Académique Documents
Professionnel Documents
Culture Documents
info/
SNS : Adrenergic Agents – Epinephrine (adrenaline)
-Atropine sulfate
Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’)
– Blocks release of norepinephrine.
– Decrease body activities except GIT (diarrhea)
Ex. Propanolol, Metopanolol
SE:
B – broncho spasm (bronchoconstriction)
E – elicits a decrease in myocardial contraction
T – treats HPN
A – AV conduction slows down
DEMYELLENATING DISEASE
S&Sx:
Bronchoscopy
o AtSO4
Anticholinergic mimics SNR
Decreases saliva dry mouth
o NPO 6 to 8 hours
o Local anesthesia check gag reflex before feeding
ABG
o Hyperventilation decreased CO2 increased blood pH respiratory alkalosis
o Hypoventilation increased CO2 decreased blood pH respiratory acidosis
o Diarrhea decreased HCO3 decreased blood pH metabolic acidosis
o Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis
o Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid
decreased blood pH metabolic acidosis
o Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis
o Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory
Alkalosis
o Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased 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
o 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 CO2
(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 kidneys
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
bronchodilation
Side effect stimulates beta 1 receptors increases cardiac rate need not to notify
the physician
Adverse effect hypotension monitor BP sign of toxicity
Evaluation check breath sounds
Pulmonary embolism
o Restlessness earliest sign
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart)
decreased TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid
PAIN management decreased O2 demand by rest and SFF
Angina
o Pain relieved by rest and NTG
o NTG
Vasodilation orthostatic hypotension 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
MI
o Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression monitor RR and O2 saturation
Antidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injection
site, high risk for injury
Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor
APTT/PTT antidote protamine SO4
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of Vitamin
B12 beefy red tongue schilling’s test definitive test 24 hour urine collection life long Vitamin
B12
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 by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids,
NSAIDs, indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and
gastric movement
Dumping syndrome tachycardia and weakness 3 D’s (diarrhea, diaphoresis and dizziness)
fluids after meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix
sudden cessation of pain, elevation of temperature and WBC
Ulcerative colitis bloody diarrhea 15 to 20 times a day fluid volume deficit, anemia
Liver cirrhosis alcohol and malnutrition (laennec’s), infection and drugs (post necrotic), 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 shifting ascites
management high protein diet
o CHON metabolism by product ammonia liver cannot convert to urea increased level of
ammonia in the brain Alteration of LOC and changes of behavior and asterexis hepatic
encephalopathy management low CHON diet and lactulose for removal of ammonia
Cholecystitis 5 F’s (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food
demerol to relieved pain
Cholecystectomy T tube level of the incision site drain excess bile
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
intake
Decreased hypocalcemia calcium supplement
Thyroid Gland
o Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increased
catabolism weight loss increased appetite increased peristalsis Diarrhea
fluid volume deficit Increased CR and RR (due to increased BMR)
Increased T3 heat intolerance
Calcitonin decreased calcium in the blood tetany compensatory calcium
withdraws 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)
Lugol’s solution decreased released of TH before thyroidectomy decreased
vascularity of the thyroid gland
o Decreased (hypothyroidism)
T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism
weight gain anorexia decreased peristalsis constipation decreased CR and
RR due to decreased BMR
T3 cold intolerance
Calcitonin hypercalcemia stone formation
Synthroid and Proloid increased TH
Adrenal Gland
o Incresead (cushing’s)
Glucocorticoids hyperglycemia and decrease wound healing
Mineral corticoids increased aldosterone sodium retention and potassium excretion
hypernatremia and hypokalemia
Hypernatremia water retention oliguria edema (moon face,buffalohump,
fluid volume excess and weight gain) concentrated urine increased urine
specific gravity low 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
Hyponatremia water excretion polyuria (dehydration, fluid volume deficit
and weight loss) diluted urine --. Decreased urine specific gravity increased
fluids and 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 DKA increased lipolysis increased ketones
o Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria
and warm flush skin
o Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurate
o Foot care
Podiatrist
Avoid removing corns and calluses
Cut toe nails straight across
Avoid walking bare foot
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 Don’t include diasylate solution in the output of the client
o Expected decreased weight monitor weight before and after decreased createnine and
BUN
Parkinson’s diasease
o Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid 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 Tensilon test confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics
Over medication cholinergic crisis give ATSO4
Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoat’s triad
Intentional tremors
Scanning of speech
Nystagmus
o Visual disturbances diplopia
Rheumatoid Arthritis
o No specific diagnostic test
o NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis
(joint fixation)
o Avoid flexion and promote prone position
Gouty Arthritis
o Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritis
o Most common related with aging
o Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
Iron supplement When is the best time to take (empty stomach), How is best taken (with orange
juice)
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision
miotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Normal Values
o BUN = 10 – 20 mg/dl
o Calcium = 9 to 10.5 mg/dl
o Creatinine = 5 to 1.5 mg/dl
o GTT = 70 to 115 mg/dl
o O2 sat = 97 to 98%