1.

CERVICAL CANCER
Risk Factors:
• African- American/ Native women
• Behavior (Sexual promiscuity)
• Chronic instrumentation of cervix
• Disease –STD
• Early age of Sex
• High Parity
• Poor Hygiene
• Low economic status
• Multiple sexual partners
• Partner with Prostate CA

Sx:
• Post-coital bleeding
• Painful sex
• Menstrual irregularities

2. OVARIAN CANCER
Risk factors:
• Ovarian dysfunction
• Vaginal use of talcum powder
• Alcohol
• Race - White women & family history
• Infertility
• Age - Peak=5th decade of life
• Nulliparity
• Genetic predisposition

3. DM FOOT CARE
• Meticulous care to feet
• Wash feet with warm water not hot & dry
• Can use lotion but No lotion in between toes
• Wear socks to keep feet warm
• Avoid thermal baths, heating pads
• Do not soak feet
• Inspect feet daily
• Do not treat corns, blisters
• Wear loose socks and no barefoot
• Change into clean cotton socks daily
• Break in new shoes gradually
• Use emery board
• Do not smoke
• Do not wear same pair of shoes 2 days in a row
• Check shoes for cracks before using
4. BLOOD TRANSFUSION REACTION
• Transfusion Reactions, Hemolytic Reaction, Allergic Reaction
• Circulatory Overload
• Septicemia
• Iron Overload
• Hypocalcemia
• Disease Transmission
• Hyperkalemia
• Citrate Intoxication

5. HYPERTHYROIDISM
• Soft smooth skin & hair
• Mood swings
• HPN
• Diaphoresis
• Intolerance to heat
• PTU drug to block thyroid synthesis

6. LUNG CA
• Bronchogenic Carcinoma
• 1st leading cause of death
• From asbestos, bacterial invasion,
cigarette
• Sx: Nagging cough, hoarseness of
voice, dyspnea, diminished breath
sounds

7. SX OF PARKINSONS
• Tremors, akinesia, rigidity
• Weakness, ―motorized propulsive gait
• Slurred speech, dysphagia, drooling
• Monotonous speech
• Mask like expression
• Teach ambulation modification: goose stepping walk (marching), ROM
exercises
• Meds—Artane, Cogentin, L-Dopa, Parlodel, Sinemet, Symmetrel
• Activities should be scheduled for late morning when energy level is highest
• Encourage finger exercises.
• Promote family understanding of disease intellect/sight/ hearing not impaired,

8. ACUTE PANCREATITIS
• Abdominal Pain severe –acute sx
• Complication : Shock,Hypovolemia
• Limited fat & protein intake
 9. CAST CARE
Don’t rest on hard surface
Don’t cover until dry 48+ hours
Handle with palms of hands not with fingers
Keep above level of heart
Check for CSM

10. HYDROCEPHALUS
• Anterior fontanel bulges & nonpulsating
• Bones of head separated (cracked pot sound)
• Check for sun-setting eyes
• D’ Increase ICP
• Evidence of Frontal Bossing
• Failure to thrive
• Irritability
• High-pitched cry

11. ESRD DIET

• Restricted protein intake
• Increase CHO
• Low K, P
• Restrict Na

12. NORMAL IN 8 MONTH OLD CHILD

- can sit with out support
- can roll from front to back
- can hold a bottle
- closure of ant. fontanel
- can say mama and dada
- 2 teeth present

13. SUPERIOR VENA CAVA OCCLUSION

• Sx occur in the morning
• Edema of face, eyes & tightness of shirt/ (Stoke’s sign)
• Late sx: edema of arms, hands,
dyspnea, erythema, epistaxis

14. ULCERATIVE COLITIS

Sx:
• Severe diarrhea with blood & mucus
• Abdominal tenderness & cramping
• Anorexia
• Wt. Loss
• Vit. K deficiency
• Anemia
• Dehydration
• Electrolyte imbalance
• Low residue & high protein diet

15. DILANTIN
• do not floss throughout the day
• do not use hard bristled toothbrush
• Gingivitis S/E

16. ANAPHYLACTIC REACTION

(steps)
• Stop medication
• Maintain airway
• Notify MD
• Maintain IV access of 0.9 NSS
• Place in supine position with legs elevated
• Monitor VS
• Administer prescribed emergency drugs

17. BLADDER CA
Risk Factors:
• Hx of smoking
• Exposure to radiation
• Working in industrial Factory

18. S/S OF DKA

• Fruity breath Odor
• Oliguria
• Kusmaull'’s (deep & nonlabored)

