 Odynophagia is painful swallowing, in the mouth (oropharynx) or esophagus.

It can occur with or without

dysphagia, or difficult swallowing
 Halitosis, oral malodor (scientific term), breath odor, foul breath, fetor oris, fetor ex ore, or most
commonly bad breath are terms used to describe
 Pyloroplasty is surgery to widen the opening of the end of the pylorus, which is found in the lower portion
of the stomach,
 Billroth I = gastroduodenal reconstruction
 Billroth II = gastrojejunal reconstruction
 ISOTONIC = the muscle shortens to produce contraction
 ISOMETRIC = NO CHANGE in muscle length
 ISOKINETIC = Involves muscle contraction or tension against a resistance
 Measure correct crutch length
LYING DOWN
Measure from the Anterior Axillary Fold to the HEEL of the foot then:
Add 1 inch (Kozier)
Add 2 inches (Brunner and Suddarth)
 Hyperalgesia—excessive sensitivity to pain
 Bruxism- commonly called night teeth-grinding occurring during stage 2 sleep
 Somnambulism- “sleepwalking"
 POLYSOMNOGRAPHY is the only method that can confirm sleep apnea.
 Urticaria - (or hives) is a skin condition, commonly caused by an allergic reaction, that is characterized by
raised red skin wheals
 Pruritus- is an itch or a sensation that makes a person want to scratch.
 CAUTION ---- Mnemonics for early detection for CANCER
C- Change in bowel/bladder habits
A- A sore that does not heal
U- Unusual bleeding
T- Thickening or lump in the breast
I- Indigestion
O- Obvious change in warts
N- Nagging cough and hoarseness
 Alopecia begins within 2 weeks of therapy. Regrowth within 8 weeks of termination
 Tenesmus is a feeling of incomplete defecation. It is experienced as an inability or difficulty to empty the
bowel at defecation.
 The CONDUCTING SYSTEM OF THE HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right and the Left bundle branch
4. Purkinje fibers- fastest conduction
 The Heart sounds
1. S1- due to closure of the AV valves
2. S2- due to the closure of the semi-lunar valves
3. S3- due to increased ventricular filling
4. S4- due to forceful atrial contraction
 The lymphatic system also is part of the vascular system and the function of this system is to collect the
extravasated fluid from the tissues and returns it to the blood
 CARDIAC Proteins and enzymes
CK- MB ( creatine kinase). Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days
 Troponin I and T
Troponin I is usually utilized for MI. Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days
to 3 weeks!
Normal value for Troponin I is less than 0.6 ng/mL
 Cholesterol= 200 mg/dL
 Triglycerides- 40- 150 mg/dL
 Ischemic changes may show ST depression and T wave inversion
 Nitrates- to dilate the coronary arteries
 Aspirin- to prevent thrombus formation
 Beta-blockers- to reduce BP and HR
 Calcium-channel blockers- to dilate coronary artery and reduce vasospasm
 After MI, Patients who are able to walk 3-4 mph are usually ready to resume sexual activities
 Infective endocarditis >> Osler’s nodes- painful nodules on fingerpads
 Infective endocarditis >> Roth’s spots- pale hemorrhages in the retina
 LEFT SIDED CHF
1. Dyspnea on exertion
2. PND
3. Orthopnea
4. Pulmonary crackles/rales
5. cough with Pinkish, frothy sputum
6. Tachycardia
7. Cool extremities
8. Cyanosis
9. decreased peripheral pulses
10. Fatigue
11. Oliguria
12. signs of cerebral anoxia
 RIGHT SIDED CHF
1. Peripheral dependent, pitting edema
2. Weight gain
3. Distended neck vein
4. hepatomegaly
5. Ascites
6. Body weakness
7. Anorexia, nausea
8. Pulsus alternans
 CARDIOGENIC SHOCK
1. HYPOTENSION
2. oliguria (less than 30 ml/hour)
3. tachycardia
4. narrow pulse pressure
5. weak peripheral pulses
6. cold clammy skin
7. changes in sensorium/LOC
8. pulmonary congestion
 CARDIAC TAMPONADE
A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac
(pericardial effusion)
 BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound
 ANEURYSM - Dilation involving an artery formed at a weak point in the vessel wall
Saccular= when one side of the vessel is affected
Fusiform= when the entire segment becomes dilated
 RISK FACTORS
Atherosclerosis
Infection= syphilis
Connective tissue disorder
Genetic disorder= Marfan’s Syndrome
 PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD) - Refers to arterial insufficiency of the extremities
usually secondary to peripheral atherosclerosis
 INTERMITTENT CLAUDICATION- the hallmark of PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD)
Intermittent claudication is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of
fatigue), classically calf muscle
 RAYNAUD’S DISEASE - A form of intermittent arteriolar VASOCONSTRICTION that results in coldness, pain
and pallor of the fingertips or toes
 Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It
sometimes occurs on only one side of the mouth
 APLASTIC ANEMIA - A condition characterized by decreased number of RBC as well as WBC and platelets
 Pernicious Anemia - Beefy, red, swollen tongue (Schilling’s test)
 Progesterone - maintains the uterine lining for implantation and relaxes all smooth muscles
 Relaxin - is the hormone that softens the muscles and joints of the pelvis
 Thyroxine - increases basal metabolic rates
 Buck's Traction - Skin traction
 Skeletal Traction - with Pins
