Morphine toxicity = pin point pupils Reversal = Narcan Prostigmin Parasympathometic Tx Myastenia gravis Side Effects: resp. depress.

, bronchi constrict, decrease BP and HR Increases peristalsis and causes hyperactive bowel sounds Dextran- administer using Z track method Sever preeclampsia BP > 160/110 4+ proteinuria, headache, epigastric pain Ab. Pain in R quad=impaired liver function and potential eclampsia Native American and males are at highest risk for cleft palate DVT : risks- joint replace, pregnancy, CHF, age, BC Meconium stained baby= hypoxic epsidode, assess fetal heart Prolapsed cord= trandelenberg Foods associated with latex allergy Apricots, cherries, bananas, grapes, kiwi, passion fruit, avocados, chesnuts, Peaches, tomatoes Bryant traction- for small kids, both legs have elastic bands and pulleys Imipramine- tricyclic antidepress, treat anxiety Angle of Louis- at sternal junction 2nd rib Aortic and pulmonic sounds- 2nd intercostal space Erbs point- 3rd intercostal space Mitral valve and PMI- 5th intercostal at L midclavicular line Sore throat=kidney/heart infection 24 post-op amputation use blocks under bed Tardive dyskenesia=involuntary grimacing and tongue protrusion from antipsychotics Librium used to tx acute alcohol withdraw

Panic level anxiety- decreased sensory input, distorted perceptions, disorganized Double-bind- saying and action are opposite Thorazine Antipsychotic/antimetic Extrapyramidial rxn (Parkonsonian effect) Orthostatic hypotension Cogentin (Benzotropine)- anti Parkinsons Amitriptylene (Elavil)- antidepressant Lithium Bipolar, narrow therapeutic range (.5-1.2), Can cause intoxication: agitation, ataxia, blurred vision, tremors Stelazine- antipsychotic, cannot breastfeed while using Phenelzine sulfate- MAOI, interacts with certain foods to increase BP (smoked foodscontain tyramine) Foods with K- potatoes, spinach, raisins, bananas, oranges Nifidipine- antianginal, Ca channel blocker, decreases hearts Oxygen demands Digoxin- glycoside, strengthens heart contractions, inhibits reabsorption of Na, Cl, causes hypokalemia Dilantin- may cause brown/red pink Take TSH in morning Sound over trachea=loud and high pitched SIADH- too much ADH causes fluid retention, opposite of Diabetes insipidus, causes decreased UOP and decreased Na in serum Neomycin- tx for pseudomonas or E. coli, used to suppress GI bacteria post op. Cuffed trachea is used to separate up and low airways Vincristine sulfate- antineoplastic causes parasthesia and difficult gait Penicillin allergy be careful with cephalosporins Crutches should be kept 8-10 inches from side of feet

Vecuronium bromide- neuromuscular blocking agent (similar to propofol), pt. on this nee eye care Coumadin inhibits prothrombin synthesis, check INR/PT, reverse with Vit K Heparin- prevents conversion of fibrinogen to fibrin and inactivates thrombin, check PTT (clotting time), reversed with protamine sulfate Aspirin inhibits platelet aggregations Urine specific gravity and hematocrit increase with dehydration Hypovolemic shockCan happen with broken bones/ blood loss Give large amounts of isotonic fluid (LR) S/S- tachycardia, hypotension, cool/clammy skin, LOC Do not use Dolls eye oculocephalic test (eye movement while head is turned quickly side to side) when pt. has head injury Cornea reflex=cotton ball to eye Levodopa- Parkinsons, restores dopamine Ca rich foods- eggs, green leafy T-tube- ensures drainage of gallbladder bile, should be ~400 cc/day TURP- no incision, cath may cause bladder spasms, avoid strenuous exercise for 3 weeks Crohns disease diet- decrease fat and residue, increase protein Verapimil- Ca channel blocker, causes transient hypotension Propantheline- anticholinergic, decrease GI motility and inhibits gastric secretions Illeostomy- does not require irrigation, only change if leaks, apply cream around stoma, increase fluids Dramatic wt. loss may precipitate gout Left hemisphere temporal lobe=speech Early s/s of glumeuralonephritis=oligouria

