HERBAL MEDS who suffer from summer depression.

SAD is recognized in the DSM-IV (The American Psychiatric

St. John's wort - antidepressant, photosensitive (C/I
in SULFA drugs)
Garlic - antihypertensive (avoid aspirin)
Ginseng - Anti stress (C/I in coumadin)
Association's diagnostic manual) as a subtype of major depressive
episode.
Some individuals who work long hours inside office buildings with few
windows may experience symptoms all year round. Some very
sensitive individuals may note changes in mood during long stretches
of cloudy weather.

Green tea - antioxidant (check if risk for A sign of improvement from dehydration would be a decreased urine
calculi-oxalates) specific gravity and a decreased/decreasing hematocrit. So the SG of
1.015 and a Hct of 46% would be the answer. It is the best answer of
Echinacea - immune stimulant (6-8 weeks only)(C/I in the two you had in you question.
SANDIMMUNE-Immunosuppressant) The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025
with normal hydration and volume) (different texts give a slightly
Licorice - cough and cold different range).
SG 1.025-1.030+ (concentrated urine)
Ginger root - antinausea (C/I in Coumadin) SG 1.001-1.010 (dilute urine)
SG 1.001-1.018 in infants under 2 years of age
Ginkgo - improves circulation (C/I in anticoagulant, Specific gravity is a measurement of the kidney's ability to concentrate
headache side effect - check PT) urine. The range of urine's SG depends on the state of hydration and
varies with urine volume and the load of solids to be excreted under
Ma huang - bronchodilator, stimulant (Ephedra) standardized conditions; when fluid intake is restricted or increased, SG
measures the concentrating and diluting functions of the kidney. Loss
of these functions is an indication of renal dysfunction.
Digitalis Toxicity includes.. SG values usually vary inversely with amounts of urine excreated
N - nausea (decrease in urine volume = increase in specific gravity). However in
A - anorexia some conditions this is not the case.
V - vomiting
D - diarrhea EYE ABBREVIATIONS
A - abdominal pain OU- both eyes
OR- right eye
OS- left eye
Drugs which can cause URINE DISCOLORATION
Adriamycyn------ Reddish
Rifabutin--------- Red orange CUSHINGS (Hypersecretion of Adrenal Cortex Hormones)
Rifampicin------- Red orange
Bactrim---------- Red orange C = Check VS, particularly BP
Robaxin--------- Brown, Black or Greenish U = Urinary output & weight monitoring
Azulfidine------ Orange yellow S = Stress Management
Flagyl------------ Brownish H = High CHON diet
Dilantin---------- Pink tinged I = Infection precaution
Anti Psychotic-- Pinkish to Red brown N = Na+ restriction
Early signs of hypoxia: G = Glucose & Electrolytes Monitoring
R-restlessness S = Spousal support
A-anxiety
T-Tachycardia ADDISON'S (Hyposecretion of Adrenal Cortex Hormones)
Late signs of hypoxia: Always Remember the 6 A's of Addison's disease
B-bradycardia
E-extreme restlessness 1.) Avoid Stress
D-dyspnea 2.) Avoid Strenuous
In pedia- 3.) Avoid Individuals with Infection
F-feeding difficulty 4.) Avoid OTC meds
I-inspiratory stridor 5.) A lifelong Glucocorticoids Therapy
N-nares flare 6.) Always wear medic alert bracelet
E-expiratory grunting
S-sternal retractions
Respiratory Patterns Hirschsprung’s diagnosed with rectal biopsy looking for absence of
Kussmaul- fruity acetone breath odor ganglionic cells. Cardinal sign in infants is failure to pass meconium,
Cheyne-stokes- near death breathing pattern and later the classic ribbon-like and foul smelling stools.

Intussusception common in kids with CF. Obstruction may cause fecal

Seasonal Affective Disorder (SAD) may affect over 10 million
Americans.
The typical symptoms of SAD include depression, lack of energy,
increased need for sleep, a craving for sweets and weight gain.
Symptoms begin in the fall, peak in the winter and usually resolve in
the spring. Some individuals experience great bursts of energy and
creativity in the spring or early summer.
Susceptible individuals who work in buildings without windows may
experience SAD-type symptoms at any time of year. Some people with
SAD have mild or occasionally severe periods of mania during the
spring or summer. If the symptoms are mild, no treatment may be
necessary. If they are problematic, then a mood stabilizer such as
Lithium might be considered. There is a smaller group of individuals
emesis, currant jelly-like stools (blood and mucus). A barium enema
may be used to hydrostatically reduce the telescoping. Resolution is
obvious, with onset of bowel movements.
With omphalocele and gastroschisis (herniation of abdominal contents)
dress with loose saline dressing covered with plastic wrap, and keep
eye on temp. Kid can lose heat quickly.
After a hydrocele repair provide ice bags and scrotal support.
No phenylalanine with a kid positive for PKU (no meat, no dairy, no
aspartame).
Second voided urine most accurate when testing for ketones and
glucose.
 B eside the nurse's station? At the end of the hallway? Single
Never give potassium if the patient is oliguric or anuric. Room/Private Room?
C hain of infection/circumstance
Nephrotic syndrome is characterized by massive proteinuria (looks D iagnosis
dark and frothy) caused by glomerular damage. Corticosteroids are the E nviroment (dim light, darkened, red nightlapm)
mainstay. Generalized edema common. Sample Test Item:
The best roommate for patient with LEUKEMIA is
A positive Western blot in a child <18 months (presence of HIV O 1 A 9-year-old with ruptured appendix
antibodies) indicates only that the mother is infected. Two or more O 2 A 12-year-old with chicken pox
positive p24 antigen tests will confirm HIV in kids <18 months. The O 3 A 2-year-old with fever of unknown origin
p24 can be used at any age. O 4 A 5-year-old with nephrotic syndrome
Correct Answer: 4. A 5-year-old with nephrotic syndrome.
For HIV kids avoid OPV and Varicella vaccinations (live), but give 1,2 & 3, manifest symptoms of infection. A client with leukemia is
Pneumococcal and influenza. MMR is avoided only if the kid is immunosuppressed and Patients with infection shouldn't be placed in
severely immunocompromised. Parents should wear gloves for care, this room. Since patient with nephrotic syndrome receives diuretics and
not kiss kids on the mouth, and not share eating utensils. steroids, this child will also need immunocompromised host precaution.

Hypotension and vasoconstricting meds may alter the accuracy of o2 INFECTION CONTROL:
sats. Sample Test Item:
3. Which of the following methods should the RN utilize in patient with
An antacid should be given to a mechanically ventilated patient w/ an SALMONELLA?
ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at O 1 Airborne Precautions
least every 12 hrs. O 2 Droplet Precautions
O 3 Neutropenic Precautions
Ambient air (room air) contains 21% oxygen. O 4 Enteric Precautions
The correct answer: 4.
The first sign of ARDS is increased respirations. Later comes dyspnea, Salmonella mode of transmission is fecal oral (enteric)
retractions, air hunger, cyanosis. Handwashing
Gloves must be used in handling bedpan and diapers
Normal PCWP is 8-13. Readings of 18-20 are considered high. Gown - if soiling is likely to happen.
Source of infection:
First sign of PE (pulmonary embolism) is sudden chest pain, followed Contaminated food and water.
by dyspnea and tachypnea. Remember - Transmission Based precautions:
A ir
High potassium is expected with carbon dioxide narcosis (hydrogen B orne, small particles are dispersed in the air like MTB, varicella
floods the cell forcing potassium out). Carbon dioxide narcosis causes C ontact, drug-resistant microorganisms
increased intracranial pressure. D roplet, large particles are dispersed into air, resp.infections except
resp syncytial
Pulmonary sarcoidosis leads to right sided heart failure. E nteric, fecal-oral like hepaA & salmonella

An NG tube can be irrigated with cola, and should be taught to family AGE APPROPRIATE GROWTH AND DEVELOPMENT
when a client is going home with an NG tube. (HOPPING WITH ONE LEG)
Sample test Item:
PRIORITY QUESTIONS (WHO TO SEE FIRST) 4. Which of the following is NOT a characteristic of a preschooler?
Sample Test Item: O 1 predominantly "parallel play" period
1. Which of the following clients should the nurse deal with FIRST? O 2 balances on 1 foot with eyes closed
o 1 A client who needs his daily vitamin O 3 skips on alternate feet
o 2 A client who needs to be suctioned O 4 jumps rope
o 3 A client who needs diaper to be changed The correct answer is: 1. Parallel play is more common in
o 4 A client who is being prepared for discharge TODDLERS.
Correct Answer: 2. A client who needs to be suctioned Preschooler (3-6 years)
PRIORITY (Use ABC) Gross motor development
Obstruction in the airway – secretions HOPS ON ONE (1) FOOT BY 4 YEARS
Need to be suctioned SKIPS & HOPS ON ALTERNATE FEET BY 5 YEARS
2. Delegation, RN, LVN, UAP, CNA PLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING,
Which of the following clients should the LPN be assigned to? SUPERHEROES (Remember the movie: Jingle All The way!)
o 1 A newly diagnosed patient with MYASTHENIC CRISIS FEAR: Intrusive procedures, venipunctures, IM injections, body
o 2 An immediate post-op client in PACU mutilation
o 3 A client awaiting medication for vitamins
o 4 A new admission for KIDNEY Transplant Patient Toxoplasmosis, where else you can contract this (thinking of cat litter
Correct Answer: 3-stable, A client awaiting medication for vitamins but it aint there)
Myasthenic Crisis – Unstable, Acute Respiratory Failure Sample test Item:
Immediate Post – op – Unstable, Risk for Complications, 5. To which of the following pregnant clients will be risk for
Kidney Transplant – Unstable, needs assessment for rejection TOXOPLASMOSIS?
DELEGATION: Remember the 5R's, Right Task, Right Person, Right Select all that apply:
Circumstance, Right Communication & Right Feedback) O 1 A pregnant client who eat raw meat.
RN Least stable, unstable, central catheters (hickman, broviac), O 2 A pregnant client handling cat litter of infected cats.
admission, discharge, health teachings, patient for transfer, blood O 3 A pregnant client gardening and cultivating soil exposed to cat
transfusion (2RNs) feces.
LPN Technical Doer, Stable, medications, wound dressing O 4 A pregnant client with low rubella titer
CNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VS O 5 A pregnant client who have undergone external radiation.
UAP turning q2H, conducting group activities, ambulation O 6 A pregnant client with draining, painful vesicles in the external
For future USRNs genitalia.
This is for you... from the purkinje fibers of my heart.... The correct answers: 1, 2 & 3.
Room Assignment(Who to Share Room with) TOXOPLASMOSIS
Check: How do people get toxoplasmosis?
A ge A Toxoplasma infection occurs by:
Accidentally swallowing cat feces from a Toxoplasma-infected cat that (female: 190 to 420 mg/dL)
is shedding the organism in its feces.
This might happen if you were to accidentally touch your hands to your Insulin
mouth after gardening, (Regular, Humulin R)
cleaning a cat's litter box, or Type: Fast acting
touching anything that has come into contact with cat feces. Onset: ½ -1 hr
Eating contaminated raw or partly cooked meat, especially pork, lamb, Peak: 2-4 hr
or venison; Duration: 6-8 hr Insulin
by touching your hands to your mouth after handling undercooked (NPH, Humulin N)
meat. Type: Intermediate acting
Contaminating food with knives, utensils, cutting boards and other Onset: 2hr
foods that have had contact with raw meat. Peak: 6-12hr
Drinking water contaminated with Toxoplasma. Duration 18-26hr Insulin
Receiving an infected organ transplant or blood transfusion, though this (Ultralente, Humulin U)
is rare. Type: Slow acting
(From the internet-Division of Parasitic Disease) Onset: 4hr
Which of these statements by the nurse is incorrect if the nurse has the Peak: 8-20hr
goal to reinforce information about cancers to a group of young adults? Duration: 24-36hr Insulin
1. “You can reduce your risk of this serious type of stomach cancer by (Humulin 70/30)
eating lots of fruits and vegetables, limiting all meat, and avoiding Type: Combination
nitrate-containing foods.” Onset: ½ hr
2. “Prostate cancer is the most common cancer in American men with Peak: 2-12hr
results to threaten sexuality and life.” Duration: 24hr
3. “Colorectal cancer is the second-leading cause of cancer-related
deaths in the United States.”
4. “Lung cancer is the leading cause of cancer deaths in the United Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm
States. Yet it's the most preventable of all cancers. Hg = too much fluid

