Top 40 Drugs and Nle Feedbacks

TOP 40 DRUGS
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1. ACETAMINOPHEN (Tylenol)
EFFECTS: Analgesic (mild to moderate pain) Antipyretic NO anti-inflammatory effect NO platelet effect THERAPEUTIC LEVEL: 10 30 mg/dL ANTIDOTE: Acetylcysteine (Mucomyst) ADVERSE EFFECTS: hepatotoxic
2. AMINOGLYCOSIDES
STREPTOMYCIN/ GENTAMYCIN Obtain Peak and trough level o Peak level 30 minutes after taking the drug o Trough level 30 minutes before the next dose Adverse effects: Neurotoxic Ototoxic therapeutic to Menieres disease to relieve from vertigo (but this is the last resort because it will lead to permanent deafness) Nephrotoxic Monitor BUN
3. ANESTHESIA
REGIONAL Epidural anesthesia o Given in epidural space o side effect: Hypotension Spinal anesthesia (Sub-Arachnoid Block/ intrathecal) o Given in subarachnoid space o side effect: Spinal headache
GENERAL Intravenous Inhalational
4. ANTICOAGULANTS AND THROMBOLYTICS

Action Onset Use WARFARIN SODIUM (Coumadin) Blocks vitamin K and clotting factors synthesis thus preventing prothrombin formation*** 2 to 5 days Thrombosis and embolism Atrial fibrillation with embolization Adjunct treatment of coronary occlusion Oral Milligrams Vitamin K/ Phytonadione (AquaMEPHYTON) Prothrombin time (PT) Normal value:11 to 15 seconds HEPARIN (Hepalean) Blocks conversion of prothrombin to thrombin 30 seconds to 1 minute Thrombosis and embolism Prevention of clotting in heparin lock sets, blood samples and during dialysis Treatment of disseminated intravascular coagulation SQ, IV (DO NOT give IM, may lead to hematoma and pain) Units Protamine sulfate Partial Thromboplastin Time (PTT) Normal value: 60 to 70 seconds; 2 to 2.5 times the control Activated Partial thromboplastin time (APTT) Normal value: 30 to 45 seconds; 1.5 to 2 times the control Short term therapy Quick
Route Expressed in Antidote Laboratory test
Usage Effect
Long term therapy Slow
Coumadin and Heparin CAN BE GIVEN together Heparin-induced side effect: thrombocytopenia*** WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF ANTICOAGULANTS? 4A Aspirin, Antihistamines, Alcohol, Antibiotics 5G Ginseng, Garlic, Ginger, Ginko biloba, Guiafenesin ANTICOGULANT prevents clot formation THROMBOLYTICS dissolves clot USE: pulmonary embolism, coronary artery thrombosis, DVT, MI SIDE EFFECT: bleeding NURSING CONSIDERATIONS:
1 | TOP DRUGS Prepared by: Brian Yu, 09175262468
Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react poorly to streptokinase*** Heparin is discontinued before streptokinase is started IM injections are contraindicated ANTIDIOTE: aminocaproic acid (Amicar) Examples: streptokinase (Streptase) PROTOTYPE; alteplase (Activase), urokinase (Abbokinase), reteplase (Retavase), tenecteplase (TNKase), anistreplase (Eminase)
5. ANTI DEPRESSANTS
2 weeks interval in shifting from one type of anti-depressant to another Antidepressant effect: 2 4 weeks Problem in DEPRESSION: Decrease norepinephrine Decrease serotonin 3 common groups: (1) TCA (2) SSRI (3) MAOI Tricyclic Antidepressants (TCA) increases norepinephrine and/or serotonin in CNS by blocking the reuptake of norepinephrine by presynaptic neurons 1. Imipramine (Tofranil) 2. Amitriptyline (Elavil) SIDE EFFECTS: hypotension, arrhythmias, blurred vision, constipation, urinary retention, dry mouth NURSING CONSIDERATIONS: Check BP and PR Give drug at BEDTIME Changing from TCA to MAOI, patient must discontinue TCA for 14 days 2 to 4 weeks needed before the full therapeutic effect happens TCA OVERDOSE (anticholinergic toxicity): o Coma, convulsion o Ataxia, agitation o Stupor, sedation
Selective Serotonin Reuptake Inhibitor (SSRI) inhibits CNS neuron uptake of SEROTONIN*** (thus increasing the level of serotonin); DOES NOT AFFECT norepinephrine 1. Fluoxetine (Prozac) 2. Sertraline (Zoloft) SIDE EFFECTS: hypotension, headaches, arrhythmias, insomnia, dry mouth, weight loss, sexual dysfunction NURSING CONSIDERATIONS: o Give drug in the MORNING o Takes 4 weeks for full effect o Changing from MAOI to SSRI, patient must discontinue MAOI for 2 weeks o Changing from SSRI to MAOI, patient must discontinue SSRI for 5 weeks o Monitor for weight o Provide oral hygiene
Monoamine Oxidase Inhibitor (MAOI) acts as a psychomotor stimulator or psychic energizers; blocks oxidative deamination of naturally occurring monoamines (epinephrine, norepinephrine, serotonin) causing CNS stimulation 1. tranylcypromine (Parnate) 2. isocarboxazid (Marplan) 3. phenelzine (Nardil) SIDE EFFECTS: Hypertensive crisis happens if the drug is taken with tyramine-containing foods o S - weating C - onstipation o H - eadache, HPN O - rthostatic hypotension o U - rinary retention P - hotophobia, dilated pupils o N - ausea, Neck stiffness A - granulocytosis o T - achycardia AVOID tyramine or tryptophan containing foods: o Aged meat, avocado o Banana, beans o Chocolates, coffee, cheese (cheddar, aged, swiss), chicken and beef liver o Drinks that are fermented (wine, beer) o o o o o o Smoked fish, soy sauce, sour cream, sausage Pickled foods (herring) Overripe foods Raisins Tea Yogurt, yeast
ALLOW: cottage and cream cheese***

Monitor BP Therapeutic effect are achieved within 10 days to 4 weeks
6. ANTI-GOUT COLCHICINE (Novocolchine) NSAID anti-inflammatory

o o SIDE EFFECTS: diarrhea, abdominal cramps NURSING CONSIDERATIONS: DO NOT give IM or SQ, this may lead to irritation Administer drug after meals No more than 12 tablets should be given in a 24 hour period
ALLOPURINOL (Zyloprim) prevent production of uric acid by inhibiting the enzyme xanthine oxidose
o o USE: prophylactic for attacks of gout; clients with calcium oxalate calculi SIDE EFFECTS: hepatotoxic
PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) uricosuric agents

o DRUGG OF CHOICE to reduce serum uric acid by increasing its renal excretion
7. ANTI-PARKINSONS
Problem in PARKINSONS: Decrease DOPAMINE Increase ACETYLCHOLINE Dopaminergic Drugs (increase dopamine) 1. Amantadine (Symmetrel) 2. Levodopa (L-dopa) 3. Levodopa-Carbidopa (Sinemet) Anticholinergic Drugs (decrease Acetylcholine) 1. Akineton 2. Cogentin 3. Artane 4. Benadryl
8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS)

USE: Schizophrenia 1. Haloperidol (Haldol) 2. Chlorpromazine (Thorazine) NURSING CONSIDERATIONS: Take drug AFTER meals*** SIDE EFFECTS: HYPOtension Agranulocytosis/ leukopenia (sore throat) serious side effect*** NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis, HYPERtension) pink-red urine (normal: thorazine)
9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID

4 EFFECTS: 1) Anti platelet reduce risk of myocardial infarction and transient ischemic attack 2) Anti-inflammatory rheumatic fever, Kawasaki disease, rheumatoid arthritis 3) Antipyretic fever 4) Analgesic mild to moderate pain ASPIRIN TOXICITY Tinnitus early sign of salicylism Metabolic acidosis late sign of salicylism Epistaxis, nephrotoxic NURSING CONSIDERATIONS: ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin) Give the drug with full stomach after meals Aspirin is ulcerogenic Monitor CBC, Prothrombin time, renal and liver functions If (+) ASA allergy, give other anti-platelet drug like Clopidogrel or Ticlopidine*** AVOID Aspirin in patients with viral infection to prevent Reyes Syndrome*** AVOID Aspirin with OHA causes hypoglycemia*** AVOID Aspirin with anticoagulant (Coumadin, Heparin) high risk for bleeding (additive effect)
10. ATROPINE SULFATE (Atropair, AtroPen)

MODE OF ACTION:
block neurotransmitter acetylcholine inhibits parasympathetic actions
USES: pre-op medication to reduce secretions and bradycardia; produces mydriasis CONTRAINDICATED in acute glaucoma***, prostatic hypertrophy NURSING CONSIDERATION: Check BP and PR
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11. BETA-BLOCKERS
2 TYPES:
SELECTIVE Beta 1 only Atenolol, metoprolol (Lopressor) NON-SELECTIVE Beta 1 and 2 propanolol (Inderal), timolol (Blocadren),
MODE OF ACTION: inhibit or blocks sympathetic stimulation of beta receptors in the*** HEART decreasing myocardial oxygen consumption and demand by: decreases heart rate*** decreases force of myocardial contraction EYES decreases intraocular pressure (IOP) by: decreasing aqueous humor formation and increases aqueous humor outflow (such as glaucoma)
Change of position gradually Take pulse before taking drug***
12. BRONCHODILATOR
USE: bronchospasms, asthma EXAMPLES: BETA-ADRENERGIC: abuterol (Proventil, Ventolin), metaproterenol (Alupent) XANTHINES: theophylline (Theo-Dur) PROTOTYPE, aminophylline (Truphylline) THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 20 mcg/ml SIGN OF THEOPHYLLINE TOXICITY: Tachycardia nausea and vomiting FOODS TO BE AVOID: ICE TEA caffeine and caffeine containing foods because Theophylline is a xanthine derivative which has same effect with caffeine
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13. CLOPIDOGREL (Plavix)/ Ticlopidine (Ticlid) ANTIPLATELET***
USE: prevent blood clots by inhibiting platelets to coagulate*** INDICATION: heart attack, stroke, or vascular diseases NURSING CONSIDERATION: Take with 1 full glass of water Can be take with or without food AVOID: Alcohol Coumadin, Heparin
14. CHEMO DRUGS

Methotrexate (folic acid antagonists) - inhibits DNA (protein) synthesis causing cell death do not give together with Vitamin B9 Tamoxifen is the primary hormonal agent used in breast cancer treatment today. NURSING INTERVENTIONS FOR CHEMOTHERAPEUTIC SIDE EFFECTS
SIDE EFFECTS Nausea and vomiting Constipation Diarrhea Pruritus/ urticaria Stomatitis Alopecia Skin pigmentation Nail changes Anemia NURSING INTERVENTIONS Administer antiemetics befoore chemotherapy; Withhold food and fluids for 4 to 6 hours before treatment Increase fluids and fiber intake Replace fluids, low fiber diet Provide good skin care Provide good oral care (water/ NSS); avoid hot and spicy food Reassure that it is temporary; encourage to wear wigs, hats or head scarf Reassure that it is temporary Reassure that nails may grow normally after chemotherapy Bed rest; provide frequent rest periods 4 | TOP DRUGS Prepared by: Brian Yu, 09175262468
Neutropenia Thrombocytopenia Hemorrhagic cystitis Urine color changes
Protect from infection; AVOID crowded places; fresh fruits and raw foods Bleeding precaution AVOID aspirin and anticoagulants, bruising, use of straight razors; USE a soft-bristle toothbrush Provide 2 to 3 liters fluids per day Reassure that it is harmless
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15. DIAZEPAM (Valium)
USE: Drug of choice for status epilepticus*** EFFECTS: Anxiolytic Anti-convulsant Muscle relaxant NURSING CONSIDERATIONS: DO NOT MIX with other drugs DO NOT withdraw abruptly AVOID alcohol, smoking, activities that requires alertness May cause physical dependence Oral form should be given BEFORE MEALS*** Examples: alprazolam (Xanax), clorazepate (Tranxene), flurazepam (Dalmane), midazolam (Versed), triazolam (Halcion), chlordiazepoxide (Librium), clonazepam (Klonopin), lorazepam (Ativan)
16. DIGOXIN (Lanoxin)

Effects: o (+) inotropic increases FORCE OF CONTRATION increase cardiac output increase kidney perfusion increase urine output o (-) chronotropic decreases HEART RATE decrease oxygen demand of the heart muscles*** Digoxin toxicity nausea, yellow color vision, arrhythmia, sign of hypokalemia (weakness, muscle cramps) 3 parameters to check BEFORE giving Digoxin: 1) Heart rate (apical pulse)* 2) Serum potassium 3) Serum Digoxin level Urine output sign of drug effectivity*** Antidote: Digoxin immune Fab (Digibind)
17. DIURETICS
CLASSIFICATIONS Potassium Sparing K-SPARING SITE OF ACTION*** Distal tubule EXAMPLES Spironolactone (Aldactone) Amiloride (Modiuretic, Midamor) Triamterene (Dyrenium) INDICATIONS Mild diuretic, CHF, HPN SPECIAL NURSING INTERVENTIONS Avoid potassium-rich foods (banana***, potatoes, spinach, broccoli, nuts, prunes, tomatoes, oranges, peaches, papaya)
Carbonic Anhydrase Inhibitors (CAI) Loop Diuretics Osmotic Diuretics K-WASTING Thiazide and Thiazide-like
Proximal tubule Loop of Henle Glomerulus
Acetazolamide (Diamox) Furosemide (Lasix) Bumetanide (Bumex) Mannitol Osmitrol Glycerin Urea Hydrochlorothiazide Chlorothiazide (Diuril) Metolazone
Menieres disease, OPEN glaucoma Severe edema and HPN Increased ICP
Fastest diuretic to take effect Warm solution to avoid crystallization
Distal tubule
HPN (Not effective for immediate dieresis)
Electrolytes removed through diuretics:
potassium, calcium, sodium***
NURSING CONSIDERATIONS: 1. Monitor blood pressure (first/ before) and weight (second/ after) 2. Administer in the MORNING 3. Administer with FOOD EVALUATION: for effectiveness of therapy
Weight loss Increased urine output Resolution of edema Decreased congestion Normal BP
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18. EPINEPHRINE
Ideal drug for cardiac arrest Drug of choice for STATUS asthmaticus Therapeutic property for bronchial asthma and anaphylactic shock: bronchodilation effect Epinephrine + anesthesia prolongs the function of anesthesia
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19. GASTRIC DRUGS
Classifications: Cytoprotective agents coats/ cover the gastric lining (give BEFORE meals) Histamine2 blockers decrease hydrochloric acid production (give WITH meals) Antacid neutralize gastric acidity (give AFTER meals) Proton Pump Inhibitor decrease hydrochloric acid production (give BEFORE meals) Best time to give these drugs: at bedtime
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20. HERBAL DRUGS that cause BLEEDING
GINKO BILOBA GINGER GARLIC GINSENG
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21. IMCI DRUGS: IRON
1 dose daily x 14 days
TABLET Ferrous sulphate 200mg + 250 mcg Folate (60 mg elemental iron) SYRUP Ferrous sulphate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml (1/2 tsp) 4 ml (3/4 tsp) tablet 1 tab 5 ml (1 tsp) 7.5 ml (1.5tsp) DROPS Ferrous sulphate 25 (25 mg elemental iron per ml) 0.6 ml 1 ml 1.5 ml 2 ml AGE or WEIGHT
2 to 4 months (4 to <6 kg) 4 to 12 months (6 to <10 kg) 1 to 3 years (10 to <14 kg) 3 to 5 years (14 to <19 kg)
22. IMCI DRUG: VITAMIN A

AGE 6 months to 12 months 12 months to 5 years 1 2 capsules VITAMIN A CAPSULES 100,000 IU capsule 1 capsules 200,000 IU
23. IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE

AGE or WEIGHT 12 months to 24 months 24 months to 59 months Albendazole 400 mg tablet or 200 mg tablet 1 Mebendazole 500 mg tablet 1 1
24. INSULIN
MODE OF ACTION: decreases blood sugar by Increasing glucose transport across cell membranes Enhancing conversion of glucose to glycogen
TYPE ULTRA RAPID Lispro (Humalog), Aspart (Novolog) DESCRIPTION Route: SQ ONSET > 15 minutes PEAK 30 60 minutes DURATION 34 hours
RAPID-ACTING: Regular, Humulin R INTERMEDIATE-ACTING: NPH/ Neutral Protamine Hagedorn (Insulin Isophane Suspension), Humulin N LONG-ACTING: Ultralente (extended insulin zinc suspension) Humulin U
Color: Clear Route: IV, SQ Color: Cloudy Route: SQ
30 min 1 hr 1 2 hrs
2 4 hrs 6 8 hrs
6 8 hrs 18 24 hrs
Color: Cloudy Route: SQ
3 4 hrs
16 20 hrs
30 to 36 hrs
PEAK TIME time of hypoglycemic episodes 1 ml of insulin = 100 units of insulin U100 insulin syringe is 100 units Administer insulin in room temperature ROUTE: SQ 45 degree (for skinny patient)*** 90 degrees (for fat patients) Area: Abdomen fastest absorption Deltoid thigh buttocks AVOID: massage and apply compression (increase absorption) aspirate after injection shake. Gently roll vial in between palms Cold insulin lipodystrophy STORAGE: In room temperature last for 1 month Refrigerated once opened last for 3 months ADJUSMENT OF DOSE: increase insulin requirement Infection, Stress, Illness decrease insulin requirement Breast feeding (Antidiabetic effect) Mixing of insulin: (Aspirate 1st clear, Inject air 1st cloudy) (1) Inject air to NPH (2) Inject air to Regular (3) Aspirate Regular (4) Aspirate NPH Most common used: U100 (1) U40 (2)
25. IRON SUPPLEMENTS

SIDE EFFECTS: dark stools (tarry stool) constipation abdominal cramps Tablet: give with citrus juice (orange, tomato) Liquid: give with citrus juice (orange, tomato) and straw IM: Z-track method (DO NOT massage) BEST given with empty stomach (1 hour before meals*** or 2 hours after meals) Citrus juice is AVOIDED with iron elixir preparation
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26. LACTULOSE (Duphalac, Cephulac)
Laxative SIDE EFFECT: ammonia binder (therapeutic to patient with hepatic encephalopathy)***
27. LITHIUM
Anti-mania Therapeutic Level: 0.5 1.5 mEq/L*** Lithium toxicity (nausea and vomiting, anorexia, abdominal cramps, diarrhea) PREPARATIONS: o Tablets: 300, and 450mg. o Capsules: 150, 300, and 600 mg. o Syrup: 300 mg/5 ml
(NO parenteral preparation)*** Maintain diet:*** o increase fluid (3L/day) o Increase Na (3 gm/day)
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28. MAGNESIUM SULFATE
tocolytic agent USE: premature labor, anticonvulsants in pregnancy induced hypertension (PIH) Check: o deep tendon reflex (DTR) FIRST reflex lost with CNS toxicity o Check RR (at least >12 breaths/ min o Check urine output (at least 30 mL/ hr) Therapeutic level = 4 to 8 mg/dL ANTIDOTE: calcium gluconate
29. METRONIDAZOLE (Flagyl)

Anti-amoeba AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect)
30. MORPHINE SULFATE (Duramorph)

INDICATION: moderate to severe pain, pain relief in myocardial infarction and burns EFFECT: o induce sedation and euphoria o analgesia o anxiolytic o DECREASES preload and afterload o DECREASES workload o DECREASES Peripheral vascular resistance SIDE EFFECTS: Miosis Orthostatic hypotension Respiratory depression Produces tolerance and dependence Hyperglycemia Increase urinary retention/ constipation Nausea and vomiting Euphoria Sedation/ dizziness
NURING CONSIDERATIONS: Assess clients pain before giving medication Check before and after the respiration May lead to tolerance FIRST SIGN of tolerance is decrease duration of effect of the analgesic AVOID activities that require alertness, alcoholic beverages, smoking, CNS depressants, sedatives, muscle relaxants Change position gradually
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31. NITRATES AND NITROGLYCERINE (Nitro-bid, Nitrodur, Nitrostat IV)
MODE OF ACTION: vasodilator USE: angina pectoris and hypertension SIDE EFFECTS OF NITRATES: headache, flushing, orthostatic hypotension, dizziness Other Related drugs: isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur) SUBLINGUAL form: 0.15 0.6 mg No more than 3 tablets should be taken in a 15 minute period (one tablet every 5 minutes); if pain not relieved after 15 minutes and 3 tablets, notify physician immediately SIGN OF POTENCY: burning sensation under tongue Drink water first BEFORE taking drug OINTMENT applied to a hairless or clipped/ shaved area new site should be used with each new dose use ruled applicator paper that comes with ointment to measure dose wear gloves during application leave applicator on site and cover it with plastic wrap and secure it with tape TRANSDERMAL PATCH Apply a patch once a day only Rotate site Place patch in non-hairy area Determine a base region and remove the old patch Wear gloves during application IV form: 5 mcg/ min dilute IV nitroglycerine in 5% dextrose or 0.9% sodium chloride and titrate every 3 to 5 minutes STORAGE: store in original dark glass container in a cool, dry place. date bottle when opening discard after 6 months NURSING CONSIDERATIONS: Change position gradually to prevent dizziness HEADACHE is a sign that the drug is taking effect. It will discontinue with long term use. AVOID alcohol, hot baths Carry drug at all times DO NOT administer nitrates with sildenafil (Viagra), both drugs are vasodilator which may lead to HYPOTENSON
32. NONI JUICE

Scientific name: Morinda citrifolia High in fiber Use for diabetes clients
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33. OCTREOTIDE (SANDOSTATIN)***
Inhibits GROWTH HORMONE, GLUCAGON, INSULIN 2 formulations: Sandostatinis a short acting version Sandostatin LARis a long acting version.
Sandostatin subcutaneous injection*** It may be necessary to take the shot several times a day. The injection sites should be rotated regularly Sandostatin LAR intramuscular injection This medication is generally given once every 4 weeks Sandostatin LAR should NOT be given by S.C. or IV routes. The preferred site for injection is the hip, because it is painful given into the arm.
COMMON SIDE EFFECT: constipation***

34. OXYTOCIN (Pitocin)

stimulate uterine contraction USE: postpartum bleeding, labor induction ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias, tachycardia, hypertension Given IM or IV (IV via piggyback and delivered with an infusion pump) Observe fetal hypoxia or distress
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35. PANCREATIC ENZYMES
USE: aid in digestion; cystic fibrosis Give WITH MEALS*** Expected outcome of the drug is absence of steatorrhea*** EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym)
36. PHENYTOIN (Dilantin)

USE: seizure SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, or red-brown ADVERSE EFFECTS: hepatotoxic, Steven-Johnsons syndrome DO NOT administer IM Give drug with NSS BEFORE AND AFTER (flushing) drug administration Provide oral hygiene, Use soft, bristled toothbrush Takes 7 to 10 days to achieve therapeutic serum level Therapeutic level: 10 20 mg/ dl
37. PRE-OPERATIVE MEDICATIONS

PURPOSE: to facilitate anesthesia induction***
PRE-OP DRUGS MUSCLE RELAXANT MODEOF ACTION Relaxes smooth and skeletal muscles Examples Midazolam Diazepam Lorazepam Alprazolam Morphine sulfate Fentanyl citrate Codeine Diphenhydramine Atropine sufate Scopolamine Hydrobromide WATCH OUT BP
Avoid rapid injection to prevent shock
OPIATE AGONISTS (Narcotic analgesic) ANTICHOLINERGIC
Increases pain threshold thus needing lesser amount of anesthesia Decrease mucus and saliva production
RR
Antidote: naloxone (narcan) Causes constipation
HR
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38. STEROIDS
USE: bronchial asthma, Addisons disease, allergies Examples: hydrocortisone (Cortisol), prednisone (Strap red), dexamethasone (Decadron), methylprednisone (Solu- medrol), betamethasone (Celestone) THERAPEUTIC EFFECTS: Anti-inflammatory Hormonal replacement SIDE EFFECTS: Long term use: Adrenal insufficiency***, osteoporosis Short term use: Cushings syndrome: Immunosuppressant, hypokalemia, edema Immunosuppression therapeutic to AUTOIMMUNE DISEASES like nephrotic syndrome, SLE, multiple sclerosis, Rheumatoid arthritis, for organ transplant, hyperthyroidism, allergies) hypocalcemia, GI ulcer NURSING CONSIDERATIONS: Give with food Give in the morning (before 9 am) Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation) Watch out for infection Taper the dose (abrupt withdrawal may lead to acute adrenal crisis) Parenteral form: Give IM avoid SQ Oral form: Give it WITH food or milk, may cause gastric irritation Topical creams: DO NOT apply in broken skin and near eyes Wear medic alert bracelet Isolation precaution AVOID:
AVOID immobility to prevent osteoporosis AVOID crowd to prevent infection AVOID sunlight DIET: Restrict sodium, alcohol and caffeine; high potassium foods Carry extra medication during travel. Adjust medications during periods of acute or chronic stress such as pregnancy or infections; contact health care provider.
39. SYMPATHETIC AND PARSYMPATHETIC

SYMPATHETIC SNS (Adrenergic) Dumping Syndrome, MG Atropine Cholinesterase fight or flight response (BIOAMINE THEORY) Epinephrine (Adrenaline) faster release but short acting Norepinephrine Dopamine Serotonin (Increase) HR, RR, BP (Decrease) peristalsis, UO, secretions Pupil dilation (mydriasis) Bronchodilation Hyperglycemia PARASYMPATHETIC PNS (Cholinergic) Glaucoma, GERD Prostigmine Anticholinesterase Sleep and digest response Acetylcholine slowly release but long acting
(Decrease) HR, RR, BP (Increase) peristalsis, UO, secretions Pupil constriction (miosis) Bronchoconstriction Diarrhea Urinary frequency Miosis (constriction) Bradycardia Bronchoconstriction Erection/ emesis L Salivation
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40. THYROID AND ANTI-THYROID DRUGS
THYROID AGONISTS used to increase blood thyroid hormones LEVOTHYROXINE (Synthroid) USE: hypothyroidism (myxedema), cretinism (congenital hypothyroidism) SIDE EFFECTS: insomnia, tachycardia, diarrhea NURING CONSIDERATIONS: Taper the dose Monitor vital signs (temperature, BP, PR) Give the drug in the morning (due to insomnia side effect) CONTRAINDICATIONS: Cabbage, Cauliflower Peaches, Peas, Pears Raddish, turnips Spinach The normal maintenance dose of levothyroxine: adult is 0.1 to 0.2 mg daily infants 0 to 6 months of age is 0.025 to 0.05 mg daily children 1 to 5 years of age, 0.075 to 0.1 mg daily children 6 to 12 months of age, 0.05 to 0.075 mg daily.
THYROID ANTAGONISTS used to decrease blood thyroid hormones A. ANTITHYROID DRUGS inhibit synthesis/production of thyroid hormones*** Examples: propylthiouracil (PTU, Propacil, Propyl-Thyracil), methimazole (Tapazole) IODIDES inhibit secretion/ release of thyroid hormone; _ decrease vascularity of the thyroid gland (for thyroidectomy preparation) Examples: Potassium Iodide Saturated Solution (Lugols solution) Give at least 10 day before surgery
B.
SIDE EFFECTS: agranulocytosis (sore throat) paresthesias bleeding (inhibits vitamin K) Taper the dose Monitor vital signs (temperature, BP, PR)
AVOID iodine, iodine containing foods and sea foods ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration)
TOP 105 DISEASES AND HUMAN ANATOMY

(for NLE review)
In alphabetical order
*** Common Board Question
1. ABSENT MECONIUM PASSAGE within 24 hours after birth

Imperforate anus Hirschprungs disease Cystic fibrosis
2. ACROMEGALY
Increase growth hormone AFTER puberty Increase glucose level (high Growth hormone = high Glucose) S/Sx: Broad and bulbous nose Enlarged hands and feet Continuous grow of soft tissues (ear, nose) Macroglossia (large tongue)*** Complications Enlarged heart Diabetes mellitus Heart failure Reason of seeking for medical care: change in appearance*** Management: Octreotide (Sandostatin)*** SEE notes on TOP DRUGS give SQ if given 3x a week***
3. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

shock lung Non-cardiogenic pulmonary edema Pathophysiology: o Decreased surfactants o Decreased surface tension o Damage to alveolar-capillary membrane o Leakage of fluid into the ITS o Resulting to pulmonary edema S/Sx: o Dyspnea, retractions o Pulmonary edema o Crackles
4. ADDISONs and CUSHINGS DISEASE

ADDISONs All STEROIDS (S.S.S.) are DOWN except for Potassium MAIN PROBLEM and its manifestations DOWN: SALT (HYPONATREMIA) HYPOVOLEMIA DHN, weight loss HYPOTENSION UP: SALT (HYPERNATREMIA) HYPERVOLEMIA Edema (Moonface, Weight gain) HYPERTENSION DOWN: SUGAR (HYPOglycemia) UP: SUGAR (HYPERglycemia) CUSHINGs All STEROIDS (S.S.S.) are UP except for Potassium
DOWN: SEX HORMONES Decrease sexual urge or libido
UP: SEX HORMONES Decrease sexual urge or libido Virilization (mascularity in female) Amenorrhea, Hirsutism, Enlargement of clitoris 12 | TOP DRUGS Prepared by: Brian Yu, 09175262468
Osteoporosis Gynecomastia (males)
DOWN: Potassium HYPOKALEMIA Weakness, fatigue Bradycardia Constipation Metabolic alkalosis Flat T wave, presence of U wave***
UP: Potassium HYPERKALEMIA Weakness, fatigue Tachycardia, Arrhythmia Diarrhea Metabolic acidosis Tall/ Tented T waves YES steroids (pro-Na, anti-K) Monitor VS, I&O, weight DIET: high calorie, high CHO (glucose), high NA, low K
MANAGEMENT
NO steroids Monitor VS, I&O, weight DIET: low calorie, low CHO, low Na, high K, high CHON Reverse isolation* BILATERAL ADRENALECTOMY GIVE Calcium (for osteoporosis)
COMPLICATIONS
ADDISONIAN CRISIS/ ACUTE ADRENAL INSUFFICIENCY (COMA): severe headache or back pain, severe generalized, muscle weakness, diarrhea or constipation, confusion, lethargy, severe hypotension, circulatory collapse
Risk for infection Pathologic fracture*** Osteoporosis*** DM Arrhythmia
S.S.S (Sugar, Salt, Sex hormone) steroids Cushings disease prone to infection (isolate patient)***
5. AGE RELATED MACULAR DEGENERATION (AMD)

related to aging bilateral loss of CENTRAL vision with presentation of peripheral vision
6. ALPORTs SYNDROME
Hereditary Like AGN (acute glomerulonephritis) S/Sx: hematuria from start to finish Common: males Confirmatory diagnostic test: kidney biopsy DIET: decrease CHON
7. ANEMIA decrease oxygen carrying capacity of RBC

Common Nursing diagnosis: Activity intolerance*** Common S/Sx: F ainting F atigue F orgetfullness TYPES Iron-deficiency anemia (microcytic and hypochromic)*** S/Sx: koilonychia (spoon shaped fingernail)*** , pale and chubby Megaloblastic anemia (macrocytic and hyperchromic) Pernicious anemia immature RBC due to lack of vitamin B12 Folic Acid Deficiency anemia immature RBC due to lack of vitamin B9 Aplastic Anemia disorder of bone marrow decrease RBC, platelet, WBC
Sickle cell anemia sickled RBC Management for Sickle cell anemia:*** 1) H ydration 2) O oxygenation 3) P ain management
8. ANEURYSM is ballooning of the blood vessel

TYPES o Saccular one sided ballooning o Fusiform two sided ballooning (circumferential) o Dissecting a TEAR in the intima of the blood vessel*** Type A affects the ascending aorta Type B affects the descending aorta Complications: rupture/ internal hemorrhage/ shock
9. ANGINA PECTORIS: Management

