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NCLEX RN 1000RN SUMMARY NOTES WELL UPDATED 2021

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NCLEX RN 1000RN SUMMARY NOTES WELL UPDATED 2021 ABDOMINAL AORTIC ANEURISM “4-A’s” Asymptomatic Abdominal mass Abdominal pulse Aches low back ABDOMINAL DISTENSTION "5-F's" Fat Fluid ... Feces Flatus Fetus ACE INHIBITOR SIDE EFFECTS "CAPTOPRIL" Cough Anaphylaxis Palpitations Taste Orthostatic -↓BP Potassium - ↑K+ Renal impairment Impotence Leukocytosis ACID-BASE "ROME" – Respiratory Opposite, Metabolic Equal ACIDOSIS » Respiratory (opposite): pH Pco2 » Metabolic (equal): pH HCO3 ALKALOSIS » Respiratory (opposite): pH Pco2 » Metabolic (equal): pH HCO3 ACIDOSIS/ALKALOSIS “ROME” Respiratory Opposite: pH↑ PCO2↓ = alkalosis pH↓ PCO2↑ = acidosis Metabolic Equal: pH↑ HCO3↑ = Alkalosis pH↓ HCO3↓ = Acidosis ACIDOSIS/ALKALOSIS – COMPENSTATION “RUB MUB” Respiratory Uses Bicarb Metabolic Uses Breathing ALKALOSIS AND ACIDOSIS AlKalosis has “K” – it’s “K”icking pH up= PH↑ AciDosis has “D” – it’s “D”ropping pH Down = PH↓ ACUTE INFLAMMATION FEATURES Think: "what a cute pair of SLIPpeRs"to tie acute inflammation to “SLIPR”mnemonic). “SLIPR” Swelling Loss of function Increased heat Pain Redness ADRENAL GLAND HORMONES “SSS” S-sugar (Glucocorticoids) S-salt (Mineralocorticoids) S-sex (Androgens) AIMS for improvement “PETEES” AIMS P - Patient centered care E - Efficient T - Timely E - Effective E - Equitable S - Safety ALCOHOL WITHDRAWAL – CLINICAL FEATURES "HITS" Hallucinations (visual, tactile) Increased vital signs & insomnia Tremens delirium tremens (potentially lethal) Shakes/Sweat/Seizures/Stomach pain (N/V) ALCOHOLISM – BEHAVIORAL PROBLEMS “5-D's” D- Denial D- Dependency D- Demanding D- Destructive D- Domineering ALCOHOLISM OUTCOME “BAD” B- Brain Damage A- Alcoholic Hallucinosis D- Death ALDOSTERONE IS REGULATED BY: "RNA’S" Renin-angiotensin mechanism Na concentration in blood Anp (ANP – atrial natriuretic peptide) Stress ALZHEIMER – “5 A’s” to DIAGNOSIS “5-A's” Amnesia – loss of memories Anomia – unable to recall names of everyday objects Apraxia – unable to perform tasks of movement Agnosia – inability to process sensory information Aphasia – disruption with ability to communicate ANGINA – PRECIPITATING FACTORS "4-E's" Eating Emotion Exertion (Exercise) Extreme Temperatures (Hot/Cold weather) “ANOREXIA” – EATING DISORDER A-menorrhea delayed N-o organic factors accounts for weight loss O-obviously thin but feels FAT R-refusal to maintain normal body weight E-epigastric discomfort is common X-symptoms (peculiar symptoms) I-intense fears of gaining weight A-always thinking of foods ANOREXIA NERVOSA – CLINICAL FEATURES "ANOREXIC" A-adolescent women/Amenorrhea N-GT alimentation (most severe cases) O-obsession w/ wt. loss/becoming fat though underweight R-refusal to eat (5% die) E-electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X-exercise I-intelligence often above average/Induced vomiting C-cathartic use (and diuretic abuse) ANTICHOLINERGIC CRISIS Can't see (blurred vision) Can't spit (dry mouth) Can't pee (urinary retention) Can't shit (constipation) ANTICHOLINERGIC CRISIS – SIGNS "SLUD" Salivation Lacrimation Urination Defecation ANTI-TB DRUGS& SIDE EFFECTS “RIPES” Rifampicin – red-orange urine Isoniazid – peripheral neuritis Pyrazinamide –increase uric acid Ethambutol – eye problems Streptomycin – ototoxic (use a star as these drugs stain the teeth) – ??? (H-eat, I-nduration) – ??? APGAR SCORING "APGAR" Appearance: cyanosis--peripheral, central, none Pulse: pulse rate Grimace: response to stimulation Activity: movement of the baby (muscle tone) Respiration: respiratory rate APPENDICITIS - ASSESSMENT “PAINS” Pain (RLQ) - pain in RLQ of abdomen Anorexia - loss of appetite Increased temperature, WBC (15,000-20,000) Nausea Signs (McBurney's, Psoas) ARTERIAL BLOOD GASES 1. look at pH: LowpH = acidosis High pH = alkalosis 2. use “ROME” mnemonic (to determine if its respiratory or metabolic): Respiratory –Opposite Metabolic –Equal ASSESSING CHANGES IN BEHAVIOR "DEMENTIA" Drug and alcohol Eyes and ears Metabolic and endocrine disorders Emotional disorders Neurologic disorders Tumors and trauma Infection Arterial vascular disease ASTHMA MANAGEMENT "ASTHMA" Adrenergics (Albuterol) Steroids Theophylline Hydration (IV) Mask (Oxygen) Antibiotics ASTHMA - MANAGEMENT Asthma is a spasm of the airways, which causes difficulty breathing. “ASTHMA” Adrenergic (Albuterol) Steroids Theophylline Hydration (IV) Mask (Oxygen) Antibiotics ATRIAL FIBRILLATION – NEW ONSET CAUSES “THE ATRIAL FIBS” Thyroid Hypothermia Embolism (PE) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine)ATRIOVENTRICULAR VALVES "LAB RAT" Left Atrium: Bicuspid Right Atrium: Tricuspid ATROPINE "A goes with B" Atropine used to treat bradycardia. BENNER'S MODEL N - Nickerr's - easy to remember b/c it rhymes with Benner's Novice – strictly able to focus on learning therules, onset of education A - and - "ad"vanced beginners– distinguish abnormal findings but cannot readily understand significance C - Comp - Competent – able to handle their pt. load and prioritize situation P - Planetary – big picture is the key word - Proficiency E - Experts– Leader/ role model not every nurse becomes one. BETA 1 AND BETA 2 Beta 1 adrenergic receptors are mostly found in the heart. Beta 2 adrenergic receptors are found in lungs, GI tract, vascular smooth muscle, skeletal muscle, liver. Beta 1 beta blockers act primarily on the heart. Beta 2 beta blockers act primarily on the lungs. Beta 1: heart Beta 2: lungs - You have one heart and two lungs BETA BLOCKERS B1 Blocks the heart (only have ONE heart) B2 Blocks the lungs (have TWO lungs) BETA BLOCKER CONTRAINDICATIONS "ABCDE" Asthma Block (heart block) COPD Diabetes mellitus Electrolyte (hyperkalemia) BETA BLOCKERS "You have 1 heart and 2 lungs" Beta-1 act primarily on heart Beta-2 act primarily on lungs BLEEDING PRECAUTIONS “RANDI” R- Razor Electric/Blades A- Aspirin N- No needles (esp. in small gauge) D- Do decrease in needle sticks) I - Injury (Protect from) BLEEDING PRECAUTIONS If a patient is taking an anticoagulant to prevent blood clots there is increased risk for bleeding. Be careful with blades when shaving. Do not take aspirin as it interferes with blood clotting and can magnify the effect of the medication. Avoid excess needle sticks and protect the patient from injury. “RANDI” Razor Electric/Blades Aspirin Needles- small gauge Decrease needle sticks Injury (Protect from) BLOOD FLOW THROUGH HEART VALVES "Tissue Paper My Ass" Tricuspid Pulmonic Mitral Aortic BLOOD GLUCOSE Symptom Implication(rhyme) Cold and clammy . . . give hard candy Hot and dry . . . glucose is high BLOOD TYPES Picture type O as a huge circle, like the universe, because they are the universal donor. They can give to everyone. However, also think of them as the “odd man out” because they can only receive type O as well. They are universally odd, able to give to all but only receive from themselves! BODY SYSTEMS "MR DICE RUNS" Muscle Respiratory Digestive Integumentary Circulatory Endocrine Reproductive Urinary Nervous Skeletal BRADYCARDIA & LOW BP DRUGS “IDEA” I - Isoproterenol D - Dopamine E - Epinephrine A - Atropine Sulfate BRADYCARDIA & LOW BLOOD PRESSURE DRUGS This refers to symptomatic bradycardia and hypotension. Bradycardia and hypotension are not necessarily adverse clinical findings requirement treatment in and of