clotting factor

Pregnancy - physiology


  • hCG - human chorionic gonadotropin - present in blood and urine, produced by blastocyst and placenta
  • Low levels of hCG could mean miscarriage, ectopic pregnancy, miscalculation of dates
  • High levels = molar pregnancy (cells that normally form a baby dysfunction and form cysts instead), multiple pregnancy (twins etc), miscalculation of dates
  • Progesterone increases fat deposition in early weeks and stimulates appetite
  • Increased oestrogen from corpus luteum promotes mammary gland development (breasts enlarge)
  • And inhibits ovulation via negative feedback [OES decreases GnRH release by hypothalamus –> linhibition of FHS and LH –> no ovulation]
  • Relaxin (secreted by corpus luteum) softens connective tissue in preparation for labour - not specific, all joints can be affected
  • Peaks in early and late pregnancy

Physical changes

Blood pressure

  • As early as 4 weeks into pregnancy 
  • plasma volume increase
  • caused by the affects of oestrogen and progesterone on the kidneys

OES and Prg cause vasodilation 

  • less resistance = less pressure
  • Heart rate increases by 25% to compensate
  • stroke volume increases 
  • increased overall cardiac output by 50% in third trimester

Direct action of enlarged uterus:

  • compresses the descending aorta and inferior vena cava 
  • decreased venous return - less blood in means less blood out, less blood in ventricle –> reduced pressure on walls –> reduced force to exit –> reduced placental perfusion
  • increased aortic pressure
  • increased heart rate
  • [shouldn’t sleep on back for this reason]


  • Fall in blood pressure (can cause collapse if serious)
  • Can cause foetal hypoxia even without mother symptoms

Haematological changes

  • red cell mass increase by 20% (renal - increased erythropoietin production in response to detection of blood oxygenation and sodium/water balance)
  • Plasma volume increases more than RBC count does, causing the impression of decreased haemoglobin (anaemia)
  • Increased tendency to clot (hypercoagulable)
  • due to increase in clotting factors and plasma fibrinogen
  • platelet production increase (however count drops due to increase in activity and consumption) - function remains normal]
  • WBC count may increase due to an increase in granulocytes

Respiratory changes

  • Increased chest diameter, diaphragmatic expression and elevation
  • dyspnoea common (difficulty breathing)
  • breathing becomes more costal (mouth) than abdominal 
  • mainly mediated by progesterone levels (cause bronchial and smooth muscle relaxation and hypersensitivity to CO2)

Changes to the urinary system

  • cardiac output increase –> increase in renal plasma flow and glomerular filtration
  • increase in urea, creatinine, urate and biocarbonate clearance 
  • with progesterone, renin and aldosterone up water retention increases
  • can lead to urinary stasis and increased risk of UTI
  • Any drugs given that are excreted renally must be given in much higher quantities consequently

Gastrointestinal changes

  • Appetite increase + cravings 
  • Gastric reflux sphincter relaxation (increased indigestion, also due to increased intra-gastric pressure (expanding uterus)) 
  • gallbladder dilated 
  • GI motility decreased and transit time slower 
  • albumin and protein decrease 
  • cholesterol twice normal value


  • Calcium reuptake into bloodstream results in mild decalcification of bones 
  • relaxin softens joints (pubic symphysis + alters gait (waddling))
  • abdominal muscles stretch to elastic limit 
  • stretch marks (stria gravidarum) caused by rupture of elastic fibres and small blood vessels 

Reproductive changes

  • Massive increase in mass
  • Placenta growth (nutrition, excretion, immunity, endocrine) 

Parental blood supply 

Anti-epileptics/Anti-convulsants Made Incredibly Easy


  • Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.
  • Monotherapy until seizures are controlled.
  • If failed: titrate up to maximum tolerated dose –> shift to alternative drug –> use drug combination –> VNS, DBS.
  • Full drug therapy for 2 – 3 years after the last fit.
  • Gradual withdrawal over at least 6 months.

Rx Profile:

(Drawings are courtesy of @mynotes4usmle​)


  • Mainly for generalized tonic-clonic seizures
  • Trigeminal neuralgia
  • Bipolar disorders (with depressive predomince) - mood stabelizier
  • NEVER in abscence seizures
  • SE:


  • Safer profile, with minimal interactions.
  • Bipolar disorders (with depressive predominance) - mood stabilizer  
  • SE: maculopapular rash; SJS


  • Broad spectrum anti-seizure; used in migraine.
  • SE of TopIRamate: enzyme Inhibitor + Renal stones.


Green: first line; Yellow: second line; Orange: third line; Red: contraindications. (Graph reproduced from Oxford Handbook of Clinical Medicine)

Epilepsy & Pregnancy:

  • Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.
  • Most of AEDs are teratogenic; Category D
  • Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.
  • Avoid phenytoin, valproate and barbiturates (use Lamotrigine)
  • Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)
  • Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.
  • Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.

Status Epilepticus:

  • WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.
  • Things to be done:
  1. Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.
  2. Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.
  3. Pulse oximetry, cardiac monitor.
  • How to treat?


Originally posted by disneypixar

Darkiplier is like Rat Poison

Specifically, like Vitamin K Antagonist type rat poisons.

Maybe it’s just me, but I do feel like certain objects have a personality, and I think this type of rat poison matches Darkiplier.

Originally posted by phanseptiic

In particular, the relevant features of this type of poison are:

  • While it can kill rapidly, this rat poison can take up to 6 weeks before killing its victim, which is an extremely long time for a poison
  • It works by depleting clotting factors. When you run out, you die
  • Until you run out, you don’t know how much danger you’re in
  • There is an antidote, but you have to take it every day for weeks at a time, assuming you don’t get re-poisoned at the same time
  • Once you’re out of clotting factors you can bleed anywhere: brain, chest, abdomen, gut, nose, gums etc.

So Vit K antagonist rat poisons are slow (patient), systematic (methodical) and provide a false sense of security (because there can be no symptoms for weeks) yet still very deadly.

Plus it is the ‘classic’ poison for a quiet murder.

Which I feel like this is probably Darkiplier’s poison of choice.

Today is the day of outreach for the March for Science’s week of outreach.I was going to post something cool about physics (probably will later this week) but I was also reading about a civil rights activist who had a hysterectomy without her consent, back in the days, well within living memory, when many southern states sterilized black women without their consent. (as an aside, the woman was Fannie Lou Hamer, and she famously coined the term Mississippi appendectomy to refer to this practice).

Now, obviously this is a terrible, racist violation of bodily autonomy, but one of the details that stuck out was that Hamer was 47 at the time. 

And then I remembered a story I’ve often retold, about Sally Ride and the Hundred Tampons. 

And then, I recalled my conversation just last night with my father about the science march, and science education, and how I don’t remember learning much about anatomy before I took it as a required course for my graduate degree. 

And then I remembered: I should take my iron pill.

And then I remembered: sexism. 

So: people who were not born with a uterus, here’s a very incomplete crash course in what I (a cis woman) for the most part was expected to learn mostly on my own between the ages of 12 and 20. Consider it a scientific public service.

1. People who get periods usually get them around once a month-ish. This can change based on a huge number of factors though, including pregnancy (don’t get periods), some forms of birth control (hormonal IUDs, some of the pill options), some other medications, some health conditions (PCOS, clotting factor disorders), stress (psychological or physical), and probably a bunch of other stuff. Ask your local gynecological specialist or certified nurse midwife since they will actually know. Actually, ask them for all of these if you need more details because they are experts.

2. People usually bleed for about 1-9 days according to the statistics from the app I personally use for tracking. 2-7 is most typical, 1 or 8-9 is nothing to worry about unless there’s a change or you’re running super low on iron or something.

3. Tampons should be changed when full. That will vary by person but I think 4-5 tampons a day is a decent estimate, so anyway long story short even if Sally Ride had gone up to space during her period and had a cycle on the longest end of normal, she would need no more than 50 tampons, and if she were more towards the average we’d be looking at closer to 20.

4. Also there are options other than tampons for blood collection. Google them if you’re interested.

5. Speaking of, periods are not in fact controllable. If someone says you should be able to hold it, they have literally no idea what they are talking about. It is the process of discharging the uterine lining, and while it would be great if humans could reabsorb it or just selectively get rid of it at leisure as if we were spitting out chewing gum, biology has not deigned to work that way. 

6. If you’re a cis man grossed out by this I have to hear about your body fluids, both liquid and gaseous, all the time, so I 100% do not care. Also at work I once had to look up what an episiotomy was while simultaneously on the phone and drinking my morning coffee so actually I 110% do not care.

7. Menopause average onset is about 48-55 years old, so there is statistically little to nothing to be gained in terms of sterilization by taking out a 47 year old’s uterus, even if she does give permission. That isn’t to say that menopausal people shouldn’t ever get hysterectomies since there are actual medical indications for that, but yeah, this didn’t even do anything for the illicit sterilization goal. The only motivation was being racist as fuck.

8. Similarly if you make jokes about a cis woman politician in her late 50s or above being on her period or being unreliable emotionally as a result of her menstrual cycle, you are almost certainly incorrect and completely certainly not funny.

9. PMS does exist and is tied to medically confirmed hormonal fluctuations that can cause psychological, digestive, and pain symptoms among others. If someone is mad at you, do not assume it is PMS. To paraphrase Margaret Atwood, I’m not mad at you because I’m PMS-ing. I’m mad because you’re an asshole.

10. Birth control pills, which contain hormones, can help smooth out those hormonal fluctuations and help with PMS symptoms.10. Speaking only anecdotally here but most people who menstruate do not take sick days every month either. Some do need to take time off, due to severe symptoms that the pill/a few NSAIDS and a death glare cannot alleviate. A recent study found that in some people, cramps are of equivalent pain as a heart attack. Would you go into work while feeling like you’re having a heart attack? I doubt it given further anecdotal observation of how people act when they have a mild cold or hangover.

This has been: the science of knowing pretty much the absolute minimum about what uteruses do when their owners aren’t pregnant.


First Aid Advance for Serious Trauma

Researchers are reporting a new sprayable foam that can stop major internal or external bleeding without needing to compress the wound, a first-aid advance desperately needed by first responders and trauma surgeons. 

Whether a person suffers a major injury in an auto accident or on the battlefield, one of the leading causes of death is blood loss. The National Trauma Institute says hemorrhage leads to 35 percent of all deaths that occur before an injured patient gets to a hospital. It is responsible for 40 percent of all trauma-related deaths in the first 24 hours. 

Now bioengineers and scientists at the University of Maryland, College Park and Massachusetts General Hospital say they have created a polymer-based foam that causes blood cells to clump together. Learn more below.

Keep reading

I spent my weekend at work taking care of the sickest baby I’ve had yet. It was a case of NEC, in a 5-day old, which included stat surgery to place her bowel in a silo in the OR Saturday, then Sunday a bedside surgery to resect most of her bowel which was necrotic. 5 of my 14 hour shift Sunday consisted of fluid resuscitation including 6 units of blood products, clotting factors, and titrating and adding new drips to compensate for severe shock.

Things like what I went through this weekend would make anyone question why they do this. How incredibly unfair it is that this happens to innocent babies. Makes a person question what’s ethical and where a stopping point is. The NICU turned into a trauma room and I at times turned into an anesthesiologist pushing paralytics and analgesics while maintaining peripheral access.

It was the hardest weekend of my career. I’m so drained and physically worn out. But I did everything I could. I have no regrets. I was trained for moments like that and I gave it my best effort. People have no idea how hard this job can be.