19. SITE FOR IM INJECTION ADULT

• Deltoid
• Ventrogluteal
• Vastus Lateralis
• Gluteus Maximus

20. S/S OF BACTERIAL MENINGITIS

•N&V
• Seizures
• Stiff Neck
• Photophobia

21. TB
• Waking up sweating at night
• Low grade fever
• Dull aching chest pain
• Cough streaked with blood
• Weight loss
• Anorexia
• Fatigue

22. LIVER CIRRHOSIS

•N&V
• Edema
• Ascites

23. PULMONARY EMBOLISM

Sx:
• Blood-tinged sputum
• Distended neck vein
• Chest Pain / Hypotension / Cyanosis
• Cough / Shallow respirations
• Rales on auscultation
• Tachypnea / Tachycardia

24. COLON CA
Risk Factors:
• Family HX
• Age above 50
• Jewish
• Male

25. DIGOXIN THERAPY

• Do not administer in infants if S/S OF CAD
• Chest Pain
• Palpitations
• Dyspnea / Syncope
• Hemoptysis
• Excessive Fatigue

27. COPD
• Rhythmic, diaphragmatic breathing
• If restless, perform purse-lip breathing not more than 1 minute
• Perform deep breathing with mouth held together during expiration

28. SEEN IN 15 MONTH OLD CHILD

• Speaks 6 words
• Sits w/o support
• Builds a tower of 5 blocks
• Strong palmar grasp

29. CUSHING’S SYNDROME

• Osteoporosis
• Muscle wasting
• Hypertension
• Purple skin striations
• Moon face
• Truncal obesity
• Decreased resistance to infection
• Low Carbohydrate, Low Calorie, High Protein, High K, Low sodium
• Monitor glucose level
• Check for color of stool, cortisol increase secretion of gastric acid – Peptic ulcer &
GI bleeding
• C/I to Aspirin, increased bleeding

30. ADDISONS DISEASE

Fatigue
Weakness
Dehydration
Eternal tan
Decreased resistance to stress
Low Sodium
Low Blood Sugar
High Potassium

High protein, carbohydrate, Sodium, Low potassium diet

Teach life-long hormone replacement

• Glucocorticoids (sugar) - Solu- Medrol (succinate) to prevent addisonian crisis
• Mineralocorticoids (salt) – Florinef

6 A's of Addison's disease

1.) Avoid Stress
2.) Avoid Strenuous
3.) Avoid Individuals with Infection
4.) Avoid OTC meds
5.) A lifelong Glucocorticoids Therapy
6.) Always wear medic alert bracelet

Addisonian Crisis
• Hypotension
• Extreme weakness
• Nausea vomiting
• Abdominal pain /
• Severe hypoglycemia
• Dehydration
• Administer NaCl IV, vasopressors, hydrocortisone
• Monitor VS /Absolute bedrest
31. PLACENTA PREVIA
• Check Hematocrit level
• External fetal monitor not internal
• No vaginal examination
• Assess for bleeding
• Improperly implanted placenta at
lower uterine
• Painless bright red, vaginal
bleeding
• Soft, relaxed, nontender uterus
• Fundal height greater than
expected

32. ABRUPTIO PLACENTA

• Premature separation of placenta from uterine wall
• Painful dark red bleeding
• Uterine rigidity
• Severe abdominal pain
• Maternal shock
• Fetal distress

33. HEMODIALYSIS
• Palpate for a bruit or thrill
• Weigh client daily, before, during & after
• Hold antihypertensive drugs b4 dialysis
• Check for thrill and bruit q 8 hours
• Don’t use extremity for BP, finger stick
• Monitor vital signs, weight, breath sounds
• Monitor for hemorrhage

34. PERITONEAL DIALYSIS

• Weight before and after treatment
• Monitor BP
• Monitor breath sounds
• Use sterile technique
• If problem w/ outflow, reposition client
• Side effects: constipation

35. TYPE 1 IDDM

• Test blood glucose every 4 hrs if no feeling well
• Eat fruit or cheese sandwich before exercise
• Do not exercise if blood glucose is >250mg/dl & urinary ketones present
• Administer regular insulin 30 minutes before meals

36. COMPARTMENT SYNDROME

• Increased pain & swelling
• Pain with passive motion
• Loss of sensation
• Inability to move joints
• Pulselessness

37. CARDIAC CATHETERIZATION

• NPO 6-8 hrs. & no liquid for 4 hrs. prior to prevent vomiting & aspiration
• Feel a flush, warm, fluttery feeling, desire to cough, palpitations in introduction of
dye
• Shave & Clean insertion site with antiseptic solution

38. PERNICIOUS ANEMIA

• Severe pallor
• Smooth, beefy red tongue
• Slight jaundice
• Paresthisias of hands & feet
• Disturbances with gait & balance

