PEDIAOKE by Sir Renchie Cainglet

Tila INFANT kung maglaro

Solitary lagi, Stranger anxiety
Weaning 6 months
Aspiration risk precaution

On TODDLERHOOD naman
Nega at Tantrums ginagawa
Separation PRODESDEN
May physio-logic anorexia pa

Push pull toys like tarak tarak
Autonomy vs. Shame and Doubt
First dental visit ay 2 and a half
Risk for poisoning problema jan

PRESCHOOL naman ay PHALLIC
Associative Play lagi ang gimik
Common fear is mutilation
Fear of dark and ghost din yun

Behavior ay gender specific
At may magi-cal thinking
Ang patay is sleeping
Initiative vs. guilt

Ang SCHOOL AGE latent yan
Concrete thinking, Logic reasoning
Same sex stage, normal na bading
Heroworship and plays competitive

Schooler starts to have a bestfriend
Takot parati control niya ay mag end
Permanent ang concept of death
Industry vs inferiority

Formal ang adolescent
Sa body image may disturbance
Ang thelarche ang first sign sa girls
At last sign yan ang menarche!


MI Management (MONA)

Morphine
O2 therapy
Nitropglycerine!
Aspirin


HYPOGLYCEMIA TIRED!!!!

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



HYPERNATREMIA
You are FRIED!

F - Fever (low grade),
flushed skin
R - Restless (irritable)
I - Increased fluid retention
and increased BP
E - Edema
(peripheral and pitting)
D - Decreased urinary output,
dry mouth


Pressure Ulcer Staging

Stage I erythema
Stage II breakdown of the
dermis
Stage III full thickness skin
Breakdown
Stage IV bones, muscles


HEART MURMURS: SPASM!!

S Stenosis
P Partial obstruction
A Aneurysms
S Septal defect
M Mitral regurgitation


Miotic: Little word=
Little pupil (constrict)
Mydriatic: Big word=
Big pupil (dilated)



Anticholingergics Side

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


Hyperthyroidism (s/s)
THYROIDISM

Tremor
Heart rate up
Yawning (fatigueability)
Restlessness
Oligomenorrhea & amenorrhea
Intolerance to heat
Diarrhea
Irritability
Sweating
Muscle wasting & weight loss

5W's of common causes of post-op fever

Wind (think pneumonia, splinting,
incentive spirometer exercises not done,
DB+ coughing NOT DONE)
Water (dehydration...)
Wound (infection, dehiscence...)
Walking (PE...)
Wonder drug (approriate antibiotic...)



To apply a telemetry monitor:

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


SALT

S Skin flushed
A - Agitation
L - Low-grade fever
T - Thirst

The HYPERKALEMIA "Machine"
- Causes of Increased Serum K+

M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, hemolysis
I - Intake - Excesssive
N - Nephrons, renal failure
E - Excretion - Impaired



Signs and Symptoms of Increased Serum
K+: MURDER !!

M - Muscle weakness
U - Urine, oliguria, anuria
R- Respiratory distress
D - Decreased cardiac contractility
E - ECG changes
R - Reflexes, hyperreflexia, or
areflexia (flaccid)



HYPOKALEMIA (SUCTION)

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



General rules regarding psychiatry
drugs:

1) Cannot be taken with alcohol,
stimulants,depressants.
2) Cannot be given to pregnant,
lactatingand patients with glaucoma.
3) Cannot be abruptly stooped but mus
be tapered slowly
4) All are given after meals except anti
anxiety agents( because food interferes
with their absorption)
5) All psychiatry drugs have anti
cholinergic side effects:
Dizziness, drowsiness, dry mouth,
constipation, urinary retention

"CATS" of "HYPOCALCEMIA"

C - Convulsions
A- Arrhythmias
T - Tetany
S - Spasms and stridor


BLEEDING - S/Sx
BEEP

B - Bleeding gums
E - Ecchymoses (bruises)
E - Epistaxis (nosebleed)
P - Petechiae (tiny purplish
spots)



TETRALOGY OF FALLOT

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


RESPIRATORY DEPRESSION -
inducing drugs
STOP breathing

S - Sedatives and hypnotics
T - Trimethoprim
O - Opiates
P - Polymyxins


PNEUMOTHORAX - S/Sx
P-THORAX
P - Pleuretic pain
T - Trachea deviation
H - Hyperresonance
O - Onset sudden
R - Reduced breath sounds (&
dypsnea)
A - Absent fremitus
X - X-ray shows collapse

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


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



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


FEMORAL HERNIA

FEMoral hernias are more
common in FEMales.






