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Medical Srgica Nursing 12 PDF
Medical Srgica Nursing 12 PDF
Course Outline
I. Client in Pain
II. Perioperative Nursing Care
III. Alterations in Human Functioning
a. Disturbances in Oxygenation: Respiratory & Cardiovascular Functions
b. Disturbances in Metabolic and Endocrine Functions
c. Disturbances in Elimination: Gastrointestinal Problems
d. Disturbances in Fluids and Electrolytes: Renal & Genitourinary Functions
e. Disturbances in Cellular Functioning: Cancer and Hematologic Problems
f. Disturbances in Auditory & Visual Functions
g. Disturbances in Musculoskeletal Functions
IV. Client in Biologic Crisis: Life threatening Conditions of the Human Body
- Shock
V. Emergency & Disaster
- First-aid and Cardiopulmonary Support
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I. CLIENT IN PAIN
Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the skin that respond to
intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System
Characteristics of Pain
1. Intensity –mild, moderate, excruciating
2. Timing – morning or evening, duration may be longer or shorter
3. Location
4. Quality – burning, aching, stabbing
5. Personal Meaning to pain – tolerance to pain may be different from one person to the other due to
some personal reasons such as economic reasons, work condition, etc.
6. Aggravating and Alleviating factors – patient’s environment
7. Pain Behaviors - facial expressions with pain
Pain Assessment
1. Evaluate: Cause, Location, Character and Intensity
2. Numeric Pain Scale – 5-severe pain - 0 – no pain
3. Descriptive Pain Scales – mild, moderate, severe
4. Visual Analogue Scales
5. Faces Pain Scale
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ii. Harmful effects of pain to the client
iii. Duration of the pain
6. Non-pharmacologic Interventions
a. Cutaneous Simulation and Massage
b. Ice and heat therapies
c. Transcutaneous Electrical Nerve Stimulation
d. Distraction
e. Relaxation Techniques
f. Guided Imagery
g. Hypnosis
a. Pre-operative Nursing
b. Inraoperative Nursing
c. Post-operative Nursing
A. Pre-operative Care
Pre-admission and Admission Test
1. Psychological support
2. Client Education:
a. Importance and practice of breathing exercises
b. Location & support of wound
c. Importance of early ambulation
d. Inform and practice leg exercises, positioning, turning
e. Anesthesia and analgesics
f. Educate regarding drains and dressings to be received post-op
g. Recovery room policies and procedures
3. Informed consent
a. At least 18 years of age
b. In sound mind- without psychologic disorder
c. Not under the influence of drugs or alcohol
d. Immediate relative over 18 years old
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g. Endocrine Functions- important in monitoring to prevent
hypo/hyperglycemia, thyrotoxicosis, acidosis
h. Immune Functions – allergies esp. to anesthetic drugs
i. Psychosocial Factors – emotional and psychological preparation to
ensure cooperation fom the patient with the procedures
j. Spiritual & Cultural Beliefs - blood transfusions, transplants, ligation,
etc are against other culture & religion.
6. Proper positioning
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Prone
Supine Lateral Recumbent
Jack-Knife Lithotomy
B. Intra-operative Care
Sterilization techniques:
o Autoclave – Steam, Ethyl Oxide (Gas)
o Glutaraldehyde Solution- Cidex
2. Ensure safety of client in the operating table- prevent falls, drape the patient properly,
provide warmth
3. Stay with the client to relieve anxiety and support during anesthesia
Anesthesia Administration:
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a. General Anesthesia via Inhalation
b. General Anestheisia via Intravenous
c. Regional Anesthesia - local anesthesia
d. Conduction Blocks/ Spinal Anesthesia – Epidural & Spinal Block
- for operation below the waist line
- patient is awake during operation
C. Post-operative Care
1. Immediate assessment of VS, and Neuro VS, drainages, surgical dressing
2. Monitoring of vital signs q 15mins until stable
3. Post-operative positioning depending on the procedure performed
4. Deep breathing exercises
5. Early ambulation
6. Health teaching for Independent (self) care upon discharge
1. DISTURBANCES IN OXYGENATION
Normal Value
pH 7.35 – 7.45
pCO2 35 -45
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Metabolic Normal Value Metabolic
Acidosis Alkalosis
pH 7.35 – 7.45
HCO3 22-26
- A group of conditions assoc. w/ chronic obstruction of airflow entering or leaving the lungs
Major diseases
1. Pulmonary Emphysema – airway is obstructed due to destroyed alveolar walls
2. Chronic Bronchitis- increased mucus production that obstructs airway
3. Asthma
CHRONIC BRONCHITIS
“Blue Bloater”
- An inflammation of the bronchi which causes increased mucus production and chronic cough.
- Chronic condition is diagnosed if symptoms occur for 3 months and for 2 consecutive years.
Clinical Manifestations:
Slight gynecomastia
Productive cough
Petechiae in midsternal area
Thicker, more tenacious mucus
Dyspnea
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Decreased exercise tolerance
Wheezes
Nursing Management:
1. Reduce or avoid irritants
2. Increase humidity
3. Administer medications as ordered
4. Chest physiotherapy
5. Postural drainage
6. Promote Breathing techniques
EMPHYSEMA
“Pink Puffer”
- A disorder where the alveolar walls are destroyed causing permanent distention of air spaces.
- (+) dead areas in the lungs that do not participate in gas or blood exchange
Cause: Cigarette smoking, Alpha-anti-trypsin deficiency (an enzyme in the alveolar walls)
Asthma
-A condition where there is an increase responsiveness and/or spasm of the trachea and bronchi due to various stimuli
which causes narrowing of airways
Types:
1. Immunologic asthma - occurs in childhood
2. Non-immunologic asthma - occurs in adulthood and assoc w/ recurrent resp infections.
- usually >35 y/o
3. Mixed, combined immunologic and non-immunologic
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PNEUMONIA
- An inflammatory process of lung parenchyma assoc. w/ marked increase in alveolar and interstitial fluids
Etiology:
1. Bacterial / Viral – streptococcus pneumoniae, pseudomonas aeruginosa, influenza
2. Aspiration
3. Inhalation of irritating fumes
Risk factors:
1. Age: too young and elderly are most prone to develop
2. Smoking, air pollution
3. URTI
4. Altered conciousness
5. Tracheal intubation
6. Prolonged immobility: post-operative, bed-ridden patients
Clinical Manifestations:
Nursing Management:
PULMONARY EDEMA
- often occurs when the left side of the heart is distended and fails to pump adequately
Clinical Manifestation:
o Constant irritating cough, dyspnea, crackles, cyanosis
Pathophysiology:
Fluid accumulation in the alveolar sacs due to hypovolemia, fluid congestions in the lungs, alveoli
are congested
Nursing Management:
1. Diuretics, low sodium diet, I&O
2. promote effective airway clearance, breathing patterns and ventilation
3. Monitor VS
4. Psychological support
5. Administer medications
TUBERCULOSIS
Risk Factors:
Poor living conditions, overcrowded
1. Poor nutritional intake
2. Previous infection
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3. Close contact with infected person
4. Inadequate treatment of primary infection
Clinical Manifestations: Diagnostic Tests:
Treatment:
1. Ethambutol
2. Rifampicin
3. Isoniazid
4. Pyrazinamide
5. Streptomycin
Client Education:
1. TB is infectious but can be cured
2. Transmitted by droplet infection and not carried on articles like clothing or eating utensils
3. Individual is generally considered not infectious after 1- 2 weeks of medication.
4. Medication regimen should be continuous and uninterrupted
5. Regimen is usually 6 months.
6. Regular check-up to monitor progress should be done.
7. Sputum samples are obtained first before drug therapy is started.
8. Advise proper handwashing and use of mask for people in contact with infected persons who are not yet under
treatment.
