Complications

• diarrhea •
• Leukemia Dehydration and met acidosis
• Addison’s • Infection and bleeding
• Cushing’s • Shock
• Sickle cell anemia • Fluid overload (anasarca)
• Valvular disease • MI and CVD
• Cystic fibrosis • CHF
• Gonorrhea • Permanent sterility
• Herpes and HPV • Pelvic inflammatory disease
• Kissing disease • Cancer of the cervix
• Meningitis • Spleenic rupture
• GABHS infection • Auditory damage
• Pancreatitis • RHD and AGN
• Phenylketonuria and cretinism • Destruction of beta cells
• Polycythemia vera • Mental retardation
• PIH and Preeclampsia • MI and CVD
• Vomiting • Abruptio placenta
• Met alkalosis

Diets
•
• AGN Low Na, Low CHON
• Addison’s • High Na, low K
• Cushing’s • Low Na, high K
• Pernicious anemia • Vit B12 injections monthly
• Sickle cell anemia • High fluids
• Angina • Low cholesterol
• Gouty arthritis • Purine restricted
• ADHD and bipolar • Finger foods
• Burns • high CHON, high Cal, high vit
• Celiac’s dse • Gluten free (BROW)
• Cystic fibrosis • High Na
• Bedsores • High CHON, high vit
• DM • Well balanced
• Dumping syndrome • Low CHO, dry diet
• Hepatic encephalopathy • Low CHON
• Hepatitis • High CHON
• Liver cirrhosis • Low CHON
• Hirschprungs’ dse • Low residue

• Hyperthyroidism • High cal, low residue

• Hypothyroidism • Low cal, low chol
• Hyperparathyroidism • Low C
• Hypoparathyroidism • High Ca
• Meniere’s dse • Low Na
• Cholecystitis • Low fat
• Pancreatitis • Low fat
• Phenylketonuria • Low phenylalanine
• PIH • High protein
• Renal Failure • Low CHON, Na, K
• Tonsillitis • Soft diet

Bedside
• Amputation • Tourniquet
• Autonomic dysreflexia • Catheter
• CTT • Clamp, bottle, vas gauze
• CVA • Suction
• Parkinson's’ • Suction
• Myasthenia gravis • ET and tracheostomy
• Epiglotitis and Croup • ET and tracheostomy
• Thyroidectomy • Tracheostomy, Ca
• DVT and ascites • Tape measure
• Radium implant • Lead container, forceps
• Sengstaken-blakemore • Scissors
• Tonsillectomy • Flashlight
• Tracheostomy tube • Obturator and hemostat
 Positioning
• AAA • High fowlers
• Air embolism • Trendelenburg, slightly left
• Appendicitis, unruptured • Position of comfort
• Appendicitis ruptured • High fowlers
• Asthma • Orthopneic
• Cardiac catheterization • Affected extremity extended
• Casting • Elevate extremity
• Cleft lip • Opposite side or Supine
• Cleft palate • Prone
• CHF • High fowlers
• CVA • Elevate HOB or side lying
• Dumping syndrome • Supine after meals
• GERD • Upright position after meals
• Epistaxis • Leaning forward
• Flail chest • Affected side on bed
• Hemorroidectomy • Side-lying
• Hip replacement • Abduction of legs

Positioning
• Laminectomy, slip disk • Keep as straight as possible
• Liver biopsy • Left during, Right after
• Lobectomy • Unaffected side down
• Pneumonectomy • Affected side down
• Lumbar puncture • Knee-chest, flat on bed after
• Mastectomy • Elevate affected extremity
• Placenta previa bleed • Bed rest
• Postural drainage • Segment to drain upwards
• Prolapsed cord • Knee-chest
• Pulmonary edema • High fowlers
• Pyloric stenosis • Right side lying
• Seizure • Side lying or prone
• Shock • Trendelenburg
• Thrombophlebitis • Elevate extremity
• Varicose veins • Elevate extremity
• Thyroidectomy • No flexion or hyperextension
• Tracheoesophageal fistula • upright

