Kaplan Decision Tree and Nurse Notes – 102 pages
Ok for those of you who did not take Kaplan, this is their infamous Decision Tree
(Can’t say I use it a lot, but some swear by it)
1. Can you identify the Topic?
Yes= proceed to step 2
No= read answers for clues, read stem, re word question
identify and proceed to step 2
2. Are all answers Assessments or Implementations?
Yes= proceed to step 3
No= determine from stem if assessment needed, validation needed; if so assess
*if no assess in stem then you need to assess
*if assess in stem, do you need validation?
*if assess or validation required and there are no right assess answers, then implement
3. Does Maslows fit?
Yes= Do they make sense? Apply ABC’s.
*eliminate psychosocial/pain (consider pain psychosocial for nclex)
*don’t alwayspick airway
No= are all physical? yes..then proceed to step 4
are all psychosocial? yes..then proceed to step 5
4. Are all answers physical?
Yes= apply ABC’s
No= proceed to step 5
5. What is outcome of each?
do they make sense?
and yes folks then you should have your answer!!!!
During peritoneal dialysis- client suddenly begins to breathe more rapidly, what do you do? Elevate the HOB! Will decrease the pressure fo the dialysate on the diaphragm and increase the vital capacity of the lungs, draining the cavity will further decrease the pressure.
Normal platelet = 150,000- 400,000. Decreased platelet= increase risk for bleeding. No IM injections, use sm. gauge needle to prevent trauma, apply firm pressure to needlestick site for 10 min, soft bristled toothbrush , do not floss, and no hard fards
Femoral to popliteal bypass graft= report if client becomes clammy. Hypovolemic shock is caused by an inadequate volume of blood caused by hemorrhage, severe dehyradtion, or burns. skin will be cold and clammy b/c the body redirects blood from the skin, kidneys, and GI tract to the brain and heart. Urine output and B/P decreases and pulse increase
Pre-op teaching of extracapsular cataract removal -post-op- activites and restrictions needs to be taught. Protect eye from ICP that will cause the suture line to rupture. To bend at the knees, avoid sneezing, coughing, blowing nose, not to strain during a BM, to avoid vomiting, and do not lie down in an dependent position
Hepatic encaphalopathy occurs with profound liver disease and results from the accumulation of ammonia in the blood. Low protein and high calorie diet.
mother receiving DES is at risk for development of vag. cancer
cervical cancer risk factor= sex at early age
WHIPPLE PROCEDURE- for pancreatic cancer= removal of head of pancreas, distal portion of common bile duct, the duodenum, and part of the stomach for tx of cancer. NG tube is connected to intermittent low suction, assess tub for kinking. Postion client in semi-fowlers. Drainage should be serosanguineous- pinkish
Post-op radical neck dissectino, detect the presence of stirdor, most probable cause is laryngeal obstruction! Is identified upon auscultation of the trachea with a stethoscope. A coarse- high pitched sound can be heard on inspiration d/t edema of the larynx.
Re: Anyoone up for random FACT THROWING??
PRAYERS BEFORE YOU TAKE THE EXAM
Today I will have my examinations. You know how important they are to me. So I am humbly asking Your gracious help and divine assitance. I pray to you, my dear God, please neve rlet me be at ease and give my very best. Please never let me guess nor rely on pure luck, but enlighten my mind and let me think clearly. Please never let me resort to chances nor to dishonesty, but let me work to the fullest of my ability. I pray for Your guidance that i as i think, I may find the right solutions, I may be able to correctly answer the questions, I may solve those difficult problems. I ask, O God, Your intercession, that as I write, I may not be careless nor overconfident, I may not be distracted but be more concentrated, I may not be in a hurry nor take the exams too lightly. Today, O my Lord, I will take my examinations Let me, with Your help, give my best effort. Let me, because of You, receive the best and fruitful results. This I pray in Jesus name. Amen.
