PEDIAOKE by Sir Renchie Cainglet Tila INFANT kung maglaro Solitary lagi, Stranger anxiety Weaning 6 months Aspiration

risk precaution On TODDLERHOOD naman Nega at Tantrums ginagawa Separation PRODESDEN May physio-logic anorexia pa Push pull toys like tarak tarak Autonomy vs. Shame and Doubt First dental visit ay 2 and a half Risk for poisoning problema jan PRESCHOOL naman ay PHALLIC Associative Play lagi ang gimik Common fear is mutilation Fear of dark and ghost din yun Behavior ay gender specific At may magi-cal thinking Ang patay is sleeping Initiative vs. guilt Ang SCHOOL AGE latent yan Concrete thinking, Logic reasoning Same sex stage, normal na bading Heroworship and plays competitive Schooler starts to have a bestfriend Takot parati control niya ay mag end Permanent ang concept of death Industry vs inferiority Formal ang adolescent Sa body image may disturbance Ang thelarche ang first sign sa girls At last sign yan ang menarche!

HYPOGLYCEMIA TIRED!!!! T Tired I Irritability (Nightmares) R Restlessness E Excessive Hunger (Polyphagia) D Depression/Diaphoresis

Anticholingergics Side Effects: Can't see Can't pee Can't spit Can't sh*t

Hyperthyroidism (s/s) THYROIDISM HYPERNATREMIA You are FRIED! F - Fever (low grade), flushed skin R - Restless (irritable) I - Increased fluid retention and increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth Tremor Heart rate up Yawning (fatigueability) Restlessness Oligomenorrhea & amenorrhea Intolerance to heat Diarrhea Irritability Sweating Muscle wasting & weight loss 5W's of common causes of post-op fever Pressure Ulcer Staging Stage I erythema Stage II breakdown of the dermis Stage III full thickness skin Breakdown Stage IV bones, muscles Wind (think pneumonia, splinting, incentive spirometer exercises not done, DB+ coughing NOT DONE) Water (dehydration...) Wound (infection, dehiscence...) Walking (PE...) Wonder drug (approriate antibiotic...)

HEART MURMURS: SPASM!! S Stenosis P Partial obstruction A Aneurysms S Septal defect M Mitral regurgitation

To apply a telemetry monitor: White over right (top right shoulder) Black beside the white (Over lt shoulder) Checkers (red below the black) Christmas (Green beside the red) Then ofcourse, the brown will be in the middle!

MI Management (MONA) Morphine O2 therapy Nitropglycerine! Aspirin Miotic: Little word= Little pupil (constrict) Mydriatic: Big word= Big pupil (dilated) SALT S Skin flushed A - Agitation L - Low-grade fever T - Thirst

5) All psychiatry drugs have anti cholinergic side effects: Dizziness, drowsiness, dry mouth, constipation, urinary retention M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory "CATS" of "HYPOCALCEMIA" C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism, hemolysis C - Convulsions I - Intake - Excesssive A- Arrhythmias N - Nephrons, renal failure T - Tetany E - Excretion - Impaired S - Spasms and stridor The HYPERKALEMIA "Machine" - Causes of Increased Serum K+

R - Reduced breath sounds (& dypsnea) A - Absent fremitus X - X-ray shows collapse PNEUMONIA - risk factors INSPIRATION I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary oedema I - Impaired alveolar macrophages R - RTI (prior) A - Antibiotics & cytotoxics T - Tracheal instrumentation I - IV dug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (eg NMJ disorders)

Signs and Symptoms of Increased Serum K+: MURDER !! M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

BLEEDING - S/Sx BEEP B - Bleeding gums E - Ecchymoses (bruises) E - Epistaxis (nosebleed) P - Petechiae (tiny purplish spots)

