You are on page 1of 110

FOCUS!

AND AIM HIGH WITH GOD


Graphics & Edited By:

J. F. ADORABLE, RN.
Text from Pentagon Review Center

NERVOUS SYSTEM
Overviewofstructuresandfunctions: CentralNervousSystem

Brain SpinalCord CranialNerves SpinalNerves Sympatheticnervoussystem Parasympatheticnervoussystem

PeripheralNervousSystem

AutonomicNervousSystem

AUTONOMICNERVOUSSYSTEM SympatheticNervousSystem (ADRENERGIC) Involvedinfightoraggressionresponse. ReleaseofNorepinephrine(cathecolamines) fromadrenalglandsandcauses vasoconstriction. IncreaseallbodilyactivityexceptGIT EFFECTSOFSNS Dilationofpupils(mydriasis)inordertobeaware. Drymouth(thickenedsaliva). IncreaseBPandHeartRate. Bronchodilation,IncreaseRR Constipation. UrinaryRetention.FLUIDVOLUMEEXCESS Increasebloodsupplytobrain,heartandskeletal muscles. SNS I.AdrenergicAgents GiveEpinephrine.[ADRENALIN] SignsandSymptoms: SNS Contraindication: ContraindicatedtopatientssufferingfromCOPD (Broncholitis,Bronchoectasis,Emphysema,Asthma). II.AnticholinergicAgents Tocountercholinergicagents. AtropineSulfatedecreasedmucusproduction SideEffects SNS Antipsychotics: Haloperidol[Haldol],chlorpromazine Thorazine,etc. SideeffectofTHORAZINE:atopic dermatitisandfoulsmellingodor. Sideeffectofallantipsychotic:signsof PARKINSONSDISEASE,therefore antipsychoticaregiventogetherwith antiparkinsondrugs Antiparkinsondrugs: C.A.P.A.B.L.E.S ParasympatheticNervousSystem (CHOLINERGIC,VAGAL,SYMPATHOLYTIC) Involvedinfightorwithdrawalresponse. ReleaseofAcetylcholine. vasodilationbronchoconstriction DecreasesallbodilyactivitiesexceptGIT. EFFECTSOFPNS Constrictionofpupils(meiosis). Increasesalivation. DecreaseBPandHeartRate. Bronchoconstriction,DecreaseRR. Diarrhea Urinaryfrequency.FLUIDVOLUMEDEF. antihypertension I.CholinergicAgents Mestinon,Neostigmine. SideEffects PNS II.BetaadrenergicBlockingAgents AlsocalledBetablockers. Allendingwithlol Propranolol[Inderal],Atenelol,Metoprolol. EffectsofBetablockers Bronchospasm Elicitsadecreaseinmyocardialcontraction. Treatshypertension. AVconductionslowsdown. Shouldbegiventopatientswith Angina Pectoris,MyocardialInfarction,and Hypertension. ANTIHYPERTENSIVEAGENTS 1.Betablockerslol 2.AceInhibitorsAngiotensin,pril(Captopril, Enalapril) 3.CalciumAntagonistNifedipine(Calcibloc) Inchroniccasesofarrhythmiagive Lidocaine(Xylocaine)

CENTRALNERVOUSSYSTEM

BrainandSpinalCord.

[SpinalcordterminatesatL1toL2thereforeaLUMBARTAPisperformedatL3,L4orL5noriskfor spinalcorddamage] I.CELLS A.NEURONS

Basiccellsfornerveimpulseandconduction.

PROPERTIES Excitabilityabilityofneurontobeaffectedbychangesinexternalenvironment. Conductivityabilityofneurontotransmitawaveofexcitationfromonecelltoanother. PermanentCelloncedestroyednotcapableofregeneration. TYPESOFCELLSBASEDONREGENERATIVECAPACITY 1.Labile


Capableofregeneration. Epidermalcells,GITcells,GUTcells,cellsoflungs. Capableofregenerationwithlimitedtime,survivalperiod. Kidneycells,Livercells,salivarycells,pancreas. Notcapableofregeneration. Myocardialcells,Neurons,Bonecells,Osteocytes,RetinalCells. Supportandprotectionofneurons.

2.Stable

3.Permanent

B.NEUROGLIA

TYPES 1.Astrocytesmaintainsbloodbrainbarriersemipermeable. Majorityofbraintumors(90%)arisesfromcalledastrocytoma. 2.OligodendriaProducesmyelinsheathinCNS.Actasinsulatorandfacilitatesrapidnerveimpulsetransmission 3.Microglia 4.Epindymal SUBSTANCESTHATCANPASSTHEBLOODBRAINBARRIER 1.Ammonia


Cerebraltoxin HepaticEncephalopathy(LiverCirrhosis) Ascites EsophagealVarices asterixis(flappinghandtremors). Headache Dizziness Confusion Fetorhepaticus(ammonialikebreath) DecreaseLOC[hepaticcoma]

EarlySignsofHepaticEncephalopathy

LateSignsofHepaticEncephalopathy

[AIRWAYFORHEPATICCOMA] 2.CarbonMonoxideandLeadPoisoning

CanleadtoParkinsonsdisease. [PILLROLLINGTREMORS] Epilepsy TreatwithANTIDOTE:CalciumEDTA ForLeadpoisoning Hyperbaricoxygenation(100%O2) Forcarbonmonoxidepoisoning

PATHOGNOMONICSIGNS

1.PTB 2.PNEUMONIA 3.ASTHMA 4.EMPHYSEMA 5.KAWASAKIDISEASE 6.PERNICIOUSANEMIA 7.DOWNSYNDROME 8.CHOLERA 9.MALARIA 10.TYPHOID 11.DIPTHERIA 12.MEASLES 13.SLE 14.LIVERCIRRHOSIS 15.LEPROSY 16.BULIMIANERVOSA 17.APPENDICITIS. 18.DENGUE 19.MENINGITIS 20.TETANY 21.TETANUS 22.PANCREATITIS 23.PYLORICSTENOSIS 24.PDA 25.ADDISONSDISEASE 26.CUSHINGSSYNDROME 27.HYPERTHYROIDISM/GRAVESDISEASE 28.INTUSSUSCEPTION 29.PARKINSONSDISEASE 30.HEPATITIS 31.THROMBOPHEBITIS 32.CATARACT 33.GLAUCOMA 34.RETINALDETACHMENT 35.CHOLECYSTITIS 36.ANGINAPECTORIS 37.MYASTHENIAGRAVIS 38.TETRALOGYOFFALLOT Lowgradeafternoonfever. Rustysputum. Wheezingonexpiration. Barrelchest. Strawberrytongue. Redbeefytongue. Protrudingtongue/semiancreaseonpalm Ricewaterystool. Stepladderlikefeverandchills. Rosespotsinabdomen. pseudomembraneformation(pharynx,tonsils,nasal) Kopliksspots. Butterflyrashes. spiderangioma,duetoesophagealvarices lioningface Chipmunkface.Parotidglandswelling reboundtenderness petechiaeor(+)Hermanssign Kernigssign(legpain),Brudzinskisign(neckpain). HYPOCALCEMIA(+)Trousseaussign/carpopedalspasmChvosteksign(facialspasm). risussardonicus. Cullenssign(ecchymosisofumbilicus)(+)Greyturnersspots. oliveSHAPEmassontheabdomen machinelikemurmur Bronzelikeskinpigmentation. Moonfaceappearanceandbuffalohump. Exopthalmus sausageshapedmass Pillrollingtremors Jaundice Homanssign Hazyvision/lossofcentralvision Tunnelvision/lossofperipheralvision Curtainveillikevision/flashesandfloaters Murphyssign(painondeepinspiration,ainflammationofthegallbladder Levinessign[handclutchinginthechest] Ptosis[droopingoftheuppereyelid] Clubbingoffingers

3.Type1DM(IDDM)[KETONES]

Causesdiabeticketoacidosis. Andincreasesbreakdownoffats. Andfreefattyacids Resultingtocholesteroland(+)toKetones(CNSdepressant). Resultingtoacetonebreathodor/fruityodor. KUSSMAULSrespiration,arapidshallowrespiration. Thismayleadtodiabeticcoma. Signsofjaundice(ictericsclerae). Causedbybilirubin(yellowpigment) Increasebilirubininbrain(Kernicterus). Causingirreversiblebraindamage.

4.Hepatitis

5.Bilirubin

DEMYELINATINGDISORDERS 1.ALZHEIMERSDISEASE

Atrophy of brain tissues. Progressive, irreversible, degenerative neurologic disease characterized by graduallossesofcognitivefx.Anddisturbancesinbehaviorandaffect.

SignandSymptoms 4AsofAlzheimer a.Amnesiapartialortotallossofmemory. b.Agnosianorecognitionofinanimateobjects. c.Apraxianorecognitionofobjectsfunction. d.Aphasianospeech(nodding). *Expressiveaphasia(BrocasAphasia)frontallobe


motorspeechcenter Nursingmgt.providePICTUREBOARD Inabilitytounderstandspokenwords. Irrationalthoughts/illogical GeneralKnowingGnosticAreaorGeneralInterpretativeArea.

*Receptiveaphasia(WernickesAphasia)temporallobe

DRUGOFCHOICE:ARICEPT(takenatbedtime)andCOGNEX.[increasingacetylcholine] 2.MULTIPLESCLEROSIS[Autoimmuneprocess]

ChronicintermittentdisorderofCNScharacterizedbywhitepatchesofdemyelinationinbrainandspinalcord. Characterizedbyremissionandexacerbation. Womenages1535areprone UnknownCause Slowgrowingvirus Autoimmunedisorders Perniciousanemia Myastheniagravis Lupus Hypothyroidism GBS

IgGonlyantibodythatpassplacental circulationcausingpassiveimmunity. Shorttermprotection. Immediateaction. IgApresentinallbodilysecretions (tears,saliva,colostrums). IgMacuteininflammation. IgEforallergicreaction. IgDforchronicinflammation. *Givepalliativeorsupportivecare. SignsandSymptoms 1.Visualdisturbances

blurringofvision(primary) Diplopia(doublevision) scotomas(blindspots)

2.Impairedsensation

Pain,pressure,heatandcold.[donotgivehotpacksbcozofdec.sensationtoheatwhichcanleadtoburns.] tinglingsensation paresthesia numbness

3.Moodswings

euphoria(senseofwellbeing) weakness spasticity paralysis scanningspeech TRIADSIGNSOFMS Ataxia (Unsteadygait,(+)Rombergstest) CHARCOTSTRIAD ANI Intentionaltremors Nystagmus

4.Impairedmotorfunction

5.Impairedcerebralfunction

6.Urinaryretention/incontinence 7.Constipation 8.Decreasesexualcapacity DIAGNOSTICPROCEDURE


CSFanalysis(increaseinIgGandProtein). MRI(revealssiteandextentofdemyelination). (+)Lhermittessignacontinuousandincreasecontractionofspinalcolumn/cordfollowinglaminotomy.

NURSINGMANAGEMENT 1.Administermedicationsasordered a.ACTH(AdrenoCorticotropicHormone)/Steroidsforacuteexacerbationtoreduceedemaatsite b.Baclofen(Dioresal)/DantroleneSodium(Dantrene)musclerelaxants. c.Interferonsalterimmuneresponse. d.Immunosupresants ofdemyelinationtopreventparalysis.[BestgiveninMorningtomimicbodynormalrhythm]

2.Maintainsiderailstopreventinjuryrelatedtofalls. 3.Institutestressmanagementtechniques. a.Deepbreathingexercises b.Yoga

4.Increasefluidintakeandincreasefibertopreventconstipation. 5.Catheterizationtopreventretention. a.Diuretics b.BethanicolChloride(Urecholine)treaturinaryretention NursingManagement


Onlygivensubcutaneous. Monitorsideeffectsbronchospasmandwheezing. Monitorbreathsounds1houraftersubcutaneousadministration.

c.ForUrinaryIncontinence Antispasmodicagent a.ProphanthelineBromide(Probanthine)antispasmodicdrugtotreaturinaryincontinence


Acidashdietlikecranberryjuice,plums,prunes,pineapple,vitaminCandorange. Toacidifyurineandpreventbacterialmultiplication.

COMMONCAUSEOFUTI Female

shorturethra(35cm,11inches) poorperinealhygiene vaginalenvironmentismoist avoidbubblebath(canalterPhofvagina). avoiduseoftissuepapers avoidusingtalcumpowderandperfume. Urethra(20cm,8inches) urinateafterintercourse

NursingManagement

Male

MICROGLIA

stationary cells that carry on phagocytosis (engulfing of bacteria or cellular debris, eating), pinocytosis (celldrinking). MACROPHAGE Microglia Monocytes Kupfferscells Histiocytes Alveolar Macrophage ORGAN Brain Blood Kidney Skin Lung

EPINDYMALCELLS

Secretesagluecalledchemoattractantsthatconcentratethebacteria. 80%brainmass 10%blood 10%CSF

COMPOSITIONOFBRAIN

I.BrainMass PARTSOFTHEBRAIN 1.CEREBRUM


largestpart Composed of the Right Cerebral Hemisphere and Left Cerebral Hemisphere enclosed in the Corpus Callosum.

FunctionsofCerebrum

integrative sensory motor

LobesofCerebrum 1.Frontal

highercorticalthinking controlspersonality controlsmotoractivity BrocasArea(motorspeecharea)whendamagedresultstogarbledspeech.

2.Temporal

hearing shorttermmemory forappreciation Discriminationofsensoryimpulsestopain,touch,pressure,heat,cold,numbness. forvision

3.Parietal

4.Occipital

Insula(IslandofReil)

Visceralfunctionactivitiesofinternalorganlikegastricmotility. controlssmellandifdamagedresultsto Anosmia(absenceofsmell). controlslibido[thetruesenseofsexualarousaliswhenyousmelledthefumesofthenaturalbody] controlslongtermmemory

LimbicSystem(Rhinencephalon)

2.BASALGAGLIA

areasofgreymatterlocateddeepwithineachcerebralhemisphere. releasedopamine(controlsgrossvoluntarymovement.) NEUROTRANSMITTER Acethylcholine Dopamine DECREASE MyastheniaGravis ParkinsonsDisease INCREASE BipolarDisorder Schizophrenia

3.MIDBRAIN/MESENCEPHALON

actsasrelaystationforsightandhearing. sizeofpupilis23mm. equalsizeofpupilisisocoria. unequalsizeofpupilisanisocoria. hearingacuityis3040dB. positivePERRLA[Pupilsequal,round,reactivetolightandaccommodation]

4.INTERBRAIN/DIENCEPHALON PartsofDiencephalon A.Thalamus

Actsasrelaystationforsensation. Controlstemperature(thermoregulatorycenter). controlsbloodpressure controlsthirst appetite/satiety sleepandwakefulness Controlssomeemotionalresponseslikefear,anxietyandexcitement. controlspituitaryfunctions Androgenichormonespromotesecondarysexcharacteristics. earlysignformalesaretesticularandpenileenlargement latesignisdeepeningofvoice. earlysignforfemalestelarcheandlatesignismenarche.

B.Hypothalamus

5.BRAINSTEM

locatedatlowestpartofbrain

PartsofBrainStem 1.Pons

pneumotaxiccentercontrolstherate,rhythmanddepthofrespiration. Controls respiration, heart rate, and swallowing, vomiting, hiccup, vasomotor center (dilation and constrictionofbronchioles). [damagetomedullaismostlifethreatening]

2.MedullaOblongata

3.Cerebellum

Smallestpartofthebrain. Lesserbrain. Controlsbalance,equilibrium,postureandgait.

INTRACRANIALPRESSURE MonroeKellieHypothesis Skullisaclosedcontainer Anyalterationorincreaseinoneoftheintracranialcomponents Increaseintracranialpressure (normalICPis015mmHg) Cervical1alsoknownasATLAS. Cervical2alsoknownasAXIS. ForamenMagnum MedullaOblongata BrainHerniation Increaseintracranialpressure *AlternatehotandcoldcompresstopreventHEMATOMA
CSFcushionsbrain(shockabsorber) ObstructionofflowofCSFwillleadtoenlargementofskullposteriorlycalledhydrocephalus. Earlyclosureofposteriorfontanelscausesposteriorenlargementofskullinhydrocephalus.

NEUROLOGICDISORDERS
INCREASE INTRACRANIAL PRESSURE increase in intracranial bulk brought about by an increase in one of the 3 majorintracranialcomponents.NORMALICP:015mmhg Causes:

headtrauma/injury localizedabscess cerebraledema hemorrhage

inflammatorycondition(stroke) hydrocephalus tumor(rarely)

SignsandSymptoms(Early)

decreaseLOC restlessness/agitation irritability changesinvitalsigns

lethargy/stupor coma

SignsandSymptoms(Late)

Bloodpressure(systolicbloodpressureincreasesbutdiastolicremainsthesame). Wideningofpulsepressureisneurologicinnature(ifnarrowcardiacinnature). heartratedecrease respiratoryratedecrease Temperatureincreasedirectlyproportionaltobloodpressure. projectivevomiting headache papilledema(edemaofopticdisc) abnormalposturing,[maypositivetobabinskireflex] Decorticateposturing(damagetocortexandspinalcord). decerebrateposturing(damagetoupperbrainstem thatincludespons,cerebellumandmidbrain). unilateraldilationofpupilscalleduncalherniation bilateraldilationofpupilscalledtentorialherniation resultingtomildheadache possibleseizureactivity

NursingManagement 1.Maintainpatentandadequateventilationby: a.Preventionofhypoxiaandhypercarbia Earlysignsofhypoxia


Restlessness Agitation Tachycardia Bradycardia Extremerestlessness Dyspnea Cyanosis

Latesignsofhypoxia

HYPERCARBIA

IncreaseCO2(mostpowerfulrespiratorystimulant)retention. InchronicrespiratorydistresssyndromedecreaseO2stimulatesrespiration.

b.Beforeandaftersuctioninghyperoxygenateclient100%anddone1015secondsonly. c.Assistinmechanicalventilation 2.Elevatebedofclient3035 anglewithneckinneutralpositionunlesscontraindicatedtopromotevenousdrainage. 3.Limitfluidintaketo12001500ml/day(inforcefluids20003000ml/day). 4.Monitorstrictlyinputandoutputandneurocheck 5.Preventcomplicationsof 6.PreventfurtherincreaseICPby: a.provideancomfortableandquiteenvironment. b.avoiduseofrestraints. c.maintainsiderails. d.instructclienttoavoidformsofvalsalvamaneuverlike:

o

strainingstool excessivevomiting(useantiemetics) excessivecoughing(useantitussivelikedextromethorphan) avoidstooping/bending avoidliftingheavyobjects

e.avoidclusteringofnursingactivitytogether.

7.Administermedicationslike: a.Osmoticdiuretic(Mannitol)

forcerebraldiuresis NursingManagement monitorvitalsignsespeciallyBP(hypotension). monitorstrictlyinputandoutputevery1hournotifyphysicianifoutputisless30cc/hr. administeredviasidedrip Regulatedfastdriptopreventcrystalformation. DrugofchoiceforCHF(pulmonaryedema) LoopofHenleinkidneys. MonitorvitalsignsespeciallyBP(hypotension). monitorstrictlyinputandoutputevery1hournotifyphysicianifoutputisless30cc/hr. AdministeredIVpushororal.

b.Loopdiuretic(Lasix,Furosemide)

NursingManagement

givenearlymorning Immediateeffectof1015minutes. maximumeffectof6hours.[monitorforpotassiumdepletion]

Dexamethasone(Decadron) Hydrocortisone Prednisone(toreduceedemathatmayleadtoincreaseICP) MildAnalgesics(CodeineSulfateforrespiratorydepression) AntiConvulsants(Dilantin,Phenytoin)

c.Corticosteroids

*CONGESTIVEHEARTFAILURE SignsandSymptoms

dyspnea orthopnea paroxysmalnocturnaldyspnea productivecough frothysalivation cyanosis rales/crackles bronchialwheezing pulsusalternans anorexiaandgeneralbodymalaise PMI(pointofmaximumimpulse/apicalpulserate)isdisplacedlaterally S3(ventriculargallop) PredisposingFactors/MitralValve RHD Aging

TREATMENT MorphineSulfate Aminophelline Digoxin Diuretics Oxygen Gases,bloodmonitor RIGHTCONGESTIVEHEARTFAILURE(Venouscongestion) SignsandSymptoms


jugularveindistention(neck) ascites pittingedema weightgain hepatosplenomegaly jaundice pruritus esophagealvarices anorexiaandgeneralbodymalaise

SignsandSymptomsofLasixintermsofelectrolyteimbalances 1.Hypokalemia

decreasepotassiumlevel normalvalueis3.45.5meq/L weaknessandfatigue

SignandSymptoms

constipation positiveUwaveonECGtracing administerpotassiumsupplementsasordered(KaliumDurule,OralPotassiumChloride) increaseintakeoffoodsrichinpotassium FRUITS Apple Banana Oranges VEGETABLES Asparagus Brocolli Spinach

NursingManagement

Cantalope Carrots

2.Hypocalcemia/Tetany

decreasecalciumlevel normalvalueis8.510.5mg/100ml tinglingsensation paresthesia numbness (+)Trousseaussign/Carpopedalspasm (+)Chvostekssign Arrhythmia Seizures CalciumGluconateperIVslowlyasordered

SignsandSymptoms

Complications

NursingManagement

*CalciumGluconatetoxicityresultstoSEIZURE MagnesiumSulfatetoxicity[B.U.R.P] S/S BP DECREASE Urineoutput MagnesiumSulfate

Respiratoryrate Patellarrelfexabsent 3.Hyponatremia


decreasesodiumlevel normalvalueis135145meq/L hypotension dehydrationsigns(InitialsigninadultisTHIRST,ininfantTACHYCARDIA) agitation drymucousmembrane poorskinturgor weaknessandfatigue

SignsandSymptoms

NursingManagement

forcefluids administerisotonicfluidsolutionasordered

4.Hyperglycemia

normalFBSis80100mg/dl

SignsandSymptoms3Ps

polyuria polydypsia polyphagia monitorFBS increaseuricacid(purinemetabolism) foodshighinuricacid(sardines,organmeatsandanchovies) *IncreaseintophidepositleadstoGoutyarthritis. jointpain(greattoes) swelling forcefluids administermedicationsasordered Drugofchoiceforgout. Mechanismofaction:inhibitssynthesisofuricacid. Acutegout Mechanismofaction:promotesexcretionofuricacid.

NursingManagement

5.Hyperuricemia

SignsandSymptoms

NursingManagement

a.Allopurinol(Zyloprim)

b.Colchecine

KIDNEYSTONES
SignsandSymptoms

renalcolic Coolmoistskin forcefluids administermedicationsasordered MorphineSulfate ANTIDOTE:Naloxone(Narcan) toxicityleadstotremors.

NursingManagement

a.NarcoticAnalgesic

b.Allopurinol(Zyloprim) Respiratorydepression(checkforRR)

SideEffects

PARKINSONSDISEASE/PARKINSONISM

ChronicprogressivedisorderofCNS characterizedbydegenerationofdopamineproducingcellsinthe SUBSTANCIANIGRAofthemidbrainandbasalganglia.

