TOP 105 DISEASES AND HUMAN ANATOMY

(for NLE review)

In alphabetical order
*** Common Board Question

1. ABSENT MECONIUM PASSAGE within 24 hours after birth

Imperforate anus Hirschprungs disease Cystic fibrosis

2. ACROMEGALY
Increase growth hormone AFTER puberty Increase glucose level (high Growth hormone = high Glucose) S/Sx: Broad and bulbous nose Enlarged hands and feet Continuous grow of soft tissues (ear, nose) Macroglossia (large tongue)*** Complications Enlarged heart Diabetes mellitus Heart failure Reason of seeking for medical care: change in appearance*** Management:

Octreotide (Sandostatin)*** SEE notes on TOP DRUGS

give SQ if given 3x a week***

3. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

shock lung Non-cardiogenic pulmonary edema Pathophysiology: o Decreased surfactants o Decreased surface tension o Damage to alveolar-capillary membrane o Leakage of fluid into the ITS o Resulting to pulmonary edema S/Sx: o Dyspnea, retractions o Pulmonary edema o Crackles

4. ADDISONs and CUSHINGS DISEASE

MAIN PROBLEM and its manifestation s ADDISONs All STEROIDS (S.S.S.) are DOWN except for Potassium DOWN: SUGAR (HYPOglycemia) DOWN: SALT (HYPONATREMIA) CUSHINGs All STEROIDS (S.S.S.) are UP except for Potassium UP: SUGAR (HYPERglycemia) UP: SALT (HYPERNATREMIA)

HYPOVOLEMIA DHN, weight loss HYPOTENSION

HYPERVOLEMIA Edema (Moonface, Weight gain) HYPERTENSION

DOWN: SEX HORMONES Decrease sexual urge or libido

UP: SEX HORMONES Decrease sexual urge or libido

Virilization (mascularity in female) Amenorrhea, Hirsutism, Enlargement of clitoris Osteoporosis Gynecomastia (males) Potassium HYPOKALEMIA Weakness, fatigue Bradycardia Constipation Metabolic alkalosis

UP: Potassium HYPERKALEMIA Weakness, fatigue Tachycardia, Arrhythmia Diarrhea Metabolic acidosis Tall/ Tented T waves MANAGEMEN T YES steroids (pro-Na, anti-K) Monitor VS, I&O, weight DIET: high calorie, high CHO (glucose), high NA, low K ADDISONIAN CRISIS/ ACUTE ADRENAL INSUFFICIENCY (COMA):

DOWN:

COMPLICATIO NS

Flat T wave, presence of U wave*** NO steroids Monitor VS, I&O, weight DIET: low calorie, low CHO, low Na, high K, high CHON Reverse isolation* BILATERAL ADRENALECTOMY GIVE Calcium (for osteoporosis) Risk for infection Pathologic fracture*** Osteoporosis***

severe headache or back pain, severe generalized, muscle weakness, diarrhea or constipation, confusion, lethargy, severe hypotension, circulatory collapse

DM Arrhythmia

S.S.S (Sugar, Salt, Sex hormone) steroids Cushings disease prone to infection (isolate patient)***

5. AGE RELATED MACULAR DEGENERATION (AMD)

related to aging bilateral loss of CENTRAL vision with presentation of peripheral vision

6. ALPORTs SYNDROME
Hereditary Like AGN (acute glomerulonephritis) S/Sx: hematuria from start to finish Common: males Confirmatory diagnostic test: kidney biopsy DIET: decrease CHON

7. ANEMIA decrease oxygen carrying capacity of RBC

Common Nursing diagnosis: Activity intolerance*** Common S/Sx: F ainting F atigue F orgetfullness TYPES

Iron-deficiency anemia (microcytic and hypochromic)***

S/Sx: koilonychia (spoon shaped fingernail)*** , pale and chubby

Megaloblastic anemia (macrocytic and hyperchromic) Pernicious anemia immature RBC due to lack of vitamin B12

Folic Acid Deficiency anemia immature RBC due to lack of vitamin B9

Aplastic Anemia disorder of bone marrow

decrease RBC, platelet, WBC

Sickle cell anemia sickled RBC Management for Sickle cell anemia:***

1) 2) 3)

H ydration O oxygenation P ain management

8. ANEURYSM is ballooning of the

TYPES

blood vessel

o o o

Saccular one sided ballooning Fusiform two sided ballooning (circumferential) Dissecting a TEAR in the intima of the blood vessel*** Type A affects the ascending aorta Type B affects the descending aorta

Complications: rupture/ internal hemorrhage/ shock

9. ANGINA PECTORIS: Management

2 GOALS IN ANGINAL MANAGEMENT: Goal # 1: Increase oxygen supply to the myocardium (vasodilation) Goal # 2: Decrease oxygen demand

A.

Nitrates Goal # 1 the mainstay for treatment of angina pectoris MODE OF ACTION: a. dilates the veins primarily (but in higher doses, it also dilates the arteries) b. causes venous pooling in peripheral body parts thus less blood returns to the heart and filling pressure (preload) is reduced

Example: Nitroglycerin (Nitrostat, Nitrol, Nitrobid IV), Isosorbide mononitrate (Imdur), Isosorbide dinitrate (Isordil) Side effects: flushing, throbbing headache, hypotension, dizziness Keep drug only for 6 months, cool, dry and dark environment Carry all times DO NOT administer with Sildenafil (Viagra) AVOID: hot baths because it causes massive vasodilation

B.

Beta Blockers Goal # 2

C.

Example: Propranolol (inderal), Metropolol (Lopressor), atenolol (Tenormin)

MODE OF ACTION: Blocks the beta-adrenergic sympathetic stimulation of the heart thus reducing myocardial oxygen consumption*** Calcium Channel Blockers Goal # 1 and 2

Examples: Amlodipine (Norvasc), Verapamil, Nifedipine, Diltiazem (Cardizem), felodipine (Plendil) amlodipine and felodipine (Plendil) are the Calcium Channel blocker of choice for heart failure

D.

Antiplatelet and Anticoagulant

Examples: aspirin, clopidrogel (Plavix), ticlopidine (Ticlid) MODE OF ACTION: prevents platelet aggregation clopidrogel (Plavix) or ticlopidine (Ticlid) is given to patients who are allergenic to aspirin***

10. APPENDICITIS

Inflammation of the appendix LOCATION: RLQ/ right iliac/ Mc Burneys point CAUSE: due to obstruction from fecalith low fiber diet Obstruction of the appendix by a fecalith, inflammation, foreign body, or Neoplasm Increased intraluminal pressure Venous congestion, bacterial invasion Abscess, Infection, thrombosis Gangrene and perforation if untreated within 36 hours Peritonitis

MANIFESTATIONS: increase WBC, fever PECULIAR SIGNS:

Rovsings sign

pressure on the LLQ causes pain in the RLQ

Mc Burneys sign pain at RLQ upon palpation Psoas sign pain on passive extension of right hip (lateral position with right hip flexion) Obturator sign*** pain with passive flexion and internal rotation of the right hip Blumberg sign rebound tenderness (peritonitis) (+) cough sign*** RLQ pain on coughing

With pain inflammation Without pain rupture Tachycardia late sign Abdominal distention and paralytic ileus/ decreased or absent bowels sounds MANAGEMENT: Bed rest NPO PAIN management o ALLOW: cold application o AVOID: warm compress analgesics will mask the pain*

Laxatives, enema, palpation increase peristalsis POSITION: o (acute phase) most comfortable position; Semi fowlers to relieve pain and discomfort o (rupture) upright Sx: Appendectomy o Position: flat on bed

