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 !
" 1#
$ %
S %
C 1
ANS &or adrener'ic of parasympatholitic response(
SNS involved in fi'ht or a''ression response Effects of SNS (anticholiner'ic)adrener'ic(
1* +ilate pupil , to aware of surroundin's
-elease of norepinephrine &adrenaline , cathecolamine( medriasis
Adrenal medulla &potent vasoconstrictor( #* +ry mouth
.ncreases /ody activities 0S 1 .ncrease 3* BP & 2-1 increased
34cept 5." , decrease 5."motility
6* -- increased /roncho dilation
7 8hy 5." is not increased 1 5." is not important9 %* Constipation & urinary retention
.ncrease /lood flow to s:eletal muscles; /rain & heart* <* Nor)3pinephrine neurotransmitter
=* Blood vesselsvasoconstriction
.* SNS : Adrener'ic A'ents , 3pinephrine &adrenaline(
Anticholiner'ic ; Sympathomimetic; Parasympatholytic
Atropine sulfate
..* PNS: Choliner'ics; Beta Adrener'ic /loc:ers; Sympatholitic; Parasympathomimetic
Beta adrener'ic /loc:in' a'ents &opposite of adrener'ic a'ents( &all end in ,>lol?(
Bloc:s release of norepinephrine*
+ecrease /ody activities e4cept 5." &diarrhea(
34* Propanolol; @etopanolol
S3A
B , /roncho spasm &/ronchoconstriction(
3 , elicits a decrease in myocardial contraction
" , treats 2PN
A , A0 conduction slows down
5iven to an'ina & @. , /eta/loc:ers to rest heart
Anti 2PN a'entsA
1* Beta /loc:ers &lol(
#* Ace inhi/itors &pril( e4 3NA$AP-.$; CAP"OP-.$
3* Calcium anta'onist
e4 CA$C.B$OC or N3F3+.P.N3
Peripheral nervous systemA choliner'ic) va'al or sympatholitic response Effect of PNS: (choliner'ic(
.nvolved in fly or withdrawal response 1* @eiosis , constriction of pupils
-elease of acetylcholine &AC"2( #* .ncrease salivation
+ecrease all /odily activities e4cept 5." &diarrhea( 3* BP & 2- decreased
6* -- decrease , /roncho constriction
. Choliner'ic a'ents %* +iarrhea , increased 5. motility
e4 1* @estinon <* Brinary freCuency
Antidote , anti choliner'ic a'ents Atropine Sulfate , S)3 , SNS =* Acetylcholine neurotransmitter
!* Blood vessels vasodilated
1
S)3 of antihpn dru'sA
1* orthostatic hpn
#* transient headache & diDDiness*@'t* -ise slowly* Assist in am/ulation*
CNS (brain s!ina" cor#$
.* Cells , A* neurons
Properties and characteristics
a* 34cita/ility , a/ility of neuron to /e affected in e4ternal environment*
/* Conductivity , a/ility of neuron to transmit a wave of e4citation from one cell to another
c* Permanent cells , once destroyed; cant re'enerate &e4* heart; retina; /rain; osteocytes(
-e'enerative capacity
A* $a/ile , once destroyed cant re'enerate
3pidermal cells; 5." cells; resp &lun' cells(* 5B"
B* Sta/le , capa/le of re'eneration BB" limited time only e4 salivary 'land; pancreas cells cell of liver; :idney cells
C* Permanent cells , retina; /rain; heart; osteocytes can?t re'enerate*
3*( Neuro'lia , attached to neurons* Supports neurons* 8here /rain tumors are found*
"ypesA
1* Astrocyte
#* Oli'odendria
Astrocytoma , EF , E%G /rain tumor from astrocyte* @ost /rain tumors are found at astrocyte*
Astrocyte , maintains inte'rity of /lood /rain /arrier &BBB(*
BBB , semi permea/le ) selective
"o4ic su/stance that destroys astrocyte & destroy BBB*
"o4ins that can pass in BBBA
1* Ammonialiver cirrhosis*
#* #* Car/on @ono4ide , seiDure & par:insons*
3* 3* Biliru/in Haundice; hepatitis; :ernicterus)hyper/iliru/enia*
6* 6* Ietones ,+@*
O$.5O+3N+-.A , Produces myelin sheath , wraps around a neuron , acts as insulator facilitates rapid nerve impulse transmission*
No myelin sheath , de'enerates neurons
+ama'e to myelin sheath , demyellenatin' disorders
+3@J3$$3NA".N5 +S3
1*(AL%&EIMER'S DISEASE, atrophy of /rain tissue due to a deficiency of acetylcholine*
S&S4A
A , amnesia , loss of memory
A , apra4ia , una/le to determine function & purpose of o/Hect
A , a'nosia , una/le to reco'niDe familiar o/Hect
A , aphasia ,
34pressive , /rocca?s aphasia , una/le to spea:
-eceptive , wernic:es aphasia , una/le to understand spo:en words
Common to AlDheimer , receptive aphasia
+ru' of choice , A-.C3P" &ta:en at /edtime( & CO5N3K*
@'tA Supportive & palliative*
@icro'lia , stationary cells; en'ulfs /acteria; en'ulfs cellular de/ris*
..* Compositions of Cord & Spinal cord
!FG /rain mass
1FG CSF
1FG /lood
@ON-O3 I3$$J 2JPO"23S.SA "he s:ull is a closed vault* Any increase in one component will increase .CP*
Normal .CPA F1%mm2'
#
Brain mass
1* Cere/rum , lar'est Connects - & $ cere/ral hemisphere
Corpus collusum
-t cere/ral hemisphere; $t cere/ral hemisphere
FunctionA
1* Sensory
#* @otor
3* .nte'rative
$o/es
1*( Frontal
a* Controls motor activity
/* Controls personality development
c* 8here primitive refle4es are inhi/ited
d* Site of development of sense of umor
e* Brocca?s area , speech center
+ama'e e4pressive aphasia
#*( "emporal ,
a* 2earin'
/* Short term memory
c* 8ernic:es area , 'en interpretative or :nowin' 5nostic area
+ama'e , receptive aphasia
3*( Parietal lo/e , appreciation & discrimation of sensory imp
Pain; touch; pressure; heat & cold
6*( Occipital vision
%*( .nsula)island of reil) Central lo/e controls visceral f4
FunctionA activities of internal or'an
<*( -hinencephalon) $im/ec
Smell; li/ido; lon'term memory
Basal 5an'lia , areas of 'ray matte located deep within a cere/ral hemisphere
34tra pyramidal tract
-eleases dopamine
Controls 'ross voluntary unit
+ecrease dopamine , &Par:inson?s( pin rollin' of e4tremiies & 2untin'ton?s +se*
+ecrease acetylcholine , @yasthenia 5ravis & AlDheimer?s
.ncreased neurotransmitter 1 psychiatric disorder .ncrease dopamine , schiDo
.ncrease acetylcholine , /ipolar
@.+ B-A.N , relay station for si'ht & hearin'
Controls siDe & reaction of pupil # , 3 mm
Controls hearin' acuity
CN 3 , 6
.socoria , normal siDe &eCual(
Anisocoria , uneven siDe , dama'e to mid /rain
P3--$A , normal reaction
+.3NC3P2A$ON /etween /rain
"halamus , acts as a relay station for sensation
2ypothalamus , &thermore'ulatin' center of temp; sleep & wa:efulness; thirst; appetite) satiety center; emotional responses;
controls pituitary function*
B-A.N S"3@ a* Pons , or pneumota4ic center , controls respiration
Cranial % , ! CNS
@3+B$$A OB$ON5A"A controls heart rate; respiratory rate; swallowin'; vomitin'; hiccups) sin'utus
0asomotor center; spinal decuissation termination ; CN E; 1F; 11; 1#
C3-3B3$$B@ , lesser /rain
Controls posture; 'ait; /alance; eCuili/rium
3
Cere/ellar "estsA
a*( - , -om/er'?s test needs # -Ns to assist
Normal anatomical position % , 1F min
&L( -om/er'?s test , &L( ata4ia or unsteady 'ait or drun:en li:e movement with loss of /alance*
/*( Fin'er to nose test ,
&L( "o F"N" , dymetria , ina/ility to stop a movement at a desired point
c*( Alternate pronation & supination
Palm up & down * &L( "o alternate pronation & supination or dama'e to cere/ellum , dymentrium
Composition of /rain /ased on @onroe Iellie 2ypothesis
S:ull is a closed container* Any alteration in 1 of 3 intracranial components 1 increase in .CP
Normal .CP , F , 1% mm2'
Foramen @a'num
C1 , atlas
C# , a4is
&L( ProHectile vomitin' 1 increase .CP
O/serve for #6 6! hrs
CSF , cushions the /rain; shoc: a/sor/er
O/struction of flow of CSF 1 increase .CP
2ydrocephalus , posteriorly due to closure of posterior fontanel
C0A , partial) total o/struction of /lood supply
INCREASED ICP , increase .CP is due to increase in 1 of the .ntra Cranial components*
Predisposin' factorsA
1*( 2ead inHury
#*( "umor
3*( $ocaliDed a/scess
6*( 2emorrha'e &stro:e(
%*( Cere/ral edema
<*( 2ydrocephalus
=*( .nflammatory conditions @enin'itis; encephalitis
B* SS( chan'e in 0S 1 always late symptoms
3arliest S4A
a*( Chan'e or decrease $OC , -estlessness to confusion 8ide pulse pressureA .ncreased .CP
+isorientation to lethar'y Narrow ppA Cardiac disorder; shoc:
Stupor to coma
$ate si'n , chan'e in 0)S
1* BP increase &systolic increase; diastole same(
#* 8idenin' pulse pressure
Normal adult BP 1#F)!F 1#F , !F 1 6F &normal pulse pressure(
.ncrease .CP 1 BP 16F)!F 1 16F , !F1 <F PP &wide(
3* -- is decreased &CheyneSto:es 1 /et period of apnea or hyperpnea with periods of apnea(
6* "emp increase
.ncreased .CPA .ncrease BP Shoc: , decrease BP ,
+ecrease 2- .ncrease 2- CBS2.N5S 3FF3C"
+ecrease -- .ncrease --
.ncrease "emp +ecrease temp
/*( 2eadache
ProHectile vomitin'
Papilledima &edema of optic dis: , outer surface of retina(
+ecorticate &a/normal fle4ion( 1 +ama'e to cortico spinal tract )
+ecere/rate &a/normal e4tension( 1 +ama'e to upper /rain stempons)
c*( Bncal herniation , unilateral dilation of pupil* &Bilateral dilation of pupil , tentorial herniation*(
d*( Possi/le seiDure*
6
Nursin' priorityA
1*( @aintain patent a)w & adeCuate ventilation
a* Prevention of hypo4ia , &decrease tissue o4y'enation( & hypercar/ia &increase in CO# retention(*
2ypo4ia , cere/ral edema increase .CP
2ypo4ia , inadeCuate tissue o4y'enation
$ate symptoms of hypo4ia , B , /radycardia
3 , e4treme restlessness
+ , dyspnea
C , cyanosis
3arly symptoms , - , restlessness
A , a'itation
" , tachycardia
.ncrease CO# retention) hypercar/ia , cere/ral vasodilatation 1 increase .CP
@ost powerful respiratory stimulant increase in C)*
2yperventilate decrease CO# , e4crete CO#
-espiratory +istress Syndrome &-+S( , decrease O4y'en
Suctionin' , 1F1% seconds; ma4 1% seconds* Suction upon removal of suction cap*
Am/u /a' , pump upon inspiration
c* Assist in mechanical ventilation
1* @aintain patent a)w
#* @onitor 0S & .&O
3* 3levate head of /ed 3F , 6% de'rees an'le nec: in neutral position unless contra indicated to promote venous
draina'e
6* $imit fluid inta:e 1;#FF , 1;%FF ml)day
&FO-C3 F$B.+ meansA.ncrease fluid inta:e)day , #;FFF , 3;FFF ml)day( not for inc .CP*
%* Prevent complications of immo/ility
<* Prevent increase .CP /yA
a* @aintain Cuiet & comfy environment
/* Avoid use of restraints , lead to fractures
c* Siderails up
d* .nstruct patient to avoid the ffA
0alsalva maneuver or /earin' down; avoid strainin' of stool
&'ive la4atives) stool softener +ulcola4) +uphalac(
34cessive cou'h , antitussive
+e4trometorpham
34cessive vomitin' , anti emetic &Plasil , Phil only() Phener'an
$iftin' of heavy o/Hects
Bendin' & stoopin'
e* Avoid clusterin' of nursin' activities
=* Administer me#s as orderedA
1*( Osmotic diuretic , @annitol*)Osmitrol promotes cere/ral diuresis /y decompressin' /rain tissue
Nursin' considerationsA Mannito"
1* @onitor BP , S3 of hypotension
#* @onitor .&O every hr* report if M 3Fcc out put
3* Administer via side drip
6* -e'ulate fast drip , to prevent formation of crystals or precipitate
#*( $oop diuretic $asi4 &Furosemide(
Nursin' @'tA Lasi(
Same as @annitol e4cept
$asi4 is 'iven via .0 push &e4pect urine after 1F1%mins( should /e in the
mornin'* .f 'iven at =am* Pt will urinate at =A1%
.mmediate effect of $asi4 within 1% minutes* @a4 effect , < hrs due &=am , 1pm(
%
S)3 of $asi4
&y!o+a"emia &normal I3*% , %*% me')$(
S&S4
1* 8ea:ness & fati'ue
#* Constipation
3* &L( NBO wave in 3C5 tracin'
Nursin' @'tA
1*( Administer I supplements , e4 Ialium +urule; I chloride
Potassium -ich foodA
ABC?s of I
0e'eta/les Fruits
A aspara'us A , apple
B , /roccoli &hi'hest( B , /anana , 'reen
C , carrots C , cantalope) melon
O , oran'e &hi'hest( ,for di'italis to4icity also*
0it A , sCuash; carrots yellow ve'eta/les & fruits; spinach; chesa
.ron , raisins;
Food appropriate for toddler , spa'hetti9 Not mil: , increase /ronchial secretions
+on?t 'ive 'rapes , may cho:e
S)3 of $asi4A
1*( 2ypo:alemia
#*( &y!oca"cemia &Normal level Ca 1 !*% , 11m')1FFml( or ,etanyA
S&S4
wea:ness
Paresthesia
&L( "rousseau si'n , patho'nomonic , or carpopedal spasm* Put /p cuff on arm1hand spasm*
&L( Chevoste:?s si'n
Arrhythmia
$aryn'ospasm
Administer , Ca 'luconate , .0 slowly

Ca -"uconate to(icityA S4 , seiDure , administer @' SO6
M- S). to(cicity, administer Ca 'luconate
/ , BP decrease
U , urine output decrease
R , -- decrease
P , patellar refle4es a/sent
3*( &y!onatremia , Normal Na level 1 13% , 16% me')$
S)S4 , 2ypotension
Si'ns of +ehydrationA dry s:in; poor s:in tur'or; 'en /ody malaise*
3arly si'ns , AdultA thirst and a'itation ) ChildA tachycardia
@'tA force fluid
Administer isotonic fluid sol
6*( &y!er-"ycemia , increase /lood su'ar level
P , polyuria
P , polypha'ia
P , polydipsia
Ns' @'tA
a* @onitor FBS &N1!F , 1#F m')dl(
%*( &y!erurecemia , increase serum uric acid* "ophi urate crystals in Hoint*
Gouty art0ritis +i#ney stones renal colic &pain(
Cool moist s:in
S4 Hoint pain & swellin' usually at 'reat toe*
<
Ns' @'t of Gouty Art0ritis
a*( Cheese &not sardines; anchovies; or'an meat(
&Not 'ood if pt ta:in' @AO(
/*( Force fluid
c*( Administer meds , Allopurinol) Pyloprim , decrease uric acid production , dru' of choice for 'out
Colchicene , e4cretes uric acid* Acute 'out dru' of choice*
1i#ney stones , renal colic &pain(* Cool moist s:in
@'tA
1*( Force fluid
#*( @eds , narcotic anal'esic
@orphine SO6
S3 of Mor!0ine S). to(icity
-espiratory depression &chec: -- 1
st
(
Antidote for morphine SO6 to4icity ,Narcan &NA$OKON3(
Nalo4one to4icity , tremors
.ncrease .CP medsA
3*( Corticosteroids +e4amethsone , decrease cere/ral edema &+ecadrone(
6*( @ild anal'esic , codeine SO6* For headache*
%*( Anti consultants , +ilantin &Phenytoin(
QuestionA .ncrease .CP what is the immediate ns' actionR
a* Administer @annitol as ordered
/* 3levate head 3F , 6% de'rees
c* -estrict fluid
d* Avoid use of restraints
Ns' Priority , ABC & safety
Pt sufferin' from epi'lotitis* 8hat is ns' priorityR
a* Administer steroids , least priority
/* Assist in 3" , temp; a)w
c* Assist in tracheotomy , permanent &Answer(
d* Apply warm moist pac:R $east priority
-ationaleA 8ont need to pass laryn4 due to laryn4 is inflamed* 3" can?t pass* Need tracheostomy only
Ma-ic *'s of #ru- monitorin-
Dru- N ran-e ,o(icity C"assification In#ication
+ , di'o4in *% , 1*% meC)$ # cardiac 'lycosides C2F
$ lithium *< , 1*# meC)$ # antimanic /ipolar
A , aminophylline 1F , 1E m')1FFml #F /ronchodilator COP+
+ , +ilantin 1F 1E m')1FF ml #F anticonvulsant seiDures
A , acetaminophen 1F , 3F m')1FFml #FF narcotic anal'esic osteoarthritis
Di-ita"is , increase cardiac contraction 1 increase CO
Nursin' @'t
1* Chec: P-; 2- &if 2- /elow <F/pm; don?t 'ive+i'o4in(
+i'italis to4icity , antidote +i'ivine
a* Anore4ia initial s4*
/* n)v 5."
c* +iarrhea
d* Confusion
e* Photopho/ia
f* Chan'es in color perception , yellow spots
&O: to 'ive to pts with renal failure* +i'o4in is meta/oliDed in liver not in :idney*(
=
L 2 "it0ium ("it0ane$ decrease levels of norepinephrine; serotonine; acetylcholine
Antimanic a'ent
$ithium to4icity
S)S4
a*( Anore4ia
/*( n)s
c*( +iarrhea
d*( +ehydration , force fluid; maintain Na inta:e 6 , 1F' daily
e*( 2ypothyroidism
&C-3".N.S@, the only endocrine disorder that can lead to mental retardation(
A 2 amino!0y"ine (t0eo!0y""ine$ 2 dilates /ronchioles*
"a:e /p /efore 'ivin' aminophylline*
S)S4 A Aminophylline to4icityA
1* "achycardia
#* 2yperactivity , restlessness; a'itation; tremors
QuestionA Avoid 'ivin' food with Aminophylline
a* Cheese)/utter, food rich in tyramine; avoided only if pt is 'iven @AO.
/* Beer) wine
c* 2ot chocolate & tea , caffeine , CNS stimulant tachycardia
d* Or'an meat) /o4 cereals , anti par:insonian
@AO. , antidepressant
m A- plan
n A- dil can lead to C0A or hypertensive crisis
p A- nate
3 , 6 wee:s /efore @AO. will ta:e effect
Anti Par:insonian a'ents , 0it B< Pyrido4ine reverses effect of $evodopa
D 2 #i"atin (P0enytoin$ , anti convulsant)seiDure
Nursin' @'tA
1* @i4ed with plain NSS or *E NaCl to prevent formation of crystals or precipitate
+o sandwich method
5ive NSS then +ilantin; then NSS9
#* .nstruct the pt to avoid alcohol , /ec alcohol L dilantin can lead to severe CNS depression
+ilantin to4icityA
S)S4A
5 , 'in'ival hyperplasia , swollen 'ums
i* Oral hy'iene , soft tooth/rush
ii* @assa'e 'ums
2 , hairy ton'ue
A ata4ia
N , nysta'mus , a/normal movement of eye/alls
A , acetaminophen) "ylenol , nonopoid anal'esic & antipyretic , fe/rile pts
Acetaminophen to4icity A
1* 2epato to4icity
#* @onitor liver enDymes
S5P" &A$"( , Serum 5lutamic Piruvate "yranase
S5O" Serum 5lutamic Acetate "yranase
3* @onitor BBN &1F , #F(
Crea &*!1(
Acetaminophen to4icity can lead to hypo'lycemia
" , tremors; "achycardia
. , irrita/ility
- , restlessness
!
