CA TOPIC 4: ○ PTT = Partial thromboplastin time = to

ADULT HEALTH NURSING check heparin effects (give

CARDIOVASCULAR SYSTEM DISORDERS parenterally/subcu); Protamine sulfate
SV X HR = CO = Good BP, GFR ○ PT = Prothrombin time = to check
FLUID OR BLOOD LOSS= ↑ HR, ↓ SV= ↑ CO warfarin effects (given oral only) = INR =
Deficits in one area Heparin and INR (2-3x above normal);
● Adequate Pump Vitamin K
○ SYSTOLE = ⅓ ○ Clotting Time
○ DIASTOLE= ⅔ ● BUN, Creatinine (kidney concern)
○ contractility ● Serum cholesterol - ↑ cholesterol = ↑ risk
○ heart can act/beat on its own HD; <200 (HDL-good; LDL-bad)
○ any damage to heart can affect CO ● Triglycerides - 10-12 hours NPO
● Good Blood Volume ● Blood cultures = throat swab
○ Venous return/ preload ● Cardiac Enzymes
○ ↓ fluid amount loss = ↓ venous return = ↓ ○ ase (Fellular = found in cell; LDH, AST)
CO ○ Also called cardiac markers - cellular
● Peripheral vascular resistance / afterload proteins (Troponin I and CK-MB) are
○ Every time the heart pumps blood, it sensitive; specific; for heart attacks
pumps against resistance. ○ ↑ Troponin = more cardiac damage
○ Overworks ○ СРК
● Normal heart rate ○ LDH
○ SGOT
Non Modifiable
● Gender = M>F estrogen may have a
protective function/ f age 50 (menopause)
● Age = >40y/o
● Genetics = family suffered from heart attack
Modifiable
● Diet
● Weight ● CVP = 5-10cm water - provides an
● Sedentary lifestyle indication of pressure in the right atrium
● Co-morbid factors = HPN, DM ● ECG - tells the electrical activities if the
● Personality = Type A (high in stress) heart but not the mechanical properties

Diagnostic procedures
Laboratory Tests
● Electrolytes
○ Na
○ K (Na K atpase pump)
○ Ca (↑ = peak T-wave, ↓ = U-waves)
○ Mg
○ Automaticity = the ability to
spontaneously generate and discharge
an electrical impulse. ● Echocardiography (2D echo/doppler) -
○ Conductivity = the ability to transmit an important assessment for the heart
electrical impulse from one cell to the ○ can look at the anatomy and changes of
next. the heart
● ESR = ↑ = systemic inflammatory reaction ○ can look at the physiology of the heart;
(RF/RHD = GABHS = antibody testing = ↑ measure how much the blood is pumped
ASO titer = streptococcal infection) out
● Blood coagulation tests = CBC, platelets ○ Ejection tractions = <50 = CHF
(150-400k)

Arteriography
1 lavaRN
Definition - introduction of catheter to put radio
opaque (iodine based) inject dye to outline blood
vessels (visualize)
Purpose - curative
● Nursing interventions:
○ Radial (do Allen’s test - for collateral
circulation) or femoral artery = common
sites
○ " NPO, informed consent, allergy history
○ Vital signs
○ Check for bleeding (after removing of
catheter; put on pressure dressing)
○ Check distal extremity for color (capillary
refill test), pulse, temperature, sensation
○ Vascular Occlusion: Pain, Pallor,
Pulselessness, Paresthesia, Paralysis
Cardiac Catheterization
● Nursing Interventions:
○ Before
■ Know approach = NO, consent
■ Mark distal pulses
■ Explain procedure
■ Assess for allergy
○ After
■ BP & apical pulse
■ Check peripheral pulse check
bleeding
■ Assess for chest pain
■ Keep extremity extended
■ Assess for impaired circulation
ANGINA “chest pain”
● caused by atherosclerosis = plaque forms =
cholesterol in artery walls
● ↑ cardiac demands = ↑ cardiac blood supply
(if poor O2 = ischemia= pain)
● ↑ effort/workload = relieved by rest/
medication
Unstable angina - thrombosis (technically heart
attack); sent right away to the hospital
○ ACS = NSTEMI, STEMI, Unstable
angina
○ ST elevations/depressions
● Prinzmetal - vasospastic; triggered by
stress
○ intermittent
● Manifestations:
○ Location
○ Character of pain, ST elevation
○ Duration
○ Precipitating events
● Help adjust lifestyle:
○ Avoid excessive cold weather
○ Avoid overeating
○ Avoid constipation
○ Rest after meals
○ Exercise (↑ cardiac resilience)
● Nursing interventions:
○ Assess pain:
■ Location, Character, Duration =
Treadmill/Stress test and 24hr cardiac
holter
■ Precipitating factors
for
Teach client how to cope:
● Nitroglycerin - ↓ workload to your heart
(preload); ↓ coronary blood flow
○ ↑ O2 = ↑ blood flow
When to take it - doctor’s order; before invasive
procedure; chest pain
How often - for 16 hours;
○ rest then take the first dose;
○ then after taking the first dose, rest for 5
minutes;
○ after 5 minutes, if the medication takes
effect, the heart must be relieved;
○ if not, take 2nd dose
○ Nitrate free period= prevents tolerance
(higher dose overcomes tolerance)
Storage - dark-colored air tight bottles
Shelf life: 3 months if stored 3 months or more,
discard. (sensitive to light, air)
Side effects - burning effect under the tongue
(normal finding), headaches
Types:
2 lavaRN
● IV = ‘e’ HPN
● Topical = patch (clean and hair free sites)
● Oral/sublingual = chest pain

MYOCARDIAL INFARCTION - chest pain is

very intense than Angina
Definition - ischemia and death of the heart
muscle; severe shock (decreased bp = ↓blood
flow to heart)
● Obstruction of blood flow
● ACS = NSTEMI, STEMI, Unstable angina
● Mondays; Christmas Eve / New Year = 2 Types of heart Attack:
heart attacks are most common STEMI - ischemia & heart muscle death
● Sudden death = sudden arrhythmias (V-fib NSTEMI - ischemia
and V-tach) ● Nursing Interventions: (assess the px →
● Causes:
call for help → efficient and proper CPR→
○ ASHD & thrombosis (platelet aggregation
blocks the blood flow) ABC = 100 bpm)
○ Coronary artery embolism ● Early Management:
● Manifestations: ○ Treat arrhythmia (AED)
○ (1) heavy chest pain, radiating to the L ○ Analgesics
arm, jaw, neck, not relieved by rest ○ Rest
○ nausea or vomiting ○ Administer 02
○ diaphoresis ○ VS
○ hypotension ○ Drugs
○ (2) ECG changes: depressed ST ○ Emotional support
segment, inverted T wave Objectives: ↑ coronary blood supply and ↓
○ Denial workload
○ (3) increased CPK, LDH, Troponin 1 “MONO TASS”
Note: 2 out of 3 = indicates heart attack

3 lavaRN
 ○ Dyspnea
○ Moist cough
○ Rales, wheezing
○ Orthopnea = sit down to relieve
■ Paroxysmal nocturnal dyspnea -
shortness of breath during sleep
○ Pulmonary edema:
■ moist rales, frothy sputum
■ severe anxiety
■ marked dyspnea & cyanosis
■ edema

● Later Management:
○ Stool softeners
○ Provide low fat, low cholesterol, low Na,
soft food
○ Commode
○ Self-care Right Heart Failure:
○ Plan for Rehabilitation - 6 weeks (able to
climb 2 flights of stairs)

○ Exercise program - starts with low MET

activities

○ Stress management
○ Teach risk factors
○ Psychological support
○ Long term drug therapy
○ Anti-arrhythmic, Anticoagulants,
Antihypertensives

CONGESTIVE HEART FAILURE - because of ● Nursing interventions: (↓ cardiac workload

the injury = failure to pump = ↑ coronary blood flow)
Left Ventricular Failure: ○ Reduce pain and anxiety
● Symptoms: ○ Improve oxygenation
4 lavaRN
 ○ Reduce congestion ● Diet - low sodium, high potassium (dried
○ Improve myocardial contraction foods), fluid management
Valvular Disorders (Endocarditis, CHD,
RF/RAD)
● Symptoms (stenosis or insufficiencies)
○ Heart failure -
○ Murmurs - soft blowing sounds; Indicates
turbulence
○ Decreased CO
● Nursing interventions:
○ Same as CHF
○ Antibiotic therapy
● Surgical (at risk for embolism - triggers the
formation of blood clots)
○ valve replacement - anticoagulants =
heparin (PTT) and warfarin (?)
○ valvulotomy
● Post Op Care
○ monitor VS
○ ECG ventilator
○ monitor intake & output
○ maintain fluid & electrolyte balance
○ chest tubes
○ relieve pain
○ neuro checks
● LVAD ○ peripheral pulses
○ Patients with LVAD don't have pulse ○ TED stockings
Cardiac Glycoside/Digitalis therapy CARDIOMYOPATHY - no cure
● Digoxin - inhibits Na K atpase pump; very AV Blocks
potent that sometimes poisonous (narrow ● 1st Degree
therapeutic index) ○ Delayed transmission
● Normal Digoxin Level: 0.2 - 2.0 ng/ml ○ Prolonged PR
○ Don't give to patients with HR <60bpm ○ No treatment
○ decrease HR (- chronotropic effect), ● 2nd Degree
improve ventricular filling, stroke volume ○ some impulse pass through
and perfusion, strength of contraction (+ ○ some do not atropine & isoproterenol
inotropic effect) = Starling’s Law ○ pacemaker sometimes
● Symptoms of Toxicity: ● 3rd Degree
○ halo around lights - midpoint symptom = ○ no impulse pass through AV node
hallucinations ○ Pacemaker (2 types: Fixed and
○ anorexia, diarrhea - early symptoms = GI Temporary )
distress ● Nursing Interventions for Pacemakers
○ nausea & vomiting - early symptoms ○ pre op teachings
○ symptoms = cardiac ○ post op care
● Nursing Implications: ○ monitor ECG & pulse
○ monitor K levels (hypokalemia) ○ check wound
○ apical HR ○ Analgesics
● Diuretics - reduces workload ○ maintain electrically safe environment
○ Furosemide - loop diuretic; potassium (microwave)observe for hiccups
wasting ○ sterile technique
○ Spironolactone - potassium sparing; ESSENTIAL HYPERTENSION
counteracts effects of furosemide ● 90% have this kind
● Vasodilators (Dilators) ● Hereditary disease
○ ACE Inhibitors - ↓ afterload =↓ workload ● Cause unknown
5 lavaRN
● Late symptoms: headaches, fatigue, ● Coldness
dyspnea, edema, nocturia, blackouts ● Absent pulse
● Nursing Interventions: ● Loss of sensation
○ Correct overweight ● Gangrene ulcers
○ Avoid stimulants ● Decreased capillary refill
○ Program of regular exercise maintain salt
restricted diet Aortic Aneurysms
○ Teach risk factors Abnormal dilation of the arterial wall, caused by
localized weakness & stretching in the medial
layer or wall of the artery.
● Types:
○ According to morphology or form:
○ Fusiform
○ Saccular
○ Dissecting
○ False (Pseudoaneurysm)
● Symptoms:
○ Thoracic: pain, dyspnea, hoarseness,
cough, dysphagia
○ Abdominal: Abdominal pain, persistent or
● Antihypertensive Drugs: intermittent low back pain, pulsating
○ Potassium depleting diuretics abdominal mass
○ Potassium sparing diuretics ● Treatment: usually surgery
○ Adrenergic inhibitors
○ Vasodilators
○ Calcium Agonist
○ all can cause ortho hypertension - get up
slowly
Venous Diseases:
1. Thrombophlebitis - clots lead to vein
inflammation
2. Phlebothrombus - a thrombus w/o
inflammation
3. Phlebitis - vein inflammation usu. assoc. w/
invasive procedures
4. Deep Vein Thrombosis
○ pain (calf or groin tenderness)
○ (+) Homan's sign
○ warm skin
5. Varicosities
● Etiology:
○ prolonged standing
○ pregnancy
○ Obesity
○ Congenital
● Incidence
○ Female
○ 35-40yo

