LPN REVIEW

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pachie_18
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161840
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LPN REVIEW
Updated:
2012-07-09 22:39:50
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LPN
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REVIEW
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  1. PERNICIOUS ANEMIA
    • *without B12, brain can't work
    • *s/s: numbness/tingling(paresthesia), bloody red tongue, mouth sores; psychosis & suicidal
    • *test: Schilling's 24hr Urine Test (24hr urine=discard 1st & save last; if no B12 then its pos = B12 injections 4life)
  2. DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
    • *cause: trauma r/t surgery , OB complication
    • *s/s: BLEEDING
    • *tx: Heparin, cryoprecipitate, IV fluids
    • *clotting factors leave arteries & veins which causes more bleeding b/c clotting factors won't be available in area of injury
    • *will need to move quickly to keep BP up
  3. HODGKIN'S LYMPHOMA
    • *CA of the lymphatic system (nomoveable, painless masses)
    • *dx test: Reed-Sternberg CA cells: Biopsy, CT, MRI
    • *prednisone
    • ***Interventions for pts receiving chemo: alopecia, antiematic, appearance of urine, mannitol (dieuretic which loses water so monitor output)
    • ***common SE of chemo: anorexia, akopecia, N/V, ecchymosis 
  4. SMOKING is a r/f for ... BOCELL !
    • B  = bladder
    • O = oral
    • C = cervical
    • E = esophageal
    • L = lung
    • L= laryngeal 
  5. PITUITARY GLAND (Cushing Vs. Addison's)
    • *anytime brain surgery is done, P is placed on pit gland
    • *if pt c/o excessive thirst/urination postop, check urine (sp. grav <1.010 = FVD so pt needs ADH (vasopressin, the "-pressins"))
    • *lots of output = ADH (lack of ADH l/t diabetes insipidus)
    • *no output = diuretics
  6. CUSHING SYNDROME (FVE = Metabolic Alkalosis)
    • *being on too much prednisone (moonface, buffalo hump; d/t steroid (sugar) long term use and storage)
    • *too much cortisol
    • *hypokalemia d/t sugar (increases HR) & hypernatremia d/t h2O retention
    • *long term steroids = loss of Ca+ l/t osteoporosis
    • *labs: check K+ 1st , electrolytes
    • *meds: potassium sparing
  7. ADDISON'S (FVD = Metabolic Acidosis)
    • *hypoTN, cyanosis is late sign
    • *airway pts b/c sugar hormones needed to breath
    • *inc melanocytes: bronze like skin
    • *hypocortisolism: dec sugar, dec glucose level (PRIORITY : give sugar hormones = glucocorticosteroids) 
    • *hyponatremia (abd cramps, belly hurts, N/V)
    • *hyperkalemia (bradycardia) 
    • *NO sedatives = can lose airway !
    • *meds: decadron = cortisol
  8. HYPERTHYROIDISM (need to stop increasing HR or else will go to her "garve" = Grave's Disease)
    *excess amount of thyroxine = hypermetabolism
    • *put in a cool rm b/c pt is hot !
    • *inc appetite = wt loss d/t hyperness
    • *No caffeine , pt is already up !
    • *give calories, sugar, proteins, carbs (she's burning cals fast & so she can continue to breathe)
    • *don't give fine motor activity b/c she's to shaky !
    • *** thyroid storm = medical emergency
  9. HYPOTHYROIDISM (adult=myxedema, infant=cretinism)
    • *s/s: dec HR, BP, T ; edema on hands & feet, wt gain, fatigue & lethargy, hoarse cry in infants
    • *prefers warm environment, high fiber diet d/t constipation
    • *check P, >100 hold med !
    • *NO sedatives, sleeping pills, Narcs !
    • ***select all that apply = irritability, artificial tears, high carb diet
  10. HYPOPARATHYROIDISM (dec Ca+, inc P+)
    • *s/s: carpopedal spasms,dry, scaly skin & thin hair, cavities, cataracts
    • *hypocalcemia = CATS (Chvostek's sign (CN7 check ) , Arrythmia, Tetany , Tremors, Trousseau's sign (BP cuff on arm for tetany) , Seizures
    • *tx: calcium gluconate (inc with VitD) 
  11. HYPERPARATHYROIDISM (inc Ca+, dec P+)
    *s/s: N/V, muscle weakness, osteoporosis, bone pain
  12. Air Embolism
     
    turn pt on l side so air bubbles stay in r atrium
  13. Pneumonectomy
    • lay on operative side
    • don't lay on good side (organs will shift) 
  14. DIGOXIN = CHF
    • strengthens heart muscle contaraction
    • has diuretic effect = helps dec volume but K+ wasting (Lasix)
    • 0.5-2.0 range
    • antidote : digibind
    •  
  15. Potassium Imbalance = PRIORITY***
    • *dec K+=heart can't be controlled (tachycardia) 
    • *inc K+=stops heart (bradycardia) ***corporal punishment via IVP;
    • *K+ always needs to be by IV pump
    • *K+ supplements given with food
    • *potatoes, peanuts 
  16. Hypokalemia = Metabolic Alkalosis
    • diuretics
    • burns
    • NG suctioning
    • steroids
    • Cushing = R alkalosis
  17. Hyperkalemia = Metabolic Acidosis
    • NSAID's
    • renal failure
    • Addison's = R acidosis
  18. Smoking
    vasoconstrictor
  19. Exercise
    vasodilator
  20. MI meds
    • *aspirin (to begin anticoagulation)
    • *morphine (vasodilates=opens up coronary arteries + reduces pain)
    • *nitrates (nitroglycerin, restores circulation to occluded vessels)
    • *wear gloves with patch & cream
    • *DIET: no prepackaged, canned, smoked foods
    •  
  21. SODIUM
    • **hypernatremia
    • *s/s: dry, sticky mucuos, fever, confusion
    • *metabolic alkalosis = diarrhea !

