HESI Hints & NCLEX Gems Answering NCLEX Questions o Maslows Hierarch o! Nee"s #h siologic Sa!

Sa!et Lo$e an" %elonging Esteem Sel!&actuali'ation o Nursing #rocess Assessment (iagnosis )Anal sis* #lanning Im+lementation )treatment* E$aluation o A%Cs Airwa %reathing Circulation Normal ,alues o Hg Males ./&.0 1emales .2&.3 o Hct Males /2&42 1emales 56&/6 o 7%Cs Males /86&38. million 1emales /82&48/ million o 9%Cs /84&..: o #latelets .4;&/;;: o #< )Couma"in=9ar!arin* ..&.284 sec )IN7 an" #< <7 > .84&2 times normal* o A#<< )He+arin* 3;&6; sec )A#<< an" #<< <7 > .84&284 times normal*

o %?N .;&2; o Creatinine ;84&.82 o Glucose 6;&..; o Cholesterol @ 2;; o %iliru-in New-orn .&.2 o #hen lalanine New-orn @ 2A A"ult @ 3 o NaB .53&./4 o CB 584&4 H +oCB 8 8 8 #rominent ? wa$esA (e+resse" S< segmentA 1lat < wa$es H +erCB 8 8 8 <all <&9a$esA #rolonge" #7 inter$alA wi"e Q7S o CaBB D&.;84 H +ocalcemia E muscle s+asmsA con$ulsionsA cram+s=tetan A B <rousseausA B Ch$oste:sA +rolonge" S< inter$alA +rolonge" Q< segment o MgB .84&284 o Cl& D3&.;3 o #hos 5&/84 o Al-umin 584&4 o S+ec Gra$it .8;;4&.8;5; o Gl cos late" Hemoglo-in )Hg- A.c*F /&3G i"ealA @ 684G > HC ).2; "a s* o (ilantin <7 > .;&2; o Lithium <7 > ;84&.84 o Arterial %loo" Gases E ?se" !or Aci"osis $s8 Al:alosis #H 6854&68/4 CH2 54&/4 )7es+irator "ri$er* E High > Aci"osis HCH5 2.&20 )Meta-olic "ri$er* E High > Al:alosis H2 0;&.;; H2 Sat D4&.;;G Anti"otes o (igoIin E (igi-an" o Couma"in E ,itamin C )Cee+ #< an" IN7 J .&.84 X normal* o %en'o"ia'a+ines E 1lum'aemil )<oma'icon* o Magnesium Sul!ate E Calcium GluconateK o He+arin E #rotamine Sul!ate )Cee+ A#<< an" #<< J .84&284 X normal*

o < lenol E Mucomist ).6 "oses B loa"ing "ose* o H+iates )narcotic analgesicsA heroinA mor+hine* E Narcan )NaloIone* o Cholinergic Me"s )M esthenic %ra" car"ia* E Atro+ine o MethotreIate E Leuco$orin (elegation o 7N Hnl %loo" #ro"ucts )2 7Ns must chec:* Clotting 1actors Sterile "ressing changes an" +roce"ures Assessments that reLuire clinical Mu"gment ?ltimatel res+onsi-le !or all "elegate" "uties o ?nlicense" Assisti$e #ersonnel Non&sterile +roce"ures #recautions & 7oom Assignments o ?ni$ersal )Stan"ar"* #recautions E HI, initiate" 9ash han"s 9ear Glo$es Gowns !or s+lashes Mas:s an" E e #rotection !or s+lashes an" "ro+lets (ont reca+ nee"les Mouth+iece or Am-u&-ag !or resuscitation 7e!rain !rom gi$ing care i! ou ha$e s:in lesion o (ro+let )7es+irator * #recautions )9ear Mas:* Se+sisA Scarlet 1e$erA Stre+A 1i!th (isease )#ar$o %.D*A #ertussisA #neumoniaA In!luen'aA (i+theriaA E+iglottitisA 7u-ellaA 7u-eolaA MeningitisA M co+lasmaA A"eno$irusA 7hino$irus 7S, )nee"s contact +recautions too* <% E 7es+irator Isolation o Contact #recautions > ?ni$ersal B GogglesA Mas: an" Gown o No in!ection +atients with immunosu++resse" +atients 9eir" Miscellaneous Stu!! o 7i!am+in )!or <%* E 7ust=orange=re" urine an" -o" !lui"s o # ri"ium )!or -la""er in!ection* E Hrange=re"=+in: urine o Glasgow Coma Scale E @ 0 > coma

o M esthenia Gra$is M esthenic Crisis > 9ea:ness with change in $itals )gi$e more me"s* Cholinergic Crisis > 9ea:ness with no change in $itals )re"uce me"s* o (ia-etic Coma $s8 Insulin Shoc: E Gi$e glucose !irst N I! no hel+A gi$e insulin o 1ruit %reath > (ia-etic Cetoaci"osis o Aci"&%ase %alance I! it comes out o! our assA its Aci"osis8 ,omiting > Al:alosis o S:in <astes Salt > C stic 1i-rosis o Li+itor )statins* in #Ms onl N No gra+e!ruit Muice o Stro:e E <ongue +oints towar" si"e o! lesion )+aral sis*A ?$ula "e$iates awa !rom the si"e o! lesion )+aral sis* o Hol" (igoIin i! H7 @ 3; o Sta in -e" !or 5 hours a!ter !irst ACE Inhi-itor "ose o A$oi" Gra+e!ruit Muice with CaBB Channel %loc:ers o AnthraI > Multi&$ector -ioha'ar" o #ulmonar air em-olism +re$ention > <ren"elen-urg )HH% "own* B on le!t si"e )to tra+ air in right si"e o! heart* o Hea" <rauma an" Sei'ures E Maintain airwa > +rimar concern o #e+tic ?lcers E 1ee" a (uo"enal ?lcer )+ain relie$e" - !oo"* E Star$e a gastric ulcer o Acute #ancreatitis E 1etal +ositionA %luish "iscoloration o! !lan:s )<urners Sign*A %luish "iscoloration o! +ericum-elical region )Cullens Sign*A %oar" li:e a-"omen with guar"ing E Sel! "igestion o! +ancreas - tr +sin8 o Hol" tu-e !ee"ing i! resi"ual O .;;mL o In case o! 1ire E 7ACE an" #ASS o Chec: 7estraints e$er 5; minutes E 2 !ingers room un"erneath o Gullain&%arre S n"rome E 9ea:ness +rogresses !rom legs u+war" N 7es+ arrest o <rough "raw > P5; min -e!ore sche"ule" a"ministration E #ea: (raw > 5;&3; min a!ter "rug a"ministration8