"TRY PULLING MY AORTA":

Tricuspid
Pulmonary
Mitral
Aorta


PLACENTA-CROSSING SUBSTANCES
"Want My Hot Dog":

Wastes
Antibodies
Nutrients
Teratogens
Microorganisms
Hormones/ HIV
Drugs


EMERGENCY MEDICINE
ACTIVATED CHARCOAL:
CONTRAINDICATIONS
CHEMICAL CamP:

Cyanide
Hydrocarbons
Ethanol
Metals
Iron
Caustics
Airway unprotected
Lithium
CAMphor
Potassium


IPECAC: CONTRAINDICATIONS
4 C's:

Comatose
Convulsing
Corrosive
hydroCarbon


COMPLICATIONS OF FALCIPARUM
MALARIA (CHAPLIN)
Cerebral malaria/ Coma Hypoglycemia
Anaemia
Pulmonary edema
Lactic acidosis
Infections
Necrosis of renal tubules (ATN)
ET TUBE DELIVERABLE DRUGS
O NAVEL:
Oxygen
Naloxone
Atropine
Ventolin (albuterol)
Epinephrine
Lidocaine


ATRIAL FIBRILLATION: CAUSES
OF NEW ONSET
THE ATRIAL FIBS:

Thyroid
Hypothermia
Embolism (P.E.)
Alcohol
Trauma (cardiac contusion)
Recent surgery (post CABG)
Ischemia
Atrial enlargement
Lone or idiopathic
Fever, anemia, high-output
states
Infarct
Bad valves (mitral stenosis)
Stimulants (cocaine,
theo, amphet, caffeine)

SHOCK: S/SX
(TV SPARC CUBE)

Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank


VENTRICULAR FIBRILLATION:
TREATMENT

"Shock, Shock, Shock,
Everybody Shock, Little Shock,
Big Shock, Momma Shock,
Poppa Shock":

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


VFIB/VTACH DRUGS USED
ACCORDING TO ACLS

"Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide



DIABETIC KETOACIDOSIS
MANAGEMENT
(KING UFC)

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










NEUROLOGICAL FOCAL DEFICITS
10 S's:

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


COMA: CONDITIONS TO EXCLUDE AS
CAUSE

MIDAS:
Meningitis
Intoxication
Diabetes
Air (respiratory failure)
Subdural/ Subarachnoid hemorrhage


MALIGNANT HYPERTHERMIA
TREATMENT
"Some Hot Dude Better Give Iced Fluids
Fast!" (Hot dude = hypothermia):

Stop triggering agents
Hyperventilate/ Hundred percent oxygen
Dantrolene (2.5mg/kg)
Bicarbonate
Glucose and insulin
IV Fluids and cooling blanket
Fluid output monitoring/ Furosemide/
Fast heart [tachycardia]



RESUSCITATION: BASIC STEPS
ABCDE:
Airway
Breathing
Circulation
Drugs
Environment

RLQ PAIN: DIFFERENTIAL
APPENDICITIS:

Appendicitis/ Abscess
PID/ Period
Pancreatitis
Ectopic/ Endometriosis
Neoplasia
Diverticulitis
Intussusception
Crohns Disease/ Cyst (ovarian)
IBD
Torsion (ovary)
Irritable Bowel Syndrome
Stones

Acid-base"ROME"
(Respiratory Opposite,
Metabolic Equal)

Acidosis
Respiratory (opposite): pH Pco2
Metabolic(equal): pH HCO3
Alkalosis
Respiratory (opposite): pH Pco2
Metabolic(equal): pH HCO3


Alcohol withdrawal: clinical
features"HITS"

Hallucinations (visual, tactile)
Increased vital signs and
insomnia
Tremens delirium tremens
(potentially lethal)
Shakes/ Sweats/ Seizures/
Stomach pains (nausea,
vomiting)


Angina: precipitating factors
"4E's"
Eating
Emotion
Exertion (Exercise)
Extreme Temperatures (Hot or
Cold weather)


