Sunday, November 6, 2011

IBWA | Bottled Water | Hydration Calculator

IBWA | Bottled Water | Hydration Calculator
Everyone agrees we need to stay hydrated. This little gadgette will help you figure just how much water you need. The International Bottled Water Association has this on their website.

Sunday, October 23, 2011

About Influenza

About Influenza
Influenza is a serious respiratory illness that is easily spread and can lead to severe complications, even
Each year in the U.S., 5 to 20 percent of the population gets the flu and an average of 226,000 people are
hospitalized from flu-related complications.5
Depending on virus severity during the influenza season, deaths can range from 3,000 to a high of about
49,000 people.5
¾ Combined with pneumonia, influenza is the nation’s eighth leading cause of death.6
1. Fluzone Intradermal vaccine [Prescribing Information]. Swiftwater, PA: Sanofi Pasteur Inc.; 2011.
2. Nestle FO, Nickoloff BJ. Deepening our understanding of immune sentinels in the skin. The Journal of
Clinical Investigation.2007;117:2382-2385.
3. Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with
vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR.
4. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on
Immunization Practices (ACIP), 2008. MMWR. 2008;57(RR-7):1-64.
5. CDC. Estimates of deaths associated with seasonal influenza – United States, 1976-2007. MMWR.
6. CDC. Deaths: Final data for 2006. National vital statistic reports. 2009. Accessed March 30, 2010.

Friday, September 30, 2011

Buckle Fracture

This post was prompted by recent experience with a Buckle Fracture of the Radius of my grandchild.

The x-rays below are from Subtle Fractures in Kids: How Not to Miss Them: Types of Fractures
Treatment may be either a removable splint or a cast for 3-4 weeks.

Angled buckle fractures in the proximal and distal radius. (A) Note the angled buckle fracture in the proximal radius (arrows). (B) Normal side for comparison; the cortex is smooth. (C) A similar angled buckle fracture (arrows) in the distal radius. (D) Normal side for comparison; the cortex is smooth.

Buckle fractures. (A) Subtle buckle fracture (arrow) in the distal radius. (B) The fracture (arrow) is more clearly visualized on the lateral view. (C) Typical angled buckle fracture (arrow) in the proximal radius.

Thursday, September 22, 2011

51st Annual FOHC

My first Florida Occupational Health Conference in Naples was a wonderful experience. I had the privilege of being sent by my employer to the Ritz Carlton in Naples, Florida. The accommodations were wonderful.  The food was delicious. The topics were great. Dental Trauma happens more time than you think and there are numerous safeguards to prevent you from overpaying. Laura McAlvain did an excellent presentation. Kellie Collins presented Head to Toe Assessment, I think she missed her calling, an awesome speaker and educator. Enough can not be said for the directors and speakers for presenting 20 continuing education hours in a 2 1/2 day period. If you are involved in Occupational Health in Florida, The Florida State Association of Occupational Health Nurses is a valuable resource.

Saturday, July 16, 2011

"Hold fast to dreams for if dreams die, life is a broken winged bird that cannot fly."
- Langston Hughes

Monday, March 21, 2011

The Future

It seems as though something is missing - no studying no goal..oh-oh....maybe after I do a bit of housekeeping I may set my next venture on combining my RN with my Computer Degree and get something in healthcare informatics. After all it was the RN requirement that made me go back. hummmmmm, never know - Life is adventure, knowledge is key.

Sunday, March 20, 2011


Well worth it, the best $7.95 I ever spent - the price of knowing if you passed the NCLEX-RN (unofficial) is $7.75. I was so afraid to look, but to curious not to. I had only 75 questions, I don't remember any on drug calculations or OB questions, so I thought I must have bombed so bad it was not worth testing me any more. This was one time I was glad to be wrong! The only study books I used were - 

Sunday, March 13, 2011

Neurosensory Disorders

  • Acute Head Injury
  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease) - progressive degenerative disorder; nerve cells degenerate and die, muscle fibers atrophy - 3 times more prevalent in males. cause is unknown, ? genetic
  • Bell's Palsy - inflammation around 7th cranial nerve (facial). unilateral facial weakness or paralysis, rapid onset; more common before 60, complete recovery in 1-8 weeks but longer in older adults, may reoccur, may result in contractures. caused from viral infection, hemorrhage, tumor, or trauma
  • Brain Abscess - free or encapsulated collection of pus usually in the temporal love, cerebellum or frontal lobe, rare, can occur at any age, most common 10 - 35.prognosis is fatal or fair. causes - infection of ears, sinuses, or dental abscess and mastoiditis, subdural empyema or trauma.
    • location of abscess
      • temporal -
        • auditory receptive dysphasia
        • central facial wekness
        • hemiparresis
      • cerebrallar abscess -
        • dixxiness
        • coarse nystagmus
        • gaxe weakness on lesion side
        • tremor
        • ataxia
      • frontal
        • expressive dysphasia
        • hemiparesis with unilateral motor seizure
        • drowsiness
        • inattention
        • mental function impairment
        • seizures
  • Brain tumor - causes - environmental, genetic
    • frontal - aphasia, memory loss, personality changes
    • temporal - aphasia, seizures
    • parietal - motor seizures, sensory impairment
    • occipital - homonymous hemianopsia (blindness or defective vision affecting the right halves or left halves of the visual field of the 2 eyes), visual hallucunation, visual impairment
    • cerebellum - impaired coordination, impaired equilibrim
  • Cartaract -
  • Cerebral aneurysm - classified by size or shape, causes - atherosclerosis, congnital weakness, head trauma, keep lights low and no stress
    • saccular - most common occur at the base of the brain at he juncture where the large arteries bifurcate, others include berry and dissecting.
    • Crushing's triad (bradicardia, high sBP, wide pulse pressure, precussor to hemmorhage
    • subarachnoid hemorrage - result of rupture, high motality rate, keep low lights, avoid overstimulation, HOB elevate 0 - 30 degrees, frequent neuro checks
  • Conjuctivitis - inflammation of the conjucntiva, may be from infection (highly contagious), chemical, or allery
    • causes -
      • bacterial -
        • staphylococcus aureus
        • strptococcus pneumoniae
        • neisseria gonorrhoeae
        • n. meningitidis
      • Chlamydial
        • chlamydia trachomatis
      • Viral
        • Adenovirus types 3,7, and 8
        • herpes simplex virus, type 1
      • other causes -
        • allergic -
          • pollen
          • grass,
          • topidal medications,
          • air pollution
          • smoke
        • fungal infections (rare)
        • Occupationa irritans (acids and slkalies)
        • parasitic diseases caused by phthirus pubis, or schistosoma haematobium
        • tickettsial diseases (Rochy Mountain spotted fever)
  • Corneal abrasion
  • Encephalitis  severe inflammation and swelling of the brain, damages optic nerve.  usually caused by misquito or tick borne virus; may also occur by drinking infected goat milk, may cause permanent neurologic damage and is commonly fatal. Keep room cool and dark
  • Glaucoma - increased intraocular pressure
    • causes -
      • diabetes mellitus
      • long term steroid treatment
      • previous eye trauma or surgeru
      • Uveitis
      • fisk factorw
      • family history of glaucoma
      • race - more prevailent in african-american
  • Gukllain-Barre syndrome
    • causes -
      • cell mediated immune response with an attach on peripheral nerves in response to a virus
      •  demyelination of the peripheral nerves
      • respiratory infection
    • test
      •  history of preceding febrile illness (usually from a respiratory infection)
      • CSF protein level begins to rise
      • EMG shows repeated firing of the motr unit reather than widespread sectional stimulation
      • nerve conduction velocities are slowed after paralysis
    • potential complication
      • mechanical ventilatory failure
      • aspiration pneumonia
      • sepsis
      • joint contractions
      • DVT
  • Hearing Loss  3 major types of hearing loss
    • conductive loss
    • sensorineural loss
    • mixed loss

