MEDICAL SURGICAL

Overview of the Structures & Functions of Nervous System Central NS PNS ANS Brain & spinal cord 31 spinal & cranial sympathetic NS Parasypathatic NS Somatic NS C- 8 T- 12 L- 5 S- 5 C- 1 ANS (or adrenergic of parasympatholitic response) SNS involved in fight or aggression response Release of norepinephrine (adrenaline – cathecolamine) Adrenal medulla (potent vasoconstrictor) Increases body activities VS = Increase Except GIT – decrease GITmotility * Why GIT is not increased = GIT is not important! Increase blood flow to skeletal muscles, brain & heart. Effects of SNS (anti-cholinergic/adrenergic) 1. Dilate pupil – to aware of surroundings - medriasis 2. Dry mouth 3. BP & HR= increased bronchioles dilated to take more oxygen 4. RR increased 5. Constipation & urinary retention

I. Adrenergic Agents – Epinephrine (adrenaline) SE: SNS effect II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’) Blocks release of norepinephrine. Decrease body activities except GIT (diarrhea) Ex. Propanolol, Metopanolol SE: B – broncho spasm (bronchoconstriction) E – elicits a decrease in myocardial contraction T – treats HPN A – AV conduction slows down Given to angina & MI – beta-blockers to rest heart Anti HPN agents: 1. Beta blockers (-lol) 2. Ace inhibitors (-pril) ex ENALAPRIL, CAPTOPRIL 3. Calcium antagonist ex CALCIBLOC or NEFEDIPINE Peripheral nervous system: cholinergic/ vagal or sympatholitic response - Involved in fly or withdrawal response - Release of acetylcholine (ACTH) - Decrease all bodily activities except GIT (diarrhea) I Cholinergic agents ex 1. Mestinon Antidote – anti cholinergic agents Atropine Sulfate – S/E – SNS S/E- of anti-hpn drugs: 1. orthostatic hpn Effect of PNS: (cholinergic) 1. Meiosis – contraction of pupils 2. Increase salivation 3. BP & HR decreased 4. RR decrease – broncho constriction 5. Diarrhea – increased GI motility 6. Urinary frequency

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transient headache & dizziness. -Mgt. Rise slowly. Assist in ambulation. CNS (brain & spinal cord) I. Cells – A. neurons Properties and characteristics a. Excitability – ability of neuron to be affected in external environment. b. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another c. Permanent cells – once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes) Regenerative capacity A. Labile – once destroyed cant regenerate - Epidermal cells, GIT cells, resp (lung cells). GUT B. Stable – capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cells C. Permanent cells – retina, brain, heart, osteocytes can’t regenerate. 3.) Neuroglia – attached to neurons. Supports neurons. Where brain tumors are found. Types: 1. Astrocyte 2. Oligodendria Astrocytoma – 90 – 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte. Astrocyte – maintains integrity of blood brain barrier (BBB). BBB – semi permeable / selective -Toxic substance that destroys astrocyte & destroy BBB. Toxins that can pass in BBB: 1. Ammonia-liver cirrhosis. 2. 2. Carbon Monoxide – seizure & parkinsons. 3. 3. Bilirubin- jaundice, hepatitis, kernicterus/hyperbilirubenia. 4. 4. Ketones –DM. OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulse transmission. No myelin sheath – degenerates neurons Damage to myelin sheath – demyellenating disorders DEMYELLENATING DSE 1.)ALZHEIMER’S DISEASE– atrophy of brain tissue due to a deficiency of acetylcholine. S&Sx: A – amnesia – loss of memory A – apraxia – unable to determine function & purpose of object A – agnosia – unable to recognize familiar object A – aphasia – - Expressive – brocca’s aphasia – unable to speak - Receptive – wernickes aphasia – unable to understand spoken words Common to Alzheimer – receptive aphasia Drug of choice – ARICEPT (taken at bedtime) & COGNEX. Mgt: Supportive & palliative.

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Microglia – stationary cells, engulfs bacteria, engulfs cellular debris. II. Compositions of Cord & Spinal cord 80% - brain mass 10% - CSF 10% - blood MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP. Normal ICP: 0-15mmHg Brain mass

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Connects R & L cerebral hemisphere - Corpus collusum Rt cerebral hemisphere, Lt cerebral hemisphere Function: 1. Sensory 2. Motor 3. Integrative Lobes 1.) Frontal a. Controls motor activity b. Controls personality development c. Where primitive reflexes are inhibited d. Site of development of sense of umor e. Brocca’s area – speech center Damage - expressive aphasia 2.) Temporal – a. Hearing b. Short term memory c. Wernickes area – gen interpretative or knowing Gnostic area Damage – receptive aphasia 3.) Parietal lobe – appreciation & discrimation of sensory imp - Pain, touch, pressure, heat & cold 4.) Occipital - vision 5.) Insula/island of reil/ Central lobe- controls visceral fx Function: - activities of internal organ 6.) Rhinencephalon/ Limbec - Smell, libido, long-term memory Basal Ganglia – areas of gray matte located deep within a cerebral hemisphere - Extra pyramidal tract - Releases dopamine- Controls gross voluntary unit Decrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse. Decrease acetylcholine – Myasthenia Gravis & Alzheimer’s Increased neurotransmitter = psychiatric disorder Increase dopamine – schizo Increase acetylcholine – bipolar MID BRAIN – relay station for sight & hearing Controls size & reaction of pupil 2 – 3 mm Controls hearing acuity CN 3 – 4 Isocoria – normal size (equal) Anisocoria – uneven size – damage to mid brain PERRLA – normal reaction DIENCEPHALON- between brain Thalamus – acts as a relay station for sensation Hypothalamus – (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center, emotional responses, controls pituitary function. BRAIN STEM- a. Pons – or pneumotaxic center – controls respiration Cranial 5 – 8 CNS MEDULLA OBLONGATA- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus Vasomotor center, spinal decuissation termination, CN 9, 10, 11, 12 CEREBELLUM – lesser brain - Controls posture, gait, balance, equilibrium

1. Cerebrum – largest -

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4 .Disorientation to lethargy Narrow pp: Cardiac disorder.) Possible seizure.) Inflammatory conditions . Widening pulse pressure Normal adult BP 120/80 120 – 80 = 40 (normal pulse pressure) Increase ICP = BP 140/80 = 140 – 80= 60 PP (wide) 3. (+) To alternate pronation & supination or damage to cerebellum – dymentrium Composition of brain .Skull is a closed container.) Cerebral edema 6.needs 2 RNs to assist . shock absorber Obstruction of flow of CSF = increase ICP Hydrocephalus – posteriorly due to closure of posterior fontanel CVA – partial/ total obstruction of blood supply INCREASED ICP – increase ICP is due to increase in 1 of the Intra Cranial components.) Headache Projectile vomiting Papilledima (edema of optic disk – outer surface of retina) Decorticate (abnormal flexion) = Damage to cortico spinal tract / Decerebrate (abnormal extension) = Damage to upper brain stem-pons/ c. RR is decreased (Cheyne-Stokes = bet period of apnea or hyperpnea with periods of apnea) 4. S&Sx change in VS = always late symptoms Earliest Sx: a.) Tumor 3.) R – Romberg’s test.same) 2.) Finger to nose test – (+) To FTNT – dymetria – inability to stop a movement at a desired point c.) Change or decrease LOC – Restlessness to confusion Wide pulse pressure: Increased ICP . (Bilateral dilation of pupil – tentorial herniation.) Hydrocephalus 7. Any alteration in 1 of 3 intracranial components = increase in ICP Normal ICP – 0 – 15 mmHg Foramen Magnum C1 – atlas C2 – axis (+) Projectile vomiting = increase ICP Observe for 24 .Cerebellar Tests: a. b. Temp increase Increased ICP: Increase BP Shock – decrease BP – Decrease HR Increase HR CUSHINGS EFFECT Decrease RR Increase RR Increase Temp Decrease temp b. diastole.Meningitis.) Head injury 2. shock .) Hemorrhage (stroke) 5.Normal anatomical position 5 – 10 min (+) Romberg’s test – (+) ataxia or unsteady gait or drunken like movement with loss of balance.) Alternate pronation & supination Palm up & down .) Uncal herniation – unilateral dilation of pupil. Predisposing factors: 1. encephalitis B.) d. BP increase (systolic increase.based on Monroe Kellie Hypothesis .) Localized abscess 4.Stupor to coma Late sign – change in V/S 1.48 hrs CSF – cushions the brain.

Nursing priority: 1.500 ml/day (FORCE FLUID means:Increase fluid intake/day – 2. Max effect – 6 hrs due (7am – 1pm) 5 .Lifting of heavy objects . avoid straining of stool (give laxatives/ stool softener Dulcolax/ Duphalac) . max 15 seconds. Monitor VS & I&O 3.Bending & stooping e. Siderails up d.increase ICP Hypoxia – inadequate tissue oxygenation Late symptoms of hypoxia – B – bradycardia E – extreme restlessness D – dyspnea C – cyanosis Early symptoms – R – restlessness A – agitation T – tachycardia Increase CO2 retention/ hypercarbia – cerebral vasodilatation = increase ICP Most powerful respiratory stimulant increase in CO2 Hyperventilate decrease CO2 – excrete CO2 Respiratory Distress Syndrome (RDS) – decrease Oxygen Suctioning – 10-15 seconds. If given at 7am. Prevent complications of immobility 6./Osmitrol promotes cerebral diuresis by decompressing brain tissue Nursing considerations: Mannitol 1. Instruct patient to avoid the ff: -Valsalva maneuver or bearing down. Monitor BP – SE of hypotension 2.200 – 1. Ambu bag – pump upon inspiration c. Prevent increase ICP by: a. Regulate fast drip – to prevent formation of crystals or precipitate 2. Maintain patent a/w 2. Administer meds as ordered: 1.) Osmotic diuretic – Mannitol.000 ml/day). Elevate head of bed 30 – 45 degrees angle neck in neutral position unless contra indicated to promote venous drainage 4.000 – 3.Excessive cough – antitussive Dextrometorpham -Excessive vomiting – anti emetic (Plasil – Phil only)/ Phenergan . Monitor I&O every hr. Maintain quiet & comfy environment b. Avoid use of restraints – lead to fractures c. Suction upon removal of suction cap. Prevention of hypoxia – (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention). Pt will urinate at 7:15 Immediate effect of Lasix within 15 minutes. Hypoxia – cerebral edema . Limit fluid intake 1. report if < 30cc out put 3. 5.Lasix (Furosemide) Nursing Mgt: Lasix Same as Mannitol except . Avoid clustering of nursing activities 7.) Loop diuretic . Administer via side drip 4.not for inc ICP.Lasix is given via IV push (expect urine after 10-15mins) should be in the morning.) Maintain patent a/w & adequate ventilation a. Assist in mechanical ventilation 1.

Tophi. K chloride Potassium Rich food: ABC’s of K Vegetables Fruits A .) Hyperglycemia – increase blood sugar level P – polyuria P – polyphagia P – polydipsia Nsg Mgt: a.) Hyponatremia – Normal Na level = 135 – 145 meg/L S/Sx – Hypotension Signs of Dehydration: dry skin.) Hypocalcemia (Normal level Ca = 8.5 – 11mg/100ml) or Tetany: S&Sx weakness Paresthesia (+) Trousseau sign – pathognomonic – or carpopedal spasm. gen body malaise. Constipation 3.5 meg/L) S&Sx 1. (+) Chevostek’s sign Arrhythmia Laryngospasm Administer – Ca gluconate – IV slowly Ca gluconate toxicity: Sx – seizure – administer Mg SO4 Mg SO4 toxcicity– administer Ca gluconate B – BP decrease U – urine output decrease R – RR decrease P – patellar reflexes absent 3. Put bp cuff on arm=hand spasm. poor skin turgor. 6 . Early signs – Adult: thirst and agitation / Child: tachycardia Mgt: force fluid Administer isotonic fluid sol 4. Vit A – squash.S/E of Lasix Hypokalemia (normal K-3.) Administer K supplements – ex Kalium Durule. Monitor FBS (N=80 – 120 mg/dl) 5. Food appropriate for toddler – spaghetti! Not milk – increase bronchial secretions Don’t give grapes – may choke S/E of Lasix: 1.5 – 5. spinach. carrots yellow vegetables & fruits. Weakness & fatigue 2. (+) “U” wave in ECG tracing Nursing Mgt: 1.) Hyperurecemia – increase serum uric acid.asparagus A – apple B – broccoli (highest) B – banana – green C – carrots C – cantalope/ melon O – orange (highest) –for digitalis toxicity also.urate crystals in joint.) Hypokalemia 2. chesa Iron – raisins.

5 meq/L . anchovies. Avoid use of restraints Nsg Priority – ABC & safety Pt suffering from epiglotitis. 5.) Corticosteroids .2 meq/L 10 – 19 mg/100ml 10 -19 mg/100 ml 10 – 30 mg/100ml Toxicity 2 2 20 20 200 Classification cardiac glycosides antimanic bronchodilator anticonvulsant narcotic analgesic Indication CHF bipolar COPD seizures osteoarthritis Digitalis – increase cardiac contraction = increase CO Nursing Mgt 1. Restrict fluid d.6 – 1.5 – 1.) Meds – narcotic analgesic Morphine SO4 SE of Morphine SO4 toxicity Respiratory depression (check RR 1st) Antidote for morphine SO4 toxicity –Narcan (NALOXONE) Naloxone toxicity – tremors Increase ICP meds: 3. Need tracheostomy onlyMagic 2’s of drug monitoring Drug D – digoxin L . Nsg Mgt of Gouty Arthritis a.Digivine a.) Force fluid 2.) Mild analgesic – codeine SO4. What is nsg priority? a. Anorexia -initial sx.) Anti consultants – Dilantin (Phenytoin) Question: Increase ICP what is the immediate nsg action? a. don’t giveDigoxin) Digitalis toxicity – antidote . Assist in ET – temp.) Administer meds – Allopurinol/ Zyloprim – inhibits synthesis of uric acid – drug of choice for gout Colchicene – excretes uric acid.lithium A – aminophylline D – Dilantin A – acetaminophen N range . Check PR. Apply warm moist pack? Least priority Rationale: Wont need to pass larynx due to larynx is inflamed. ET can’t pass. Administer steroids – least priority b. HR (if HR below 60bpm. Kidney stones – renal colic (pain). Administer Mannitol as ordered b.) Cheese (not sardines.) Force fluid c.renal colic (pain) Cool moist skin Sx joint pain & swelling usually at great toe. Confusion 7 . organ meat) (Not good if pt taking MAO) b. Assist in tracheotomy – permanent (Answer) d. n/v GIT c. Elevate head 30 – 45 degrees c. Acute gout drug of choice. Cool moist skin Mgt: 1.Gou ty arthritis kidney stones.Dexamethsone – decrease cerebral edema (Decadrone) 4. For headache. b. a/w c. Diarrhea d.

then NSS! 2.) L – lithium (lithane) decrease levels of norepinephrine.e. tremors Question: Avoid giving food with Aminophylline a. avoided only if pt is given MAOI b. Tachycardia 2. Photophobia Changes in color perception – yellow spots (Ok to give to pts with renal failure.) n/s c.) Diarrhea d. Cheese/butter– food rich in tyramine. Massage gums H – hairy tongue A . Digoxin is metabolized in liver not in kidney. serotonine. Monitor liver enzymes SGPT (ALT) – Serum Glutamic Piruvate Tyranase SGOT. Monitor BUN (10 – 20) Crea (. f.Do sandwich method .before MAOI will take effect Anti Parkinsonian agents – Vit B6 Pyridoxine reverses effect of Levodopa D – dilatin (Phenytoin) – anti convulsant/seizure Nursing Mgt: 1.9 NaCl to prevent formation of crystals or precipitate .) Hypothyroidism (CRETINISM– the only endocrine disorder that can lead to mental retardation) A – aminophyline (theophylline) – dilates bronchioles. Organ meat/ box cereals – anti parkinsonian MAOI – antidepressant m AR plan n AR dil can lead to CVA or hypertensive crisis p AR nate 3 – 4 weeks .Serum Glutamic Acetate Tyranase 3.) Dehydration – force fluid. Instruct the pt to avoid alcohol – bec alcohol + dilantin can lead to severe CNS depression Dilantin toxicity: S/Sx: G – gingival hyperplasia – swollen gums i.8-1) Acetaminophen toxicity can lead to hypoglycemia 8 . maintain Na intake 4 – 10g daily e. Hot chocolate & tea – caffeine – CNS stimulant tachycardia d. acetylcholine Antimanic agent Lithium toxicity S/Sx a. agitation.) Anorexia b. Oral hygiene – soft toothbrush ii. Hyperactivity – restlessness. Mixed with plain NSS or . Take bp before giving aminophylline.Give NSS then Dilantin. Hepato toxicity 2.ataxia N – nystagmus – abnormal movement of eyeballs A – acetaminophen/ Tylenol – non-opoid analgesic & antipyretic – febrile pts Acetaminophen toxicity : 1. Beer/ wine c. S/Sx : Aminophylline toxicity: 1.

anti psychotic SE of anti psychotic drugs – Extra Pyramidal Symptom Over meds of anti psychotic drugs – neuroleptic malignant syndrome char by tremors (severe) S/Sx: Parkinsonism – 1.) depression .Palliative. Stooped posture b. Haloperidol (Haldol). Methyldopa (aldomet) . Increase salivation – drooling type 10.) breast cancer b.Constipation . Poisoning (lead & carbon monoxide).Increase lacrimation . SE – 1. Propulsive gait 5.chronic. Weakness d. Reserpine (serpasil) anti HPN. Diaphoresis PARKINSONS DSE (parkinsonism) . Diaphoresis Antidote for acetaminophen toxicity – Acetylcesteine = causes outporing of secretions. Monotone speech 7. Predisposing Factors: 1. Phenothiazide . Carbidopa (Sinemet). Rigidity (cogwheel type) a.Seborrhea (increase sebaceous gland) . Nightmares b. Amantadine Hcl (Symmetrel) Mechanism of action Increase levels of dopa – relieving tremors & bradykinesia S/E of anti parkinsonian Anorexia n/v Confusion Orthostatic hypotension 9 . Suction. Antidote for lead = Calcium EDTA 2.T – tremors. Question: The following are symptoms of hypoglycemia except: a. Hypoxia 3. Encephalitis High doses of the ff: a.anti psychotic d. Over fatigue 4. Arteriosclerosis 4. progressive disease of CNS char by degeneration of dopamine producing cells in substancia nigra at mid brain & basal ganglia .promote safety c.suicidal 2. Pill rolling tremors of extremities – early sign 2. Supportive Function of dopamine: controls gross voluntary motors. Extreme thirst – hyperglycemia symptoms c.Decrease sexual activity Nsg Mgt 1.) Anti parkinsonian agents Levodopa (L-Dopa). Tachycardia I – irritability R – restlessness E – extreme fatigue D – depression (nightmares) . Autonomic signs: . Bradykinesia – slow movement 3. Mood labilety – always depressed – suicide Nsg priority: Promote safety 9.Increase sweating . Prepare suctioning apparatus. Mask like facial expression with decrease blinking eyes 6. Difficulty rising from sitting position 8. Shuffling – most common c.

Hallucination Arrhythmia Contraindication: 1.Cause B6 reverses therapeutic effects of levodopa Give INH (Isoniazide-Isonicotene acid hydrazide. sweat Ig M – acute inflammation Ig E – allergic reactions IgD – chronic inflammation S & Sx of MS: (everything down) 1. Slow growing virus 2. Short acting. pain.Remission & exacerbation .Turn pt every 2h Turn pt every 1 h – elderly 3. Nsg Mgt – Parkinson 1.) Dopamine agonist Bromotriptine Hcl (Parlodel) – respiratory depression. Mood swings – euphoria (sense of elation ) 10 . Blurring of vision b. Monitor RR. green leafy veg .) encephalitis MULTIPLE SCLEROSIS (MS) Chronic intermittent disorder of CNS – white patches of demyelenation in brain & spinal cord. cold a. 15 – 35 yo cause – unknown Predisposing factor: 1. Visual disturbances a. pressure. . heat.) aneurism 3. colostrums. Paresthesia 3.) Assist in passive ROM exercises to prevent contractures 4. Marplan.1.) Prevent complications of immobility .) Subarachnoid hemorrhage 2.) Maintain good nutrition CHON – in am CHON – in pm – to induce sleep – due Tryptopan – Amino Acid 5.) Increase fluid in take. Ig A – body secretions – saliva. Impaired sensation to touch. Autoimmune – (supportive & palliative treatment only) Normal Resident Antibodies: Ig G – can pass placenta – passive immunity. Take with meals – to decrease GIT irritation 2.Common – women. Scotomas (blind spots) – initial sx 2. Child – hyperactivity CNS excitement for kids. organ meats.) SE-Peripheral neuritis.don’t take food Vit B6 (Pyridoxine) cereals. Tingling c. Take at bedtime.) Maintain siderails 2. Nardil) Nsg Mgt when giving anti-parkinsonian 1.– avoid driving & operating heavy equipt.) Assist in surgery – Sterotaxic Thalamotomy Complications in sterotaxic thalmotomy. 2. S/E . high fiber diet to prevent constipation 6. Narrow angled closure glaucoma 2. Diplopia/ double vision c. Numbness b. Instruct pt. Pt taking MAOI (Parnate. tears.SNS 3. Inform pt – urine/ stool may be darkened 3.) Anti cholinergic agents – relieves tremors Artane mech – inhibits acetylcholine Cogentin action .) Antihistamine – Diphenhydramine Hcl (Benadryl) – take at bedtime S/E: adult– drowsiness. 4.

