NOTES DIGOXIN monitor the creatinine the TV DOESNT look good to me (DIGOXIN TOXICITY nausea/vomiting, abdl cramps) Olive

ive = butter CK LDH normalize 1 3 days after MI - 10 14 days

ATRIAL FLUTTER SAW TOOTH PROCESS OF ELIMINATION consider MASLOWs H of NEEDS consider the COMPLICATION whether ACUTE ALWAYS prioritize CHRONIC ABCs SAFETY FIRST NSG PROCESS

MMR VACCINE only vaccine for HIV pt. Pt on HEPARIN APTT (N 30-40sec), therefore if INCREASE bleeding POISON - nursing action in order : #1 CALL poison control center # 2 MINIMIZE EXPOSURE of pt to poison pull him/her away from the poison # 3 IDENTIFY the poison
GENTAMYCIN

s/e tinnitus, vertigo, ototoxicity, oliguria for ELDERLY : N level NOT more than 1.0meq/L ADULT : N .5 1.2 meq/L

LITHIUM CARBONATE

HEPA B diet : low fat, increase CHON DOWN SYNDROME large tongue feeding problem poor sucking (infants) SAFETY PRINCIPLE 1. when can a child USE ADULT SEAT BELT? - if the infant is 40 lbs and 40 inches in height seat belt location in car: BACK CENTER SEAT 2. TODDLER falls 3. SUPRATENTORIAL craniotomy semi fowlers position INFRATENTORIAL flat in bed 4. SCATTER RUGS osteoporosis pts. 5. TRIAGE ; burns, open fx SHOCK Things NOT TO BE DELEGATED by RN: Assessment, Teachings, Evaluation

Pt 50y/o and

- mammogram once a year.

Pt with PKU LOW PHENYLALAMINE DIET (NOT phenyl FREE). therefore LOW CHON Pt with Rocky Mountain Fever exposure to dog ticks Lymes Dses deer ticks PSYCHE PATIENTS 1. remember to stick to unit rules/policy be consistent to pt. 2. encourage verbalization tel me how.. 3. sound knowledge of cultural diversity - seek help of interpreter 4. acknowledge pt feelings it seems. this must be difficult.. 5. emphatize with your patientss feelings I understand how you feel.. CATARACT CAUSES aging and trauma MRSA (methicillin resistant staphyliccocus aureus) - USE GLOVES AND GOWN WHEN W/ PT

TUBES
1. GROSHONG CATHETER HICKMAN BROVIAC - 2 lumen - 3 lumen - 1 lumen

ALL requires Central Venous Access - sites: cephalic, brachial, basilica and superior vena cava
PURPOSE:

For TPN Administration of Chemo Agents, Blood Products, Antibiotics

COMPLICATION: Thrombosis and Bleeding 2. CHEST TUBES Water Sealed Drainage Types: Anterior w/c drains AIR Posterior - w/c drains FLUIDS Water Sealed Drainage : 1 bottle, 2 bottle and Three bottle system 1 BOTTLE 2 BOTTLE 3 bottle : : : 3 5cm of only (length of tube to be emerge) First bottle drainage bottle (no tube emerge), 2nd bottle - long rod 3-5cm FREQUENTLY USED

1st bottle drainage 2nd bottle water sealed 3rd bottle suction bottle control COMPLICATIONS: Nsg ALERT: NORMAL : BUBBLING is N in the 3rd bottle it indicates that suction is ADEQUATE (if no bubbling STOPS in the 3rd bottle, meaning inadequate suction) ABNORMAL : if bubbling occurs at the 2nd bottle indicates LEAKAGE action, check sealed at air tight container and the pt and bottle connection. bubbling, breakage, blockage

In case there BREAKAGE, have extra bottle and emerge tube ASAP to prevent entry of air and or may use forcep to clamp tube temporarily. If pt. ambulates, keep bottle LOWER than the patient. ABSENCE of OSCILLATION at the 2nd Bottle indicates blockage
TOWARDS THE BOTTLE - When MILKING the tubings. EMERGENCY EQUIPMETS AT BEDSIDE: xtra bottle,clamp, gauze