 Mental Health & #s chiatr o Most suici"es occur a!ter -eginning o! im+ro$ement with increase in energ le$els o MAHIs E H +ertensi$e Crisis with < ramine !oo"s Nar"ilA Mar+lanA #arnate Nee" 2 w: ga+ !rom SS7Is an" <CAs to a"min MAHIs o Lithium <hera+eutic 7ange > ;84&.84 o #henothia'ines )t +ical anti+s chotics* N E#SA #hotosensiti$it o At +ical Anti+s chotics N wor: on +ositi$e an" negati$e s m+tomsA less E#S o %en'os )Ati$anA Lora'e+amA etc* goo" !or Alcohol with"rawal an" Status E+ile+ticus o Anta-use !or Alcohol "eterrence N Ma:es ou sic: with HH inta:e o Alcohol 9ith"rawal > (elerium <remens N <ach car"iaA tach +neaA anIiet A nauseaA sha:esA hallucinationsA +aranoia E )(<s start .2&53 hrs a!ter last "rin:* o H+iate )HeroinA Mor+hineA etc8* 9ith"rawal > 9ater e esA runn noseA "ilate" +u+ilsA N,(A cram+s o Stimulants 9ith"rawal > (e+ressionA !atigueA anIiet A "istur-e" slee+ Me"ical&Surgical o H +o$entilation > Aci"osis )too much CH2* o H +er$entilation > Al:alosis )low CH2* o No %# or I, on si"e o! Mastectom o H+iate H( > #in+oint #u+ils o Lesions o! Mi"-rain > (ecere-rate #osturing )EIten"e" el-owsA hea" arche" -ac:* o Lesions o! CorteI > (ecorticate #osturing )1leIion o! el-owsA wristsA !ingersA straight legsA mumm +osition* o ?rine Hut+ut o! 5; mL=hr > minimal com+etenc o! heart an" :i"ne !unction o Ci"ne Stone > Cholelithiasis 1lan: +ain > stone in :i"ne or u++er ureter A-"ominal=scrotal +ain > stone in mi"=lower ureter or -la""er o 7enal 1ailure E 7estrict +rotein inta:e

 1lui" an" electrol te +ro-lems E 9atch !or H +erCB )"i'' A w:A nauseaA cram+sA arh thmias* #re&renal #ro-lem > Inter!erence with renal +er!usion Intra&renal #ro-lem> (amage to renal +arench ma #ost&renal #ro-lem > H-struction in ?< an where !rom tu-ules to urethral meatus8 ?suall 5 +hases )HligouricA (iureticA 7eco$er * Monitor %o" 9t an" I&Hs o Steroi" E!!ects > Moon !aceA h +ergl cemiaA acneA hirsutismA -u!!alo hum+A moo" swingsA weight gain N S+in"le sha+eA osteo+orosisA a"renal su++ression )"ela e" growth in :i"s* 8 8 8 )Cushings S n"rome s m+toms* o A""isons Crisis > me"ical emergenc )$ascular colla+seA h +ogl cemiaA tach car"ia E A"min I, glucose B corticosteroi"s* E No #H corticosteroi"s on em+t stomach o #otassium s+aring "iuretic > Al"actone )S+ironolactone* E 9atch !or h +erCB with this an" ACE Inhi-itors8 o Car"iac En' mes E <ro+onin ). hr*A CCM% )2&/ hr*A M oglo-in ).&/ hr*A L(H. ).2&2/ hr* o MI <I E Nitro N Qes E NH (igoIinA %eta-loc:ersA Atro+ine o 1i-rinol tics > Stre+to:inaseA <enecte+lase )<NCase* o CA%G > Coronar Arter % +ass Gra!t o #<CA > #ercutaneous <ransluminal Coronar Angio+last o SeI a!ter MI o:a when a-le to clim- 2 slights o! stairs without eIertion )<a:e nitro +ro+h lacticall -e!ore seI* o %#H <I > <?7# )<ransurethral 7esection o! #rostate* E some -loo" !or / "a sA an" -urning !or 6 "a s +ost&<?7#8 o Hnl isotonic sterile saline !or %la""er Irrigation o #ost <h roi"ectom N Cee+ tracheostom set - the -e" with H2A suction an" Calcium gluconate o #ericar"itis E #ericar"ial 1riction 7u-A #ain relie$e" - leaning !orwar" o #ost Stre+ ?7I (iseases an" Con"itionsF Acute Glomerulone+hritis 7heumatic 1e$er E ,al$e (isease Scarlet 1e$er o I! a chest&tu-e -ecomes "isconnecte"A "o not clam+ E #ut en" in sterile water

o Chest <u-e "rainage s stem shoul" show -u--ling an" water le$el !luctuations )ti"aling with -reathing* o <% E <reatment with multi"rug regimen !or D months E 7i!am+in re"uces e!!ecti$eness o! HCs an" turns +ee orange E Isonia'i"e )INH* increases (ilantin -loo" le$els o ?se -roncho"ilators -e!ore steroi"s !or asthma E EIhale com+letel A Inhale "ee+l A Hol" -reath !or .; secon"s o ,entilators E Ma:e sure alarms are on E Chec: e$er / hours minimum o Suctioning E #re an" #ost oI genate with .;;G H2 E No more than 5 +asses E No longer than .4 secon"s E Suction on with"rawal with rotation o CH#(F Em+h sema > #in: #u!!er Chronic %ronchitis > %lue %loater )C anosisA 7t si"e" heart !ailure > -loating=e"ema* o H2 A"ministration Ne$er more than 3L=min - cannula Must humi"i! with more than /L=hr No more than 2L=min with CH#( E )CH2 Narcosis* In ascen"ing or"er o! "eli$er +otenc F Nasal CannulaA Sim+le 1ace Mas:A Nonre-reather Mas:A #artial 7e-reather Mas:A ,enturi Mas: 7estlessness an" Irrita-ilit > Earl signs o! cere-ral h +oIia I,s an" %loo" #ro"uct A"ministration o .0&.D gauge nee"le !or -loo" with !ilter in tu-ing o 7un -loo" with NS onl an" within 5; minutes o! hanging o ,itals an" %reath Soun"s E -e!oreA "uring an" a!ter in!usion ).4 min a!ter startA then 5; min laterA then hourl u+ to . hr a!ter* o Chec: %loo"F EI+ (ateA clotsA colorA air -u--lesA lea:s o 2 7Ns must chec: or"erA +tA -loo" +ro"uct E As: #t a-out +re$ious trans!usion HI o Sta with #t !or !irst .4 minutes E I! trans!usion rIn E Sto+ an" C,H with NS o #re&me"icate with %ena"r l +rn !or +re$ious urticaria rIns o Isotonic Solutions (49

