MEDICAL- SURGICAL Overview of the Structures & Functions of Nervous System Central NS PNS ANS Brain & spinal

cord 31 spinal & cranial sympathetic NS Parasypathatic NS Somatic NS

C " $ S C

! 1# % % 1

ANS &or adrener'ic of parasympatholitic response( SNS involved in fi'ht or a''ression response -elease of norepinephrine &adrenaline , cathecolamine( Adrenal medulla &potent vasoconstrictor( .ncreases /ody activities 0S 1 .ncrease 34cept 5." , decrease 5."motility 8 9hy 5." is not increased 1 5." is not important: .ncrease /lood flow to s6eletal muscles; /rain & heart* Effects of SNS (anti choliner'ic)adrener'ic( 1* +ilate pupil , to aware of surroundin's medriasis #* +ry mouth 3* BP & 2-1 increased /ronchioles dilated to ta6e more o4y'en 7* -- increased %* Constipation & urinary retention

.* Adrener'ic A'ents , 3pinephrine &adrenaline( S3< SNS effect ..* PNS< Beta adrener'ic /loc6in' a'ents &opposite of adrener'ic a'ents( &all end in ,=lol>( Bloc6s release of norepinephrine* +ecrease /ody activities e4cept 5." &diarrhea( 34* Propanolol; ?etopanolol S3< B 3 " A , /roncho spasm &/ronchoconstriction( , elicits a decrease in myocardial contraction , treats 2PN , A0 conduction slows down

5iven to an'ina & ?. , /eta /loc6ers to rest heart Anti 2PN a'ents< 1* Beta /loc6ers & lol( #* Ace inhi/itors & pril( e4 3NA$AP-.$; CAP"OP-.$ 3* Calcium anta'onist e4 CA$C.B$OC or N3F3+.P.N3 Peripheral nervous system< choliner'ic) va'al or sympatholitic response .nvolved in fly or withdrawal response -elease of acetylcholine &AC"2( +ecrease all /odily activities e4cept 5." &diarrhea( . Choliner'ic a'ents e4 1* ?estinon Antidote , anti choliner'ic a'ents Atropine Sulfate , S)3 , SNS S)3 1* #* 3* 7* %* @* Effect of PNS: (choliner'ic( ?eiosis , contraction of pupils .ncrease salivation BP & 2- decreased -- decrease , /roncho constriction +iarrhea , increased 5. motility Arinary freBuency

of anti hpn dru's< 1* orthostatic hpn #* transient headache & diCCiness* ?'t* -ise slowly* Assist in am/ulation* CNS (brai ! s"i a# cor$% .* Cells , A* neurons Properties and characteristics a* 34cita/ility , a/ility of neuron to /e affected in e4ternal environment* /* Conductivity , a/ility of neuron to transmit a wave of e4citation from one cell to another c* Permanent cells , once destroyed; cant re'enerate &e4* heart; retina; /rain; osteocytes( -e'enerative capacity A* $a/ile , once destroyed cant re'enerate 3pidermal cells; 5." cells; resp &lun' cells(* 5A" B* Sta/le , capa/le of re'eneration BA" limited time only e4 salivary 'land; pancreas cells cell of liver; 6idney cells C* Permanent cells , retina; /rain; heart; osteocytes can>t re'enerate* 3*( Neuro'lia , attached to neurons* Supports neurons* 9here /rain tumors are found* "ypes< 1* Astrocyte #* Oli'odendria Astrocytoma , DE , D%F /rain tumor from astrocyte* ?ost /rain tumors are found at astrocyte* Astrocyte , maintains inte'rity of /lood /rain /arrier &BBB(* BBB , semi permea/le ) selective "o4ic su/stance that destroys astrocyte & destroy BBB* "o4ins that can pass in BBB< 1* Ammonia liver cirrhosis* #* #* Car/on ?ono4ide , seiCure & par6insons* 3* 3* Biliru/in Gaundice; hepatitis; 6ernicterus)hyper/iliru/enia*

7*

7* Hetones ,+?*

O$.5O+3N+-.A , Produces myelin sheath , wraps around a neuron , acts as insulator facilitates rapid nerve impulse transmission* No myelin sheath , de'enerates neurons +ama'e to myelin sheath , demyellenatin' disorders +3?I3$$3NA".N5 +S3 1*(AL&'EIMER(S DISEASE, atrophy of /rain tissue due to a deficiency of acetylcholine* S&S4< A , amnesia , loss of memory A , apra4ia , una/le to determine function & purpose of o/Gect A , a'nosia , una/le to reco'niCe familiar o/Gect A , aphasia , 34pressive , /rocca>s aphasia , una/le to spea6 -eceptive , wernic6es aphasia , una/le to understand spo6en words Common to AlCheimer , receptive aphasia +ru' of choice , A-.C3P" &ta6en at /edtime( & CO5N3J* ?'t< Supportive & palliative*

?icro'lia , stationary cells; en'ulfs /acteria; en'ulfs cellular de/ris* ..* Compositions of Cord & Spinal cord !EF /rain mass 1EF CSF 1EF /lood ?ON-O3 H3$$I 2IPO"23S.S< "he s6ull is a closed vault* Any increase in one component will increase .CP* Normal .CP< E 1%mm2' Brain mass Connects - & $ cere/ral hemisphere Corpus collusum -t cere/ral hemisphere; $t cere/ral hemisphere Function< 1* Sensory #* ?otor 3* .nte'rative $o/es 1*( Frontal a* Controls motor activity /* Controls personality development c* 9here primitive refle4es are inhi/ited d* Site of development of sense of umor e* Brocca>s area , speech center +ama'e e4pressive aphasia #*( "emporal , a* 2earin' /* Short term memory c* 9ernic6es area , 'en interpretative or 6nowin' 5nostic area +ama'e , receptive aphasia 3*( Parietal lo/e , appreciation & discrimation of sensory imp Pain; touch; pressure; heat & cold 7*( Occipital vision %*( .nsula)island of reil) Central lo/e controls visceral f4 Function< activities of internal or'an @*( -hinencephalon) $im/ec Smell; li/ido; lon' term memory Basal 5an'lia , areas of 'ray matte located deep within a cere/ral hemisphere 34tra pyramidal tract -eleases dopamine Controls 'ross voluntary unit +ecrease dopamine , &Par6inson>s( pin rollin' of e4tremities & 2untin'ton>s +se* +ecrease acetylcholine , ?yasthenia 5ravis & AlCheimer>s .ncreased neurotransmitter 1 psychiatric disorder .ncrease dopamine , schiCo .ncrease acetylcholine , /ipolar ?.+ B-A.N , relay station for si'ht & hearin' Controls siCe & reaction of pupil # , 3 mm Controls hearin' acuity CN 3 , 7 .socoria , normal siCe &eBual( Anisocoria , uneven siCe , dama'e to mid /rain P3--$A , normal reaction +.3NC3P2A$ON /etween /rain "halamus , acts as a relay station for sensation 2ypothalamus , &thermore'ulatin' center of temp; sleep & wa6efulness; thirst; appetite) satiety center; emotional responses; controls pituitary function* B-A.N S"3? a* Pons , or pneumota4ic center , controls respiration Cranial % , ! CNS 1* Cere/rum , lar'est

?3+A$$A OB$ON5A"A controls heart rate; respiratory rate; swallowin'; vomitin'; hiccups) sin'utus 0asomotor center; spinal decuissation termination; CN D; 1E; 11; 1# C3-3B3$$A? , lesser /rain Controls posture; 'ait; /alance; eBuili/rium

Cere/ellar "ests< a*( - , -om/er'>s test needs # -Ns to assist Normal anatomical position % , 1E min &K( -om/er'>s test , &K( ata4ia or unsteady 'ait or drun6en li6e movement with loss of /alance* /*( Fin'er to nose test , &K( "o F"N" , dymetria , ina/ility to stop a movement at a desired point c*( Alternate pronation & supination Palm up & down * &K( "o alternate pronation & supination or dama'e to cere/ellum , dymentrium Composition of /rain /ased on ?onroe Hellie 2ypothesis S6ull is a closed container* Any alteration in 1 of 3 intracranial components 1 increase in .CP Normal .CP , E , 1% mm2' Foramen ?a'num C1 , atlas C# , a4is &K( ProGectile vomitin' 1 increase .CP O/serve for #7 7! hrs CSF , cushions the /rain; shoc6 a/sor/er O/struction of flow of CSF 1 increase .CP 2ydrocephalus , posteriorly due to closure of posterior fontanel C0A , partial) total o/struction of /lood supply

INCREASED ICP , increase .CP is due to increase in 1 of the .ntra Cranial components* Predisposin' factors< 1*( 2ead inGury #*( "umor 3*( $ocaliCed a/scess 7*( 2emorrha'e &stro6e( %*( Cere/ral edema @*( 2ydrocephalus L*( .nflammatory conditions ?enin'itis; encephalitis B* S!S) chan'e in 0S 1 always late symptoms 3arliest S4< a*( Chan'e or decrease $OC , -estlessness to confusion 9ide pulse pressure< .ncreased .CP +isorientation to lethar'y Narrow pp< Cardiac disorder; shoc6 Stupor to coma $ate si'n , chan'e in 0)S 1* BP increase &systolic increase; diastole same( #* 9idenin' pulse pressure Normal adult BP 1#E)!E 1#E , !E 1 7E &normal pulse pressure( .ncrease .CP 1 BP 17E)!E 1 17E , !E1 @E PP &wide( 3* -- is decreased &Cheyne Sto6es 1 /et period of apnea or hyperpnea with periods of apnea( 7* "emp increase .ncreased .CP< .ncrease BP Shoc6 , decrease BP , +ecrease 2.ncrease 2CAS2.N5S 3FF3C" +ecrease -.ncrease -.ncrease "emp +ecrease temp /*( 2eadache ProGectile vomitin' Papilledima &edema of optic dis6 , outer surface of retina( +ecorticate &a/normal fle4ion( 1 +ama'e to cortico spinal tract ) +ecere/rate &a/normal e4tension( 1 +ama'e to upper /rain stem pons) c*( Ancal herniation , unilateral dilation of pupil* d*( Possi/le seiCure* &Bilateral dilation of pupil , tentorial herniation*(

Nursin' priority< 1*( ?aintain patent a)w & adeBuate ventilation a* Prevention of hypo4ia , &decrease tissue o4y'enation( & hypercar/ia &increase in CO# retention(* 2ypo4ia , cere/ral edema increase .CP 2ypo4ia , inadeBuate tissue o4y'enation $ate symptoms of hypo4ia , B , /radycardia 3 , e4treme restlessness + , dyspnea C , cyanosis 3arly symptoms , - , restlessness A , a'itation " , tachycardia .ncrease CO# retention) hypercar/ia , cere/ral vasodilatation 1 increase .CP

?ost powerful respiratory stimulant increase i 2yperventilate decrease CO# , e4crete CO#

C*+

-espiratory +istress Syndrome &-+S( , decrease O4y'en Suctionin' , 1E 1% seconds; ma4 1% seconds* Suction upon removal of suction cap* Am/u /a' , pump upon inspiration c* Assist in mechanical ventilation 1* ?aintain patent a)w #* ?onitor 0S & .&O 3* 3levate head of /ed 3E , 7% de'rees an'le nec6 in neutral position unless contra indicated to promote venous draina'e 7* $imit fluid inta6e 1;#EE , 1;%EE ml)day &FO-C3 F$A.+ means<.ncrease fluid inta6e)day , #;EEE , 3;EEE ml)day( not for inc .CP* %* Prevent complications of immo/ility @* Prevent increase .CP /y< a* ?aintain Buiet & comfy environment /* Avoid use of restraints , lead to fractures c* Siderails up d* .nstruct patient to avoid the ff< 0alsalva maneuver or /earin' down; avoid strainin' of stool &'ive la4atives) stool softener +ulcola4) +uphalac( 34cessive cou'h , antitussive +e4trometorpham 34cessive vomitin' , anti emetic &Plasil , Phil only() Phener'an $iftin' of heavy o/Gects Bendin' & stoopin' e* Avoid clusterin' of nursin' activities L* Administer me$s as ordered< 1*( Osmotic diuretic , ?annitol*)Osmitrol promotes cere/ral diuresis /y decompressin' /rain tissue Nursin' 1* #* 3* 7* #*( $oop diuretic considerations< Ma ito# ?onitor BP , S3 of hypotension ?onitor .&O every hr* report if M 3Ecc out put Administer via side drip -e'ulate fast drip , to prevent formation of crystals or precipitate

$asi4 &Furosemide( Nursin' ?'t< Lasi) Same as ?annitol e4cept $asi4 is 'iven via .0 push &e4pect urine after 1E 1%mins( should /e in the mornin'* .f 'iven at Lam* Pt will urinate at L<1% .mmediate effect of $asi4 within 1% minutes* ?a4 effect , @ hrs due &Lam , 1pm(

S)3 of $asi4 'y"o,a#emia &normal H 3*% , %*% me')$( S&S4 1* 9ea6ness & fati'ue #* Constipation 3* &K( NAO wave in 3C5 tracin' Nursin' ?'t< 1*( Administer H supplements , e4 Halium +urule; H chloride Potassium -ich food< ABC>s of H 0e'eta/les Fruits A aspara'us A , apple B , /roccoli &hi'hest( B , /anana , 'reen C , carrots C , cantalope) melon O , oran'e &hi'hest( ,for di'italis to4icity also* 0it A , sBuash; carrots yellow ve'eta/les & fruits; spinach; chesa .ron , raisins; Food appropriate for toddler , spa'hetti: Not mil6 , increase /ronchial secretions +on>t 'ive 'rapes , may cho6e S)3 of $asi4< 1*( 2ypo6alemia #*( 'y"oca#cemia &Normal level Ca 1 !*% , 11m')1EEml( or -eta y< S&S4 wea6ness Paresthesia &K( "rousseau si'n , patho'nomonic , or carpopedal spasm* Put /p cuff on arm1hand spasm* &K( Chevoste6>s si'n Arrhythmia $aryn'ospasm Administer , Ca 'luconate , .0 slowly Ca .#uco ate to)icity< S4 , seiCure , administer ?' SO7 M. S*/ to)cicity, administer Ca 'luconate 0 , BP decrease U , urine output decrease R , -- decrease P , patellar refle4es a/sent

3*(

'y"o atremia , Normal Na level 1 13% , 17% me')$ S)S4 , 2ypotension Si'ns of +ehydration< dry s6in; poor s6in tur'or; 'en /ody malaise* 3arly si'ns , Adult< thirst and a'itation ) Child< tachycardia ?'t< force fluid Administer isotonic fluid sol

7*( 'y"er.#ycemia , increase /lood su'ar level P , polyuria P , polypha'ia P , polydipsia a* Ns' ?'t< ?onitor FBS &N1!E , 1#E m')dl(

%*( 'y"erurecemia , increase serum uric acid* "ophi urate crystals in Goint* Gouty art1ritis ,i$ ey sto es renal colic &pain( Cool moist s6in S4 Goint pain & swellin' usually at 'reat toe* Ns' ?'t of Gouty Art1ritis a*( Cheese &not sardines; anchovies; or'an meat( &Not 'ood if pt ta6in' ?AO( /*( Force fluid c*( Administer meds , Allopurinol) Pyloprim , inhi/its synthesis of uric acid , dru' of choice for 'out Colchicene , e4cretes uric acid* Acute 'out dru' of choice* 2i$ ey sto es , renal colic &pain(* Cool moist s6in ?'t< 1*( Force fluid #*( ?eds , narcotic anal'esic ?orphine SO7 S3 of Mor"1i e S*/ to)icity st -espiratory depression &chec6 -- 1 ( Antidote for morphine SO7 to4icity ,Narcan &NA$OJON3( Nalo4one to4icity , tremors .ncrease .CP meds< 3*( Corticosteroids +e4amethsone , decrease cere/ral edema &+ecadrone( 7*( ?ild anal'esic , codeine SO7* For headache* %*( Anti consultants , +ilantin &Phenytoin( Question< .ncrease .CP what is the immediate ns' actionR a* Administer ?annitol as ordered /* 3levate head 3E , 7% de'rees c* -estrict fluid d* Avoid use of restraints Ns' Priority , ABC & safety Pt sufferin' from epi'lotitis* 9hat is ns' priorityR a* Administer steroids , least priority /* Assist in 3" , temp; a)w c* Assist in tracheotomy , permanent &Answer( d* Apply warm moist pac6R $east priority -ationale< 9ont need to pass laryn4 due to laryn4 is inflamed* 3" can>t pass* Need tracheostomy only Ma.ic +(s of $ru. mo itori . + $ A + A Dru. , di'o4in lithium , aminophylline , +ilantin , acetaminophen N ra .e *% , 1*% meB)$ *@ , 1*# meB)$ 1E , 1D m')1EEml 1E 1D m')1EE ml 1E , 3E m')1EEml -o)icity # # #E #E #EE C#assificatio cardiac 'lycosides antimanic /ronchodilator anticonvulsant narcotic anal'esic I $icatio C2F /ipolar COP+ seiCures osteoarthritis

Di.ita#is , increase cardiac contraction 1 increase CO Nursin' ?'t 1* Chec6 P-; 2- &if 2- /elow @E/pm; don>t 'ive+i'o4in( +i'italis to4icity , antidote +i'ivine a* Anore4ia initial s4* /* n)v 5." c* +iarrhea d* Confusion e* Photopho/ia f* Chan'es in color perception , yellow spots &O6 to 'ive to pts with renal failure* +i'o4in is meta/oliCed in liver not in 6idney*(

L 3 #it1ium (#it1a e% decrease levels of norepinephrine; serotonine; acetylcholine Antimanic a'ent $ithium to4icity S)S4 a*( Anore4ia /*( n)s c*( +iarrhea d*( +ehydration , force fluid; maintain Na inta6e 7 , 1E' daily e*( 2ypothyroidism &C-3".N.S?, the only endocrine disorder that can lead to mental retardation( A 3 ami o"1y#i e (t1eo"1y##i e% 3 dilates /ronchioles* "a6e /p /efore 'ivin' aminophylline* S)S4 < Aminophylline to4icity< 1* "achycardia #* 2yperactivity , restlessness; a'itation; tremors a* /* c* d* Question< Avoid 'ivin' food with Aminophylline Cheese)/utter, food rich in tyramine; avoided only if pt is 'iven ?AO. Beer) wine 2ot chocolate & tea , caffeine , CNS stimulant tachycardia Or'an meat) /o4 cereals , anti par6insonian

?AO. , antidepressant m A- plan n A- dil can lead to C0A or hypertensive crisis p A- nate 3 , 7 wee6s /efore ?AO. will ta6e effect Anti Par6insonian a'ents , 0it B@ Pyrido4ine reverses effect of $evodopa D 3 $i#ati (P1e ytoi % , anti convulsant)seiCure Nursin' ?'t< 1* ?i4ed with plain NSS or *D NaCl to prevent formation of crystals or precipitate +o sandwich method 5ive NSS then +ilantin; then NSS: #* .nstruct the pt to avoid alcohol , /ec alcohol K dilantin can lead to severe CNS depression +ilantin to4icity< S)S4< 5 , 'in'ival hyperplasia , swollen 'ums i* Oral hy'iene , soft tooth/rush ii* ?assa'e 'ums 2 , hairy ton'ue A ata4ia N , nysta'mus , a/normal movement of eye/alls A , acetaminophen) "ylenol , non opoid anal'esic & antipyretic , fe/rile pts Acetaminophen to4icity < 1* 2epato to4icity #* ?onitor liver enCymes S5P" &A$"( , Serum 5lutamic Piruvate "yranase S5O" Serum 5lutamic Acetate "yranase 3* ?onitor BAN &1E , #E( Crea &*! 1( Acetaminophen to4icity can lead to hypo'lycemia " , tremors; "achycardia . , irrita/ility - , restlessness 3 , e4treme fati'ue + , depression &ni'htmares( ; +iaphoresis Antidote for acetaminophen to4icity , Acetylcesteine 1 causes outporin' of secretions* Suction* Prepare suctionin' apparatus* Question< "he followin' are symptoms of hypo'lycemia e4cept< a* Ni'htmares /* 34treme thirst , hyper'lycemia symptoms c* 9ea6ness d* +iaphoresis

PAR2INS*NS DSE &par6insonism( chronic; pro'ressive disease of CNS char /y de'eneration of dopamine producin' cells in su/stancia ni'ra at mid /rain & /asal 'an'lia Palliative; Supportive Function of dopamine< controls 'ross voluntary motors* Predisposin' Factors< 1* Poisonin' &lead & car/on mono4ide(* Antidote for lead 1 Calcium 3+"A #* 2ypo4ia 3* Arteriosclerosis 7* 3ncephalitis 2i'h doses of the ff<

a* /* c* d*

-eserpine &serpasil( anti 2PN; S3 , 1*( depression suicidal #*( /reast cancer ?ethyldopa &aldomet( promote safety 2aloperidol &2aldol( anti psychotic PhenothiaCide anti psychotic

S3 of anti psychotic dru's , E)tra Pyrami$a# Sym"tom Over meds of anti psychotic dru's , neuroleptic mali'nant syndrome char /y tremors &severe( S)S4< Par6insonism , 1* Pill rollin' tremors of e4tremities , early si'n #* Brady6inesia , slow movement 3* Over fati'ue 7* -i'idity &co'wheel type( a* Stooped posture /* Shufflin' , most common c* Propulsive 'ait %* ?as6 li6e facial e4pression with decrease /lin6in' eyes @* ?onotone speech L* +ifficulty risin' from sittin' position !* ?ood la/ilety , always depressed , suicide Ns' priority< Promote safety D* .ncrease salivation , droolin' type 1E* Autonomic si'ns< .ncrease sweatin' .ncrease lacrimation Se/orrhea &increase se/aceous 'land( Constipation +ecrease se4ual activity Ns' ?'t 1*( Anti par6insonian a'ents $evodopa &$ +opa(; Car/idopa &Sinemet(; Amantadine 2cl &Symmetrel( ?echanism of action .ncrease levels of dopa , relievin' tremors & /rady6inesia S)3 of anti par6insonian Anore4ia n)v Confusion Orthostatic hypotension 2allucination Arrhythmia Contraindication< 1* Narrow an'led closure 'laucoma #* Pt ta6in' ?AO. &Parnate; ?arplan; Nardil( Ns' ?'t when 'ivin' anti par6insonian 1* "a6e with meals , to decrease 5." irritation #* .nform pt , urine) stool may /e dar6ened 3* .nstruct pt don>t ta6e food 0it B@ &Pyrido4ine( cereals; or'an meats; 'reen leafy ve' Cause B@ reverses therapeutic effects of levodopa 5ive .N2 &.soniaCide .sonicotene acid hydraCide*( S3 Peripheral neuritis* #*( Anti choliner'ic a'ents , relieves tremors Artane mech , inhi/its acetylcholine Co'entin action ; S)3 SNS 3*( Antihistamine , +iphenhydramine 2cl &Benadryl( , ta6e at /edtime S)3< adult, drowsiness;, avoid drivin' & operatin' heavy eBuipt* "a6e at /edtime* Child , hyperactivity CNS e4citement for 6ids* 7*( +opamine a'onist Bromotriptine 2cl &Parlodel( , respiratory depression* ?onitor --* Ns' ?'t , Par6inson 1*( ?aintain siderails #*( Prevent complications of immo/ility "urn pt every #h "urn pt every 1 h , elderly 3*( Assist in passive -O? e4ercises to prevent contractures 7*( ?aintain 'ood nutrition C2ON , in am C2ON , in pm , to induce sleep , due "ryptopan , Amino Acid %*( .ncrease fluid in ta6e; hi'h fi/er diet to prevent constipation @*( Assist in sur'ery , Sterota4ic "halamotomy Complications in sterota4ic thalmotomy 1*( Su/arachnoid hemorrha'e #*( aneurism 3*( encephalitis

