Guillain-Barr Syndrome

   

AKA: polyradiculoneuritis.
It is an acute inflammatory polyneuropathy of the peripheral sensory and motor and nerve roots. Affected nerves are demyelinated with possible axonal degeneration. Its exact cause is unknown, Guillain-Barr Syndrome is believed to be an autoimmune disorder that may be triggered by viral infection, Campylobacter diarrheal illness, immunization, or other precipitating event.

The syndrome is marked by acute onset of symmetric progressive muscle weakness, most often beginning in the legs and ascending to involve the trunk, upper extremities, and facial muscles. Paralysis may develop. Complications may include respiratory failure, cardiac arrhythmias, and complications of immobility. Assessment:

1. Acute onset (hours to weeks) of progressive, usually ascending muscle weakness and fasciculation, possibly leading to paralysis (maximal weakness is reached within 2 weeks). 2. Paresthesia and painful sensations. 3. Possible hypoventilation due to chest muscle weakness. 4. Difficulty with swallowing, chewing, speech, and gag, indicating fifth (trigeminal) and ninth (glossopharyngeal) cranial nerve movement. 5. Reduce or absent deep tendon reflexes, position and vibratory perception. 6. Autonomic dysfunction with orthostatic hypotension and tachycardia. Diagnostic Evaluation: 1. Lumbar puncture obtains cerebrospinal fluid samples, which reveal low cell count and high protein levels. 2. Nerve conduction studies, which allow decreased conduction velocity of peripheral nerves due to demyelination. 3. Abnormal laboratory studies may point to prior infection or illness. Pharmacologic Interventions: 1. Analgesics and muscle relaxants to control painful sensations and fasciculations.

Nursing Interventions: 1. Monitor respiratory status through vital capacity measurements, rate and depth of respirations, and breath sounds. 2. Monitor level of muscle weakness as it ascends toward respiratory muscles. Watch for breathlessness while talking which is a sign of respiratory fatigue. 3. Monitor the patient for signs of impending respiratory failure. 4. Monitor gag reflex and swallowing ability. 5. Position patient with the head of bed elevated to provide for maximum chest excursion. 6. Avoid giving opioids and sedatives that may depress respirations. 7. Position patient correctly and provide range-of-motion exercises. 8. Provide good body alignment, range-of-motion exercises, and change of position to prevent complications such as contractures, pressure sores, and dependent edema. 9. Ensure adequate nutrition without the risk of aspiration. 10. Encourage physical and occupational therapy exercises to help the patient regain strength during rehabilitation phase. 11. Provide assistive devices as needed (cane or wheelchair) to maximize independence and activity. 12. If verbal communication is possible, discuss the patients fears and concerns. 13. Provide choices in care to give the patient a sense of control. 14. Teach patient about breathing exercises or use of an incentive spirometer to reestablish normal breathing patterns. 15. Instruct patient to wear good supportive and protective shoes while out of bed to prevent injuries due to weakness and paresthesia. 16. Instruct patient to check feet routinely for injuries because trauma may go unnoticed due to sensory changes. 17. Urge the patient to maintain normal weight because additional weight will further stress monitor function. 18. Encourage scheduled rest periods to avoid fatigue.

Acute Bronchitis
 Is an infection of the lower respiratory tract that generally follows an upper respiratory tract infection. As a result of this viral (most common) or bacterial infection, the airways become inflamed and irritated, and mucus production increases. Assessment: 1. Fever, tachypnea, mild dyspnea, pleuritic chest pain (possible). 2. Cough with clear to purulent sputum production. 3. Diffuse rhonchi and crackles(contrast with localized crackles usually heard with pneumonia). Diagnostic Evaluation: 1. Chest X-ray may rule out pneumonia. In bronchitis, films show no evidence of lung infiltrates or consolidation. Therapeutic Intervention: 1. Chest physiotherapy to mobilize secretions, if indicated. 2. Hydration to liquefy secretions. Pharmacologic Interventions: 1. Inhaled bronchodilators to reduce bronchospasm and promote sputum expectoration. 2. A course of oral antibiotics such as a macrolide may be instituted, but is controversial. 3. Symptom management for fever and cough. Nursing Interventions: 1. Encourage mobilization of secretion through ambulation, coughing, and deep breathing. 2. Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by fever and tachypnea. 3. Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery. 4. Instruct the patient to complete the full course of prescribed antibiotics and explain the effect of meals on drug absorption. 5. Caution the patient on using over-the-counter cough suppressants, antihistamines, and decongestants, which may cause drying and retention of secretions. However, cough preparations containing the mucolytic guaifenesin may be appropriate.

6. Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. Suggest avoiding dry environments and using a humidifier at bedside. Encourage smoking cessation. 7. Teach the patient to recognize and immediately report early signs and symptoms of acute bronchitis. Introduction Leukemias are cancers of the blood-forming tissues. White blood cells may be produced in excessive amounts and are unable to work properly which weakens the immune system. The blood is made up of fluid called plasma and three types of cells and each type has special functions. White blood cells (also called WBCs or leukocytes) help the body fight infections and other diseases. Red blood cells (also called RBCs or erythrocytes) carry oxygen from the lungs to the bodys tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color. Platelets (also called thrombocytes) help form blood clots that control bleeding. Blood cells are formed in the bone marrow, the soft, spongy center of bones. New (immature) blood cells are called blasts. Some blasts stay in the marrow to mature. Some travel to other parts of the body to mature. Normally, blood cells are produced in an orderly, controlled way, as the body needs them. This process helps keep us healthy. When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly. In both men and women, leukemia incidence is highest among whites and lowest among Chinese, Japanese, and Koreans. The incidence in men is about 50% higher than in women for all racial/ethnic groups except Vietnamese, among whom the male rates are only slightly higher. Ethnic differences in the incidence rates are small in the youngest adult age group (30-54 years), but become more evident in each of the older age groups. It is found that childhood leukemia rates are highest among Filipinos, followed by white Hispanics, non-Hispanic whites and blacks. Anatomy and physiology Blood Blood is one of the connective tissues. As a connective tissue, it consists of cells and cell fragments (formed elements) suspended in an intercellular matrix (plasma). Blood is the only liquid tissue in the body that measures about 5 liters in the adult human and accounts for 8 percent of the body weight. The body consists of metabolically active cells that need a continuous supply of nutrients and oxygen. Metabolic waste products need to be removed from the cells to maintain a stable cellular environment. Blood is the primary transport medium that is responsible for meeting these cellular demands. Blood cells are formed in the bone marrow, the soft, spongy center of bones. New (immature) blood cells are called blasts. Some blasts stay in the marrow to mature. Some travel to other parts of the body to mature. The activities of the blood may be categorized as transportation, regulation, and protection. These functional categories overlap and interact as the blood carries out its role in providing suitable conditions for celluar functions. The transport functions include:   carrying oxygen and nutrients to the cells. transporting carbon dioxide and nitrogenous wastes from the tissues to the lungs and kidneys where these wastes can be removed from the body. Carrying hormones from the endocrine glands to the target tissues. The regulation functions include:  Helping regulate body temperature by removing heat from active areas, such as skeletal muscles, and transporting it to other regions or to the skin where it can be dissipated.

Playing a significant role in fluid and electrolyte balance because the salts and plasma proteins contribute to the osmotic pressure. Functioning in pH regulation through the action of buffers in the blood. The protection functions include:

Preventing fluid loss through hemorrhage when blood vessels are damaged due to its clotting mechanisms. Helping (phagocytic white-blood cells) to protect the body against microorganisms that cause disease by engulfing and destroying the agent. Protecting (antibodies in the plasma) protect against disease by their reactions with offending agents. Composition of blood When a sample of blood is spun in a centrifuge, the cells and cell fragments are separated from the liquid intercellular matrix. Because the formed elements are heavier than the liquid matrix, they are packed in the bottom of the tube by the centrifugal force. The light yellow colored liquid on the top is the plasma, which accounts for about 55 percent of the blood volume and red blood cells is called the hematocrit,or packed cell volume (PCV). The white blood cells and platelets form a thin white layer, called the buffy coat, between plasma and red blood cells.

Plasma

The watery fluid portion of blood (90 percent water) in which the corpuscular elements are suspended. It transports nutrients as well as wastes throughout the body. Various compounds, including proteins, electrolytes, carbohydrates, minerals, and fats, are dissolved in it.

Formed Elements

The formed elements are cells and cell fragments suspended in the plasma. The three classes of formed elements are the erythrocytes (red blood cells), leukocytes (white blood cells), and the thrombocytes (platelets).
Erythrocytes (red blood cells)

Erythrocytes, or red blood cells, are the most numerous of the formed elements. Erythrocytes are tiny biconcave disks, thin in the middle and thicker around the periphery. The shape provides a combination of flexibility for moving through tiny capillaries with a maximum surface area for the diffusion of gases. The primary function of erythrocytes is to transport oxygen and, to a lesser extent, carbon dioxide.

Leukocytes (white blood cells)

Leukocytes or white blood cells are generally larger than erythrocytes, but they are fewer in number. Even though they are considered to be blood cells, leukocytes do most of their work in the tissues. They use the blood as a transport medium. Some are phagocytic, others produce antibodies, some secrete histamine and, heparin, and others neutralize histamine. Leukocytes are able to move through the capillary walls into the tissue spaces, a process called diapedesis.In the tissue spaces they provide a defense against organisms that cause disease and either promote or inhibit inflammatory responses.

There are two main groups of leukocytes in the blood. The cells that develop granules in the cytoplasm are called granulocytes and those that do not have granules are called agranulocytes. Neutrophils, eosinophils, and basophils are granulocytes. Monocytes and lymphocytes are agranulocytes. Neutrophils, the most numerous leukocytes, are phagocytic and have light-colored granules. Eosinophils have granules and help counteract the effects of histamine. Basophils secrete histomine and heparin and have blue granules. In the tissues, they are called mastcells. Lymphocytes are agranulocytes that have a special role in immune processes. Some attack bacteria directly; others produce antibodies.