PredisposingFactors 1.Poisoning(leadandcarbonmonoxide) 2.Arteriosclerosis 3.Hypoxia 4.Encephalitis 5.Increasedosageofthefollowingdrugs: a.Reserpine(Serpasil) b.Methyldopa(Aldomet)AntihypertensiveS c.Haloperidol(Haldol) d.PhenothiazineAntipsychoticS

SIDEEFFECTSRESERPINEMajordepressionleadingto suicide Aloneness


LossofJob

Multipleloss causessuicide

Lossofspouse

directapproachtowardstheclient closesurveillanceisanursingpriority timetocommitsuicideisonweekendsearlymorning

SignsandSymptomsforParkinsons

pillrollingtremorsofextremitiesespeciallythehands. bradykinesia(slownessofmovement) rigidity(cogwheeltype) stoopedposture shufflingandpropulsivegait overfatigue masklikefacialexpressionwithdecreaseblinkingoftheeyes. difficultyrisingfromsittingposition. DysphoniasoftslurredMonotonetypespeech moodlability(instateofdepression) Micrographiashrinkingslowhandwriting increasesalivation(droolingtype) autonomicchanges a.increasesweating b.increaselacrimation c.seborrhea d.constipation e.decreasesexualcapacity

NursingManagement 1.Administermedicationsasordered AntiParkinsonianagents


Levodopa(Ldopa)shortacting AmantadineHydrochloride(Symmetrel) Carbidopa(Sinemet) increaselevelofdopamine GITirritation(shouldbetakenwithmeals

MechanismofAction

SideEffects

orthostatichypotension(CBQ)
arrhythmia hallucinations clientswithnarrowangleclosureglaucoma clientstakingMAOIs(nofoodswithtryptophanandthiamine:cheese,beer,avocado,wine) urineandstoolmaybedarkened noVitaminB6(Pyridoxine)reversesthetherapeuticeffectsofLevodopa

Contraindications

*IncreaseVitaminBwhentakingINH(Isoniazid),IsonicotinicAcidHydrazide

AntiCholinergicAgents(ARTANEandCOGENTIN)torelievetremors MechanismofAction

inhibitsactionofacethylcholine SNS

SideEffects

AntiHistamine(DipenhydramineHydrochloride) SideEffects Adult:drowsiness Children:CNSexcitement(hyperactivity)becausebloodbrainbarrierisnotyetfullydeveloped. DopamineAgonistrelievestremorrigidity BromocripteneHydrochloride(Parlodel) SideEffects

Respiratorydepression

2.Maintainsiderailstopreventinjury 3.Preventcomplicationsofimmobility 4.Decreaseproteininmorningandincreaseproteininafternoontoinducesleep 5.Encourageincreasefluidintakeandfiber. 6.Assist/superviseinambulation 7.AssistinStereotaxicThalamotomyaportionofthalamusisdestroyedtoreducetremors

MAGIC2sINDRUGMONITORING[D.L.A.D.A]
DRUG Digoxin/Lanoxin (Increaseforceof cardiacoutput) Lithium/Lithane (Decreaselevelof Ach/NE/Serotonin) Aminophylline (Dilatesbronchialtree) Dilantin/Phenytoin Acetaminophen/Tylenol 1.DigitalisToxicity SignsandSymptoms

NORMALRANGE .51.5meq/L .61.2meq/L 1019mg/100ml 1019mg/100ml 1030mg/100ml

TOXICITY LEVEL 2 2 20 20 200

INDICATION CHF Bipolar COPD Seizures Osteoarthritis

CLASSIFICATION CardiacGlycoside AntiManicAgents Bronchodilators AntiConvulsant Nonnarcotic Analgesic

nauseaandvomiting/anorexia diarrhea confusion/fatigue/depression/malaise photophobia changesincolorperception(yellowishorgreenhaloaroundlightsorsnowyvision)

Antidote:DigibinddigoxinimmuneFAB 2.LithiumToxicityantimanicagent/moodstabilizingagent SignsandSymptoms


anorexia nauseaandvomiting diarrhea dehydrationcausingfinetremors hypothyroidism(cretinismtheonlyendocrinedisorderthatcanleadtomentalretardation) forcefluids increasesodiumintaketo410g%daily

NursingManagement

3.AminophyllineToxicity SignsandSymptoms

tachycardia palpitations CNSexcitement(tremors,irritability,agitationandrestlessness) OnlymixedwithplainNSSor0.9NaCltopreventdevelopmentofcrystalsorprecipitate. administeredsandwichmethod avoidtakingalcoholbecauseitcanleadtosevereCNSdepression avoidcaffeine

NursingManagement

4.DilantinphenytoinToxicity SignsandSymptoms

gingivalhyperplasia(swollen&tendergums) hairytongue ataxia nystagmus provideoralcare massagegums

NursingManagement

5.AcetaminophenToxicity SignsandSymptoms

hepatotoxicity(monitorforliverenzymes) SGPT/ALT(SerumGlutamicPyruvateTransaminace) SGOT/AST(SerumGlutamicOxaloAcetilTransaminace) nephrotoxicitymonitorBUN(1020)andCreatinine(.81) hypoglycemia

Tremors,tachycardia Irritability Restlessness Extremefatigue Diaphoresis,depression Antidote:Acetylcisteine(mucomyst)preparesuctionapparatusatbedside. MYASTHENIAGRAVIS

Neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to musclecellsattheneuromuscularjunctionleadingtodescendingmuscleweakness.

Incidencerate:women2040yearsold Predisposingfactors

unknown Autoimmune:itinvolvesreleaseofcholinesteraseanenzymethatdestroysAcetylcholine initialsignisptosisaclinicalparametertodetermineptosisispalpebralfissure.(droopingofeyelid) diplipia masklikefacialexpression dysphagia hoarsenessofvoice [dysphoniavoiceimpairment] respiratorymuscleweaknessthatmayleadtorespiratoryarrest(tracheostomyatbedside) extrememuscleweaknessespeciallyduringactivityorexertion Tensilontest (EdrophoniumHydrochloride)providestemporaryreliefofsignsandsymptomsforabout 5 10minutesandamaximumof15minutes. ifthereisnoeffectthereisdamagetooccipitallobeandmidbrainandisnegativeforM.G.

SignsandSymptoms

DiagnosticProcedure

NursingManagement 1.Airway 2.Aspirationmaintainpatentairwayandadequateventilation 3.Immobility *assistinmechanicalventilationandmonitorpulmonaryfunctiontest *monitorstrictlyvitalsigns,inputandoutputandneurocheck *monitorstrengthormotorgradingscale 4.Maintainsiderailstopreventinjuryrelatedtofalls 5.InstituteNGTfeeding 6.Administermedicationsasordered a.Cholinergic(Mestinon)pyridostigminebromide b.AntiCholenisterase(Prostigmin)neostigminebromide MechanismofAction

increaselevelofAch PNS Cortocosteroidssuppressimmuneresponse monitorfor2typesofcrisis: MYASTHENICCRISIS CHOLINERGICCRISIS Cause: overmedication SignsandSymptoms PNS TensilontestdoesntimproveMG Treatment Administeranticholinergicagents(Atropine Sulfate)

SideEffects

Causes: undermedication stress(diseaseexacerbation,hightemp.) infection SignsandSymptoms Theclientisunabletosee,swallow,speak, breathe Treatment administercholinergicagentsasordered

7.AssistinsurgicalprocedureknownasthymectomybecauseitisbelievedthatthethymusglandisresponsibleforM.G. 8.Assistinplasmaparesisandremovingautoimmuneantibodies 9.Preventcomplications

INFLAMMATORYCONDITIONSOFTHEBRAIN
MENINGITIS Meninges

3foldmembranethatcoversbrainandspinalcord. forsupportandprotection fornourishment bloodsupply

LAYERSOFTHEMENINGES 1.Duramatterouterlayer 2.Arachnoidmiddlelayer 3.Piamatterinnerlayer


subduralspacebetweentheduraandarachnoid Subarachnoidspacebetweenthearachnoidandpia,CSFaspirationisdone.

A.Etiology 1.Meningococcusmostdangerous 2.Pneumococcus 3.Streptococcuscausesadultmeningitis 4.HemophilusInfluenzaecausespediatricmeningitis B.Modeoftransmission

airbornetransmission(dropletnuclei)

C.SignsandSymptoms

headache photophobia projectilevomiting fever&chills,anorexia,generalizedbodymalaiseandweightloss PossibleincreaseinICPandseizureactivity Abnormalposturing(decorticateanddecerebrate) Signsofmeningealirritation a.Nuchalrigidityorstiffneck b.Opisthotonus(archingofback) c.(+)Kernigssign(legpain) d.(+)Brudzinskisign(neckpain)

D.DiagnosticProcedures

Lumbarpuncture:a hollowspinalneedle isinsertedinthesubarachnoidspace betweentheL3 L4to L5.

NursingManagementforLP BeforeLumbarPuncture.[noteallsurgeryprocedureexplainbythedoctor,diagnosticprocedureisbythenurse] 1. Secureinformedconsentandexplainprocedure. 2. Emptybladderandboweltopromotecomfort. 3. EncouragetoarchbacktoclearlyvisualizeL3L4.(fetalposition) PostLumbarPuncture o 1. Placeflatonbed1224 2. Forcefluids 3. Checkpuncturedsiteforanydiscoloration,drainageandleakagetotissues. 4. Assessformovementandsensationofextremities. CSFanalysisreveals 1. IncreaseCHONandWBC 2. Decreaseglucose 3. IncreaseCSFopeningpressure(normalpressureis50100mmHg) 4. (+)culturedmicroorganism(confirmsmeningitis) CBCreveals 1.Increasewbc E.NursingManagement 1.Enforcecompletebedrest 2.Administermedicationsasordered a.Broadspectrumantibiotics(Penicillin,Tetracycline) b.Mildanalgesics c.Antipyretics
o

notesonhematology:

RBC WBC PLATELETS

INCREASED Polycythemia Leukocytosis

DECREASED Anemia Leukopenia

Thrombocytosis Thrombocytopenia

3.Institutestrictrespiratoryisolation24hoursafterinitiationofantibiotictherapy 4.Elevatehead3045 5.MonitorstrictlyV/S,inputandoutputandneurocheck 6.InstitutemeasurestopreventincreaseICPandseizure. 7.Provideacomfortableanddarkenedenvironment. 8.Maintainfluidandelectrolytebalance. 9.Provideclienthealthcareanddischargeplanningconcerning: a.MaintaingooddietofincreaseCHO,CHON,calorieswithsmallfrequentfeedings. b.Preventcomplications


mostfearedishydrocephalus hearingloss/nervedeafnessissecondcomplication consultaudiologist mentalretardation delayedpsychomotordevelopment

c.Rehabilitationforneurologicaldeficit

CVA(STROKE/BRAINATTACK/ADOPLEXY/CEREBRALTHROMBOSIS)

apartialorcompletedisruptioninthebrainsbloodsupply. 2mostcommoncerebralarteryaffectedbystroke

a.MidCerebralArtery b.InternalCerebralArterythe2largestartery menare23timeshighrisk

A.IncidenceRate

B.PredisposingFactors

thrombus(attached) embolus (detached and most dangerous because it can go to the lungs and cause pulmonary embolismorthebrainandcausecerebralembolism.

SignsandSymptomsofPulmonaryEmbolism

Suddensharpchestpain Unexplaineddyspnea Tachycardia Palpitations Diaphoresis Mildrestlessness Headacheanddizziness Confusion Restlessness DecreaseLOC

SignsandSymptomsofCerebralEmbolism

Fatembolismisthemostfearedcomplicationsafterfemurfracture. Yellowbonemarrowareproducedfromthemedullarycavityofthelongbonesandproducesfatcells. Ifthereisbonefracturethereishemorrhageandtherewouldbeescapeofthefatcellsinthecirculation. Compartmentsyndrome(compressionofarteriesandnerves)

C.RiskFactors 1.Hypertension,DiabetesMellitus,MyocardialInfarction,Atherosclerosis,ValvularHeartDisease,PostCardiacSurgery (mitralvalvereplacement) 2.Lifestyle(smoking),sedentarylifestyle 3.Obesity(increase20%idealbodyweight) 4.Hyperlipidemiamoreongenetics/genesthatbindstocholesterol 5.TypeApersonality a.deadlinedriven b.candomultipletasks c.usuallyfellsguiltywhennotdoinganything

6.Relatedtodiet:increaseintakeofsaturatedfatslikewholemilk 7.Relatedstressphysicalandemotional 8.Prolonguseoforalcontraceptivespromoteslypolysis(breakdownoflipids)leadingtoatherosclerosisthatwillleadto hypertensionandeventuallyCVA. D.SignsandSymptoms

dependentonstagesofdevelopment Initialsignofstrokeorwarningsign headacheanddizziness tinnitus visualandspeechdisturbances paresistoplegia possibleincreaseICP

1.TIA

SignsandSymptoms

2.Strokeinevolution progressionofsignsandsymptomsofstroke 3.Completestroke

resolutionphasecharacterizedby: headacheanddizziness CheyneStokesRespiration anorexia,nauseaandvomiting dysphagia (+)KernigssignandBrudzinskisign whichmayleadtohemorrhagicstroke focalneurologicaldeficits a.phlegia b.aphasia c.dysarthria(inabilitytoarticulatewords) d.alexia(difficultyreading) e.agraphia(difficultywriting) f.homonymoushemianopsia(lossofhalfofvisualfield)
Notes: Plegiaparalysis Ex:Hemiplegia paralysisofonesideof thebody. Paresisweakness Ex: Hemiparesis weakness of one side ofthebody.

SignsandSymptoms

E.DiagnosticProcedure 1.CTScanrevealsbrainlesions 2.CerebralArteriography


revealsthesiteandextentofmalocclusion usesdyeforvisualization mostofdyeareiodinebased checkforshellfishallergy afterdiagnosticexamforcefluidstoreleasedyebecauseitisnephrotoxic checkfordistalpulse(femoral) checkforhematomaformation

F.NursingManagement 1.Maintainpatentairwayandadequateventilationby: a.assistinmechanicalventilation b.administrateO2inhalation


o

2.RestrictfluidstopreventcerebraledemathatmightincreaseICP 3.Elevatehead3045 4.Monitorstrictlyvitalssigns,I&Oandneurocheck 5.Preventcomplicationsofimmobilityby: a.turnclienttoside b.provideeggcratemattressesorwaterbed c.providesandbagorfootboard.

6.AssistinpassiveROMexerciseevery4hourstopromoteproperbodilyalignmentandpreventcontractures 7.InstituteNGTfeeding 8.Providealternativemeansofcommunication a.nonverbalcues b.magicslate

9.Ifpositivetohemianopsiaapproachclientonunaffectedside 10.Administermedicationsasordered a.OsmoticDiuretics(Mannitol) b.LoopDiuretics(Lasix,Furosemide) c.Cortecosteroids d.MildAnalgesics e.Thrombolytic/FibrinolyticAgentsdissolvesthrombus

Streptokinase SideEffect:AllergicReaction Urokinase TissuePlasminogenActivatingFactor SideEffect:ChestPain

f.AntiCoagulants

Heparin(shortacting) checkforpartialthromboplastintimeifprolongedthereisariskforbleeding. giveProtamineSulfate Comadin/Warfarin(longacting) givesimultaneouslybecauseCoumadinwilltakeeffectafter3days checkforprothrombintimeifprolongedthereisariskforbleeding giveVit.K(AquaMephyton)

g.AntiPlatelet

PASA(Aspirin) Contraindicated for dengue, ulcer and unknown cause of headache because it may potentiate bleeding

11.Provideclienthealthteachingsanddischargeplanningconcerning GUILLAINBARRESYNDROME(AcuteEdiopathicPolyneuropathy)

a.avoidanceofmodifiableriskfactors(diet,exercise,smoking) b.preventcomplication(subarachnoidhemorrhageisthemostfearedcomplication) c.dietarymodification(decreasesalt,saturatedfatsandcaffeine) d.importanceoffollowupcare

a disorder of the CNS characterized by bilateral symmetrical polyneuritis leading to ascending muscle paralysis/weakness.

A.PredisposingFactors 1.Autoimmune 2.AntecedentviralinfectionssuchasLRTinfections

B.SignsandSymptoms 1.Clumsiness(initialsign) 2.Dysphagia 3.Ascendingmuscleweaknessleadingtoparalysis 4.Decreasedofdiminisheddeeptendonreflex 5.Alternatehypotensiontohypertension **ARRYTHMIA(mostfearedcomplication) 6.Autonomicsymptomsthatincludes C.DiagnosticProcedures 1.CSFanalysisrevealsincreaseinIgGandprotein D.NursingManagement 1.Maintainpatentairwayandadequateventilationby: a.assistinmechanicalventilation b.monitorpulmonaryfunctiontest a.vitalsigns b.intakeandoutput c.neurocheck d.ECG a.increasesalivation b.increasesweating c.constipation

2.Monitorstrictlythefollowing

3.Maintainsiderailstopreventinjuryrelatedtofall 4.Preventcomplicationsofimmobilitybyturningtheclientevery2hours 5.InstituteNGTfeedingtopreventaspiration 6.AssistinpassiveROMexercise 7.Administermedicationsasordered a.Corticosteroidssuppressimmuneresponse b.AntiCholinergicAgentsAtrophineSulfate c.AntiArrythmicAgents


Lidocaine,Zylocaine BretyliumblocksreleaseofnorepinephrinetopreventincreaseofBP

8.Assistinplasmapharesis(filteringofbloodtoremoveautoimmuneantibodies) 9.Preventcomplications *SengstakenBlakemoreTube


a.Arrythmia b.Paralysisorrespiratorymuscles/Respiratoryarrest

forlivercirrhosis todecompressbleedingesophagealverices(prepare scissor tocuttubeincaseofdifficultyinbreathing toreleaseairintheballoon forhemodialysispreparebulldogclipstopreventairembolism.

CONVULSIVEDISORDER/CONVULSION

Disorder of CNS characterized by paroxysmal seizure with or without loss of consciousness abnormal motoractivityalternationinsensationandperceptionandchangesinbehavior. Seizurefirstconvulsiveattack Epilepsysecondorseriesofattacks Febrileseizurenormalinchildrenagebelow5years

A.PredisposingFactors 1.Headinjuryduetobirthtrauma 2.Genetics 3.Presenceofbraintumor 4.Toxicityfrom a.lead bcarbonmonoxide

5.NutritionalandMetabolicdeficiencies 6.Physicalandemotionalstress 7. Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam, Valium) B.SignsandSymptoms

Dependentonstagesofdevelopmentortypesofseizure

I.GeneralizedSeizure 1.GrandmalSeizure(tonicclonicseizure) a.Signsoraurawithauditory,olfactory,visual,tactile,sensoryexperience b.Epilepticcryischaracterizedbyfallandlossofconsciousnessfor35minutes c.Toniccontractionsdirectsymmetricalextensionofextremities II.PartialorLocalizedSeizure 1.JacksonianSeizure(focalseizure)

Cloniccontractionscontractionofextremities d.Postictalsleepunresponsivesleep a.blankstare b.decreaseblinkingofeyes c.twitchingofmouth d.lossofconsciousness(510seconds)

2.PetitmalSeizureabsenceofseizurecommonamongpediatricclientscharacterizedby

Characterizedbytinglingandjerkymovementofindexfingerandthumbthatspreadstotheshoulderandotherside ofthebody.

2.PsychomotorSeizure(focalmotorseizure) III.StatusEpilepticus

a.automatismstereotyperepetitiveandnonpropulsivebehavior b.cloudingofconsciousnessnotincontactwithenvironment c.mildhallucinatorysensoryexperience

A continuous uninterrupted seizure activity, if left untreated can lead to hyperpyrexia and lead to coma andeventuallydeath. Drugofchoice:Diazepam,ValiumandGlucose

C.DiagnosticProcedures 1.CTScanrevealsbrainlesions 2.EEGrevealshyperactivityofelectricalbrainwaves D.NursingManagement 1.Maintainpatentairwayandpromotesafetybeforeseizureactivity a.clearthesiteofbluntorsharpobjects b.loosenclothingofclient c.maintainsiderails d.avoiduseofrestrains e.turnclientsheadtosidetopreventaspiration f.placemouthpieceoftongueguardtopreventbitingortongue

2.Avoidprecipitatingstimulussuchasbright/glaringlightsandnoise 3.Administermedicationsasordered COMPREHENSIVENEUROEXAM GLASGOWCOMASCALE

a.Anticonvulsants(Dilantin,Phenytoin) b.Diazepam,Valium c.Carbamazepine(Tegretol)Trigeminalneuralgia d.Phenobarbital,Luminal a.administerO2inhalation b.providesuctionapparatus a.onsetandduration b.typesofseizures c.durationofpostictalsleepmayleadtostatusepilepticus d.assistinsurgicalprocedurecorticalresection

4.Instituteseizureandsafetyprecautionpostseizureattack

5.Documentandmonitorthefollowing

objectivemeasurementofLOCsometimescalledasthequickneurocheck Conscious1514 Lethargy1311 Stupor108 Coma7 DeepComa3 Surveyofmentalstatusandspeech a.LOC b.Testofmemory

Components 1.Motorresponse 2.Verbalresponse 3.Eyeopening

Levelsoforientation Cranialnerveassessment Sensorynerveassessment Motornerveassessment Deeptendonreflex Autonimics Cerebellartest a,Rombergstest2nurses,positiveforataxia b.Fingertonosetestpositiveresultmeandimetria (inabilityofbodytostopmovementatdesiredpoint) c.Alternatesupinationandpronationpositiveresultmeandimetria

I.LEVELOFCONSCIOUSNESS 1.Consciousawake 2.Lethargylethargic(drowsy,sleepy,obtunded) 3.Stupor


stuporous(awakenedbyvigorousstimulation) generalizedbodyweakness decreasebodyreflex comatose lightcoma(positivetoallformsofpainfulstimulus) deepcoma(negativetoallformsofpainfulstimulus)

4.Coma

DIFFERENTPAINFULSTIMULATION 1.Deepsternalstimulation/deepsternalpressure 2.Orbitalpressure 3.Pressureongreattoes 4.Cornealorblinkingreflex Consciousclientuseawispofcotton Unconsciousclientplace1dropofsalinesolution II.TESTOFMEMORY 1.Shorttermmemory


askmostrecentactivity positiveresultmeananterogradeamnesiaanddamagetotemporallobe askforbirthdayandvalidateonprofilesheet positiveresultmeanretrogradeamnesiaanddamagetolimbicsystem considereducationalbackground CRANIALNERVES I.OLFACTORY II.OPTIC IIIOCCULOMOTOR IV.TROCHLEAR V.TRIGEMINAL VI.ABDUCENSE dontusealcohol,ammonia,perfumebecauseitisirritating andhighlydiffusible. usecoffeegranules,vinegar,barofsoap,cigarette testeachnostrilbyoccludingeachnostril VII.FACIAL VIII.ACOUSTIC IX.GLOSSOPHARYNGEAL X.VAGUS XI.SPINALACCESSORY XII.HYPOGLOSSAL FUNCTION S S M M (Smallest) B (Largest) M B S B B (Longest) M M

2.Longtermmemory

III.LEVELSOFORIENTATION 1.Timefirstasked 2.Personsecondasked 3.Placethirdasked CRANIALNERVES CRANIALNERVEI:OLFACTORY

sensoryfunctionforsmell

MaterialUsed

Procedure

AbnormalFindings 1.Hyposniadecreasesensitivitytosmell 2.Dysosmiadistortedsenseofsmell 3.Anosmiaabsenceofsmell Indicativeof

1.headinjurydamagingthecribriformplateofethmoidbonewhereolfactorycellsarelocated 2.mayindicateinflammatoryconditions(sinusitis) CRANIALNERVEII:OPTIC

sensoryfunctionforvisionorsight

Functions 1.Testvisualacuityorcentralvisionordistance

useSnellensChart SnellensAlphabetchart:forliterateclients SnellensEchart:forilliterateclients SnellensAnimalchart:forpediatricclients normalvisualacuity20/20 numeratorisconstant,itisthedistanceofpersonfromthechart(67m,20feet) denominatorchanges,indicatesdistancebywhichthepersonnormallycanseeletterinthechart. 20/200indicatesblindness 20/20visualacuityifclientisabletoreadlettersabovetheredline.

2.Testofvisualfieldorperipheralvision

a.Superiorly b.Bitemporaly c.Nasally d.Inferiorly

COMMONVISUALDISORDERS 1.Glaucoma

increaseIOP normalIOPis1221mmHg preventablebutnotcurable Commonamong40yearsoldandabove Hereditary Hypertension Obesity

A.PredisposingFactors

B.SignsandSymptoms 1.Lossofperipheralvision

pathognomonicsignistunnelvision steamycornea mayleadtoblindness

2.Headache,nausea,vomiting,eyepain(halosaroundlight)

C.DiagnosticProcedures 1.Tonometry 2.Perimetry 3.Gonioscopy D.Treatment 1.Mioticsconstrictspupil a.PilocarpineSodium,Carbachol 2.Epinephrineeyedropsdecreaseformationofaqueoushumor 3.CarbonicAnhydraseInhibitors E.SurgicalProcedures 1.TRABECULECTOMY(PeripheralIndectomy)drainaqueoushumor 2.CATARACT

a.Acetazolamide(Diamox)promotesincreaseoutflowofaqueoushumorordrainage

4.Timoptics(TimololMaleate)

Decreaseopacityoflens

A.PredisposingFactor 1.Aging65yearsandabove 2.Relatedtocongenital 3.DiabetesMellitus 4.ProlongedexposuretoUVrays B.SignsandSymptoms 1.Lossofcentralvision C.PathognomonicSigns 1.Blurringorhazyvision 2.Milkywhiteappearanceatcenterofpupils 3.Decreaseperceptiontocolors

Complicationisblindness

D.DiagnosticProcedure 1.Opthalmoscopicexam E.Treatment 1.Mydriatics(Mydriacyl)dilatingpupils 2.Cyclopegics(Cyclogyl)paralysescilliarymuscle F.SurgicalProcedure Extra Capsular Cataract Lens Extraction Intra Capsular Cataract Lens Extraction Totalremovalofcataractwithitssurroundingcapsules

Partialremoval

MostfearedcomplicationpostopisRETINALDETACHMENT

3.RetinalDetachment

Separationofepithelialsurfaceofretina

A.PredisposingFactors 1.PostLensExtraction 2.Myopia(nearsightedness) B.SignsandSymptoms 1.Curtainveillikevision 2.Floaters C.SurgicalProcedures 1.ScleralBuckling 2.Cryosurgerycoldapplication 3.Diathermyheatapplication 4.MacularDegeneration

Degenerationofthemaculalutea(yellowishspotatthecenterofretina)

A.SignsandSymptoms 1.BlackSpots CRANIALNERVEIII,IV,VI:OCULOMOTOR,TROCHLEAR,ABDUCENS


A.normalretina

Controlsorinnervatesthemovementofextrinsicocularmuscle(EOM) 6muscles

B.wetmaculardegeneration c.drymaculardegeneration

SuperiorRectus LateralRectus InferiorOblique InferiorRectus MedialRectus SuperiorOblique

trochlearcontrolssuperioroblique abducenscontrolslateralrectus oculomotorcontrolsthe4remainingEOM

Oculomotor

controlsthesizeandresponseofpupil normalpupilsizeis23mm equalsizeofpupil:Isocoria Unequalsizeofpupil:Anisocoria Normalresponse:positivePERRLA

CRANIALNERVEV:TRIGEMINAL

largestcranialnerve consistsofophthalmic,maxillary,mandibular sensory:controlssensationofface,mucousmembrane,teeth,softpalateandcornealreflex) motor:controlsthemuscleofmasticationorchewing damagetoCNVleadstotrigeminalneuralgia/ticdouloureux(nervepain) medication:Carbamezapine(Tegretol)anticonvulsant

CRANIALNERVEVII:FACIAL

Sensory:controlstaste,anterior2/3oftongue pinchofsugarandcottonapplicatorplacedontipoftongue Motor:controlsmuscleoffacialexpression Instruct client to smile, frown and if results are negative there is facial paralysis or Bells palsy and the primarycauseisforcepsdelivery.

