J. F. ADORABLE, RN.
Text from Pentagon Review Center
NERVOUS SYSTEM
Overview of structures and functions:
Central Nervous System
Brain
Spinal Cord
Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Autonomic Nervous System
Sympathetic nervous system
Parasympathetic nervous system
- Mestinon, Neostigmine.
Side Effects
- PNS
Thorazine, etc.
Side effect of THORAZINE: atopic
dermatitis and foul smelling odor.
Side effect of all antipsychotic: signs of
PARKINSONS DISEASE, therefore
antipsychotic are given together with
antiparkinson drugs
Anti-parkinson drugs:
C.A.P.A.B.L.E.S
I. Cholinergic Agents
Effects of Beta-blockers
B roncho spasm
E licits a decrease in myocardial contraction.
T reats hypertension.
A V conduction slows down.
Lidocaine(Xylocaine)
B. NEUROGLIA
rstuv
w101
Support and protection of neurons.
TYPES
0 Astrocytes maintains blood brain barrier semi-permeable.
0.0 Majority of brain tumors (90%) arises from called astrocytoma.
2. Oligodendria Produces myelin sheath in CNS. Act as insulator and facilitates rapid nerve
0 Microglia
1 Epindymal
SUBSTANCES THAT CAN PASS THE BLOOD-BRAIN BARRIER
1. Ammonia
0
1
Cerebral toxin
Hepatic Encephalopathy (Liver Cirrhosis)
impulse transmission
Ascites
Esophageal Varices
Dizziness
25
Confusion
26
27
5889Epilepsy
PATHOGNOMONIC SIGNS
1. PTB
2. PNEUMONIA
Rusty sputum.
3. ASTHMA
Wheezing on expiration.
4. EMPHYSEMA
Barrel chest.
5. KAWASAKI DISEASE
Strawberry tongue.
6. PERNICIOUS ANEMIA
7. DOWN SYNDROME
8. CHOLERA
9. MALARIA
10. TYPHOID
11. DIPTHERIA
12. MEASLES
Kopliks spots.
13. SLE
Butterfly rashes.
15. LEPROSY
17. APPENDICITIS.
18. DENGUE
19. MENINGITIS
20. TETANY
21. TETANUS
22. PANCREATITIS
24. PDA
Exopthalmus
28. INTUSSUSCEPTION
30. HEPATITIS
Jaundice
31. THROMBOPHEBITIS
Homans sign
32. CATARACT
33. GLAUCOMA
35. CHOLECYSTITIS
23
24
lioning face
rebound tenderness
risus sardonicus.
Clubbing of fingers
25
26
27
28
29
Hepatitis
23 Signs of jaundice (icteric sclerae).
24
5. Bilirubin
23 Increase bilirubin in brain (Kernicterus).
24
DEMYELINATING DISORDERS
1. ALZHEIMERS DISEASE
5888
Atrophy of brain tissues.
characterized by
24
25
26
25
26
Unknown Cause
27
28
Autoimmune disorders
29
Pernicious anemia
30
Myasthenia gravis
31
Lupus
32
Hypothyroidism
33
GBS
5889
Immediate action.
Visual disturbances
blurring of vision (primary)
24
25
23
Impaired sensation
Pain, pressure, heat and cold. [do not give hot packs bcoz of dec. sensation to heat which can lead to burns.]
24
tingling sensation
25
paresthesia
26
numbness
24
CHARCOTS TRIAD
ANI
Intentional tremors
Nystagmus
0 Urinary retention/incontinence
1 Constipation
2 Decrease sexual capacity
DIAGNOSTIC PROCEDURE
0
CSF analysis (increase in IgG and Protein).
1
(+) Lhermittes sign a continuous and increase contraction of spinal column/cord following laminotomy.
NURSING MANAGEMENT
23
ACTH (Adreno Corticotropic Hormone)/ Steroids for acute exacerbation to reduce edema
at site of demyelination to prevent paralysis. [Best given in Morning to mimic body normal rhythm]
24
25
26
Immunosupresants
24
25
24
Yoga
26
27
Diuretics
24
Nursing Management
5888 Only given subcutaneous.
5889Monitor side effects bronchospasm and wheezing.
after
subcutaneous
Nursing Management
0 avoid bubble bath (can alter Ph of vagina).
1
Male
0 Urethra (20 cm, 8 inches)
1 urinate after intercourse
MICROGLIA
0stationary cells that carry on phagocytosis (engulfing of bacteria or cellular debris, eating), pinocytosis (cell
drinking).
MACROPHAGE
ORGAN
Microglia
Monocytes
Brain
Blood
Kupffers cells
Kidney
Histiocytes
Skin
Alveolar
Lung
Macrophage
EPINDYMAL CELLS
23 Secretes a glue called chemo attractants that concentrate the bacteria.
COMPOSITION OF BRAIN
23 80% brain mass
24
24
10% blood
25
10% CSF
Brain Mass
Composed of the Right Cerebral Hemisphere and Left Cerebral Hemisphere enclosed in the Corpus
Callosum.
Functions of Cerebrum
5888
integrative
5889sensory
5890motor
Lobes of Cerebrum
1. Frontal
0.0
1 Temporal
1.0
hearing
2 Parietal
2.0
for appreciation
2.1 Discrimination of sensory impulses to pain, touch, pressure, heat, cold, numbness.
3 Occipital
3.0
for vision
controls libido [the true sense of sexual arousal is when you smelled the fumes of the natural body]
2. BASAL GAGLIA
23 areas of grey matter located deep within each cerebral hemisphere.
24
NEURO TRANSMITTER
DECREASE
INCREASE
Acethylcholine
Myasthenia Gravis
Bi-polar Disorder
Dopamine
Parkinsons Disease
Schizophrenia
3. MIDBRAIN/ MESENCEPHALON
5888acts as relay station for sight and hearing.
5889size of pupil is 2 3 mm.
5890equal size of pupil is isocoria.
5891unequal size of pupil is anisocoria.
5892hearing acuity is 30 40 dB.
5893positive PERRLA [Pupils equal, round, reactive to light and accommodation]
4. INTERBRAIN/ DIENCEPHALON
Parts of Diencephalon
23 Thalamus
23
24 Hypothalamus
23 Controls temperature (thermoregulatory center).
24
25
controls thirst
26
appetite/satiety
27
28
29
30
31
32
33
5. BRAIN STEM
4 located at lowest part of brain
Parts of Brain Stem
1. Pons
23 pneumotaxic center controls the rate, rhythm and depth of respiration.
1025
Medulla Oblongata
23 Controls respiration, heart rate, and swallowing, vomiting, hiccup, vasomotor center (dilation and
constriction of bronchioles).
[damage to medulla is most life threatening]
1026
Cerebellum
23 Smallest part of the brain.
24
Lesser brain.
25
NEUROLOGIC DISORDERS
INCREASE INTRACRANIAL PRESSURE increase in intra-cranial bulk brought about by an increase in one of the 3
major intra cranial components. NORMAL ICP: 0-15 mmhg
Causes:
head trauma/injury
localized abscess
hydrocephalus
cerebral edema
tumor (rarely)
hemorrhage
lethargy/stupor
coma
decrease LOC
restlessness/agitation
irritability
Nursing Management
0 Maintain patent and adequate ventilation by:
a.
Prevention
of
hypoxia
hypercarbia Early signs of hypoxia
0
Restlessness
1
Agitation
Tachycardia
and
HYPERCARBIA
23 Increase CO2 (most powerful respiratory stimulant) retention.
24
24Before and after suctioning hyper oxygenate client 100% and done 10 15 seconds only.
25
4 Elevate bed of client 30 35o angle with neck in neutral position unless contraindicated to promote venous drainage.
5 Limit fluid intake to 1200 1500 ml/day (in force fluids 2000 3000 ml/day).
6 Monitor strictly input and output and neuro check
7 Prevent complications of
8 Prevent further increase ICP by:
23
24
25
26
23
23
23
Nursing Management
24 Monitor vital signs especially BP (hypotension).
25
monitor strictly input and output every 1 hour notify physician if output is less 30 cc/hr.
26
5888given
early morning
5889
Corticosteroids
5888Dexamethasone (Decadron)
5889Hydrocortisone
5890Prednisone (to reduce edema that may lead to increase ICP)
5891Mild Analgesics (Codeine Sulfate for respiratory depression)
5892Anti Convulsants (Dilantin, Phenytoin)
orthopnea
productive cough
frothy salivation
cyanosis
rales/crackles
bronchial wheezing
pulsus alternans
10
11
S3 (ventricular gallop)
12
TREATMENT
Morphine Sulfate
Aminophelline
Digoxin
Diuretics
Oxygen
Gases, blood monitor
RIGHT CONGESTIVE HEART FAILURE (Venous congestion)
Signs and Symptoms
0 jugular vein distention (neck)
1
ascites
pitting edema
weight gain
hepatosplenomegaly
jaundice
pruritus
esophageal varices
constipation
Nursing Management
2
FRUITS
Apple
VEGETABLES
Asparagus
Banana
Brocolli
Cantalope
Carrots
Oranges
Spinach
2. Hypocalcemia/ Tetany
23 decrease calcium level
24
paresthesia
27
numbness
28
29
Complications
Arrhythmia
Seizures
Nursing Management
23 Calcium Gluconate per IV slowly as ordered
5889
Magnesium Sulfate
Magnesium Sulfate toxicity [B.U.R.P]
S/S
BP
Urine output
DECREASE
Respiratory rate
Patellar relfex absent
3. Hyponatremia
3
decrease sodium level
4
agitation
10
Nursing Management
0
force fluids
1
4. Hyperglycemia
polyuria
polydypsia
polyphagia
Nursing Management
3 monitor FBS
5. Hyperuricemia
3.0 increase uric acid (purine metabolism)
3.1 foods high in uric acid (sardines, organ meats and anchovies)
3.2 *Increase in tophi deposit leads to Gouty arthritis.
swelling
Nursing Management
0
force fluids
1
1 Allopurinol (Zyloprim)
0
Drug of choice for gout.
1
2 Colchecine
0
Acute gout
1
KIDNEY STONES
Signs and Symptoms
0 renal colic
1
Nursing Management
0
fluids
1
as ordered
force
administer medications
1 Narcotic Analgesic
0
orphine Sulfate
1 ANTIDOTE:
Naloxone (Narcan) toxicity leads
to tremors.
2 Allopurinol (Zyloprim)
Side Effects
0
Respiratory depression (check for RR)
24
Arteriosclerosis
25
Hypoxia
26
Encephalitis
27
AntihypertensiveS
c. Haloperidol(Haldol)
d. Phenothiazine
AntipsychoticS
Multiple
loss causes
suicide
Loss of spouse
Loss of Job
25
25
26
stooped posture
27
28
over fatigue
29
30
31
32
33
34
35
autonomic changes
23
increase sweating
24
increase lacrimation
25
seborrhea
26
constipation
27
Nursing Management
1. Administer medications as ordered
Anti Parkinsonian agents
5888
Levodopa (L-dopa) short acting
5889Amantadine Hydrochloride (Symmetrel)
5890Carbidopa (Sinemet)
Mechanism of Action
0 increase level of dopamine
Side Effects
23 GIT irritation (should be taken with meals
24 orthostatic hypotension (CBQ)
25
arrhythmia
26
hallucinations
Contraindications
5888clients with narrow angle closure glaucoma
5889clients taking MAOIs (no foods with tryptophan and thiamine: cheese, beer, avocado, wine)
5890urine and stool may be darkened
5891no Vitamin B6 (Pyridoxine) reverses the therapeutic effects of Levodopa
5889
SNS
24
25
26
27
28
Assist/supervise in ambulation
29
NORMAL RANGE
TOXICITY
LEVEL
INDICATION
CLASSIFICATION
.5 1.5 meq/L
CHF
Cardiac Glycoside
.6 1.2 meq/L
Bipolar
Anti-Manic Agents
10 19 mg/100 ml
20
COPD
Bronchodilators
Dilantin/ Phenytoin
10 19 mg/100 ml
20
Seizures
Anti-Convulsant
Acetaminophen/Tylenol
10 30 mg/100 ml
200
Osteoarthritis
Non-narcotic
Analgesic
Digoxin/ Lanoxin
(Increase force of
cardiac output)
Lithium/ Lithane
(Decrease level of
Ach/NE/Serotonin)
Aminophylline
(Dilates bronchial tree)
1. Digitalis Toxicity
Signs and Symptoms
5888nausea and vomiting / anorexia
5889diarrhea
5890confusion / fatigue / depression / malaise
5891photophobia
5892changes in color perception (yellowish or green halo around lights or snowy vision)
25
diarrhea
26
27
hypothyroidism (cretinism the only endocrine disorder that can lead to mental retardation)
Nursing Management
5888force fluids
5889increase sodium intake to 4 10 g% daily
3. Aminophylline Toxicity
Signs and Symptoms
0 tachycardia
1
palpitations
Nursing Management
0.0 Only mixed with plain NSS or 0.9 NaCl to prevent development of crystals or precipitate.
0.1 administered sandwich method
0.2 avoid taking alcohol because it can lead to severe CNS depression
0.3 avoid caffeine
Nursing Management
0
provide oral care
1
massage gums
1 Acetaminophen Toxicity
Signs and Symptoms
0
hepatotoxicity (monitor for liver enzymes)
1
hypoglycemia
Tremors, tachycardia
Irritability
Restlessness
Extreme fatigue
Diaphoresis, depression
Antidote: Acetylcisteine (mucomyst) prepare suction apparatus at bedside.
