NCLEX Cram Sheet PDF

NCLEX Cram Sheet Powered by Join for free! Lab Values...

NCLEX Cram Sheet Powered by Join for free! Lab Values Health Assessments Basic Metabolic Panel (BMP) Complete Blood Count (CBC) Head to Toe Assessment Panel & Electrolytes Normal Range Vitals: Hemoglobin: Normal = 12-18 Sodium (Na+): normal range = 135-145 mEq Vital Sign Normal Range Location Classification Risky = 8-11 LOW Sodium - Low & Slow Heaven or blood transfusion = 0-7 Pulse 60-100bpm Radial, carotid, Absent, weak, HIGH sodium = Big & Bloated brachial, normal, increased, femoral, bounding. Hematocrit: Normal = 36-54% popliteal, Potassium (K+): Normal range = 3.5-5.0 mEq/L, Elevated Hct = Dehydration dorsalis pedis, pumps the heart muscles posterior Decreased Hct = Bleeding, Anemia, Malnutrition tibialis, temporal Chloride (Cl-): Normal range = 97-107, helps to Red blood cell count (RBC): 4-6 million pulse. maintain acid base balance Low = Anemia, Renal Failure Respirations 12-20bpm Anterior Normal, (RR) (chest) and adventitious, absent, Carbon Dioxide (CO2): Helps to maintain acid base High = Dehydration posterior diminished. pH balance (too much can put the body in Acidosis). (back) Normal range = 23-29 (mEq/L) BP 120/70-139/89 Brachial, Systole: Max Memory trick: Carbon DiACID radial, contraction of the White Blood Cells (WBC) popliteal, left ventricle. posterior Bicarbonate (HCO3): Pushes the body into an & Coagulation Panel tibialis. Diastole: Pressure alkalotic state of resting ventricles. Normal range = 23-30 mEq/L WBC Total Count: Normal = 5,000-10,000 Temperature 98.6/37*C Temporal, Febrile, afebrile Higher = Leukocytosis rectal, oral, Memory trick: Bicarb Base tympanic, Low = “Leukopenia” axillary BUN & Creatinine: 2 labs for 2 kidneys BUN normal range = 10-20, over 20 usually means CD4 Count: Normal = Over 200 Below = AIDS Circulation dehydration. Capillary Refill Creatinine over 1.3 = Bad Kidney (kidney injury) Platelets: normal range = 150k - 400k Skin Turgor Glucose: Normal range = 70-110 Head & Neck: Hair, Eyes, Nares, Mouth, Jaw & Neck PTT: normal range = 30-40 Chest: Heart: All Pigs Eat Too Much Hyperglycemia (over 120) usually clients with uncontrolled diabetes, INR: normal range = 0.9-1.2 A - Aortic Hypoglycemia (60 or less) brain will DIE! Very deadly P - Pulmonic E - Erb’s Point Calcium (Ca): normal range = 9.0-10.5 mEq/L T - Tricuspid Memory trick: Calcium Contracts Muscles M - Mitral Lungs Magnesium (Mg+): normal range = 1.3 - 2.1 mEq/L Breast Memory trick: Magnesium Mellows Muscles Abdomen: Bowel Sounds, Shape  Assessment Components: Obstetric History, Pain Assessment Positioning Current Labor Status, Medical–Surgical History, Social History, Desires/Plans for Labor and Birth Types of Pain: Chronic: Persistent, malignant pain that lasts more than six months. GTPAL: Gravida, Term, Preterm, Abortion, Living Fowler’s Position: The head and trunk are raised 30-90 Acute: Sudden onset of pain, specific to injury. Lasts degrees. from seconds to six months For cardiac issues, SOB, or NG tube. Ambulation: Body Mechanics Effects of Pain: Chronic: Immune suppression, Lateral: Right lateral = The right side of the patient & Mobility depression, disability, fatigue, anger, inability to touches the bed. perform ADLs Left lateral = The left side of the patient touches the bed. Acute: Increased cardiac output, impaired insulin General ease of movement: Normal finding = For GI issues and rectal surgery. response, immune suppression, increased cortisol voluntary, controlled, purposeful, fluid, and Lithotomy: Most common in OB; patient lies flat on their production, increased fluid retention. coordinated movements back