NCLEX and CGFNS

Basic Pharmacology - Scope of Pharmacology on NCLEX Test

2011-07-11T12:45:00.004+03:00

It is also important for nurses to understand and apply knowledge or pharmacology in nursing practice. Nurses are frequently responsible for instructing the client and family regarding the safe administration of medications. National Council Licensure Exam (NCLEX) devoted 13% - 19 % of the physiological integrity section to pharmacology.

There are three major areas of pharmacology as followed here:

Pharmacokinetics: How drugs are absorbed, distributed, metabolized and excreted by the body.
Pharmacodynamics: How drugs are used by the body.
Pharmacotherapeutics: How the client response to the drugs.

Nurses are expected to use their knowledge of pharmacology to:

Recognize common uses, side effects, and adverse effects.
Challenge medication errors
Meet the client's learning need.

Administering of medication depend on the area of practice and the assigned patient. Here are medication classifications that commonly prescribed for adult patient:

Anti-infectives: for the treatment of infections have common side effects - GI upset
Antihypertensive: to lower blood pressure and increase blood flow to the myocardium, have common side effects such as orthostatic hypotention,
Antidiarrheals: to decrease gastric motility and reduce water content in the intestinal tract, have side effects include bloating and gas.
Diuretics: to decrease water and sodium absorption from the loof of Henle or inhibit antidiuretic hormone (potassium-sparing diuretics). Side effects include hypokalemia.
Antacids: to reduce hydrochloric acid in the stomach. The calcium and aluminum based antacids have side effect of constipation whereas the magnesium based antacids have side effects of diarrhea.
Antipyretics: to reduce fever
Bronchodilators: to dilate large air passages (for asthma patient), have common side effect of tachycardia.
Laxatives: to promote the passage of stool (such as stool softeners, cathartics, fiber, lubricants and stimulants).
Anticoagulants: to prevent clot formation by decreasing vitamin K levels and blocking the clotting chain or by preventing platelet aggregation.
Antianemics: to increase factors necessary for red blood cell production such as B12, iron, and Epogen.
Narcotics / analgesics: to relieve moderate to severe pain, include opioids (morphine and codeine), synthetic opioids (meperidine), and NSAIDs (ketoralac).
Anticonvulsants: to treat seizure disorder and bipolar disorder, such as phenobarbital, phenytoin and lorazepam.
Anticholinergics: to dry mucous membranes such as atropine.
Mydriatics: to dilate the pupils, such as for cataract patients.
Miotics: to constric the pupil, such as pilocarpin HCl for treatment of glaucoma.

Time-released Drugs:
Here are abbreviations of time-released drugs:

Dur = Duration
SR = Sustained release
CR = Continuous release
SA = Sustained action
Contin = Continuous action
LA = Long acting

Administrating Medication

2011-07-11T08:19:00.002+03:00

When preparing to administer medication, the physicians order must be reviewed by the nurse such as the rout of the medicines. Many medication are supplied in various preparation and need specific right route. Of course the choice of medication administration is depend on several factor including the client's blood level, ability to swallow and disease or disorder being treated.

However there is the seven rights when administering medication to the patient. They include five rights of drug administration and two of patient's bill of rights.

These seven rights of medication administration are:

Right client / patient: should be done by asking the client to state his name and checking the identification band.
Right route: medications should be given as physician's prescribed route of administration.
Right drug: the name of the drug as well as the generic name ordered by physician should be checked promptly. The nurse should investigate when the patient's diagnosis does not match the drug category.
Right amount: The nurse is expected to know common dosages for both adults and children.
Right time: the nurse can administer the medication either 30 minutes before or after the assigned time.
Right documentation (as the Patient's Bill of Rights and legality issues in nursing): it mus be done to prevent duplicating drug administration,
Right to refuse treatment (as the Patient's Bill of Rights): the patient / client has the right to refuse medication or treatment physician ordered.

NCLEX-CGFNS: Magnetic Resonance Imaging

2009-03-30T09:47:00.002+03:00

Magnetic Resonance Imaging

Magnetic resonance imaging provides cross-sectional images of brain tissue. It is more detailed than a CT scan
The procedure is contraindicated to pregnant women, obesity (more than 300 lbs), claustrophobic patients, patients with metal implants (pacemaker, hip replacements and jewelries)

NCLEX-CGFNS: Mantoux Test

2009-03-30T09:43:00.002+03:00

Mantoux Test

Mantoux test is done to determine the exposure to mycobacterium tuberculosis
Positive reaction means there is an exposure to the TB bacilli
Positive test: induration of 10 mm or more for foreign-born patient and children under 4 years old, and induration of 5 mm or more if the patient is HIV (+), with healed TB and if patient has had contact with a patient with active TB
BCG vaccine may cause false positive reaction
Assess the patient for previous history of TB and report it to the physician

NCLEX-CGFNS: Mammography

2009-03-30T09:38:00.002+03:00

Mammography

Mammography procedure detects the presence of breast tumor
Instruct patient not to use deodorant, talcum powder, lotion, perfume and any ointment on the day of the exam since they contain calcium oxalate which may crystallize and may give a false positive result
Inform the patient that the breast will be placed between two x-ray plates
The procedure is best done a week after menstruation
During the procedure, the patient will be positioned on lying down with pillow under the shoulder of the breast being examined

NCLEX-CGFNS: Lung Scan

2009-03-30T09:35:00.003+03:00

Lung Scan

Lung scan determines lung perfusion when pulmonary emboli and infarction are suspected
It needs consent
Assess patient for allergy to dye, iodine and sea-foods
Remove jewelry from the chest area if any
Sedative is given as prescribed
The procedure involves injection of radioactive isotope into the body
Nurse should wear gloves within 24 hour after the procedure when urine is being discarded

NCLEX-CGFNS: Lumbar Puncture

2009-03-28T22:32:00.003+03:00

Lumbar Puncture

Lumbar puncture is a procedure to withdraw CSF and it is used to determine the abnormalities of CSF
Empty bladder and bowel before the procedure
Place patient on C-position
During the procedure, the needle is inserted between L3-L4 or L4-L5
After the procedure, increase fluid intake and place the patient on flat position to prevent spinal headache

NCLEX-CGFNS: Liver Biopsy

2009-03-28T22:28:00.002+03:00

Liver Biopsy

This diagnostic procedure is mainly done to rule out liver disorder
Bleeding is a common complication, so obtain the result of hemostatis tests before procedure
Patient is positioned on the left side or supine during biopsy
To stabilize the position of the liver and to prevent accidental puncture to the diaphragm, instruct patient to inhale, exhale and hold breath during needle insertion
Patient is positioned on the right side after biopsy for two hours to prevent hemorrhage
Encourage patient to bedrest for 24 hours after biopsy

NCLEX-CGFNS: Laparoscopy

2009-03-28T22:23:00.002+03:00

Laparascopy

Laparoscopy is done to evaluate the pelvic pain and infertility and treat endometriosis lesions
Patient should NPO before the procedure
Enema is administered prior to procedure
Patient will have shoulder and abdominal discomfort after the procedure since the use of carbon dioxide