MUL-IPLE SCLER*SIS (MS% Chronic intermittent disorder of CNS , white patches of demyelenation in /rain & spinal cord* -emission & e4acer/ation Common , women; 1% , 3% yo cause , un6nown Predisposin' factor< 1* Slow 'rowin' virus #* Autoimmune , &supportive & palliative treatment only( Normal -esident Anti/odies< .' 5 , can pass placenta , passive immunity* Short actin'* .' A , /ody secretions , saliva; tears; colostrums; sweat

.' ? , acute inflammation .' 3 , aller'ic reactions .'+ , chronic inflammation S & S4 of ?S< &everythin' down( 1* 0isual distur/ances a* Blurrin' of vision /* +iplopia) dou/le vision c* Scotomas &/lind spots( , initial s4 #* .mpaired sensation to touch; pain; pressure; heat; cold a* Num/ness /* "in'lin' c* Paresthesia 3* ?ood swin's , euphoria &sense of elation ( 7* .mpaired motor function< a* 9ea6ness /* Spasiticity ,N ti'asO c* Paralysis ,maGor pro/lem %* .mpaired cere/ellar function "riad S4 of ?S . , intentional tremors N , nysta'mus , a/normal rotation of eyes Charcots triad A , Ata4ia S scannin' speech @* Arinary retention or incontinence L* Constipation !* +ecrease se4ual a/ility +4 , ?S 1* CSF analysis thru lum/ar puncture -eveals increase C2ON & .'5 #* ?-. , reveals site & e4tent of demyelination 3* $hermitte>s response is &K(* .ntroduce electricity at the /ac6* "heres spasm & paralysis at spinal cord* Ns' ?'t ?S Supportive m't 1*( ?eds a* Acute e4acer/ation AC"2 , adenocorticotopic Steroids , to reduce edema at the site of demyelination to prevent paralysis S"i a# Cor$ I 4ury Administer dru' to prevent paralysis due to edema a* 5ive AC"2 , steroids /* Baclopen &$ioresol( or +antrolene Na &+antrene( "o decrease muscle spasticity c* .nterferone , to alter immune response d* .mmunosuppresants #* ?aintain siderails 3* Assist passive -O?e4ercises , promote proper /ody ali'nment 7* Prevent complications of immo/ility %* 3ncoura'e fluid inta6e & increase fi/er diet , to prevent constipation @* Provide catheteriCation die urinary retention L* 5ive diuretics Arinary incontinence , 'ive Prophantheline /romide &pro/anthene( Antispasmodic anti choliner'ic !* 5ive stress reducin' activity* +eep /reathin' e4ercises; /iofeed/ac6; yo'a techniBues* D* Provide acid ash diet , to acidify urine & prevent /acteria multiplication 5rape; Cran/erry; Oran'e Guice; 0it C

M5AS-'ENIA GRA6IS (MG% , distur/ance in transmission of impulses from nerve to muscle cell at neuro muscular Gunction* Common in 9omen; #E , 7E yo; un6nown cause or idiopathic Autoimmune , release of cholenesterase , enCyme Cholinesterase destroys AC2 &acetylcholine( 1 +ecrease acetylcholine +escendin' muscle wea6ness &Ascendin' muscle wea6ness , 5uillain Barre Syndrome( Ns' priority< 1( a)w #( aspiration 3( immo/ility S) S4< 1*(

#*( 3*( 7*( %*( @*( L*( +4 test 1* "ensilon test &3drophonium 2cl( , temporarily stren'thens muscles for % , 1E mins* Short term choliner'ic* PNS effect* Ns' ?'t

Ptosis , droopin' of upper lid & initial si'n( Chec6 Palpe/ral fissure , openin' of upper & lower lids 1 to 6now if &K( of ?5* +iplopia , dou/le vision ?as6 li6e facial e4pression +yspha'ia , ris6 for aspiration: 9ea6enin' of laryn'eal muscles , hoarseness of voice -esp muscle wea6ness , lead respiratory arrest* Prepare at /edside tracheostomy set 34treme muscle wea6ness durin' activity especially in the mornin'*

1* ?aintain patent a)w & adeBuate vent /y< a*( Assist in mechanical vent , attach to ventilator /*( ?onitor pulmonary function test* +ecrease vital lun' capacity* #* ?onitor 0S; .&O neuro chec6; muscle stren'th or motor 'radin' scale &7)%; %)%; etc( 3* Siderails 7* Prevent complications of immo/ility* Adult every # hrs* 3lderly every 1 hr* %* N5" feedin' Administer meds , a*( Choliner'ics or anticholinesterase a'ents ?estinon &Pyridosti'mine( Neosti'nine &prosti'min( , $on' term .ncrease acetylcholine s)e , PNS /*( Corticosteroids , to suppress immune resp +ecadron &de4amethasone( ?onitor for # types of Crisis< ?yastinic crisis A cause , 1* Ander medication #* Stress 3* .nfection B S&S4 1* Ana/le to see , Ptosis & diplopia #* +yspha'ia una/le to swallow* 3* Ana/le to /reath C ?'t , adm choliner'ic a'ents Choliner'ic crisis Cause< 1 over meds S)S4 PNS

?'t* adm anti choliner'ic Atropine SO7 SNS , dry mouth L* Assist in sur'ical proc , thymectomy* -emoval of thymus 'land* "hymus secretes auto immune anti/ody* !* Assist in plasmaparesis , filter /lood D* Prevent complication , respiratory arrest Prepare tracheostomy set at /edside*

G0S , Gui##ai 0arre Sy $rome +isorder of CNS Bilateral symmetrical polyneuritis Ascendin' paralysis Cause , un6nown; idiopathic Auto immune r)t antecedent viral infection .mmuniCations S&S4 .nitial < 1* Clumsiness #* Ascendin' muscle wea6ness , lead to paralysis 3* +yspha'ia 7* +ecrease or diminished +"- &deep tendon refle4es( Paralysis %* Alternate 2PN to hypotension , lead to arrhythmia complication @* Autonomic chan'es , increase sweatin'; increase salivation* .ncrease lacrimation Constipation +4 most important< CSF analysis thru lum/ar puncture reveals increase in < .'5 & C2ON &same with ?S( Ns' ?'t 1* ?aintain patent a)w & adeBuate vent a* Assist in mechanical vent /* ?onitor pulmonary function test #* ?onitor vs*; .&O neuro chec6; 3C5 tracin' due to arrhythmia 3* Siderails 7* Prevent compl , immo/ility %* Assist in passive -O? e4ercises @* .nstitute N5" feedin' , due dyspha'ia L* Adm meds &5BS( as ordered< , 1* Anti choliner'ic , atropine SO7 #* Corticosteroids , to suppress immune response 3* Anti arrhythmic a'ents a*( $idocaine )Jylocaine ,S3 confusion 1 0"ach /*( Bretyllium c*( Quinines)Quinidine , anti malarial a'ent* 5ive with meals* "o4ic effect , cinchonism Quinidine to4icity S)3 , anore4ia; n)v; headache; verti'o; visual distur/ances !* Assist in plasmaparesis &?5* 5BS( D* Prevent comp , arrhythmias; respiratory arrest Prepare tracheostomy set at /edside* .NF$ CON+."ONS OF B-A.N ?enin'es , 3 fold mem/rane , cover /rain & spinal cord F4< Protection & support Nourishment Blood supply

3 layers 1* +uramater #* Arachmoid matter 3* Pia matter su/ dural space su/ arachnoid space where CSF flows $3 & $7* Site for lum/ar puncture*

MENINGI-IS , inflammation of menin'itis & spinal cord 3tiolo'y , ?enin'ococcus Pneumococcus 2emophilous influenCa , child Streptococcus , adult menin'itis ?O" , direct transmission via droplet nuclei S&S4 S4 Stiff nec6 or nuchal ri'idity &initial si'n( 2eadache ProGectile vomitin' , due to increase .CP Photopho/ia Fever chills; anore4ia 5en /ody malaise 9t loss +ecorticate)decere/ration , a/normal posturin' Possi/le seiCure of menin'eal irritation , nuchal ri'idity or stiffness Opisthotonus ri'id archin' of /ac6

Patho'nomonic si'n , &K( Herni'>s & BrudCins6i si'n $e' pain nec6 pain

+4< 1* Lumbar "u cture , lum/ar) spinal tap , use of hallow spinal needle , su/ arachnoid space $3 & $7 or $7 & $% Aspirate CSF for lum/ar puncture* Ns' ?'t for lum/ar puncture , invasive 1* Consent ) e4plain procedure to pt -N , d4 procedure &la/( ?+ , operation procedure #* 3mpty /ladder; /owel , promote comfort 3* Arch /ac6 , to clearly visualiCe $3; $7 Ns' N't 1* #* 3* 7* post lum/ar Flat on /ed , 1# , #7 h to prevent spinal headache & lea6 of CSF Force fluid Chec6 punctured site for draina'e; discoloration & lea6a'e to tissue Assess for movement & sensation of e4tremeties a* increase C2ON & 9BC /* +ecrease 'lucose Co te t of CS7< Chon; w/c; 'lucose

-esult 1* CSF analysis< Confirms /acterial menin'itis

c* increase CSF openin' pressure N %E , 1@E mm2' d* &K( Culture microor'anism #* Complete /lood count CBC , reveals increase 9BC ?'t< 1* Adm meds a*( Broad spectrum anti/iotic penicillin S)3 1* 5." irritation , ta6e with food #* 2epatoto4icity; nephroto4cicity 3* Aller'ic reaction 7* Super infection , alteration in normal /acterial flora - N flora throat , streptococcus - N flora intestine , e coli S4 of superinfection of penicillin 1 diarrhea /*( Antipyretic c*( ?ild anal'esic #* Strict resp isolation #7h after start of anti/iotic therapy A , Cushin'>s synd , reverse isolation due to increased corticosteroid in /ody* B , Aplastic anemia , reverse isolation due to /one marrow depression* C , Cancer anytype , reverse isolation , immunocompromised* + , Post liver transplant , reverse isolation , ta6es steroids lifetime* 3 , Prolon'ed use steroids , reverse isolation F , ?enin'itis , strict respiratory isolation , safe after #7h of anti/iotic therapy 5 , Asthma , not to /e isolated 3* 7* %* @* L* Comfy & dar6 room , due to photopho/ia & seiCure Prevent complications of immo/ility ?aintain F & 3 /alance ?onitor vs; .&O ; neuro chec6 Provide client health teachin' & dischar'e plan

10

a* Nutrition , increase cal & C2O; C2ON for tissue repair* Small freB feedin' /* Prevent complication hydrocephalus; hearin' loss or nerve deafness* !* Prevent seiCure* 9here to /rin' # yo post menin'itis Audiolo'ist due to dama'e to hearin' post repair myelomenin'ocele Arolo'ist +ama'e to sacral area , spina /ifida , controls urination D* -eha/ for neurolo'ical deficit* Can lead to mental retardation or a delay in psychomotor development*

CERE0R* 6ASCULAR ACCIDEN- , stro6e; /rain attac6 or cere/ral throm/osis; apople4y Partial or complete disruption in the /rains /lood supply # lar'est & common artery in stro6e ?iddle cere/ral artery .nternal carotid artery Common to male , # , 34 hi'h ris6 Predisposin' factor< 1* "hrom/osis , clot &attached( #* 3m/olism , dislod'ed clot , pulmo em/olism S)S4< "u#mo embo#ism Sudden sharp chest pain Ane4plained dyspnea; SOB "achycardia; palpitations; diaphoresis & mild restlessness S)S4< cerebra# embo#ism 2eadache; disorientation; confusion & decrease in $OC Femur fracture , complications< fat em/olism , most feared complication w)in #7hrs Iellow /one marrow , produces fat cells at meduallary cavity of lon' /one -ed /one marrow , provides 9BC; platelets; -BC found at epiphisis

#*( 2emorrha'e 3*( Compartment syndrome , compression of nerves) arteries

-is6 factors of C0A< 2PN; +?; ?.; artherosclerosis; valvular heart dse $ifestyle<

Post heart sur'ery , mitral valve replacement

S & S4 1* ".A warnin' si'ns of impendin' stro6e attac6s 2eadache &initial s4(; diCCiness) verti'o; num/ness; tinnitus; visual & speech distur/ances; paresis or ple'ia &monople'ia , 1 e4treme( .ncrease .CP #* Stro6e in evolution , pro'ression of S & S4 of stro6e 3* Complete stro6e , resolution of stro6e a*( 2eadache /*( Cheyne Sto6es -esp c*( Anore4ia; n)v d*( +yspha'ia e*( .ncrease BP f*( &K( Herni'>s & BrudCins6i , s4 of hemorrha'ic stro6e '*( Focal & neurolo'ical deficit 1* Phle'ia #* +ysarthria , ina/ility to vocaliCe; articulate words 3* Aphasia 7* A'raphia diff writin' %* Alesia , diff readin' @* 2omoninous hemianopsia , loss of half of field of vision $eft sided hemianopsia , approach -i'ht side of pt , the unaffected side +4 1* C" Scan , reveals /rain lesion #* Cere/ral arterio'raphy , site & e4tent of mal occlusion .nvasive procedure due to inGect dye Aller'y test All , 'raphy , invasive due to iodine dye Post 1*( Force fluid , to e4crete dye is nephroto4ic #*( Chec6 peripheral pulses distal Ns' ?'t 1* ?aintain patent a)w & adeBuate vent

1* Smo6in' , nicotine , potent vasoconstrictor #* Sedentary lifestyle 3* 2yperlipidemia , 'enetic 7* Prolon'ed use of oral contraceptives ?acro pill , has lar'e amt estro'en ?ini pill , has lar'e amt of pro'estin Promote lipolysis &/rea6down of lipids)fats( , artherosclerosis , 2PN %* "ype A personality a* +eadline driven person /* # , % thin's at the same time c* 5uilty when not don' anythin' @* +iet , increase saturated fats L* 3motional & physical stress !* O/esity

stro6e

11

#* 3* 7* %*

@* L* !*

D*

Assist mechanical ventilation Administer O# -estrict fluids , prevent cere/ral edema 3levate head of /ed 3E 7% de'rees an'le* Avoid valsalva maneuver* ?onitor vs*; .&O; neuro chec6 Prevent compl of immo/ility /y< a* "urn client B#h 3lderly B1h "o prevent decu/itus ulcer "o prevent hypostatic pneumonia , after prolon'ed immo/ility* /* 3'' crate mattress or 2#O /ed c* Sand /a' or foot /oard prevent foot drop N5" feedin' , if pt can>t swallow Passive -O? e4ercise B7h Alternative means of communication Non ver/al cues ?a'ic slate* Not paper and pen* "irin' for pt* &K( "o hemianopsia , approach on unaffected side ?eds Osmotic diuretics , ?annitol $oop diuretics , $asi4) Furosemide Corticosteroids , de4tamethaCone ?ild anal'esic "hrom/olytic) fi/rolitic a'ents , tunaw clot* S3 Articaria; pruritus caused /y forei'n su/s* Strepto6inase Aro6inase "issue plasmino'en activatin' ?onitor /leedin' time Anticoa'ulants , 2eparin & CoumadinO sa/ayO Coumadin will ta6e effect after 3 days 2eparin , monitor P"" partial throm/oplastin time if prolon'ed , /leedin' 'ive Protamine SO7 antidote* Coumadin ,$on' term* monitor P" prothrom/in time if prolon'ed /leedin' 'ive 0it H , ABuamephyton antidote* Antiplatelet , PASA , aspirin paraanemo aspirin; don>t 'ive to den'ue; ulcer; and un6nown headache*

2ealth "eachin' 1* Avoidance modifia/le lifestyle +iet; smo6in' #* +ietary modification Avoid caffeine; decrease Na & saturated fats Complications< Su/arachnoid hemorrha'e -eha/ for focal neurolo'ical deficit , physical therapy 1* ?ental retardation #* +elay in psychomotor development

C*N6ULSI6E Disor$er (C*N6ULSI*NS% disorder of the CNS char* /y paro4ysmal seiCures with or without loss of consciousness; a/normal motor activity; alteration in sensation & perception & chan'e in /ehavior* Can you out'row fe/rile seiCureR Fe/rile seiCure Normal if M % yo Patholo'ic if S % yo +ifference /etween< SeiCure 1 convulsive attac6 nd 3pilepsy , # and with history of seiCure
st

Predisposin' Factor 2ead inGury due /irth trauma "o4icity of car/on mono4ide Brain tumor 5enetics Nutritional & meta/olic deficit Physical stress Sudden withdrawal to anticonvulsants will /rin' a/out status epilepticus Status epilepticus , dru' of choice< +iaCepam & 'lucose S & S4 .* 5eneraliCed SeiCure , a*( 5rand mal ) tonic clonic seiCures 9ith or without aura , warnin' symptoms of impendin' seiCure attac6 3pi'astric pain associated with olfactory; tactile; visual; auditory sensory e4perience 3pileptic cry , fall $oss of consciousness 3 , % min "onic clonic contractions +irect symmetrical e4tension of e4tremities "ON.C* Contractions C$ON.C Post ictal sleep state of lethar'y or drowsiness unrespondin' sleep after tonic clonic /*( Petimal seiCure , &same as daydreamin':( or a/sence seiCure* Blan6 stare +ecrease /lin6in' eye "witchin' of mouth no loss of consciousness &aware of his surroundin's ..* $ocaliCed)partial seiCure a*( Tac6sonian seiCure or focal seiCure , tin'lin')Ger6y movement of inde4 fin'er)thum/ & spreads to shoulder & 1 sideof the /ody with Gan6sonian march

12

/*( Psychomotor) focal motor seiCure Automatism , stereotype repetitive & non purposive /ehavior Cloudin' of consciousness , not in control with environment ?ild hallucinatory sensory e4perience 1* #* 3* 2A$$AC.NA".ONS Auditory , schitCo , paranoid type 0isual , 6orsa6offs psychosis , chronic alcoholism "actile , addict , su/stance a/useU alcohol withdrawal

...* Status epilecticus , continuous; uninterrupted seiCure activity; if untreated; lead to hyperpre4ia , coma , death SeiCure< inc electrical firin' in /rain1increased meta/olic activity in /rain1/rain usin' 'lucose and O#1dec 'lucose; dec O#* "4<+iaCepam &dru' of choice(; 'lucose +4 Convulsion 'et health history: 1* C" scan , /rain lesion #* 335 electroencephalo'raphy 2yperactivity /rain waves Ns' ?'t Priority , Airway & safety 1* ?aintain patent a)w & promote safety Before seiCure< 1* -emove /lunt)sharp o/Gects #* $oosen clothin' 3* Avoid restraints 7* ?aintain siderails %* "urn head to side to prevent aspiration @* "on'ue 'uard or mouth piece to prevent /itin' of ton'ue B3FO-3 S3.PA-3 ON$I: Can use spoon at home* L* Avoid precipitatin' stimulus , /ri'ht 'larin' li'hts & noises !* Administer meds a* +ilantin &Phenytoin( ,& to4icity level , #E ( S3 5in'ival hyperplasia 2 hairy ton'ue A ata4ia N nysta'mus A acetaminophen fe/rile pt ?i4 with NSS +on>t 'ive alcohol , lead to CNS depression /* &"e'retol( Car/amasene 'iven also to "ri'eminal Neural'ia* S3< arrythmia c* Pheno/ar/ital &$uminal( S3< hallucinations #* .nstitute seiCure & safety precaution* Post seiCure< Administer O#* Suction apparatus ready at /edside 3* ?onitor onset & duration "ype of seiCure +uration of post ictal sleep* "he lon'er the duration of post ictal sleep; the hi'her chance of havin' status epilepticus: 7* Assist in sur'ical procedure* Cortical resection %* Complications< Su/arachnoid hemorrha'e and encephalitis

Question< 1 yo 'rand mal , immediate nursin' action 1 a)w & safety a* ?outhpiece , 1 yr old , little teeth only /* Adm o# inhalation , post: c* 5ive pillow , safety &answer( d* Prepare suction Neurolo'ical assessment< 1* Comprehensive neuro e4am #* 5CS G#as.o8 coma sca#e , o/G measurement of $OC or Buic6 neuro chec6 3 components of 3CS ? , motor @ 0 , ver/al resp % 3 , eye openin' 7 1% 1% , 17 , conscious 13 , 11 , lethar'y 1E , ! , stupor L , coma 3 , deep coma , lowest score Survey of mental status & speech &Comprehensice Neuro 34am( 1*( $OC & test of memory #*( $evels of orientation 3*( CN assessment 7*( ?otor assessment %*( Sensory assessment @*( Cere/ral test , -hom/er'; fin'er to nose L*( +"!*( Autonomics $evels of consciousness &$OC( , 1* Conscious &conscious( , awa6e , levels of wa6efulness #* $ethar'y &lethar'ic( , drowsy; sleepy; o/tunded

13

3*

Stupor &stuporous( , awa6ened /y vi'orous stimulation Pt has 'en /ody wea6ness; decrease /ody refle4 7* Coma &Comatose( li'ht , &K( all forms of painful stimulations +eep , & ( to painful stimulation Question< Describe a conscious pt ? a* Alert , not all pt are alert & oriented to time & place /* Coherent c9 A8a,e- answer d* Aware +ifferent types of pain stimulation Do (t "ric, 1* +eep sternal stimulation) pressure 34, fist 6nuc6le 9ith response , li'ht coma 9ithout response , deep coma #* Pressure on 'reat toe , 34 3* Or/ital pressure , pressure on or/its only , /elow eye 7* Corneal refle4) /lin6in' refle4 9isp of cotton , used to illicit /lin6in' refle4 amon' conscious patients .nstill 1 drop saline solution , unconscious pt if & ( response pt is in deep coma %* "est of memory , considered educational /ac6'round a*( Short term memory , 9hat did you eat for /rea6fastR +ama'e to temporal lo/e , &K( antero 'rade amnesia /*( $on' term memory &K( -etro'rade amnesia , dama'e to lim/ic system @* $evels of orientation "ime Place Person 5raphesthesia can identify num/ers or letters written on palm with a /lunt o/Gect* A'raphesthesia , cant identify num/ers or letters written on palm with a /lunt o/Gect*

CN assessme t: . , Olfactory .. , Optic ... , Oculomotor .0 , "rocheal 0 , "ri'eminal 0. , A/ducens 0.. , Facial 0... , Acustic)auditory .J , 5lassopharyn'eal J , 0a'us J., Spinal accessory J.. , 2ypo'lossal

s s m m / m / s / / m m

smallest CN lar'est CN

lon'est CN

.* *#factory , don>t use ammonia; alcohol; colo'ne irritatin' to mucosa , use coffee; /ar soap; vine'ar; ci'arette tar 2yposmia , decrease sensitivity to smell +iposmia , distorted sense of smell Anosmia , a/sence of sense of smell 3ither of 3 mi'ht indicate head inGury , dama'e to cri/riform plate of ethmoid /one where olfactory cells are located or indicate inflammation condition , sinusitis .. o"tic test of visual acuity , Snellens chart , central or distance vision Snellens 3 chart , used for illiterate chart N #E)#E vision distance /y w)c person can see letters #E ft Numerator , distance to snellens chart +enominator , distance the person can see the letters O+ , -t eye #E)#E #E)#EE , /lindness , cant read 3 , /i''est OS , left eye #E)#E OA , /oth eye #E)#E #* a* /* c* d* "est of peripheral vision) visual field Superiority Bitemporally .nferiorly Nasally

Common +isorders , see pa'e !% !L for more info on 'laucoma; etc* 1* 5laucoma , Normal 1# , #1 mm2' pressure .ncrease .OP $oss of peripheral vision , Ntunnel visionO #* Cataract , opacity of lens $oss of central vision; NBlurrin' or haCy visionO 3* -etinal detachment , curtain veil , li6e vision & floaters 7* ?acular de'eneration , /lac6 spots ...; .0; 0. , tested simultaneously .nnervates the movementt of e4trinsic ocular muscle @ cardinal 'aCe 3O?