Anorexia nervosa: clinical
features"ANOREXIC"

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


Appendicitis: assessment
"PAINS"

Pain (RLQ)
Anorexia
Increased temperature, WBC
(15,00020,000)
Nausea
Signs (McBurney's, Psoas)


Neurovascular Occlusion:
symptoms "6 P's"

Pain
Pale
Pulseless
Paresthesia
Poikilothermic
Paralysis




Blood glucose (rhyme)

Symptom Implication
Cold and clammy . . . give hard
candy
Hot and dry . . . glucose is high





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

Artery
Vein
Artery


Cholecystitis: risk factors"5F's"

Female
Fat
Forty
Fertile
Fair


Cleft lip: nursing care plan
(postoperative)"CLEFT LIP"

Crying, minimize
Logan bow
Elbow restraints
Feed with Brecht feeder
Teach feeding techniques; two months
of age (average age at repair)
Liquid (sterile water), rinse after feeding
Impaired feeding (no sucking)
Positionnever on abdomen


Cognitive disorders: assessment of
difficulties"JOCAM"

Judgment
Orientation
Confabulation
Affect
Memory


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


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



Complication of severe
preeclampsia"HELLP"
syndrome

Hemolysis
Elevated Liver enzymes
Low Platelet count


Cushing's syndrome:
symptoms"3S's"

Sugar (hyperglycemia)
Salt (hypernatremia)
Sex (excess androgens)



Diet: low cholesterolavoid
the "3C's"

Cake
Cookies
Cream (dairy, e.g., milk, ice
cream)



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


Dystocia: general aspects
(maternal)"3P's"

Psych
Placenta
Position


Episiotomy assessment
"REEDA"

Redness
Edema
Ecchymosis
Discharge
Approximation of skin


Coma: causes"A-E-I-O-U
TIPS"

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



Hypertension: complications
"4 C's"

CAD (coronary artery disease)
CHF (congestive heart failure)
CRF (chronic renal failure)
CVA (cardiovascular accident;
now called brain attack or
stroke)

Hypertension: nursing care
plan "I-TIRED"

Intake and output (urine)
Take blood pressure
Ischemia attack, transient
(watch for TIAs)
Respiration, pulse
Electrolytes
Daily weight


Hypoglycemia: signs and
symptoms"DIRE"

Diaphoresis
Increased pulse
Restless
Extra hungry


Infections during pregnancy
"TORCH"

Toxoplasmosis
Other (hepatitis B, syphilis, group B
beta strep)
Rubella
Cytomegalovirus
Herpes simplex virus


IUD: potential problems with use
"PAINS"

Period (menstrual: late, spotting,
bleeding)
Abdominal pain, dyspareunia
Infection (abnormal vaginal
discharge)
Not feeling well, fever or chills
String missing


Manipulation: nursing plan
promote the "3C's"

Cooperation
Compromise
Collaboration


Medication administration"six
rights"

RIGHT medication
RIGHT dosage
RIGHT route
RIGHT time
RIGHT client
RIGHT technique


Melanoma characteristics"ABCD"

Asymmetry
Border
Color
Diameter


Mental retardation: nursing
care plan"3R's"

Regularity (provide routine and
structure)
Reward (positive
reinforcement)
Redundancy (repeat)



Newborn assessment
components"APGAR"

Appearance
Pulse
Grimace
Activity
Respiratory effort


Obstetric (maternity) history
"GTPAL"

Gravida
Term
Preterm
Abortions (SAB, TAB)
Living children


Oral contraceptives: signs of
potential problems"ACHES"

Abdominal pain (possible liver
or gallbladder problem)

Chest pain or shortness of
breath (possible pulmonary
embolus)

Headache (possible
hypertension, brain attack)

Eye problems (possible
hypertension or vascular
accident)

Severe leg pain (possible
thromboembolic process)

Pain: assessment"PQRST"

What Provokes the pain?
What is the Quality of the pain?
Does the pain Radiate?
What is the Severity of the pain?
What is the Timing of the pain?