3. TRACHEOSTOMY TUBE - to maintain patent airway for pt w/ neurological problems and musculoskeletal disorders. nursing care: 1. Suctioning 10-15seconds - if (+) bradycardia, STOP - if accidentally dislodge, insert obturator to keep it open 2. AVOID: water sports swimming 3. In changing ties insert new one first BEFORE REMOVING old tie. 4. Ribbon or ties @ side of the neck only to avoid pressure. 5. Before and After suctioning hyperoxygenate the patient. 4. PTCA enlarge the passageway for bloodflow. problem: spasms that lead to arrhythmia

C-STENT (cardiac-stent) alternative to PTCA Maintains patency of bld vessels Problem: dislodge IABP (Intra Aortic Balloon Pump) - for Cardiogenic Shock problem: thrombus formation, infection and arrhythmia 5. PENROSE DRAIN - wound drainage system - doctors the one who removes this. - remove gradually

6. NASO GASTRIC TUBE stomach and intestine (duodenum) Types: Levine Tube for stomach - 1 lumen, for lavage (cleaning) and gavage (feeding) Salem Sump for stomach - 2 lumen (I for suctioning, I for lavage/gavage) - if pt (infant) is having enteric coated meds, request for change in form of meds Miller Abbot for intestinal (w/ mercury b4 injection) - 2 lumen (insert then inject the mercury) Cantor for intestinal - 1 lumen

Nursing Care for NGT: 1. tip of nose to earlobe to xyphoid process (for stomach) 2. tip of nose to earlobe to XP + 7-10 inches for intestinal NGT 3. accurate means to verify correct placement: ALWAYS consider Two checking criteria: ASPIRATION and Gurgling Sounds
Report the following:

If (-) or decrease drainage, (+) nausea and vomiting (+) abdml rigidity Characteristic of Gastric Residual: more than 50 mo and coffee ground. Before feeding check for placement. 7. GASTROSTOMY TUBE (GT) PEG both for NUTRITIONAL PURPOSES GT incision (abdomen to stomach) - for pt (+) lesion at esophagus - nsg care : report s/s of infection, abdl cramps, n/v - provide adequate skin care PEG incision at skin - long term therapy 8. T TUBE - to drain excess bile until hearing occurs - place drainage bag at the level of t-tube (obstruction of t-tube there will be excess drainage) 500 ml N drainage in 24hrs, if report ASAP.

9. HEMOVAC JACKSON-PRATTS (JP) BOTH used as close wound drainage suction system BOTH system function on the system of (-) pressure.

JP compress the container before attaching to the drainage. WHEN TO EMPTY: when its usually 1/3 to full then RECORD the amount. 10. THREE-WAY FOLEY absence of clot effective Characteristic of drainage 2-3 days after surgery (bloody to pinkish) NO NEED TO REPORT THIS it is expected 11. SUPRAPUBIC CATHETER for genito urinary problem - inserted directly at the bladder wall - check if properly anchored 12. URETHRAL CATHETER to drain urine. - never clamp because it can only hold 4-8 ml of urine. - keep open to drain urine from kidney pelvis. SENGSTAKEN BLAKEMORE TUBE - 3 lumen ( for esophageal balloon, gastric balloon, for meds) - for pt w/ esophageal varices - balloon tamponade - 48 hrs keep balloon inflated for 10 minutes to decrease bleeding 3 lumen 4 lumen

LINTON TUBE

MINESOTTA TUBE

SCISSORS important EQUIPMENT AT BEDSIDE FOR ALL TUBES. HEMOSTAT important instrument that shld be @ bedside for water sealed drainage. Persistent bubbling at water drainage bottle for bottle #2 check if tubing is properly sealed. NGT IS REMOVED if patient exhibits return of bowel sounds. BULB SYRINGE use to clean the nares of pt with NGT (child) To facilitate removal of air at lungs purpose of water sealed chamber in 3 way bottle system.