Thrombocytes (platelets)

Thrombocytes, or platelets, are not complete cells, but are small fragments of very large cells calledmegakaryocytes. Megakaryocytes develop from hemocytoblasts in the red bone marrow. Thrombocytes become sticky and clump together to form platelet plugs that close breaks and tears in blood vessels. They also initiate the formation of blood clots. Blood Cell Lineage: The production of formed elements, or blood cells, is called hemopoiesis. Before birth, hemopoiesis occurs primarily in the liver and spleen, but some cells develop in the thymus, lymph nodes, and red bone marrow. After birth, most production is limited to red bone marrow in specific regions, but some white blood cells are produced in lymphoid tissue. All types of formed elements develop from a single cell type stem cell (pleuripotential cells or hemocytoblasts). Seven different cell lines, each controlled by a specific growth factor, develop from the hemocytoblast. When a stem cell divides, one of the daughters remains a stem cell and the other becomes a precursor cell, either a lymphoid cell or a myeloid cell. These cells continue to mature into various blood cells. A leukemia can develop at any point in cell differentiation. The illustration below shows the development of the formed elements of the blood. Blood-related cancers, or leukemias, have been shown to arise from a rare subset of cells that escape normal regulation and drive the formation and growth of the tumor. The finding that these so-called cancer stem cells, or leukemic stem cells (LSC), can be purified away from the other cells in the tumor allows their precise analysis to identify candidate molecules and regulatory pathways that play a role in progression, maintenance, and spreading of leukemias. The analyses of the other, numerically dominant, cells in the tumor, while also interesting, do not directly interrogate these key properties of malignancies. Mouse models of human myeloproliferative disorder and acute myelogenous leukemia have highlighted the remarkable conservation of disease mechanisms between both species. They can now be used to identify the LSC for each type of human leukemia and understand how they escape normal regulation and become malignant. Given the clinical importance of LSC identification, the insights gained through these approaches will quickly translate into clinical applications and lead to improved treatments for human leukemias. Predisposing factors The exact cause of leukemia is unknown, although many genetic and environmental factors are involved in its development. The basic mechanism involves damage to genes controlling cell growth. This damage then changes cells from a normal to a malignant (cancer) state. Analysis of bone marrow of a client with acute leukemias shows abnormal chromosomes about 50% of the time. Possible risk factors for the development of leukemia include ionizing radiation, exposure to chemicals and drugs, bone marrow hypoplasia (reduced production of blood cells), genetic factors, immunologic factors, environmental factors, and the interaction of theses factors. Ionizing radiation exposures such as radiation therapy for cancer treatment or environmental irradiation increase the risk for leukemia development, particularly acute myelogenous leukemia (AML). Certain chemicals and drugs have been linked to the development of leukemia because of their ability to damage DNA. Previous treatment for cancer that included melphaplan, cyclosphamide, doxorubicin, and etoposide poses risks for leukemia development about 5 to 8 years after treatment. Bone marrow hypoplasia can increase leukemia risk by reducing or changing bone marrow cell production. Disorders that have marrow hypoplasia and may lead to leukemia development include Fanconis anemia, paroxysmal nocturnal hemoglobinuria, and myelodysplastic syndromes. Genetic factors influence leukemia development. There is an increased incidence of the disease among clients with hereditary conditions such as Down syndrome, blooms syndrome, Klinefelter syndrome, and

Fanconis anemia. Identical siblings of client with leukemia have a higher rate of leukemia than does general population. Immunologic factors, especially immune deficiencies, may promote the development of leukemia. Leukemia among immunodeficient people may be a result of immune surveilance failure, or the same mechanisms that cause the immune deficiency may also trigger cancer in the white blood cells population. Interaction of many host and environmental factors may result in leukemia. Because each person tolerates the interaction of these factors differently, it is difficult to determine the origin of any specific leukemia. Pathophysiology Leukemia is a type of cancer with uncontrolled production of immature white blood cells (usually blast cells) in the bone marrow. As a result, the bone marrow becomes overcrowded with immature, nonfunctional calls and production of normal blood cell is greatly decreased. Leukemia may be acute, with sudden onset ans short duration, or chronic with a slow onset and symptoms that persist for a period of years. Leukemias are classified by cell type. Abnormal leukemic cells coming from lymphoid pathways are lymphocytic or lymphoblastic. Leukemias in which the abnormal cells come from the myeloid pathways are myelocytic or lymphoblastic. Several subtype exist for each of these diseases, which are classified according to the degree of maturity of the abnormal cell and the specific cell type involved. With leukemia, cancer occurs in the stem cells or early precursor leukocyte cell, causing excessive growth of a specific type of leukocyte. These cells are abnormal and their excessive production in the bone marrow stops normal bone marrow production of red blood cells, platelets, and mature leukocytes. Anemia, thrombocytopenia, and leukopenia result. The number of immature, abnormal white blood cells in the blood is greatly elevated. Leukemic cells can also be found in the spleen, liver, liver nodes and central nervous system. Without treatment, the client dies of infection or hemorrhage. For clients with acute leukemia, theae changes occur rapidly and, without intervention, progress to death. Chronic leukemia may be present for years before changes appear. Physical Manifestations Leukemias affects all blood cells, and blood influences the health and function of all organs and systems, thus many body areas and system cells may be affected. The following manifestations occur with the acute luekemias. Some of this findings may also be present in the client with chronic leukemia in the blast phase. Integumantary Manifestations:  Ecchymoses  Petechiae  Open infected lesions  Pallor of the conjunctiva, nail beds, palmar creases, and around the mouth. Gastrointestinal Manifestations:  Bleeding gums  Anorexia  Weight loss  Enlarged liver and spleen Renal Manifestations:  Hematuria Cardiovascular Manifestations:  Tachycardia at basal activity levels.  Orthostatic hypotension  Palpitations Respiratory Manifestations:  Dyspnea on exertion. Neurologic Manifestations:  Fatigue  Headache  Fever Musculoskeletal Manifestations:

Bone pain Joint swelling and pain. Diagnostic Evaluation 1. CBC and blood smear peripheral WBC count varies widely from 1,000 to 100,000/mm3 and may include significant numbers of abnormal immature (blast) cells, anemia may be profound; platelet count may be abnormal and coagulopathies may exist. 2. Bone marrow aspiration and biopsy cells also studied for chromosomal abnormalities (cytogenetics) and immunologic markers to classify type of leukemia further. 3. Lymph node biopsy to detect the spread. 4. Lumbar puncture and examination of cerebrospinal fluid for leukemic cells (especially ALL). Treatment To eradicate leukemic cells and allow restoration of normal hematopoiesis. 1. High-dose chemotherapy given as an induction course to obtain a remission (disappearance of abnormal cells in bone marrow and blood) and then in cycles as consolidation or maintenance therapy to prevent recurrence of disease. 2. Leukapheresis (or exchange transfusion to infants) may be used when abnormally high numbers of white cells are present to reduce the risk of leukostasis and tumor burden before chemotherapy. 3. Radiation particularly of central nervous system (CNS) in ALL. 4. Autologous or allogeneic bone marrow or stem cell transplantation. Complications 1. Leukostasis; in setting of high numbers (greater than 50,000/mm3) of circulating leukemic cells (blasts), blood vessel walls are infiltrated and weakened, with high risk of rupture and bleeding, including intracranial hemorrhage. 2. Disseminated intravascular coagulation(DIC). 3. Tumor lysis syndrome: rapid destruction of large numbers of malignant cells leads to alteration in electrolytes (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia). 4. May lead to renal failure and other complications. 5. Infection, bleeding, and organ damage. Pharmacologic Interventions   Acute leukemia Different types of leukemia are best treated with different kinds of medicine.  Acute lymphoblastic leukemia (ALL) drugs include prednisone, vincristine, daunorubicin, Lasparaginase or pegaspargase, methotrexate, and cyclophosphamide. Imatinib (Gleevec) is sometimes used to treat ALL. Dasatinib (Sprycel) is a newer drug for treating some ALL that has not improved with other drugs. Acute myelogenous leukemia (AML) drugs include daunorubicin, idarubicin, cytosine arabinoside, andmitoxantrone.10 Gemtuzumab (Mylotarg) may be given to people whose AML has relapsed. It helps your body destroy cancer cells. Acute promyelocytic leukemia (APL) drugs include all-trans-retinoic acid (ATRA) and chemotherapy with arsenic trioxide, idarubicin, or daunorubicin. ATRA helps control the risk of life-threatening bleeding fromdisseminated intravascular coagulation (DIC). Later treatment can include ATRA with or withoutmethotrexate and 6-mercaptopurine. Or if a first round of ATRA and chemotherapy does 10 not work, arsenic trioxide may be used. To treat leukemia in the brain or prevent it from spreading to the brain and central nervous system, methotrexateand cytarabine/cytosine arabinoside are injected into the spinal canal. This is called intrathecal chemotherapy. Supportive treatments during cancer treatment include:  Antibiotics and immunoglobulins help to prevent or fight infections. This is important when you do not have enough normal white blood cells to fight infections on your own.

   

Transfusions of red blood cells and platelets. Epoetin and hematopoietic stimulants help your body make new blood cells. Allopurinol to prevent kidney problems and gout. Saline or steroid eyedrops for relief during treatment with cytarabine/cytosine arabinoside. Chronic leukemia

Chemotherapy for chronic leukemia can involve a single drug or a combination of drugs. For example, you may be given a combination of cyclophosphamide, vincristine, and prednisone. Other drug choices includefludarabine, chlorambucil, hydroxyurea (hydroxycarbamide), cytarabine, busulfan, rituximab, andalemtuzumab. Allopurinol may be given to prevent kidney problems and gout. Dasatinib (Sprycel) blocks the growth of cancer cells. It can be used for CML that has not been helped by imatinib or other drugs. Imatinib (Gleevec) blocks the growth of cancer cells. It is often given to people who have chronic myelogenous leukemia (CML). Immune globulin (IG) helps prevent infections. It is sometimes used for people with chronic lymphocytic leukemia (CLL), because CLL weakens the immune system. Interferon alfa helps your immune system fight disease and may keep cancer cells from growing. It is often given to people who have CML. Medication for nausea and vomiting Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe drugs to help relieve nausea. These may include:

 

Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program. Dimenhydrinate, such as Dramamine. Metoclopramide, such as Reglan and Octamide. Phenothiazines, such as Compazine and Phenergan. Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These drugs work best when they are combined with corticosteroids such as dexamethasone (Hexadrol).

   

Nursing Interventions Preventing infection:  Frequently monitor the client for pneumonia, pharyngitis, esophagitis, perianal cellulitis, urinary tract infection, and cellulitis, which are common in leukemia and which carry significant morbidity and mortality.