MYASTHENIA GRAVIS
0
diplipia
dysphagia
hoarseness of voice[dysphonia-voice
respiratory muscle weakness that may lead to respiratory arrest (tracheostomy at bed side)
impairment]
Diagnostic Procedure
0 Tensilon test (Edrophonium Hydrochloride) provides temporary relief of signs and symptoms for about 5
10 minutes and a maximum of 15 minutes.
1 if there is no effect there is damage to occipital lobe and midbrain and is negative for M.G.
Nursing Management
1. Airway
2. Aspiration
3. Immobility
0 assist in mechanical ventilation and monitor pulmonary function test
1 monitor strictly vital signs, input and output and neuro check
2 monitor strength or motor grading scale
0 Maintain side rails to prevent injury related to falls
1 Institute NGT feeding
2 Administer medications as ordered
0 Cholinergic (Mestinon) pyridostigmine bromide
1 Anti Cholenisterase (Prostigmin) neostigmine bromide
Mechanism of Action
0
increase level of Ach
Side Effects
1
PNS
2
MYASTHENIC CRISIS
Causes:
under medication
stress (disease exacerbation, high temp.)
infection
Signs and Symptoms
The client is unable to see, swallow, speak,
breathe
Treatment
administer cholinergic agents as ordered
CHOLINERGIC CRISIS
Cause:
over medication
Signs and Symptoms
PNS
Tensilon test doesnt improve MG
Treatment
Administer anti cholinergic agents (Atropine
Sulfate)
0 Assist in surgical procedure known as thymectomy because it is believed that the thymus gland is responsible for M.G.
1 Assist in plasma paresis and removing auto immune anti bodies
2 Prevent complications
Subarachnoid space between the arachnoid and pia, CSF aspiration is done.
A. Etiology
0 Meningococcus most dangerous
1 Pneumococcus
2 Streptococcus - causes adult meningitis
3 Hemophilus Influenzae causes pediatric meningitis
0 Mode of transmission
0 airborne transmission (droplet nuclei)
photophobia
projectile vomiting
fever & chills, anorexia, generalized body malaise and weight loss
Lumbar puncture: a hollow spinal needle is inserted in the subarachnoid space between the L3 L4 to
L5.
notes on hematology:
E. Nursing Management
INCREASED
DECREASED
RBC
Polycythemia
Anemia
WBC
Leukocytosis
Leukopenia
PLATELETS
Thrombocytosis
Thrombocytopenia
Institute strict respiratory isolation 24 hours after initiation of anti biotic therapy
embolus (detached and most dangerous because it can go to the lungs and cause pulmonary
embolism or the brain and cause cerebral embolism.
Unexplained dyspnea
Tachycardia
Palpitations
Diaphoresis
Mild restlessness
1
femur fracture.
produces
2
fat cells.
Yellow bone marrow are produced from the medullary cavity of the long bones and
in
3
the circulation.
If there is bone fracture there is hemorrhage and there would be escape of the fat cells
C. Risk Factors
5888 Hypertension, Diabetes Mellitus, Myocardial Infarction, Atherosclerosis, Valvular Heart Disease, Post Cardiac
Surgery (mitral valve replacement)
5889
5890
5891
5892
Type A personality
5888
deadline driven
5889
5890
5893
5894
5895 Prolong use of oral contraceptives promotes lypolysis (breakdown of lipids) leading to atherosclerosis that will
lead to hypertension and eventually CVA.
D. Signs and Symptoms
dependent on stages of development
1. TIA
Initial sign of stroke or warning sign
Signs and Symptoms
headache and dizziness
tinnitus
visual and speech disturbances
paresis to plegia
possible increase ICP
Stroke in evolution
-progression of signs and symptoms of stroke
3. Complete stroke
resolution phase characterized by:
Signs and Symptoms
headache and dizziness
Cheyne Stokes Respiration
anorexia, nausea and vomiting
dysphagia
Notes:
Plegia paralysis
Ex: Hemiplegia paralysis of one
side of the body.
Paresis weakness
Ex: Hemiparesis - weakness of one
side of the body.
F. Nursing Management
Maintain patent airway and adequate ventilation by:
assist in mechanical ventilation
administrate O2 inhalation
Restrict fluids to prevent cerebral edema that might increase ICP
Elevate head 30 45o
Monitor strictly vitals signs, I & O and neuro check
Prevent complications of immobility by:
turn client to side
provide egg crate mattresses or water bed
provide sand bag or foot board.
Assist in passive ROM exercise every 4 hours to promote proper bodily alignment and prevent contractures
Institute NGT feeding
Provide alternative means of communication
non verbal cues
magic slate
If positive to hemianopsia approach client on unaffected side
Administer medications as ordered
Osmotic Diuretics (Mannitol)
Loop Diuretics (Lasix, Furosemide)
Cortecosteroids
Mild Analgesics
Thrombolytic/Fibrinolytic Agents dissolves thrombus
Streptokinase
Side Effect: Allergic Reaction
Urokinase
Tissue Plasminogen Activating Factor
Side Effect: Chest Pain
Anti Coagulants
Heparin (short acting)
check for partial thromboplastin time if prolonged there is a risk for bleeding.
give Protamine Sulfate
Anti Platelet
PASA (Aspirin)
Contraindicated for dengue, ulcer and unknown cause of headache because it may potentiate
bleeding
A. Predisposing Factors
Head injury due to birth trauma
Genetics
Presence of brain tumor
Toxicity from
a. lead
b carbon monoxide
Nutritional and Metabolic deficiencies
Physical and emotional stress
Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam,
Valium)
B. Signs and Symptoms
Dependent on stages of development or types of seizure
I. Generalized Seizure
Grand mal Seizure (tonic-clonic seizure)
Signs or aura with auditory, olfactory, visual, tactile, sensory experience
Epileptic cry is characterized by fall and loss of consciousness for 3 5 minutes
Tonic contractions - direct symmetrical extension of extremities
Clonic contractions - contraction of extremities
Post ictal sleep unresponsive sleep
Petit mal Seizure absence of seizure common among pediatric clients characterized by
blank stare
decrease blinking of eyes
twitching of mouth
loss of consciousness (5 10 seconds)
II. Partial or Localized Seizure
Jacksonian Seizure (focal seizure)
Characterized by tingling and jerky movement of index finger and thumb that spreads to the shoulder and other side of
the body.
Psychomotor Seizure (focal motor seizure)
automatism stereotype repetitive and non propulsive behavior
clouding of consciousness not in contact with environment
mild hallucinatory sensory experience
III. Status Epilepticus
A continuous uninterrupted seizure activity, if left untreated can lead to hyperpyrexia and lead to coma and
eventually death.
Drug of choice: Diazepam, Valium and Glucose
Diagnostic Procedures
CT Scan reveals brain lesions
EEG reveals hyper activity of electrical brain waves
D. Nursing Management
Maintain patent airway and promote safety before seizure activity
clear the site of blunt or sharp objects
loosen clothing of client
maintain side rails
avoid use of restrains
turn clients head to side to prevent aspiration
place mouth piece of tongue guard to prevent biting or tongue
Conscious
15 14
2. Verbal response
Lethargy
13 11
3. Eye opening
Stupor
10 8
Coma
Deep Coma
7
3
LEVEL OF CONSCIOUSNESS
Conscious - awake
Lethargy lethargic (drowsy, sleepy, obtunded)
Stupor
stuporous (awakened by vigorous stimulation)
4. Coma
comatose
light coma (positive to all forms of painful stimulus)
deep coma (negative to all forms of painful stimulus)
CRANIAL NERVES
FUNCTION
I. OLFACTORY
II. OPTIC
III OCCULOMOTOR
IV. TROCHLEAR
CRANIAL NERVES
(Smallest)
CRANIAL NERVE I: OLFACTORY
B
(Largest)
VII. FACIAL
VIII. ACOUSTIC
IX. GLOSSOPHARYNGEAL
Material Used
V. TRIGEMINAL
Procedure
X. VAGUS
B
(Longest)
XII. HYPOGLOSSAL
Superiorly
Bitemporaly
Nasally
Inferiorly
COMMON VISUAL DISORDERS
1. Glaucoma
increase IOP
normal IOP is 12 21 mmHg
preventable but not curable
Predisposing Factors
Common among 40 years old and above
Hereditary
Hypertension
Obesity
C. Diagnostic Procedures
Tonometry
Perimetry
Gonioscopy
D. Treatment
Miotics constricts pupil
Pilocarpine Sodium, Carbachol
Epinephrine eyedrops decrease formation of aqueous humor
Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox) promotes increase outflow of aqueous humor or drainage
2. CATARACT
Decrease opacity of lens
Predisposing Factor
Aging 65 years and above
Related to congenital
Diabetes Mellitus
Prolonged exposure to UV rays
Signs and Symptoms
1. Loss of central vision
Pathognomonic Signs 1.
Blurring or hazy vision
Complication is blindness
D. Diagnostic Procedure
1. Opthalmoscopic exam
E. Treatment
Mydriatics (Mydriacyl) dilating pupils
Cyclopegics (Cyclogyl) paralyses cilliary muscle
F. Surgical Procedure
Extra
Intra
Capsular
Capsular
Cataract
Cataract
Lens
Lens
Extraction
Extraction
- Partial removal
- Total removal of cataract with its surrounding capsules
Most feared complication post op is RETINAL DETACHMENT
3. Retinal Detachment
Separation of epithelial surface of retina
Predisposing Factors
Post Lens Extraction
Myopia (near sightedness)
B. Signs and Symptoms
Curtain veil like vision
Floaters
C. Surgical Procedures
Scleral Buckling
Cryosurgery cold application
Diathermy heat application
4. Macular Degeneration
Degeneration of the macula lutea (yellowish spot at the center of retina)
Signs and Symptoms
1. Black Spots
CRANIAL NERVE III, IV, VI: OCULOMOTOR, TROCHLEAR, ABDUCENS
6 muscles
Superior Rectus
Superior Oblique
Lateral Rectus
Medial Rectus
Inferior Oblique
Inferior Rectus
A. normal retina
B. wet macular
degeneration
c. dry macular
degeneration
Oculomotor
controls the size and response of pupil
normal pupil size is 2 3 mm
equal size of pupil: Isocoria
Unequal size of pupil: Anisocoria
Normal response: positive PERRLA
Instruct client to smile, frown and if results are negative there is facial paralysis or Bells palsy and the primary
cause is forceps delivery.
CRANIAL NERVE VIII: ACOUSTIC/VESTIBULOCOCHLEAR
Controls balance particularly kinesthesia or position sense, refers to movement and orientation of the
body in space.
Parts of the Ear
Outer Ear
Pinna
Eardrum
Middle Ear
Hammer
Anvil
Malleus
Incus
Stirrup
Stapes
Inner Ear
Vestibule: Meineres Disease
Cochlea
Mastoid Cells
Endolymph and Perilymph
COCHLEA: controls hearing, contains the Organ of Corti (the true organ of hearing)
Let client repeat words uttered
ENDOCRINE SYSTEM
Overview of the structures and functions
1. Pituitary Gland (Hypophysis Cerebri)
o
o
2. Antidiuretic Hormone
o
Pitressin (Vasopressin)
ADH
OXYTOCIN
Posterior pituitary
GH
ACTH
TSH
FSH & LH
o
o
Trauma
Inflammation
Presence of tumor
Signs and Symptoms
Polyuria
Signs of dehydration
Adult: thirst
Agitation
Poor Skin turgor
Dry mucous membrane
Weakness and fatigue
Hypotension
Weight loss (payat)
If left untreated results to hypovolemic shock (sign is anuria)
C. Diagnostic Procedures
1. Urine Specific Gravity
o
Ph 4 8
Serum Sodium
Increase resulting to hypernatremia
D. Nursing Management
Force fluids
Monitor strictly vital signs and intake and output
Administer medications as ordered
a. Pitressin (Vasopresin Tannate) administered IM Z-tract
Prevent complilcations HYPOVOLEMIC SHOCK is the most feared complication
PROLACTIN
MSH
Predisposing Factors
1. Head injury
2. Related to presence of bronchogenic cancer
o initial sign of lung cancer is non productive cough
o non invasive procedure is chest x-ray
3. Related to hyperplasia (increase size of organ brought about by increase of number of cells) of pituitary gland.
5. Leutinizing hormone
secretes estrogen
Follicle stimulating hormone
secretes progesterone
PINEAL GLAND
o secretes melatonin
o inhibits LH secretion
o
THYROID GLAND
located anterior to the neck
Hormones secreted
T3 (Tri iodothyronine) - 3 molecules of iodine (more potent)
T4 (tetra iodothyronine, Thyroxine)
T3 and T4 are metabolic or calorigenic hormone
promotes cerebration (thinking)
Thyrocalcitonin antagonizes the effects of parathormone to promote calcium resorption.
