PATHOGNOMONIC SIGNS

1. PTB- low grade fever

2. PNEUMONIA- rusty sputum
3. ASTHMA- wheezing on expiration
4. EMPHYSEMA- barrel chest
5. KAWASAKI SYNDROME- strawberry tongue
6. PERNICIOUS ANEMIA- red beefy tongue
7. DOWN SYNDROME- protruding tongue
8. CHOLERA- rice watery stool
9. MALARIA- stepladder like fever with chills
10. THYPOID- rose spots in abdomen
11. DIPTHERIA- pseudo membrane formation
12. MEASLES- koplik’s spot
13. SLE- butterfly rash
14. LIVER CIRRHOSIS- spider like varices
15. LEPROSY- lioning face
16. BULIMIA- chipmunk face
17. APPENDICITIS- rebound tenderness
18. DENGUE- petechiae or + homan’s sign
19. MENINGITIS- kernig’s sign (leg pain), brudzinki (neck pain)
20. TETANY- hypocal, + trousseau/carpopedal spasm, chovstek (facial spasm)
21. TETANUS- risus sardonicus
22. PANCREATITIS- cullen’s sign (ecchymosis of umbilicus), + grey turner’s sign
23. PYLORIC STENOSIS- olive like mass
24. PDA- machine like murmur
25. ADDISON- bronze like skin pigmentation
26. CUSHING- moon face appearance and buffalo hump
27. HYPERTHYROIDISM/GRAVE’S DIS- exopthalmus
28. INTUSSUSCEPTION- sausage shaped mass

TYPE 1 DM

-Insulin dependent
-Juvenile onset (common among children)
-Brittle disease
-Non obese
-Etiology: Hereditary
-Weight loss, polyuria, polydipsia, polyphagia, glucosuria, anorexia, n/v, blurring vision
-Treatment: insulin, diet, exercise
-Complications: DKA; NaHCO3 administer to treat acidosis; can lead to coma
TYPE 2 DM

-Non insulin dependent

-Adult/maturity onset type (common among 40 above)
-Obese
-Non-brittle disease
-Etiology: Obesity
-Asymptomatic, weight gain, polyuria, polydipsia, polyphagia, glucosuria
-Treatment: OHA, diet, exercise
-Complication: Hyperosmolar Non-Ketotic Coma; no lipolysis; can lead to coma & seizure

REMEMBER:

Dopamine deficit- PARKINSON’S DISEASE (RX: Anti-parkinsonian drug to inc dopa)

Dopamine excess- SCHIZOPRENIA (RX: Anti-psychotic drug to dec dopa)
Acethylcholine deficit- MYASTHENIA GRAVIS (RX: Mestinon to inc ACH)
Acethylcholine excess- BIPOLAR DISORDER (RX: Lithium to dec ACH)

NOTICE THAT:

Neurotransmitter deficit= Medsurg illness

Neurotransmitter excess= Psych illness

VITAL SIGNS INC ICP SHOCK

BP increased decreased
Heart rate decreased increased
Respiratory decreased increased
Temp high low
Pulse pressure widening narrowing

EARLY SIGNS OF INCREASED ICP

-Change or dec LOC (restlessness to confusion)

-Irritability and agitation
-Disorientation
LATE SIGNS OF INCREASED ICP

-Hypertension, bradycardia, irregular rr = CUSHING TRIAD of inc ICP

-Widening pulse pressure
-Headache, papilledema, projectile vomiting
-Abnormal posturing: decorticate, decerebrate
-Unilateral dilation of pupils

EARLY SIGNS OF HYPOXIA LATE SIGNS OF HYPOXIA

Restlessness Bradycardia
Agitation Cyanosis
Tachycardia Dyspnea
Extreme restlessness

