HESI Hints & NCLEX Gems Answering NCLEX Questions o Maslows Hierarch o!

Nee"s #h
siologic Sa!et Lo$e an" %elonging Esteem Sel!&actuali ation o Nursing #rocess As
sessment (iagnosis )Anal sis* #lanning Im+lementation )treatment* E$aluation o A
%Cs Airwa %reathing Circulation Normal ,alues o Hg Males ./&.0 1emales .2&.3 o Hc
t Males /2&42 1emales 56&/6 o 7%Cs Males /86&38. million 1emales /82&48/ million
o 9%Cs /84&..: o #latelets .4;&/;;: o #< )Couma"in=9ar!arin* ..&.284 sec )IN7 a
n" #< <7 > .84&2 times normal* o A#<< )He+arin* 3;&6; sec )A#<< an" #<< <7 > .84
&284 times normal*

o %?N .;&2; o Creatinine ;84&.82 o Glucose 6;&..; o Cholesterol @ 2;; o %iliru-i

n New-orn .&.2 o #hen lalanine New-orn @ 2A A"ult @ 3 o NaB .53&./4 o CB 584&4 H
+oCB 8 8 8 #rominent ? wa$esA (e+resse" S< segmentA 1lat < wa$es H +erCB 8 8 8
<all <&9a$esA #rolonge" #7 inter$alA wi"e Q7S o CaBB D&.;84 H +ocalcemia E muscl
e s+asmsA con$ulsionsA cram+s=tetan A B <rousseausA B Ch$oste:sA +rolonge" S< inte
r$alA +rolonge" Q< segment o MgB .84&284 o Cl& D3&.;3 o #hos 5&/84 o Al-umin 584
&4 o S+ec Gra$it .8;;4&.8;5; o Gl cos late" Hemoglo-in )Hg- A.c*F /&3G i"ealA @
684G > HC ).2; "a s* o (ilantin <7 > .;&2; o Lithium <7 > ;84&.84 o Arterial %lo
o" Gases E ?se" !or Aci"osis $s8 Al:alosis #H 6854&68/4 CH2 54&/4 )7es+irator "r
i$er* E High > Aci"osis HCH5 2.&20 )Meta-olic "ri$er* E High > Al:alosis H2 0;&.
;; H2 Sat D4&.;;G Anti"otes o (igoIin E (igi-an" o Couma"in E ,itamin C )Cee+ #<
an" IN7 J .&.84 X normal* o %en o"ia a+ines E 1lum aemil )<oma icon* o Magnesiu
m Sul!ate E Calcium GluconateK o He+arin E #rotamine Sul!ate )Cee+ A#<< an" #<<
J .84&284 X normal*

o < lenol E Mucomist ).6 "oses B loa"ing "ose* o H+iates )narcotic analgesicsA h
eroinA mor+hine* E Narcan )NaloIone* o Cholinergic Me"s )M esthenic %ra" car"ia*
E Atro+ine o MethotreIate E Leuco$orin (elegation o 7N Hnl %loo" #ro"ucts )2 7N
s must chec:* Clotting 1actors Sterile "ressing changes an" +roce"ures Assessmen
ts that reLuire clinical Mu"gment ?ltimatel res+onsi-le !or all "elegate" "uties
o ?nlicense" Assisti$e #ersonnel Non&sterile +roce"ures #recautions & 7oom Assi
gnments o ?ni$ersal )Stan"ar"* #recautions E HI, initiate" 9ash han"s 9ear Glo$e
s Gowns !or s+lashes Mas:s an" E e #rotection !or s+lashes an" "ro+lets (ont reca
+ nee"les Mouth+iece or Am-u&-ag !or resuscitation 7e!rain !rom gi$ing care i! o
u ha$e s:in lesion o (ro+let )7es+irator * #recautions )9ear Mas:* Se+sisA Scarl
et 1e$erA Stre+A 1i!th (isease )#ar$o %.D*A #ertussisA #neumoniaA In!luen aA (i+
theriaA E+iglottitisA 7u-ellaA 7u-eolaA MeningitisA M co+lasmaA A"eno$irusA 7hin
o$irus 7S, )nee"s contact +recautions too* <% E 7es+irator Isolation o Contact #
recautions > ?ni$ersal B GogglesA Mas: an" Gown o No in!ection +atients with imm
unosu++resse" +atients 9eir" Miscellaneous Stu!! o 7i!am+in )!or <%* E 7ust=oran
ge=re" urine an" -o" !lui"s o # ri"ium )!or -la""er in!ection* E Hrange=re"=+in:
urine o Glasgow Coma Scale E @ 0 > coma

o M esthenia Gra$is M esthenic Crisis > 9ea:ness with change in $itals )gi$e mor
e me"s* Cholinergic Crisis > 9ea:ness with no change in $itals )re"uce me"s* o (
ia-etic Coma $s8 Insulin Shoc: E Gi$e glucose !irst N I! no hel+A gi$e insulin o
1ruit %reath > (ia-etic Cetoaci"osis o Aci"&%ase %alance I! it comes out o! our
assA its Aci"osis8 ,omiting > Al:alosis o S:in <astes Salt > C stic 1i-rosis o L
i+itor )statins* in #Ms onl N No gra+e!ruit Muice o Stro:e E <ongue +oints towar
" si"e o! lesion )+aral sis*A ?$ula "e$iates awa !rom the si"e o! lesion )+aral
sis* o Hol" (igoIin i! H7 @ 3; o Sta in -e" !or 5 hours a!ter !irst ACE Inhi-ito
r "ose o A$oi" Gra+e!ruit Muice with CaBB Channel %loc:ers o AnthraI > Multi&$ec
tor -ioha ar" o #ulmonar air em-olism +re$ention > <ren"elen-urg )HH% "own* B on
le!t si"e )to tra+ air in right si"e o! heart* o Hea" <rauma an" Sei ures E Mai
ntain airwa > +rimar concern o #e+tic ?lcers E 1ee" a (uo"enal ?lcer )+ain relie
$e" - !oo"* E Star$e a gastric ulcer o Acute #ancreatitis E 1etal +ositionA %lui
sh "iscoloration o! !lan:s )<urners Sign*A %luish "iscoloration o! +ericum-elical
region )Cullens Sign*A %oar" li:e a-"omen with guar"ing E Sel! "igestion o! +anc
reas - tr +sin8 o Hol" tu-e !ee"ing i! resi"ual O .;;mL o In case o! 1ire E 7ACE
an" #ASS o Chec: 7estraints e$er 5; minutes E 2 !ingers room un"erneath o Gulla
in&%arre S n"rome E 9ea:ness +rogresses !rom legs u+war" N 7es+ arrest o <rough
"raw > P5; min -e!ore sche"ule" a"ministration E #ea: (raw > 5;&3; min a!ter "ru
g a"ministration8