Meds that are ok in pregnancy: celebrex, catapress, Habitrol, clofaximine Meds that are NOT ok in pregnancy: Coumadin, Finasteride Photosensitive drugs: Cipro, Sulfanamides, Norxin, Bactrim, Accutane Non-photosensitive drugs: Nitrodur Meds that discolor urine: Sulfasalyzine, Levadopa, Phenolphthalein IGg is the only antibody that protects fetus in womb AZT is used as prophylaxis after AIDS exposure (rape, needle stick) Autonomic neuropathy can cause inability to urinate Damage to nerves that manage day to day tasks (BP, HR, BM, bladder, digestion) S/S Hypercalemia: confusion, constipation, ab. Pain, polyuria, hx of myeloma S/S Hypocalemia: Increased GI motility and hyperactive bowel sounds, + Chveloks sign RBC live 120 days Bowel obstruction=intensified bowel sounds Swishing and buzzing in abdomen=bruit of aortic aneurysm During SZ: Do not restrain Place pt on side with head flexed forward Admin rectal diazepam Blood PH: 7.35-7.45 pCO2: 35-45 pHCO3: 19-25 Na: 133-145 K: 3.3-5.1 Hemoglobin: 12-16 Ca: 8.5-10 Rheumatic fever: + antistreptolysin O test, sore throat in recent past, red rash on trunk and extremities, fever Therapeutic level of Dilanti: 10-20 Morphine sulfate surpresses respiration and resp. reflex S/S Hyperglycemia: polydipsia, polyphagia, blurred vision

S/S Hypoglycemia: Confusion, shaking Naproxen: NSAID, causes GI inflammation 10 grains=600mg of medication TB skin test=Mantoux test: > 10mm=+ in healthy adult; > 5mm in AIDS pt = + Normal Newborn: respiration 40-60; HR 120 to 160 Coffee inhibits iron absorption Yeast infection: odorless, cheesy white discharge, erythema, itching, BC and abx predisposes to infection Direct cooms test is done on cord blood after a baby is born Diabetic moms need less insulin while breastfeeding Thrush: white patchy mucosa, tx with nystatin always If presenting part is engaged, this helps prevent cord prolapsed Ovulation: cervix softens, temp decrease prior to and increases after, mucus is clear, thin, watery When using cane: hold in opposite hand of effected side, advance cane then bad leg first, then strong leg. Leaking fluid around CVC drssg indicates break in line and potential for air embolism Lower head of bed below feet Antabuse (Disulfram)- used to deter drinking in alcoholics, must not have drank in last 12 hrs. Methadone: narcotic withdrawal Narcan- morphine OD COPD: low flow O2 to prevent CO2 necrosis Pernicious anemia- cant absorb vit B12: s/s- pallor, jaundice, fatigue, wt. loss; txmonthly vit B12 injections

Elastic stockings-remove and reapply 2x daily, do not use if skin lesion is present; not necessary during sleep; put on when get out of bed Paracentesis (peritoneal): 2-3 L may be removed; pt. should void and be weighed prior to, pt. is positioned upright w/ feet supported during procedure Kayexelate enemas decrease serum K Protein breakdown produces ammonia which can cause hepatic coma Sengsteken-Blakemore tube- applies pressure against bleeding esophageal varices Salt-poor albumin IV balances osmotic pressure Insulin is compatible with TPN Pancreatitis: does not affect renal fx, s/s- jaundice (which causes dry itcy skin), nutritional needs are very important b/c pt. have sever wt. loss and anorexia, take panrelipase before meals, no alcohol. 24hr urine specimen: must use preservative free container Kaposi Sarcoma Chest tube removal: Exhale and bare down (Valsalva method) New Cholostomy diet: Increase protein, decrease residual and fat; salad and fiber are high residue foods Normal UOP=1200-1500 mL/day; 5-6 x during the day and 1x at night Newborns: feed for 15-20 minutes at a time, sleep 2-3 hours at a time, 6-8 wet diapers + 2 BM per day, birth wt. reached in 10-14 days Quadrecep setting- isometric exercises for unaffected limb Administration of ear drops: Adults: pull earlobe up and back; kids: pull earlobe down and back; warm solution and drop meds along side of ear canal Ketoacidosis S/S: fruity breath, polyuria, polydipsia, nausea, vomit, dry mucous membranes, ab. Pain, hypotension Hyperglycemia Hyperosmolar Nonketotic Coma (HHNK): BG 800-1000, type II DM, absence of acidosis, caused by infection, stress, and some meds; S/S- polyphagia, polyuria, polydipsia, glucouria, ab. Pain, hyperpyrexia, dehydration, LOC

