where's the camera and so what's my voice i think that's it that's so tiny hi everyone my name is amanda from beautifulnursing.com so i'm here because when i first graduated nursing school i had no idea where to turn to to start studying for my nclex i had no idea what they were testing on i had no idea which program was for me and so i decided that i wanted to make my own little comprehensive review for you here on youtube so um that it's more accessible to everybody all right so we have quite an agenda today we are going to go over lab values abg's electrolytes safety precautions cast traction crutches canes walkers restraints diabetes ob maternity psych pediatric pharmacology blood therapy iv fluid types anaphylaxis ekgs delegation and prioritization that's it we're going to dive right in and hopefully by the end of this you'll have a good solid foundation on how you can study and what is going to be the most important remember the nclex is a safety test it's wanting to make sure you are safe as a nurse to practice so you have to think about that when you're studying why would they ask me this question what would make me safe in practice just show them what you showed your clinical instructors and you should be fine okay so let's start hi guys so i know lab values are quite a struggle for many people so watch these two tick tocks that i made on lab values to see if they help clarify these values for you and then we're going to talk about what to look for well i'm getting another call student nursing fairy godmother speaking lab values of course i can help with that potassium the number of bananas you buy from a store 3.5 to 5 fluoride it usually has to be at least 95 to 105 degrees to go swimming in a pool hemoglobin think puberty males 13 to 18 females 12 to 16. females usually go through puberty first magnesium think of magnum okay these are for men that are at least 1.5 to 2.5 times bigger finally bun levels if somebody has a nice bun usually they're a perfect 10 10 to 20. student nursing fairy godmother speaking more lab values of course i can help calcium you're reporting a theft from a redheaded mermaid calcium call 9-1-1 9-11 phosphate fossils oh my god these are at least 2.5 to 4.5 million years old creatine he is a creatine creature on a scale of zero to ten he's definitely a 0.5 to 1.5 white blood cells kids ages 4 to 11 are always getting sick really sodium this is absolutely delightful this can of color only cost me a dollar thirty five to a dollar forty five one thirty five to one forty five so now that you know these lab values you have to figure out what is critical what is concerning to the nurse now if you have a person in that's in with like pneumonia and maybe they have a white blood cell count of like 13 000 that's going to be more normal we're looking for things that are abnormal for their diagnosis coming in and there are some labs that are critical no matter what it is but you just remember the number six when you think of six i want you think of critical the concerning labs if the ph is in the sixes if potassium is in the sixes so 3.5 to five is normal if it's over that so over six that is going to be concerning and they might having heart arrhythmias so co2 of greater than 60 is concerning an o2 of less than 60 and platelets this is the only one that doesn't follow the sixes but if it's less than forty thousand all right so another thing with labs i wanted to mention was something called neutropenic precautions and what that means is if a patient has a white blood cell count of less than a thousand or neutrophils of less than 500 that means that they are put on what's called neutropenic precautions so any person that is taking care of that patient needs to have strict hand hygiene they need to not have fresh fruit or fresh vegetables or fresh flowers in the room they limit the amount of visitors that come in they cannot have people that have certain illnesses come in that room so again that's if a patient has less than a thousand with their white blood cell count or less than 500 with their neutrophils all right so you might get an abg question abg's are arterial blood gases they're to look at the blood to see the oxygenation to see if they're in an acidic state alkaline state so you need to know the numbers with the abg's the first thing you should know is hco3 which is bicarbonate so it's basic so that number is going to be 22 to 26. you should know paco2 that is going to be your carbon dioxide and those numbers should be 35 to 45 and then you should have your ph which is 7.35 to 7.45 now if you can remember the ph you can remember the paco2 because the last number is in the ph 7.3535 to seven point four five thirty five to forty five that's what the paco2 is so you might get one of these questions and we can do one together so when you see that the ph is high usually that patient is going to be irritable your everything in your body goes up they're going to be very irritated their respiratory rate's going to be high bp high heart rate is high um so everything is kind of going up whereas if the ph is low like if they're in an acidotic state that is more critical that's showing us that their body is shutting down so i'm just going to tell you what causes the body to be in an alkalosis state or meaning that the ph is high or they could have high bicarbonate bicarbonate basic remember bicarb basic you can remember a patient is put in an alkaline state if they have excessive vomiting suction or hyperventilation okay so if you remember those three things then everything else you can kind of put in that category of metabolic acidosis or respiratory acidosis okay those three things are going to cause that alkalosis so with acidosis meaning your ph is going to be low but your paco2 which is your carbon dioxide is going to be high so a very common cause of that is excessive diarrhea diarrhea is basic your stomach the acid in your stomach that's acidic but your diarrhea your your bowel movements are basic so if you're getting a rid of a lot of that basic material your body is going to be acidotic so signs and symptoms when your body is in acidosis or shutting down is going to be bradycardia lethargy hypotension coma and those are some of the symptoms again it's just showing when your body's in an acidotic state it is shutting down it's not functioning correctly and we need to you know intervene normally with the nclex that you know the questions might be like you have a patient coming in with excessive diarrhea what metabolic state might they be in but if you don't get a question like that and you actually have to do an abg question let's do it together so you get a white board and you want to write these down okay so let's get a pretend question ph is 7.5 that is going to be high so it's acidotic pco2 pco2 is normal and then hco3 normal is 22 to 26 this is low meaning that it's acidotic so it looks like here when we combine our arrows we figure out because this remember this carbon dioxide is respiratory this is going to be metabolic this bicarbonate so we have metabolic acidosis because they're acid so metabolic acidosis all right so as i said that the nclex is a safety exam so knowing your proper ppe and your safety precautions is crucial so we're going to start out with going through each of the precautions so we have standard precautions which you should know but i will just repeat it hand hygiene gloves gown mask when we say standard this means that applies to every single person that walks through the door in a clinic hospital whatever okay so next we have droplet droplet think of water through their droplets in the air okay so this is what you see in pertussis pneumonia influenza rubella and mumps okay so with this one you want to always have standard precautions but you also want to be wearing a surgical mask and have a private room if available now