child regresses in behaviors
Meningeal irritation S/s nuchal rigidity, positive Brudzinski
+ Kernig signs and PHOTOPHOBIA too!
Babinski sign - toes curl great! toes fan bad
Glucose Tolerance Test for preggies result of 140 or highter
needs further evaluation. Assessing extraocular eye
movements check cranial nerves 3, 4, and 6.
Stomas:
dusky stoma means poor blood supply, protruding means
prolapsed, sharp pain + rigidity means peritonitis, mucus
in ileal conduit is expected.
Dilantin s/e rash (stop med), gingival hyperplasia (good
hygiene)
toxicity>poor gait + coordination, slurred speech,
nausea, lethargy, and diplopia.
Phenobarbital can be taken during pregnancy but Dilatin is
contraindicated.
Tension pneumothorax trachea shifts to opposite side.
This is GREAT! Heres some I got from a review class I went
to several months ago
*Change in color is always a LATE sign!
*Incentive Spirometry steps:1) Sit upright 2) Exhale 3)
Insert mouthpiece 4) Inhale for 3 seconds, and then HOLD
for 10 seconds
*Aminoglycocide (__Mycin ; except erythromycine) Adverse
Effects are bean shaped - Nephrotoxic to Kidneys and
Ototoxic to Ears
*MRSA - Contact precaution ONLY
*VRSA - Contact AND airborne precaution (Private room,

door closed, negative pressure) *LITHIUM

L-level of therapeutic affect is 0.5-1.5
I-indicate mania
T-toxic level is 2-3 - N/V, diarrhea, tremors
H-hyrdrate 2-3L of water/day
I-increased UO and dry mouth
U-uh oh; give Mannitol and Diamox if toxic s/s are present
M-maintain Na intake of 2-3g/day
*All psych meds (except Lithium) side effects are the
same as SNS but the BP is decreased.
*SNS- Increase in BP, HR and RR (dilated bronchioled),
dilated pupils (blurred vision), Decreased GUT (urniary
retention), GIT (constipation), Constricted blood vessels
and Dry mouth.
*Blood transfusion- sign of allergies in order:
1)Flank pain
2)Frequent swallowing
3)Rashes
4)Fever
5)Chills
*Thrombocytopenia -Bleeding precautions!
1)Soft bristled toothbrush
2)No insertion of anything! (c/i suppositories, douche)
3)No IM meds as much as possible!
*Iron deficiency anemia - easily fatigued
1)Fe PO - give with Vitamin C or on an empty stomach
2)Fe via IM- Inferon via Ztrack
*Pernicious Anemia - Red, Beffy tongue; will take Vit.B12
for life!
*BURNS

1st Degree - Red and Painful

2nd Degree - Blisters
3rd Degree - No Pain because of blocked and burned
nerves
*Menieres Disease - Admin diuretics to decrease
endolymph in the cochlea, restrict Na, lay on affected ear
when in bed. Triad:
1)Vertigo
2)Tinnitus
3)N/V
*Gastric Ulcer pain occurs 30 minutes to 90 minutes after
eating, not at night, and doesnt go away with food
*Think positive and you can achieve great things. Think of
present and future, the past is gone. *Forget your past
mistakes and focus on your successes encouraging
yourself to greater achievements in the future.
*Always do your best so you can be proud that you gave it
your best shot.
*Focus on your achievements rather than your failures. If
you do find yourself thinking about how you failed then
look at what you managed to do right and how you could
correct what you did next time.
*A mind that is troubled with doubt wont be able to focus
on the victory to be had.
*Take it one day at a time.
*Take time for yourself. A fried mind cant focus or learn.
Pediatric Tips:
What is an intraosseous infusion? In pediatric lifethreatening emergencies, when iv access cannot be
obtained, an osseous (bone) needle is hand-drilled into a

