Professional Documents
Culture Documents
NEUROLOGIC DISORDERS
Nursing Management
Magnesium Sulfate
Aloneness
Multiple loss
causes suicide
Agitation
TRIAD SIGNS
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2. Watch out for accidental removal of parathyroid gland that may lead to
Hypocalcemia (tetany)
Signs and Symptoms
o (+) trousseau’s sign
o (+) chvostek sign
o Watch out for arrhythmia, seizure give Calcium Gluconate IV slowly as ordered
3. Watch out for accidental Laryngeal damage which may lead to hoarseness of voice
Nursing Management
o encourage client to talk/speak immediately after operation and notify physician
4. Signs of bleeding (feeling of fullness at incisional site)
Nursing Management
o Check the soiled dressings at the back or nape area.
5. Hormonal replacement therapy for lifetime
6. Importance of follow up care
PARATHYROID GLAND
o A pair of small nodules behind the thyroid gland
o Secretes parathormone
o Promotes calcium reabsorption
o Hypoparathyroidism
o Hyperparathyroidism
HYPOPARATHYROIDISM
o Decrease secretion of parathormone leading to hypocalcemia
o Resulting to hyperphospatemia
A. Predisposing Factors
1. Following subtotal thyroidectomy
2. Atrophy of parathyroid gland due to:
a. inflammation
b. tumor
c. trauma
B. Signs and Symptoms
1. Acute tetany
a. tingling sensation
b. paresthesia
c. numbness
d. dysphagia
e. positive trousseu’s sign/carpopedal spasm
f. positive chvostek sign
g. laryngospasm/broncospasm 48
h. seizure feared complications
i. arrhythmia
2. Chronic tetany
a. photophobia and cataract formation
D. Nursing Management
1. Administer medications as ordered such as:
a. Acute Tetany
Calcium Gluconate IV slowly
b. Chronic Tetany
Oral Calcium supplements
Calcium Gluconate
Calcium Lactate
Calcium Carbonate
c. Vitamin D (Cholecalciferol) for absorption of calcium
2. Avoid precipitating stimulus such as glaring lights and noise
3. Encourage increase intake of foods rich in calcium
a. anchovies
b. salmon
c. green turnips
4. Institute seizure and safety precaution
5. Encourage client to breathe using paper bag to produce mild respiratory acidosis result.
6. Prepare trache set at bedside for presence of laryngo spasm
7. Prevent complications
8. Hormonal replacement therapy for lifetime
9. Importance of follow up care.
HYPERTHYROIDISM
o Decrease parathormone
o Hypercalcemia: bone demineralization leading to bone fracture (calcium is stored 99% in bone and 1%
blood)
o Kidney stones
A. Predisposing Factors
1. Hyperplasia of parathyroid gland
2. Over compensation of parathyroid gland due to vitamin D deficiency
a. Children: Ricketts
b. Adults: Osteomalacia
B. Signs and Symptoms
1. Bone pain especially at back (bone fracture)
2. Kidney stones
a. renal cholic
b. cool moist skin
3. Anorexia, nausea and vomiting
4. Agitation and memory impairment
C. Diagnostic Procedures 48
1. Serum Calcium is increased
2. Serum Phosphate is decreased
3. X-ray of long bones reveals bone demineralization
D. Nursing Management
C. Nursing Management
1. Monitor strictly vital signs and intake and output
2. Weigh patient daily and assess for pitting edema
3. Measure abdominal girth daily and notify physician
4. Restrict sodium intake
5. Provide meticulous skin care
6. Administer medications as ordered
a. Spinarolactone – potassium sparring diuretics
7. Prevent complications (DM)
8. Assist in surgical procedure (bilateral adrenoraphy)
9. Hormonal replacement for lifetime
10. Importance of follow up care
PANCREAS
- Located behind the stomach
- Mixed gland (exocrine and endocrine)
- Consist of acinar cells which secretes pancreatic juices that aids in digestion thus it is an exocrine gland
- Consist of islets of langerhans
- Has alpha cells that secretes glucagons (function: hyperglycemia)