NCLEX-CGFNS: IVP (Intravenous Pyelography)

2009-03-28T22:18:00.002+03:00

IVP (Intravenous Pyelography)

This diagnostic test is used to visualize the urinary tract
It needs consent from patient
Patient should NPO for 8-10 hours before the procedure
Administer laxative to clear bowels before the procedure
The procedure requires the use of iodine base dye
Assess patient if has an allergy to iodine, seafoods or shellfish before the procedure
Epinephrine should be kept at the bedside to counteract possible allergic reaction
Inform patient that salty taste may be experienced during procedure
Encourage patient to increase fluid intake after procedure to facilitate excretion of the dye

NCLEX-CGFNS: Incentive Spirometry

2009-03-28T22:17:00.002+03:00

Incentive Spirometry

It is mainly used in the prevention and treatment of atelectasis
Patient should be kept in semi-fowler's position
Patient should take deep breath slowly and easily from the mouthpiece

NCLEX-CGFNS: Hysterosalpingography

2009-03-20T22:36:00.002+03:00

Hysterosalpingography

Hysterosalpingography determines the patency of fallopian tube
It also detects pathology in the uterine cavity
It is done by x-ray examination and administration of a radiopaque dye into the uterine cavity

NCLEX-CGFNS: Guthrie Capillary Blood Test

2009-03-20T22:33:00.003+03:00

Guthrie Capillary Blood Test

It is a screening test for phenylketonuria
Normal level of phenylketonuria is 2 mg/dl
Patient should take a high protein diet 24-48 hour before the test

NCLEX-CGFNS: Glucose Tolerance Test

2009-03-20T22:29:00.003+03:00

Glucose Tolerance Test

Glucose tolerance test is done to confirm the presence of sugar in the blood
Procedure: patient take high carbohydrate diet 24-48 hours before the procedure is done.
Blood is drawn after an overnight fast

NCLEX-CGFNS: Gastric Analysis

2009-03-20T22:24:00.004+03:00

Gastric Analysis

This procedure is done to assess ulcers or to rule out pernicious anemia
It also used to analyze acidity, appearance and volume of gastric secretions
Gastric samples should be refrigerated if not tested within four hours
HCL is normal in gastric ulcer and will be elevated in duodenal ulcer

NCLEX-CGFNS: Fetal Heart Monitoring

2009-03-20T22:17:00.003+03:00

Fetal Heart Monitoring

Fetal heart monitoring is done to assess fetal heart rate abnormalities. There are there types of result:

Early Decelerations

It indicates fetal head compression
Mirror image is reflected on monitor
No specific treatment is required

Late decelerations

It indicates placental insufficiency
Reverse mirror image is reflected on monitor
Patient needs oxygen administration

Variable decelerations

It indicates cord compression
U or W shape image is seen on monitor
Nursing interventions: change the patient position to left lateral recumbent and administer oxygen

NCLEX-CGFNS: Endoscopy (Gastroscopy, Esophagoscopy)

2009-01-15T07:04:00.003+03:00

NCLEX-CGFNS: Endoscopy (Gastroscopy, Esophagoscopy)

This procedure is done to assess the esophagus and the stomach by inserting a tube into them
It needs an informed consent
Remove patient’s denture if any
Patient should be in NPO 6-8 hours before the procedure of endoscopy and resume feeding after gag reflex returns

NCLEX-CGFNS: Endoscopic Retrograde Cholangio Pancreatography (ERCP)

2009-01-15T07:01:00.001+03:00

NCLEX-CGFNS: Endoscopic Retrograde Cholangio Pancreatography (ERCP)

It provides radiographic visualization of the bile and pancreatic ducts
It is used to diagnose problems in the liver, gallbladder, bile ducts, and pancreas
It is contraindicated in pancreatitis
Patient should be kept in NPO before and after the procedure
Keep narcan at the bedside
There might be hoarse and sore throat several days after the procedure

NCLEX-CGFNS: Electromyography – EMG

2008-12-29T15:06:00.002+03:00

Electromyography – EMG

This test used to monitor the electrical activity of muscles
It needs informed consent
Inform the patient to avoid any stimulant and sedative before the procedure
Patient is positioned depends on the muscle being tested
Ask the patient to contract the muscle slowly and progressively
Inform the patient that a needle will be inserted into the muscle

NCLEX-CGFNS: Electroencephalogram – EEG

2008-12-29T14:18:00.002+03:00

Electroencephalogram – EEG

Electroencephalogram records the electrical activity of the brain as well as detects intracranial hemorrhage and tumors
Clean patient’s hair using shampoo before and after the procedure
If the electrode gel is not removed by shampooing, use acetone
Avoid caffeine containing foods and mind altering substances before the test
Withhold stimulants, antidepressants, tranquilizers and anticonvulsants for 24-48 hours prior to the test

NCLEX-CGFNS: Electrocardiogram – ECG

2008-12-29T14:12:00.002+03:00

Electrocardiogram – ECG

Electrocardiogram records electrical waves of the heart
Let the patient to lie still, breath normally and refrain from talking during the procedure
ST segment elevation or T wave inversion indicates Myocardial Infarction

NCLEX-CGFNS: Cystoscopy

2008-12-28T00:07:00.002+03:00

CYSTOSCOPY

Cystoscopy is an Endoscopy of the urinary bladder via the urethra
It is implemented to inspect bladder and urethra
The procedure needs informed consent
Patient should be in NPO status if general anesthesia is used, and liquid diet if local anesthesia is used
Force fluids as prescribed after procedure
Administer sitz bath for abdominal pain
Pink-tinged or tea-colored urine is expected
If bright red urine or clots occur, notify the doctor

NCLEX-CGFNS: CVP (Central Venous Pressure Monitoring)

2008-12-27T23:50:00.002+03:00

Central Venous Pressure Monitoring

Central Venous Pressure (CVP) is the pressure of blood in the thoracic vena cava, near the right atrium of the hear
The purpose of central venous pressure monitoring is to provides an indication of pressure in the right atrium
The zero level of manometer should be placed at the level of the right atrium at the 4th intercostals space
Teach patient to avoid coughing and straining since it increases the readings
Normal CVP : 2-12 mmHg. when the tube is at the superior vena cava

NCLEX-CGFNS: CT Scan

2008-12-27T23:32:00.002+03:00

CT SCAN

CT Scan is implemented to provides photograph of tissue densities with the use of radiation
Keep the patient NPO for 4 hours before the procedure and check for allergies (if a dye is used)
CT Scan has contraindications to pregnant women, obesity (more than 300 lbs), claustrophobic patients, patient with allergy to dye, and patient with unstable vital signs

NCLEX-CGFNS: Cranial Nerve Assessment

2008-12-16T18:02:00.003+03:00

CRANIAL NERVE ASSESSMENT

Cranial nerve assessment is performed to determine abnormalities in brain stem activity
It usually performed by the physician or advance practice nurse

Here is the list of cranial nerves:

