LETS DO SOME DRILLS

Complications

diarrhea Leukemia Addisons Cushings Sickle cell anemia Valvular disease Cystic fibrosis Gonorrhea Herpes and HPV Kissing disease Meningitis GABHS infection Pancreatitis Phenylketonuria and cretinism Polycythemia vera PIH and Preeclampsia vomiting

Dehydration and met acidosis Infection and bleeding Shock Fluid overload (anasarca) MI and CVD CHF Permanent sterility Pelvic inflammatory disease Cancer of the cervix Spleenic rupture Auditory damage RHD and AGN Destruction of beta cells Mental retardation MI and CVD Abruptio placenta Met alkalosis

Diets
AGN Addisons Cushings Pernicious anemia Sickle cell anemia Angina Gouty arthritis ADHD and bipolar Burns Celiacs dse Cystic fibrosis Bedsores DM Dumping syndrome Hepatic encephalopathy Hepatitis Liver cirrhosis Hirschprungs dse

Low Na, Low CHON High Na, low K Low Na, high K Vit B12 injections monthly High fluids Low cholesterol Purine restricted Finger foods high CHON, high Cal, high vit Gluten free (BROW) High Na High CHON, high vit Well balanced Low CHO, dry diet Low CHON High CHON Low CHON Low residue

Diets

Hyperthyroidism Hypothyroidism Hyperparathyroidism Hypoparathyroidism Menieres dse Cholecystitis Pancreatitis Phenylketonuria PIH Renal Failure Tonsillitis

High cal, low residue Low cal, low chol Low Ca High Ca Low Na Low fat Low fat Low phenylalanine High protein Low CHON, Na, K Soft diet

Bedside

Amputation Autonomic dysreflexia CTT CVA Parkinson's Myasthenia gravis Epiglotitis and Croup Thyroidectomy DVT and ascites Radium implant Sengstaken-blakemore Tonsillectomy Tracheostomy tube

Tourniquet Catheter Clamp, bottle, vas gauze Suction Suction ET and tracheostomy ET and tracheostomy Tracheostomy, Ca Tape measure Lead container, forceps Scissors Flashlight Obturator and hemostat

Positioning

AAA Air embolism Appendicitis, unruptured Appendicitis ruptured Asthma Cardiac catheterization Casting Cleft lip Cleft palate CHF CVA Dumping syndrome GERD Epistaxis Flail chest Hemorroidectomy Hip replacement

High fowlers Trendelenburg, slightly left Position of comfort High fowlers Orthopneic Affected extremity extended Elevate extremity Opposite side or Supine Prone High fowlers Elevate HOB or side lying Supine after meals Upright position after meals Leaning forward Affected side on bed Side-lying Abduction of legs

Positioning

Laminectomy, slip disk Liver biopsy Lobectomy Pneumonectomy Lumbar puncture Mastectomy Placenta previa bleed Postural drainage Prolapsed cord Pulmonary edema Pyloric stenosis Seizure Shock Thrombophlebitis Varicose veins Thyroidectomy Tracheoesophageal fistula

Keep as straight as possible Left during, Right after Unaffected side down Affected side down Knee-chest, flat on bed after Elevate affected extremity Bed rest Segment to drain upwards Knee-chest High fowlers Right side lying Side lying or prone Trendelenburg Elevate extremity Elevate extremity No flexion or hyperextension upright

Laboratory data
AGN Leukemia Addisons Cushings AIDS Gouty arthritis Rheumatoid arthritis Prostate cancer Colorectal cancer Cystic fibrosis DM Hemophilia Hepatic encephalopathy Hyperthyroidism hypothyroidism

High ASO titer, BUN, Crea High WBC, low RBC & PLT Low Na & glucose, high K High Na & glucose, low K (+) ELISA and western blot High uric acid High RF & ANA, high ESR High PSA High CEA High NaCl on sweat Hyperglycemia Prolonged bleeding time Elevated BUN High T3, T4 Low T3, T4