Assessment: In comparison w/ arterial

diseases
● Arterial
● Intermittent Claudication
● Canosis

6 lavaRN
RESPIRATORY SYSTEM DISORDERS
Anatomy and Physiology
Function of the Lungs:
Respiration Normal RR: 12-20 breaths/min
Ventilation
Right: 3 lobes, 10 segments
Left: 2 lobes, 8 segments
Alveoli
● Obstructive Disorders: COPD,
bronchiectasis, allergy
● Restrictive Disorders: kyphoscoliosis,
abdominal distension, edema
● Trauma: stab wound, surgery
● Secretions: infections, irritations
Diagnostic Tests:
● Chest X-ray - non-invasive procedure with
no special preparation, lead shield for
women of childbearing age
● Mantoux Test (PPD/tuberculin skin test) -
test for allergies/skin testing
● Sputum Examination - first morning before
breakfast specimen preferable;
approximately 15 ml required
● Thoracentesis - drawing of fluid in the
pleural space for diagnosis
○ Preparation:
■ Consent and explanation
■ Position sitting on side of the bed with
feet on chair, leaning over bedside
table.
■ No more than 1200 ml should be
removed at one time because this can
cause sudden fluid shifts which can
cause
○ Post Procedure:
■ Apply pressure to puncture site
■ Semi Fowler's position on puncture site
up
■ Monitor for shock, pneumothorax,
respiratory arrest, subcutaneous
emphysema (crepitus)
● Bronchoscopy - is used to view the
airways and check for any abnormalities
○ Preparation:
■ Consent and explanation
■ NPO after midnight
■ ABG, O2 administration
○ Post Procedure:
■ NPO until gag reflex returns
■ Vital signs until stable
■ Assess respiratory distress
■ Warm saline gargles
■ Semi-Fowler's position
Management of Clients with Respiratory
Disorders:
Chronic Obstructive Pulmonary Disease
(COPD)
Definition: a group of conditions associated
with chronic obstruction of airflow entering or
leaving lungs
Progressive and irreversible
3 Kinds: Chronic bronchitis, emphysema,
asthma (asthma is not included anymore
because it is reversible)
Pulmonary Emphysema
Definition: an in the size of the distal air spaces
with the loss of alveolar walls and elastic recoil
of the lungs.
Etiology: cigarette smoking, deficiency of alpha
anti-trypsin
● Manifestations:
○ Shortness of breath
○ Difficult exhalation
○ pursed lip breathing
○ Wheezing, rales
○ Barrel chest
○ Shallow, rapid respirations
○ Anorexia, weight loss
7 lavaRN
 ○ Hypoxia ■ Eat four to six small meals rather than
○ Productive cough three large ones
○ Chronic respiratory acidosis ■ Take small bites and chew slow
Chronic Bronchitis “blue bloater” ○ Pneumothorax
Definition: excessive mucous secretions within ○ Respiratory Failure
the airways and recurrent cough. ● COPD Therapeutic Interventions:
Etiology: heavy cigarette smoking, pollution, ○ Stop Smoking!!
infection ○ Oxygen 1-2 L/m - low flow because pts
● Manifestations: w/ COPD develops hypoxic drive
○ Cough (copious sputum) ○ Supportive Care
○ Dyspnea on exertion, later at rest ○ Pulmonary Rehab
○ Hypoxemia polycythemia ○ Surgery
○ Rales, ronchi ○ Mechanical Ventilation
○ Pulmonary HT leading to cor pulmonale ○ End-of-Life Planning
and peripheral edema ○ Medications
COPD Prevention: stop smoking ■ Bronchodilators
● COPD Diagnostics: ■ Corticosteroids
○ Chest X-Ray ■ Expectorants
○ CT Scan ○ NMT/MDI
○ ABGs ● Nursing Interventions:
○ CBC ○ Prevent exposure to irritants
○ Spirometry - how bad it is ○ Reduce irritants
○ Sputum Analysis ○ Increase humidity
○ Pulmonary Function Test (PFT) ○ Relieve bronchospasm
○ Pulse OxH/H ○ Provide chest physiotherapy
○ Chest physiotherapy ○ Provide postural drainage
○ AAT levels ○ Promote breathing techniques
○ Peak expiratory flow meters ○ Position sitting up, leaning forward
○ Pulmonary toilet/drainage
● COPD Signs and Symptoms: ○ Frequent rest periods
○ Chronic Cough ○ Nebulization
○ Chronic Dyspnea ○ Use Intermittent Positive Pressure
○ Prolonged Expiration ○ Breathing
○ Barrel Chest ○ Oxygen at low flow
○ Activity Intolerance ● Health Teachings:
○ Diminished breath sounds ○ Avoid crowds
○ Hypoxemia ○ Diaphragmatic breathing
○ Hypercarbia ○ Pursed lip breathing
○ Thin extremities ○ Report first sign of URI
○ Wheezing, Crackles ● Home Care:
○ Thick, Tenacious Sputum ○ Dust with wet cloth
○ Increased Susceptibility to Infection ○ Avoid powerful odors
○ Mucous Plug ○ No fireplace
○ Accessory muscles ○ No pets
○ Rapid, Shallow respirations ○ No feather pillows
○ Pallor; cyanosis (late)
○ Hyperresonance - (emphysema) Asthma
Definition: condition of abnormal bronchial
● Complications of COPD: hyperreactivity to certain substances.
○ Cor Pulmonale Etiology: Extrinsic/Intrinsic
○ Weight Loss ● FEV1 improves by 12% or more with
■ Resting before eating ● Beta2 agonist
■ Avoid gas-producing food ● Cough is Non-Productive
● Cough worse at night & early AM
8 lavaRN
● Triggered by allergies/environment Pleural Effusion
● Asthma is reversible Definition: accumulation of non-purulent fluid in
● Manifestations: the pleural cavity
○ Severe, sudden dyspnea Etiology: Blood vessels exudate - hemothorax;
○ Use of accessory muscles Tissue surfaces transudate
○ Sitting up Empyema
○ Diaphoresis Definition: Accumulation of pus in the pleural
○ Anxiety, apprehension cavity
○ Wheezing Etiology: Spread of infection from lungs, chest
○ Cyanosis wall.
● Nursing Interventions: ● Nursing Interventions:
○ Remain with client ○ Remain with client and remain calm
○ High-fowler's position ○ Position High-fowler's
○ Emotional support ○ Assess VS
○ Monitor respiratory status, ABGs ○ Notify MD on any change in condition
○ Promote hydration ○ Provide CXR
○ Provide bronchodilators, nebulization ○ Provide thoracentesis tray
○ Monitor O2 therapy ○ Monitor ABGS
○ Incentive Spirometry ○ Monitor for shock
○ Chest Physiotherapy ○ Assist with insertion of chest tubes - at
the bedside or in an OR done by MD
○ Aseptic technique
○ Local anesthetic, stab wound
○ Upper - air
○ Lower - fluid
○ Occlusive dressing
Closed Chest Drainage
● Purposes:
○ Remove fluid and/or air from pleural
Chest Traumas space
Pneumothorax ○ Re-establish normal negative pressure in
Definition: collection of air in the pleural space the pleural space
Etiology: Trauma, Thoracic surgery, Positive ○ Promote re-expansion of the lung
pressure ventilation, Iatrogenic ○ Prevent reflux of air/fluid into the pleural
● Thoracentesis space form the drainage apparatus
● CVP line insertion ● Types:
● Types: ○ One Bottle System
○ Spontaneous - sudden, sharp pain, ■ Water seal and drainage in same
sudden shortness of breath with violent bottle
attempts to breathe, hypotension, ■ Observe for intermittent bubbling
tachycardia, hyperresonance and breath fluctuation of fluid with each
sounds over the affected lungs, anxiety, respiration
diaphoresis, restlessness ■ Uses: Emphysema
○ Tension - subcutaneous emphysema, ○ Two Bottle System
dyspnea, cyanosis, acute chest pain, ■ Air and fluid into first bottle water; seal
tympany on percussion in second bottle
■ Management: Needle ■ Observe for intermittent bubbling and
Decompression - fluctuation of fluid with each
■ Mediastinal Shift respiration in the water seal bottle
■ Cyanosis ■ Uses: Thoracic surgery,
■ Tracheal deviation pneumothorax
■ Change in PMI ○ Three Bottle System
■ Air and fluid into first bottle
Disorders of the Pleural Space ■ Water seal in second bottle
9 lavaRN
 ■ Suction control on the third bottle ○ Elderly
■ Observe for: Intermittent bubbling and ○ Infants
fluctuation of fluid with each ○ Alcohol abusers
respiration; continuous bubbling in the ○ Post-operative clients
suction-control bottle ○ Clients with chronic respiratory distress
■ Uses: After thoracic surgery, ○ Clients with viral infections
pneumothorax
● Nursing Interventions:
○ Know the purpose for the system
○ Be sure CXR is done to assess
placement
○ Check for bubbling and fluctuation
○ Assess respiratory status
○ Turn; ask the client to cough, deep
breathe
○ Mark the amount of drainage at the
beginning of each shiftNote character of
drainage
○ Be sure the tubing is without kinks, coiled
on bed
○ Keep bottles below level of heart
○ Maintain water seal
○ Maintain dry, occlusive dressing
○ Removal of chest tubes: done by MD
○ Equipment: suture removal kit, sterile
gauze, petroleum gauze, adhesive tape
○ Semi fowler’s or high fowler's position
○ Removal of tubes during expiration or at
the end of full inspiration
○ Apply occlusive dressing
○ CXR
○ Assess complications: subcutaneous Common Manifestation:
emphysema, respiratory distress ● Sudden onset of chills, fever
● Cough: dry and painful
Flail Chest
Causative: Blunt chest trauma often associated Nursing Interventions:
with multiple rib fractures ● Administer drug therapy
Pathophysiology: Paradoxical movement ● Cough suppressants
Result : ● Expectorants
Treatment goals ● Penicillin
○ control pain ● Cephalosporin
○ clear secretions ● Tetracycline
○ ventilatory support ● Erythromycin
● Bedrest
Pneumonia ● Oral hygiene
Definition: inflammation of the lung ● Maintain F&E balance
parenchyma caused by infectious agents ● Pulmonary toilet
Etiology: Bacteria - most common ● Assess for complications
○ S. pneumonia (Pneumococcal)
○ P. aeruginosa (Bronchopneumonia) Tuberculosis
● Influenza (viral) ● Opportunistic infection
● Aspiration ● Inflammatory communicable disease that
● Inhalation of irritating fumes commonly attack lungs
● Persons at risk: ● Caused by mycobacterium tuberculosis
10 lavaRN
● Spreads via droplet ○ muffled voice
● Assess: ● Laryngoscopy
○ Chronic cough - more than 2 wks = ● Bronchoscopy
possible tuberculosis ● Surgery - total laryngectomy
○ Anorexia and weight loss
○ Malaise and fatigue
○ PM Low grade fever
○ Night sweat
○ Chest pain
● Positive PPD
● Gastric Analysis
● Sputum Positive for AFB & Culture
● Chest X-ray
● Transmitted by airborne/droplet infection
● Pharmacotherapy - 6 months
● should take for 2 months - INH,
○ Rifampicin, Ethambutol, PZA Lung Cancer
○ for the next 4 months - INH and ● > males 40-70
Rifampicin ● Risk Factor: cigarette smoking
○ long term ● Chronic cough, weight loss, hemoptysis
○ INH + B6 (most common) - check LFT ● May present with paraneoplastic syndromes
○ Streptomycin - ototoxic/nephrotoxic ○ hypercalcemia of malignancy (HHM) in
○ Rifampicin (2nd most common drug) - squamous cell carcinoma
body fluids red-orange ○ syndrome of inappropriate antidiuretic
○ PZA - raises uric acid levels, check LFT hormone secretion (SIADH) in small cell
○ Ethambutol - neurotoxic = optic neuritis, lung cancer
color blind

Laryngeal Cancer
● Risk Factors
○ Smoking
○ Alcohol
○ Voice abuse
○ Chronic Laryngitis
○ Genetics
● Early sign:
○ hoarseness of voice
○ throat lump or pain
● Late sign:
○ cough, sore throat earache
○ Dysphagia Post-op care for Lung Resection:
○ Dyspnea ● Pneumonectomy
○ enlarged cervical lymph nodes ○ Removal of entire lung
○ weight loss ○ Reasons: CA, abscess
11 lavaRN
 ○ Post op: Dorsal recumbent or
semi-fowler's on affected side
○ ROM to shoulder
○ No chest tube, if there is one, used as a
post op drain
● Pulmonary Embolism
○ Thrombi most often arise from deep
veins in the legs, the righ side of the
heart or pelvic can also be air, fat,
ambiotic
Medical emergency!
Risk factors: immobility, bed rest, history of
previous DVT, pre post op
Assessment findings: severity if symptoms
depend on the size and location
GASTROINTESTINAL DISORDERS
The Digestive System
Anterior View of DigestiveSystem
Stomach
Gastrointestinal Anatomy and Physiology
● Oral Cavity and Pharynx - mechanical
digestion begins in the oral cavity.
● Esophagus - reflexive
● Stomach
● Small Intestine
● Large Intestine
Upper GI - Duodenum - Lower GI
Blood in the Stool - note for the characteristics;
Upper GI bleeding - melena
Lower GI bleeding - hematochezia
Vomiting d/t GI obstruction
Accessory Organs
Liver, Gallbladder, Pancreas and Duodenum
● Liver - produces bile
● Gallbladder - stores bile
○ Bile - emulsifies fat (water-soluble)
● Pancreas - secretion of insulin and
glucagon; main function is endocrine
function and exocrine function — includes
secretion of amylase, lipase, and protease.
Liver Functions (GI → portal vein → liver)
● Carb metabolism - stores glycogen
● Amino acid metabolism - converts excess
ammonia to urea to be removed by kidneys.
(ammonia → urea → urine); responsible for
albumin production
● Lipid metabolism - excretes excess
cholesterol
● Produces clotting factors prothrombin and
fibrinogen (Vitamin K)
● Form bilirubin (cleaning of RBC)
○ hgb → heme → bilirubin →bile → stool
○ bilirubin → urine → yellow/amber in color
● Stores iron, copper, Vitamins A, E, D, K
● Detoxification (alcohol, meds, ammonia)
● Albumin formation
12 lavaRN

Gallbladder/Pancreas Functions
● Stores bile and contracts to secrete bile into
duodenum in response to cholecystokinin
● Pancreas secretes digestive enzymes
amylase, lipase, trypsinogen,
bicarbonate juice (potent)
● Gallbladder stores bile
○ Avoids eating fats - causes pain to
patients with gallbladder disease
Pancreas
● Amylase - changes Starch to Maltose
● Lipase - changes Emulsified Fats to Fatty
Acids and glycerol
● Trypsinogen - changes to Trypsin in
duodenum and digests polypeptides to
amino acids
● Bicarbonate Juice - neutralizes
hydrochloric acid as it enters the duodenum
○ HCL acid - produces chyme (1-2 hrs)
then enters duodenum
Aging and Gastrointestinal System
● Tooth Enamel Harder/More Brittle
● Tongue Atrophy-sweet/sour taste decrease
● Saliva Production Decreased 33%
● Esophagus Motility Less, Emptying Slower
● Weaker Gag Reflex
● Faulty absorption of Bi, Biz, calcium, iron
● Decreased Motility of Stomach
● Decreased Gastric HCL Production
● Fat Absorption Slower
● Atrophy of Large/Small Intestine
● Decreased Mucous Secretions
● Decreased Elasticity of Rectal Wall
Data Collection: Subjective Data
● Health History
● Travel (Clostridium Difficile)
○ diarrhea
● Elimination Patterns
○ changes in the bowel habits
● Medications
○ antihistamine (S/E: GI irritation)
● Nutritional assessment
○ Problem in absorbing food or steatorrhea
● Family History
○ History of cancer/colon cancer
● Cultural influences "Which foods do you
most commonly consume?"
○ What areas in the world where gastric
cancer is common?
■ Mongolia - eat foods that are either
grilled or raw
■ Japan - people eat raw foods
■ South Korea - due to samgy (raw
foods) - carcinogenic
and ■ Tajikistan
■ China
■ Kyrgyzstan
■ Cabo Verde
■ Bhutan
■ Iran
■ Kazakhstan
Data Collection: Objective Data
● Inspection - appearance
● Jaundice, N/V, pain, distention
● Auscultation- listen, normal BS 5-30 per min
● Percussion - detect fluid, air or masses
(usually NP or Dr.); tympany
● Palpation- feel for masses, rigidity, pain
○ RUQ tenderness, distended
○ Appetite/wt changes, bowel changes, HT,
Wt, body mass
○ don’t palpate if there is a large mass (can
putok and cause aneurysm)
Physical Assessment
● Inspection
● Striae - light silver colored or thin red lines
on the abdomen
● Bruising
● Caput medusae - bluish purple swollen
vein pattern extended out from navel
● Spider angiomas - thin reddish-purple vein
lines close to the skin
● Jaundice (icterus) - yellowing of skin
Jaundice Pathophysiology
● Destruction of old red blood cells yield
bilirubin
● Liver converts bilirubin to water-soluble
compound for excretion
● Jaundice (icterus) occurs if liver unable to
convert bilirubin and buildup occurs
● May also occur if bile drainage obstructed
Abdominal Palpation
13 lavaRN

Diagnostic Laboratory Test
● Laboratory Tests
● CBC - reveals anemia or infection
○ bleeding is one manifestation of GI
disease
○ blood in the stool
● Electrolytes - imbalance occurs from
vomiting, diarrhea, or malabsorption
disorders
○ diarrhea - at risk for electrolyte imbalance
● Carcinoembryonic Antigen (CEA) -
monitor effectiveness of GI cancer tx and
reoccurrence
○ CEA - to detect colon cancer; needs to
undergo biopsy (confirmatory)
● Liver Enzymes - ALT(SGPT), AST(SGOT)
increase indicates liver damage
○ High ALT - indicates liver injury
● Stool test-test/ Guaiac Stool Test for
occult blood, false + with bleeding gums
and eating red meats
○ Preparation: 3 days; avoid all meats,
certain fruits and vegetables
(cantaloupe); avoid medications that can
cause GI bleeding
○ Melena - observable
○ Hematochezia - observable
● Radiographic Tests
● Flat Plate of the Abdomen
○ scout film (w/o contrast)
● Upper GI Series (Barium Swallow)
○ N/R - informed consent
○ refrain from eating or drinking anything
○ give laxatives after the procedure;
observe for stool output
● Lower GI Series (Barium Enema)
○ give patient laxatives night before the
procedure
○ barium can trigger peritonitis
○ given laxatives after the procedure;
observe for the stool output
○ observe for signs of peritonitis
● Computed Tomography (CT) Scan
○ contrast allergies
● Magnetic Resonance Imaging (MRI)
○ high risk for patients with prosthetics
● Nuclear Scan
● Angiography
● Liver Scan - nuclear or UTZ (8 hrs NPO)
● Endoscopy
○ Esophagogastroduodenoscopy [EGD]
○ Cholangiopancreatography (ERCP)
○ Lower Gastrointestinal Endoscopy
■ have laxative the day or night before
■ Proctosigmoidoscopy
■ Colonoscopy
● Gastroscopy
● Endoscopic Retrograde
Cholangiopancreatography
● Ultrasonography - will use lubricating gel
on and with a transducer that produces
sound waves. A picture of your abd will
appear on a screen
● Endoscopic Ultrasonography
● Percutaneous Liver Biopsy
● Oral Cholecystogram - (gallbladder series)
if gallstones. Pt ingests a radiopaque dye
that collects in the bile in the liver. Dye
shows up in x-ray.
○ Pretest - high-fat diet x2 days, low-fat
day before test; tke tablets evening
before the test with water 5 mins apart.
NPO after MN
Therapeutic Measures
● Gastrointestinal Intubation
● Tube feedings - Gravity, bolus, pump
● Gastrointestinal decompression
● Total Parenteral Nutrition (intravenous
hyperalimentation)
Purposes
● Remove gas or fluids from the stomach or
intestines.
● Obtain gastric secretions from analysis
● Tx obstructions or bleeding in Gl tract
14 lavaRN
● Provide means for nutrition (gavage
feeding)
● hydration, and medications.

