lOMoARcPSD|39804106

MED SURG notes 4

bs nursing (Southwestern University PHINMA)

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 lOMoARcPSD|39804106

"
silent type
"

OPEN ANGLE GLAUCOMA 14501^1 CLOSED ANGLE GLAUCOMA lt45° ) b. Laser Trabeculoplasty

primary Glaucoma simple Glaucoma secondary Glaucoma Acute ↳ enlarge trabecular meshwork =P Drainage
angle glaucoma
' '
, , , ,

Congenital Glaucoma ,
Wide Angle Glaucoma Narrow angle glaucoma c. Trabeculectomy '
post : 4) Bleb
'
less common ? '
Most common ? '
requires immediate ↳ remove trabecular meshwork -
-

rapid drainage
intervention
Noto Milat Moderate Pain 130-50 mmHg ) severe Pain 150-70 mmHg )
'

peripheral Iridotomy Ifor close angle)

.
d.

•
problems : .
problem :
' avoid anti -

cholinergic > create opening atsideoi.in's

" →%
-

^AH production -

PAH production post instructions : protective sunglasses instill prescribed eye drops ,

small drainage / Holes in -1M -

small to Nohoiesin -1M do not rub eyes ,

eye shield .lv straining
-

obstruction oi.TN/CS-ilvflexibi1ityoi.TM
-
* Obstruction of -1M / CS 3. Cataract →
opacity of the lens lnon transparent )
-

Honors TM 450 lrido Corneal Angle Types : i. senile caused by aging 16001Mt ) # leye problem in elderly
-
-
-
- -

signs and symptoms : i. Congenital -

inborn abnormality
*
i. Painful Blurred Vision -
MOP 3. Traumatic -

Direct damage 20 trauma

*
i. tunnel vision tossup -

peripheral vision :
permanent
>
scar tissue formation
-

4) central vision -
-

it will gradually t
signs and symptoms : 4. secondary -
caused by diseases ( Diabetes , Hypertension )
peripheral vision
*

cloudy white pupil 402 Injury

'
-
f) i.
:

*
pt instruction : Turn head from side to side
.
20N peripheral vision 2. loss of red reflex =
4) gray reflex :-( tlcataract

3. Halos around lights =

Green > Assess : PERRLAIPUPII equally rounder reactive to light and accommodation )

4. HIV , Dizziness syncope ,

6. Eye edema > other name : Torch use : outer to inner

5- permanent Blindness 7- PLOP *

3. Decreased Night ision

Diagnostic Test : 4. Painless Blurred Vision

Tonometry assess IOP Glare 20 to diffused light it photosensitivity

-

1- -

5- =

-
-

non-invasive , painless 6. Decreased color Perception -

-
Dullcolors

=
1-111^21 .

mmHg =L-11 Glaucoma Green :

Blue Red pink
:

U
2. Gonioscopy -_
test -10 differentiate OAG -1 CAG Diagnostic Test :

=
measures the KA using mirrors .

n i. visualization Test

3. Visualization :
visualize -1M Opthalmoslopy

✓ opthalmoscopy ✓ slit lamp ✗ Mydriatic ,

be infront of iris slit lamp

instruct patient to look straight Lens -

behind iris -_
Mydriatrics ( atropine sulfate )

Management : 2. Snellen 's chart

i. Nursing : 3. Ishihara Polychromatic Plates

a. Allow patient to rest with head elevated lsemi Fowlers / -

to lower 1012=142 s read letters and numbers

b. No lifting of heavy objects , Max :

10kg -
assess colorblindness -
-

red and green -_

gray

c. TFIUID Intake tfiber Activity Laxative coral ) prevent constipation straining Men :( tl colorblind women carrier → genes
-
→
-
- :
. . .

a. Medical : 4. PERRLA

a. OAG →
Mydriatic .SI/ttropineso4)-di1atepupi1st-orAHtopass lanaqement : non-surgical management
contraindication : Miotics a. Intra capsular cataract Extraction
-

( KEE )

Myotis ( pilocarpine ) pupil constriction -450 ort ↳ remove the lens + lens capsule
CAG →
mmHg top
-
: -

lwholel lnomorelens implants )

b. Beta -
blockers tanti adrenergic ) - -

WAH production -
-

HOP IVE -_
external lens

ex : Betaxolollbe.toptidiimololltimopti.cl -0101 e. Alpha agonist -

→ TAH prod .
2. Extra Capsular Cataract Extraction LECCE )
-

> CI : bradycardia , COPD ,

c. Oral Carbon Anhydrase Inhibitor asthma ex : Brimonidinetidine ) , removal of lens only lwholel
ex : Acetazolamidecliamox ) -
-

IAH production i. Prostaglandin →

TAH drainage
-

4) lens capsule =L-11 lens implants

ex : Bimatoprost
d. Diuretics cosmetic diuretics ) →
remove fluids in eye =tAH removal
-
-
flop -
alternate lens : eyeglasses or contact lens

ex : Mannitol → diuretics for eyes and brain -

give mydriatrics : Dilate pupil fort access

> uwaves.in ECG

Kwastinq -

Monitor -
-
tuk -

Hypokalemia / Hypokalemia -

give anti -

biotic →
prophylaxis
consideration for Medication Administration : -

leyeatatime interval 01=1 year ,

phacoe.MU/sification.2setsoi.medicationl1athome+1inbag
•
Always follow medication schedule : avoid complications 3. "

) >
remove lenslinpieces)