NCLEX-CGFNS: Coombs Test

2008-12-16T17:59:00.002+03:00

COOMBS TEST

There are two types of coombs test: direct coombs test and indirect coombs test
Direct coombs test is used to test antibodies on patient's erythrocytes. A positive test indicates erythroblastosis fetalis
Direct coombs test is helpful in evaluating transfusion reactions
Indirect coombs test is used to test antibodies on patient's serum

NCLEX-CGFNS: Contraction Stress Test

2008-12-16T17:53:00.003+03:00

CONTRACTION STRESS TEST
(OXYTOCIN CHALLENGE TEST)

Contraction stress test is done to detect uteroplacental insufficiency and risk of pregnancies
Negative result: NORMAL, means there is no abnormal fetal heart rate decelerations with all contractions
Positive result: ABNORMAL, means there is abnormal fetal heart rate decelerations will all contractions
Deceleration is slowing of fetal heart rate below 120 bpm

NCLEX-CGFNS: Colonoscopy

2008-12-16T17:47:00.003+03:00

COLONOSCOPY

Colonoscopy is done to get visualization of the large intestines
It needs an informed consent
Clear liquid diet for 48 hours prior to the test
Laxative is given on the evening before the test and an enema before the test
Resume normal diet after procedure

NCLEX-CGFNS: Chorionic Villi Sampling

2008-11-28T23:37:00.002+03:00

CHORIONIC VILLI SAMPLING

Chorionic villi sampling is done to determine some genetic aberrations
Risk of the procedure: spontaneous abortions, infection, hematoma, and intrauterine death
Instruct patient to drink water to fill the bladder to aid in the attainment of the desired position of the uterus

NCLEX-CGFNS: Cholecystogram

2008-11-28T23:31:00.002+03:00

CHOLECYSTOGRAM

Cholecystogram is done to assess the gallstones
Check patient for allergy to iodine, seafoods or shellfish before procedure because the procedure requires the use of iodine based dye
Epinephrine should be available at the bed side to treat possible allergic reaction
Patient should be NPO after midnight and maintain low fat diet
Tell to the patient that dysuria is common since the dye is excreted in the urine

NCLEX-CGFNS: Cholangiogram

2008-11-28T23:20:00.002+03:00

CHOLANGIOGRAM

Cholangiogram is done to get visualization of the bile ducts
Check patient for allergy to iodine, seafoods or shellfish before procedure because the procedure requires the use of iodine based dye
Epinephrine should be available at the bed side to treat possible allergic reaction

NCLEX-CGFNS: Urinary Catheterization

2008-11-28T01:28:00.003+03:00

URINARY CATHETERIZATION

Urinary catheterization will determine residual urine and obtain sterile specimen
Urinary catheterization procedure is sterile and should maintain a close system
The drainage bag should be kept below the bladder
Male patient: tape the catheter on the lower abdoment to prevent pressure at the penoscrotal junction
Female patient: tape the catheter at the inner thigh

NCLEX-CGFNS: Cardiac Catheterization

2008-11-28T01:22:00.003+03:00

CARDIAC CATHETERIZATION

Cardiac catheterization is done to measure oxygen concentration, saturation, tension, and pressure in various chambers of the heart.
It is also done to determine the need of cardiac surgery
This procedure needs informed consent
Assess patient for allergy
Keep patient NPO for 6 hours before procedure
After procedure: monitor peripheral and apical pulses every 15 minutes for 2-4 hours, check puncture site for bleeding, and keep 20 lbs sandbag at the bed side to apply pressure in case bleeding occurs
Keep extremity extended for 4-6 hours
The physician should be notified if the patient complains of numbness, tingling, cool extremity, pale, cyanotic, or if there is sudden loss of peripheral pulses

NCLEX-CGFNS: Caloric Stimulation Test

2008-11-28T01:14:00.003+03:00

CALORIC STIMULATION TEST

Caloric stimulation test is done to detect disorder of the inner ear like meniere's disease. Alternating warm and cold water will be used.
Instillation of warm water produces horizontal nystagmus toward the irrigated ear if the 8th cranial nerve is normal.
Instillation of cold water will produce horizontal nystagmus away from the side of the irrigated ear if the brainstem is intact
Severe nystagmus indicates normal inner ear
Moderate nystagmus indicates Meniere's disease
No nystagmus indicates acoustic neuroma

NCLEX-CGFNS: Brain Scan and Bronchoscopy

2008-11-28T01:05:00.004+03:00

BRAIN SCAN

Brain scan is done to detects neoplasms, brain abscess, and subdural hematoma
It needs an informed consent
After procedure: increase oral fluid intake

BRONCHOSCOPY

Bronchoscopy is the examination done for visualization of bronchial tree
It needs an informed consent
Keep patient NPO before and after procedure
Keep patient in semi-fowler position after procedure
Prepare suction equipment at the bedside
Notify the physician if fever or difficulty in breathing occurs after the procedure

NCLEX-CGFNS: Blood Coagulation Test

2008-11-28T00:47:00.003+03:00

BLOOD COAGULATION TEST

Blood coagulation test can determine the presence of bleeding disorders
Normal Partial Thromboplastin Time (PTT): 60-70 seconds. The critical level is 175 seconds.
Normal Prothrombin Time (PT): 11-12 seconds. The critical level is 24 seconds
Clotting Time: 9 minutes, critical level is 12 minutes
Patient with heparin therapy: monitor partial thromboplastin time (PTT)
Patient with coumadin therapy: monitor prothrombin time (PT)
Patient with Von Willebrands Disease: monitor clotting time

NCLEX-CGFNS: Barium Enema & Barium Swallow

2008-11-23T11:19:00.003+03:00

BARIUM ENEMA

This diagnostic procedure is done to assess of large colon.
Liquid diet is given before procedure
Laxative is given before procedure to promotes visualization
Laxative also given after procedure to prevent constipation
If the bowel movement is absent in two days, report to the physician.

BARIUM SWALLOW

Barium swallow procedure is done to visualize esophagus and stomach
Instruct patient to keep NPO 6-8 hours before the procedure
Laxative is administered after the procedure to prevent constipation
Encourage patient to increase fluid intake for at least two days after the procedure to help pass the barium

NCLEX-CGFNS: Lochia Assessment

2008-11-15T09:39:00.003+03:00

ASSESSMENT OF LOCHIA

The normal color of lochia are:

Lochia Rubra (reddish) : 1-3 days postpartum.
Lochia Serosa (brownish): 4-10 days postpartum.
Lochia Alba (whitesh): 10-14 days postpartum, or no longer than 3-6 weeks.

NCLEX-CGFNS: Arterial Blood Gas Analysis & Arteriography

2008-11-15T09:24:00.003+03:00

ARTERIAL BLOOD GAS ANALYSIS

Arterial Blood Gas (ABG) Analysis is done to detect the presence of acid-base imbalance or to monitor patient's response to oxygen therapy.
Avoid suctioning prior to drawing of blood specimen.
Assess bleeding or hematoma formation from the puncture site.
Apply firm pressure 5-10 minutes to the puncture site.
Patient with diarrhea: metabolic acidosis.
Patient with vomiting: metabolic alkalosis.