Saturday, March 12, 2011

Neurosensory Systems and Tests

  • Neuron - nerve cell -
    • axons carry away
    • dentrites bring to
    • neurotransmitters - help conduct impulses across the synapse
      • acetylcholine
      • seotonin
      • dopamine
      • endorphins
      • gamma-aminobutyric acid
      • norepinephrine
  • CNS - central nervous system - brain and spinal cord
  • Cerebrum - largest part of the brain 
    • hemispheres - right and left opposite control because motor impulses cross in the deulla
    • fissures divide cerebrum into 4 lobes
      • frontal - personality, memory, reasoning, concetration and motor control of speech
      • parietal  - sensation, integration of sensory information and spatial relationships
      • temporal  - hearing, speech, memory, and emotion
      • occipital - vision and involuntary eye movements
  • Thalamus - 2 oval shaped parts deep in the brain, the relay station - recieves input form all senses except smell, analyses input and transmits to other parts of the brain.
  • Hypothalamus - beneath the thalamus - control sleep and wakefulness, temperature, respiration, BP, sexual arousal , fluid balance, and emotioal response.
  • Cerebellum - base of the brain - coordinates muscle movements, maintains balance and controls posture
  • Brain Stem - connects brain and spinal cord has 3 sections
    • midbrain - pupillary relexes and eye movements; relfex center of the 3rd and 4th cranial nerves
    • pons - helps regulate respiration, mediates chewing, tasting, saliva and equilibruim; reflex center for the 5th, 6th, 7th and 8th cranial nerve
    • medulla oblongata - vomiting, vasomotor, respiratory and cardiac centers
  • Spinal cord - 2 way conduction system between brain and peripheral nervous system (PNS)
    • gray matter - cell bodies and dendrites and axons
    • white matter ascending (sensory) sends signalsto the brain and desending (motor) tracts send signals out to the muscles
  • PNS - Periperal Nervous System - delivers messages (like the post office) main nerves grouped
    • 31 pairs of spinal nerves - carry mixed impulses (motor and sensory)
    • 12  pairs of cranial nerves -
      1. olfactory
      2. optic
      3. oculomotor
      4. trochlear
      5. trigeminal
      6. abducen
      7. facial
      8. acoustic
      9. glossopharyngeal
      10. vagus
      11. spinal accessory
      12. hypoglossal
    • Autonomic nervous system - subdividsion of PNS - controls involuntary body functions
      • digestion
      • respiration
      • cardiovascular
        • 2 cooperating systems
          • sypathetic - fight or flight
          • parasympathetic - conserves and restores energy
  • Eyes -
    • external -
      • eyelids
      • conjuctivae (thin transparent membrane that line the lids)
      • lacrimal apparatuses,extraocular muscles, and the eyeballs
    • internal -
      • iris
      • cornea
      • pupil
      • lens
      • vitreous humor
      • retina
      • retinal cones - visual acuity and color discrimination under bright lights
      • retinal rods - peripheral vision under decreased light conditions
      • optic nerve - 2nd cranial nerve
  • Ears
    • External -  pinna (auricle) and external auditory canal separated by the tympanic membrane
    • Middle -  AKA tympanum - air filled cavity in the temporal bone - 3 small bones - malleus, incus, and stapes
    • Inner - AKA Labyrinth - cochlea, vestibule and semicircular canals
Most Important Tests
  • Electroencephalogram (EEG) electrical graph of brain activty
  • Computer tomography (CT) - cross scetion veiws of brain images
  • Magnetic Resonance Imaging (MRI) - magnetic snapshot - contraindications - pacemaker
  • Cerebral Angiogram - upstairs artery exam blood flow using dye
    • check site for bleeding
    • assess distal pulses
    • assess neuro status
    • encourage fluids
  • Lumbar Puncture L(P) - reveals pressure also used to inject dye for myelogram *contra indicated with increase intracranial pressur (ICP)
    • keep flat
    • monitor neuro status
    • monitor site for leakage or bleeding
    • encourage fluids
  • Cerebrospinal fluid (CFS) analysis - LAB
  • Electromypgraphy (EMG) - electrical acitivity of a muscle at rest and contraction
  • Myelography - see the spine - subarachnoid space, spinal cord and verebrae contraindicated with seafood or iodine allergies
    • keep flat after
    • check site for leakage or bleeding
    • encourage fluids
  • Skull x-ray
  • Positron emission tomography (PET) injection of radioisotope after visulaization of the brain's oxygen uptake, blood flow and glucose metabolism
    • no tobacco, alcohol,  or caffeine 24 hours before
  • Blood Chemestry Test - checking levels of potassium, sodium, calcium, phoshorus, protein, osmolality, glucose, bicarbonate, blood urea nitrogen and creatinine
  • Hematologic study - WBCs, RBCs, erythrocyte sedimentation rate, platelets, hemoglobin, hematocrit.
  • Coagulation study
  • Visual Acuity
  • Extraocular eye muscle testing - checks for parallet alignment of the eyes, muscle strength and cranial nerve function
  • Visual field examinaitn
  • Tonometry test - measures intra ocular pressure
  • Tick-tock test is an auditory acuity test checking ability to hear a whispered phrase or a ticking watch
  • Otoscopic examination to visulize the tympanic membrane
  • Audiometry - measures degree of deafness