Pyridostigimine bromide (Mestinon)- tx Myasthia gravis, must be admin. On time!, cholinesterase inhibitor Isonicotinic acid hydrazide (INH)-for TB, admin. Daily. Trust-Infats Industry-6-12 years Identity- Adolescents Intimacy-20-40 Chronic steroid use causes truncal obesity, purple striation of skin, moon face Lack of steroids causes gaunt face Sims- side lying with knees flexed, used for vaginal or rectal exam Cyanocobalamin (Cyomin)- vit B12 injection Iron- client must remain upright for 15-20 minutes after dose Cardiogenic shock- caused by cardiac dysfunction (MI, CHF) Depressed fontanel signals dehydration Crackling/rales- air passes fluid (on inspiration) Wheezing-narrowed air ways Whistling- obstructed larynx Absent-pneumothorax NG tube only goes to duodenum Swan Gaz line-measures cardiac OP and pressure in L ventrical or pulm. Art. CVP- measures pressure in R atrium Chicken pox- maculopapular, do not remove crust, when crusted not infectious CVA pt.: hard time w/ liquids, need soft or semisoft foods, head and neck forward to aid in swallowing, high fowlers, place food on unaffected side of mouth Best place to give and adult IM injection is Vastus lateralis (quad) Cholecystitis: can cause hypokalemia, and hypomagemia Adrenal crisis- not enough hormones, hypotension, cool pale skin, increased UOP, dehydration

Dystonia rxn- tightness in throat, neck, tongue, eyes, mouth, back following antipsychotic med, tx- IM Benadryl or Cogentin PTT=clotting time=heparin Antrectomy- surgery to reduce acid secreting portion of stomach Dumping syndrome: happens after gastric resection, undigested food is dumped into jejunum, distention, pain, cramping and diarrhea 15-30 minutes after eating. Pt. should lay down after meals and eat increased protein and fat, decreased carbs Homonymous hemianopia- blindness in half of each visual field Osteoarthritis pain reduction- warm bath and rest, no ROM or stretching Aluminum hydroxide- antacid, causes constipation, hypophosphatemia Normal CVP-4-10 Propanolol- beta andregenic blocker used as antihypertensive, may cause bronchospasms, bradycardia, depression Air embolism- S/S sudden coughing, pale, dyspenic, tachycardia, when CVC is being inserted, tx by turning pt. on L side and lower head of bed. Risk for cervical cancer- exposure to estrogen, obesity (fat stores estrogen), nullparity, late onset of menopause. Cap refill=neurovascular fxn Radiation site- clean only with water, lose or no clothes (bra), no lotion, are needs to be assessed for redness and irritation. Somogyi effect- sudden fall in BG followed by rebound hyperglycemia Diabetic diet: 50% carbs, 20% protein, 30% fat Sweet potato=1 serving of bread Akathesia- desire to keep moving, can occur after 1st does of Haldol Myelomeningocelle- sac like cyst with meninges and spinal cord coming from defect in spine. Should cover with moist sterile drssg. T-tube- implanted gravity drain for gallbladder bile, 1000 ml in 24hr.