bone (usually the tibia), where crystalloids, colloids, blood

products anddrugs can be administered into the marrow. It
is a temporary, life-saving measure, and I have seen it
once! (Gruesome.) When venous access is achieved it can
be d/cd. One medication that cannot be administered by
intraosseous infusion is isoproterenol, a beta agonist. (I
dont know more about that drug; it was just pointed out
on a practice exam.)
During sickle cell crisis there are two interventions to
prioritize: fluids and pain relief.
With glomerulonephritis you should consider blood
pressure to be your most important assessment
parameter. Dietary restrictions you can expect include
fluids, protein, sodium, and potassium.
Remember yesterday when I mentioned how congenital
cardiac defects result in hypoxia which the body attempts
to compensate for (influx of immature rbcs)? Labs
supporting this would show increased hematocrit,
hemoglobin, and rbc count.
Did you know there is an association between low-set
ears and renal anomalies? Now you know what to look for
if downs isnt there to choose. (just to expand on it a little,
the kidneys and ears develop around the same time in
utero. Hence, theyre shaped similarly. Which is why when
doing an assessment of a neonate, if the nurse notices low
set or asymmetrical ears, there is good reason to
investigate renal functioning. Knowing that the kidneys
and ears are similar shapes helped me remember this).

School-age kids (5 and up) are old enough, and should

have an explanation of what will happen a week before
surgery such as tonsillectomy.
If you gave a toddler a choice about taking medicine and
he says no, you should leave the room and come back in
five minutes, because to a toddler it is another episode.
Next time, dont ask.
The first sign of pyloric stenosis in a baby is mild vomiting
that progresses to projectile vomiting. Later you may be
able to palpate a mass, the baby will seem hungry often,
and may spit up after feedings.
We know Kawasaki disease causes a heart problem, but
what specifically?Coronary artery aneurysms d/t the
inflammation of blood vessels.
A child with a ventriculoperitoneal shunt will have a small
upper-abdominalincision. This is where the shunt is guided
into the abdominal cavity, and tunneled under the skin up
to the ventricles. You should watch for abdominal
distention, since fluid from the ventricles will be redirected to the peritoneum. You should also watch for signs
of increasing intracranial pressure, such as irritability,
bulging fontanels, and high-pitched cry in an infant. In a
toddler watch lack of appetite and headache. Careful on a
bed position question! Bed-position after shunt placement
is flat, so fluid doesnt reduce too rapidly. If you see s/s of
increasing icp, then raise the hob to 15-30 degrees.
What could cause bronchopulmonary dysplasia? Dysplasia
means abnormality or alteration. Mechanical
ventilation can cause it. Premature newborns with
immature lungs are ventilated and over time it damages

the lungs. Other causes could be infection, pneumonia, or

other conditions that cause inflammation or scarring.
It is essential to maintain nasal patency with children <
1 yr. because they are obligatory nasal breathers.
Watch out for questions suggesting a child drinks more
than 3-4 cups of milk each day. (Milks good, right?) Too
much milk reduces intake of other essential nutrients,
especially iron. Watch for anemia with milk-aholics. And
dont let that mother put anything but water in that kids
bottle during naps/over-night. Juice or milk will rott that
kids teeth right out of his head.
What traction is used in a school-age kid with a femur or
tibial fracture with extensive skin damage? Ninety,
ninety. Huh? I never heard of it either. The name refers to
the angles of the joints. A pin is placed in the distal part of
the broken bone, and the lower extremity is in a boot cast.
The rest is the normal pulleys and ropes youre used to
visualizing with balanced suspension. While were talking
about traction, a kids hinder should clear the bed when in
Bryants traction (also used for femurs and congenial hip
for young kids).
If you can remove the white patches from the mouth of a
baby it is just formula. If you cant, its candidiasis.
Just know the MMR and Varicella immunizations come
later (15 months).
Undescended testis or cryptorchidism is a known risk
factor for testicular cancer later in life. Start teaching boys
testicular self exam around 12, because most cases occur
during adolescence.

Not pediatrics but have to throw it in A guy loses his

house in a fire. Priority is using community resources to
find shelter, before assisting with feelings about the
tremendous loss. (Maslow).
No aspirin with kids b/c it is associated with Reyes
Syndrome, and also no nsaids such as ibuprofen. Give
Tylenol.
CSF in meningitis will have high protein, and low glucose.
It is always the correct answer to report suspected cases
of child abuse.
No nasotracheal suctioning with head injury or skull
fracture.
Feed upright to avoid otitis media.
Position prone w hob elevated with gerd. In almost every
other case, though, you better lay that kid on his back
(Back To Sleep - SIDS).
Pull pinna down and back for kids < 3 yrs. when instilling
eardrops.
Kids with RSV; no contact lenses or pregnant nurses in
rooms where ribavirinis being administered by hood, tent,
etc.
Positioning with pneumonia lay on the affected side to
splint and reducepain. But if you are trying to reduce
congestion the sick lung goes up. (Ever had a stuffy nose,
and you lay with the stuff side up and it clears?)
A positive ppd confirms infection, not just exposure.
A sputum test will confirm active disease.
Coughing w/o other s/s is suggestive of asthma. Speaking
of asthma, watch out if your wheezer stops wheezing. It
could mean he is worsening.