Chvostek's sign, Amin&Shwani 2010

Trausseau's sign

Hematologic and Immune System

  • Serum Magnesium if less than 1.5mEq/l confirms hypomagnesemia; if greater than 2.5 mEq/l confirms hypermagnesemia.
  • CD4=T cell count less than 200 cells/ul indicative of AIDS
  • Serum ionized calcium leve less than 4.5 mEq/L confirms hypocalcemia; if greater than 5.5 confirms hypercalcemia
  • Serum chloride level less than 98mEq/L confirms hypochloremia
    • supportive values with metabolic alkalosis include a serum pH greater than 7.45 and a serum carbon dioxide level greater than 32 mEq/L
  • Serum chloride level greater than 108 mEq/L confirms hyperchloremia
    • supportive values with metabolic acidosios include a serum pH less than 7.35 and a serum carbon dioxide level less than 22 mEq/L
  • Serum Phosphorus level less than 1.7 mEq/L (or 2.5 mg/dl) confirms hypophosphatemia, urine phosphorus level more than 1.3 g/24/hrs supports this
  • Serum Phosphorus level greater than 2.6 mEq/L (or 4.5 mg/dl) confirms hyperphosphatemia, urine phosphorus level less than 0.9 g/24/hrs supports this
  • Sodium - hyponatremia less than 135 mEq/;L hypernatremia greater than 145 mEq/L

  • Disseminated Intravascular Coagulation - PT greater than 15 seconds; PTT greater than 60 to 80 seconds; fibrinogen levels less than 150 mg/sl; platelets less than 100,000; fibrin degradation products typically greater than 100 mcg/ml; and a positive D-dimer test specific for DIC
  • Hemophilia Factor VIII assay reveals 0% to 25% of normal factor VIII (hemophilia A)
    • hemophilia B factor IX assay shows deficiency in addition to baseline coagulation results similar to that of A
  • Idiopathic Thrombocytopenic Purpura (ITP)  platelet count is less than 20,000/ul; prolonged bleeding time
  • Iron Deficiency Anemia decreased Hb, HCT, iron, ferritin, reticulocytes, red cell indices, transferring and saturation; absent hemosiderin, and increased iron biding capacity.
  • Aplastic Anemia - bone marrow biopsy shows fatty marrow with reduction of stem cells, Fecal occult blood test is positive, decreased granulocytes, thromobocytes, and RBCs, hematuria
  • Pernicious Anemia - from vitamin B mal-absorption
  • Polycythemia vera - chronic myeloproliferateve disorder characterized by increased RBC mass, leukocytosis, thrombocytosis and increased Hb, common with jewish males age 40 - 60
  • Rheumatoid Arthritis -  antibodies attack the synnovium of the joint , then the articular cartilage and surrounding tendons and ligaments. ANA positive, elevated ESR, WBC, platelets and anemia, Rheumatoid factor test is positive
  • Scleroderma - connective tissue disease, more women 30 -50 elevated ESR, positive rheumatoid factor 25% - 35% of the time, positive antinuclear antibody test. CXR - bilateral basilar pulmonary fibrosis, UA - proteinuria, microscopic hematuria, and casts
  • Sickle Cell Anemia - congenital hematologic disease, inherited
  • Systemic lupus erythematosus (SLE) - ANA test positive, decreased HB, HCT, WBC and platelets and an increased ESR, rheumatoid factor is positive, UA - proteinuria and heaturia. Lupus Erythematosus cell positive
  • Vasculitis - inflammation and necrosis of blood vessels
    • Wegener's Granulomatosis - affects medium to large vessels of upper and lower respiratory tract and kidney
      • positive leukocytosis, elevated ESR, IgA, IgG; low titer rheumatoid factor; tissue biopsy shows narcotizing vasculitis with granulomatous inflammation
    • Temporal arteritis - affects medium to large arteries, most connonly branches of th ecarotid artery
      • decreased Hb and elevated ESR, tissue biopsy shows panarteritis with infiltration of mononucliar cells, giant cells within vessel wall, fragmentation of internal elastic lamina and proliferation of intima
    • Takayasu's arteritis - AKA aortic arch syndrome 
      • decreased HB, leukocytosis, positive lupus erythematosus cell preparation and elevated ESR; Arteriography shows calcification and obstruction of affected vessels; tissue biopsy shows inflammation of adventita and intima of vessels and thickening of vessel wall
PLATE = key blood components:
Plasma - liquid portion - water, protein (albumin and globulin), glucose, and electrolytes
Leucocytes- white blood cells
AB antigens - blood type
Thrombocytes - platelets clotting - contributors
Erythocytes - red blood cells - oxygen carrier

T-Cells -
killer, helper or suppressor
B-Cells -
 responsible for humeral or immunoglobulin-mediated immunity
Immunoglobulin -
Immunoglobulin G (IgG) - major antibacterial and antiviral antibody
Immunoglobulin M (IgM) - first Immunoglobulin produced too large to cross membrane barriers, usually only in vascular system
Immunoglobulin  A (IgA) - mainly found in body secretions, defends against pathogens on body surfaces, especially respiratory and GI tract
Immunoglobulin D (IgD) - in plasma, dominant antibody on surface of B cells mainly an antigen receptor.
Immunoglobulin E (IgE) - antibody involved in immediate hypersensitivity or allergic reactions, stimulates the release of mast cell granules which contain histamine and heparin.