Monitor for fever, flushed appearance, chills, tachycardia; appearance of white patches in the mouth; redness, swelling, heat or pain in the eyes, ears, throat, skin, joints, abdomen, rectal and perineal areas; cough, changes in sputum; skin rash.  Check results of granulocyte counts. Concentrations less than 500/mm3 put the patient at serious risk for infection.  Avoid invasive procedures and trauma to skin or mucous membrane to prevent entry of microorganisms.  Use the following rectal precautions to prevent infections: Avoid diarrhea and constipation, which can irritate the rectal mucosa, avoid the use of rectal thermometers, and keep perineal are clean.  Care for the patient in private room with strict handwashing practice.  Encourage and assist patient with personal hygiene, bathing, and oral care.  Obtain cultures and administer antimicrobials promptly as directed. Preventing and Managing bleeding:  Watch for signs of minor bleeding, such as petechiae, ecchymosis, conjunctival hemorrhage, epistaxis, bleeding gums, bleeding at puncture sites, vaginal spotting, heavy menses.  Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension, tachycardia, dizziness.  Test all urine, stool, emesis for gross and occult blood.  Monitor platelet counts daily.  Administer blood components as directed.  Keep patient on bed rest during bleeding episodes. Patient Education and Health Maintenance:  Teach signs and symptoms of infection and advise whom to notify.  Encourage adequate nutrition to prevent emaciation from chemotherapy.  Teach avoidance of constipation with increased fluid and fiber, and good perineal care.  Teach bleeding precautions.  Encourage regular dental visits to detect and treat dental infections and disease. 

Nursing Care Plan - Constipation

Posted: 21 Apr 2009 06:15 PM PDT Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person experiences hard feces that are difficult to expel.  This usually happens because the colon absorbs too much water from the food. If the food moves through the gastro-intestinal tract too slowly, the colon may absorb too much water, resulting in feces that are dry and hard. Defecation may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. Causes of constipation:    may be dietary hormonal anatomical a side effect of medications (e.g. some opiates) or an illness or disorder. Treatments consist of:

 

changes in dietary and exercise habits the use of laxatives, and other medical interventions depending on the underlying cause. Prevention:

1. Drink plenty of water. Most people who suffer from constipation are dehydrated. Water is essential in moving waste matter through the colon. Drinking 6 to 8 8-oz. glasses of water can help prevent constipation. 2. Eat a high fiber diet. Fiber is an important element in promoting healthy digestion. Fiber helps to add bulk to stools, making them easier to pass through the bowel. Your diet should include fiber-rich foods such as fruits, vegetables and whole grains. 3. Avoid dehydrating liquids such as soda, coffee and tea. Avoid too much alcohol consumption, as alcohol also has a dehydrating effect on the body. Cut your intake of meat, eggs, cheese and refined processed foods. 4. Start an exercise program. Studies show that regular exercise can prevent constipation. 5. Cleanse your colon with natural remedies such as Colon Sweep. There are products available that are made with natural ingredients, including psyllium husks, and can help to cleanse your colon of built-up waste resulting from constipation. 6. Take natural remedies such as Natural Moves that can relax the bowel, ease tension and promote regular bowel movements. Many such products are available online or at health food stores. Helpful Habits include:      Have regular mealtimes, no skipped meals. Chew your food well. Eat slowly. Be more active. Get some daily exercise. Use the bathroom at a regular time each day. Choose a time when you wont have to rush. Get 7-8 hours sleep (per 24 hours).

What You Need to Know About Swine Flu

Posted: 29 Apr 2009 10:38 PM PDT

Definition:  Swine influenza, or swine flu, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses.

Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2) The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a reassortant virus. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans. The 2009 Swine flu outbreak in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza. Modes of Transmission: Swine flu viruses can be passed between pigs and humans, but human infections are not common.

 

  

Most infections occur among people with direct pig contact. Sometimes a flu virus can mutate to be more transmissible to humans. People who work with swine, especially people with intense exposures, are at risk of catching swine influenza if the swine carry a strain able to infect humans. Swine flu cannot be spread by pork products, since the virus is not transmitted through food Period of Communicability:

The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Signs and Symptoms: The signs and symptoms of swine flu are similar to those of influenza and of influenza-like illness in general:

1. chills 2. fever 3. sore throat 4. muscle pains 5. severe headache 6. coughing 7. weakness 8. general discomfort Diagnostic Procedures:  To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus).

 

However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing. Vaccines and Treatment:

 

Officials do not know if the seasonal flu vaccine will protect against the A(H1N1) swine flu virus. In the laboratory, the antiviral drugs Tamiflu and Relenza are effective against this new flu; amantadine and rimantadine are not. Safety precautions:

1. Cover your nose and mouth with a tissue when coughing or sneezing. 2. Wash hands regularly with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. 3. Avoid close contact with sick people. 4. If sick, self-monitor and stay home from work or school and limit contact with others. 5. Consult your doctor immediately should signs and symptoms of flu persist.

GLASGOW COMA SCALE

The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury...

TO NOTE FOR THE SCORE, YOU NEED TO CLOSELY MONITOR

EVERYMOVE..

Eye opening Verbal response Motor response

Posted by rapstick88 at 9:03 PM | 0 comments Links to this post

THE STROKE/CVA
The 3 most common causes of stroke are the, are the,the,mmmm,the,got it???????

THE T-HROMBUS H-EMORRHAGE E-MBOLI

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STRESS
STAGES OF GENERAL ADAPTATION SYNDROME (GAS)

The 3 stages are ARE

A-larm -awareness of the stress,fight or flight response stage of R-esistance - homeostasis,adaptation stage of E-xhaustion -death may ensue unless other adaptive mechanisms
stage of will be mobilized
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Thursday, September 18, 2008

BLEEDING

HI!
(this is actually one of my pneumonics)

Hemorrhage and Infection

- common complications of bleeding HI

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Wednesday, September 17, 2008

HEAT AND ACETIC TECHNIQUE

H for PIH RESULTS: CLEAR----(-) PIH CLOUDY--(+) PIH for faster memory, just remember if the sky is CLEAR, (-) rain (- PIH) if the sky is CLOUDY, (+) rain (+ PIH)
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BENEDICT'S TEST
B for BLOOD GLUCOSE
results: just remember BGYOR

Blue-------(-) Green------(+) Yellow-----(++) Orange---(+++) Red---------(++++)

Benedict's reagent (also called Benedict's solution or Benedict's test) is a reagent used as a test for the presence of reducing sugars (such as glucose, lactose, and fructose, but not sucrose), or more generally for the presence of aldehydes, in a solution.It tests for reducing sugars. The color change is blue-green-yellow-orange-red. The closer to brick-red, the higher the conc. of reducing sugar present.
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Tuesday, September 16, 2008

NURSING PROCEDURES (COMMUNITY BASED)

THERMOMETER TECHNIQUE
the proponent of this thermo technique made my life so complicated... candidly speaking I was hard up with this concept before... its only now that I understand... hope you can use this simple presentation of mine....
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Monday, September 15, 2008

DANGER SIGNS
V-OMITTING I-NABILITY TO DRINK OR BREASTFEED C-ONVULSION, HIGH FEVER/38C AND ABOVE S-LEEPING ABNORMALITIES/ DIFFICULT TO AWAKEN MAIN SYMPTOMS

C-OUGH D-IARRHEA E-AR PROBLEM F-EVER

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MGA SAKIT SA IMCI

JUST REMEMBER THIS... PDFMHMA

Pinatay, Dinukot, Finingerling, Minolestiya, Hinalay, Minaltrato,Ang asa ko

Pneumonia,

Diarrhea,
Dehydration Dysentery

Fever, Measles, Hemorrhagic, Mastoiditis, Ear Problem Anemia, Malnutrition

Posted by rapstick88 at 6:59 PM | 0 comments Links to this post

TRAFFIC LIGHTS IN IMCI

PINK- (STOP)- to be given the first dose of antibiotic/ urgent refferal YELLOW- (WAIT)- In the RHU for further assessment GREEN- (GO)- go home or go to the next question
Posted by rapstick88 at 6:26 PM | 0 comments Links to this post
Sunday, September 14, 2008

EASY IMCI

We're able to come up with this kind of stuff during our review because of our desperation to pass the board exam-and it did help us a lot. We call this the one minute formula... hope this could work for you...

For PEM (Pneumonia, Ear problem, and Mastoiditis), the first line of antibiotic is COTRI 250mg to be given 2x or BID FOR5 days, second line would be AMOX 250mg TID for 5 days.. For DS (Dysentery and Shigellosis), the first line is still COTRI250 mg BID for 5 days, second line is NALIDIXIC ACID250 mg 4x a day for 5 days. For Cholera, the first line of antibiotic is TETRA, second line isCOTRI... Just remember the triangle and the numbers in it... 2 for Cotri 3 for Amox and 4 for Nalidixic to be given in 5days... even a grade 2 student can memorize this, and so are you... Go RN's...
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Saturday, September 13, 2008

valsalva maneuver

this is my nephew Josh, trying to concentrate to do the valsalva maneuver with his hand pushing against the wall... my sister started to toilet train him when he was two years old, now that he's already four, he wants to do it all by himself... CAUTION: for patients with cardiac problems, esp. MI-avoid straining, check Docs order for laxatives,CBR w/o BPS...
HYPERKALEMIA - Causes MACHINE M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism/ hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion - Impaired HYPOCALCEMIA CATS C - Convulsions A - Arrhythmias T - Tetany S - Spasms and stridor BLEEDING - S/Sx BEEP B - Bleeding gums E - Ecchymoses (bruises) E - Epistaxis (nosebleed) P - Petechiae (tiny purplish spots) RESPIRATORY DEPRESSION - inducing drugs STOP breathing S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins

PNEUMOTHORAX - S/Sx P-THORAX P - Pleuretic pain T - Trachea deviation H - Hyperresonance O - Onset sudden

R - Reduced breath sounds (& dypsnea) A - Absent fremitus X - X-ray shows collapse PNEUMONIA - risk factors INSPIRATION I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary oedema I - Impaired alveolar macrophages R - RTI (prior) A - Antibiotics & cytotoxics T - Tracheal instrumentation I - IV dug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (eg NMJ disorders) CROUP - S/Sx SSS S - Stridor S - Subglottic swelling S - Seal-bark cough SHORTNESS OF BREATH - Causes AAAA PPPP A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax P - Pulmonary Edema P - Pulmonary Embolus

CARDIAC VALVES "TRI before you BI": Tricuspid valve is located in left heart and Bicuspid valve is located in right heart. Blood flows through the tricuspid before bicuspid.

FEMORAL HERNIA FEMoral hernias are more common in FEMales.

