Touch For Spatial orientation)God hath not given us the

II Timothy 1:7

spirit of fear, but of power, and love, and a sound mind.

NURSING FACTS IN BRIEF Bio Physical Concept in Nursing and Rehabilitation/laboratory tests
NEUROLOGY CT SCAN A structural imaging study using a computer-basedx-ray to provide a cross sectional image of the brain. Advantages: 100% sensitivity When MRI is contraindicated ,CT is the procedure of choice. To Dos: Ask if (+) allergy to Iodine Tell the patient to expect a sensation of feeling flushed if contrast is injected through IV catheter Procedure may last for 10 to 30 min Maintain immobility on the entire process Instruct clients to remove metallic items MRI Noninvasive structural imaging procedure that uses powerful magnetic field and radiofrequency waves to create an image The imaging procedure of choice for most neurololgic disorders. Types: Closed-tunnel-like Open MRI-NO close chamber.The patient can comfortably see all views while the scan is in progress. Advantages: NO radiation / exposure to contrast medium Sensitivity to blood flow Ability to distinguish water, iron, fat and blood. Disadvantages: NO to patients with pacemakers, aneurysm clips/implants To DOs: Use of bathroom prior to procedure-( may last 40 to 90minutes.) Instruct patients to remove metal items Encourage patient to remain still as possible during the procedure Inform that the scanner will make a dull , thumping noise throughout the procedure PET (Positron Emission Tomography) A computer based functional imaging that permits study of the brains metabolism , blood flow and chemical processes. Provides information on patterns of glucose and O2 metabolism. To Dos: Procedure requires injection or inhalation of a radioactive substance that emits protons. Reassure patient that radiation exposure is minimal Advise patient to void prior to procedure since it may take several hours Cerebral Angiography Following local anesthesia , radiopaque dye is injected through catheter in brachial or femoral artery and passed through cervical blood vessels to assess cerebral circulation. Cerebral Hemisphere Frontal lobe Thought Memories Emotions Moral behavior Parietal lobe Taste Temporal lobe Smell Hearing Memory Emotional expression Occipital lobe Language Visual interpretation Cranial nerves:
CN I II DYSFUNCTION Decreased sense of smell Decreased visual acuity and visual fields INTERVENTIONS Is often accompanied by impaired taste and weight loss Frequent reorientation to environment. Position objects around client in deference to visual impairment Intermittent eye patching Lubricate eyes to protect against corneal abrasions Caution in shaving and mouth care. Choose easy to chew foods with high caloric content. Protect corneas from abrasion by using lubricant Oral hygiene. Account for decreased food intake. Cosmetic approach to hiding facial weakness. SAFETY! Move slowly to prevent nausea and emesis. Assist ambulation

III Double vision IV,VI (diplopia) V Decreased facial sensation Inability to chew Decreased corneal reflexes

VII Facial weakness and decreased taste(ant. tongue) VIII Hearing loss, imbalance, vertigo, tinnitus IX X XI

Dysarthria, Dysphagia, Maintain airway. Prevent aspiration. cardiac and respiratory Swallow therapy instability Inability to turn Mobility aids. Physical therapy shoulders or turn head from side to side Maintain airway. Prevent aspiration. Swallow therapy

XII Dysarthria, dysphagia

Brainstem (Midbrain , Pons , Medulla) Medulla Oblongata - Apneustic center. Potent stimulus is hypoxia. Cerebellum- Coordination of movement Pituitary Gland - the master gland Neurons-the functional unit of the Nervous system wrapped by myelin sheath. Choroid plexus-Responsible for the production of CSF. EENT: Ophthalmoscopic Test Examination of the eye that combines an ophthalmoscope and a lens for observing minute structures in the cornea , iris and fundus. Tonometer applied to cornea-measures IOP Normal: 12 21 mmHg