HYPOTHYROIDISM thyroid deficiency
o all are decrease except weight and
menstruation o memory impairment
Signs and Symptoms
o
menorrhagia or amenorrhea
cold intolerance
constipation
extreme fatigue
hypothermic
HYPERTHYROIDISM
o
Pharmacologic therapy
Myxedema coma
amenorrhea
for hypothyroidism
exophthalmos
Tachycardia, palpitations
insomnia
Synthetic levothyroxine
(syndroid or levothroid)
Severe hypothyroidism
- Increased
lethargic
- Hypothermic
- Stupor
- coma
restlessness agitation
Heat intolerance
HPN
THYROID DISORDERS
SIMPLE GOITER
enlargement of thyroid gland due to iodine deficiency
Predisposing Factors
Goiter belt area
places far from sea
Mountainous regions
Increase intake of goitrogenic foods
o
cabbage, turnips, radish, strawberry, carrots, sweet potato, broccoli, all nuts
goitrogenic drugs
Anti Thyroid Agent Prophylthiuracil (PTU)
b. Lithium Carbonate
c. PASA (Aspirin)
d. Cobalt
e. Phenylbutazones (NSAIDs) - if goiter is caused by
D. Nursing Management
Enforce complete bed rest
Administer medications as ordered
a. Lugols Solution/SSKI ( Saturated Solution of Potassium Iodine)
o
color purple or violet and administered via straw to prevent staining of teeth.
4 Medications to be taken via straw: Lugols, Iron, Tetracycline, Nitrofurantoin (drug of choice for
pyelonephritis)
b. Thyroid Hormones
Levothyroxine (Synthroid)
o Liothyronine (Cytomel)
o Thyroid Extracts
Nursing Management when giving Thyroid Hormones
Instruct client to take in the morning to prevent insomnia
Monitor vital signs especially heart rate because drug causes tachycardia and palpitations
Monitor side effects
o
insomnia
hypertension
heat intolerance
Increase dietary intake of foods rich in iodine
seaweeds
seafoods like oyster, crabs, clams and lobster but not shrimps because it contains lesser amount of iodine.
iodized salt, best taken raw because it it is easily destroyed by heat
Assist in surgical procedure of subtotal thyroidectomy
HYPOTHYROIDISM
o
children: CRETINISM the only endocrine disorder that can lead to mental retardation
Predisposing Factors
Iatrogenic Cause disease caused by medical intervention such as surgery
Related to atrophy of thyroid gland due to trauma, presence of tumor, inflammation
Iodine deficiency
lethargy
psychosis
menorrhagia
Diagnostic Procedures
Serum T3 and T4 is decreased
Serum Cholesterol is increased
RAIU (Radio Active Iodine Uptake) is decreased
Nursing Management
Monitor strictly vital signs and intake and output to determine presence of
Myxedema coma is a complication of hypothyroidism and an emergency case a severe form of
hypothyroidism is characterized by severe hypotension, bradycardia, bradypnea, hypoventilation,
hyponatremia, hypoglycemia, hypothermia leading to pregressive stupor and coma.
Nursing Management for Myxedema Coma
Assist in mechanical ventilation
Administer thyroid hormones as ordered
Force fluids
Force fluids
Administer isotonic fluid solution as ordered
Administer medications as ordered
Thyroid Hormones
Levothyroxine
Leothyronine
Thyroid Extracts
Provide dietary intake that is low in calories due to wt. gain
Provide comfortable and warm environment due to cold intolerance
Provide meticulous skin care
Provide client health teaching and discharge planning concerning a.
Avoid precipitating factors leading to myxedema coma
stress
infection
cold intolerance
HYPERTHYROIDISM graves disease or thyroid toxicosis (everything is up except wt. and mens.
o
increase in T3 and T4
POST OPERATIVELY,
1. Watch out for signs of thyroid storm/ thyrotoxicosis
Agitation
TRIAD SIGNS
Hyperthermia
Tachycardia
offer TSB
Watch out for accidental removal of parathyroid gland (secretes parathormone) that may lead to
Hypocalcemia (tetany)
Signs and Symptoms
o (+) trousseaus sign
o (+) chvostek sign
o
Watch out for arrhythmia, seizure give Calcium Gluconate IV slowly as ordered
Ca gluconate toxicity antidote MgSO4
3. Watch out for accidental Laryngeal (voice box) damage which may lead to hoarseness of voice
Nursing Management
o
Hypoparathyroidism
Hyperparathyroidism
HYPOPARATHYROIDISM
o Decrease secretion of parathormone leading to hypocalcemia (tetany)
o Resulting to Hyperphosphatemia
[If Ca decreases, phosphate increases]
A. Predisposing Factors
Following subtotal thyroidectomy
Atrophy of parathyroid gland due to:
a. inflammation
tumor
trauma
B. Signs and Symptoms
1. Acute tetany
tingling sensation
paresthesia
numbness
dysphagia
positive trousseaus sign/carpopedal spasm
positive chvostek sign
laryngospasms / broncospasm
seizurefeared complications
arrhythmia
Chronic tetany
photophobia and cataract formation
loss of tooth enamel
anorexia, nausea and vomiting
agitation and memory impairment (irritable)
C. Diagnostic Procedures
Serum Calcium is decreased (normal value: 8.5 10.5 mg/100 ml)
Serum Phosphate is increased (normal value: 2.5 4.5 mg/100 ml)
X-ray of long bones reveals a decrease in bone density
CT Scan reveals degeneration of basal ganglia
D. Nursing Management
Administer medications as ordered such as:
Acute Tetany
Calcium Gluconate IV slowly
Chronic Tetany
Oral Calcium supplements
Calcium Gluconate
Calcium Lactate
Calcium Carbonate
DRUG
DIET
Cholecalceferol
SUNLIGHT
calcidiol
calcitriol
7am 9am
d. Phosphate binder
Aluminum Hydroxide Gel (Ampogel)
Side effect: constipation
ANTACID
A.A.C
Aluminum Containing
Antacids
Aluminum
Hydroxide
Gel
Less s/e)
MAD
Magnesium Containing
Antacids
Decrease parathormone
o Hypercalcemia: bone demineralization leading to bone fracture (calcium is stored 99% in bone and 1% blood)
o Kidney stones
(parathormone pullout the Ca in from the bone to the blood)
A. Predisposing Factors
Hyperplasia of parathyroid gland
over compensation of parathyroid gland due to vitamin D deficiency
Children: Rickets - the bone do not hardened
Adults: Osteomalacia - softening of the bone
B. Signs and Symptoms
Bone pain especially at back (bone fracture)
Kidney stones
renal cholic
cool moist skin
Anorexia, nausea and vomiting
Agitation and memory impairment
C. Diagnostic Procedures
Serum Calcium is increased
Serum Phosphate is decreased
X-ray of long bones reveals bone demineralization
D. Nursing Management
Force fluids to prevent kidney stones
Strain all the urine using gauze pad for stone analysis
Provide warm sitz bath
Administer medications as ordered a.
Morphine Sulfate (Demerol)
Encourage increase intake of foods rich in phosphate but decrease in calcium
Provide acid ash in the diet to acidify urine and prevent bacterial growth
Assist/supervise in ambulation
Maintain side rails
Prevent complications (seizure and arrhythmia) most feared renal failure
Assist in surgical procedure known as parathyroidectomy
Hormonal replacement therapy for lifetime
Importance of follow up care
ADRENAL GLAND
o Located atop of each kidney
o 2 layers of adrenal gland
function:
controls
glucose
metabolism
Sugar
2. Zona
Reticularis
secretes
traces
of
glucocortico
ids
and
androgenic
hormones
function:
promotes
secondary
sex
characteristi
cs
Sex
3. Zona
Glumerulos
a
secretes
mineralocor
ticoids
(aldosteron
e)
function:
promotes
sodium and
water
reabsorptio
n
and
excretion of
potassium
Salt
I love
Sex!!!
ADDISONS DISEASE - payat
o
ex
ugar
alt
A. Predisposing Factors
Related to atrophy of adrenal glands
Fungal infections
B. Signs and Symptoms
Hypoglycemia TIRED
Decrease tolerance to stress
Hyponatremia
hypotension
signs of dehydration
weight loss
Hyperkalemia
agitation
diarrhea
arrhythmia
Decrease libido
Loss of pubic and axillary hair
Bronze like skin pigmentation
Addisonian crisis:
Cyanosis
Classic sign of circulatory shock:
pallor, apprehension, rapid weak
pulse, rapid RR, low BP
Hydrocortisone (Solu-Cortef)
admin. IV, followed w/ 5% D5NS.
C. Diagnostic Procedures
FBS is decreased (normal value: 80 100 mg/dl)
Plasma Cortisol is decreased
Serum Sodium is decrease (normal value: 135 145 meq/L)
Serum Potassium is increased (normal value: 3.5 4.5 meq/L)
D. Nursing Management
1. Monitor strictly vital signs, input and output to determine presence of Addisonian crisis (complication of addisons
disease)
Addisonian crisis results from acute exacerbation of addisons disease characterized by
severe hypotension
hypovolemic shock
hyponatremia leading to progressive stupor and coma
Nursing Management for Addisonian Crisis
1. Assist in mechanical ventilation,
administer steroids as ordered
force fluids
Administer isotonic fluid solution as ordered
Force fluids
Administer medications as ordered
Corticosteroids
Dexamethasone (Decadrone)
Prednisone
Hydrocortisone (Cortison)
Nursing Management when giving steroids
Instruct client to take 2/3 dose in the morning and 1/3 dose in the afternoon to mimic the normal diurnal rhythm
A. Predisposing Factors
1 Related to hyperplasia of adrenal gland
Increase susceptibility to infections
Hypernatremia
hypertension
edema
weight gain
moon face appearance and buffalo hump
obese trunk
pendulous abdomen
thin extremities
Hypokalemia
weakness and fatigue
constipation
U wave upon ECG (T wave hyperkalemia)
Hirsutism
Acne and striae
Easy bruising
Increase masculinity among females
B. Diagnostic Procedures
FBS is increased
Plasma Cortisol is increased
Cushings syndrome.
Client prior to syndrome.
Client 4 months after diagnosis of syndrome.
Consist of acinar cells which secretes pancreatic juices that aids in digestion thus it is an exocrine gland
Type 1 (IDDM)
- Juvenile onset type
- Brittle disease
Type 2 (NIDDM)
- Adult onset
- Maturity onset type
- Obese over 40 years old
A. Incidence Rate
A. Incidence Rate
B. Predisposing Factors
B. Predisposing Factors
2. Related to viruses
3. Drugs
a. Lasix
b. Steroids
1. Usually asymptomatic
2. Polyuria
3. Polydypsia
4. Polyphagia
1. Polyuria
5. Glucosuria
2. Polydypsia
6. Weight gain
Polyphagia
Glycosuria
Weight loss
6. Anorexia, nausea and vomiting
7. Blurring of vision
D. Treatment
1. Oral Hypoglycemic agents
2. Diet
3. Exercise
D. Treatment
1. Insulin therapy
E. Complications
2. Diet
1. Hyper
3. Exercise
2. Osmolar
3. Non
E. Complication
4. Ketotic
1. Diabetic Ketoacidosis
5. Coma
ANABOLISM
CATABOLISM
1. Carbohydrates
Glucose
Glycogen
2. Protein
Amino Acids
Nitrogen
3. Fats
Fatty Acids
HYPERGLYCEMIA
Increase osmotic diuresis
Glycosuria
Cellular starvation weight loss
Stimulates the appetite/satiety center
Polyuria
Cellular dehydration
Stimulates the thirst center
(Hypothalamus)
(Hypothalamus)
Polyphagia
Polydypsia
Ketones
Atherosclerosis
Hypertension
Kussmauls Respiration
odor
MI
CVA
Death
Diabetic Coma
DIABETIC KETOACIDOSIS
- Acute complication of type 1 DM due to severe hyperglycemia leading to severe CNS depression
A. Predisposing Factors
Hyperglycemia
Stress number one precipitating factor
Infection
B. Signs and Symptoms
Polyuria
Polydypsia
Polyphagia
Glucosuria
Weight loss
Anorexia, nausea and vomiting
Blurring of vision
Acetone breath odor
Kussmauls Respiration (rapid shallow breathing)
CNS depression leading to coma
Diagnostic Procedures
1. FBS is increased
2. BUN (normal value: 10 20)
3. Creatinine (normal value: .8 1)
4. Hct (normal value: female 36 42, male 42 48) due to severe dehydration
Nursing Management
Assist in mechanical ventilation
Administer 0.9 NaCl followed by .45 NaCl (hypotonic solutions) to counteract dehydration and shock
Monitor strictly vital signs, intake and output and blood sugar levels
Administer medications as ordered
Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 4 hours)
Sodium Bicarbonate to counteract acidosis
Antibiotics to prevent infection
HYPER OSMOLAR NON KETOTIC COMA
Hyperosmolar: increase osmolarity (severe dehydration)
Non ketotic: absence of lypolysis (no ketones)
A. Signs and Symptoms
Headache and dizziness
Restlessness
Seizure activity
Decrease LOC diabetic coma
B. Nursing Management
Assist in mechanical ventilation
Administer 0.9 NaCl followed by .45 NaCl
(hypotonic solutions) to counteract dehydration and shock
Monitor strictly vital signs, intake and output and blood sugar levels
Administer medications as ordered
Insulin therapy (regular acting insulin peak action of 2 4 hours)
for DKA use rapid acting insulin
Antibiotics to prevent infection
Sources of Insulin 1.