"TRY PULLING MY AORTA": Tricuspid Pulmonary Mitral Aorta

PLACENTA-CROSSING SUBSTANCES "Want My Hot Dog": Wastes Antibodies Nutrients Teratogens Microorganisms

Hormones/ HIV Drugs

EMERGENCY MEDICINE ACTIVATED CHARCOAL: CONTRAINDICATIONS CHEMICAL CamP: Cyanide Hydrocarbons Ethanol Metals Iron Caustics Airway unprotected Lithium CAMphor Potassium

IPECAC: CONTRAINDICATIONS 4 C's: Comatose Convulsing Corrosive hydroCarbon

ATRIAL FIBRILLATION: CAUSES OF NEW ONSET THE ATRIAL FIBS: Thyroid Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine)

ENDOTRACHEAL TUBE DELIVERABLE DRUGS O NAVEL: Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine

MALARIA: COMPLICATIONS OF FALCIPARUM MALARIA CHAPLIN: Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema Lactic acidosis Infections Necrois of renal tubules (ATN)

MI: IMMEDIATE TREATMENT DOGASH: Diamorphine Oxygen GTN spray Asprin 300mg Streptokinase Heparin

PAIN HISTORY CHECKLIST OLDER SAAB: Onset Location Description (what does it feel like) Exacerbating factors Radiation Severity Associated symptoms

Alleviating factors Before (ever experience this before)

SHOCK: SIGNS AND SYMPTOMS TV SPARC CUBE: Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank

SUBARACHNOID HEMORRHAGE (SAH) CAUSES BATS: Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (eg being struck with baseball bat) Stroke

VENTRICULAR FIBRILLATION: TREATMENT "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock": Shock= Defibrillate Everybody= Epinephine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide

VFIB/VTACH DRUGS USED ACCORDING TO ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium

Magsulfate Procainamide

DIABETIC KETOACIDOSIS MANAGEMENT KING UFC: K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) Glucose (once serum levels drop to 12) Urea (check it) Fluids (crytalloids) Creatinine (check it)/ Catheterize

NEUROLOGICAL FOCAL DEFICITS 10 S's: Sugar (hypo, hyper) Stroke Seizure (Todd's paralysis) Subdural hematoma Subarachnoid hemorrhage Space occupying lesion (tumor, avm, aneurysm, abscess) Spinal cord syndromes Somatoform (conversion reaction) Sclerosis (MS) Some migraines

COMA: CONDITIONS TO EXCLUDE AS CAUSE MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage

MALIGNANT HYPERTHERMIA TREATMENT "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen

Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]

RESUSCITATION: BASIC STEPS ABCDE: Airway Breathing Circulation Drugs Environment

RLQ PAIN: DIFFERENTIAL APPENDICITIS: Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones

Alcohol withdrawal: clinical features"HITS" Hallucinations (visual, tactile) Increased vital signs and insomnia Tremens delirium tremens (potentially lethal) Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting)

Angina: precipitating factors"4E's" Eating Emotion

Exertion (Exercise) Extreme Temperatures (Hot or Cold weather)

Anorexia nervosa: clinical features"ANOREXIC" Adolescent women/ Amenorrhea NGT alimentation (most severe cases) Obsession with losing weight/ becoming fat though underweight Refusal to eat (5% die) Electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X - ercise Intelligence often above average/ Induced vomiting Cathartic use (and diuretic abuse)

Appendicitis: assessment"PAINS" Pain (RLQ) Anorexia Increased temperature, WBC (15,00020,000) Nausea Signs (McBurney's, Psoas)

Neurovascular Occlusion: symptoms "6 P's" Pain Pale Pulseless Paresthesia Poikilothermic Paralysis

Blood glucose (rhyme) Symptom Implication Cold and clammy . . . give hard candy Hot and dry . . . glucose is high

Blood vessels in umbilical cord"AVA" (2 arteries and 1 vein) Artery Vein Artery

Cholecystitis: risk factors"5F's"

Female Fat Forty Fertile Fair

Cleft lip: nursing care plan (postoperative)"CLEFT LIP" Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Positionnever on abdomen

Cognitive disorders: assessment of difficulties"JOCAM" Judgment Orientation Confabulation Affect Memory

Coma: causes"A-E-I-O-U TIPS" Alcohol, acidosis (hyperglycemic coma) Epilepsy (also electrolyte abnormality, endocrine problem) Insulin (hypoglycemic shock) Overdose (or poisoning) Uremia and other renal problems Trauma; temperature abnormalities (hypothermia, heat stroke) Infection (e.g., meningitis) Psychogenic ("hysterical coma") Stroke or space-occupying lesions in the cranium

Complication of severe preeclampsia"HELLP" syndrome Hemolysis Elevated Liver enzymes Low Platelet count

Cushing's syndrome: symptoms"3S's" Sugar (hyperglycemia) Salt (hypernatremia) Sex (excess androgens)

Diabetes: signs and symptoms"3P's," Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency)

Diet: low cholesterolavoid the "3C's" Cake Cookies Cream (dairy, e.g., milk, ice cream)

Dystocia: etiology"3P's" Power Passageway Passenger

Dystocia: general aspects (maternal)"3P's" Psych Placenta Position

Episiotomy assessment"REEDA" Redness Edema Ecchymosis Discharge Approximation of skin

Eye medications Mydriatic = dilated pupils Miotic = tiny (constricted) pupils

Hypertension: complications"4 C's" CAD (coronary artery disease) CHF (congestive heart failure)

CRF (chronic renal failure) CVA (cardiovascular accident; now called brain attack or stroke)

Hypertension: nursing care plan "I-TIRED" Intake and output (urine) Take blood pressure Ischemia attack, transient (watch for TIAs) Respiration, pulse Electrolytes Daily weight

Hypoglycemia: signs and symptoms"DIRE" Diaphoresis Increased pulse Restless Extra hungry

Infections during pregnancy"TORCH" Toxoplasmosis Other (hepatitis B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus

IUD: potential problems with use"PAINS" Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing

Manipulation: nursing planpromote the "3C's" Cooperation Compromise Collaboration

Medication administration"six rights" RIGHT medication RIGHT dosage

RIGHT route RIGHT time RIGHT client RIGHT technique

Melanoma characteristics"ABCD" Asymmetry Border Color Diameter

Mental retardation: nursing care plan"3R's" Regularity (provide routine and structure) Reward (positive reinforcement) Redundancy (repeat)

Myocardial infarction: treatment"MONA" Monitor/ Morphine Oxygen Nitroglycerin Aspirin

Newborn assessment components"APGAR" Appearance Pulse Grimace Activity Respiratory effort

Obstetric (maternity) history"GTPAL" Gravida Term Preterm Abortions (SAB, TAB) Living children

Oral contraceptives: signs of potential problems"ACHES" Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus)

Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident) Severe leg pain (possible thromboembolic process)

Pain: assessment"PQRST" What Provokes the pain? What is the Quality of the pain? Does the pain Radiate? What is the Severity of the pain? What is the Timing of the pain?

Pain: management"ABCs" Ask about the pain Believe when clients say they have pain Choiceslet clients know their choices Deliver what you can, when you said you would Empower/Enable clients' control over pain

Postoperative complications: order"4W's" Wind (pulmonary) Wound Water (urinary tract infection) Walk (thrombophlebitis)

Preterm infant: anticipated problems"TRIES" Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])

Psychotropic medications: common antidepressives (tricyclics)"VENT" Vivactil Elavil Norpramin Tofranil

Schizophrenia: primary symptoms"4A's" Affect

Ambivalence Associative looseness Autism Sprain: nursing care plan"RICE" Rest Ice Compression Elevation

Stool assessment"ACCT" Amount Color Consistency Timing

Tracheoesophageal fistula: assessment"3Cs" Coughing Choking Cyanosis

Traction: nursing care plan"TRACTION" Trapeze bar overhead to raise and lower upper body Requires free-hanging weights; body alignment Analgesia for pain, prn Circulation (check color and pulse) Temperature (check extremity) Infection prevention Output (monitor) Nutrition (alteration related to immobility)

Transient ischemic attacks: assessment"3Ts" Temporary unilateral visual impairment Transient paralysis (one-sided) Tinnitus = vertigo

Trauma care: complications"TRAUMA" Thromboembolism; Tissue perfusion, altered Respiration, altered Anxiety related to pain and prognosis

Urinary elimination, altered Mobility impaired Alterations in sensory-perceptual functions and skin integrity (infections)

Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)"COAT RACK"

Wernicke's encephalopathy (acute phase) clinical features: Confusion Ophthalmoplegia Ataxia Thiamine is an important aspect of Tx

Korsakoff's psychosis (chronic phase) characteristic findings: Retrograde amnesia (recall of some old memories) Anterograde amnesia (ability to form new memories) Confabulation Korsakoff's psychosis

SIGNS OF CANCER
Change in bowel /bladder habits A sore that doesnt heal Unusual bleeding/ Discharge Thickening of lump breast or elsewhere Indigestion/ Dysphagia Obvious change in wart/ mole Nagging cough/ hoarseness

Unexplained anemia Sudden weight loss

FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER

Chemotherapy Assess body image disturbance (related to alopecia) Nutritional needs when N/V present Comfort from pain Effective response to Tx? (Evaluate) Rest (for patient and family)

Basic MI management - "BOOMAR" Bed rest Oxygen Opiate Monitoring Anticoagulation Reduce clot size

To Remember Immunoglobulins - "GAMED" IgG IgA IgM IgE IgD

Location of the heart valve from right to left - "A Permanently Temperamental Man" Aortic Pulmonary Tricuspid Mitral

"Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm.

Types of Joint movements - "FEEDPIPE CARDSHARP" Flexion Extension Eversion Dorsiflexion Pronation Inversion Plantarflexion Elevation Circumduction Abduction Rotation Depression Supination Hyperextension

Adduction Retraction Protraction

Cranial Nerves - "Oh Ohh Ohhh To Try And Fit A Gold Velvet So Heavenly" Olfactory CN I Optic CN II Occulomotor CN III Trochlear CN IV Trigeminal CN V Abducens CN VI Facial CN VII Auditory CN VIII Glasopharyngeal CN IX Vagus CN X Spinal/Accessory CN XI Hypoglossal CN XII

"Point and Shoot!" For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation.