CRANIALNERVEVIII:ACOUSTIC/VESTIBULOCOCHLEAR

Controls balance particularly kinesthesia or position sense, refers to movement and orientation of the bodyinspace.

PartsoftheEar 1.OuterEar

Pinna Eardrum Hammer Anvil Stirrup Malleus Incus Stapes

2.MiddleEar

3.InnerEar

Vestibule:MeineresDisease Cochlea MastoidCells EndolymphandPerilymph

COCHLEA:controlshearing,containstheOrganofCorti(thetrueorganofhearing) Letclientrepeatwordsuttered CRANIALNERVEIX,X:GLOSOPHARYNGEAL,VAGUSNERVE


Glosopharyngeal:controlstaste,posterior1/3oftongue Vagus:controlsgagreflex Uvulashouldbemidlineandifnotindicativeofdamagetocerebralhemisphere EffectsofvagalstimulationisPNS

CRANIALNERVEXI:SPINALACCESSORY

Innervateswithsternocleidomastoid(neck)andtrapezius(shoulder)

CRANIALNERVEXII:HYPOGLOSSAL

Controlsthemovementoftongue Letclientprotrudetongue and itshouldbemidline andifunabletodo indicativeofdamagetocerebral hemisphereand/orhasshortfrenulum.

ENDOCRINESYSTEM
Overviewofthestructuresandfunctions 1.PituitaryGland(HypophysisCerebri) o Locatedatbaseofbrainparticularlyatsellaturcica o Masterglandormasterclock o Controlsallmetabolicfunctionofbody PARTSOFTHEPITUITARYGLAND 1.AnteriorPituitaryGland o calledasadenohypophysis 2.PosteriorPituitaryGland o calledasneurohypophysis o secreteshormonesoxytocinpromotesuterinecontractionspreventingbleeding/hemorrhage o administrateoxytocinimmediatelyafterdeliverytopreventuterineatony. o initiatesmilkletdownreflexwithhelpofhormoneprolactin 2.AntidiureticHormone o Pitressin(Vasopressin) o Function:preventsurinationtherebyconservingwater o Diabetes Insipidus/ Syndrome of Inappropriate Anti Diuretic Hormone DIABETESINSIPIDUS(DalasIhi) o Decreaseproductionofantidiuretichormone A.PredisposingFactor o Relatedtopituitarysurgery o Trauma o Inflammation o Presenceoftumor B.SignsandSymptoms 1.Polyuria 2.Signsofdehydration a.Adult:thirst b.Agitation c.PoorSkinturgor d.Drymucousmembrane
ADH OXYTOCIN Anteriorpituitary GH ACTH TSH FSH&LH PROLACTIN MSH Posteriorpituitary

3.Weaknessandfatigue 4.Hypotension 5.Weightloss(payat) 6.Ifleftuntreatedresultstohypovolemicshock(signisanuria) C.DiagnosticProcedures 1.UrineSpecificGravity o Normalvalue:1.0151.030 o Ph48 2.SerumSodium o Increaseresultingtohypernatremia D.NursingManagement 1.Forcefluids 2.Monitorstrictlyvitalsignsandintakeandoutput 3.Administermedicationsasordered a.Pitressin(VasopresinTannate)administeredIMZtract 4.Preventcomplilcations HYPOVOLEMICSHOCK isthemostfearedcomplication

SIADHlunodsatubig
o hypersecretionofantidiuretichormone A.PredisposingFactors 1.Headinjury 2.Relatedtopresenceofbronchogeniccancer o initialsignoflungcancerisnonproductivecough o noninvasiveprocedureischestxray 3.Relatedtohyperplasia(increasesizeoforganbroughtaboutbyincreaseofnumberofcells)ofpituitarygland. B.SignsandSymptoms 1.Fluidretention C.DiagnosticProcedure 1.Urinespecificgravityisincreased 2.SerumSodiumisdecreased(hyponatremia135mg/dl) D.NursingManagement 1.Restrictfluid 2.Administermedicationsasordered a.Loopdiuretics(Lasix) b.Osmoticdiuretics(Mannitol) a.Hypertension b.Edema c.Weightgain(mataba)

2.WaterintoxicationmayleadtocerebraledemaandleadtoincreaseICPmayleadtoseizureactivity

3.Monitorstrictlyvitalsigns,intakeandoutputandneurocheck 4.Weighpatientdailyandassessforpittingedema 5.Providemeticulousskincare 6.Preventcomplications ANTERIORPITUITARYGLAND o alsocalledADENOHYPOPHYSISsecretes 1.Growthhormones(somatotropichormone) o Promoteselongationoflongbones o HyposecretionofGHamongchildrenresultstoDwarfism o HypersecretionofGHresultstoGigantism o HypersecretionofGHamongadultsresultstoAcromegaly(squareface) o Drugofchoice:Ocreotide(Sandostatin) 2.MelanocyteStimulatinghormone o forskinpigmentation o HyposecretionofMSHresultsto Albinism o Mostfearedcomplicationsofalbinism 3.Adrenochorticotropichormone(ACTH) o promotesdevelopmentofadrenalcortex 4.Lactogenichomone(Prolactin) o promotesdevelopmentofmammarygland o withhelpofoxytocinitinitiatesmilkletdownreflex a.Leadtoblindnessduetoseverephotophobia b.Pronetoskincancer o HypersecretionofMSHresultstoVitiligo

5.Leutinizinghormone o secretesestrogen 6.Folliclestimulatinghormone o secretesprogesterone PINEALGLAND o secretesmelatonin o inhibitsLHsecretion o itcontrols/regulatescircadianrhythm(bodyclock) THYROIDGLAND o locatedanteriortotheneck 3Hormonessecreted 1.T3(Triiodothyronine)3moleculesofiodine(morepotent) 2.T4(tetraiodothyronine,Thyroxine) o T3andT4aremetabolicorcalorigenichormone o promotescerebration(thinking) 3.Thyrocalcitoninantagonizestheeffectsofparathormonetopromotecalciumresorption. HYPOTHYROIDISMthyroiddeficiency o allaredecreaseexceptweightandmenstruation o memoryimpairment SignsandSymptoms o thereislossofappetitebutthereisweightgain o menorrhagiaoramenorrhea o coldintolerance o constipation o canleadtoMyxedema o extremefatigue o babagsaksaexam(mentalproc.Decreased) o weightgain o hypothermic HYPERTHYROIDISM o allareincreaseexceptweightandmenstruation SignsandSymptoms o increaseappetitebutthereisweightloss o amenorrhea o exophthalmos o Tachycardia,palpitations o insomnia o restlessnessagitation o Heatintolerance o HPN THYROIDDISORDERS SIMPLEGOITER o enlargementofthyroidglandduetoiodinedeficiency A.PredisposingFactors 1.Goiterbeltarea a.placesfarfromsea b.Mountainousregions o containsprogoitrinanantithyroidagentthathasnoiodine. o cabbage,turnips,radish,strawberry,carrots,sweetpotato,broccoli,allnuts
Pharmacologictherapy forhypothyroidism Syntheticlevothyroxine (syndroidorlevothroid) Myxedemacoma Severehypothyroidism Increased lethargic Hypothermic Stupor coma

2.Increaseintakeofgoitrogenicfoods

o soilerosionwashesawayiodine o goitrogenicdrugs a.AntiThyroidAgentProphylthiuracil(PTU) b.LithiumCarbonate d.Cobalt c.PASA(Aspirin) e.Phenylbutazones(NSAIDs)ifgoiteriscausedby

B.SignsandSymptoms 1.Enlargedthyroidgland 2.Milddysphagia 3.Mildrestlessness C.DiagnosticProcedures 1.SerumT3andT4revealsnormalorbelownormal 2.ThyroidScanrevealsenlargedthyroidgland. 3.SerumThyroidStimulatingHormone(TSH) isincreased(confirmatorydiagnostictest) D.NursingManagement 1.Enforcecompletebedrest 2.Administermedicationsasordered a.LugolsSolution/SSKI(SaturatedSolutionofPotassiumIodine) o colorpurpleorvioletandadministeredviastrawtopreventstainingofteeth. o 4 Medications to be taken via straw: Lugols, Iron, Tetracycline, Nitrofurantoin (drug of choice for pyelonephritis) b.ThyroidHormones o Levothyroxine(Synthroid) o Liothyronine(Cytomel) o ThyroidExtracts NursingManagementwhengivingThyroidHormones 1.Instructclienttotakeinthemorningtopreventinsomnia 2.Monitorvitalsignsespeciallyheartratebecausedrugcausestachycardiaandpalpitations 3.Monitorsideeffects o insomnia o tachycardiaandpalpitations o hypertension o heatintolerance 4.Increasedietaryintakeoffoodsrichiniodine o seaweeds o seafoods like oyster, crabs, clams and lobster but not shrimps because it contains lesser amount of iodine. o iodizedsalt,besttakenrawbecauseititiseasilydestroyedbyheat 5.Assistinsurgicalprocedureofsubtotalthyroidectomy HYPOTHYROIDISM o hyposecretionofthyroidhormone o adults:MYXEDEMAnonpittingedema o children:CRETINISMtheonlyendocrinedisorderthatcanleadtomentalretardation A.PredisposingFactors 1.IatrogenicCausediseasecausedbymedicalinterventionsuchassurgery 2.Relatedtoatrophyofthyroidglandduetotrauma,presenceoftumor,inflammation 3.Iodinedeficiency

4.Autoimmune(HashimotosDisease) B.SignsandSymptoms (EarlySigns) 1.Weaknessandfatigue 2.LossofappetitebutwithweightgainwhichpromoteslipolysisleadingtoatherosclerosisandMI 3.Dryskin 4.Coldintolerance 5.Constipation (LateSigns) 1.Brittlenessofhairandnails 2.Nonpittingedema(Myxedema) 3.Hoarsenessofvoice 4.Decreaselibido 5.Decreaseinallvitalsignshypotension,bradycardia,bradypnea,hypothermia 6.CNSchanges o lethargy o memoryimpairment(forgetfulness) o psychosis o menorrhagia C.DiagnosticProcedures 1.SerumT3andT4isdecreased 2.SerumCholesterolisincreased 3.RAIU(RadioActiveIodineUptake)isdecreased D.NursingManagement 1.Monitorstrictlyvitalsignsandintakeandoutputtodeterminepresenceof o Myxedema coma is a complication of hypothyroidism and an emergency case a severe form of hypothyroidism is characterized by severe hypotension, bradycardia, bradypnea, hypoventilation, hyponatremia,hypoglycemia,hypothermialeadingtopregressivestuporandcoma. NursingManagementforMyxedemaComa 2.Forcefluids 3.Administerisotonicfluidsolutionasordered 4.Administermedicationsasordered ThyroidHormones a.Levothyroxine b.Leothyronine c.ThyroidExtracts Assistinmechanicalventilation Administerthyroidhormonesasordered Forcefluids

5.Providedietaryintakethatislowincaloriesduetowt.gain 6.Providecomfortableandwarmenvironmentduetocoldintolerance 7.Providemeticulousskincare 8.Provideclienthealthteachinganddischargeplanningconcerning a.Avoidprecipitatingfactorsleadingtomyxedemacoma o stress o infection o coldintolerance o useofanesthetics,narcotics,andsedatives o preventcomplications(myxedemacoma,hypovolemicshock o hormonalreplacementtherapyforlifetime o importanceoffollowupcare

HYPERTHYROIDISMgravesdiseaseorthyroidtoxicosis(everythingisupexceptwt.andmens. o increaseinT3andT4 o GravesDiseaseorThyrotoxicosis o developedbyRobertGraves A.PredisposingFactors 1. Autoimmune it involves release of long acting thyroid stimulator causing exopthalmus (protrusion of eyeballs)enopthalmus(latesignofdehydrationamonginfants) 2.Excessiveiodineintake 3.RelatedtohyperplasiaofTG(increasesize) B.SignsandSymptoms 1.Increaseappetite(hyperphagia)butthereisweightlossduetoincreasedmetabolism 2.Moistskin 3.Heatintolerance 4.Diarrhea 5.Allvitalsignsareincreased 6.CNSinvolvement a.Irritabilityandagitation b.Restlessness c.Tremors d.Insomnia e.Hallucinations

7.Goiter 8.Exopthalmus(Pathognomonicsign) 9.Amenorrhea C.DiagnosticProcedures 1.SerumT3andT4isincreased 2.RAIU(RadioActiveIodineUptake)isincreased 3.ThyroidScanrevealsanenlargedthyroidgland D.NursingManagement 1. Monitor strictly vital signs and intake and output determine thyroid storm or most feared complication: Thyrotoxicosis 2.Administermedicationsasordered AntiThyroidAgent a.Prophythioracill(PTU) b.Methymazole(Tapazole) MosttoxicSideEffectsAgranulocytosis o increaselymphocytesandmonocytes o feverandchills o sorethroat(throatswab/culture) o leukocytosis(CBC) o Mostfearedcomplication:ThrombosisstrokeCVS 3.Providedietaryintakethatisincreasedincalories. 4.Providemeticulousskincare 5.Comfortableandcoldenvironment 6.Maintainsiderailsduetoagitation/restlessness 7.Providebilateraleyepatchtopreventdryingoftheeyes. 8.Assistinsurgicalproceduresknownassubtotalthyroidectomy *BeforethyroidectomyadministerLugolsSolution(SSKI)todecreasevascularityofthethyroid glandtopreventbleedingandhemorrhage.

POSTOPERATIVELY, 1.Watchoutforsignsofthyroidstorm/thyrotoxicosis Hyperthermia o administermedicationsasordered a.AntiPyretics b.Betablockerstachycardia Tachycardia TRIADSIGNS Agitation

o Monitorstrictlyvitalsigns,inputandoutputandneurocheck. o maintainsiderails o offerTSB 2.Watchoutforaccidentalremovalofparathyroidgland(secretesparathormone)thatmayleadto Hypocalcemia(tetany) SignsandSymptoms o (+)trousseaussign o (+)chvosteksign o Watchoutforarrhythmia,seizuregiveCalciumGluconateIVslowlyasordered CagluconatetoxicityantidoteMgSO4 3.WatchoutforaccidentalLaryngeal(voicebox)damagewhichmayleadtohoarsenessofvoice NursingManagement o encourageclienttotalk/speakimmediatelyafteroperationandnotifyphysician 4.Signsofbleeding(feelingoffullnessatincisionalsite) NursingManagement o Checkthesoileddressingsatthebackornapearea. o SignoflaryngealspasmDOB,SOB(tracheostomyatbedside) PARATHYROIDGLAND o Apairofsmallnodulesbehindthethyroidgland o Secretesparathormone o Promotescalciumreabsorption o Thyrocalcitoninantagonisessecretionofparathyroidhormone o Hypoparathyroidism o Hyperparathyroidism HYPOPARATHYROIDISM o Decreasesecretionofparathormoneleadingtohypocalcemia(tetany) o ResultingtoHyperphosphatemia [IfCadecreases,phosphateincreases] A.PredisposingFactors 1.Followingsubtotalthyroidectomy 2.Atrophyofparathyroidglanddueto: a.inflammation 5.Hormonalreplacementtherapyforlifetime 6.Importanceoffollowupcare

b.tumor c.trauma

B.SignsandSymptoms 1.Acutetetany C.DiagnosticProcedures 1.SerumCalciumisdecreased(normalvalue:8.510.5mg/100ml) 2.SerumPhosphateisincreased(normalvalue:2.54.5mg/100ml) 3.Xrayoflongbonesrevealsadecreaseinbonedensity 4.CTScanrevealsdegenerationofbasalganglia D.NursingManagement 1.Administermedicationsasorderedsuchas: a.AcuteTetany CalciumGluconateIVslowly b.ChronicTetany OralCalciumsupplements CalciumGluconate CalciumLactate CalciumCarbonate d.Phosphatebinder AluminumHydroxideGel(Ampogel) Sideeffect:constipation MAD MagnesiumContaining Antacids Ex.Milkofmagnesia
DRUG

a.tinglingsensation b.paresthesia c.numbness d.dysphagia e.positivetrousseaussign/carpopedalspasm f.positivechvosteksign g.laryngospasms/broncospasm h.seizure i.arrhythmia a.photophobiaandcataractformation b.lossoftoothenamel c.anorexia,nauseaandvomiting d.agitationandmemoryimpairment(irritable) fearedcomplications

2.Chronictetany

c.VitaminD(Cholecalciferol)forabsorptionofcalcium
VIT.D (CHOLECALCEFEROL) DIET

SUNLIGHT

Cholecalceferol

calcidiol

calcitriol 7am9am

ANTACID A.A.C AluminumContaining Antacids Aluminum Hydroxide Gel SideEffect:Constipation

(Maaloxmagnesium&aluminumLesss/e) SideEffect:Diarrhea

2.Avoidprecipitatingstimulussuchasglaringlightsandnoise 3.Encourageincreaseintakeoffoodsrichincalcium(decreasedphosphorus) a.anchoviesincreaseCa,decreasephosphorus+incuricacid.Tuna&greenturnipsIncCa. b.salmon c.greenturnips

Dontgivemilkduetoincreasephosphorus 4.Instituteseizureandsafetyprecaution 5.Encourageclienttobreatheusingpaperbagtoproducemildrespiratoryacidosisresult. 6.Preparetracheasetatbedsideforpresenceoflaryngospasm 7.Preventcomplications 8.Hormonalreplacementtherapyforlifetime 9.Importanceoffollowupcare. HYPERPARATHYROIDISM o Decreaseparathormone o Hypercalcemia:bonedemineralizationleadingtobonefracture(calciumisstored99%inboneand1%blood) o Kidneystones (parathormonepullouttheCainfromthebonetotheblood) A.PredisposingFactors 1.Hyperplasiaofparathyroidgland 2.overcompensationofparathyroidglandduetovitaminDdeficiency a.Children:Ricketsthebonedonothardened b.Adults:Osteomalaciasofteningofthebone

B.SignsandSymptoms 1.Bonepainespeciallyatback(bonefracture) 2.Kidneystones a.renalcholic b.coolmoistskin

3.Anorexia,nauseaandvomiting 4.Agitationandmemoryimpairment C.DiagnosticProcedures 1.SerumCalciumisincreased 2.SerumPhosphateisdecreased 3.Xrayoflongbonesrevealsbonedemineralization D.NursingManagement 1.Forcefluidstopreventkidneystones 2.Strainalltheurineusinggauzepadforstoneanalysis 3.Providewarmsitzbath 4.Administermedicationsasordered a.MorphineSulfate(Demerol) 5.Encourageincreaseintakeoffoodsrichinphosphatebutdecreaseincalcium 6.Provideacidashinthediettoacidifyurineandpreventbacterialgrowth 7.Assist/superviseinambulation 8.Maintainsiderails 9.Preventcomplications(seizureandarrhythmia)mostfearedrenalfailure 10.Assistinsurgicalprocedureknownasparathyroidectomy 11.Hormonalreplacementtherapyforlifetime 12.Importanceoffollowupcare ADRENALGLAND o Locatedatopofeachkidney o 2layersofadrenalgland

a.AdrenalCortexoutermost b.AdrenalMedullainnermost(secretescatecholaminesapowerhormone)

2TypesofCatecholamines o EpinephrineandNorepinephrine(vasoconstrictor)increasedBP o Pheochromocytoma(adrenalmedulla) o Increasesecretionofnorepinephrine o LeadingtohypertensionwhichisresistanttopharmacologicalagentsleadingtoCVA o Usebetablockers

PHEOCHROMOCYTOMApresenceoftumoratadrenalmedulla

Increasenorepinephrine.HPNwithpoundingheadache. withHPNandresistanttodrugs drugofchoice:betablockers complication:HPNcrisis=leadtostroke novalsalvamaneuver.Dontsmoke.Nocaffeine.

ADRENALCORTEX 3Zones/Layers 1.ZonaFasciculata secretesglucocortocoids(cortisol) function:controlsglucosemetabolism Sugar 2.ZonaReticularis secretestracesofglucocorticoidsandandrogenichormones function:promotessecondarysexcharacteristics Sex 3.ZonaGlumerulosa secretesmineralocorticoids(aldosterone) function:promotessodiumandwaterreabsorptionandexcretionofpotassium Salt ADDISONSDISEASEpayat o Hyposecretionofadrenocorticalhormoneleadingto ex secondarysexdisturbances/decreasedlibido fluid&electrolytesimbalance ugar metabolicdisturbance/hypoglycemia alt

I love Sex!!!

A.PredisposingFactors 1.Relatedtoatrophyofadrenalglands 2.Fungalinfections B.SignsandSymptoms 1.HypoglycemiaTIRED 2.Decreasetolerancetostress 3.Hyponatremia hypotension signsofdehydration weightloss 4.Hyperkalemia agitation diarrhea arrhythmia 5.Decreaselibido 6.Lossofpubicandaxillaryhair 7.Bronzelikeskinpigmentation

Hydrocortisone(SoluCortef)admin.IV,followed w/5%D5NS. C.DiagnosticProcedures 1.FBSisdecreased(normalvalue:80100mg/dl) 2.PlasmaCortisolisdecreased 3.SerumSodiumisdecrease(normalvalue:135145meq/L) 4.SerumPotassiumisincreased(normalvalue:3.54.5meq/L) D.NursingManagement 1. Monitor strictly vital signs, input and output to determine presence of Addisonian crisis (complication of addisons disease) o Addisoniancrisisresultsfromacuteexacerbationofaddisonsdiseasecharacterizedby a.severehypotension b.hypovolemicshock c.hyponatremialeadingtoprogressivestuporandcoma
Addisoniancrisis: Cyanosis Classicsignofcirculatoryshock:pallor, apprehension,rapidweakpulse,rapid RR,lowBP

NursingManagementforAddisonianCrisis 1.Assistinmechanicalventilation, administersteroidsasordered forcefluids 2.Administerisotonicfluidsolutionasordered 3.Forcefluids 4.Administermedicationsasordered

Corticosteroids a.Dexamethasone(Decadrone) b.Prednisone c.Hydrocortisone(Cortison)

NursingManagementwhengivingsteroids 1.Instructclienttotake2/3doseinthemorningand1/3doseintheafternoontomimicthenormaldiurnalrhythm 2.Taperdose(withdrawgraduallyfromdrug) 3.Monitorsideeffects a.hypertension b.edema c.hirsutism d.increasesusceptibilitytoinfection e.moonfaceappearance

4.Mineralocorticoids(Flourocortisone) 5.Providedietaryintake,increasecalories,carbohydrates,proteinbutdecreaseinpotassium 6.Providemeticulousskincare 7.Provideclienthealthteachinganddischargeplanning CUSHINGSYNDROMEmataba o Hypersecretionofadenocorticalhormones A.PredisposingFactors 1Relatedtohyperplasiaofadrenalgland 2.Increasesusceptibilitytoinfections 3.Hypernatremia a.hypertension b.edema c.weightgain d.moonfaceappearanceandbuffalohump e.obesetrunk f.pendulousabdomen g.thinextremities a.weaknessandfatigue b.constipation c.UwaveuponECG(Twavehyperkalemia) a.avoidprecipitatingfactorleadingtoaddisoniancrisisleadingto stress infection suddenwithdrawaltosteroids b.preventcomplications addisoniancrisis hypovolemicshock c.hormonalreplacementforlifetime d.importanceoffollowupcare
Cushingssyndrome. A.Clientpriortosyndrome. B.Client4monthsafterdiagnosisofsyndrome.