THERAPEUTIC DIET
GENERAL CONSIDERATION Know the DIAGNOSIS of the patient Identify & incorporate the pt. dietary preferences

Instruct pt on what to avoid For pregnant pt, note dietary changes: a. addtl calories (300 cal/day) average of 2400 - 2700 b. addtl of 10gms/day for CHON c. IRON : 15-30mg/day d. CALCIUM : RDA is 1000 then +200mg/day (broccoli,tuna,cheese) e. Galactogogues increase production of milk

PEDIATRIC pt by 4-6 mos START iron supplement due to iron depletion and (-) extrusion reflex. - cereals, fruits, vegetables,meat and table foods - egg yolk (6mos), egg white (1yr)

TRANSCULTURAL CONSIDERATION CHINESE like cold desserts after surgery for optimum health JEWS kosher diet (no meat and diary products at the same time) EUROPEANS main meal is served at mid day followed by espresso MUSLIM halal diet no pork SDA strictly vegs diet (vit B6 and B12 deficiency) MORMONS words of wisdom (no caffeine, alcohol and once a month fasting) the amount due for food is donated to the church

KEY POINTS FOR NURSES Sodium (Na) source down the soil Potassium (K) - source up the tree Low Na Diet : AVOID processed foods, milk products and salty foods KNOW the serving: CHO - 6-11 servings CHON - 2-3 FRUITS & Vegs - 3-4 FATS - sparingly

MOST COMMON DIET

CLEAR LIQUID DIET (light can pass thru it, meaning TRANSPARENT) - given to pt to relieve thirst, correct fld & electrolyte imbalance - given also to pt post-op ex: apple juice, gelatin (strawberry), popsicle, candy

RENAL DIET for kidney disorder (renal failure, AGN, Nephrotic syndrome) to maintain fld & e imbalance

LOW CHON avoid poultry products LOW Na - avoid processed foods, milk products, & salty foods Low K - avoid fruits (anything you see in a tree)

LOW FAT/CHOLESTEROL RESTRICTED DIET - for liver disorder, cardiovascular and renal dses ALLOWED: lean meat, fruits, vegs and fish AVOID : Sea foods, fried foods, preserved foods

(cheese cake and custard)

HIGH FIBER DIET - to prevent constipation, hemorrhoids & diverticulitis - vegs, fruits and grain products SOFT DIET for inflammatory conditions: esophagitis, peptic ulcer gastritis pureed foods/ blenderized foods soup

PURINE RESTRICTED DIET for gouty arthritis increase fluid intake AVOID: preserved foods, sea foods, alcohol, organ meat (liver, gizzard)

NA RESTRICTED DIET for cardiovascular dses, renal, fld & e imbalance ALLOWED: fresh vegs AVOID : processed foods, milk products and salty foods

BLAND DIET for peptic ulcer, inflammatory GI conditions

AVOID: chemically and mechanically irritating foods such as fried foods, fresh and raw fruits & vegs (EXCEPT: avocado, banana & pinya) and spicy foods with preservatives

HIGH PROTEIN, HIGH CARBO DIET for burns (about 5000 cal/day) grain products and poultry to aid the healing tissues

ACID ASH DIET to decrease the ph of the urine indicated for pt w/ alkaline stone ex struvite ex. 3 CS cranberry, cheese, & corn 3 PS - prunes, plums & pastries

ALKALINE ASH DIET to increase ph of the urine indicated for acid stone ( uric acid stone, cystine stone) ex. Milk

GLUTEN-FREE DIET for celiac dses ALLOWED : rice, corn, cereals, soy beans AVOID (LIFETIME): barley, rye, oats, wheat

PHENYLALANINE DIET for PKU, until age 10 and adolescence only AVOID : CHON rich foods (meat products luncheon meat)