ARTERIOGRAPHY

Arteriography is used to detect suspected congenital anomalies as an evaluation tool before coronary artery surgery.
Assess patient for allergy of iodine, sea foods or shellfish.
Keep epinephrine at the bedside to counteract passible allergic reaction.
Encourage patient to increase fluid intake after the procedure to promote excretion of the dye.

NCLEX-CGFNS: Apgar Score

2008-11-14T07:13:00.005+03:00

APGAR SCORE

Five criteria of APGAR score: Appearance, Pulse, Grimace, Activity, and Respiration.
It is scored two times: at 1 and 5 minutes after birth.
The first apgar score detects cardiorespiratory-nervous functioning, the second apgar score is used for planning nursing care.
Interpretation of score:
0-3 is POOR, needs resuscitation.
4-6 is FAIR, needs suctioning and oxygenation.
7-10 is GOOD, needs only admission care.

NCLEX-CGFNS: Alfa-Fetoprotein Level & Amniocentesis

2008-11-14T07:02:00.004+03:00

ALPHA-FETOPROTEIN LEVEL

Alfa-fetoprotein level assesses the presence of neural tube defects and down's syndrome.
Neural tube defects: elevated alpha-fetoprotein level.
Down's syndrome: decreased alpha-fetoprotein level.

AMNIOCENTESIS

Amniocentesis assesses fetal growth and maturity, determines genetic disorders and sex of the fetus.
In 14-16 weeks of gestation: it is done to assess chromosomal aberration or other disorder.
After 35 weeks of gestation: it is done to assess fetal lung maturity.
Patient should be instructed to void before procedure if gestation is greater than 20 weeks.
Position patient on supine
L/S ratio 2:1 indicates fetal lung maturity.
Complication of procedure: placental, cord, and bladder rupture.
Encourage patient to report: fetal hyperactivity or hypoactivity, vaginal bleeding, chills, fever, fluid leakage, and vaginal discharge.

NCLEX-CGFNS: Abdominal Assessment

2008-11-14T06:59:00.002+03:00

ABDOMINAL ASSESSMENT

It is practiced to detect abnormalities in the abdominal area like mass and abdominal bowel sounds.
Place the patient in supine position.
Do it in this order: inspection, auscultation, percussion, and palpation.
Palpation is done last because of disrupt bowel rhythm and may rise abdominal sounds.
Palpation is contraindicated in patients with wilm's tumor and abdominal aortic aneurysm.

NCLEX-CGFNS: Triage

2008-11-07T23:57:00.002+03:00

Triage is a system of patient evaluation to establish priorities and assign appropriate treatment or personal. The process of prioritizing patients is based on the severity of their condition so as to treat as many as possible when resources are insufficient for all to be treated immediately.

Here are the essential principles on triage:

Intervention must benefit the largest number.
In major disaster: patients requiring minimal care to save their lives are treated first.
In emergency situations: the greatest risk receives priority.
Use the essential concepts of ABC: Airway, Breathing, and Circulation.
In case of Fire, use essential concepts of "RACE": Rescue, Alarm, Confine the fire, and Evacuation.

NCLEX-CGFNS: Delegation

2008-11-07T23:40:00.002+03:00

In real work situation, when the staffs are shortage, a registered nurse should delegates some intervention to an unlicensed assistive personel and/or nurse aid.

Just remember the concepts that:
DO NOT DELEGATE assessment, teaching and evaluation.

A registered nurse can delegate: feeding patient, taking vital signs, hygiene care, and stable patients.

There are five rights of delegation:

Right task
Right circumstances
Right person
Right communication
Right supervision

NCLEX-CGFNS: Diseases With X-Linked Recessive

2008-11-06T23:35:00.002+03:00

Just simply remember that the following diseases are diseases with x-linked recessive:

Color blindness
Duchenne muscular dystrophy
G6PD deficiency
Hemophilia

NCLEX-CGFNS: Advance Directive

2008-11-06T23:26:00.002+03:00

Advance directive is a document made by an individual before becoming ill. There are two types of advance directive: living wills and durable power of attorney for health care (DPAHC).

Living Wills:

It is a direction that no life-sustaining treatment is to be administered.
It takes effect only when the patient is terminally ill.

Durable Power of Attorney for Health Care (DPAHC)

It is more broad than a living will.
It appoints a proxy to decide on behalf of the patient.
It takes effect only when patient has lost decision-making capacity.

NCLEX-CGFNS: Diseases and Unique Manifestations

2008-11-05T23:39:00.003+03:00

Diabetic Ketoacidosis
Kussmaul's breathing: deep rapid breathing

Duchene's Muscular Dystrophy
Gower Sign: use of hands to push one's self from the floor.

GERD (Gastroesophageal reflux disease)
Barretts Esophagus: erosion of the lower portion of the esophageal mucose.

Hepatic Encephalopathy
Flapping tremors

Hydrocephalus
Bossing sign: prominent forehead.

Intussusception
Dance sign: empty portion of the lower right intestines.

Meningitis

Kernig sign: inability to extend the legs.
Brudzinki sign: flexion of the neck causes flexion of the lower extremities.

Parkinson disease
Pill-rolling tremors

Phempigus vulgaris
Nikolsky's sign: separation of epidermis caused by rubbing the skin.

Retinal detachment
Visual floaters

Retino blastoma
Cat eye reflex (grayish discoloration of the pupil.

NCLEX-CGFNS: Cultural Diversity

2008-11-04T06:52:00.003+03:00

When nurse gives care to patient, there are cultural specifics that must be considered. There are nursing cares failed to be implemented not because of incompetent nurse but simply because of culture diversity that not be considered.

Here are the simplest guidelines to understand cultural diversity when caring patient. We can simply say A-B-C-D principles of cultural diversity:

A: Administration of medications that must take into consideration of patient's beliefs and practices.

Muslim patients will fast during ramadhan month.
Catholics usually will fast on Ash Wednesday and Good Friday except for sick patients.
Jehovah's witnesses-medications are acceptable to the extent necessary.

B: Be familiar with some diseases which are common in specific race

African: sickle cell anemia and hypertension
Asian: osteoporosis
Blacks: cervical cancer (female) and prostate cancer (male)
Jewish: breast cancer
Whites: testicular cancer.

C: Communicate properly with specific race patients.

Asians: rarely communicate their need for pain killer since they were taught self-restraint (stoicism)
Hispanic women: It is impolite to discuss reproductive organs with male relatives or health care provider.
Muslim women: prefer to talk to female doctors.

D: Dietary modification for specific race

Chinese: cold dessert ("YIN") are served after surgery
Europeans: main meal is served by midday and is usually followed by coffee.
Jewish: Kosher diet, no meat and dairy products at the same time.
Muslim: Halal diet (no pork)

NCLEX-CGFNS: Patient's Right

2008-11-04T06:32:00.002+03:00

So many patient’s right if I have to mention all of them. But just remember that here are the most common patient's rights comes in real NCLEX-CGFNS exams:

Confidentiality of medical records.
Freedom from restraints and seclusion.
Treatment in the least restrictive alternative.
Give or refuse consent to treatment.
Access personal belongings.
Having visitors.
Daily exercises
Use of writing materials and uncensored mail.
Use of telephone.
Be informed of rights.
Access courts and attorneys.
Refuse electro convulsive therapy (ECT).