 Vit. B2 (riboflavin) deficiency - scaly skin
 Vit. A deficiency - Night blindness
 Vit. D deficiency - Skeletal Pain
 Zinc deficiency - slow wound healing
 Selenium deficiency - heart damage
 Toxoplasmosis parasite - infection from inadequately cooked meat, eggs, or milk, ingestion or inhaling the
oocyst excreted in feline feces
 Sclerotherapy - injecttion of a sclerosing agent into a varicosity. The agent damages the vessels and causes
aseptic thrombosis, which result in vein closure.
 Deep Tendon Reflex Test
1+ - diminished
2+ - normal
3+ - increased, brisker-than-average
4+ very brisk, hyperactive
 Involution is a progressive descent of the uterus into the pelvic cavity that occurse at approx. 1cm per day.
 FHR can be first heard with fetoscope at 18 to 20 weeks gestation. 10 weeks with a doppler ultrasound.
 Folic acid rich food are peanuts, sunflower seeds and raisins
 Variable deceleration = cord compression
 Early deceleration = pressure on the fetal head during a contraction
 Later deceleration = uteroplacental insufficiency
 Cystitis is inflammation of the urinary bladder.
 Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney
(nephros in Greek).
 Partial weightbearing - 30% to 50% of the body weight on the affected limb
 Touch-down weight bearing allows the client to let the limb touch the floor but not bear weight.
 Thyroid supplements for hypothyroidism should be taken in the morning to avoid insomia.
 Croup - dont administer cough syrup and cold medicines because they will dry and thicken secretions. Sips
of warm fluid will relax the vocal cords and thin the mucos.
 Koplik spots - small bluish-white spots with a red base found on the buccal mucosa
 German measles - pinkish-rose maculopapular rash on the face, neck and scalp. Reddish and pinpoint
petechiae spots found on the soft palate
 Erythema infectiosum (fifth disease) [slapped cheek] - an intense, fiery-red, edematous rash on the
cheeks.
 Rocky Mountain Spotted Fever (RMSF) - rash on the palm and soles of the feed and on the remainder of
the body. Fever, headache, anorexia and restlessness. Meds given is Tetracycline hydrochloride
(achromycin)
 Thioguanine and thiotepa are antineoplastic medications
 Ticlopidine hydrochloride (Ticlid) is a platelet aggregation inhibitor
 Erythema marginatum is characterized by red skin lesions that start as flat or slightly raised macules,
usually over the trunk and that spread peripherally.
 Atrial fibrillation - Auscultating the apical pulse for an irregular rate while palpating the radial pulse for
pulse deficit
 Triple dye is used for initial cord care because it minimizes bateria and promotes drying.
 A low cardiac output will cause the increased build-up of blood in the heart and pulmonary system,
causing crackles to be heard in the lung fields.
 S3 heart sounds = ventricular gallop
 Trachoesophageal fistual = abdominal distension
 3 stages of separation anxiety are PROTEST, DESPAIR AND DETACHMENT
 Anaphylactic shock = fatal allergic reaction
 Cardiac Tamponade - assessment findings include tachycardia, distant or muffled heart sounds, jugular
vein distention and falling blood pressure accompanied by pulsus paradoxus ( a drop in inspiratory BY by >
10 mmhg)
 Spironolactone (Aldactone) > pt. may experience body image changes due to threatened sexual identity.
These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in
females.
 Diabetic ketoacidosis (DKA) - fruity odor to the client's breath
 Rhonchi - occur as a result of the passing of air through fluid-filled narrow passages. Rhonchi are
sometimes referred to as "gurgles". Diseases with excess mucous product, such as pnemonia are
associated with rhonchi. Rhonchi are usually heard on expiration and may clear with a cough.
 Urolithiasis is a condition in which crystals in the urine combine to form stones, also called calculi or
uroliths
 Hodgkin's disease is a type of lymphoma distinguished by the presence of a particular kind of cancer cell
called a Reed-Sternberg cell.
 Cardiogenic shock (left-sided heart failure) - includes altered sensorium, tachycardia, hypotension,
tachypnea, oliguria, and cold, clammy, cyanotic skin
 Ovarian cancer symptoms include abdominal discomfort, irreg. menses, flatulence, fullness after a light
mean and increase abdominal girth.
 Myocardial infarction:
-ST segment elevation usually occurs immediately or during the early stages of MI.
-The CK-MB isoenzyme begins to rise 3 to 6 hourse after MI.
-T wave depression and abnormal Q wave changes occur within several hours to several days after the MI.
 Abdominal aortic aneurysm (AAA) symptoms are "heart beating" in the abdomen when supine or be able
to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic
bruit may be ausculated over the mass.
 Neuroleptic Malignant syndrome experiences an elevated in temperature ( sometimes up to 107 F) and
parkinsonian symptoms
 Intermittent claudication usually refers to cramplike pains in the legs (usually the calf muscles, but may be
in the thigh.
 Cholinergic effect includes increase in salivation, lacrimation, urination and defecation, bradycardia,
hypotension and increaes muscle weakness
 Ventricular tachycardia is characterized by the absense of P waves, wide QRS complexes (usually greater