Pain: management"ABCs"

Ask about the pain
Believe when clients say they have pain
Choiceslet clients know their choices
Deliver what you can, when you said
you would
Empower/Enable clients' control over
pain


Postoperative complications: order
"4W's"

Wind (pulmonary)
Wound
Water (urinary tract infection)
Walk (thrombophlebitis)



Preterm infant: anticipated
problems"TRIES"

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










Psychotropic medications: common
antidepressives (tricyclics)"VENT"

Vivactil
Elavil
Norpramin
Tofranil


Schizophrenia: primary symptoms
"4A's"

Affect
Ambivalence
Associative looseness
Autism


Sprain: nursing care plan"RICE"

Rest
Ice
Compression
Elevation


Stool assessment"ACCT"

Amount
Color
Consistency
Timing


Tracheoesophageal fistula:
assessment"3Cs"

Coughing
Choking
Cyanosis



Transient ischemic attacks:
assessment"3Ts"

Temporary unilateral visual
impairment
Transient paralysis (one-sided)
Tinnitus = vertigo

Traction: nursing care plan
"TRACTION"

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


Trauma care: complications
"TRAUMA"

Thromboembolism; Tissue
perfusion, altered
Respiration, altered
Anxiety related to pain and
prognosis
Urinary elimination, altered
Mobility impaired
Alterations in sensory-
perceptual functions and skin
integrity (infections)


Wernicke-Korsakoff syndrome
(alcohol-associated
neurological disorder)"COAT
RACK"

Wernicke's encephalopathy
(acute phase)
clinical features:

Confusion
Ophthalmoplegia
Ataxia
Thiamine is an important aspect
of Tx


Korsakoff's psychosis (chronic
phase)

characteristic findings:
Retrograde amnesia (recall of
some old memories)
Anterograde amnesia (ability to
form new memories)
Confabulation

Korsakoff's psychosis

SIGNS OF CANCER
Change in bowel /bladder
habits
A sore that doesnt heal
Unusual bleeding/ Discharge
Thickening of lump breast or
elsewhere
Indigestion/ Dysphagia
Obvious change in wart/ mole
Nagging cough/ hoarseness
Unexplained anemia
Sudden weight loss



FOCUS OF PATIENT CARE IN
CLIENTS WITH CANCER

Chemotherapy
Assess body image disturbance
(related to alopecia)
Nutritional needs when N/V
present
Comfort from pain
Effective response to Tx?
(Evaluate)
Rest (for patient and family)


Location of the heart valve
from right to left - "A
Permanently Temperamental
Man"

Aortic
Pulmonary
Tricuspid
Mitral



"Cut C4, breathe no more"

The 3rd, 4th and 5th cervical spinal
nerves innervate the diaphragm.


"Point and Shoot!"

For remembering that
Parasympathetics are involved with
erection and Sympathetics with
ejaculation.



Layers of the scalp - "SCALP"

Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium


Carpal bones of the hand (lateral to
medial) - "She Looks Too Proud, Try To
Chase Her"

Proximal row:
Scaphoid
Lunate
Triquetrum
Pisiform

Distal row:
Trapezium
Trapezoid
Capitate
Hamate

Bronchodilators - "TO A SIS"

Terbutaline
Orciprenaline
Adrenaline
Salbutamol
Isoprenaline
Salmeterol


Viruses causing diarrhea -
"ACNE CAR"

Adeno virus
Corana virus
Norwak virus

Entero virus
Calci virus
Astro virus
Rota virus


The Krebs cycle - "Can I
Actually See Some Filipina
Mothers"

Citrate
Isocitrate
alpha Ketoglutarate
Succinyl CoA
Succinate
Fumarate
Malate
Oxaloacetate


Stages of mitosis/meiosis
including interphase as a phase
- "In Philippines, Men Are
Talented"

Interphase
Prophase
Metaphase
Anaphase
Telophase


Signs of cor pulmonale -
"Please Read His Text"

Peripheral edema
Raised JVP
Hepatomegaly
Tricuspid incompetence




Order of prevalence of White
Blood Cells, most prevalent to
least - "Never Let Monkeys Eat
Bananas"

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils



10 essential amino acids -
"PVT. TIM HALL"

Phenylalanine
Valine
Tryptophan
Threonine
Isoleucine
Metheonine
Histidine(semi-essential)
Arginine(semi-essential)
Leucine
Lysine