39. DUMPING SYNDROME

• Occurs 30 minutes after eating
• Abdominal fullness & cramping
• Diarrhea
• Tachycardia
• Perspiration
• Weakness / dizziness
• Borborygmi sound

40. TPN COMPLICATIONS

• Air Embolism
• Fluid Overload
• Hyperglycemia
• Hypoglycemia
• Infection
• Pneumothorax
41. DIC
• Bruising, purpura
• Presence of occult blood
• Low fibrinogen level, hct, platelet
• Increased PT, PTT
• Complication: RENAL FAILURE

42. PERIPHERAL ARTERIAL DISEASE

• Dry scaly skin on lower extremities
• Rest Pain, at night
• Intermittent claudication/
• Thickened toenails
• Cold & gray-blue color of skin
• Decreased or absent peripheral pulses
• Instruct pt. to walk to point of claudication, stop & rest & walk a little farther

43. THROMBOPHLEBITIS
• Avoid pressure behind legs
• Avoid prolonged sitting
• Avoid constrictive clothing
• Avoid crossing the legs
• Avoid massaging the legs

44. SYPHILIS
Painless chancre fades after 6 weeks
Low grade fever
Copper-colored rash on palms and soles of feet
Spread by contact of mucous membranes
Treat with Penicillin G IM
If patient has penicillin allergy, will use erythromycin for 10-15 days.
After treatment, patient must be retested to make sure disease is gone

45. POLYCYTHEMIA VERA

• Increased RBC
• Leukocytosis / Thrombocytosis
• Angina
• Intermittent claudication
• Dyspnea /HPN
• Lethargy / Syncope / Paresthesia

46. PRIMARY HPN

Risk Factors:
• Aging
• Black race
• Chronic stress
• Family Hx
• Obesity
• Smoking
• Men

47. CHOLECYSTITIS
Sx:
•N&V
• Belching
• Indigestion
• Flatulence
• Epigastric pain that radiates to the scapula 2 hrs. after eating fatty food
• Pain localized in RLQ
• Guarding, rigidity & rebound tenderness
• Cannot take a deep breath when fingers are pressed below hepatic margin
(Murphy’s Sign)

II. COMPUTATION
1. Dopamine
2. Dobutamine drip: Order is 2.5mcg/kg/min, patient weights 176 lbs.
Stock is 500mg in 500ml of NSS,
Compute for ml/hr?

Formula: Stock (mg) x 1000 mcg/mg

Quantity (ml)
Flow rate: Dose (mcg/kg/min) x wt (kg) x
60 min/hr
Concentration
(mcg/ml)

Answer: 12ml/hr

3. Md with IV order for patient 3,000ml in 24 hrs., get the rate at ml per hour.
Solution: 3000/24 = 125 ml/hr

4. Tablets : Dose of 20 mg per dose in stock dose of 5 mg per tablet, how many
tablets?
Solution: 20/5 x 1 = 4 tablets

III. TOPICS
1. SAFETY INFECTION CONTROL

AIRBORNE : Hepa Filter Mask / N95

Particulate MASK
PTB
Measles / Rubella
Chicken Pox/
Varicella
SARS
Anthrax

CONTACT : GGG
(gown,gloves,goggles)
Conjunctivitis
Open wounds /drainage
Lesions
MRSA / VRSA /
CDAD
RSV/ VRE

DROPLET : Surgical Mask

Scarlett Fever
Diphtheria
Meningitis
Strep. Pharyngitis
Pneumonia

ENTERIC: Gown , Gloves

Diarrhea
Hep. A
Salmonella
Acute Gastroenteritis
Peptic H. Pylori
Shigella / Rotavirus Giardiasis /
Cryptosporidium Muris

FROTECTIVE:
Blood dyscrasias
Aplastic anemia
Leukemia
Major burns (50%)
Organ transplant
Aids
Multiple Myeloma
Prolong Steroid Therapy

Concepts:
1. Infection control:
a. clean with clean for example patients with CVA, DM, Cardio disease

2. Same precaution techniques:

a. Universal precaution: Hep B,D, AIDS

2. PRIORITIZATION
Remember the rule of stable vs. unstable. Although you consider the client unstable
but if it expected in him, this is stable. Example. Asthma with wheezing- you
consider this unstable.
ABC, unstable , first think EXPECTED in asthma so this will be considered stable.

3. DELEGATION
RN - Newly admitted, needs assessment, pre op teaching and post op, nsg. Judgment
& discharge planning ,IV meds, BT.
LPN-Can give meds except IV, sterile techniques like wound dressing,
catheterization, insertion of NG tube, remove sutures. Stable expected outcome.