then 0.14 second) and a rate between 100 and 250 impulses per minute.
 Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. There are
no measurable rate and no visible P waves or QRS complexes.
 Inguinal hernia is a common defect that appears as a painless inguinal swelling when the child cries or
strains.
 Partial obstruction of the herniated loop of intestine - difficulty in defecating
 Phimosis - a dribbling stream, indicating an obstruction in the flow of urine
 Cryptorchidism - absense of the testes within the scrotum.
 Triamterene (Dyrenium) is a potassium-sparing diuretic. Side effects include frequent urination and
polyuria.
 Erythroblastosis fetalis is a hemolytic disease of the fetus or newborn resulting in excessive destruction of
red blood cells (RBCs) and stimulation of immature erythrocytes.
 Glycosylated hemoglobin values of 8% or less are acceptable.
 A partial-thickness superficial burn appears wet, shiny, and weeping or may contain blisters.
 A partial-thinkness deep burn appears dry and may be deep red or white. No blanching occurs and
thrombosed vessels may be visible.
 Hypercalcemia is a serum calcium ion level greater than 11 mg/dl or 5.5 mEq/L.
 Keratoplasty is referred to as corneal tranplantation or grafting
 The 3 characteristic symptoms of Menieres disease are tinnitus, sensorineural hearing loss on the involved
side.
 Otoscopy is an examination that involves looking into the ear with an instrument called an otoscope (or
auriscope).
 Nystagmus is an uncontrolled movement of the eyes, usually from side to side, but sometimes the eyes
swing up and down or even in a circular movement
 Presbycusis is the loss of hearing that gradually occurs in most individuals as they grow older.
 Tinnitus is the most common compaint of clients with otological disorders, esp. disorders involving the
inner ear.
 Nikolsky's sign is a clinical dermatological sign in which blisters spread easily upon application of
horizontal, tangential pressure to the skin.
 Pemphigus hallmark sign is Nikolsky sign which occurs when the epidermis can be rubbed off by slight
friction or injury. Its a rare, autoimmune skin disorder that causes blistering and raw sores on skin and
mucous membranes.
 Scabies can be identified by the presence of multiple straight or wavy threadlike lines beneath the skin.
The skin lesions are caused by a female mites that burrows beneath the skin and lays its eggs.
 A melanoma is an irregularly shaped, pigmented papule or plaque with a red, white or blue color.
 Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border.
 Squamous cell carcinoma is a firm, nodular lesion topped with a crust or a central area of ulceration.
 A hydrocele is an abnormal collection of fluid within the layers of the tunica vaginalis that surrounds the
testis. It may be unilateral or bilateral and can occur in an infant or adult.
 A Cunningham clamp is a adjustable, lightweight, foam-lined molded clamp that fits over the penis behind
the glans. It is sed for client experiencing urinary incontinence.
 Raynaud disease (RAY-noz) is a vascular disorder that affects blood flow to the extremities which include
the fingers, toes, nose and ears when exposed to temperature changes or stress.
 Osteomalacia is the general term for the softening of the bones due to defective bone mineralization.
Osteomalacia in children is known as rickets
 Calcium supplements should not be taken with whole grain cereals, rhubarb, spinach, or bran because
these foods decrease the absorption of the calcium.
 A blunted affect is a minimal emotional response and expresses the clients outward affect.
 Caput succedaneum - swelling of the soft tissues of the head
 Cephalhematoma - edema resulting from bleeding below the periosteum of the cranium
 An increased interest in sounds occurs between 6 and 8 months for an infant.
  Babbling sound begin between the ages of 3 and 4 months.
 Between the ages of 1 and 3 months the infant produces cooing sounds.
 Use of gestures occurs between 9 and 12 months.
 At age 15 mnts the child would be expected to build a tower of 2 blocks.
 At age of 18 months the child would be expected to build a tower of 4 to 5 blocks.
 At age 30 mnts the child would be expected to snap large snaps and put on simple clothes independently.
 An increase pH and bicarbonate level indicate metabolic alkalosis.
 Urine specific gravity is normally 1.010 to 1.030.
 Arterial ischemic leg ulcers are characteristically deep, pale and painful.
 Intermittent claudication is the name given to leg pain that occurs with exercise and relieved by rest.
 Aldactone is a potassium-sparing diuretic used to treat edema, high blood pressure and
hyperaldosteronium.
 Maturational crises involve developmental crises at any transition point in life, such as marriage,
pregnancy, or retirement.
 Situational crises are adverse happenings that disturb a person's functionaning, such as death of a loved
one, divorce or illness.
 Adventitious crises involve unexpected accidents, such as floods or earthquakes.
 Onspecific crisis is unrelated to this situation.
 Brown-S-Quard syndrone results from hemisection of the spinal cord, resulting in ipsilateral paralysis and
loss of tuch, pressure, vibration.