Laboratory data
• AGN • High ASO titer, BUN, Crea
• Leukemia • High WBC, low RBC & PLT
• Addison’s • Low Na & glucose, high K
• Cushing’s • High Na & glucose, low K
• AIDS • (+) ELISA and western blot
• Gouty arthritis • High uric acid
• Rheumatoid arthritis • High RF & ANA, high ESR
• Prostate cancer • High PSA
• Colorectal cancer • High CEA
• Cystic fibrosis • High NaCl on sweat
• DM • Hyperglycemia
• Hemophilia • Prolonged bleeding time
• Hepatic encephalopathy • Elevated BUN
• Hyperthyroidism • High T3, T4
• Hypothyroidism • Low T3, T4

Laboratory data
• Hypoparathyroidism • Low Ca
• Hyperparathyroidism • High Ca
• Liver cirrhosis • High SGPT, SGOT
• Multiple myeloma • Low WBC, RBC, PLT, High Ca
• MI • High troponin, Ck, LDH, SGOT
• Pancreatitis • Hyperglycemia, high amylase
• Polycythemia vera • High RBC
• Renal failure • High BUN, Crea, Na, K low Ca
• Rheumatic heart dse • High ASO titer
• Met acidosis • Low pH, low bicarbonate
• Met alkalosis • High pH, high bicarbonate
• Respi acidosis • Low pH, high CO2
• Respi alkalosis • High pH, low CO2
 Initial manifestation
• AGN • Edema & tea colored urine
• Alzeimer’s • Memory loss, forgetfulness
• Anemia • Fatigue
• Sickle cell anemia • Growth retardation
• Angina • Chest pain
• Arthritis • Morning stiffness
• BPH • Dec force & flow of urine
• Bladder cancer • Painless hematuria
• Breast cancer • Lump or mass
• Cervical cancer • Painless vaginal bleeding
• Esophageal cancer • Dysphagia
• Laryngeal cancer • Hoarseness
• Cataract • Blurred vision, glare
• CHF • Dyspnea or edema
• Congenital hip dislocation • Affected leg is shor

Initial manifestation
• Cystitis • Burning upon urination
• DM • Polyuria, polydipsia
• GBS • Clumsiness
• MS • Diplopia
• MG • Muscle weakness
• Liver failure • Personality change, asterixis
• GERD • Heartburn after eating
• Hypocalcaemia • Tingling and muscle twitch
• Hypokalemia • Parasthesia
• Hypoxia • Restlessness
• Increased ICP • Widening pulse pressure
• Meniere’s dse • Vertigo
• Parkinson’s dse • Pill rolling movement
• Retinal detachment • Visual floaters
• Tardive dyskinesia • Lip smacking

LETS INTEGRATE SIGN AND SYMPTOMS

PAIN
• Dull abdominal or low back pain associated with a pulsating abd mass
• Ans : AAA
• Squeezing, burning, choking pain relieved by rest or nitroglycerine
• Ans: Angina
• Squeezing, burning, choking pain relieved by morphine
• Ans : MI

PAIN
• Rebound tenderness at Mcburney’s point
• Ans : Appendicitis
• RUQ pain radiating to R shoulder, associated with fat intake
• Ans: Cholelithiasis
• LUQ pain radiating to L shoulder
• Ans : Spleenic rupture

PAIN
• Gnawing, burning aching pain 3hrs after eating relieved by food intake
• Ans : duodenal ulcer
• Gnawing, burning aching pain 30min after eating relieved by vomiting
• Ans: gastric ulcer
• Sudden sharp knife like unilateral abd pain
• Ans : ectopic pregnancy

Alopecia
• Endocrine disorder • Hypothyroidism

• Cancer therapy • Chemotherapy and radiation therapy

amenorrhea
• Endocrine disorder • Hypothyroidism

• Psychiatric d/o • Anorexia nervosa and bulimia nervosa

Amnesia
• Psych d/o • Alzheimer's(dementia)

