Mark Klimek Note -Nclex Resources

Hyperthyroidism is also called 

Grave's disease or hypermetabolism 

Tip to remember Grave's disease s/s's 

"Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance 

Treatment for Grave's disease 

Radioactive Iodine, PTU (put thyroid under), surgically remove 

Total thyroidectomy ... totals get 

tetany, need lifelong hormone replacement 

After thyroidectomy patients are at risk for 

hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia 

parathesia 

numbness and tingling, first sign of electrolyte imbalance 

Subtotal thyroidectomy ... subs get 

storm 

S/S of thyroid storm 

Extremely high vital signs, hyperpyrexia, psychotic delerium 

How to treat thyroid storm 

give o2, lower temp to spare brain 

Risks post op for total thyroidectomy 

airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany 

Risks post op for sub total thyroidectomy 

airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm 

Hypothyroidism is also called 

Myxedema or hypometabolism 

S/S of mydexema 

everything is down, constipation, heat tolerance, cold intolerance 

Treatment for mydexema 

give thyroid medications 

Where to put the 5 ice packs to cool a thyroid storm patient 

neck pits groin 

If you cool a patient too fast what might happen? 

Heart arrythmias 

Never hold the hormone for what patient? 

patient who is NPO with mydexema 

Addison's disease easy way to remember 

Add a Sone (sone = steroid) 

Adrenal Cortex diseases easy way to remember 

A in Adrenal stands for Addison's

C in Cortex stands for Cushing's 

Addison's disease is 

undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger. 

Addison's disease treatment 

give a steroid, chronic steroid therapy 

Cushing's syndrome 

Over secretion of adrenal cortex, too much hormone, too much steroid. 

S/S of Cushing's syndrome 

same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood sugar, losing Potassium, 

Treatment for Cushing's syndrome 

Surgery, bi or uni lateral adrenalectomy (bilateral is worse) 

Donning PPE's order 

Gown, Mask, Goggles, Gloves 

Removing PPE's order 

alphabetically inside the room 

For airborne precautions the mask is removed where? 

outside of the room 

Avoid answers with what words for children 9 mths and younger? 

build, sort, stack, construct, make 

Toddlers (1-3) work on 

their gross motor skills (jump, hop, throw), NO fine motor, parallel play 

Preschoolers (3-6) work on 

fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend 

School age (7-11) work on 

creative, collect, competitive 

Best default order for click and drag order questions? 

Hold ..... med

Assess ..... what med does

Prepare ...... the correction

Call ..... or notify 

Rarely if ever answer ... 

call Doctor, NCLEX wants you to think critically 

Creatinine lab values 

same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about 

INR lab values 

2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify 

Potassium lab values 

3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K

if high, hold all K, assess heart (EKG), give D5W and reg insulin, call

if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!! 

pH lab values 

7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the patient 

If bad vitals, call rapid response team 

BUN lab values 

8-30 check for dehydration if elevated not a big deal, just be concerned 

If a deadly or dangerous lab value is discovered AND they have symptoms call the 

rapid response team! 

HgB lab values 

12-18 check for bleeding if low or high, if low prepare for tranfussion 

HCO3 lab values 

22-26 if it is abnormal so what! 

CO2 lab values 

35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's considered deadly and respiratory failure, need intubated 

Hct lab values 

36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration 

PO2 lab values 

78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr 

O2 sat lab values 

93-100 pulse ox, if under 93 assess resp status and give O2 

BNP lab value 

less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF 

NA lab values 

135-145, if a change in LOC then evaluate for fall/safety risk 

WBC lab values 

5000-11000 if low assess for infection 

CD4 count less than 200 equals 

AIDS 

Neutropenic precautions (low WBC) 

strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H 

Platelets lab value 

150000-400000 if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia 

Bleeding precautions 

no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods 

RBC lab values 

4-6 million abnormal doesn't really matter 

Reason for laminectomy 

treat nerve root compression 

S/S of nerve root compression 

Pain

Parasthesia (numbness & tingling)

Paresis (muscle weakness) 

Cervical 

Diaphram and Arms affected, breathing, respiratory pattern 

Thoracic 

Abd muscles and gut affected, ability to cough 

Lumbar 

Bladder and legs affected, when did they last void, are they distended 

#1 post op answer for spinal problems is 

log roll patient 

Activity post op spinal issue 

do not dangle

stand, walk, lie down w/o restricitons

limit sitting to 30 min at a time 

Post op complications for cervical spinal surgery 

pneumonia 

Post op complications for thoracic spinal surgery 

pneumonia (no cough), paralytic illeus (gut shuts down) 

Post op complications for lumbar spinal surgery 

urinary retention 

How long does temporary restrictions usually mean? 

6 weeks (driving, lifting, etc.) 

