U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED, Exams of Nursing

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U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U World – NCLEX STUDY NOTES Pharmacology • Afib o Warfarin ▪ INR 2-3 ▪ Affected by antibiotics (destroy bacteria which produce vitamin K, increasing INR) ▪ Leafy greens can lower INR ▪ Omeprazole, Amiodarone, Tylenol, NSAIDs, SSRIs, Thyroid hormone ^ bleeding risk o Digoxin (Lanoxin) ▪ Increase cardiac contractility but slows heart rate and conduction o Macrolide (azithromycin, erythromycin, clarithromycin) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Can cause prolonged QT interval, which may lead to cardiac death due to torsades de pointes ▪ can cause hepatotoxicity o Penicillin (amoxicillin, ampicillin) ▪ Allergy may have cross-sensitivity to cephalosporin (cefazolin, cephalexin, ceftriaxone) o “Sulfa” medications (trimethoprim, sulfamethoxazole, sulfasalazine) ▪ Side effects: crystalluria causing kidney injury (drink at least 8 glasses of water), photosensitivity, folic acid deficiency, agranulocytosis, stevens- johnson syndrome • Stop taking if rash develops, monitor CBC and report fever and sore throat immediately. o Tetracyclines (tetracycline, doxycycline, minocycline) ▪ Take on empty stomach (1 hour before or 2 hour after meals) ▪ Avoid antacids, iron supplements or dairy products ▪ Take with full glass of water ▪ Photosensitivity ▪ Can decrease effectiveness of contraceptives (is teratogenic also) • Antidotes U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Aminoglycosides (gentamicin, tobramycin, amikacin) ▪ Side effects: ototoxicity, nephrotoxicity ▪ Assess hearing, balance, and urinary output o Levofloxacin (Levaquin) – quinolone ▪ 2 hours should pass between drug ingestion and consumption of aluminum/magnesium antacids, iron, multivitamins with zinc, or sucralfate • Antiemetic o Metoclopramide ▪ Treats N+V, and gastroparesis (increase Gi motility and promote emptying) ▪ May lead to tardive dyskinesa (often irreversible) • Breast Cancer o Tamoxifen ▪ block estrogen in breast, but agonist in the uterus (excessive endometrial proliferation) ▪ Risk: endometrial cancer, and thrombolytic events ▪ Take for 5-10 years to prevent recurrence ▪ Can cause symptoms of menopause (hot flashes, decreased libido, vaginal dryness) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Chemotherapy o Allopurinol (Zyloprim) ▪ Blocks nucleic acid catabolism to prevent hyperuricemia that can occur from chemotherapy (tumor lysis syndrome) ▪ Can also be used for kidney stones, prevent gout ▪ Does not affect calcium, phosphate, or potassium levels • Clostridium difficile o Metronidazole (Flagyl) ▪ First line treatment ▪ Leukocytosis is expected with this infection ▪ Can temporarily turn urine dark, brownish colour ▪ Avoid alcohol for 3 days after completion • Can cause flushing, N+V, severe abdominal pain • Cough o Dextromethorphan/Guaifenesin (Robitussin) ▪ Antitissuve ▪ Relatively safe to use 10-30mg q4-8h (doesn’t produce respiratory depression at this level, and side effects uncommon) • COPD o Anticholinergic (ipratroprium, tiotropium, umeclidinium) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Relax airway, do not reduce inflammation ▪ Tiotropium and umeclidinium: Long acting, 24-hour ▪ Ipratropium: rescue medication ▪ Capsule-inhaler system (handi-haler) o Corticosteriods (methylprednisolone, prednisone, dexamethasone) ▪ Side effects: fluid retention, hypertension, increase blood sugar (require more insulin if diabetic), gastric irritation (do not take on empty stomach) • Cataracts – particularly in glucocorticoid therapy ▪ Started at higher dose then gradually decreased (slow taper prevents adrenal crisis) ▪ Recommended diet high in calcium (>1500mg/day) and protein (1.5g/kg/day) but low in fat and simple carbs is recommended • Can cause osteoporosis and muscle weakness • Depression o SSRIs (fluoxetine, paroxetine, citalopram, escitalopram, sertraline) ▪ side effect = sexual dysfunction, weight gain • Gi disturbance, headache, dizziness, drowsiness, insomnia • Increase suicide risk U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Amiodarone ▪ Antiarrhythmic used to treat life-threatening arrhythmias (last resort to other treatments) ▪ Severe side effects = pulmonary toxicity (dry cough, pleuritic chest pain, dyspnea) • GERD o PPI (omeprazole, pantaprazole) ▪ May increase risk of C.dif ▪ Associated with decreased bone density ▪ Increase risk of pneumonia • Heart Failure o Carvedilol (Coreg) ▪ Improve cardiac output and slow progression of heart failure ▪ B-type natriuretic peptide (BNP) normal <100pmol/L is secreted from ventricles in response to increased ventricular stretch. Elevated BNP