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Registered Nurse (RN)
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HESI®
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HESI®-RN Comprehensive Review
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Neuromuscular Disorders

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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid

Neuromuscular Disorders
41 Picmonics to Learn | 1 hr 23 mins
Down Syndrome
Pathophysiology
Trisomy 21
Meiotic Nondisjunction
Signs and Symptoms
Intellectual Disability (Mental Retardation)
Single palmar crease
Flat Facies
Duodenal Atresia
Hirschsprung's Disease
Septum Primum Type ASD
Endocardial Cushion Defects
Prominent Epicanthal Folds
Increased Risk of Acute Lymphoblastic Leukemia
Alzheimer's Disease
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3 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
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5 mins
Cerebral Palsy (CP)
Cause/Mechanism
Maternal Infections
Fetal Hypoxia
Assessment
Developmental Delay
Neurological Dysfunction
Spasticity
Dysphagia
Interventions
Muscle Relaxants
Muscle Exercises
Assistive Devices
Braces
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2 mins
Phenytoin (Dilantin)
Mechanism
Blocks Na+ Channels
Indications
Tonic-clonic Seizures
Side Effects
Ataxia
Nystagmus
Sedation
Gingival Hyperplasia
Purple Glove Syndrome
Hirsutism
Rash
Anemia
Considerations
Individualized Dosing
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2 mins
Diazepam (Valium)
Indications
Anxiety
Seizures and Status Epilepticus
Muscle Spasms
Alcohol Withdrawal
Side Effect/Assessment
Dizziness/Vision Changes
Confusion/Amnesia
Urinary Incontinence
Behavioral Changes
Respiratory Depression
Antidote
Flumazenil (Romazicon)
Nursing Considerations
Fall Precaution
Do Not Stop Abruptly
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2 mins
Phenobarbital (Barbiturates)
Mechanism
Barbiturate
Indications
Seizures
Side Effects
Ataxia
Paradoxical Excitement
Fatigue/Drowsiness
Considerations
Monitor Plasma Levels
High Potential for Abuse
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1 min
Valproic Acid (Depakote)
Mechanism
Blocks Na+ Channels
Increases GABA Concentration
Indications
Tonic-clonic Seizures
Bipolar Disorder
Migraine Prophylaxis
Side Effects
Hepatotoxicity
Blood Dyscrasias
GI Distress
Tremor
Pancreatitis
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1 min
Carbamazepine (Tegretol)
Mechanism
Inactivates Na+ Channels
Indications
Seizures
Bipolar Disorder
Trigeminal Neuralgia
Side Effects
Nystagmus
Ataxia
Hepatotoxicity
Blood Dyscrasias
Water Retention
Stevens-Johnson Syndrome
Considerations
Avoid Grapefruit Juice
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2 mins
Lamotrigine (Lamictal)
Mechanism
Blocks Na+ Channels
Indications
Seizures
Bipolar Disorder
Side Effects
Diplopia
Stevens-Johnson Syndrome
Headache
Aseptic Meningitis
Nausea and Vomiting
Considerations
Screen for Suicide Risk
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2 mins
Long-acting Benzodiazepines
Drug Names
Lorazepam
Diazepam
Clonazepam
Chlordiazepoxide
Indications
Insomnia
Anxiety
Seizures
Eclampsia
Alcohol Withdrawal
Considerations
Half-life > 24 Hours
Dependence
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3 mins
Attention-Deficit Hyperactivity Disorder (ADHD) Assessment
Assessment
Inattention
Incomplete Tasks
Easily Distracted
Hyperactivity
Impulsiveness
Disruptive
Considerations
Two Areas of Life
Onset by Age 12
Symptoms > 6 Months
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3 mins
Attention-Deficit Hyperactivity Disorder (ADHD) Interventions
Drug Therapy
CNS Stimulants
Amphetamine
Methylphenidate
Bupropion (Wellbutrin)
Atomoxetine (Strattera)
Guanfacine (Intuniv)
Considerations
Manage Disruptive Behavior
Provide Simple Instructions