3.
surgery
-

phacotip -

breaks lens + suction

÷¥É
-
,

cyclo therapy 1 Freezing probe) small incision entry point oiphacotip

-

a.
-
-

> close ciliary body ducts give anesthesia and antibiotics

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-

> WAH
 lOMoARcPSD|39804106

Diet : Fruits c. chemical Irritation

Intraocular lens Implant IVeggies.lv sugar
/
4.
" ' " "ma "
> insert totems capsule No smoking , no alcohol Mechanical Irritation

post
-

consideration : cataract surgery management : Wash affected eye with running water
coughing
Eye shield sneezing
misawa position in nonsurgical side d. Hordeolum / Stye : arrival infection
straining
prevent TIOP by :
lifting
lowering head pain : minimal give acetaminophen
, management : ✓ warm Application toomfort __

Give Osmotic Diuretics 1 Mannitol ) prevent MOPCIVFKKHOP ) Dilation

.tl/cretionoipus-tyecream(
' :

antibiotic with steroids / antiviral topical )

4.
conjunctivitis lpinktye Disease ) howtoapply : inner to outer canthus

✓ inflammation of loniuctiva -
1- 7%
-
-
medication component of eye cream

# 1 eye disorder in the world

Transmission : contact >

eye secretions B. EARS -
-

hearing acoustic CCNE ) cvestibulocochlear)

t t

causes : balance + hearing

Increased secretions lttears ) Temporal lobe cerebrum )

i. Allergy
-
-

2. viral =
self-limiting ( 7- days ) Parts : a. Outer → auricle .
> ear canal

"
3. Bacteria -_
PUS i. Auricle -_
external ear structure ( cartilage )

can cause permanent eye damage .

Pinna -

3-lty.co .
-
-

pullback + down

signs &
symptoms :
3+1^4.0 :
pullback -1 UP

i. Pruritus leye itchiness ) 2. Ear Canal :

passage sound

2. Redness Earwax -

trap Foreign objects

.

3. tsecretion Ear hair

-

filter

4. Fever :
Bacterial / Viral Hearing :
Air conduction

5- Purulent Drainage Hearing loss :

conductive Hearing Loss 1 Partial )

Diagnostic Test : Middle Ear -

-
eardrum to oval window

1. Visualization of conjunctiva + cornea lfront) i. Eardrum tiymlanic Membrane )

pt instruction : look
.
straight only > convention, from sound to vibration

specimen eye secretion using petri dish with agar

/
Ct Test :
M """"
-

a. -

"
-

↳ agent pass vibration

>
dragon: choice -1 prevent drug resistance I -

Incus sources → eardrum

/
'
> skull
3. Blood Test S -

stapes

Eosinophils
"
Oval window entry of vibration to inner ear
/
-

3. -

+ allergic reaction
"Y¥ity
'
-

IgE 4. Eustachian Tube -

equalize ear pressure lmiddleear ) →

pressure is released at

Management : open :b pressure by opening mouth / chew gum / pinch blow

'
nose +

i. cold applications :b inflammation :b pruritus / tiredness tpressure.lv Hearing Hearing :

bone conduction

ruse sterile water ii. using cold compress Inner Ear

maximum time : 30min average time : 15-20 mins i. cochlea → snail like structure -

> 1^30 minutes :

rebound effect (1^1117) >
houses theorganofcorti →
converts vibrations to sensorineural impulses

2. Medication >
sensorineural conduction

Allergy antihistamine stops allergic reactions

-_ -

Hearing loss -_
sensorineural Hlctotal )

virus :
palliative management -1 universal precaution ctlandwashing ) 2. labyrinth lsemi -

circular canals )

Anti-viral s production of endolymph → maintains balance

-

Bacterial :
antibiotics with steroids Abnormal Endolymph ->
Imbalance ( Menier 's Disease ) →
Vertigo
kill bacteria trim!1amm 3. Acoustic Nerve CCN8)

5. Other Eye Condition Outer Ear → Air conduction conductive Hearing

} loss
.

middle Ear → Bone conduction → Partial hearing loss

a. Blunt Trauma > 1-11 Hematoma Inner Ear -
> sensorineural → sensory neural hearing
loss → complete hearing loss
Management : cold Application :
1513 days →
prevent edema

warm Application : Next 3days-itreabsorpti.vn of edema DISEASES

b. piercing Trauma
1. Otitis Media -

inflamoimiddleear

Management : F. 0 lodged -
-

secure / stabilize bring to hospital causes : i. Bacterial →

infants -_
milk drainage
F. 0 Dislodged -
-
covert apply pressure →
children -_
dirty water
bring to hospital 2.
Allergy
-

Give antibiotics
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 lOMoARcPSD|39804106

slsx : Manifestation :
i. Hearing loss → conductive i. Tinnitus -

ringing of the ears

pain Throbbing Hearing Loss difficulty hearing high pitched sound

-_
a. Ear →
i.

3- Purulent Drainage management : assign a Male nurse to patient

4. Fever Diagnostic Test :

5. loss of Balance 1. HAS -11 Hearing Acquity screening Test )

Diagnostic Test : " Whisper test

a. otoscopy -

visullizeeardrumtearcanal b. Watch Test

} assess hearing loss

3-it back down

-

Align Ear canal 3+1 backup 2 .