• Psych treatment • ECT

• alcoholism • Wernicke’s and korsakoff’s

• Barrel chest • COPD

• Absent bowel sounds • Paralytic Ileus
• Brudzinski & kernigs • Meningitis, brain hemorrhage
• Buffalo hump • Cushing’s
• Butterfly rash • SLE
• Paradoxical chest movement • Flail chest
• Chvostek’s & trousseaus’ • Hypocalcemia
• Carpopedal spasm • Hypocalcemia
• Cogwheel rigidity • Parkinson's

• Diplopia • MS and MG
• Vertigo (ear dse) • Meniere’s
• Absent Doll’s eye • Brain stem damage
• Exopthalmos • Hyperthyroidism
• Halo vision • Glaucoma
• Green halo vision • Digitalis toxicity
• Heat intolerance • Hyperthyroidism
• Painless Hematuria • Bladder cancer
• Hoarseness of voice • Laryngeal cancer
• Hiccups • Pacemaker failure
• Hirsutism & virilism • Cushing’s
• Homan’s sign • DV

• Moon face • Cushing’s

• Night blindness • Vit A deficiency
• Nuchal rigidity • Meningitis and encephalitis
• Orthostatic hypotension • Hypovolemia and Addison's
• Chest retractions • Asthma, epiglottitis, croup
• Sunset eyes • Hydrocephalus
• Bossing sign • hydrocephalus

• Intention tremors • MS
• Resting tremors or pill rolling tremors • Parkinson’s
• Flapping tremors • Asterixis
• Trismus • Tetanus & rabies
• Decreased caliber of urine • BPH
• Projectile vomiting • Inc ICP & pyloric stenosis
•
Stool
• Clay or gray colored • Biliary dse
• Steatorrhea • Pancreatitis
• Currant jelly • Intussuception
• Ribbon like • hirshprungs
• Hematochezia • Lower GI bleed
• Melena • Upper GI bleed
• Alternating diarrhea and constipation • CA of the colon

• LETS COMBINE EVERYTHING

Abdominal aortic aneurism
• Problem:
• Pulsating abdominal mass
• S/S:
• Pulsating abd mass on palpation
• Best Lab:
• UTZ
• Intervention: Don’t perform?
• Abd palpation
Abruptio placenta
• Problem:
• Premature separation of the placenta
• S/S:
• Dark red vaginal bleeding, peritonitis
• Best Lab:
• UTZ
• Complication:
• Shock and DIC

• Diarrhea
• Problem:
• Increased passage of liquid stools
• S/S:
• Loose watery stools
• Lab:
• Met acidosis
• Intervention:
• Fluid replacement (pedialyte and Oresol)

• AGN
• Problem:
• Damage to kidneys filtering system
• S/S:
• Cola urine, edema
• Lab:
• High crea, BUN, ASO titer
• Interventions:
• Infection and injury precautions
• Diet:
• Low CHON, Low Na
• DOC:
• Steroids

• Leukemia
• Problem:
• Carcinoma of the WBC
• S/S:
• Fatigue, bruising, freq infxn
• Best Lab:
• Biopsy of bone marrow (WBC high)
• Interventions:
• Infection and bleeding precautions

• AIDS
• Problem:
• Degeneration of the immune system
• S/S:
• Non-specific catarrhal symptoms for 1 month
• Lab:
• ELISA and Western blot, CD4 counts
• Intervention:
• Infection precautions, Safe sex