11. ARNOLD-CHAIRI MALFORMATION

Related to neural tube defect S/Sx: o Swallowing difficulty

o o
12. ARTHRITIS

Weakening of the extremities Stridor

RHEUMATOID ARTHRITIS Autoimmune Systemic Chronic Small joints (wrist, elbow) Bilateral Women Ulnar drift

OSTEOARTHRITIS Degenerative disease (wear and tear) Common aggravating factor: obesity Non-systemic Chronic Weight bearing joints (hips, spine, knee, ankle) Unilateral/ progressive Not sex specific Heberdends distal Bouchards proximal

GOUTY ARTHRITIS Metabolic (altered purine metabolism) Non-systemic Acute Big toe, ankle

Onset JOINTS AFFECTED

S/Sx

Boutenniere deformity proximal

Tophi/ podagra uric acid crystallization Elevated uric acid

PAIN MANAGEMENT

Swan neck deformity distal Sjogrens syndrome excessive dryness of eyes, mouth and vagina Feltys syndrome leukopenia, spleenomegaly Anemia*** Pain due to immobility Gold therapy Aspirin regularly (watch out for tinnitus) Steroids/ NSAIDS Hot and cold compress Plasmapharesis

Pain due to mobility W-weight control (decrease calorie) H-hot compress or ice packs A- aspirin use T- trunk assistive devices (cane) Steroids/ NSAIDS Drugs: glucosamine, chondroitin

AVOID: organ meats, alcohol legumes, sardines DIET: low purine, high fluids

P-probenecid - increase excretion of uric acid A-allopurinol - decrease production of uric acid C-colchicine - d S-sulfinpyrazone- reduces uric acid in the blood

13. AUTOSOMAL AND SEX-LINKED DISORDERS

AUTOSOMAL RECESSIVE Sickle-cell anemia Cystic Fibrosis PKU Thalassemia major Albinism Tay-sachs Maple syrup urine disease SEX-LINKED/ X-LINKED RECESSIVE Hemophilia A & B Duchennes muscular dystrophy Color blindness Baldness AUTOSOMAL DOMINANT Von Willebrands disease Neurofibromatosis Huntingtons disease Myotonic muscular dystrophy Nightblindness Osteogenesis imperfecta Marfans Syndrome

14. BENIGN PROSTATE HYPRPLASIA

A

15. BITES 16. BOTULISM

paralytic illness caused by nerve toxin released by Clostridium botulinum spore in soil; can spread through air or food or contaminated wound no person-to-person progressive paralysis (extremities, lungs)

17. BRONCHIAL ASTHMA

Most common triggering factor: dust mites*** TRIAD manifestations:

B ronchoconstriction caused by leukotrienes I nflammation caused by IgE M ucus production caused by GOBLET CELLS

Give BRONCHODILATOR first, followed by STEROIDS Wash mouth after inhaling steroid-based drugs (to prevent oral thrush)

18. BRONCHIOLITIS

Causative agent: Respiratory Syncytial Virus Inflammation of the bronchioles that causes thick mucus production resulting to obstruction DOC: Ribavirin (Virazole)* AVOID pregnant nurses and children during Ribavirin therapy

19. BROWN-SEQUARDs SYNDROME

Results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the cord IPSILATERAL (same side): motor function, propioception, vibration, deep touch sensations ARE LOST CONTRALATERAL (opposite side from the injury): pain sensation, temperature, light touch are LOST

20. BURNS

CAUSES/ TYPES: Thermal burns a. Scald burns hot fluids b. Flame ignition/ fire c. Flash explosion d. contact with hot objects Chemical burns acids, alkali

1)

Electrical burns electrical wires Radiation 2 Parameters:*** Extent percentage Rule of 9 quick way Palm method use for scattered burn

2)
Severity depth

1 Palm = 1%***

1st to 4th degree

PARTI AL

CLASSIFICATION 1st Superficial degree thickness burn 2nd Superficial degree Partial thickness burn 3rd Deep partial degree thickness burn 4th degree Full thickness burn

Epidermis Epidermis and dermis Skin to SQ

pain, red (erythematosus), no edema Very painful, very red, blistered (vesicle), edema, blanches with pressure Mixed red or waxy white color Wet surface (broken blisters) Edema painless painless, dry, pale, white or charred

sunburn Scalds (contact with hot liquids) Fire Electricity or lightning Prolonged exposure to hot liquids/ objects

FULL Epidermis, Dermis, SQ, muscles, bones

HEALING PROCESS 1st degree 3 to 7 days 2nd degree average of 21 days 3rd degree skin grafting compartment syndrome 4th degree amputation; skin grafting STAGES OF BURN INJURY
1st stage Fluid Accumulation IV to IT Hypovolemia/ shock 2nd stage Fluid Remobilization IT to IV (Hypervolemia) Diuresis Increase Blood volume 3rd stage Recovery/ Convalescence Healing process Decreased calcium (calcium is used in wound healing)

Oliguria Decrease Blood volume

Decrease BP Increase HR, Increase RR Increase HCT Increase potassium Decrease sodium and water Myoglobinuria

Increased BP Fluid overload CHF Decrease HCT Decrease potassium Decrease sodium and water

PHASES OF BURN MANAGEMENT BEGINS Begins at the time of injury ENDS ends with the restoration of capillary permeability GOAL/ FOCUS Fluid resuscitation Fluid replacement are calculated from the TIME of INJURY and not from the TIME OF ARRIVAL at the hospital Amount of fluid: based on the clients weight and extent of injury infection control wound care, wound closure, nutritional support, pain management, and physical therapy

EMERGENT; usually 24 to 48 hours following injury

ACUTE; Begins 48 to 72 hours after the time of injury

REHABILITATIV E

Begins when the client is hemodynamically stable, capillary permeability is restored, and diuresis has begun begins with wound closure

until the burn is healed

until the patient has reached the highest level of functioning

Designed so that the client can gain independence and achieve maximal function

Burns to the chest, back, neck, and face. PRIORITY nursing diagnosis o Ineffective airway clearance IV fluid used in FLUID RESUSCITATION: Lactated Ringers (LR) Patient with burns with diarrhea, suspected organism: o Clostridium Deficile Chemical burn to the eyes, first thing to do is: o flush the eyes with water continuously for 20 minutes. SKIN GRAFT o Heterograft (xenograft) is a graft of skin obtained from another species, such as a pig. o Autograft is a graft of skin obtained from the patient itself o Homograft is a graft of skin obtained from same species like a cadaver 6 to 24 hours after dead Patient is burning: DROP and ROLL*** o AVOID: Standing to prevent inhalation Running to prevent fanning of fire Electric burn, first to be done:*** o Turn OFF the electric source Components of FIRE:*** o Oxygen (open window, oxygen tank) o Friction (drapes, electric spark, friction producing equipment) o Combustible material (kerosene, LPG)

FIRE management, sequence*** 1- Protect patient 2- Activate alarm 3- Confine the fire 4- Extinguish the fire FIRE EXTINGUISHER, types*** Type A for Trash fire paper, woods, leaves Type B for Fuel fire oil, gasoline, kerosene Type C for Electric Fire appliances, wire Type D any kind all (contain water under pressure) (contains carbon dioxide) (contains dry chemicals) (contains graphite)

21. CANCER, RISK FACTORS Breast Cancer***

Early menarche Late menopause Nulliparity 1st pregnancy at 35 years old Breast Cancer Treatment Guidelines by Stage at Diagnosis

STAGE 0 I II

TUMOR*** DCIS (no evidence of cancer cells) 02 cm 2 cm and below with axillary lymph node metastasis OR More than 2 cm but less than 5 cm with NO axillary lymph node metastasis >5 cm with axillary and neck lymph node metastasis Metastatic disease to distant organs (lungs, distant lymph nodes, skin, bones, liver, or brain)

SURGERY TM or lumpectomy BCT or MRM BCT or MRM

CHEMOTHERAPY Tamoxifen Considered for all invasive tumors Regimen depends on tumor size and nodal status Postoperative and possibly preoperative To control progression and/or palliation

RADIATION For lumpectomy For BCT For BCT

III IV

MRM MRM Possible lumpectomy

To chest wall and possibly axillae after MRM To control progression and/or palliation

DCIS, ductal carcinoma in situ; TM, total mastectomy; BCT, breast-conservation treatment (lumpectomy and axillary dissection); MRM, modified radical mastectomy.

