Ace Your Fundamentals of Nursing, 8th Ed., Potter, Perry, Stockert & Hall, 2013 Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Practical Nurse (LPN) Students
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If tube dislodges from patient, use petroleum gauze taped 3 ways
If drainage system is damaged, place disconnected drainage tube in sterile water
1 min
Pneumothorax
Mechanism
Air Enters Pleural Space
Assessment
Sudden Dyspnea
Absent or Restricted Movement on Affected Side
Decreased or Absent Breath Sounds on Affected Side
Chest Pain
Tracheal Deviation
Vital Sign Changes
Crepitus
Considerations
High Fowler's Position With Oxygen
Prepare For Chest Tube Placement
Educate High Risk Patients
2 mins
Oxygen Delivery Methods
Nasal Cannula
Simple Face Mask
Non-Rebreather Mask
Venturi-Mask
Safety Precautions
Oxygen In Use Sign
No Electrical Sparks
Six Feet Away from Open Flames
Nursing Considerations
Dry Nasal and Upper Airway Mucosa
Skin Irritation
Home Education
1 min
Tuberculosis Assessment
Etiology
Airborne Droplet
Assessment
3 Week Productive Cough
Night Sweats
Chest Pain
Fever
Weight Loss
Fatigue
Diagnosis
Chest X-Ray
Blood Tests
Mantoux Skin Test
3 Positive Sputum Tests
1 min
Right Heart Failure Assessment
Jugular Venous Distention (JVD)
Peripheral Edema
Hepatosplenomegaly
Nocturia
Weight Gain
Ascites
Fatigue
1 min
Left Heart Failure Assessment
Pulmonary Assessment
Pulmonary Congestion
Pink Frothy Sputum
Wheezing or Crackles
Dyspnea with Exertion
Cough
Systemic Assessment
Fatigue
Tachycardia
Weak Peripheral Pulse
S3, S4 Heart Sounds
1 min
Types of Heart Failure
Left Sided
Pulmonary Congestion
Right Sided
Peripheral Edema
High Output
Unable to Meet Metabolic Needs
1 min
Hypoxia (Early Symptoms)
Diaphoresis
Restlessness
Tachypnea
Dyspnea on Exertion
Tachycardia
Hypertension
Arrhythmias
Decreased Urine Output
Unexplained Fatigue
1 min
Hypoxia (Late Symptoms)
Cyanosis
Cool, Clammy Skin
Use of Accessory Muscles
Retractions
Hypotension
Arrhythmias
2 mins
Cholesterol Lab Values
LDL (Low Density Cholesterol)
< 100 mg/dL
HDL (High Density Cholesterol)
> 40 mg/dL Males
> 50 mg/dL Females
Total Cholesterol
< 200 mg/dL
1 min
Triglycerides Lab Value
< 150 mg/dL
51 secs
Troponin Lab Values
Troponin T (cTnT)
< 0.1 ng/mL Normal
Troponin I (cTnI)
< 0.5 ng/mL Normal
> 2.3 ng/mL Myocardial Injury
2 mins
Tuberculosis Skin Mantoux Test (PPD)
Delayed Hypersensitivity (Cell Mediated Response)
Intradermal Injection
Read 48-72 hours
Positive Results
≥ 5 mm Induration
Immunosuppressed
≥ 10 mm Induration
High Risk Patients
≥ 15 mm Induration
Considerations
Chest X-Ray
3 mins
Tracheostomy Care
Inner Cannula Removed and Cleaned
Clean Q8 Hours Around Stoma
One Finger Under Ties
Considerations
Speak with Deflated Cuff
Can Eat with Tube in Place
Keep Replacement Tube Nearby
Immediately Replace if Dislodged
Physician Does First Tube Change
2 mins
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