14

.O $-

-t eye

SO ?-

N O S 3

left eye

S3 , 7 3O? .0 , sup o/liBue 0. , lateral rectus Normal response , P3--$A &isocoria , eBual pupil( Anisocoria , uneBual pupil Oculomotor 1* -aisin' of eyelid , Ptosis #* Controls pupil siCe # 3 cm or 1*% , # mm 0 , -ri.emi a# , $ar'est , consists of ophthalmic; ma4illary; mandi/ular Sensory , controls sensation of the face; mucus mem/raneU teeth & cornea refle4 Anconscious , instill drop of saline solution ?otor , controls muscles of chewin') muscles of mastication "ri'eminal neural'ia , diff chewin' & swallowin' , e4treme food temp is not recommended Question< "ri'eminal neural'ia; -N should 'ive a* 2ot mil6; /utter; raisins /* Cereals c* 5elatin; toast; potato , all correct /ut d* Potato; salad; 'elatin , salad easier to chew 0. 7acia#< Sensory , controls taste , ant #)3 of ton'ue test cotton applicator put su'ar* Put applicator with su'ar to tip to ton'ue* Start of taste insensitivity< A'e 'roup , 7E yrs old ?otor controls muscles of facial e4pression; smile frown; raise eye/row +ama'e , Bells palsy , facial paralysis Cause , /ells palsy pedia , -)" forcep delivery "emporary only ?ost evident clinical si'n of facial symmetry< Nasola/ial folds 0... Acoustic) vesti/ule cochlear &controls hearin'( , controls /alance &6enesthesia or position sense( ?ovement & orientation of /ody in space Or'an of Corti , for hearin' , true sense or'an of hearin' Outer , tympanic mem/rane; pinna; oricle &impacted cerumen(; cerumen ?iddle , hammer; anvil; stirrup or melleus; incus; staples* ?id otitis media 3ustachean ear .nner ear meniere dse; sensory hearin' loss &research parts: & dse( -emove vesti/ule , meniere>s dse , disease inner ear

Archimedes law , /uoyancy &pre'nancy , fetus( +altons law , partial pressure of 'ases .nertia , law of motion &diCCiness; verti'o( 1*( Pt with multiple sta/ wound chest ?ovement of air in & out of lun's is carried /y what principleR +iffusion , +alton>s law #*( Pre'nant , chec6 up , ultrasound reveals fetus is carried /y amniotic fluid Archimedes 3*( Severe verti'o due .nertia "est for acoustic nerve< -epeat words uttered .J , G#osso"1ary .ea# , controls taste , posterior 1)3 of ton'ue J , 6a.us , controls 'a' refle4 "est D , 1E Pt say ah , chec6 uvula , should /e midline +ama'e cere/ral hemisphere is $ or 5a' refle4 , place ton'ue depression post part of ton'ue +on>t touch uvula J. , S"i a# Accessory controls sternocleidomastoid &nec6( & trapeCius &shoulders and /ac6( Shru' shoulders; put pressure* Pt should resist pressure* Paresis or phle'ia J.. , 'y"o.#ossa# , controls movement of ton'ue , say NahO* Assess ton'ue position1midline $ or - deviation Push ton'ue a'ainst chee6 Short frenulum lin'ue , "on'ue tied , N/ulolO

15

END*CRINE F4 of endocrine , ductless 'land ?ain 'land , Pituitary 'land , located at /ase of /rain of Stella "urcica ?aster 'land of /ody ?aster cloc6 of /ody Anterior pituitary 'land , adenohypophysis Posterior pituitary 'land , neurohypophysis Posterior pituitary< 1*( O4ytocin , a*( Promotes uterine contraction preventin' /leedin') hemorrha'e* 5ive after placental delivery to prevent uterine atony* /*( ?il6 letdown refle4 with help of prolactin* #*( A+2 , antidiuretic hormone , &vasopressin( Prevents urination , conserve 2#O

A9 DIA0E-IS INSIPIDUS &+. dalas ihi( , hyposecretion of A+2 Cause< idiopathic) un6nown Predisposin' factor< 1* Pituitary sur'ery #* "rauma) head inGury 3* "umor 7* .nflammation 8 alcohol inhi/its release of A+2 S & S4< 1* Polyuria #* S4 of dehydration 34cessive thirst &adult( A'itation Poor s6in tur'or +ry mucus mem/rane 3* 9ea6ness & fati'ue 7* 2ypotension , if left untreated %* 2ypovolemic shoc6 Anuria , late si'n hypovolemic shoc6 &1
st

s4 of dehydration in children tachycardia(

+4 Proc< 1* +ecrease urine specific 'ravity concentrated urine N1 1*E1% , 1*E3% #* Serum Na 1 increase &N113% 17% meB)$( 2ypernatremia ?'t< 1* #* 3* 7* %* Force fluid #;EEE , 3;EEEml)day Administer .0 fluid replacement as ordered ?onitor 0S; .&O Administer meds as ordered a*( Pitresin &vasopressin( .? Prevent complications ?ost feared complication , 2ypovolemic shoc6

B*( SIAD' - Sy $rome of I a""ro"riate A ti-Diuretic 'ormo e .ncrease A+2 .diopathic) un6nown Predisposin' factor 1* 2ead inGury #* -elated to Broncho'enic cancer or lun' caner 3arly Si'n of $un' Ca Cou'h ,1* non productive #* productive 3* 2yperplasia of Pit 'land .ncrease siCe of or'an S&S4 1* #* 3* 7* %* Fluid retention .ncrease BP , 2PN 3dema 9t 'ain +an'er of 2#O into4ication ,Complications< 1* cere/ral edema , increase .CP , #* seiCure

+4 Proc< 1* Arine specific 'ravity increase , diluted urine #* 2yponatremia , +ecreased Na

16

Ns' ?'t< 1* -estrict fluid #* Administer meds as ordered e'* +iuretics< $oop and Osmotic 3* ?onitorstrictly 0)S; .&O; neuro chec6 , increase .CP 7* 9ei'h daily %* Assess for presence edema @* Provide meticulous s6in care L* Prevent complications , increase .CP & seiCures activity Anterior Pituitary 5land , adeno 1* 5rowth hormone &52( &Somatotropic hormone( F4< 3lon'ation of lon' /ones +ecrease 52 , dwarfism children .ncrease 52 , 'i'antism .ncrease 52 , acrome'aly , adult Pu/erty D yo , #1 yo 3piphyseal plate closes at #1 yo SBuare face SBuare Gaw +ru' of choice in acrome'aly< Ocreotide &Sandostatin( S3 diCCiness Somatostatin 2ormone , anta'oniCes the release of of 52 ?elanocytes stimulatin' hormone ?S2 S6in pi'mentation Prolactin)luteotrpic hormone) lacto'enic hormone Promotes development of mammary 'land &O4ytocin .nitiates mil6 letdown refle4( 7* Adrenocorticotropic hormone , AC"2 +evelopment & maturation of adrenal corte4 %* $uteiniCin' hormone , produces pro'esterone* @* FS2 produces estro'en #* 3* PINEAL GLAND 1* Secretes ?elatonin , inhi/its luteniCin' hormone &$2( secretion -'5R*ID GLAND &"5( Question< Normal physical findin' on "5< a* 9ith tenderness , thyroid never tender b9 :it1 o$u#ar co siste cy- answer c* ?ar6ed asymmetry , only 1 "5 d* Palpa/le upon swallowin' Normal "5 never palpa/le unless with 'oiter "5 hormones< "3 "riodothyronine 3 molecules of iodine

"7 "etraiodothyronine) "yro4ine 7 molecules of iodine

"hyrocalcitonin FJ , anta'oniCes effects of parathormone

?eta/olic hormone .ncrease meta/olism /rain ,inc cere/ration; inc v)s 2ypo "3 "7 lethar'y & memory impairment , 2yper "3 "7 a'itation; restlessness; and hallucination L* .ncrease 0S; increase motility 2IPO"2I-O.+.S? , all decreased e4cept wt & menstruation; loss of appetite /ut with wt 'ain menorrha'ia , increase in mens 2IP3-"2I-O.+.S? .ncrease appetite , wt loss; amenorrhea all v)s down; constipation

SIMPLE G*I-ER , enlar'ed thyroid 'land iodine deficiency Predisposin' factors 1* 5oiter /elt area Place far from sea , no iodine* Seafood>s rich in iodine #* ?ountainous area , increase inta6e of 'oitro'enic foods &AS< ?idwest; N3; Salt $a6e( Ca//a'e , has pro'oitrin , an anti thyroid a'ent with no iodine 34ample< "urnips &sin'6amas(; radish; peas; straw/erries; potato; /eans; 6amote; cassava &root crops(; all nuts* 3* 5oitro'enic dru's< Anti thyroid a'ents <&P"A( prophylthiouracil $ithium car/onate; Aspirin PASA Co/alt; Phenyl /utasone 3ndemic 'oiter , cause V 1 Sporadic 'oiter , caused /y V# & 3 S & S4 , enlar'ed "5 ?ild restlessness ?ild dyspha'ia +4 Proc* 1* "hyroid scan , reveals enlar'ed "5

17

#* 3*

Serum "S2 , increase &confirmatory( Serum "3; "7 , N or /elow N

Ns' ?'t< 1* Administer meds a*( .odine solution , $u'ol>s solution or saturated solution of potassium &H( iodide SSH. Ns' ?'t $u'ol>s sol , violet color 1* use straw , prevent stainin' teeth #* Prophyla4is # 3 drops "reatment , % to @ drops Ase straw , to prevernt stainin' of teeth 1* $u'ol>s sol*; #* tetracycline 3* nitrofurantin &macrodantin( urinary anticeptic pyelonephritis* 7* .ron solution* B* 1* #* 3* "hyroid hormone replacement $evothyro4ine &Synthroid( $iothyronine &cytomel( "hyroid e4tract

Ns' ?'t< for "2)a'ents 1* ?onitor vs* , 2- due tachycardia & palpitation #* "a6e it early A? , S3 insomnia 3* ?onitor S)3< "achycardia; palpitations Si'ns of insomnia 2yperthyroidism restlessness a'itation 2eat intolerance 2PN 3* 3ncoura'e increase inta6e iodine , iodine is e4tracted from seaweeds &:( Seafood hi'hest iodine content oysters; clams; cra/s; lo/ster $owest iodine , shrimps .odiCed salt ,easily destroyed /y heat ta6e it raw not coo6ed Assist sur'ery Su/ total thyroidectomy Complication< 1* 2emorrha'e ,chec6 dressin' & anterior)posterior part of the nec6U vital si'ns #* 2oarseness , dama'e to recurrent laryn'eal nerve , assess patient>s voice 3* 2ypothyroidism , thyroid has /een removed , assess heart rate for /rady cardia 7* 2ypoparathyroidim , accidental removal of parathyroid , loo6 for s)s4 of hypocalcemia %* 2ypocalcemia , due to hypoparathyroidism , &K( chvoste6>s si'n; &K( trousseau>s si'n; muscle twitchin'; /rocho & laryn'eal spasm , calcium 'luconate & tracheostomy set W the /edside

7*

#*( '5P*-'5R*IDISM , decrease secretion of "3; "7 , can lead to ?. ) Atherosclerosis Adult , my4edema Child cretinism , only endocrine dis lead to mental retardation Predisposin' factor< 1* X.atro'enic causes , caused /y sur'ery #* Atrophy of "5 due to< a* .rradiation /* "rauma c* "umor; inflammation 3* .odine def 7* Autoimmune , 2ashimoto disease S&S4 everythin' decreased e4cept wt 'ain & mens increase( 3arly si'ns , wea6ness and fati'ue $oss of appetite , increased lypolysis , /rea6down of fats causin' atherosclerosis 1 ?. 9t 'ain Cold intolerance , my4edema coma Constipation $ate S4 , /rittle hair) nails Non pittin' edema due increase accumulation of mucopolysacharide in SQ tissue ?y4edema 2orseness voice +ecrease li/ido +ecrease 0S , hypotension /radycardia; /radypnea; and hypothermia $ethar'y ?emory impairment leadin' to psychosis for'etfulness ?enorrha'ia +4< 1* #* 3* Serum "3 "7 decrease Serum cholesterol increase , can lead to ?. -A .A , radio iodine upta6e , decrease

Ns' ?'t< ?onitor strictly 0)S* .&O , to determine presence of my4edema coma: My)e$ema Coma Severe form of hypothyroidism 2ypotension; hypoventilation; /radycardia; /radypnea; hyponatremia; hypo'lycemia; hypothermia ?i'ht lead to pro'ressive stupor & coma .mpt m't for ?y4edema coma 1* Assist mech vent , priority a)w #* Adm thyroid hormone 3* Adm .0F replacement , force fluid

1*

18

?'t my4edema coma 1* ?onitor 0S; .&O #* Provide dietary inta6e low in calories , due to wt 'ain 3* S6in care due to dry s6in 7* Comforta/le & warm environment due to cold intolerance %* Administer .0F replacements @* Force fluid L* Administer meds , ta6e A? , S3 insomia* ?onitor 2-* "hyroid hormones $evothyro4ine&Synthroid(; $iothyronine &cytomel( "hyroid e4tracts !* 2ealth teachin' & dischar'e plan a* Avoidance precipitatin' factors leadin' to my4edema coma< 1* 34posure to cold environment #* Stress 3* .nfection 7* Ase of sedative; narcotics; anesthetics not allowed , CNS depressants 0)S already down Complications< D* 2ypovolemic shoc6; my4edema coma 1E* 2ormonal replacement therapy lifetime 11* .mportance of follow up care

'5PER-'5R*IDISM 5raves dse or thyroto4icosis & everythin' up e4cept wt and mens( .ncreased "3 & "7 Predisposin' factors< 1* Autoimmune disease , release of lon' actin' thyroid stimulator &$A"S( 34opthalmos 3nopthalmos , severe dehydration depressed eye #* 34cessive iodine inta6e 3* 2yperplasia of "5 S&S4< 1* #* 3* 7* %* @* !* L* !* D* +4< 1* #* 3* Serum "3 & "7 increased -adio iodine upta6e , increase "hyroid scan , reveals enlar'ed "5 .ncrease in appetite , hyperpha'ia , wt loss due to increase meta/olism S6in is moist perspiration 2eat intolerance +iarrhea , increase motility All 0S increase 1 2PN; tachycardia; tachypnea; hyperthermia CNS chan'es .rrita/ility & a'itation; restlessness; tremors; insomnia; hallucinations 5oiter 34opthalmos , patho'nomonic s4 Amenorrhea

Ns' ?'t< 1* ?onitor 0S & . & O , determine presence of thyroid storm or most feared complication< "hyroto4icosis

#*
a*

Administer meds Antithyroid a'ents 1* Prophylthiuracil &P"A( #* ?ethimaCole &"apaCole( ?ost to4ic s)e a'ranulocytosis fever; sore throat; leu6ocytosis1inc w/c< chec6 c/c and throat swa/ culture ?ost feared complication < "hrom/osis , stro6e C0S 3* 7* %* @* L* !* +iet , increase calorie , to correct wt loss S6in care , Comfy & cool environment ?aintain siderails due a'itation)restlessness Provide /ilateral eye patch , to prevent dryin' of eyes e4opthalmos Assist in sur'ery , su/total thyroidectomy

Ns' ?'t< pre op Adm $u'ol>s solution &SSH.( H iodide D* "o decrease vascularity of "5 1E* "o prevent /leedin' & hemorrha'e ?'t post op< Complication< 1* 9atch out for si'ns of thyroid storm or thyroto4icosis -ria$ si. s of t1yroi$stormU a* "achycardia )palpitation /* 2yperthermia c* A'itation 1* #* 3* Ns' ?'t "hyroid Storm< ?onitor 0S & neuro chec6 A'itated mi'ht decrease $OC Antipyretic , fever "achycardia /loc6ers & lol( Siderails , a'itated

Comp #* 9atch for inadvertent &accidental( removal of parathyroid 'land

19

Secretes Para hormone .f removed; hypocalcemia classic si'n tetany , 1* *&K( "rousseau si'n) #* Chvostec6>s si'n Ns' ?'t< Adm calcium 'luconate slowly , to prevent arrhythmia Ca 'luconate to4icity , antidote , ?'SO7 3*$aryn'eal &voice /o4( nerve dama'e &accidental( S4< hoarseness of voice 8883ncoura'e pt to tal6 or spea6 post operatively asap to determine laryn'eal nerve dama'e Notify physician: 7* Si'ns of /leedin' post su/total thyroidectomy NFeelin' of fullnessO at incision site Ns' m't< Chec6 soiled dressin' at nape area %* Si'ns of laryn'eal spasm a* +OB /* SOB Prepare at /edside tracheostomy @* 2ormonal replacement therapy L* .mportance of follow up care lifetime

Parat1yroi$ .#a $ , pair of small nodules located /ehind the "5 11* Secrets parathyroid hormone , promotes Ca rea/sorption "hyrocalcitonin , anta'onises secretion of parathyroid hormone 1* #* 2ypoparthroidism , decrease of parathyroid hormone 2yperparathroidsm

'5P*PARA-'5R*IDISM , decreased parathormone 2ypocalcemia &Or tetany( Y.f Ca decreases; phosphate increasesZ A* Predisposin'; factors< 1* Followin' su/total thyroidectomy #* Atrophy of parathyroid 'land due to a* .rradiation /* "rauma S&S4< 1* 2yperphosphatemia

Acute tetany a* "in'lin' sensation /* Paresthesia c* +yspha'ia d* $aryn'ospasm e* Bronchospasm Patho'nomonic Si'n of tetany< a* &K( "rousseau>s or carpopedial spasm /* &K( Chvostec6>s si'n f* SeiCure '* Arrhythmia most feared complication

#*

Chronic a* /* c* d*

tetany $oss of tooth enamel Photopho/ia & cataract formation 5." chan'es , anore4ia; n)v; 'eneral /ody malaise CNS chan'es , memory impairment; irrita/ility

+4< 1* #* 3* 7* Serum calcium , decrease &N !*% , 11 m')1EEml( Serum phosphate increase &N #*% , 7*% m')1EEml( J ray of lon' /one , decrease /one density C" Scan , reveals de'eneration of /asal 'an'lia

Ns' ?'t< 1* Administration of meds< a*( Acute tetany , Ca 'luconate , .0; slowly /*( Chronic tetany 1* Oral Ca supplements 34* Ca 'luconate Ca car/onate Ca lactate

20

0it + &Cholecalceferol( +ru' Cholecalceferol diet calcidiol sunli'ht calcitriol Lam , Dam

#* Phosphate /inder Alumminum +2 'el &ampho 'el( S3 constipation Antacid AAC ?A+ Aluminum containin' acids Aluminum O2 'el +iarrhea

?' containin' antacids 34* ?il6 or ma'nesia

Constipation ?aalo4 , ma'nesium & aluminum $ess s)e #* Avoid precipitatin' stimulus such as /ri'ht li'hts & noise< photopho/ia leadin' to seiCure 3* +iet , increase Ca & decrease phosphorus +on>t 'ive mil6 , due to increase phosphorus 5ood 1 anchovies , increase Ca; decrease phosphorus K inc uric acid* "una & 'reen turnips .nc Ca* 7* Bedside , tracheostomy set ,due to laryn'ospasm %* 3ncoura'e to /reath with paper /a' in order to produce mild respiratory acidosis , to promote increase ioniCed Ca levels @* ?ost feared complication < SeiCure & arrhythmia L* 2ormonal replacement therapy lifetime !* .mportant fallow up care '5PERPARA-'5R*IDISM increase parathormone* Complication< -enal failure 2ypercalcemia can lead to 2ypophosphatemia Bone dse demineraliCation $eadin' to /one fracture Ca , DDF /ones 1F serum /lood Predisposin' Factors< 1* 2yperplasia parathyroid 'land &P"5( #* Over compensation of P"5 due to 0it + deficiency Children , -ic6ets 0it + Adults , Osteomalacia deficiency Sippy>s diet , 0it + diet , not 'ood for pt with ulcer # 7 cups of mil6 & /utter Harrel>s diet , 0it + diet , not 'ood for pt with ulcer @ cups of mil6 & whole cream Food rich in C2ON , e''no' , com/ination of e'' & mil6 S)S4< Bone fracture 1* Bone pain &especially at /ac6(; /one fracture #* Hidney stone , a* -enal colic /* Cool moist s6in 3* 5." chan'es , anore4ia; n)v; ulcerations 7* CNS involvement, irrita/ility; memory impairment +4 Proc< 1* Serum Ca increase #* Serum phosphorus decreases 3* J ray lon' /ones , reveals /one demineraliCation Ns' ?'t< 2i$ ey Sto e 1* #* 3* 7* %* @* Force fluids , #;EEE , 3;EEE)day or # 3$)day .sotonic solution 9arm sitC /ath , for comfort Strain all urine with 'auCe pad Acid ash diet , cran/erry; plum; 'rapefruit; vit C; calamansi , to acidify urine Adm meds a* Narcotic anal'esic , ?orphine SO7; +emerol &?eperidine 2cl( S)3 , resp depression* ?onitor --( Narcan) Nalo4one , antidote Nalo4one to4icity , tremors L* Siderails !* Assist in am/ulation D* +iet , low in Ca; increase phosphorus lean meat 1E* Prevent complication ?ost feared , renal failu re 6idney stones

21

11* Assist sur'ical procedure , parathyroidectomy 1#* .mpt ff up care 13* 2ormonal replacement lifetime

A+-3NA$ 5$AN+ 1#* Atop of W 6idney 13* # parts Adrenal corte4 , outermost layer Adrenal medulla innermost layer 17* Secrets cathecolamines a*( 3pinephrine ) Norephinephrine , potent vasoconstrictor , adrenaline1.ncrease BP Adrenal ?edulla>s only disease< P'E*C'R*M*C5-*MA- presence of tumor at adrenal medulla increase nor)epinephrine with 2PN and resistant to dru's dru' of choice< /eta /loc6ers complication< 2PN crisis 1 lead to stro6e no valsalva maneuver

Adrenal Corte4 ,

1* #*

Pona fasiculata , secrets 'lucocorticoids 34* Cortisol Controls 'lucose meta/olism &SA5A-(

Pona reticularis , secrets traces of 'lucocorticoids & andro'enic hormones ? , testosterone F , estro'en & pro'esterone F4 , promotes development of secondary se4ual characteristics 3* Pona 'lomerulosa secretes mineralcortisone 34* Aldosterone F4< promotes Na & 2#O rea/sorption & e4cretion of potassium &SA$"( ADDIS*N(S DISEASE , Steroids lifetime +ecreased adrenocortical hormones leadin' to< a*( ?eta/olic distur/ances &su'ar( /*( F&3 im/alances Na; 2#O; H c*( +eficiency of neuromuscular function &salt & se4( Predisposin' Factors< 1* Atrophy of adrenal 'land #* Fun'al infections 3* "u/ercular infections S)S4< 1* Decrease su.ar , 2ypo'lycemia , +ecreased 'lucocorticoids cortisol

" , tremors; tachycardia . irrita/ility - restlessness 3 , e4treme fati'ue + , diaphoresis; depression +9 Decrease "#asma cortiso# +ecrease tolerance to stress , lead to Addisonian>s crisis Aldosterone