themselves. “IDEA” Isoproterenol Dopamine Epinephrine Atropine Sulfate BRADYCARDIA AND HYPOTENSION MEDS "IDEA" Isoproterenol Dopamine Epinephrine Atropine Sulfate BREASTFEEDING ASSESSMENT "LATCH" Latch achieved by infant Audible swallow Type of nipple Comfort of mother Help given to mother with nursing BRONCHODILATORS "TO A SIS" Terbutaline Orciprenaline Adrenaline Salbutamol Isoprenaline Salmeterol “BULIMIA” – EATING DISORDER B-binge eating U-under strict dieting L-lacks control over-eating I-induced vomiting M-minimum of two binge eating episodes I-increased/Persistent concern of body size/shape A-abuse of diuretics & laxatives BULIMIA CLIENT FINDINGS “WASHED” W-weight loss of 15% of original body weight A-amenorrhea S-social withdrawal H-history of high activity & achievement E-electrolyte Imbalance D-depression/ Distorted Body Image CANCER ASSESSMENT "CAUTION" Change in bowel or bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump Indigestion or difficulty swallowing Obvious changes in a wart or mole Nagging cough or hoarseness CANCER - EARLY WARNING SIGNS Cancer can sometimes be difficult to identify, but the earlier it is detected the better chance treatment will be effective. “CAUTION UP” Change in bowel or bladder A lesion that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or persistent hoarseness Unexplained weight loss Pernicious Anemia CANCER - INTERVENTIONS “CANCER” Comfort Altered Body Image Nutrition Chemotherapy Evaluate response to meds Respite for caretakers CANCERS THAT METASTASIZE IN BONE "Particular Tumors Love Killing Bone" Prostate Thyroid Lung Kidney Breast CANES AND WALKERS "COAL" and "WWAL" Cane Opposite Affected Leg Walker With Affected Leg CANES AND WALKERS “COAL & WWAL” C- Cane O- Opposite A- Affected L- Leg W- Walker W- With A- Affected L – Leg CARDIAC VALVES BLOOD FLOW This simple mnemonic helps to remember the order in which blood passes through the four heart valves in sequential order. “Toilet Paper My A**” Tricuspid Pulmonic Mitral Aortic CEREBELLAR DAMAGE SYMPTOMS "VANISHED" Vertigo Ataxia Nystagmus Intention tremor Slurred (or staccato) speech Exaggerated broad based gait Hypotonic reflexes Dysdiadochokinesia. CHF TREATMENT "UNLOAD FAST" Upright Position Nitrates (in low dose) Lasix Oxygen Aminophylline Digoxin Fluids (decrease) Afterload (decrease) Sodium restriction Test (Dig level, ABGs, K level) CHF - TREATMENT These treatments used in conjunction will help in reducing the symptoms and complications associated with CHF. “UNLOAD FAST” U sit Upright Nitro Lasix Oxygen Aminophylline Digoxin Fluids - decrease Afterload - decrease Sodium - decrease Tests: dig level, ABG, K+ CHILD ABUSE/NEGLECT – WARNING SIGNS “CHILD ABUSE” C-child’s excessive knowledge on sex & abusive words H-hair growth in various lengths I-inconsistent stories from the child & parent/s L-low self-esteem D-depression A-apathy, no emotion B-bruised U-unusual injuries S-serious injuries E-evidence of old injuries not reported Wernicke-Korsakoff syndrome (WKS) – (alcohol-associated neurological disorder) "COAT RACK" Wernicke's encephalopathy (acute phase) clinical features: C-confusion O-ophthalmoplegia A-ataxia Thiamine is an important aspect of T-x Korsakoff's psychosis (chronic phase) characteristic findings: R-retrograde amnesia (recall of some old memories) A-anterograde amnesia (ability to form new memories) C-confabulation K-korsakoff's psychosis CHLOROQUINE USES (OTHER THAN MALARIA) "RED LIP" Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions CHOLECYSTITIS – RISK FACTORS “5 F's” Female Fat Forty Fertile Fair CHOLINERGIC CRISIS "SLUD" Salivation Lacrimation Urination Defecation CHOLINERGIC CRISIS - SIGNS AND SYMPTOMS “SLUDGE” Salvation Lacrimation Urination Defecation Gastric upset Emesis CHRONIC OBSTRUCTIVE PULMONARY DISEASE "blue bloater vs. pink puffer" emPhysema has letter P (and not B) so Pink Puffer. chronic Bronchitis has letter B (and not P) so Blue Bloater. CIRCULATION CHECKS "5 P's" Pain Paresthesia Paralysis Pulse Pallor (Paleness) CIRCULATORY CHECKS “The 5 P’s” Pain Paresthesia (numbness/tingling) Paralysis Pulse Pallor (Paleness) CLEFT LIP – POST-OP NURSING CARE PLAN "CLEFT LIP" Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position (never on abdomen) CLEFT LIP POST OP CARE "CLEFT LIP" Choking Lie on back Evaluate Airway Feed Slowly Teaching Larger nipple opening Incidence increase in males Prevent crust formation and aspiration CLIENT IN TRACTION NURSING CARE "TRACTION" Temperature (Extremity, Infection) Ropes hang freely Alignment Circulation Check (5 P's) Type & Location of fracture Increase fluid intake Overhead trapeze No weights on bed or floor COAGULATION TESTS "PiTT" (PTT - I for Intrinsic pathway) - PiTTsburgh "PeT" (PT - E for Extrinsic pathway) **Bleeding Time – provides assessment of platelet count & function (normal value: 2-8 minutes). **Prothrombin Time (PT) – measures effectiveness of “E”xtrinsic pathway. Mnemonic – PET (normal value: 10-15 seconds). **Partial Thromboplastin Time (PTT) – measures effectiveness of “I”ntrinsic pathway. Mnemonic – PITT (normal value: 25-40 seconds). **Thrombin Time (TT) – time for Thrombin to convert Fibrinogen → Fibrin (a measure of Fibrinolytic Pathway). (normal value 9-13 seconds). COGNITIVE DISORDERS – ASSESSMENT OF DIFFICULTIES "JOCAM" Judgment Orientation Confabulation Affect Memory COMA – CAUSES "A-E-I-O-U TIPS" Alcohol, acidosis (hyperglycemic coma) Epilepsy (also electrolyte abnormality, endocrine problem) Insulin (hypoglycemic shock) Overdose (or poisoning) Uremia and other renal problems Trauma; temp abnormalities (hypothermia, heat stroke) Infection (e.g., meningitis) Psychogenic ("hysterical coma") Stroke or space-occupying lesions in cranium COMMON CAUSES OF POST OP FEVER "Five W's" Wind (pneumonia) Water (dehydration) Wound (infection, dehiscence) Walking (PE) Wonder drug (wrong antibiotic) COMPLEMENT: FUNCTION OF C3A vs C3B C3A: Activates Acute [inflammation]. C3B: Bonds Bacteria [to macrophages- easier digestion]. • If wish to know more than just C3: C3a, C4a, C5a – Activate Acute. C3b, C4b – Bind Bacteria. CONGESTIVE HEART FAILURE “DAM DDOG” Digoxin Aminophylline Morphine Dopamine Diuretics O2 Gasses - monitor (ABG) CONGESTIVE HEART FAILURE – TREATMENT “UNLOAD FAST” U-upright Position N-nitrates (in low dose) L-Lasix O-oxygen A-aminophylline D-digoxin F-fluids (decrease) A-afterload (decrease) S-sodium restriction T-test (Dig level, ABGs, K level) COPD 4 TYPES AND HALLMARK SIGN "ABCDE" Asthma Bronchiectasis Chronic bronchitis Dyspnea [hallmark of group] Emphysema CORONARY ARTERIES Right = Right C=Coronary A=Artery M=Marginal Artery P=Posterior Interventricular Artery Left=Left A=Anterior Interventricular Artery C=Circumflex Artery CORONARY ARTERIES - LOCATION “I have a RIGHT to CAMP if you LEFT off the AC” Right C = coronary A = artery M = marginal artery P = posterior intraventricular artery Left A = anterior ventricular artery C = circumflex artery COR PULMONALE – SIGNS "PleaseRead His Text" Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence COR PULMONALE - SIGNS & SYMPTOMS Cor pulmonale is an enlargement of the right side of the heart caused by a problem with the lungs or pulmonary vessels. “Please Read His Text” Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence CORTICOSTEROID ADVERSE SIDE EFFECTS "CUSHINGS BAD MD" Cataracts Up all night (sleep disturbances) Suppression of HPA axis Hypertension/ buffalo Hump Infections