MY NCLEX NOTES & CHARTS
YouTube: @Heyrona

"Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time."
-Thomas A. Edison

Cerebral Angiography
BEFORE
1. Informed consent
2. Explain procedure
3. Lie the patient flat
4. Dye injected into femoral artery. Fluoroscopy & radiologic films taken after injection
5. Procedure Sedation
6. Skin prep; Chosen site shaved
7. Mark peripheral pulses
8. May experience feeling of warmth and metallic taste when dye injected
AFTER
1. Neurological assessment every 15-30 minutes until vitals stable
2. Keep flat in bed 12 to 14 hours
3. Check puncture site every hour
4. Immobilize site for 6 to 8 hours
5. Assess distal pulses, color & temperature
6. Observe symptoms of complications (allergic response to dye, puncture site, hematoma) 7. Force fluids
8. Accurate I&O

Lumbar Puncture
BEFORE
1. Informed Consent
2. Explain procedure
3. Position patient in lateral recumbent\fetal position at edge of bed

AFTER
1. Neuro checks every 15-30 minutes
2. Position flat for several hours
3. Encourage P.O. fluid to 3,000 mL
4. P.O. analgesics for headache
5. Observe insertion site for bleeding

Urinary Frequency Teaching
1. Empty the bladder frequently (every 2 hours)
2. Drinking at least 2000 mL of fluid per day
3. Limiting fluid intake before bedtime (NOT avoiding fluid intake) 4. Perform kegel exercises to strengthen the perineal muscles
5. Wearing a perineal pad

OB Maternity
*May occur in the first trimester and then again late in the third trimester because of pressure placed on the bladder by the enlarged uterus Potassium Rich Foods
• Kiwi
• Oranges
• Dried Fruit
• Bananas
• Cantaloupe
• Avocados
• Broccoli

• Dried Beans/Peas
• Lima Beans
• Mushrooms
• Potatoes
• Seaweed
• Soybeans
• Spinach

Sanguineous
• BRIGHT RED Indicates active bleeding
Serous
• Watery or Clear usually normal
Serosanguineous
• Pink tinged  Indicative of some bleeding
Purulent
• Yellow/Green Infection

CVA (Stroke)
LEFT CVA
• Aphasia (language difficulty)
• Alexia (reading difficulty)
• Agraphia (writing difficulty)
• Right hemiplegia or hemiparesis
• Slow, cautious behavior
• Depression & quick frustration visual changes, such as hemianopsia
*Responsible for language, mathematic skills, & Analytic thinking

RIGHT CVA
• Unawareness of deficits
• Loss of depth perception
• Disorientation
• Impulse control difficulty
• Poor Judgment
• Left hemiplegia OR hemiparesis
• Visual changes, such as hemianopsia
*Responsible for visual and spatial awareness &proprioception

Phosphate Rich Foods
• Fish
• Eggs
• Milk
• Cheese
• Large amounts of meat & fish
• Whole grains
• Carbonated beverages

Cardiac Catheterization
BEFORE
1. Informed consent
2. Explain procedure
3. NPO 8-12 hours
4. Empty bladder
5. Check pulse
6. Explain client may experience heat palpitations; desire to cough when dye injected
AFTER
1. Monitor vitals every 15 min for 2 hours. Then every 30 min for 1 hour 2. Check pulses, sensations, and bleeding at insertion site
3. Bed rest 6-8 hours with insertion site extremity straight!

SIADH
Early symptoms
1. Headache
2. Muscle cramps
3. Weight gain (no edema: Due to water being retained, NOT sodium)
Nursing Interventions
1. Restrict oral fluids 500-1000mL/day
2. Weigh daily same clothes + same time
3. Report altered LOC [headaches, confusion, lethargy]
4. Take seizure precautions
5. Monitor intake/output accurately
6. Medications: Demeclocycline or Lithium carbonate
7. Monitor Vitals: tachycardia, increased BP, hypothermia
8. Monitor decreased serum sodium + elevated urine sodium osmolality Heart Failure Teaching
Teaching
1. Follow fluid and sodium restrictions
2. Conserve energy  schedule REST PERIODS
3. Adhere to medication regimen
4. Weight self daily  notify health care provider of weight gain of
2lbs/24 hours OR 5lbs in 1 week*
5. Get influenza vaccine yearly
6. If prescribed  DIGOXIN, take pulse for 1 minute. Notify health care provider if pulse is below 60bpm.
7. Take diuretics in early morning and early afternoon
8. Notify health care provider of increased dyspnea, orthopnea, and inability to wear rings or shoes*