Laboratory data

Hypoparathyroidism Hyperparathyroidism Liver cirrhosis Multiple myeloma MI Pancreatitis Polycythemia vera Renal failure Rheumatic heart dse Met acidosis Met alkalosis Respi acidosis Respi alkalosis Low Ca High Ca High SGPT, SGOT Low WBC, RBC, PLT, High Ca High troponin, Ck, LDH, SGOT Hyperglycemia, high amylase High RBC High BUN, Crea, Na, K low Ca High ASO titer Low pH, low bicarbonate High pH, high bicarbonate Low pH, high CO2 High pH, low CO2

History

AAA AGN AIDS or HIV Breast cancer Cervical cancer Laryngeal cancer Cystic fibrosis & hirschprungs Cholecystitis Liver cirrhosis & pancreatitis PID RHD Hypertension Sore throat Multiple sexual partners 1st child after 35 Herpes or HPV infection Smoking, teacher Meconium ileus Intolerance to fatty food Alcoholism STD Sore throat

Initial manifestation
AGN Alzeimers Anemia Sickle cell anemia Angina Arthritis BPH Bladder cancer Breast cancer Cervical cancer Esophageal cancer Laryngeal cancer Cataract CHF Congenital hip dislocation

Edema & tea colored urine Memory loss, forgetfulness Fatigue Growth retardation Chest pain Morning stiffness Dec force & flow of urine Painless hematuria Lump or mass Painless vaginal bleeding Dysphagia Hoarseness Blurred vision, glare Dyspnea or edema Affected leg is shorter

Initial manifestation
Cystitis DM GBS MS MG Liver failure GERD Hypocalcaemia Hypokalemia Hypoxia Increased ICP Menieres dse Parkinsons dse Retinal detachment Tardive dyskinesia

Burning upon urination Polyuria, polydipsia Clumsiness Diplopia Muscle weakness Personality change, asterixis Heartburn after eating Tingling and muscle twitch Parasthesia Restlessness Widening pulse pressure Vertigo Pill rolling movement Visual floaters Lip smacking

LETS INTEGRATE SIGN AND SYMPTOMS

PAIN
Dull abdominal or low back pain associated with

a pulsating abd mass Ans : AAA Squeezing, burning, choking pain relieved by rest or nitroglycerine Ans: Angina Squeezing, burning, choking pain relieved by morphine Ans : MI

PAIN
Rebound tenderness at Mcburneys point Ans : Appendicitis RUQ pain radiating to R shoulder,
associated with fat intake Ans: Cholelithiasis LUQ pain radiating to L shoulder Ans : Spleenic rupture

PAIN
Gnawing, burning aching pain 3hrs after
eating relieved by food intake Ans : duodenal ulcer Gnawing, burning aching pain 30min after eating relieved by vomiting Ans: gastric ulcer Sudden sharp knife like unilateral abd pain Ans : ectopic pregnancy

Alopecia
Endocrine disorder
Cancer therapy

Hypothyroidism
Chemotherapy and
radiation therapy

amenorrhea
Endocrine disorder
Psychiatric d/o

Hypothyroidism
Anorexia nervosa and
bulimia nervosa

Amnesia
Psych d/o
Psych treatment alcoholism

Alzheimer's(dementia)
ECT Wernickes and
korsakoffs

 Barrel chest Absent bowel

sounds Brudzinski & kernigs Buffalo hump Butterfly rash

COPD Paralytic Ileus Meningitis, brain

hemorrhage Cushings SLE

Paradoxical chest

Flail chest Hypocalcemia Hypocalcemia Parkinson's

movement Chvosteks & trousseaus Carpopedal spasm Cogwheel rigidity

Diplopia Vertigo (ear dse) Absent Dolls eye Exopthalmos Halo vision Green halo vision Heat intolerance Painless Hematuria Hoarseness of voice Hiccups Hirsutism & virilism Homans sign

MS and MG Menieres Brain stem damage Hyperthyroidism Glaucoma Digitalis toxicity Hyperthyroidism Bladder cancer Laryngeal cancer Pacemaker failure Cushings DVT

