Summit College Nclex Lecture Notes Video 1 11 PDF

Preview

Summary

Nclex...

Description

Summit College NCLEX LECTURE Notes Videos 1 to 11 Only She has total of 26 videos on youtube. I was able to watched and typed only 11 videos only. With these notes combined with Remar quick facts audio dvd, Registered nurse sarah, MK audio, and u world helped me to pass. Good luck Thanksssss

Video 1 1. Dilantin- The drug is given for seizure. Detoxify by liver Monitor when do you give dilatin: Gums (Hypertrophy of the gums) Gum bleeding, Oral hygiene, Dental visit If patient having a seizure, what do you report to HCP? Bleeding from the gums. (That’s one of the side effect)

2. Phelebities: Inflammation Red warm to touch around the IV area (Infection) Stop the IV Discontinue the IV Apply warm compression Restart IV When you are giving IV maintain Sterile technique 3. Infiltration: Your IV is not going in the Vein instead its going around the tissue. Cold to touch, there is swelling Stop the IV Restart on other side Elevate the arm ( because you want to reduce swelling) 4. Lasix :Loop diuretic. Loosing potassium watch for potassium. Food to replace potassium Orange juice and Banana

5. Aminophylline: Bronchodilator ( Affects heart) Side effect: Palpitation, Nervousness, Dysrhythmia Toxic effect: Tachycardia also you can go in Seizure Avoid giving stimulant: Do not give Coffee and Caffeine because it can cause tachycardia Monitor for any cardiac problems 6. Morphine Sulfate it causes relief anxiety and pain Monitor: Respiratory distress Long time Morphine use can cause Contipation 7. Dopamine: affect on the blood vessels, Giving IV when blood pressure is very low (Hypotensive crisis). When patient is in shock, MI, Heart attack Dopamine: To raise the blood pressure S/E It can raise to hypertension and dysthythmia. Watch: Blood pressure every 2 minute until stabilize 8. TPN : Hang no longer than 24 hours. 1 bag is only good for 24 hours How do you give TPN: Tubing filter every 24 hours Give Central line and peripheral line, IV Given by RN 50 cc hr Should given by the Pump Prevent for sepsis (infection) Report any sign of infection Don’t draw blood or infuse from same line Sterile dressing lvn can do it yes. Glucose monitor If solution is not available: 10 % in water start Lab check Calcium, magnesium TPN taper off because can go to hypoglycemia No shower, give bed bath water getting into the line Given when patient has GI problem or absorption problem, crohn disease, pancreatitis How to its effective: Maintaining weight Where do you get the bag: Pharmacy Keep in fridge. Take out 30 minute before you hang Who gives: RN

9. Prozac ( SSRI); Depression medication Can give to OCD What to monitor: Monitor for hypotension, DRY mouth, Weight Loss

Takes about 2-3 weeks to work 10. Indernal ( Beta blocker) Given for antihypertensive S/E bronchospasm. Bradycardia Check for Heart rate and pulse rate Don’t stop sudden: To prevent hypertensive crisis 11. Glypezide ( oral hypoglycemic) Diabetic type 2 Where do we get insulin? Beta cells of pancreas S/E aplastic anemia, photosensivity, diarrhea, rashes 12. Deltasone For Steroids Monitor for hyperglycemia Turning into Cushion Retain more sodium Calcium and potassium low Low calcium can lead to fracture Whenever you are giving Steroids they are Risk for Infection Put them with anyone without infection or reverse isolation because their resistance is low If you stop steroid all of sudden they will go into Adrenal crisis or Addison crisis 13. Synthyroid (thyroid hormone) Which patient you giving thyroid hormone Hypothyroid or thyroidectomy Other name of hypothyroid is Myxedema ( they have low thyroid hormone Give empty stomach before breakfast Monitor for Insomnia Monitor for pulse rate before taking meds Hold if pulse is 100 or more than 100 They are turning into grace disease (hyperthyroid Life-long to take 14. Tegretol ( Seizure medication (prevention of seizure) S/E photosensitivity Some of seizure meds are used in Trigeminal neuralgia Tic douloureux What cranial nerve effected in Tic douloureux? Cranial nerve 5th Where is the pain? Facial pain Don’t eat on the same side Soft diet not too hot not too cold Don’t rub face too hard