Need to memorize for Nclex Potassium: 3.5-5.0 mEq/L

Sodium: 135-145 mEq/L
Tonometry: normal (10-21 mm Hg)
Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL
Magnesium: 1.5-2.5 mEq/L
PR Interval: normal (0.12-0.20 seconds)
Chloride: 96-107 mEq/L
Phosphorus: 2.7 to 4.5 mg/dL
Serum Amylase: normal (25-151 units/dL)
PR measurements: normal (0.12 to 0.20 second)
Serum Ammonia: normal (35 to 65 mcg/dL)
QRS measurements: normal (0.04 to 0.10 second)
Calcium: adult (8.6-10 mg/dL)
child (8 to 10.5 mg/dL)
Ammonia: 35 to 65 ug/dL
term<1week (7 to 12 mg/dL)
Amylase:25 to 151 IV/L
Partial Thromboplastin Time (aPTT): normal (20-36 seconds)
Lipase: 10 to 140 U/L
therapeutic 1.5-2.5
Cholesterol: 140 to 199 mg/dL
Prothrombin Time: normal (Male: 9.6-11.8 seconds) and
LDL: <130 mg/dL
(Female: 9.5-11.3 seconds)
HDL: 30 to 70 mg/dL
Triglycerides: <200 mg/dL
Platelet Count: normal (150,000-400,000 cells/uL)
Bilriubin
Albumin level: normal (3.4 to 5 g/dL)
• Direct: 0 to 0.3 mg/dL
• Indirect: 0.1 to 1.0 mg/dL
Serum Osmolality: normal (285 to 295 mOsm/kg)
• Total: <1.5 mg/dL
high value indicates dehydration
Safe Suction Range: normal [Infant] 50-95 mm Hg
[Child] 95-115 mm Hg
Protein: 6.0 to 8.0 g/dL
[Adult]100-120 mm Hg)
Serum Lithium: normal (1 to 1.5 mEq/L)
Uric acid: Male 4.5 to 8 mg/dL
acute mania (0.6 to 1.4 mEq/L) maintenance treatment
Female 2.5 to 6.3 mg/dL
Phenytoin (Dilantin): normal serum (10 to 20 mcg/mL)
Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml)
Glycosylated Hemoglobin HbA1c: good control 7.5% or less
Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl)
Serum creatinine: 0.6 to 1.3 mg/dL
Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6
BUN: 9-25 mg/dL
Farenheit)
Normal CK is 26-174 U/L
WBC’s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to
18,000 cells/mm3). Immediate postpartum period, (maybe as high as
Troponin I value: normal (<0.6 ng/mL)
25,000 to 30,000 cells/mm3)
Troponin T >0.1 to 0.2 ng/mL = MI
Stomach Capacity:
Erythrocyte studies: 0-30 mm/hour
Newborn infant (10 to 20 mL)
1-week-old (30 to 60 mL)
Serum iron: Male 65-175 ug/dL
2-3-week-old infant (75 to 100 mL)
Female 50-170 ug/dL
1-month-old infant (90 to 150 mL)
Left Atrial Pressure: normal (1 to 10 mm Hg)
RBC: Male 4.5 to 6.2 M/uL
Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and
Female 4.0 to 5.5 M/uL Intimacy vs. isolation

25 – 50 Generativity vs. stagnation

Theophylline levels normal (10 to 20 mcg/dl) 50 - ?

Integrity vs.despair

LABORATORY VALUES
MOTOR DEVELOPMENT
ELECTROLYTES

Chin up Sodium (Na+): 135 – 145 meq/L

1 month (increase-dehydration; decrease overhydration)
Potassium (K+): 3.5 - 5.0 meq/L
Chest up Magnesium (Mg++): 1.5 – 2.5 meq/L
2 month Calcium (Ca++): 4.5 – 5.8 meq/L
Neonate : 7.0 to 12 mg/dL
Knee push and “swim” Child: 8.0 to 10.5 mg/dL
6 month Phosphorus (PO4): 1.7 – 2.6 meq/L
Chloride (Cl-): 96 – 106 meq/L
Sits alone/stands with help
7 month COAGULATION STUDIES

Crawls on stomach Activated partial thromboplastin time(APTT): 20 – 36 seconds

8 month depending on the type of activator used
Prothrombin time(PT): male: 9.6 – 11.8 seconds
Stands holding on furniture Female: 9.5 – 11.3 seconds
10 month International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin
therapy
Walks when led 3.0 – 4.5 for high-dose Coumadin therapy
11 month Clotting time: 8 – 15 minutes
Platelet count: 150,000 to 400,000 cells/Ul
Stands alone Bleeding time: 2.5 to 8 minutes
14 month
SERUM GASTROINTESTINAL STUDIES
Walks alone
15 month Albumin: 3.4 to 5 g/dL
Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL
Ammonia: 15 to 45 ug/dL
AT THE PLAY GROUND Amylase: 50 – 180 Somogyi U/dL in adult
20 – 160 Somogyi U/dL in the older adult
* Stranger anxiety: 0 -1 year Bilirubin: direct: 0 - 0.3 mg/dL
* Separation anxiety: 1 - 3 years Indirect: 0.1 – 1.0 mg/dL
* Solitary play: 0 – 1 year Total: less than 1.5 mg/dL
* Parallel play: 2 – 3 years Cholesterol: 120 – 200mg/dL
* Group play: 3 – 4 years Lipase: 31 -186 U/L
Lipids: 400 – 800 mg/dL
Triclycerides: Normal range: 10 – 190 mg/dL
PSYCHOLOGICAL DEVELOPMENT Borderline high: 200 – 400 mg/dL
High: 400 – 1000mg/dL
AGE Very high: greater than 1000mg.dL
ERIKSON Protien: 6.0 – 8.0 g/L
FREUD Uric acid: male: 4.5 – 8 ng/dL
PIAGET Female: 2.5 – 6.2 ng/dL
Infant
0 – 1.5
Trust vs. mistrust Oral (trust & dependence GLUCOSE STUDIES
sensorimotor
Toddler Fasting blood sugar: 70 – 105 mg/dL
1.5 -3 Glucose monitoring (capillary Blood): 60 – 110 mg/dL
Autonomy vs. shame Anal (holding vs. letting out)
preoperational
Pre-school
3-6
Initiative vs. guilt Phallic (Oedipus complex)
preoperational RENAL FUNCTION TEST
School age
6 - 11 Industry vs. inferiority Creatinine: 0.6 – 1.3 mg/dL
latency Blood urea nitrogen (BUN): 5 – 20 mg/dL
Concrete operational
ERYTROCYTES STUDIES
11 - 20 Identity vs. role confusion
genital Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age
Formal operational Hemoglobin: male: 14 – 16.5 g/dL
Female: 12 – 15 g/dL
20 – 25 Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid
loss and dehydration) Decreased heart rate
Female: 35% - 47% ( decreased in fluid retention)
Red blood cell (RBC): male: 4.5 to 6.2 million/uL Bronchi
Female: 4 to 5.5 million/uL dilation
constriction
White blood cell (WBC): 4500 to 11,000/uL
Erytrocyte Protoporthyrin (EP) : <9ug/dL GI tract
Phenylalanine Level: <2 mg/dL Reduced motility
PKU: >25 mg/dL Increased motility

CRANIAL NERVES Rectum

Allows filling Empties rectum
MAJOR FUNCTIONS Relaxes internal sphincter

I. Olfactory (S) Bladder

smell Allows filling Empties bladder
Relaxes internal sphincter
II. Optic (S)
vision Erection
Maintains erection
III. Oculomotor (M)
IV. Trochlear (M) Ejaculation
Eye movement Triggers ejaculation

V. Trigeminal (S-M) Facial sensation Pupils of eye

Jaw movement Big (mydriasis)
Small (miosis)
VI. Abducent (M)
Eye movement Salivary glands
Secretion
VII. Facial (S-M) Taste
Facial expression Blood vessels Depends on receptors
-a contrict
VIII. Acoustic (S) -b dilates
Hearing and balance

IX. Glossopharyngeal (S-M) Taste

Throat sensation
Gag and swallow

X. Vagus (S-M) Gag and swallow FLOW OF BLOOD THROUGH THE HEART
Parasympathetic activity
Inferior vena cava and superior vena cava – right atrium – tricuspid
XI. Spinal Accessory (M) Neck and back muscles valve – right ventricle – pulmonic valve – pulmonary artery – lungs –
pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle
XII. Hypoglossal (M) – aortic valve aorta – systemic circulation
Tongue movement
CARDIAC IMPULSES
On Old Olympus’ Towering Tops, A Finn And German Viewed Some
Hops Sinoatrial (SA) node – right and left atria (atria contract) –
Some Says Marry Money, But My Brother Says Bad Business Marry atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s
Money fibers – ventricles contract.

ARTERIAL BLOOD GAS (ABG) Blood volume: 5000mL

Central venous pressure: 4 to 10 cmH2O (increased in cardiac
pH: 7.35 – 7.45 overload; decreased in dehydration)
PCO2: 35 - 45 mmHg Pressure within the right atrium: 2 to 7 mmHg
PO2: 80 - 100 mmHg Capillary refill time: <3 seconds
HCO3: 22 - 27 mEq/L Normal sweat chloride: <40 mEq/L
O2 saturation: 96% - 100% Normal pupil diameter: 3 to 5mm
Acid-base “RAMS”(Respiratory Alternate, Metabolic Same) Normal ocular pressure: 10 to 21 mmHg
Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg
GLASGOW COMA SCALE Normal cardiac output : 4 to 8 L/min.

Eye opening response THERAPEUTIC SERUM MEDICATION LEVELS

Motor response
Verbal response Acetaminopen (Tylenol) 10 – 20 ug/mL
Amikacin (Amikin) 25 – 30 ug/mL
AUTONOMIC NERVOUS SYSTEM Amitryptyline (Elavil) 120 -150 ng/mL
Carbamazepine (Tegretol) 5 -12 ug/mL
SYMPATHETIC/ Chloramphenicol (Chloromycetin) 10 – 20 ug/mL
ADRENERGIC PARASYMPATHETIC/ Desipramine (Norpramin) 150 -300 ng/mL
CHOLINERGIC Digotoxin ( Crystodigin) 15- 25 ng/mL
Digoxin ( Lanoxin) 0.5 – 2.0 ng/mL
Heart Increased heart rate Disopyramide (Norpase) 2 -5 ug/mL
Increased conduction Ethosuximide ( Zarontin) 40 – 100 ug/mL
Increased force Gentamycin (Garamycin) 5 – 10 ug/mL
Imipramide (Tofranil) 150 – 300 ug/mL A
Lidocaine (Xylocaine) 1.5 – 5.0 ug/mL
Lithium (Lithobid) 0.5 -1.5 ug/mL
Magnesium sulphate 4 -7 mg/dL Formulas for Intravenous Calculations
Nortriptyline (Aventyl) 50 – 150 ng/mL
Phenobarbital (Luminal) 10 – 30 ug/mL Flow Rates:
Phenytoin (Dilantin) 10 -20 ug/mL Total volume x gtt factor = gtt per min
Primidone (Myoline) 5 – 20 ug/mL Time in minutes
Procainamide (Pronestryl) 4 – 10 ug/mL
Propranolol (Inderal) 50 – 100 ng/mL
Quinidine (Quinalaglute, Cardioquin) 2 – 5ug/mL Infusion Time:
Salisylate 100 -250 ug/mL Total volume to infuse = Infusion time
Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL mL per hour being infused
Tobramycin (Nebcin ) 5 -10 ug/mL
Valproic acid (depakene) 50 -100 ug/mL IMMUNIZATION

Birth Hepatitis B
1 months Hepatitis B
2 months OPV, DPT, HIB
4 months DPT, HIB, OPV
Pulmonary capillary wedge pressure: 5 to 13 mmHg 6 months DPT, HIB, hepatitis B
Pulmonary artery pressure: systolic: 16 to 30 mmHg 12 months HIB, OPV
Diastolic: 0 to 7 mmHg 15 months MMR
Spinal pressure: 70 to 200mmH2O 18 months DPT
Morphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour 12 – 18 months Varicella vaccine
4 -6 years DPT, OPV, MMR
11 – 12 years MMR ( if not administered at 4 -6 years)
SULFONYLUREAS 11 – 16 TD booster
For treatment of NIDDM
Sulfonylureas should not be given to patients with liver or kidney
failure. SPINAL CORD INJURY
Accummulation of drug will increase risk of hypoglycaemia. Cervical Injury:
C2 to C3 injury usually fatal
C4 is the major innervation to the diaphragm by th phrenic nerve
DURATION Involvement above th C4 causes respiratory difficulty and
paralysis of all the four extremities
tolbutamide C5 or below client may have movement in the shoulder
8h
Thoracic Level Injury:
Glycburide, glipizide loss of movement of the chest, trunk, bowel, bladder, and legs,
20 h, most potent depending on the level of injury
Leg paralysis (paraplegia)
chlorpropamide Autonomic dysreflexia with lesions above T6 and in cervical
48 h lesions
Visceral distention from a distended bladder or impacted rectum
may cause reactions such as sweating, bradycardia, hypertension, nasal
Apothecary and Household System stuffiness, and gooseflesh