DRUG TOXICITY THERAPEUTIC RANGE INDICATION

-DIGOXIN (Lanoxin) 2ng/ml 0.5-1.5 ng/ml CHF

Cardiac Glycoside

-LITHIUM (Lithane, Eskalith) 2mEq/l 0.6-1.2 mEq/l Bipolar disorder

Anti-maniac

-AMINOPHYLLINE (Theophylline) 20mg/dl 10-19 mg/dl COPD

Bronchodilator

-DILANTIN (Phenytoin) 20mg/dl 10-19 mg/dl Seizure disorder

Anti-convulsant

-ACETAMINOPHEN (Tylenol) 200mg/dl 10-30 mg/dl Osteoarthritis

Non-narcotic agent

4 TYPES OF COPD

1. BRONCHITIS- “blue bloater” with edema; can lead to Cor Pulmonale (enlarge RV)
2. ASTHMA- wheezing on expiration; caused by allergic reaction’ hereditary
3. BRONCHIECTASIS- hemoptysis; pneumonectomy; bronchoscopy
4. EMPHYSEMA- “pink puffer” pursed lip breathing; barrel chest; irreversible; can lead to
pneumothorax; c02 narcosis; caused by allergic reaction; hereditary; can lead to Cor
Pulmonale
LEFT SIDED CHF

S/SX- Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Productive cough
Frothy salivation
Cyanosis
Rales/crackles
Bronchial wheezing
Pulsus alternans
Anorexia and general body malaise
PMI (point of maximum impulse/apical pulse rate) is displaced laterally
S3 (ventricular gallop)
Predisposing factors/mitral valve- RHD, Aging

TREATMENT- Morphine
Aminophelline
Digoxin
Diuretics
Oxygen
Gases, blood monitor

RIGHT SIDED CHF

S/SX: Jugular vein distention (neck)

Ascites
Pitting edema
Weight gain
Hepato-spleenomegaly
Jaundice
Pruritus
Esophageal varices
Anorexia and general body malaise

MYASTHENIC CRISIS CHOLINERGIC CRISIS

-under medication -over medication

-stress
-infection
-unable to see, swallow, speak, breathe -PNS
-administer cholinergic agent -administer anti-choli (atropine)
S/SX OF PULMONARY EMBOLISM S/SX OF CEREBRAL EMBOLISM

-Sudden sharp chest pain -Headache and dizziness

-Unexplained dyspnea -Confusion
-Tachycardia -Restlessness
-Palpitations -Decrease LOC
-Diaphoresis
-Mild restlessness

DIABETES INSIPIDUS

S/SX: Polyuria, Signs of DHN, Weakness, Fatigue, Hypotension, Weight loss

MGX: Force fluids

Monitor strictly vs and i&o
Administer Pitressin (Vasopressin Tannate)
Prevent CX: Hypovolemic shock

SIADH

S/SX: Fluid retention- hypertension, edema, weight gain

Water intoxication may lead to cerebral edema and lead to inc ICP- may lead to sz

MGX: Restrict fluid

Administer meds- Loop diuretics (Lasix); osmotic (Mannitol)
Monitor strictly vs, intake and output, neuro check
Weigh patient daily and assess pitting edema
Provide meticulous skin care
Prevent complications

HYPERTHYROIDISM- all are increase except weight and menstruation; Grave’s Disease

S/SX: Inc appetite but there is weight loss; amenorrhea; exophthalmos

MGX: Monitor vs and i&o

Administer anti-thyroid- Prophythiouracil (PTU), Methymazole (Tapazole)
Provide dietary intake that is inc in cal
Meticulous skin care
Comfortable and cold environment
Provide bilateral eye patch to prevent drying of the eyes
HYPOTHYROIDISM- all are decrease except weight and menstruation

S/SX: EARLY- Loss of appetite but there is weight gain; cold intolerance; constipation;
dry skin; weakness and fatigue
LATE- Brittleness of hair and nails; non pitting edema (myxedema); hoarseness of
voice; dec libido; lethargy; memory impairment; psychosis; menorrhagia

MGX: Monitor vs and i&o to determine the presence of Myxedema Coma

Nsg Mgx of M.C- mech vent; thyroid hormones; force fluids
Administer isotonic fluid
Administer thyroid hormones- levothyroxine, levothyronine, thyroid extract
Provide dietary intake that is low in cal
Provide comfortable and warm environment

