Download KEEP CALM and PASS NCLEX with MARK KLIMEK Review Updated Summer 2025/26. and more Study Guides, Projects, Research Nursing in PDF only on Docsity!
KEEP CALM
and
PASS NCLEX
with
MARK KLIMEK
Review
Acid-base balance/ventilators Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic If they are in different directions = respiratory pH = 7.35-7.45 acidosis/alkalosis HCO3 (bicarb) = 22-26 (2+2+2 = 6) CO2 = 45- ex: pH: 7.30 = ↓ bicarb: 20 = ↓ = metabolic acidosis ex: pH: 7.58 =↑ bicarb: 32 = ↑ = metabolic alkalosis ex: pH: 7.22 =↓ bicarb: 30 =↑ = respiratory acidosis ex: You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO 29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing: ↓ = acidosis, ↑ = respiratory -opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc).. *principle: acid base signs/symptoms.. as the pH goes… so goes my patient!!! -when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down) …except with potassium: when pH goes up; potassium goes down… when pH goes down; potassium goes up! (up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure, aspirate.. (down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased bowel sounds), coma, respiratory arrest (ambu-bag!!) Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC Kussmaul!! M: metabolic AC: acidosis ex: pT has respiratory acidosis… (select all that apply).. +1 reflexes diarhhea adynamic ileus spasm urinary retention tachycardia 2nd degree mobits type 2 heart block hypokalemia SATA questions: never only 1… never all of them diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels down = paralytic ileus …with scenarios.. always ask first “is it lung?” = respiratory …then ask if the pt is over-ventilating or under-ventilating? over-ventilating = alkalosis under-ventilating = acidosis …it’s about the SaO2!!! (pay attention!!) if it isn’t lung = metabolic.. if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis… why? losing acid = becomes basic.. for everything else that is not lung - choose metabolic acidosis.. -if you don’t know the answer… always answer metabolic acidosis.. ventilators alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (machine is pushing too hard to get air into the lungs).. respiratory alkalosis 3 obstructions: kink in tubing (get kink out), water condensing within the tube (empty tube), mucus secretions in the airway (turn, cough, deep breathe… then suction).. suction as needed!! in that order… low pressure alarm.. decreased resistance (too easy for the machine..)
abuse = confront
loss = support
#2 problem = dependency when the abuser get the significant other to do something.. “Call my boss, i’m sick” (abuser gets to keep abusing..) = co-dependency calls the boss… (positive self esteem)
How to treat this?!? Set limits and enforce them… Learn to say NO!
manipulation = when the abuser gets the significant other to do things for him or her… the nature of the act is dangerous or harmful how is it like dependency? the abuser is getting the other person to do something no harm = dependent / co-dependent (wife buying alcohol for husband) dangerous/harmful = manipulated (kid buying alcohol for father) …depends on legal/illegal…………. Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, respectively, of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thiamine (B1) plays a role in metabolizing glucose to produce energy for the brain. primary symptom of WKS = amnesia with confabulation (making up stories) they believe the lie.. ex: You have a pt who believes he is Ronald Regan’s Natioal Security Officer… And they want to go to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower and then we’ll go watch CNN and see what the news is in Washington D.C.”) WKS is… -It’s preventable & arrestable (stop it from getting worse) - Take vitamin B -Irreversible… About 70% Antibuse (disulfiram) -alcoholism medication aversion therapy! It can treat problem drinking by creating an unpleasant reaction to alcohol. It's used in recovery programs that include medical supervision and counseling. How long does it take to get into & out of their system… 2 weeks Patient teaching - teach how to avoid NAUSEA, VOMITING & DEATH NO: mouthwash, aftershaves, perfumes/colognes, insect repellants, -elixer (Robitussin), alcohol-based hand santizers, un-cooked icings (vanilla extract)… However, they CAN have RED WINE VINAGERETTE! Overdoses/Withdrawals… Every abused drug is either an upper or a downer… *Laxative (not upper or downer) but can be abused by the elderly.. UPPERS: caffiene, cocaine, PCP/LSD, methaphetamines, adderall.. Signs/symptoms: things go up… euphoria, tachycardia, restlessness, irritibility, diarhhea, reflex