Grain –gr 1 gr = 60 mg Lumbar and Sacral Level Injuries:

Dram – dr 5 gr = 300 mg loss of movement and sensation of the lower extremities.
Ounce –oz 15 gr = 1000mg or 1g S2 and S3 center on micturation; therefore below this level, the
Minim – min, M, m 1/150 gr =0.4 mg bladder will contract but not empty (neurogenic bladder)
Quart – qt 1 oz = 30 mL Injury above S2 in males allows them to have an erection, but they
Pint – pt 1 dr = 4 mL are unable to ejaculate because of sympathetic nerve damage.
Drop – gtt 1 T = 15 mL or 3 tsp Injury between S2 and S4 damages the sympathetic and
Tablespoon – T or tbs 1 min = 1 gtt parasympathetic response, preventing erection and ejaculation.
Teaspoon – t or tsp 15 min = 1mL
Pound – lb 60 min = 1 dr RULE OF NINE
8 dr = 1 oz
1 qt = 1000mL or 1L Head and neck 9%
1 qt = 2 pt or 32 oz Anterior trunk 18%
1 pt = 16 oz Posterior trunk 18%
16 oz = 1 lb Arms (9%) 18%
2.2lb = 1 kg Legs (18%) 36%
Perineum 1%
Fahrenheit to Celcius (F – 32) divide 1.8 = C

Celcius to Fahrenheit 1.8 C + 32 = F

Formula for Calculating a Medication Dosage

D (desired ) = the dosage that the physician ordered

A (available) =the dosage strength as stated on the medication label
Q (quantity ) = the volume that the dosage strength is available in, such
as tablet, capsules, or mL NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

DXQ=X Neutrophils 56% or 18000 – 7800/uL

Bands 3% or 0 – 700/uL Gotu Kola (Centella asiatica) – mental support, wound healing and
Eosinophils 2.7% or 0 – 450/uL venous disorders
Basophils 0.3% or 0 – 200/uL Hawtorn ( Crategus species) – CHF and related cardiovascular
Lymphocytes 34% or 1000 – 4800/uL conditions
Monocytes 4% or 0 – 800/uL Horebound (Marribium vulgare) – primary cough suppression and
expectoration
Horse Chestnut Seed (Aesculus hippocastanum) chronic venous
THYROID STUDIES insufficiency
Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease
Thyroxine (T4): 5.0 to 12.0 ug/dL Kava ( piper methysticum) – mild psychoactive and antianxiety
Thyroxine free (FT3) : 0.8 to 2.4 ng/dL property
Triiodothyronine (T3): 80 to 230 ng/dL Lemon Balm (Melissa officinalis) – sedative and for dyspepsia
Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis,
inflammatory diseases, and infections
Melatonin – insomia, jet lag
Normal Fribrinogen level: for men: 180 to 340mg/dL Milk Thistle – hepatitis, liver desease
Women: 190 to 420mg/dL Mints (Mentha species) – minor calcium channel antagonists, used for
Fribrinogen is used up in the clotting process. upper respiratory problems, irritable bowel syndrome, dyspepsia, and
colonic spasm and as a topical counterirritant
Erythrocyte Protoporhyrin (EP): < 9ug/dL Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic
Phenylalanine level: < 2mg/dL Papaya (Carica papaya) – digestive aid, dyspepsia, and for
PKU: >25 mg/dL inflammatory, topically applied to wounds
Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic
diabetes insipidus herb
Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre Pokeroot (Phytolacca Americana) – inflammatory conditions also as an
syndrome emetic/cathartic
Normal CSF pressure: 5 – 15 mmHg Pygeum (Pygeum africanum) – mild symptoms of BPH
Normal serum osmolality: 285 – 295 mOsmlkgH2O increase in Red Clover (Trifolium pratense) – used as a natural estrogen substitute
dehydration; for women’s health
Decrease in over hydration St. John’s Wort (Hypericum perforatum) – antidepressant effect
Normal scalp pH: 7.26 and above Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial
Borderline acidosis: 7.20 to 7.25 Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti
Acidosis: < 7.15 cancer, and antioxidant
Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic
Yohimbe – erectile dysfunction

HERBAL MEDICINE FOUR STRATEGIES:

1. If the question asks what you should do in the situation. Use the
Aloe vera Gel – abrasionsand dermatologic conditions nursing process to determine which step in the nursing process would
American Ginseng (Panax quinquefolius) – boost energy, relieve stress, be next?
improve concentration and enhance physical or cognitive performance. 2. If the question asks what the client needs. Use maslow’s hierarchy to
Ashwagandha (Withania somnifera) – stress arthritis determine which need to address.
Asian gingseng (Panax ginseng) – enhance health and combat stress 3. If the question indicates that the client doesn’t have urgent
and disease physiologic need, focus on the patient safety.
Bilberry (Vaccinium myrtillus) – vision and peripheral vascular 4. If the question involves communicating with a patient. Use
disorders and as antioxidant principles of therapeutic communication.
Black Cohosh (Cimicifuga racemosa) – menopausal
Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – REMEMBER:
anti-inflammatory, rheumatoid arthritis AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)
Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other
painful treatment
Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, The nurse in primary care clinic is caring for a 50-year-old woman.
colic, or dyspepsia and anxiety History reveals that she had experienced on and off chest pain. After
Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, series of cardiac tests (EKG & Blood Chem), the doctor orders for
cyclical mastalgia THALLIUM STRESS TEST. Which of the following medications
Chodroitin – osteoarthritis should the RN prepare if the patient needs an alternative exercise in
Coenzyme Q10 – antioxidant thallium test?
Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders 1.Nitroglycerin
Cranberry (Vaccinium macrocarpon) – UTI 2.Morphine
Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and 3.Aminophylline
analgesic 4.Persantin
Echinacea (Echinacea spp.) – acute viral URI symptoms The correct answer is #4. Persantin (dipyridamole)
Ederberry (Sanbacus nigra) – respiratory tract infection Persantin is use as an alternative to exercise in thallium myocardial
Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and perfusion imaging for the evaluation of CAD in those who cannot
pseudoephedrine exercise adequately.
Evening Primrose Oil (Oenothera biennis) – eczema, breast pain Purpose: to determine myocardial wall viability
associated with PMS and inflammatory condition Other names:
Fenugreek (Trigonella foenum-graecum) – lowering blood glucose 1. Cardiac pooling
Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis 2. MUGA-multigated radionuclide angiographic scanning
Garlic (Allium sativaum)- help prevent cardiovascular disease and 3. nurclear scan
cancer 4. sestamibi test
Ginger (Zingiber officinale) –nausea and motion sickness, anti- 5. thallium scan
inflammatory 6. dipyridamole or persantin stress test
Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, 7. In short, heart scan :)
memory enhancement and treatment of vertigo nad tinnitus Loving NCLEX-RN
Glucosamine – osteoarthritis URC
Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic 09178364589
Posted by Anaski from IP 203.131.183.186 on August 23, 2005 at M-marplan
21:44:00: N-nardil
For Future USRN's: P-parnate
Cervical Cancer
Etiology: Hypertensive crisis within several hours of ingestion of tyramine
* Early age of sexual intercourse containing foods
* Multiple sexual partners Tyramine foods:
* Sexually Transmitted Disease (Venereal Wart) aged cheese, beer, ale, red wine, pickled foods, smoked or pickled fish,
* Virus - HPV beef or chopped liver, avocado of figs.
Cancer Carcinoma in SITU - only in epithelial linings
Situ sounds like Ziru - Stage 0
Tumor marker - CEA ANTI-DEPRSSION
Signs and Symptoms (3 P's)
POST COITAL BLEEDING A- asendin
N-norpramin
T- tofranil
PAINFUL INTERCOURSE
PROFUSE (PERIOD IRREGULARITIEs - menorrhagia and S-sinequan
metrorrhagia) A-anafranil
- aventyl
Management: V-vivactil
E-Elavil
U - pera (Surgery HYSTERECTOMY) P-paxil
R - radiation (intracavitary cessium - remember STD - shielding, Z-zoloft
timing and distance))
C - chemotherapy to destroy the DNA,RNA & CHON synthesis. D-riving is contraindicated
E-ffect has a delayed onset of 7-21 days
P-regnancy consult with your physician
R-elieves symptoms but never cure
Psychiatric Drugs
E- valuate vital sign
ANTI PARKINSON'S S-toppind drug abruptly is Out!
S-afety measures
C- cogentin I-nstruct to report undesirable side effect
A- artane O-bserve for suicidal tendencies
P- parlodel N-o alcohol or CNS depressants
A- akineton
B- benadryl ANTI-MANIC DRUGS
L- larodopa
E- Eldepryl Lithium- Eskalith
S- symmetril
Increase risk of toxicity when given with: thiazide diuretics,
Increase protein and give B6 methyldopa, and NSAIDs
Akathisia Decrease lithium levels with excess sodium and antacids.
Dystonia Increase CNS toxicity with Haloperidol
Tardive Dysinesia
Neuroleptic Malignant Syndrome 0.6-1.2 -meq/l Therapeutic Effect
> 1.5 meq/l Toxic
2.0 meq/l lethal
ANTI-ANXIETY
L- evel - therapeutic 0.6-1.2 meq/l
V-valium I-ncreased Urination
L-librium T-hirst Increased
A-ativan H-eadaches and Tremors
S-serax I-ncreased fluids
T-tranxene U-nsteady
M-orton's Salt -adequate intake
M-miltown
E- equanil
V-vistaril
A-taxene Hepatotoxic Drugs ( liver)
I-Inderal * ACE inhibitors
B-buspar * acetaminophen
* alcohol
Tolerance develop until seven days * iron overdose
* erythromycins
A- void abrupt discontinuation after prolonged use * estrogens
N- Not give if BP is up, hepatic/renal dysfunction or history of drug * fluconazole (Difulcan)
abuse * isoanazid (INH)
X-xanax, ativan, serax is also an anti-anxiety meds * itraconazole (Sporanox)
I-increase in 3D's- drowsiness, dizziness, decreased BP * phenothiazines
Enhances action of GABA * phenytoin (Dilantin)
T-teach client to rise slowly from supine position * rifampin (Rifadin)
Y-es alcohol should also be avoided. * sulfonamids