if there isn't a private room and in the question they say okay you have a patient that is on droplet precautions and you need to you know put two patients together you want to find somebody else that has that same precaution as your patient so like putting two pneumonia cases together or pertussis and pneumonia you don't want to put somebody that's on you know airborne precautions with someone on droplets so making sure to know those differences is very important so the next one airborne this is going to be measles tv and varicella chickenpox and so with airborne again we have those standard that are always in place but on top of that you want to have an n95 mask and you want to have the patient in a negative pressure room okay and then you also want to have a private room if available again you can put together two people with airborne precautions but a private room is preferred and these are for patients that have measles tb or varicella so now finally contact this one a lot of people when they hear it they're like seed if you know that's always the first one at least that i think of but with contact this can also apply to mrsa vre um herpes and it's important with contact that you use very good hand hygiene that is the number one thing that you should be doing to prevent crosstalk contamination or infection and then gloves gown all right so the next thing you should know is ppe how to put it on and how to take it off now thankfully with taking it off there's a really easy way to remember this and it's just to do it alphabetically so the components of ppe are that gown gloves mass goggles but with taking it off it's alphabetical so we're gonna start with gloves right because gl is the first one and then you're gonna have your goggles gog and then gown g-o-w and then mask so it's alphabetical so for putting ppe on i always thought of this about big don putting on his big equipment so he always wants to put the big things on first so he puts his gown on and then his mask and then his goggles and then the gloves so big don what's wants to put on the big equipment first all right so i did have an electrolytes video tick tock that was quite a great hack that you guys should watch now [Music] after watching that video remember that when you have a patient that has a potassium in the sixes that can be critical so that's one of those big electrolytes that you need to look for so you should know that with potassium you never want to do iv push with potassium and if you do have a patient that has high potassium levels you want to give them the antidote which is k so sodium chaoxylate a few other things with electrolytes when you think of calcium you know you think of skeletal uh muscle calcium movement you know so something with when you have low calcium your skeletal movements are going to be abnormal so you're going to see a person have tetany right abnormal skeletal movements they could have chavocyne or trosuscine all right guys so now that we've done a lot of these lab values and electrolytes we're going to go on to crutches and canes and walkers and i promise this section is going to be a lot easier than you think all right so with crutches your fingers should be two finger breaths below the axilla so the the crutches should come up to two finger breaths below the axilla line okay so as far as the crutch gates um so pretty much when you hear two or three or four point gates that just means the amount of points that are on the floor when this person is ambulating for an example like a two point gate that just means that you're moving like let's say your left crutch and your right foot together you're moving those two together now you're usually gonna with crutches move your affected side or your weak side first but with two point gate think about it you have two points on the ground you're going to move these two points together so maybe the left crutch and the right foot or the right crutch and the left foot so then for the three-point gait you're going to move both your crutches forward and have your weak leg advance and your strong leg on the ground move forward so that's going to be three points on the ground the four point gate it most resembles walking right because four points you're gonna have each of those crutches on the ground you're gonna have each of your feet on the ground so you're gonna have maybe you usually again move your affected side first but you can move your left crutch gate forward and your right leg forward then your right crutch gate forward and then your left leg forward if that makes sense so again when you think of crutch gates it's just the amount of points that you have on the floor okay and then for swing through it's just what it sounds like a swing so you put both crutches forward and your body kind of swings through ahead this is for people that have you know stronger extremities all right so i have a kind of a goofy way to remember um stairs with assistive devices so when you go up the stairs you want to use your good leg or good foot first when you go down the stairs you want to use your weak or bad leg or foot first so i always remember that with like good you're going up to heaven or down your it's bad you're going somewhere else that's how i remember going upstairs you know the stairs up to heaven is good you're using that good leg first whereas down you know there's different plans all right restraints so a restraint is a good thing to use if a patient becomes aggressive now you do not want to use restraints on somebody that might have a past history of being aggressive or a past history of something you want to use it only if in that present moment that that person is going to harm themselves or somebody else or if somebody you know maybe with dementia is pulling on their tubes you might have to put them in a restraint so um for restraints if they're less than nine years old it can be in for up to an hour nine to 17 two hours and adults for 18 plus 17 plus is four hours so an easy way to remember that is you keep timesing it by two so less than nine is one and then the next one is two and then two times two is four so if you keep timesing that by two that is the number you're gonna have of how many hours that patient should be in a restraint so there are two different types of restraints there is chemical which is giving some kind of medications maybe psychotropic or something that will calm the patient down um and maybe sedate them otherwise there is mechanical restraints which is going to be you know some kind of velcro or ties that will keep the patient held down informed consent is needed for restraints you also need a md order but in an emergency you can apply restraints you just need to make sure you have that order within an hour of applying those restraints so with medication administration the basics you should know is that with iv it usually has an onset of 5 to 15 minutes so it's the quickest way to get medication in and working sub q and im can take longer usually they're 35 to 45 minutes for an onset your antibiotics are doing some kind of ointment you want to make sure if the patient is three years old or older three years plus that you pull the pin up and back okay so when you're doing some kind of ointment administration and the patient is older than three years old you want to pull the pin up and back and i always think of that because when people are older you have to kind of look up to them so that's how i remember that and the nclex is a safety test so know your rights in medication administration so i always like to remember with this little phrase my parents drove right to dairy queen all right guys so when you go into this nclex exam there's a good chance that you might get a question on diabetes so it's important to know the different types and the different types of insulin that you might use to treat it so let's