3 , e4treme fati'ue
+ , depression &ni'htmares( ; +iaphoresis
Antidote for acetaminophen to4icity , Acetylcesteine 1 causes outporin' of secretions* Suction*
Prepare suctionin' apparatus*
QuestionA "he followin' are symptoms of hypo'lycemia e4ceptA
a* Ni'htmares
/* 34treme thirst , hyper'lycemia symptoms
c* 8ea:ness d* +iaphoresis
PAR1INS)NS DSE &par:insonism( chronic; pro'ressive disease of CNS char /y de'eneration of dopamine
producin' cells in su/stancia ni'ra at mid /rain & /asal 'an'lia
Palliative; Supportive
Function of dopamineA controls 'ross voluntary motors*
Predisposin' FactorsA
1* Poisonin' &lead & car/on mono4ide(* Antidote for lead 1 Calcium 3+"A
#* 2ypo4ia
3* Arteriosclerosis
6* 3ncephalitis
2i'h doses of the ffA
a* -eserpine &serpasil( anti 2PN; S3 , 1*( depression suicidal #*( /reast cancer
/* @ethyldopa &aldomet( promote safety
c* 2aloperidol &2aldol( anti psychotic
d* PhenothiaDide anti psychotic
S3 of anti psychotic dru's , E(tra Pyrami#a" Sym!tom
Over meds of anti psychotic dru's , neuroleptic mali'nant syndrome char /y tremors &severe(
S)S4A Par:insonism ,
1* Pill rollin' tremors of e4tremities , early si'n
#* Brady:inesia , slow movement
3* Over fati'ue
6* -i'idity &co'wheel type(
a* Stooped posture
/* Shufflin' , most common
c* Propulsive 'ait
%* @as: li:e facial e4pression with decrease /lin:in' eyes
<* @onotone speech
=* +ifficulty risin' from sittin' position
!* @ood la/ilety , always depressed , suicide
Ns' priorityA Promote safety
E* .ncrease salivation , droolin' type
1F* Autonomic si'nsA
.ncrease sweatin'
.ncrease lacrimation
Se/orrhea &increase se/aceous 'land(
Constipation
+ecrease se4ual activity
Ns' @'t
1*( Anti par:insonian a'ents
$evodopa &$+opa(; Car/idopa &Sinemet(; Amantadine 2cl &Symmetrel(
@echanism of action
.ncrease levels of dopa , relievin' tremors & /rady:inesia
S)3 of anti par:insonian
Anore4ia
n)v
Confusion
Orthostatic hypotension
2allucination
Arrhythmia
ContraindicationA
E
1* Narrow an'led closure 'laucoma
#* Pt ta:in' @AO. &Parnate; @arplan; Nardil(
Ns' @'t when 'ivin' antipar:insonian
1* "a:e with meals , to decrease 5." irritation
#* .nform pt , urine) stool may /e dar:ened
3* .nstruct pt don?t ta:e food 0it B< &Pyrido4ine( cereals; or'an meats; 'reen leafy ve'
Cause B< reverses therapeutic effects of levodopa
5ive .N2 &.soniaDide.sonicotene acid hydraDide*( S3Peripheral neuritis*
#*( Anti choliner'ic a'ents , relieves tremors
Artane mech , inhi/its acetylcholine
Co'entin action ; S)3 SNS
3*( Antihistamine , +iphenhydramine 2cl &Benadryl( , ta:e at /edtime
S)3A adult, drowsiness;, avoid drivin' & operatin' heavy eCuipt* "a:e at /edtime*
Child , hyperactivity CNS e4citement for :ids*
6*( +opamine a'onist
Bromotriptine 2cl &Parlodel( , respiratory depression* @onitor --*
Ns' @'t , Par:inson
1*( @aintain siderails
#*( Prevent complications of immo/ility
"urn pt every #h
"urn pt every 1 h , elderly
3*( Assist in passive -O@ e4ercises to prevent contractures
6*( @aintain 'ood nutrition
C2ON , in am
C2ON , in pm , to induce sleep , due "ryptopan , Amino Acid
%*( .ncrease fluid in ta:e; hi'h fi/er diet to prevent constipation
<*( Assist in sur'ery , Sterota4ic "halamotomy
Complications in sterota4ic thalmotomy 1*( Su/arachnoid hemorrha'e #*( aneurism 3*( encephalitis
MUL,IPLE SCLER)SIS (MS$
Chronic intermittent disorder of CNS , white patches of demyelenation in /rain & spinal cord*
-emission & e4acer/ation
Common , women; 1% , 3% yo cause , un:nown
Predisposin' factorA
1* Slow 'rowin' virus
#* Autoimmune , &supportive & palliative treatment only(
Normal -esident Anti/odiesA
.' 5 , can pass placenta , passive immunity* Short actin'*
.' A , /ody secretions , saliva; tears; colostrums; sweat
.' @ , acute inflammation
.' 3 , aller'ic reactions
.'+ , chronic inflammation
S & S4 of @SA &everythin' down(
1* 0isual distur/ances
a* Blurrin' of vision
/* +iplopia) dou/le vision
c* Scotomas &/lind spots( , initial s4
#* .mpaired sensation to touch; pain; pressure; heat; cold
a* Num/ness
/* "in'lin'
c* Paresthesia
3* @ood swin's , euphoria &sense of elation (
6* .mpaired motor functionA
a* 8ea:ness
/* Spasiticity ,N ti'asO
c* Paralysis ,maHor pro/lem
1F
%* .mpaired cere/ellar function
"riad S4 of @S
. , intentional tremors
N , nysta'mus , a/normal rotation of eyes Charcots triad
A , Ata4ia
& Scannin' speech
<* Brinary retention or incontinence
=* Constipation
!* +ecrease se4ual a/ility
+4 , @S
1* CSF analysis thru lum/ar puncture
-eveals increase C2ON & .'5
#* @-. , reveals site & e4tent of demyelination
3* $hermitte?s response is &L(* .ntroduce electricity at the /ac:* "heres spasm & paralysis at spinal cord*
Ns' @'t @S
Supportive m't
1*( @eds
a* Acute e4acer/ation
AC"2 , adenocorticotopic
Steroids , to reduce edema at the site of demyelination to prevent paralysis
S!ina" Cor# In3ury
Administer dru' to prevent paralysis due to edema
a* 5ive AC"2 , steroids
/* Baclopen &$ioresol( or +antrolene Na &+antrium(
"o decrease muscle spasticity
c* .nterferone , to alter immune response
d* .mmunosuppresants
#* @aintain siderails
3* Assist passive -O@e4ercises , promote proper /ody ali'nment
6* Prevent complications of immo/ility
%* 3ncoura'e fluid inta:e & increase fi/er diet , to prevent constipation
<* Provide catheteriDation due urinary retention
=* 5ive diuretics
Brinary incontinence , 'ive Prophantheline /romide &pro/anthene(
Antispasmodic anti choliner'ic
!* 5ive stress reducin' activity* +eep /reathin' e4ercises; /iofeed/ac:; yo'a techniCues*
E* Provide acidash diet , to acidify urine & prevent /acteria multiplication
5rape; Cran/erry; Oran'e Huice; 0it C
M4AS,&ENIA GRA5IS (MG$ , distur/ance in transmission of impulses from nerve to muscle cell at neuro muscular
Hunction*
Common in 8omen; #F , 6F yo; un:nown cause or idiopathic
Autoimmune , release of cholenesterase , enDyme
Cholinesterase destroys AC2 &acetylcholine( 1 +ecrease acetylcholine
+escendin' muscle wea:ness
&Ascendin' muscle wea:ness , 5uillain Barre Syndrome(
Ns' priorityA
1( a)w
#( aspiration
3( immo/ility
S) S4A
1*( Ptosis , droopin' of upper lid & initial si'n(
Chec: Palpe/ral fissure , openin' of upper & lower lids 1 to :now if &L( of @5*
#*( +iplopia , dou/le vision
3*( @as: li:e facial e4pression
6*( +yspha'ia , ris: for aspiration9
%*( 8ea:enin' of laryn'eal muscles , hoarseness of voice
<*( -esp muscle wea:ness , lead respiratory arrest* Prepare at /edside tracheostomy set
11
=*( 34treme muscle wea:ness durin' activity especially in the mornin'*
+4 test
1* "ensilon test &3drophonium 2cl( , temporarily stren'thens muscles for % , 1F mins* Short term choliner'ic* PNS effect*
Ns' @'t
1* @aintain patent a)w & adeCuate vent /yA
a*( Assist in mechanical vent , attach to ventilator
/*( @onitor pulmonary function test* +ecrease vital lun' capacity*
#* @onitor 0S; .&O neuro chec:; muscle stren'th or motor 'radin' scale &6)%; %)%; etc(
3* Siderails
6* Prevent complications of immo/ility* Adultevery # hrs* 3lderly every 1 hr*
%* N5" feedin'
Administer meds ,
a*( Choliner'ics or anticholinesterase a'ents
@estinon &Pyridosti'mine(
Neosti'nine &prosti'min( , $on' term
.ncrease acetylcholine
s)e , PNS
/*( Corticosteroids , to suppress immune resp
+ecadron &de4amethasone(
@onitor for # types of CrisisA
@yastinic crisis Choliner'ic crisis
A cause , 1* Bnder medication
#* Stress
3* .nfection
B S&S4 1* Bna/le to see , Ptosis &
diplopia
#* +yspha'ia una/le to swallow*
3* Bna/le to /reath
C @'t , adm choliner'ic a'ents
CauseA 1 over meds
S)S4 PNS
n)v; diarrhea; hypotension; meiosis; facial muscle twitchin';
a/dominal cramps
@'t* adm anticholiner'ic
Atropine SO6
SNS , dry mouth
=* Assist in sur'ical proc , thymectomy* -emoval of thymus 'land* "hymus secretes auto immune anti/ody*
!* Assist in plasmaparesis , filter /lood
E* Prevent complication , respiratory arrest
Prepare tracheostomy set at /edside*
G/S , Gui""ain /arre Syn#rome
+isorder of CNS
Bilateral symmetrical polyneuritis
Ascendin' paralysis
Cause , un:nown; idiopathic
Auto immune
r)t antecedent viral infection
.mmuniDations
S&S4
.nitial A
1* Clumsiness
#* Ascendin' muscle wea:ness , lead to paralysis
3* +yspha'ia
6* +ecrease or diminished +"- &deep tendon refle4es(
Paralysis
%* Alternate 2PN to hypotension , lead to arrhythmia complication
<* Autonomic chan'es , increase sweatin'; increase salivation*
.ncrease lacrimation
Constipation
+4 most importantA CSF analysis thru lum/ar puncture reveals increase in A .'5 & C2ON &same with @S(
1#
Ns' @'t
1* @aintain patent a)w & adeCuate vent
a* Assist in mechanical vent
/* @onitor pulmonary function test
#* @onitor vs*; .&O neuro chec:; 3C5 tracin' due to arrhythmia
3* Siderails
6* Prevent compl , immo/ility
%* Assist in passive -O@ e4ercises
<* .nstitute N5" feedin' , due dyspha'ia
=* Adm meds &5BS( as orderedA , 1* Anti choliner'ic , atropine SO6
#* Corticosteroids , to suppress immune response
3* Anti arrhythmic a'ents
a*( $idocaine )Kylocaine ,S3 confusion 1 0"ach
/*( Bretyllium
c*( Quinines)Quinidine , anti malarial a'ent* 5ive with meals*
"o4ic effect , cinchonism
Quinidine to4icity
S)3 , anore4ia; n)v; headache; verti'o; visual distur/ances
!* Assist in plasmaparesis &@5* 5BS(
E* Prevent comp , arrhythmias; respiratory arrest
Prepare tracheostomy set at /edside*
.NF$ CON+."ONS OF B-A.N
@enin'es , 3fold mem/rane , cover /rain & spinal cord
F4A
Protection & support
Nourishment
Blood supply
3 layers
1* +uramater su/ dural space
#* Arachmoid matter
3* Pia matter su/ arachnoid space where CSF flows $3 & $6* Site for lum/ar puncture*
MENINGI,IS , inflammation of menin'itis & spinal cord
3tiolo'y , @enin'ococcus
Pneumococcus
2emophilous influenDa , child
Streptococcus , adult menin'itis
@O" , direct transmission via droplet nuclei
S&S4
Stiff nec: or nuchal ri'idity &initial si'n(
2eadache
ProHectile vomitin' , due to increase .CP
Photopho/ia
Fever chills; anore4ia
5en /ody malaise
8t loss
+ecorticate)decere/ration , a/normal posturin'
Possi/le seiDure
S4 of menin'eal irritation , nuchal ri'idity or stiffness
Opisthotonus ri'id archin' of /ac:
Patho'nomonic si'n , &L( Ierni'?s & BrudDins:i si'n
$e' pain nec: pain
13
+4A
1* Lumbar !uncture , lum/ar) spinal tap , use of hallow spinal needle , su/ arachnoid space $3 & $6 or $6 & $%
Aspirate CSF for lum/ar puncture*
Ns' @'t for lum/ar puncture , invasive
1* Consent ) e4plain procedure to pt
-N , d4 procedure &la/(
@+ , operation procedure
#* 3mpty /ladder; /owel , promote comfort
3* Arch /ac: , to clearly visualiDe $3; $6
Ns' N't post lum/ar
1* Flat on /ed , 1# , #6 h to prevent spinal headache & lea: of CSF
#* Force fluid
3* Chec: punctured site for draina'e; discoloration & lea:a'e to tissue
6* Assess for movement & sensation of e4tremeties
-esult
1* CSF analysisA a* increase C2ON & 8BC Content of CS6A Chon; w/c; 'lucose
/* +ecrease 'lucose
Confirms menin'itis c* increase CSF openin' pressure
N %F , 1<F mm2'
d* &L( Culture microor'anism
#* Complete /lood count CBC , reveals increase 8BC
@'tA
1* Adm meds
a*( Broadspectrum anti/iotic penicillin
S)3
1* 5." irritation , ta:e with food
#* 2epatoto4icity; nephroto4cicity
3* Aller'ic reaction
6* Super infection , alteration in normal /acterial flora
N flora throat , streptococcus
N flora intestine , e coli
S4 of superinfection of penicillin 1 diarrhea
/*( Antipyretic
c*( @ild anal'esic
#* Strict resp isolation #6h after start of anti/iotic therapy
A , Cushin'?s synd , reverse isolation due to increased corticosteroid in /ody*
B , Aplastic anemia , reverse isolation due to /one marrow depression*
C , Cancer anytype , reverse isolation , immunocompromised*
+ , Post liver transplant , reverse isolation , ta:es steroids lifetime*
3 , Prolon'ed use steroids , reverse isolation
F , @enin'itis , strict respiratory isolation , safe after #6h of anti/iotic therapy
5 , Asthma , not to /e isolated
3* Comfy & dar: room , due to photopho/ia & seiDure
6* Prevent complications of immo/ility
%* @aintain F & 3 /alance
<* @onitor vs; .&O ; neuro chec:
=* Provide client health teachin' & dischar'e plan
a* Nutrition , increase cal & C2O; C2ONfor tissue repair* Small freC feedin'
/* Prevent complication hydrocephalus; hearin' loss or nerve deafness*
!* Prevent seiDure*
8here to /rin' # yo post menin'itis
Audiolo'ist due to dama'e to hearin' post repair myelomenin'ocele
Brolo'ist +ama'e to sacral area , spina /ifida , controls urination
E* -eha/ for neurolo'ical deficit* Can lead to mental retardation or a delay in psychomotor development*

16
CERE/R) 5ASCULAR ACCIDEN, , stro:e; /rain attac: or cere/ral throm/osis; apople4y
Partial or complete disruption in the /rains /lood supply
# lar'est & common artery in stro:e
@iddle cere/ral artery
.nternal carotid artery
Common to male , # , 34 hi'h ris:
Predisposin' factorA
1* "hrom/osis , clot &attached(
#* 3m/olism , dislod'ed clot , pulmo em/olism
S)S4A !u"mo embo"ism
Sudden sharp chest pain
Bne4plained dyspnea; SOB
"achycardia; palpitations; diaphoresis & mild restlessness
S)S4A cerebra" embo"ism
2eadache; disorientation; confusion & decrease in $OC
Femur fracture , complicationsA fat em/olism , most feared complication w)in #6hrs
Jellow /one marrow , produces fat cells at meduallary cavity of lon' /one
-ed /one marrow , provides 8BC; platelets; -BC found at epiphisis
#*( 2emorrha'e
3*( Compartment syndrome , compression of nerves) arteries
-is: factors of C0AA 2PN; +@; @.; artherosclerosis; valvular heart dse Post heart sur'ery , mitral valve replacement
$ifestyleA 1* Smo:in' , nicotine , potent vasoconstrictor
#* Sedentary lifestyle
3* 2yperlipidemia , 'enetic
6* Prolon'ed use of oral contraceptives
@acro pill , has lar'e amt estro'en
@ini pill , has lar'e amt of pro'estin
Promote lipolysis &/rea:down of lipids)fats( , artherosclerosis , 2PN stro:e
%* "ype A personality
a* +eadline driven person
/* # , % thin's at the same time
c* 5uilty when not don' anythin'
<* +iet , increase saturated fats
=* 3motional & physical stress
!* O/esity
S & S4
1* ".A warnin' si'ns of impendin' stro:e attac:s
2eadache &initial s4(; diDDiness) verti'o; num/ness; tinnitus; visual & speech distur/ances; paresis or ple'ia &monople'ia , 1
e4treme(
.ncrease .CP
#* Stro:e in evolution , pro'ression of S & S4 of stro:e
3* Complete stro:e , resolution of stro:e
a*( 2eadache
/*( CheyneSto:es -esp
c*( Anore4ia; n)v
d*( +yspha'ia
e*( .ncrease BP
f*( &L( Ierni'?s & BrudDins:i , s4 of hemorrha'ic stro:e
'*( Focal & neurolo'ical deficit
1* Phle'ia
#* +ysarthria , ina/ility to vocaliDe; articulate words
3* Aphasia
6* A'raphia diff writin'
1%
%* Alesia , diff readin'
<* 2omoninous hemianopsia , loss of half of field of vision
$eft sided hemianopsia , approach -i'ht side of pt , the unaffected side
+4
1* C" Scan , reveals /rain lesion
#* Cere/ral arterio'raphy , site & e4tent of mal occlusion
.nvasive procedure due to inHect dye
Aller'y test
All , 'raphy , invasive due to iodine dye
Post
1*( Force fluid , to e4crete dye is nephroto4ic
#*( Chec: peripheral pulses distal
Ns' @'t
1* @aintain patent a)w & adeCuate vent
Assist mechanical ventilation
Administer O#
#* -estrict fluids , prevent cere/ral edema
3* 3levate head of /ed 3F6% de'rees an'le* Avoid valsalva maneuver*
6* @onitor vs*; .&O; neuro chec:
%* Prevent compl of immo/ility /yA
a* "urn client C#h
3lderly C1h
"o prevent decu/itus ulcer
"o prevent hypostatic pneumonia , after prolon'ed immo/ility*
/* 3'' crate mattress or 2#O /ed
c* Sand /a' or foot /oard prevent foot drop
<* N5" feedin' , if pt can?t swallow
=* Passive -O@ e4ercise C6h
!* Alternative means of communication
Nonver/al cues
@a'ic slate* Not paper and pen* "irin' for pt*
&L( "o hemianopsia , approach on unaffected side
E* @eds
Osmotic diuretics , @annitol
$oop diuretics , $asi4) Furosemide
Corticosteroids , de4tamethaDone
@ild anal'esic
"hrom/olytic) fi/rolitic a'ents , tunaw clot* S3Brticaria; prurituscaused /y forei'n su/s*
Strepto:inase
Bro:inase
"issue plasmino'en activatin'
@onitor /leedin' time
Anticoa'ulants , 2eparin & CoumadinO sa/ayO
Coumadin will ta:e effect after 3 days
2eparin , monitor P"" partial throm/oplastin time if prolon'ed , /leedin' 'ive Protamine SO6 antidote*
Coumadin ,$on' term* monitor P" prothrom/in time if prolon'ed /leedin' 'ive 0it I , ACuamephyton antidote*
Antiplatelet , PASA , aspirin paraanemo aspirin; don?t 'ive to den'ue; ulcer; and un:nown headache*
2ealth "eachin'
1* Avoidance modifia/le lifestyle
+iet; smo:in'
#* +ietary modification
Avoid caffeine; decrease Na & saturated fats
ComplicationsA
Su/arachnoid hemorrha'e
-eha/ for focal neurolo'ical deficit , physical therapy
1* @ental retardation
#* +elay in psychomotor development
1<
C)N5ULSI5E Disor#er (C)N5ULSI)NS$ disorder of the CNS char* /y paro4ysmal seiDures with or without loss of
consciousness; a/normal motor activity; alteration in sensation & perception & chan'e in /ehavior*
Can you out'row fe/rile seiDureR +ifference /etweenA SeiDure 1
st
convulsive attac:
Fe/rile seiDure Normal if M % yo 3pilepsy , #
nd
and with history of seiDure
Patholo'ic if S % yo
Predisposin' Factor
2ead inHury due /irth trauma
"o4icity of car/on mono4ide
Brain tumor
5enetics
Nutritional & meta/olic deficit
Physical stress
Sudden withdrawal to anticonvulsants will /rin' a/out status epilepticus
Status epilepticus , dru' of choiceA +iaDepam & 'lucose
S & S4
.* 5eneraliDed SeiDure ,
a*( 5rand mal ) tonic clonic seiDures
8ith or without aura , warnin' symptoms of impendin' seiDure attac: 3pi'astric pain associated with
olfactory; tactile; visual; auditory sensory e4perience
3pileptic cry , fall
$oss of consciousness 3 , % min
"onic clonic contractions
+irect symmetrical e4tension of e4tremities"ON.C* ContractionsC$ON.C
Post ictal sleep state of lethar'y or drowsiness unrespondin' sleep after tonic clonic
/*( Petimal seiDure , &same as daydreamin'9( or a/sent seiDure*
Blan: stare
+ecrease /lin:in' eye
"witchin' of mouth
$oss of consciousness , % , 1F secs &Cuic: & short(
..* $ocaliDed)partial seiDure
a*( Tac:sonian seiDure or focal seiDure , tin'lin')Her:y movement of inde4 fin'er)thum/ & spreads to shoulder &
1 sideof the /ody with Han:sonian march
/*( Psychomotor) focal motor seiDure
Automatism , stereotype repetitive & nonpurposive /ehavior
Cloudin' of consciousness , not in control with environment
@ild hallucinatory sensory e4perience
2A$$BC.NA".ONS
1* Auditory , schitDo , paranoid type
#* 0isual , :orsa:offs psychosis , chronic alcoholism
3* "actile , addict , su/stance a/use
...* Status epilecticus , continuous; uninterrupted seiDure activity; if untreated; lead to hyperpre4ia , coma , death
SeiDureA inc electrical firin' in /rain1increased meta/olic activity in /rain1/rain usin' 'lucose and O#1dec 'lucose; dec O#*
"4A+iaDepam &dru' of choice(; 'lucose
+4Convulsion 'et health history9
1* C" scan , /rain lesion
#* 335 electroencephalo'raphy
2yperactivity /rain waves
Ns' @'t
Priority , Airway & safety
1* @aintain patent a)w & promote safety
Before seiDureA
1* -emove /lunt)sharp o/Hects
1=
#* $oosen clothin'
3* Avoid restraints
6* @aintain siderails
%* "urn head to side to prevent aspiration
<* "on'ue 'uard or mouth piece to prevent /itin' of ton'ueB3FO-3 S3.PB-3 ON$J9 Can use spoon at home*
=* Avoid precipitatin' stimulus , /ri'ht 'larin' li'hts & noises
!* Administer meds
a* +ilantin &Phenytoin( ,& to4icity level , #F (
S3 5in'uial hyperplasia
2hairy ton'ue
Aata4ia
Nnysta'mus
Aacetaminophen fe/rile pt
@i4 with NSS
+on?t 'ive alcohol , lead to CNS depression
/* &"e'retol( Car/amasene 'iven also to "ri'eminal Neural'ia* S3A arrythmia
c* Pheno/ar/ital &$uminal( S3A hallucinations
#* .nstitute seiDure & safety precaution* Post seiDureA Administer O#* Suction apparatus ready at /edside
3* @onitor onset & duration
"ype of seiDure
+uration of post ictal sleep* "he lon'er the duration of post ictal sleep; the hi'her chance of havin' status
epilepticus9
6* Assist in sur'ical procedure* Cortical resection
%* ComplicationsA Su/arachnoid hemorrha'e and encephalitis
QuestionA 1 yo 'rand mal , immediate nursin' action 1 a)w & safety
a* @outhpiece , 1 yr old , little teeth only
/* Adm o# inhalation , post9
c* 5ive pillow , safety &answer(
d* Prepare suction
Neurolo'ical assessmentA
1* Comprehensive neuro e4am
#* 5CS G"as-o7 coma sca"e , o/H measurement of $OC or Cuic: neuro chec:
3 components of 3CS
@ , motor <
0 , ver/al resp %
3 , eye openin' 6
1%
1% , 16 , conscious
13 , 11 , lethar'y
1F , ! , stupor
= , coma
3 , deep coma , lowest score
Survey of mental status & speech &Comprehensice Neuro 34am(
1*( $OC & test of memory
#*( $evels of orientation
3*( CN assessment
6*( @otor assessment
%*( Sensory assessment
<*( Cere/ral test , -omh/er'; fin'er to nose
=*( +"-
!*( Autonomics
$evels of consciousness &$OC( ,
1* Conscious &conscious( , awa:e , levels of wa:efulness
1!
#* $ethar'y &lethar'ic( , drowsy; sleepy; o/tunded
3* Stupor &stuporous( , awa:ened /y vi'orous stimulation
Pt has 'en /ody wea:ness; decrease /ody refle4
6* Coma &Comatose( li'ht , &L( all forms of painful stimulations
+eep , &( to painful stimulation
QuestionA Describe a conscious pt ?
a8 Alert , not all pt are alert & oriented to time & place
b8 Coherent
c8 A7a+e9 answer
#8 Aware
+ifferent types of pain stimulation
Don't !ric+
1* +eep sternal stimulation) pressure 34, fist :nuc:le
8ith response , li'ht coma
8ithout response , deep coma
#* Pressure on 'reat toe , 34
3* Or/ital pressure , pressure on or/its only , /elow eye
6* Corneal refle4) /lin:in' refle4
8isp of cotton , used to illicit /lin:in' refle4 amon' conscious patients
.nstill 1drop saline solution , unconscious pt if &( response pt is in deep coma
%* "est of memory , considered educational /ac:'round
a*( Short term memory ,
8hat did you eat for /rea:fastR
+ama'e to temporal lo/e , &L( antero 'rade amnesia
/*( $on' term memory
&L( -etro'rade amnesia , dama'e to lim/ic system
<* $evels of orientation
"ime Place Person
5raphesthesia can identify num/ers or letters written on palm with a /lunt o/Hect*
A'raphesthesia , cant identify num/ers or letters written on palm with a /lunt o/Hect*
CN assessment:
. , Olfactory s
.. , Optic s
... , Oculomotor m
.0 , "rocheal m smallest CN
0 , "ri'eminal / lar'est CN
0. , A/ducens m
0.. , Facial /
0... , Acustic)auditory s
.K , 5lassopharyn'eal /
K , 0a'us / lon'est CN
K., Spinal accessory m
K.. , 2ypo'lossal m
.* )"factory , don?t use ammonia; alcohol; colo'ne irritatin' to mucosa , use coffee; /ar soap; vine'ar; ci'arette tar
2yposmia , decrease sensitivity to smell
+iposmia , distorted sense of smell
Anosmia , a/sence of sense of smell
3ither of 3 mi'ht indicate head inHury , dama'e to cri/riform plate of ethmoid /one where olfactory cells are located
or indicate inflammation condition , sinusitis
.. o!tic test of visual acuity , Snellens chart , central or distance vision
Snellens 3 chart , used for illiterate chart
N #F)#F vision distance /y w)c person can see letters #F ft
Numerator , distance to snellens chart
+enominator , distance the person can see the letters
O+ , -t eye #F)#F #F)#FF , /lindness , cant read 3 , /i''est
OS , left eye #F)#F
1E
OB , /oth eye #F)#F
#* "est of peripheral vision) visual field
a* Superiority
/* Bitemporally
c* .nferiorly
d* Nasally
Common +isorders , see pa'e !%!= for more info on 'laucoma; etc*
1* 5laucoma , Normal 1# , #1 mm2' pressure
.ncrease .OP $oss of peripheral vision , Ntunnel visionO
#* Cataract , opacity of lens $oss of central vision; NBlurrin' or haDy visionO
3* -etinal detachment , curtain veil , li:e vision & floaters
6* @acular de'eneration , /lac: spots
...; .0; 0. , tested simultaneously
.nnervates the movementt of e4trinsic ocular muscle
< cardinal 'aDe 3O@
-t eye N left eye
.O SO O
S
$- @- 3
S-
3 , 6 3O@
.0 , sup o/liCue
0. , lateral rectus
Normal response , P3--$A &isocoria , eCual pupil(
Anisocoria , uneCual pupil
Oculomotor
1* -aisin' of eyelid , Ptosis
#* Controls pupil siDe # 3 cm or 1*% , # mm
0 , ,ri-emina" , $ar'est , consists of ophthalmic; ma4illary; mandi/ular
Sensory , controls sensation of the face; mucus mem/raneU teeth & cornea refle4
Bnconscious , instill drop of saline solution
@otor , controls muscles of chewin') muscles of mastication
"ri'eminal neural'ia , diff chewin' & swallowin' , e4treme food temp is not recommended
QuestionA "ri'eminal neural'ia; -N should 'ive
a* 2ot mil:; /utter; raisins
/* Cereals
c* 5elatin; toast; potato , all correct /ut
d* Potato; salad; 'elatin , salad easier to chew
0. 6acia"A Sensory , controls taste , ant #)3 of ton'ue test cotton applicator put su'ar*
Put applicator with su'ar to tip to ton'ue*
Start of taste insensitivityA A'e 'roup , 6F yrs old
@otor controls muscles of facial e4pression; smile frown; raise eye/row
+ama'e , Bells palsy , facial paralysis
Cause , /ells palsy pedia , -)" forcep delivery
"emporary only
@ost evident clinical si'n of facial symmetryA Nasola/ial folds
0... Acoustic) vesti/ule cochlear &controls hearin'( , controls /alance &:enesthesia or position sense(
@ovement & orientation of /ody in space
#F
Or'an of Corti , for hearin' , true sense or'an of hearin'
Outer , tympanic mem/rane; pinna; oricle &impacted cerumen(; cerumen
@iddle , hammer; anvil; stirrup or melleus; incus; staples* @id otitis media
3ustachean ear
.nner ear meniere dse; sensory hearin' loss &research parts9 & dse(
-emove vesti/ule , meniere?s dse , disease inner ear
Archimedes law , /uoyancy &pre'nancy , fetus(
+altons law , partial pressure of 'ases
.nertia , law of motion &diDDiness; verti'o(
1*( Pt with multiple sta/ wound chest
@ovement of air in & out of lun's is carried /y what principleR
+iffusion , +alton?s law
#*( Pre'nant , chec: up , ultrasound reveals fetus is carried /y amniotic fluid
Archimedes
3*( Severe verti'o due .nertia
"est for acoustic nerveA
-epeat words uttered
.K , G"osso!0aryn-ea" , controls taste , posterior 1)3 of ton'ue
K , 5a-us , controls 'a' refle4
"est E , 1F
Pt say ah , chec: uvula , should /e midline
+ama'e cere/ral hemisphere is $ or -
5a' refle4 , place ton'ue depression post part of ton'ue
+on?t touch uvula
K. , S!ina" Accessory controls sternocleidomastoid &nec:( & trapeDius &shoulders and /ac:(
Shru' shoulders; put pressure* Pt should resist pressure* Paresis or phle'ia
K.. , &y!o-"ossa" , controls movement of ton'ue , say NahO* Assess ton'ue position1midline
$ or - deviation
Push ton'ue a'ainst chee:
Short frenulum lin'ue ,
"on'ue tied , N/ulolO
END)CRINE
F4 of endocrine , ductless 'land
@ain 'land , Pituitary 'land , located at /ase of /rain of Stella "urcica
@aster 'land of /ody
@aster cloc: of /ody
Anterior pituitary 'land , adenohypophysis
Posterior pituitary 'land , neurohypophysis
Posterior pituitaryA
1*( O4ytocin , a*( Promotes uterine contraction preventin' /leedin') hemorrha'e*
5ive after placental delivery to prevent uterine atony*
/*( @il: letdown refle4 with help of prolactin*
#*( A+2 , antidiuretic hormone , &vasopressin( Prevents urination , conserve 2#O

Eric *:
#1
A8 DIA/E,IS INSIPIDUS &+. dalas ihi( , hyposecretion of A+2
CauseA idiopathic) un:nown
Predisposin' factorA
1* Pituitary sur'ery
#* "rauma) head inHury
3* "umor
6* .nflammation
7 alcohol inhi/its release of A+2
S & S4A
1* Polyuria
#* S4 of dehydration &1
st
s4 of dehydration in childrentachycardia(
34cessive thirst &adult(
A'itation
Poor s:in tur'or
+ry mucus mem/rane
3* 8ea:ness & fati'ue
6* 2ypotension , if left untreated
%* 2ypovolemic shoc:
Anuria , late si'n hypovolemic shoc:
+4 ProcA
1* +ecrease urine specific 'ravity concentrated urine
N1 1*F1% , 1*F3%
#* Serum Na 1 increase &N113% 16% meC)$( 2ypernatremia
@'tA
1* Force fluid #;FFF , 3;FFFml)day
#* Administer .0 fluid replacement as ordered
3* @onitor 0S; .&O
6* Administer meds as ordered
a*( Pitresin &vasopressin( .@
%* Prevent complications
@ost feared complication , 2ypovolemic shoc:
B*( SIAD& 9 Syn#rome of Ina!!ro!riate Anti9Diuretic &ormone
.ncrease A+2
.diopathic) un:nown
Predisposin' factor
1* 2ead inHury
#* -elated to Broncho'enic cancer or lun' caner
3arly Si'n of $un' Ca Cou'h ,1* non productive #* productive
3* 2yperplasia of Pit 'land
.ncrease siDe of or'an
S&S4
1* Fluid retention
#* .ncrease BP , 2PN
3* 3dema
6* 8t 'ain
%* +an'er of 2#O into4ication ,ComplicationsA 1* cere/ral edema , increase .CP , #* seiDure
+4 ProcA
1* Brine specific 'ravity increase , diluted urine
#* 2yponatremia , +ecreased Na
##
Ns' @'tA
1* -estrict fluid
#* Administer meds as ordered e'* +iureticsA $oop and Osmotic
3* @onitorstrictly 0)S; .&O; neuro chec: , increase .CP
6* 8ei'h daily
%* Assess for presence edema
<* Provide meticulous s:in care
=* Prevent complications , increase .CP & seiDures activity
Anterior Pituitary 5land , adeno
:8 5rowth hormone &52( &Somatotropic hormone(
F4A 3lon'ation of lon' /ones
+ecrease 52 , dwarfism children
.ncrease 52 , 'i'antism
.ncrease 52 , acrome'aly , adult
Pu/erty E yo , #1 yo
3piphyseal plate closes at #1 yo
SCuare face
SCuare Haw
+ru' of choice in acrome'alyA Ocreotide &Sandostatin( S3 diDDiness
Somatostatin 2ormone , anta'oniDes the release of of 52
*8 @elanocytes stimulatin' hormone @S2
S:in pi'mentation
;8 Prolactin)luteotrpic hormone) lacto'enic hormone Promotes development of mammary 'land
&O4ytocin.nitiates mil: letdown refle4(
.8 Adrenocorticotropic hormone , AC"2 +evelopment & maturation of adrenal corte4
<8 $uteiniDin' hormone , produces pro'esterone*
=8 FS2 produces estro'en
PINEAL GLAND
1* Secretes @elatonin , inhi/its luteniDin' hormone &$2( secretion
,&4R)ID GLAND &"5(
QuestionA Normal physical findin' on "5A
a* 8ith tenderness , thyroid never tender
b8 >it0 no#u"ar consistency9 answer
c* @ar:ed asymmetry , only 1 "5
d* Palpa/le upon swallowin' Normal "5 never palpa/le unless with 'oiter
"5 hormonesA
"3 "6 "hyrocalcitonin
"riodothyronine "etraiodothyronine) "yro4ine FK , anta'oniDes effects of parathormone
3 molecules of iodine 6 molecules of iodine
@eta/olic hormone
.ncrease meta/olism /rain ,inc cere/ration; inc v)s all v)s down; constipation
2ypo "3 "6 lethar'y & memory impairment ,
2yper "3 "6 a'itation; restlessness; and hallucination
?8 .ncrease 0S; increase motility
#3
2JPO"2J-O.+.S@ , all decreased e4cept wt & menstruation; loss of appetite /ut with wt 'ain
menorrha'ia , increase in mens
2JP3-"2J-O.+.S@ .ncrease appetite , wt loss; amenorrhea
SIMPLE G)I,ER , enlar'ed thyroid 'land iodine deficiency
Predisposin' factors
1* 5oiter /elt area Place far from sea , no iodine* Seafood?s rich in iodine
#* @ountainous area , increase inta:e of 'oitro'enic foods &BSA @idwest; N3; Salt $a:e(
Ca//a'e , has pro'oitrin , an anti thyroid a'ent with no iodine
34ampleA "urnips &sin':amas(; radish; peas; straw/erries; potato; /eans; :amote; cassava &root crops(; all nuts*
3* 5oitro'enic dru'sA
Anti thyroid a'ents A&P"B( prephyl thiupil
$ithium car/onate; Aspirin PASA
Co/alt; Phenyl /utasone
3ndemic 'oiter , cause V 1
Sporadic 'oiter , caused /y V# & 3
S & S4 , enlar'ed "5
@ild restlessness
@ild dyspha'ia
+4 Proc*
1* "hyroid scan , reveals enlar'ed "5
#* Serum "S2 , increase &confirmatory(
3* Serum "3; "6 , N or /elow N
Ns' @'tA
1* Administer meds
a*( .odine solution , $o'ol?s solution or saturated sol of I iodide SSI.