Layers of the scalp - "SCALP" Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium

Carpal bones of the hand (lateral to medial) - "She Looks Too Proud, Try To Chase Her" Proximal row: Scaphoid Lunate Triquetrum Pisiform Distal row: Trapezium Trapezoid Capitate

Hamate

Viruses causing diarrhea - "ACNE CAR" Adeno virus Corana virus Norwak virus Entero virus Calci virus Astro virus Rota virus

The Krebs cycle - "Can I Actually See Some Filipina Mothers" Citrate Isocitrate alpha Ketoglutarate Succinyl CoA Succinate Fumarate Malate Oxaloacetate

Stages of mitosis/meiosis including interphase as a phase - "In Philippines, Men Are Talented" Interphase Prophase Metaphase Anaphase Telophase

Order of prevalence of White Blood Cells, most prevalent to least - "Never Let Monkeys Eat Bananas" Neutrophils Lymphocytes Monocytes Eosinophils Basophils

10 essential amino acids - "PVT. TIM HALL" Phenylalanine Valine Tryptophan

Threonine Isoleucine Metheonine Histidine(semi-essential) Arginine(semi-essential) Leucine Lysine

Uses of Chloroquine (other than malaria) - "RED LIP" Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions

Bronchodilators - "TO A SIS" Terbutaline Orciprenaline Adrenaline Salbutamol Isoprenaline Salmeterol

Signs of cor pulmonale - "Please Read His Text" Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence

Portal hypertension features - "ABCDE" Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen

Key questions needed in an emergency history taking situation - "AMPLE" Allergies

Medication Past medical history Last meal Events and environment related to injury

Malignancies that metastisize to bone - "Laging Panalo Kung Taga Bulacan" Lung Prostat Kidney Thyroid Breast

Six "S" in Scarlet Fever Streptococci causal organism Sorethroat Swollen tonsils Strawberry tongue Sandpaper rash miliarySudamina vesicles over hands, feet, abdomen

Signs of anti-cholinergic crisis - "SLUD" Salivation Lacrimation Urination Defecation

Causes of huge spleen - "3M's" Myelofibrosis Malaria Myelogenous leukemia

Cardinal Symptoms of Parkinson's Disease - "TRAP" Tremor Rigidity Akinesia and bradykinesia Postural Instability

Days of appearance of rashesVaricella(chickenpox) - "Very Sick Patients Must Take Double Exercise" 1st dayScarlet fever

2nd dayPox(smallpox) 3rd dayMumps 4th dayTyphus 5th dayDengue 6th dayEnteric fever(typhoid) SHOCK HYPOTACHYTACHY

HYPOTENSION TACHYPNEA TACHYCARDIA

INCREASE ICP HYPERBRADYBRADY

CUSHINGS TRIAD: HYPERTENSION (WIDE PULSE PRESSURE) BRADYCARDIA BRADYPNEA

HYPOGLYCEMIA

TREMORS, TACHYCARDIA IRRITABILITY RESTLESSNESS EXTREME DIAPHORESIS

EARLY SIGNS OF HYPOXIA RESTLESSNESS AGITATION TACHYCARDIA

LATE SIGNS OF HYPOXIA BRADYCARDIA EXTREME RESTLESSNESS DYSPNEA CYANOSIS

CONGESTIVE HEART FAILURE

DIGOXIN MORPHINE AMINOPHYLLINE DOPAMINE DIURETICS O2 GASSES MONITOR (ABG)

MG SO4 TOXICITY

BP DECREASE URINE OUTPUT DECREASE RESPIRATORY RATE DECREASE PATELLAR REFLEX ABSENT

SICKLE CELL DISEASE HYDRATION OXYGENATION PAIN INFECTION AVOID HIGH PLACES

PREGNANCY INDUCED HYPERTENSION HEMOLYSIS ELEVATED LIVER ENZYMES LOW PLATELETS

GI SYMPTOMS AND TOXICITY TO DIGOXIN

VOMITTING ANOREXIA

NAUSEA DIARRHEA ABDOMINAL PAIN

FRACTURE

PRESSURE REST ICE COMPRESSION ELEVATION

TETRALOGY OF FALLOT DISPLACED AORTA RIGHT VENTRICULAR HYPERTROPHY OPENING INTO THE SEPTUM (VSD) PULMONARY STENOSIS

HYPOKALEMIA

SKELETAL MUSCLE WEAKNESS U-WAVE ON ECG CONSTIPATION TOXICITY TO DIGOXIN IRREGULAR WEAK PULSE OTOSTASIS NUMBNESS PARESTHESIA

PAIN ASSESSMENT

PROVOCATION QUALITY RADIATION, RELIEF SEVERITY TIME

NEUROVASCULAR CHECK PAIN PULSELESSNESS PARESTHESIA PARALYSIS PALLOR

VIRCHOWS TRIAD IN DVT

VENUS STASIS DAMAGE TO VESSELS HYPERCOAGUABILITY ABDOMINAL AORTIC ANEURISM (4A)

ASSYMPTOMATIC ABDOMINAL MASS ABDOMINAL PULSE ACHES LOW BACK ANTI TB DRUGS AND SIDE EFFECTS

RIFAMPICIN RED-ORANGE URINE ISONIAZID PERIPHERAL NEURITIS PYRAZINAMIDE INCREASE URIC ACID ETHAMBUTOL EYE PROBLEMS STREPTOMYCIN OTOTOXIC

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH LILUGOL'S SOLUTION IRON

N - NITROFURANTOIN TTETRACYCLINE

LR6 - LATERAL RECTUS : CN6 SO4 - SUPERIOR OBLIQUE : CN4 ALL3 - ALL THE REST : CN3

RADIATION TX VIA: MUSTARD

ESTROGEN NITROGEN STEROIDS ANTIBIOTICS

DILUTE DECREASE OSMOLALITY

TYPES OF STONES
OXALATE STONES - caused by: tea, choco

URIC ACID STONES - caused by: liver, brain, kidney and other organ meat

CALCIUM STONES - caused by: milk and other dairy products

STRUVITE STONES - caused by: infection, staghorn calculus

CYSTEINE, XANTHINE STONES - caused by: other medical condition, hereditary

SHOCK
Labels: + MEDICAL SURGICAL | 0 comments TYPES:

HYPOVOLEMIC == DECREASED BLOOD VOLUME Active Bleeding, Burns, Placenta Previa, Abrubtio Placenta, Asites, Ectopic Rupture, etc.

CARDIOGENIC == DECREASED CARDIAC OUTPUT Myocardial Infarction, Congestive Heart Failure

DISTRIBUTIVE == MASSIVE VASODILATION a) ANAPHYLACTIC ALLERGY = chemical mediation, histamine, bradykinin b) SEPTIC INFECTION = Pyrogens c) NEUROGENIC BRAIN & SPINAL CORD = decrease vasomotor, trauma ALL OF THESE TYPES RESULTS TO: DECREASE TISSUE PERFUSION POSITION MODIFIED TRENDELENBURG

ROTATING TOURNIQUET, BLOODLESS PHLEBOTOMY

Labels: + MEDICAL SURGICAL | 1 comments
PURPOSE:

to decrease congestion in the heart

y
STEPS:

to decrease venous return

y y y y

apply the tourniquet: 3 extremities are occluded, leave 1 extremity free after 15 minutes, rotate the tourniquet, rotate in a clockwise direction rotate the tourniquet 3 times remove the tourniquet

EXAMPLE:

y y y y y

1 - 12:00 PM tourniquet is applied 2 - 12:15 PM rotate the tourniquet 3 - 12:30 PM rotate the tourniquet 4 - 12:45 PM rotate the tourniquet 5 - 1:00 PM remove all the tourniquet

NEUROLOGIC DISEASES
Labels: + MEDICAL SURGICAL | 0 comments
MYASTHENIA GRAVIS Decreased Acetylcholine Receptor Sites

MULTIPLE SCLEROSIS Patches of demyelination

ALZHEIMERS DISEASE neuro fibrillary tangles, senile plaques, and decrease Acetylcholine

PARKINSONS DISEASE degeneration of Substantia Nigra

GUILLAIN BARRE SYNDROME degeneration of Myelin Sheath of peripheral nerves

PICKS DISEASE swelling of neurons taking a ballooned appearance

CREUTZFELDT JAKOB DISEASE development of porous tissue, mad cow disease, and infections

HUNTINGTONS DISEASE degeneration of Striatum (caudate and putamen) in basal ganglia

AMYOTROPHIC LATERAL SCLEROSIS degeneration of Anterior Horn Cells and Corticospinal Tracts

EKG READING
Labels: + MEDICAL SURGICAL | 0 comments
Electrocardiogram or EKG measures the electrical activity of the heart Electrical conduction

AUTOMATICITY ability of the heart muscle to initiate an electrical impulse

1. 2. 3. 4.

SA Node (normal pacemaker of the heart) AV junction Bundle of His Purkinje fibers

P wave Atrial depolarization

QRS Complex Ventricular depolarization

T wave Ventricular repolarization

U wave may or may not be seen; repolarization of Purkinje fibers; Hypokalemia

PR Interval from the onset of P wave to the onset of QRS complex

QRS Complex amount of time the ventricles depolarize

NURSING INTERVENTIONS: 1. Avoid bony areas/ scar tissues/ skin folds/ increased muscle mass 2. Perform a 10 cm shaving around the area; AVOID if possible 3. Dry the skin with the use of gauze 4. Remove excess skin oils EXCEPT for geriatric pts 5. Dry with gauze 6. Place the electrodes. Make sure the center is moist; otherwise, discard. 7. EQUIPMENT Trouble shooting

Horizontal axis - represents the time in seconds (sec) 1 small square = 0.02 seconds 5 small squares = 1.0 seconds

Vertical axis - represents the amplitude in millivolts (mv) 1 small square = 0.1 mv 5 small squares = 0.5 mv 2 big squares = 1.o mv

NORMAL SINUS RHYTHM (60-100 bpm) Sinus Bradycardia atrial rate of 50 or <60> Sinus Tachycardia atrial rate of >100 bpm due to anxiety, blood loss, Fever, Pain

SINUS ARRYTHMIA: Paroxysmal Atrial Tachycardia (PAT) or Premature Supraventricular Tachycardia (PSVT) >150 250 bpm due to CADse, Mitral valve dse, Thyrotoxicosis INTERVENTION:

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Valsalva maneuver + Exhale slowly Rest Medications to sedate Medications to slow electrical conduction to the heart (VERAPAMIL HCL)

Atrial Flutter due to inflammation, fluid overload INTERVENTION:

y y y

Medications to slow ventricular rate (DIGITALIS) Anti arrhythmics Procainamide HCL Synchronized cardioversion

Atrial fibrillation due to alcoholism 350 600 bpm decreased CO INTERVENTION:

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Administer medications (Digitalis, Verapamil HCL) Synchronized cardioversion

1st degree AV Block damaged hearts due to ischemia, Rheumatic fever, Infection INTERVENTION:

Atropine Sulfate (IV- 0.5 mg)

2nd degree AV block Mobitz Type 1 AV Block/ Wenckebach due acute RF, MI, Digitalis toxicity 2nd degree AV Block Mobitz Type 2 AV Block due to Pulmonary edema, Digitalis toxicity, worsened MI dse INTERVENTION:

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Atropine Sulfate ( IV 0.5 mg) Isoproterenol

3rd degree AV Block Pacemakers (Permanent, Delayed, Demand, Fixed rate, AV Pacemaker)

Premature Ventricular Contraction (PVCs) common in Type A personality due to CADse, can precede dysrrhythmias, Acute MI/ Ischemia INTERVENTION:

y y

Lidocaine HCL (IV bolus, initially then thru Infusion) Atropine Sulfate IV

COUPLETS IV Lidocaine Multiform/ Multifocal PVCs Bolus Lidocaine

Ventricular Tachycardia Due to mild Congestive heart failure Tachyarrhytmia

>150 bpm / HPN INTERVENTION:

y y y

IV Lidocaine Procainamide Precordial thump (obsolete)

COMMON SIGNS AND SYMPTOMS

01. PTB low-grade afternoon fever. 02. PNEUMONIA rusty sputum. 03. ASTHMA wheezing on expiration. 04. EMPHYSEMA barrel chest.