just go over it really quickly so type one i always remember with this with the letter k okay so type one you want to keep okay keep insulin nearby these patients are insulin dependent they need insulin to live another k kids usually this is adolescents that have this onset of finding out that they have diabetes type one okay these are younger patients that have this diagnosis when they find out and so that's another k and then the last one for type 1 is ketosis ketosis in type 1 you have the dka diabetic ketoacidosis which we'll get into but if you can just remember the letter k with type ones you will be great so the symptoms you see polyuria which is excessive urination polyphagia which is excessive appetite and polygypsia which is which is excessive thirst so those are the three big telltale signs of diabetes and so with the treatment in type one again i said if they don't have insulin they will die so remember d i e d for diet i for insulin that is the most important thing that they need and e is exercise exercise is like a natural insulin so those three things are very important for our type 1 diabetics type 2 is opposite usually these are people who have an adult onset because maybe you know they weren't following an exercise regime or a certain nutritious diet you know obesity and being overweight so they develop they can develop type 2 diabetes it's an adult onset they don't have ketosis the symptoms are very similar to type 1 but the treatment is going to be diet again that's the biggest thing with type 2 you want to make sure they stay away from those carbs and that they are having a more nutritious diet with less carbs and calories and protein they want more protein like they're going to have oral hypoglycemics so that's going to be your metformins and then a for activity so physical activity five times a week 30 minutes um that is usually what is recommended and yeah all right so diabetes insipidus what is that it's a decrease adh or antidiuretic hormone so what that is is think of diuretics they're getting rid of fluid in the body right so if you have anti-diuretics that fluid is staying in the body but you're having this excessive urination this excessive thirst so that polyuria and polydipsia and you're going to be really dehydrated so i always remember this diabetes insipidus with sip the word sip in there i need a sip of this because i'm dehydrated diabetes and sip it is i need a sip of this because i'm very dehydrated because i'm having so much urine output and i'm very thirsty oh it's not uncommon to get a urine specific gravity question with diabetes because with certain like diabetes mellitus and diabetes insipidus you have a high amount of urine output right so you're getting rid of a lot of urine and what does that do to your urine specific gravity it increases it's completely opposite and so that means that your specific gravity is more concentrated because you're having if you're having less urine out your specific gravity is going to go high if you're having more urine out your specific gravity is going to go low so normal urine specific gravity numbers are 1.003 to 1.030 all right so complications of diabetes so dka diabetic ketoacidosis that comes with type 1 diabetics and you can remember this by them having a blood glucose of usually over 250 and there is a simple way to remember the signs and symptoms of dka with just remembering the words dka so d is for dehydration k is for ketones okay because you're going to see ketones you're also going to see coo small breathing which is another k and you could see high potassium which is another k so d dehydration k for ketones acoustimal breathing and high potassium and then a meaning they are going to be in an acidotic state they're going to have acetone breath that fruity breath and they might have anorexia so they might not be eating due to them being nauseous so what is the treatment for dk the biggest thing you want to give is those iv fluids with regular insulin hypoglycemia this actually can be a fatal life-threatening complication of diabetes when your blood glucose is less than 70. so usually the causes are by a patient not having enough food or too much exercise or too much insulin and their blood glucose is just tanking so usually they're going to look like they're almost like drunk they're going to have slurred speech they might have a delayed reaction their heart rate and respiratory rate can be high their bp can be low so it looks too kind of like they're in shock so they're going to have those symptoms and with treatment if they are coherent and they're able to swallow you want to give orange juice first that's the first thing that you're going to do is give some kind of um like rapid carbs or sugar like orange juice and if you can't do that then you're gonna have to give them glucagon which is gonna raise their blood glucose levels okay and then finally hhs or hhnk which happens in our type 2 diabetics usually you'll see blood glucose levels of over 600 and with these symptoms you know you're going to see that they're going to have hot flush skin and it could be caused from like dehydration again when you have dehydration your skin is going to be hot and flushed and so the treatment for that one is just rehydrating the patient and giving them those fluids that they need along with insulin all right so you're gonna have to know insulin timings and the different types so we're gonna just start so with rapid you're going to have aspart or list sprue they all have ours in it for rapid you're going to these are ones that are quick so the onset is going to be 15 minutes their peak is going to be 30 minutes and their duration is going to be 3 hours 15 33 this is for rapid lispro or aspart the next one is short acting insulin this is the one that's rapid two that you can run iv so this is going to be your regular insulin that is short acting this one is the only one that can be run iv and your onset is going to be one hour your peak is going to be two hours and your duration is four hours so again you can just times it by two so one times two is two and then two times two is four so that makes it a little easier to remember that one all right so the next one is intermediate acting nph and so not clear it's not fast um and that one is you know that cloudy one as i said not clear so the onset with that one is going to be six hours the peak is eight hours and the duration is twelve so six eight twelve for intermediately the last one which is long acting long acting lontis this one is going to not even have a peak because it's going to have a 24 hour duration usually this patient takes it once a day the duration can actually be anywhere from 12 to 24 hours and you can give this medication in the night but just remember long long tests it can also be glossier so those are the ones for long-acting insulin just a few more things with diabetes remember normal blood glucoses are usually 70 to 110 when a patient is in the hospital we want to aim for them to be around 140 to 180 some other things to think about is an a1c what that is is also looking at your blood glucose levels but this is not the kind of thing you can fast for overnight it looks at the body's uh levels for the last three months so you just have to remind that patient that's getting an a1c test that they do not need to fast for it and usually you want to have less than six is considered normal if they already do have diabetes you want to have them less than eight honey we're pregnant what am i do okay so it's last menstrual period minus three months plus a week okay oh yeah these contractions yeah i'm 30 weeks okay i'll head on in thank you probable signs of pregnancy that a woman might notice is good dell sign which is softening of the cervix or they might see chadwick sign chadwick c cyanosis c so you'll see that cyanosis in chadwick sign