Ns' @'t $u'ol?s sol , violet color
1* use straw , prevent stainin' teeth
#* Prophyla4is # 3 drops "reatment , % to < drops
Bse straw , to prevernt stainin' of teeth
1* $u'ol?s sol*; #* tetracycline 3* nitrofurantin &macrodantin(urinary anticepticpyelonephritis* 6* .ron solution*
B* "hyroid h ) A'ents
1* $evothyro4ine &Synthroid(
#* $iothyronine &cytomel(
3* "hyroid e4tract
Ns' @'tA for "2)a'ents
1* @onitor vs* , 2- due tachycardia & palpitation
#* "a:e it early A@ , S3 insomnia
3* @onitor s)e
"achycardia; palpitations
Si'ns of insomnia
2yperthyroidism restlessness a'itation
2eat intolerance
2PN
3* 3ncoura'e increase inta:e iodine , iodine is e4tracted from seaweeds &9(
Seafood hi'hest iodine content oysters; clams; cra/s; lo/ster
$owest iodine , shrimps
.odiDed salt ,easily destroyed /y heat ta:e it raw not coo:ed
6* Assist sur'ery Su/ total thyroidectomy
ComplicationA 1* "etany #* laryn'eal nerve dama'e 3*2emorrha'efeelin' of fullness at incision site*Chec: nape for
wet /lood* 6*$aryn'eal spasm , +OB; SOB , trache set ready at /edside*
#6
#*( &4P),&4R)IDISM , decrease secretion of "3; "6 , can lead to @. ) Atherosclerosis
Adult , my4edema
Child cretinism , only endocrine dis lead to mental retardation
Predisposin' factorA
1* W.atro'enic causes , caused /y sur'ery
#* Atrophy of "5 due toA
a* .rradiation
/* "rauma
c* "umor; inflammation
3* .odine def
6* Autoimmune , 2ashimoto disease
S&S4 everythin' decreased e4cept wt 'ain & mens increase(
3arly si'ns , wea:ness and fati'ue
$oss of appetite , increased lypolysis , /rea:down of fats causin' atherosclerosis 1 @.
8t 'ain
Cold intolerance , my4edema coma
Constipation
$ate S4 , /rittle hair) nails
Non pittin' edema due increase accumulation of mucopolysacharide in SQ tissue @y4edema
2orseness voice
+ecrease li/ido
+ecrease 0S , hypotension /radycardia; /radypnea; and hypothermia
$ethar'y
@emory impairment leadin' to psychosisfor'etfulness
@enorrha'ia
+4A
1* Serum "3 "6 decrease
#* Serum cholesterol increase , can lead to @.
3* -A .B , radio iodine upta:e , decrease
Ns' @'tA
1* @onitor strictly 0)S* .&O , to determine presence of my4edema coma9
My(e#ema Coma Severe form of hypothyroidism
2ypotension; hypoventilation; /radycardia; /radypnea; hyponatremia; hypo'lycemia; hypothermia
@i'ht lead to pro'ressive stupor & coma
.mpt m't for @y4edema coma
1* Assist mech vent , priority a)w
#* Adm thyroid hormone
3* Adm .0F replacement , force fluid
@'t my4edema coma
1* @onitor 0S; .&O
#* Provide dietary inta:e low in calories , due to wt 'ain
3* S:in care due to dry s:in
6* Comforta/le & warm environment due to cold intolerance
%* Administer .0F replacements
<* Force fluid
=* Administer meds , ta:e A@ , S3 insomia* @onitor 2-*
"hyroid hormones
$evothyro4ine&Synthroid(; $iothyronine &cytomel(
"hyroid e4tracts
!* 2ealth teachin' & dischar'e plan
a* Avoidance precipitatin' factors leadin' to my4edema comaA
1* 34posure to cold environment
#%
#* Stress 3* .nfection
6* Bse of sedative; narcotics; anesthetics not allowed , CNS depressants 0)S already down
ComplicationsA
E* 2ypovolemic shoc:; my4edema coma
1F* 2ormonal replacement therapy lifetime
11* .mportance of follow up care
&4PER,&4R)IDISM 5raves dse or thyroto4icosis & everythin' up e4cept wt and mens(
.ncreased "3 & "6
Predisposin' factorsA
1* Autoimmune disease , release of lon' actin' thyroid stimulator &$A"S(
34opthalmos
3nopthalmos , severe dehydration depressed eye
#* 34cessive iodine inta:e
3* 2yperplasia of "5
S&S4A
1* .ncrease in appetite , hyperpha'ia , wt loss due to increase meta/olism
#* S:in is moist perspiration
3* 2eat intolerance
6* +iarrhea , increase motility
%* All 0S increase 1 2PN; tachycardia; tachypnea; hyperthermia
<* CNS chan'es
@8 .rrita/ility & a'itation; restlessness; tremors; insomnia; hallucinations
=* 5oiter
!* 34opthalmos , patho'nomonic s4
E* Amenorrhea
+4A
1* Serum "3 & "6 increased
#* -adio iodine upta:e , increase
3* "hyroid scan , reveals enlar'ed "5
Ns' @'tA
1* @onitor 0S & . & O , determine presence of thyroid storm or most feared complicationA "hyroto4icosis
#* Administer meds
a* Antithyroid a'ents
1* Prophylthiuracil &P"B(
#* @ethymaDole &"apaDole(
@ost to4ic s)e a'ranulocytosis fever; sore throat; leu:ocytosis1inc w/cA chec: c/c and throat swa/ culture
@ost feared complication A "hrom/osis , stro:e C0S
3* +iet , increase calorie , to correct wt loss
6* S:in care ,
%* Comfy & cool environment
<* @aintain siderails due a'itation)restlessness
=* Provide /ilateral eye patch , to prevent dryin' of eyes e4opthalmos
!* Assist in sur'ery , su/total thyroidectomy
Ns' @'tA preop
Adm $u'ol?s solution &SSI.( I iodide
A8 "o decrease vascularity of "5
:B8 "o prevent /leedin' & hemorrha'e
@'t post opA
ComplicationA 1* 8atch out for si'ns of thyroid storm or thyroto4icosis
,ria# si-ns of t0yroi#stormU
a* "achycardia )palpitation
#<
/* 2yperthermia
c* A'itation
Ns' @'t "hyroid StormA
1* @onitor 0S & neuro chec:
A'itated mi'ht decrease $OC
#* Antipyretic , fever
"achycardia /loc:ers &lol(
3* Siderails , a'itated
Comp #* 8atch for inadvertent &accidental( removal of parathyroid 'land
Secretes Para hormone
.f removed; hypocalcemia classic si'n tetany , 1* *&L( "rousseau si'n) #* Chvostec:?s si'n
Ns' @'tA
Adm calcium 'luconate slowly , to prevent arrhythmia
Ca 'luconate to4icity , antidote , @'SO6
3* $aryn'eal &voice /o4( nerve dama'e &accidental(
S4A hoarseness of voice
7773ncoura'e pt to tal: or spea: post operatively asap to determine laryn'eal nerve dama'e
Notify physician9
6* Si'ns of /leedin' post su/total thyroidectomy
NFeelin' of fullnessO at incision site
Ns' m'tA
Chec: soiled dressin' at nape area
%* Si'ns of laryn'eal spasm
a* +OB
/* SOB
Prepare at /edside tracheostomy
<* 2ormonal replacement therapy lifetime
=* .mportance of follow up care
&$iver cirrhosis , /edside scissor , if pt complaints of +OB(
&Cut cystachean tu/e to deflate /alloon(
Parat0yroi# -"an# , pair of small nodules located /ehind the "5
::8 Secrets parathyroid hormone , promotes Ca rea/sorption
"hyrocalcitonin , anta'onises secretion of parathyroid hormone
1* 2ypoparthroidism , decrease of parathyroid hormone
#* 2yperparathroidsm
&4P)PARA,&4R)IDISM , decreased parathormone
2ypocalcemia 2yperphosphatemia
&Or tetany(
X.f Ca decreases; phosphate increasesY
A* Predisposin'; factorsA
1* Followin' su/total thyroidectomy
#=
#* Atrophy of parathyroid 'land due to
a* .rradiation
/* "rauma
S&S4A
1* Acute tetany
a* "in'lin' sensation
/* Paresthesia
c* +yspha'ia
d* $aryn'ospasm
e* Bronchospasm
Patho'nomonic Si'n of tetanyA
a* &L( "rousseau?s or carpopedial spasm
/* &L( Chvostec:?s si'n
f* SeiDure most feared complication
'* Arrhythmia
#* Chronic tetany
a* $oss of tooth enamel
/* Photopho/ia & cataract formation
c* 5." chan'es , anore4ia; n)v; 'eneral /ody malaise
d* CNS chan'es , memory impairment; irrita/ility
+4A
1* Serum calcium , decrease &N !*% , 11 m')1FFml(
#* Serum phosphate increase &N #*% , 6*% m')1FFml(
3* Kray of lon' /one , decrease /one density
6* C" Scan , reveals de'eneration of /asal 'an'lia
Ns' @'tA
1* Administration of medsA
a*( Acute tetany ,
Ca 'luconate , .0; slowly
/*( Chronic tetany
1* Oral Ca supplements
34* Ca 'luconate
Ca car/onate
Ca lactate
0it + &Cholecalceferol(
+ru' diet sunli'ht
Cholecalceferol calcidiol calcitriol =am , Eam
#* Phosphate /inder
Alumminum +2 'el &ampho 'el(
S3 constipation
Antacid
AAC @A+
Aluminum containin' acids @' containin' antacids
34* @il: or ma'nesia
Aluminum O2 'el +iarrhea
Constipation @aalo4 , ma'nesium & aluminum $ess s)e
#* Avoid precipitatin' stimulus such as /ri'ht li'hts & noiseA photopho/ia leadin' to seiDure
3* +iet , increase Ca & decrease phosphorus
#!
+on?t 'ive mil: , due to increase phosphorus
5ood 1 anchovies , increase Ca; decrease phosphorus L inc uric acid* "una & 'reen turnips .nc Ca*
6* Bedside , tracheostomy set ,due to laryn'ospasm
%* 3ncoura'e to /reath with paper /a' in order to produce mild respiratory acidosis , to promote increase ioniDed Ca levels
<* @ost feared complication A SeiDure & arrhythmia
=* 2ormonal replacement therapy lifetime
!* .mportant fallow up care
&4PERPARA,&4R)IDISM increase parathormone* ComplicationA -enal failure
2ypercalcemia can lead to 2ypophosphatemia
Bone dse :idney stones
@ineraliDation
$eadin' to /one fracture
Ca , EEG /ones
1G serum /lood
Predisposin' FactorsA
1* 2yperplasia parathyroid 'land &P"5(
#* Over compensation of P"5 due to 0it + deficiency
Children , -ic:ets 0it +
Adults , Osteomalacia deficiency
Sippy?s diet , 0it + diet , not 'ood for pt with ulcer
# 6 cups of mil: & /utter
Iarrel?s diet , 0it + diet , not 'ood for pt with ulcer
< cups of mil: & whole cream
Food rich in C2ON , e''no' , com/ination of e'' & mil:
S)S4A
Bone fracture
1* Bone pain &especially at /ac:(; /one fracture
#* Iidney stone ,
a* -enal colic
/* Cool moist s:in
3* 5." chan'es , anore4ia; n)v; ulcerations
6* CNS involvement, irrita/ility; memory impairment
+4 ProcA
1* Serum Ca increase
#* Serum phosphorus decreases
3* Kray lon' /ones , reveals /one demineraliDation
Ns' @'tA 1i#ney Stone
1* Force fluids , #;FFF , 3;FFF)day or #3$)day
#* .sotonic solution
3* 8arm sitD /ath , for comfort
6* Strain all urine with 'auDe pad
%* Acid ash diet , cran/erry; plum; 'rapefruit; vit C; calamansi , to acidify urine
<* Adm meds
a* Narcotic anal'esic , @orphine SO6; +emerol &@eperidine 2cl(
S)3 , resp depression* @onitor --(
Narcan) Nalo4one , antidote
#E
Nalo4one to4icity , tremors
=* Siderails
!* Assist in am/ulation
E* +iet , low in Ca; increase phosphorus lean meat
1F* Prevent complication
@ost feared , renal failure
11* Assist sur'ical procedure , parathyroidectomy
1#* .mpt ff up care
13* 2ormonal replacement lifetime
A+-3NA$ 5$AN+
:*8 Atop of Z :idney
:;8 # parts
Adrenal corte4 , outermost layer
Adrenal medulla innermost layer
:.8 Secrets cathecolamines
a*( 3pinephrine ) Norephinephrine , potent vasoconstrictor , adrenaline1.ncrease BP
Adrenal @edulla?s only diseaseA
P&E)C&R)M)C4,)MA9 presence of tumor at adrenal medulla
increase nor)epinephrine* 2PN with poundin' headache*
with 2PN and resistant to dru's
dru' of choiceA /eta /loc:ers
complicationA 2PN crisis 1 lead to stro:e
no valsalva maneuver* Son?t smo:e* No caffeine*
Adrenal Corte4 ,
1* Pona fasiculata , secrets 'lucocorticoids* 34* Cortisol Controls 'lucose meta/olism &SB5A-(
#* Pona reticularis , secrets traces of 'lucocorticoids & andro'enic hormones
@ , testosterone
F , estro'en & pro'esterone
F4 , promotes development of secondary se4ual characteristics
3* Pona 'lomerulosa secretes mineralcortisone* 34* Aldosterone F4A promotes Na & 2#O rea/sorption & e4cretion of
potassium &SA$"(
ADDIS)N'S DISEASE , Steroidslifetime
+ecreased adrenocortical hormones leadin' toA
a*( @eta/olic distur/ances &su'ar(
/*( F&3 im/alances Na; 2#O; I
c*( +eficiency of neuromuscular function &salt & se4(
Predisposin' FactorsA
1* Atrophy of adrenal 'land
#* Fun'al infections
3* "u/ercular infections
S)S4A
:8 Decrease su-ar , 2ypo'lycemia , +ecreased 'lucocorticoids cortisol
" , tremors; tachycardia
. irrita/ility
- restlessness
3 , e4treme fati'ue
+ , diaphoresis; depression
*8 Decrease !"asma cortiso"
+ecrease tolerance to stress , lead to Addisonian?s crisis
3F
;8 Decrease sa"t , 2yponatermia , +ecreased mineralocorticoids Aldosterone
2ypovolemia
a*( 2ypotension
/*( Si'ns of dehydration , e4treme thirst; a'itation
c*( 8t loss
.8 2yper:alemia
a*( .rrita/ility
/*( +iarrhea
c*( Arrhythmia
<8 +ecrease se4ual ur'e or li/ido +ecreased Andro'en
=8 $oss of pu/ic and a4illary hair
"o Prevent S"+ Loca" , practice mono'amous relationship
CG6NSCNCLED , condom
?8 Patho'nomonic si'n, /ronDe li:e s:in pi'mentation due to decrease cortisol will stimulate pituitary 'land to release
melanocyte stimulatin' hormone*
+4 ProcA
1* FBS , decrease FBS &N !F , 1#F m')d$(
#* Plasma cortisol , decreased
Serum Na , decreased &N 13% , 16% me')$(
3* Serum I , increased &N 3*% , %*% me')$(
Ns' @'tA
1* @onitor 0S; .&O , to determine presence of Addisonian crisis
:<8 Complication of Addison?s dse A Addisonian crisis
:=8 -esults the acute e4acer/ation of Addison?s dse characteriDed /y A
2ypotension; hypovolemia; hyponatremia; wt loss; arrhythmia
:?8 $ead to pro'ressive stupor & coma
Ns' @'t A##isonian Crisis &Coma(
1* Assist in mechanical ventilation
#* Adm steroids
3* Force fluids
#* Administer meds
a*( Corticosteroids &+ecadron( or +e4amethaDone
2ydrocortisone &cortisone( Prednisone
Ns' @'t with Steroi#s
1* Adm #)3 dose in A@ & 1)3 dose in P@ in order to mimic the normal diurnal rhythm*
#* "aper the dose &w)draw; 'radually from dru'( , sudden withdrawal can lead to addisonian crisis
3* @onitor S)3 &Cushin'?s syndrome S)S4(
a*( 2PN
/*( 2irsutism
c*( 3dema
d*( @oon face & /uffalo hump
e*( .ncrease suscepti/ility to infection sue to steroids reverse isolation
/*( @ineralocorticoids e4* Flourocortisone
3* +iet , increase calorie or C2O
.ncrease Na; .ncrease C2ON; +ecrease I
6* Force fluid
%* Administer isotonic fluid as ordered
<* @eticulous s:in care , due to /ronDe li:e
=* 2" & dischar'e plannin'
a( Avoid precipitatin' factors leadin' to A##isonian crisis
31
1* Sudden withdrawal crisis
#* Stress
3* .nfection
/( Prevent complications
Addisonian crisis & 2ypovolemic shoc:
!* 2ormonal replacement therapy , lifetime
E* .mportantA follow up care
CUS&ING'S S4NDR)ME , increase secretion of adrenocortical hormone
Predisposin' FactorsA
1* 2yperplasia of adrenal 'land
#* "u/ercular infection , milliary "B
S)S4
1* .ncrease su'ar , 2yper'lycemia
3 P?s
1* Polyuria
#* Polydipsia , increase thirst
3* Polypha'ia , increase appetite
Classic S4 of +@ , 3 P?s & 'lycosuria L wt loss
#* .ncrease suscepti/ility to infection , due to increased corticosteroid
3* 2ypernatrermia
a* 2PN
/* 3dema
c* 8t 'ain
d* @oon face
Buffalo hump
O/ese trun: classic si'ns
Pendulous a/domen
"hin e4tremities
6* 2ypo:alemia
a* 8ea:ness & fati'ue
/* Constipation
c* 3C5 , &L( NBO wave
%* 2irsutism , increase se4
<* Acne & striae
=* .ncrease muscularity of female
+4A
1* FBS , increase[ &NA !F1#Fm')d$(
#* Plasma cortisol increase
3* Na , increase &13%16% meC)$(
6* I decrease &3*%%*% meC)$(
Ns' @'tA
:8 @onitor 0S; .&O
*8 Administer meds
a* I sparin' diuretics &Aldactone( Spironolactone
promotes e4cretion of NA while conservin' potassium
Not lasi4 due to S)3 hypoI & 2yper'lycemia9
;8 -estrict Na
.8 Provide +ietary inta:e , low in C2O; low in Na & fats
2i'h in C2ON & I
<8 8ei'h pt daily & assess presence of edema measure a/dominal 'irth notify doc*
=8 -everse isolation
?8 S:in care , due acne & striae
@8 Prevent complication
@ost feared , arrhythmia & +@
&3ndocrine disorder lead to @. , 2ypothyroidism & +@(
3#
A8 Sur'ical /ilateral Adrenolectomy
:B8 2ormonal replacement therapy , lifetime due to adrenal 'land removal no more corticosteroid9
PANC-3AS , /ehind the stomach; mi4ed 'land , /oth endocrine and e4ocrine 'land
Acinar cells &e4ocrine 'land( .slets of $an'erhans &endocrine 'land ductless(
Secrete pancreatic Huices at pancreatic ducts* cells
Aids in di'estion &in stomach( secrets 'luca'on
F4nA hyper'lycemia &hi'h 'lucose(
Cells
Secrets insulin
F4nA hypo'lycemia
+elta Cells
Secrets somatostatin
F4nA anta'oniDes 'rowth hormone
3 disorders of the Pancreas
1* +@
#* Pancreatic Cancer
3* Pancreatitis
Overview onlyA
PANCREA,I,IS (chec: pa'e =#(, acute inflammation of pancreas leadin' to pancreatic edema; hemorrha'e & necrosis due to
Autodi'estion , selfdi'estion
CauseA un:nown)idiopathic
:@8 Or alcoholism
Patho'nomonic si'n &L( Cullen?s si'n 3cchymosis of um/ilicus &/luish color( pasa
&L( 5rey turner?s si'n , ecchymosis of flan: area
Both s4 means hemorrha'e
C&R)NIC &EM)RR&AGIC PANCREA,I,IS N/an'u'otO
Predisposin' factors un:nown
-is: factorA
1* 2istory of hepato/iliary disorder
#* Alcohol
3* +ru's , thiaDide diuretics; oral contraceptives; aspirin; penthan
6* O/esity
%* 2yperlipidemia
<* 2yperthyroidism
=* 2i'h inta:e of fatty food , saturated fats
33
DIA/E,ES MELLI,US meta/olic disorder characteriDed /y non utiliDation of C2O; C2ON;& fat meta/olism
ClassificationA
.* ,y!e I DM (IDDM( , NTuvenile N onset; common in children; nono/ese N/rittle dseO
.nsulin dependent dia/etes mellitus
.ncidence rate
1*( 1FG of population with +@ have "ype .