2 GOALS IN ANGINAL MANAGEMENT: Goal # 1: Increase oxygen supply to the myocardium (vasodilation) Goal # 2: Decrease oxygen demand A. Nitrates Goal # 1 the mainstay for treatment of angina pectoris MODE OF ACTION: a. dilates the veins primarily (but in higher doses, it also dilates the arteries) b. causes venous pooling in peripheral body parts thus less blood returns to the heart and filling pressure (preload) is reduced Example: Nitroglycerin (Nitrostat, Nitrol, Nitrobid IV), Isosorbide mononitrate (Imdur), Isosorbide dinitrate (Isordil) Side effects: flushing, throbbing headache, hypotension, dizziness Keep drug only for 6 months, cool, dry and dark environment Carry all times DO NOT administer with Sildenafil (Viagra) AVOID: hot baths because it causes massive vasodilation Beta Blockers Goal # 2 Example: Propranolol (inderal), Metropolol (Lopressor), atenolol (Tenormin) MODE OF ACTION: Blocks the beta-adrenergic sympathetic stimulation of the heart thus reducing myocardial oxygen consumption*** Calcium Channel Blockers Goal # 1 and 2 Examples: Amlodipine (Norvasc), Verapamil, Nifedipine, Diltiazem (Cardizem), felodipine (Plendil) amlodipine and felodipine (Plendil) are the Calcium Channel blocker of choice for heart failure Antiplatelet and Anticoagulant Examples: aspirin, clopidrogel (Plavix), ticlopidine (Ticlid) MODE OF ACTION: prevents platelet aggregation clopidrogel (Plavix) or ticlopidine (Ticlid) is given to patients who are allergenic to aspirin***
B.
C.
D.
10. APPENDICITIS
Inflammation of the appendix LOCATION: RLQ/ right iliac/ Mc Burneys point CAUSE: due to obstruction from fecalith low fiber diet Obstruction of the appendix by a fecalith, inflammation, foreign body, or Neoplasm Increased intraluminal pressure Venous congestion, bacterial invasion Abscess, Infection, thrombosis Gangrene and perforation if untreated within 36 hours Peritonitis
MANIFESTATIONS: increase WBC, fever PECULIAR SIGNS: Rovsings sign pressure on the LLQ causes pain in the RLQ Mc Burneys sign pain at RLQ upon palpation Psoas sign pain on passive extension of right hip (lateral position with right hip flexion) Obturator sign*** pain with passive flexion and internal rotation of the right hip Blumberg sign rebound tenderness (peritonitis) (+) cough sign*** RLQ pain on coughing With pain inflammation Without pain rupture Tachycardia late sign Abdominal distention and paralytic ileus/ decreased or absent bowels sounds MANAGEMENT: Bed rest NPO PAIN management o ALLOW: cold application o AVOID: warm compress analgesics will mask the pain* Laxatives, enema, palpation increase peristalsis POSITION: o (acute phase) most comfortable position; Semi fowlers to relieve pain and discomfort o (rupture) upright Sx: Appendectomy o Position: flat on bed
11. ARNOLD-CHAIRI MALFORMATION

Related to neural tube defect S/Sx: o Swallowing difficulty o Weakening of the extremities o Stridor
12. ARTHRITIS
RHEUMATOID ARTHRITIS Autoimmune Degenerative disease (wear and tear) Common aggravating factor: obesity Systemic Onset JOINTS AFFECTED Chronic Small joints (wrist, elbow) Bilateral Women S/Sx Ulnar drift Boutenniere deformity proximal Swan neck deformity distal Sjogrens syndrome excessive dryness of eyes, mouth and vagina Feltys syndrome leukopenia, spleenomegaly Anemia*** Pain due to immobility Gold therapy Aspirin regularly (watch out for Non-systemic Chronic Weight bearing joints (hips, spine, knee, ankle) Unilateral/ progressive Not sex specific Heberdends distal Bouchards proximal Tophi/ podagra uric acid crystallization Elevated uric acid Non-systemic Acute Big toe, ankle OSTEOARTHRITIS GOUTY ARTHRITIS Metabolic (altered purine metabolism)
PAIN MANAGEMENT
Pain due to mobility W-weight control (decrease calorie) AVOID: organ meats, alcohol legumes, sardines DIET: low purine, high fluids 15 | TOP DRUGS Prepared by: Brian Yu, 09175262468
tinnitus) Steroids/ NSAIDS Hot and cold compress Plasmapharesis
H-hot compress or ice packs A- aspirin use T- trunk assistive devices (cane) Steroids/ NSAIDS Drugs: glucosamine, chondroitin
P-probenecid - increase excretion of uric acid A-allopurinol - decrease production of uric acid C-colchicine - d S-sulfinpyrazone- reduces uric acid in the blood
13. AUTOSOMAL AND SEX-LINKED DISORDERS
AUTOSOMAL RECESSIVE Sickle-cell anemia Cystic Fibrosis PKU Thalassemia major Albinism Tay-sachs Maple syrup urine disease SEX-LINKED/ X-LINKED RECESSIVE Hemophilia A & B Duchennes muscular dystrophy Color blindness Baldness
AUTOSOMAL DOMINANT Von Willebrands disease Neurofibromatosis Huntingtons disease Myotonic muscular dystrophy Nightblindness Osteogenesis imperfecta Marfans Syndrome
14. BENIGN PROSTATE HYPRPLASIA

A
15. BITES 16. BOTULISM

paralytic illness caused by nerve toxin released by Clostridium botulinum spore in soil; can spread through air or food or contaminated wound no person-to-person progressive paralysis (extremities, lungs)
17. BRONCHIAL ASTHMA

Most common triggering factor: dust mites*** TRIAD manifestations: B ronchoconstriction caused by leukotrienes I nflammation caused by IgE M ucus production caused by GOBLET CELLS Give BRONCHODILATOR first, followed by STEROIDS Wash mouth after inhaling steroid-based drugs (to prevent oral thrush)
18. BRONCHIOLITIS
Causative agent: Respiratory Syncytial Virus Inflammation of the bronchioles that causes thick mucus production resulting to obstruction DOC: Ribavirin (Virazole)* AVOID pregnant nurses and children during Ribavirin therapy
19. BROWN-SEQUARDs SYNDROME

Results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the cord IPSILATERAL (same side): motor function, propioception, vibration, deep touch sensations ARE LOST CONTRALATERAL (opposite side from the injury): pain sensation, temperature, light touch are LOST
20. BURNS
CAUSES/ TYPES: Thermal burns a. Scald burns hot fluids b. Flame ignition/ fire c. Flash explosion d. contact with hot objects Chemical burns acids, alkali Electrical burns electrical wires Radiation
2 Parameters:*** 1) Extent percentage Rule of 9 quick way Palm method use for scattered burn 1 Palm = 1%*** Severity depth st th 1 to 4 degree
2)
CLASSIFICATION 1st degree Superficial thickness burn
Epidermis
pain, red (erythematosus), no edema
sunburn
PARTIAL
2nd degree
Superficial Partial thickness burn
Epidermis and dermis
Very painful, very red, blistered (vesicle), edema, blanches with pressure Mixed red or waxy white color Wet surface (broken blisters) Edema
Scalds (contact with hot liquids)
3rd degree
Deep partial thickness burn
Skin to SQ
Fire Electricity or lightning Prolonged exposure to hot liquids/ objects
FULL 4th degree Full thickness burn Epidermis, Dermis, SQ, muscles, bones
painless painless, dry, pale, white or charred
HEALING PROCESS st 1 degree 3 to 7 days nd 2 degree average of 21 days rd 3 degree skin grafting compartment syndrome th 4 degree amputation; skin grafting
STAGES OF BURN INJURY

1st stage Fluid Accumulation IV to IT Hypovolemia/ shock Oliguria Decrease Blood volume Decrease BP Increase HR, Increase RR 2nd stage Fluid Remobilization IT to IV (Hypervolemia) Diuresis Increase Blood volume Increased BP 17 | TOP DRUGS Prepared by: Brian Yu, 09175262468 3rd stage Recovery/ Convalescence Healing process Decreased calcium (calcium is used in wound healing)
Increase HCT Increase potassium Decrease sodium and water Myoglobinuria
Fluid overload CHF Decrease HCT Decrease potassium Decrease sodium and water
PHASES OF BURN MANAGEMENT BEGINS ENDS ends with the restoration of capillary permeability Begins when the client is hemodynamically stable, capillary permeability is restored, and diuresis has begun begins with wound closure until the burn is healed GOAL/ FOCUS Fluid resuscitation Fluid replacement are calculated from the TIME of INJURY and not from the TIME OF ARRIVAL at the hospital Amount of fluid: based on the clients weight and extent of injury infection control wound care, wound closure, nutritional support, pain management, and physical therapy
EMERGENT; usually 24 to 48 hours following injury ACUTE; Begins 48 to 72 hours after the time of injury
Begins at the time of injury
REHABILITATIVE
until the patient has reached the highest level of functioning
Designed so that the client can gain independence and achieve maximal function
Burns to the chest, back, neck, and face. PRIORITY nursing diagnosis o Ineffective airway clearance IV fluid used in FLUID RESUSCITATION: Lactated Ringers (LR) Patient with burns with diarrhea, suspected organism: o Clostridium Deficile Chemical burn to the eyes, first thing to do is: o flush the eyes with water continuously for 20 minutes. SKIN GRAFT o Heterograft (xenograft) is a graft of skin obtained from another species, such as a pig. o Autograft is a graft of skin obtained from the patient itself o Homograft is a graft of skin obtained from same species like a cadaver 6 to 24 hours after dead Patient is burning: DROP and ROLL*** o AVOID: Standing to prevent inhalation Running to prevent fanning of fire Electric burn, first to be done:*** o Turn OFF the electric source Components of FIRE:*** o Oxygen (open window, oxygen tank) o Friction (drapes, electric spark, friction producing equipment) o Combustible material (kerosene, LPG) FIRE management, sequence*** 1- Protect patient 2- Activate alarm 3- Confine the fire 4- Extinguish the fire FIRE EXTINGUISHER, types*** Type A for Trash fire Type B for Fuel fire Type C for Electric Fire Type D any kind
paper, woods, leaves oil, gasoline, kerosene appliances, wire all
(contain water under pressure) (contains carbon dioxide) (contains dry chemicals) (contains graphite)
21. CANCER, RISK FACTORS

Breast Cancer*** Early menarche Late menopause Nulliparity 1st pregnancy at 35 years old Breast Cancer Treatment Guidelines by Stage at Diagnosis
STAGE 0 I II TUMOR*** DCIS (no evidence of cancer cells) 02 cm 2 cm and below with axillary lymph node metastasis OR More than 2 cm but less than 5 cm with NO axillary lymph node metastasis >5 cm with axillary and neck lymph node metastasis Metastatic disease to distant organs (lungs, distant lymph nodes, skin, bones, liver, or brain) SURGERY TM or lumpectomy BCT or MRM BCT or MRM CHEMOTHERAPY Tamoxifen Considered for all invasive tumors Regimen depends on tumor size and nodal status RADIATION For lumpectomy For BCT For BCT
III
MRM
Postoperative and possibly preoperative To control progression and/or palliation
To chest wall and possibly axillae after MRM To control progression and/or palliation
IV
MRM Possible lumpectomy
DCIS, ductal carcinoma in situ; TM, total mastectomy; BCT, breast-conservation treatment (lumpectomy and axillary dissection); MRM, modified radical mastectomy.
Uterine Cancer Age: at least 55 years; median age, 61 years Postmenopausal bleeding Obesity that results in increased estrone levels (related to excess weight) resulting from conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen Unopposed estrogen therapy (estrogen used without progesterone, which offsets the risk of unopposed estrogen) Other: nulliparity, truncal obesity, late menopause (after 52 years of age) and, possibly, use of tamoxifen Bladder Cancer Smoking Hair dye Gastric Cancer Smoked foods Peptic Ulcer Disease: gastric ulcer Raw foods
22. CARPAL TUNNEL SYNDROME

Cumulative trauma of wrist (median nerve carpal tunnel) Inflammation and swelling RISK: Carpenters Computer user Compression during sleeping Cellular phone use (texting) Rower Typist/ pianist Working using vibrating tools S/Sx: Phalens test Durkan test press thumb (examiner) over carpal tunnel (patient) for 30 seconds Tinels sign - percussion Pain wrist relieved by massaging and shaking Loss of sensation of fingertips
23. CEREBRO-VASCULAR ACCIDENT (CVA)/ STROKE/ BRAIN ATTACK
24. CHOLECYSTITIS
CHOLELITHIASIS: stones in the gall bladder (occurs due to hypercholesterolemia) CHOLECYSTITIS: inflammation of the gall bladder Stone: cholesterol*, bile pigments, calcium: may cause obstruction, infection stones may spread to:
o o 6Fs: o o o o o o
common bile duct (choledocholithiasis) pancreatic duct (pancreatitis)
Female (contraceptives) Fat (obesity) Forty (low estrogen levels) Flatulence Fair Fertile (decrease estrogen, high progesterone)
MANIFESTATIONS: TRIAD manifestations: 1) RUQ pain that radiates to midsternum, scapular area or right shoulder*** 2) Fever 3) Jaundice/ pruritus Increased bilirubin and alkaline phosphatase if with obstruction*** Urine deep orange, foamy urine, dark tea-colored urine (+) Murphys sign pain during inhalation when the physicians hand is placed on the patients RUQ abdomen Decrease ADEK bleeding (low Vitamin K) Acholic stools (pale/ gray stools/ clay-colored) Steatorrhea (no bile to emulsify the fats)
DIAG AND LAB UTZ PROCEDURE OF CHOICE!*** ERCP (endoscopic retrograde cholangiopancreatography) Oral cholecystography
INTERVENTION Pain control o Narcotics (to decrease pain) o antipasmodics and anticholinergics (to reduce spasms and contractions of the GB) NGT insertion gastric decompression DIET: high CHO, moderate CHON, low fat give Vitamin K as ordered
SURGICAL INTERVENTIONS: Cholecystostomy: incision into the GB for the purpose of drainage Abdominal cholecystectomy: removal of the GB for the purpose of drainage Laparoscopic cholecystectomy: removal of GB thru an endoscope inserted thru the abdominal wall Choledochotomy: incision into the CBD for removal of stones Intracorporeal lithotripsy (with the aid of endoscope stone is directly pulverized by hydraulic process)
25. CONGESTIVE HEART FAILURE 26. CORONARY ARTERY BYPASS GRAFT

Used for multiple vessel affection Sources of Grafts:*** Saphaneous vein Internal mammary artery Radial artery
27. DELIRIUM and DEMENTIA

DELIRIUM Acute confusion Onset Abrupt, sudden Reversible confusion Distinguishing feature Duration Time of day Sleep-wake cycle Acute, fluctuating change in mental status may last hours to days Worsens at night Disturbed No change with time of day Disturbed. Fragmented. Awakes often during the night. DEMENTIA Chronic confusion Insidious, Gradual Irreversible confusion Memory impairment
Alertness
Thinking
Fluctuates (may be alert and oriented during the day but become confused and disoriented at night) Disorganized, disoriented Impaired attention Alterations in memory May have tactile, auditory and visual hallucinations CVA, infections, stress, sleep deprivation, dehydration, environmental change
Generally normal
Judgment impaired Difficulty with abstraction and word finding Delusions. Usually no hallucinations Alzheimers disease Multiple infarct dementia
Delusions/ hallucinations
Cause and risk factors
28. DIABETES INSIPIDUS and SIADH

DIABETES INSIPIDUS MAIN PROBLEM NURSING DIAGNOSIS Decrease ADH secretion Fluid Volume Deficit Decrease urine specific gravity DILUTED Dehydration, Constipation Polyuria, Polydipsia Weight loss S/SX Hypotension Hypovolemia Hypernatremia (CONCENTRATIONAL) Hemoconcentration (increase HCT) COMPLICATION Shock DIET: Hydration - Force fluids (2 3 L/ day), IVF Regular diet Avoid foods/ beverages that exert diuretic effect (coffee, tea) Hypertension, Hypervolemia Hyponatremia (DILUTIONAL) Hemodilution (decrease HCT) Water intoxication DIET: Drugs: Skin care Restrict fluid regular diet decrease sodium intake Increase ADH secretion Fluid Volume Excess Increase urine specific gravity - CONCENTRATED Edema Oliguria Weight gain SIADH
MANAGEMENT
Drugs: Vasopressin
Diuretics (Loop and Osmotic) Demeclocycline(Declomycin) Monitor VS, I&O, urine SpGr, weigh daily
Monitor VS, I&O, urine SpGr, weigh daily Surgical removal of tumor
Surgery (tumor excision)
29. DIABETES MELLITUS

MI in DM Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level reaches an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
30. DIARRHEAL DISEASES

MICROORGANISM Salmonella Shigella Bacteria Bacteria Enteric fecal-oral ROUTE common in eggs ampicillin, Cotrimoxazole (TMP-SMX), fluoroquinolones such as ciprofloxacin and of course rehydration. Campylobacter Bacteria Enteric/ fecal-oral Self-limiting and symptomatic
sexual contact eating of raw meat. Giardia Cyrptosporidium Parasite Parasite Fecal-oral Enteric (feces, swimming pools) Hand washing, purifying/filter water Adult standard; Child contact; Supportive management Clostridium difficle (CDAD) Rotavirus Norwalk virus Virus Virus Fecal-oral route Fecal-oral route Common: winter Self-limiting; Norwalk, Ohio Bacteria Antibiotic-associated/ nosocomial
(CDAD)- Clostridium difficile associated diarrhea)
DUCHENNES MUSCULAR DYSTROPHY Duchenne muscular dystrophy is a rapidly-worsening form of muscular dystrophy. Other muscular dystrophies (including Becker's muscular dystrophy) get worse much more slowly.Duchenne muscular dystrophy is caused by a defective gene for dystrophin (a protein in the muscles). However, it often occurs in people without a known family history of the condition.
31. the most common type of muscular disorder
X-linked recessive (but the myotonic muscular dystrophy is autosomal dominant) Progressive Pathognomonic sign: GOWERs SIGN (observe when the patient tries to stand while bracing his feet with his upper extremities)
32. DUMPING SYNDROMEDumping syndrome is a group of symptoms that are most likely to develop if you've had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea.
Common complication of gastrectomy S/sx: Shock-like manifestations: diaphoresis, cold and clammy Diarrhea Position after feeding: turn to LEFT (to delay drainage to stomach)
33. EPIGLOTTITIS
Tripod position*** Always an emergency situation Ineffective airway clearance Essential equipment for epiglottitis: tracheostomy
34. ERUPTIVE RASHES

AGENT First disease: Rubeola virus S/Sx Koplik's spots (blue-white spots with a red halo) on the buccal mucous membrane The rash begins on the 4th or 5th day on the face and behind the ears. Maculopapules From head to feet Photophobia MMR vaccine Dim lights Respiratory precaution
(Rubeola, Measles, Hard measles, 14-day measles, Little Red Disease) Second disease: GABHS
(Scarlet Fever,
Tonsillitis White strawberry tongue (the tongue is coated heavily with a white membrane through which swollen, red papillae protrude) diffuse, fine erythematous rash circumoral pallor (pale area around mouth) Pastia's lines or Pastia's sign (dark, hyperpigmented areas on the skin, especially in skin creases)
Contact, droplet precaution
Scarlatina) Third disease: Rubella virus
(Rubella, German measles, 3-day measles) Fourth disease: caused by epidermolytic (exfoliative) toxin-producing strains of Staphylococcus aureus (Staphylococcal Scalded Skin Syndrome/ SSSS or Ritter's disease) Parvovirus
fever and sore throat rash characteristic: feel of sandpaper and typically lasts five to six days. begins as discrete macules (red spots) on the face that spread to the neck, trunk, and extremities. exanthem lasts 1-3 days Forscheimer's spots of pinpoint red macules and petechiae can be seen over the soft palate and uvula just before or with the exanthem. Swelling of the lymph nodes abrupt appearance of perioral erythema (+) Nikolsky's sign: Applying slight pressure with side to side movement of a finger to the skin lesions results in displacement of the epidermis from the dermis bullae or cutaneous blisters Within 7-10 days of lesion appearance the skin heals without any scarring. Secondary bacterial infections of the lesions can result in scarring. - Pruritus - low-grade fever, malaise - sore throat precede the rash - Facial erythema ("slapped cheek") - red papules on the cheeks that rapidly coalesce in hours; symmetric on both cheeks but do not cover the nasolabial fold and the circumoral region. high fever rash (maculopapular, non-pruritus) neck, trunk, arms; fades within 24 hours; appearance of the rash after the fall of the fever
MMR vaccine
(Filatow-Dukes Disease)
Fifth disease:
Not usually hospitalized AVOID: pregnant
(Erythema Infectiosum) Sixth Disease: (Roseola infantum, Exanthem subitum) Human Herpes Virus
Standard precaution Common: spring, fall Self-limiting
FIFTHS DISEASE/ ERYTHEMA INFECTIOSUM CA: Human Parvo Virus Respiratory isolation: Airborne (more than 3 feet) S/Sx: red rash on the cheeks (slapped cheek appearance of rash) low grade fever malaise and joint pain swelling in the hands, wrists and heels Nursing diagnosis: Activity Intolerance Diagnostic test: light and electron microscopy Complication: anemia MANAGEMENT: Rest frequently, take analgesics and anti-inflammatory medications, increase iron in the diet, cover mouth when coughing or sneezing
35. EYES: OTITIS MEDIA (ear problem)

Causes: Propping the bottle Passive smoking*** Frequent tonsillitis/ Upper respiratory infection*** S/Sx: Otalgia pulling of ear that signifies ear pain Otorrhrea Management Myringotomy with tympanostomy tube st 1 line of drug: Ampicillin nd 2 line of drug: Cotrimoxazole
36. EYES: CATARACT

S/sx: A - bsent red eye reflex B - lurring of vision C - louding of lens from inner to outer Management: SURGERY ONLY
37. EYES: BLIND PATIENT

20/ 200 POSITION: Nurse walk one step ahead of the patient Never rearrange things (familiarization of environment)***
38. EYES: GLAUCOMA

S/sx: Tunnel vision/ PERMANENT peripheral vision loss (I cant see the person besides me.) Eye pain Halo lights*** Eye meds for life NO need for water restriction AVOID: Mydriatics (dilation)
39. EYES: POST-SURGERY

Patch AFFECTED eye Night shield at NIGHT AVOID: o Coughing o sneezing, o lifting more than 5 5lbs o bending (from waist), o prolonged watching or reading after surgery ALLOW: o bending (from knees) o sneezing (mouth open) NORMAL: mild to moderate eye pain ABNORMAL: Severe eye pain infection/ hemorrhage
40. FAILURE TO THRIVE

Weight (below 5th percentile on standard growth chart) S/Sx: Weight below 5th percentile Late developmental milestones Abdominal distention Cachexia (malnutrition with wasting) Weakness 2 Types: (1) Organic: physiologic cause (cystic fibrosis, celiac disease, GERD, CHD, kidney problem) (2) Non-organic: psychosocial cause (decrease bonding) Management: feed on demand Diet: high CHON, high calories Small frequent feeding
41. FEVER: Types

Intermittent fluctuates between fever and normal/subnormal at least once daily (malaria) Remittent fluctuates widely but remains above normal (flu) Relapsing elevated for few days, alternating normal for 1 to 2 days, then recurs (dengue) Constant consistently high and fluctuates less (typhoid)
42.
GARDIASIS (beaver fever or backpacker's diarrhea)

ROUTE: fecal oral Major reservoir hosts include beavers, dogs, cats, horses, humans, cattle and birds. It is a particular danger to people hiking or backpacking in wilderness areas worldwide. Management: metronidazole, albendazole and quinacrine; Furazolidone and nitazoxanide may be used in children.
43.
Geriatric client, hearing impairment

Speak infront Talk slowly AVOID mounting (lip exaggeration)*** AVOID: high pitched voice (shouting)
44.
Geriatric client, poor vision

Blind patient: 20/ 200 Stimulating color: red, orange and yellow*** Nurse walk one step ahead of the patient
45.
GUILLIAN BARRE SYNDROME

acquired inflammatory disease (12 cranial and 31peripheral nerves) Bilateral, Symmetrical, Polyneuritis MANIFESTATIONS:
Clumsiness - 1st sign ASCENDING PARALYSIS: progressive, bilateral Dysphagia, Dysarthria, Dyspnea Sensory findings: paresthesia, burning pain, numbness
COMPLICATION: respiratory failure MANAGEMENT: Symptomatic Steroid SAFETY: Side rails Self-limiting
46.
HEADACHE: Migraine
Diagnosis of migraine without aura Five or more attacks for migraine with aura, two attacks are sufficient for diagnosis. Four hours to three days in duration Two or more of the following: Unilateral (affecting half the head); Pulsating; "Moderate or severe pain intensity"; "Aggravation by or causing avoidance of routine physical activity" One or more of the following: Nausea and/or vomiting; Sensitivity to both light (photophobia) and sound (phonophobia)
The mnemonic POUNDing (Pulsating, duration of 472 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If four of the five criteria are met, then the positive likelihood ratio for diagnosing migraine Migraine should be differentiated from other causes of headaches, such as cluster headaches. These are extremely painful, unilateral headaches of a piercing quality. The duration of the common attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the preliminary signs characteristic of a migraine.
47. HEARING LOSS***

Severity of hearing loss LOSS IN DECIBELS 015 >1525 >2540 >4055 >5570 >7090 >90 INTERPRETATION Normal hearing Slight hearing loss Mild hearing loss Moderate hearing loss Moderate to severe hearing loss Severe hearing loss Profound hearing loss
Critical level of loudness 30 dB Shuffling of papers 15 dB Low conversion 40 dB a jet plane 100 feet away 150 dB Sound louder than 80 dB is perceived by the human ear to be harsh and can be damaging to the inner ear.
48. HEPATIC ENCEPHALOPATHY

S/Sx: Altered Level of Consciousness: memory loss, confusion to coma ASTERIXIS flapping tremor DRUG: lactulose (NH3 binding effect) neomycin sulfate (Mycifradin) inhibits action of intestinal bacteria (that produces ammonia) Diet: decrease protein (to reduce ammonia)
49. HEPATITIS
Hepatitis A and E fecal-oral (contaminated food and drink) Hepatitis B, C and D blood (needle stick, sex)
50. HERNIATED NUCLEUS PULPOSUS (HNP)

Protrusion of nucleus pulposus (central part of the intervertebral disc) causing spinal nerve compression Most common: L4 and L5 Causes: heavy lifting, degeneration S/Sx: Pain Sensory disturbance: numbness, paresthesia Sciatica Lasegues sign pain on raising leg Muscle spasm in lumbar Management: Position: flat on bed with bed board*** Turning: log-rolling at least 3 nurses Surgery: laminectomy, chymopapain/ chemonucleolysis Heat application
51. HUNTERS SYNDROME

x-linked disorder deficiency in I2S (iduronate 2-suitatase), which is responsible in breaking down polysaccharide S/Sx: ivory-colored skin lesions on the upper back and sides of the upper arms and thighs short neck, broad chest, too large head progressive deafness atypical retinitis pigmentosa
52. HYPERKALEMIA: management

Management for hyperkalemia is G.I.C.K.S. + D2 G lucose (D50) I nsulin C calcium replacement (to force potassium back in the IC compartment) K ayexalate enema (retain enema for 30 minutes to allow for sodium exchange; afterward, expect client to have diarrhea.) S odium bicarbonate + DIALYSIS DIURETICS
53. HYPERTHYROIDISM AND HYPOTHYROIDISM

HYPOTHYROIDISM (myxedema, Hashimotos disease, cretinism: children) HYPERTHYROIDISM (Graves disease, Parrys disease, Basedows disorder, Toxic diffuse goiter, Thyrotoxicosis) Decrease T3 decrease BMR, wt. Gain MAIN Decrease T4 decrease body heat production, catabolism PROBLEM Decrease Thyrocalcitonin increased serum calcium Decrease GI motility (constipation) Decrease Appetite increased lypolysis atherosclerosis MI Decrease VS (Cold intolerance, bradycardia, hypothermia most fatal) Decrease Energy (fatigue, lethargy, hypoactive) Decrease Metabolic rate S/SX Decrease SKIN moist (dry, brittle/ coarse hair/ skin) Increase SKIN moist (diaphoresis) Increase Thyrocalcitonin decreased serum calcium Increase GI motility (diarrhea) Increase Appetite Increase VS (Heat intolerance, tachycardia) Increase Energy (Restlessness, nervousness, tremors insomnia) Increase Metabolic rate Increase T4 increased body heat production Increase T3 increase BMR, increase VS
Increase weight (fluid retention, edema) Increase menstruation (menorrhagia)
Decrease weight (tissue wasting) Decrease menstruation (amenorrhea) Exopthalmus
MNGT
Monitor VS, I&O (to determine myxedema coma)
Monitor VS, I&O (to determine thyroid storm)
DIET: Skin care Low calorie, High fiber Increase fluid intake/ IVF (constipation) or decrease fluids (edema) High CHON, Low CHO, Low FATS
DIET: Skin care High calorie, Low fiber Increase fluids High CHON, High CHO, High FATS SFF
Warm environment
Cool environment Sx: SUBTOTAL THYROIDECTOMY
DRUG
Lifetime thyroid hormone (Levothyroxine (Synthroid)) a. SE: insomnia Atrophine SO4, isopreterenol (bradycardia) Diuretics (edema) Stool softeners/ laxatives (constipation)
Radioactive iodine (131I) therapy Anti-thyroid agents (Thionamides): Propylthiouracil (PTU), Methimazole (Tapazole) Beta blockers: Propranolol (Inderal) IODIDES: KISS: Potassium Iodide Saturated solution (lugols solution) Steroids: Dexamethasone Digitalis, Ca+ blockers, Antidiarrheal
NOTE: never give SEDATIVES, narcotics, other CNS depressants COMPLICATION MYXEDEMA COMA S/Sx: Hypothermia, Hypoventilation, Altered LOC leading to coma, Bradycardia THYROTOXIC CRISIS (THYROID STORM) S/Sx: Fever, Agitation, Tachycardia
54. HYPOPARATHYROIDISM AND HYPERPARATHYROIDISM

HYPOPARATHYROIDISM MAIN PROBLEM Decrease Calcium Increased Phosphate Tetany (Chvostek and Trousseau) S/SX Laryngospasm Paresthesia High calcium diet DIET Low phosphate diet DRUGS Calcium gluconate AlOH (Amphogel) COMPLICATION Seizure High phosphate diet Calcitonin Furosemide Renal stones HYPERPARATHYROIDISM Increase Calcium Decreased Phosphate Bone pain/ fracture Renal colic Anorexia, nausea and vomiting Low calcium diet
FOODS high in CALCIUM: Milk Orange*** Yogurt Spinach ANTACID: Aluminum hydroxide (Amphogel), given in HYPOparathyroidism Antacid but the side effect is phosphate binder DIURETIC: Furosemide (Lasix), given in HYPERparathyroidism Diuretic that eliminates calcium as well as sodium and potassium in urine
55. INCREASED INTRACRANIAL PRESSURE

Cushings manifestations: Increased BP and MAP Decreased RR and PR Wide pulse pressure Management: Position: high-fowlers position AVOID: Straining/ constipation, Lifting heavy objects IV fluid: hypertonic*** DRUGS: mannitol
56. JUVENILE RHEUMATOID ARTHRITIS (JRA)

Autoimmune inflammatory disease cause is antibodies Idiophatic JRA cause is unknown S/Sx: J Joint swelling and pain R Redness and warmth A A.M. stiffness Insist to be carried Management: J Junk excess weight R ROM (range of motion exercises) A Aspirin, Apply moist heat NSAIDS, Methotrexate Priority nursing diagnosis: Pain r/t inflammatory process Complication: loss of vision (due to iridocyclitis) Referral: ophthalmologist (evaluate iridocyclitis)* Sport: hanging on monkey bars, water exercises
57. LATEX ALLERGY

FOODS: Avocado Bananas Chestnuts Kiwi fruits Grapes Pineapple Potatoes Passion fruits Tropical fruits (mango) Strawberry Soy beans
Catheters, rubbers, condom, balloons Contraindicated with spina bifida patients Assess for signs and symptoms: STRIDOR (best option) harsh, high pitch sound caused by air passing through constricted air passages Urticaria Wheezing Watery eyes Non-latex gloves vinyl gloves Non-latex balloon mylar balloon
58. LEGIONNAIREs DISEASE

Severe form of pneumonia -) bacteria Convention of American Legion in Philadelphia, January 18, 1977 Common: man-made and naturally occurring water sources aerosolized route (like respiratory therapy equipment) air conditioning units S/Sx: flu-like manifestrations/ pneumonia-like manifestations DOC: Azithromycin (Zithromax)
59. LEGG-CALVE-PERTHES
Aseptic, avascular necrosis of the femoral head treatment: traction for 2-4 years self- limiting S/Sx: L limping due to synovitis C contracture deformities P pain from the knee to the groin; aggravated by activity but relieved by rest; stiffness in the morning or after rest D dislocation (complication) Management: Initial: reduce inflammation, restore motion Goal: keep the femoral head in contact with acetabulum Keep the leg abducted Avoid weight bearing Traction: 2 to 4 years
60. LEUKEMIA
Most common cancer in pediatric clients Increased immature WBC Decrease matured WBC risk for infection Decrease RBC activity intolerance Decreases platelets risk for bleeding
61. LIVER CIRRHOSIS

Most common type: Laennecs cirrhosis (due to alcohol) repeated destruction of hepatic cell scar tissue formation (fibrotic) cycle (scarring and regeneration) hardening and shrinkage of the cell obstruction of blood flow increase resistance/ pressure in the portal vein congestion in the portal system PORTAL HYPERTENSION Portal HPN, Increase collateral circulation Caput medusa (dilated veins over the abdomen) Hepatomegaly, Spleenomegaly Hemorrhoids Ascites and edema (unable to metabolize protein) Spider angioma/ telangiectasia (dilated vein/capillaries over the face and trunk) Esophageal varices, GI bleeding
29 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Leg varicositites
62. LYMEs DISEASE vs ROCKY MOUNTAIN SPOTTED FEVER

