MEDICAL-SURGICAL NURSING REVIEW

Course Outline

I. II. III.

Client in Pain Perioperative Nursing Care Alterations in Human Functioning a. Disturbances in Oxygenation: Respiratory & Cardiovascular Functions

IV. V.

Disturbances in Musculoskeletal Functions Client in Biologic Crisis: Life threatening Conditions of the Human Body - Shock Emergency & Disaster - First-aid and Cardiopulmonary Support

b. c. d. e. f. g.

Disturbances in Metabolic and Endocrine Functions Disturbances in Elimination: Gastrointestinal Problems Disturbances in Fluids and Electrolytes: Renal & Genitourinary Functions Disturbances in Cellular Functioning: Cancer and Hematologic Problems Disturbances in Auditory & Visual Functions

I.

-------------------------------------------------------------------------------------------------------------------------------------CLIENT IN PAIN

Pain – the fifth vital sign an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Basic Categories of Pain: 1. Acute Pain – sudden pain which is usually relieved in seconds or after a few weeks.

2. 3.

Chronic Pain (Non-Malignant) – constant, intermittent pain which usually persists even after healing of the injured tissue Cancer-Related Pain- May be acute or chronic; may or may not be relieved by medications

Pain Transmission: 1. Nociceptors are called pain receptors. These are the free nerve endings in the skin that respond to intense, potentially damaging stimuli. 2. Peripheral Nervous System 3. Central Nervous System 4. Descending Control System Factors Influencing Pain Response 1. Past Experience – e.g. trauma 2. Anxiety and Depression 3. Culture - beliefs

4. 5.
6.

Age – infants are more sensitive Gender Placebo Effect

Characteristics of Pain 1. Intensity –mild, moderate, excruciating

2.
3.

4. 5. 6. 7.

Timing – morning or evening, duration may be longer or shorter Location Quality – burning, aching, stabbing Personal Meaning to pain – tolerance to pain may be different from one person to the other due to some personal reasons such as economic reasons, work condition, etc. Aggravating and Alleviating factors – patient’s environment Pain Behaviors - facial expressions with pain

Pain Assessment 1. Evaluate: Cause, Location, Character and Intensity 2. Numeric Pain Scale – 5-severe pain - 0 – no pain 3. Descriptive Pain Scales – mild, moderate, severe 4. Visual Analogue Scales 5. Faces Pain Scale Nurse’s Role in Pain Management 1. Identify goals for Pain management a. Decrease intensity, duration or frequency b. Factors in identifying goals: i. Severity of pain

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ii. iii. 2.

Harmful effects of pain to the client Duration of the pain

3.

Establish Nurse-Patient Relationship and Teaching a. Acknowledge the verbalization of pain by the client b. Relieve patient’s anxiety c. Teach measures how to relieve pain Provide Physical care a. Teach and assist in self-care b. Environmental conditions c. Application of ice/heat on painful area Manage anxiety related to Pain a. Teach about the nature of pain that may be felt by the client and reassure him/her b. Teach alternative measures to relieve pain c. Stay with the client/ frequent communication with the client Pain Medications may be administered as:

4.

5.

a.
b.

c.
d.

e.
6.

Balanced Anesthesia – given to avoid experiencing pain PRN – “Pro Re Nata” – as needed Preventive – taken before pain is felt Individualized Dosage Patient-Controlled Analgesia (PCA) – patient takes medication if pain felt is becoming intolerable

Non-pharmacologic Interventions a. Cutaneous Simulation and Massage b. Ice and heat therapies c. Transcutaneous Electrical Nerve Stimulation d. Distraction e. Relaxation Techniques f. Guided Imagery g. Hypnosis

II.

PERIOPERATIVE CARE o Phases of Perioperative Nursing a.

b.
c. A.

Pre-operative Nursing Inraoperative Nursing Post-operative Nursing

Pre-operative Care Pre-admission and Admission Test 1. Psychological support 2. Client Education: a. Importance and practice of breathing exercises b. Location & support of wound c. Importance of early ambulation d. Inform and practice leg exercises, positioning, turning e. Anesthesia and analgesics f. Educate regarding drains and dressings to be received post-op g. Recovery room policies and procedures 3. Informed consent a. At least 18 years of age b. In sound mind- without psychologic disorder c. Not under the influence of drugs or alcohol d. Immediate relative over 18 years old Physical Assessment and preparation a. Physical Preparation – NPO, remove dentures, jewelries, clothesetc.

4.

b. c. d. e. f.

Nutritional & Fluid Status – should be well hydrated Drug or alcohol Use – may experience delirium or intoxication to anesthetic drugs because ormal doses do not usually take effect to these patients and require heavier dose to achieve anesthetic effect. Respiratory Status - teach breathing exercises Cardiovascular Status – should have controlled and stable cardiovascular functioning before operation to prevent intraoperative problems Hepatic & Renal Functions – normal functioning is important in absorbing anesthetic drugs

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g. h. i. j. 5. 6.
Semi-Fowlers

Endocrine Functions- important in monitoring to hypo/hyperglycemia, thyrotoxicosis, acidosis Immune Functions – allergies esp. to anesthetic drugs

prevent

Psychosocial Factors – emotional and psychological preparation to ensure cooperation fom the patient with the procedures Spiritual & Cultural Beliefs - blood transfusions, transplants, ligation, etc are against other culture & religion.

Pre-operative drugs – given 20-60 mins.pre-operative o Makes patient drowsy, keep siderails up Proper positioning HOB elevated at 30 degrees HOB elevated at 45 degrees Head injury, pot-op cranial surgery, post-op cataract removal, increased ICP, dyspneic patients Head injury, pot-op cranial surgery; post-op abdominal surgery; post-op thyroidectomy, post-op cataract surgery, increased ICP; dyspnea Pneumothorax, hiatus hernia Spinal cord injury, urinary catheterization Amputation of legs/feet, post lumbar puncture, post myelogram, post tonsillectomy & adenoidectomy (T&A) Post-abominal surgery, post tonsillectomy & adenoidectomy (T&A), post-liver biopsy ( right side down), post pyloric stenosis (right) Unconscious client

Fowlers

High-Fowler’s Supine/ Dorsal Recumbent

HOB elevated at 90 degrees Lying on back w/ small pillow under head Lying on abdomen with head turned to the side

Lateral / Side lying

Lying on side, weight on the lateral side, the lower scapula and lower iliac. Lying on side, weight on the clavicle, humerus and anterior aspect of the iliac. Lying on back with knees and legs bent and raised on a stir up

Perineal, rectal & vaginal procedures

Trendelenburg Reverse Tredelenburg Elevate extremity

Head & body lowered, feet elevated Head elevated , feet lowered Support with pillows

Shock Cervical traction Post-op surgical procedure on extremity, cast, edema, thrombophlebitis

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Prone Supine Lateral Recumbent

Sim’s Position

Reverse Trendelenburg

High-Fowler’s

Jack-Knife

Lithotomy

B.

Intra-operative Care

1.

Ensure sterility of all instruments and supplies at the operating field Principle: STERILE TO STERILE, CLEAN TO CLEAN
Sterile objects touches only sterile surfaces/objects Clean objects touches only clean surfaces/objects

Sterilization techniques: o Autoclave – Steam, Ethyl Oxide (Gas) o Glutaraldehyde Solution- Cidex

2.
3.

Ensure safety of client in the operating table- prevent falls, drape the patient properly, provide warmth Stay with the client to relieve anxiety and support during anesthesia Anesthesia Administration:

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a. b. c. d.

General Anesthesia via Inhalation General Anestheisia via Intravenous Regional Anesthesia - local anesthesia Conduction Blocks/ Spinal Anesthesia – Epidural & Spinal Block - for operation below the waist line - patient is awake during operation

4. 5. 6. 7. C.

Perform sponge count, instrument count and needle count Aseptic technique in handling and preparing all instruments and supplies Applies grounding device to prevent electrical burn during use of electrosurgical equipment Proper documentation Post-operative Care 1. Immediate assessment of VS, and Neuro VS, drainages, surgical dressing 2. Monitoring of vital signs q 15mins until stable 3. Post-operative positioning depending on the procedure performed

4.
5. 6.

Deep breathing exercises Early ambulation Health teaching for Independent (self) care upon discharge

III. ALTERATIONS IN HUMAN FUNCTIONING
1. DISTURBANCES IN OXYGENATION Arterial Blood Gas Normal Value pH pCO2 Measure of acidity or alkalinity Partial pressure of carbon dioxide parameter influenced by lungs only respiratory 7.35 – 7.45 35 -45

pO2

Partial pressure of oxygen; measure of amount oxygen delivered to lungs Bicarbonate, metabolic parameter influenced only by metabolic factors

80-100

HCO3

22-26

Respiratory Acidosis pH pCO2 Normal Compensation HCO3

Normal Value 7.35 – 7.45 35 -45 22-26

Respiratory Alkalosis

Normal Compensation

a. Administer NaHco3 b. Get rid of CO2 c. Bronchodilators d. Monitor ABG

Nursing Intervention

a. Breathe into paper bag or cupped hands b. Oxygen

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Give NAHCO3 via IV Normal Value 7. Antibiotics 5. Promote good air exchange c. Keratogenic diet. Adequate rests 4. renal failure. Oxygen therapy at 2LPM – use cautiously Nursing Management: 1. excessive exercise) b. infection.with or without sputum production CHRONIC BRONCHITIS “Blue Bloater” An inflammation of the bronchi which causes increased mucus production and chronic cough.increased mucus production that obstructs airway 3. systemic infections.35 – 7. more tenacious mucus Slight gynecomastia Petechiae in midsternal area Dyspnea 120 . gastric suction. excessive diuretic Nursing Intervention CHRONIC OBSTRUCTIVE PULMONARY DISEASE - A group of conditions assoc. Administer meds and O2 as ordered 2. 2. alkali ingestion. w/ chronic obstruction of airflow entering or leaving the lungs Major diseases 1. Steroids 4. Avoid allergens or other irritants 5.45 Metabolic Alkalosis Normal Compensation 35 -45 22-26 Restore fluid loss which may be cause by vomiting. diarrhea. pollution Clinical Manifestations:   Productive cough Thicker.Metabolic Acidosis pH Normal Compensation pCO2 HCO3 a. Psychological Support Clinical Manifestations:  Few words between breaths  Pursed-lip breathing  Cyanosis  Distended neck veins  Barrel chest – increased diameter of thorax  Pulsus paradoxus –  Clubbing of fingers  Nicotine Stains  Pitting edema  exertional dyspnea or dyspnea at rest  Enlarged pulsating liver  Cough. Cause: Cigarette Smoking. 4. Expectorants 6. Asthma Cause: 1. Antihistamines 3. Bronchodilators 2. 3. Pulmonary Emphysema – airway is obstructed due to destroyed alveolar walls 2. Cigarette smoking Chronic respiratory infections Family history of COPD Air pollution Medical Management: 1. Chronic Bronchitis. Chronic condition is diagnosed if symptoms occur for 3 months and for 2 consecutive years. Diabetic acidosis. Promote adequate activities to enhance cardiovascular fitness 3. Treat underlying cause (Starvation.

aerosol Complication: STATUS ASTHMATICUS . crackles  Pallor. persistent cough  (+) wheezes. Antibiotics 3. Promote pulmonary ventilation Facilitate expectoration Health teaching  Breathing techniques  Stress management  Avoid allergens     Chronic barrel chest. 3. combined immunologic and non-immunologic Nursing Management: Clinical Manifestations:  Increased tightness of chest. diaphoresis 1. 3. Wheezes 5. usually >35 y/o Mixed. hacking. 2. Tachypnea 3. elevated shoulders distended neck veins orthopnea Tenacious. Promote Breathing techniques EMPHYSEMA “Pink Puffer” A disorder where the alveolar walls are destroyed causing permanent distention of air spaces. Dyspnea on exertion 2. Alpha-anti-trypsin deficiency (an enzyme in the alveolar walls) Clinical Manifestations: 1. O2. dyspnea  Tachycardia. 3. pollens. Reduce or avoid irritants 2. Bronchodilators. Shallow rapid respirations 7. (+) dead areas in the lungs that do not participate in gas or blood exchange Cause: Cigarette smoking.  Decreased exercise tolerance Wheezes Medical Management: see COPD Nursing Management: 1. nebulization. Postural drainage 6. mucoid sputum Treatment: 1. Administer medications as ordered 4.a life-threatening asthmatic attack in w/c symptoms of asthma continues and do not respond to treatment II. Family history of asthma 2. Chest physiotherapy 5. Steroids. Air pollution 5. Stress Types: 1. Secondary smoke inhalation 4. Barrel-chest 4. Immunologic asthma - occurs in childhood Non-immunologic asthma occurs in adulthood and assoc w/ recurrent resp infections. Allergens: dust. 2. expectorants 4. Pinkish skin color 6. tachypnea  Dry. 2. Pursed lip breathing Nursing Management: Position: Sit up and lean forward Pulmonary toilet: Cough->Breathe deeply->Chest physiotherapy-> turn & position Frequent rest periods Nebulization IPPB – Intermittent Positive Pressure Breathing (aerosolized inhalation) O2 @ 2LPM Asthma -A condition where there is an increase responsiveness and/or spasm of the trachea and bronchi due to various stimuli which causes narrowing of airways Cause and Risk Factors: 1. PARENCHYMAL DISORDERS: 121 . Increase humidity 3. cyanosis.

productive . Altered conciousness 5. rusty/ yellowish/greenish sputum. promote effective airway clearance. Smoking. elevated sedimentation rate Nursing Management:    Promote adequate ventilation. fluid congestions in the lungs. overcrowded 1. dyspnea. Aspiration 3. nausea. Age: too young and elderly are most prone to develop 2.often occurs when the left side of the heart is distended and fails to pump adequately o Clinical Manifestation: Constant irritating cough. Psychological support 5. Inhalation of irritating fumes Risk factors: 1. Administer medications TUBERCULOSIS . cyanosis Pathophysiology:  Fluid accumulation in the alveolar sacs due to hypovolemia. tetracycline. pseudomonas aeruginosa. cephalosphorin. Chest pain. Bacterial / Viral – streptococcus pneumoniae. Risk Factors: Poor living conditions. irritability. Prolonged immobility: post-operative. crackles.positioning. anorexia. apprehensiveness. increased WBC. w/ marked increase in alveolar and interstitial fluids Etiology: 1. restlessness. sputum culture. Blood culture. Tracheal intubation 6. IPPB Provide rest and comfort Prevent potential complications Health teaching: skin care. I&O 2. breathing patterns and ventilation 3. Chest physiotherapy. alveoli are congested     Nursing Management: 1. bed-ridden patients Clinical Manifestations: 1. hx of exposure Cough. URTI 4. influenza 2. 3. 2. Monitor VS 4. air pollution 3. hygiene Drug therapy: o Antibiotics: penicillin. Previous infection 122 . low sodium diet.PNEUMONIA .An inflammatory process of lung parenchyma assoc. erythromycin o Cough suppressants o Expectorants Rest and adequate activity Proper Nutrition PULMONARY EDEMA . Diuretics. splinting of affected side.A chronic lung infection that leads to consumption of alveolar tissues Etiology: Mycobacterium tuberculosis. chest retration CXR. Poor nutritional intake 2. irritability.