Nausea and Vomiting Therapeutic

Interventions
● Nausea - urge to vomit, Vomiting - expel
contents
● None - may be self-limited
● Protect Airway- prevent aspiration
● Medications - benadryl, vistaril, zofran,
compazine; antihistamine and atropine -
reduces GI secretions
● IV Fluids
● NG Tube Oral Cancer
● Clear Liquids, Dry Toast - can help relieve Risk: Alcohol or Tobacco Use
symptoms ● Detected Early, Curable
Nausea and Vomiting ● Painless
● Nursing Diagnoses ● Difficulty in Chewing, Swallowing, Speaking
○ Nausea ● Biopsies
○ Risk for Aspiration - NPO, SAP, Position: ● Radiation, Chemotherapy, Surgery
High Fowler’s
○ Deficient Fluid Volume - replacement Radical Neck Dissection
through oral and IV; monitor weight

UPPER GASTROINTESTINAL CONDITIONS

Oral Health Care
● Important to overall health/ often neglected
● Oral hygiene with chlorhexidine gluconate
○ Prevents Pneumonia
○ Reduces Ventilator Associated
Pneumonia
○ Candidiasis - tx with nystatin
swish/swallow
Stomatitis Oral Cancer Nursing Care
● Inflammation of Oral Cavity Referral: Alcohol/Tobacco Cessation
● Aphthous Stomatitis (Canker Sores) Pre Op Teaching- communication if trach
(“singaw”) common with dental braces Post-op
patient ● Airway - control secretions
● Herpes Simplex Virus Type I (Cold Sores) ● Communication
commonly in kissing; trigger in cold ● Nutrition - tube feeding
temperature and exposure to the sun, and Esophageal Cancer
stress. Treatment of Choice: Antiviral Risk: Alcohol or Tobacco Use
○ Stage 1 - tingingling, itching and burning ● Detected Late, Metastasizes
○ Stage 2 - blister formation ● Difficulty Swallowing, Feeling Full, Pain in
○ Stage 3 - blister burst Chest, Foul Breath, Food Regurgitation
○ Stage 4 - scab formation Diagnostic: EGD, Biopsy
○ Stage 5 - healing stage Treatment: Radiation, chemo, surgery
● Esophagogastrostomy, dacron esophagus
replacement or esophagoenterostomy
Nursing Diagnoses
● Pain
● Risk for Deficient Fluid Volume

15 lavaRN
● Imbalanced Nutrition: Less Than Body
Requirements
Hiatal Hernia
● Lower Esophagus/ Stomach Slides up
Through Hiatus of Diaphragm into Thorax
● Common: women>60, obese, pregnant
● S/S hernia: pain, heartburn, full feeling,
reflux, possible bleeding, ulceration. s/s
worsen lying down.
● Diagnostic: x-ray, fluoroscope
Therapeutic Interventions
● Antacids
● Eating small meals
● No reclining 1 hour after eating
● Raise head of ed 6-12 Inches
● No bedtime snacks, spicy foods, alcohol,
caffeine, smoking
● Surgery: Fundoplication - assess for
dysphagia with 1st meal
Gastroesophageal Reflux Disease (GERD)
● Gastric secretions reflux into esophagus,
becomes damaged, lower esophageal
sphincter does not close tightly
● S/S: heartburn, regurgitation, dysphagia,
bleeding
○ Trigger by caffeinated beverages
● Complications: esophagitis, Barrett's
esophagus cancer, aspiration pneumonia
● Barium swallow, esophagoscopy
GERD Therapeutic Interventions
● Lifestyle changes - exercise, low fat diet
● Medications
○ Antacids - Tums, Mylanta, Gaviscon
○ H, Receptor Antagonists - Tagamet,
pepcid, Zantac, Axid
○ Proton Pump Inhibitors - Nexium,
prilosec
○ Prokinetic Agents-Reglan, Maxalon
Nursing Diagnoses
● Acute Pain
○ Lose Weight
○ Low-Fat, High-Protein Diet
○ Avoid Caffeine, Milk Products, Spicy
Foods
○ Sleep with HOB > 4-6 inches
○ Eat small meals, avoid lying down 1-2
hrs per eating
Mallory-Weiss Tear
● Longitudinal tear in mucous membrane of
esophagus at stomach junction.
○ Tears from sudden or prolonged
force, usually hiatal hernia
present
● S/S bright red bloody emesis or bloody
stools
● Diagnostic: EGD, hemoglobin/hematocrit
● Usually self heal, antiemetics, avoid alcohol
Gastritis
● Inflammation of the stomach, protective
mucosal barrier is broken down
● S/S: abdominal pain, nausea, anorexia
● Remove irritating substance
● Bland diet of liquids/soft foods - will recover
in 24 hrs
● Antacids
● Inflammation of stomach mucosa, protective
mucosa barrier broken down, acute or
chronic
● S/S: Abdominal pain, N/V, anorexia, feeling
of fullness, abd
● Tenderness, reflux, belching.
● Treatment cause, bland diet of liquids/soft
foods, antacids, antiemetics
Chronic Gastritis
● Type A - Autoimmune gastritis, occurs in
the fundus of the stomach, often
asymptomatic, leads to pernicious anemia.
○ Fundus - decrease intrinsic factor
● Type B - infection with Heliobacter pylori,
occurs in the lower stomach. s/s heartburn,
poor appetite, belching, sour taste, N/V.
Treatment is antibiotics with bismuth.
○ Urease - breath test
○ Proton pump inhibitor - omeprazole
16 lavaRN
Peptic Ulcer Disease
● Erosion of GI lining, primary cause is H.
pylori, curable. Risk factors include
smoking, stress (type A personality,
cushing’s = increased ICP; curling’s =
burns), medications and caffeine
● S/S Gastric - high left epigastric/upper
abdominal burning/gnawing pain, > 1-2 hrs
pc or with food.
● S/S Duodenal - Midepigastric/upper
abdominal pain, burning/ cramping, > 2-4
hrs after meal/middle of night. Relieved with
food or antacids
● Diagnostic - upper GI, urea breath test, IgG
antibody test
Therapeutic Interventions
● Antibiotics
● Proton pump inhibitors
● Histamine H, antagonists
● Bismuth subsalicylate
● Sucralfate (carafate)
● Antacids, bland diet
● Misoprostol - NSAID ulcers or gastritis
● Complications - bleeding, perforation,
obstruction
○ perforation → peritonitis (surgical
abdomen) Subtotal Gastrectomy
● Parietal removal stomach
Stress Ulcers ● Billroth I Procedure (gastroduodenostomy)
● The stress response to illness causes < in ○ Distal 75% stomach removed
blood flow to stomach and small intestines, ○ Anastomosed to duodenum
results in ischemia, allows acid secretions to ● Billroth II procedure (gastrojejunostomy)
create ulcers. ○ Distal 50% of stomach, anastomosed to
● Preventive treatment - Quick trauma care, jejunum
early feedings. Test gastric pH- keep > 5, Total Gastrectomy
antacids, histamine blockers ● Total Stomach Removal, tx gastric cancer
Gastric Bleeding ● Anastomosis of esophagus to jejunum
● Caused by ulcer perforation, tumor, gastric ● Vagotomy (vagus nerve is cut) may be
surgery, occult or observable performed with total gastrectomy. This
● Symptoms vary by severity eliminates vagal stimulation for hydrochloric
● Treat hypovolemic shock if present acid and gastrin hormone secretion and
● NPO, IV Fluids, Blood, NG Tube, Oxygen slows gastric motility
● Nsg Dx: Deficient fluid volume Nursing Care After Gastric Surgery
Gastric Cancer ● Monitor vital signs and resp status
● Malignant Lesion in Stomach, 2nd most ● Control pain
common. Seen in men more than women ● Intake and output
● H. pylori Infection risk factor ● Incisional site
● Poor prognosis as metastasizes ● Assess bowel sounds, abd distention
● No early s/s, late s/s like peptic ulcers - ● NG tube care
indigestion, anorexia, pain relieved by ● Ambulate early
antacids, wt loss N/V ● Education
● Surgery, chemo, radiation Complications of Gastric Surgery
● Hemorrhage

17 lavaRN
● Gastric Distention ● Causes - bacterial/viral Infection, food
● Nutritional Problems allergies
○ Pernicious Anemia ● S/S - fever, foul odor, abdominal cramping,
○ Steatorrhea distention, anorexia, intestinal rumbling
○ Pyloric obstruction
○ Dumping syndrome - ate something that
is osmotic; occurs after an hour or 2 hrs
after eating; s/sx: hypoglycemia;
management: sitting the patient up, eat
food that is high in protein, low in fat and
low (?) in carbohydrates; after eating lie
down in bed to delay gastric emptying

LOWER GASTROINTESTINAL CONDITIONS

Constipation
In stool chart: Indications
● Fecal mass held in rectum, feces become
● Normal = 3-4
dry, hard
● Diarrhea = 6-7
● Causes include meds, narcotics, antacids c
Therapeutic Interventions
calcium, < fiber and < water intake,<
● Identify cause
mobility,fatigue, chronic laxative use
● Replace fluids/electrolytes - most important
● Prevention: high fiber diet, fluids, exercise
● Increase fiber/bulk
● Signs and Symptoms
● Diphenoxylate (Lomotil), Loperamide
○ Abd pain, distention
(Imodium)
○ Indigestion
● Lactinex restores normal flora
○ Rectal pressure
● Nursing Diagnoses: Pain, Risk for deficient
○ Intestinal rumbling
fluid volume
○ HA, fatigue, < appetite
● Complications
Appendicitis
○ Impaction
● Inflammation of the appendix
○ Ulcers
● Fever, nausea/vomiting, anorexia, pain right
○ Straining - valsalva
lower quadrant
○ Megacolon
● Increased white blood cells
○ Bowel obstruction
● Intussusception - can be treated by barium
● Diagnostic: patient c/o, H&P
enema
● NPO, Surgery
Therapeutic Interventions
● Post Op Care - NPO till Gl function returns,
● High Fiber Diet
control pain, TCDB, early ambulation
● 2-3 L Fluid Daily
Peritonitis
● Exercise- Strengthen Abdominal Muscles
● Inflammation/infection of peritoneal cavity
● Bulk-Forming Agents
● Commonly caused by trauma, infection
● Stool softeners
Signs and Symptoms
● Education
● Abdominal pain, abdomen rigidity,
Data Collection
nausea/vomiting, fever
● History - elimination patterns, diet
Therapeutic Interventions
● Assessment - establish rapport
● NPO
● Auscultate Bowel Sounds
● Fluid/electrolyte replacement
● Inspect/Palpate Abdomen
● NG tube
● Nsg Dx: Constipation, Anxiety, Knowledge
● Antibiotics
deficit, perceived constipation
● Surgery
● Pain control
Diarrhea
● Nursing Diagnoses: Acute pain, Deficient
● Fecal matter passes rapidly, decreased
fluid volume, imbalanced nutrition: less than
absorption leads to dehydration
body requires

