- It takes 3 things to pass the NCLEX exam

Mark Klimek Audio Lectures

• It takes 3 things to pass the NCLEX exam
• Knowledge
• Confidence
• Exam Proficiency

• You can’t apply what you don't know, but you have to be able to apply what you do

know.

- Go with majority: if something is 75% fatal, consider it fatal.

• If you try to learn everything you will master nothing.

Lecture 6 Drug toxicity’s, Dumping Syndrome vs. Hiatal Hernia, Electrolytes Drug Toxicity’s

• Drug toxicity’s is one of the biggest areas that can cause patient harm.

Medication Use Therapeutic Levels Toxic Levels

Lithium Used in anti-mania, Medication used in bipolarism.

0.6 -1.2

Greater than or equal to 2 Lanoxin (Digoxin) Used to treat A-fib, and congestive heart failure.

• - 2 Greater than or equal to 2

Aminophylline Used to treat airway spasms that cause airway constriction.Given first, then a bronchodilator.

10 – 20

Greater than or equal to 20 Dilantin (Phenytoin) Used to treat seizures. 10 - 20 Greater than or equal to 20

Bilirubin (waste product of RBC breakdown) Waste product of red blood cell breakdown.In adults it is abnormal to have a high bilirubin.In newborns the bilirubin is elevated because they are breaking down RBC’s from the mother blood stream.

Adult: 1-2

Newborn: less

than 10

Adult: elevated levels

Newborn: The toxic level is

20, however a newborn with 14 and above is cause for concern

-Kernicterus:

• Bilirubin in the brain.
• Jaundice is caused by Bilirubin in the skin and is a sign of elevated Bilirubin

levels.

• When Bilirubin levels in a newborn reach around 20, the bilirubin enters

the brain and spinal cord and irritates the brain.

• The bilirubin causes aseptic meningitis and aseptic encephalitis.

- Opisthotonos:

• This is a position the newborn assumes due to the irritation of the bilirubin

on the brain and meninges.

• The newborn hyperextends.
• The neck will begin to extend backwards and the heels will arch

towards their head

• The newborn should be placed on its side.

Pathological Jaundice vs. Physiological Jaundice:

- Pathological Jaundice: the bilirubin is high and jaundice at birth. (Bad)

• Physiological Jaundice: the bilirubin is normal at birth and goes high 2 – 3

days after birth causing jaundice. (typical)

Dumping Syndrome vs. Hiatal Hernia

- Hiatal Hernia:

• The upper part of the stomach has herniated through the diaphragm.
• The stomach then has two chambers, one inside the abdominal

cavity and the other in the thoracic cavity.

• This causes gastric acid to be regurgitated back up into the esophagus.
• The gastric contents move in the wrong direction at the right rate.

- Signs and symptoms of Hiatal hernia:

- GERD: Gastric esophageal reflux disease.

• Heartburn
• Indigestion
• Hiatal hernia is GERD if you lay down after you eat.

- Example: Eating a pizza then lay down and get GERD.

• Dependent on position and time of last meal.

- Treatment of Hiatal hernia:

- Goal is to empty the stomach faster by:

• Bed in high position
• Increase fluids with meal
• Increase carbohydrates, decrease protein

- Dumping Syndrome:

• The gastric contents dump too quickly into the duodenum
• Usually happens after gastric surgery.
• The gastric contents move in the right direction at the wrong rate.

- Signs and symptoms of dumping syndrome:

- Appearance of being drunk: Since all the stomach contents emptied at once

blood rushes to the abdomen to compensate for the added stress.

• Slurred speech
• Poor gait
• Impaired judgment
• Labile

- Appearance of shock:

• Hypotension
• Tachycardia/tachypnea
• Pale
• Cold/clammy

- Acute abdominal distress:

• Cramping
• Abdominal protecting
• Borborygmi

- Treatment of Dumping syndrome:

- Goal is to slow down gastric emptying:

• Bed in flat position, turn to side to eat
• Liquids 1-2 hours after meal
• Decrease carbohydrates, increase proteins

Appearance Medical Problem Drunk Alcohol intoxication Shock Shock Drunk and shock Hypoglycemia Drunk, shock, Abdominal distress Dumping syndrome

Electrolyte Imbalances

- To know electrolyte imbalances you need to know these three sentences:

• Kalemia’s (potassium) do the same as the prefix (hyper, hypo) except for the heart

rate and urine output do the opposite. (controlled by kidneys)

• Hyperkalemia: “hyper” everything goes high, except the heart rate and urine

output, which go down.

• Brain excitability (irritable)
• Tachypnea
• Bradycardia (only effects heart rate not electrical impulses)
• Diarrhea
• 3, 4 reflexes
• Decreased urine output (oliguria)

- Hypokalemia: “hypo” everything goes down, except for the heart rate and

urine output, which go up.

• Decreased brain activity (lethargy)
• Decreased respirations
• Tachycardia
• Constipation
• 1 reflexes
• Increased urine output (polyuria)

[Question] Your patient has hyperkalemia (up, everything goes up except HR/urine output), what signs and symptoms would you expect to find? Select all that apply

• Adynamic ileus - U wave (slowed repolarization)
• Obtundent - Depressed ST wave
• 1 reflexes - Polyuria
• Clonus (muscle irritability) - Bradycardia
• For best/most common sign questions dealing with potassium favor the heart.

• Calcemia’s (calcium) do the opposite of the prefix’s (hyper, hypo). (Controlled by

parathyroid gland)

- Hypercalcemia: “hyper” everything goes down when calcium goes up.

• Hypoactive reflexes
• Lethargy
• Bradycardia
• Constipation
• Decreased respirations

- Hypocalcemia: “hypo” everything goes up when calcium goes down.

• Agitation/irritability
• Hyperactive reflexes
• Clonus
• Tachycardia
• Seizures