4.Hypokalemia

5.Hirsutism 6.Acneandstriae 7.Easybruising 8.Increasemasculinityamongfemales B.DiagnosticProcedures 1.FBSisincreased 2.PlasmaCortisolisincreased

3.SerumSodiumisincreased 4.SerumPotassiumisdecreased 5.Dexamethasonesuppressiontest C.NursingManagement 1.Monitorstrictlyvitalsignsandintakeandoutput 2.Weighpatientdailyandassessforpittingedema 3.Measureabdominalgirthdailyandnotifyphysician 4.Restrictsodiumintake 5.Providemeticulousskincare 6.Administermedicationsasordered a.Spinarolactonepotassiumsparringdiuretics 7.Preventcomplications(DM) 8.Assistinsurgicalprocedure(bilateraladrenoraphy) 9.Hormonalreplacementforlifetime 10.Importanceoffollowupcare PANCREAS Locatedbehindthestomach Mixedgland(exocrineandendocrine) Consistofacinarcellswhichsecretespancreaticjuicesthataidsindigestionthusitisanexocrinegland Type1(IDDM) Juvenileonsettype Brittledisease A.IncidenceRate 10%generalpopulationhastype1DM B.PredisposingFactors 1.Hereditary(totaldestructionofpancreaticcells) 2.Relatedtoviruses 3.Drugs C.SignsandSymptoms 1.Polyuria 2.Polydypsia 3.Polyphagia 4.Glycosuria 5.Weightloss 6.Anorexia,nauseaandvomiting 7.Blurringofvision 8.Increasesusceptibilitytoinfection 9.Delayed/poorwoundhealing D.Treatment 1.Insulintherapy 2.Diet 3.Exercise E.Complication 1.DiabeticKetoacidosis a.Lasix b.Steroids Adultonset Maturityonsettype Obeseover40yearsold A.IncidenceRate 90%ofgeneralpopulationhastype2DM B.PredisposingFactors 1. Obesity because obese persons lack insulin receptorbindingsites C.SignsandSymptoms 1.Usuallyasymptomatic 2.Polyuria 3.Polydypsia 4.Polyphagia 5.Glucosuria 6.Weightgain D.Treatment 1.OralHypoglycemicagents 2.Diet 3.Exercise E.Complications 1.Hyper 2.Osmolar 3.Non 4.Ketotic 5.Coma Type2(NIDDM)
BestexampleofCUSHINGSYNDROMEis nootherthan JOLLIBEEmoonface&bigbodywith thinextremities

4.Relatedtocarbontetrachloridetoxicity

Consistofisletsoflangerhans Hasalphacellsthatsecretesglucagons(function:hyperglycemia) Betacellssecretesinsulin(function:hypoglycemia) Deltacellssecretessomatostatin(function:antagonizestheeffectsofgrowthhormones) 3MainDisordersofPancreas 1.PancreaticTumor/Cancer 2.DiabetesMellitus 3.Pancreatitis DIABETESMELLITUS Metabolicdisordercharacterizedbynonutilizationofcarbohydrates,proteinandfatmetabolism MAIN FOODSTUFF 1.Carbohydrates 2.Protein 3.Fats ANABOLISM Glucose FattyAcids Glycogen FreeFattyAcids Cholesterol Ketones HYPERGLYCEMIA Increaseosmoticdiuresis *Liverhasglycogenthatundergoglycogenesis/glycogenolysis GLUCONEOGENESIS FormationofglucosefromnonCHOsources Increaseproteinformation NegativeNitrogenbalance Tissuewasting(Cachexia) INCREASEFATCATABOLISM Freefattyacids Cholesterol Ketones Atherosclerosis Hypertension MI CVA Death DiabeticKetoAcidosis AcetoneBreath KussmaulsRespiration odor Glycosuria Polyuria Cellularstarvationweightloss Stimulatestheappetite/satietycenter (Hypothalamus) Polyphagia CATABOLISM

AminoAcids Nitrogen

Cellulardehydration Stimulatesthethirstcenter (Hypothalamus) Polydypsia

DiabeticComa

DIABETICKETOACIDOSIS Acutecomplicationoftype1DMduetoseverehyperglycemialeadingtosevereCNSdepression A.PredisposingFactors 1.Hyperglycemia 2.Stressnumberoneprecipitatingfactor 3.Infection B.SignsandSymptoms 1.Polyuria 2.Polydypsia 3.Polyphagia 4.Glucosuria 5.Weightloss 6.Anorexia,nauseaandvomiting 7.Blurringofvision 8.Acetonebreathodor 9.KussmaulsRespiration(rapidshallowbreathing) 10CNSdepressionleadingtocoma C.DiagnosticProcedures 1.FBSisincreased 2.BUN(normalvalue:1020) 3.Creatinine(normalvalue:.81) 4.Hct(normalvalue:female3642,male4248)duetoseveredehydration D.NursingManagement 1.Assistinmechanicalventilation 2.Administer0.9NaClfollowedby.45NaCl(hypotonicsolutions)tocounteractdehydrationandshock 3.Monitorstrictlyvitalsigns,intakeandoutputandbloodsugarlevels 4.Administermedicationsasordered a.Insulintherapy(regularactinginsulin/rapidactinginsulinpeakactionof24hours) b.SodiumBicarbonatetocounteractacidosis c.Antibioticstopreventinfection HYPEROSMOLARNONKETOTICCOMA Hyperosmolar:increaseosmolarity(severedehydration) Nonketotic:absenceoflypolysis(noketones) A.SignsandSymptoms 1.Headacheanddizziness 2.Restlessness 3.Seizureactivity 4.DecreaseLOCdiabeticcoma B.NursingManagement 1.Assistinmechanicalventilation 2.Administer0.9NaClfollowedby.45NaCl (hypotonicsolutions)tocounteractdehydrationandshock 3.Monitorstrictlyvitalsigns,intakeandoutputandbloodsugarlevels 4.Administermedicationsasordered a.Insulintherapy(regularactinginsulinpeakactionof24hours) forDKAuserapidactinginsulin b.Antibioticstopreventinfection

TypesofInsulin

Color&consistency

INSULINTHERAPY A.SourcesofInsulin 1.Animalsources Derivedfrombeefandpork 2.HumanSources

Rapid Intermediate Longacting

Clear Cloudy Cloudy

Peak 24 612 1224

Rarelyusedbecauseitcancausesevereallergicreaction

Frequentlyusedtypebecauseithaslessantigenicitypropertythuslessallergicreaction 3.ArtificiallyCompoundInsulin B.TypesofInsulin 1.RapidActingInsulin(clear) Regularactinginsulin(IVonly) Peakactionis24hours 2.IntermediateActingInsulin(cloudy) NonProtamineHagedornInsulin(NPH) Peakactionis816hours 3.LongActingInsulin(cloudy) UltraLente Peakactionis1624hours C.NursingManagementforInsulinInjections 1. Administer at room temperature to prevent development of lipodystrophy (atrophy, hypertrophy of subcutaneous tissues) 2.Placeinrefrigeratoronceopened 3.Avoidshakinginsulinvialvigorouslyinsteadgentlyrollvialbetweenpalmstopreventformationofbubbles 4.Usegauge2526needle 5.Administerinsulineither45 90 dependingonamountofclientstissuedeposit 6.Noneedtoaspirateuponinjection 7.Rotateinsulininjectionsitestopreventdevelopmentoflipodystrophy 8.Mostaccessiblerouteisabdomen 9. When mixing 2 types of insulin aspirate first the clear insulin before cloudy to prevent contaminating the clear insulinandpromotepropercalibration. 10.Monitorforsignsoflocalcomplicationssuchas ORALHYPOGLYCEMICAGENTSOHA Stimulatesthepancreastosecreteinsulin A.Classsification 1.FirstGenerationSulfonylureas a.Chlorpropamide(Diabenase) b.Tolbutamide(Orinase) c.Tolamazide(Tolinase) a.Glipzide(Glucotrol) b.Diabeta(Micronase) a.Allergicreactions b.Lipodystrophy c.SomogyiPhenomenonreboundeffectofinsulincharacterizedbyhypoglycemiatohyperglycemia
o o

2.SecondGenerationSulfonylureas

NursingManagementwhengivingOHA 1.InstructtheclienttotakeitwithmealstolessenGITirritationandpreventhypoglycemia 2.InstructtheclienttoavoidtakingalcoholbecauseitcanleadtoseverehypoglycemiareactionorDisulfiram(Antabuse) toxicitysymptoms

B.DiagnosticProceduresforDM 1.FBSisincreased(3consecutivetimeswithsignsor
polyuria,polydypsia,polyphagiaandglucosuriaconfirmatoryforDM)

2.RandomBloodSugarisincreased 3.Oralglucosetolerancetestisincreasedmostsensitivetest 4.AlphaGlycosylatedHemoglobinisincreased C.NursingManagement 1.MonitorforpeakactionofinsulinandOHAandnotifyphysician 2.AdministerinsulinandOHAtherapyasordered 3.Monitorstrictlyvitalsigns,intakeandoutputandbloodsugarlevels 4.Monitorforsignsofhypoglycemiaandhyperglycemia administersimplesugars forhypoglycemia(coldandclammyskin)givesimplesugars forhyperglycemia(dryandwarmskin) 5. Provide nutritional intake of diabetic diet that includes: carbohydrates 50%, protein 30% and fats 20% or offer alternativefoodsubstitutes 6. Instruct client to exercise best after meals when blood glucoseisrising 7.Monitorsignsforcomplications a.Atherosclerosis(HPN,MI,CVA) b.Microangiopathy(affectssmallminutebloodvesselsofeyesandkidneys) c.HPNandDMmajorcauseofrenalfailure d.Gangreneformation e.Shockduetodehydration peripheralneuropathy diarrhea/constipation sexualimpotence a.instructclienttoavoidwalkingbarefooted b.instructclienttocuttoenailsstraight c.instructclienttoavoidwearingconstrictivegarments d.encourageclienttoapplylanolinlotionto preventskinbreakdown e.assistinsurgicalwounddebriment (giveanalgesics1530minsprior) 9.Instructclienttohaveanannualeyeandkidneyexam 10.MonitorforsignsofDKAandHONKC 11.Assistinsurgicalprocedure
EYES PREMATURECATARACT Blindness KIDNEY RECURRENTPYELONEPHRITIS Renalfailure

8.Institutefootcaremanagement

CHRONICHEMORRHAGICPANCREATITISbangugot
Predisposingfactorsunknown Riskfactor: Historyofhepatobiliarydisorder Alcohol Drugsthiazidediuretics,oralcontraceptives,aspirin,penthan Obesity Hyperlipidemia Hyperthyroidism Highintakeoffattyfoodsaturatedfats Overviewonly: PANCREATITISacuteinflammationofpancreasleadingtopancreaticedema,hemorrhage&necrosisdueto Autodigestionselfdigestion Cause:unknown/idiopathic alcoholism Pathognomonicsign(+)CullenssignEcchymosisofumbilicus(bluishcolor)pasa (+)Greyturnerssignecchymosisofflankarea

HEMATOLOGICALSYSTEM 55%Plasma Serum ALBUMIN I.Blood II.BloodVessels III.BloodFormingOrgans 1.Liver 3.Spleen 4.LymphoidOrgan 5.LymphNodes 6.BoneMarrow

1.Arteries 45%Formed 2.Veins PlasmaCHON (formedinliver) 1.Albumin 2.Globulins 3.ProthrombinandFibrinogen

LargestandnumerousplasmaCHON Maintainsosmoticpressurepreventingedema GLOBULINS Alphaglobulinstransportsteroids,bilirubinandhormones Betaglobulinsironandcopper Gammaglobulins a.antibodiesandimmunoglobulins FORMEDELEMENTS 1.RBC(ERYTHROCYTES) normalvalue:46million/mm onlyunnucleatedcell biconcavediscs consistofmoleculesof hgb (redpigment) bilirubin(yellowpigment) biliverdin(greenpigment) hemosiderin(golden brownpigment) transportsandcarriesoxygentotissues hemoglobin:normalvaluefemale1214gms%male1416gms% hematocritredcellpercentageinwholeblood normalvalue:female3642%male4248% substancesneededformaturationofRBC 2.WBC(LEUKOCYTES) normalvalue:500010000/mm A.Granulocytes 1.PolymorphoNeutrophils 6070%ofWBC involvedinshorttermphagocytosisforacuteinflammation 2.PolymorphonuclearBasophils forparasiteinfections responsibleforthereleaseofchemicalmediationforinflammation 3.PolymorphonuclearEosinophils forallergicreaction B.NonGranulocytes 1.Monocytes
3 3

b.prothrombinandfibrinogenclottingfactors

a.folicacid b.iron c.vitaminc d.vitaminb12(cyanocobalamin) e.vitaminb6(pyridoxine) f.intrinsicfactor

NormallifespanofRBCis80120daysandiskilledinredpulpofspleen

macrophageinblood largestWBC involvedinlongtermphagocytosisforchronicinflammation 2.Lymphocytes Bcell Tcell bonemarrow thymus forimmunity HIV 6months5yearsincubationperiod 6monthswindowperiod westernblotopportunistic ELISA drugofchoiceAZT(ZidonRetrovir) 2CommonfungalopportunisticinfectioninAIDS 1.KaposisSarcoma 2.PneumocystisCariniiPneumonia 3.Platelets(THROMBOCYTES) Normalvalue:150,000450,000/mm
3

Naturalkillercell antiviralandantitumorproperty

Promoteshemostasis(preventionofbloodloss) Consistofimmatureorbabyplateletsormegakaryocyteswhichisthetargetofdenguevirus Normallifespanofplateletis912days SignsofPlateletDysfunction 1.Petechiae 2.Echhymosis 3.Oozingofbloodfromvenipuncturedsite

BLOODDISORDERS
IronDeficiencyAnemia Achronicmicrocyticanemiaresultingfrominadequateabsorptionofironleadingtohypoxemictissueinjury A.IncidenceRate 1.Commonamongdevelopedcountries 2.Commonamongtropicalzones 3.Commonamongwomen1535yearsold 4.Relatedtopoornutrition B.PredisposingFactors 1.Chronicbloodlossduetotrauma a.Heavymenstruation b.RelatedtoGITbleedingresultingtohematemesisandmelena(signforupperGITbleeding) c.freshbloodperrectumiscalledhematochezia 2.Inadequateintakeofirondueto a.Chronicdiarrhea b.Relatedtomalabsorptionsyndrome c.Highcerealintakewithlowanimalproteindigestion d.Subtotalgastrectomy

4.Relatedtoimpropercookingoffoods C.SignsandSymptoms 1.Usuallyasymptomatic 2.Weaknessandfatigue(initialsigns)

3.Headacheanddizziness 4.Pallorandcoldsensitivity 5.Dyspnea 6.Palpitations 7.Brittlenessofhairandspoonshapenails(koilonychias) 8.AtropicGlossitis(inflammationoftongue) Stomatitis Dysphagia 9.PICA(abnormalappetiteorcravingfornonediblefoods D.DiagnosticProcedures 1.RBCisdecreased 2.Hgbisdecreased 3.Hctisdeceased 4.Ironisdecreased 5.Reticulocyteisdecreased 6.Ferritinisdecreased E.NursingManagement 1.Monitorforsignsofbleedingofallhematestincludingurine,stoolandGIT 2.EnforceCBRsoasnottoovertireclient 3.Instructclienttotakefoodsrichiniron a.Organmeat b.Egg(yolk) c.Raisin d.Sweetpotatoes e.Driedfruits f.Legumes g.Nuts 4.Instructtheclienttoavoidtakingteaandcoffeebecauseitcontainstannateswhichimpairsironabsorption 5.Administermedicationsasordered OralIronPreparations a.FerrousSulfate b.FerrousFumarate c.FerrousGluconate 300mg/day NursingManagementwhentakingoralironpreparations 1.InstructclienttotakewithmealstolessenGITirritation 2.Whendilutingitinliquidironpreparationsadministerwithstrawtopreventstainingofteeth Medicationsadministeredviastraw Lugolssolution Iron Tetracycline Nitrofurantoin(Macrodentin) 3.AdministerwithVitaminCororangejuiceforabsorption 4.Monitorandinformclientofsideeffects a.Anorexia b.Nauseaandvomiting c.Abdominalpain d.Diarrhea/constipation e.Melena a.IronDextran(IM,IV) b.Sorbitex(IM) PLUMBERVINSONSSYNDROME

5.Ifclientcanttolerate/nocomplianceadministerparenteralironpreparation

NursingManagementwhengivingparenteralironpreparations 1.AdministerZtracttechniquetopreventdiscomfort,discolorationandleakagetotissues 2.Avoidmassagingtheinjectionsiteinsteadencouragetoambulatetofacilitateabsorption 3.Monitorsideeffects

a.Painatinjectionsite b.Localizedabscess c.Lymphadenopathy d.Feverandchills e.Skinrashes f.Pruritus/orticaria g.Hypotension(anaphylacticshock)

PERNICIOUSANEMIA Chronic anemia characterized by a deficiency of intrinsic factor leading to hypochlorhydria (decrease hydrochloric acidsecretion) A.PredisposingFactors 1.Subtotalgastrectomy 2.Hereditaryfactors 3.Inflammatorydisordersoftheileum 4.Autoimmune 5.Strictlyvegetariandiet STOMACH Pareitalcells/ArgentaffinorOxynticcells Producesintrinsicfactors Secreteshydrochloricacid B.SignsandSymptoms 1.Weaknessandfatigue 2.Headacheanddizziness 3.Pallorandcoldsensitivity 4.Dyspneaandpalpitationsaspartofcompensation 5.GITchangesthatincludes C.DiagnosticProcedure SchillingsTestrevealsinadequate/decreaseabsorptionofVitaminB12 D.NursingManagement 1.EnforceCBR a.mouthsore b.redbeefytongue c.indigestion/dyspepsia d.weightloss e.jaundice a.tinglingsensation b.numbness c.paresthesia d.positivetoRombergstestdamagetocerebellumresultingtoataxia e.resulttopsychosis PromotesreabsorptionofVitB12 PromotesmaturationofRBC Aidsindigestion

6.CNSchanges

2.AdministerVitaminB12injectionsatmonthlyintervalsforlifetimeasordered Nevergivenorallybecausethereispossibilityofdevelopingtolerance SiteofinjectionforVitaminB12isdorsoglutealandventrogluteal Nosideeffects 3.Provideadietaryintakethatishighincarbohydrates,protein,vitamincandiron 4.Instructclienttoavoidirritatingmouthwashesinsteadusesoftbristledtoothbrush 5.Avoidheatapplicationtopreventburns APLASTICANEMIA Stemcelldisorderleadingtobonemarrowdepressionleadingtopancytopenia PANCYTOPENIA DecreaseRBC (anemia) A.PredisposingFactors 1.Chemicals(Benzineanditsderivatives) 2.Relatedtoirradiation/exposuretoxray 3.Immunologicinjury 4.Drugs B.SignsandSymptoms 1.Anemia a.Weaknessandfatigue b.Headacheanddizziness c.Pallorandcoldsensitivity d.Dyspneaandpalpitations a.Increasesusceptibilitytoinfection a.Petechiae(multiplepetechiaeiscalledpurpura) b.Ecchymosis c.Oozingofbloodfromvenipuncturedsites BroadSpectrumAntibiotics a.Chloramphenicol(Sulfonamides) ChemotherapeuticAgents a.Methotrexate(AlkylatingAgent) b.Vincristine(PlantAlkaloid) c.NitrogenMustard(Antimetabolite) Phenylbutazones(NSAIDS) Whenallofthebloodelements aredepressed,theterm pancytopeniaisused.Pan meaningeverything. DecreaseWBC (leucopenia) DecreasePlatelet (thrombocytopenia)

2.Leukopenia 3.Thrombocytopenia

C.DiagnosticProcedures 1.CBCrevealspancytopenia 2.Bonemarrowbiopsy/aspiration(siteistheposterioriliaccrest)revealsfatnecrosisinbonemarrow D.NursingManagement 1.Removalofunderlyingcause 2.InstituteBTasordered 3.Administeroxygeninhalation 4.EnforceCBR 5.Institutereverseisolation 6.Monitorforsignsofinfection a.fever b.cough

7.AvoidIM,subcutaneous,venipuncturedsites 8InsteadprovideHeplock 9.Instructclienttouseelectricrazorwhenshaving 10.Administermedicationsasordered AntiLymphocyteGlobulin Givenviacentralvenouscatheter Given6daysto3weekstoachieve Maximumtherapeuticeffectofdrug a.Corticosteroidscausedbyimmunologicinjury b.Immunosuppressants

DISSEMINATEDINTRAVASCULARCOAGULATION Acutehemorrhagicsyndromecharacterizedbywidespreadbleedingandthrombosisduetoadeficiencyofprothrombin andfibrinogen A.PredisposingFactors 1.Relatedtorapidbloodtransfusion 2.Massiveburns 3.Massivetrauma 4.Anaphylaxis 5.Septicemia 6.Neoplasia(newgrowthoftissue) 7.Pregnancy B.SignsandSymptoms 1.Petechiae(widespreadandsystemic)eye,lungsandlowerextremities 2.Ecchymosis 3.Oozingofbloodfrompuncturedsites 4.Hemoptysis 6.Oliguria(latesign) C.DiagnosticProcedures 1.CBCrevealsdecreasedplatelets 2.Stooloccultbloodpositive 3.ABGanalysisrevealsmetabolicacidosis 4.Opthamoscopicexamrevealssubretinalhemorrhages D.NursingManagement 1.MonitorforsignsofbleedingofallhematestincludingstoolandGIT 2.Administerisotonicfluidsolutionasordered 3.Administeroxygeninhalation 4.Forcefluids 5.Administermedicationsasordered a.VitaminK b.Pitressin/Vasopresintoconservefluids c.Heparin/Coumadinisineffective

6.Provideheparinlock 7.InstituteNGTdecompressionbyperforminggastriclavagebyusingiceorcoldsalinesolutionof500 1000ml 8.MonitorNGToutput 9.Preventcomplication a.Hypovolemicshock b.Anurialatesign

BLOOD TRANSFUSION
Goals/Objectives 1.Replacecirculatingbloodvolume 2.Increasetheoxygencarryingcapacityofblood 3.PreventinfectioninthereisadecreaseinWBC 4.Preventbleedingifthereisplateletdeficiency Principlesofbloodtransfusion 1.Properrefrigeration ExpirationofpackedRBCis36days Expirationofplateletis35days 2.Propertypingandcrossmatching a.TypeOuniversaldonor b.TypeABuniversalrecipient c.85%ofpopulationisRHpositive a.Filterset b.Gauge1819needle c.Isotonicsolution(0.9NaCl/plainNSS)topreventhemolysis a.Clientname b.Bloodtypingandcrossmatching c.Expirationdate d.Serialnumber

3.AsepticallyassembleallmaterialsneededforBT

4.InstructanotherRNtorecheckthefollowing

5.Checkthebloodunitforbubblescloudiness,sedimentsanddarknessincolorbecauseitindicatesbacterial contamination Neverwarmbloodasitmaydestroyvitalfactorsinblood. Warmingisonlydoneduringemergencysituationandifyouhavethewarmingdevice EmergencyrapidBTisgivenafter30minutesandletnaturalroomtemperaturewarmtheblood. 6.BTshouldbecompletedlessthan4hoursbecausebloodthatisexposedatroomtemperaturemore than2hourscausesblooddeteriorationthatcanleadtoBACTERIALCONTAMINATION 7.AvoidmixingoradministeringdrugsatBTlinetopreventHEMOLYSIS 8.RegulateBT1015gtts/minorKVOrateorequivalentto100cc/hrtopreventcirculatoryoverload 9.Monitorstrictlyvitalsignsbefore,duringandafterBTespeciallyevery15minutesforfirsthour becausemajorityoftransfusionreactionoccursduringthisperiod SignsandSymptomsofHemolyticreaction 1.Headacheanddizziness 2.Dyspnea 3.Diarrhea/Constipation 4.Hypotension 5.Flushedskin 6.Lumbar/sternal/Flankpain 7.Urineiscolorred/portwineurine a.Hemolyticreaction b.Allergicreaction c.Pyrogenicreaction d.Circulatoryoverload e.Airembolism f.Thrombocytopenia g.Cytrateintoxication h.Hyperkalemia(causedbyexpiredblood)

NursingManagement 1.StopBT 2.Notifyphysician 3.FlushwithplainNSS 4.Administerisotonicfluidsolutiontopreventshockandacutetubularnecrosis 5.Sendthebloodunittobloodbankforreexamination 6.Obtainurineandbloodsampleandsendtolaboratoryforreexamination 7.Monitorvitalsignsandintakeandoutput SIGNSANDSYMPTOMSOFALLERGICREACTION 1.Fever 2.Dyspnea 3.Broncialwheezing 4.Skinrashes 5.Urticaria 6.LaryngospasmandBroncospasm NursingManagement 1.StopBT 2.Notifyphysician 3.FlushwithplainNSS 4.Administermedicationsasordered a.AntiHistamine(Benadryl)ifpositivetohypotension,anaphylacticshocktreatwithEpinephrine 5.Sendthebloodunittobloodbankforreexamination 6.Obtainurineandbloodsampleandsendtolaboratoryforreexamination 7.Monitorvitalsignsandintakeandoutput SIGNSANDSYMPTOMSPYROGENICREACTIONS(FEVER) 1.Feverandchills 2.Headache 3.Tachycardia 4.Palpitations 5.Diaphoresis 6.Dyspnea NursingManagement 1.StopBT 2.Notifyphysician 3.FlushwithplainNSS 4.Administermedicationsasordered a.Antipyretic b.Antibiotic

5.Sendthebloodunittobloodbankforreexamination 6.Obtainurineandbloodsampleandsendtolaboratoryforreexamination 7.Monitorvitalsignsandintakeandoutput 8.RenderTSB SIGNSANDSYMPTOMSOFCIRCULATORYREACTION 1.Orthopnea 2.Dyspnea 3.Rales/Cracklesuponauscultation 4.Exertionaldiscomfort NursingManagement 1.StopBT 2.Notifyphysician 3.Administermedicationsasordered a.Loopdiuretic(Lasix

CARDIOVASCULARSYSTEM
OVERVIEWOFTHESTRUCTUREANDFUNCTIONSOFTHEHEART HEART Muscularpumpingorganofthebody. Locatedontheleftmediastinum Resemblelikeaclosefist Weighsapproximately300400grams Coveredbyaserousmembranecalledthepericardium 2layersofpericardium a.Parietalouterlayer b.Visceralinnerlayer

Inbetweenisthepericardialspacefilledw/fluid whichis1030cclubricatesthesurfacetoreduces frictionduringsystole. CommonamongMI,pericarditis,Cardiactamponade A.LayersofHeart 1.Epicardiumouterlayer 2.Myocardiummiddlelayer 3.Endocardiuminnerlayer Myocarditiscanleadtocardiogenicshockandrheumaticheartdisease B.ChambersoftheHeart 1.UpperChamber(connectingorreceiving) C.Valves Topromoteunidimensionalfloworpreventbackflow 1.AtrioventricularValvesguardsopeningbetween 2.SemilunarValves ExtraHeartSounds 1.S3ventriculargallopusuallyseeninLeftCongestiveHeartFailuresoundoccurringduringrapidventricularfilling 2. S4 atrialgallopusuallyseenin MyocardialInfarction and Hypertension soundheadduringatrialcontraction(often heardwhentheventricleisenlargedorhypertrophied a.pulmonic b.aortic a.tricuspidvalve b.mitralvalve a.Atria a.Ventricles Leftventriclehasincreasedpressurewhichis120180mmHg Inordertopropelbloodtothesystemiccirculation Rightatriumhasdecreasedpressurewhichis6080mmHg 2.LowerChamber(contractingorpumping)

ClosureofAVvalvesgiverisetofirstheartsound(S1lub)

ClosureofSVvalvegiverisetosecondheartsound(S2dub)

D.CoronaryArteries Arisesfrombaseoftheaorta TypesofCoronaryArteries 1.RightMainCoronaryArtery 2.LeftMainCoronaryArterying Suppliesthemyocardium E.CardiacConductionSystem 1.SinoAtrialNode(SAorKeithFlackNode) Locatedatthejunctionofsuperiorvenacavaandrightatrium Actsasprimarypacemakeroftheheart Initiateselectricalimpulseof60100bpm 2.AtrioVentricularNode(AVorTawaraNode) Locatedattheinteratrialseptum Delayofelectricalimpulseforabout.08millisecondstoallowventricularfilling 3.BundleofHis RightMainBundleofHis LeftMainBundleofHis Locatedattheinterventricularseptum 4.PurkinjeFibersterminalpointintheconductionsystem (pointwhichthemyocardialcellsarestimulatedcausingventricularcontraction) Locatedatthewallsoftheventriclesforventricularcontraction PWAVE(atrialdepolarization)contraction QRSWAVE(ventriculardepolarization) TWAVE(ventricularrepolarization) Insertpacemakerifthereiscompleteheartblock Mostcommonpacemakeristhemetalpacemakerandlastsupto25years Cardiacelectricalactivityistheresultofthemovementofions(chargedparticlessuchas SODIUM,POTASSIUM, ANDCALCIUM)acrossthecellmembrane.