Molecule of the Day: Warfarin

Warfarin (C19H16O4) is an extremely important drug; it is used as an anticoagulant, and is routinely used to prevent blood clotting and the subsequent migration of the clots to other parts of the body, which could cause severe effects such as cardiac arrest and hypoxia of tissues.

It was first discovered when a mysterious case of cattle bleeding to death after minor medical procedures occurred in the 1920s. This were traced back to mouldy fodder made from sweet clover, and upon analysis, warfarin was found to be responsible for the effects. Since then, it has been used as a useful life-saving drug worldwide.

Warfarin acts by inhibiting Vitamin K epoxide and quinone reductases, which are responsible for regenerating Vitamin K. Since Vitamin K is needed for the carboxylation and thus activation of proteins responsible for blood cells to adhere to each other, a lower amount of clotting factors is produced, and consequently blood clotting is inhibited.

Warfarin does have side effects: most commonly, due to the decrease in blood clotting, the risk of bleeding, or more severely, haemorrhaging, increases. Other possible adverse effects, such as necrosis or osteoporosis, are uncommon. However, consumption of particular foods, such as ginger and garlic, and drugs, especially antibiotics, can increase the risk of side effects by impeding the metabolism of warfarin.

Warfarin has also been used as a rat poison since 1948, although its usage has been declining due to increasing resistance to it as well as the emergence of more potent poisons.

(Lachesis stenophrys) Central American bushmaster

Highly potent proteolytic, hemorrhagic, myotoxic, clotting & possibly even neurotoxic factors present. Human envenomations fairly frequent, often quickly fatal; symptoms of even limited envenomation (by even young specimens) often include immediate pain, rapidly progressive swelling & numbness, rapid pulse, shock, vomiting, diarrhea, stabbing muscle pains, & respiratory distress.

cameoappearance  asked:

As the local Lore: Disturbing expert, you seem like you could answer this question. What sort of marine life would be able to survive in a body of water filled mostly with human blood? (Inspired by the latest XKCD: What If.)

Gonna be honest, the very first thing to come to mind is the marine members of phyum Tardigrada. Because tardigrades, hello. Little bastards survived all five prior mass extinctions and they’re on track to survive this one. They can survive in just about any kind of environmental condition, including low-oxygen high-particulate-matter situations, which strikes me as what you’d get with the blood thing.

Beyond that I could do with a few more details. Temperature’s gonna affect dissolved oxygen availability, which is kind of important when it comes to a body of water that no longer qualifies as pure water. As far as ‘mostly’ goes, I’m gonna need a percentage- 51% human blood? 2/3 human blood? More than that? How long does the marine life need to survive? More importantly, has anything been added to the water to prevent clotting? If there’s a significant percentage of blood in the water, there’s a good chance the clotting factors are going to be present in sufficient concentration as to start working their chemical mojo.

Also, since I’m back to the tardigrade part, are we looking at multicellular marine life only or will aquatic microorganisms count towards the total?

Blood thinners on The Strain(and why I care too much)

Hold on to your butts, its a long post..

I’d take a moment of my time to explain oroboros.. But I don’t want to… I will however explain the workings of blood thinners..For I am a long time needer of them. I’ve been on blood thinners since I was 13. (i’ll make a separate post if people really want to know why a 24 year old still requires them). The Strain does get the history of coumaidin/warfarin right. It was designed to be a rat poison. However, the kind we humans use VS rats is different so we don’t fucking die. We honestly only started using blood thinners in human care in the 50′s. However this separation doesn’t matter when Setrakian takes an entire bottle of blood thinners.. So he would have been dead.. Eichorst would still be alive and kicking provided he didn’t get curious and try to drink him. But the lethal dose Setrakian takes would cause total organ failure before Eichorst has a chance to drink him. The beating he gives him would have killed him right then and there.. Let me take another moment to explain how this shit works..

As someone who had to monitor my “coumaidin level” for 9 goddamn years..I ought to know what is the dosing for this shit(I had my blood drawing weekly to monthly to make sure I wouldn’t die). The range for people to not die from stroke, blood clots(in my case) is typically about 2- 3 for a coumaidin level to be normal. 4 is high, but not looking into damage. 5 and higher, you need to pump yourself with vitamin K cause you might fucking die from thinned blood(if you cut yourself, you’ll bleed a lot. if you hit you head.. you’ll have bleeding in the brain). 1 is too low and you’re in trouble of having a stroke or heart attack or blood clots. When I was on coumaidin I took 2 mg everyday to prevent certain doom from happening. Missing 1 dose is fine.. but missing 3 months worth.. Setrakian should have technically been dead by now.. but who knows.. maybe the partnership gave him blood thinners… i doubt it.. its suppose to be outlawed by this point. Anyway, he took a entire bottle of blood thinners later on. Also, prolonged exposure to Warfarin or coumaidin causes bone damage. Me being 22 at the time I switched from to a less damaging blood thinner.. Because by the time I turn 30.. I would have needed a hip replacement. (theres a bunch of things coumaidin can cause.. but I’m sticking to why it matters here)

So what does this have to do with not killing Eichorst? Setrakian would have suffered from organ failure from taking the entire bottle of blood thinners. His blood would get super super watery.. His blood couldn’t reach certain parts of his body.. The Brain would suffer the most. He wouldn’t be able to function. His heart would be pumping faster trying to get blood to where it needs to go. If blood is too thin, it doesn’t hold the cells and other things we need to survive. He is hit several times to the head by Eichorst. His brain would immediately start to bleed as the result. He would be dazed and incoherent.. His body would try to clot those areas to stop the bleeding, but it can’t. It wouldn’t be able to stop the bleeding or slow it down because the blood isn’t thick enough to slow it down. Causing him to bleed even faster and bleed out even more into his brain. He’s in dire stress trying to fight off Eichorst; meaning his body needs to  produce more blood to have the strength to swing his sword. He need more oxygen to catch his breath. But he can’t catch his breath when his body is going into chaos. He is shown bleeding in several spots.. His body would just keep bleeding out his blood as his clotting factor would basically not exist at this point. He would also be bleeding internally. So he’s bleeding in the brain, the torso.. He would not be able to fight Eichorst as well as he did. Not too mention he’s 95.. He’s super frail at this point and one blow to the head would have been enough anyway… Not to mention the bone damage I mentioned earlier. He could easily break his bones and what not.

Why does this even matter? Why do I care so goddamn much? Because I hate sloppy writing and not researched enough subjects. I get the average viewer won’t make these connections or have this kind of knowledge burned into their mind. I get that people won’t care enough like I do. But when this kind of shit is your goddamn life. It kind of makes you angry. I was on coumaidin for 9 long gattdamn years until switched to xeralto. Its why Setrakian is my second favorite character next to Eichorst. He’s a badass on blood thinners. I grew to love both these characters and their finale, their big fight wasn’t epic. It was too fast, it was done so sloppily.. It was done in a episode where they kill all the characters we don’t need at this point to create this sense of “drama”. But they’re all characters I don’t feel like anyone gave a shit about. It was done in a hurry. It was done in a “We have to wrap this up.. because we don’t know wtf we’re doing anymore” fashion.  Those characters don’t even live up to this point in the book. They’re both dead before the world gets plunged into Eternal Night. But the original fight is.. So.. so much better.. Setrakian takes on The goddamn Master and Eichorst. He’s able to kill his long time enemy and do horrible damage to The Master. Fucking Angel joins the fight. So you have Two epic old men duking it out with a horrible monster and getting their final revenge. One last hoo-rah before finally being taken out. Instead we got sloppy writing in a episode design to “tie up lose ends” and create fake drama..  

anonymous asked:

Weird question I'd like answered: Hemophilia and menstruation. Are there any causes for concern?

First off, I think you misspelled are there any causes of concern for my hemophiliac character? Because writing advice blog. Yes? Yes. Glad we fixed that typo. 

Hemophilia is a lot more common in those who don’t menstruate, because it’s an X-chomosome-based disease. Males have only one X chromosome, whereas women have two, one from each parent. If the male gets a copy of the defective gene, it’s the only copy he’s got, whereas if a female gets the same defective gene, she has another one to rely on. This is why women are typically carriers of hemophilia but not so often hemophiliacs themselves; they may have reduced amounts of the clotting factors in question, but they don’t bleed to death every time their cycle is on. 

(And yes, I’m aware of XXY males and XYY males and XXYY males, and that “male” is a crap descriptor because trans and nb humans. I’m going to keep things simple as I can with this, but believe me, y’all are on my mind!) 

Heavy menstrual bleeding is actually the primary symptom of being a hemophilia carrier, but it’s not life-threatening. Just expensive, and a pain in the ass, I would imagine. 

Hope that answered your question. 

xoxo, Aunt Scripty


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nilimadaisy-blog  asked:

I will love to have all your study notes ,as I am also appearing final prof coming January 13th :( and I'm in dire need of help. P.s I am from india too. Means same subjects n same syllabus ;)

I haven’t made a lot of notes this year. But I have made sure whatever lil notes I have made are published on the blog, you can find them on the contents page here :)

Same syllabus, yaay! So we have Medicine, Surgery & Orthopedics, Obstetrics and Gynaecology and Peadiatrics, right?

Here’s the list. Hope it helps!

PeadiatricsDevelopmental milestones mnemonic: Copies, draws, scribbles!
Developmental milestones mnemonic: Pincer grasp
Pica mnemonic
Thumb sucking sequelae mnemonic
Hydrops fetalis mnemonic
Minor clinical problems observed in normal infants during first week of life illustration
Malnutrition: Waterlow Gomez classification menmonic
My low osmolarity ORS notes for MBBS exam and constituents of ORS mnemonicOral Rehydration Therapy
Management of nephrotic syndrome (Mnemonic + notes for MBBS exam)

SurgeryGastrointestinal system
Tumors of colon and various polyposis syndrome mnemonic
What is the cause of reversal of sleep wake pattern in patients with cirrhosis?
Choledochal cyst types mnemonic
Ransons criteria for prognosis of acute pancreatitis mnemonic
Cullen’s sign, Grey Turner’s sign and Fox’s sign seen in pancreatitis mnemonic
Child Pugh score mnemonic
Medical management of variceal bleeding mnemonic
♥ Clinical features of acute appendicitis mnemonic
Somatostatinoma mnemonic
Whipple’s triad mnemonic
Charcot’s triad mnemonic
Exception to Courvoisier’s law mnemonic
Saint’s triad mnemonic
Pyloric stenosis mnemonic
Hematemesis mnemonic
Risk factors for carcinoma stomach mnemonic
Treatment of bleeding peptic ulcer mnemonic
Sugiura Futagawa operation mnemonic
Surgery for acute bleeding varices and portal hypertension that cause portoazygos disconnection mnemonic
Treatment of upper gastrointestinal bleeding mnemonic
Intussusception mnemonic
Fistula in ano mnemonics
Abdominal anatomy mnemonics related to hernia
Surgery mnemonics
Genitourinary system:
Differentials of inguinoscrotal swelling
Treatment of carcinoma penis mnemonic
Unilateral and bilateral causes of hydronephrosis
Epidural anaesthesia mnemonic
Testicular tumors surgical management mnemonic
Paraumbilical hernia mnemonic
Fournier’s gangrene mnemonic
Thyroid eye signs mnemonic
Types of perforators of the lower limb mnemonic
Intermittent claudication notes
Treatment of Varicose veins mnemonic
What does flush ligation mean?MBBS surgery instruments mnemonic
OrthopeadicsFoot drop (Notes)
Injuries that can occur due to fall on outstretched hand mnemonic
Tuberculosis spine mnemonic
Types of sequestrum
Clinical features of tuberculosis spine mnemonic
Colles fracture mnemonic
Congenital Talipes Equinovarus (CTEV) and club foot surgical treatment mnemonic
Tuberculosis spine mnemonic (Potts disease)
Heberden’s and Bouchard’s Nodes Mnemonic
Bones that undergo avascular necrosis mnemonic