3* Decrease sa#t , 2yponatermia , +ecreased mineralocorticoids 2ypovolemia a*( 2ypotension /*( Si'ns of dehydration , e4treme thirst; a'itation c*( 9t loss 7* 2yper6alemia a*( .rrita/ility /*( +iarrhea c*( Arrhythmia +ecrease se4ual ur'e or li/ido +ecreased Andro'en $oss of pu/ic and a4illary hair Loca# , practice mono'amous relationship CG7NS;NCLE< , condom

%* @*

"o Prevent S"+ L*

Patho'nomonic si'n, /ronCe li6e s6in pi'mentation due to decrease cortisol will stimulate pituitary 'land to release melanocyte stimulatin' hormone*

+4 Proc< 1* FBS , decrease FBS &N !E , 1#E m')d$( #* Plasma cortisol , decreased Serum Na , decreased &N 13% , 17% me')$( 3* Serum H , increased &N 3*% , %*% me')$(

22

Ns' ?'t< 1* ?onitor 0S; .&O , to determine presence of Addisonian crisis Complication of Addison>s dse < Addisonian crisis -esults the acute e4acer/ation of Addison>s dse characteriCed /y < 2ypotension; hypovolemia; hyponatremia; wt loss; arrhythmia $ead to pro'ressive stupor & coma 1* #* 3* Ns' ?'t A$$iso ia Crisis &Coma( Assist in mechanical ventilation Adm steroids Force fluids

#*

Administer meds a*( Corticosteroids &+ecadron( or +e4amethaCone 2ydrocortisone &cortisone( Prednisone Ns' 1* #* 3* a*( /*( c*( d*( e*( ?'t with Steroi$s Adm #)3 dose in A? & 1)3 dose in P? in order to mimic the normal diurnal rhythm* "aper the dose &w)draw; 'radually from dru'( , sudden withdrawal can lead to addisonian crisis ?onitor S)3 &Cushin'>s syndrome S)S4( 2PN 2irsutism 3dema ?oon face & /uffalo hump .ncrease suscepti/ility to infection sue to steroids reverse isolation

3*
7* %* @* L* a(

!* D*

/*( ?ineralocorticoids e4* Flourocortisone +iet , increase calorie or C2O .ncrease Na; .ncrease C2ON; +ecrease H Force fluid Administer isotonic fluid as ordered ?eticulous s6in care , due to /ronCe li6e 2" & dischar'e plannin' Avoid precipitatin' factors leadin' to A$$iso ia crisis 1* Sudden withdrawal crisis #* Stress 3* .nfection 7* "rauma %* Sur'ery /*(Prevent complications Addisonian crisis & 2ypovolemic shoc6 2ormonal replacement therapy , lifetime .mportant< follow up care

CUS'ING(S S5NDR*ME , increase secretion of adrenocortical hormone Predisposin' Factors< 1* 2yperplasia of adrenal 'land #* "u/ercular infection , milliary "B S)S4 1* .ncrease su'ar , 2yper'lycemia 3 P>s 1* Polyuria #* Polydipsia , increase thirst 3* Polypha'ia , increase appetite Classic S4 of +? , 3 P>s & 'lycosuria K wt loss #* .ncrease suscepti/ility to infection , due to increased corticosteroid

3*

2ypernatrermia a* 2PN /* 3dema c* 9t 'ain d* ?oon face Buffalo hump O/ese trun6 Pendulous a/domen "hin e4tremities 2ypo6alemia a* 9ea6ness & fati'ue /* Constipation c* 3C5 , &K( NAO wave 2irsutism , increase se4 Acne & striae .ncrease muscularity of female

classic si'ns

7*

%* @* L* +4< 1* #* 3* 7*

FBS , increase &N< !E 1#Em')d$( Plasma cortisol increase Na , increase &13% 17% meB)$( H decrease &3*% %*% meB)$(

Ns' ?'t<

23

1* ?onitor 0S; .&O #* Administer meds a* H sparin' diuretics &Aldactone( Spironolactone promotes e4cretion of NA while conservin' potassium Not lasi4 due to S)3 hypoH & 2yper'lycemia: 3* 7* -estrict Na Provide +ietary inta6e , low in C2O; low in Na & fats 2i'h in C2ON & H =9 9ei'h pt daily & assess presence of edema measure a/dominal 'irth notify doc* @* -everse isolation >9 S6in care , due acne & striae !* Prevent complication ?ost feared , arrhythmia & +? &3ndocrine disorder lead to ?. , 2ypothyroidism & +?( D* Sur'ical /ilateral Adrenolectomy 1E* 2ormonal replacement therapy , lifetime due to adrenal 'land removal no more corticosteroid: PANC-3AS , /ehind the stomach; mi4ed 'land , /oth endocrine and e4ocrine 'land Acinar cells &e4ocrine 'land( Secrete pancreatic Guices at pancreatic ducts* Aids in di'estion &in stomach( .slets of $an'erhans &endocrine 'land ductless( cells secrets 'luca'on F4n< hyper'lycemia &hi'h 'lucose( Cells Secrets insulin F4n< hypo'lycemia +elta Cells Secrets somatostatin F4n< anta'oniCes 'rowth hormone

3 disorders of the Pancreas 1* +? #* Pancreatic Cancer 3* Pancreatitis Overview only< PANCREA-I-IS (chec6 pa'e L#(, acute inflammation of pancreas leadin' to pancreatic edema; hemorrha'e & necrosis due to Autodi'estion , self di'estion Cause< un6nown)idiopathic 1%* Or alcoholism Patho'nomonic si'n &K( Cullen>s si'n 3cchymosis of um/ilicus &/luish color( pasa &K( 5rey turner>s si'n , ecchymosis of flan6 area Both s4 means hemorrha'e C'R*NIC 'EM*RR'AGIC PANCREA-I-IS N/an'u'otO Predisposin' factors un6nown -is6 factor< 1* 2istory of hepato/iliary disorder #* Alcohol 3* +ru's , thiaCide diuretics; oral contraceptives; aspirin; penthan 7* O/esity %* 2yperlipidemia @* 2yperthyroidism L* 2i'h inta6e of fatty food , saturated fats

DIA0E-ES MELLI-US

meta/olic disorder characteriCed /y non utiliCation of C2O; C2ON;& fat meta/olism

Classification< .* -y"e I DM (IDDM( , NTuvenile N onset; common in children; non o/ese N/rittle dseO .nsulin dependent dia/etes mellitus .ncidence rate 1*( 1EF of population with +? have "ype .

24

Predisposin' Factor< 1* DEF hereditary , total destruction of pancreatic dells #* 0irus 3* "o4icity to car/on tetrachloride 7* +ru's , Steroids /oth cause hyper'lycemia $asi4 loop diuretics S)S4< 3 P>S K 5 1*( Polyuria #*( Poydipsia 3*( Polypha'ia 7*( 5lycosuria %*( 9ei'ht loss @*( Anore4ia L*( N)0 !*( Blurrin' of vision D*( .ncrease suscepti/ility to infection 1E*( +elayed) poor wound healin' ?'t< 1* .nsulin "herapy +iet 34ercise Complications , +ia/etic Hetoacidosis &+HA( +ia/etic Hetoacidosis &+HA( , due to increase fat cata/olism or /rea6down of fats +HA ,&K( fruity or acetone /reath odor Hassmaul>s respiration , rapid; shallow /reathin' +ia/etic coma &needs o4y'en( II9 -y"e II DM 3 (NIDDM% Adult) maturity onset type , a'e 7E & a/ove; o/ese .ncidence -ate 1* DEF of pop with +? have "ype .. ?id 1D!E>s mar6ed increase in type .. /ecause of increase proliferation of fast food chains: Predisposin' Factor< 1* O/esity , o/ese people lac6 insulin receptors /indin' site #* 2ereditary S)S4< 1* #* "4< 1* #* 3* Oral 2ypo'lycemic A'ents &O2A( +iet 34ercise Asymptomatic 3 P>s and 15

Complication< 2ONHC 2 , hyper O , osmolar N , non H , 6etotic C , coma III9 GES-A-I*NAL DM , occurs durin' pre'nancy & terminates upon delivery of child Predisposin' Factors< 1* An6nown) idiopathic #* .nfluence of maternal hormones S)S4 < Same as type .. , 1* Asymptomatic #* 3 P>s & 15 "ype of delivery , CS , due to lar'e /a/y S4 of hypo'lycemia on infant 1* 2i'h pitched shrill cry #* Poor suc6in' refle4 I69 DM ASS*CIA-ED :I-' *-'ER DIS*RDER a*( Pancreatic tumor /*( Cancer c*( Cushin'>s syndrome 3 ?A.N FOO+ 5-OAPS Ana/olism Cata/olism 1* C2ON 'lucose 'lyco'en #* C2ON amino acids nitro'en 3* Fats fatty acids free fatty acids &FFA( , Cholesterol & Hetones

25

Pancreas 'lucose A"P &?ain fuel)ener'y of cell ( -eserve 'lucose , 'lyco'en $iver will under'o , 'luco'enesis , synthesis of 'luca'ons & 5lyco'enolysis , /rea6down of 'luca'ons & 5luconeo'enesis , formation of 'lucose form C2O sources , C2ON & fats

2yper'lycemia , pancreas will not release insulin* 5lucose can>t 'o to cell; stays at circulation causin' hyper'lycemia* increase osmotic diuresis , 'lycosuria $ead to cellular starvation

$ead to wt loss

stimulates the appetite) satiety center &2ypothalamus( Polypha'ia

polyuria Cellular dehydration

Stimulates thirst center &hypothalamus( Polydipsia .ncreased C2ON cata/olism $ead to & ( nitro'en /alance "issue wastin' &cache4ia(

.ncrease fat cata/olism Free fatty acids Cholesterol Atherosclerosis 2PN ?. stro6e 6etones +HA coma death

DIA0E-IC 2E-*ACID*SIS (D2A% Acute complication of "ype . +? due to severe hyper'lycemia leadin' to CNS depression & Coma* Hetones a CNS depressant Predisposin' factor< 1* Stress , /etween stress and infection; stress causes +HA more* #* 2yper'lycemia 3* .nfection S)S4< 1* #* 3* 7* %* @* L* !* D* 1E* 3 P>s & 15 Polyuria Polydipsia Polypha'ia 5lycosuria 9t loss Anore4ia; N)0 &K( Acetone /reath odor fruity odor Hussmaul[s resp rapid shallow respiration CNS depression Coma

patho'nomonic +HA

+4 Proc< 1* FBS increase; 2ct , increase &compensate due to dehydration( N 1BAN , 1E #E m')1EEml increased due to severe dehydration Crea *! , 1 m')1EEml 2ct 7#F &should /e 34 hi'h( nto h'/ Ns' ?'t< 1* Can lead to coma , assist mechanical ventilation

26

#*

Administer *DNaCl , isotonic solution Followed /y *7%NaCl hypotonic solution "o counteract dehydration* ?onitor 0S; .&O; /lood su'ar levels Administer meds as ordered< a*( .nsulin therapy , .0 push -e'ular Actin' .nsulin , clear &# 7hrs; pea6 action( /*( "o counteract acidosis , Na 'C*? c*( Anti/iotic to prevent infection

3* 7*

.nsulin "herapy A* Sources< 1* Animal source , /eef) por6 rarely used* Causes severe aller'ic reaction* #* 2uman , has less anti'enecity property Cause less aller'ic reaction* 2umulin 3* B* .f 6id is aller'ic to chic6en , don>t 'ive measles vaccine due it comes from chic6en em/ryo* Artificially compound "ypes of .nsulin 1* -e'ular .nsulin 34* -e'ular actin' . #* .ntermediate actin' . 34* NP2 &non protamine 2a'edorn .( 3* $on' actin' . 34* Altra lente co#or ! co siste cy clear cloudy cloudy o set "ea, $uratio # 7h @ 1#h 1# #7h

-y"es of I su#i 1* -e'ular #* .ntermediate 3* $on' actin'

34* %am 2emo'lucose test &25"( #%E m')dl Adm % units of -A . Pea6 L Dam , monitor hypo'lycemic reaction at this time ".-3+ Ns' ?'t< upon inGection of insulin< 1*Administer insulin at room temp: , "o prevent lipodystrophy 1 atrophy) hypertrophy of SQ tissues #* .nsulin is only refri'erated once opened: 3* 5ently roll vial /et palms* Avoid sha6in' to prevent formation of /u//les* 7* Ase 'au'e #% , #@needle , tu/erculin syrin'e %* Administer insulin at either 7%&for s6inny pt( or DE &ta/a pt(dependin' on the client tissue deposit* @* +on>t aspirate after inGection L* -otate inGection site to prevent lipodystrophy !* ?ost accessi/le site , a/domen D* 9hen mi4in' # types of insulin; aspirate st 1 re'ular) clear , /efore cloudy to prevent contaminatin' clear insulin & to promote accurate cali/ration* 1E* ?onitor si'ns of complications< a* Aller'ic reactions , lipodystrophy /* Somo'yi>s phenomenon , hypo'lycemia followed /y periods of hyper'lycemia or re/ound effect of insulin* 11* 1ml or cc of tu/erculin 1 1EE units of insulin 1 cc 1 1EE units *%cc 1 %E units

*1 cc 1 1E units @ units -A ?ost Feared Complication of "ype .. +? 2yper osmolarity 1 severe dehydration Osmolar Non a/sence of lipolysis Hetotic no 6etone formation Coma , S)S4< headache; restlessness; seiCure; decrease $OC 1 coma Ns' ?'tU same as +HA e4cept don>t 'ive Na2CO3:

1*Can lead to coma , assist mechanical ventilation #* Administer *DNaCl , isotonic solution Followed /y *7%NaCl hypotonic solution "o counteract dehydration* 3*?onitor 0S; .&O; /lood su'ar levels 7*Administer meds a*( .nsulin therapy , .0 /*( Anti/iotic to prevent infection "4< O ral 2 ypo'lycemic A 'ents 1@* Stimulates pancreas to secrete insulin

27

Classifications of O2A 1* First 'eneration Sulfonylureas a* Chlorpropamide &dia/enase( /* "ol/utamide &orinase( c* "olaCamide &tolinase( #* #
nd

'eneration sulfonylureas a* +ia/eta &?icronase( /* 5lipiCide &5lucotrol(

Ns' ?'t or O2A 1* Administer with meals , to lessen 5." irritation & prevent hypo'lycemia #* Avoid alcohol &alcohol K O2A 1 severe hypo'lycemic reaction1CNS depression1coma( Anta/use +isufram +4 for +? 1* FBS , N !E , 1#E m')dl 1 .ncreased for 3 consecutive times K 3 P>s & 15 #* Oral 'lucose tolerance &O5""( ?ost sensitive test 3* -andom /lood su'ar , increased 7* Alpha 5lucosylated 2'/ , elevated Ns' ?'tU 1* ?onitor for P3AH action of O2A & insulin Notify +oc #* ?onitor 0S; .&O; neurochec6; /lood su'ar levels* 3* Administer insulin & O2A therapy as ordered* 7* ?onitor si'ns of hyper & hypo'lycemia* Pt +? ,N hinimatayO Iou don>t 6now if hypo or hyper'lycemia* 5ive simple su'ar &Brain can tolerate hi'h su'ar; /ut /rain can>t tolerate low su'ar:( Cold; clammy s6in , hypo , Oran'e Tuice or simple su'ar ) 9arm to touch , hyper , administer insulin %* Provide nutritional inta6e of $iabetic $iet< C2O , %EF C2ON , 3EF Fats , #EF Or offer alternative food products or /evera'e* 5lass of oran'e Guice* 34ercise , after meals when /lood 'lucose is risin'* ?onitor complications of +? a* Atherosclerosis , 2PN; ?.; C0A /* ?icroan'iopathy , small /lood vessels 3yes , dia/etic retinopathy ; premature cataract & /lin dness Hidneys , recurrent pyelonephritis & -enal Failu re &# common causes of -enal Failure < +? & 2PN( c* 5an'rene formation d* Peripheral neuropathy 1* +iarrhea) constipation #* Se4ual impotence e* Shoc6 due to cellular dehydration Foot care m't a* Avoid wa6in' /arefooted /* Cut toe nails strai'ht c* Apply lanolin lotion , prevent s6in /rea6down d* Avoid wearin' constrictive 'arments 1confirms +?::

@* L*

!*

D* Annual eye & 6idney e4am 1E* ?onitor urinalysis for presence of 6etones Blood or serum , more accurate 11* Assist in sur'ical wound de/ridement 1#* ?onitor si'ns or +HA & 2ONHC 13* Assist sur'ical procedure BHA or a/ove 6nee amputation *vervie8: 23?A"O$O5.CA$ SIS"3?S . Blood .. Blood vessels ... Blood formin' or'ans 1* "hymus , removed myasthenia 'ravis #* $iver , lar'est 'land 3* $ymph nodes 7* $ymphoid or'ans , payers patch %* Bone marrow @* Spleen , destroys -BC Blood vessels 1* 0eins ,S0C; .0C; Tu'ular vein , /lood towards the heart #* Artery , carries /lood away from the 1L* Aorta; carotid 3* Capillaries

28

Blood 7%F formed elements , %%F plasma , fluid portion of vlood* Iellow color* Serum Plasma C2ON>s &Produced in $iver( 1* Al/umin lar'est; most a/undant plasma ?aintains osmotic pressure preventin' edema FJN< promotes s6in inte'rity #* 5lo/ulins , alpha , transports steroids 2ormones & /iliru/in "ransports iron & copper 5amma , transport immuno'lo/ulins or anti/odies 3* Prothrom/in , fi/rino'en , clottin' factor to prevent /leedin'

Formed 3lements< 1* -BC &erythrocytes( Spleen life span 1 1#E days &N( 3 , @ ?)mm3 Anucleated Biconcave discs 2as molecules of 2'/ &red cell pi'ment( "ransports & carries O#

SIC2LE CELL ANEMIA ,sic6le shaped -BC* Should /e round* .mpaired circulation of -BC* immature cells1hemolysis of -BC1decreased h'/ 3 Ns' priority 1* a)w , avoid deo4y'enatin' activities 2i'h altitude is /ad #* Fluid deficit , promote hydration 3* Pain & comfort 2'/ & hemo'lo/in( F1 1# , 17 'ms F ? 1 17 1@ 'ms F 2ct , 34 h'/ 1# 4 3 1 3@ &hamatocrit( F 3@ , /+@ 17 4 3 1 7# ? /+ , 7!F Avera'e 7#F -ed cell percenta'e in whole red Su/stances needed for maturation of -BC a*( Folic acid /*( .ron c*( 0it C d*( 0it B1# &cyanoco/alamin( e*( 0it B@ &Pyrido4ine( f*( .ntrinsic factor Pre'nant< 1 trimester Folic acid , prevent neural tu/e deficit rd 3 tri , iron $ife span of r/c , !E , 1#E days* +estroyed at spleen*
st

9BC , leucocytes %;EEE , 1E;EEE)mm3 5-ANA$OCI"3S 1* Po#ymor"1o uc#ear eutro"1i#s ?ost a/undant @E LEF 9BC f4 , short term pha'ocytosis For acute inflammation #* PM 0aso"1i#s .nvolved in Parasitic infection -elease of chem* ?ediator for inflammation Serotonin; histamine; prosta'landin; /rady6inins 3* PM eosi o"1i#s Aller'ic reactions

NON 5-ANA$OCI"3S 1* Mo ocytes &macropha'e( lar'est 9BC involved in lon' term pha'ocytes For chronic inflammation Other name macropha'e ?acropha'e in CNS micro'lia ?acropha'e in s6in , 2istiocytes ?acropha'e in lun's , alveolar macropha'e ?acropha'e in Hidneys , Hupffer cells #* Lym"1ocytes B Cell , $ , /one marrow or /ursa dependent " cell , dev>t of immunity tar'et site for 2.0 NH cell , natural 6iller cell 2ave /oth antiviral & anti tumor properties 3*P#ate#ets &throm/ocytes( N 1%E;EEE , 7%E; EEE) mm3 it promotes hemostasis , prevention of /lood loss /y activatin' clottin' Consists of immature or /a/y platelets 6nown as me'a6aryocytes , tar'et of virus , den'ue Normal lifespan D , 1# days

+ru' of choice for 2.0 Pidovudine &AP" or -etrovir( Standard precaution for 2.0 'loves; 'own; 'o''les & mas6 ?alaria , ni'ht /itin' mosBuito +en'ue , day /itin' mosBuito Si'ns of platelet dysfunction< a*( Petecchiae /*( 3cchemosis) /ruises

29

c*( OoCin' or /lood from venipuncture site ANEMIA .ron deficiency Anemia , chronic normocytic; hypocromic &pale(; microcytic anemia due to inadeBuate a/sorption of iron leadin' to hypo4emic inGury* .ncidence rate< 1* Common , developed country , due to hi'h cereal inta6e +ue to accidents , common on adults #* Common , tropical countries , /lood suc6in' parasites 3* 9omen , 1% , 3%yo , reproductive yrs 7* Common amon' the poor , poor nutritional inta6e Predisposin' factor< 1* Chronic /lood loss a* "rauma /* ?ens c* 5." /leedin'< i* 2ematemesis ii* ?elena , upper 5." , duodenal cancer iii* 2ematocheCia , lower 5." , lar'e intestine , fresh /lood from rectum #* .nadeBuate inta6e of food rich in iron 3* .nadeBuate a/sorption of iron , due to < a* Chronic diarrhea /* ?ala/sorption syndrome ,celiac disease 'luten free diet* Food for celiac pts sardines c* 2i'h cereal inta6e with low animal C2ON in'estion d* Su/total 'astrectomy 7* .mproper coo6in' of food S)S4< 1* #* 3* 7* %* Asymptomatic 2eadache; diCCiness; dyspnea; palpitations; cold sensitivity; 'en /ody malaise; pallor Brittle hair; spoon shaped nails &HO.$ONIC2.A(1+ec O#1hypo4ia1atrophy of epidermal cells Atropic 'lossitis; dyspha'ia; stomatitis Pica , a/normal cravin' for non edi/le food &caused /y hypo4ia1dec tissue perfusion1psychotic /ehavior(

Brittle hair; spoon shaped nail , atrophy of epidermal cells N 1 capillary refill time M # secs N 1 shape nails , /iconcave shape; 1!E Atrophy of cells NPlummer 0insons SyndromeO due to cere/ral hypo4ia 1* Atropic 'lossiti , inflammation of ton'ue due to atrophy of pharyn'eal and ton'ue cells #* Stomatitis , mouth sores 3* +yspha'ia +4 Proc< 1* -BC #* 2'/ 3* -eticulocyte 7* 2ct %* .ron @* Ferritin Ns' ?'t 1* #* 3* 1!* 7* %* ?onitor si'ns of /leedin' of all hema test includin' urine & stool Complete /ed rest , don>t overtire pt 1wea6ness and fati'ue1activity intolerance 3ncoura'e , iron rich food -aisins; le'umes; e'' yol6 .nstruct the pt to avoid ta6in' tea impairs iron a/sorption Administer meds a*( Oral iron preparation Ferrous SO7 Fe 'luconate Fe Fumarate Ns' ?'t oral iron meds< 1* Administer with meals , to lessen 5." irritation #* .f dilutin' in iron liBuid prep ,adm with straw Straw 1* #* 3* 7* $u'ol>s "etracycline Oral iron ?acrodantine 3* 7* a* /* c* d* e* 5ive Oran'e Guice , for iron a/sorption ?onitor & inform pts S)3 Anore4ia n)v A/dominal pain +iarrhea or constipation ?elena

.f pt can>t tolerate oral iron prep , administer parenteral iron prep e4ample< 1* .ron de4tran &.0; .?( #* Sor/ite4 &.?( Ns' ?'t parenteral iron prep