Uterine Cancer Age: at least 55 years; median age, 61 years Postmenopausal bleeding

Obesity that results in increased estrone levels (related to excess weight) resulting from conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen Unopposed estrogen therapy (estrogen used without progesterone, which offsets the risk of unopposed estrogen) Other: nulliparity, truncal obesity, late menopause (after 52 years of age) and, possibly, use of tamoxifen

Bladder Cancer Smoking Hair dye Gastric Cancer Smoked foods Peptic Ulcer Disease: gastric ulcer Raw foods

22. CARPAL TUNNEL SYNDROME

Cumulative trauma of wrist (median nerve carpal tunnel) Inflammation and swelling RISK: Carpenters Computer user Compression during sleeping Cellular phone use (texting) Rower Typist/ pianist Working using vibrating tools S/Sx: Phalens test Durkan test press thumb (examiner) over carpal tunnel (patient) for 30 seconds Tinels sign - percussion Pain wrist relieved by massaging and shaking Loss of sensation of fingertips

23. CEREBRO-VASCULAR ACCIDENT (CVA)/ STROKE/ BRAIN ATTACK

24. CHOLECYSTITIS
CHOLELITHIASIS: stones in the gall bladder (occurs due to hypercholesterolemia) CHOLECYSTITIS: inflammation of the gall bladder Stone: cholesterol*, bile pigments, calcium: may cause obstruction, infection stones may spread to: o common bile duct (choledocholithiasis) o pancreatic duct (pancreatitis) 6Fs: o o o o o o Female (contraceptives) Fat (obesity) Forty (low estrogen levels) Flatulence Fair Fertile (decrease estrogen, high progesterone)

MANIFESTATIONS:

TRIAD manifestations: 1) RUQ pain that radiates to midsternum, scapular area or right shoulder*** 2) Fever 3) Jaundice/ pruritus Increased bilirubin and alkaline phosphatase if with obstruction*** Urine deep orange, foamy urine, dark tea-colored urine (+) Murphys sign pain during inhalation when the physicians hand is placed on the patients RUQ abdomen Decrease ADEK bleeding (low Vitamin K) Acholic stools (pale/ gray stools/ clay-colored) Steatorrhea (no bile to emulsify the fats)

DIAG AND LAB

UTZ PROCEDURE OF CHOICE!*** ERCP (endoscopic retrograde cholangiopancreatography) Oral cholecystography

INTERVENTION Pain control o Narcotics (to decrease pain) o antipasmodics and anticholinergics (to reduce spasms and contractions of the GB)

NGT insertion gastric decompression DIET: high CHO, moderate CHON, low fat give Vitamin K as ordered

SURGICAL INTERVENTIONS: Cholecystostomy: incision into the GB for the purpose of drainage Abdominal cholecystectomy: removal of the GB for the purpose of drainage Laparoscopic cholecystectomy: removal of GB thru an endoscope inserted thru the abdominal wall Choledochotomy: incision into the CBD for removal of stones Intracorporeal lithotripsy (with the aid of endoscope stone is directly pulverized by hydraulic process)

25. CONGESTIVE HEART FAILURE 26. CORONARY ARTERY BYPASS GRAFT

Used for multiple vessel affection Sources of Grafts:*** Saphaneous vein Internal mammary artery Radial artery

27. DELIRIUM and DEMENTIA

Onset Distinguishing feature Duration Time of day Sleep-wake cycle Alertness Thinking Delusions/ hallucinations Cause and risk factors DELIRIUM Acute confusion Abrupt, sudden Reversible confusion Acute, fluctuating change in mental status may last hours to days Worsens at night Disturbed Fluctuates (may be alert and oriented during the day but become confused and disoriented at night) Disorganized, disoriented Impaired attention Alterations in memory May have tactile, auditory and visual hallucinations CVA, infections, stress, sleep deprivation, dehydration, environmental change DEMENTIA Chronic confusion Insidious, Gradual Irreversible confusion Memory impairment No change with time of day Disturbed. Fragmented. Awakes often during the night. Generally normal Judgment impaired Difficulty with abstraction and word finding Delusions. Usually no hallucinations Alzheimers disease Multiple infarct dementia

28. DIABETES INSIPIDUS and SIADH

MAIN PROBLEM NURSING DIAGNOSIS S/SX DIABETES INSIPIDUS Decrease ADH secretion Fluid Volume Deficit Decrease urine specific gravity DILUTED Dehydration, Constipation Polyuria, Polydipsia Weight loss SIADH Increase ADH secretion Fluid Volume Excess Increase urine specific gravity CONCENTRATED Edema Oliguria Weight gain

COMPLICATION

MANAGEMENT

Hypotension Hypovolemia Hypernatremia (CONCENTRATIONAL) Hemoconcentration (increase HCT) Shock DIET: Hydration - Force fluids (2 3 L/ day), IVF Regular diet Avoid foods/ beverages that exert diuretic effect (coffee, tea) Drugs: Vas opressin Monitor VS, I&O, urine SpGr, weigh daily Surgical removal of tumor

Hypertension, Hypervolemia Hyponatremia (DILUTIONAL) Hemodilution (decrease HCT) Water intoxication DIET: Restrict fluid regular diet decrease sodium intake Drugs: Diuretics (Loop and Osmotic) Demeclocycline(Declomycin) Monitor VS, I&O, urine SpGr, weigh daily Skin care Surgery (tumor excision)

29. DIABETES MELLITUS

MI in DM Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level reaches an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.

30. DIARRHEAL DISEASES

Salmonella Shigella Campylobacte r Giardia Cyrptosporidi um Clostridium difficle (CDAD) Rotavirus Norwalk virus MICROORGA NISM Bacteria Bacteria Bacteria Parasite Parasite Bacteria Virus Virus ROUTE Enteric fecal-oral Enteric/ fecal-oral sexual contact eating of raw meat. Fecal-oral Enteric (feces, swimming pools) Antibiotic-associated/ nosocomial Fecal-oral route Fecal-oral route Common: winter Self-limiting; Norwalk, Ohio common in eggs ampicillin, Cotrimoxazole (TMP-SMX), fluoroquinolones such as ciprofloxacin and of course rehydration. Self-limiting and symptomatic Hand washing, purifying/filter water Adult standard; Child contact; Supportive management

(CDAD)- Clostridium difficile associated diarrhea)

31. DUCHENNES MUSCULAR DYSTROPHY

the most common type of muscular disorder X-linked recessive (but the myotonic muscular dystrophy is autosomal dominant) Progressive Pathognomonic sign: GOWERs SIGN (observe when the patient tries to stand while bracing his feet with his upper extremities)

32. DUMPING SYNDROME

Common complication of gastrectomy S/sx:

Shock-like manifestations: diaphoresis, cold and clammy Diarrhea turn to LEFT (to delay drainage to stomach)

Position after feeding:

33. EPIGLOTTITIS
Tripod position*** Always an emergency situation Ineffective airway clearance Essential equipment for epiglottitis: tracheostomy

34. ERUPTIVE RASHES

First disease: (Rubeola, Measles, Hard measles, 14-day measles, Little AGENT Rubeola virus S/Sx

Koplik's spots (blue-white spots with a red

halo) on the buccal mucous membrane

The rash begins on the 4

th

or 5th day on the

face and behind the ears.