MAOI Drugs
Drugs That Can Cause Nephrotoxicity CRCL = creatinine clearance
CRF = chronic renal failure
• acetaminophen (high doses, acute)
CRT = capillary refill time
* acyclovir; parenteral (zovirax)
CSF = cerebrospinal fluid
* aminoglycocides
CT = computerized tomography
* amphotericin B
CVA = cerebral vascular accident, costovertebral angle
* ciprofloxacin
CVP = central venous pressure
* cisplatin (platinol)
D5W = 5% dextrose in water
* methotrexate (high doses)
DAT = diet as tolerated
* nonsteriodal anti-inflamatory drugs (NSAIDS)
DC = (dc) discontinue
* rifampicin
DIC = disseminated intravascular coagulopathy
* sulfonamides
DKA = diabetic ketoacidosis
* tetracyclines ( exceptions are doxycycline and minocycline)
DM = diabetes mellitus
* vancomycin
DNA = deoxyribonucleic acid
• DNR = do not resuscitate
DOA = dead on arrival
Basic Nursing Abbreviations DOE = dyspnea on exertion
DPT = diphtheria, pertussis, tetanus
A /G = albumin/globulin ratio DTR = deep tendon reflexes
ABG = arterial blood gases DVT = deep venous thrombosis
AC = before eating DX = diagnosis
ACE = angiotensin converting enzyme EAA = essential amino acids
ACL = anterior cruciate ligament EBL = estimated blood loss
ACLS = advanced cardiac life support EBV = Epstein-Barr Virus
ACTH = adrenocorticotropic hormone ECF = extracellular fluid, extended care facility
ad lib = as much as needed ECG = electrocardiogram
ADH = anti-diuretic hormone ECT = electroconvulsive therapy
ADL = activities of daily living EENT = eye, ear, nose and throat
AFB = acid-fast bacilli EFAD = essential fatty acid deficiency
AFP = alpha-fetoprotein EMG = electromyogram
AGA = appropriate for gestational age EMV = eyes, motor, verbal response (Glasgow coma scale)
AI = aortic insufficiency ENT = ears, nose, and throat
AIDS = acquired immune deficiency syndrome EOM = extraocular muscles
AKA = above knee amputation ESR = erythrocyte sedimentation rate
ALD = alcoholic liver disease ESRD = end stage renal disease
ALL = acute lymphocytic leukemia ET = endotracheal tube
ALP = alkaline phosphatase ETT = endotracheal tube
ALT = alanine transaminase, alanine aminotransferase EUA = examination under anesthesia
ATN = acute tubular necrosis FBS = fasting blood sugar
AU = both ears FDA = Food & Drug Administration
AV = atrioventricular FEV = forced expiratory volume
B.S. = Bachelor of Science FFP = fresh frozen plasma
B/K = below knee FNP = Family Nurse Practitioner
BM = bowel movement or breast milk GB = gallbladder
BX = biopsy GC = gonorrhea
c = with GERD = gastroesophageal reflux disease
C/O = complaining of GFR = glomerular filtration rate
CA = calcium, cancer, carcinoma GI = gastrointestinal
CAA = crystalline amino acids GSW = gun shot wound
CABG = coronary artery bypass graft GTT = glucose tolerance test
CAD = coronary artery disease GU = genitourinary
CAPD = continuous ambulatory peritoneal dialysis HB = hemoglobin
CAT = computerized axial tomography HBP = high blood pressure
CBC = complete blood count HCG = human chorionic gonadotropin
CBD = common bile duct HCO3 = bicarbonate
CBG = capillary blood gas HCT = hematocrit
CBI = continuous bladder irrigation HD = hemodialysis
CBS = capillary blood sugar HDL = high density lipoprotein
CC = chief complaint HEENT = head, eyes, ears, nose, throat
CCK = cholecystokinin
CCPD = continuous cyclic peritoneal dialysis
CCU = clean catch urine or cardiac care unit
CCV = critical closing volume Caring for the Patient on a Ventilator
CF = cystic fibrosis The nurse must be able to do the following:
CHF = congestive heart failure
CHO = carbohydrate 1. Identify the indications for mechanical ventilation.
CI = cardiac index 2. List the steps in preparing a patient for intubation.
CLT = Clinical Laboratory Technician 3. Determine the FIO2, tidal volume, rate and mode of ventilation on a
CML = chronic myelogenous leukemia given
CN = cranial nerves ventilator.
CNS = central nervous system 4. Describe the various modes of ventilation and their implications.
CO = cardiac output 5. Describe at least two complications associated with patient’s
COPD = chronic obstructive pulmonary disease response to mechanical ventilation and their signs and symptoms.
CP = chest pain, cleft palate 6. Describe the causes and nursing measures taken when trouble-
CPD = cephalo-pelvic disproportion shooting ventilator alarms.
CPK = creatinine phosphokinase 7. Describe preventative measures aimed at preventing selected other
CPP = cerebral perfusion pressure complications related to endotracheal intubation.
CPR = cardiopulmonary resuscitation
8. Give rationale for selected nursing interventions in the plan of care 2. Symptoms – may result in pneumothorax, pneumomediastinum,
for the ventilated patient. pneumoperitoneum, or subcutaneous emphysema.
9. Complete the care of the ventilated patient checklist. 3. Treatment - aimed at reducing TV, cautious use of PEEP, and
10. Complete the suctioning checklist. avoidance of high airway pressures resulting in development of auto-
PEEP in high risk patients (patients with obstructive lung diseases
1. To review indications for and basic modes of mechanical ventilation, (asthma, bronchospasm), unevenly distributed lung diseases (lobar
possible complications that can occur, and nursing observations and pneumonia), or hyperinflated lungs (emphysema).
procedures to detect and/or prevent such complications.
2. To provide a systematic nursing assessment procedure to ensure C. Nosocomial Pneumonia
early detection of complications associated with mechanical 1. Cause – invasive device in critically ill patients becomes colonized
ventilation. with pathological bacteria within 24 hours in almost all patients. 20-
60% of these, develop nosocomial pneumonia.
Indication for Intubation 2. Treatment – aimed at prevention by the following:
1. Acute respiratory failure evidenced by the lungs inability to maintain Avoid cross-contamination by frequent handwashing
arterial oxygenation or eliminate carbon dioxide leading to tissue Decrease risk of aspiration (cuff occlusion of trachea, positioning, use
hypoxia in spite of low-flow or high-flow oxygen delivery devices. of small-bore NG tubes)
(Impaired gas exchange, airway obstruction or ventilation-perfusion Suction only when clinically indicated, using sterile technique
abnormalities). Maintain closed system setup on ventilator circuitry and avoid pooling
2. In a patient with previously normal ABGs, the ABG results will be as of condensation in the tubing
follows: Ensure adequate nutrition
PaO2 > 50 mm Hg with pH < 7.25 Avoid neutralization of gastric contents with antacids and H2 blockers
PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion,
anxiety, tachypnea, tachycardia, and diaphoresis D. Positive Water Balance
PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), 1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to
cyanosis (late), and LOC (late) vagal stretch receptors in right atrium sensing a decrease in venous
3. Neuromuscular or neurogenic loss of respiratory regulation. return and see it as hypovolemia, leading to a release of ADH from the
(Impaired ventilation) posterior pituitary gland and retention of sodium and water. Treatment
4. Usual reasons for intubation: Airway maintenance, Secretion control, is aimed at decreasing fluid intake.
Oxygenation and Ventilation. 2. Decrease of normal insensible water loss due to closed ventilator
circuit preventing water loss from lungs. This fluid overload evidenced
Types of intubation: Orotracheal, Nasotracheal, Tracheostomy by decreased urine specific gravity, dilutional hyponatremia, increased
Preparing for Intubation heart rate and BP.
1. Recognize the need for intubation.
2. Notify physician and respiratory therapist. Ensure consent obtained E. Decreased Renal Perfusion – can be treated with low dose dopamine
if not emergency. therapy.
3. Gather all necessary equipment:
a. Suction canister with regulator and connecting tubing F. Increased Intracranial Pressure (ICP) – reduce PEEP
b. Sterile 14 Fr. suction catheter or closed in-line suction catheter
c. Sterile gloves G. Hepatic congestion – reduce PEEP
d. Normal saline
e. Yankuer suction-tip catheter and nasogastric tube H. Worsening of intracardiac shunts –reduce PEEP
f. Intubation equipment: Manual resuscitator bag (MRB),
Laryngoscope and blade, Wire guide, Water soluble lubricant, 2. Associated with ventilator malfunction:
Cetacaine spray A. Alarms turned off or nonfunctional – may lead to apnea and
g. Endotracheal attachment device (E-tad) or tape respiratory arrest
h. Get order for initial ventilator settings Troubleshooting Ventilator Alarms
i. Sedation prn Low exhaled volume: Cuff leak, Tubing disconnect, Patient
j. Soft wrist restraints prn disconnected
k. Call for chest x-ray to confirm position of endotracheal tube Evaluate cuff; reinflate prn; if ruptured, tube will need to be replaced.
l. Provide emotional support as needed/ ensure family notified of Evaluate connections; tighten or replace as needed; check ETT
change in condition. placement, Reconnect to ventilator
High pressure: Secretions in airway, Patient biting tubing, Tube kinked,
Intubation Cuff herniation, Increased airway resistance/decreased lung compliance
(caused by bronchospasm, right mainstem bronchus intubation,
Types of Ventilators pneumothorax, pneumonia), Patient coughing and/or fighting the
Ventilator Settings ventilator; anxiety; fear; pain.
Modes of Mechanical Ventilation Suction patient, Insert bite block, Reposition patient’s head/neck; check
Complications of Mechanical Ventilation all tubing lengths, Deflate and reinflate cuff, Auscultate breath sounds,
1. Associated with patient’s response to mechanical ventilation: Evaluate compliance and tube position; stabilize tube, Explain all
procedures to patient in calm, reassuring manner, Sedate/medicate as
A. Decreased Cardiac Output necessar
1. Cause - venous return to the right atrium impeded by the Low oxygen pressure: Oxygen malfunction
dramatically increased intrathoracic pressures during inspiration from Disconnect patient from ventilator; manually bag with ambu; call R.T
positive pressure ventilation. Also reduced sympatho-adrenal
stimulation leading to a decrease in peripheral vascular resistance and 3. Other complications related to endotracheal intubation.
reduced blood pressure. A. Sinusitis and nasal injury – obstruction of paranasal sinus drainage;
2. Symptoms – increased heart rate, decreased blood pressure and pressure necrosis of nares
perfusion to vital organs, decreased CVP, and cool clammy skin. 1. Prevention: avoid nasal intubations; cushion nares from tube and
3. Treatment – aimed at increasing preload (e.g. fluid administration) tape/ties.
and decreasing the airway pressures exerted during mechanical 2. Treatment: remove all tubes from nasal passages; administer
ventilation by decreasing inspiratory flow rates and TV, or using other antibiotics.
methods to decrease airway pressures (e.g. different modes of B. Tracheoesophageal fistula – pressure necrosis of posterior tracheal
ventilation). wall resulting from overinflated cuff and rigid nasogastric tube
1. Prevention: inflate cuff with minimal amount of air necessary;
B. Barotrauma monitor cuff pressures q. 8 h.
1. Cause – damage to pulmonary system due to alveolar rupture from 2. Treatment: position cuff of tube distal to fistula; place gastrostomy
excessive airway pressures and/or overdistention of alveoli. tube for enteral feedings; place esophageal tube for secretion clearance
proximal to fistula. These signs may indicate hypoxia.
C. Mucosal lesions – pressure at tube and mucosal interface .
1. Prevention: Inflate cuff with minimal amount of air necessary; Observe skin color and capillary refill.
monitor cuff pressure q. 8 h.; use appropriate size tube. Determine adequacy of blood flow needed to carry oxygen to tissues.
2. Treatment: may resolve spontaneously; perform surgical .
interventions. Monitor CBC.
D. Laryngeal or tracheal stenosis – injury to area from end of tube or Indicates the oxygen carrying capacity available.
cuff, resulting in scar tissue formation and narrowing of airway .
1. Prevention: inflate cuff with minimal amount of air necessary; Administer oxygen as ordered.
monitor cuff pressure q. 8.h.; suction area above cuff frequently. Decreases work of breathing and supplies supplemental oxygen.
2. Treatment: perform tracheostomy; place laryngeal stint; perform .
surgical repair. Observe for tube obstruction; suction prn; ensure adequate
E. Cricoid abcess – mucosal injury with bacterial invasion humidification.
1. Prevention: inflate cuff with minimal amount of air necessary; May result in inadequate ventilation or mucous plug.
monitor cuff pressure q. 8 h.; suction area above cuff frequently. .
2. Treatment: perform incision and drainage of area; administer Reposition patient q. 1-2 h.
antibiotics. Repositioning helps all lobes of the lung to be adequately perfused and
4. Other common potential problems related to mechanical ventilation: ventilated.
Aspiration, GI bleeding, Inappropriate ventilation (respiratory acidosis
Potential altered nutritional status: less than body requirements r/t NPO
or alkalosis, Thick secretions, Patient discomfort due to pulling or status
jarring of ETT or tracheostomy, High PaO2, Low PaO2, Anxiety and Monitor lymphocytes and albumin.
fear, Dysrhythmias or vagal reactions during or after suctioning, Indicates adequate visceral protein.
Incorrect PEEP setting, Inability to tolerate ventilator mode. .
Provide nutrition as ordered, e.g. TPN, lipids or enteral feedings.
PLAN OF CARE FOR THE VENTILATED PATIENT Calories, minerals, vitamins, and protein are needed for energy and
Patient Goals: tissue repair.
Patient will have effective breathing pattern. .
Patient will have adequate gas exchange. Obtain nutrition consult.
Patient’s nutritional status will be maintained to meet body needs. Provides guidance and continued surveillance.
Patient will not develop a pulmonary infection. Potential for pulmonary infection r/t compromised tissue integrity.
Patient will not develop problems related to immobility. Secure airway and support ventialtor tubing.
Patient and/or family will indicate understanding of the purpose for Prevent mucosal damage.
mechanical ventilation. .
Provide good oral care q. 4 h.; suction when need indicated using
Nursing Diagnosis sterile technique; handwashing with antimicrobial for 30 seconds
Nursing Interventions before and after patient contact; do not empty condensation in tubing
Rationale back into cascade.
Ineffective breathing pattern r/t ____________________________. Measures aimed at prevention of nosocomial infections.
Observe changes in respiratory rate and depth; observe for SOB and .
use of accessory muscles. Use disposable saline irrigation units to rinse in-line suction; ensure
An increase in the work of breathing will add to fatigue; may indicate ventilator tubing changed q. 7 days, in-line suction changed q. 24 h.;
patient fighting ventilator. ambu bags changes between patients and whenever become soiled.
. IAW Infection Control Policy and Respiratory Therapy Standards of
Observe for tube misplacement- note and post cm. Marking at Care for CCNS.
lip/teeth/nares after x-ray confirmation and q. 2 h. Potential for complications r/t immobility.
Indicates correct position to provide adequate ventilation. Assess for psychosocial alterations.
. Dependency on ventilator with increased anxiety when weaning;
Prevent accidental extubation by taping tube securely, checking q.2h.; decreased ability to communicate; social isolation/alteration in family
restraining/sedating as needed. dynamics.
Avoid trauma from accidental extubation, prevent inadequate .
ventilation and potential respiratory arrest. Assess for GI problems. Preventative measures include relieving
. anxiety, antacids or H2 receptor antagonist therapy, adequate sleep
Inspect thorax for symmetry of movement. cycles, adequate communication system.
Determines adequacy of breathing pattern; asymmetry may indicate Most serious is stress ulcer. May develop constipation.
hemothorax or pneumothorax. .
. Observe skin integrity for pressure ulcers; preventative measures
Measure tidal volume and vital capacity. include turning patient at least q. 2 h.; keep HOB < 30 degrees with a
Indicates volume of air moving in and out of lungs. 30 degree side-lying position; use pressure relief mattress or turning
. bed if indicated; follow prevention of pressure ulcers plan of care;
Asses for pain maintain nutritional needs.
Pain may prevent patient from coughing and deep breathing. Patient is at high risk for developing pressure ulcers due to immobility
. and decreased tissue perfusion.
Monitor chest x-rays .
Shows extent and location of fluid or infiltrates in lungs. Maintain muscle strength with active/active-assistive/passive ROM and
. prevent contractures with use of span-aids or splints.
Maintain ventilator settings as ordered. Patient is at risk for developing contractures due to immobility, use of
Ventilator provides adequate ventilator pattern for the patient. paralytics and ventilator related deficiencies.
. Knowledge deficit r/t intubation and mechanical ventilation
Elevate head of bed 60-90 degrees. Explain purpose/mode/and all treatments; encourage patient to relax
This position moves the abdominal contents away from the diaphragm, and breath with the ventilator; explain alarms; teach importance of deep
which facilitates its contraction. breathing; provide alternate method of communication; keep call bell
within reach; keep informed of results of studies/progress; demonstrate
Impaired gas exchange r/t alveolar-capillary membrane changes confidence.
Monitor ABG’s. Reduce anxiety, gain cooperation and participation in plan of care.
Determines acid-base balance and need for oxygen.
.
Assess LOC, listlessness, and irritability.
Common Syndromes * Red rash followed by desquamation
DOWN SYNDROME:
Trisomy 21. Mental retardation, characteristic facial features, Simeon
CARPAL-TUNNEL SYNDROME: Compression of Median Nerve
crease in hand.
through the Carpal Tunnel - pain and parasthesia over distribution of
Median N.
MARFAN SYNDROME: Connective Tissue disorder
* Arachnodactyly: Abnormally long digits and extremities
HORNER'S SYNDROME: Loss or lesion of cervical sympathetic
* Subluxation of lens
ganglion -
* Dissecting aortic aneurism
* Ptosis, miosis, anhydrosis
* Enophthalmos (caved in eyes)
SUDDEN INFANT DEATH SYNDROME: Unexplained death in
sleeping infants.
KORSAKOFF SYNDROME: Loss of short-term memory in chronic
alcoholism, caused by degeneration of mamillary bodies.
TURNER'S SYNDROME: XO monosomy.
* Dwarfism
MALABSORPTION SYNDROME: Impaired absorption of dietary
* Webbed neck
substance - diarrhea, weakness, weight loss, or symptoms from specific
* Valgus of elbow.
deficiencies.
* Amenorrhea