18 lavaRN
Diverticulosis/Diverticulitis ○ Acute Pain
● Diverticulum - outpouching of bowel ○ Diarrhea
mucous membrane caused by > pressure ○ Deficient Fluid Volume
within the colon and weakness in the bowel ○ Anxiety
wall. ○ Impaired Skin Integrity
● Diverticulosis - multiple diverticula; ○ Ineffective nutrition: less than body
inflammation and bleeding requires
● Diverticulitis - inflammation/infection of ○ Ineffective coping
diverticulum Irritable Bowel Syndrome
● Causes - chronic constipation or decreased ● Altered intestinal motility, colon does not
intake of dietary fiber contract in a normal pattern, bowel mucosa
● S/s - Bowel changes, constipation to not changed
diarrhea, cramping pain L lower quad, ● Psychological Stress/Food Intolerances
bleeding ● More Common in Women
● Treatment: ● Dx: H&P, BE, UGI, sigmoidoscopy
○ Prevent constipation ● Signs and Symptoms
○ Intravenous antibiotics ○ Gas, bloating, constipation, diarrhea, abd
○ Pain control pain, depression, anxiety
○ Surgery ● Tx: High fiber and bran diet
Crohn’s Disease ○ Avoid trigger foods
● Inflammatory bowel disease in any part of ○ Small frequent meals
the intestine, has remissions and ○ Stress management
exacerbations, cause unknown, may be ○ Exercise and medications
hereditary. Abdominal Hernia (congenital or acquired)
● S/S - Abdominal pain or cramping, weight ● Protrusion of organ or structure through
loss, diarrhea, fluid/electrolyte imbalance weakness or tear in wall of abdomen
● Dx: Barium enema, colonoscopy ● Inguinal- groin area where spermatic cord
● Complications: malnutrition, fistulas is in males round ligaments in females
● Therapeutic Interventions ● Umbilical- failure of umbilical orifice to
○ Avoid Offending Foods close
○ Medications - anti inflammatory, ● Ventral- (incisional) result from weakness
antidiarrheal antibiotics, corticosteroids inabd wall following surgery
○ Surgery if necessary ● Direct and Indirect inguinal hernia -
○ Elemental formula or TPN if required common in both men and women
○ Support and education ● Femoral hernia - common in women
Ulcerative Colitis ● S/S- none or abnormal bulging in affected
● IBD of large colon and rectum, remissions area (> with straining or coughing)
and exacerbations ● Complications
● S/S - Abd pain, 5-20 stools daily, rectal ○ Strangulated Incarcerated Hernia -
bleeding, fecal urgency, poor appetite, when edema or adhesions occur
weight loss, cramping, vomiting, fever, between the sac and its contents, can
dehydration become irreducible. The trapped loop of
● Dx: endoscopy, barium enema, ESR>, bowel becomes strangulated and blood
CBC, WBC> supply cut off. Will see pain at site, n/v,
● Therapeutic Interventions and abd pain
○ Avoid Offending Foods
○ Medications - anti inflammatory,
antidiarrheal, immunosuppressants,
corticosteroids
○ Surgery if necessary
○ Elemental formula or TPN
○ Support and education
Inflammatory Bowel Disease
● Nursing Diagnoses
19 lavaRN
● Treatment includes observation and brief or ● Causes: diverticulitis, polyps, anal fissures,
binder to hold hernia in place. hemorrhoids, IBD, cancer
● Surgery: ● Occult blood, melena, bright red stools
○ Herniorrhaphy - incision into abdominal ● Treat cause: monitor stools and bleeding,
wall, replace contents of hernia sac, sew VS, diagnostic preps
weakened tissue and close opening Colon Cancer
○ Hernioplasty - replace hernia in ● Major Cause: Lack of Dietary Fiber
abdomen, reinforce muscle wall with ● Signs and Symptoms:
wire, fascia or mesh ○ Change in Bowel Habits (age = older)
○ NPO until return of bowel movement ○ Blood or Mucus in Stools
Bowel Obstruction ○ Abdominal or Rectal Pain
● Flow of Intestinal Contents Blocked ○ Weight Loss
● Mechanical - blockage occurs within the ○ Anemia
intestine ○ Obstruction
● Paralytic - peristalsis impaired ● Diagnosis
● Can be partial or complete- severity ○ Colon Care
depends on area of affected bowel, amount ○ Colonoscopy with Biopsy
of occlusion, and amount of blood flow ○ Sigmoidoscopy with Biopsy
disturbance ○ Proctosigmoidoscopy
● Signs and Symptoms: ○ Barium enema
○ Abdominal Pain ○ Abdominal and rectal exam
○ Blood and mucus per rectum (currant ○ Fecal occult blood
jelly stool) Therapeutic Interventions
○ Feces and flatus cease ● Surgery - resection, possibly colostomy
○ Fecal vomiting may occur ○ Radiation
○ Bowel sounds high-pitched/tinkling or ○ Chemotherapy/radiation
absent ○ Analgesics
○ Abdominal distention ○ TPN if necessary
○ Fluid/Electrolyte imbalance ● Nursing Care: support and education
● Diagnostic: abd x-ray, CT, CBC & ● Nursing Diagnoses: Pain, anxiety,
electrolytes imbalanced nutrition
● Treatment
○ NPO Ostomy Management
○ Frequent Mouth Care ● Ostomy: surgically created opening diverts
○ Nasogastric Tube stool or urine to outside of body
○ Fluid and Electrolyte Replacement ● Stoma: portion of bowel sutured onto
○ Medications: antibiotics, antiemetics, abdomen (beefy red; if bluish = report)
analgesic ● Abdominal Ostomies: Ileostomy,
○ Surgery Colostomy, Urostomy
Anorectal Problems Ileostomy Types
● Hemorrhoids - varicose veins in the anal ● Conventional Ileostomy
canal (poor toilet habits). ○ Small Stoma Right Lower Quadrant
○ Prevent constipation, avoid straining ○ Continuous Flow Liquid Effluent
○ Sitz bath, antiinflammatory med, stool ● Continent Ileostomy
softeners, sclerotherapy, or surgical ○ Internal Reservoir with Nipple Valve
removal ○ Empty Reservoir 3-4 Times Daily
● Anal Fissures - cracks or ulcers in the Colostomy
lining of anal canal. Stool softeners, sitz ● Stool becomes less liquid and more solid as
bath, anesthetic suppositories location of ostomy becomes more distal in
● Anorectal Abscess - pus pocket in rectal colon
area. ● Types:
○ Antibiotics (ointments), I&D ○ End Stoma
Lower GI Bleeding Causes ○ Proximal Bowel End Brought to
Abdominal Wall
20 lavaRN
 ○ Loop Stoma
○ Loop of Bowel Outside Abdomen with
Bridge Under It
Preoperative Ostomy Care
● Wound Ostomy Continence Nurse
○ Marks Site
○ Emotional, Physical Support
● Teaching - appliance change, hygiene,
dietary considerations
● Bowel Preparation
● Antibiotics
Data Collection
● Vital Signs
● Reinforce teaching
● Stoma - monitor skin for irritation
● Stoma shrinks over weeks
○ Pink To Red, Moist = Normal
○ Bluish = Inadequate Blood Supply
○ Black = Necrosis
Hepatitis
● Inflammation of the Cells of the Liver,
Usually Caused by a Virus.
● Types:
○ HAV - epidemic form → oral - fecal route
= immune ka na 4life
○ HBV - bodily fluids = HIV transmitted
through sex and sharing needles = build
up defenses, start vaccination.
○ HCV - transmitted HIV; blood product
○ HDV - transmitted HIV; blood product
○ HEV -
○ HGV -
● Prevention
○ Cleanliness - HAV
○ Vaccines - HAV, HBV up to 3rd dose
○ Standard Precautions
● Diagnostic: Liver enzymes, serum bilirubin,
ESR, PT
● Signs and Symptoms
○ Prodromal Stage - Flu-Like Symptoms
last 1-2 wks. Fatigue, HA, loss of
appetite, low- grade fever, RUQ Pain
○ Icteric Stage - 2-6 Weeks, Worsening
s/S, Jaundice, liver may begin to enlarge
○ Convalescent - 4-6 Weeks or months
■ Return to Normal Liver Function
Therapeutic Interventions
● Rest
● Nutrition
● Interferon therapy
● Antivirals - ribavirin
● Avoid alcohol and liver toxic drugs
(paracetamol)
● Nursing Diagnoses: Imbalanced nutrition,
skin, pain, risk for ineffective regimen
management
Fulminant Liver Failure
● Sudden massive necrosis of liver tissue
● Etiology - drug toxicity or hepatitis
● S/S hepatic encephalopathy (CNS
dysfunction) lapse into serious illness,
begins with confusion, progresses to coma.
In a matter of hours, the liver may show
rapid reduction in size. Sudden in liver
enzymes, bilirubin, PT.
● Therapeutic Interventions
○ Bedrest - tx to stop or reverse damage
○ Eliminate all drugs
○ Possible dialysis - if liver damage is
result of toxic substance
○ High calorie, low Na, low protein diet
○ Lactulose, neomycin to < ammonia levels
○ Transplant
● Complications
○ Metabolic alkalosis - r/t disruption of urea
production
○ Hypokalemia - kidneys excrete K+ in
attempt to correct alkalosis
○ Hypoglycemia - loss of glycogen stores
in damaged liver
○ Clotting disturbances
○ Sepsis - poor WBC migration
○ Renal failure and respiratory failure
Chronic Liver Failure (Cirrhosis)
21 lavaRN
● Caused by chronic alcohol ingestion ● Serum Ammonia
(Laennec’s), postnecrotic liver failure r/t ● PT
exposure to toxins or hepatitis, biliary liver ● Abdominal X-Ray
failure r/t inflammation and obstruction of ● UGI Series
the gallbladder, cardiac liver failure r/t ● Liver Scan
severe congestion of the liver from heart ● EGD
disease ● Liver Biopsy
○ Hepatotoxins Therapeutic Interventions
○ Hepatitis ● Ascites
○ Gallbladder Obstruction ○ Diuretics (furosemide
○ Heart Failure = hypokalemia;
● Signs/Symptoms spironolactone = K
○ Liver failure = increase SGPT and ALT sparing), Sodium
○ Inflammation of Liver Cells, infiltrates Restriction
with fat and WBCs, fibrotic Scar tissue ○ Albumin infusion
replace liver tissue ○ TIPS (shunt) -
○ Malaise, anorexia, indigestion, n/v, wt Transjugular
loss intrahepatic
○ Diarrhea, constipation, RUQ pain, liver portosystemic
enlargement, bleeding, jaundice, itching,
loss of liver function

● Esophageal Varices
○ Vasoconstrictors -
vasopressin
○ Tamponade
○ Sclerotherapy
○ Sengstaken -
Complications of Cirrhosis blakemore tube =
● Hepatorenal Syndrome - 2nd kidney scissors at bedside
failure, < GFR with oliguria < 200ml, ● Encephalopathy (increase ammonia =
● Clotting Defects - impaired prothrombin hepatic coma)
and fibrinogen production in liver ○ Enemas (Saline or MgSO4) = rifaximin
● Ascites - serous fluid in abd ○ Neomycin, Lactulose = 2-3 stools/day
● Portal Hypertension - blockage of blood ○ Restrict Dietary Protein
flow in portal vein ○ Dialysis
● Encephalopathy - liver cannot make toxins ● Nursing Diagnoses: Acute and Chronic
water-soluble for excretion in the urine. Liver Failure
End-stage ○ Excess Fluid Volume
Diagnostic Tests ○ Imbalanced Nutrition
● Liver Enzymes ○ Pain
● Bilirubin, Urobilinogen ○ Risk for Disturbed Thought Processes

22 lavaRN
 ○ Risk for Ineffective Breathing Pattern ● Functioning pancreas tissue is replaced with
○ Risk for Deficient Fluid Volume fibrotic tissue. Pancreatic ducts become
○ Risk for Infection obstructed, dilated and atrophy. Pancreas
becomes small/hard and smaller amounts of
Liver Transplant enzymes are produced.
● Candidates ● Major cause is alcohol consumption and
○ Liver failure, no cancer repeated attacks of acute pancreatitis
○ No complications, otherwise stable Sign and Symptoms
● S/S rejection ● Remission and Exacerbations
○ Pulse above 100 bpm ● Midline or LUQ Pain
○ Temp > 101, RUQ pain ● Anorexia and Weight Loss
○ Jaundice, elevated liver enzymes ● 6 Malabsorption - fatty stools and diarrhea
○ Decrease in bile from T-Tube ● Diabetés Mellitus
Cancer of the Liver ● Diagnostic: amylase/lipase normal or <,
● Usually Metastasized from Another Site fecal fat analysis, CT
● Risk Factors Therapeutic Interventions
○ Chronic Hepatitis B ● Diet - clear liquids to high - carb, low - fat
○ Nutritional Deficiencies diet.
○ Exposure to Hepatotoxins - ● Analgesics
dioxins (toxic) ● Pancreatic Enzyme Replacement, vitamin
● S/sx: encephalopathy, bleeding, jaundice, supplements, B12
ascites ● Surgery
● Diagnostic / Treatment: alkaline ● Nursing Diagnoses - Pain, Nutrition, risk for
phosphatase, liver scan, biopsy, surgery, Injury, risk for ineffective breathing
chemotherapy
Acute Pancreatitis Cancer of the Pancreas = biliary obstruction
● Inflammation caused by autodigestion of ● Risk Factors include high fat diet, smoking,
pancreatic enzymes, pancreas normally diabetes, alcohol, chronic pancreatitis
secretes enzymes, become activated in the ● S/sx: wt loss, abd pain- worse @ HS, poor
pancreas and begin to digest the pancreas appetite, n/ v, bloated feeling
● S/Sx: abdominal pain, epigastric area, ● Diagnostic: serum amylase/lipase, liver
guarding LUQ, hypotension, low-grade enzymes, CEA, CT, biopsy
fever, N/V, jaundice ● Treatment: whipple procedure, stent,
○ Grey turner’s sign chemo radiation
○ Cullen’s sign - superficial bruising in the
subcutaneous fat around the umbilicus
● Diagnostic: serum amylase/lipase, x-ray,
CT
● Complications
○ Cardiovascular Failure
○ ARD
○ Renal Failure
○ Hemorrhage
○ Infection
Therapeutic Interventions
● IV Fluids/TPN, 02
● Blood Products PRN
● Analgesics, Antianxiety Agents
● NPO, NG Suction
● Histamine Antagonists
● Complications: ARDS, Renal failure,
hemorrhage, infection, cardiovascular
failure
Chronic Pancreatitis
23 lavaRN
 ● Sign and Symptoms:
○ Increased Vital Signs
○ Vomiting
○ Jaundice
○ Epigastric Pain
○ RUQ Tenderness - may radiate to back,
R scapula, and shoulder
○ Nause
○ Indigestion
○ Positive Murphy's Sign
○ Biliary Colic
● Complications
○ Cholangitis
○ Necrosis/perforation of GB
○ Empyema
Gall Bladder Disorders ○ Fistulas
These 3 are the common: ○ carcinoma of GB, pancreatitis
● Cholecystitis: inflammation of GB ● Diagnostics: WBC, x-ray, oral
● Cholelithiasis: gallstones, mainly of cholecystography, ultrasound
cholesterol Therapeutic Interventions
● Choledocholithiasis: stones in common ● Analgesics- demerol
bile duct ● Antispasmodic - probanthine, bentyl
● Causes: stasis of bile, > cholesterol intake ● Antiemetics - compazine, phenergan
combined with sedentary lifestyle, family hx ● Diet - teach to distribute fat intake in small
● Risk Factors portions throughout the day to prevent
○ Fat excess fat in the intestines at one time.
○ Forty ○ Avoid fatty meals; if the patient eat the
○ Female bladder will contract
○ Fertile Cholelithiasis Treatment
● Cholecystectomy - removal of GB
○ Laparoscopic
○ Traditional
● Choledochoscopy - endoscope to explore
common bile duct (ERCP)
● ESWL - extracorporeal shock-wave
lithotripsy
● Drugs to Dissolve - chemodiol, ursodiol
T-Tube

24 lavaRN
 GENITOURINARY DISORDERS
Functions of the Kidney
○ Acid-base balance
○ Excretion of metabolic wastes
○ BP regulation
○ Secretes erythropoietin
○ Conversion of Vit D
○ Excretion of water soluble metabolites
● Diagnostic Tests
○ Urinalysis;
○ Specific gravity; N = 1.005-1.015
○ Color - amber
○ Negative RBC, WBC, CHON, CHO
Nursing Care (DRAIN) ○ pH: 5-8
● Drainage bag positioned correctly ○ 1st voided sample
● Record and empty drainage per facility's
protocol ● Renal Function Tests
● Assess color and consistency of drainage ○ BUN
● Inspect skin and abdomen frequently ○ Creatinine - most important to monitor for
(monitor) kidney function; elevates
● Need physician's order to clamp or flush the ○ Creatinine clearance = 24 hr urine; 1st
t-tube void throw
○ Uric acid
○ PSP
○ KUB
○ GFR

Retrograde Pyelogram
● A retrograde pyelogram uses X-rays to look
at bladder, ureters and kidneys. This test is
done using fiberoptic ureteroscope during
cystoscopy procedure wherein contrast dye
is injected directly into the ureters. The
contrast helps parts of the body show up
more clearly on an X-ray. The exam is
performed under anesthesia.
● Cystoscopy
● Diagnostic
● Treatment
○ Needle Biopsy

25 lavaRN
 ○ dehydration immobilization
○ Hypercalcemia
○ Hyperuricemia
○ Vit A deficiency
○ Heredity
○ Sex & Age - more common on older
people
○ Most are calcium stones

○ Catheterization

Urinary Tract Infection

● Definition
○ Bacterial infection of the urinary tract
○ Urethritis
○ Cystitis
○ Pyelonephritis - more severe infection
and prone to sepsis (w/ lumbar pain) ● Manifestation
○ More common to women than men due ○ Pain
to anatomical position and hygiene ○ Nausea & vomiting
problems ○ Hematuria
● Manifestations ○ Symptoms of UTI
○ Frequency & urgency ● Nursing Intervention
○ Dysuria ○ Eradicate stones
○ suprapubic tenderness ○ Force fluids
○ Hematuria ○ Strain urine
○ Fever ○ Give meds as ordered - buscopan
○ Cloudy, foul-smelling urine ○ Maintain proper urine pH
● Risk Factors ○ Diet therapy - avoid foods high in oxalate
○ Men over 50 and calcium
○ Infants
○ Patients who have
undergone urological
procedures
○ Prolonged bed rest
○ Frequent sexual
intercourse
● Nursing Intervention
○ Urine C/S
○ Antibiotics
○ Maintain urine pH
○ Force fluids
○ Analgesics
○ Teaching

Urolithiasis /Nephrolithiasis /Ureterolithiasis

/Cystolithiasis
● Etiology
○ obstruction & urinary stasis - nidus
formation (formation of stones)
○ proteus infection
26 lavaRN
 ○ Diuresis: high CHON, high Calorie,
restrict fluids
● Phosphate gels - correct hypokalemia and
hypocalcemia
● Prevent infection
● Weigh daily
● Intake & Output
● Dialysis - rare cases