Weber 's Test → lab Near

hold like a pencil + insert gently > use tuning fork and place in vertex of skull or forehead
a. Hearing Acaviity Screening .
Test ( HAST) abnormal ear :
loud collar)= CHL

assess ii. 1+11-11 Weaklsilent )=sNHL

-

a. Whisper Testconeachear ) normal ear

-
-

equal SoundCloud / on both ears

✓ 1 syllable word 3. Rinne 's Test =

2 abnormal ears

1 foot away from.pt 's ear over ear :

air conduction

Ask to repeat word mastoid bone -

-
bone conduction

b. watch test R Ear =

Airconduction → 1min = conductive Hearing
loss
watch over ear Bone conduction >
-

1min30sec

listen to ticking sound 1 Ear =

Airconduction → 1min20s

3. Weber 's Test :

1 Abnormal . ear Bone conduction → 50s

Differentiate between CHLORSNHI . Nears :P Air conduction

Tuning fork -
vertex of the skull or forehead after tuning NO Hearing loss

Askptto listen +
compare Ntoltb Near 4. Acidimetry -
-
best hearing test

Result =AbN Ear Assess hearing loss and severity of hearing loss
>
loudlfteurl -
conductive Hearing to Assess type of hearing loss

↳ weakls.int ) -

SNHL Management :
a. Rinne 's Test =2AbN Ears i. Insert a hearing aide -
-
louder sound
-
-

test to differentiate CHLORSNHL imonitor batteries

-
-

b- years

Tuning fork →
over ear → air conduction > no water contact
-
-

remove hearing aide

Mastoid Bone >
-

Bone conduction > Remove during MRI

✓ Rear → air conduction 1min -_

bone conduction 1min20sec : .

→ conductive hearing loss > Uses bone conduction
✓ LEar-iairwnduction-s-osecs-sensi.ro neural hearing loss

bone conduction -45 secs - 2- stapedectomy :

removal of stapes

✓ Normal Ear -
swngerairno hearing loss put on Robinson 's prosthesis
-
-

stainless steel stapes

5. Audiometry -
assess hearing ability , using decibels 1dB )
14413--14
assess HLI,pdB=wHL 3. Meniere 'S Disease / Endo lymphatic Hydrops ) → imbalance in endolymph
>
severity Etiology : Idiopathic Genetics )
Differentiate typeoi.tk/.YiYHL Common : Both male / Female , 504.0 -1T

Management : HL : sensory neural Hotan

1- Meds :
Allergy
-

antihistamine signs / sx : 3 cardinal signs

Bacterial -

antibiotics teardrops ) alignearcanal -

*
i. Tinnitus -

earliest

a. Flush ear with sterile water +

a. Vertigo -

common complain
3. surgery : ↳ severe dizziness →
Nausea +
vomiting
Myrinqotomy-openingoi.eu/rdrumcdrainuge7
*
Early Fluctuating HL SNHL
-
:
3 .
-

Late Tymphanoplasty > repair eardrum Diagnostic Test

-

-
:
-

1. HAST

2. Oto sclerosis =

Hardening of stapes i. Weber 's Test lsilentorweaksound ) →

sensory neural HL

etiology : Idiopathic 1 Genetics ) 3. Rinne 's Test → fair 1- hearing loss →

sensory neural HL

common : Women 604.0T 4. Audiometry

Hearing loss : Conductive 5. Romberg 's sign
-
-

balance test

1-11=105501 balance :
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 lOMoARcPSD|39804106

Management :

i. priority safety =

frisk for head injury 20 to Falls

4) Attack =
lie down

Raise side rails

2. Diet -
-

Furstenberg Diet
IN a .lv Flds t Msg , t sugar ,

Eat fresh =
fruits / veggies CCI : celery )

⇐ Medication, :

✓ Anti -

Vertigo =
Iv dizziness , give only if I -11 attack
Medizine ( Anti Vertigo ) -

effect =
after 30 mins

sedatives =
t sleep → Iv dizziness

Anti -

histamine

Diazepam

Thiazide Diuretics ( Diuril ) :b Endolymph

> K Wasting hypokalemia -

K rich .
Food's I diet
.

4. surgery =
Labyrinth ectomy ,
with ear T Endolymph

> removal labyrinth IN endolymph )

effect : No Vertigo
SE :
hearing loss on the affected ear

i. Pt instruction
.

No sudden head movements

>
no rough terrains

-
No unpressurized air crafts

> Helicopters small planes ,

6. Other Ear Abnormality

1. Impacted era men 1 Earwax )
> HL = ( HL

mgt : irrigate with water

Mineral oil drops =

lubrication

2. Insects or foreign objects entry

HL : LHL

mgt : Mineral oil drops =

Lubrication ,

3.
piercing injury to ears

mgt : stabilize object

Bring to hospital
4.
Bleeding from Ears 20 Blunt Trauma

assess if I -11 CSF

'
* Otorrhea → ear bleeding
assess halo sign :
yellow ring
M Glucose in blood =
It ) CSF

ii. 1+1 CSF →

do not obstruct bleeding -

prevent t ICP

ii. f.) CSF → obstruct → stop bleeding

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 lOMoARcPSD|39804106

☒ 1171111114117¥ THEN e. urethra / urinary meatus →

Passage a- urine

function : elimination process of blood waste products ) -

alkaline in nature

waste products : BUN .

creatinine excess , fluid -

urethral sphincters -
-
Allow urine to pass

1. kNBHEH$ -

prevents reflux

Function : BINAFFE DISEASES :

Regulation 1- UTI
B- BP →
ascending infection
ex : MBP :P diuresis Carine output)=tBld Volume :b Blood Pressure to Normal -
causative agent : E.CO/icnormallyfoundinL.I.l
ttBP= RAAS -
-

TBP Risk factors : UTIS

> IBID Volume / IBP.