30

1* #* 3*

Administer of use P tract method to prevent discomfort; discoloration lea6a'e to tissues* +on>t massa'e inGection site* Am/ulate to facilitate a/sorption* ?onitor S)3< a*( Pain at inGury site /*( $ocaliCed a/scess &NnanaO( c*( $ymphadenopathy d*( Fever) chills e*( Articaria , itchiness f*( 2ypotension , anaphylactic shoc6

Anaphylactic shoc6 , 'ive epinephrine PERNICI*US ANEMIA me'alo/lastic; chronic anemia due to deficiency of intrinsic factor leadin' to 2ypochlorhydria , decrease 2cl acid secretion* $ifetime B1# inGections* 9ith CNS involvement* Predisposin' factor 1* Su/total 'astrectomy , removal stomach #* 2ereditary 3* .nfl dse of ileum 7* Autoimmune %* Strict ve'eta/le diet S-*MAC' Parietal or er'entaffen O4yntic cells F4n , produce intrinsic factor For rea/sorption of B1# For maturation of -BC +iet hi'h caloric or C2O to correct wt loss S)S4< 1* #* 2eadache diCCiness; dyspnea; palpitations; cold sensitivity; 'en /ody malaise; pallor 5." chan'es a* -ed , /eefy ton'ue , PA"2O5NO?ON.C , mouth sores /* +yspepsia , indi'estion c* 9t loss d* Taundice 3* CNS , ?ost dan'erous anemia< pernicious due to neuro'lo'ic involvement* a* "in'lin' sensation /* Paresthesia c* &K( -om/er'>s test Ata4ia d* Psychosis +4< Shillin'>s test Ns' ?'t , Pernicious anemia 1* 3nforce CB#* Administer B1# inGections at monthly intervals for lifetime as ordered* .? dorso'luteal or ventro'luteal* Not .ive due pt mi'ht have tolerance to dru' 3* +iet , hi'h calorie or C2O* .ncrease C2ON; iron & 0it C 7* Avoid irritatin' mouthwashes* Ase of soft /ristled tooth/rush is encoura'ed* %* Avoid applyin' electric heatin' pads , can lead to /urns APLAS-IC ANEMIA , stem cell disorder due to /one marrow depression leadin' to pancytopenia , all -BC are decreased F4n , secrets 2cl acid F4 aids in di'estion

ora# ,

platelets

+ecrease -BC

decrease 9BC leu6openia

decrease

Anemia throm/ocytopenia .ncrease 9BC leu6ocytocys .ncrease -BC polycythemia vera , complication stro6e; C0A; throm/osis Predisposin' factors leadin' to Aplastic Anemia 1* Chemicals , BanCene & its derivatives #* radiation 3* .mmunolo'ic inGury 7* +ru's , cause /one marrow depression a* Broad spectrum anti/iotic Chlorampenicol Sulfonamides , /actrim /* Chemo therapeutic a'ents ?ethotre4ate , al6ylatin' a'ents Nitro'en mustard , anti meta/olic 0incristine , plant al6aloid S)S4< 1* Anemia< a* 9ea6ness & fati'ue /* 2eadache; diCCiness; dyspnea c* cold sensitivity; pallor

31

+4<

d* palpitations #* $eucopenia , increase suscepti/ility to infection 3* "hrom/ocytopenia , a* Peticchiae /* OoCin' of/lood from venipuncture site c* ecchymosis

1* CBC , pancytopenia #* Bone marrow /iopsy) aspiration at post iliac crest , reveals fatty strea6s in /one marrow Ns' ?'t< 1* -emoval of underlyin' cause #* Blood transfusion as ordered 3* Complete /ed rest 7* O# inhalation %* -everse isolation due leu6openia @* ?onitor si'ns of infection L* Avoid SQ; .? or any venipuncture site 1 23P$OCH !* Ase electric raCor when shavin' to prevent /leedin' D* Administer meds .mmunosuppresants Anti lymphocyte 'lo/ulin &Al'( 'iven via central venous catheter; @ days , 3 wee6s to achieve ma4 therapeutic effect of dru'* 0L**D -RANS7USI*N< O/Gectives< 1* "o replace circulatin' /lood volume #* "o increase O# carryin' capacity of /lood 3* "o com/at infection if there>s decrease 9BC 7* "o prevent /leedin' if there>s platelet deficiency Ns. M.t ! "ri ci"#es i 0#oo$ -ra sfusio 1* Proper refri'eration #* Proper typin' & crossmatchin' "ype O , universal donor AB , universal recipient !%F of people is -2 &K( 3* Asceptically assem/le all materials needed< a*( Filter set /*( .sotonic or PNSS or *DNaCl to prevent 2emolysis 2ypotonic sol , swell or /urst 2ypertonic sol , will shrin6 or crenate c*( Needle 'au'e 1! 1D or lar'e /ore needle to prevent hemolysis* d*( .nstruct another -N to rechec6 the followin' * Pts name; /lood typin' & cross typin' e4piration date; serial num/er* e*( Chec6 /lood unit for presence of /u//les; cloudiness; dar6 in color & sediments , indicates /acterial contamination* +on>t dispose* -eturn to /lood /an6* f*( Never warm /lood products , may destroy vital factors in /lood* 9armin' is done if with warmin' device , only in 3?3-53NCI: For multiple B"* 9ithin 3E mins room temp only: '*( Blood transfusion should /e completed A /1rs /ecause /lood that is e4posed at room temp for S #h causes /lood deterioration* h*( Avoid mi4in' or administerin' dru' at B" line , leads to hemolysis i*( -e'ulate B" 1E , 1% 'tts)min H0O or 1EEcc)hr to prevent circulatory overload G*( ?onitor 0S /efore; durin' & after B" especially B1% mins&local /oard( for 1st hour* st NC$3J B%min for 1 1%min* ?aGority of B" reaction occurs within 1h*

0- reactio s S)S4 2emolytic reaction< 2 , hemolytic -eaction 1* 2eadache; diCCiness; dyspnea; palpitation; lum/ar) sterna) flan6 pain; A , aller'ic -eaction hypotension; flushed s6in ; &red( port wine urine* P , pyro'enic -eaction C , circulatory overload A , air em/olism " throm/ocytopenia C , citrate into4ication , e4pired /lood 1hyper6alemia 2 , hyper6alemia Ns' ?'t< 'emo#ytic 1* #* 3* 7* %* @* L* A##er.ic Reactio : S)S4 1* Fever) chills Reactio : Stop B" Notify +oc Flush with plain NSS Administer isotonic fluid sol , to prevent acute tu/ular necrosis & conteract shoc6 Send /lood unit to /lood /an6 for ree4amination O/tain urine & /lood samples of pt & send to la/ for ree4amination ?onitor 0S & Aller'ic -4n

32

#* 3* 7* %*

Articaria) pruritus +yspnea $aryn'ospasm) /ronchospasm Bronchial wheeCin'

Ns' ?'t< 1* Stop B" #* Notify +oc 3* Flush with PNSS 7* Administer antihistamine , diphenhydramine 2cl &Benadryl(* 5ive /edtime*S3 Adult drowsiness* Child hyperactive .f &K( 2ypotension , anaphylactic shoc6 administer , epinephrine %* Send /lood unit to /lood /an6 @* O/tain urine & /lood samples , send to la/ L* ?onitor 0S & .O !* Adm* Antihistamine as ordered for Aller'ic-4n; if &K( to hypotension , indicates anaphylactic shoc6 1D* administer epinephrine D* Adm antipyretic & anti/iotic for pyro'enic -4n & "SB Pyro.e ic Reactio : S)S4 a*( Fever) chills /*( 2eadache c*( +yspnea Ns' ?'t< 1* #* 3* 7* %* @* L* !* d* tachycardia e* palpitations f* diaphoresis

Stop B" Notify +oc Flush with PNSS Administer antipyretics; anti/iotics Send /lood unit to /lood /an6 O/tain urine & /lood samples , send to la/ ?onitor 0S & .O "epid spon'e /ath , offer hypothermic /lan6et

Circu#atory *ver#oa$: S4 a* +yspnea /* Orthopnea c* -ales or crac6les d* 34ertional discomfort Ns' ?'t< 1* Stop B" #* Notify +oc* +on>t flush due pt has circulatory overload* 3* Administer diuretics Priority cases< st st 2emolytic -4n , 1 due to hypotension , 1 priority , attend to destruction of 2'/ , O# /rain dama'e rd Aller'ic 3 th Pyro'enic 7 nd Circulatory # 2emolytic Anaphylitic # st 1
nd priority

DIC 3 DISSEMINA-ED IN-RA6ASCULAR C*AGULA-I*N +B9 Acute hemorrha'ic syndrome char /y wide spread /leedin' & throm/osis due to a def of clottin' factors & Prot1rombi 7ibri o.e %9 Predisposin' factor< 1* -apid B" #* ?assive trauma 3* ?assive /urns 7* Septicemia %* 2emolytic reaction @* Anaphyla4is L* Neoplasia , 'rowth of new tissue !* Pre'nancy S)S4 1* #* 3* 7* %* @* Petechiae , widespread & systemic &lun's; lower & upper trun6( 3cchymosis , widespread OoCin' of /lood from venipunctured site 2emoptysis , cou'h /lood 2emorrha'e Oli'uria , late s4

+4 Proc, 1* CBC , reveals decrease platelets #* Stool for occult /lood &K( Specimen , stool 3* Opthalmoscopic e4am , su/ retinal hemorrha'e 7* AB5 analysis , meta/olic acidosis "' 'C*?

33

O ? 3

p2 ph ph ph

PCO# PCO# 2CO3 2CO3

respiratory al6alosis respiratory acidosis meta/olic al6alosis meta/olic acidosis

+iarrhea , met acidosis 0omittin' , met al6 Pyloric stenosis , met al6alosis , vomitin' .leostomy or intestinal tu/in' , met acidosis Cushin'>s , met al6 +? met acid Chronic /ronchitis , resp acid , with hypo4emia; cyanosis Ns. M.t DIC 1* #* 3* 7* a* /* %* ?onitor si'ns of /leedin' , hema test K urine; stool; 5." Administer isotonic fluid solution to prevent shoc6* Administer O# inhalation Administer meds 0it H aBuamephyton Pitressin or vasopressin , to conserve water* N5" , lava'e Ase iced saline lava'e @* ?onitor N5" output L* Provide heploc6 !* Prevent complication< hypovolemic shoc6 $ate si'ns of hypovolemic shoc6 < anuria

*NC*L*GIC NSG< Oncolo'y , study of neoplasia ,new 'rowth Beni'n &tumor( +iff well differentiated 3ncapulation , &K( ?etastasis , & ( Pro'nosis , 'ood "herapeutic modality sur'ery ?ali'nancy &cancer( poorly or undifferentiated & ( &K( poor 1* Chemotherapy plenty S)3 #* -adiation 3* Sur'ery most preferred treatment 7* Bone marrow transplant $eu6emia only

Pre$is"osi . factors: (carci o.e esis% 5 , 'enetic factors . , immunolo'ic factors 0 , viral factors a* 2uman papiloma virus , causin' warts /* 3pstein /arr virus 3 , environmental Factors DEF a* Physical , irradiation; A0 rays; nuclear e4plosion; chronic irritation; direct trauma /* Chemical factors , Food additives &nitrates 2ydrocar/on vesicants; al6alies +ru's &still/estrol( Araehane 2ormones Smo6in' ?ale 3*( Prostate cancer common 7E & a/ove &middle a'e & a/ove( BP2 , %E & a/ove 1*( $un' cancer #*( $iver cancer Female 1* Breast cancer , 7E yrs old & up , mammo'raphy #* Cervical cancer , DEF multi se4ual partners %F early pre'nancy 3* Ovarian cancer C#asses of ca "issue typin' 1* #* 3* cer 1% , #E mins &SB3 , L days after mens(

Carcinoma , arises from surface epithelium & 'landular tissues Sarcoma from connective tissue or /ones ?ultiple myeloma , from /one marrow Patholo'ical fracture of ri/s & /ac6 pain 7* $ymphoma , from lymph 'lands %* $eu6emia , from /lood

:ar i . ; Da .er S) of CA C , chan'e in /owel )/ladder ha/its A , a sore that doesn>t heal A , unusual /leedin') +ischar'e " , thic6enin' of lump , /reast or elsewhere . , indi'estionR +yspha'ia

34

O N A S

, o/vious chan'e in wart) mole , na''in' cou'h) hoarseness , une4plained anemia A anemia , sudden wt loss $ , loss of wt

"herapeutic ?odality< 1* C1emot1era"y , use various chemotherapeutic a'ents that 6ills cancer cells & 6ills normal rapidly producin' cells , 5."; /one marrow; and hair follicle* Classification< a*( Al6ylatin' a'ents , /*( Plant al6aloids , vincristine c*( Anti meta/olites , nitro'en mustard d*( 2ormones , +3S Steroids e*( Antineoplastic anti/iotics S)3 & m't 5." Nausea & vomitin' Ns' ?'t< 1* Administer anti emetic 7 , @h /efore start of chemo Plasil #* 9ithhold food) fluid /efore start of chemo 3* Provide /land diet post chemo #1* Non irritatin' ) non spicy +iarrhea 1* Administer anti diarrheal 7 , @h /efore start of chemo #* ?onitor urine; .&O Bh Stomatitis) mouth sores 1* Oral care , offer ice chips) popsic6les #* .nform pt , hair loss , temporary alopecia 2air will 'row /ac6 after 7 , @ months post chemo* Bone marrow depression , anemia 1* 3nforce CB#* O# inhalation 3* -everse isolation 7* ?onitor si'ns of /leedin' -epro or'an , sterility 1* +o sperm /an6in' /efore start of chemo -enal system , increase uric acid 1* Administer allopurinol) 4yloprin &'out( ##* .nhi/its uric acid #3* Acute 'out , colchicines #7* .ncrease secretion of uric acid Neurolo'ical chan'es , peristalsis , paralytic ileus ?ost feared complication ff any a/dominal sur'ery 0incristine , plant al6aloid causes peripheral neuropathy +9 Ra$iatio "ypes of 1* #* 3* t1era"y , involves use of ioniCin' radiation that 6ills cancer cells & inhi/it their 'rowth & 6ill N rapidly producin' cells*

ener'y emitted Alpha rays , rarely used , doesn>t penetrate s6in tissues Beta rays , internal radiation , more penetration 5amma ray , e4ternal radiation , penetrates deeper underlyin' tissues

?ethods of delivery 1* 34ternal radiation involves electro ma'netic waves 34* co/alt therapy #* .nternal radiation , inGection) implantation of radioisotopes pro4imal to CA site for a specific period of time* # types< a*( Sealed implant , radioisotope with a container & doesn>t contaminate /ody fluid* /*( Ansealed implant , radioisotope without a container & contaminates /ody fluid* 34* Phosphorus 3# 3 Factors affectin' e4posure< A*( 2alf life , time period reBuired for half of radioisotopes to decay* At end of half life , less e4posure B*( +istance , the farther the distance , lesser e4posure C* ( "ime , the shorter the time; the lesser e4posure +*( Shieldin' , rays can /e shielded or /loc6ed /y usin' ru//er 'loves , & 'amma , use thic6 lead on concrete* S)3 & ?'t< a*( S6in errythema; redness; slou'hin' 1* Assist in /attlin' pt #* Force fluid , #;EEE , 3;EEE ml)day 3* Avoid lotion or talcum powder , s6in irritation 7* Apply cornstarch or olive oil /*( 5." ,nausea ) vomitin' 1* Administer antiemetic 7 , @h /efore start of chemo Plasil # 9ithhold food) fluid /efore start of chemo 3* Provide /land diet post chemo Non irritatin' ) non spicy +ys'lusia , decrease taste sensitivity 9hen atrophy papilla &taste /uds( , 7E yo Stomatitis

35

c*( Bone marrow 1* #* 3* 7*

depression 3nforce CBO# inhalation -everse isolation ?onitor si'ns of /leedin'

*vervie8 of fu ctio ! structure of t1e 1eart 'EAR?uscular; pumpin' or'an of the /ody $eft mediastinum 9ei'h 3EE , 7EE 'rams -esem/les a closed fist Covered /y serous mem/rane , pericardium Pericardium Parietal layer Pericardial Fluid , prevent Friction ru/ 0isceral layer

$ayer 1* 3picardium , outermost #* ?yocardium , inner , responsi/le for pumpin' action) most dan'erous layer 3* 3ndocardium , innermost layer Cham/ers 1* Apper , collectin') receivin' cham/er Atria #* $ower , pumpin') contractin' cham/er 0entricles 0alves 1* Atrioventricular valves "ricuspid & mitral valve st Closure of A0 valves , 'ives rise to 1 heart sound or S1 or Nlu/O #* Semi lunar valve a*( Pulmonic /*( Aortic nd Closure of semilunar valve , 'ives rise to # heart sound or S# or Ndu/O 34tra heart Sound S3 , ventricular 5allop , C2F S7 , atrial 'allop , ?.; 2PN

cardio'enic shoc6

2eart conduction system 1* Sino atrial node &SA node( &or Heith Floc6 node( $oc , Gunction of S0C & -t atrium F4 primary pace ma6er of heart .nitiates electric impulse of @E , 1EE /pm #* Atrioventicular node &A0 node or "awara node( $oc , inter atrial septum +elay of electric impulse to allow ventricular fillin' 3* Bundle of 2is , location interventricular septum -t main Bundle Branch $t main Bundle Branch 7* Pur6enGie Fi/er $oc walls of ventricles 0entricular contractions SA node

AV
Pur6enGie Fi/ers

Bundle of 2is Complete heart /loc6 , insertion of pacema6er at Bundle Branch ?etal , Pace ?a6er , chan'e B3 , % yo Prolon'ed P- , atrial fi/ S" se'ment depression , an'ina S" , elev , ?.

" wave inversion , ?. widenin' Q-S , arrhythmia

CA+ , coronary artery dse or .schemic 2eart +se &.2+( Atherosclerosis , ?yocrdial inGury An'ina Pectoris , ?yocardial ischemia ?. myocardial necrosis

A"23-OSC$3-OS.S 2ardenin' or artery due to fat) lipid deposits at tunica intima* Artery , tunica adventitia , outer "unica intima , innermost "unica media , middle

A-"3-OSC$3-OS.S Narrowin' or artery due to calcium & C2ON deposits at tunica media*

36

A"23-OSC$3-OS.S Predisposin' Factor 1* Se4 , male #* Blac6 race 3* 2yperlipidemia 7* Smo6in' %* 2PN @* +? L* Oral contraceptive prolon'ed use !* Sedentary lifestyle D* O/esity 1E* 2ypothyroidism Si'ns & Symptoms 1* Chest pain #* +yspnea 3* "achycardia 7* Palpitations %* +iaphoresis "reatment P , percutaneous " , tansluminar C , coronary A , an'ioplasty O/G< 1* #* 3* "o revasculariCe the myocardium "o prevent an'ina .ncrease survival rate

P"CA , done to pt with sin'le occluded vessel * ?ultiple occluded vessels C , coronary A , arterial B , /ypass A ,and 5 , 'raft sur'ery Ns' ?'t 1* #* 3* Before CABA5 +eep /reathin' cou'h e4ercises Ase of incentive spirometer $e' e4ercises

ANGINA PEC-*RIS- A clinical syndrome characteriCed /y paro4ysmal chest pain usually relieved /y -3S" or N5" nitro'lycerin; resultin' fr temp myocardial ischemia* Predisposin' Factor< 1* se4 , male #* /lac6 raise 3* hyperlipidemia 7* smo6in' %* 2PN @* +? L* oral contraceptive prolon'ed !* sedentary lifestyle D* o/esity 1E*hypothyroidism Precipitatin' factors 7 3>s 1* 34cessive physical e4ertion #* 34posure to cold environment 0asoconstriction 3* 34treme emotional response 7* 34cessive inta6e of food , saturated fats* Si'ns & Symptoms 1* .nitial symptoms , $evine>s si'n , hand clutchin' of chest #* Chest pain , sharp; sta//in' e4cruciatin' pain* $ocation , su/sternal radiates /ac6; shoulders; a4illa; arms & Gaw muscles relieve /y rest or N5" 3* +yspnea 7* "achycardia %* Palpitation @*diaphoresis +ia'nosis 1*2istory ta6in' & P3 #* 3C5 , S" se'ment depression 3* Stress test , treadmill 1 a/normal 3C5 7* Serum cholesterol & uric acid increase* Nursin' ?ana'ement 1*( 3nforce CB#*( Administer meds N"5 , small doses , venodilator $ar'e dose , vasodilator st 1 dose N"5 , 'ive 3 , % min nd # dose N"5 , 3 , % min rd 3 & last dose , 3 , % min rd Still painful after 3 dose , notify doc* ?.: %% yrs old with chest pain<

37

1 Buestion to as6 pt< what did you do /efore you had chest pain* nd # Buestion< does pain radiateR .f radiate , heart in nature* .f not radiate , pulmonary ori'in 0enodilator , veins of lower e4t , increase venous poolin' lead to decrease venous return* ?eds< A* N"5 Ns' ?'t< 1* Heep in a dry place* Avoid moisture & heat; may inactivate the dru'* #* ?onitor S)3< orthostatic hypotension , dec /p transient headache diCCiness 3* -ise slowly from sittin' position 7* Assist in am/ulation* %* .f 'ivin' N"5 via patch< i* avoid placin' it near hairy areas will dec dru' a/sorption ii* avoid rotatin' transdermal patches will dec dru' a/sorption iii* avoid placin' near microwave oven or durin' defi/rillation will /urn pt due aluminum foil in patch B* Beta /loc6ers , propanolol C* AC3 inhi/itors , captopril +* Ca anta'onist nefedipine Administer O# inhalation Semi fowler +iet +ecrease Na and saturated fats ?onitor 0S; .&O; 3C5 2"< +ischar'e plannin'< a* Avoid precipitatin' factors , 7 3>s /* Prevent complications , ?. c* "a6e meds /efore physical e4ertion to achieve ma4imum therapeutic effect of dru' d* .mportance of follow up care*

st

3*( 7*( %*( @*( L*(

MI 3 M5*CARDIAL IN7ARC-I*N , hear attac6 , terminal sta'e of CA+ CharacteriCed /y necrosis & scarrin' due to permanent mal occlusion "ypes< 1* #* "rasmural ?. , most dan'erous ?. , ?al occlusion of /oth -&$ coronary artery Su/ endocardial ?. , mal occlusion of either - & $ coronary artery

?ost critical period upon d4 of ?. , 7! to L#h ?aGority of pt suffers from P0C premature ventricular contraction*

Predisposin' factors 1* se4 , male #* /lac6 raise 3* hyperlipidemia 7* smo6in' %* 2PN @* +? L* oral contraceptive prolon'e d !* sedentary lifestyle D* o/esity 1E* hypothyroidism

Si'ns & symptoms 1* chest pain , e4cruciatin'; vice li6e; visceral pain located su/sternal or precodial area &rare( radiates /ac6; arm; shoulders; a4illa; Gaw & a/d muscles* not usually relived /y rest r N"5 #* dyspnea 3* erthermia 7* initial increase in BP %* mild restlessness & apprehensions @* occasional findin's a*( split S1 & S# /*( pericardial friction ru/ c*( rales )crac6les d*( S7 &atrial 'allop(

+ia'nostic 34am 1* cardiac enCymes a*( CPH , ?B , Creatinine Phospho6inase /*( $+2 , lactic acid dehydro'enase c*( S5P" , &A$"( , Serum 5lutanic Pyruvate "ransaminase increased d*( S5O" &AS"( , Serum 5lutamic O4alo acetic increased #* "roponin test , increase 3* 3C5 tracin' , S" se'ment increase; widenin' or Q-S comple4es , means arrhythmia in ?. indicatin' P0C 7* serum cholesterol & uric acid increase %* CBC , increase 9BC