 Mental Health & #s chiatr o Most suici"es occur a!ter -eginning o! im+ro$ement w
ith increase in energ le$els o MAHIs E H +ertensi$e Crisis with < ramine !oo"s N
ar"ilA Mar+lanA #arnate Nee" 2 w: ga+ !rom SS7Is an" <CAs to a"min MAHIs o Lithi
um <hera+eutic 7ange > ;84&.84 o #henothia ines )t +ical anti+s chotics* N E#SA
#hotosensiti$it o At +ical Anti+s chotics N wor: on +ositi$e an" negati$e s m+to
msA less E#S o %en os )Ati$anA Lora e+amA etc* goo" !or Alcohol with"rawal an" S
tatus E+ile+ticus o Anta-use !or Alcohol "eterrence N Ma:es ou sic: with HH inta
:e o Alcohol 9ith"rawal > (elerium <remens N <ach car"iaA tach +neaA anIiet A na
useaA sha:esA hallucinationsA +aranoia E )(<s start .2&53 hrs a!ter last "rin:*
o H+iate )HeroinA Mor+hineA etc8* 9ith"rawal > 9ater e esA runn noseA "ilate" +u
+ilsA N,(A cram+s o Stimulants 9ith"rawal > (e+ressionA !atigueA anIiet A "istur
-e" slee+ Me"ical&Surgical o H +o$entilation > Aci"osis )too much CH2* o H +er$e
ntilation > Al:alosis )low CH2* o No %# or I, on si"e o! Mastectom o H+iate H( >
#in+oint #u+ils o Lesions o! Mi"-rain > (ecere-rate #osturing )EIten"e" el-owsA
hea" arche" -ac:* o Lesions o! CorteI > (ecorticate #osturing )1leIion o! el-ow
sA wristsA !ingersA straight legsA mumm +osition* o ?rine Hut+ut o! 5; mL=hr > m
inimal com+etenc o! heart an" :i"ne !unction o Ci"ne Stone > Cholelithiasis 1lan
: +ain > stone in :i"ne or u++er ureter A-"ominal=scrotal +ain > stone in mi"=lo
wer ureter or -la""er o 7enal 1ailure E 7estrict +rotein inta:e

 1lui" an" electrol te +ro-lems E 9atch !or H +erCB )"i A w:A nauseaA cram+sA a
rh thmias* #re&renal #ro-lem > Inter!erence with renal +er!usion Intra&renal #ro
-lem> (amage to renal +arench ma #ost&renal #ro-lem > H-struction in ?< an where
!rom tu-ules to urethral meatus8 ?suall 5 +hases )HligouricA (iureticA 7eco$er
* Monitor %o" 9t an" I&Hs o Steroi" E!!ects > Moon !aceA h +ergl cemiaA acneA hi
rsutismA -u!!alo hum+A moo" swingsA weight gain N S+in"le sha+eA osteo+orosisA a
"renal su++ression )"ela e" growth in :i"s* 8 8 8 )Cushings S n"rome s m+toms* o
A""isons Crisis > me"ical emergenc )$ascular colla+seA h +ogl cemiaA tach car"ia E
A"min I, glucose B corticosteroi"s* E No #H corticosteroi"s on em+t stomach o #
otassium s+aring "iuretic > Al"actone )S+ironolactone* E 9atch !or h +erCB with
this an" ACE Inhi-itors8 o Car"iac En mes E <ro+onin ). hr*A CCM% )2&/ hr*A M o
glo-in ).&/ hr*A L(H. ).2&2/ hr* o MI <I E Nitro N Qes E NH (igoIinA %eta-loc:er
sA Atro+ine o 1i-rinol tics > Stre+to:inaseA <enecte+lase )<NCase* o CA%G > Coro
nar Arter % +ass Gra!t o #<CA > #ercutaneous <ransluminal Coronar Angio+last o S
eI a!ter MI o:a when a-le to clim- 2 slights o! stairs without eIertion )<a:e ni
tro +ro+h lacticall -e!ore seI* o %#H <I > <?7# )<ransurethral 7esection o! #ros
tate* E some -loo" !or / "a sA an" -urning !or 6 "a s +ost&<?7#8 o Hnl isotonic
sterile saline !or %la""er Irrigation o #ost <h roi"ectom N Cee+ tracheostom set
- the -e" with H2A suction an" Calcium gluconate o #ericar"itis E #ericar"ial 1
riction 7u-A #ain relie$e" - leaning !orwar" o #ost Stre+ ?7I (iseases an" Con"i
tionsF Acute Glomerulone+hritis 7heumatic 1e$er E ,al$e (isease Scarlet 1e$er o
I! a chest&tu-e -ecomes "isconnecte"A "o not clam+ E #ut en" in sterile water

o Chest <u-e "rainage s stem shoul" show -u--ling an" water le$el !luctuations )
ti"aling with -reathing* o <% E <reatment with multi"rug regimen !or D months E
7i!am+in re"uces e!!ecti$eness o! HCs an" turns +ee orange E Isonia i"e )INH* in
creases (ilantin -loo" le$els o ?se -roncho"ilators -e!ore steroi"s !or asthma E
EIhale com+letel A Inhale "ee+l A Hol" -reath !or .; secon"s o ,entilators E Ma
:e sure alarms are on E Chec: e$er / hours minimum o Suctioning E #re an" #ost o
I genate with .;;G H2 E No more than 5 +asses E No longer than .4 secon"s E Suct
ion on with"rawal with rotation o CH#(F Em+h sema > #in: #u!!er Chronic %ronchit
is > %lue %loater )C anosisA 7t si"e" heart !ailure > -loating=e"ema* o H2 A"min
istration Ne$er more than 3L=min - cannula Must humi"i! with more than /L=hr No
more than 2L=min with CH#( E )CH2 Narcosis* In ascen"ing or"er o! "eli$er +otenc
F Nasal CannulaA Sim+le 1ace Mas:A Nonre-reather Mas:A #artial 7e-reather Mas:A
,enturi Mas: 7estlessness an" Irrita-ilit > Earl signs o! cere-ral h +oIia I,s
an" %loo" #ro"uct A"ministration o .0&.D gauge nee"le !or -loo" with !ilter in t
u-ing o 7un -loo" with NS onl an" within 5; minutes o! hanging o ,itals an" %rea
th Soun"s E -e!oreA "uring an" a!ter in!usion ).4 min a!ter startA then 5; min l
aterA then hourl u+ to . hr a!ter* o Chec: %loo"F EI+ (ateA clotsA colorA air -u
--lesA lea:s o 2 7Ns must chec: or"erA +tA -loo" +ro"uct E As: #t a-out +re$ious
trans!usion HI o Sta with #t !or !irst .4 minutes E I! trans!usion rIn E Sto+ a
n" C,H with NS o #re&me"icate with %ena"r l +rn !or +re$ious urticaria rIns o Is
otonic Solutions (49