is expected. o selective beta blockers (metoprolol, atenolol, bisprolol) o non-selective beta blockers (propranolol, nadolol) – contraindicated in asthma • Hepatic Encephalopathy U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Lactulose ▪ Helps to eliminate ammonia through bowels ▪ Can be given with water, juice, or milk or via enema ▪ Can be administer on empty stomach for faster results ▪ Therapeutic effect = 2-3 soft bowel movements each day U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Hyperkalemia o Calcium Gluconate ▪ Does not decrease serum potassium, but is administered to hyperkalemic clients with ECG changes (eg. Peaked T waves) ▪ Temporarily stabilizes the myocardium o Insulin with 50% dextrose ▪ Corrects by shifting potassium into cells ▪ Dextrose is administed concurrently to prevent hypoglycemia o Sodium polystyrene sulfonate (Kayexalate) ▪ Treats hyperkalemia (trade sodium for potassium) ▪ Given PO or enema, not rapid treatment • Hyperphosphatemia o Calcium acetate (PhosLo) ▪ Phosphate binder • Hypertension o ACE Inhibitors (lisinopril, Ramipril) ▪ Can cause hyperkalemia ▪ Side effect: cough, angioedema, o ARBs (losartan, valsartan, candesartan) ▪ Can cause hyperkalemia o Calcium Channel Blockers (nifedipine, amlodipine, felodipine) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Mannitol (Osmitrol) ▪ Hold if serum osmolality > 310-320 ▪ Contraindicated in heart failure (can cause circulatory overload); may also need a loop diuretic to prevent serious complications ▪ Always use filter needle (crystalizes at room temp) • Labour o Oxytocin ▪ High-alert medication ▪ Stimulates contraction of uterine smooth muscle ▪ Should be administer with pump, prevents hypotension associated with bolus dose ▪ Must monitor fetal HR and uterine contraction pattern q15 minutes (1st stage of labour), and q5min (2nd stage of labour) ▪ Administer in secondary IV line via proximal port ▪ Start lowest possible dose and titrate until contractions are 2-3 minutes apart and last for 80-90 seconds • Infusion decreased if uterine tachysystole (>5 contractions in 10 minutes) or fetal distress ▪ Adverse effects: • Uterine tachysystole (>5 contractions in 10 minutes U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ averaged over 30 min) • Abnormal or indeterminate fetal heart rate patterns • Postpartum hemorrhage (uterine atony and uterine fatigue may occur if prolonged exposure) • Water intoxication (antidiuretic effect when high doses over time) ▪ Stop immediately if: • Nonreassuring FHR patterns (late decelerations, fetal tachycardia, bradycardia) o Methylergonovine (Methergine) ▪ Improves muscle tone and strength of contractions, used just after baby is born to help deliver placenta ▪ Do not give to mother with hypertension (vasoconstricts further) o Misoprostol ▪ Combats uterine atony by contracting uterine muscle, rather than vasoconstrict, making it safe for clients with hypertension ▪ Usually given rectally PPH to increase absorption o Tocolytic ▪ Stops contractions in premature labour U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • MRSA o Vancomycin ▪ Excreted by kidneys ▪ Serum vancomycin trough level monitored before 4th dose (15- 20mg/L) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Magnesium Sulfate ▪ Prevents seizures ▪ Assess: deep tendon reflexes hourly (hyperreflexia or clonus may indicate impending seizure, whereas hyporeflexia may indicate toxicity) ▪ Reversal agent: calcium gluconate • Pulmonary Embolism U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Low-molecular-weight heparin (enoxaparin, dalteparin) ▪ Initial management o Factor Xa Inhibitors (apixaban, rivaroxaban) ▪ Once PE resolved, maintenance therapy ▪ Concurrent NSAID use contraindicated (increased risk of bleeding) ▪ Avoid garlic and ginger • Rheumatoid Arthritis o Methotrexate (Rheumatrex) ▪ Immunosuppressant ▪ Can cause bone marrow suppression; client is at risk for infection ▪ Live vaccines contraindicated ▪ Teratogenic; do not become pregnant for at least 3 months after discontinuing ▪ Avoid alcohol as it is hepatotoxic • Schizophrenia o Clozapine (Clozaril) ▪ Risk for agranulocytosis (low WBC) ▪ Client must have WBC >3500, and ANC of >2000 before starting ▪ Side effects: Prolonged QT, orthostatic hypotension, U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ hyperglycemia, weight gain, dyslipidemia • Seizures o Benzodiazepines (Diazepam, Lorazepam) ▪ Used acutely to control seizures o Carbamazepine (Tegretol) ▪ Anti-convulsant o Phenytoin (Dilantin) ▪ may decrease effectiveness of other meds (oral contraceptives, warfarin) ▪ non hormonal birth control method should be used ▪ Can cause gingival hyperplasia ▪ Folic acid supplementation can reduce this side effect ▪ Major