    • **hyponatremia 
    •  *cool, moist skin, h/a, low BP, cramps
    • *metabolic acidosis = vomiting ! 
  22. CELIAC DISEASE (G.I disorder = small intestine)
    • *intolerance to gluten
    • *s/s: steatorrhea, abd distention
    • *gluten=wheat, oat, barley
    • *gluten free=grains with corn, rice
  23. METABOLIC ALKALOSIS
    • hypernatremia
    • hypocalcemia
    • hypokalemia 
  24. METABOLIC ACIDOSIS
    • hyponatremia
    • hypercalcemia
    • hyperkalemia 
  25. RENAL FAILURE = Metabolic Acidosis b/c pt are not making urine
    • in urine = NH3 (high=confusion & G.I bleed)
    • pt should be right by nurse's station/leave light on
    • 3 D's of options : dialysis, donor, death 
  26. BENIGN PROSTATIC HYPERTHROPHY (BPH)
    • *enlargement of prostate can obstruct the vesicle neck or prostate urethra, leading to incomplete emptying of the bladder & urinary retention
    • *s/s: nocturia, frequency, urgency, dysuria 
    • *tx: TURP= check for hemorhage
  27. DIVERTICULITIS
    • *prevent rupture = peritonitis = death
    • *inc fluid to prevent constipation
    • *s/s: irregular bowel, intervals of diarrhea, LLQ pain, low-grade fever
    • *tx: increase dietary intake of soft fiber foods (a low fiber diet is used during the acute episode) 
  28. APLASTIC ANEMIA = dec bone marrow
    • *cells are replaced with fat
    • *s/s: dec erythrocytes, leukopenia, thrombocytopenia
    • *tx: bone marrow transplant
  29. SICKLE CELL ANEMIA = abnormal RBC l/t impaired tissue perfusion
    • ***HHOP
    • H= HEAT
    • H= HYDRATION
    • O= O2
    • P= PAIN RELIEF
    • *avoid contact sports and take frequent rest periods 
  30. HEMOPHILIA = abnormal clotting
    *s/s: bleeding & bruising easily, nose bleeds
  31. POLYCYTHEMIA VERA =thick blood
    • *s/s: enlarged spleen, burning sensation in fingers and toes, dizziness, tinnitus
    • *tx: phlebotomy, hydration, anticoagulant therapy
  32. Chronic Liver Pts
    • ***ONLY chronic liver pts get ascites. A pt can have cirrhosis of the liver & not have ascites , 
    • *Ascites Test: push on belly - if a wave of fluid appears = ascites if it jiggles = fat ! 
  33. Gallbladder
    • Gall Stones = prone (4F's:forty, fertile, feamle, fat)
    • Bile Duct Stones = supine
    • ** no morphine , DEMEROL !
  34. OSTEOMYELITIS = bone infection
    • *@risk: malnourished, elderly, overwt
    • *s/s: fever, tachycardia, swelling, tenderness, pain
    • *tx: antibiotics & pain meds
    • *interventions: immobilize body part, diet high in protein & vitC 
  35. GOUT = uric acid --> big toe !
    • *s/s: painful joint & tophi (growths of urate crystals )
    • *tx: low purine diet = cheese, eggs, fats, milk, gelatin, cherries
    • * AVOID: fish, liver, lobster, spinach, mussels 
  36. GULLAIN-BARRE = ascending progressive paralysis or weakness
    • *s/s: diminished or absent tendon reflexes, low-grade fever
    • *frequently develops 1-3wks following upper respiratory or G.I infection 
    • *Nsg Care: AIRWAY -> encourage incentive spirometer 
  37. PAGET'S DISEASE
     
    • inc skull size
    • inc head circumference
    • hard of hearing
    • long arms & bowed legs
    • wadding gait 
  38. CROHN'S DISEASE
    • *inflammation of segments of the bowel = l/t swelling, thickening, & abscess formation
    • *s/s: abd pain, diarrhea*
    • *dx: string sign
    • *tx: low residue diet, vits and Fe supp 
  39. ULCERATIVE COLITIS
    • *inflammation of colon & rectum
    • *s/s: bloody diarrhea, fever, vomiting, abd cramping 
  40. INFANT
    • 1-3 mos = RECLINER
    • 3-6 mos = SITTER
    • 6-9 mos = BOUNCER/CRAWLER
    • 9-12 mos= CRALWER/CRUISER 
  41. TODDLER (1-3yrs) = PRAISE
    • P = push-pull toys; parallel play
    • R= rituals & routines; regression
    • A= autonomy vs. shame & doubt; accidents
    • I= involve parents
    • S= separation anxiety
    • E= elimination & explore 
  42. PRESCHOOLER (3-5yrs) = MAGIC
    • M= mutilation
    • A= associative play & abandonment
    • G= guilt
    • I= initiative, imaginary friend, imagination
    • C= curious 
  43. SCHOOL AGE (6-12yrs) = DIMPLE
    • D= death
    • I= industry vs inferiority
    • M= modesty
    • P= peers
    • L= loss of control
    • E= explanation procedures 
  44. ADOLESCENCE (12-18yrs) = PAIRS
    • P= peer group
    • A=altered body image
    • I= identity
    • R= role confusion
    • S= separation from peers 

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