o o o

o o o o losis o Vomiting blood decreased O2 anaerobic metabolism formation of lactic aci d decreased blood pH metabolic acidosis o Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidos is o Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreas ed Respiratory Alkalosis o Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decrea sed metabolic acidosis Cancer of the larynx CS, alcohol and over usage of voice (choir member) o A - nterior neck mass o B urning sensation with hot beverages / Bad breath o C - hange in the voice (hoarseness) o D ysphagia/dyspnea Chronic Obstructive Pulmonary Disease o Chronic Bronchitis Blue bloater Excessive mucus production o Asthma Periods of bronchospasm and bronchoconstriction o Emphysema Disequilibrium of elastase and antielastase Pink puffer

Chest X ray painless procedure Bronchoscopy AtSO4 Anticholinergic mimics SNR Decreases saliva dry mouth NPO 6 to 8 hours Local anesthesia check gag reflex before feeding ABG Hyperventilation decreased CO2 increased blood pH respiratory alkalosis Hypoventilation increased CO2 decreased blood pH respiratory acidosis Diarrhea decreased HCO3 decreased blood pH metabolic acidosis Vomiting gastric content decreased HCL increased blood pH metabolic alka

Manifestations A LTERATION IN LOC decreased O2 Thoracic anatomy over distention of alveoli TD = APD barrel chest Skin o Temperature cool clammy skin o Color pale to cyanotic ABG Respiratory acidosis Increased CO2 B reathing difficulty, purse lip expiration > inhalation removal of excess CO diet low CHO) C ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and SFF) clubbing of the fingers and decreased TP to the kidne ys causing polycythemia D ecreased Metabolism Anorexia weight loss (high calorie diet) fatigue weakness Bronchodilators o Theophylline and aminophylline Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodila ion Side effect stimulates beta 1 receptors increases cardiac rate need not to noti y the physician

o o

Adverse effect hypotension monitor BP sign of toxicity Evaluation check breath sounds Acute Respiratory Distress Syndrome Causes A spiration R espiratory trauma (embolism) fracture embolism ARDS D rug toxicity (ASA) S epsis and shock Vomiting, bleeding, dehydration hypovolemia shock ARDS Syndrome Severe hypoxia Bilateral infiltrates Dyspnea Pulmonary embolism Restlessness earliest

Water Seal System Drainage Bottle marked the level every shift Water seal bottle Presence of fluctuation normal Absence of fluctuation lungs are fully expanded assess first patient (X ray con irm) OR presence of obstruction Intermittent bubbling normal Absent obstruction Continuous leakage o Suction Control continuous bubbling normal Risk factors for cardiovascular disorders o R ace non modifiable o I ncresed blood pressure modifiable o S tress SNR increased BP and CR, vasoconstriction modifiable o K nowing sedentary life style modifiable o F at foods atherosclerosis modifiable o A lcohol (modifiable) / Age above 40 (non modifiable) o C igarette smoking vasoconstriction (nicotine) modifiable / Contraceptiv e pills clotting of blood thrombus formation o T ype A behavior (modifiable) competitiveness, perfectionist high stress level o O besity o R esult of DM lipolysis increased fatty acids atherosclerosis o S ex gender males > female (before menopausal because estrogen decreases PVR) after menopausal female eversible}[inverted T wave] Injury [elevated ST seg ment] > male Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[patholog ic Q wave/permanent in the ECG] Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood f low (heart) decreased TP (heart) decreased O2 (heart) anaerobic respiration product ion of lactic acid PAIN management decreased O2 demand by rest and SFF Angina o Pain relieved by rest and NTG o NTG Vasodilation orthostatic hypotention move gradually Monitor BP Store in a dark and amber container Effective tingling sensation no need to notify physician Maximum of 3 tablets with 5 minute interval o o MI

Pain relieved by Morphine SO4 Narcotic analgesic Can cause respiratory depression monitor RR and O2 saturation Antidote narcan Cardioversion synchronous Defibrillation unsynchronous Buergers disease CS vasoconstriction stop CS common in men Raynauds stress and cold vasoconstriction common in female Congestive heart failure o Left sided pulmonary Dyspnea Crackles Polycythemia due to decrease O2 to the kidneys Clubbing of the fingers due to prolonged hyxia Orthopnea o Right sided systemic Hepatomegaly Distended neck veins Edema Portal hypertension Ascites weight gain Varicose veins o Digoxin Cardiac glycoside Positive inotrophic effect increased strength of myocardial contraction Negative chronotrophic effect decreased cardiac rate monitor CR never give if C below 60 bpm Adverse effect V omitting A norexia N ausea D iarrhea A bdominal pain REMEMBER: earliest GI; late halo vision Antidote Digibind Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high risk for injury Decreased WBC prone to infection, reverse isolation Increased WBC presence of infection First Day/Newly diagnosed Knowledge deficit

o o o o o o o o

Diuretic D iet high K diet except aldactone I input and Output expected increased output U ndesirable effect electrolyte imbalance (K) R ecord weight expected decreased weight E lderly special precaution T ake in AM and with food I ncreased orthostatic hypotension monitor BP and move gradually C ancel alcohol because of mild diuretic effect