 NS );8DG NaCl* 7ingers Lactate NS onl with -loo" +ro"ucts an" (ilantin (ia-etes an" Insulin o 9hen in "ou-t N <reat !or H +ogl cemia !irst o 1irst I, !or (CA > NSA then in!use regular insulin I, as 7I" o H +ogl cemia E con!usionA HAA irrita-leA nauseaA sweatingA tremorsA hungerA slurring o H +ergl cemia E wea:nessA s nco+eA +ol "i+siaA +ol uriaA -lurre" $isionA !ruit -reath o Insulin ma -e :e+t at room < !or 20 "a s o (raw 7egular )Clear* insulin into s ringe !irst when miIing insulins o 7otate InMection Sites )7otate in . regionA then mo$e to new region* o 7a+i" Acting Insulins E Lis+ro )Humalog* an" As+art )No$olog* E HF 4&.4 minA #F 864&.84 hrs o Short Acting Insulin E 7egular )human* E HF 5;&3; minA #F 2&5 hrs )I, H:a * o Interme"iate Acting Insulin E Iso+hane Insulin )N#H* E HF .&2 hrsA #F 3&.2 hrs o Long Acting Insulin E Insulin Glargine )Lantus* E HF .8. hrA #F ./&2; hrs )(ont MiI* o Hral H +ogl cemics "ecrease glucose le$els - stimulating insulin +ro"uction - -eta cells o! +ancreasA increasing insulin sensiti$it an" "ecreasing he+atic glucose +ro"uction Gl -uri"eA Met!ormin )Gluco+hage*A A$an"iaA Actos Acar-ose -lunts sugar le$els a!ter meals Hncolog o Leu:emia E Anemia )re"uce" 7%C +ro"uction*A Immunosu++ression )neutro+enia an" immature 9%Cs*A Hemorrhage an" -lee"ing ten"encies )throm-oc to+enia* Acute L m+hoc tic > most common t +eA :i"sA -est +rognosis o <esticular Cancer E #ainless lum+ or swelling testicle E S<E in shower O ./ rs E .4&54 > Age o #rostate Cancer E O /; > Age #SA ele$ation (7E

 Mets to s+ineA hi+sA legs Ele$ate" #A# )+rostate aci" +hos+hatase* <7?S > <ransurethral ?S #ost H+ E Monitor o! hemorrhage an" car"io$ascular com+lication o Cer$ical an" ?terine Cancer LaserA cr othera+ A ra"iationA coni'ationA h sterectom A eIenteration E Chemothera+ > No hel+ #A# smears shoul" start within 5 ears o! intercourse or - age 2. o H$arian Cancer > lea"ing cause o! "eath !rom g necological cancer o %reast Cancer > Lea"ing cause o! cancer in women ?++er outer Lua"rantA le!t O right Monthl S%E Mammogra+h E %aseline J 54A Annuall a!ter age 4; Mets to l m+h no"esA then lungsA li$erA -rainA s+ine Mastectom E 7a"ical Mastectom > L m+h no"es too )-ut no mm resecte"* A$oi" %# measurementsA inMections an" $eni+uncture on surgical si"e o Anti&emetics gi$en with Chemothera+ Agents )C toIanA MethotreIateA Inter!eronA etc8* #henergan )#rometha'ine HCl* Com+a'ine )#rochlor+era'ine* 7eglan )Metocol+rami"e* %ena"r l )(i+henh "ramine* Ro!ran )Hn"ansetron HCl* C tril )Granisetron* SeIuall <ransmitte" (iseases o S +hilis )<re+onema +alli"um* E Chancre B re" +ainless lesion )#rimar StageA D; "a s* 888 Secon"ar Stage )u+ to 3 mo* > 7ash on +alms an" soles B 1lu&li:e s m+toms E <ertiar Stage > Neurologic an" Car"iac "estruction ).;&5; rs* E <reate" with #enicillin G IM8 o Gonorrhea )Neisseria Gonorrhea* E Qellow green urethral "ischarge )<he Cla+* o Chlam "ia )Chlam "ia <rachomatis* E Mil" $aginal "ischarge or

urethritis E (oI c clinA <etrac cline o <richomoniasis )<richomonas ,aginalis* E 1roth !oul&smelling $aginal "ischarge E 1lag l o Can"i"iasis )Can"i"a Al-icans* E QellowA chees "ischarge with itching E Micona'oleA N statinA Clomitra'ole )G ne&Lotrimin* o Her+es Sim+leI 2 E Ac clo$ir o H#, )Human #a++ilo$irus* E Aci"A LaserA Cr othera+ o HI, E Coc:tails #erio+erati$e Care o %reathing Es taught in a"$ance )-e!ore or earl in +re&o+* o 7emo$e nail +olish )nee" to see ca+ re!ill* o #re H+ E Me"s as or"ere"A N#H X 0 hrsA Incenti$e S+irometr & %reathing Es taught in a"$anceA ,oi"A No NSAI(S X /0 hrs o Increase" corticosteroi"s !or surger )stress* E Ma nee" to increase insulin too o #ost H+ restlessness ma > hemorrhageA h +oIia o 9oun" "ehiscence or eItra$isation E 9et sterile NS "ressing B Call (r8 o Call (r8 +ost o+ i! E @ 5; mL=hr urineA S s %# @ D;A < O .;; or @ D3 o #ost H+ Monitoring ,S an" %S E E$er .4 minutes the !irst hourA E$er 5; min neIt 2 hoursA E$er hour the neIt / hoursA then E$er / hours +rn o .&/ hrs #ost H+ > Imme"iate Stage E 2&2/ hrs #ost H+ > Interme"iate Stage E .&/ "a s #ost H+ > EIten"e" Stage o #ost H+ #ositioning <H7 E No A""uction +ast mi"lineA No hi+ !leIion +ast D; "egrees Su+ratentorial SI E HH% 5;&/4 "egrees )Semi&1owler* In!rantentorial SI E 1lat #hle-itis E Su+ineA ele$ate in$ol$e" leg Harris <u-e E 7t=-ac:=Lt N to a"$ance tu-e in GI Miller A--ott <u-e E 7ight si"e !or GI a"$ancement into small intestine <horacocentesis E ?na!!ecte" si"eA HH% 5;&/4 "egrees Enema E Le!t Sims )!low into sigmoi"* Li$er %io+s E 7ight si"e with +illow=towel against +uncture site