MMR vaccine Dim lights Respiratory precaution

Red Disease)

Second disease: (Scarlet Fever, Scarlatina)

GABHS

Maculopapules From head to feet Photophobia Tonsillitis White strawberry tongue (the tongue is coated heavily with a white membrane through which swollen, red papillae protrude) diffuse, fine erythematous rash

Contact, droplet precaution

circumoral pallor (pale area around mouth) Pastia's lines or Pastia's sign (dark,
hyperpigmented areas on the skin, especially in skin creases) fever and sore throat rash characteristic: feel of sandpaper and typically lasts five to six days. begins as discrete macules (red spots) on the face that spread to the neck, trunk, and extremities. exanthem lasts 1-3 days

Third disease: (Rubella, German measles, 3-day measles)

Rubella virus

MMR vaccine

Fourth disease: (Filatow-Dukes Disease)

caused by epidermolytic (exfoliative) toxinproducing strains of Staphylococcus aureus (Staphylococcal Scalded Skin Syndrome/ SSSS or Ritter's disease) Parvovirus

Fifth disease: (Erythema Infectiosum)

Sixth Disease: (Roseola infantum, Exanthem subitum)

Human Herpes Virus

Forscheimer's spots of pinpoint red macules and petechiae can be seen over the soft palate and uvula just before or with the exanthem. Swelling of the lymph nodes abrupt appearance of perioral erythema (+) Nikolsky's sign: Applying slight pressure with side to side movement of a finger to the skin lesions results in displacement of the epidermis from the dermis bullae or cutaneous blisters Within 7-10 days of lesion appearance the skin heals without any scarring. Secondary bacterial infections of the lesions can result in scarring. - Pruritus - low-grade fever, malaise - sore throat precede the rash - Facial erythema ("slapped cheek") - red papules on the cheeks that rapidly coalesce in hours; symmetric on both cheeks but do not cover the nasolabial fold and the circumoral region. high fever rash (maculopapular, non-pruritus) neck, trunk, arms; fades within 24 hours; appearance of the rash after the fall of the fever

Not usually hospitalized AVOID: pregnant

Standard precaution Common: spring, fall Self-limiting

FIFTHS DISEASE/ ERYTHEMA INFECTIOSUM CA: Human Parvo Virus Respiratory isolation: Airborne (more than 3 feet) S/Sx: red rash on the cheeks (slapped cheek appearance of rash) low grade fever malaise and joint pain swelling in the hands, wrists and heels Nursing diagnosis: Activity Intolerance Diagnostic test: light and electron microscopy Complication: anemia MANAGEMENT: Rest frequently, take analgesics and anti-inflammatory medications, increase iron in the diet, cover mouth when coughing or sneezing

35. EYES: OTITIS MEDIA (ear problem)

Causes: Propping the bottle Passive smoking*** Frequent tonsillitis/ Upper respiratory infection*** S/Sx:

Otalgia pulling of ear that signifies ear pain Otorrhrea

Management Myringotomy with tympanostomy tube 1st line of drug: Ampicillin 2nd line of drug: Cotrimoxazole

36. EYES: CATARACT

S/sx:

A - bsent red eye reflex B - lurring of vision C - louding of lens from inner to outer

Management: SURGERY ONLY

37. EYES: BLIND PATIENT

20/ 200 POSITION: Nurse walk one step ahead of the patient Never rearrange things (familiarization of environment)***

38. EYES: GLAUCOMA

S/sx: Tunnel vision/ PERMANENT peripheral vision loss (I cant see the person besides me.) Eye pain Halo lights*** Eye meds for life NO need for water restriction AVOID: Mydriatics (dilation)

39. EYES: POST-SURGERY

Patch AFFECTED eye Night shield at NIGHT AVOID: o Coughing o sneezing, o lifting more than 5 5lbs o bending (from waist), o prolonged watching or reading after surgery ALLOW: o bending (from knees) o sneezing (mouth open) NORMAL: mild to moderate eye pain ABNORMAL: Severe eye pain infection/ hemorrhage

40. FAILURE TO THRIVE

Weight (below 5th percentile on standard growth chart) S/Sx: Weight below 5th percentile Late developmental milestones Abdominal distention Cachexia (malnutrition with wasting) Weakness

2 Types: (1) Organic: physiologic cause (cystic fibrosis, celiac disease, GERD, CHD, kidney problem) (2) Non-organic: psychosocial cause (decrease bonding)

Management: feed on demand Diet: high CHON, high calories Small frequent feeding

41. FEVER: Types

Intermittent fluctuates between fever and normal/subnormal at least once daily (malaria) Remittent fluctuates widely but remains above normal (flu) Relapsing elevated for few days, alternating normal for 1 to 2 days, then recurs (dengue) Constant consistently high and fluctuates less (typhoid)

42. GARDIASIS (beaver fever or backpacker's diarrhea)

ROUTE: fecal oral Major reservoir hosts include beavers, dogs, cats, horses, humans, cattle and birds. It is a particular danger to people hiking or backpacking in wilderness areas worldwide. Management: metronidazole, albendazole and quinacrine; Furazolidone and nitazoxanide may be used in children.

43. Geriatric client, hearing impairment

Speak infront Talk slowly AVOID mounting (lip exaggeration)*** AVOID: high pitched voice (shouting)

44. Geriatric client, poor vision

Blind patient: 20/ 200 Stimulating color: red, orange and yellow*** Nurse walk one step ahead of the patient

45. GUILLIAN BARRE SYNDROME

acquired inflammatory disease (12 cranial and 31peripheral nerves) Bilateral, Symmetrical, Polyneuritis MANIFESTATIONS: Clumsiness - 1st sign ASCENDING PARALYSIS: progressive, bilateral Dysphagia, Dysarthria, Dyspnea Sensory findings: paresthesia, burning pain, numbness COMPLICATION: respiratory failure MANAGEMENT: Symptomatic Steroid SAFETY: Side rails Self-limiting

46. HEADACHE: Migraine

Diagnosis of migraine without aura Five or more attacks for migraine with aura, two attacks are sufficient for diagnosis. Four hours to three days in duration Two or more of the following: Unilateral (affecting half the head); Pulsating; "Moderate or severe pain intensity"; "Aggravation by or causing avoidance of routine physical activity" One or more of the following: Nausea and/or vomiting; Sensitivity to both light (photophobia) and sound (phonophobia)

The mnemonic POUNDing (Pulsating, duration of 472 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If four of the five criteria are met, then the positive likelihood ratio for diagnosing migraine Migraine should be differentiated from other causes of headaches, such as cluster headaches. These are extremely painful, unilateral headaches of a piercing quality. The duration of the common attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the preliminary signs characteristic of a migraine.

47. HEARING LOSS***

Severity of hearing loss LOSS IN DECIBELS 015 >1525 >2540 >4055 >5570 >7090 >90 INTERPRETATION Normal hearing Slight hearing loss Mild hearing loss Moderate hearing loss Moderate to severe hearing loss Severe hearing loss Profound hearing loss 30 dB 15 dB 40 dB

Critical level of loudness Shuffling of papers Low conversion

a jet plane 100 feet away 150 dB Sound louder than 80 dB is perceived by the human ear to be harsh and can be damaging to the inner ear.