 NS );8DG NaCl* 7ingers Lactate NS onl with -loo" +ro"ucts an" (ilantin (ia-etes
an" Insulin o 9hen in "ou-t N <reat !or H +ogl cemia !irst o 1irst I, !or (CA >
NSA then in!use regular insulin I, as 7I" o H +ogl cemia E con!usionA HAA irritaleA nauseaA sweatingA tremorsA hungerA slurring o H +ergl cemia E wea:nessA s nc
o+eA +ol "i+siaA +ol uriaA -lurre" $isionA !ruit -reath o Insulin ma -e :e+t at
room < !or 20 "a s o (raw 7egular )Clear* insulin into s ringe !irst when miIing
insulins o 7otate InMection Sites )7otate in . regionA then mo$e to new region*
o 7a+i" Acting Insulins E Lis+ro )Humalog* an" As+art )No$olog* E HF 4&.4 minA
#F 864&.84 hrs o Short Acting Insulin E 7egular )human* E HF 5;&3; minA #F 2&5 h
rs )I, H:a * o Interme"iate Acting Insulin E Iso+hane Insulin )N#H* E HF .&2 hrs
A #F 3&.2 hrs o Long Acting Insulin E Insulin Glargine )Lantus* E HF .8. hrA #F
./&2; hrs )(ont MiI* o Hral H +ogl cemics "ecrease glucose le$els - stimulating i
nsulin +ro"uction - -eta cells o! +ancreasA increasing insulin sensiti$it an" "e
creasing he+atic glucose +ro"uction Gl -uri"eA Met!ormin )Gluco+hage*A A$an"iaA
Actos Acar-ose -lunts sugar le$els a!ter meals Hncolog o Leu:emia E Anemia )re"u
ce" 7%C +ro"uction*A Immunosu++ression )neutro+enia an" immature 9%Cs*A Hemorrha
ge an" -lee"ing ten"encies )throm-oc to+enia* Acute L m+hoc tic > most common t
+eA :i"sA -est +rognosis o <esticular Cancer E #ainless lum+ or swelling testicl
e E S<E in shower O ./ rs E .4&54 > Age o #rostate Cancer E O /; > Age #SA ele$a
tion (7E

 Mets to s+ineA hi+sA legs Ele$ate" #A# )+rostate aci" +hos+hatase* <7?S > <ransu
rethral ?S #ost H+ E Monitor o! hemorrhage an" car"io$ascular com+lication o Cer
$ical an" ?terine Cancer LaserA cr othera+ A ra"iationA coni ationA h sterectom
A eIenteration E Chemothera+ > No hel+ #A# smears shoul" start within 5 ears o!
intercourse or - age 2. o H$arian Cancer > lea"ing cause o! "eath !rom g necolog
ical cancer o %reast Cancer > Lea"ing cause o! cancer in women ?++er outer Lua"r
antA le!t O right Monthl S%E Mammogra+h E %aseline J 54A Annuall a!ter age 4; Me
ts to l m+h no"esA then lungsA li$erA -rainA s+ine Mastectom E 7a"ical Mastectom
> L m+h no"es too )-ut no mm resecte"* A$oi" %# measurementsA inMections an" $e
ni+uncture on surgical si"e o Anti&emetics gi$en with Chemothera+ Agents )C toIa
nA MethotreIateA Inter!eronA etc8* #henergan )#rometha ine HCl* Com+a ine )#roch
lor+era ine* 7eglan )Metocol+rami"e* %ena"r l )(i+henh "ramine* Ro!ran )Hn"anset
ron HCl* C tril )Granisetron* SeIuall <ransmitte" (iseases o S +hilis )<re+onema
+alli"um* E Chancre B re" +ainless lesion )#rimar StageA D; "a s* 888 Secon"ar
Stage )u+ to 3 mo* > 7ash on +alms an" soles B 1lu&li:e s m+toms E <ertiar Stage
> Neurologic an" Car"iac "estruction ).;&5; rs* E <reate" with #enicillin G IM8
o Gonorrhea )Neisseria Gonorrhea* E Qellow green urethral "ischarge )<he Cla+*
o Chlam "ia )Chlam "ia <rachomatis* E Mil" $aginal "ischarge or

urethritis E (oI c clinA <etrac cline o <richomoniasis )<richomonas ,aginalis* E

1roth !oul&smelling $aginal "ischarge E 1lag l o Can"i"iasis )Can"i"a Al-icans*
E QellowA chees "ischarge with itching E Micona oleA N statinA Clomitra ole )G
ne&Lotrimin* o Her+es Sim+leI 2 E Ac clo$ir o H#, )Human #a++ilo$irus* E Aci"A L
aserA Cr othera+ o HI, E Coc:tails #erio+erati$e Care o %reathing Es taught in a
"$ance )-e!ore or earl in +re&o+* o 7emo$e nail +olish )nee" to see ca+ re!ill*
o #re H+ E Me"s as or"ere"A N#H X 0 hrsA Incenti$e S+irometr & %reathing Es taug
ht in a"$anceA ,oi"A No NSAI(S X /0 hrs o Increase" corticosteroi"s !or surger )
stress* E Ma nee" to increase insulin too o #ost H+ restlessness ma > hemorrhage
A h +oIia o 9oun" "ehiscence or eItra$isation E 9et sterile NS "ressing B Call (
r8 o Call (r8 +ost o+ i! E @ 5; mL=hr urineA S s %# @ D;A < O .;; or @ D3 o #ost
H+ Monitoring ,S an" %S E E$er .4 minutes the !irst hourA E$er 5; min neIt 2 ho
ursA E$er hour the neIt / hoursA then E$er / hours +rn o .&/ hrs #ost H+ > Imme"
iate Stage E 2&2/ hrs #ost H+ > Interme"iate Stage E .&/ "a s #ost H+ > EIten"e"
Stage o #ost H+ #ositioning <H7 E No A""uction +ast mi"lineA No hi+ !leIion +as
t D; "egrees Su+ratentorial SI E HH% 5;&/4 "egrees )Semi&1owler* In!rantentorial
SI E 1lat #hle-itis E Su+ineA ele$ate in$ol$e" leg Harris <u-e E 7t=-ac:=Lt N t
o a"$ance tu-e in GI Miller A--ott <u-e E 7ight si"e !or GI a"$ancement into sma
ll intestine <horacocentesis E ?na!!ecte" si"eA HH% 5;&/4 "egrees Enema E Le!t S
ims )!low into sigmoi"* Li$er %io+s E 7ight si"e with +illow=towel against +unct
ure site

