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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid
Mycoplasma Pneumoniae
- Characteristics
- No Cell Wall and No Gram Stain
- Cholesterol Membrane
- Eaton's Agar
- Mulberry Colonies
- Disease
- Atypical pneumonia
- Military Recruits
- Cold IgM Autoimmune Hemolytic Anemia
- Erythema Multiforme
- Treatment
- Tetracycline
- Erythromycin
2 mins
Streptococcus Pneumoniae Characteristics
- Characteristics
- Gram-Positive
- Diplococci
- Lancet-Shaped
- Catalase-Negative
- Optochin-Sensitive
- Bile Soluble
- Alpha-Hemolytic
- Polysaccharide Capsule
- Positive Quellung Reaction
- IgA Protease
1 min
Pneumonia Assessment
- Risk Factors
- Older Adult
- Immunocompromised
- Long Term Care
- Assessment
- Shortness of Breath (SOB)
- Hypoxemia
- Cough and Sputum Production
- Wheezing or Crackles
- Fever
- Pleuritic Pain
- Diagnosis
- Chest X-ray
2 mins
Pneumonia Intervention
- Interventions
- Humidified Oxygen
- Deep Breathing Exercises
- Position of Comfort
- Increase Fluid Intake
- Manage Fever
- Medications
- Antibiotics
- Mucolytics
- Expectorants
- Considerations
- Pneumococcal Vaccine
- Sepsis
- Acute Respiratory Failure (ARF)
- Prevention Education
2 mins
Common Causes of Pneumonia: Neonates (< 4 Weeks Old)
- Group B Streptococci
- E. coli
44 secs
Common Causes of Pneumonia: Children (4 Weeks - 18 Years)
- Runts May Cough Chunky Sputum
- RSV (Viruses)
- Mycoplasma
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Streptococcus pneumoniae
1 min
Common Causes of Pneumonia: Adults (18 - 40 Years Old)
- Mycoplasma
- Streptococcus pneumoniae
- Chlamydia pneumoniae
41 secs
Common Causes of Pneumonia: Middle-Aged Adults (40 - 65 Years Old)
- Streptococcus pneumoniae
- Mycoplasma
- Haemophilus influenzae
- Anaerobes
- Viruses
1 min
Common Causes of Pneumonia: Elderly (65+ Years Old)
- Influenza Virus
- Haemophilus influenzae
- Anaerobes
- Streptococcus pneumoniae
- Gram-Negative Rods
59 secs
Airway and Lungs Assessment
- Inspection
- Examine Back of Chest
- Determine Respiratory Rate for 1 Minute
- Assess for Abnormalities with Uneven Movement or Use of Accessory Muscles
- Inspect Skin, Nails and Mucous Membrane
- Palpation
- Palpate for Crepitus, Tenderness, Alignment, Masses or Retraction
- Palpate for Tactile Fremitus
- Check Chest-Wall Symmetry and Expansion
- Note Resonance, Hyperresonance, Dullness and Tympany
- AUSCULTATION
- Use Diaphragm of Stethoscope to Listen to Full Inspiration and Full Expiration
- Ask Patient to Breathe Through Mouth
- Normal Breath Sounds
- Abnormal Breath Sounds
5 mins
Lung Sounds - Crackles
- Location
- Lower Lobes
- Description
- Fine/Coarse
- Sounds Like
- Fine: Twisting Hair through Fingers
- Coarse: Velcro
- Cause
- Collapsed Small Airways and Alveoli "Popping Open"
1 min
Lung Sounds - Rhonchi
- Location
- Trachea and Bronchi
- Description
- Low Pitched Rumbling
- Sounds Like
- Gurgling
- Cause
- Narrowed Airway
- Secretions or Bronchospasm
49 secs
Lung Sounds - Wheezes
- Location
- Throughout Lung
- Description
- High Pitched
- Sounds Like
- Musical
- Cause
- Air Moving through Narrowed Airways
38 secs
Lung Sounds - Pleural Friction Rub
- Location
- Anterior Lateral Lung
- Description
- Dry, Rubbing, or Squeaking
- Sounds Like
- Rubbing a Balloon with Finger
- Cause
- Inflamed Pleura
50 secs
Chronic Bronchitis Assessment
- Clinical Findings
- Chronic Productive Cough
- > 3 Months for 2 Years
- Increased Mucus Production
- Dyspnea
- Cyanosis
- Wheezes
- Complications
- Right Side Heart Failure
- Jugular Venous Distention (JVD)
- Peripheral Edema
2 mins
Chronic Bronchitis Interventions
- Tripod Position
- Humidified Oxygen
- Pursed Lip Breathing
- Increase Fluid Intake
- ABGs