Rapid
Intermediate
Clear
Cloudy
Pea
k
2-4
6-12
Animal sources
Long acting
Cloudy
12-24
INSULIN THERAPY A.
EYES
-PREMATURE CATARACT
- Blindness
KIDNEY
-RECURRENT PYELONEPHRITIS
- Renal failure
PANCREATITIS - acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to
Autodigestion self-digestion
Cause: unknown/idiopathic
alcoholism
Pathognomonic sign- (+) Cullens sign - Ecchymosis of umbilicus (bluish color)- pasa
(+) Grey turners sign ecchymosis of flank area
HEMATOLOGICAL SYSTEM
I. Blood
55% Plasma
45% Formed
Serum
2. Veins
3. Spleen
4. Lymphoid Organ
5. Lymph Nodes
6. Bone Marrow
Plasma CHON
(formed in liver)
Albumin
Globulins
Prothrombin and Fibrinogen
ALBUMIN
Largest and numerous plasma CHON
Maintains osmotic pressure preventing edema
GLOBULINS
Alpha globulins - transport steroids, bilirubin and hormones
Beta globulins iron and copper
Gamma globulins
anti-bodies and immunoglobulins
prothrombin and fibrinogen clotting factors
FORMED ELEMENTS
1. RBC (ERYTHROCYTES)
normal value: 4 6 million/mm3
only unnucleated cell
biconcave discs
consist of molecules of hgb (red pigment) bilirubin (yellow pigment) biliverdin (green pigment) hemosiderin (golden
brown pigment)
transports and carries oxygen to tissues
hemoglobin: normal value female 12 14 gms% male 14 16 gms%
hematocrit red cell percentage in wholeblood
normal value: female 36 42% male 42 48%
substances needed for maturation of RBC
folic acid
iron
vitamin c
vitamin b12 (cyanocobalamin)
vitamin b6 (pyridoxine)
intrinsic factor
Normal life span of RBC is 80 120 days and is killed in red pulp of spleen
2. WBC (LEUKOCYTES)
normal value: 5000 10000/mm3
A. Granulocytes
1. Polymorpho Neutrophils
60 70% of WBC
involved in short term phagocytosis for acute inflammation
2. Polymorphonuclear Basophils
for parasite infections
responsible for the release of chemical mediation for inflammation
3. Polymorphonuclear Eosinophils
for allergic reaction
B. Non Granulocytes
1. Monocytes
macrophage in blood
largest WBC
involved in long term phagocytosis for chronic inflammation
2. Lymphocytes
B-cell
T-cell
- bone marrow
- thymus
for immunity
HIV
6 months 5 years incubation period
6 months window period
western blot opportunistic
ELISA
drug of choice AZT (Zidon Retrovir)
2 Common fungal opportunistic infection in AIDS
Kaposis Sarcoma
Pneumocystis Carinii Pneumonia
Platelets (THROMBOCYTES)
Normal value: 150,000 450,000/mm3
Promotes hemostasis (prevention of blood loss)
Consist of immature or baby platelets or megakaryocytes which is the target of dengue virus
Normal life span of platelet is 9 12 days
Signs of Platelet Dysfunction
Petechiae
Echhymosis
Oozing of blood from venipunctured site
BLOOD DISORDERS
Iron Deficiency Anemia
- A chronic microcytic anemia resulting from inadequate absorption of iron leading to hypoxemic tissue injury
A. Incidence Rate
Common among developed countries
Common among tropical zones
Common among women 15 35 years old
Related to poor nutrition
B. Predisposing Factors
Chronic blood loss due to trauma
Heavy menstruation
Related to GIT bleeding resulting to hematemesis and melena (sign for upper GIT bleeding)
fresh blood per rectum is called hematochezia
Inadequate intake of iron due to
Chronic diarrhea
Related to malabsorption syndrome
High cereal intake with low animal protein digestion
Subtotal gastrectomy
4. Related to improper cooking of foods
C. Signs and Symptoms
Usually asymptomatic
Weakness and fatigue (initial signs)
- Dysphagia
9. PICA (abnormal appetite or craving for non edible foods
Diagnostic Procedures
1. RBC is decreased
2. Hgb is decreased
3. Hct is deceased
4. Iron is decreased
5. Reticulocyte is decreased
6. Ferritin is decreased
Nursing Management
Monitor for signs of bleeding of all hema test including urine, stool and GIT
Enforce CBR so as not to over tire client
Instruct client to take foods rich in iron
Organ meat
Egg (yolk)
Raisin
Sweet potatoes
Dried fruits
Legumes
Nuts
Instruct the client to avoid taking tea and coffee because it contains tannates which impairs iron absorption
Administer medications as ordered
Oral Iron Preparations
Ferrous Sulfate
Ferrous Fumarate
Ferrous Gluconate 300 mg/day
PERNICIOUS ANEMIA
- Chronic anemia characterized by a deficiency of intrinsic factor leading to hypochlorhydria (decrease hydrochloric
acid secretion)
A. Predisposing Factors
Subtotal gastrectomy
Hereditary factors
Inflammatory disorders of the ileum
Autoimmune
Strictly vegetarian diet
STOMACH
Aids in digestion
APLASTIC ANEMIA
- Stem cell disorder leading to bone marrow depression leading to pancytopenia
PANCYTOPENIA
Decrease RBC
Decrease WBC
Decrease Platelet
(anemia)
A. Predisposing Factors
(leucopenia)
(thrombocytopenia)
3. Immunologic injury
4. Drugs
BLOOD TRANSFUSION
Goals/Objectives
Replace circulating blood volume
Increase the oxygen carrying capacity of blood
Prevent infection in there is a decrease in WBC
Prevent bleeding if there is platelet deficiency
Principles of blood transfusion
Proper refrigeration
Expiration of packed RBC is 3 6 days
Expiration of platelet is 3 5 days
Proper typing and cross matching
Type O universal donor
Type AB universal recipient
85% of population is RH positive
Aseptically assemble all materials needed for BT
Filter set
Gauge 18 19 needle
Isotonic solution (0.9 NaCl/plain NSS) to prevent hemolysis
Instruct another RN to re check the following
Client name
Blood typing and cross matching
Expiration date
Serial number
Check the blood unit for bubbles cloudiness, sediments and darkness in color because it indicates bacterial
contamination
- Never warm blood as it may destroy vital factors in blood.
- Warming is only done during emergency situation and if you have the warming device
- Emergency rapid BT is given after 30 minutes and let natural room temperature warm the blood.
BT should be completed less than 4 hours because blood that is exposed at room temperature more
than 2 hours causes blood deterioration that can lead to BACTERIAL CONTAMINATION
Avoid mixing or administering drugs at BT line to prevent HEMOLYSIS
Regulate BT 10 15 gtts/min or KVO rate or equivalent to 100 cc/hr to prevent circulatory overload
Monitor strictly vital signs before, during and after BT especially every 15 minutes for first hour
because majority of transfusion reaction occurs during this period
Hemolytic reaction
Allergic reaction
Pyrogenic reaction
Circulatory overload
Air embolism
Thrombocytopenia
Cytrate intoxication
Hyperkalemia (caused by expired blood)
Signs and Symptoms of Hemolytic reaction
Headache and dizziness
Dyspnea
Diarrhea/Constipation
Hypotension
Flushed skin
Lumbar/sternal/ Flank pain
Urine is color red/ portwine urine
Nursing Management
Stop BT
Notify physician
Flush with plain NSS
Administer isotonic fluid solution to prevent shock and acute tubular necrosis
Send the blood unit to blood bank for re examination
Obtain urine and blood sample and send to laboratory for re examination
Monitor vital signs and intake and output
SIGNS AND SYMPTOMS OF ALLERGIC REACTION
Fever
Dyspnea
Broncial wheezing
Skin rashes
Urticaria
Laryngospasm and Broncospasm
Nursing Management
Stop BT
Notify physician
Flush with plain NSS
Administer medications as ordered
a. Anti Histamine (Benadryl) - if positive to hypotension, anaphylactic shock treat with Epinephrine
Send the blood unit to blood bank for re examination
Obtain urine and blood sample and send to laboratory for re examination
Monitor vital signs and intake and output
SIGNS AND SYMPTOMS PYROGENIC REACTIONS (FEVER)
Fever and chills
Headache
Tachycardia
Palpitations
Diaphoresis
Dyspnea
Nursing Management
Stop BT
Notify physician
Flush with plain NSS
Administer medications as ordered
Antipyretic
Antibiotic
Send the blood unit to blood bank for re examination
Obtain urine and blood sample and send to laboratory for re examination
Monitor vital signs and intake and output
Render TSB
SIGNS AND SYMPTOMS OF CIRCULATORY REACTION
Orthopnea
Dyspnea
Rales/Crackles upon auscultation
Exertional discomfort
Nursing Management
Stop BT
Notify physician
Administer medications as ordered
a. Loop diuretic (Lasix
CARDIOVASCULAR SYSTEM
OVERVIEW OF THE STRUCTURE AND FUNCTIONS OF THE HEART
HEART
Muscular pumping organ of the body.
Located on the left mediastinum
Resemble like a close fist
Weighs approximately 300 400 grams
Covered by a serous membrane called the pericardium
2 layers of pericardium
Parietal outer layer
Visceral inner layer
In between is the pericardial space filled w/ fluid
which is 10 30 cc lubricates the surface to
reduces friction during systole.
Common among MI, pericarditis, Cardiac tamponade
A. Layers of Heart
Epicardium outer layer
Myocardium middle layer
Endocardium inner layer
- Myocarditis can lead to cardiogenic shock and rheumatic heart disease
B. Chambers of the Heart
Upper Chamber (connecting or receiving)
Atria
Lower Chamber (contracting or pumping)
Ventricles
Left ventricle has increased pressure which is 120 180 mmHg
In order to propel blood to the systemic circulation
Right atrium has decreased pressure which is 60 80 mmHg
C. Valves
- To promote unidimensional flow or prevent backflow
Atrioventricular Valves guards opening between
tricuspid valve
mitral valve
- Closure of AV valves give rise to first heart sound (S 1 lub)
Semi lunar Valves
pulmonic
aortic
- Closure of SV valve give rise to second heart sound (S 2 dub)
Extra Heart Sounds
S3 ventricular gallop usually seen in Left Congestive Heart Failure sound occurring during rapid ventricular filling
S4 atrial gallop usually seen in Myocardial Infarction and Hypertension sound head during atrial contraction (often
heard when the ventricle is enlarged or hypertrophied
D. Coronary Arteries
- Arises from base of the aorta
Types of Coronary Arteries
Right Main Coronary Artery
Left Main Coronary Arterying
Supplies the myocardium
Cardiac Conduction System
1. Sino Atrial Node (SA or Keith Flack Node)
Located at the junction of superior vena cava and right atrium
Acts as primary pacemaker of the heart
Initiates electrical impulse of 60 100 bpm
Atrio Ventricular Node (AV or Tawara Node)
- Located at the inter atrial septum
- Delay of electrical impulse for about .08 milliseconds to allow ventricular filling
Bundle of His
Right Main Bundle of His
Left Main Bundle of His
Located at the interventricular septum
4. Purkinje Fibers terminal point in the conduction system
(point which the myocardial cells are stimulated causing ventricular contraction)
Located at the walls of the ventricles for ventricular contraction
P WAVE (atrial depolarization) contraction
QRS WAVE (ventricular depolarization)
T WAVE (ventricular repolarization)
Insert pacemaker if there is complete heart block
Most common pacemaker is the metal pacemaker and lasts up to 2 5 years
Cardiac electrical activity is the result of the movement of ions (charged particles such as SODIUM, POTASSIUM,
AND CALCIUM) across the cell membrane.
