1.

Charlie's (blood) Chemistry or Comprehensive

Metabolic Panel (CMP)
to detect electrolyte imbalances,
myocardial damage
2. Ex X-rays chest x-ray is used to determine size of
heart and signs of heart failure
3. PACked
Ruth
Pulmonary Artery Catheter (PAC) to detect left- or right-sided heart failure
4. In Intake and output to assess renal perfusion and possible
fluid retention
5. Granny's (arterial blood) Gases to help determine O2 flow rates
6. V Vital signs to monitor response to therapy and detect
complications
7. W Weight daily weight to assess possible fluid
retention


A Activities of daily
living (ADLs)
Help the client with ADLs it stresses the heart less
B Bed rest Maintain bed rest it reduces the oxygen
demands on the heart
C Commode Commode at bedside it stresses the heart less than
using a bedpan
D Diversions Offer diversionary activities while on
bedrest
offer diversions that don't
stress the heart
E Elevate Elevate head of bed (semi-Fowler's) or
sit client up
to increase chest expansion
and improve ventilation
F Feelings Listen to client's concerns; provide
emotional support to reduce anxiety
anxiety increases oxygen
demand

T Tests and Explain tests and treatments in simple, culturally sensitive ways
Treatments
D Drugs Write out names and explain reason for drugs, their side effects, and how
long client will take them
D Diet Good nutrition and restrictions, i.e., low sodium diet, reduce cholesterol
levels
D Disease Explanation of the disorder and treatment plan
S Smoker? Encourage to stop smoking

Treatment for pulmonary edema: M DOG

M =Morphine
D =Diuretics (Lasix)
O =Oxygen (100% CPAP or intubation)
G =Gases (blood gasses)


C ardiogenic - ventricle loses pumping power and cardiac output becomes inadequate
H ypovolemic - excessive blood loss
A naphylactic - severe allergic reaction inappropriately dilates the veins to pool blood
N eurogenic - sympathetic NS inappropriately dilates the veins to pool blood
S eptic shock - systemic infection causes excessive capillary permeability with excess intravascular
volume loss
R =Respiratory
O =Opposite
M =Metabolic
E =Equal

All of the musculoskeletal disorders - EXCEPT GuillainBarr syndrome - feature the letter M:

Myasthenia Gravis
Poliomyelitis
Amyotrophic Lateral Sclerosis
Muscular Dystrophy

6-Fs of gallbladder disease
F air (skin and hair)
F at
F orty (and older)
F ertile (lots of children)
F emale
F latulant
After a urinary catheter is removed, the client may have some burning on urination,
frequency and dribbling. These findings should subside within 24 to 48 hours.
Co-trimoxazole (Bactrim) remains the drug of choice to treat urinary tract infections
(unless the client is allergic to sulfa).
After a transurethral resection of the prostate (TURP), the client will continuously feel
the urge to void for 24 to 48 hours because the three-way foley catheter has a large
diameter.
After prostatic surgery, it is normal for the client's urine to be blood tinged for 48 to 72
hours and for him to pass blood clots and tissue debris.
Because the prostate gland receives a rich blood supply, it is a priority to observe the
client undergoing a prostatectomy for bleeding and shock.
Chlamydia is the most common sexually transmitted bacterial infection in the U.S. If
untreated, it can cause PID in women and epididymitis in men.
HPV vaccine Gardasil protects against types of HPV that cause most cervical
cancers and can help protect against genital warts in both young men and women.
Clearly communicate that no blood pressures or blood draws should be taken on the
arm with the fistula.
Breast cancer starts with the alteration of a single cell and takes a minimum of 2
years to become palpable.
At the time of diagnosis, about one-half of clients with breast cancer have regional or
distant metastasis.
Nerve damage and lymphedema may occur with a radical or modified radical
mastectomy (when lymph nodes are removed).

Adrenal gland (cortex) hormones - SSS :
S =Sugar (glucocorticoids)
S =Salt (mineralcorticoids)
S =Sex (androgens)

To help remember the glands of the endocrine system, remember: " Herman Probably Pasted The
Paper To A Pot Of Tea "
H =Hypothalamus
P =Pituitary
P =Pineal
T =Thyroid
P =Parathyroid
T =Thymus
A =Adrenal
P =Pancreas
O =Ovaries
T =Testes

Although it's extremely oversimplified, think of the relationship between insulin and glucose as a see-saw.
When one is higher, the other tends to be lower.