Not communicable from one person to another
LYMEs DISEASE Cause S/Sx Carrier Treatment Spirochete Borrelia Burgdorferi Bulls eye rash Deer tick (white-tailed deer/ white-footed mice) Doxycycline (Vibramycin) Diethytoluamide (DEET) Permethrine WHEN common Summer Stage I flu like + rashes Stage II neurlogic deficits (bellspalsy, paralysis) and heart conduction defects Lyme , Connecticut Snake River Valley, Idaho ROCKY MOUNTAIN SPOTTED FEVER Rickettsia rickettsii Diffused rash (maculopapular/ petechial rash) Dog tick, wood tick, rabbit tick Doxycycline (Vibramycin)/ Tetracycline; Chloramphenicol; Diethytoluamide (DEET) Permethrine Spring
Northeast (Massachusetts to Maryland), Mid-atlantic states (Winconsin to Minnesota)
63. MARFAN SYNDROME

Caused by mutation of fibrilin gene S/Sx: long extremities, tall and lanky arachnodactyly (elongation of fingers) muscular underdevelopment joint hypermobility Complication: Aortic Aneurysm, blindness (eye lens dislocation), kyphoscoliosis Priority: SAFETY
64. MENIEREs DISEASE (endolymphatic hydrops)

Dilation of the endolymphatic system by overproduction or decreased reabsorption of the endolymphatic fluid TRIAD manifestations: 1. tinnitus 2. vertigo 3. lateral sensorineural hearing loss Management: Administer nicotinic acid (niacin) as prescribed for its vasodilator effect Restrict water, low sodium diet Streptomycin (to eliminate vertigo)
65. MRSA (methicillin-resistant Staphylococcus aureus)

2 types of infection: Hospital-associated MRSA happens to people in healthcare settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling. Practice good hygiene Keep cuts and scrapes clean and covered with a bandage until healed AVOID: contact with other peoples wounds or bandages sharing personal items, such as towels, washcloths, razors, or clothes Wash soiled sheets, towels and clothes in hot water with bleach and dry in a hot dryer DOC: Linezolid, Vancomycin
66. MUSCULAR DYSTROPHY

Progressive degeneration of skeletal muscles Inherited Duchennes muscular dystrophy (pseudohypertrophic muscular dystrophy) S/Sx: Gowers sign (standing) Pseudohypertrophy: woody on palpation, look enlarged Management: Diet: low calorie, high protein (tom prevent obesity) high fiber and high fluid (to prevent constipation) death is due to respiratory or heart failure
DUCHENNES MUSCULAR DYSTROPHY X-linked recessive (defective gene: Rapidly progressive muscular weakness and atrophy Gowers sign (standing) self- splinting NO cure!
67. MYELOSUPPRESSION
THROMBOCYTOPENIA Petechiae ANEMIA Fatigue NEUTROPENIA Fever and sore throat
68. MYOCARDIAL INFARCTION

Cardiac enzymes after 1 hour after 2 hour after 4 hour after 24 hour Myoglobin Troponin CPK-MB LDH
ECG changes Pathologic Q wave ST elevation*** T wave inversion Effects of Morphine in MI Reduces pain and anxiety Reduces preload and afterload*** Reduces workload Relaxes bronchioles Lowers BP Depressed respiration
69. NEPHRITIS (Nephritic Syndrome) and NEPHROSIS (Nephrotic Syndrome)

NEPHROSIS (NEPHROTIC SYNDROME) Increase glomerular membrane permeability Autoimmune Hypoalbuminemia Proteinemia Hyperlipidemia Edema (anasarca) NEPHRITIS (NEPHRITIC SYNDROME) Inflammation of the kidneys GABHS Hematuria (gross) Edema (periorbital) HPN Proteinuria Oliguria/ Anuria Increase BUN/ creatinine DIET: low sodium, decrease OFI Bed rest
DIET: high protein, low sodium, decrease OFI Ambulate Normal BUN = 10 20 Normal creatinine 0.4 1.2
70. OBSTRUCTIVE SLEEP APNEA (OSA)

OSA is the most common type of sleep apnea syndrome Cause: Obesity Old men Smoking
Pathophysiology: decrease diameter of the upper airway S/Sx: Insomnia Snoring Morning headaches Hypertension Enuresis Complications:*** CAD, HPN CVA Premature death MI, dysrhythmias Management: AVOID: sleeping in supine, alcohol Lose weight
71. ORTHOSTATIC HYPOTENSION

An increase in PR of 15 to 30 bpm OR A decrease in BP of 20 mmHg in systole and 10 mmHg in diastole BP falls when client sits or stands
72. OSTEITIS DEFORMANS (PAGETs DISEASE)

affects skeletal system Management: Alendronate (Fosamax) Monitor: alkaline phosphate (increase: bone problem) affects men and women with familial predisposition S/Sx: joint pain Chronic headache Cartilage damage Nerve pressure
73. OSTEOGENESIS IMPERFECTA

Problem in collagen (collagen protein of connective tissues) Pathologic fractures due to connective tissue and bone defects Autosomal S/Sx: Normal serum calcium and phosphate Abnormal pre-collagen type 1* (major component of collagen) prevents formation of collagen Multiple/ frequent fractures Blue sclera Management: Drugs: Calcitonin aid in bone healing Biphosphonates increase bone mass Exercise (swimming) to improve muscle tone and prevent obesity
74. OSTEOMYELITIS
Cause: Staphylococcus aureus Open wounds(compound fracture, surgery) S/Sx: Fever Pain Redness Swelling Drainage Necrosis (sequestrum) Management: Incision and drainage Sequestrectomy Immobilize***
75. OSTEOPOROSIS
Decrease in bone amount. Density
Cause: 1. Primary (non-modifiable cause) senile, menopausal (decrease estrogen) 2. Secondary (modifiable cause) malnutrition, immobilization, decrease exercise S/Sx: Loss of height (kyphosis) Dowagers hump*** Low back pain Lung problem Management: Brisk walking for 30 minutes, 4x/ day Lifestyle: stop smoking, decrease alcohol and caffeine Drugs: o Calcitonin/ Calcitriol o Biphosphonates: akendronate (Fosamax) o Hormonal replacement therapy: estrogen
76. PANCREATITIS
Acute pancreatitis can become chronic PAIN associated with acute pancreatitis is:*** a. severe and unrelenting b. located in the epigastric region c. radiates to the back AVOID: Morphine sulfate is not used to treat pain since it can cause the sphincter of Oddi to spasm enteral feedings (it stimulates the pancreas) MANAGEMENT: Position: Side-lying to lessen the pain Meperidine (Demerol) Pancreatic enzymes and bile salts with meals*** IV fluids (to prevent shock) insulin for hyperglycemia calcium replacement decrease stimulation of pancreas o NPO-TPN (nothing by mouth; total parenteral nutrition) o NG tube o anticholinergics o H2-receptor antagonists
77. PARKINSONs DISEASE

Tremors (resting and pillrolling) Rigidity (cogwheel) Akinesia/ Bradykinesia Mask like face
78. PEMPHIGUS VULGARIS

cause: unknown presence of fluid-filled vesicles over 1 cm in size associated with an autoimmune response S/Sx: Hallmark: Nikolskys sign when the epidermis is rubbed off by slight friction or injury pain, dysphagia, skin lesion: bullae rupture easily, foul-smelling drainage Laboratory data: increase WBC Nursing diagnosis: PAIN Management: potassium permanganate Oatmeal bath decrease pruritus
79.
PEPTIC ULCER DISEASE

Risk factors: Helicobacter pylori*** NSAIDS Iron Steroids Smoking and alcohol Stress
80. PERICARDITIS***
Pain is aggravated by: Cough*** Deep inspiration (so the patient do shallow inspiration)*** swallowing food
lying down turning
Characteristic of breathing pattern: Shallow Position to relieve pain: sitting and leaning forward (orthopneic)***
81. PHEOCHROMOCYTOMA
Tumor of adrenal MEDULLA Main problem: increased production of catecholamines (epinephrine and norepinephrine) S/Sx: HPN Hyperhydrosis High PR
82. PITUITARY GLAND

Anterior o o o o o o Prolactin/ lactotropin TSH (thyroid stimulating hormone) GH (growth hormone)/ somatotropin*** GnRH (gonadodropin releasing hormone) FSH (follicle stimulating hormone) LH (luteinizing hormone) MSH (melanocytes timulating hormone) ACTH (adrenocorticotropic hormone)
Posterior o Oxytocin/ vasopressin o ADH (antidiuretic hormone)
83. PNEUMOTHORAX
Air in the pleural space Types: o Spontaneous/ Simple o Traumatic Closed Open o Tension S/Sx: o o o o
Percussion hyperresonance*** Palpation absent/ decreased fremitus Auscultation decreased breath sounds Inspection asymmetry
84. POLYCYTHEMIA VERA

S/Sx:*** o o o o o o Ruddy complexion d/t capillary congestion in the skin and mucous membranes Splenomegaly d/t organ infiltration Hypertension d/t viscosity of blood Generalized pruritus (due to basophils)*** Elevated Hct, bilirubin, liver enzymes Elevated RBC, WBC and platelets all immature
Complications: o Thrombus formation Brain: CVA Heart: MI, Heart failure o Bleeding due to congestion and overdistention of capillaries and venules shock o Peptic ulcer due to increased gastric secretions o Gout due to increased uric acid released by nucleoprotein Management o Increase fluids o Phlebotomy removal of excess blood then DISCARD*** o Drugs: 32 Radioactive phosphorus ( P) reduces RBC production Nitrogen mustard, busulfan, chlorambucil, cyclophosphamide to effect myelosuppression o AVOID: IRON rich foods*** will enhance the production of RBC
85. PREGNANCY: DISCOMFORTS OF PREGNANCY

ASSESSMENT Nausea and vomiting (morning sickness) 1
NURSING MANAGEMENT Eat small frequent meals eat dry crackers on arising may occur any time of day
Breast soreness1
Well-fitting bra decrease caffeinated and carbonated drinks
Nasal stuffiness1
Use cool air vaporizer increase fluid intake place moist towel on the sinuses
Ptyalism1
Use mouthwash as needed chew gum or suck on hard candy
Urinary frequency1 & 3
Kegels exercise decrease fluids before bed report signs of infection, avoid caffeine
Constipation2 & 3
Increase fiber on the diet drink additional fluids have a regular bowel movement
Leg Cramps2 & 3
Increase calcium intake avoid pointing your toes, flex feet, local heat application
Backache2 & 3
Emphasize posture careful lifting, good shoes (low heeled) stoop to pick up objects
Heartburn2 & 3
Small, frequent meals avoid overeating, as well as spicy and fatty foods
Dizziness2 & 3
Slow, deliberate movements support stockings lie on left side when at rest
Ankle edema2 & 3
Rest with your feet elevated avoid restrictive garments on the lower half of the body
Fatigue2 & 3
Schedule a rest period daily use extra pillow for comfort
Hemorrhoids2 & 3
Avoid constipation and straining with bowel movement take a sitz bath apply witch hazel compress
Varicose veins2 & 3
Walk regularly rest with feet elevated avoid long periods of standing do not cross your legs
*1- first trimester; 2-second trimester; 3-third trimester
86. PREGNANCY: SIGNS

Presumptive Signs and Symptoms (FUNQPAB) - suspicion not proof, predominantly subjective Fatigue response to increased hormonal levels Urinary frequency caused by pressure of expanding uterus in the bladder Nausea and vomiting (morning sickness) Quickening - sensations of fetal movement in the abdomen) - occurs between the 16th and 20th week after the onset of the last menses. Pigmentation of the skin Melasma gravidarum (Chloasma) mask of pregnancy Abdominal striae (striae gravidarum) due to stretching, rupture and atrophy of deep connective tissues of the skin Linea nigra Amenorrhea cessation of menses Breast changes enlarge and become tender Probable Signs and Symptoms (+ BBLUE HCG) - increased suspicion but still no proof, no subjective data Positive hCG laboratory (urine or serum) test for pregnancy. Ballottement - sinking and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus (occurs near midpregnancy). Braxton Hicks contractions - painless, palpable contractions occurring at irregular intervals, more frequently felt after 28 weeks. They usually disappear with walking or exercise. Leukorrhea - increase in vaginal discharge Uterine changes from pear shape to spherical around 8 weeks gestation and becomes ovoid from 16 weeks until term Enlargement of abdomen - at about 12 weeks' gestation, the uterus can be felt through the abdominal wall, just above the symphysis pubis Hegar's sign - lower uterine segment softens 6 to 8 weeks after the onset of the last menstrual period. Chadwick's sign - bluish or purplish discoloration of cervix and vaginal wall. Goodell's sign - softening of the cervix; may occur as early as 4 weeks Positive Signs and Symptoms (4 Fs) - definite signs of pregnancy Fetal heart tones (FHTs) usually heard between 16th and 20th week of gestation with a fetoscope or the 10th and 12th week of gestation with a Doppler stethoscope Fetal movement felt by the examiner (after about 20 weeks gestation) Fetal body outline through the maternal abdomen in the second half of pregnancy. Fetal sonographical evidence (after 4 weeks' gestation) using vaginal ultrasound. Fetal cardiac motion can be detected by 6 weeks' gestation
87. PREGNANCY: smoking

Effects: Congenital heart defects SGA Respiratory distress Premature death SIDS
88. PRURITUS
Bathe in tepid water and apply emollient lotion AVOID soaps and detergents AVOID petroleum, mineral oil Use calamine, antihistamine Provide cool, light, nonrestrictive clothing Keep nails short Apply cool and moist compress
89. RENAL FAILURE

Causes: 1. Pre-renal due to DECREASED RENAL PERFUSION Shock, DHN, CHF, burns, hypovolemia 2. Intra-renal due to KIDNEY INJURY UTI, DM, BT, nephritis Post-renal due to KIDNEY TRACT OBSTRUCTTION Cystitis, calculi, BPH
3.
90. RENAL STONES

Type of stones: Alkaline stone calcium oxalate, struvite Acidic stone uric acid, cystine Calcium oxalate stone most common kidney stone
Location:*** UPPER GU tract (kidney, ureter) flank pain radiating to abdomen LOWER GU tract (bladder, urethra) inguinal (groin) pain radiating to testicular or labial Characteristic of pain (renal colic) Sharp and Sudden*** KUB Xray CONFIRMATORY*** Sources of Oxalate: dark green vegetables (spinach) rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
91. SEIZURES
Priority DURING: safety Priority AFTER: airway Seizure Precaution P osition: side-lying L oose the clothings A VOID: resrictions N ote: duration and characteristics of the seizure O xygenate: jaw-thrust D rugs: diazepam,phenytoin, carbamazepine R emove harmful objects at the bedside A t the bedside: suction machine P ad and raise the side rails E liminate environmental stimuli (bright lights, noise)
92.
SHOCK Reduction of arterial pressure leading to decrease blood flow (deficiency in nutrients, oxygen, electrolytes delivery
to tissue, as well as waste removal) Types: Cardiogenic loss of cardiac pumping action (MI, CHF) Hypovolemic decrease blood volume (burns, bleeding/ hemorrhagic shock, dehydration) most common Distributive/ Circulatory Neurogenic (SCI, drug depressants) Vasogenic massive vasodilation Anaphylactic massive reaction to food, drugs and chemical Septic Septic massive infection Stages:
COMPENSATORY Normal BP Increased RR and PR cold clammy skin oliguria hypoactive bowel sounds PROGRESSIVE Decreased BP Increased RR and PR Altered LOC Oliguria increased BUN and Creatinine stress ulcers and increased risk for GI bleeding. metabolic acidosis (due to accumulation of lactic acid) IRREVERSIBLE severe organ damage
Common manifestations:*** o Decrease BP, MAP (Mean Arterial Pressure) o Increase RR, PR o Narrow Pulse Pressure Position: modified trendelenburg*** In neurogenic shock, the patient is also at an increased risk for deep vein thrombosis. Major cause of septic shock gram-negative bacteria First drug to be given for SHOCK Epinephrine The degree of cardiogenic shock is proportional to the extent of left ventricular dysfunction.***
93. SJOGRENs SYNDROME

Chronic, inflammatory autoimmune process that affects lacrimal glands and salivary glands MAIN CONCEPT: dryness S/Sx: xerostamia (dry mouth), xerodermia (dry skin), dysparenuria
94. STILLBORN CHILD

Management: Parents need to see, touch, wash, and dress baby Get footprints, pictures, lock of hair, ID band, name the child and use the name often.
If they dont see their baby; the parents often never face reality and stuck in the grieving process. Again, encourage to hold, rock, and cuddle their baby. Allow and encourage them to take photos of their angel.
95. STRABISMUS
Lack of coordination of the extraocular muscles causing misalignment of the eye Normal in infant up to 4 months only Management eye)
96. SUDDEN INFANT DEATH SYNDROME (SIDS)

Causes: smoking, drinking, or drug use during pregnancy poor prenatal care prematurity or low birth-weight mothers younger than 20 tobacco smoke exposure following birth overheating from excessive sleepwear and bedding stomach sleeping
97. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling manifestations Steroids Plasmapharesis***
98. TETRALOGY OF FALLOT

Severe acute ccyanosis tet spells 4 Defects:*** o Pulmonic Stenosis o Right Ventricular Hypertrophy o Ventricular Septal Defect o Overridding of the Aorta Position: Knee-chest/ Squatting*** S/Sx: o o o
Machine-like murmurs Clubbing of fingers Cyanosis
Management: o Surgery: Blalock Taussig procedure shunting of the subclavian artery and pulmonary artery
99. TRIAGE
trier- to sort To sort patients in groups based on the severity of their health problem and the immediacy with which these problems must be addressed 3 CATEGORIES IN TRIAGE in E.R.
EMERGENT Color Urgency Examples Red Life, limb, eye threatening Needs immediate attention Chest pain, cardiac arrest, severe respiratory distress, chemicals in the eye, limb amputation, penetrating trauma, severe hemorrhage Yellow Needs treatment in 20 minutes to 2 hours Fever >40oC, simple fracture, abdominal pain, asthma with no respiratory distress URGENT Green Can wait hours or days sprain, minor laceration, rash, simple headache. Toothache, sore throat NON-URGENT
4 CATEGORIES IN TRIAGE in DISASTER

IMMEDIATE Number Color Examples 1 Red Chest wounds, shock, open fractures, 2-3 burns 2 Yellow
DELAYED 3 Green
MINIMAL 4
EXPECTANT
Black Unresponsive, high spinal cord injury
Stable abdominal wound, eye and CNS injuries
Minor burns, minor fractures, minor bleeding
100.
TURNER SYDNROME vs KLINEFELTER SYNDROME

TURNER SYNDROME (Gonadal Dysgenesis) STATISTICS CAUSE S/Sx Females Absent X chromosome (X0) Neck webbing; no secondary sex characteristics short neck Short stature Webbed neck Infantile genitalia Amenorrhea/ sterility Widely spaced nipple/ broad chest Failure o secondary sex characteristics at puberty Mngt HORMONAL REPLACEMENT (Estrogen therapy secondary sex characteristic) Growth hormone Others No secondary sex characteristics No treatment HORMONAL REPLACEMENT (Testosterone) Small testicles Sterility Gynecomastia Hypogonadism (low testicular hormone) High follicle-stimulating hormone/ LH males Extra X chromosome (XXY) Non-develop reproductive organ; no secondary sex characteristics KLINEFELTER SYNDROME
- refer to geneticist (reproductive problem)
101.

VANCOMYCIN RESISTANT ENTERROCOCCUS (VRE)

A mutation of very common bacterium that is spread easily by direct person-to-person contact S/Sx: There are no specific signs and symptoms related to VRE NURSING DIAGNOSIS: Risk of infection (transmission) MANAGEMENT: Explain to the patient the importance of hand washing to prevent the spread of the infection.
102.

VENOUS DISORDERS, Management:

Elevate legs Exercise legs Early ambulation Elastic stockings
103.

VON WILLEBRANDS DISEASE

with bleeding deficiency with Von Willebrands factor (factor VIII) and platelet dysfunction autosomal dominant like hemophilia (Hemophlia 8, 9, 11) affects: males and females Inherited as a dominant trait and affects both sexes equally
S/Sx: B bruising A abnormal menstruation B bleeding during tooth extraction E epistaxis Management: Bleeding precaution Cryoprecipitate (contains factor VIII, fibrinogen and factor XIII ) Check for: coagulation profile Desmopressin (DDAVP) to prevent bleeding associated with dental or surgical procedures, intranasally increase production of Von Willebrand factor
104.

WEST NILE VIRUS/ WEST NILE ENCEPHALITIS

natural reservoir of virus: birds mosquito bite (Culex species) human (dead end host) NO human-to-human, NO bird-to-human transmission Management: -none-, fluid replacement, airway management
TOP 87 DISEASES AND HUMAN ANATOMY

(for NLE review)
In alphabetical order
*** Common Board Question
105.

ABSENT MECONIUM PASSAGE within 24 hours after birth

Imperforate anus Hirschprungs disease Cystic fibrosis
106.

ACROMEGALY
Increase growth hormone AFTER puberty Increase glucose level (high Growth hormone = high Glucose) S/Sx: Broad and bulbous nose Enlarged hands and feet Continuous grow of soft tissues (ear, nose) Macroglossia (large tongue)*** Complications Enlarged heart Diabetes mellitus Heart failure Reason of seeking for medical care: change in appearance*** Management: Octreotide (Sandostatin)*** SEE notes on TOP DRUGS give SQ if given 3x a week***
107.

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

shock lung Non-cardiogenic pulmonary edema Pathophysiology: o Decreased surfactants o Decreased surface tension o Damage to alveolar-capillary membrane o Leakage of fluid into the ITS o Resulting to pulmonary edema S/Sx: o Dyspnea, retractions o Pulmonary edema o Crackles
108.
ADDISONs and CUSHINGS DISEASE

ADDISONs CUSHINGs
All STEROIDS (S.S.S.) are DOWN except for Potassium MAIN PROBLEM and its manifestations DOWN: SALT (HYPONATREMIA) HYPOVOLEMIA DHN, weight loss HYPOTENSION UP: SALT (HYPERNATREMIA) DOWN: SUGAR (HYPOglycemia) UP: SUGAR (HYPERglycemia)
All STEROIDS (S.S.S.) are UP except for Potassium
HYPERVOLEMIA Edema (Moonface, Weight gain) HYPERTENSION
DOWN: SEX HORMONES Decrease sexual urge or libido
UP: SEX HORMONES Decrease sexual urge or libido Virilization (mascularity in female) Amenorrhea, Hirsutism, Enlargement of clitoris Osteoporosis Gynecomastia (males)
DOWN: Potassium HYPOKALEMIA Weakness, fatigue Bradycardia Constipation Metabolic alkalosis Flat T wave, presence of U wave***
UP: Potassium HYPERKALEMIA Weakness, fatigue Tachycardia, Arrhythmia Diarrhea Metabolic acidosis Tall/ Tented T waves YES steroids (pro-Na, anti-K) Monitor VS, I&O, weight DIET: high calorie, high CHO (glucose), high NA, low K
MANAGEMENT
NO steroids Monitor VS, I&O, weight DIET: low calorie, low CHO, low Na, high K, high CHON Reverse isolation* BILATERAL ADRENALECTOMY GIVE Calcium (for osteoporosis)
COMPLICATIONS
ADDISONIAN CRISIS/ ACUTE ADRENAL INSUFFICIENCY (COMA): severe headache or back pain, severe generalized, muscle weakness, diarrhea or constipation, confusion, lethargy, severe hypotension, circulatory collapse
Risk for infection Pathologic fracture*** Osteoporosis*** DM Arrhythmia
S.S.S (Sugar, Salt, Sex hormone) steroids Cushings disease prone to infection (isolate patient)***
109.

AGE RELATED MACULAR DEGENERATION (AMD)

related to aging bilateral loss of CENTRAL vision with presentation of peripheral vision
110.

ALPORTs SYNDROME
Hereditary Like AGN (acute glomerulonephritis) S/Sx: hematuria from start to finish Common: males Confirmatory diagnostic test: kidney biopsy DIET: decrease CHON
111.
ANEMIA decrease oxygen carrying capacity of RBC

Common Nursing diagnosis: Activity intolerance*** Common S/Sx: F ainting F atigue F orgetfullness TYPES Iron-deficiency anemia (microcytic and hypochromic)*** S/Sx: koilonychia (spoon shaped fingernail)*** , pale and chubby Megaloblastic anemia (macrocytic and hyperchromic) Pernicious anemia immature RBC due to lack of vitamin B12 Folic Acid Deficiency anemia immature RBC due to lack of vitamin B9 Aplastic Anemia disorder of bone marrow decrease RBC, platelet, WBC Sickle cell anemia sickled RBC Management for Sickle cell anemia:*** 1) H ydration 2) O oxygenation 3) P ain management
112.
ANEURYSM is ballooning of the blood vessel

TYPES o Saccular one sided ballooning o Fusiform two sided ballooning (circumferential) o Dissecting a TEAR in the intima of the blood vessel*** Type A affects the ascending aorta Type B affects the descending aorta Complications: rupture/ internal hemorrhage/ shock
113.
ANGINA PECTORIS: Management

2 GOALS IN ANGINAL MANAGEMENT: Goal # 1: Increase oxygen supply to the myocardium (vasodilation) Goal # 2: Decrease oxygen demand E. Nitrates Goal # 1 the mainstay for treatment of angina pectoris MODE OF ACTION: c. dilates the veins primarily (but in higher doses, it also dilates the arteries) d. causes venous pooling in peripheral body parts thus less blood returns to the heart and filling pressure (preload) is reduced Example: Nitroglycerin (Nitrostat, Nitrol, Nitrobid IV), Isosorbide mononitrate (Imdur), Isosorbide dinitrate (Isordil) Side effects: flushing, throbbing headache, hypotension, dizziness Keep drug only for 6 months, cool, dry and dark environment Carry all times DO NOT administer with Sildenafil (Viagra) AVOID: hot baths because it causes massive vasodilation Beta Blockers Goal # 2 Example: Propranolol (inderal), Metropolol (Lopressor), atenolol (Tenormin) MODE OF ACTION: Blocks the beta-adrenergic sympathetic stimulation of the heart thus reducing myocardial oxygen consumption***
F.
G. Calcium Channel Blockers Goal # 1 and 2 Examples: Amlodipine (Norvasc), Verapamil, Nifedipine, Diltiazem (Cardizem), felodipine (Plendil) amlodipine and felodipine (Plendil) are the Calcium Channel blocker of choice for heart failure H. Antiplatelet and Anticoagulant Examples: aspirin, clopidrogel (Plavix), ticlopidine (Ticlid) MODE OF ACTION: prevents platelet aggregation clopidrogel (Plavix) or ticlopidine (Ticlid) is given to patients who are allergenic to aspirin***
114.

APPENDICITIS
Inflammation of the appendix LOCATION: RLQ/ right iliac/ Mc Burneys point CAUSE: due to obstruction from fecalith
low fiber diet Obstruction of the appendix by a fecalith, inflammation, foreign body, or Neoplasm Increased intraluminal pressure Venous congestion, bacterial invasion Abscess, Infection, thrombosis Gangrene and perforation if untreated within 36 hours Peritonitis
MANIFESTATIONS: increase WBC, fever PECULIAR SIGNS: Rovsings sign pressure on the LLQ causes pain in the RLQ Mc Burneys sign pain at RLQ upon palpation Psoas sign pain on passive extension of right hip (lateral position with right hip flexion) Obturator sign*** pain with passive flexion and internal rotation of the right hip Blumberg sign rebound tenderness (peritonitis) (+) cough sign*** RLQ pain on coughing With pain inflammation Without pain rupture Tachycardia late sign Abdominal distention and paralytic ileus/ decreased or absent bowels sounds MANAGEMENT: Bed rest NPO PAIN management o ALLOW: cold application o AVOID: warm compress analgesics will mask the pain* Laxatives, enema, palpation increase peristalsis POSITION: o (acute phase) most comfortable position; Semi fowlers to relieve pain and discomfort o (rupture) upright Sx: Appendectomy o Position: flat on bed
115.

ARNOLD-CHAIRI MALFORMATION
Related to neural tube defect S/Sx: o Swallowing difficulty o Weakening of the extremities o Stridor
116.
ARTHRITIS
RHEUMATOID ARTHRITIS Autoimmune Degenerative disease (wear and tear) Common aggravating factor: obesity Systemic Non-systemic Chronic Weight bearing joints (hips, spine, knee, ankle) Unilateral/ progressive Non-systemic Acute Big toe, ankle OSTEOARTHRITIS GOUTY ARTHRITIS Metabolic (altered purine metabolism)
Onset JOINTS AFFECTED
Chronic Small joints (wrist, elbow) Bilateral
Women S/Sx Ulnar drift Boutenniere deformity proximal Swan neck deformity distal Sjogrens syndrome excessive dryness of eyes, mouth and vagina Feltys syndrome leukopenia, spleenomegaly Anemia*** Pain due to immobility Gold therapy Aspirin regularly (watch out for tinnitus) Steroids/ NSAIDS
Not sex specific Heberdends distal Bouchards proximal Tophi/ podagra uric acid crystallization Elevated uric acid
PAIN MANAGEMENT
Pain due to mobility W-weight control (decrease calorie) H-hot compress or ice packs A- aspirin use T- trunk assistive devices (cane) AVOID: organ meats, alcohol legumes, sardines DIET: low purine, high fluids P-probenecid - increase excretion of uric acid A-allopurinol - decrease production of uric acid C-colchicine - d S-sulfinpyrazone- reduces uric acid in the blood
Hot and cold compress Steroids/ NSAIDS Plasmapharesis Drugs: glucosamine, chondroitin
117.
AUTOSOMAL AND SEX-LINKED DISORDERS
AUTOSOMAL RECESSIVE Sickle-cell anemia Cystic Fibrosis PKU Thalassemia major Albinism Tay-sachs Maple syrup urine disease SEX-LINKED/ X-LINKED RECESSIVE Hemophilia A & B Duchennes muscular dystrophy Color blindness Baldness
AUTOSOMAL DOMINANT Von Willebrands disease Neurofibromatosis Huntingtons disease Myotonic muscular dystrophy Nightblindness Osteogenesis imperfecta Marfans Syndrome
118.

BOTULISM
paralytic illness caused by nerve toxin released by Clostridium botulinum spore in soil; can spread through air or food or contaminated wound no person-to-person progressive paralysis (extremities, lungs)
119.

BRONCHIAL ASTHMA
Most common triggering factor: dust mites*** TRIAD manifestations: B ronchoconstriction caused by leukotrienes I nflammation caused by IgE M ucus production caused by GOBLET CELLS Give BRONCHODILATOR first, followed by STEROIDS Wash mouth after inhaling steroid-based drugs (to prevent oral thrush)
120.