 Moon face Night blindness Nuchal rigidity

Orthostatic
hypotension Chest retractions

Cushings Vit A deficiency Meningitis and

Sunset eyes Bossing sign

encephalitis Hypovolemia and Addison's Asthma, epiglottitis, croup Hydrocephalus hydrocephalus

 Intention tremors MS Resting tremors or pill Parkinsons

rolling tremors Flapping tremors Trismus Decreased caliber of urine Projectile vomiting

Asterixis Tetanus & rabies BPH Inc ICP & pyloric

stenosis

Stool

Clay or gray colored Steatorrhea Currant jelly Ribbon like Hematochezia Melena Alternating diarrhea and constipation

Biliary dse Pancreatitis Intussuception hirshprungs Lower GI bleed Upper GI bleed CA of the colon

LETS COMBINE EVERYTHING

Abdominal aortic aneurism

Problem: Pulsating abdominal mass S/S: Pulsating abd mass on palpation Best Lab: UTZ Intervention: Dont perform? Abd palpation

Abruptio placenta

Problem: Premature separation of the placenta S/S: Dark red vaginal bleeding, peritonitis Best Lab: UTZ Complication: Shock and DIC

Diarrhea

Problem: Increased passage of liquid stools S/S: Loose watery stools Lab: Met acidosis Intervention: Fluid replacement (pedialyte and Oresol)

AGN
Problem: Damage to kidneys filtering system S/S: Cola urine, edema Lab: High crea, BUN, ASO titer Interventions: Infection and injury precautions Diet: Low CHON, Low Na DOC: Steroids

Leukemia

Problem: Carcinoma of the WBC S/S: Fatigue, bruising, freq infxn Best Lab: Biopsy of bone marrow (WBC high) Interventions: Infection and bleeding precautions

AIDS

Problem: Degeneration of the immune system S/S: Non-specific catarrhal symptoms for 1 month Lab: ELISA and Western blot, CD4 counts Intervention: Infection precautions, Safe sex

Addisons disease

Problem: Hypo functioning of the adrenal glands S/S: Thin, hypovolemia, bronze discoloration of skin Lab: Low Na and glucose, high K Intervention: Prevention of shock, infection precautions, fluids and electrolytes, hypotension DIET: High Na, Low K

Cushings disease

Problem: Hyper functioning of the adrenal glands S/S: Edema, hypervolemia, buffalo hump, moon face Lab: high Na and glucose, low K Intervention: Infection and injury precautions, Hypertension DIET: low Na, high K

Alzheimer's

Problem: Progressive degeneration of cerebral cortex S/S: Forgetfulness, confusion, confabulation, sun downing Lab: No specific (ACTH high) Intervention: 5Cs: clock, calendar, color, caregiver, cognex

Angina

Problem: Ischemia of myocardium S/S: Squeezing, crushing chest pain relieved by rest or nitroglycerine, last for no more than 30min ECG: ST segment depression DOC: Nitroglycerine DIET: Low cholesterol

Appendicitis

Problem: Inflammation of the appendix S/S: Rebound tenderness, RLQ pain, Mcburneys point Position: Before rupture - Position of comfort After rupture - High fowlers NO: pain relievers, laxatives, enema, warm compress

Asthma

Problem: Hyperactivity of the bronchial airway S/S: Dyspnea and wheezing Lab: Respiratory acidosis Intervention: Orthopneic position, pursed-lip breathing Drugs: Bronchodilator 1st then corticosteroids

BPH

Problem: Overgrowth of prostate (benign) S/S: Decreased caliber of urine Lab: High acid phosphatase surgery: TURP No incision Post-op: Cystoclysis: OUT must always be more than IN

BURNS

Problem: Thermal, electric, chemical injury to skin S/S: 1st degree: pink and red 2nd degree: vesicles 3rd degree: charred, white, with eschar Lab: Initially Inc K & dec Na then becomes both dec K & Na Intervention: Fluid resuscitation (rule of 9s), Pain control, infxn, contractures DIET: High cal, CHON, Vit

Cataract

Problem: Opacity of the lens S/S: Blurring of vision, glare Lab: (slit-lamp) Red reflex absent Intervention: Injury precautions Surgery: PECLE or PHACO : prevent inc IOP