3/4, spastic - suction!!! DOWNERS: heroin, alcohol, marijuana, etc. Sign/symptoms: things go ↓ ~ lethargic, respiratory depression, bradycardia, reflex 1/2, - ambubag!!! 2 steps… Step 1: ask yourself, is it an Upper or Downer Step 2: ask yourself, is it an Overdose (too much) or Withdrawal (not enough) If they say: “overdosed on an upper” (too much upper)… pick ↑ things!! If they say: “downer & intoxication” (too much DOWNER)… pick ↓ things!! If they say: “withdrawal downer” (don’t have enough downer; too little!) Too little downer makes everything go up.. Too little upper makes everything go down.. Upper overdose LOOKS LIKE downer withdrawal… Downer overdose LOOKS LIKE upper withdrawal… 2 situtions (highest priority) = Respiratory depression/arrest: Downer overdose/upper withdrawal.. Seizure: Upper overdose/downer withdrawal… ex: Overdose on cocaine: UPPER/OVERDOSE.. (too much UPPER) aka everything goes ↑ What would you expect to see? (select all that apply) -irritability, reflex 3/4, increased temp, borborygmi (increased bowel sounds) Withdrawing from cocaine.. -Make sure the RR is above 12! Need NARCAN!!! Drug addiction in the NEWBORN Always assume intoxication, not withdrawal at birth …After 24 hours - it’s in withdrawal.. You are caring for an infant born to a equaline (pain killer) addicted mother… It is 24 hours after the birth… What do you expect to see.. SELECT ALL THAT APPLY: difficult to console, low core body temp, exaggerated startle reflex, respiratory depression, seizure risk, shrill high pitch cry… alcohol withdrawls = 24 (stable; not life threatening) AWS delirium tremens = 72 hours (unstable; can kill you) DTS AWS: regular diet, semi-private anywhere, up ad lib, no restraints.. DTS: NPO/clear liquid (seizure), private/near nurse’s station, restricted bed rest (bed pans/urinals), restrained (VEST or 2 point locked leathers 1 arm & opposite leg)… AWS & DTS get a anti-hypertensive (BP pill) - everything is going up - keep everything down… They both get a tranquilizer, because their up… multivitamin b1 to prevent WKS. DRUGS:
normal sinus rhythm a-fib a flutter v-fib v-tach asystole QRS de-polarization = ventricular P wave = atrial 6 rhythms… -a lack of QRS’s = asystole -saw tooth = a flutter -chaotic = atrial fibrilation -chaotic = ventricular fibrilation
-QRS = ventricular tachycardia (bizzarre) -periodic bizarre wide QRS = PVC (low priority… can elevate to moderate: if there are more than 6/min.. or more than 6 PVC’s in a row.. or if the PVC falls on the T wave of the previous beat) PVC’s never reach HIGH.. LETHAL arrhytmias.. (they will kill you in 8 minutes or less) -asystole (HIGH) -v fib (HIGH) …have in common: NO cardiac output (pulse).. NO brain perfusion. Potentially LIFE threatening v-tach… (they have a cardiac output) TREATMENTS… PVCs/V-TACH: Ventricular… A (amioderone) Atrial: ABCD’s adenocard (adenosine); push in <8 seconds… asystole for about 30 seconds! beta blockers (side effects: HA/HTN) no asthma! calcium channel blockers… digitalis (digoxin, lanoxin) V-FIB: you D-FIB… Shock them! Asystole: EPI & atropine.. CHEST TUBES -purpose: re-establish negative pressure in the pleural space (need negative pressure for air exchange) Look for the reason why it was placed! pnemothorax (air = positive pressure.. put chest tube in to re-establish negative pressure!) hemothorax (blood= positive pressure.. put chest tube in to re-establish negative pressure!) pneumohemo (air & blood = positive pressure.. put chest tube in to re-establish negative pressure!) …what do you expect from a hemo chest tube: drain blood… LOCATION of the tube.. APICAL (high; air) & BASILAR (bottom; blood) example: unilateral pneumohemo.. apical for pneumo & basilar for hemo bilateral pneumo: 2 apicals chest trauma: unilateral (always assume its unilateral) post op R pneumonectomy (no chest tube!!) TROUBLE SHOOTING: Knocked it over… DON’T freak out! Water seal breaks…? CLAMP IT!!! (so nothing gets in).. CUT IT AWAY FROM BROKEN DEVICE… SUBMERGE TUBE UNDER STERILE WATER!!! UNCLAMP IT… FIRST: CLAMP BEST: SUBMERGE (re-establishes water seal) KNOW FIRST vs BEST… V-Fib.. BAD! FIRST: place backboard.. BEST: chest compressions..