Stages of Dying:
Normal growth and development
Most People Can Get Stuff
BIRTH to 1 year- Mobiles
1-3 years- Push and pull toys
3-5 years – Coloring
6-12 years- Board Games
12-19 years- own Stuff
Diabetic KetoAcidosis (DKA): (5-10% mortality)
– Almost exclusively in Type 1 diabetics
– S/S: Polyuria, dehydration, ab pain, fruity breath, AMS, ↓Na/Mg/Phos, ↑K (↓total body), + following:
• Hyperglycemia (>250)
• Metabolic acidosis (pH <7.3,> 20)
• IV insulinbolus (0.1 unit/kg) then IV infusion with same amount per hr AFTER making sure pt is not ↓K
– Continue until acidosis corrects then taper
• NSimmediately upon diagnosis
– Switch to D5NSwhen glucose < 250
• Why in the world would I give D5NS when a patient still has high glucose levels?The most important problem is the acidosis that is occurring. To reverse this we give insulin to drive glucose into the cell. Remember that K rushes into the cell along with the glucose, and wherever K can go, H+ can go. Since high levels of H+ in the blood is the cause of the acidosis, we give insulin to drive this H+ intercellularly, thereby reversing acidosis. We can’t give insulin if the level of glucose is too low, so we give D5NS to keep levels around 250 so we can give insulin until the acidosis is gone.
• Add KCl to IV fluids once K < 5; replenish other electrolytes as necessary; Even though K usually appears high, it most often is total body low and when you give glucose, the K is driven into the cell, and hypokalemia can develop rapidly.
Hyperosmolar Hyperglycemic nonketotic syndrome (HHNS):
– Severe ↑Glucose, almost exclusively in Type 2 diabetics
– Similar to DKA but usually have much higher glucose (>600) and NO acidosis or ketonuria/ketonemia
– Treat with fluidsand low dose Insulininfusion
– An important distinction is that DKA usually occurs in Type 1 Diabetics, while HHNS most often occurs in Type 2 Diabetics. Remember this as it is a common question in the NCLEX world.
– Patho: When glucose drops to 80 = insulin levels ↓; 70 = Glucagon ↑; 50 = epinephrine ↑along with s/s such as sweaty, ↑BP, ↑HR, tremors; Also around 50 CNS s/s (drowsy, h/a, confused) begin
– Note: S/S from epinephrine release are absent if pt is on a BB
– TX: If pt is alcoholic giveThiaminebefore any other treatment to prevent encephalopathy
• Can eat = ↑sugar food;
• Can Not eat = ½ – 2 amps D50 IV push; (Glucagon alternative option if no IV access is available, however is of no use in prolonged hypoglycemia because stores of glycogen are depleted)
Points to remember:
– For high sugar (DKA, HHNS) most of the signs and symptoms are from polyuria, so look for dehydration and electrolyte imbalances…remember High and Dry
– For low sugar most of the signs and symptoms are from the release of epinephrine, so look for things that would happen when someone was high on adrenaline, such as hypertension, sweating, tachycardia and tremors.
–Imperativethat you can recognize the difference between these two, as you are almost guaranteed to see a question relating to this difference!
Re: Anyoone up for random FACT THROWING??
PULMONARY EDEMA:TX “MAD DOG”
Gases in blood(ABG’S)
drugs to treat viral respiratory infections
“you’d get a respiratory infection if you shoot an ARO (arrow)
laced with viruses into thelungs
Re: Anyoone up for random FACT THROWING??
d1206,thanks for the correction
back to facts:
Reduced breath sounds(dyspnea)
X-ray shows collapse
Hi everyone my simple “PHARMA” facts for today from COMMERCIALS:
1)Sumatriptan (IMITREX)—an NSAID for MIGRAINE
2)Alleve—for muscle pain
3)Advair—COPD, bronchitis, emphysema
4)Lipitor— to decrease BP, and for CAD
5)Mucinex— expectorant, can last for 12 hours
6)Zopidem (AMBIEN)—anti-insomnia,taken at bedtimewith full glass of waterin an empty stomach(seen this at Saunders Q & A too)
7) Enbrel—for Rheumatoid ArthitisSE: immunosuppression, fever and bruising
Oh and GLUCERNAdiet for people with DM.. So far those are the drugs that Ive seen on TV ads. and 1 came up on Saunders Q &A the ambienCR.
ABCDE mnemonic –CAUSE of secondary hypertension
A: Accuracy, Apnea, Aldosteronism
B: Bruits, Bad Kidney
C: Catecholamines, Coarctation of the Aorta, Cushing’s Syndrome
D: Drugs, Diet
E: Erythropoietin, Endocrine Disorders