Chronic Renal Failure

● Irreversible, Chronic, and Progressive
Acute Renal Failure ● Etiology - nephropathy (diabetic and
● Etiology hypertension)
○ Pre-renal ● Stages
○ Renal ○ diminished renal reserve
○ Post-renal ■ GFR is 40-50%
Causes of Acute Renal Failure ○ renal insufficiency
● Prerenal 60-70% of cases ■ GFR is 20-40%
○ Volume depletion as seen in ■ Azotemia is present
hemorrhage, renal losses from diuretics, ○ renal failure
I losses from vomiting, diarrhea ■ GFR is 10%
○ Impaired cardiac output 2ndary to MI, ■ Electrolyte imbalance
heart failure, dysrhythmias, cardiogenic ○ uremia - end stage
shock
○ Vasodilation from sepsis, anaphylaxis,
antihypertensive meds
● Intrarenal actual parenchymal damage
○ Prolonged renal ischemia from
myoglobinuria (rhabdo, trauma, burns),
hemoglobinuria (transfusion reaction,
hemolytic anemia)
○ Nephrotoxic agents like aminoglycosides,
radiopaque contrast, heavy metals,
solvents, NSAIDs, ACEls, acute
glomerulonephritis
● Postrenal
○ Urinary tract obstruction by calculi,
tumors, BPH, blood clots ● Manifestations
● Manifestations ○ Fatigue
○ Oliguric (8th-14th day) ○ Headache
■ Sudden onset, <400cc/24 hours, ○ GI symptoms
elevated BUN, crea, K, decrease ○ HPN
urine SP ○ Irritability
■ Lowered CVP ○ Convulsions
○ Diuretic Phase (12th-14th day) ○ Anemia
■ Dilute urine, 1000cc/24 hrs ○ Edema
○ Recovery ○ Hypocalcemia
Nursing Intervention ○ Pruritus, uremic frost (very itchy)
● Treat/eliminate/prevent cause ○ Metabolic acidosis
● Maintain F & E balance ○ Elevated BUN, Creatinine, Na, K
● Diet ● Nursing Interventions
○ Oliguric: low CHON, high CHO, high Fat, ○ Maintain kidney homeostasis
low K ○ Bedrest
○ Diet: low CHON, low K, high CHO,
27 lavaRN
 ○ Vitamin supplements, low Na
○ Treat HPN
○ Watch out for signs of cerebral irritation
○ Prevent water & electrolyte imbalances
○ Fluid replacement
○ Aluminum hydroxide
○ Dialysis: osmosis, diffusion, filtration =
semipermeable membrane dialysis
● Goals:
○ Remove end products of metabolism
○ Maintain safe concentration of
electrolytes
○ Correct acidosis and restore blood
buffers
○ Remove excess fluid blood
○ Types:
■ Hemodialysis
■ Peritoneal dialysis
○ Diuretics
○ Skin care
○ Emotional support

Hemodialysis
● Diffusion, osmosis, filtration
● Nursing Intervention:
Peritoneal Dialysis
○ Weigh client before and after procedure
● uses the peritoneum as a dialyzing
○ Withhold any antihypertensive drugs or
membrane
sedatives
● Goals:
○ Continuous monitoring during the
○ Removal of end products of metabolism
procedure
○ Maintenance of safe concentration of
○ Care of access site (precautions; e.g.,
serum electrolytes
don’t use the arm during vital signs
○ Correction of acidosis
taking)
○ Removal of excess fluid from blood
○ Assess for bruit and thrills
● Nursing Interventions
○ Provide adequate nutrition
○ Have client void
○ Observe for psychologic problem
○ Weigh client daily
● Alert for frequently occurring medical
○ Take VS frequently, baseline electrolytes
problems:
○ Maintain asepsis
○ arteriosclerotic cardiovascular disease
○ Keep accurate record of fluid balance
○ intercurrent infection anemia
● Procedure
○ bleeding
○ Warm dialysate
○ disordered Ca metabolism
○ Allow to flow in by gravity
○ chronic ascites
○ 5-10 mins inflow time
○ disequilibrium syndrome
○ 30 mins equilibration (dwell time) - record
○ fatigue after the procedure
input
REMEMBER AEIOU
○ 10-30 mins drainage (drainage time) -
A - acid-base imbalance
record output
E - electrolyte imbalance
○ Continued for 24-48 exchanges
I - intoxication - patient who overdose alcohol
○ Monitor for complications
O - overload of fluids
● Complications:
U - uremia
○ Peritonitis
○ Bladder perforation
○ Hypotension

28 lavaRN
 ○ Bowel perforation

Prostate Enlargement
Benign Prostatic Hyperplasia (BPH) VS
Prostate Cancer
● Enlargement of the prostate
● Etiology: unknown, accompanies the aging
process in males

● Manifestations: Treatments:
○ Difficulty starting stream ● Urinary antiseptics
○ UTI ● Terazosin - alpha 1 agonist; tx for BPH =
○ Nocturia, hematuria, dribbling urethra relaxes
○ Decrease in the size and force of urinary
stream

● TURP

29 lavaRN
Nursing Intervention
Preoperative
● Maintain adequate bladder drainage
● Antibiotics
● Check BP
● Ensure adequate hydration
● Weigh client daily
Postoperative
● Observe for shock and hemorrhage
● Watch out for arterial bleeding
● Common during the 1st 48 hours and after
6-10 days post-op
● Provide pressure using the catheter
Cystoclysis/ Bladder Irrigation
Purpose:
● To prevent blood clot formation
○ allow free flow of urine and maintain IDC
patency, by continuously irrigating the
bladder with Normal Saline
Procedure:
● Unclamp the irrigation flask that was used to
prime the irrigation set and set the rate of
administration by adjusting the roller clamp
Note: The aim of the bladder irrigation is to keep
the urine rose coloured and free from clots
Note: Continuous bladder irrigation
should not go beyond in weeks
● Failure to recognize that the fluid is not
draining can result in severe bladder injury,
as large volumes of irrigation solution are
typically instilled. .
Example:
● 100cc is irrigated + 30cc urine output/hr =
130cc is expected
Note: If output is less than NOTIFY THE
PHYSICIAN
● Dilutional hyponatremia
○ Agitation, confusion, nausea
○ Use isotonic glycine solution
● Sepsis
○ Watch out for signs of septicemia
● Thrombus & embolus
○ Turn patient
○ Leg exercise
● Bladder spasms
○ Give antispasmodics
○ Encourage ambulation
○ Should decrease in 24-48 hrs
○ Avoid valsalva maneuvers
● Promote urinary drainage
○ Catheterization
○ Continuous or manual irrigation
○ Encourage perineal exercises MUSCULOSKELETAL DISORDERS
● Help in adjusting in self concept Musculoskeletal Assessment
30 lavaRN
Skeletal System ○ Promote bone growth
Functions: ○ Stops it release:
● Support - framework of the body ■ Female - 18 yrs old
● Mobility - ROM; protection ■ Male - 21 yrs old
● Protection - hard bones ○ Midnight - peak release of growth
○ stomach - no protection hormone
● Cell production - blood cells (platelets and ● Glucocorticoids
WBC) ○ Steroids = bone resorption
● Storage - minerals (calcium and ● Estrogen
phosphorus) ○ PTH antagonist (bone resorption)
Types of Bones ○ Menopause = decreased estrogen =
● Long bones - humerus, radius & ulna, bone resorption = osteoporosis
femur, tibia & fibula
● Short bones - carpals, metacarpals, Diagnostic Examinations
phalanges, tarsals, metatarsals ● Radiographic Exams
● Irregular bones - spinal column/vertebral ○ X-ray - remove jewelry
column ○ CT scan
● Flat bones - skull, rib cage, scapula, ilium ■ Plain - no special preparation
Bone marrow ■ Contrast - Consent, Allergy to
● Yellow Marrow - bulalo, taba, wala iodine/seafoods, NPO
masyadong ambag ○ Myelography
● Red Marrow - site of production of immature ■ For detecting tumors or herniated
RBCs intervertebral disc
Flat bones - richest site of red marrow ■ Pre Test - consent, check for allergy,
● Ilium - common site of red marrow NPO
aspiration ■ Post Test - neurological assessment,
Long bones - richest site of yellow marrow Cerebrospinal Fluid → Spinal
Headache, proper position (depends
Growth and Metabolism on dye; oil-based, water-based), flat
● Parathyroid Hormone (Parathormone) for 12 hrs for oil-based, head of bed
○ increases serum calcium elevated (30-45 degree)
○ bone resorption - withdrawal of calcium ■ Mixing of dye with CSF (Brain;
in the bones irritation → seizure)
● Calcitonin
○ decreases serum calcium
○ calcium absorption to bones
● Calcium and Phosphorus
○ normal ca levels:
■ Ionized calcium: 4.5-5.5 meq/L
■ Total serum calcium: 8.5 to 10 mg/dL
○ normal phosphorus levels:
■ Potassium: 3.5 to 5
■ Phosphorus: 3.5 to 4.5
■ Protein (Albumin): 3.5 to 5.5 g/dL
○ Calcium - 90%; Phosphorus - 10% ○ Electromyography (EMG)
○ Hyperphosphatemia ■ Helps differentiate muscle disease
○ Hypocalcemia from motor neuron dysfunction
● Vitamin D (Calciferol) ■ Prepare patient for discomfort
○ Calciferol = facilitates absorption (stinging sensation) of needle
○ Kidneys - responsible for synthesis of insertion.
Vitamin D
○ Kidney failure → low vitamin D →
Hypocalcemia
● Growth Hormone (GH)
31 lavaRN
 ■ Bone pain
■ Fallophobia - Fear of falling
○ Diagnostic Assessment
○ Arthroscopy
○ Arthrocentesis
○ Synovial Fluid

Musculoskeletal Disorder
Common Symptoms of MSK Disorder
● Pain - first symptom since bone is a solid
organ
● Swelling
● Altered Movement
● Color changes
● Muscles stiffness ■ Ca levels - increased
● Deformity ■ X-ray
● Sensory changes ■ DEXA = Dual Energy X-ray
Absorptiometry
Osteoporosis ■ Bone Mineral Density (BMD)
● Osteo - bone; Porosis - Porous (get holes) Examination
○ Bone resorption/ demineralization → ● Management
decreased bone density ○ Prevent possible injuries - use of cane
○ Risk Factors: menopause (due to low and walker, install side bars, use of
estrogen), malnutrition, sedentary rubber mats, use of good quality slippers,
lifestyle chairs when showering
○ Ca and Vitamin D
○ Calcitonin - responsible for ca
absorption; artificial hormone for patient
○ Hormone Replacement Therapy (HRT)
- artificial estrogen for female patient
○ Biphosphonates (Na alendronate) - reflux
esophagitis; GERD like manifestations.
■ Remain upright prior to and after
administration for 30 mins to 1 hour.
○ Assessment: ■ Best time: before meals with one full
■ Early: fractures of thoracic, lumbar, glass of water.
neck of femur and wrist ○ Pain relievers - NSAIDS; cause gastric
■ Kyphosis (vertebral collapse r/t irritation, take it with food.
compression fracture) ○ Exercise - low impact exercises, brisk
walking, biking
○ Fracture Management

Osteomalacia
● Softening of the bones
32 lavaRN
● Metabolic bone disease
● Inadequate bone mineralization
○ Calciferol - ca absorption
● Soft and weak bones
● Risk Factors:
○ Diet - green leafy vegetables
○ Activity
○ GI resection - billroth I and II,
○ Inflammatory Bowel Disease (IBD) -
Crohn's Dse
○ Renal insufficiency - kidney failure
● Assessment
○ Bone pain
○ Fractures
○ X-ray: Looser’s zones
● Management: correcting underlying cause

Bone Tumors
Common Sites
● Pedia - most common; immature bones;
chronic irritation.
● Manifestations:
○ Dull pain that worsens ● Compression of the median nerve
○ Decreased ROM ● Risk Factors:
○ Pathologic fractures ○ Trauma
○ Sports - volleyball
○ Occupation - computer related jobs,
construction jobs
● Manifestations: di ko narinig (2 Ps)
● Assessment Tests
○ Phalen’s Test
■ Flex wrists and place the dorsal
surface of the hands against one
another
bone with tumor ○ Tinel’s Test
● Diagnosis ■ Tap the wrist
○ X-ray, CT scan, MRI ● Management
○ Biopsy ○ Splint - minimize the pressure and
○ ALP (Alkaline Phosphatase → increased; compression of the median nerve
there is bone fractures), Ca, Erythrocyte ○ Surgery (OCTR/ECTR)
Sedimentation Rate (ESR) ■ Open carpal tunnel release
● Management ■ Endoscopic carpal tunnel release
○ Pain relief ■ Post-op care: immobilize the body
■ Narcotics - for severe pain part, position - above the heart level to
■ Tramadol minimize edema
■ Morphine
■ Fentanyl Musculoskeletal Trauma
■ Contraindicated for NSAIDS because Fractures
there is a severe pain ● Break in the continuity of bone
○ Radiation ● Risk Factors:
○ Chemotherapy ○ Injury
○ Surgery (Amputation) ○ Sports - contact sports
Carpal Tunnel Syndrome ○ Medications - steroids
○ Diseases
33 lavaRN
● Concept ○ Myoglobinuria - presence of red urine
○ Injury to surrounding tissues ○ Amputation
○ Muscle spasms ● ACS: Management
● Types ○ Surgery
○ Simple (Closed Fracture) ■ Excision of the fibrous membrane
■ skin remains intact covering the muscles
■ bones are separated with one another ■ Fasciotomy
■ fracture is the only problem
○ Compound (Open Fracture)
■ there is skin trauma
■ the problem is fracture and skin
trauma
■ lumabas yung half ng bone
○ Complete
■ bones are separated
○ Incomplete ● Shock
■ magkasama pa rin pero may cracks ○ Manifestations:
■ Vital signs: Low BP, High Pr, High RR
(HypoTachyTachy)
■ Level of Consciousness (LOC)
■ UO
○ Management:
■ Restoration of blood volume and
circulation
● Fat Embolism Syndrome (FES)
○ Occurs within 48 hrs after fracture
○ Manifestations:
■ Hypoxia/Ischemia
■ Changes in LOC, HR, RR
■ Rash over upper chest and neck
○ Management:
■ Prevention: Early immobilization
■ Oxygen
■ Fluid
■ Emergency Care: Immediate and
systematic assessment
■ ABC, LOC: Life saving measures first
if necessary
● Assessment ■ Fracture Site
○ Musculoskeletal ■ Neurovascular Check
■ Pain ■ Immobilization: Anatomical splint
■ Deformity ■ Control bleeding (PRICE): Pressure,
■ Crepitus - grating, crackling sound Rest, Ice, Compress, Elevate
○ Neurovascular ● Fractures: Management
■ 6 P’s - Pain, Paresthesia, Paralysis, ○ Closed Reduction
Pallor, Pulselessness, Poikilothermia ■ Splint
(cold extremities) ■ Cast (Semento) - Immobilization;
Fractures: Early Complications plaster of paris (cheaper), POP (color
● Acute Compartment Syndrome (ACS) gray →white and should be odorless),
○ Compromised circulation related to sensation (warm, presence of
increased pressure in a confined space. inflammation → infection), handling
○ Emergency Situation (24-36 hrs before it gets dry; use palm
○ Manifestation = 6 P’s when handling)
● Complications
34 lavaRN
 ● Colored Casts: Fiberglass casts: ● Joints affected: Weight bearing joints
15 minutes lightweight; water (Knee, Hip joints, Fingers)
resistant, reduce the ● Manifestations:
accumulation of moisture. ○ Pain - is worse during activity
● Advantages ○ Crepitus
● Cast Care: Drying, Positioning, ○ Limited ROM
Neurovascular check, Exercises ○ Node formation
(Isotonic - movement and ■ Heberden’s Node - Proximal
Isometric - No movement; inter-phalangeal joint
contraction only), No weight ■ Bouchard’s Node - Distal
bearing (crutches), Inspection inter-phalangeal joint
■ Traction - Application of pulling force ● Management:
associated with counterpull. ○ Ambulatory aids - cane and walker
● Purposes: Immobilization, relieve ○ Weight reduction
muscle spasm/pain ○ Moist and warm compress
● Application: Skin, skeletal ○ NSAIDS (naproxen, mefenamic acid,
● Traction care: traction ibuprofen, acid), corticosteroid injections
continuously, weights to hang ○ Surgery
freely, do neurovascular check, ■ Arthroplasty - repair of the joint
prevent complications of capsule
immobility
○ Open Reduction Gout/Gouty Arthritis
■ Needle ● Cause: Metabolic (hyperuricemia)
■ Pins ● Incidence: Male, hyperUA
■ Rods ● Joints/sites affected: Foot part (Big toe),
● Hip Fracture Earlobes
○ SADDER Deformity ● Manifestations:
○ Management: ○ Pain - during rest and activity
■ ORIF ○ Pruritus
■ Hip replacement ○ Elevated UA levels
● Nursing Care Post-op: Stabilize ● Characteristic Nodules
prosthesis, Anatomical position
(extended, abduction), Positions
to prevent: external rotation,
flexion and adduction,
Ambulation, Avoid weight bearing
● Surgical Amputation
○ Nursing Care (Post op)
■ Assess tissue perfusion
■ Prevent edema - elevate
■ Pain relief - GABA (Gabapentin,
Pregabalin)
■ Prevent contractures
■ Ambulation
● ROM ● Management:
● Trapeze ○ Medical Management:
● Firm mattress ■ For pain - colchicine
■ Preparation for prostheses ■ For uric acid inhibition - allopurinol,
● Elastic bandage febuxostat
Arthritic Conditions ■ For uric acid excretion - probenecid
Osteoarthritis ○ Lifestyle modification
● Cause: Degenerative (the cartilage became ■ Fluid intake - to excrete uric acid
thinner) crystals
● Incidence: Older age/obese
35 lavaRN
 ■ Dietary modification - avoid foods rich
in uric acid (organ meats, shellfish,
sardines, anchovies, beans, alcoholic
beverages)

