Bronchoscopy
AtSO4
Anticholinergic mimics SNR
ABG
Hyperventilation decreased CO2 increased blood pH respiratory alkalosis
Hypoventilation increased CO2 decreased blood pH respiratory acidosis
Diarrhea decreased HCO3 decreased blood pH metabolic acidosis
Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis
Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid decreased blood pH
metabolic acidosis
Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis
Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic acidosis
Cancer of the larynx CS, alcohol and over usage of voice (choir member)
A - nterior neck mass
B – urning sensation with hot beverages / Bad breath
C - hange in the voice (hoarseness)
D – ysphagia/dyspnea
Manifestations
A – LTERATION IN
LOC decreased O2
Thoracic anatomy over distention of alveoli TD = APD barrel chest
Skin
Temperature cool clammy skin
Color pale to cyanotic
ABG Respiratory acidosis Increased CO2
B – reathing difficulty, purse lip expiration > inhalation removal of excess CO2 (diet low CHO)
C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and
SFF) clubbing of the fingers and decreased TP to the kidneys causing polycythemia
D – ecreased Metabolism
1
Anorexia weight loss (high calorie diet) fatigue weakness
Bronchodilators
Theophylline and aminophylline
Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodilation
Side effect stimulates beta 1 receptors increases cardiac rate need not to notify the physician
Adverse effect hypotension monitor BP sign of toxicity
Evaluation check breath sounds
Pulmonary embolism
Restlessness earliest
2
S – ex gender males > female (before menopausal because estrogen decreases PVR) after menopausal
female eversible}[inverted T wave] Injury [elevated ST segment] > male
Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in
the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart) decreased
TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid PAIN
management decreased O2 demand by rest and SFF
Angina
Pain relieved by rest and NTG
NTG
Vasodilation orthostatic hypotention move gradually Monitor BP
Store in a dark and amber container
Effective tingling sensation no need to notify physician
Maximum of 3 tablets with 5 minute interval
MI
Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression monitor RR and O2 saturation
Antidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Buerger’s disease CS vasoconstriction stop CS common in men
Raynaud’s stress and cold vasoconstriction common in female
Digoxin
Cardiac glycoside
Positive inotrophic effect increased strength of myocardial contraction
Negative chronotrophic effect decreased cardiac rate monitor CR never give if CR below 60 bpm
Adverse effect
V – omitting
A – norexia
N – ausea
D – iarrhea
3
A – bdominal pain
Diuretic
D – iet high K diet except aldactone
I – input and Output expected increased output
U – ndesirable effect electrolyte imbalance (K)
R – ecord weight expected decreased weight
E – lderly special precaution
T – ake in AM and with food
I – ncreased orthostatic hypotension monitor BP and move gradually
C – ancel alcohol because of mild diuretic effect
Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT
antidote protamine SO4
Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PT vitamin K is
the antidote
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of Vitamin B12
beefy red tongue schilling’s test definitive test 24 hour urine collection life long Vitamin B12
Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) pain relieved
by antacids
Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids, NSAIDs,
indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and gastric
movement
Dumping syndrome tachycardia and weakness 3 D’s (diarrhea, diaphoresis and dizziness) fluids
after meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix sudden
cessation of pain, elevation of temperature and WBC
Liver cirrhosis alcohol and malnutrition (laanec’s), infection and drugs (post necrotic), RSCHF (cardiac)
and biliary obstruction (biliary)
Cholecystitis 5 F’s (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food
demerol to relieved pain
5
Increased water retention oliguria edema (fluid volume excess) and weight gain concentrated urine
increased urine specific gravity
Decreased water excretion polyuria dehydration (fluid volume deficit and weight loss) diluted urine
decreased urine specific gravity
Parathyroid gland
Parathormone
Increased increased calcium in the blood and decrease calcium in the bones stone formation and