 Cataract SI E H++ si"e N Semi&1owler Car"iac Catheteri ation E 1lat )HH% no more
than 5; "egrees*A Leg straight /&3 hrsA -e" rest 3&.2 hrs %urn Autogra+h E Ele$
ate" an" Immo- 5&6 "a s Am+utation E Su+ineA ele$ate stum+ !or /0 hrs Large %rai
n <umor 7esection E Hn non&o+erati$e si"e o Incenti$e S+irometr E Inhale slowl a
n" com+letel to :ee+ !low at 3;;&D;;A Hol" -reath 4 secon"sA .; times +er hr o #
ost H+ %reathing EIercises E E$er 2 hours Sit u+ straight %reath in "ee+l thru n
ose an" out slowl thru +urse" li+s Hol" last -reath 5 secon"s <hen cough 5 times
)unless a-" woun" N rein!orce=s+lint i! cough* o 9atch !or Stri"or a!ter an nec
:=throat SI E Cee+ <rach :it at -e" si"e o Sta+les an" sutures remo$e" in 6&./ "
a s N Cee+ "r until then o No li!ting o$er .; l-s !or 3 wee:s )in general* o I!
chest tu-e comes "isconnecte"A +ut !ree en" in container o! sterile water o 7emo
$ing Chest <u-e E ,alsal$asA or (ee+ -reath an" hol" o I! chest tu-e "rain sto+s
!luctuatingA the lung has re&in!late" )or there is a +ro-lem* o Cee+ scissors -e" i! +t has S8 %la:emore <u-e )!or eso+h $arices*E Su""en res+irator "istress
N Cut in!lation tu-es an" remo$e o <racheostom +atients E Cee+ Cell clam+ an" H
-turator )use" to insert into trachea then remo$e" lea$ing cannula* at -e" si"e
o <urn o!! NG suction !or 5; min a!ter #H me"s o NG <u-e 7emo$al E <a:e a "ee+ reath an" hol" it o Stomach contents +H > @ / )gastric Muices as+irate"* o NG <u
-e Insertion E I! cough an" gagA -ac: o!! a littleA let calmA a"$ance again with
+t si++ing water !rom straw o NG <u-e Length E En" o! noseA to era lo-eA to I +
hoi" )P22&23 inches* o (ecu-itus )+ressure* ?lcer Staging Stage . > Er thema onl
Stage 2 > #artial thic:ness

 Stage 5 > 1ull thic:ness to SQ Stage / > 1ull thic:ness B in$ol$ing mm =-one Acu
te Care o C,A E Hemorrhagic or Em-olic A&!i- an" A&!lutter > throm-us !ormation
( sarthria )$er-al enunciation=articulation*A A+raIia )+er!orm +ur+ose!ul mo$eme
nts*A ( s+hasia )s+eech an" $er-al com+rehension*A A+hasia )s+ea:ing*A Agra+hia
)writing*A AleIia )rea"ing*A ( s+hagia )swallowing* Le!t Hemis+here Lesion E a+h
asiaA agra+hiaA slowA cautiousA anIiousA memor o:a 7ight Hemis+here Lesion E cant
recogni e !acesA loss o! "e+th +erce+tionA im+ulsi$e -eha$iorA con!a-ulatesA +o
or Mu"gmentA constantl smilesA "enies illnessA loss o! tonal hearing o Hea" InMu
ries E E$en su-tle changes in moo"A -eha$iorA restlessnessA irrita-ilit A con!us
ion ma in"icate increase" IC# Change in le$el o! res+onsi$eness > Most im+ortant
in"icator o! increase" IC# 9atch !or CS1 lea:s !rom nose or ears N Lea:age can
lea" to meningitis an" mas: intracranial inMur since usual increase" IC# s m+s m
a -e a-sent8 o S+inal Cor" InMuries 7es+irator status +aramount E C5&C4 inner$at
es "ia+hragm . w: to :now ultimate +rognosis S+inal Shoc: > Com+lete loss o! all
re!leIA motorA sensor an" autonomic acti$it -elow the lesion > Me"ical emergenc
#ermanent +aral sis i! s+inal cor" in com+resse" !or .2&2/ hrs H +otension an"
%ra" car"ia with an inMur a-o$e <3 %la""er In!ection > Common cause o! "eath )tr
to :ee+ urine aci"ic* o %urns In!ection > #rimar concern H +erCB "ue to cell "a
mage an" release o! intracellular CB Gi$e me"s -e!ore "ressing changes N #ain!ul
Massi$e $olumes o! I, !lui" gi$enA "ue to !lui" shi!t to interstitial s+aces an
" resultant shoc:

 1irst (egree > E+i"ermis )su+er!icial +artial thic:ness* Secon" (egree > E+i"erm
is an" (ermis )"ee+ +artial thic:ness* <hir" (egree > E+i"ermisA (ermisA an" SQ
)!ull thic:ness* 7ule o! Ds E Hea" an" nec: > DGA ?E > DG eachA LE > .0G eachA 1
ront trun: > .0GA %ac: <run: > .0G Singe" nasal hair an" circumoral soot=-urns >
Smo:e inhalation -urns o 1ractures 7e+ort a-normal assessment !in"ings +rom+tl
E Com+artment S n"rome ma occur > #ermanent "amage to ner$es an" $essels 4 #s o!
neuro$ascular status )im+ortant with !ractures* #ainA #allorA #ulseA #aresthesia
A #aral sis #ro$i"e age&a++ro+riate to s !or :i"s in traction S+ecial <ests an"
#athognomonic Signs o <ensilon <est E M esthenia Gra$is )B in M esthenic crisisA
& in Cholinergic crisis* o ELISA an" 9estern %lot E HI, o Sweat <est E C stic 1
i-rosis o Cheilosis > Sores on si"es o! mouth E 7i-o!la$in "e!icienc )%2* o <rou
sseaus Sign )Car+al s+asm in"uce" - %# cu!!* E H +ocalcemia )h +o+arath roi"ism*
o Ch$oste:s Sign )1acial s+asm a!ter !acial ner$e ta+* E H +ocalcemia )h +o+arath
roi"ism* o %loo" (iarrhea > ?lcerati$e Colitis o Hli$e&Sha+e" Mass )e+igastric*
an" #roMectile ,omiting > # loric Stenosis o Current Sell Stool )-loo" an" mucu
s* an" Sausage&Sha+e" Mass in 7?Q > Intussice+tion o MantouI <est !or <% is B i!
.; mm in"uration /0 hrs +ost a"min )+re$ious %CG $accine reci+ients will test B
* o %utter!l 7ash > SLE E A$oi" "irect sunlight o 4 #s o! N, !unctioning E #ainA
+aresthesiaA +ulseA +allorA +aral sis o Cullens Sign )+erium-elical "iscoloratio
n* an" <urners Sign )-lue !lan:* > Acute #ancreatitis o Mur+h s Sign )7t8 costal m
argin +ain on +al+ with ins+iration*

> G% or Li$er "isease o HA more se$ere on wa:ening > %rain <umor )remo$e -enign
an" malignant* o ,omiting not associate" with nausea > %rain <umor o Ele$ate" IC
# > Increase" %#A wi"ene" +ulse +ressureA increase" <em+ o #ill&7olling <remor >
#ar:insons )<I with Le$o"o+aA Car"i"o+a* N 1all +recautionsA rigi"A stoo+e"A shu
!!ling o IG %an"s on Electro+horesis > MS E 9ea:ness starts in u++er eItremities
N -owel=-la""er a!!ecte" in D;G E (em elination & <I with AC<HA corticosteroi"s
A C toIan an" other immunosu++ressants o 7ee"&Stern-erg Cells > Ho"g:ins o Co+li:
S+ots > 7u-eola )Measles* o Er thema Marginatum > 7ash o! 7heumatic 1e$er o Gow
ers Sign > Muscular ( stro+h E Li:e Minors sign )wal:s u+ legs with han"s* #e"iatr
ics o %ench Mar:s %irth wt "ou-les at 3 months an" tri+les at .2 months %irth le
ngth increases - 4;G at .2 months #ost !ontanel closes - 0 w:s Ant !ontanel clos
es - .2&.0 months Moro re!leI "isa++ears at / months Stea" hea" control achie$e"
at / months <urns o$er at 4&3 months Han" to han" trans!ers at 6 months Sits un
su++orte" at 0 months Crawls at .; months 9al:s at .;&.2 months Cooing at 2 mont
hs Monos lla-ic %a--ling at 5&3 monthsA Lin:s s lla-les 3&D mo MamaA (a"a B a !e
w wor"s at D&.2 months <hrows a -all o$erhan" at .0 months (a time toilet traini
ng at .0 mo & 2 ears 2&5 wor" sentences at 2 ears 4;G o! a"ult Ht at 2 ears