side effects: • Increase in body hair, rash, folic acid depletion, decreased bone density ▪ Do not stop abruptly • Tuberculosis o Isoniazid (INH) ▪ Interferes with action of vitamin B6 (pyridoxine) resulting in peripheral neuropathy; ataxia and paresthesia ▪ Vitamin B6 supplement 25-50mg/day recommended U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Acceleration of HR at least 15/min above baseline lasting at least 15s = fetal movement ▪ HR 110-160 ▪ No late or variable decelerations ▪ + accelerations, + early deceleration ▪ Moderate variability = HR fluctuation between 6-25/min o Early deceleration ▪ Symmetric to contraction ▪ Fetal head compression ▪ Can be normal o Late deceleration ▪ Delayed compared to contraction ▪ Uteroplacental insufficiency ▪ Treatment: • Stop oxytocin immediately • Side-lying position • Administer oxygen via face-mask 8-10L/min and IV fluid bolus to improve oxygen availability and blood volume to fetus • Notify HCP o Variable deceleration U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Abrupt <30 sec from onset to nadir, decrease >15/min; duration >15sec but <2 min ▪ Cord compression, oligohydramnios, cord prolapse o VEAL CHOP U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ Patter n Clinical significance Actio n Variable decelerations Cord compression/prolapse, oligohydraminos Cord compression = trendelenberg Prolapse = cover with saline gauze Recurrent = amnioinfusion (to compensate for low amniotic fluid) If baseline uterine tone is elevated (>20mmHg) and minimal absent fluid return, pause infusion and notify HCP Early decelerations Head compression Accelerations Okay (normal fetal oxygenation) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ Should not be >q2min Intensity Strength of the contraction at its peak 25-50mmHg Should not exceed >80mmHg Resting Tone Tension in the uterine muscle between contractions Allows fetal oxygenation between contractions Average 10mmHg Should not exceed >20mmHg U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Normal Findings: ▪ Left lateral position = increased blood flow and fetal oxygenation ▪ Occiput anterior = proper • (Right occiput posterior = “back labour”, lower back pain with contractions) o Position woman on hands and knees to relieve pain and help fetal rotation ▪ Fetal station below maternal ischial spines (+1 or greater) often cause N+V and trembling ▪ End of first stage of labour: • Increased pain, fear, irritability, anxiety, self-doubt in ability to birth o Amniotomy ▪ Artificial rupture of membranes (AROM) ▪ Performed to induce labor ▪ Client should be upright after AROM to allow for drainage ▪ Risk of: umbilical cord prolapse > fetal bradycardia ▪ Assess: temp q2h, amniotic fluid colour amount and odour (should be clear/colourless and without odour) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Bishop Score ▪ Cervix: consistency, position, dilation, effacement, station • Soft, anterior, >5cm dilation, >80% effacement, station +1 or +2 U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ is alkaline o Placental Abruption ▪ Potential complication of preeclampsia related to hypertension ▪ Premature detachment of placenta from uterine wall, resulting in bleeding ▪ Symptoms: U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Abdominal pain, dark red vaginal bleeding, rigid uterus, abnormal fetal heart rate patterns, and uterine tachysystole ▪ Emergency C-section very common as condition deteriorates o Placenta Accreta ▪ Placental adheres directly to myometrium instead of endometrium ▪ Major complications: life-threatening hemorrhage ▪ Previous C-section is a risk factor o Placenta Previa ▪ Placenta covering the cervical os ▪ Diagnosed by ultrasound ▪ Symptoms: • Painless vaginal bleeding after 20 weeks ▪ Pelvic rest (no intercourse), digital exams contraindicated in presence of vaginal bleeding of unknown origin o Precipitous birth ▪ <3 hours of labour from contraction onset to birth o Shoulder Dystocia ▪ Signs: initially observe the fetal head retracting back toward perineum after birth of head (turtle sign). Frequently U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ associated with macrosomia (>4000g) secondary to gestational diabetes. ▪ Suprapubic pressure • Helps dislodge impacted anterior shoulder from under the client’s pubic bone in the event of shoulder dystocia ▪ McRobert’s maneuvers ▪ Contraindication: • Do not use fundal pressure, forceps or vacuum (will wedge fetal shoulder further into pubis) o Umbilical cord prolapse ▪ Place into knee-chest position or in Trendelenburg ▪ May use sterile, gloved hand to lift the presenting part off the cord ▪ Administer oxygen and IV fluids ▪ Emergency C-section, unless vaginal birth imminent and safe o Uterine rupture ▪ First sign is usually abnormal fetal heart rate patterns ▪ Other signs: constant abdominal pain, loss of fetal station, and sudden cessation of uterine contractions • FHR deceleration followed by fetal bradycardia ▪ Tachysystole increases risk for uterine rupture U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Antenatal glucocorticoids (betamethasone, dexamethasone) • Stimulate lung maturation and promote surfactant development ▪ Antibiotics (penicillin) to prevent group B strep infection ▪ Initiate IV magnesium sulfate for neuroprotection if at <32 weeks ▪ Tocolytic medications (nifedipine) to supress uterine activity, which allows glucocorticoids time to have therapeutic effect ▪ AROM contraindicated o Necrotizing Enterocolitis ▪ Primarily occurs in preterm infants secondary to GI and Immunological immaturity. Enteral feeds may introduce bacteria into bowel where they proliferate. Results in inflammation and ischemic necrosis of intestine • Treatment: o Measure abdominal girth daily o NPO o Nasogastric suction to decompress stomach and intestines o Parenteral hydration, nutrition, and IV antibiotic o Avoid rectal temperatures (risk of perforation) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Place supine and undiapered (avoid pressure on abdomen) • Pregnancy o Normal findings: ▪ Systolic murmur (swoosh heard during S1) common ▪ Weight gain: 1.1-4.4.lb (0.5-2.0kg) in 1st trimester, then 1lb (0.5kg) per week ▪ Edema in lower extremities, especially in third trimester U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Vaginal discharge increases near end, may become mucoid and blood tinged in days preceding labour • Leukorrhea: think milky white vaginal discharge is normal ▪ Hemodilution in late pregnancy (lower hemoglobin and hematocrit) ▪ WBC increase up to 15,000mm3 o Contraindications: ▪ ARBs and ACE inhibitors contraindicated in pregnancy • Beta blocker (labetalol) is safe ▪ NSAIDs ▪ Warfarin ▪ Oral hypoglycemics o Cervical Cerclage ▪ Prevent preterm labour ▪ Placement occurs at 12-14 weeks gestation with a history of cervical insufficiency (painless, premature cervical dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs noted (short cervix) ▪ Removed 36-37 weeks ▪ Recognize signs: U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Hemolysis, Elevated Liver enzymes, Low Platelets ▪ Symptoms: • RUQ pain, N+V, malaise, headache, hypertension o Hyperemesis Gravidarum ▪ Symptoms: • Weight loss, poor skin turgor, dry mucous membranes, hypotension, tachycardia • Hypokalemia/hyponatremia, ketonuria, increased urine specific gravity, hemoconcentration, metabolic alkalosis ▪ Treatment: • May require IV fluid replacement and antiemetic therapy o Leopold maneuvers ▪ Palpating the pregnant abdomen to identify fetal presentation o Ruptured ectopic pregnancy U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Symptoms: • Unilateral abdominal pain, hypotension, tachycardia, referred shoulder pain Paediatr ic o TORCH ▪ Toxoplasmosis, Other (parvo-B19 [fifth disease]/varicella zoster), Rubella, Cytomegalovirus, Herpes) ▪ Can cause fetal abnormalities • Normal Findings: o Birth weight double by age 6 month, triple by age 1 year o Birth length increases by about 50% in first year o Weight gain during toddler years = 4-6lbs (1.8-2.7kg) per year o Head circumference = chest circumference by first year o Head circumference increases by 1in (2.5cm) during second year and then slows to 0.5in (1.25cm) per year till age 5 o Circle chest shape until age 2 o Chest circumference > abdominal after age 2 o Posterior fontanelle fuse by 2 months o Anterior fontanelle fuse by 18 months o S3 sound (heard in diastole, dull low pitch) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Bowlegs until age 18 months, then at age 4 genu valgum, then age >7 straight o Common allergenic foods should be introduced around 4-6 months U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Toddlers (1-3 years): ▪ Thrive on routines and rituals ▪ Separation anxiety, limited ability to cope ▪ Hospital: Rooming in, follow home routines, regular visits to playroom ▪ May have physiologic anorexia (increasingly picky about food choices and schedules) o Preschool age (3-5 years): ▪ Egocentric and magical thinking U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ May think the illness was caused by something they have done or thought ▪ Fantasy play with puppets o School age (6-12 years): ▪ Attaining sense of industry (competence) is most significant developmental goal. ▪ Encourage to complete missed school work to avoid sense of inferiority • Failure to Thrive o <80% of ideal age and/or depressed weight for length o Underlying cause = dietary intake o Contributing factors = disturbance in feeding behaviour