Glycosylated Hgb gives an indication of what the patient ate over the past 3 months by reporting the average
blood sugar over a period of time.

MgSO4 causes vasodilatation and lowers BP. The patient could become hypotensive.

Cryptorchidism is the absence of one or both testes from the scrotum. Cryptorchidism may cause permanent
damage to the testicle and interfere with either sperm production or transport of sperm.

Adoption studies of twins indicates that predisposition for schizophrenia may be inherited. Research indicates that
there is a genetic vulnerability as well as other factors that contribute to the development of schizophrenia.

Low serum albumin can indicate poor nutritional status or liver failure, making patient poor candidate for surgery.

Gowns, masks and goggles or face shields are required if there is a possibility of splattering.

Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the
cheeks, gums, tongue, lips, throat, and roof or floor of the mouth.

People who drink alcohol are more susceptible to cancer of mouth, liver, pancreas, stomach.

SIADH causes water retention, which leads to edema, and weight gain. Urine output is low, Serum Na is low and
urine specific gravity is high > 1.020.

Haloperidol is used in the treatment of schizophrenia and, more acutely, in the treatment of acute psychotic states
and delirium.

It is preferred that cyclophosphamide (cytoxan) be given in the morning, this will permit to force fluids during the
day and increase the number of times the child voids, which will help prevent hemorrhagic cystitis.

Tingling in the mouth and fingers is a sign of hyperventilation commonly occurring during the transitional phase of
labor due to increased breathing patterns in response to pain. Slowing of breathing pattern will help to increase
CO2 content.

Leukemia or leukaemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation
(production by multiplication) of blood cells, usually white blood cells (leukocytes). It is part of the broad group of
diseases called hematological neoplasms.

In severe depression activities of daily living are ignored as self-esteem and self worth are severely impaired. The
patient is showing an interest in self-care, which is a sign of improvement.

PTT normal is 35-45 seconds

Humulin R is a regular (short acting) insulin the only type that can be given IV.

Monthly self-breast exam should be done on the 7th day after the beginning of the menstrual flow.

Because the release of oxytocin during breastfeeding stimulates uterine contractions. During the first few days of
involution this may feel like strong cramping. A mild analgesic will relieve the pain and will not interfere with
establishing breastfeeding milk supply.

Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon, caused by
bowel obstruction resulting from an aganglionic section of bowel (the normal enteric nerves are absent) that starts
at the anus and progresses upwards.

Hirschprung's disease usually includes a temporary colostomy until the dilated portion of the bowel returns to
normal function.

Interfering with the completion of the ritual increases anxiety. Providing hand cream offers some protection to the
skin until the rituals reduce as the patient improves.

Chicken liver is high in Tyramine.

Patient with rheumatic fever will not develop bronchitis, oliguria or nausea. He will develop polyarthritis.

Prudent nursing practice is turning bed-bound patient every 2 hours. Turning every 4 hours fails to meet nursing
standards.

Green leafy vegetables are full of Vitamin K which interferes with Coumadin therapy. They may be eaten but intake
should be consistent so therapy can be adequately adjusted. None of the others are contraindicated.

Patient has cirrhosis, you should be concern with itching which could indicate pruritus and liver failure.

Babies with hydrocephalus may have difficulty lifting and turning their heads due to the increased size. To prevent
skin breakdown of the bony prominences it is important to turn and position the child frequently.

Hypertension with Acute Glomerulonephritis occurs during the acute phase of the disease. Normal BP range would
indicate that the condition was resolving.

In the court case Rogers vs. Okin in the Federal District Court of Massachusetts, it was ruled that involuntary
mental patients are competent and have the right to make treatment decisions. Forcible administration of
medication is justified in an emergency if needed to prevent violence and if other alternatives have been ruled out.

Guillain-Barre Syndrome (Polyradiculitis) is a clinical syndrome which affects both cranial and peripheral nerves. Its'
origin is not known, however it has been found to be preceded by either a recent Upper Respiratory Infection,
Gastrointestinal Infection, or immunization against the flu (ie: Swine Flu). It is NOT hereditary.

During the acute phase of Bacterial Endocarditis the patient is usually on bed rest and the nurse must assist
patient, to conserve energy and reduce cardiac workload. At the same time the nurse should be able to provide, as
tolerated, activities to reduce feelings of boredom and helplessness.

Ecchymoses - The passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple
discoloration of the skin.

Patients receiving Carafate should not be given antacids for at least a half hour following the administration of this
drug for the drug to exert its' maximum efficacy.

The BEST indicator of efficacy of Lasix in a patient with CHF, is the patient's CVP. The change in CVP is an indication
of adequacy of venous blood volume. Along with the patient's clinical picture the improvement in breathing,
weight loss, increased urine output, and reduction in edema indicate a therapeutic response to the action of this
medication.

Patients on TPN must be monitored closely, and the rate of the infusion must be maintained as ordered. If the rate
is too fast hyperosmolar diuresis occurs, and the patient may c/o headache, nausea, chills, and may have a fever. In
this situation the nurse should suspect Hyperglycemia, and check glucose (finger stick), and urine output (Diuresis
is likely) and notify M.D. Also be prepared to add Insulin to infusion.

HIB vaccine is against H influenza virus. People who have allergies to eggs often have allergic reaction to HIB
vaccine.

Toxoplasmosis is a protozoa infection caused by Toxoplasma gondii, found in raw or undercooked foods and cat
feces.

Celestone is corticosteroid and is used to accelerate fetal lung maturity. It has a better effect if it is given at least 24
hours prior to delivery.

Children with Tetralogy of Fallot do not have enough energy to practice gross motor skills therefore become
developmentally delayed. They also may have frequent hospitalizations, which limit their activity.