NA/ UAP/CN/ Senior nursing student - All “-ing” ex bathing, reading v/s in long
term pt. Testing occult blood, BS, monitoring, soap sud enema, testing occult blood,
-Isolation precautions, basic hygiene ADL, Input & Output, Finger stick with
gestational diabetes, urinalysis, TSB, turning unconscious patient, change perineal
pad, assist in ambulation,
discharge tomorrow,
-Stable v/s, pulse oximetry, reading,
terminally ill because of comfort only
needed.
- Routinary Procedure

4. Patient Hx C/I for MRI :

• Mitral Valve Replacement

5. Glaucoma :
• Halos around light

6. U waves :
• Hypokalemia

7. Patient with arterial insufficiency

• Elevate the affected leg

8. Patient with Dumping Syndrome:

• Avoid cheese

9. Adverse Effect of Anti-metabolite 5FU

• Stomatitis

10. Obtaining sputum specimen from pt. with tracheostomy:

• Instruct pt. to cough prior to obtaining sputum

11. Post-hypophysectomy pt. Report if:

• Specific Gravity of 1.005

12. Diet for Hypothyroidism

• Low sodium, High K

13. Patient with CHF cor pulmonale S & S

• Jugular vein distention & peripheral edema

14. Circumcision of a new infant:

• Diaper fasted loosely

15. Acute Pancreatitis

• Increase lipase/amylase

16. Short-term goal for anti-social patient

• Follow unit rules

17. Use of walker

• Partial weight bearing
• Stand in front, walk unto walker

18. Borderline patient

• Splitting

19. Neonates in nursery developed diarrhea

• Meconium stool study w/in 24 hrs.

20. Nsg. Action in pt. post cardiac catherization

• Check pulse in lower extremities

21. Diet for Diverticulitis

• Avoid high-fiber foods when inflammation occurs, only low residue
• Introduce soft high-fiber foods when inflammation has resolved

22. Low iron.WBC & albumin, what type?

• Nutritional deficit (malnutrition)

23. What will you ask on pt for cardiac stress test (Thallium stress test)?
• Is he on beta-blocker? (if with radionuclide already, Persantine, then invasive &
shld.
avoid caffeine, calcium channel blockers, b-blockers, theophylline)

24. Highest risk of accident

• 9 month infant eating grapes & apricot

25. Pancrease in Cystic Fibrosis

• Give with meals, dilute in applesauce

26. Client post-CVA, diet teaching

• Low salt, low fat

27. Client passing stones with calcium, diet teaching:

• Should be acid-ash diet & avoid oxalate rich & Ca rich food such as tea, almonds,
rhubarbs beans, spinach, cocoa, vegetables, fruits
• Give cranberries, prunes, plums, tomatoes, cereals, corn, legumes I
28. Paget’s Disease
• Bowing of bones

29. Side Effect of Ansef (Cefazolin)

• Antibiotic (RTI,URTI)
• Diarrhea, Nausea
• Oral candidiasis
• Pancythopenia

30. Peptic ulcer disease

• Avoid stressful situation to prevent exacerbation

31. Schilling’s Test

• For pernicious anemia

32. Prior To MUGA SCAN:

• Informed consent
• Allergy not a concern

33. Action of Aquamephyton

• Prevention of hypoprothrobinemia

34. Action of Lipitor

• Anti-lipimec

35. Positioning of Hip Spica Cast in children

• Maintain flexion, abduction & external rotation

36. Fear of 3 y/o child

• Injury (abandonment, castration)

37. To prevent ureteral stones

• Increase fluids

38. MDI
• Hold breath

39. Frostbite
• Soak in warm water

40. Normal respiratory changes in elderly

• Decreased cough reflex

41. Patient w/ DM & HPN, question if

• Given beta-blocker (causes bronchospasm )
42. Maximum injection on 10 month old infant
• 1 ml

43. Pt. with endometriosis takes Danocrine, action of the drug?

• Suppress menstruation/ ovulation

44. Post NSD with epidural anesthesia with bladder distension

• Offer bedpan

45. Apmhotericin B, side effect?

• Headache
• Hypokalemia
• Hypotension

46. PT. with angina unrelieved by 3 nitroglycerin

• Administer O2

47. Patient on Halo Vest

• Tape the wrench to the vest (Torque screw)

48. Pre-menopausal syndrome experiencing hot flashes

• Black Cohosh for menoposh

49. Abdominal Assessment

• Inspection
• Auscultation
• Percussion
• Palpation

50. Sclerotherapy
• Application of pressure dressing for 12-48 hrs.