• Addison’s disease
• Problem:
• Hypo functioning of the adrenal glands
• S/S:
• Thin, hypovolemia, bronze discoloration of skin
• Lab:
• Low Na and glucose, high K
• Intervention:
• Prevention of shock, infection precautions, fluids and electrolytes, hypotension
• DIET:
• High Na, Low K
• Cushing’s disease
• Problem:
• Hyper functioning of the adrenal glands
• S/S:
• Edema, hypervolemia, buffalo hump, moon face
• Lab:
• high Na and glucose, low K
• Intervention:
• Infection and injury precautions, Hypertension
• DIET:
• low Na, high K
• Alzheimer's
• Problem:
• Progressive degeneration of cerebral cortex
• S/S:
• Forgetfulness, confusion, confabulation, sun downing
• Lab:
• No specific (ACTH high)
• Intervention:
• 5C’s: clock, calendar, color, caregiver, cognex
• Angina
• Problem:
• Ischemia of myocardium
• S/S:
• Squeezing, crushing chest pain relieved by rest or nitroglycerine, last for no more than 30min
• ECG:
• ST segment depression
• DOC:
• Nitroglycerine
• DIET:
• Low cholesterol
• Appendicitis
• Problem:
• Inflammation of the appendix
• S/S:
• Rebound tenderness, RLQ pain, Mcburney’s point
• Position:
• Before rupture - Position of comfort
• After rupture - High fowlers
• NO:
• pain relievers, laxatives, enema, warm compress
• Asthma
• Problem:
• Hyperactivity of the bronchial airway
• S/S:
• Dyspnea and wheezing
• Lab:
• Respiratory acidosis
• Intervention:
• Orthopneic position, pursed-lip breathing
• Drugs:
• Bronchodilator 1st then corticosteroids
• BPH
• Problem:
• Overgrowth of prostate (benign)
• S/S:
• Decreased caliber of urine
• Lab:
• High acid phosphatase
• surgery:
• TURP – No incision
• Post-op:
• Cystoclysis: OUT must always be more than IN
• BURNS
• Problem:
• Thermal, electric, chemical injury to skin
• S/S:
• 1st degree: pink and red
• 2nd degree: vesicles
• 3rd degree: charred, white, with eschar
• Lab:
• Initially Inc K & dec Na then becomes both dec K & Na
• Intervention:
• Fluid resuscitation (rule of 9’s), Pain control, infxn, contractures
• DIET:
• High cal, CHON, Vit
• Cataract
• Problem:
• Opacity of the lens
• S/S:
• Blurring of vision, glare
• Lab: (slit-lamp)
• Red reflex absent
• Intervention:
• Injury precautions
• Surgery:
• PECLE or PHACO : prevent inc IOP
• CVA
• Problem:
• Disruption of blood supply to the brain (hemorrhagic or thrombotic)
• S/S:
• Hemiplegia, hemi paresis, speech problems, hemianopsia
• Positioning:
• ICP : Elevate HOB
• Aspiration : Side-lying
• Chicken pox
• Problem:
• Infection by varicella zoster
• S/S:
• Fever, fluid filled vesicles
• Intervention:
• Isolate for 2 weeks, treat pruritus
• DRUGS: Never give
• aspirin
• Cholecystitis
• Problem:
• Inflammation of the gall bladder
• S/S:
• Pain in the RUQ radiates to shoulder ass with fat intake
• Steatorrhea and jaundice if severe obstruction
• Surgery:
• Cholecystectomy: high abd incision
• DIET:
• Pre-op: Low fat
• Post-op: No more fat restriction
• Chronic bronchitis
• Problem:
• Copious mucus secretion on the bronchioles (smoking number 1 risk factor)
• S/S:
• Blue bloater
• Lab:
• Respiratory acidosis
• Intervention:
• Max O2 at 4L/min
• Purse lip breathing, chest physiotherapy
• CHF
• Problem:
• Cardiac pump failure due to cardiomegaly
• S/S:
• RSHF: systemic
• LSHF: Pulmonary
• Lab:
• Elevated CVP, PAWP
• Positioning:
• High fowlers position
• DOC:
• Digitalis – (+)inotropic, (-)chronotropic
• Croup
• Problem:
• Inflammation of the airway (laryngotracheobronchitis)
• S/S:
• Barking cough, inspiratory stridor
• Intervention:
• Mist inhalation
• Bedside:
Bedside:
• ET and tracheostomy