and psychosocial factors • Fetal Alcohol Syndrome o Leading cause of intellectual disability and developmental delay o Symptoms: ▪ Growth deficiency, microcephaly U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, short palpebral fissures) • Group A B-hemolytic Streptococcus o Can lead to glomerulonephritis or rheumatic fever o Treatment: ▪ Soft diet and cool ice chips ▪ Complete full course of antibiotics ▪ Toothbrushes replaced 24 hours after antibiotics ▪ May return to school after 24 hours of antibiotic and afebrile • Hirschsprung Disease o Distal large intestine missing nerve cells; internal anal sphincter unable to relax o No peristalsis and stool unable to pass o Symptoms of distal intestinal obstruction o Symptoms: ▪ Distended abdomen, will not pass meconium within expected 48 hours, difficulty feeding, vomit green bile o Fatal complication = Enterocolitis  sepsis  death ▪ Presents with fever, lethargy, explosive, foul-smelling diarrhea, rapidly worsening abdominal distension • Immunizations U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Varicella, MMR, Nasal influenza, Rotavirus, Yellow fever • Infant Botulism o Raw honey, milk <1 year o Symptoms: ▪ Life-threatening paralysis ▪ Early: constipation, difficulty feeding, decreased head control, diminished deep-tendon reflexes ▪ Later: respiratory failure and arrest • Injury Patterns in Non-Accidental Trauma o Coup-contrecoup o Long bone fractures in humerus or femur o Subdural and epidural hematomas o Linear-type immersion burns o Frenulum tears and gingival lesions o Retinal hemorrhage on funduscopic exam • Intussusception o Symptoms = stools with blood and mucus “currant jelly” appearance, intermittent pain (q15-20minutes, drawing up of knees), vomiting, “sausage- shaped” right sided mass o Treatment = saline or pneumatic (air) enema, note for normal U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ brown stool indicating reduction of intussusception o At risk = perforation  peritonitis  fever, abdominal rigidity, guarding, and rebound tenderness • Neonatal Abstinence Syndrome o Symptoms: ▪ Irritability, hypertonia, jittery movements ▪ Diarrhea, vomiting, feeding intolerance ▪ Sweating, sneezing, pupillary dilation o Treatment: ▪ Opioid therapy (morphine, methadone) • Kawasaki Disease o Systemic vasculitis of childhood (usually kids younger than 5) o Symptoms: ▪ Presents with >5 days of fever, nonexudative conjunctivitis, lymphadenopathy, mucositis, hand and foot swelling, and a rash ▪ Desquamation of hands and feet, irritability, temporary joint pain o Treatment: ▪ IV immunoglobulin and aspirin to prevent coronary artery U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ aneurysms ▪ Monitor fever q6h first 48 hours following last fever, then check daily until follow-up • Marfan Syndrome o Autosomal dominant disorder o Symptoms: ▪ Tall and thin, disproportionate long arms, legs, and fingers ▪ Abnormalities of the aorta and cardiac valves ▪ Crowding of teeth from high-arched palate ▪ Risk for scoliosis (Especially during adolescence) ▪ Ocular problems (lens dislocation, retinal detachment, cataracts, glaucoma) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ ASD • Systolic murmur with fixed split second heart sound • May be asymptomatic, may have signs of HF, atrial arrhythmias ▪ VSD • Holosystolic murmur at left lower sternal border = classic sign • Acyanotic defect, may result in R sided HF • May close spontaneously in 1st year of life ▪ Patent ductus arteriosus • asymptomatic besides loud machine-like systolic and diastolic murmur o Injections: ▪ IM site for <1 year = vastus lateralis muscle (anterolateral middle portion of thigh) ▪ IM size = 5/8 inch (up to 1inch for infants), needle 22 to 25 gauge <1 year • Play o Solitary Play ▪ Common in infants <1 year ▪ Focused on their own activity and play alone in presence of U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ others o Parallel Play ▪ age 1-3; toddlers ▪ Play next to each other, but do not play directly with one another o Associative Play ▪ age 3-6; preschoolers ▪ Engage in similar activities, but play is unorganized without specific goals or rules. Often borrow items without directing each other’s play. Involve motor activities and imaginative, pretend play o Cooperative play ▪ Age 6-12; school age ▪ Play with one another with a specific goal, often within a rigid set of rools • Puberty o Men: first sign is testicular enlargement (age 9½-14), followed by hair, voice change, and growth spurt • Pyloric Stenosis o Symptoms: U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Palpable epigastric olive-shaped mass, non-bloody projectile vomiting • Sudden Infant Death Syndrome (SIDS) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ respiratory support (BIPAP or tracheostomy), feeding tube, medications to decrease symptoms, mobility assistive devices, communication assistive devices • Anaphylactic Shock o Symptoms: acute onset (usually 20-30 minutes), circulatory failure and respiratory manifestations (laryngeal edema, bronchoconstriction due to histamine release) o Treatment: ▪ Ensure patent airway, administer oxygen ▪ Remove allergen ▪ IM epinephrine, repeat q5-15min ▪ Place in recumbent position and elevate legs ▪ Maintain BP with IV fluids, volume expanders or vasopressors ▪ Bronchodilator (such as Ventolin) ▪ Antihistamine ▪ Corticosteroid to decrease inflammation and swelling ▪ Anticipate cricothyrotomy with severe laryngeal edema • Aphasia o Broca (expressive) ▪ Impaired speech and writing, difficulty with word choice U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Wernicke (receptive) ▪ Impaired comprehension of speech and writing, may make full sentences but words make no sense • Appendicitis o Symptoms: pain (begins in periumbilical region then RLQ), N+V, rebound tenderness, guarding • Autonomic Dysreflexia o Acute, life-threatening response to noxious stimuli, which clients with spinal cord injuries above T6 are unable to feel. o Symptoms: hypertension, bradycardia, pounding headache, diaphoresis, nausea o Noxious stimuli: bladder distension, fecal impaction, tight clothing • Breast Cancer U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Burn Injuries o Emergent phase (24-72 hours) = fluid, proteins, and intravascular components leak into interstitium  hypovolemia o Hyperkalemia (K+ released when cellular damage occurs), may have ECG changes (tall, peaked T waves, shortened QT interval) o Hyponatremia occurs o Hematocrit and hemoglobin values will be elevated due to hypovolemia (hemoconcentration) • Cancer o Warning signs: ▪ Change in bowel or bladder habits U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Your liver is normally responsible for: ▪ Detoxifying, clotting blood, metabolizing drugs, synthesizing albumin o Symptoms: ▪ Firm nodular liver, abdominal pain (due to liver capsule stretch), chronic dyspepsia, change in bowels, ascites, splenomegaly (means immune system involvement), low albumin, high AST/ALT, anemia, elevated bilirubin (jaundice), PT/INR/PTT elevated (coagulation factors normally produced in liver), low sodium (dilution effect) ▪ Can progress to hepatic encephalopathy/coma (due to build up of ammonia) o Treatment: ▪ Antacids, vitamins, diuretics ▪ No more alcohol, rest, I+O and weights ▪ Prevent bleeding ▪ Avoid narcotics (liver cannot metabolize drugs; can overdose) ▪ Diet: low in protein and salt • Protein normally breaks down to ammonia  liver converts to urea  kidneys excrete U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Compartment Syndrome o 6 P’s: pain, pallor, pulselessness, parasthesias, poikilothermia (coolness), paralysis o Treatment = place extremity AT heart level • Cystic Fibrosis o Diet = high calories, fat, and protein o Defective protein responsible for transporting sodium and chloride, results in secretions from exocrine glands to be thicker and stickier than normal o Expected bad symptoms = blood streaked sputum (damage of airways), weight loss, fluid retention o Emergency = decreased pulse ox U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Symptoms: ▪ Inability to clear the airway and chronic cough ▪ Increased salt loss, dehydration, and hyponatremia during times of significant perspiration (increase salt intake during hot weather) ▪ Malabsorption of fat-soluble vitamins (AEDK) ▪ Often cough up blood-streaked sputum ▪ Fecal retention and impaction common ▪ Eventually develop bronchiectasis (chronic lung disease) and risk for recurrent lung infections ▪ Risk for rupture of damaged alveoli, which results in sudden- onset pneumothorax (worsening dyspnea, tachypnea, tachycardia, drop in O2) o Treatment: ▪ Pancreatic enzymes with meal ▪ Enteric coated (may sprinkle onto applesauce, yogurt, or acidic foods pH <4.5) ▪ Do not crush or chew capsules, do not take with milk • Diabetes Insipidus o ADH insufficiently produced or suppressed U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Treatment = small frequent meals, replace simple sugars with complex carbs, incorporate high-fibre and protein rich foods, avoid fluids with meals and lie down after eating to slow gastric emptying o 15-30 minutes post meal, due to rapid emptying of hypertonic gastric content o Can occur after gastrojejunostomy • Epiglottitis o Symptoms = High-grade fever, severe sore throat U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o 4D’s: drooling, dysphonia, dysphagia, distressed airway (inspiratory stridor) o Children typically toxic-appearing, may be “tripoding” o