Nagele's Rule 

1st day of last period + 7 days - 3 months 

Weight gain during pregnancy 

28 lbs plus or minus 3 lbs 

1st trimester weight gain 

1 lb/month or 3 lbs for 1st trimester 

2nd/3rd trimester weight gain 

1 lb/week 

Easy way to calculate appropriate weight gain during pregnancy 

The week number minus 9 so if 12 weeks pregnant 12-9=3 lbs. not allowed to be off by more than 2 lbs. 

Fundal Height 

not palpable until 12 weeks, 2nd and 3rd trimesters week gestation 20-22 in cm so at the navel is 20 weeks 

Positive signs of pregnancy 

xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement 

Probable signs of pregnancy 

blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign 

Chadwick's sign 

Cervical color changes to Cyanosis See all the CCCCCC's! 

Goodell's sign 

Cervical softening 

Hegar's sign 

Uterine softening 

All changes in cervix and vagina occur in what order? 

alphabetical order 

Pattern of Office Visits for prenatal care 

once a month until 28 weeks, once every 2 weeks until week 36, once a week until delivery or week 42 when induction is scheduled 

Pregnancy hemoglobin 

normal is 12-18, first trimester falls to 11 which is okay, second trimester falls to 10.5 which is okay and then third trimester falls to 10 also okay 

Easy way to remember station 

has it made it through the "tight squeeze" (ischial spine) no then its a negative, yes then its a positive, 0 station is when it's at the ischial spine 

Presenting part is 99% of the time the 

head 

What is bad as far as Lie? 

Transverse is bad, vertical is good, parallel is good 

Stage 1 of L&D 

Labor - thinning and opening, has 3 phases, Latent, Active, Transitional, nothing to do with the baby just the cervix, no baby at the end of labor 

Stage 2 of L&D 

Delivery - pushing the baby out 

Stage 3 of L&D 

Placenta delivery 

Stage 4 of L&D 

Recovery (1st 2 hrs after delivery of placenta), considered unstable patient, stop the bleeding in stage 4 

Memorize 1st stage 2nd phase of L&D then you know the rest 

Active phase

CM dilated 5-7 cm

CXN Freq 3-5 min

Duration 30-60 sec

Intensity moderate 

Contractions should not be longer than ____ seconds or closer than every _____ minutes. 

90, 2 

Prolapsed cord 

OB emergency, baby will die if you don't do something 

What to do with prolapsed cord 

Push then position! Push head off cord then position in knee/chest of trendelenburg (head down) 

Lithotomy position 

on back with knees drawn up 

Easy to remember interventions for complications of L&D 

LIONPit

L left side, I increase IV, O oxygenate, N notify Dr, Pitocin 

If question says there is pitocin running and there are complications 

stop pit first then LIONpit 

Pain meds in labor 

know your peaks for IV, IM, PO, Subling. If baby is likely to be born when the pain med is peaking don't give! Why? Respiratory depression in baby 

Fetal monitor patterns 

if it starts with L it's bad so do LIONPit, ex; low fetal heart rate, low baseline variability, late decels 

V C

E H

A O

L P 

Variable Decels Cord Compression (bad)

Early Decels Head (bad)

Acels Okay (good)

Late Decels Placenta (bad) 

Best answer for what to check first in fetal monitoring is 

fetal heart rate, it's the ace of spades! 

During the 2nd stage (delivery of baby), order of actions. 

Deliver the head then stop pushing, suction the mouth first then the nose, check for nuchal cord, deliver shoulders and body, ID band 

If the baby has to leave the delivery area, the priority is 

the ID band 

Umbilical cord has what in it 

AVA 2 arteries and a vein 

4th stage of L&D recovery stage, what do do? 

4 things you do 4 times an hour in 4th stage

Vitals (assess for s/s of shock)

Fundus (want midline and firm, if boggy, massage, if displaced void/cath)

Pads (check and replace)

Roll on side (check for bleeding under patient) 

Excessive Lochia is 

a pad saturated in less than or equal to 15 minutes 

Postpartum Uterus Tone 

Firm NOT boggy 

Postpartum Fundal Height 

Fundal height should equal day post partum, day 5 = 5 cm below navel 

Postpartum Uterus location 

midline, if not void/cath 

Postpartum Lochia color 

Rubra - Red (ruby red)

Serosa - Pink (rosa pink)

Alba - whitish (albino white) 

Postpartum Lochia amount 

Moderage 4-6 inches on pad in one hour

Excessive pad saturated in 15 min 

Best way to measure DVT is 

calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's sign 

Postpartum assessment of extremities 

Pulses, Edema, S&S of Thrombophlebitis 

Postpartum assessment includes assessment of 

Uterus, Lochia and Extremities 

Way to remember difference between Cephalohematoma and Caput Succedaneum 

C S in Caput Succedaneum = Crosses suture lines, both are swelling on scalp caused by bleeding and both are normal or okay. 