VarieD PictureS Of A RancH (initials) INFECTIOUS DISEASE & TRANSMISSION BASED PRECAUTIONS 4 types… STANDARD/UNIVERSAL: CONTACT: for anything enteric (fecal/oral); c-diff, hep a, cholera, staph infections, RSV (however it is transmitted via droplet), herpes.. PRIVATE ROOM IS PREFERRED.. GLOVES, GOWN, HAND WASHING, DISPOSABLE SUPPLIES.. DROPLET: bugs that travel (sneezing/coughing); menegitis, h flu (causes epiglotitis)… PRIVATE ROOM IS PREFERRED, MASK, GLOVES, HAND WASHING, PATIENT WEARING MASK - WHEN LEAVING ROOM, DISPOSABLE SUPPLIES.. AIRBORNE: measles, mumps, rhubella, TB & varicella chickenpox.. PRIVATE ROOM REQUIRED, MASK, GLOVES, HAND WASHING, SPECIAL FILTER MASK (only for TB), PATIENT WEARING MASK - IF LEAVING ROOM, NEGATIVE AIR FLOW.. TB: (transmitted through droplet though).. PPE: Order to put on/take off… TAKE OFF: in ABC order… gloves, goggles, gown, mask! PUT ON: reverse ABC for the G’s, but mask comes 2nd.. gown, mask, goggles, gloves! MATH IV DRIP RATES… volume x drop factor / time in minutes (volume/hours) micro drips: 60 drop/ml macro drips: 10 drops /ml PEDIATRIC DOSE childs weight… 2.2 lbs/kg… IV REPLACEMENT… Always ROUND at the END!!! (NCLEX will tell you to where)
CRUTCHES, CANES, WALKERS Locomotion (human functioning): cast, traction, canes, crutches, walkers… CRUTCHES: how do you measure? (for risk reduction; nerve damange)… Length of crutch: 2-3 finger widths below the anterior axillary fold to a point lateral to and slightly in front of the foot.. Hand grip: when properly set, the elbox flexion will be about 30 degrees.. -How to teach how to use the different type of crutch GATES: 2 point, 3 point, 4 point & swing through… 2 point: 1 crutch/opposite foot.. other crutch/other foot.. 3 point: moving 2 crutches & the bad leg… 4 point: move everything separately… Swing through: NON-weight bearing.. amputations plant the crutches & swing through…
WHEN DO THEY USE THESE…?? Even for even; odd for odd = use the even # of gates when the weakness is evenly distributed… Use 2 point (mild), 4 point (severe).. use odd # gate (3), when 1 leg is odd.. can’t bear weight/amputation = swing through! early stages of RA: 2 left above knee amptuee: swing through 1st day post op R knee replacement; partial weight bearing allowed: 3 advanced stages: 4 left hip replacement; 2nd day post op non weight bearing: swing through bilateral knee replacement: 4 bilateral total knee; 3 weeks post op: 2 Going up and down stairs with crutches: UP with the GOOD, DOWN with the BAD! CANES: Hold the cane on the strong side… WALKERS: Pick them up, set them down… If they must tie belongings to the walker; have them tie it to the side & not the front (can tip over); no wheels/tennis balls (per boards!) DELUSIONS, HALLUCINATIONS & ILLUSIONS: PSYCH Is my patient NON-psychotic vs. psychotic? (1st thing you must decide) NON psychotic (neurotic): has insight and reality based; they know they have a problem… they need “good general therapuetic communication”; that must be very difficult, how are you feeling, what do you mean by, can you tell me more? psychotic: has NO insight & is not reality-based; they don’t have a problem/they aren’t sick; they blame everyone else… “unique specific strategies” SYMPTOMS: delusions, hallucinations & illusions… delusion = a false fixed idea or belief; there is no sensory component. 