4- Urinary Retention :b urine passage

1- ACE
-

RAAS will release : Renin ( Kidney ) -

Thongs → prolonged underwear use

(
'

Angiotensin -1 Cliver )
.
1- improper Hygiene
(
'

Angiotensin # Clangs ) proper cleaning : Women :

front to back
⇐
Aldosterone ( Adrenal cortex) Men :
Head → circular
( inner → outer )
TINA -
-
Water Retention :P Bld.VN/TBP=tK Shaft → downward stroke

^BP= PHC a
PK excretions uncircumstized __
retract prepuce
coitus
tthirst / drinking
>
-

aste Excretion s -
sex →
activity > toys

Bloodlwastel >
Kidneys gender → common among females 20 short urethra

L J

urine a waste Blood >

circulate 20 close proximity
BUN Protein waste products
creatinine }
*

* ↳ a protein Diet signs and symptoms :

-
-
-
Cid Base Balance
-
=
Metabolic pH i. hallmark : Dysuria # Painful Urination 1 Burning sensation
-
Hcosl Bicarb ) Production -
-
Alkaline Puffer 2. Pain →
Urinary Tract →
supra pubic
-

Renal Failure :
THIO }
-
-

Metabolic Acidosis kidneys →

Retroperitoneal
= -

Formation of Urine 3. Fever → earliest manifestation of infection

>
Excess Fluids
-

urine > solid wastes 4. Urgency → Tdesiretovoidltu -01=1+1 bladder involvement

urine output --T1OOm4hr= Poiyuria '

DM 5. Frequency →
Avoiding (1^4.0)=1+1 bladder involvement

t3Oml1hr= Oliguria '

Acute RF , shock 6
.
Hematuria , Bacteria , Pyuria
lvlomllhr : Anuria ' Chronic RF ESRD
, Diagnostic Test :

urine characteristics i. Urinalysis :-.

-30 -50mL urine of urine

pH -4.6-8 collect clean catch Midstream collection

-

color = Yellow Amber Straw

, , Result : 1+1 RBC , a) Bacteria , G) Pus , tsp Gravity Dark colored
,

sp Gravity ( measures solid )= 1.010-1.030 2. Culture and sensitivity =

5- 10mL vi. urine
it solid .lv Fluid : TSP Gravity
= 24hr5 -124 Hrs
tsolid.tl Fluid tsp Gravity
-

>
-

F- Fluid Electrolyte Balance -

to determine DOC →
prevent drug resistance

1^1^1=10-1 Electrolytes Eliminate Balloon

EFF! collect : catheterized collection > Foley Cath
- -

uteri ,eµzo,
ay
,

Hundt Electrolytes -_
Retain sterile Techniques
Clamp for
E- Erythropoiesis : RBC production 30min , self-sealing port -450 -

>
Erythropoietin Production =
Management : INFECT
> stimulates RBC production in Bone Marrow I -
Increase Fluid Intake =
H2O / Bilko Juice

a. Nephrons contraindication : Alcohol + softdrinks

Glomerulus -_
filter semi permeable
,
-
membrane ( small molecules :
pass ) H never forget tovoidaftersex
-
-
-

flush out
-

ltllarge Molecules in urine -_

Glomerular Damage F- frequent voiding =q2Hrs
-

Glumerular Filtration Rate ( GFR ) :

90 -100% ,
IVGFR :(+1 Renal Failure stimulate voiding by : Give privacy -1 Time
-

Normal Urine produced :3 -6mL / hr water sound -

open Faucet

b. ureters -
urine passage E- t.at/tcidAshDiet--1vpH-iPAcidiFyurine
Barley , Rye ,
-

Alkaline :P infection risk C- Cranberries IN -

Wheat ( Whole Grains / BROW oatsiwineatl
c. Bladder llysto ) :
storage of Urine P -
prunes E- Eggs =P Amino Acid

d. Prostate CMAK ) :
p -
Plums T tomatoes
-

location : Below Bladder + Surround Urethra M -

Meat lttftaimdinioaoid ) CI CITRUS Alkaline)

-

Benign Prostatic Hyperplasia

-
-

compression of Urethra c- antibiotics ciproi-loiaxin.cc/:uroxime,Co-trimoxazole

↳ " " "s
>
Nocturia :p Night
voiding by at after take meals / Full stomach * FINISH -

complete treatment
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II. Alcohol :b effect to prevent drug resistance
 lOMoARcPSD|39804106

1+1 Allergy Rashes Managements : RSTONES

}
* -

stop report replace

,
* Antihistamine
* ( t) Toxicity Tinnitus -
R -

Rest :b Pain

* N antibiotics , do skin test :

1-1 / ANST latter negative skin Test ) ( t ) pain -
-
Rest

113110-159 Location of f) pain -

-

Activity → promote stone evacuation

-
create a weal ,
encircle w/ black ink kidney stones : S -

strain urine →
determine composition of stone

Monitor for 30min read Physician

" "
-_
use cheesecloth strainer → stone samples test
-
-
-
,

1- TOP analgesics mild to Moderate Pain Teach Diet Management

-

: -

Pyrictiumlphenazopyridine ) calcium oxalate

avoidtca.to/a1atelalkaline7sE:RedUrine--
ex : →

Meds Eat Acid Ash Diet

struvite → Eat Acid Ash

Fatin - calkaline )
RENAL CALCULI ( Kidney stones) IGI disorders
-
-

digestion uric Acid → avoid diet urine

lucid )

Types : i. calcium oxalate stones →

caused by : Diettca.to/alate , hypercalcemia Eat alkaline Ash Diet
based on

composition Alkaline stones most common Hyper parathyroid -1171-1--1^10 in Blood Eat Alka Ash Diet
>
. cystine → -

TCAFOOCI : Milk , Dairy products Achovies ,GW

, Alkaline rich Food : Milk Dairy products Veggies , >

toxalate Food : chocolates .NU/-s.softdrinKs -

observe urine output

I

struvite stones caused Proteus Bacteria Obstruction tt.lt -0 191^1-120 intake to dilute stone (3-41) unless CI
g. UTI
a)
2. →
by : :
.
.

dangerous staghorn appearance :.

