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Remar Virtual Trainer
when to give an amniocentesis - CORRECT ANSWER- 16 - 20 weeks gestation Amniocentesis teaching points - CORRECT ANSWER--written consent
- empty bladder before test
- ultrasound to locate uterus
- vital signs and FHR Q Amniocentesis watch for - CORRECT ANSWER--PROM Decreased fetal movement
- Infections Rh immune globulin - CORRECT ANSWER-This is given to a negative mother when the baby is positive RH when to give - CORRECT ANSWER-28 weeks gestation and 72 hours after indirect combs test - CORRECT ANSWER-This shows if the mother has antibodies for the RH factor. Negative means no antibodies Nonstress test - CORRECT ANSWER--Baby has irregular HR
- Decreased oxygenation
- Monitor fetal well being Administering NST - CORRECT ANSWER--28 weeks gestation
- Good if it is negative
- Non reactive: baby isn't moving as it should Hegar's sign - CORRECT ANSWER-softening of the uterus Goodell's sign - CORRECT ANSWER-softening of the cervix Chadwick sign - CORRECT ANSWER-bluish discoloration of the vagina and cervix Positive signs of pregnancy - CORRECT ANSWER--doctor notes fetal heart sounds
- doctor/tech visualizes fetus through ultrasound
- provider feels movement outside of stomach up to 28 weeks - CORRECT ANSWER-Mother is seen monthly 16 weeks gestation - CORRECT ANSWER-Lanugo is formed (tiny baby hairs)
28 - 36 weeks - CORRECT ANSWER-2 times a month visits/ Q2 weeks 28 weeks - CORRECT ANSWER-Alveoli and surfactant develops 36 - 42 weeks - CORRECT ANSWER-Weekly doctor visits 36 weeks gestation - CORRECT ANSWER-Rapid fat production occurs lightening - CORRECT ANSWER-The movement of the fetus down into the pelvis late in pregnancy. Gravidity - CORRECT ANSWER-number of pregnancies Parity - CORRECT ANSWER-Number of term pregnancies amniocentesis - CORRECT ANSWER-Fetal lung maturity and overall well being NST teach mother - CORRECT ANSWER--To eat or drink before test to help monitor baby's movement Morning sickness - CORRECT ANSWER--Due to hypoglycemia
- Eat dry carbohydrates
- Sit up after meals Back Pain (Pregnancy) - CORRECT ANSWER--Maintain good posture
- Use pelvic rocking Leg Cramps (Pregnancy) - CORRECT ANSWER--Prevent dorsiflexed foot Pregnancy Diet - CORRECT ANSWER-High protein diet with prenatal vitamins Anemia (Pregnancy) - CORRECT ANSWER-Normal finding. More RBC when pregnant. Kegals - CORRECT ANSWER-exercises to do that will strengthen the pelvic muscles to help treat incontinence Danger signs of pregnancy - CORRECT ANSWER--Sudden abdominal pain
- Abrupt flow of vaginal fluids
- Vaginal Bleeding
- Puffiness in hands and feer Terbutaline - CORRECT ANSWER--Premature labor, Watch for tachycardia Magnesium Sulfate - CORRECT ANSWER-Watch for decrease in RR, Urine output decrease and decrease in deep tendon reflexes
LION
LION - CORRECT ANSWER-Left side, IV fluids, Oxygen by face mask, Notify provider Variable FHR - CORRECT ANSWER-Cord compression
- Reposition and add fluids Post partum risk factors - CORRECT ANSWER-Dehydration and complications happen in first 24 hours Breast - CORRECT ANSWER-Enlargement, cabbage leaves Uterus atony - CORRECT ANSWER-Midline, firm, uterine massage Bladder - CORRECT ANSWER-Patient must urinate after birth Bowel - CORRECT ANSWER-Constipation can occur, narcotics slow down bowel Lochia - CORRECT ANSWER-vaginal discharge after childbirth Rubra - CORRECT ANSWER-Red 1-3 days Serosa - CORRECT ANSWER-Bloody tint, 4-6 days Alba - CORRECT ANSWER-White, clear 7-14 days episiotomy - CORRECT ANSWER--edges are approximated Extremeties - CORRECT ANSWER-Monitor for DVT, temperature, blood clots PICA - CORRECT ANSWER-eating non food items Eye ointment - CORRECT ANSWER-Protect against infections vaginally AVA - CORRECT ANSWER-two arteries and one vein umbilical cord Cord - CORRECT ANSWER-Monitor for signs of infection, redness Best way to test for illegal drugs for infants - CORRECT ANSWER-Urine Drug born infants - CORRECT ANSWER-High cry, poor sucking, elevated vital signs Drug treatment for newborns - CORRECT ANSWER--Cluster care Turn baby on Right side