You better pick do vitals before administering

that dig. (apical pulse for one full minute). Tet spells
treated with morphine.
Group-a strep precedes rheumatic fever. Chorea is part of
this sickness (grimacing, sudden body movements, etc.)
and it embarrasses kids. They havejoint pain. Watch for
elevated antistreptolysin O to be elevated. Penicillin!
Dont pick cough over tachycardia for signs of chf in an
infant. Random Tips:
No milk (as well as fresh fruit or veggies)
on neutropenic precautions.
Tylenol poisoning liver failure possible for about 4
days. Close observation required during this time-frame,
as well as tx with Mucomyst.
Radioactive iodine The key word here is flush. Flush
substance out of body w/3-4 liters/day for 2 days, and
flush the toilet twice after using for 2 days. Limit contact
w/patient to 30 minutes/day. No pregnant visitors/nurses,
and no kids.
The main hypersensitivity reaction seen
with antiplatelet drugs isbronchospasm (anaphylaxis).
Common sites for metastasis include the liver, brain, lung,
bone, and lymph.Orthostasis is verified by a drop in
pressure with increasing heart rate. Bence Jones protein in
the urine confirms multiple myeloma.
Dont fall for reestablishing a normal bowel pattern as a
priority with smallbowel obstruction. Because the patient
cant take in oral fluids maintainingfluid balance comes
first.

Pernicious anemia s/s include pallor, tachycardia, and sore

red tongue.
With flecainide (Tambocor), an antiarrythmic, limit
fluids and sodium intake, because sodium
increases water retention which could lead to heart failure.
Basophils release histamine during an allergic response.
Adenosine is the treatment of choice for paroxysmal
atrial tachycardia.
Iatragenic means it was caused by treatment, procedure,
or medication.
Other than initially to test tolerance, G-tube and Jtube feedings are usually given as continuous feedings.
Four side-rails up can be considered a form
of restraint. Even in LTC facility when a client is a fall risk,
keep lower rails down, and one side of bed against the
wall, lowest position, wheels locked.
Your cancer patient is getting radiation. What should you
be most concerned about? Skin irritation? No. Infection
kills cancer patients most because of
theleukopenia caused by radiation.
A breast cancer patient treated with Tamoxifen should
report changes in visualacuity, because the adverse effect
could be irreversible.
Pneumovax 23 gets administered post splenectomy to
prevent pneumococcal sepsis.
Lets say every answer in front of you is
an abnormal value. If potassium is there you can bet it is a
problem they want you to identify, because values outside
of normal can be life threatening. Normal potassium is 3.5-

5.0. Even a bun of 50 doesnt override a potassium of 3.0

in a renal patient in priority.
You better be making sure that patient on Dig and Lasix is
getting enough potassium, because low potassium
potentiates Dig and can cause dysrrhythmias.
You will ask every new admission if he has an advance
directive, and if not you will explain it, and he will have the
option to sign or not.
An example of when you would implement before going
through a bunch of assessments is when someone is
experiencing anaphylaxis. Get the ordered epinephrine in
them stat, especially if they stem clearly states the s/s
(difficulty breathing, increasing anxiety, etc.)
In a disaster you should triage the person who is most
likely to not survive last.
A little trick regarding potassium: ALKALOSIS: K is LOW
Acidosis is just the opposite: K is High
The vital sign you should check first with high
potassium is pulse (due to dysrhythmias).
Give neostigmine to clients with Myesthenia Gravis about
45 min. before eating, so it will help with chewing and
swallowing.
Anectine is used for short-term neuromuscular blocking
agent for procedures like intubation and ECT. Norcuron is
for intermediate or long-term.
The parathyroid gland relies on the presence of vitamin
D to work. Glucagonincreases the effects of
oral anticoagulants.
Bleeding is part of the circulation assessment of
the ABCDs in an emergent situation. Therefore, if airway