RESTLESS LEGS SYNDROME: Need to stretch legs at night before

WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading
going to sleep; twitch in legs causing insomnia.
to buildup of copper mental retardation, cirrhosis, hepatolenticular
degeneration.

Herbal Plants
AMENNORRHEA-GALACTORRHEA SYNDROME: Non-
1) ALOE VERA
physiologic lactation, resulting from endocrinologic causes or from a
Aloe vera syn. A. barbadensis (Liliaceae)
pituitary disorder.
The clear gel found inside the plant's leaf contains aloin, are both used
for medicinal and cosmetic purposes. It is a effective healer of wounds
and burns, speeding up the rate of healing and reducing the risk of
CUSHING'S SYNDROME: Hypersecretion of cortisol secondary
infection. The brownish part containing aloin is a strong laxative,
symptoms and characteristics:
useful for short-term constipation. Aloe is present in many cosmetic's
* Fatness of face and trunk with wasting of extremities
formulae because its emollient and scar preventing properties.
* Buffalo hump
* Bone decalacification
MAIN PROPERTIES: Heals wounds, emollient, laxative.
* Corticoid diabetes
* Hypertension
2) ANGELICA
Angelica arcangelica (Umbelliferae)
Angelica has been used to reduce muscular spasms in asthma and
PREMENSTRUAL SYNDROME: Abnormal sensation in breasts,
bronchitis. It has also been shown to ease rheumatic inflammation, to
abdominal pain, thirst, headache, pelvic congestion, nervous irritability.
regulate menstrual flow and as an appetite stimulant. The stems are
candied for culinary use.
Ocassionally nausea and vomiting.
MAIN PROPERTIES: Antispasmodic, promotes menstrual flow.
GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown
3) ANISE
cause.
Pimpinella anisum (Umbelliferae)
It has been used as a flavoring spice in recipes and as a diuretic, to treat
digestive problems and to relieve toothache. Anise seeds are known for
REYE'S SYNDROME: Loss of consciousness and seizures in kids,
their ability to reduce flatulence and colic, to settle the digestion, to
after a viral infection treated by aspirin.
relieve colic, and to ease nausea and indigestion. It also has an
expectorant and antispasmodics action that is helpful in countering
period pain, asthma, whooping cough and bronchitis. The mild
REITER'S SYNDROME: Symptom cluster. Etiology is thought to be
hormonal action of anise seeds may explain its ability to increase
Chlamydial or post-chlamydial.
breast-milk production and its reputation for easing childbirth and
Urethritis
treating impotence and frigidity. Anise essential oil is used externally to
Iridocyclitis (Conjunctivitis)
treat lice and scabies.
Arthritis
Skin lesions like karatoderma blenorrhagicum
MAIN PROPERTIES: Reduces colic and flatulence, promotes
Also can see fatty liver or liver necrosis.
digestion, antispasmodic

4) ARNICA
STEVENS-JOHNSON SYNDROME: Erythema Multiforme
Arnica montana (Compositae)
complication.
Arnica improves the local blood supply and accelerates healing. It is
Large areas of skin slough, including mouth and anogenital
anti-inflammatory and increases the rate of re-absorption of internal
membranes.
bleeding. The internal use of arnica is restricted to homeopathic
Mucous membranes: stomatitis, urethritis, conjunctivitis.
dosages as it is potentially toxic.
Headache, fever, malaise.
MAIN PROPERTIES: Anti-inflammatory, germicide, muscular
soreness, pain reliever.
TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons.
Infection with Staph Aureus and subsequent toxicity of exotoxin TSST
5) ARROWROOT
systemic anaphylaxis.
Maranta arundinacea (Marantaceae)
* Fever, vomiting, diarrhea
Its root is used as a poultice for smallpox sores, and as an infusion for distillates are used extensively in perfumery. Orange flower water is a
urinary infections. It helps to relieve acidity, indigestion and colic, and by-product of distillation and is used in perfumery and to flavor sweets
is mildly laxative. It may be applied as an ointment or poultice mixed and biscuits, as well as being used medicinally to reduce heart rate and
with some other antiseptic herbs such as comfrey. palpitations, to encourage sleep and calm the digestive tract.

MAIN PROPERTIES: Anti-inflammatory, digestive, antiseptic. MAIN PROPERTIES: Anti-inflammatory, antifungal, antibacterial,
digestive.
6) ARTEMISIA, WORMWOOD
Artemisia absinthium (Compositae) 12) BOLDO
Wormwood has a marked tonic effect on the stomach, the gallbladder Peumus boldus (Umbelliferae)
and in adjusting weak digestive problems. It is used to expel It activates the secretion of saliva and gastric juices. Boldine, one of its
roundworms and threadworms. By improving the functions of the constituents, induces the flow of bile as well as the total amount of
digestive system it helps in many conditions, including anaemia. It is
solids that it excretes. Its protective action over the hepatic cells has
also a muscle relaxant occasionally used to treat rheumatism. The been demonstrated "in vitro" and "in vivo". Boldo stimulates liver
leaves of wormwood have antiseptic properties which may derive fromactivity and bile flow and is chiefly valued as a remedy for gallstones
the azulenes that the plant contains. and liver or gallbladder pain. It is normally taken for a few weeks at a
time, either as a tincture or infusion. Boldo also has antiseptic
MAIN PROPERTIES: Bitter, carminative, muscle relaxant, antiseptic. properties which help in combating cystitis.

7) BASIL, HOLY BASIL MAIN PROPERTIES: Bile and liver activity stimulant, digestive.
Ocimum sanctum (Labiatae)
The herb has very important medicinal properties - notably its ability to 13) CALENDULA, MARIGOLD
reduce blood sugar levels. It also prevents peptic ulcers and other stress Calendula officinallis (Compositae)
related conditions like hypertension, colitis and asthma. Basil is also Marigold is one of the best herbs for treating local skin problems.
used to treat cold and reduce fever, congestion and joint pain. Due to its Infusions or decoctions of Calendula petals decrease the inflammation
anti-bacterial and fungicide action, basil leaves are used on itching of sprains, stings, varicose veins and other swellings and also soothes
skin, insect biting and skin affections. burns, sunburns, rashes and skin irritations. These remedies are
excellent for inflamed and bruised skin, their antiseptic and healing
MAIN PROPERTIES: Lowers blood sugar levels, antispasmodic, properties helping to prevent the spread of infection and accelerate the
analgesic, lowers blood pressure, reduces fever, fungicidal, anti- healing. Marigold is also a cleansing and detoxifying herb, and the
inflammatory. infusion and tincture are used to treat chronic infections. Taken
internally, it has been used traditionally to promote the draining of
8) BELLADONA, DEADLY NITIGHTSHADE swollen lymph glands such as tonsillitis.
Atropa belladonna (Solanaceae)
Herba bella dona, or "herb of the beautiful lady" is known for its MAIN PROPERTIES: Anti-inflammatory, astringent, heals wounds,
poisonous effects (belladonna increases heartbeat and can lead to antiseptic, detoxifying.
death), like many other plants it is an important and beneficial remedy
when used correctly. Belladonna contains atropine used in conventional 14) CAMPHOR
medicine to dilate the pupils for eye examinations and as an anesthetic. Cinnamomum camphora syn. Laurus camphora (Lauraceae)
In herbal medicine, deadly nightshade is mainly prescribed to relieve Camphor crystals have strong antiseptic, stimulant and antispasmodic
intestinal colic, to treat peptic ulcers and to relax distended organs, properties and are applied externally as unguents or balms as a counter-
especially the stomach and intestine. Deadly nightshade is also used as irritant and analgesic liniment to relieve arthritic and rheumatic pains,
an anaesthetic in conventional medicine. neuralgia and back pain. It may also be applied to skin problems, such
as cold sores and chilblains, and used as a chest rub for bronchitis and
MAIN PROPERTIES: Smooth muscle, antispasmodic, narcotic, other chest infections.
reduces sweating, sedative.
MAIN PROPERTIES: Antiseptic, antispasmodic, analgesic,
9) BENZOIN GUM expectorant.
Styrax benzoin (Styraceae)
Its trunk exudes a gum well known for its strong astringent and 15) CARDAMOM
antiseptic action. For this reason it is used externally to fight tissue Elettaria cardamomum (Zingiberaceae)
inflammation and disinfection of wounds. When taken internally, Cardamom is an excellent remedy for many digestive problems,
benzoin gum acts to settle griping pain, to stimulate coughing, and to helping to soothe indigestion, dyspepsia, gastralgia, colon spasms and
disinfect the urinary tract. Benzoin gum is widely used in cosmetics as flatulence. It has an aromatic and pungent taste and combines well with
an antioxidant in oils, as a fixative in perfumes and as an additive to other herbs and helps to disguise the less pleasant taste of other herbs.
soaps. When steam inhaled, it helps healing sore throats, head and chest
colds, asthma and bronchitis. MAIN PROPERTIES: Eases stomach pain, carminative, aromatic,
antispasmodic.
MAIN PROPERTIES: Antiseptic, astringent, anti-inflammatory.
16) CARDUS, MILK THISTLE, MARY THISTLE
10) BERGAMOT Carduus marianus syn. Silybum marianum (Compositae)
Citrus bergamia syn. C. aurantium var. bergamia (Rutaceae) Milk thistle has been in use as a remedy for liver problems for
Bergamot oil, expressed from the peel, assists in avoiding infectious hundreds, if not thousands, of years. It is used in a whole range of liver
diseases. In cosmetics it is used in preventing oily skin, acne, psoriasis and bladder conditions including hepatitis and cirrhosis. Recent
and acne. The oil (or constituents of it) is sometimes added to sun- research has confirmed that the herb has a remarkable ability to protect
tanning oils. Bergamot oil is also used to relieve tension, relax muscle the liver from damage resulting from alcoholic and other types of
spasms and improve digestion. poisoning. Today, milk thistle is widely used in the West for the
treatment of a range of liver conditions.
MAIN PROPERTIES: Disinfectant, muscle relaxant. MAIN PROPERTIES: Digestive, liver tonic, stimulates secretion of
bile, increases breast-milk production, antidepressant.
11) BITTER ORANGE
Citrus aurantium (Rutaceae) 17) CELERY, SMALLAGE
Its oil contains flavonoids which are anti-inflammatory, antibacterial Apium graveolens (Umbelliferae)
and antifungal. Bitter orange juice is rich in vitamin C which helps the More familiar as a vegetable than as a medicine, celery find its main
immune system. As an infusion, it helps to relieve fever, soothe use in the treatment of rheumatism, arthritis and gout. Containing apiol,
headaches and lower fever. It yields neroli oil from its flowers, and the the seeds are also used as a urinary antiseptic. Celery is a good
oil known as petitgrain from its leaves and young shoots. Both cleansing, diuretic herb, and the seeds are used specifically for arthritic
complaints where there is an accumulation of waste products. The 24) CYMBOPOGON, LEMON GRASS
seeds also have a reputation as a carminative with a mild tranquilizing Cymbopogon citratus (Gramineae)
effect. The stems are less significant medicinally. Its oil is used as a culinary flavoring, a scent and medicine. Lemon
grass is principally taken as a tea to remedy digestive problems
MAIN PROPERTIES: Anti-rheumatic, antispasmodic, diuretic, urinary diarrhea and stomach ache. It relaxes the muscles of the stomach and
antiseptic. gut, relieves cramping pains and flatulence and is particularly suitable
for children. In the Caribbean, lemon grass is primarily regarded as a
18) CHAMOMILE, GERMAN CHAMOMILE fever-reducing herb. It is applied externally as a poultice or as diluted
Chamomilla recutita syn. Matricaria recutita (Compositae) essential oil to ease pain and arthritis.
Its flowers help to ease indigestion, nervousness, depressions and
headaches, being ideal for emotion related problems such as peptic MAIN PROPERTIES: Digestive, antispasmodic, analgesic.
ulcers, colitis, spastic colon and nervous indigestion. Chamomile's
essential oil have anti-inflammatory, anti-spasmodic and anti-microbial 25) DAMIANA
activity. It is an excellent herb for many digestive disorders and for Turnera diffusa syn. T. diffusa var. aphrodisiaca (Turneraceae)
nervous tension and irritability. Externally, it is used for sore skin and It has an ancient reputation as an aphrodisiac and is an excellent
eczema. Roman chamomile (Chamaemelum nobile) is a close relation, remedy for the nervous system acting as a stimulant and tonic in cases
used in a similar way. of mild depression. Damiana has a strongly aromatic, slightly bitter
taste. The leaves are used to flavor liqueurs and are taken in Mexico as
MAIN PROPERTIES: Anti-inflammatory, antispasmodic, relaxant, a substitute for tea.
carminative, bitter, nervine.
MAIN PROPERTIES: Nerve tonic, antidepressant, urinary antiseptic.
19) CHICORY
Cicorium intybus (Compositae) 26) DANDELION
As a tea or extract, chicory root is a bitter digestive tonic that also Taraxacum officinale (Compositae)
increases bile flow and decrease inflammation. Its roasted root is Known principally as a weed, dandelion has an astonishing range of
commonly used as a coffee substitute. Chicory is an excellent mild health benefits. The leaves, which can be eaten in salads, are a powerful
bitter tonic for the liver and digestive tract. The root is therapeutically diuretic. The roots act as a "blood purifier" that helps both kidneys and
similar to dandelion root supporting the action of the stomach and liver the liver to remove impurities from the blood. This effect seems to be
and cleansing the urinary tract. Chicory is also taken for rheumatic due to its potassium content. It also acts like a mild laxative and
conditions and gout, and as a mild laxative, one particularly appropriate improves appetite and digestion.
for children. An infusion of the leaves and flowers also aids the
digestion. MAIN PROPERTIES: Diuretic, digestive, antibiotic, bitter.