Rheumatoid Arthritis
● Cause: Autoimmune disease
● Incidence: Females
● Joints/sites affected: Upper extremities
(digits/fingers)
● Manifestations:
○ Pain - most painful upon waking or at
rest
○ Swollen and painful joints in AM
○ Anorexia, fatigue, weight loss
○ Low grade fever, peripheral neuropathy
● Characteristic Nodules - pannus formation
EYE AND EAR DISORDERS
● Deformities (Ankyloses)
Assessment of the Eye
○ Swan Neck Deformity - flexion of distal
● Diagnostic Assessment
IPJ
○ Snellen’s chart
○ Boutonniere Deformity
■ Purpose: test of visual acuity
■ Values:
● N = distance from the chart
● D = distance at which the normal
eye can see the letters
● Legal Blindness: 20/200
■ Findings:
● EOR - errors of refraction
● Blindness
● Myopia - nearsightedness
● Hyperopia - farsightedness

● Management:
○ Warm compress
○ Medications
■ NSAIDs, steroids
■ Immunosuppressants (Cyclosporine,
Azathioprine, Methotrexate)
■ Gold salts (Auranofin)
○ Surgery
■ Joint repair - arthroplasty ○ Tonometry
■ Joint removal and replacement - ■ Indirect measure of IOP
synovectomy ■ Normal finding of IOP: 11-21 MMHG
○ Ophthalmoscopy
■ Diagnosis - can be used as diagnosis
in problems in retina
■ Preparation
● Dim the lights
36 lavaRN
EYE DISORDERS ○ Sudden, severe physical exertion
Cataract ● Manifestations:
● Opacity of the lens ○ FFF (Floating spots, Flashes of light,
● Number 1 cause of blindness Falling curtains in visual field)
● Causes: ● Management:
○ Degeneration ○ Quiet on bed with eyes covered
○ Injury ○ Dependent head position (kapag left eye
○ Other conditions: hypertension, diabetes yung affected, left side lying yung
○ Birth deformities position)
● Management: ○ Immediate surgery
○ Surgery - gold standard management ■ Scleral Buckling
■ ECCE - extracapsular cataract Glaucoma
extraction ● Problem in aqueous humor flow
■ ICCE - intracapsular cataract ● Eye disorder characterized by increased
extraction IOP
■ Cryoextraction - use of a small probe ● Classifications:
that has been cooled to a temperature ○ ACUTE GLAUCOMA
below zero ■ displacement of iris against the
■ Phacoemulsion - breaking up the lens anterior chamber
and flushing it out into tiny pieces ■ Infection, eye injury
● Care of Clients undergoing surgery ■ Manifestations:
○ Pre-op ● Severe eye pain
■ Orient to the staff and physical ● Blurred vision
environment ● Headache
■ Call light system ● “Rainbows” or “Halos” around the
■ Instillation of drugs lights
■ Head position - side-lying position if ■ Management:
one eye lang nasurgery ● Head position - semi fowlers
■ Activity restrictions - coughing, position
sneezing, vomiting, moving suddenly ● Environment - non stimulating
■ Medications to reduce IOP environment
● Antitussives - dextromethorphan ● Drug therapy - eye drops (to
● Antiemetics - metoclopramide constrict the pupils); oral
(plasil) medication to decrease aqueous
● Laxatives - lactulose humor (diuretics - acetazolamide)
○ Post-op care ● Surgery - removal of portion of
■ Sensation the iris (iridectomy)
● Normal - stinging sensation (wear ○ CHRONIC GLAUCOMA
off anesthesia), “something in the ■ Due to either hereditary thickening of
eye” trabecular meshwork or narrowing of
● Abnormal - sudden sharp pain canal of Schlemm
(increased IOP), bleeding → refer ■ Characteristic sign
to the doctor → back to OR ● Tunnel vision - loss of peripheral
■ Safety measures vision
■ Eye drops and Ointment - no direct ■ Manifestations:
contact, close eyes, apply gentle ● Halos/rainbows
pressure ● No eye pain
Retinal Detachment ■ Management:
● Separation of the two primitive layers of the ● Same as acute glaucoma
retina EYE EMERGENCIES
● Causes: ● Penetrating eye injuries
○ Degeneration ○ Eye pad
○ Trauma ○ Surgery
○ Tumor ○ Note for sympathetic ophthalmia
37 lavaRN
 ● Conductive hearing loss
● Sensorineural hearing loss

● IOFB/Chemical Injury
○ Napuwing
○ Avoid pressure - more rubbing = more
pressure
○ Limit eye movement
○ Flushing
■ If chemical, flush with saline solution
for 15 minutes

Rehabilitation of a Blind Person Conductive hearing loss - affected ear

● Orientation Sensorineural hearing loss - unaffected ear
● Encourage independence ○ Rinne’s Test
● Use cane or guide dog ■ Procedure: use tuning fork to the
● TALK before TOUCHING mastoid or front on the ear
● Assist in ambulation: stay a step ahead of ● Mastoid: bone conduction; 10 secs
the client ● Front of the ear: air conduction; 18
● Promote safety secs
● Suggest gifts that appeal to other senses ● Longest conduction: Air
● Air > Bone - normal
EAR DISORDERS ● Air < Bone - abnormal
Anatomy ■ Findings
● Conductive
● Sensorineural

Otoscopy
3 and above - up and back
Less than 3 - down and back

Middle Ear Ear Drops

Ossicles - bone like structures that basically ● Temperature
vibrates due to soundwaves ● Straighten control
● Instillation - corner of the ear canal; in order
Diagnostic Assessment to not be painful
Hearing Test ● Absorption - massage the tragus
● Hearing Test
○ Weber Test
■ Procedure: use tuning fork to the top
of the forehead or bony prominence
■ Interpretation:
● Normal
38 lavaRN
 Post OP Care
● Position
● Gradual ambulation
● No watching fast-moving objects
● No hair shampoo
● No airplane travel; riding elevator
● No sneeze, cough; people with UTRI

Meniere’s Disease
● Accumulation of inner fluid; endolymph;
version of glaucoma
Ear Problems Emergencies
● Foreign body in ear
○ Position: rule of gravity; side lying
position
○ ENT referral
● Insect in the ear
○ Position: towards the unaffected site
○ Hum: cause vibration insects don't want
it
○ Light: insects want light
○ Oil/water: to suffocate

Otosclerosis

● Chronic, remission/exacerbation
● Cause: Unknown
● Assessment:
○ Triad Sx
■ Deafness (Sensorineural)
■ Vertigo
■ Tinnitus
○ N/V
○ Weber test findings
● Sclerosis - hardening of ossicles ● Management:
● Abnormal, spongy, highly vascularized bone ○ During attacks
sin the ear → stapes become fixed/hard ■ Bed rest; close eyes
● Hearing loss ■ No reading
● Assessment: ■ Medications - betahistine (SERC),
○ Rinne’s Test: Bone > Air - normal stugeron forte
○ Weber Test: will be heard at the affected ○ Na and fluid accumulation
side of the ear due to hardening. ○ No caffeine, tobacco
● Management: Hearing Aid ○ Stress therapy
● Surgery: removal of affected part, Priority NDX: Risk for injury due to presence
prosthesis → artificial stapes - of DVT
stapedectomy
Communicating with Hearing-Impaired
Care of Client Undergoing Ear Surgery Patients
Pre Op Care ● Talk directly to the person
● Assess for URTI ● Clearly enunciated words, normal tone of
● Shampoo the hair voice; Do not shout.
39 lavaRN
● Gestures with speech Anatomy and Physiology
● Do not whisper to anybody in front of the ● The Nervous System
patient ○ Central Nervous System
● Avoid careless facial expressions ○ Peripheral Nervous System
● Move closer to the person or toward the ■ Sensory
better ear ■ Motor
● Do not smile, do not chew gum, or cover the ● Autonomic - involuntary
mouth. ○ Sympathetic - fight or flight
response
○ Parasympathetic - rest and
digest
● Somatic - “soma” body (voluntary)

● Neuron
○ Myelin sheath - protects neuron And
makes the transmission fast
○ Nerve Transmission
■ Inhibitory Transmitter - pampabagal
or pamparelax
● Serotonin
● GABA (Diazepam, etc)
■ Excitatory Transmitter -
● Epinephrine
● Norepinephrine
■ Dopamine & Acetylcholine - both
inhibitory and excitatory
■ Schizophrenia - increased levels of
dopamine; inhibitory.

● The Brain
○ Lobes
■ Frontal
● Primary motor area
● Broca’s area (speech); Expressive
aphasia
● cognition, judgment
● personality, behavior
■ Parietal
● Primary sensory area
● Tactile sensations
■ Temporal
● Auditory and olfactory area
Wernicke’s area; (receptive
aphasia - hindi mo maintindihan
mga sinasabi ng patient)
■ Occipital
● Visual area
○ Diencephalon
■ Autonomic control center
■ Temperature, hunger, thirst
■ Emotions
○ Cerebellum - little brain
NEURO-ENDO DISORDERS ■ Balance and coordination
Care of Patients with Neurological Disorders ■ Ataxia (parang lasing maglakad)
40 lavaRN
 ■ Tentorium cerebelli - line separating
the cerebellum
● Infratentorial cerebellum
● Supratentorial cerebellum
○ Brainstem
■ Midbrain
■ Pons - controls heart, respiratory, and
blood pressure
■ Medulla Oblongata -
○ CNS Protection
■ Meninges
● Dura Mater (periosteal &
meningeal layer)
● Arachnoid Mater
● Pia Mater
■ Cerebrospinal Fluid - cushion &
nutrition; normal color - clear Neurological Assessment
● Mental Status Exam
● Spinal Cord - reflex center ○ Orientation - disorientation, confusion
○ Cervical (C1-C7) (ask them the time (kung anong araw na;
○ Thoracic (T1-T12) petsa, if morning or afternoon na) , place,
○ Lumbar (L1-L5) and person)
○ Sacral (S1-S5) ○ Memory - delirium, dementia (memory
○ Coccyx loss)
● 3 types of memory
Peripheral Nervous System ○ Immediate (short-term)
● Cranial Nerves ○ Recent (within 24 hours)
○ Olfactory - smell ○ Remote (past events (?))
○ Optic - vision ○ Speech - aphasia, dysarthria (difficulty in
○ Oculomotor - ocular and pupillary pronouncing words; slurred speech)
movement ● LOC - lethargic (drowsy yet oriented),
○ Trochlear - ocular movement obtunded (drowsy and disoriented),
○ Trigeminal - chewing, facial sensation stuporous (awakened/stimuated by pain),
○ Abducens - ocular movement comatose (GCS 3, no response;
○ Facial - facial expression, taste (anterior unconscious) (Normal finding: patient is
⅔ - sweet, salty, sour) alert & oriented)
○ Vestibulocochlear - hearing and ● Trapezius pinch - pressure on nail beds
balance ● Comatose - does not respond
○ Glossopharyngeal - Swallowing ● Reflex Testing
○ Vagus - PNS sensation, valsava ● ERRL, PERRLA, Converge and pupils will
maneuver constrict
○ Accessory - head and shoulder ● NRTL
movement ● DTR
○ Hypoglossal - tongue movement ○ Weak
○ Normal
Autonomic Nervous System ○ Increased
● Parasympathetic ○ Clonus
● Sympathetic Signs of Meningeal Irritation
● Brudzinski’s Sign - flex the neck;
involuntary leg flex
● Kernig’s sign - extend the knee; pain
occurs
Sensory and Motor Testing
● Sensory

41 lavaRN
● Agnosia
● Paresthesia EEG
● Anesthesia ● Shampoo.
Motor ● No need to be NPO; avoid
● Paresis stimulants/depressants.
● Plegia
● Apraxia EMG
● Mild discomfort
Diagnostic Examinations
Lumbar Puncture CT Scan
Diagnostic and therapeutic ● Plain or Contrast medium can do
● Nursing Considerations: ● Consent
○ Before ● Allergy
■ Consent ● NPO
■ Position
○ After MRI
■ Position ● No metal objects (claustrophobic; lie still)
■ Sensation (Lower extremities) ● Metal objects
■ Findings
● Normal Neurological Disorders
● Cloudy Increased ICP
● Pleocytosis Manage factors that increase ICP:
● Inc CHON, dec CHO ● Position
○ HOB position
Cerebral angiography ○ Positions to avoid
● Nursing Considerations (e.g. cardiac ● Movement
catheterization) ○ No restraints
○ Before ○ Log roll
■ Consent ● Hypoxia
■ Allergy ○ O2 therapy
■ NPO ○ Minimize suctioning
○ After ● Environmental stimulation
■ Femoral artery ○ Modify environment (noise, lighting)
■ Brachial artery ○ Cluster care
■ Pressure (sandbag) ● Medical management
■ Cold compress ○ Diuretics
■ Position - extension of extremity ○ Acetazolamide
(keep it straight) ■ mannitol - icp; powerful diuretic
○ Assess the neurovascular status of the ■ Do not give mannitol to pt with bp of
patient. 90/60 or below
○ Distal - 6 Ps ○ Steroids - anti inflammatory
■ Pallor ■ Blood brain barrier (BBB)
■ Pain ■ Dexamethasone
■ Paresthesia ○ Anticonvulsants
■ Paralysis ■ Diazepam
■ Poikilothermia ■ Phenytoin
■ Pulselessness ■ Phenobarbital
○ Antipyretics
Myelography ■ Paracetamol
● Nursing Considerations ■ Shunt for CSF
○ Before ■ bypass/diversion
○ After ■ Tube insertion to drain CSF
■ Oil-based (VentriculoPeritoneal Shunt)
■ Water-based (Semi fowler’s)
42 lavaRN