" "
>
, e) Obstruction .
:
NU -0 .

alkaline stones N Narcotics

.
-
→ tseueré pain Control pain : round the dock pt .

train
pain monitoring
>
#

3. Uric Acid stones -

caused by : Diettpurine , dehydration , diabetes t.tt ex :
Morphine 504 >
. sedatives --tRR

Gout > Genetic Abnormality in Purine Metabolism sgiveonly ii. RRISTR

tlpurinefood : organ Meats Beans Nuts Anchovies sardines shells , , , , ,
MNarcotics= Respi / Medullary Depression

4. Cystine Camino Acid ) :

Genetic Abnormality in protein metabolism Antidote : Naloxone ( Narcan )=tRR
amino
> Rare > Accumulate → stones , because PCT doesnt absorb 10010 OF acid Pt controlled.

Analgesia :

other causes : i.
Urinary retention E- ESINL -

Extracorporeal Shockwave lithotrity

2. lvcitrate ( citrate prevents calcium formation ) > Ultrasonic waves → Break /shatter stones

.nl ) >
☐ >
if;☐ → urine → strain -
-
composition

Nolncision
Types : i. Urolitniasis →
stones in urinary tract > GAISA
based on
location
i. lilephrolithiasis →
stones in kidneys 1+1 Bleeding .lt) Pain >
Analgesics after >
because broken stones
are passed out through
*

signs / sx : i. severe Pain →

radiating to the legs S -

surgery 1- lithotomy --
removal of stones ) the urinary tracts .

Urolithiasis →
supra pubic -

lilephrolithotomy

lilephrolithiasis →
retroperitoneal / costovevtebral angle -

urolithotomy

2. Dysuria :

painful voiding (sharp / piercing pain ) RENAL FAILURE =

tfiltrationof Blood
↳ ✗ Fluids

3. Hematuria -20 to trauma 7-

Urinary Retention itiwaste
tell -0

4. (t ) obstruction =
urgency 8. Asymptomatic until stones are big Types : i. ARE :
reversible
Alto
51-1 obstruction :

frequency
or mobile a. CRF :
Irreversible

i¥÷µ÷¥y¥nÉ÷1÷¥
6- UTI signs and symptoms > End Stage Renal Disease

Diagnostic Test : () a. ACUTE RENAL FAILURE Club months)

"
1. Ultrasonography
-

visualize stone "" "

avium ,
i. Pre renal
-
-_ outside kineys
HPN Thrombus Embolus hypovolemia burns
}
aminoaoid.eu
↳ toz . , , ,
"" " "" " "'

full bladder (1^1--10)=1 visualization ↳ lvcirculation Pvc Hemorrhage Shock Cardiac arrest
'

.
, , >

2- KUB X-ray : visualization 2. Intra renal-

: direct damage to kidney or nephrons :b Filter blood
↳ Trauma
bladder -11^1=1 d) =P Visualization NPC Intravenous Pyelogram ) Neurotoxic :# 1 Antibiotics 1 Aminoglycosides) lcnemodrugs
'
full 5. ↳ Drugs →

↳ Enzymes → Myoglobin -
muscle enzyme
3. Blood Test
-

ex : tca.tw/alatE=Ca0xa1ate >
Ndyeliodinetxrayq : U.S .
↳ triggers tubular necrosis ( constant SP .

Gravity )= 1.010
↳ DM -1M Glucose .
→ At Function of kidney
'
t Bacteria -_
struvite 6. 24hr urine Test

Auric Acid =
uric acid nsg consideration : keeponke ! 3. Post renal
-

failure =
urinary tract > prevent urine From draining
t cystine
'
obstruction triggered by lnflammor : stones or tumors / stroke
cystine
-
-
-

4. lystoscopy -

endoscopic visualization of Bladder

'
reflux Dfurinet Kidneys :
Damage
-

f) incision .lt ) Bleeding .lt/Pain Stages :

n
.
medical infection
contraindication : UTI Iatrogenic Infection Oliguria tttoomllday

{④
→
prevent i.
- -

complications : i. t Hydrostatic pressure t kidney 's ability to filter lasts for 1- 2. weeks if more than 2weeks → CRF
-
- -

2.
Hydronephrosis / Hydrometernephrosis > 2. Diuretic -3-5 liters /day but urine , still concentrated , but Pt is better
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3. Infection Dilation a -

lasts For 2-3 weeks

.
.
 lOMoARcPSD|39804106

3. convalescent >
-

normal urine output R -

Replacement

-
3-12 Months Normal Values : 1. sodium Bicarb / NAHCO } IU )

signs
.
I symptoms : BINAFFE →
Oliguria BUN -16 -20mg 1dL 2. calcium Gluconate

Creatinine -70.6 -1.20mg /dl Dialysis Artificial Blood Filtration

BP→M= Hypertension secondary tot Blood Volume D- :
i.

2. Waste →
Min blood -
TBUN tcrea } Azotemia ( excessive
>
nitrogenous waste products) Types : 1. Peritoneal

neuro status SISX

3. Acid Base Balance -14 Bicarbonate -
-
Metabolic Acidosis >
2. Hemodialysis
mgt : SAFETY ! !
compensation :( tlkussmaul 's
breathing CHRONIC RENAL FAILURE →
End-stage Renal Disease
-

> 1^1^1212=1^0214021-1 Respiratory Alka > Irreversible Terminal __

Iv
↳ 61--12=154 v11 Filtration 60 -89mL / min 3:30-59mL/min
Formation of Urine Oliguria Ctisomllhr ) stage 2 :
→ →
4. :
. or ,

5. Fluid and Electrolyte Balance → 1=1^1 Fluid -

-

Edema →
Anasarca (Generalized Edema) * ARF →
CRF →
t.SI?D-- Death 4:15 -29.mil/min.5:lv15Ml1min

> Pwt . DOBdcrackles201-tuidinlun.gs "'" " severe ARE slsx :

End-stage renal disease '