After hip replacements, pulmonary embolism, often a fat embolus, may occur even
without thrombosis in foot or leg.
Clients, after hip replacement, should sit in a straight, high chair; use a raised toilet
seat; and never cross their legs or ankles.
In hip or knee replacement, clients will need assistive devices for walking until muscle
tone strengthens and they can walk without pain.
After an amputation, the home must be assessed for any modifications needed to
ensure safety.
The management of soft tissue injury can be remembered by the acronym R.I.C.E.:
Rest
Ice
Compression
Elevation
Some clients will need transportation to continue rehabilitation out of the home.
Amputee support groups can be helpful for clients.
After arthroscopy, outpatient rehab may be prescribed depending on procedure;
health care provider may prescribe knee immobilizer.
Prepare client preoperatively (if possible) about external fixator device to reduce
anxiety; device looks clumsy, but client should be reassured that discomfort is
minimal.
After a femoral-head prosthesis, caution client not to force hip into more than 90
degree of flexion, into adduction or internal rotation.
Caution clients with a new prosthesis not to use any substances such as lotions,
powders etc. unless prescribed by the health care provider.
Osteoporosis cannot be detected by conventional x-ray until more than 30% of bone
calcium is lost.
Foods high in calcium include milk, yogurt, turnip greens, cottage cheese, sardines,
and spinach.
When collecting musculoskeletal data on a client with Paget's disease, note the size
and shape of the skull; the skulls of these clients will be soft, thick and enlarged.
Clients at high risk for acute osteomyelitis are: elderly, diabetics, and those with
peripheral vascular disease.
Immunosuppressed clients should avoid contact with persons who have infections
and locations where there are crowds.
Steroids may mask the signs of infections, so clients should promptly report a slight
change in temperature.
Photosensitive clients should avoid the sun, limit outdoor activities during peak sun
hours, wear sun block, or use clothing and hats to avoid sun exposure


CANCER Interventions:

C =Comfort
A =Altered body image
N =Nutrition
C =Chemotherapy
E =Evaluate response to medications
R =Respite for caretakers
Radiation has more local effects; chemotherapy has systemic effects.
Only certified nurses may administer chemotherapeutic agents.
Although clients with cancer may experience pain at any time during their disease,
pain is usually a late symptom of cancer.
Ionizing radiation will damage both normal and cancerous cells, and cause side
effects.
Clients who receive external radiation are not radioactive at any time.
Clients receiving internal radiation are not radioactive; the implant or injection is.
If the source of radiation is metabolized, the client's secretions and excretions may be
radioactive for a time, based on the half-life of the isotope (usually 48 to 72 hours).
Highly active antiretroviral therapy (HAART) used in the treatment of AIDS can cost
up to $30,000 - $50,000 per year.
THE TRAUMA CLIENT
Assessment and early management of the trauma client includes the following:
Primary survey: ABCs
A = airway maintenance with spinal cored control, i.e., cervical stabilization
B = breathing
C = circulation
Assess cognitive levels: Glasgow Coma Scale
Provides an objective score based on a 15 point scale (for adults)
Assesses three categories of responses
eye opening response
verbal response
motor response
Assess: A.M.P.L.E.
A = allergies
M = medications
P = past illness
L = last meal
E = events preceding the injury
Types of trauma
Penetrating
Blunt
deceleration
compression
Findings of trauma
Deformity/angulation of extremity
Swelling
Pain
Paresis/paralysis
Pallor
Absent pulses
Life threatening injuries of an extremity
Massive open comminuted fractures
Bilateral femoral shaft fractures
Vascular injuries
Crush injuries of the abdomen or pelvis
Traumatic amputation of an arm or leg
Predictable musculoskeletal injuries
Child/pedestrian injuries
Waddell's triad
associated with high-velocity accidents involving children, i.e.,
motor vehicle, auto-pedestrian, or bicycle crashes
consists of femur fracture, intra-abdominal or intrathoracic
injury, and/or head injury
take care to determine
point of impact with the car bumper
point of impact with the car hood
point of impact where the body is thrown
children tend to face car when incident is about to occur
Adult/pedestrian injuries
take care to determine
point of impact with the car bumper
point of impact with the car hood
injuries to opposing ligaments
unlike children, adults tend to turn away from car before impact
Unrestrained drivers
head injuries
injuries to larynx and sternum
knee/femur injuries
posterior hip dislocation
Fall from a height ("Don Juan syndrome")
lands on feet and fractures ankles: bilateral calcaneal fractures
falls backwards: L2-L3 injuries
hyperflexion of the lumbar spine
bilateral Colles' fractures
compression fracture of vertebrae
then may land on hands: fractured wrists
Blast injuries
gunshot/missile type injuries
source of infection: when energy travels it leaves a vacuum behind it,
drawing in debris and body hair
results in both an entry and exit wound
shock waves extend throughout body
Goals of nursing care
Sustain life
Maintain function
Preserve appearance
Goals of rehabilitation
Decrease pathology
Prevent secondary disabilities
Increase function of unaffected and affected systems

