Tips and Tricks

Studying/Testing
Foundations

Some “quick” tips and foundational info that will enrich your understanding of everything:

·         KNOW THE PATHO. Know why things are happening, so you can estimate what sort of things you will see as normal and abnormal (complications). This will also dictate your nursing actions (interventions). If you know and understand things, you won’t have to memorize them! J

·         Physiological (ABC’s!) always trumps Psychosocial.

·         Never consider yourself an expert in a disorder until you know the priority

·         Start thinking in terms of “cause and effect,” and write down keywords and processes using arrows to show the causes and effects.

o   Example: blood vessel wall damageà accumulation of plaques in the damaged areas and atherosclerosis (wall hardening and thickening from accumulation of lipids)à vessel lumen stenosis (narrowing)à ischemia and/or thrombus (clot) formation, and possible thromboembolism (mobilized clot)à blood vessel occlusion (blood supply “cut-off” or “cut short”)à severe hypoxia, ischemia to cellsà cell death (necrosis, infarction)à Myocardial infarction (heart attack)

·         Break information down so you can retain it and recall it better. By the time you are at a test, you should be able to think of many things as a keyword or concept.

·         It never hurts to brush up on your A&P. If you are having trouble learning a new disorder, ask yourself… “Should I go back and quickly review some A&P?” You can often do this via YouTube and Google.

·         The majority of drugs and fluids must be administered slowly.

·         You know more than you think you do. “Go with your gut” is a pretty good rule of thumb, but ONLY IF YOU HAVE READ, RE-READ, and UNDERSTAND the question.

·         When you find yourself having trouble understanding or remembering what something is, look at the name of it, and try to break the name apart and reveal it’s meaning.

o   Example: what the heck is an “endarterectomy?” It’s removal of plaques within an artery.

§  Endo- = “in”

§  Art- = “artery”

§  -ectomy- = “removal”

·         According to Maslow, ABC’s trump Safety. However, SAFETY is the underlying theme that the NCLEX (thus, nursing school tests) are bound to be concerned with.

·         Airway is always the priority, pretty much. I don’t care what anyone says (ok I’m kidding… but am I?) This concept will inevitably cause controversy in your stay at hotel STCC.

·         Know that the human body is amazing. It has many different compensatory mechanisms. Watch for them. Start thinking of this concept EARLY. The mechanism may also be referred to as autoregulation. Two major autoregulators are either chemical (sensing O2 or CO2) or pressure (sensing high or low blood pressure). You will see this concept throughout these “tips.”

·         Get used to dealing with opposing forces. This means that when something is occurring somewhere in the body, something else with the opposite nature or effect is likely occurring elsewhere. It is the nature of homeostasis, but it sure can be annoying when trying to learn new concepts. My advice is to be ready for it J

·         *The body is ultimately and in a very primal sense motivated to get oxygen (and other “nutrients”) to it’s cells. Know that many compensatory mechanisms are naturally built to ensure that this takes place. Thus, “Airway is always the priority. I don’t care what anyone says.” J

·         If something affects the CNS at least know that it may affect your:           

1.    Respiratory rate (notice, I put airway first)

2.    Heart rate

3.    Mental status

·         Get to know (especially Adult health 1 and 2) the stress response, blood sugar, and catecholamines (epinephrine and norepinephrine).

·         Understand the differences in the central and peripheral nervous system

·         Adult health 1 and 2: Fluid volume excess looks a lot like heart failure. Go figure.

·         The heart rate will often move in the same direction as the respiratory rate. These are often compensatory mechanisms to get oxygen to the cells.

·         Get to know heart failure as soon as possible and reduced cardiac output

·         Get to know the body’s response to stress (including how it responds to hypoxia) as soon as possible

·         Get to know the concept of infarction as soon as possible. That is, know what causes it, and what results from it. Yes, the concepts underlying myocardial infarction are applicable all over the body.

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·    Heart surgery or anything else significantly affecting the heart (cardiac output)? Be worried about your kidneys.

·         Delivering oxygen to someone who is severely fluid depleted may be somewhat ineffective. Why? Because the oxygen has inadequate amounts of fluid to travel in, to get to cells.

Very generic lung sounds (not set-in-stone rules)

·         Wheezing = inflammation/constriction (think=asthma). A bronchodilator may be indicated

·         Rhonchi = large airway obstruction (i.e. secretions blocking the airway) Suctioning may help

·         Crackles = Fluid in the alveoli. Suctioning may NOT help (fluid is too far down). Oxygen support and possibly Diuretics may be prescribed. Why diuretics? Diuretics rid the body of excess fluid, which is a major cause of fluid in the lungs.