all right so i'm sure you heard all about the fundus back in ob maternity but overall the fundus is the top of the uterus it keeps changing position as the woman progresses in her pregnancy so there are some important times to know so at 12 weeks is when they usually can start to palpate the fundus and then at 22 weeks the fundus should be at the umbilical after 24 weeks the fundus should be the same height as the number of weeks that the woman is in her pregnancy at 16 to 20 weeks a woman should feel quickening which is just a fancy term for the fetus kicking so it is common in the first trimester of pregnancy for the client to have a lot of nausea that is why you want to tell them to have dry carbohydrates so like crackers before they get out of bed now a pregnant woman should not be taking ibuprofen that is a category x they can take acetaminophen all right so you should know the stages of labor so in stage one that is when the cervix is dilating from zero to ten centimeters and there are three phases in stage one and the first phase is laden when the cervix is dilated one to four centimeters and the patient's contractions are not very close together okay so they're gonna be like five to thirty minutes apart they can be in this phase for weeks phase two is when it starts to get a little bit more serious it's active so this i like to think of when it's active it's happening kind of 24 7. so that's when they're going to be dilated four to seven centimeters get it 24 7 4 to 7 centimeters and their contractions could start to be three to five minutes apart last phase is the transition phase when the client is going to be eight to ten centimeters dilated usually they're like a hundred percent of face and their contractions are two to three minutes apart so contractions that last longer than 90 seconds or closer than two minutes apart are a very bad sign that is a danger sign that's saying okay this fetus could be in trouble they could have um fetal hypoxia so we want to you know do something right away you need to intervene when you see that these contractions are longer than 90 seconds or less than two minutes apart right so here are some common ob maternity meds that you should know so if a client comes in and she is pre-term and having contractions we might try to slow down those contractions by giving her a chocolytic turbutely in turbulene i think of a turbulence on a plane we want to slow that plane down slow those contractions down and that's what terbutaline is now on the other hand if maybe a woman is past her due date she's maybe at 41 or 42 weeks whatever it is or we need to get the baby out we're going to give that woman pitocin or oxytocin this is going to induce labor but this can also be used for postpartum postpartum hemorrhage so that is a important drug that you should know is pitocin or oxytocin all right so complications of pregnancy the first one is placenta previa that is that painless bright red vaginal bleeding that the patient has because they're placenta attached to part of the uterus instead of the fundus and it causes this bright red painless bleeding so you're going to want to give them fluids blood and they might have to deliver their baby all right so the next complication is a brepto placenta which is exactly what it sounds like the placenta was separated from the uterus so you're going to see this dark vaginal bleeding it's going to be very painful so with that one you know you're going to want to do oxygen you want to have bed rests they're going to have to deliver another complication that you should be aware of with pregnancy is going to be preeclampsia or eclampsia so what that is if you remember pre and preeclampsia that stands for protein area so these clients are going to see protein in their urine they're going to have a rising blood pressure a high blood pressure and they're going to see edema but the difference between preeclampsia and eclampsia is that the client with eclampsia is going to have seizures so if they come in you're going to have to put them on seizure precautions okay and just remember with seizure precautions what we want to do is we want to lie them on their side we don't want to have anything in their mouth like a tongue blade or anything you don't want anything in the mouth you want to make sure that you have oxygen and suction at the bedside you also want to have them in a circular position so if they are up in bed you want to have the rails up if they're down on the floor you want to be with them you want to time the seizure and you know just watch and yeah you might have to give them some kind of anti-seizure medication well for most complications and obedient maternity if you are in a rut and you don't remember anything just remember this that you want to use the phrase lion when you hear or see you have a question about ob maternity and some kind of complication remember this l is for lie them on their side i is to increase iv fluids o is to give them oxygen and n is to notify the provider of what's going on so we can intervene as quickly as possible all right so fetal heart rate is 110 to 160. if you see fetal bradycardia if their heart rate is less than 100 you're going to stop pitocin and do lion so lie on the left side the increase iv fluids oxygen and notify the provider now there are different fetal heart rates that you should be aware of because you might get a picture of it you might get a question and we're going to go over it so with fetal heart rates just remember that phrase veal chop so v for variable which is very bad um so vv variable very bad just remember that is a more fatal situation you have to intervene quickly because that is due to cord compression the next one is early acceleration so that is going to be head compression that is okay and the next one is accelerations which again is okay then the last one is late this one is not good so this is euro placental insufficiency and with that you are going to use lion when a woman is in recovery after giving birth there are four things that you should be checking frequently one is vital signs you want to make sure you're looking if there's any signs of you know infection or complications that you should be aware of two is checking the fundus so with that if you hear the words that it is displaced you want to catheterize if you hear that it's boggy you want to massage the fundus um you want to be checking those perineal plants if they're saturated in less than 15 minutes that might be something that you have to intervene with and they might you know need to have pitocin or something if they're having a postpartum hemorrhage and then finally repositioning and check for bleeding the postpartum to the fundal height should be after 24 hours back at the umbilicus all right so fetal positioning this is something you should also know is the most common fetal positions that are um most wanted because they have the least risk of complications are alloway and roa so left occiput anterior or right occiput anterior um the most uh dangerous uh fetal position that the p the baby could be in is op which is occipit occiput i can't pronounce it right posterior so with that you're going to put the patient in knee to chest position and have them push so the fetal station is the fetus's presenting part in relation to the maternal is ischial spine so you'll see it anywhere from like negative five to plus five been in labor for a while and they're still a negative one meaning that they're not descending down um you know the uterus then that could mean that maybe the head is too big or there might be some other issue at stake um but if the fetus is in like a plus one or plus two station that means that they are um going down that means that they are doing they're doing well that means they're ready psychiatric disorders the big ones that you should know there's major