Predisposin' FactorA
1* EFG hereditary , total destruction of pancreatic dells
#* 0irus
3* "o4icity to car/on tetrachloride
6* +ru's , Steroids /oth cause hyper'lycemia
$asi4 loop diuretics
S)S4A
3 P?S L 5
1*( Polyuria
#*( Poydipsia
3*( Polypha'ia
6*( 5lycosuria
%*( 8ei'ht loss
<*( Anore4ia
=*( N)0
!*( Blurrin' of vision
E*( .ncrease suscepti/ility to infection
1F*( +elayed) poor wound healin'
@'tA
1* .nsulin "herapy
+iet
34ercise
Complications , +ia/etic Ietoacidosis &+IA(
+ia/etic Ietoacidosis &+IA( , due to increase fat cata/olism or /rea:down of fats
+IA ,&L( fruity or acetone /reath odor
Iassmaul?s respiration , rapid; shallow /reathin'
+ia/etic coma &needs o4y'en(
II8 ,y!e II DM 2 (NIDDM$
Adult) maturity onset type , a'e 6F & a/ove; o/ese
.ncidence -ate
1* EFG of pop with +@ have "ype ..
@id 1E!F?s mar:ed increase in type .. /ecause of increase proliferation of fast food chains9
Predisposin' FactorA
1* O/esity , o/ese people lac: insulin receptors /indin' site
#* 2ereditary
S)S4A
1* Asymptomatic
#* 3 P?s and 15
"4A
1* Oral 2ypo'lycemic A'ents &O2A(
#* +iet
3* 34ercise
36
ComplicationA 2ONIC
2 , hyper
O , osmolar
N , non
I , :etotic
C , coma
III8 GES,A,I)NAL DM , occurs durin' pre'nancy & terminates upon delivery of child
Predisposin' FactorsA
1* Bn:nown) idiopathic
#* .nfluence of maternal hormones
S)S4 A
Same as type .. ,
1* Asymptomatic
#* 3 P?s & 15
"ype of delivery , CS , due to lar'e /a/y
S4 of hypo'lycemia on infant
1* 2i'h pitched shrill cry
#* Poor suc:in' refle4
I58 DM ASS)CIA,ED >I,& ),&ER DIS)RDER
a*( Pancreatic tumor
/*( Cancer
c*( Cushin'?s syndrome
3 @A.N FOO+ 5-OBPS
Ana/olism Cata/olism
1* C2ON 'lucose 'lyco'en
#* C2ON amino acids nitro'en
3* Fats fatty acids free fatty acids &FFA( , Cholesterol & Ietones
Pancreas \ 'lucose \ A"P &@ain fuel)ener'y of cell (
-eserve 'lucose , 'lyco'en
$iver will under'o , 'luco'enesis , synthesis of 'luca'ons
& 5lyco'enolysis , /rea:down of 'luca'ons
& 5luconeo'enesis , formation of 'lucose form C2O sources , C2ON & fats
2yper'lycemia , pancreas will not release insulin* 5lucose can?t 'o to cell; stays at circulation causin' hyper'lycemia*
increase osmotic diuresis , 'lycosuria
$ead to cellular starvation
$ead to wt loss stimulates the appetite) satiety center polyuria
&2ypothalamus(
Cellular dehydration
Polypha'ia
Stimulates thirst center &hypothalamus(
Polydipsia
.ncreased C2ON cata/olism
$ead to &( nitro'en /alance
"issue wastin' &cache4ia(
3%
.ncrease fat cata/olism
Free fatty acids
Cholesterol :etones +IA
Atherosclerosis coma
2PN death
@. stro:e
DIA/E,IC 1E,)ACID)SIS (D1A$
Acute complication of "ype . +@ due to severe hyper'lycemia leadin' to CNS depression & Coma*
Ietones a CNS depressant
Predisposin' factorA
1* Stress , /etween stress and infection; stress causes +IA more*
#* 2yper'lycemia
3* .nfection
S)S4A 3 P?s & 15
1* Polyuria
#* Polydipsia
3* Polypha'ia
6* 5lycosuria
%* 8t loss
<* Anore4ia; N)0
=* &L( Acetone /reath odor fruity odor patho'nomonic +IA
!* Iussmaul]s resprapid shallow respiration
E* CNS depression
1F* Coma
+4 ProcA
1* FBS increase; 2ct , increase &compensate due to dehydration(
N 1BBN , 1F #F m')1FFml increased due to severe dehydration
Crea *! , 1 m')1FFml

2ct 6#G &should /e 34 hi'h(nto h'/
Ns' @'tA
1* Can lead to coma , assist mechanical ventilation
#* Administer *ENaCl , isotonic solution
Followed /y *6%NaCl hypotonic solution
"o counteract dehydration*
3* @onitor 0S; .&O; /lood su'ar levels
6* Administer meds as orderedA
a*( .nsulin therapy , .0 push
-e'ular Actin' .nsulin , clear &#6hrs; pea: action(
/*( "o counteract acidosis , Na &C);
c*( Anti/iotic to prevent infection
.nsulin "herapy
A* SourcesA
1* Animal source , /eef) por:rarely used* Causes severe aller'ic reaction*
#* 2uman , has less anti'enecity property
3<
Cause less aller'ic reaction* 2umulin
.f :id is aller'ic to chic:en , don?t 'ive measles vaccine due it comes from chic:en em/ryo*
3* Artificially compound
B* "ypes of .nsulin
1* -apid Actin' .nsulin 34* -e'ular actin' .
#* .ntermediate actin' . 34* NP2 &nonprotamine 2a'edorn .(
3* $on' actin' . 34* Bltra lente
,y!es of Insu"in co"or consistency onset !ea+ #uration
1* -apid clear #6h
#* .ntermediate cloudy <1#h
3* $on' actin' cloudy 1##6h
34* %am 2emo'lucose test &25"(
#%F m')dl
Adm % units of -A .
Pea: =Eam , monitor hypo'lycemic reaction at this time ".-3+
Ns' @'tA upon inHection of insulinA
1*Administer insulin at room temp9 , "o prevent lipodystrophy 1 atrophy) hypertrophy of SQ tissues
#* .nsulin is only refri'erated once opened9
3* 5ently roll vial /et palms* Avoid sha:in' to prevent formation of /u//les*
6* Bse 'au'e #% , #<needle , tu/erculin syrin'e
%* Administer insulin at either 6%&for s:inny pt( or EF &ta/a pt(dependin' on the client tissue deposit*
<* +on?t aspirate after inHection
=* -otate inHection site to prevent lipodystrophy
!* @ost accessi/le site , a/domen
E* 8hen mi4in' # types of insulin; aspirate
1
st
re'ular) clear , /efore cloudy to prevent contaminatin' clear insulin & to promote accurate cali/ration*
1F* @onitor si'ns of complicationsA
a* Aller'ic reactions , lipodystrophy
/* Somo'yi?s phenomenon , hypo'lycemia followed /y periods of hyper'lycemia or re/ound effect of insulin*
11* 1ml or cc of tu/erculin 1 1FF units of insulin
1 cc 1 1FF units

*%cc 1 %F units
*1 cc 1 1F units

< units -A
@ost Feared Complication of "ype .. +@
2yper [ osmolarity 1 severe dehydration
Osmolar
Non a/sence of lipolysis
Ietotic no :etone formation
Coma , S)S4A headache; restlessness; seiDure; decrease $OC 1 coma
Ns' @'tU same as +IA e4cept don?t 'ive Na2CO39
3=
1*Can lead to coma , assist mechanical ventilation
#* Administer *ENaCl , isotonic solution
Followed /y *6%NaCl hypotonic solution
"o counteract dehydration*
3*@onitor 0S; .&O; /lood su'ar levels
6*Administer meds
a*( .nsulin therapy , .0
/*( Anti/iotic to prevent infection
"4A
O ral
2 ypo'lycemic
A 'ents
:A8 Stimulates pancreas to secrete insulin
Classifications of O2A
1* First 'eneration Sulfonylurear
a* Chlorpropamide &dia/enase(
/* "ol/utamide &orinase(
c* "olaDamide &tolinase(
#* #
nd
'eneration sulfonylurear
a* +ia/eta &@icronase(
/* 5lipside &5lucotrol(
Ns' @'t or O2A
1* Administer with meals , to lessen 5." irritation & prevent hypo'lycemia
#* Avoid alcohol &alcohol L O2A 1 severe hypo'lycemic reaction1CNS depression1coma( Anta/use+isufram
+4 for +@
1* FBS , N !F , 1#F m')dl 1 .ncreased for 3 consecutive times 1confirms +@99
L 3 P?s & 15
#* Oral 'lucose tolerance &O5""( @ost sensitive test
3* -andom /lood su'ar , increased
6* Alpha 5lucosylated 2'/ , elevated
Ns' @'tU
1* @onitor for P3AI action of O2A & insulin
Notify +oc
#* @onitor 0S; .&O; neurochec:; /lood su'ar levels*
3* Administer insulin & O2A therapy as ordered*
6* @onitor si'ns of hyper & hypo'lycemia*
Pt +@ ,N hinimatayO
*B8 Jou don?t :now if hypo or hyper'lycemia*
5ive simple su'ar
&Brain can tolerate hi'h su'ar; /ut /rain can?t tolerate low su'ar9(
Cold; clammy s:in , hypo , Oran'e Tuice or simple su'ar ) warm to touch , hyper , adm insulin
%* Provide nutritional inta:e of #iabetic #ietA
C2O , %FG
C2ON , 3FG
Fats , #FG
Or offer alternative food products or /evera'e*
5lass of oran'e Huice*
<* 34ercise , after meals when /lood 'lucose is risin'*
=* @onitor complications of +@
a* Atherosclerosis , 2PN; @.; C0A
/* @icroan'iopathy , small /lood vessels
3yes , dia/etic retinopathy ; premature cataract & /lindness
3!
Iidneys , recurrent pyelonephritis & -enal Failure
&# common causes of -enal Failure A +@ & 2PN(
c* 5an'rene formation
d* Peripheral neuropathy
1* +iarrhea) constipation
#* Se4ual impotence
e* Shoc: due to cellular dehydration
!* Foot care m't
a* Avoid wa:in' /arefooted
/* Cut toe nails strai'ht
c* Apply lanolin lotion , prevent s:in /rea:down
d* Avoid wearin' constrictive 'arments
E* Annual eye & :idney e4am
1F* @onitor urinalysis for presence of :etones
Blood or serum , more accurate
11* Assist in sur'ical wound de/ridement
1#* @onitor si'ns or +IA & 2ONIC
13* Assist sur'ical procedure
BIA or a/ove :nee amputation
)vervie7: 23@A"O$O5.CA$ SJS"3@S
. Blood
%%G Plasma; 6%G cellular) formed elements
.. Blood vessels
... Blood formin' or'ans
1* "hymus , removed myasthenia 'ravis
#* $iver , lar'est 'land
3* $ymph nodes
6* $ymphoid or'ans , payers patch
%* Bone marrow
<* Spleen , destroys -BC
Blood vessels
1* 0eins ,S0C; .0C; Tu'ular vein , /lood towards the heart
#* Artery , carries /lood away from the
*:8 Aorta; carotid
3* Capillaries
Blood 6%G formed elements , %%G plasma , fluid portion of vlood* Jellow color*
Serum Plasma C2ON?s &Produced in $iver(
1* Al/umin lar'est; most a/undant plasma
@aintains osmotic pressure preventin' edema
FKNA promotes s:in inte'rity
#* 5lo/ulins , alpha , transports steroids 2ormones & /iliru/in
"ransports iron & copper
5amma , transport immuno'lo/ulins or anti/odies &Acute or Chronic(
3* Prothrom/in and Fi/rino'en , clottin' factor to prevent /leedin'
Cellular 3lementsA
1* -BC &erythrocytes( Spleen life span 1 1#F days
&N( 3 , < @)mm3
Anucleated
Biconcave discs
2as molecules of 2'/ &red cell pi'ment(
"ransports & carries O#
3E
SIC1LE CELL ANEMIA ,sic:le shaped -BC* Should /e round* .mpaired circulation of -BC*
immature cells1hemolysis of -BC1decreased h'/
3 Ns' priority
1* A.-8AJ &priority( , avoid deo4y'enatin' activities
2i'h altitude is /ad
#* Fluid deficit , promote hydration
3* Pain & comfort
2'/ & hemo'lo/in( red cell pi'ment which transport O#
F1 1# , 16 'ms G
@ 1 161< 'ms G
2ct , 34 h'/ 1# 4 3 1 3<
&hamatocrit( F 3< , .*E 16 4 3 1 6# 72ematocrit is the red cell pi'ment in whole /lood
@ .* , 6!G 73rythropoietin stimulate /one marrow to produce -BC
Avera'e 6#G
-ed cell percenta'e in whole red
Su/stances needed for maturation of -BC
a*( Folic acid
/*( .ron
c*( 0it C
d*( 0it B1# &cyanoco/alamin(
e*( 0it B< &Pyrido4ine(
f*( .ntrinsic factor
Pre'nantA 1
st
trimester Folic acid , prevent neural tu/e deficit
3
rd
tri , iron
$ife span of r/c , !F , 1#F days* +estroyed at spleen*
8BC , leu:ocytes %;FFF , 1F;FFF)mm3
5-ANB$OCJ"3S
1* Po"ymor!0onuc"earneutro!0i"s
@ost a/undant <F=FG 8BC
f4 , short term pha'ocytosis
For acute inflammation
#* PM /aso!0i"s
.nvolved in Parasitic infection
-elease of chemical mediators for inflammation
Serotonin; histamine; prosta'landin; /rady:inins
3* PM Eosino!0i"s
Aller'ic reactions
NON5-ANB$OCJ"3S
1* Monocytes &macropha'e( lar'est 8BC
involved in lon' term pha'ocytes
For chronic inflammation
Other name macropha'e
@acropha'e in CNS micro'lia
@acropha'e in s:in , 2istiocytes
@acropha'e in lun's , alveolar macropha'e
@acropha'e in Iidneys , Iupffer cells
#* Lym!0ocytes
B Cell , $ , /one marrow or /ursa dependent immunity
" cell , dev?t of immunity tar'et site for 2.0
NI cell , natural :iller cell
2ave /oth antiviral & antitumor properties
3*P"ate"ets &throm/ocytes(
N 1%F;FFF , 6%F; FFF) mm3
it promotes hemostasis , prevention of /lood loss /y activatin'
clottin'
Consists of immature or /a/y platelets :nown as me'a:aryocytes
, tar'et of virus , den'ue
Normal lifespan E , 1# days
6F
+ru' of choice for 2.0 Pidovudine &AP"( or -itonavir or -etrovir
Standard precaution for 2.0 'loves; 'own; 'o''les & mas:
@alaria , ni'ht /itin' mosCuito
+en'ue , day /itin' mosCuito
Si'ns of platelet dys functionA
a*( Petechiae 2emophilia
/*( 3cchymoses) /ruises +.C
c*( OoDin' or /lood ON venipuncture site
ANEMIA
.ron deficiency Anemia , chronic normocytic; hypochromic &pale(; microcytic anemia due to inadeCuate a/sorption of iron leadin' to
hypo4emic tissue inHury*
.ncidence rateA
1* Common , developed country , due to hi'h cereal inta:e
"hird leadin' cause of death in the BS due to accidents
#* Common , tropical countries , /lood suc:in' parasites
3* 8omen , 1% , 3%yo , reproductive yrs
6* Common amon' the poor , poor nutritional inta:e
"2.N5S "O -3@3@B3-A
Suicide common in teena'ers
Poisonin' , common in children &aspirin(
Aspiration , common in infant
Accidents , common in adults
Cho:in' , common in toddler
S.+S , common in infant in BS
**8 Common in tropical Done , Phil due /lood suc:s
Predisposin' factorsA
1* Chronic /lood loss
a* "rauma
/* @ens
c* 5." /leedin'A
i* 2ematemesis
ii* @elena , upper 5." , duodenal cancer
iii* 2ematocheDia , lower 5." , lar'e intestine , fresh /lood from rectum
#* .nadeCuate inta:e of food rich in iron
A* 3''s
B* Or'an meats; e''s; oatmeals; dried fruits; le'umes; raisins
3* .nadeCuate a/sorption of iron , due to A
a* Chronic diarrhea
/* @ala/sorption syndrome ,celiac disease'luten free diet* Food for celiac pts sardines
c* 2i'h cereal inta:e with low animal C2ON in'estion
d* Su/total 'astrectomy partial removal of the stomach
6* .mproper coo:in' of food
S)S4A
1* Bsually asymptomatic
#* 8ea:ness and Fati'ue
3* 2eadache; diDDiness; dyspnea; palpitations; cold sensitivity; 'en /ody malaise; pallor
6* Brittle hair; spoon shaped nails &IO.$ONJC2.A(1+ec O#1hypo4ia1atrophy of epidermal cells
%* Atropic 'lossitis; dyspha'ia; stomatitis
<* Pica , a/normal cravin' for non edi/le food &caused /y hypo4ia1dec tissue perfusion1psychotic /ehavior(
61
Brittle hair; spoon shaped nail , atrophy of epidermal cells
N 1 capillary refill time M # secs
N 1 shape nails , /iconcave shape; 1!F
Atrophy of cells NPlummer 0insons SyndromeO due to cere/ral hypo4ia
1* Atropic 'lossiti s, inflammation of ton'ue due to atrophy of pharyn'eal and ton'ue cells
#* Stomatitis , mouth sores
3* +yspha'ia
+4 ProcA
1* -BC
#* 2'/
3* -eticulocyte
6* 2ct
%* .ron
<* Ferritin
Ns' @'t
1* @onitor si'ns of /leedin' of all hema test includin' urine & stool; 5."
#* Complete /ed rest , don?t overtire pt 1wea:ness and fati'ue1activity intolerance
3* 3ncoura'e , iron rich food
*;8 -aisins; le'umes; e'' yol:
6* .nstruct the pt to avoid ta:in' tea impairs iron a/sorption
%* Administer meds
a*( Oral iron preparation
Ferrous SO6
Fe 'luconate
Fe Fumarate
Ns' @'t oral iron medsA
1* Administer with meals , to lessen 5." irritation
#* .f dilutin' in iron liCuid prep ,adm with straw
Straw
1* $u'ol?s
#* "etracycline
3* Oral iron
6* @acrodantine
3* 5ive Oran'e Huice , for iron a/sorption
6* @onitor & inform pts S)3
a* Anore4ia
/* n)v
c* A/dominal pain
d* +iarrhea or constipation
e* @elena
.f pt can?t tolerate oral iron prep , administer parenteral iron prep e4ampleA
1* .ron de4tran &.0; .@(
#* Sor/ite4 &.@(
Ns' @'t parenteral iron prep
1* Administer of use P tract method to prevent discomfort; discoloration lea:a'e to tissues*
#* +on?t massa'e inHection site* Am/ulate to facilitate a/sorption*
3* @onitor S)3A
a*( Pain at inHury site
/*( $ocaliDed a/scess &NnanaO) pus formation(
c*( $ymphadenopathy
d*( Fever) chills
e*( Brticaria , itchiness
f*( 2ypotension , anaphylactic shoc:
6#
Anaphylactic shoc: , 'ive epinephrine
PERNICI)US ANEMIA me'alo/lastic; chronic anemia due to deficiency of intrinsic factor leadin' to
2ypochlorhydria , decrease 2cl acid secretion* $ifetime B1# inHections* 8ith CNS involvement*
Predisposin' factor
1* Su/total 'astrectomy ,partial removal stomach
#* 2ereditary
3* .nflammatory dse of ileum
6* Autoimmune
%* Strict ve'eta/le diet
S,)MAC&
Parietal or ar'entaffin O4yntic cells
F4n , produce intrinsic factor F4n , secrets 2cl acid
For rea/sorption of B1# F4 aids in di'estion
For maturation of -BC
<* +iet hi'h caloric or C2O to correct wt loss
S)S4A
1* 2eadache diDDiness; dyspnea; palpitations; cold sensitivity; 'en /ody malaise; pallor
#* 5." chan'es
a* -ed , /eefy ton'ue , PA"2O5NO@ON.C , mouth sores
/* +yspepsia , indi'estion
c* 8t loss
d* Taundice
3* CNS ,
@ost dan'erous anemiaA pernicious due to neuro'lo'ic involvement*
a* "in'lin' sensation
/* Paresthesia
c* &L( -om/er'?s test &Ata4ia(
d* Psychosis
+4A Schillin'?s test^measures rea/sorption of 0it B1#
ConfirmatoryA a/sence of intrinsic factor
Ns' @'t , Pernicious anemia
1* 3nforce CB-
#* Administer B1# inHections at monthly intervals for lifetime as ordered* .@ dorso'luteal or ventro'luteal* Not -iven ora" ,
due pt mi'ht develop resistance to dru'
+oes not develop to4icity /ecause of it is water solu/le therefore it is easily e4creted
3* +iet , hi'h calorie or C2O* .ncrease C2ON; iron & 0it C
6* Avoid irritatin' mouthwashes* Bse of soft /ristled tooth/rush is encoura'ed* Provide oral care
%* Avoid applyin' electric heatin' pads or any heat application , can lead to /urns
APLAS,IC ANEMIA , stem cell disorder due to /one marrow depression leadin' to pancytopenia , all -BC are decreased
+ecrease -BC decrease 8BC decrease platelets
Anemia leu:openia throm/ocytopenia
.ncrease 8BC leu:ocytocystosis
.ncrease -BC polycythemia vera , complication stro:e; C0A; throm/osis
63
Predisposin' factors leadin' to Aplastic Anemia
1* Chemicals , BanDene & its derivatives
#* radiation
3* .mmunolo'ic inHury
6* +ru's , cause /one marrow depression
a* Broad spectrum anti/iotic Chloramphenicol
Sulfonamides , /actrim
/* Chemo therapeutic a'ents
@ethotre4ate , al:ylatin' a'ents
Nitro'en mustard , anti meta/olic
0incristine , plant al:aloid
S)S4A
1* AnemiaA
a* 8ea:ness & fati'ue
/* 2eadache; diDDiness; dyspnea
c* cold sensitivity; pallor
d* palpitations
#* $eu:openia , increase suscepti/ility to infection
3* "hrom/ocytopenia ,
a* Petecchiae
/* OoDin' of /lood from venipuncture site
c* ecchymoses
+4A
1* CBC , pancytopenia
#* Bone marrow /iopsy) aspiration at post iliac crest , reveals fatty strea:s in /one marrow
Ns' @'tA
1* -emoval of underlyin' cause
#* Blood transfusion as ordered
3* Complete /ed rest
6* O# inhalation
%* -everse isolation due leu:openia
<* @onitor si'ns of infection
=* Avoid SQ; .@ or any venipuncture site 1 23P$OCI
!* Bse electric raDor when shavin' to prevent /leedin'
E* Administer meds
.mmunolo'ical inHuryA 'ive steroids
.mmunosuppresantsA Anti lymphocyte 'lo/ulin &Al'( 'iven via central venous catheter; < days , 3 wee:s to achieve ma4
therapeutic effect of dru'*
/L))D ,RANS6USI)NA
O/HectivesA
1* "o replace circulatin' /lood volume
#* "o increase O# carryin' capacity of /lood
3* "o com/at infection if there?s decrease 8BC
6* "o prevent /leedin' if there?s platelet deficiency
Ns- M-t !rinci!"es in /"oo# ,ransfusion
1* Proper refri'eration
#* Proper typin' & crossmatchin'
"ype O , universal donor
AB , universal recipient
!%G of people are -2 &L(
3* Asceptically assem/le all materials neededA
a*( Filter set
/*( .sotonic or PNSS or *ENaCl to prevent 2emolysis
2ypotonic sol , swell or /urst
2ypertonic sol , will shrin: or crenate
c*( Needle 'au'e 1! 1E or lar'e /ore needle to prevent hemolysis*
66
d*( .nstruct another -N to rechec: the followin' *
Pts name; /lood typin' & cross typin'; e4piration date; serial num/er*
e*( Chec: /lood unit for presence of /u//les; cloudiness; dar: in color & sediments , indicates /acterial contamination*
+on?t dispose* -eturn to /lood /an:*
f*( Never warm /lood products , may destroy vital factors in /lood*
8armin' is done if with warmin' device , only in 3@3-53NCJ9 For multiple B"*
8ithin 3F mins room temp only9
'*( Blood transfusion should /e completed F .0rs /ecause /lood that is e4posed at room temp for S #h causes /lood
deterioration may cause /acterial contamination*
h*( Avoid mi4in' or administerin' dru' at B" line , leads to hemolysis
i*( -e'ulate B" 1%#F 'tts)min I0O or 1FFcc)hr to prevent circulatory overload
H*( @onitor 0S /efore; durin' & after B" especially C1% mins&local /oard( for 1st hour* NC$3KC%min for 1
st
1%min*
@aHority of B" reaction occurs within 1h*
/, reactions S)S4 2emolytic reactionA
2 , hemolytic -eaction 1* 2eadache; diDDiness; dyspnea; palpitation; lum/ar) sterna) flan: pain;
A , aller'ic -eaction hypotension; flushed s:in ; &red( port wine urine*
P , pyro'enic -eaction
C , circulatory overload
A , air em/olism
" throm/ocytopenia
C , citrate into4ication , e4pired /lood 1hyper:alemia
2 , hyper:alemia
Ns' @'tA &emo"ytic Reaction:
1* Stop B"
#* Notify +oc
3* Flush with plain NSS
6* Administer isotonic fluid sol , to prevent acute tu/ular necrosis & conteract shoc:
%* Send /lood unit to /lood /an: for ree4amination
<* O/tain urine & /lood samples of pt & send to la/ for ree4amination
=* @onitor 0S & Aller'ic -4n
A""er-ic Reaction:
S)S4
1* Fever) chills
#* Brticaria) pruritus
3* +yspnea
6* $aryn'ospasm) /ronchospasm
%* Bronchial wheeDin'
Ns' @'tA
1* Stop B"
#* Notify +oc
3* Flush with PNSS
6* Administer antihistamine , diphenhydramine 2cl &Benadryl(* 5ive /edtime*S3Adultdrowsiness* Childhyperactive
.f &L( 2ypotension , anaphylactic shoc: administer , epinephrine
%* Send /lood unit to /lood /an:
<* O/tain urine & /lood samples , send to la/
=* @onitor 0S & .O
!* Adm antipyretic & anti/iotic for pyro'enic -4n & "SB
Pyro-enic Reaction:
S)S4
a*( Fever) chills d* tachycardia
/*( 2eadache e* palpitations
6%
c*( +yspnea f* diaphoresis
Ns' @'tA
1* Stop B"
#* Notify +oc
3* Flush with PNSS
6* Administer antipyretics; anti/iotics
%* Send /lood unit to /lood /an:
<* O/tain urine & /lood samples , send to la/
=* @onitor 0S & .O
!* "epid spon'e /ath , offer hypothermic /lan:et
Circu"atory )ver"oa#:
S4
a* +yspnea
/* Orthopnea
c* -ales or crac:les
d* 34ertional discomfort
Ns' @'tA
1* Stop B"
#* Notify +oc* +on?t flush due pt has circulatory overload*
3* Administer diuretics ,$oop &Furosemide(
Priority casesA
2emolytic -4n , 1
st
due to hypotension , 1st priority , attend to destruction of 2'/ , O# /rain dama'e
Aller'ic 3
rd
Pyro'enic 6
th
Circulatory #
nd

2emolytic #
nd
Anaphylitic 1
st priority
P$A"3$3" +.SO-+3-S
DIC 2 DISSEMINA,ED IN,RA5ASCULAR C)AGULA,I)N
*.8 Acute hemorrha'ic syndrome char /y wide spread /leedin' & throm/osis due to a defiency of clottin' factors &Prot0rombin
6ibrino-en$8
Predisposin' factorA
1* -apid B"
#* @assive trauma
3* @assive /urns
6* Septicemia
%* 2emolytic reaction
<* Anaphyla4is
=* Neoplasia , 'rowth of new tissue
!* Pre'nancy
S)S4
6<
1* Petechiae , widespread & systemic &lun's; lower &
upper trun:(
#* 3cchymoses , widespread
3* OoDin' of /lood from venipunctured site
6* 2emoptysis , cou'h /lood
%* 2emorrha'e
<* Oli'uria , late s4
+4 Proc,
1* CBC , reveals decrease platelets
#* Stool for occult /lood &L(
Specimen , stool
3* Opthalmoscopic e4am , su/ retinal hemorrha'e
6* AB5 analysis , meta/olic acidosis
!& &C);
- p2 PCO# respiratory al:alosis
O ph PCO# respiratory acidosis
@ ph 2CO3 meta/olic al:alosis
3 ph 2CO3 meta/olic acidosis
+iarrhea , met acidosis
0omittin' , met al:
Pyloric stenosis , met al:alosis , vomitin'
.leostomy or intestinal tu/in' , met acidosis
Cushin'?s , met al:
+@ met acid
Chronic /ronchitis , resp acid , with hypo4emia; cyanosis
Ns- M-t DIC
1* @onitor si'ns of /leedin' , hema test L urine; stool; 5."
