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)
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
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!!
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
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
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
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), age only important for peds
All psych drugs cause
low BP and weight change (usually gain)
Phenothiazines
all end in ‘zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety
‘Zines for the
Zanny
In large doses Phenothiazines are
anti-psychotics
In small doses Phenothiazines are
anti-emetics
Side effects of Phenothiazines
Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness, Extrapyramidal syndrome (parkinsons), Fotosensitivity, aGranulocytosis (low WBC’s)
1 problem or concern for patient taking Phenothiazines
SAFETY
Deconoate drug is
a long acting IM form given to non compliant patients
Tricyclic Antidepressants are
mood elevators to treat depression
Examples of Tricyclic anti depressants
Elavil, tofranil, aventyl desyrel
Side effects of Tricyclic medications
Anticholinergic(dry mouth), Blurred Vision, Constipation, Drowsiness, Euphoria HInt: Elavil starts with E so this group goes through E
How long does a tricyclic need to be taken before results are seen?
2-4 weeks
Benzodiazepines are for
anti anxiety, they are minor tranquilizers, have ‘zep in the name, EX: Diazepam (Valium), plus Xanax, Often given pre op, muscle relaxant, alcohol withdrawal, seizures, facilitates mechanical ventilation
Benzodiazepines works
quickly, must not take for 6 weeks, keep on Valium until Elavil kicks in
Side effects for Benzodiazepines
Anticholinergic (dry mouth), Blurred Vision, Constipation, Drowsiness
Number one nursing concern for patient taking Benzo’s is
also safety
MAOI’s
antidepressants, happy pills
Depression is caused by a deficiency of
norepinephrine, dopamine and serotonin in the brain
Names of MAOI’s
MAR, NAR, PAR: Marplan, Nardil, Parnate
Side effects of MAOI’s
Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness
How long can a person be on MAOI’s and how long before they work?
rest of life, 2-4 weeks
MAOI’s interact with LOTS
Avoid all foods containing Tyramine, causes fatal hypertension
Tyramine foods
Fruits and Veggies are okay except remember salad BAR, avoid Banannas, Avacados, Raisins, Grains are okay except for active yeast, no organ meats, no preserved meats, no dairy, no alcohol, tinctures, caffiene, chocolate, licorice, soy sauce
Lithium
for bipolar disorder (manic depression) it decreases mania
Side effects of Lithium
peeing, pooping, parasthesia
Lithium Toxicity
2 or greater, tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too
Lithium monitor what levels
sodium, low sodium levels prolong lithium’s half-life, causing lithium toxicity, high sodium levels decrease the effectiveness of lithium
Prozac
it an SSRI, similar to Elavil so same info as Tricyclic’s
Prozac causes
insomnia, so give before noon, so if BID, give at 6A and 12N NOT at bedtime
When changing the dose of Prozac for an adolescent or young adult, watch for
suicide
‘zine, ‘zep, ‘zap
all tranquilizers
a good guess about psych med weening
decrease the dose of the old drug
Haldol
just like the Thorazine’s, also has a deconoate form
Dose of Haldol for elderly patient should be
half of usual adult dose
Clozaril (Clozapine)
‘zap’s, for schizophrenia
‘zap’s, for schizophrenia
aGranulocytosis
How often should WBC be drawn when pt is taking ‘zap’s for schizo?
1 time per week for 1 month, 1 month every month for 6 months then every 6 months
Zoloft (sertraline)
also a SSRI like prozac, antidepressant, doesn’t cause insomnia so it can be taken at bedtime.
Zoloft interacts with other medications like
St John’s wart (causes serotonin syndrome) – sweating, apprehension (impending sense of doom), dizziness (vertigo), headache, also with Coumadin so watch for bleeding
Zoloft with Coumadin?
Question the order if the coumadin dose wasn’t lowered
Never mix _ in children’s food
medications
If you know what a particular drug does, choose a side effect in the same _ ____ where the drug is working.
body system Ex: heart drug – tachycardia
If a medication is taken PO and you dont know what the drug does pick a __ side effect
GI
If two answers say the same thing …
neither one is right EX: tachycardia and racing heart
If two answers are opposite, one of them is
probably right (consider one of them)
Names of uppers
caffiene, cocaine, PCP/LSD, Amphetamines/meth, adderol/ritalin
Do give aminoglycocides via PO in
hepatic encephalopathy & pre-op bowel surgery
Peak level for sublingual
5-10 minutes after disolved
Peak level for IV
15-30 min after finished
Peak level for IM
30-60 min after drug is in
Peak level for SQ
diabetes peak levels apply here
Ventricular gets what med
Lidocane (think of the V turning sideways to an L) & Amiodorone
AsystolE gets what med
A for Atropine and E for Epinephrine … Epi is first though
Atrial Arrhythmias (same as supraventricular) medications
ABCD
Adenocard (push fast)
Beta Blockers (‘lol)
CCB’s
Digoxin
Water Seal bubbling intermittently or a suction control chamber bubbling continously is
GOOD
Water Seal bubbling continuously or a suction control chamber bubbling intermittently is
BAD
A Seal should not be
bubbling
What to do first if a water seal breaks?
clamp