depression which is you know somebody having um many different symptoms like sadness lethargy fatigue weight gain weight loss plus anedonia which is that loss of pleasure in doing things they normally would or in doing everyday things um schizophrenia you know having these hallucinations these delusions they might have um and then bipolar so bipolar you're going to have two different types bipolar 1 is more severe this is going to be more of that mania so when somebody is really hyper they're talking really fast they're moving fast they might wear bright colors and you know walk into the street and think they're invincible that they can't be hit by cars or something like that so that is the mania part of bipolar whereas the other part of bipolar has the depression so there's kind of a mix of the two and that's what makes it bipolar is that mania and the depression and bipolar 2 it's a less severe form that's more emphasized on the depression part of bipolar there are some things that you need to do as a professional nurse to have a therapeutic communication and relationship with these patients so one is that you're going to acknowledge their feelings say um i see that you are feeling this way how does this make you feel or you know tell me more about how you are feeling that's always the most sweet spot phrase tell me more tell me how you feel so if there is an answer for that pick that one because usually it's that oh again you want to acknowledge their feelings you want to put them back in reality present reality so you know say i know that you're seeing this or i know you're hearing these sounds but they're not real they're not here i'm here i'm real kind of bring them back to reality it kept talking about something that you know you weren't comfortable with other residents maybe weren't comfortable with you're going to say hey that topic is off-limits or you know i'm sorry but we can't talk about that anymore dementia is usually the first stage of alzheimer's alzheimer's is that more severe memory depletion that you need to make sure to keep assessing their alert and orientation presenting reality and if they don't have dementia if all of a sudden they have this onset confusion they might have what's called delirium which is like this temporary um like ish like temporary psychosis that usually can come from you know having a uti or high fevers and as that's if they're you know they're alert and oriented and make sure to re-establish you know you're in a safe place and this is not going to last because with those patients that have delirium that is a temporary thing and you need to keep reminding of that them of that in a therapeutic way all right so we're going to get into pediatrics with talking about tetralogy of fellow so what is that that is a heart defect that causes chronic hypoxemia and so it's like they're not moving at warp speed get it like their hearts not pumping well enough to get oxygen out into the body so i remember the word vorp so i'm going to tell you what that stands for it is v for ventricular septal deviation o for overriding aorta r for right ventricular hypertrophy and p for pulmonary outflow tract obstruction is one heart defect that you should know with pediatrics but all of these other pediatric heart defects it is coincidental that all the ones that start with the t are the ones that are considered trouble or more complex cases that need further interventions or instructions so so an issue that some infants can face is this bilirubin this excess bilirubin that causes what's called jaundice or yellowing of the skin now normal bilirubin levels are 10 to 20 and so if jaundice is in the skin there's something called kernicterus which is bilirubin in the brain and that can cause this opus stonos which is this like positions of babies being hyper extended so that's just a side complication of having bilirubin in the brain so on to the more common pediatric milestones that you should know is at one month they should have a grasp reflex so when my daughter was born she grabbed my finger right away that was amazing and that's what they should have by four months they should be rolling from front to back and they might be starting to smile which is so cute and then around six months they should be rolling from back to front this is when they also can be starting their first sounds and they start getting teeth you'll start to see baby teeth starting to erupt around six months now six months is also the period where if the baby is on formula or breast fed they can supplement with milk or other foods that are mashed so like avocados or bananas or any kind of like soft foods so that's when you can start introducing those foods is that six months so then at eight months they should be able to sit unsupported nine to 12 months is when kids can start to walk to go on at two years they should be able to kick or throw a ball walk up and down the stairs so by three years old they should be able to run or draw a circle and then four years old you know they'll start to use scissors or poor beverages these pediatric milestones you want to keep in mind that you know if you get a question that asks what should a six month be able to do um and it gives you this list make sure to do the one that is like one that you would see at two months or three months something that you know they should be able to do it that age because not all kids that are at six months start to get teeth or not all kids that you know are nine months old start walking you know some kids it takes a lot longer so make sure to pick the earlier month or milestone than what they're actually asking if they're asking like what which one should they know how to do um so just a note that back is best so lying a baby supine is best when they're infants um to prevent sids and also suffocation and um another thing is that for pain levels you can tell a uh child's pain level by either using the wong baker faces scale which can be used from three plus or the flax scale this one is usually used for two-month-old to seven years old also important to know if you get a pediatric question is about nutrition now when kids are in the school age so four to six years old they might not start eating as much and it's because they're growing at a slower pace so they develop something called physiologic anorexia which is where they just don't have that need to eat so i remember in my case with my daughter our pediatrician said you know she's getting you know one full meal a day like that was good enough for her because you know she's not demanding as much so she was it felt like she was never hungry but that can be normal two in the form of nutrition you want to make sure that half their plate is gonna be fruits and veggies one fourth of the plate is grains one-fourth is protein and 1 cup dairy all right and then for medication administration for pediatrics remember that it's different that their dosages are usually based on weight so if you get a dosage calc question make sure to pay attention if the is a pediatric client that you look at their weight and what is appropriate for them based on that so the nclex is a safety exam so with pharmacology you should know uh toxic drug levels so we're gonna start with lithium lithium is used for bipolar disorder and those levels are 0.6 to 1.2 it is toxic over two the next one is digoxin otherwise known as digitalis otherwise known as lenoxone it is used for a fib atrial fibrillation or heart failure those levels are 0.5 to 2 anything over 2 are toxic the next one is theophylline those relax airway spasms those levels are 10 to 20. anything over 20 is toxic and then the last one is phenotoid or delanten those are an anti-seizure medication those levels are again 10 to 20 it's toxic over 20. there's a quick little tick tock video on anti-hypertensive medications that you might need to