#* Administer isotonic fluid solution to prevent shoc:*
3* Administer O# inhalation
6* Administer meds
a* 0it I aCuamephyton
/* Pitressin or vasopressin , to conserve water
%* N5" , lava'e
Bse iced saline lava'e for decompensation; iced saline is used
<* @onitor N5" output
=* Provide heploc:
!* Prevent complicationA hypovolemic shoc:
$ate si'ns of hypovolemic shoc:A anuria
)nco"o-ic Ns-A
Oncolo'y , study of neoplasia ,new 'rowth
Beni'n &tumor( @ali'nancy &cancer(
+iff well differentiated poorly or undifferentiated
3ncapulation , &L( &(
@etastasis , &( &L(
Pro'nosis , 'ood poor
"herapeutic modality sur'ery 1* Chemotherapy plenty S)3
#* -adiation
3* Sur'ery most preferred treatment
6* Bone marrow transplant $eu:emia only
Pre#is!osin- factors: (carcino-enesis$
5 , 'enetic factors
. , immunolo'ic factors
0 , viral factors
a* 2uman papiloma virus , causin' warts
/* 3pstein /arr virus
3 , environmental Factors EFG
a* Physical , irradiation; B0 rays; nuclear e4plosion; chronic irritation; direct trauma
/* Chemical factors ,
Food additives &nitrates
2ydrocar/on vesicants; al:alies
+ru's &still/estrol(
Braehane
2ormones
Smo:in'
@ale
3*( Prostate cancer common 6F & a/ove &middle a'e & a/ove(
BP2 , %F & a/ove
1*( $un' cancer
#*( $iver cancer
Female
6=
1* Breast cancer , 6F yrs old & up , mammo'raphy 1% , #F mins &SB3 , = days after mens(
#* Cervical cancer , EFG multi se4ual partners
%G early pre'nancy
3* Ovarian cancer
C"asses of cancer
"issue typin'
1* Carcinoma , arises from surface epithelium & 'landular tissues
#* Sarcoma from connective tissue or /ones
3* @ultiple myeloma , from /one marrow
Patholo'ical fracture of ri/s & /ac: pain
6* $ymphoma , from lymph 'lands
%* $eu:emia , from /lood
>arnin- C Dan-er S( of CA
C , chan'e in /owel )/ladder ha/its
A , a sore that doesn?t heal
B , unusual /leedin') +ischar'e
" , thic:enin' of lump , /reast or elsewhere
. , indi'estionR +yspha'ia
O , o/vious chan'e in wart) mole
N , na''in' cou'h) hoarseness
B , une4plained anemia A anemia
S , sudden wt loss $ , loss of wt
"herapeutic @odalityA
1* C0emot0era!y , use various chemotherapeutic a'ents that :ills cancer cells & :ills normal rapidly producin' cells , 5.";
/one marrow; and hair follicle*
ClassificationA
a*( Al:ylatin' a'ents ,
/*( Plant al:aloids , vincristine
c*( Anti meta/olites , nitro'en mustard
d*( 2ormones , +3S
Steroids
e*( Antineoplastic anti/iotics
S)3 & m't
5." Nausea & vomitin'
Ns' @'tA
1* Administer anti emetic 6 , <h /efore start of chemo
Plasil
#* 8ithhold food) fluid /efore start of chemo
3* Provide /land diet post chemo
*<8 Non irritatin' ) non spicy
+iarrhea
1* Administer anti diarrheal 6 , <h /efore start of chemo
#* @onitor urine; .&O Ch
Stomatitis) mouth sores
1* Oral care , offer ice chips) popsic:les
#* .nform pt , hair loss , temporary alopecia
2air will 'row /ac: after 6 , < months post chemo*
Bone marrow depression , anemia
1* 3nforce CB-
#* O# inhalation
3* -everse isolation
6* @onitor si'ns of /leedin'
-epro or'an , sterility
1* +o sperm /an:in' /efore start of chemo
-enal system , increase uric acid
1* Administer allopurinol) 4yloprin &'out(
*=8 .nhi/its uric acid
*?8 Acute 'out , colchicines
*@8 .ncrease secretion of uric acid
Neurolo'ical chan'es , peristalsis , paralytic ileus
@ost feared complication ff any a/dominal sur'ery
0incristine , plant al:aloid causes peripheral neuropathy
*8 Ra#iation t0era!y , involves use of ioniDin' radiation that :ills cancer cells & inhi/it their 'rowth & :ill N rapidly producin'
cells*
"ypes of ener'y emitted
1* Alpha rays , rarely used , doesn?t penetrate s:in tissues
#* Beta rays , internal radiation , more penetration
3* 5amma ray , e4ternal radiation , penetrates deeper underlyin' tissues
@ethods of delivery
6!
1* 34ternal radiation involves electro ma'netic waves
34* co/alt therapy
#* .nternal radiation , inHection) implantation of radioisotopes pro4imal to CA site for a specific period of time*
# typesA
a*( Sealed implant , radioisotope with a container & doesn?t contaminate /ody fluid*
/*( Bnsealed implant , radioisotope without a container & contaminates /ody fluid*
34* Phosphorus 3#
3 Factors affectin' e4posureA
A*( 2alf life , time period reCuired for half of radioisotopes to decay*
At end of half life , less e4posure
B*( +istance , the farther the distance , lesser e4posure
C* ( "ime , the shorter the time; the lesser e4posure
+*( Shieldin' , rays can /e shielded or /loc:ed /y usin' ru//er 'loves , & 'amma , use thic: lead on concrete*
S)3 & @'tA
a*( S:in errythema; redness; slou'hin'
1* Assist in /attlin' pt
#* Force fluid , #;FFF , 3;FFF ml)day
3* Avoid lotion or talcum powder , s:in irritation
6* Apply cornstarch or olive oil
/*( 5." ,nausea ) vomitin'
1* Administer antiemetic 6 , <h /efore start of chemo Plasil
# 8ithhold food) fluid /efore start of chemo
3* Provide /land diet post chemo
Non irritatin' ) non spicy
+ys'lusia , decrease taste sensitivity
8hen atrophy papilla &taste /uds( , 6F yo
Stomatitis
c*( Bone marrow depression
1* 3nforce CB-
#* O# inhalation
3* -everse isolation
6* @onitor si'ns of /leedin'
)vervie7 of function structure of t0e 0eart
&EAR,
@uscular; pumpin' or'an of the /ody
$eft mediastinum
8ei'h 3FF , 6FF 'rams
-esem/les a closed fist
Covered /y serous mem/rane , pericardium
Pericardium
Parietal layer Pericardial 0isceral layer
&outer( Fluid , to prevent &inner(
Friction ru/ &1F#F cc(

$ayer
1* 3picardium , outermost
#* @yocardium , inner , responsi/le for pumpin' action) most dan'erous layer cardio'enic shoc:
may lead to myocarditis; which may lead to -2+
3* 3ndocardium , innermost layer
Cham/ers
1* Bpper , collectin') receivin' cham/er Atria
#* $ower , pumpin') contractin' cham/er 0entricles
0alves
1* Atrioventricular valves "ricuspid & mitral valve
Closure of A0 valves , 'ives rise to 1
st
heart sound or S1 or Nlu/O
#* Semi lunar valve
a*( Pulmonic
/*( Aortic
Closure of semilunar valve , 'ives rise to #
nd
heart sound or S# or Ndu/O
34tra heart Sound
S3 , ventricular 5allop , C2F
S6 , atrial 'allop , @.; 2PN
Coronary Arteries arise from /ase of the aorta
-i'ht main coronary artery Supply the
$eft main coronary artery myocardium
2eart conduction system
1* Sino atrial node &SA node( &or IeithFloc: node(
$oc , Hunction of S0C & -t atrium
F4 primary pace ma:er of heart
6E
.nitiates electric impulse of <F , 1FF /pm
#* Atrioventicular node &A0 node or "awara node(
$oc , inter atrial septum
+elay of electric impulse to allow ventricular fillin' &for a/out ;F!millisecond(
3* Bundle of 2is , location interventricular septum
-t main Bundle Branch
$t main Bundle Branch
6* Pur:inHe Fi/ers
$oc walls of ventricles leadin' to 0entricular contractions
SA node

Pur:enHie Fi/ers
Bundle of 2is
Complete heart /loc: or the /undle /loc: , insertion of pacema:er at Bundle Branch is needed
@etal , Pace @a:er , chan'e C3 , % yo

Prolon'ed P- , atrial fi/ " wave inversion , @.
S" se'ment depression , an'ina widenin' Q-S , arrhythmia
S" , elev , @.
CA+ , coronary artery dse or .schemic 2eart +se &.2+( 11Ns' @'tA decrease myocardial wor:load
Sta'esA
1* Atherosclerosis , @yocrdial inHury
#* An'ina Pectoris , @yocardial ischemia
3* @. myocardial necrosis
AR,ERI)SC$3-OS.S A,&ER)SC$3-OS.S
Narrowin' of artery due to fat
lipid deposits at tunica intima*
2ardenin' or artery due to calcium & C2ON
deposits at tunica media*
Artery , tunica adventitia , outer
"unica intima , innermost
"unica media , middle
A"23-OSC$3-OS.S
Predisposin' Factor
1* Se4 , male
#* Blac: race
3* 2yperlipidemia; increase in saturated fats
6* Smo:in'
%* 2PN
<* +@
=* Oral contraceptive prolon'ed use
!* Sedentary lifestyle
E* O/esity
1F* 2ypothyroidism
11* Stress
Si'ns & Symptoms
1* Chest pain
#* +yspnea
3* "achycardia
6* Palpitations
%* +iaphoresis
"reatment
P , percutaneous
" , tansluminar For sin'le occluded vessels
C , coronary
A , an'ioplasty
A0
%F
O/HA
1* "o revasculariDe the myocardium
#* "o prevent an'ina
3* .ncrease survival rate
P"CA , done to pt with sin'le occluded vessel *
@ultiple occluded vessels
C , coronary
A , arterial for # or more occluded vessels
B , /ypass
A ,and
5 , 'raft sur'ery
Ns' @'t Before CABA5
1* +eep /reathin' cou'h e4ercises
#* Bse of incentive spirometer
3* $e' e4ercises
ANGINA PEC,)RIS9 A clinical syndrome characteriDed /y paro4ysmal chest pain usually relieved /y -3S" or N5"
nitro'lycerin; resultin' fr temp myocardial ischemia*
Predisposin' FactorA &same with CA+(
1* se4 , male
#* /lac: race
3* hyperlipidemia
6* smo:in'
%* 2PN
<* +@
=* oral contraceptive prolon'ed
!* sedentary lifestyle
E* o/esity
1F* hypothyroidism
Precipitatin' factors
6 3?s
1* 34cessive physical e4ertion
#* 34posure to cold environment 0asoconstriction
3* 34treme emotional response
6* 34cessive inta:e of food , saturated fats
Si'ns & Symptoms
1* .nitial symptoms , $evine?s si'n , hand clutchin' of chest
#* Chest pain , sharp; sta//in' e4cruciatin' pain*
$ocation , su/sternal
radiates /ac:; shoulders; a4illa; arms & Haw muscles
relieve /y rest or N5"
3* +yspnea
6* "achycardia
%* Palpitation
<* diaphoresis
+ia'nosis
1* 2istory ta:in' & P3
#* 3C5 , S" se'ment depression
3* Stress test , treadmill 1 a/normal 3C5
6* Serum cholesterol & uric acid increase
Nursin' @ana'ement
1*( 3nforce CB-
#*( Administer meds as ordered
N"5 , small doses , venodilator
$ar'e dose , vasodilator
1
st
dose N"5 , 'ive 3 , % min
#
nd
dose N"5 , 3 , % min
3
rd
& last dose , 3 , % min
Still painful after 3
rd
dose , notify doc* @.9
%% yrs old with chest painA
1
st
Cuestion to as: ptA what did you do /efore you had chest pain*
#
nd
CuestionA does pain radiateR
.f chest pain radiates , heart in nature* .f not radiate , pulmonary ori'in &P"B; Pneumonia; 3mphysema(
Nitro'lycerin act as 0enodilator &if 'iven in small doses(, dilate veins of lower e4t , increase venous poolin' lead to
decrease venous return*
$ar'e doses vasodilators
@edsA
A* N"5 Ns' @'tA
1* Ieep in a dry place*
#* Avoid moisture & heat; sunli'ht may inactivate the dru'*
%1
3* @onitor S)3A
orthostatic hypotension , dec /p
transient headache
diDDiness
6* -ise slowly from sittin' position
%* Assist in am/ulation*
<* .f 'ivin' N"5 via patchA
i* avoid placin' it near hairy areaswill dec dru' a/sorption &S2A03 A-3A(
ii* avoid rotatin' transdermal patches will dec dru' a/sorption
iii* avoid placin' near microwave oven or durin' defi/rillationwill /urn pt due aluminum foil in patch
B* Beta /loc:ers , P-OPANO$O$ &inderal(
C* AC3 inhi/itors , CAP"OP-.$
+* Ca anta'onist N.F3+.P.N3
3*( Administer O# inhalation
6*( Semifowler
%*( +iet +ecrease Na and saturated fats; caffeine
<*( @onitor 0S; .&O; 3C5
=*( 2"A +ischar'e plannin'A
a* Avoid precipitatin' factors , 6 3?s
/* Prevent complications , @.
c* "a:e meds /efore physical e4ertionto achieve ma4imum therapeutic effect of dru'
d* .mportance of followup care*
MI 2 M4)CARDIAL IN6ARC,I)N , heart attac: , terminal sta'e of C0+ characteriDed /y malocclusion leadin' to
necrosis and scarrin'
"ypesA
A* Accordin' to $ocation
1* "rasmural @. , most dan'erous @. , @alocclusion of /oth -&$ coronary artery
#* Su/endocardial @. , malocclusion of either - & $ coronary artery
@ost critical period upon d4 of @. , 6! to =#h^most dan'erous hoursA first <! hours &maHority of arrythmias occur; P0Cs(
@aHority of pt suffers from P0C premature ventricular contraction*
B* Accordin' to mortality
Iillip . , 1%#FG chance of mortality &=%!FG survival(
Iillip .. , 3F3%G mortality
Iillip ... 6%%FG mortality
Iillip .0 <%=FG mortality^spiritual support is needed; pt chronically ill characteriDed /y cardio'enic shoc:
Predisposin' factors Si'ns & symptoms +ia'nostic 34am
1* se4 , male
#* /lac: raise
3* hyperlipidemia
6* smo:in'
%* 2PN
<* +@
=* oral contraceptive
prolon'ed
!* sedentary lifestyle
E* o/esity
1F* hypothyroidism
1* chest pain , e4cruciatin'; visceral pain located
su/sternal or precodial area &rare(
radiates /ac:; arm; shoulders; a4illa; Haw & a/d
muscles &a/dominal ischemia(*
not usually relived /y rest or N"5
#* dyspnea
3* 2yperthermia
6* initial increase in BP
%* mild restlessness & apprehensions
<* cool; moist ashen s:in
=* occasional findin's
a*( split S1 & S#
/*( pericordial friction ru/
c*( rales )crac:les
d*( S6 &atrial 'allop( ,&@. and 2ypertension(
1* cardiac enDymes
a*( CPI , @B , Creatinine Phospho:inase
&1##62(increased
/*( $+2 , lactic acid dehydro'enaseincreased
c*( S5P" , &A$"( , Serum 5lutanic Pyruvate
"ransaminase increased
d*( S5O" &AS"( , Serum 5lutamic O4alo
acetic increased
#* "roponin test , increase
3* 3C5 tracin' , S" se'ment
increase)elevation; " wave inversion;
widenin' or Q-S comple4es , means
arrhythmia in @. indicatin' P0C
6* serum cholesterol & uric acid increase
%* CBC , increase 8BC
Nursin' @ana'ement
1* Narcotic anal'esics , @orphine SO6 , to induce vasodilation & decrease levels of an4iety*
#* Administer O# inhalation , low inflow &C2Fincrease inflow(^#3$)min &hi'h inflow may lead to respiratory arrest(
3* 3nforce CB- without B-P
a*( use Bedside commode
6* Avoid 0alsalva maneuver &'ive la4atives(
%* Semi fowler
<* Provide a 'eneral liCuid to soft diet that is low in saturated fats; Na; caffeine
=* @onitor 0S; .&O & 3C5 tracin's
!* "a:e #F , 3F ml)wee: , wine; /randy; or whis:y to induce vasodilation*
E* Assist in sur'icalU CABA5
ComplicationsA 1* Pneumonia
#* "hrom/ophle/itis
3* .nfarction
1F* Provide pt 2"
a*( Avoid modifia/le ris: factors &diet; lifestyle(
%#
/*( Prevent complicationsA
1* Arrhythmias , P0C
#* Shoc: , cardio'enic shoc:* $ate si'ns of cardio'enic shoc: in @. , oli'uria
3* "hrom/ophle/itis deep vein throm/osis
6* C2F , left sided
%* +ressler?s syndrome , post @. syndrome
-esistant to medications
Administer 1%F;FFF , 6%F;FFF units of strepto:inase
c*( Strict compliance to meds
0asodilators
1* N"5
#* .SOSB-B.+3 +.N."-A"3 &.sordil(
Antiarrythmic
1* $ydocaine /loc:s release of norepinephrine
#* Bretylium
Beta/loc:ers , NlolO
1* P-OPANO$O$ &.nderal(
AC3 inhi/itors pril
1* CAP"OP-.$, &3nalapril(
Ca , anta'onist
1* N.F3+.P.N3
"hrom/olytics or fi/rinolytics, to dissolve clots) throm/us
S)3 aller'ic reactions) uticaria
1* Strepto:inase^S)3A aller'ic reaction &urticaria or pruritus(^/ec Strepto:inase is a forei'n protein su/stance
#* Bro:inase
3* "issue plasmino'en activatin' factor^S)3A chest pain
@onitor for /leedin'A
Anticoa'ulants
1* 2eparin &short actin'( #* Coumadin &8arfarin( , delayed reaction ta:es # , 3 days to ta:e effect
P"" P"
.f prolon'ed /leedin' prolon'ed /leedin'
Antidote antidote 0it I
Protamine sulfate
Anti platelet PASA &aspirin(^antithrom/otic properties
C).A +en'ue; vasoconstrictors; un:nown cause of headache
d*( -esume A+$ , se4) activity , 6 to < wee:s
Postcardiac reha/
1*(Se4 as an appetiDer rather then dessert ,
Before meals not after; due after meals increase meta/olism , heart is pumpin' hard after meals*
#*( Position , nonwei'ht /earin' position*
8hen to resume se4) actA 8hen pt can already use staircase; then he can resume se4*
e*( +iet , decrease Na; Saturated fats; and caffeine
f*( "each importance of follow up care*
C&6 2 C)NGES,I5E &EAR, 6AILURE 9 .na/ility of heart to pump /lood towards systemic circulation*
Bac:flow
1*( Left si#e# 0eart fai"ure:
Predisposin' factorsA
1*( EFG mitral valve stenosis , due -2+; a'in'
-2+ affects mitral valve , streptococcal infection
+4A Aso titer , anti streptolysine O S 3FF total units
+ru's 'iven Steroids
Penicillin
Aspirin
ComplicationA -SC2F
A'in' , de'eneration ) calcification of mitral valve
.schemic heart disease
2PN; @.; Aortic stenosis
S)S4
Pulmonary con'estion) 3dema
1* +yspnea
#* Orthopnea &+iff of /reathin' put patient on sittin' pos , platypnea(^#3 pillows or hi'h fowlers
3* Paro4ysmal nocturnal dysnea , PNO nalulunod &+OB at ni'ht(
6* Productive cou'h with /lood tin'ed sputum
%* Frothy saliva &from lun's(
<* Cyanosis
=* -ales) crac:les , due to fluid
%3
!* Bronchial wheeDin'
E* P@. , displaced lateral , due cardiome'aly
1F* Pulsus alternons , wea: pulse followed /y alternatin' stron' /oundin' pulse
11* Anore4ia & 'eneral /ody malaise
1#* S3 , ventricular 'allop
+4
1* CK- , cardiome'aly
#* PAP , Pulmonary Arterial Pressure
PC8P , Pulmonary Capillary8ed'e Pressure
PAP , measures pressure of - ventricle* .ndicates cardiac status*
PC8P , measures end systolic) diastolic pressure
PAP & PC8PA
Swan , 5anD catheteriDation , cardiac catheteriDation is done at /edside at .CB
Operatin' roomA laryn'eal)throat cancer tracheostomy set
&"rachesostomy , /edside( +one % , #F mins , scalpel & trachesostomy set
C0P , indicates fluid or hydration status &NA 61Fcm of 2#O(
.ncrease C0P , decrease flow rate of .0
+ecrease C0P , increase flow rate of .0
3* 3chocardio'raphy , reveals enlar'ed heart cham/er or cardiomyopathy
6* AB5 , PCO# increase; PO# decrease 1 1 hypo4emia 1 resp acidosis
#*( Ri-0t si#e# &6

Predisposin' factor
1* EFG tricuspid stenosis
#* COP+
3* Pulmonary em/olism
6* Pulmonic stenosis
%* $eft sided heart failure
S)S4
0enous con'estion
Nec: or Hu'ular vein distension
Pittin' edema
Ascites
8t 'ain
2epatome'alo) splenome'aly
Taundice
Pruritus
3sopha'eal varies
Anore4ia; 'en /ody malaise
+ia'nosisA
1* CK- , cardiome'aly
#* C0P , measures the pressure at - atrium
NormalA 6 to 1F cm of water
.ncrease C0P S 1F , hypervolemia , 'ive loop diuretics
+ecrease C0P M 6 , hypovolemia &fluid challen'e /y inc .0F rate(
Flat on /ed , post of pt when 'ivin' C0P
Position durin' C0P insertion , "rendelen/ur' to prevent pulmonary em/olism & promote ventricular
fillin'*
3* 3chocardio'raphy , enlar'ed heart cham/er ) cardiomyopathy
.*$iver enDyme elevation
S5P" & A$"(
S5O" AS"
Ns' m'tA .ncrease force of myocardial contraction 1 increase cardiac output
3 , <$ of CO enforce CB-
1* Administer medsA
"4 for $S2FA @ , morphine SO6 to induce vasodilatation
A , aminophylline & decrease an4iety
+ , di'italis &di'o4in(
+ diuretics
O o4y'en
5 'ases
a*( Cardiac 'lycosides
.ncrease myocardial 1 increase CO
+i'o4in &$ano4in(* AntidoteA di'ivine
+i'ito4inA meta/oliDes in liver not in :idneys not 'iven if with :idney failure*
/*( $oop diureticsA $asi4 , effect with in 1F1% min* @a4 1 < hrs
c*( BronchodilatorsA Aminophyline &"heophyline(* Avoid 'ivin' caffeine
d*( Narcotic anal'esicA @orphine SO6 induces vasodilaton & decrease an4iety
%6
e*( 0asodilators , N"5
f*( Antiarrythmics , $idocaine
3thacrynic acid "hiaDide diuretics
#* Administer O# inhalation , hi'h9 Z 3 6$)min via nasal cannula
3* 2i'h fowlers
6* -estrict Na9
%* Provide meticulous s:in care
<* 8ei'h pt daily* Assess for pittin' edema*
@easure a/dominal 'irth daily & notify @+
=* @onitor 0)S; .&O; /reath sounds; 3I5 tracin's
!* .nstitute /loodless phle/otomy* -otatin' tourniCuet or BP cuff rotated cloc:wise C 1% mins 1 to promote decrease venous
return
E* +iet , decrease salt; fats & caffeine
1F* 2"A
a( Complications Ashoc:
Arrhythmia
"hrom/ophle/itis
@.