' Ascites , Bipedal Edema [ Dependent, -

severe Hypertension
* Electrolyte =tNa+itHd= Dilution at Hyponatremia -

severe Azotemia

=P Ki> Acid .
→ ECGres.cl/t:Peak1Tai1T- waves > Urine in Blood
Uremia -
-

uremic Frost
-
-

flawless nutritional intake =

Tetany czoperspiration ) a) crystals Askin .
- → pruritus

chvostekis.tross.eu?u.Aivwuy.spasm '
-
Nausea I
vomiting 20T Waste in brain

G. Erythropoiesis.=tRBC production =
Erythrocytopenia ( Anemia ) -

severe Metabolic Acidosis Ctlvtltco } )

manifestation : i. G) Pallor →
cyano in Distal Areas -
Anuria ltlomllhr ) -120 HVGFR

2. Fatigue
-

severe Anasarca

3. THR ,TBP,tRR →
compensatory Mechanism
-

severed " " 't " " " '

4. Hypoxia slsx -

restlessness
-

severe Anemia → bloc ;

it waste

Diagnostic Test :
' waste product from muscle breakdown * COMA :b Brain function
"
i. BUN and creatinine level IRR
-
-

Respiratory Arrest
result : 1^1^1341111 Crea :(HRF Diagnostic Test :

ttBUN&Crea= f) RF level -1^1^1^1134 Ndcreawl

}cRf
1. .

2. BUN and creatinine clearance Normal values : a. clearance -

t.tw/3UN-creaC1earanceEsRD
result : 1^1^1341111 Crea clearance =HRF female : 85 -125mL / min Management :

ttBUN&Crea Clearance :(HRF Male : 95 -140mL / min i. ACUTE RD

Management : ACUTE RD GT-R : 90mL / Minori 2. Kidney Transplant

A- Appropriate Diet 1
kidney Transplant tinHam=tlNBC
/
= *

tprotein-tBUN.lv creatinine * Leave old kidneys ↳ lvrejection

teams =
prevent ketosis * Location :
Iliac fossa

PNa.tk.tca.lv Water intake * Blood supply :

renal artery

c- Control Elevation Of Potassium ORGAN TRANSPLANT :

how ? - Diuretics →
loop Diuretics ( Furosemide Lasixl -

Organ Donor List

monitor: Hypokalemia ( Kean be given via incorporation N ) ↳ blood + tissue compatible

Insulin ↳ Principle oftustice )

" "

• →
brings glucose 1-
potassium into cells , goal :b potassium only first come , first serve l
1-

Glucose IV prevent hypoglycemia Immunosuppressant :b Rejection lriskfor rejection lifetime)

-
-

-1

-
Kayaxelate Enema ( sodium Polysterenesulforene ) i taken lifetime

>
promotes exchange of KtNa From Blood blame Intestines ex : cyclosporine
4- urine Monitoring steroids →
prednisone
purine Output :
Good cyclophosphamide llytoxan )

lvurineoutputlpersistentl :
Bad → CRF Best Donor : First degree family
NUO -720 -1440mL / day -
>
Identical Twins ( same DNA )
stwastes
T -

Total Rest :
sleep =P Healing =P Mitosis cell Replacement ) 3- Dialysis :
Filter Blood ↳ ppfluids

luton Hormones -1 Chemical Mediators also SAFETY since

, no effect : -
RBC.lk/BC platelets ,

☐ neuro status
-

conserve 02 -

hgb
E- Edema Management :
Types : i. Peritoneal Dialysis IPD )
i. Assess the →
weight girth , . BP → Baseline ↳ usebialysate solution →
tfluid.lv solid
2. Restrict fluid 1-211 day :
3. Diuretics ( loop ) Natural
↳ Use Membrane / Peritoneal )
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Monitor II. Oltoutputl
 lOMoARcPSD|39804106

* CAPDI Manual ) 0 -

observe sterile Technique

-

4-8 hours ✓ cap , goggles , mask , gown , dirtiest cleanest

gloves ,
* remove →

* ACPDC Automated ) D- Donotusesiteforother procedures

-

30min54 hrs CI : BP assessment , -11711,111

processes involved : s -

strictly noconstrictionatsite
↳
Diffusion : solid waste , Higher > lower Hemodialysis complications :
↳ osmosis :P Fluids lower , itligher
-

i. Infection -_
blood
>
Edema
management : Antibiotics
1311 t solid t.fldt.tt/vmayspacena
Peritoneal Membrane
a-
Bleeding
mgt : ✓ Apply pressure
> ÑFld=MFluids / osmosis)
>
Dialysate-tsolid-ttsoh.de Diffusion ) Cold Application
PD Management : ABDOM Elevate

A- Assess :wt loss , girth ,BP→SE:tBP 3. Disequilibrium syndrome →

cerebral Edema → MKP → train Brain -1 Brain Fxn
t
B- BesuretoWARMDialysate.to prevent cramps / abdominal cramp cause : rapid infusion or prolonged infusion lt4hm seizure

ii. Ctlcramps kink / clamp tube , management : stop + report

f) cramps → continue PD ✓
stop cerebral edema by giving Mannitol cosmetic )

D- Dialysis Time

LAPD 4-8 hours

-
- -

ACPD -30min -41-1

-
-

"

Technique 1 surgical Asepsis )

"

0 -

observe sterile -

O microorganism
M -
Monitor outflow -_
ttoutflow

* t outflow →
Trapped fluids

management : Turn / Reposition pt .