- Early Detection of Exacerbation
- Considerations
- Lowest O2 Therapy
- Assisted Ventilation
- Increased Infection Risk
2 mins
COPD Overview (Chronic Obstructive Pulmonary Disease Overview)
- Causes
- Inhaled Toxins
- Smoking
- AAT Deficiency
- Assessment
- Emphysema
- Chronic Bronchitis
- Asthma
- Considerations
- Spirometry
- Slow Progression
2 mins
Emphysema
- Mechanism
- Hyperinflation and Loss of Elasticity
- Assessment
- Pursed Lip Breathing
- Barrel Chest
- Dyspnea on Exertion
- Clubbing
- Depression and Anxiety
- Thin Appearance
- Nursing Considerations
- CO2 Retention
- Low Concentration of O2
- High Fowler's Position
- High Calorie, High Protein Diet
2 mins
Asthma Assessment
- Assessment
- Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)
- Shortness of Breath (SOB)
- Tachypnea and Tachycardia
- Wheezing
- Diaphoresis
- Accessory Muscles
- Decreased Pulmonary Function Tests
2 mins
Stages of Asthma Treatments
- Mild Intermittent
- Short-acting Inhaled Beta-Agonist
- Mild Persistent
- Low-Dose Inhaled Corticosteroid
- Montelukast (Leukotriene Receptor Antagonist)
- Moderate Persistent
- Low to Medium-dose Inhaled Corticosteroid
- Zileuton
- Severe Persistent
- High-Dose Inhaled Corticosteroid
- Systemic Corticosteroids
- Omalizumab (Allergies)
2 mins
Asthma Implementation and Education
- Medication
- Oxygen
- Corticosteroids
- Ipratropium (Anticholinergic)
- Albuterol
- Implementation
- Inhaler/nebulizer
- Pulse Oximetry
- Pursed Lip Breathing
- Education
- Carry Inhaler
- Rinse Mouth after Inhaler
- Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)
2 mins
Restrictive vs. Obstructive Lung Diseases
- Restrictive Lung Disease
- Decreased Lung Volume
- FEV1/FVC Ratio Normal to Increased
- Obstructive Lung Disease
- Increased Lung Volume
- Decreased FEV1/FVC Ratio
2 mins
Penicillin
- Mechanism of Action
- Weakens Cell Wall
- Indications
- Gram-Positive Infections
- Prophylaxis
- Side Effects
- Pain at IM Injection Site
- Allergic Reaction
- Considerations
- Skin Tests
- Allergy ID
- Medication Education
2 mins
Ampicillin and Amoxicillin
- Mechanism
- Aminopenicillin
- Broad Spectrum Penicillin
- Indications
- Gram-Positive and Some Gram-Negative Infections
- Side Effects
- Rash
- Diarrhea
- Considerations
- No Effect Against Staph Aureus
- Often combined with Beta Lactamase Inhibitor
- Allergic Reaction
2 mins
Tetracyclines Overview
- End in "-cycline"
- Mechanism of Action
- Bacteriostatic
- Indications
- Infectious Diseases
- Acne
- Periodontal Disease
- Nursing Considerations
- Avoid Milk, Antacids, Iron
- Sunlight Protection
1 min
Tetracycline Toxicities
- Inhibition of Bone Growth in Children
- Teratogen
- Discoloration of Teeth
- Photosensitivity
- GI Distress
2 mins
Tetracyclines Side Effects
- Side Effects
- Superinfection
- Clostridioides difficile
- Discoloration of Teeth
- Bone Deformities
- Photosensitivity
- Contraindications
- Children Under 8
- Pregnancy
1 min
Aminoglycoside Overview
- End in "-mycin"
- GNATS
- Gentamicin
- Neomycin
- Amikacin
- Tobramycin
- Streptomycin
- Mechanism of Action
- Bactericidal
- Indications
- Severe Gram Negative Infections
- Bowel Surgery Prep
1 min
Vancomycin
- Mechanism of Action
- Inhibits Bacterial Cell Wall Synthesis
- Indications
- Serious Gram-Positive Infections
- Side Effects
- Nephrotoxicity
- Ototoxicity
- Red Man Syndrome
- Thrombophlebitis
- Nursing Considerations
- Culture Samples First
- Infuse IV Over 60 Minutes
- Take Around the Clock
2 mins
Vancomycin Side Effects & Toxicity
- Side Effects
- Thrombophlebitis
- Nephrotoxicity
- Ototoxicity
- Diffuse Flushing Called Red Man Syndrome
- Prevent with Antihistamine
- Prevent with Slow Infusion
2 mins
Metronidazole
- Mechanism of Action
- Bactericidal