- Elevate the bed and decrease handling
HIV mother - CORRECT ANSWER-No breast feeding, no live vaccinations until 18 months fetal alcohol syndrome - CORRECT ANSWER--low birth weight
- Flat nose
- Small eyes
- Thin lips
- Withdrawal:likes to be held spina bifida - CORRECT ANSWER-Neural tube defect, folic acid deficiency spina bifida treatment - CORRECT ANSWER-Shunt placement, don't place on their back Cleft Lip/Palate - CORRECT ANSWER-Surgical, do not give straws
- Elbow restraint
- Monitor for nutrition Blue baby - CORRECT ANSWER-Tetralogy of Fallot Tetralogy of Fallot - CORRECT ANSWER-Real: Right ventricular hypertrophy Oxygenation: Overriding aorta Problem: Pulmonary Stenosis Very Scary: Ventrical Septal Knees to chest Tetralogy of Fallot what is seen - CORRECT ANSWER--Clubbing of the fingers
- Dyspnea with activity
- Cyanosis 0 - 6 months - CORRECT ANSWER-Babblings, hold neck up, roll front to back, rattle mouth toy 6 - 9 months - CORRECT ANSWER-Fear of strangers, fear of height, pincher grasp, teething, blocks 9 - 12 months - CORRECT ANSWER-crawling, small words, standing, head circumfrence and chest are the same, push and pull toy, stand up with walker 1 - 3 years old - CORRECT ANSWER-parallel playing, possesive, time out for 1 minute per year 4 - 6 years old - CORRECT ANSWER-fine motor, hand dominence, schedule, feed themselves and teaching through play
Skin Breakdown - CORRECT ANSWER--nutrition monitor albumin 3.4-5.
- restraints
- Braden Skill Cardiac Aging - CORRECT ANSWER--Decreased cardiac output
- increase blood pressure
- Poor skin circulation and orthostatic hypertension Respiratory Aging - CORRECT ANSWER--increased oxygen demand
- deceased lung expansion
- O2 is a medication should not wear constantly integumentary Aging - CORRECT ANSWER-Repair the skin damage and low self esteem Reproductive System - CORRECT ANSWER--Women decrease estrogen
- Men decrease testosterone musculoskeletal aging - CORRECT ANSWER-Decrease muscle tone, decrease calcium levels Genital Urinary Aging - CORRECT ANSWER-Kidneys get smaller with age Bladder decrease in size Incontinence is normal Gastrointestinal Aging - CORRECT ANSWER-Dry mouth, constipation Nervous Aging - CORRECT ANSWER--Decrease in reaction time Mental function should stay intact Immune System Aging - CORRECT ANSWER-Encourage the flu vaccine Endocrine Aging - CORRECT ANSWER-Decrease in thyroid hormone, insulin production. Blood sugar increases. Sensory Aging - CORRECT ANSWER-Hearing, tasting, touching. High pitch sounds are the first to not hear NPO - CORRECT ANSWER-Bowel rest, aspiration, no food or water clear liquid diet - CORRECT ANSWER--prevent dehydration
- water, juice, see through coffee and tear Full Liquid - CORRECT ANSWER-Prevent dehydration as tolerated
- ice cream, milk, pudding
Pureed - CORRECT ANSWER-Small babies, dysphagia
- Keep foods seperate Mechanical Soft - CORRECT ANSWER--no nuts, no seeds
- difficulty chewing Bland - CORRECT ANSWER-Gastric irritation diet
- avoid CAP, caffiene, alcohol and peppers Protein restricted diet - CORRECT ANSWER-renal patients
- no animal meat, poultry or fish Sodium Restricted - CORRECT ANSWER-Heart healthy diet
- no canned food or salt High Fiber - CORRECT ANSWER--Prevent constipation, fruit and veggies Low Purine diet - CORRECT ANSWER-Gout