48. HEPATIC ENCEPHALOPATHY

S/Sx:

Altered Level of Consciousness: memory loss, confusion to coma ASTERIXIS flapping tremor DRUG: lactulose (NH3 binding effect)

neomycin sulfate (Mycifradin) inhibits action of intestinal bacteria (that produces ammonia)

Diet: decrease protein (to reduce ammonia)

49. HEPATITIS
Hepatitis A and E fecal-oral (contaminated food and drink) Hepatitis B, C and D blood (needle stick, sex)

50. HERNIATED NUCLEUS PULPOSUS (HNP)

Protrusion of nucleus pulposus (central part of the intervertebral disc) causing spinal nerve compression Most common: L4 and L5 Causes: heavy lifting, degeneration S/Sx: Pain

Sensory disturbance: numbness, paresthesia Sciatica Lasegues sign pain on raising leg Muscle spasm in lumbar

Management:

Position: flat on bed with bed board*** Turning: log-rolling at least 3 nurses Surgery: laminectomy, chymopapain/ chemonucleolysis Heat application

51. HUNTERS SYNDROME

x-linked disorder deficiency in I2S (iduronate 2-suitatase), which is responsible in breaking down polysaccharide S/Sx: ivory-colored skin lesions on the upper back and sides of the upper arms and thighs short neck, broad chest, too large head progressive deafness atypical retinitis pigmentosa

52. HYPERKALEMIA: management Management for hyperkalemia is G.I.C.K.S. + D2

G lucose (D50) I nsulin C calcium replacement (to force potassium back in the IC compartment) K ayexalate enema (retain enema for 30 minutes to allow for sodium exchange; afterward, expect client to have diarrhea.) S odium bicarbonate + DIALYSIS DIURETICS

53. HYPERTHYROIDISM AND HYPOTHYROIDISM

HYPOTHYROIDISM (myxedema, Hashimotos disease, cretinism: children) Decrease T3 decrease BMR, wt. Gain Decrease T4 decrease body heat production, catabolism Decrease Thyrocalcitonin increased serum calcium Decrease GI motility (constipation) Decrease Appetite increased lypolysis atherosclerosis MI Decrease VS (Cold intolerance, bradycardia, hypothermia most fatal) Decrease Energy (fatigue, lethargy, hypoactive) Decrease Metabolic rate Decrease SKIN moist (dry, brittle/ coarse hair/ skin) Increase weight (fluid retention, edema) Increase menstruation (menorrhagia) Monitor VS, I&O (to determine myxedema coma) DIET: Low calorie, High fiber Increase fluid intake/ IVF (constipation) or decrease fluids (edema) High CHON, Low CHO, Low FATS Skin care Warm environment HYPERTHYROIDISM (Graves disease, Parrys disease, Basedows disorder, Toxic diffuse goiter, Thyrotoxicosis) Increase T3 increase BMR, increase VS Increase T4 increased body heat production Increase Thyrocalcitonin decreased serum calcium Increase GI motility (diarrhea) Increase Appetite Increase VS (Heat intolerance, tachycardia) Increase Energy (Restlessness, nervousness, tremors insomnia) Increase Metabolic rate Increase SKIN moist (diaphoresis) Decrease weight (tissue wasting) Decrease menstruation (amenorrhea) Exopthalmus Monitor VS, I&O (to determine thyroid storm) DIET: High calorie, Low fiber Increase fluids High CHON, High CHO, High FATS SFF Skin care Cool environment

MAIN PROBLEM

S/SX

MNGT

Sx: SUBTOTAL THYROIDECTOMY DRUG Lifetime thyroid hormone (Levothyroxine (Synthroid)) a. SE: insomnia Atrophine SO4, isopreterenol (bradycardia) Diuretics (edema) Stool softeners/ laxatives (constipation) NOTE: never give SEDATIVES, narcotics, other CNS depressants

Radioactive iodine ( I) therapy Anti-thyroid agents (Thionamides): Propylthiouracil

131

(PTU), Methimazole (Tapazole)

Beta blockers: Propranolol (Inderal) IODIDES: KISS: Potassium Iodide Saturated solution
(lugols solution)

Steroids: Dexamethasone Digitalis, Ca+ blockers, Antidiarrheal

THYROTOXIC CRISIS (THYROID STORM) S/Sx: Fever, Agitation, Tachycardia

COMPLICATI ON

MYXEDEMA COMA S/Sx: Hypothermia, Hypoventilation, Altered LOC leading to coma, Bradycardia

54. HYPOPARATHYROIDISM AND HYPERPARATHYROIDISM

HYPOPARATHYROIDIS M Decrease Calcium Increased Phosphate Tetany (Chvostek and Trousseau) Laryngospasm Paresthesia High calcium diet Low phosphate diet Calcium gluconate AlOH (Amphogel) Seizure HYPERPARATHYROI DISM Increase Calcium Decreased Phosphate Bone pain/ fracture Renal colic Anorexia, nausea and vomiting Low calcium diet High phosphate diet Calcitonin Furosemide Renal stones

MAIN PROBLEM S/SX DIET DRUGS COMPLICATI ON

FOODS high in CALCIUM: Milk

Orange*** Yogurt Spinach

ANTACID: Aluminum hydroxide (Amphogel), given in HYPOparathyroidism Antacid but the side effect is phosphate binder DIURETIC: Furosemide (Lasix), given in HYPERparathyroidism Diuretic that eliminates calcium as well as sodium and potassium in urine

55. INCREASED INTRACRANIAL PRESSURE

Cushings manifestations: Increased BP and MAP Decreased RR and PR Wide pulse pressure Management: Position: high-fowlers position

AVOID: Straining/ constipation, Lifting heavy objects IV fluid: hypertonic*** DRUGS: mannitol

56. JUVENILE RHEUMATOID ARTHRITIS (JRA)

Autoimmune inflammatory disease cause is antibodies Idiophatic JRA cause is unknown S/Sx: J Joint swelling and pain R Redness and warmth A A.M. stiffness Insist to be carried Management: J Junk excess weight R ROM (range of motion exercises) A Aspirin, Apply moist heat NSAIDS, Methotrexate Priority nursing diagnosis: Pain r/t inflammatory process Complication: loss of vision (due to iridocyclitis) Referral: ophthalmologist (evaluate iridocyclitis)*

Sport: hanging on monkey bars, water exercises

57. LATEX ALLERGY

FOODS: Avocado Potatoes Bananas Passion fruits Chestnuts Tropical fruits (mango) Kiwi fruits Strawberry Grapes Soy beans Pineapple Catheters, rubbers, condom, balloons Contraindicated with spina bifida patients Assess for signs and symptoms: STRIDOR (best option) harsh, high pitch sound caused by air passing through constricted air passages Urticaria Wheezing Watery eyes

Non-latex gloves vinyl gloves Non-latex balloon mylar balloon

58. LEGIONNAIREs DISEASE

Severe form of pneumonia Causative Agent: Legionella pneumophila gram (-) bacteria Convention of American Legion in Philadelphia, January 18, 1977 Common: man-made and naturally occurring water sources aerosolized route (like respiratory therapy equipment)

air conditioning units

S/Sx: flu-like manifestrations/ pneumonia-like manifestations DOC: Azithromycin (Zithromax)