- Forms Free Radical Toxic Metabolites
- Damages DNA
- Indications
- Giardia lamblia
- Entamoeba Histolytica
- Trichomonas
- Gardnerella
- Anaerobes
- Side Effects
- Metallic taste
- Disulfiram like Reaction with Alcohol
2 mins
Cephalosporins
- Starts with "Cef-"
- Mechanism of Action
- Bactericidal
- Indications
- Gram-Positive and Gram-Negative Infections
- Side Effects
- Allergic Reactions
- Thrombophlebitis
- Bleeding
- Contraindications
- Renal Impairment
- Considerations
- Avoid IV Calcium with Ceftriaxone
- No Alcohol
2 mins
Imipenem and Meropenem (Carbapenems)
- Mechanism
- Carbapenems
- Broad-spectrum Antibiotic
- Bactericidal
- Indications
- Gram Positive and Gram Negative Infections
- Side Effects
- GI Distress
- Suprainfections
- Seizures
- Considerations
- Penicillin Allergy
- IV or IM Route
- Imipenem Combined with Cilastatin
3 mins
Aztreonam (Azactam)
- Mechanism
- Monobactam Antibiotic
- Bactericidal
- Indications
- Gram-Negative Infections
- No Activity on Gram-Positives or Anaerobes
- Side Effects
- Blood Dyscrasias
- Pain at Injection Site
- Considerations
- Safe for Penicillin Allergy
- Synergistic with Aminoglycosides
- Nebulizer Form Available
2 mins
Macrolides
- End in "-thromycin"
- Mechanism of Action
- Bacteriostatic
- Indications
- Alternative for Penicillin Allergy
- Respiratory Infections
- Pneumonia
- Side Effects
- QT Prolongation and Sudden Death
- C.Diff Overgrowth
- GI Distress
- Considerations
- Slow IV Infusion
2 mins
Macrolides Side Effects
- Side Effects
- Diarrhea
- Prolonged QT Interval
- P450 Inhibitor
- Cholestatic Hepatitis
- Skin Rash
- Eosinophilia
3 mins
Fluoroquinolones
- End in "-floxacin"
- Mechanism of Action
- Bactericidal
- Indications
- Variety of Infections
- Side Effects
- GI Distress
- Photosensitivity
- Achilles Tendon Rupture
- Contraindications
- Pregnancy
- Children
- Myasthenia Gravis
- Considerations
- Avoid Milk Products or Antacids
- Slow IV Infusion
2 mins
Fluoroquinolones Toxicities
- Diarrhea
- Skin Rash
- Headache
- Tendon Rupture in Adults
- Myalgias in Kids
- Damage to Cartilage
- Teratogen
- QT Prolongation
1 min
Clindamycin
- Mechanism
- Bacteriostatic
- Binds 50S Ribosomal Subunit
- Indications
- Gram-Positive Infections
- Anaerobic Infections
- Side Effects
- Rash
- Pseudomembranous Colitis
- C. Difficile (Associated Diarrhea)
- Arrhythmias
- Blood Dyscrasias
- Considerations
- Monitor for Diarrhea
3 mins
Linezolid (Zyvox)
- Mechanism Of Action
- Oxazolidinone Antibiotic
- Binds 23S rRNA of 50S Subunit
- Inhibits Protein Synthesis
- Indication
- Gram-Positive Organisms
- MRSA
- VRE (Vancomycin Resistant Enterococci)
- Side Effects
- Bone Marrow Suppression
- Decreased Platelet Count
- Peripheral Neuropathy
- Lactic Acidosis
- Serotonin Syndrome
- Considerations & Patient Education
- Avoid Tyramine Containing Foods
4 mins
Alveolar Gas Exchange
- Characteristics
- Pulmonary Artery Blood is O2-Poor, CO2-Rich
- Two-Cell Thick Air-Blood Barrier
- CO2 Diffuses Into Air
- O2 Diffuses Into Blood
- Gases Equilibrate
- Pulmonary Vein is O2-Rich, CO2-Poor
- Thermoregulation
2 mins
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
Diet Progression
- Types of Diets
- Clear Liquid
- Full Liquid
- Pureed
- Mechanical Soft
- Low Residue (Fiber)
- High Fiber
- Regular
1 min
Patient Position Overview
- Position Techniques
- Trochanter Roll
- Trapeze Bar
- Ankle-Foot Orthotic (AFO) Devices
- Positions
- Fowlers Position
- Supine Position
- Trendelenburg
- Side-Lying Position
- Prone Position
- Sims' Position
- Nursing Considerations
- Reposition q2 Hours/Prevent Skin Breakdown
- Confirm Body Alignment
2 mins
Airway, Breathing, Circulation (ABC's)
- Airway Assessment
- Changed Sound of Voice