and breathing are accounted for, a compound fracture

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

Decorticate positioning in response to pain

= Cortex involvement. Decerebratein response to pain =
Cerebellar, brain stem involvement
Dantrium, for spasticity, may take a week or more to be
effective.
Decreased acetylcholine is related to senile dementia.
Hyperactive deep tendon reflexes, vision changes, fatigue
and spasticity are all symptoms of MS
After removal of the pituitary gland you must watch
for hypocortisolism and temporary diabetes insipidus.
Position on right side with legs flexed after appendectomy.
Hirschsprungs diagnosed with rectal biopsy looking
for absence of ganglioniccells. Cardinal sign in infants is
failure to pass meconium, and later the classic ribbon-like
and foul smelling stools.
Intussusception common in kids with CF. Obstruction may
cause fecal emesis,currant jelly- like stools (blood and
mucus). A barium enema may be used to hydrostatically
reduce the telescoping. Resolution is obvious, with onset of
bowel movements.
With omphalocele and gastroschisis (herniation of
abdominal contents) dress with loose saline
dressing covered with plastic wrap, and keep eye on temp.
Kid can lose heat quickly.
After a hydrocele repair provide ice bags and scrotal
support.
No phenylalanine with a kid positive for PKU (no meat, no
dairy, no aspartame).
Second voided urine most accurate when testing
for ketones and glucose.

Never give potassium if the patient is oliguric or anuric.

Nephrotic syndrome is characterized by
massive proteinuria (looks dark and frothy) caused by
glomerular damage. Corticosteroids are the mainstay.
Generalized edema common.
A positive Western blot in a child <18 months (presence of
HIV antibodies) indicates only that the mother is infected.
Two or more positive p24 antigentests will confirm HIV in
kids <18 months. The p24 can be used at any age.
For HIV kids avoid OPV and Varicella vaccinations (live),
but give Pneumococcal and influenza. MMR is avoided only
if the kid is severely immunocompromised. Parents should
wear gloves for care, not kiss kids on the mouth, and not
share eating utensils.
Hypotension and vasoconstricting meds may alter the
accuracy of o2 sats.
An antacid should be given to a mechanically ventilated
patient w/ an ng tube if the ph of the
aspirate is <5.0. Aspirate should be checked at least every
12 hrs. Ambient air (room air) contains 21% oxygen.
The first sign of ARDS is increased respirations. Later
comes dyspnea, retractions, air hunger, cyanosis.
Normal PCWP (pulm capillary wedge pressure) is 813. Readings of 18-20 are considered high.
First sign of PE is sudden chest pain, followed by dyspnea
and tachypnea.
High potassium is expected with carbon dioxide
narcosis (hydrogen floods the cell forcing

potassium out). Carbon dioxide narcosis causes increased

intracranial pressure. Pulmonary sarcoidosis leads to right
sided heart failure.
An NG tube can be irrigated with cola, and should be
taught to family when a client is going home with an NG
tube.
Digitalis increases ventricular irritability, and could convert
a rhythm to v-fib following cardioversion.
If your normally lucid patient starts seeing bugs you better
check hisrespiratory status first. The first sign of hypoxia is
restlessness, followed by agitation, and things go downhill
from there all the way to delirium, hallucinations, and
coma. So check the o2 stat, and get abgs if possible.
The biggest concern with cold stress and the newborn
is respiratory distress.
Look carefully when you have no idea. In a word like
rhabdomyosarcoma you can easily ascertain
it has something to do with muscle (myo) cancer
(sarcoma). The same thing goes for drug names. For
example, if it ends in ide its probably a diuretic, as in
Furosemide, and Amyloride.
Lasix can cause a patient to lose his appetite (anorexia)
due to reduced potassium.
If your laboring moms water breaks and she is any minus
station you better know there is a risk of prolapsed cord.
In a five-year old breathe once for every 5 compressions
doing cpr.
After g-tube placement the stomach contents are drained
by gravity for 24 hours before it can be used for feedings.