Necrosis (avascular) Gain weight Striae Bone loss (osteoporosis) Acne Diabetes Myopathy, moon faces Depression and emotional changes CORTICOSTEROID SIDE EFFECTS "5 S's" Sick- easier to get sick Sad-causes depression Sex-increases libido Salt-retains more and causes weight gain Sugar-raises blood sugar   CRANIAL NERVE MNEMONICS “Oh OhOh To Try And Fit A Gold Velvet So Heavenly” “Oh OhOh To Touch And Feel A Girl's Vagina, Ah Heaven” “Olympic Opium Occupies Troubled Triathletes AfterFinishing Vegas Gambling Vacations Still High” “Old Operators Occasionally Troubleshoot Tricky Abducted Family Veterans Galloping Valiantly Across History” “Ohohoh to touch and feel very good velvet…ah” “Oh OhOh To Touch And Feel Very Generous Vegas Slot Handles” “On Old Olympus Towering Top A Fine Agile German Vaulted And Hopped” “On Old Olympus' Towering Tops, A Finn And German Viewed Some Hops!” “On Occasion, Our Trusty Truck Acts Funny - Very Good Vehicle AnyHow” “Oh Oh Oh To Touch And Feel A Guy's Viagra Sent ("Spinal Access") Hard-on” “Oh Once One Takes The Anatomy Final - Very Good Vacations Are Heavenly” “Old Opie Occasionally Tries Trigonometry and Feels Very Gloomy Vague and Hypoactive” “OhOhOh To Tough And Feel Virgin Girls Vaginas And Hymens” CRANIAL NERVES – SENSORY, MOTOR OR BOTH “Some Say Marry Money But My Brother Says Big Boobs Matter More” “Some Say Money Matters But My Brother Says Big Brains Matter More”   CRISIS SITUATIONS “RAPE” R- Ruthless A- Abusive P- Personal E- Experience CUSHING'S SYNDROME – SYMPTOMS “3 S's” Sugar (hyperglycemia) Salt (hypernatremia) Sex (excess androgens) CUSHINGS VS ADDISONS Cushing is gushing cortisol. Addison's patient's cortisol doesn't add up. CUSHING SYNDROME "CUSHING" Central obesity/Comedones (acne) Urinary glucose increase Striae/ Suppressed immunity Hypercortisolism/Hypertension/Hyperglycemia/Hirsutism Iatrogenic (Increased administration of corticosteroids) Noniatrogenic (Neoplasms) Glucose intolerance/ Growth retardation "Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm. CYANOTIC DEFECTS "3 T's" Tetralogy of Fallot Truncus Arteriosus Tricuspid Atresia CYCLOSPORINE – SIDE EFFECTS “5 H's” Hirsutism Hyperplasia of gums Harm to Kidneys Hypertension Hyperglycemia DELEGATION - WHAT NEVER DELEGATE TO UAP Don’t share your “TEAACUP” T – Teach E – Education A – Assessment A – C – U – P – Plan DEEP VEIN THROMBOSIS DIAGNOSIS "DVT" Dilated superficial veins/discoloration Venography is gold standard Tenderness of thigh and calf DEHYDRATION – SEVERE “BRAT” Diet B- Banana R- Rice A- Apple T- Toasted Bread DEMENTIA (SENILE) – ASSESSING CHANGES “JAMCO” J- Judgment A- Affect M- Memory C- Cognition O- Orientation DEMENTIA Make sure they don't have problems with: D-Drug and alcohol E-Eyes and ears M-Metabolic and endocrine disorders E-Emotional disorders N-Neurologic disorders T-Tumors and trauma I-Infection A-Arteriovascular disease DEPRESSION ASSESSMENT “SIG” S-Sleep Disturbances I-Interest Decreased G-Guilty Feelings DIABETES – SIGN & SYMPTOMS “3 P's” Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency) DIABETES MELLITUS - TYPE 1 “3 P's” (Signs & Symptoms) P-Polyuria(excessive urination) P- Polydipsia (excessive thirst) P- Polyphagia (excessive hunger) DIABETIC FITNESS “FIT” exercise guide F - Frequency (3x per week) I - Intensity (60-80% of Maximal Heart Rate) T- Time (Aerobic Activity) DIABETIC KETOACIDOSIS – MANAGEMENT “KING UFC” K+ (potassium) Insulin (5u/hr. Note: sliding scale not recommended in UK) Nasogastric tube (if patient comatose) Glucose (once serum levels drop to 12) Urea (check it) Fluids (crystalloids) Creatinine (check it)/ Catheterize DIABETES COMPLICATIONS "KNIVES” Kidney Neuropathy Infection Vascular (Cardio) Eyes Skin lesions DIABETES TYPE 1 SYMPTOMS "3 P's" Polyuria (excessive urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) DIABETIC KETOACIDOSIS (DKA) - CAUSES "5 I's" Infection Ischemia (cardiac, mesenteric) Infarction Ignorance (poor control) Intoxication (alcohol) DIABETIC KETOACIDOSIS (DKA) - SIGNS "DKA" Dehydrated Ketones/Kussmaul breathing/K drops Acidosis DIALYSIS – WHO NEEDS DIALYSIS? “AEIOU” (check the vowels) A- Acid-Base Problems E- Electrolyte Problems I- Intoxications O- Overload of fluids U - Uremic Symptoms DIALYSIS CANDIDATES "AEIOU" Acid-Base Problems Electrolyte Problems Intoxications Overload of fluids Uremic Symptoms DIARRHEA - TREATMENT The BRAT diet is a bland diet that is low in protein, fiber, and fat. It is thought to be easy on the GI tract and helpful to lesson diarrhea. It is not used commonly anymore because of the lack of protein in the diet. “BRAT” Banana Rice Apple Toast DIC “PCFCFMCF” Platelets Clotting Factors Consumed, Form Microthrombi, Coagulation Fails DIET FOR SEVERE DEHYDRATION "BRAT" Banana Rice Apple Toasted Bread DILATED PUPILS "FEAR, FITS OR FAST LIVING” Fear: panic, extreme anxiety Fits: seizures Fast Living: cocaine, crack, phencyclidine (PCP) DISSEMINATED INTRAVASCULAR COAGULATION DIC “D-I-S-S-E-M-I-N-A-T-E-D” D-Dx: D dimer I-Immune complexes S-Snakebite, shock, heatstroke S-SLE E-Eclampsia, HELLP syndrome M-Massive tissue damage I-Infections: viral and bacterial N-Neoplasms A-Acute promyelocytic leukemia T-Tumor products: Tissue Factor (TF) and TF-like factors released by carcinomas of pancreas, prostate, lung, colon, stomach E-Endotoxins (bacterial) D-Dead fetus (retained) DIURETICS "Leak Over The CAN" Loop diuretics Osmotics Thiazides Carbonic anhydrase inhibitors Aldosterone inhibitors Na (sodium) channel blockers DIGOXIN – TOXICITY & GI SYMPTOMS “VANDA” Vomiting Anorexia Nausea Diarrhea Abdominal pain DRUGS THAT INTERACT "These Drugs Can Interact" Theophylline Dilantin Coumadin losone (Erythromycin) DRUG INTERACTIONS Coumadin and ilosone: ilosone can increase the effects of Coumadin, increased risk for bleeding Coumadin and Dilantin: potential for increased effects of both Coumadin and Dilantin Theophylline and Dilantin: if taken orally they can interfere with absorption of each other and decrease medication effect “TDCI (These Drugs Can Interact)” Theophylline Dilantin Coumadin Ilosone (Erythromycin) DYSPNEA "6 P's" Pulmonary Bronchial Constriction Possible Foreign Body Pulmonary Embolus Pneumothorax Pump Failure Pneumonia DYSPNEA Pulmonary bronchial constriction prevents passage of air into lungs which contributes to dyspnea. (Possible) foreign bodies can become trapped or logged within trachea restricting air flow. PEs can prevent complete oxygenation of the blood in alveoli d/t restricted blood flow. Pneumothorax collapses the lung and prevents full expansion, restricting oxygenation. Pump failure refers to heart not beating appropriately. If heart is not perfusing the lungs than lungs are unable to oxygenate blood. Pneumonia leads to poor lung ventilation. These are six major causes for dyspnea. “The 6 P’s” Pulmonary Bronchial Constriction Possible Foreign Body Pulmonary Embolus (PE) Pneumothorax Pump Failure Pneumonia DYSPNEA DIFFERENTIAL "3-A's, 3-P's, 3-C's, 3-M's" “3-A's” Three Airways: Airway obstruction Anaphylaxis Asthma “3-P's” Three Pulmonary's: Pneumothorax PE Pulmonary edema “3-C's” Three Cardiacs: Cardiogenic pulmonary edema Cardiac ischemia Cardiac tamponade “3-M's” Three Metabolics: (DOC) DKA Organophosphates (pesticides) Carbon monoxide poisoning E. COLI – CAUSES “DUNG” Diarrhea UTI Neonatal meningitis Gram negative sepsis ECG LEAD PLACEMENT White - right Clouds over grass (white over green) Smoke over