ABNORMALECGTRACING
1.PositiveUwave 2.PeakTwave Hypokalemia Hyperkalemia AnginaPectoris MyocardialInfarction MyocardialInfarction Arrhythmias

3.STsegmentdepression 4.STsegmentelevation 5.Twaveinversion

6.WideningofQRScomplexes

CARDIACDISORDERS
CoronaryArterialDisease/IschemicHeartDisease StagesofDevelopmentofCoronaryArteryDisease 1.MyocardialInjuryAtherosclerosis 2.MyocardialIschemiaAnginaPectoris 3.MyocardialNecrosisMyocardialInfarction


ATHEROSCLEROSIS ATHEROSCLEROSIS narrowingofartery lipidorfatdeposits(plaques) tunicaintima ARTERIOSCLEROSIS hardeningofartery,thicken calciumandproteindeposits tunicamedia

A.PredisposingFactors
1.Sexmale 2.Raceblack 3.Smoking 4.Obesity 5.Hyperlipidemia 6.Sedentarylifestyle 7.DiabetesMellitus 8.Hypothyroidism 9.Dietincreasedsaturatedfats 10.TypeApersonality

B.SignsandSymptoms
1.Chestpain 2.Dyspnea 3.Tachycardia 4.Palpitations 5.Diaphoresis

C.Treatment PercutaneousTransluminalCoronaryAngioplasty

ObjectivesofPTCA 1.Revascularizemyocardium 2.Topreventangina 3.Increasesurvivalrate Donetosingleoccludedvessels Ifthereis2ormoreoccludedbloodvesselsCABGisdone

CoronaryArterialBypassAndGraftSurgery
3ComplicationsofCABG 1.Pneumoniaencouragetoperformdeepbreathing,coughingexerciseanduseofincentivespirometer 2.Shock 3.Thrombophlebitis ANGINAPECTORIS(SYNDROME) Clinical syndrome characterized by paroxysmal chest pain that is usually relieved by rest or nitroglycerine due to temporarymyocardialischemia A.PredisposingFactors 1.Sexmale 2.Raceblack 3.Smoking 4.Obesity 5.Hyperlipidemia 6.Sedentarylifestyle 7.DiabetesMellitus 8.Hypothyroidism 9.Dietincreasedsaturatedfats 10.TypeApersonality B.PrecipitatingFactors 4EsofAnginaPectoris 1.Excessivephysicalexertionheavyexercises 2.Exposuretocoldenvironment 3.Extremeemotionalresponsefear,anxiety,excitement 4.Excessiveintakeoffoodsrichinsaturatedfatsskimmedmilk C.SignsandSymptoms 1.LevinesSigninitialsignthatshowsthehandclutchingthechest 2.Chestpaincharacterizedbysharpstabbingpainlocatedatsubsternausuallyradiatesfromback,shoulder,arms,axilla andjawmuscles,usuallyrelievedbyrestortakingnitroglycerine 3.Dyspnea 4.Tachycardia 5.Palpitations 6.Diaphoresis D.DiagnosticProcedure 1.Historytakingandphysicalexam 2.ECGtracingrevealsSTsegmentdepression 3.Stresstesttreadmilltest,revealabnormalECG 4.Serumcholesterolanduricacidisincreased E.NursingManagement 1.Enforcecompletebedrest 2.Administermedicationsasordered a. Nitroglycerine (NTG) when given in small doses will act as venodilator, but in large doses will act as vasodilator GivefirstdoseofNTG(sublingual)35minutes Anginaisusuallycausedby ATHEROSCLEROTICDisease. narrowingofartery lipidorfatdeposits tunicaintima

GiveseconddoseofNTGifpainpersistaftergivingfirstdosewithintervalof35minutes GivethirdandlastdoseofNTGifpainstillpersistsat35minutesinterval NursingManagementwhengivingNTG Keepthedruginadryplace,avoidmoistureandexposuretosunlightasitmayinactivatethedrug Monitorsideeffects Orthostatichypotension Transientheadacheanddizziness Instructtheclienttoriseslowlyfromsittingposition Assistorsuperviseinambulation Whengivingnitrolortransdermalpatch o Avoidplacingnearhairyareasasitmaydecreasedrugabsorption o Avoidrotatingtransdermalpatchesasitmaydecreasedrugabsorption o Avoidplacingnearmicrowaveovensorduringdefibrillationasitmayleadtoburns(mostimportant thingtoremember) b.Betablockers (lol) PropanololsideeffectsPNSbronchoconstriction,vasodilation NotgiventoCOPDcasesbecauseitcausesBronchospasm c.ACEInhibitors (pril) Enalapril,captopril,apriljanedolo d.CalciumAntagonist calciblock Nifedipine,diltiazem 3.Administeroxygeninhalation 4.Placeclientonsemifowlersposition 5.Monitorstrictlyvitalsigns,intakeandoutputandECGtracing 6.Providedecreasesaturatedfatssodiumandcaffeine 7.Provideclienthealthteachingsanddischargeplanning a.Avoidanceof4Es b.Preventcomplication(myocardialinfarction) c. Instruct client to take medication before indulging into physical exertion to achieve the maximum therapeutic effectofdrug d.Theimportanceoffollowupcare MYOCARDIALINFARCTIONareasinmyocardialcellsintheheartarepermanentlydestroyed. Heartattack Terminalstageofcoronaryarterydiseasecharacterizedbymalocclusion,necrosisandscarring. A.Types 1.TransmuralMyocardialInfarction mostdangeroustypecharacterizedbyocclusionofbothrightandleftcoronary artery 2.SubendocardialMyocardialInfarctioncharacterizedbyocclusionofeitherrightorleftcoronaryartery B.TheMostCriticalPeriodFollowingDiagnosisofMyocardialInfarction **68hoursbecausemajorityofdeathoccursduetoarrhythmialeadingtoPVCs C.PredisposingFactors

1.Sexmale 2.Raceblack 3.Smoking 4.Obesity 5.Hyperlipidemia 6.Sedentarylifestyle 7.DiabetesMellitus 8.Hypothyroidism 9.Dietincreasedsaturatedfats 10.TypeApersonality D.SignsandSymptoms 1.Chestpain Excruciatingvisceral,viselikepainlocatedatsubsternalandrarelyinprecordial Usuallyradiatesfromback,shoulder,arms,axilla,jawandabdominalmuscles(abdominalischemia)andhands Notusuallyrelievedbyrestorbynitroglycerine 2.Dyspnea 3.Increaseinbloodpressure(initialsign) 4.Hyperthermia 5.Ashenskin(pale),cool,clammy,diaphoretic 6.Mildrestlessnessandapprehension,anxiety 7.Occasionalfindings

a.Pericardialfrictionrub b.SplitS1andS2 c.Rales/Cracklesuponauscultation d.S4oratrialgallop

E.DiagnosticProcedure 1.CardiacEnzymes a.CPKMB Creatininephosphokinaseisincreased Heartonly,1224hours b.LDHLacticdehydroginaseisincreased c.SGPTSerumglutamicpyruvatetransaminaseisincreased d.SGOTSerumglutamicoxalacetictransaminaseisincreased 2.TroponinTestisincreased(proteininmyocardial) 3.ECGtracingreveals a.STsegmentelevation b.Twaveinversion c.WideningofQRScomplexesindicatesthatthereisarrhythmiainMI

4.SerumCholesterolanduricacidarebothincreased 5.CBCincreasedWBC F.NursingManagement Goal:Decreasemyocardialoxygendemand 1.Decreasemyocardialworkload(restheart) Administernarcoticanalgesic/morphinesulfate SideEffects:respiratorydepression Antidote:Narcan/Naloxone

SideEffectsofNaloxoneToxicityistremors 2.Administeroxygenlowinflowtopreventrespiratoryarrestat23L/min 3.EnforceCBRwithoutbathroomprivileges a.Usingbedsidecommode 4.Instructclienttoavoidformsofvalsalvamaneuver 5.Placeclientonsemifowlersposition 6.Monitorstrictlyvitalsigns,intakeandoutputandECGtracing 7.Provideageneralliquidtosoftdietthatislowinsaturatedfats,sodiumandcaffeine 8.Encourageclienttotake2030cc/weekofwine,whiskyandbrandytoinducevasodilation 9.Administermedicationasordered: a.Vasodilators Nitroglycerine ISD(IsosorbideDinitrate,Isordil)sublingual Lidocaine(Xylocane SideEffects:confusionanddizziness Brutylium (lol) (pril) amlodipine,verapamil,diltiazem Streptokinase SideEffects:allergicreaction,pruritus Urokinase TIPAF(tissueplasminogenactivatingfactor) SideEffects:chestpain Monitorforbleedingtime Heparin(checkforpartialthrombintime) Antidote:protaminesulfate Coumadin/WarfarinSodium(checkforprothrombintime) Antidote:VitaminK h.AntiPlatelet PASA(Aspirin) Antithromboticeffect SideEffectsofAspirin Tinnitus Heartburn Indigestion/Dyspepsia Contraindication Dengue PepticUlcerDisease Unknowncauseofheadache 10.Provideclienthealthteachinganddischargeplanningconcerning a.Avoidanceofmodifiableriskfactors e.CalciumAntagonist f.Thrombolytics/FibrinolyticAgents

b.AntiArrythmicAgents

c.Betablockers

d.ACEInhibitors

g.AntiCoagulant

Arrhythmia(causedbyprematureventricularcontraction) latesignisoliguria

b.Cardiogenicshock c.LeftCongestiveHeartFailure d.Thrombophlebitis homanssign e.Stroke/CVA f.PostMISyndrome/DresslersSyndrome Client is resistant to pharmacological agents administer 150,000 450,000 units of streptokinase as ordered g.ResumptionofADLparticularlysexualintercourseis 4 6weekspostcardiacrehab,postCABGandinstruct to makesexasanappetizerratherthandessert instructclienttoassumeanonweightbearingposition Clientcanresumesexualintercourseifcanclimbstaircase dietarymodification h.Strictcompliancetomediationandimportanceoffollowupcare

CONGESTIVEHEARTFAILURE Inabilityofthehearttopumpbloodtowardssystemiccirculation TypesofHeartFailure 1.LEFTSIDEDHEARTFAILURE A.PredisposingFactors 1.90%ismitralvalvestenosisdueto a.RHDinflammationofmitralvalveduetoinvasionofGroupAbetahemolyticstreptococcus Formationofaschoffbodiesinthemitralvalve Commonamongchildren(throatinfection) ASOTiter(AntistreptolysinOtiter) Penicillin Aspirin b.Aging 2.MyocardialInfarction 3.Ischemicheartdisease 4.Hypertension 5.Aorticvalvestenosis B.SignsandSymptoms 1.Dyspnea 2.ParoxysmalnocturnaldyspneaclientawakenedatnightduetoDOB(suddenattacksofOrthopneaatnight) 3.Orthopneause23pillowswhensleepingorplaceinhighfowlers 4.Productivecoughwithbloodtingedsputum(severepulmonaryedema) 5.Frothysalivation 6.Cyanosis 7.Rales/Crackles(bibasilarlobesthatdonotclearw/coughing) 8.Bronchialwheezing 9.PulsusAlternansweakpulsefollowedbystrongboundingpulse 10.PMIisdisplacedlaterallyduetocardiomegaly 11.Thereisanorexiaandgeneralizedbodymalaise 12.S3ventriculargallop 13.Oliguriabloodflowtothekidneydecreases,causingdecreasedperfusionandreduceurineoutput.(Daytime) 14.Nocturiasleepingcardiacworkloaddecreased,improvingrenalperfusion,whichthenleadstofrequenturinationat Night.

C.DiagnosticProcedure 1.Chestxrayrevealscardiomegaly 2.PAP(pulmonaryarterialpressure)measurespressureinrightventricleorcardiacstatus PCWP(pulmonarycapillarywedgepressure)measuresendsystolicanddyastolicpressure bothareincreased donebycardiaccatheterization(insertionofswanganzcatheter)

3.Echocardiographyenlargedheartchamber(cardiomyopathy),dependentonextentofheartfailure 4.ABGrevealsPO2isdecreased(hypoxemia),PCO2isincreased(respiratoryacidosis)

2.RIGHTSIDEDHEARTFAILURERIGHTVENT.FAILS.
A.PredisposingFactors 1.Tricuspidvalvestenosis 2.Pulmonaryembolism 3.RelatedtoCOPD 4.Pulmonicvalvestenosis 5.Leftsidedheartfailure B.SignsandSymptoms(venouscongestion) 1.Neck/jugularveindistension 2.Pittingedema(lowerextremities) 3.Ascites 4.Weightgain 5.Hepatosplenomegaly 6.Jaundice 7.Pruritus(albumin) 8.Anorexia 9.Esophagealvarices C.DiagnosticProcedures 1.Chestxrayrevealscardiomegaly 2.Centralvenouspressure(CVP) Measurepressureinrightatrium(410cmofwater) CVPfluidstatusmeasure

IfCVPislessthan4cmofwaterhypovolemicshock Dothefluidchallenge(increaseIVflowrate) IfCVPismorethan10cmofwaterhypervolemicshock Administerloopdiureticsasordered WhenreadingCVPpatientshouldbeflatonbed Upon insertion place client in Trendelenburg position to promote ventricular filling and prevent pulmonary embolism 3.Ecocardiographyrevealsenlargedheartchambers(cardiomyopathy) 4.LiverenzymesSGPTandSGOTisincreasedB.hypertrophiccardiomyopathy D.NursingManagement Goal:increasecardiaccontractilitytherebyincreasingcardiacoutput(36L/min) 1.EnforceCBR 2.Administermedicationsasordered 3.Administeroxygeninhalationwithhighinflow,34L/min,deliveredvianasalcannula 4.Highfowlersposition 5.Monitorstrictlyvitalsigns,intakeandoutputandECGtracing 6.Measureabdominalgirthdailyandnotifyphysician 7.Provideadietaryintakeoflowsodium,cholesterolandcaffeine 8.Providemeticulousskincare 9.Assistinbloodlessphlebotomy rotatingtourniquet,rotatedclockwiseevery15minutestopromotedecreasevenous return 10.Provideclienthealthteachinganddischargeplanning a.Preventcomplications Arrhythmia Shock Rightventricularhypertrophy MI Thrombophlebitis a.Cardiacglycosides B.dilatedcardiomyopathy Digoxin(Lanoxin)(increasescardiaccontractionbutlowersthepulserate) Increaseforceofcardiaccontraction Ifheartrateisdecreaseddonotgive b.LoopDiuretics Lasix(Furosemide)peak12hrs,duration68hrs(monitorforhyperkalemia) c.Bronchodilatorsaminophylline d.Narcoticanalgesics MorphineSulfate e.Vasodilators Nitroglycerine f.AntiArrhythmic Lidocaine(Xylocane)

b.Dietarymodification c.Strictcompliancetomedications

PERIPHERALVASCULARDISORDER ArterialUlcer I.ThromboAngIitisObliterans(BUERGERSDISEASE) BurgersDiseasemale/feet ReynaudsDiseasefemale/hands VenousUlcer 1.VaricoseVeins 2.Thrombophlebitis(deepveinthrombosis)

THROMBOANGIITISOBLITERANSorBUERGERSDISEASE(MALEFEET)2035yrsold
Acuteinflammatorydisorderusuallyaffectingthesmallmediumsizedarteriesandveinsofthelowerextremities (Autoimmunedisease) A.PredisposingFactors 1.Highriskgroupsmen30yearsoldandabove 2.Smoking 3.Thrombusformationandocclusionofthevessels 4.Age2035yrs B.SignsandSymptoms(painistheoutstandingsymptom) 1.Intermittentclaudicationlegpainuponwalking(footcramps,especiallythearch(instepclaudicationafterexercise) 2.Coldsensitivityandchangesinskincolorrubor(reddishbluediscoloration,pallor,andcyanosis) 3.Decreasedperipheralpulses 4.Trophicchanges 5.Ulceration 6.Gangreneformation 7.Absenceofpedalpulsebutwithnormalfemoralpulseandpoplitealpulses. 8.Radialandulnararterypulsesareabsentordiminished. C.DiagnosticProcedures 1.Oscillometrydecreaseinperipheralpulses 2.DopplerUTZdecreasebloodflowtotheaffectedextremity 3.Angiographyrevealssiteandextentofmalocclusion 4.Segmentallimbbloodpressure(alternationoftourniquet) D.NursingManagement 1.Encourageaslowprogressivephysicalactivity A.walking34timesaday B.outofbed34timesaday a.Analgesics b.Vasodilators c.Anticoagulants Lowertheextremitiesbelowthe level of the heart if the conditionisarterialinnature Elevate the extremities above theheartlevel ifthecondition isvenousinnature

2.Administermedicationsasordered

3.Institutefootcaremanagement 4.Instructclienttoavoidsmokingandexposuretocoldenvironment 5.Assistinsurgicalprocedure bellowkneeamputation(elevatethestumpfor24hrspostoptopromotevenousreturn andminimizeedema). 6.Painisrelievebyrest

REYNAUDSDISEASE
Disordercharacterizedbyacuteepisodesofarterial(smallarteries)spasm/vasoconstrictionthatresultincoldness,pain, andpallorinvolvingthefingersordigitsofthehands. A.PredisposingFactors 1.Highriskgroupfemale1640yearsoldandabove 2.Smoking 3.Collagendiseases B.SignsandSymptoms 1.Intermittentclaudicationlegpainuponwalking 2.Coldsensitivityandchangesinskincolor(pallor,cyanosisthenrubor) 3.Trophicchanges 4.Ulceration 5.Gangreneformation 6. Raynaudsphenomenon refertolocalized,intermittentepisodesofvasoconstrictionofsmallarteriesofthehands thatcauseschangesincolorandtemperature.(aswhite,blue,andred) C.DiagnosticProcedures 1.DopplerUTZdecreasebloodflowtotheaffectedextremity 2.Angiographyrevealssiteandextentofmalocclusion D.NursingManagement 1.Administermedicationsasordered a.Analgesics b.Vasodilators(calciumchannelblockers:nifedipine) a.SLE(butterflyrash) b.RheumatoidArthritis a.Pianoplaying b.Excessivetyping c.Operatingchainsaw

4.Directhandtrauma

5.Coldclimatesandduringwinter

2.Encouragetoweargloves 3.Instructclientonimportanceofcessationofsmokingandexposuretocoldenvironment

VARICOSITIES
Dilated,tortuous,superficialveinscausedbyincompetentvenousvalves Abnormaldilationofveinsoflowerextremitiesandtrunksdueto A.PredisposingFactors 1.Hereditary 2.Congenitalweaknessofveins 3.Thrombophlebitis 4.Cardiacdisorder 5.Pregnancy 6.Obesity 7.Prolongedstandingorsitting 8.Tortuousveins(saphenousveins) Incompetentvalveresultingto Increasedvenouspoolingresultingto Venousstasiscausing Decreasevenousreturn

B.SignsandSymptoms 1.Painafterprolongedstanding 2.Dilatedtortuousskinveins 3.Warmtotouch 4.Heavinessinlegs C.DiagnosticProcedure 1.Venography 2.TrendelenburgsTestveinsdistendsquicklyinlessthan35seconds D.NursingManagement 1.Elevatelegsaboveheartleveltopromoteincreasedvenousreturnbyplacing23pillowsunderthelegs 2.Measurethecircumferenceoflegmuscletodetermineifswollen 3.Wearantiembolicstockings 4.Administermedicationsasordered a.Analgesics a.Veinstrippingandligation(mosteffective) b.Sclerotherapy canrecurandonlydonesmall/spiderwebvaricositiesanddangerofthrombosis(2 3years forembolism) sclerosingagentisinjected intothevein,irritatingthevenousendotheliumandproducing localizedphlebitisandfibrousis,therebyobliteratingthelumenofthevein. 5.Assistinsurgicalprocedure

THROMBOPHLEBITIS
Deepveinthrombosis Inflammationoftheveinswiththrombusformation 3factorsknownasVIRCHOWSTRIADbelievetoplayasignificantroleinitsdevelopment: Stasisoftheblood(venousstasis) Vesselwallinjury Alteredbloodcoagulation A.PredisposingFactors 1.Obesity 2.Smoking 3.Relatedtopregnancy 4.Chronicanemia 5.Prolonguseoforalcontraceptivespromoteslipolysis 6.Diabetesmellitus 7.Congestiveheartfailure 8.Myocardialinfarction 9.Postopcomplication 10.Postcannulationinsertionofvariouscardiaccatheter. 11.Increaseinsaturatedfatsinthediet. B.SignsandSymptoms 1.Painataffectedextremity 2.Warmtotouch 3.Dilatedtortuousskinveins 4.PositiveHomansSignspainatthecalforlegmuscleupondorsiflexionofthefoot C.DiagnosticProcedure 1.Venography

2.Angiography D.NursingManagement 1.Elevatelegsaboveheartleveltopromoteincreasevenousreturn 2.Applywarmmoistpacktoreducelymphaticcongestion 3.Measurecircumferenceoflegmuscletodetermineifswollen 4.Encouragetowearantiembolicstockingsorkneeelasticstockings 5.Administermedicationsasordered a.Analgesics b.AntiCoagulanttakeatthesametimeeachday,usuallybet.89am Heparin Note:ifanyoftheff.signareappear,reportthemimmediately Faintness,dizziness,orincreasedweakness Severeheadachesorabdominalpain Reddishorbrownishurine Anybleedingnosebleeding,cuts,andunusual Redblackbowelmovements Rash 6.Monitorforsignsofcomplications Embolism a.Pulmonary Suddensharpchestpain Unexplaineddyspnea Tachycardia Palpitations Diaphoresis Restlessness b.Cerebral Headache Dizziness DecreaseLOC MURPHYS SIGN is seen in clients with cholelithiasis, cholecystitis characterized by pain at the right upper quadrantwithtenderness(inflammationofthegallbladder)