Cephalhematoma (caput succinidanium) resolves on its

own in a few days. This is the type of edema that crosses
the suture lines.
During the acute stage of Hep-A gown and gloves are
required. In the convalescent stage it is no longer
contagious.
Low magnesium and high creatinine signal renal failure.
Pain is usually the highest priority with RA
If a TB patient is unable/unwilling to comply with tx they
may need supervision (direct observation). TB is a public
health risk.
Level of consciousness is the most important assessment
parameter withstatus epilepticus. Crackles suggest
pneumonia, which is likely to be accompanied
by hypoxia, which would manifest itself as mental
confusion, etc.
Cant cough=ineffective airway clearance
Absence of menstruation leads to osteoporosis in the
anorexic.
Toddlers need to express autonomy (independence)
A patient with a low hemoglobin and/or hematocrit should
be evaluated for signs of bleeding, such as dark stools.
A laxative is given the night before an IVP in order to
better visualize the organs.
A patient with liver cirrhosis and
edema may ambulate, then sit with legs elevated to try
to mobilize the edema.
Managing stress in a patient with adrenal insufficiency
(Addisons) is paramount, because if the adrenal glands
are stressed further it could result in Addisonian crisis.

While were on Addisons, remember blood pressure is the

most important assessment parameter, as it causes
severe hypotension.
After pain relief, cough and deep breathe is important
in pancreatitis, because of fluid pushing up in the
diaphragm.
Safety over Nutrition with a severely depressed client.
Prolonged hypoxemia is a likely cause of cardiac arrest in a
child.
Fluid volume overload caused by IVC fluids infusing too
quickly (or whatever reason) and CHF can cause an S3
Coarctation of the aorta causes increased blood flow
and bounding pulses in the arms
A newly diagnosed hypertension patient should have BP
assessed in both arms
Depression often manifests itself in somatic ways, such as
psychomotor retardation, gi complaints, and pain.
Respiratory problems are the chief concern
with CF speaking of TB PPD is positive if area of
induration is:
>5 mm in an immunocompromised patient
>10 mm in a normal patient
>15 mm in a patient who lives in an area where TB is very
rare.
another tiP:
HbA1c - test to assess how well blood sugars have been
controlled over the past 90-120 days. 4- 6 corresponds to
a blood sugar of 70-110; 7 is ideal for a diabetic and
corresponds to a blood sugar of 130.

BSA is considered the most accurate method for

medication dosing with kids. (I though it was weight, but
apparently not)
Place a wheelchair parallel to the bed on the side of
weakness
If one nurse discovers another nurse has made a mistake it
is always appropriate to speak toher before going to
management. If the situation persists, then take it higher.
Sepsis and anaphylaxis (along with the obvious
hemorrhaging) reduce circulating volume by way of
increased capillary permeability, which leads toreduced
preload (volume in the left ventricle at the end of diastole).
This is a toughiethink about it.
Amniotic fluid is alkaline, and turns nitrazine
paper blue. Urine and normal vaginal discharge are acidic,
and turn it pink.
Gonorrhea is a reportable disease
Remember the phrase step up when picturing a person
going up stairs with crutches. The good leg goes up first,
followed by the crutches and the bad leg. The opposite
happens going down. The crutches go first, followed by the
good leg.
While treating DKA, bringing the glucose down too far and
too fast can result in increased intracranial pressure d/t
water being pulled into the CSF.
Polyuria is common with the hypercalcemia caused by
hyperparathyroidism.
Remember the action of vasopressin because it sounds like
press in, orvasoconstrict.

Water intoxication will be evidenced by drowsiness and

altered mental status in a patient with TUR syndrome, or
as an adverse reaction to desmopressin (for diabetes
insipidus).
Burning sensation in the mouth, and brassy taste are
adverse reactions toLugol solution (for hyperthyroid).
Report it to the doc. Give synthroid on an empty stomach
Extra insulin may be needed for a patient
taking Prednisone (remember, steroids cause increased
glucose).
Nonfat milk reduces reflux by increasing lower esophageal
sphincter pressure Patients with GERD should lay on
their left side with the HOB elevated 30 degrees.
Unusual positional tip - Low-fowlers recommended during
meals to preventdumping syndrome. Limit fluids while
eating.
In emphysema the stimulus to breathe is low PO2, not
increased PCO2 like the rest of us, so dont slam them with
oxygen. Encourage pursed-lip breathingwhich
promotes CO2 elimination, encourage up to 3000mL/day
fluids, high-fowlers and leaning forward.
Theophylline causes GI upset, give with food
TB drugs are liver toxic. (Does your patient have hepB?) An
adverse reaction isperipheral neuropathy.