CALORIC STIMULATION TEST
BRAIN SCAN
BLOOD COAGULATION TEST
BARIUM ENEMA
ASSESSMENT OF LOCHIA
The normal color of lochia are:
ARTERIAL BLOOD GAS ANALYSIS
ALPHA-FETOPROTEIN LEVEL
ABDOMINAL ASSESSMENT
In real work situation, when the staffs are shortage, a registered nurse should delegates some intervention to an unlicensed assistive personel and/or nurse aid.
Just remember the concepts that:
DO NOT DELEGATE assessment, teaching and evaluation.
A registered nurse can delegate: feeding patient, taking vital signs, hygiene care, and stable patients.
There are five rights of delegation:
Advance directive is a document made by an individual before becoming ill. There are two types of advance directive: living wills and durable power of attorney for health care (DPAHC).
Living Wills:
Diabetic Ketoacidosis
Kussmaul's breathing: deep rapid breathing
Duchene's Muscular Dystrophy
Gower Sign: use of hands to push one's self from the floor.
When nurse gives care to patient, there are cultural specifics that must be considered. There are nursing cares failed to be implemented not because of incompetent nurse but simply because of culture diversity that not be considered.
Here are the simplest guidelines to understand cultural diversity when caring patient. We can simply say A-B-C-D principles of cultural diversity:
A: Administration of medications that must take into consideration of patient's beliefs and practices.
So many patient’s right if I have to mention all of them. But just remember that here are the most common patient's rights comes in real NCLEX-CGFNS exams:
Don not miss this concepts. Some question in relation with safety precaution may be come on real exam. Prepare it and remember this concepts.
Infants:
Isolation precautions are used to isolate the infections NOT patients. Isolation is selected based on the mode of transmission and pathogenesis of infection. Some question on NCLEX-CGFNS deal with isolation precautions.
STRICT ISOLATION
There is a specific care for patient with specific tube. Some real questions of NCLEX-CGFNS exams were found asking the principles in providing nursing care to patients with tubes.
Let's review most commonly tube that questioned on NCLEX-CGFNS exam.
BROVIAC CATHETER
It a single lumen usually used for patient with small central vessel (children and elderly).
There are many essential concepts of tractions. Here are the essential guidelines to be remembered:
T : trapeze bar over head is used to raise and lower the upper body
R : requires free hanging weights
A : analgesic to relieve pain
C : check circulation
T : temperature monitoring
I : infection prevention
O : output and intake monitoring
N : nutrition in appropriate diet
S : skin check frequently
Here are the tractions most questioned on exams:
BRYANT'S TRACTION
It is used to reduce femoral fracture in children. The buttocks are slightly elevated and clear off the bed. Position is on flat.
Acromegaly: coarsening of facial features
Acute glomerulonephritis: edema
Acute lympocytic leukemia: anemia
Acute respiratory distress syndrome: rapid shallow breathing
Alzeimer's disease: progressive memory loss
Anemia – iron deficiency: fatigue
Anemia – pernicious: fatigue
Anemia – sickle cell: growth retardation
Angina pectoris: chest pain
Arthritis rheumatoid: morning stiffness
Autonomic dysreflexia: hypertension
Benign prostatic hypertrophy: reduction in size and force of urinary stream
Bronchogenic carcinoma: changing cough
Cancer – bladder: painless hematuria
Cancer – breast: mass/lump/thickening
Cancer – cervix: bleeding
Cancer – esophagus: dysphagia after ingestion of solid foods.
Cancer – larynx: change in voices or hoarseness
Cancer – ovary: vague abdominal discomfort and dyspepsia
Cancer – testes: painless swelling
Cataract: blurring of vision
Congestive heart failure: dyspnea (if left side) and edema (if right side)
Congenital hip dislocation: shorter of affected leg
Crohn's disease: right lower quadrant pain
Cystic fibrosis: meconium ileus
Cystitis: burning on urination
Diabetes mellitus: polyuria
Dumping syndrome: dizziness, diarrhea, diaphoresis
Guillain-bare syndrome: ascending weakness beginning in the lower extremities, clumsiness
Hepatic encephalopathy: personality changes
Hiatal hernia: heartburn 30 minutes after meals
Hyperthyroidism: nervousness
Hypocalcemia: tingling sensation around the lips and the fingers
Hypokalemia: muscle weakness
Hypovolemic shock: increased pulse rate
Hypoxia: restlessness
Increased ICP : widening pulse pressure , decreasing LOC
Liver cirrhosis: hepatomegaly
Lyme's disease: bull's eye rash
Meniere's disease: vertigo
Mengingitis: headache
Multiple sclerosis: diplopia
Myasthenia gravis: muscle weakness
Nephrotic syndrome: periorbital edema
Otitis media: pain
Pancreatitis: periumbilical pain
Parkinson's disease: unilateral pill rolling tremors
Retinal detachment: visual floaters
Retinoblastoma: cat's eye reflex
Tardive dyskinesia: tongue twitching
Thyroid crisis: increased temperature
Ulcerative colitis: recurrent bloody diarrhea
The concept of patient positioning is important to understand as preparing for NCLEX or CGFNS. What position will you place your patient in? That is the question you can ask to yourself. Specific position will aggravate or lessen the patient condition.
Abdominal aneurysm surgery: Fowler position to prevent pressure on the graft.
Air embolism: Left side position and lower head of the bed to promote air to the right atrium and prevent to be carried to the systemic circulation.
Appendicitis: Any position if unruptured, and semi fowler if ruptured.
Asthma: Sitting position, leaning forward, to promote patient breathing
Autonomic dysreflexia: High fowler. It will prevent patient from hypertension stroke.