etc.determine the ability of the heart to affect circulation and regulatory functions of fluids and electrolytes. c. Medication regimen should be continuous and uninterrupted 5. Clotting time – 10 mins. Atherosclerosis 4. 7. PT – 9-12 sec. Read after 48-72 hrs. Mg (see fluids & electrolytes) b. Transmitted by droplet infection and not carried on articles like clothing or eating utensils 3. Diseases of the Vascular System: Arterial Disorders: 1. DIAGNOSTIC PROCEDURES: Procedure 1. Venous Disorders: 1. 5. Buerger’s Disease (Thromboangitis Obliterans) 6. e.. 7. vomiting Indigestion. 8. Sputum samples are obtained first before drug therapy is started. 3. Chloride .determines ability of the blood to form clot or thrombus Purpose Determines hyperkalemia. Regimen is usually 6 months. 6. Arteriosclerosis 3. Pyrazinamide 5. 3. Induration: 10mm – > positive exposure to TB bacillus 5 – 9 mm -> doubtful. Advise proper handwashing and use of mask for people in contact with infected persons who are not yet under treatment. Isoniazid 4. pallor 1. K.1 ml of PPD (Purified Protein Derivative) . b. Raynaud’s Disease A. Failure d. may repeat the procedure > 4 mm -> Negative 3. Laboratory Tests Values / Description a. Rifampicin 3. 4. . 9. Hypernatremia. Infarction c. Individual is generally considered not infectious after 1. Inadequate treatment of primary infection Clinical Manifestations: Diagnostic Tests: 1. Diagnostic Procedure Laboratory Test Electrocardiogram Echocardiography Central Venous Pressure Pulmonary Artery Pressure/ Swan-Ganz Cardiac Catheterization II. Streptomycin Client Education: 1. PTT – 16-40 sec. 6. 2. Regular check-up to monitor progress should be done. Ca. 2. -------------------------------------------------------------------------------------------------------------------------------------------------------CARDIOVASCULAR SYSTEM THE HEART AND MAJOR VESSELS I. 8. Angina Pectoris Myocardial Congestive heart Valvular Stenosis AV Heart Block Pacemakers 123 . Treatment: 1. e. 2. Hypertension 2. Ethambutol 2. Productive cough Hemoptysis Dypnea Rales Malaise Night Sweats Weight loss Anorexia. d.Close contact with infected person 4. Cholesterol – 150-250 mg/dl . Electrolytes – Na. Thrombophlebitis Varicose Veins Cardiac Disorders a. 4. f. Aortic Aneurysm 5.2 weeks of medication. CXR Sputum acid-fast Mantoux Test . TB is infectious but can be cured 2.

determines tissue damage in the myocardium  Determines the electrical impulse of the heart  Normal impulses ensures adequate circulation to all body organs and tissues Procedure 3.women.) > SGOT – 5-40 u/ml i. drug therapy. pericardial effusion. f. Right atrium Port d.determines the development of atherosclerosis which causes coronary artery disease .ventricles moves to a resting state Values / Description Ultrasound of the heart . Distal branches of the pulmonary artery Thermodilution Obtain blood for O2 saturation d. 4.etc  Serves as guide for fluid replacement  Monitor pressures in the right atrium and central veins  Administer blood products.Resting state of the ventricles PR interval. TPN. Swan-Ganz Catheter / Pulmonary Artery Pressure (PAP) Measures the level of pressure in the left atrium 4 Ports: a.Subclavian . thickening of myocardium. ESR.contraction of atrium until the beginning of the contraction of ventricles ST. tip is at the inferior vena cava) 5.30-135 ( rises 3-6 hrs after M.I.55-170 . Balloon Port for inflating balloon used for placement of catheter c.test of renal function. Electrocardiogram P. . Enzymes: > CPK – men.0-30. Central Venous Pressure (CVP) Normal = 5 – 10 cm Water Measures the right atrial pressure or the pressure of the greater veins within the thorax by threading a catheter into a large central vein.  Obtain venous access when peripheral veins are inadequate  To insert a temporary pacemaker  Obtain central venous samples Monitor pressure in the ff: Right ventricle Pulmonary artery e..– also rises after MI 2. Thermodilution port b.contraction of the atrium QRS complex. BUN – 6-20 mg/dl . 2-Dimensional Echocardiography (2D Echo) Purpose  Determines valvular deformities. Triglyceride – 50-250 mg/dl > LDL (bad cholesterol) – 60-180 mg/dl > HDL (good cholesterol) – 30-80 mg/dl g.Median . Pulmonary atrium port c.cardiac enzymes are present in high concentration in the myocardial tissues .Jugular .Basilic .I. 124 .contraction of the ventricles T. determines adequacy of circulation from the heart to the kidneys and its ability to excrete protein and urea h.Femoral End of catheter or Tip – positioned at the right atrium or upper portion superior vena cava (for femoral insertion.) > LDH – 150-450 u/ml (rises 12 hrs after M.

etc Regular exercise Salt restrictions Administer medications Teach risk factors 125 . To get blood samples d. Methyldopa Nursing Interventions BP monitoring Correct cause: obesity. Nephritis Endocrine problems – Thyroid problem. DISEASES OF THE VASCULAR SYSTEM: B. Detect shunts c. 3. DM Neurologic Disorders – Brain tumors. oxygen and fluids to the tissues B. palpitations. hydrochlorothizide  Adrenergic inhibitors: Propanolol. Cardiac Catheterization Catheter inserted into the right or left side of the heart and vessels and a dye is introduced Used to determine details on the structure and performance of the valves.carries oxygenated blood Veins . Arteries . fatigue. tension and pressure in the chambers of the heart b. saturation.carries unoxygenated blood Capillaries – allows the delivery of nutrients. blurred vision and epistaxis Non-pharmacologic:     Weight reduction Diet modification Alcohol & Smoking cessation Relaxation Techniques √ Sodium restriction √ Exercise √ Caffeine Restriction  Potassium. Magnesium supplements (to balance sodium and other electrolytes) Pharmacologic:  Calcium Agonist: Nifedipine. 1. 2. stress. weakness. Trauma Pregnancy-Induced HPN Many others Signs & Symptoms Treatment BP=140/90 . Measure O2 concentration. heart and circulation a.may be caused by an increase in cardiac output or increase in peripheral resistance Essential hypertension Genetic Obesity Stress Loss of elastic tissues Arteriosclerosis of aorta Secondary hypertension caused by other physiologic problems Types of Hypertension Risk Factors Secondary hypertension Renal problems – Renal Failure.most common . Determine cardiac output & pulmonary flow e. Verapamil  Vasodilators: Hydralazine  Diuretics: Aldactone. Determine need for bypass surgery Three types of Blood Vessels: 1.6.ARTERIAL DISORDERS HYPERTENSION persistent BP above 140 /90 Types of Hypertension Etiology: Essential hypertension unknown etiology . headache. Calcium. diet. dizziness. Clonidine. flushing.

c. Sometimes there aren't any noticeable symptoms until the condition has advanced to a very serious stage. and a heart attack or a stroke may result. e. and the circulation of blood through the vessels becomes difficult.Arteriosclerosis occurs when lipids in the blood. A person with clogged arteries of the heart may also have occasional difficulty in breathing and may experience unusual fatigue after short periods of exertion. a. they harden and constrict. d. b. Monitor patient for signs of rupture of aneurysm Nursing Intervention: 126 . a. c. blood pressure becomes elevated. including cholesterol. one of the first symptoms is chest pain. Psychological support b. often called angina. interfering with the normal flow of blood and oxygen throughout the body. . Medical & Surgical Interventions for Athero and Arteriosclerosis: Lifestyle Modification . e. ATHEROSCLEROSIS “Thickening” . Reduce Risk Factors Coronary Artery Bypass Graft (CABG Percutaneous Transluminal Coronary Angioplasty (PTCA) Directional Coronary Atherectomy (DCA) Intracoronary Stents Nursing Intervention: Health Teaching Reduce Risk Factors Restore Blood Supply Pre & Post-op Care for Surgical Patients AORTIC ANEURYSM Types of Aneurysm: Thoracic or Abdominal Aortic Aneurysm Risk Factors: Presence of Atherosclerosis.ARTERIOSCLEROSIS “Obstruction” . b.When the arteries become obstructed with plaque and cholesterol. d. When the arteries of the heart are affected.A degenerative condition of the arteries characterized by thickening due to localized accumulation of fats. As a result. the heart has to work harder to pump blood through the narrowed blood vessels. Predisposing factors:  cigarette smoking  high fat levels in the blood  high cholesterol  high blood pressure  obesity Signs and symptoms: The symptoms of atherosclerosis depend on the part of the body where the condition is taking place. When this happens. Infections or a Congenital abnormality Signs & Symptoms: Thoracic Aortic Aneurysm Dyspnea Dysphagia voice hoarseness Treatment: Thoracic/chest pain cough Abdominal Aortic Aneurysm (AAA) Abdominal Pain Low back pain Pulsating Abdominal Mass Surgical Removal of Aneurysm a. The term atherosclerosis refers to a condition in which fatty deposits build up in and on the artery walls. mainly cholesterol. accumulate inside the walls of blood vessels and reduce the size of the veins or arteries through which blood flows. forcing the blood through narrower passageways.

2. Serotonin release Cyanosis/pallor of the fingers when exposed to cold environment or emotional stimuli Numbness and occasional pain Bilateral or symmetrical involvement Treatment:  Nifedipine to decrease vasospasm  Avoid exposure to cold and keep hands warm  Avoid smoking Nursing Intervention  Same as buerger’s disease B. heavy smokers. numbness and tingling of toes sensitivity to cold Weak or absent pulsations at the dorsalis pedis. stasis. Increased coagulability Edema of the extremity. Back or Flank pain (scrotal pain may also occur) 3. redness. Heavy smokers. (+) Homan’s sign . Abdominal pain 2. local induration. Use of thromboembolytic (TED) stockings 127 . Thromboangitis Obliterans (TAO) Definition: Risk Factors: b. d. women with Systemic Lupus Erythematosus (SLE) or rheumatoid arthritis hypersensitivity of fingers to colds.Triad of manifestations for ruptured abdominal aneurysm: 1. spec. posterior tibial Reddish or Cyanotic extremity which may progress to ulceration or gangrene Treatment:  Calcium Channel Blockers to promote vasodilation  Rest. Pre-operative preparation d. smoking  Ensure protection of extremities against cold  Administration of medications as ordered  Protect client from injury  Assessment of extremities  RAYNAUD’S DISEASE Definition: Risk Factors: Cause: Signs & Symptoms:    Vasospasm of arteries in the hands (upper extremities only) Women. pain. pain in legs relieved by immobility. individuals spec. congenital vasospasm. Shock: Bp= >100 systolic. Nursing Intervention:  Health teaching on lifestyle modifications.calf pain upon dorsiflexion of foot Nursing Intervention: a. Vasculitis of the veins and arteries in the upper & lower extremities Men -20-35 y/o. Pulse Rate >100bpm c. hypersensitivity to intradermal injections Signs & Symptoms: a. e. c.a. Avoid exposure to cold  Surgery: Amputation of extremity is delayed until conservative treatments fail to effect.VENOUS DISORDERS: THROMBOPHLEBITIS Definition: Risk Factors: Signs & Symptoms: Clot disorder in the vein usually at the lower extremity Trauma of the blood vessels. Post-operative care: monitor peripheral circulation BUERGER’S DISEASE a. Pain Relievers.k.

b. Heparin therapy. Not a treatment. nerve damage IV.    Precipitating factor:  over exertion  eating  exposure to cold  emotional stress Classification of Symptoms: Class I – no limitations of physical activity (ordinary physical activity does not cause symptoms). obesity. tortuous veins in the legs distention. After prolonged standing  Wear thromoembolic stockings  Teach client o avoid prolong sitting or standing  Avoid cross-legs while sitting  Post-op Care after Sclerotherapy: a.    Signs and symptoms:  Patient experiences retrosternal chest discomfort Pressing. therefore severe limitations (patient may be symptomatic even at rest). Elevate legs c. back neck jaw or in the shoulders. Regular but careful exercise of the legs to promote circulation – ambulate for short periods 24-48 hrs post-op c. burning and choking sensation. hence. lengthening and totuosity of veins loss of valvular competence and constant elevation of venous pressure most commonly in the veins of the legs. Prolonged standing. Pain in the epigastrium. Class II – slight limitation of physical activity (ordinary physical activity does cause symptoms). squeezing. heaviness. infection. as ordered d. shoulders and the neck. Class IV – unable to perform any physical activity without discomfort. for cosmetic purpose only) Nursing Intervention  Elevate legs at least 30 mins. pregnancy  Surgical Management: Sclerotherapy (injection of sclerosing agent to the vein. Class III – moderate limitation of activity (patient is comfortable at rest.CARDIAC DISORDERS ANGINA PECTORIS Chest pain  insufficient coronary blood flow inadequate oxygen exchange in the heart causing intermittent chest pain can be relieved with rest. Bed rest e. Warm compress VARICOSE VEINS Definition: Cause: Risk Factors: Signs & Symptoms:     Treatment: Aching Heaviness Moderate swelling Enlarged. Radiation of pain in the arms. Assessfor complications such as bleeding. 128 . Maintain firm elastic pressure over the whole limb b. It lasts only for 1-5 minutes and taking up of nitroglycerine will be beneficial for the client. but less than ordinary activity can cause symptoms).