Cor Pulmonale , -" ventricular hypertrophy
/*( +ietary modifications
c*( Adherence to meds
PERIP&ERAL MUSCULAR DISEASE
Arterial ulcers venous ulcer
1* "hrom/oan'itis O/literans &Buer'ers(, male) feet 1* 0aricose veins
#* -eynauds , female) hands #* "hrom/ophle/itis
18$ ,0romboan-itis ob"iteratesC /UERGERS DISEASE Acute inflammatory disorder affectin' small to medium siDed
arteries & veins of lower e4tremities* @ale) feet
Predisposin' factorsA
@ales 'reater than 3Fyo &hi'h ris: 'roup(
Smo:ers
S)S4
1* .ntermittent claudication , le' pain upon wal:in' -elieved /y rest
#* Cold sensitivity & s:in color chan'es
8hite /luish red
Pallor cyanosis ru/or
3* +ecrease or diminished peripheral pulses Post ti/ial; +orsalis pedis
6* "rophic chan'es
%* Blcerations
<* 5an'rene formation
+4A
1* Oscillometry , decrease peripheral pulse volume*
#* +oppler B"P , decrease /lood flow to affected e4tremities*
3* An'io'raphy , reveals site & e4tent of malocculsion*
%*
Ns' @'tA
1* 3ncoura'e a slow pro'ression of physical activity
a*( 8al: 3 6 4 ) day
/*( Out of /ed # , 3 4 a ) day
#* @eds
a*( Anal'esic
/*( 0asodilator
c*( Anticoa'ulant
3* Foot care m't li:e +@ ,
a*( Avoid wal:in' /arefoot
/*( Cut toe nails strai'ht
c*( Apply lanolin lotion , prevent s:in /rea:down
d*( Avoid wearin' constrictive 'arments
6* Avoid smo:in' & e4posure to cold environment
%* Assist patient in sur'eryA BIA &Below the :nee amputation(
#*(RE4NAUD'S P&EN)MEN)N , acute episodes of arterial spasm affectin' di'its of hands & fin'ers
%%
Predisposin' factorsA
1* Female; 6F yrs
#* Smo:in'
3* Colla'en dse
a*( S$3 , patho'nomonic si'n , /utterfly rash on face
Chipmun: face , /ulimia nervosa
Cherry red s:in , car/on mono4ide poisonin'
Spider an'ioma , liver cirrhosis
Caput medusae , le' & trun: um/ilicus $iver cirrhosis
$ion face , leprosy
/*( -heumatoid arthritis ,
6* +irect hand trauma , piano playin'; e4cessive typin'; operatin' chainsaw
S)S4A
1* .ntermittent claudication le' pain upon wal:in' -elieved /y rest
#* Cold sensitivity
Ns' @'tA
a* Anal'esics
/* 0asodilators
c* 3ncoura'e to wear 'loves especially when openin' a refri'erator*
d* Avoid smo:in' & e4posure to cold environment
5EN)US ULCERS
1* 5ARIC)SI,IES C 5aricose veins A/normal dilation of veins , lower e4t & trun:
+ue toA
a*( .ncompetent valves leadin' to
/*( .ncrease venous poolin' & stasis leadin' to
c*( +ecrease venous return
Predisposin' factorsA
a* 2ereditary
/* Con'enital wea:ness of veins
c* "hrom/ophle/itis
d* 2eart dse
e* Pre'nancy
f* O/esity
'* Prolon'ed immo/ility Prolon'ed standin'
S)S4A
1* Pain especially after prolon'ed standin'
#* +ilated tortuous s:in veins
3* 8arm to touch
6* 2eaviness in le's
+4A
1* 0eno'raphy
#* "rendelen/er'?s test , vein distend Cuic:ly M 3% secs
Ns' @'tA
1* 3levate le's a/ove heart level , to promote venous return , 1 to # pillows
#* @easure circumference of le' muscles to determine if swollen*
3* 8ear anti em/olic or :nee hi'h stoc:in's* 8omen , panty hose
6* @edsA Anal'esics
%* Sur'eryA vein sweepin' & li'ation
Sclerotherapy , spider we/ varicosities
S)3 throm/osis
,&R)M/)P&LE/I,IS &deep vein throm/osis( .nflammation of veins with throm/us formation
Predisposin' factorsA
1* Smo:in'
#* O/esity
#* 2yperlipedemia
6* Prolon'ed use of oral contraceptives
%* Chronic anemia
<* +@
=* @.
!* C2F
E* Postop complications
1F* Post cannulation , insertion of various cardiac catheters
S)S4A
1* Pain at affected e4tremities
#* Cyanosis
3* &L( 2oman?s si'n Pain at le' muscles upon dorsifle4ion of foot*
+4A
%<
1* An'io'raphy
#* +oppler B"P
Ns' @'tA
1* 3levate le's a/ove heart level*
#* Apply warm; moist pac:s to decrease lymphatic con'estion*
3* @easure circumference of le' muscles to detect if swollen*
6* Bse anti em/olic stoc:in's*
%* @edsA Anal'esics*
Anticoa'ulantA 2eparin
<* ComplicationA
Pu"monary Embo"ism:
Sudden sharp chest pain
+yspnea
"achycardia
Palpitation
+iaphoresis
@ild restlessness
)5ER5IE> )6 RESPIRA,)R4 S4S,EM:
.* Bpper respiratory tractA
F4A
1* Filterin' of air
#* 8armin' & moistenin'
3* 2umidification
a* Nose , cartila'e
PartsA -t nostril separated /y septum
$t nostril
Consists of anastomosis of capillaries ,
$iessel , Bach Ple4us , site of epista4is
/* Pharyn4 &throat( , muscular passa'eway for air& food
BranchesA
1* Oropharyn4
#* Nasopharyn4
3* $ayn'opharyn4
c* $aryn4 , voice /o4
F4A
1* For phonation voice or speech production
#* Cou'h refle4
@ade up of framewor:A
a* epi'lottis
/* hyoid /one
c* thyroid & crichoid cartila'e
5lottis , openin' of laryn4
Opens to allow passa'e of air
Closes to allow passa'e of food
.na/ility to cou'h; complete o/struction of airway
..* $ower -espiratory tract , F4 for 'as e4chan'e
d* "rachea , windpipe
has cartilla'enous rin's
site for permanent) artificial a)w , tracheostomy
/* Bronchus , - & $ main /ronchus
c* $un's , - , 3 lo/es 1 1F se'ments
$ , # lo/es , ! se'ments
Post pneumonectomy position affected side to promote e4pansion of lun's11Semi Fowlers
Post se'mental lo/ectomy , position unaffected side to promote draina'e
Serous mem/rane
Pleura
Parietal 0isceral
Pleural Fluid
Pleural Friction -u/ ches pain pain upon inspiration
Pneumonia
Pleurisy
Pleural 3ffusion
$un's , covered /y pleural cavity; parietal lo/e & visceral lo/e
Alveoli , acinar cells
site of 'as e4chan'e &O# & CO#(diffusion
diffusionA +altons law of partial pressure of 'ases
/asic livin' units
Powerful stimulatin' stimulant^increase CO#
%=
COP+ , decrease O# stimulant
0entilation , movement of air in & out of lun's
-espiration , movement of air into cells
"ype .. cells of alveoli , secretes surfactant; lipoprotein in nature
Surfactant decrease surface tension of alveoli^prevents collapse of lun's also :nown as atelectasis
$ecithin & spino'omyelin
$)S ratio #A1 , indicator of lun' maturity
.f 1A# , adm O# M 6FG Concentration to prevent atelectasis & retinopathy or /lindness*
-etrolental Fi/roplasiaretinopathy)/lindness in prematurity
.* PNEUM)NIA , inflammation of lun' parenchyma leadin' to pulmonary consolidation as alveoli is filled with e4udates*
3tiolo'ic a'entsA
1* Streptococcus pneumoniae &pnemococcal pneumonia(
#* 2aemophilus pneumoniae&Bronchopneumonia( in children
3* 3scherichia coli
6* Ile/siella P*
%* +iplococcus P*
2i'h ris:A elderly & children /elow % yo /ec of low resistance
Predisposin' factorsA
1* Smo:in'
#* Air pollution
3* .mmunocompromised patients
a* A.+S , P$P
/* Broncho'enic CA Nonproductive to productive cou'h CK-
6* Prolon'ed immo/ility , C0A hypostatic pneumonia
%* Aspiration of food
<* Over fati'ue
S)S4A
:8 Productive cou'h , patho'nomonicA -reenis0 to rusty s!utum
*8 +yspnea with prolon'ed respiratory 'runt
;8 Fever; chills; anore4ia; 'en /ody malaise
.8 8t loss
<8 Pleuritic friction ru/
=8 -ales) crac:les
?8 Cyanosis
@8 A/dominal distension leadin' to paralytic ileus &a/sence of peristalsis(
Sputum e4am , could confirm presence of "B & pneumonia
+4A
1* Sputum 5SCS 'ram stainin' & culture sensitivity -eveals &L( culture microor'anism*
#* CK- , pulmonary consolidation
3* CBC , increase 8BC and inc 3rythrocyte sedimentation rate
6* AB5 , PO# decrease; hypo4emia
Ns' @'tA
1* 3nforce CB-
#* Strict respiratory isolation
3* @edsA
a*( Broad spectrum anti/iotics
Penicillin or tetracycline
@acrolides , e4 aDythromycin &Dythroma4(
/*( Anti pyretics
c*( @ucolytics or e4pectorants
6* Force fluids , # to 3 $)day
%* .nstitute pulmonary toilet
a*( +eep /reathin' e4ercise
/*( Cou'hin' e4ercise
c*( Chest physiotherapy , cuppin'
d*( "urnin' & reposition Promote e4pectoration of secretions
<* Semifowler
=* Ne/uliDe & suction as necessary; O# inhalation
!* Comfy & humid environment
E* +ietA increase C2O or calories; C2ON & 0it C
1F* Postural draina'e "o drain secretions usin' 'ravity
@'t for postural draina'eA
%!
a*( Best done /efore meals &/rea:fast( or # , 6 hrs after meals to prevent 5astroesopha'eal -eflu4
/*( @onitor 0S & /reath sounds
Normal /reath sound , /ronchovesicular
c*( +eep /reathin' e4ercises
d*( Adm /ronchodilators 1% , 3F min /efore procedure
e*( Stop if pt can?t tolerate procedure
f*( Provide oral care , it may alter taste sensation
'*( C). , pt with unsta/le 0S & hemoptysis; increase .CP; increase .OP &'laucoma(
Normal .OP , 1# , #1 mm2'
11* 2"A
a*( Avoidance of precipitatin' factors &smo:in'(
/*( ComplicationA Atelectacies & menin'itis
c*( Compliance to meds
PULM)NAR4 ,U/ERCUL)SIS (1)C&'S DSE$ 9 .nflammation of lun' tissue caused /y invasion of myco/acterium "B
or tu/ercle /acilli or acid fast /acilli , 'ram &L( aero/ic; motile & easily destroyed /y heat or sunli'ht*
Predisposin' factorsA
1* @alnutrition
#* Overcrowdin'
3* Alcoholism
6* .n'estion of infected cattle &myco/acterium BO0.S(
%* 0irulence
<* Over fati'ue or stress
S)S4A
1* Productive cou'h , yellowish
#* $ow 'rade afternoon fever
3* Ni'ht sweats
6* +yspnea
%* Anore4ia; 'eneraliDed /ody malaise; wt loss
<* Chest) /ac: pain
=* 2empotysis
11Air/orne transmission; droplet nuclei infection
+ia'nosisA
1* S:in test , @antou4 test , infection of Purified Protein +erivative PP+
+O2 , !1F mm induration
82O , 1F16 mm induration
-esult within 6! , =#h
&L( @antou4 test , previous e4posure to tu/ercle /acilli
@ode of transmission , droplet infection
#* Sputum AFB , &L( to cultured microor'anism
3* CK- , pulmonary infiltrate caseous necrosis
6* CBC , increase 8BC
Nursin' @'tA
1* CB-
#* Strict resp isolation
3* O# inhalation
6* Semi fowler
%* Force fluid to liCuefy secretions
<* +eep /reathin' and cou'h e4ercises
=* Ne/uliDe & suction if necessary
!* Provide comforta/le & humid environment
E* +iet , increase C2O & calories; C2ON; 0it; minerals
1F* Short course chemotherapyA
.ntensive phase
1* .N2 , isoniaDid /oth 'iven /efore meals for a/sorption
#* -ifampicin /oth 'iven within 6 months; 'iven simultaneously to prevent resistance
S)3A peripheral neutitis , vit B< &cereals; 'reen leafy ve'eta/les; or'an meat(
-ifampicin All /ody secretions turn to red oran'e color urine; stool; saliva; sweat & tears*
3* PPA , PyraDinamide , 'iven # mos) after meals* S)3A aller'ic r4n; nephroto4icity & hepato4icity
PPA may /e replaced /y 3"2A@BB"O$ &S)3A optic neuritis(
Stan#ar# re-imen
1* .nHection of streptomycin , Amino'lycosides
34* Ianamycin; 'entamycin; neomycin
S)3A
a*( Ototo4icity , dama'e CN V ! , tinnitus &rin'in' in the ears(; diDDiness; verti'o
/*( Nephroto4icicity , monitor BBN &1F#F( & Creatinine &*!1(
2"A
a*( Avoid predisposin' factors li:e alcoholism; crowded places
/*( Provide the dietary inta:e of increased C2O;calories; C2ONm and 0itamin C
c*( Avoid complicationsA
%E
1*( Atelectasis
#*( @iliary "B , spread of "/ to other system
/*( Strict compliance to meds &if one misses a dose; continue ta:in' the meds(
-eli'iously ta:e meds
e( Inow the importance of follow up care
&IS,)PLASM)SIS acute fun'al infection caused /y inhalation of contaminated dust with 2istoplasma Capsulatum
transmitted from /ird?s manure*
S)S4A Same as pneumonia & P"B , li:e
1* Productive cou'h
#* +yspnea
3* Chest & Hoint pains
6* Cyanosis
%* Anore4ia; 'en /ody malaise; wt loss
<* 2emoptysis
=* Fever and chills
+4A
1* 2istoplasmin s:in test 1 &L( 2istoplasma Capsulatum
#* AB5 , pO# decrease
Ns' @'tA
1* CB-
#* @edsA
a*( Antifun'al a'ents
Amphotericin B &Fun'iDone(
S)3A
a*( Nephroto4cicity chec: BBN and Creatinine
/*( 2ypo:alemia
/*(Corticosteroids
c*( @ucolytic) or 34pectorants
3* Administer O#; force fluids
6* 3ncoura'e deep /reathin' and cou'hin' e4ercises
%* Ne/uliDe; suction
<* ComplicationsA
a*( Atelectasis
/*( Bronchiectasis COP+
=* Prevent spread of histoplasmosisA
a*( Spray /readin' places or :ill the /ird*
C)PD 2 C0ronic )bstructive Pu"monary Disease
1* Chronic /ronchitis
#* Bronchial asthma
3* Bronchiectasis
6* Pulmonary emphysema , terminal sta'e
C&R)NIC /R)NC&I,IS called B$B3 B$OA"3-S inflammation of /ronchus due to hypertrophy or hyperplasia of 'o/let
mucus producin' cells leadin' to narrowin' of smaller airways*
Predisposin' factorsA
1* Smo:in' , all COP+ types
#* Air pollution
S)S4A
1* Productive cou'h
#* +yspnea on e4ertion
3* Prolon'ed e4piratory 'runt
6* Scattered rales) rhonchi
%* Cyanosis
<* Pulmonary 2PN , a*( $eadin' to peripheral edema
/*( Cor pulmonale , ri'ht ventricular hypertrophy respiratory in ori'in
=* Anore4ia; 'en /ody malaise
+4A
1* AB5
PO# PCO# -esp acidosis
2ypo4emia , causin' cyanosis ComplicationsA 3mphysema and Pleurisy
Ns' @'tA
&Same as emphysema(
#*( /R)NC&IAL AS,&MA reversi/le inflammation lun' condition due to hyerpsensitivity to aller'ens leadin' to narrowin'
of smaller airways*
Predisposin' factorA
1* 34trinsic Asthma , called Atopic) aller'ic asthma
a*( Pollen
/*( +ust
c*( 5ases
<F
d*( Smo:e)fumes
e*( +ander
f*( $ints
'*( 0iral infection
#* .ntrinsic Asthma called NonAtopic; nonaller'ic asthma
CauseA
2ereditary
+ru's , aspirin; penicillin; /loc:ers &/eta /loc:ers are /ronchoconstrictors(
Food additives , nitrites
Foods , seafood; chic:en; e''s; chocolates; mil:
Physical) emotional stress
Sudden chan'e of temp; humidity &air pressure
3* mi4ed typeA com/ination of /oth e4trinsic & intrinsic Asthma
EFG cause of asthma
S)S4A
1* C , cou'h , non productive to productive
#* + , dyspnea
3* 8 , wheeDin' on e4piration
6* Cyanosis
%* @ild apprehension & restlessness
<* "achycardia & palpitation
=* +iaphoresis
+4A
1* Pulmo function test , decrease vital lun' capacity
#* AB5 , PO# decrease; PCO# increase hypo4emia; Ph decreased
-espiratory Acidosis
Ns' @'tA
1* CB- , all COP+
#* @eds
a*( Bronchodilator throu'h inhalation or metered dose inhaled ) pump* 5iven 1
st
/efore corticosteroids to facilitate
a/sorption
/*( Corticosteroids , due inflammatory* 5iven 1F min after adm /ronchodilator
c*( @ucolytic) e4pectorant
d*( @ucomist &Acetylcysteine( , at /edside put suction machine*
e*( Antihistamine
#* Force fluids
3* .nstitute pulmonary toilet
6* O# , all COP+ low inflow to prevent resp distress
%* Ne/uliDe & suction client P-N
<* +ietA increase C2O; C2ON
=* Semifowler , all COP+ e4cept emphysema due late sta'e
!* 2"
a*( Avoid predisposin' factors &dust; pollen; etc(; provide a comforta/le environment
/*( ComplicationsA
Status astmaticus 'ive epinephrine & /ronchodilators
3mphysema
c*( Adherence to meds to prevent status asmaticus
d*( "each the importance of follow up care
/R)NC&IEC,ASIS , a/normal permanent dilation of /ronchus resultin' to destruction of muscular & elastic tissues of alveoli*
Predisposin' factorsA
1* -ecurrent upper & lower respiratory tract infections
#* Con'enital anomalies
3* $un' "umors
6* Chest "rauma
S)S4A
1* Productive cou'h
#* +yspnea
3* Anore4ia; 'eneraliDed /ody malaise all ener'y are used to increase respiration*
6* Cyanosis
%* 2emoptisis
+4A
1* AB5 , PO# decrease
#* Bronchoscopy , direct visualiDation of /ronchus usin' fi/erscope*
3* Chest 4ray
Ns' @'tA /efore /ronchoscopy
1* Consent; e4plain procedure , @+) la/ e4plain -N
#* NPO
3* @onitor 0S
Ns- M-t after bronc0osco!y
1* Feedin' after return of 'a' refle4
#* .nstruct client to avoid tal:in'; smo:in' or cou'hin'
3* @onitor si'ns of fran: or 'ross /leedin'
6* @onitor of laryn'eal spasm
<1
+OB
Prepare at /edside tracheostomy set
@'tA same as emphysema e4cept Sur'ery
Pneumonectomy , removal of affected lun' , lie on affected side
Se'mental lo/ectomy , position of pt , unaffected side to promote draina'e
PULM)NAR4 EMP&4SEMA , irreversi/le terminal sta'e of COP+
CharacteriDed /y inelasticity of alveolar walls leadin' to air trappin'; leadin' to maldistri/ution of 'ases*
Body will compensate over distension of thoracic cavity
Barrel chest
Predisposin' factorA
1* Smo:in'
#* Aller'y
3* Air pollution
6* 2i'h ris: , elderly &a/ove <%yo(
%* 2ereditary 1 anti trypsin to release elastase for recoil of alveoli*
S)S4A
1* Consistent productive cou'h
#* +yspnea at rest with prolon'ed e4piratory 'runt , due terminal
3* Anore4ia & 'eneraliDed /ody malaise
6* Barrel chest
%* -ales) rhonchi
<* Bronchial wheeDin'
=* +ecrease tactile fremitus &should have vi/ration( , palpation , NEEO* +ecreased with air or fluid
!* -esonance to hyperresonance , percussion
E* +ecreased or diminished /reath sounds on affected lun's
1F* Patho'nomonicA /arrel chest , increase post) anterior diameter of chest
11* Pursed lip /reathin' , to eliminated CO#
1#* Flarin' of alai nares) ala nasi
+ia'nosisA
1* Pulmonary function test , decrease vital lun' capacity
#* AB5 ,
a*( Panlo/ular ) centri lo/ular emphysema
pCO# increase
pO# decrease , hypo4ema resp acidosis Blue /loaters , Chronic /ronchitis
/*( Panacinar) Centriacinar
pCO# decrease
pO# increase , hypera4emia resp al:alosis Pin: puffers
Nursin' @'tA
1* CB-
#* @eds ,
a*( Bronchodilators
/*( Corticosteroids prone to infection
c*( Antimicro/ial a'ents
d*( @ucolytics) e4pectorants
e*( Antipyretics P-N
Patient is prone to develop an infection
3* O# , $ow inflow , to avoid rsp arrest
6* Force fluids
%* 2i'h fowlers
<* Ne/iliDe & suction
=* .nstitute
P , posture
3 , end
3 , e4piratory to prevent collapse of alveoli
P , pressure
!* 2"
a*( Avoid smo:in'
/*( Prevent complications
1*( Cor pulmonale , - ventricular hypertrophy
#*( CO# narcosis , lead to coma
3*( Atelectasis
6*( Pneumothora4 , air in pleural space
E* Adherence to meds
1F* 3ncoura'e deep /reathin' and cou'hin' e4ercises
11* +ietA increase C2O; +2ON; vitamins and minerals
1#* .mportance of follow up care
-3S"-.C".03 $BN5 +.SO-+3-
PNEUM),&)RAD , partial ) or complete collapse of lun's due to entry or air in pleural space*
"ypesA
1* Spontaneous pneumothora4 , entry of air in pleural space without o/vious cause*
e'* -upture of /le/ &alveoli filled sacs( in pt with inflammed lun' conditions
<#
#* Open pneumothora4 , air enters pleural space throu'h an openin' in chest wall
Sta/) 'un shot wound
3* "ension Pneumothora4 , air enters plural space with Z inspiration & can?t escape leadin' to over distension of thoracic
cavity resultin' to shiftin' of mediastinum content to unaffected side*
3'* Flail chest , Nparado4ical /reathin' patternO
Predisposin' factorsA
1* Chest trauma
#* .nflammatory lun' conditions
3* "umor
S)S4A
1* Sudden sharp chest pain
#* une4plained +yspnea or SOB
3* Cyanosis
6* +iminished or decreased /reath sound of affected lun'
%* Cool moist s:in initial si'n of shoc:
<* @ild restlessness) apprehension; an4iety
=* -esonance to hyperresonance
!* decreased tactile fremitus
+ia'nosisA
1* AB5 , pO# decrease ,
#* CK- , confirms pneumothora4) collapse of lun'
Nursin' @'tA
1* Assist in endotracheal intu/ation
#* Assist in thoracenthesis
3* Administer meds , @orphine SO6 , due to pain
Anti micro/ial a'ents due to /acteria
6* Assist in test tu/e thoracotomy attached to 2#O sealed draina'e system
Purpose of 2#O sealed draina'e
1* -esta/lish &( pressure in the lun's lun' <1#mm 2'
#* Promote ree4pansion of the lun's
3* +rain fluid; /lood and air
6* "o prevent reflu4 of /lood fluid and air
Nursin' @'t if pt is on CP" attached to 2#O draina'e
1* @aintain strict aseptic techniCue
#* +B3
3* At /edside
a*( Petroleum 'auDe pad if dislod'ed 2emostat
/*( .f with air lea:a'e , clamp
c*( 34tra /ottle
6* @eds , @orphine SO6
Antimicro/ial
%* @onitor & assess for oscillation fluctuations or /u//lin'
a*( .f &L( to intermittent /u//lin' means normal or intact
2#O rises upon inspiration
2#o 'oes down upon e4piration
/*( .f &L( to continuous; remittent /u//lin'
1* Chec: for air lea:a'e
#* Clamp towards chest tu/e
3* Notify @+
c*( .f &( to /u//lin'
1* Chec: for loop; clots; and :in:
#* @il: towards 2#O seal
3* .ndicates ree4pansion of lun's
6* Auscultate for /reath sounds; Krays
%* -emoval of C""
8hen will @+ remove chest tu/eR
1* .f &( fluctuations
#* &L( Breath sounds
3* CK- , full e4pansion of lun's
Nursin' @'t of removal of chest tu/e
1* 3ncoura'e +B3
#* .nstruct to perform 0alsalva maneuver for easy removal; to prevent entry of air in pleural space*
3* Apply vaselinated air occlusive dressin'
@aintain dressin' dry & intact
6* PrepareA 34tra /ottle; e4cellent clamp; petroleum 'auDe
GI,
.* Bpper alimentary canal function for di'estion
a* @outh
/* Pharyn4 &throat(
c* 3sopha'us
d* Stomach site of di'estion
e* 1
st
half of duodenum
..* @iddle Alimentary canal , FunctionA for a/sorption
Complete a/sorption , lar'e intestine
<3
a* #
nd
half of duodenum for a/sorption
/* TeHunum
c* .leum
d* 1
st
half of ascendin' colon
...* $ower Alimentary Canal , FunctionA elimination
a* #
nd
half of ascendin' colon for elimination
/* "ransverse for complete a/sorption^ $ .