decreased bone mass osteoporosis management increased water intake
Decreased hypocalcemia calcium supplement
Thyroid Gland
Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increased catabolism weight
loss increased appetite increased peristalsis Diarrhea fluid volume deficit Increased CR and RR
(due to increased BMR)
Increased T3 heat intolerance
Calcitonin decreased calcium in the blood tetany compensatory calcium withdraws from the bones
bone destruction (complication)
PTU decreased synthesis of TH watch out for SE (similar to signs and symptoms of hypothyroidism)
watch out for agrunulocytosis (fever, skin rash and sore throat)
Lugol’s solution decreased released of TH before thyroidectomy decreased vascularity of the thyroid
gland
Decreased (hypothyroidism)
T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight gain
anorexia decreased peristalsis constipation decreased CR and RR due to decreased BMR
T3 cold intolerance
Calcitonin hypercalcemia stone formation
Synthroid and Proloid increased TH
Adrenal Gland
Incresead (cushing’s)
Glucocorticoids hyperglycemia and decrease wound healing
Mineral corticoids increased aldosterone sodium retention and potassium excretion hypernatremia and
hypokalemia
Hypernatremia water retention oliguria edema (moon face,buffalohump, fluid volume excess and
weight gain) concentrated urine increased urine specific gravity low sodium diet
Hypokalemia weakness Prominent U wave high potassium diet
Epinephrine and Norepinephrine Increased BP and CR
Sex hormones
Males gynecomastia and falling of hair
Females hirsutism and deepening of the voice
Decreased (addisons)
Glucocorticoids hypoglycemia and inability to cope with stress
Mineralcorticoids decreased aldosterone sodium excretion and potassium retention hyponatremia and
hyperkalemia
Hyponatremia water excretion polyuria (dehydration, fluid volume deficit and weight loss) diluted urine
--. Decreased urine specific gravity increased fluids and Na
6
Hyperkalemia weakness tall or peaked T waves low K diet
Epinephrine and Norepinephrine decreased BP and CR
Diabetes Mellitus
Type I absolutely no insulin thin insulin
Type II insufficient insulin obese OHA
Diet 50% CHO, 30% Fats, 20% CHON
Exercise Increased uptake of glucose Decreased insulin requirement
Oral hypoglycemic agent (OHA)
Stimulates pancreas to produce insulin
Insulin
SC; IV if DKA
Never massage the area
Never administer cold insulin
Rotate the site of injection
PREVENTS LIPODYSTROPHY
Mix
Aspirate clear first
Inject air to cloudy first
Hypoglycemia
W – eakness
H – unger pangs
A – alteration of LOC
T – achycardia and tremors
A – bdominal pain
B – blurring of vision
C – ool clammy skin
D – iaphoresis
Give orange juice (simple sugars)
Peritoneal Dialysis
Diasylate output is decreased turn patient from side to side
Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and rigid abdomen
peritonitis
7
Don’t include diasylate solution in the output of the client
Expected decreased weight monitor weight before and after decreased createnine and BUN
Parkinson’s diasease
Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6 foods
Cardinals signs tremors (non intentional) muscle rigidity bradykinesia
Pill rolling
Microphonia ask your client to speak aloud to be aware
Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Gravis
Tensilon test confirmatory test
Decreased Acetylcholine and increased cholinesterase
Muscle weakness priority airway
NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
Cholinergics (mestinon) increased muscle strength antidote ATSO4
Multiple Sclerosis
Demyelinization of the myelin sheath
Charcoat’s triad
Intentional tremors
Scanning of speech
Nystagmus
Visual disturbances diplopia
Rheumatoid Arthritis
No specific diagnostic test
NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis (joint fixation)
Avoid flexion and promote prone position
Gouty Arthritis
Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritis
Most common related with aging
Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
DEATH inflammation
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision
miotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
Meniere’s Triad tinnitus, impaired hearing loss and vertigo low Na diet
Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the room
assume a flat or reclining position
ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Normal Values
BUN = 10 – 20 mg/dl
Calcium = 9 to 10.5 mg/dl
Creatinine = 5 to 1.5 mg/dl
GTT = 70 to 115 mg/dl
O2 sat = 97 to 98%
“ I wish you all good luck for your LOCAL BOARD EXAM ….. “