fire (black over red) Chocolate on the stomach (brown) ELECTROLYTES “PISO” P- Potassium I- Inside S- Sodium O- Outside ELECTROLYTES - LOCATION IN CELLS Potassium and sodium are the two most abundant cations in the body and have an inverse relationship in regards to intracellular and extracellular concentrations. Potassium is primarily located within the cell and sodium is primarily located outside the cell. “PISO” Potassium Inside the cell Sodium Outside the cell EMERGENCY DRUGS The above drugs work in a variety of emergency settings. Lidocaine can be used in emergency situations for ventricular arrhythmias. Epinephrine is a vital drug in the ACLS protocol. Atropine can be given with symptomatic bradycardia. Narcan is a reversal agent for opiate overdose. “Drugs to LEAN on” Lidocaine Epinephrine Atropine Sulfate Narcan EMERGENCY DRUGS TO “LEAN” ON L- Lidocaine E - Epinephrine A- Atropine Sulfate N - Narcan EMERGENCY TRAUMA ASSESSMENT “ABCDEFGHI” A-airway B-breathing C-circulation D-disability E-examine F-Fahrenheit G-get Vitals H-head to Toe Assessment I-intervention EMERGENCY MEDS "drugs to LEAN on" Lidocaine Epinephrine Atropine Sulfate Narcan EMERGENCY MI TREATMENT "MONATAS" Morphine Oxygen Nitroglycerine ASA Thrombolytics Anti-Coagulants Stool Softeners EMERGENCY TRAUMA GENERAL PROCEDURE "ABCDEFGHI" Airway Breathing Circulation Disability Examine Fahrenheit Get Vitals Head to Toe Assessment Intervention ENDOCARDITIS “FROM JANE” Fever Roth's Spots Osler's nodes Murmur Janeway Lesions Anemia Nail Hemorrhage (splinter hemorrhage) Emboli ENERGY DECREASED “CAPS” C-concentration decreased A-appetite P-psychomotor function decreased S-suicidal Ideations EPIGLOTTITIS “AIR RAID” A-airway Closed I-increased Pulse R-restlessness R-retractions A-anxiety Increased I-inspiratory Stridor D-drooling EPIGLOTTITIS – SIGNS & SYMPTOMS “ADD AIR NURSE” A-abnormal posturing (tripod) D-dysphagia → D-drooling D-different speaking (muffled/soft) A-apprehension I-increased temperature (high) R-rapid onset N-nasal flaring U-using accessory muscles R-retractions (chest) S-stridor (inspiratory) E-enlarged epiglottis (enlarged on x-ray or visible) **cough NOT typically present** EPIGLOTTITIS - ASSOCIATED S/S The epiglottis is a flap of cartilage that covers the entrance to our airway when we swallow food. Inflammation of the epiglottis can close off the airway entirely. “AIR RAID” Airway Closed Increased Pulse Restlessness Retractions- occur when the muscles between the ribs pull inward Anxiety Increased Inspiratory Stridor- high-pitched breath sound resulting from turbulent airflow in the larynx Drooling EPISIOTOMY ASSESSMENT "REEDA" Redness Edema Ecchymosis Discharge, Drainage Approximation EPISIOTOMY ASSESSMENT "REEDA" Redness Edema Ecchymosis Discharge Approximation of skin EPISIOTOMY HEALING – EVALUATION OF “REEDA” R- Redness E- Edema E - Ecchymosis D - Discharge, Drainage A – Approximation EYE MEDICATIONS Mydriatic = dilated pupils Miotic = tiny (constricted) pupils FETAL WELL BEING DIAGNOSTICS "ALONE" Amniocentesis L/S Ratio Oxytocin test Non-Stress test Estriol level FETAL WELL-BEING – ASSESSMENT TESTS “ALONE” A- Amniocentesis L- L/S Ratio O- Oxytocin Test N- Non-Stress Test E- Estriol Level FOODS TO AVOID WITH CELIAC DISEASE "BROW" Barley Rye Oats Wheat FOUR CAUSES OF CELL INJURY "TIPD the scale of homeostasis" Toxin or other lethal (cytotoxic) substance Infection Physical insult or injury Deficit or lack of water, oxygen, or nutrients FRACTURE “PRICE” Pressure Rest Ice Compression Elevation GLUTEN FREE DIET “ROW” R- Rye O- Oats W- Wheat GLUTEN FREE DIET Gluten is a protein found in wheat, barley and rye. People with gluten allergies can be affected by even trace amount of gluten in foods. Oats do not contain gluten, but they are often milled in the same factories as wheat. Always check food labels to make sure a product is gluten free. “BROW“ Barley Rye Oats Wheat GOUT TRIGGERS "DARK" Diuretics Alcohol Renal disease Kicked (trauma) And, the attack occurs most often at night [thus "dark"] HEART FAILURE – LEFT-SIDED “CHOP” C- Cough H- Hemoptysis O- Orthopnea P- Pulmonary Congestion (crackles/ rales) HEART FAILURE - LEFT-SIDED Left sided heart failure will primarily manifest as pulmonary edema as the left side of the heart moves blood from the lungs throughout the body. If this portion of the pump is broken the blood will become "backed up" within the lungs. Left sided heart failure can often lead to right sided heart failure. “CHOP” Cough Hemoptysis Orthopnea Pulmonary Congestion (crackles/rales) HEART FAILURE – RIGHT SIDED “HEAD” H- Hepatomegaly E- Edema (Bipedal) A- Ascites D- Distended Neck Vein HEART FAILURE - RIGHT-SIDED Right sided heart failure will primarily manifest as central edema as the right side of the heart takes fluid from the body and moves it forward. If this portion of the pump is broken, fluid will become "backed up" behind the pump and therefore within the body. “HEAD” Hepatomegaly Edema (Bipedal) Ascites Distended Neck Vein HEART VALVE LOCATION – RT TO LT "A Permanently Temperamental Man" Aortic Pulmonary Tricuspid Mitral HEART AUSCULTATION ORDER "APETM" Atrial Pulmonic Erb's point Tricuspid Mitral HEART SOUNDS - 1 Aortic and Pulmonic (A&P): 2 words, 2 spaces; these coincide in that they are both in the 2nd intercostal space. A is immediately to the right of the sternum; P is immediately to the left of the sternum. Erb's Point: Erb has 3 letters; you can find this point in the 3rd intercostal space (just to the left of the sternum), also the 3rd space to auscultate Tricuspid: 5th intercostal, just to the left of the sternum. Tri = 3, this is the fourth place to auscultate in the 5th intercostal space! Mitral: Mit sounds similar to mid…Midclavicular area and straight down just below nipple line “APE To Man” “All People Enjoy Time Magazine” “Apple Pie Especially Tastes Mmmm” Aortic Pulmonic Erbs points Tricuspid Mitral HEMOLYTIC ANEMIA TYPES “SHEEP TiT” Sickle cell Hereditary splenocytosis Enzyme deficiencies: [G6P, pyruvate kinase] Erythroblastosis fetalis Paroxysmal nocturnal hemoglobinuria Trauma to RBCs Immunohemolytics: [warm Ab, cold Ag] Thalassemia’s: [alpha, beta] HEMOPHILIA: TYPE A FACTOR Hemophilia A: problems with VIII factor (number V as an inverted A). HEPATITIS TRANSMISSION ROUTES "Vowels are bowels" Hepatitis A and E transmitted by fecal oralroute HISTAMINE: FEATURES “HISTAMINE” HCL production Inflammation Strong vasodilator Therapeutic value none Allergy Mast cells Neurotransmitter/ Narrow airways IgE HOLISTIC CARE COMPONENETS “SPISE” S - Spiritual P - Physical I - Intellectual S - Social E - Emotional HORMONES – THAT ↑ BLOOD GLUCOSE “STENGG” Somatotropin (growth hormone) Thyroid Hormones (thyroxine and triiodothyronine) Epinephrine Norepinephrine Glucagon Glucocorticosteroids HYPERCALCEMIA – S/S RHYME “Groans, Moans, Bones, Stones, Overtones” Groans: constipation Moans: pain - joint aches Bones: calcium loss from bones, bone metastasis Stones: kidney stones Overtones: psychiatric overtones - depression, confusion HYPERCALCEMIA "MD PIMPS ME" Malignancy Diuretics (thiazide the main culprit) Parathyroid (hyperparathyroidism) Immobilization/ Idiopathic Megadoses of vitamins A,D Paget's disease Sarcoidosis Milk alkali syndrome Endocrine (Addison's disease, thyrotoxicosis) HYPERGLYCEMIA – SIGNS “3 P's” Polydipsia Polyphagia Polyuria Hot and dry, sugar high HYPERGLYCEMIA/HYPOGLYCEMIA During hyperglycemia, a patient is