know it's such a beautiful day in nature my blood pressure is so low that pine tree is blocking my calcium oh our beta fish is so funny lol it's almost like he slows our heart rate just being by him ace you need to take a chill prill to relax your blood pressure i am jafar sultan of arghraba because i have decreased the workload of my heart i am the sartin the tide of this pool is making me swim so hard that it's literally draining the fluid from my body to lower my blood pressure oh diuretics and here is another tick-tock video on psychiatric medications that you should know [Music] so again with psychiatric medications you just want to remember your abcd ease fgs so a anticholinergics b blurred vision c constipation d drowsiness e euphoria f photophobia g-granulosotisis or low white blood cell and aphenothiazine is a first generation typical antipsychotic also an antiometic and it's a major tranquilizer tricyclic antidepressants i always think of this one because you know when you're on a tricycle you're releasing these endorphins and they're elevating your mood so one of the common drugs is elivils alivil so aleville aventille deceril ill that'll end with and they're mood elevators for depression benzodiazepine so these are your pams and diazepam all those pans and they're used pre-operatively they're used for muscle relaxants they're used for alcohol withdrawal and then for mao eyes usually they'll start with that mar gnar or par um the big thing to know with maoi is they are a antidepressant but they are not as commonly used because they can have a lot of interactions um but it is important to know that it can cause hypertensive crisis if combined with foods that are high in tyramine so you want to avoid like smoked meats and cheeses avocados bananas see them again is used for bipolar disorder so just remember the peas with lithium peeing pooping and paresthesia those are the three p's of lithium that you should know and when lithium is at toxic levels like i said levels for lithium are 0.6 to 1.2 anything over 2 is toxic when they have toxic levels they can have the t's tremors a taste that's metallic and too much pooping so diarrhea so tremors a taste that's metallic and too much pooping so diarrhea those are the toxicity symptoms and so um two another thing with uh lithium to know is that you need to watch also their sodium levels because patients can get low on sodium and they might need increased sodium to have normal levels if they're on lithium prolact zoloft those are all ssris um prozac in particular that can cause insomnia so you don't want to have that at night but these ones yeah are antidepressants they can have anti um anxiety properties so with ssris there's something that can be cause if there's too much called serotonin syndrome and a way to remember that is with the acronym sad so s is going to be for sweating a is for apprehension and d is for dizziness and they might even have a headache too so it's kind of those serotonin syndrome kind of looks a lot like panic and anxiety they're having too much serotonin so they're gonna be sweating apprehensive they're gonna be having that dizziness and might have a headache um so that's a way to remember serotonin syndrome with some of these ssris like prozac or zoloft circulating so two medications that you should be aware of too is you know just your ibuprofen acetaminophen so both of them are antipyretic so anti-fever analgesics anti-pain but ibuprofen is also an anti-inflammatory and aspirin which is part of that ibuprofen family is also an anti-platelet clopidogrel is an anti-platelet used to prevent mi and cva but there are those side effects because it is an antiplatelet they have a higher risk of bleeding and hemorrhage so you have to watch for that also know warfarin versus heparin so warfarin is like a maintenance oral anticoagulant um make sure to measure the pt inr the inr should be .8 to 1.1 less than 1.2 is good and heparin is like an immediate onset through iv or sub-q that can be used as an anticoagulant that you might see in the hospital um and you want to check the uh aptt levels right so some so some cardiac drugs you should know is nitroglycerin nitroglycerin is a vasodilator that decreases your blood pressure it dilates the vessels it is used for patients that are having stable angina so they can take those three times five minutes apart now if they're not having any relief from taking the nitroglycerin they need to call 9-1-1 because they're probably having an mi fourth thing with nitroglycerin too is you cannot mix nitroglycerin with erectile dysfunction medications like viagra with digoxin i already talked about digoxin but it's a cardiac glycoside used for heart failure to it help with those contractions of the heart you just want to remember those levels again so that point five to two epinephrine this is a vasopressor used for sepsis shock asthma it'll help increase that heart rate that cardiac output and blood pressure okay so here are some respiratory drugs that you should know first is albuterol this is a short acting rapid beta2 agonist usually used for acute asthma attacks then there's theophylline which is a bronchodilator that's more of like a maintenance medication but you want to remember that those levels should be 10 to 20. so then you want to remember prednisone that is an anti-inflammatory medication but you never want to abruptly discontinue using it i wanted to talk to you about antimicrobial drugs so anything with um cilin like amoxicillin or penicillin these are broad spectrum antibiotics that can be used for various infections do not want to give a patient cephalosporin if they are allergic to penicillin it's very important that is a huge safety issue if you give a patient who is already allergic to penicillin cephalosporin because they're have the same properties some of the same properties one antibiotic you should pay attention to is aminoglycosides somebody called it a mean old myosin so it is the top gun it's these big bad antibacks that we're going to use on these nasty gram-negative infections trying to wipe them out so with that when you think of a mean old mice think of a mouse mice have these big ears right so just remember there's ototoxicity and if there's issues with the ears then they're going to be dizzy and they might have some other issues like vertigo and then it also causes nephrotoxicity rifampin this is a medication used for tb but the big adverse effect to remember is that it can turn your body fluids orange so you might have orange tears orange um sweating orange urine that can be a common side effect and you should know the number one way to check for nephrotoxicity is check the creatinine levels always check creatinine levels for nephrotoxicity other antibiotic to be aware of is vancomycin and this can cause red man syndrome and hypotension which is something you need to monitor for other drugs you want to know is statins this is an anti-hyperlipidemic drug so you want to know that cholesterol should be less than 200 triglycerides less than 150 you want your ldls which is your lower density lipoproteins that should be less than 100 lower bad high is good so those high density lipoproteins should be greater than 60. so for a safety exam you should know antidotes so for warfarin it's vitamin k for acetaminophen it's acetylcysteine for opioids it's narcan or naloxone aspirin it's sodium bicarbonate makes sulfate it's calcium gluconate for heparin it's protamine sulfate and those are the antidotes that you should know for the nclex all right so now i'm going to talk about blood administration and iv fluids administration so with blood before you give the administration of blood you want to make sure that the patient is compatible with the type of blood that you ordered so you want to make sure you know that little chart knowing that o negative they're