Obstetrics and Gynaecology
DeLancey supports of genital tract mnemonic
Semen report notes + mnemonic
What is the difference between menstrual regulation and vacuum evacuation?
Vaginal candidiasis (Candida infection) mnemonic
Fothergills repair or Manchester operation mnemonic
Hirsutism mnemonic
Dermoid cyst mnemonic
What is extra ovular space?
Breech delivery diagrams
Tests for ovulation mnemonic
Tocolytic agents mnemonic
Magnesium sulphate regimens for eclampsia and preeclampsia mnemonic
Total dose infusion formula (Haldane and Ganzoni) mnemonic
Hydatidiform mole (Complete vesicular mole) mnemonic
Tubal ectopic pregnancy mnemonic
What is the significance of pain during child birth?
Normal labor: Mechanism on dummy pelvis and mnemonics
Difference between partial and complete hydatidiform mole mnemonic
Quad screen results and trisomy mnemonicMinimum number of antenatal visits recommended by WHO mnemonicEngagement, synclitism and asynclitismPostpartum hemorrhage causes mnemonicLecithin–sphingomyelin ratio mnemonicPathophysiology and Medicine- Cardiac and vascular pathophysiology
Types of pulse mnemonic
Evaluating axis from ECG (Mnemonic)
Kawasaki disease mnemonic
Submissions: Mnemonic for arterial involvement in atherosclerosis
Baroreceptors mnemonic
Mean systemic filling pressure
Cardiac Output and Venous Return curve mnemonic
♥ Vasomotor reversal of Dale
Why does heart stop in diastole when plasma potassium level rises?
♥ Why are there differences in cardiac action potential in different parts of the heart?
Cardiac fast fibers and slow fibers - Why does a less negative membrane potential convert a normally fast fiber into a slow fiber?
Behind the scenes: Subendocardial fibres lack phase 1
♥ What are the factors affecting diastolic blood pressure?
Arteriovenous fistula - What happens to cardiac output and total peripheral resistance and why?
Investigations in renovascular hypertension
- Pulmonology (Respiratory)
Nail disorders, diagnosis and abnormalities due to systemic diseases mnemonic
Case scenarios: When you don’t give patients 100% O2 and why
Decompression sickness - Caisson’s disease
Ondine’s curse
Exudate & Transudate
Why lactate dehydrogenase in Light’s criteria?
♥ Obstructive and restrictive lung diseases
♥ Oxygen - hemoglobin dissociation curve mnemonic
Ghon’s complex in primary tuberculosis mnemonic
- Gastrointestinal and Hepatobiliary system (Abdomen)
Causes of hepatosplenomegaly mnemonic
Extraintestinal manifestations of inflammatory bowel disease mnemonic
Leptin thin. Ghrelin gobble. Mnemonic.
Ulcers of the stomach mnemonic
♥ Difference between primary biliary cirrhosis and primary sclerosing cholangitis mnemonic
♥ Difference between chronic atrophic gastritis type A and type B
- Hematology (Blood) and oncology
Chronic Myelogenous Leukemia (CML) treatment mnemonic
♥ Hairy cell leukaemia simplified
French American British classification of Acute Myeloblastic Leukemia (AML types) mnemonic
Oxygen saturation mnemonic
Mechanism of Invasion of Tumor cells
Mantle cell lymphoma mnemonic
♥ Burkitts lymphoma mnemonic
Follicular lymphoma mnemonic
Hemolytic uremic syndrome mnemonic
Thalassemia blood picture mnemonic
Hemolytic face mnemonic
♥ Clotting factors mnemonic
The Rh factor
Difference between iron deficiency anemia and anemia of chronic disease
♥ How to remember lipoprotein disorders
- Reproduction
Which cell secretes what? Male reproductive system mnemonics
Which cell secretes what? A simplified ovarian cycle comic video
Which cell secretes what? A simplified ovarian cycle comic
- Nephrology (Renal)
Normal arterial blood gas values and serum electrolytes mnemonic
Clearance of inulin and para-aminohippuric acid mnemonic
♥ Free water clearance
Glomerular filtration rate formula and mnemonic
♥ What is the difference between prerenal failure & acute tubular necrosis?
♥ Darrow-Yannet Diagrams simplified
Darrow Yannet diagram: Doubt
- Endocrine
What happens in type 1 diabetes mellitus?
What happens in type 2 diabetes mellitus?
Hashimoto’s & Graves’ disease mnemonic
Intrinsic tyrosine kinase and receptor-associated tyrosine kinase mnemonic
Multiple Endocrine Neoplasia mnemonic
Treatment of thyrotoxic crisis mnemonic
What is the function of thyroid peroxidase?
Felty’s syndrome mnemonic
- Neurology (CNS)
Causes of ischemic stroke
Clinical manifestations of stroke within anterior circulation
Peripheral neuropathy definition and causes (MBBS notes)
Neurofibromatosis 1 mnemonic
Tuberous sclerosis mnemonic
Remembering the autonomic innervation of the bladder
Wernicke Korsakoff syndrome mnemonic
Cerebellar lesion clinical signs and symptoms mnemonic
Site of lesion of CNS disorders that cause involuntary movements mnemonic
The crossed paralyses: Millard-Gubler, Foville, Weber & Raymond-Cestan brainstem syndromes mnemonic
Multiple sclerosis mnemonic
Site of lesion of CNS disorders that cause involuntary movements mnemonic
Pilocytic astrocytoma
Pathology brain tumors mnemonic- Other
Neuromuscular (myoneural) junction
♥ Difference between Pemphigus vulgaris & Bullous pemphigoid mnemonic
Marfan’s syndrome
Collagen in wound healing & Ehlers-Danlos syndrome mnemonic
Kartageners syndrome
Bone talk - How to remember the most commons of bone tumors
Paget’s cells mnemonic
Prepping Medical Supplies

One of the most horrifying thoughts of a post-apocalyptic world is a world without medicine. Luckily, with a little foresight, we can put off that horror just a little longer. In this post, I’m going to go over what kind of stuff to stockpile, and then how to create a functional first aid kit out of it, say, that you could take in your bug-out bag.

OTC Medications:

These will be the easiest to stockpile, if not the cheapest. The first thing you should do, before starting a long-term stockpile, is take a good look at your medicine cabinet and decide what you need. A well-stocked medicine cabinet should include:

Anything you use regularly


At least one kind of NSAID (ibuprofen, acetaminophen, naproxen, etc)

Pepto-bismol or some other kind of medicine for upset stomach

Heartburn medicine like Prevacid and/or Tums


Dayquil or Nyquil

Some kind of sinus or flu-specific Tylenol or other drug

Allergy medicine - both benadryl and a non-drowsy drug like Allegra

Plenty of neosporin

Bandages of various sizes

Gauze of various sizes and tape

Ace bandages

Cold compresses

Antiseptic agents like isopropyl alcohol or witch hazel

Hydrogen peroxide for cleaning debris out of a wound

And, if anyone in your household has a tendency towards these things:

Orajel for canker sores

AZO for urinary tract infections

Laxatives for constipation

Once you have all these things, look at your medicine cabinet. It should always be this full. You will rotate through these medicines and you will replace them. In addition, you will buy more as often as you can afford them.

Other OTC supplies you should look into:

First of all, you can never have too much of the stuff I listed above. but if you want to have a truly well-rounded medical stock, you should consider these things:

A thermometer - digital is more accurate, but the battery will eventually run out, so invest in a mercury one, too

A pulse oximeter - learn how to use one (the box usually includes instructions) and you can identify health problems early

A blood pressure cuff - same advice

Iodine - if you ever have to perform any sort of incision, you’ll want to sterilize the area with iodine

Celox - this is a clotting factor that can cause heavy bleeding to stop. I cannot overstate how useful it is. It is a little bit expensive, but worth every penny.

Butterfly closures - in a world where going to a hospital to get stitches isn’t an option, these will be a lifesaver

Liquid bandage - same thing

Vinyl gloves - do you really want to be touching all these sick people and blood with your bare hands? That’s a good way to get you both sick.

MULTIVITAMINS!!!! I emphasized that as much as possible because they are very, very important. Nutritional deficiencies suck a lot. They can cause everything from fatigue and headaches to loss of teeth to bone deformities and death. When you’re living off of food storage, your multivitamin may be the difference between life and death.

Also, if you or anyone in your household has psychiatric issues, some vitamins and supplements have been shows to help - St. John’s Wort, B-complex vitamins, fish oil, folic acid, and magnesium, just to name a few. It might be worth looking into.

Sunscreen - sunburns hurt and can lead to skin cancer. An ounce of prevention is worth a pound of the cure.

Bug spray - trust me, you want the kind with DEET. I don’t care how natural organic crunchy granola you are - you want the kind with DEET because it works. Do you want malaria? No? Then get the kind with DEET.

A&D Ointment - I’m gonna hop up on a soapbox here and proclaim how much I love this stuff. It is great for everything. Dry, cracked skin, chapped lips, diaper rash, everything. A little goes a long way, and it comes in a huge bottle, so it’s definitely worth the investment.

On a similar note, hydrocortisone cream. For those bug bites you will inevitably get.

Deodorant - I shouldn’t have to explain this one

Toothbrushes and toothpaste - Ditto

Soap - ditto

Water-free body wash - this can be found in the camping section at most stores. It is great for when the water is turned off. Simply put it on a rag, wash your body with it, and towel off. Bam, you’re clean. No water required. Great for saving water when supplies are running low, too.

Prescription Medicines to Stockpile

I promised I would do a post on this, so here we go.

I’ve already talked a little bit about stockpiling fish and bird antibiotics - they’re the same medicine, held to almost the same quality standards, but available for purchase without a prescription. Depending on your insurance, they may even be cheaper.

If you’re dead-set on stockpiling human antibiotics, I only have one tip. Convince a doctor that you have chronic “honeymoon cystitis.” That is, every time you have sex, you get a UTI. After a while, they will prescribe you a large dose of antibiotics with directions to take one immediately after each act of intercourse. Don’t have intercourse, or don’t take them, or don’t have the UTIs in the first place, and you can keep getting prescribed antibiotics for quite a while.

If you’re on medication for a psychological condition, I recommend being honest with your doctor - tell them that you would like to create a small back stock of your medication in case something happens and you can’t get your meds. Natural disasters happen all the time. Medication shortages also happen all the time. And if you’re on psychiatric meds, it’s probably not unthinkable that you might become unable to leave the house and get your refills. As long as you’re not on controlled substances, most doctors will prescribe you a little extra.

I do not know if this approach will work with non psychiatric meds, since I have never tried it. If you have a chronic condition, and you’re not on controlled substances, I don’t see why it wouldn’t work, but if it doesn’t, please don’t come yelling at me. I’m just telling you what has worked for me.

There is one other option for stockpiling prescription medication. It is dangerous, and I don’t recommend it, but I would be remiss if I didn’t at least address it. If you feel safe doing so, you could occasionally skip your medication and stockpile what you did not take. Please be aware that this could cause all kinds of negative effects, such as withdrawal, return of symptoms, and making your medication less effective. I do not recommend this course of action. But if you are dead set on it, I can’t stop you.