) Meds a. Prevent complications of immobility 5. Give diuretics Urinary incontinence – give Prophantheline bromide (probanthene) Antispasmodic anti cholinergic 8. Provide catheterization die urinary retention 7. Give ACTH – steroids b.) Diplopia – double vision 11 . Spasiticity –“ tigas” c. Introduce electricity at the back. Deep breathing exercises. Give stress reducing activity. Acute exacerbation ACTH – adenocorticotopic Steroids – to reduce edema at the site of demyelination to prevent paralysis Spinal Cord Injury Administer drug to prevent paralysis due to edema a. Immunosuppresants 2. Urinary retention or incontinence 7. Constipation 8. biofeedback. Assist passive ROMexercises – promote proper body alignment 4. Impaired motor function: a. Decrease sexual ability Dx – MS 1. CSF analysis thru lumbar puncture . Baclopen (Lioresol) or Dantrolene Na (Dantrene) To decrease muscle spasticity c. 2. yoga techniques. Paralysis –major problem 5. Cranberry. Common in Women.Supportive mgt 1. MRI – reveals site & extent of demyelination 3. Interferone – to alter immune response d. Nsg Mgt MS . Vit C MYASTHENIA GRAVIS (MG) – disturbance in transmission of impulses from nerve to muscle cell at neuro muscular junction. Impaired cerebellar function Triad Sx of MS I – intentional tremors N – nystagmus – abnormal rotation of eyes Charcots triad A – Ataxia & Scanning speech 6. Weakness b. Lhermitte’s response is (+). Theres spasm & paralysis at spinal cord. Orange juice. 20 – 40 yo. 9.4. Encourage fluid intake & increase fiber diet – to prevent constipation 6. Provide acid-ash diet – to acidify urine & prevent bacteria multiplication Grape. unknown cause or idiopathic Autoimmune – release of cholenesterase – enzyme Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine Descending muscle weakness (Ascending muscle weakness – Guillain Barre Syndrome) Nsg priority: 1) a/w 2) aspiration 3) immobility S/ Sx: 1.) Ptosis – drooping of upper lid ( initial sign) Check Palpebral fissure – opening of upper & lower lids = to know if (+) of MG.Reveals increase CHON & IgG 2. Maintain siderails 3.

muscle strength or motor grading scale (4/5.every 1 hr. Tensilon test (Edrophonium Hcl) – temporarily strengthens muscles for 5 – 10 mins. Thymus secretes auto immune antibody. Increase lacrimation 12 .3. Infection B S&Sx 1.) Cholinergics or anticholinesterase agents Mestinon (Pyridostigmine) Neostignine (prostigmin) – Long term . PNS effect. 5/5.Bilateral symmetrical polyneuritis .) Weakening of laryngeal muscles – hoarseness of voice 6. NGT feeding Administer meds – a.Auto immune .complication Autonomic changes – increase sweating.cholinergic. Assist in surgical proc – thymectomy.Disorder of CNS .) Resp muscle weakness – lead respiratory arrest. Adult-every 2 hrs. Unable to see – Ptosis & diplopia 2.SNS – dry mouth 7. Clumsiness Ascending muscle weakness – lead to paralysis Dysphagia Decrease or diminished DTR (deep tendon reflexes) Paralysis Alternate HPN to hypotension – lead to arrhythmia .Increase acetylcholine s/e – PNS b. 2. Stress 3. Under medication 2. Prepare at bedside tracheostomy set 7. Siderails 4. 4. etc) 3. Dysphagia. 5.PNS Mgt. Monitor VS.unable to swallow. 6.) Corticosteroids – to suppress immune resp Decadron (dexamethasone) Monitor for 2 types of Crisis: Myastinic crisis A cause – 1. Prevent complication – respiratory arrest Prepare tracheostomy set at bedside.) Mask like facial expression 4. Decrease vital lung capacity. Elderly.Atropine SO4 .Immunizations S&Sx Initial : 1. 5. idiopathic . 2. Assist in plasmaparesis – filter blood 9. 3. Unable to breath C Mgt – adm cholinergic agents Cholinergic crisis Cause: 1 over meds S/Sx .) Dysphagia – risk for aspiration! 5. Short term.r/t antecedent viral infection . GBS – Guillain Barre Syndrome .) Extreme muscle weakness during activity especially in the morning. 8.) Assist in mechanical vent – attach to ventilator b. increase salivation. Nsg Mgt 1. 3. Removal of thymus gland. Dx test 1. I&O neuro check.Ascending paralysis Cause – unknown. adm anti-cholinergic . Maintain patent a/w & adequate vent by: a. Prevent complications of immobility.) Monitor pulmonary function test.

Constipation Dx most important: CSF analysis thru lumbar puncture reveals increase in : IgG & CHON (same with MS) Nsg Mgt 1. Corticosteroids – to suppress immune response 3. Assist in mechanical vent b. Arachmoid matter 3. Assist in plasmaparesis (MG. anorexia . Adm meds (GBS) as ordered: – 1. GBS) 9. MENINGITIS – inflammation of meningitis & spinal cord Etiology – Meningococcus Pneumococcus Hemophilous influenza – child Streptococcus – adult meningitis MOT – direct transmission via droplet nuclei S&Sx .rigid arching of back Pathognomonic sign – (+) Kernig’s & Brudzinski sign 13 . Prevent compl – immobility 5. Monitor vs. Duramater sub dural space 2. Anti cholinergic – atropine SO4 2.Stiff neck or nuchal rigidity (initial sign) . Institute NGT feeding – due dysphagia 7. Give with meals. Pia matter sub arachnoid space where CSF flows L3 & L4. Maintain patent a/w & adequate vent a. Siderails 4..Fever chills. visual disturbances 8.) Lidocaine /Xylocaine –SE confusion = VTach b.Projectile vomiting – due to increase ICP . I&O neuro check. INFL CONDITONS OF BRAIN Meninges – 3-fold membrane – cover brain & spinal cord Fx: Protection & support Nourishment Blood supply 3 layers 1. respiratory arrest Prepare tracheostomy set at bedside. n/v.) Bretyllium c. Assist in passive ROM exercises 6. . headache.Possible seizure Sx of meningeal irritation – nuchal rigidity or stiffness Opisthotonus. Anti arrhythmic agents a. vertigo. Monitor pulmonary function test 2.Toxic effect – cinchonism Quinidine toxicity S/E – anorexia.Gen body malaise .Photophobia .) Quinines/Quinidine – anti malarial agent. Prevent comp – arrhythmias.Headache . ECG tracing due to arrhythmia 3.Decorticate/decerebration – abnormal posturing .Wt loss . Site for lumbar puncture.

neuro check Provide client health teaching & discharge plan a. Flat on bed – 12 – 24 h to prevent spinal headache & leak of CSF 2. Prevent seizure. B – Aplastic anemia – reverse isolation . Small freq feeding b. CHON-for tissue repair. Complete blood count CBC – reveals increase WBC Mgt: 1. (+) Culture microorganism 2. Assess for movement & sensation of extremeties Result 1. Adm meds a. Hepatotoxicity. Super infection – alteration in normal bacterial flora N flora throat – streptococcus N flora intestine – e coli Sx of superinfection of penicillin = diarrhea b.due to bone marrow depression. 7.MD – operation procedure 2. wbc. Strict resp isolation 24h after start of antibiotic therapy A – Cushing’s synd – reverse isolation . Empty bladder. Allergic reaction 4. D – Post liver transplant – reverse isolation – takes steroids lifetime.) Broad-spectrum antibiotic penicillin S/E 1. Force fluid 3. CSF analysis: a.) Antipyretic c. Check punctured site for drainage. increase CHON & WBC Content of CSF: Chon. discoloration & leakage to tissue 4. Lumbar puncture – lumbar/ spinal tap – use of hallow spinal needle – sub arachnoid space L3 & L4 or L4 & L5 Aspirate CSF for lumbar puncture. 4. bowel – promote comfort 3. Nutrition – increase cal & CHO. 5. glucose b.Leg pain neck pain Dx: 1. Consent / explain procedure to pt . 6. increase CSF opening pressure N 50 – 160 mmHg d. 14 . C – Cancer anytype – reverse isolation – immunocompromised.) Mild analgesic 2. Nsg Mgt for lumbar puncture – invasive 1. I&O . GIT irritation – take with food 2. nephrotoxcicity 3. Arch back – to clearly visualize L3. hearing loss or nerve deafness. E – Prolonged use steroids – reverse isolation F – Meningitis – strict respiratory isolation – safe after 24h of antibiotic therapy G – Asthma – not to be isolated 3. Prevent complication hydrocephalus. L4 Nsg Ngt post lumbar 1. 8. Comfy & dark room – due to photophobia & seizure Prevent complications of immobility Maintain F & E balance Monitor vs.RN – dx procedure (lab) . Decrease glucose Confirms meningitis c.due to increased corticosteroid in body.

disorientation. paresis or plegia (monoplegia – 1 extreme) Increase ICP 2.Post heart surgery – mitral valve replacement Lifestyle: 1.) Compartment syndrome – compression of nerves/ arteries Risk factors of CVA: HPN. 2 – 5 things at the same time c. Rehab for neurological deficit. Guilty when not dong anything 6.Macro pill – has large amt estrogen . Embolism – dislodged clot – pulmo embolism S/Sx: pulmo embolism Sudden sharp chest pain Unexplained dyspnea. numbness.Mini pill – has large amt of progestin . RBC found at epiphisis 2. Smoking – nicotine – potent vasoconstrictor 2.Headache (initial sx).Promote lipolysis (breakdown of lipids/fats) – artherosclerosis – HPN . diaphoresis & mild restlessness S/Sx: cerebral embolism Headache. visual & speech disturbances. n/v d.) Dysphagia 15 . confusion & decrease in LOC Femur fracture – complications: fat embolism – most feared complication w/in 24hrs Yellow bone marrow – produces fat cells at meduallary cavity of long bone Red bone marrow – provides WBC. Stroke in evolution – progression of S & Sx of stroke 3. DM. Emotional & physical stress 8. TIA. dizziness/ vertigo. Can lead to mental retardation or a delay in psychomotor development.post repair myelomeningocele . Prolonged use of oral contraceptives . Deadline driven person b.) Cheyne-Stokes Resp c. SOB Tachycardia. apoplexy Partial or complete disruption in the brains blood supply 2 largest & common artery in stroke Middle cerebral artery Internal carotid artery Common to male – 2 – 3x high risk Predisposing factor: 1. Diet – increase saturated fats 7. Type A personality a.Urologist -Damage to sacral area – spina bifida – controls urination 9. artherosclerosis.Audiologist due to damage to hearing. Sedentary lifestyle 3. Hyperlipidemia – genetic 4.) Hemorrhage 3. Complete stroke – resolution of stroke a.Where to bring 2 yo post meningitis . Thrombosis – clot (attached) 2.warning signs of impending stroke attacks . tinnitus. brain attack or cerebral thrombosis.) Headache b. MI.stroke 5. valvular heart dse .) Anorexia. Obesity S & Sx 1. palpitations. platelets. CEREBRO VASCULAR ACCIDENT – stroke.

Non-verbal cues . NGT feeding – if pt can’t swallow 7. Meds Osmotic diuretics – Mannitol Loop diuretics – Lasix/ Furosemide Corticosteroids – dextamethazone Mild analgesic Thrombolytic/ fibrolitic agents – tunaw clot. SE-Urticaria.antidote.bleeding give Vit K – Aquamephyton. Monitor vs.. Not paper and pen. Elevate head of bed 30-45 degrees angle. don’t give to dengue. CT Scan – reveals brain lesion 2.) Check peripheral pulses .Invasive procedure due to inject dye .prevent foot drop 6. Avoid valsalva maneuver. b.Assist mechanical ventilation .e. Antiplatelet – PASA – aspirin paraanemo aspirin. Turn client q2h Elderly q1h To prevent decubitus ulcer To prevent hypostatic pneumonia – after prolonged immobility.(+) To hemianopsia – approach on unaffected side 9. monitor PT prothrombin time if prolonged. I&O. Agraphia diff writing 5.) Force fluid – to excrete dye is nephrotoxic 2. Alesia – diff reading 6.Administer O2 2.Diet. and unknown headache. Prevent compl of immobility by: a. articulate words 3.antidote. Health Teaching 1. 4. Maintain patent a/w & adequate vent . ulcer. Coumadin –Long term. Dietary modification 16 . . Aphasia 4. Restrict fluids – prevent cerebral edema 3. Streptokinase Urokinase Tissue plasminogen activating Monitor bleeding time Anticoagulants – Heparin & Coumadin” sabay” Coumadin will take effect after 3 days Heparin – monitor PTT partial thromboplastin time if prolonged – bleeding give Protamine SO4. Cerebral arteriography – site & extent of mal occlusion . smoking 2.distal Nsg Mgt 1.Magic slate. Phlegia 2. Alternative means of communication . Tiring for pt. Dysarthria – inability to vocalize. Avoidance modifiable lifestyle .Allergy test All – graphy – invasive due to iodine dye Post 1. pruritus-caused by foreign subs. Egg crate mattress or H2O bed c. Passive ROM exercise q4h 8. Sand bag or foot board. neuro check 5.) Focal & neurological deficit 1.) (+) Kernig’s & Brudzinski – sx of hemorrhagic stroke g.) Increase BP f. Homoninous hemianopsia – loss of half of field of vision Left sided hemianopsia – approach Right side of pt – the unaffected side Dx 1.

disorder of the CNS char. Generalized Seizure – a.. dec O2.seizure -Automatism – stereotype repetitive & non-purposive behavior .Decrease blinking eye . Visual – korsakoffs psychosis – chronic alcoholism 3.associated with olfactory. Auditory – schitzo – paranoid type 2. decrease Na & saturated fats Complications: Subarachnoid hemorrhage Rehab for focal neurological deficit – physical therapy 1.Blank stare .) Jacksonian seizure or focal seizure – tingling/jerky movement of index finger/thumb & spreads to shoulder & 1 sideof the body with janksonian march b. Can you outgrow febrile seizure? Febrile seizure Normal if < 5 yo Pathologic if > 5 yo Difference between: Seizure. lead to hyperprexia – coma – death Seizure: inc electrical firing in brain=increased metabolic activity in brain=brain using glucose and O2=dec glucose.Twitching of mouth . Tx:Diazepam (drug of choice). uninterrupted seizure activity.Avoid caffeine. Delay in psychomotor development CONVULSIVE Disorder (CONVULSIONS).) Grand mal / tonic clonic seizures With or without aura – warning symptoms of impending seizure attack. Status epilecticus – continuous.Loss of consciousness – 5 – 10 secs (quick & short) II.Clouding of consciousness – not in control with environment . .) Psychomotor/ focal motor .Mild hallucinatory sensory experience HALLUCINATIONS 1. Contractions-CLONIC . visual.Epigastric pain.) Petimal seizure – (same as daydreaming!) or absent seizure.Epileptic cry – fall . Localized/partial seizure a. glucose 17 .1st convulsive attack Epilepsy – 2nd and with history of seizure Predisposing Factor Head injury due birth trauma Toxicity of carbon monoxide Brain tumor Genetics Nutritional & metabolic deficit Physical stress Sudden withdrawal to anticonvulsants will bring about status epilepticus Status epilepticus – drug of choice: Diazepam & glucose S & Sx I. Tactile – addict – substance abuse III.unresponding sleep after tonic clonic b. alteration in sensation & perception & change in behavior.Post ictal sleep -state of lethargy or drowsiness .Loss of consciousness 3 – 5 min . auditory sensory experience . abnormal motor activity. tactile. if untreated. by paroxysmal seizures with or without loss of consciousness. Mental retardation 2.Direct symmetrical extension of extremities-TONIC.Tonic clonic contractions .

GCS .Glasgow coma scale – obj measurement of LOC or quick neuro check 3 components of ECS M – motor 6 V – verbal resp 5 E – eye opening 4 15 15 – 14 – conscious 13 – 11 – lethargy 10 – 8 – stupor 7 – coma 3 – deep coma – lowest score Survey of mental status & speech (Comprehensice Neuro Exam) 1. Monitor onset & duration . Adm o2 inhalation – post! c. the higher chance of having status epilepticus! 4. Dilantin (Phenytoin) –( toxicity level – 20 ) SE Ginguial hyperplasia H-hairy tongue A-ataxia N-nystagmus A-acetaminophen. Avoid restraints 4. Complications: Subarachnoid hemorrhage and encephalitis Question: 1 yo grand mal – immediate nursing action = a/w & safety a. (Tegretol) Carbamasene. Suction apparatus ready at bedside 3.febrile pt Mix with NSS . The longer the duration of post ictal sleep. CT scan – brain lesion 2. Mouthpiece – 1 yr old – little teeth only b.Duration of post ictal sleep. Avoid precipitating stimulus – bright glaring lights & noises 8. EEG electroencephalography .Dx-Convulsion. Post seizure: Administer O2. Tongue guard or mouth piece to prevent biting of tongue-BEFORE SEIZURE ONLY! Can use spoon at home.) LOC & test of memory 18 . Cortical resection 5. SE: arrythmia c.get health history! 1.Don’t give alcohol – lead to CNS depression b.given also to Trigeminal Neuralgia. Loosen clothing 3. Prepare suction Neurological assessment: 1. Turn head to side to prevent aspiration 6. Administer meds a. 7.SE: hallucinations 2. Maintain patent a/w & promote safety Before seizure: 1.Type of seizure . Phenobarbital (Luminal). Remove blunt/sharp objects 2.Hyperactivity brain waves Nsg Mgt Priority – Airway & safety 1. Give pillow – safety (answer) d. Assist in surgical procedure. Comprehensive neuro exam 2. Maintain siderails 5. Institute seizure & safety precaution.

) Short term memory – . cigarette tar . obtunded 3. Conscious (conscious) – awake – levels of wakefulness 2. CN assessment: I– II – III – IV – V– VI – VII – VIII – IX – X– XI– XII – Olfactory Optic Oculomotor Trocheal Trigeminal Abducens Facial Acustic/auditory Glassopharyngeal Vagus Spinal accessory Hypoglossal s s m m b m b s b b m m smallest CN largest CN longest CN I.) 4.) 8. Olfactory – don’t use ammonia. Alert – not all pt are alert & oriented to time & place b. Agraphesthesia – cant identify numbers or letters written on palm with a blunt object.can identify numbers or letters written on palm with a blunt object. Awake. finger to nose DTR Autonomics Levels of consciousness (LOC) – 1.) 7. Deep sternal stimulation/ pressure 3x– fist knuckle With response – light coma Without response – deep coma 2.Diposmia – distorted sense of smell 19 . cologne irritating to mucosa – use coffee. vinegar. Orbital pressure – pressure on orbits only – below eye 4. Lethargy (lethargic) – drowsy. decrease body reflex 4. Test of memory – considered educational background a.Hyposmia – decrease sensitivity to smell . Corneal reflex/ blinking reflex Wisp of cotton – used to illicit blinking reflex among conscious patients Instill 1-drop saline solution – unconscious pt if (-) response pt is in deep coma 5. Pressure on great toe – 3x 3.answer d. Aware Different types of pain stimulation . Coherent c.) 6.) 5. Stupor (stuporous) – awakened by vigorous stimulation Pt has gen body weakness. sleepy.) Levels of orientation CN assessment Motor assessment Sensory assessment Cerebral test – Romhberg.) Long term memory (+) Retrograde amnesia – damage to limbic system 6.Don’t prick 1.What did you eat for breakfast? Damage to temporal lobe – (+) antero grade amnesia b.2. Coma (Comatose) light – (+) all forms of painful stimulations Deep – (-) to painful stimulation Question: Describe a conscious pt ? a. bar soap. alcohol. Levels of orientation Time Place Person Graphesthesia.) 3.

Inferiorly d. maxillary. “Blurring or hazy vision” 3.5 – 2 mm V – Trigeminal – Largest – consists of . Bitemporally c. Test of peripheral vision/ visual field a. toast.Increase IOP .20 ft Numerator – distance to snellens chart Denominator – distance the person can see the letters OD – Rt eye 20/20 20/200 – blindness – cant read E – biggest OS – left eye 20/20 OU – both eye 20/20 2. RN should give a.. raisins b. Gelatin. Retinal detachment – curtain veil – like vision & floaters 4. potato – all correct but d. teeth & cornea reflex Unconscious – instill drop of saline solution Motor – controls muscles of chewing/ muscles of mastication Trigeminal neuralgia – diff chewing & swallowing – extreme food temp is not recommended Question: Trigeminal neuralgia.test of visual acuity – Snellens chart – central or distance vision Snellens E chart – used for illiterate chart N 20/20 vision distance by w/c person can see letters. Glaucoma – Normal 12 – 21 mmHg pressure . Cereals c. mucus membrane. VI – tested simultaneously . Controls pupil size 2 -3 cm or 1. etc.Loss of peripheral vision – “tunnel vision” 2. butter. Raising of eyelid – Ptosis 2.Loss of central vision. 1. Nasally Common Disorders – see page 85-87 for more info on glaucoma.Anosmia – absence of sense of smell Either of 3 might indicate head injury – damage to cribriform plate of ethmoid bone where olfactory cells are located or indicate inflammation condition – sinusitis II optic.ophthalmic. Superiority b. salad. Potato. Cataract – opacity of lens . Hot milk. IV. gelatin – salad easier to chew SO MR N O S E left eye 20 . Macular degeneration – black spots III. mandibular Sensory – controls sensation of the face.Innervates the movementt of extrinsic ocular muscle 6 cardinal gaze EOM Rt eye IO LR SR 3 – 4 EOM IV – sup oblique VI – lateral rectus Normal response – PERRLA (isocoria – equal pupil) Anisocoria – unequal pupil Oculomotor 1.