NCLEX-CGFNS: Safety Precautions

2008-11-01T02:56:00.002+03:00

Don not miss this concepts. Some question in relation with safety precaution may be come on real exam. Prepare it and remember this concepts.

Infants:

Choking
Aspiration

Toddlers:

Falls
Poisoning

Pre-school Age:

Motor vehicle accident
Drowning

School Age:

Motor vehicle accident

NCLEX-CGFNS: Therapeutic Doses

2008-11-01T02:46:00.002+03:00

Some questions on real NCLEX-CGFNS exams will test nurse knowledge in relation with drugs. Drug doses will be ordered by doctor while nurse will administer the drug as prescribed. One of nurse responsibility is to monitor the response patient in relation the effectiveness of the drugs given to patient.

Accordance to the assessment of the drug effectiveness, nurse should has knowledge about the therapeutic doses in specific drugs. Here are the most common drugs with therapeutic doses come in real exams.

Compazine (prochlorperazine)
7.5 – 15 mg/dl

Digoxin (Lanoxin)
0.5 – 2 mg

Lithium
Acute dose: 0.5 – 1.5 mEq
Maintenance dose: 0.5 – 1.2 mEq
For elderly patients, serum level should not exceed: 1.0 mEq/L

Magnesium sulfate
1.5 – 3.0 mEq/L

Mellaril (Thioridazine)
Maximum daily doses is 800 mg

Theo-Dur (Theophylline)
10 – 20 ug/ml

NCLEX-CGFNS: Isolation Precautions

2008-11-01T02:29:00.003+03:00

Isolation precautions are used to isolate the infections NOT patients. Isolation is selected based on the mode of transmission and pathogenesis of infection. Some question on NCLEX-CGFNS deal with isolation precautions.

STRICT ISOLATION

It is practiced for highly transmissible diseases by direct contact and airborne routes.
It requires: private room, gown, mask, glove, hand washing, and double bagged for soiled articles.
Diseases: Diptheria-pharyngeal, herpes zoster, pneumonia, varicella.

RESPIRATORY ISOLATION

It is practiced for droplet transmission.
It requires: private room, mask, hand washing, and labeled plastic bags for soiled articles.
Patient with same organism may share room.
Diseases: H. influenza, measles, mumps, N. meningitis.

TUBERCULOSIS / AFB ISOLATION

It is practiced for suspected or active tuberculosis.
It requires: mask, hand washing, and private room with negative pressure (room air vented to outside).
Disease: Tuberculosis

CONTACT ISOLATION

It is practiced for infectious diseases or multiple resistant micro organism that are spread by close or direct contact.
It requires: private room, mask, gown, and glove.
Diseases: Diptheria-cutaneous, herpes simplex, MRSA, pediculosis, scabies, syphilis.

ENTERIC PRECAUTION

It is practiced for infectious diseases that transmitted through direct or indirect contact with infected feces.
It requires: private room, hand washing, gloves, and gowns.
Gowns are worn only when contact any object contaminated with feces.
Diseases: Aseptic meningitis, diarrhea, gastroenteritis, hepatitis A, typhoid fever.

DRAINAGE / SECRETION PRECAUTION

It is practiced for patient with wound drainage (infected wound).
It requires: gloves and gowns.
Disease: Burns

UNIVERSAL BLOOD AND BODY FLUID PRECAUTION

It is practiced when possibly contact with blood-borne and body fluids pathogens (blood, semen, vaginal secretion, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, CSF, and tissue.
It requires: gloves, masks, protective eye gears, and gowns.
Used / contaminated needle should never recapped.
Used needles and other sharp items are kept in a puncture resistant container (sharp box container).
Diseases: AIDS, hepatitis B, hepatitis C.

NCLEX-CGFNS: Care With Tubes

2008-10-26T11:21:00.005+03:00

There is a specific care for patient with specific tube. Some real questions of NCLEX-CGFNS exams were found asking the principles in providing nursing care to patients with tubes.

Let's review most commonly tube that questioned on NCLEX-CGFNS exam.

BROVIAC CATHETER
It a single lumen usually used for patient with small central vessel (children and elderly).

CANTOR TUBE

It is used for intestinal drainage.
The balloon is injected with 4-5 ml of mercury before insertion of the tube.

CHEST TUBE

It is used to allow air and fluid drain from the pleural space.
Fluid fluctuation in the water seal chamber will stop when the lungs has reexpanded.
Sterile water should be used in the water seal chamber.
Keep two hemostats at bedside to clamp chest tube if the system becomes disconnected or broken.

GROSHONG CATHETER

It is a double lumen catheter used for long term central venous access and infusion fluid (antibiotics, total parenteral nutrition, blood or chemotherapy)
The catheter should be checked periodically for kinks and leakage.
Saline solution can be used for flushing to clear the full length of catheter.

HEMOVAC

It is used to maintain constant drainage from wound and to prevent pressure on skin flaps.
The tubing is milked away from the patient every 1-2 hours for the first 24 hours posoperatively and then 4 hours and as needed.

HICKMAN CATHETER
It is triple lumen as same purpose as Groshong catheter.

JACKSON-PRATT DRAIN

It is used for wound drainage.
The negative suction should be maintained by compressing the reservoir before attaching it to the tubing.

LEVINE TUBE

It is a single lumen used to remove air and fluid from stomach.
Frequent irrigation is required.

MILLER-ABOTT TUBE

It is a double lumen tube used for intestinal drainage and irrigation.
One lumen is connected to the balloon and filled with mercury after insertion, other lumen is opened for drainage and irrigation.

SALEM-SUMP TUBE

It a double lumen tube used for suctioning gastric contents.
One lumen is used for air entry that keeps the gastric lining from occluding the drainage hole.
Frequent irrigation is required.

SENGSTAKEN-BLAKEMORE TUBE

It used to stop bleeding from esophageal varicose by applying pressure.
The esophageal balloon can be left inflated for up to 48 hours without tissue damage.
Keep a pair of scissors at bedside.

THREE-WAY FOLEY CATHETER

It is used to drain bladder.
Keep strict asepsis when inserting and assembling the drainage equipment.
It is changed when obstructed by sediments.

NCLEX-CGFNS: Obstetric - Contraceptives

2008-10-25T15:11:00.003+03:00

ORAL CONTRACEPTIVES

It an effective and reversible method, and can be used for emergency contraception after unprotected sex.
It should be taken daily.
It can protect against certain cancers and anemia.
It is not recommended for breastfeeding women because it can reduce milk supply
Side effects: missed periods, upset stomach, and irregular vaginal bleeding.

DMPA (Depo Medroxy Progesterone Acetate)

It is an effective and safe method
It can changes in vaginal bleeding and weight gain.
It does not prevent STD's
Does not contain estrogen
Injection is done every 3 months.

NORPLANT

The capsules are placed under the skin of a women's upper arm.
It is effective within 24 hours after insertion and can prevent pregnancy for at least 5 years.
Side Effects: changes in menstrual bleeding, headache, heat tenderness, acne, weight gain, hair loss, and more hair growth on the face.