- Beta cells secretes insulin (function: hypoglycemia)
DIABETIC KETOACIDOSIS
- Acute complication of type 1 DM due to severe hyperglycemia leading to severe CNS depression
A. Predisposing Factors
1. Hyperglycemia
2. Stress – number one precipitating factor
3. Infection
B. Signs and Symptoms
1. Polyuria
2. Polydypsia
3. Polyphagia
4. Glucosuria
5. Weight loss
6. Anorexia, nausea and vomiting
7. Blurring of vision
8. Acetone breath odor
9. Kussmaul’s Respiration (rapid shallow breathing)
10 CNS depression leading to coma
C. 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
D. Nursing Management
1. Assist in mechanical ventilation 48
2. Administer 0.9 NaCl followed by .45 NaCl (hypotonic solutions) to counteract dehydration and shock
3. Monitor strictly vital signs, intake and output and blood sugar levels
4. Administer medications as ordered
a. Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 – 4 hours)
BLOOD TRANSFUSION
Goals/Objectives
1. Replace circulating blood volume
2. Increase the oxygen carrying capacity of blood
3. Prevent infection in there is a decrease in WBC
4. Prevent bleeding if there is platelet deficiency
Principles of blood transfusion
1. Proper refrigeration
- Expiration of packed RBC is 3 – 6 days
- Expiration of platelet is 3 – 5 days
2. Proper typing and cross matching
a. Type O – universal donor
b. Type AB – universal recipient
c. 85% of population is RH positive
3. Aseptically assemble all materials needed for BT
a. Filter set
b. Gauge 18 – 19 needle
c. Isotonic solution (0.9 NaCl/plain NSS) to prevent hemolysis
4. Instruct another RN to re check the following
a. Client name
b. Blood typing and cross matching
c. Expiration date
d. Serial number
5. 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.
6. 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
7. Avoid mixing or administering drugs at BT line to prevent HEMOLYSIS
8. Regulate BT 10 – 15 gtts/min or KVO rate or equivalent to 100 cc/hr to prevent circulatory overload
9. 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
a. Hemolytic reaction
b. Allergic reaction
c. Pyrogenic reaction
d. Circulatory overload
e. Air embolism 48
f. Thrombocytopenia
g. Cytrate intoxication
h. Hyperkalemia (caused by expired blood)
Signs and Symptoms of Hemolytic reaction
ATHEROSCLEROSIS
ATHEROSCLEROSIS ARTERIOSCLEROSIS
C. Treatment
ANGINA PECTORIS (SYNDROME)
Clinical syndrome characterized by paroxysmal chest pain that is usually relieved by rest or nitroglycerine due
to temporary myocardial ischemia
A. Predisposing Factors
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
6. sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet – increased saturated fats
10. Type A personality
B. Precipitating Factors
4 E’s 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
C. Signs and Symptoms
1. Levine’s Sign – initial sign that shows the hand clutching the chest
2. 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
3. Dyspnea
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4. Tachycardia
5. Palpitations
6. Diaphoresis
D. Diagnostic Procedure
e. Calcium Antagonist
f. Thrombolytics/ Fibrinolytic Agents
- Streptokinase
- Side Effects: allergic reaction, pruritus
- Urokinase
- TIPAF (tissue plasminogen activating factor)
- Side Effects: chest pain 48
- Monitor for bleeding time
g. Anti Coagulant
- Heparin (check for partial thrombin time)
- Antidote: protamine sulfate
A. Etiologic Agents
1. Streptococcus Pneumonae – causing pneumococal pneumonia
2. Hemophylus Influenzae – causing broncho pneumonia
3. Diplococcus Pneumoniae
4. Klebsella Pneumoniae 48
5. Escherichia Pneumoniae
6. Pseudomonas
B. High Risk Groups
1. Children below 5 years old
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