dehydrated with elevated blood sugars. In hypoglycemia, a patient is cold and clammy and need a carbohydrate source to bring their sugars back up to a normal range. Hyper - hot/dry = sugar high Hypo- cold/clammy = needs candy HYPERGLYCEMIA - SIGNS AND SYMPTOMS “Groans-Moans-Bones-Stones-Overtones” Groans - constipation Moans - joint pain Bones - loss of calcium from bones Stones - kidney stones Overtones - psychiatric overtones (confusion, depression) HYPERKALEMIA “MURDER & SALT" Signs & Symptoms “MURDER” M - Muscle weakness U - Urine, oliguria, anuria R - Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid) Causes “MACHINE” M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism/ hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion - Impaired HYPERKALEMIA – SIGNS “MURDER” Muscle Weakness Urine (oliguria or anuria) Respiratory Distress Decreased cardiac contractility EKG Changes (Peaked T waves or small P waves) Reflexes (hyper or hypo) HYPERKALEMIA – MANAGEMENT “KIND” K- Kayexalate (orally/ enema) I- Insulin N- Na HCO3 D- Diuretics (Furosemide & Thiazides) HYPERKALEMIA CAUSES "MACHINE" Medications - ACE inhibitors, NSAIDS Acidosis - Metabolic and respiratory Cellular destruction - Burns, traumatic injury Hypoaldosteronism, hemolysis Intake - Excessive Nephrons, renal failure Excretion – Impaired HYPERKALEMIA - CAUSES “the hyperkalemia MACHINE” Medications - ACE Inhibitors, NSAIDS, potassium-sparing diuretics Acidosis - Metabolic and respiratory Cellular destruction - burns, traumatic injury, hemolysis Hypoaldosteronism - Addison's Intake- excessive Nephrons- renal failure Excretion - Impaired HYPERKALEMIA - SIGNS AND SYMPTOMS “MURDER” Muscle weakness Urine- oliguria, anuria Respiratory distress Decreased cardiac contractility ECG changes Reflexes- hyperreflexia or areflexia (flaccid) HYPERKALEMIA - MANAGEMENT “AIRED” Administer IV Calcium - to immediately decrease cardiac toxicity Increase excretion - via both stool (kayexlate) and urine (diuretics) Remove sources of potassium - from all sources, including enteral, parenteral, IV, and PO Enhance potassium uptake into cells - insulin, glucose, sodium bicarb, beta-adrenergic antagonists Dialysis - emergent response for patients with lethal hyperkalemia HYPERKALEMIA - DEFINITION Hyperkalemia is elevated potassium in the blood. Typical levels of K+ in blood are 3.7-5.2 mEq/L. In acidosis and cellular destruction, potassium shifts from inside the cell to the blood stream. Medications and kidney damage can decrease urinary excretion of potassium. Excessive intake of potassium can also lead to hyperkalemia. Potassium is necessary for the transmission of electrical impulses in heart and skeletal muscle; therefore increased potassium can cause ECG changes. HYPERKALEMIA SYMPTOMS "MURDER" Muscle weakness Urine, oliguria, anuria Respiratory distress Decreased cardiac contractility ECG changes (peaked T at 6, prolonged PR at 7, absent P andwide QRS at 8-9) Reflexes, hyperreflexia, or areflexia (flaccid) HYPERKALEMIA TREATMENT "KIND" Kayexalate (orally/ enema) Insulin Na HCO3 Diuretics (Furosemide & Thiazides) HYPERNATREMIA - CAUSES “MODEL” Medications / Meals Osmotic diuretics Diabetes insipidus Excessive water loss Low water intake HYPERNATREMIA – SIGNS “FRIED” Fever Restless Increased BP Edema Decreased Urinary Output HYPERNATREMIA – FRIED SALT “FRIED” F - Fever (low), flushed skin R - Restless (irritable) I - Increased fluid retention & increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth “SALT” S - Skin flushed A - Agitation L - Low-grade fever T - Thirst CAUSE: “MODEL” Medications, meals Osmotic diuretics Diabetes insipidus Excessive water loss Low water intake HYPERNATREMIA CAUSES "6 D's": Diuretics Dehydration Diabetes insipidus Docs (iatrogenic) Diarrhea Disease: kidney, sickle cell, etc. HYPERNATREMIA SYMPTOMS "FRIED" Fever (low grade), flushed skin Restless (irritable) Increased fluid retention and increased BP Edema (peripheral and pitting) Decreased urinary output, dry mouth HYPERNATREMIA - SIGNS AND SYMPTOMS “You are FRIED from learning about sodium” Flushed skin Restlessness: irritability Increased fluid retention and increased BP Edema: peripheral and pitting Deceased urinary output, dry mouth HYPERNATREMIA - SIGNS AND SYMPTOMS “SWINE” (bacon has high amounts of sodium)” Sleepy - lethargy (typically the very first sign!) Weakness Irritability Neuromuscular excitability Edema HYPERNATREMIA - SIGNS AND SYMPTOMS “SALT” Skin flushed Agitation Low grade fever Thirst HYPERSENSITIVITY REACTIONS “ACID” Type 1 - Anaphylactic Type 2 - Cytotoxic Type 3 - Immune Complex Type 4 - Delayed Hypersensitivity HYPERSENSITIVITY REACTIONS Gell and Goombs nomenclature “ACID” From I to IV: Anaphylactic type: type I Cytotoxic type: type II Immune complex disease: type III Delayed hypersensitivity cell mediated: type IV HYPERTENSION – COMPLICATIONS “4 C's” C- Coronary ArteryDisease C- Coronary Rheumatic Fever C- Congestive Heart C- Cardio Vascular Accident HYPERTENSION – COMPLICATIONS “4 C's” CAD (coronary artery disease) CHF (congestive heart failure) CRF (chronic renal failure) CVA (cardiovascular accident; now called brain attack or stroke) HYPERTENSION - COMPLICATIONS “The 4 C’s” Coronary Artery Disease Coronary Rheumatic Fever Congestive Heart Failure Cerebral Vascular Accident HYPERTENSION – NURSING CARE “DIURETIC” D-daily Weight I-intake and Output (I & O) U-urine Output R-response of BP E-electrolytes T-take Pulses I-ischemic Episodes (TIA) C-complications: 4C's HYPERTENSION – NURSING CARE PLAN "I-TIRED" Intake and output (urine) Take blood pressure Ischemia attack, transient (watch for TIAs) Respiration, pulse Electrolytes Daily weight HYPERTENSION NURSING CARE "DIURETIC" Daily Weight Intake and Output (I & O) Urine Output Response of BP Electrolytes Take Pulses Ischemic Episodes (TIA) Complications: 3C's (CAD, CHF, CVA) HYPERTENSION TREATMENT "ABCD" ACE inhibitors Beta blockers Calcium antagonists Diuretics (sometimes vaso"D"ilators also) HYPOCALCEMIA “CATS” C - Convulsions A - Arrhythmias T - Tetany S - Spasms and stridor HYPOCALCEMIA Hypocalcemia is low levels of calcium in the blood. Calcium in the blood can be bound to proteins, bound to anions like phosphate, or ionized. Large of stores of calcium are in the bone. Calcium blocks sodium channels, inhibiting depolarization of muscle and nerve fibers. The effects of hypocalcemia are a result of muscle fibers being more excitable. “CATS of hypocalcemia” Convulsions Arrhythmias Tetany Spasms and stridor HYPOCALCEMIA SYMPTOMS "CATS": Convulsions Arrhythmias Tetany Spasms and stridor HYPOGLYCEMIA – SIGNS “TIRED” Tachycardia Irritability Restlessness Excessive Hunger Diaphoresis Cold and Clammy, need some candy HYPOGLYCEMIA “TIRED” Tremors, tachycardia Irritability Restlessness Extreme Diaphoresis HYPOGLYCEMIA – SIGNS &SYMPTOMS "DIRE" Diaphoresis Increased pulse Restless Extra hungry HYPOGLYCEMIA - SIGNS AND SYMPTOMS During hypoglycemia the serum glucose level is too low. Cells of the body can't get adequate energy supply when there is not enough sugar in the blood. You will feel TIRED and have the symptoms listed above. “TIRED” Tachycardia Irritability Restless Excessive Hunger Diaphoresis / Depression HYPOGLYCEMIA CAUSES "RE-EXPLAIN": Renal failure Exogenous Pituitary Liver failure Alcohol Infection Neoplasm (insulinoma) HYPOGLYCEMIA VS HYPERGLYCEMIA "Hot and Dry" "Cold and Clammy": Hot and dry = sugar high Cold and clammy = need some