the universal donor a b positive is the universal recipient with blood you have to be giving that within 30 minutes of receiving blood from the blood bank and it has to be infused within four hours of administration so with blood that's one of those medications it is considered a medication that you administer that you need to verify with the second nurse to do your rights of medication administration and make sure to verify this order with a second set of eyes you want to stay with the patient for the first 15 minutes of giving the blood administration to look for if they have any reactions like anaphylactic shock and then you also want to take a set of vitals at the 15 minute mark if your patient does start to develop some kind of reaction to the blood you should be stopping the infusion immediately so with iv fluid administration you're going to do your rights of medication administration but there are different types of iv fluids there's the isotonic which means same osmolarity as blood this is used to replace fluid losses usually in emergencies like burns or shock so this is going to be your normal saline the 0.9 percent or lactated ringers then you have hypotonic solutions i always think of cells expanding with hypo so that is just sucking fluid into the cells to rehydrate these cells and the example fluid of that is going to be that half normal saline so that point 45 and then finally hypertonic solutions these are sucking fluid out of the cells maybe they're in fluid overload they got to get some of that fluid out so that solution is going to be three percent saline so there are different complications that can arise from iv fluid administration um you can have infiltration where fluid kind of seeps into the tissues here you're gonna discontinue whatever iv you have going you're gonna get a warm compress because you're gonna feel the skin it's gonna be edematous it's gonna be cool there's extravisation which is you having some kind of vesican going through that peripheral line and it goes out into the tissues like the same thing before but this is a vesican where it can harm these tissues so you're going to see all of a sudden the skin looking so red and painful and necrosis and burning so you're going to want to discontinue the iv get a cold compress and possibly give them an antidote and then the last complication is phlebitis which is a red streak at the insertion site and again you're going to want to discontinue that iv and give them a warm compress all right so i'm really quickly going to talk about burns so you have different types of burns you have superficial which is you know they might have some redness heat maybe some blanching of the skin it heals quickly then they could have superficial partial thickness burns where they're wet there's blisters it's pink they might have some pain and then there's full partial thickness which they're going to have blisters it's going to start to get more dry it's going to go deeper in the skin and it might be actually less pain because the deeper you go into the skin the less pain they're going to feel because it's going to burn those nerve tissue next one is full thickness burns they're going to be waxy they're going to be dry they're going to be white there's no pain or sensation something to know is that burn patients need a higher caloric intake so something too with burns that you should probably know is the rule of nines meaning that nines is how you're going to calculate the burn extent of the skin all right guys going on to ekgs so i made a tick tock first i want you to watch ekg is made ridiculously simple so the p wave is known as atrial depolarization or contraction after that the blood travels down to the ventricles to form the qrs complex known as ventricle depolarization or contraction after that you have the st segment which is the beginning of ventricular repolarization otherwise known as relaxation then finally you have the t wave where there again is ventricular repolarization anything with the p wave is considered atrial whereas the qrs is ventricular a lack of qrs complexes means asystole treat it with atropine or epinephrine this is to be aware of lack of qrs aces silly sawtooth appearance atrial flutter chaotic fibrillation bizarre tachycardia that you've seen an overview i just want to go over the rhythms real quick so over here this is sinus tachycardia so you want to treat if it's symptomatic and if it has over a hundred beats per minute that's when it's defined as that sinus tachycardia treatment is going to be beta blockers calcium channel blockers or cardioversion there is sinus bradycardia so the heart rate is less than 60 and again you can do that by counting the qrs complexes and timesing that by 10. and with this you want to treat it with atropine or even a pacemaker and that's if it's symptomatic okay so atrial flutter over here which is kind of that sawtooth appearance um so that one you're going to treat with like the vagal maneuver or adenosine or cardioversion so any atrial arrhythmias whether it's a flutter or a fibrillation you're going to do those abcds so you're going to treat with the adenosine you're going to treat with beta blockers calcium channel blockers and digoxin or linoxone or digitalis there's many different names so for example atrial flutter over here which is like a sawtooth appearance you're going to treat that usually with adenosine and then afib you're going to use those beta blockers the calcium channel blockers digoxins some patients can even be put on warfarin said in that tic-tac video before that tachycardia is usually described as bizarre so if you see an issue with the qrs complex meaning that it's ventricular so vtac a bizarre qrs complex ventricular tachycardia um this is treated with amiodarone or epi or defibrillation so anything that has to do with the p wave is going to be considered atrial so when you see that do those abcds now if it says something with the qrs that's going to mean that it's ventricular the most deadly one that you should be aware of besides a systole which is just a flat line is going to be ventricular fibrillation this is very deadly a patient can be dead within eight minutes if it's not treated properly so you want to do cpr right away and defibrillate and then finally asystole asicily is that flat line and just remember the a in a cistly stands for atropine e at the end of a sicily is epinephrine so those are the two things you're going to do to treat it and only cardiovert on rhythms that have the r the qrs complex because you need to cardiovert on that r so that is the time you can do that you can do that with a fibrillation that is just one example and then what are the ones that you can shock on those are like asus silly v-fib v-tac so just a quick thing about chest tubes what do they do they re-establish negative pressure in the pleural cavity so you have these different chambers in the chest tube you have a water seal a suction control and if you notice bubbling in the water seal this is not good this is the sign of an air leak so if for some reason the chest tool becomes this lodge you need to right away put a dressing on that is tented on three sides you need to monitor that patient hourly you need to notify the provider and just keep assessing your patient with chest tubes it's good to also understand air pressures so negative pressure is like keeping air inside it's like a vacuum keeping that inside your lungs um so it stays in there like if a person's on airborne precautions and they are in a negative pressure room they don't want those air particles going all over the room they want them to stay inside their lungs so positive pressure is where there is no air exchange so if a patient comes in and they have like a gunshot or pneumothorax we don't want that air to escape we also want them to get adequate oxygenation so