RESPIRATORYSYSTEM
OVERVIEWOFTHESTRUCTURESANDFUCNTIONSOFTHERESPIRATORYSYSTEM I.UpperRespiratorySystem 1.Filteringofair 2.Warmingandmoisteningofair 3.Humidification A.Nose Cartillage Rightnostril Leftnostril Separatedbyseptum ConsistofanastomosisofcapillariesknownasKesselbachsPlexus(thesiteofnosebleeding) B.Pharynx/Throat Servesasamuscularpassagewayforbothfoodandair

C.Larynx Forphonation(voiceproduction) Forcoughreflex Glottis Openingoflarynx Openstoallowpassageofair Closestoallowpassageoffoodgoingtotheesophagus Theinitialsignofcompleteairwayobstructionistheinabilitytocough II.LowerRespiratorySystem Forgasexchange A.Trachea/Windpipe Consistofcartilaginousrings Servesaspassagewayofairgoingtothelungs Siteoftracheostomy B.Bronchus Rightmainbronchus Leftmainbronchus C.Lungs Rightlung(consistof3lobes,10segments) Leftlung(consistof2lobes,8segments) Serousmembranes PleuralCavity a. Pareital b. Pleuralfluid c. Visceral WithPleuriticFrictionRub a.Pneumonia b.Pleuraleffusion c.Hydrothorax(airandbloodinpleuralspace

Alveoliacinarcells Siteofgasexchange(CO2andO2) Diffusion(Daltonslawofpartialpressureofgases) RespiratoryDistressSyndrome Decreaseoxygenstimulatesbreathing Increasecarbondioxideisapowerfulstimulantforbreathing Ventilationmovementofairin&outoflungs Respirationmovementofairintocells TypeIICellsofAlveoli Secretessurfactant Decreasesurfacetension Preventcollapseofalveoli Composedoflecithinandspingomyelin L/Sratiotodeterminelungmaturity NormalL/Sratiois2:1 Inprematureinfants1:2 Giveoxygenofless40%inprematuretopreventatelectasisandretrolentalfibroplasias retinopathy/blindnessinprematurity

DisordersofRespiratorySystem
1.PTB/PulmonaryTuberculosis(KochsDisease) Infectionoflungtissuecausedbyinvasionofmycobacteriumtuberculosisortuberclebacilli Anacidfast,gramnegative,aerobicandeasilydestroyedbyheatorsunlight A.PrecipitatingFactors 1.Malnutrition 2.Overcrowdedplaces 3.Alcoholism 4.Overfatigue 5.Ingestionofinfectedcattlewithmycobacteriumbovis 6.Virulence(degreeofpathogenecity)ofmicroorganism B.ModeofTransmission 1.Airbornetransmissionviadropletnuclei C.SignsandSymptoms 1.Lowgradeafternoonfever,nightsweats 2.Productivecough(yellowishsputum) 3.Anorexia,generalizedbodymalaise 4.Weightloss 5.Dyspnea 6.Chestpain 7.Hemoptysis(chronic) D.DiagnosticProcedure 1.MantouxTest(skintest) Purifiedproteinderivative DOH810mminduration,4872hours WHO1014mminduration,4872hours PositiveMantouxtest(previousexposuretotuberclebacillibutwithoutactiveTB) 2.SputumAcidFastBacillus Positivetoculturedmicroorganism 3.ChestXray Revealspulmonaryinfiltrates(chalkthorax) 4.CBC RevealsincreaseWBC E.NursingManagement 1.EnforceCBR 2.Institutestrictrespiratoryisolation 3.Administeroxygeninhalation 4.Forcefluidstoliquefysecretions 5.Placeclientonsemifowlerspositiontopromote expansionoflungs 6.Encouragedeepbreathingandcoughingexercise 7.Nebulizeandsuctionwhenneeded 8.Comfortableandhumidenvironment

9.Instituteshortcoursechemotherapy a.Intensivephase INH(IsonicotinicAcidHydrazide) Rifampicin(Rifampin) PZA(Pyrazinamide) Giveneverydaysimultaneouslytopreventresistance INHandRifampicinisgivenfor4months,takenbeforemealstofacilitateabsorption PZAisgivenfor2months,takenaftermealstofacilitateabsorption SideEffectINH:peripheralneuritis/neuropathy(increaseintakeofVitaminB6/Pyridoxine) SideEffectRifampicin:allbodilysecretionsturntoredorangecolor SideEffectPZA:allergicreaction,hepatotoxicity,nephrotoxicity PZAcanbereplacedbyEthambutol SideEffectEthambutol:opticneuritis b.Standardphase Injectionofstreptomycin(aminoglycoside) Kanamycin Amikacin Neomycin Gentamycin SideEffect: Ototoxicitydamagetothe8 cranialnerveresultingtotinnitusleadingtohearingloss NephrotoxicitycheckforBUNandCreatinine Giveaspirinifthereisfever SideEffect:tinnitus,dyspepsia,heartburn 10.Provideincreasecarbohydrates,protein,vitaminCandcalories 11.Provideclienthealthteachinganddischargeplanning PTB Bones(potts) Meninges Eyes Skin Adrenalgland c.Strictcompliancetomedications d.Importanceoffollowupcare a.Avoidanceofprecipitatingfactors b.Preventcomplications(Atelectasis,militarytuberculosis)
th

PNEUMONIA
Inflammationofthelungparenchymaleadingtopulmonaryconsolidationasthealveoliisfilledwithexudates A.EtiologicAgents 1.StreptococcusPneumonaecausingpneumococalpneumonia 2.HemophylusInfluenzaecausingbronchopneumonia(children) 3.DiplococcusPneumoniae 4.KlebsellaPneumoniae 5.EscherichiaPneumoniae 6.Pseudomonas B.HighRiskGroups 1.Childrenbelow5yearsoldbec.Oflowresistance 2.Elderly C.PredisposingFactors

1.Smoking 2.Airpollution 3.Immunocompromised a.AIDS Pneumocysticcarinipneumonia DrugofchoiceisRetrovir b.BronchogenicCancer Initialsignisnonproductivecoughtoproductivecough Chestxrayconfirmslungcancer 4.Relatedtoprolongedimmobility(CVAclients),causinghypostaticpneumonia 5.Aspirationoffoodcausingaspirationpneumonia D.SignsandSymptoms 1.Productivecoughwithgreenishtorustysputum 2.Dyspneawithprolongexpiratorygrunt 3.Fever,chills,anorexiaandgeneralbodymalaise 4.Weightloss 5.Rales/crackles 6.Bronchialwheezing 7.Cyanosis 8.Pleuriticfrictionrub 9.Chestpain 10.Abdominaldistentionleadingtoparalyticileus(absenceofperistalsis) E.DiagnosticProcedure 1.SputumGramStainingandCultureSensitivitypositivetoculturedmicroorganisms 2.Chestxrayrevealspulmonaryconsolidation 3.ABGanalysisrevealsdecreasePO2 4.CBCrevealsincreaseWBC,erythrocytesedimentationrateisincreased F.NursingManagement 1.EnforceCBR 2.Administeroxygeninhalationlowinflow 3.Administermedicationsasordered BroadSpectrumAntibiotic a. Penicillin b. Tetracycline c. Microlides(Zethromax) Azethromycin(SideEffect:Ototoxicity) Antipyretics Mucolytics/Expectorants Analgesics

4.Forcefluid 5.Placeonsemifowlersposition 6.Institutepulmonarytoilet (tendstopromoteexpectoration) Deepbreathingexercises Coughingexercises Chestphysiotherapy Turningandreposition

7.Nebulizeandsuctionasneeded 8.Assistinposturaldrainage Drainuppermostareaoflungs Placedonvariousposition

NursingManagementforPosturalDrainage a.Bestdonebeforemealsor24hoursaftermealstopreventgastroesophagealreflux b.Monitorvitalsigns c.Encourageclientdeepbreathingexercisesnormalbreathesoundbronchovesicular d.Administerbronchodilators1530minutesbeforeprocedure e.Stopifclientcannottolerateprocedure f.Provideoralcareafterprocedure g.Contraindicatedwith Unstablevitalsigns Hemoptysis Clientswithincreaseintraocularpressure(NormalIOP1221mmHg) IncreaseICP

9.Provideincreasecarbohydrates,calories,proteinandvitaminC 10.Healthteachinganddischargeplanning a.Avoidsmoking b.Preventcomplications Atelectasis Meningitis(nervedeafness,hydrocephalus)

c.Regularadherencetomedications d.Importanceoffollowupcare

HISTOPLASMOSIS
Acutefungal infectioncausedbyinhalationofcontaminateddustor particles with histoplasmacapsulatumderivedfrom birdsmanure A.SignsandSymptoms PTBorPneumonialike 1.Productivecough 2.Dyspnea 3.Fever,chills,anorexia,generalbodymalaise 4.Cyanosis 5.Hemoptysis 6.Chestandjointpains B.DiagnosticProcedures 1.HistoplasminSkinTestpositive 2.ABGanalysisPO2decrease C.NursingManagement 1.EnforceCBR 2.Administeroxygeninhalation 3.Administermedicationsasordered a.Antifungal AmphotericinB Fungizone(Nephrotoxicity,checkforBUNandCreatinine,Hypokalemia) b.Steroids c.Mucolytics d.Antipyretics

4.Forcefluidstoliquefysecretions 5.Nebulizeandsuctionasneeded 6.Preventcomplicationsbronchiectasis 7.Preventthespreadofinfectionbysprayingofbreedingplaces

COPD(ChronicObstructivePulmonary/LungDisease)

ChronicBronchitis
Inflammationofbronchusresultingtohypertrophyorhyperplasiaofgobletmucousproducingcellsleadingtonarrowingof smallerairways A.PredisposingFactors 1.Smoking 2.Airpollution B.SignsandSymptoms 1.Productivecough(consistenttoallCOPD) 2.Dyspneaonexertion 3.Prolongedexpiratorygrunt 4.Anorexiaandgeneralizedbodymalaise 5.Scatteredrales/ronchi 6.Cyanosis 7.Pulmonaryhypertension C.DiagnosticProcedure ABGanalysisrevealsPO2decrease(hypoxemia),PCO2increase,andpHdecrease(resp.acidosis) a.Peripheraledema b.CorPulmonale(rightventricularhypertrophy)

BronchialAsthma
Reversibleinflammatorylungconditionduetohypersensitivitytoallergensleadingtonarrowingofsmallerairways A.PredisposingFactors(DependingonTypes) 1.ExtrinsicAsthma(Atopic/Allergic) Causes a.Pollen b.Dust c.Fumes d.Smoke e.Gases f.Danders g.Furs h.Lints 2.IntrinsicAsthma(Nonatopic/Nonallergic) Causes a.Hereditary b.Drugs(aspirin,penicillin,betablocker) c.Foods(seafoods,eggs,milk,chocolates,chicken d.Foodadditives(nitrates) e.Suddenchangeintemperature,airpressureandhumidity f.Physicalandemotionalstress 3.MixedType9095% B.SignsandSymptoms 1.Coughthatisnonproductive 2.Dyspnea 3.Wheezingonexpiration

4.Cyanosis 5.MildStress/apprehension 6.Tachycardia,palpitations 7.Diaphoresis C.DiagnosticProcedure 1.PulmonaryFunctionTest Incentivespirometerrevealsdecreasevitallungcapacity 2.ABGanalysisPO2decrease BeforeABGtestforpositiveAllensTest,applydirect pressuretoulnarandradialarterytodeterminepresence ofcollateralcirculation D.NursingManagement 1.EnforceCBR 2.Oxygeninhalation,withlowinflowof23L/min 3.Administermedicationsasordered a.BronchodilatorsgivenviainhalationormetereddoseinhalaerorMDIfor5minutes b.Steroidsdecreaseinflammation c.Mucomysts(acetylceisteine) d.Mucolytics/expectorants e.Antihistamine

4.Forcefluids 5.Semifowlersposition 6.Nebulizeandsuctionwhenneeded 7.Provideclienthealthteachingsanddischargeplanningconcerning a.Avoidanceofprecipitatingfactor b.Preventcomplications Emphysema StatusAsthmaticus(givedrugofchoice) Epinephrine Steroids Bronchodilators

c.Regularadherencetomedicationstopreventdevelopmentofstatusasthmaticus d.Importanceoffollowupcare

BRONCHIECTASIS
Abnormalpermanentdilationofbronchusleadingtodestructionofmuscularandelastictissuesofalveoli A.PredisposingFactors 1.Recurrentlowerrespiratorytractinfections 2.Chesttrauma 3.Congenitaldefects 4.Relatedtopresenceoftumor B.SignsandSymptoms 1.Productivecough 2.Dyspnea 3.Cyanosis 4.Anorexiaandgeneralizedbodymalaise 5.Hemoptysis(onlyCOPDwithsign) C.DiagnosticProcedure 1.ABGPO2decrease

2.Bronchoscopydirectvisualizationofbronchususingfiberscope NursingManagementPREBronchoscopy 1.Secureinformconsentandexplainproceduretoclient 2.MaintainNPO68hourspriortoprocedure 3.Monitorvitalsignsandbreathesound POSTBronchoscopy 1.Feedinginitiateduponreturnofgagreflex 2.Avoidtalking,coughingandsmoking,maycauseirritation 3.Monitorforsignsofgross 4.Monitorforsignsoflaryngealspasmpreparetracheostomyset D.Treatment 1.Surgery(pneumonectomy,1lungisremovedandpositiononaffectedside) 2.SegmentalWedgeLobectomy(promotereexpansionoflungs) Unaffectedlobectomyfacilitatedrainage

EMPHYSEMA
IrreversibleterminalstageofCOPDcharacterizedby A.PredisposingFactors 1.Smoking 2.Airpollution 3.Allergy 4.Highrisk:elderly 5.Hereditaryitinvolvesdeficiencyof ALPHA1ANTITRYPSIN (neededtoformElastase,forrecoilofalveoli) B.SignsandSymptoms 1.Productivecough 2.Dyspneaatrest 3.Prolongexpiratorygrunt 4.Anorexiaandgeneralizedbodymalaise 5.Resonancetohyperresonance 6.Decreasetactilefremitus 7.Decreaseordiminishedbreathsounds 8.Ralesorronchi 9.Bronchialwheezing 10.Barrelchest 11.Flaringofalainares 12.PurselipbreathingtoeliminatesexcessCO2
(compensatorymechanism)

a.Inelasticityofalveoli b.Airtrapping c.Maldistributionofgases d.Overdistentionofthoraciccavity(barrelchest)

C.DiagnosticProcedure 1.PulmonaryFunctionTestrevealsdecreasevitallungcapacity 2.ABGanalysisreveals a.Panlobular/centrilobular DecreasePO2(hypoxemialeadingtochronicbronchitis,BlueBloaters) Decreaseph

IncreasePCO2 Respiratoryacidosis b.Panacinar/centriacinar IncreasePO2(hyperaxemia,PinkPuffers) DecreasePCO2 Increaseph Respiratoryalkalosis D.NursingManagement 1.EnforceCBR 2.Administeroxygeninhalationvialowinflow 3.Administermedicationsasordered a.Bronchodilators b.Steroids c.Antibiotics d.Mucolytics/expectorants

4.Highfowlersposition 5.Forcefluids 6.Institutepulmonarytoilet 7.Nebulizeandsuctionwhenneeded 8.InstitutePEEP(positiveendexpiratorypressure)inmechanicalventilationpromotesmaximumalveolarlungexpansion 9.Providecomfortableandhumidenvironment 10.Providehighcarbohydrates,protein,calories,vitaminsandminerals 11.Healthteachingsanddischargeplanningconcerning a.Avoidsmoking b.Preventcomplications Atelectasis CorPulmonale CO2narcosismayleadtocoma Pneumothorax

c.Strictcompliancetomedication d.Importanceoffollowupcare

RESTRICTIVELUNGDISORDER

PNEUMOTHORAXpartial/orcompletecollapseoflungsduetoentryorairinpleuralspace. Types: 1. Spontaneouspneumothoraxentryofairinpleuralspacewithoutobviouscause. eg.Ruptureofbleb(alveolifilledsacs)inptwithinflammedlungconditions 2. Openpneumothoraxairenterspleuralspacethroughanopeninginchestwall Stab/gunshotwound 3. TensionPneumothoraxairenterspluralspacewith@inspiration&cantescapeleadingtooverdistensionof thoraciccavityresultingtoshiftingofmediastinumcontenttounaffectedside. Eg.Flailchestparadoxicalbreathingpattern

Predisposingfactors: 1.Chesttrauma 2.Inflammatorylungconditions 3.Tumor S/Sx: 1. Suddensharpchestpain 2. unexplainedDyspneaorSOB 3. Cyanosis 4. Diminishedordecreasedbreathsound ofaffectedlung 5. Coolmoistskininitialsignofshock 6. Mildrestlessness/apprehension,anxiety 7. Resonancetohyperresonance 8. decreasedtactilefremitus Diagnosis: 1. ABGpO2decrease 2. CXRconfirmspneumothorax/collapseoflung NursingMgt: 1. Assistinendotrachealintubation 2. Assistinthoracenthesis 3. AdministermedsMorphineSO4duetopain Antimicrobialagentsduetobacteria 4. Assistintesttubethoracotomyattached toH2Osealeddrainagesystem

PurposeofH2Osealeddrainage 1.Reestablish()pressureinthelungslung612mmHg 2.Promotereexpansionofthelungs 3.Drainfluid,bloodandair 4.Topreventrefluxofbloodfluidandair NursingMgtifptisonCPTattachedtoH2Odrainage 1. Maintainstrictaseptictechnique 2. DBE 3. Atbedside a.) PetroleumgauzepadifdislodgedHemostat b.) Ifwithairleakageclamp c.) Extrabottle 4. MedsMorphineSO4 Antimicrobial 5. Monitor&assessforoscillationfluctuationsorbubbling a.) If(+)tointermittentbubblingmeansnormalorintact H2Orisesuponinspiration H2Ogoesdownuponexpiration b.)If(+)tocontinuous,remittentbubbling 1.Checkforairleakage 2.Clamptowardschesttube 3.NotifyMD c.)If()tobubbling 1.Checkforloop,clots,andkink 2.MilktowardsH2Oseal 3.Indicatesreexpansionoflungsnormal 4.Auscultateforbreathsounds,Xrays 5.RemovalofCTT

If client has a tension pneumothorax, the initial treatment of choice is to insert a largebore needle into the secondintercostalspacemidclavicularlinetorelievepressure.Next,achesttubesystemisplacedintothefourth intercostalspace. Asmallchesttube(28french)isinsertednearthesecondintercostalspacethisspace isusedbecauseitisthe thinnestpartofthechestwall,minimizesthedangerofcontractingthethoracicnerve,andleavesmallscar.If thepatienthasalsohemothorax,alargediameterchesttube(32french)orgreaterisinsertedusuallyinthe4 th or5thinterscostalspaceatthemidaxillaryline.

WhenwillMDremovechesttube? 1. If()fluctuations 2. (+)Breathsounds 3. CXRfullexpansionoflungs NursingMgtofremovalofchesttube 1. EncourageDBE 2. InstructtoperformValsalvamaneuverforeasyremoval,toprevententryofairinpleuralspace. 3. Applyvaselinatedairocclusivedressingandpressuredressing Maintaindressingdry&intact 4. Prepare:Extrabottle,excellentclamp,petroleumgauze

GastroIntestinalTract
I.Upperalimentarycanalfunctionfordigestion a. Mouth b. Pharynx(throat) c. Esophagus d. Stomachsiteofdigestion e. 1sthalfofduodenum II.MiddleAlimentarycanalFunction:forabsorption Completeabsorptionlargeintestine a. 2ndhalfofduodenumforabsorption b. Jejunum c. Ileum d. 1sthalfofascendingcolon III.LowerAlimentaryCanalFunction:elimination a. 2ndhalfofascendingcolonforelimination b. TransverseforcompleteabsorptionLI c. Descendingcolon d. Sigmoid e. Rectum IV.AccessoryOrgan a. Salivarygland b. Verniformappendix c. Liver d. Pancreasautodigestion e. Gallbladderstorageofbile I.SalivaryGlands 1.Parotidbelow&frontofear 2.Sublingual 3.Submaxillary Producessalivaformechanicaldigestion 1,2001,500ml/daysalivaproduced Lacrimalglanddepressiononthefrontalbone Lacrimalductoutercanthus

PAROTITISmumpsinflammationofparotidgland
Paramyxovirus S/Sx: 1. 2. 3. 4. 5. Fever,chillsanorexia,generalizedbodymalaise enlargedparotidgland Swellingofparotidgland Dysphagia Earacheotalgia

Modeoftransmission:Directtransmission&dropletnuclei Incubationperiod:1421days Periodofcommunicability1weekbeforeswelling&immediatelywhenswellingbegins. NursingMgt: 1. CBR 2. Instituteastrictrespiratoryisolation 3. Meds: analgesic Antipyretic Antibioticstoprevent2 complications 4. Alternatewarm&coldcompressataffectedpart(vinegarpromotescooling)

5. Generalliquidtosoftdiet 6. Complications Womencervicitis,vaginitis,oophoritis Bothsexesmeningitis&encephalitis/reasonwhyantibioticsisneeded Menorchitismightleadtosterilityifitoccursduring/afterpuberty. VERNIFORMAPPENDIXRt.iliacorRt.inguinalarea FunctionlymphaticorganproducesWBCduringfetallifeceasestofunctionuponbirthofbaby APENDICITISinflamationofverniformappendix Predisposingfactor: 1. Microbialinfection 2. Feacalithundigestedfoodparticlestomatoseeds,guavaseeds 3. Intestinalobstruction S/Sx: 1. Pathognomonicsign:(+)reboundtenderness 2. Lowgradefever,anorexia,n/v 3. Diarrhea&/orconstipation 4. PainatRt.iliacregionMCBURNEYSpointsiteofsurgicalincision 5. Latesignduepaintachycardia Rovsingssignelicitedbypalpatingtheleftlowerquadrantthisparadoxicallycausespaintobefeltintheright lowerquadrant. Diagnosis: 1. CBCmildleukocytosisincreaseWBC 2. PE(+)reboundtenderness(flexRtleg,palpateRtiliacarearebound) 3. Urinalysis(+)acetoneinurine Treatment:appendectomy2445 NursingMgt: 1. Secureconsent 2. Routinelynursingmeasures: a.) Skinprep b.) NPO c.) Avoidenema/laxativesleadtoruptureof appendix 3. Meds: Antipyretic Antibiotics *Dontgiveanalgesicprediagnosiswillmaskpain Giveanalgesicpostdiagnosis Presenceofpainmeansappendixhasnotruptured. 4.Avoidheatapplicationwillruptureappendix. 5.MonitorVS,I&Obowelsound 6.MaintainapatentIVline Complications: Peritonitis Septicemia NursingMgt:postop 1. If(+)toPenrosedrainindicatesruptureofappendix Positionaffectedsidetodrain 2. Meds:analgesicduepostoppain Antibiotics,AntipyreticsPRN 3. MonitorVS,I&O,bowelsoundNborborygmysound 4. MaintainpatentIVline 5. Complicationsperitonitis,septicemia PEPTICULCERDISEASE(PUD)excoriation/erosionofsubmucosa&mucosalliningdueto: a.) Hypersecretionofacidpepsin b.) Decreaseresistancetomucosalbarrier IncidenceRate: 1. Men4055yrsold 2. Aggressivepersons/typeApersonality 3. Hereditary 4. EmotionalStress Predisposingfactors: 1. Hereditary 2. Emotional 3. SmokingvasoconstrictionGITischemia 4. Alcoholismstimulatesreleaseofhistamine=ParietalcellreleaseHclacid=ulceration 5. Caffeinetea,soda,chocolate 6. Irregulardiet

7. Rapideating 8. UlcerogenicdrugsNSAIDS,aspirin,steroids,indomethacin,ibuprofen IndomethacinS/Ecornealcloudiness.Needsannualeyecheckup. NSAIDandsteroids=gastropathy 9. GastrinproducingtumororgastrinomaZollingerEllisonssyndrome 10. Microbialinvasionhelicobacterpylori.Metronidazole(Flagyl)

Typesofulcers
Ascendingtoseverity 1. Acuteaffectssubmucosallining 2. Chronicaffectsunderlyingtissues heals&formsascar,deeper Accordingtolocation 1. Stressulcer 2. Gastriculcer 3. Duodenalulcermostcommon Stressulcerscommonamongcriticallyillclients 2types 1.Curlingsulcercause:trauma&Burns Hypovolemia GITschemia DecreaseresistanceofmucosalbarrierstoHclacid Ulcerations 2.Cushingsulcercausestroke/CVA/headinjury Increasevagalstimulation Hyperacidity Ulcerations Treatment:Vagotomydonetopreventhemorrhageandshockpriortosurgeryonthestomach GASTRICULCER DUODENALULCER SITE PAIN Antrumorlessercurvature 30min1hraftereating epigastrium gaseous&burning notusuallyrelievedbyfood&antacid Eatingleadstopain Normalgastricacidsecretion common hematemesis Wtloss a.stomachcancer b.hemorrhage 50or60yearsoldandabove Malefemale=1:1 15%ofpepticulcersaregastric Duodenalbulb 23hrsaftereating midepigastrium cramping&burningpain usuallyrelievedbyfood&antacid 12MN3ampain Eatinglessenspain Increasedgastricacidsecretion Notcommon Melena Wtgain a.perforation 20yearsoldandabove Male:Female=23:1 80%ofpepticulcersareduodenal