c* +escendin' colon
d* Si'moid
e* -ectum
.0* Accessory Or'an
a* Salivary 'land
/* 0erniform appendi4
c* $iver
d* Pancreas , auto di'estion
e* 5all/ladder , stora'e of /ile
.* Salivary 5lands
1* Parotid , /elow & front of ear
#* Su/lin'ual
3* Su/ma4illary
Produces saliva , for mechanical di'estion
1;#FF 1;%FF ml)day saliva produced
$acrimal 'land depression on the frontal /one
$acrimal duct outer canthus
PAR),I,IS , NmumpsO , inflammation of parotid 'land
Paramy4ovirus
S)S4A
1* Fever; chills anore4ia; 'eneraliDed /ody malaise
#* enlar'ed parotid 'land
3* Swellin' of parotid 'land
6* +yspha'ia
%* 3arache , otal'ia
@ode of transmissionA +irect transmission & droplet nuclei
.ncu/ation periodA 16 , #1 days
Period of communica/ility , 1 wee: /efore swellin' & immediately when swellin' /e'ins*
Nursin' @'tA
1* CB-
#* .nstitute a strict respiratory isolation
3* @edsA anal'esic
Antipyretic
Anti/iotics , to prevent # complications
6* Alternate warm & cold compress at affected part &vine'ar promotes coolin'(
%* 5eneral liCuid to soft diet
<* Complications
8omen , cervicitis; va'initis; oophoritis
Both se4es , menin'itis & encephalitis) reason why anti/iotics is needed
@en , orchitis mi'ht lead to sterility if it occurs durin' ) after pu/erty*
03-N.FO-@ APP3N+.K , -t iliac or -t in'uinal area
Function , lymphatic or'an , produces 8BC durin' fetal life ceases to function upon /irth of /a/y
APENDICI,IS , inflamation of verniform appendi4
Predisposin' factorA
1* @icro/ial infection
#* Feacalith , undi'ested food particles , tomato seeds; 'uava seeds
3* .ntestinal o/struction
S)S4A
1* Patho'nomonic si'nA &L( re/ound tenderness
#* $ow 'rade fever; anore4ia; n)v
3* +iarrhea &) or constipation
6* Pain at -t iliac re'ion @CBB-N3J?S point , site of sur'ical incision
%* $ate si'n due pain , tachycardia
+ia'nosisA
1* CBC , mild leu:ocytosis , increase 8BC
#* P3 , &L( re/ound tenderness &fle4 -t le'; palpate -t iliac area , re/ound(
3* Brinalysis^&L( acetone in urine
"reatmentA appendectomy #6 , 6%
Nursin' @'tA
1* Secure consent
#* -outinary nursin' measuresA
<6
a*( S:in prep
/*( NPO
c*( Avoid enema , lead to rupture of appendi4
3* @edsA
Antipyretic
Anti/iotics
7+on?t 'ive anal'esic , will mas: pain
Presence of pain means appendi4 has not ruptured*
6* Avoid heat application , will rupture appendi4*
%* @onitor 0S; .&O /owel sound
<* @aintain a patent .0 line
ComplicationsA
Peritonitis; Septicemia
Nursin' @'tA post op
1* .f &L( to Penrose drain , indicates rupture of appendi4
Position affected side to drain
#* @edsA anal'esic due post op pain
Anti/iotics; Antipyretics P-N
3* @onitor 0S; .&O; /owel sound N /or/ory'my sound
6* @aintain patent .0 line
%* Complications peritonitis; septicemia
$iver , lar'est 'land
Occupies most of ri'ht hypochondriac re'ion
ColorA scarlet red; /rown shiny and transparent
Covered /y a fi/rous capsule , 5lisson?s capsule
Functional unit , liver lo/ules
FunctionA
1* Produces /ile
Bile , emulsifies fats^2#O and /ile salts1 cholesterol
-i'ht sided painA Cholelithiasis easy /ruisin'
$eft sided painA Pancreatitis
Composed of 2#O & /ile salts
5ives color to urine , uro/ilin
Stool color , stecho/ilin
#* +eto4ifies dru's
3* Promotes synthesis of vit A; +; 3; I fat solu/le vitamins &needs fat for a/sorption(
2ypervitaminosis , vit + & I
0it A , retinol
+ef 0it A , ni'ht /lindness
0it + , cholecalciferon
2elps calcium
-ic:ets; osteoarthritis
6* .t destroys e4cess estro'en hormone
%* for meta/olism
A* C2O ,
1* 5lyco'enesis , synthesis of 'lyco'ens
#* 5lyco'enolysis , /rea:down of 'lyco'en
3* 5luconeo'enesis , formation of 'lucose from C2O sources
B* C2ON
1* Promotes synthesis of al/umin & 'lo/ulin
$iver Cirrhosis , decrease al/uminU ascites and edema
Al/umin , maintains osmotic pressure; prevents edema
#* Promotes synthesis of prothrom/in & fi/rino'en
3* Promotes conversion of ammonia to urea*
Ammonia li:e /reath , fetor hepaticus
C* FA"S , promotes synthesis of cholesterol to neutral fats , called tri'lycerides
LI5ER CIRR&)SIS lost of architectural desi'n of liver leadin' to fat necrosis & scarrin'
$aennac Cirrhosis loss of architectural desi'n of the liver leadin' to fat necrosis and scarrin'
3arly si'n , hepatic encephalopathy
1* Asteri4is , flappin' hand tremors
$ate si'ns , headache; restlessness; disorientation; decrease $OC , hepatic coma*
Nursin' priority , assist in mechanical ventilation
Predisposin' factorA
+ecrease $aennac?s cirrhosis , caused /y alcoholism
1* Chronic alcoholism maHor cause
#* @alnutrition , decrease0it B; thiamin primary cause
3* 0irus ,
6* "o4icity e'* Car/on tetrachloride &CC$6(
%* Bse of hepatoto4ic a'ents
S)S4A
<%
3arly si'nsA
a*( 8ea:ness; fati'ue
/*( Anore4ia; n)v
c*( Stomatitis
d*( Brine , tea color
Stool , clay color
e*( Amenorrhea
f*( +ecrease se4ual ur'e
'*( $oss of pu/ic; a4illa hair
h*( 2epatome'aly
i*( Taundice
H*( Pruritus or urticaria
:*( +ecrease /owel sounds
#* $ate si'ns
a*( 2ematolo'ical chan'es , all /lood cells decrease
$eu:openia decrease
"hrom/ocytopenia /leedin' tendencies
Anemia decrease
/*( 3ndocrine chan'es
Spider an'iomas; 5ynecomastia
Caput medusae; Palmar errythema; loss of tortousity of the um/ilicus
c*( 5." chan'es
Ascites; /leedin' esopha'eal varices , due to portal 2PN
d*( Neurolo'ical chan'esA
hepatic encephalopathy
&e!atic ence!0a"o!at0y 9 ammonia &cere/ral to4in(
$ate si'nsA 3arly si'nsA
2eadache and diDDiness astere4is
Fetor hepaticus &flappin' hand tremors(
Confusion
-estlessness
+ecrease $OC
2epatic coma
+ia'nosisA
1* $iver enDymes increase
S5P" &A$"(
S5O" &AS"(
#* Serum cholesterol & ammonia increase
3* .ndirect or conHu'ated /iliru/in increase
6* CBC pancytopenia
%* P"" , prolon'ed /leedin'
<* 2epatic ultrasono'ram , fat necrosis of liver 'lo/ules
Nursin' @'t
1* CB-
#* -estrict Na9
3* @onitor 0S; .&O
6* 8ei'h pt daily & assess pittin' edema
%* @easure a/dominal 'irth daily , notify @+
<* @eticulous s:in care
=* +iet , increase C2O; vit & minerals* @oderate fats* +ecrease C2ON
8ell /alanced diet
!* Complications of liver cirrhosisA
a*( Ascites , fluid in peritoneal cavity
Nursin' @'tA
1* @edsA $oop diuretics , 1F , 1% min effect
#* Assist in a/dominal paracentesis aspiration of fluid
0oid /efore paracentesis to prevent accidental puncture of /ladder as trochar is inserted
b8$ /"ee#in- eso!0a-ea" varices
+ilation of esopha'eal veins
1* @edsA 0it I
Pitressin or 0asopressin &.@(
#* N5" decompression lava'e
5ive /efore lava'e , ice or cold saline solution
@onitor N5" output
3* Assist in mechanical decompression
.nsertion of Sen'sta:enBlac:emore tu/e to decompress veins of esopha'usto prevent esopha'eal
varices
3 lumen typed catheter
Scissors at /edside to deflate)decompress /alloon* Prep scissors when pt complains of +OB
c*( 2epatic encephalopathy ,
1* Assist in mechanical ventilation , due coma
#* @onitor 0S; neuro chec:
<<
3* Siderails , due restless
6* @eds , $a4atives , to e4crete ammonia &$actulose(
&EPA,I,IS Haundice &icteric sclera(
Biliru/in
Iernicterus) hyper/iliru/inia
.rreversi/le /rain dama'e
Pancreas , mi4ed 'land &e4ocrine & endocrine 'land(U found /ehind the stomach
PANCREA,I,IS , acute or chronic inflammation of pancreas leadin' to pancreatic edema; hemorrha'e & necrosis due to auto
di'estion &selfdi'estion(*
Bleedin' of pancreas Cullen?s si'n on um/ilical area
Predisposin' factorsA
1* Chronic alcoholism
#* 2epato/ilary disease
3* O/esity
6* 2yperlipidemia
%* 2yperparathyroidism
<* +ru's , "hiaDide diuretics;aspirin; pills; Pentamidine 2C$ &Pentam( for clients with A.+S;
=* +iet , increase saturated fats
S)S4A
1* Severe $t epi'astric pain , radiates from /ac: &flan: area &left upper Cuadrant(
A''ravated /y eatin'; accompanied /y +OB
#* N)0
3* "achycardia
6* Palpitation due to pain
%* +yspepsia )indi'estion
<* +ecrease /owel sounds
=* &L( Cullen?s si'n ecchymosis of um/ilicus hemorrha'e
!* &L( 5rey "urner?s spots , ecchymosis of flan: area
E* 2ypocalcemia
+ia'nosisA
1* Serum amylase & lipase , increase
#* Brine lipase , increase
3* Serum Ca , decrease
Nursin' @'tA
1* @eds
a*( Narcotic anal'esic @eperidine 2cl &+emerol(
+on?t 'ive @orphine SO6 ,will cause spasm of sphincter*
/*( Smooth muscle rela4ant) anti choliner'ic
34* Papavarine 2cl
Prophantheline Bromide &Profanthene(
c*( 0asodilator , N"5
d*( Antacid , @aalo4
e*( 2# receptor anta'onist -anitidin &Pantac( to decrease pancreatic stimulation
f*( Ca , 'luconate
#* 8ithold food & fluid , a''ravates pain
3* Assist in ,ota" Parentera" Nutrition (,PN$ or hyperalimentation
Complications of "PN
1* .nfection^maintain a strict aseptic techniCue
#* Pulmonary 3m/olism^chec: all connection to system
3* 2yper'lycemia
6* 2yper:alemia
6* .nstitute stress m't tech
a*( +B3
/*( Biofeed/ac:
%* Comfy position Inee chest or fetal lie position
<* .f pt can tolerate food; 'ive increase C2O; decrease fats; and moderate C2ON
=* ComplicationsA Chronic hemorrha'ic pancreatitis; Peritonitis; Septicemia; Shoc:
5A$$B$A++3- , stora'e of /ile , made up of cholesterol*
C&)LEC4S,I,ISC C&)LELI,&IASIS , inflammation of 'all/ladder with 'allstone formation*
Predisposin' factorA
1* 2i'h ris: , women 6F years old
<=
#* Post menopausal women , under'oin' estro'en therapy
3* O/esity
6* Sedentary lifestyle; prolon'ed immo/ility
%* 2yperlipidemia
<* Neoplasm
=* O/struction
S)S4A
1* Severe -i'ht a/dominal pain &after eatin' fatty food(* Occurrin' especially at ni'ht
1 epi'astric or ri'ht a/dominal Cuadrant after eatin' a heavy meal
#* Fat intolerance
3* Anore4ia; n)v; feelin' of fullness
6* Taundice
%* Pruritus
<* 3asy /ruisin'
=* "ea colored urine
!* Steatorrhea
+ia'nosisA
1* Oral cholecysto'ram &or 'all/ladder series( confirms presence of 'all stones
#* .ncreased indirect /iliru/in
3* .ncreased al:aline phosphatase
6* increased serum and amylase
Nursin' @'tA
1* @eds , a*( Narcotic anal'esic @eperdipine 2cl , +emerol
/*( Anti choliner'ic)Antispasmodic Atropine SO6
c*( Anti emetic
Phener'an , PhenothiaDide with anti emetic properties
d( Broad spectrum anti/iotics
#* +iet , increase C2O; moderate C2ON; decrease fats
3* @eticulous s:in care
6* Sur'eryA Cholecystectomy
Nursin' @'t post cholecystectomy
@aintain patency of "tu/e intact & prevent infection
Stomach , widest section of alimentary canal
T shaped structures
1* Anthrum
#* Pylorus
3* Fundus
0alves , prevent 53-+
1* 1*cardiac sphincter valve
#* Pyloric sphincter valve stomach and first half of duodenum
Cells
1* Chief) Pymo'enic cells , secrets
a*( 5astric amylase di'est C2O) su'ars
/*( 5astric lipase , di'est fats
c*( Pepsin , C2ON
d*( -ennin , di'ests mil: products
#* Parietal ) Ar'entaffin ) o4yntic cells
FunctionA
a*( Produces intrinsic factor , promotes rea/sorption of vit B1# cyanoco/alamin , promotes maturation of -BC
/*( Secrets 2cl acid , aids in di'estion
3* 3ndocrine cells Secretes 'astrin , increase 2cl acid secretion
Function of the stomach
1*@echanical di'estion
#*Chem*
3*Stora'e of food
C2O; C2ON stored 1 # hrs* Fats , stored # , 3 hrs
PEP,IC ULCER DISEASE 2 (PUD( , e4coriation ) erosion of su/mucosa & mucosal linin' due toA
a*( 2ypercecretion of acid , pepsin
/*( +ecrease resistance to mucosal /arrier
.ncidence -ateA
1* @en , 6F , %% yrs old
#* A''ressive persons) type A personality
3* 2ereditary
6* 3motional Stress
Predisposin' factorsA
1* 2ereditary
#* 3motional
3* Smo:in' , vasoconstriction , 5." ischemia
6* Alcoholism , stimulates release of histamine 1 Parietal cell release 2cl acid 1 ulceration
%* Caffeine , tea; soda; chocolate
<* .rre'ular diet
=* -apid eatin'
<!
!* Blcero'enic dru's , NSA.+S; aspirin; steroids; indomethacin; i/uprofen
.ndomethacin S)3 corneal cloudiness* Needs annual eye chec: up*
NSA.+ and steroids1 'astropathy
E* 5astrin producin' tumor or 'astrinoma , Pollin'er 3llisons syndrome
1F* @icro/ial invasion , helico/acter pylori* @etronidaDole &Fla'yl(
"ypes of ulcers
Ascendin' to severity
1* Acute , affects su/mucosal linin'
#* Chronic , affects underlyin' tissues , heals & forms a scar; deeper
Accordin' to location
1* Stress ulcer
#* 5astric ulcer
3* +uodenal ulcer , most common
Stress ulcers , common amon' eritically ill clients
# types
1* Curlin'?s ulcer , causeA trauma & Burns
2ypovolemia
5." schemia
+ecrease resistance of mucosal /arriers to 2cl acid
Blcerations
#* Cushin'?s ulcer , cause , stro:e)C0A) head inHury
.ncrease va'al stimulation
2yperacidity
Blcerations
"reatmentA 0a'otomy done to prevent hemorrha'e and shoc: prior to sur'ery on the stomach

5AS"-.C B$C3- +BO+3NA$ B$C3-
S."3 Antrum or lesser curvature +uodenal /ul/
PA.N 3F min , 1 hr after eatin'
epi'astrium
'aseous & /urnin'
not usually relieved /y food &
antacid
#3 hrs after eatin'
mid epi'astrium
crampin' & /urnin' pain
usually relieved /y food & antacid
1# @N , 3am pain
2JP3-S3C-3".ON Normal 'astric acid secretion .ncreased 'astric acid secretion
0O@.".N5 common Not common
23@O--2A53 hematemesis @elena
8" 8t loss 8t 'ain
CO@P$.CA".ONS a* stomach cancer
/* hemorrha'e
a* perforation
2.52 -.SI <F years old and a/ove #F years old and a/ove
EFE%G are cases ofduodenal ulcers less /icar/onate ions; decrease so increase incidence
+ia'nosisA
1* 3ndoscopic e4am
#* Stool from occult /lood &L(
3* 5astric analysis , 5astric BlcerA normal 'astric acid secretion
+uodenalA increased 'astric acid secretion
6* 5. series , confirms presence of ulceration
Nursin' @'tA
1* +iet , /land; non irritatin'; non spicy
#* Avoid caffeine & mil:) mil: products
.ncrease 'astric acid secretion
3* Administer meds
a*( Antacids
AAC
A"uminum containin- antaci#s @a'nesium containin' antacids
34* aluminum hydro4ide 'el e4* mil: of ma'nesia
&Ampho'el( S)3 diarrhea
S)3 constipation
@aalo4 &fever S)3(
<E
/*( 2# receptor anta'onist
34
1* -anitidine &Pantac( S3A fever
#* Cimetidine &"a'amet(^hastens the effect of oral anticoa'ulants
3* Famotidine &Pepcid( S3A fever
Avoid smo:in' , decrease effectiveness of dru'
Nursin' @'tA
1* Administer antacid & 2# receptor anta'onist &Cimetidine( , 1hr apart
Cemetidine decrease antacid a/sorption & vise versa
c*( Cytoprotective a'ents
34
1* Sucralfate &Carafate( Provides a paste li:e su/s that coats mucosal linin' of stomach
#* @isoprostol &Cytotec( ,S3A menstrual spottin'
d*( Sedatives) "ranCuiliDers 0alium; lithium
e*(Anticholiner'ics ) Antispasmodic
1* Atropine SO6
#* Prophantheline Bromide &Profanthene(

&Pt has history of hpn crisis with peptic ulcer disease* -n should not administer al:a seltDer has lar'e amount of Na*
3* Sur'eryA su/total 'astrectomy Partial removal of stomach
Billroth . &5astroduodenostomy(
-emoval of _ of stomach & anastomoses of 'astric stump
to the duodenum*
Billroth .. &5astroHeHunostomy(
-emoval of _ 3)6 of stomach & duodenal /ul/ & anastomostoses of
'astric stump to HeHunum*
Before sur'ery for B. or B.. +o va'otomy &severin' of va'us nerve( & pyloroplasty &draina'e( first*
Nursin' @'tA
1* @onitor N5" output or draina'e immediately post op /ri'ht red
a*( .mmediately post op should /e /ri'ht red
/*( 8ithin 3< 6!h , output is yellow 'reen
c*( After 6!h , output is dar: red due to 2Cl acid
#* Administer medsA
a*( Anal'esic
/*( Anti/iotic
c*( Antiemetics
3* @aintain patent .0 line
6* 0S; .&O & /owel sounds
%* ComplicationsA
a*( 2emorrha'e , hypovolemic shoc:
$ate si'ns , anuria
/*( Peritonitis
c*( Paralytic ileus , most feared
d*( 2ypo:alemia
e*( "hromo/phle/itis
f*( Pernicious anemia
'*( Septicemia
=*(Dum!in- syn#rome , common complication , rapid 'astric emptyin' of hypertonic food solutions , C2J@3 leadin' to
hypovolemia*
S4 of +umpin' syndromeA
1* +iDDiness
#* +iaphoresis
3* +iarrhea
6* Palpitations
Nursin' m'tA
1* Avoid fluids in chilled solutions; sweets &fluids must /e ta:en after meals(
#* Small freCuent feedin's< eCually divided feedin's
3* +iet , decrease C2O; moderate fats & C2ON
6* Flat on /ed 1% 3F minutes after C feedin'
DI5ER,ICULI,ISCDI5ER,ICUL)SIS
1* +iverticulum an outpouchin' of the intestinal mucosa particularly the si'moid colon
#* +iverticulosis multiple diverticulum
3* +iverticulitis inflammation of diverticula
A* Predisposin' Factors
1* 2i'h -is: 5roups men &6F6%yo(
#* Con'enital wea:ness of muscle fi/ers of the intestine*
3* low rou'ha'e and fi/er in the diet
S)SA
1* .ntermittent lower left a/dominal Cuadrant pain; particularly in the rectosi'moid area
#* tenderness
3* alternatin' /outs of constipation or diarrhea with /lood or mucous
+4A
1* Barium enema^reveals inflammatory process
#* CBC revealsA decreased hematocrit and hemo'lo/in
Ns' @'tA
=F
1* Administer meds as orderedA
a* anti/iotics
/* /ul: la4atives
c* stool softeners
d* anti spasmodic a'ents
#* .nstruct clients to ta:e foods hi'h in fi/er if there is diverticulosis
3* @onitor for si'ns of infection
Feared complicationsA Peritonitis
6* Assists in sur'ical procedure
-esection of the diseased /owel and creation of a colostomy
/URNS , direct tissue inHury caused /y thermal; electric; chemical & smo:e inhaled &"3CS(
Nursin' Priority , infection &all :inds of /urns(
2ead /urnpriority a)w
#
nd
priority for 1
st
& #
nd
pain
#
nd
priority for 3
rd
F&3
"hermal direct contact , flames; hot 'rease; sun/urn*
3lectric; , wires
Chem* , direct contact , corrosive materials acids
Smo:e , 'as ) fume inhalation
Sta'esA
1* 3mer'ent phase , -emoval of pt from cause of /urn* +etermine source or loc or /urn
#* Shoc: phase , 6! =#* CharacteriDed /y shiftin' of fluids from intravascular to interstitial space
12ypovolemia
S)S4A
BP decrease
Brine output
2- increase
2ct increase
Serum Na decrease
Serum I increase
@et acidosis
3* +iuretic) Fluid remo/iliDation phase 3 to % days* -eturn of fluid from interstitial to intravascular space
6* -ecovery) convalescent phase , complete diuresis* 8ound healin' starts immediately after tissue inHury*
ClassA
.* Partial Burn
1* 1
st
de'ree , superficial /urns
Affects epidermis
CauseA thermal /urn
Painful
-edness &erythema( & /lanchin' upon pressure with no fluid filled vesicles
#* #
nd
de'ree , deep /urns
Affects epidermis & dermis
Cause ,chem* /urns
very painful
3rythema & fluid filled vesicles &/listers(
.. Full thic:ness Burns
1* "hird & 6
th
de'rees /urn
Affects all layers of s:in; muscles; /ones
Cause , electrical
$ess painful
+ry; thic:; leathery wound surface , :nown as 3SC2A- , devitaliDed or necrotic tissue*
Assessment findin's
-ule of nines
2ead & nec: 1 EG
Ant chest 1 1!G
Post chest 1 1!G
Z Arm ELE 1 1!G
Z le' 1!L1! 1 1!G
5enitalia) perineum1 1G
"otal 1FFG
Nursin' @'t
1* @eds
a*( "etanus to4oid /urn surface area is source of anaero/ic 'rowth , Claustridium tetany
"etany
"etanolysin tetanospasmin
2emolysis muscle spasm
/*( @orphine SO6
=1
c*( Systemic anti/iotics
1* Ampicillin
#* Cephalosporin
3* "etracyclin
6* "opical anti/iotic A
1* Silver SulfadiaDene &silvadene(
#* Sulfamylon
3* Silver nitrate
6* Povidone iodine &/etadine(
#* Administer isotonic fluid sol & C2ON replacements
3* Strict aseptic techniCue
6* +iet , increase C2O; increase C2ON; increase 0it C; and increase I oran'e
%* .f &L( to /urns on head; nec:; face Assist in intu/ation
<* Assist in hydrotherapy
=* Assist in sur'ical wound de/ridement* Administer anal'esic 1% , 3F minutes /efore de/ridement
!* ComplicationsA
a*( .nfection
/*( Shoc:
c*( Paralytic ileus due to hypovolemia & hypo:alemia
d*( Curlin'?s ulcer , 2# receptor anta'onist
e*( Septicemia /lood poisonin'
f*( Sur'eryA s:in 'raftin'
GU, , 'enitourinary tract
FunctionA
1* Promote e4cretion of nitro'enous waste products
#* @aintain F&3 & acid /ase /alance
1* Iidneys , pair of /ean shaped or'an
$ocated retroperitonially &/ac: of peritoneum( on either side of verte/ral column* 3ncased in Bowmans?s capsule*
PartsA
1* -enal pelvis , pyelonephritis , inflammation of the renal pelvis
#* Corte4
3* @edulla
Nephrons , /asic livin' unit of the :idneys consistin' of 'lomerulus
5lomerulus , filters /lood 'oin' to :idneys
Function of :idneysA
1* Brine formation
#* -e'ulation of BP
Brine formation , #%G of total CO &Cardiac Output( is received /y :idneys &3;FFF<;FFF ml*(
1#%ml) min filtered /y the 'lomerulus S 5lomerular filtration rate
1* Filtration
#* "u/ular -ea/sorption^1#6ml of ultra filtered are rea/sor/ed in the /lood
3* "u/ular Secretion 1 ml is e4creted in the urine
Filtration , Normal 5F-) min is 1#% ml of /lood
"u/ular rea/sorption , 1#6ml of ultra infiltrates &2#O & electrolytes is for rea/sorption(
"u/ular secretion , 1 ml is e4creted in urine
Causes of C-FA
1* 2PN
#* +@
-e'ulation of BPA
Predisposin' factorA
34 CS , hypovolemia , decrease BP 'oin' to :idneys
Activation of -AAS
-elease of -enin &hydrolytic enDyme( at Hu4ta'lomerular apparatus
An'iotensin . mild vasoconstrictor
An'iotensin .. vasoconstrictor
Adrenal corte4 increase CO increase P-
Aldosterone
.ncrease BP
.ncrease Na &
2#O rea/sorption
=#
2ypervolemia
Breters , #% , 3% cm lon'; passa'eway of urine to /ladder
Bladder , loc /ehind symphisis pu/is* @uscular & elastic tissue that is distensi/le
Function , reservoir of urine
1#FF , 1!FF ml , Normal adult can hold
#FF , %FF ml , needed to initiate micturition refle4
Color , am/er
Odor , aromatic
Consistency , clear or sli'htly tur/id
p2 , 6*% , !
Specific 'ravity , 1*F1% , 1*F3F
8BC) -BC , &(
Al/umin , &(
3 coli , &(
@ucus thread , few
Amorphous urate &(
Brethra , e4tends to e4ternal surface of /ody* Passa'e of urine; seminal & va'inal fluids*
8omen 3 , % cm or 1 to 1 _ N
@ale , #Fcm or !O
U,I
C4S,I,IS , inflammation of /ladder
Predisposin' factorsA
1* @icro/ial invasion , 3* coli
#* 2i'h ris: , women
3* O/struction
6* Brinary retention
%* .ncrease estro'en levels
<* Se4ual intercourse
S)S4A
1* Pain , flan: area
#* Brinary freCuency & ur'ency
3* Burnin' upon urination
6* +ysuria & hematuria
%* Fever; chills; anore4ia; 'en /ody malaise
<* Nocturia
+ia'nosisA Brine culture & sensitivity !FG of the cases are &L( to 3* coli
Nursin' @'tA
1* Force fluid , #FFF ml1 to prevent /acterial multiplication
#* 8arm sitD /ath , to promote comfort
3* @onitor & assess for 'ross hematuria
6* @onitor and assess urine for color; odor; and /leedin' N p2A 6*!