HYPOPARATHYROIDISM- dec secretion of parathormone leading to hypocalcemia

-resulting to hyperphosphatemia

S/SX: Acute Tetany- tingling sensation

Paresthesia
Numbness
Dysphagia
Positive trosseu’s sign/carpopedal spasm
Laryngospasm/bronchospasm
Seizure and Arrhythmia- FEARED CX

MGX: Calcium Gluconate IV slowly

Chronic Tetany- Photophobia

Loss of tooth enamel
Anorexia, nausea and vomiting
Agitation and memory impairment

MGX: Oral calcium supplements

Calcium Gluconate
Calcium Lactate
Calcium Carbonate

MGX: Encourage inc intake foods rich in ca- anchovies, salmon, green trunips
Institute seizure and safety precaution
Prepare trache set at bedside for presence of laryngo spasm
Hormonal replacement therapy for lifetime
HYPERPARATHYROIDISM- hypercalcemia, kidney stones; hyperplasia of parathyroid gland

S/SX: Bone pain especially at back (bone fracture)

Kidney stones- renal colic, cool moist skin
Anorexia, nausea and vomiting
Agitation and memory impairment

MGX: Force fluids to prevent kidney stones

Strain all the urine using gauze for stone analysis
Provide warm sitz bath
Administer- Morphine (Demerol)
Encourage inc intake of foods rich in phosphate but dec in calcium
Provide acid ash diet to acidify urine and prevent bacterial growth
Assist/supervise in ambulation
Surgical procedure- Parathyroidectomy

ADDISON’S DISEASE- hyposecretion of adreno cortical hormone leading to

a.metabolic disturbance- Sugar
b.fluid and electrolyte imbalance- Salt
c.deficiency of neuromuscular function- Salt/Sex

S/SX: Hypoglycemia- TIRED

Decrease tolerance to stress
Hyponatremia- hypotension, signs of DHN, weight loss
Hyperkalemia- agitation, diarrhea, arrhythmia
Decrease libido
Bronze like skin pigmentation

MGX: Monitor vs, input and output to determine the presence of Addisonian Crisis
(severe hypotension, hypovolemic shock, hyponatremia)

NSG MGX FOR CRISIS- Assist in mech vent

Administer isotonic fluid
Force fluid
Administer corticosteroids (dexamethasone,
prednisone, hydrocortisone)

Monitor side effects- hypertension, edema, hirsutism,

Provide dietary intake inc in cal, carbo, protein but dec in potassium
Avoid stress, infection, sudden withdrawal to steroids
Hormonal replacement for lifetime
CUSHING SYNDROME- hypersecretion of adrenocortical hormones

S/SX: Increase susceptibility to infection

Hypernatremia- hypertension
Edema
Weight gain
MOON FACE AND BUFFALO HUMP
Obese trunk
Thin extremities
Hypokalemia- weakness and fatigue
Constipation
U wave upon ECG (T wave hyperkalemia)
Hirsutism
Acne and striae
Easy bruising

MGX: Weigh patient daily and assess for pitting edema

Measure abdominal girth daily and notify physician
Restrict sodium intake
Administer- Spinarolactone: potassium sparring diuretics
Prevent complications (DM)
Surgical procedure- Bilateral Adrenoraphy

DKA- acute cx of DM1 due to severe hyperglycemia leading to severe CNS depression; STRESS

S/SX: 3 P’s
Weight loss
Anorexia, n/v
KUSSMAUL’S RESPIRATION
CNS depression leading to coma

MGX: Assist in mech vent

Administer- insulin therapy (reg acting/rapid acting insulin peak 2-4h)
Sodium bicarb to counteract acidosis
Antibiotics to prevent infection

HYPER OSMOLAR NON-KETOTIC COMA

S/SX: Headache and dizziness, Restlessness, Seizure Activity, Decrease LOC

MGX: Insulin therapy

Antibiotics to prevent infection
IRON DEFICIENCY ANEMIA

S/SX: Usually asymptomatic

Weakness and fatigue- INITIAL SIGNS
Headache and dizziness
Pallor and cold sensitivity
Dyspnea
Palpitations
Brittleness of hair and spoon shape nails (koilonchias)
Atropic glossitis, stomatitis, dysphagia- Plumber Vinson’s Syndrome