11. if still not relieved go to the hospital Diagnostic Assessment: a. ECG (ST elevation). arms.an irregular heart beat or pulse. pressure. crushing. Weakness and altered mental status – common in elderly patients. Neck vein distention – represents right pump failure. Help client to adjust lifestyle to prevemt angina attack – avoid excessive activity in cold weather. Dysrythmias . 4. The left arm is affected more frequently. 8. usually tachycardic. squeezing)  usually across the anterior pericardium typically is described as tightness. Radioisotope Imaging d. 9. 13. 2.    Destruction of myocardial tissue due to reduced coronary blood flow. Wheezing Nausea with or without vomiting Cold diaphoresis. c. c. Coronary Angiography Medical Management: a. 5. Stress Test c. character. Opiate Analgesic – MoSo4 Vasidilators – Nitroglygcerin. 12. 6. Rales – may be present in congestive heart failure. avoid overeating. resulting in an acute reduction of blood supply to a portion of the myocardium. or squeezing. however. exercise Teach patient how to cope with angina attack – nitroglycerin every 5 mins upto 3x. Nifedipine Beta Blocking Agents –Propanolol MYOCARDIAL INFARCTION d. Coronary Artery Embolism Signs and symptoms: 1. precipitating factors b. back. Atherosclerotic heart 2. 3. b. Isosorbide Mononitrate/Dinitrate Calcium Channel Blockers – Dlitiazem. Results from plaque rupture with thrombus formation in a coronaryvessel. and epigastrium. rest after meals. Orthopnea – sense of suffocation Nausea and/or abdominal pain.Nursing Interventions: a.gas pains around the heart Anxiety. Dyspnea. 10. avoid constipation. Causes: 1. Assess pain – location. gray facial color. Oliguria – urine less than 30 ml/hr Risk factors: 129 . neck. a patient may experience pain in both arms. The rapid development of myocardial necrosis caused by imbalance between the oxygen supply and demand of the myocardium. 7. ECG b.  Pain may radiate to the jaw. Apprehension Light headedness with or without syncope Cough . chest pain – heavy (viselike.

which augments coronary blood flow and reduces cardiac work by decreasing preload and afterload . (metoprolol) Platelet aggregation inhibitors – inhibits platelet aggregation clopidogrel (plavix) Analgesics – reduce pain which decreases sympathetic stress (morphine sulfate) 130 . (nitroglycerine) Beta-adrenergic blockers . obesity.ST-segment elevation greater than 1 mm.the presence of new Q waves. delayed enhancement (infarction). Age . Immediate emergency intervention:          IV access – thrombolytic agents e.g. heparin supplemental oxygen pulse oximetry – maintain oxygen saturation at >90% Immediate administration of aspirin en route Nitroglycerin for active chest pain. stress. diet. and wall motion abnormalities (ischemia). topically. DM. Chest Pain relief Prevention and treatment of complications. hypertension. Smoking. . -heparin) Vasodilators . or IV. CT scan Radionuclide Imaging Positron Emission Imaging Transesophageal Echocardiography Magnetic resonance imaging (MRI) . Male gender. (aspirin.reduce blood pressure. Drug of choice for patient with MI: Antithrombotic agents . which decreases myocardial oxygen demand. Type A personality DIAGNOSTICS: Lab studies:   Creatine kinase–MB (CK-MB) Myoglobin CBC .prevent the formation of thrombus and inhibit platelet function. scar. Trponin Potassium and magnesium level Creatinine level C – Reactive protein (CRP) Erythrocyte sedimentation rate (ESR) Serum lactate dehydrogenase (LDH)              - Imaging studies: Chest radiography or chest x-ray – reveals pulmonary edema secondary to heart failure. T-wave inversion.can be administered sublingually by tablet or spray. given sublingually or by spray ECG Treatment is aimed at: Restoration of balance between oxygen supply and demand to prevent further ischemia.can identify wall thinning. Sedentary lifestyle. Electrocardiogram (ECG) . intermediate probability of MI are ST-segment depression. and other nonspecific ST-T wave abnormalities. Family history.Opposes coronary artery spasm.

Anticoagulant therapy: aspirin. move tongue. Sudden loss of motor function Management: . d. 131 . A warning sign of stroke especially in first 4 weeks after TIA Causes: 1. chlorathiazide TRANSIENT ISCHEMIC ATTACK (TIA) temporary episode of neurological dysfunction lasting only a few minutes or seconds (in a day/ 24hrs) due to decreased blood flow to the brain. Sudden loss of visual function 2. a potent vasoconstrictor.All MI patients should be admitted in the ICU. Long-term drug therapy Antiarryhtmics. soft food Commode Self-care Plan for rehabilitation Exercise program Stress management Teach risk factors f.quinidine. Psychological support g. low sodium diet. avoid flexing neck Inability to swallow. Patient should remain on complete bed rest during his stay in the hospital and avoid straining activities. b. e. CONGESTIVE HEART FAILURE (CHF) Definition: inability of the heart to meet oxygen and metabolic needs of the body   2. aspirin Antihypertensives – propanolol. ruptured papillary muscles Pericarditis Recommendations: . e. rupture of the heart. a. raise arm. Give stool softener Provide low fat.Surgical Carotid Endarterectomy (bypass) 1. f.morphine Provide physical rest Administer O2 via cannula Frequent VS Nifedipine Propanolol HCL Emotional Support Later g. Early Treat arrythmias promptly – lidocaine Give analgesic. Post-op focus – assess neurologic deficits. Sudden loss of sensory function 3. low cholesterol. -captopril(capoten) Complications of MI: Dysrhytmias Cardiogenic Shock Heart Failure Pulmonary Edema Pulmonary Embolism Recurrent MI Complications due to Necrosis – VSD. d. a. c. Nursing interventions for MI 1. Atherosclerosis 2.Angiotensin converting enzyme (ACE) inhibitors – prevents conversion of angiotensin I to angiotensin II. b. lidocaine Anticoagualnt – heparin. etc. c. 2. smile may indicate problem in the specific cranial nerve. h. Microemboli from atherosclerotic plaque Manifestations: 1.

Patent Ductus Arteriosus. Cardiovascular: d. Renal Changes. pulmonary disease. hypervolemia Left Ventricular Failure Signs & Symptoms Causes Pulmonary Congestion: a. yne’s Stroke Dys Che Right Ventricular Peripheral edema Venous congestion of organs Hepatomegaly Cyanosis of the nail beds Massive swelling of the legs. Reduce pain and anxiety 3. positioning 132 . pnea b.Causes: 1. Central Nervous System: Halo around lights Diarrhea. anemia. High Peripheral Vascular Resistance 2. Cou gh. anorexia. Management:  Positioning – High fowler’s position to reduce pulmonary congestion  O2 Administration  Pharmacology: Digitalis. Eyes: b. nutritional deficiency. pregnancy. Anxiety. ACE inhibitors  Digitalis: • increases ventricular contractility • Increases ventricular emptying • Increase Cardiac output • Watch out for Digitalis toxicity Signs of Digitalis Toxicity: a. Nocturia c. Valvular stenosis. Sodium restriction 2. O2 4. Pul monary Edema g. genitals and trunk (Anasarca) f. Cer ebral hypoxia h. 3. Improve oxygenation: proper positioning. Abnormal muscle function . dysrhythmia. frequent PVC’s Headache . Lethargy Nursing Intervention: 1. abdominal cramps Bradycardia. Abnormal loading conditions . ventricular / atrial septal defect. vomiting. ventricular aneurysm Diseases that exacerbate or precipitate heart failure – Stress. Rales. cardiomyopathy. HPN. thyroid disorders. wheezing d. infection. Dopamine & Dobutamine. Reduce congestion and edema: meds.Congenital defects. fear and depression f. Fatigue. Orth opnea e. Gastrointestinal Tract: c. myocarditis. Par oxysmal Nocturnal Dyspnea f.Myocardial Infarction. Fati gue &muscular weakness i.

inserted trans thoracic. transesophageal b. transesophageal. . temporary pacing . Nursing Intervention: a. decreased cardiac output.Coumadin Management: low sodium.external. device can be held in a belt. microwave: if dizziness or tachycardia occur. device. b. transvenous.operated) that produce electrical stimuli to the heart and controls heart rate a. ask patient to move 4-6 feet away from source. Remind to wear ID-information bracelet at all times esp. c. skin breakdown Avoid high-energy radar. when traveling Care of Site: > wear loose-fitting around pace-maker > Encourage bath tubs rather than shower to protect incision site for the first 10 days > Explain that healing takes place within 3 months Treatment None Degree of Block First-degree AV Block Second-degree AV Block Atrophine Isoproterenol Ventricular Pacemaker Third-degree AV Block 133 . mitral commisurotomy Pharmacology: Anti-coagulant.used for emergency purposes. Permanent Pacemakers – internal. heat. Temporary Pacemakers . transcutaneous. sutured within the subcutaneous tissue. television. heart failure Heart valve replacement. low cholesterol diet Stenosed Nursing Intervention: same as CHF AV HEART BLOCK Definition: Altered transmission of impulse from SA node through AV node Description delayed transmission of impulse to AV node not all impulses pass through AV node No impulse pass through AV node PACEMAKERS Definition: Types: Electronic device (battery. pain.VALVULAR STENOSIS Definition: Signs & Symptoms: Treatment: Narrowing of valve which prevents blood flow or impaired closure of the valves causing regurgitation Murmurs. d. Check for signs of infection on the site: fever.

heavy. substernal. left of sternum. jaw. pressing. burning Retrosternal. radiates to one or both arms. crushing. tightness Substernal. radiates to the left arm Usually 3-5 mins duration <30 mins rest. narcotics.--- External Pacemaker Internal Pacemaker (sutured subcutaneously) Appearance of a person w/ internal pacemaker -------------------------------------------------------------------------------------------------------------------------------------------------------------Comparison of Chest Pain Angina Pectoris Myocardial Infarction • • • • • Sudden. not relieved by rest & nitroglycerin Type Location • • squeezing. Oxygen. nitroglycerin Duration Relief • • Comparison of other signs & symptoms Angina Pectoris Myocardial Infarction Transient Ischemic Attack 134 . severe. neck >30 mins.

7. mouth breathing. Urine Output & ECG • Meds: Anti-arrythmics & anticoagulants • Check for edema.PTCA. Gland DISTURBANCES IN METABOLIC & ENDOCRINE FUNCTIONING Hormone Functions 135 .C. diet. • • • • Maintain fluid & electrolyte balance / Nutrition Keep IV open. fear of impending death • Nausea Objective Data: • Symptoms of shock • Cyanosis. O2. CVP. UO Lab data: Na+135-145. • • • • • 2. exercise.Blockers 4. 3. CABG 1. Health teaching 2.5-5. anti-embolic stockings 3. • 4. • • • • Provide relief from pain: Rest Nitroglycerin Lifestyle modification Vital signs Assist w/ ambulation Provide emotional support Health teaching Pain differentiation Medication Dx test Diet. diaphoresis Sudden loss of: • Visual fxn • Sensory fxn • Motor fxn Objective Data: • Tachycardia • Pallor • Diaphoresis • Restless Objective Data: Loss of functioning about and returns normal for to Nursing Care Management Arteriosclerosis Angina Pectoris Transient Ischemic Attack 1. • 2. low cholesterol. bedside commode Provide emotional support Promote sexual functioning discuss concerns include partner resume 5-8 wks after uncomplicated MI 5. 2. vasopressors. • Monitor VS. water Meds: vasodilators.operated 2. cough. • • • • Decrease oxygen demand/ Promote oxygenation O2. Assess neurologic status Administer meds Nursing Care Management Myocardial Infarction 1. K 3. low fat Facilitate fecal elimination stool softener. Semi-fowler’s position to improve ventilation battery. • Reduce pain & discomfort: Narcotics. dyspnea. low sodium. Bedrest (24-48 hrs). rest periods Semi-fowler’s position Anticipate needs of client: call light. Cal. habits Restore blood supply Anti-embolic stockings. 1. VS. • • 8. stress mgt.0 mEq/L ECG Diet: low calorie. • Lifestyle Modification Diet. • 6. crackles • CVP: normal= 5-15cm H20 • ROM. cyanosis.Subjective Data: Dyspnea Palpitation Dizziness Faintness Subjective Data: • Shortness of breath • Apprehens ion.etc. avoid Valsalva. Stents Health teaching Modifications. Maintain adequate circulation. anti-coagulants Pre & post-op care CABG. • 3.

thus decreasing urine output Stimulates ejection of milk from mammary alveoli into the ducts: stimulates uterine contractions may possibly be involved in the transport of sperm in the reproductive tract of the female Increases metabolic activity of almost all cells. glucagons. dilates bronchioles Stimulate development of secondary sex characteristics. protein and fat catabolism. all corticoids are important for defense against stress or injury Elevates blood pressure. protein and carbohydrate metabolism Lowers serum calcium levels and elevates phosphate level. increases heart rate. increases cardiac contractility.Pituitary Gland Anterior Lobe Growth Hormone Prolactin Thyrotropic hormone (TSH) Gonadotropic hormones (LH & FSH) Adrenocorticotropic hormone (ACTH) Melanocyte-stimulating Hormone (MSH) Anti-diuretic hormones (ADH. increases tissue responsiveness to other hormones Tends to increase sodium retention and potassium excretion Governs certain secondary sex characteristics. increases resorption of bones Promotes carbohydrate. vasopressin) Oxytocin Stimulates growth of body tissues and bones Stimulates mammary tissue growth & lactation Stimulates thyroid gland Affect growth. converts glycogen to glucose when needed by muscles for energy. stimulates development of secondary sex characteristics Promotes metabolism of carbohydrates. effect repair of the endometrium after menstruation Essential for normal functioning of male reproductive organs.20% Ovaries Estrogens and progesterone Testes Testosterone Pancreas Islets of Langerhans Insulin Glucagon Somatostatin PITUITARY GLAND PROBLEMS 136 . protein and fat thus decreasing blood glucose Mobilizes glycogen stores.Salt Androgens (male hormones) -. may affect pigmentation Posterior lobe Promotes reabsorption of water by the distal tubules and collecting ducts of the kidney. maturity and functioning of primary and secondary sex organs Stimulates steroid production by adrenal cortex May stimulate adrenal cortex. secretin) Thyroid Gland Thyroxine (T4) Triiodothyronine (T3) Thryrocalcitonin Parathyroid Adrenal Cortex Controls SSS: SUGAR. SALT. SEX Parathormone (PTH) Glucocorticoids (primarily cortisol) -.Sugar Mineralcorticoids (Aldosterone) -. opposite effect from that of PTH Increases calcium levels and decreases phosphate levels. thus raising blood glucose levels Decreases secretion of insulin.Sex Medulla Epinephrine (Adrenalin)-80% Norepinephrine. growth hormone and several gastrointestinal hormones( gastrin. stimulates most aspects of fat.

Sodium Restriction c. Mental confusion 3. Weight gain 6. Polydipsia 3. Pharma: a. vomiting 1. Hypressin Nasal Spray 2. nausea. Pharmacology: a. Vasopressin Tannate – IM injections c. Avoid coughing. Assess ICP b. Fluid restriction 2. Personality changes 4. Visual problems 6. Anorexia. Surgery: Hypophysectomy-removal of the pituitary gland 3. Polyuria 2. Butorphanol Tatrate ADRENAL GLAND PROBLEMS 137 . Daily weights f. Premature body aging 3.Clinical Manifestations Acromegaly Growth Hormone IN ADULTS 1. Retarded physical growth 2. Lethargy. headache 5. Abdominal cramping 7. Maintain adequate fluids b. Slow intellectual development 1. Nursing Interventions. Enlarged extremities 2. blowing nose Gigantism Overgrowth of all body tissues and bones Growth Hormone In CHILDREN Dwarfism Growth Hormone In CHILDREN 1. Protrusion of jaw and orbit 3. Teach self-injection techniques e. Irradiation of pituitary with Bromocriptine to decrease secretion of growth hormone 2. Treat underlying causes 3. Demeclocycline administration as ordered b. Increased perspiration 5. Intake & Output monitoring d. Desmopressin Acetate nasal spray b. Dehyration 1. No increase in height and weight but hands and feet become bigger 4. Post-op Care: a. Lithium Carbonate c. sneezing. Hyperglycemia/calcemia Management 1. Same as acromegaly & gigantism Diabetes Insipidus Antidiuretic Hormone 1. Specific gravity SIADH – Syndrome of Inappropriate secretion of ADH 1. weakness. Human Growth Hormone Injection 3. a. Hyponatremia 2. Removal of cause : tumor 2. Elevate head of bed (HOB) 30 degrees c.