Borderline Personality Disorder- engaging w/ intense relationships, test relationships for signs of rejection, tend to make others feel they are not helpful and could never be. Eclampsia- SZ Croup: fever, barking (metallic) cough, inspiratory stridor and laryngeal edema. Nephrotic Styndrom- hypoalbuminemia, fluid shifts from plasma to abdomen, s/s- fluid retention, ascites, proteinuria, decreased UOP Poststrep glomerulonephritis- causes cerebral edema and possible sz, K is contraindicated, Na foods may increase fluid retention, decreased UOP Chest tube- atmosphere pressure > pleural space, water seal prevents air from entering pleural space which would cause a pneumothorax, drainage collection chamber and suction help remove blood drainage Piaget: Repetitive reflex: first few months; Object perm: 6 months, Sense of time and early memory: 13-24 months. Internal fetal monitor- placed on fetus scalp, position of mom doesnt really matter Flaring of nostrils=respiratory distress Breast engorgement- occurs due to lack of boob support; occurs before lactation or milk production begins, Effective breast feeding doesnt prevent; the reason for this is a lag between milk production and efficacy of ejection reflex Older adults have decreased GI motility, smell, taste, muscle strength but not decreased ability to cope with stress. Grieving Process: Anger, Denial, Bargaining, Depression Cystic FibrosisObstruction of pancreatic duct Causes thick, sticky mucous in lungs, digestive tract and other areas of body Inherited Absence of digestion enzymes- amylase, lipase, tyrpsin- so pt. cannot digest or absorb fat, this leads to tissue wasting and failure to thrive big appetites when feeling well tx is oral digestion enzymes nutrition is important Poor feeding and suckling, fatigue in newborn may indicate congenital heart defect Systematic desensitization- exposure to phobia while using relax tech

Protein=tissue repair and promotes healing Beclomethasone- decreases cell inflammatory response (steroid) Temper tantrum-give to reasonable choices Diuretics block Na reabsorption and promote fluid loss, decreased blood volume, decreased arterial pressure Thiazide and Lasix diuretic are K depleting (broccoli has a lot of K) After suicide attempt, 1st priority is a no-suicide contract Diagram- good for school aged kids Therapeutic play- good for toddlers CKFCauses hypocalcemia (Ca and Ph have inverse relationship) Hyperphosphorus Due to decreased glomureal filtration rate Hyperkalemia Hyperglycemia NO hypernatremia Lower spinal anesthesia causes headache that worsens in upright position and ambulation Myxedema- decrease fxn of subeceous glands, makes skin very dry, due to decreased TSH, require decreased amount of opioid for pain due to lower metabolism After a pneumonectomy, the mediastinum may shift toward remaining lung or lung may shift towards empty space depending on pressure, results in shift of trachea from midline Tracheal edema cannot be palpated Ventricularperitonieal shunt is associated with infections in kids with hydrocephalus Cephalhematoma- collection of blood bwtn skull and perisoteum, results from trauma, resolves spontaneously in 3-6 weeks Famotadine (Pepcid)- inhibits histamine at H2 receptors in stomach, inhibiting gastric secretions Lavage-removes blood from stomach and the irrigation solution produces vascular constriction

Exophthalmos (bulging eyes)- results from accumulation of fluid behind the eyeball, associated with hyperthyroidism Alcoholic=self help group Full-term Newborn head circumfrence: 33-38cm Hip abduction in newborns- normal >70%; hip dysplasia < 60-70% S/S of Increased ICP- vomiting, HA, irritability, decreased resp, increased BP Diplopia is associated with Myasthia gravis Nystagmus is associated with MS Tensilon is used to dx Myasthia gravis b/c it strengthens muscles temporarily Disodium EDTA- Ca chelating agent Cleft lip/palate- babies need to be given frequent rests and burps during feedings Genital herpes: pt. must abstain from sex for the last 4-6 weeks of pregnancy when partner is the one that is positive, condom as limited protection against herpes because the virus is smaller than the pores in condom, causes newborn visual problems Breast bud size is an indication of preterm babys gestational age Simian crease (palmar crease) 1 instead of 3 can be indicative of genetic disorder such as down syndrome Atherlosclerosis-accumulation of fat in arteries Arteriosclerosis- thickening and hardening of arteries.