What does your medicine cabinet look like? What are your top priorities for stockpiling? I love feedback, so let me hear from you guys!

In the next post, How To Create A First Aid Kit.

anonymous asked:

If somebody gets cut across one of their femoral arteries, what are their options? How long do they have?

In order: dying, and somewhere south of two minutes. Death may take a little longer, but loss of consciousness will come sooner.

Where the artery is damage will affect how treatable it is. When you have some distance from the torso (the mid-to lower thigh) you can apply a tourniquet above the wound and possibly keep the victim alive long enough to get them medical attention. In the upper thigh or near the groin, unless you already have EMTs on site, you probably won’t have enough time to effectively clamp it.

That said, the last fifteen years have seen an explosion in technologies designed to counter catastrophic blood loss. This includes things like QuikClot and HemCon. The former dehydrates blood on contact inducing rapid clotting. The latter becomes highly adhesive and is supposed to seal into the wound (though the survival rate was reportedly only around 10%.) Of random interest, early iterations of QuikClot came in powdered form (the current version is saturated into gauze), it used a different mineral base, and had an exothermic reaction on contact with blood, resulting in second degree burns. This saw military use in the early 2000s, and never made it to the civilian market.

There’s also NovoEight, which, if I’m reading this correctly, is recombinant blood (or more accurately, just the clotting factor from human blood). This is sold in powdered form and needs to be reconstituted immediately prior to use (once reconstituted it only lasts about 4 hours).  Technically, this stuff is intended for treating hemophiliacs who were seriously injured or going in for surgery.

An earlier iteration, NovoSeven was used experimentally in the mid 2000s. It can be effective for managing blood loss in cases of severe trauma, but is also risky to use, as it in can result in arterial thrombosis, (clotting in the arteries that obstruct the flow of blood). In case it wasn’t clear, this is a very bad thing, though preferable to bleeding to death. I don’t know if NovoEight still has that risk, though, it would surprise me. Neither is actually approved for use on non-hemophiliacs, but it is an option of last resort. (The primary difference between NovoSeven and NovoEight appears to be how the drug is produced, and the potency (NovoSeven is stronger, and indicated for patients who have no clotting factor, while NovoEight is intended for patients with a congenitally deficient clotting factor.)

If you can get the victim into surgery, then it’s possible they may survive. But, this is still an extremely dangerous injury to suffer, and even medical attention doesn’t mean the victim will survive, only that they might. From what little I know, the actual procedure is just to clamp the artery and suture it back together. The problem is that the femoral artery moves a lot of blood, making it harder to control, and causing the bleed out to occur faster.

So, their options aren’t that appealing.


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ayinyourpocket replied to your post “A controversial statement, apparently: I had a bad experience with a…”

My dog is a dobe mix and the vet told me she doesnt have vWD even though her lab results came back positive… i just keep an extra eye on her…

How was she tested for it? The only accurate test is the genetic test. There is affected genetically and then also affected clinically. Not all genetically affected dogs will lose all their clotting factor and “go clinical”, as it were. Many never bleed more than a carrier or clear dog. If she came back for low clotting factor, it’s possible she has a different bleeding disorder if she is also clear for vWD. There are many things that can affect clotting factor as well including thyroid and malabsorbion (fish oil and vitE can also lead to bleeding issues if overdosed, one big reason I don’t use supplements). So it would really depend how she was tested and, barring the genetic test, what was going on with her at the time of testing to perhaps make you feel she has vWD.

ayinyourpocket replied to your post “ayinyourpocket replied to your post “A controversial statement,…”

They did a blood test of some sort for vWD. She had gotten spayed, and spent the night at the vet, and when they came in the next day, she and her kennel were covered in blood, even though her stitches were intact. So they did the blood work. And the vet said she was fine, even though the results say abnormal in almost all thr tested factors. She was an iron supplement for like a month after due to the amount of blood loss

Sounds like an Elisa test, which only determines clotting factor at that moment in time and not vWD status. There are many vets who are not skilled with the difference- the Elisa test was initially THE way to determine if a dog was vWD affected or not as it was once thought that clotting factor was constant. We now know that clotting factor can change based on stress, exercise, diet, and more, and so it was an incomplete look at the disease. Clear dogs were testing very poorly, affected dogs testing very well, etc. 

The genetic test is a cheek swab. It is absolutely possible that your dog is vWD affected. It’s also possible that she had a different reason for her clotting factor to be so low. If she was anemic (which iron supplements also treat) or if she had low blood volume or thin blood, that could also have caused the problem you’re talking about without vWD being part of it. There are clear and carrier dogs that still bleed due to clotting related disorders- vWD is not to blame for every instance of abnormal bleeding within the breed.

Skoll was clinically affected. He, on one occasion, sprayed blood due to a superficial injury on his toe as he flailed. He also bled frequently from the paw pads (after running on rough ground) and mouth (after spearing his lips by clacking his teeth), occasionally for hours, from very small cuts that practically disappeared the moment the bleeding stopped. It was usually a slow ooze but occasionally a big gush like with the toe injury that would eventually begin to slow after a lot of effort and time were put in to making it stop bleeding.

Having your dog sustain a small injury is something most dog owners don’t even notice until they see the scab or scar. Creed has had plenty of small injuries like that with me not noticing until well after they occurred, as well as three times of skinning himself in a large patch running through brush in the woods on a hike. @powerfulexistance and @smoothexpression both witnessed one of them, a 3in stripe of skinned side that I only noticed because it was a bald patch against black. He didn’t even bleed more than a few drops. A similar injury on Skoll could possibly have led to him bleeding to death if that was a “gusher”, since we were several miles away from our cars and would have had to hike back to get him to a vet (exercise makes blood flow stronger). On Creed, it was a scab I treated with neosporin for a few weeks until it healed, and then he grew fur back over it.

Not all affected dogs are as bad as Skoll. Most well bred affected dogs have very minimal problems with clotting and are not considered clinical or bleeders. But dogs like him are out there, and that is a risk I no longer agree with taking.

shlork  asked:

I understand you have hemophilia, yes? I understand you have to be much more careful around some places and situation due to your little or no thrombocytes count. If any, how many times have you had to go to get a blood transfusion?

Yep. I don’t have a lot of clotting/coagulation factor as a result of a genetic defect on my X chromosome. I’ve never had a blood transfusion though. I give myself infusions of clotting factor proteins in a saline solution. That makes me go from having a factor level of 3% up to about 60%. A clotting factor level below 50% is considered hemophiliac.

anonymous asked:

Yixing is such a sweetheart and seriously I've NEVER seen an idol where i said smth like 'I want to marry him' but with Yixing ... it's like.. he's perfect??? He's not even my bias but he is such a good human being, caring for fans, the exo members and his family. He's kind and cute and i hope he will always be happy. Your blog just kinda made me love him even more. Thank you. Have a beautiful day!

hello~ yes!! thank you so much for your message ;;; reading this made me so happy ughudsd pls give Yixing more love~ this is a very long reply (i would like to expand on your ask~) and i know my view of Yixing is biased because i’m Yixing biased (have always been Yixing biased tbh *u*) but i really hope i can convince some of you (or refresh for memory) on why Yixing stans (xingmi) and EXO-Ls love him to bits. I really think Zhang Yixing is a very humble, polite [(x) (x) (x) (x)] and kind hearted [(x) (x) (x)] person who always put others before himself (x) ;_; 

I know all artists work very hard, are very determined and strong, but Yixing in my eyes, he’s a little stronger than the rest? I cant even imagine how hard it must have been when he left home at 17 to train in a foreign country, where he had no family, no friends and no knowledge of the language spoken there (he’s definitely not the first, nor the last idol who has had to go through this, but it must have been so hard). People in our generation often forget to care for our parents and grandparents, but Yixing - if he was given one day off, he’d spend it with his family. Yixing who puts on shoes for his grandmother, Yixing who holds his grandmother as they go for walks [(x) (x)]. He often tells the fans not to wait for him and to go home, spend time with their family and to care for them. Why? Because he misses his family so much and he doesn’t want his fans to forget the importance of family. Also I have to point out, his birthday messages (2012 // 2013 // 2014) truly show Yixing. The one thing Yixing said that really stood out to me (everything he said in his bday messages are important tho!) was “Even if you’re sad, don’t be afraid! Because I am here to write a healing song for all of you!” being able to hear something like this from the person I admire most when I was going through one of the most difficult times in my life was just so encouraging (I teared up when I read his 2013 bday message ;;; actually tearing up rn as well ;A;)

He’s very talented as well: he draws well, sings well, self-learned piano/guitar, composes songs, dances well - but he steps away from the spot light and lets the other members shine instead. When EXO was on Happy Camp in 2013 (Wolf Era) and they were asked to rank themselves according to appearance, Yixing immediately moved towards the end of the line and insisted that the other members are more handsome. Recently he said that his main role is an exo member and that he is happiest/most at ease when he is with the members. He stresses the fact that he is an exo member - he doesn’t want us to think he is putting his movie filming before exo (because he rlly isn’t :|) I don’t recall Yixing ever telling us he is tired but recently he has said that he hasn’t been able to sleep and that he is very tired having to jump from exo schedule to his movie filming schedule (yes, he “signed up for this,” ofc yixing knows the idol life is very busy/tiring but he enjoys performing on stage, dancing and singing. we cannot just tell them to “sleep in” or “just get more sleep” because their schedules are very packed, but as his fans, we can give him strength by supporting him, encouraging him)

Yixing is hardworking and determined to keep going when he is tired, determined to improve himself, determined to achieve his dreams. One of his dance instructor once said “As long as it is what he wants, there is nothing he cannot achieve.” His weibo username is “努力努力再努力x” (work hard, work hard, work even harder). However, yixing is very stubborn though ;; when he is injured, he continues to push himself to keep going (i still remember back in october 2012 he injured his waist and couldn’t walk without the help of staff members ;; and he refused to use a wheelchair because he was stubborn :x). Speaking of Yixing and injuries, everyone probably knows about how he injured his hand during a music show recording. I’ve seen a lot of people say that he “should not be on stage because he has haemophilia/blood disorder” - haemophilia ranges from mild to moderate to severe, depending on the clotting factor an individual is lacking and the degree of deficiency. Small cuts do not affect most people with haemophilia any more than anyone else, they may bleed a little longer but internal bleeding is the biggest concern for people with haemophilia. Just wanted to point this out - I’m not saying that Yixing’s injury wasn’t important (i was very worried tbh ;_;) - but a lot of fans don’t seem to know much about haemophilia except it is a x-linked blood disorder and that it can be life threatening for an individual with it. (NOTE: also just wanted to clear some things up, I am in no way romanticising yixing/idols + the injuries they encounter idk I’ve seen some posts floating around about this :|) 

Yixing adores his fans; he loves and cares [(x) (x) (x) (x)] for each and every one of them. He often reminds the fans not to buy him presents and to save the money to spend on themselves/their family. In the song he wrote for his fans, ”Because of You” (因為你), he called himself ordinary (as in ordinary person like everyone else) and us, his xingmi and EXO-Ls, his heroes and the reason why he is happy everyday + why he holds back his tears (in the song he said it’s because our love touched his heart ;;). In his song, he also says “Don’t know how high or how far I can fly, but (i’m) hoping all of you will stay by my side.” He doesn’t know where he’s going to end up in the future, he doesn’t know what will happen in the future - no one knows, and that’s all part of the human experience; but he clings onto the hope that his fans will always love him, support him and stay by his side. EXO-Ls, please stop doubting Yixing, please give Yixing more love, please have more faith in Yixing.

bonus: best of yixing (x) (x) (x) (x) my baby uhguhgd \o/

anonymous asked:

Do you have any suggestions to passing the exit RN Hesi?