TUBAL LIGATION

It is a permanent and effective method, help protect from ovarian cancer, but reversal surgery is difficult.
Patient should be prepared for minilaparotomy or laparoscopy. Before procedure: NPO for 8 hours and no medications. After procedure: rest for 2-3 days, avoid heavy lifting for 1 week, avoid sex for at least 1 week, and take paracetamol.
Nurse should report if any signs and symptoms: high fever in the first 4 weeks, pain, pus, abdominal pain, diarrhea, fainting, and dizziness.

VASECTOMY

It is a permanent method with no effect on sexual performance.
It will be fully effective only after 20 ejaculations or 3 months.
Common complications are pain in the scrotum, swelling, bruising, brief feeling of faintness after procedure.

CONDOMS

It can prevent pregnancy and STD including HIV/AIDS.
It comes in different size, shape, colors, and textures.
Contraindication for those who have Latex allergy (redness, itching, swelling)

IUDS

It a small flexible plastic frame inserted into uterus through vagina.
It can be removed by pulling gently on the strings with forceps.
Side effects: menstrual changes (longer, heavier menstrual periods, bleeding and spotting, cramps or pain during periods).
Check the IUD once a week during the first month after insertion and after each menstrual period.
Return for visit 3-6 weeks after insertion.

VAGINAL METHODS

Vaginal methods: spermicide, diaphragm, cervical cap)
These methods can protect against some STD's.
Women can fully control and use it when needed.
Spermicide is inserted one hour before sex, placed high in vagina.
Foaming tablets, films, and suppositories are inserted at least 10 minutes before sex and do not douche for at least 6 hours after sex.
Diaphragm or cervical cap is inserted ahead of time when before sex and leave them in place and do not douche for at least 6 hours.

FERTILITY BASED METHODS

There are four conditions to control with this methods: cervical secretion, basal body temperature, calendar or rhythm, both of cervical secretion and basal body temperature.
Cervical Secretion: Avoid unprotected sex from the first time day of any cervical secretions or feelings of vaginal wetness until the fourth day after the peak day of slippery secretion.
Basal Body Temperature (BBT): Avoid unprotected sex from the first day of menstrual bleeding until body temperature has risen and stayed up to for 3 full days.
Calendar of Rhythm: Avoid unprotected sex between the first and last days of the estimated fertile time.
Cervical Secretion and BBT: Avoid unprotected sex from the first day of cervical secretion until both the 4th day after the peak of slippery secretion ad the 3rd full day after the rise in body temperature.

LACTATION AMENORRHEA METHOD

This is a temporary method base on breastfeeding. It can be use only when the women breastfeed often both day and night, menstruation have not returned, and baby is less than 6 months.
Mother breastfeeds at least 8-10 times a day and at least once at night.

NCLEX-CGFNS: Obstetric - Basic Concepts

2008-10-25T14:52:00.004+03:00

There are basic concepts in obstetrics that nurse should learn as preparation for NCLEX-CGFNS exams. Some questions in real NCLEX or CGFNS exams are based on this concepts. The concepts are contained in the acronym:

O-B-S-T-E-T-R-I-C-S

O: oxytocin is used to induce uterine contractions

B: bleeding disorder: placenta previa causes painless bright red vaginal bleeding while abruption placenta causes painful dark red vaginal bleeding

S: substance abuse during pregnancy: fetal alcohol syndrome (small for gestational age) and reslessnes in infants born of cocain-addicted mothers.

T: teratogen agents should be avoided such as: accutan, alcohol, MMR, OPV, cigarettes, etc)

E: Exercises:

Squatting: to stretches the perineal muscles
Abdominal muscle contractions: to help strengthen the abdominal muscles.
Pelvic floor contraction (Kegel's exercises): to help prevent stress incontinence.
Pelvic rocking: to helps relieve backache.

T: true labor must be differentiated from false labor in which in true labor the progressive cervical changes are occurred.

R: ritodrine is used to prevent preterm labor.

I: infections like TORCH (Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, and Herpes) can cause abortions, malformation, and fetal death.

C: contraction of client should be assessed.

Duration of contraction: the time from the beginning to the end of the same contraction.
Frequency of contraction: the time from the beginning of the first contraction to the beginning of the next contraction.
Interval of contraction: the time from the end of the first contraction to the beginning of the next contraction.

S: stage of labor:

First Stage: from the onset of true labor contractions to the complete dilatation of cervix.
Second Stage: from the complete dilatation of the cervix to the delivery of the baby.
Third Stage: from the delivery of the baby to the delivery of the placenta.
Fourth Stage: first few hours after delivery

NCLEX-CGFNS: Psychiatric Nursing Key Points

2008-10-21T00:09:00.003+03:00

Basic concepts of psychiatric nursing, just remember: B-E-H-A-V-E

B: be consistent with client, especially client with personality disorders, manic, paranoid, autistic and Alzheimer disease.

E: encourage verbalization of client feeling. Do not forget to ask : tell me more…."

H: have a sound knowledge of cultural variations related to behavior.

A: acknowledge the patient's feeling.

V: voluntarily and involuntarily admitted patient do not lose their right to five informed consent.

E: empathize with your patient

Concepts in Psychosocial Interventions:

Gestalt Therapy:
The therapy focuses on enhancement of self awareness. It can be implemented for patients who are victims of family violence.

Cognitive Therapy:
The therapy focuses on changing distorted thought processes. It can be implemented for depressed patients.

Crisis Intervention:
Crisis intervention is a short term therapy that intends to address the present problems of the patient in order to reestablish a level of functioning equal or better than pre-crisis level.

Play Therapy:
Play therapy focuses on the use of play to facilitate expression of the patient's feeling.

Rational Emotive Therapy:
It focuses on risk taking and on assuming responsibility for one's behavior.

NCLEX-CGFNS: TRACTIONS

2008-10-20T23:45:00.005+03:00

There are many essential concepts of tractions. Here are the essential guidelines to be remembered:

T : trapeze bar over head is used to raise and lower the upper body
R : requires free hanging weights
A : analgesic to relieve pain
C : check circulation
T : temperature monitoring
I : infection prevention
O : output and intake monitoring
N : nutrition in appropriate diet
S : skin check frequently

Here are the tractions most questioned on exams:

BRYANT'S TRACTION
It is used to reduce femoral fracture in children. The buttocks are slightly elevated and clear off the bed. Position is on flat.

BUCK'S TRACTION
It is used to reduce femoral fracture in children. Nurse should periodically assess skin status. Skin should be clean and dry. Position is on flat or trendelenburg.

CRUTCHFIELD TONG
It is used to immobilize the cervical spine. The X-ray may be taken to verify the placement. Encourage to massage occiput.

DUNLOP'S TRACTION
Dunlop's traction includes horizontal and vertical tractions. Horizontal traction is used to align fracture of the humerus. Vertical traction is used to maintain proper alignment of forearm. Nurse should assess for skin breakdown and signs of circulatory impairment and nerve damage, and make sure that the weight is hanged freely.