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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IOP increased in glaucoma Snellens Chart Normal: 20/20 Assesses visual acuity The higher the denominator, the poorer the vision GENERAL NURSING CARE FOR EYE SURGERY PRE-OPERATIVE: -Explain procedures -Allow verbalization of feeling and expectations -Teach post-op care POST-OPERATIVE NURSING CARE Lie on unoperated side Avoid constipation Avoid sneezing and coughing Neck Hyperextension Report any sudden sharp pain Avoid sensory deprivation Nutrition Innervation: ALL Extraocular muscle-innervated by CN III EXCEPT: Superior Oblique-Trochlear nerve Lateral Rectus-Abducens nerve Larynx-the voice box Phonation (Voice formation)-the most complicated function of the larynx. Epiglottis-The structure that overhangs the larynx that prevents the foods from entering the larynx and the trachea while swallowing. S.Mutans and S.Viridans-two of the normal flora of the oral cavity implicated in the causation of bacterial endocarditis. Respiratory: Chest X ray A radiograph made by projecting xrays through organs or structures of the body onto the photographic film. Sputum Exam Sputum coughed out first thing in the morning and specimen sent to the laboratory. Done for three consecutive mornings. Mantoux Test (Tuberculin Test) Administration of Intradermal injection of a purified protein derivative of the tubercle bacilli. RESULT READ AFTER 48 TO 72 HOURS-a hardened ,raised , red area of 8 to 10 mm is a positive reaction. ABG This test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample ABG normal values PaO2 80-100 mmHg PaCO2 35-45 mmHg pH 7.35- 7.45 HCO3 22- 26 mEq/L O2 Sat 95-99% Vibraessae-group of hair in the nostrils use to filter the inspired air . Mucociliary escalator-group of fine cells called cilia continuously moving bringing the minute dirt and mucus accessible for expectoration. TURBINATE BONES ( CONCHAE) INCREASE THE MUCOUS MEMBRANE SURFACE OF THE NASAL PASSAGES AND SLIGHTLY OBSTRUCT THE AIR FLOWING THROUGH THEM. TRAPS DUST WARMS INSPIRED AIR Pneumocytes: Type I responsible for the lining of the lungs and alveoli Type II-responsible for the secretion of surfactants Type III resposible for the natural defense of the lungs.

Surfactants Certain lipoproteins that reduce the surface tension of pulmonary fluids , allowing change of gases in the alveoli and contributing to the elasticity of the pulmonary tissue. Lecithin Spingomyelin ( Normal ratio - 2:1). Alveoli Small outpouching of walls of alveolar space through which gas exchange takes place. Cardiology ECG Measurement of the electrical current spread into the tissues surrounding the heart. Depolarization - reversal of the resting potential in excitable cell membranes when stimulated Repolarization - the return to resting potential. P wave- Atrial depolarization QRS complex- potentials generated when the ventricles depolarize prior to contraction T wave- ventricular repolarization. PR interval the duration between the beginning of the P wave and the beginning of the QRS complex.. Q-T interval-contraction of the ventricles lasts almost from the beginning of the Q wave to the end of the T wave.

Laboratory Tests: Creatinine Phosphokinase (CPK-MB) A blood test used to detect damage to the heart muscle, skeletal muscle and brain. Lactate Dehydrogenase (LDH) Measures anaerobic carbohydrate metabolism and as one of the several serum indicators of MI and muscular dystrophies. Troponin Test Measures level of cardiac troponins to differentiate cardiac from non-cardiac chest pain. Purposes: Evaluating patients with unstable angina Detecting reperfusion after coronary recanalization Estimating MI size Detecting MI perioeperatively

Gastrointestinal System GUAIAC TESTS (Occult Blood Test) Common practices are the following; for 3 days before the test and during the stool collection period: High fiber content. Avoid red meat in the diet. Avoid food with a high peroxide content: Turnips Cauliflower Broccoli Horseradish Melon. Avoid : Iron preparations Iodides Bromides Aspirin NSAIDs Vitamin C supplements greater than 250 mg/day Hydrogen Breathe Test