BRONCHIOLITIS
Causative agent: Respiratory Syncytial Virus Inflammation of the bronchioles that causes thick mucus production resulting to obstruction DOC: Ribavirin (Virazole)* AVOID pregnant nurses and children during Ribavirin therapy
121.
BURNS
CAUSES/ TYPES: Thermal burns a. Scald burns hot fluids b. Flame ignition/ fire c. Flash explosion d. contact with hot objects Chemical burns acids, alkali Electrical burns electrical wires Radiation
2 Parameters:*** 1) Extent percentage Rule of 9 quick way Palm method use for scattered burn 1 Palm = 1%*** Severity depth st th 1 to 4 degree
2)
CLASSIFICATION 1st degree Superficial thickness burn
Epidermis
pain, red (erythematosus), no edema
sunburn
PARTIAL
2nd degree
Superficial Partial thickness burn
Epidermis and dermis
Very painful, very red, blistered (vesicle), edema, blanches with pressure Mixed red or waxy white color Wet surface (broken blisters) Edema
Scalds (contact with hot liquids)
3rd degree
Deep partial thickness burn
Skin to SQ
Fire Electricity or lightning Prolonged exposure to hot liquids/ objects
FULL 4th degree Full thickness burn Epidermis, Dermis, SQ, muscles, bones
painless painless, dry, pale, white or charred
HEALING PROCESS st 1 degree 3 to 7 days nd 2 degree average of 21 days rd 3 degree skin grafting compartment syndrome th 4 degree amputation; skin grafting
STAGES OF BURN INJURY

1st stage Fluid Accumulation IV to IT Hypovolemia/ shock Oliguria Decrease Blood volume 2nd stage Fluid Remobilization IT to IV (Hypervolemia) Diuresis Increase Blood volume 45 | TOP DISEASES Prepared by: Brian Yu, 09175262468 3rd stage Recovery/ Convalescence Healing process Decreased calcium (calcium is used in wound healing)
Decrease BP Increase HR, Increase RR Increase HCT Increase potassium Decrease sodium and water Myoglobinuria
Increased BP Fluid overload CHF Decrease HCT
PHASES OF BURN MANAGEMENT BEGINS ENDS ends with the restoration of capillary permeability Begins when the client is hemodynamically stable, capillary permeability is restored, and diuresis has begun begins with wound closure until the burn is healed GOAL/ FOCUS Fluid resuscitation Fluid replacement are calculated from the TIME of INJURY and not from the TIME OF ARRIVAL at the hospital Amount of fluid: based on the clients weight and extent of injury infection control wound care, wound closure, nutritional support, pain management, and physical therapy
EMERGENT; usually 24 to 48 hours following injury ACUTE; Begins 48 to 72 hours after the time of injury
Begins at the time of injury
REHABILITATIVE
until the patient has reached the highest level of functioning
Designed so that the client can gain independence and achieve maximal function
Burns to the chest, back, neck, and face. PRIORITY nursing diagnosis o Ineffective airway clearance IV fluid used in FLUID RESUSCITATION: Lactated Ringers (LR) Patient with burns with diarrhea, suspected organism: o Clostridium Deficile Chemical burn to the eyes, first thing to do is: o flush the eyes with water continuously for 20 minutes. SKIN GRAFT o Heterograft (xenograft) is a graft of skin obtained from another species, such as a pig. o Autograft is a graft of skin obtained from the patient itself o Homograft is a graft of skin obtained from same species like a cadaver 6 to 24 hours after dead Patient is burning: DROP and ROLL*** o AVOID: Standing to prevent inhalation Running to prevent fanning of fire Electric burn, first to be done:*** o Turn OFF the electric source Components of FIRE:*** o Oxygen (open window, oxygen tank) o Friction (drapes, electric spark, friction producing equipment) o Combustible material (kerosene, LPG) FIRE management, sequence*** 1- Protect patient 2- Activate alarm 3- Confine the fire 4- Extinguish the fire FIRE EXTINGUISHER, types*** Type A for Trash fire Type B for Fuel fire Type C for Electric Fire Type D any kind
paper, woods, leaves oil, gasoline, kerosene appliances, wire all
(contain water under pressure) (contains carbon dioxide) (contains dry chemicals) (contains graphite)
122.
CANCER, RISK FACTORS

Breast Cancer*** Early menarche Late menopause Nulliparity 1st pregnancy at 35 years old Breast Cancer Treatment Guidelines by Stage at Diagnosis
STAGE 0 I II
TUMOR*** DCIS (no evidence of cancer cells) 02 cm 2 cm and below with axillary lymph node metastasis OR More than 2 cm but less than 5 cm with NO axillary lymph node metastasis >5 cm with axillary and neck lymph node metastasis Metastatic disease to distant organs (lungs, distant lymph nodes, skin, bones, liver, or brain)
SURGERY TM or lumpectomy BCT or MRM BCT or MRM
CHEMOTHERAPY Tamoxifen Considered for all invasive tumors Regimen depends on tumor size and nodal status
RADIATION For lumpectomy For BCT For BCT
III
MRM
Postoperative and possibly preoperative To control progression and/or palliation
To chest wall and possibly axillae after MRM To control progression and/or palliation
IV
MRM Possible lumpectomy
DCIS, ductal carcinoma in situ; TM, total mastectomy; BCT, breast-conservation treatment (lumpectomy and axillary dissection); MRM, modified radical mastectomy.
Uterine Cancer Age: at least 55 years; median age, 61 years Postmenopausal bleeding Obesity that results in increased estrone levels (related to excess weight) resulting from conversion of androstenedione to estrone in body fat, which exposes the uterus to unopposed estrogen Unopposed estrogen therapy (estrogen used without progesterone, which offsets the risk of unopposed estrogen) Other: nulliparity, truncal obesity, late menopause (after 52 years of age) and, possibly, use of tamoxifen Bladder Cancer Smoking Hair dye Gastric Cancer Smoked foods Peptic Ulcer Disease: gastric ulcer Raw foods
123.

CARPAL TUNNEL SYNDROME

Cumulative trauma of wrist (median nerve carpal tunnel) Inflammation and swelling RISK: Carpenters Computer user Compression during sleeping Cellular phone use (texting) Rower Typist/ pianist Working using vibrating tools S/Sx: Phalens test Durkan test press thumb (examiner) over carpal tunnel (patient) for 30 seconds Tinels sign - percussion Pain wrist relieved by massaging and shaking Loss of sensation of fingertips
124.
CHOLECYSTITIS
CHOLELITHIASIS: stones in the gall bladder (occurs due to hypercholesterolemia) CHOLECYSTITIS: inflammation of the gall bladder Stone: cholesterol*, bile pigments, calcium: may cause obstruction, infection stones may spread to: o common bile duct (choledocholithiasis) o pancreatic duct (pancreatitis)
6Fs: o o o o o o
Female (contraceptives) Fat (obesity) Forty (low estrogen levels) Flatulence Fair Fertile (decrease estrogen, high progesterone)
MANIFESTATIONS: TRIAD manifestations: 4) RUQ pain that radiates to midsternum, scapular area or right shoulder*** 5) Fever 6) Jaundice/ pruritus Increased bilirubin and alkaline phosphatase if with obstruction*** Urine deep orange, foamy urine, dark tea-colored urine (+) Murphys sign pain during inhalation when the physicians hand is placed on the patients RUQ abdomen Decrease ADEK bleeding (low Vitamin K) Acholic stools (pale/ gray stools/ clay-colored) Steatorrhea (no bile to emulsify the fats)
DIAG AND LAB UTZ PROCEDURE OF CHOICE!*** ERCP (endoscopic retrograde cholangiopancreatography) Oral cholecystography
INTERVENTION Pain control o Narcotics (to decrease pain) o antipasmodics and anticholinergics (to reduce spasms and contractions of the GB) NGT insertion gastric decompression DIET: high CHO, moderate CHON, low fat give Vitamin K as ordered
SURGICAL INTERVENTIONS: Cholecystostomy: incision into the GB for the purpose of drainage Abdominal cholecystectomy: removal of the GB for the purpose of drainage Laparoscopic cholecystectomy: removal of GB thru an endoscope inserted thru the abdominal wall Choledochotomy: incision into the CBD for removal of stones Intracorporeal lithotripsy (with the aid of endoscope stone is directly pulverized by hydraulic process)
125.

CORONARY ARTERY BYPASS GRAFT

Used for multiple vessel affection Common Sources of Grafts:*** Saphaneous vein Internal mammary artery Radial artery
126.
DELIRIUM and DEMENTIA

DELIRIUM Acute confusion Onset Abrupt, sudden Reversible confusion Distinguishing feature Duration Time of day Sleep-wake cycle Acute, fluctuating change in mental status may last hours to days Worsens at night Disturbed No change with time of day Disturbed. Fragmented. Awakes often during the night. Generally normal DEMENTIA Chronic confusion Insidious, Gradual Irreversible confusion Memory impairment
Alertness
Thinking
Fluctuates (may be alert and oriented during the day but become confused and disoriented at night) Disorganized, disoriented Impaired attention Alterations in memory
Judgment impaired Difficulty with abstraction and 48 | TOP DISEASES Prepared by: Brian Yu, 09175262468
word finding Delusions/ hallucinations May have tactile, auditory and visual hallucinations CVA, infections, stress, sleep deprivation, dehydration, environmental change Delusions. Usually no hallucinations Alzheimers disease Multiple infarct dementia
Cause and risk factors
127.
DIABETES INSIPIDUS and SIADH

DIABETES INSIPIDUS MAIN PROBLEM Decrease ADH secretion Fluid Volume Deficit Decrease urine specific gravity DILUTED Dehydration, Constipation Polyuria, Polydipsia Weight loss S/SX Hypotension Hypovolemia Hypernatremia (CONCENTRATIONAL) Hemoconcentration (increase HCT) COMPLICATION Shock DIET: Hydration - Force fluids (2 3 L/ day), IVF Regular diet Avoid foods/ beverages that exert diuretic effect (coffee, tea) Hypertension, Hypervolemia Hyponatremia (DILUTIONAL) Hemodilution (decrease HCT) Water intoxication DIET: Drugs: Skin care Restrict fluid regular diet decrease sodium intake Increase ADH secretion Fluid Volume Excess Increase urine specific gravity - CONCENTRATED Edema Oliguria Weight gain SIADH
NURSING DIAGNOSIS
MANAGEMENT
Drugs: Vasopressin
Diuretics (Loop and Osmotic) Demeclocycline(Declomycin) Monitor VS, I&O, urine SpGr, weigh daily
Monitor VS, I&O, urine SpGr, weigh daily Surgical removal of tumor
Surgery (tumor excision)
128.

DUMPING SYNDROME
Common complication of gastrectomy S/sx: Shock-like manifestations: diaphoresis, cold and clammy Diarrhea Position after feeding: turn to LEFT (to delay drainage to stomach)
129.

EPIGLOTTITIS
Tripod position*** Always an emergency situation Ineffective airway clearance Essential equipment for epiglottitis: tracheostomy
130.
EYES: OTITIS MEDIA (ear problem)

Causes: Propping the bottle Passive smoking*** Frequent tonsillitis/ Upper respiratory infection*** S/Sx: Otalgia pulling of ear that signifies ear pain Otorrhrea
Management Myringotomy with tympanostomy tube st 1 line of drug: Ampicillin nd 2 line of drug: Cotrimoxazole
131.
EYES: CATARACT
S/sx: A - bsent red eye reflex B - lurring of vision C - louding of lens from inner to outer Management: SURGERY ONLY
132.

EYES: BLIND PATIENT

20/ 200 POSITION: Nurse walk one step ahead of the patient Never rearrange things (familiarization of environment)***
133.
EYES: GLAUCOMA
S/sx: Tunnel vision/ PERMANENT peripheral vision loss (I cant see the person besides me.) Eye pain Halo lights*** Eye meds for life NO need for water restriction AVOID: Mydriatics (dilation)
134.

EYES: POST-SURGERY
Patch AFFECTED eye Night shield at NIGHT AVOID: o Coughing o sneezing, o lifting more than 5 5lbs o bending (from waist), o prolonged watching or reading after surgery ALLOW: o bending (from knees) o sneezing (mouth open) NORMAL: mild to moderate eye pain ABNORMAL: Severe eye pain infection/ hemorrhage
135.

FAILURE TO THRIVE
Weight (below 5th percentile on standard growth chart) S/Sx: Weight below 5th percentile Late developmental milestones Abdominal distention Cachexia (malnutrition with wasting) Weakness 2 Types: (1) Organic: physiologic cause (cystic fibrosis, celiac disease, GERD, CHD, kidney problem) (2) Non-organic: psychosocial cause (decrease bonding) Management: feed on demand Diet: high CHON, high calories Small frequent feeding
136.

FEVER: Types
Intermittent fluctuates between fever and normal/subnormal at least once daily (malaria) Remittent fluctuates widely but remains above normal (flu) Relapsing elevated for few days, alternating normal for 1 to 2 days, then recurs (dengue) Constant consistently high and fluctuates less (typhoid)
137.
FIFTHS DISEASE/ ERYTHEMA INFECTIOSUM

CA: Human Parvo Virus Respiratory isolation: Airborne (more than 3 feet) S/Sx: red rash on the cheeks (slapped cheek appearance of rash) low grade fever malaise and joint pain swelling in the hands, wrists and heels Nursing diagnosis: Activity Intolerance Diagnostic test: light and electron microscopy Complication: anemia MANAGEMENT: Rest frequently, take analgesics and anti-inflammatory medications, increase iron in the diet, cover mouth when coughing or sneezing
138. Geriatric client, hearing impairment Speak infront Talk slowly AVOID mounting (lip exaggeration)*** AVOID: high pitched voice (shouting)
139. Geriatric client, poor vision Blind patient: 20/ 200 Stimulating color: red, orange and yellow*** Nurse walk one step ahead of the patient
140. GUILLIAN BARRE SYNDROME acquired inflammatory disease (12 cranial and 31peripheral nerves) Bilateral, Symmetrical, Polyneuritis MANIFESTATIONS: Clumsiness - 1st sign ASCENDING PARALYSIS: progressive, bilateral Dysphagia, Dysarthria, Dyspnea Sensory findings: paresthesia, burning pain, numbness COMPLICATION: respiratory failure MANAGEMENT: Symptomatic Steroid SAFETY: Side rails Self-limiting
141. HEADACHE: Migraine Diagnosis of migraine without aura Five or more attacks for migraine with aura, two attacks are sufficient for diagnosis. Four hours to three days in duration Two or more of the following: Unilateral (affecting half the head); Pulsating; "Moderate or severe pain intensity"; "Aggravation by or causing avoidance of routine physical activity" One or more of the following: Nausea and/or vomiting; Sensitivity to both light (photophobia) and sound (phonophobia) QUALITY: extremely painful, unilateral headaches of a piercing quality DURATION: 15 minutes to 3 hours ONSET: rapid FOODS to be AVOIDED: tyramine-containing foods (cheese, chocolates), processed foods (smoked fish)
142.
HEARING LOSS***
Severity of hearing loss LOSS IN DECIBELS 015 >1525 >2540 >4055 >5570 INTERPRETATION Normal hearing Slight hearing loss Mild hearing loss Moderate hearing loss Moderate to severe hearing loss
>7090 >90
Severe hearing loss Profound hearing loss
Critical level of loudness 30 dB Shuffling of papers 15 dB Low conversion 40 dB a jet plane 100 feet away 150 dB Sound louder than 80 dB is perceived by the human ear to be harsh and can be damaging to the inner ear.
143.

HEPATIC ENCEPHALOPATHY
S/Sx: Altered Level of Consciousness: memory loss, confusion to coma ASTERIXIS flapping tremor DRUG: lactulose (NH3 binding effect) neomycin sulfate (Mycifradin) inhibits action of intestinal bacteria (that produces ammonia) Diet: decrease protein (to reduce ammonia)
144.

HEPATITIS
Hepatitis A and E fecal-oral (contaminated food and drink) Hepatitis B, C and D blood (needle stick, sex)
145.

HERNIATED NUCLEUS PULPOSUS (HNP)

Protrusion of nucleus pulposus (central part of the intervertebral disc) causing spinal nerve compression Most common: L4 and L5 Causes: heavy lifting, degeneration S/Sx: Pain Sensory disturbance: numbness, paresthesia Sciatica Lasegues sign pain on raising leg Muscle spasm in lumbar Management: Position: flat on bed with bed board*** Turning: log-rolling at least 3 nurses Surgery: laminectomy, chymopapain/ chemonucleolysis Heat application
146.
HYPERKALEMIA: management
Management for hyperkalemia is G.I.C.K.S. + D2 G lucose (D50) I nsulin C calcium replacement (to force potassium back in the IC compartment) K ayexalate enema (retain enema for 30 minutes to allow for sodium exchange; afterward, expect client to have diarrhea.) S odium bicarbonate + DIALYSIS DIURETICS
147.
HYPERTHYROIDISM AND HYPOTHYROIDISM

HYPOTHYROIDISM (myxedema, Hashimotos disease, cretinism: children) HYPERTHYROIDISM (Graves disease, Parrys disease, Basedows disorder, Toxic diffuse goiter, Thyrotoxicosis) Decrease T3 decrease BMR, wt. Gain Increase T3 increase BMR, increase VS Increase T4 increased body heat production Increase Thyrocalcitonin decreased serum calcium Increase GI motility (diarrhea)
MAIN Decrease T4 decrease body heat production, catabolism PROBLEM Decrease Thyrocalcitonin increased serum calcium S/SX Decrease GI motility (constipation)
Decrease Appetite increased lypolysis atherosclerosis MI Decrease VS (Cold intolerance, bradycardia, hypothermia most fatal) Decrease Energy (fatigue, lethargy, hypoactive) Decrease Metabolic rate Decrease SKIN moist (dry, brittle/ coarse hair/ skin)
Increase Appetite Increase VS (Heat intolerance, tachycardia) Increase Energy (Restlessness, nervousness, tremors insomnia) Increase Metabolic rate Increase SKIN moist (diaphoresis)
Increase weight (fluid retention, edema) Increase menstruation (menorrhagia)
Decrease weight (tissue wasting) Decrease menstruation (amenorrhea) Exopthalmus
Monitor VS, I&O (to determine myxedema coma) DIET: Skin care Low calorie, High fiber Increase fluid intake/ IVF (constipation) or decrease fluids (edema) High CHON, Low CHO, Low FATS
Monitor VS, I&O (to determine thyroid storm) DIET: Skin care High calorie, Low fiber Increase fluids High CHON, High CHO, High FATS SFF
MNGT
Warm environment
Cool environment Sx: SUBTOTAL THYROIDECTOMY
DRUG
Lifetime thyroid hormone (Levothyroxine (Synthroid)) b. SE: insomnia Atrophine SO4, isopreterenol (bradycardia) Diuretics (edema) Stool softeners/ laxatives (constipation)
Radioactive iodine (131I) therapy Anti-thyroid agents (Thionamides): Propylthiouracil (PTU), Methimazole (Tapazole) Beta blockers: Propranolol (Inderal) IODIDES: KISS: Potassium Iodide Saturated solution (lugols solution) Steroids: Dexamethasone Digitalis, Ca+ blockers, Antidiarrheal
NOTE: never give SEDATIVES, narcotics, other CNS depressants COMPLICATION MYXEDEMA COMA S/Sx: Hypothermia, Hypoventilation, Altered LOC leading to coma, Bradycardia THYROTOXIC CRISIS (THYROID STORM) S/Sx: Fever, Agitation, Tachycardia
148.
HYPOPARATHYROIDISM AND HYPERPARATHYROIDISM

HYPOPARATHYROIDISM MAIN PROBLEM Decrease Calcium Increased Phosphate Tetany (Chvostek and Trousseau) S/SX Laryngospasm Paresthesia High calcium diet DIET Low phosphate diet DRUGS Calcium gluconate AlOH (Amphogel) COMPLICATION Seizure High phosphate diet Calcitonin Furosemide Renal stones HYPERPARATHYROIDISM Increase Calcium Decreased Phosphate Bone pain/ fracture Renal colic Anorexia, nausea and vomiting Low calcium diet
FOODS high in CALCIUM: Milk Orange*** Yogurt Spinach

ANTACID: Aluminum hydroxide (Amphogel), given in HYPOparathyroidism Antacid but the side effect is phosphate binder DIURETIC: Furosemide (Lasix), given in HYPERparathyroidism Diuretic that eliminates calcium as well as sodium and potassium in urine
149.
INCREASED INTRACRANIAL PRESSURE

Cushings manifestations: Increased BP and MAP Decreased RR and PR Wide pulse pressure Management: Position: high-fowlers position AVOID: Straining/ constipation, Lifting heavy objects IV fluid: hypertonic*** DRUGS: mannitol
150.

JUVENILE RHEUMATOID ARTHRITIS (JRA)

Autoimmune inflammatory disease cause is antibodies Idiophatic JRA cause is unknown S/Sx: J Joint swelling and pain R Redness and warmth A A.M. stiffness Insist to be carried Management: J Junk excess weight R ROM (range of motion exercises) A Aspirin, Apply moist heat NSAIDS, Methotrexate Priority nursing diagnosis: Pain r/t inflammatory process Complication: loss of vision (due to iridocyclitis) Referral: ophthalmologist (evaluate iridocyclitis)* Sport: hanging on monkey bars, water exercises
151.
LATEX ALLERGY
FOODS: Avocado Bananas Chestnuts Kiwi fruits Grapes Pineapple Potatoes Passion fruits Tropical fruits (mango) Strawberry Soy beans
Catheters, rubbers, condom, balloons Contraindicated with spina bifida patients Assess for signs and symptoms: STRIDOR (best option) harsh, high pitch sound caused by air passing through constricted air passages Urticaria Wheezing Watery eyes Non-latex gloves vinyl gloves Non-latex balloon mylar balloon
152.

LEGG-CALVE-PERTHES
Aseptic, avascular necrosis of the femoral head treatment: traction for 2-4 years self- limiting S/Sx: L limping due to synovitis C contracture deformities P pain from the knee to the groin; aggravated by activity but relieved by rest; stiffness in the morning or after rest D dislocation (complication) Management: Initial: reduce inflammation, restore motion Goal: keep the femoral head in contact with acetabulum Keep the leg abducted Avoid weight bearing Traction: 2 to 4 years
153.

LEUKEMIA
Most common cancer in pediatric clients Increased immature WBC Decrease matured WBC risk for infection Decrease RBC activity intolerance Decreases platelets risk for bleeding
154.
LIVER CIRRHOSIS
Most common type: Laennecs cirrhosis (due to alcohol) repeated destruction of hepatic cell scar tissue formation (fibrotic) cycle (scarring and regeneration) hardening and shrinkage of the cell obstruction of blood flow increase resistance/ pressure in the portal vein congestion in the portal system
PORTAL HYPERTENSION Portal HPN, Increase collateral circulation Caput medusa (dilated veins over the abdomen) Hepatomegaly, Spleenomegaly Hemorrhoids Ascites and edema (unable to metabolize protein) Spider angioma/ telangiectasia (dilated vein/capillaries over the face and trunk) Esophageal varices, GI bleeding Leg varicositites
155.
LYMEs DISEASE vs ROCKY MOUNTAIN SPOTTED FEVER

Not communicable from one person to another
LYMEs DISEASE Cause S/Sx Carrier Treatment Spirochete Borrelia Burgdorferi Bulls eye rash Deer tick (white-tailed deer/ white-footed mice) Doxycycline (Vibramycin) Diethytoluamide (DEET) Permethrine WHEN common Summer Stage I flu like + rashes Stage II neurlogic deficits (bellspalsy, paralysis) and heart conduction defects Lyme , Connecticut
ROCKY MOUNTAIN SPOTTED FEVER Rickettsia rickettsii Diffused rash (maculopapular/ petechial rash) Dog tick, wood tick, rabbit tick Doxycycline (Vibramycin)/ Tetracycline; Chloramphenicol; Diethytoluamide (DEET) Permethrine Spring
Snake River Valley, Idaho
Northeast (Massachusetts to Maryland), Mid-atlantic states (Winconsin to Minnesota)
156.

MENIEREs DISEASE (endolymphatic hydrops)

Dilation of the endolymphatic system by overproduction or decreased reabsorption of the endolymphatic fluid TRIAD manifestations: 4. tinnitus 5. vertigo 6. lateral sensorineural hearing loss Management: Administer nicotinic acid (niacin) as prescribed for its vasodilator effect Restrict water, low sodium diet Streptomycin (to eliminate vertigo)
157.
MRSA (methicillin-resistant Staphylococcus aureus)

2 types of infection: Hospital-associated MRSA happens to people in healthcare settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling. Practice good hygiene Keep cuts and scrapes clean and covered with a bandage until healed AVOID: contact with other peoples wounds or bandages sharing personal items, such as towels, washcloths, razors, or clothes Wash soiled sheets, towels and clothes in hot water with bleach and dry in a hot dryer DOC: Linezolid, Vancomycin
158.

MUSCULAR DYSTROPHY
Progressive degeneration of skeletal muscles Inherited Duchennes muscular dystrophy (pseudohypertrophic muscular dystrophy) S/Sx: Gowers sign (standing) Pseudohypertrophy: woody on palpation, look enlarged Management: Diet: low calorie, high protein (tom prevent obesity) high fiber and high fluid (to prevent constipation) death is due to respiratory or heart failure
DUCHENNES MUSCULAR DYSTROPHY X Rapidly progressive muscular weakness and atrophy

Gowers sign (standing) self- splinting NO cure!
159.

MYELOSUPPRESSION
THROMBOCYTOPENIA Petechiae ANEMIA Fatigue NEUTROPENIA Fever and sore throat
160.
MYOCARDIAL INFARCTION
Cardiac enzymes after 1 hour after 2 hour after 4 hour after 24 hour Myoglobin Troponin CPK-MB LDH
ECG changes Pathologic Q wave ST elevation*** T wave inversion Effects of Morphine in MI Reduces pain and anxiety Reduces preload and afterload*** Reduces workload Relaxes bronchioles Lowers BP Depressed respiration
161.
NEPHRITIS (Nephritic Syndrome) and NEPHROSIS (Nephrotic Syndrome)

NEPHROSIS (NEPHROTIC SYNDROME) Increase glomerular membrane permeability Autoimmune Hypoalbuminemia Proteinemia Hyperlipidemia Edema (anasarca) NEPHRITIS (NEPHRITIC SYNDROME) Inflammation of the kidneys GABHS Hematuria (gross) Edema (periorbital) HPN Proteinuria Oliguria/ Anuria Increase BUN/ creatinine DIET: low sodium, decrease OFI Bed rest
DIET: high protein, low sodium, decrease OFI Ambulate Normal BUN = 10 20 Normal creatinine 0.4 1.2
162.

OBSTRUCTIVE SLEEP APNEA (OSA)

OSA is the most common type of sleep apnea syndrome Cause: Obesity Old men Smoking Pathophysiology: decrease diameter of the upper airway S/Sx: Insomnia Snoring Morning headaches Hypertension Enuresis Complications:*** CAD, HPN CVA
Premature death MI, dysrhythmias
Management: AVOID: sleeping in supine, alcohol Lose weight
163.

ORTHOSTATIC HYPOTENSION
An increase in PR of 15 to 30 bpm OR A decrease in BP of 20 mmHg in systole and 10 mmHg in diastole BP falls when client sits or stands
164.

OSTEITIS DEFORMANS (PAGETs DISEASE)

affects skeletal system Management: Alendronate (Fosamax) Monitor: alkaline phosphate (increase: bone problem) affects men and women with familial predisposition S/Sx: joint pain Chronic headache Cartilage damage Nerve pressure
165.

OSTEOMYELITIS
Cause: Staphylococcus aureus Open wounds(compound fracture, surgery) S/Sx: Fever Pain Redness Swelling Drainage Necrosis (sequestrum) Management: Incision and drainage Sequestrectomy Immobilize***
166.

OSTEOPOROSIS
Decrease in bone amount. Density Cause: 1. Primary (non-modifiable cause) senile, menopausal (decrease estrogen) 2. Secondary (modifiable cause) malnutrition, immobilization, decrease exercise S/Sx: Loss of height (kyphosis) Dowagers hump*** Low back pain Lung problem Management: Brisk walking for 30 minutes, 4x/ day Lifestyle: stop smoking, decrease alcohol and caffeine Drugs: o Calcitonin/ Calcitriol o Biphosphonates: akendronate (Fosamax) o Hormonal replacement therapy: estrogen
167.

PANCREATITIS
Acute pancreatitis can become chronic PAIN associated with acute pancreatitis is:*** a. severe and unrelenting b. located in the epigastric region c. radiates to the back AVOID: Morphine sulfate is not used to treat pain since it can cause the sphincter of Oddi to spasm enteral feedings (it stimulates the pancreas)
MANAGEMENT: Position: Side-lying to lessen the pain Meperidine (Demerol) Pancreatic enzymes and bile salts with meals*** IV fluids (to prevent shock) insulin for hyperglycemia calcium replacement decrease stimulation of pancreas o NPO-TPN (nothing by mouth; total parenteral nutrition) o NG tube o anticholinergics o H2-receptor antagonists
168.

PARKINSONs DISEASE
Tremors (resting and pillrolling) Rigidity (cogwheel) Akinesia/ Bradykinesia Mask like face
169.

PEMPHIGUS VULGARIS
cause: unknown presence of fluid-filled vesicles over 1 cm in size associated with an autoimmune response S/Sx: Hallmark: Nikolskys sign when the epidermis is rubbed off by slight friction or injury pain, dysphagia, skin lesion: bullae rupture easily, foul-smelling drainage Laboratory data: increase WBC Nursing diagnosis: PAIN Management: potassium permanganate Oatmeal bath decrease pruritus
170. PEPTIC ULCER DISEASE Risk factors: Helicobacter pylori*** NSAIDS Iron Steroids Smoking and alcohol Stress 2 Types: Gastric Ulcer Duodenal ulcer
171.
PERICARDITIS***
Pain is aggravated by: Cough*** Deep inspiration (so the patient do shallow inspiration)*** swallowing food lying down turning Characteristic of breathing pattern: Shallow Position to relieve pain: sitting and leaning forward (orthopneic)***
172.

PHEOCHROMOCYTOMA
Tumor of adrenal MEDULLA Main problem: increased production of catecholamines (epinephrine and norepinephrine) S/Sx: HPN Hyperhydrosis High PR
173.
PITUITARY GLAND
Anterior
o o o o o o
Prolactin/ lactotropin TSH (thyroid stimulating hormone) GH (growth hormone)/ somatotropin*** GnRH (gonadodropin releasing hormone) FSH (follicle stimulating hormone) LH (luteinizing hormone) MSH (melanocytes timulating hormone) ACTH (adrenocorticotropic hormone)
Posterior o Oxytocin/ vasopressin o ADH (antidiuretic hormone)
174.

PNEUMOTHORAX
Air in the pleural space Types: o Spontaneous/ Simple o Traumatic Closed Open o Tension S/Sx: o o o o
Percussion hyperresonance*** Palpation absent/ decreased fremitus Auscultation decreased breath sounds Inspection asymmetry
175.
POLYCYTHEMIA VERA
S/Sx:*** o o o o o o Ruddy complexion d/t capillary congestion in the skin and mucous membranes Splenomegaly d/t organ infiltration Hypertension d/t viscosity of blood Generalized pruritus (due to basophils)*** Elevated Hct, bilirubin, liver enzymes Elevated RBC, WBC and platelets all immature
Complications: o Thrombus formation Brain: CVA Heart: MI, Heart failure o Bleeding due to congestion and overdistention of capillaries and venules shock o Peptic ulcer due to increased gastric secretions o Gout due to increased uric acid released by nucleoprotein Management o Increase fluids o Phlebotomy removal of excess blood then DISCARD*** o Drugs: 32 Radioactive phosphorus ( P) reduces RBC production Nitrogen mustard, busulfan, chlorambucil, cyclophosphamide to effect myelosuppression o AVOID: IRON rich foods*** will enhance the production of RBC
176.
PREGNANCY: DISCOMFORTS OF PREGNANCY

ASSESSMENT Nausea and vomiting (morning sickness) 1 NURSING MANAGEMENT Eat small frequent meals eat dry crackers on arising may occur any time of day Breast soreness1 Well-fitting bra decrease caffeinated and carbonated drinks Nasal stuffiness1 Use cool air vaporizer increase fluid intake place moist towel on the sinuses 60 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Ptyalism1
Use mouthwash as needed chew gum or suck on hard candy
Urinary frequency1 & 3
Kegels exercise decrease fluids before bed report signs of infection, avoid caffeine
Constipation2 & 3
Increase fiber on the diet drink additional fluids have a regular bowel movement
Leg Cramps2 & 3
Increase calcium intake avoid pointing your toes, flex feet, local heat application
Backache2 & 3
Emphasize posture careful lifting, good shoes (low heeled) stoop to pick up objects
Heartburn2 & 3
Small, frequent meals avoid overeating, as well as spicy and fatty foods
Dizziness2 & 3
Slow, deliberate movements support stockings lie on left side when at rest
Ankle edema2 & 3
Rest with your feet elevated avoid restrictive garments on the lower half of the body
Fatigue2 & 3
Schedule a rest period daily use extra pillow for comfort
Hemorrhoids2 & 3
Avoid constipation and straining with bowel movement take a sitz bath apply witch hazel compress
Varicose veins2 & 3
Walk regularly rest with feet elevated avoid long periods of standing do not cross your legs
*1- first trimester; 2-second trimester; 3-third trimester
177.
PREGNANCY: SIGNS
Presumptive Signs and Symptoms (FUNQPAB) - suspicion not proof, predominantly subjective Fatigue response to increased hormonal levels Urinary frequency caused by pressure of expanding uterus in the bladder Nausea and vomiting (morning sickness) Quickening - sensations of fetal movement in the abdomen) - occurs between the 16th and 20th week after the onset of the last menses. Pigmentation of the skin Melasma gravidarum (Chloasma) mask of pregnancy Abdominal striae (striae gravidarum) due to stretching, rupture and atrophy of deep connective tissues of the skin Linea nigra Amenorrhea cessation of menses Breast changes enlarge and become tender
Probable Signs and Symptoms (+ BBLUE HCG) - increased suspicion but still no proof, no subjective data Positive hCG laboratory (urine or serum) test for pregnancy. Ballottement - sinking and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus (occurs near midpregnancy). Braxton Hicks contractions - painless, palpable contractions occurring at irregular intervals, more frequently felt after 28 weeks. They usually disappear with walking or exercise. Leukorrhea - increase in vaginal discharge Uterine changes from pear shape to spherical around 8 weeks gestation and becomes ovoid from 16 weeks until term Enlargement of abdomen - at about 12 weeks' gestation, the uterus can be felt through the abdominal wall, just above the symphysis pubis Hegar's sign - lower uterine segment softens 6 to 8 weeks after the onset of the last menstrual period. Chadwick's sign - bluish or purplish discoloration of cervix and vaginal wall. Goodell's sign - softening of the cervix; may occur as early as 4 weeks Positive Signs and Symptoms (4 Fs) - definite signs of pregnancy Fetal heart tones (FHTs) usually heard between 16th and 20th week of gestation with a fetoscope or the 10th and 12th week of gestation with a Doppler stethoscope Fetal movement felt by the examiner (after about 20 weeks gestation) Fetal body outline through the maternal abdomen in the second half of pregnancy. Fetal sonographical evidence (after 4 weeks' gestation) using vaginal ultrasound. Fetal cardiac motion can be detected by 6 weeks' gestation
178.
PREGNANCY: smoking
Effects: Congenital heart defects SGA Respiratory distress Premature death SIDS
179.