Pt should resist pressure.Archimedes 3. Mid otitis media . -Put applicator with sugar to tip to tongue.chest . raise eyebrow Damage – Bells palsy – facial paralysis Cause – bells palsy pedia – R/T forcep delivery Temporary only Most evident clinical sign of facial symmetry: Nasolabial folds VIII Acoustic/ vestibule cochlear (controls hearing) – controls balance (kenesthesia or position sense) . oricle (impacted cerumen). stirrup or melleus.controls sternocleidomastoid (neck) & trapezius (shoulders and back) . pinna. sensory hearing loss (research parts! & dse) Remove vestibule – meniere’s dse – disease inner ear Archimedes law – buoyancy (pregnancy – fetus) Daltons law – partial pressure of gases Inertia – law of motion (dizziness. anvil. incus.Movement & orientation of body in space . -Start of taste insensitivity: Age group – 40 yrs old Motor.Short frenulum lingue – Tongue tied – “bulol” ENDOCRINE Fx of endocrine – ductless gland Main gland – Pituitary gland – located at base of brain of Stella Turcica Master gland of body Master clock of body 21 .) Severe vertigo due. staples. cerumen Middle – hammer.Push tongue against cheek . Paresis or phlegia XII – Hypoglossal – controls movement of tongue – say “ah”. smile frown.controls muscles of facial expression.) Pt with multiple stab wound .Diffusion – Dalton’s law 2.Repeat words uttered IX – Glossopharyngeal – controls taste – posterior 1/3 of tongue X – Vagus – controls gag reflex Test 9 – 10 Pt say ah – check uvula – should be midline Damage cerebral hemisphere is L or R Gag reflex – place tongue depression post part of tongue  Don’t touch uvula XI – Spinal Accessory .Inertia Test for acoustic nerve: .Eustachean ear Inner ear.VI Facial: Sensory – controls taste – ant 2/3 of tongue test cotton applicator put sugar.Movement of air in & out of lungs is carried by what principle? . put pressure.Organ of Corti – for hearing – true sense organ of hearing Outer – tympanic membrane.Shrug shoulders. Assess tongue position=midline L or R deviation .) Pregnant – check up – ultrasound reveals fetus is carried by amniotic fluid . vertigo) 1.meniere dse.

Related to Bronchogenic cancer or lung canerEarly Sign of Lung Ca .Excessive thirst (adult) . b.) Promotes uterine contraction preventing bleeding/ hemorrhage. Hypovolemic shock Anuria – late sign hypovolemic shock (1st sx of dehydration in children-tachycardia) Dx Proc: 1. Pituitary surgery 2.) Milk letdown reflex with help of prolactin. Force fluid 2. I&O Administer meds as ordered a.Anterior pituitary gland – adenohypophysis Posterior pituitary gland – neurohypophysis Posterior pituitary: 1. Hyperplasia of Pit gland Increase size of organ 22 .Increase ADH .000ml/day Administer IV fluid replacement as ordered Monitor VS. Sx of dehydration .035 2. 2.000 – 3.) Pitresin (vasopressin) IM 5.Dry mucus membrane 3. Decrease urine specific gravity.concentrated urine N= 1.Poor skin turgor .Cough –1. productive 3. 4. Prevent complications Most feared complication – Hypovolemic shock B. Polyuria 2.Idiopathic/ unknown Predisposing factor 1. 3.) SIADH . Weakness & fatigue 4. Serum Na = increase (N=135 -145 meq/L) Hypernatremia Mgt: 1.015 – 1.Syndrome of Inappropriate Anti-Diuretic Hormone . Trauma/ head injury 3.) ADH – antidiuretic hormone – (vasopressin) -Prevents urination – conserve H2O A.) Oxytocin – a.Give after placental delivery to prevent uterine atony. Head injury 2.dalas ihi) – hyposecretion of ADH Cause: idiopathic/ unknown Predisposing factor: 1. 2. Hypotension – if left untreated 5. Inflammation * alcohol inhibits release of ADH S & Sx: 1. non productive 2. Tumor 4. .Agitation . DIABETIS INSIPIDUS (DI.

Urine specific gravity increase – diluted urine 2. With tenderness – thyroid never tender b.Promotes development of mammary gland (Oxytocin-Initiates milk letdown reflex) 4. Restrict fluid 2.4 molecules of iodine Thyrocalcitonin FX – antagonizes effects of parathormone 23 . FSH. Palpable upon swallowing .produces estrogen 2. cerebral edema – increase ICP – 2.answer c.Triodothyronine . neuro check – increase ICP 4. Weigh daily 5.S&Sx 1.Development & maturation of adrenal cortex 5. Adrenocorticotropic hormone – ACTH . 2.Normal TG never palpable unless with goiter TG hormones: T3 . Monitorstrictly V/S. Hyponatremia – Decreased Na Nsg Mgt: 1. Diuretics: Loop and Osmotic 3.MSH Skin pigmentation 3. Growth hormone (GH) (Somatotropic hormone) Fx: Elongation of long bones Decrease GH – dwarfism children Increase GH – gigantism Increase GH – acromegaly – adult Puberty 9 yo – 21 yo Epiphyseal plate closes at 21 yo Square face Square jaw Drug of choice in acromegaly: Ocreotide (Sandostatin) SE dizziness Somatostatin Hormone – antagonizes the release of of GH Melanocytes stimulating hormone .3 molecules of iodine T4 -Tetraiodothyronine/ Tyroxine . Marked asymmetry – only 1 TG d. Prevent complications – increase ICP & seizures activity Anterior Pituitary Gland – adeno 1. seizure Dx Proc: 1. I&O. 4. With nodular consistency. Fluid retention Increase BP – HPN Edema Wt gain Danger of H2O intoxication –Complications: 1. Provide meticulous skin care 7. 6. Assess for presence edema 6. PINEAL GLAND 1. 5. Secretes Melatonin – inhibits lutenizing hormone (LH) secretion THYROID GLAND (TG) Question: Normal physical finding on TG: a. Luteinizing hormone – produces progesterone. 3. Administer meds as ordered eg. Prolactin/luteotrpic hormone/ lactogenic hormone .

and hallucination 7. Goiter belt area . Lugol’s sol. tetracycline 3. Serum TSH – increase (confirmatory) 3.lethargy & memory impairment – Hyper T3 T4 . NE. Monitor s/e 24 . B. loss of appetite but with wt gain menorrhagia – increase in mens HYPERTHYROIDISM . Take it early AM – SE insomnia 3. Aspirin PASA Cobalt. – HR due tachycardia & palpitation 2. 1. Administer meds a. peas. kamote. Levothyroxine (Synthroid) 2. strawberries.Increase appetite – wt loss. potato. T4 – N or below N Nsg Mgt: 1. radish. cassava (root crops).) Iodine solution – Logol’s solution or saturated sol of K iodide SSKI Nsg Mgt Lugol’s sol – violet color 1. Increase VS. 4. inc v/s Hypo T3 T4 . beans. Serum T3. Prophylaxis 2 -3 drops Treatment – 5 to 6 drops Use straw – to prevernt staining of teeth 1. 3. all nuts.. Liothyronine (cytomel) 3. use straw – prevent staining teeth 2. 2. increase motility HYPOTHYROIDISM – all decreased except wt & menstruation. Mountainous area – increase intake of goitrogenic foods (US: Midwest.agitation. restlessness. Thyroid h / Agents 1. Thyroid extract Nsg Mgt: for TH/agents 1. Thyroid scan – reveals enlarged TG 2. Monitor vs. Iron solution. Seafood’s rich in iodine 2. Goitrogenic drugs: Anti thyroid agents :(PTU) prephyl thiupil Lithium carbonate. constipation SIMPLE GOITER – enlarged thyroid gland .iodine deficiency Predisposing factors 1. amenorrhea all v/s down.Metabolic hormone Increase metabolism brain –inc cerebration. nitrofurantin (macrodantin)-urinary anticeptic-pyelonephritis.Place far from sea – no iodine. Phenyl butasone Endemic goiter – cause # 1 Sporadic goiter – caused by #2 & 3 S & Sx – enlarged TG Mild restlessness Mild dysphagia Dx Proc. Salt Lake) Cabbage – has progoitrin – an anti thyroid agent with no iodine Example: Turnips (singkamas).

Monitor strictly V/S.coma Constipation Late Sx – brittle hair/ nails Non pitting edema due increase accumulation of mucopolysacharide in SQ tissue -Myxedema Horseness voice Decrease libido Decrease VS – hypotension bradycardia. hyponatremia. 2.cretinism – only endocrine dis lead to mental retardation Predisposing factor: 1. hypoventilation. I&O – to determine presence of myxedema coma! Myxedema Coma .Sub total thyroidectomyComplication: 1. and hypothermia Lethargy Memory impairment leading to psychosis-forgetfulness Menorrhagia Dx: 1. hypoglycemia.Hemorrhage-feeling of fullness at incision site. bradycardia. Encourage increase intake iodine – iodine is extracted from seaweeds (!) Seafood. inflammation 3.Severe form of hypothyroidism Hypotension.highest iodine content oysters.Check nape for wet blood. Tetany 2. Tumor. Autoimmune – Hashimoto disease S&Sx everything decreased except wt gain & mens increase) Early signs – weakness and fatigue Loss of appetite – increased lypolysis – breakdown of fats causing atherosclerosis = MI Wt gain Cold intolerance – myxedema . Iodine def 4. Trauma c. Assist mech vent – priority a/w 2. clams. bradypnea. Irradiation b. bradypnea. crabs. hypothermia Might lead to progressive stupor & coma Impt mgt for Myxedema coma 1. Nsg Mgt: 1. Assist surgery. Adm thyroid hormone 3. Adm IVF replacement – force fluid 25 . lobster Lowest iodine – shrimps Iodized salt –easily destroyed by heat take it raw not cooked 4.Laryngeal spasm – DOB. 3. 4. Serum T3 T4 decrease Serum cholesterol increase – can lead to MI RA IU – radio iodine uptake – decrease 2. palpitations Signs of insomnia Hyperthyroidism restlessness agitation Heat intolerance HPN 3. T4 – can lead to MI / Atherosclerosis Adult – myxedema Child.) HYPOTHYROIDISM – decrease secretion of T3. `Iatrogenic causes – caused by surgery 2. laryngeal nerve damage 3. SOB – trache set ready at bedside.Tachycardia. Atrophy of TG due to: a.

tachycardia. leukocytosis=inc wbc: check cbc and throat swab culture Most feared complication : Thrombosis – stroke CVS 26 .Mgt myxedema coma 1.increased Radio iodine uptake – increase Thyroid scan – reveals enlarged TG Nsg Mgt: 1. Monitor VS & I & O – determine presence of thyroid storm or most feared complication: Thyrotoxicosis 2. Comfortable & warm environment due to cold intolerance 5. insomnia.lifetime 11. Administer meds a. Thyroid hormones Levothyroxine(Synthroid). Liothyronine (cytomel) Thyroid extracts 8. Excessive iodine intake 3. Monitor HR. sore throat. tremors. Administer meds – take AM – SE insomia. hyperthermia 6. Heat intolerance 4. restlessness. Force fluid 7. hallucinations 7. Goiter 8. Hormonal replacement therapy . Infection 4. Increase in appetite – hyperphagia – wt loss due to increase metabolism 2. Health teaching & discharge plan a. Methymazole (Tapazole) Most toxic s/e agranulocytosis. Prophylthiuracil (PTU) 2. Skin is moist . Irritability & agitation. narcotics. Avoidance precipitating factors leading to myxedema coma: 1. Exopthalmos – pathognomonic sx 9. Hyperplasia of TG S&Sx: 1. CNS changes 8. Amenorrhea Dx: 1. Hypovolemic shock. Antithyroid agents 1. Provide dietary intake low in calories – due to wt gain 3.Graves dse or thyrotoxicosis ( everything up except wt and mens) -Increased T3 & T4 Predisposing factors: 1. Diarrhea – increase motility 5.perspiration 3.fever. All VS increase = HPN. myxedema coma 10. Monitor VS. Serum T3 & T4 . Stress 3. anesthetics not allowed – CNS depressants V/S already down Complications: 9. Use of sedative. 3. tachypnea. 2. Administer IVF replacements 6. Exposure to cold environment 2. Autoimmune disease – release of long acting thyroid stimulator (LATS) Exopthalmos Enopthalmos – severe dehydration depressed eye 2. I&O 2. Importance of follow up care HYPERTHYROIDISM . Skin care due to dry skin 4.

Signs of laryngeal spasm a. 8. 6. . Hormonal replacement therapy .“Feeling of fullness” at incision site Nsg mgt: Check soiled dressing at nape area 5. Watch out for signs of thyroid storm or thyrotoxicosis Triad signs of thyroidstorm. Tachycardia /palpitation b.(+) Trousseau sign/ 2. 5. Chvosteck’s sign Nsg Mgt: Adm calcium gluconate slowly – to prevent arrhythmia Ca gluconate toxicity – antidote – MgSO4 3.lifetime 7.3. Monitor VS & neuro check Agitated might decrease LOC 2. Diet – increase calorie – to correct wt loss Skin care – Comfy & cool environment Maintain siderails. Siderails – agitated Comp 2.due agitation/restlessness Provide bilateral eye patch – to prevent drying of eyes. To prevent bleeding & hemorrhage Mgt post op: Complication: 1. Importance of follow up care (Liver cirrhosis – bedside scissor – if pt complaints of DOB) (Cut cystachean tube to deflate balloon) Parathyroid gland – pair of small nodules located behind the TG 27 . Antipyretic – fever Tachycardia . 7.classic sign tetany – 1. SOB Prepare at bedside tracheostomy 6. a.Laryngeal (voice box) nerve damage (accidental) Sx: hoarseness of voice ***Encourage pt to talk or speak post operatively asap to determine laryngeal nerve damage Notify physician! 4. 4. hypocalcemia . Agitation Nsg Mgt Thyroid Storm: 1. To decrease vascularity of TG 10. Signs of bleeding post subtotal thyroidectomy .exopthalmos Assist in surgery – subtotal thyroidectomy Nsg Mgt: pre-op Adm Lugol’s solution (SSKI) K iodide 9. DOB b. Hyperthermia c. Watch for inadvertent (accidental) removal of parathyroid gland Secretes Para hormone If removed.β blockers (-lol) 3.

11. Loss of tooth enamel b. Irradiation b. Seizure g. irritability Dx: 1. Serum calcium – decrease (N 8. most feared complication Hyperphosphatemia Chronic tetany a.5 – 11 mg/100ml) 2. 2. Serum phosphate increase (N 2. Tingling sensation b. Oral Ca supplements Ex. Bronchospasm Pathognomonic Sign of tetany: a.5 – 4.) Chronic tetany 1. n/v. (+) Trousseau’s or carpopedial spasm b. slowly b. Photophobia & cataract formation c. Dysphagia d. Administration of meds: a. phosphate increases] A. general body malaise d. (+) Chvosteck’s sign f. Predisposing. Paresthesia c. Trauma S&Sx: 1.) Acute tetany – Ca gluconate – IV. Following subtotal thyroidectomy 2. Laryngospasm e. X-ray of long bone – decrease bone density CT Scan – reveals degeneration of basal ganglia Nsg Mgt: 1. Atrophy of parathyroid gland due to a. GIT changes – anorexia.5 mg/100ml) 3. Acute tetany a. Ca gluconate 28 . Secrets parathyroid hormone – promotes Ca reabsorption Thyrocalcitonin – antagonises secretion of parathyroid hormone 1. Arrhythmia 2. CNS changes – memory impairment. factors: 1. 4. Hypoparthroidism – decrease of parathyroid hormone Hyperparathroidsm HYPOPARATHYROIDISM – decreased parathormone Hypocalcemia (Or tetany) [If Ca decreases.

Phosphate binder Alumminum DH gel (ampho gel) SE constipation Antacid AAC MAD Aluminum containing acids Mg containing antacids Ex. Bedside – tracheostomy set –due to laryngospasm 5.Less s/e 2. decrease phosphorus + inc uric acid. Hyperplasia parathyroid gland (PTG) 2. Avoid precipitating stimulus such as bright lights & noise: photophobia leading to seizure 3. 4. Encourage to breath with paper bag in order to produce mild respiratory acidosis – to promote increase ionized Ca levels 6. Tuna & green turnips.Inc Ca.increase parathormone.Don’t give milk – due to increase phosphorus Good = anchovies – increase Ca. Most feared complication : Seizure & arrhythmia 7. Important fallow up care HYPERPARATHYROIDISM . Diet – increase Ca & decrease phosphorus . Hormonal replacement therapy . Over compensation of PTG due to Vit D deficiency Children – Rickets Vit D Adults – Osteomalacia deficiency Sippy’s diet – Vit D diet – not good for pt with ulcer 2 -4 cups of milk & butter Karrel’s diet – Vit D diet – not good for pt with ulcer 6 cups of milk & whole cream Food rich in CHON – eggnog – combination of egg & milk S/Sx: Bone fracture 1. Complication: Renal failure Hypercalcemia can lead to Hypophosphatemia Bone dse Mineralization Leading to bone fracture Ca – 99% bones 1% serum blood Predisposing Factors: 1. Bone pain (especially at back).lifetime 8.Ca carbonate Ca lactate Vit D (Cholecalceferol) Drug Cholecalceferol diet calcidiol sunlight calcitriol 7am – 9am 2. Milk or magnesia Aluminum OH gel Diarrhea Constipation Maalox – magnesium & aluminum . bone fracture kidney stones 29 .

Serum phosphorus decreases 3. 5. Renal colic b.000/day or 2-3L/day Isotonic solution Warm sitz bath – for comfort Strain all urine with gauze pad Acid ash diet – cranberry. Impt ff up care 13.presence of tumor at adrenal medulla -increase nor/epinephrine -with HPN and resistant to drugs -drug of choice: beta blockers -complication: HPN crisis = lead to stroke -no valsalva maneuver Adrenal Cortex – 1. calamansi – to acidify urine Adm meds a.innermost layer 14. Hormonal replacement. vit C. Force fluids – 2. 2. 3. Narcotic analgesic – Morphine SO4. 2. 2 parts Adrenal cortex – outermost layer Adrenal medulla . Prevent complication Most feared – renal failure 11. Kidney stone – a.Controls glucose metabolism (SUGAR) Zona reticularis – secrets traces of glucocorticoids & androgenic hormones M – testosterone F – estrogen & progesterone 30 . increase phosphorus lean meat 10. Siderails 8. Secrets cathecolamines a. Assist in ambulation 9. n/v. 4. plum. Diet – low in Ca. 4. Atop of @ kidney 13. X-ray long bones – reveals bone demineralization Nsg Mgt: Kidney Stone 1. ulcerations CNS involvement– irritability.2. Zona fasiculata – secrets glucocorticoids Ex.) Epinephrine / Norephinephrine – potent vasoconstrictor – adrenaline=Increase BP Adrenal Medulla’s only disease: PHEOCHROMOCYTOMA. memory impairment Dx Proc: 1. Serum Ca increase 2. 3. grapefruit. Cool moist skin GIT changes – anorexia. Assist surgical procedure – parathyroidectomy 12.lifetime ADRENAL GLAND 12. Demerol (Meperidine Hcl) S/E – resp depression.000 – 3. 6. Monitor RR) Narcan/ Naloxone – antidote Naloxone toxicity – tremors 7. Cortisol .

K c. Decrease sugar – Hypoglycemia – Decreased glucocorticoids .Fx – promotes development of secondary sexual characteristics 3. Zona glomerulosa .Aldosterone Hypovolemia a.) Diarrhea c. tachycardia I . arrhythmia 31 .) Irritability b. depression 2. H2O. Aldosterone Fx: promotes Na & H2O reabsorption & excretion of potassium (SALT) ADDISON’S DISEASE – Steroids-lifetime Decreased adrenocortical hormones leading to: a. FBS – decrease FBS (N 80 – 120 mg/dL) 2.) Deficiency of neuromuscular function (salt & sex) Predisposing Factors: 1. Decrease sexual urge or libido. Dx Proc: 1.5 – 5. Fungal infections 3. Loss of pubic and axillary hair To Prevent STD Local – practice monogamous relationship CGFNS/NCLEX – condom 7. Tubercular infections S/Sx: 1. Atrophy of adrenal gland 2. Complication of Addison’s dse : Addisonian crisis 16.irritability R .) Signs of dehydration – extreme thirst. Decrease salt – Hyponatermia – Decreased mineralocorticoids . Monitor VS.cortisol T – tremors.Decreased Androgen 6.5 meg/L) Nsg Mgt: 1.) Wt loss 4. Plasma cortisol – decreased Serum Na – decreased (N 135 – 145 meg/L) Serum K – increased (N 3.Na. hypovolemia. wt loss. agitation c.restlessness E – extreme fatigue D – diaphoresis.) Hypotension b. Decrease plasma cortisol Decrease tolerance to stress – lead to Addisonian’s crisis 3.) Arrhythmia 5. hyponatremia. Pathognomonic sign– bronze like skin pigmentation due to decrease cortisol will stimulate pituitary gland to release melanocyte stimulating hormone.secretes mineralcortisone Ex. 3. Results the acute exacerbation of Addison’s dse characterized by : Hypotension. Hyperkalemia a. I&O – to determine presence of Addisonian crisis 15.) F&E imbalances.) Metabolic disturbances (sugar) b.