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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Measures the amount of hydrogen produced in the colon,absorbed in the blood,and then exhaled in the breath. NPO 12 hours before the procedure. The patient should not smoke after midnight before the test. NO Antibiotics and laxative / enemas 1 week before the test. UPPER GASTROINTESTINAL SERIES AND SMALL BOWEL SERIES Upper GI series and small-bowel series are fluoroscopic x-ray examinations of the esophagus, stomach, and small intestine after the patient ingests barium sulfate. As the barium passes through the GI tract, fluoroscopy outlines the GI mucus and organs. Double-contrast studies administer barium first followed by a radio lucent substance, such as air, to produce a thin layer of barium to coat the mucusa. Important: Explain procedure to patient. Instruct patient to maintain low-residue diet for 2 to 3 days before test and a clear liquid dinner the night before the procedure. Emphasize NPO after midnight before the test. Patient will be instructed at various times throughout the procedure to drink the barium (480 to 600 mL). Instruct the patient that stool will be light in color for the next 2 to 3 days from the barium. BARIUM ENEMA Fluoroscopic x-ray examination visualizing the entire large intestine. Can visualize structural changes, such as tumors, polyps, diverticula, fistulas, obstructions, and ulcerative colitis. Air may be introduced to provide a double-contrast study. Explain to the patient: What the x-ray procedure involves. That proper preparation provides a more accurate view of the tract and that preparations may vary. ULTRASONOGRAPHY 1. A noninvasive test focuses high-frequency sound waves to obtain an image of the structure. 2. Ultrasound can detect small abdominal masses, fluid-filled cysts, gallstones, dilated bile ducts, ascites, and vascular abnormalities. 3. Ultrasound with Doppler for vascular assessment. NURSING AND PATIENT CARE CONSIDERATIONS Abdominal ultrasound usually requires the patient to be NPO for at least 6 hours before the procedure. Change position of patient, as indicated, for better visualization of certain organs ENDOSCOPIC PROCEDURES Endoscopy is the use of a flexible fiberoptic tube to visualize the GI tract Endoscopes contain multipurpose channels that allow for air insufflation, irrigation, fluid aspiration, and the passage of special instruments. Other functions include: Biopsy or cytology of lesions Removal of foreign objects or polyps Control of internal bleeding Opening of strictures. Important: An IV sedative will be administered. A plastic mouthpiece will be used to help relax the jaw and protect the endoscope.

The patient may be asked to swallow once in a while as the endoscope is being advanced. Air is inserted during the procedure to permit better visualization of the GI tract. Keep patient NPO until patient is alert and gag reflex has returned. May resume regular diet after gag reflex returns and tolerating fluids. PROCTOSIGMOIDOSCOPY AND COLONOSCOPY Visualization of the anal canal, rectum, and sigmoid colon through a fiberoptic sigmoidoscope. The patient must be NPO after midnight. Use of Enemas containing neomycin to decrease the bowels bacteria count . Kayexalate enema to decrease the serum potassium level) To soften the stool ( oil-retention enemas) To relieve gas( tidal,milk and molasses,or fleet enemas) Endocrine Growth hormone 2. Prolactin 3. Gonadotrophins- LH and FSH 4. Stimulating hormones and trophic hormones ACTH TSH MSH Stores and releases 1. OXYTOCIN 2. ADH/Vasopressin Growth Hormone (Somatotrophic Hormone) Causes growth of almost all cells and tissues of the body. Promotes mitosis and cell size an specific differentiation of certain types of cells. Prolactin Promotes development of the breasts and secretion of milk Gonadothrophs LH Plays important role in ovulation Secretion of female sex hormones by the ovaries and testosterone by the testes. FSH Causes growth of follicles in the ovaries prior to ovulation Promotes sperm formation in the testes. Adrenals:CORTEX Secretes three types of STEROID hormones 1. Glucocorticoids Cortisol, cortisone and corticosterone 2. Mineralocorticoids Aldosterone 3. Sex hormones Estrogen and testosterone ADRENAL MEDULLA Secretes Adrenergic Hormones: Epinephrine Nor-epinephrine Pancreas (Endocrine) ALPHA - GLUCAGON BETA - INSULIN DELTA - SOMATOSTATIN F Pancreatic polpeptide The Ovaries contains Granulosa and Theca cells which secrete ESTROGEN and Progesterone The testes contains Leydig cells that secrete Testosterone Radio-Active iodine uptake (RAI) Measures the absorption of the injected iodine isotope by the thyroid tissue Increased uptake may indicate HYPERfunctioning gland