59. LEGG-CALVE-PERTHES
Aseptic, avascular necrosis of the femoral head treatment: traction for 2-4 years self- limiting S/Sx: L limping due to synovitis C contracture deformities P pain from the knee to the groin; aggravated by activity but relieved by rest; stiffness in the morning or after rest D dislocation (complication) Management: Initial: reduce inflammation, restore motion Goal: keep the femoral head in contact with acetabulum Keep the leg abducted Avoid weight bearing Traction: 2 to 4 years

60. LEUKEMIA
Most common cancer in pediatric clients Increased immature WBC Decrease matured WBC risk for infection Decrease RBC activity intolerance Decreases platelets risk for bleeding

61. LIVER CIRRHOSIS

Most common type: Laennecs cirrhosis (due to alcohol) repeated destruction of hepatic cell scar tissue formation (fibrotic) cycle (scarring and regeneration) hardening and shrinkage of the cell obstruction of blood flow

increase resistance/ pressure in the portal vein congestion in the portal system PORTAL HYPERTENSION Portal HPN, Increase collateral circulation Caput medusa (dilated veins over the abdomen) Hepatomegaly, Spleenomegaly Hemorrhoids Ascites and edema (unable to metabolize protein) Spider angioma/ telangiectasia (dilated vein/capillaries over the face and trunk) Esophageal varices, GI bleeding Leg varicositites

62. LYMEs DISEASE vs ROCKY MOUNTAIN SPOTTED FEVER

Not communicable from one person to another
Cause S/Sx Carrier Treatment LYMEs DISEASE Spirochete Borrelia Burgdorferi Bulls eye rash Deer tick (white-tailed deer/ white-footed mice) Doxycycline (Vibramycin) Diethytoluamide (DEET) Permethrine Summer Stage I flu like + rashes Stage II neurlogic deficits (bellspalsy, paralysis) and heart conduction defects Lyme , Connecticut Northeast (Massachusetts to Maryland), Midatlantic states (Winconsin to Minnesota) ROCKY MOUNTAIN SPOTTED FEVER Rickettsia rickettsii Diffused rash (maculopapular/ petechial rash) Dog tick, wood tick, rabbit tick Doxycycline (Vibramycin)/ Tetracycline; Chloramphenicol; Diethytoluamide (DEET) Permethrine Spring

WHEN common

Snake River Valley, Idaho

63. MARFAN SYNDROME

Caused by mutation of fibrilin gene S/Sx: arachnodactyly (elongation of fingers) muscular underdevelopment joint hypermobility Complication: Aortic Aneurysm, blindness (eye lens dislocation), kyphoscoliosis Priority: SAFETY

long extremities, tall and lanky

64. MENIEREs DISEASE (endolymphatic hydrops)

Dilation of the endolymphatic system by overproduction or decreased reabsorption of the endolymphatic fluid TRIAD manifestations: 1. tinnitus 2. vertigo 3. lateral sensorineural hearing loss Management: Administer nicotinic acid (niacin) as prescribed for its vasodilator effect Restrict water, low sodium diet Streptomycin (to eliminate vertigo)

65. MRSA (methicillin-resistant Staphylococcus aureus)

2 types of infection: Hospital-associated MRSA happens to people in healthcare settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling. Practice good hygiene Keep cuts and scrapes clean and covered with a bandage until healed AVOID: contact with other peoples wounds or bandages sharing personal items, such as towels, washcloths, razors, or clothes Wash soiled sheets, towels and clothes in hot water with bleach and dry in a hot dryer DOC: Linezolid, Vancomycin

66. MUSCULAR DYSTROPHY

Progressive degeneration of skeletal muscles Inherited

Duchennes muscular dystrophy (pseudohypertrophic muscular dystrophy) S/Sx: Gowers sign (standing) Pseudohypertrophy: woody on palpation, look enlarged

Management: Diet: low calorie, high protein (tom prevent obesity) high fiber and high fluid (to prevent constipation) death is due to respiratory or heart failure

DUCHENNES MUSCULAR DYSTROPHY

X-linked recessive (defective gene: dystorphin protein) Rapidly progressive muscular weakness and atrophy Gowers sign (standing) self- splinting NO cure!

67. MYELOSUPPRESSION THROMBOCYTOPENIA Petechiae ANEMIA Fatigue NEUTROPENIA Fever and sore throat

68. MYOCARDIAL INFARCTION

Cardiac enzymes after 1 hour Myoglobin after 2 hour Troponin after 4 hour CPK-MB after 24 hour LDH ECG changes Pathologic Q wave

ST elevation*** T wave inversion

Effects of Morphine in MI Reduces pain and anxiety

Reduces preload and afterload*** Reduces workload Relaxes bronchioles Lowers BP Depressed respiration

69. NEPHRITIS (Nephritic Syndrome) and NEPHROSIS (Nephrotic Syndrome)

NEPHROSIS (NEPHROTIC SYNDROME) Increase glomerular membrane permeability Autoimmune Hypoalbuminemia Proteinemia Hyperlipidemia Edema (anasarca) DIET: high protein, low sodium, decrease OFI Ambulate Normal BUN = 10 20 Normal creatinine 0.4 1.2 NEPHRITIS (NEPHRITIC SYNDROME) Inflammation of the kidneys GABHS Hematuria (gross) Edema (periorbital) HPN Proteinuria Oliguria/ Anuria Increase BUN/ creatinine DIET: low sodium, decrease OFI Bed rest

70. OBSTRUCTIVE SLEEP APNEA (OSA)

OSA is the most common type of sleep apnea syndrome Cause: Obesity Old men Smoking Pathophysiology: decrease diameter of the upper airway S/Sx:

Insomnia Snoring Morning headaches Hypertension Enuresis

Complications:***

CAD, HPN CVA Premature death MI, dysrhythmias

Management: AVOID: sleeping in supine, alcohol Lose weight

71. ORTHOSTATIC HYPOTENSION

An increase in PR of 15 to 30 bpm OR A decrease in BP of 20 mmHg in systole and 10 mmHg in diastole BP falls when client sits or stands

72. OSTEITIS DEFORMANS (PAGETs DISEASE)

affects skeletal system Management: Alendronate (Fosamax) Monitor: alkaline phosphate (increase: bone problem) affects men and women with familial predisposition S/Sx: joint pain Chronic headache Cartilage damage Nerve pressure

73. OSTEOGENESIS IMPERFECTA

Problem in collagen (collagen protein of connective tissues) Pathologic fractures due to connective tissue and bone defects Autosomal S/Sx:

Normal serum calcium and phosphate Abnormal pre-collagen type 1* (major component of collagen) prevents formation of collagen Multiple/ frequent fractures Blue sclera

Management: Drugs:

Calcitonin aid in bone healing Biphosphonates increase bone mass Exercise (swimming) to improve muscle tone and prevent obesity

74. OSTEOMYELITIS
Cause: Staphylococcus aureus Open wounds(compound fracture, surgery) S/Sx: Fever Pain Redness Swelling Drainage Necrosis (sequestrum) Management: Incision and drainage Sequestrectomy Immobilize***

75. OSTEOPOROSIS
Decrease in bone amount. Density Cause: 1. Primary (non-modifiable cause) senile, menopausal (decrease estrogen)

2.
S/Sx:

Secondary (modifiable cause) malnutrition, immobilization, decrease exercise

Loss of height (kyphosis) Dowagers hump*** Low back pain

Lung problem

Management: Brisk walking for 30 minutes, 4x/ day Lifestyle: stop smoking, decrease alcohol and caffeine Drugs: o Calcitonin/ Calcitriol o Biphosphonates: akendronate (Fosamax) o Hormonal replacement therapy: estrogen