%* Acid ash diet , cran/erry; vit C OT to acidify urine & prevent /acterial multiplication
<* @edsA systemic anti/iotics
Ampicillin
Cephalosporin
Sulfonamides , cotrimo4aDole &Bactrim(
5antrism &'anthanol(
Amino'lycosidesA 5entamycin
Brinary antiseptics , Nitrofurantoin &@acrodantin(
Brinary anal'esic Pyridum
<* 2t
a*( .mportance of 2ydration
/*( 0oid after se4 &male and female(
c*( Female , avoids cleanin' /ac: & front
Bu//le /ath; "issue paper; Powder; perfume
d*( ComplicationsA
Pyelonephritis
P4EL)NEP&RI,IS , acute) chronic infl of 1 or # renal pelvis of :idneys leadin' to tu/ular destruction; interstitial a/scess
formation*
$ead to -enal Failure
Predisposin' factorA
1* @icro/ial invasion &Bacterial(
a*( 3* Coli
/*( Streptococcus
#* Brinary retention )o/struction
3* Pre'nancy
6* +@
=3
%* 34posure to renal to4ins or nephroto4ic a'ents
S)S4A
Acute pyelonephritis
a*( Costoverti/ral an'le pain; tenderness
/*( Fever; anore4ia; 'en /ody malaise
c*( Brinary freCuency; ur'ency
d*( Nocturia; dysuria; hematuria
e*( Burnin' upon urination
Chronic Pyelonephritis
a*( Fati'ue; wt loss; wea:ness
/*( Polyuria; polydypsia
c*( 2PN
+ia'nosisA
1* Brine culture & sensitivity , &L( 3* coli & streptococcus
#* Brinalysis
&L( 8BC; &L(-BC; &L( Pus cells
3* Cystoscopic e4am , urinary o/struction
Nursin' @'tA
1* Provide CB- , especially durin' acute phase
#* Force fluid
3* Acid ash diet
6* Provide a warm sitD /ath for comfort
%* @edsA
a*( Brinary antiseptic , nitrofurantoin &macrodantin(
S3A peripheral neuropathy
5. irritation
2emolytic anemia
Stainin' of teeth
/*( Brinary anal'esic , Pyridium
#* Complication -enal Failure
NEP&R)LI,&IASISC UR)LI,&IASIS formation of stones at urinary tract
calcium ; o4alate; uric acid
mil: ca//a'e anchovies
cran/erries or'an meat
nuts tea nuts
chocolates sardines
Predisposin' factorsA
1* +iet , increase Ca & o4alate
#* 2ereditary , 'out
3* O/esity
6* Sedentary lifestyle
%* 2yperparathyroidism
S)S4A
1* -enal colic
#* Cool moist s:in &shoc:(
3* Burnin' upon urination
6* 2ematuria
%* Anore4ia; n)v
+ia'nosisA
1* .0P , intravenous pyelo'raphy* -eveals location of stone
#* IBB , reveals location of stone
3* Cytoscopic e4am urinary o/struction
6* Stone analysis , composition & type of stone
%* Brinalysis , increase 3BC; increase C2ON
Nursin' @'tA
1*Force fluid
#*Strain urine usin' 'auDe pad
3*8arm sitD /ath , for comfort
6*Alternate warm compress at flan: area
%* a*( Narcotic anal'esic @orphine SO6
/*( Allopurinol &Pyeoprim(
c*( Patent .0 line
d*( +iet , if L Ca stones , acid ash diet
.f L o4alate stone , al:aline ash diet &34 mil:) mil: products(
.f L uric acid stones , decrease or'an meat ) anchovies sardines
<* Sur'ery
a*( Nephectomy , removal of affected :idney
$itholapo4y , removal of 1)3 of stones Stones will recur* Not advised for pt with /i' stones
/*( 34tracorporeal shoc: wave lithotripsy
Non invasive
+issolve stones /y shoc: wave
=6
=* ComplicationsA -enal Failure
/ENIGN PR)S,A,IC &4PER,R)P&4 enlar'ed prostate 'land leadin' to
a*( 2ydro ureters , dilation of ureters
/*( 2ydronephrosis , dilation of renal pelvis
c*( Iidney stones Stone formation -enal failure
d*( -enal failure
encircles the nec: of the /ladder
decreased form of urinary stream
Caurse is un:nown
Predisposin' factorA
1* 2i'h ris: , %F years old & a/ove
<F , =F , &3 to 6 4 at ris:(
Prostate cancerA 6F years old & a/ove
#* .nfluence of male hormone
S)S4A
1*+ecrease force of and amount of urinary stream
#*+ysuria
3*2ematuria
6*Burnin' upon urination
%*"erminal dri//lin'^early si'n of BP2
<*Bac:ache
=*Sciatica
!* 2esitancy
+ia'nosisA
1* +i'ital rectal e4am , enlar'ed prostate 'land
#* IBB , urinary o/struction
3* Cystoscopic e4am , o/struction
6* Brinalysis , increase 8BC; C2ON; -BC
Nursin' @'tA
1* Prostatic messa'e , promotes evacuation of prostatic fluid
#* $imit fluid inta:e
3* Provide catheteriDation
6* Provide a warm sitD /ath for comfort
%* @edsA
a* "eraDoDine &hytrin( -ela4es /ladder sphincter; rela4es the smooth muscle of urinary sphincter
S)3A 2A; hypotension
/* Fenasteride &Proscar( Atrophy of Prostate 5land &'iven after meals(
S)3A N&0; Anore4ia
%* Sur'eryA Prostatectomy , "B-P "ransurethral resection of Prostate No incision
8ithout incisionA for de/ilitated clients
Assist in cystoclysis or continuous /ladder irri'ation*
ComplicationA
1* 2emorrha'e
#* Brinary o/struction
3* Penile dysfunction
Nursin' m'tA
c* @onitor si'ns and symptoms of infection
d* @onitor symptoms 'ross) fran: /leedin'* Normal /leedin' within #6h*
3* @aintain irri'ation or tu/e patent to flush out clots to prevent /ladder spasm & distention
ACU,E RENAL 6AILURE , sudden immo/ility of :idneys to e4crete nitro'enous waste products & maintain F&3 /alance
due to a decrease in 5F-* &N 1#% ml)min(
Predisposin' factorsA
Pre renal cause decrease /lood flow
CausesA
1* Septic shoc:
#* 2ypovolemia
3* 2ypotension decrease flow to :idneys
6* C2F
%* 2emorrha'e
<* +ehydration &chronic diarrhea(
.ntrarenal cause , involves renal patholo'y1 :idney pro/lem
1* Acute tu/ular necrosis
#* Pyelonephritis
3* 2PN
6* Acute 5lumerulonephritis
Post renal cause , involves mechanical o/struction
CausesA
1* Brinary strictures
#* Brolithiasis
3* BP2
6* Presence of tumors
Sta'esA
=%
77.* O$.5B-.C S"A53 &1# wee:s(
involves passa'e of urine M 6FFml)day
S)SA
a* 2yper:alemia arrhythmia
/* 2ypernatremia
c* 2yperphosphatemia
d* 2ypocalcemia
e* 2i'h BBN 1F#F and creatinine *!1
f* @eta/olic acidosis 1#w:s
..* +.B-3".C P2AS3 #3 wee:s
increased amount of urine
S)SA
a* 2ypo:alemia
/* 2yponatremia
c* @eta/olic Acidosis
d* .ncreased Creatinine and BBN
...* CON0A$3SC3N")-3CO03-J P2AS3^E1# months
C&R)NIC R6 , irreversi/le loss of :idney function
Predisposin' factorsA
1* +@
#* 2PN
3* -ecurrent B".) nephritis) pyelonephritis
6* 34posure to renal to4ins
Sta'es of C-F
1* +iminished -eserve 0olume , asymptomatic
Normal BBN & Crea; 5F- M 1F , 3FG
#* -enal .nsufficiency
3* 3nd Sta'e -enal disease
S)S4A
1*( Brinary System
a*( polyuria
/*( nocturia
c*( hematuria
d*( +ysuria
e*( oli'uria
#*( @eta/olic distur/ances
a*( aDotemia &increase BBN & Crea(
/*( hyper'lycemia
c*( hyperinulinemia
3*( CNS
a*( headache
/*( lethar'y
c*( disorientation
d*( restlessness
e*( memory impairment
6*( 5."
a*( n)v
/*( stomatitis
c*( uremic /reath
d*( diarrhea) constipation
%*( -espiratory
a*( Iassmaul?s resp
/*( decrease cou'h
refle4
<*( hematolo'ical
a*( Normocytic anemia
/leedin' tendencies
=*( Fluid & 3lectrolytes
a*( hyper:alemia
/*( hypernatermia
c*( hyperma'nesemia
d*( hyperposphatemia
e*( hypocalcemia
f*( met acidosis
!*( .nte'umentary
a*( itchiness) pruritus
/*( uremic frost
E*( Cardiovascular chan'es
a* 2PN
/* C2F
c* Pericarditis
Nursin' @'tA
1* 3nforce CB-; reverse isolation
#* @onitor strictly 0S; .&O; neurochec:; monitor for si'ns of hypocalcemia
3* @eticulous s:in care* Bremic frost , assist in /athin' pt
6* @edsA
a*( Na 2CO3 , due 2yper:alemia
/*( Iaye4elate enema
c*( Anti 2PN , 2ydralaDine &Apresoline(
d*( 0it & minerals &@ultivitamins(
e*( Phosphate /inder
&Ampho'el( Al O2 'el S)3 constipation
f*( +ecrease Ca , Ca 'luconate
%* Assist in hemodialysis
1*( Consent) e4plain procedure
#*( 8ei'h patient
3*( O/tain /aseline data & monitor 0S /efore and durin' C3Fmins; .&O; wt; /lood e4am
6*( 3ncoura'e patient to void
%*( Strict aseptic techniCue
<*( @onitor for si'ns of complicationsA
B , /leedin' &due to heparin(
3 , em/olism
+ , diseCuili/rium syndrome
S , septicemia
=<
S , shoc: , decrease in tissue perfusion
+iseCuili/rium syndrome , from rapid removal of urea & nitro'enous waste prod leadin' toA
a*( n)v
/*( 2PN
c*( $e' cramps
d*( +isorientation
e*( Paresthesia
#* Avoid BP ta:in'; /lood e4traction; .0; at side of shunt or fistula* Can lead to compression of fistula*
3* @aintain patency of shunt /yA
i* Palpate for thrills & auscultate for /ruits if &L( patent shunt9
ii* Bedside /ulldo' clip
.f with accidental removal of fistula to prevent em/olism*
.nfersole &diastole( , common dialisate used
=* Complication
Peritonitis &most feared(
Shoc:
.nflow timeA 1F#Fmins
.ndwellin' timeA 3F6% mins
!* Assist in sur'eryA
-enal transplantation A Complication , reHection &feared complication(* -everse isolation
-eHection time in Acute^<mos to 1 year
-eHection time in Chronic^%1F years
E4ES
34ternal parts
1* Or/ital cavity , made up of connective tissue protects eye form trauma*
#* 3O@ , e4trinsic ocular muscles , involuntary muscles of eye needed for 'aDin' movement*
3* 3yelashes) eye/rows , esthetic purposes
6* 3yelids , palpe/ral fissure , openin' upper & lower lid* Protects eye from direct sunli'ht
@ei/omean 'land , secrets a lu/ricatin' fluid inside eyelid
/*( Stye) sty or 2ordeolum inflamed @ei/omean 'land
%* ConHunctiva
<* $acrimal apparatus , tears

Process of -rievin-
a* +enial
/* An'er
c* Bar'ainin'
d* +epression
e* Acceptance
#* .ntrinsic coat
.* sclerotic coat , outer most
a*( Sclera , white* Occupies ` post of eye* -efracts li'ht rays
/*( Canal of schlera , site of aCueous humor draina'e
c*( Cornea , transparent structure of eye
..) Bveal tract , nutritive care
Bveitis , infl of uveal tract
Consist ofA
a*( .ris , colored muscular rin' of eye
# muscles of irisA
1* Circular smooth muscle fi/er Constricts the pupil
#*radial smooth muscle fi/er +ilates the pupil
# cham/ers of the eye
1* Anterior
a*( 0itereous 2umor , maintains spherical shape of the eye
/*( ACueous 2umor , maintains intrinsic ocular pressure
Normal .OP1 1##1 mm2'
..* -etina &innermost layer(
i* Optic discs or /lind spot , nerve fi/ers only
No auto receptors
cones &dayli'ht) colored vision( rods , ni'ht twili'ht vision
phototopic vision Nscotopic visionO 1 vit A deficiency , rods insufficient
ii* @aculla lutea , yellow spot center of retina
iii* Fovea centralis , area with hi'hest visual acuity oracute vision
Physiolo'y of vision
6 Physiolo'ical processes for vision to occurA
==
1* -efraction of li'ht rays , /endin' of li'ht rays
#* Accommodation of lens
3* Constriction & dilation of pupils
6* Conver'ence of eyes
Bnit of measurements of refraction , diopters
Normal eye refraction , emmetropia
3--O- of refraction
1* @yopia , near si'htedness , "reatmentA /iconcave lens
#* 2yperopia) or farsi'htedness , "reatmentA /iconve4 lens
3* Asti'matisim , distorted vision , "reatmentA cylindrical
6* Pre/yopia , Nold sli'htO , inelasticity of lens due to a'in' , "reatmentA /ifocal lens or dou/le vista
Accommodation of lenses , /ased on thelmholtD theory of accommodation
Near vision 1 far vision1
Ciliary muscle contracts1 ciliary muscle dilates ) rela4es1
$ens /ul'es lens is flat
Conver'ence of the eyeA
3rrorA
1* 34otropia , 1 eye normal
#* 3sophoria , corrected /y corrective eye sur'ery
3* Stra/ismus sCuint eye
6* Am/lyopia , prolon' sCuintin'
GLAUC)MA , increase .OP , if untreated; atrophy of optic nerve disc , /lindness
Predisposin' factorsA
1* 2i'h ris: 'roup , 6F & a/ove
#* 2PN
3* +@
6* 2ereditary
%* O/esity
<* -ecent eye trauma; infl; sur'ery
"ypeA
1* Chronic , &open an'le 5*( , most common type
O/struct in flow of aCueous humor at tra/ecular meshwor: of canal of schlema
#* Acute &close an'le 5*( , @ost dan'erous type
Forward displacement of iris to cornea leadin' to /lindness*
3* Chronic &closed , an'le( Precipitated /y acute attac:
S)S4A
1* $oss of peripheral vision , tunnel vision
#* 2alos around li'hts
3* 2eadache
6* n)v
%* Steamy cornea
<* 3ye discomfort
=* .f untreated , 'radual loss of central vision , /lindness
+ia'nosisA
1* "onometry , increase .OP S1# #1 mm2'
#* Perimetry , decrease peripheral vision
3* 5onioscopy , a/struction in anterior cham/er
Nursin' m'tA
1* 3nforce CB-
#* @aintain siderails
3* Administer meds
a*( @iotics , lifetime contracts ciliary muscles & constricts pupil* 34 Pilocarpine Na &Car/achol(
/*( 3pinephrine eye drops , decrease secretion of aCueous humor
c*( Car/onic anhydrase inhi/itors* 34* acetapolamide &+iamo4(
Promotes increase out flow of aCuaeous humor
d*( "emoptics &"imolol maleate( .ncrease outflow of aCuaous humor
#* Sur'eryA
.nvasiveA
a*( "ra/eculectomy , eyetrephinin' , removal of tra/elar meshwor: of canal or schlera to drain aCueous humor
/*( Peripheral .ridectomy , portion of iris is e4cised to drain aCueous humor
NoninvasiveA
"ra/eculoctomy &eye laser sur'ery(
Nursin' @'t pre op all types sur'ery
1* Apply eye patch on unaffected eye to force wea:er eye to /ecome stron'er*
=!
Nursin' @'t post op , all types of sur'ery
:8 Position unaffected) unoperated side to prevent tension on suture line*
*8 Avoid valsalva maneuver
;8 @onitor sym!toms of I)P
a*( 2eadache
/*( n)v
c*( 3ye discomfort
d*( "achycardia
*8 3ye patch , /oth eyes post op
CA,ARAC, , partial) complete opacity of lens
Predisposin' factorA
1* EFE%G a'in' &de'enerative) senile cataract(
#* Con'enital
3* Prolon'ed e4posure to B0 rays
6* +@
S)S4A
1* $oss of central vision N2aDy or /lurrin' of visionO
#* Painless
3* @il:y white appearance at center of pupil
6* +ecrease perception of colors
+ia'nosisA Opthalmoscopic e4am , &L( opacity of lens
Ns' @'tA
1* -eorient pt to environment , due opacity
#* Siderails
3* @eds , a*( @ydriatics , dilate pupil , not lifetime
34* @ydriacyl
c*( Cyslope'ics , paralyDes ciliary muscle* 34* Cyclo'ye
6* Sur'ery
3 , e4tra
C capsular
C , cataract partial removal of lens
$ lens
3 , e4traction
. intra
C capsular
C , cataract total removal of lens & surroundin' capsules
$ lens
3 , e4traction
Nursin' @'tA
1*Position unaffected) unoperated side to prevent tension on suture line*
#*Avoid valsalva maneuver
3*@onitor sym!toms of I)P
a*( 2eadache
/*( n)v
c*( 3ye discomfort
d*( "achycardia
6*3ye patch , /oth eyes post op
RE,INAL DE,AC&MEN, separation of # layers of retina
Predisposin' factorsA
1* Severe myopia , nearsi'htedness
#* +ia/etic -etinopathy
3* "rauma
6* Followin' lens e4traction
%* 2PN
S)S4A
1* NCurtain ,veilO li:e vision
#* Flashes of li'hts
3* Floaters
6* 5radual decrease in central vision
%* 2eadache
=E
+ia'nosis opthaloscopic e4am
Nursin' @'tA
1* Siderails &all visual disease(
#* Sur'eryA
a*( Cryosur'ery
/*( Scleral /uc:lin'
3A- ,
1* 2earin'
#* Balance &Iinesthesia or position sense(
PartsA
1* Outer
a*( Pinna) auricle , protects ear from direct trauma
/*( 34t* auditory meatus , has ceruminous 'land* Cerumen
c*( "ympanic mem/rane , transmits sound waves to middle ear
Disor#ers of outer ear
3ntry of insects , put flashli'ht to 'ive route of e4it
Forei'n o/Hects , /eans &/rin' to @+(
2#O drain
#* @iddle ear
a*( 3ar osssicle
1* 2ammer malleus
#* Anvil .ncus for /one conduction disorder conductive hearin' loss
3* Stirrups stapes
/* 3ustachian tu/e Opens to allow eCualiDation of pressure on /oth ears
Jawn; chew; and swallow
Children , strai'ht; wide; short
c*( Otitis media
Adult , lon'; narrow & slanted
c* @uscles
1* Stapedius
#* "ensor tympani
3* .nner ear
a* Bony la/yrinth , for /alance; vesti/ule
Btricle & succule
Otolithe or ear stone , has Ca car/onate
@ovement of head 1 -i'htin' refle4 1 Iinesthesia
/* @em/ranous $a/yrinth
1* Cochlea , & function for hearin'( has or'an of corti
#* 3ndolymph & perilymph , for static eCuili/rium
3* @astoid air cells , air filled spaces in temporal /one in s:ull
Complications of @astoditis , menin'itis
"ypes of hearin' lossA
1* Conductive hearin' loss , transmission hearin' loss
CausesA
a*( .mpacted cerumen , tinnitus & conduction hearin' loss assist in ear irri'aton
/*( .mmo/ility of stapes , O"OSC$3-OS.S
d*( @iddle ear disease char /y formation of spon'y /one in the inner ear causin' fi4ation or immo/ility of stapes
e*( Stapes can?t transmit sound waves
Sur'ery
Stapedectomy , removal of stapes; spon'y /one & implantation of 'raft) ear prosthesis
Predisposin' factorA
1* Familiar tendency
#* 3ar trauma & sur'ery
S)S4A
1* "innitus
#* Conductive hearin' loss
+ia'nosisA
1* Audiometry , various sound stimulates &L( conductive hearin' loss
#* 8e/er?s test , Normal ACS BC
result BC S AC
!F
Sta!e#ectomy
Nursin' @'t post op
1* Position pt unaffected side
#* +B3
No cou'hin' & /lowin' of nose
Ni'ht lead to removal of 'raft
3* @edsA
a*( Anal'esic
/*( Antiemetic
c*( Antimotion sic:ness a'ent* 34* meclesine 2cl &Bonamine(
6* Assess , motor function , facial nerve &Smile; frown; raise eye/row(
%* Avoid shampoo hair for 1 to # wee:s* Bse shower cap
SENS)R4 NEURAL &EARING L)SSC NER5E DEA6NESS
CauseA
1* "umor on cocheal
#* $oud noises &'un shot(
3* Pres/ycusis , /ilateral pro'ressive hearin' loss especially at hi'h freCuencies , elderly
Face elderly to promote lip readin'
6* @eniere?s disease , endolymphatic hydrops
f*( .nner ear disease char /y dilation of endo , lympathic system leadin' to increase volume of endolin
Predisposin' factor of MENIERE'S DISEASE
Smo:in'
2yperlipidemia
3F years old
O/esity , &L( chosesteatoma
Aller'y
3ar trauma & infection
S)S4A
1* "-.A+ symptoms of @eniere?s disease
a*( "innitus
/*( 0erti'o
c*( Sensory neural hearin' loss
#* Nysta'mus
3* n)v
6* @ild apprehension; an4iety
%* "achycardia
<* Palpitations
=* +iaphoresis
+ia'nosisA
1* Audiometry , &L( sensory hearin' loss
Nursin' m'tA
1* Comfy & dar:ened environment
#* Siderails
3* 3metic /asin
6* @edsA
a*( +iuretics ,to remove endolymph
/*( 0asodilator
c*( Antihistamine
d*( Antiemetic
e*( Antimotion sic:ness a'ent
f*( Sedatives) tranCuiliDers
%* -estrict Na
<* $imit fluid inta:e
=* Avoid smo:in'
!* Sur'ery , endolymphatic sac decompression Shunt
I5 N),ES
Clindamycin; ICl111NO" for .0 push^it may cause arrhythmia
Chloramphenicol111NO" for .@
Procaine; Penicillin; BenDatine; Pen 5; 0ancomycin 2Cl; Acyclovir &Povira4( 111NO" for .0
Opened /ottles must /e used in ! hours
2ep $oc: flush with NSS
ICl M !FmeC)$
3pinephrine 1A1F;FFF
$idocaine 6 m' )ml &1')#%Fml(
CO@PA".B$3 8."2 PNSS ON$J
Phenytoin
0it I
0it B<
0it C
2ydralaDine
Furosemide
!1
CO@PA".B$3 8."2 +%8 ON$J
3pinephrine
Norepinephrine
3phedrine
+opamine
+o/utamine
Nitroprusside
Na2CO3
Not to /e diluted in $-
Penicillin 5
Ampicillin
Cephalosporin
Na2CO3
P-BC^to /e infused within #6hours
FFP^11*% hours
Platelet concentrate^infuse immediately and Cuic:ly
Patho'nomonic si'nA
Pernicious Anemia red /eefy ton'ue
Car/on mono4ide poisonin' cherry red face
Addison?s +isease /ronDe pi'mentation of s:in
Cushin'?s syndrome /uffalo hump
Bulimia Nervosa chipmun: face
$iver Cirrhosis spider an'ioma & Caput medusae
$eprosy lion face
S$3 /utterfly rash on face
3mphysema /arrel chest
Par:inson?s , pill rollin' tremors
@yasthenia 5ravis ptosis & +escendin' paralysis
5BS Ascendin' paralysis clumsiness
@enin'itis nuchal ri'idity* Ierni'?s & BrudDins:is si'n
2ypoparathyroidism "rousseau si'n & Chvostec: si'n
Pancreatitis Cullen?s si'n & 5rey "urner?s si'n
+IA Acetone /reath odor & Iussmaul?s respiration
An'ina Pectoris $evine?s si'n
Pneumonia rusty sputum
Chronic /ronchitis Blue /loaters
Asthma Pin: puffers
Appendicitis re/ound tenderness
5laucomaloss of peripheral vision "unnel vision
Cataract $oss of central vision
-etinal detachmentCurtainveil li:e vision
+ecreased dopamine Par:inson?s disease
.ncreased dopamine SchiDophrenia
+ecreased acetylcholine @yasthenia 5ravis ) AlDheimer
.ncreased acetylcholine Bipolar
Autoimmune diseases
@ultiple Sclerosis 2ypothyroidism Acute 5lomerulonephritis
@yasthenia 5ravis 2yperthyroidism
5BS Pernicious Anemia
Apparatus needed at /edsideA
Acetaminophen to4icity Acetylcisteine* Prepare suction apparatusacetylcysteine causes outpourin' of secretions*
@yasthenia 5ravis tracheostomy set* For respiratory arrest*
2emodyalisis /ulldo' clip
Sen:sta:en tu/e scissors to deflate /alloon*
5uillain Barre Syndrome tracheostomy set* For respiratory arrest*
Convulsion suction apparatus* .ncreased secretions*
2yperthyroidism tracheostomy set* For laryn'eal spasm post su/total thyroidectomy complication*
5oiter tracheostomy set* For laryn'eal spasm post su/total thyroidectomy complication*
2ypoparathyroidism tracheostomy set* For laryn'eal spasm*
.solation precautionsA
Cushin'?s synd , reverse isolation due to increased corticosteroid in /ody*
Aplastic anemia , reverse isolation due to /one marrow depression*
Cancer any type , reverse isolation , immunocompromised*
Post liver transplant , reverse isolation , ta:es steroids lifetime*
Prolon'ed use steroids , reverse isolation
@enin'itis , strict respiratory isolation , safe after #6h of anti/iotic therapy
"B strict respiratory isolation
!#
!3