 Cataract SI E H++ si"e N Semi&1owler Car"iac Catheteri'ation E 1lat )HH% no more than 5; "egrees*A Leg straight /&3 hrsA -e" rest 3&.2 hrs %urn Autogra+h E Ele$ate" an" Immo- 5&6 "a s Am+utation E Su+ineA ele$ate stum+ !or /0 hrs Large %rain <umor 7esection E Hn non&o+erati$e si"e o Incenti$e S+irometr E Inhale slowl an" com+letel to :ee+ !low at 3;;&D;;A Hol" -reath 4 secon"sA .; times +er hr o #ost H+ %reathing EIercises E E$er 2 hours Sit u+ straight %reath in "ee+l thru nose an" out slowl thru +urse" li+s Hol" last -reath 5 secon"s <hen cough 5 times )unless a-" woun" N rein!orce=s+lint i! cough* o 9atch !or Stri"or a!ter an nec:=throat SI E Cee+ <rach :it at -e" si"e o Sta+les an" sutures remo$e" in 6&./ "a s N Cee+ "r until then o No li!ting o$er .; l-s !or 3 wee:s )in general* o I! chest tu-e comes "isconnecte"A +ut !ree en" in container o! sterile water o 7emo$ing Chest <u-e E ,alsal$asA or (ee+ -reath an" hol" o I! chest tu-e "rain sto+s !luctuatingA the lung has re&in!late" )or there is a +ro-lem* o Cee+ scissors - -e" i! +t has S8 %la:emore <u-e )!or eso+h $arices*E Su""en res+irator "istress N Cut in!lation tu-es an" remo$e o <racheostom +atients E Cee+ Cell clam+ an" H-turator )use" to insert into trachea then remo$e" lea$ing cannula* at -e" si"e o <urn o!! NG suction !or 5; min a!ter #H me"s o NG <u-e 7emo$al E <a:e a "ee+ -reath an" hol" it o Stomach contents +H > @ / )gastric Muices as+irate"* o NG <u-e Insertion E I! cough an" gagA -ac: o!! a littleA let calmA a"$ance again with +t si++ing water !rom straw o NG <u-e Length E En" o! noseA to era lo-eA to I +hoi" )P22&23 inches* o (ecu-itus )+ressure* ?lcer Staging Stage . > Er thema onl Stage 2 > #artial thic:ness

 Stage 5 > 1ull thic:ness to SQ Stage / > 1ull thic:ness B in$ol$ing mm =-one Acute Care o C,A E Hemorrhagic or Em-olic A&!i- an" A&!lutter > throm-us !ormation ( sarthria )$er-al enunciation=articulation*A A+raIia )+er!orm +ur+ose!ul mo$ements*A ( s+hasia )s+eech an" $er-al com+rehension*A A+hasia )s+ea:ing*A Agra+hia )writing*A AleIia )rea"ing*A ( s+hagia )swallowing* Le!t Hemis+here Lesion E a+hasiaA agra+hiaA slowA cautiousA anIiousA memor o:a 7ight Hemis+here Lesion E cant recogni'e !acesA loss o! "e+th +erce+tionA im+ulsi$e -eha$iorA con!a-ulatesA +oor Mu"gmentA constantl smilesA "enies illnessA loss o! tonal hearing o Hea" InMuries E E$en su-tle changes in moo"A -eha$iorA restlessnessA irrita-ilit A con!usion ma in"icate increase" IC# Change in le$el o! res+onsi$eness > Most im+ortant in"icator o! increase" IC# 9atch !or CS1 lea:s !rom nose or ears N Lea:age can lea" to meningitis an" mas: intracranial inMur since usual increase" IC# s m+s ma -e a-sent8 o S+inal Cor" InMuries 7es+irator status +aramount E C5&C4 inner$ates "ia+hragm . w: to :now ultimate +rognosis S+inal Shoc: > Com+lete loss o! all re!leIA motorA sensor an" autonomic acti$it -elow the lesion > Me"ical emergenc #ermanent +aral sis i! s+inal cor" in com+resse" !or .2&2/ hrs H +otension an" %ra" car"ia with an inMur a-o$e <3 %la""er In!ection > Common cause o! "eath )tr to :ee+ urine aci"ic* o %urns In!ection > #rimar concern H +erCB "ue to cell "amage an" release o! intracellular CB Gi$e me"s -e!ore "ressing changes N #ain!ul Massi$e $olumes o! I, !lui" gi$enA "ue to !lui" shi!t to interstitial s+aces an" resultant shoc:

 1irst (egree > E+i"ermis )su+er!icial +artial thic:ness* Secon" (egree > E+i"ermis an" (ermis )"ee+ +artial thic:ness* <hir" (egree > E+i"ermisA (ermisA an" SQ )!ull thic:ness* 7ule o! Ds E Hea" an" nec: > DGA ?E > DG eachA LE > .0G eachA 1ront trun: > .0GA %ac: <run: > .0G Singe" nasal hair an" circumoral soot=-urns > Smo:e inhalation -urns o 1ractures 7e+ort a-normal assessment !in"ings +rom+tl E Com+artment S n"rome ma occur > #ermanent "amage to ner$es an" $essels 4 #s o! neuro$ascular status )im+ortant with !ractures* #ainA #allorA #ulseA #aresthesiaA #aral sis #ro$i"e age&a++ro+riate to s !or :i"s in traction S+ecial <ests an" #athognomonic Signs o <ensilon <est E M esthenia Gra$is )B in M esthenic crisisA & in Cholinergic crisis* o ELISA an" 9estern %lot E HI, o Sweat <est E C stic 1i-rosis o Cheilosis > Sores on si"es o! mouth E 7i-o!la$in "e!icienc )%2* o <rousseaus Sign )Car+al s+asm in"uce" - %# cu!!* E H +ocalcemia )h +o+arath roi"ism* o Ch$oste:s Sign )1acial s+asm a!ter !acial ner$e ta+* E H +ocalcemia )h +o+arath roi"ism* o %loo" (iarrhea > ?lcerati$e Colitis o Hli$e&Sha+e" Mass )e+igastric* an" #roMectile ,omiting > # loric Stenosis o Current Sell Stool )-loo" an" mucus* an" Sausage&Sha+e" Mass in 7?Q > Intussice+tion o MantouI <est !or <% is B i! .; mm in"uration /0 hrs +ost a"min )+re$ious %CG $accine reci+ients will test B* o %utter!l 7ash > SLE E A$oi" "irect sunlight o 4 #s o! N, !unctioning E #ainA +aresthesiaA +ulseA +allorA +aral sis o Cullens Sign )+erium-elical "iscoloration* an" <urners Sign )-lue !lan:* > Acute #ancreatitis o Mur+h s Sign )7t8 costal margin +ain on +al+ with ins+iration*

> G% or Li$er "isease o HA more se$ere on wa:ening > %rain <umor )remo$e -enign an" malignant* o ,omiting not associate" with nausea > %rain <umor o Ele$ate" IC# > Increase" %#A wi"ene" +ulse +ressureA increase" <em+ o #ill&7olling <remor > #ar:insons )<I with Le$o"o+aA Car"i"o+a* N 1all +recautionsA rigi"A stoo+e"A shu!!ling o IG %an"s on Electro+horesis > MS E 9ea:ness starts in u++er eItremities N -owel=-la""er a!!ecte" in D;G E (em elination & <I with AC<HA corticosteroi"sA C toIan an" other immunosu++ressants o 7ee"&Stern-erg Cells > Ho"g:ins o Co+li: S+ots > 7u-eola )Measles* o Er thema Marginatum > 7ash o! 7heumatic 1e$er o Gowers Sign > Muscular ( stro+h E Li:e Minors sign )wal:s u+ legs with han"s* #e"iatrics o %ench Mar:s %irth wt "ou-les at 3 months an" tri+les at .2 months %irth length increases - 4;G at .2 months #ost !ontanel closes - 0 w:s Ant !ontanel closes - .2&.0 months Moro re!leI "isa++ears at / months Stea" hea" control achie$e" at / months <urns o$er at 4&3 months Han" to han" trans!ers at 6 months Sits unsu++orte" at 0 months Crawls at .; months 9al:s at .;&.2 months Cooing at 2 months Monos lla-ic %a--ling at 5&3 monthsA Lin:s s lla-les 3&D mo MamaA (a"a B a !ew wor"s at D&.2 months <hrows a -all o$erhan" at .0 months (a time toilet training at .0 mo & 2 ears 2&5 wor" sentences at 2 ears 4;G o! a"ult Ht at 2 ears