Hypoglycemia (60-70) 9. CHON diet 3. Nursing Mgt: Monitor BP. 10. Hypokalemia. Teach importance of lifelong medications 4. Stress Tolerance Medication: a. Anorexia. 4. Hypokalemia 1. administer meds. Diet: high CHON. dexamethasone) 2. Amenorrhea 13. Vomiting. Nursing Mgt: > protect from infection > protect from accidents > health teaching on self-medication STEROIDS: Purpose: Anti-inflammatory and anti-allergy. 2. male characteristics appear in women 11. Hyperglycemia. Personality Changes Management 1. Nursing Mgt: > High caloric diet > Adequate Rest THYROID GLAND PROBLEMS 138 . Weight loss 7. Hyperglycema 1. 7. Thin scalp Moon Face Acne Increased body hair Buffalo hump Obesity Hyperpigmentation Thin extremities Easy Bruising Mood swings. WOF Signs of Addisonian Crisis: Addisonian Crisis: Sudden profound weakness Severe abdominal.Palpitations 5. back and leg pain Hyperpyrexia followed by hypothermia Peripheral vascular collapse Shock Renal Shutdown -> Death Glucocorticoids Mineralcorticoids Sex Hormones Cushing’s Syndrome Glucocorticoids 1. HPN 2. Follow regime and do not stop abruptly c. Loss of libido 8.Apprehension 4. Diet: high CHO. vomiting 5. 5. 3. Electrolyte Imbalance 6. 9. potassium supplement 4. Osteoporosis 1. Treatment of hypertension 4. Causes gastric upset Side effects: Cushingoid Appearance Conn’s Syndrome / Aldosteronism 1.Clinical Manifestations Addison’s Disease 1. low CHO. Hypotension. hypovolemia 3. provide quiet environment Mineralcorticoids (Aldosterone) Pheochromocytoma Epinephrine/ Norepinephrine 1. Medical Management: Symptomatic (Treat symptoms as it occurs) 3. HPN 2. Increase Perspiration 3. nausea. Malaise and general weakness 2. Tachycardia 7. Potassium replacement 3. Increased pigmentation of skin 4. Observe side effects of hormone replacement – Cushingoid Appearance 4. Surgery: Removal of tumor 2. HPN 12. Headache 6. Take at the same time everyday b. Chemotherapy: Bromocriptine 3. Surgical Mgt: Adrenalectomy 2. Nausea. Surgical Mgt: Removal o tumor 2. 6. low Na diet . Monitor fluid & electrolyte 5. 8. Pharmacology: Steroids (Prednisone.

139 . vitamins without stimulants c. T4. carbohydrate. Fluid retention. Insomnia Management 1. Enlargement of the thyroid gland 3. Drug therapy: Levothyroxine. Dry. High caloric. diarrhea. Easy fatigability 7. Methimazole b. Dry skin 4. Dry skin 5. edema 4. Personality changes 5. Muscle weakness 8. diaphoresis 4. Decreased libido. Delirium d. T4. Anxiety. Radioiodine therapy 4. irregular menses Easy bruising Constipation Fatigue.protrusion of eyes 2. Thyroid Replacement (Desiccated thyroid) ** taken in empty stomach ** heart rate less than 100 bpm -ok PARATHYROID GLAND PROBLEMS Clinical Manifestations Hypoparathyroid Parathormone Management 1. Fever b. Cardiac Arrythmias 6. Propyl.Thyracil c. Surgery: Thyroidectomy 2. anorexia and constipation 2. intolerance to cold 3.Clinical Manifestations Grave’s Disease / Hyperthyroidism/ Thyrotoxicosis 1. drink w/ straw Saturated Solution of Potassium Iodide (SSKI) d. Thyrocalcitonin INFANTS 1. Tachycardia c. Thyrocalcitonin ADULT 1. Propanolol 3. Drug Therapy: a. Enlarged thyroid 1. Liothyronine Sodium 2. Irritability Cretinism T3. Physical & mental retardation 2. Iodides: Lugol’s solution – strains teeth. high protein. Thyrocalcitonin THYROID STORM: a. Poor appetite and constipated Treatment: Hormone Replacement Myxedema T3. Slow metabolism: decreased sweating. lethargy Menorrhagia. Exopthalmos. Measure daily weights d. Sensitive to cold 3. Avoid stimulus Bradycardia . T4. Drug Therapy: a. Nursing Mgt: a. Increase metabolism: weight loss. coarse skin. HPN 9. Eye protection for xopthalmos e. Adequate Rest b. Levothyroxine b. WOF: Thyroid Storm T3.

Nausea. Glipizide b. exercise. Radioactive Iodine 2. Treatment: 1. Saturated solution of Potassium Iodide. before meals to promote faster absorption of the meds 140 . Chlorpropamide Polyuria Polyphagia .for IDDM Side effects: a. Glyburide c.excessive hunger Weight Loss . Tolazamide e. Skin rashes c. Flushing e. Acetohexamide f.excessive thirst . Force fluid PANCREATIC PROBLEMS DIABETES MELLITUS Type I Insulin Dependent DM (IDDM) Other Name Age of Onset Before 30 years old but may occur at any age Onset Abrupt Incidence 10% Insulin production Little or none Insulin Injections Required Ketosis May occur Body weight at onset Ideal body weight or thin Management Diet. vomiting Administration: > usually administered 30 mins.frequent urination 2. 4. Hypoglycemia b.Hyperthyroid Parathormone Tachycardia Palpitations Increased persitalsis weight loss Heat intolerance Decreased libido Amenorrhea 1. GI disturbances d. Diet: low calcium. Oral hypoglycemics: a. Drug therapy: Prophylthiuracil Methimazole. Tolbutamide d. Polydipsia . high fiber 3. 3. hypoglycemic agent or insulin Cardinal Signs & Symptoms: 1. exercise and insulin Juvenile DM Type II Non-Insulin Dependent DM (NIDDM) Adult DM >35 y/o but can occur in children Insidious 85-90% Below normal Normal or Above normal Necessary for only 20-30% of clients Unlikely to occur Usually Obese Diet.

irritability. Insulin Nursing Interventions: 141 . Kussmaul resp. hypotension.Regular Insulin . 6 – 12 hrs. 4 – 6 hrs. changes in sensorium. – 1 hr. Peak 2 – 4 hrs. Stress Polyuria. thirst. 1 – 3 hrs. Infection. 18.30% regular Complications of DM: a.Protamine zinc . Lipodystrophy Cause: Signs & Symptoms: Nursing Interventions: d. hyperpyrexia. Coma. 1 – 2 hrs. confusion Give candy. 36 hrs. hyperventilation. 6 – 12 hrs. less dietary intake.2. 18 – 24 hrs. excessive insulin Diaphoresis. 2 – 8 hrs. 18 -26 hrs. Insulin Injections: Action Appearance.24 hrs. no ketosis Polyphagia. 8 – 16 hrs 18 -26 hrs. 2 -12 hrs. 14 – 24 hrs. Diabetic Ketoacidosis Cause: Signs & Symptoms: Lack of insulin . polydipsia. – 1 hr. abdominal discomfort. coma. abdominal rigidity Give regular insulin Nursing Interventions: c.Ultralente 30 mins. 30 mins.Semilente . sunken eyesballs. tremors. glucosuria. Hypoglycemia Cause: Signs & Symptoms: Nursing Interventions: Hunger. hypotension.Lente . polyuria. 4 – 6 hrs. Indurated areas on skin due to injections Skin indurations Teach client to rotate sites of injection Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK) Cause: Signs & Symptoms: Extremely high glucose. Duration of Effect 6 – 8 hrs. 28 – 36 hrs. acetone odor of breath. dry mucous membranes. Cloudy . juice or softdrinks. vomiting.Preparation Onset of Effect Short-Acting Clear Cloudy Intermediate Acting Long-Acting Cloudy Cloudy Cloudy Cloudy Pre-Mixed .70% NPH . Nausea. shock Fluid & electroluyte replacement.NPH . dehydration. Tachycardia. 30 mins. let the patient eat Check sugar level b. weakness.

vomiting and sometimes hematemesis Increased hydrochloric acid. cramping. high carbohydrate Medical Treatment: Antacids . Relaxation techniques o Most common in persons like farmers. belching. steroids Food: Alcohol. old a. executives). intolerance to spicy or fatty foods No increase in hydrochloric acid Duration: Clinical Manifestations: Short Epigastric discomfort. pc. o Usually in a wellnourished individual Gastric Ulcer Nursing Intervention: > 50 yrs. spicy foods o History of or presence of peptic ulcer disease o Previous gastric surgery o Same as acute gastritis Prolonged o May be asymptomatic o Other symptoms include: o Dyspepsia. May prescribe anticholinergics in chronic gastritis Nursing Interventions/ Health Teaching: -Avoid spicy foods -Avoid alcohol intake -Frequent small meals Incidence: o Common in age 50-60 years old o Frequent in male than female o Greater incidents in heavy drinkers and smokers Cause: Helicobacter Pylori Medicines: Aspirin. Duodenal Ulcer d. Abdominal pain. hs H2 Antagonists .with meals/pc Anticholinergics Prostaglandin Analogs **misoprostol** & ACID PUMP INHIBITORS . vague epigastric pain. Bland diet d. coffee. Gastric Cancer Acute Gastritis Chronic Gastritis o Same in Acute Gastritis Treatment Medical Management: a. Antacids b.avoid administration within 1-2 hr of other oral meds . construction workers o Usually affects malnourished individuals Excessive smoking. alcohol intake and spicy foods c. severe nausea. cigarette smoking. N/V. salicylates intake Normal to hyposecretion Lesser curvature o Experienced ½ to 1 hour after meal o Ingestion of FOOD DOES NOT RELIEVE PAIN b. Chronic Gastritis c.frequent administration – ac. Small frequent meals c. Acute Gastritis b.**inhibits the enzyme that produces gastric acid H Pylori –  Metronidazole  Omeprazole  Tetraycline/Clarithromycin  Cytoprotective – binds with Cause: Acid production: Location of Ulcer Pain: Stress. High fat.1. DISTURBANCES IN ELIMINATION 3. Acid production: Duodenal Ulcer Occurrence: o 25-50 yrs. Eliminate caffeine.4. Inflammatory and Neoplastic Disorders a. Gastric Ulcer e. chemo drugs. NSAIDS. Poor food habit Hypersecretion Pylorus o Experienced 2-3 hrs after meal o Ingestion of FOOD RELIEVES PAIN 142 . old o Type A personality (leaders.

emotional support. Dysphagia e.Bleeding Melena is more common than hematemesis Not possible diseased tissue and provides a protective barrier to acid Hematemesis is more common than melena Surgical Treatment 1. fever. gastric resection Nursing Intervention: Same as with patient’s with ulcer. live in urban area Exposure to radiation or trace metals in soil Cause: Helicobacter Pylori Clinical Manifestations: a. Common in men than women History or presence of Pernicious Anemia Often develops with the occurrence of atrophic gastritis Low-socio economic status. Clostriduum difficile from antibiotics) o o o o Risk Factors: Poor food handling Poor sanitary conditions Overcrowding Food remaining on high temperature making organisms incubate and colonize easily. (+) high lactate dehydrogenase level in gastric juice Diagnosis: GIT x-ray. mild to severe temperature Cause: Viral Dysentery Inflammation in the colon S/S: severe bloody diarrhea and abdominal cramping. old 143 . S/S: abdominal cramps.g. Disorders of the Large and Small Bowel VIRAL AND BACTERIAL GASTROENTERITIS/ DYSENTERY Gastroenteritis Inflammation of stomach and intestine usually the small bowel. Palpable mass b. Management: o Replace fluid loss o Anti-infective Agent (e.2. Ascites c. Metronidazole spec for amoebiasis. j. gastroscopy Treatment: Chemotherapy. Gastric ResectionGastroduodenostomy. Vagotomy 2. h. severe fluid and electrolyte loss. diarrhea. Weight loss d. severe fluid and electrolyte loss. g. Bactrim) Nursing Intervention: o Measure intake and output o Administer medications o Replace fluids APPENDICITIS o Inflammation of the vermiform appendix Incidence: Common between 20-30 yrs. mild to severe temperature Cause: Bacterial ( E. salmonella. pre and post-operative health teaching 3. Gastrojejunostomy Malignancy: Possible GASTRIC CANCER Incidence: f. i. Indigestion and anorexia f.coli nd/or shigella. radiation therapy. vomiting.

dilation and edema of intestines revealed in GIT x-ray Medical Management: NGT: Lavage to relieve pressure in the abdomen Fluid & electrolyte replacement Surgical Treatment: Appendectomy or Exploration of the abdomen with drainage Nursing intervention: Careful assessment of history. vomiting (N/V) Absence of bowel sounds Shallow respirations Increased WBC . (+) pain at Mc Burney’s point (RLQ) Treatment: Appendectomy Nursing intervention: Assess the VS and pain scale carefully Observe for symptoms of peritonitis . low grade fever.Cause: Fecalith (stone or calculus in the appendix) Fibrous condition in the bowel wall . loss of apetite. fluid & electrolytes Pre & Post-operative Care o o o c.-> Kinking of the appendix -> Bowel adhesion S/S: Pain starts in the epigastriium the shifts to the the right lower quadrant Guarding of painful area Keeps legs bent to relieve tension May have vomiting. V/S. Inflammatory Bowel Disease: ULCERATIVE COLITIS & CHRON’S DISEASE CHRON’S DISEASE Pathology & Anatomy Involves primarily the ileum & right colon Distribution of d’se is segmental Malignancy is rare May be genetic Usually in the 30’s Remissions and relapses Course of Disease Slowly progressive Common ULCERATIVE COLITIS Mucosal ulceration of lower colon and rectum Distribution of d’se is continuous Malignancy may occur after 10 years May be caused by infection or alteration in immunity Young adults (20-40) Onset Etiology 144 . Pre & post-operative care PERITONITIS o o Inflammation of the peritoneal membrane Cause: Gangrenous cholecystitis Ruptured gallbladder Perforated gastric cancer Perforated Peptic ulcer Ruptured spleen Acute pancreatitis Penetrating wound Ulcerative colitis Gangrenous obstruction of the bowel Perforated diverticulum o Ileitis Appendicitis with perforation Ruptured retroperitoneal abscess Strangulated hernia Salpingitis Septic Abortion Ruptured bladder Puerperal infection Iatrogenic Cause Signs and Symptoms: Localized pain Abdominal rigidity Increased pain upon movement Nausea. coated tongue and halitosis Diagnosis: Increased WBC.