HALO VEST It is used to immobilize the cervical spine. When caring client with halo vest the nurse should:
- avoid putting powder inside the vest
- turn the client as a unit (do not use the halo vest to lift the client)
- assess for signs of shoulder stress or pressure ulcer

PELVIC TRACTION
It is used to relieve back pain. The client is position in which the head of the bed is slightly elevated.

RUSSELL'S TRACTION
It is used to immobilize the hip or knees or to reduce fracture. The heel of the client should be off the bed.

NCLEX-CGFNS: Diseases and Initial Manifestations

2008-10-19T22:40:00.002+03:00

Acromegaly: coarsening of facial features
Acute glomerulonephritis: edema
Acute lympocytic leukemia: anemia
Acute respiratory distress syndrome: rapid shallow breathing
Alzeimer's disease: progressive memory loss
Anemia – iron deficiency: fatigue
Anemia – pernicious: fatigue
Anemia – sickle cell: growth retardation
Angina pectoris: chest pain
Arthritis rheumatoid: morning stiffness
Autonomic dysreflexia: hypertension
Benign prostatic hypertrophy: reduction in size and force of urinary stream
Bronchogenic carcinoma: changing cough
Cancer – bladder: painless hematuria
Cancer – breast: mass/lump/thickening
Cancer – cervix: bleeding
Cancer – esophagus: dysphagia after ingestion of solid foods.
Cancer – larynx: change in voices or hoarseness
Cancer – ovary: vague abdominal discomfort and dyspepsia
Cancer – testes: painless swelling

Cataract: blurring of vision
Congestive heart failure: dyspnea (if left side) and edema (if right side)
Congenital hip dislocation: shorter of affected leg
Crohn's disease: right lower quadrant pain
Cystic fibrosis: meconium ileus
Cystitis: burning on urination
Diabetes mellitus: polyuria
Dumping syndrome: dizziness, diarrhea, diaphoresis
Guillain-bare syndrome: ascending weakness beginning in the lower extremities, clumsiness
Hepatic encephalopathy: personality changes
Hiatal hernia: heartburn 30 minutes after meals
Hyperthyroidism: nervousness
Hypocalcemia: tingling sensation around the lips and the fingers
Hypokalemia: muscle weakness
Hypovolemic shock: increased pulse rate
Hypoxia: restlessness
Increased ICP : widening pulse pressure , decreasing LOC
Liver cirrhosis: hepatomegaly
Lyme's disease: bull's eye rash
Meniere's disease: vertigo
Mengingitis: headache
Multiple sclerosis: diplopia
Myasthenia gravis: muscle weakness
Nephrotic syndrome: periorbital edema
Otitis media: pain
Pancreatitis: periumbilical pain
Parkinson's disease: unilateral pill rolling tremors
Retinal detachment: visual floaters
Retinoblastoma: cat's eye reflex
Tardive dyskinesia: tongue twitching
Thyroid crisis: increased temperature
Ulcerative colitis: recurrent bloody diarrhea

NCLEX-CGFNS: Patient Positioning

2008-10-19T22:33:00.002+03:00

The concept of patient positioning is important to understand as preparing for NCLEX or CGFNS. What position will you place your patient in? That is the question you can ask to yourself. Specific position will aggravate or lessen the patient condition.

Abdominal aneurysm surgery: Fowler position to prevent pressure on the graft.
Air embolism: Left side position and lower head of the bed to promote air to the right atrium and prevent to be carried to the systemic circulation.
Appendicitis: Any position if unruptured, and semi fowler if ruptured.
Asthma: Sitting position, leaning forward, to promote patient breathing
Autonomic dysreflexia: High fowler. It will prevent patient from hypertension stroke.
Bronchoscopy: Semi Fowler, to prevent aspiration after procedure.
Broncholitis: Tripod position.
Cast: elevate extremity to prevent edema.
Cataract surgery: Semi fowler to prevent edema at the operative site.
Cerebral aneurysm: Semi fowler.
Cleft lip: Supine after operation, prevent pressure on the suture line.
Cleft palate: Prone position.
Congestive heart failure: High Fowler that improve oxygenation.

Craniotomy: Semi fowler if supratentorial, and Flat if infratentorial that can promote drainage from the head.
Cerebro vascular accident: Elevate the head to reduce intra cranial pressure.
Dumping syndrome: Supine position after meal. It prevents rapid emptying or the stomach.
Epistaxis: Leaning forward to prevent blood aspiration.
Flail chest: Keep patient on affected side to promote expansion of the unaffected lung.
Hemorroidectomy: Side lying.
Hiatal hernia: Upright position after meals to prevent reflux of stomach contents.
Hip surgery: Legs in abduction position that can prevent dislodge of the head of the femur from acetabulum.
Hypophysectomy: Elevate head of the bed to prevent increase intracranial pressure
Increased Intracranial Pressure (ICP): Elevate head of the bed.
Laminectomy: Prevent twisting of the spine with keeping the back as straight as possible.
Laryngectomy: Semi fowler for maintaining airway and reduce edema.
Liver biopsy: Right side position post procedure to prevent patient from bleeding.
Lobectomy: Semi fowler
Lumbar puncture: Lateral side lying during procedure and flat after procedure.
Mastectomy: Elevate the extremity of the affected side (on pillow) to prevent edema.
Myelogram: Elevate the head if water based dye was used, and flat if oil based dye was used.
Placenta previa: Sitting position that can minimize bleeding.
Prolapse cord: Knee-chest Position to prevent pressure on the cord.
Pulmonary edema: Fowler position.
Pyloric stenosis: Right side lying position after meal, to facilitate entry of the stomach contents into the intestines.
Radium implant in the cervix: Flat to prevent dislodge of the implant.
Retinal detachment: The affected side toward the bed to help the detached retina to fall back in place.
Seizure: Side lying position
Shock: Modified trendelenburg to promote venous return.
Spinal cord injury: Immobilize the patient
Thoracentesis: Fowler position during procedure and any position after
Thrombophlebitis: Bed rest and elevate the affected leg to promote circulation
Thyroidectomy: Semi Fowler ad avoid hyperflexion and hyperextension of the neck.
Tonsillectomy: Sidelying or prone
Total Parenteral Nutrition: Trendelenburg during tube insertion to prevent air embolism
Tracheoesophagel Fistula (TEF): Supine with the head elevated at least 30 degrees
Varicose veins: elevate the legs above the level of heart
Vein stripping and ligation: Legs are elevated to prevent venous stasis

NCLEX-CGFNS: Diseases and Diets

2008-10-16T19:45:00.002+03:00

There are many questions asked about diets for specific diseases. Here are the most diseases and diets:

Acne : low fat
Acute gastroenteritis : clear liquid
Acute glomerulonephritis : low Natrium, low Protein
Addison disease : high Natrium, Low kalium
Anemia - iron deficiency : high iron
Anemia - pernicious : high protein, vitamin B
Anemia – sickle cell : high fluid
Angina pectoris : low cholesterol
Arthritis – gout : purine restricted
Attention Deficit Hyperactivity Disorder (ADHD) : finger foods
Bipolar disorder : finger foods
Burn : high calorie, high protin
Celiac's disease : gluten free
Cholecystitis : high protein, high carbohydrate, low fat
Congestive heart failure : low natrium, low cholesterol
Congestive heart failure : low natrium, low cholesterol
Cretinism : high protein, high calcium
Crohn disease : high protein, high carbohydrate, low fat
Cushing disease : high kalium, low natrium
Cystic fibrosis : high calorie, high natrium
Cystitis : acid ash (for alkaline stones) and alkaline ash( for acid stones)