  • Lymphangiography - radiographic picture of lymphatic system -
    • note allergies to iodine, seafood and radiopaque dyes
    • possible throat irritation and flushing after dye
    • NPO
  • After procedure
    • monitor V/S
    • encourage fluids
    • may have blue discolored skin, stool, and urine for about 48 hours
Schilling Test - oral radioactive cyanocobalamin then 24 hour urine (all urine, room temp) for vitamin B 12

Hodgkin's progress - 4 stages
    • Stage I  - single lymph node region or single extralymphatic organ
    • Stage II  - two or more nodes on same side of diaphragm or in an extralymphatic organ
    • Stage III - spreads to both sides of the diaphragm or in an extralymphatic organ, the spleen or both
    • Stage IV -  disease disseminates
*all review material was taken from - NCLEX-RN Review made Incredibly Easy 5th Edition Lippincott, Williams & Wilkins

Informative Videos of various tests

Romberg Test done to assess loss of balance for pernicious anemia

Basic Heart Sounds heard here

Basic Heart Sounds
this is a wonderful learning tool.

Listen to Actual Lung Sounds

This link will take you to a page that you can actually listen to the breathsound to help identify them.
Listen to lung sounds

Sunday, March 6, 2011


Normal Values

Values at sea level:

•Partial pressure of oxygen (PaO2) - 75 - 100 mmHg
•Partial pressure of carbon dioxide (PaCO2) - 38 - 42 mmHg
•Arterial blood pH of 7.38 - 7.42
•Oxygen saturation (SaO2) - 94 - 100%
•Bicarbonate - (HCO3) - 22 - 28 mEq/L

Note: mEq/L = milliequivalents per liter; mmHg = millimeters of mercury
At altitudes of 3,000 feet and above, the oxygen values are lower.