• Cystic fibrosis
• Problem:
• genetic disorder of the exocrine glands
• S/S:
• Sweat glands: high NaCl
• Respi glands: copious sputum
• Digestive glands: steatorrhea
• Reproductive: permanent sterility
• Lab:
• Sweat chloride test (40meq/L or higher)
• DIET:
• Low fat, high cal, high Na
• Cystitis
• Problem:
• Inflammation of the urinary bladder
• S/S:
• Dysuria, urgency, frequency
• Lab:
• High WBC, ESR (culture : E.Coli)
• Intervention:
• EOF, Acidify urine
• NO:
• Tight fitting underwear, bubble baths
• Diabetes insipidus
• Problem:
• Hyposecretion of ADH
• S/S:
• Polyuria and polydipsia, hypotension
• Lab:
• Low urine spec. grav
• Intervention:
• EOF, monitor for shock
• DOC:
• Desmopressin
• NSG DX:
• Fluid volume deficit
• Sleep pattern disturbance
• SIADH
• Problem:
• Hypersecretion of ADH
• S/S:
• Edema, anasarca, hypertension
• Lab:
• high urine spec. grav
• Intervention:
• monitor for fluid overload
• DOC:
• Demeclocycline (furosemide may also be used)
• NSG DX:
• Fluid volume excess
• Risk for injury
• Dumping syndrome
• Problem:
• Rapid entry of carbohydrate rich chyme to duodenum
• Long term complication of billroth(gastrectomy)
• S/S:
• Shock like symptoms, diaphoresis
• Intervention:
• Supine position after meals
• DIET:
• Small frequent feedings, Low CHO, dry
• Ectopic pregnancy
• Problem:
• Implantation outside the uterus (fallopian tubes)
• S/S:
• Sharp, stabbing, unilateral abd pain with spotting
• Lab:
• UTZ
• Intervention:
• Prepare client for surgery

• Emphysema
• Problem:
• Loss of alveolar elasticity thus trapping of air
• S/S:
• Pink puffer, barrel chest
• Labs:
• Respiratory acidosis
• Interventions:
• Breathing technique: Pursed lip
• Position: Orthopneic
• Max oxygen: 2-4L/min

• Epiglotitis
• Problem:
• Complete airway obstruction due to infxn of epiglotis
• S/S:
• sore throat
• Positioning
• Tripod position
• Bedside:
• ET and tracheostomy