MAOIs + TYRAMINE RICH FOOD= HYPERTENSIVE CRISIS

DON'Ts of PREGNANCY
y y y y y y y y y y y y
LIPID LOWERING AGENTS (..... STATIN) ESTROGEN PILLS COUMADIN / WARFARIN ISOTRETINOIN OHA ANTIPSYCHOTICS RADIATION TORCH (Toxoplasmosis, Others, Rubella, Chlamydia, Herpes) RIBAVIRIN (inhaled) ALKASELTZER (contains ASA) DILANTIN ALCOHOL AND SMOKING !HeHeHe!

FALSE RESULT ON OCCULT BLOOD EXAM IS DUE TO:

y y y y

VITAMIN C = FALSE (-) ASA = FALSE (+) CORTICOSTEROIDS = (+) RED MEAT = (+)

MUSCLE RELAXANTS AVOID GIVING TO MYASTHENIA GRAVIS PATIENT MAY BE GIVEN TO MULTIPLE SCLEROSIS (ex. Baclofen) BACLOFEN (ang mga BACLA malalambot ang muscles) FLEXRIL (palaging naka flex ang elbows nila diba? ) NEOMYCIN MORPHINE SO4

CAUSES URINE DISCOLORATION DIAMOX DOXORUBICIN RIFAMPICIN PYRIDIUM LEVODOPA OTOTOXIC DRUGS STREPTOMYCIN THIAZIDES AMINOGLYCOSIDES ANTI-NEOPLASTICS LOOP DIURETICS

HIGH PITCH CRY ICREASE ICP HYDROCEPHALUS MENINGITIS

MAY LEAD TO ANGINA EXERCISE EMOTION EATING EXTREME WEATHER

ANTICIPATE ACUTE RESPIRATORY FAILURE GULLAIN BARRE SYNDROME MYASTENIA GRAVIS AMYOTROPIC LATERAL SCLEROSIS

DONT GIVE TO PATIENT WITHCELIACS DISEASE BARLEY RYE OAT

WEAT

MUST URINATE, VOID, EMPTY BLADDER

AMNIOCENTHESIS PARACENTHESIS LEOPOLDS MANEUVER ULTRASOUND (TRANSVAGINAL ONLY)

DRINK, DONT URINATE, FULL BLADDER CHORIONIC VILLI SAMPLING ULTRASOUND (ABDOMINAL)

IMPOTENCE OR DECREASE LIBIDO

ALDACTONE ACE INHIBITORS BETA BLOCKERS

PHOTOSENSITIVE PROTECT THE PATIENT

ST. JOHNS WORT ANTI PSYCHOTIC THIAZIDE DIURETICS DANTRIM

PHOTOSENSITIVE - COVER THE DRUG LIQUID DILANTIN MANNITOL NITROGLYCERIN

DECREASES DOPAMINE (Disturbs Dopamine Acetylcholine Balance)

PLASIL REGLAN RESERPINE

COMMON SIGNS AND SYMPTOMS

01. PTB low-grade afternoon fever. 02. PNEUMONIA rusty sputum. 03. ASTHMA wheezing on expiration. 04. EMPHYSEMA barrel chest. 05. KAWASAKI SYNDROME strawberry tongue. 06. PERNICIOUS ANEMIA red beefy tongue. 07. DOWN SYNDROME protruding tongue. 08. CHOLERA rice watery stool. 09. MALARIA stepladder like fever with chills. 10. TYPHOID rose spots in abdomen. 11. DIPTHERIA pseudo membrane formation 12. MEASLES kopliks spots. 13. SLE butterfly rashes. 14. LIVER CIRRHOSIS spider like varices. 15. LEPROSY lioning face. 16. BULIMIA chipmunk face. 17. APPENDICITIS rebound tenderness. 18. DENGUE petechiae or (+) Hermans sign. 19. MENINGITIS Kernigs sign (leg flex then leg pain on extension), Brudzinski sign (neck flex = lower leg flex). 20. TETANY hypocalcemia (+) Trousseaus sign/carpopedal spasm; Chvostek sign (facial spasm). 21. TETANUS risus sardonicus. 22. PANCREATITIS Cullens sign (ecchymosis of umbilicus); (+) Grey turners spots. 23. PYLORIC STENOSIS olive like mass. 24. PDA machine like murmur. 25. ADDISONS DISEASE bronze like skin pigmentation. 26. CUSHINGS SYNDROME moon face appearance and buffalo hump. 27. HYPERTHYROIDISM/GRAVES DISEASE exopthalmus. 28. INTUSSUSCEPTION sausage shaped mass, Dance Sign (empty portion of RLQ) 29. MS Charcots Triad (IAN) 30. MG descending muscle weakness

31. Guillain Barre Syndrome ascending muscle weakness 32. DVT Homans Sign 33. CHICKEN POX Vesicular Rash (central to distal) dew drop on rose petal 34. ANGINA Crushing stubbing pain relieved by NTG 35. MI Crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG 36. LTB inspiratory stridor 37. TEF 4Cs Coughing, Choking, Cyanosis, Continous Drooling 38. EPIGLOTITIS 3Ds Drooling, Dysphonia, Dysphagia 39. HODGEKINS DSE/LYMPHOMA painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells 40. INFECTIOUS MONONUCLEOSIS Hallmark: sore throat, cervical lymph adenopathy, fever 41. PARKINSONS Pill-rolling tremors 42. FIBRIN HYALIN Expiratory Grunt 43. CYSTIC FIBROSIS Salty skin 44. DM polyuria, polydypsia, polyphagia 45. DKA Kussmauls breathing (Deep Rapid RR) 46. BLADDER CA painless hematuria 47. BPH reduced size & force of urine 48. PEMPHIGUS VULGARIS Nikolskys sign (separation of epidermis caused by rubbing of the skin) 49. RETINAL DETACHMENT Visual Floaters, flashes of light, curtain vision 50. GLAUCOMA Painfull vision loss, tunnel/gun barrel/halo vision (Peripheral Vision Loss) 51. CATARACT Painless vision loss, Opacity of the lens, blurring of vision 52. RETINO BLASTOMA Cats eye reflex (grayish discoloration of pupils) 53. ACROMEGALY Coarse facial feature 54. DUCHENNES MUSCULAR DYSTROPHY Gowers sign (use of hands to push ones self from the floor) 55. GERD Barretts esophagus (erosion of the lower portion of the esophageal mucosa) 56. HEPATIC ENCEPHALOPATHY Flapping tremors 57. HYDROCEPHALUS Bossing sign (prominent forehead) 58. INCREASE ICP HYPERtension BRADYpnea BRADYcardia (Cushings Triad) 59. SHOCK HYPOtension TACHYpnea TACHYcardia 60. MENIERES DSE Vertigo, Tinnitus 61. CYSTITIS burning on urination 62. HYPOCALCEMIA Chvostek & Trosseaus sign 63. ULCERATIVE COLITIS recurrent bloody diarrhea 64. LYMES DSE Bulls eye rash

DRUGS AND ANTIDOTES

ACETAMINOPHEN ACETYLCYSTEIN MUCOMIST DIGOXIN DIGIBIND, DIDIFAB HEPARIN PROTAMINE SULFATE COUMADIN, WARFARIN VITAMIN K, FRESH FROZEN PLASMA LOVENOX VITAMIN K LITHIUM DIAMOX BENZODIAZEPINE FLUMAZENIL ATROPINE SULFATE MESTINON CURARE EDROPHONIUM TENSILON MORPHINE NALOXONE HCL (NARCAN) DEMEROL NALOXONE HCL (NARCAN) METHOTREXATE LEUCOVORINE NEOSTIGMINE PRALIDOXINE CHLORIDE (PAM) PENICILLIN EPINEPHRINE THROMBOLYTIC AMINO CAPROIC ACID METHYLERGONOVINE MAGNESSIUM SULFATE OXYTOCIN MAGNESSIUM SULFATE MAGNESSIUM SULFATE CALCIUM GLUCONATE YUTOPAR INDERAL LEAD EDETATE DISODIUM (EDTA) LEAD DIMERCAPROL (BAL) LEAD SUCCIMER (CHEMET) IRON DESFERAL COPPER PENICILLAMINE ETHYLENE POISONING FOMEPIZOL (ANTIZOL) CYANIDE POISONING METHYLENE BLUE

The PSYCH MAP explains a lot of concepts needed in the study of Psychiatric Nursing. I hope that this will help you in your study. First, you have to click on the picture above in order to enlarge it.

Then click on this icon on the right lower portion of the screen to further enlarge the picture. Save the picture in your computer. Open and print the picture (landscape format). Place the picture above your bed, beside your study table, in front of your bowl (CR), at the mirror, ceiling and floor. Memorize and Enjoy!