PRURITUS
Bathe in tepid water and apply emollient lotion AVOID soaps and detergents AVOID petroleum, mineral oil Use calamine, antihistamine Provide cool, light, nonrestrictive clothing Keep nails short Apply cool and moist compress
180.
RENAL FAILURE
Causes: 4. Pre-renal due to DECREASED RENAL PERFUSION Shock, DHN, CHF, burns, hypovolemia 5. Intra-renal due to KIDNEY INJURY UTI, DM, BT, nephritis Post-renal due to KIDNEY TRACT OBSTRUCTTION Cystitis, calculi, BPH
6.
181.
RENAL STONES
Type of stones: Alkaline stone calcium oxalate, struvite Acidic stone uric acid, cystine Calcium oxalate stone most common kidney stone Location:*** UPPER GU tract (kidney, ureter) flank pain radiating to abdomen LOWER GU tract (bladder, urethra) inguinal (groin) pain radiating to testicular or labial Characteristic of pain (renal colic) Sharp and Sudden*** KUB Xray CONFIRMATORY*** Sources of Oxalate:
dark green vegetables (spinach) rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
182.

SEIZURES
Priority DURING: safety Priority AFTER: airway Seizure Precaution P osition: side-lying L oose the clothings A VOID: resrictions N ote: duration and characteristics of the seizure O xygenate: jaw-thrust D rugs: diazepam,phenytoin, carbamazepine R emove harmful objects at the bedside A t the bedside: suction machine P ad and raise the side rails E liminate environmental stimuli (bright lights, noise)
183. SHOCK Reduction of arterial pressure leading to decrease blood flow (deficiency in nutrients, oxygen, electrolytes delivery to tissue, as well as waste removal) Types: Cardiogenic loss of cardiac pumping action (MI, CHF) Hypovolemic decrease blood volume (burns, bleeding/ hemorrhagic shock, dehydration) most common Distributive/ Circulatory Neurogenic (SCI, drug depressants) Vasogenic massive vasodilation Anaphylactic massive reaction to food, drugs and chemical Septic Septic massive infection Stages:
COMPENSATORY Normal BP Increased RR and PR cold clammy skin oliguria hypoactive bowel sounds PROGRESSIVE Decreased BP Increased RR and PR Altered LOC Oliguria increased BUN and Creatinine stress ulcers and increased risk for GI bleeding. metabolic acidosis (due to accumulation of lactic acid) IRREVERSIBLE severe organ damage
Common manifestations:*** o Decrease BP, MAP (Mean Arterial Pressure) o Increase RR, PR o Narrow Pulse Pressure Position: modified trendelenburg*** In neurogenic shock, the patient is also at an increased risk for deep vein thrombosis. Major cause of septic shock gram-negative bacteria First drug to be given for SHOCK Epinephrine The degree of cardiogenic shock is proportional to the extent of left ventricular dysfunction.***
184.
STILLBORN CHILD
Management: Parents need to see, touch, wash, and dress baby Get footprints, pictures, lock of hair, ID band, name the child and use the name often. If they dont see their baby; the parents often never face reality and stuck in the grieving process. Again, encourage to hold, rock, and cuddle their baby. Allow and encourage them to take photos of their angel.
185.

STRABISMUS
Lack of coordination of the extraocular muscles causing misalignment of the eye Normal in infant up to 4 months only
186.
SUDDEN INFANT DEATH SYNDROME (SIDS)

Causes:
smoking, drinking, or drug use during pregnancy poor prenatal care prematurity or low birth-weight mothers younger than 20 tobacco smoke exposure following birth overheating from excessive sleepwear and bedding stomach sleeping
187.

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Autoimmune S/SX: Fatigue Arthritis Sensitivity to sunlight Butterfly rash Management: NO CURE GOAL: controlling manifestations Steroids Plasmapharesis***
188.

TETRALOGY OF FALLOT
Severe acute ccyanosis tet spells 4 Defects:*** o Pulmonic Stenosis o Right Ventricular Hypertrophy o Ventricular Septal Defect o Overridding of the Aorta Position: Knee-chest/ Squatting*** S/Sx: o o o
Machine-like murmurs Clubbing of fingers Cyanosis
Management: o Surgery: Blalock Taussig procedure shunting of the subclavian artery and pulmonary artery
189.

TRIAGE
trier- to sort To sort patients in groups based on the severity of their health problem and the immediacy with which these problems must be addressed 3 CATEGORIES IN TRIAGE in E.R.
EMERGENT Color Urgency Examples Red Life, limb, eye threatening Needs immediate attention Chest pain, cardiac arrest, severe respiratory distress, chemicals in the eye, limb amputation, penetrating trauma, severe hemorrhage Yellow Needs treatment in 20 minutes to 2 hours Fever >40oC, simple fracture, abdominal pain, asthma with no respiratory distress URGENT Green Can wait hours or days sprain, minor laceration, rash, simple headache. Toothache, sore throat NON-URGENT
IMMEDIATE Number Color Examples 1 Red Chest wounds, shock, open fractures, 2-3 burns
4 CATEGORIES IN TRIAGE in DISASTER DELAYED MINIMAL 2 Yellow Stable abdominal wound, eye and CNS injuries 3 Green Minor burns, minor fractures, minor bleeding 4
EXPECTANT
Black Unresponsive, high spinal cord injury
190.

VANCOMYCIN RESISTANT ENTERROCOCCUS (VRE)

A mutation of very common bacterium that is spread easily by direct person-to-person contact S/Sx: There are no specific signs and symptoms related to VRE NURSING DIAGNOSIS: Risk of infection (transmission) MANAGEMENT: Explain to the patient the importance of hand washing to prevent the spread of the infection.
191.

VENOUS DISORDERS, Management:

Elevate legs Exercise legs Early ambulation Elastic stockings
TOP 93 NURSING SKILLS, PROCEDURES and NORMAL VALUES
A
1. ABDOMINAL ASSESSMENT
Procedure: I-A-Pe-Pa Regular assessment: I-Pa-Pe-A Sequence: RLQ RUQ LUQ LLQ Position: dorsal recumbent AVOID: A ppendicitis P heochromocytoma A bdominal Aortic Aneurysm W ilms tumor
2. AMNIOCENTESIS vs. ULTRASONOGRAPHY

AMNIOCENTESIS aspiration of amniotic fluid inside the amniotic sac through an outside puncture 1. If more than 20 weeks' gestation (empty bladder) to prevent confusion between it and the amniotic sac 2. If less than 20 weeks' gestation (full bladder) to elevate the uterus and increase visualization of the fluid pocket 1. If done early in pregnancy: To detect chromosomal abnormalities 2. If done late in pregnancy: To detect fetal lung maturity and to resolve polyhydramnios VARIABLES Definition ULTRASONOGRAPHY visualization of the uterine content including all the products of conceptus 1. After 20 weeks (empty bladder) 2. Before 20 weeks (full bladder) to increase ultrasonic resolution and elevate the presenting head for biparietal diameter measurement
Preparation of the mother
Purpose (s)
First Trimester 1. Gestational age assessment 2. Evaluation of congenital anomalies; 3. Confirm multiple pregnancy Second Trimester 1. Guidance of procedure (amniocentesis); 2. Assessment of placental location Third Trimester*** 1. Determination of fetal position 2. Estimation of fetal size/ weight
3. ARTERIAL BLOOD GAS (ABG) ANALYSIS

Serum pH 7.35 7.45 CO2 35 45 HCO3 22 26 PaO2 85 95 mmHg Increased: Polycythemia Decrease: Anemia BEFORE: Allen Test to assess patency of the RADIAL artery*** Avoid suctioning at least 20-30 minutes BEFORE procedure AFTER: Apply pressure on puncture site for 5 minutes First step in ABG analysis determine pH***
4. ABDOMINAL PARACENTESIS
Purpose: Obtain fluid specimen To relieve pressure on the abdominal organs d/t the excess fluid BEFORE: Ask client to void*** DURING: Position: Sitting position Common site: midway between the umbilicus and symphysis pubis Measure abdominal girth at the umbilical level Maximum amount to be drain is 1500 mL Strict STERILE technique
5. ASEPSIS
Purpose Indication Technique MEDICAL ASEPSIS To reduce microorganism Routine nursing care Disinfection (clean) SURGICAL ASEPSIS To destroy microorganism including spores Procedure involving sterile areas Sterilization (sterile)
B
6. BARIUM SWALLOW AND BARIUM ENEMA
USE BEFORE BARRIUM SWALLOW Examination of UGT NPO 6 8 hours BARIUM ENEMA Examination of LGT NPO at midnight (6 8 hrs) DIET: Low residue diet, Clear liquid diet (1 3 days) Laxatives, Cleansing enema Constipation: Increase fluids, Laxative Stool color: chalky white 1 3 days
AFTER
7. BENNERs STAGES OF NURSING EXPERTISE***

Stage 1 Stage 2 Stage 3 Novice Advanced beginner Competent No experience Limited performance Inflexible Marginally acceptable performance Recognizes the meaningful aspect of a real situation 2 or 3 years of experience Demonstrates organizational and planning abilities Coordinates multiple complex care demands 3 to 5 years of experience Perceives situations as wholes rather in terms of parts, as in Stage 2 Has holistic understanding of the client, which improves decision making Focus on long term goals Performance is fluid, flexible, and highly proficient No longer requires rules, guidelines, or maxims Demonstrates highly skilled intuitive and analytic ability in new situations
Stage 4
Proficient
Stage 5
Expert
8. BLEEDING PRECAUTION (OPEN wounds)

P ressure over the injury E levate above the heart C old compress A rterial pressure T orniquet
9. BLOOD TRANSFUSION
BEFORE Check order 2 RNs o Client name and identification number o Unit number o Blood type matching o Expiration date o Doctors order/ Informed consent Obtain baseline VS
warm blood at room temperature for NOT more than 30 minutes
DURING st STAY with the patient and Check every 15 minutes 1 hour Check every hour succeeding hours BLOOD COMPONENTS
Blood Component Whole blood PRBC Cryoprecipitate Platelets Fresh frozen plasma Infusion rate 2 to 4 hours 2 to 4 hours 30 minutes Rapid Rapid of bleeding; 1 to 2 hours Volume 450 ml 250 ml 10 ml 35 to 50 ml 250 ml
BT REACTION
REACTION C irculatory overload/ congestion H emolytic A llergic P yrogenic CAUSE too rapid incompatibility antigen/ antibody reaction bacterial S/SX dyspnea, HPN, increased PR jaundice, shock HA urticaria, wheezing, facial edema fever, chills MANAGEMENT Slow down the infusion rate Stop the infusion Stop the infusion Antihistamine Stop the infusion Paracetamol Save unit of blood and return to blood bank for analysis.
BT REACTION MANAGEMENT: (in sequence)*** B T stop L et the tubings be changed O pen NSS A lways check the VS D octor, where are you! S cold the bank OTHERS:*** Gauge: 18 or 19 Y set filter IV transfusion set IV fluid: NSS only (other solution like dextrose causes hemolysis) Start at KVO for 15 minutes Monitoring: 15 minutes for the 1st hours and hourly thereafter Time o 4 hours: WBC, PRBC o Rapid: Plasma, Platelets, Cryoprecipitate
10. BONE MARROW BIOPSY/ ASPIRATION

Bones commonly used: sternum, iliac crest, iliac spines, or proximal tibia (children) DURING Position: site is iliac crest Prone site is sternum Supine About 1 to 2 mL of bone marrow is obtained. AFTER: PREVENT BLEEDING Bed rest for 30 minutes Ice bag on punctured site Pressure on the puncture site Position: Lie on operative/biopsied side for 10 to 15 minutes
11. BOWEL DIVERSIONS

TYPES OF OSTOMY Ileostomy Cecostomy Ascending colostomy Transverse colostomy Descending colostomy Sigmoid colostomy STOMA watery (prone to Fluid Volume Deficit and Impaired skin integrity) watery (prone to Fluid Volume Deficit and Impaired skin integrity) watery (prone to Fluid Volume Deficit and Impaired skin integrity) mushy/ semi-formed formed formed
Color Sensation Protrusion Drain Appliance size (pouch opening)
brick red (May turn to pink after several months and years) normally no sensation to inches 1/3 to full 1/16 to 1/8 inches
COLOSTOMY IRRIGATIONS needed by Descending and sigmoid colostomy st 1 stimulate nd 2 evacuate Position: sitting FOODS
Causes odor Beans Asparagus Garlic Eggs Spices Celery Cabbage Corn Camote Cauliflower Champagne Cucumbers Carbonated drinks Tapioca Rice Yogurt Apple and apple sauce Banana Cheese
Causes gas
Thicken stool
Permanent colostomy Descending and sigmoid colostomy Colon cancer sigmoid colostomy
12. BREASTFEEDING
ASSESSMENT OF PROPER LATCHING C hin to breast pen mouth widely L ips turned outward A reola is visible above only Nipple touches the posterior tongue 9to promote swallowing reflex) Nipple (bottle) always filled with milk 9to prevent colic) Color of stools: Breast fed: golden yellow Formula fed: pale yellow
13. BRONCHOSCOPY
BEFORE: NPO for 6-12 hours prior to procedure; no dentures; maintain good oral hygiene DURING: uses local anesthetic spray to minimize gagging while inserting the bronchoscope supine with head hyperextended AFTER: POSITION: semi fowler's NPO till gag returns then start with ice chips then followed by sips of water soft diet regular diet ice bags to throat minimize talking, coughing, laughing; warm saline gargles; assess for respiratory distress
C
14. CANCER SCREENING
PROCEDURE Breast Self Exam (BSE) Testicular Self Exam (TSE) Mammogram SCHEDULE Monthly, 3 to 5 days after the onset of menstruation Monthly, after a warm bath 35 to 40 years 1x (baseline) 41 to 50 years every 2 years 51 and above yearly Onset 40 every 3 years 41 and above yearly 50 and above yearly 40 and above yearly (if high risk)
Paps smear Digital rectal Exam (DRE)
15. CHEMOTHERAPY SIDE EFFECTS

SIDE EFFECTS INTERVENTIONS 68 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Nausea and vomiting Anorexia
GATRO-INTESTINAL Oral thrush
Neutropenia (WBC)
HEMATOPOEITIC (Bone marrow suppression)
Thrombocytopenia (Platelets) Anemia (RBC) Alopecia
INTEGUMENTARY Cystitis Sterility/ infertility
GENITO-URINARY
o Provide antiemetics 30 60 minutes before chemotherapy o AVOID: unpleasant odor, spicy foods, hot o Small Frequent Feedings o Diet: soft bland o Ensure adequate fluid hydration o Frequent oral hygiene o Rinse mouth with strength peroxide and NSS o Brush teeth with soft toothbrush and baking soda o USE: unwaxed dental floss, cotton-tip applicator for viscous xylocaine over lesions Neutropenic precaution o Handwashing o Neutropenic diet/ low-bacteria diet: cooked foods AVOID: fresh flowers, fruits, vegetables, raw foods, vaccinations o Reverse isolation/ private room o Assess vital signs every 4hours Thrombocytopenic precaution o AVOID: aspirin, IM, invasive procedures, punctures, contact sports o Use soft bristled toothbrush, electric razor, stool softener Blood transfusion Bed rest o Discuss potential TEMPORARY hair loss (2 to 4 weeks) o Use of wigs o If hair grows back color and texture changes o AVOID: excessive shampooing o Increase fluids o Temporary
Nadir lowest point of RBC, WBC and platelets after chemotherapy administration; occurs within 7 to 14 days after
16. CHESTPHYSIOTHERAPY (CPT)

Purpose Method Duration POSTURAL DRAINAGE To drain by GRAVITY Positioning 10 to 15 minutes per position PERCUSSION To mechanically dislodge Striking by cupped hands 1 to 2 inches/ lung segment VIBRATION To loosen mucus secretions Quivering palm on chest wall 5 exhalation***
Sequence:*** 1 postural drainage 2 percussion 3 vibration done BEFORE meals ask patient to COUGH after chestphysiotherapy
17. CHEST TUBE

a. DRAINAGE BOTTLE NURSING CONSIDERATIONS: Keep at least 2 to 3 feet below the chest (to allow drainage by gravity) NEVER raise the bottle above the level of the heart (to prevent reflux of air or fluid) NOTE: COLOR: bloody drainage during the first 24 hours OUPUT: 500 1000 ml during the first 24 hours FLUID DRAINAGE: the tube is inserted at 8th or 9th ICS AIR DRAINAGE: the tube is inserted 2nd or 3rd ICS COMMON OBSERVATIONS NO DRAINAGE Resolution Obstruction b. WATER SEAL BOTTLE NURSING CONSIDERATIONS: Immerse tip of the tube in 2- 3 cm of sterile NSS to create water seal COMMON OBSERVATION: INTERMITTENT BUBBLING/ FLUCTUATIONS/ OSCILLATION/ TIDALLING (rise on inspiration, fall during expiration) NO FLUCTUATIONS Obstruction check and milk the tubing with CAUTION Low suction Re expand lungs do chest X- ray for confirmation CONTINUOUS BUBBLING Air leakage (except during suctioning) c. SUCTION CHAMBER NURSING CONSIDERATIONS:
Immerse the tube of the suction control bottle in 10 to 20 cm of sterile NSS (to stabilize the normal negative pressure in the lungs and protects the pleura from trauma if the suction pressure is inadvertently increased)
COMMON OBSERVATION: CONTINUOUS GENTLE BUBBLING (indicates adequate suction control) NORMAL d. CHEST TUBE REMOVAL Give analgesics 30 minutes before removal Clamp on bedside DURING removal: let the patient EXHALE and hold breath while doing VALSALVA MANEUVER Maintain dry, sterile, occlusive dressing EMERGENCY SITUATION DISLODGE (chest tube removal FROM THE CLIENT) AT BEDSIDE: vaselinized gauze Palm pressure (for splinting) DISCONNECTION (disconnection FROM THE BOTTLE/ bottle breakage) ATBEDSIDE: Extra bottle immersed in sterile water Clamp (Hemostat) ALERT! Never clamp the test tubes over an expanded period of time. Clamping the chest tubes IF a client with an air in the pleural space will cause increased pressure buildup and possible TENSION PHEUMOTHORAX
e.
f.
18. CEREBROSPINAL FLUID (CSF) ANALYSIS

Protects from mechanical trauma Function of CSF: Carries nutrients to brain Characteristics Normal pressure: 5 to 15 mmHg/ 70 to 180 mmH2O Normal volume: 100 to 200 ml WBC: 0 - 5 cells/mm Glucose: 40 to 80 mg/dl (40 to 80 mg/100ml) Protein: 15 to 45 mg/dl (15 to 45 mg/100 ml) Meningitis Increase protein content Decrease glucose content Increase WBC content Cloudy (bacterial meningitis) Clear (viral meningitis)
19. COMMUNICATION: ATTENTIVE LISTENING

Absorbing both the CONTENT and the FEELING the person is conveying, without selectivity Listening actively, using all senses (as opposed to listening passively with just the ear) Active process that requires energy and concentration Paying attention to the total message (both verbal and non-verbal) and noting whether these communications are congruent Conveys an attitude of caring and interest, thereby encouraging the client to talk
20. COMMUNICATION: PHYSICAL ATTENDING***

1) face the other person squarely 2) adopt an open posture 3) lean towards the person 4) maintain good eye contact 5) try to be relatively relaxed
21. CT SCAN
X-ray Contrast medium warm sensation AVOID: pregnant women Before: NPO After: increase fluid
22. CVP MONITORING

Measure the pressure of the right atrium Place the zero level of the manometer at the level if the right atrium (4th ICS) AVOID: coughing and straining NORMAL: 2 -12 mmHg
23. CYSTOSCOPY
Direct visualization of the LOWER urinary tract (bladder and urethra) PURPOSE: specimen collection treatment of the interior of the bladder and urethra Prostate surgery Local anesthesia commonly used POSITION: dorsal recumbent CONTRAINDICATIONS: acute cystitis, bleeding disorders AFTER: Assess VS urine characteristic (NORMAL: pink tinged or tea-colored urine) I&O Encourage fluids Sitz bath Observe for fever, dysuria, pain in suprapubic region
D
24. DIALYSIS
Urgent indication for dialysis in patient with CRF is PERICARDIAL FRICTION RUB. Objectives of hemodialysis: a. To extract toxic nitrogenous substances from the blood b. To remove excess water Principles of hemodialysis: Diffusion toxic and wastes move from an area of higher concentration in the blood to an area of lower concentration in the dialysate Osmosis excess water is removed from the blood by osmosis Ultrafiltration water moving under high pressure to an area of lower pressure accomplished by negative pressure (suction) Before peritoneal dialysis, patient should empty bladder and bowels.
E
25. EAR
Ear bones (Ossicles) M alleus A nvil S tapes Hammer Incus Stirrups
Position during drug administration: Below 3 years old down and back Above 3 years old up and back Outer ear problem (otitis externa) conductive hearing loss Middle ear problem (otitis media, otosclerosis) conductive hearing loss Inner ear problem (labrynthitis, Menieres disease) sensorineural hearing loss
26. ECG
NORMAL PR QT QRS 0.12 0.20 seconds 0.32 0.40 seconds 0.04 0.10 seconds Tall T wave Flat T wave, presence of u wave Short ST segment and QT interval*** Lengthened ST segment and QT interval
HYPERKALEMIA HYPOKALEMIA HYPERCALCEMIA HYPOCALCEMIA
Atrial flutter With P wave (saw tooth) Regular rhythm Normal QRS Atrial fibrillation*** No P wave Irregular rhythm
Normal QRS
Atrial tachycardia With P wave (different shape) Regular rhythm Normal QRS Ventricular fibrillation No P wave Chaotic rhythm No QRS Ventricular tachycardia No P wave Regular rhythm Wide and bizarre QRS
27. ENEMA
TYPES: Cleansing enema cleansing (3x) Carminative enema flatus Return flow/ Harris flush/ Colonel irrigation flatus (5 6x) Retention soften; lubricate (1 3 hours) VOLUME-based*** o Small volume (150 to 240 ml) used to cleanse rectum and sigmoid o Large volume (500 to 1000 ml) used to cleanse entire colon
SOLUTIONS: Hypertonic Hypotonic Isotonic Irritants Lubricants
sodium biphosphate tap water NSS soapsuds, Bisacodyl/ Fleet oil
Position: left-sidelying/ dorsal recumbent*** Enema tube lubricate first; insert in rotating motion Infant 1 1.5 inches Child 2 3 inches Adult 3 4 inches Cramping: Lower the solution Clamp and wait for 30 seconds*** Restart Temperature: 100 F (37.7 C) 4 factors affecting Force of flow of the solution: (1) Height of the solution container (2) Size of the tubing (3) Viscosity of the fluid (4) Resistance of the rectum
o o
28. E.S.S.R. feeding method of patients with cleft lip and cleft palate
E nlarge the nipple hole S timulate the sucking S wallow R est
29. ESR (Erythrocyte Sedimentation rate) value:

30 to 40 mm/hr indicates mild inflammation 40 to 70 mm/hr indicates moderate inflammation, and 70 to 150 mm/hr indicates severe inflammation.
30. EXERCISES
TYPES OF EXERCISE
CHARACTERISTICS OTHER NAME JOINT MOVEMENT CONTRACTION ISOTONIC Dynamic ISOMETRIC Static/Setting x ISOKINETIC Resistive 72 | TOP DISEASES Prepared by: Brian Yu, 09175262468
BENEFITS on MUSCLES
EXAMPLES
Increase strength Increase tone Increase mass Joint flexibility Use of trapeze Walking Swimming Cycling Running
Increase strength Increase endurance Increase heart rate and cardiac output
Increase strength Increase size Increase blood pressure and blood flow to muscles May be isometric or isotonic with resistance Weight-lifting
Quadricep setting Squeezing on stress ball Kegels
31. FIRE EXTINGUISHER

Type A trash fire paper, woods, leaves (water under pressure) B fuel fires oil, gasoline, kerosene (CO2) C electric fire appliances, wire (dry chemicals) D any kind (graphite)
F
32. FECAL
C-olor -----------brown/yellow stercobilin O-dor------------aromatic C-onsistensy-----------solid-semi-formed moist A-mount ----------------100-400g/day S-hape------------------cylindrical
33. FOODS rich in IRON***

Liver Green leafy vegetables Dried fruits Scallops, shrimps Oyster, clams molasses
34. PROBLEMS IN STOOL ELIMINATION

M elena A cholic stool S teatorrhea H ematochezia dark colored stool (upper Gi bleeding) gray colored stool (bile obstruction) fat containing stool (malabsorption) bright red colored stool (lower GI bleeding)
G
35. GTPALM
G Gravida P Para refers to the number of pregnancies regardless of outcome refers to the number of deliveries that reached viability (20 weeks gestation) born dead or alive; multiple births count as 1 delivery regardless of the number of newborns delivered number of TERM births (infants born after 37 weeks and above) number of PRETERM births (infants born between 20 to 37 weeks) number of pregnancies that end in spontaneous or therapeutic abortion prior to age of viability (20 weeks) number of children currently alive number of pregnancy with more than one newborn (regardless of the number of neonates delivered)
T Term deliveries P Preterm deliveries A Abortions L Live M Multiple gestations
36. GLOVING***
Open-glove technique used when: o Gloving another team member o Changing a glove DURING a procedure (self or team member)*** o A sterile scrub or gown is not required Closed-glove technique used when: o Anytime you are initially applying sterile gown and gloves CHANGING GLOVES DURING A PROCEDURE 1. Ask the Circulating Nurse (CN) to remove contaminated glove 2. CN should wear gloves
3.
CN grasp contaminated glove at palm Scrubbed person holds onto the sleeve of the gown (to prevent riding over)
Using OPEN-GLOVE method, reapply sterile glove***
H
37. COLORS OF HOSPITAL TANKS
Nitrous oxide (laughing gas) Oxygen Cyclospropane Nitrogen Carbon dioxide Helium Medical air Halothane Blue Green Orange Black Grey Brown Yellow Red
38. HOSPITAL COLOR CODES

Code blue cardiac arrest, medical emergency Code pink infant abduction Code red fire Code yellow bomb threat Code silver combative person with weapon
I
39. IMMUNIZATION
SENSITIVITY MOST SENSITIVE to heat LEAST SENSIITVE to heat OPV, measles DPT, Hepa B, BCG, TT
FORM:
Toxoid killed bacteria live attenuated freeze dried
Diphtheria and Tetanus Pertusis OPV measles and BCG
40. INFORMED CONSENT

Purpose: To ensure the clients understanding of the nature of the surgery To indicate the clients decision To protect the client against unauthorized procedure To protect the surgeon and hospital against legal action 2 TYPES: 1) Express consent may be either an oral or written agreement 2) Implied consent nonverbal behaviour indicates agreement General guidelines/ content of informed consent: Diagnosis or condition that requires treatment Purpose of the treatment What the client can expect to feel or experience The intended benefits of the treatment Possible risks or negative outcomes of the treatment Advantages and disadvantages of possible alternatives to the treatment (including no treatment) 4 elements of informed consent:*** Voluntary no force, coercion, or manipulation Comprehension all interior and exterior impediments to comprehension have been assessed and removed Interior anxiety, pain, sedative medication Exterior transcultural barrier, terminology, speed of presentation Competence Can give consent: must be at least 18 years old emancipated minor: a person under 18 who is self supporting or married Cannot give consent: Unconscious Sedated mentally ill and
judged to be incompetent Discloure all possible options and outcomes
Circumstances requiring an Informed Consent: R adiation or cobalt therapy A nesthesia use B lood administration I nvasive procedure o E ntrance into a body cavity o S - urgical procedure using scalpel, scissors, suture (Invasive procedures) Requisites for validity of informed consent Legal age Mentally capacitated Secured within 24 hours before the surgery Secured before pre-op medication administration Written permission Signature Witness nurse, physician For minors (under 18), unconscious, psych For emancipated minors (married, college student living away from home, in military service, any pregnant female or any who has given birth) 4 Criteria are needed to be met if consent is NOT needed anymore: There is an immediate threat to life Experts agree that it is an emergency Client is unable to consent A legally authorized person cannot be reached Surgery without consent-- BATTERY! Role of the physician: to obtain the informed consent Role of the nurse: Witness a clients signature after the physician has explained the procedure Place informed consent in the clients chart Respond to any questions the client have about the procedure Notify the physician if the client appears to have concerns
41. ISOLATION PRECAUTION

Tier 1: Standard Precaution to all blood and body fluids except for sweat to all clients regardless of diagnosis hand washing and PPE (clean) Tier 2: Transmission-based precaution
Airborne > 3 feet Droplet nuclei < 5 microns < 3 feet Droplet nuclei > 5 microns N95 Measles TB Varicella (chickenpox) Meningitis, mumos Pertussis, pneumonia German measles, GABHS (Scarlet fever, pharyngitis) Diptheria MRSA (Staph) Impetigo Scabies Herpes Simplex Hepatitis A Diarrhea
Droplet
Mask
Contact
Skin
Gloves gown
Immunocompromised first Infectious - last
42. IV SOLUTIONS
Characteristics Fluid movement Effect to the cell Indications Examples HYPOTONIC Solute < solvent from Intravascular TO cells Swell Dehydrated patients Distilled water 0.45% NSS 0.33% NSS 2.5% dextrose ISOTONIC Solute = solvent O pressure of solution No movement expand the intravascular compartment Hypovolemia Burns (resuscitative stage) D5W LR NSS D5 0.225% NSS HYPERTONIC Solute > solvent From Intracellular TO Intravascular shrink/ crenation Edema 10% dextrose in water 5% dextrose in 0.9% saline solution 5% dextrose in 0.45% 5% dextrose in LR TPN 75 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Dialysate contraindicated for clients with increased intracranial pressure, clients at risk of 3rd space fluid shift Avoid D5W if the client is at risk of increased intracranial pressure (ICP) Use LR for BURNS
43. IV THERAPY COMPLICATIONS:

COMPLICATIONS Circulatory overload MANIFESTATIONS Dyspnea increased BP SOB, crackles Dyspnea decreased BP Swelling + Heat ACTIONS slow down contact physician elevate HOB give oxygen Discontinue Left sidelying and trendelenburg Discontinue Cold Elevate Restart (another site) Discontinue Warm/ Moist heat (due to edema) Elevate Restart (another site) Discontinue Retain IV equipment for C&S
Air embolism Phlebitis
Infiltration
Swelling + Cool Decrease infusion rate***
Pyrogenic reaction
Fever, chills
METHODS OF IV ADMINISTRATION 1. Large volume infusion safest and easiest 2. IV Bolus fastest effect 3. Intermittent Venous Access (heparin lock/ Saline lock) increase mobility and comfort Sequence: SASH methods o S - Saline A - Antibiotic S - Saline H - Heparin 4. Volume controlled infusions 5. Piggy back SELECTING A VEIN First verify the order for I.V. therapy unless it is an emergency situation. Explain the procedure to the patient. Select a vein suitable for venipuncture. o Back of hand (metacarpal vein.) Avoid digital veins, if possible. (The advantage of this site is that it permits arm movement.) If a vein problem develops later at this site, another vein higher up the arm may be used. Forearm (basilic or cephalic vein) o Inner aspect of elbow, antecubital fossa, median basilic and median cephalic for relatively short-term infusion. However, use of these veins prevents bending of arm. Lower extremities. o Foot - venous plexus of dorsum, dorsal venous arch, medial marginal vein o Ankle - great saphenous vein Central veins are used: o When medications and infusions are hypertonic or highly irritating, requiring rapid, high-volume dilution to prevent systemic reactions and local venous damage (eg, chemotherapy and hyperalimentation). o When peripheral blood flow is diminished (eg, shock) or when peripheral vessels are not accessible (eg, obese patients). o When CVP monitoring is desired. o When moderate or long-term fluid therapy is expected. NURSING ALERT o The median basilic and cephalic veins are not recommended for chemotherapy administration due to the potential for extravasation and poor healing resulting in impaired joint movement. In addition, these veins may be needed for intermediate or long-term indwelling catheters. o Use lower extremities as a last resort. A patient with diabetes or peripheral vascular disease is not a suitable candidate. Obtain an order from the health care provider for the I.V. site and monitor lower extremity closely for signs of phlebitis and thrombosis.
L
44. LASER
a. L ight A mplification by S timulated E mission of R adiation
b.
TYPES Carbon dioxide gas (clear goggles) ND:YAG Neodymium: Yttrium Alluminum garnet) bright lamp (green goggles) Argon gas (orange goggles) HAZARDS Eyes goggles Skin gown and gloves Lungs mask
c.
45. LEVEL OF CONSCIOUSNESS

a. GLASGOW COMA SCALE
EYE OPENING 4 Spontaneous 3 To verbal command 2 To pain 1 No response GLASGOW COMA SCALE VERBAL RESPONSE 5 Oriented, converses 4 Disoriented, converses 3 Uses inappropriate words 2 Makes incomprehensible sounds 1 No response MOTOR RESPONSE 6 To verbal command 5 To localized pain 4 Withdraws 3 Flexes abnormally (Decorticate) 2 Extends abnormally (Decerebrate) 1 No response
b.
7 and below - in a comatose state 3 lowest score 15 highest score
A.V.P.U. (for Pediatric client) use to assess neurologic condition (like Glasgow Coma Scale) Usually used in infants A Alert and Awake V Verbal response to stimuli P Pain response in stimuli U Unresponsive Level I (conscious) 3 Cs: conscious, cognitive, coherent Level II (lethargic) drowsy, sleepy, obtunded, confused Level III (stuporous) responds to strong stimuli only Level IV (coma) unresponsive; absent protective reflexes
c.
46. LEOPOLDs MANEUVER