with knees elevated and hips level (often supported Abnormal finding = involuntary movements, tremors, by stirrups). Factors that Influence Pain: Past Experience, tics, chorea, dystonia, fasciculations, oral or facial Anxiety, Depression, Age, Gender, Culture For gynecological procedures and childbirth. dyskinesias Patho: Nociceptors, Nociception, Cox 1, Cox 2, Sim’s Position: Prone/lateral; Patient lies on their side Gait: Normal finding = head erect with vertebral with upper leg flexed and drawn towards the chest, and Decrease pain sensation straight, knees and feet forward, arms at side with upper arm flexed at the elbow. Pharmacologic Treatments: Non opioids: NSAIDS, elbows flexed, arms wing freely in alternation with For administering enemas, perineal examination, and Acetaminophen, Ofirmev leg swings comfort in pregnancy. Opioids: Tramadol, Tylenol 3, Meperidine, Abnormal finding = spastic hemiparesis, scissor gait, Propoxyphene (with tylenol), Oxycodone, Fetanyl, steppage gait, sensor ataxia, cerebellar ataxia, Prone: Patient lies on their stomach with back up, and Morphine, Dilaudid parkinsonian gait, use of assistive devices head turned to one side. Other: PCA pump, PRN medications, Multi modal (use For drainage of the mouth after oral or neck surgery. It Alignment: Normal finding = when standing or allows for full flexion of knee and hip joints. of one or more drugs), Routine admin (admin around sitting, a line can be drawn from the ear to shoulder the clock), Topical, Local anesthesia, Intraspinal and hip. Supine: On patient’s spine; Considered the most natural Non-pharmacologic Treatments: Cutaneous Abnormal finding = spinal curvatures as seen in “at rest” position. stimulation (TENS machine), Massage, Thermal scoliosis, inability to maintain normal alignment For abdominal, facial, and extremity procedures. therapies (heat and cold), Distraction, Relaxation, Joint structure: Normal finding = absence of joint Trendelenburg: “Upside Down”; Patient is in supine Guided imagery, Hypnosis, Music therapy, Alternative deformities and full range of motion. position and has their head sharply lowered and raised therapy (Acupuncture) Abnormal finding = limitation of full range of motion, feet. Focused Pain Assessment: Scale (0-10), Timing, swelling, heat, tenderness, crepitation, deformities For hypotension, gynecological and abdominal hernia Location, Duration, Quality, Aggravating and surgeries, and placement and removal of central lines. Muscles mass and tone: Normal finding = adequate Alleviating factors mass, tone and strength to complete ADLs. Reverse Trendelenburg: Patient is in supine position Abnormal finding = atrophy, hypertrophy, flaccidity, with head of the bed elevated and the foot of the bed spasticity, paralysis. down. For types of surgery to help promote perfusion in obese Endurance: Normal finding = turning in bed, patients. Also helpful in treating venous air embolism Mother Assessment maintaining correct alignment, ambulating, and preventing pulmonary aspiration. performing self-care activities Admission: Birth imminence, Fetal status, Maternal Abnormal finding = increased pulse, respirations, BP, status, Risk assessment SOB, dyspnea, weakness, pallor, confusion, vertigo, 2 of 6 pain.  