Abrupt cessation of alcohol when addicted can result in seizures including status epilepticus.
Depending on the area of the brain affected, and the degree of involvement, the patients with cerebral aneurysms
may exhibit one or more of the following signs/symptoms/behaviors, ie: unilateral neglect of paralyzed side,
astereognosis, aphasia, emotional lability, etc. The nurse should be aware of these and be able to intervene
effectively, ie. In this case use of good communication skills, and provide reassurance.

Asterixis is a tremor of the wrist when the wrist is extended (dorsiflexion), sometimes said to resemble a bird
flapping its wings. Also called "liver flap", it can be a sign of hepatic encephalopathy, damage to brain cells due to
the inability of the liver to metabolize ammonia to urea. The cause is thought to be related to abnormal ammonia
metabolism.

Lactulose (Cephulac) is prescribed to patients with impending or actual Hepatic Coma. The drug's primary action is
to reduce serum ammonia. It does this by retaining ammonia in the colon and expelling it in the stool through an
osmotic laxative effect. The BEST indicator that the drug is exerting its physiological effect would be the patient
having two to three soft stools per day.

Often after removal of foley, patient will have frequent sensation to void accompanied by burning sensation on
first void.

The mood stabilizing effect of Lithium takes around one to two weeks based on how fast a therapeutic level can be
reached and maintained.

Crutchfield tongs are cervical tongs applied for immobilization of cervical injuries. Post-procedure nursing care
includes assessing the client for any changes in neurologic status. The insertion site is monitored for signs of
infection.

National stroke association says 2/3 of all strokes occur in people over 65, M>F, Blacks>Whites. HTN is the No.1
risk factor.

Soft or pureed foods are easier to swallow and be controlled with a lazy tongue. Liquids increase risk of aspiration.

Unlocking Halo vest traction - An open-ended wrench is taped to the client's vest. This wrench provides immediate
release of the bolts to remove the vest in the event the client, requires external cardiac compression. The posterior
portion of vest remains in place to provide stability for the spine during CPR.

Indomethacin is NSAIDS. Bleeding may occur.

Verapamil is a calcium channel blocker, antihypertensive and antianginal.

K-Lor is a potassium supplement.

Clozaril requires weekly blood tests.

Risperdal [risperidone] - It targets both negative and positive symptoms of schizophrenia; It has fewer neurological
side effects than the phenothiazines; It is unlikely to cause tardive dyskinesia.
The heparin drip has a protocol that needs to be followed, including regular PTT levels, and adjustment of the
heparin drip ---- Assign to RN

Any threat to inflict harm is assault.

Shock phase (24-48 hrs after) the patient is dehydrated decrease B/P, increased P, decreased U/O.

Variable deceleration is the result of compression of umbilical cord. Nurse should change maternal position, if no
improvement seen, administer oxygen, discontinue oxycitocin if infusing.

Influenza virus vaccine and the pneumococcal vaccine can be administered concomitantly; Deltoid or lateral mid-
thigh is the preferred injection site; The vaccines should be administered in the dominant arm.

Check for fecal impaction on client with spinal cord injury has autonomic dysreflexia.

Family and friends around the bed, chanting and singing depicts Hindu death rituals. What the nurse should expect
is that while Hindus normally bring their ill home to die, on occasion the hospital is the site of death. When death is
imminent, the person is placed with his head facing east. A lamp is lit near his head and he is encouraged to
concentrate on his mantra. Family members keep vigil until death comes, singing hymns, praying and reading
scriptures.

Nurse should instruct the client to rinse her mouth with a normal saline and baking soda solution on a patient with
painful and bleeding ulcerations in her mouth.

Good Samaritan laws shield you from liability for negligence but not gross negligence.

A health care proxy is a document appointing someone else to make medical decision.

Celiac disease - gluten free diet.

PKU patient needs to avoid protein.

Sternum and forehead are reliable sites for evaluating dehydration in elderly.

Magnesium sulfate is an anti-convulsant which can cause cardiac arrhythmias. Nurse should check for clients pulse
and respiration

Tricyclic anti-depressants have anti-cholinergic s/effects (urinary retention)

Genital herpes is transmitted when lesions are present and 10 days after lesions have healed.

Counter transference reaction: The tendency of the nurse/counselor to displace feelings that are a response to
people in the counselor's past onto the client.

Barbiturates decrease anti-coagulant activity. Should not be medicated along with warfarin sodum (coumadin) or
other anti-coagulant meds.
S/S of adrenal insufficiency are anorexia, nausea and hypotension

Spinal shock occurs 30-60 minutes after a spinal cord injury due to disruption of nerve pathways. S/s are pulse and
respirations are increasing and blood pressure is decreasing

Position of choice when caring for a client with increased intracranial pressure (IICP)? This position allows proper
drainage of cerebral edema and helps decrease ICP. Anything less than 30º increases pressure (blood flow) to the
brain.

Client with Bulimia has a deficit in the sense of responsibility. They feel unable to take charge of their own life.

Spinal cord patients are prone to autonomic dysreflexia which is triggered by some form of stimulus-most common
is full bowel, or full bladder.

Two groups are especially susceptible - men whose testicles descended into the scrotum after age 6 and those,
whose testicles never descended. Males with either of these risks are up to 17 times more likely to develop
testicular cancer.

VIT D preparations are given 3 times per week during dialysis. Iron is given to treat anemia.