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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Decreased uptake my indicate HYPOfunctioning gland Thyroid Scan Performed to identify nodules or growth in the thyroid gland Pretest Check for pregnancy Thyroid medication may be withheld temporarily NPO Post-test Ensure proper disposal of body wastes FASTING BLOOD GLUCOSE Aids in the diagnosis of Diabetes (Screening) Pre-test: NPO for 8 hours Normal FBS- 80-109 mg/dL Glycosylated Hemoglobin A 1-C Blood glucose bound to RBC hemoglobin Reflects how well blood glucose is controlled for the past 3 months FASTING is NOT required! N- 4-7% Good control- 7.5%or less Fair control- 7.5 % to 8.9% Poor control- 9% and above Thyroid Growth CNS maturation and development BMR regulation Stroke volume increased Circulation Fat Metabolism CHO metabolism VIT D:

Advise client to eat Vitamin D rich foods Place a tracheostomy set, O2 & suction machine at bed side Active form is 1,25-dihydroxycholecalciferol

Calcitonin Facilitates Ca reabsorption in the kidneys Increases Ca absorption in the GIT Synthesized and secreted by parafollicular cells of the thyroid Secretion is stimulated by an increase in serum Ca Inhibits bone resorption Urine testing for glucose Benedicts test Ketones ONLY Regular insulin can be used INTRAVENOUSLY

IMPORTANT: Insulin is administered at home subcutaneously Cloudy insulin should be thoroughly mixed by gently inverting the vial or ROLLING between the hands Select syringes that match the insulin concentration. U-100 means 100 units per mL Instruct the client to draw up the REGULAR (clear) Insulin FIRST before drawing the intermediate acting (cloudy) insulin SOMOGYI EFFECT Nocturnal hypoglycemia followed by rebound hyperglycemia Due to the production of counter regulatory hormones- glucagon. cortisol and epinephrine Hematology Delivers nutrients,hormones O2 to tissues Collect and dispose wastes from the cellular metabolism RBC Responsible for carrying O2 and CO2 between the lungs and tissues via the hemoglobin Biconcave, disc-shaped NO nucleus. WBC Colorless, nucleated ,primary function is for protection against invading microorganism Functions: Phagocytocis Immunocytes B and T lymphocytes Plasma Cells (BM) Life Span of 1 week. WBC Differential: Neuts: infection, inflammation, stress Eosin: allergies Baso: polycythemias, allergic reactions Monos: Lymphoproliferative disorders, some leukemias Lympho: infection, immunodeficiencies, lymphoproliferative disordes, leukemia Hemoglobin Heme-the O2 carrying component of Hemoglobin Globin-bound to Iron Sites of Blood components formation Liver - active fro 5 to 6 weeks to 6 months AOG Spleen -active 4 to 8 months AOG BM -active at 5 moths AOG and becomes the primary site from 7 month AOG and thereafter.