No cold air coming in the room Don’t move bed

15. Amphojel (aluminum hydroxide) Antiacid When patient has ulcer or Gerd It neutralize hydrochloric acid Give 1 hour before bedtime What do you monitor? Constipation It lower phosphorus and increase the calcium level Which patient has high phosphorus level? Patient with renal failure They can use in renal failure also to lover phosphorus level

16. INH (TB meds) S/e peripheral neuropathy Administer: pyridoxine B 6 to prevent peripheral neuropathy, urticaria rashes and allergy) Monitor: liver ( before and during monitor liver Given 6-9 months Teach to take B6 to prevent peripheral neuropathy

17. B1 thymine deficiency call Berry Berry (mental confusion) ( Give them when they have alcohol problem) 18. B6 monitor for peripheral neuropathy that can lead to seizure. When giving INH patient. DO NOT GIVE B6 with parkison’s drug because it lower the absorption 19. Folic Acid leads to anemia 20. B12 leads to pernicious anemia Signs and symptoms of pernicious anemia? Red beefy toungue. Paresthesia ( tingling sensation How do we treat : b12 injection IM monthly all life How do you dx: Schilling test. (Collect urine specimen 24 hours) How to give b12? by Mouth and it excreted through urine Which patient risk for pernicious anemia? If you have gastritis and gastrectomy (billroth 1 and 2) Where do you absorb b12? In the stomach 21. Vit D; leads to Rickets and osteomalacia in the children 22. Vitamin C is water soluble vitamin. Leads to Scurvy ( Gum bleedin) 23. niacin b3 pelligra is causing dermatitis rashes 24. Catapres is a patch (clonidine hydrochloride,) treats Hypertension Cause sedation and orthostatic hypotension. If patches are used do not go close to microwave because it can cause the burn. And heat will increase absorption leading to toxicity.

orthostatic hypotension get up slowly to prevent fall 25. Autologous blood: Blood transfusion given 2-4 units before surgery to treat anemia 26. Partial burn; Only part of skin is destroyed. Epidermis is destroyed may also have blisters. Very painful, sensitive to heat, heal faster 21-22 days. Pain meds is important 27. Full thickness burn destroyed all skin epidermis and dermis. Muscle and bone may be involved Eschar Not painful 28. Superficial burn like on the skin Sensitive to heat Some Swelling Painful 29. Electrical burn; Whitish area at the point of entry and exit What do you monitor patient with burn? Cardiac assessment first 24 hours 30. Parkland forumula The widely quoted Baxter (Parkland) formula for initial fluid resuscitation of burn victims is 4 mL of Ringer's lactate per kilogram of body weight per %TBSA burned, one half to be given during the first 8 hours after injury and the rest in the next 16 hours.

31. When patient has burn about wound care: Never break the blister. Lacted ringer is given Closed method: Covering the wound. Silvadene cream Open method: Sulfamylon (Mafenide Acetate) not covered with dressing. S/E burning IV pain meds given Morphine No PO pill or IM because circulation impairment Before wound care medicate patient silver nitrate when patient skin turn the black Diet: High calorie, high carbs, high protein and vitamin B< C iron may be TPN given When pt has burn what it the complication: Infection (reverse isolation) Sterile technique Hypoxia 100 % oxygen non breather mask. Keep Patient NPO 24 hours because it can cause ulcers TPN can start 24 hours later They can go to hypovolemic shock First 24 hours potassium is important Keep I and O

Keep them foley cathether Risk for tetanus so give them Tetanus shot Burn patient risk for DIC ( Clothing factor)

