NCLEX Bullets

• Odynophagia is painful swallowing, in the mouth (oropharynx) or esophagus. It can occur with or without dysphagia, or difficult swallowing
• Halitosis, oral malodor (scientific term), breath odor, foul breath, fetor oris, fetor ex ore, or most commonly bad breath are terms used to describe
• Pyloroplasty is surgery to widen the opening of the end of the pylorus, which is found in the lower portion of the stomach,
• Billroth I = gastroduodenal reconstruction
• Billroth II = gastrojejunal reconstruction
• ISOTONIC = the muscle shortens to produce contraction
• ISOMETRIC = NO CHANGE in muscle length
• ISOKINETIC = Involves muscle contraction or tension against a resistance
• Measure correct crutch length
  LYING DOWN
  Measure from the Anterior Axillary Fold to the HEEL of the foot then:
  Add 1 inch (Kozier)
  Add 2 inches (Brunner and Suddarth)
• Hyperalgesia—excessive sensitivity to pain
• Bruxism- commonly called night teeth-grinding occurring during stage 2 sleep
• Somnambulism- “sleepwalking"
• POLYSOMNOGRAPHY is the only method that can confirm sleep apnea.
• Urticaria - (or hives) is a skin condition, commonly caused by an allergic reaction, that is characterized by raised red skin wheals
• Pruritus- is an itch or a sensation that makes a person want to scratch.
• CAUTION ---- Mnemonics for early detection for CANCER
  C- Change in bowel/bladder habits
  A- A sore that does not heal
  U- Unusual bleeding
  T- Thickening or lump in the breast
  I- Indigestion
  O- Obvious change in warts
  N- Nagging cough and hoarseness
• Alopecia begins within 2 weeks of therapy. Regrowth within 8 weeks of termination
• Tenesmus is a feeling of incomplete defecation. It is experienced as an inability or difficulty to empty the bowel at defecation.
• The CONDUCTING SYSTEM OF THE HEART
  Consists of the
  1. SA node- the pacemaker
  2. AV node- slowest conduction
  3. Bundle of His – branches into the Right and the Left bundle branch
  4. Purkinje fibers- fastest conduction
• The Heart sounds
  1. S1- due to closure of the AV valves
  2. S2- due to the closure of the semi-lunar valves
  3. S3- due to increased ventricular filling
  4. S4- due to forceful atrial contraction
• The lymphatic system also is part of the vascular system and the function of this system is to collect the extravasated fluid from the tissues and returns it to the blood
• CARDIAC Proteins and enzymes
  CK- MB ( creatine kinase). Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days
• Troponin I and T
  Troponin I is usually utilized for MI. Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks!
  Normal value for Troponin I is less than 0.6 ng/mL
• Cholesterol= 200 mg/dL
• Triglycerides- 40- 150 mg/dL
• Ischemic changes may show ST depression and T wave inversion
• Nitrates- to dilate the coronary arteries
• Aspirin- to prevent thrombus formation
• Beta-blockers- to reduce BP and HR
• Calcium-channel blockers- to dilate coronary artery and reduce vasospasm
• After MI, Patients who are able to walk 3-4 mph are usually ready to resume sexual activities
• Infective endocarditis >> Osler’s nodes- painful nodules on fingerpads
• Infective endocarditis >> Roth’s spots- pale hemorrhages in the retina
• LEFT SIDED CHF
  1. Dyspnea on exertion
  2. PND
  3. Orthopnea
  4. Pulmonary crackles/rales
  5. cough with Pinkish, frothy sputum
  6. Tachycardia
  7. Cool extremities
  8. Cyanosis
  9. decreased peripheral pulses
  10. Fatigue
  11. Oliguria
  12. signs of cerebral anoxia
• RIGHT SIDED CHF
  1. Peripheral dependent, pitting edema
  2. Weight gain
  3. Distended neck vein
  4. hepatomegaly
  5. Ascites
  6. Body weakness
  7. Anorexia, nausea
  8. Pulsus alternans
• CARDIOGENIC SHOCK
  1. HYPOTENSION
  2. oliguria (less than 30 ml/hour)
  3. tachycardia
  4. narrow pulse pressure
  5. weak peripheral pulses
  6. cold clammy skin
  7. changes in sensorium/LOC
  8. pulmonary congestion
• CARDIAC TAMPONADE
  A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
• BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound
• ANEURYSM - Dilation involving an artery formed at a weak point in the vessel wall
  Saccular= when one side of the vessel is affected
  Fusiform= when the entire segment becomes dilated
  
  RISK FACTORS
  Atherosclerosis
  Infection= syphilis
  Connective tissue disorder
  Genetic disorder= Marfan’s Syndrome
• PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD) - Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis
• INTERMITTENT CLAUDICATION- the hallmark of PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD)
  Intermittent claudication is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically calf muscle
• RAYNAUD’S DISEASE - A form of intermittent arteriolar VASOCONSTRICTION that results in coldness, pain and pallor of the fingertips or toes
• Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It sometimes occurs on only one side of the mouth
• APLASTIC ANEMIA - A condition characterized by decreased number of RBC as well as WBC and platelets
• Pernicious Anemia - Beefy, red, swollen tongue (Schilling’s test)
• Progesterone - maintains the uterine lining for implantation and relaxes all smooth muscles
• Relaxin - is the hormone that softens the muscles and joints of the pelvis
• Thyroxine - increases basal metabolic rates
• Buck's Traction - Skin traction
• Skeletal Traction - with Pins
• Vit. B2 (riboflavin) deficiency - scaly skin
• Vit. A deficiency - Night blindness
• Vit. D deficiency - Skeletal Pain
• Zinc deficiency - slow wound healing
• Selenium deficiency - heart damage
• Toxoplasmosis parasite - infection from inadequately cooked meat, eggs, or milk, ingestion or inhaling the oocyst excreted in feline feces
• Sclerotherapy - injecttion of a sclerosing agent into a varicosity. The agent damages the vessels and causes aseptic thrombosis, which result in vein closure.