 %irth Length "ou-les at / ears ?ses scissors at / ears <ies shoes at 4 ears Girl
s growth s+urt as earl at .; ears E %o s catch u+ P Age ./ Girls !inish growing a
t P.4 E %o s P .6 o Autosomal 7ecessi$e (iseases C1A #C?A Sic:le Cell AnemiaA <a
&SachsA Al-inismA 24G chance i!F AS )trait onl * X AS )trait onl * 4;G chance i
!F AS )trait onl * X SS )"isease* o Autosomal (ominant (iseases HuntingtonsA Mar!
ansA #ol "act lA Achon"ro+lasiaA #ol c stic Ci"ne (isease 4;G i! one +arent has
the "isease=trait )trait > "isease in autosomal "ominant* o X&Lin:e" 7ecessi$e (
iseases Muscular ( stro+h A Hemo+hilia A 1emales are carriers )ne$er ha$e the "i
sease* Males ha$e the "isease )-ut cant +ass it on* 4;G chance "aughters will -e
carriers )cant ha$e "isease* 4;G chance sons will ha$e the "isease )not a carrier
> cant +ass it on* <his translates to an o$erall 24G chance that each +regnanc w
ill result in a chil" that has the "isease o Scoliosis E Milwau:ee %race N 25 hr
s="a A Log rolling a!ter SI o (own S n"rome > <risom 2. E Simian creases on +alm
sA h +otoniaA +rotru"ing tongueA u+war" outwar" slant o! e es o Cere-ral #als E
Scissoring > legs eIten"e"A crosse"A !eet +lantar&!leIe" o #C? E lea"s to M7 E G
uthrie <est EAs+artame )NutraSweet* has +hen lalanine in it an" shoul" not -e gi
$en to #C? +atient o H +oth roi"ism E Lea"s to M7 o #re$ent Neural tu-e "isor"er
s with 1olic Aci" "uring #G o M elomeningocele E Co$er with moist sterile water
"ressing an" :ee+ +ressure o!! o H "roce+halus E Signs o! increase" IC# are o++o
site o! shoc: E Shoc: > Increase" +ulse an" "ecrease" %# IIC# > (ecrease" +ulse
an" increase" %# E )B Altere" LHC >

Most sensiti$e sign* In!ants 888 IIC# > %ulging !ontanelsA high +itche" cr A inc
rease" h" circumA sunset e esA wi"e suture linesA letharg E <reat with +eritonea
l shunt N "ont +um+ shunt8 Hl"er :i"s II#C > 9i"ene" +ulse +ressure IIC# cause" suctioningA coughingA strainingA an" turning N <r to a$oi" o Muscular ( stro+h
E X&lin:e" 7ecessi$eA wa""ling gaitA h +er lor"osisA Gowers Sign > "i!!icult risi
ng wal:s u+ legs )li:e Minors sign*A !at +seu"oh +ertro+h o! cal$es8 o Sei ures E
Nothing in mouthA turn h" to si"eA maintain airwa A "ont restrainA :ee+ sa!e E <
reat with #heno-ar-itol )Luminol*A #hen toin )(ilantinF <7 > .;&2; E Gingi$al H
+er+lasia*A 1os+hen toin )Cere- I*A ,al+roic Aci" )(e+a:ene*A Car-ama e+ine )<eg
ritol* o Meningitis )%acterial* E Lum-ar +uncture shows Increase" 9%CA +roteinA
IIC# an" "ecrease" glucose Ma lea" to SIA(H )<oo much A(H* E 9ater retentionA !l
ui" o$erloa"A "ilutional h +onatremia o C1 Ci"s taste salt an" nee" en mes s+ri
n:le" on their !oo" o Chil"ren with 7u-ella > threat to un-orn si-lings )ma reLu
ire tem+orar isolation !rom Mom "uring #G* o #ain in oung chil"ren measure" with
1aces +ain scale o No MM7 Immuni ation !or :i"s with HI o! allergic rIn to eggs
or neom cin o Immuni ation Si"e E!!ects E < @ .;2A re"ness an" soreness at inMe
ction site !or 5 "a s E gi$e < lenol an" -i:e +e"al legs )+assi$el * !or chil"8
o Call #h sician i! sei uresA high !e$erA or high&+itche" cr a!ter immuni ation
o All cases o! +oisoning E Call #oison Control Center E No I+ecacT o E+iglottiti
s > H8 in!luen a % E Chil" sits u+right with chin out an" tongue +rotru"ing )ma
-e <ri+o" +osition* E #re+are !or intu-ation or trach E (H NH< +ut an thing into
:i"s mouth o Isolate 7S, +atient with Contact #recautions E #ri$ate room is -est
E ?se Mist <ent to +ro$i"e H2 an" 7i-a$irin N 1loo" tent with H2 !irst an" wi+e
"own insi"e o! tent +erio"icall so ou can see +atient

o Acute Glomerulone+hritis E A!ter % stre+ N Antigen&Anti-o" com+leIes clog u+ g

lomeruli an" re"uce G17 > (ar: urineA +roteinuria o 9ilms <umor > Large :i"ne tum
or E (ont +al+ate o <E1 > <racheoeso+hageal Atresia E 5 Cs o! <E1 > CoughingA Cho:
ingA C anosis o Cle!t Li+ an" #alate E #ost&H+ N #lace on si"eA maintain Logan %
owA el-ow restraints o Congenital Megacolon > Hirschs+rungs (isease E Lac: o! +er
istalsis "ue to a-sence o! ganglionic cells in colon E Sus+ect i! no meconium w=
in 2/ hrs or ri--on&li:e !oul smelling stools o Iron (e!icienc Anemia E Gi$e Iro
n on em+t stomach with citrus Muice )$itamin C enhances a-sor+tion*A ?se straw o
r "ro++er to a$oi" staining teethA <arr stoolsA limit mil: inta:e @ 52 o ="a o S
ic:le Cell (isease EH "ration most im+ortant ESC Crisis > !e$erA a-" +ainA +ain!
ul e"ematous han"s an" !eet )han"&!oot s n"rome*A arthralgia E<I B restA h "rati
on E A$oi" high altitu"e an" strenuous acti$ities o <onsillitis E usuall Stre+ E
Get #< an" #<< #re&H+ )as: a-out HI o! -lee"ing* E Sus+ect %lee"ing #ost&H+ i!
!reLuent swallowingA $omiting -loo"A or clearing throat E No re" liLui"sA no str
awsA ice collarA so!t !oo"s E Highest ris: o! hemorrhage > !irst 2/ hrs an" 4&.;
"a s +ost&o+ )with sloughing o! sca-s* o #rimar me"s !or E7 !or res+irator "ist
ress > Sus&+hrine )E+ine+hrine HCl* an" <heo+h lline )<heo&"ur* E %roncho"ilator
s o Must :now normal res+irator rates !or :i"s E 7es+irator "isor"ers > #rimar r
eason !or most me"ical=E7 $isits !or :i"s E New-orn E 5;&3; .&.. mo E 24&54 .&5
ears E 2;&5; 5&4 ears E 2;&24 3&.; ears E .0&22 ..&.3 ears E.3&2; Car"io$ascular
(isor"ers o Ac anotic > ,S(A AS(A #(AA Coarc o! AortaA Aortic Stenosis Anti+ros
taglan"ins cause closure o! #(A )aorta & +ulmonar arter *