Maternity & Pediatric Pregnancy Maternal Pharmacology Signs of Pregnancy - Presumptive: subjective data the woman reports to the HCP. Probable: objective data, such as cervical changes. Pediatric: Positive: diagnostic confirmation such as, fetal heartbeat Drug Mode of Action Indication Contraindication/ Dose/Route & ultrasound Adverse Effects Phytonadione Helps prevent bleeding by Prevention and treatment Pain, swelling, flushing, IM Weight Gain: A pregnant patient should increase their Vit K activating clotting factors. of hypoprothrombinemia. dizziness, rapid heartbeat, Subcut, IV (Children 1 caloric intake by 300 kcal/day during 2nd & 3rd sweating. mo): 1– 2 mg single dose. trimesters. Erythromycin Suppresses protein Administered immediately Infantile hypertrophic Eye drops/cream. Erythrocin synthesis at the level of the after birth along with pyloric stenosis, IV/ P.O FIRST TRIMESTER: 3-4 lb total 50S bacterial ribosome. Vitamin K shot. Infections pancreatitis, interstitial PO (Neonates): caused by nephritis rash. Ethylsuccinate—20– 50 susceptible organisms. Benzyl alcohol should be mg/kg/day divided q 6– 12 REMAINDER OF PREGNANCY: 1 lb per week. avoided in neonates. hr. IV (Children 1 mo): 15– Total weight gain: 50 mg/kg/day divided q 6 hr, maximum 4 g/day. 25-35 lb for a patient with a normal BMI. HEp B vaccine Causes a primary immune Provides immunity against Do not give if baby is 5 mcg/0.5 mL ; 5 mcg/mL Nutritional Requirements: Proteins, Minerals, Iron, response. HEP B. already ; 10 mcg/0.5 mL +. Calcium, Phosphorus, Zinc, Iodine HEP B IG Confers passive immunity Hepatitis b infection in Erythema at IM site, pain, IM: 0.5 mL within 12 hr of Vitamin requirements: Folic acid (Vitamin B9), Vitamin BayHep B, Nabi-HB to hepatitis B infection post neonates born to HBsAg- swelling, tenderness. birth. exposure. + women, provides Hypersensitivity to immune A, Vitamin C, Vitamin B6, Vitamin B12 passive immunity. globulins, glycine, or thimerosal. Hematologic Changes: Blood volume increases by 45-50%. Red blood cell count increases up to 30%. Postpartum: Plasma increases up to 50% Hemoglobin decreases Drug Mode of Action Indications Contraindications/Side Dose/Route Effects Hematocrit decreases Phytonadion Bind to opiate receptors in Management of moderate Avoid chronic use. ROUTE PO Cardiac changes: Blood pressure slightly decreases the CNS. to severe pain. Dizziness, sedation, —2.5– 10 mg q 3– 6 hr as respiratory depression, needed. Heart rate increases by 10-15 BPM hypotension. Cardiac output increases Simethicone Passage of gas through Relief of painful symptoms Not recommended for ROUTE PO Gas-X the GI tract by belching or of excess gas in the GI tract infant colic 40– 120 mg qid, after Integumentary changes: passing flatus. that may occur meals and at bedtime (up to Chloasma, Linea nigra, Striae postoperatively. 500 mg/day). Musculoskeletal changes: Docusate Promotes incorporation of Prevention of constipation Hypersensitivity; Abdominal ROUTE PO Lordosis, Diastasis rectus abdominis Peri-Colace water into stool, resulting in (in patients who should pain, nausea, or vomiting. 2 tablets once daily at softer fecal mass. avoid straining, such as bedtime; after MI or rectal surgery). maximum 4 tablets twice daily. 3 of 6 Respiratory changes: Anticonvulsants: Antiemetics: Nasal mucosa edematous due to vasocongestion. Increases interval between seizures. Decreases/prevents nausea & vomiting. Nasal congestion and voice changes are possible. Common Brands Generic Brands Common Brands Generic Brands Accommodations to maintain lung capacity. May feel short of breath when eupneic. Dilantin Phenytoin Phenergan Promethazine Third trimester diaphragm pressure. Neurontin Gabapentin Zofran Ondansetron Tegretol Carbamazepine GI changes: Intestines are displaced upwards & to the side. Depakote Valproic Acid Pressure changes in the esophagus & stomach which leads to heartburn. Antihypertensives–(PRIL): Constipation ACE Inhibitors; Blocks the conversion of angiotensin I to Antidepressants: angiotensin II (potent