Respiratory System Disorders

  1. ARDS -Acute Respiratory Distress Syndrome  - S/S anxiety, dyspnea, crackles, rhonchi, diminished lung sounds. Tests: ABGs - respiratory and metabolic acidosis, no change with oxygen. Chest x-ray - bil. infiltrates (early), massive consolidation bil. (late stage) Tx: O2, intubation, Vent support, antibiotics, bronchodilator, neuromuscular blocker, steroids. Interventions/Assessments - assess respiratory, cardiovascular, and neuro status, maintain prone position, CPT.
  2. - Acute Respiratory Failure - decreased respiratory excersion, accessory muxcle use, retractions, dyspnea, tachypnea, orthopnea, nail abnormalities, clubbing of the fingers. Tests -  ABG shows hypoxemia, acidosis, aldalosis, and hypercapnia. Tx - oxygen, intubation, vent support, anesthetic, anti anxiety med, bronchodilators, steroids. Interventions/Assessment - respiratory assessment, O2, bedrest, suctioning, CPT, DB and C, repositioning.
  3. Asbestosis - crackles at the bases, dry cough, exertional dyspnea, plueritic chest pain Tests - Chest xray - infiltrates, plueral thickening, calcification, enlarged heart, gallium scan, Chest CT Scan, PFT.  Tx - CPT, at least 3 liters per day fluids, oxygen, vent support (advanced cases), antibiotics,mucolytic inhalation therapy. Interventions/Assessments - CPT, O2, lung assessment, DB and Coughing exercises.
  4. Asphyxia - agitation, apnea, bradypnea, occasional tachypnea, anxiety, confusion, decreased breath sounds, coma, death. Test - ABG, o2 Sat.  Tx - determine cause, open airway, bronch, O2, narcan, trach. Intervention/Assessment - high fowlers position, oxygen, suction, encourage deep breathing,
  5. Asthma - no symptoms between attacks, expiratory wheezing, Tests; •Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin), PFT, ABG, Pulse ox,  Tx; , 3 liters fluids daily, beta adrenergic meds, epi, serevent, bronchodilators, mast cell stabilizer - cromolyn, antileukotrienes - singulair. Intervention/assessment - reduce anxiety, administer humidified oxygen, high fowlers position, lung assessment, education to know triggers and have a plan to prevent a severe attack.
  6. Atelectasis - decreased breath sound, bronchial breath sounds, dyspnea, anxiety, cyanosis, diaphoresis, substernal or intercostal retractions, tachycardia. Tests: Chest Xray, Chest CT Scan, Bronchoscopy. Tx: CPT, broncodilator, mucolytic inhalation therapy, Intervention/Assessment: position on health side to allow expansion of collapsed lung, encourage DB and Coughing, analgesics as ordered. teach splinting, humidified air, chest assessment.
  7. Bronchiectasis - chronic cough, copious foul smelling sputum, dyspnea, clubbing of fingers, cyanosis, coarse inspirational  rhonchi, wheezing, crackles, anorexia. Tests: Chest Xray, Sputum culture, gram stain, bronchoscopy. Tx: 3 liters of fluid daily, intubation, ventilation, vaccines, steroids, nebulizer, antibiotics, bronchodilator, expectorants,  oxygen, surgery, CPT. Intervention/Assessment - administer meds, teach diaphragmatic and pursed lip breathing, chest assessment, monitor secretions, maintatin fowlers position, Incentive spirommetry and suctioning.
  8. Cor Pulmonale - exertional dyspnea, edema, fatique, orhtopnea, tachypnea, weakness, ascites. Tests: ABG, Chest Xray, pulmonary artery pressure measurements, V/Q Scan, echocardiogram, BNP, blood antiboies, right heart cath. Tx: O2, dig, lasix, vasodilators, calcium channel blocker, angiotenin cnverting enzyme inhibitor. Interventions/Assessments: limit fluids to 1 - 2 liters per day, low-sodium diet, reposition every 2 hours, O2, pursed lip breathing exercises, monitor ABG, monitor vitals.
  9. Emphysema - S/S: barrel chest, dyspnea, pursed lip breathing, Tests: chest xray, PFT, spirometry. ts: CPT, fluids up to 3 liters per day, antibiotics, bronchodilators, vaccines, steroids, nebulizer. Interventiioon/Assessments: respiratory assessment, assess with diaphramic/pursed lip breathing, monitor sputum for color, consistancy, ordor. provide CPT, suction.
  10. Idiopathic Pulmonary Fibrosis - S/S: dry cough, exersional dyspnea, fatigue, rapid shallow respirations; (in late stages) cyanosis, hypoxemia, pulmonary hypertention. Tests: lung biopsy, chest xray, chest CT, PFT, Bronchoscopy, ABG. Tx: lung transplant, oxygen, corticosteroids, cytotoxic drugs. Intervention/Assessments: Respiratory assessment, monitor O2 Sats, emotional support, encourage activity to tolerance.
  11. Lung Cancer - S/S:  Cough, hemoptysis, weight loss, Tests: Chest Xray, PET scan, CT scan, cytology. Tx: Resection on the affected lobe, radiation therapy, chemotherapy. Interventions/Assessments: assess pain and medicate as ordered, suctioning, oxygen, monitor for infection, bleeding, watch labs.
  12. Pleural Effusion and Empyema - S/S: dyspnea, fever, chest pain, decreased breath sounds. Tests: Chest xray, thoracenetesis, lab studies, gram stain, culture, CT Scan of chest. Tx: thoracentesis to drain fluid, thoracotomy if not effective, antibiotics, oxygen, chest tube. Intervention/Assessment: O2, antibiotics, chest tube care, monitor and record drainage.
  13. Pleurisy -S/S:  friction rub, sharp chest pain with breathing. Tests: US of Chest, Chest Xray, Chest CT, Thorencentesis, Chest assessment. Tx: bed rest, analgesic, anti inflammatories. Interventions/Assessment: stress importants of bedrest, administer antiussives and pain medicaitons as ordered, incourage Deep Breathing and Coughing, show splinting technique.
  14. Pneumocystis Pneumonia: S/S: generalized fatigue, low grade fever, non-productive cough, dyspnea, weight loss. Tests: Chest Xray, histologic studies Tx: oxygen, , antibiotics, antipyretics Intervention/Assessment: monitior I and O, antimicrobial meds, montior for adverse reaction, nutritional supplements, encouage to eat hight calorie, protiein rich diet.
  15. Pneumonia: S/S; chills, fever, crackles, rhonchi, friction rub, dyspnea, SOB, accessory muscle use, sputum - rusty, green, or bloody with pneumococcal pneumonia; yellow-green with brochopneumonia.  Tests: Chest xray, sputum gram stain and cultures, CBC, chest CT Scan. Tx: oxygen, antibiotics, nebulizer treatments. CPT.  Intervention/assessments: monitor intake and output, encourage fluids of 3 - 4 liters per day, monitor O2 saturation, lung assessment, encourage deep breathing and coughing, monitor labs.
  16. Pneumothorax and Hemothorax: S/S - diminished or absent breath sounds unilaterally, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increases with exertion. Tests - chest xray. Tx: chest tube to drainage or suction. Intervention/Assessment: monitor and record vital signs, chest assessment, chest tube drainage, cardiovascular status.
  17. Pulmonary Edema - S/S: anxiety, pale, sweaty, restless, dyspnea, orthopnea, tachypnea, productive cough, frothy, bloody sputum. Tests: chest x-ray - cardiomegaly, plural effusions, diffuse haziness of the lung fields; hemodynamic monitoring - incresase in pulmonary artery pressure, pulmonary artery wedge pressure, and central venous pressure and decreased cardiac output. Tx: oxygen, diuretics, nitrates, dig, inotropic agents, vasodilator. Interventions/Assessments: assess hemodynamics, cardiac and respiratory assessment, high fowlers position, O2 sats.
  18. Pulmonary Embolism - S/S: sudden onset of dyspnea, tachypnea, crackles, chest pain. Tests: ABG, V/Q Scan, Spiral CT of chest Tx: Vena cava filter or pulmonary embolectomy, oxygen, intubation, ventilation, anticoagulant, fibrinolytics. Interventions/Assessments: assess respiratory, and  cardiovascular status, oxygen.
  19. Respiratory Acidosis - causes the blood to become too acid due to inability to remove the carbon dioxide. S/S: tachycardia, hypertension, atrial and ventricular arrhythmias, in severe acidosis hypotension with vasodilation. Tests: ABG Paco2 greater than 45 and pH is less than 7.35, in acute stage bicarb is normal in chronic stage it is elevated, PFT, Chest xrays Tx: oxygen, bronchodilator, CPAP, BiPAP, Vent, treat cause, bicarb in severe cases. Causes: asthma, COPD, Smokiong, Obesity. Interventions/Assessments: closely monitor blood pH levels, watch for changes in respiratory, CNS, and cardiovascular functions, monitor ABG, and electrolytes, maintain hydration, maintain vent and suction if severe case.
  20. Respiratory Alkalosis: low levels of carbon dioxide. Causes - anxiety, hyperventilation S/S: agitation, arrhythmias that fail t respond to conventional treatment, circumoral or periphera paresthesia, deep, rapid breathing, exceeding 40 bpm, lightheadedness or dizziness. Tests: ABG - Paco2 is less than 35 and pH is wlwvated in proprotion to the dall in Paco2 in the acute stage but drops toward normal in the chronic stage, Bicarb in normal in acute, but lower in chronic. PFT, Chest xray. Tx: treat cause, increasin CO2 levels by having patient breathin a paper bag. Intervention/Assessment: assess  neurologic, neuromuscular and cardiovascular functions, monitor ABGs and electrolye levels.
  21. Sarcoidosis: Initial S/S - Arthralgia n the wrists, ankles, and elbows; fatigue, malaise, weight loss; Respiratory - Breathlessness, substernal pain; Cutaneous -  erythema nodosum, subcutaneous skin nodules with maculopapular eruptions; Ophthalmic - anterior uveitis; Musculoskeletal - muscle weakness, pain; hepatic - granulomatous hepatitis; Genitorurinary - Hypercalciuria; Cardiovascular -  arryhythmias; CNS - cranial or peripheral nerve palsies, basilar meningitis Test: a positive Kveim-Siltzbach skin test. Tx: low calcium diet, avoid direct sun, oxygen, systemic or topical steroid Intervention/Assessment: high calorie diet, plenty of fluids, low calcium if hypercalcemia, oxygen.
  22. Severe Acute Respiratory Syndrome (SARS) S/S: Chills, Fever, general discomfort, headache, short of breath. Test: cell culture. Tx: possible vent support, oxygen, CPT, antibiotics, antivirals, high dose cortcosteroids. Interventions/Assessment: treat symptoms, maintain patent airway, airborne precautions, monitor vital signs and respiratory status.
  23. Tuberculosis: S/S: prolonged cough, bloody sputum, fever at night, night sweats, weight loss. Test: TST, Chest x-ray, AFB and cultures. Tx: antituberculars, airborne precautions. Intervention/Assessment: maintain positive pressure room, assess respiratory status, oxygen.