HYPERSECRETION VOMITING HEMORRHAGE WT COMPLICATIONS HIGHRISK INCIDENCE

9095%iscasesofduodenalulcerslessbicarbonateions,decreasesoincreaseincidence Diagnosis: 1. Endoscopicexam 2. Stoolfromoccultblood(+) 3. GastricanalysisGastricUlcer:normalgastricacidsecretion Duodenal:increasedgastricacidsecretion 4. GIseriesconfirmspresenceofulceration NursingMgt: 1. Dietbland,nonirritating,nonspicy 2. Avoidcaffeine&milk/milkproductsIncreasegastricacidsecretion 3. Administermeds

a.)Antacids ACA Aluminumcontainingantacids Magnesiumcontainingantacids ex.aluminumhydroxidegel ex.milkofmagnesia (Amphogel) S/Ediarrhea S/Econstipation Maalox(feverS/E) b.)H2receptorantagonist: 1. Ranitidine(Zantac)SE:fever 2. Cimetidine(Tagamet)hastenstheeffectoforalanticoagulants 3. Famotidine(Pepcid)SE:fever Avoidsmokingdecreaseeffectivenessofdrug NursingMgt: 1. Administerantacid&H2receptorantagonist(Cimetidine)1hrapart Cemetidinedecreaseantacidabsorption&viseversa c.)Cytoprotectiveagents Ex 1.Sucralfate(Carafate)Providesapastelikesubsthatcoatsmucosalliningofstomach 2.Misoprostol(Cytotec)SE:menstrualspotting d.)Sedatives/TranquilizersValium,lithium e.)Anticholinergics/Antispasmodic 1. AtropineSO4 2. ProphanthelineBromide(Profanthene) (Pthashistoryofhpncrisiswithpepticulcerdisease.RnshouldnotadministeralkaseltzerhaslargeamountofNa. 3. Surgery:subtotalgastrectomyPartialremovalofstomach BillrothI(Gastroduodenostomy) BillrothII(Gastrojejunostomy) Removalofofstomach&anastomosesof Removalof3/4ofstomach&duodenalbulb& gastricstumptotheduodenum. anastomostosesofgastricstumptojejunum. BeforesurgeryforBIorBIIDovagotomy(severingofvagusnerve)&pyloroplasty(drainage)first. NursingMgt: 1. MonitorNGToutputordrainageimmediatelypostopbrightred a.) Immediatelypostopshouldbebrightred b.) Within3648houtputisyellowgreen c.) After48houtputisdarkredduetoHClacid 2. Administermeds: a.) Analgesic b.) Antibiotic c.) Antiemetics 3. MaintainpatentIVline 4. VS,I&O&bowelsounds 5. Complications: a.) Hemorrhagehypovolemicshock Latesignsanuria b.) Peritonitis c.) Paralyticileusmostfeared d.) Hypokalemia e.) Thrombophlebitis f.) Perniciousanemia g.) Septicemia 7.)Dumpingsyndromecommoncomplicationrapidgastric emptyingofhypertonicfoodsolutionsCHYMEleadingtohypovolemia. SxofDumpingsyndrome: 1. Dizziness 2. Diaphoresis 3. Diarrhea 4. Palpitations Nursingmgt: 1. Avoidfluidsinchilledsolutions,sweets (fluidsmustbetakenaftermeals) 2. Smallfrequentfeedings6equallydividedfeedings 3. DietdecreaseCHO,moderatefats&CHON 4. Flatonbed1530minutesafterqfeeding

DIVERTICULITIS/DIVERTICULOSIS
1. 2. 3. A. S/S: Diverticulumanoutpouchingoftheintestinalmucosaparticularlythesigmoidcolon Diverticulosismultiplediverticulum Diverticulitisinflammationofdiverticula PredisposingFactors 1.HighRiskGroupsmen(4045yo) 2.Congenitalweaknessofmusclefibersoftheintestine. 3.Lowroughageandfiberinthediet 1. Intermittentlowerleftabdominalquadrantpain,particularlyintherectosigmoidarea 2. tenderness 3. alternatingboutsofconstipationordiarrheawithbloodormucous

Dx: 1. Bariumenemarevealsinflammatoryprocess 2. CBCreveals:decreasedhematocritandhemoglobin NsgMgt: 1. Administermedsasordered: a. antibiotics b. bulklaxatives c. stoolsofteners d. antispasmodicagents 2.Instructclientstotakefoodshighinfiberifthereisdiverticulosis 3.Monitorforsignsofinfection Fearedcomplications:Peritonitis 4.Assistsinsurgicalprocedure Resectionofthediseasedbowelandcreationofacolostomy

Liverlargestgland
Occupiesmostofrighthypochondriacregion Color:scarletred,brownshinyandtransparent CoveredbyafibrouscapsuleGlissonscapsule Functionalunitliverlobules

Function: 1. Producesbile BileemulsifiesfatsH2Oandbilesalts=cholesterol Rightsidedpain:Cholelithiasiseasybruising Leftsidedpain:Pancreatitis ComposedofH2O&bilesalts Givescolortourineurobilin Stoolcolorstechobilin 2. Detoxifiesdrugs 3. PromotessynthesisofvitA,D,E,Kfatsolublevitamins(needsfatforabsorption) HypervitaminosisvitD&K VitAretinol(DefVitAnightblindness) VitDcholecalciferon Helpscalcium Rickets,osteoarthritis 4.Itdestroysexcessestrogenhormone 5.formetabolism A.CHO 1.Glycogenesissynthesisofglycogens 2.Glycogenolysisbreakdownofglycogen 3.GluconeogenesisformationofglucosefromCHOsources B.CHON 1.Promotessynthesisofalbumin&globulin LiverCirrhosisdecreasealbuminascitesandedema Albuminmaintainsosmoticpressure,preventsedema 2.Promotessynthesisofprothrombin&fibrinogen 3.Promotesconversionofammoniatourea. Ammonialikebreathfetorhepaticusasweet,slightlyfecalodortothebreathpresumed2beintestinalorig. C.FATSpromotessynthesisofcholesteroltoneutralfatscalledtriglycerides LIVERCIRRHOSISlostofarchitecturaldesignofliverleadingtofatnecrosis&scarring LaennacCirrhosislossofarchitecturaldesignoftheliverleadingtofatnecrosisandscarring Earlysignhepaticencephalopathyaccumulationofammoniaandothertoxicsubstanceintheblood 1. Asterixisflappinghandtremors Latesignsheadache,restlessness,disorientation,decreaseLOChepaticcoma. Nursingpriorityassistinmechanicalventilation Predisposingfactor: DecreaseLaennacscirrhosiscausedbyalcoholism 1. Chronicalcoholismmajorcause 2. MalnutritiondecreaseVitB,thiaminprimarycause 3. Virus 4. Toxicityeg.Carbontetrachloride(CCL4) 5. Useofhepatotoxicagents S/Sx: 1.Earlysigns: a.) Weakness,fatigue b.) Anorexia,n/v c.) Stomatitis d.) Urineteacolor Stoolclaycolor e.) Amenorrhea f.) Decreasesexualurge

g.) h.) i.) j.) k.)

Lossofpubic,axillahair Hepatomegaly Jaundice Pruritusorurticaria(palmarerythema) Decreasebowelsounds a.)Hematologicalchangesallbloodcellsdecrease Leukopeniadecrease Thrombocytopeniableedingtendencies Anemiadecrease b.)Endocrinechanges Spiderangiomas,Gynecomastia Caputmedusae,Palmarerythema,lossoftortousityoftheumbilicus c.)GITchanges Ascites,bleedingesophagealvaricesduetoportalHPN d.)Neurologicalchanges: hepaticencephalopathy

2.Latesigns

Hepaticencephalopathyammonia(cerebraltoxin)
Latesigns: Earlysigns: Headacheanddizziness asterexisflappinghandtremors Fetorhepaticus Minormentalchangesandmotordisturbances Confusion hyperactivedeeptendonreflexes Restlessness Hypoactivedeeptendonreflexesflaccid DecreaseLOC Hepaticcoma Diagnosis: 1. Liverenzymesincrease SGPT(ALT) SGOT(AST) 2. Serumcholesterol&ammoniaincrease 3. Indirectorconjugatedbilirubinincrease 4. CBCpancytopenia 5. PTTprolongedbleeding 6. Hepaticultrasonogramfatnecrosisofliverglobules NursingMgt 1. CBR 2. RestrictNa! 3. MonitorVS,I&O 4. Weighptdaily&assesspittingedema 5. MeasureabdominalgirthdailynotifyMD 6. Meticulousskincare 7. DietincreaseCHO,vit&minerals.Moderatefats.DecreaseCHON Wellbalanceddiet 8. Complicationsoflivercirrhosis: a.) Ascitesfluidinperitonealcavity NursingMgt: 1. Meds:Loopdiuretics1015mineffectorpotassiumsparingdiuretic 2. Assistinabdominalparacentesisaspirationoffluid Voidbeforeparacentesistopreventaccidentalpunctureofbladderastrocharisinserted

b.) Bleedingesophagealvarices Dilationofesophagealveins 1.Meds:VitK PitressinorVasopressin(IM) 2.NGTdecompressionlavage Givebeforelavageiceorcoldsalinesolution MonitorNGToutput 3.Assistinmechanicaldecompression InsertionofSengstakenBlackemoretubetodecompressveinsofesophagustoprevent esophagealvarices 3lumentypedcatheter Scissorsatbedsidetodeflate/decompressballoon.PrepscissorswhenptcomplainsofDOB c.) Hepaticencephalopathy 1. Assistinmechanicalventilationduecoma 2. MonitorVS,neurocheck 3. Siderailsduerestless 4. MedsLaxativestoexcreteammonia(Lactulose)

HEPATITISjaundice(ictericsclera)
Bilirubin Kernicterus/hyperbilirubinia Irreversiblebraindamage

HepatitisA
HepatitisAvirus(HAV)isavirusthatcausesliverdisease.Incubationisabout30days,andthevirusisexcretedinthe stool for about 2 weeks before the illness and about a week after it. The mortality rate is low. Children are typically asymptomatic.Adultsgenerallyhaveamoresevereillness.Thediseaseisnotchronicandisnotcarried: FECALORAL TRANSMISSION INFECTIONCONTROL

HandhygienetopreventthespreadofHAV. VaccinebeforetravelingtoplaceswhereHAVisendemic. Standardprecautions,whencaringforthisclient. Contactprecautions,forincontinentclients(cannotcontrolbladder/bowel).

HepatitisB
Hepatitis B (HBV) is one of thefive hepatitis viruses that infect the liver. This virus has a complex structure capable of attackinganddestroyinglivercells,resultinginillnessordisease.Cellulardestructionresultsinarchitecturalchangesof thenormalstructure,oftheliverwhichleadstoadisruptionintheflowofbloodandbile.Illnesscanrangefrommildsigns andsymptomstochronicdisease,suchasfatalcirrhosisorlivercancer.BLOODCARRIER Pancreasmixedgland(exocrine&endocrinegland)foundbehindthestomach PANCREATITISacuteorchronicinflammationofpancreasleadingtopancreaticedema,hemorrhage&necrosisdueto autodigestion(selfdigestion). BleedingofpancreasCullenssignonumbilicalarea Predisposingfactors: 1. Chronicalcoholism 2. Hepatobilarydisease 3. Obesity 4. Hyperlipidemia

5. Hyperparathyroidism 6. DrugsThiazidediuretics,aspirin,pills,PentamidineHCL(Pentam)forclientswithAIDS, 7. Dietincreasesaturatedfats S/Sx: 1. SevereMidepigastriumepigastricpainradiatesfromback&flankarea(leftupperquadrant) 2448hrs.Aggravatedbyheavymeals/eating,accompaniedbyDOB 2. N/V 3. Tachycardia 4. Palpitationduetopain(abdominalguarding) 5. Dyspepsia/indigestion(rigidboardlikeabdomen) 6. Decreasebowelsounds 7. (+)Cullenssignecchymosisofumbilicushemorrhage 8. (+)GreyTurnersspotsecchymosisofflankarea 9. Hypocalcemia Diagnosis: 1. Serumamylase&lipaseincrease 2. Urinelipaseincrease 3. SerumCadecrease NursingMgt: 1.Meds a.)NarcoticanalgesicMeperidineHcl(Demerol) DontgiveMorphineSO4willcausespasmofthesphincterofODDI. b.)Smoothmusclerelaxant/anticholinergic Ex. PapavarineHcl ProphanthelineBromide(Profanthene) c.)VasodilatorNTG d.)AntacidMaalox e.)H2receptorantagonistRanitidin(Zantac) todecreasepancreaticstimulation f.)Cagluconate 2.Witholdfood&fluidaggravatespain(totalNPO) 3.AssistinTotalParenteralNutrition(TPN)orhyperalimentation ComplicationsofTPN 1. Infectionmaintainastrictaseptictechnique 2. PulmonaryEmbolismcheckallconnectiontosystem 3. Hyperglycemia 4. Hyperkalemia 4.Institutestressmgttech a.)DBE b.)Biofeedback 5.ComfypositionKneechestorfetallieposition 6.Ifptcantoleratefood,giveincreaseCHO,decreasefats,andmoderateCHON 7.Complications: Chronichemorrhagicpancreatitis,Peritonitis,Septicemia,Shock

GALLBLADDERstorageofbilemadeupofcholesterol.

Definitionofterms:Biliary
Cholecystitis Cholelithiasis Cholecystectomy Cholecystostomy Choledochotomy Choledocholithiasis Choledocholitholithotomy Choledochoduodenostomy Choledochojejunostomy Lithotripsy Laparoscopiccholecystectomy Lasercholecystectomy Inflammationofthegallbladder Thepresenceofcalculiinthegallbladder Removalofthegallbladder Openinganddrainageofthegallbladder Openingintothecommonduct Stonesinthecommonduct Incisionofcommonbileductforremovalofstones Anastomosisofcommonducttoduodenum Anastomosisofcommonducttojejunum Disintegrationofgallstonesbyshockwaves Removalofgallbladderthroughendoscopic procedure Removalofgallbladderusinglaserratherthan scalpelandtraditionalsurgicalinstruments

CHOLECYSTITIS/CHOLELITHIASISinflammationofgallbladderwithgallstoneformation.
Predisposingfactor: 1. Highriskwomen40yearsold 2. Postmenopausalwomenundergoingestrogentherapy 3. Obesity 4. Sedentarylifestyle,prolongedimmobility 5. Hyperlipidemia 6. Neoplasm 7. Obstruction S/Sx: 1. SevereRightabdominalpain(aftereatingfattyfood).Occurringespeciallyatnight =epigastricorrightabdominalquadrantaftereatingaheavymeal 2. Fatintolerance 3. Anorexia,n/v,feelingoffullness 4. Jaundice 5. Pruritus 6. Easybruising 7. Teacoloredurine 8. Steatorrhea Diagnosis: 1. Oralcholecystogram(orgallbladderseries)confirmspresenceofgallstones 2. Increasedindirectbilirubin 3. Increasedalkalinephosphatase 4. increasedserumandamylase NursingMgt: 1. Medsa.)NarcoticanalgesicMeperdipineHclDemerol b.)Anticholinergic/AntispasmodicAtropineSO4 c.)Antiemetic PhenerganPhenothiazidewithantiemeticproperties d)Broadspectrumantibiotics 2. DietincreaseCHO,moderateCHON,decreasefats 3. Meticulousskincare 4. Surgery: Cholecystectomy NursingMgtpostcholecystectomy MaintainpatencyofTtubeintact&preventinfection

Stomachwidestsectionofalimentarycanal
Jshapedstructures 1. Anthrum 2. Pylorus 3. Fundus ValvespreventGERD 1. cardiacsphinctervalve 2. Pyloricsphinctervalvestomachandfirsthalfofduodenum Cells 1. Chief/Zymogeniccellssecrets a.) GastricamylasedigestCHO/sugars b.) Gastriclipasedigestfats c.) PepsinCHON d.) Rennindigestsmilkproducts

2. Parietal/Argentaffin/oxynticcells Function: a.) ProducesintrinsicfactorpromotesreabsorptionofvitB12cyanocobalaminpromotesmaturationof RBC b.) SecretsHclacidaidsindigestion 3. EndocrinecellsSecretesgastrinincreaseHclacidsecretion Functionofthestomach 1.Mechanicaldigestion 2.Chem. 3.Storageoffood CHO,CHONstored12hrs.Fatsstored23hrs

BURNSdirecttissueinjurycausedbythermal,electric,chemical&smokeinhaled(TECS)
NursingPriorityinfection(allkindsofburns) HeadburnpriorityAirway nd st nd 2 priorityfor1 &2 burnpain nd rd 2 priorityfor3 burnFluidandelectrolytes Thermaldirectcontactflames,hotgrease,sunburn. Electric,wires Chemicaldirectcontactcorrosivematerialsacids Smokegas/fumeinhalation Stages: EmergentphaseRemovalofptfromcauseofburn.Determinesourceorlocationofburn Shockphase4872 .Characterizedbyshiftingoffluidsfromintravasculartointerstitialspace(Hypovolemia) S/Sx: BP decrease Urineoutput HR increase Hct. increase SerumNa decrease SerumK increase Metacidosis Diuretic/Fluidremobilizationphase3to5days.Returnoffluidfrominterstitialtointravascularspace Recovery/convalescentphasecompletediuresis.Woundhealingstartsimmediatelyaftertissueinjury. Class: I.PartialBurn st 1.1 degreesuperficialburns Affectsepidermis Cause:thermalburn Painful Redness(erythema)&blanchinguponpressure withnofluidfilledvesicles nd 2.2 degreedeepburns Affectsepidermis&dermis Causechem.burns verypainful Erythema&fluidfilledvesicles(blisters) IIFullthicknessBurns th 1.Third&4 degreesburn Affectsalllayersofskin,muscles,bones Causeelectrical Lesspainful Dry,thick,leatherywoundsurfaceknownasESCHARdevitalizedornecrotictissue. Assessmentfindings: Ruleofnines Head&neck =9% Antchest =18% Postchest =18% @Arm9+9 =18% @leg18+18 =18% Genitalia/perineum =1% Total 100% NursingMgt: 1.Meds

a.)TetanustoxoidburnsurfaceareaissourceofanaerobicgrowthClaustridiumtetany Tetany Tetanolysin tetanospasmin Hemolysis musclespasm b.)MorphineSO4 c.)Systemicantibiotics 1.Ampicillin 2.Cephalosporin 3.Tetracyclin 4.Topicalantibiotic: 1.SilverSulfadiazene(silvadene) 2.Sulfamylon 3.Silvernitrate 4.Povidoneiodine(betadine) 2.Administerisotonicfluidsol&CHONreplacements 3.Strictaseptictechnique 4.DietincreaseCHO,increaseCHON,increaseVitC,andincreaseKorange 5.If(+)toburnsonhead,neck,faceAssistinintubation 6.Assistinhydrotherapy 7.Assistinsurgicalwounddebridement.Administeranalgesic1530minutesbeforedebridement 8.Complications: a.)Infection b.)Shock c.)Paralyticileusduetohypovolemia&hypokalemia d.)CurlingsulcerH2receptorantagonist e.)Septicemiabloodpoisoning f.)Surgery:skingrafting

GUTgenitourinarytract
Function: 1. Promoteexcretionofnitrogenouswasteproducts 2. MaintainF&E&acidbasebalance 1.Kidneyspairofbeanshapedorgan Locatedretroperitonially(backofperitoneum)oneithersideofvertebralcolumn.EncasedinBowmansscapsule. Parts: 1. RenalpelvisPyelonephritisinflammationoftherenalpelvis 2. Cortex 3. Medulla Nephronsbasiclivingunitofthekidneysconsistingofglomerulus Glomerulusfiltersbloodgoingtokidneys

Functionofkidneys: 1. Urineformation CausesofTransientIncontinence:DIAPPERS 2. RegulationofBP Delirium Urineformation25%oftotalCO(CardiacOutput)is receivedbykidneys(3,0006,000ml.) 125ml/minfilteredbytheglomerulus> Infectionofurinarytract Glomerularfiltrationrate 1. Filtration Atrophicvaginitis,urethritis 2. TubularReabsorption124mlofultrafilteredare reabsorbedintheblood 3. TubularSecretion1mlisexcretedintheurine Pharmacologicagents(anticholinergic) FiltrationNormalGFR/minis125mlofblood Tubularreabsorption124mlofultrainfiltrates(H2O& Psychologicalfactors(depression,regression) electrolytesisforreabsorption) Tubularsecretion1mlisexcretedinurine Excessiveurineproduction(DI,diabeticketo,inc.intake) CausesofCRF: 1. HPN Restrictedactivity 2. DM RegulationofBP: Stoolimfaction Predisposingfactor: ExCSHypovolemiadecreaseBPgoingtokidneys ActivationofRAAS ReleaseofRenin(hydrolyticenzyme)atjuxtaglomerularapparatus AngiotensinImildvasoconstrictor AngiotensinIIvasoconstrictor Adrenalcortex increaseCOincreasePR Aldosterone IncreaseBP IncreaseNa& H2Oreabsorption Hypervolemia Ureters2535cmlong,passagewayofurinetobladder Bladderlocbehindsymphisispubis.Muscular&elastictissuethatisdistensible Functionreservoirofurine 12001800mlNormaladultcanhold 200500mlneededtoinitiatemicturitionreflex(voiding) Color amber Odor aromatic Consistency clearorslightlyturbid pH 4.58 Specificgravity 1.0151.030 WBC/RBC () Albumin () Ecoli () Mucusthreads few Amorphousurate () Urethraextendstoexternalsurfaceofbody.Passageofurine,seminal&vaginalfluids. Women35cmor1to1 Male20cmor8

UTI

CYSTITISinflammationofbladder
Predisposingfactors: 1. MicrobialinvasionE.coli 2. Highriskwomen 3. Obstruction 4. Urinaryretention 5. Increaseestrogenlevels 6. Sexualintercourse In the older adult, the most S/Sx: common signs & symptoms of 1. Painflankarea 2. Urinaryfrequency&urgency cystitisorUTI: 1.Fatigue. 3. Burninguponurination 2.Changeincognitivestatus. 4. Dysuria&hematuria 5. Fever,chills,anorexia,genbodymalaise 6. Nocturia

Diagnosis: Urineculture&sensitivity80%ofthecasesare(+)toE.coli NursingMgt: 1. Forcefluid2000ml=topreventbacterialmultiplication 2. Warmsitzbathtopromotecomfort 3. Monitor&assessforgrosshematuria 4. Monitorandassessurineforcolor,odor,andbleedingNpH:4.8 5. Acidashdietcranberry,vitCOJtoacidifyurine&preventbacterialmultiplication 6. Meds:systemicantibiotics Ampicillin Cephalosporin Sulfonamidescotrimoxazole(Bactrim) Gantrism(ganthanol) Aminoglycosides:Gentamycin UrinaryantisepticsNitrofurantoin(Macrodantin) UrinaryanalgesicPyridum 7.Ht a.)ImportanceofHydration b.)Voidaftersex(maleandfemale) c.)Femaleavoidscleaningback&front Bubblebath,Tissuepaper,Powder,perfume d.)Complications:Pyelonephritis

PYELONEPHRITISacute/chronicinflammationof1or2renalpelvisofkidneysleadingtotubulardestruction,
interstitialabscessformation. LeadtoRenalFailure Predisposingfactor: 1. Microbialinvasion(Bacterial) a.) E.Coli b.) Streptococcus 2. Urinaryretention/obstruction 3. Pregnancy 4. DM 5. Exposuretorenaltoxinsornephrotoxicagents S/Sx: Acutepyelonephritis a.) Costovertibralanglepain,tenderness b.) Fever,anorexia,genbodymalaise c.) Urinaryfrequency,urgency d.) Nocturia,dysuria,hematuria e.) Burninguponurination f.) FLANKPAIN g.) Enlargedkidney ChronicPyelonephritis a.) Fatigue,wtloss,weakness b.) Polyuria,polydypsia c.) HPN Diagnosis: 1. Urineculture&sensitivity(+)E.coli&streptococcus 2. Urinalysis (+)WBC,(+)RBC,(+)Puscells 3. Cystoscopicexamurinaryobstruction NursingMgt: 1. ProvideCBRespeciallyduringacutephase 2. Forcefluid 3. Acidashdiet 4. Provideawarmsitzbathforcomfort 5. Meds: a.) Urinaryantisepticnitrofurantoin(macrodantin) SE:peripheralneuropathy GIirritation Hemolyticanemia Stainingofteeth b.) UrinaryanalgesicPyridium 6. ComplicationRenalFailure

NEPHROLITHIASIS/UROLITHIASISformationofstonesaturinarytract
calcium, milk oxalate, cabbage cranberries nutstea chocolates uricacid anchovies organmeat nuts sardines