32. Sinemet is for parkison Given before meals High protein meals may impairment effectiveness. You don’t give high protein. Don’t give B6 and MOAI also for Glaucoma patients 33. Tetracycline Don’t give them at bedtime it can esophageal irritation Don’t give with antacids Don’t give Tetracycline to the children and pregnant women. It effects bones Monitor: Photosensitivity don’t let them go out in sun 34. Proventil ( bronchodilator) S/E headache ,hyperactive, tachycardia Used first before Steroids Wait 1 minute between puffs

35. Vanceril (Beclometasone) S/E fungal infection ,dry mouth and throat infiltration 36. NPH insulin cloudy Only given Sub q Intermediate insulin Peak 6-12 hours Given 8 am, 3-730 around that time check it 10 am, 2pm, 9pm, 11 pm Check 2 pm Go before 6 hours little bit 37. Regular insulin Peak 2-4 hours Sub q and IV Given IV when patient has Diabteic ketoacidosis Given 10 am 8am. 10 am. 2pm. 4 pm 10 am best answer 38. Topamax ( Seizure meds) Give fluids prevents kidney stones Prevent blindness, hypotension Lower blood pressure

39. Inderal It is for blood pressure Check for blood sugar

40. Pyridium giving for UTI and analgesic It helps to relief pain Changes the color of urine to Orange 41. Bactrim (sulfamethoxazole and trimethoprim) Monitor: check for Allergic ,rashes Used for UTI Increase fluids 42. Aminoglycosides ( Ending word myocin or cin word vancomycin, gentamyacin S/e Auto toxicity ( Auto means hearing) and nephrotoxicity (kidney) Nephrotoxic blood test BUN and creatinine Given IV and IM Can damage kindey and hearning What lab to report : Creatinine Must do blood test when giving Aminoglycosides Peak and trough Peak after the dose Trough before you start your antibiotic 30 min after and before

43. Stadol (Butorphanol Tartrate) Pain medication It causes respiratory depression and bradycardia 44. Normal heart rate of infant more than 120-140 Below 100 not normal 45. High potassium in renal failure and Addison disease Should not used salt substitute 46. Delegation which patient to give UAP Communicate clearly. Explain them RN is responsible Assign chronic and stable patients 5 p patient neurovascular patient) with fracture, cast and traction patients to prevent compartment syndrome

47. Antiopsycotic meds EPS NPS Prevent EPS by giving them cogentin and artane and Benadryl If your patient start NPS hold or stop medication 48. Celiac Disease ( absorption problem) Do not give gluten free diet Do not give BROW diet Barley rye oats wheat If you give what happen? Severe diarrhea and vomiting and can go to celiac crisis Best to give Corn, rice, soy bean, potato, eggs 49. Dexamethasone Give steroids always with food. Other wise it can cause bleeding empty stomach, ulcer Steroids cause bleeding disorders 50. Separation anxiety 1-3 age in toddler Monitor for autonomy vs shame Autonomy independent Prevent form accident Safety Drug must be lock Tempered tantrum is common Egocentric word- they don’t play together, they don’t share toys

Video # 2 1. S/E of antipsychotic meds Tardive dyskinesia and EPS is the same Tardive dyskinesia smacking lips Tongue movement/Involuntary movement S/E of antipsychotic meds 2. Verapmil/Amidrone are cardiac medication They can increase serum digoxin level This drug can cause digoxin toxicity 3. Digoxin level 0.5 to 2.0

Sign of Digoxin toxicity: Anorexia (Loss of appetite), Nausea, Vomiting Visual disturbance, Yellow hallows around the eyes Bradycardia Lowering the potassium level Infant and small children first symptoms of overdose of cardiac Arrhythemia Infant S/E of digoxin toxicity is vomiting and bradycardia Check for apical pulse before giving digoxin When patient going home check for radial pulse