- Hypokalemia
Hyperkalemia
3. ST segment depression
Angina Pectoris
4. ST segment elevation
Myocardial Infarction
5. T wave inversion
Myocardial Infarction
Arrhythmias
CARDIAC DISORDERS
Coronary Arterial Disease/ Ischemic Heart Disease
Stages of Development of Coronary Artery Disease
Myocardial Injury - Atherosclerosis
Myocardial Ischemia Angina Pectoris
Myocardial Necrosis Myocardial Infarction
ATHEROSCLEROSIS
ATHEROSCLEROSIS
ARTERIOSCLEROSIS
- narrowing of artery
- lipid or fat deposits (plaques)
- tunica intima
- tunica media
A. Predisposing Factors
Sex male
Race black
Smoking
Obesity
Hyperlipidemia
Sedentary lifestyle
Diabetes Mellitus
Hypothyroidism
Diet increased saturated fats
Type A personality
C. Treatment
Percutaneous Transluminal Coronary Angioplasty
Objectives of PTCA
Revascularize myocardium
To prevent angina
Increase survival rate
Done to single occluded vessels
If there is 2 or more occluded blood vessels CABG is done
2. Race black
- narrowing of artery
3. Smoking
4. Obesity
- tunica intima
Hyperlipidemia
Sedentary lifestyle
Diabetes Mellitus
Hypothyroidism
Diet increased saturated fats
Type A personality
Precipitating Factors
4 Es of Angina Pectoris
1. Excessive physical exertion heavy exercises
2. Exposure to cold environment
3. Extreme emotional response fear, anxiety, excitement
4. Excessive intake of foods rich in saturated fats skimmed milk
Signs and Symptoms
Levines Sign initial sign that shows the hand clutching the chest
Chest pain characterized by sharp stabbing pain located at sub sterna usually radiates from back, shoulder, arms, axilla
and jaw muscles, usually relieved by rest or taking nitroglycerine
Dyspnea
Tachycardia
Palpitations
Diaphoresis
D. Diagnostic Procedure
History taking and physical exam
ECG tracing reveals ST segment depression
Stress test treadmill test, reveal abnormal ECG
Serum cholesterol and uric acid is increased
E. Nursing Management
Enforce complete bed rest
Administer medications as ordered
a. Nitroglycerine (NTG) when given in small doses will act as venodilator, but in large doses will act as
vasodilator
Give first dose of NTG (sublingual) 3 5 minutes
Give second dose of NTG if pain persist after giving first dose with interval of 3 - 5 minutes
Give third and last dose of NTG if pain still persists at 3 5 minutes interval
Nursing Management when giving NTG
Keep the drug in a dry place, avoid moisture and exposure to sunlight as it may inactivate the drug
Monitor side effects
Orthostatic hypotension
Transient headache and dizziness
Instruct the client to rise slowly from sitting position
Assist or supervise in ambulation
When giving nitrol or transdermal patch
o
Avoid placing near microwave ovens or during defibrillation as it may lead to burns ( most important
thing to remember)
Beta-blockers
(lol)
Propanolol - side effects PNS - broncho constriction, vasodilation
Not given to COPD cases because it causes Bronchospasm
c. ACE Inhibitors
(pril)
Enalapril, captopril, april jane dolo
Calcium Antagonist
- calciblock
- Nifedipine, diltiazem
Administer oxygen inhalation
Place client on semi fowlers position
Monitor strictly vital signs, intake and output and ECG tracing
Provide decrease saturated fats sodium and caffeine
Provide client health teachings and discharge planning
Avoidance of 4 Es
Prevent complication (myocardial infarction)
Instruct client to take medication before indulging into physical exertion to achieve the maximum therapeutic
effect of drug
The importance of follow up care
MYOCARDIAL INFARCTION areas in myocardial cells in the heart are permanently destroyed.
Heart attack
Terminal stage of coronary artery disease characterized by malocclusion, necrosis and scarring.
A. Types
1. Transmural Myocardial Infarction most dangerous type characterized by occlusion of both right and left coronary
artery
2. Subendocardial Myocardial Infarction characterized by occlusion of either right or left coronary artery
B. The Most Critical Period Following Diagnosis of Myocardial Infarction
** 6 8 hours because majority of death occurs due to arrhythmia leading to PVCs
C. Predisposing Factors
Sex male
Race black
Smoking
Obesity
Hyperlipidemia
Sedentary lifestyle
Diabetes Mellitus
Hypothyroidism
Diet increased saturated fats
Type A personality
CPK MB
Creatinine phosphokinase is increased
Heart only, 12 24 hours
LDH Lactic dehydroginase is increased
SGPT Serum glutamic pyruvate transaminase is increased
SGOT Serum glutamic oxal-acetic transaminase is increased 2.
Troponin Test is increased (protein in myocardial)
3. ECG tracing reveals
ST segment elevation
T wave inversion
Widening of QRS complexes indicates that there is arrhythmia in MI
4. Serum Cholesterol and uric acid are both increased
5. CBC increased WBC
Nursing Management
Goal: Decrease myocardial oxygen demand
1. Decrease myocardial workload (rest heart)
Administer narcotic analgesic/morphine sulfate
Side Effects: respiratory depression
Antidote: Narcan/Naloxone
Contraindication
Dengue
Peptic Ulcer Disease
Unknown cause of headache
2. Myocardial Infarction
3. Ischemic heart disease
4. Hypertension
5. Aortic valve stenosis
B. Signs and Symptoms
Dyspnea
Paroxysmal nocturnal dyspnea client awakened at night due to DOB (sudden attacks of Orthopnea at night)
Orthopnea use 2 3 pillows when sleeping or place in high fowlers
Productive cough with blood tinged sputum (severe pulmonary edema)
Frothy salivation
Cyanosis
Rales/Crackles (bi-basilar lobes that do not clear w/ coughing)
Bronchial wheezing
Pulsus Alternans weak pulse followed by strong bounding pulse
PMI is displaced laterally due to cardiomegaly
There is anorexia and generalized body malaise
S3 ventricular gallop
Oliguria blood flow to the kidney decreases, causing decreased perfusion and reduce urine output. (Daytime)
Nocturia sleeping cardiac workload decreased, improving renal perfusion, which then leads to frequent urination at
Night.
C. Diagnostic Procedure
Chest x-ray reveals cardiomegaly
PAP (pulmonary arterial pressure) measures pressure in right ventricle or cardiac status PCWP
(pulmonary capillary wedge pressure) measures end systolic and dyastolic pressure
B. hypertrophic cardiomyopathy
D. Nursing Management
Goal: increase cardiac contractility thereby increasing cardiac output (3 6 L/min)
Enforce CBR
Administer medications as ordered
a. Cardiac glycosides
B. dilated cardiomyopathy
Digoxin (Lanoxin) (increases cardiac contraction but lowers the pulse rate)
Increase force of cardiac contraction
If heart rate is decreased do not give
b. Loop Diuretics
Lasix (Furosemide) peak 1-2 hrs, duration 6-8 hrs (monitor for hyperkalemia)
c. Bronchodilators aminophylline
d. Narcotic analgesics
Morphine Sulfate
e. Vasodilators
- Nitroglycerine
f. Anti Arrhythmic
Lidocaine (Xylocane)
Administer oxygen inhalation with high inflow, 3 4 L/min, delivered via nasal cannula
High fowlers position
Monitor strictly vital signs, intake and output and ECG tracing
Measure abdominal girth daily and notify physician
Provide a dietary intake of low sodium, cholesterol and caffeine
Provide meticulous skin care
Assist in bloodless phlebotomy rotating tourniquet, rotated clockwise every 15 minutes to promote decrease venous
return
Provide client health teaching and discharge planning
Prevent complications
Arrhythmia
Shock
Right ventricular hypertrophy
MI
Thrombophlebitis
Dietary modification
Strict compliance to medications
Venous Ulcer
Varicose Veins
Thrombophlebitis (deep vein thrombosis)
Acute inflammatory disorder usually affecting the small medium sized arteries and veins of the lower
extremities (Autoimmune disease)
A. Predisposing Factors
High risk groups men 30 years old and above
Smoking
Thrombus formation and occlusion of the vessels
Age 20-35 yrs
B. Signs and Symptoms (pain is the outstanding symptom)
Intermittent claudication leg pain upon walking (foot cramps, especially the arch (instep claudication after exercise)
Cold sensitivity and changes in skin color rubor (reddish blue discoloration, pallor, and cyanosis)
Decreased peripheral pulses
Trophic changes
Ulceration
Gangrene formation
Absence of pedal pulse but with normal femoral pulse and popliteal pulses.
Radial and ulnar artery pulses are absent or diminished.
C. Diagnostic Procedures
Oscillometry decrease in peripheral pulses
Doppler UTZ decrease blood flow to the affected extremity
Angiography reveals site and extent of malocclusion
Segmental limb blood pressure (alternation of tourniquet)
D. Nursing Management
Encourage a slow progressive physical activity
Analgesics
Vasodilators
Anti coagulants
Institute foot care management
Instruct client to avoid smoking and exposure to cold environment
Assist in surgical procedure bellow knee amputation (elevate the stump for 24 hrs postop to promote venous return and
minimize edema).
Pain is relieve by rest
REYNAUDS DISEASE
Disorder characterized by acute episodes of arterial (small arteries) spasm/vasoconstriction that result in coldness, pain,
and pallor involving the fingers or digits of the hands.
A. Predisposing Factors
High risk group female 16-40 years old and above
Smoking
Collagen diseases
SLE (butterfly rash)
Rheumatoid Arthritis
Direct hand trauma
Piano playing
Excessive typing
Operating chainsaw
Cold climates and during winter
B. Signs and Symptoms
Intermittent claudication leg pain upon walking
Cold sensitivity and changes in skin color (pallor, cyanosis then rubor)
Trophic changes
Ulceration
Gangrene formation
Raynauds phenomenon refer to localized, intermittent episodes of vasoconstriction of small arteries of the hands that
causes changes in color and temperature. (as white, blue, and red)
C. Diagnostic Procedures
Doppler UTZ decrease blood flow to the affected extremity
Angiography reveals site and extent of malocclusion
D. Nursing Management
Administer medications as ordered
Analgesics
Vasodilators (calcium channel blockers: nifedipine)
Encourage to wear gloves
Instruct client on importance of cessation of smoking and exposure to cold environment
VARICOSITIES
Dilated, tortuous, superficial veins caused by incompetent venous valves
Abnormal dilation of veins of lower extremities and trunks due to
Incompetent valve resulting to
Increased venous pooling resulting to
Venous stasis causing
Decrease venous return
A. Predisposing Factors
Hereditary
Congenital weakness of veins
Thrombophlebitis
Cardiac disorder
Pregnancy
Obesity
Prolonged standing or sitting
Tortuous veins (saphenous veins)
C. Diagnostic Procedure
Venography
Trendelenburgs Test - veins distends quickly in less than 35 seconds
D. Nursing Management
Elevate legs above heart level to promote increased venous return by placing 2 3 pillows under the legs
Measure the circumference of leg muscle to determine if swollen
Wear anti embolic stockings
Administer medications as ordered
Analgesics
Assist in surgical procedure
Vein stripping and ligation (most effective)
Sclerotherapy can recur and only done small/ spider web varicosities and danger of thrombosis (2 3 years for
embolism)
sclerosing agent is injected into the vein, irritating the venous endothelium and producing
localized phlebitis and fibrousis, thereby obliterating the lumen of the vein.
THROMBOPHLEBITIS
Deep vein thrombosis
Inflammation of the veins with thrombus formation
3 factors known as VIRCHOWS TRIAD believe to play a significant role in its development:
Stasis of the blood (venous
stasis) Vessel wall injury
Altered blood coagulation
A. Predisposing Factors
Obesity
Smoking
Related to pregnancy
Chronic anemia
Prolong use of oral contraceptives promotes lipolysis
Diabetes mellitus
Congestive heart failure
Myocardial infarction
Post op complication
Post cannulation insertion of various cardiac catheter.
Increase in saturated fats in the diet.