Medical emergency, can have airway occlusion in hours • GERD o Treatment = weight loss, small frequent meals with sips of water, avoid triggers or anything that delays gastric emptying (caffeine, alcohol, nicotine, high-fat foods, chocolate, spicy, peppermint, carbonated beverages) • Heart Failure o NSAIDs contraindicated due to sodium/fluid retention o Daily weights • Hepatic Encephalopathy o Frequent complication of liver cirrhosis o Precipitating factors: hypokalemia, constipation, GI hemorrhage, infection o Results from accumulation of ammonia and other toxic substances in blood o Symptoms: ▪ Sleep disturbances (early) to lethargy and coma ▪ Mental status change U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Presence of astrexis (flapping tremors of hand), asses by having client extend and dorsiflex wrists ▪ Fetor hepaticus (musty, sweet odor of the breath) • Hyperthyroidism o Treatment: ▪ Adhere to high calorie diet (4000-5000) ▪ ~6 meals and snacks per day, with ^ protein, carbs, and full of vitamins ▪ Avoid high fibre foods (constant hyperstimulation of GI) ▪ Avoid stimulating substances and spicy food • Hypoglycemia o Symptoms: ▪ Sweating & pallor, irritability, tremors & weakness, tachycardia, drowsiness, hunger • Hypotension o Tachycardia compensatory mechanism • Hypothermia o <35 degrees o Myocardium extremely irritable and prone to dysrhythmias o Client handled gently as spontaneous ventricular fibrillation can develop when moved or touched, anticipate defibrillation in these U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Hodgkin (Reed-Sternberg cells) or non-Hodgkin o Symptoms: ▪ At least one painless, enlarged lymph node ▪ Fever ▪ Unexplainable/unintentional weight loss ▪ Drenching night sweats ▪ Itching, fatigue • Malignant Hyperthermia o Life-threatening condition precipitated by certain medications used for anesthesia including inhaled anesthetics (desflurane, isoflurane, halothane) and succinylcholine (paralytic) ▪ Skeletal muscles become unable to control calcium levels, leading to hypermetabolic state manifested by contracture and increased temp o Symptoms = tachypnea, tachycardia, rigid jaw (early signs), high fever (later), hyperkalemia, dysrhythmias, and myoglobinuria (muscle tissue broken down) • Measles (Rubeola) o Symptoms = conjunctivitis, Koplik spots, coughing, erythematous morbilliform U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ rash, copious clear mucus o Post-exposure prophylaxis for eligible, susceptible family members within 72 hours of exposure o N95 mask and negative pressure isolation room o Treatment = vitamin A supplements to prevent measles-induced deficiency which can cause blindness • Meningitis o Symptoms = fever, severe headache, N+V, nuchal rigidity, photophobia, altered mental status, and increased ICP U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Treatments = vasopressors, lab and blood cultures, empiric antibiotics, head CT prior to LP (increased ICP may contraindicate LP) o CSF usually purulent and turbid in bacterial meningitis • Myocardial Infarct o Anterior wall MI = pumping ability of left ventricle, at risk for cardiogenic shock o Report = development of S3 sound, jugular vein distension, crackles (heart failure) • Nephrotic Syndrome o Collection of symptoms resulting from various causes of glomerular injury o 4 classic manifestations: ▪ Massive proteinuria – caused by increased glomerular permeability ▪ Hypoalbuminemia – due to excess protein loss in urine ▪ Edema – due to low protein and albumin (anasarca) ▪ Hyperlipidemia o Additional symptoms = decreased urine output, fatigue, pallor, and weight gain o Treatment: bed rest (promotes diuresis), albumin with diuretics, U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Pancreati tis o Palpate for thrill, hear bruit • Peritoneal Dialysis o 2500mL dialysate warmed and infused via gravity (dwell time 20 minutes), then bag lowered and fluid drained o Cloudy = infection o Reposition side-to-side if poor outflow o #1 complication = peritonitis o Symptoms = severe pain LUQ or mid-epigastric that often radiates to the back o Pain improves with leaning forward, worsens when lying flat o Risk for hypovolemia, acute respiratory distress syndrome, and hypocalcemia • Sickle Cell Crisis o Inadequate oxygenation or hydration exacerbates sickling and causes RBC to clump together in capillaries (vasoocclusion) o Symptoms: severe ischemic pain, hypoxia, and possible organ dysfunction if left untreated o Treatment: priority = IV fluids to reduce blood viscosity and restore U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ perfusion to areas previously affected by vasoocclusion, bed rest (improves oxygen use and reduces energy consumption), blood transfusion if unresponsive to IV fluids • Skull Fracture o Racoon eyes = periorbital hematomas o Halo sign = coagulated blood surrounded by CSF o Battle sign = mastoid or postauricular ecchymosis • Do not insert NG or OG tube blindly • Paralytic Ileus o Symptoms: abdominal discomfort, distension, N+V o Remain NPO, Nasogastric suction may be required to decompress stomach o Do not take opioids (prolong ileus) • Peripheral Artery Disease o Treatment = Lower extremities below heart when sitting (promotes arterial blood flow) ▪ Compared to venous return = raise legs ▪ Moderate exercise ▪ Daily skin care, maintain mild warmth (do not use heating pads) U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ ▪ Avoid tight clothing and stress (prevents vasoconstriction) o Symptoms: decreased peripheral pulses, thick brittle nails, cool dry shiny skin, gangrene, hair loss, intermittent claudication, small circular deep ulcers o Meds = vasodilators, antiplatelet • Phlebitis o Inflammation of vein o Symptoms = Pain, swelling, warmth at site, redness extending along vein • Pneumothorax o Potential complication from thoracentesis o Symptoms: ▪ Hyper-resonance to percussion, diminished breath sounds, decreased tactile fremitus, hypotension, tracheal deviation to normal side • Pulmonary Embolism o Symptoms: anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, hemoptysis o At risk clients: abdominal C-section, postpartum state U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ Possible etiologyCharacteristics of Stool U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Treatment = Low-residue, high protein, high calorie diet ▪ Limits trauma to inflamed colon ▪ Easily digested foods = enriched breads, rice, pastas, cooked vegetables, tender meats ▪ Drink at least 2L of water daily ▪ Avoid foods = raw vegetables and fruit, whole grains, highly seasoned, fried foods, and alcohol ▪ Multivitamin containing calcium o Small frequent meals o Symptoms = frequent bouts of bloody diarrhea, anorexia, and anemia, abdominal pain U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ Small, dry, rocky-hard masses Constipation Light gray “clay-colored” Biliary obstruction Mucus or pus Ulcerative colitis Infective colitis Greasy, foamy, foul- smelling, fatty Chronic pancreatitis Black tarry Upper GI bleed Bright red bloody Lower GI bleed Blood present on surface of stool Hemorrhoids Mental Health • Alcohol Withdrawal o Generally starts within 8 hours after last drink o Peaks at 24-72 hours U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Acute intoxication can cause hypoglycemia • Anorexia o Weight gain goal 2-3lb/wk • CBT o Education about disorder o Self-observation and monitoring o Physical control strategies (ex. DB+C) o Cognitive restructuring o Behavioural strategies • Defence Mechanisms U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ o Administer anti-anxiety meds • Personality Disorder o Borderline ▪ Symptoms: • Often make suicidal threats, gestures, and attempts (all should be taken seriously) • Most commonly encountered • Intensely emotional, manipulative • Fear of abandonment (any relationship is better than none) o Narcissistic ▪ Symptoms: • Grandiosity, needs admiration, and lack of empathy • May project a picture of superiority, uniqueness, and independence that hides their true sense of emptiness ▪ Damaged ego resulting from childhood environment that fostered a sense of inferiority, poor self-esteem, and severe self-criticism o Histrionic ▪ Symptoms: U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • self-dramatizing, exaggerated or shallow emotional response • attention-seeking • overly friendly and seductive • demands immediate gratification and little tolerance for frustration • PTSD o 1st step = client’s readiness (ability and willingness) to discuss the details of the traumatic event without experiencing high levels of anxiety o 3 categories: ▪ Re-experiencing the trauma • Intrusive memories, flashbacks, recurring nightmares, feelings of intense distress/loss of control or strong physical reactions to event reminders (rapid pounding heart; GI distress, diaphoresis) ▪ Avoiding reminders of the trauma • Avoiding activities, feeling emotionally numb, loss of interest in life, amnesia ▪ Increased anxiety and emotional arousal U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+ • Insomnia, irritability, rage, anger/fear, concentrating difficulty, hypervigilance • Schizophrenia o Impaired thought processes seen: ▪ Neologisms: made-up words or phrases of bizarre nature (ex. I would like to have a phjinox) ▪ Concrete Thinking: literal interpretation of an idea; difficulty abstract thinking U WORLD- NCLEX REVISION STIUDY GUIDE NOTES LATEST UPDATE BEST EXAM SOLUTION RATED/UPGRADED A+