Heparin anticoagulant prevent further enlargement of clot not dissolve them mon tor APTT/PTT antidote protamine SO4 Coumadin anticoagulant prevent further enlargement of clot not dissolve it moni or PT vitamin K is the antidote Urokinase/Streptoase dissolves the clot

Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorp tion of Vitamin B12 beefy red tongue schillings test definitive test 24 hour urin e collection life long Vitamin B12 Gastritis LUQ pain Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) pain relieved by antacids Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved y food Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, i on, steroids, NSAIDs, indomethacin Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased H l and gastric movement Dumping syndrome tachycardia and weakness 3 Ds (diarrhea, diaphoresis and dizzin ss) fluids after meals, lie down after meals and SFF Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendi udden cessation of pain, elevation of temperature and WBC Diverticulitis LLQ pain low fiber diet Diverticulosis high fiber diet Ulcerative colitis bloody diarrhea 20 to 30 times a day fluid volume deficit

Liver cirrhosis alcohol and malnutrition (laanecs), infection and drugs (post nec rotic), RSCHF (cardiac) and biliary obstruction (biliary) o Portal hypertention can lead to Blood shifted to the different collateral Esophageal varices Spider angioma (face and neck) Caput medusae (abdomen) Hemorrhoids (rectal) Management avoid rupture avoid shouting, valsalva maneuver Increased hydstatic pressure fluid shifting ascites o Decreased albumin decreased oncotic / colloidal osmotic pressure fluid s hifting ascites management high protein diet o CHON metabolism by product ammonia liver cannot convert to urea increase d level of ammonia in the brain Alteration of LOC and changes of behavior and as terexis hepatic encephalopathy management low CHON diet and lactulose for removal of ammonia Hepatitis A fecal oral prone plumber Hepatitis B body secretion prone working in a dialysis Cholecystitis 5 Fs (fair, female, fat, fertile and forty) RUQ pain after inges n of fatty food demerol to relieved pain Cholecystectomy T tube level of the incision site drain excess bile Pancreatitis alcohol autodigestion LUQ pain Anterior Pituitary gland o Growth hormone Increased before the closure of the epiphysis of the long bones gigantism tall Increased after the closure of the epiphysis acromegaly big hands (big gloves), big feet (big shoes) and big head (big hat) Decreased dwarfism o Prolactin Increased galactorrhea Decreased decreased milk production o ACTH

Increased Decreased TSH Increased Decreased

secondary cushings secondary addisons secondary hypethyroidism secondary hypothyroidism

Posterior pituitary gland ADH Increased water retention oliguria edema (fluid volume excess) and weight gain oncentrated urine increased urine specific gravity Decreased water excretion polyuria dehydration (fluid volume deficit and weight loss) diluted urine decreased urine specific gravity Parathyroid gland o Parathormone Increased increased calcium in the blood and decrease calcium in the bones stone formation and decreased bone mass osteoporosis management increased water intak e Decreased hypocalcemia calcium supplement Thyroid Gland o Increased (hyperthyroidism) T3 and T4 increased BMR hyperactive inability to focus insomia increased ca ism weight loss increased appetite increased peristalsis Diarrhea fluid volume d eficit Increased CR and RR (due to increased BMR) Increased T3 heat intolerance Calcitonin decreased calcium in the blood tetany compensatory calcium withdra from the bones bone destruction (complication) PTU decreased synthesis of TH watch out for SE (similar to signs and symptoms of hypothyroidism) watch out for agrunulocytosis (fever, skin rash and sore throat ) Lugols solution decreased released of TH before thyroidectomy decreased vascul ty of the thyroid gland o Decreased (hypothyroidism) T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight anorexia decreased peristalsis constipation decreased CR and RR due to decrease d BMR T3 cold intolerance Calcitonin hypercalcemia stone formation Synthroid and Proloid increased TH Adrenal Gland o Incresead (cushings) Glucocorticoids hyperglycemia and decrease wound healing Mineral corticoids increased aldosterone sodium retention and potassium excretio n hypernatremia and hypokalemia Hypernatremia water retention oliguria edema (moon face,buffalohump, fluid volu e excess and weight gain) concentrated urine increased urine specific gravity lo w sodium diet Hypokalemia weakness Prominent U wave high potassium diet Epinephrine and Norepinephrine Increased BP and CR Sex hormones Males gynecomastia and falling of hair Females hirsutism and deepening of the voice o Decreased (addisons) Glucocorticoids hypoglycemia and inability to cope with stress Mineralcorticoids decreased aldosterone sodium excretion and potassium retention hyponatremia and hyperkalemia o