Hypothyroidism DOC-Levothyroxin( Synthroid) -should be taken on an empty stomach LOW calorie, LOW cholesterol and LOW fat diet Manage constipation appropriately Provide a WARM environment Avoid sedatives and narcotics Instruct patient to report chest pain promptly Hyperthyroidism Exophthalmos-The least seen yet he most pathognomonic in hyperthyroidism Goiter-the most common manifestation PTH Actions: o Increases bone resorption o Inhibits renal PO4 reabsoprtion (Phosphaturic effect). o Increases renal Ca reabsorption o Increases intestinal absorption of Ca Parathyroid hormone regulates serum calcium levels HYperparathyroidism Increased serum Ca level Decreased serum PO4 Increase bone resorption Hypoparathyroidism Numbness and tingling sensation on the face (+) Trosseaus and Chvosteks signs Bronchospasms, laryngospasms, dysphagia Cardiac dysrhythmias Hypotension TO DOs: Place a tracheostomy set. O2 tank and suction at the bedside Prepare CALCIUM gluconate Provide a HIGH-calcium and LOW phosphate diet

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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Vertebrae, Sternum,Iliac bones, Skull, and long bones .

ANEMIA

Kinds:

Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA
MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTATIC Suffix SARCOMA / CARCINOMA Processes Involved Point mutation - Change in a gene occurring spontaneously affecting the expression of the gene. Deletion - Loss of a piece of a chromosome. STEPS: INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy Etiology of Cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs Benzene 3. Genetics and Family History Colon Cancer Breast cancer 4. Dietary Habits Low-Fiber High-fat Processed foods Alcohol 5. Viruses and Bacteria DNA viruses- Hepa B, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV Bacterium- H. pylori 6. Hormonal agents DES OCP especially estrogen 7. Immune Disease AIDS Tumor Characteristics Differentiation extent to which the parenchymal cells resemble comparable normal cells both morphologically and functionally. Anaplasia-Marked morphologic and functional changes. Pleomorphism-variation in size and function Rate of Growth Local Invasion The growth of Cancer cells are accompanied by progressive infiltration , invasion , and destruction of the surrounding tissue. ` The Spread of Primary Cancer in Another Organ Made Possible: Direct seeding into body cavities or surfaces Lymphatics Hematogenous Diagnostic Evaluation Complete medical history PE Biopsy Estrogen and Progesterone levels CBC Platelet count Blood Chem

Iron Deficiency Anemia Folate Deficiency Anemia Aplastic Anemia Pernicious Anemia Duodenum and Upper Jejunum-site of Iron Absorption Fe Deficiency Anemia(Microcytic, hypochromic anemia) Most common Anemia Causes: Chronic Blood Loss Bleeding FOLATE DEFICIENCY ANEMIA (MEGALOBLASTIC ANEMIA) Causes Poor dietary intake Alcoholism Anorexia nervosa Malignancy Pernicious Macrocytic, hyperchromic anemia A progressive megaloblastic macrocytic anemia that results from the lack of intrinsic factor resulting to disorder in RBC maturation. May be caused by certain drugs as: Colchicine Neomycin Cimetidine Hormonal contraceptives Schillings Test Most definitive diagnostic test to note absorption of Vit B12.

To Do:

Vitamin B12 IM Iron therapy Blood transfusion as needed Physical examination every six months *At risk for Gastric Cancer Aplastic anemia Hypoplasia of the bone marrow resulting to PANCYTOPENIA Anemia Leukopenia Thrombocytopenia Causes Congenital Acquired Idiopathic Infections Medications Heavy metals Cellular Growth and Differentiation Repair of Tissues -Needs nutrients as Vitamins ACE Iron and Protein. Regeneration - Same cell type replacement after injury or Apoptosis. Fibroplasia - Replacement by connective tissue. Hypertrophy- Compensatory mechanism as a result of increased workload as exemplified by Ventricular hypertrophy in CHF. Apoptosis - Programmed cell death to balance cell proliferation. Metaplasia - Metaplasia-the reversible conversion of normal tissue cells into another Anaplasia - Loss of normal cell differentiation .A characteristic of a tumor cell. Pleomorphism-variation in size and function Cancer Normal mechanism and proliferation of cells are disturbed which results in distinctive morphologic alterations of the cell and aberrations in tissue patterns. BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