4. Fat embolism When patient has fracture its leads to Fat embolism Fat embolism leads to Pulmonary embolism Pulmonary embolism is Restlessness, Tachycardia, Headache followed by Temperature How to prevent Fat embolism: Immobilization Complication of Fat embolism: Osteomyelitis ( infection of the bone) and Compartment syndrome (Neurovascular assessment) The "5 P's" are oftentimes associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements). 3 complication of patient when they fell? Fat embolism Osteomyelitis Compartment syndrome How do you get pulmonary embolism? Fat embolism leading into pulmonary embolism Air embolism if air goes into IV or TPN or Hemodialysis can lead to pulmonary embolism DVT (patient is lying in bed) Positive human sign (Pain on dorflexion) DVT No ambulation, Elevate legs, turning is good, Anti-embolism stockings is good, if there is swelling and pain then can go with warm compress How to prevent pulmonary embolism?: Immobilize the patient Air embolism: Turn to patient to left side and lower the head of the bed (trendelenburg position) For IV and TPN no air should go in. As soon as IV finish you change your IV Patient in Dialysis what is the complication? Air Embolism DVT: Cardio Air Embolism: Renal, Dialysis Fat embolism: Fracture Which patient are you going to prevent DVT: Hip surgery risk for DVT, Abdominal surgery, Oral contraceptive, If you are not ambulation after abdominal and hip surgery. If bleeding and clotting time delayed can cause DVT Pulmonary Embolism early sign is restless 1. For NCLEX early sign is Petechiae over chest ( Bleeding disorder)

2. Early sign Hypoxia (lack of oxygen) Late sign chest pain, dyspnea, cyanosis 3. Shock (bp down, tachycardia, pulse high, (tachypnea high respiration) When you see patient has Petechiae what do you do? Raise the head up of the bed In emergency you can start oxygen 100 % non brether mask. Never pick up cannula because you are not getting enogh oxygen Then can give morphine or nitrate for chest pain And you gotta give Heparin (To prevent clotting) How do you give heparin in emergency (IV) Monitor for bleeding Hepain is Anticoagulant

4. Neologism: Making New words seen in mental health. Psychosis patient What to monitor in schizophrenia? Psychosis and Neologism Psychosis: Delusion and hallucination 5. Pancreatic enzyme: Where do you get? From Pancreas Pancreatitis is on left upper quadrant What do you monitor patient with Pancreatic enzyme Pancreatic enzyme help is digestion in fats Cut down Fat Give Pancreatic enzyme (viokase) is also used as a medication to help digestion in fats Give before meals or with meals and snacks Which baby do they have problem about pancreas: Cystic Fibrosis Which patient you encouraged Pancreatic enzyme? Pancreatitis and Cystic fibrosis questions 6. Delusion is suspicious ( They believe something that is not true) My husband is cheating My husband is love with somebody else They don’t trust

7. Pychosis something not correct . Something wrong in their mind. Suspecious

8. UAP You give them chronic patient Don’t give them acute/ exacerbation of mutilple sclerosis exacerbation of Rhematoid arthritis exacerbation of COPD exacerbation of Asthma exacerbation of Pneumonia Don’t assign them 9. Chronic : Remission is, they are ok You have MS remission Rhematoid arthirits remission Never leave you patient. Whether is mental health, anxiety, afraid, even you taking telephone order. Do not leave. Stay with patient

10. Don’t say patient has Inflammation or right leg or right foot or stable Write down objective: Redness, swelling, pain, appear to be having inflammation What you observe you chart. And what patient says you document Never say patient has pneumonia? How do you diagnosis pneumonia? 11. Restrain: You do not allow patient to move around Physical: Putting Side rails, wrist or body restraint and chemical

Before you restraint the patient: Assess and doctor order Less restrictive method ( lower the bed) Call light, special mattress, padding on the floor Get consent and care plan Where do you put restaint: Tie on bed frame and easy release knot Check frequently every 2 hour. Open you restaint and allow Remove one at a time Checking for circulation Wrist restraint problem: Fracture, swelling Wrist restraint problem: Check for radial pulse Check for circulation (Check for radial pulse)