76. PANCREATITIS
Acute pancreatitis can become chronic PAIN associated with acute pancreatitis is:*** a. severe and unrelenting b. located in the epigastric region

c. radiates to the back AVOID: Morphine sulfate is not used to treat pain since it can cause the sphincter of Oddi to spasm enteral feedings (it stimulates the pancreas) MANAGEMENT:
Position: Side-lying to lessen the pain Meperidine (Demerol) Pancreatic enzymes and bile salts with meals*** IV fluids (to prevent shock) insulin for hyperglycemia calcium replacement decrease stimulation of pancreas o NPO-TPN (nothing by mouth; total parenteral nutrition) o NG tube

o o

anticholinergics H2-receptor antagonists

77. PARKINSONs DISEASE

Tremors (resting and pillrolling) Rigidity (cogwheel) Akinesia/ Bradykinesia Mask like face

78. PEMPHIGUS VULGARIS

cause: unknown presence of fluid-filled vesicles over 1 cm in size associated with an autoimmune response S/Sx: Hallmark: Nikolskys sign when the epidermis is rubbed off by slight friction or injury pain, dysphagia, skin lesion: bullae rupture easily, foul-smelling drainage Laboratory data: increase WBC Nursing diagnosis: PAIN Management: potassium permanganate Oatmeal bath decrease pruritus

79. PEPTIC ULCER DISEASE

Risk factors: Helicobacter pylori*** NSAIDS Iron Steroids Smoking and alcohol Stress

80. PERICARDITIS*** Pain is aggravated by: Cough*** Deep inspiration (so the patient do shallow inspiration)***
swallowing food lying down turning

Characteristic of breathing pattern: Shallow Position to relieve pain: sitting and leaning forward (orthopneic)***

81. PHEOCHROMOCYTOMA
Tumor of adrenal MEDULLA Main problem: increased production of catecholamines (epinephrine and norepinephrine) S/Sx: HPN Hyperhydrosis High PR

82. PITUITARY GLAND

Anterior

o o o o o o

Prolactin/ lactotropin TSH (thyroid stimulating hormone) GH (growth hormone)/ somatotropin*** GnRH (gonadodropin releasing hormone) FSH (follicle stimulating hormone) LH (luteinizing hormone) MSH (melanocytes timulating hormone) ACTH (adrenocorticotropic hormone)

Posterior o Oxytocin/ vasopressin

ADH (antidiuretic hormone)

83. PNEUMOTHORAX
Air in the pleural space Types: o Spontaneous/ Simple o Traumatic Closed Open o Tension S/Sx:

o o o o

Percussion hyperresonance*** Palpation absent/ decreased fremitus Auscultation decreased breath sounds Inspection asymmetry

84. POLYCYTHEMIA VERA

S/Sx:***

o o o
o o

Ruddy complexion d/t capillary congestion in the skin and mucous membranes Splenomegaly d/t organ infiltration Hypertension d/t viscosity of blood Generalized pruritus (due to basophils)*** Elevated Hct, bilirubin, liver enzymes Elevated RBC, WBC and platelets all immature

Complications: o Thrombus formation Brain: CVA

o
o

Heart: MI, Heart failure Bleeding due to congestion and overdistention of capillaries and venules shock Peptic ulcer due to increased gastric secretions Gout due to increased uric acid released by nucleoprotein

Management o Increase fluids o Phlebotomy removal of excess blood then DISCARD*** o Drugs: Nitrogen mustard, busulfan, chlorambucil, cyclophosphamide to effect myelosuppression AVOID: IRON rich foods*** will enhance the production of RBC

Radioactive phosphorus (32P) reduces RBC production

85. PREGNANCY: DISCOMFORTS OF PREGNANCY

ASSESSMENT Nausea and vomiting (morning sickness) 1 NURSING MANAGEMENT Eat small frequent meals eat dry crackers on arising may occur any time of day Breast soreness1 Well-fitting bra decrease caffeinated and carbonated drinks Nasal stuffiness1 Use cool air vaporizer increase fluid intake place moist towel on the sinuses Ptyalism1 Use mouthwash as needed chew gum or suck on hard candy Urinary frequency1 & 3 Kegels exercise decrease fluids before bed report signs of infection, avoid caffeine Constipation2 & 3 Increase fiber on the diet drink additional fluids have a regular bowel movement Leg Cramps2 & 3 Increase calcium intake avoid pointing your toes, flex feet, local heat application Backache2 & 3 Emphasize posture careful lifting, good shoes (low heeled) stoop to pick up objects Heartburn2 & 3 Small, frequent meals avoid overeating, as well as spicy and fatty foods Dizziness2 & 3 Slow, deliberate movements support stockings lie on left side when at rest Ankle edema2 & 3 Rest with your feet elevated avoid restrictive garments on the lower half of the body Fatigue2 & 3 Schedule a rest period daily use extra pillow for comfort Hemorrhoids2 & 3 Avoid constipation and straining with bowel movement take a sitz bath apply witch hazel compress Varicose veins2 & 3 Walk regularly rest with feet elevated avoid long periods of standing do not cross your legs *1- first trimester; 2-second trimester; 3-third trimester

86. PREGNANCY: SIGNS

Presumptive Signs and Symptoms (FUNQPAB) - suspicion not proof, predominantly subjective Fatigue response to increased hormonal levels Urinary frequency caused by pressure of expanding uterus in the bladder Nausea and vomiting (morning sickness) Quickening - sensations of fetal movement in the abdomen) - occurs between the 16th and 20th week after the onset of the last menses. Pigmentation of the skin Melasma gravidarum (Chloasma) mask of pregnancy Abdominal striae (striae gravidarum) due to stretching, rupture and atrophy of deep connective tissues of the skin Linea nigra Amenorrhea cessation of menses Breast changes enlarge and become tender Probable Signs and Symptoms (+ BBLUE HCG) - increased suspicion but still no proof, no subjective data Positive hCG laboratory (urine or serum) test for pregnancy. Ballottement - sinking and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus (occurs near midpregnancy). Braxton Hicks contractions - painless, palpable contractions occurring at irregular intervals, more frequently felt after 28 weeks. They usually disappear with walking or exercise. Leukorrhea - increase in vaginal discharge Uterine changes from pear shape to spherical around 8 weeks gestation and becomes ovoid from 16 weeks until term Enlargement of abdomen - at about 12 weeks' gestation, the uterus can be felt through the abdominal wall, just above the symphysis pubis Hegar's sign - lower uterine segment softens 6 to 8 weeks after the onset of the last menstrual period. Chadwick's sign - bluish or purplish discoloration of cervix and vaginal wall. Goodell's sign - softening of the cervix; may occur as early as 4 weeks Positive Signs and Symptoms (4 Fs) - definite signs of pregnancy Fetal heart tones (FHTs) usually heard between 16th and 20th week of gestation with a fetoscope or the 10th and 12th week of gestation with a Doppler stethoscope Fetal movement felt by the examiner (after about 20 weeks gestation) Fetal body outline through the maternal abdomen in the second half of pregnancy. Fetal sonographical evidence (after 4 weeks' gestation) using vaginal ultrasound. Fetal cardiac motion can be detected by 6 weeks' gestation

87. PREGNANCY: smoking

Effects:

Congenital heart defects SGA Respiratory distress Premature death SIDS

88. PRURITUS
Bathe in tepid water and apply emollient lotion AVOID soaps and detergents AVOID petroleum, mineral oil Use calamine, antihistamine Provide cool, light, nonrestrictive clothing Keep nails short Apply cool and moist compress