BEFORE: patient void first Nurse warm hands
PURPOSE NURSING CONSIDERATIONS
MANEUVER 1. First maneuver
to determine fetal presentation
While facing the woman, place the hands on top and side of the uterus (fundus) and palpate. HEAD - smooth, hard/firm, and round, freely movable and ballotable. BREECH - irregular, rounded, softer, and is less mobile.
2. Second maneuver to determine the fetal position to determine fetal back (heart)
Still facing the woman, place hands on either side at the middle of the abdomen. Determine what fetal body part lies on the side of the abdomen. If firm, smooth, and a hard continuous structure FETAL BACK If smaller, knobby, irregular, protruding, and moving, EXTREMITIES While facing the woman, grasp the part of the fetus situated in the lower uterine segment between the thumb and middle finger of one hand. Using firm, gentle pressure, determine if the head is the presenting part. HEAD - will feel firm and globular. If immobile, engagement has occurred. This maneuver is also known as Pallach's maneuver or grip
3. Third maneuver
To determine engagement to determine fetal presentation
4. Fourth maneuver to determine attitude fetal The examiner palpates the abdomen along the side of the uterus below the umbilicus towards the symphysis pubis (pelvic inlet) to detect heads 77 | TOP DISEASES Prepared by: Brian Yu, 09175262468 The examiner faces the woman's feet.
degree of flexion, position and even station.
47. LIVER BIOPSY

BEFORE: Note COAGULATION PROFILE (clotting factors, PT, PTT, APTT and platelet count* DURING: exhale and hold breath AFTER: Position: Right side-lying position
48. LUMBAR PUNCTURE (LUMBAR TAP)

PURPOSE: To withdraw CSF to determine abnormalities Measures CSF pressure (normal opening pressure 60-150 mm H2O) Obtain specimens for lab analysis (protein [normally not present], sugar [normally present], cytology, C&S) Check color of CSF (normally clear) and check for blood Inject air, dye, or drugs (anesthesia) into the spinal canal AREA: Insert needle between L3 L4 or L4 L5 (spinal cord ends in L2) BEFORE PROCEDURE: Obtain consent Empty bladder DURING PROCEDURE: Position of the patient: C-position (flex the shoulders, not the head) Position of the nurse: infront of the patient Position of the doctor: at the back of the patient AFTER PROCEDURE: prevent spinal headache Position: flat for 6-12 hours (to prevent spinal headache) Force fluids (to maintain pressure and prevent spinal headache) Blood patching label specimen
M
49. MAGNETIC RESONANCE IMAGING (MRI)/ NUCLEAR MAGNETIC RESONANCE (NMR)
Uses radio waves BEFORE: remove metals: jewelry, hairpins, glasses, wigs (with metal clips), and other metallic objects. AVOID: patients with orthopedic hardware intrauterine devices pacemaker internal surgical clips or other fixed metallic objects in the body (braces, retainers) BEFORE: Have client void before test. DURING remain still while completely enclosed in scanner throughout the procedure, which lasts 45-60 minutes. Teach relaxation techniques to assist client to remain still and to help prevent claustrophobia*** NORMAL: audible humming and thumping noises from the scanner during test. Sedate client if ordered.
50. MANTOUX TEST/ Tuberculin Sensitivity Test or Purified Protein Derivative (PPD) Test
Route: ID, 0.1 mL of PPD is injected INTRADERMALLY, creating a wheal or bleb Read: 48 to 72 hours Result: (+) to exposure 10 mm and above not immunocompromised 5 mm and above immunocompromised (HIV, with history of TB, pediatric and geriatric clients) 0 - 4 mm= NOT SIGNIFICANT Erythema without induration is NOT considered significant***
51. MASLOWs HIERARCHY OF NEEDS

Physiologic needs basic survival needs Air, Food, Water Shelter Rest, Sleep Activity Temperature Safety and Security needs physical aspects: comfort***, protection from bodily harm psychological aspects: security and stability Love and belonging needs (Social Acceptance)*** Giving and receiving affection Attaining a place in a group Maintaining the feeling of belonging Acceptance by others Self-esteem needs Self-esteem: feelings of independence, competence, self-respect Esteem from others: recognition, respect, appreciation, feel they are valued and worthwhile Self-actualization The innate need to develop ones maximum potential and realize ones abilities and qualities the need to function at ones optimal level, and to be personally fulfilled.
52. MEDICATION
a. Drug interaction Additive effect b. Synergism/ potentiation Antagonist Interference 1+1=2 eg. diazepam + alcohol = increase sedation 1+1=3 eg. codeine + aspirin = intense pain relief 1+1=0 eg. Coumadin + Vitamin K increase or decrease metabolism/ excretion eg. Probenecid decrease excretion of Penicillin
Medication order STAT (statim) Single order/ one time Standing / routine PRN (Pro Re Nata) Telephone order
immediate/ once eg. Magnesium sulfate (preeclampsia) once eg. Anxiolytic (pre-surgery) carried out indefinitely eg. antibiotics no specific time of administration/ as needed eg. Pain relievers within 24 hours Signed Indicate as Telephone Order Put decimal number
c.
Components of Medication order (Drug prescription)*** Clients name Date and time of order Name of drugs Dose and route Time of frequency Signature Drug effects Therapeutic desired nd Side effects 2 effect, expected Adverse effects severe side effect, unexpected Allergic reaction immunologic response
d.
N
53. NAEGELEs RULE
If LMP is from APRIL TO DECEMBER, use the formula: o - 03 + 07 + 01 (MM, DD, YY) If LMP is from JANUARY TO MARCH, use the formula: o + 09 + 07 (MM, DD)
54. NASOGASTRIC TUBE (NGT)

TYPES Levin - single lumen Salem sump double lumen INSERTION Measurement: adult (N.E.X.), pedia (N.E.M.U.X.) Position: high-fowlers and neck hyperextended Instruction: ask to swallow Placement: 1- X-ray 2- Aspirate and pH test normal gastric pH = 1 to 4 (acidic) 3- Listen/ auscultate for borborygmi sound after introduction of 10 30 ml of air (20 ml) 4- Listen/ auscultate for breath sounds (to double check) REMOVAL Instil 50 ml of air Take deep breath and hold pinch catheter withdraw Mouth care and blow nose FEEDING Check placement Position: sitting/ upright/ fowlers Check for RESIDUAL CONTENT dont discard; above 100ml STOP Hang: 12 inches from point of insertion Flush : 50 to 100 ml of water Remain upright 30 minutes
55. NON-STRESS TEST (NST) and CONTRACTION STRESS TEST(CST) NON STRESS TEST vs. CONTRACTION STRESS TEST
Non Stress Test Fetal movement and fetal heart rate NORMAL (Reactive/ Positive) Increase FM Increase FHR (acceleration) Decrease FM Decrease FHR (deceleration) ABNORMAL (Nonreactive/ Negative) Increase FM Decrease FHR (deceleration) Decrease FM Increase FHR (acceleration) 2 FHR accelerations within a 10min period, each acceleration increasing to 15bpm and lasting at least 15 sec Abnormal or non reactive result needs further evaluation that same day; usually needs contraction stress testing DIFFERENTIATION Variables compared Contraction Stress Test Uterine contraction and fetal heart rate NORMAL (Non-reactive/ Negative) Increase UC Decrease FHR (deceleration) Decrease UC Increase FHR (acceleration) ABNORMAL (Reactive/ Positive) Increase UC Increase FHR (acceleration) Decrease UC Decrease FHR (deceleration) Two ways: Nipple Rolling and Intravenous Oxytocin Delivery 3 contractions within 10min, lasting 40 to 60 sec is needed Not performed until about 38+week Watch out for Preterm labor
Result
Desired response
Management
FETAL HEART RATE DECELERATIONS

EARLY LATE CAUSE Head compression Uteroplacental insufficiency MANAGEMENT Observation Side-lying position Oxygenation Increased IV fluids Stop Oxytocin (Pitocin) Call the MD Caesarean if not corrected Trendelenburg/ Knee-chest/ Side-lying position Oxygenation Increased IV fluids Stop Oxytocin (Pitocin) Call the MD Caesarean section if not corrected
VARIABLE
Cord compression
56. NORMAL VALUES

serum protein = 6.0 to 8.0 g/dL. albumin level = 3.4 and 5 g/dL. BUN: creatinine ration = 10:1 to 20:2 Electrolytes: K = 3.5 5.5 mEq/L Na = 135 145 mEq/ L Ca = 4.5 5.5 mEq/ L
Mg = 1.5 2.5 mEq/ L Ph = 2.5 4.5 mEq/ L Cl = 98 108 mEq/ L
serum amylase level = 25 to 151 units/L. In chronic pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Therapeutic serum drug level Carbamazepine = 3 to 14 mcg/mL Phenytoin = 10 and 20 mcg/mL Magnesium sulfate = 4 to 8 mg/dL Lithium = 0.5 to 1.5 mEq/L*** Digoxin = 0.5 to 2 ng/dl Acetaminophen = 10 30 mg/dL Theophylline = 10 20 mcg/ml
57. O.R. TEAM MEMBERS

SCRUB Surgeon Surgical assistant Scrub nurse NON SCRUB Anesthesiologist Biomed Circulating nurse
o o o o o o o
SCRUB NURSE Performs complete scrub Prepares and hands out instruments Hands instruments while maintaining sterile technique Ensures everybody in the scrub team practices sterile technique Partner in OS and instrument counting Anticipates the needs of the team Patient advocate (act in behalf of the patient); GUARDIAN OF THE PATIENT; doing something that patient cant do
o o o o o o
CIRCULATING NURSE Greets the client upon arrival 1st primary responsibility of circulating nurse Checks client identification Sponge counting together with scrub nurse Monitors the urine output and blood loss together with anesthesiologist Ensures the consent form is signed Documents the entire procedure
*Scrub and Circulating Nurses best tandem in OR***
P
58. PACEMAKER: CONTRAINDICATIONS
Strong magnetic fields MRI Electrical fields high powered instruments (microwave oven, TV, radio, vacuum cleaners) Cellular phones do not place near chest; place in the ear farthest in the pacemaker implant
59. PAIN
LOCATION: Referred pain appear to arise in different areas*** Cardiac pain left shoulder, left arm Gallbladder right shoulder Visceral pain pain arising from organs or hollow viscera
60. PERSONAL SPACE/ COMMUNICATION ZONES

Intimate distance Touching to 1.5 feet Body contact Heightened sensations of body heat and smell Voice tone low Cuddling a baby Touching a blind client Positioning a client Observing an incision Restraining a toddler for injection Lovemaking Confiding secrets Sharing confidential information Communication between nurse and patient/ facilitates sharing of thought and feelings (interviewing) Sitting with a client Giving medications Establishing IV infusions Bantering 81 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Personal distance
1.5 to 4 feet
Body heat and smell noticed less Voice tone moderate Physical contact is allowed (handshake or touching a shoulder)
Social distance Public distance
4 to 12 feet
12 to 15 feet
Body heat and smell re imperceptible Voice tone loud enough to be overheard by others Clear visual perception of the whole person Loud, clear vocal tones with careful enunciation
Physical assessment Nurses rounds Wave a greeting Public talk/ giving speech Gathering of strangers
61. PRESSURE ULCERS

Stage 1 non-blanchable, erythema 2 epidermis and dermis involvement, shallow water blister 3 subcutaneous involvement, deeper crater 4 muscles and bone involvement, tissue necrosis
62. PULSE OXIMETRY/ O2 SATURATION

Measures: 1) Oxygen saturation 2) Pulse rate Site:
Adult: finger Pedia: toes Other sites: nose, earlobe or forehead
Normal: 95 to 100% 70% and below life threatening SaO2 and SpO2 same*** AVOID: Sudden movement Nail polish Light
R
63. RADIATION THERAPY
Radiation therapy uses high-energy ionizing rays that destroys the cells ability to reproduce by damaging the cells DNA
TELETHERAPY External Not radioactive Cobalt therapy, Linear Accelerated Radiation SOURCE PATIENT EXAMPLES BRACHYTHERAPY Internal Radioactive 1. Unsealed oral, IV radioactive iodine 131, Vitamin B12 2. Sealed implant (seeds) cesium, iridium S hield: lead + Dosimeter badge T ime: 5 min/visit; 30 min/ shift; 1 pt/ day D istance: 3 feet away At bedside: forceps and lead container AVOID: pregnant and children Aratula: Caution
ALLOW Leave markings Vitamin A and D Soap and water and pat dry
AVOID Sunlight Alcohol Lotion, powder, cosmetics Adhesive tape Tight clothing
64. RESTRAINTS
PURPOSE: to prevent injuring self and others CLASSIFICATION: 1. Physical manual/ physical device 2. Chemical substances/ medications 2 standards for applying restraints: 1. behavioural management standard when the client is a danger to self or others 2. acute medical and surgical care standard temporary immobilization of a client is required to perform a procedure Guidelines: 1. Obtain consent o Should be RENEWED DAILY o PRN order is PROHIBITED 2. 3. 4. Use clove-hitch knot*** Tie the free ends of the restraints on MOVABLE part of the bed frame*** Assess skin integrity per agency protocol (every 15 to 30 minutes) Release restraints every 2 hours
Reassess the need for restraints every 8 hours
S
65. SENTINEL EVENT
Is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. (by The Joint Commission)
66. SCHILLINGs TEST

PART 1 (CONFIRMATORY) Vitamin B12 (+) vitamin B12 in urine normal (-) vitamin B12 in urine (+) Pernicious Anemia PART 2 (IDENTIFICATION OF CAUSE) Vitamin B12 and Intrinsic factor (+) vitamin B12 in urine Pernicious Anemia is stomach in origin (-) vitamin B12 in urine Pernicious Anemia is small intestine in origin
67. SLEEP
Promoting Sleep: SLEEP PATTERN Establish a regular bedtime and wake-up time Establish regular, relaxing bedtime routine Provide short daytime nap (15 to 30 minutes)*** Promoting Sleep: ENVIRONMENT Adequate exercise during the day. Avoid exercise at least 3 hours before bedtime Associate bed for sleep Keep noise to minimum. Use white noise from a fan, air conditioner, or white noise machine Sleep on comfortable mattress and pillow Promoting Sleep: DIET AVOID heavy and spicy meals 2 to 3 hours before bedtime AVOID alcohol and caffeine-containing foods (coffee, tea, chocolates) at least 4 hours before bedtime Alcohol and caffeine act as DIURETICS If bedtime snacks are necessary: consume light carbohydrates or a milk drink Promoting Sleep: MEDICATION Sleeping pills last resort Take analgesics before bedtime to relieve pains
68. Specimen collection: STOOL

a. Defecate in a clean bed pan or bedside commode. Void before the specimen collection (to prevent urine contamination) QUANTITY: SOLID STOOL: About a pea-size or 1 inch (2.5cm) LIQUID STOOL: 15 to 30 mL Refrigerate and label
FECAL OCCULT BLOOD TESTING (Guaiac Test) Occult = hidden Uses a chemical reagent which detects the presence of the enzyme peroxidase in the hemoglobin molecule. RESULTS: Changes in color like blue indicates a guaiac positive result No change or any other color than blue indicates a negative result. Avoid contaminating the specimen with urine or toilet tissue. Label Avoid specified foods and vitamin C 3 days prior to collection and specified medication 7 days prior to collection.
FALSE POSITIVE RED MEAT (Beef, liver, and processed meats) RAW VEGETABLES or FRUITS (Particularly radishes, turnips, horseradish, and melon) MEDICATIONS (NSAIDs, IRON preparations, and ANTICOAGULANTS) FALSE NEGATIVE VITAMIN C
69. Specimen collection: SPUTUM

Sputum arises from the tissue of the respiratory tract Saliva excreted by the salivary and mucus glands BEST TIME: early morning BEFORE: Mouth care DURING: o Deep breaths then cough up 15 to 30 mL (1 to 2 tablespoons). o Wear gloves when collection. o Ask the client to expectorate, not spit o Should be cough directly into the specimen container
70. Specimen collection: URINE

SPECIMEN CLEAN VOIDED
PURPOSE For routine examination
CLEAN-CATCH or MIDSTREAM URINE
For urine cultures Done when a woman has menstrual period
CATHETER
24-HOUR
Collection of sterile specimen usually done when clients are catheterized for other reasons To determine the ability of the kidneys to concentrate urine To determine disorders of glucose metabolism To determine levels of specific constituents
CONSIDERATIONS WHEN COLLECTING Usually collected by the client with minimal assistance Preferably done on the first voided specimen in the morning but it can be collected anytime if needed At least 10 to 30 mL Clean container is used BEST TIME: early morning concentrated urine Sterile specimen container Place specimen during midstream flow. QUANTITY: 30 to 50 ml routine urinalysis 5 to 10 ml C&S Nurse aspirates from the lumen of a latex catheter or from a self-sealing port Collection of all urine produced in 24 hours The first voided urine is discarded; last urine voided included Either refrigerated or preservative is added
71. SPONGE COUNTING

1 Before the operation starts (immediately preceding incision) to establish a baseline 2 Before closure of body cavity 3 Before the skin is closed/ before wound closure starts
The SCRUB and the CIRCULATING nurses should count audibly and concurrently***
72. SUCTIONING
Time per attempt Interval insertion Endotracheal/ tracheostomy 5 to 10 seconds 2 to 3 minutes 5 inches and withdraw 1 to 2 cm Naso-/ oropharyngeal 5 to 10 seconds 20 to 30 seconds 4 to 6 inches
Endotracheal Position: semi-fowlers Time: 5 to 10 seconds/ 5 minutes Interval: 20 to 30 seconds DURING Lubricate the catheter with water-soluble lubricant (2 to 3 inches) Insert during INHALATION in CIRCULAR motion*** DO NOT insert during swallowing (it may enter the esophagus) o But in NGT let the patient swallow to promote entrance in stomach Apply suction: during withdrawal GLOVE: dominant hand Hyperoxygenate BEFORE and AFTER suctioning Conscious: DBE Unconscious: ambubag, 3 to 5 times (12 15 LPM)
73. SUTURES (catgut) a thread, wire, or other material used in the operation of stitching parts of the body together
TYPES OF SUTURES: Absorbable digested by body enzyme plain gut (yellow) chromic gut (brown) Non-absorbable become encapsulated by tissue and remains unless removed (removed 7 days after) silk (light blue) nylon (green) cotton (pink) Prolene (royal blue) Mersilenne (Turquoise) Vicryl (purple) Dacron (orange)
T
74. T-TUBE
PURPOSE: To maintain patency*** To drain To prevent bile leakage to the peritoneum
DRAINAGE st Color: 1 24 hours reddish brown st Amount: 1 24 hours 500 to 1000 ml Normal color of stool after removal brown Draining does not need doctors order
75. TELEPHONE ORDER

Only RNs may receive telephone orders The order should be countersigned by the physician within 24 hours
76. TENSILON TEST

edrophonium chloride (Tensilon) IV evaluation of muscle strength USE: To diagnose myasthenia gravis At bedside: resuscitation equipment atropine sulfate on bedside for possible CHOLINERGIC CRISIS neostigmine for possible MYASTHENIC CRISIS Results: (+) diagnosis = improvement on muscle function after administration of drug (-) diagnosis = muscle fasciculations occur as a result of the drug
77. THORACENTESIS
Purpose: To remove excess fluid or air from the pleural space to ease breathing POSITION: sitting while leaning forward over a pillow Chest X-ray identifies best insertion site Within the first 30 minutes, not more than 1000 mL should be removed AVOID: coughing , deep breathing o AFTER: Unaffected side with head elevation of 30 for at least 30 minutes
78. THYROIDECTOMY: Complications

Bleeding Feeling of fullness at incision site Check soiled dressing at nape area, sandbag Accidental removal of parathyroid Hypocalcemia classic sign tetany Calcium gluconate, slowly administer- to prevent arrhythmia Laryngospasm DOB, SOB tracheostomy at bedside, suction Accidental damage of the laryngeal nerve Hoarseness of voice Encourage patient to talk post op asap to determine laryngeal nerve damage Thyroid storm Fever, Irritability, Agitation, restlessness, Tachycardia beta blockers
79. TOTAL PARENTERAL NUTRITION (TPN)/ PN/ IV HYPERALIMENTATION

Dextrose content 10 to 50% Duration of TPN 24 hours Site: central veins (SVC) subclavian vein (an x-ray is done to confirm its placement)*** Position during insertion: trendelenburg Complication: Thrombophlebitis due to hypertonicity of the solution change access site Hyperglycemia rapid infusion regulate Hypoglycemia abrupt discontinuation hyperinsulinism dont stop abruptly Infection unsterile procedure sterile technique Fluid overload rapid infusion regulate Air embolism Allergy If empty, give hypertonic solution: D10W pedia D50W adult BEFORE: check label of solution and rate of infusion with medical order inspect TPN bottle for precipitates or turbidity administer via an infusion pump DURING: Initially administered at 50 ml/hr*** for the FIRST hour Monitor glucose
Monitor vital signs every 4 hours AFTER: Monitor WBC PRIORITY NURSING DIAGNOSIS: High risk for infection Do not overcorrect flow rate if too slow or fast STERILE technique*** Use transparent air-occlusive dressing***
80. TRACHEOSTOMY CARE

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) Position Open sterile packages Pour soaking solutions Suction Remove inner cannula and place in soaking solution Remove dressing Clean inner cannula Replace Clean incision site and flange Apply dressing Change ties
81. TRACTIONS
TYPES Skin traction impaired skin integrity Skeletal traction risk for infection Counter traction weight of the patient Bucks not more than 8 to 10 lbs of weight should be applied Crutchfield tongs (skull tongs) used to immobilize the cervical spine (indicated for unstable fractures or dislocation of the cervical spine) Crutchfield tongs/ Gardner-Wells skull tongs POSITION: supine
82. TRANSFERRING Patient from BED to WHEELCHAIR

1 assist patient into sitting position 2 position chair parallel to the bed (strong side***) Client with walking difficulty, angle the chair to 45 degrees*** 3 use transfer belt NURSE: hold belt PATIENT: hold shoulder of nurse 4 pivot towards the wheelchair
83. TRANSFERRING Patient from BED to STRETCHER

1 lower HOB 2 raise bed slightly higher than stretcher 3 stretcher parallel to the bed 4 nurse press own body against stretcher to secure it against the bed Client flex neck and arms across chest 5 roll both sides of pull sheet towards the patient 6 grasp and pull the pull sheet towards the stretcher
84. TRIAGE
trier- to sort To sort patients in groups based on the severity of their health problem and the immediacy with which these problems must be addressed 3 CATEGORIES IN TRIAGE in E.R. URGENT Red Yellow Life, limb, eye threatening Needs treatment in 20 minutes Needs immediate attention to 2 hours Chest pain, cardiac arrest, Fever >40oC, simple fracture, severe respiratory distress, abdominal pain, asthma with no chemicals in the eye, limb respiratory distress amputation, penetrating trauma, severe hemorrhage EMERGENT
Color Urgency Examples
NON-URGENT Green Can wait hours or days sprain, minor laceration, rash, simple headache. Toothache, sore throat
IMMEDIATE Number Color Examples 1 Red Chest wounds, shock, open
4 CATEGORIES IN TRIAGE in DISASTER DELAYED MINIMAL 2 3 Yellow Green Stable abdominal wound, eye Minor burns, minor fractures,
EXPECTANT 4 Black Unresponsive, high spinal
fractures, 2-3 burns
and CNS injuries
minor bleeding
cord injury
85. TUNNING FORK TEST

b. WEBERS TEST To test for bone conduction by examining lateralization of sound. Hold and place the base of the tunning fork on top of the clients head; ask the client where he/she hears the noise. Results: Weber negative if sound is heard on both sides or localized at the center of the ear. Weber positive sound heard better on the impaired ear bone-conductive hearing loss; sound heard on the normal ear sensorineural disturbance RINNE TEST To compare air conduction from bone conduction. Ask client to block one ear intermittently (move a fingertip in and out of the ear) Hold the handle of the activated tuning fork against the mastoid process (until vibrations can no longer be felt/heard by the client). Immediately hold the vibrating fork with the prongs in front of the clients ear canal. Results: Positive Rinne Air conduction (AC) is greater than bone conducted (BC). Negative Rinne BC is equal to or longer than air conduction indicating a conductive hearing loss. Infants: ring a bell or have the parent call the childs name (to assess gross hearing); newborns may become silent or open their eyes wide; by 3 or 4 months, child will turn his/her head toward the sound.
c.
VITAL SIGNS
86. BLOOD PRESSURE
a. b. Systolic contraction depolarization Diastolic relaxation repolarization DETERMINANTS OF BLOOD PRESSURE*** Pumping action of the heart strong pumping BP increases weak pumping BP decreases Peripheral Vascular Resistance (PVR) increased vasoconstriction BP increases decreased vasoconstriction BP decreases Blood volume BV increases BP increases BV decreases BP decreases Blood viscosity blood highly viscous BP increases blood less viscous BP decreases ASSESSING BLOOD PRESSURE*** The cuff should wrap (A) 40% of the arm length and (B) 80% should encircle the adults arm (arm circumference)/ 100% of the childs arm The lower border of the cuff should be 2.5 cm above the antecubital space. Use the bell of the stethoscope low pitched sounds Pump about 30 mmHg more from the point the pulse has disappeared. Deflate the cuff at a rate of 2 to 3 mmHg per second. Rest the arms for 1 to 2 minutes before taking the blood pressure again, in cases reading is not certain. Calibrate the sphygmomanometer every 6 months Allow 30 minutes for resting if the client has exercise, smoking or ingested caffeine Read lower meniscus of the mercury to prevent error of parallax o error of parallax if the eye level is higher than the level of lower meniscus
c.
A 40% B 80%
d.
KOROTKOFF PHASES*** Phase 1 a sharp thump determines the systole Phase 2 a blowing or whooshing sound (increasing sound)
e.
Phase 3 a crisp, intense tapping (loud tapping) Phase 4 a softer blowing sound that fades (muffled sound) Phase 5 Silence determines the diastole
Taking BP in thigh 1 Position patient Prone (best) Supine with legs flexed 2 Expose thigh 3 Locate popliteal pulse 4 Wrap the cuff Common mistakes
FALSE-LOW Bladder of cuff too wide Arm above heart level Deflating cuff too quickly FALSE-HIGH Bladder of cuff narrow Arm below heart level Deflating cuff too slowly Inflating too slowly Smoking, caffeine and exercise for the last 30 minutes
f.
g. h. i.
Systolic in legs is higher compared to brachial around 10 to 40mmHg 3 years old and above - Start taking BP routinely BP of 120/100/80 phase 1/4/5
87. TEMPERATURE
a. ORAL accessible and convenient S Smoking* N Newborn O Oral surgery U Ulceration/injury to the mouth T Tremors/convulsions H Hot/cold foods & fluids just ingested wait for 15 to 30 minutes before taking temperature AXILLARY Safe and non-invasive A Axillary injury X eXercise/activity I Inadequate circulation L Laging basa (moist pits) A After bathing RECTAL Reliable measurement (Inconvenient and more unpleasant) R Rectal disease/diarrhea I Immunosuppressed C Clotting disorders T Turning to the side is difficult H Hemorrhoids U Undergone rectal surgery M Myocardial infarction TYMPANIC Readily accessible, reflects the core temperature, very fast 9 Risk of injuring the membrane) E Evident cerumen A An ear infection is present R Reading may vary between left and right measurement
b.
c.
d.
88. PULSE the wave of blood created by the contraction of the left ventricle.
Wait for 10 to 15 minutes if he client has been physically active. Use 2 or 3 middle fingertips lightly over the pulse site. Doppler ultrasound stethoscope (DUS): transducer probe (gel may be applied) and stethoscope headset; when using a DUS, hold the probe lightly over the pulse site. Apical pulse th 7 years old and above located at the 5 ICS LMCL th below 7 years old located at the 4 ICS LMCL PULSE SITES Infants, palpable: brachial and femoral Allens test: radial CPR, infants: brachial CPR, adults: carotid
89. RESPIRATIONS The act of breathing.