Infection b) Prevent complications Addisonian crisis & Hypovolemic shock 8. Polydipsia – increase thirst 3.) Moon face & buffalo hump e.) Corticosteroids . Hormonal replacement therapy – lifetime Important: follow up care CUSHING’S SYNDROME – increase secretion of adrenocortical hormone Predisposing Factors: 1. Adm steroids 3. Lead to progressive stupor & coma Nsg Mgt Addisonian Crisis (Coma) 1. Wt gain d. Polyuria 2. 9.) Hirsutism c. 2. Assist in mechanical ventilation 2.reverse isolation b. Stress 3. Taper the dose (w/draw. 4. 7.17.) Mineralocorticoids ex.(Decadron) or Dexamethazone . Flourocortisone 3.) Edema d. Diet – increase calorie or CHO Increase Na. Increase CHON. gradually from drug) – sudden withdrawal can lead to addisonian crisis 3. 5. Sudden withdrawal crisis 2. Hyperplasia of adrenal gland 2.) HPN b.Hydrocortisone (cortisone). 6.) Increase susceptibility to infection sue to steroids. Hypernatrermia a. Adm 2/3 dose in AM & 1/3 dose in PM in order to mimic the normal diurnal rhythm. Monitor S/E (Cushing’s syndrome S/Sx) a. Edema c. Increase susceptibility to infection – due to increased corticosteroid 3. Polyphagia – increase appetite Classic Sx of DM – 3 P’s & glycosuria + wt loss 2. Tubercular infection – milliary TB S/Sx 1. Force fluids 2. Increase sugar – Hyperglycemia 3 P’s 1.Prednisone Nsg Mgt with Steroids 1. Decrease K Force fluid Administer isotonic fluid as ordered Meticulous skin care – due to bronze like HT & discharge planning a) Avoid precipitating factors leading to Addisonian crisis 1. Moon face Buffalo hump 32 . HPN b. Administer meds a.

4.

5. 6. 7. Dx:

Obese trunk Pendulous abdomen Thin extremities Hypokalemia a. Weakness & fatigue b. Constipation c. ECG – (+) “U” wave Hirsutism – increase sex Acne & striae Increase muscularity of female

classic signs

1. FBS – increase↑ (N: 80-120mg/dL)
2. Plasma cortisol increase

3. Na – increase (135-145 meq/L) 4. K- decrease (3.5-5.5 meq/L)
Nsg Mgt: 1. Monitor VS, I&O 2. Administer meds a. K- sparing diuretics (Aldactone) Spironolactone - promotes excretion of NA while conserving potassium Not lasix due to S/E hypoK & Hyperglycemia! 3. 4. Restrict Na Provide Dietary intake – low in CHO, low in Na & fats High in CHON & K Weigh pt daily & assess presence of edema- measure abdominal girth- notify doc. Reverse isolation Skin care – due acne & striae Prevent complication - Most feared – arrhythmia & DM (Endocrine disorder lead to MI – Hypothyroidism & DM) Surgical bilateral Adrenolectomy Hormonal replacement therapy – lifetime due to adrenal gland removal- no more corticosteroid!

5.
6.

7. 8.
9.

10.

PANCREAS – behind the stomach, mixed gland – both endocrine and exocrine gland
Acinar cells (exocrine gland) Secrete pancreatic juices at pancreatic ducts. Aids in digestion (in stomach) Islets of Langerhans (endocrine gland ductless) α cells secrets glucagon Fxn: hyperglycemia (high glucose) β Cells Secrets insulin Fxn: hypoglycemia Delta Cells

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Secrets somatostatin Fxn: antagonizes growth hormone

3 disorders of the Pancreas 1. DM 2. Pancreatic Cancer 3. Pancreatitis

Overview only:

PANCREATITIS (check page 72)– acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to
Autodigestion – self-digestion Cause: unknown/idiopathic 18. Or alcoholism Pathognomonic sign- (+) Cullen’s sign - Ecchymosis of umbilicus (bluish color)- pasa (+) Grey turner’s sign – ecchymosis of flank area Both sx means hemorrhage

CHRONIC HEMORRHAGIC PANCREATITIS- “bangugot”
Predisposing factors - unknown Risk factor: 1. History of hepatobiliary disorder 2. Alcohol 3. Drugs – thiazide diuretics, oral contraceptives, aspirin, penthan 4. Obesity 5. Hyperlipidemia 6. Hyperthyroidism 7. High intake of fatty food – saturated fats

DIABETES MELLITUS - metabolic disorder characterized by non utilization of CHO, CHON,& fat metabolism
Classification:

I.

Type I DM (IDDM) – “Juvenile “ onset, common in children, non-obese “brittle dse”

-Insulin dependent diabetes mellitus Incidence rate 1.) 10% of population with DM have Type I Predisposing Factor: 1. 90% hereditary – total destruction of pancreatic dells 2. Virus 3. Toxicity to carbon tetrachloride 4. Drugs – Steroids both cause hyperglycemia Lasix - loop diuretics S/Sx: 3 P’S + G 1.) Polyuria 2.) Poydipsia 3.) Polyphagia 4.) Glycosuria 5.) Weight loss

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6.) Anorexia 7.) N/V 8.) Blurring of vision 9.) Increase susceptibility to infection 10.) Delayed/ poor wound healing Mgt: 1. Insulin Therapy Diet Exercise Complications – Diabetic Ketoacidosis (DKA) Diabetic Ketoacidosis (DKA) – due to increase fat catabolism or breakdown of fats DKA –(+) fruity or acetone breath odor Kassmaul’s respiration – rapid, shallow breathing Diabetic coma (needs oxygen)

II. Type II DM – (NIDDM)
Adult/ maturity onset type – age 40 & above, obese Incidence Rate 1. 90% of pop with DM have Type II Mid 1980’s marked increase in type II because of increase proliferation of fast food chains! Predisposing Factor: 1. Obesity – obese people lack insulin receptors binding site 2. Hereditary S/Sx: 1. 2. Tx: Asymptomatic 3 P’s and 1G

1. Oral Hypoglycemic Agents (OHA)
2. 3. Diet Exercise

Complication: HONKC H – hyper O – osmolar N – non K – ketotic C – coma III. GESTATIONAL DM – occurs during pregnancy & terminates upon delivery of child Predisposing Factors: 1. Unknown/ idiopathic 2. Influence of maternal hormones S/Sx : Same as type II – 1. Asymptomatic 2. 3 P’s & 1G Type of delivery – CS – due to large baby Sx of hypoglycemia on infant 1. High pitched shrill cry

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2. Poor sucking reflex IV. DM ASSOCIATED WITH OTHER DISORDER a.) Pancreatic tumor b.) Cancer c.) Cushing’s syndrome 3 MAIN FOOD GROUPS Anabolism 1. CHON glucose 2. CHON amino acids 3. Fats fatty acids

Catabolism glycogen nitrogen free fatty acids (FFA) – Cholesterol & Ketones

Pancreas → glucose → ATP (Main fuel/energy of cell ) Reserve glucose – glycogen Liver will undergo – glucogenesis – synthesis of glucagons & Glycogenolysis – breakdown of glucagons & Gluconeogenesis – formation of glucose form CHO sources – CHON & fats Hyperglycemia – pancreas will not release insulin. Glucose can’t go to cell, stays at circulation causing hyperglycemia. increase osmotic diuresis – glycosuria Lead to cellular starvation Lead to wt loss stimulates the appetite/ satiety center (Hypothalamus) Polyphagia Stimulates thirst center (hypothalamus) Polydipsia Increased CHON catabolism Lead to (-) nitrogen balance Tissue wasting (cachexia) polyuria Cellular dehydration

Increase fat catabolism Free fatty acids Cholesterol Atherosclerosis HPN MI stroke ketones DKA coma death

DIABETIC KETOACIDOSIS (DKA)
Acute complication of Type I DM due to severe hyperglycemia leading to CNS depression & Coma. Ketones- a CNS depressant

Predisposing factor:

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1. Stress – between stress and infection, stress causes DKA more.
2. 3. S/Sx: 1. 2. 3. 4. 5. 6. Hyperglycemia Infection

3 P’s & 1G Polyuria Polydipsia Polyphagia Glycosuria Wt loss Anorexia, N/V 7. (+) Acetone breath odor- fruity odor 8. Kussmaul's resp-rapid shallow respiration 9. CNS depression 10. Coma

pathognomonic DKA

Dx Proc: 1. FBS increase, Hct – increase (compensate due to dehydration) N =BUN – 10 -20 mg/100ml --increased due to severe dehydration Crea - .8 – 1 mg/100ml Hct 42% (should be 3x high)-nto hgb Nsg Mgt: 1. Can lead to coma – assist mechanical ventilation 2. Administer .9NaCl – isotonic solution Followed by .45NaCl hypotonic solution To counteract dehydration. 3. Monitor VS, I&O, blood sugar levels 4. Administer meds as ordered: a.) Insulin therapy – IV push Regular Acting Insulin – clear (2-4hrs, peak action) b.) To counteract acidosis – Na HCO3 c.) Antibiotic to prevent infection Insulin Therapy A. Sources: 1. Animal source – beef/ pork-rarely used. Causes severe allergic reaction. 2. Human – has less antigenecity property Cause less allergic reaction. Humulin 3. If kid is allergic to chicken – don’t give measles vaccine due it comes from chicken embryo. Artificially compound

B. Types of Insulin 1. Rapid Acting Insulin - Ex. Regular acting I 2. Intermediate acting I - Ex. NPH (non-protamine Hagedorn I) 3. Long acting I - Ex. Ultra lente Types of Insulin 1. Rapid 2. Intermediate 3. Long acting color & consistency clear cloudy cloudy onset peak duration 2-4h 6-12h 12-24h -

Ex. 5am Hemoglucose test (HGT) 250 mg/dl Adm 5 units of RA I

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1ml or cc of tuberculin = 100 units of insulin .TIRED Nsg Mgt: upon injection of insulin: 1. Chlorpropamide (diabenase) b. Insulin is only refrigerated once opened! 3.same as DKA except don’t give NaHCO3! 1.. Gently roll vial bet palms.) Antibiotic to prevent infection Tx: O ral H ypoglycemic A gents 19. Administer .. Monitor signs of complications: a..Monitor VS. 4. First generation Sulfonylurear a.9NaCl – isotonic solution Followed by . I&O.45NaCl hypotonic solution To counteract dehydration. restlessness. Somogyi’s phenomenon – hypoglycemia followed by periods of hyperglycemia or rebound effect of insulin.Peak 7-9am – monitor hypoglycemic reaction at this time. Use gauge 25 – 26needle – tuberculin syringe 5. 6. blood sugar levels 4.. seizure.no ketone formation Coma – S/Sx: headache. Allergic reactions – lipodystrophy b.) Insulin therapy – IV b. Rotate injection site to prevent lipodystrophy 8.absence of lipolysis Ketotic .Administer meds a. Don’t aspirate after injection 7.Can lead to coma – assist mechanical ventilation 2. Tolazamide (tolinase) 38 .5cc = 50 units .1 cc = 100 units . Tolbutamide (orinase) c..Administer insulin at room temp! – To prevent lipodystrophy = atrophy/ hypertrophy of SQ tissues 2. Avoid shaking to prevent formation of bubbles. Administer insulin at either 45(for skinny pt) or 90° (taba pt)depending on the client tissue deposit. . 11. decrease LOC = coma Nsg Mgt. Stimulates pancreas to secrete insulin Classifications of OHA 1. When mixing 2 types of insulin. aspirate 1st regular/ clear – before cloudy to prevent contaminating clear insulin & to promote accurate calibration. Most accessible site – abdomen 9. 3. 10.1 cc = 10 units 6 units RA Most Feared Complication of Type II DM Hyper ↑ osmolarity = severe dehydration Osmolar Non .

Exercise – after meals when blood glucose is rising. blood sugar levels. but brain can’t tolerate low sugar!) Cold. Avoid alcohol (alcohol + OHA = severe hypoglycemic reaction=CNS depression=coma) AntabuseDisufram Dx for DM 1. 4. Atherosclerosis – HPN. Give simple sugar (Brain can tolerate high sugar. Assist in surgical wound debridement 12. Annual eye & kidney exam 10. I&O.Most sensitive test 3. Monitor for PEAK action of OHA & insulin Notify Doc 2. CVA b. Microangiopathy – small blood vessels Eyes – diabetic retinopathy . Administer insulin & OHA therapy as ordered. Avoid wearing constrictive garments 9. Gangrene formation d. Administer with meals – to lessen GIT irritation & prevent hypoglycemia 2. Oral glucose tolerance (OGTT) . -Glass of orange juice. 6. Shock due to cellular dehydration 8. Provide nutritional intake of diabetic diet: CHO – 50% CHON – 30% Fats – 20% -Or offer alternative food products or beverage. FBS – N 80 – 120 mg/dl = Increased for 3 consecutive times + 3 P’s & 1G 2. 7. clammy skin – hypo – Orange Juice or simple sugar / warm to touch – hyper – adm insulin 5. 1. Cut toe nails straight c. Avoid waking barefooted b. Monitor urinalysis for presence of ketones Blood or serum – more accurate 11. Monitor complications of DM a. 2nd generation sulfonylurear a. Peripheral neuropathy 1.2. Apply lanolin lotion – prevent skin breakdown d. Foot care mgt a. Monitor VS. Pt DM –“ hinimatay” 20. You don’t know if hypo or hyperglycemia. neurocheck. 3. Monitor signs or DKA & HONKC =confirms DM!! 39 . Monitor signs of hyper & hypoglycemia. MI. Random blood sugar – increased 4. premature cataract & blindness Kidneys – recurrent pyelonephritis & Renal Failure (2 common causes of Renal Failure : DM & HPN) c. Diabeta (Micronase) b. Diarrhea/ constipation 2. Glipside (Glucotrol) Nsg Mgt or OHA 1. Alpha Glucosylated Hgb – elevated Nsg Mgt. Sexual impotence e.

Albumin.Has molecules of Hgb (red cell pigment) Transports & carries O2 SICKLE CELL ANEMIA –sickle shaped RBC.Transports iron & copper Gamma – transport immunoglobulins or antibodies 3. Assist surgical procedure BKA or above knee amputation Overview: HEMATOLOGICAL SYSTEMS I Blood II Blood vessels III Blood forming organs 1. -immature cells=hemolysis of RBC=decreased hgb 3 Nsg priority 1. Lymphoid organs – payers patch 5.High altitude is bad 2. RBC (erythrocytes) Spleen life span = 120 days (N) 3 – 6 M/mm3 .Anucleated . Yellow color.13. Globulins – alpha – transports steroids Hormones & bilirubin β .Red cell percentage in whole red 40 .Biconcave discs . a/w – avoid deoxygenating activities . Liver – largest gland 3. Capillaries Blood 45% formed elements – 55% plasma – fluid portion of vlood. most abundant plasma Maintains osmotic pressure preventing edema FXN: promotes skin integrity 2.largest. Pain & comfort Hgb ( hemoglobin) F= 12 – 14 gms % M = 14-16 gms % Hct – 3x hgb 12 x 3 = 36 (hamatocrit) F 36 – 42% 14 x 3 = 42 M 42 – 48% Average 42% . Artery – carries blood away from the 21. Serum Plasma CHON’s (Produced in Liver) 1. IVC. Veins –SVC. Aorta. Impaired circulation of RBC. Spleen – destroys RBC Blood vessels 1. Thymus – removed myasthenia gravis 2. Should be round. Bone marrow 6. Prothrombin – fibrinogen – clotting factor to prevent bleeding Formed Elements: 1. carotid 3. Fluid deficit – promote hydration 3. Lymph nodes 4. Jugular vein – blood towards the heart 2.

) Ecchemosis/ bruises c.000/mm3 GRANULOCYTES 1.000 – 10.) Folic acid b.Release of chem. Common – tropical countries – blood sucking parasites 3. Polymorphonuclearneutrophils Most abundant 60-70% WBC . hypocromic (pale).) Vit B6 (Pyridoxine) f.microglia Macrophage in skin – Histiocytes Macrophage in lungs – alveolar macrophage Macrophage in Kidneys – Kupffer cells 2.Allergic reactions ANEMIA Iron deficiency Anemia – chronic normocytic. Monocytes (macrophage) . Incidence rate: 1.) Vit B12 (cyanocobalamin) e. gown. histamine.) Vit C d.involved in long term phagocytes . Common among the poor – poor nutritional intake 41 . prostaglandin.Normal lifespan 9 – 12 days Drug of choice for HIV Zidovudine (AZT or Retrovir) Standard precaution for HIV gloves.Folic acid – prevent neural tube deficit 3rd tri – iron Life span of rbc – 80 – 120 days.target site for HIV NK cell – natural killer cell Have both antiviral & anti-tumor properties 3. 000/ mm3 it promotes hemostasis – prevention of blood loss by activating clotting . goggles & mask Malaria – night biting mosquito Dengue – day biting mosquito Signs of platelet dis function: a.fx – short term phagocytosis For acute inflammation 2.150.) Intrinsic factor Pregnant: 1st trimester.largest WBC .Other name macrophage Macrophage in CNS.Substances needed for maturation of RBC a. Women – 15 – 35yo – reproductive yrs 4. microcytic anemia due to inadequate absorption of iron leading to hypoxemic injury. Destroyed at spleen.Consists of immature or baby platelets known as megakaryocytes – target of virus – dengue .For chronic inflammation . Mediator for inflammation Serotonin. Lymphocytes B Cell – L – bone marrow or bursa dependent T cell – dev’t of immunity. NON-GRANULOCYTES 1.) Petecchiae b.) Iron c.000 – 450. bradykinins 3. PM eosinophils . PM Basophils -Involved in Parasitic infection .) Oozing or blood from venipuncture site WBC – leucocytes 5. Common – developed country – due to high cereal intake Due to accidents – common on adults 2.Platelets (thrombocytes) N.

Chronic diarrhea b. dyspnea. Hematochezia – lower GIT – large intestine – fresh blood from rectum 2. RBC 2. Hematemesisii.common in teenager Poisoning – common in children (aspirin) Aspiration – common in infant Accidents – common in adults Choking – common in toddler SIDS – common in infant in US 22. dizziness. 180° Atrophy of cells “Plummer Vinsons Syndrome” due to cerebral hypoxia 1. Subtotal gastrectomy 4. GIT bleeding: i. Hct 5. Administer meds a.sardines c. Stomatitis – mouth sores 3. spoon shaped nails (KOILONYCHIA)=Dec O2=hypoxia=atrophy of epidermal cells Atropic glossitis. Monitor signs of bleeding of all hema test including urine & stool 2. Ferritin Nsg Mgt 1. gen body malaise. 3. spoon shaped nail – atrophy of epidermal cells N = capillary refill time < 2 secs N = shape nails – biconcave shape. 2. Trauma b. Malabsorption syndrome –celiac disease-gluten free diet. Dysphagia Dx Proc: 1. pallor Brittle hair.Suicide . Iron 6. dysphagia. legumes. palpitations. 5. Complete bed rest – don’t overtire pt =weakness and fatigue=activity intolerance 3. 4. Inadequate intake of food rich in iron 3. High cereal intake with low animal CHON ingestion d. Hgb 3. Mens c. Melena – upper GIT – duodenal cancer iii. Reticulocyte 4. Instruct the pt to avoid taking tea .impairs iron absorption 5.) Oral iron preparation Ferrous SO4 Fe gluconate Fe Fumarate 42 . Chronic blood loss a. Encourage – iron rich food 23. Atropic glossiti – inflammation of tongue due to atrophy of pharyngeal and tongue cells 2. Raisins. Improper cooking of food S/Sx: 1. stomatitis Pica – abnormal craving for non edible food (caused by hypoxia=dec tissue perfusion=psychotic behavior) Brittle hair. Common in tropical zone – Phil due blood sucks Predisposing factor: 1. cold sensitivity. Inadequate absorption of iron – due to : a. Food for celiac pts. Asymptomatic Headache. egg yolk 4.

) Fever/ chills e. 2. Predisposing factor 1. Infl dse of ileum 4.megaloblastic.) Pain at injury site b.) Hypotension – anaphylactic shock Anaphylactic shock – give epinephrine PERNICIOUS ANEMIA . Don’t massage injection site. 3. Subtotal gastrectomy – removal stomach 2.Nsg Mgt oral iron meds: 1. e. Sorbitex (IM) Nsg Mgt parenteral iron prep 1. Hereditary 3. If diluting in iron liquid prep –adm with straw Straw 1. Administer of use Z tract method to prevent discomfort. 4.) Urticaria – itchiness f. d. Lifetime B12 injections. Iron dextran (IV. Monitor & inform pts S/E Anorexia n/v Abdominal pain Diarrhea or constipation Melena If pt can’t tolerate oral iron prep – administer parenteral iron prep example: 1. chronic anemia due to deficiency of intrinsic factor leading to Hypochlorhydria – decrease Hcl acid secretion. Autoimmune 5. Lugol’s Tetracycline Oral iron Macrodantine 3. a. Ambulate to facilitate absorption. Give Orange juice – for iron absorption 4. With CNS involvement. c. 2.) Lymphadenopathy d.) Localized abscess (“nana”) c. Monitor S/E: a. Administer with meals – to lessen GIT irritation 2. Strict vegetable diet STOMACH Parietal or ergentaffen Oxyntic cells Fxn – produce intrinsic factor For reabsorption of B12 For maturation of RBC Diet high caloric or CHO to correct wt loss S/Sx: Fxn – secrets Hcl acid Fx aids in digestion 43 . IM) 2. 3. b. discoloration leakage to tissues.