 Hyponatremia water excretion polyuria (dehydration, fluid volume deficit and wei ght loss) diluted urine --. Decreased urine specific gravity increased fluids an d Na Hyperkalemia weakness tall or peaked T waves low K diet Epinephrine and Norepinephrine decreased BP and CR Diabetes Mellitus o Type I absolutely no insulin thin insulin o Type II insufficient insulin obese OHA o Diet 50% CHO, 30% Fats, 20% CHON o Exercise Increased uptake of glucose Decreased insulin requirement o Oral hypoglycemic agent (OHA) Stimulates pancreas to produce insulin o Insulin SC; IV if DKA Never massage the area Never administer cold insulin Rotate the site of injection PREVENTS LIPODYSTROPHY Mix Aspirate clear first Inject air to cloudy first o Hypoglycemia W eakness H unger pangs A alteration of LOC T achycardia and tremors A bdominal pain B blurring of vision C ool clammy skin D iaphoresis Give orange juice (simple sugars) o DKA increased lipolysis increased ketones o Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glyc osuria, ketonuria and warm flush skin o Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accu rate o Foot care Podiatrist Avoid removing corns and calluses Cut toe nails straight across Avoid walking bare foot Hepatitis A fecal oral Hepatitis B body and bloody secretions (hemodialysis) Peritoneal Dialysis o Diasylate output is decreased turn patient from side to side o Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and rigid abdomen peritonitis o Dont include diasylate solution in the output of the client o Expected decreased weight monitor weight before and after decreased crea tenine and BUN Heart block decreased tissue perfusion Parkinsons diasease o Decreased dopamine in the basal ganglia levodopa to increased dopamine a void Vit B6 foods o Cardinals signs tremors (non intentional) muscle rigidity bradykinesia o Pill rolling o Microphonia ask your client to speak aloud to be aware o Artane and Cogentin anticholinergic decreased muscle rigidity Myasthenia Gravis

o o o o o

o o

o o

Tensilon test confirmatory test Decreased Acetylcholine and increased cholinesterase Muscle weakness priority airway NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin Cholinergics (mestinon) increased muscle strength antidote ATSO4 Undermedication myasthenic crisis give cholinergics Over medication cholinergic crisis give ATSO4 Multiple Sclerosis Demyelinization of the myelin sheath Charcoats triad Intentional tremors Scanning of speech Nystagmus Visual disturbances diplopia Pancreatitis autodigestion alcohol bleeding shock Elevated amylase

Rheumatoid Arthritis o No specific diagnostic test o NSAIDs and ASA (antipyretic, analgesic and anti-inflammatory) o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bo ny ankylosis (joint fixation) o Avoid flexion and promote prone position Gouty Arthritis o Increased uric acid allopurinol and avoid organ meats (liver) tophi (ear s) Osteoarthritis o Most common related with aging o Pain after weight bearing exercise or activity rest to relieved pain wei ght reduction Diverticulitis LLQ pain and low fiber diet Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased flu id intake Vincristine (Oncovin) increased fiber in the diet Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice) Steroids and NSAIDs o DEATH inflammation o BIRTH side effects B one marrow depression prone to infection monitor temperature and WBC I ncreased gastric irritation take it with food or after meals R enal toxicity T innitus H epato toxic Cataract common cause is aging (senile) opacity of the lens position on the una fected side Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gu barrel vision miotics (constricts pupils) avoid ATSO4 (dilates pupil) Retinal detachment trauma blood clots floating spots dependent position scle uckling Avoid Increased Intraocular pressure PRIORITY o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bend ing, crying Menieres Triad tinnitus, impaired hearing loss and vertigo low Na diet o Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the room assume a flat or reclining position ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo Antibiotics allergic reactions Normal Values

o o o o o o o o o o o

BUN = 10 20 mg/dl Calcium = 9 to 10.5 mg/dl Creatinine = 5 to 1.5 mg/dl GTT = 70 to 115 mg/dl O2 sat = 97 to 98% Signs and Symptoms of Increased Intracranial Pressure B lood pressure and temperature are elevated R espiratory and cardiac rate are decreased A lteration of LOC I rritability N ote for projectile vomiting S eizure