2 Types of breathing Costal thoracic Diaphragmatic Abdominal
First to take BEFORE invasive procedures Physiologic apnea RATE Eupnea (breathing that is normal in rate and depth), bradypnea (abnormally slow), tachypnea (abnormally fast), and apnea (absence of breathing).
a.
APNEA BRADYPNEA
b.
EUPNEA TACHYPNEA
DEPTH Hyperventilation (rapid and deep breaths), hypoventilation (very shallow respirations), and Kussmauls breathing (hyperventilation associated with metabolic acidosis).
HYPERVENTILATION HYPOVENTILATION
c. RHYTHM Cheyne-Stokes breathing (regular rhythm from very deep to very shallow respirations then temporary apnea) and Biots respiration (shallow breaths interrupted by apnea).
CHEYNE-STOKES BIOTS
U
90. URINARY CATHETERIZATION: TYPES
TYPES NO. OF LUMENS Straight Catheter SINGLE: only for drainage Indwelling Catheter (Foley or Retention catheter) DOUBLE: urine drainage for inflation of balloon (serves as an anchor) OR TRIPLE: urine drainage for inflation of balloon (serves as an anchor) for continuous irrigation Inserted and stays connected to the bladder for a long time
PURPOSE
SPECIAL CONISDERATIONS
Inserted only as much times as it takes to drain the bladder or obtain a urine specimen Coude catheter is a variation of straight catheter which has a curved and tapered tip, usually used for male patients with prostatic hypertrophy
Secure catheter tubing: male - upper thigh or abdomen Female - inner thigh NO TUB BATHS, shower is preferable
Collection bag should always be below bladder Position during procedure: FEMALE Dorsal Recumbent MALE Supine Lubricate catheter Catheter accidentally slips into vagina: leave the catheter in vagina, get new catheter and insert to urethra then remove the catheter from vagina Increases susceptibility to infection 2 Main Principles observed: 1) Principle of sterility 2) Principle of gravity Replace urinary catheter every 5 to 10 days
91. URINE ELIMINATION

Color amber/straw, transplant Order aromatic pH 4.5 to 8 Amount 1200-1500 ml/day (30-60 ml/hr) Sp.gr 1.010-10.25
92. PRESENTING UTI

W ash before and after sex O n time voiding
M ake us of cotton undergarment A lways wipe from anterior to posterior N o sprays, harsh soaps, powder.
W
93. WRITING NURSING DIAGNOSIS
1. Write the diagnosis in terms of response rather than need. 2. Use related to rather than due to or caused by to link etiology to problem statement 3. Write diagnosis in legally advisable terms. AVOID libellous words or would imply nursing negligence. INCORRECT Needs assistance with bathing related to bed rest Noncompliance due to hostility towards nursing staff Spouse abuse related to husbands immaturity and violent temper. Impaired skin integrity related to clients lying back all night Mild anxiety related to impending surgery. CORRECT Self care deficit: bathing related to immobility Noncompliance related to hostility towards nursing staff High risk for violence: spouse abuse related to husbands reported inability to control behaviour Impaired skin integrity related to immobility. ---
4. Include in the problem statement only client responses that are unhealthy or that the client wants to change. 5. AVOID including signs and symptoms of illness in the problem statement. 6. Express the client statement and etiologic factors in terms that can be changed; otherwise, nursing energies are being directed to a hopeless task 7. Express the problem statement in terms of unhealthy client responses rather than environmental conditions 8. AVOID reversing the problem statement and etiologic statement 9. Make sure that the 2 parts of the diagnosis do not mean the same thing 10. Write diagnosis without value judgments. WATCH OUT for your ADJECTIVES! 11. DO NOT include medical diagnosis.
Cough related to long history of smoking. Alterations in Bowel elimination: Permanent colostomy related to cancer of the bowel
Ineffective airway clearance related to 20 year history of smoking. Self-care deficit: Care of colostomy, related to feeling s of powerlessness
Cluttered home related to inability to discard anything Impaired swallowing related to possible aspiration. Alteration in comfort related to pain. Poor home maintenance management related to laziness. Impaired home maintenance management related to arthritis.
High risk for injury related to cluttered home (inability to discard anything) Risk for aspiration related to difficulty swallowing. Unrelieved incisional pain related to fear of drug addiction Impaired home maintenance management related to low value ascribed to home safety and cleanliness Impaired home maintenance management related to mobility, endurance and comfort alterations.
TOP 18 OTHERS
1. Quality Assurance (QA) focus upon doing it right A systematic process of organization-wide participation and partnership in planning and implementing improvement methods to understand and meet customer needs and expectations emphasis is on maintaining minimum standards of care tended to be REACTIVE rather than proactive involves such methods as: o chart audits o reviewing incident reports o determining whether performance conforms to standards. 3 TYPES: Structure Evaluation evaluating the physical setting Process Evaluation evaluating how the nursing care is rendered Outcome Evaluation evaluating the demonstrable changes brought by the nursing process
2.
Total Quality Management (TQM) focuses on doing the right thing aka Quality Improvement (QI)/ Process Improvement (PI) QIs emphasis is upon identifying real and potential problems participation and partnership in planning and implementing improvement methods to understand and meet customer needs and expectations. tends to be PROACTIVE instead of reactive. General Principles of TQM: o quality is achieved through the participation of everyone in the organization o improvement opportunities are developed by focusing upon the work process o the improvement of the quality of services is an ongoing (continuous) process o decisions to change or improve a system or process are made based on data (not majority rule) uses such methods as o building quality performance into the work process
o meeting the needs of the customer proactively. Principle benefits o viewing every problem as a possible opportunity for improvement o involving staff in how the work is designed and delivered (improves staff satisfaction) o empowering staff to identify and implement improvement resulting in increased patient outcomes o increasing the customers perception that you care by designing health care processes to meet customer needs, as opposed to the health care providers needs. Quality Assurance Doing it right Reactive (after) Maintaining standards of care Reviewing incident reports Evaluation Audit Total Quality Management Doing the right thing Proactive (before) Identifying real and potential problems Building quality performance into the work process Meeting the needs of the customer proactively
3. 4.
PROCESS A set of causes and conditions that repeatedly come together in a series of steps to transfer inputs into outcomes EXTERNAL CUSTOMER are those people who are outside the (health care) organization and receive the output of the organization such as patients regulatory agencies (Joint Commission, the Department of Health) the community the organization serves private practitioners INTERNAL CUSTOMERS are those people who work within the organization and received output of another employee Nurses Pharmacists hospital chaplains therapists. The plan-do-study-act (PDSA) cycle, a process improvement tool, begins with starts with three questions: 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What changes can we make that will result in improvement? FOCUS methodology uses a stepwise process for how to move through the improvement process. 1) Focus on an improvement idea, 2) Organize a team that knows the work process, 3) Clarify the current process, 4) Understand the degree of change needed, and 5) Solution, select a solution for improvement. SENTINEL EVENT an unexpected incident involving a death or serious physical or psychological injury to a patient Related common-sense skills that help one to use their time in the most effective and productive manner possible are called: time management
5.
6.
7.
8. 9.
10. PARETO PRINCIPLE 80% of unfocused effort results in 20% of outcome results The Pareto principle is based upon the prioritization of work effort through such measures as managing ones time effectively . The basic premise is that 80% of unfocused efforts results in 20% of outcome results or that 20% of focused efforts results in 80% of outcome results. 11. STEPS IN A QUANTITATIVE STUDY A. CONCEPTUAL PHASE (1) Identify the problem (2) Determine purpose of the study (3) Review the literature (4) Develop a theoretical/ conceptual framework (5) Identify the study assumptions (6) Acknowledge the limitations of the study (7) Formulate the hypothesis or research question (8) Define study variables/ terms B. DESIGN and PLANNING PHASE (9) Select the Research Design the plan for how the study will be conducted; concerned with the type of data that will be collected and the means used to obtain these data (10) Identify the population (11) Designing the sampling plan (12) Select the sample (13) Conduct a pilot study
C.
EMPIRICAL PHASE (14) Collect the data (15) Organize the data for analysis ANALYTIC PHASE (16) Analyze the data (17) Interpret the findings DISSEMINATION HASE (18) Communicate the findings (19) Utilize the findings
D.
E.
12. RIGHTS IN RESEARCH*** a. SELF- DETERMINATION: The person has the right to control his or her own destiny b. PRIVACY: The person has to determine the time, extent, and general circumstances under which private information will be shared with or withheld from others. Be left alone (i.e., freedom from intrusion) Determine bodily integrity (to consent to or refuse treatment) Control how personal information is shared c. d. e. f. ANONYMITY: Data collected will be kept confidential. FAIR TREATMENT: The person should be treated fairly and should receive what he or she is due or owed. PROTECTION FROM DISCOMFORT AND HARM: Based on the principle of beneficence (one should do good and, above all, do no harm) the person should be protected from physical, emotional, social, and economic discomfort and harm. INFORMED CONSENT: The person understands the reason for the proposed intervention and its benefits and risks, and agrees
13. BENCHMARKING is a continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers and uses those best processes (practices) to improve work design and patient care delivery. 14. VALUE is a function of quality outcomes and cost The repercussions of quality improvement for patient care can be measured by the overall value of that care. Value itself is a function of both quality outcomes and cost. For example outcomes can be a patients return to functional status or mortality/morbidity, and the cost is a combination of both the indirect and direct patient care needs. 15. SYSTEM are independent groups of people, processes, or items with a common purpose or goal. Organizations are made up of various systems such as different departments (i.e., radiology, laboratory, and cardiology) or processes (i.e., QI or risk management departments). 16. 3 components of health care systems are: 1) Structure - (resources or structures required to deliver health care) 2) Process - (quality activities, procedures, and tasks performed to deliver quality health care) 3) Outcome - (the results of good health care delivery) 17. COHESIVE GROUPS substitutes for leadership substitutes for leadership are variables that eliminate the need for leadership or nullify the effect of the leaders behavio r. These include cohesive groups, work experience, intrinsic satisfaction, formal organizational structures, professionalism, indifference to rewards, routine tasks, feedback provided by the task, rigid adherence to rules, role distance, and low position power of the leader. 18. Nurses Assigned in Rural Service (NARS) Project Launched by President Gloria Macapagal-Arroyo last 9 February 2009 during the Multi-Sectoral Summit on "Joining Hands Against the Global Crisis" in Malacanan Palace, Manila. Program Coverage With valid nurse license issued by the PRC Not over 35 years old Resident of the identified municipalities No nursing-related practice for the past 3 years Nurse applicants who are dependents of workers affected by the Global Crisis based on the list provided by the DOLE Regional office shall be given priority in the selection. P8,000.00 per month during training (P366.00 per day for a forty (40) hours training/workweek.) The stipend of P8,000 may be increased if the host LGUs will offer a counterpart of say P2,000. Corporations may chip in by providing shirts, insurance, vitamins, etc., making the program a national enterprise with private equity. Nurses will be deployed at an average of 5 per town in the 1,000 poorest municipalities, for a six-months tour of duty. Another batch will be deployed for the second half of the year. These nurses will undergo training and development for competency enhancement in accordance with the training program designed by the DOH in collaboration with the PRC-BON. The training program will cover both the clinical and public health functions. Unemployed nurses will be mobilized in their hometowns as warriors for wellness to do the three I's: Initiate primary health, school nutrition, maternal health programs, first line diagnosis Inform about community water sanitation practices and also do health surveillance Immunize children and mothers.
They shall likewise serve as roving nurses for rural schools.
TOPICS for JUNE-JULY 2012

COMMUNITY HEALTH NURSING, IMCI, COMMUNICABLE DISEASE NURSING
1 QUESTIONS 4 Non-Communicable Diseases (NCD) ANSWERS 1- CVD (cardiovascular Diseases) 2- COPD 3- Cancer 4- DM Physical inactivity Unhealthy diet Smoking Physician Public Health Nurse Midwives Supervisor (role) The community is self-reliant Essential for the effectiveness and efficiency of health services OPV and measles DPT, Hepa B, BCG, TT Diphtheria and Tetanus Pertusis OPV Measles and BCG Health Sector Reform FOURmula One for Health 1 better health outcomes 2 more responsive health systems 3 equitable health care financing 1 - Health financing 2 - Health regulation 3 - Health service delivery 4 - Good governance 1 active community participation 2 intra and inter sectoral linkages 3 use of appropriate technology 4 support mechanism made available 1 environmental sanitation 2 control of communicable diseases 3 immunization 4 health education 5 MCH and Family planning 6 food and proper nutrition 7 provision medical care and emergency treatment 8 treatment of locally endemic diseases 9 provision of essential drugs Food fortification Law National Diabetes Act Registration of birth within 30 days Reporting of communicable diseases Civil registry law Breastfeeding and Rooming in act Special Children Protection against child abuse Local Government Unit Code Allocation of personnel, budget and provide structures for cascading health care delivery to all 50 breaths per minute and above 40 breaths per minute and above C - onvulsions U - nable to drink V - omits everything A - bnormally sleepy C - ough D - iarrhea F - ever E - ar infection Family 1 Leadership in Health 2 Enabler and Capacity Builder 3 Administrator of specific services Public health nurse Bronchodilator 1st LINE: Ciprofloxacin 1st LINE: Amoxicillin 2nd LINE: COTRIMOXAZOLE 1st LINE: Tetracycline 2nd LINE: Erythromycin 1st LINE: Artemeter - Lumefrantine 93 | TOP DISEASES Prepared by: Brian Yu, 09175262468
NCD, risk factors
Basic Primary Health Care Team (under the Restructured health Care Delivery System) PHN monitors and supervise the performance of midwives Community organizing ends when Team planning Vaccines, most sensitive to heat Vaccines, least sensitive to heat Vaccine, toxoid Vaccine, killed bacteria Vaccine, live attenuated Vaccine, freeze dried Overriding goal of DOH Framework of Health Reform Sector Program Goals of FOURmula ONE for Health
4 5 6 7 8 9 10 11 12 13 14 15
16
4 Elements of FOURmula One for Health
17
4 cornerstones/ pillars in Primary Health Care (PHC)
18
Elements/ components of PHC
19 20 21 22 23 24 25 26 27 28 29 30
RA 8976 RA 8191 PD 651 RA 3573 RA 3753 RA 7600 RA 7610 RA 7160 Local Government Unit Code Fast breathing, 2 months to 12 month Fast breathing, 12 months to 5 years General Danger signs
31
Main Symptoms
32 33
Basic unit of care in CHN Role and function of DOH under EO 102
34 35 36 37 38 39
Supervisor of midwives NEW IMCI: If wheezing + Fast breathing OR If wheezing + Chest indrawing NEW IMCI: Dysentery NEW IMCI: Pnemonia, acute ear infection, or very severe disease NEW IMCI: Cholera NEW IMCI: Malaria
40
Strategies to address the nutritional problems of Filipinos
2nd LINE: Chloroquine, Primaquine, Sulfadoxine, Pyrimethamine A im for ideal body weight B uild healthy nutrition-related practices C hoose food wisely
MATERNAL CHILD HEALTH NURSING

QUESTIONS 1 Positive signs of pregnancy ANSWERS Fetal heart tone Fetal outline Fetal movement felt by the examiner 20 weeks 500 gms Probable sign Decreases hot flashes Deep vein thrombosis (leg pain) Hypertension Pelvic Inflammatory Disease (PID) First day of the mense Insert 2 hours before sexual activity and leave it in place for 6 hours after sex Pelvic rocking Offer dry crackers Dorsiflex the legs and offer high calcium diet Contraction frequency and duration increases and Interval decreases Umbilical level 12 weeks Increase HCG, nausea and vomiting No FRT Enlarging abdomen Rise of fundus Lengthening of the cord Check for completeness of the placental cotyledons to determine fetal part lying in the fundus/ to determine fetal presentation To determine fetal back and FHT To determine engagement and presentation as well To determine fetal attitude Knee chest Blurring of vision, epigastric pain Decrease BP Decrease UO Decrease RR Decrease DTR (patellar reflex) From the BEGINNING of the contraction to the END of the contraction From the BEGINNING of the contraction to the BEGINNING of the next contraction From the END of the first contraction to the BEGINNING of the next contraction Increment Acme Decrement Pressure of fundus to the bladder Pressure of presenting to the bladder 12 weeks 20 weeks Metal retardation Facial anomalies Low hemoglobin and hematocrit Causes pain during labor (BACK LABOR) Plus 300 calories Infection Dimple in RUQ of breast Nullliparity 8 weeks and onwards Termination of pregnancy before 20 weeks Zygote, blastomere, morula, blastocyt, embryo, fetus Tracheoesophageal fistula Kidney problem Heart and kidney problem Prevent antibodies formation Educator/ counselor Weight loss or gain of 10 to 15 pounds 20 to 25 pounds (More than 30 pounds PIH) Minus 3 (months) Plus 7 (days) Normal Abnormal Abnormal 94 | TOP DISEASES Prepared by: Brian Yu, 09175262468
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Age of viability Weight of viability Positive pregnancy test Hormonal Replacement therapy, expected effect Hormonal Replacement therapy, adverse effect Intra-utrrine device, side effect Last menstrual period Diaphragm, correct health teaching Back ache in pregnant women, management Morning sickness in pregnant women, management Leg cramps, management TRUE labor Fundus at 20 weeks Earliest time fundus is palpable H-mole 3rd stage of labor (stage of Placental), first sign 3rd stage of labor (stage of Placental), best sign 3rd stage of labor, first nursing action Leopolds maneuver, 1st, purpose Leopolds maneuver, 2nd, purpose Leopolds maneuver, 3rd, purpose Leopolds maneuver, 4th, purpose Cord prolapsed, position PIH, severe eclampsia Magnesium sulfate, effects
17 18 19 20 21 22 23 24 25 26
27 28 29 30
Characteristic of contraction, DURATION Characteristic of contraction, FREQUENCY Characteristic of contraction, INTERVAL Phases of contraction Urinary frequency in 1st trimester Urinary frequency in 3rd trimester FHT using doppler FHT using stethoscope Effects of alcohol in fetus Expected to happen during pregnancy LOP and ROP posterior Additional calories during pregnancy Bag of water broke Breast cancer, manifestation Breast cancer, risk factor Fetus Abortion Sequence of fetal development Polyhydramnios Oligihydramnios Missing blood vessel in umbilical cord Rhogam Role of nurse in family planning Re-fit diaphragm Weight gain during pregnancy Naegels rule NST, reactive/ acceleration NST, non-reactive/ deceleration CST, reactive/ acceleration
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55
56 57 58 59 60 61 62 63 64 65
CST, non-reactive/ deceleration Amniocentesis, 2nd trimester Amniocentesis, 3rd trimester Ultrasound, 1st trimester Ultrasound, 2nd trimester Ultrasound, 3rd trimester Best and common fetal position During EXTENSION During EXPULSION TRUE labor
Normal Neural tube defect/ Chromosomal abnormalities Lung maturity AOG, multiple pregnancy Placental location Fetal position and size LOA, ROA Check for nuchal cord call the time of birth Begins in back and radiates to abdomen
PEDIATRIC NURSING
QUESTIONS 1 Newborn, priority after birth ANSWERS 1 Airway 2 Body temperature 3 Cord clamp and cut Divert the attention Provide privacy Ignore the BEHAVIOR To get attention Provide food choices Putting life to non living things I, me, my and myself 2 words plus mama and dada middle seat at the back rear facing Despair stage Allow simple decision making Autonomy, Independence and Control SGA and prematurity Orchiopexy Between 6 months to 2 years old E enlarge the nipple S stimulate the sucking S swallow R rest Using small-holed nipple Elbow restraints Cleft lip before 10 weeks Cleft palate before development of speech A lert and awake V erbal response to stimuli P ain response to stimuli U nresponsive Indomethacin/ Ibuprofen Increase BP in upper extremities Decrease BP in lower extremities Pulmonic stenosis Right ventricular hypertrophy Ventricular septal defect Overriding of the aorta Squatting/ Knee chest Side lying to the unooperative side Mylar Wong Bakers Faces Scale Iron Growth Retardation/ inability to gain weight Hurting 4 months 60 ml Threat or with force Allow Autoimmune Proteinuria Hypoproteinemia Edema (generalized) Hypercholesterolemia Zebra pattern Hands is burned that has a look of a glove Stridor Weakening Swallowing difficulties Lactose
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Masturbation in schooler, management Temper tantrums, management Temper tantrums, goal Picky eater, management Animism in preschooler Egocentrism 12 months old, language CAR Seat for an infant Toddler is having temper tantrums and suddenly becomes quiet To promote autonomy (independence), in toddlers 3 psychosocial task of toddlers Cryptorchidism, causes Cryptorchidism, surgery Orchiopexy, when to be done Cleft lip and cleft palate, international feeding method
17 18 19 20
Inappropriate in a child with cleft lip and palate RESTRAINT, post surgery of Cleft lip and cleft palate When to do surgery for cleft lip and cleft palate AVPU is used to measure leavel of consciousness in preverbal child
21 22 23
Patent Ductus Arteriosus, drug that promote closure Coarctation of the Aorta, common findings TOF, defects
24 25 26 27 28 29 30 31 32 33 34 35 36
Position for tet spells Position after VP shunting Non latex balloon/ Safest balloon for infants Pain assessment in pediatric clients What is added to most infant milk formulas making it superior to breastmilk beyond 6 months of breastfeeding? Congenital Heart defect S/sx: For hospitalized children, red means Head lag disappears at Gastric capacity of newborn Date or acquiantance rape Amulet in sick children Nephrotic syndrome, cause Nephrotic syndrome, manifestation
37 38 39
Flexion burn in child abuse Glove type burn Arnold chiari malformation
40
Component of breastmilk at makes the stool sour in odor
LEADERSHIP AND MANAGEMENT