FULL LIQUID DIET opaque transitional diet from liquid ex : cream soup, ice cream, milk, leche flan, pumpkin cake

ABGs

ATERIAL BLOOD GASES

Ph 7.35 7.45 PCO2 - 35 35 HCO3 - 22 26 meq/L Ph Uncompensated abnormal Partially compensated abnormal Fully Compensated normal Compensatory Mechanism no change increase or decrease increase or decrease

Diarrhea metabolic acidosis Vomiting metabolic alkalosis

PRIORITIZING of case: Med.-Surg abc Psyche - safety first Fire - race Triage - pt evaluation system (prioritizing)

APGAR SCORING
0 Appearance Pulse Grimace Activity Respiratory pallor (-) (-) flaccid (-) 1 acrocyanosis <100 grimace some flexion irregular 2 all pink >100 vigorous flexion & extension lusty cry

T.R.I.A.G.E -prioritizing LEVEL 1 emergency severe shock, cardiac arrest, cervical spine injury, airway compromise, altered level of consciousness, multiple system trauma, eclampsia

LEVEL 2 urgent (stable) LEVEL 3 chronic/ minor illness (can be delegated) dental problems, routine medications and chronic low back pa can be delegated (fever, minor burns, lacerations, dizziness)

TIPS ON PRIORITIZING
1. PT @ ER sleeping pills overdose; 2. pt bp 80/30 & mother died of CVA 1st priority : assess pt for addtl risk factor; 3. pt ask what procedure: Rn Action : notify the doctor 4. MI attack 1st action : report ASAP (esp. presence of vent. Fibrillation) 5. pt on NGT check patency of tube

DELEGATION
do not delegate Assessment, Teaching and Evaluation do not delegate meds preparation, administration, documentation

CONCEPT OF DELEGATION
consider the competence of personnel 5 Rs in delegating (RIGHT task, person, circumstances, direction/communication supervision) RN may delegate feeding client, routine vital sign (pt w/ no complications) and hygiene care

MI ATTACK enzymes to increase IN ORDER - #1 #2 #3 #4

myoglobin troponin CK LDH

RISK FOR INJURY menieres dses INEFFECTIVE BREATHING PATTERN myasthenia gravis ALTERED TISSUE PERFUSION pt w/ complete heart block INEFFECTIVE AIRWAY CLEARANCE pt w/ kussmauls breathing

POSITIONING FOR SPECIFIC SURGICAL CONDITION

Positioning a. b. c. independent nsg function know the purpose of the position to prevent or promote soothing; what to prevent or promote; know your anatomy & physiology R side lying to prevent bleeding (during the procedure L side lying). upright to prevent reflux.

Post Liver Biopsy

Hiatal Hernia

AMPUTATION complication: hemorrhage (keep tourniquet @ bedside) 1st 24hr goal: to decrease edema elevate the stump at foot part w/ the use of pillow AFTER 24hr goal : to prevent contracture deformity (keep leg extended) APPENDICITIS Unruptured : any position of comfort

Ruptured : semi to high fowlers position to prevent the upward spread of infection complication: peritonitis

Ruptured appendicitis indication: pain decreases or go away. (pt say, I want to go home pain is gone) BURNS Position is FLAT or Modified Trendelenburg to prevent shock. SHOCK occurs w/in 24-48hrs (immediate post burn phase). Complication: infection CAST, EXTREMITY Elevate the Extremity to prevent edema (use rubber pillow) Nsg care: a. b. c. d. e. capillary refill N 1-3 seconds only (complication: altered circulation) note for s/s of infection (when there is musty odor inside the cast) pruritus (inject air using bulb syringe) blood stained mark and note (if increasing in diameter - report ASAP) tingling sensation indicate nerve damage CRANIOTOMY
Types:

a. Supratentorial C semi fowlers orlow fowlers position to prevent accumulation of fluid at surgical site; b. Infratentorial C - flat or supine. Purpose: same FLAIL CHEST (+) Traumatic Injury paradoxical chest movement areas of chest GOES IN inspiration and OUT on Expiration position: towards the affected side to stabilize the chest. GASTRIC RESECTION to prevent dumping syndrome usually for 10 mos only NOT LIFETIME disorder (post gastrectomy) position : LIE FLAT for 1-2hrs post meal

HIATAL HERNIA there is damage to esophageal mucosa what to prevent: gastric reflux therefore FEEP PT IN UPRIGHT POSITION.