Signs and Symptoms
1. Pain at affected extremity
2. Warm to touch
3. Dilated tortuous skin veins
4. Positive Homans Signs pain at the calf or leg muscle upon dorsiflexion of the foot
Diagnostic Procedure
1. Venography
2. Angiography
D. Nursing Management
Elevate legs above heart level to promote increase venous return
Apply warm moist pack to reduce lymphatic congestion
Measure circumference of leg muscle to determine if swollen
Encourage to wear anti embolic stockings or knee elastic stockings
Administer medications as ordered
Analgesics
Anti Coagulant take at the same time each day, usually bet. 8-9 am
Heparin
Note: if any of the ff. sign are appear, report them immediately
Faintness, dizziness, or increased weakness
Severe headaches or abdominal pain
Reddish or brownish urine
Any bleeding nose bleeding, cuts, and unusual
Red black bowel movements
Rash
6. Monitor for signs of complications
Embolism
a. Pulmonary
Sudden sharp chest pain
Unexplained dyspnea
Tachycardia
Palpitations
Diaphoresis
Restlessness
b. Cerebral
Headache
Dizziness
Decrease LOC
MURPHYS SIGN is seen in clients with cholelithiasis, cholecystitis characterized by pain at the right upper
quadrant with tenderness (inflammation of the gall bladder)
RESPIRATORY SYSTEM
OVERVIEW OF THE STRUCTURES AND FUCNTIONS OF THE RESPIRATORY SYSTEM
I. Upper Respiratory System
Filtering of air
Warming and moistening of air
Humidification
A. Nose
Cartillage
Right nostril
Left nostril
Separated by septum
Consist of anastomosis of capillaries known as Kesselbachs Plexus (the site of nose bleeding)
B. Pharynx/Throat
Serves as a muscular passageway for both food and air
C. Larynx
- For phonation (voice production)
For cough reflex
Glottis
Opening of larynx
Opens to allow passage of air
Closes to allow passage of food going to the esophagus
The initial sign of complete airway obstruction is the inability to cough
II. Lower Respiratory System
For gas exchange
A. Trachea/Windpipe
Consist of cartilaginous rings
Serves as passageway of air going to the lungs
Site of tracheostomy
B. Bronchus
Right main bronchus
Left main bronchus
C. Lungs
Right lung (consist of 3 lobes, 10 segments)
Left lung (consist of 2 lobes, 8 segments)
Serous membranes
Pleural Cavity
Pareital
Pleural fluid
Visceral
With Pleuritic Friction Rub
Pneumonia
Pleural effusion
Hydrothorax (air and blood in pleural space
Alveoli acinar cells
Site of gas exchange (CO2 and O2)
Diffusion (Daltons law of partial pressure of gases)
Respiratory Distress Syndrome
Decrease oxygen stimulates breathing
Increase carbon dioxide is a powerful stimulant for breathing
Ventilation movement of air in & out of lungs
Respiration movement of air into cells
Type II Cells of Alveoli
Secretes surfactant
Decrease surface tension
Prevent collapse of alveoli
Composed of lecithin and spingomyelin
L/S ratio to determine lung maturity
Normal L/S ratio is 2:1
In premature infants 1:2
Give oxygen of less 40% in premature to prevent atelectasis and retrolental fibroplasias
retinopathy/blindness in prematurity
D. Diagnostic Procedure 1.
Mantoux Test (skin test)
PNEUMONIA
Inflammation of the lung parenchyma leading to pulmonary consolidation as the alveoli is filled with exudates
A. Etiologic Agents
Streptococcus Pneumonae causing pneumococal pneumonia
Hemophylus Influenzae causing broncho pneumonia (children)
Diplococcus Pneumoniae
Klebsella Pneumoniae
Escherichia Pneumoniae
Pseudomonas
B. High Risk Groups
1. Children below 5 years old bec. Of low resistance 2.
Elderly
C. Predisposing Factors
Smoking
Air pollution
Immuno compromised
a. AIDS
- Pneumocystic carini pneumonia
Drug of choice is Retrovir
b. Bronchogenic Cancer
Initial sign is non productive cough to productive cough
Chest x-ray confirms lung cancer
Related to prolonged immobility (CVA clients), causing hypostatic pneumonia
Aspiration of food causing aspiration pneumonia
D. Signs and Symptoms
Productive cough with greenish to rusty sputum
Dyspnea with prolong expiratory grunt
Fever, chills, anorexia and general body malaise
Weight loss
Rales/crackles
Bronchial wheezing
Cyanosis
Pleuritic friction rub
Chest pain
Abdominal distention leading to paralytic ileus (absence of peristalsis)
E. Diagnostic Procedure
Sputum Gram Staining and Culture Sensitivity positive to cultured microorganisms
HISTOPLASMOSIS
Acute fungal infection caused by inhalation of contaminated dust or particles with histoplasma capsulatum derived from
birds manure
Signs
and
Symptoms
1. Productive cough
2. Dyspnea
3. Fever, chills, anorexia, general body malaise
4. Cyanosis
5. Hemoptysis
6. Chest and joint pains
Diagnostic Procedures
Histoplasmin Skin Test positive
ABG analysis PO2 decrease
C. Nursing Management
Enforce CBR
Administer oxygen inhalation
Administer medications as ordered
a. Antifungal
Amphotericin B
Fungizone (Nephrotoxicity, check for BUN and Creatinine, Hypokalemia)
b. Steroids
c. Mucolytics
d. Antipyretics
Force fluids to liquefy secretions
Nebulize and suction as needed
Prevent complications bronchiectasis
Prevent the spread of infection by spraying of breeding places
Chronic Bronchitis
Inflammation of bronchus resulting to hypertrophy or hyperplasia of goblet mucous producing cells leading to narrowing of
smaller airways
Predisposing Factors
1. Smoking
2. Air pollution
Signs and Symptoms
Productive cough (consistent to all COPD)
Dyspnea on exertion
Prolonged expiratory grunt
Anorexia and generalized body malaise
Scattered rales/ronchi
Cyanosis
Pulmonary hypertension
Peripheral edema
Cor Pulmonale (right ventricular hypertrophy)
C. Diagnostic Procedure
ABG analysis reveals PO2 decrease (hypoxemia), PCO2 increase, and pH decrease (resp. acidosis)
Bronchial Asthma
Reversible inflammatory lung condition due to hypersensitivity to allergens leading to narrowing of smaller airways
3. Mixed Type
90 95%
Cyanosis
Mild Stress/apprehension
Tachycardia, palpitations
Diaphoresis
Diagnostic Procedure
1. Pulmonary Function Test
- Incentive spirometer reveals decrease vital lung capacity
2. ABG analysis PO2 decrease
- Before ABG test for positive Allens Test, apply direct
pressure to ulnar and radial artery to determine
presence of collateral circulation
Nursing Management
Enforce CBR
Oxygen inhalation, with low inflow of 2 3 L/min
Administer medications as ordered
Bronchodilators given via inhalation or metered dose inhalaer or MDI for 5 minutes
Steroids decrease inflammation
Mucomysts (acetylceisteine)
Mucolytics/expectorants
Anti histamine
Force fluids
Semi fowlers position
Nebulize and suction when needed
Provide client health teachings and discharge planning concerning
Avoidance of precipitating factor
Prevent complications
Emphysema
Status Asthmaticus (give drug of choice)
Epinephrine
Steroids
Bronchodilators
Regular adherence to medications to prevent development of status asthmaticus
Importance of follow up care
BRONCHIECTASIS
Abnormal permanent dilation of bronchus leading to destruction of muscular and elastic tissues of alveoli
A. Predisposing Factors
Recurrent lower respiratory tract infections
Chest trauma
Congenital defects
Related to presence of tumor
B. Signs and Symptoms
Productive cough
Dyspnea
Cyanosis
Anorexia and generalized body malaise
Hemoptysis (only COPD with sign)
C. Diagnostic Procedure
1. ABG PO2 decrease
EMPHYSEMA
Irreversible terminal stage of COPD characterized by
Inelasticity of alveoli
Air trapping
Maldistribution of gases
Over distention of thoracic cavity (barrel chest)
A. Predisposing Factors
Smoking
Air pollution
Allergy
High risk: elderly
Hereditary it involves deficiency of
ALPHA-1 ANTI TRYPSIN
(needed to form Elastase, for recoil of alveoli)
B. Signs and Symptoms
1. Productive cough
2. Dyspnea at rest
3. Prolong expiratory grunt
4. Anorexia and generalized body malaise
5. Resonance to hyperresonance
6. Decrease tactile fremitus
7. Decrease or diminished breath sounds
8. Rales or ronchi
9. Bronchial wheezing
10. Barrel chest
11. Flaring of alai nares
12. Purse lip breathing to eliminates excess CO2
(compensatory mechanism)
C. Diagnostic Procedure
1. Pulmonary Function Test reveals decrease vital lung capacity
2. ABG analysis reveals
a. Panlobular/ centrilobular
Decrease PO2 (hypoxemia leading to chronic bronchitis, Blue Bloaters)
Decrease ph
Increase PCO2
Respiratory acidosis
b. Panacinar/ centriacinar
Increase PO2 (hyperaxemia, Pink Puffers)
Decrease PCO2
Increase ph
Respiratory alkalosis
D. Nursing Management
Enforce CBR
Administer oxygen inhalation via low inflow
Administer medications as ordered
Bronchodilators
Steroids
Antibiotics
Mucolytics/expectorants
High fowlers position
Force fluids
Institute pulmonary toilet
Nebulize and suction when needed
Institute PEEP (positive end expiratory pressure) in mechanical ventilation promotes maximum alveolar lung expansion
Open pneumothorax air enters pleural space through an opening in chest wall
-Stab/ gunshot wound
3. Tension Pneumothorax air enters plural space with @ inspiration & cant escape leading to over
distension of thoracic cavity resulting to shifting of mediastinum content to unaffected side.
Eg. Flail chest paradoxical breathing pattern
Predisposing factors:
Chest trauma
Inflammatory lung conditions
Tumor
S/Sx:
Sudden sharp chest pain
unexplained Dyspnea or SOB
Cyanosis
Diminished or decreased breath
sound of affected lung
Cool moist skin- initial sign of shock
Mild restlessness/ apprehension, anxiety
Resonance to hyperresonance
decreased tactile fremitus
Diagnosis:
ABG pO2 decrease
CXR confirms pneumothorax/collapse of
lung Nursing Mgt:
Assist in endotracheal intubation
Assist in thoracenthesis
Administer meds Morphine SO4 due to
pain - Anti microbial agents- due to bacteria
Assist in test tube thoracotomy attached
to H2O sealed drainage system
If client has a tension pneumothorax, the initial treatment of choice is to insert a large-bore needle
into the second intercostal space midclavicular line to relieve pressure. Next, a chest tube system is
placed into the fourth intercostal space.
A small chest tube(28 french) is inserted near the second intercostal space; this space is used
because it is the thinnest part of the chest wall, minimizes the danger of contracting the thoracic
nerve, and leave small scar. If the patient has also hemothorax, a large-diameter chest tube (32
french) or greater is inserted usually in the 4th or 5th interscostal space at the midaxillary line.
Purpose of H2O sealed drainage
Reestablish (-) pressure in the lungs-lung 6-12mm Hg
Promote re-expansion of the lungs
Drain fluid, blood and air
To prevent reflux of blood fluid and air
Nursing Mgt if pt is on CPT attached to H2O drainage
Maintain strict aseptic technique
DBE
At bedside
a.) Petroleum gauze pad if dislodged
Hemostat b.) If with air leakage clamp
c.) Extra bottle
Meds Morphine SO4
Antimicrobial
Monitor & assess for oscillation fluctuations or bubbling
a.) If (+) to intermittent bubbling means normal or intact
H2O rises upon inspiration
H2O goes down upon expiration
b.) If (+) to continuous, remittent bubbling
Check for air leakage
Clamp towards chest tube
Notify MD
c.) If (-) to bubbling
Check for loop, clots, and kink
Milk towards H2O seal
Indicates re-expansion of lungs normal
Auscultate for breath sounds, Xrays
Removal of CTT
S/Sx:
Fever, chills anorexia, generalized body malaise
enlarged parotid gland
Swelling of parotid gland
Dysphagia
Earache otalgia
Mode of transmission: Direct transmission &
droplet nuclei Incubation period: 14 21 days
Period of communicability 1 week before swelling & immediately when swelling begins.
Nursing Mgt:
CBR
Institute a strict respiratory isolation
Meds: analgesic
Antipyretic
Antibiotics to prevent 2 complications
4. Alternate warm & cold compress at affected part (vinegar promotes cooling)
PEPTIC ULCER DISEASE (PUD) excoriation / erosion of submucosa & mucosal lining due
to: a.) Hyper secretion of acid pepsin
b.) Decrease resistance to mucosal barrier
Incidence Rate:
Men 40 55 yrs old
Aggressive persons/ type A personality
Hereditary
Emotional Stress
Predisposing factors:
Hereditary
Emotional
Smoking vasoconstriction GIT ischemia
Alcoholism stimulates release of histamine = Parietal cell release Hcl acid = ulceration
Caffeine tea, soda, chocolate
Irregular diet
Rapid eating
Ulcerogenic drugs NSAIDS, aspirin, steroids, indomethacin, ibuprofen
Indomethacin - S/E corneal cloudiness. Needs annual eye check up.
NSAID and steroids= gastropathy
Gastrin producing tumor or gastrinoma Zollinger Ellisons syndrome
Microbial invasion helicobacter pylori. Metronidazole (Flagyl)
Types of ulcers
Ascending to severity
Acute affects submucosal lining
Chronic affects underlying tissues
heals & forms a scar, deeper
According to location
Stress ulcer
Gastric ulcer
Duodenal ulcer most common
Stress ulcers common among critically ill
clients 2 types
1. Curlings ulcer cause: trauma & Burns
Hypovolemia
GIT schemia
Decrease resistance of mucosal barriers to Hcl acid
Ulcerations
2. Cushings ulcer cause stroke/CVA/ head injury
Increase vagal stimulation
Hyperacidity
Ulcerations
Treatment: Vagotomy - done to prevent hemorrhage and shock prior to surgery on the stomach
GASTRIC ULCER
SITE
PAIN
HYPERSECRETION
VOMITING
HEMORRHAGE
WT
COMPLICATIONS
HIGH RISK
INCIDENCE
DUODENAL ULCER
Duodenal bulb
- 2-3 hrs after eating
- mid epigastrium
- cramping & burning pain
- usually relieved by food & antacid
- 12 MN 3am pain
- Eating lessens pain
Increased gastric acid secretion
Not common
Melena
Wt gain
a. perforation
20 years old and above
Male: Female = 2-3:1
80% of peptic ulcers are duodenal
a.) Antacids
ACA
Aluminum containing antacids
Billroth I (Gastroduodenostomy)
Removal of of stomach & anastomoses of gastric
stump to the duodenum.