CVA. palpitations 2. dyspnea c. Headache. Drugs – cause bone marrow depression a. Anemia: a.Shilling’s test Nsg Mgt – Pernicious anemia 1. Psychosis Dx:. Broad spectrum antibiotic . dizziness. thrombosis Predisposing factors leading to Aplastic Anemia 1. Enforce CBR 2. Paresthesia c. a. Use of soft bristled toothbrush is encouraged. Not given oral – due pt might have tolerance to drug 3. radiation 3.Headache dizziness. Wt loss d. iron & Vit C 4. Immunologic injury 4. Weakness & fatigue b. IM. pallor GIT changes a. Tingling sensation b. Jaundice 3. Administer B12 injections at monthly intervals for lifetime as ordered. dyspnea. 5. Thrombocytopenia – Peticchiae Oozing ofblood from venipuncture site ecchymosis Dx: 1. Removal of underlying cause decrease WBC leukopenia decrease platelets thrombocytopenia 44 . cold sensitivity. Leucopenia – increase susceptibility to infection 3. CBC – pancytopenia 2. Red – beefy tongue – PATHOGNOMONIC – mouth sores b. palpitations. Avoid applying electric heating pads – can lead to burns 1.Sulfonamides – bactrim b. CNS – Most dangerous anemia: pernicious due to neuroglogic involvement. (+) Romberg’s test Ataxia d. pallor d. Dyspepsia – indigestion c. 2. cold sensitivity. Bone marrow biopsy/ aspiration at post iliac crest – reveals fatty streaks in bone marrow Nsg Mgt: 1.dorsogluteal or ventrogluteal.Chlorampenicol . APLASTIC ANEMIA – stem cell disorder due to bone marrow depression leading to pancytopenia – all RBC are decreased Decrease RBC Anemia Increase WBC leukocytocys Increase RBC polycythemia vera – complication stroke. Increase CHON. Chemo therapeutic agents Methotrexate – alkylating agents Nitrogen mustard – anti metabolic Vincristine – plant alkaloid S/Sx: 1. Diet – high calorie or CHO. gen body malaise. Avoid irritating mouthwashes. Chemicals – Banzene & its derivatives 2.

7. (red) port wine urine. 5. h. cloudiness. serial number. To prevent bleeding if there’s platelet deficiency Nsg Mgt & principles in Blood Transfusion 1. 8. BT reactions S/Sx Hemolytic reaction: H – hemolytic Reaction 1.9NaCl to prevent Hemolysis Hypotonic sol – swell or burst Hypertonic sol – will shrink or crenate c.Warming is done if with warming device – only in EMERGENCY! For multiple BT. A – allergic Reaction hypotension.19 or large bore needle to prevent hemolysis.) Regulate BT 10 – 15 gtts/min KVO or 100cc/hr to prevent circulatory overload j. palpitation. NCLEX-q5min for 1st 15min.Within 30 mins room temp only! g. lumbar/ sterna/ flank pain. f. e.) Isotonic or PNSS or . IM or any venipuncture site = HEPLOCK Use electric razor when shaving to prevent bleeding Administer meds Immunosuppresants Anti lymphocyte globulin (Alg) given via central venous catheter. To replace circulating blood volume 2.) Monitor VS before. 9. blood typing & cross typing expiration date. 3.) Instruct another RN to recheck the following . .) Needle gauge 18 . Return to blood bank. To increase O2 carrying capacity of blood 3. To combat infection if there’s decrease WBC 4.2. 6. Blood transfusion as ordered Complete bed rest O2 inhalation Reverse isolation due leukopenia Monitor signs of infection Avoid SQ. Asceptically assemble all materials needed: a.) Never warm blood products – may destroy vital factors in blood.Majority of BT reaction occurs within 1h. 4. during & after BT especially q15 mins(local board) for 1st hour.) Avoid mixing or administering drug at BT line – leads to hemolysis i. dark in color & sediments – indicates bacterial contamination. . 6 days – 3 weeks to achieve max therapeutic effect of drug. d. Proper typing & crossmatching Type O – universal donor AB – universal recipient 85% of people is RH (+) 3. P – pyrogenic Reaction C – circulatory overload A – air embolism T . Proper refrigeration 2. dyspnea. dizziness.) Blood transfusion should be completed < 4hrs because blood that is exposed at room temp for > 2h causes blood deterioration.) Filter set b. Pts name. Don’t dispose.) Check blood unit for presence of bubbles. flushed skin .thrombocytopenia C – citrate intoxication – expired blood =hyperkalemia H – hyperkalemia Nsg Mgt: Hemolytic Reaction: 45 . Headache. . BLOOD TRANSFUSION: Objectives: 1.

) Fever/ chills b. Obtain urine & blood samples – send to lab 7. 7. tachycardia e. 2. Antihistamine as ordered for AllergicRxn.) Headache c. 4. 7. Adm. Stop BT 2. 3. antibiotics Send blood unit to blood bank Obtain urine & blood samples – send to lab Monitor VS & IO Tepid sponge bath – offer hypothermic blanket Circulatory Overload: Dyspnea Orthopnea Rales or crackles Exertional discomfort Nsg Mgt: 1. 5. 3. if (+) to hypotension – indicates anaphylactic shock 24. Fever/ chills Urticaria/ pruritus Dyspnea Laryngospasm/ bronchospasm Bronchial wheezing Nsg Mgt: 1. 6. Don’t flush due pt has circulatory overload. Stop BT Notify Doc Flush with plain NSS Administer isotonic fluid sol – to prevent acute tubular necrosis & conteract shock Send blood unit to blood bank for reexamination Obtain urine & blood samples of pt & send to lab for reexamination Monitor VS & Allergic Rxn Allergic Reaction: S/Sx 1. Flush with PNSS 4. 4. 6. Send blood unit to blood bank 6. 2. b.SE-Adult-drowsiness. Give bedtime. Child-hyperactive If (+) Hypotension – anaphylactic shock administer – epinephrine 5. c. Notify Doc 3. administer epinephrine 9. d. Administer diuretics Priority cases: 46 . Stop BT Notify Doc Flush with PNSS Administer antipyretics. d. diaphoresis 8. Adm antipyretic & antibiotic for pyrogenic Rxn & TSB Pyrogenic Reaction: S/Sx a. 2. 4. palpitations f. Sx a. Monitor VS & IO 8. 5. Stop BT 2. Administer antihistamine – diphenhydramine Hcl (Benadryl). Notify Doc. 5. 3.1.) Dyspnea Nsg Mgt: 1. 3.

Stool for occult blood (+) Specimen – stool 3. Anaphylaxis 7. 47 . 3. Massive trauma 3.Hemolytic Rxn – 1st due to hypotension – 1st priority – attend to destruction of Hgb – O2 brain damage Allergic 3rd Pyrogenic 4th Circulatory 2nd Hemolytic Anaphylitic 2nd 1st priority DIC – DISSEMINATED INTRAVASCULAR COAGULATION 25. Pregnancy S/Sx 1. Dx Proc– 1. Septicemia 5. 2. Predisposing factor: 1. Administer isotonic fluid solution to prevent shock. stool. Acute hemorrhagic syndrome char by wide spread bleeding & thrombosis due to a def of clotting factors (Prothrombin & Fibrinogen). Neoplasia – growth of new tissue 8. 3. 4. Hemolytic reaction 6. Rapid BT 2. GIT Administer O2 inhalation 2. cyanosis Nsg Mgt DIC 1. Petechiae – widespread & systemic (lungs. lower & upper trunk) Ecchymosis – widespread Oozing of blood from venipunctured site Hemoptysis – cough blood Hemorrhage Oliguria – late sx 6. ABG analysis – metabolic acidosis pH pH ph ph ph HCO3 PCO2 PCO2 HCO3 HCO3 R O M E respiratory alkalosis respiratory acidosis metabolic alkalosis metabolic acidosis Diarrhea – met acidosis Vomitting – met alk Pyloric stenosis – met alkalosis – vomiting Ileostomy or intestinal tubing – met acidosis Cushing’s – met alk DM met acid Chronic bronchitis – resp acid – with hypoxemia. 5. Monitor signs of bleeding – hema test + urine. CBC – reveals decrease platelets 2. Opthalmoscopic exam – sub retinal hemorrhage 4. Massive burns 4.

Provide heplock 8. alkalies . direct trauma b. Multiple myeloma – from bone marrow Pathological fracture of ribs & back pain 4. Radiation 3. Ovarian cancer Classes of cancer Tissue typing 1. Chemical factors – .from connective tissue or bones 3. Chemotherapy plenty S/E 2.Smoking Male 3.common 40 & above (middle age & above) BPH – 50 & above 1. NGT – lavage .) Prostate cancer . Surgery most preferred treatment 4.Uraehane .Hormones . Monitor NGT output 7. chronic irritation. Cervical cancer – 90% multi sexual partners 5% early pregnancy 3. Leukemia – from blood 2.Use iced saline lavage 6. Warning / Danger Sx of CA 48 . 5. Physical – irradiation.) Liver cancer Female 1. Carcinoma – arises from surface epithelium & glandular tissues Sarcoma. Human papiloma virus – causing warts b. nuclear explosion. Breast cancer – 40 yrs old & up – mammography 15 – 20 mins (SBE – 7 days after mens) 2. Bone marrow transplant .Food additives (nitrates . Prevent complication: hypovolemic shock Late signs of hypovolemic shock : anuria Oncologic Nsg: Oncology – study of neoplasia –new growth Benign (tumor) Diff . Epstein barr virus E – environmental Factors 90% a. a.well differentiated Encapulation – (+) Metastasis – (-) Prognosis – good Therapeutic modality surgery Malignancy (cancer) poorly or undifferentiated (-) (+) poor 1. Pitressin or vasopressin – to conserve water. UV rays. Lymphoma – from lymph glands 5.) Lung cancer 2.Leukemia only 4.Drugs (stillbestrol) .Hydrocarbon vesicants. Predisposing factors: (carcinogenesis) G – genetic factors I – immunologic factors V – viral factors a.Administer meds Vit K aquamephyton b.

bone marrow. Administer anti emetic 4 – 6h before start of chemo Plasil 2. and hair follicle. Withhold food/ fluid before start of chemo 3.-Nausea & vomiting Nsg Mgt: 1.) Plant alkaloids – vincristine c.) Anti metabolites – nitrogen mustard d.) Alkylating agents – b. Provide bland diet post chemo 26. Enforce CBR 2.anemia S – sudden wt loss L – loss of wt Therapeutic Modality: 1. Inform pt – hair loss – temporary alopecia Hair will grow back after 4 – 6 months post chemo. I&O qh .Stomatitis/ mouth sores 1. Acute gout – colchicines 29. Inhibits uric acid 28. Classification: a. Monitor urine. Alpha rays – rarely used – doesn’t penetrate skin tissues 2. Monitor signs of bleeding Repro organ – sterility 1. Radiation therapy – involves use of ionizing radiation that kills cancer cells & inhibit their growth & kill N rapidly producing cells. O2 inhalation 3. Administer anti diarrheal 4 – 6h before start of chemo 2.) Hormones – DES Steroids e. -Bone marrow depression – anemia 1.C – change in bowel /bladder habits A – a sore that doesn’t heal U – unusual bleeding/ Discharge T – thickening of lump – breast or elsewhere I – indigestion? Dysphagia O – obvious change in wart/ mole N – nagging cough/ hoarseness U – unexplained anemia A . Increase secretion of uric acid Neurological changes – peristalsis – paralytic ileus Most feared complication ff any abdominal surgery Vincristine – plant alkaloid causes peripheral neuropathy 2. Chemotherapy – use various chemotherapeutic agents that kills cancer cells & kills normal rapidly producing cells – GIT. Reverse isolation 4. Do sperm banking before start of chemo Renal system – increase uric acid 1. Administer allopurinol/ xyloprin (gout) 27. Types of energy emitted 1. Non irritating / non spicy . Beta rays – internal radiation – more penetration 49 .) Antineoplastic antibiotics S/E & mgt GIT .Diarrhea 1. Oral care – offer ice chips/ popsickles 2.

) Distance – the farther the distance – lesser exposure C. sloughing 1. Provide bland diet post chemo Non irritating / non spicy Dysglusia – decrease taste sensitivity -When atrophy papilla (taste buds) – 40 yo Stomatitis c. Monitor signs of bleeding Overview of function & structure of the heart HEART .) Skin errythema. Avoid lotion or talcum powder – skin irritation 4. Assist in battling pt 2. Internal radiation – injection/ implantation of radioisotopes proximal to CA site for a specific period of time.000 – 3. ) Time – the shorter the time.Resembles a closed fist .Left mediastinum . Ex. S/E & Mgt: a. b. Enforce CBR 2. External radiation. . Endocardium – innermost layer Chambers 1. Force fluid – 2.Plasil 2 Withhold food/ fluid before start of chemo 3. Gamma ray – external radiation – penetrates deeper underlying tissues Methods of delivery 1.Atria 2.3.) Shielding – rays can be shielded or blocked by using rubber gloves – α & β gamma – use thick lead on concrete.Covered by serous membrane – pericardium Pericardium Parietal layer Pericardial Fluid – prevent Friction rub Visceral layer Layer 1. redness.) GIT –nausea / vomiting 1.involves electro magnetic waves Ex. cobalt therapy 2.cardiogenic shock 3. O2 inhalation 3. Epicardium – outermost 2.Ventricles Valves 50 .) Sealed implant – radioisotope with a container & doesn’t contaminate body fluid.) Unsealed implant – radioisotope without a container & contaminates body fluid.) Half life – time period required for half of radioisotopes to decay.Weigh 300 – 400 grams .At end of half life – less exposure B.000 ml/day 3. the lesser exposure D. Upper – collecting/ receiving chamber . Reverse isolation 4. Myocardium – inner – responsible for pumping action/ most dangerous layer . Phosphorus 32 3 Factors affecting exposure: A. Lower – pumping/ contracting chamber . 2 types: a.Muscular. pumping organ of the body . Apply cornstarch or olive oil b. Administer antiemetic 4 – 6h before start of chemo .) Bone marrow depression 1.

Atrioventricular valves . Sex – male ARTEROSCLEROSIS . 51 . Atrioventicular node (AV node or Tawara node) Loc – inter atrial septum Delay of electric impulse to allow ventricular filling 3.Narrowing or artery due to calcium & CHON deposits at tunica media. HPN 1. Heart conduction system 1.Tunica media – middle ATHEROSCLEROSIS Predisposing Factor 1. Purkenjie Fiber Loc.primary pace maker of heart -Initiates electric impulse of 60 – 100 bpm 2.Tunica intima – innermost .myocardial necrosis ATHEROSCLEROSIS .Tricuspid & mitral valve Closure of AV valves – gives rise to 1st heart sound or S1 or “lub” 2. Bundle of His – location interventricular septum Rt main Bundle Branch Lt main Bundle Branch 4.Hardening or artery due to fat/ lipid deposits at tunica intima.) Pulmonic b.Ventricular contractions SA node AV Purkenjie Fibers Bundle of His Complete heart block – insertion of pacemaker at Bundle Branch Metal – Pace Maker – change q3 – 5 yo Prolonged PR – atrial fib ST segment depression – angina ST – elev – MI T wave inversion – MI widening QRS – arrhythmia CAD – coronary artery dse or Ischemic Heart Dse (IHD) Atherosclerosis – Myocrdial injury Angina Pectoris – Myocardial ischemia MI. Semi lunar valve a. Sino atrial node (SA node) (or Keith-Flock node) Loc – junction of SVC & Rt atrium Fx.walls of ventricles-. Artery – tunica adventitia – outer .) Aortic Closure of semilunar valve – gives rise to 2nd heart sound or S2 or “dub” Extra heart Sound S3 – ventricular Gallop – CHF S4 – atrial gallop – MI.

sex – male 2. DM 7. hyperlipidemia 4. Chest pain 2. DM 7. sedentary lifestyle 9. Oral contraceptive. Tachycardia 4. Sedentary lifestyle 9. resulting fr temp myocardial ischemia.hypothyroidism Precipitating factors 4 E’s 1. Excessive physical exertion 2. HPN 6. Obesity 10. Predisposing Factor: 1. To revascularize the myocardium To prevent angina Increase survival rate PTCA – done to pt with single occluded vessel . 2. Extreme emotional response 4.prolonged use 8. black raise 3. Diaphoresis Treatment P – percutaneous T – tansluminar C – coronary A – angioplasty Obj: 1. HPN 6.A clinical syndrome characterized by paroxysmal chest pain usually relieved by REST or NGT nitroglycerin. Black race 3. Excessive intake of food – saturated fats. Multiple occluded vessels C – coronary A – arterial B – bypass A –and G – graft surgery Nsg Mgt Before CABAG 1. Hyperlipidemia 4. oral contraceptive prolonged 8. Palpitations 5. Dyspnea 3. Signs & Symptoms 52 . 3. Leg exercises ANGINA PECTORIS. smoking 5. Deep breathing cough exercises 2. Hypothyroidism Signs & Symptoms 1. Use of incentive spirometer 3. Exposure to cold environment .2.Vasoconstriction 3. obesity 10. Smoking 5.

Rise slowly from sitting position 4. Assist in ambulation. Nursing Management 1. avoid placing near microwave oven or during defibrillation-will burn pt due aluminum foil in patch B. If giving NTG via patch: i. NTG.diaphoresis Diagnosis 1. I&O. Avoid moisture & heat. Stress test – treadmill = abnormal ECG 4.) 7. Initial symptoms – Levine’s sign – hand clutching of chest Chest pain – sharp. avoid rotating transdermal patches. axilla. 2. 2nd question: does pain radiate? If radiate – heart in nature. ECG – ST segment depression 3. Importance of follow-up care.) MI – MYOCARDIAL INFARCTION – hear attack – terminal stage of CAD Characterized by necrosis & scarring due to permanent mal-occlusion 53 . Palpitation 6. Tachycardia 5.1.increase. Meds: A. MI! 55 yrs old with chest pain: 1st question to ask pt: what did you do before you had chest pain. Take meds before physical exertion-to achieve maximum therapeutic effect of drug d. arms & jaw muscles -relieve by rest or NGT 3.Decrease Na and saturated fats Monitor VS. shoulders. Ca antagonist .History taking & PE 2. avoid placing it near hairy areas-will dec drug absorption ii.) 6. Keep in a dry place. ECG HT: Discharge planning: a. Monitor S/E: orthostatic hypotension – dec bp transient headache dizziness 3. Location – substernal -radiates back.will dec drug absorption iii.) Administer meds NTG – small doses – venodilator Large dose – vasodilator 1st dose NTG – give 3 – 5 min 2nd dose NTG – 3 – 5 min 3rd & last dose – 3 – 5 min Still painful after 3rd dose – notify doc.) 5. 3. Avoid precipitating factors – 4 E’s b.Nsg Mgt: 1.) Enforce CBR 2. Prevent complications – MI c.nefedipine Administer O2 inhalation Semi-fowler Diet. ACE inhibitors – captopril D. Beta blockers – propanolol C. 2. Dyspnea 4.) 4. 5. If not radiate – pulmonary origin Venodilator – veins of lower ext – increase venous pooling lead to decrease venous return. stabbing excruciating pain. Serum cholesterol & uric acid . may inactivate the drug.

9. Trasmural MI – most dangerous MI – Mal-occlusion of both R&L coronary artery 2.) SGOT (AST) – Serum Glutamic Oxaloacetic . occasional findings a.) Bedside commode 4.) pericardial friction rub c. thrombophlebitis . vice like. Predisposing factors sex – male black raise hyperlipidemia smoking HPN DM oral contraceptive prolonged sedentary lifestyle obesity hypothyroidism Signs & symptoms 1.) Strict compliance to meds . Administer O2 inhalation – low inflow (CHF-increase inflow) 3.) LDH – lactic acid dehydrogenase c. CBC – increase WBC Nursing Management 1.) SGPT – (ALT) – Serum Glutanic Pyruvate Transaminase. caffeine 7. shoulders. axilla. Arrhythmias – PVC 2. Semi fowler 6. I&O & ECG tracings 8.increase 5.) CPK – MB – Creatinine Phosphokinase b. NTG 2. initial increase in BP 5.Majority of pt suffers from PVC premature ventricular contraction. Isordil . brandy/whisky to induce vasodilation. Lydocaine blocks release of norepenephrine 2. jaw & abd muscles. Brithylium .deep vein 4.radiates back. erthermia 4.) rales /crackles d.Antiarrythmic 1.) Avoid modifiable risk factors b.000 – 450.) split S1 & S2 b. Avoid valsalva maneuver 5.000 units of streptokinase c. dyspnea 3.increased d.not usually relived by rest r NTG 2. CABAG 10. Dressler’s syndrome – post MI syndrome -Resistant to medications -Administer 150. saturated fat. chest pain – excruciating.ACE inhibitors . Late signs of cardiogenic shock in MI – oliguria 3.Beta-blockers – “lol” 1. ECG tracing – ST segment increase. arm. Troponin test – increase 3.Vasodilators 1. Shock – cardiogenic shock. serum cholesterol & uric acid . cardiac enzymes a.increased 2.pril 54 . . Assist in surgical. CHF – left sided 5. Narcotic analgesics – Morphine SO4 – to induce vasodilation & decrease levels of anxiety. Sub-endocardial MI – mal-occlusion of either R & L coronary artery Most critical period upon dx of MI – 48 to 72h . widening or QRS complexes – means arrhythmia in MI indicating PVC 4.) S4 (atrial gallop) Diagnostic Exam 1. Propanolol (inderal) . General liquid to soft diet – decrease Na. mild restlessness & apprehensions 6. visceral pain located substernal or precodial area (rare) . Provide pt HT a. Take 20 – 30 ml/week – wine. Monitor VS. 2.) Prevent complications: 1.Types: 1. Enforce CBR without BP a.