1 2 QUESTIONS A set of causes and conditions that repeatedly come together in a series of steps to transfer inputs into outcomes is called: External customer are those people who are outside the (health care) organization and receive the output of the organization such as ANSWERS Process Patients regulatory agencies (Joint Commission, the 95 | TOP DISEASES Prepared by: Brian Yu, 09175262468
Internal customers are those people who work within the organization and received output of another employee
The plan-do-study-act (PDSA) cycle, a process improvement tool, begins with starts with three questions:
FOCUS methodology uses a stepwise process for how to move through the improvement process.
6 7 8
A sentinel event is: Related common-sense skills that help one to use their time in the most effective and productive manner possible are called: The Pareto principle is:
Department of Health) the community the organization serves private practitioners Nurses Pharmacists hospital chaplains therapists 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What changes can we make that will result in improvement? 1) F - ocus on an improvement idea, 2) O - rganize a team that knows the work process, 3) C - larify the current process, 4) U - nderstand the degree of change needed, and 5) S - olution, select a solution for improvement an unexpected incident involving a death or serious physical or psychological injury to a patient time management 80% of unfocused effort results in 20% of outcome results The Pareto principle is based upon the prioritization of work effort through such measures as managing ones time effectively. The basic premise is that 80% of unfocused efforts results in 20% of outcome results or that 20% of focused efforts results in 80% of outcome results. System Organizations are made up of various systems such as different departments (i.e., radiology, laboratory, and cardiology) or processes (i.e., QI or risk management departments). a function of quality outcomes and cost The repercussions of quality improvement for patient care can be measured by the overall value of that care. Value itself is a function of both quality outcomes and cost. For example outcomes can be a patients return to functional status or mortality/morbidity, and the cost is a combination of both the indirect and direct patient care needs. Benchmarking measuring and comparing the results of key work processes with those of the best performers and uses those best processes (practices) to improve work design and patient care delivery. Cohesive groups, work experience, intrinsic satisfaction, formal organizational structures, professionalism, indifference to rewards, routine tasks, feedback provided by the task, rigid adherence to rules, role distance, and low position power of the leader Structure (resources or structures required to deliver health care), Process (quality activities, procedures, and tasks performed to deliver quality health care) Outcome (the results of good health care delivery). Process Focus on the formal/ technical aspect of a work Views a good act as one that brings the most good and the least hem for the greatest number of people (eg funding and delivery of health care) The morality of an action is determined not by its consequences but by whether it is done according to an impartial, objective principle (eg following the rule DO NOT LIE) Every person is liable for his own tortous conduct The things speaks for itself Action done with force
An independent group of items, people, or procedures with a common purpose is called a:
10
Value is:
11
A team assessing and analyzing the care given to TB patients is an example of which organizational strategy for quality and process improvement? Which of the following is a substitute for leadership?
12
13
Three components of health care systems are:
14 15 16
A set of causes and conditions that repeatedly come together in a series of steps to transfer inputs into outcomes is called: Formalist theory (use in art and literature) Utilitarian theory (consequence-based theory)
17
Deontological theory (principle-based theory)
18 19 20
Rule of personal liability Doctrine of Res Ipsa Loquitor Assault
TOPICS FOR NLE JUNE-JULY 2012 Prepared by: Brian Yu 400+ FEEDBACKS MEDICAL SURGICAL NURSING/ FUNDAMENTALS OF NURSING 1. Purpose of small volume enema ANSWER: Used to clean the sigmoid and rectum How enema function ANSWER: Causes distention of the bowel and stimulates the defecation reflex During enema administration, direct rectal tip of enema solution container to ANSWER: Causes distention of the bowel and stimulates the defecation reflex Once the client is in position the nurse visualizes the anus and is ready to insert the rectal tip. She is doing the procedure correctly when she directs the rectal tip to the: ANSWER: umbilicus Principle behind obtaining informed consent before invasive procedure ANSWER: Autonomy Autonomy ANSWER: respect for an individuals right to self-determination and freedom to choose and implement ones own decision be sure that all patients have consented to all treatments and procedure explain procedures to patients properly A staff nurse reports to the supervisor that a newly hired nurse is falsifying data in the vital signs sheet for the clients assigned to her. What action should the supervisor do FIRST? ANSWER: Take the clients vital signs and compare with the data recorded by the new nurse ANSWER: C Priority management in patient with restraint ANSWER: Release every 2 to 4 hours, Assess every 30 minutes or as needed The parents understand safety precautions on children when they state that they: ANSWER: Will keep plastic bags and wraps are away from reach of children ANSWER: C
18. The nurse is administering a bronchodilator to a client with severe upper respiratory tract infection. The client is manifesting the desired effect of the bronchodilator when the nurse assesses which of the following: ANSWER: Effortless respiration 19. When the nurse conducts physical assessment of the abdomen, auscultation should precede palpation to: ANSWER: Prevent altering the frequency and character of bowel sounds 20. Dimming lights of the room as request by the client, level of Maslows hierarchy of needs met ANSWER: Safety and Security 21. Inadequate nutrition ANSWER: Emaciated and weak appearance 22. Desired effect of the bronchodilator in patient with severe upper respiratory tract infection ANSWER: effortless respiration 23. In abdominal assessment, auscultation should precede palpation to: ANSWER: Prevent altering the frequency and character of bowel sounds 24. During palpation ANSWER: use fingertips 25. After giving analgesic, what is the priority ANSWER: reassess pain level after 30 minutes to 1 hour of giving the drug 26. McCafferys guideline in pain management ANSWER: "whatever the experiencing person says it is, existing whenever and wherever the person say it does" has become the prevailing conceptualization of pain for clinicians over the past few decades 27. To maintain efficacy of nitroglycerine, store drug where ANSWER: Keep sublingual tablets in amber glass bottle 28. Appropriate instruction to patient with Patient-Controlled Analgesia ANSWER: Push the button when you feel the pain is starting. 29. Possible sign of ruptured appendix ANSWER: Pain subsides 30. An effective intervention to prevent perforation of the inflamed appendix ANSWER: Keep patient on N PO 31. Short discrete bubbling sounds over the lower region of lungs ANSWER: crackles 32. Continuous, high-pitched, squeaky musical sounds adventitious breath sound ANSWER: wheezing 33. Acromegaly, manifestation ANSWER: Enlarged extremities due to skeletal thickness and macroglossia (large tongue) 34. Transphenoidal hypophysectomy, incision site ANSWER: under the upper lip 35. What to wear BEFORE scrubbing of hands in OR ANSWER: head cap, mask, goggles 36. Skin preparation in OR, what and how to wear ANSWER: sterile gloves open glove technique 37. Most painful site of the wrist during venipuncture ANSWER: inner aspect of the WRIST 38. Cause of hypospadias ANSWER: congenital (occurs during 3rd month of fetal development) 39. Surgical operation needed to be postponed for a child with hypospadias ANSWER: Circumcision 40. Radioactive iodine uptake determines what 97 | TOP DISEASES Prepared by: Brian Yu, 09175262468
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10. Accidental poisoning is an important concern because poisons cause serious injuries to children and the elderly. As you conduct your safety awareness class for parents, you find that you need to give more detailed instructions when a parent says I will: ANSWER: induce vomiting if my child swallows kerosene. 11. Which of the following are required measures observed by health care workers when in contact with blood and body fluids? ANSWER: Hand hygiene and gloves 12. When communicating with Theresa, the nurse assumes the face to face position to: ANSWER: Express availability and desire to communicate 13. Communication zone for communication between nurse and patient ANSWER: Personal distance 14. While communicating with Theresa you use attentive listening. This requires that the nurse: ANSWER: Pays attention to both the content and feeling tone of the client 15. The client complains of pain in the left chest down to the left shoulder and left jaw. In your documentation for your nurses notes, you will record this as: ANSWER: Radiating pain 16. The changes in Mrs. De Veras vital signs that you would expect when she complains of pain are the following EXCEPT: ANSWER: Decrease in temperature 17. A client with congestive heart failure is taking hydrochlorothiazide once a day. While the client is taking the medication, the nurse should encourage the client to eat which of the following fruits: ANSWER: banana
ANSWER: Absorption of the iodine isotope 41. Diet for hypothyroidism ANSWER: low calorie, high fiber 42. Post-thyroidectomy, assessment for possible laryngeal nerve damage ANSWER: Talk with the client and note change in voice 43. Serum calcium level of 5.0 mg/dl, what to do ANSWER: Assess for signs of tetany 44. Confirmatory diagnosis for hiatal hernia ANSWER: barium swallow 45. To prevent increase in gastric acid secretion ANSWER: avoid cigarette smoking 46. Confirmatory test for cholelithiasis ANSWER: UTZ 47. Morphine is contraindicated for cholelithaisis because: ANSWER: Causes spasm of the Sphincter of Oddi 48. Bilateral tubal ligation, ask for informed consent to whom ANSWER: BOTH husband and wife 49. Role of nurse in informed consent ANSWER: witness 50. Characteristic (typology) of RBC in iron deficiency anemia ANSWER: Microcytic and hypochromic 51. Vitamin B12 deficiency, S/Sx ANSWER: Slight jaundice, fatigue, paresthesia, glossitis 52. Surgeon came into the OR suite swinging her hands ANSWER: Oblige the assistant surgeon to scrub again 53. How to apply dressing after stithing of incisional site ANSWER: Put the dressings, remove his gloves to apply the tape 54. Processes of absorption of nutrients by SMALL intestine ANSWER: diffusion and active transport 55. Psoriasis ANSWER: A chronic inflammatory skin disorder, not contagious 56. Psoriasis skin lesions ANSWER: Well demarcated regions of erythematous plaques that shed thick silvery white flakes 57. Herpes Zoster (shingles), precipitating factor ANSWER: decrease immune system 58. Shock, position ANSWER: modified trendelenburg 59. 2 characteristics of circulating blood volume in septic shock ANSWER: (1) Vasodilation and (2) Maldistribution of circulating blood volume 60. Water in the water seal bottle to fluctuate ANSWER: patent chest tube 61. Chest tube is dislodged ANSWER: Cover insertion site with petroleum gauze 62. sudden increase drainage in chest tube ANSWER: Assess for signs of hemorrhage 63. Corticosteroids use, nursing diagnosis ANSWER: Ineffective protection (risk for infection) 64. Hypoglycemia, manifestations ANSWER: Cool, moist skin, Slurred speech, Tremors 65. Hyperresonance, determined by ANSWER: percussion 66. Rat bite, what to do first ANSWER: Cleanse wound thoroughly 67. Critical nursing intervention for a patient with status epilepticus ANSWER: protecting airway 68. Effect of Diazepam in seizure
ANSWER: Relaxes peripheral muscles 69. Patient with head trauma, seizure happens when ANSWER: Within the first few weeks postrauma 70. Chlorpromazine (Thorazine), adverse effect ANSWER: Agranulocytosis and jaundice 71. Ants are crawling all over my body. (Akathisia), problem in ANSWER: sensorium or orientation 72. Patient with multiple sclerosis with fluctuating physical condition and generalized weakness, management ANSWER: Space activities throughout the day 73. Exacerbation of multiple sclerosis ANSWER: diplopia and nystagmus 74. Patient Marina verbalized to the nurse that she is like her mother ANSWER: transference 75. Neurotransmitters that are decrease in depression ANSWER: serotonin and norepinephrine 76. Therapeutic effect of Sertraline (Zoloft) ANSWER: increases Serotonin 77. Crisis ANSWER: Can no longer cope with usual problem-solving skills 78. Crisis, characteristic ANSWER: Opportunity of learning better ways of coping, Presence of a threatening event, Failure of usual problem-solving mechanisms 79. Polyneuropathy, deficiency in vitamin ANSWER: B 80. Prompt treatment of alcoholism, assess for ANSWER: At most eight hours from the time the patient last drank alcohol 81. I dont need help. Leave me alone. I am just fine. ANSWER: denial 82. A immediate goal of crisis intervention ANSWER: Resolve the problem 83. Duration of crisis ANSWER: 4 to 6 weeks 84. Research: double blind approach ANSWER: Neither the subject of those who administer the treatment know how is in the experimental and control group 85. Right to self-determination is reflected in ANSWER: Informed consent obtained 86. Blind patent, nursing diagnosis ANSWER: Risk for injury 87. Dementia, nursing diagnosis ANSWER: Risk for injury 88. Sodium Polystyrene Sulfonate (Kayexalate), effect ANSWER: Excrete potassium through the intestinal tract 89. Before paracentesis ANSWER: Have patient void 90. Increase of 1 kg in body weight is equivalent to ANSWER: 1 LITER of fluid retention 91. Goal of HIV management ANSWER: Improve the patients immune function 92. Juvenile Idiopathic Arthritis, cause ANSWER: unknown 93. Plasmapharesis ANSWER: Remove antibody-antigen complexes from circulation 94. Palliative Care ANSWER: Provides relief from pain and other distressing symptoms 95. Demonstrate respect of clients autonomy 98 | TOP DISEASES Prepared by: Brian Yu, 09175262468
ANSWER: Facilitating and supporting clients choices regarding treatment options 96. failed to attend to clients needs AMSWER: negligence 97. leave me alone, I need rest, the nurse responds by saying: ANSWER: You sound upset. 98. A client suddenly shouts Why is this taking so long? I have been waiting for several hours and nobody attends to us? What should be the initial response of the nurse? ANSWER: Talk to the client and determine her immediate needs 99. Client says to the nurse, Im nervous. Is the doctor competent in this kind of surgery? Are there clients with similar surgery who survived the procedure? How should the nurse best respond? ANSWER: You seem concerned about the surgery. 100. An order to discontinue catheterization of the client was implemented. She has complaints of difficulty in her first attempt to urinate. The nurse explains that this is due to: ANSWER: Attempt of the body to adjust to normal reflex mechanism. 101. removal of the inner cannula when he/she: ANSWER: Unlocks inner cannula by turning counter-clockwise and gently withdrawing in line with its curvature 102. clear liquid diet for a post-surgery client ANSWER: Tea, cola drinks, gelatin 103. assists the client to identify and cope with stressful emotional problems ANSWER: Counselor 104. hospital director gives the nurse a position of authority within a formal organization, she assumes the role of: ANSWER: Manager 105. The nurse who uses his interpersonal skills to guide the client in making decisions about his health care is acting the role of: ANSWER: Leader 106. Part of your teaching plan that helps address nutrition problems in the community include all ANSWER: Aiming for ideal body weight in all age brackets Building health nutrition related practices Choosing food wisely focusing on food pyramid guide 107. The nurse observes that childhood obesity is more common now. The frequent cause of this is the Filipino parents belief that: ANSWER: A fat child is healthy, a thin child is sickly 108. plan to do first for a client who is experiencing depression? ANSWER: Assist the patient to express feelings, beliefs, and values 109. While the nurse is assisting the client in her care, the client starts to cry and strikes her. The behavior that the client is manifesting best describes which of the following stages of death and dying? ANSWER: Anger 110. A client with injured left leg is sitting on the bed preparing to transfer to a wheel chair. The nurse is assisting the client and positions the wheelchair on the: ANSWER: Clients right side 111. A client has difficulty walking and needs a wheel chair to facilitate performance of daily activities. Anticipating the needs of the client, the nurse should have the wheel chair ready by placing it at: ANSWER: 45-degree angle to the bed 112. You noticed that a clients temperature has widely fluctuated above the normal temperature. You will record this type of fever in the clients chart as: ANSWER: Remittent 113. temperature readings indicate that he has been having fever but his body temperature would return to normal only to recur the next day ANSWER: Relapsing 114. While conducting rounds, the nurse notices a fire in a clients room. Which of the following should be the appropriate action of the nurse?
ANSWER: Evacuate the client from the room 115. To confirm pregnancy, the doctor will most likely: ANSWER: Order an ultrasound examination 116. Madelaine complains that her early morning nausea and vomiting really bothers her and prevents her from completing her work. To decrease the discomfort and keep her nourished, you advise her to: ANSWER: Eat dry crackers or toast before getting up in the morning 117. Last menstrual period (LMP) was March 15, 2010. Using Nagels rule, her expected date of delivery (EDD) is: ANSWER: December 22, 2010 118. A pregnant she was diagnosed with gestational diabetes. She asks, what are my chances of becoming a real diabetic later in life? The best reply by the nurse would be: ANSWER: Women diagnosed with gestational diabetes have an increased risk of developing diabetes later in life. 119. A 17 weeks gestation a type 1 diabetic undergoes an ultrasound examination. What information about the fetus at this time in pregnancy will the results of this examination provide? ANSWER: Placental Maturity 120. a toddler loves to play at the park, and the nurse encourages the mother to continue physical activities for what reason ANSWER: allowing the toddler to walk, run and hop enhances the childs kinaesthesia 121. how to prevent early-childhood dental cavities ANSWER: Make sure your childs diet is nutritious, and limit snacks high in sugar. 122. In caring for a 3-year-old Nurse Sarah knows that she needs to obtain the height of the child as part of routine health screening. To obtain an accurate measurement, the child must: ANSWER: Remove his shoes and stand upright, with head level 123. The 12 month old child with birth weight 8 lbs. Upon assessment the child now weighs 18 lbs. in documenting this result, the nurse knows that this weight is: ANSWER: Below the expected weight 124. radiation safety ANSWER: Shielding, distance, time 125. LEAST protection from radiation ANSWER: Rubber gloves 126. On auscultation, Mitral Stenosis? ANSWER: Low pitched, rumbling murmur occurring during diastole 127. On auscultation, Aortic Stenosis? ANSWER: Cresendo-decresendo systolic murmur 128. On auscultation, Mitral regurgitation? ANSWER: Blowing high pitched systolic murmur 129. Which of the following chemotherapeutic agents effects will be interfered by vitamin folic acid? ANSWER: methotrexate 130. Chronic Hepatitis B can transmitted by ANSWER: Contaminated needle 131. therapeutic range of lithium ANSWER: 0.5 to 1.5 mEq/L 132. When the body responds to stress, epinephrine is released producing which physiological response? ANSWER: A more forceful heart beat 133. terminate SVT through stimulation of which of the following cranial nerves? ANSWER: Cranial nerve X 134. Stevens-Johnson Syndrome? ANSWER: Hypersensitivity reaction 135. Which of the following symbols are used to document arterial oxygen saturation as measured by pulse oximeter? ANSWER: SpO2 (SaO2) 99 | TOP DISEASES Prepared by: Brian Yu, 09175262468
136. The ICU nurse orientee observed the following arterial blood gases results in one of the patients record: ph-7.46; paO297mmHg; paCO2-40mmHg and HCO3-30meq/L. Which of the following is the interpretation of these results? ANSWER: Metabolic alkalosis 137. Epinephrine ANSWER: Bronchodilating effects 138. Based on the suspected diagnosis, the nurse would expect that the gnawing epigastric pain will DECREASE with which of the following activities of the client? ANSWER: Eating a bland diet 139. The stool examination result of clients with peptic ulcer is POSITIVE for: ANSWER: blood 140. Intussusception, manifestation ANSWER: Crampy and intermittent severe abdominal pain 141. intussusception ANSWER: Telescoping of bowel into the adjacent segment 142. primary indication of the NGT in intussusception ANSWER: decompresssion 143. Which of the following food enhance absorption of iron? ANSWER: Citrus fruits 144. The client was prescribed ferrous Sulfate as iron supplement. For better absorption, the nurse would instruct the client to take this supplement. ANSWER: 1 hour before 145. The scrub nurse aids the assistant surgeon apply the sterile drape. The scrub nurse understands that once the drapes are positioned over the prepped incision site, the drapes must not be: ANSWER: Moved 146. During the interview, nurse found out that the client takes Prophythiouracil (Prophyl-Thracil) daily. Which of the following is the specific action of this drug? ANSWER: Blocks thyroid hormone production 147. Along with other treatments. Metformin HCL (Glucophage) was prescribed. The nurse should monitor for which potential serious side effect of the drug? ANSWER: Lactic acidosis 148. Colchicine is prescribed during the acute attack phase. Nurse Karmela is aware that the action of the drug is to: ANSWER: Interfere with the inflammation response of uric acid crystals in the joints. 149. Hydrochlorothiazide (Hytaz) 12.5mg 1 tablet orally once daily has been prescribed for the client. The specific action of this thiazide diuretic is to: ANSWER: Promote excretion of sodium and chloride be decreasing absorption in the distal tubule. 150. From the results of the laboratory test prescribed by the physician, which of the following will the nurse consider as an indication of impaired renal function? Elevated levels of: ANSWER: Creatinine 151. Which of the following examination would the nurse expect to be ordered? ANSWER: Synovial fluid analysis 152. The client is 24-hour urine collection for uric acid determination. To have a reliable result, the nurse anticipates which diet prescribed prior to the examination? ANSWER: Low-purine diet 153. Which activity indicates that a client is fully aware of his/her impending surgery? ANSWER: Voluntarily signs the consent for surgery 154. For client who cannot totally give up smoking, nurses should instruct client to cease smoking at least how many weeks before surgery? ANSWER: 1 155. Health instructions like encourage the client to move after surgery should also be understood and reinforced to the significant others. The goal of the instruction includes the following EXCEPT:
ANSWER: Comply with Institutional policy 156. The purpose of pre-anesthetic medication is one vital information given by the nurse prior to any surgery. Clients should be made to understand that this medication will: ANSWER: Facilitate induction of anesthesia 157. Virgilio has been taking Atenolol (Tenormin) 50 mg orally once daily. The nurse understands thatr the specific action is to block: ANSWER: Beta receptor stimulation of the heart 158. Stools of breastfed babies ANSWER: Breastfed infants usually have soft stools the bottle-fed infants. 159. The nurse is inserting a nasogastric tube on a toddler. Which of the following restraints would be most appropriate for the nurse to use with this child during the procedure? ANSWER: elbow 160. When assessing a client with Menieres disease, the nurse expects the client to experience: ANSWER: ringing of the ears 161. The nurses focus of care on clients with hearing and balance problems is: ANSWER: safety and promotion of independence 162. The onset of crisis is triggered by a: ANSWER: sudden precipitating event 163. A client is in a skeletal traction, the nurse understands that this procedure involves pulling force: ANSWER: Directly through pins inserted into the bone 164. High in purine ANSWER: Organ meats, wine and mussels 165. Shooting in ER, first to do by the nurse ANSWER: hide 166. Hypotension, compensatory mechanism of the body ANSWER: Activation of Renin-Angiotensin 167. Scrub nurse, role played for patient under anesthesia ANSWER: Client advocate (the nurse fights for the rights of the patient) 168. Scrub nurse ANSWER: Guardian of asepsis 169. Surgeon ANSWER: Captain of the ship (makes major decision) 170. Circulating nurse, function ANSWER: Validates informed consent 171. Circulating nurse, first thing to be done upon entrance of patient in OR ANSWER: Greet the patient and CHECK the IDENTITY 172. Surgery done without consent ANSWER: Battery 173. Role of nurse in obtaining informed consent ANSWER: Witness 174. Role of head nurse in OR ANSWER: Scheduling of patients for surgery 175. Anterior Pituitary Gland, hormones ANSWER: Prolactin/ Lactotropic TSH Growth Hormone (Somatostatin) GnRH: FSH and LH MSH ACTH 176. Posterior Pituitary Gland ANSWER: Oxytocin ADH 177. Hypophysectomy, post-op position ANSWER: Fowlers 178. Transphenoidal Hypophysectomy, watch out for bleeding 100 | TOP DISEASES Prepared by: Brian Yu, 09175262468
ANSWER: Nose 179. Potassium, acceptable rate ANSWER: 10 to 15 mEq/ hr Give with NSS 180. Maximum drug given subcutaneously ANSWER: 1 ml pedia 2 ml adult 181. Maximum drug given intramuscularly ANSWER: 3 ml 182. SQ, drug administration, obese ANSWER: 90 degrees and taut the skin 183. SQ, drug administration, skinny ANSWER: 45 degrees and pinch the skin 184. ID, drug administration ANSWER: Parallel to skin, 10 to 15 degree Bevel up 185. 1L NSS to be given in 24 hours, rate per hour ANSWER: 41 ml/ hr 186. D5W, classification ANSWER: Isotonic fluid but hypotonic in function 187. Heparin lock ANSWER: S.A.S.H. method (Saline, Antibiotic, Saline, Heparin) 188. Infiltration ANSWER: Stop and warm compress 189. Dehiscence ANSWER: Stop and cold compress 190. Billroth 1 ANSWER: Gastroduodenostomy 191. Billroth 2 ANSWER: Gastrojejunostomy 192. Complication of Billroth 1 and 2 ANSWER: dumping syndrome and pernicious anemia 193. Confirmatory test for cancer ANSWER: Biopsy 194. Preferred treatment of cancer for pedia ANSWER: Chemotherapy 195. Preferred treatment of cancer for adult ANSWER: Surgery 196. Cruciferous vegetables (anti-cancer) ANSWER: Cabbage, broccoli, cauliflower, Brussels sprouts, Kohlrabi 197. Prostate cancer, risk factors ANSWER: Age above 40 198. Bladder cancer, risk factors ANSWER: Smoking, hair dye 199. Lung cancer, risk factors ANSWER: Smoking, asbestosis, radon gas 200. Cervical cancer, risk factors ANSWER: Multiple sex partners, early sexual experience, HPV 201. Breast cancer, risk factors ANSWER: Nulliparity, high fat diet/obesity, early menarche, late menopause 202. Breast cancer, S/Sx ANSWER: Dimple or mass at RUQ o the breast (tail of Spence) 203. Stage III Breast Cancer ANSWER: Surgery and Chemotherapy 204. Korotkoff sounds ANSWER: 1- loud tapping 2- whoosing sound 3- crisp tapping 4- muffled sound 5- silence 205. BP of 104/100/90 ANSWER: Korotkoff sound phases I/IV/V (systolic/ muffling/ disappearance) 206. Auscultate pulse, use ANSWER: Bell of stethoscope (diaphragm for obese patients) 207. Inflate cuff more after palpable systolic BP around ANSWER: 30 mmHg 208. Deflate cuff, rate ANSWER: 2 to 3 mmHg/ beat 209. Correct about VS taking ANSWER: wait at last 30 minutes after exercise, eating or smoking 210. Sequence of chest physiotherapy (CPT) ANSWER: 1 postural drainage 2 percuss 3 vibrate 4 let the patient cough 211. Death certificate, signing ANSWER: physician/ municipal health officer 212. Suctioning, oropharyngeal/ nasopharyngeal ANSWER: Interval: 20 to 30 seconds 213. Suctioning, tracheal ANSWER: Interval: 2 to 3 minutes 214. Suctioning, entire procedure ANSWER: 5 minutes 215. Suctioning, per attempt ANSWER: 5 to 10 seconds 216. Withdrawal of NGT ANSWER: Inhale hold breath pinch the catheter withdraw 217. During liver biopsy, instruction ANSWER: Inhale exhale hold breath 218. Sleep disturbance ANSWER: Quality of sleep > Quantity of sleep 219. Kidney transplant patient taking immunosuppressant may still experience rejection, what is the possible sign ANSWER: Increase serum creatinine 220. Dialysis, not affected by the treatment ANSWER: Hemoglobin 221. Iron deficiency anemia ANSWER: Spoon shaped fingernail (koilonychia) 222. Post-pneumonectomy, position ANSWER: Supine or to the affected side 223. Post-mastectomy, position ANSWER: Elevate arms (liberty position) 224. Post-laminectomy, position ANSWER: Supine position 225. Post-laryngectomy, expect ANSWER: Absence of voice 226. Rich in iron ANSWER: Clams, leafy greens, enriched cereals, and liver 227. Rich in calcium ANSWER: Orange, yogurt, spinach 101 | TOP DISEASES Prepared by: Brian Yu, 09175262468
228. Hepatitis A and E ANSWER: Fecal-oral 229. Hepatitis B, C and D ANSWER: Blood, sexual intercourse, needle prick 230. Hepatic encephalopathy, diet ANSWER: Low protein diet (protein increases ammonia) 231. Hepatic encephalopathy, laboratory findings: ANSWER: a. Increase serum ammonia b. Increase bilirubin level in blood 232. Non absorbable suture (silk, nylon, vicryl, cotton, daron) ANSWER: Commonly used in SKIN 233. Absorbable sutures (chromic gut, plain gut) ANSWER: Commonly used in internal organs 234. 1st successful heart transplant ANSWER: Cape Town, South Africa 235. 1st successful bone marrow and kidney transplant ANSWER: USA 236. Coumadin (Warfarin), foods to avoid ANSWER: Green leafy vegetables (contains Vitamin K) 237. Anticoagulants (Coumadin, Heparin), how does it work ANSWER: It inhibit synthesis of Vitamin K dependent clotting factors 238. Heparin-induced side effect ANSWER: Thrombocytopenia 239. Burn in chest, arms, face ANSWER: Priority patient because it may cause inhalation burn and airway edema 240. Electrical burn, immediate management ANSWER: Turn off the electrical source 241. Patient is burning, priority management ANSWER: STOP, DROP and ROLL 242. Burns, 2 parameters to measure ANSWER: 1 extent percentage 2 severity degree 243. Fire in hospital, management (in sequence) ANSWER: 1 protect client 2 activate the alarm 3 confine the fire 4 extinguish the fire 244. Burns, 2nd degree (superficial partial thickness burn) ANSWER: Blisters (vesicles), painful 245. Burns, 3rd degree (deep partial thickness burn) ANSWER: Red to gray, local edema, wet, painless 246. Burns, 4th degree (full thickness burn) ANSWER: Charred, dry, leathery, painless 247. MRI, avoid ANSWER: Pacemaker, jewelry, metallic objects 248. CT scan, before ANSWER: check for allergy to iodine 249. Cardiac catheterization, after ANSWER: Check for distal pulses and possible bleeding 250. Ventricular tachycardia, characteristic ANSWER: Bizarre QRS complex, regular rhythm 251. Ventricular fibrillation, characteristic ANSWER: Chaotic pattern, no rhythm, no P wave, no QRS complex 252. Parkinson disease, S/Sx: ANSWER: Tremors (resting and pill rolling) Rigidity (cogwheel)
Akinesia or Bradykinesia Mask like appearance 253. Menieres disease, S/Sx: ANSWER: Vertigo, Hearing loss (sensorineural), Tinnitus 254. Menieres disease, priority ANSWER: Safety (Nursing Diagnosis: Risk for Injury) 255. Menieres disease, diet ANSWER: Low sodium, restrict fluid 256. Legal Blind, visual acuity ANSWER: 20/ 200 257. DM patient, before extraneous activity, AVOID ANSWER: Insulin injection 258. Insulin, when to decrease dose ANSWER: During breastfeeding 259. 100ml of NSS to be given at 10ml/ hour starting at 10 am, when will it end ANSWER: 8pm 260. Cholecystitis, pain location ANSWER: RUQ radiating to midsternal, shoulders and back 261. Cholecystitis, laboratory data ANSWER: Increase bilirubin Increase alkaline phosphatase Increase WBC 262. Obstructed bile flow ANSWER: increase bilirubin 263. Pericarditis, characteristic of breathing ANSWER: Rapid and shallow 264. Pericarditis, pain location ANSWER: Substernal 265. pH 7.30 CO2 28 HCO3 12 ANSWER: Metabolic acidosis, Partially compensated 266. Long bone fracture, check ANSWER: RR (possible fat embolism) 267. Rheumatoid arthritis and Osteoarthritis ANSWER: RA pain occurs during immobility whereas OA pain happens because of mobility 268. Patient prone to chocking or aspiration, priority management ANSWER: Position the patient in upright 269. Otic medication administration ANSWER: Up and back (out) adults Down and back (out) pedia 270. Patient prone to infection ANSWER: Removal of spleen ICU patients Steroids (Kidney transplant patient, Cushings disease) HIV 271. Phytochemicals, examples ANSWER: lycopene in tomatoes, isoflavones in soy and flavanoids in fruits. 272. Antioxidants and phytochemicals, benefits ANSWER: Anti-cancer 273. Total Parenteral Nutrition (TPN), most appropriate ANSWER: Sterile technique 274. Total Parenteral Nutrition (TPN), type of dressing to be use ANSWER: Air occlusive and transparent dressing 275. TPN solution is emptied but no follow up doctors order, what will you give ANSWER: hypertonic solution D10 W pedia 102 | TOP DISEASES Prepared by: Brian Yu, 09175262468
D50W adult 276. Liver cirrhosis, health teaching ANSWER: Good nutrition, avoid infection and abstain from alcohol 277. Bronchoconstriction, appropriate nursing diagnosis ANSWER: Ineffective airway clearance 278. Crackles, appropriate nursing diagnosis ANSWER: Impaired breathing pattern 279. Respiratory acidosis, appropriate nursing diagnosis ANSWER: Impaired gas exchange 280. Infusion pump, alarm on when ANSWER: Empty/ near empty IV fluid Sudden twisting or movement Tension on the tubing/ occlusion Sudden change on the solution 281. Pulse oximeter, purpose ANSWER: measures oxygen saturation and pulse 282. To reduce tenacity of secretions ANSWER: Increase fluid intake 283. Stimulant of breathing ANSWER: Carbon dioxide 284. Metered dose inhaler, correct teaching ANSWER: Disperse drug with inhalation Do not place inside the mouth the tip of the inhaler, provide 1 to 2 inches apart from the lips Provide mouthwash after drug administration 285. Evaluation of Tissue perfusion ANSWER: Monitor hourly urine output 286. Foods that retain fluids in the body ANSWER: Salty foods (dried fish), cola, pickles 287. Foods that causes diuresis ANSWER: Tea, coffee 288. To prevent atelectasis: ANSWER: Ambulate as soon as possible 289. Fifth vital sign: ANSWER: Pain 290. SEVERE pain medication: ANSWER: Morphine 291. Pain assessment used in pediatric clients ANSWER: Faces scale 292. Colonic Cancer ANSWER: CEA- Carcino Embryonic Antigen 293. Ascites, measure ANSWER: abdominal girth 294. Eye pain after cataract surgery ANSWER: Call the MD 295. Myasthenia Gravis, initial manifestation ANSWER: Ptosis (drooping, sinking or falling down of an organ or part, particularly the drooping of the upper eyelid) 296. AV fistula how long does it mature? ANSWER: 3-4 weeks 297. AV fistula with no bruit/thrill ANSWER: Obstruction/clot 298. Purpose of neomycin in peri-ops ANSWER: To kill bacteria in the gut 299. Heparin/Insulin is measured as ANSWER: Units/ml 300. 1 grain is equal to ANSWER: 60 mg
301. 1 tsp is equal to ANSWER: 5 ml 302. Appendicitis report ASAP ANSWER: Rigid abdomen, indicates peritonitis 303. Colorectal cancer, screening: ANSWER: a. Rectal exam (DRE) correct answer b. Biopsy confirmatory test 304. Best way to measure fluid retention ANSWER: Weight 305. Best way to measure body fat ANSWER: Skin fold thickness 306. Nursing audit ANSWER: Review of records 307. Quality assurance ANSWER: ensuring and evaluating that the nursing care rendered is within the minimum standards of care (REACTIVE) 308. Structure evaluation ANSWER: physical setting 309. Process evaluation ANSWER: how the nursing care is given 310. Outcome evaluation ANSWER: output of nursing care given (demonstrable changes) 311. Total quality management ANSWER: focus on identifying real and potential problem (PROACTIVE) 312. Hyperparathyroidism, main problem ANSWER: Increased serum calcium Decreased serum phosphate 313. Hypoparathyroidism, main problem ANSWER: Decreased serum calcium Increased serum phosphate 314. Increased ICP, position ANSWER: Fowlers position 315. Increased ICP (Cushings response) ANSWER: Increased BP, Increased MAP Decreased RR, Decreased PR Widening pulse pressure 316. Reason for elevating patient with increase ICP ANSWER: To promote venous drainage 317. Shock ANSWER: Decreased BP, Decreased MAP Increased RR, Increased PR Narrowing pulse pressure 318. Digoxin (Lanoxin), effects ANSWER: Increased force of contraction, increased cardiac output, increased tissue perfusion increased urine output decreased electrical impulse decreased heart rate, decreased workload increased myocardial oxygenation 319. Decreased tissue perfusion in kidney, effect ANSWER: Stimulates erythropoietin causing bone marrow stimulation leading to polycythemia 320. Most common nosocomial infection: ANSWER: UTI 321. Best management for UTI ANSWER: increased water intake 322. Stridor and wheezing, first drug to be given ANSWER: bronchodilator 103 | TOP DISEASES Prepared by: Brian Yu, 09175262468
ANSWER: the deeper the level of consciousness 323. Pruritus ANSWER: oatmeal bath colloidal bath 324. Tinea Capitis hair loss is: ANSWER: temporary 325. Pediculosis Capitis: ANSWER: Treat all household members Lindane is not given in children (can cause seizure in children) 326. Gastric Cancer s/sx: ANSWER: Weight Loss 327. Lung Cancer s/sx: ANSWER: dry hacking cough 328. Herpes zoster: ANSWER: give antiviral 329. Patient with Luccid (clear thoughts) then unarousable: ANSWER: hematoma cerebral 330. Most reliable sign of cardiac arrest: ANSWER: absence of pulse 331. High Risk for bleeding: ANSWER: Patient with thrombocytopenia 332. Non-plaster cast a.k.a. synthetic cast gets wet: ANSWER: Hair blower on a cool setting for itchiness 333. Assessing brachial plexus injury in Newborn ANSWER: Assess moro reflex 334. Collecting urine specimen for C&S sterile procedure ANSWER: 5 to 10ml 335. Routine urinalysis ANSWER: 30 to 50 ml 336. Abdominal: post-op: sleeping intestines: ANSWER: paralytic ileus 337. Residual volume of urine ANSWER: 50-100 ml 338. Spina Bifida lack of: ANSWER: folic acid 339. Arthralgia is ANSWER: with pain and no swelling 340. Arthritis is ANSWER: with pain and swelling 341. PRESBYOPIA ANSWER: Decrease accommodative ability of the lens that occurs with aging 342. HYPEROPIA ANSWER: Farsightedness 343. MYOPIA ANSWER: Nearsightedness 344. SIADH s/s: ANSWER: (dilutional) hyponatremia 345. Meningeal irritation s/s: ANSWER: nuchal rigidity, photophobia, kernings sign, brudzinskis sign 346. Breast exams ANSWER: 5-7 days after onset of mens 347. GCS score of a patient who is moaning and mumbling ANSWER: 2 348. GCS score, highest ANSWER: 15 349. GCS score, coma ANSWER: 7 and below 350. GCS, the higher the score 373. OSTEOMYELITIS ANSWER: Immobilize 374. Milwaukee brace ANSWER: wear it for 23 hours and 1 hour intended for bathing 375. Plaster of Paris ANSWER: 24 to 72 hours 376. synthetic/ fiber glass ANSWER: 20 minutes 104 | TOP DISEASES Prepared by: Brian Yu, 09175262468 351. Manifestation of ICP ANSWER: Bradycardia 352. Pernicious anemia CORRECT UNDERSTANDING: ANSWER: Vitamin B12 for life IM 353. Urine output per hour ANSWER: 30 60 ml 354. What substance is produced by the kidneys that assists in blood pressure control ANSWER: Renin 355. A patient has had a sudden 5-kg weight gain. How much fluid has been retained? ANSWER: 5L 356. The functional unit of the kidney is called a(n) ANSWER: Nephron 357. What is oliguria? ANSWER: c. Oliguria is a urine output less than 400 mL in 24 hours. 358. Anuria is a urine output of ANSWER: 50 to 100 mL/24 hours 359. most reliable pain indicator ANSWER: Subjective complaint of patient; DIAPHORESIS 360. Analgesics ANSWER: Before formation of prostaglandin 361. Position cord prolapse ANSWER: Trendelenurg/ knee chest 362. Acute Renal Failure: ANSWER: decrease urine output 363. Creatinine clearance ANSWER: 24 hour urine collection 364. Most common post op complication ANSWER: Hemorrhage 365. Most common triggering factor of asthma ANSWER: Dust mites 366. Most common type of liver cirrhosis ANSWER: Laennecs (due to alcohol) 367. The worst of all fears among clients undergoing surgery is: ANSWER: Fear of unknown 368. HYPERCALCEMIA,S/SX: ANSWER: muscle weakness 369. Theophylline toxicity ANSWER: Tachycardia and nausea and vomiting 370. In OR, who validates/verifies consent: ANSWER: Ciculator 371. Sellick maneuver ANSWER: application of pressure in the cricoid cartilage 372. Discharges Serous Sanguineous Seroanguineous Purulent Purosanguineous
Clear Red (open wounds) Pinkish (surgical incision) Pus Pus and blood (new infected wound)
377. Patient has weak side, where to place the wheelchair during transfer? a. Unaffected/ STRONG SIDE b. Affected 378. Transfer from surgical bed to wheelchair, position of the wheelchair? a. Foot of the bed b. Facing the client c. Middle of the bed d. Parallel to the bed 379. First to check if patient has 1000 mL blood loss: a. VS b. Soaked dressing c. Pain 380. Patient on NPO complains of thirst, how to alleviate? a. Wet cotton put on lips b. Gargle but dont swallow c. Sip water 381. Promote safety to a patient in a bed without siderails ANSWER: lower the bed 382. Most common type of goiter is related to deficiency of ANSWER: Iodine 383. Earliest sign of skin reaction to radiation therapy is ANSWER: Erythema 384. Waste disposal like biological wastes disposal should be coordinated to ANSWER: DILG, MMDA 385. 3 TYPES OF JAUNDICE ANSWER: 1. Hepatic jaundice inability of the liver to conjugated unconjugated bilirubin to conjugated bilirubin) 2. Obstructive jaundice due to cholelithiasis 3. Hepatic jaundice due to RBC hemolysis 386. Last step in research process ANSWER: utilization of the research into practice 387. Incident report, not included ANSWER: derogatory comments of patient 388. Final step in nursing process ANSWER: putting research evidence into nursing practice 389. Correct understanding about sampling technique ANSWER: the greater the sample size, the more accurate will be the estimate of the true population mean 390. Client with hearing impairment ANSWER: speak slowly in front of the patient 391. Patient is teary eyed and stops talking ANSWER: remain silent, sit with the client 392. fight free radicals ANSWER: antioxidants and phytochemicals 393. Signs of dysphagia ANSWER: Coughing while eating Delayed swallowing Abnormal movements of tongue and mouth Uncoordinated speech 394. Positioning patient into lithotomy position ANSWER: place both legs slowly and simultaneously on wellpadded stirrups 395. Document outlining selected medical treatment to be done to a patient when he/ she losses his/ her ability to decide ANSWER: advance directives 396. Chest pain in patient with pneumonia is due to ANSWER: pleuritic friction rub 397. Peptic ulcer disease, cause ANSWER: H. pylori, NSAIDs smoking, alcohol
398. Sign of gastric ulcer perforation ANSWER: rigid, board-like abdomen 399. Grafts used in CABG ANSWER: Saphaneous vein Internal mammary artery Radial artery 400. Pain during coughing exercises ANSWER: splint using cough pillow 401. Antacids ANSWER: neutralize gastric acidity 402. Ezomeprazole magnesium (Nexium) ANSWER: Proton pump inhibitor 403. Cushing syndrome ANSWER: OVERSECRETION of glucocorticoids 404. 3 elements of fire ANSWER: Oxygen (open windows Combustible material (leaking gas stove) Friction (disposable drapes) 405. Furosemide, excrete what electrolytes in urine ANSWER: sodium, potassium and calcium 406. Renal stones ANSWER: Flank pain/ costovertebral pain Strain urine 407. Swelling of leg due to congestion ANSWER: elevate leg 408. Phatom limb pain caused by ANSWER: severing peripheral nerves 409. Laboratory result in patient with pericarditis ANSWER: Erythrocyte sedimentation rate 410. OHA (Metformin) and NSAIDS or ASA ANSWER: hypoglycemia 411. Insertion of foley catheter ANSWER: sterile technique 412. White pulp of spleen ANSWER: lymphocyte production 413. Kidney function, indicator ANSWER: creatinine clearance 414. increased hematocrit ANSWER: polycythemia, dehydration
Burn percentage in adults: Rule of nines A method of estimating the extent of body surface that has been burned in an adult, dividing the body into sections of 9 per cent or multiples of 9 per cent.
Infants<10kg Anatomic Surface structure area Head and neck 20% Anterior torso 16% Posterior torso 16% Each leg 16% Each arm 8% Genitalia/perineum 1%
Rule of palms The surface of the patient's palm represents approximatley 1% of body surface area and is helpful in estimating the area of small burns. Parkland formula The Parkland Formula gives you the calculation you need to know how much fluids to give to patient. V ( fluids volume)= total body surface area of burn (%) x weight (kg) x 4
Adults Anatomic Surface structure area Anterior Head 4.5% Posterior Head 4.5% Anterior torso 18% Posterior torso 18% Each Anterior arm 4.5% Each Posterior arm 4.5% Each Anterior leg 9% Each Posterior leg 9% Genitalia/perineum 1% Burn percentage in children and Infants For children and infants, the Lund-Browder chart is used to assess the burned body surface area. Children Anatomic Surface structure area Anterior Head 8.5% Posterior Head 8.5% Anterior torso 18% Posterior torso 18% Each Anterior arm 4.5% Each Posterior arm 4.5% Each Anterior leg 6.5% Each Posterior leg 6.5% Genitalia/perineum 1%

Top 40 Drugs and Nle Feedbacks

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TOP 40 DRUGS

GENERAL Intravenous Inhalational

4. ANTICOAGULANTS AND THROMBOLYTICS

Route Expressed in Antidote Laboratory test

Long term therapy Slow

ALLOW: cottage and cream cheese***

Monitor BP Therapeutic effect are achieved within 10 days to 4 weeks

6. ANTI-GOUT COLCHICINE (Novocolchine) NSAID anti-inflammatory

PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) uricosuric agents

8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS)

9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID

10. ATROPINE SULFATE (Atropair, AtroPen)

block neurotransmitter acetylcholine inhibits parasympathetic actions

Change of position gradually Take pulse before taking drug***

14. CHEMO DRUGS

Neutropenia Thrombocytopenia Hemorrhagic cystitis Urine color changes

16. DIGOXIN (Lanoxin)

Proximal tubule Loop of Henle Glomerulus

Fastest diuretic to take effect Warm solution to avoid crystallization

HPN (Not effective for immediate dieresis)

Electrolytes removed through diuretics:

potassium, calcium, sodium***

22. IMCI DRUG: VITAMIN A

23. IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE

6 | TOP DRUGS Prepared by: Brian Yu, 09175262468

Color: Clear Route: IV, SQ Color: Cloudy Route: SQ

Color: Cloudy Route: SQ

25. IRON SUPPLEMENTS

29. METRONIDAZOLE (Flagyl)

30. MORPHINE SULFATE (Duramorph)

8 | TOP DRUGS Prepared by: Brian Yu, 09175262468

32. NONI JUICE

COMMON SIDE EFFECT: constipation***

34. OXYTOCIN (Pitocin)

36. PHENYTOIN (Dilantin)

37. PRE-OPERATIVE MEDICATIONS

Avoid rapid injection to prevent shock

OPIATE AGONISTS (Narcotic analgesic) ANTICHOLINERGIC

Antidote: naloxone (narcan) Causes constipation

39. SYMPATHETIC AND PARSYMPATHETIC

TOP 105 DISEASES AND HUMAN ANATOMY

1. ABSENT MECONIUM PASSAGE within 24 hours after birth

3. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

4. ADDISONs and CUSHINGS DISEASE

DOWN: SEX HORMONES Decrease sexual urge or libido

Osteoporosis Gynecomastia (males)

Risk for infection Pathologic fracture*** Osteoporosis*** DM Arrhythmia

5. AGE RELATED MACULAR DEGENERATION (AMD)

7. ANEMIA decrease oxygen carrying capacity of RBC

8. ANEURYSM is ballooning of the blood vessel

9. ANGINA PECTORIS: Management

14 | TOP DRUGS Prepared by: Brian Yu, 09175262468

11. ARNOLD-CHAIRI MALFORMATION

tinnitus) Steroids/ NSAIDS Hot and cold compress Plasmapharesis

13. AUTOSOMAL AND SEX-LINKED DISORDERS

14. BENIGN PROSTATE HYPRPLASIA

15. BITES 16. BOTULISM

17. BRONCHIAL ASTHMA

19. BROWN-SEQUARDs SYNDROME

CLASSIFICATION 1st degree Superficial thickness burn

pain, red (erythematosus), no edema

Superficial Partial thickness burn

Epidermis and dermis

Scalds (contact with hot liquids)

Risk for infection Pathologic fracture* Osteoporosis* DM Arrhythmia