o C anotic > <etralog o! 1allotA <runcus Arteriosis )one main $essel gets miIe"
-loo"*A <,G )<rans+osition o! Great ,essels* E #ol c themia common in C anotic "
isor"ers 5 <s o! C anotic Heart (isease )<etralog A <runcusA <rans+osition* o <et
ralog o! 1allot E ?noI genate" -loo" +um+e" into aorta #ulmonar Stenosis ,S( H$e
ri"ing Aorta 7ight ,entricular H +ertro+h <E< S+ells EH +oIic e+iso"es that are
relie$e" - sLuatting or :nee chest +osition o CH1 can result E ?se (igoIin E <7
> ;80&28; !or :i"s o (uctus ,enosus > ?m-elical ,ein to In!erior ,ena Ca$a o (uc
tus Arteriosus > Aorta to #ulmonar Arter o 7heumatic 1e$er E AcLuire" Heart (ise
ase E A!!ects aortic an" mitral $al$es #rece"e" - -eta hemol tic stre+ in!ection
Er thema Marginatum > 7ash Ele$ate" ASH titer an" ES7 Chest +ainA shortness o!
-reath )Car"itis*A migrator large Moint +ainA tach car"ia )e$en "uring slee+* <r
eat with #enicillin G > #ro+h laIis !or recurrence o! 71 Maternit o (a . o! c cl
e > 1irst "a o! menses )-lee"ing* E H$ulation on (a ./ E 20 "a s total E S+erm 5
&4 "a sA Eggs 2/ hrs E 1ertili ation in 1allo+ian <u-e o Cha"wic:s Sign > %luing
o! ,agina )earl as / wee:s* o Hegars Sign > So!tening o! isthmus o! cer$iI )0 wee
:s* o Goo"ells Sign > So!tening o! Cer$iI )0 wee:s* o #regnanc <otal wt gain > 24
&5; l-s )..&./ :g* o Increase calorie inta:e - 5;; calories="a "uring #G E Incre
ase +rotein 5; g="a E Increase ironA CaBBA 1olic Aci"A A & C o (angerous In!ecti
ons with #G E <H7CH > <oIo+lasmosisA otherA 7u-ellaA C tomegalo$irusA H#, o %raI
ton Hic:s common throughout #G

o Amniotic !lui" > 0;;&.2;; mL )@ 5;; mL > Hligoh "ramnios > !etal :i"ne +ro-lem
s* o #ol h "ramnios an" Macrosomia )large !etus* with (ia-etes o ?m-elical cor"F
2 arteriesA . $ein E ,ein carries oI genate" -loo" to !etus )o++osite o! normal
* o 1H7 > .2;&.3; o 1olic Aci" (e!icienc > Neural tu-e "e!ects o #re&term > 2;&5
6 wee:s o <erm > 50&/2 wee:s o #ost&term > /2 wee:sB o <#AL > <erm -irthsA #re&t
erm -irthsA A-ortionsA Li$ing chil"ren o Gra$i"a > U o! #regnancies regar"less o
! outcome o #ara > U o! (eli$eries )not :i"s* a!ter 2; w:s gestation o Nagales 7u
le E A"" 6 "a s to !irst "a o! last +erio"A su-tract 5 monthsA a"" .2 months > E
(C o Hg- an" Hct a -it lower "uring #G "ue to h +erh "ration o Si"e&l ing is -es
t +osition !or utero+lacental +er!usion )either si"e tho le!t is tra"itional * o
2F. LecithinFS+hingom elin 7atio > 1etal lungs mature o A1# in amniotic !lui" >
+ossi-le neural tu-e "e!ect o Nee" a !ull -la""er !or Amniocentesis earl in #G
)-ut not in later #G* o Lightening > 1etus "ro+s into true +el$is o Nesting Inst
inct > %urst o! Energ Must -e!ore la-or o <rue La-or > 7egular contractions that
intensi! with am-ulationA L%# that ra"iates to a-"omenA +rogressi$e "ilation an
" e!!acement o Station > Negati$e a-o$e ischial s+inesA #ositi$e -elow o Leo+ol"
Maneu$er tries to re+osition !etus !or "eli$er o La-oring Maternal ,itals E #ul
se @ .;; )usuall a little higher than normal with #G & %# is unchange" in #G*8 <
@ .;;8/ o NHN&Stress <est E 7eacti$e > Health )1H7 goes u+ with mo$ements* o Co
ntraction Stress <est )Hc tocin Challenge <est*E ?nhealth > Late "ecels note" )+
ositi$e result* in"icati$e o! ?#I E VNegati$eW result > No late "ecels note" )go
o" result* o 9atch !or h +ore!leIia with Mag Sul!ate a"min 8 8 8 (ia+hragmatic I
nhi-ition

 Cee+ Calcium gluconate - the -e" )anti"ote* o 1irsts 1etal H% E 0&.2 wee:s - (o+
+lerA .4&2; wee:s - !etosco+e 1etal mo$ement > Quic:eningA ./&2; wee:s Showing >
./ wee:s %raIton Hic:s N / months an" onwar" o Earl (ecels > Hea" com+ression >
HC o ,aria-le (ecels > Cor" com+ression > Not Goo" o Late (ecels > ?tero&+lacen
tal insu!!icienc > %A(T o I! ,aria-le or Late (ecels E Change maternal +ositionA
Sto+ #itocinA A"minister H2A Noti! #h sician o (IC E <I is with He+arin )sa!e i
n #G* E 1etal (emiseA A-ru+tio #lacentaA In!ection o 1un"al Heights .2&./ w:s E
At le$el o! s m+h sis 2; wee:s E 2; cm > Le$el o! um-ilicus 7ises P . cm +er wee
: o Stages o! La-or Stage . > %eginning o! 7egular contraction to !ull "ilation
an" e!!acement Stage 2 > .; cm "ilation to "eli$er Stage 5 > (eli$er o! #lacenta
Stage / > .&/ Hrs !ollowing "eli$er o #lacenta Se+aration E Lengthening o! cor"
outsi"e $aginaA gush o! -loo"A !ull !eeling in $agina E Gi$e oI tocin a!ter +la
centa is out N Not -e!ore8 o Schult #resentation > Shin si"e out )!etal si"e o!
+lacenta* o #ost+artum ,S Sche"ule E$er .4 min X . hr E$er 5; min X neIt 2 hour
s E$er Hour X neIt 2&3 hours <hen e$er / hours o Normal %M !or mom within 5 "a s
> Normal o Lochia E no more than /&0 +a"s="a an" no clots O . cm E 1lesh smell
is normalA 1oul smell > in!ection o Massage -ogg uterus to encourage in$olution
E em+t -la""er ASA# N ma nee" to catheteri e E 1ull -la""er can lea" to uterine
aton an" hemorrhage