Bronchoscopy: Semi Fowler, to prevent aspiration after procedure.
Broncholitis: Tripod position.
Cast: elevate extremity to prevent edema.
Cataract surgery: Semi fowler to prevent edema at the operative site.
Cerebral aneurysm: Semi fowler.
Cleft lip: Supine after operation, prevent pressure on the suture line.
Cleft palate: Prone position.
Congestive heart failure: High Fowler that improve oxygenation.
Craniotomy: Semi fowler if supratentorial, and Flat if infratentorial that can promote drainage from the head.
Cerebro vascular accident: Elevate the head to reduce intra cranial pressure.
Dumping syndrome: Supine position after meal. It prevents rapid emptying or the stomach.
Epistaxis: Leaning forward to prevent blood aspiration.
Flail chest: Keep patient on affected side to promote expansion of the unaffected lung.
Hemorroidectomy: Side lying.
Hiatal hernia: Upright position after meals to prevent reflux of stomach contents.
Hip surgery: Legs in abduction position that can prevent dislodge of the head of the femur from acetabulum.
Hypophysectomy: Elevate head of the bed to prevent increase intracranial pressure
Increased Intracranial Pressure (ICP): Elevate head of the bed.
Laminectomy: Prevent twisting of the spine with keeping the back as straight as possible.
Laryngectomy: Semi fowler for maintaining airway and reduce edema.
Liver biopsy: Right side position post procedure to prevent patient from bleeding.
Lobectomy: Semi fowler
Lumbar puncture: Lateral side lying during procedure and flat after procedure.
Mastectomy: Elevate the extremity of the affected side (on pillow) to prevent edema.
Myelogram: Elevate the head if water based dye was used, and flat if oil based dye was used.
Placenta previa: Sitting position that can minimize bleeding.
Prolapse cord: Knee-chest Position to prevent pressure on the cord.
Pulmonary edema: Fowler position.
Pyloric stenosis: Right side lying position after meal, to facilitate entry of the stomach contents into the intestines.
Radium implant in the cervix: Flat to prevent dislodge of the implant.
Retinal detachment: The affected side toward the bed to help the detached retina to fall back in place.
Seizure: Side lying position
Shock: Modified trendelenburg to promote venous return.
Spinal cord injury: Immobilize the patient
Thoracentesis: Fowler position during procedure and any position after
Thrombophlebitis: Bed rest and elevate the affected leg to promote circulation
Thyroidectomy: Semi Fowler ad avoid hyperflexion and hyperextension of the neck.
Tonsillectomy: Sidelying or prone
Total Parenteral Nutrition: Trendelenburg during tube insertion to prevent air embolism
Tracheoesophagel Fistula (TEF): Supine with the head elevated at least 30 degrees
Varicose veins: elevate the legs above the level of heart
Vein stripping and ligation: Legs are elevated to prevent venous stasis
There are many questions asked about diets for specific diseases. Here are the most diseases and diets:
Acne : low fat
Acute gastroenteritis : clear liquid
Acute glomerulonephritis : low Natrium, low Protein
Addison disease : high Natrium, Low kalium
Anemia - iron deficiency : high iron
Anemia - pernicious : high protein, vitamin B
Anemia – sickle cell : high fluid
Angina pectoris : low cholesterol
Arthritis – gout : purine restricted
Attention Deficit Hyperactivity Disorder (ADHD) : finger foods
Bipolar disorder : finger foods
Burn : high calorie, high protin
Celiac's disease : gluten free
Cholecystitis : high protein, high carbohydrate, low fat
Congestive heart failure : low natrium, low cholesterol
Congestive heart failure : low natrium, low cholesterol
Cretinism : high protein, high calcium
Crohn disease : high protein, high carbohydrate, low fat
Cushing disease : high kalium, low natrium
Cystic fibrosis : high calorie, high natrium
Cystitis : acid ash (for alkaline stones) and alkaline ash( for acid stones)
Decubitus ulcer : high protein, high vitamin C
Diabetes mellitus : well balanced diet
Diarrhea : high kalium, high natrium
Diverticulitis : low residue
Diverticulosis : high residue with no seeds
Dumping syndrome : high fat, high protein, dry food
Hepatic encephalopathy : low protein
Hepatitis : hight protein, high calorie
Hirschsprung disease : high calorie, low residue, high protein
Hyperparathyroidism : low calcium
Hypertension : salt restricted
Hyperthyroidism : high calorie, high protein
Hypoparathyroidism : high calcium, low phosphorus
Hypthyroidism : low calorie, low cholesterol, low saturated fat
Kawasakis' disease : clear liquid
Liver cirrhosis : low protein
Meniere's disease : low natrium
Myocardial infarction : low fat, low cholesterol, low natrium
Nephritic syndrome : low natrium, high protein, high calorie
Osteoporosis : high calcium, high vitamin D
Pancreatitis : low fat
Peptic ulcer : high fat, high carbohydrate, low protein
Phenylketonuria : low protein/phenylalanine
Pregnancy induced hypertension : high protein
Renal colic : low sodium, low protein
Renal failure – acute : low protein, high carbohydrate, low natrium (oliguric phase), high protein, high calorie, restricted fluid (diuretic phase)
Renal failure – chronic : low protein, low natrium, low kalium
Tonsillitis : clear liquidMAJOR DIETARY SOURCES:CARBOHYDRATE
PROTEIN
FAT SOURCE
INFANT (0-1 YEAR)
Here are specific diseases with specific their complication. It is important to remember them as preparation for NCLEX and CGFNS Exam.
There are diseases that have no initial symptoms.