Backflow 1.Anticoagulants 1.) Position – non-weight bearing position. Captopril – (enalapril) .Steroids . MI.)Sex as an appetizer rather then dessert – Before meals not after. Dyspnea 2.Aspirin Complication: RS-CHF Aging – degeneration / calcification of mitral valve Ischemic heart disease HPN. Aortic stenosis S/Sx Pulmonary congestion/ Edema 1. and caffeine f.) 90% mitral valve stenosis – due RHD. e. Caumadin – delayed reaction 2 – 3 days PT prolonged bleeding Antidote antidote Vit K Protamine sulfate .Thrombolitics or fibrinolytics– to dissolve clots/ thrombus S/E allergic reactions/ uticaria 1.) Left sided heart failure: Predisposing factors: 1. Paroxysmal nocturnal dysnea – PNO. Nifedipine . Streptokinase 2.Inability of heart to pump blood towards systemic circulation. Frothy salivation (from lungs) 6.Aso titer – anti streptolysine O > 300 total units .nalulunod 4. When to resume sex/ act: When pt can already use staircase.) Diet – decrease Na. Orthopnea (Diff of breathing sitting pos – platypnea) 3.Anti platelet PASA (aspirin) d. Saturated fats. Rales/ crackles – due to fluid 8. Tissue plasminogen adjusting factor Monitor for bleeding: . Heparin PTT If prolonged bleeding 2.) Resume ADL – sex/ activity – 4 to 6 weeks Post-cardiac rehab 1.Penicillin .1. Productive cough with blood tinged sputum 5. Urokinase 3.Ca – antagonist 1. Cyanosis 7. . due after meals increase metabolism – heart is pumping hard after meals. Bronchial wheezing 55 . 2.) Follow up care. CHF – CONGESTIVE HEART FAILURE . then he can resume sex. aging RHD affects mitral valve – streptococcal infection Dx: .

Ascites . 3. Left sided heart failure S/Sx Venous congestion .) Right sided HF Predisposing factor 1.9. 10.Wt gain . 12. Pulmonary embolism 4. 2. gen body malaise Diagnosis: 1.Done 5 – 20 mins – scalpel & trachesostomy set CVP – indicates fluid or hydration status Increase CVP – decrease flow rate of IV Decrease CVP – increase flow rate of IV Echocardiography – reveals enlarged heart chamber or cardiomayopathy ABG – PCO2 increase. 90% . Dx 1. COPD 3.Anorexia.Hepatomegalo/ splenomegaly .Neck or jugular vein distension . 2. Indicates cardiac status. PMI – displaced lateral – due cardiomegaly Pulsus alternons – weak-strong pulse Anorexia & general body malaise S3 – ventricular gallop CXR – cardiomegaly PAP – Pulmonary Arterial Pressure PCWP – Pulmonary CapillaryWedge Pressure PAP – measures pressure of R ventricle.Liver enzyme SGPT ( ALT) SGOT AST 56 . 3. PCWP – measures end systolic/ diastolic pressure PAP & PCWP: Swan – ganz catheterization – cardiac catheterization is done at bedside at ICU (Trachesostomy – bedside) .Pitting edema . Echocardiography – enlarged heart chamber / cardiomyopathy 4. 4.Esophageal varies . CXR – cardiomegaly CVP – measures the pressure at R atrium Normal: 4 to 10 cm of water Increase CVP > 10 – hypervolemia Decrease CVP < 4 – hypovolemia Flat on bed – post of pt when giving CVP Position during CVP insertion – Trendelenburg to prevent pulmonary embolism & promote ventricular filling. PO2 decrease = = hypoxemia = resp acidosis 2.Jaundice . 11.Pruritus .tricuspid stenosis 2. Pulmonic stenosis 5.

Acute inflammatory disorder affecting small to medium sized 57 .) Anti-arrythmics – Lidocaine 2. Monitor V/S.) Narcotic analgesic: Morphine SO4 . Measure abdominal girth daily & notify MD 7. I&O. Administer meds: Tx for LSHF: M – morphine SO4 to induce vasodilatation A – aminophylline & decrease anxiety D – digitalis (digoxin) D . Rotating tourniquet or BP cuff rotated clockwise q 15 mins = to promote decrease venous return 9.) Loop diuretics: Lasix – effect with in 10-15 min. Thromboangiitis Obliterans – male/ feet 2. Antidote: digivine Digitoxin: metabolizes in liver not in kidneys not given if with kidney failure.) Dietary modifications c.) Thromboangiitis obliterates/ BUERGER arteries & veins of lower extremities. Weigh pt daily. HT: a) Complications :shock Arrhythmia Thrombophlebitis MI Cor Pulmonale – RT ventricular hypertrophy b.induce vasodilaton & decrease anxiety e.diuretics O . breath sounds 8. Provide meticulous skin care 6.) Bronchodilators: Aminophillin (Theophyllin).gases a. Administer O2 inhalation – high! @ 3 -4L/min via nasal cannula 3.Nsg mgt: Increase force of myocardial contraction = increase CO 3 – 6L of CO 1. Varicose veins 2.) Cardiac glycosides Increase myocardial = increase CO Digoxin (Lanoxin). b.) Adherence to meds PERIPHERAL MUSCULAR DISEASE Arterial ulcers 1.) Vasodilators – NTG f.oxygen G . Diet – decrease salt. Reynauds – female/ hands venous ulcer 1. Avoid giving caffeine d. Assess for pitting edema. fats & caffeine 10. High fowlers 4. Thrombophlebitis 1.Male . Male/ feet Predisposing factors: .Smokers DISEASE. Max = 6 hrs c. Institute bloodless phlebotomy. Restrict Na! 5.

leg pain upon walking . Intermittent claudication – leg pain upon walking .) Rheumatoid arthritis – Direct hand trauma – piano playing. 2. Dorsalis pedis 4. Foot care mgt like DM – a.Post tibial. operating chainsaw 1. 3.)REYNAUD’S Predisposing factors: 1. Ulcerations 6. Surgery: BKA (Below the knee amputation) 2.) Avoid wearing constrictive garments 4. Cold sensitivity & skin color changes White Pallor bluish cyanosis red rubor 3.) Cut toe nails straight c.) Vasodilator c.) Analgesic b.S/Sx 1. Oscillometry – decrease peripheral pulse volume.Relieved by rest 2. Meds a. Nsg Mgt: Intermittent claudication .) SLE – pathognomonic sign – butterfly rash on face Chipmunk face – bulimia nervosa Cherry red skin – carbon monoxide Spider angioma – liver cirrhosis Caput medusae – leg & trunk Lion face – leprosy b.) Anticoagulant 3. 40 yrs Smoking Collagen dse a. Decrease or diminished peripheral pulses . excessive typing.) Apply lanolin lotion – prevent skin breakdown d. Nsg Mgt: 1.) Out of bed 2 – 3 x a / day 2. S/Sx: 58 .Liver cirrhosis 4. Encourage a slow progression of physical activity a.) Walk 3 -4 x / day b. Tropic changes 5. 5. Gangrene formation Dx: 1. 3. Angiography – reveals site & extent of mal-occulsion. Female. Doppler UTZ – decrease blood flow to affected extremities. 2. Avoid smoking & exposure to cold environment 5. 2.) Avoid walking barefoot b.Relieved by rest Cold sensitivity PHENOMENON – acute episodes of arterial spasm affecting digits of hands & fingers poisoning umbilicus.

Pregnancy f.) Decrease venous return Predisposing factors: a. Surgery: vein sweeping & ligation Sclerotherapy – spider web varicosities S/E thrombosis THROMBOPHLEBITIS (deep vein thrombosis) . Pain especially after prolonged standing 2.) Incompetent valves leading to b. Prolonged use of oral contraceptives 5. MI 8. Smoking 2. 3. Avoid smoking & exposure to cold environment VENOUS ULCERS 1.Pain at leg muscles upon dorsiflexion of foot. c. Chronic anemia 6. Post cannulation – insertion of various cardiac catheters S/Sx: 1.) Increase venous pooling & stasis leading to c. 3. VARICOSITIES / Varicose veins . Venography 2. 59 . d. Women – panty hose 4. Meds: Analgesics 5. Heaviness in legs Dx: 1. Obesity g. Elevate legs above heart level – to promote venous return – 1 to 2 pillows 2. DM 7. Hereditary b. Postop complications 10. Measure circumference of leg muscles to determine if swollen. 2. Pain at affected extremities Cyanosis (+) Homan’s sign .Inflammation of veins with thrombus formation Predisposing factors: 1. Hyperlipedemia 4.Prolonged standing S/Sx: 1. Warm to touch 4.Abnormal dilation of veins – lower ext & trunk . Trendelenberg’s test – vein distend quickly < 35 secs Nsg Mgt: 1.Due to: a. Analgesics Vasodilators Encourage to wear gloves especially when opening a refrigerator. Prolonged immobility .a. b. CHF 9. Obesity 2. Thrombophlebitis d. Wear anti embolic or knee high stockings. Heart dse e. Congenital weakness of veins c. Dilated tortuous skin veins 3.

2. Humidification a.Consists of anastomosis of capillaries – Kessel – Bach Plexus – site of epistaxis b. parietal lobe & visceral lobe Alveoli – acinar cells . Lower Rt – Fx for gas exchange a. Nose – cartilage .site of gas exchange (O2 & CO2) 60 .has cartillagenous rings . moist packs to decrease lymphatic congestion. Filtering of air 2. 2. 3. Apply warm. Complication: Angiography Doppler UTZ Pulmonary Embolism: . Nsg Mgt: 1.Palpitation . Lungs – R – 3 lobes = 10 segments L – 2 lobes – 8 segments Post pneumonectomy . Upper respiratory tract: Fx: 1. Trachea – windpipe .Diaphoresis .Tachycardia . Meds: Analgesics. Elevate legs above heart level. 2. Anticoagulant: Heparin 6. Bronchus – R & L main bronchus c.Sudden sharp chest pain . Use anti embolic stockings. Larynx – voice box Fx: 1.Parts: Rt nostril separated by septum Lt nostril . Nasopharynx 3. Layngopharynx c. Oropharynx 2.site for permanent/ artificial a/w – tracheostomy b. Measure circumference of leg muscles to detect if swollen. 4. Warming & moistening 3. Pharynx (throat) – muscular passageway for air& food Branches: 1. For phonation Cough reflex Glottis – opening Opens to allow passage of air Closes to allow passage of food II.position affected side to promote expansion of lungs Post segmental lobectomy – position unaffected side to promote drainage Lungs – covered by pleural cavity. 5.Mild restlessness OVERVIEW OF RESPIRATORY SYSTEM: I.Dx: 1.Dyspnea .

4. 8.< 40% Concentration to prevent atelectasis & retinopathy or blindness. Immuno-compromised a. anorexia. Air pollution 3. Productive cough – pathognomonic: greenish to rusty sputum 2.gram staining & culture sensitivity . 3. Over fatigue S/Sx: 1.Non-productive to productive cough 4. ABG – PO2 decrease 61 .decrease surface tension of alveoli Lecithin & spinogometer L/S ratio 2:1 – indicator of lung maturity If 1:2 – adm O2 . 5. Streptococcus pneumoniae (pnemococcal pneumonia) 2. AIDS – PLP b. Prolonged immobility – CVA. 2.hypostatic pneumonia 5. Hemophilus pneumoniae(Bronchopneumonia) 3. Aspiration of food 6. 7. Diplococcus P. CXR – pulmo consolidation 3. 6. Etiologic agents: 1. gen body malaise Wt loss Pleuritic friction rub Rales/ crackles Cyanosis Abdominal distension leading to paralytic ileus Sputum exam – could confirm presence of TB & pneumonia Dx: 1. Sputum GSCS.- diffusion: Daltons law of partial pressure of gases Ventilation – movement of air in & out of lungs Respiration – movement of air into cells Type II cells of alveoli – secrets surfactant Surfactant . chills. CBC – increase WBC Erythrocyte sedimentation rate 4. High risk elderly & children below 5 yo Predisposing factors: 1. 5. Klebsiella P. Escherichia coli 4. Bronchogenic CA . PNEUMONIA – inflammation of lung parenchyma leading to pulmonary consolidation as alveoli is filled with exudates.Reveals (+) cultured microorganism. Dyspnea with prolonged respiratory grunt Fever. Smoking 2. I.

Inflammation of lung tissue caused by invasion of mycobacterium TB or tubercle bacilli or acid fast bacilli – gram (+) aerobic.) Mucolytics or expectorants 4. increase IOP (glaucoma) Normal IOP – 12 – 21 mmHg 11.) Adm bronchodilators 15 – 30 min before procedure e.) Chest physiotherapy – cupping d.) Anti pyretics c.Nsg Mgt: Enforce CBR Strict respiratory isolation Meds: a.) Provide oral care – it may alter taste sensation g.) Coughing exercise c. Virulence 6. 2. Nebulize & suction 8.Promote expectoration of secretions 6. 7. 5. 3. Force fluids – 2 to 3 L/day 5. increase ICP. Predisposing factors: 1. general body malaise. Skin test – mantoux test – infection of Purified CHON Derivative PPD DOH – 8-10 mm induration WHO – 10-14 mm induration Result within 48 – 72h 62 . wt loss Chest/ back pain Hempotysis Diagnosis: 1. 6. HT: a. Overcrowding 3. Semi-fowler 7. 2.) C/I – pt with unstable VS & hemoptysis. Alcoholism 4. Postural drainage .) Deep breathing exercise b. PULMONARY TUBERCULOSIS (KOCH DSE) . Institute pulmonary toileta.) Deep breathing exercises d. Over fatigue S/Sx: 1. Ingestion of infected cattle (mycobacterium BOVIS) 5.) Best done before meals or 2 – 4 hrs after meals to prevent Gastroesophageal Reflux b.) Broad spectrum antibiotics Penicillin or tetracycline Macrolides – ex azythromycin (zythromax) b. 4.) Compliance to meds 1.) Turning & reposition .) Avoidance of precipitating factors b.) Stop if pt can’t tolerate procedure f.) Monitor VS & breath sounds Normal breath sound – bronchovesicular c. CHON & vit C 10. Comfy & humid environment 9. Productive cough – yellowish Low fever Night sweats Dyspnea Anorexia. Malnutrition 2. 3.To drain secretions using gravity Mgt for postural drainage: a. motile & easily destroyed by heat or sunlight.) Complication: Atelectacies & meningitis c. Diet: increase CHO or calories.

sweat & tears. nephrotoxicity & hepatoxicity Standard regimen 1. CHON. Histoplasmin skin test = (+) ABG – pO2 decrease 63 .) Complications: 1. Vit. Diet – increase CHO & calories.give before meals for absorption . 2. Strict resp isolation 3. Short course chemotherapy - Intensive phase INH – isoniazide Rifampicin .acute fungal infection caused by inhalation of contaminated dust with histoplasma capsulatum transmitted to birds manure. PZA – Pyrazinamide – given 2 mos/ after meals.) Compliance to meds . Dyspnea 3. CXR – pulmonary infiltrate caseosis necrosis 4. gentamycin. CBC – increase WBC Nursing Mgt: 1.Religiously take meds HISTOPLASMOSIS. DBCE 7. Sputum AFB – (+) to cultured microorganism 3.) Atelectasis 2. stool. Productive cough 2. Comfy & humid environment 9. Hemoptysis Dx: 1. Nebulize & suction 8. Chest & joint pains 4. Semi fowler 5.given within 4 months. minerals 10. Cyanosis 5. CBR 2. S/Sx: Same as pneumonia & PTB – like 1. O2 inhalation 4. neomycin S/E: a. Force fluid to liquefy secretions 6. given simultaneously to prevent resistance -S/E: peripheral neutitis – vit B6 Rifampicin -All body secretions turn to red orange color urine.(+) Mantoux test – previous exposure to tubercle bacilli Mode of transmission – droplet infection 2.) Ototoxicity – damage CN # 8 – tinnitus – hearing loss b. Kanamycin. Anorexia. Injection of streptomycin – aminoglycoside Ex. wt loss 6. gen body malaise. saliva.) Miliary TB – spread of Tb to other system b.) Avoid pred factors b. S/E: allergic rxn.) Nephrotoxicicity – monitor BUN & Crea HT: a.

Extrinsic Asthma – called Atropic/ allergic asthma a. gen body malaise Dx: 1. O2 – force fluids 4. Dyspnea on exertion 3. Prevent spread of histoplasmosis: a.)Corticosteroids c.) Atelectasis b. Prolonged expiratory grunt 4.) Dust c.) Mucolytic/ or expectorants 3.) Bronchiectasis COPD 6. ABG PO2 PCO2 Resp acidosis Hypoxemia – causing cyanosis Nsg Mgt: (Same as emphysema) 2. CBR 2. Cyanosis 6.) Cor pulmonary – respiratory in origin 7.) Hypokalemia b.) Anti fungal agents Amphotericin B (Fungizone) S/E : a.) Gases d. 4. Anorexia. Scattered rales/ rhonchi 5. COPD – Chronic Obstructive Pulmonary Disease 1.) Nephrotoxcicity check BUN b. 2.) Smoke 64 . Pulmo HPN – a. 3.Nsg Mgt: 1.) Spray breading places or kill the bird. Predisposing factor: 1.reversible inflammation lung condition due to hyerpsensitivity leading to narrowing of smaller airway.called BLUE BLOATERS inflammation of bronchus due to hypertrophy or hyperplasia of goblet mucus producing cells leading to narrowing of smaller airways. Nebulize. Complications: a. suction 5. Chronic bronchitis Bronchial asthma Bronchiectasis Pulmonary emphysema – terminal stage CHRONIC BRONCHITIS .)Leading to peripheral edema b.) Pallor b. Air pollution S/Sx: 1. Smoking – all COPD types 2. Predisposing factors: 1. Prod cough 2. Meds: a.) BRONCHIAL ASTHMA.

Dx: 1.) Lints 2. HT a.) Complications: . Predisposing factors: 1.) Avoid pred factors b. mixed type: combi of both ext & intr.) Antihistamine 2. Anorexia. CBR – all COPD 2. C – cough – non productive to productive D – dyspnea W – wheezing on expiration Cyanosis Mild apprehension & restlessness Tachycardia & palpitation Diaphoresis Pulmo function test – decrease lung capacity ABG – PO2 decrease 3. Tumors 4. eggs. Productive cough 2. Semifowler – all COPD except emphysema due late stage 6. Give 1st before corticosteroids b.) Corticosteroids – due inflammatory.Status astmaticus. Recurrent upper & lower RI 2. gen body malaise. milk Physical/ emotional stress Sudden change of temp. Medsa. Cyanosis 5. Dyspnea 3. Force fluid 3.Emphysema c. Congenital anomalies 3. e. 5. 4.) Adherence to med BRONCHIECTASIS – abnormal permanent dilation of bronchus resulting to destruction of muscular & elastic tissues of alveoli. 7.e. penicillin. 4. 2. Nsg Mgt: 1. β blockers Food additives – nitrites Foods – seafood. chicken. O2 – all COPD low inflow to prevent resp distress 4.) Bronchodilator through inhalation or metered dose inhaled / pump. Trauma S/Sx: 1. Hemoptisis 65 . Intrinsic AsthmaCause: Herediatary Drugs – aspirin.) Dander f.all energy are used to increase respiration.) Mucolytic/ expectorant d. chocolates. 2. Given 10 min after adm bronchodilator c. 6. Nebulize & suction 5.) Mucomist – at bedside put suction machine.give epinephrine & bronchodilators . humidity &air pressure 3. Asthma 90% cause of asthma S/Sx: 1.

Pathognomonic: barrel chest – increase post/ anterior diameter of chest 10. Consent.Characterized by inelasticity of alveolar wall leading to air trapping. explain procedure – MD/ lab explain RN 2.Body will compensate over distension of thoracic cavity .with air or fluid Resonance to hyperresonance – percussion Decreased or diminished breath sounds 9. ABG – a. Allergy 3. Feeding after return of gag reflex Instruct client to avoid talking. Dyspnea at rest – due terminal Anorexia & gen body malaise Rales/ rhonchi Bronchial wheezing Decrease tactile fremitus (should have vibration)– palpation – “99”. Nsg Mgt after bronchoscopy 1. Monitor VS 2.) Bronchodilators 66 . NPO 3. ABG – PO2 decrease Nsg Mgt: before bronchoscopy 1.) Panlobular / centrolobular emphysema pCO2 increase pO2 decrease – hypoxema resp acidosis Blue bloaters b. Meds – a. 2. Air pollution 4. leading to maldistribution of gases.) Panacinar/ Centracinar pCO2 decrease pO2 increase – hyperaxemia resp alkalosis Pink puffers Nursing Mgt: 1. smoking or coughing Monitor signs of frank or gross bleeding Monitor of laryngeal spasm DOB Prepare at bedside tracheostomy set Mgt: same as emphysema except Surgery Pneumonectomy – removal of affected lung Segmental lobectomy – position of pt – unaffected side PULMONARY EMPHYSEMA – irreversible terminal stage of COPD . Purse lip breathing – to eliminated PCO2 11. . 8. Productive cough 2. Smoking 2. Bronchoscopy – direct visualization of bronchus using fiberscope.Barrel chest Predisposing factor: 1. 3. Decreased . Flaring of alai nares Diagnosis: 1. CBR 2. 7. Hereditary . 4. 5. High risk – elderly 5. S/Sx: 1. 6.α 1 anti trypsin to release elastase for recoil of alveoli.Dx: 1. Pulmonary function test – decrease vital lung capacity 2. 3. 4.