Nursin' ?ana'ement 1* Narcotic anal'esics , ?orphine SO7 , to induce vasodilation & decrease levels of an4iety* #* Administer O# inhalation , low inflow &C2F increase inflow( 3* 3nforce CB- without BP a*( Bedside commode 7* Avoid valsalva maneuver %* Semi fowler @* 5eneral liBuid to soft diet , decrease Na; saturated fat; caffeine L* ?onitor 0S; .&O & 3C5 tracin's !* "a6e #E , 3E ml)wee6 , wine; /randy)whis6y to induce vasodilation* D* Assist in sur'icalU CABA5 1E* Provide pt 2" a*( Avoid modifia/le ris6 factors /*( Prevent complications< 1* Arrhythmias , P0C #* Shoc6 , cardio'enic shoc6* $ate si'ns of cardio'enic shoc6 in ?. , oli'uria 3* throm/ophle/itis deep vein 7* C2F , left sided %* +ressler>s syndrome , post ?. syndrome -esistant to medications Administer 1%E;EEE , 7%E;EEE units of strepto6inase c*( Strict compliance to meds

38

0asodilators 1* N"5 #* .sordil Antiarrythmic 1* $ydocaine /loc6s release of norepenephrine #* Brithylium Beta /loc6ers , NlolO 1* Propanolol &inderal( AC3 inhi/itors pril 1* Captopril , &enalapril( Ca , anta'onist 1* Nifedipine "hrom/olitics or fi/rinolytics, to dissolve clots) throm/us S)3 aller'ic reactions) uticaria 1* Strepto6inase #* Aro6inase 3* "issue plasmino'en adGustin' factor ?onitor for /leedin'< Anticoa'ulants 1* 2eparin P"" .f prolon'ed /leedin'

#* Caumadin , delayed reaction # , 3 days P" prolon'ed /leedin'

Antidote antidote 0it H Protamine sulfate Anti platelet PASA &aspirin( d*( -esume A+$ , se4) activity , 7 to @ wee6s Post cardiac reha/ 1*(Se4 as an appetiCer rather then dessert , Before meals not after; due after meals increase meta/olism , heart is pumpin' hard after meals* #*( Position , non wei'ht /earin' position* 9hen to resume se4) act< 9hen pt can already use staircase; then he can resume se4* e*( +iet , decrease Na; Saturated fats; and caffeine f*( Follow up care* C'7 3 C*NGES-I6E 'EAR- 7AILURE - .na/ility of heart to pump /lood towards systemic circulation* Bac6flow 1*( Left si$e$ 1eart fai#ure: Predisposin' factors< 1*( DEF mitral valve stenosis , due -2+; a'in' -2+ affects mitral valve , streptococcal infection +4< Aso titer , anti streptolysine O S 3EE total units Steroids Penicillin Aspirin Complication< -S C2F A'in' , de'eneration ) calcification of mitral valve .schemic heart disease 2PN; ?.; Aortic stenosis

S)S4 Pulmonary con'estion) 3dema 1* +yspnea #* Orthopnea &+iff of /reathin' sittin' pos , platypnea( 3* Paro4ysmal nocturnal dysnea , PNO nalulunod 7* Productive cou'h with /lood tin'ed sputum %* Frothy salivation &from lun's( @* Cyanosis L* -ales) crac6les , due to fluid !* Bronchial wheeCin' D* P?. , displaced lateral , due cardiome'aly 1E* Pulsus alternons , wea6 stron' pulse 11* Anore4ia & 'eneral /ody malaise 1#* S3 , ventricular 'allop +4 1* #* CJ- , cardiome'aly PAP , Pulmonary Arterial Pressure PC9P , Pulmonary Capillary9ed'e Pressure PAP , measures pressure of - ventricle* .ndicates cardiac status* PC9P , measures end systolic) diastolic pressure PAP & PC9P< Swan , 'anC catheteriCation , cardiac catheteriCation is done at /edside at .CA &"rachesostomy , /edside( +one % , #E mins , scalpel & trachesostomy set

39

3* 7*

C0P , indicates fluid or hydration status .ncrease C0P , decrease flow rate of .0 +ecrease C0P , increase flow rate of .0 3chocardio'raphy , reveals enlar'ed heart cham/er or cardiomayopathy AB5 , PCO# increase; PO# decrease 1 1 hypo4emia 1 resp acidosis

#*( Ri.1t si$e$ '7 Predisposin' factor 1* DEF tricuspid stenosis #* COP+ 3* Pulmonary em/olism 7* Pulmonic stenosis %* $eft sided heart failure S)S4 0enous con'estion Nec6 or Gu'ular vein distension Pittin' edema Ascites 9t 'ain 2epatome'alo) splenome'aly Taundice Pruritus 3sopha'eal varies Anore4ia; 'en /ody malaise

+ia'nosis< 1* #* CJ- , cardiome'aly C0P , measures the pressure at - atrium Normal< 7 to 1E cm of water .ncrease C0P S 1E , hypervolemia +ecrease C0P M 7 , hypovolemia Flat on /ed , post of pt when 'ivin' C0P Position durin' C0P insertion , "rendelen/ur' to prevent pulmonary em/olism & promote ventricular fillin'*

3* 3chocardio'raphy , enlar'ed heart cham/er ) cardiomyopathy /*$iver enCyme S5P" & A$"( S5O" AS" Ns' m't< .ncrease force of myocardial contraction 1 increase CO 3 , @$ of CO 1* Administer meds< "4 for $S2F< ? , morphine SO7 to induce vasodilatation A , aminophylline & decrease an4iety + , di'italis &di'o4in( + diuretics O o4y'en 5 'ases a*( Cardiac 'lycosides .ncrease myocardial 1 increase CO +i'o4in &$ano4in(* Antidote< di'ivine +i'ito4in< meta/oliCes in liver not in 6idneys not 'iven if with 6idney failure* /*( $oop diuretics< $asi4 , effect with in 1E 1% min* ?a4 1 @ hrs c*( Bronchodilators< Aminophillin &"heophyllin(* Avoid 'ivin' caffeine d*( Narcotic anal'esic< ?orphine SO7 induce vasodilaton & decrease an4iety e*( 0asodilators , N"5 f*( Anti arrythmics , $idocaine #* 3* 7* %* @* Administer O# inhalation , hi'h: W 3 7$)min via nasal cannula 2i'h fowlers -estrict Na: Provide meticulous s6in care 9ei'h pt daily* Assess for pittin' edema* ?easure a/dominal 'irth daily & notify ?+ L* ?onitor 0)S; .&O; /reath sounds !* .nstitute /loodless phle/otomy* -otatin' tourniBuet or BP cuff rotated cloc6wise B 1% mins 1 to promote decrease venous return D* +iet , decrease salt; fats & caffeine 1E* 2"< a( Complications <shoc6 Arrhythmia "hrom/ophle/itis ?. Cor Pulmonale , -" ventricular hypertrophy /*( +ietary modifications c*( Adherence to meds

PERIP'ERAL MUSCULAR DISEASE

40

Arterial ulcers 1* "hrom/oan'iitis O/literans , male) feet #* -eynauds , female) hands

venous ulcer 1* 0aricose veins #* "hrom/ophle/itis

19% -1romboa .iitis ob#iterates; 0UERGER DISEASE Acute inflammatory disorder affectin' small to medium siCed arteries & veins of lower e4tremities* ?ale) feet Predisposin' factors< ?ale Smo6ers S)S4 1* .ntermittent claudication , le' pain upon wal6in' #* Cold sensitivity & s6in color chan'es 9hite Pallor 3* 7* %* @* /luish cyanosis

-elieved /y rest red ru/or

+ecrease or diminished peripheral pulses "ropic chan'es Alcerations 5an'rene formation

Post ti/ial; +orsalis pedis

+4< 1* #* 3* Oscillometry , decrease peripheral pulse volume* +oppler A"P , decrease /lood flow to affected e4tremities* An'io'raphy , reveals site & e4tent of mal occulsion*

Ns' ?'t< 1* 3ncoura'e a slow pro'ression of physical activity a*( 9al6 3 7 4 ) day /*( Out of /ed # , 3 4 a ) day #* ?eds a*( Anal'esic /*( 0asodilator c*( Anticoa'ulant 3* Foot care m't li6e +? , a*( Avoid wal6in' /arefoot /*( Cut toe nails strai'ht c*( Apply lanolin lotion , prevent s6in /rea6down d*( Avoid wearin' constrictive 'arments 7* Avoid smo6in' & e4posure to cold environment %* Sur'ery< BHA &Below the 6nee amputation( #*(RE5NAUD(S P'EN*MEN*N , acute episodes of arterial spasm affectin' di'its of hands & fin'ers Predisposin' factors< 1* #* 3* Female; 7E yrs Smo6in' Colla'en dse a*( S$3 , patho'nomonic si'n , /utterfly rash on face Chipmun6 face , /ulimia nervosa Cherry red s6in , car/on mono4ide poisonin' Spider an'ioma , liver cirrhosis Caput medusae , le' & trun6 um/ilicus $iver cirrhosis $ion face , leprosy /*( -heumatoid arthritis , +irect hand trauma , piano playin'; e4cessive typin'; operatin' chainsaw 1* #* .ntermittent claudication Cold sensitivity le' pain upon wal6in' -elieved /y rest

7* S)S4<

Ns' ?'t< a* Anal'esics /* 0asodilators c* 3ncoura'e to wear 'loves especially when openin' a refri'erator* d* Avoid smo6in' & e4posure to cold environment 6EN*US ULCERS 1* 6ARIC*SI-IES ; 6aricose vei s A/normal dilation of veins , lower e4t & trun6 +ue to< a*( .ncompetent valves leadin' to /*( .ncrease venous poolin' & stasis leadin' to c*( +ecrease venous return Predisposin' factors< a* 2ereditary

41

/* c* d* e* f* '* S)S4<

Con'enital wea6ness of veins "hrom/ophle/itis 2eart dse Pre'nancy O/esity Prolon'ed immo/ility Prolon'ed standin' 1* #* 3* 7* Pain especially after prolon'ed standin' +ilated tortuous s6in veins 9arm to touch 2eaviness in le's

+4< 1* #* 0eno'raphy "rendelen/er'>s test , vein distend Buic6ly M 3% secs

Ns' ?'t< 1* 3levate le's a/ove heart level , to promote venous return , 1 to # pillows #* ?easure circumference of le' muscles to determine if swollen* 3* 9ear anti em/olic or 6nee hi'h stoc6in's* 9omen , panty hose 7* ?eds< Anal'esics %* Sur'ery< vein sweepin' & li'ation Sclerotherapy , spider we/ varicosities S)3 throm/osis -'R*M0*P'LE0I-IS &deep vein throm/osis( .nflammation of veins with throm/us formation Predisposin' factors< 1* Smo6in' #* O/esity 3* 2yperlipedemia 7* Prolon'ed use of oral contraceptives %* Chronic anemia @* +? L* ?. !* C2F D* Postop complications 1E* Post cannulation , insertion of various cardiac catheters S)S4< 1* #* 3* +4< Pain at affected e4tremities Cyanosis &K( 2oman>s si'n Pain at le' muscles upon dorsifle4ion of foot*

1* An'io'raphy #* +oppler A"P Ns' ?'t< 1* 3levate le's a/ove heart level* #* Apply warm; moist pac6s to decrease lymphatic con'estion* 3* ?easure circumference of le' muscles to detect if swollen* 7* Ase anti em/olic stoc6in's* %* ?eds< Anal'esics* Anticoa'ulant< 2eparin @* Complication< Pu#mo ary Embo#ism: Sudden sharp chest pain +yspnea "achycardia Palpitation +iaphoresis ?ild restlessness

*6ER6IE: *7 RESPIRA-*R5 S5S-EM: .* Apper respiratory tract< F4< 1* Filterin' of air #* 9armin' & moistenin' 3* 2umidification a* Nose, cartila'e Parts< -t nostril separated /y septum $t nostril /* Consists of anastomosis of capillaries , Hessel , Bach Ple4us , site of epista4is Pharyn4 &throat( , muscular passa'eway for air& food Branches< 1* Oropharyn4 #* Nasopharyn4 3* $ayn'opharyn4

c* $aryn4 , voice /o4 F4< 1* For phonation

42

#*

Cou'h refle4

5lottis , openin' Opens to allow passa'e of air Closes to allow passa'e of food ..* $ower -t , F4 for 'as e4chan'e a* "rachea , windpipe has cartilla'enous rin's site for permanent) artificial a)w , tracheostomy /* Bronchus , - & $ main /ronchus c* $un's , - , 3 lo/es 1 1E se'ments $ , # lo/es , ! se'ments Post pneumonectomy position affected side to promote e4pansion of lun's Post se'mental lo/ectomy , position unaffected side to promote draina'e $un's , covered /y pleural cavity; parietal lo/e & visceral lo/e Alveoli , acinar cells site of 'as e4chan'e &O# & CO#( diffusion< +altons law of partial pressure of 'ases 0entilation , movement of air in & out of lun's -espiration , movement of air into cells "ype .. cells of alveoli , secrets surfactant Surfactant decrease surface tension of alveoli $ecithin & spino'ometer $)S ratio #<1 , indicator of lun' maturity .f 1<# , adm O# M 7EF Concentration to prevent atelectasis & retinopathy or /lindness*

.* PNEUM*NIA , inflammation of lun' parenchyma leadin' to pulmonary consolidation as alveoli is filled with e4udates* 3tiolo'ic a'ents< 1* Streptococcus pneumoniae &pnemococcal pneumonia( #* 2emophilus pneumoniae&Bronchopneumonia( 3* 3scherichia coli 7* Hle/siella P* %* +iplococcus P* 2i'h ris6 elderly & children /elow % yo Predisposin' factors< 1* Smo6in' #* Air pollution 3* .mmuno compromised a* A.+S , P$P /* Broncho'enic CA Non productive to productive cou'h 7* Prolon'ed immo/ility , C0A hypostatic pneumonia %* Aspiration of food @* Over fati'ue S)S4< 1* #* 3* 7* %* @* L* !* Productive cou'h , patho'nomonic< .ree is1 to rusty s"utum +yspnea with prolon'ed respiratory 'runt Fever; chills; anore4ia; 'en /ody malaise 9t loss Pleuritic friction ru/ -ales) crac6les Cyanosis A/dominal distension leadin' to paralytic ileus

Sputum e4am , could confirm presence of "B & pneumonia +4< 1* Sputum 5SCS 'ram stainin' & culture sensitivity #* CJ- , pulmo consolidation 3* CBC , increase 9BC 3rythrocyte sedimentation rate 7* AB5 , PO# decrease Ns' ?'t< 1* #* 3* 3nforce CBStrict respiratory isolation ?eds< a*( Broad spectrum anti/iotics Penicillin or tetracycline ?acrolides , e4 aCythromycin &Cythroma4( /*( Anti pyretics c*( ?ucolytics or e4pectorants Force fluids , # to 3 $)day .nstitute pulmonary toilet a*( +eep /reathin' e4ercise -eveals &K( cultured microor'anism*

7* %*

43

/*( Cou'hin' e4ercise c*( Chest physiotherapy , cuppin' d*( "urnin' & reposition Promote e4pectoration of secretions @* Semi fowler L* Ne/uliCe & suction !* Comfy & humid environment D* +iet< increase C2O or calories; C2ON & vit C 1E* Postural draina'e "o drain secretions usin' 'ravity ?'t for postural draina'e< a*( Best done /efore meals or # , 7 hrs after meals to prevent 5astroesopha'eal -eflu4 /*( ?onitor 0S & /reath sounds Normal /reath sound , /ronchovesicular c*( +eep /reathin' e4ercises d*( Adm /ronchodilators 1% , 3E min /efore procedure e*( Stop if pt can>t tolerate procedure f*( Provide oral care , it may alter taste sensation '*( C). , pt with unsta/le 0S & hemoptysis; increase .CP; increase .OP &'laucoma( Normal .OP , 1# , #1 mm2' 11* 2"< a*( Avoidance of precipitatin' factors /*( Complication< Atelectacies & menin'itis c*( Compliance to meds PULM*NAR5 -U0ERCUL*SIS (2*C' DSE% - .nflammation of lun' tissue caused /y invasion of myco/acterium "B or tu/ercle /acilli or acid fast /acilli , 'ram &K( aero/ic; motile & easily destroyed /y heat or sunli'ht* Predisposin' factors< 1* ?alnutrition #* Overcrowdin' 3* Alcoholism 7* .n'estion of infected cattle &myco/acterium BO0.S( %* 0irulence @* Over fati'ue S)S4< 1* #* 3* 7* %* @* L* Productive cou'h , yellowish $ow fever Ni'ht sweats +yspnea Anore4ia; 'eneral /ody malaise; wt loss Chest) /ac6 pain 2empotysis

+ia'nosis< 1* S6in test , mantou4 test , infection of Purified C2ON +erivative PP+ +O2 , ! 1E mm induration 92O , 1E 17 mm induration -esult within 7! , L#h &K( ?antou4 test , previous e4posure to tu/ercle /acilli ?ode of #* 3* 7* Nursin' 1* #* 3* 7* %* @* L* !* D* 1E* transmission , droplet infection Sputum AFB , &K( to cultured microor'anism CJ- , pulmonary infiltrate CBC , increase 9BC

caseosis necrosis

?'t< CBStrict resp isolation O# inhalation Semi fowler Force fluid to liBuefy secretions +BC3 Ne/uliCe & suction Comfy & humid environment +iet , increase C2O & calories; C2ON; 0it; minerals Short course chemotherapy .ntensive phase .N2 , isoniaCide -ifampicin 'ive /efore meals for a/sorption 'iven within 7 months; 'iven simultaneously to prevent resistance S)3< peripheral neutitis , vit B@ -ifampicin All /ody secretions turn to red oran'e color urine; stool; saliva; sweat & tears*

PPA , PyraCinamide , 'iven # mos) after meals* S)3< aller'ic r4n; nephroto4icity & hepato4icity Sta $ar$ re.ime 1* .nGection of streptomycin , amino'lycoside 34* Hanamycin; 'entamycin; neomycin S)3< a*( Ototo4icity , dama'e CN V ! , tinnitus , hearin' loss /*( Nephroto4icicity , monitor BAN & Crea a*( Avoid pred factors /*( Complications< 1*( Atelectasis #*( ?iliary "B , spread of "/ to other system

2"<

44

c*( Compliance to meds -eli'iously ta6e meds 'IS-*PLASM*SIS acute fun'al infection caused /y inhalation of contaminated dust with histoplasma capsulatum transmitted to /irds manure* S)S4< Same as pneumonia & P"B , li6e 1* Productive cou'h #* +yspnea 3* Chest & Goint pains 7* Cyanosis %* Anore4ia; 'en /ody malaise; wt loss @* 2emoptysis +4< 1* #* 2istoplasmin s6in test 1 &K( AB5 , pO# decrease

Ns' ?'t< 1* CB#* ?eds< a*( Anti fun'al a'ents Amphotericin B &Fun'iCone( S)3 < a*( Nephroto4cicity chec6 BAN /*( 2ypo6alemia /*(Corticosteroids c*( ?ucolytic) or e4pectorants 3* O# , force fluids 7* Ne/uliCe; suction %* Complications< a*( Atelectasis /*( Bronchiectasis COP+ @* Prevent spread of histoplasmosis< a*( Spray /readin' places or 6ill the /ird*

C*PD 3 1* #* 3* 7*

C1ro ic *bstructive Pu#mo ary Disease Chronic /ronchitis Bronchial asthma Bronchiectasis Pulmonary emphysema , terminal sta'e

C'R*NIC 0R*NC'I-IS called B$A3 B$OA"3-S inflammation of /ronchus due to hypertrophy or hyperplasia of 'o/let mucus producin' cells leadin' to narrowin' of smaller airways* Predisposin' factors< 1* Smo6in' , all COP+ types #* Air pollution S)S4< 1* Prod cou'h #* +yspnea on e4ertion 3* Prolon'ed e4piratory 'runt 7* Scattered rales) rhonchi %* Cyanosis @* Pulmo 2PN , a*($eadin' to peripheral edema /*( Cor pulmonary , respiratory in ori'in L* Anore4ia; 'en /ody malaise +4< 1* AB5 PO# PCO# -esp acidosis

2ypo4emia , causin' cyanosis Ns' ?'t< &Same as emphysema( #*( 0R*NC'IAL AS-'MA reversi/le inflammation lun' condition due to hyerpsensitivity leadin' to narrowin' of smaller airway* Predisposin' factor< 1* 34trinsic Asthma , called Atropic) aller'ic asthma a*( Pallor /*( +ust c*( 5ases d*( Smo6e e*( +ander f*( $ints #* .ntrinsic Asthma Cause< 2erediatary +ru's , aspirin; penicillin; /loc6ers Food additives , nitrites Foods , seafood; chic6en; e''s; chocolates; mil6 Physical) emotional stress

45

3* S)S4< 1* #* 3* 7* %* @* L* +4< 1* #*

Sudden chan'e of temp; humidity &air pressure mi4ed type< com/i of /oth e4t & intr* Asthma DEF cause of asthma C , cou'h , non productive to productive + , dyspnea 9 , wheeCin' on e4piration Cyanosis ?ild apprehension & restlessness "achycardia & palpitation +iaphoresis Pulmo function test , decrease lun' capacity AB5 , PO# decrease

Ns' ?'t< 1* CB- , all COP+ #* ?eds st a*( Bronchodilator throu'h inhalation or metered dose inhaled ) pump* 5ive 1 /efore corticosteroids /*( Corticosteroids , due inflammatory* 5iven 1E min after adm /ronchodilator c*( ?ucolytic) e4pectorant d*( ?ucomist , at /edside put suction machine* e*( Antihistamine 3* Force fluid 7* O# , all COP+ low inflow to prevent resp distress %* Ne/uliCe & suction @* Semifowler , all COP+ e4cept emphysema due late sta'e L* 2" a*( Avoid pred factors /*( Complications< Status astmaticus 'ive epinephrine & /ronchodilators 3mphysema c*( Adherence to med 0R*NC'IEC-ASIS , a/normal permanent dilation of /ronchus resultin' to destruction of muscular & elastic tissues of alveoli* Predisposin' factors< 1* -ecurrent upper & lower -. #* Con'enital anomalies 3* "umors 7* "rauma S)S4< 1* Productive cou'h #* +yspnea 3* Anore4ia; 'en /ody malaise all ener'y are used to increase respiration* 7* Cyanosis %* 2emoptysis +4< AB5 , PO# decrease Bronchoscopy , direct visualiCation of /ronchus usin' fi/erscope* Ns' ?'t< /efore /ronchoscopy 1* Consent; e4plain procedure , ?+) la/ e4plain -N #* NPO 3* ?onitor 0S 7* Ns. M.t after bro c1osco"y 1* Feedin' after return of 'a' refle4 #* .nstruct client to avoid tal6in'; smo6in' or cou'hin' 3* ?onitor si'ns of fran6 or 'ross /leedin' 7* ?onitor of laryn'eal spasm +OB Prepare at /edside tracheostomy set ?'t< same as emphysema e4cept Sur'ery Pneumonectomy , removal of affected lun' Se'mental lo/ectomy , position of pt , unaffected side 1* #*