3 types: paranoid, grandiose (you’re christ) & somatic (x-ray vision) hallucination = false fixed sensory (hear, feel, taste, smell, see) most common hallucination = auditory.. then visual… then tactile (feeling), gustatory (taste).. olfactory (smell) most common auditory = voices telling you to harm yourself. illusion = misinterpretation of reality.. (sensory) there is a referent in reality (something to which a person refers) HOW DO YOU DEAL WITH THESE PATIENTS?!? If, psychotic - what is their problem? (What kind of psychosis do they have?) A FUNCTIONAL psychosis: they can function in every day life (schizophrenia, schizoaffective disorder, major depression, manic) DEMENTIA: the brain is damaged (senile, alzheimers, organic brain syndrome) DELIRIUM: FUNCTIONAL: this person has the potential to learn reality/improve.. Teach reality… Use 4 step process.. acknowledge feeling, present reality, set a limit, enforce the limit.. Example (answer): FEELING: I see you’re angry, you seem upset, tell me more of how you’re feeling… REALITY: I know that the voices are real to you, but they are not real… I’m a nurse, this is a hospital… SET LIMIT: That topic is off limits in our converstion.. We aren’t going to talk about that.. ENFORCE LIMIT: I see you are too ill to stay reality based, so our conversation is over (it ends the conversation).
Lantus (Glargine): onset: 1 hr.. peak: NONE.. duration: 12-24 hrs. LITTLE to NO RISK for HYPOGLYCEMIA (can SAFELY give at BEDTIME) LONG acting NPH: intermediate acting onset: 6 hrs.. peak: 8-10 hrs.. duration: 12 hrs. cloudy.. suspension NEVER put anything in an IV bag! NOT so fast & NOT in the bag Humalog (Lispro): onset: 15 mins.. peak: 30 mins.. duration: 3 hrs. give it WITH MEALS! ALWAYS check expiration dates!! (manufacturer’s expiration date is only good when the bottle is closed… after it’s open; it expires in 30 days!) make sure you write the date on the bottle with EXP! You should teach patients to refridgerate their insulin at home, but it doesn’t need to be refridgerated in the hospital. …EXERCISE (like another shot of insulin) ex: “and he exercised…” aka “and he got another shot of insulin”………. “she’s going to play soccer this afternoon”.. “she’s going to get a shot of insulin this afternoon!” more exercise (more insulin) = really need less insulin less exercise = need more insulin SICK days: glucose is going to go up.. still take insulin, even if they’re not eating.. take sips of water; they get dehydrated fast.. (HYPERGLYCEMIA & DEHYDRATION).. needs to stay active as possible. COMPLICATIONS of diabetes (mellitus) Acute -low blood glucose (type 1/type 2) HYPOGLYCEMIA.. not enough food, too much insulin/meds, too much exercise.. danger = brain damage (permanent).. S/S: drunk in shock = staggerin’ gait, slurred speech, impaired judgement, delayed reaction time, labile (emotions all over the place), loud/obnoxious.. (vasomotor) low BP, tachycardia, tachpnea, cold, pale, clammy, mottled.. WHAT DO YOU DO?! adminster rapidly metabolizable carbohydrates (sugars); any juice, candy, milk, honey, icing, jam… ideal combo = sugar plus a starch or protein.. ORANGE juice & crackers! apple juice & slice of turkey… 1/2 cup skim milk (has both sugars & protein). if UNCONSCIOUS, give GLUCAGON; IM injection.. DEXTROSE D10/D50; given IV..