- "See-saw" Respirations
- Stridor
- Breathing Assessment
- Normal Respiratory Rate: 12–20 Breaths/Min
- Use of Accessory Muscles in Respiration
- Cyanosis
- Circulation Assessment
- Color of Hands and Digits
- Normal Capillary Refill Time (CRT): 2 Seconds
- Decreased LOC
- Considerations
- Initial ‘Look, Listen and Feel” Assessment
- Emergency Treatment
- Prioritization in Exam Questions
5 mins
Cardiopulmonary Resuscitation (CPR) for Adults
- Steps Before CPR
- Scan Scene
- Activate Emergency Response System
- Check For Breathing (Max 10 Seconds)
- Open Airway
- Compressions, Airway, Breathing (CAB)
- Compressions: 2 Inches Deep (100-120 Compressions/Min)
- Airway: Ensure Airway is Still Open
- Breathing: Administer 2 Rescue Breaths
- Considerations
- Repeat C-A-B Sequence (30:2) Until Help Arrives
3 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
Epinephrine (Adrenaline)
- Mechanism
- Alpha and Beta Agonist
- Indications
- Anaphylaxis
- Primary Open Angle Glaucoma (POAG)
- Bleeding
- Cardiac Arrest
- Side Effects
- Tachycardia
- Hypertension
- Tremors
- Insomnia
- Considerations
- Multiple Strengths
2 mins
Albuterol (Proventil)
- Mechanism
- Short-Acting Beta-2 Agonist
- Indications
- Bronchospasm
- Asthma
- Side Effects
- Angina
- Tachycardia
- Tremor
1 min
Terbutaline (Brethine)
- Mechanism of Action
- Beta-2 Agonists
- Indications
- Asthma
- Tocolytic
- Side Effects
- Hypotension
- Tremor
- Tachycardia
- Pulmonary Edema
- Hyperglycemia
2 mins
Theophylline (Theo-24)
- Mechanism
- Bronchial Smooth Muscle Relaxation
- Indications
- Asthma
- Side Effects
- Insomnia
- Restlessness
- Arrhythmias
- Seizures
- Considerations
- Narrow Therapeutic Range
- Monitor Plasma Levels
1 min
Prednisone (Glucocorticoids)
- Mechanism
- Glucocorticoid
- Indications
- Inflammatory Conditions
- Organ Transplant Rejection
- Side Effects
- Cataracts and Glaucoma
- Cushing's Syndrome
- Osteoporosis
- Immunosuppression
- Hyperglycemia
- Ulcers
- Considerations
- Adrenal Insufficiency
- Taper Gradually
2 mins
Second Generation Antihistamines
- Indications
- Allergies
- Mechanism of Action
- Lipophobic
- Histamine H1 Receptor Antagonist
- Drugs
- Azelastine + Fluticasone (Dymista)
- Intranasal Spray
- Cetirizine (Zyrtec)
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Considerations
- Fewer Anticholinergic Effects
- Fewer CNS Effects
2 mins
Anticholinergics
- B.O.AT.S Acronym
- Benztropine
- Parkinson's Disease
- Oxybutynin
- Decrease bladder spasms
- Atropine
- Mydriasis and Cycloplegia
- Scopolamine
- Motion Sickness
1 min
Anticholinergics Continued
- Drugs
- Glycopyrrolate
- Reduces Airway Secretions
- Ulcer Treatment
- Ipratropium
- Asthma and C.O.P.D
- Dicyclomine
- Hyoscyamine
- Irritable Bowel Syndrome
1 min
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
Isoniazid (INH)
- Mechanism
- Interferes with DNA Metabolism
- Indications
- Tuberculosis (TB)
- Side Effects
- Optic Neuritis
- Nausea and Vomiting
- Hepatotoxicity
- Peripheral Neuropathy
- Considerations
- Vitamin B6 Prophylaxis
- Monitor AST/ALT
2 mins
Rifampin
- Tuberculosis (TB)
- Blocks RNA Polymerization
- Haemophilus influenzae Type B
- Leprosy
- Meningitis
- P450 inducer
- Red-orange urine
55 secs
Ethambutol (Myambutol)
- Mechanisms
- Inhibits RNA Synthesis
- Bacteriostatic
- Indications
- Tuberculosis (TB)
- Side Effects
- Optic Neuritis
- Red/Green Color Blindness
- Gouty Arthritis
- Consideration
- Monitor Vision Acuity
2 mins
Chest Tubes: Management and Care
- Confirm suction order
- Assessment
- Crepitus
- Kinking
- Shortness of Breath (SOB)
- Infection
- Excessive bubbling
- Quick Interventions
- 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
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