*
Cloudy outflow → G) pus -
-

Infection
management : Antibiotics
2. Hemodialysis -
Direct filtration of Blood

Dialysate Solution

Artificial Membrane lsemi Permeable)→ serves -

as kidney
to

Removal of solid waste

Heparin -_
prevent clot

↳ tiriskfor
bleeding
antidote : Protamine 504

Laboratory : Ptt
Diuretics -
-

remove excess fluids

Access sites :

Av : Arteriovenous ( Arteries -

Vein )

Shunt Coulter ) Fistula [ internal )

✓ Ztubesivein
• artery
H anastomosis ofarterytve.in
D :P infection ,t bleeding risk A
TiÑtH
Aieasytocreuteanduse , painless v

D: youneedskillsllv)

A: lviniectionelv bleeding risk

management : BLOODS

B- Bleeding Precaution → 20 Heparin

Antidote : Protamine 504

CI : Meds w/ Bleeding effects

1- let patient use / exercise site

o
-
observe Patency of site

Auscultate Bruit
}
by : i.
# Good
patency
=

2. Palpate Thrill :

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 lOMoARcPSD|39804106

HI -
Y
2. Dopaminergic → tdopamine
> anti-viral
briain ¥014
.
> anti -

parkinsonIan

DISEASES : ex : Amantadine csymmetrell levodopa carbidopacsinemet) ,

-

PARKINSON 'S DISEASE Dopamine Agonist side effects : NV , orthostatic hpn ,

1- 3. →
frigidity >

insomnia agitation mental

lvtdopamine levels Bromooriptinecparlodell
, ,
- -

Ivlumovement ex :
confusion
-

✓
•
lvdopamine -
tacetykholine :P muscle rigidity / contraction 1Blocks the effect) Do not take : Phenothiazine Reserpine ,

Idiopathic MULTIPLE SCLEROSIS Demyelination opcentra / Nerves pyridoxine

Etiology
=
- :

dendrites
Degeneration / myelin
•
Probable cause : i. Midbrain sheath __
Fast impulse transmission Types OF Neurons :

¥#É€} '
sensory → affarent
2. Head Trauma .
> synapse motor> efferent

•
common inmates 50 and above Boxers "
Nucleus T-cells
>

impulse transmission
.

axon = slow
•
Pattern of condition : mild -
>
severe progressive) attacks e

cause of Death : Respiratory complication Hypostatic Pneumonia Etiology : Idiopathic

'

. •

signs and symptoms : 4A 's -

Probable cause : i. Autoimmune -
-

T-cells → attack myelin sheath

A- Affect lfacial Expression ) -

-
flat affect ( Mask like face ) -

* ALS -

Amyotropic lateral sclerosis >

-

Demyelination ofsidesofspinalcorc
A- Attitude -_
Irritable . Risk Factors : Women .
20-404.0 ,t stress .

A- Articulation ( speech ) -
-

slurred speech +
drooling saliva . Pattern : Remission ltslsxl -

Exacerbation ltslsxl

A- Activity :
Rigidity of Muscle
*
> rest healthy , Triggers : F- Fatigue
•
Pill .ro/linyTremorslRestingTr-emors)-'pt- instruction : Hold something
lifestyle enough ,

E- Extreme Temperature
sleep

iBradykinesia-Akinesialf-reezi.mg ) s -

stress

rigidity Respiratory complication Hypostatic Pneumonia

'

•
Lead pipe -

( hard muscle) •
cause of Death :

'
shuffling propulsive Gait signs and symptoms :
'
Rocking back and forth to stand i. spasm -

rigidity -1 pain
-
-
earliest manifestation ofm.SE
manifestation
'×
Diagnostic Test : a. Charcoal's Triad →
hallmark
1- Ion scan , single Photon Emission Tomography
imaging technique that uses → 3D

radio nuclei as and instruments to detect photons

s -

scanning speech
2. Visualization .
I -
Intention Tremors louring activity )

with contrast liodinedye ) * check ifltlallergy involuntary

}
CT scan -

N -

Nystagmus >
eye movement

MRI agent unless may obstruction Diplopia → double vision

Management : DOPAM 3. Bowel + Bladder Retention →

how to assess ? Palpate for distention

optic Neuritis ) blind spots in visual field

-

D- DORON :
tolvtigidity a. scotoma →

Passive :
with assistance →
stop ii. there is slight resistance 5. sexual Dysfunction -_
tlibidolsexdrivel
Active -
-

alone women
-
-
tlubrication

* Active Assistive -
→ the unaffected part assists the affected part Men -
-
Erectile Dysfunction
* Active resistance -

→ with weights Diagnostic Test :

O Observe Proper
-

Hygiene → nurse 's role : upervise / assist i. MRI -

visualize demyelination
ADE patient to promote self esteem its claustrophobia >
give sedatives cdiazepam)
-
- -

p -

provide warm Bath and Massage → tmuscle relaxation z.HN/tTestlAnti-NudearAntibodyTest1

A- Aspiration precaution → prevent aspiration pneumonia > It)
-
-
4) Autoimmune -11-11 Antibodies

How ? Thick liquid > blood

use straw Management : SPASMS

soft Diet S steroids prednisone ) lower antibodies lvdemylenation
-
- - -
-

NGT -

Levine Tube
medical
SE :
Infection risk → reverse isolation neutropenia / protective
,
>
x-ray →

aspirate nursing
precaution precaution
>
universal
→
* Placement iauscuitate-oonvinie.int ,
-_
hand wash

* assess residual volume P plasmapheresis separates anti bodies from blood

-
- -
-

100mL -11 -_
do not give se :P Infection
100mL -14 Give A- Avoid FES prevent exacerbation
-

- - :

* position : semi Fowlers -

s -

stimulate Bowel + Bladder function

* Ideal : 50C syringe :b Air '

Give time -1
Privacy '
Give Time -1 Privacy , tho sound ,

Indwelling -
Foley
M -

Medication tlfluid tfiber , ,

Inactivity , Urinary catheter intermittent -
-

straight
,

i. Anti parkinsonism Drugs

-

→
lowers ACH :b rigidity laxative , stool softener Enema .