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2 mins
Spina Bifida Assessment
Cause
Congenital Malformation of Vertebrae
Assessment
Dimple With or Without Hair Tuft
Lumbar Sac
Hydrocephalus
Paralysis
Considerations
Identify Type
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2 mins
Spina Bifida Interventions
Surgery
Prone Position
Cover Sac with Moist (Sterile) Dressing
Measure Head Circumference
Bulging Fontanel
Considerations
Other Congenital Malformations Common
Bowel Control
Neurogenic Bladder
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2 mins
Hydrocephalus
Cause
Increased CSF in Ventricles of Brain
Assessment
Signs of Increased ICP
Infant Assessment
High Pitched Cry
Irritability
Opisthotonus
Increased Head Circumference
Bulging Fontanel
Setting Sun Sign
Interventions
Seizure Precautions
Elevate HOB
CSF Shunt
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2 mins
Meningitis Assessment
Assessment
Nausea and Vomiting
Fever
Nuchal Rigidity
Severe Headache
Purpura
Seizures
Photophobia
Infants and Young Children
Opisthotonus Position
High-Pitched Cry
Bulging Fontanel
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2 mins
Meningitis Interventions
Drug Therapy
IV Antibiotics
Dexamethasone
Analgesics
Antipyretics
Considerations
Closely Monitor for Increased ICP
Bed Rest
Preventative Vaccinations
Droplet-Airborne Precautions
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2 mins
Common Causes of Meningitis: Newborn (0-6 Months)
Group B Streptococci
E. coli
Listeria monocytogenes
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1 min
Common Causes of Meningitis: Children (6 Months - 6 Years)
Enteroviruses
Neisseria meningitidis
Haemophilus influenzae Type B
Streptococcus pneumoniae
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2 mins
Types of Seizures
Tonic-Clonic
Tonic
Clonic
Absence (Petit Mal)
Myoclonic
Atonic
Partial (Focal) Seizure
Focal Aware (Formerly Called Simple Partial)
Focal Impaired Awareness (Formerly Called Complex Partial)
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3 mins
Seizure Interventions
Maintain Airway
Side-lying Position
Support Head
Move to Floor
Benzodiazepines
Considerations
Never Restrain
No Objects in Mouth
Document Details
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2 mins
Seizure Precautions
Reduce Environmental Stimuli
Identify Triggers
Aura
Pad Side Rails
Bed Lowest Position
Oxygen and Suction Available
Consideration
Monitor Therapeutic Drug Levels
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2 mins
Gabapentin
Primary Indication
Seizure Treatment
Secondary Indications
Peripheral Neuropathy
Postherpetic Neuralgia
Bipolar Disorder
Migraine Prophylaxis
Characteristics
Inhibits Voltage-Gated Ca2+ channels
Designed as a GABA Analog
Side Effects
Ataxia
Sedation
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2 mins
Topiramate
Indications
Seizure Treatment
Migraine Prophylaxis
Mechanism of Action
Increase GABA Action
Blocks Voltage-Gated Na+ Channels
Side Effects
Kidney Stones
Weight Loss
Sedation
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1 min
Ethosuximide (Zarontin)
Indications
First Line Absence Seizure
Mechanism of Action
Blocks Thalamic T-Type Ca2+ Channels
Side Effects
Stevens-Johnson Syndrome
Fatigue
Diarrhea
Blood Dyscrasias
Considerations
Do Not Stop Abruptly
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2 mins
Streptococcus Pneumoniae Disease
Signs and Symptoms
Sickle Cell Anemia
Sepsis in Patients with Splenectomy
Rusty Sputum
MOPS
Meningitis
Otitis Media
Pneumonia
Sinusitis
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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
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1 min
Neisseria Meningitidis
Characteristics
Gram-Negative
Diplococci
Chocolate Agar
Thayer-Martin Media
VPN
Oxidase-Positive
Maltose Fermentation
Glucose Fermentation
Endotoxin