First, be assured the HESI is a lot harder than the NCLEX!!!!  There are numerous free tests online to practice (google HESI exit).  Quizlet has multiple flashcards available for the HESI.  You can also access study guides on  Also access the HESI website.

HESI Hints & NCLEX Gems

• Answering NCLEX Questions
o Maslow’s Hierarchy of Needs
• Physiologic
• Safety
• Love and Belonging
• Esteem
• Self-actualization
o Nursing Process
• Assessment
• Diagnosis (Analysis)
• Planning
• Implementation (treatment)
• Evaluation
o ABCs
• Airway
• Breathing
• Circulation

• Normal Values
o Hgb
• Males 14-18
• Females 12-16
o Hct
• Males 42-52
• Females 37-47
o RBCs
• Males 4.7-6.1 million
• Females 4.2-5.4 million
o WBCs
• 4.5-11k
o Platelets
• 150-400k
o PT (Coumadin/Warfarin)
• 11-12.5 sec (INR and PT TR = 1.5-2 times normal)
o APTT (Heparin)
• 60-70 sec (APTT and PTT TR = 1.5-2.5 times normal)
o BUN 10-20
o Creatinine 0.5-1.2
o Glucose 70-110
o Cholesterol < 200
o Bilirubin Newborn 1-12
o Phenylalanine Newborn < 2, Adult < 6
o Na+ 136-145
o K+ 3.5-5
• HypoK+ … Prominent U waves, Depressed ST segment, Flat T waves
• HyperK+ … Tall T-Waves, Prolonged PR interval, wide QRS
o Ca++ 9-10.5
• Hypocalcemia … muscle spasms, convulsions, cramps/tetany, + Trousseau’s, + Chvostek’s, prolonged ST interval, prolonged QT segment
o Mg+ 1.5-2.5
o Cl- 96-106
o Phos 3-4.5
o Albumin 3.5-5
o Spec Gravity 1.005-1.030
o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
o Dilantin TR = 10-20
o Lithium TR = 0.5-1.5
o Arterial Blood Gases … Used for Acidosis vs. Alkalosis
• PH 7.35-7.45
• CO2 35-45 (Respiratory driver) … High = Acidosis
• HCO3 21-28 (Metabolic driver) … High = Alkalosis
• O2 80-100
• O2 Sat 95-100%

• Antidotes
o Digoxin … Digiband
o Coumadin … Vitamin K (Keep PT and INR @ 1-1.5 X normal)
o Benzodiazapines … Flumzaemil (Tomazicon)
o Magnesium Sulfate … Calcium Gluconate?
o Heparin … Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal)
o Tylenol … Mucomist (17 doses + loading dose)
o Opiates (narcotic analgesics, heroin, morphine) … Narcan (Naloxone)
o Cholinergic Meds (Myesthenic Bradycardia) … Atropine
o Methotrexate … Leucovorin

• Delegation
o RN Only
• Blood Products (2 RNs must check)
• Clotting Factors
• Sterile dressing changes and procedures
• Assessments that require clinical judgment
• Ultimately responsible for all delegated duties
o Unlicensed Assistive Personnel
• Non-sterile procedures

• Precautions & Room Assignments
o Universal (Standard) Precautions … HIV initiated
• Wash hands
• Wear Gloves
• Gowns for splashes
• Masks and Eye Protection for splashes and droplets
• Don’t recap needles
• Mouthpiece or Ambu-bag for resuscitation
• Refrain from giving care if you have skin lesion
o Droplet (Respiratory) Precautions (Wear Mask)
• Sepsis, Scarlet Fever, Strep, Fifth Disease (Parvo B19), Pertussis, Pneumonia, Influenza, Diptheria, Epiglottitis, Rubella, Rubeola, Meningitis, Mycoplasma, Adenovirus, Rhinovirus
• RSV (needs contact precautions too)
• TB … Respiratory Isolation
o Contact Precautions = Universal + Goggles, Mask and Gown
o No infection patients with immunosuppressed patients

• Weird Miscellaneous Stuff
o Rifampin (for TB) … Rust/orange/red urine and body fluids
o Pyridium (for bladder infection) … Orange/red/pink urine
o Glasgow Coma Scale … < 8 = coma
o Myesthenia Gravis
• Myesthenic Crisis = Weakness with change in vitals (give more meds)
• Cholinergic Crisis = Weakness with no change in vitals (reduce meds)
o Diabetic Coma vs. Insulin Shock … Give glucose first – If no help, give insulin
o Fruity Breath = Diabetic Ketoacidosis
o Acid-Base Balance
• If it comes out of your ass, it’s Acidosis.
• Vomiting = Alkalosis
o Skin Tastes Salty = Cystic Fibrosis
o Lipitor (statins) in PMs only – No grapefruit juice
o Stroke … Tongue points toward side of lesion (paralysis), Uvula deviates away from the side of lesion (paralysis)
o Hold Digoxin if HR < 60
o Stay in bed for 3 hours after first ACE Inhibitor dose
o Avoid Grapefruit juice with Ca++ Channel Blockers
o Anthrax = Multi-vector biohazard
o Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side (to trap air in right side of heart)
o Head Trauma and Seizures … Maintain airway = primary concern
o Peptic Ulcers … Feed a Duodenal Ulcer (pain relieved by food) … Starve a gastric ulcer
o Acute Pancreatitis … Fetal position, Bluish discoloration of flanks (Turner’s Sign), Bluish discoloration of pericumbelical region (Cullen’s Sign), Board like abdomen with guarding … Self digestion of pancreas by trypsin.
o Hold tube feeding if residual > 100mL
o In case of Fire … RACE and PASS
o Check Restraints every 30 minutes … 2 fingers room underneath
o Gullain-Barre Syndrome … Weakness progresses from legs upward – Resp arrest
o Trough draw = ~30 min before scheduled administration … Peak Draw = 30-60 min after drug administration.

• Mental Health & Psychiatry
o Most suicides occur after beginning of improvement with increase in energy levels
o MAOIs … Hypertensive Crisis with Tyramine foods
• Nardil, Marplan, Parnate
• Need 2 wk gap from SSRIs and TCAs to admin MAOIs
o Lithium Therapeutic Range = 0.5-1.5
o Phenothiazines (typical antipsychotics) – EPS, Photosensitivity
o Atypical Antipsychotics – work on positive and negative symptoms, less EPS
o Benzos (Ativan, Lorazepam, etc) good for Alcohol withdrawal and Status Epilepticus
o Antabuse for Alcohol deterrence – Makes you sick with OH intake
o Alcohol Withdrawal = Delerium Tremens – Tachycardia, tachypnea, anxiety, nausea, shakes, hallucinations, paranoia … (DTs start 12-36 hrs after last drink)
o Opiate (Heroin, Morphine, etc.) Withdrawal = Watery eyes, runny nose, dilated pupils, NVD, cramps
o Stimulants Withdrawal = Depression, fatigue, anxiety, disturbed sleep