12. Gag reflex monitor in? Monitor in upper GI or EGD (Esophagogastroduodenoscopy) and ERCP (Endoscopic retrograde cholangiopancreatography)

Hold fluids until gag reflex returns Another thing to monitor: Endoscopy

13. Nifedipine (Procardia): Calcium channel blocker Do not crush Can give sublingual for high blood pressure Can give For chest pain To improve circulation in Burger and raynord disease raynord disease teach: Prevent them from cold ( poor circulation) More in young people buerger disease: Always in smoking (comes from age and smoker)

14. RN is not assign and does not have authority to tell a nurse a what to do. Only you are allowed to assigned. You take authority Cannot go other floor and start looking chart for unassigned clients 15. Doctor has order contraindicated meds (question the doctor Contraindicated means you cannot do If doctor order atropine eye drops for glaucoma patient Are you going to question to MD? Yes Doctor order to apply heat on appendicitis. Can you apply heat? Are you going to question the doctor? YES because It will rupture 16. Assessment Percussion: Listening the sound (put hand and percussion) Palpation: Feeling, touching , pressing on the skin Auscultation: Listening Inspection: For abdominal assessment: IAPP 17. CABG Which patient to see Heart attack, MI What does patient come back: mechanical ventilator and chest tube. Monitor frequently

18. Acromegaly (too big person) Where to see; Hyperpituitary gland Where is pituitary gland? In the brain What is your pituitary gland doing: Growth hormone Patient has hyperpituitarism what are you assessing? Acromegaly

Patient has hyporpituitarism what are you assessing? Dwarfism (short) Acromegaly monitor for: Blood sugar High Vision problem Fall Chewing problem Food Pain in joints ( Ambulation) All the organs are big

How do you treat acromegaly? Removing the gland. Hypophysectomy Radiation (destroy the gland) How do you remove pituitary gland ? Craniectomy (go through brain) Or transsphenoidal (in the nose) pituitary gland producing growth hormones and ADH What is ADH does? In the water urine output What do you do after Craniectomy or transsphenoidal hypophysectomy? Watch for CSF (positive for sugar). Level of consiousnees. Monitor for urine output? Because they are going to be showing symptoms of DI DI pee more polyuria and polydipsia. Give patient to water 19. Bone marrow: Aspirate from the bone Best site is Ileac crest Very painful Give pain meds Prevent Infection Sterile technique 20. Craniectomy: Keep them flat What are you removing through Craniectomy? Pituitary gland, or may be tumor in the brain or bleeding in the brain Supratentorial: Elevate head 30-45 Degree Semi fowler Infratentorial; Keep them flat If ICP goes up keep them semi fowler Craniectomy can lead to meningitis and monitor for 3 things. 1. ICP ( monitor level of consciousness, vital signs Bp goes up, pulse goes down, respiration goes down) pupil reaction ( If you pupil dilated and fixed that’s means ICP there, It should be constricted) 2. DI 3. Meningities

21. Myelogram: looking for Muscles in neuro Need consent Check allergies with Iodine

After the procedure. If water soluble die: Elevate head If oil based them Keep them flat

22. Fractures What do you when patient has fracture: Immobilize Why do you immobilize? To prevent fat embolism Fat embolism leads into Pulmonary embolism Cover the wound and clean/wash with soap and water to prevent Osteomylities Check color and capillary refill at the distal part to check neurovascular to prevent Compartment syndrome (poor circulation, poor nerve problem) Tx of Compartment syndrome: Open it, bivalved (cut the cast, make it loose) Fasciotomy: Going Deep surgery and removing the dead tissues Why do you do it? To improve circulation 23. Closed reduction: Manually fixing the bone by hand Open Reduction (ORIF): The surgery (They have open it and fix the bone through surgery) 24. Buck traction ( Skin traction) Why do you apply traction?: To relief the muscle spasms and Immobilize If used for fr...