Billroth II (Gastrojejunostomy)
Removal of -3/4 of stomach & duodenal bulb &
anastomostoses of gastric stump to jejunum.
Before surgery for BI or BII - Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first.
Nursing Mgt:
Monitor NGT output or drainage immediately post op- bright red a.)
Immediately post op should be bright red
b.) Within 36- 48h output is yellow green
c.) After 48h output is dark red due to HCl acid
Administer meds: a.)
Analgesic
DIVERTICULITIS/DIVERTICULOSIS
Diverticulum- an outpouching of the intestinal mucosa particularly the sigmoid colon
Diverticulosis- multiple diverticulum
Diverticulitis- inflammation of diverticula
Predisposing Factors
High Risk Groups- men (40-45yo)
Congenital weakness of muscle fibers of the intestine.
Low roughage and fiber in the diet
S/S:
Intermittent lower left abdominal quadrant pain, particularly in the rectosigmoid area
tenderness
alternating bouts of constipation or diarrhea with blood or mucous
Dx:
Barium enemareveals inflammatory process
CBC reveals: decreased hematocrit and hemoglobin
Nsg Mgt:
Administer meds as ordered:
antibiotics
bulk laxatives
stool softeners
anti spasmodic agents
Instruct clients to take foods high in fiber if there is diverticulosis
Monitor for signs of infection
Feared complications: Peritonitis
4. Assists in surgical procedure
Resection of the diseased bowel and creation of a colostomy
LIVER CIRRHOSIS - lost of architectural design of liver leading to fat necrosis & scarring
Cirrhosis- loss of architectural design of the liver leading to fat necrosis and scarring
Laennac
Early sign hepatic encephalopathy accumulation of ammonia and other toxic substance in the
blood 1. Asterixis flapping hand tremors
Late signs headache, restlessness, disorientation, decrease LOC hepatic
coma. Nursing priority assist in mechanical ventilation
Predisposing factor:
Decrease Laennacs cirrhosis caused by alcoholism
Chronic alcoholism- major cause
Malnutrition decreaseVit B, thiamin - primary cause
Virus
Toxicity- eg. Carbon tetrachloride (CCL4)
Use of hepatotoxic agents
S/Sx:
1. Early signs:
a.) Weakness, fatigue
b.) Anorexia, n/v
c.) Stomatitis
d.) Urine tea color
Stool clay color
e.) Amenorrhea
f.) Decrease sexual urge
g.)
h.)
i.)
j.)
k.)
2. Late signs
a.) Hematological changes all blood cells
decrease Leukopenia- decrease
Thrombocytopenia- bleeding tendencies
Anemia- decrease
b.) Endocrine changes
Spider angiomas, Gynecomastia
Caput medusae, Palmar erythema, loss of tortousity of the umbilicus
c.) GIT changes
Ascites, bleeding esophageal varices due to portal HPN
d.) Neurological changes:
hepatic encephalopathy
Early signs:
asterexis - flapping hand tremors
Minor mental changes and motor disturbances
Hepatic coma
Diagnosis:
Liver enzymes- increase
SGPT (ALT)
SGOT (AST)
Hepatitis A
Hepatitis A virus (HAV) is a virus that causes liver disease. Incubation is about 30 days, and the virus is excreted in the stool for
about 2 weeks before the illness and about a week after it. The mortality rate is low. Children are typically asymptomatic. Adults
generally have a more severe illness. The disease is not chronic and is not carried : FECAL ORAL
TRANSMISSION
INFECTION CONTROL
Hepatitis B
Hepatitis B (HBV) is one of the five hepatitis viruses that infect the liver. This virus has a complex structure capable of
attacking and destroying liver cells, resulting in illness or disease. Cellular destruction results in architectural changes of
the normal structure, of the liver which leads to a disruption in the flow of blood and bile. Illness can range from mild signs
and symptoms to chronic disease, such as fatal cirrhosis or liver cancer. BLOOD CARRIER
Pancreas mixed gland (exocrine & endocrine gland); found behind the stomach
PANCREATITIS acute or chronic inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to
auto digestion (self-digestion).
Bleeding of pancreas - Cullens sign on umbilical area
Predisposing factors:
Chronic alcoholism
Hepatobilary disease
Obesity
Hyperlipidemia
Hyperparathyroidism
Drugs Thiazide diuretics,aspirin, pills, Pentamidine HCL (Pentam) for clients with AIDS,
Diet increase saturated fats
S/Sx:
Severe Midepigastrium epigastric pain radiates from back & flank area (left upper quadrant) 24-48 hrs. Aggravated by heavy meals/eating, accompanied by DOB
N/V
Tachycardia
Palpitation due to pain (abdominal guarding)
Dyspepsia /indigestion (rigid board like abdomen)
Decrease bowel sounds
7. (+) Cullens sign - ecchymosis of umbilicus
hemorrhage
(+) Grey Turners spots ecchymosis of flank area
Hypocalcemia
Diagnosis:
Serum amylase & lipase increase
Urine lipase increase
Serum Ca decrease
Nursing Mgt:
1. Meds
a.) Narcotic analgesic - Meperidine Hcl (Demerol)
Dont give Morphine SO4 will cause spasm of the sphincter of ODDI.
b.) Smooth muscle relaxant/ anticholinergic
- Ex. Papavarine Hcl
Prophantheline Bromide (Profanthene)
c.) Vasodilator NTG
d.) Antacid Maalox
e.) H2 receptor antagonist - Ranitidin (Zantac)
to decrease pancreatic stimulation
f.) Ca gluconate
Withold food & fluid aggravates pain (total NPO)
Assist in Total Parenteral Nutrition (TPN) or hyperalimentation
Complications of TPN
Infectionmaintain a strict aseptic technique
Pulmonary Embolismcheck all connection to system
Hyperglycemia
Hyperkalemia
Institute stress mgt tech
a.) DBE
b.) Biofeedback
Comfy position - Knee chest or fetal lie position
If pt can tolerate food, give increase CHO, decrease fats, and moderate CHON
7. Complications:
Chronic hemorrhagic pancreatitis, Peritonitis, Septicemia, Shock
Cholelithiasis
Cholecystectomy
Cholecystostomy
Choledochotomy
Choledocholithiasis
Choledocholitholithotomy
Choledochoduodenostomy
Choledochojejunostomy
Lithotripsy
Laparoscopic cholecystectomy
Laser cholecystectomy
CHOLECYSTITIS / CHOLELITHIASIS
Predisposing factor:
High risk women 40 years old
Post menopausal women undergoing estrogen therapy
Obesity
Sedentary lifestyle, prolonged immobility
Hyperlipidemia
Neoplasm
Obstruction
S/Sx:
Severe Right abdominal pain (after eating fatty food). Occurring especially at night =
epigastric or right abdominal quadrant after eating a heavy meal
Fat intolerance
Anorexia, n/v, feeling of fullness
Jaundice
Pruritus
Easy bruising
Tea colored urine
Steatorrhea
Diagnosis:
Oral cholecystogram (or gallbladder series) - confirms presence of gall stones
Increased indirect bilirubin
Increased alkaline phosphatase
increased serum and amylase
Nursing Mgt:
1. Meds a.) Narcotic analgesic - Meperdipine Hcl Demerol
b.) Anti cholinergic/Anti-spasmodic - Atropine SO4 c.)
Anti emetic
Phenergan Phenothiazide with anti emetic properties
Broad spectrum antibiotics
Diet increase CHO, moderate CHON, decrease fats
Meticulous skin care
Surgery:Cholecystectomy
Nursing Mgt post cholecystectomy
-Maintain patency of T-tube intact & prevent infection
BURNS
direct tissue injury caused by thermal, electric, chemical & smoke inhaled (TECS)
Nursing Priority infection (all kinds of burns)
Head burn-priority - Airway
2nd priority for 1st & 2nd burn - pain
2nd priority for 3rd burn - Fluid and electrolytes
= 9%
= 18%
= 18%
= 18%
= 18%
= 1%
100%
a.) Tetanus toxoid- burn surface area is source of anaerobic growth Claustridium tetany
Tetany
Tetanolysin
tetanospasmin
Hemolysis
muscle spasm
Function of kidneys:
Urine formation
Regulation of BP
Delirium
Infection of urinary tract
Atrophic vaginitis, urethritis
Pharmacologic agents (anticholinergic)
Causes of CRF:
HPN
DM Regulation
of BP: Predisposing
factor:
Restricted activity
increase CO
increase PR
Aldosterone
Increase BP
Increase Na &
H2O reabsorption
Hypervolemia
Ureters 25 35 cm long, passageway of urine to bladder
Bladder loc behind symphisis pubis. Muscular & elastic tissue that is distensible
- Function reservoir of urine
1200 1800 ml Normal adult can hold
200 500 ml needed to initiate micturition reflex (voiding)
Color
Odor
Consistency
pH
Specific gravity
WBC/ RBC
Albumin
E coli
Mucus threads
Amorphous urate
amber
aromatic
clear or slightly turbid
4.5 8
1.015 1.030
(-)
(-)
(-)
few
(-)
Urethra extends to external surface of body. Passage of urine, seminal & vaginal fluids.
Women 3 5 cm or 1 to 1
Male 20cm or 8
UTI
CYSTITIS inflammation of bladder
Predisposing factors:
Microbial invasion E. coli
High risk women
Obstruction
Urinary retention
Increase estrogen levels
Sexual intercourse
S/Sx:
1. Pain flank area
2. Urinary frequency & urgency
3. Burning upon urination
Diagnosis:
Urine culture & sensitivity - 80% of the cases are (+) to E. coli
Nursing Mgt:
Force fluid 2000 ml= to prevent bacterial multiplication
Warm sitz bath to promote comfort
Monitor & assess for gross hematuria
Monitor and assess urine for color, odor, and bleeding N pH: 4.8
Acid ash diet cranberry, vit C -OJ to acidify urine & prevent bacterial multiplication
Meds: systemic antibiotics
Ampicillin
Cephalosporin
7. Ht
a.) Importance of Hydration
b.) Void after sex (male and female)
c.) Female avoids cleaning back & front
Bubble bath, Tissue paper, Powder, perfume
d.) Complications: Pyelonephritis
PYELONEPHRITIS acute/ chronic inflammation of 1 or 2 renal pelvis of kidneys leading to tubular destruction,
interstitial abscess formation.
Predisposing factor:
Microbial invasion (Bacterial) a.)
E. Coli
b.) Streptococcus
Urinary retention /obstruction
Pregnancy
DM
Exposure to renal toxins or nephrotoxic agents
S/Sx:
Acute pyelonephritis
a.) Costovertibral angle pain, tenderness
b.) Fever, anorexia, gen body malaise c.)
Urinary frequency, urgency
d.) Nocturia, dysuria, hematuria
e.) Burning upon urination
f.) FLANK PAIN g.)
Enlarged kidney
Chronic Pyelonephritis
a.) Fatigue, wt loss, weakness
b.) Polyuria, polydypsia
c.) HPN
Diagnosis:
Urine culture & sensitivity (+) E. coli & streptococcus
Urinalysis
(+) WBC, (+)RBC, (+) Pus cells
Cystoscopic exam urinary obstruction
Nursing Mgt:
Provide CBR especially during acute phase
Force fluid
Acid ash diet
Provide a warm sitz bath for comfort
Meds:
a.) Urinary antiseptic nitrofurantoin (macrodantin)
SE: peripheral neuropathy
GI irritation
Hemolytic anemia
Staining of teeth
oxalate,
cabbage
uric acid
anchovies
cranberries
nuts tea
chocolates
organ meat
nuts
sardines
Predisposing factors:
Diet increase Ca & oxalate
Hereditary gout
Obesity
Sedentary lifestyle
Hyperparathyroidism
S/Sx:
Renal colic
Cool moist skin (shock)
Burning upon urination
Hematuria
Anorexia, n/v
Diagnosis:
IVP intravenous pyelography. Reveals location of stone
KUB reveals location of stone
Cytoscopic exam- urinary obstruction
Stone analysis composition & type of stone
Urinalysis increase EBC, increase CHON
X-ray
Nursing Mgt:
Force fluid
Strain urine using gauze pad
Warm sitz bath for comfort
Alternate warm compress at flank area
a.) Narcotic analgesic- Morphine SO4 b.)