OB medications tocolytics 

stop contractions, Brethine causes maternal tachycardia, Nifedipine (dipine - CCB) causes Hypotension and headache 

OB medications oxytocics 

makes labor more intense, Pitocin, Methergine, Cervidil 

Uterine Hyperstimulation 

contractions longer than 90 seconds or closer than 2 minutes 

OB medications Fetal/Neonatal Lung meds 

Betamethasone, speeds the development of the baby's lungs, given to Mom before baby is born, given IM, will increase the blood sugar of Mom 

Survanta (surfactant) 

given to baby after baby is born given trastracheal through the airway develops lungs 

Med hints for IM injections 

Look for 1's in both parts (the 1 looks like an I), guage and length, 21 g, 1 inch means IM 

Med hints for SQ injections 

look for 5's in both parts (the 5 looks like an S), guage and length, 25 g, 5/8 inch means SQ 

Drawing up Insulin rules 

R then N, Draw up R then N, NRRN the whole process 

Pressurizing Insulin rule 

put air into N then R , NRRN the whole process 

If 70/30 insulin it is 

70% N and 30% R, may have to make your own on boards, no 70/30 on the floor 

Heparin is given IV or SQ NOT PO, info re: Heparin 

works immediately, labs Ptt or any clotting or bleeding time, antidote: protamine sulfate, course: 21 days, pregnancy: YES (Class C pregnancy drug, use caution) 

Coumadin is given PO, info re: Coumadin 

takes days to work, labs ONLY PT-INR, antidote: Vit K (think Koumadin), course: forever, prengancy: NO (never use) 

If a diuretic ends in the letter X it is a potassium 

wasting drug plus Diurel 

Baclofen/ Flexoril 

muscle relaxant, think on your back loafin'! makes a patient drowsy, weak muscles, don't drink, don't drive, don't care of kids under 12 

Piaget's stage Sensorimotor 

age 0-2, totally present oriented, only think about what they sense or what they are doing NOW. tell them what you are doing as you are doing it 

Piaget's stage Pre-Poperational 

age 3-6, fantasy oriented, illogical, no rules, if they can think it it can happen, play with them, tell them what you are going to do the day of the event. 

Piaget's stage Concrete Operations 

age 7-11, rule oriented, live and die by the rules,only 1 way to do things, everything different is wrong, tell them days ahead what you are going to do plus skills, reading and visual tools 

Piaget's stage Formal Operations 

age 12-15, able to think abstractly, understand cause and effect, tell them like an adult 

Child has to be at least what age for PRE op teaching?: 

3 

When can a child give themselves their own insulin shot? 

7 

What 2 parts are always irrelevant in a prioritization question? 

age and gender (NCLEX is testing discrimination against agism) 

If it is a pediatric question the age is critical but if it is a prioritization question ... 

age is not critical 

In prioritization questions decide which patient is _________ or ____________ 

sickest, healthiest 

Rule #1 for prioritization 

Acute beats Chronic, unstable beats stable. Ex: COPD, CHF, CRF and acute appendicitis, who wins? Acute appendicitis. No ABC's, an acute gut beats a chronic COPD all day long 

ABC's don't count for 

acuity 

Prioritize patients at this very moment, not 

3 seconds later or 10 minutes ago, Right NOW, right HERE, as they say it! 

Rule #2 for prioritization 

Fresh post op (12 hours out) beats medical or other surgical, Ex: 2 hr post op cholesysectomy beats acute appendicitis and post op one day CABG and COPD, CHF, CRF (then do ABC's) 

Rule #3 for prioritization 

Unstable beats stable 

Things that make a patient stable 

the word stable, chronic, post op greater than 12 hours, local or regional anesthesia, unchanged assessment, to be discharged, lab values that aren't urgent 

Stable patients are experiencing the ___________ or __________ s/s's of the disease with which they have been diagnosed and for which they are receiving treatment 

Typical, expected 

Things that make a patient unstable 

the word unstable, acute, post op less than 12 hours, general anesthesia, changing assessment, newly, recently admitted or diagnosed, lab values that are critical or deadly 

Unstable patients are experiencing _________ or ____________ s/s's, complications 

unexpected, atypical 

Patients who are always unstable 

hypoglycemia, hemorrhaging clients, fevers over 104, pulselessness, breathlessness 

Faulty reasoning, prioritizing by symptom severity 

It is not how severe the symptom is, its if the symptom has changed or if its typical or expected. 

Rule #4 for prioritization 

Tie-breaker, ONLY use for a tie breaker, the more Vital the organ the higher the priority. 

Vital organ priority list 

brain

lung

heart

liver

kidney

pancreas 

LPN's can't do 

IV anything (don't assume they have IV cert unless it says so), assessments, planning, admission, discharge, transfer, teaching, taking verbal orders or 1st of anything 

AID's can't do 

charting (only document what they did), assess, meds, IV, treatments, fleet enemas 

AIDS can do 

Soap suds enema, beds, bath, ADL's VS (not the first set), Accu check (not the first one) 

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