Aspirin prolongs bleeding time 4-7 days.

You cannot treat a minor without the permission of her parents unless she is emancipated. If she has a sexually
transmitted disease, you must tell health department. Minor cannot sign for her own treatment.

Normal PT is 9.5-12 seconds.

The bronchodilator first opens the airways then the steroid can be inhaled deeply enough to reduce inflammation.

Patient with intussusception, Vomiting is an expected finding and can lead to dehydration.

MMR immunization, nurse should check the child for allergy to neomycin for prior to administering the vaccine

Coumadin takes 2-3 days to start working

A patient is on a Heparin drip and is started on Coumadin. Why she is on both not just one. The only time it is
appropriate to see both anti-coagulants given is when a patient is to be sent home on Coumadin. Then they must
wean the heparin and start the Coumadin in order to give it time to work.

Give simple, slow directions to patient which receptive aphasia.

disseminated intravascular coagulation (DIC) is characterized by dropping platelet count and prolonged
coagulation studies.

Atenolol needs to be withheld to avoid aggravating the hypotensive effect of dialysis.

Remember that folic acid is needed to maturation of RBC .... Spinach, eggs, peanuts

Giardia is transmitted by drinking contaminated water or food. People who travel to undeveloped nations are
susceptible as are those who do not travel out of the US but who drink water from mountain streams.

When the gallstones are in the gallbladder, the condition is called cholelithiasis; when they are in the bile ducts the
condition is called choledocolithiasis.

Cholecystitis is often caused by cholelithiasis (the presence of choleliths, or gallstones, in the gallbladder), with
choleliths most commonly blocking the cystic duct directly. This leads to inspissation of bile, bile stasis, and
secondary infection by gut organisms, predominantly E coli and Bacteroides species.

Cholecystitis usually presents as a pain in the right upper quadrant. This is usually a constant, severe pain. The pain
may be felt to 'refer' to the right flank or right scapular region at first.

Colitis (also called ulcerative colitis) is an acute or chronic inflammation of the membrane lining the colon—your
large intestine or bowel.

Crohn disease differs from ulcerative colitis because it causes inflammation deeper within the intestinal wall. Crohn
disease usually occurs in the small intestine, but it can also occur in the mouth, esophagus, stomach, duodenum,
large intestine, appendix, and anus. Ulcerative colitis affects only the colon.

A Sengstaken-Blakemore tube is an oro- or nasogastric tube used occasionally in the management of upper
gastrointestinal hemorrhage due to bleeding from esophageal varices (distended veins in the esophageal wall,
usually as a result of cirrhosis). see http://en.wikipedia.org/wiki/Sengstaken-Blakemore_tube

Gastro Intestinal Animation Video

Cholecystectomy is the surgical removal of the gallbladder.

Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity

Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and
esophageal aperistalsis, is an esophageal motility disorder, a disease is which normal movement of the muscles in
the esophagus is disturbed. It is characterized by difficulty swallowing, chest pain and regurgitation. Diagnosis is
reached with esophageal manometry. most commonly the abdomen.

Esophagojejunostomy - the surgical formation of an artificial communication between the esophagus and the
jejunum.

KaPLAN

Phenytoin (Dilantin) is an anticonvulsant medication

Chlorpromazine (Thorazine) is more likely to be used PRN when a client is experiencing agitation associated with
schizophrenia.

Heparin is not pass on through breast milk.

Metoclopramide hydrocloride (Reglan) stimulates motility of upper GI tract, contraindicated with possibel
hemorrhage of GI tract, used to treat nausea of chemotheraphy.

Dexamethasone (Decadron) - oral steroids have ulceragenic properties and need to be administered with meals
Babinski reflex disappear approx. one year

Extrusion reflex disappears between three and four months of age

Fetal heartbeat can be heard at 12 weeks

Appearance of any decelerations of the fetal heart rate (FHR) during NST shoudl be immediately evaluated by the
physician

Impetigo is a superficial bacterial skin infection most common among children 2 to 6 years old.

Increased systolic pressure and widenng pulse pressure indicates increased intracranial pressure.

Docusate sodium (Colace) is a stool softener

Levodopa (Larodopa) reduces the rigidity and tremors, which facilitates mobility for the client
A salem sump tube is inserted for gastric immobility, to drain gastric contents in drug overdosage for gastric lavage
or for initial enteral feeding to allow monitoring of feed absorption

Diabetic acidosis - fruity breath odor

Diabetes insipidus (DI) is a condition characterized by excretion of large amounts of severely diluted urine, which
cannot be reduced when fluid intake is reduced. It denotes inability of the kidney to concentrate urine.

Dissociative Identity Disorder is a psychiatric diagnosis that describes a condition in which a single person displays
multiple distinct identities or personalities, each with its own pattern of perceiving and interacting with the
environment

Client receiving cyclophosphamide (Cytoxan) usually develop alopecia four to five weeks after starting treatment

When irrigating the ear, Water that is too cool can elicit dizziness when it comes into contact with the tympanic
membrane

Muscle weakness and lethargy are signs of hypokalemia which can occur on the 3rd day after a burn; hypokalemia
is caused by diuresis.
Diabetic ketoacidosis is frequently associated with dehydration; fluids should be encourage.
Garamycin (Gentamycin) adverse reaction includes ototoxicity.