CXR – confirms pneumothorax Nursing Mgt: 1. flail chest – “paradoxical breathing” Predisposing factors: 1. Thoracenthesis 3. Meds – Morphine SO4 . Cyanosis 4.) CO2 narcosis – lead to coma 3. rupture of bleb (alveoli filled sacs) in pt with inflammed lung conditions Eg. Maintain strict aseptic technique 2. Cool moist skin 6. Types: 1. Institute P – posture E – end E – expiratory to prevent collapse of alveoli P – pressure 8. Neb & suction 7.) Mucolytics/ expectorants 3.Inflammatory lung conditions 3. Assist in test tube thoracotomy Nursing Mgt if pt is on CPT attached to H2O drainage 1.) Pneumothorax – air in pleural space 9. O2 – Low inflow 4. Mild restlessness/ apprehension 7.) Avoid smoking b. Dyspnea 3. Sudden sharp chest pain 2. Force fluids 5. open pneumothorax – air enters pleural space through an opening in chest wall -Stab/ gun shot wound 2. At bedside 67 .Chest trauma 2. Adherence to meds RESTRICTIVE LUNG DISORDER PNEUMOTHORAX – partial / or complete collapse of lungs due to entry or air in pleural space.Tumor S/Sx: 1. HT a.Anti microbial agents 4. Spontaneous pneumothorax – entry of air in pleural space without obvious cause. ABG – pO2 decrease – 2.) Prevent complications 1.) Antimicrobial agents d. Tension Pneumothorax – air enters plural space with @ inspiration & can’t escape leading to over distension of thoracic cavity resulting to shifting of mediastinum content to unaffected side. Diminished breath sound of affected lung 5.b. Eg.) Cor pulmonary – R ventricular hypertrophy 2. Resonance to hyper resonance Diagnosis: 1. Endotracheal intubation 2. High fowlers 6.) Corticosteroids c.) Atelectasis 4. Eg. DBE 3.

Indicates re-expansion of lungs When will MD remove chest tube: 1. Notify MD c. DBE 2.) Petroleum gauze pad if dislodged Hemostan b. Mouth b.function for digestion a. Jejunum c. Transverse c. Milk towards H2O seal 3.Complete absorption – large intestine a. Gallbladder – storage of bile I. to prevent entry of air in pleural space. Salivary gland b. Liver d. Middle Alimentary canal – Function: for absorption . Check for air leakage 2. Accessory Organ a.a. Monitor & assess for oscillation fluctuations or bubbling a. Lower Alimentary Canal – Function: elimination a.) Extra bottle 4. clots. Ileum d. Salivary Glands 1. Pharynx (throat) c. CXR – full expansion of lungs Nursing Mgt of removal of chest tube 1. Instruct to perform Valsalva maneuver for easy removal. Sigmoid e. 3.H2o goes down upon expiration b. Sublingual 3.) If with air leakage – clamp c.) If (-) to bubbling 1. Meds – Morphine SO4 Antimicrobial 5. Rectum IV. Verniform appendix c. (+) Breath sounds 3. Pancreas – auto digestion e. Check for loop. 2nd half of ascending colon b. 1st half of duodenum II. 2nd half of duodenum b. Clamp towards chest tube 3.Maintain dressing dry & intact GIT I. and kink 2. Apply vaselinated air occlusive dressing . remittent bubbling 1. Parotid – below & front of ear 2. Descending colon d. If (-) fluctuations 2. 1st half of ascending colon III.) If (+) to intermittent bubbling means normal or intact . Submaxillary Produces saliva – for mechanical digestion 68 . Stomach e. Upper alimentary canal . Esophagus d.) If (+) to continuous.H2O rises upon inspiration .

3. Fever.saliva produced PAROTITIS – “mumps” – inflammation of parotid gland -Paramyxo virus S/Sx: 1. PE – (+) rebound tenderness (flex Rt leg.ceases to function upon birth of baby APENDICITIS – inflamation of verniform appendix Predisposing factor: 1. Meds: analgesic Antipyretic Antibiotics – to prevent 2° complications 4. gen body malaise Swelling of parotid gland Dysphagia Ear ache – otalgia Mode of transmission: Direct transmission & droplet nuclei Incubation period: 14 – 21 days Period of communicability – 1 week before swelling & immediately when swelling begins. Complications Women – cervicitis. CBR 2. oophoritis Both sexes – meningitis & encephalitis/ reason why antibiotics is needed Men – orchitis might lead to sterility if it occur during / after puberty. Meds: Antipyretic Antibiotics 69 .appendectomy 24 – 45° Nursing Mgt: 1. 4. guava seeds 3. n/v Diarrhea / & or constipation Pain at Rt iliac region Late sign due pain – tachycardia 5. Strict isolation 3.Function – lymphatic organ – produces WBC during fetal life . 2. Pathognomonic sign: (+) rebound tenderness 2. CBC – mild leukocytosis – increase WBC 2.) Avoid enema – lead to rupture of appendix 3. chills anorexia. Microbial infection 2. Diagnosis: 1. Alternate warm & cold compress at affected part 5.) Skin prep b.- 1200 -1500 ml/day . Low grade fever. Gen liquid to soft diet 6. Nursing Mgt: 1. vaginitis. 3. Feacalith – undigested food particles – tomato seeds. Routinary nursing measures: a. anorexia.) NPO c. Consent 2. Urinalysis Treatment: . palpate Rt iliac area – rebound) 3. VERNIFORM APPENDIX – Rt iliac or Rt inguinal area . 4. Intestinal obstruction S/Sx: 1.

Promotes synthesis of albumin & globulin Cirrhosis – decrease albumin Albumin – maintains osmotic pressure. Promotes conversion of ammonia to urea. osteoarthritis 4.Composed of H2O & bile salts -Gives color to urine – urobilin Stool – stircobilin 2. 5. Monitor VS. Promotes synthesis of prothrombin & fibrinogen 3.Occupies most of right hypochondriac region . For metabolism A. D. Nursing priority – assist in mechanical ventilation Predisposing factor: Decrease Laennac’s cirrhosis – caused by alcoholism 70 .Covered by a fibrous capsule – Glisson’s capsule . prevents edema 2. Promotes synthesis of vit A. Monitor VS. E. Gluconeogenesis – formation of glucose from CHO sources B. decrease LOC – hepatic coma. disorientation. CHO – 1.Rickets. Complications. Avoid heat application – will rupture appendix.fat soluble vitamins Hypevitaminosis – vit D & K Vit A – retinol Def Vit A – night blindness Vit D – cholecalciferon .lost of architectural design of liver leading to fat necrosis & scarring Early sign – hepatic encephalopathy 1.Functional unit – liver lobules Function: Produces bile Bile – emulsifies fats . Glycogenolysis – breakdown of glycogen 3. 4.peritonitis. FATS – promotes synthesis of cholesterol to neutral fats – called triglycerides 1. restlessness. LIVER CIRRHOSIS . Maintain patent IV line 5. Glycogenesis – synthesis of glycogens 2. K . I&O. If (+) to Pendrose drain – indicates rupture of appendix Position. CHON1.*Don’t give analgesic – will mask pain .Helps calcium . Detoxifies drugs 3.Color: scarlet red .Presence of pain means appendix has not ruptured. bowel sound 4. Asterixis – flapping hand tremors Late signs – headache. Antipyretics PRN 3. I&O bowel sound Nursing Mgt: post op 1. Meds: analgesic due post op pain Antibiotics. It destroys excess estrogen hormone 5.affected side to drain 2. septicemia Liver – largest gland . Ammonia like breath – fetor hepaticus C.

) Anorexia.) Stomatitis d.1. Decrease CHON 71 . With pt daily & assess pitting edema 5.ammonia (cerebral toxin) Late signs: Early signs: Headache asterexis Fetor hepaticus (flapping hand tremors) Confusion Restlessness Decrease LOC Hepatic coma Diagnosis: Liver enzymes.increase SGPT (ALT) SGOT (AST) Serum cholesterol & ammonia increase Indirect bilirubin increase CBC .main cause Virus – Toxicity.) Hepatomegaly i. fatigue b.) Loss of pubic. Diet – increase CHO. Palmar errythema c.decrease Thrombocytopenia. Monitor VS. Gynecomastia Caput medusate. bleeding esophageal varices – due to portal HPN d.) Hematological changes – all blood cells decrease Leukopenia. Chronic alcoholism Malnutrition – decreaseVit B. 4. Measure abdominal girth daily – notify MD 6. I&O 4. Restrict Na! 3. Meticulous skin care 7.) Endocrine changes Spider angiomas. thiamin .) GIT changes Ascitis.) Neurological changes: Hepatic encephalopathy . Moderate fats.) Weakness. Late signs a.) Pruritus or urticaria 2. vit & minerals. 2.) Urine – tea color Stool – clay color e.) Jaundice j.decrease b. n/v c.eg. axilla hair h.) Amenorrhea f. Carbon tetrachloride Use of hepatotoxic agents S/Sx: Early signs: a. 3. CBR 2. 5.decrease Anemia.) Decrease sexual urge g.pancytopenia PTT – prolonged Hepatic ultrasonogram – fat necrosis of liver lobules Nursing Mgt 1.

ecchymosis of umbilicus hemorrhage 72 .Give before lavage – ice or cold saline solution . Palpitation due to pain 5.Void before paracentesis to prevent accidental puncture of bladder as trochar is inserted b. (+) Cullen’s sign .Aggravated by eating. neuro check 3. Bleeding of pancreas . Meds – Laxatives – to excrete ammonia HEPATITIS. hemorrhage & necrosis due to auto digestion. Siderails – due restless 4. Meds: Loop diuretics – 10 – 15 min effect 2. Hyperparathyroidism 6. with DOB 2.aspiration of fluid .) Bleeding esophageal varices . Meds: Vit K Pitrisin or Vasopresin (IM) 2.8. Obesity 4. Drugs – Thiazide diuretics. Assist in mechanical ventilation – due coma 2.3 lumen typed catheter .Scissors at bedside to deflate balloon. Diet – increase saturated fats S/Sx: 1. Hyperlipidemia 5.Cullen’s sign at umbilicus Predisposing factors: 1. Monitor VS. c. Well balanced diet Complications: a. Severe Lt epigastric pain – radiates from back &flank area . Decrease bowel sounds 7.) Hepatic encephalopathy – 1.Insertion of sengstaken-blackemore tube .Dilation of esophageal veins 1. Dyspepsia – indigestion 6. NGT decompression. Tachycardia 4.jaundice (icteric sclera) Bilirubin Kernicterus/ hyperbilirubinia Irreversible brain damage Pancreas – mixed gland (exocrine & endocrine gland) PANCREATITIS – acute or chronic inflammation of pancreas leading to pancreatic edema.) Ascites – fluid in peritoneal cavity Nursing Mgt: 1.Monitor NGT output 3. Chronic alcoholism 2. N/V 3.lavage . Hepatobilary disease 3. Assist in abdominal paracentesis . pills Pentamidine HCL (Pentam) 7. Assist in mechanical decompression .

Meperdipine Hcl – Demerol b.) DBE b. Sedentary lifestyle 5. High risk – women 40 years old 2.Atropine SO4 c.8.) Anti cholinergic . Embolism 3. Meds – a. Severe Right abdominal pain (after eating fatty food). Serum amylase & lipase – increase 2. Institute stress mgt tech a. Pruritus 6. Steatorrhea Diagnosis: 1. Meds a.) Biofeedback 5. Urine lipase – increase 3. Infection 2. Hyperglycemia 4.) Vasodilator – NTG d. Anorexia.) Anti emetic Phenergan – Phenothiazide with anti emetic properties 2. Papavarine Hcl Prophantheline Bromide (Profanthene) c.confirms presence of stones Nursing Mgt: 1. Occurring especially at night 2.) Narcotic analgesic . Hypocalcemia Diagnosis: 1. n/v 4.Ex. and increase CHON 7. Fatty intolerance 3. Jaundice 5.) Antacid – Maalox e.) Ca – gluconate 2. b. If pt can tolerate food.) Narcotic analgesic . Tea colored urine 8. Complications: Chronic hemorrhagic pancreatitis GALLBLADDER – storage of bile – made up of cholesterol. Comfy position . Oral cholecystogram (or gallbladder series). Hyperlipidemia 6.) Smooth muscle relaxant/ anti cholinergic .Ranitidin (Zantac) to decrease pancreatic stimulation f. decrease fats 73 . Predisposing factor: 1. Assist in Total Parenteral Nutrition (TPN) or hyperalimentation Complications of TPN 1. Easy bruising 7. Post menopausal women – undergoing estrogen therapy 3. Neoplasm S/Sx: 1.Meperidine Hcl (Demerol) Don’t give Morphine SO4 –will cause spasm of sphincter.Knee chest or fetal like position 6.) H2 receptor antagonist . give increase CHO. moderate CHON. Diet – increase CHO. (+) Grey Turner’s spots – ecchymosis of flank area 9. Obesity 4. decrease fats. Serum Ca – decrease Nursing Mgt: 1. Withold food & fluid – aggravates pain 3. CHOLECYSTITIS/ CHOLELITHIASIS – inflammation of gallbladder with gallstone formation.

Ulcerogenic drugs – NSAIDS. indomethacin. Irregular diet 7. Microbial invasion – helicobacter pylori.Mechanical 2. Anthrum 2. CHON. Acute – affects submucosal lining 2. Rapid eating 8.stored 1 -2 hrs.) Secrets Hcl acid – aids in digestion Endocrine cells .) Produces intrinsic factor – promotes reabsorption of vit B12 cyanocobalamin – promotes maturation of RBC b. Chief/ Zymogenic cells – secrets a.Chem. Emotional 3.) Rennin – digests milk products Parietal / Argentaffin / oxyntic cells Function: a. Gastrin producing tumor or gastrinoma – Zollinger Ellisons sign 10. Chronic – affects underlying tissue – heals & forms a scar 74 .3.S/E corneal cloudiness. Men – 40 – 55 yrs old 2.Secrets gastrin – increase Hcl acid secretion 2.cardiac sphincter 2.digest CHO b. ibuprofen Indomethacin . Fundus Valves 1. Fats – stored 2 – 3 hrs PEPTIC ULCER DISEASE – (PUD) – excoriation / erosion of submucosa & mucosal lining due to: a.Storage of food -CHO. Pyloric sphincter Cells 1. Digestion 3. chocolate 6.) Hypercecretion of acid – pepsin b. Function of the stomach 1.) Gastric amylase . Meticulous skin care Surgery: Cholecystectomy Nursing Mgt post cholecystectomy -Maintain patency of T-tube intact & prevent infection Stomach – widest section of alimentary canal .) Pepsin – CHON d. Alcoholism – stimulates release of histamine = Parietal cell release Hcl acid = ulceration 5.J shaped structures 1.) Gastric lipase – digest fats c. 9. aspirin. 1. 4. Smoking – vasoconstriction – GIT ischemia 4. soda. Metromidazole (Flagyl) Types of ulcers Ascending to severity 1. Pylorus 3. Hereditary 2.) Decrease resistance to mucosal barrier Incidence Rate: 1. steroids. Needs annual eye check up. Aggressive persons Predisposing factors: 1. Caffeine – tea. 3.

cramping & burning . non spicy 2.12 MN – 3am pain Increased gastric acid secretion Not common Melena Wt gain a. Diet – bland.epigastrium . Gastric analysis – N – gastric Increase – duodenal 4.usually relieved by food & antacid . GI series – confirms presence of ulceration Nursing Mgt: 1. Endoscopic exam 2. Stool from occult blood 3. stomach cause b. Avoid caffeine & milk/ milk products Increase gastric acid secretion 3.mid epigastrium . Gastric ulcer 3. Stress ulcer 2. non irritating. perforation 20 years old 75 . Administer meds GASTRIC ULCER Intrum or lesser curvature -30 min – 1 hr after eating .According to location 1.Cushing’s ulcer – cause – stroke/CVA/ head injury Increase vagal stimulation Hyperacidity Ulcerations SITE PAIN HYPERSECRETION VOMITING HEMORRHAGE WT COMPLICATIONS HIGH RISK Diagnosis: 1. Duodenal ulcer – most common Stress ulcers – common among eritically ill clients 2 types 1.not usually relieved by food & antacid Normal gastric acid secretion common hematemeis Wt loss a.gaseous & burning .Curing’s ulcer – cause: trauma & birth hypovolemia GIT schemia Decrease resistance of mucosal barriers to Hcl acid Ulcerations 2. hemorrhage 60 years old DUODENAL ULCER Duodenal bulb -2-3 hrs after eating .

gastric stump to jejunum. Atropine SO4 2.Partial removal of stomach Billroth I (Gastroduodenostomy) Billroth II (Gastrojejunostomy) -Removal of ½ of stomach & anastomoses of gastric stump . Tamotidine (Pepcid) . Monitor NGT output a.) Antiemetics 3.) Hemorrhage – hypovolemic shock Late signs – anuria b. aluminum OH gel (Ampho-gel) S/E constipation Maalox (fever S/E) b. 4.Valium.Provides a paste like subs that coats mucosal lining of stomach 2. Administer meds: a. Prophantheline Bromide (Profanthene) (Pt has history of hpn crisis With peptic ulcer disease. Maintain patent IV line 4. Nursing Mgt: 1. Before surgery for BI or BII .42h – output is yellow green c.) After 42h – output is dark red 2.) Immediately post op should be bright red b.) Antacids AAC Aluminum containing antacids Ex. Rn should not administer alka seltzer.) Paralytic ileus – most feared d. I&O & bowel sounds 5.) Pernicious anemia 76 . Cytotec d.) Sedatives/ Tranquilizers . VS.a. Ranitidine (Zantac) 2.)Anticholinergics 1. milk of magnesia S/E diarrhea 1.) H2 receptor antagonist Ex 1.) Analgesic b. Complications: a.removal of ½ -3/4 of stomach & duodenal bulb & anastomostoses of to the duodenum.has large amount of Na.) Antibiotic c. Cimetidine (Tagamet) 3.) Thromobphlebitis f.) Cytoprotective agents Ex 1. Administer antacid & H2 receptor antagonist – 1hr apart -Cemetidine decrease antacid absorption & vise versa c. lithium e.Avoid smoking – decrease effectiveness of drug Nursing Mgt: Magnesium containing antacids ex.) Peritonitis c. Surgery: subtotal gastrectomy .) Within 36. Sucralfate (Carafate) .) Hypokalemia e.Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first.

electric. – direct contact – corrosive materials acids Smoke – gas / fume inhalation Stages: 1.)Dumping syndrome – common complication – rapid gastric emptying of hypertonic food solutions – CHYME leading to hypovolemia. Determine source or loc or burn 2. muscles. Diet – decrease CHO. Sx of Dumping syndrome: 1. sunburn. Diarrhea 4.F&E Thermal. Palpitations Nursing mgt: 1. Flat on bed 15 -30 minutes after q feeding BURNS – direct tissue injury caused by thermal. – wires Chem. Return of fluid from interstitial to intravascular space 4.Redness (erythema) & blanching upon pressure with no fluid filled vesicles 2. Small frequent feeding s-6 equally divided feedings 3. Third & 4th degrees burn .Cause: thermal burn .Dry. Avoid fluids in chilled solutions 2. Diaphoresis 3.Cause –chem. 2nd degree – deep burns .pain 2nd priority for 3rd ° . Characterized by shifting of fluids from intravascular to interstitial space =Hypovolemia S/Sx: BP decrease Urine output HR increase Hct increase Serum Na decrease Serum K increase Met acidosis 3. Electric. burns . 1st degree – superficial burns . leathery wound surface – known as ESCHAR – devitalized or necrotic tissue. hot grease. Recovery/ convalescent phase – complete diuresis.Less painful . Diuretic/ Fluid remobilization phase .direct contact – flames.a/w 2nd priority for 1st & 2nd ° . thick. Shock phase – 48 . moderate fats & CHON 4. chemical & smoke inhaled (TECS) Nursing Priority – infection (all kinds of burns) Head burn-priority. Partial Burn 1.3 to 5 days. Class: I. Emergent phase – Removal of pt from cause of burn.Erythema & fluid filled vesicles (blisters) II Full thickness Burns 1. Wound healing starts immediately after tissue injury.7. 77 . bones . Dizziness 2.Affects all layers of skin.Affects epidermis & dermis .very painful .Cause – electrical .Affects epidermis .Painful .72°.