Suffix- OMA Adipose tissue- LipOMA

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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 Imaging Procedures Screening Male and female- Occult Blood, CXR, and DRE Female- Breast Examination, Mammography and Paps Smear Male- DRE for prostate, Testicular self-exam Nursing Assessment Utilize the ACS 7 Warning Signals CAUTION C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression Presence of mass Non-healing wounds Presence of discharge The American Joint Committee of Cancer (The TNM Classification) T-Primary tumor Tx-Primary tumor unable to assess TO-NO evidence or Primary tumor Tis-Carcinoma in Situ T1,T2,T3,T4- Increasing size and or local extent of primary tumor N - Presence or absence or regional lymph node involvement Nx - Regional lymph nodes are unable to assess NO - No regional lymph node involvement N1,N2,N3 - Increasing involvement of regional lymph nodes M - Absence or presence of distant metastases Mx - Unable to assess Mo - Absence of distant metastasis M1 - Presence of distant metastases Management Depends on type of malignancy histologic cell type, stage, presence of metastasis and condition of the patient. BIOPSY Fine Needle Aspiration Biopsy-Tissue is obtained by application of suction through a needle attached to a syringe. Core needle biopsy Needle biopsy with a large hollow needle.Highly accurate and done in OPD Incisional Biopsy of a selected portion of a lesion. Excisional Biopsy of tissue removed by surgical cutting. Treatment and Types of Surgical Procedures Primary treatment Removal of tumor with margin Local excision- for small-sized mass Wide excision -For bigger sized mass Adjuvant treatment- In addition to the treatment rendered. Debulking Therapy may be bone prior to surgery to lessen the mass size and bleeding tendency. Salvage treatment -The use of an extensive surgical approach to treat a local recurrence after implementing a less extensive primary approach. Palliative Treatment - A control NOT a treatment Reconstructive or Rehabilitative Preventive or Prophylactic Chemotherapy Intent is to destroy as many tumor cells as possible with minimal effect on healthy cells An induction for advanced disease with no alternative treatment exists Adjunct therapy Cell Cycle G1 (Gap 1 )-RNA and CHON synthesis

S (Synthesis)- DNA component doubles in preparation for cell division G2 (Gap 2 Phase ) - CHON and RNA synthesis occurs M (mitosis) phase - Divides in 2 identical daughter cells GO - Resting, refractory to chemotherapy. Therapeutic Strategies Adjuvant therapy Neoadjuvant therapy - Administration of several courses of chemotherapy before definitive surgical intervention. High dose /Intensive therapy Administered in the BM Preoperative Chemotherapy Done prior to surgery Adverse Effects of Chemotherapy Alopecia Anorexia Renal /hepatic d/o Mucositis Anemia Neutropenia Thrombocytopenia

MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water Nursing Intervention MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color Chemotherapy General Effects: Assessment : Integumentary Pain Swelling Rashes Skin pigmentation Taste changes Stomatitis if present Gastrointestinal DHN Nausea and vomiting Electrolyte Imbalance Anorexia Jaundice Liver enzymes,liver function tests and total bilirubin Hematopoietic Disorder Anemia Color, Turgor, capillary refill Presence of Dyspnea,fatigue,weakness,vertigo Provide frequent Rest Periods Neutropenia Assess signs of infection Adventitious breath sounds Fever Thrombocytopenia<20thou Assess skin Stool,urine,gums Respiratory and Cardiovascular System Assess: Lung sounds Pulmonary fibrosis (Age>60,Has had pulmonary radiation,Bleomycin or with preexisting lung disease) Cardiac studies before administering Doxorubicin and Cyclophosphamide (Cardiotoxic) Neuromuscular Paresthesia DTR GUT

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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Monitor UO BUN Crea

We make our world significant by the courage of our questions and by the depth of our answers.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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