·         Fluid in the lungs: 2 major causes

1.    Fluid Volume excess. Fluid is moving to places it shouldn’t be. You’re getting waterlogged!

2.    Heart Failure: Fluid is “backing up,” because the heart is “failing” it’s job as an effective pump.

·         Serum CO2 and O2 tend to move opposite. Low serum O2 or high CO2 are “depressive” to blood vessel tone. That is, they relax and dilate the blood vessels, to encourage blood flow to the tissues they supply. Why? If you have too little O2, the body wants to increase perfusion (blood delivery) to increase oxygen delivery to cells. If CO2 is high, the body assumes O2 is low. What might this do to the blood pressure?

·         Basically, most disorders are treated in one of two ways: medicine or surgery. So test questions will often refer to medicine (drugs) or surgeries. Know what is normal and what is abnormal post-op.

·         Inactive particles are bound to proteins (albumin) in the blood (Important mostly for fourth semester)

·         Active = ionized, inactive = bound (mostly for fourth semester).

·         *Don’t ignore teaching. This could be very simple, such as taking a drug before meals or with meals. Test questions will often ask about teaching… some pretty simple things that you may have overlooked!

·         VERY generally speaking, a quick nursing blood pressure fix: Aim the head of the bed TOWARD of the blood pressure (high or low) to treat it.

o   That is… hypertensive? Raise the head of the bed. Hypotensive? Lower the head of the bed.

o   Why? Think about it… If you are hypotensive and you lower the head of the bed, blood is shunted from the periphery (fingers/toes/limbs) to the heart and the headà more blood to the head and heartà more blood pressure. If they are hypertensive, raising the head of the bed forces blood away from the head and heart… lowering the blood pressure.

·         Dehydration, Shock, hypoxia (inadequate O2, also as a result of shortness of breath), and internal hemorrhage all can have similar signs and symptoms. Why? Because they all involve LACK of OXYGEN getting to the cells (and/or lack of available fluid in the vascular system to carry that oxygen to the cells).

1.    A change in the Level of consciousness: This means you will first become agitated, dizzy, confused, and later: Lethargic à comatose.  Why? Because the brain requires two very essential things to function: oxygen and glucose. The brain is very close to the heart, so it will be one of the first things affected by hypoxia.

2.    Elevated HR and RR. Why? I mentioned this elsewhere, but basically the body is trying to take in and pump as much oxygen to the cells as possible.

3.    LOW Blood pressure: Primarily due to the lack of volume of blood in the vascular system, thus lack of force pressing against vessel walls. With hypoxia, there is systemic vasodilation (vessels relax, open up) in an attempt to allow more blood to reach cells (perfusion).

·         Adult Health 1: Study Diabetes and oncology ASAP

·         Adult Health 2: Study Endocrine and Cardiac ASAP, and DO NOT underestimate the Management Test!

·         Peds: Know the pages in your textbook regarding Safety, PLAY, and Growth and Development. The growth and development chapters are some of the only ones I actually liked. Do practice test questions. If you’re totally lost on a test question, ask yourself if the answer is growth and development related.

o   Example: What is the best way to communicate a surgical procedure to a toddler? It might be to USE A DOLL.

·         Peds: Know that you will get some seemingly OFF THE WALL answer choices on tests. Looking back, they may have actually been accurate. WORKING WITH CHILDREN IS DIFFERENT THAN WORKING WITH ADULTS.

·         Urine output of LESS than 30mL per hour for two consecutive hours is BAD

·         Blood transfusion: Know AT LEAST the following image (arrows indicate “can give to”):

o   O negative is the universal “DONOR” (donor has 2 O’s). Can give to everyone.

o   AB positive is the universal recipient.

o    In addition to donating to the same blood group; type O blood donors can give to A, B and AB; blood donors of types A and B can give to AB.

o    Basically (other than O) if the recipient doesn’t have the donor’s letter in their own blood type, they should not receive the blood product. This is known as “typing,” or blood matching.

o    Probably the biggest worry with a transfusion reaction is that the body senses the incorrect blood type as “foreign” (aka a foreign “antigen”) and will call on antibodies to attack and destroy the foreign red blood cells. Look up hemolytic reaction.