it increases oxygen and decreases carbon dioxide get on to trach tubes tracheostomy is an incision made in the windpipe to relieve airway obstruction and so the tracheostomy is that stoma that's sitting there helping these patients breathe and so it's important when the nurse is taking care of a patient with a trach tube that you are suctioning as needed and not more than 10 seconds okay because that can increase intracranial pressure and we want to avoid doing that as much as possible with trach tubes you also want to use sterile technique there's a high risk of infection so always using sterile technique for trach tubes is incredibly important the patient does have a trach tube it's important at the bedside for them to have an obturator an ambu bag an oxygen device of some kind suction and a trach size that is normal to their size in one size smaller and if they do for some reason have decannulation or the trait coming out you want to call rapid response team you want to lay them supine give them oxygen and ventilate them using a bag valve mask okay so now i'm going to be talking about addiction and intoxication and overdoses so if a patient is on a depressant or a stimulant it's actually pretty easy to remember what their withdrawal symptoms will look like or what their intoxication symptoms will look like because if they are on a depressant and they have too much of that they are going to be super depressed everything is going to be low right but if they're withdrawing it's the opposite effect accent withdrawal are going to show a high heart rate a high bp tremors diaphoresis they can even have seizures and some depressants are like alcohol benzos or barbiturates uppers um usually these are not as tested upon but some to think about are just like caffeine cocaine adderall um methamphetamine skewades are a little different um so we're just gonna call them kind of a downer so when you have a high amount of a downer you're still gonna be down right because everything's gonna go down so your respiratory rates down heart rate your blood pressure you're gonna have constricted pupils now if you're withdrawing on a downer your symptoms are going to be a little bit more high so you're going to have panic diaphoresis yawning nausea vomiting diarrhea chills and fever so two if a patient is on an opioid and they're having intoxication remember if their respiratory rate is 12 you want to hold whatever medication maybe that they're on and notify the provider less than 10 you need to intervene and give them naloxone or narcan all right so this is the most important part of my lecture in my opinion because this is how you can answer the questions if you know none of this information that i just taught you and it all goes out the window i want you just to remember this section okay so we're gonna go over what is most important for you to answer in a question now if this question that the nclex is asking you is like who can you discharge home they're asking you who is the healthiest so you want to look at these different patients and trying to figure out who has something that's chronic who is something that is been in the hospital for a couple days for something that's not so serious um maybe they had a local anesthetic or you know they were admitted several days ago and they're just ready to go home that would be a patient that is okay to discharge you know what's going to happen when they go home someone that is unstable so it most of these questions are kind of like this where they're going to say okay which patient should the nurse look at force which patient should the nurse call back first you see a lot of those kind of questions with these nclex programs and you're always going to look for who's the most unstable it's like a game who's the most unstable welcome to the show when you look for the person that you need to that the nurse needs to intervene with first you're going to look for somebody that has an acute issue something that doesn't line up with their diagnosis so maybe a patient comes in that has crohn's but all of a sudden they're having tremors or seizures or some kind of neurological issue going on that doesn't go with their diagnosis so that is unstable it's unknown you don't know what's going to happen when they go home stable would be newly diagnosed or newly admitted or somebody that just transferred over from the ed or icu those are more unstable patients that the nurse should usually tend to first some unexpected things that you should look at they begin with h hemorrhage high fevers of like 105 or greater hypoglycemia and has no pulse or breathless those are very unexpected those are your unstable patients and if you see those that's the first one the nurse should go to all right so you need to know for the nclex delegation know the rights of delegation which is the right task the right circumstance the right person the right communication and the right supervision and i always remember that with the car pedals ken speed because you don't want to fastly go through delegating and doing something wrong you want to make sure when you are delegating to someone that you are staying in your lane and doing what is appropriate for to help not only you but to help this other person and the patient load okay you want to be a safe nurse so here's a list of things that might uh vary from institution to institution or what you cannot delegate to an lpn you cannot delegate hanging or mixing iv meds pushing iv meds giving blood products assessments planning teaching education you do not want to give unstable patients and an lpn should not be the first to do anything it usually should be the nurse who does something first and then they can reinforce whatever was done so if it was a wound change they can do the second wound change the nurse should do the first one if they're teaching something they should do the second set of teachings they shouldn't do the initial this is a list of things that you cannot delegate to a uap so that includes charting giving meds assessments that education that teaching planning treatments except enemas and never again the first of anything so uaps usually they are really great resource for doing you know ambulation helping with meals vitals blood glucose there's so many different things that lpns and uaps can help the nurse with you just need to know which ones are appropriate to delegate you do not want to give them an unstable patient or give them the first of anything especially if they did not have that training but you did so that wouldn't be inappropriate so you want to watch that on the nclex because you want to be a safe nurse love cnn's i i love lpns too i just i do try to try to convince me not to so finally when in doubt when you have these test questions and you might have select all the applies my best advice is to turn each of those little answers into a true false statement that will help you eliminate any unnecessary answers and if two answers are alike in one of those select all apply neither is correct okay and if there is an opposite answer so in one of these questions one of those is usually right you like what is the nurse's best action and that is not asking you what is the first thing you should do it's asking you if you could do one thing and leave what would it be so when you look at your list of options which of these things most will serve this problem or be a solution to this problem or fix it okay guys i hope you enjoyed this overview please comment if this helped you in any way i was super nervous to put this video out here i almost didn't want to but if i helped just one person if just one of you comments that this helped you then it will have been for something i it'll be worth it to me so i hope you guys have a good day i hope you pass your nclex you can do it i will be rooting for you keep me updated um bye you guys