Saturday, March 5, 2011

System Review Intro and CardioVascular disorders - VicNotes

Based on the NCLEX-RN Review MIE I am doing an entire system review this week. Nursing and Medicine are a constantly changing science and reading all the journals and news sometimes makes me less sharp on the basics - okay I forget. I will start with Vickie's version of Cliff Notes of Nursing Basics using my forementioned book as my guide. it is not my intention to plagerize I read, then write what I have understood so I can acess this with out carrying my books to work and family gatherings.

This is my study method - read, write, remember.

  1. AAA - asymptomatic until it is ready to rupture. Prior to rupture c/o back pain and pulsations in the abdomen as common. If it ruptures s/s of hypovolemic shock to know are: anxiety, restlessness, cool, moist, clammy skin, severe back pain, rapid, thready pulse, decreased pressure. Test - chest x-ray. The treatment would be surgical repair a AAA Resection.
  2. Angina - chest pain that usually last 3-5 minutes is described as crushing and substernal but may radiate to the jaw, back and/or arms. Usually triggered by some sort of exertional exercise, emotional extremes or cold exposure. Women tend to have atypical s/s and c/o indigestion, back pain less severe chest discomfort. After assessing, administer meds as ordered, hold nitrates if SBP <90, hold beta-adrenergic blockers for AR <60 abd notify the MD. Tests would be 12 lead EKG looking for ST segment depression and T wave inversion during pain. Treatment PTCA or stent placement.
  3. Arrhythmia's - Afib - rapid P-Wave, irregular pulse, Tx - amiodarone, digoxin, diltiazem, procainamide, verapamil;  Asystole - no pulse and flat line, Tx CPR, intubation, transcutaneous pacing ACLS meds - atropine, epinephrine; V Fib - wavy line no pulse or B/P,  Tx -  CPR,defibrillate, intubation, ACLS meds - amiodarone, epinephrine, lidocaine, magnesium sulfate, procainamide, vasopressin; V Tach -  large wide complex may have weak pulse or no pulse, can be awake, Tx Cardioversion, if pulseless, CPR , defibrillation, intubate, ALCS meds, amiodarone, epinephrine, lidocaine, magnesium sulfate, procainamide. Things to assess- mental status, vital signs, cardiac monitor
  4. Cardiac Tamponade - JVD, Narrow Pulse Pressure, Muffled heart sounds, restlessness, leaning forward posture, pulsus paradoxus. tests - chest x ray - shows widened mediastinum and cardiomegaly, Echo Cardiogram  reveals pericardial diffusion with signs of right ventricular and atrial compression, EKG used to r/o other disorders. TX pericardiocentesis, or thoracotomy to drain fluid epinephrine, dopamine. Things to have on hand, assess, remember -maintain a EKG machine, crash cart, pericardial aspiration needle attached to a 50 ml syringe by a 3-way stopcock connect the precordial EKG lead to the hub of the aspiration needle via alligator clamp and connecting wire this will show either an STsegment elevation or PVCs when the needle touches the myocardium, maintain  HOB 45-60 degrees, monitor vital signs, hypertension could be sign of punctured cardiac chamber. complications  - v fib, vasogagal response, punctured coronary artery or cardiac chamber.
  5. Cardiogenic Shock - cold and clammy, hypotension, narrow pulse pressure, less than30 cc urine output per hour, tachycardia; tests - EKG enlarged Q waves and elevated ST - MI; TX intra-aortic balloon pump, epi, dig, dopamine, dobutamine, inamrinon, milrinone, lasix, bumex, zaroxolyn, ntroprusside, nitro, norepinephrine; Interventions/Assessments - v/s, heart sounds, hemodynamics, cap refill, skin temp, peripheral pulses, breath sounds, ABGs, administer O2, IVs, meds as ordered.
  6. Cardiomyopathy -S3 and S4, murmur; tests EKG shows left Ventricular hypertrophy and non-specific changes. Tx - dual chambers pacing, Beta-Adrenergic blockers - Inderal, Corgard, Lopressor, Calcium Channel Blockers - Cardizem, Calan, Diuretics, Lasix, Bumex, metolazone, Inotropics - dobutamine, milrinone, dig, Anticoagulant - Coumadin. Intervention/Assessments - EKG, VS, Hemodynamics, administer O2 and med as ordered.
  7. CAD (Coronary Artery Disease) - S/S - angina pain, tests - lipids show low high density and high low density lipoproteins, ST segment depression and Twave inversion during angina pain, TX weight loss, increase activity, exercise, change eating habits, low-fat high fiber diet, low dose ASA, antilipemic meds - cholestyramine, lovastatin, simvastatin, nicotinic acid, gemfibrozil, colestipol. Interventions/Assessments - monitor labs, I & O,follow angina protocal with angina pain.
  8. Endocarditis - S/S - fever, chills, fatique, loud murmur Tests - EKG, Echo, serial blood cultures, Tx - fluids, antibiotics, asa, Intervention/Assessment - monitor for embolisms, BUN, Creatine, I&O, s/s heart failure ie. dyspnea, edema, JVD, weight gain, crackles, tachycardia, prophylactic antibiotics before, during, and after dental work, childbirth, GU, GI or GYN procedures.
  9. Heart Failure - Left sided - crackles, dyspnea, gallop rhythm S3, S4; Right sided - dependent edema, JVD, Weight gain; Tests - (left sided) BNP elevation, Chest xray results show increased pulmonary congestion and left ventricular hypertrophy; (right sided) BNP elevation, chest xray shows pulmonary congestion, cardiomegaly and pleural effusions, ABG hyppoxemis, and hypercapnia. Tx - human BPN Natrecor, ACE inhibitors - capipril, enalapril, lisinopril, diuretics, dig, inoropic agents, nitrates, vasodilators. Interventions/Assessments - v/s, hemodynamics, O2 Sats Respiratory status, maintain semi fowlers position, daily weights.
  10. Hypertention - can be asymtomatic, headache, visual disterbances. Tests - Bp sustained readings higher than 140/90. Tx - weight reduction, exercise, dietary changes - low sodium, limiting alcohol, ACE inhibitors, antihypertensive meds - methyldop, hydralazine, prazosin, doxazosin, diuretics Interventions/Assess - take the average of 2 or more readings.
  11. Hypovolemic Shock - cold and clammy, decreased sensorium, hypotensive, narrow pulse pressure, less than 25 cc/hr urine output, tachycardia. Tests - labs - high potassium, serum lactate and BUN, urine specific gravity 1.020, urine osmolarity increased, decreased blood pH, ppaO2, increased ppaCO2, possible H & H. Tx - blood and fluid replacement, control bleeding. Interventions/assessment - v/s, assess peripheral pulsed, respiratory status, O2 Sat, telemetry, if sbp less than 80 low cardiac out put may reslut aeb -  inadequate coronary artery blood flow, cardiac ischemia, arrhythmias, increase oxygen and notify MD STAT. large bore IV - NS, LR, blood. Hemodynamic montitoring, Foley for hourly outputs (30cc/hr) manitol.
  12. MI - anginal type pain that last longer and is not releived by nitro or rest, may not be painful in women just fatique or other atypical pain symptoms. Test - EKG - enlarged Q wave, elevated or depessed St segment, and T wave invertion. Tx-anticoagulants, thrombolitic therapy, oxygen, nitrate, pain management, morphine. Interventions/assessments - VS, telemetry, medication as ordered, assess cardiovascular and respiratory status.