candy HYPOKALEMIA – SIGNS “6 L's” Lethargy Lethal cardiac arrhythmia Leg cramps Limp muscles Low, shallow respirations Less Stool (constipation) HYPOKALEMIA SKELETAL MUSCLE WEAKNESS U-WAVE ON ECG CONSTIPATION TOXICITY TO DIGOXIN IRREGULAR WEAK PULSE OTOSTASIS NUMBNESS PARESTHESIA Signs and Symptoms “6 L's” Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac dysrhythmias Lots of urine (polyuria) HYPOKALEMIA - SIGNS AND SYMPTOMS “6 L’s” Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac dysrhythmias Lots of urine (polyuria) HYPONATREMIA SYMPTOMS "SALT LOSS" Stupor/coma Anorexia, N&V Lethargy Tendon reflexes decreased Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping HYPONATREMIA – SIGNS & SYMOTOMS “SALT LOSS” S-stupor/coma A-anorexia, N&V L-lethargy T-tendon reflexes decreased L-limp muscles (weakness) O-orthostatic hypotension S-seizures/headache S-stomach cramping HYPONATREMIA – SIGNS & SYMPTOMS “SALT” Stupor/coma Anorexia Lethargy Tendon reflexes decreased “LOSS” Limp muscles Orthostatic hypotension Seizures/headache Stomach cramps HYPONATREMIA - S/S Hyponatremia is decreased levels of sodium in the blood. It can be caused by inadequate sodium or excess free water which leads to lower concentration of sodium. Sodium and potassium work together to allow depolarization of muscles. Low sodium levels can limit this ability and cause muscle weakness. Sodium in the blood helps maintain the oncotic pressure. If fluid leaves the blood vessels, it can lead to decreased blood pressure. “SALT LOSS” Stupor/coma Anorexia, N&V Lethargy Tendon Reflexes decreased Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping HYPOXIA – EARLY SIGNS “RAT” Restlessness Agitation Tachycardia HYPOXIA - SIGNS AND SYMPTOMS Patients experiencing hypoxia will initially demonstrate signs of anxiety and restlessness. As hypoxia continues, the patient’scondition deteriorates to bradycardia and dyspnea. “RAT BED” Early Hypoxia: Restlessness Anxiety Tachycardia / Tachypnea Late Hypoxia: Bradycardia Extreme Restlessness Dyspnea HYPOXIA – LATE SIGNS Bradycardia Extreme restlessness Dyspnea Cyanosis HYPOXIA – SYMPTOMS IN PEDIATRICS “FINES” F-feedingdifficulty I-inspiratory Stridor N-nares Flares E-expiratory Grunting S-sternal Retractions IMMUNITY – PASSIVE VS. ACTIVE "Pay for Passive, Active Ages" Passive: Pay for a shot of antibodies for fast results following exposure to Rabies, etc. Active: Slow onset "aging" and memory. IMMUNOGLOBULINS "MADGE" IgM IgA IgD IgG IgE INCREASE ICP - CUSHINGS TRIAD “HYPER-BRADY-BRADY” Hypertension (wide pulse pressure) Bradycardia Bradypnea INFLAMMATION – SIGNS “PRISH” Pain Redness Immobility (loss of function) Swelling Heat INFLAMMATION “HIPER” H-heat I-induration P-pain E-edema R-redness INFLAMMATION "HIPER" Heat Induration Pain Edema Redness INFLAMMATION - SIGNS AND SYMPTOMS In response to tissue damage the body elicits the inflammatory response in attempt to rid itself of the initial offender. These attempts can sometimes become more of a problem than a solution. “HIPER” Heat Indurations (hardening) Pain Edema Redness INSULIN MIXING "Not Ready, Ready Now" Air into NPH Air into Regular Draw up Regular Draw up NPH IUD – POTENTIAL PROBLEMS WITH USE "PAINS" Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing KETOACIDOSIS CAUSES "SAD" Starvation Alcohol DM K+ INCREASING DRUGS "K BANK" K-sparing diuretics Beta blockers ACE inhibitors NSAIDs K supplements KEY QUESTIONS NEEDED IN AN EMERGENCY HISTORY TAKING SITUATION "AMPLE" Allergies Medication Past medical history Last meal Events and environment related to injury LACTATION HORMONES "Prolactin vs Oxytocin" PRO-lactin stimulates mammaryglands to PRO-duce milk. Oxytocin stimulates mammary glands to Ooze (release)milk. LEUKEMIA SYMPTOMS "ANT" Anemia Neutropenia Thrombocytopenia LEUKEMIA – SYMPTOMS “ANT” A- Anemia N- Neutropenia T- Thrombocytopenia LEUKEMIA - SIGNS AND SYMPTOMS Leukemia can lead to anemia as it will disrupt the production of blood within the bone marrow. Neutropenia is a natural result of leukemia as the body's supply of white blood cells is decreased. Thrombocytopenia is a reduced platelet count which can also result from leukemia, especially in infants. “ANT” Anemia Neutropenia Thrombocytopenia LEUKOCYTES: GRANULATED AND AGRANULATED "BEN Loves Money" Granulocytes: B-basophil E-eosinophil N-neutrophil •Agranulocytes: L-lymphocytes M-monocytes Alternatively: Granpa BEN..."to keep the granulated group straight. LIDOCAINE TOXICITY “SAMS” S-slurred Speech A-altered Central Nervous System M-muscle Twitching S-seizures LIDOCAINE TOXICITY - SIGNS AND SYMPTOMS Lidocaine is an anesthetic that prevents painful impulses from reaching the brain. “SAMS” Slurred Speech Altered Central Nervous System Muscle Twitching Seizures LIVER FUNCTIONS “PUSH DoG” Protein Synthesis Urea synthesis Storage Hormone synthesis Detoxification Glucose and fat metabolism LOW CHOLESTEROL DIET “3 C's” to avoid… Cake Cookies Cream (dairy, e.g., milk, ice cream) LUPUS SIGNS AND SYMPTOMS "SOAP BRAIN" Serositis [pleuritis, pericarditis] Oral ulcers Arthritis Photosensitivity Blood [all are low - anemia, Leukopenia, thrombocytopenia] Renal [protein] ANA Immunologic [DS DNA, etc.] Neurologic [psych, seizures] MACROCYTOSIS: NON-B12/FOLATE CAUSES “ALPHA NERD” Alcohol Liver disease Pregnancy Hemolysis (especially chronic) Agglutination Neoplasia (including myelodysplasia) Endocrine (hypothyroidism) Reticulocytes Drugs (especially myelosuppressives like chemotherapy, anti-HIV meds) MALIGNANCIES THAT METASTISIZE TO BONE "Laging Panalo Kung Taga Bulacan" Lung Prostate Kidney Thyroid Breast MALIGNANT HYPERTHERMIA – TREATMENT "Some Hot Dude Better Give Iced Fluids Fast" Hot dude = hypothermia Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia] MANIC ATTACK – MAJOR SYMPTOMS “DIG FAST” D-Distractibility I- Indiscretion G- Grandiosity F- Flight of Ideas A- Activity Increase S- Sleep Deficit T- Talkative MANIPULATION – NURSING PLAN "3C's" Cooperation Compromise Collaboration MED ADMINISTRATION "DR TMP" Dose Route Time Patient Med MED ADMIN – 5-CHECKS “TRAMP” T = right TIME R = right ROUTE A = right AMOUNT M = right MEDICATION P = right PERSON MELANOMA – CHARACTERISTICS “ABCD” Asymmetrical Borders irregular Color dark and variation Diameter is large (>6 mm) MENTAL RETARDATION – NURSING CARE PLAN “3 R's" Regularity (provide routine and structure) Reward (positive reinforcement) Redundancy (repeat) METABOLIC ACIDOSIS CAUSES "LUSK" Lactic Uremic Salicylate Ketoacidosis MG SO4 TOXICITY BP decrease Urine output decrease Respiratory rate decrease Patellar reflex absent MICROCYTIC ANEMIA: CAUSES "Find Those Small Cells" Fe deficiency Thalassemia Sideroblastic Chronic disease MINOR BLEEDING SYMPTOMS "BEEP" Bleeding gums Ecchymosis (bruises) Epistaxis (nosebleed) Petechiae (tiny purplish spots) MI SEQUENCE OF ELEVATED ENZYMES (FIRST TO LAST) "Time to CALL 911" Troponin CK-MB AST LDH1 MULTIPLE MYELOMA – SYMPTOMS “CRAB” Calcium level elevated Renal Failure Anemia Bone Breakdown and resorption MYOCARDIAL INFARCTION (MI) "BOOMAR" (basic management) Bed rest Oxygen Opiate Monitoring Anticoagulation Reduce clot size MYOCARDIAL INFARCTION - MANAGEMENT “MONATAS” M-Morphine O- Oxygen N- Nitrates (Nitroglycerin) A- Aspirin (ASA) T- Thrombolytics A- Anti-Coagulants S- Stool Softeners MYOCARDIAL INFARCTION – IMMEDIATE TREATMENT “DOGASH” Diamorphine Oxygen GTN spray Aspirin 300mg Streptokinase Heparin “MONA” Morphine Oxygen Nitrates