Predisposingfactors: 1. DietincreaseCa&oxalate 2. Hereditarygout 3. Obesity 4. Sedentarylifestyle 5. Hyperparathyroidism S/Sx: 1. Renalcolic 2. Coolmoistskin(shock) 3. Burninguponurination 4. Hematuria 5. Anorexia,n/v Diagnosis: 1. IVPintravenouspyelography.Revealslocationofstone 2. KUBrevealslocationofstone 3. Cytoscopicexamurinaryobstruction 4. Stoneanalysiscomposition&typeofstone 5. UrinalysisincreaseEBC,increaseCHON 6. Xray NursingMgt: 1.Forcefluid 2.Strainurineusinggauzepad 3.Warmsitzbathforcomfort 4.Alternatewarmcompressatflankarea 5. a.)NarcoticanalgesicMorphineSO4 b.)Allopurinol(Zyeoprim) c.)PatentIVline d.)Dietif+Castonesacidashdiet If+oxalatestonealkalineashdiet(Exmilk/milkproducts) If+uricacidstonesdecreaseorganmeat/anchoviessardines 6. Surgery a.) Nephectomyremovalofaffectedkidney Litholapoxyremovalof1/3ofstonesStoneswillrecur.Notadvisedforptwithbigstones b.) Extracorporealshockwavelithotripsy Noninvasive Dissolvestonesbyshockwave 7. Complications:RenalFailure

BENIGNPROSTATICHYPERTROPHYenlargedprostateglandleadingto
a.) Hydrouretersdilationofureters b.) Hydronephrosisdilationofrenalpelvis c.) KidneystonesStoneformationRenalfailure d.) Renalfailure encirclestheneckofthebladder decreasedformofurinarystream Causeisunknown Predisposingfactor: 1. Highrisk50yearsold&above 6070(3to4xatrisk) Prostatecancer:40yearsold&above 2. Influenceofmalehormone S/Sx: 1.Decreaseforceofandamountofurinarystream 2.Dysuria 3.Hematuria 4.Burninguponurination 5.TerminaldribblingearlysignofBPH 6.Backache 7.Sciatica 8.Hesitancy Diagnosis: 1. Digitalrectalexamenlargedprostategland 2. KUBurinaryobstruction 3. Cystoscopicexamobstruction 4. UrinalysisincreaseWBC,CHON,RBC NursingMgt: 1. Prostaticmessagepromotesevacuationofprostaticfluid 2. Limitfluidintake 3. Providecatheterization 4. Provideawarmsitzbathforcomfort 5. Meds: a. Terazozine(hytrin)Relaxesbladdersphincter,relaxesthesmoothmuscleofurinarysphincter S/E:HA,hypotension b. Fenasteride(Proscar)AtrophyofProstateGland(givenaftermeals) S/E:N&V,Anorexia

5.Surgery:ProstatectomyTURPTransurethralresectionofProstateNoincision Withoutincision:fordebilitatedclients Assistincystoclysisorcontinuousbladderirrigation. Complication: 1. Hemorrhage 2. Urinaryobstruction 3. Peniledysfunction Nursingmgt: c. Monitorsignsandsymptomsofinfection d. Monitorsymptomsgross/frankbleeding.Normalbleedingwithin24h. 3. Maintainirrigationortubepatenttoflushoutclotstopreventbladderspasm&distention ACUTERENALFAILUREsuddenimmobilityofkidneystoexcretenitrogenouswasteproducts&maintainF&E balanceduetoadecreaseinGFR.(N125ml/min) Predisposingfactors: Prerenalcausedecreasebloodflow Causes: 1. Septicshock 2. Hypovolemia 3. Hypotension decreasebloodflowtothekidneys 4. CHF 5. Hemorrhage 6. Dehydration(chronicdiarrhea) Intrarenalcauseinvolvesrenalpathology=kidneyproblem 1. Acutetubularnecrosis 3.HPN 2. Pyelonephritis 4.AcuteGlom. Postrenalcauseinvolvesmechanicalobstruction Causes: 1. Urinarystrictures 2. Urolithiasis 3. BPH 4. Presenceoftumors Stages:Initiationperiodbeginswiththeinitialinsultandendswhenoliguriadevelops. I.OLIGURICSTAGE(12weeks) Increasedserumconcentration: involvespassageofurine<400ml/day Urea S/S: Creatinine a. Hyperkalemiaarrhythmia Uricacid b. Hypernatremia Organicacids c. Hyperphosphatemia Intracellularcations Potassium d. Hypocalcemia Magnesium e. HighBUN1020andcreatinine.81 f. Metabolicacidosis12wks II.DIURETICPHASE23weeksIncreasedamountofurine a.Hypokalemia b.Hyponatremia c.MetabolicAcidosis d.IncreasedCreatinineandBUN III.CONVALESCENT/RECOVERYPHASE312months CHRONICRFirreversiblelossofkidneyfunction Predisposingfactors: 1. DM 2. HPN 3. RecurrentUTI/nephritis/pyelonephritis 4. Exposuretorenaltoxins StagesofCRF 1. DiminishedReserveVolumeasymptomatic NormalBUN&Crea,GFR<1030% 2.RenalInsufficiency 3.EndStageRenaldisease

S/Sx:
1.)UrinarySystem a.)polyuria b.)nocturia c.)hematuria d.)Dysuria e.)oliguria 3.)CNS a.)headache b.)lethargy c.)disorientation d.)restlessness e.)memoryimpairment 5.)Respiratory a.)Kassmaulsresp b.)decreasecoughreflex c.)crackles 7.)Fluid&Electrolytes a.)hyperkalemia b.)hypernatermia c.)hypermagnesemia d.)hyperposphatemia e.)hypocalcemia f.)metacidosis 2.)Metabolicdisturbances a.)azotemia(increaseBUN&Crea) b.)hyperglycemia c.)hyperinulinemia

4.)GIT a.)n/v b.)stomatitis c.)uremicbreath d.)diarrhea/constipation 6.)hematological a.)Normocyticanemia bleedingtendencies 8.)Integumentary a.)itchiness/pruritus b.)uremicfrost 9.)Cardiovascularchanges a.HPN b.CHF c.Pericarditis

NursingMgt: 1. EnforceCBR,reverseisolation 2. MonitorstrictlyVS,I&O,neurocheck,monitorforsignsofhypocalcemia(increasedphosphate) 3. Meticulousskincare.Uremicfrostassistinbathingpt 4.Meds: a.)NaHCO3dueHyperkalemia b.)Kayexelateenema c.)AntiHPNHydralazine(Apresoline) d.)Vit&minerals(Multivitamins) e.)Phosphatebinder (Amphogel)AlOHgelS/Econstipation f.)DecreaseCaCagluconate 5.Assistinhemodialysis 1.) Consent/explainprocedure 2.) Weighpatient 3.) Obtainbaselinedata&monitorVSbeforeandduringq30mins,I&O,wt,bloodexam 4.) Encouragepatienttovoid 5.) Strictaseptictechnique 6.) Monitorforsignsofcomplications: Bbleeding(duetoheparin) Eembolism Ddisequilibriumsyndrome Ssepticemia Sshockdecreaseintissueperfusion Disequilibriumsyndromefromrapidremovalofurea&nitrogenouswasteproductleadingto: a.) n/v b.) HPN c.) Legcramps d.) Disorientation e.) Paresthesia 5. AvoidBPtaking,bloodextraction,IV,atsideofshuntorfistula.Canleadtocompressionoffistula. 6. Maintainpatencyofshuntby: i. Palpateforthrills&auscultateforbruitsif(+)patentshunt! ii. Bedsidebulldogclip Ifwithaccidentalremovaloffistulatopreventembolism. Infersole(diastole)commondialisateused 7.Complication Peritonitis(mostfeared) Shock Inflowtime:1020mins Indwellingtime:3045mins 8.Assistinsurgery: Renaltransplantation:Complicationrejection(fearedcomplication).Reverseisolation Rejectiontimeinacute6mosto1year Rejectiontimeinchronic510years

EYES
Externalparts 1. Orbitalcavitymadeupofconnectivetissueprotectseyeformtrauma. 2. EOMextrinsicocularmusclesinvoluntarymusclesofeyeneededforgazingmovement. 3. Eyelashes/eyebrowsestheticpurposes 4. Eyelidspalpebralfissureopeningupper&lowerlid.Protectseyefromdirectsunlight Meibomeanglandsecretsalubricatingfluidinsideeyelid b.) Stye/styorHordeoluminflamedMeibomeangland 5. Conjunctiva 6. Lacrimalapparatustears Processofgrieving a. b. c. d. e. Denial Anger Bargaining Depression Acceptance

Intrinsiccoat I.scleroticcoatoutermost a.)Sclerawhite.Occupiespostofeye.Refractslightrays b.)Canalofschlerasiteofaqueoushumordrainage c.)Corneatransparentstructureofeye II.Uvealtractnutritivecare Uveitisinflofuvealtract Consistof: a.)Iriscoloredmuscularringofeye 2musclesofiris: 1.CircularsmoothmusclefiberConstrictsthepupil 2.radialsmoothmusclefiberDilatesthepupil 2chambersoftheeye 1.Anterior a.)VitreousHumormaintainssphericalshapeoftheeye b.)AqueousHumormaintainsintrinsicocularpressure NormalIOP=1221mmHg II.Retina(innermostlayer) i. Opticdiscsorblindspotnervefibersonly Noautoreceptors cones(daylight/coloredvision) rodsnighttwilightvision phototopicvision scotopicvision=vitAdeficiencyrodsinsufficient ii. Macullaluteayellowspotcenterofretina iii. Foveacentralisareawithhighestvisualacuityoracutevision Physiologyofvision 4Physiologicalprocessesforvisiontooccur: 1.Refractionoflightraysbendingoflightrays 2.Accommodationoflens 3.Constriction&dilationofpupils 4.Convergenceofeyes Unitofmeasurementsofrefractiondiopters Normaleyerefractionemmetropia ERRORofrefraction 1. MyopianearsightednessTreatment:biconcavelens 2. Hyperopia/orfarsightednessTreatment:biconvexlens 3. AstigmatisimdistortedvisionTreatment:cylindrical 4. PresbyopiaoldslightinelasticityoflensduetoagingTreatment:bifocallensordoublevista AccommodationoflensesbasedonHelmholtztheoryofaccommodation Nearvision= farvision= Ciliarymusclecontracts= ciliarymuscledilates/relaxes= Lensbulges lensisflat Convergenceoftheeye: Error: 1. Exotropia1eyen. 2. Esophoria correctedbycorrectiveeyesurgery 3. Strabismussquint 4. Amblyopiaprolongsquinting

GLAUCOMAincreaseIOPifuntreated,atrophyofopticnervediscblindness
Predisposingfactors: 1. Highriskgroup40&above (nearsightedness) 2. HPN 3. DM 4. Hereditary 5. Obesity 6. Recenteyetrauma,infl,surgery Type: 1. Chronic(openangleG.)mostcommontypeObstructinflowofaqueoushumorattrabecularmeshworkof canalofschlema 2. Acute(closeangleG.)MostdangeroustypeForwarddisplacementofiristocornealeadingtoblindness. 3. Chronic(closedangle)Precipitatedbyacuteattack S/Sx: 1. Lossofperipheralvisiontunnelvision 2. Halosaroundlights 3. Headache 4. n/v 5. Steamycornea 6. Eyediscomfort 7. Ifuntreatedgraduallossofcentralvisionblindness Diagnosis: 1.TonometryincreaseIOP>1221mmHg 2.Perimetrydecreaseperipheralvision 3.Gonioscopyabstructioninanteriorchamber Nursingmgt: 1. EnforceCBR 2. Maintainsiderails 3. Administermeds a.) Mioticslifetimecontractsciliarymuscles&constrictspupil.ExPilocarpineNa(Carbachol) b.) Epinephrineeyedropsdecreasesecretionofaqueoushumor c.) Carbonicanhydraseinhibitors.Ex.Acetazolamide(Diamox) Promotesincreaseoutflowofaquaeoushumor d.)Temoptics(Timololmaleate)Increaseoutflowofaquaoushumor 4. Surgery: Invasive: a.) Trabeculectomyeyetrephiningremovaloftrabelarmeshworkofcanalorschleratodrainaqueous humor b.) PeripheralIridectomyportionofirisisexcisedtodrainaqueoushumor Noninvasive: Trabeculoctomy(eyelasersurgery) NursingMgtpreopalltypessurgery 1. Applyeyepatchonunaffectedeyetoforceweakereyetobecomestronger. NursingMgtpostopalltypesofsurgery 1. Positionunaffected/unoperatedsidetopreventtensiononsutureline. 2. Avoidvalsalvamaneuver 3. MonitorforsymptomsofIOP a.) Headache b.) n/v c.) Eyediscomfort d.) Tachycardia 4. Eyepatchbotheyespostop CATARACTpartial/completeopacityoflens Predisposingfactor: 1. 9095%aging(degenerative/senilecataract) 2. Congenital 3. ProlongedexposuretoUVrays 4. DM S/Sx: 1. LossofcentralvisionHazyorblurringofvision 2. Painlessblurryvision

3. Milkywhiteappearanceatcenterofpupil 4. Decreaseperceptionofcolors 5. Diplopia Diagnosis: Opthalmoscopicexam(+)opacityoflens NsgMgt: 1. Reorientpttoenvironmentdueopacity 2. Siderails 3. Meds:a.)Mydriaticsdilatepupilnotlifetime(SNS) Ex.Mydriacyl c.) Cyslopegicsparalyzesciliarymuscle.Ex.Cyclogye 4. Surgery Eextra Ccapsular Ccataract partialremovaloflens Llens Eextraction Iintra Ccapsular Ccataract totalremovaloflens&surroundingcapsules Llens Eextraction NursingMgt: 1.Positionunaffected/unoperatedsidetopreventtensiononsutureline. 2.Avoidvalsalvamaneuver 3.MonitorsymptomsofIOP a.) Headache b.) n/v c.) Eyediscomfort d.) Tachycardia 4.Eyepatchbotheyespostop

RETINALDETACHMENTseparationof2layersofretina
Predisposingfactors: 1. Severemyopianearsightedness 2. DiabeticRetinopathy 3. Trauma 4. Followinglensextraction 5. HPN S/Sx: 1. Curtainveillikevision 2. Flashesoflights 3. Floaters 4. Gradualdecreaseincentralvision 5. Headache 6. Cobwebs Diagnosis:ophthalmoscopicexam NursingMgt: 1. Siderails(allvisualdisease) 2. Surgery: a.) Cryosurgerycoldapplication (Diathermyheatapplication) b.) Scleralbuckling

EAR
1. Hearing 2. Balance(Kinesthesiaorpositionsense) Parts: 1. Outer a.) Pinna/auricleprotectsearfromdirecttrauma b.) Ext.auditorymeatushasceruminousgland.Cerumen c.) Tympanicmembranetransmitssoundwavestomiddleear

Disordersofouterear
Entryofinsectsputflashlighttogiverouteofexit Foreignobjectsbeans(bringtoMD) H2Odrain 2.Middleear a.)Earosssicle 1.Hammer malleus 2.Anvil Incus forboneconductiondisorderconductivehearingloss 3.Stirrups stapes b.EustachiantubeOpenstoallowequalizationofpressureonbothears Yawn,chew,andswallow Childrenstraight,wide,short c.)Otitismedia Adultlong,narrow&slanted c.Muscles 1.Stapedius 2.Tensortympani 3.Innerear a.Bonylabyrinthforbalance,vestibule Utricle&succule OtolitheorearstonehasCacarbonate Movementofhead=Rightingreflex=Kinesthesia b.MembranousLabyrinth 1. Cochlea(functionforhearing)hasorganofcorti 2. Endolymph&perilymphforstaticequilibrium 3. Mastoidaircellsairfilledspacesintemporalboneinskull ComplicationsofMastoditismeningitis Typesofhearingloss: 1. Conductivehearinglosstransmissionhearingloss Causes: a.) Impactedcerumentinnitus&conductionhearinglossassistinearirrigation b.) ImmobilityofstapesOTOSCLEROSIS d.) Middleeardiseasecharbyformationofspongyboneintheinnerearcausingfixationorimmobilityofstapes e.) Stapescanttransmitsoundwaves Surgery Stapedectomyremovalofstapes,spongybone&implantationofgraft/earprosthesis Predisposingfactor: 1. Familiartendency 2. Eartrauma&surgery S/Sx: 1. Tinnitus 2. Conductivehearingloss

Diagnosis: 1. Audiometryvarioussoundstimulates(+)conductivehearingloss 2. WeberstestNormalAC>BC resultBC>AC Stapedectomy NursingMgtpostop 1. Positionptunaffectedside 2. DBE Nocoughing&blowingofnose Nightleadtoremovalofgraft 3. Meds: a.) Analgesic b.) Antiemetic c.) Antimotionsicknessagent.Ex.meclesineHcl(Bonamine) 4. Assessmotorfunctionfacialnerve(Smile,frown,raiseeyebrow) 5. Avoidshampoohairfor1to2weeks.Useshowercap SENSORYNEURALHEARINGLOSS/NERVEDEAFNESS Cause: 1. Tumoroncocheal 2. Loudnoises(gunshot) 3. Presbycusisbilateralprogressivehearinglossespeciallyathighfrequencieselderly Faceelderlytopromotelipreading 4. Menieresdiseaseendolymphatichydrops f.) Innereardiseasecharbydilationofendolympathicsystemleadingtoincreasevolumeofendolin PredisposingfactorofMENIERESDISEASE Smoking Hyperlipidemia 30yearsold Obesity(+)chosesteatoma Allergy Eartrauma&infection S/Sx: 1. TRIADsymptomsofMenieresdisease a.) Tinnitus b.) Vertigo c.) Sensoryneuralhearingloss 2. Nystagmus 3. n/v 4. Mildapprehension,anxiety 5. Tachycardia 6. Palpitations 7. Diaphoresis Diagnosis: 1. Audiometry(+)sensoryhearingloss Nursingmgt: 1. Comfy&darkenedenvironment 2. Siderails 3. Emeticbasin 4. Meds: a.) Diureticstoremoveendolymph b.) Vasodilator c.) Antihistamine d.) Antiemetic e.) Antimotionsicknessagent f.) Sedatives/tranquilizers 5. RestrictNa 6. Limitfluidintake 7. Avoidsmoking 8. SurgeryendolymphaticsacdecompressionShunt

OTITISMEDIAInflammationofthemiddleear.(lastlessthan6wks)
Signandsymptoms: Pain Temporaryhearingloss Tuggingattheaffectedear Difficultysleeping Drainingfluid/pus Frequentpullingoftheear(children) Fever Nursingmanagement: Usuallyselflimitingandresolvedspontaneously Antibiotic Drainage(leanontheaffectedsidetofacilitatedrainage)

Complication: Hearingloss Mastoiditis Delayedspeechandlanguagedevelopment PerforationoftheTM

OTHERMNEMONICS

IVNOTES
Clindamycin,KCl===NOTforIVpushitmaycausearrhythmia Chloramphenicol===NOTforIM Procaine,Penicillin,Benzatine,PenG,VancomycinHCl,Acyclovir(Zovirax)===NOTforIV Openedbottlesmustbeusedin8hours HepLockflushwithNSS KCl<80meq/L Epinephrine1:10,000 Lidocaine4mg/ml(1g/250ml) COMPATIBLEWITHPNSSONLY o Phenytoin o VitK o VitB6 o VitC o Hydralazine o Furosemide COMPATIBLEWITHD5WONLY o Epinephrine o Norepinephrine o Ephedrine o Dopamine o Dobutamine o Nitroprusside o NaHCO3 NottobedilutedinLR PenicillinG Ampicillin Cephalosporin NaHCO3 PRBCtobeinfusedwithin24hours FFP11. 5hours Plateletconcentratesinfusesimmediatelyandquickly Autoimmunediseases Apparatusneededatbedside Acetaminophentoxicity Preparesuctionapparatus Acetylcisteine acetylcysteinecausesoutpouringof MultipleSclerosis secretions Hypothyroidism AcuteGlomerulonephritis MyastheniaGravis tracheostomyset.Forrespiratory MyastheniaGravis arrest Hyperthyroidism Hemodyalisis bulldogclip GBS Senkstakentube scissorstodeflateballoon PerniciousAnemia GuillainBarreSyndrome tracheostomyset.Forrespiratory arrest Convulsionsuctionapparatus Increasedsecretions Hyperthyroidism tracheostomyset.Forlaryngeal spasmpostsubtotalthyroidectomy complication Goiter tracheostomyset.Forlaryngeal spasmpostsubtotalthyroidectomy complication Hypoparathyroidism tracheostomyset.Forlaryngeal spasm NEUROTRANSMITTER Acethylcholine Dopamine DECREASE MyastheniaGravis/ Alzheimer ParkinsonsDisease INCREASE BipolarDisorder Schizophrenia

Jerome Adorable, RN 2010

PATHOGNOMONICSIGNS

1.PTB 2.PNEUMONIA 3.ASTHMA 4.EMPHYSEMA 5.KAWASAKIDISEASE 6.PERNICIOUSANEMIA 7.DOWNSYNDROME 8.CHOLERA 9.MALARIA 10.TYPHOID 11.DIPTHERIA 12.MEASLES 13.SLE 14.LIVERCIRRHOSIS 15.LEPROSY 16.BULIMIANERVOSA 17.APPENDICITIS. 18.DENGUE 19.MENINGITIS 20.TETANY 21.TETANUS 22.PANCREATITIS 23.PYLORICSTENOSIS 24.PDA 25.ADDISONSDISEASE 26.CUSHINGSSYNDROME 27.HYPERTHYROIDISM/GRAVESDISEASE 28.INTUSSUSCEPTION 29.PARKINSONSDISEASE 30.HEPATITIS 31.THROMBOPHEBITIS 32.CATARACT 33.GLAUCOMA 34.RETINALDETACHMENT 35.CHOLECYSTITIS 36.ANGINAPECTORIS 37.MYASTHENIAGRAVIS 38.TETRALOGYOFFALLOT Lowgradeafternoonfever. Rustysputum. Wheezingonexpiration. Barrelchest. Strawberrytongue. Redbeefytongue. Protrudingtongue/semiancreaseonpalm Ricewaterystool. Stepladderlikefeverandchills. Rosespotsinabdomen. pseudomembraneformation(pharynx,tonsils,nasal) Kopliksspots. Butterflyrashes. spiderangioma,duetoesophagealvarices lioningface Chipmunkface.Parotidglandswelling reboundtenderness petechiaeor(+)Hermanssign Kernigssign(legpain),Brudzinskisign(neckpain). HYPOCALCEMIA(+)Trousseaussign/carpopedalspasmChvosteksign(facialspasm). risussardonicus. Cullenssign(ecchymosisofumbilicus)(+)Greyturnersspots. oliveSHAPEmassontheabdomen machinelikemurmur Bronzelikeskinpigmentation. Moonfaceappearanceandbuffalohump. Exopthalmus sausageshapedmass Pillrollingtremors Jaundice Homanssign Hazyvision/lossofcentralvision Tunnelvision/lossofperipheralvision Curtainveillikevision/flashesandfloaters Murphyssign(painondeepinspiration,ainflammationofthegallbladder Levinessign[handclutchinginthechest] Ptosis[droopingoftheuppereyelid] Clubbingoffingers

Jerome Adorable, RN 2010

SITE PAIN HYPERSECRETION VOMITING HEMORRHAGE WT COMPLICATIONS HIGHRISK INCIDENCE

GASTRICULCER Antrumorlessercurvature 30min1hraftereating epigastrium gaseous&burning notusuallyrelievedbyfood&antacid Eatingleadstopain Normalgastricacidsecretion common hematemesis Wtloss a.stomachcancer b.hemorrhage 50or60yearsoldandabove Malefemale=1:1 15%ofpepticulcersaregastric

DUODENALULCER Duodenalbulb 23hrsaftereating midepigastrium cramping&burningpain usuallyrelievedbyfood&antacid 12MN3ampain Eatinglessenspain Increasedgastricacidsecretion Notcommon Melena Wtgain a.perforation 20yearsoldandabove Male:Female=23:1 80%ofpepticulcersareduodenal

ATHEROSCLEROSIS narrowingofartery lipidorfatdeposits(plaques) tunicaintima

ARTERIOSCLEROSIS hardeningofartery,thicken calciumandproteindeposits tunicamedia

THE5MOSTCOMMONDRUGGIVENINBOARDEXAM:D.L.A.D.AMAJIC2s TOXICITY DRUG NORMALRANGE INDICATION CLASSIFICATION LEVEL Digoxin/Lanoxin (Increaseforceof .51.5meq/L 2 CHF CardiacGlycoside cardiacoutput) Lithium/Lithane (Decreaselevelof .61.2meq/L 2 Bipolar AntiManicAgents Ach/NE/Serotonin) Aminophylline 1019mg/100ml 20 COPD Bronchodilators (Dilatesbronchialtree) Dilantin/Phenytoin Acetaminophen/Tylenol
PITUITARYSECRETIONS Anteriorpituitary ADH OXYTOCIN GH ACTH TSH FSH&LH PROLACTIN MSH Posteriorpituitary

1019mg/100ml 1030mg/100ml

20 200

Seizures Osteoarthritis

AntiConvulsant NonnarcoticAnalgesic

JESUS EVERY TIME I SAY JESUS I wish to offer to GOD the infinite merits of Jesus Christ, His passion and death, with all the masses being said all over the world for: (a) The glory of GOD, (b) my own intentions, (c) the peace of the World.
Jerome Adorable, RN 2010 CSLRM

Happinessisonlyreal,whenitshared