- avoid seafood, fish or sardines High Protein Diet - CORRECT ANSWER--Elderly and burn patients
- eat red meat, fish and beans Diabetic Diet - CORRECT ANSWER--blood glucose stable diets Celiac Diet - CORRECT ANSWER-Avoid gluten
- no bread, spagetti, pie, cookies, waffles or pancakes Elderly Hygiene - CORRECT ANSWER-Skin is prone to tears, wash and dry feet daily do not cut nails Who should give a patient a bath - CORRECT ANSWER-CNA Infants Sleep - CORRECT ANSWER- 14 - 20 hours a day, SIDS 2 - 8 Sleep - CORRECT ANSWER- 10 - 14 hours of sleep a day Adults sleep - CORRECT ANSWER- 7 - 9 hours of sleep a night Elderly 65+ sleep - CORRECT ANSWER-decline in deep sleep, establish a routine Dehydration signs - CORRECT ANSWER-No pee, dry mucous membranes, poor skin turgor and tachycardia Dehydration cure - CORRECT ANSWER-oral ml of 5 ml do not force fluids
EC - CORRECT ANSWER-coated medication ER - CORRECT ANSWER-extended release Ear medication - CORRECT ANSWER-Adult: pinna back and up Child: back and down Barrium - CORRECT ANSWER-White chalky mixture to drink before procedure Sodium polystyrene sodium - CORRECT ANSWER-Kayexalate, decreases potassium Gastric tube - CORRECT ANSWER-check placement with an x-ray
- assess for 500 ml of residual, over 500 do not give call doctor Intramuscular - CORRECT ANSWER-Maximum adults: 5 ml Maximum child: 2ml 90 degree angle Aminoglycosides - CORRECT ANSWER-clindamycin, azithromycin, streptomycin. Ototoxic, kidney, every 8 hours. Penicillin - CORRECT ANSWER--uti, STD, pneumonia, check for allergic reactions. Epinephrine. Tetracycline - CORRECT ANSWER--acne, pneumonia, UTI, STD
- don't ingest milk, antacids, iron, calcium
- stains the teeth
- nephrotoxic and phototoxic IV tubing should be changed every - CORRECT ANSWER-72 hours Infiltration - CORRECT ANSWER--swelling, puffiness, leaking, coolness, pallor
- Remove, Ice before 30 minutes, warm after 30 minutes phelebitis - CORRECT ANSWER--redness, warmth, pain
- Remove, Ice and restart in new location air embolism - CORRECT ANSWER--weak pulse, drop in blood pressure, chest pain.
- left side, feet elevated, oxygen and notify provider TPN - CORRECT ANSWER-bypasses the GI tract going through the veins TPN labs to monitor - CORRECT ANSWER-blood glucose
Substitute for TPN - CORRECT ANSWER-10% dextrose How often to change tubing for TPN - CORRECT ANSWER-24 hours PCA pump - CORRECT ANSWER-deliver pain medication when the patient wants, use for cancer and post op patients. Family can't push button, only patient. Substance abuse - CORRECT ANSWER-continued use of a substance to alter a patients mood emotion or state of consciousness Alcoholism - CORRECT ANSWER-Denial and rationalize the abuse
- tremors, sleeplessness, increased vital signs Delirium Tremors - CORRECT ANSWER-physical shaking, increased vital, halliucinations, paranoia, begins 12-36 hours. Wernickes - CORRECT ANSWER-brain damage from B1/thiamine deficiency. Encephalopathy Korsakoff's syndrome - CORRECT ANSWER-amnesia caused by chronic alcoholism Chloridiazepoxide/Lorazapam - CORRECT ANSWER-Seditive to reduce alcohol withdrawl symptoms Disulfiram - CORRECT ANSWER-Antabuse, makes patient not want to drink alcohol. beware of other items containing alcohol Opioids - CORRECT ANSWER-Heroin, cocaine, morphine, amphetamines Withdraw of opioids - CORRECT ANSWER-Flu like symptoms, it is an upper so they will be down. Medication for opioids - CORRECT ANSWER-Methadone - legal heroin Hypotonic - CORRECT ANSWER-lower than normal concentration
- concentration of particles, pulls fluid into the cells Osmotic Pressure - CORRECT ANSWER-pressure of the fluid as it crosses the membrane Hypotonic use - CORRECT ANSWER-Hypernatremia, avoid decreased renal patients, pulmonary edema and clients with burns.