Ileostomy Rectal bleeding. nausea (mimics Appendicitis) Replacement of fluid loss Anti-diarrheal: Diphenoxylate HCL (Lomotil) . . Loperamide HCL (Imodium) Total Parenteral Nutrition Bowel Resection. Ice pack over the incisional site to control pain and swelling d. cramping. Femoral Hernia 4. Same as Chron’s D’se Medical Treatment Surgical Treatment Nursing interventions: Bowel Resection.Rectal bleeding Anorectal fistula Other S/S: Occasional Rare Common Abdominal pain Weight loss Diarrhea – soft or semi-liquid Pain in RLQ. weight Emotionla support Client teaching regarding surgery Post-op intervention: Observation of the stoma Teach client re: self-care Same as Chron’s D’se HERNIA -An abnormal protrusion of an organ or tissue through the structure that contains it. Male & Female Lower fiber diet which causes bulk in stools which may cause intraluminal pressure in the bowel causing diverticula Chronic Constipation Anorexia Low grade fever Risk factors: S/S: Left Quadrant Pain Increased flatus 145 . urinary retention is common after herniorrhaphy b. Direct Inguinal Hernia 3. Surgical Treatment: Herniorrhaphy 1. Resume diet as tolerated by the patient c. old .Frequently a congenital occurrence or acquired weakness of the abdominal muscles Types: Indirect Inguinal Hernia 2. flatulence. Incisional Hernia Medical Treatment: Use of TRUSS if hernia is not strangulated or incarcerated. weight loss Urgency. Instruct patient to avoid heavy lifting from 4-6 weeks post surgery DIVERTICULUM Diverticulum – an outpouching of intestinal mucosa through the muscular coat of the large intestine (most commonly the sigmoid colon) Diverticulosis – refers to the presence of non-inflamed out pouching of the intestine Diverticulitis – inflammation of a diverticulum Incidence: Etiology: > 45 yrs. emotional stress. Ileostomy Assess Intake and output. tenderness. cramping. Pain LLQ. abdominal distention. Stools may occur with blood or pus. Nursing Intervention: Pre & Post-operative Care Post-op Care: a. Make sure the client voids after surgery. diarrhea (20 stools/day or more). Umbilical Hernia 5.

Colostomy b.(+) rectal mass on digital rectal examination Medical Intervention: High-fiber diet and laxatives NGT insertion to relieve pressure Control inflammation through antibiotics and advise patient to: a. Intake of 6-8 glasses of water a day c. Cleansing Enema Post-op Nursing Intervention. Avoid activities that may increase abdominal pressure (bending. Avoid incision by keeping diapers low e. 146 . Teach colostomy care. emesis w/ bile stain Treatment: a. Reduce weight if obese Indicated for those who developed complications as manifested by hemorrhage. ribbon-like stool. Hemorrhoids o Peri-anal varicosities which is either internal or external o Types: a. Heath Education regarding: a.check color of stoma (should be bright leg) b. Bowel Resection c. e. old child can already take care of his/her own stoma. Self-care Surgical Intervention: Ileostomy o Involves the small bowel (ileum) o stool is in liquid form o o d. diarrhea. chronic constipation. Check dressing c. etc) b. lifting. Psychological Support 3.surgery (ileostomy/colostomy) b. o Colon resection with colostomy Indications Colostomy o Involves the large bowel (colon) o stool is semi-formed Inflammatory / obstructive process of the lower intestinal tract Trauma Rectal or sigmoid cancer Diverticulum o Chron’s Disease Ulcerative Colitis Nursing Intervention 1. abscess. 10-11 yr. Internal – varicosities above the mucocutaneous border covered by the mucous membrane. Emotional support 2. Hirschprung’s Disease and Megacolon Congenital absence of parasympathetic ganglion Clinical Manifestations: o NB fail to pass meconium 24 hrs after birth o Older child – recurrent abdominal distention. perforation and obstruction. a. Monitor intake & output d.

Intravenous Solutions Used to correct imbalance: e.b. Actions of the Fluids & Electrolytes Diffusion – fluids move from area of higher concentration to an area of lower concentration Osmosis .fluids move from an area of lesser concentration to a higher concentration Filtration – fluids and substances moves from higher hydrostatic pressure to lesser hydrostatic pressure.g. constipation.controls the Carbondioxide levels in the body and water vapor c. Bicarbonate (HCO3 ) 50-55% of body weight is water 60-70% of body weight is water 75. 5. D5W f. Potassium (K) c. Blunt Trauma – injury like vehicular accident Penetrating Abdominal Trauma – stab wound DISTURBANCES IN FLUIDS AND ELECTROLYTES Fluid Content in the Human Body : a. Prolonged sitting or standing. Regulates exchange of water between fluid compartments a. tubular fibrous tract that extends into the anal canal May develop from trauma.3. b. Relieve pain through heat application / Sith’s bath Surgical Intervention: Hemorrhoidectomy. Lungs. Hypertonic – has greater concentration of solis substances than the fluid substances e. CHF. Pain Medical Intervention: a. portal hypertension Increased abdominal pressure. Maintains fluid volume c.5 mEq/L 85-115 mEq/L 22-29 mEq/L Functions of the Fluid & Electrolytes in the Human Body: a.3.9 NSS. Treat constipation b. Abdominal Trauma : a. Kidneys – responsible in controlling the balance of fluid & electrolytes b. Isotonic – 0. D50 g. Pregnancy. fissures or regional enteritis Fistulectomy is recommended.Total Parenteral Nutrition.5 – 5. Fistula-in-ano Tiny. 0. c. Hypotonic – has fewer solid and has higher fluid content. e. Incidence: Risk factors: S/S: Both male and female aged 20-50 y/o. cryosurgery f. bleeding and rectal itching External – enlarged mass at the anus Present symptoms in both internal & external: Bright red (blood) stain in stool or tissue. External Hemorrhoids. Skin – means of elimination of fluid in the body through perspiration d. Regulates acid-base balance in the body b. Chloride (Cl) d. straining during bowel Movement Internal – bleeding and renal prolapse. Sclerotheraphy.g.45 NaCl System of Fluid Balance in the body: a. Men c.– varicosities below the mucocutaneous border covered by the anal skin. Infant d. Women b. Endocrine –Controls hormones which regulates normal functioning of systems Imbalances in Fluids & Electrolytes Fluid Volume Excess Cause fluids exceeds the normal volume the body needs . Laser Surgery. Rubber band ligation.physiologic or over hydration as Fluid Volume Deficit fluids and/or electrolytes are loss physiologic or dehydration 147 . . Elderly Electrolytes in the Human Body: a. b.80% of body weight is water 47% of body weight is water - 135-145 mEq/L 3. Sodium (Na) b.

Serum Creatinine.in IV therapy Illness: Renal Disease Neurologic Diseases Congestive Heart Failure Addison’s Disease Renal Disease Diarrhea Post-operative conditions Burns Trauma GIT Suction/Drainage Weight loss Dry skin and mucous Membrane Tachycardia (same w/ excess) Poor skin turgor Decreased urine output Decreased Central Venous Pressure Increased hematocrit Urine output: < 30 cc/hr ( Normal Urine Output =30 cc/hr) Clinical Manifestations Weight gain Edema Flushed skin Tachycardia Increased BP. Cystitis / Urethritis/ Urinary Tract Infection –usually caused by E. Urine Uric Acid – 250-750 mg/ 24 hrs. beans. prunes. Serum Uric Acid -3.8 mg/dL e. turkey Iodized or table Salt Peas. fever. nuts & vegetables. Creatinine Clearance – 100-120 ml/ minute (24 hr. cheese.5 -7. Force fluids d. (24 hr.500 ml/day Monitor vital signs Monitor I & O Fluid restriction Low sodium diet Weight daily Prevent skin breakdown. red meat. raisins. tomato.0-1 mg/dL c. Antibiotic treatment.2. fruits Milk. chills.1 Genitourinary & Renal Problems Renal Function Tests Normal Values: a. Rehydration Weight daily Administer medications as ordered ( depending on electrolytes loss) Encourage proper nutrition an fluid intake Sources of Electrolytes: Electrolyte Potassium Sodium Magnesium Calcium Food source Bananas. as ordered c. nausea. urine collection) 4. Fever. vomiting Edema Oliguria 148 . RR Rales Neck Vein distention Increased Central Venous Pressure Decreased Hct Urine output: > 1. melon.skin is fragile Keep client in Semi-fowler’s position to establish good gas exhange Administer Diuretics as orderedLasix (Furosemide) Nursing Interventions Monitor vital signs Monitor I & O Replace fluids. nuts. Cloudy urine Nursing Considerations: a. proteinuria. chills f. Frequency & Urgency of urination b. urine collection) d.1. Collect urine for testing b.1. Hematuria e. sardines. weakness. Dysuria c. fish 4.Coli Signs & Symptoms a. Suprapubic pain d. apricots. • • • Glomerulonephritis – inflammatory damage of the glomeruli – usually Streptococcus Signs & Symptoms: Hematuria. Blood Urea Nitrogen (BUN) – 10-20 mg/dl b.3. peaches. Good hygiene 4.

caused by chronic gomerulonephritis (CGN).6. Psychological & emotional support 4. Weigh daily g. Prevent hypokalemia d. diarrhea c. low sodium c.urine is less than 400 cc in 24 hrs. bed rest b.1. Force fluids: at least 3L of water in a day b. Edema Nursing Considerations: a. Maintain Fluid & electrolyte balance c. pyelopnephritis. Urolithiasis . uncontrolled HPN Signs & Symptoms: a.4.5. Administer insulin or IV glucose as ordered to promote potassium absorption e. anticoagulants 4.1. Immunosuppresiove agents. Acute Renal Failure –sudden and reversible malfunction of the kidney due to trauma. Sodium & fluid restriction d. Hypoalbunimemia c. High CHO. Protect from infection e. Dull aching pain b. Monitor I & O h. Bed rest 4. Headache c. allergies.• • • • • HPN Headache Increased Urea Nitrogen Flank Pain Anemia Nursing Considerations: a. Proper diet :  Oliguric – low CHON. less fluid f.7. Hyperbilirubinemia d. Signs & Sypmtoms: a. as ordered b. Steroids. Administer meds as ordered: Diuretics. high calorie. Administer meds as ordered 4. vomiting. less potassium  Diuresis – high CHON. stones or benign Prostatic hyperplasia Signs & Symptoms: 3 Phases a. Hematuria d. Chronic Renal Failure – progressive failure of kidney function which may result to death. high protein. UTI symptoms Nursing Considerations: a. high calorie. Strain Urine for stones c. Period of Diuresis – urine is 1000 ml in 24 hrs and is diluted c. fatigue b. DM. Recovery Period Nursing Intervention: a. SLE.stones in the urinary system Signs & Symptoms: a.1. Convulsions 149 . HPN e. Treat cause of sudden occurrence b.1. high fat. Irritability f. Proper dietary intake c. Dialysis if indicated i. etc. Monitor I & O d. Gastrointestinal symptoms d. Nausea. Nephrotic Sydrome – glomeruli disorder due to other diseases like DM. Penicillin. b. (+) edema . Proteinuria b. Oliguric Phase – sudden .

monitor I&O  Monitor vital signs  Maintain asepsis at all times  Monitor for complications: Bleeding. high CHO and vitamins Control HPN WOF cerebral irritation e. c. dyspnea.8. dribbling sensation Surgical Treatment:  Prostatectomy Post-operative Nursing Consideration: a. 4. b. bowel perforation Urinary Tract Surgery a. d. abdominal pain. low sodium. arms or at the femoral area. Elevated BUN. Benign Prostatic Hyperplasia – enlargement of the prostate with unknown etiology usually in older males Signs & Symptoms:  Difficulty in urinating  Nocturia. 2. Hemodialysis  Process of cleansing the blood of waste products which the GUT is unable to eliminate  Cathether inserted via a small incision on the neck (intrajugular). abdominal pain. Observe for shock and hemorrhage b. Anemia h. crea.000 new cases of renal disease per year Affects all ages Adult: End-Stage Renal Disease (ESRD) 150 . d. Avoid lifting heavy objects x 6 weeks and avoid strenuous activities d. potassium Treatment: Dialysis Renal Transplant a. Bladder Drainage. a. Decrease pain. Kidney Transplant KIDNEY DISEASE IN THE PHILIPPINE HEALTH SITUATION 6. bowel  Replace fluids  Proper irrigation 3.g. dyspnea. peritonitis.1. hematuria. b. c. b. Peritoneal Dialysis  Use of peritoneum via a catheter for proper exchange of fluids and electrolytes and drainage of fluids  Catheter inserted just below the umbilicus with small incision Continuous Ambulatory Peritoneal Dialysis c. monitor bladder irrigation c. e. Nursing Interventions: Weigh daily Monitor vital signs Maintain asepsis at all times Record intake and output Monitor for complications: Bleeding. administer meds as odered TREATMENT FOR GENITOURINARY PROBLEMS: 1. peritonitis. sodium. Prostatectomy Nursing Interventions:  Weigh daily . Dialysis a. Increase fluid intake e. Nursing Considerations: Maintain fluid & electrolyte balance Bedrest Diet: low protein. Transurethral Removal of the Prostate b.

Rectal Ca . Clinical Manifestations of Tumor Presence (based on Community Health Nursing Services in the Philippines by the DOH) C A U T I Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in Ex. Diabetes Mellitus. Chronic Pyelopnephritis – 17% 3. Carcinoma . Sacrcoma. b. Prostate Ca Ex.cancer from blood-forming organs c. T2. Gastric Ca. d. T4 = progressive tumor in size and involvement TX = tumor cannot be assessed Involvement of Regional Nodes NO = regional lymph nodes not abnormal N1. M3 = increasing degree of distant metastasis c. Chronic Glomerulonephritis – 47% 2. Uterine Ca Ex. Breast Ca. Colon Ca. N2. Increase awareness and prevent renal disease: • Adequate water intake • Balanced diet • Good personal hygiene • Regular exercise • Regular BP check-up • Complete immunization for infants and children • Proper management of throat and skin infections • Yearly urinalysis 2.epithelial cells lining the internal and external surfaces of the body. Increase awareness of signs & symptoms of kidney disease as edema and HPN 6.N3. 3.5% Kidney Disease Prevention: Good Nutrition Clean Environment Early detection of of the disease Thorough urinary screening of asymptomatic children Increase casefinding and treatment for chronic glomerulonephritis Good glycemic control (w/ DM) Optimum Blood Pressure Control Nursing Health Education: 1. diabetes and kidney disease DISTURBANCES IN CELLULAR FUNCTIONING CANCER o Abnormal growth of tissues a. Renal Ca. Extent of Malignancy T0 = no evidence of primary tumor TIS= Carcinoma in Situ T1.Children and young: Chronic Glomrulonephritis Causes: 1. M2. Routine screening for UTI. T3. Extent of tumor T= primary tumor N= regional nodes M= metastasis b. 6.1. Laryngeal Ca Ex.13% 4. Hypertensive Nephrosclerosis.cancer from connective tissues o o Cancer in the Philippines: Ranks third in leading cause of morbidity and mortality 75% of cancers occur at age 50 y/o Staging of Tumors a. Esophageal Ca 151 . Leukemia . N4 = increasing degree of abnormal regional lymph nodes Metastatic Development MO= no evidence of distant metastasis M1. Lymphoma – cancer from reticulo-endothelial lymph node organs d. Hodgkin’s Lymphoma Ex.