HIP PROSTHESIS

Position: to prevent subloxation (KEEP LEG ABDUCTED) with the use of wedge pillow or triangular pillow from perinium to the knees.
dumping syndrome : flat

LAMINECTOMY log-roll the patient (3 nurses) KEEP SPINE IN STRAIGHT ALIGNMENT AVOID: hyperflexion, hyperextension and prone it causes hyperextension of the spine.

LIVER BIOPSY before LB : supine or L side lying to expose the part during LB : - doafter LB : R side lying w/ small pillow under the coastal margin to prevent bleeding.

LOBECTOMY removal of Lobe (N R lobe 3, L lobe 2) position : semi fowlers position to promote lung expansion

MASTECTOMY -

removal of breast elevate or extend affected arm to prevent lymp edema (or elevate higher that the level of the heart. AVOID: venipuncture, specimen taking, blood pressure ON THE AFFECTED ARM coz there is no more lymph node w/c predispose pt to bleeding.
Post mastectomy Exercises:

squeezing exercises, finger wall climbing, flexionextension (folding of clothing, washing face, vacuuming the house)

Due to removal of axillary lymph node, avoid also gardening and hand sewing PNEUMONECTOMY either L or R lung. Position pt on the AFFECTED SIDE to promote lung expansion.

RADIUM IMPLANT OF THE CERVIX keep pt on complete bed rest to prevent dislodge. AVOIDE SEX (may burn penis bec of the implant inside)

RESPIRATORY DISTRESS Adult : Orthopneic position over bed table then lean forward Pedia : TRIPOD lean forward and stick out tongue to maximize the Airflow RETINAL DETACHMENT to prevent further detachment, place pt on the AFFECTED SIDE.

Ex. If operation is on the R outer of the R eye, place pt on the R position. If operation is on the L inner of the R eye, position pt on the L side AVOID: sudden head movement.

VEIN STRIPPING keep extremities extended then elevate the legs at level of the heart to promote venous return

TIPS
liver biopsy is done on a pt. during 1st 24hrs after the procedure, turn the pt on his abdomen w/ pillow under the subcoastal area; when draining the L lower lobe of the lung the pt shld be positioned on his R side w/ hip higher or slightly higher than the head; after tonsillectomy position: prone a pt is about to go on thoracenthesis - how shld the nurse position the pt? sitting w/ a arms resting on the overbed table; to maintain the integrity of pt w/ hip prosthesis abduction splints immediately after supratentorial craniotomy- fowlers position best position for pt in shock supine w/ lower extremities elevated

THERAPEUTIC COMMUNICATION
1. DONT ASK WHY this put pt on the defensive 2. AVOID PASSING BACK I will refer you to. 3. DONT GIVE FAKE REASSURANCE everything will be alright. youre in the hands of the best 4. AVOID NURSE CENTERED RESPONSE I felt same too I had the same feeling. In GROUP DISCUSSION nurse is just a facilitator let the group decide, he/she channel are concern back to the group.