Lipooligosaccharide (LOS) in Membrane
Polysaccharide Capsule
IgA Protease
Disease
Waterhouse Friderichsen Syndrome
Adrenal Insufficiency
Petechial Rash
Treatments
Ceftriaxone
Rifampin Prophylaxis
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5 mins
Streptococcus agalactiae
Characteristics
Group B Streptococci
Gram-Positive
Cocci
Beta-Hemolytic
Bacitracin-Resistant
Catalase-Negative
Pyrrolidonyl Arylamidase (PYR) Negative
Polysaccharide Capsule
Hippurate Positive (+)
Produces CAMP Factor
Enlarges Area of Hemolysis by S. aureus
Disease
Mainly in Babies
Meningitis
Pneumonia
Sepsis
Colonizes Vagina
Treatment
Screen Pregnant Women at 35-37 Weeks
Penicillin
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3 mins
Haemophilus Influenzae Disease
Disease
Pneumonia
Cherry Red Epiglottitis
Meningitis
Otitis Media
COPD Exacerbation
Thumbprint Sign (on X-ray)
Treatment
Rifampin Prophylaxis
Ceftriaxone
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2 mins
Haemophilus influenzae Characteristics
Characteristics
Gram-Negative
Coccobacilli
PRP Capsule in Type B
Positive Quellung Reaction
IgA Protease
Chocolate Agar
Factor V is NAD
Factor X is Hematin
Staph Aureus Provides Factor V
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2 mins
Listeria Monocytogenes Disease
Signs and Symptoms
Soft Cheese
Pregnant Women Have Flu-Like Symptoms
Pregnant Women Have GI Symptoms
Granulomatosis Infantiseptica
Spontaneous Abortion
Meningitis
Monocytes in CSF
Treatment
Ampicillin
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2 mins
Listeria Monocytogenes Characteristics
Characteristics
Gram Positive
Bacillus
Intracellular
Survives in Cold Temperature
Actin Rocket
Tumbling Motility
Catalase-Positive
Beta-Hemolytic
Only Gram-Positive with Endotoxin-Like Structure
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2 mins
Common Causes of Meningitis: Adolescent and Adult (6 - 60 Years Old)
Enteroviruses
Herpes Simplex Virus (HSV)
Neisseria meningitidis (#1 Cause in Teens)
Streptococcus pneumoniae
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1 min
Common Causes of Meningitis: Elderly (60+ Years Old)
Streptococcus pneumoniae
Gram-Negative Rods
Listeria Monocytogenes
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56 secs
Lumbar Puncture
Indications
CSF Sample
CSF Pressure
Considerations
Empty Bladder
Side-lying Position
Between 3rd and 4th Lumbar Vertebrae
Number Tubes
Supine Position After Procedure
Contraindications
Increased ICP (Intracranial Pressure)
Infection at Puncture Site
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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
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2 mins
Reye's Syndrome
Cause
Aspirin (Salicylates) to Treat Viral Illness (In Children)
Assessment
Cerebral Edema
Lethargy (Decreased LOC)
Vomiting
Liver Failure
Interventions
Monitor for Increased ICP
Mannitol (Osmitrol)
Considerations
No Aspirin for Children
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2 mins
Aspirin (Acetylsalicylic Acid)
Mechanism
Inhibits Platelet Aggregation
NSAID
Indications
Thrombotic Event Prevention
General Pain
Inflammatory Conditions
Fever
Side Effects
Pancytopenia
GI Ulcers
Bleeding
Considerations
Withhold Before Surgery 7-10 Days
Reye's Syndrome
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2 mins
Aspirin Poisoning (Salicylism) Assessment
Early Symptoms
Nausea and Vomiting
Tinnitus
Confusion
Hyperventilation
Respiratory Alkalosis
Late Symptoms
Metabolic Acidosis
Coma
Hyperthermia
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1 min
Muscular Dystrophy
Mechanism
X-linked Recessive
Signs and Symptoms
Muscle Weakness
Motor Problems
Gower Sign
Large Calves
Waddling Gait
Loss of Ambulation
Consideration
Cardiac and Respiratory Failure
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2 mins

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