- DKA (diabetic ketoacidosis/diabetic coma) only type 1’s… glucose goes HIGH.. too much food, not enough medication, not enough exercise.. #1 cause = acute viral upper respiratory infections (in the last 2 weeks).. So, when they come into the hospital & their BS is 850 ALWAYS ask the parents “have they had a viral infection in the last 2 weeks!!! S/S: DKA = dehydration, ketones in their blood/kussmaul breathing (deep & rapid)/K (high) potassium, acidosis (metabolic)/acetone breath/anorexia due to nausea… WHAT DO YOU DO!?! HYDRATE!! (IV fluids; fast!! 200ml/hour; regular insulin; normal saline/D5?) D5 doesn’t stay in veins; goes into the tissues.. won’t cause HYPERGLYCEMIA (D10 & D50 will!) hyperglycemic hyperosmolar nonketotic coma HHNK (type 2) = DEHYDRATION… HYDRATE them!!!! insulin is most essential in treating DKA!!! higher mortality rate = HHNK, however DKA has higher priority. **long term complications of diabetes are related to: poor tissue perfusion & peripheral
neuropathy… *lab test: A1c (average glucose rate over 3 months)… you want it to be 6 & <!! 7 = need to check on it 8 & > = out of control
DRUG TOXICITIES (5) Lithium: ANTImania drug for BiPolar.. Therapuetic level: 0.6-1. Toxic level: 2 & > Lanoxin (Digoxin): A-Fib & CHF Therapuetic level: 1-2… 2 can be toxic! Toxic level: 2 & > Aminophylline: Airway Anti-Spasmodic NOT a bronchodilator (when a bronchodilator doesn’t work in an acute airway problem, give them aminophylline to relax the spasm; then give the bronchodilator). Therapuetic level: 10-20… 20 can be toxic! Toxic level: 20 & > Dilantin: Used for Seizures Therapuetic level: 10-20… 20 can be toxic! Toxic level: 20 & > Bilirubin: Waste product from the breakdown of RBCs (only tested in NEWBORNS on the NCLEX) Normal: 9.9 and < Elevated level: 10-20… 20 can be toxic! 14-15 is when they need to be hospitalized Toxic level: 20 & > Jaundice: yellowing; bilirubin in the skin Kernicterus: bilirubin the the brain… usually occurs when the level gets around 20.. Opisthotonus: a position the baby assumes when they have bilirubin on the brain; HYPEREXTEND.. In what position do you place an opisthotonic child? On their side! DUMPING SYNDROME vs. HIATAL HERNIA Hiatal hernia: regurgitation of acid into the esophagus, because the upper part of your stomach herniates upward through the diaphragm… moves in the wrong direction in the correct rate (you want it to empty faster; so it doesn’t reflux) S/S: GERD (heartburn & indegestion) when lying down after eating Treatment: play around with the head of the bed (raise), play around with water content with the meal (flush faster) & you can play around with the carbohydrate content of the meal (carbs go fast)… LOW protein!! Dumping syndrome: gastric contents dump too quickly into the duodenum… moves in the right direction, but at the wrong rate (you want it to empty slower) S/S: DRUNK (staggering gait, slurred speech, impaired judgement) & SHOCK (tachycardia, tachypnea, cold, clammy, pale) DRUNK + SHOCK = HYPOGLYCEMIA ACUTE ABDOMINAL DISTRESS (cramping, pain, doubling over, borborygmi increased bowel sounds, diarhhea, bloating, distension) Treatment: Eat with head low & turned to the side, low fluids with meal and low carb content in
the hand. Magnesiums do the OPPOSITE AS the prefix… (in a tie, DON’T pick magnesium!) S/S… HYPERmagnesium: brain: lethergy lungs: bradypnea heart: bradycardia urine: oliguria bowel: constipation muscles: flaccidity reflexes: 1/ HYPOmagnesium: brain: irritability, restlessness, agitation… lungs: tachypnea heart: tachycardia urine: polyuria bowel: diarhhea muscles: spasms reflexes: +3/+ Sodiums S/S… HYPERnatremia: DEHYDRATION DKA DI… HHNK? HYPOnatremia: OVERLOAD Fluid volume excess SIADH NUMBNESS & TINGLING (paresthesia) = earliest sign of any electrolyte disorder “circumoral” = numb & tingling lips UNIVERSAL sign of any electrolyte disorder = MUSCLE weakness (paresis) TREATMENT: (boards should only test potassium) HIGH potassium (will stop your heart) Rules for Potassium: -NEVER push IV! -NEVER more than 40 of K per liter of IV fluid.. If more than 40, question & clarify with DOC first!