• Medical-Surgical
o Hypoventilation = Acidosis (too much CO2)
o Hyperventilation = Alkalosis (low CO2)
o No BP or IV on side of Mastectomy
o Opiate OD = Pinpoint Pupils
o Lesions of Midbrain = Decerebrate Posturing (Extended elbows, head arched back)
o Lesions of Cortex = Decorticate Posturing (Flexion of elbows, wrists, fingers, straight legs, mummy position)
o Urine Output of 30 mL/hr = minimal competency of heart and kidney function
o Kidney Stone = Cholelithiasis
• Flank pain = stone in kidney or upper ureter
• Abdominal/scrotal pain = stone in mid/lower ureter or bladder
o Renal Failure … Restrict protein intake
• Fluid and electrolyte problems … Watch for HyperK+ (dizzy, wk, nausea, cramps, arhythmias)
• Pre-renal Problem = Interference with renal perfusion
• Intra-renal Problem= Damage to renal parenchyma
• Post-renal Problem = Obstruction in UT anywhere from tubules to urethral meatus.
• Usually 3 phases (Oligouric, Diuretic, Recovery)
• Monitor Body Wt and I&Os
o Steroid Effects = Moon face, hyperglycemia, acne, hirsutism, buffalo hump, mood swings, weight gain – Spindle shape, osteoporosis, adrenal suppression (delayed growth in kids) … (Cushing’s Syndrome symptoms)
o Addison’s’ Crisis = medical emergency (vascular collapse, hypoglycemia, tachycardia … Admin IV glucose + corticosteroids) … No PO corticosteroids on empty stomach
o Potassium sparing diuretic = Aldactone (Spironolactone) … Watch for hyperK+ with this and ACE Inhibitors.
o Cardiac Enzymes … Troponin (1 hr), CKMB (2-4 hr), Myoglobin (1-4 hr), LDH1 (12-24 hr)
o MI Tx … Nitro – Yes … NO Digoxin, Betablockers, Atropine
o Fibrinolytics = Streptokinase, Tenecteplase (TNKase)
o CABG = Coronary Artery Bypass Graft
o PTCA = Percutaneous Transluminal Coronary Angioplasty
o Sex after MI okay when able to climb 2 slights of stairs without exertion (Take nitro prophylactically before sex)
o BPH Tx = TURP (Transurethral Resection of Prostate) … some blood for 4 days, and burning for 7 days post-TURP.
o Only isotonic sterile saline for Bladder Irrigation
o Post Thyroidectomy – Keep tracheostomy set by the bed with O2, suction and Calcium gluconate
o Pericarditis … Pericardial Friction Rub, Pain relieved by leaning forward
o Post Strep URI Diseases and Conditions:
• Acute Glomerulonephritis
• Rheumatic Fever … Valve Disease
• Scarlet Fever
o If a chest-tube becomes disconnected, do not clamp … Put end in sterile water
o Chest Tube drainage system should show bubbling and water level fluctuations (tidaling with breathing)
o TB … Treatment with multidrug regimen for 9 months … Rifampin reduces effectiveness of OCs and turns pee orange … Isoniazide (INH) increases Dilantin blood levels
o Use bronchodilators before steroids for asthma … Exhale completely, Inhale deeply, Hold breath for 10 seconds
o Ventilators … Make sure alarms are on … Check every 4 hours minimum
o Suctioning … Pre and Post oxygenate with 100% O2 … No more than 3 passes … No longer than 15 seconds … Suction on withdrawal with rotation
• Emphysema = Pink Puffer
• Chronic Bronchitis = Blue Bloater (Cyanosis, Rt sided heart failure = bloating/edema)
o O2 Administration
• Never more than 6L/min by cannula
• Must humidify with more than 4L/hr
• No more than 2L/min with COPD … (CO2 Narcosis)
• In ascending order of delivery potency: Nasal Cannula, Simple Face Mask, Nonrebreather Mask, Partial Rebreather Mask, Venturi Mask
• Restlessness and Irritability = Early signs of cerebral hypoxia
IVs and Blood Product Administration
o 18-19 gauge needle for blood with filter in tubing
o Run blood with NS only and within 30 minutes of hanging
o Vitals and Breath Sounds … before, during and after infusion (15 min after start, then 30 min later, then hourly up to 1 hr after)
o Check Blood: Exp Date, clots, color, air bubbles, leaks
o 2 RNs must check order, pt, blood product … Ask Pt about previous transfusion Hx
o Stay with Pt for first 15 minutes … If transfusion rxn … Stop and KVO with NS
o Pre-medicate with Benadryl prn for previous urticaria rxns
o Isotonic Solutions
• D5W
• NS (0.9% NaCl)
• Ringers Lactate
• NS only with blood products and Dilantin
Diabetes and Insulin
o When in doubt – Treat for Hypoglycemia first
o First IV for DKA = NS, then infuse regular insulin IV as Rx’d
o Hypoglycemia … confusion, HA, irritable, nausea, sweating, tremors, hunger, slurring
o Hyperglycemia … weakness, syncope, polydipsia, polyuria, blurred vision, fruity breath
o Insulin may be kept at room T for 28 days
o Draw Regular (Clear) insulin into syringe first when mixing insulins
o Rotate Injection Sites (Rotate in 1 region, then move to new region)
o Rapid Acting Insulins … Lispro (Humalog) and Aspart (Novolog) … O: 5-15 min, P: .75-1.5 hrs
o Short Acting Insulin … Regular (human) … O: 30-60 min, P: 2-3 hrs (IV Okay)
o Intermediate Acting Insulin … Isophane Insulin (NPH) … O: 1-2 hrs, P: 6-12 hrs
o Long Acting Insulin … Insulin Glargine (Lantus) … O: 1.1 hr, P: 14-20 hrs (Don’t Mix)
o Oral Hypoglycemics decrease glucose levels by stimulating insulin production by beta cells of pancreas, increasing insulin sensitivity and decreasing hepatic glucose production
• Glyburide, Metformin (Glucophage), Avandia, Actos
• Acarbose blunts sugar levels after meals
o Leukemia … Anemia (reduced RBC production), Immunosuppression (neutropenia and immature WBCs), Hemorrhage and bleeding tendencies (thrombocytopenia)
• Acute Lymphocytic = most common type, kids, best prognosis
o Testicular Cancer … Painless lump or swelling testicle … STE in shower > 14 yrs … 15-35 = Age
o Prostate Cancer … > 40 = Age
• PSA elevation
• Mets to spine, hips, legs
• Elevated PAP (prostate acid phosphatase)
• TRUS = Transurethral US
• Post Op … Monitor of hemorrhage and cardiovascular complication
o Cervical and Uterine Cancer
• Laser, cryotherapy, radiation, conization, hysterectomy, exenteration … Chemotherapy = No help
• PAP smears should start within 3 years of intercourse or by age 21
o Ovarian Cancer = leading cause of death from gynecological cancer
o Breast Cancer = Leading cause of cancer in women
• Upper outer quadrant, left > right
• Monthly SBE
• Mammography … Baseline @ 35, Annually after age 50
• Mets to lymph nodes, then lungs, liver, brain, spine
• Mastectomy … Radical Mastectomy = Lymph nodes too (but no mm resected)
• Avoid BP measurements, injections and venipuncture on surgical side
o Anti-emetics given with Chemotherapy Agents (Cytoxan, Methotrexate, Interferon, etc.)
• Phenergan (Promethazine HCl)
• Compazine (Prochlorperazine)
• Reglan (Metocolpramide)
• Benadryl (Diphenhydramine)
• Zofran (Ondansetron HCl)
• Kytril (Granisetron)
Sexually Transmitted Diseases
o Syphilis (Treponema pallidum) … Chancre + red painless lesion (Primary Stage, 90 days) … Secondary Stage (up to 6 mo) = Rash on palms and soles + Flu-like symptoms … Tertiary Stage = Neurologic and Cardiac destruction (10-30 yrs) … Treated with Penicillin G IM.
o Gonorrhea (Neisseria Gonorrhea) … Yellow green urethral discharge (The Clap)
o Chlamydia (Chlamydia Trachomatis) … Mild vaginal discharge or urethritis … Doxycyclin, Tetracycline
o Trichomoniasis (Trichomonas Vaginalis) … Frothy foul-smelling vaginal discharge … Flagyl
o Candidiasis (Candida Albicans) … Yellow, cheesy discharge with itching … Miconazole, Nystatin, Clomitrazole (Gyne-Lotrimin)
o Herpes Simplex 2 … Acyclovir
o HPV (Human Pappilovirus) … Acid, Laser, Cryotherapy
o HIV … Cocktails

• Perioperative Care
o Breathing Es taught in advance (before or early in pre-op)
o Remove nail polish (need to see cap refill)
o Pre Op … Meds as ordered, NPO X 8 hrs, Incentive Spirometry & Breathing Es taught in advance, Void, No NSAIDS X 48 hrs
o Increased corticosteroids for surgery (stress) … May need to increase insulin too
o Post Op restlessness may = hemorrhage, hypoxia
o Wound dehiscence or extravisation … Wet sterile NS dressing + Call Dr.
o Call Dr. post op if … < 30 mL/hr urine, Sys BP < 90, T > 100 or < 96
o Post Op Monitoring VS and BS … Every 15 minutes the first hour, Every 30 min next 2 hours, Every hour the next 4 hours, then Every 4 hours prn
o 1-4 hrs Post Op = Immediate Stage … 2-24 hrs Post Op = Intermediate Stage … 1-4 days Post Op = Extended Stage
o Post Op Positioning
• THR … No Adduction past midline, No hip flexion past 90 degrees
• Supratentorial Sx … HOB 30-45 degrees (Semi-Fowler)
• Infrantentorial Sx … Flat
• Phlebitis … Supine, elevate involved leg
• Harris Tube … Rt/back/Lt – to advance tube in GI
• Miller Abbott Tube … Right side for GI advancement into small intestine
• Thoracocentesis … Unaffected side, HOB 30-45 degrees
• Enema … Left Sims (flow into sigmoid)
• Liver Biopsy … Right side with pillow/towel against puncture site
• Cataract Sx … Opp side – Semi-Fowler
• Cardiac Catheterization … Flat (HOB no more than 30 degrees), Leg straight 4-6 hrs, bed rest 6-12 hrs
• Burn Autograph … Elevated and Immob 3-7 days
• Amputation … Supine, elevate stump for 48 hrs
• Large Brain Tumor Resection … On non-operative side
o Incentive Spirometry … Inhale slowly and completely to keep flow at 600-900, Hold breath 5 seconds, 10 times per hr
o Post Op Breathing Exercises … Every 2 hours
• Sit up straight
• Breath in deeply thru nose and out slowly thru pursed lips
• Hold last breath 3 seconds
• Then cough 3 times (unless abd wound – reinforce/splint if cough)
o Watch for Stridor after any neck/throat Sx … Keep Trach kit at bed side
o Staples and sutures removed in 7-14 days – Keep dry until then
o No lifting over 10 lbs for 6 weeks (in general)
o If chest tube comes disconnected, put free end in container of sterile water
o Removing Chest Tube … Valsalvas, or Deep breath and hold
o If chest tube drain stops fluctuating, the lung has re-inflated (or there is a problem)
o Keep scissors by bed if pt has S. Blakemore Tube (for esoph varices)… Sudden respiratory distress – Cut inflation tubes and remove
o Tracheostomy patients … Keep Kelly clamp and Obturator (used to insert into trachea then removed leaving cannula) at bed side
o Turn off NG suction for 30 min after PO meds
o NG Tube Removal … Take a deep breath and hold it
o Stomach contents pH = < 4 (gastric juices aspirated)
o NG Tube Insertion … If cough and gag, back off a little, let calm, advance again with pt sipping water from straw
o NG Tube Length … End of nose, to era lobe, to xyphoid (~22-26 inches)
o Decubitus (pressure) Ulcer Staging
• Stage 1 = Erythema only
• Stage 2 = Partial thickness
• Stage 3 = Full thickness to SQ
• Stage 4 = Full thickness + involving mm /bone

• Acute Care
o CVA … Hemorrhagic or Embolic
• A-fib and A-flutter = thrombus formation
• Dysarthria (verbal enunciation/articulation), Apraxia (perform purposeful movements), Dysphasia (speech and verbal comprehension), Aphasia (speaking), Agraphia (writing), Alexia (reading), Dysphagia (swallowing)
• Left Hemisphere Lesion … aphasia, agraphia, slow, cautious, anxious, memory okay
• Right Hemisphere Lesion … can’t recognize faces, loss of depth perception, impulsive behavior, confabulates, poor judgment, constantly smiles, denies illness, loss of tonal hearing
o Head Injuries …
• Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP
• Change in level of responsiveness = Most important indicator of increased ICP
• Watch for CSF leaks from nose or ears – Leakage can lead to meningitis and mask intracranial injury since usual increased ICP symps may be absent.
o Spinal Cord Injuries
• Respiratory status paramount … C3-C5 innervates diaphragm
• 1 wk to know ultimate prognosis
• Spinal Shock = Complete loss of all reflex, motor, sensory and autonomic activity below the lesion = Medical emergency
• Permanent paralysis if spinal cord in compressed for 12-24 hrs
• Hypotension and Bradycardia with any injury above T6
• Bladder Infection = Common cause of death (try to keep urine acidic)
o Burns
• Infection = Primary concern
• HyperK+ due to cell damage and release of intracellular K+
• Give meds before dressing changes – Painful
• Massive volumes of IV fluid given, due to fluid shift to interstitial spaces and resultant shock
• First Degree = Epidermis (superficial partial thickness)
• Second Degree = Epidermis and Dermis (deep partial thickness)
• Third Degree = Epidermis, Dermis, and SQ (full thickness)
• Rule of 9s … Head and neck = 9%, UE = 9% each, LE = 18% each, Front trunk = 18%, Back Trunk = 18%
• Singed nasal hair and circumoral soot/burns = Smoke inhalation burns
o Fractures
• Report abnormal assessment findings promptly … Compartment Syndrome may occur = Permanent damage to nerves and vessels
• 5 P’s of neurovascular status (important with fractures)
• Pain, Pallor, Pulse, Paresthesia, Paralysis
• Provide age-appropriate toys for kids in traction

• Special Tests and Pathognomonic Signs
o Tensilon Test … Myesthenia Gravis (+ in Myesthenic crisis, - in Cholinergic crisis)
o ELISA and Western Blot … HIV
o Sweat Test … Cystic Fibrosis
o Cheilosis = Sores on sides of mouth … Riboflavin deficiency (B2)
o Trousseau’s Sign (Carpal spasm induced by BP cuff) … Hypocalcemia (hypoparathyroidism)
o Chvostek’s Sign (Facial spasm after facial nerve tap) … Hypocalcemia (hypoparathyroidism)
o Bloody Diarrhea = Ulcerative Colitis
o Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pyloric Stenosis
o Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RUQ = Intussiception
o Mantoux Test for TB is + if 10 mm induration 48 hrs post admin (previous BCG vaccine recipients will test +)
o Butterfly Rash = SLE … Avoid direct sunlight
o 5 Ps of NV functioning … Pain, paresthesia, pulse, pallor, paralysis
o Cullen’s Sign (periumbelical discoloration) and Turner’s Sign (blue flank) = Acute Pancreatitis
o Murphy’s Sign (Rt. costal margin pain on palp with inspiration) = GB or Liver disease
o HA more severe on wakening = Brain Tumor (remove benign and malignant)
o Vomiting not associated with nausea = Brain Tumor
o Elevated ICP = Increased BP, widened pulse pressure, increased Temp
o Pill-Rolling Tremor = Parkinson’s (Tx with Levodopa, Cardidopa) – Fall precautions, rigid, stooped, shuffling
o IG Bands on Electrophoresis = MS … Weakness starts in upper extremities – bowel/bladder affected in 90% … Demyelination - Tx with ACTH, corticosteroids, Cytoxan and other immunosuppressants
o Reed-Sternberg Cells = Hodgkin’s
o Koplik Spots = Rubeola (Measles)
o Erythema Marginatum = Rash of Rheumatic Fever
o Gower’s Sign = Muscular Dystrophy … Like Minor’s sign (walks up legs with hands)