Extreme tearing, redness, foreign body sensation are symptoms of viral conjunctivitis; highly contageious; children
restricted from school until sympthoms have resulved, 3 - 7 days

Librium (antianxiety) medication is pharmacologically similar to alcohol; is used effectively as a substitute for
alcohol in decreasing doses to comfortably and safely withdraw a client from alcohol dependence.

Expectorating thick yellow mucos is indicative of pneumonia.

When administering soapsuds enemas, hold the irrigation set 12-18 inches; too high causes rapid distention and
pressure in intestine causing rapid expulsion of solution, poor defecation, damage to mucouse membranes.

Normal potassium is 3.5 - 5.0 mEq/L

Rebound hyperglycemia = Somogyi effect

Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache

Placenta produces hormones that make the cells insulin-resistant; as pregnancy progresses, these hormones
increases; if insulin requirement is decreased, this indicateds that the placenta is not functioning appropriately

When inserting subclavian triple lumen catheter to be used for TPN, position the client in supine with the client's
head low and turned away from the insertion site-- produces dilation of nect and shoulder vessels, amking entry
easier and preventing air embolus

Clients with meningitis are placed on droplet for at least 24 hours

Any time the pulse rate drops below the preset rate on the pacemaker, the pacer is malfunctioning; the pulse
should be maintained at a minimal rate set on the pacemaker

Hemophilia is a sex-linked disorder. A mother who is a carrier has a 50% chance of passing the faulty X
chromosome to her daughter, while an affected father will always pass on the affected gene to his daughters. A
son cannot inherit the defective gene from his father.

There are two main types of hemophilia. If you have hemophilia A, you have little to no clotting factor VIII (8).
About 9 out of 10 people with hemophilia have type A. If you have hemophilia B, you’re missing or have low levels
of clotting factor IX (9).

Pincher grasp present at nine months of age

Posterior fontanels closed by two to three months

Phobias involves projection and displacement.

An infant with fetal alcohol syndrome will have a small head circumference, low birth weight and underveloped
cheekbones.
Hydromorphone hydrochloride (Dilaudid) is a narcotic analgesic used for moderate to severe pain, monitor vital
signs frequently.

Chlorpromazine hydrocloride (Thorazine) extrapyramidal side effects includes akathisia (motor restlessness),
dystonias (protrusio of tongue, abnormal posturing), pseudoparkinsonism (tremors, rigidity), dyskinesia (still neck,
difficulty swallowing)

1 grain (gr) = 60mg

Right upper quadrant pain to diagnose cholecyctitis

Tremors, elevated temperature and pain symptoms are indicative of an alcohol-related problem

Long term use of ceftriaxone sodium (Rocephin) can cause overgrouth of organisms; monitoring of tongue and oral
cavity is recommended.
Client with hypothyroidism are very sensitive to narcotics, barbiturates and anesthetics

When performing a Rinne tests, the stem of a vibrating tuning fork is held against the mastoid bone until the child
indicates that she can no longer hear the sound. Then the tuning fork is moved in front of the auditory canal.

Clomiphene citrate (Clomid) induce ovulation by changing hormonal effects n the ovary. It alters estrogen and
stimulating follicular growth to produce a mature ovum.

Naproxen sodium (Naprosyn) is an NSAID used as analgesic; side effects include headache, dizziness, GI distress,
pruitus and rash. Assess the patient for fluid retention and dizziness.

Cortisol is responsible for converting proteins and fat into glucose; is also an antiflamatory agent.

Verapamil (Isoptin) is indicated for the treatment of supraventricular tachycardias, so the client's heart rate should
be checked prior to administration

Breastfeeding mothers are advice to increase their caloric intake because milk productions requires an increase of
500 calories per day.

Digoxin increases the force of myocardial contraction.

Pacemaker increase the cardiac output; acts to regulate cardiac rhythm.

Quinidine prevent premature ventricular contractions (PVCs); antiarrhythmics

Lasiz prevent systemic overload; diuretics

With lead poisioning, milk provides a large amount of vitamin D; vitamin D optimizes depoosition of lead in the
long bones; purpoase of the treatment is to remove lead from the blood and soft tissues.

An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses
contrast material.

SIDS is a support group of parents who have had an infant die from sudden infant death syndrome

SHARE is a support group for parents who have lost a newborn or have experienced a miscaarriage

RESOLVE is a support group for infertile clients

CANDLELIGHTERS is a support group for families who have lost a child to cancer

Accurate intake and output is the best indicator for fluid status.

Women need 1200-1500 kcal/day (men need 1500-1899 kcal/day); women need 15mg/day of iron (men need
10mg/day); with pregnancy 30mg required

Hemolytic reaction when tranfusing blood includes chills, headache, backache, dyspnea, cyanosis, chest pains,
tachycardia, and hypotension.

Glycosylated Hemoglobin assay (BhA1c) test indates how well blood suger has been controlled during the past 6-8
weeks.

Primary goal of a reminiscing group for geriatric clients is to review and hsare their live experiences with the group
members.

Symptoms associated with hypercalcemia are constipation, decreased reflexes, decreased muscle strength.