■ Surgery for decompression
● Ventriculostomy
Seizures - abnormal excessive discharge of
electrical activity within the brain
● Seizure - electrical activity
● Convulsions - muscular contractions
● Epilepsy - medical condition / chronic
seizure disorder; common in children
● Types of Seizures
○ Grand Mal (Tonic Clonic)
■ Upward rolling of eyeballs
■ Drooling
■ Cyanosis
○ Petit Mal - patient losses conscious but
still standing (absence seizure)
○ Jacksonian - focal (localized)
○ Febrile - high fever attacked with
seizures
○ Psychomotor - as manifestation of
mental disorders
● Phases
○ Prodromal (aura or sensory signals)
■ Flashes of light
■ Unique smell or taste
■ Eclampsia - epigastric pain
○ Ictal
■ Upward rolling of eyeballs
■ Drooling of saliva
■ Cyanosis
■ Stiffening of the muscles
○ Postictal
■ Side lying pt to prevent aspiration
● Management
○ Note time and duration of seizure
○ 4-6 minutes - how long can the brain hold
oxygen??
○ Properly position patient (flat on bed, no
pillow, side lying position of head and
neck to drain)
○ Promote safety and airway (do not
restrain; padded side rails)
○ After the seizure
■ Oxygen; suction
■ Monitor for incontinence
■ Provide rest and sleep
■ Once awake, reorient the pt
● Medical Management
○ Anticonvulsant
■ Diazepam - active seizure
■ Phenytoin - prevention/maintenance
■ Phenobarbital
■ Valproic Acid
■ Carbamazepine
● Status epilepticus - series of generalized
seizures that occur without full recovery
between attacks
Cerebrovascular Accident (CVA)
● Top 2 cause of morality in the PH
● Destruction of brain cells due to sudden
decrease in cerebral blood flow
● Cerebral infarction with irreversible damage
Causes:
● Thrombus (HTN, DM)
● Embolus (AF, RHD, MI)
● Hemorrhage (HTN, aneurysm)
Types:
● Ischemic/occlusive- most common
○ Thrombotic
○ Embolic
● Transient ischemic attacks (TIA)
○ Warning signs reversible
■ Stroke in evolution
■ Hemorrhagic
■ MCA - most common site
● Manifestations
○ Increased ICP
○ Depends on the are affected
(sensory/motor)
■ Eyes (Hemianopsia - loss of the half
of visual field)
■ Face (facial drooping/asymmetry)
■ Throat (dysphagia)
■ Extremities (hemiparesis - weakness;
hemiplegia - paralysis)
■ Language (broca’s - expressive
aphasia; wernicke's - receptive
aphasia; dysarthiaglia)
43 lavaRN
 ■ F - facial drooping ○ Communication board, speech
■ A - arm weakness pathologist, allow the patient to express
■ S - speech difficulty himself.
■ T - time to call for ambulance ○ Nutrition
● Complications ○ Elimination
○ Comatose ○ Ambulation
○ Seizures
○ Upper GI bleeding Head Injury
● Medical Management Traumatic Brain Injury
○ Anticoagulants (for ischemic stroke ● Trauma to the skull resulting in mild to
only) - to prevent further embolus extensive damage to the brain.
formation ● Causes
■ Heparin (for ischemic stroke only) - ○ Fall
IV/SC ○ Vehicular accident
● Protamine Sulfate - antidote ○ Assault
■ Enoxaparin (low molecular weight ○ Sports
heparin) ● Concussion - jarring of the brain
■ Warfarin - PO ● Contusion - hematoma
● Vitamin k - antidote ● Manifestations
● Avoid green leafy vegetables ○ Signs of increased ICP.
○ Antiplatelets (for ischemic stroke only) ○ Skull fracture > CSF leakage
■ Aspirin - taken with meals because it ○ Halo sign - clear transparent ring
causes GI irritation ○ Raccoon sign - periorbital ecchymosis.
■ Clopidogrel ● Management
○ Thrombolytics - dissolves clot; 4-6 ○ Bed rest with proper positioning
hours after clot ○ Continue GCS monitoring
■ Streptokinase ○ Seizure precautions
■ Urokinase ○ Monitor for DI/SIADH
■ Alteplase ○ Surgical removal and evacuation of
○ Diuretics hematoma.
○ Antihypertensives
■ Nicardipine - CA blocker NEUROMUSCULAR DISORDERS
■ -sartan, -olol, -dipine, -pril drugs (oral) Parkinson’sDisease
○ Anticonvulsants ● Degeneration and destruction of nerve cells
○ Anti-ulcerants of the basal ganglia
■ Omeprazole
○ Neurostimulants/protectants
■ Citicholine
■ Acetylcholine - Excitatory
○ Gastric intubation
● Surgical Management
○ Atherectomy
○ Craniectomy
○ Craniotomy
■ Supratentorial - semi-fowler’s (30-45
degrees) Dopamine → inhibits involuntary movements
■ Infratentorial - flat on bed ● Incidence - common in older adults
● Nursing Management ● Cause: unknown
○ Airway and oxygenation ● Manifestations
■ Position, suction, and O2 Therapy. ○ Triad sx:
○ Prevent increase ICP ■ Bradykinesia
○ Position and turning ■ Rigidity
○ communication ■ Tremors
● Resting Tremors
44 lavaRN
 ■ Abnormal gait ○ Ptosis - drooping of eyelids
● Shuffling gait ○ S/sx of decrease muscular function
○ Dysphagia and drooling ■ Dysphagia, dysarthria, respiratory
○ Constipation difficulty paralysis
○ Dysphonia, micrographia (small ● Diagnosis
handwriting) ○ Tensilon test (Edrophonium CI)
● Pharmacologic Management ■ Rapid-acting cholinergic (kapag
○ Dopaminergics naopen nya eyes it's confirm na need
■ Levodopa, Carbidopa nya ng meds.
■ Side effects: Hypotension ● Management
■ Drug interaction: Vit B6; promotes ○ Surgery:
nerve impulse transmission (sobra ■ Thymoma - thymectomy
yung tremors so need bagalan
nag-opposite effects)
■ DON’T: green leafy vegetables is rich
in vitamins
■ Methyldopa: Antihypertensive; for
preeclampsia patient
○ Anticholinergics -
■ Acetylcholine - excitatory - PNS
● ANTI-PNS - PRO-SNS
■ Cogentin (Benztropine)
■ Artane (Trihexyphenidyl)
■ Akineton (Biperiden)
■ Note for side effects
■ Anticholinergics Side effects:
● Pupils will dilate ○ Medications
● Blurring of vision ■ Cholinergic - before meals; this two
● Dry Mouth tigmine med need on time bawal early
● Urinary bawal late magkakaroon ng crisis
● Constipation ● Pyridostigmine
● Nursing Management ● Neostigmine
○ Decrease tremors ■ Overdose and underdose → crisis
■ Keep extremities busy (stress balls) ■ Myasthenic Crisis → underdose
○ Improve mobility ● severe weakness; give tensilon
■ Exercise (ROM) ■ Cholinergic crisis → overdose
○ Communication ● PNS overstimulation; give atropine
○ Nutrition and elimination ■ Avoid CNS depressants
■ Patient with dysphagia: ■ Avoid infection
● Soft Diet ● Nursing Management
● Small Frequent Feedings (SFF) ○ Prevent aspiration
● High Fiber ■ Gag reflex assessment
● Increase fluids ■ Meds before meal
● High CHON, calorie ■ Diet modification: SFF, soft diet,
increase fluids
Myasthenia Gravis ○ Promote respiration
● Decreased secretion of ACH or increase in ■ Positioning
cholinesterase at the myoneural junction ■ O2 therapy as needed
○ Dec ACH → Excitatory ■ Balance rest/activity
● Cause by autoimmune problems ○ Medication compliance
● Incidence - common among females; ○ Promote mobility
osteoporosis, rheumatoid arthritis, gout ■ Exercise (passive ROM if bedridden)
● Manifestations ■ Safety (side rails)
○ Weakness , fatigue
45 lavaRN
Multiple Sclerosis
● Multiple patches of demyelination or nerve
degeneration throughout the brain and
spinal cord

ALS (Amyotrophic Lateral Sclerosis)

● Amyotrophic - absence of muscle
nourishment (nerve stimulation)
● Lateral - (extremities)
● Sclerosis - (myelin sheath)
● Cause: unknown ● Motor neuron degeneration - do tensilon
● Incidence test para malaman if mg or ms sya)
● Manifestations depends on affected nerves ● Voluntary movement
○ Charcot’s Triad ● Hereditary
■ Scanning speech
■ Intention tremors
■ Nystagmus
○ Lhermitte’s Sign
■ Electrical shock when head is
passively flexed
○ Weakness
○ Vision impairment (diplopia, scotoma,
blindness)
○ Bowel/bladder problems
● Medical Management
○ Steroids
■ Inflammation
○ Immunomodulating agents:
■ Avonex
■ Betaseron
■ Copaxone
○ Muscle Relaxants
■ Baclofen
● Manifestations
● Nursing Management
○ Loss of voluntary movement
○ Eye patch
○ Involuntary control remains intact
○ Diet
● Prognosis: poor
○ Promote ADLs
● Management
○ Fluid intake
○ Riluzole - FDA approved for ALS; will
delay the neurons.

GBS (Guillain-Barre Syndrome)

● Infectious polyneuritis
● Immune reaction to infection
● After a respiratory or GI infections
46 lavaRN
● Demyelination ■ Vasoactive agents
● Manifestations ○ Managing autonomic dysreflexia
○ Weakness, paralysis (ascending ■ Autonomic dysreflexia - involuntary
paralysis; lower ex → upper ex) abnormal response to certain stimuli
● Management ● Increase BP (headache, nasal
○ Supportive congestion)
○ IVIG ● Decrease HR
○ Immunoglobulin - antibodies ■ T6 and above
■ Prevent stimulants
Spinal Cord Injury SCI ● Distended Bladder
● (Y) Impacted Stool
● Skin Pressure
■ Manage s/sx
○ Dietary Management
■ Prevent aspiration (SFF, soft diet,
increase fluids, high fiber)
■ Dietary Modification
● Medical Management
○ Airway Management
■ Suction
■ Mechanically assisted respiration
○ Circulatory management
■ IVF
● Complications and Management
○ Paralysis
○ Neurogenic Bladder
● Injury to the SC which ranges from mild ■ Intermittent Catheterization
flexion-extension “whiplash” injuries to ○ Neurogenic Bowel
complete transection of the cord ■ Lactulose - manual (digital) extraction
● Concept: Disconnection/trauma ○ Autonomic dysreflexia
● Outcome: Loss of Function (LOF) ○ Other
● Risk Factors: ■ Skin
○ Flexion-Rotation ■ Sexual expression
○ Hyperextension
○ Compression HNP (Herniated Nucleus Pulposus)
● Assessment ● condition in which part or all of the soft,
○ Depends on the level of injury gelatinous central portion of an
○ Motor and sensory changes below the intervertebral disk is forced through a
injury weakened part of the disk, resulting in back
○ Loss of reflexes, sweating, below the pain and nerve root irritation.
level of injury
○ Loss of bowel and bladder control
● SCI Emergency Management
○ Open airway safely; jaw thrust maneuver
○ Log-rolling
○ Head and neck in neutral position
■ Equipment
■ Positions to avoid
○ Always suspect SCI until ruled out
○ Clothing is cut off
● Managing Spinal Cord Injury
○ Relieve inflammation
■ Methylprednisolone
○ Managing the spinal shock phase
47 lavaRN
 ENDOCRINE DISORDERS
Concepts
● Function: Homeostasis = Balance
● Dysfunction: Imbalance
● Communication Channel / Pathway:
Blood
● Effect: Systemic

Pituitary Gland
● Anterior
○ GH, ACTH, TSH
● Risk Factors ○ FSH, LH
○ Aging ○ Prolactin - milk production
○ Heavy lifting ○ MSH - responsible for skin
● Manifestations ● Posterior
○ Pain (Sciatica) ○ ADH
○ Weakness ○ Oxytocin
○ Paresthesias Thyroid and Parathyroid Gland
● Management ● Thyroid (Follicular cells)
○ Bed rest ○ T3
○ Traction ○ T4
○ Drug therapy ● Thyroid (C cells)
■ Anti-inflammatory agents ○ Thyrocalcitonin
■ Muscle relaxants ● Parathyroid glands
○ Heat ○ PTH
○ Surgery Adrenal Gland
■ Laminectomy ● Cortex
○ Glucocorticoid Sugar
○ Mineralocorticoid Salt
○ Androgen Sex
● Medulla
○ Catecholamines
● Pancreas
○ Insulin - dec BS
○ Glucagon - inc BS
● Ovaries
● Testes