CVA
Problem: Disruption of blood supply to the brain
(hemorrhagic or thrombotic) S/S: Hemiplegia, hemi paresis, speech problems, hemianopsia Positioning: ICP : Elevate HOB Aspiration : Side-lying

Chicken pox
Problem: Infection by varicella zoster S/S: Fever, fluid filled vesicles Intervention: Isolate for 2 weeks, treat pruritus DRUGS: Never give aspirin

Cholecystitis

Problem: Inflammation of the gall bladder S/S: Pain in the RUQ radiates to shoulder ass with fat intake Steatorrhea and jaundice if severe obstruction Surgery: Cholecystectomy: high abd incision DIET: Pre-op: Low fat Post-op: No more fat restriction

Chronic bronchitis
Problem: Copious mucus secretion on the bronchioles
(smoking number 1 risk factor) S/S: Blue bloater Lab: Respiratory acidosis Intervention: Max O2 at 4L/min Purse lip breathing, chest physiotherapy

CHF

Problem: Cardiac pump failure due to cardiomegaly S/S: RSHF: systemic LSHF: Pulmonary Lab: Elevated CVP, PAWP Positioning: High fowlers position DOC: Digitalis (+)inotropic, (-)chronotropic

Croup
Problem: Inflammation of the airway
(laryngotracheobronchitis) S/S: Barking cough, inspiratory stridor Intervention: Mist inhalation Bedside: ET and tracheostomy

Cystic fibrosis

Problem: genetic disorder of the exocrine glands S/S: Sweat glands: high NaCl Respi glands: copious sputum Digestive glands: steatorrhea Reproductive: permanent sterility Lab: Sweat chloride test (40meq/L or higher) DIET: Low fat, high cal, high Na

Cystitis

Problem: Inflammation of the urinary bladder S/S: Dysuria, urgency, frequency Lab: High WBC, ESR (culture : E.Coli) Intervention: EOF, Acidify urine NO: Tight fitting underwear, bubble baths

Diabetes insipidus

Problem: Hyposecretion of ADH S/S: Polyuria and polydipsia, hypotension Lab: Low urine spec. grav Intervention: EOF, monitor for shock DOC: Desmopressin NSG DX: Fluid volume deficit Sleep pattern disturbance

SIADH

Problem: Hypersecretion of ADH S/S: Edema, anasarca, hypertension Lab: high urine spec. grav Intervention: monitor for fluid overload DOC: Demeclocycline (furosemide may also be used) NSG DX: Fluid volume excess Risk for injury

Dumping syndrome
Problem: Rapid entry of carbohydrate rich chyme to
duodenum Long term complication of billroth(gastrectomy) S/S: Shock like symptoms, diaphoresis Intervention: Supine position after meals DIET: Small frequent feedings, Low CHO, dry

Ectopic pregnancy

Problem: Implantation outside the uterus (fallopian tubes) S/S: Sharp, stabbing, unilateral abd pain with spotting Lab: UTZ Intervention: Prepare client for surgery

Emphysema

Problem: Loss of alveolar elasticity thus trapping of air S/S: Pink puffer, barrel chest Labs: Respiratory acidosis Interventions: Breathing technique: Pursed lip Position: Orthopneic Max oxygen: 2-4L/min

Epiglotitis
Problem: Complete airway obstruction due to infxn of

epiglotis S/S: sore throat Positioning Tripod position Bedside: ET and tracheostomy

Epilepsy/seizure

Problem: Excessive electrical discharge in the brain S/S: rapid flexion and extension of skeletal muscles, aura and prodrome Labs: EEG Goals: During seizure: Safety After seizure: Aspiration

Glaucoma
Problem: Increased IOP S/S: PAIN, tunnel vision, permanent vision loss Labs: Tonometry = 25mmHg and up Interventions: Prevent inc IOP Eye gtts: Miototics

Guillain-barre syndrome
Problem: Inflammation of motor neurons S/S: Paralysis = Ascending Complication: Respiratory failure
-Prevent Respi infxn -Suction and Tracheostomy at bedside