Miller-Abbott tube provides intestinal decompression; intestinal tube is often used for treatment of paralytic ileus

Promethazine hydrocloride (Phenergan) - nurse should check patency of the patient's vein; extravasation will
cause necrosis.

Buerger's disease - digital sensitivity to cold; vasculitis of blood vessels in upper and lower extremities.

Continuous bladder irrigation (CBI) is necessary because it enables urine to keep flowing; prevents formation of
clots that can lead to obstruction and spasm in the postoperative TURP client.
Pain related to a gastric ulcer occurs about one-half to one hour after a meal and rarely at night; is not helped by
ingestion of food

To auscultate patient's right middle lobe (RML), RML is found in the right anterior chest between the fourth and
sixth intercostal spaces.
Characteristics of Mania --- agitation, grandiose delusions, euphoria, difficulty concentrating
Characteristics of Sxhizonphrenia -- Paranoia, hallucinations, disturbed thought processes, hypervigilance.

Meniere's disease - Stand in front of the patient so that the client does not have to turn her head to see the nurse;
by decreasing movement of the client's head, vertigo attacks may be decreased.

Use standard precautions is method of transmission is saliva, feces and blood; use contact isolation if fecal
incontinence.

Play theraphy is suggested for children undergoing a stressful event because they have diffulty putting feelings
into words; play is how they express themselves.

Normal PT 11-15 sec, normal Hgb male : 13.5-17.5 g/dl, female: 12-16 g/dl

Normal BUN 10-20 mg/dl, normal creatine 0.6-1.2 mg/dl

Normal Ca+ 4.5-5.3 mEq/L

Normal AST (SGOT) 8-20 U/L, normal ALT (SGPT) 8-20 U/L

Fluid challenge test is used to rule out dehydration as the cause of oliguria. Expected response after a fluid
challenge on normally functioning kidneys is an increase in urine output; will occur if low urine output is due to
dehydration; if it is due to acute renal failure, there will continue to be oliguria.

Normal specific gravitity is 1.010-1.030

Chlorpromazine (Thorazine) medication is contraindicated for the treatment of alcohol withdrawal symptoms;
medication will lower client's seizure threshold and BP, causing potentially serious medical consequences.

Low intestinal obstruction, nurse would anticipate that the client's abdomen will be distended, nausea, vomiting;
no stool, as motility distal to (below) the obstruction would cease

Why are we not using beef or pork insulin and only human insulin? Human insulin does nto cause the formation of
antibodies because the protein structure is identical to your own.
Approx. 65% of AIDS clients demonstrate a progressive dementia staged according to severity of debilitation; late
stage ois typified by cognitive confusion and disorientation.

Two major side effects of haloperidol (Haldol) is hematologic problems primarily blood syscrasia and
extrapyramidal symptom (EPS)

Anatomical Body Landmarks

Anatomical Position
anatomical position

The first important thing in learning about anatomy and physiology is to know the anatomical
position and body landmarks. To accurately describe body parts and position, initial reference
point and directional terms should be used in a medical setting. The correct anatomical position
is standing up (erect) with the feet parallel and the arms hanging at the sides with the palms
facing forward and the thumbs pointing away from the body.

Body Landmarks

To precisely point out the chief complaint of a patient, the nurse or physician uses anatomical
terms representing a certain body part. For example, a patient walks in the emergency room with
a hacking wound on the posterior portion of the left lower leg. To clearly state the area of injury
the nurse uses the term “sural” which means the posterior surface of the lower leg rather than
writing “back area of the lower leg”. Knowing these terms not only give the nurse a more
accurate formulation of chief complaints but it also saves time of a good deal of description.

Anterior Body Landmarks

Abdominal – anterior body trunk inferior to ribs

Acromial – point of shoulder

Antecubital – anterior surface of elbow

Axillary – armpit

Brachial – arm
Buccal – cheek area

Carpal – wrist

Cervical – neck region

Coxal – hip

Crural – leg

Digital – fingers, toes

Femoral – thigh

Fibular – lateral part of the leg

Inguinal – area where thigh meets body part

Nasal – nose area

Oral – mouth

Orbital – eye area

Patellar – anterior knee

Pelvic – area overlying the pelvis anteriorly

Pubic – genital region

Sternal – breastbone area

Tarsal – ankle region

Thoracic – chest

Umbilical – navel

Posterior Body Landmark

Calcaneal – heel of foot

Cephalic – head

Deltoid – curve of shoulder formed by large deltoid muscle

Femoral – thigh

Gluteal – buttock

Lumbar – area of back between ribs and hips

Occipital – posterior surface of head

Olecranal – posterior surface of elbow

Popliteal – sacral

Scapular – shoulder blade region

Sural – posterior surface of the lower leg

Vertebral – area of spine

Plantar – sole of the foot

Directional Terms

To clearly explain exactly the relation of a body structure to each other, directional terms are
used. For example to describe the relationship or location of the heart to the arms, we can say
“the heart is located in between the arms”. Using anatomical terminology, this is expressed as
“the heart is medial to the arms.” Hence, it is a more clear and precise statement.
Superior – above

Inferior – below

Anterior – in front of

Posterior – behind

Medial – middle

Lateral – away from the middle; at outer the sides

Intermediate – between a more medial and a more a lateral surface

Proximal – close to the body part

Distal – away from a body part

Superficial – external; at the surface

Deep – internal; away from the surface