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.
·
· 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.