The center or the word NORMAL represents a state in which there is equilibrium or the absence of any problem. If you encounter problems or stressors, you will become ANXIOUS and your Sympathetic Nervous System SNS will be activated. Epinephrine and norepinephrine will be released. In severe cases, medications are given. The main purpose of the medication given for anxiety is to decrease the action of the SNS. GABA decreases your SNS and further to your left, you will see a list of medications used to decrease anxiety (VLASTMEVAIB). zepam, zepine and zolam are the common ending letters of these anxiolytic medications. It will take 3 to 4 weeks until these drugs take effect. While taking these drugs, you should watch out for anticholinergic effects such as constipation and urinary retention. It is important to remember that there are safety precautions when taking these drugs. You should not drive because these drugs can make you drowsy which means that you should not engage yourself in an activity which requires alertness (ex. driving, operating a machine). You may also experience orthostatic hypotension. You should not drink alcohol because it is a depressant and this will potentiate the effect of the drug. On the other hand, you are also not allowed to drink coffee. It is a stimulant that counteracts the effect of your anxiolytic drugs, and besides, you are taking medications to decrease the stimulants causing your anxiety. Anxiolytic drugs or anti-anxiety drugs may lead to dependence. Withdrawal from these drugs are done gradually to prevent seizures.

There are lots of theories explaining the cause of SCHIZOPHRENIA. One theory states that there is an increase in the neurotransmitter DOPAMINE. Dopamine is a neurotransmitter responsible for cognition and regulation of emotional responses, it is generally a stimulant. Different kinds of drugs are given to a schizophrenic patient (SSTTCHAMPZR), these drugs are called Neuroleptics or Antipsychotics. The main action of these drugs is to decrease Dopamine or its effects. Ldol and azine are the common ending letters of these drugs. Side effects of these drugs include, agranulocytosis (which has an early symptom of sore throat) and photosensitivity (use wide brimmed hat). When Dopamine is severely decreased during the use of neuroleptic drugs, ACETYLCHOLINE DOPAMINE balance is affected, when this happens, Pseudoparkinsonism and EPSE will manifest (NMS fatal). In order to bring equilibrium, two types of drugs are given, the ANTICHOLINERGIC drugs (AABC) which decreases Acetylcholine and the DOPAMINERGIC drugs (PLES) which increases the Dopamine. To remember the two types of drugs you must remember the word CAPABLES.

When norepinephine is increased, there is a distinct period during which, a mood of a person is constantly elated or persistently high, we consider this to be a manic episode or MANIA. When this happens, we place the person to be at risk for injury because of impulsive actions. He is also monitored for nutritional imbalance due to loss of attention and focus on his own basic needs. Lithium is the drug of choice for mania. A narrow level of 0.6 to 1.2 meq/L must be maintained. Toxicity is manifested by gastro intestinal symptoms such as nausea, vomiting and diarrhea (VANDA). To avoid this, give liberal amount of fluid intake (3L/day). This is also the reason why we dont combine this drug with a Diuretic. Diamox (a drug also used for Vertigo) is the antidote for lithium toxicity. Avoid strenuous activities which may lead to cardiac collapse. Monitor the kidney function because this drug is nephrotoxic. It takes 2-4 weeks before you see the effects of this drug. Serotonin makes us happy. MAO is a substance which decreases the amount of serotonin present in our body. If serotonin level falls, depression takes place. Depression is a state in which a persons mood is persistently low. There are different types of medications given to people who are depressed. First, the SSRI, this medication aims to inhibit the reuptake of serotonin in our body which means that the usual serotonin will be made available in the synapses for a longer period of time. Second is the TCA, this drug works just like the SSRI except that it has a different target neurotransmitter which is the norepinephrine. Third is the MAOI, a MAOI inhibits the action of a MAO therefore it inhibits the breakdown of neurotransmitters. It is important to remember that the effects of these drugs will take place after a week of continuous medication, as in the case of MAOI, it can take up to 6 weeks. At these times, we should monitor the patient for possible suicide because when a patient has just been lifted from depression, he now has the power to execute the suicidal ideations that has been his mind. Hypertensive Crisis is the adverse effect of MAOI, this happens when the drug is combined with tyramin rich food. Pentolamine is given during hypertensive episodes. During the use of antidepressants,

you should monitor for any increase in the intraocular pressure which is an indication of developing glaucoma. Male sexual function may also be affected. An ECT may be used while waiting for the therapeutic effects of the antidepressants or if the patient is not responding to medications. Prior to ECT, short-acting sedatives are given so the client may sleep (Barbiturates) and a muscle relaxant (Succinylcholine) so that there would be a less chance of injury due to the rigid effects of seizure contractions. Best position after ECT is side lying. Check the vital signs, orient the patient and reassure that memory loss is only temporary. Before giving oral intake, it is important to check the gag reflex to prevent aspiration. Pregnancy is not a contraindication to ECT.

LAB VALUES
ABG Ph 7.35 - 7.45 PCO2 35 45 mm Hg HCO3 22 27 mEq/ml PO2 80 100 mm Hg SaO2 93 100% RBC Male 4.5 - 6.2 million/ cubic mm Female 4.0 - 5.5 million/cubic mm WBC 4,300 - 10,800/ cubic mm Platelets 150,000 - 350,000/ cubic mm Hgb Male 14 - 16.5 g/dL Female 12 - 15 g/ dL Hct Male 42 - 52% Female 35 - 47% PT (Warfarin/ Coumadin) Male 9.6-11.8 secs Female 9.5-11.3 secs Should be 1.5 to 2 times the Normal PTT/ APTT (Heparin) 20-36 secs / 30-45 secs Should be 1.5 to 2.5 times the Normal INR 2 3 Standard Warfarin therapy 3 4.5 High dose Warfarin therapy 2-3 Atrial fibrillation, DVT and Pulmonary embolism 2.5-3.5 Prosthetic heart valves Bleeding Time 3 - 7 mins. 8 - 15mins (Saunders) Electrolytes K 3.5 - 5.1 mEq/ L Mg 1.6 - 2.6 mEq/ L Ph 2.7 - 4.5 mEq/ L Na 135 - 145 mEq/ L

Cl 98-107 mEq/ L Ca 8.6 - 10 mg/dL Potassium Chloride IT IS NEVER GIVEN BY IV PUSH, IM OR SUB Q With a dilution of not more than 1mEq/10ml Maximum infusion rate of 5-10 mEq/ hr NEVER to exceed 20 mEq/ hr at any circumstance Blood Sugar 70 110 mg/dL Glycosylated Hgb (glycohemoglobin) less than 7.5% Good 7.6 - 8.9% Fair greater than 9% Poor Vanillylmandelic Acid (VMA) 0.7 - 6.8 mg/24 hrs GFR 125 ml/min Creatinine 0.8 - 1 mg/dL 0.6-1.3 mg/dL (Saunders) BUN 10 20 mg/dL 8-25 mg/dL (Saunders) UO Adult: 30 cc/hr and 720 cc/24 hours Pedia: 2cc/ kg/ hr AST/ ALT 5-40 IU/L Ammonia 9-33 mol/L 35-65 mcg/ dl Albumin 3 - 5 g/dL Amylase 25-151 units/ L Lipase 10-140 units/ L Bilirubin (Total) less than 1.5 mg/ dL Pulmonary capillary mean wedge pressure 4-12 mmHg Central Venous Pressure 2-6 mmHg Plasma Osmolality 280-300 mOsm/kg Serum Alcohol

LEGAL .08 - .10 TOXIC! grater than 0.15 (50mg/100cc of blood) greater than 8%

IMMUNITY
IMMUNITY bodys reaction to any foreign body that might enter our tissues
2 types: NON SPECIFIC/ CELLULAR / Innate immunity present in our body since we were born SPECIFIC

y y

Mediators (non specific) 1. MECHANICAL BARRIERS Skin (keratinized) Body secretions ( sweat, oil) Cilia (transports) Mucus (traps organism entering the Respiratory tract)

y y y y

2. CHEMICAL BARRIERS Enzymes (lysozymes) Acids ( kills bacteria by denaturation) Fatty acids skin Gastric acids stomach Complement system becomes activated in cascade fashion 1,2,3.. Activated Complements System presents antigen to the bacteria; once activated, has to be removed from the body

y y y

3. INFLAMMATORY RESPONSE Presents the 5 Cardinal signs which is chemically mediated that can come from: Damaged tissues Inflammatory cells Even from the bacteria itself

y y y

5 Cardinal signs & symptoms of inflammation: 1. redness (rubor) 2. swelling (tumor) 3. pain (dolor) 4. heat (calor) 5. loss of function (functiolaesa) FXN: forms a barrier to confine infection tries to eliminate infectious agent initiates repair of damaged tissues

y y y

4. CELLS WBCs

a) GRANULOCYTES granulocytic leukocytes; WBCs with granules inside the cytoplasm

1. Neutrophiles plenty; 1st line of defense; 1st to respond during an infection HALLMARK OF ACUTE INFECTION (10days) Once they leave, they cannot go back (through DIAPEDESIS) CBC - increased Neutrophiles = acute infection Disease is current; can be bacterial HOW DO NEUTROPHILES KILL BACTERIA? Phagocytic active engulfing Degranulation release granules in the cytoplasm which contains cytotoxins that kill the bacteria

y y

2. Eosinophiles mediate for Allergies; Hypersensitivity reaction; Anaphylactic reaction; Contains vasoactive dilators: Serotonin Histamine Bradykinin

y y y

Limited phagocytic activities Picky eaters eat only * complement system, * Ag aggregated with Ab 3. Basophiles HEPARIN anti coagulant; lesser blood clots

b) AGRANULOCYTES
1. Monocytes found in the blood which rids bacteria, virus, and other debris scavengers (10 days in circulation) ACTIVE phagocytes DIAPEDESIS mode of escape w/o damage MACROPHAGES once they are out, monocytes take this form; derivative Neutrophiles, Monocytes, Macrophages = 3 active phagocytic cells 2. Lymphocytes non phagocytic cells HALLMARK OF CHRONIC INFECTION a) T CELLS/ T-LYMPHOCYTES = (Cellular Immunity) T- cells mature in the Thymus glands(Lymphoid organs) Once there is an infection, they become ACTIVE EFFECTOR CELLS Natural killer cells non phagocytic cells which kills by secreting LYMPHOKINES kills ON CONTACT; has intimate contact with bacteria (sila ang Police na pumapatay sa kahit sinong magnanakaw - virus,bacteria) Helper cells calls for other WBCs which circulate around the body by secreting OPSONINS (chemically attract WBC). WBC aids in the attack; (nagtatawag para may katulong ang Police sa laban) Suppressor cells the absence of these mediators will cause destruction of normal tissues (taga awat kung bugbog na ang kalaban, kung walang aawat sila-sila din ang magpapatayan kahit kakampi nila"Autoimmune disease")

y y y

b) B CELLS/ B LYMPHOCYTES - mediator of specific immunity must 1st recognize specific Ag (nag draw-drawing ng cartographic sketch ng magnanakaw the 1st time na pumasok sya sa bahay) acquires Abs once exposed to microorganism (ipapakita niya yung drawing niya sa police para next time na papasok ang magnanakaw kilala na ng police at bubugbugin na niya ang magnanakaw) improves with exposure (mas madalas niya makita at mas madalas sya manakawan, mas lalo na niya nakikilala ang magnanakaw para lalong maituro at mahuli ng police ) Humoral immunity

y y y y

ACTIVE EFFECTOR B CELLS: MEMORY CELLS (Ang "WITNESS" na nag draw-drawing ng cartographic sketch ng magnanakaw the 1st time na pumasok sya sa bahay) PLASMA CELLS makes Abs specific to description of the memory cells; (bumubuo ng "TASK FORCE POLICE" para lumaban sa muling pagbalik, dun lang sa magnanakaw na nai-drawing ng witness - "Antigen-Antibody Response")

y y

IMMUNIZATION is the process by which we reinforce our immune system by introducing antigens that stimulate antibody responses

y y

ACTIVE our own body participates in the production of Abs slow acting so it is introduced during our childhood; last longer than passive VACCINES made up of dead, inactivated organisms; parts of Ags; or attenuated (weakened virus or bacteria) PASSIVE giving antibodies (Abs) especially during epidemic Gives immediate protection but temporary (3-6months) Ex. Equine vaccine from horses A) NATURAL from mother to baby B) PASSIVE Abs from other sources