o <ears E.st (egree > (ermisA 2n" (egree > mm=!asciaA 5r" (egree > anal s+hincte
rA /th (egree > rectum o A#GA7 > H7A 7A mm toneA 7e!leI irrita-ilit A Color E .
an" 4 minutes E6&.; > Goo"A /&3 > mo"erate resuscitati$e e!!ortsA .&5 > mostl "e
a" o E e care > E&m cin B Sil$er Nitrate E !or gonorrhea o #u"en"al %loc: > "ecr
eases +ain in +erineum an" $agina N No hel+ with contraction +ain o E+i"ural %lo
c: > <.;&S4 E %loc:s all +ain E 1irst sign > warmth or tingling in -all o! !oot
or -ig toe o 7egional %loc:s o!ten result in !orce+s or $acuum assiste" -irths ecause the a!!ect the mothers a-ilit to +ush e!!ecti$el o 9%C counts are ele$ate"
u+ to 24A;;; !or P.; "a s +ost +artum o 7ho)(* immune glo-ulin )7hoGAM* is gi$e
n to 7h& mothers who "eli$er 7hB :i"sE Not gi$en i! mom has a BCoom-s <est E She
alrea" has "e$elo+e" anti-o"ies )too late* o Ca+ut Succe"aneum > e"ema un"er sc
al+A crosses suture lines o Ce+halhematoma > -loo" un"er +eriosteumA "oes not cr
oss suture lines o Suction Mouth !irst N then nostrils o Moro 7e!leI > Startle r
e!leI )a-"uction o! all eItremities* N u+ to / months o 7ooting 7e!leI E u+ to /
months o %a-ins:i 7e!leI E u+ to.0 months o #almar Gras+ 7e!leI ELessens - / mo
nths o %allar" Scale use" to estimate gestational age o Heel Stic: > lateral sur
!ace o! heel o #h siologic Saun"ice is normal at 2&5 "a s E A-normal i! -e!ore 2
/ hours or lasting longer than 6 "a s E ?nconMugate" -iliru-in is the cul+rit8 o
,itamin C gi$en to hel+ with !ormation o! clotting !actors "ue to !act that the
new-orn gut lac:s the -acteria necessar !or $itamin C s nthesis initiall E ,ast
us lateralis mm IM o A-rutio #lacenta > (ar: re" -lee"ing with rigi" -oar" li:e
a-"omen o #lacenta #re$ia > #ainless -right re" -lee"ing o (IC > (isseminate" In
tra$ascular Coagulation E clotting !actors

use" u+ - intra$ascular clotting N Hemorrhage an" increase" -lee"ing times resul

t E Associate" with !etal "emiseA in!ection an" a-ru+tio +lacenta8 o Magnesium S
ul!ate use" to re"uce +reterm la-or contractions an" +re$ent sei ures in #re&Ecl
am+sia E Mg re+laces CaBB in the smooth mm cells resulting relaIation E Can lea"
to h +ore!leIia an" res+irator "e+ression N Must :ee+ Calcium Gluconate - -e" w
hen a"ministering "uring la-or > Anti"ote E Monitor !orF A-sent (<7s 7es+irations
@ .2 ?rinar Hut+ut @ 5;=hr 1etal %ra" car"ia o #itocin )HI tocin* use !or ( sto
ciaE I! uterine tetan "e$elo+sA turn o!! #itocinA a"min H2 - !ace mas:A turn +t
on si"e8 #itocin can cause water intoIication owing to A(H e!!ects8 o Sus+ect ut
erine ru+ture i! woman com+lains o! a shar+ +ain !ollowe" - cessation o! contrac
tions o #re&Eclam+sia > Htn B E"ema B #roteinuria o Eclam+sia > Htn B E"ema B #r
oteinuria B Sei ures an" Coma E Sus+ect i! Se$ere HA B $isual "istur-ances o No
Couma"in "uring #G )He+arin is HC* o H +eremesis Gra$i"arum > uncontrolla-le nau
sea an" $omiting E Ma -e relate" to H8 + olori E 7eglan )metaclo+romi"e* o Insul
in "eman"s "ro+ +reci+itousl a!ter "eli$er o No oral h +ogl cemics "uring #G N <
eratogenic E Insulin onl !or control o! (M o %a-ies -orn without $aginal sLuee e
more li:el to ha$e res+irator "i!!icult initiall o C&Section can lea" to #aral
tic Ileus E Earl am-ulation hel+s o #ost+artum In!ection common in +ro-lem +regn
ancies )anemiaA "ia-etesA traumatic -irth* o #ost+artum Hemorrhage > Lea"ing cau
se o! maternal "eath E 7is: !actors inclu"eF ( stociaA +rolonge" la-orA o$er"ist
en"e" uterusA a-rutio +lacentaA in!ection <I inclu"es E 1un"al massageA count +a
"sA ,SA I, !lui"sA HI tocinA noti! +h sician o Sitteriness is a s m+tom o! h +og
l cemia an" h +ocalcemia in

the new-orn o H +ogl cemia E tremorsA high +itche" cr A sei ures o High +itche"
cr B -ulging !ontanels > IIC# o H +othermia can lea" to H +oIia an" aci"oisis E
Cee+ warm an" use -icar-onate +rn to treat aci"osis in new-orn8 o La on right si
"e a!ter !ee"ing E Mo$e stomach contents into small intestine o Saun"ice an" Hig
h -iliru-in can cause ence+halo+ath E @ .2 > normal E #hotothera+ "ecom+oses -il
iru-in $ia oIi"ation E #rotect e esA turn e$er 2 hours an" watch !or "eh "ration
E <he "angerous -iliru-in is the unconMugate" in"irect t +e8 Nutrition o CB E %
ananasA "rie" !ruitsA citrusA +otatoesA legumesA teaA +eanut -utter o ,itamin C
E CitrusA +otatoesA cantalou+e o CaBB E Mil:A cheeseA green lea! $eggiesA legume
s o NaB E SaltA +rocesse" !oo"sA sea!oo" o 1olic Aci" E Green lea! $eggiesA li$e
rA citrus o 1eBB E Green lea! $eggiesA re" meatA organ meatA eggsA whole wheatA
carrots ?se R&trac: !or inMections to a$oi" s:in staining o MgB E 9hole grainsA
green lea! $eggiesA nuts o <hiamine )%.* E #or:A -ee!A li$erA whole grains o %.2
E Hrgan meatsA green lea! $eggiesA eastA mil:A cheeseA shell!ish (e!icienc > %i
g re" -ee! tongueA Anemia o ,itamin C E Green lea! $eggiesA mil:A meatA so o ,it
amin A E Li$erA orange an" "ar: green !ruits an" $eggies o ,itamin ( E (air A !i
sh oilA sunlight o ,itamin E E ,eggie oilsA a$oca"osA nutsA see"s o %MI E .084&2
/8D > Normal )Higher > H-ese* Gerontolog o Essentiall e$er one goes to Hell in a
+rogressi$el "egenerati$e han"&-as:et <hin s:inA -a" slee+A mm wastingA memor l
ossA -la""er shrin:sA incontinenceA "ela e" gastric em+t ingA CH#(A