• Deep Tendon Reflex Test
  1+ - diminished
  2+ - normal
  3+ - increased, brisker-than-average
  4+ very brisk, hyperactive
• Involution is a progressive descent of the uterus into the pelvic cavity that occurse at approx. 1cm per day.
• FHR can be first heard with fetoscope at 18 to 20 weeks gestation. 10 weeks with a doppler ultrasound.
• Folic acid rich food are peanuts, sunflower seeds and raisins
• Variable deceleration = cord compression
• Early deceleration = pressure on the fetal head during a contraction
• Later deceleration = uteroplacental insufficiency
• Cystitis is inflammation of the urinary bladder.
• Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek).
• Partial weightbearing - 30% to 50% of the body weight on the affected limb
• Touch-down weight bearing allows the client to let the limb touch the floor but not bear weight.
• Thyroid supplements for hypothyroidism should be taken in the morning to avoid insomia.
• Croup - dont administer cough syrup and cold medicines because they will dry and thicken secretions. Sips of warm fluid will relax the vocal cords and thin the mucos.
• Koplik spots - small bluish-white spots with a red base found on the buccal mucosa
• German measles - pinkish-rose maculopapular rash on the face, neck and scalp. Reddish and pinpoint petechiae spots found on the soft palate
• Erythema infectiosum (fifth disease) [slapped cheek] - an intense, fiery-red, edematous rash on the cheeks.
• Rocky Mountain Spotted Fever (RMSF) - rash on the palm and soles of the feed and on the remainder of the body. Fever, headache, anorexia and restlessness. Meds given is Tetracycline hydrochloride (achromycin)
• Thioguanine and thiotepa are antineoplastic medications
• Ticlopidine hydrochloride (Ticlid) is a platelet aggregation inhibitor
• Erythema marginatum is characterized by red skin lesions that start as flat or slightly raised macules, usually over the trunk and that spread peripherally.
• Atrial fibrillation - Auscultating the apical pulse for an irregular rate while palpating the radial pulse for pulse deficit
• Triple dye is used for initial cord care because it minimizes bateria and promotes drying.
• A low cardiac output will cause the increased build-up of blood in the heart and pulmonary system, causing crackles to be heard in the lung fields.
• S3 heart sounds = ventricular gallop
• Trachoesophageal fistual = abdominal distension
• 3 stages of separation anxiety are PROTEST, DESPAIR AND DETACHMENT
• Anaphylactic shock = fatal allergic reaction
• Cardiac Tamponade - assessment findings include tachycardia, distant or muffled heart sounds, jugular vein distention and falling blood pressure accompanied by pulsus paradoxus ( a drop in inspiratory BY by > 10 mmhg)
• Spironolactone (Aldactone) > pt. may experience body image changes due to threatened sexual identity. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females.
• Diabetic ketoacidosis (DKA) - fruity odor to the client's breath
• Rhonchi - occur as a result of the passing of air through fluid-filled narrow passages. Rhonchi are sometimes referred to as "gurgles". Diseases with excess mucous product, such as pnemonia are associated with rhonchi. Rhonchi are usually heard on expiration and may clear with a cough.
• Urolithiasis is a condition in which crystals in the urine combine to form stones, also called calculi or uroliths
• Hodgkin's disease is a type of lymphoma distinguished by the presence of a particular kind of cancer cell called a Reed-Sternberg cell.
• Cardiogenic shock (left-sided heart failure) - includes altered sensorium, tachycardia, hypotension, tachypnea, oliguria, and cold, clammy, cyanotic skin
• Ovarian cancer symptoms include abdominal discomfort, irreg. menses, flatulence, fullness after a light mean and increase abdominal girth.
• Myocardial infarction:
  -ST segment elevation usually occurs immediately or during the early stages of MI.
  -The CK-MB isoenzyme begins to rise 3 to 6 hourse after MI.
  -T wave depression and abnormal Q wave changes occur within several hours to several days after the MI.
• Abdominal aortic aneurysm (AAA) symptoms are "heart beating" in the abdomen when supine or be able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be ausculated over the mass.
• Neuroleptic Malignant syndrome experiences an elevated in temperature ( sometimes up to 107 F) and parkinsonian symptoms
• Intermittent claudication usually refers to cramplike pains in the legs (usually the calf muscles, but may be in the thigh.
• Cholinergic effect includes increase in salivation, lacrimation, urination and defecation, bradycardia, hypotension and increaes muscle weakness
• Ventricular tachycardia is characterized by the absense of P waves, wide QRS complexes (usually greater then 0.14 second) and a rate between 100 and 250 impulses per minute.
• Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. There are no measurable rate and no visible P waves or QRS complexes.
• Inguinal hernia is a common defect that appears as a painless inguinal swelling when the child cries or strains.
• Partial obstruction of the herniated loop of intestine - difficulty in defecating
• Phimosis - a dribbling stream, indicating an obstruction in the flow of urine
• Cryptorchidism - absense of the testes within the scrotum.
• Triamterene (Dyrenium) is a potassium-sparing diuretic. Side effects include frequent urination and polyuria.
• Erythroblastosis fetalis is a hemolytic disease of the fetus or newborn resulting in excessive destruction of red blood cells (RBCs) and stimulation of immature erythrocytes.
• Glycosylated hemoglobin values of 8% or less are acceptable.