  13. Myocarditis - arrythmias, dyspnea, fatique, fever Tests - EKG - diffuse St segment and t wave abnormality, conduction defects, arrhythmias, endomyocardial biopsy confirms dx may get false negative. Tx - bedrest, antibiotics, antiarrhythmics, diuretic, dig. interventions/assessments - assess cardiovascular status, assist wtih bathing, stress bedrest, reassure patient,
  14. Pericarditis - (Acute) - pericardial friction rub, sharp and sudden pain starts over the sternum and radiates to the neck, shoulders, back, and arms, increases with deep inspiration, decresases when sits upright, leaning forward; (Chronic) friction rub, fluid retention, ascites, hepatomegaly. Tests - Echo - shows an echo-free space between the ventricular wall and the pericadium (in cases of pleual effusion)EKG - shows (acute) ST segments in the standad limb leads and most precordial leads w/o significant changes in QRS that occur in MIs. Tx- bedrest, surgery - pericardectomy for recurent pericarditis, total pericadectomy or constrictive pericarditis, antibiotics, Intervention/Assessments - bedrest, assess pain maintain upright position, medicate for pain, O2, reassurance is temporary and treatable.
  15. Peripheral Artery Disease - (Femoral, popliteal, or innominate ateries) mottling of extremity, pallor, paralysis and paresthesia in affected limb, pulselessness distal to the occlusion, sudden and localized pain in affected limb, temperature change distal to occlusion. (Internal and External Carotid arteries) TIAs, s/s minocular blindness, dysarthria, hemiparesis, aphasia, confusion, decreased mentation, headache. (Subclavian artery) subclavian steel syndrome - this characacterized by the backflow of blood from the brain through the vertebral artery on the same side as the occlusion into the suclavian artery distal to the occlsion; clinical effects of the vertebrobasilar occlusion and exercise-indused arm claudicaiton. (Vertebral and basilar arteries) TIAs, s/s  binocular vision, vertigo, dysarthria, falling without LOC. Tests - arteriography, doppler US, Tx - Surgery, atherectomy, balloon angioplasty, bypass graft, embolectomy, lser angioplasty, patch grafting, stent placement, thromboendartectomy or amputaion; Thrombolytic agents - Activase, Streptase. Interventions/assessment: (during acute episode) - Pre-op- PVA, pain management, IV heparin, I & O, monitor lytes. Post-op - VS, PVA, monitor drsg, watch for s/s hemorrhage. Carotid, innominate, vertebral, or Subclavian artery occulsion, neuro assessment, in mesenteric occulsion, NG to low intermittent suction. I & O. Abd assessment, Saddle block occlusion - ck distal pulses, s/s renal failure, severe abd pain (mesenteric occulsion) and cardiac arrhythmias. IIliac artery occlusion - output, meticulous catherter care, Fem/Pop occlusions - PVA, early ambulation, discourage prolonged sitting.
  16. Raynaud's Disease - numbness, and tingling relieved by warmth, blanching of the skin on fingers, cyanotic before turning to red after exposed to cold or stress. Test - arteriography TX activie changes: avoid cold, Smoking cessation, surgery, calcium channel blockers Interventions/Assessments: warn against exposure to the cold
  17. Rheumatic Fever and Rheumatic Heart Disease - carditid, temp greater than 100.4, migratory joint pain or polyarthitis. Tests: elevated WBC, and ESR and slight anemia during inflamation, cardia emzymes elevated in severe carditis, positive C-reactive protein. Tx: Bedrest, Valvular surgery in persistent heart failure, antibiotics - erythromycin and penicillin, NSAIDs - ASA, Indocin. Interventions/Assessments: check for any sensitivity to PCN, instruct on S?S heart failure and have pt report, warn to watch for sign of recurrent infections - sudden sore throat, diffuse throat redness and oropharyngeal exudate, swollen, tender cervical lymph nodes, pain on swallowing, temp of 101 -104, headache, and nausea. Stay away from people with respiratory tract infections.
  18. Thoracic Aortic Aneurysm - Ascending Aneurysm - severe, boring, ripping and extending to hte neck, shoulders, lower back, or abdomen, right carotid and left radial pulses unequal in intesity. Desending Aneurysm - pain is discribed as sharp and tearing, usually starting suddenly between the shoulder blades and radiating to the chest. Transverse Aneurysm - dyspnea, pain is described as sharp and tering and radiating to the shoulders. Test - Aortography  - this shows the lumen of the aneurysm, its size and locatin and the false lumen in a dissecting aneurym, chest xray shows widening of the aorta, CT Scan confirms and locates and my monitor progression. Tx - surgery with Dacron or Teflon graft, replacement of aortic valve, morphine, antihypertensives, Negative inotropic - inderal. Intervientions/Assessment: monitor BP, PAWP, and CVP. assess pain, respirations, carotid, radial and femoral pulses, review labs - CBC with diff, lytes. type and crossmatch, ABG, UA, FC, I and O, IV Nitroprusside. post-op assess LOC, VS, PAP, PAWP, CVP, output, chest tube drainage, heart and lung sounds, medicate as order.
  19. Thrombophlebitis - DVT - cramping calf pain, edema, tender to touch; Superficial vein thrombophlebitis - redness along the vein, warmth, and tender to touch. Test - photoplethysmography shows venous-filling defects, US reveals decreased blood flow. TX - bed rest, elevate affected extremity, anticoagulants, coumadin, heparin, lovenox, antie-inflammatory lmed - ASA, Fragmin, Fibrinolytic med - Streptokinase. Intervention/Assessment - Assess pulmonary status, neurovascular checks, monitor labs, wm moist compressess.
  20. Valvular Heart Disease - Aortic insufficiency - angina, cough, dyspnea, fatique, palpatations. Mitral insufficiency - angina, dyspnea, fatigue, orthopnea, peripheral edema. Mitral stenosis - exertional dyspnea, fatigue, orthopnea, palpitations, peripheral edema, weakness, Mitral Valve Prolapse - may be asymptomatic, palpitations. Tricuspid Insufficiency - dyspnea, fatigue. Test - Aortic Insufficiency - echo and xray checking for left ventricular enlargement and pulmonary vein congestion. Mitral Insufficiency - cardiac cath checking for for mitral insufficiency and elevated atrial pressure and PAWP. Mitral stenosis - cardiac cath checking for diastolic pressure gradient across valve and elevated left atrial and PAWP, echo shows thickened mitral valve leaflets, EKG left atrial hypertrophy. Mitral valve prolapse - EKG shows prolapse of the mitral valve into the left atrium. Tricuspid insufficiency - echo shows systolic prolapses of the tricuspid valve, EKG shows right atrial or right ventricular hypertrophy, x ray shows right atrial dilation and right ventricular enlargement. Tx - surgery - open heart for valve replacement in severe cases, anticoagulant. Intervention/Assessment - watch for s/s heart failur or pulmonary edema and bleeding from anticoagulant, position upright, bedrest, assist with bath and ADLs, monitor VS, heart rhythm, clots, monitor I and O, daily weight, Blood chemistries, chest x-rays, pulmonary artery catheter readings.