• Pediatrics
o Bench Marks
• Birth wt doubles at 6 months and triples at 12 months
• Birth length increases by 50% at 12 months
• Post fontanel closes by 8 wks
• Ant fontanel closes by 12-18 months
• Moro reflex disappears at 4 months
• Steady head control achieved at 4 months
• Turns over at 5-6 months
• Hand to hand transfers at 7 months
• Sits unsupported at 8 months
• Crawls at 10 months
• Walks at 10-12 months
• Cooing at 2 months
• Monosyllabic Babbling at 3-6 months, Links syllables 6-9 mo
• Mama, Dada + a few words at 9-12 months
• Throws a ball overhand at 18 months
• Daytime toilet training at 18 mo - 2 years
• 2-3 word sentences at 2 years
• 50% of adult Ht at 2 years
• Birth Length doubles at 4 years
• Uses scissors at 4 years
• Ties shoes at 5 years
• Girls’ growth spurt as early at 10 years … Boys catch up ~ Age 14
• Girls finish growing at ~15 … Boys ~ 17
o Autosomal Recessive Diseases
• CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism,
• 25% chance if: AS (trait only) X AS (trait only)
• 50% chance if: AS (trait only) X SS (disease)
o Autosomal Dominant Diseases
• Huntington’s, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease
• 50% if one parent has the disease/trait (trait = disease in autosomal dominant)
o X-Linked Recessive Diseases
• Muscular Dystrophy, Hemophilia A
• Females are carriers (never have the disease)
• Males have the disease (but can’t pass it on)
• 50% chance daughters will be carriers (can’t have disease)
• 50% chance sons will have the disease (not a carrier = can’t pass it on)
• This translates to an overall 25% chance that each pregnancy will result in a child that has the disease
o Scoliosis … Milwaukee Brace – 23 hrs/day, Log rolling after Sx
o Down Syndrome = Trisomy 21 … Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes
o Cerebral Palsy … Scissoring = legs extended, crossed, feet plantar-flexed
o PKU … leads to MR … Guthrie Test …Aspartame (NutraSweet) has phenylalanine in it and should not be given to PKU patient
o Hypothyroidism … Leads to MR
o Prevent Neural tube disorders with Folic Acid during PG
o Myelomeningocele … Cover with moist sterile water dressing and keep pressure off
o Hydrocephalus … Signs of increased ICP are opposite of shock …
• Shock = Increased pulse and decreased BP
• IICP = Decreased pulse and increased BP … (+ Altered LOC = Most sensitive sign)
• Infants … IICP = Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy … Treat with peritoneal shunt – don’t pump shunt. Older kids IIPC = Widened pulse pressure
• IICP caused by suctioning, coughing, straining, and turning – Try to avoid
o Muscular Dystrophy … X-linked Recessive, waddling gait, hyper lordosis, Gower’s Sign = difficulty rising walks up legs (like Minor’s sign), fat pseudohypertrophy of calves.
o Seizures … Nothing in mouth, turn hd to side, maintain airway, don’t restrain, keep safe … Treat with Phenobarbitol (Luminol), Phenytoin (Dilantin: TR = 10-20 … Gingival Hyperplasia), Fosphenytoin (Cerebyx), Valproic Acid (Depakene), Carbamazepine (Tegritol)
o Meningitis (Bacterial) … Lumbar puncture shows Increased WBC, protein, IICP and decreased glucose
• May lead to SIADH (Too much ADH) … Water retention, fluid overload, dilutional hyponatremia
o CF Kids taste salty and need enzymes sprinkled on their food
o Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during PG)
o Pain in young children measured with Faces pain scale
o No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin
o Immunization Side Effects … T < 102, redness and soreness at injection site for 3 days … give Tylenol and bike pedal legs (passively) for child.
o Call Physician if seizures, high fever, or high-pitched cry after immunization
o All cases of poisoning … Call Poison Control Center … No Ipecac!
o Epiglottitis = H. influenza B … Child sits upright with chin out and tongue protruding (maybe Tripod position) … Prepare for intubation or trach … DO NOT put anything into kid’s mouth
o Isolate RSV patient with Contact Precautions … Private room is best … Use Mist Tent to provide O2 and Ribavirin – Flood tent with O2 first and wipe down inside of tent periodically so you can see patient
o Acute Glomerulonephritis … After B strep – Antigen-Antibody complexes clog up glomeruli and reduce GFR = Dark urine, proteinuria
o Wilm’s Tumor = Large kidney tumor … Don’t palpate
o TEF = Tracheoesophageal Atresia … 3 C’s of TEF = Coughing, Choking, Cyanosis
o Cleft Lip and Palate … Post-Op – Place on side, maintain Logan Bow, elbow restraints
o Congenital Megacolon = Hirschsprung’s Disease … Lack of peristalsis due to absence of ganglionic cells in colon … Suspect if no meconium w/in 24 hrs or ribbon-like foul smelling stools
o Iron Deficiency Anemia … Give Iron on empty stomach with citrus juice (vitamin C enhances absorption), Use straw or dropper to avoid staining teeth, Tarry stools, limit milk intake < 32 oz/day
o Sickle Cell Disease …Hydration most important …SC Crisis = fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia …Tx + rest, hydration … Avoid high altitude and strenuous activities
o Tonsillitis … usually Strep … Get PT and PTT Pre-Op (ask about Hx of bleeding) … Suspect Bleeding Post-Op if frequent swallowing, vomiting blood, or clearing throat … No red liquids, no straws, ice collar, soft foods … Highest risk of hemorrhage = first 24 hrs and 5-10 days post-op (with sloughing of scabs)
o Primary meds for ER for respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) … Bronchodilators
o Must know normal respiratory rates for kids … Respiratory disorders = Primary reason for most medical/ER visits for kids …
• Newborn … 30-60
• 1-11 mo … 25-35
• 1-3 years … 20-30
• 3-5 years … 20-25
• 6-10 years … 18-22
• 11-16 years …16-20
Cardiovascular Disorders
o Acyanotic = VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis
• Antiprostaglandins cause closure of PDA (aorta - pulmonary artery)
o Cyanotic = Tetralogy of Fallot, Truncus Arteriosis (one main vessel gets mixed blood), TVG (Transposition of Great Vessels) … Polycythemia common in Cyanotic disorders
• 3 T’s of Cyanotic Heart Disease (Tetralogy, Truncus, Transposition)
o Tetralogy of Fallot … Unoxygenated blood pumped into aorta
• Pulmonary Stenosis
• Overiding Aorta
• Right Ventricular Hypertrophy
• TET Spells …Hypoxic episodes that are relieved by squatting or knee chest position
o CHF can result … Use Digoxin … TR = 0.8-2.0 for kids
o Ductus Venosus = Umbelical Vein to Inferior Vena Cava
o Ductus Arteriosus = Aorta to Pulmonary Artery
o Rheumatic Fever … Acquired Heart Disease … Affects aortic and mitral valves
• Preceded by beta hemolytic strep infection
• Erythema Marginatum = Rash
• Elevated ASO titer and ESR
• Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep)
• Treat with Penicillin G = Prophylaxis for recurrence of RF