Uses of Chloroquine (other
than malaria) - "RED LIP"

Rheumatoid arthritis
Extra intestinal amoebiasis
Discoid lupus erythematosus
Lepra reaction
Infectious mononucleosis
Photogenic reactions



Portal hypertension features -
"ABCDE"

Ascites
Bleeding (hematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen



Key questions needed in an emergency
history taking situation - "AMPLE"

Allergies
Medication
Past medical history
Last meal
Events and environment related to
injury


Malignancies that metastisize to bone -
"Laging Panalo Kung Taga Bulacan"

Lung
Prostate
Kidney
Thyroid
Breast


Six "S" in Scarlet Fever

Streptococci causal organism
Sorethroat
Swollen tonsils
Strawberry tongue
Sandpaper rash
miliarySudamina vesicles over hands,
feet, abdomen


Signs of anti-cholinergic crisis - "SLUD"

Salivation
Lacrimation
Urination
Defecation


Causes of huge spleen - "3M's"

Myelofibrosis
Malaria
Myelogenous leukemia




Cardinal Symptoms of
Parkinson's Disease - "TRAP"

Tremor
Rigidity
Akinesia and bradykinesia
Postural Instability


Days of appearance of
rashesVaricella(chickenpox) -
"Very Sick Patients Must Take
Double Exercise"

1st dayScarlet fever

2nd dayPox(smallpox)

3rd dayMumps

4th dayTyphus

5th dayDengue

6th dayEnteric fever(typhoid)


SHOCK HYPOTACHYTACHY


HYPOTENSION
TACHYPNEA
TACHYCARDIA


INCREASE ICP
HYPERBRADYBRADY

CUSHINGS TRIAD:
HYPERTENSION (WIDE PULSE
PRESSURE)
BRADYCARDIA
BRADYPNEA


EARLY SIGNS OF HYPOXIA
RESTLESSNESS
AGITATION
TACHYCARDIA


LATE SIGNS OF HYPOXIA

BRADYCARDIA
EXTREME RESTLESSNESS
DYSPNEA
CYANOSIS



CONGESTIVE HEART FAILURE

DIGOXIN
MORPHINE
AMINOPHYLLINE
DOPAMINE
DIURETICS
O2
GASSES MONITOR (ABG)



MG SO4 TOXICITY

BP DECREASE
URINE OUTPUT DECREASE
RESPIRATORY RATE DECREASE
PATELLAR REFLEX ABSENT




SICKLE CELL DISEASE

HYDRATION
OXYGENATION
PAIN
INFECTION
AVOID HIGH PLACES



PREGNANCY INDUCED
HYPERTENSION

HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW
PLATELETS



GI SYMPTOMS AND TOXICITY
TO DIGOXIN

VOMITTING
ANOREXIA
NAUSEA
DIARRHEA
ABDOMINAL PAIN



FRACTURE

PRESSURE
REST
ICE
COMPRESSION
ELEVATION



NEUROVASCULAR CHECK

PAIN
PULSELESSNESS
PARESTHESIA
PARALYSIS
PALLOR




VIRCHOWS TRIAD IN DVT

VENUS STASIS
DAMAGE TO VESSELS
HYPERCOAGUABILITY



ABDOMINAL AORTIC
ANEURISM (4A)

ASSYMPTOMATIC
ABDOMINAL MASS
ABDOMINAL PULSE
ACHES LOW BACK



ANTI TB DRUGS AND SIDE
EFFECTS


RIFAMPICIN RED-ORANGE
URINE

ISONIAZID PERIPHERAL
NEURITIS

PYRAZINAMIDE INCREASE
URIC ACID

ETHAMBUTOL EYE PROBLEMS

STREPTOMYCIN OTOTOXIC



USE STRAW BECAUSE THESE
DRUGS STAIN THE TEETH

L - LUGOL'S SOLUTION
I - IRON
N - NITROFURANTOIN
T - TETRACYCLINE


LR6 - LATERAL RECTUS : CN6

SO4 - SUPERIOR OBLIQUE : CN4

ALL3 - ALL THE REST : CN3


RADIATION TX VIA:
MUSTARD
ESTROGEN
NITROGEN
STEROIDS
ANTIBIOTICS



DILUTE DECREASE
OSMOLALITY