vasoconstrictor). SRIs; Inhibits serotonin reuptake in CNS. Common Brands Generic Brands Pharmacology Common Brands Generic Brands Altace Ramipril Celexa Citalopram Analgesics: Capoten Captopril Opioid; Increases pain threshold by Effexor Venlafaxine altering pain perception. Prinivil, Zestril Lisinopril Lexapro Escitalopram Oxalate Vasotec Enalapril Common Brands Generic Brands Paxil Paroxetine Prozac Fluoxetine Demerol Meperidine HCL Zoloft Sertraline Dilaudid Hydromorphone Duragesic, Antilipidemics: Inhibits HMG-CoA reductase, an early Fentanyl Sublimaze step in cholesterol production. Morphine Sulfate Morphine Sulfate Anti-Diabetics: Sulfonylureas; Promotes insulin secretion by the Common Brands Generic Brands Vicodin, Norco Hydrocodone pancreas; Increases tissue response to insulin. Crestor Rosuvastatin Common Brands Generic Brands Lipitor Atorvastatin Anticoagulants: Amaryl Glimepiride Interferes with blood clotting processes. Zocor Simvastatin Diabeta, Glynase, Glyburide Common Brands Generic Brands Micronase Coumadin Warfarin Glucotrol (XL) Glipizide Lovenox Enoxaparin Heparin Sodium-from Heparin beef/pork 4 of 6 Antiplatelets: Beta Blockers-(OLOL): Corticosteroids: Interferes with the 1ST step in the clotting process: Prevents sympathetic heart stimulation, thus Inflammation, produces intentional immunosuppression, platelet aggregation. Decreases HR and contractility. and treats adrenocortical insufficiency. Common Brands Generic Brands Common Brands Generic Brands Common Brands Generic Brands ASA - aspirin Acetylsalicylic Acid Inderal Propranolol Celestone Betamethasone Lopressor Metoprolol Tartrate Decadron Dexamethasone Plavix Clopidogrel Toprol-XL Metoprolol Succinate Deltasone Prednisone Tenormin Atenolol Solu-Cortef Hydrocortisone Anxiolytics: Azaspirodecanedione derivatives; Solu-Medrol Methylprednisolone Decreases anxiety. Biguanides: Common Brands Generic Brands Decreases hepatic glucose production & intestinal absorption of glucose. Diuretics: Decreases fluid volume in the body. Buspar Buspirone Hydrochloride Common Brands Generic Brands Common Brands Generic Brands Bumex Bumetanide Glucophage Metformin Arbs-(SARTAN): Demadex Torsemide Blocks binding of angiotensin II at the receptor site. Lasix Furosemide Common Brands Generic Brands Calcium Channel Blockers: Atacand Candesartan Blocks Na+ influx into the beta-receptors. Glitazones: Decreases insulin resistance. Cozaar Losartan Common Brands Generic Brands Common Brands Generic Brands Diovan Valsartan Cardizem Diltiazem Actos Pioglitazone Norvasc Amlodipine Benzodiazepines (Pam & Lam): Procardia Nifedipine Avandia Rosiglitazone Enhances/facilitates GABA, an inhibitory neurotransmitter Verelan, Isoptin, Verapamil Calan H2-Histamine Receptor Antagonists: Inhibit histamine Common Brands Generic Brands at histamine H2-receptor sites, gastric acid secretion. Xanax Alprazolam Cardiac Glycosides: Common Brands Generic Brands Positive inotropes (improve contractility Valium Diazepam and cardiac output). Pepcid Famotidine Ativan Lorazepam Common Brands Generic Brands Zantac Ranitidine Versed Midazolam Lanoxin Digoxin 5 of 6 Nitrates: Peripheral and coronary vasodilators. Common Brands Generic Brands Nitro BID, Tridil, Transderm Nitro, Nitroglycerin Nitrostat Imdur Isosorbide Mononitrate www.simplenursing.com Isorbid, Isordil, Isosorbide Dinitrate Sorbitrate Proton Pump Inhibitors (PPI): Blocks final step of gastric acid production; Ulcer-reducing. Common Brands Generic Brands Nexium Esomeprazole Prilosec Omeprazole Protonix Pantoprazole Tricyclics: Blocks reuptake of norepinephrine and serotonin at nerve endings. Common Brands Generic Brands Elavil Amitriptyline