Complications: a.) Curling’s ulcer – H2 receptor antagonist e. Assist in hydrotherapy 7.) Morphine SO4 c.) Surgery: skin grafting GUT – genito-urinary tract Function: 1.Assist in intubation 6. Kidneys – pair of bean shaped organ .) Infection b. Cephalosporin 3. Renal pelvis – pyenophritis – infl Cortex Medulla Nephrones – basic living unit Glomerulus – filters blood going to kidneys 78 .) Septicemia blood poisoning f. Silver nitrate 4. Silver Sulfadiazene (silvadene) 2. If (+) to burns on head. 2. neck. Tetracyclin 4. 3. Maintain F&E & acid base balance 1. Topical antibiotic : 1.) Systemic antibiotics 1. increase Vit C.Retro peritonially (back of peritoneum) on either side of vertebral column. Diet – increase CHO.Assessment findings Rule of nines Head & neck = 9% Ant chest = 18% Post chest = 18% @ Arm 9+9 = 18% @ leg 18+18 = 18% Genitalia/ perineum= 1% Total 100% Nursing Mgt 1. Ampicillin 2. Promote excretion of nitrogenous waste products 2. Parts: 1. Administer analgesic 15 – 30 minutes before debridement 8. Administer isotonic fluid sol & CHON replacements 3.burn surface area is source of anaerobic growth – Claustridium tetany Tetany Tetanolysin Hemolysis tetanospasmin muscle spasm b.) Shock c.) Tetanus toxoid.due to hypovolemia & hypokalemia d. Meds a. Sulfamylon 3. Strict aseptic technique 4.orange 5. increase CHON. Povidone iodine (betadine) 2. Encased in Bowmans’s capsule. face . Assist in surgical wound debridement.) Paralytic ileus . and increase K.

Tubular Secretion Filtration – Normal GFR/ min is 125 ml of blood Tubular reabsorption – 124ml of ultra infiltrates (H2O & electrolytes is for reabsorption) Tubular secretion – 1 ml is excreted in urine Regulation of BP: Predisposing factor: Ex CS – hypovolemia – decrease BP going to kidneys Activation of RAAS Release of Renin (hydrolytic enzyme) at juxtaglomerular apparatus Angiotensin I mild vasoconstrictor Angiotensin II vasoconstrictor Adrenal cortex Aldosterone Increase BP Increase Na & H2O reabsorption Hypervolemia Ureters – 25 – 35 cm long.Male – 20cm or 8” UTI increase CO increase PR CYSTITIS – inflammation of bladder Predisposing factors: 1. Passage of urine. passageway of urine to bladder Bladder – loc behind symphisis pubis. .Women 3 – 5 cm or 1 to 1 ½ “ . Microbial invasion – E.Function – reservoir or urine 1200 – 1800 ml – Normal adult can hold 200 – 500 ml – needed to initiate micturition reflex Color – amber Odor – aromatic Consistency – clear or slightly turbid pH – 4. Urine formation 2. seminal & vaginal fluids. coli 79 .030 WBC/ RBC – (-) Albumin – (-) E coli – (-) Mucus thread – few Amorphous urate (-) Urethra – extends to external surface of body. Tubular Reabsorption 3. Filtration 2.Function of kidneys: 1.5 – 8 Specific gravity – 1.015 – 1. Regulation of BP Urine formation – 25% of total CO (Cardiac Output) is received by kidneys 1. Muscular & elastic tissue that is distensible .

) Urinary frequency. . Sexual intercourse S/Sx: 1. anorexia. Ht a.) HPN 80 . tenderness b. Warm sitz bath – to promote comfort 3.) Nocturia. Acid ash diet – cranberry.Lead to Renal Failure Predisposing factor: 1. Dysuria & hematuria 5.Gantrism (ganthanol) Urinary antiseptics – Mitropurantoin (Macrodantin) Urinary analgesic.) E. gen body malaise Diagnosis: 1. Urinary retention 5. Fever. perfume d. Meds: systemic antibiotics Ampicillin Cephalosporin Sulfonamides – cotrimaxazole (Bactrim) . anorexia.) Burning on urination Chronic Pyelonephritis a. hematuria e.) Costovertibral angle pain.) Void after sex c. urgency d.2. Coli b. vit C -OJ to acidify urine & prevent bacterial multiplication 5. Obstruction 4. gen body malaise c. DM 5.) Female – avoids cleaning back & front Bubble bath. chills. High risk – women 3. coli Nursing Mgt: 1. Powder. interstitial abscess formation.) Streptococcus 2. Tissue paper. Microbial invasion a.) Importance of Hydration b. Pregnancy 4. Increase estrogen levels 6.) Fatigue. Burning upon urination 4.) Polyuuria.Pyridum 6. polydypsia c. Urinary frequency & urgency 3. Pain – flank area 2.(+) to E. Urine culture & sensitivity . Monitor & assess for gross hematuria 4. Urinary retention /obstruction 3. Exposure to renal toxins S/Sx: Acute pyelonephritis a.) Fever. dsyuria. wt loss b. Force fluid – 2000 ml 2.) Complications: Pyelonephritis PYELONEPHRITIS – acute/ chronic infl of 1 or 2 renal pelvis of kidneys leading to tubular destruction.

Cystoscopic exam – urinary obstruction Nursing Mgt: 1.) Urinary antiseptic – nitrofurantoin (macrodantin) SE: peripheral neuropathy GI irritation Hemolytic anemia Staining of teeth b. Force fluid 3. Hyperparathyroidism S/Sx: 1. Surgery a. Renal colic 2.) Urinary analgesic – Peridium 2.) Nephectomy – removal of affected kidney Litholapoxy – removal of 1/3 of stones.(Ex milk/ milk products) If + uric acid stones – decrease organ meat / anchovies sardines 6.Morphine SO4 b.Strain urine using gauze pad 3. IVP – intravenous pyelography. Reveals location of stone 2.Renal Failure NEPHROLITHIASIS/ UROLITHIASIS.) Allopurinol (Zyeoprim) c. Anorexia. Provide CBR – acute phase 2. Cytoscopic exam. a.Force fluid 2.Alternate warm compress at flank area 5.) Diet – if + Ca stones – acid ash diet If + oxalate stone – alkaline ash diet . Diet – increase Ca & oxalate 2. CHON & pus cells 3. cabbage cranberries nuts tea chocolates uric acid anchovies organ meat nuts sardines Predisposing factors: 1.urinary obstruction 4. Urinalysis – increase EBC. Urinalysis Increase WBC. Stone analysis – composition & type of stone 5. Sedentary lifestyle 5.Stones will recur. Acid ash diet 4.Warm sitz bath – for comfort 4.Diagnosis: 1. increase CHON Nursing Mgt: 1. milk oxalate. KUB – reveals location of stone 3.) Extracorporeal shock wave lithotripsy 81 . Meds: a.formation of stones at urinary tract . Not advised for pt with big stones b.) Narcotic analgesic. coli & streptococcus 2. Urine culture & sensitivity – (+) E. Complication. Obesity 4. Cool moist skin (shock) 3. Hematuria 5.) Patent IV line d. Burning upon urination 4.calcium . n/v Diagnosis: 1. Hereditary – gout 3.

Monitor symptoms gross/ flank bleeding. Septic shock 2.Sciatica Diagnosis: 1. Meds: a. Maintain irrigation or tube patent to flush out clots . Provide catheterization 4. Surgery: Prostatectomy – TURP.No incision -Assist in cystoclysis or continuous bladder irrigation.) b. High risk – 50 years old & above 60 – 70 – (3 to 4 x at risk) 2.) c.Transurethral resection of Prostate.Hematuria 4.decrease blood flow Causes: 1. Cystoscopic exam – obstruction 4.Relaxes bladder sphincter b.Terminal bubbling 6. Terazozine (hytrin) .Dissolve stones by shock wave Complications: Renal Failure BENIGN PROSTATIC HYPERTROPHY . Normal bleeding within 24h.enlarged prostate gland leading to a. Hypovolemia 3.) Hydro ureters – dilation of ureters Hydronephrosis – dilation of renal pelvis Kidney stones Renal failure Predisposing factor: 1. . Dehydration Intra-renal cause – involves renal pathology= kidney problem 1.Decrease force of urinary stream 2.to prevent bladder spasm & distention ACUTE RENAL FAILURE – sudden immobility of kidneys to excrete nitrogenous waste products & maintain F&E balance due to a decrease in GFR.invasive .) d.Burning upon urination 5.Non . Fenasteride (Proscar) . Nursing mgt: c. KUB – urinary obstruction 3. Acute tubular necrosis- 82 . Monitor symptoms of infection d. (N 125 ml/min) Predisposing factor: Pre renal cause. Prostatic message – promotes evacuation of prostatic fluid 2. Digital rectal exam – enlarged prostate gland 2.Backache 7.7. Hemorrhage 6. Urinalysis – increase WBC. 3. Hypotension decrease flow to kidneys 4. Influence of male hormone S/Sx: 1.Dysuria 3.Atrophy of Prostate Gland 5. CHON Nursing Mgt: 1. Limit fluid intake 3. CHF 5.

) hypocalcemia f.) Normocytic anemia b.) hyperkalemia a.) Metabolic disturbances a. HPN 3.) Integumentary a.) CNS 4.) Anti HPN – hydralazine d. Urolithiasis 3.) Vit & minerals e.) Dysuria e.) Decrease Ca – Ca gluconate 5.) headache a. BPH CHRONIC RF – irreversible loss of kidney function Predisposing factors: 1.2. Monitor VS.) hematological a.) hyperinulinemia d.) diarrhea/ constipation e.) Kassmaul’s resp a. Meticulous skin care. Stricture 2.) stomatitis c.) itchiness/ pruritus b. Renal Insufficiency 3.) restlessness d. I&O 3.) polyuria a. Enforce CBR 2. Diminished Reserve Volume – asymptomatic Normal BUN & Crea. Exposure to renal toxins Stages of CRF 1. Pyelonephritis HPN Acute GN Post renal cause – involves mechanical obstruction 1.) met acidosis Nursing Mgt: 1.) memory impairment 5.) nocturia b.) azotemia (increase BUN & Crea) b.) uremic breath d. Recurrent UTI/ nephritis 4. 3.) hypernatermia b. Assist in hemodialysis 1.) uremic frost c.S/E constipation f.) n/v b.) Urinary System 2. DM 2.) hematuria c.) Na HCO3 – due Hyperkalemia b.) lethargy b.) Kagexelate enema c.) decrease cough bleeding tendencies reflex 7.) disorientation c.) Fluid & Electrolytes 8. 4.) Consent/ explain procedure 83 . GFR < 10 – 30% 2.) Phosphate binder (Amphogel) Al OH gel .) GIT a.) oliguria 3.) hyperglycemia c. Uremic frost – assist in bathing pt 4. Meds: a. End Stage Renal disease S/Sx: 1.) hyperposphatemia e.) Respiratory 6.) hypermagnesemia d.

Eyelids – palpebral fissure – opening upper & lower lid.) Obtain baseline data & monitor VS.bulldog clip . blood extraction. Maintain patency of shunt by: i.Infersole (diastole) – common dialisate used 7. at side of shunt or fistula.2. 3. EOM – extrinsic ocular muscles – involuntary muscles of eye needed for gazing movement. Conjunctiva 6. Intrinsic coat I.) Stye/ sty or Hordeolum.Peritonitis .) Sclera – white. Protects eye from direct sunlight Meibomean gland – secrets a lubricating fluid inside eyelid b. Reverse isolation 2. Refracts light rays b. Acceptance 2. wt. Palpate for thrills & auscultate for bruits if (+) patent shunt! ii.) Cornea – transparent structure of eye II/ Uveal tract – nutritive care 84 . EYES External parts 1.) Monitor for signs of complications: B – bleeding E – embolism D – disequilibrium syndrome S – septicemia S – shock – decrease in tissue perfusion Disequilibrium syndrome – from rapid removal of urea & nitrogenous waste prod leading to: a. 2. I&O. Bedside. IV.) Leg cramps d. sclerotic coat – outer most a. 3.) n/v b. . Occupies ¾ post of eye.) Canal of schlera – site of aqueous humor drainage c.) Disorientation e. Assist in surgery: Renal transplantation : Complication – rejection. Lacrimal apparatus – tears Process of grieving a. blood exam 3. Can lead to compression of fistula.) HPN c. Eyelashes/ eyebrows – esthetic purposes 4. Orbital cavity – made up of connective tissue protects eye form trauma.) Strict aseptic technique 4. Complication .) Paresthesia Avoid BP taking. Bargaining d. Denial b.inflamed Meibomean gland 5. Depression e.If with accidental removal of fistula to prevent embolism. Anger c.Shock 8.

Maculla lutea – yellow spot center of retina iii. Myopia – near sightedness – Treatment: biconcave lens 2. Fovea centralis – area with highest visual acuity oracute vision Physiology of vision 4 Physiological processes for vision to occur: 1. DM 85 .squint eye 4. Anterior a. Constriction & dilation of pupils 4. Retina (innermost layer) i. Accommodation of lens 3. Circular smooth muscle fiber . Refraction of light rays – bending of light rays 2. High risk group – 40 & above 2. Exotropia – 1 eye normal 2.Constricts the pupil 2. Convergence of eyes Unit of measurements of refraction – diopters Normal eye refraction – emmetropia ERROR of refraction 1. Strabismus.Dilates the pupil 2 chambers of the eye 1. HPN 3.) Vitereous Humor – maintains spherical shape of the eye b.Uveitis – infl of uveal tract Consist of: a.) Iris – colored muscular ring of eye 2 muscles of iris: 1. atrophy of optic nerve disc – blindness Predisposing factors: 1. Hyperopia/ or farsightedness – Treatment: biconvex lens 3.radial smooth muscle fiber . Optic discs or blind spot – nerve fibers only No auto receptors cones (daylight/ colored vision) phototopic vision rods – night twilight vision “scotopic vision” = vit A deficiency – rods insufficient ii. Esophoria – 3.) Aqueous Humor – maintains intrinsic ocular pressure Normal IOP= 12-21 mmHg II. Prebyopia – “old slight” – inelasticity of lens due to aging – Treatment: bifocal lens or double vista Accommodation of lenses – based on thelmholtz theory of accommodation Near vision = Ciliary muscle contracts= Lens bulges Convergence of the eye: Error: 1. Amblyopia – prolong squinting far vision= ciliary muscle dilates / relaxes= lens is flat corrected by corrective eye surgery GLAUCOMA – increase IOP – if untreated. Astigmatisim – distorted vision – Treatment: cylindrical 4.

2.) Peripheral Iridectomy – portion of iris is excised to drain aqueous humor Non-invasive: Trabeculoctomy (eye laser surgery) Nursing Mgt pre op.) Miotics – lifetime . Eye patch – both eyes .Precipitated by acute attack 1. Monitor symptoms of IOP a. Perimetry – decrease peripheral vision 3. Ex Pilocarpine Na (Carbachol) b.) – most common type Obstruct in flow of aqueous humor at trabecular meshwork of canal of schlema Acute (close angle G. 6.) Trabeculectomy – eyetrephining – removal of trabelar meshwork of canal or schlera to drain aqueous humor b.) Headache b.) Tachycardia 2.all types surgery 1. 3.) Epinephrine eye drops – decrease secretion of aqueous humor c. Type: 1. 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.) Eye discomfort d. 4. Ex. Enforce CBR 2.Increase outflow of aquaous humor 2.) Carbonic anhydrase inhibitors.) Temoptics (Timolol maleate).Promotes increase out flow of aquaeous humor d. Tonometry – increase IOP >12. Nursing Mgt post op – all types of surgery 1. surgery Chronic – (open angle G. acetapolamide (Diamox) .4. 6.) – Most dangerous type Forward displacement of iris to cornea leading to blindness. infl. Apply eye patch on unaffected eye to force weaker eye to become stronger. 5. 7. S/Sx: Hereditary Obesity Recent eye trauma. Avoid valsalva maneuver 3. Gonioscopy – abstruction in anterior chamber Nursing mgt: 1.) n/v c. 2.to prevent tension on suture line. Maintain siderails 3. Administer meds a.post op CATARACT – partial/ complete opacity of lens Predisposing factor: 86 .21 mmHg 2. 5. Position unaffected/ unoperated side . Surgery: Invasive: a. 3. Chronic (closed – angle) .contracts ciliary muscles & constricts pupil. 2.

) n/v c. S/Sx: 1. Reorient pt to environment – due opacity 2. 4.) Cyslopegics – paralyzes ciliary muscle.lens E – extraction I . 4. S/Sx: 90-95% .capsular C – cataract L .Monitor symptoms of IOP a.to prevent tension on suture line. 5. 2. 2. 4.) Eye discomfort d. 2. Surgery E – extra C . 3. Ex.1.Position unaffected/ unoperated side . 3.intra C .) Tachycardia 4. Cyclogye 4.capsular C – cataract L . Loss of central vision .aging (degenerative/ senile cataract) Congenital Prolonged exposure to UV rays DM- 1.) Headache b. Mydriacyl c.“Hazy or blurring of vision” 2. 2. Painless Milky white appearance at center of pupil Decrease perception of colors Diagnosis: Opthalmoscopic exam – (+) opacity of lens Nsg Mgt: 1. 3. Meds – a. 3.Avoid valsalva maneuver 3. 5.Eye patch – both eyes . Siderails 3.post op partial removal of lens total removal of lens & surrounding capsules RETINAL DETACHMENT. Severe myopia – nearsightedness Diabetic Retinopathy Trauma Following lens extraction HPN “Curtain –veil” like vision Flashes of lights Floaters Gradual decrease in central vision Headache 87 .separation of 2 layers of retina Predisposing factors: 1.) Mydriatics – dilate pupil – not lifetime Ex.lens E – extraction Nursing Mgt: 1. 4.

wide. Muscles 1.Opens to allow equalization of pressure on both ears .assist in ear irrigaton b.) Cryosurgery b. Bony labyrinth – for balance.opthaloscopic exam Nursing Mgt: 1. Membranous Labyrinth 1. and swallow Children – straight.) Ear osssicle 1. Tensor tympani 3. Hearing 2. Stapedius 2. chew.) Stapes can’t transmit sound waves 88 . vestibule Utricle & succule Otolithe or ear stone – has Ca carbonate Movement of head = Righting reflex = Kinesthesia b. Balance (Kinesthesia or position sense) Parts: 1.) Pinna/ auricle – protects ear from direct trauma b. auditory meatus – has ceruminous gland.) Impacted cerumen – tinnitus & conduction hearing loss. narrow & slanted c.Yawn. Endolymph & perilymph – for static equilibrium 3. Cerumen c. Anvil -Incus 3.Diagnosis. Cochlea – ( function for hearing) has organ of corti 2. Inner ear a. Surgery: a. Siderails (all visual disease) 2. Middle ear a. short c. Outera. Eustachian tube .) Otitis media Adult – long.drain 2.) Tympanic membrane – transmits sound waves to middle ear Disorders of outer ear Entry of insects – put flashlight to give route of exit Foreign objects – beans (bring to MD) H2O .) Ext. Hammer -malleus 2.) Middle ear disease char by formation of spongy bone in the inner ear causing fixation or immobility of stapes e. Conductive hearing loss – transmission hearing loss Causes: a. Stirrups -stapes for bone conduction disorder conductive hearing loss b.) Scleral buckling EAR – 1. Mastoid air cells – air filled spaces in temporal bone in skull Complications of Mastoditis – meningitis Types of hearing loss: 1.) Immobility of stapes – OTOSCLEROSIS d.

Audiometry – various sound stimulates (+) conductive hearing loss 2. Presbycusis – bilateral progressive hearing loss especially at high frequencies – elderly Face elderly to promote lip reading 4. DBE No coughing & blowing of nose .) Sensory neural hearing loss 89 .) Analgesic b. Weber’s test – Normal AC> BC result BC > AC Stapedectomy Nursing Mgt post op 1.Surgery Stapedectomy – removal of stapes. Tinnitus Conductive hearing loss Diagnosis: 1.) Inner ear disease char by dilation of endo – lympathic system leading to increase volume of endolin Predisposing factor of MENIERE’S DISEASE Smoking Hyperlipidemia 30 years old Obesity – (+) chosesteatoma Allergy Ear trauma & infection S/Sx: 1. Ear trauma & surgery S/Sx: 1. Position pt unaffected side 2. Loud noises (gun shot) 3.) Vertigo c.Night lead to removal of graft 3.) Antiemetic c. Ex. Meds: a. Use shower cap SENSORY NEURAL HEARING LOSS/ NERVE DEAFNESS Cause: 1. raise eyebrow) 5.) Tinnitus b. Avoid shampoo hair for 1 to 2 weeks. meclesine Hcl (Bonamine) 4. Assess – motor function – facial nerve .(Smile.) Antimotion sickness agent. Meniere’s disease – endolymphatic hydrops f. spongy bone & implantation of graft/ ear prosthesis Predisposing factor: 1. frown. 2. Tumor on cocheal 2. Familiar tendency 2. TRIAD symptoms of Meniere’s disease a.

Nystagmus n/v Mild apprehension. 6.) Antimotion sickness agent f.Shunt 90 . Siderails 3. 4.) Antiemetic e. 7.2. 8.) Antihistamine d.) Vasodilator c. Diagnosis: 1. 3.) Diuretics –to remove endolymph b. 5.) Sedatives/ tranquilizers 5. Meds: a. 6. Comfy & darkened environment 2. Restrict Na Limit fluid intake Avoid smoking Surgery – endolymphatic sac decompression. anxiety Tachycardia Palpitations Diaphoresis Audiometry – (+) sensory hearing loss Nursing mgt: 1. 7. Emetic basin 4.

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