Aspirin MYOCARDIAL INFARCTION - IMMEDIATE TREATMENT After a MI the immediate treatment is morphine sulfate, O2, nitroglycerin, and aspirin. Morphine works to decrease pain and difficulty breathing, O2 insures that poorly oxygenated tissues receive the required O2, nitroglycerin is a potent vasodilator and aids in restoring oxygenation to tissues, aspirin helps to thin the blood and increase tissue perfusion. “MONA” Morphine sulfate Oxygen Nitroglycerin ASA (aspirin) MYOCARDIAL INFRACTION - MANAGEMENT “MONATAS” Morphine Oxygen Nitrates (Nitroglycerin) Aspirin (ASA) Thrombolytics Anticoagulants Stool Softeners MYOCARDIAL INFARCTION – TREATMENT “MONA" Monitor/Morphine Oxygen Nitroglycerin Aspirin NEPHRITIC SYNDROME “PHARAOH” Proteinuria and Edema Hematuria Azotemia RBC casts Anti-strep tires (if post strep) Oliguria Hypertension NEPHROTIC SYNDROME – SYMPTOMS “People Have Endless Appetites” Proteinuria Hyperlipidemia Edema Albuminuria and hypoalbuminemia NEUROLEPTIC MALIGNANT SYNDROME “FEVER” Fever Encephalopathy Vitals unstable Elevated enzymes (CK) Rigidity of muscles NEUROVASCULAR CHECK Pain Pulselessness Paresthesia Paralysis Pallor NEWBORN ASSESSMENT COMPONENTS "APGAR" Appearance Pulse Grimace Activity Respiratory effort NINE-POINT POSTPARTUM ASSESSMENT “BUBBLEHER” B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Homan's sign E- Emotional Status R- Respiratory System NURSING PROCESS – ANA “AD"PO"IE” A- Assessment D- Diagnosis O- Outcome identification P- Planning interventions I- Implementation E- Evaluation OB NON-STRESS TEST “NNN” (3 negatives in a row to interpret results of Non-Stress Test) Non-reactive Non-stress is Not good OBSTETRIC (MATERNITY) HISTORY "GTPAL" Gravida Term Preterm Abortions (SAB, TAB) Living children OPIOID EFFECTS "BAD AMERICANS" Bradycardia & hypotension Anorexia Diminished pupillary size Analgesia Miosis Euphoria Respiratory depression Increased smooth muscle activity (biliary tract constriction) Constipation Ameliorate cough reflex Nausea and vomiting Sedation ORAL BIRTH CONTROL PILLS (BCP) – SERIOUS COMPLICATIONS “ACHES” A- AbdominalPain C - Chest Pain H - Headache E - Eye Problems S - Severe Leg Pain ORAL CONTRACEPTIVES – SIGNS OF POTENTIAL PROBLEMS "ACHES" A-abdominal pain (possible liver or gallbladder problem) C-chest pain or shortness of breath (possible pulmonaryembolus) H-headache (possible hypertension, brain attack) E-ye problems (possible hypertension or vascular accident) S-severe leg pain (possible thromboembolic process) OSMOTIC DIURETICS "GUM" Glycerol Urea Mannitol OSTEOPOROSIS RISKS "ACCESS" Alcohol Use Corticosteroid Use Calcium low Estrogen low Smoking Sedentary lifestyle/s OSTEOPOROSIS RISK FACTORS “ACCESS” leads to OSTEOPOROSIS A-alcohol Use C-corticosteroid Use C-calcium low E-estrogen low S-smoking S-sedentary lifestyle PAIN ASSESSMENT "PQRST” What Provokes the pain? What is the Quality of the pain? Does the pain Radiate? What is the Severity of the pain? What is the Timing of the pain? PAIN MANAGEMENT Moderate pain (5-6) Severe pain (7-10) = opioids PAIN MANAGEMENT "ABCDE" Ask about the pain Believe when clients say they have pain Choices—let clients know their choices Deliver what you can, when you said you would Empower/Enable clients' control over pain PARKINSON'S DISEASE – CARDINAL SYMPTOMS "TRAP" Tremor Rigidity Akinesia and bradykinesia Postural Instability PARKINSON'S MEDICATIONS "Ali Loves Boxing Matches" Amantadine Levodopa Bromocriptine MAO inhibitors PARKINSON'S MEDICATIONS "Ali Loves Boxing Matches" Amantadine Levodopa Bromocriptine MAO inhibitors PEDIATRIC HYPOXIA SYMPTOMS "FINES" Feeding difficulty Inspiratory Stridor Nares Flares Expiratory Grunting Sternal Retractions PINPOINT PUPILS "Drugs, Drops, or Nearly dead" Drugs: opiates Drops: meds for glaucoma Nearly dead: damage in the pons area of the brainstem PITUITARY HORMONES "FLAGTOP" Follicle stimulating hormone Luteinizing hormone Adrenocorticotropic hormone Growth hormone Thyroid stimulating hormone Oxytocin Prolactin PNEUMONIA – RISK FACTORS “INSPIRATION” I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary edema I - Impaired alveolar macrophages R - RTI (prior) A - Antibiotics &cytotoxics T - Tracheal instrumentation I - IV drug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (e.g. NMJ disorders) PNEUMOTHORAX – S/SX “P-THORAX” P - Pleuritic pain T - Trachea deviation H - Hyperresonance O - Onset sudden R - Reduced breath sounds (&dyspnea) A - Absent fremitus X - X-ray shows collapse POLYCYTHEMIA RUBRA VERA (PRV): COMMON SYMPTOMS “PRV” Plethora/Pruritus Ringing in ears Visual blurriness PORTAL HYPERTENSION FEATURES "ABCDE" Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen POSTOPERATIVE COMPLICATIONS – ORDER "4 W's" Wind (pulmonary) Wound Water (urinary tract infection) Walk (thrombophlebitis) POST-PARTUM ASSESSMENT “BUBBLE” B-breasts U-uterus B-bowels B-bladder L-lochia E-episiotomy/laceration/C-section incision POSTPARTUM ASSESSMENT "BUBBLE HER" Breasts Uterus Bladder Bowel function Lochia Episiotomy Homan's sign Emotional Status Respiratory System PREECLAMPSIA(SEVERE) – COMPLICATIONS "HELLP" syndrome H- Hemolysis E- Elevated L- Liver function tests L- Low P- Platelet count PREGNANCY – INFECTIONS "TORCH" Toxoplasmosis Other (hep B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus PREGNANCY INDUCED HYPERTENSION “HELP” Hemolysis Elevated liver enzymes Low Platelets PRETERM INFANT – ANTICIPATED PROBLEMS "TRIES" Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP]) PROMOTION OF NORMAL ELIMINATION “POOPER SCOOP” P-position O-output O-offer Fluids P-privacy E-exercise R-report Results S-size (Amount) C-consistency O-occult Blood O-odor P-peristalsis PROSTAGLANDIN USES "RIPE PI" Raynaud's Ischemia of a limb Pulmonary hypertension Erectile dysfunction Peptic ulcers Induce labor PROSTATE SYMPTOMS "no FUN" Frequency Urgency Nocturia PROSTATE PROBLEMS ARE NO... “FUN” F- Frequency U- Urgency N- Nocturia PSYCHOTROPIC MEDS – COMMON TCAs "VENT" Vivactil Elavil Norpramin Tofranil PULMONARY EDEMA “MAD DOG” M-Morphine A-Aminophylline D- Digitalis D-Diuretics (Lasix) O- Oxygen G- Gases (Blood Gases ABG's) QSEN COMPETENCIES I QSEN PETS using the I to the N for informatics, I - informatics Q - Quality improvements P - Patient centered care E - Evidence based practice T - Teamwork/collaboration S - Safety RASHES – DAYS OF APPEARANCE OF "Very Sick PatientsMust Take Double Exercise" Varicella(chickenpox) 1st day - Scarlet fever 2nd day - Pox(smallpox) 3rd day - Mumps 4th day - Typhus 5th day - Dengue 6th day - Enteric fever (typhoid) RASH DAYS AFTER ONSET WHEN IT FIRST APPEARS "Really Sick Children Must Take No Exercise" 1 Day: Rubella 2 Days: Scarlet fever/ Smallpox 3 Days: Chickenpox 4 Days: Measles (and see the Koplick spots one day prior torash) 5 Days: Typhus & rickettsia (this is variable) 6 Days: Nothing 7 Days: Enteric fever (salmonella) RENAL FAILURE CAUSES "AVID GUT" Acute tubular necrosis Vascular obstruction Infection Diffuse intravascular coagulation Glomerular disease Urinary obstruction Tubulointerstitial nephritis RESPIRATORY DEPRESSION – INDUCING DRUGS “STOP” breathing S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins RESUSCITATION – BASIC STEPS “ABCDE” Airway Breathing Circulation Drugs Environment RLQ PAIN DIFFERENTIAL “APPENDICITIS” Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohn’s Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones SCARLET FEVER “6 S’s” Streptococci