TETRALOGY OF FALLOT DISPLACED AORTA RIGHT VENTRICULAR HYPERTROPHY OPENING INTO THE SEPTUM (VSD) PULMONARY STENOSIS

CROUP - S/Sx SSS S - Stridor S - Subglottic swelling S - Seal-bark cough

HYPOKALEMIA (SUCTION) SKELETAL MUSCLE WEAKNESS U-WAVE ON ECG CONSTIPATION TOXICITY TO DIGOXIN IRREGULAR WEAK PULSE OTOSTASIS NUMBNESS PARESTHESIA

RESPIRATORY DEPRESSION inducing drugs STOP breathing S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins

SHORTNESS OF BREATH - Causes AAAA PPPP A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax P - Pulmonary Edema P - Pulmonary Embolus

General rules regarding psychiatry drugs: 1) Cannot be taken with alcohol, stimulants,depressants. 2) Cannot be given to pregnant, lactatingand patients with glaucoma. 3) Cannot be abruptly stooped but mus be tapered slowly 4) All are given after meals except anti anxiety agents( because food interferes with their absorption)

FEMORAL HERNIA FEMoral hernias are more common in FEMales.

PNEUMOTHORAX - S/Sx P-THORAX P - Pleuretic pain T - Trachea deviation H - Hyperresonance O - Onset sudden

"TRY PULLING MY AORTA":

Lactic acidosis Infections Tricuspid Necrosis of renal tubules (ATN) Pulmonary ET TUBE DELIVERABLE DRUGS Mitral O NAVEL: Aorta Oxygen Naloxone Atropine PLACENTA-CROSSING SUBSTANCES Ventolin (albuterol) "Want My Hot Dog": Epinephrine Lidocaine Wastes Antibodies Nutrients ATRIAL FIBRILLATION: CAUSES Teratogens OF NEW ONSET Microorganisms THE ATRIAL FIBS: Hormones/ HIV Drugs Thyroid Hypothermia Embolism (P.E.) EMERGENCY MEDICINE Alcohol ACTIVATED CHARCOAL: Trauma (cardiac contusion) CONTRAINDICATIONS Recent surgery (post CABG) CHEMICAL CamP: Ischemia Atrial enlargement Cyanide Lone or idiopathic Hydrocarbons Fever, anemia, high-output Ethanol states Metals Infarct Iron Bad valves (mitral stenosis) Caustics Stimulants (cocaine, Airway unprotected theo, amphet, caffeine) Lithium CAMphor SHOCK: S/SX Potassium (TV SPARC CUBE) Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank

"Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock": Shock= Defibrillate Everybody= Epinephine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide

VFIB/VTACH DRUGS USED ACCORDING TO ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide

DIABETIC KETOACIDOSIS MANAGEMENT (KING UFC) K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) Glucose (once serum levels drop to 12) Urea (check it) Fluids (crytalloids) Creatinine (check it)/ Catheterize

IPECAC: CONTRAINDICATIONS 4 C's: Comatose Convulsing Corrosive hydroCarbon

COMPLICATIONS OF FALCIPARUM MALARIA (CHAPLIN) Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema

VENTRICULAR FIBRILLATION: TREATMENT

NEUROLOGICAL FOCAL DEFICITS 10 S's: Sugar (hypo, hyper) Stroke Seizure (Todd's paralysis) Subdural hematoma Subarachnoid hemorrhage Space occupying lesion (tumor, avm, aneurysm, abscess) Spinal cord syndromes Somatoform (conversion reaction) Sclerosis (MS) Some migraines

RLQ PAIN: DIFFERENTIAL APPENDICITIS: Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones Acid-base"ROME" (Respiratory Opposite, Metabolic Equal) Acidosis Respiratory (opposite): pH Pco2 Metabolic(equal): pH HCO3 Alkalosis Respiratory (opposite): pH Pco2 Metabolic(equal): pH HCO3

Anorexia nervosa: clinical features"ANOREXIC" Adolescent women/ Amenorrhea NGT alimentation (most severe cases) Obsession with losing weight/ becoming fat though underweight Refusal to eat (5% die) Electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X - ercise Intelligence often above average/ Induced vomiting Cathartic use (and diuretic abuse)