Assist the patient in maintaining self-dignity and integrity by continued and sustained communication and contact Allow patient to ventilate feelings such as fear. vaccine. Avoid moldy foods Maintenance of a high fiber and low fat diet Avoid excessive sun exposure No conclusive evidence for early prevention Annual check-up Regular pap smear: Once sexually active then every 3 years if findings are normal None Liver Colon and Rectum Skin Prostate Regular medical check-up after 40 years. e. Betel quid “Nganga” chewing. Proper cavity and dental chewing No conclusive evidence for early prevention Early Detection Thorough dental check-up each year Breast Monthly self-exam and annual exam with physician. b. Squamous cell Ca Ex. Lung Ca Most Ca conditions Risk Factors Age Health Habits Sex Family History Race Socio-Economic Status Occupation Lifestyle Cancer Therapy a. Melanoma. Chemotherapy – chemical/ medication c.given if chemo.O N U S swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained Anemia Sudden uexplained weight loss Ex. anger. Surgery b. Minimal alcohol intake. it is a holistic care for the patient and family . safe sex Single partner reduces risk Hepa. yearly occult blood tests in stools. d. d. surgery or radiation therapy cannot assure treatment of the patient . Radiation Therapy – electromagnetic rays destroys cancer cells Palliative/ Supportive Care.for end-stage or terminal stage .should consult a doctor before age 40 Lung Uterine / Cervix Avoid smoking Clean. indifference Make arrangements for spiritual consolation Assist in rehabilitation even before treatment and until she recovers and adjust to the society Collaborate with other health workers for the patient’s holistic needs 152 . Mammography: o Initially at age 40 and then 1-2 yrs thereafter o High risk women. rectal exams and sigmoidoscopy Self skin assessment Rectal Exam Nursing Intervention a.management o f care is geared towards a symptom-free individual with psychologic and spiritual support Cancer Prevention & Early Detection Type of Cancer Oral Cancer Early Prevention Avoid Smoking tobacco. c.

hematocrit Female: Male: Female: Male: Female: Male: Normal Values 4. malabsorption gastric mucosa Pernicious Anemia – Vit. hemoglobin & hematocrit Types of Anemia: a.000/ mm3 150. then 153 .5 – 15. Weakness.7 – 6. Newly diagnosed cases b. c. RBC fails to mature adequately Signs & Symptoms: Fatigue. B12 following this regimen: o 3x a week for 2 weeks.due to radiation. b. or atrophy of the Megaloblastic Anemia – due to previous gastric surgery.2 – 5. 000 – 400. B12 and Folic acid deficiency in gastric juice Clinical Manifestations:  Paresthesia  Tingling or numbness of extremities  Gait disturbances  Behavioral Disturbances Nursing Intervention:  Intake of Vit.500 – 11. a. Hypoproliferation Anemia – bone marrow fails to produce adequate blood cells a. blood loss b. Home visits and education about the client’s condition. Pallor.2.hemoglobin Hct . ANEMIA Platelet count 4. drugs. Dizziness.f. Aplastic Anemia .2.1 x 106 11. HEMATOLOGIC PROBLEMS Normal Values to Remember: Blood Component RBC – red blood cells Hgb .000 / mm3 Causes: Sudden or Chronic blood loss Abnormal bone marrow function c. Post-operative Cases c. toxin Anemia due to Renal Disease Clinical Manifestations:  Hypoxia  Prone to infection  Fatigue  Easy bruising Nursing Intervention:  Proper nutrition  Psychological support  Protect against infection and injury b.5 g/dL 13. course of treatment and alternatives Priorities for Health Supervision: a.5 g/dL 36 – 48% 40 -52% WBC – white blood cells PC6. Indigent Cases d.1.5 – 17. Terminal Cases 6. Iron Deficiency Anemia – nutritional deficiency. Decreased RBC.4 x 106 4.

2. Steroids Nursing Interventions:  Emotional Support  Reverse isolation  Adequate Rest and Nutrition  Strict Medication Regimen 154 . • • Multiple Myeloma Thrombocytophenia – low platelet . then o Once a month Protect lower extremities Rest in non-stimulating environment Hemolytic Anemia • Sickle Cell Anemia. turns to sickle cell when oxygen in venous blood is low • Thalassemia • Glucose-6 Phosphate Dehydrogenase Deficiency Clinical Manifestations:  Thalassemia & G6PD – usually asymptomatic  Sickle Cell Anemia: o Severe Pain o Swelling o Fever o Jaundice o Prone to infection Nursing Intervention:       Proper oxygenation Hydration Analgesics Adequate Rest Refer to genetic counseling Avoid cold places to prevent sickle cell proliferation 6.  c. headache.4. LEUKOCYTOSIS & LEUKEMIA Leukocytosis Leukemia • • • – increase level of WBC.proliferation of neoplastic white blood cells in the bone marrow affecting the different tissues and organs in the body Acute & Chronic Myeloid Leukemia (AML / CML) Acute & Chronic Lymphocytic Leukemia (ALL / CML) Angiogenic Myeloid Metaplasia (AMM) Clinical Manifestations:  Fever  Prone to Infection  Pain  Weight Loss  Fatigue Nursing Interventions:  Energy conservation  Reverse Isolation  Blood Transfusion 6. POLYCYTHEMIA – neoplasm of myeloid cells Clinical Manifestations:  Dizziness. Radiation therapy. Reverse Isolation.2.2.3. atherosclerosis THROMBOCYTOPHENIA . blurred vision.2.2. bleeding Management: Chemotherapy. paresthesia. o 2 x a week for 2 weeks.5. persistent increased can be malignant . fatige.defective hemoglobin. tinnitus. Blood Transfusions. 6.Increased Bleeding Tendencies LYMPHOMAS – neoplasm of lymphatic cells • Hodgkin’s Lymphoma • Non-Hodgkin’s Lymphoma 6.

2. 155 . ID. fever. sudden anxiety Diseases Transmitted through Blood Transfusion  Hepatitis B or C . 4. AIDS / HIV. 2. respiratory distress.Fever Hemolytic Reaction. 3.life threatening: fear.6. serial # Take baseline vitals signs Blood pack should be at room temperature Monitor for transfusion reaction  Allergic (pruritus. if present – symptomatic treatment 5. orthopnea. dyspnea and anxiety Allergic reaction –urticaria.5. BLOOD TRANSFUSION 1. Check name. blood type. backpain. urticaria)  Hemolytic (low back pain. chills. nausea. Cytomegalovirus Nursing Interventions: 1. tachycardia.2. flushing. expiration. 3. Types of Blood Components Transfused Whole Blood Packed Red Blood Cells Fresh Frozen Plasma/ Plasma Concentrate Transfusion Complications Non-hemolytic reaction. chills) Treat transfusion reaction. chest tightness. dyspnea. itching Hypervolemia – neck vein distention.

Oh. No response a. Oh.7. and follows command Lethargic. c. To speech c.alert. Extension: abnormal (decerebrate) f. Central Nervous System: Brain Spinal Cord II. Cranial Nerves – 12 pairs Spinal Nerves – 31 pairs Cervical – 8 Thoracic – 12 Lumbar – 5 Sacral – 5 Coccygeal . speaking ability and motor abilities in response to a stimuli.1 c. d. To pain d. Localizes pain c. No response to pain on any limb Points 4 3 2 1 6 5 4 3 2 1 Moto r Response 156 . Obeys verbal commands b. motor and verbal response Lowest score is 3 points . Peripheral Nervous System a. Flexion: no withdrawal d.drowsy but awakens. Coma. b. Client identifies taste. Conscious.Spontaneous/ Normal eye. but slowly and inattentively Stuporous . Perfect score is 15 points .arouses to vigorous and continuous stimulation -response may be an attempt to remove the painful stimulus. Eyelid reaction to stimulus Hearing Acuity Gag Response Ability to speak clearly Shoulder’s ability to resist against pressure Tongue at midline Neurologic Status: a. no movement THE GLASGOW COMA SCALE - An assessment tool measuring the individual’s neurologic status specifically the spontaneity of the client’s eye movement . attentive. Autonomic Nervous System Sympathetic Nervous System Parasympathetic Nervous System The Cranial Nerves: Oh. Spontaneous b. To Touch And Feel A Girls Veil So Heaven I II III IV V VI VII VIII IX X XI XII Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Auditory Glossopharyngeal Vagus Spinal Accessory Hypoglossal Smell Visual Acuity Pupil constriction and dilation Eye movement: Inferior and medial Jaw muscles Eye movement: Lateral directions Symmetrical facial movement.No response Eye Opening Response a. b. follows command. Flexion: abnormal (decorticate) e. – no sounds. NEUROLOGIC DISTURBANCES I.

d. Speech problem / Aphasia . Able to Converse c. can look at surroundings. Cerebral hemorrhage . Cerebral thrombosis . Maintain adequate airway 2. HPN. Maintain fluid & electrolyte balance - 157 . Makes incomprehensible sound e.blood clot that forms and then travel to the brain. When calling the nurse: can only say “ne…. Inappropriate speech d. With a hemorrhage. answer questions appropriately. Nursing Interventions: 1. Decreased awareness of body space Risks Factors: Types of stroke: 1. No response 5 4 3 2 1 Example: Patient s conscious. 2. leg and trunk on the same side f the body. No movement/response when skin is Pinched . and can express self through words. GCS Scoring: Eye opening Motor Response Verbal Response GCS Score = 4 = 6 = 5 = 15 Eye slightly opens when name is called . 3. Transient Ischaemic Attack (TIA) short-term stroke that lasts for less than 24 hours ( seconds or minutes in a day) oxygen supply to the brain is restored quickly transient stroke needs prompt medical attention as it is a warning of serious risk of a major stroke.weakness of one side of the body c.occurs when a blood vessel bursts inside the brain and bleeds (haemorrhages). Hemiplegia . aneurysm Signs & Syptoms: a.Best verbal response a. Can tell where he is. Hemiparesis. Oriented b.total paralysis of the arm. can raise hands when asked to. Cerebral embolism .” sound GCS Scoring: Eye opening Motor Response Verbal Response GCS Score = 3 = 1 = 2 = 6 CEREBROVASCULAR ACCIDENT (CVA) “Stroke” o A sudden disruption of blood supply to the brain which may lead to temporary or permanent dysfunction.brain cells are starved of oxygen. coherent.e…e. peripheral vascular disease. extra damage is done to the brain tissue by the blood that seeps into it. . 4.a loss or impairment of the ability to produce and/or comprehend language b. Monitor neuro vital signs: Vital signs and Glasgow coma scale including intake and output 3. obesity.a blood clot (thrombus) forms in an artery (blood vessel) supplying blood to the brain. Obesity.

Spinal Shock (Areflexia) 2. loss of bladder and bowel control Sacral Nerve Sexual. bowel & bladder incontinence. Autonomic Hyperreflexia Injury in T6 and above Life-threatening Nursing Interventions: 1. upper arm. sensory loss and altered activity.etc Decrease sensation in the peineum 158 . ventilation support Elbow. Falls. Tumor The Spinal Nerves: 1. Cervical Nerve 2.SPINAL CORD INJURY Definition: A damage in the nerve structure causing dysfunction resulting to paralysis. Infection. Immobilization specially after injury or trauma 2. Bladder & bowel management 4. Cause: Vehicular accidents. Maintain respiratory function. Thoracic Nerve 3. Paralysis below waist Chest Muscles Abdominal Muscles Trunk and Abdominal control Lumbar Nerve Paralysis of legs. Sacral Nerve Etiology: 1. wrist movement Thoracic Nerve Injury causes Paraplegia Loss of hand control. sexual dysfunction Cervical Nerve Injury causes Quadriplegia/ Tetraplegia Diaphragm Deltoid. ABC 3. Lumbar Nerve 4. Violence. impaired breathing. biceps Wrist Extenders Triceps Hand Shoulder elevation possible. Bladder & Bowel conrol Hip adduction impaired Leg muscles Knee and ankle movement impaired Bladder & Bowel control Sexual Control Bladder/Bowel Incontinence. Rehabilitation Nerves Level C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 S1 S2 S3 S4 S5 Body part affected Head & Neck Spinal Cord Injury Effect Paralysis below neck. Sports.

Atrophine Sulfate b. Clinical Manifestations: 2.Facial Nerve Clinical Manifestation: 1. b. Diplopia. Gradual visual loss.PARKINSON’S DISEASE Definition: - A disorder affecting control and regulation of movement Unilateral flexion of arms. propulsion Medical Management: Surgical Management: Nursing Interventions: a. Hazy vision / Yellowish haze Whitish to yellowish eyelense. disability Clinical Manifestations: Rigidity Involuntary body tremors Hips and knees flexion Masklike facial expression Slurred speech Drooling Constipation Depression Retropulsion. Rehabiltation – exercise Speech therapy Diet: Low CHIN in am. c.double-vision 3. c. a. Surgical Treatment: Cataract extraction Drug: 1. Phenylephrine Hydrochloride Vision w/ Cataract Vision w/ Cataract 159 . Ptosis.causes dilation of pupils. Mask-like facial expression 2. increases intraocular pressure (IOP) a. Dyphagia Management: b. Severe weakness of the neuro functions most commonly affecting the Seventh cranial nerve.difficulty opening of the eye 4. Pyridostigmine Bromine (mestinon) Ambenomium Chloride Steroids –Prednisone Atrophine Sulfate Nursing Interventions: Avoid fatigue Administer meds as ordered Avoi neomycin and morphine CATARACT Definition: . 3. d. shuffling gait. d. Mydriatrics . 4. high CHON in PM High fiber foods to promote bowel elimination Prevent Injury – fall. etc Anti-parkinsonian Agent: Anti-cholinergic: Levodopa Cogentin Stereotaxic Thalamotomy – surgery of the thalamus to treat disorder MYASTHENIA GRAVIS Definition: Severe weakness of one or ore groups of skeletal muscles. difficulty in walking. e.the eye lenses becomes thick and unclear or yellowish. weakness.