MGX: Monitor for signs of bleeding of all hema test, urine, stool and GIT
CBR
Take foods rich in iron- organ meat, egg yolk, raisin, sweet potato, dried fruits
Avoid tea and coffee it contains tannates which impairs iron absorption
Drugs- Ferrous Sulfate, Ferrous Fumarate, Ferrous Gluconate 300mg/d
-take with meals
-use straw to prevent staining of teeth
MEDS ADMINISTERED VIA STRAW
-Lugol’s solution
-Iron
-Tetracycline
-Nitrofurantoin (Macrodentin)

PERNICIOUS ANEMIA

S/SX: Weakness and fatigue

Headache and dizziness
Pallor and cold sensitivity
Dyspnea and palpitations
Mouth sore
RED BEEFY TONGUE
Indigestion/dyspepsia
Weight loss
Jaundice
CNS changes- tingling sensation, numbness, paresthesia, +Romberg’s test

DX: Schilling’s test- reveal inadequate/dec absorption of Vit. B12

MGX: CBR
Vit. B12 injections at monthly intervals for lifetime
Diet- food high in carbo, protein, vit c and iron
Avoid mouth wash, use soft bristled toothbrush
 Avoid heat application to prevent burns
APLASTIC ANEMIA

S/SX: Anemia- weakness, headache, dizziness, pallor, dyspnea, palpitations

Leukopenia- increase susceptibility to infection
Thrombocytopenia- petechiae, ecchymosis, oozing of blood

DX: CBC reveals pancytopenia

Bone marrow biopsy/aspiration (posterior iliac crest)

MGX: Institute BT as ordered

Administer 02
CBR
Reverse isolation
Monitor signs of infection- fever, cough
Avoid IM, subQ, venipuntured sites
Use electric razor
Drugs- Corticosteroid, Immunosuppressants

CAD/ISCHEMIC HEART DISEASE

STAGES OF DEVELOPMENT OF CORONARY ARTERY DISEASE

1. Myocardial Injury- Atherosclerosis

2. Myocardial Ischemia- Angina Pectoris
3. Myocardial Necrosis- Myocardial Infarction

ATHEROSCLEROSIS ARTERIOSCLEROSIS
-Narrowing of artery -Hardening of artery
-Lipid or fat deposit -Calcium and protein deposit
-TUNICA INTIMA -TUNICA MEDIA

S/SX: Chest pain, dyspnea, tachycardia, palpitations, diaphoresis

TX: Percutaneous Transluminal Coronary Angioplasty

CABG- CX: Pneumonia, Shock, Thrombophlebitis

ANGINA PECTORIS- paroxysmal chest pain that is usually relieved by rest or nitroglycerine

S/SX: Levine’s sign- initial sign that shows the hand clutching the chest
Chest pain- sharp stabbing located at sub sterna radiates back, shoulder, axilla
 Dyspnea, Tachycardia, Palpitations, Diaphoresis
MGX: CBR
Nitroglycerine- Give 1st dose sublingual 3-5mins
-Give 2nd dose if pain persist after giving 1st w/interval of 3-5mins
-Give 3rd and last if pain persist at 3-5mins interval
Beta-Blockers- Propanolol: side effect PNS
ACE Inhibitor- Enalapril
Calcium Antagonist
Administer 02
High Fowlers
Provide decrease saturated fats sodium and caffeine

ANTERIOR PITUITARY GLAND

HORMONE EFFECT (DECREASED)

-Luteinizing hormone (LH) -Oligomenorrhea, Amenorrhea, Infertility

-FSH -Dec libido, poor devt of sexual characteristic
-Growth Hormone -Dwarfism
-ACTH -Adrenal insufficiency or disorder
-TSH -Hypothyroidism

POSTERIOR PITUITARY GLAND

HORMONE EFFECT (DECREASED)

-ADH -Diabetes Insipidus

-Oxytocin -Child birth problems/Pregnancy problem

ANTI-CHOLINERGIC- Probanthine

CHOLINERGIC- Bethanecol

Crackles/rales- CHF, Pneumonia

Wheezes- Asthma
Rhonchi- Obstruction in trachea
Pleural friction rub- pleurisy