- HIGH POTASSIUM = worst electrolyte imbalance! can STOP heart! So, how do we lower potassium?!?! Give D5W with REGULAR insulin (drive potassium into the cell & out of the blood) temporary/fast!!! “enters early”
- Kayexalate “K exits late” (switch the potassium with soldium) permanent/slow So… Give both D5W w/ REG insulin & kayexalate!… switching from a life threatening imbalance (HYPERkalemia) for a non-life threatening imbalance (HYPERnatremia); just hydrate!! ☺
60 drops/ml remember!!
ENDOCRINE Overview HYPERthyroidism: “thyroidsim” = “metabolism”, because that is what the thyroid does, so HYPERthyroidism = HYPERmetabolism S/S: weightloss, high pulse & BP, irritable, heat intolerance, cold tolerance, exophthalmos (bulging eyes).. GRAVES disease (running yourself into the grave) Treatments:
- radioactive iodine… KNOW: patient needs to be by themself for 24 hours (restriction of visitors).. and then be really careful with their urine (flush 3 times!) If the urine is spilled, they must call the hazmat team!! Only RISK to the Nurse is the patient’s urine (how the radioactivity is excreted!)
- PTU (propylthiouracil): Puts Thyroid Under …CANCER drug! KNOW: that it is an IMMUNOsuppressor; monitor WBCs!!
- thyroidectomy (most common way used!) TOTAL (complete) or SUBTOTAL (partial) tyroidectomy -TOTAL: need lifelong hormone replacements.. at risk now for HYPOcalcemia! -SUBTOTAL: do NOT need lifelong hormone replacements.. at risk now for THYROID STORM/CRISIS THYROID Storm = medical EMERGENCY (can cause BRAIN damage!!!) basically frying your brain to death with HYPOXIA! S/S: super HIGH temps (105 & >), extremely HIGH BP’s ex: 210/180 (stroke category!), severe TACHYCARDIA (ex: 180-200) & PSYCHOTIC DELIRIUM Treatment: Get temperature DOWN & get the oxygen UP!! *FIRST way to get temp down: ice packs.. BEST way to get temp down: cooling blanket… OXYGEN (per mask @ 10L)!!! DO NOT USE TYLENOL - it works in the hypothalamus and isn’t going to work at this time.. FYI: If it’s a sequence question: oxygen, ice packs, cooling blanket.. NEVER, EVER leave patient! Post OP RISKS: (1st 12 hours): priority = airway & hemmorhage.. (same for both!) (12-48 hours): TOTAL: Tetany (muscular spasms in laraynx; can cut off airway) due to low calcium.. SUBTOTAL: Thyroid STORM! (>48 hours 42-72): INFECTION FYI for INFECTION: NEVER choose infection as a PRIORITY in the first 72 hours for anything!!! ONLY CHOOSE it after the first 72 hours!!! HYPOthyroidism: “thyroidsim” = “metabolism”, because that is what the thyroid does, so HYPOthyroidism = HYPOmetabolism S/S: obese, cold intolerance, heat tolerance, low pulse & BP = MYXedema Treatment: give them thyroid hormones: synthroid (levothyroxine) CAUTION!! do NOT sedate these patients; can put them in a coma -What pre-op order would you question? AMBIEN @ HS.. If the patient is supposed to be NPO; make sure you question that they still get their morning pill!! (they NEED it! NEVER hold your thyroid pills unless you have EXPRESS orders to do so). ADRENOCORTEX Disease (start with A & C) ex: Cushings, Conns, Addisons..