 %irth Length "ou-les at / ears ?ses scissors at / ears <ies shoes at 4 ears Girls growth s+urt as earl at .; ears E %o s catch u+ P Age ./ Girls !inish growing at P.4 E %o s P .6 o Autosomal 7ecessi$e (iseases C1A #C?A Sic:le Cell AnemiaA <a &SachsA Al-inismA 24G chance i!F AS )trait onl * X AS )trait onl * 4;G chance i!F AS )trait onl * X SS )"isease* o Autosomal (ominant (iseases HuntingtonsA Mar!ansA #ol "act lA Achon"ro+lasiaA #ol c stic Ci"ne (isease 4;G i! one +arent has the "isease=trait )trait > "isease in autosomal "ominant* o X&Lin:e" 7ecessi$e (iseases Muscular ( stro+h A Hemo+hilia A 1emales are carriers )ne$er ha$e the "isease* Males ha$e the "isease )-ut cant +ass it on* 4;G chance "aughters will -e carriers )cant ha$e "isease* 4;G chance sons will ha$e the "isease )not a carrier > cant +ass it on* <his translates to an o$erall 24G chance that each +regnanc will result in a chil" that has the "isease o Scoliosis E Milwau:ee %race N 25 hrs="a A Log rolling a!ter SI o (own S n"rome > <risom 2. E Simian creases on +almsA h +otoniaA +rotru"ing tongueA u+war" outwar" slant o! e es o Cere-ral #als E Scissoring > legs eIten"e"A crosse"A !eet +lantar&!leIe" o #C? E lea"s to M7 E Guthrie <est EAs+artame )NutraSweet* has +hen lalanine in it an" shoul" not -e gi$en to #C? +atient o H +oth roi"ism E Lea"s to M7 o #re$ent Neural tu-e "isor"ers with 1olic Aci" "uring #G o M elomeningocele E Co$er with moist sterile water "ressing an" :ee+ +ressure o!! o H "roce+halus E Signs o! increase" IC# are o++osite o! shoc: E Shoc: > Increase" +ulse an" "ecrease" %# IIC# > (ecrease" +ulse an" increase" %# E )B Altere" LHC >

Most sensiti$e sign* In!ants 888 IIC# > %ulging !ontanelsA high +itche" cr A increase" h" circumA sunset e esA wi"e suture linesA letharg E <reat with +eritoneal shunt N "ont +um+ shunt8 Hl"er :i"s II#C > 9i"ene" +ulse +ressure IIC# cause" - suctioningA coughingA strainingA an" turning N <r to a$oi" o Muscular ( stro+h E X&lin:e" 7ecessi$eA wa""ling gaitA h +er lor"osisA Gowers Sign > "i!!icult rising wal:s u+ legs )li:e Minors sign*A !at +seu"oh +ertro+h o! cal$es8 o Sei'ures E Nothing in mouthA turn h" to si"eA maintain airwa A "ont restrainA :ee+ sa!e E <reat with #heno-ar-itol )Luminol*A #hen toin )(ilantinF <7 > .;&2; E Gingi$al H +er+lasia*A 1os+hen toin )Cere- I*A ,al+roic Aci" )(e+a:ene*A Car-ama'e+ine )<egritol* o Meningitis )%acterial* E Lum-ar +uncture shows Increase" 9%CA +roteinA IIC# an" "ecrease" glucose Ma lea" to SIA(H )<oo much A(H* E 9ater retentionA !lui" o$erloa"A "ilutional h +onatremia o C1 Ci"s taste salt an" nee" en' mes s+rin:le" on their !oo" o Chil"ren with 7u-ella > threat to un-orn si-lings )ma reLuire tem+orar isolation !rom Mom "uring #G* o #ain in oung chil"ren measure" with 1aces +ain scale o No MM7 Immuni'ation !or :i"s with HI o! allergic rIn to eggs or neom cin o Immuni'ation Si"e E!!ects E < @ .;2A re"ness an" soreness at inMection site !or 5 "a s E gi$e < lenol an" -i:e +e"al legs )+assi$el * !or chil"8 o Call #h sician i! sei'uresA high !e$erA or high&+itche" cr a!ter immuni'ation o All cases o! +oisoning E Call #oison Control Center E No I+ecacT o E+iglottitis > H8 in!luen'a % E Chil" sits u+right with chin out an" tongue +rotru"ing )ma -e <ri+o" +osition* E #re+are !or intu-ation or trach E (H NH< +ut an thing into :i"s mouth o Isolate 7S, +atient with Contact #recautions E #ri$ate room is -est E ?se Mist <ent to +ro$i"e H2 an" 7i-a$irin N 1loo" tent with H2 !irst an" wi+e "own insi"e o! tent +erio"icall so ou can see +atient

o Acute Glomerulone+hritis E A!ter % stre+ N Antigen&Anti-o" com+leIes clog u+ glomeruli an" re"uce G17 > (ar: urineA +roteinuria o 9ilms <umor > Large :i"ne tumor E (ont +al+ate o <E1 > <racheoeso+hageal Atresia E 5 Cs o! <E1 > CoughingA Cho:ingA C anosis o Cle!t Li+ an" #alate E #ost&H+ N #lace on si"eA maintain Logan %owA el-ow restraints o Congenital Megacolon > Hirschs+rungs (isease E Lac: o! +eristalsis "ue to a-sence o! ganglionic cells in colon E Sus+ect i! no meconium w=in 2/ hrs or ri--on&li:e !oul smelling stools o Iron (e!icienc Anemia E Gi$e Iron on em+t stomach with citrus Muice )$itamin C enhances a-sor+tion*A ?se straw or "ro++er to a$oi" staining teethA <arr stoolsA limit mil: inta:e @ 52 o'="a o Sic:le Cell (isease EH "ration most im+ortant ESC Crisis > !e$erA a-" +ainA +ain!ul e"ematous han"s an" !eet )han"&!oot s n"rome*A arthralgia E<I B restA h "ration E A$oi" high altitu"e an" strenuous acti$ities o <onsillitis E usuall Stre+ E Get #< an" #<< #re&H+ )as: a-out HI o! -lee"ing* E Sus+ect %lee"ing #ost&H+ i! !reLuent swallowingA $omiting -loo"A or clearing throat E No re" liLui"sA no strawsA ice collarA so!t !oo"s E Highest ris: o! hemorrhage > !irst 2/ hrs an" 4&.; "a s +ost&o+ )with sloughing o! sca-s* o #rimar me"s !or E7 !or res+irator "istress > Sus&+hrine )E+ine+hrine HCl* an" <heo+h lline )<heo&"ur* E %roncho"ilators o Must :now normal res+irator rates !or :i"s E 7es+irator "isor"ers > #rimar reason !or most me"ical=E7 $isits !or :i"s E New-orn E 5;&3; .&.. mo E 24&54 .&5 ears E 2;&5; 5&4 ears E 2;&24 3&.; ears E .0&22 ..&.3 ears E.3&2; Car"io$ascular (isor"ers o Ac anotic > ,S(A AS(A #(AA Coarc o! AortaA Aortic Stenosis Anti+rostaglan"ins cause closure o! #(A )aorta & +ulmonar arter *

