IMPORTANT POINTS WHICH YOU MUST KNOW TO PASS THE NCLEX EXAM:

by

If you really want to become a RN nurse, then have a look on following points which is must for every student to know. Here, I am going to mention those points which definitely helps you to pass the NCLEX exam.

  1. Shock’s sign and symptoms:
    • The first sign and symptom of the shock is ALTERED LEVEL OF CONSCIOUSNESS.
    • The second one is HYPOTENSION
    • The third one is TACHYCARDIA
    • The fourth one is OLIGURIA
    • The fifth one is PALE and COOL SKIN
  2. Always use BILATERAL 16 GAUZE CANNULA in case of shock. Two IV fluid cannulas use for the fast fluid replacement. On one side, it may be IV FLUID like NS and on other side it may be blood product (depending upon what type of shock it is)
  3. FLUID VOLUME OVERLOAD sign and symptoms:
    • 1st sign is BOUNDING PULSE
    • 2nd one is TACHYCARDIA
    • 3rd one is ELEVATED BLOOD PRESSURE
    • 4th one is DISTENDED NECK VEIN
    • 5th one is ELEVATED CVP (central venous pressure)
    • DYSRHYTHMIA (volume increase, electrolyte decrease)
    • PULMONARY EDEMA (CRACKLE SOUNDS present)
    • Altered level of consciousness
    • Headache
    • Visual disturbances
    • Skeletal Muscle weakness
    • Parathesis
    • Pitting edema (dependent areas)
    • Pale, cool skin
    • Increases motility in GI tract
    • Diarrhea
    • Increased body weight
    • Liver enlargement
    • Ascites.
  4. In case of DEHYDRATION, the temperature of the body is high because water keeps body cool.
  5. CVP is the pressure inside the Superior Vena Cava.
  6. Normal CVP is the 3-8mmHg
  7. If CVP is less than 3mmHg then HYPOVOLEMIA occurs
  8. If CVP is more than 8mmHg then HYPERVOLEMIA occurs
  9. In case of renal patient, cardiac patient, the CVP is more than 8mmHg.
  10. Always feel CRACKLES SOUNDS on the BASE OF THE LUNGS during AUSCULTATION.
  11. Nurse responsibility in case of fluid volume excess:
    • First action of the nurse: Never stop the IV-line (Always remember) Reason: If you stop the IV line, the cannula gets BLOCKED until DOCTOR ARRIVES.
    • The correct answer for the first action of the nurse is the KEEP NS AT OPEN VEIN RATE.
    • In other words, as a nurse the first action is to DEAD SLOW THE NS normal saline
    • After that start QUICK ASSESSMENT of the patient, check the respiratory status, blood pressure etc.
    • If CRACKLES notify, next step after assessment is the KEEP PATIENT IN SEMI-FOWLER’s POSITON.
    • Attach PULSE OXIMETRY, seek oxygen saturation.
    • If patient’s condition is allowing, place patient in sitting position, keep legs in dependent position (so that with the effect of gravity fluid moves towards the legs from the lungs.
    • Now I call to DOCTOR.
    • If needed, as a RN I can start oxygen in case of pulse oximetry reading is lower than 95%. (Before doctor came)
    • 1 RN have right to start 2-liter oxygen (without any doctor prescription).
    • Now give DIURETICS (as doctor prescribed).
  12. In case of FLUID VOLUME OVERLOAD, ALWAYS SUPPORT AIRWAY FIRST. (Remember MASLOW’S theory).

ACIDOSIS AND ALKALOSIS:

  1. ACID: the solution having more H+ ions are known as acid.
  2. BASE: the solution having OH- or in other words, the solution having less H-, the solution is alkaline.
pH of BLOOD7.35-7.45
PO280-100mmHg
PCO235-45mmHg
HCO3-21-28mEq/L
NORMAL VALUES (MUST REMEMBER)