MUSCULOSKELETAL DISTURBANCES RHEUMATOID ARTHRITIS A systemic inflammatory disorder of connective tissues and/ or joints characterized by exacerbation & remission. Teach client that glaucoma can be controlled but not curable (even surgery can’t cure the disease) 3. 4. high fiber diet 8. can also be involved:heart and lung (as in rheumatic heart disease) Chronic disease. Rainbow around lights b. Pain around the eye c. 3.Drains aqueous humor Acetazolamide – decreases production of aqueous humor Mannitol – reduces IOP Isosorbid – also decreases production of aqueous humor Nursing Intervention: 1. Cervical. Trabeculectomy 2. Dilation of pupils 2. Encourage low residue. Chronic or Open-Angle Glaucoma a. Halo around lights b. Encourage moderate exercise 4. 2.2. Iridenclesis Drugs: Miotics – causes constriction of pupils -A Vision w/ Glaucoma 1. Slowly diminishing peripheral vision Surgical Management: 1. Pilocarpine hydrochloride .Angle Glaucoma a. hips. supine position  Avoid bending or lifting heavy objects. Post-op intervention:  keep eye covered  head of bed elevated at 30-45 degreed. 4. Cyclopegics – decreases ciliary muscle accomodation Side effects: blurred vision. increase BP Nursing Intervention: 2. Monitor BP. Administer drugs as ordered 2. ulnar. Thermosclerectomy 3. Avoid straining of bowel 5. Progressive loss of vision c. Cloudy and blurred vision d. finger joints. early to mid-adulthood. coughing and sneezing as it may further increase IOP GLAUCOMA non-curable condition of the eye due to increase in intraocular pressure causing deterioration of the optic nerve. Nausea & vomiting e. Acute or Closed. avoid use to patients with HPN Teach client that blurring of vision may be experienced. common in women OSTEOARTHRITIS Degeneration of the articular cartilage Wear & Tear of joints Weight-bearing joints: knees. 3. Tired feeling in the eye d. spine JOINT DISORDERS Definition Kinds of Joints Incidence Clinical Manifestations Older women Pain felt after activity • • Synovitis Pain relieved with rest 160 . 2 types of Glaucoma: 1.

exercise. middle-aged and elderly. serous membranes of the heart and lungs. heat packs. umbrella or sunscreen Adequate nutrition. joints.. painful and swollen joints Tophi (crystal formation in joints) are palapated around great toes. earlobes Allopurinol NSAID’s – Ibubrofen . anorexia. malaise. NSAIDs. rest and exercise Stress management. ASA. Heat or cold compress c. kidney. heat Balanced rest and activity. Increase fluid intake to flush out uric acid d. c. Indomethacin Probenecid Colchicine Sulfinpyrazone Drugs: Nursing Management: a. steroids in joist only Drug: Steroid. weight loss Management Rest. if possible avoid stress Fractures Definition: A break in the continuity of the bones Clinical Manifestations: 161 . redness.. most common in men A salt of uric acid (Urate) crystallizes in soft and bony tissues causing local inflammation and irritation. b. swelling. Steroids.granulation of tissue causing destruction of adjacent cartilage. Phenylbutazone Nursing Intervention Maintain body alignment.food with high purine / uric acid content Systemic Lupous Erythematosus (SLE) Definition: Risk factors: Diffuse connective tissue disease affecting skin. Bedrest during attacks b. hereditary Clinical Manifestations: “Butterfly rash” in the face ( across both cheeks and nose) Manifests symptoms same as that of arthritis and Raynaud’s Management: NSAID’s Steroids Cytotoxic drugs a. fingers. Children. Cyclophosphamide Nursing Intervenions: Avoid exposure to sunlight because symptoms aggravate symptoms or wear hats. ASA. sardines . Severe pain. shellfish. lymph nodes and GI tract. proper diet Gout / Gouty Arthritis Defintion: Risk Factors: Clinical Manifestations painful metabolic disorder due to inflammation of the joints due to high uric acid Hereditary.• Intermittent bone pain. Avoid eating organ meats. . warm feeling due to vasodialtion and increased blood flow • Pannus formation. Balance rest and exercise.Azathioprine. Indomethacin. joints and bones • fatigue. usually in great toe Red.

3. Maintain airway and circulation Immobilize joints that may be affected. For patients who have lower pain tolerance (elderly. subsides quickly Pain. 2. Paralysis 9. . Splint limb Bring to nearest hospital/medical institution Traction Closed Reduction -balanced pulling of the musculoskeletal structure to align bones. with blisters (fluid formation) Reddish. fat.applying nails and metal screws to bones through the skin surface Open Reduction Internal Fixation External Fixation Casts - -a rigid mold used to immobilize an injured structure to promote healing Nursing Management: 1. subcutaneous tissue. nails to align bones (opening of the skin and exposing bones affected). pins. painless. plates. 3.degree Fourth-degree Rule of Nines: a. Pain b. 4. Mainatin positioning For tractionL maintaing weights and countertraction Clean wounds to prevent infection Assess for VASCULAR OCCLUSION 5 P’s: 5 signs of Vascular Occlusion due to extremely tight casts / traction a. skin is closed after the procedure.surgically applying screws. eschar formation (Leather-like skin) Level of Skin Affected Epidermis and part of dermis Epidermis and dermis hair follicle intact Epidermis. Head and Neck b. pink to reddish. dermis. children) reduction may be done under sedation anesthesia. 2. requires countertraction . Deep partial thickness Full thickness Third. brownish or whitish. Anterior Truck Full thickness - 9% 18% 162 .external manipulation such as manually aligning bones by pulling. . Pulselessness d.internal manipulation of bones requiring surgical operation . fascia. muscle and bone Superficial Superficial partial thickness. PAresthesia e. Pallor c.Pain Loss of function Deformity False motion Edema Spasm Crepitus Hematoma around skin Breaks for penetrating bone fragments Management: First Aid 1. pink to red. dermis. subcutaneous tissue Epidermis. INTEGUMENTARY DISTURBANCES Burn Depth of Injury First-degree Second-degree Manifestation Painful.

oxygen and electrolytes delivered to body tissues. history of injury (time. Debridement SHOCK Failure of the circulatory system to maintain adequate perfusion of vital organs. Arms e. 3.Inadequate tissue perfusion . DIC Crystalloid loss: Dehydration. Surgery. Topical Anti-microbial agent: Silver Nitrate. Tetanus toxoid b. Ball thrombus 163 . severe dermatitis. Protracted Vomiting. Ruptured Papillary muscle. Types of Shock Cause Etiology Hypovolemic Shock due to inadequate circulating blood volume Blood loss: Massive Trauma. Legs f. Disseminated Intravascular Coaguation Plasma loss: Burns. Myocardial Contusion Cardiomypathies Valvular Disease or injury: Ruptured Aortic Cusp. Hospital Interventions: 1.Body compensates Progressive Stage . drop and roll ( lie down and roll) Burning person: Stop burning process such as wrapping the burning part with wet towel or blanket Check airway First-degree burn: Run cool water to affected area for 10 minutes 2.progressive Stage . Ruptured Aortic Aneurysm. Posterior Trunk d. Medical – Surgical Management: a. nasogastric suction Cardiogenic Shock due to inadequate pumping action of the heart because of primary cardiac muscle dysfunction or mechanical obstruction of blood flow caused by MI or valvular insufficiency Myocardial disease: Acute MI. resulting to cardiac failure I.blood flow to the heart is not adequate thus heart begins to deteriorate 3. malnutrition.Cellular ischemia & necrosis lead to organ failure II.Cardiac output is slightly decreased . plus deficiency in removal of cellular wastes.burn patients are very prone to infections 4. Check ABC. tubes or other devices. Gentamicin Sulfate. Diarrhea. Erosion of Vessesl due to lesion. GI Bleeding. Irreversible Stage .etc) 3. Critically severe deficiency in nutrients. cause.Compensatory mechanism is not adequate . Mafenide acetate c. Accumulation of intraabdominal fluid. Silver Sulfadiazine.c. Stages of Shock Non. Rule of Nine’s Burning person: Ask person to stop. Perineum - 18% 9% each = 18% 18% each = 36% 1% 100% Management: First-Aid: 1. 4. give oxygen and IV fluids 2. Maintain asepsis. Assess client’s data.

Nursing Care Management GOAL: Promote venous return. severe emotional stress Allergy to food. Distributive Shock a. Adrenocorticoids Vasodilators (nitroprusside). cardiac surgery. aneurysm.O. tension pneumothorax Cardiac Dysrhtymias: Tachyarrhythmias. Beta-adrenergic (dobutamine) Mechanical support : Military Anti-shock Trousers(MAST) Effects of Shock in Different Organs Respiratory System Cardiovascular System Neuroendocrine System Hypoxia Lactic acid accumulates tissue necrosis Myocardial deterioration Disseminated Intravascular Coagulation Stage of resistance o ADH is released causing kidneys to retain sodium and water o Increase in adrenocorticoid mineralcorticoid hormones 164 . Septic Shock systemic reaction vasodilation due to infection Gram-negative septicemia but also caused by other organisms III. Slow capillary refill BP. norepinephrine. urticaria in anaphylactic shock Oliguria. pericarditis. Signs of Shock Anxiety Restlessness Dizziness Thirst Fainting Pale skin.hypotension Pulse – tachycardia. spinal cord injury Vaso-vagal reaction: Severe pain. U. administer blood/plasma as ordered ( stop blood immediately in anaphylactic s. dopamine) Anti-arrythmics. monitor respiration Fluids: IV. O2. thready. Electromechanical dissociation 3.External Pressure on the Heart interferes with heart filling or emptying: Pericardial Tamponade due to Trauma. Neurogenic Shock - interference with nervous system control of the blood vessels Spinal: Spinal anesthesia. Antibiotics. oriented. dye.Swan Ganz Medications (depends on type) Antihypotensive (epinephrine. massive pulmonary embolus. unresponsive CVP – below 5 cm H20 (hypovolemic) .could be alert. elevated in anaphylactic LOC . ECG.Shock) Respiration: increased depth.above 15 cms (cardio & septic) IV. medicines.. Cardiac Glycosides. Bradyarrythmias. wheezing (anaphylactic shock) Temperature: cold clammy skin.) Vital signs: CVP. insect bites or stings b. circulatory perfusion Position: Feet elevated with head slightly elevated also Ventilation: loosen restrictive clothing. tachypnea. irregular (Cardio. Anaphylactic Shock -severe hypersensitivity reaction resulting in massive systemic vasodilation c.

Change the dressing at least daily or whenever it becomes wet or dirty. Soap can irritate the wound. If the blood spurts or continues to flow after continuous pressure. Splint the affected joint into its fixed position. Cuts and scrapes: First aid*** Minor cuts and scrapes usually don't require a trip to the emergency room. Certain ingredients in some ointments can cause a mild rash in some people. so try to keep it out of the actual wound. don't apply them directly on the wound. stop using the ointment. Don't move the joint. use tweezers cleaned with alcohol to remove the particles. blood is pooled in the liver or portal bed Altered capillary blood pressure and glomerular filtration Renal ischemia GI System Renal System IV. The products don't make the wound heal faster. Change the dressing. apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. After the wound has healed enough to make infection unlikely. If they don't. ligaments. These supplies generally are available at pharmacies. If a rash appears.Immune System Macrophages in bloodstream and tissues are depressed Increased susceptibility to shock GIT vagal stimulation stops/slow down no peristalsis Liver – ability to detoxify is lost. If debris remains embedded in the wound after cleaning. If dirt or debris remains in the wound after washing. These substances irritate living cells. After you clean the wound. Put ice on the injured joint. 2. Hold the pressure continuously for 20 to 30 minutes. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint. This can damage the joint and its surrounding muscles. 165 . apply gentle pressure with a clean cloth or bandage. If you choose to use them. see your doctor.redcross. 3. 3. Rinse out the wound with clear water. There's no need to use hydrogen peroxide. switch to adhesive-free dressings or sterile gauze held in place with paper tape. These guidelines can help you care for simple wounds: 1. Yet proper care is essential to avoid infection or other complications. Stop the bleeding. exposure to the air will speed wound healing. nerves or blood vessels. Minor cuts and scrapes usually stop bleeding on their own. Apply an antibiotic. Bandages can help keep the wound clean and keep harmful bacteria out.org Dislocation: First aid*** 1. Get medical help immediately. gauze roll or a loosely applied elastic bandage. Don't try to move a dislocated joint or force it back into place. Thorough wound cleaning reduces the risk of tetanus. Cover the wound. 4. use soap and a washcloth. seek medical assistance. FIRST AID *** FIRST AID: Details from www. Don't keep checking to see if the bleeding has stopped because this may damage or dislodge the fresh clot that's forming and cause bleeding to resume. To clean the area around the wound. 5. Clean the wound. but they can discourage infection and allow your body's healing process to close the wound more efficiently. 2. iodine or an iodine-containing cleanser. If you're allergic to the adhesive used in most bandages.

Watch for signs of infection. or until the pain subsides. A wound that cuts deeply through the skin or is gaping or jaggededged and has fat or muscle protruding usually requires stitches. Don't remove burnt clothing. your doctor may recommend a tetanus shot booster. Minor burns usually heal without further treatment. seek medical help. If a Chemical burns: First aid*** chemical burns the skin. Get a tetanus shot.6. others). Don't immerse severe large burns in cold water. Wrap the gauze loosely to avoid putting pressure on burned skin. ibuprofen (Advil. others). 2. 3. or moist towels. Don't use fluffy cotton. If infection develops. If your wound is deep or dirty and your last shot was more than five years ago. Get the booster within 48 hours of the injury Burns: First aid*** For minor burns. naproxen (Aleve) or acetaminophen (Tylenol. immerse the burn in cold water or cool it with cold compresses. Until an emergency unit arrives. Areas may be charred black or appear dry and white. If there is no breathing or other sign of circulation. swelling or oozing. Remove the cause of the burn by flushing the chemicals off the skin surface with cool. Doctors recommend you get a tetanus shot every 10 years. If this is impractical. See your doctor if the wound isn't healing or you notice any redness. These include aspirin. 4. Never give aspirin to children or teenagers. carbon monoxide poisoning or other toxic effects may occur if smoke inhalation accompanies the burn. moist cloth. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat. dial 911 or call for emergency medical assistance. If the burning chemical is a powder-like substance such as lime. Use a cool. follow these steps: 1. drainage. Putting ice directly on a burn can cause frostbite. including second-degree burns limited to an area no larger than 2 to 3 inches in diameter. Difficulty inhaling and exhaling. For major burns. running water for 15 minutes or more. brush it off the skin before flushing. Doing so could cause shock. Cooling the burn reduces swelling by conducting heat away from the skin. Broken blisters are vulnerable to infection. redness. further damaging your skin. Use sunscreen on the area for at least a year. reduces pain and protects blistered skin. 7.  Take an over-the-counter pain reliever. Motrin. Get stitches for deep wounds. fever. follow these steps: 1. However. Third-degree burn The most serious burns are painless and involve all layers of the skin. muscle and even bone may be affected. Proper closure within a few hours minimizes the risk of infection. Hold the burned area under cold running water for at least 5 minutes. sterile bandage. clean. Check for signs of circulation (breathing. 8. Fat. warmth or swelling.  Don't break blisters. coughing or movement). begin cardiopulmonary resuscitation (CPR). Don't put ice on the burn. Bandaging keeps air off the burned skin. take the following action:  Cool the burn. but if you can't easily close the mouth of the wound. such as increased pain. meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection. Cover the area of the burn. see your doctor as soon as possible. A strip or two of surgical tape may hold a minor cut together.  Cover the burn with a sterile gauze bandage. moist. They may heal with pigment changes. Caution  Don't use ice. 166 . which may irritate the skin.