AGE APPROPRIATE considerations Infant 0m-6m: BEST toy: musical mobile stimulates motor & sensory… 2nd BEST toy: something SOFT & LARGE 6m-9m: working on object permanance: they know it’s still there even though they can’t see it* ex: you put a toy under a blanket - if they don’t have it; they’ll cry.. if they have it: they know to lift the blanket & get it.. At this age, your “play” should be teaching them that; that is their big task at this time. BEST toy: cover/uncover toy; play PEEK-a-BOO, the parent putting a blanket over their head and then taking it off, Jack-in-the-Box, etc… 2nd BEST toy: something large/hard.. WORST toy: musical mobile; they can sit up/reach up and then can stranglate themselves 9m-12m: working on vocalization: BEST toy: speaking toys; ex: “Talking” Woody (Toy Story!), Tickle Me Elmo, Teddy Ruxpin, See & Say: “the COW says MOO”, etc.. They also need PURPOSEFUL ACTIVITY… NEVER PICK THESE ANSWERS if the kid is UNDER 9m: build, sort, stack, make, construct - why? PURPOSE words!! Toddlers 1-3: Best toy: PUSH/PULL.. ex: lawn mower, baby stroller work on GROSS MOTOR; running, jumping NO finger dexterity yet; can’t color, use scissors, etc. “Finger painting”, yes, because they can use their HAND! Finger painting = HAND painting. -They do PARALLEL Play (play along-side, but not with) Preschoolers Work on their FINE MOTOR (finger dexterity), work on BALANCE (tricylces, dance class, iceskates) Characterized by CO-OPERATIVE play (play together in groups) -They like to PRETEND; highly imaginative! School Age Characterized by the 3 C’s
- Creative (blank paper & colored pencils)
- Collective (collect anything & everything)
- Competitive (they don’t like being the loser) Adolescents Peer Group Association (hang out with their friends) Question (pertaining to Nursing): Do you let 5-8 adolescents hang out in a room together? YES!! UNLESS these 3 things: if anyone is fresh post-op (less than 12 hours out of surgery), if anyone is immunosuppressed & if anyone has a contagious disease. LAMINECTOMY (is surgery that creates space by removing the lamina - the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves). lamina = vertebral spinous processes (posterior) ectomy = removal WHY do you do this?? RELIEVE NERVE ROOT COMPRESSION S/S of nerve root compression: 3 P’s -pain -paresthesia (numbness & tingling) -paresis (muscle weakness)
MOST IMPORTANT thing to pay attention in any NEURO question = LOCATION! 3 locations for laminectomy: -cervical (neck), thoracic (upper back) & lumbar (lower back) Questions pertaining to areas: cervical; diaphragm… #1 answer = check out their breathing… #2 answer = check out the function of their arms & hands. thoracic; cough & bowels… #1 answer = check how well they cough lumbar; bladder & legs… #1 answer = is their bladder distended or empty… #2 answer = how is the function of their legs POST op laminectomy: #1 answer = log roll! 3 things to mobilizing pt: do NOT dangle them (sit on the edge of the bed), do NOT sit for longer than 30 minutes & they may walk, stand & lie down without restriction.. POST op COMPLICATIONS (depends on LOCATION!!) cervical: trouble breathing after surgery.. #1 complication: PNEUMONIA thoracic: trouble with coughing.. #1 complication: PNEUMONIA & ileus (because bowels won’t work) lumbar: #1 complication: urinary retention & problems with the legs ANTERIOR THORACIC (from front through the chest to the spine) laminectomy: will have a CHEST TUBE (pneumothorax)!! But no others will have a chest tube… Laminectomy with FUSION: they take a bone graft from the iliac crest… If you remove the disc, you have to get bone from somwhere, so there isn’t bone on bone (grinding)! So, there will be 2 incisions; spine & hip; the most pain will be at the hip -Most bleeding & drainage will be at the hip; will have a JP (Jackson-Pratt) drain… -HIGHEST risk for INFECTION: they are equal.. -HIGHEST risk for REJECTION: the spine! Surgeons are using bones from cadavers quite a bit to lower infection rates.. Discharge TEACHING: Permanent restrictions = -NEVER pick up object by bending at the waist; lift with the knees!! -cervical lams can NEVER lift anything over your head (for life!) -NO mountain biking, jerky moving ride (rollercoasters), horseback riding, etc. Temporary restrictions = -do NOT sit longer than 30 minutes (6 weeks) -lie flat & log roll (6 weeks) -NO driving (6 weeks) -do NOT anything more than 5 lbs; gallon of milk (6 weeks) Remember: MOST IMPORTANT thing to pay attention to in any NEURO question = LOCATION!