COMA: CONDITIONS TO EXCLUDE AS CAUSE MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage

Appendicitis: assessment "PAINS" Pain (RLQ) Anorexia Increased temperature, WBC (15,00020,000) Nausea Signs (McBurney's, Psoas)

MALIGNANT HYPERTHERMIA TREATMENT "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]

Neurovascular Occlusion: symptoms "6 P's" Alcohol withdrawal: clinical features"HITS" Hallucinations (visual, tactile) Increased vital signs and insomnia Tremens delirium tremens (potentially lethal) Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting) Pain Pale Pulseless Paresthesia Poikilothermic Paralysis

Blood glucose (rhyme) Angina: precipitating factors "4E's" Eating Emotion Exertion (Exercise) Extreme Temperatures (Hot or Cold weather) Symptom Implication Cold and clammy . . . give hard candy Hot and dry . . . glucose is high

RESUSCITATION: BASIC STEPS ABCDE: Airway Breathing Circulation Drugs Environment

Blood vessels in umbilical cord"AVA" (2 arteries and 1 vein) Artery Vein Artery

Complication of severe preeclampsia"HELLP" syndrome Hemolysis Elevated Liver enzymes Low Platelet count

Coma: causes"A-E-I-O-U TIPS" Alcohol, acidosis (hyperglycemic coma) Epilepsy (also electrolyte abnormality, endocrine problem) Insulin (hypoglycemic shock) Overdose (or poisoning) Uremia and other renal problems Trauma; temperature abnormalities (hypothermia, heat stroke) Infection (e.g., meningitis) Psychogenic ("hysterical coma") Stroke or space-occupying lesions in the cranium

Cholecystitis: risk factors"5F's" Female Fat Forty Fertile Fair

Cushing's syndrome: symptoms"3S's" Sugar (hyperglycemia) Salt (hypernatremia) Sex (excess androgens)

Cleft lip: nursing care plan (postoperative)"CLEFT LIP" Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Positionnever on abdomen

Diet: low cholesterolavoid the "3C's" Cake Cookies Cream (dairy, e.g., milk, ice cream)

Hypertension: complications "4 C's" CAD (coronary artery disease) CHF (congestive heart failure) CRF (chronic renal failure) CVA (cardiovascular accident; now called brain attack or stroke) Hypertension: nursing care plan "I-TIRED" Intake and output (urine) Take blood pressure Ischemia attack, transient (watch for TIAs) Respiration, pulse Electrolytes Daily weight

Dystocia: etiology"3P's" Powe Passageway Passenger

Cognitive disorders: assessment of difficulties"JOCAM" Judgment Orientation Confabulation Affect Memory Dystocia: general aspects (maternal)"3P's" Psych Placenta Position

Diabetes: signs and symptoms"3P's,"

Episiotomy assessment "REEDA" Redness Edema Ecchymosis Discharge Approximation of skin

Hypoglycemia: signs and symptoms"DIRE" Diaphoresis Increased pulse Restless Extra hungry

Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency)

Infections during pregnancy "TORCH" Toxoplasmosis Other (hepatitis B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus

Mental retardation: nursing care plan"3R's" Regularity (provide routine and structure) Reward (positive reinforcement) Redundancy (repeat)

Pain: assessment"PQRST" What Provokes the pain? What is the Quality of the pain? Does the pain Radiate? What is the Severity of the pain? What is the Timing of the pain?