o C anotic > <etralog o! 1allotA <runcus Arteriosis )one main $essel gets miIe" -loo"*A <,G )<rans+osition o! Great ,essels* E #ol c themia common in C anotic "isor"ers 5 <s o! C anotic Heart (isease )<etralog A <runcusA <rans+osition* o <etralog o! 1allot E ?noI genate" -loo" +um+e" into aorta #ulmonar Stenosis ,S( H$eri"ing Aorta 7ight ,entricular H +ertro+h <E< S+ells EH +oIic e+iso"es that are relie$e" - sLuatting or :nee chest +osition o CH1 can result E ?se (igoIin E <7 > ;80&28; !or :i"s o (uctus ,enosus > ?m-elical ,ein to In!erior ,ena Ca$a o (uctus Arteriosus > Aorta to #ulmonar Arter o 7heumatic 1e$er E AcLuire" Heart (isease E A!!ects aortic an" mitral $al$es #rece"e" - -eta hemol tic stre+ in!ection Er thema Marginatum > 7ash Ele$ate" ASH titer an" ES7 Chest +ainA shortness o! -reath )Car"itis*A migrator large Moint +ainA tach car"ia )e$en "uring slee+* <reat with #enicillin G > #ro+h laIis !or recurrence o! 71 Maternit o (a . o! c cle > 1irst "a o! menses )-lee"ing* E H$ulation on (a ./ E 20 "a s total E S+erm 5&4 "a sA Eggs 2/ hrs E 1ertili'ation in 1allo+ian <u-e o Cha"wic:s Sign > %luing o! ,agina )earl as / wee:s* o Hegars Sign > So!tening o! isthmus o! cer$iI )0 wee:s* o Goo"ells Sign > So!tening o! Cer$iI )0 wee:s* o #regnanc <otal wt gain > 24&5; l-s )..&./ :g* o Increase calorie inta:e - 5;; calories="a "uring #G E Increase +rotein 5; g="a E Increase ironA CaBBA 1olic Aci"A A & C o (angerous In!ections with #G E <H7CH > <oIo+lasmosisA otherA 7u-ellaA C tomegalo$irusA H#, o %raIton Hic:s common throughout #G

o Amniotic !lui" > 0;;&.2;; mL )@ 5;; mL > Hligoh "ramnios > !etal :i"ne +ro-lems* o #ol h "ramnios an" Macrosomia )large !etus* with (ia-etes o ?m-elical cor"F 2 arteriesA . $ein E ,ein carries oI genate" -loo" to !etus )o++osite o! normal* o 1H7 > .2;&.3; o 1olic Aci" (e!icienc > Neural tu-e "e!ects o #re&term > 2;&56 wee:s o <erm > 50&/2 wee:s o #ost&term > /2 wee:sB o <#AL > <erm -irthsA #re&term -irthsA A-ortionsA Li$ing chil"ren o Gra$i"a > U o! #regnancies regar"less o! outcome o #ara > U o! (eli$eries )not :i"s* a!ter 2; w:s gestation o Nagales 7ule E A"" 6 "a s to !irst "a o! last +erio"A su-tract 5 monthsA a"" .2 months > E(C o Hg- an" Hct a -it lower "uring #G "ue to h +erh "ration o Si"e&l ing is -est +osition !or utero+lacental +er!usion )either si"e tho le!t is tra"itional * o 2F. LecithinFS+hingom elin 7atio > 1etal lungs mature o A1# in amniotic !lui" > +ossi-le neural tu-e "e!ect o Nee" a !ull -la""er !or Amniocentesis earl in #G )-ut not in later #G* o Lightening > 1etus "ro+s into true +el$is o Nesting Instinct > %urst o! Energ Must -e!ore la-or o <rue La-or > 7egular contractions that intensi! with am-ulationA L%# that ra"iates to a-"omenA +rogressi$e "ilation an" e!!acement o Station > Negati$e a-o$e ischial s+inesA #ositi$e -elow o Leo+ol" Maneu$er tries to re+osition !etus !or "eli$er o La-oring Maternal ,itals E #ulse @ .;; )usuall a little higher than normal with #G & %# is unchange" in #G*8 < @ .;;8/ o NHN&Stress <est E 7eacti$e > Health )1H7 goes u+ with mo$ements* o Contraction Stress <est )Hc tocin Challenge <est*E ?nhealth > Late "ecels note" )+ositi$e result* in"icati$e o! ?#I E VNegati$eW result > No late "ecels note" )goo" result* o 9atch !or h +ore!leIia with Mag Sul!ate a"min 8 8 8 (ia+hragmatic Inhi-ition

 Cee+ Calcium gluconate - the -e" )anti"ote* o 1irsts 1etal H% E 0&.2 wee:s - (o++lerA .4&2; wee:s - !etosco+e 1etal mo$ement > Quic:eningA ./&2; wee:s Showing > ./ wee:s %raIton Hic:s N / months an" onwar" o Earl (ecels > Hea" com+ression > HC o ,aria-le (ecels > Cor" com+ression > Not Goo" o Late (ecels > ?tero&+lacental insu!!icienc > %A(T o I! ,aria-le or Late (ecels E Change maternal +ositionA Sto+ #itocinA A"minister H2A Noti! #h sician o (IC E <I is with He+arin )sa!e in #G* E 1etal (emiseA A-ru+tio #lacentaA In!ection o 1un"al Heights .2&./ w:s E At le$el o! s m+h sis 2; wee:s E 2; cm > Le$el o! um-ilicus 7ises P . cm +er wee: o Stages o! La-or Stage . > %eginning o! 7egular contraction to !ull "ilation an" e!!acement Stage 2 > .; cm "ilation to "eli$er Stage 5 > (eli$er o! #lacenta Stage / > .&/ Hrs !ollowing "eli$er o #lacenta Se+aration E Lengthening o! cor" outsi"e $aginaA gush o! -loo"A !ull !eeling in $agina E Gi$e oI tocin a!ter +lacenta is out N Not -e!ore8 o Schult' #resentation > Shin si"e out )!etal si"e o! +lacenta* o #ost+artum ,S Sche"ule E$er .4 min X . hr E$er 5; min X neIt 2 hours E$er Hour X neIt 2&3 hours <hen e$er / hours o Normal %M !or mom within 5 "a s > Normal o Lochia E no more than /&0 +a"s="a an" no clots O . cm E 1lesh smell is normalA 1oul smell > in!ection o Massage -ogg uterus to encourage in$olution E em+t -la""er ASA# N ma nee" to catheteri'e E 1ull -la""er can lea" to uterine aton an" hemorrhage