or is experiencing changes in his or her breathing. If you notice signs of infection such as swelling. Prevent shock. bats and foxes than in cats and dogs. Turn off the source of electricity if possible.  The chemical burn occurred on the eye. Cover the affected areas. The person may still be in contact with the electrical source. hands. Check for signs of circulation (breathing. resulting in fractures or other associated injuries. is confused. such as a heart rhythm disturbance or cardiac arrest. Apply an antibiotic cream to prevent infection and cover the bite with a clean bandage. coughing or movement). feet. If the bite barely breaks the skin and there is no danger of rabies. 3. Rabies is more common in raccoons. Wrap the burned area loosely with a dry. Don't touch. plastic or wood.  The chemical burn penetrated through the first layer of skin. 5. Animal bites: First aid*** Domestic pets cause most animal bites. 2. Dial 911 or call for emergency medical assistance if the person who has been burned is in pain. If you're unsure whether a substance is toxic. follow these steps: 1. pale complexion or breathing in a notably shallow manner. If absent. such as fainting. cover any burned areas with a sterile gauze bandage. face. If a strong electrical current passes through your body. and the resulting second-degree burn covers an area more than 2 to 3 inches in diameter. apply pressure with a clean. Rabbits. if available. Don't use a blanket or towel. If the person is breathing. Look first. internal damage. Dogs are more likely to bite than cats. or over a major joint. Sometimes the jolt associated with the electrical burn can cause you to be thrown or to fall. Wash the wound thoroughly with soap and water. 3. however.2. Seek emergency medical assistance if:  The victim has signs of shock. Lay the person down with the head slightly lower than the trunk and the legs elevated. call the poison center. Electrical burns: First aid*** An electrical burn may appear minor or not show on the skin at all. sterile dressing or a clean cloth. move the source away from both you and the injured person using a nonconducting object made of cardboard. begin cardiopulmonary resuscitation (CPR) immediately.  For deep wounds. Minor chemical burns usually heal without further treatment. treat it as a minor wound. While helping someone with an electrical burn and waiting for medical help. squirrels and other rodents rarely carry rabies. redness. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Touching the person may pass the current through you. are more likely to cause infection. Loose fibers can stick to the burns. see your doctor immediately. Cat bites. If not. can occur.  For infection. 167 . dry cloth to stop the bleeding and see your doctor. heartbeat or consciousness. increased pain or oozing. If an animal bites you or your child. 4. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding. follow these guidelines:  For minor wounds. skunks. groin or buttocks. Remove clothing or jewelry that has been contaminated by the chemical. or a clean cloth. but the damage can extend deep into the tissues beneath your skin.

Still. You should have the booster within 48 hours of the injury. Prevent falls with these fall-prevention measures. Fall-prevention step 3: Wear sensible shoes Consider changing your footwear as part of your fall-prevention plan. massage or ultrasound. Fall-prevention step 2: Keep moving If you aren't already getting regular physical activity. including when. Consider activities such as walking.  Have you fallen before? Write down the details.  Could your health conditions cause a fall? Your doctor likely wants to know about eye and ear disorders that may increase your risk of falls. Your doctor may then evaluate your muscle strength. joint pain. If you have inner ear problems that affect your balance. along with the dosages. most of these falls aren't serious. he or she may decide to wean you off certain medications. For suspected rabies. Doctors recommend getting a tetanus shot every 10 years. falls are the leading cause of injury and injury-related death among older adults. balance and individual walking style (gait). You needn't let the fear of falling rule your life. In order to devise a fall-prevention plan. If you suspect the bite was caused by an animal that might carry rabies — any bite from a wild or domestic animal of unknown immunization status — see your doctor immediately. coordination and flexibility. muscle strength and gait. balance. water workouts or tai chi — a gentle exercise that involves slow and graceful dance-like movements. especially those used to treat anxiety and insomnia. your doctor will want to know:  What medications are you taking? Include all the prescription and over-the-counter medications you take. age-related physical changes and medical conditions — and the medications you take to treat such conditions. Or bring them all with you. 168 . Such activities reduce your risk of falls by improving your strength. Fall prevention: 6 ways to reduce your falling risk*** Falls put you at risk of serious injury. the physical therapist may use techniques such as electrical stimulation. though. since your size can change. numbness or shortness of breath that affects your walk. he or she may also teach you balance retraining exercises (vestibular rehabilitation) — which involve specific head and body movements to correct loss of balance. bring this concern to your doctor. Be prepared to discuss instances when you almost fell but managed to grab hold of something just in time or were caught by someone.  Buy properly fitting. He or she may recommend carefully monitored exercise programs or give you a referral to a physical therapist who can devise a custom exercise program aimed at improving your balance. Your odds of falling each year after age 65 are about one in three. floppy slippers and shoes with slick soles can make you slip. consider starting a general exercise program as part of your fall-prevention plan. So can walking in your stocking feet. Be prepared to discuss these and to tell him or her how you walk — describe any dizziness. stumble and fall. If you avoid exercise because you're afraid it will make a fall more likely. If your last one was more than five years ago and your wound is deep or dirty. Many falls and fall-related injuries are preventable with fallprevention measures. You and your doctor can take a comprehensive look at your environment. To improve your flexibility. Your doctor can review your medications for side effects and interactions that may increase your risk of falling. High heels. Fall-prevention step 1: Make an appointment with your doctor Begin your fall-prevention plan by making an appointment with your doctor. Here's a look at six fall-prevention approaches that can help you avoid falls. You're more likely to fall as you get older because of common. Be sure to get your doctor's OK first. sturdy shoes with nonskid soles. Fortunately. your doctor may recommend a booster. where and how you fell. To help with fall prevention. Instead:  Have your feet measured each time you buy shoes. your health and your medications to identify situations when you're vulnerable to falling.

Consider installing glow-in-the-dark or illuminated switches. Some solutions are easily installed and relatively inexpensive. To make your home safer.    Avoid shoes with extra-thick soles.  Store clothing. dishes.  Move coffee tables. This might require installing switches at the top and bottom of stairs.  Secure loose rugs with double-faced tape.  Use nonslip mats in your bathtub or shower.  A raised toilet seat or one with armrests to stabilize yourself. too. electrical cords and phone cords from walkways. Also:  Place a lamp near your bed and within reach so that you can use it if you get up at night. wooden floorboards and carpeting right away. Don't use bulbs that exceed the wattage rating on lamps and lighting fixtures.  Store flashlights in easy-to-find places in case of power outages. Make a clear path to the switch if it isn't right near the room entrance. Some you might consider:  Grab bars mounted inside and just outside your shower or bathtub. Shop in the men's department if you're a woman who can't find wide enough shoes. however. but so can the decorative accents you add to your home. food and other household necessities within easy reach.  Handrails on both sides of stairways. If bending over to put on your shoes puts you off balance. Other assistive devices can help. Buy a hand-held shower nozzle so that you can shower sitting down.  Repair loose. and keep the laces tied. Clutter can get in your way.  Nonslip treads on bare-wood steps. newspapers.  Make light switches more easily accessible in rooms. take a look around you — your living room. grease or food. bathroom and hallways. you might try these tips:  Remove boxes. since this can present a fire hazard. kitchen. bedroom.  Turn on the lights before going up or down stairs. Others may require 169 . hallways and stairways may be filled with booby traps. All sorts of gadgets have been invented to make everyday tasks easier. magazine racks and plant stands from high-traffic areas.  Place night lights in your bedroom. Choose lace-up shoes instead of slip-ons. Fall-prevention step 6: Use assistive devices Your doctor might recommend using a cane or walker to keep you steady.  A sturdy plastic seat placed in your shower or tub so that you can sit down if you need to. less light reaches the back of your eyes where you sense color and motion. So keep your home brightly lit with 100-watt bulbs or higher to avoid tripping on objects that are hard to see. Fall-prevention step 4: Remove home hazards As part of your fall-prevention measures. tacks or a slip-resistant backing. Ask your doctor for a referral to an occupational therapist who can help you devise other ways to prevent falls in your home.  Use nonskid floor wax.  Immediately clean spilled liquids. Fall-prevention step 5: Light up your living space As you get older. Select footwear with fabric fasteners if you have trouble tying laces. bathroom. consider a long shoehorn that helps you slip your shoes on without bending over.

an investment in safety and fall prevention now may make that possible.  Apply 0. See your doctor promptly if you experience any of these signs and symptoms. Wash the affected area with soap and water. biting flies and some spiders also can cause reactions. EpiPen). doing so may release more venom. yellow jackets and fire ants are typically the most troublesome. The severity of your reaction depends on your sensitivity to the insect venom or substance.  Scrape or brush off the stinger with a straight-edged object. Allergic reactions may include mild nausea and intestinal cramps. causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. diarrhea or swelling larger than 2 inches in diameter at the site.5 percent or 1 percent hydrocortisone cream. Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton. Bites from bees. but these are generally milder. Check for special medications that the person might be carrying to treat an allergic attack. Signs and symptoms of a severe reaction include facial swelling. such as an auto-injector of epinephrine (for example. Administer the drug as directed — usually by pressing the auto-injector against the person's thigh and holding it in place for several seconds. You might experience both the immediate and the delayed reactions from the same insect bite or sting. hornets. difficulty breathing and shock.  To reduce pain and swelling. After administering epinephrine. Bites from mosquitoes. 2. Insect bites and stings: First aid*** Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin. Don't try to pull out the stinger. For severe reactions: Severe reactions may progress rapidly. ticks. calamine lotion or a baking soda paste — with a ratio of 3 teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day until your symptoms subside. wasps. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. have the person take an antihistamine pill if he or she is able to do so without choking. cramps and vomiting Take these actions immediately while waiting with an affected person for medical help: 1. 3. hives.professional help and more of an investment. For mild reactions:  Move to a safe area to avoid more stings. A delayed reaction may cause fever. Teldrin). Dial 911 or call for emergency medical assistance if the following signs or symptoms occur:         Difficulty breathing Swelling of your lips or throat Faintness Dizziness Confusion Rapid heartbeat Hives Nausea. Massage the injection site for 10 seconds to enhance absorption. If you plan on staying in your home for many more years. The venom triggers an allergic reaction. Have the person lie still on his or her back with feet higher than the head. such as a credit card or the back of a knife.  Take an antihistamine containing diphenhydramine (Benadryl. apply a cold pack or cloth filled with ice. painful joints and swollen glands. Most reactions to insect bites are mild. 170 .

like for patients with tracheostomy Mouth to Mask Ambu Bag to Mouth & Nose Ambu Bag. If there's vomiting or bleeding from the mouth. 5. Check if Air is going backLook. Mouth to Mouth . 2. Rabies. 6. If there are no signs of circulation (breathing. Scorpions.chest compression not indicated because there is pulse rate METHODS IN GIVING ARTIFICIAL RESPIRATION 1. Don't give anything to drink. Inhalation  Injection. Ingestion. Repeat blind finger sweep 5. 4. 6. begin CPR. Strangulation Poisoning-Injection. spiders Severe Bleeding Drowning Electrocution Suffocation Choking: Universal Sign of Choking.redcross. 8.if mouth is obstructed Mouth to Mouth & Nose – used in infants Mouth to Stoma .org RESPIRATORY ARREST Respiratory Arrest (-) RR (+) PR. 5. 6. Artificial Respiration 2X if effective First Aid: Artificial Respiration (AR) – Giving of artificial air only either through a blow or ambubag .Snakebite. 3. Artificial Respiration (AR) 2X 3. 5. bees.4.  A condition of the victim wherein there is no breathing but pulse continues CAUSES: 1. turn the person on his or her side to prevent choking. Loosen tight clothing and cover the person with a blanket. THREE (3) KINDS OF AIRWAY OBSTRUCTION Kind OF Airway Obstruction With Good Air Exchange With Poor Air Exchange Total Airway Obstruction with No Air Exchange Signs Victim can still TALK Victim produces wheezing sound Unconscious First Aid Observe the victim as he cough out obstruction Abdominal Thrust / Heimlich Maneuver 1. 4. jellyfish. 3. http://www.usual method Mouth to Nose .a device used for artificial mechanical breathing unit 171 . coughing or movement).palms guarding throat Disease 7. 2. Listen & Feel (LLF) 4. Abdominal Thrust 10X Blind Finger sweep for adults 2.

3. BIOLOGICAL DEATH. 3. 2. CARDIAC ARREST  Condition of the victim when the pulse and breathing is absent. 5.ADULT METHOD Manner of Breathing Rate of Blows Mouth TO Mouth Full and Slow 1 Blow every 5 secs 12 blows per min CHILD Mouth TO Mouth Regulated 1 Blow every 4 secs 15 blows per min INFANT Mouth TO Mouth & Nose Puff 1 Blow every 3 seconds 20 blows per min START WITH A BLOW AND END WITH A BLOW WHEN TO STOP 1. 2.start with 2 blows end with 2 blows 172 . When the rescuer is exhausted When the victim is breathing on his own When the service of the physician is available When the pulse disappears. Stroke Location Of Chest Compressions Danger of Failure to revive Patient: 1.along nipple line ADULT Method Depth Rate Speed 2 Heels of 2 Hands 1 ½’. 5.3 fingers above mid xiphoid INFANT. Heart Attack. ADULT.A combination of external chest compression and artificial ventilations to revive the heart and the lungs CAUSES  All causes of Respiratory Arrest.usually occurs after 4-6 mins of cardiac arrest 1. CLINICAL DEATH. artificial respiration is stopped and cardiopulmonary rescucitation begins When another first aider takes over 4. Intervention for Cardiac Arrest: CPR CPR. 2.Cardio Pulmonary Resuscitation .1 ½” 5ECC/1 blow 15X/min 80-100 ECC/min INFANT 2 Fingers (ring and mid finger) ½” – 1” 5ECC/1 blow 20X/min 100-120 ECC/min 5 ECC/1 blow CPR. Don’t be a double crosser Don’t be a rocker Don’t be a jerker Don’t be a render Don’t be a bouncer Don’t be a massager CHILD 1 Heel of 1 hand 1”. 4.2” 15 ECC/2 blows 4X/min 60-80 ECC/min 12X/min 2 RESCUERS DON’T’S IN CPR: 1. 6.may occur if heart rate is not revived within 4-6 minutes 2.

1002. 6. etc. “Breathless” If Breathless. R U Okay” Position the victim Open and Clear the airway (head tilt chin lift) “Mouth is clear” Check breathing for 3-5 seconds (LLF) 1001. 2. check pulse for 5 sec. Recovery Position 173 . then deliberate 11. Survey the scene “ the scene is safe” Check for responsiveness “ Hey 2X. After each cycle. 8. give 2 blows Check for Pulse: Carotid 5-10 seconds State the condition of the victim “Victim is breathless with pulse” or “Victim is breathless & pulse less” 9. Activate medical assistance “Arrange transfer facilities and I’ll do…AR or CPR” 10. 3. 4.SEQUENCE: 1. 5. 7.

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