Pain: management"ABCs" IUD: potential problems with use "PAINS" Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing Newborn assessment components"APGAR" Appearance Pulse Grimace Activity Respiratory effort Ask about the pain Believe when clients say they have pain Choiceslet clients know their choices Deliver what you can, when you said you would Empower/Enable clients' control over pain

Obstetric (maternity) history "GTPAL" Manipulation: nursing plan promote the "3C's" Cooperation Compromise Collaboration Gravida Term Preterm Abortions (SAB, TAB) Living children

Postoperative complications: order "4W's" Wind (pulmonary) Wound Water (urinary tract infection) Walk (thrombophlebitis)

Medication administration"six rights" RIGHT medication RIGHT dosage RIGHT route RIGHT time RIGHT client RIGHT technique

Oral contraceptives: signs of potential problems"ACHES" Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident) Severe leg pain (possible thromboembolic process)

Preterm infant: anticipated problems"TRIES" Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])

Melanoma characteristics"ABCD" Asymmetry Border Color Diameter

Psychotropic medications: common antidepressives (tricyclics)"VENT" Vivactil Elavil Norpramin Tofranil

Traction: nursing care plan "TRACTION" Trapeze bar overhead to raise and lower upper body Requires free-hanging weights; body alignment Analgesia for pain, prn Circulation (check color and pulse) Temperature (check extremity) Infection prevention Output (monitor) Nutrition (alteration related to immobility)

characteristic findings: Retrograde amnesia (recall of some old memories) Anterograde amnesia (ability to form new memories) Confabulation Korsakoff's psychosis SIGNS OF CANCER Change in bowel /bladder habits A sore that doesnt heal Unusual bleeding/ Discharge Thickening of lump breast or elsewhere Indigestion/ Dysphagia Obvious change in wart/ mole Nagging cough/ hoarseness Unexplained anemia Sudden weight loss

Schizophrenia: primary symptoms "4A's" Affect Ambivalence Associative looseness Autism

Sprain: nursing care plan"RICE" Rest Ice Compression Elevation

Trauma care: complications "TRAUMA" Thromboembolism; Tissue perfusion, altered Respiration, altered Anxiety related to pain and prognosis Urinary elimination, altered Mobility impaired Alterations in sensoryperceptual functions and skin integrity (infections)

FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER Chemotherapy Assess body image disturbance (related to alopecia) Nutritional needs when N/V present Comfort from pain Effective response to Tx? (Evaluate) Rest (for patient and family)

Stool assessment"ACCT" Amount Color Consistency Timing

Tracheoesophageal fistula: assessment"3Cs" Coughing Choking Cyanosis

Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)"COAT RACK" Wernicke's encephalopathy (acute phase) clinical features: Confusion Ophthalmoplegia Ataxia Thiamine is an important aspect of Tx

Location of the heart valve from right to left - "A Permanently Temperamental Man" Aortic Pulmonary Tricuspid Mitral

Transient ischemic attacks: assessment"3Ts" Temporary unilateral visual impairment Transient paralysis (one-sided) Tinnitus = vertigo

Korsakoff's psychosis (chronic phase)

"Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm.

Viruses causing diarrhea "ACNE CAR" Adeno virus Corana virus Norwak virus Entero virus Calci virus Astro virus Rota virus

Order of prevalence of White Blood Cells, most prevalent to least - "Never Let Monkeys Eat Bananas" Neutrophils Lymphocytes Monocytes Eosinophils Basophils

"Point and Shoot!" For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation.

The Krebs cycle - "Can I Actually See Some Filipina Mothers" Layers of the scalp - "SCALP" Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium Citrate Isocitrate alpha Ketoglutarate Succinyl CoA Succinate Fumarate Malate Oxaloacetate

10 essential amino acids "PVT. TIM HALL" Phenylalanine Valine Tryptophan Threonine Isoleucine Metheonine Histidine(semi-essential) Arginine(semi-essential) Leucine Lysine

Carpal bones of the hand (lateral to medial) - "She Looks Too Proud, Try To Chase Her" Proximal row: Scaphoid Lunate Triquetrum Pisiform Distal row: Trapezium Trapezoid Capitate Hamate Bronchodilators - "TO A SIS" Terbutaline Orciprenaline Adrenaline Salbutamol Isoprenaline Salmeterol