Decubitus ulcer : high protein, high vitamin C
Diabetes mellitus : well balanced diet
Diarrhea : high kalium, high natrium
Diverticulitis : low residue
Diverticulosis : high residue with no seeds
Dumping syndrome : high fat, high protein, dry food
Hepatic encephalopathy : low protein
Hepatitis : hight protein, high calorie
Hirschsprung disease : high calorie, low residue, high protein
Hyperparathyroidism : low calcium
Hypertension : salt restricted
Hyperthyroidism : high calorie, high protein
Hypoparathyroidism : high calcium, low phosphorus
Hypthyroidism : low calorie, low cholesterol, low saturated fat
Kawasakis' disease : clear liquid
Liver cirrhosis : low protein
Meniere's disease : low natrium
Myocardial infarction : low fat, low cholesterol, low natrium
Nephritic syndrome : low natrium, high protein, high calorie
Osteoporosis : high calcium, high vitamin D
Pancreatitis : low fat
Peptic ulcer : high fat, high carbohydrate, low protein
Phenylketonuria : low protein/phenylalanine
Pregnancy induced hypertension : high protein
Renal colic : low sodium, low protein
Renal failure – acute : low protein, high carbohydrate, low natrium (oliguric phase), high protein, high calorie, restricted fluid (diuretic phase)
Renal failure – chronic : low protein, low natrium, low kalium
Tonsillitis : clear liquid

MAJOR DIETARY SOURCES:

CARBOHYDRATE

Bread
Cereal
Crackers
Corn
Potatoes

PROTEIN

Beef
Pork
Fish
Cheese

FAT SOURCE

Margarine
Avocado
Nuts
Olives
Peanut
Mayonnaise

NCLEX-CGFNS: Immunization

2008-10-10T02:03:00.005+03:00

IMMUNIZATION SCHEDULES

Birth – 2 months
Hepatitis B #1

1 – 4 months
Hepatitis B #2

2 months
DTaP1
Hib 1
IPV 1

4 months
DTaP 2
Hib 2
IPV 2

6 months
DTaP 3
Hib 3

6 – 18 months
Hepatitis B # 3
IPV or OPV 3

12 - 15 months
MMR
Hib 3
Var 1

15 – 18 months
DTaP 4

4 – 6 years
DTaP 5
MMR 2
IPV or OPV 4

11 – 12 years
Td 1

IMMUNIZATION – CONTRAINDICATION

All types of vaccines are contra-indicative if there is anaphylactic reaction to vaccine, moderate or sever illness with or without fever.

OPV, MMR, Varicella
Contraindication : Pregnancy, immuno-suppression, immuno-deficiency.

DTP/DTaP
Contraindication : Encephalopathy

IPV
Contraindication : Anaphylactic reaction to neomycin, streptomycin or polymyxin B.

MMR, Varicella
Contraindication : Anaphylactic reaction to neomycin or gelatin.

Influenza
Contraindication : Anaphylactic reaction to eggs or egg protein.

Hepatitis B
Contraindication : Anaphylactic reaction to bakers yeast.

NCLEX-CGFNS: Growth and Development

2008-10-10T01:54:00.002+03:00

INFANT (0-1 YEAR)

Immunization schedule: Hepatitis B is given at birth, at two months, and at six months. OPV at 2, 4, 15 months, DPT at 2, 4, 6 months. Iron supplement starts at 4-6 months
No choking hazards.
Fear of stranger at 8 months.
Allow to use pacifier if in NPO.
Note the weight: doubles at 6 months, triples at 1 year, and quadruples at 2.5 years.
Trust vs. mistrust.
Solitary play.

TODDLER (1-3 YEARS)

Talk to child in simple terms
Offer choices to provide some control.
Do not leave alone near the swimming pool or bathtub.
Doubt and shame vs. autonomy
Learns about death beginning at 3 years
Elimination pattern: toilet training begins at 18 months.
Rituals and routine.

PRE-SCHOOLER (3-6 YEARS)

Play is associative – cooperative
Regression is common.
Explain every procedure.
Same age group for room assignment
Curious
Highly imaginative – Imaginary playmate
Observe for initiative vs. guilt
Off limits to the kitchen because of risk for poisoning and burns.
Loss of body part (mutilation) is a common fear.

SCHOOLER (6-12 YEARS)

Same sex stage.
Competitive play
Hero-worship, realistic and universal concept of death: age 9-10 age.
Observe for industry vs. inferiority.
Off limits to vehicles because of risk for accidents.
Loss of control is a common fear.
Explain procedures.
Regression is common.

NCLEX-CGFNS: Diseases and Complication

2008-09-27T07:09:00.002+03:00

Here are specific diseases with specific their complication. It is important to remember them as preparation for NCLEX and CGFNS Exam.

Acute gastroenteritis : dehydration
Acute lymphcytic leukemia : bleeding
Addison's disease : shock
Anemia-pernicious : peripheral neuritis
Anemia-sickle cell : cerebrovascular accident
Cardia vulvular disorder congestive heart failure
Cystic fibrosis : male to be sterility, female to be difficulty conceiving
Cholelithiasis : cholecystitis
Complete heart block : congestive heart failure
Gonorrhea : pelvic inflammatory disease (PID)
Herpes : cervical cancer
Hypertension : cerebrovascular accident
Infectious mononucleosis : splenic rupture
Lyme's disease : pralysis
Lead poisoning : mental retardation
Meningitis : hearing impairment
Mitral valve stenosis : acute glomerulonephritis

Mycardiacl infarction : premature ventricular contraction (PVC)

Pancreatitis : hypocalcemia / hyperglycemia

Phenylkenounia (PKU) : mental retardation

Polycyethemia vera : cerebrovascular accident

Pre-eclampsia : abruption placenta

Septicemia : shock

Sexually transmitted disease (STD) : pelvic inflammatory disease (female)

Sore throat : rheumatic heart disease, mitral valve stenosis, acute glomerulonephritis

NCLEX-CGFNS: Diseases - Asymptomatic

2008-09-27T06:55:00.004+03:00

There are diseases that have no initial symptoms.

Amoebiasis
Cancer of cervix
Cancer of esophagus
Cancer or rectum
Chlamydia trachomatis
Cholelithiasis
Coarctation of the aorta
Diverticulitis
Genital herpes
Gonorrhea in female patient
Gout
Hemophilia B – Christmas disease
Hiatal hernia
Hypothyroidism
Hypertension
Lung cancer
Osteoporosis
Patent ductus arteriosus
Pelvic inflammatory
Phenylketonuria (PKU) in newborn
Prostatic cancer
Trichomoniasis
Tuberculosis