MAIN PROPERTIES: Digestive, liver tonic, anti-rheumatic, mild 27) DILL

laxative. Anethum graveolens syn. Peucedanum graveolens (Umbelliferae)
Dill has always been considered a remedy for the stomach, relieving
20) CINNAMON wind and calming the digestion. Dill's essential oil relieves intestinal
Cinnamomum verum syn. C. zeylanicum (Lauraceae) spasms and griping and helps to settle colic, hence it is often used in
The infusion or powder is used for stomach pains and cramps. gripe water mixtures. Chewing the seeds improves bad breath. Dill
Traditionally, the herb was taken for colds, flu and digestive problems. makes a useful addition to cough, cold and flu remedies, and is a mild
diuretic. Dill increases milk production, and when taken regularly by
MAIN PROPERTIES: Warming stimulant, carminative, antispasmodic, nursing mothers, helps to prevent colic in their babies.
antiseptic, anti-viral.
MAIN PROPERTIES: Digestive, antibacterial, antispasmodic, diuretic.
21) CLOVE
Eugenia caryophyllata syn. Syzgium aromaticum (Myrtaceae) 28) EUCALYPTUS, BLUE GUM
The dried flower buds, clove, are extensively used as spice. The buds, Eucalyptus globulus (Myrtaceae)
leaves and stems are used for the extractions of clove's oil. The oil Eucalyptus is a powerful antiseptic used all over the world for relieving
contains eugenol, a strong anesthetic and antiseptic substance. Cloves coughs and colds, sore throats and other infections. The leaves cool the
are also well known for their antispasmodic and stimulant properties. body and relive fever. Inhaling the vapors of the essential oils heated in
water, clears sinus and bronchial congestions. Eucaliptol, one of the
MAIN PROPERTIES: Antiseptic, mind and body stimulant, analgesic, substances found in the essential oil, is one of the main constituents of
antibacterial, carminative. the many existing commercial formulas of chest rubs for colds. The
essential oil has also strong anti-biotic, anti-viral and anti-fungal action.
22) COMFREY, KNITBONE Eucalyptus is a common ingredient in many over-the-counter cold
Symphytum officinale (Boraginaceae) remedies.
Comfrey leaves and roots contain allantoin, a cell multiplication agent
that increases the healing of wounds. Today, it is still highly regarded MAIN PROPERTIES: Antiseptic, expectorant, stimulates local blood
for its healing properties. Externally it is used for rashes, wounds, flow, anti-fungal.
inflammations and skin problems. Internally, comfrey has action over
the digestive tract helping to cure ulcers and colitis. It is also used for a 29) FENNEL
variety of respiratory problems. Foeniculum vulgare (Umbelliferae)
The primary use of fennel seeds is to relieve flatulence, but they also
MAIN PROPERTIES: Digestive problems, anti-inflammatory, wound settle colic, stimulate the appetite and digestion. Fennel is also diuretic
healing, astringent. and anti-inflammatory. Like anise (Pimpinella anisum) and caraway
(Carum carvi), it has a calming effect on bronchitis and coughs. An
23) CORIANDER infusion of the seeds may be taken as a gargle for sore throats and as a
Coriandrum sativum (Umbelliferae) mild expectorant. Fennel increases breast-milk production and the herb
It aids digestion, reduce flatulence and improves appetite. It helps is still used as an eye wash for sore eyes and conjunctivitis. Essential
relieving spasms within the gut and counters the effects of nervous oil from the sweet variety is used for its digestive and relaxing
tension. Coriander is also chewed to sweeten the breath, especially afterproperties.
consumption of garlic (Allium sativum). It is applied externally as a
lotion for rheumatic pain. Coriander essential oil is used in the MAIN PROPERTIES: Digestive, antispasmodic, anti-inflammatory.
manufacture of perfumes, cosmetics and dentifrices.
30) GARLIC
MAIN PROPERTIES: Digestive, antispasmodic, anti-rheumatic. Allium sativum (Liliaceae)
Recognized for its pungent odor and taste, garlic is a powerful home
medicine for the treatment for a host of health problems. It is one of the Crataegus oxyacantha & C. monogyna (Rosaceae)
most effective anti-biotic plants available, acting on bacteria, viruses It has been shown that its effects are only present when a whole plant
and alimentary parasites. It counters many infections, including those preparation is used. Its applications are: the loss of cardiac function,
of the nose, throat and chest. Garlic is also known to reduce feelings of congestions and oppression in the hearth region. Western
cholesterol, helps circulatory disorders, such as high blood pressure, herbalists consider it literally to be a "food for the heart", increasing
and lower blood sugar levels, making it useful in cases of late-onset blood flow to the heart muscles and restoring normal heart beat. Recent
diabetes. research has confirmed the validity of these uses.

MAIN PROPERTIES: Antibiotic, expectorant, diaphoretic, MAIN PROPERTIES: Cardiotonic, diuretic, astringent, dilates blood
hypotensive, antispasmodic, expels worms. vessels, relaxant, antioxidant.

31) GENTIAN 38) HYSSOP

Gentiana lutea (Gentianaceae) Hyssopus officinalis (Labiatae)
Gentian is a powerful bitter that stimulates appetite and promotes Currently an undervalued medicinal herb, hyssop is potentially useful
digestion through the increased production of saliva, gastric juices and as it is both calming and tonic. It has a large spectrum of uses which are
bile. It also decreases gastric inflammation and kill worms. Gentian is due to its anti-spasmodic action. It is used in coughs, bronchitis, tight-
also used to treat liver and spleen problems and to promote chestedness, respiratory catarrh, sore throat and common cold. As a
menstruation. Medicinally, gentian strengthens a weak or under-active sedative, hyssop is a useful remedy against asthma in both children and
digestive system. adults, especially where the condition is exacerbated by mucus
congestion.
MAIN PROPERTIES: Bitter, digestive stimulant, eases stomach pain.
MAIN PROPERTIES: Anti-spasmodic, expectorant, diaphoretic, anti-
32) GINGER inflammatory, hepatic.
Zingiber officinali (Zingiberaceae)
The Chinese consider ginger as an important drug to treat cold and 39) JASMINE
encourage sweating. Ginger brings relief to digestion, stimulates Jasminum grandiflorum (Oleaceae)
circulation, reduce headaches and kill intestinal parasites. Jasmine flowers make a calming and sedative infusion, taken to relieve
tension. The oil is considered antidepressant and relaxing. It is used
MAIN PROPERTIES: Diaphoretic, carminative, circulatory stimulant, externally to soothe dry and sensitive skin.
inhibits coughing, anti-inflammatory, antiseptic.
MAIN PROPERTIES: Aromatic, anti-spasmodic, expectorant.
33) GINKGO
Ginkgo biloba (Ginkgoaceae) 40) JUNIPER
Traditionally known as an anti-microbial and anti-tubercular action, it Juniperus communis (Cupressaceae)
has now been shown that ginkgo as a profound activity on brain It is a valuable remedy for cystitis, and helps relieve fluid retention, but
function and cerebral circulation. This action is useful to prevent should be avoided in cases of kidney disease. In the digestive system,
dizziness, tinnitus, short-term memory loss, depression and other juniper is warming and settling, easing colic and supporting the
symptoms related to poor brain circulation. Its effect on poor function of the stomach. Taken internally or applied externally, juniper
circulation also used to treat other related disorders like diabetes, is helpful in the treatment of chronic arthritis, gout and rheumatic
hemorrhoids and varicose veins. Ginkgo is also valuable for asthma. conditions. Applied externally as a diluted essential oil, it has a slightly
warming effect on the skin and is thought to promote the removal of
MAIN PROPERTIES: Circulatory stimulant and tonic, anti-asthmatic, waste products from underlying tissues.
antispasmodic, anti-allergenic, anti-inflammatory.
MAIN PROPERTIES: Diuretic, anti-microbial, carminative, anti-
34) GINSENG rheumatic.
Panax ginseng (Araliaceae)
Ginseng increases mental and physical efficiency and resistance to 57) RADISH
stress and disease. It often shows a dual response like sedating or Raphanus sativus (Cruciferae)
stimulating the central nervous system according to the condition it is Radish stimulates the appetite and the digestion. The juice of the black
being taken to treat. In the West, ginseng is regarded as a life-enhancingradish is drunk to counter gassy indigestion and constipation. Black
tonic. radish juice has a tonic and laxative action on the intestines, and
indirectly stimulates the flow of bile. Consuming radish generally
MAIN PROPERTIES: Tonic, stimulant, physical and mental results in improved digestion, but some people are sensitive to its
enhancement. acridity and strong action. In China, radish is eaten to relieve
abdominal distention.
35) GUMPLANT
Grindelia camporum syn. G. robusta var. rigida (Compositae) MAIN PROPERTIES: Digestive, mild laxative.
Its anti-spasmodic, expectorant and hypotensive actions find
applications in treating heart conditions, asthmatic and bronchial 58) RAUVOLFIA, INDIAN SNAKEROOT
conditions. It has been employed in the treatment of wooping cough, Rauvolfia serpentina (Apocynaceae)
hay fever and cystitis. Externally in relieves and heals skin irritations Indian snakeroot contains reserpine, a substance now widely used to
and burns. lower blood pressure and lessen some symptoms of mental illness. The
MAIN PROPERTIES: Anti-spasmodic, expectorant, hypotensive. root has a pronounced sedative and depressant effect on the
sympathetic nervous system. By reducing the system's activity, the herb
36) HAMAMELIS, WITCH HAZEL brings about the lowering of blood pressure. It may also be used to treat
Hamamamelis virginiana (Hamamelidaceae) anxiety and insomnia, as well as more serious mental health problems
Witch hazel acts mostly on the veins and circulation. For this reason it such as psychosis.
has been used to decrease the inflammation and pain of bruises, sore
muscles, bleeding, hemorrhoids, varicose veins, phlebitis, and insect MAIN PROPERTIES: Antidepressant, lowers blood pressure.
bites. American indians used poultices soaked in a decoction of bark to
treat tumors and inflammations, especially of the eye, and took the herb 59) RHUBARB, CHINESE RHUBARB
internally for hemorrhaging and heavy menstrual bleeding. Rheum palmatum (Polysonaceae)
Its main use is as a laxative safe even for young children due to its
MAIN PROPERTIES: Astringent, anti-inflammatory, stops external gentle action. It is also extremely effective in the treatment for many
and internal bleeding. digestive problems. Paradoxically, it is a laxative when taken in large
doses but has a constipating effect in small measures. The rhizome has
37) HAWTHORN an astringent, unpleasant taste.
 the wood is used to soothe rashes and itchy skin. In China, sandalwood
MAIN PROPERTIES: Laxative, constipating, astringent, eases stomachis held to be useful for chest and abdominal pain.
pain, antibacterial.
MAIN PROPERTIES: Antiseptic, aromatic.
60) ROSE
Rosa gallica (Rosaceae) 66) SARSAPARILLA
The essential oil, called "attar of rose", is used in aromatherapy as a Smilax spp. (Liliaceae)
mildly sedative, antidepressant and anti-inflammatory remedy. Rose Sarsaparilla is anti-inflammatory and cleansing, and can bring relief to
petals and their preparations have a similar action. They also reduce skin problems such as eczema, psoriasis and general itchiness, and help
high cholesterol levels. Rosewater is mildly astringent and makes a treat rheumatism, rheumatoid, arthritis and gout. Sarsaparilla also has a
valuable lotion for inflamed and sore eyes. progesterogenic action, making it beneficial in pre-menstrual problems,
and menopausal conditions such as debility and depression.
MAIN PROPERTIES: Aromatic, antidepressant,, sedative, anti-
inflammatory. MAIN PROPERTIES: Diuretic, anti-inflammatory, anti-rheumatic.