Wednesday, March 2, 2011

Study Plan

I am scheduled to test on St. Patty's Day. I began my plan of taking 100 practice test questions or more each day. Also reading NCLEX-RN Review Made Incredibly Easy. This one has chapters of different systems and a web link for review questions either with instant result and rationale as you go or NCLEX style. The number of questions are determined by the user, as well as the subject. There are over 3000 question. That is nice for studying on breaks at work. I also have the NCLEX-RN Questions and Answers Made Incredibly Easy. After a chapter on the strategy there are chapters of questions that you cover one side and answer so you know why the answer is what it is. Each chapter is a different system. These are the last version of the NCLEX 2011.

Tuesday, March 1, 2011

ATT Letter

I received my Authorization to Test (ATT) today via e-mail. I thought it would come snail mail so I have been checking daily. I was pleasantly surprised when it was in my inbox. Another surprise was the email address was from Pearson not the department of health, board of nursing. Well I really best get the old nose to the grindstone. Tomorrow I will see what day is best and schedule. My plan is to do a practice exam of 50 - 100 questions each night, using my books and practice my drug calculations. the website on my resource page is still the best one in my opinion. The website by Louise Diehl, RN, MSN, ND, CCRN, ACNS-BC, NP-C Nurse Practitioner - Owner Doctor of Naturopathy has lots of great study information.

Sunday, February 27, 2011

Back to Business

I received my official diploma, so I know I will be getting the ATT letter soon. I have been reading the Kalplan NCLEX-RN 2010-2011 EDITION Strategies, Practice, and Review in addition to the 2 Made Incredibly Easy books. The Kaplan book has a CD included with timed practice exams. The exams are 180 questions and timed for three hours. If you find you can not complete the exam and try to quit you lose any questions you already did. You get the option of reviewing what you missed or the entire exam when you are finished. They do include the rationale. The book focuses on Critical thinking techniques and how to know what the questions are asking. I found it to be extremely helpful. Each of the 11 chapters focus is on one of the sections of the exam and includes quizzes after the content. There are also 2 practice written exams in the book with answers and rationales.
The Made Incredibly Easy Books have a web link with options to do practice tests with the amount of questions you select and instant results and a practice NCLEX timed. I will be working more on these next. I think the more practice I have the better my chance of success. Things are always changing in Nursing and there is just so much to know.

Saturday, February 26, 2011

Are you happy?

I am still determined to be cheerful and happy, in whatever situation I may be; for I have also learned from experience that the greater part of our happiness or misery depends upon our dispositions, and not upon our circumstances.

- Martha Washington

Tuesday, February 1, 2011

Daily Inspiration « Deepak Chopra Official Website

Daily Inspiration « Deepak Chopra Official Website: "Think clearly and concisely. Be sure you aren’t influenced too much by stress, emotion, or the heat of the moment. -Deepak Chopra"

Tuesday, January 11, 2011

Study for the NCLEX

I searched for a good resource for preparing for the NCLEX. Most of the recommended ccompanies were not only quite expensive but also limited to the schools or classes as a whole. Excelsior is Albany NY, I am in Florida thus a bit of a problem. I bought the Nursing made Incredibly Easy as I used their other subjects with success. They actually make studying less of a chore and more enjoyable. they have links to a companion web site with thousands of practice questions in both a study format and a mock NCLEX format. I highly recommend these study aids.