- 0.45% or 2.5% dextrose Isotonic Fluid - CORRECT ANSWER-Same osmotic pressure, same concentration of particles
WBC value - CORRECT ANSWER--5,000-10, K purpose - CORRECT ANSWER-potassium is a mineral that is important for cardiac function K value - CORRECT ANSWER-3.5-5. Na purpose - CORRECT ANSWER-sodium maintains the fluid levels, nerve and muscle NA value - CORRECT ANSWER- 135 - 145 Ca purpose - CORRECT ANSWER-calcium is a mineral that is important for bone and teeth CA value - CORRECT ANSWER- 8 - 6 - 10 Mg purpose - CORRECT ANSWER-important for the nerves and muslce MG value - CORRECT ANSWER-1.6-2. CL purpose - CORRECT ANSWER-chloride keeps fluid balance in check, digested in the intestines CL value - CORRECT ANSWER- 95 - 105 CO2 purpose - CORRECT ANSWER-waste product for the respiratory system CO2 value - CORRECT ANSWER- 22 - 32 BUN purpose - CORRECT ANSWER-measures the level of urea in the blood from protein. Kidney function BUN value - CORRECT ANSWER- 8 - 25 Creatnine purpose - CORRECT ANSWER-Main test for kidney function. High creatnine meals renal failure Creatnine value - CORRECT ANSWER-0.6-1. Glucose purpose - CORRECT ANSWER-amount of sugar in the blood Glucose value - CORRECT ANSWER- 70 - 110 PTT purpose - CORRECT ANSWER-bodys ability to form a blood clot
PTT value - CORRECT ANSWER- 60 - 70 seconds aPTT purpose - CORRECT ANSWER-clients response to heparin, blood clotting with additive aPTT value - CORRECT ANSWER- 30 - 40 seconds INR purpose - CORRECT ANSWER-clotting time when a patient is on Warfarin or another anticoagulant INR value - CORRECT ANSWER- 1 - 2 Urine Specific Gravity purpose - CORRECT ANSWER-test kidney function and look at the particles in the urine Urine specific gravity value - CORRECT ANSWER-1.016-1. Platelets purpose - CORRECT ANSWER-smallest of the 3 major types of blood cells. Prevent bleeding Platelets value - CORRECT ANSWER-150,000-400, Potassium hyper signs - CORRECT ANSWER-Everything goes up except heart rate and urine Potassium hyper treatment - CORRECT ANSWER-Regular insulin, Kayexalate and loop diuretic Potassium hypo signs - CORRECT ANSWER-Down except heart rate and urine, weak, constipated, tachy. Fatigue High potassium food - CORRECT ANSWER-Bananas, potatoes, spinach Calcium hyper treatment - CORRECT ANSWER-Calcitonin What glands help absorb calcium - CORRECT ANSWER-Parathyroid gland 3 T for hyper calcium - CORRECT ANSWER-Tetany, twitches, trousseau Calcium hyper treatment - CORRECT ANSWER-Oral calcium 30 minutes before meal Magnesium hyper signs - CORRECT ANSWER-Hypotension, drowsiness, decreased respiration's, bradycardia Hyper magnesium treatment - CORRECT ANSWER-Stop magnesium and antacids
Red Disaster - CORRECT ANSWER-Life threatening. Yellow disaster - CORRECT ANSWER-Bodily injuries but stable green disaster - CORRECT ANSWER-Minor injuries stable walking Black disaster - CORRECT ANSWER-Death Who goes home abc - CORRECT ANSWER-Ambulatory, bedridden, critical care St. John wort action - CORRECT ANSWER-Reduce anxiety and depression St. John wort teaching - CORRECT ANSWER-Photosensitive and do not give to SSRI Garlic: Action - CORRECT ANSWER-Lowering blood pressure and cholesterol Garlic teaching - CORRECT ANSWER-Do not use with anticoagulant Ginkgo biloba - CORRECT ANSWER-Helps memory Ginkgo biloba teaching - CORRECT ANSWER-Do not use with anticoagulant Echinacea: Action - CORRECT ANSWER-Improve immune system, seasonal flu Echinacea teaching - CORRECT ANSWER-HIV, liver toxicity Ginger action - CORRECT ANSWER-Reduces nausea and vomiting Ginger teaching - CORRECT ANSWER-At risk for bleeding Black Cohosh: Action - CORRECT ANSWER-Alleviate menopausal symptoms, hot flash, sweats Black cohosh teaching - CORRECT ANSWER-Premature labor Kava Kava action - CORRECT ANSWER-Anxiety, insomnia, muscle pain Kava kava treatment - CORRECT ANSWER-Hepatotoxic and lowers Parkinson's medication Saw palmetto: Action - CORRECT ANSWER-Benign prostate hypertrophy, headache Saw Palmetto teaching - CORRECT ANSWER-Cause erectile dysfunction R.o.m.e - CORRECT ANSWER-Respiratory Opposite Metabolic Equal
