o Anesthetic Blocks
▪ Pudendal block = decreases pain in perineum and vagina – no help with contraction pain
▪ Epidural block = T10-S5
• Blocks all pain
• First sign = warmth or tingling in ball of foot or big toe
▪ Regional blocks often result in forceps or vacuum assisted births ...
HESI Hints and NCLEX Gems
• Answering NCLEX questions
o Maslow’s Hierarchy of Needs
▪ Physiologic
▪ Safety
▪ Love and Belonging
▪ Esteem
▪ Self-Actualization
o Nursing Process
▪ Assessment
▪ Diagnosis
▪ Planning
▪ Implementation
▪ 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 – 6.1million
▪ 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
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: 135 – 145
o K: 3.5 – 5.0
▪ Hypokalemia: Prominent U waves, Depresses ST segment, Flat T waves
▪ Hyperkalemia: Tented T waves, prolonged PR interval, wide QRS
,HESI NCLEX HESI HELP UPDATED VERSION
o Calcium: 9 – 10.5
▪ Hypocalcemia: muscle spasms, convulsions, cramping, tetany, pos Trousseau’s, pos Chvostek’s,
prolonged ST interval, prolonged QT segments
o Mg: 1.5 – 2.5
o Cl: 96 – 106
o Phos: 3 – 4.5
o Albumin: 3.5 – 5
o Specific Gravity: 1.005 – 1.030
o HgbA1C:
▪ Ideal = 4-6%
▪ Ok (120 days) <7%
o Dilantin TR: 10 – 20
o Lithium TR: 0.5 – 1.5
o Arterial Blood Gas
▪ pH = 7.35 – 7.45
▪ CO2 = 35 – 45
▪ HCO3 = 22 – 28
▪ O2 = 80 – 100
▪ O2 Sat = 95 – 100%
• Antidotes
o Digoxin – Digiband
o Coumadin – Vit K
o Benzos – Flumzaemil (Tomazicon)
o Heparin – Protamine Sulfate (Keep aPTT and PTT at 1.5-2 times normal)
o Tylenol – Mucomyst (loading dose + 17 doses)
o Opiates (narcotics 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 and 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 of Ambu-bag for resuscitation
▪ Refrain from giving care if you have skin lesions
o Droplet (Respiratory) Precautions – wear mask
▪ Sepsis, scarlet fever, strep, fifth disease (Parvo B19), pertusis, pneumonia, influenza, diphtheria,
epiglottitis, rubella, rubeola, meningitis, mycoplasma, adenovirus, rhinovirus
, HESI NCLEX HESI HELP UPDATED VERSION
▪ RSV (needs contact precautions too)
▪ TB (Respiratory isolation)
o Contact Precautions = universal + goggles, mask, and gown
o No infectious patients with immunosuppressed patients
▪ Clean with clean
▪ Dirty with dirty
• Misc.
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 Myasthenia Gravis
▪ Myasthenic 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 CCBs
o Anthrax = Multi-vector biohazard
o Pulmonary air embolism prevention = Trendelenberg (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 Gullian-Barre Syndrome
▪ Weakness progresses from legs upward – leads to Resp arrest
o Trough draw = ~30 min before scheduled administration
o Peak Draw = 30-60 min after drug administration.
• Mental Health and 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
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