PULM*NAR5 EMP'5SEMA , irreversi/le terminal sta'e of COP+ CharacteriCed /y inelasticity of alveolar wall leadin' to air trappin'; leadin' to maldistri/ution of 'ases* Body will compensate over distension of thoracic cavity Barrel chest Predisposin' factor< 1* Smo6in' #* Aller'y 3* Air pollution 7* 2i'h ris6 , elderly %* 2ereditary 1 anti trypsin to release elastase for recoil of alveoli* S)S4< 1* #* 3* Productive cou'h +yspnea at rest , due terminal Anore4ia & 'en /ody malaise

46

7* %* @* L* !* D* 1E* 11*

-ales) rhonchi Bronchial wheeCin' +ecrease tactile fremitus &should have vi/ration(, palpation , NDDO* +ecreased -esonance to hyperresonance , percussion +ecreased or diminished /reath sounds Patho'nomonic< /arrel chest , increase post) anterior diameter of chest Purse lip /reathin' , to eliminated PCO# Flarin' of alai nares

with air or fluid

+ia'nosis< 1* Pulmonary function test , decrease vital lun' capacity #* AB5 , a*( Panlo/ular ) centrolo/ular emphysema pCO# increase pO# decrease , hypo4ema resp acidosis Blue /loaters /*( Panacinar) Centracinar pCO# decrease pO# increase , hypera4emia resp al6alosis Pin6 puffers

Nursin' ?'t< 1* CB#* ?eds , a*( Bronchodilators /*( Corticosteroids c*( Antimicro/ial a'ents d*( ?ucolytics) e4pectorants 3* O# , $ow inflow 7* Force fluids %* 2i'h fowlers @* Ne/ & suction L* .nstitute P , posture 3 , end 3 , e4piratory to prevent collapse of alveoli P , pressure !* 2" a*( Avoid smo6in' /*( Prevent complications 1*( Cor pulmonary , - ventricular hypertrophy #*( CO# narcosis , lead to coma 3*( Atelectasis 7*( Pneumothora4 , air in pleural space D* Adherence to meds

-3S"-.C".03 $AN5 +.SO-+3PNEUM*-'*RA< , partial ) or complete collapse of lun's due to entry or air in pleural space* "ypes< 1* Spontaneous pneumothora4 , entry of air in pleural space without o/vious cause* 3'* rupture of /le/ &alveoli filled sacs( in pt with inflammed lun' conditions 3'* open pneumothora4 , air enters pleural space throu'h an openin' in chest wall Sta/) 'un shot wound #* "ension Pneumothora4 , air enters plural space with W inspiration & can>t escape leadin' to over distension of thoracic cavity resultin' to shiftin' of mediastinum content to unaffected side* 3'* flail chest , Nparado4ical /reathin'O Predisposin' factors< 1*Chest trauma #*.nflammatory lun' conditions 3*"umor S)S4< 1* Sudden sharp chest pain #* +yspnea 3* Cyanosis 7* +iminished /reath sound of affected lun' %* Cool moist s6in @* ?ild restlessness) apprehension L* -esonance to hyper resonance +ia'nosis< 1* AB5 , pO# decrease , #* CJ- , confirms pneumothora4 Nursin' ?'t< 1* 3ndotracheal intu/ation #* "horacenthesis 3* ?eds , ?orphine SO7 Anti micro/ial a'ents 7* Assist in test tu/e thoracotomy Nursin' ?'t if pt is on CP" attached to 2#O draina'e 1* ?aintain strict aseptic techniBue #* +B3 3* At /edside a*( Petroleum 'auCe pad if dislod'ed 2emostan /*( .f with air lea6a'e , clamp c*( 34tra /ottle 7* ?eds , ?orphine SO7

47

%*

Antimicro/ial ?onitor & assess for oscillation fluctuations or /u//lin' a*( .f &K( to intermittent /u//lin' means normal or intact 2#O rises upon inspiration 2#o 'oes down upon e4piration /*( .f &K( to continuous; remittent /u//lin' 1* Chec6 for air lea6a'e #* Clamp towards chest tu/e 3* Notify ?+ c*( .f & ( to /u//lin' 1* Chec6 for loop; clots; and 6in6 #* ?il6 towards 2#O seal 3* .ndicates re e4pansion of lun's

9hen will ?+ remove chest tu/e< 1* .f & ( fluctuations #* &K( Breath sounds 3* CJ- , full e4pansion of lun's Nursin' 1* #* 3* ?'t of removal of chest tu/e +B3 .nstruct to perform 0alsalva maneuver for easy removal; to prevent entry of air in pleural space* Apply vaselinated air occlusive dressin' ?aintain dressin' dry & intact

GI.* Apper alimentary canal function for di'estion a* ?outh /* Pharyn4 &throat( c* 3sopha'us d* Stomach st e* 1 half of duodenum ..* ?iddle Alimentary canal , Function< for a/sorption Complete a/sorption , lar'e intestine nd a* # half of duodenum /* TeGunum c* .leum st d* 1 half of ascendin' colon ...* $ower Alimentary Canal , Function< elimination nd a* # half of ascendin' colon /* "ransverse c* +escendin' colon d* Si'moid e* -ectum .0* Accessory Or'an a* Salivary 'land /* 0erniform appendi4 c* $iver d* Pancreas , auto di'estion e* 5all/ladder , stora'e of /ile .* Salivary 5lands 1* Parotid , /elow & front of ear #* Su/lin'ual 3* Su/ma4illary Produces saliva , for mechanical di'estion 1#EE 1%EE ml)day saliva produced

PAR*-I-IS , NmumpsO , inflammation of parotid 'land Paramy4o virus S)S4< 1* #* 3* 7* Fever; chills anore4ia; 'en /ody malaise Swellin' of parotid 'land +yspha'ia 3ar ache , otal'ia

?ode of transmission< +irect transmission & droplet nuclei .ncu/ation period< 17 , #1 days Period of communica/ility , 1 wee6 /efore swellin' & immediately when swellin' /e'ins* Nursin' 1* #* 3* ?'t< CBStrict isolation ?eds< anal'esic Antipyretic Anti/iotics , to prevent # complications 7* Alternate warm & cold compress at affected part %* 5en liBuid to soft diet @* Complications 9omen , cervicitis; va'initis; oophoritis Both se4es , menin'itis & encephalitis) reason why anti/iotics is needed ?en , orchitis mi'ht lead to sterility if it occur durin' ) after pu/erty*

48

03-N.FO-? APP3N+.J , -t iliac or -t in'uinal area Function , lymphatic or'an , produces 9BC durin' fetal life

ceases to function upon /irth of /a/y

APENDICI-IS , inflamation of verniform appendi4 Predisposin' factor< 1* ?icro/ial infection #* Feacalith , undi'ested food particles , tomato seeds; 'uava seeds 3* .ntestinal o/struction S)S4< 1* #* 3* 7* %* Patho'nomonic si'n< &K( re/ound tenderness $ow 'rade fever; anore4ia; n)v +iarrhea ) & or constipation Pain at -t iliac re'ion $ate si'n due pain , tachycardia

+ia'nosis< 1* CBC , mild leu6ocytosis , increase 9BC #* P3 , &K( re/ound tenderness &fle4 -t le'; palpate -t iliac area , re/ound( 3* Arinalysis "reatment< appendectomy #7 , 7% Nursin' ?'t< 1* Consent #* -outinary nursin' measures< a*( S6in prep /*( NPO c*( Avoid enema , lead to rupture of appendi4 3* ?eds< Antipyretic Anti/iotics 8+on>t 'ive anal'esic , will mas6 pain Presence of pain means appendi4 has not ruptured* 7* Avoid heat application , will rupture appendi4* %* ?onitor 0S; .&O /owel sound Nursin' ?'t< post op 1* .f &K( to Pendrose drain , indicates rupture of appendi4 Position affected side to drain #* ?eds< anal'esic due post op pain Anti/iotics; Antipyretics P-N 3* ?onitor 0S; .&O; /owel sound 7* ?aintain patent .0 line %* Complications peritonitis; septicemia $iver , lar'est 'land Occupies most of ri'ht hypochondriac re'ion Color< scarlet red Covered /y a fi/rous capsule , 5lisson>s capsule Functional unit , liver lo/ules Function< Produces /ile Bile , emulsifies fats Composed of 2#O & /ile salts 5ives color to urine , uro/ilin Stool , stirco/ilin #* +eto4ifies dru's 3* Promotes synthesis of vit A; +; 3; H 2ypevitaminosis , vit + & H 0it A , retinol +ef 0it A , ni'ht /lindness 0it + , cholecalciferon 2elps calcium -ic6ets; osteoarthritis 1*

fat solu/le vitamins

7* .t destroys e4cess estro'en hormone %* For meta/olism A* C2O , 1* 5lyco'enesis , synthesis of 'lyco'ens #* 5lyco'enolysis , /rea6down of 'lyco'en 3* 5luconeo'enesis , formation of 'lucose from C2O sources B* C2ON 1* Promotes synthesis of al/umin & 'lo/ulin Cirrhosis , decrease al/umin Al/umin , maintains osmotic pressure; prevents edema #* Promotes synthesis of prothrom/in & fi/rino'en 3* Promotes conversion of ammonia to urea* Ammonia li6e /reath , fetor hepaticus C* FA"S , promotes synthesis of cholesterol to neutral fats , called tri'lycerides LI6ER CIRR'*SIS lost of architectural desi'n of liver leadin' to fat necrosis & scarrin'

3arly si'n , hepatic encephalopathy 1* Asteri4is , flappin' hand tremors $ate si'ns , headache; restlessness; disorientation; decrease $OC , hepatic coma* Nursin' priority , assist in mechanical ventilation

49

Predisposin' factor< +ecrease $aennac>s cirrhosis , caused /y alcoholism 1* Chronic alcoholism #* ?alnutrition , decrease0it B; thiamin 3* 0irus , 7* "o4icity e'* Car/on tetrachloride %* Ase of hepatoto4ic a'ents S)S4< 3arly si'ns< a*( 9ea6ness; fati'ue /*( Anore4ia; n)v c*( Stomatitis d*( Arine , tea color Stool , clay color e*( Amenorrhea f*( +ecrease se4ual ur'e '*( $oss of pu/ic; a4illa hair h*( 2epatome'aly i*( Taundice G*( Pruritus or urticaria #* $ate si'ns

main cause

a*( 2ematolo'ical chan'es , all /lood cells decrease $eu6openia decrease "hrom/ocytopenia decrease Anemia decrease /*( 3ndocrine chan'es Spider an'iomas; 5ynecomastia Caput medusate; Palmar errythema c*( 5." chan'es Ascitis; /leedin' esopha'eal varices , due to portal 2PN d*( Neurolo'ical chan'es< 'e"atic e ce"1a#o"at1y - ammonia &cere/ral to4in( $ate si'ns< 3arly si'ns< 2eadache astere4is Fetor hepaticus &flappin' hand tremors( Confusion -estlessness +ecrease $OC 2epatic coma

+ia'nosis< 1* $iver enCymes increase S5P" &A$"( S5O" &AS"( Serum cholesterol & ammonia increase .ndirect /iliru/in increase CBC pancytopenia P"" , prolon'ed 2epatic ultrasono'ram , fat necrosis of liver lo/ules

#* 3* 7* %* @* Nursin' 1* #* 3* 7* %* @* L*

?'t CB-estrict Na: ?onitor 0S; .&O 9ith pt daily & assess pittin' edema ?easure a/dominal 'irth daily , notify ?+ ?eticulous s6in care +iet , increase C2O; vit & minerals* ?oderate fats* +ecrease C2ON 9ell /alanced diet !* Complications< a*( Ascites , fluid in peritoneal cavity Nursin' ?'t< 1* ?eds< $oop diuretics , 1E , 1% min effect #* Assist in a/dominal paracentesis aspiration of fluid 0oid /efore paracentesis to prevent accidental puncture of /ladder as trochar is inserted /*( 0#ee$i . eso"1a.ea# varices +ilation of esopha'eal veins 1* ?eds< 0it H Pitrisin or 0asopresin &.?( #* N5" decompression lava'e 5ive /efore lava'e , ice or cold saline solution ?onitor N5" output 3* Assist in mechanical decompression .nsertion of sen'sta6en /lac6emore tu/e 3 lumen typed catheter Scissors at /edside to deflate /alloon*

50

c*( 2epatic encephalopathy , 1* Assist in mechanical ventilation , due coma #* ?onitor 0S; neuro chec6 3* Siderails , due restless 7* ?eds , $a4atives , to e4crete ammonia

'EPA-I-IS Gaundice &icteric sclera( Biliru/in Hernicterus) hyper/iliru/inia .rreversi/le /rain dama'e

Pancreas , mi4ed 'land &e4ocrine & endocrine 'land( PANCREA-I-IS , acute or chronic inflammation of pancreas leadin' to pancreatic edema; hemorrha'e & necrosis due to auto di'estion* Bleedin' of pancreas Cullen>s si'n at um/ilicus Predisposin' factors< 1* Chronic alcoholism #* 2epato/ilary disease 3* O/esity 7* 2yperlipidemia %* 2yperparathyroidism @* +ru's , "hiaCide diuretics; pills Pentamidine 2C$ &Pentam( L* +iet , increase saturated fats S)S4< 1* Severe $t epi'astric pain , radiates from /ac6 &flan6 area A''ravated /y eatin'; with +OB #* N)0 3* "achycardia 7* Palpitation due to pain %* +yspepsia , indi'estion @* +ecrease /owel sounds L* &K( Cullen>s si'n ecchymosis of um/ilicus hemorrha'e !* &K( 5rey "urner>s spots , ecchymosis of flan6 area D* 2ypocalcemia +ia'nosis< 1* Serum amylase & lipase , increase #* Arine lipase , increase 3* Serum Ca , decrease Nursin' ?'t< 1* ?eds a*( Narcotic anal'esic ?eperidine 2cl &+emerol( +on>t 'ive ?orphine SO7 ,will cause spasm of sphincter* /*( Smooth muscle rela4ant) anti choliner'ic 34* Papavarine 2cl Prophantheline Bromide &Profanthene( c*( 0asodilator , N"5 d*( Antacid , ?aalo4 e*( 2# receptor anta'onist -anitidin &Pantac( to decrease pancreatic stimulation f*( Ca , 'luconate #* 9ithold food & fluid , a''ravates pain 3* Assist in -ota# Pare tera# Nutritio (-PN% or hyperalimentation Complications of "PN 1* .nfection #* 3m/olism 3* 2yper'lycemia 7* .nstitute stress m't tech a*( +B3 /*( Biofeed/ac6 %* Comfy position Hnee chest or fetal li6e position @* .f pt can tolerate food; 'ive increase C2O; decrease fats; and increase C2ON L* Complications< Chronic hemorrha'ic pancreatitis 5A$$B$A++3- , stora'e of /ile , made up of cholesterol* C'*LEC5S-I-IS; C'*LELI-'IASIS , inflammation of 'all/ladder with 'allstone formation* Predisposin' factor< 1* 2i'h ris6 , women 7E years old #* Post menopausal women , under'oin' estro'en therapy 3* O/esity 7* Sedentary lifestyle %* 2yperlipidemia @* Neoplasm S)S4< 1* Severe -i'ht a/dominal pain &after eatin' fatty food(* Occurrin' especially at ni'ht #* Fatty intolerance

51

3* 7* %* @* L* !*

Anore4ia; n)v Taundice Pruritus 3asy /ruisin' "ea colored urine Steatorrhea

+ia'nosis< 1* Oral cholecysto'ram &or 'all/ladder series( confirms presence of stones Nursin' ?'t< 1* ?eds , a*( Narcotic anal'esic ?eperdipine 2cl , +emerol /*( Anti choliner'ic Atropine SO7 c*( Anti emetic Phener'an , PhenothiaCide with anti emetic properties #* +iet , increase C2O; moderate C2ON; decrease fats 3* ?eticulous s6in care 7* Sur'ery<Cholecystectomy Nursin' ?'t post cholecystectomy ?aintain patency of " tu/e intact & prevent infection Stomach , widest section of alimentary canal T shaped structures 1* Anthrum #* Pylorus 3* Fundus 0alves 1* 1*cardiac sphincter #* Pyloric sphincter Cells 1* Chief) Pymo'enic cells , secrets a*( 5astric amylase di'est C2O /*( 5astric lipase , di'est fats c*( Pepsin , C2ON d*( -ennin , di'ests mil6 products Parietal ) Ar'entaffin ) o4yntic cells Function< a*( Produces intrinsic factor , promotes rea/sorption of vit B1# cyanoco/alamin , promotes maturation of -BC /*( Secrets 2cl acid , aids in di'estion 3ndocrine cells Secrets 'astrin , increase 2cl acid secretion

#*

3*

Function of the stomach 1*?echanical #*Chem* +i'estion 3*Stora'e of food C2O; C2ON stored 1 # hrs* Fats , stored # , 3 hrs PEP-IC ULCER DISEASE 3 (PUD( , e4coriation ) erosion of su/mucosa & mucosal linin' due to< a*( 2ypercecretion of acid , pepsin /*( +ecrease resistance to mucosal /arrier .ncidence -ate< 1* ?en , 7E , %% yrs old #* A''ressive persons Predisposin' factors< 1* 2ereditary #* 3motional 3* Smo6in' , vasoconstriction , 5." ischemia 7* Alcoholism , stimulates release of histamine 1 Parietal cell release 2cl acid 1 ulceration %* Caffeine , tea; soda; chocolate @* .rre'ular diet L* -apid eatin' !* Alcero'enic dru's , NSA.+S; aspirin; steroids; indomethacin; i/uprofen .ndomethacin S)3 corneal cloudiness* Needs annual eye chec6 up* D* 5astrin producin' tumor or 'astrinoma , Pollin'er 3llisons si'n 1E* ?icro/ial invasion , helico/acter pylori* ?etromidaCole &Fla'yl( "ypes of ulcers Ascendin' to severity 1* Acute , affects su/mucosal linin' #* Chronic , affects underlyin' tissue , heals & forms a scar Accordin' to location 1* Stress ulcer #* 5astric ulcer 3* +uodenal ulcer , most common Stress ulcers , common amon' eritically ill clients # types 1*Curin'>s ulcer , cause< trauma & /irth hypovolemia

52

5." schemia +ecrease resistance of mucosal /arriers to 2cl acid Alcerations

#*Cushin'>s ulcer , cause , stro6e)C0A) head inGury .ncrease va'al stimulation 2yperacidity Alcerations 5AS"-.C A$C3.ntrum or lesser curvature 3E min , 1 hr after eatin' epi'astrium 'aseous & /urnin' not usually relieved /y food & antacid Normal 'astric acid secretion common hematemeis 9t loss a* stomach cause /* hemorrha'e @E years old 3ndoscopic e4am Stool from occult /lood 5astric analysis , N , 'astric .ncrease , duodenal 5. series , confirms presence of ulceration +AO+3NA$ A$C3+uodenal /ul/ # 3 hrs after eatin' mid epi'astrium crampin' & /urnin' usually relieved /y food & antacid 1# ?N , 3am pain .ncreased 'astric acid secretion Not common ?elena 9t 'ain a* perforation #E years old

S."3 PA.N

2IP3-S3C-3".ON 0O?.".N5 23?O--2A53 9" CO?P$.CA".ONS 2.52 -.SH +ia'nosis< 1* #* 3* 7*

Nursin' ?'t< 1* +iet , /land; non irritatin'; non spicy #* Avoid caffeine & mil6) mil6 products 3* Administer meds a*( Antacids .ncrease 'astric acid secretion

AAC A#umi um co tai i . a taci$s 34* aluminum O2 'el &Ampho 'el( S)3 constipation ?aalo4 &fever S)3(

?a'nesium containin' antacids e4* mil6 of ma'nesia S)3 diarrhea

/*( 2# receptor anta'onist 34 1* -anitidine &Pantac( #* Cimetidine &"a'amet( 3* "amotidine &Pepcid( Avoid smo6in' , decrease effectiveness of dru' Nursin' ?'t< Administer antacid & 2# receptor anta'onist , 1hr apart Cemetidine decrease antacid a/sorption & vise versa c*( Cytoprotective a'ents 34 1* Sucralfate &Carafate( Provides a paste li6e su/s that coats mucosal linin' of stomach #* Cytotec d*( Sedatives) "ranBuiliCers 0alium; lithium e*(Anticholiner'ics 1* Atropine SO7 #* Prophantheline Bromide &Profanthene( &Pt has history of hpn crisis 9ith peptic ulcer disease* -n should not administer al6a seltCer has lar'e amount of Na* 1*

7* Sur'ery< su/total 'astrectomy Partial removal of stomach Billroth . &5astroduodenostomy( Billroth .. &5astroGeGunostomy( -emoval of \ of stomach & anastomoses of 'astric stump removal of \ 3)7 of stomach & duodenal /ul/ & anastomostoses to the duodenum* of 'astric stump to GeGunum*

53

Before sur'ery for B. or B..