■ Post-Op Diabetes Mellitus

● Position Insulin
● Bedpan ● Transport and metabolize glucose for
energy
● Stimulates storage of glucose in the liver
and muscle
● Signals the liver to stop release of glucose
● Enhances the storage of dietary fat in
adipose tissue
● Accelerates transport of amino acids
Diabetes Mellitus
● A chronic metabolic disorder characterized
by insulin insufficiency that results to
impaired utilization of CHO, CHON, and
fats.
● Risk factors:
48 lavaRN
 ○ Genetic predisposition ● Kussmaul’s respirations, altered level of
○ Poor diet consciousness (ALOC)
○ Physical Inactivity ● Interventions:
○ Age ○ Insulin
○ Race ○ Monitor blood glucose
Characteristics Type 1 Type 2
○ Monitor K levels, replace fluids = PISO
potassium in; sodium out
Problem Destruction of Decrease in ○ Monitor respirations and ABGs
B cells → endogenous ○ Give sodium bicarbonate
absence of insulin of
insulin insulin HHNS Hyperglycaemic hyperosmolar
resistance non-ketotic syndrome
● Severe hyperglycemia and hypertonic
Risk Factors Genetics, Genetics, dehydration without KA
Autoimmune Obesity
● Inadequate insulin secretion, increased
Onset < 30 yrs > 30 yrs insulin needs; increased sugar intake
● Hyperglycemia, glycosuria, polyuria
Patient Thin Obese ● Interventions:
appearance ○ Monitor for VS (dehydration), blood
glucose
Prone to Yes (DKA) No (HHNS) ○ F and E, administer insulin and replace
Ketosis fluids
Management Insulin for life OHA
Hypoglycemia
lifestyle Insulin
modification Lifestyle ● Excess insulin or OHA
Modification ● Decrease food intake
● Excessive exercise
GDM (Gestational Diabetes Mellitus) ● Manifestations:
● Onset during pregnancy ○ Hunger, disorientation, pallor
● Due to the hormones secreted by the ○ Nervousness, coma
placenta ○ Cold, clammy skin
● Risk for perinatal complications ● Interventions:
● Management ○ Conscious: oral simple sugars
● Manifestations ○ Unconscious: depends on setting
○ 3Ps ○ Give D5050
○ Fatigue, weakness ● Complications:
○ Dry skin ○ Angiopathy (CAD, CVD, PVD)
○ Delayed wound healing ○ Retinopathy
○ Sudden vision changes ○ Nephropathy
○ Paresthesias ■ ESRD
● Diagnosis ○ Neuropathy
○ FBS greater than 126mg/dL or (7mmol/L) ○ Risk for infection
○ 2 hours PPBS >200 mg/dL after 75 g of ○ Delayed wound healing
anhydrous glucose dissolved ● Management
○ Increased Glycosylated Hgb (HbA1c) ○ Teach SMBG
■ Evaluated effectiveness of diabetic ○ Nutritional therapy
therapy/compliance ■ Dietary requirements
■ Caloric Distribution: 50% CHO; 30%
DKA (Diabetes KetoAcidosis) CHON; 20% FATS
● Metabolic acidosis ■ Wheat, Oats, Quinoa, Brown Rice,
● Blood sugar 600-800 mg/dl Melon, Apple, Berries, Sweet potato
● Polyuria, Polydipsia, Ketonuria, ■ Food classification systems
Hypokalemia ● Nutrition labels, food guide
pyramid, glycemic index
49 lavaRN
 ■ Alcohol consumption ○ Issue atrophy/hypertrophy which may
■ Sweeteners interfere with insulin absorption
■ Have sources of simple sugar ○ Rotate injection: 1 inch apart; back upper
available arms, abdomen, outer thighs, buttocks
■ Never skip meals ○ Do not massage the injection site
○ Nursing Care ○ Do not administer cold insulin
■ Exercise and weight loss programs ● Somogyi effect
● After meals ○ Insulin induced hypoglycemia rebounds
● Simple sugars close to the patient to hyperglycemia
■ Regular monitoring and follow up ○ Epinephrine and glucagon released
■ Daily foot care ○ Prevention: Gradual reduction of insulin
● Insect foot daily for irritation dosage and close monitoring of blood
cracking and lesions, corns and sugar especially at night
calluses. ● Dawn phenomenon
● Inspect shoes for proper fitting and ○ Early morning hyperglycemia
before wearing ○ Increased secretion of GH at night
● Test temperature of water ○ Prevention: delay administration of pm
● Avoid walking barefoot insulin or inc the dosage
● Apply lotion ● Nursing Care
● Properly cut and trim toenails ○ Ensure proper insulin storage
● Refer to podiatrist ■ Store in a cool place away from direct
■ Methods of insulin delivery sun light
● Insulin pens ○ Monitor patients
● Jet injectors ■ During times of trauma or severe
● Insulin pumps stress
INSULIN ■ Glucose levels before meals or 2 hrs
Type Onset Peak Duration
after.
■ Signs of hypo or hyperglycemia.
Rapid < 15 mins 30 mins - 2-4 hrs ○ Ensure proper administration
acting 1hr ■ Avoid vigorous shaking
humalog ■ Use insulin syringes
■ If combining insulin
Short 30 mins - 2-4 hrs 6-8 hrs ■ Use only Regular Insulin for IV
acting or 1 hr ■ Avoid lipodystrophy
regular ● Oral Anti-diabetic Drugs
acting
○ Sulfonylureas
Humulin R
Novolin R ■ Stimulate beta cells to produce insulin
■ 1st generation - rarely used -
Intermedia 1-2 hrs 6-12 hrs 18-24 hrs tolbutamide
te acting ■ 2nd generation - glipizide, gliclazide
NPH - ○ Biguanides
Humulin ■ 3 modes of actions
N, Novolin ■ Metformin - dec hepatic production;
N dec intestinal absorptio; promotes
Isophane insulin sensitivity
Long 4-8 hrs 8-24 hrs 24-48 hrs
○ Thiazolidonediones
acting PZI ■ Improve insulin sensitivity
(Humulin ■ Rosiglitazone (Avandia), Pioglitazoe
U) (Actos)
Glargine ○ Meglitinides
(Lantus)- ■ Stimulate the release of insulin
O:60 mins; ■ Repaglinide (Prandin, Nateglinide
D: 24 hrs (Starlix)
● Lipodystrophy ○ Alpha-glucosidase inhibitors
50 lavaRN
 ■ Block digestion of complex CHO and ○ BMR: Decrease HR, Weight, Bowel
slow absorption of glucose. elimination, Intolerance to certain
■ Acarbose (Glucobay), Miglitol (Glyset) temperatures (cold intolerance) (mababa
lahat except for the weight!)
Thyroid and Parathyroid Disorders ○ Nervous System: Decreased LOC,
Thyroid Gland Mentation, Lethargy, Drowsiness
● T3 and T4 ○ Dermatologic: Hair loss, brittle nails and
○ Metabolism (Basal Metabolic Rate) - dry skin, edema
metabolism during rest ○ Myxedema - accumulation of
■ Anabolism = production mucopolysaccharides in the SQ and
■ Catabolism = breakdown interstitial tissues
○ Iodine - important for synthesis of T3 ○ Advanced stages: diminished
and T4 cardio-respiratory function, myxedema
■ Goiter = enlargement of the thyroid coma (delikado)
gland; caused by low iodine level ○ Contributing factors in myxedema
● Calcitonin coma:
○ CA absorption to bones ■ Decreased CO;
○ Decrease serum CA ■ Hyponatremia; Na= neurological
Assessment electrocyte
● RAIU (radioactive iodine uptake) ■ Hypothermia; slowed body release
○ Measure the amount of iodine taken up ■ Hypoglycemia; sugar is the main food
by the thyroid gland in 24 hrs - determine of our brain
the thyroid function ● Management
○ Don’t ingest iodine rich foods x 24hrs ○ Pharmacotherapy
○ Discontinue all thyroid and cough ■ Levothyroxine (Synthroid)
medications 7-10 days prior to exam ■ Thyroglobulin (Proloid)
● Thyroid Scan - size of thyroid gland ■ Thyrolar (Cytomel)
● Serum T4 and T3 ■ Liotrix (euthroid)
● TSH (thyroid stimulating hormone) from ○ Monitoring thyroid hormones
pituitary gland ○ Supportive therapy
○ Thyroid → produce t3 and t4 ■ Activity - to exercise the brain; more
○ Determines primary from secondary on simple physical activities (walking,
hypothyroidism biking, organizing things)
■ Primary = thyroid; decrease t3 and t4; ■ Nutrition and elimination; low fat, low
increase tsh salt, high fiber
■ Secondary = other organ (pituitary);
decrease t3 and t4; decrease tsh Hyperthyroidism
● Primary Hyperthyroidism = the problem is
Hypothyroidism the thyroid gland
● Primary ○ Increased T3/T4, Decreased/Normal
○ Congenital defects, Hashimoto’s TSH
thyroiditis (autoimmune) ● Secondary Hyperthyroidism = the
● Secondary problem is the pituitary/other
○ Failure of the pituitary gland or ○ Increased T3/T4, Increased TSH
hypothalamus (hypoactive) ● Graves disease ( autoimmune)
● Other Causes ○ Toxic diffuse goiter
○ Aging, Iodine deficiency or excess ○ Caused by abnormal stimulation of the
○ Medications - Lithium thyroid gland by immunoglobulins
○ Radiation ● Common among female adults
○ Treatment of hyperthyroidism ● Toxic multinodular nodules
● Manifestations ○ Multiple thyroid nodules
○ Diagnosis: TSH, T3, and T4 ● Exogenous hyperthyroidism
○ Slow metabolism ○ Caused by excessive use of thyroid
replacement
51 lavaRN
● Manifestations ○ IVF
○ Diagnosis: TSH, T3 and T4 ○ PTU or Methimazole and Iodine via IV
○ BMR: Increase HR, weight, Increase route for fast absorption
bowel elimination, Intolerance to certain ○ Hydrocortisone (immunosuppressants)
temperatures (heat intolerance) (mataas ● Nursing Care
lahat except for weight!) ○ Monitor/ Watch out for thyroid storm
○ Nervous system function: Increased ○ Monitor cardiovascular status -
LOC and mentation hypertension, cardiac arrhythmias
○ Dermatologic: Long hair, flushed skin ○ Improve nutritional status - Increase
perspiration carbohydrates, protein, and fat
○ Cardiovascular: Tachycardic ○ Maintain normal body temperature
insufficiency ○ Proper eye care
○ Reproductive: amenorrhea ■ Keep HOB elevated, prevent drying of
○ Eye changes; exophthalmos - bulging the eyes (moist dressings, eye drops)
■ Dalrymple sign: retraction of upper ○ Modify environment - non stimulating
eyelid ● Surgery
■ Von Graefe sign: Lid lag ○ Thyroidectomy
■ Joffroy’s sign: absent creases in the ■ Subtotal
forehead ■ Total
● Medical Management ○ Post op care
○ Anti-thyroid medications: Methimazole ■ Position (Semi-fowler’s position) and
(tapazole) and Propylthiouracil (TPU) protect site
■ Nursing Interventions: ■ WOF complications:
● Monitor for leukopenia, ● Tetany (hypocalcemia): Chvostek’s
agranulocytosis and sign (facial tapping), Trousseau's
thrombocytopenia sign (carpal spasms)
● Taken with meals Laryngospasms (respiratory
● Avoid OTC cough/cold drugs and difficulty)
stimulants ● Hoarseness or aphonia - due to
○ For CV symptoms: Beta blocker - ends damage of laryngeal nerve
with olol; Propranolol (preferred ● Bleeding - NR: inspect nape,
medication) assess presence of bleeding
○ Pre-op meds (thyroidectomy) ● Changes in VS
■ Reduce size and vascularity of thyroid
gland Parathyroid Gland
■ KISS/SSKI - Saturated Solution of ● Calcium Regulation
Potassium Iodide/Lugol’s solution; Hypoparathyroidism - hypocalcemia
given to reduce the activity of thyroid ○ Causes:
gland ■ Deficient PTH or decrease
■ Sip thru straw; avoid staining of the effectiveness of PTH on target tissues
teeth (small intestines/kidney)
○ Radioactive Iodine Therapy (123 or 131) ■ Damage to glands due to surgery
Thyroid Storm (Emergency!!) ● Manifestations:
● Autoimmune problem ○ 2 classic signs:
● Thyrotoxicosis or thyroid crisis ● Management:
● Due to lack of medications or induced by ○ Administer Ca supplements
stress post-subtotal thyroidectomy ○ Monitor Ca and phosphorus levels
● Manifestations: ○ Calcium gluconate SIVP
○ Hyperpyrexia (40°C fever) ○ Vitamin D
○ Extreme tachycardia and HPN Hyperparathyroidism - hypercalcemia
○ Altered neurologic or mental state ● Glands do not respond to normal feedback
● Management: of Ca and secrete autonomously
○ Hypothermia blanket ● Massive bone resorption
○ Humidified oxygen ● Manifestations:
52 lavaRN
 ○ N/V, anorexia, constipation ● Monitor and prevent increase in
● Complications: ICP; head and neck position,
○ Bones activity intolerance
○ Kidneys ● Oral care
○ Hypercalcemic crisis - psychosis with ● Administer steroids;
mental confusion dexamethasone
● Management: ● Monitor for I&O and check for fluid
○ Surgery (Parathyroidectomy) imbalance
○ Pharmacotherapy
■ Bisphosphonates (Alendronate, Diabetes Insipidus
Etidronate, Pamidronate) ● ADH deficiency - decreased water
■ Calcitonin reabsorption
■ Calcium chelators - Mithramycin ● Causes:
○ Hydration Therapy ○ Head trauma, brain tumor
○ Promote mobility ○ Surgical ablation and irradiation
○ Dietary modification - decrease calcium ● Manifestations:
intake (milk, dairy products) ○ Fluid volume deficit
○ Renal: Increased urine output and
Pituitary Gland Disorders diluted concentration, electrolyte
Anterior Pituitary Gland imbalance (hypokalemia)
● Hyperpituitarism ○ Cardiovascular: (decreased BP,
○ Causes: Pituitary adenoma increased HR, pulse strength, increased
○ 2 forms: blood concentration, weight loss)
■ Gigantism - excess of GH before ○ Integumentary: Poor skin turgor, dry
puberty; lalaki mucous membranes
■ Acromegaly - excess of GH after ● Diagnosis:
puberty; lalapad ○ Fluid deprivation test - absence of water
● Acromegaly intake overnight and then check the urine
○ Hands, feet, face enlargement concentration and amount
○ Prognathism and widening of teeth ● Medical Management:
○ Soft tissue and visceral organ ○ Replace ADH - Desmopressin (DDAVP);
enlargement administered intranasal, Pitressin
○ Neurological and visual changes (Vasopressin); administered IM
(increase ICP) ● Management:
○ Changes in: glucose, BP, skin ○ Monitor I&O and weight
(stretched), weight gain, menstruation, ○ Administer F and E replacement as
joints needed
○ Management: ○ Fluids
■ Counseling ○ Monitor VS, neuro and CV status
● Altered body image and visual ○ Avoid food/fluids with diuretic effect
disturbances (coffee, watermelon, buko juice)
■ Skin care
■ Pharmacotherapy SIADH
● Octreotide ● ADH excess
● Bromocriptine ● AKA Schwartz-Bartter Syndrome
■ Removal of tumor ● Causes:
● Hypophysectomy ○ Head injury, brain surgery
● Radiation ○ Tumor
● Surgery ● Manifestations:
■ Post-op Care: ○ Fluid volume excess
● Monitor VS and LOC ○ Renal: Decreased urine output and
● Monitor for any post-nasal drip concentration, electrolyte imbalance
(dilutional hyponatremia)

53 lavaRN
 ○ Cardiovascular: (Elevated BP, ○ Monitor VS and labs and I&O
increased HR, pulse strength, (decreased)
hemodilution, weight gain) ○ Pharmacologic: Antihypertensives,
● Management: Insulin
○ Fluid restriction ○ Prevent infection (reverse or protective
○ Eliminate cause isolation)
○ Pharmacotherapy: ○ Emotional support
■ Hypertonic saline ○ Diet: Decrease CHO, Increase CHON,
■ Demeclocycline (preferred) and Decrease Fats
Lithium carbonate (can cause kidney ○ Encourage rest and activity
problems) ○ Surgery
■ Diuretics - Furosemide (fluid overload) ■ Adrenalectomy
○ Weigh daily ■ Hypophysectomy - removal of pituitary
gland if necessary
Adrenal Gland Disorders ■ Removal of adrenal glands
Pheochromocytoma ● Preop: Control blood sugar,
● Benign tumor of the adrenal medulla Cardiac monitoring
● Problem in the medulla ● Postop: Hormone replacement,
● Manifestations: Prevent adverse effects of steroids
○ 5 H’s: Hypermetabolism, Hyperhidrosis, (skin breakdown, fractures, GI
Hyperthermia, Hyperglycemia, bleeding)
Hypertension
○ Tremors and anxiety Addison’s Disease
● Diagnosis: ● Inadequate adrenocortical activity
○ Urine VMA (Vanillylmandelic Acid) and ● Causes:
Metanephrine (MN) test ○ Primary
■ 24 hr urine collection ■ Autoimmune, idiopathic
■ Avoid use of substances that can ■ Metastatic cancer
increase catecholamines (cough ■ Adrenalectomy
syrup) ■ Sudden withdrawal of steroids
○ Clonidine Suppression test ○ Secondary
■ Check catecholamine levels after ■ Pituitary tumors, hypophysectomy
giving clonidine ■ High dose pituitary and brain radiation
● Diagnosis:
Cushing’s Disease ○ ACTH stimulation test
● Excessive adrenocortical activity ○ Urinary 17-hydroxycorticosteroids and
● Causes: 17-ketosteroid test
○ Tumors ○ Skull X-ray and CT scans or MRI
○ Corticosteroid medications ● Manifestations:
● Diagnosis: ○ CNS changes: Depression, fatigue,
○ Overnight dexamethasone suppression apathy
test ○ Gastrointestinal: Anorexia, N/C,
○ 24 hr urinary free cortisol levels abdominal pain, salt craving
● Manifestations: ○ Cardiovascular: Hypotension,
○ General appearance: Fat deposition Hyponatremia, Hyperkalemia, Weight
(moon face, buffalo hump, truncal loss
obesity) ○ Integumentary: Hyperpigmentation
○ Cardiovascular: Increased BP, risk for ● Management:
thromboembolic events, edema and ○ Monitor glucose, fluids and electrolytes
capillary fragility ○ Restore fluid balance
○ Musculoskeletal: Atrophy (extremities), ○ Modify diet: Increase CHO, Increase
osteoporosis CHON, Low fats
○ Integumentary: Thinning of skin, striae ○ Improve activity tolerance
● Management: ○ Pharmacotherapy:
54 lavaRN
 ■ Hydrocortisone, 5% dextrose and
vasopressors
■ Corticosteroids
■ Mineralocorticoids (Fludrocortisone)
● Addisonian Crisis
○ Life threatening disorder caused by acute
adrenal insufficiency
○ Precipitated by stress, infection, trauma
or surgery
○ Imbalance in Na, K, CHO, and shock
○ Administer IV glucocorticoid as
prescribed

55 lavaRN