o <ears E.st (egree > (ermisA 2n" (egree > mm=!asciaA 5r" (egree > anal s+hincterA /th (egree > rectum o A#GA7 > H7A 7A mm toneA 7e!leI irrita-ilit A Color E . an" 4 minutes E6&.; > Goo"A /&3 > mo"erate resuscitati$e e!!ortsA .&5 > mostl "ea" o E e care > E&m cin B Sil$er Nitrate E !or gonorrhea o #u"en"al %loc: > "ecreases +ain in +erineum an" $agina N No hel+ with contraction +ain o E+i"ural %loc: > <.;&S4 E %loc:s all +ain E 1irst sign > warmth or tingling in -all o! !oot or -ig toe o 7egional %loc:s o!ten result in !orce+s or $acuum assiste" -irths -ecause the a!!ect the mothers a-ilit to +ush e!!ecti$el o 9%C counts are ele$ate" u+ to 24A;;; !or P.; "a s +ost +artum o 7ho)(* immune glo-ulin )7hoGAM* is gi$en to 7h& mothers who "eli$er 7hB :i"sE Not gi$en i! mom has a BCoom-s <est E She alrea" has "e$elo+e" anti-o"ies )too late* o Ca+ut Succe"aneum > e"ema un"er scal+A crosses suture lines o Ce+halhematoma > -loo" un"er +eriosteumA "oes not cross suture lines o Suction Mouth !irst N then nostrils o Moro 7e!leI > Startle re!leI )a-"uction o! all eItremities* N u+ to / months o 7ooting 7e!leI E u+ to / months o %a-ins:i 7e!leI E u+ to.0 months o #almar Gras+ 7e!leI ELessens - / months o %allar" Scale use" to estimate gestational age o Heel Stic: > lateral sur!ace o! heel o #h siologic Saun"ice is normal at 2&5 "a s E A-normal i! -e!ore 2/ hours or lasting longer than 6 "a s E ?nconMugate" -iliru-in is the cul+rit8 o ,itamin C gi$en to hel+ with !ormation o! clotting !actors "ue to !act that the new-orn gut lac:s the -acteria necessar !or $itamin C s nthesis initiall E ,astus lateralis mm IM o A-rutio #lacenta > (ar: re" -lee"ing with rigi" -oar" li:e a-"omen o #lacenta #re$ia > #ainless -right re" -lee"ing o (IC > (isseminate" Intra$ascular Coagulation E clotting !actors

use" u+ - intra$ascular clotting N Hemorrhage an" increase" -lee"ing times result E Associate" with !etal "emiseA in!ection an" a-ru+tio +lacenta8 o Magnesium Sul!ate use" to re"uce +reterm la-or contractions an" +re$ent sei'ures in #re&Eclam+sia E Mg re+laces CaBB in the smooth mm cells resulting relaIation E Can lea" to h +ore!leIia an" res+irator "e+ression N Must :ee+ Calcium Gluconate - -e" when a"ministering "uring la-or > Anti"ote E Monitor !orF A-sent (<7s 7es+irations @ .2 ?rinar Hut+ut @ 5;=hr 1etal %ra" car"ia o #itocin )HI tocin* use !or ( stociaE I! uterine tetan "e$elo+sA turn o!! #itocinA a"min H2 - !ace mas:A turn +t on si"e8 #itocin can cause water intoIication owing to A(H e!!ects8 o Sus+ect uterine ru+ture i! woman com+lains o! a shar+ +ain !ollowe" - cessation o! contractions o #re&Eclam+sia > Htn B E"ema B #roteinuria o Eclam+sia > Htn B E"ema B #roteinuria B Sei'ures an" Coma E Sus+ect i! Se$ere HA B $isual "istur-ances o No Couma"in "uring #G )He+arin is HC* o H +eremesis Gra$i"arum > uncontrolla-le nausea an" $omiting E Ma -e relate" to H8 + olori E 7eglan )metaclo+romi"e* o Insulin "eman"s "ro+ +reci+itousl a!ter "eli$er o No oral h +ogl cemics "uring #G N <eratogenic E Insulin onl !or control o! (M o %a-ies -orn without $aginal sLuee'e more li:el to ha$e res+irator "i!!icult initiall o C&Section can lea" to #aral tic Ileus E Earl am-ulation hel+s o #ost+artum In!ection common in +ro-lem +regnancies )anemiaA "ia-etesA traumatic -irth* o #ost+artum Hemorrhage > Lea"ing cause o! maternal "eath E 7is: !actors inclu"eF ( stociaA +rolonge" la-orA o$er"isten"e" uterusA a-rutio +lacentaA in!ection <I inclu"es E 1un"al massageA count +a"sA ,SA I, !lui"sA HI tocinA noti! +h sician o Sitteriness is a s m+tom o! h +ogl cemia an" h +ocalcemia in

the new-orn o H +ogl cemia E tremorsA high +itche" cr A sei'ures o High +itche" cr B -ulging !ontanels > IIC# o H +othermia can lea" to H +oIia an" aci"oisis E Cee+ warm an" use -icar-onate +rn to treat aci"osis in new-orn8 o La on right si"e a!ter !ee"ing E Mo$e stomach contents into small intestine o Saun"ice an" High -iliru-in can cause ence+halo+ath E @ .2 > normal E #hotothera+ "ecom+oses -iliru-in $ia oIi"ation E #rotect e esA turn e$er 2 hours an" watch !or "eh "ration E <he "angerous -iliru-in is the unconMugate" in"irect t +e8 Nutrition o CB E %ananasA "rie" !ruitsA citrusA +otatoesA legumesA teaA +eanut -utter o ,itamin C E CitrusA +otatoesA cantalou+e o CaBB E Mil:A cheeseA green lea! $eggiesA legumes o NaB E SaltA +rocesse" !oo"sA sea!oo" o 1olic Aci" E Green lea! $eggiesA li$erA citrus o 1eBB E Green lea! $eggiesA re" meatA organ meatA eggsA whole wheatA carrots ?se R&trac: !or inMections to a$oi" s:in staining o MgB E 9hole grainsA green lea! $eggiesA nuts o <hiamine )%.* E #or:A -ee!A li$erA whole grains o %.2 E Hrgan meatsA green lea! $eggiesA eastA mil:A cheeseA shell!ish (e!icienc > %ig re" -ee! tongueA Anemia o ,itamin C E Green lea! $eggiesA mil:A meatA so o ,itamin A E Li$erA orange an" "ar: green !ruits an" $eggies o ,itamin ( E (air A !ish oilA sunlight o ,itamin E E ,eggie oilsA a$oca"osA nutsA see"s o %MI E .084&2/8D > Normal )Higher > H-ese* Gerontolog o Essentiall e$er one goes to Hell in a +rogressi$el "egenerati$e han"&-as:et <hin s:inA -a" slee+A mm wastingA memor lossA -la""er shrin:sA incontinenceA "ela e" gastric em+t ingA CH#(A