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CARDIOVASCULAR SYSTEM
THE HEART AND MAJOR VESSELS
A. DIAGNOSTIC PROCEDURES:
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.
f. Triglyceride – 50-250 mg/dl
> LDL (bad cholesterol) - determines the development of atherosclerosis
– 60-180 mg/dl which causes coronary artery disease
> HDL (good cholesterol)
– 30-80 mg/dl
h. Enzymes:
> CPK – men- 55-170
- women- 30-135 - cardiac enzymes are present in high
( rises 3-6 hrs after M.I.) concentration in the myocardial tissues ;
determines tissue damage in the myocardium
> LDH – 150-450 u/ml
(rises 12 hrs after M.I.)
> SGOT – 5-40 u/ml
4. Central Venous Measures the right atrial Serves as guide for fluid
Pressure (CVP) pressure or the pressure of the replacement
greater veins within the thorax
Normal = 5 – 10 cm by threading a catheter into a Monitor pressures in the
Water large central vein. right atrium and central
- Subclavian - Jugular veins
- Median - Basilic
Administer blood
- Femoral
products, TPN, drug
therapy.
End of catheter or Tip –
positioned at the right atrium or Obtain venous access
upper portion superior vena cava when peripheral veins
are inadequate
(for femoral insertion, tip is at
the inferior vena cava) To insert a temporary
pacemaker
Obtain central venous
samples
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6. Cardiac Catheter inserted into the right or a. Measure O2
Catheterization left side of the heart and vessels concentration, saturation,
and a dye is introduced tension and pressure in
the chambers of the
Used to determine details on heart
the structure and performance of
the valves, heart and circulation b. Detect shunts
c. To get blood samples
d. Determine cardiac output
& pulmonary flow
e. Determine need for
bypass surgery
B. 1.ARTERIAL DISORDERS
HYPERTENSION
persistent BP above 140 /90
Signs & Symptoms BP=140/90 ; headache, fatigue, weakness, dizziness, palpitations, flushing, blurred vision and
epistaxis
Treatment Non-pharmacologic:
Weight reduction √ Sodium restriction
Diet modification √ Exercise
Alcohol & Smoking cessation √ Caffeine Restriction
Relaxation Techniques
Potassium, Calcium, Magnesium supplements (to balance sodium and other
electrolytes)
Pharmacologic:
Calcium Agonist: Nifedipine, Verapamil
Vasodilators: Hydralazine
Diuretics: Aldactone, hydrochlorothizide
Adrenergic inhibitors: Propanolol, Clonidine, Methyldopa
Nursing Interventions
BP monitoring
Correct cause: obesity, diet, stress, etc
Regular exercise
Salt restrictions
Administer medications
Teach risk factors
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ARTERIOSCLEROSIS
“Obstruction”
- When the arteries become obstructed with plaque and cholesterol, they harden and constrict, and the
circulation of blood through the vessels becomes difficult, forcing the blood through narrower passageways.
As a result, blood pressure becomes elevated.
- Arteriosclerosis occurs when lipids in the blood, including cholesterol, accumulate inside the walls of blood
vessels and reduce the size of the veins or arteries through which blood flows.
ATHEROSCLEROSIS
“Thickening”
Predisposing factors:
cigarette smoking
high fat levels in the blood
high cholesterol
high blood pressure
obesity
Nursing Intervention:
a. Health Teaching
b. Reduce Risk Factors
c. Restore Blood Supply
d. Pre & Post-op Care for Surgical Patients
e.
AORTIC ANEURYSM
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Triad of manifestations for ruptured abdominal aneurysm:
1. Abdominal pain
2. Back or Flank pain (scrotal pain may also occur)
3. Shock: Bp= >100 systolic; Pulse Rate >100bpm
c. Pre-operative preparation
d. Post-operative care: monitor peripheral circulation
BUERGER’S DISEASE
a.k.a. Thromboangitis Obliterans (TAO)
Definition: Vasculitis of the veins and arteries in the upper & lower extremities
Risk Factors: Men -20-35 y/o, Heavy smokers, hypersensitivity to intradermal injections
Nursing Intervention:
Health teaching on lifestyle modifications, spec. smoking
Ensure protection of extremities against cold
Administration of medications as ordered
Protect client from injury
Assessment of extremities
RAYNAUD’S DISEASE
Risk Factors: Women, heavy smokers, individuals spec. women with Systemic Lupus
Erythematosus (SLE) or rheumatoid arthritis
Treatment:
Nifedipine to decrease vasospasm
Avoid exposure to cold and keep hands warm
Avoid smoking
Nursing Intervention
Same as buerger’s disease
B.2.VENOUS DISORDERS:
THROMBOPHLEBITIS
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b. Elevate legs
c. Heparin therapy, as ordered
d. Bed rest
e. Warm compress
VARICOSE VEINS
Treatment:
Surgical Management: Sclerotherapy (injection of sclerosing agent to the
vein. Not a treatment, hence, for cosmetic purpose only)
Nursing Intervention
Elevate legs at least 30 mins. After prolonged standing
Wear thromoembolic stockings
Teach client o avoid prolong sitting or standing
Avoid cross-legs while sitting
Post-op Care after Sclerotherapy: a. Maintain firm elastic pressure over the whole limb
IV.CARDIAC DISORDERS
ANGINA PECTORIS
Chest pain
Precipitating factor:
over exertion
eating
exposure to cold
emotional stress
Classification of Symptoms:
Class I – no limitations of physical activity (ordinary physical activity does not cause symptoms).
Class II – slight limitation of physical activity (ordinary physical activity does cause symptoms).
Class III – moderate limitation of activity (patient is comfortable at rest, but less than ordinary
activity can cause symptoms).
Class IV – unable to perform any physical activity without discomfort, therefore severe limitations
(patient may be symptomatic even at rest).
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Nursing Interventions:
a. Assess pain – location, character, ECG (ST elevation), precipitating factors
b. Help client to adjust lifestyle to prevemt angina attack – avoid excessive activity
in cold weather, avoid overeating, avoid constipation, rest after meals, exercise
c.
Teach patient how to cope with angina attack – nitroglycerin every 5 mins upto
3x, if still not relieved go to the hospital
Diagnostic Assessment:
a. ECG
b. Stress Test
c. Radioisotope Imaging
d. Coronary Angiography
Medical Management:
MYOCARDIAL INFARCTION
The rapid development of myocardial necrosis caused by imbalance between the oxygen supply
and demand of the myocardium.
Results from plaque rupture with thrombus formation in a coronaryvessel, resulting in an acute
reduction of blood supply to a portion of the myocardium.