CONVERSION TABLE OF MEASUREMENTS - COMMONLY USED FOR MEDICATION AND DRUG COMPUTATIONS
1 gram (g) = 1000 milligrams (mg) 1 kilogram (kg) = 1000 grams (g) 1 microgram (mcg) = .001 milligram (mg) 1 milligram = 1000 microgram (mcg) 1 liter (L) = 1000 milliliters (ml) 1 milliliter (ml) = 1 cubic centimeter (cc) 1 meter = 100 centimeters (cm) 1 meter = 1000 millimeters (mm) 1 cubic centimeter (cc) = 1 milliliter (ml) 1 teaspoon = 5 cubic centimeter (cc) = 5 milliliters (ml) 1 tablespoon = 15 cubic centimeter (cc) = 15 milliliters (ml) 1 tablespoon = 3 teaspoon 1 ounce = 30 cc = 30 ml = 2 tablespoons = 6 teaspoons 8 ounces = 240 cc = 240 ml = 1 cup 1 milliliter (ml) = 15 minims (M) = 15 drops (gtt) 5 milliliters (ml) = 1 fluidram = 1 teaspoon 15 milliliters (ml) = 4 fluidrams = 1 tablespoon 30 milliliters (ml) = 1 ounce (oz) = 2 tablespoons 500 milliliters (ml) = 1 pint (pt) 1000 milliliters (ml) = 1 quart (qt) Weight 1 kilogram = 2.2 pound (lb) 1 gram (g) = 1000 milligrams = 15 grains (gr) Length 2.5 centimeters = 1 inch Centigrade/Fahrenheit Conversions C = (F - 32) X 5/9 F = (C X 9/5) + 32

FOUR STRATEGIES
1. 2. 3. 4. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would be next? If the question asks what the client needs. Use maslows hierarchy to determine which need to address. If the question indicates that the client doesnt have urgent physiologic need, focus on the patient safety. If the question involves communicating with a patient. Use principles of therapeutic communication.

REMEMBER: AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)

ENDOCRINE SYSTEM
Labels: - ENDOCRINE SYSTEM | Understanding the endocrine system Hypothalamus helps control endocrine glands. Adrenal cortex secretes mineralocorticoids, glucocorticoids, adrenal androgens, and estrogen. Adrenal medulla produces epinephrine and norepinephrine. Pancreas produces glucagon and insulin. Pituitary gland secretes oxytocin and antidiuretic hormone. Thyroid gland secretes thyroxine and triiodothyronine. Parathyroid glands secrete parathyroid hormone.

Endocrine disorders are caused by: hypersecretion or hyposecretion of hormones

 hyporesponsiveness of receptors of hormones inflammation of gland tumor of gland.

How endocrine disorders develop Addisons disease autoimmune disease (primary) that causes massive destruction of both adrenal glands. Cushings syndrome typically results from excess corticotropin, which leads to hyperplasia of the adrenal cortex. Diabetes insipidus caused by deficiency of antidiuretic hormone (ADH). Diabetes mellitus disease occurs in two primary forms: type 1 beta cells in pancreas are destroyed or suppressed; insulin isnt secreted. type 2 may be insulin resistance, overproduction of glucose, or abnormal insulin secretion. Goiter enlargement of the thyroid gland. This condition occurs in two forms: nontoxic goiter thyroid gland is enlarged because its unable to secrete enough thyroid hormone to meet metabolic needs. toxic goiter occurs after long-standing nontoxic goiter. Hyperthyroidism autoimmune disorder that overproduces thyroid hormone. Hypothyroidism a thyroid deficiency that causes metabolic processes to slow down.

FLOW OF BLOOD THROUGH THE HEART

Labels: - CIRCULATORY SYSTEM | 0 comments inferior vena cava and superior vena cava right atrium tricuspid valve right ventricle pulmonic valve pulmonary artery lungs pulmonary veins left atrium mitral valve left ventricle aorta systemic circulation

2 Atrioventricular Valves:

y y

Mitral valve Tricuspid valve

2 Semilunar Valves

y y

Aortic valve Pulmonic valve

CARDIOVASCULAR SYSTEM
Labels: - CIRCULATORY SYSTEM |
The cardiovascular system is made up of the heart, arteries, veins, and lymphatics, which transport life-supporting oxygen and nutrients to cells, remove metabolic waste products, and carry hormones from one part of the body to another.

Myocardial function Increase in oxygen demand must be met by increase in oxygen supply. Blood normally flows in one direction across heart valves. Pressure gradient causes the valves to open and close.

Response to blood pressure drop Heart rate increases. Force of contraction increases. Arterioles constrict.

Response to blood pressure increase Heart rate decreases. Force of contraction decreases. Vasodilation occurs.

How cardiac disorders develop Abdominal aneurysm an abnormal dilation in the arterial wall that occurs in the aorta between the renal arteries and the iliac branches. Cardiogenic shock a condition of diminished cardiac output that severely impairs tissue perfusion as well as oxygen delivery to the tissues. Cardiac tamponade a condition thats caused by blood or fluid accumulation in the pericardium, which leads to compressed heart chambers and decreased cardiac output. Coronary artery disease occurs when oxygen demand exceeds the supply from diseased vessels, leading to myocardial ischemia. Dilated cardiomyopathy a disorder thats caused by extensive damage to the hearts muscle fibers, which results in dilated heart chambers. Heart failure impaired ventricular function due to a heart muscle abnormality that prevents the heart from pumping enough blood. Hypertension an intermittent or sustained elevation of diastolic or systolic blood pressure. Hypertrophic cardiomyopathy a primary disease of the myocardium thats characterized by a thickened, inflexible heart muscle. Myocardial infarction caused by blockage of one or more coronary arteries, which leads to prolonged myocardial ischemia, resulting in irreversible cell damage and muscle death. Pericarditis an acute or chronic condition thats caused by an attack of bacteria or other substances that results in fibrosis and scar tissue once the infection ceases. Rheumatic fever and heart disease a systemic inflammatory disease of childhood that develops after infection of the upper respiratory tract with group A beta-hemolytic streptococci.

STREPTOCOCCAL PHARYNGITIS
Labels: + COMMUNICABLE DISEASE, - RESPIRATORY SYSTEM |
STREPTOCOCCAL SORE THROAT Group A streptococcus or Strep A. secrete 70+ variety of enzymes or toxins common to abusing voice

Causative Agent: Group A beta hemolytic Streptococcus

Modes of Transmission: Droplet Direct contact discharges form respiratory passages; saliva

Signs and Symptoms: sudden onset high-grade fever, rapid pulse, chills enlarge, tender cervical lymph nodes inflamed tonsils with whitish muco-purulent exudates headache, abdominal pain beefy red throat

Diagnostic Exam: throat culture det strep throat to a patient throat swab det antigen

Nursing Care: bedrest, no sweets oral hygiene with oral antiseptic or with saline gargle, saline solution 1 glass lukewarm water + 1 tsp rocksalt taken 3 4x a day

Prevention: Avoid MOT

Complications: Rheumatic Heart Disease Acute Glomerulonephritis

Treatment: Erythromycin oral 10 days Single shot IM Benzathine (Penicillin) 1.2 MU single dose (adult)

How respiratory disorders develop Adult respiratory distress syndrome a form of pulmonary edema that can quickly lead to acute respiratory failure. Asbestosis a condition thats characterized by diffuse interstitial pulmonary fibrosis. Asthma a chronic reactive airway disorder that can present as an acute attack. Chronic bronchitis a form of chronic obstructive pulmonary disease (COPD), is an inflammation of the bronchi caused by resistance in small airways from prolonged irritant inhalation. Cor pulmonale a condition that develops secondary to a disease that affects the structure or function of the lungs or its vasculature. Emphysema a form of COPD that is the abnormal, permanent enlargement of the acini accompanied by destruction of the alveolar walls. Pneumonia an acute infection of the lunch parenchyma that impairs gas exchange. Pneumothorax an accumulation of air in the pleural cavity that leads to partial or complete lung collapse. Pulmonary edema a common complication of cardiac disorders thats marked by accumulated fluid in the extravascular spaces of the lung.

 Tuberculosis an infectious disease that primarily affects the lungs but can invade other body systems.

How respiratory disorders develop Adult respiratory distress syndrome a form of pulmonary edema that can quickly lead to acute respiratory failure. Asbestosis a condition thats characterized by diffuse interstitial pulmonary fibrosis. Asthma a chronic reactive airway disorder that can present as an acute attack. Chronic bronchitis a form of chronic obstructive pulmonary disease (COPD), is an inflammation of the bronchi caused by resistance in small airways from prolonged irritant inhalation. Cor pulmonale a condition that develops secondary to a disease that affects the structure or function of the lungs or its vasculature. Emphysema a form of COPD that is the abnormal, permanent enlargement of the acini accompanied by destruction of the alveolar walls. Pneumonia an acute infection of the lunch parenchyma that impairs gas exchange. Pneumothorax an accumulation of air in the pleural cavity that leads to partial or complete lung collapse. Pulmonary edema a common complication of cardiac disorders thats marked by accumulated fluid in the extravascular spaces of the lung. Tuberculosis an infectious disease that primarily affects the lungs but can invade other body systems.