THERAPEUTIC PHRASES it seems you seem. - open ended question - close ended for manic pt and pt in crisis - direct question- for suicidal pt

ISOLATION PRECAUTION
Purpose : to isolate infection transmission
TYPE PRIVATE ROOM HAND WASHING GOWN GLOVE MASK

STRICT
(airborne dses, direct contact-Diptheria)

RESPIRATORY
(AIRBORNE: BEYOND 3FT DROPLET : W/IN 3FT)

OPTIONAL

OPTIONAL

TB CONTACT
(direct contact NOT AIRBORNE DSES) eX SCABIES

OPTIONAL (negative airflow room)

OPTIONAL

ENTERIC

(fecal contamination)

X X

OPTIONAL

OPTIONAL

DISCHARGE (drainage: pus ex burn pt) UNIVERSAL

OPTIONAL

OPTIONAL

(AIDS, HEPA b TRANSMITTED BY BLD AND DODY FLUIDS)

TIPS:
When implementing universal precaution, w/c nsg action require intervention: recapping the needle this might prick your hand; When discarding the contents of the bed pan use by a pt under enteric precaution GLOVE IS NECESSARY; A nurse is giving health teaching to the parents of child with scabies: family member must be treated; Preventing pediculosis in school age children: avoiding contact w/ hair articles of infected children like clips, head bands, hats no sharing

Patient with full blown AIDS is placed on isolation precaution pt ask nurse why his visitors is wearing mask response: it will help in the prevention of infection; Essential when a pt w/ meningitis is kept in isolation: isolation precaution remains until 24hrs after initiating antibiotic therapy

DIAGNOSTIC PROCEDURES
side notes: pt for IVP pt for KUB schilling test USG : : : : assess for allergy (cleansing enema b4 the procedure) no dye (dont assess for allergy) 24hr urine specimen no consent required

GENERAL CONSIDERATION

EXPLAIN the procedure to the pt (initial nsg action) - if not ready inform the doctor; - pt has the right to refuse procedure; - doctor the one who asked for consent Check pt for CONSENT if INVASIVE WITH CONSENT NON INVASIVE NO CONSENT needed CONTRAST MEDIUM check for allergy For procedure requiring anesthesia KEEP PT NPO B4 PROCEDURE When local anesthesia used NPO, 1- 2HRS AFTER General anesthesia keep NPO at least 8hrd after (check gag reflex before meals) PEDIATRIC PATIENT use flash cards, games and play to encourage participation

TRANSCULTURAL CONSIDERATION

HISPANIC PATIENT women prefer same gender health care provider Obtain help of interpreter when explaining procedures (except or dont ask family members) For muslim patient - they prefer same sex health care provider however, if procedures require life threatening they prefer to have male doctor. - they only want good news information of their condition

DELEGATION and DOCUMENTATION

Delegation assessment, monitoring and evaluation of treatment (cannot be delegated) BUT standard and changing procedures can be delegated ex. 24hr urine specimen and urine catheter collection. Documentation type of treatment and any untoward reactions.

KEYPOINTS FOR NURSES Prepare the patient; Monitor for adverse reaction; Report complication to the doctor

FRAMEWORK includes the Purpose, Special Consideration and Interpretation

DIAGNOSTIC TESTS (to evaluate FETAL GROWTH AND WELL-BEING)

DAILY FETAL MOVEMENT Purpose : to determine fetal activity by counting fetal movements usually perform by pt himself
N Fetal Movement

10-12 for 12 hr period (average: 1 movement/hr with average 3fm/hr)

NON STRESS TEST (NST) correlates fetal heart rate w/ fetal movement monitor the baseline FHR then induce fetal movements by (HOW) : a. ring a bell b. feed the patient

then check FHR, NST is (+) if FHR increase at least 15 beats/min than the baseline. (ex. 140 FHB baseline, then after challenge it increase to 155) POSITIVE result means, BABY is REACTIVE (good condition) and no need for contraction stress test/oxytocin challenge test coz baby is OK and doing well.

CONTRACTION STRESS TEST (oxytocin challenge test) correlates FHR with uterine contractions pt on NPO get baseline FHR then induce uterine contraction

HOW: Thru breast stimulation it triggers the release of oxytocin from pituitary gland If (-) patient is given Oxytocin onset is 20-30 minutes. Then check FHR and note the presence of DECELERATION (slowing of FHR)
types of deceleration a. early deceleration indicates head compression (MIRROR IMAGE) b. late deceleration indicates placental insufficiency (REVERSE MIRROR IMAGE) mgt: L Lateral Recumbent Position, Administer O2, Treat Hypotenson

c.

variable deceleration due to cord (image: U or W shape) and slowing of FHR can occur anytime.