Allopurinol (Zyeoprim)
c.) Patent IV line
d.) Diet if + Ca stones acid ash diet
If + oxalate stone alkaline ash diet - (Ex milk/ milk products)
If + uric acid stones decrease organ meat / anchovies sardines
Surgery
a.) Nephectomy removal of affected kidney
Litholapoxy removal of 1/3 of stones- Stones will recur. Not advised for pt with big stones
b.) Extracorporeal shock wave lithotripsy
Non - invasive
Dissolve stones by shock wave
Complications: Renal Failure
Predisposing factor:
1. High risk 50 years old & above
60 70 (3 to 4 x at risk)
Prostate cancer: 40 years old &
above 2. Influence of male hormone
S/Sx:
Decrease force of and amount of urinary stream
Dysuria
Hematuria
Burning upon urination
Terminal dribblingearly sign of BPH
Backache
Sciatica
Hesitancy
Diagnosis:
Digital rectal exam enlarged prostate gland
KUB urinary obstruction
Cystoscopic exam obstruction
Urinalysis increase WBC, CHON, RBC
Nursing Mgt:
Prostatic message promotes evacuation of prostatic fluid
Limit fluid intake
Provide catheterization
Provide a warm sitz bath for comfort
Meds:
a. Terazozine (hytrin) - Relaxes bladder sphincter, relaxes the smooth muscle of urinary sphincter
S/E: HA, hypotension
b. Fenasteride (Proscar) - Atrophy of Prostate Gland (given after meals)
S/E: N&V, Anorexia
Urea
In
cr
Creatinine
Uric acid
anic
acids
Intra
ACUTE RENAL FAILURE sudden immobility of kidneys to excrete nitrogenous waste products & maintain F&E
balance due to a decrease in GFR. (N 125 ml/min)
Predisposing factors:
Pre renal cause- decrease blood flow
Causes:
Septic shock
Hypovolemia
3. Hypotension
CHF
Hemorrhage
Dehydration (chronic diarrhea)
Causes:
Urinary strictures
Urolithiasis
BPH
Presence of tumors
Stages: Initiation period begins with the initial insult and ends when oliguria develops.
I. OLIGURIC STAGE (1-2 weeks)
- involves passage of urine < 400ml/day S/S:
a. Hyperkalemia- arrhythmia
b. Hypernatremia
c. Hyperphosphatemia
d. Hypocalcemia
e. High BUN 10-20 and creatinine .8-1
Metabolic acidosis 1-2wks
Renal Insufficiency
End Stage Renal disease
S/Sx:
1.) Urinary System
a.) polyuria
b.) nocturia
c.) hematuria
d.) Dysuria
e.) oliguria
3.) CNS
a.) headache
b.) lethargy
c.) disorientation
d.) restlessness
e.) memory impairment
5.) Respiratory
a.) Kassmauls resp
b.) decrease cough reflex
c.) crackles
7.) Fluid & Electrolytes
a.) hyperkalemia
b.) hypernatermia
c.) hypermagnesemia
d.) hyperposphatemia
e.) hypocalcemia
f.) met acidosis
4.) GIT
a.) n/v
b.) stomatitis
c.) uremic breath
d.) diarrhea/ constipation
6.) hematological
a.) Normocytic anemia
bleeding tendencies
8.) Integumentary
a.) itchiness/ pruritus
b.) uremic frost
9.) Cardiovascular changes
a. HPN
b. CHF
c. Pericarditis
Nursing Mgt:
Enforce CBR, reverse isolation
Monitor strictly VS, I&O, neurocheck, monitor for signs of hypocalcemia (increased phosphate)
E embolism
D disequilibrium
syndrome S septicemia
S shock decrease in tissue perfusion
Disequilibrium syndrome from rapid removal of urea & nitrogenous waste product leading to:
a.) n/v
b.) HPN
c.) Leg cramps
d.) Disorientation
e.) Paresthesia
Avoid BP taking, blood extraction, IV, at side of shunt or fistula. Can lead to compression of fistula.
Maintain patency of shunt by:
Palpate for thrills & auscultate for bruits if (+) patent shunt!
Bedside- bulldog clip
If with accidental removal of fistula to prevent embolism.
Infersole (diastole) common dialisate used
Complication
Peritonitis (most feared)
Shock
Inflow time: 10-20mins
Indwelling time: 30-45 mins
8. Assist in surgery:
Renal transplantation: Complication rejection (feared complication). Reverse
isolation Rejection time in acute6mos to 1 year
Rejection time in chronic5-10 years
EYES
External parts
Orbital cavity made up of connective tissue protects eye form trauma.
EOM extrinsic ocular muscles involuntary muscles of eye needed for gazing movement.
Eyelashes/ eyebrows esthetic purposes
Eyelids palpebral fissure opening upper & lower lid. Protects eye from direct sunlight
Meibomean gland secrets a lubricating fluid inside eyelid
b.) Stye/ sty or Hordeolum- inflamed Meibomean gland
Conjunctiva
Lacrimal apparatus tears
Process of grieving
Denial
Anger
Bargaining
Depression
Acceptance
Intrinsic coat
I. sclerotic coat outer most
a.) Sclera white. Occupies post of eye. Refracts light rays
b.) Canal of schlera site of aqueous humor drainage
c.) Cornea transparent structure of eye
II. Uveal tract nutritive care
Uveitis infl of uveal tract
Consist of:
a.) Iris colored muscular ring of
eye 2 muscles of iris:
1. Circular smooth muscle fiber - Constricts the pupil
2.radial smooth muscle fiber - Dilates the pupil
2 chambers of the eye
1. Anterior
a.) Vitreous Humor maintains spherical shape of the eye
b.) Aqueous Humor maintains intrinsic ocular pressure
phototopic vision
far vision=
ciliary muscle dilates / relaxes=
lens is flat
(nearsightedness)
Type:
1. Chronic (open angle G.) most common type Obstruct in flow of aqueous humor at trabecular meshwork of
canal of schlema
2. Acute (close angle G.) Most dangerous type Forward displacement of iris to cornea leading to blindness. 3.
Chronic (closed angle) - Precipitated by acute attack
S/Sx:
Loss of peripheral vision tunnel vision
Halos around lights
Headache
n/v
Steamy cornea
Eye discomfort
If untreated gradual loss of central vision blindness
Diagnosis:
1. Tonometry increase IOP >12- 21 mmHg
Perimetry decrease peripheral vision
Gonioscopy abstruction in anterior chamber
Nursing mgt:
Enforce CBR
Maintain siderails
Administer meds
a.) Miotics lifetime - contracts ciliary muscles & constricts pupil. Ex Pilocarpine Na (Carbachol)
b.) Epinephrine eye drops decrease secretion of aqueous humor
c.) Carbonic anhydrase inhibitors. Ex. Acetazolamide (Diamox)
- Promotes increase out flow of aquaeous humor
d.) Temoptics (Timolol maleate)- Increase outflow of aquaous humor
Surgery:
Invasive:
a.) Trabeculectomy eyetrephining removal of trabelar meshwork of canal or schlera to drain aqueous
humor
b.) Peripheral Iridectomy portion of iris is excised to drain aqueous humor
Non-invasive:
Trabeculoctomy (eye laser surgery)
CATARACT
Predisposing factor:
90-95% - aging (degenerative/ senile cataract)
Congenital
Prolonged exposure to UV rays
DM
S/Sx:
Loss of central vision - Hazy or blurring of vision
Painless blurry vision
Nsg Mgt:
Reorient pt to environment due opacity
Side rails
Meds: a.) Mydriatics dilate pupil not lifetime (SNS)
Ex. Mydriacyl
c.) Cyslopegics paralyzes ciliary muscle. Ex. Cyclogye
4. Surgery
E extra
C - capsular
C cataract
L - lens
E extraction
I - intra
C - capsular
C cataract total removal of lens & surrounding capsules L lens
E extraction
Nursing Mgt:
Position unaffected/ unoperated side - to prevent tension on suture line.
Avoid valsalva maneuver
Monitor symptoms of IOP
a.) Headache
b.) n/v
c.) Eye discomfort
d.) Tachycardia
4. Eye patch both eyes - post op
EAR
Hearing
Balance (Kinesthesia or position sense)
Parts:
1. Outera.) Pinna / auricle protects ear from direct trauma
b.) Ext. auditory meatus has ceruminous gland. Cerumen
c.) Tympanic membrane transmits sound waves to middle ear
Diagnosis:
Audiometry various sound stimulates (+) conductive hearing loss
Webers test Normal AC> BC
result BC > AC
Stapedectomy
Nursing Mgt post op
Position pt unaffected side
DBE
No coughing & blowing of nose
- Night lead to removal of graft
Meds:
a.) Analgesic
b.) Antiemetic
c.) Antimotion sickness agent. Ex. meclesine Hcl (Bonamine)
Assess motor function facial nerve - (Smile, frown, raise eyebrow)
Avoid shampoo hair for 1 to 2 weeks. Use shower cap
S/Sx:
TRIAD symptoms of Menieres disease a.)
Tinnitus
b.) Vertigo
c.) Sensory neural hearing loss
Nystagmus
n/v
Mild apprehension, anxiety
Tachycardia
Palpitations
Diaphoresis
Diagnosis:
1. Audiometry (+) sensory hearing loss
Nursing mgt:
Comfy & darkened environment
Siderails
Emetic basin
Meds:
a.) Diuretics to remove endolymph
b.) Vasodilator
c.) Antihistamine
d.) Antiemetic
e.) Antimotion sickness agent
f.) Sedatives/ tranquilizers
Restrict Na
Limit fluid intake
Avoid smoking
Surgery endolymphatic sac decompression - Shunt
OTITIS MEDIA Inflammation of the middle ear. (last less than 6 wks)
Sign and symptoms:
Pain
Temporary hearing loss
Tugging at the affected ear
Difficulty sleeping
Draining fluid / pus
Frequent pulling of the ear
(children) Fever
Nursing management:
Usually self limiting and resolved spontaneously
Antibiotic
Drainage (lean on the affected side to facilitate drainage)
Complication:
Hearing loss
Mastoiditis
Delayed speech and language development
Perforation of the TM
OTHER MNEMONICS
IV NOTES
Clindamycin, KCl===NOT for IV pushit may cause arrhythmia
Chloramphenicol===NOT for IM
Procaine, Penicillin, Benzatine, Pen G, Vancomycin HCl, Acyclovir (Zovirax) ===NOT for IV
Autoimmune diseases
Multiple Sclerosis
Hypothyroidism
Acute Glomerulonephritis
Myasthenia Gravis
Hyperthyroidism
GBS
Pernicious Anemia
NEURO TRANSMITTER
DECREASE
INCREASE
Acethylcholine
Myasthenia Gravis /
Alzheimer
Bi-polar Disorder
Dopamine
Parkinsons Disease
Schizophrenia
PATHOGNOMONIC SIGNS
1. PTB
2. PNEUMONIA
Rusty sputum.
3. ASTHMA
Wheezing on expiration.
4. EMPHYSEMA
Barrel chest.
5. KAWASAKI DISEASE
Strawberry tongue.
6. PERNICIOUS ANEMIA
7. DOWN SYNDROME
8. CHOLERA
9. MALARIA
10. TYPHOID
11. DIPTHERIA
12. MEASLES
Kopliks spots.
13. SLE
Butterfly rashes.
15. LEPROSY
lioning face
17. APPENDICITIS.
rebound tenderness
18. DENGUE
19. MENINGITIS
20. TETANY
21. TETANUS
risus sardonicus.
22. PANCREATITIS
24. PDA
Exopthalmus
28. INTUSSUSCEPTION
30. HEPATITIS
Jaundice
31. THROMBOPHEBITIS
Homans sign
32. CATARACT
33. GLAUCOMA
35. CHOLECYSTITIS
Clubbing of fingers
GASTRIC ULCER
SITE
DUODENAL ULCER
PAIN
Duodenal bulb
- 2-3 hrs after eating
- mid epigastrium
- cramping & burning pain
- usually relieved by food & antacid
- 12 MN 3am pain
- Eating lessens pain
Increased gastric acid secretion
Not common
Melena
Wt gain
a. perforation
HYPERSECRETION
VOMITING
HEMORRHAGE
WT
COMPLICATIONS
HIGH RISK
INCIDENCE
ATHEROSCLEROSIS
ARTERIOSCLEROSIS
- narrowing of artery
- lipid or fat deposits (plaques)
- tunica intima
- tunica media
TOXICITY
LEVEL
INDICATION
CLASSIFICATION
.5 1.5 meq/L
CHF
Cardiac Glycoside
.6 1.2 meq/L
Bipolar
Anti-Manic Agents
10 19 mg/100 ml
20
COPD
Bronchodilators
Dilantin/ Phenytoin
10 19 mg/100 ml
20
Seizures
Anti-Convulsant
Acetaminophen/Tylenol
10 30 mg/100 ml
200
Osteoarthritis
Non-narcotic Analgesic
DRUG
Digoxin/ Lanoxin
(Increase force of
cardiac output)
Lithium/ Lithane
(Decrease level of
Ach/NE/Serotonin)
Aminophylline
(Dilates bronchial tree)
PITUITARY SECRETIONS
Anterior pituitary
ADH
Posterior pituitary
GH
OXYTOCIN
ACTH
TSH
FSH & LH
PROLACTIN
MSH
JESUS
EVERY TIME JESUS
I SAY
I wish to offer to GOD
the infinite
merits of Jesus
passi a
Christ, His
on
n
d
death, with all
being al
the masses
said
l
over the world
for:
(a) The glory of GOD, (b) my own intentions, (c) the peace of the World.