Emergency trauma assessment: ABCDEFGHI

A =Airway
B =Breathing
C =Circulation
D =Disability
E =Examine/expose
F =Fahrenheit (temperature)
G =Get vitals
H =Head-to-toe assessment/history
I =Inspect the back

Complications of a trauma client: TRAUMATIC

T =Tissue perfusion problems
R =Respiratory problems
A =Anxiety
U =Unstable clotting factors
M =Malnutrition
A =Altered body image
T =Thromboembolism
I =Infection
C =Coping problems

Cyanotic defects - the 4 T's:

T =Tetralogy of fallot
T =Truncus arteriosus
T =Transportation of the great vessels
T =Tricuspid atresia


Associate Hir schsprung's with a girl ("her") who wears "ribbons" in her
hair - to recall that "ribbon-like" stools are a classic finding of this
disease.



Normal labor progress in active labor is 1.2 cm/hr for primiparas and 1.5 cm/hr for
multiparas
Prolonged labor at any stage should be evaluated for fetal, pelvic or uterine
dysfunction
Pain and anxiety can impede the laboring progress
Vaginal birth is the birth method of choice and interventions should be directed at
accomplishing that goal
Cesarean birth is utilized to rescue the infant when fetal, pelvic or uterine dysfunction
cannot be overcome
Maintenance of a calm, soothing environment is necessary
Efficient and effective gathering of supplies and personnel is imperative
Maintain eye contact and verbal contact with woman to provide support
Assist mother to birth as slowly as possible to prevent maternal/newborn trauma
Be prepared to assist with the newborn transition to extrauterine environment
Anticipate predisposing factors for prolapsed cord
Inform and support mother in any emergency
Prepare for expeditious birth - vaginal or cesarean
Surgical interventions have associated complications of increased infection,
increased postoperative hemorrhage, increased morbidity and potential of increased
mortality
Surgical delivery, c-section, of the newborn reduces mechanical compression of the
chest. It may potentiate respiratory difficulties in the newborn such as transient
tachypnea of the newborn.
Severe postpartum hemorrhage may result in organ failure, disseminated
intravascular coagulation (DIC), and/or mortality
Estimation of bleeding is critical
Uterine massage is the first line of defense against excessive hemorrhage
Oxytocins are used to contract the uterus during the laboring process and after
delivery

If the maternal pancreas is unable to increase insulin production sufficiently, gestational
diabetes mellitus results
Maternal hyperglycemia results in glucose crossing the placenta and the fetus manufacturing
insulin
Insulin in the fetus acts as a growth hormone producing a large-size infant
Shoulder dystocia is the most common complication of vaginal delivery in large-size infants
Maternal insulin needs are dramatically reduced following delivery
Newborns of diabetic mothers may incur birth injury, hyperbilirubinemia, hypoglycemia, and
neurologic damage
Euglycemia is the most important factor in avoiding maternal/fetal complications
Anemia in pregnancy is associated with abortion, infection, pregnancy induced hypertension,
preterm labor and heart failure
Fetal problems from anemia of mother include growth retardation with associated morbidity
and mortality
Daily logs of dietary intake may help the woman focus on positive improvement
Pica is the craving by pregnant women for nonfood substances due to low iron levels
Failure to correct nutritional imbalances in pregnancy can result in intrauterine growth
retardation, central nervous system malformations and fetal death
Failure to correct nutritional imbalances in pregnancy can result in severe dehydration,
metabolic alkalosis, ketosis, cardiac dysrhythmias and death for the woman
Maternal understanding of the disease process and recommended therapies may provide
impetus for self-care
Normal pregnancy cardiovascular changes increase the heart's workload
Cardiac disease in pregnancy can deteriorate rapidly
Women must verbalize understanding of cardiac findings indicating complications
Pregnant cardiac clients must be monitored closely for decompensation
Failure to detect blood incompatibility with the fetus can result in RBC hemolysis and severe
morbidity or mortality
RhoGAM should be administered to all sensitized women within 72 hours following delivery,
miscarriage, or abortion