causal organism Sore throat Swollen tonsils Strawberry tongue Sandpaper rash Military Sudamina vesicles over hands, feet, abdomen SCHIZOPHRENIA – PRIMARY SYMPTOMS "4A's" Affect Ambivalence Associative looseness Autism SECONDARY HYPERTENSION – CAUSES “ABCDE” A:Aldosterone/apnea B: Bad Kidney/Bruits C: Catecholamine’s/Cushing’s syndrome D: Drugs/diet E: Endocrine SEVERE PRE-ECLAMPSIA "HELLP" Hemolysis Elevated Liver function tests Low Platelet count SHOCK – CAUSES “HAVANA” Hypovolemia Adrenal Crisis Vascular Stasis Acute Respiratory Obstruction Neurogenic Anaphylaxis SHOCK – SIGNS “CPR” Compensatory Stage Progressive Stage Refractory Stage SHOCK “HYPO-TACHY-TACHY” Hypotension Tachypnea Tachycardia SHOCK – SIGNS AND SYMPTOMS “TV SPARC CUBE” Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank SHORTNESS OF BREATH – CAUSES “AAAA-PPPP” A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax P - Pulmonary Edema P - Pulmonary Embolus SICKLE CELL DISEASE Hydration Oxygenation Pain Infection Avoid high places SLE: FACTORS THAT MAKE SLE ACTIVE “UV PRISM” UV (sunshine) Pregnancy Reduced drug (e.g. steroid) Infection Stress More drugs SLE SYSTEMIC LUPUS ERYTHEMATOSUS DIAGNOSIS "MD SOAP 'N HAIR" Malar rash Discoid rash Serositis Oral ulcer Arthritis Photosensitivity Neurologic abnormality Hematologic abnormality ANA (+) Immunologic abnormality Renal involvement SLE SYSTEMIC LUPUS ERYTHEMATOSUS DIAGNOSIS “DAMP AS RHINO” Discoid rash ANA (+) Malar rash Photosensitivity Arthritis Serositis (pleural, pericardial) Renal involvement Hematologic abnormality Immunologic abnormality Neurologic abnormality (seizures, psychosis) Oral / nasal ulcer, Observed SNS VS PNS "No sympathy for a Pair of Aces" Norepinephrine is secreted by the Sympathetic Acetylcholine is secreted by the Parasympathetic SPLEEN – CAUSES FOR ENLARGMENT "3M's" Myelofibrosis Malaria Myelogenous leukemia SPRAIN – NURSING CARE PLAN "RICE" Rest Ice Compression Elevation SPRAINS AND STRAINS NURSING CARE "RICE" Rest Ice Compression Elevation SSRI – SIDE EFFECTS “BAD SSRI” Body weight increase Anxiety Dizziness Serotonin Syndrome Stimulated CNS Reproductive/sexual dysfunction Insomnia STAPH AUREUS – CAUSES “SOFT PAINS” Skin infections Osteomyelitis Food Poisoning Toxic Shock Syndrome Pneumonia Acute Endocarditis Infective arthritis Necrotizing fasciitis Sepsis ST ELEVATION CAUSES IN ECG "ELEVATION" Electrolytes LBBB Early repolarization Ventricular hypertrophy Aneurysm Treatment (e.g. pericardiocentesis) Injury (AMI, contusion) Osborne waves (hypothermia) Non-occlusive vasospasm STEROIDS - SIDE EFFECTS Steroids are an effective treatment for asthma, COPD, Crohn’s, Lupus and more. However, they have the potential for very serious side effects, which are listed below. Steroids can be taken by mouth, via an inhaler, topically, or via injection. “6 S’s” Sugar - hyperglycemia Soggy Bones - causes osteoporosis Sick - decreased immunity Sad - depression Salt - water and salt retention (hypertension) Sex - decreased libido STOOL ASSESSMENT "ACCT" Amount Color Consistency Timing SUBARACHNOID HEMORRHAGE (SAH) – CAUSES “BATS” Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (e.g. being struck with baseball bat) Stroke SYNCOPE CAUSES, BY SYSTEM "HEAD HEART VESSELS" -----CNS causes include HEAD: Hypoxia/ Hypoglycemia Epilepsy Anxiety Dysfunctional brainstem (basivertebral TIA) -----Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia -----Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia) Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus T AND B CELLS: TYPES When bacteria enter body, T-cell says to B: "Help Me Catch Some!" B-cell replies: "My Pleasure!": T-cell types: Helper Memory Cytotoxic Suppressor B-cell types: Memory cell Plasma cell THERAPEUTIC DOSAGES "The Magic 2's" Digitalis (.5-1.5) Toxicity = 2. Lithium (.6-1.2) Toxicity = 2. Theophylline (10-20) Toxicity = 20. Dilantin (10-20) Toxicity = 20. APAP (1-30) Toxicity = 200. “THESE DRUGS CAN INTERACT” “TDCI” T- Theophylline D- Dilantin C- Coumadin I- ilosone (Erythromycin) THROMBOTIC THROMBOCYTOPENIC PURPURA: SIGNS “FAT RN” Fever Anemia Thrombocytopenia Renal problems Neurologic dysfunction THROMOCYTOPENIA: CAUSES “SHAPIRO” Splenectomy Hodgkin's disease Arteritis Polycythemia Infection Rheumatoid Occult malignancy TRACHEOESOPHAGEAL FISTULA ASSESSMENT "3 C’s" Coughing Choking Cyanosis TRACTION – NURSING CARE PLAN "TRACTION" T-trapeze bar overhead to raise and lower upper body R-requires free-hanging weights; body alignment A-analgesic for pain, prn C-circulation (check color and pulse) T-temperature (check extremity) I-infection prevention O-output (monitor) N-nutrition (alteration related to immobility) TRANSIENT INCONTINENCE – COMMON CAUSES “DIAPPERS” Delirium Infection Atrophic Urethra Pharmaceuticals Psychologic Excess Urine Output Restricted Mobility Stool Impaction TRANSIENT ISCHEMIC ATTACKS ASSESSMENT "3T’s" Temporary unilateral visual impairment Transient paralysis (one-sided) Tinnitus = vertigo TRAUMA CARE – COMPLICATIONS "TRAUMA" T-thromboembolism; Tissue perfusion, altered R-respiration, altered A-anxiety related to pain and prognosis U-urinary elimination, altered M-mobility impaired A-alterations in sensory-perceptual functions and skin integrity (infections) TRAUMA CLIENT – COMPLICATIONS “TRAUMATIC” T-tissuePerfusion Problems R-respiratory Problems A-anxiety U-unstable Clotting Factors M-malnutrition A-altered Body Image T-thromboembolism I-infection C-coping Problems TRAUMA SURGERY (“AMPLE”) AFTER INITIAL ASSESSMENT A-allergies M-medications P-past Medical History L-last Meal E-events Surrounding Injury TRAUMA SURGERY PREP "AMPLE" Allergies Medications Past Medical History Last Meal Events Surrounding Injury TYPES OF INCONTINENCE "OUTS" Overflow incontinence (loss when specific volume reached) Urge incontinence (loss from contraction that follows strong, sudden need) Total incontinence (complete loss of urinary control, as from a nonfunctioning urethral sphincter muscle) Stress incontinence (loss of small amounts of urine when abdominal pressure increases through cough, sneeze, or laugh) URINARY INCONTINENCE CAUSES "DRIP" Delirium Restricted mobility, retention Infection, inflammation, impaction Polyuria, pharmaceuticals VENTRICULAR FIBRILLATION – TREATMENT "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock" Shock= Defibrillate Everybody= Epinephrine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Procainamide VFIB/VTACH – DRUGS USED ACCORDING TO ACLS "Every Little Boy Must Pray" Epinephrine Lidocaine Bretylium Magsulfate Procainamide VIRCHOW'S TRIAD: FACTORS LEADING TO VENOUSTHROMBOSIS "VIR-chow" Vascular trauma Increased coagulability Reduced blood flow (stasis) WARFARIN INTERACTIONS "ACADEMIC QACS" Amiodarone Cimetidine Aspirin Dapsone Erythromycin Metronidazole Indomethacin Clofibrate Quinidine Azapropazone Ciprofloxacin Statins WBC RELATIVE CONCENTRATIONS "Never Let Monkeys Eat Bananas" (From greatest to least) Neutrophils 56% Lymphocytes 34% Monocytes 4% Eosinophils 2.7% Basophils 0.3% • Alternatively: "Nine Little Monkeys Eating Bananas" • Alternatively: "No-one Likes My Educational Background" • Alternatively: "Never Let Mamma Eat Beans" • Can remember that Eosinophils is 3%, by the mirror image of E is 3. WBC – In order of decreasing numbers “Never Let Monkeys Eat Bananas” Neutrophils Lymphocytes Monocytes Eosinophils Basophils [Show More]

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