H +oth roi"ismA (ia-etes o Common AilmentsF (elerium an" (ementia Car"iac ( srh
thmias Cataracts an" Glaucoma C,A )usuall throm-oticA <IAs common* (ecu-itus ?lc
ers H +oth roi"ism <h rotoIicosis )Gra$es (isease* CH#( )usuall com-ination o! em
+h sema an" C%* ?<Is an" #neumonia E Can cause con!usion an" "elerium o Memor lo
ss starts with recent N +rogresses to !ull o (ementia > Irre$ersi-le )Al heimers*
E (e+ressionA Sun"owningA Loss o! !amil recognition o (elerium > Secon"ar to an
other +ro-lem > 7e$ersi-le )in!ections common cause* o Me"ication AlertT E (ue t
o "ecrease" renal !unctionA "rugs meta-oli e" - the :i"ne s ma +ersist to toIic
le$els o 9hen in "ou-t on NCLEX E Answer shoul" contain something a-out eIercise
an" nutrition8 A"$ance" Clinical Conce+ts o Eric:son E #s cho&Social (e$elo+men
t ;&. r )New-orn* E <rust $s8 Mistrust .&5 rs )<o""ler*E Autonom $s8 (ou-t an" S
hame E 1ear intrusi$e +roce"ures & Securit o-Mects goo" )%lan:iesA stu!!e" anima
ls* 5&3 rs )#re&school* E Initiati$e $s8 Guilt E 1ear mutilation N %an"&Ai"s goo
" 3&.2 rs )School Age* E In"ustr $s8 In!eriorit E Games goo"A #eers im+ortant E
1ear loss o! control o! their -o"ies .2&.D rs )A"olescent* E I"entit $s8 7ole Co
n!usion E 1ear %o" Image (istortion 2;&54 rs )Earl A"ulthoo"* E Intimac $s8 Isol
ation 54&34 rs )Mi""le A"ulthoo"* E Generati$it $s8 Stagnation H$er 34 )Hl"er A"
ulthoo"* E Integrit $s8 (es+air o #iaget E Cogniti$e (e$elo+ment

 Sensorimotor Stage );&2* E Learns a-out realit an" o-Mect +ermanence #reo+eratio
nal Stage )2&6* E Concrete thin:ing Concrete H+erational Stage )6&..* E A-stract
thin:ing 1ormal H+erational Stage )..&a"ult* E A-stract an" logical thin:ing o
1reu" E #s cho&SeIual (e$elo+ment Hral Stage )%irth &. ear* E Sel! grati!ication
A I" is in control an" running wil" Anal Stage ).&5* E Control an" +leasure wrt
retention an" +oo+ing N <oilet training in this stage #hallic Stage )5&3* E #lea
sure with genitalsA He"i+us com+leIA Su+erEgo "e$elo+s Latenc Stage )3&.2* E SeI
urges channele" to culturall acce+ta-le le$elA Growth o! Ego Genital Stage ).2
u+* E Grati!ication an" satis! ing seIual relationsA Ego rules o Cohl-erg E Mora
l (e$elo+ment Moral "e$elo+ment is seLuential -ut +eo+le "o not aromaticall go !
rom one stage to the neIt as the mature Le$el . > #re&con$entional E 7ewar" $s8
#unishment Hrientation Le$el 2 > Con$entional Moralit E Con!orms to rules to +le
ase others Le$el 5 > #ost& Con$entional E 7ightsA #rinci+les an" Conscience )%es
t !or All is a concern* Calculations 7ules & 1ormulas o 7oun" !inal answer to te
nths +lace o 7oun" "ro+s to nearest "ro+ o 9hen calculating mL=hrA roun" to near
est !ull mL o Must inclu"e ; in !ront o! $alues @ . o #e"iatric "oses roun"e" to
nearest .;;th8 7oun" "own !or +e"s o Calculating I, 1low 7ates <otal mL X (ro+
1actor = 3; X UHrs > 1low 7ate in gtts=min o Calculating In!usion <imes <otal mL
X (ro+ 1actor = 1low 7ate in gtts=min X 3; > Hrs to In!use

 Con$ersions o . t > 4mL o . < > 5 t > .4 mL o . o > 5; cc > 5; mL > 2 < o . gr
> 3; mg o . mg > .;;; ug )or mcg* o . :g > 282 l-s o . cu+ > 0 o > 2/; mL o . +
int > .3 o o . Luart > 52 o o (egrees 1 > ).80 X C* B 52 o (egrees C > )1 N 52
* = .80 56 C > D083 1 50 C > .;;8/ 1 5D C > .;282 1 /; C > .;/ 1 1all #recaution
s o 7oom close to nurses station o Assessment an" orientation to room o Get hel+
to stan" )"angle !eet i! light hea"e"* o %e" low with si"e rails u+ o Goo" ligh
ting an" re"uce clutter in room o Cee+ consistent toileting sche"ule o 9ear +ro+
er non&sli+ !ootwear o At home E #aint e"ges o! stairs -right color %ell on cats
an" "ogs Neutro+enic )Immunosu++resse"* #recautions o No +lants or !lowers in r
oom o No !resh $eggies E Coo:e" !oo"s onl o A$oi" crow"s an" in!ectious +ersons
o Meticulous han" washing an" h giene to +re$ent in!ection o 7e+ort !e$er O .;;8
4 )immunosu++resse" +ts ma not mani!est !e$er with in!ection*

 %lee"ing #recautions )AnticoagulantsA etc8* o So!t -ristle" tooth -rush o Electr

ic ra or onl )no sa!et ra ors* o Han"le gentl A Limit contact s+orts o 7otate in
Mection sites with small -ore nee"les !or -loo" thinners o Limit nee"le stic:sA
?se small -ore nee"lesA Maintain +ressure !or 4 minutes on $eni+uncture sites o
No straining at stool & Chec: stools !or occult -loo" )Stool so!teners +rn* o No
salic latesA NSAI(sA or su++ositories o A$oi" -lowing or +ic:ing nose o (o not
change ,itamin C inta:e i! on Couma"i