example :( ongentiniltrthane , Benadryl Akineton . M -

Muscle Relaxants :b spasm

antidote : anti cholinergic -

:S >
Physostigmine ex : Baclofen llioresall Dantroleneclantriuml Diazepam . ( Valium )
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SE : muscle weakness t.la?akW1oBRP-snsgint .

 lOMoARcPSD|39804106

S -

sex management 2. CT scan / MRI

-
-

visualize brain

women : lubricants 11-120 Based ) Management :

men : Viagra
-
-

CI : Hypertension , cardiac abnormalities Nursing : i. Before

-
-

Identify Aura

2. During ( Rigid / =
SESURE

SEIZURE -

tltelectrical impulses / activity in brain imbalance in GABAR Glutamate s -

safety is priority
-
Etiology : Idiopathic E- easepatienttoploor
+ Nalle:Ss

• Probable cause : FITHIM s -

side rails padded -1 raised ibeolinlontest position

f- fever 1404+1=11 cellular metabolism -1^02
-

demand -
-
Febrile seizure u -

use soft object under head

↳ common in children -
-
b- yo -14 R -

restrains not used + remove restrictive items or glasses

I. Infection 1 Encephalitis / Meningitis ) :

Hypoxia to brain E- evaluate time and duration ( should becceosl.ii.is Epilepticus .

Trauma to head Triggers : stress hormone shift to sleep After colonic Post ktal ! AREST
'

T -

, , , 3. + -

> turntoside
H -

Hypoxia in brain electrolyte imbalances under .

-
A- airway is priority -

aspiration risk > suction

medication alcohol
I -
Intracranial Tumor :
common in Pediatrics .
,
R -
reorient =
person place time , . + vital signs
M -
Metabolic Factors -
-
Genetics / Drugs ex : Methamphetamine E- Encourage +
promote sleep
-
-
conserve 02

'
Common : Men ,0 -54.0 .
, 6:09 -0 .tt 20402in brain s -

supplemental 02=1^02 →
gradual awakening
•
Pattern : Remission Exacerbation -

.
T -
Teach seizure precautions

'
cause of Death :
Respiratory complication -
-

Aspiration pneumonia 20 bubbling of saliva stimulants :X

type : i. localized Focal simple . ,

-_
affect / area OF brain pedi a seizure mgt : ✓ room away from station

KETOGENIC DIET A Fats blurbs

2. Generalized lsystemic) affects :
entire brain →
✓ Limit visitors dim.room.no radio / TV
.

>
Absence Blank stare lpctit trial )
regular food
-
=

localized =t stimulant
Mechanical Mannerisms galawngpaa
.

↳
lvmusck
-

atonic
-

>
.

tone consideration =
no swimming w/o supervision
> Tonic clonic ( Grandmal )
-
→ severe seizure
t
Generalized t
/ happens 2-3 days b4 seizures Medical : i. Dilatinl Phenytoin ) :
lowers electrical impulses in brain
rigid rigid , relax -

↳ do not give wl
stages : TONIC CLONIC SEIZURES
-
1. 1. Drodroma / symptoms
→
starts to appear it seizure ,
SE : i. Gingival Hyperplasia milk

i. Aura stage sensory perceptions subjective ) happens w/ in seconds / min b4 HISE >
gradually stop Dilatin management : oral Hygiene & Massage Gums
- -

-
→

flashes OF "9ht seizure considerations : Red Urine -2° Medication :c) RBC

flaming
ex : 2.

Tinnitus . remembered i. Nf
-
-
PN.ss.l.ci/uNacH
before Passing out

/
peculiar smell / Taste a. Avoid alcohol or Milk to avoid drowsiness

Abdominal Pain 3. stop gradually to prevent status: epilepticus

loss of consciousness no recollection / memory Ictus stage actual seizure Phenobarbital luminal / Barbiturates lsedative.SI
-
→
2. - :
2.

3. Tonic -_
rigidity -130 -60sec it Electrical Activity Of Brain Drug level : 15-45 mcgl
ML
- No respiration 402 -_ .
Biting of tongue SE :ttL0C :(+ 1.Drowsiness , respi depression
- 1^605 :
status epilepticus → tutor 3. Diazepam CVAIIUM ) → Doc
t a
•
Epileptic cry =P pitched sound in status Epilepticus

Ends With antidote : Huma zenit

-
Deep Breath

4. clonic -

alternating rigidity -1 relax ALZHEIMER 'S DISEASE

•
Blowing of saliva __ Risk for aspiration . Etiology : Idiopathic

5. Post total -

stage →
ptis asleep 2010402 →
30 mins -

Hours . probable cause : i. T Beta Amyloid Plaques 1 Protein Plaques)

-
Disorientation after seizure nsgint : reorient patient a. tneuroiibrillary Tangles
>
ptis v. tired
Diagnostic Test : Acetylcholine :b impulse transmission
.

s.lv

i. EEGC Electroencephalogram ) → measures electrical activity of the brain a. cerebral Degeneration -_

shrinking opcerebrum
↳ determine type of seizure
-

painless •
common in women 60y.oanc.IT
↳ determine location -
-

part of brain
-

wash hair I DM : pattern :

Progressive lluildtoseverel occurs .
when bedridden

REGULAR EEG SLEEP EEG . cause of Death : Respi complication ltlypostatic Pneumonia !
•
Daytime -
Night signs and symptoms :

• 30min -1hr - 8- 10hr5 1. Gradual Memory loss

- patient is awake - Patient is asleep i. Irritability

• Ky Jelly used for leads =
colloidal Glue used for leads 3. Accident-prone
> remove w/ H2O '
remove w/ acetone 4. Limited vocabulary

HONDO needed
"
• -
-

give food 5. sundown ing phenomenon -

it confusion

-
avoid stimulants / Depressant + Meds wandering purposeless :

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