61) ROSEMARY 67) SCOTS PINE

Rosmarinus officinalis (Labiatae) Pinus sylvestris (Pinaceae)
Rosemary is a well-known and greatly valued herb that is native to Its oil, extracted from the leaves, is added to disinfectants and other
southern Europe. It has been used since antiquity to improve and preparations. Scots pine leaves, taken internally, have a mildly
strengthen the memory. Rosemary leaves increase circulation, reduce antiseptic effect within the chest, and may also be used for arthritic and
headaches and have anti-bacterial and fungal properties. Rosemary rheumatic problems. Essential oil from the leaves may be taken for
improves food absorbtion by stimulating digestion, the liver, the asthma, bronchitis and other respiratory infections, and for digestive
intestinal tract, and the gallbladder. It also is used in antiseptic gargles disorders such as wind. Scots pine branches and stems yield a thick
for sore throats, gum problems and canker sores. Rosemary has a long- resin, which is also antiseptic within the respiratory tract. The seeds
standing reputation as a tonic, invigorating herb, imparting a zest for yield an essential oil with diuretic and respiratory-stimulant properties.
life that is to some degree reflected in its distinctive aromatic taste.
MAIN PROPERTIES: Antiseptic, diuretic and anti-rheumatic.
MAIN PROPERTIES: Tonic, stimulant, astringent, nervine, anti-
inflammatory, carminative. 68) SESAME
Sesamum indicum (Pedaliaceae)
62) RUE The seeds are prescribed for problems such as dizziness, tinnitus
Ruta graveolens (Rutaceae) (ringing in the ears), and blurred vision. Owing to their lubricating
The rutin contained in the plant helps to strengthen fragile blood effect within the digestive tract, the seeds are also considered a remedy
vessels and alleviates varicose veins. Rue is also used due to its for constipation. Sesame seed oil benefits the skin and is used as a base
antispasmodic properties, especially in the digestive system where it for cosmetics. A decoction of the root is used in various traditions to
eases griping and bowel tension. The easing of spasms gives it a role in treat coughs and asthma.
the stopping of spasmodic coughs. In European herbal medicine, rue
has also been taken to treat conditions as varied as hysteria, epilepsy, MAIN PROPERTIES: Digestive, aromatic, antispasmodic.
vertigo, colic, intestinal worms, poisoning and eye problems. The latter
use is well founded, as an infusion used as an eyewash brings quick 69) ST JOHN'S WORT
relief to strained and tired eyes, and reputedly improves the eyesight. Hypericum perforatum (Guttiferae)
St. John's wort flowers at the time of the summer solstice, and in
MAIN PROPERTIES: Antispasmodic, increases peripheral blood medieval Europe it was considered to have powerful magical properties
circulation, relieves eye tension. that enabled it to repel evil. The most well-known action of St. John's
wort is in repairing nerve damage and reducing pain and inflammation.
63) SAGE, CLARY CLARY SAGE It is taken to relieve the pain of menstrual cramps, sciatica and arthritis.
Salvia sclarea (Labiatae) The oil is applied to inflammations, sprains, bruises and varicose veins.
Clary sage has been perceived both as a weaker version of its close St. John's wort is also used to treat circulation problems, bronchitis and
relative, sage (S. officinalis), and as a significant herb in its own right. gout.
Since the seeds were once commonly used to treat eye problems, it was
also known as "clear eye". An antispasmodic and aromatic plant, clary MAIN PROPERTIES: Antidepressant, antispasmodic, astringent,
sage is used today mainly to treat digestive problems such as wind and sedative, relieves pain, anti-viral.
indigestion. It is also regarded as a tonic, calming herb that helps
relieve period pain and premenstrual problems. Owing to its estrogen- 70) TARRAGON
stimulating action, it is most effective when levels of this hormone are Artemisia dracunculus (Compositae)
low. Tarragon is widely used as a herb in cooking. In French, it is sometimes
known as herbe au dragon, because of its reputed ability to cure serpent
MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, bites. While tarragon stimulates the digestion, it is reputed to be a mild
estrogenic, reduces sweating, tonic. sedative and has been taken to aid sleep. With its mild menstruation-
inducing properties, it is taken if periods are delayed. The root has
64) SAGE traditionally been applied to aching teeth.
Salvia officinalis (Labiatae)
Its leaves are a well-known cold germ and flu fighter. It has been found MAIN PROPERTIES: Anti-inflammatory, digestive.
to be very effective to reduce many physical emissions like sweating
and is an excellent remedy for sore throats, poor digestion and irregular 71) TEA TREE
periods. It is also taken as a gently stimulating tonic. It has a slightly Malaleuca alternifolia (Myrtaceae)
warm, noticeably bitter and astringent taste. Tea tree, and in particular its essential oil, is one of the most important
natural antiseptics. Useful for stings, burns, wounds and skin infections
MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, of all kinds, the herb merits a place in every medicine chest. Its
estrogenic, reduces sweating, tonic. therapeutic properties were first researched during the 1920s and it is
now widely used in Europe and the US, as well as in Australia.
65) SANDALWOOD
Santalum album (Santalaceae) MAIN PROPERTIES: Antiseptic, antibacterial, anti-fungal, anti-viral.
The heartwood is most often used in perfumery, but it has also been
taken as a remedy in China since around AD 500. Sandalwood and its 72) THYME
essential oil are used for their antiseptic properties in treating genito- Thymus vulgaris (Labiatae)
urinary conditions such as cystitis and gonorrhea. In India, a paste of Its main medicinal application is in treating coughs and clearing
congestion. Many current formulas for mouth washes and vapor rubs MAIN PROPERTIES: Antiseptic, anti-fungal, antispasmodic.
contain thymol, one of the constituents found in thyme. It also
improves digestion, destroys intestinal parasites and is an excellent 79) YARROW
antiseptic and tonic. Achillea millefolium (Compositae)
It has long been taken as a strengthening bitter tonic and all kinds of
MAIN PROPERTIES: Antiseptic, tonic, relieves muscle spasm, bitter drinks have been made from it. Yarrow helps recovery from colds
expectorant. and flu and is beneficial for hay fever. It is also helpful for menstrual
problems and circulatory disorders.
73) TURMERIC
Curcuma longa syn. C. domestica (Zingiberaceae) MAIN PROPERTIES: Antispasmodic, astringent, bitter tonic, increases
Best known for its bright yellow color and spicy taste to lovers of sweating, lowers blood pressure, reduces fever, mild diuretic and
Indian food, its medicinal value is not so well known. However, recent urinary antiseptic.
research has confirmed the effects traditionally associated in ancient
practices in the treatment of digestive and liver problems. The herb has
80) YLANG -YLANG
also been shown to inhibit blood-clotting, relieve inflammatory Canananga odorata syn. Canangium odoratum (Annonaceae)
conditions and help lower cholesterol levels. Their scent is thought to have aphrodisiac qualities. The flowers and
essential oil are sedative and antiseptic. The oil has a soothing effect,
MAIN PROPERTIES: Stimulates secretion of bile, anti-inflammatory, and its main therapeutic uses are to slow an excessively fast heart rate
eases stomach pain, antioxidant, antibacterial. and to lower blood pressure. With its reputation as an aphrodisiac,
ylang-ylang may be helpful in treating impotence.
74) VALERIAN
Valeriana officinalis (Valerianaceae) MAIN PROPERTIES: Antiseptic, aromatic, regulates blood pressure.
Valerian root is a general tranquilizer used for relieving nervous
tension, insomnia and headaches. Valerian decreases muscular spasm,
being useful in cases of nervous digestion, bowel syndrome, stomach
Preventing Clogged Feeding Tubes
and menstrual cramps. Valerian helps relieve stress and has become an
increasingly popular remedy in recent decades. It is a safe, non- Going with the flow. (preventing clogged feeding tubes)
addictive relaxant that reduces nervous tension and anxiety and Author/s: Karen Brennan Krupp
promotes restful sleep. Issue: April, 1998

MAIN PROPERTIES: Sedative, relaxant, relieves muscle spasm, Find out what problems to anticipate-- and how a few simple steps can
relieves anxiety, lowers blood pressure. head them off.