Causes:
1. Atherosclerotic heart
2. Coronary Artery Embolism
4. Anxiety, Apprehension
6. Cough , Wheezing
Risk factors:
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Age , Male gender, Smoking, DM, Family history, Sedentary lifestyle, obesity, diet, stress,
hypertension, Type A personality
DIAGNOSTICS:
Lab studies:
Creatine kinase–MB (CK-MB)
Myoglobin
CBC , Trponin
Potassium and magnesium level
Creatinine level
C – Reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
Serum lactate dehydrogenase (LDH)
Imaging studies:
Chest radiography or chest x-ray – reveals pulmonary edema secondary to heart failure.
CT scan
Radionuclide Imaging
Positron Emission Imaging
Transesophageal Echocardiography
Magnetic resonance imaging (MRI) - can identify wall thinning, scar, delayed
enhancement (infarction), and wall motion abnormalities (ischemia).
Electrocardiogram (ECG) - ST-segment elevation greater than 1 mm.
- the presence of new Q waves.
Antithrombotic agents - prevent the formation of thrombus and inhibit platelet function.
(aspirin, -heparin)
Vasodilators - Opposes coronary artery spasm, which augments coronary blood flow and
reduces cardiac work by decreasing preload and afterload
Beta-adrenergic blockers - reduce blood pressure, which decreases myocardial oxygen demand. (metoprolol)
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Angiotensin converting enzyme (ACE) inhibitors – prevents conversion of angiotensin I to angiotensin II, a potent
vasoconstrictor. -captopril(capoten)
Complications of MI:
Dysrhytmias Cardiogenic Shock
Heart Failure Pulmonary Edema
Pulmonary Embolism Recurrent MI
Complications due to Necrosis – VSD, rupture of the heart, ruptured papillary muscles
Pericarditis
Recommendations:
- All MI patients should be admitted in the ICU.
- Patient should remain on complete bed rest during his stay in the hospital and avoid
straining activities.
1. Early
a. Treat arrythmias promptly – lidocaine
b. Give analgesic- morphine
c. Provide physical rest
d. Administer O2 via cannula
e. Frequent VS
f. Nifedipine
g. Propanolol HCL
h. Emotional Support
2. Later
a. Give stool softener
b. Provide low fat, low cholesterol, low sodium diet, soft food
c. Commode
d. Self-care
e. Plan for rehabilitation
Exercise program
Stress management
Teach risk factors
f. Psychological support
g. Long-term drug therapy
Antiarryhtmics- quinidine, lidocaine
Anticoagualnt – heparin, aspirin
Antihypertensives – propanolol, chlorathiazide
temporary episode of neurological dysfunction lasting only a few minutes or seconds (in a day/
24hrs) due to decreased blood flow to the brain.
Causes:
1. Atherosclerosis
2. Microemboli from atherosclerotic plaque
Manifestations:
1. Sudden loss of visual function
2. Sudden loss of sensory function
3. Sudden loss of motor function
Definition: inability of the heart to meet oxygen and metabolic needs of the body
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Causes:
1. Abnormal loading conditions - Congenital defects, ventricular / atrial septal
defect, Patent Ductus Arteriosus, Valvular stenosis, HPN, High
Peripheral Vascular Resistance
Management:
Positioning – High fowler’s position to reduce pulmonary congestion
O2 Administration
Pharmacology: Digitalis, Dopamine & Dobutamine, ACE inhibitors
Digitalis:
• increases ventricular contractility
• Increases ventricular emptying
• Increase Cardiac output
• Watch out for Digitalis toxicity
Nursing Intervention:
1. Sodium restriction
2. Reduce pain and anxiety
3. Improve oxygenation: proper positioning, O2
4. Reduce congestion and edema: meds, positioning
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VALVULAR STENOSIS
Definition: Narrowing of valve which prevents blood flow or impaired closure of the valves
causing regurgitation
AV HEART BLOCK
PACEMAKERS
Definition: Electronic device (battery- operated) that produce electrical stimuli to the heart and controls
heart rate
Nursing Intervention:
a. Check for signs of infection on the site: fever, heat, pain, skin breakdown
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Subjective Data: Subjective Data: Sudden loss of:
Dyspnea • Shortness • Visual fxn
Palpitation of breath • Sensory fxn
Dizziness • Apprehens • Motor fxn
Faintness ion, fear of
impending death
• Nausea
Myocardial Infarction
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Pituitary Gland
Anterior Lobe Growth Hormone Stimulates growth of body tissues and bones
Gonadotropic hormones (LH & Affect growth, maturity and functioning of primary and
FSH) secondary sex organs
Thyroid Gland Thyroxine (T4) Increases metabolic activity of almost all cells;
stimulates most aspects of fat, protein and
Triiodothyronine (T3) carbohydrate metabolism
Adrenal Cortex Glucocorticoids (primarily Promotes carbohydrate, protein and fat catabolism,
cortisol) -- Sugar increases tissue responsiveness to other hormones
Controls SSS:
SUGAR, SALT, Mineralcorticoids (Aldosterone) Tends to increase sodium retention and potassium
SEX -- Salt excretion
136
Clinical Manifestations Management
Gigantism
Overgrowth of all body tissues and bones
Growth
Hormone
In CHILDREN
137
Clinical Manifestations Management
STEROIDS:
Purpose: Anti-inflammatory and anti-allergy; Stress Tolerance
Medication:
a. Take at the same time everyday
b. Follow regime and do not stop abruptly
c. Causes gastric upset
Mineralcorticoids
(Aldosterone)
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Clinical Manifestations Management
d. Propanolol
THYROID STORM: 3. Radioiodine therapy
a. Fever 4. Nursing Mgt:
b. Tachycardia a. Adequate Rest
c. Delirium b. High caloric, high protein,
d. Irritability carbohydrate, vitamins without
stimulants
c. Measure daily weights
d. Eye protection for xopthalmos
e. WOF: Thyroid Storm
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Hyperthyroid Tachycardia 1. Drug therapy: Prophylthiuracil
Palpitations Methimazole, Saturated solution
Increased persitalsis of Potassium Iodide, Radioactive
weight loss Iodine
Heat intolerance 2. Diet: low calcium, high fiber
Decreased libido 3. Force fluid
Parathormone Amenorrhea
PANCREATIC PROBLEMS
DIABETES MELLITUS
Type I Type II
Insulin Dependent DM Non-Insulin Dependent DM
(IDDM) (NIDDM)
Age of Onset
Before 30 years old but may occur at >35 y/o but can occur in children
any age
Onset
Abrupt Insidious
Incidence
10% 85-90%
Insulin production
Little or none Below normal
Normal or
Above normal
Insulin Injections
Required Necessary for only 20-30% of clients
Ketosis
May occur Unlikely to occur
Body weight at onset
Ideal body weight or thin Usually Obese
Management
Diet, exercise and insulin Diet, exercise, hypoglycemic agent or
insulin
Treatment:
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2. Insulin Injections:
Complications of DM:
a. Hypoglycemia
Nursing Interventions: Give candy, juice or softdrinks, let the patient eat
Check sugar level
b. Diabetic Ketoacidosis
Signs & Symptoms: Polyuria, thirst, Nausea, vomiting, dry mucous membranes, Kussmaul resp,
Coma, sunken eyesballs, acetone odor of breath, hypotension, abdominal
rigidity
c. Lipodystrophy
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4. DISTURBANCES IN ELIMINATION
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diseased tissue and provides a
Bleeding Melena is more common protective barrier to acid
than hematemesis Hematemesis is more
common than melena Surgical Treatment
1. Vagotomy
Malignancy: Not possible 2. Gastric Resection-
Gastroduodenostomy;
Possible Gastrojejunostomy
GASTRIC CANCER
Incidence:
f. Common in men than women
g. History or presence of Pernicious Anemia
h. Often develops with the occurrence of atrophic gastritis
i. Low-socio economic status; live in urban area
j. Exposure to radiation or trace metals in soil
Clinical Manifestations:
a. Palpable mass
b. Ascites
c. Weight loss
d. Dysphagia
e. Indigestion and anorexia
f. (+) high lactate dehydrogenase level in gastric juice
Nursing Intervention: Same as with patient’s with ulcer, emotional support, pre and post-operative health
teaching
Risk Factors:
o Poor food handling
o Poor sanitary conditions
o Overcrowding
o Food remaining on high temperature making organisms incubate and colonize easily.
Management:
o Replace fluid loss
o Anti-infective Agent (e.g. Metronidazole spec for amoebiasis, Bactrim)
Nursing Intervention:
o Measure intake and output
o Administer medications
o Replace fluids
APPENDICITIS
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Cause: Fecalith (stone or calculus in the appendix) .-> Kinking of the appendix
Fibrous condition in the bowel wall -> Bowel adhesion
S/S: Pain starts in the epigastriium the shifts to the the right lower quadrant
Guarding of painful area
Keeps legs bent to relieve tension
May have vomiting, loss of apetite, low grade fever, coated tongue and halitosis
Treatment: Appendectomy
Nursing intervention:
Assess the VS and pain scale carefully
Observe for symptoms of peritonitis , Pre & post-operative care
PERITONITIS
o Medical Management:
NGT: Lavage to relieve pressure in the abdomen
Fluid & electrolyte replacement
o Surgical Treatment:
Appendectomy or Exploration of the abdomen with drainage
o Nursing intervention:
Careful assessment of history, V/S, fluid & electrolytes
Pre & Post-operative Care
Pathology & Involves primarily the ileum & right Mucosal ulceration of lower colon
Anatomy colon and rectum
Distribution of d’se is segmental Distribution of d’se is continuous
Malignancy is rare Malignancy may occur after 10 years
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Rectal bleeding Occasional
Rare
Anorectal fistula Common
Rectal bleeding, diarrhea (20
Other S/S: Abdominal pain stools/day or more); Stools may
Weight loss occur with blood or pus, weight loss
Diarrhea – soft or semi-liquid Urgency, cramping,
Pain in RLQ, cramping, tenderness, Pain LLQ, abdominal distention,
flatulence, nausea (mimics emotional stress.
Appendicitis)
Post-op intervention:
Observation of the stoma
Teach client re: self-care
HERNIA
-An abnormal protrusion of an organ or tissue through the structure that contains it.
- Frequently a congenital occurrence or acquired weakness of the abdominal muscles
Types:
1.Indirect Inguinal Hernia
2. Direct Inguinal Hernia
3. Femoral Hernia
4. Umbilical Hernia
5. Incisional Hernia
Medical Treatment: Use of TRUSS if hernia is not strangulated or incarcerated.
DIVERTICULUM
Diverticulum – an outpouching of intestinal mucosa through the muscular coat of the large
intestine (most commonly the sigmoid colon)
Diverticulosis – refers to the presence of non-inflamed out pouching of the intestine
Diverticulitis – inflammation of a diverticulum
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(+) rectal mass on digital rectal examination
e. Hemorrhoids
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b. External Hemorrhoids- – varicosities below the mucocutaneous border
covered by the anal skin.
S/S: Internal – bleeding and renal prolapse, bleeding and rectal itching
External – enlarged mass at the anus
Present symptoms in both internal & external: Bright red (blood) stain in
stool or tissue, Pain
Medical Intervention: a. Treat constipation
b. Relieve pain through heat application / Sith’s bath
f. Fistula-in-ano
Tiny, tubular fibrous tract that extends into the anal canal
May develop from trauma, fissures or regional enteritis
Fistulectomy is recommended.
Cause fluids exceeds the normal volume fluids and/or electrolytes are
the body needs loss
- physiologic or over hydration as physiologic or dehydration
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in IV therapy
Illness:
Renal Disease Renal Disease
Neurologic Diseases Diarrhea
Congestive Heart Failure Post-operative conditions
Addison’s Disease Burns
Trauma
GIT Suction/Drainage
Sources of Electrolytes:
Nursing Considerations:
a. Collect urine for testing
b. Antibiotic treatment, as ordered
c. Force fluids
d. Good hygiene
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• HPN
• Headache
• Increased Urea Nitrogen
• Flank Pain
• Anemia
Nursing Considerations:
a. Penicillin, as ordered
b. Proper dietary intake
c. Sodium & fluid restriction
d. Bed rest
4.1.4. Nephrotic Sydrome – glomeruli disorder due to other diseases like DM, SLE, etc.
Nursing Considerations:
a. bed rest
b. high calorie, high protein, low sodium
c. Monitor I & O
d. Protect from infection
e. Administer meds as ordered: Diuretics, Steroids, Immunosuppresiove agents,
anticoagulants
Nursing Considerations:
a. Force fluids: at least 3L of water in a day
b. Strain Urine for stones
c. Administer meds as ordered
4.1.6. Acute Renal Failure –sudden and reversible malfunction of the kidney due to trauma,
allergies, stones or benign Prostatic hyperplasia
Nursing Intervention:
a. Treat cause of sudden occurrence
b. Maintain Fluid & electrolyte balance
c. Prevent hypokalemia
d. Administer insulin or IV glucose as ordered to promote potassium absorption
e. Proper diet :
Oliguric – low CHON, High CHO, high fat, less potassium
Diuresis – high CHON, high calorie, less fluid
f. Weigh daily
g. Monitor I & O
h. Dialysis if indicated
i. Psychological & emotional support
4.1.7. Chronic Renal Failure – progressive failure of kidney function which may result to death,
caused
by chronic gomerulonephritis (CGN), pyelopnephritis, DM, uncontrolled HPN
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g. Anemia
h. Elevated BUN, crea, sodium, potassium
Treatment:
Dialysis
Renal Transplant
Nursing Considerations:
a. Maintain fluid & electrolyte balance
b. Bedrest
c. Diet: low protein, low sodium, high CHO and vitamins
d. Control HPN
e. WOF cerebral irritation
4.1.8. Benign Prostatic Hyperplasia – enlargement of the prostate with unknown etiology usually in
older males
Signs & Symptoms:
Difficulty in urinating
Nocturia, hematuria, dribbling sensation
Surgical Treatment:
Prostatectomy
b. Peritoneal Dialysis
Use of peritoneum via a catheter for proper exchange of fluids and electrolytes and
drainage of fluids
Catheter inserted just below the umbilicus with small incision
Nursing Interventions:
a. Weigh daily
b. Monitor vital signs
c. Maintain asepsis at all times
d. Record intake and output
e. Monitor for complications: Bleeding, peritonitis, abdominal pain, dyspnea, bowel
perforation
2. Urinary Tract Surgery
a. Transurethral Removal of the Prostate
b. Prostatectomy
Nursing Interventions:
Weigh daily , monitor I&O
Monitor vital signs
Maintain asepsis at all times
Monitor for complications: Bleeding, peritonitis, abdominal pain, dyspnea, bowel
Replace fluids
Proper irrigation
3. Kidney Transplant
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Children and young: Chronic Glomrulonephritis
Causes:
1. Chronic Glomerulonephritis – 47%
2. Chronic Pyelopnephritis – 17%
3. Diabetes Mellitus- 13%
4. Hypertensive Nephrosclerosis- 5%
2. Increase awareness of signs & symptoms of kidney disease as edema and HPN
6.1. CANCER
Staging of Tumors
a. Extent of tumor
T= primary tumor
N= regional nodes
M= metastasis
b. Extent of Malignancy
T0 = no evidence of primary tumor
TIS= Carcinoma in Situ
T1, T2, T3, T4 = progressive tumor in size and involvement
TX = tumor cannot be assessed
d. Metastatic Development
MO= no evidence of distant metastasis
M1, M2, M3 = increasing degree of distant metastasis
C Change in bowel or bladder habits Ex. Gastric Ca, Colon Ca, Rectal Ca ,
Renal Ca, Prostate Ca
A A sore that does not heal Ex. Laryngeal Ca
U Unusual bleeding or discharge Ex. Uterine Ca
T Thickening or lump in breast or Ex. Breast Ca, Hodgkin’s Lymphoma
elsewhere
I Indigestion or difficulty in Ex. Esophageal Ca
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swallowing
O Obvious change in wart or mole Ex. Melanoma, Squamous cell Ca
N Nagging cough or hoarseness Ex. Lung Ca
U Unexplained Anemia
S Sudden uexplained weight loss Most Ca conditions
Risk Factors
Age Health Habits
Sex Family History
Race Socio-Economic Status
Occupation Lifestyle
Cancer Therapy
a. Surgery
b. Chemotherapy – chemical/ medication
c. Radiation Therapy – electromagnetic rays destroys cancer cells
d. Palliative/ Supportive Care- for end-stage or terminal stage
- given if chemo, surgery or radiation therapy cannot assure treatment of
the patient ; it is a holistic care for the patient and family
- management o f care is geared towards a symptom-free individual with
psychologic and spiritual support
Oral Cancer Avoid Smoking tobacco, Betel Thorough dental check-up each year
quid “Nganga” chewing,
Proper cavity and dental
chewing
Breast No conclusive evidence for Monthly self-exam and annual exam with
early prevention physician;
Mammography:
o Initially at age 40 and then 1-2 yrs
thereafter
o High risk women- should consult a
doctor before age 40
Uterine / Cervix Clean, safe sex Regular pap smear: Once sexually active then
Single partner reduces risk every 3 years if findings are normal
Colon and Maintenance of a high fiber Regular medical check-up after 40 years,
Rectum and low fat diet yearly occult blood tests in stools, rectal exams
and sigmoidoscopy
Nursing Intervention
a. Assist the patient in maintaining self-dignity and integrity by continued and sustained
communication and contact
b. Allow patient to ventilate feelings such as fear, anger, indifference
c. Make arrangements for spiritual consolation
d. Assist in rehabilitation even before treatment and until she recovers and adjust to the
society
e. Collaborate with other health workers for the patient’s holistic needs
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f. Home visits and education about the client’s condition, course of treatment and
alternatives
6.2.1. ANEMIA
Causes:
a. Sudden or Chronic blood loss
b. Abnormal bone marrow function
c. RBC fails to mature adequately
Types of Anemia:
Clinical Manifestations:
Hypoxia
Prone to infection
Fatigue
Easy bruising
Nursing Intervention:
Proper nutrition
Psychological support
Protect against infection and injury
Pernicious Anemia – Vit. B12 and Folic acid deficiency in gastric juice
Clinical Manifestations:
Paresthesia
Tingling or numbness of extremities
Gait disturbances
Behavioral Disturbances
Nursing Intervention:
Intake of Vit. B12 following this regimen:
o 3x a week for 2 weeks, then
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o 2 x a week for 2 weeks, then
o Once a month
Protect lower extremities
Rest in non-stimulating environment
c. Hemolytic Anemia
• Sickle Cell Anemia- defective hemoglobin, turns to sickle cell when oxygen in venous
blood is low
• Thalassemia
• Glucose-6 Phosphate Dehydrogenase Deficiency
Clinical Manifestations:
Thalassemia & G6PD – usually asymptomatic
Sickle Cell Anemia:
o Severe Pain
o Swelling
o Fever
o Jaundice
o Prone to infection
Nursing Intervention:
Proper oxygenation
Hydration
Analgesics
Adequate Rest
Refer to genetic counseling
Avoid cold places to prevent sickle cell proliferation
Leukemia - proliferation of neoplastic white blood cells in the bone marrow affecting the
different tissues and organs in the body
Clinical Manifestations:
Fever
Prone to Infection
Pain
Weight Loss
Fatigue
Nursing Interventions:
Energy conservation
Reverse Isolation
Blood Transfusion
Nursing Interventions:
Emotional Support
Reverse isolation
Adequate Rest and Nutrition
Strict Medication Regimen
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5.2.6. BLOOD TRANSFUSION
Transfusion Complications
Non-hemolytic reaction- Fever
Hemolytic Reaction- life threatening: fear, chills, backpain, nausea, chest tightness, dyspnea and anxiety
Allergic reaction –urticaria, flushing, itching
Hypervolemia – neck vein distention, dyspnea, orthopnea, tachycardia, sudden anxiety
Nursing Interventions:
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7. NEUROLOGIC DISTURBANCES
Brain
Spinal Cord
Neurologic Status:
- An assessment tool measuring the individual’s neurologic status specifically the spontaneity of
the client’s eye movement , speaking ability and motor abilities in response to a stimuli.
Perfect score is 15 points - Spontaneous/ Normal eye, motor and verbal response
Lowest score is 3 points - No response
Points
a. Spontaneous 4
Eye b. To speech 3
Opening c. To pain 2
Response d. No response 1
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a. Oriented 5
Best verbal b. Able to Converse 4
response c. Inappropriate speech 3
d. Makes incomprehensible sound 2
e. No response 1
Example:
o A sudden disruption of blood supply to the brain which may lead to temporary or
permanent dysfunction.
2. Cerebral thrombosis
- a blood clot (thrombus) forms in an artery (blood vessel) supplying blood to the brain.
- brain cells are starved of oxygen.
3. Cerebral embolism
- blood clot that forms and then travel to the brain.
4. Cerebral hemorrhage
- occurs when a blood vessel bursts inside the brain and bleeds (haemorrhages). With
a hemorrhage, extra damage is done to the brain tissue by the blood that seeps into it.
Nursing Interventions:
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SPINAL CORD INJURY
Cause:
Vehicular accidents, Violence, Falls,
Sports, Infection, Tumor
Etiology:
1. Spinal Shock (Areflexia)
2. Autonomic Hyperreflexia
Injury in T6 and above
Life-threatening
Nursing Interventions:
1. Immobilization specially after injury or
trauma
2. Maintain respiratory function, ABC
3. Bladder & bowel management
4. Rehabilitation
C1 Head & Neck Paralysis below neck; impaired breathing, bowel & bladder
Cervical C2 incontinence, sexual dysfunction
Nerve C3
C4
Injury causes C5 Diaphragm Shoulder elevation possible, ventilation support
Quadriplegia/ C6 Deltoid, biceps
Tetraplegia C7 Wrist Extenders Elbow, upper arm, wrist movement
C8 Triceps
Thoracic T1 Hand
Nerve T2 Loss of hand control, Paralysis below waist
T3
Injury causes T4
Paraplegia T5 Chest Muscles
T6
T7
T8 Abdominal Trunk and Abdominal control
T9 Muscles
T10
T11
T12
Lumbar L1
Nerve Hip adduction impaired
L2
Paralysis of L3 Leg muscles
legs; loss of L4 Knee and ankle movement impaired
bladder and L5
bowel control
S1
Sacral Nerve S2 Bladder & Bowel control Bladder/Bowel Incontinence,etc
Sexual, S3
Bladder & S4 Sexual Control Decrease sensation in the peineum
Bowel conrol S5
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PARKINSON’S DISEASE
Clinical Manifestations:
Rigidity
Involuntary body tremors
Hips and knees flexion
Masklike facial expression
Slurred speech
Drooling
Constipation
Depression
Retropulsion, propulsion
Nursing Interventions:
a. Rehabiltation – exercise
b. Speech therapy
c. Diet: Low CHIN in am, high CHON in PM
d. High fiber foods to promote bowel elimination
e. Prevent Injury – fall, etc
MYASTHENIA GRAVIS
Clinical Manifestation:
1. Mask-like facial expression
2. Diplopia- double-vision
3. Ptosis- difficulty opening of the eye
4. Dyphagia
Management:
a. Pyridostigmine Bromine (mestinon)
b. Ambenomium Chloride
c. Steroids –Prednisone
d. Atrophine Sulfate
Nursing Interventions:
Avoid fatigue
Administer meds as ordered
Avoi neomycin and morphine
CATARACT
Clinical Manifestations:
2. Gradual visual loss.
3. Hazy vision / Yellowish haze
4. Whitish to yellowish eyelense.
Drug: Vision
Vision w/
w/ Cataract
Cataract
1. Mydriatrics - causes dilation of pupils; increases intraocular pressure (IOP)
a. Atrophine Sulfate
b. Phenylephrine Hydrochloride
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2. Cyclopegics – decreases ciliary muscle accomodation
Nursing Intervention:
2. Monitor BP; avoid use to patients with HPN
3. Teach client that blurring of vision may be experienced.
4. Post-op intervention:
keep eye covered
head of bed elevated at 30-45 degreed, supine position
Avoid bending or lifting heavy objects, coughing and sneezing as
it may further increase IOP
GLAUCOMA -A
non-curable condition of the eye due to increase in intraocular pressure causing
deterioration of the optic nerve.
2 types of Glaucoma:
Drugs:
Miotics – causes constriction of pupils
Nursing Intervention:
1. Administer drugs as ordered
2. Teach client that glaucoma can be controlled but not curable (even surgery can’t cure the disease)
3. Encourage moderate exercise
4. Avoid straining of bowel
5. Encourage low residue, high fiber diet
8. MUSCULOSKELETAL DISTURBANCES
Kinds of Joints Cervical, finger joints, ulnar, can also be Weight-bearing joints: knees, hips, spine
involved:heart and lung (as in rheumatic heart
disease)
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• Intermittent bone pain, swelling, redness,
warm feeling due to vasodialtion and
increased blood flow
• Pannus formation- granulation of tissue
causing destruction of adjacent cartilage,
joints and bones
• fatigue, anorexia, malaise, weight loss
Management Rest, exercise, ASA, NSAIDs, Steroids, heat Balanced rest and activity, heat packs,
steroids in joist only
Nursing Intervention Maintain body alignment, Balance rest and exercise, proper diet
Clinical Manifestations A salt of uric acid (Urate) crystallizes in soft and bony tissues causing local inflammation and
irritation.
Severe pain, usually in great toe
Red, painful and swollen joints
Tophi (crystal formation in joints) are palapated around great toes, fingers,
earlobes
Drugs: Allopurinol
NSAID’s – Ibubrofen , Indomethacin
Probenecid
Colchicine
Sulfinpyrazone
Nursing Management:
a. Bedrest during attacks
b. Heat or cold compress
c. Increase fluid intake to flush out uric acid
d. Avoid eating organ meats, shellfish, sardines - - - food with high purine / uric acid content
Definition: Diffuse connective tissue disease affecting skin, joints, kidney, serous membranes of the heart and
lungs, lymph nodes and GI tract.
Clinical Manifestations: “Butterfly rash” in the face ( across both cheeks and nose)
Manifests symptoms same as that of arthritis and Raynaud’s
Management: NSAID’s
Steroids
Cytotoxic drugs - Azathioprine, Cyclophosphamide
Nursing Intervenions:
a. Avoid exposure to sunlight because symptoms aggravate symptoms or wear hats,
umbrella or sunscreen
b. Adequate nutrition, rest and exercise
c. Stress management, if possible avoid stress
Fractures
Clinical Manifestations:
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Pain Edema
Loss of function Spasm
Deformity Crepitus
False motion Hematoma around skin
Breaks for penetrating bone fragments
Management:
Closed Reduction - external manipulation such as manually aligning bones by pulling. For patients
who have lower pain tolerance (elderly, children) reduction may be done under
sedation anesthesia.
Internal Fixation - surgically applying screws, plates, pins, nails to align bones (opening of the
skin and exposing bones affected); skin is closed after the procedure.
External Fixation - applying nails and metal screws to bones through the skin surface
Nursing Management:
1. Mainatin positioning
2. For tractionL maintaing weights and countertraction
3. Clean wounds to prevent infection
4. Assess for VASCULAR OCCLUSION
9. INTEGUMENTARY DISTURBANCES
Burn
Second-degree Pain, pink to red, with blisters Epidermis and dermis hair follicle Superficial partial
(fluid formation) intact thickness; Deep
partial thickness
Third- degree Reddish, brownish or whitish, Epidermis, dermis, subcutaneous Full thickness
painless, eschar formation tissue
(Leather-like skin)
Rule of Nines:
a. Head and Neck - 9%
b. Anterior Truck - 18%
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c. Posterior Trunk - 18%
d. Arms - 9% each = 18%
e. Legs - 18% each = 36%
f. Perineum - 1%
100%
Rule of
Management: Nine’s
First-Aid:
1. Burning person: Ask person to stop, drop and roll ( lie down and roll)
2. Burning person: Stop burning process such as wrapping the burning part with wet towel or blanket
3. Check airway
4. First-degree burn: Run cool water to affected area for 10 minutes
Hospital Interventions:
1. Check ABC, give oxygen and IV fluids
2. Assess client’s data, history of injury (time, cause,etc)
3. Maintain asepsis- burn patients are very prone to infections
4. Medical – Surgical Management:
a. Tetanus toxoid
b. Topical Anti-microbial agent: Silver Nitrate, Silver Sulfadiazine, Gentamicin Sulfate, Mafenide acetate
c. Debridement
SHOCK
I. Stages of Shock
Progressive Stage
- Compensatory mechanism is not adequate
- blood flow to the heart is not adequate thus heart begins to deteriorate
3. Irreversible Stage
- Inadequate tissue perfusion
- Cellular ischemia & necrosis lead to organ failure
Cause Etiology
Hypovolemic Shock due to inadequate circulating blood Blood loss: Massive Trauma, GI Bleeding,
volume Ruptured Aortic Aneurysm, Surgery,
Erosion of Vessesl due to lesion, tubes or
other devices, Disseminated Intravascular
Coaguation
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External Pressure on the Heart interferes with
heart filling or emptying:
Pericardial Tamponade due to Trauma,
aneurysm, cardiac surgery,
pericarditis, massive pulmonary
embolus, tension pneumothorax
Cardiac Dysrhtymias:
Tachyarrhythmias, Bradyarrythmias,
Electromechanical dissociation
3. Distributive Shock
c. Septic Shock - systemic reaction vasodilation Gram-negative septicemia but also caused by
due to infection other organisms
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Immune System Macrophages in bloodstream and tissues are depressed
Increased susceptibility to shock
2. Don't move the joint. Splint the affected joint into its fixed position. Don't try to move a dislocated
joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments,
nerves or blood vessels.
3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the
buildup of fluids in and around the injured joint.
Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to
avoid infection or other complications. These guidelines can help you care for simple wounds:
1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply
gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes.
Don't keep checking to see if the bleeding has stopped because this may damage or dislodge the
fresh clot that's forming and cause bleeding to resume. If the blood spurts or continues to flow after
continuous pressure, seek medical assistance.
2. Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to
keep it out of the actual wound. If dirt or debris remains in the wound after washing, use tweezers
cleaned with alcohol to remove the particles. If debris remains embedded in the wound after
cleaning, see your doctor. Thorough wound cleaning reduces the risk of tetanus. To clean the area
around the wound, use soap and a washcloth. There's no need to use hydrogen peroxide, iodine or
an iodine-containing cleanser. These substances irritate living cells. If you choose to use them,
don't apply them directly on the wound.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or
ointment such as Neosporin or Polysporin to help keep the surface moist. The products don't make
the wound heal faster, but they can discourage infection and allow your body's healing process to
close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in
some people. If a rash appears, stop using the ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After
the wound has healed enough to make infection unlikely, exposure to the air will speed wound
healing.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If
you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile
gauze held in place with paper tape, gauze roll or a loosely applied elastic bandage. These supplies
generally are available at pharmacies.
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6. Get stitches for deep wounds. A wound that cuts deeply through the skin or is gaping or jagged-
edged and has fat or muscle protruding usually requires stitches. A strip or two of surgical tape may
hold a minor cut together, but if you can't easily close the mouth of the wound, see your doctor as
soon as possible. Proper closure within a few hours minimizes the risk of infection.
7. Watch for signs of infection. See your doctor if the wound isn't healing or you notice any redness,
drainage, warmth or swelling.
8. Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is
deep or dirty and your last shot was more than five years ago, your doctor may recommend a
tetanus shot booster. Get the booster within 48 hours of the injury
Cool the burn. Hold the burned area under cold running water for at least 5 minutes, or until the
pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses.
Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.
Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin.
Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned
skin, reduces pain and protects blistered skin.
Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others),
naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the
healed area may be a different color from the surrounding skin. Watch for signs of infection, such as
increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring
or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation
changes. Use sunscreen on the area for at least a year.
Caution
Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
Third-degree burn
The most serious burns are painless and involve all layers of the skin. Fat, muscle and even bone may be
affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon
monoxide poisoning or other toxic effects may occur if smoke inhalation accompanies the burn.
For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow
these steps:
1. Don't remove burnt clothing. However, do make sure the victim is no longer in contact with
smoldering materials or exposed to smoke or heat.
2. Don't immerse severe large burns in cold water. Doing so could cause shock.
3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or
other sign of circulation, begin cardiopulmonary resuscitation (CPR).
4. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.
If a
Chemical burns: First aid***
chemical burns the skin, follow these steps:
1. Remove the cause of the burn by flushing the chemicals off the skin surface with cool, running
water for 15 minutes or more. If the burning chemical is a powder-like substance such as lime,
brush it off the skin before flushing.
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2. Remove clothing or jewelry that has been contaminated by the chemical.
3. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.
The victim has signs of shock, such as fainting, pale complexion or breathing in a notably shallow
manner.
The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn
covers an area more than 2 to 3 inches in diameter.
The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint.
An electrical burn may appear minor or not show on the skin at all, but the damage can extend deep into
the tissues beneath your skin. If a strong electrical current passes through your body, internal damage,
such as a heart rhythm disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the
electrical burn can cause you to be thrown or to fall, resulting in fractures or other associated injuries.
Dial 911 or call for emergency medical assistance if the person who has been burned is in pain, is
confused, or is experiencing changes in his or her breathing, heartbeat or consciousness.
While helping someone with an electrical burn and waiting for medical help, follow these steps:
1. Look first. Don't touch. The person may still be in contact with the electrical source. Touching the
person may pass the current through you.
2. Turn off the source of electricity if possible. If not, move the source away from both you and the
injured person using a nonconducting object made of cardboard, plastic or wood.
4. Prevent shock. Lay the person down with the head slightly lower than the trunk and the legs
elevated.
5. Cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze
bandage, if available, or a clean cloth. Don't use a blanket or towel. Loose fibers can stick to the
burns.
For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a
minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent
infection and cover the bite with a clean bandage.
For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn
and bleeding, apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.
For infection. If you notice signs of infection such as swelling, redness, increased pain or oozing,
see your doctor immediately.
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For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies —
any bite from a wild or domestic animal of unknown immunization status — see your doctor
immediately.
Doctors recommend getting a tetanus shot every 10 years. If your last one was more than five years ago
and your wound is deep or dirty, your doctor may recommend a booster. You should have the booster
within 48 hours of the injury.
Falls put you at risk of serious injury. Prevent falls with these fall-prevention measures.
Your odds of falling each year after age 65 are about one in three. Fortunately, most of these falls aren't
serious. Still, falls are the leading cause of injury and injury-related death among older adults. You're more
likely to fall as you get older because of common, age-related physical changes and medical conditions —
and the medications you take to treat such conditions.
You needn't let the fear of falling rule your life. Many falls and fall-related injuries are preventable with fall-
prevention measures. Here's a look at six fall-prevention approaches that can help you avoid falls.
Begin your fall-prevention plan by making an appointment with your doctor. You and your doctor can take a
comprehensive look at your environment, your health and your medications to identify situations when
you're vulnerable to falling. In order to devise a fall-prevention plan, your doctor will want to know:
What medications are you taking? Include all the prescription and over-the-counter medications
you take, along with the dosages. Or bring them all with you. Your doctor can review your
medications for side effects and interactions that may increase your risk of falling. To help with fall
prevention, he or she may decide to wean you off certain medications, especially those used to treat
anxiety and insomnia.
Have you fallen before? Write down the details, including when, where and how you fell. Be
prepared to discuss instances when you almost fell but managed to grab hold of something just in
time or were caught by someone.
Could your health conditions cause a fall? Your doctor likely wants to know about eye and ear
disorders that may increase your risk of falls. Be prepared to discuss these and to tell him or her how
you walk — describe any dizziness, joint pain, numbness or shortness of breath that affects your
walk. Your doctor may then evaluate your muscle strength, balance and individual walking style
(gait).
If you aren't already getting regular physical activity, consider starting a general exercise program as part of
your fall-prevention plan. Consider activities such as walking, water workouts or tai chi — a gentle exercise
that involves slow and graceful dance-like movements. Such activities reduce your risk of falls by improving
your strength, balance, coordination and flexibility. Be sure to get your doctor's OK first, though.
If you avoid exercise because you're afraid it will make a fall more likely, bring this concern to your doctor.
He or she may recommend carefully monitored exercise programs or give you a referral to a physical
therapist who can devise a custom exercise program aimed at improving your balance, muscle strength and
gait. To improve your flexibility, the physical therapist may use techniques such as electrical stimulation,
massage or ultrasound. If you have inner ear problems that affect your balance, he or she may also teach
you balance retraining exercises (vestibular rehabilitation) — which involve specific head and body
movements to correct loss of balance.
Consider changing your footwear as part of your fall-prevention plan. High heels, floppy slippers and shoes
with slick soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead:
Have your feet measured each time you buy shoes, since your size can change.
Buy properly fitting, sturdy shoes with nonskid soles.
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Avoid shoes with extra-thick soles.
Choose lace-up shoes instead of slip-ons, and keep the laces tied.
Select footwear with fabric fasteners if you have trouble tying laces.
Shop in the men's department if you're a woman who can't find wide enough shoes.
If bending over to put on your shoes puts you off balance, consider a long shoehorn that helps you slip your
shoes on without bending over.
As part of your fall-prevention measures, take a look around you — your living room, kitchen, bedroom,
bathroom, hallways and stairways may be filled with booby traps. Clutter can get in your way, but so can the
decorative accents you add to your home. To make your home safer, you might try these tips:
Remove boxes, newspapers, electrical cords and phone cords from walkways.
Move coffee tables, magazine racks and plant stands from high-traffic areas.
Store clothing, dishes, food and other household necessities within easy reach.
As you get older, less light reaches the back of your eyes where you sense color and motion. So keep your
home brightly lit with 100-watt bulbs or higher to avoid tripping on objects that are hard to see. Don't use
bulbs that exceed the wattage rating on lamps and lighting fixtures, however, since this can present a fire
hazard. Also:
Place a lamp near your bed and within reach so that you can use it if you get up at night.
Make light switches more easily accessible in rooms. Make a clear path to the switch if it isn't right
near the room entrance. Consider installing glow-in-the-dark or illuminated switches.
Turn on the lights before going up or down stairs. This might require installing switches at the top
and bottom of stairs.
Your doctor might recommend using a cane or walker to keep you steady. Other assistive devices can help,
too. All sorts of gadgets have been invented to make everyday tasks easier. Some you might consider:
Grab bars mounted inside and just outside your shower or bathtub.
A raised toilet seat or one with armrests to stabilize yourself.
A sturdy plastic seat placed in your shower or tub so that you can sit down if you need to. Buy a
hand-held shower nozzle so that you can shower sitting down.
Handrails on both sides of stairways.
Nonslip treads on bare-wood steps.
Ask your doctor for a referral to an occupational therapist who can help you devise other ways to prevent
falls in your home. Some solutions are easily installed and relatively inexpensive. Others may require
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professional help and more of an investment. If you plan on staying in your home for many more years, an
investment in safety and fall prevention now may make that possible.
Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin.
The venom triggers an allergic reaction. The severity of your reaction depends on your sensitivity to the
insect venom or substance.
Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation
and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful
joints and swollen glands. You might experience both the immediate and the delayed reactions from the
same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to
insect venom. Signs and symptoms of a severe reaction include facial swelling, difficulty breathing and
shock.
Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from
mosquitoes, ticks, biting flies and some spiders also can cause reactions, but these are generally milder.
Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a
knife. Wash the affected area with soap and water. Don't try to pull out the stinger; doing so may
release more venom.
To reduce pain and swelling, apply a cold pack or cloth filled with ice.
Apply 0.5 percent or 1 percent hydrocortisone cream, calamine lotion or a baking soda paste —
with a ratio of 3 teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day
until your symptoms subside.
Allergic reactions may include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches
in diameter at the site. See your doctor promptly if you experience any of these signs and symptoms.
Severe reactions may progress rapidly. Dial 911 or call for emergency medical assistance if the following
signs or symptoms occur:
Difficulty breathing
Swelling of your lips or throat
Faintness
Dizziness
Confusion
Rapid heartbeat
Hives
Nausea, cramps and vomiting
Take these actions immediately while waiting with an affected person for medical help:
1. Check for special medications that the person might be carrying to treat an allergic attack, such as
an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by
pressing the auto-injector against the person's thigh and holding it in place for several seconds.
Massage the injection site for 10 seconds to enhance absorption.
2. After administering epinephrine, have the person take an antihistamine pill if he or she is able to do
so without choking.
3. Have the person lie still on his or her back with feet higher than the head.
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4. Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.
5. If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
http://www.redcross.org
RESPIRATORY ARREST
CAUSES:
1. Strangulation
2. Poisoning-Injection, Ingestion, Inhalation
Injection- Snakebite, Rabies, Scorpions, bees, jellyfish, spiders
3. Severe Bleeding
4. Drowning
5. Electrocution
6. Suffocation
7. Choking: Universal Sign of Choking- palms guarding throat
8. Disease
With Good Air Exchange Victim can still TALK Observe the victim as he cough out
obstruction
With Poor Air Exchange Victim produces wheezing sound Abdominal Thrust / Heimlich
Maneuver
5. Artificial Respiration 2X if
effective
First Aid: Artificial Respiration (AR) – Giving of artificial air only either through a blow or ambubag
- chest compression not indicated because there is pulse rate
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ADULT CHILD INFANT
Rate of Blows 1 Blow every 5 secs 1 Blow every 4 secs 1 Blow every 3 seconds
12 blows per min 15 blows per min 20 blows per min
WHEN TO STOP
CARDIAC ARREST
CAUSES
All causes of Respiratory Arrest, Heart Attack, Stroke Danger of Failure to revive Patient:
Rate 15 ECC/2 blows 4X/min 5ECC/1 blow 15X/min 5ECC/1 blow 20X/min
DON’T’S IN CPR:
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SEQUENCE:
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