89. RENAL FAILURE

Causes: 1. Pre-renal due to DECREASED RENAL PERFUSION Shock, DHN, CHF, burns, hypovolemia 2. 3. Intra-renal due to KIDNEY INJURY UTI, DM, BT, nephritis Post-renal due to KIDNEY TRACT OBSTRUCTTION Cystitis, calculi, BPH

90. RENAL STONES

Type of stones: Alkaline stone calcium oxalate, struvite Acidic stone uric acid, cystine Calcium oxalate stone most common kidney stone Location:*** UPPER GU tract (kidney, ureter) flank pain radiating to abdomen LOWER GU tract (bladder, urethra) inguinal (groin) pain radiating to testicular or labial Characteristic of pain (renal colic) Sharp and Sudden*** KUB Xray CONFIRMATORY*** Sources of Oxalate: dark green vegetables (spinach) rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

91. SEIZURES
Priority DURING: safety Priority AFTER: airway Seizure Precaution P osition: side-lying L oose the clothings A VOID: resrictions N ote: duration and characteristics of the seizure O xygenate: jaw-thrust D rugs: diazepam,phenytoin, carbamazepine R emove harmful objects at the bedside

A t the bedside: suction machine P ad and raise the side rails E liminate environmental stimuli (bright lights, noise)

92. SHOCK Reduction of arterial pressure leading to decrease blood flow (deficiency in nutrients, oxygen, electrolytes delivery
to tissue, as well as waste removal) Types:

Cardiogenic loss of cardiac pumping action (MI, CHF)

Hypovolemic decrease blood volume (burns, bleeding/ hemorrhagic shock, dehydration) most common Distributive/ Circulatory

Neurogenic (SCI, drug depressants) Vasogenic massive vasodilation

Stages:

Anaphylactic massive reaction to food, drugs and chemical Septic Septic massive infection

COMPENSATORY Normal BP Increased RR and PR cold clammy skin oliguria hypoactive bowel sounds

PROGRESSIVE Decreased BP Increased RR and PR Altered LOC Oliguria increased BUN and Creatinine stress ulcers and increased risk for GI bleeding. metabolic acidosis (due to accumulation of lactic acid)

IRREVERSIBLE severe organ damage

o o o

Common manifestations:*** Decrease BP, MAP (Mean Arterial Pressure) Increase RR, PR Narrow Pulse Pressure Position: modified trendelenburg*** In neurogenic shock, the patient is also at an increased risk for deep vein thrombosis. Major cause of septic shock gram-negative bacteria First drug to be given for SHOCK Epinephrine

The degree of cardiogenic shock is proportional to the extent of left ventricular dysfunction.***

93. SJOGRENs SYNDROME

Chronic, inflammatory autoimmune process that affects lacrimal glands and salivary glands MAIN CONCEPT: dryness S/Sx: xerostamia (dry mouth), xerodermia (dry skin), dysparenuria

94. STILLBORN CHILD

Management: Parents need to see, touch, wash, and dress baby Get footprints, pictures, lock of hair, ID band, name the child and use the name often. If they dont see their baby; the parents often never face reality and stuck in the grieving process.

Again, encourage to hold, rock, and cuddle their baby. Allow and encourage them to take photos of their angel.

95. STRABISMUS
Lack of coordination of the extraocular muscles causing misalignment of the eye Normal in infant up to 4 months only Management: OCCLUSIVE THERAPY patch the good eye (to strengthen the weak eye)

96. SUDDEN INFANT DEATH SYNDROME (SIDS)

Causes: smoking, drinking, or drug use during pregnancy poor prenatal care prematurity or low birth-weight mothers younger than 20 tobacco smoke exposure following birth overheating from excessive sleepwear and bedding stomach sleeping

97. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling manifestations

Steroids Plasmapharesis***

98. TETRALOGY OF FALLOT

Severe acute ccyanosis tet spells 4 Defects:*** o Pulmonic Stenosis o Right Ventricular Hypertrophy o Ventricular Septal Defect o Overridding of the Aorta Position: Knee-chest/ Squatting*** S/Sx: o o o Machine-like murmurs Clubbing of fingers Cyanosis

Management: o Surgery: Blalock Taussig procedure shunting of the subclavian artery and pulmonary artery

99. TRIAGE
trier- to sort To sort patients in groups based on the severity of their health problem and the immediacy with which these problems must be addressed 3 CATEGORIES IN TRIAGE in E.R.
EMERGENT Color Urgency Examples Red Life, limb, eye threatening Needs immediate attention Chest pain, cardiac arrest, severe respiratory distress, chemicals in the eye, limb amputation, penetrating trauma, severe hemorrhage URGENT Yellow Needs treatment in 20 minutes to 2 hours Fever >40oC, simple fracture, abdominal pain, asthma with no respiratory distress NON-URGENT Green Can wait hours or days sprain, minor laceration, rash, simple headache. Toothache, sore throat

Number Color Examples

4 CATEGORIES IN TRIAGE in DISASTER DELAYED MINIMAL 1 2 3 Red Yellow Green Chest wounds, shock, Stable abdominal wound, Minor burns, minor open fractures, 2-3 burns eye and CNS injuries fractures, minor bleeding IMMEDIATE

EXPECTANT 4 Black Unresponsive, high spinal cord injury

100.

TURNER SYDNROME vs KLINEFELTER SYNDROME

TURNER SYNDROME (Gonadal Dysgenesis) Females KLINEFELTER SYNDROME males

Absent X chromosome (X0) Extra X chromosome (XXY) Neck webbing; Non-develop reproductive organ; no secondary sex characteristics no secondary sex characteristics short neck Short stature Small testicles Webbed neck Sterility Infantile genitalia Gynecomastia Amenorrhea/ sterility Hypogonadism (low testicular Widely spaced nipple/ broad chest hormone) Failure o secondary sex characteristics High follicle-stimulating hormone/ at puberty LH Mngt HORMONAL REPLACEMENT (Estrogen HORMONAL REPLACEMENT therapy secondary sex characteristic) (Testosterone) Growth hormone Others No secondary sex characteristics No treatment - refer to geneticist (reproductive problem)

STATISTI CS CAUSE S/Sx

101.

VANCOMYCIN RESISTANT ENTERROCOCCUS (VRE)

A mutation of very common bacterium that is spread easily by direct person-to-person contact S/Sx: There are no specific signs and symptoms related to VRE NURSING DIAGNOSIS: Risk of infection (transmission) MANAGEMENT: Explain to the patient the importance of hand washing to prevent the spread of the infection.

102.

VENOUS DISORDERS, Management:

Elevate legs

Exercise legs Early ambulation Elastic stockings

103.

VON WILLEBRANDS DISEASE

with bleeding deficiency with Von Willebrands factor (factor VIII) and platelet dysfunction autosomal dominant like hemophilia (Hemophlia 8, 9, 11) affects: males and females Inherited as a dominant trait and affects both sexes equally S/Sx: B bruising A abnormal menstruation B bleeding during tooth extraction E epistaxis Management: Bleeding precaution

Cryoprecipitate (contains factor VIII, fibrinogen and factor XIII )

Check for: coagulation profile Desmopressin (DDAVP) to prevent bleeding associated with dental or surgical procedures, intranasally increase production of Von Willebrand factor

104.

WEST NILE VIRUS/ WEST NILE ENCEPHALITIS

natural reservoir of virus: birds mosquito bite (Culex species) human (dead end host) NO human-to-human, NO bird-to-human transmission Management: -none-, fluid replacement, airway management