75) VERBENA A clogged enteral feeding tube that can't be cleared must be replaced
Verbena officinalis (Verbenaceae) an unwelcome prospect for you and your patient. At the very least,
Verbena is used in mouth washes for infected gums and as a poultice he'll miss getting some of the fluid and nutrition he needs. At
for hemorrhoids. A tea has been used as a nerve tonic, to treat insomnia worst, if he's homebound or a nursing home resident, he'll need to
and to help digestion. It has tonic, restorative properties, and is used to travel to an appropriate facility for tube reinsertion and X-ray
relieve stress and anxiety, and to improve digestive function. confirmation of placement. The expression An ounce of prevention is
worth a pound of cure could have been coined by a nurse managing
MAIN PROPERTIES: Nervine, tonic, mild sedative, stimulates bile feeding tubes.
secretion, mild bitter.
In this article, we'll describe two simple ways you can keep feeding
76) WHITE WILLOW tubes patent: pump-assisted infusion of enteral formulas and frequent
Salix alba (Salicaceae) tube flushing. But first, let's review factors that can increase the
White willow is an excellent remedy for arthritic and rheumatic pain, risk of a clogged feeding tube.
affecting the joints like knees and hips.
Problems in the pipeline
MAIN PROPERTIES: Anti-inflammatory, analgesic, reduces fever,
anti-rheumatic, astringent. Feeding tubes can become clogged for one of these reasons:

77) WORMWOOD * calorically dense formulas. When a dense formula is delivered in a

Artemisia absinthium (Compositae) slow, uneven infusion (as by gravity drip), formula coagulation and
Wormwood leave's primary uses is to stimulate the gallbladder, help tube occlusion are more likely.
prevent and release stones, and to adjust digestive malfunctions. It also
increases bile secretion and is useful in expelling intestinal worms. It is * small-bore feeding tubes. Small-bore tubes are more flexible and
taken in small doses and sipped, the intensely bitter taste playing an less irritating to patients and can be left in place longer than
important part in its therapeutic effect. In the past, wormwood was one larger ones. But their smaller lumens make them more likely to clog.
of the main flavorings of vermouth (whose name derives from the
German for wormwood). * gravity drip. An imprecise roller clamp adjustment may increase or
decrease the amount of formula delivered by as much as 50%. When
MAIN PROPERTIES: Aromatic bitter, stimulates secretion of bile, formula flows slowly, residue clings to the wall of the tube,
anti-inflammatory, eliminates worms, eases stomach pains, mild creating a buildup that eventually clogs the tube.
antidepressant.
A slow or stopped flow of formula also causes gastric pH to decrease
78) WILD THYME because there's less nutritional liquid to dilute the stomach acid.
Thymus serpyllum (Labiatae) This excess acid may then flow into the tube, causing the formula to
Like its close relative thyme (Thymus vulgaris), wild thyme is strongly clump.
antiseptic and anti-fungal. It may be taken as an infusion or syrup to
treat flu and colds, sore throats, coughs, whooping cough, chest * medications. Bulk-forming agents such as psyllium (Metamucil),
infections, and bronchitis. Wild thyme has anti-catarrhal properties and antacids, and medications that haven't been properly crushed or
helps clear a stuffy nose, sinusitis, ear congestion and related reconstituted can also clog a tube. The combination of crushed
complaints. It has been used to expel thread worms and roundworms in medications and a small-bore feeding tube is a common cause of
children, and is used to settle wind and colic. Wild thyme's slowed
antispasmodic action makes it useful and is used to settle wind and or blocked formula flow. Whenever possible, administer the liquid
colic. Wild thyme is also used in herbal baths and pillows. formulation of a medication rather than creating a mixture from
crushed tablets.
 · Specific plan
* gastric residuals. When you check gastric residuals through a · Social support system
feeding tube, gastric acid mixes with the formula in the tube and · DO NOT make “ suicide contract”!
causes formula coagulation, which can lead to tube clogging. This
problem is more common when small-bore feeding tubes are used to For Anxious clients
aspirate gastric residuals. · Convey interest and care
· Don’t “force” client
An ounce of prevention · Help client identify source of anxiety
· Suggest relaxation techniques
Now let's look at the two steps you can take to prevent feeding tubes
from clogging. For Violent clients
· Remain calm and in control of the situation
A pump-assisted infusion is especially helpful for administering a · Give client space, avoid sudden movements
calorically dense formula. The slight degree of pump-generated · Encourage verbal expression of anger
pressure means the formula is delivered in a continuous, even · Restrain or seclude if necessary
infusion, avoiding the problems associated with an uneven
administration rate. For Compulsive clients
· Allow client to engage in rituals (these are used to cover up anxiety)
Regular tube flushing with water is, the simplest way to prevent tube · Gradually limit length of time for rituals.
clogging--and the most often neglected. The most common practice is
to instill 50 to 100 ml of water every 4 hours; before, after, and For Manipulative clients
between multiple doses of medications; and when stopping and starting · Set clear limits
a feeding. If you flush the tube consistently, you can clear even · Hold client responsible for behavior
viscous enteral formulas from the tube lumen. Also flush before and
after you check gastric residuals. For Dependent clients
· Don’t reward dependent behavior
Continued from page 1 · Client should share responsibility for treatment

Cranberry juice, carbonated beverages, meat tenderizers, enzymatic For Paranoid clients
solutions ... over the years, nurses have tried all sorts of remedies · Don’t argue with client (simply state that you don’t share his beliefs)
for clogged enteral tubes. But researchers who've studied various · Be reliable and consistent
preventive irrigants have learned something surprising: Nothing beats
plain water. In fact, acidic colas and cranberry juice can actually For Delusional clients
cause an obstruction by promoting formula coagulation. · Stay with client
· Don’t argue about the reality of delusions
The bottom line? Flushing the tube regularly with water remains the · Orient frequently to reality (place, situation)
most effective and practical way to prevent enteral, feeding tube · Assess potential for self harm
clogs.
For Somatization clients
Making it automatic · Respect client and his problems (client is not faking)
· Rule out physical basis for symptoms
A heavy nursing workload and lack of written policies and procedures · Help client express anxiety
for tube flushing can lead to inconsistency in tube flushing. So some
enteral pumps also have an automatic flush feature, which delivers a
preprogrammed amount of fluid, typically water, every hour. This DEFENSE MECHANISMS:
simulates the flushing action of a syringe and helps minimize residue 1. Conversion: A college student develops diarrhea on day of exam
buildup. 2. Regression: Returning to immature ways of dealing with stress:
crying, tantrums…
Automatic flushing doesn't just save nursing time--it's also more 3. Repression: Blocking of unacceptable urges and feelings from
effective. Two studies found clogging in 75% of gastrostomy tubes in awareness.
the manually flushed group, compared with only 5% in the 4. Denial: Blocking of unacceptable information or perceptions from
automatically flushed group. The results were even more dramatic for awarness.
nasogastric tubes: 91% in the manually flushed group clogged; none 5. Dissociation of affect: A girl laughs when telling about her failed
clogged in the automatic flush group. exam
6. Rationalization: Substituting an acceptable motive for attitudes or
Smooth sailing behavior for an unacceptable motive
7. Reaction formation: you want to “kick your bosses ass” but end up
By knowing which, factors predispose an enteral tube to clogging and kissing it.
taking a few preventive measures, you can keep your patient 8. Identification: A teenager dresses like Madonna and mimics her
comfortable- -and save yourself some time. behavior.
9. Projection: “ you are acting like a teenager, not I”
10. Introjection: A boy yells at his dog like his father does him
11. Displacement: Client is upset about disease and yells at nurse.
Psyche Nursing
Nurse gets upset and yells at nursing assistant
For Withdrawn clients 12. Undoing: “ magic,”
· Allow client to set pace
· Encourage social activities or games SIGNS AND SYMPTOMS

For Depressed client Aphasia

· Assess suicide potential Receptive (Wernicke =difficulty to comprehend language) or
· Let client talk about personal problems expressive (Broca = difficulty to find “the right word” language
· Do not leave alone disorder

For Suicidal clients Apraxia

Crisis intervention to assess suicide protential. Failure to do, despite intact motor function
· Communicate intent “ are you tired of living?”
· Previous attempts Agnosia
Failure to recognize 5. Confabulation: invents stories to fill memory gaps: Korsakoff
encephalopathy.
Dementia
Gradual impairment of cognitive functions, memory DELIRIUM
· Alzheimer dementia: early memory loss Ø Acute onset
· Multi infarct dementia: step like decline Ø Fluctuating consciousness
Ø Disorientation
Delirium Ø Optical hallucinations
Acute, organic, short lasting
Clouded consciousness DEMENTIA
Confusion, disorientation, anxiety Ø Gradual onset
Sometimes hallucinations Ø No impairment of consciousness
Ø Loss of intellectual functions: memory, orientation, language.
Delusions
Persistent false belief despite invalidating evidence
Grandeur ALZHEIMER’S
Paranoia
Somatic delusions ASSESSMENT:
§ Progressive memory loss
illusions § Declining mental, social, and self care abilities
Misperception of external stimuli
ANALYSIS:
Hallucinations § Risk of injury due to cognitive deficits
Perception without external stimuli § Family/caregiver burnout

TERMS:
1. Neologisms: invents new words: Schizophrenia
2. Echolalia: echoes words or sentences: Schizophrenia
3. Word Salad: jumble of words without meaning: Schizophrenia
4. Flight of ideas: rapid switching from topic to topic: Mania
IMPLEMENTATION:
§ Support family caregivers
§ Provide safe and familiar environment
§ Support client’s attempts at independence
§ Continually orient client to time, date and person
§ Advance directive should be drafted as early as possible

GRIEF DEPRESSION

Initial: shock/ denial Feeling of hopelessness

Illusions/hallucinations may occur Feeling of worthlessness

Low risk of suicide High risk of suicide

PERSONALITY DISORDERS:
Behavior is inflexible across a broad range of situations
Behavior is markedly deviant from cultural norms
Significant distress and impairment of functioning

DEPENDENT Afraid of being helpless

Need to be cared for

COMPULSIVE Fear of loss of control

Tries to control physician

PASSIVE-AGGRESSIVE Appears willing but is not compliant

HISTRIONIC Dramatic, emotional

May display inappropriate sexual behavior

NARCISSISTIC Feels better than others

Perfect self image is threatened by disease

PARANOID May blame nurse or others for disease

SCHIZOID Anxious, withdrawn

 (doesn’t want close relationships)

BORDERLINE Severe disorder!

Intense unstable relationships

Paranoia and suicidal behavior

Features of psychoses

ANXIETY DISORDERS:
Clients are distressed and know that their symptoms are irrational.

PHOBIA Persistent excessive of specific objects or situations.

Patient knows that his fear is unrealistic

PANIC ATTACK Abrupt onset, peak within 10 min.

Palpitations, tachycardia

Sweating, trembling, shaking

Fear of dying

Derealization: feeling of unreality of the external

world.

Depersonalization: feeling of being detached from

oneself

AGORAPHOBIA Hx of panic attacks

Patient avoids places where panic attack might occur

(especially public places)

OBSESSSIVE COMPULSIVE Obsessions: recurrent thoughts

Compulsions: repetitive behavior

POSTRAUMATIC STRESS DISORDER Traumatic event in client’s history

May occur any time after event

Persists for > 1 month

HYPOCHONDRIASIS & MALINGERING:

HYPOCHONDRIASIS Unrealistic interpretation of body signs

Client believes to have serious disease that is

unrecognized by family and physicians

FACTITIOUS DISORDER Intentional feigning of symptoms

Motivation: to assume the sick role: external

incentives such as economic gain or avoiding legal
responsibilities are absent

MALINGERING Intentional feigning of symptoms

Motivation: economic gain

 Avoiding leagal responsibilities

MAJOR DEPRESSION

ASSESSMENT:

 Feeling of worthlessness
 Thoughts of death or suicide
 Lethargy
 Slow, muted speech
 Anorexia, weight loss
 Early morning awakening
ANALYSIS:

 Risk of suicide
IMPLEMENTATION:

Assess suicidal risk ( ask client directly)

Remove potentially harmful objects
Encourage verbal expression of feelings
Encourage participation in group activities
MEDICATIONS:

 Antidepressants (require several weeks for full effect)

 Watch for anticholinergic side effects:
Blurred vision

Dry mouth

Constipation

Urinary retention

BIPOLAR DISORDER:
Manic episodes alternate with episodes of major depression.
Some clients have only manic episodes, no depressive episodes.

ASSESSMENT:

 Euphoria
 Grandiose ideas
 Uninhibited sexuality
 Buying sprees
 Psychomotor agitation
IMPLEMENTATION:

 Low stimulus environment

 Provide frequent small meals, snacks
 Encourage physical activity as a means to “act out”
MEDICATION:

 Lithium
 Watch for signs of toxicity
Abdominal pain, nausea

Hand tremor

Ataxia, nystagmus

Slurred speech

 Monitor serum levels closely

 Not to exceed 1 mEq/L

SCHIZOPHRENIA:

ASSESSMENT:

 Defect in reality testing

 Affect incongruent ( does not match thoughts)
 Thought form: tangential, circumstantial, loose associations
“POSITIVE SYMPTOMS”

Delusions

Hallucinations

“NEGATIVE SYMPTOMS”

Flat affect

Loss of interest

Ambivalence

Autism

CATATONIA:

Waxy rigidity of muscles

Client maintains bizarre positions

IMPLEMENTAION:

Establish trusting, honest relationship

Maintain calm, consistent manner

Don’t challenge client’s thought content

Decrease environmental stimuli

MEDICATION:

 Neuroleptics: monitor for signs of tardive dyskinesia

Choreoathetosis

Lateral movements of jaw

Tongue protrusion

CLIENT EDUCATION:

Stress importance to comply with follow up visits

Encourage family support

DRUG ABUSE:

Abuse: recurrent use of drugs resulting in social failures at home, school or work, legal problems or hazardous situations.
Dependence: Tolerance (needs larger doses to achieve effect). Withdrawal symptoms.
 INTOXICAITON WITHDRAWAL

ALCOHOL Euphoria Nausea

Disorientaion Delusions, hallucinations

Unsteady gait Delirium

Tremor, seizures

BARBITURATES Sedation Delirium

Epilepsy

Coma, death

BENZODIAZEPINES Antianxiety Anxiety

Sedation Irritability

insomnia

AMPHETAMINES, COCAINE Arousal Fatigue

Euphoria Dysphoria

OPIOIDS Euphoria Nausea, vomiting

Apathy Sweating, fever

Muscle aches

LSD Hallucinations NONE

Anxiety

Paranoid ideas