respiratory alkalosis breathing - CORRECT ANSWER-Breathing too fast respiratory acidosis breathing - CORRECT ANSWER-Breathing too slow Metabolic alkalosis sign - CORRECT ANSWER-Vomiting, suction Metabolic acidosis - CORRECT ANSWER-Everything besides vomiting and suction chest tube - CORRECT ANSWER-One way to drain fluid our air that has escaped the plural space Negative pressure - CORRECT ANSWER-Normal breathing tension pneumothorax - CORRECT ANSWER-Air between the lung and chest wall Trachea deviation - CORRECT ANSWER-Lowers blood pressure, lung expansion is down on affected side, oxygenation is down and jugular veins distended Tx of tension pneumothorax - CORRECT ANSWER-Needle decompression into second intercostal space Collection chamber - CORRECT ANSWER-Collect fluid, should not have bright Read fluid or more than 100 ML water seal chamber - CORRECT ANSWER-2 cm of water allow air to exist from plural space, prevent air to enter during inhalation. Bubbling equals bad. Intermittent equals good suction control chamber - CORRECT ANSWER-Amount of suction applied, bubbling is great intermittent is bad that suction isn't working Care for chest tube and the client - CORRECT ANSWER-Respiratory distress, breath sounds, stable vitals. Chest tube should be placed below chest level. Daily x-rays. Occlusive dressing. Chest tube nclex - CORRECT ANSWER-Water seal is broken place distal end in 2 cm of water Pulled the chest tube out - CORRECT ANSWER-Use a gloved hand cover the opening within occlusive dressing tape on 3 sides Patient won't comply complains of pain - CORRECT ANSWER-Medicate client, teach cough deep breath What kind of lung sounds will you here with a chest tube - CORRECT ANSWER- Crackles diminished
After angiogram - CORRECT ANSWER-Assess for bleeding, bed for 4-6 hours What does cholesterol do - CORRECT ANSWER-matters for hormones, food intake and protecting the cells LDL - CORRECT ANSWER-less than 100 HDL - CORRECT ANSWER-more than 60 Total cholesterol - CORRECT ANSWER-less than 200 Triglycerides - CORRECT ANSWER-less than 150 Statin medication - CORRECT ANSWER-works for cholesterol lowering SS of statin medication - CORRECT ANSWER-weak, tired, muscle aches B3 niacin - CORRECT ANSWER-better than statin medication raises HDL SS of niacin - CORRECT ANSWER-fluishing face, give aspirin 30 minutes before Dyslipidemia - CORRECT ANSWER-check for rhabdomyolysis - death of muscles Damage from free flowing muscle - CORRECT ANSWER-kidneys Goal for loweing cholesterol - CORRECT ANSWER-avoid high fat foods, avocados are good Menieres disease - CORRECT ANSWER-in the inner ear that results in too much fluid meniere disease affects - CORRECT ANSWER-only one side meniere symptoms - CORRECT ANSWER-vertigo, tinnitus, loss of hearing unilateral meniere patient - CORRECT ANSWER-complains of nausea, balance and fullness in the ear Diagnosis of meniere's disease - CORRECT ANSWER-MRI, dehydration test Meniere treatment - CORRECT ANSWER-antiemetic, aminoglycoside, diuretic, sedatives SS of diabetes - CORRECT ANSWER-Polyuria, polydipsia, polyphasia. Can't see can't spit, cant pee cant shit
Hyperglycemia - CORRECT ANSWER-IV fluid and iv regular insulin 0. Hypoglycemia - CORRECT ANSWER-eat carbs, IV dextorose Rapid insulin - CORRECT ANSWER-with meals, 1 hour peak and 3 hour duration Short acting insulin - CORRECT ANSWER-1 hour, before meals, 2 hour peak and 4 hour duration intermediate acting insulin - CORRECT ANSWER-2 hour onset, 6 hour peak and 14 hour duration Long action insulin - CORRECT ANSWER-1 hour onset, peakless, give medication at bedtime, 70/30 insulin - CORRECT ANSWER-30 minutes onset, 2 hour peak and 12 hour duration Metformin - CORRECT ANSWER-B12 deficiency, nausea, GI distress Metformin education - CORRECT ANSWER-can take pregnant, use for pcos, decrease sugar by the liver Sulfonylureas (tolbutamide, glyburide, glipizide, glimepiride) - CORRECT ANSWER- weight gain and rash Sulfonylurea client education - CORRECT ANSWER-stimulate insulin beta cell, multiple dosage may be needed, can be mixed with metformin Insulin injection - CORRECT ANSWER-90 degree angle Akastasia - CORRECT ANSWER-Inability to sit still