Stages of mitosis/meiosis including interphase as a phase - "In Philippines, Men Are Talented" Interphase Prophase Metaphase Anaphase Telophase

Uses of Chloroquine (other than malaria) - "RED LIP" Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions

Signs of cor pulmonale "Please Read His Text" Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence

Portal hypertension features "ABCDE" Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen

Key questions needed in an emergency history taking situation - "AMPLE" Allergies Medication Past medical history Last meal Events and environment related to injury

Cardinal Symptoms of Parkinson's Disease - "TRAP" Tremor Rigidity Akinesia and bradykinesia Postural Instability

LATE SIGNS OF HYPOXIA BRADYCARDIA EXTREME RESTLESSNESS DYSPNEA CYANOSIS

Malignancies that metastisize to bone "Laging Panalo Kung Taga Bulacan" Lung Prostate Kidney Thyroid Breast

Days of appearance of rashesVaricella(chickenpox) "Very Sick Patients Must Take Double Exercise" 1st dayScarlet fever 2nd dayPox(smallpox) 3rd dayMumps 4th dayTyphus

CONGESTIVE HEART FAILURE DIGOXIN MORPHINE AMINOPHYLLINE DOPAMINE DIURETICS O2 GASSES MONITOR (ABG)

Six "S" in Scarlet Fever 5th dayDengue Streptococci causal organism Sorethroat Swollen tonsils Strawberry tongue Sandpaper rash miliarySudamina vesicles over hands, feet, abdomen 6th dayEnteric fever(typhoid)

MG SO4 TOXICITY BP DECREASE URINE OUTPUT DECREASE RESPIRATORY RATE DECREASE PATELLAR REFLEX ABSENT

SHOCK HYPOTACHYTACHY

Signs of anti-cholinergic crisis - "SLUD" Salivation Lacrimation Urination Defecation

HYPOTENSION TACHYPNEA TACHYCARDIA

SICKLE CELL DISEASE HYDRATION OXYGENATION PAIN INFECTION AVOID HIGH PLACES

INCREASE ICP HYPERBRADYBRADY CUSHINGS TRIAD: HYPERTENSION (WIDE PULSE PRESSURE) BRADYCARDIA BRADYPNEA

Causes of huge spleen - "3M's" Myelofibrosis Malaria Myelogenous leukemia

PREGNANCY INDUCED HYPERTENSION HEMOLYSIS ELEVATED LIVER ENZYMES LOW PLATELETS

EARLY SIGNS OF HYPOXIA RESTLESSNESS AGITATION TACHYCARDIA

GI SYMPTOMS AND TOXICITY TO DIGOXIN VOMITTING ANOREXIA NAUSEA DIARRHEA ABDOMINAL PAIN

ANTI TB DRUGS AND SIDE EFFECTS

RIFAMPICIN RED-ORANGE URINE ISONIAZID PERIPHERAL NEURITIS PYRAZINAMIDE INCREASE URIC ACID ETHAMBUTOL EYE PROBLEMS STREPTOMYCIN OTOTOXIC

FRACTURE PRESSURE REST ICE COMPRESSION ELEVATION

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH NEUROVASCULAR CHECK PAIN PULSELESSNESS PARESTHESIA PARALYSIS PALLOR L - LUGOL'S SOLUTION I - IRON N - NITROFURANTOIN T - TETRACYCLINE

LR6 - LATERAL RECTUS : CN6 SO4 - SUPERIOR OBLIQUE : CN4 VIRCHOWS TRIAD IN DVT VENUS STASIS DAMAGE TO VESSELS HYPERCOAGUABILITY ALL3 - ALL THE REST : CN3

ABDOMINAL AORTIC ANEURISM (4A) ASSYMPTOMATIC ABDOMINAL MASS ABDOMINAL PULSE ACHES LOW BACK

RADIATION TX VIA: MUSTARD ESTROGEN NITROGEN STEROIDS ANTIBIOTICS

DILUTE DECREASE OSMOLALITY