H +oth roi"ismA (ia-etes o Common AilmentsF (elerium an" (ementia Car"iac ( srh thmias Cataracts an" Glaucoma C,A )usuall throm-oticA <IAs common* (ecu-itus ?lcers H +oth roi"ism <h rotoIicosis )Gra$es (isease* CH#( )usuall com-ination o! em+h sema an" C%* ?<Is an" #neumonia E Can cause con!usion an" "elerium o Memor loss starts with recent N +rogresses to !ull o (ementia > Irre$ersi-le )Al'heimers* E (e+ressionA Sun"owningA Loss o! !amil recognition o (elerium > Secon"ar to another +ro-lem > 7e$ersi-le )in!ections common cause* o Me"ication AlertT E (ue to "ecrease" renal !unctionA "rugs meta-oli'e" - the :i"ne s ma +ersist to toIic le$els o 9hen in "ou-t on NCLEX E Answer shoul" contain something a-out eIercise an" nutrition8 A"$ance" Clinical Conce+ts o Eric:son E #s cho&Social (e$elo+ment ;&. r )New-orn* E <rust $s8 Mistrust .&5 rs )<o""ler*E Autonom $s8 (ou-t an" Shame E 1ear intrusi$e +roce"ures & Securit o-Mects goo" )%lan:iesA stu!!e" animals* 5&3 rs )#re&school* E Initiati$e $s8 Guilt E 1ear mutilation N %an"&Ai"s goo" 3&.2 rs )School Age* E In"ustr $s8 In!eriorit E Games goo"A #eers im+ortant E 1ear loss o! control o! their -o"ies .2&.D rs )A"olescent* E I"entit $s8 7ole Con!usion E 1ear %o" Image (istortion 2;&54 rs )Earl A"ulthoo"* E Intimac $s8 Isolation 54&34 rs )Mi""le A"ulthoo"* E Generati$it $s8 Stagnation H$er 34 )Hl"er A"ulthoo"* E Integrit $s8 (es+air o #iaget E Cogniti$e (e$elo+ment

 Sensorimotor Stage );&2* E Learns a-out realit an" o-Mect +ermanence #reo+erational Stage )2&6* E Concrete thin:ing Concrete H+erational Stage )6&..* E A-stract thin:ing 1ormal H+erational Stage )..&a"ult* E A-stract an" logical thin:ing o 1reu" E #s cho&SeIual (e$elo+ment Hral Stage )%irth &. ear* E Sel! grati!icationA I" is in control an" running wil" Anal Stage ).&5* E Control an" +leasure wrt retention an" +oo+ing N <oilet training in this stage #hallic Stage )5&3* E #leasure with genitalsA He"i+us com+leIA Su+erEgo "e$elo+s Latenc Stage )3&.2* E SeI urges channele" to culturall acce+ta-le le$elA Growth o! Ego Genital Stage ).2 u+* E Grati!ication an" satis! ing seIual relationsA Ego rules o Cohl-erg E Moral (e$elo+ment Moral "e$elo+ment is seLuential -ut +eo+le "o not aromaticall go !rom one stage to the neIt as the mature Le$el . > #re&con$entional E 7ewar" $s8 #unishment Hrientation Le$el 2 > Con$entional Moralit E Con!orms to rules to +lease others Le$el 5 > #ost& Con$entional E 7ightsA #rinci+les an" Conscience )%est !or All is a concern* Calculations 7ules & 1ormulas o 7oun" !inal answer to tenths +lace o 7oun" "ro+s to nearest "ro+ o 9hen calculating mL=hrA roun" to nearest !ull mL o Must inclu"e ; in !ront o! $alues @ . o #e"iatric "oses roun"e" to nearest .;;th8 7oun" "own !or +e"s o Calculating I, 1low 7ates <otal mL X (ro+ 1actor = 3; X UHrs > 1low 7ate in gtts=min o Calculating In!usion <imes <otal mL X (ro+ 1actor = 1low 7ate in gtts=min X 3; > Hrs to In!use

 Con$ersions o . t > 4mL o . < > 5 t > .4 mL o . o' > 5; cc > 5; mL > 2 < o . gr > 3; mg o . mg > .;;; ug )or mcg* o . :g > 282 l-s o . cu+ > 0 o' > 2/; mL o . +int > .3 o' o . Luart > 52 o' o (egrees 1 > ).80 X C* B 52 o (egrees C > )1 N 52* = .80 56 C > D083 1 50 C > .;;8/ 1 5D C > .;282 1 /; C > .;/ 1 1all #recautions o 7oom close to nurses station o Assessment an" orientation to room o Get hel+ to stan" )"angle !eet i! light hea"e"* o %e" low with si"e rails u+ o Goo" lighting an" re"uce clutter in room o Cee+ consistent toileting sche"ule o 9ear +ro+er non&sli+ !ootwear o At home E #aint e"ges o! stairs -right color %ell on cats an" "ogs Neutro+enic )Immunosu++resse"* #recautions o No +lants or !lowers in room o No !resh $eggies E Coo:e" !oo"s onl o A$oi" crow"s an" in!ectious +ersons o Meticulous han" washing an" h giene to +re$ent in!ection o 7e+ort !e$er O .;;84 )immunosu++resse" +ts ma not mani!est !e$er with in!ection*

 %lee"ing #recautions )AnticoagulantsA etc8* o So!t -ristle" tooth -rush o Electric ra'or onl )no sa!et ra'ors* o Han"le gentl A Limit contact s+orts o 7otate inMection sites with small -ore nee"les !or -loo" thinners o Limit nee"le stic:sA ?se small -ore nee"lesA Maintain +ressure !or 4 minutes on $eni+uncture sites o No straining at stool & Chec: stools !or occult -loo" )Stool so!teners +rn* o No salic latesA NSAI(sA or su++ositories o A$oi" -lowing or +ic:ing nose o (o not change ,itamin C inta:e i! on Couma"i