• Epilepsy/seizure
• Problem:
• Excessive electrical discharge in the brain
• S/S:
• rapid flexion and extension of skeletal muscles, aura and prodrome
• Labs:
• EEG
• Goals:
• During seizure: Safety
• After seizure: Aspiration
• Glaucoma
• Problem:
• Increased IOP
• S/S:
• PAIN, tunnel vision, permanent vision loss
• Labs:
• Tonometry = 25mmHg and up
• Interventions:
• Prevent inc IOP
• Eye gtts: Miototics
• Guillain-barre syndrome
• Problem:
• Inflammation of motor neurons
• S/S:
• Paralysis = Ascending
• Complication: Respiratory failure
-Prevent Respi infxn
-Suction and Tracheostomy at bedside
• Hemophilia
• Problem:
• X-linked recessive d/o of clotting
• S/S:
• bruising, abnormal bleeding
• Labs:
• prolonged INR (PT,PTT, bleeding time)
• Risk for:
• bleeding – use RICE
• Question on PUNNET SQUARE
• Hepatic encephalopathy
• Problem:
• progressive loss of consciousness due to nitrogenous waste
• S/S:
• asterixis, personality changes, dec level of consciousness
• Labs:
• inc BUN
• diet:
• low CHON
• DOC to dec ammonia levels in GIT:
• -Neomycin and lactulose
• Hip Fracture
• Problem:
• break in continuity of hip bone
• S/S:
• pain, shortening and external rotation of leg
• Complication:
• fat embolus
• TTT:
• Splint and immobilize
• surgery ORIF
• post-op goal:
• maintain leg in alignment
• Abduction pillow-to
pillow-to keep head of femur inside Acetabulum
• Trochanter rolls-to
rolls-to prevent external rotation
• Hirschsprung's dse
• problem:
• no nerve innervations on colon
• S/S:
• meconium ileus, constipation, ribbon like stool
• Diet:
• low residue
• TTT:
• Surgery (rectal pull through)
 •
• Hydatidiform mole
• AKA: Gestational Mole
• Problem:
• abN number of chromosomes in fertilization
• S/S:
• rapid growing uterus, passage of grape fruit like vesicles, no fetal movement or heart beat
• TTT:
• surgery (D and C)
• Complication:
• choriocarcinoma - levels of HCG will be monitored for 2yrs
• Hydrocephalus
• Problem:
• excessive CSF in the brain. Can be communicating or non-communicating
• S/S:
• bulging fontanels, sunset eyes, inc ICP
• Position:
• elevate HOB
• TTT: A-V shunt; watch for:
• shunt failure – dilated scalp veins
• infxn – temp and foul drainage
• Shock
• Problem:
Problem:
• decreased circulating blood volume leading to inadequate tissue perfusion
• S/S:
S/S:
• dec BP, inc PR, RR, dec CVP
• Position:
Position:
• trendelenburg
• Increased intracranial pressure
• Problem:
Problem:
• ICP greater than 15mmHg
• S/S:
S/S:
• inc BP (widening
(widening pulse pressure),
pressure), dec PR, RR, projectile vomiting
• Position:
Position:
• elevate HOB
• TTT:
TTT:
• Strongest diuretic - mannitol
• Strongest anti-inflam - steroid
• Surgery - craniotomy
• Infectious mononucleosis
• Problem:
Problem:
• infxn of lymphatic system by Epstein Barr virus
• S/S:
S/S: lymph edema, sore throat, fatigue
• Transmission:
Transmission:
• saliva – no sharing of kitchen utensils
• Complication:
Complication:
• splenic rupture (pain at LUQ)
• Meniere's dse
• Problem:
Problem:
• over production of endolymph in inner ear
• S/S:
S/S:
• vertigo, tinnitus, hearing loss
• Risk for:
for:
• injury
• Diet:
Diet:
• low Na
• Position:
Position:
• Supine on attack
• Multiple myeloma
• Problem:
Problem:
• Carcinoma of plasma cells which invade bone marrow
• S/S:
S/S:
• Bone pain, myelosuppresion
• Labs:
Labs:
• dec rbc, wbc, plt, inc Ca
• Confirmatory:
Confirmatory:
• Bone marrow biopsy
• Risk for:
• bleeding, infxn, fracture, kidney stones
• Interventions:
Interventions:
• EOF, prevent immobility
• Parkinson's Dse
• Problem:
Problem:
• degeneration of substancia nigra leading to diminished dopamine levels
• S/S:
• mask like face, bradykinesia, shuffling gait, drooling, resting tremors, constipation
• Risk for:
for:
• injury and aspiration
• DOC:
DOC: levodopa
• CHON and vit B6 antagonize levodopa
• Bedside: Suction
• Polycythemia Vera
• Problem:
Problem:
• overproduction of rbc
• Labs:
Labs:
• inc rbc, inc plasma osmolarity
• S/S:
S/S:
• hypervolemia, hypertension
• Complication:
Complication:
• thrombus formation - CVA, MI
• PIH
• Problem:
Problem:
• hypertension after 1st trimester of pregnancy (inc in 30-50% of BV)
• Triad S/S:
S/S:
• inc BP, proteinuria, edema
• NSG:
NSG:
• limit environmental stimulation, monitor for epigastric pain, seizure precautions
• DOC:
DOC:
• MgSO4 -CNS depressant, assess: DTR
• Pyloric stenosis

• Problem:
Problem:
• hypertrophy of pylorus
• S/s:
S/s:
• projectile Vomiting
• Position:
Position:
• R side lying
• Retinal detachment

• Problem:
Problem:
• separation of the retina from the pigment layer
• S/S:
S/S:
• visual floaters, curtain falling down, painless
• Emergency TTT:
• patch both eyes

• Reye's syndrome

• Problem:
Problem:
• degeneration of brain, liver, and kidneys due to concurrent viral infxn and aspirin use
• S/S:
S/S:
• inc ICP, elevated SGPT SGOT, dec urine output
• Monitor for worsening of dse:
• dec LOC, crushing's triad, RUQ pain, Jaundice, Oliguria