+o va'otomy &severin' of va'us nerve( & pyloroplasty &draina'e( first*

Nursin' ?'t< 1* ?onitor N5" output a*( .mmediately post op should /e /ri'ht red /*( 9ithin 3@ 7#h , output is yellow 'reen c*( After 7#h , output is dar6 red #* Administer meds< a*( Anal'esic /*( Anti/iotic c*( Antiemetics 3* ?aintain patent .0 line 7* 0S; .&O & /owel sounds %* Complications< a*( 2emorrha'e , hypovolemic shoc6 $ate si'ns , anuria /*( Peritonitis c*( Paralytic ileus , most feared d*( 2ypo6alemia e*( "hromo/phle/itis f*( Pernicious anemia L*(Dum"i . sy $rome , common complication , rapid 'astric emptyin' of hypertonic food solutions , C2I?3 leadin' to hypovolemia* S4 of +umpin' syndrome< 1* +iCCiness #* +iaphoresis 3* +iarrhea 7* Palpitations Nursin' 1* #* 3* 7* m't< Avoid fluids in chilled solutions Small freBuent feedin' s @ eBually divided feedin's +iet , decrease C2O; moderate fats & C2ON Flat on /ed 1% 3E minutes after B feedin'

0URNS , direct tissue inGury caused /y thermal; electric; chemical & smo6e inhaled &"3CS( Nursin' Priority , infection &all 6inds of /urns( 2ead /urn priority a)w nd st nd # priority for 1 & # pain nd rd # priority for 3 F&3 "hermal direct contact , flames; hot 'rease; sun/urn* 3lectric; , wires Chem* , direct contact , corrosive materials acids Smo6e , 'as ) fume inhalation Sta'es< 1* 3mer'ent phase , -emoval of pt from cause of /urn* +etermine source or loc or /urn #* Shoc6 phase , 7! L#* CharacteriCed /y shiftin' of fluids from intravascular to interstitial space 12ypovolemia S)S4< BP decrease Arine output 2increase 2ct increase Serum Na decrease Serum H increase ?et acidosis

3* +iuretic) Fluid remo/iliCation phase 3 to % days* -eturn of fluid from interstitial to intravascular space 7* -ecovery) convalescent phase , complete diuresis* 9ound healin' starts immediately after tissue inGury* Class< .* Partial Burn st 1* 1 de'ree , superficial /urns Affects epidermis Cause< thermal /urn Painful -edness &erythema( & /lanchin' upon pressure with no fluid filled vesicles nd #* # de'ree , deep /urns Affects epidermis & dermis Cause ,chem* /urns very painful 3rythema & fluid filled vesicles &/listers( .. Full thic6ness Burns th 1* "hird & 7 de'rees /urn Affects all layers of s6in; muscles; /ones Cause , electrical $ess painful +ry; thic6; leathery wound surface , 6nown as 3SC2A- , devitaliCed or necrotic tissue* Assessment findin's -ule of nines

54

2ead & nec6 1 DF Ant chest 1 1!F Post chest 1 1!F W Arm DKD 1 1!F W le' 1!K1! 1 1!F 5enitalia) perineum1 1F "otal 1EEF Nursin' ?'t 1* ?eds a*( "etanus to4oid

/urn surface area is source of anaero/ic 'rowth , Claustridium tetany "etany

"etanolysin 2emolysis

tetanospasmin muscle spasm

/*( ?orphine SO7 c*( Systemic anti/iotics 1* Ampicillin #* Cephalosporin 3* "etracyclin 7* "opical anti/iotic < 1* Silver SulfadiaCene &silvadene( #* Sulfamylon 3* Silver nitrate 7* Povidone iodine &/etadine( #* Administer isotonic fluid sol & C2ON replacements 3* Strict aseptic techniBue 7* +iet , increase C2O; increase C2ON; increase 0it C; and increase H oran'e %* .f &K( to /urns on head; nec6; face Assist in intu/ation @* Assist in hydrotherapy L* Assist in sur'ical wound de/ridement* Administer anal'esic 1% , 3E minutes /efore de/ridement !* Complications< a*( .nfection /*( Shoc6 c*( Paralytic ileus due to hypovolemia & hypo6alemia d*( Curlin'>s ulcer , 2# receptor anta'onist e*( Septicemia /lood poisonin' f*( Sur'ery< s6in 'raftin' GU- , 'enito urinary tract Function< 1* Promote e4cretion of nitro'enous waste products #* ?aintain F&3 & acid /ase /alance 1* Hidneys , pair of /ean shaped or'an -etro peritonially &/ac6 of peritoneum( on either side of verte/ral column* 3ncased in Bowmans>s capsule*

Parts< 1* #* 3* -enal pelvis , pyenophritis , infl Corte4 ?edulla

Nephrones , /asic livin' unit 5lomerulus , filters /lood 'oin' to 6idneys Function of 6idneys< 1* Arine formation #* -e'ulation of BP Arine formation , #%F of total CO &Cardiac Output( is received /y 6idneys 1* Filtration #* "u/ular -ea/sorption 3* "u/ular Secretion Filtration , Normal 5F-) min is 1#% ml of /lood "u/ular rea/sorption , 1#7ml of ultra infiltrates &2#O & electrolytes is for rea/sorption( "u/ular secretion , 1 ml is e4creted in urine -e'ulation of BP< Predisposin' factor< 34 CS , hypovolemia , decrease BP 'oin' to 6idneys Activation of -AAS -elease of -enin &hydrolytic enCyme( at Gu4ta'lomerular apparatus An'iotensin . mild vasoconstrictor An'iotensin .. vasoconstrictor

55

Adrenal corte4 Aldosterone .ncrease Na & 2#O rea/sorption 2ypervolemia

increase CO

increase P-

.ncrease BP

Areters , #% , 3% cm lon'; passa'eway of urine to /ladder Bladder , loc /ehind symphisis pu/is* ?uscular & elastic tissue that is distensi/le Function , reservoir or urine 1#EE , 1!EE ml , Normal adult can hold #EE , %EE ml , needed to initiate micturition refle4 Color , am/er Odor , aromatic Consistency , clear or sli'htly tur/id p2 , 7*% , ! Specific 'ravity , 1*E1% , 1*E3E 9BC) -BC , & ( Al/umin , & ( 3 coli , & ( ?ucus thread , few Amorphous urate & ( Arethra , e4tends to e4ternal surface of /ody* Passa'e of urine; seminal & va'inal fluids* 9omen 3 , % cm or 1 to 1 \ N ?ale , #Ecm or !O A". C5S-I-IS , inflammation of /ladder Predisposin' factors< 1* ?icro/ial invasion , 3* coli #* 2i'h ris6 , women 3* O/struction 7* Arinary retention %* .ncrease estro'en levels @* Se4ual intercourse S)S4< 1* Pain , flan6 area #* Arinary freBuency & ur'ency 3* Burnin' upon urination 7* +ysuria & hematuria %* Fever; chills; anore4ia; 'en /ody malaise +ia'nosis< 1* Arine culture & sensitivity &K( to 3* coli Nursin' ?'t< 1* Force fluid , #EEE ml #* 9arm sitC /ath , to promote comfort 3* ?onitor & assess for 'ross hematuria 7* Acid ash diet , cran/erry; vit C OT to acidify urine & prevent /acterial multiplication %* ?eds< systemic anti/iotics Ampicillin Cephalosporin Sulfonamides , cotrima4aCole &Bactrim( 5antrism &'anthanol( Arinary antiseptics , ?itropurantoin &?acrodantin( Arinary anal'esic Pyridum @* 2t a*( .mportance of 2ydration /*( 0oid after se4 c*( Female , avoids cleanin' /ac6 & front Bu//le /ath; "issue paper; Powder; perfume d*( Complications< Pyelonephritis

P5EL*NEP'RI-IS , acute) chronic infl of 1 or # renal pelvis of 6idneys leadin' to tu/ular destruction; interstitial a/scess formation* $ead to -enal Failure Predisposin' factor< 1* ?icro/ial invasion a*( 3* Coli /*( Streptococcus #* Arinary retention )o/struction 3* Pre'nancy 7* +? %* 34posure to renal to4ins S)S4< Acute pyelonephritis a*( Costoverti/ral an'le pain; tenderness /*( Fever; anore4ia; 'en /ody malaise c*( Arinary freBuency; ur'ency d*( Nocturia; dsyuria; hematuria

56

e*( Burnin' on urination Chronic a*( /*( c*( Pyelonephritis Fati'ue; wt loss Polyuuria; polydypsia 2PN

+ia'nosis< 1* Arine culture & sensitivity , &K( 3* coli & streptococcus #* Arinalysis .ncrease 9BC; C2ON & pus cells 3* Cystoscopic e4am , urinary o/struction Nursin' 1* #* 3* 7* ?'t< Provide CB- , acute phase Force fluid Acid ash diet ?eds< a*( Arinary antiseptic , nitrofurantoin &macrodantin( S3< peripheral neuropathy 5. irritation 2emolytic anemia Stainin' of teeth /*( Arinary anal'esic , Peridium %* Complication -enal Failure

NEP'R*LI-'IASIS; UR*LI-'IASIS formation of stones at urinary tract calcium ; o4alate; uric acid mil6 ca//a'e cran/erries nuts tea chocolates anchovies or'an meat nuts sardines

Predisposin' factors< 1* +iet , increase Ca & o4alate #* 2ereditary , 'out 3* O/esity 7* Sedentary lifestyle %* 2yperparathyroidism S)S4< 1* -enal colic #* Cool moist s6in &shoc6( 3* Burnin' upon urination 7* 2ematuria %* Anore4ia; n)v +ia'nosis< 1* .0P , intravenous pyelo'raphy* -eveals location of stone #* HAB , reveals location of stone 3* Cytoscopic e4am urinary o/struction 7* Stone analysis , composition & type of stone %* Arinalysis , increase 3BC; increase C2ON Nursin' ?'t< 1*Force fluid #*Strain urine usin' 'auCe pad 3*9arm sitC /ath , for comfort 7*Alternate warm compress at flan6 area %* a*( Narcotic anal'esic ?orphine SO7 /*( Allopurinol &Pyeoprim( c*( Patent .0 line d*( +iet , if K Ca stones , acid ash diet .f K o4alate stone , al6aline ash diet &34 mil6) mil6 products( .f K uric acid stones , decrease or'an meat ) anchovies sardines @* Sur'ery a*( Nephectomy , removal of affected 6idney $itholapo4y , removal of 1)3 of stones Stones will recur* Not advised for pt with /i' stones /*( 34tracorporeal shoc6 wave lithotripsy Non invasive +issolve stones /y shoc6 wave L* Complications< -enal Failure 0ENIGN PR*S-A-IC '5PER-R*P'5 enlar'ed prostate 'land leadin' to a*( 2ydro ureters , dilation of ureters /*( 2ydronephrosis , dilation of renal pelvis c*( Hidney stones d*( -enal failure Predisposin' factor< 1* 2i'h ris6 , %E years old & a/ove @E , LE , &3 to 7 4 at ris6( #* .nfluence of male hormone S)S4< 1*+ecrease force of urinary stream #*+ysuria 3*2ematuria 7*Burnin' upon urination

57

+ia'nosis< 1* +i'ital rectal e4am , enlar'ed prostate 'land #* HAB , urinary o/struction 3* Cystoscopic e4am , o/struction 7* Arinalysis , increase 9BC; C2ON Nursin' 1* #* 3* 7* ?'t< Prostatic messa'e , promotes evacuation of prostatic fluid $imit fluid inta6e Provide catheteriCation ?eds< a* "eraCoCine &hytrin( -ela4es /ladder sphincter /* Fenasteride &Proscar( Atrophy of Prostate 5land %* Sur'ery< Prostatectomy , "A-P "ransurethral resection of Prostate No incision Assist in cystoclysis or continuous /ladder irri'ation* Nursin' m't< c* ?onitor symptoms of infection d* ?onitor symptoms 'ross) flan6 /leedin'* Normal /leedin' within #7h* 3* ?aintain irri'ation or tu/e patent to flush out clots to prevent /ladder spasm & distention

%*"erminal /u//lin' @*Bac6ache L*Sciatica

ACU-E RENAL 7AILURE , sudden immo/ility of 6idneys to e4crete nitro'enous waste products & maintain F&3 /alance due to a decrease in 5F-* &N 1#% ml)min( Predisposin' factor< Pre renal cause decrease /lood flow Causes< 1* Septic shoc6 #* 2ypovolemia 3* 2ypotension decrease flow to 6idneys 7* C2F %* 2emorrha'e @* +ehydration .ntra renal cause , involves renal patholo'y1 6idney pro/lem 1* Acute tu/ular necrosis #* Pyelonephritis 3* 2PN 7* Acute 5N Post renal cause , involves mechanical o/struction 1* Stricture #* Arolithiasis 3* BP2 C'R*NIC R7 , irreversi/le loss of 6idney function Predisposin' factors< 1* +? #* 2PN 3* -ecurrent A".) nephritis 7* 34posure to renal to4ins Sta'es of C-F 1* +iminished -eserve 0olume , asymptomatic Normal BAN & Crea; 5F- M 1E , 3EF #* -enal .nsufficiency 3* 3nd Sta'e -enal disease S)S4< 1*( Arinary System a*( polyuria /*( nocturia c*( hematuria d*( +ysuria e*( oli'uria 3*( CNS a*( headache /*( lethar'y c*( disorientation d*( restlessness e*( memory impairment %*( -espiratory a*( Hassmaul>s resp /*( decrease cou'h refle4 L*( Fluid & 3lectrolytes a*( hyper6alemia /*( hypernatermia c*( hyperma'nesemia d*( hyperposphatemia e*( hypocalcemia f*( met acidosis Nursin' ?'t< #*( ?eta/olic distur/ances a*( aCotemia &increase BAN & Crea( /*( hyper'lycemia c*( hyperinulinemia 7*( 5." a*( n)v /*( stomatitis c*( uremic /reath d*( diarrhea) constipation @*( hematolo'ical a*( Normocytic anemia /leedin' tendencies !*( .nte'umentary a*( itchiness) pruritus /*( uremic frost

58

1* 3nforce CB#* ?onitor 0S; .&O 3* ?eticulous s6in care* Aremic frost , assist in /athin' pt 7* ?eds< a*( Na 2CO3 , due 2yper6alemia /*( Ha'e4elate enema c*( Anti 2PN , hydralaCine d*( 0it & minerals e*( Phosphate /inder &Ampho'el( Al O2 'el S)3 constipation f*( +ecrease Ca , Ca 'luconate %* Assist in hemodialysis 1*( Consent) e4plain procedure #*( O/tain /aseline data & monitor 0S; .&O; wt; /lood e4am 3*( Strict aseptic techniBue 7*( ?onitor for si'ns of complications< B , /leedin' 3 , em/olism + , diseBuili/rium syndrome S , septicemia S , shoc6 , decrease in tissue perfusion +iseBuili/rium syndrome , from rapid removal of urea & nitro'enous waste prod leadin' to< a*( n)v /*( 2PN c*( $e' cramps d*( +isorientation e*( Paresthesia %* @* Avoid BP ta6in'; /lood e4traction; .0; at side of shunt or fistula* Can lead to compression of fistula* ?aintain patency of shunt /y< i* Palpate for thrills & auscultate for /ruits if &K( patent shunt: ii* Bedside /ulldo' clip .f with accidental removal of fistula to prevent em/olism* .nfersole &diastole( , common dialisate used L* Complication Peritonitis Shoc6 !* Assist in sur'ery< -enal transplantation < Complication , reGection* -everse isolation

E5ES 34ternal 1* #* 3* 7*

parts Or/ital cavity , made up of connective tissue protects eye form trauma* 3O? , e4trinsic ocular muscles , involuntary muscles of eye needed for 'aCin' movement* 3yelashes) eye/rows , esthetic purposes 3yelids , palpe/ral fissure , openin' upper & lower lid* Protects eye from direct sunli'ht

?ei/omean 'land , secrets a lu/ricatin' fluid inside eyelid /*( Stye) sty or 2ordeolum inflamed ?ei/omean 'land %* ConGunctiva @* $acrimal apparatus , tears Process of .rievi . a* +enial /* An'er c* Bar'ainin' d* +epression e* Acceptance #* .ntrinsic coat .* sclerotic coat , outer most a*( Sclera , white* Occupies ] post of eye* -efracts li'ht rays /*( Canal of schlera , site of aBueous humor draina'e c*( Cornea , transparent structure of eye ..) Aveal tract , nutritive care Aveitis , infl of uveal tract Consist of< a*( .ris , colored muscular rin' of eye # muscles of iris< 1* Circular smooth muscle fi/er Constricts the pupil #*radial smooth muscle fi/er +ilates the pupil # cham/ers of the eye 1* Anterior a*( 0itereous 2umor , maintains spherical shape of the eye /*( ABueous 2umor , maintains intrinsic ocular pressure Normal .OP1 1# #1 mm2' ..* -etina &innermost layer( i* Optic discs or /lind spot , nerve fi/ers only No auto receptors cones &dayli'ht) colored vision( rods , ni'ht twili'ht vision

59

phototopic vision ii* iii*

Nscotopic visionO 1 vit A deficiency , rods insufficient ?aculla lutea , yellow spot center of retina Fovea centralis , area with hi'hest visual acuity oracute vision

Physiolo'y of vision 7 Physiolo'ical processes for vision to occur< 1* -efraction of li'ht rays , /endin' of li'ht rays #* Accommodation of lens 3* Constriction & dilation of pupils 7* Conver'ence of eyes Anit of measurements of refraction , diopters Normal eye refraction , emmetropia 3--O- of refraction 1* ?yopia , near si'htedness , "reatment< /iconcave lens #* 2yperopia) or farsi'htedness , "reatment< /iconve4 lens 3* Asti'matisim , distorted vision , "reatment< cylindrical 7* Pre/yopia , Nold sli'htO , inelasticity of lens due to a'in' , "reatment< /ifocal lens or dou/le vista Accommodation of lenses , /ased on thelmholtC theory of accommodation Near vision 1 Ciliary muscle contracts1 $ens /ul'es Conver'ence of the eye< 3rror< 1* 34otropia , 1 eye normal #* 3sophoria , 3* Stra/ismus sBuint eye 7* Am/lyopia , prolon' sBuintin' GLAUC*MA , increase .OP , if untreated; atrophy of optic nerve disc , /lindness Predisposin' factors< 1* 2i'h ris6 'roup , 7E & a/ove #* 2PN 3* +? 7* 2ereditary %* O/esity @* -ecent eye trauma; infl; sur'ery "ype< 1* #* 3* S)S4< 1* #* 3* 7* %* @* L* $oss of peripheral vision , tunnel vision 2alos around li'hts 2eadache n)v Steamy cornea 3ye discomfort .f untreated , 'radual loss of central vision , /lindness Chronic , &open an'le 5*( , most common type O/struct in flow of aBueous humor at tra/ecular meshwor6 of canal of schlema Acute &close an'le 5*( , ?ost dan'erous type Forward displacement of iris to cornea leadin' to /lindness* Chronic &closed , an'le( Precipitated /y acute attac6 far vision1 ciliary muscle dilates ) rela4es1 lens is flat

corrected /y corrective eye sur'ery

+ia'nosis< 1* "onometry , increase .OP S1# #1 mm2' #* Perimetry , decrease peripheral vision 3* 5onioscopy , a/struction in anterior cham/er Nursin' 1* #* 3* m't< 3nforce CB?aintain siderails Administer meds a*( ?iotics , lifetime contracts ciliary muscles & constricts pupil* 34 Pilocarpine Na &Car/achol( /*( 3pinephrine eye drops , decrease secretion of aBueous humor c*( Car/onic anhydrase inhi/itors* 34* acetapolamide &+iamo4( Promotes increase out flow of aBuaeous humor d*( "emoptics &"imolol maleate( .ncrease outflow of aBuaous humor 7* Sur'ery< .nvasive< a*( "ra/eculectomy , eyetrephinin' , removal of tra/elar meshwor6 of canal or schlera to drain aBueous humor /*( Peripheral .ridectomy , portion of iris is e4cised to drain aBueous humor Non invasive< "ra/eculoctomy &eye laser sur'ery(

Nursin' ?'t pre op all types sur'ery

60

1* Nursin' 1* #* 3*

Apply eye patch on unaffected eye to force wea6er eye to /ecome stron'er* to prevent tension on suture line*

?'t post op , all types of sur'ery Position unaffected) unoperated side Avoid valsalva maneuver ?onitor sym"toms of I*P a*( 2eadache /*( n)v c*( 3ye discomfort d*( "achycardia 7* 3ye patch , /oth eyes post op

CA-ARAC- , partial) complete opacity of lens Predisposin' factor< 1* DE D%F a'in' &de'enerative) senile cataract( #* Con'enital 3* Prolon'ed e4posure to A0 rays 7* +? S)S4< 1* #* 3* 7* $oss of central vision N2aCy or /lurrin' of visionO Painless ?il6y white appearance at center of pupil +ecrease perception of colors

+ia'nosis< Opthalmoscopic e4am , &K( opacity of lens Ns' ?'t< 1* -eorient pt to environment , due opacity #* Siderails 3* ?eds , a*( ?ydriatics , dilate pupil , not lifetime 34* ?ydriacyl c*( Cyslope'ics , paralyCes ciliary muscle* 34* Cyclo'ye 7* Sur'ery 3 , e4tra C capsular C , cataract $ lens 3 , e4traction . intra C capsular C , cataract $ lens 3 , e4traction Nursin' ?'t< 1*Position unaffected) unoperated side #*Avoid valsalva maneuver 3*?onitor sym"toms of I*P a*( 2eadache /*( n)v c*( 3ye discomfort d*( "achycardia 7*3ye patch , /oth eyes post op RE-INAL DE-AC'MEN- separation of # layers of retina Predisposin' factors< 1* #* 3* 7* %* S)S4< 1* #* 3* 7* %* Severe myopia , nearsi'htedness +ia/etic -etinopathy "rauma Followin' lens e4traction 2PN to prevent tension on suture line*

partial removal of lens

total removal of lens & surroundin' capsules

NCurtain ,veilO li6e vision Flashes of li'hts Floaters 5radual decrease in central vision 2eadache

+ia'nosis opthaloscopic e4am Nursin' ?'t< 1* Siderails &all visual disease( #* Sur'ery< a*( Cryosur'ery /*( Scleral /uc6lin EAR 3 1* 2earin'

61

#* Parts< 1*

Balance &Hinesthesia or position sense( Outer a*( Pinna) auricle , protects ear from direct trauma /*( 34t* auditory meatus , has ceruminous 'land* Cerumen c*( "ympanic mem/rane , transmits sound waves to middle ear

Disor$ers of outer ear 3ntry of insects , put flashli'ht to 'ive route of e4it Forei'n o/Gects , /eans &/rin' to ?+( 2#O drain #* ?iddle ear a*( 3ar osssicle 1* 2ammer #* Anvil 3* Stirrups /* 3ustachian tu/e malleus .ncus stapes for /one conduction disorder conductive hearin' loss

Opens to allow eBualiCation of pressure on /oth ears Iawn; chew; and swallow Children , strai'ht; wide; short c*( Otitis media Adult , lon'; narrow & slanted c* 1* #* 3* a* ?uscles Stapedius "ensor tympani .nner ear Bony la/yrinth , for /alance; vesti/ule Atricle & succule Otolithe or ear stone , has Ca car/onate ?ovement of head 1 -i'htin' refle4 1 Hinesthesia /* ?em/ranous $a/yrinth 1* Cochlea , & function for hearin'( has or'an of corti #* 3ndolymph & perilymph , for static eBuili/rium 3* ?astoid air cells , air filled spaces in temporal /one in s6ull Complications of ?astoditis , menin'itis "ypes of hearin' loss< 1* Conductive hearin' loss , transmission hearin' loss Causes< a*( .mpacted cerumen , tinnitus & conduction hearin' loss assist in ear irri'aton /*( .mmo/ility of stapes , O"OSC$3-OS.S d*( ?iddle ear disease char /y formation of spon'y /one in the inner ear causin' fi4ation or immo/ility of stapes e*( Stapes can>t transmit sound waves Sur'ery Stapedectomy , removal of stapes; spon'y /one & implantation of 'raft) ear prosthesis Predisposin' factor< 1* Familiar tendency #* 3ar trauma & sur'ery S)S4< 1* #* "innitus Conductive hearin' loss

+ia'nosis< 1* Audiometry , various sound stimulates &K( conductive hearin' loss #* 9e/er>s test , Normal ACS BC result BC S AC Sta"e$ectomy Nursin' ?'t post op 1* Position pt unaffected side #* +B3 No cou'hin' & /lowin' of nose Ni'ht lead to removal of 'raft 3* ?eds< a*( Anal'esic /*( Antiemetic c*( Antimotion sic6ness a'ent* 34* meclesine 2cl &Bonamine( 7* Assess , motor function , facial nerve &Smile; frown; raise eye/row( %* Avoid shampoo hair for 1 to # wee6s* Ase shower cap

SENS*R5 NEURAL 'EARING L*SS; NER6E DEA7NESS Cause< 1* "umor on cocheal

62

#* 3* 7* f*(

$oud noises &'un shot( Pres/ycusis , /ilateral pro'ressive hearin' loss especially at hi'h freBuencies , elderly Face elderly to promote lip readin' ?eniere>s disease , endolymphatic hydrops .nner ear disease char /y dilation of endo , lympathic system leadin' to increase volume of endolin

Predisposin' factor of MENIERE(S DISEASE Smo6in' 2yperlipidemia 3E years old O/esity , &K( chosesteatoma Aller'y 3ar trauma & infection S)S4< 1* "-.A+ symptoms of ?eniere>s disease a*( "innitus /*( 0erti'o c*( Sensory neural hearin' loss Nysta'mus n)v ?ild apprehension; an4iety "achycardia Palpitations +iaphoresis

#* 3* 7* %* @* L*

+ia'nosis< 1* Audiometry , &K( sensory hearin' loss 1* #* 3* 7* Nursin' m't< Comfy & dar6ened environment Siderails 3metic /asin ?eds< a*( +iuretics ,to remove endolymph /*( 0asodilator c*( Antihistamine d*( Antiemetic e*( Antimotion sic6ness a'ent f*( Sedatives) tranBuiliCers -estrict Na $imit fluid inta6e Avoid smo6in' Sur'ery , endolymphatic sac decompression Shunt

%* @* L* !*

Suicide common in teena'er Poisonin' , common in children &aspirin( Aspiration , common in infant Accidents , common in adults Cho6in' , common in toddler S.+S , common in infant in AS

63