  1. Milk is alkaline in nature.
  2. COMPENSATORY MECHANISM:
    • It is helpful in maintaining the pH between 7.35-7.45
    • These compensatory mechanisms make sure that you are not going into alkalosis or acidosis.
    • LUNGS:
      • Lungs play important role in maintaining acid-base balance.
      • CO2 is an ACIDIC GAS
      • Lungs are emitting CO2
      • In case of acidosis, the respiratory rate increases, deep respiration. So that more CO2 emit from the lungs
      • Kussmaul respiration is the deep, labored breathing that is seen when the body or organs have become too acidic. (Compensatory mechanism in case of acidosis)
      • In case of Alkalosis, the lungs start breathing slow, respiration become more shallow.
    • KIDNEY:
      • Act late
      • In case of DEHYDRATION, the chances of acidosis is high.
      • The Best treatment for the acidosis is to START NORMAL SALINE. Because of the alkaline nature of the sodium, the acidosis corrects up to some extent and secondly the H+ ions expelled out from the body once mix in the fluid.
      • In case of Alkalosis, the kidney starts to retain the H+ ions with the help of compensatory mechanism.
    • POTASSIUM:
      • It plays an important role in maintaining the acid and base balance.
      • During acidosis, the body protects itself from the acidic state by moving hydrogen ions into the cells. Therefore, potassium moves out to make room for the H+ i.e., hydrogen ions and the level of the potassium starts increases. (HYPERKALEMIA)
      • During alkalosis, the cells start release the hydrogen ions into the blood to increase the blood acidity, this force potassium into the cells and the level of the potassium decreases. (HYPOKALEMIA)
  3. ACIDOSIS AND ALKALOSIS ARE OF TWO TYPES.
  4. RESPIRATORY ACIDOSIS AND ALKALOSIS
  5. METABOLIC ACIDOSIS AND ALKALOSIS
  6. Respiratory acidosis and alkalosis are related to carbon dioxide CO2.
  7. Metabolic acidosis and alkalosis are related to disturbance in the digestive system.
  8. HCO3- is the indicator of the metabolic
  9. If the level of CO2 is more than 45mmHg then respiratory acidosis occur.
  10. If the level of CO2 is less than 355mmHg then respiratory alkalosis occur.
  11. If the level of HCO3- is more than 28mEq/L, then metabolic alkalosis occurs.
  12. If the level of HCO3- is less than 21mEq/L, then metabolic acidosis occurs.

RESPIRATORY CONDITION:

  1. CO2 is Respiratory Indicator.
  2. PCO2 is 35-45 mmHg
  3. CO2 is an acidic gas.
  4. If the CO2 level is more than 45mmHg then Respiratory ACIDOSIS occur
  5. If the CO2 level is less than 35mmHg then Respiratory ALKALOSIS occur
  6. CO2 high = pH low
  7. CO2 low = pH high

RESPIRATORY ACIDOSIS

  1. RESPIRATORY ACIDOSIS= CO2 more than 45mmHg and pH is lower than 7.35
  2. Inspection and Auscultation (quick assessment) {Inspection: nasal flaring, difficult breathing, pulse oximetry reading is lower than 95%. Auscultation: notice wheezing, crackles, find problem, For ABG sampling, the PCO2 is more than 45mmHg.}
  3. Semi fowler’s position
  4. Provide Oxygen (if needed)
  5. Suctioning (if needed)
  6. Administered prescribed medicine.
  7. NEVER FORGET TO CHECK HYPERKALEMIA

RESPIRATORY ALKALOSIS

  1. The CO2 is less than 35 mmHG
  2. pH is more than 7.45
  3. CAUSES
    • In case of FEVER, overstimulation of the respiratory system
    • In case of HYPERVENTILATION,
    • HYPOXIA, it occurs
    • Overventilation by mechanical ventilations
  4. INTERVENTIONS:
    • Voluntary hold the breath (told to the patient)
    • Rebreathing mask
    • Rebreathing using paper bag
    • Notify Calcium Level (HCO3 has strong bond with CALCIUM= CALCIUMBICARBONATE)
    • Calcium gluconates administer.

METABOLIC ACIDOSIS:

  1. HCO3- is metabolic indicator
  2. HCO3- is alkaline in nature.
  3. Normal HCO3- is 21-28mEq/L
  4. If HCO3- is less than 21mEq/L, then metabolic acidosis occurs
  5. If HCO3- is more than 28mEq/L, then metabolic alkalosis occurs
  6. HCO3- high= pH is high
  7. HCO3- low = pH is low
  8. Cause:
    • Diabetic Ketoacidosis. (type1) [Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If it’s left untreated, the buildup can lead to diabetic ketoacidosis.]
    • Malnutrition
    • Renal patient
    • If you are doing exercise in closed room, there is not enough supply of oxygen that lactic acid will gets accumulate in muscles only and hence, your body go into LACTIC ACIDOSIS.
    • Severe diarrhea [ alkaline more loss] [acidosis occurs]
    • Vomiting [ acid loss more] [alkalosis occurs]
  9. Because of the DEHYDRATION, body is not able to expel out ketone. Hence, DKA occur.
  10. INTERVENTIONS:
    • Rehydration
    • NS with INSULIN
    • Correct hyperglycemia, dehydration, ketone acidosis, hyperkalemia {NS with INSULIN}
    • NEVER GIVE DEXTROSE SEPARETELY

METABOLIC ALKALOSIS:

  1. HCO3- is more than 28mEq/L
  2. HCO3- alkaline in nature
  3. pH is high = HCO3- is also high
  4. CAUSES:
    • Diarrhea
    • Diuretics [release H+ ions more from the body]
    • Vomiting
    • Cushing syndrome {corticosteroid level increase, they retain sodium more, sodium is alkaline in nature, hyperaldosterone}
    • Excess Soda bicarbonate [alkaline in nature]
    • Massive infusion of whole blood. [The citrate {anticoagulant} combine with calcium, the product is made is alkaline in nature]

Leave a Comment