Hemophilia
Problem: X-linked recessive d/o of clotting S/S: bruising, abnormal bleeding Labs: prolonged INR (PT,PTT, bleeding time) Risk for: bleeding use RICE Question on PUNNET SQUARE

Hepatic encephalopathy
Problem: progressive loss of consciousness due to
nitrogenous waste S/S: asterixis, personality changes, dec level of consciousness Labs: inc BUN diet: low CHON DOC to dec ammonia levels in GIT: -Neomycin and lactulose

Hip Fracture

Problem: break in continuity of hip bone S/S: pain, shortening and external rotation of leg Complication: fat embolus TTT: Splint and immobilize surgery ORIF post-op goal: maintain leg in alignment Abduction pillow-to keep head of femur inside Acetabulum Trochanter rolls-to prevent external rotation

Hirschsprung's dse
problem: no nerve innervations on colon S/S: meconium ileus, constipation, ribbon like
stool Diet: low residue TTT: Surgery (rectal pull through)

Hydatidiform mole
AKA: Gestational Mole Problem: abN number of chromosomes in
fertilization S/S: rapid growing uterus, passage of grape fruit like vesicles, no fetal movement or heart beat TTT: surgery (D and C) Complication: choriocarcinoma - levels of HCG will be monitored for 2yrs

Hydrocephalus
Problem: excessive CSF in the brain. Can be
communicating or non-communicating S/S: bulging fontanels, sunset eyes, inc ICP Position: elevate HOB TTT: A-V shunt; watch for: shunt failure dilated scalp veins infxn temp and foul drainage

Shock
Problem: decreased circulating blood volume
leading to inadequate tissue perfusion S/S: dec BP, inc PR, RR, dec CVP Position: trendelenburg

Increased intracranial pressure

Problem: ICP greater than 15mmHg S/S: inc BP (widening pulse pressure), dec PR, RR, projectile vomiting Position: elevate HOB TTT: Strongest diuretic - mannitol Strongest anti-inflam - steroid Surgery - craniotomy

Infectious mononucleosis
Problem: infxn of lymphatic system by Epstein Barr
virus S/S: lymph edema, sore throat, fatigue Transmission: saliva no sharing of kitchen utensils Complication: splenic rupture (pain at LUQ)

Meniere's dse

Problem: over production of endolymph in inner ear S/S: vertigo, tinnitus, hearing loss Risk for: injury Diet: low Na Position: Supine on attack

Multiple myeloma

Problem: Carcinoma of plasma cells which invade bone marrow S/S: Bone pain, myelosuppresion Labs: dec rbc, wbc, plt, inc Ca Confirmatory: Bone marrow biopsy Risk for: bleeding, infxn, fracture, kidney stones Interventions: EOF, prevent immobility

Parkinson's Dse
Problem: degeneration of substancia nigra leading to
diminished dopamine levels S/S: mask like face, bradykinesia, shuffling gait, drooling, resting tremors, constipation Risk for: injury and aspiration DOC: levodopa CHON and vit B6 antagonize levodopa Bedside: Suction

Polycythemia Vera
Problem: overproduction of rbc Labs: inc rbc, inc plasma osmolarity S/S: hypervolemia, hypertension Complication: thrombus formation - CVA, MI

PIH
Problem: hypertension after 1st trimester of pregnancy
(inc in 30-50% of BV) Triad S/S: inc BP, proteinuria, edema NSG: limit environmental stimulation, monitor for epigastric pain, seizure precautions DOC: MgSO4 -CNS depressant, assess: DTR

Pyloric stenosis
Problem: hypertrophy of pylorus S/s: projectile Vomiting Position: R side lying

Retinal detachment
Problem: separation of the retina from the pigment
layer S/S: visual floaters, curtain falling down, painless Emergency TTT: patch both eyes

Reye's syndrome
Problem: degeneration of brain, liver, and kidneys due to
concurrent viral infxn and aspirin use S/S: inc ICP, elevated SGPT SGOT, dec urine output Monitor for worsening of dse: dec LOC, crushing's triad, RUQ pain, Jaundice, Oliguria