Iron Rich Foods
• Red meat
• Kidney & Lima beans
• Egg yolk
• Chickpeas
• Cooked Swiss chard
• Liver
• Molasses
• Lentils

• Carrots
• Raisins
• Apricots
• Kale
• Spinach
• Organ Meats
• Clams

Blood Transfusion Reactions
Circulatory overload
*Chest or lumbar pain, cyanosis, dyspnea, moist productive cough, crackles in the lung bases, distended neck veins, increased BP
Sepsis
*Tachycardia, Fever, abdominal cramps, N/V, diarrhea
Allergic + Transfusion Reaction
*Flushing, itching, urticarial, tachycardia, low back pain
Febrile Reaction
*Fever, chills, nausea

Magnesium (1.5-2.5)
Below 1.5 = Hypomagnesaemia
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Arrhythmias
Seizures
Tetany
Muscle weakness
Irritability
Lethargy
Dizziness
Confusion

Above 2.5 = Hypermagnesaemia
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Arrhythmias
Muscle weakness and fatigue
Nausea/Vomiting
Flushing & Sweating
Loss of deep tendon reflexes
Respiratory depression
Hypotension
Loss of consciousness

Sodium (135-145)
Below 135 = Hyponatremia
• Nausea
• Seizures
• Confusion
• Muscle weakness
• Headache
• Apprehension
*Fresh water drowning

Above 145 = Hypernatremia

• Lethargy
• Neuromuscular excitability
• Irritability
• Muscle twitching
• Weakness
• Fever
• Increased Blood Pressure
• Edema
*Heart Failure, Cushing's Syndrome, Diabetes Insipidus

Tyramine Rich Foods
• Red wine
• Beer
• Chocolate
• Aged Cheese
• Yogurt
• Soy Sauce
• Sauerkraut (sour cabbage)
• Liver
• Pizza or Homemade bread
• Meats that have been fermented
• Figs
• Bananas

Peripheral IV Complications
Infiltration
• Pain on IV site
• Cool and pale
• Flow of IV Stopped
• IV now into subcutaneous tissue Phlebitis
• Redness
• Pain
• Swelling
• Inflammation of vein
Infection
• Fever
• Pain at the site

Thrombosis
• Presence of a blood clot
• Absent pulses below the site of the clot formation
Thrombophlebitis
• Pain & swelling
• Redness
• Warmth
• Fever
• Leukocytosis (Increased
WBC)
Hematoma
• Leak of blood
• Bruise
• Swelling

Peripheral IV Treatment (Contin.)
Treatment
1. Stop the IV
2. Apply warm compress
3. Elevate arm
4. Start IV in new site OR opposite arm
*Infiltration, Phlebitis, Infection, Thrombosis, Thrombophlebitis
Treatment
1. Discontinue IV
2. Apply pressure
3. Apply cool compress
4. Start IV in new site OR opposite arm
*Hematoma

Therapeutic Drug Levels
Digoxin: 0.5-2.0 ng/mL
Lithium: 0.8-1.5 mEq/mL
Dilantin: 10-20 mcg/mL
Theophylline: 10-20 mcg/mL

Need to know *** Lab values***
Electrolytes
Chemistry
Sodium: 135-145
Glucose: 70-110
Potassium: 3.5-5.0
BUN: 7-22
Calcium: 8.5-11
Creatinine: 0.5-1.2
Chloride: 95-105
CPK: 21-232
Magnesium: 1.5-2.5
Urine specific gravity: 1.010Phosphorus : 2.5-4.5
1.030
Bilirubin: