DIABETES MELLITUS  To control hypertension and tachycardia in

hyperthyroidism, the drug BETA-BLOCKERS

must be given.
 Upon taking glucose, it will transported to the
 The most serious side effect of thioamides is
cells within 2 hours.
BONE MARROW DEPRESSION.
 Insulin lowers blood glucose level by
 After thyroidectomy, the client must be
transporting glucose to the cell and
placed in SEMI-FOWLER’S POSITION.
converting excess to become glycogen.
 Hypocalcemia after thyroidectomy is caused by
 The hormone that raises blood glucose level by
possible damage to the parathyroid glands.
converting glycogen to become glucose during
 Signs of tetany are:
hypoglycemia is Glucagon
 (+) Chvostek’s sign
 Diabetes mellitus is prolonged hyperglycemia
 (+) Trousseau’s sign and
 Gestational DM is caused by elevation in the
 Laryngospasm.
hormone human placental lactogen which
antagonizes insulin.  Because of possible laryngospasm after
 The closest predisposition of IDDM is thyroidectomy, TRACHEOSTOMY SET must
be at bedside.
HEREDITY.
 The first sign of thyroid crisis is
 The closest predisposition of NIDDM is
HYPERTHERMIA.
OBESITY.
 To reverse hypocalcemia, CALCIUM
 Cushing’s related DM is related to elevation in
GLUCONATE must be administered to the
the hormone glucocorticoids.
client.
 Polyuria in DM is secondary to OSMOTIC
 Exopthalmos in Grave’s disease is known as the
DIURESIS.
DALYRIMPLE’S SIGN.
 Polydipsia in DM is secondary to TOTAL
 The priority to a client having CNS involvement
DEHYDRATION.
in hyperthyroidism is SAFETY.
 Polyphagia in in DM is caused by CELLULAR
 The rationale for administering iodides prior to
STARVATION.
thyroidectomy is to reduce the size and
 The hallmark of DKA is KUSSMAUL’S
vascularity of the thyroid gland.
BREATHING
 To assess laryngeal nerve damage after
 The only management of DKA is IV insulin.
thyroidectomy, observe for hoarseness of
 The triad of management of DM are
voice.
 Diet
 FACIAL TWITCHING upon tapping of facial
 Activity nerve is known as the (+) Chvostek’s sign.
 Medications  CARPAL SPASM upon occlusion of brachial
 OHAs are only used to NIDDM. nerve is known as the (+) Trousseau’s sign.
 The reason for rotating sites for insulin  Hypothyroidism for the adults is known as
administration is to prevent lipodystrophy. MYXEDEMA.
 The ideal route of insulin is subcutaneous.  Hypothyroidism for the children is known as
 Rebound hyperglycemia to a client taking CRETINISM.
insulin is known as the SOMOGYI  Hyperlipidemia and bradycardia in
PHENOMENON. hypothyroidism often leads to atherosclerosis.
 The only insulin given IV is the REGULAR  Too little T4 in hypothyroidism may cause COLD
INSULIN. INTOLERANCE.
 Complications of administering IV insulin  The drug of choice for hypothyroidism is
 hypokalemia LEVOTHYROXINE (synthroid)
 hypoglycemia
 edema
 The most accurate test to determine blood
CUSHING’S & ADDISON’S
glucose level is FBS. DISEASE
 The most accurate test to diagnose DM is  The hormones of adrenal cortex are:
GLYCOSLATED HEMOGLOBIN.  Glucocorticoids – major is cortisol
 Gluconeogenesis
HYPERTHYROIDISM AND  Fat distribution
 Mineralocorticoids – major is aldosterone
HYPOTHYROIDISM  Sodium retention
 When taken by oral route, iodine will stay in  Potassium excretion
the blood for 6 hours before it is utilized by  Sex hormones
the thyroid gland.  androgen
 The hormones of the thyroid gland are;  progesterone
 T3 – metabolism  estrogen
 T4 – heat production  Development of secondary sex characteristics
 TC – PTH antagonist  The hypersecretion of adrenal cortex is
 The most dangerous symptoms of known as Cushing’s disease.
hyperthyroidism are cardiovascular  Hypercorticism secondary to administration
symptoms. of steroids is known as Cushing’s syndrome.
  Fat misdistribution in Cushing’s disorders may
cause thinning of arms and legs, Buffalo
hump and truncal obesity.
 Truncal obesity may cause congestion of
femoral veins that may lead to
thrombophlebitis.
 Lability of mood in Cushing’s disease is
caused by EXCESSIVE GLUCOCORTICOIDS.
 Hypertension in Cushing’s disease is caused
by EXCESSIVE MINERALOCORTICOIDS.
 Primary adrenal hypofunction is known as
Addison’s disease.
 The occurrence of profound weakness, shock
and pains in Addison’s disease is known as
Addisionian crisis.
 The goal to a client with Addison’s disease is to
prevent irreversible shock.
 CROMOLYN SODIUM is classified as a mast cells
stabilizer.
 PULMONARY HYPERTENSION may occur for a
pressure exceeding 25 mmHg
 The main purpose of PURSED-LIP BREATHING
is to expel more carbon dioxide.
PNEUMOTHORAX
 Most common type: SECONDARY
TYPE OF PAIN
 PLEURITIC - more pronounced on inhalation
 Drug of choice - CODEINE SO4
 Best position to promote breathing: Semi-Fowler’s
 Oxygen delivery: LOW-FLOW
 Main management: Chest-Tube Thoracostomy
PEPTIC ULCER DISEASE
 The cells responsible in producing HCl are the
PARIETAL CELLS.
 Stress ulcer is also known as CURLING’S ULCER.
 To obtain maximum effect, the drugs for PUD must
be taken:
 Antacids – 1-2 hours after meals
 H2 Blockers – with meals
 Cytoprotective drugs – 30-60 mins. before
meals.
 Diet: BLAND
 Surgical management:
 Billroth 1 – Gastroduodenostomy
 Billroth 2 - Gastrojejunostomy
 Complication of Billroth procedures:
 DUMPING SYNDROME

COPD  PERITONITIS
 Most common cause: perforated ulcer
ASTHMA BRONCHITI EMPHYSEM  Classic sign: rigid, board-like abdomen
S A  Complications:
DISORDER Allergic Inflammatory Autoimmune  septicemia
INVOLVEMENT Ventilation Ventilation Alveolar  respiratory depression
diffusion  The microorganism which is thought to cause
HALLMARK Wheezing Productive Barrel Chest PUD is H. Pylori.
Cough
Other name ROAD/RAD Blue Bloaters Pink Puffers
APPENDICITIS
 Exact cause: UNKNOWN
 Oxygen delivery: Low-flow (1-3 LPM)
 Gender: MALE
 Most accurate method: VENTURI MASK
 TRIAD:
 Mixes with room air: NASAL CANNULA
 Blumberg’s sign
 Diet:
 Low-grade fever
 Consistency: Soft
 Leukocytosis
 Frequency: 6-10 x/ day
 Assessment: (Pain)
 The most common side effect of bronchodilators is
 Rebound tenderness on RLQ: Blumberg’s sign
TACHYCARDIA
 Palpation on LLQ will cause more pain on RLQ:
 In asthma, the damage to the mast cells by the
ROVSING’S SIGN
IgE can cause release of histamine 1.
 Comfort on lateral hip flexion: PSOAS’ SIGN
 HISTAMINE 1 can cause bronchoconstriction and
 Loss of pain: RUPTURE
vasodilation
 Absolute management: Appendectomy
 The best position to promote maximum lung
 Must be done within 24-36 hours
expansion is ORTHOPNEIC.
 Anesthesia type: SPINAL
 In bronchitis, the excessive production of
secretion is caused by the activation of  Postop position: Flat on bed (6-8 hours)
GOBLET CELLS.  Best indicator of peristalsis return: Presence of
 Right-sided CHF secondary to COPD is known bowel sounds
as COR PULMONALE.
 Permanent alveolar dilation is known as
EMPHYSEMA.
 The primary symptoms of the “Blue Bloaters”
are CYANOSIS AND EDEMA. LIVER CIRRHOSIS
  Most common type: LAENNEC’S  Passageway
 Primary biliary cirrhosis is caused by  Most common type: HYPOVOLEMIC
obstruction of the common hepatic duct.  Most dangerous: CARDIOGENIC
 RSCHF may lead to CARDIAC CIRRHOSIS.  TYPES:
 Laboratories for liver cirrhosis:  HYPOVOLEMIC - low blood volume
 Most sensitive: Elevated total bilirubin  CARDIOGENIC - failure of the heart to maintain
 Most indicative: Elevated liver enzymes circulation
 Most definitive: Liver biopsy  DISTRIBUTIVE - systemic vasodilation
 After liver biopsy, the client must be placed on the  SEPTIC - infection
RIGHT side.  ANAPHYLACTIC - allergy
 The waste product that increases in liver  NEUROGENIC – pain
cirrhosis is AMMONIA.  OBSTRUCTIVE - physical or mechanical
 Signs of hepatic encephalopathy are: obstruction
 Motor: asterixis  Primary compensatory mechanisms
 Psychological: Hallucinations, Illusions,  Tachycardia
delusions  Activation of SNS
 Neurological: Altered LOC  Activation of RAAS
 The EARLIEST impending signs of  Best drug to increase BP: DOPAMINE
encephalopathy
 asterixis BURNS
 fetor hepaticus  Most common type: THERMAL
 To reduce ammonia, management:  Priority: AIRWAY
 Diet: GIORDANO GIOVANNETTI
 Lactulose Shock Diuretic Recovery
 Neomycin sulfate (Emergent) (Compensatory (Rehabilitative
 The management of choice for esophageal ) )
bleeding is SENGSTAKEN-BLAKEMORE TUBE. TIME 1st 48 hours 2nd 48 hours 5th day
 The balloon is SBT must be released every 15 onwards
minutes to avoid tissue damage. Fluid Fluid volume Fluid volume NONE
Imbalance deficit excess
 Emergency equipment needed in SBT is
s
SCISSORS.
Electrolyte Hyponatremi Hyponatremia Hypokalemia
 The most indicative sign of esophageal
imbalance a Hypokalemia Hypocalcemia
bleeding is FREQUENT SWALLOWING. s Hyperkalemi
a
PANCREATITIS Acid-Base Metabolic Metabolic NONE
imbalance Acidosis Acidosis
 Exact cause: UNKNOWN s
 Predisposing factors:
 male
 middle-age TRIAGE
 medicine / substance  Primary Goal: TO PRESERVE LIFE
 meat / heavy meal
 Primary Survey: Used to UNCONSCIOUS or
 midnight
unable to respond
 Hallmark: AUTODIGESTION  Airway
 Drug of choice: MORPHINE SULPHATE  Breathing
 Given with antispasmodic drugs  Circulation
 LABORATORIES:  Disability
 Most sensitive: ELEVATED LIPASE  Electrolytes
 Most indicative: ELEVATED AMYLASE  Fluids
 Most definitive: AUTOPSY  Secondary Survey: Used to CONSCIOUS victims
 Chief complaint
 History
CHOLELITHIASIS/  Exact location
CHOLECYSTITIS  Compare
 Keep checking
 The liver can produce 700-1000 cc of bile every
24 hours.  By COLOR
 The predisposing factors of gallbladder  Immediate RED
problems are:  Delayed YELLOW
 Female  Minimal GREEN
 Fat  Expectant BLACK
 Forty  By CLASSIFICATION:
 Fertile  Care may be delayed / less chance of survival:
 Fair complexion NON-URGENT
 Family Planning  Care within 1-2 hours: URGENT
 Without fail: EMERGENT

SHOCK
 Problems on 3 P’s
 COMPREHENSIVE CRITICAL CARE:
 Pump
 Normal ward: Zero
 Passenger
 Multiple organs / systems involved: Three
  1 additional support: One  The hormone the moves calcium from the bone to
 Single failing organ: Two the blood is the parathyroid hormone.
 The mainstay drug in rheumatoid arthritis is
MYASTHENIA GRAVIS ASPIRIN.
 Depleted Neurotransmitter: ACETYLCHOLINE  Aspirin is used in arthritis because of its analgesic
 Hallmark: MUSCLE WEAKNESS and anti-inflammatory properties.
 Confirmatory Test: TENSILON TEST  The major goal in any form of arthritis is to prevent
 DOC: NEOSTIGMINE/ PYRIDOSTIGMINE joint deformities.
 The effect Gold compound preparations may be
GUILLAIN - BARRE’ SYNDROME noticed in 3-6 months
 The only anti-rheumatoid drugs that doesn't cause
 Exact cause: UNKNOWN
GI irritation are the COX-2 INHIBITORS
 Predisposing factor: Postviral exposure
 Relevant hormonal changes in women that
 Pathophysiologic basis: POLYNEURITIS
predisposes osteoporosis is decrease in
 Classic sign: ASCENDING PARALYSIS
ESTROGEN
 Priorities: S B A
 The back brace must be worn 23 hours a day.
 DOC: STEROIDS
 Defined as a break in the continuity of the bone is
FRACTURE
PARKINSON’S DISEASE  TYPES OF FRACTURES:
 Exact cause: UNKNOWN  GREENSTICK- Crack on one side
 Depleted neurotransmitter: DOPAMINE  COMMINUTED- Bone is fragmented
 Hallmarks:  SPIRAL- Caused by twisting force
 Muscle rigidity  IMPACTED- Bone forced to each other
 Tremors  DEPRESSED- Broken bone pressed inward
 Priority: SAFETY  6 P’s of NEUROMUSCULAR DAMAGE
 Cranial nerves affected:  Pain
EARLY: 7 and 11  Paresthesia
LATE : 9 and 12  Paralysis
 Drugs given  Pulselessness
 Dopaminergics  Poikilothermia
 Anticholinergics  Pallor
 EMERGENCY MANAGEMENT OF FRACTURE
MULTIPLE SCLEROSIS  R- EST
 Exact cause: UNKNOWN  I- CE
 Predisposing factor:  C- OMPRESSION
 G enetics  E- LEVATION
 S- PLINT
 U nnecessary radiation exposure
 N utritional deficits  PRINCIPLES OF FRACTURE MANAGEMENT:
 S low acting virus  I- MMOBILIZATION
 Pathophysiologic basis: SYSTEMIC  R- EDUCTION
DEMYELINATION  A- LIGNMENT
 Earliest sign: DIPLOPIA
 Hallmark: CHARCOT’S TRIAD OSTEOMYELITIS
 Scanning of speech  Common Agent: STAPHYLOCOCCUS AUREUS
 Intentional tremors  Complication: SEPTICEMIA
 Nystagmus  DOC: CEFAZOLIN (ANCEF)
 Priorities: S - A - B - A – P  Preventive surgery: DEBRIDEMENT

ALZHEIMER’S DISEASE
 Exact cause: UNKNOWN
 Depleted neurotransmitter: ACETYLCHOLINE
 Hallmark: DEMENTIA
 Priorities: Safety and Security
 DOC: ANTICHOLINESTERASE
GOUTY ARTHRITIS
 Common joint: BIG TOE
 Symmetry: RANDOM
 Involvement: SYSTEMIC
 Hallmark: TOPHI

SYSTEMIC LUPUS OSTEOARTHRITIS

ERYTHEMATOSUS  Also known as DEGENERATIVE JOINT DISEASE
 Exact cause: UNKNOWN  Common joints: WEIGHT-BEARING
 Hallmark: (+) ANA  Symmetry: UNILATERAL
 Pathognomonic: BUTTERFLY RASH  Involvement: LOCAL
 Most common complication: RENAL FAILURE  Hallmark: OSTEOPHYTES
 DOC: STEROIDS
RHEUMATOID ARTHRITIS
MUSCULO-SKELETAL SYSTEM  Common joints: SMALL JOINTS
  Symmetry: BILATERAL  Treatment: SURGERY
 Involvement: SYSTEMIC
 Hallmark: BONY ANKYLOSIS RETINAL DETACHMENT
 Common cause: TRAUMA
CANCER CONCEPTS  TRIAD
 Most common cancer (Both gender): LUNG  Floaters
 Most common cancer (Males): LUNG  Flashes of lights
 Most common cancer (Females): LUNG  Curtain-shadow across visual field
 Most common cancer (Gender-specific for males):  Type of blindness: SPOT BLINDNESS
PROSTATE  Surgery of choice: SCLERAL BUCKLING
 Most common cancer (Gender-specific for
females): BREAST ANEURYSM
 Most common cancer (children below 12):  Most common site: AORTA
LEUKEMIA  COMMON CAUSES
 First sign of bladder cancer: PAINLESS  Pressure
HEMATURIA  Blood vessel damage
 Cell identified in Hodgkin’s lymphoma: REED-  Danger: RUPTURE
STERNBERG CELL  Predisposing factor for rupture: HYPERTENSION
 Virus allegedly causing Hodgkin’s lymphoma:  Complications:
EPSTEIN-BARR VIRUS  Cardiogenic shock
 PRINCIPLES OF CARE FOR A PATIENT UNDER  Hypovolemic shock
RADIATION THERAPY  TYPES:
 All are regarded radioactive  Affecting 3 walls: FUSIFORM
 Safe distance: 6 FEET  Sac on one side: SACCULAR
 Safe shield: LEAD  Made of tumor or other objects: PSEUDO-
 Safe time exposure: 30 MINS / SHIFT ANEURYSM
 Absolute contraindications:  Tear inside: DISSECTING
 Pregnant  Drugs used to prevent rupture:
 Children below 12 years old  ANTIHYPERTENSIVES
 VASODILATORS
CONGESTIVE HEART FAILURE  DIURETICS
 The major therapy in CHF is DIGITALIS
THERAPY. PERIPHERAL VASCULAR
 Digitalis have (+) inotropic and (-) chronotropic
effects.
DISORDERS
RAYNAUD’S BUERGER’S
 To prevent digitalis toxicity, potassium level must
be kept normal. Blood Vessels Arteries Arteries and Veins
 The safest diuretic is the POTASSIUM-SPARING. Extremities Upper Lower
 Bloodless phlebotomy is also known as Gender Female Male
ROTATING TOURNIQUET
 The effect of vasodilator in a client with CHF is that  Pain upon dorsiflexion is known as (+) HOMAN’S
it decreases the AFTERLOAD. SIGN.
 The goal of diuretic therapy in CHF is to promote  The best time to wear the anti-embolism stocking is
urination, decreasing the blood volume. BEFORE ARISING FROM BED.
 Buerger’s disease is also known as
THROMBOANGIITIS OBLITERANS.

HEPARIN WARFARIN
Route IV/SC Oral
Labs checked PTT PT
RENAL FAILURE Antidote Protamine SO4 Vitamin K
 Acute Advantage Fast Acting Long Half-Life
 Reversible
 Sudden
 Azotemia MENIERE’S DISEASE
 Chronic  Also known as: ENDOLYMPHATIC HYDROPS
 Irreversible  Exact Cause: UNKNOWN
 Progressive  Part affected: INNER EAR
 Azotemia  TRIAD:
 Type of azotemia: UREMIA  Tinnitus
 Most accurate diagnostic: CREATININE  Vertigo
CLEARANCE  Sensorineural hearing loss
 Diet: GIORDANO GIOVANNETTI  Priority: SAFETY
 All electrolytes are elevated except for CALCIUM  Diet: LOW-SODIUM
 Crisis: HYPERKALEMIA
SIGNS OF INCREASED ICP
CATARACT  B P & temp = increased
 Most common cause: AGING  R R & HR = decreased
 Type of blindness: LEGAL  A ltered LOC
 Main symptom: BLURRING OF VISION
  I rritability  Congestion of major organs – Sequestration
 N&V
 S eizures URINARY TRACT INFECTION
 Signs of Increased ICP: CUSHING’S TRIAD  Common pathogen: E. COLI
 Systolic hypertension  TYPES
 Widened pulse pressure  Upper – pyelonephritis
 Bradycardia  Lower
 Bladder – cystitis
DRUGS USED IN TREATING  Urethra – urethritis
 CLASSIC SYMPTOMS OF LOWER UTI:
TRAUMATIC HEAD INJURY  Frequency
 Inflammation or swelling: STEROIDS  Urgency
 Cerebral edema: MANNITOL  Dysuria
 Bleeding: VASOPRESSIN  Hallmark of pyelonephritis: CVA TENDERNESS
 The priority to a client having seizures is SAFETY.  Cause of dysuria: IRRITATION
 The most common sign of autonomic dysreflexia is  DOC: PYRIDIUM
POUNDING HEADACHE.  Cause of suprapubic pain: bladder spasm
 The normal ICP is 0-15 mmHg  DOC: PROBANTHINE
 Management:
HYPERTENSION  Fluid intake = 3-5 liters
 Most common type: PRIMARY  Diet: ACID-ASH
 BP of 140/90 or more for 6 months or longer.  Hygiene (3W’s)
 Common complication: NEPHROPATHY  Wash
 Drugs used:  Wear
 Vasodilators  Wipe
 Diuretics

BENIGN PROSTATIC
HYPERPLASIA VS. PROSTATE CORONARY ARTERY DISEASES
CANCER  The 4 E’s that predispose the attack of stable
angina are:
BPH Prostate Cancer  emotional stress
Cells Benign Malignant  exercise
Elevated ESTROGEN ANDROGEN  extreme temperatures
Hormones  eating heavy meals
Age of Onset 40 50  The pain of angina pectoris should not last more
Tumors Multiple, Small Single, Large than 15 minutes.
Labs (+) PSA Elevated PSA  The drug of choice of angina pectoris is
(+) Acid Elevated Acid NITROGLYCERIN.
Phosphatase Phosphatase  CAD’s are usually caused by atherosclerosis.
 The waste product of anaerobic glycolysis is
LACTIC ACID.
ANEMIA  The most sensitive laboratory test for myocardial
 CLASSIFICATIONS OF ANEMIA infarction is TROPONIN I.
 Renal failure: RENAL  The most indicative laboratory test for myocardial
 Bone marrow depression: APLASTIC infarction is CK-MB.
 Lack of nutrition: NUTRITIONAL  The most definitive laboratory test for myocardial
 Bleeding or RBC structural problems: infarction is ECG.
MORPHOLOGIC  The drug of choice for myocardial infarction is
 Hallmark: PALLOR MORPHINE SULFATE.
 Priority in most anemia: OXYGENATION  When giving morphine sulfate, RR must be
 Pathognomonic for pernicious anemia: RED- monitored because it can cause respiratory
BEEFY TONGUE depression.
 Priority in Sickle-cell anemia: HYDRATION  The antidote for morphine sulfate is NALOXONE.
 Drug of choice for renal anemia: EPOGEN  In MI, LDH flip may indicate MULTISYSTEM
 Drug of choice for Folic acid deficiency anemia: FAILURE.
FOLIC ACID SUPPLEMENT: 1000 MG  The most common complication of MI is
 Drug of choice for iron-deficiency anemia: FESO4 DYSRHYTHMIAS.
 Best given with Vitamin C  TOP 3 DRUGS IN ANGINA PECTORIS(In order)
 Only treatment for pernicious anemia: LIFETIME  Nitroglycerin
MONTHLY VITAMIN B12 IM INJECTION  Beta-Blockers
 Confirmatory for pernicious anemia: SCHILLING’S  Calcium-channel Blockers
TEST
 The best food source of iron for adults is LIVER. ECG READINGS
 The best food source of iron for children is EGG  Hyperkalemia: TALL, PEAKED T-WAVES
YOLK.  Hypokalemia: PROMINENT U-WAVES
 CRISIS IN SICKLE-CELL ANEMIA  MI, 1st 4-24 hours: ST ELEVATION
 Pain - Sickle-cell crisis  MI, after 4-24 hours: ST DEPRESSION
 Infection with parvovirus – Aplastic T-WAVE INVERSION
 MI, refractory stage: DEEP Q-WAVE