• Maternity
o Day 1 of cycle = First day of menses (bleeding) … Ovulation on Day 14 … 28 days total … Sperm 3-5 days, Eggs 24 hrs … Fertilization in Fallopian Tube
o Chadwick’s Sign = Bluing of Vagina (early as 4 weeks)
o Hegar’s Sign = Softening of isthmus of cervix (8 weeks)
o Goodell’s Sign = Softening of Cervix (8 weeks)
o Pregnancy Total wt gain = 25-30 lbs (11-14 kg)
o Increase calorie intake by 300 calories/day during PG … Increase protein 30 g/day … Increase iron, Ca++, Folic Acid, A & C
o Dangerous Infections with PG … TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV
o Braxton Hicks common throughout PG
o Amniotic fluid = 800-1200 mL (< 300 mL = Oligohydramnios = fetal kidney problems)
o Polyhydramnios and Macrosomia (large fetus) with Diabetes
o Umbelical cord: 2 arteries, 1 vein … Vein carries oxygenated blood to fetus (opposite of normal)
o FHR = 120-160
o Folic Acid Deficiency = Neural tube defects
o Pre-term = 20-37 weeks
o Term = 38-42 weeks
o Post-term = 42 weeks+
o TPAL = Term births, Pre-term births, Abortions, Living children
o Gravida = # of Pregnancies regardless of outcome
o Para = # of Deliveries (not kids) after 20 wks gestation
o Nagale’s Rule … Add 7 days to first day of last period, subtract 3 months, add 12 months = EDC
o Hgb and Hct a bit lower during PG due to hyperhydration
o Side-lying is best position for uteroplacental perfusion (either side tho left is traditional )
o 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature
o AFP in amniotic fluid = possible neural tube defect
o Need a full bladder for Amniocentesis early in PG (but not in later PG)
o Lightening = Fetus drops into true pelvis
o Nesting Instinct = Burst of Energy just before labor
o True Labor = Regular contractions that intensify with ambulation, LBP that radiates to abdomen, progressive dilation and effacement
o Station = Negative above ischial spines, Positive below
o Leopold Maneuver tries to reposition fetus for delivery
o Laboring Maternal Vitals … Pulse < 100 (usually a little higher than normal with PG - BP is unchanged in PG). T < 100.4
o NON-Stress Test … Reactive = Healthy (FHR goes up with movements)
o Contraction Stress Test (Ocytocin Challenge Test)… Unhealthy = Late decels noted (positive result) indicative of UPI … “Negative” result = No late decels noted (good result)
o Watch for hyporeflexia with Mag Sulfate admin … Diaphragmatic Inhibition
• Keep Calcium gluconate by the bed (antidote)
o Firsts
• Fetal HB … 8-12 weeks by Doppler, 15-20 weeks by fetoscope
• Fetal movement = Quickening, 14-20 weeks
• Showing = 14 weeks
• Braxton Hicks – 4 months and onward
o Early Decels = Head compression = OK
o Variable Decels = Cord compression = Not Good
o Late Decels = Utero-placental insufficiency = BAD!
o If Variable or Late Decels … Change maternal position, Stop Pitocin, Administer O2, Notify Physician
o DIC … Tx is with Heparin (safe in PG) … Fetal Demise, Abruptio Placenta, Infection
o Fundal Heights
• 12-14 wks … At level of symphysis
• 20 weeks … 20 cm = Level of umbilicus
• Rises ~ 1 cm per week
o Stages of Labor
• Stage 1 = Beginning of Regular contraction to full dilation and effacement
• Stage 2 = 10 cm dilation to delivery
• Stage 3 = Delivery of Placenta
• Stage 4 = 1-4 Hrs following delivery
o Placenta Separation … Lengthening of cord outside vagina, gush of blood, full feeling in vagina … Give oxytocin after placenta is out – Not before.
o Schultz Presentation = Shiny side out (fetal side of placenta)
o Postpartum VS Schedule
• Every 15 min X 1 hr
• Every 30 min X next 2 hours
• Every Hour X next 2-6 hours
• Then every 4 hours
o Normal BM for mom within 3 days = Normal
o Lochia … no more than 4-8 pads/day and no clots > 1 cm … Fleshy smell is normal, Foul smell = infection
o Massage boggy uterus to encourage involution … empty bladder ASAP – may need to catheterize … Full bladder can lead to uterine atony and hemorrhage
o Tears …1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal sphincter, 4th Degree = rectum
o APGAR = HR, R, mm tone, Reflex irritability, Color … 1 and 5 minutes …7-10 = Good, 4-6 = moderate resuscitative efforts, 1-3 = mostly dead
o Eye care = E-mycin + Silver Nitrate … for gonorrhea
o Pudendal Block = decreases pain in perineum and vagina – No help with contraction pain
o Epidural Block = T10-S5 … Blocks all pain … First sign = warmth or tingling in ball of foot or big toe
o Regional Blocks often result in forceps or vacuum assisted births because they affect the mother’s ability to push effectively
o WBC counts are elevated up to 25,000 for ~10 days post partum
o Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver Rh+ kids… Not given if mom has a +Coombs Test … She already has developed antibodies (too late)
o Caput Succedaneum = edema under scalp, crosses suture lines
o Cephalhematoma = blood under periosteum, does not cross suture lines
o Suction Mouth first – then nostrils
o Moro Reflex = Startle reflex (abduction of all extremities) – up to 4 months
o Rooting Reflex … up to 4 months
o Babinski Reflex … up to18 months
o Palmar Grasp Reflex …Lessens by 4 months
o Ballard Scale used to estimate gestational age
o Heel Stick = lateral surface of heel
o Physiologic Jaundice is normal at 2-3 days … Abnormal if before 24 hours or lasting longer than 7 days … Unconjugated bilirubin is the culprit.
o Vitamin K given to help with formation of clotting factors due to fact that the newborn gut lacks the bacteria necessary for vitamin K synthesis initially … Vastus lateralis mm IM
o Abrutio Placenta = Dark red bleeding with rigid board like abdomen
o Placenta Previa = Painless bright red bleeding
o DIC = Disseminated Intravascular Coagulation … clotting factors used up by intravascular clotting – Hemorrhage and increased bleeding times result … Associated with fetal demise, infection and abruptio placenta.
o Magnesium Sulfate used to reduce preterm labor contractions and prevent seizures in Pre-Eclampsia … Mg replaces Ca++ in the smooth mm cells resulting relaxation … Can lead to hyporeflexia and respiratory depression – Must keep Calcium Gluconate by bed when administering during labor = Antidote … Monitor for:
• Absent DTR’s
• Respirations < 12
• Urinary Output < 30/hr
• Fetal Bradycardia
o Pitocin (Oxytocin) use for Dystocia… If uterine tetany develops, turn off Pitocin, admin O2 by face mask, turn pt on side. Pitocin can cause water intoxication owing to ADH effects.
o Suspect uterine rupture if woman complains of a sharp pain followed by cessation of contractions
o Pre-Eclampsia = Htn + Edema + Proteinuria
o Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma … Suspect if Severe HA + visual disturbances
o No Coumadin during PG (Heparin is OK)
o Hyperemesis Gravidarum = uncontrollable nausea and vomiting … May be related to H. pyolori … Reglan (metaclopromide)
o Insulin demands drop precipitously after delivery
o No oral hypoglycemics during PG – Teratogenic … Insulin only for control of DM
o Babies born without vaginal squeeze more likely to have respiratory difficulty initially
o C-Section can lead to Paralytic Ileus … Early ambulation helps
o Postpartum Infection common in problem pregnancies (anemia, diabetes, traumatic birth)
o Postpartum Hemorrhage = Leading cause of maternal death … Risk factors include:
• Dystocia, prolonged labor, overdistended uterus, abrutio placenta, infection
Tx includes … Fundal massage, count pads, VS, IV fluids, Oxytocin, notify physician
o Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn
o Hypoglycemia … tremors, high pitched cry, seizures
o High pitched cry + bulging fontanels = IICP
o Hypothermia can lead to Hypoxia and acidoisis … Keep warm and use bicarbonate prn to treat acidosis in newborn.
o Lay on right side after feeding … Move stomach contents into small intestine
o Jaundice and High bilirubin can cause encephalopathy … < 12 = normal … Phototherapy decomposes bilirubin via oxidation … Protect eyes, turn every 2 hours and watch for dehydration … The dangerous bilirubin is the unconjugated indirect type.

• Nutrition
o K+ … Bananas, dried fruits, citrus, potatoes, legumes, tea, peanut butter
o Vitamin C … Citrus, potatoes, cantaloupe
o Ca++ … Milk, cheese, green leafy veggies, legumes
o Na+ … Salt, processed foods, seafood
o Folic Acid … Green leafy veggies, liver, citrus
o Fe++ … Green leafy veggies, red meat, organ meat, eggs, whole wheat, carrots
• Use Z-track for injections to avoid skin staining
o Mg+ … Whole grains, green leafy veggies, nuts
o Thiamine (B1) … Pork, beef, liver, whole grains
o B12 … Organ meats, green leafy veggies, yeast, milk, cheese, shellfish
• Deficiency = Big red beefy tongue, Anemia
o Vitamin K … Green leafy veggies, milk, meat, soy
o Vitamin A … Liver, orange and dark green fruits and veggies
o Vitamin D … Dairy, fish oil, sunlight
o Vitamin E … Veggie oils, avocados, nuts, seeds
o BMI … 18.5-24.9 = Normal (Higher = Obese)

• Gerontology
o Essentially everyone goes to Hell in a progressively degenerative hand-basket
• Thin skin, bad sleep, mm wasting, memory loss, bladder shrinks, incontinence, delayed gastric emptying, COPD, Hypothyroidism, Diabetes

o Common Ailments:
• Delerium and Dementia
• Cardiac Dysrhythmias
• Cataracts and Glaucoma
• CVA (usually thrombotic, TIAs common)
• Decubitus Ulcers
• Hypothyroidism
• Thyrotoxicosis (Grave’s Disease)
• COPD (usually combination of emphysema and CB)
• UTIs and Pneumonia … Can cause confusion and delerium
o Memory loss starts with recent – progresses to full
o Dementia = Irreversible (Alzheimer’s) … Depression, Sundowning, Loss of family recognition
o Delerium = Secondary to another problem = Reversible (infections common cause)
o Medication Alert! … Due to decreased renal function, drugs metabolized by the kidneys may persist to toxic levels
o When in doubt on NCLEX … Answer should contain something about exercise and nutrition.

• Advanced Clinical Concepts
o Erickson … Psycho-Social Development
• 0-1 yr (Newborn) … Trust vs. Mistrust
• 1-3 yrs (Toddler)… Autonomy vs. Doubt and Shame … Fear intrusive procedures - Security objects good (Blankies, stuffed animals)
• 3-6 yrs (Pre-school) … Initiative vs. Guilt … Fear mutilation – Band-Aids good
• 6-12 yrs (School Age) … Industry vs. Inferiority… Games good, Peers important … Fear loss of control of their bodies
• 12-19 yrs (Adolescent) … Identity vs. Role Confusion … Fear Body Image Distortion
• 20-35 yrs (Early Adulthood) … Intimacy vs. Isolation
• 35-65 yrs (Middle Adulthood) … Generativity vs. Stagnation
• Over 65 (Older Adulthood) … Integrity vs. Despair
o Piaget … Cognitive Development
• Sensorimotor Stage (0-2) … Learns about reality and object permanence
• Preoperational Stage (2-7) … Concrete thinking
• Concrete Operational Stage (7-11) … Abstract thinking
• Formal Operational Stage (11-adult) … Abstract and logical thinking
o Freud … Psycho-Sexual Development
• Oral Stage (Birth -1 year) … Self gratification, Id is in control and running wild
• Anal Stage (1-3) … Control and pleasure wrt retention and pooping – Toilet training in this stage
• Phallic Stage (3-6) … Pleasure with genitals, Oedipus complex, SuperEgo develops
• Latency Stage (6-12) … Sex urges channeled to culturally acceptable level, Growth of Ego
• Genital Stage (12 up) … Gratification and satisfying sexual relations, Ego rules
o Kohlberg … Moral Development
• Moral development is sequential but people do not aromatically go from one stage to the next as they mature
• Level 1 = Pre-conventional … Reward vs. Punishment Orientation
• Level 2 = Conventional Morality … Conforms to rules to please others
• Level 3 = Post- Conventional … Rights, Principles and Conscience (Best for All is a concern)

• Calculations Rules & Formulas
o Round final answer to tenths place
o Round drops to nearest drop
o When calculating mL/hr, round to nearest full mL
o Must include 0 in front of values < 1
o Pediatric doses rounded to nearest 100th. Round down for peds
o Calculating IV Flow Rates
• Total mL X Drop Factor / 60 X #Hrs = Flow Rate in gtts/min
o Calculating Infusion Times
• Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse

• Conversions
o 1 t = 5mL
o 1 T = 3 t = 15 mL
o 1 oz = 30 cc = 30 mL = 2 T
o 1 gr = 60 mg
o 1 mg = 1000 ug (or mcg)
o 1 kg = 2.2 lbs
o 1 cup = 8 oz = 240 mL
o 1 pint = 16 oz
o 1 quart = 32 oz
o Degrees F = (1.8 X C) + 32
o Degrees C = (F – 32) / 1.8
• 37 C = 98.6 F
• 38 C = 100.4 F
• 39 C = 102.2 F
• 40 C = 104 F

• Fall Precautions
o Room close to nurses station
o Assessment and orientation to room
o Get help to stand (dangle feet if light headed)
o Bed low with side rails up
o Good lighting and reduce clutter in room
o Keep consistent toileting schedule
o Wear proper non-slip footwear
o At home …
• Paint edges of stairs bright color
• Bell on cats and dogs

• Neutropenic (Immunosuppressed) Precautions
o No plants or flowers in room
o No fresh veggies … Cooked foods only
o Avoid crowds and infectious persons
o Meticulous hand washing and hygiene to prevent infection
o Report fever > 100.5 (immunosuppressed pts may not manifest fever with infection)

• Bleeding Precautions (Anticoagulants, etc.)
o Soft bristled tooth brush
o Electric razor only (no safety razors)
o Handle gently, Limit contact sports
o Rotate injection sites with small bore needles for blood thinners
o Limit needle sticks, Use small bore needles, Maintain pressure for 5 minutes on venipuncture sites
o No straining at stool - Check stools for occult blood (Stool softeners prn)
o No salicylates, NSAIDs, or suppositories
o Avoid blowing or picking nose
o Do not change Vitamin K intake if on Coumadin

Hope this helps….MS. D

anonymous asked:

I think I remember you saying you had hemophilia, and I was wondering how does it affect your life on a daily basis? It's completely OK if you don't feel comfortable answering this if its too personal.

It doesn’t really affect it a whole lot. I have some limited range of motion in my elbows from when I was younger and some arthritis in one of my ankles. But other than that, I spend 15 minutes every few days to a week giving myself an infusion (a shot basically) of clotting factor. I do tha drugs.

I was a little restricted to how much physical activity I could do when I was younger. I couldn’t join a sports team or get a skateboard even though I really wanted to. I sort of gravitated towards video games and computers for that reason haha.