If (+) CST, meaning there is deceleration, baby is NOT OK coz there is decrease FHR and during labor he/she may stand the labor process.

BIOPHYSICAL PROFILE to determine fetal well being w/ the use of 5 CRITERIA fetal breathing movement heart tone reaction to NST amniotic fld volume 2 points 2 points 2 points 2 points 2 points 10 points

score below 6, indicates fetal jeopardy

ULTRASOUND - provide data on placenta (age and location) gender of baby structural abnormalities position of baby - for pregnant: site is lower abdominal USG

types: a. Upper USG NPO b. Lower USG - NPO - preparation: increase fluid intake (oral) NO consent needed If pt ask if it is painful: NO PAIN; Pt shld have full bladder
CHORIONIC VILLI SAMPLING CVS AMNIOCENTESIS AMNIO PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING PUBS

CVS
Purpose: to detect chromosomal Aberration (eg. Down syndrome, Trisomy 21) Done in 1st trimester (can be done as early as 5th wk but can be done on 8-10th wk)

AMNIO
Purpose : same w/ CVS

PUBS
Purpose: to check chromosomal aberrations, & presence of RH Incompatibility Extract blood at umbilical cord then it is tested if it really comes from the umbilical cord (can be done on either 2nd or 3rd tri.

can be done on the 2nd wk (14-16 wk) - but not recommended bec. of danger abortion (assess pt age of gestation) or can be done on the 3rd wk (34-36 wk) purpose: to detect fetal maturity (FLM) thru monitoring of L/S Ratio N 2:1 (if mother is (+) DM LS ratio is 3:1)

Get sample at chorion (by 10-12wks The placenta matures, get some sample)

This procedure also check level of alpha-feto Protein if INCREASE spina befida; If DECRTEASE down syndrome

(+) Consent invasive

(+) Consent

(+) Consent

Bladder : Empty

consider the Pt Age of Gestation (if age of gestation : is higher than 20wks and above : empty bladder, if AOG is 20wks and below : full bladder

COMPLICATIONS of CVS, AMNIO & PUBS: a. b. c. d. infection bleeding abortion fetal death

TIPS

EARLY DECELERATION expected in the fetal monitor when there is fetal head compression;

AMNIOCENTESIS was done @ 35 wks gestation purpose: to determine fetal lung maturity;

A mother asked the nurse what will amniocentesis provide during pregnancy: it will show as whether the baby lungs are developed enough for the baby to be born;

a nurse is preparing pt for lower abdl usg w/c of the following done by the pt needs further teaching pt voids b4 the procedure; after amniocentesis w/c of the following manifestation if observed by the nurse on the patient that needs to be reported : bleeding; pt ask the nurse what deceleration means it refers to slowing of babys heart rate; before Amniocentesis, what to check USG DEVICE

DIAGNOSTIC TESTS (to evaluate pediatric patients)

CARDIOPNEUMOGRAM use to diagnose apnea of infancy assess HR, RR, nasal airflow and O2 saturation N 95-98% below 85 report ASAP GLUTEN CHALLENGE - detect presence of Celiac Disease (CD) - intolerance to gluten; - pt is given gluten rich food for 3-4 months the observe s/s of CD s/s of CD: abdl cramps, steatorrhea, abdl rigidity, abdl distention (if + for CD, gluten free diet will be for life time)

ORTOLANIS TEST (OT)

purpose: test developmental dysplacia of the hip or congenital hip dislocation (+) if w/ click sound (lateral)

BARLOWS MANUEVER (BM)

purpose : same (+) barlows click press downward and w/ click sound

POLYSOMNOGRAPHY or sleep test EEG is connected to pt when he sleeps Check the brain waves, check for apnea of infancy preparation : No Special prep, HOLD CAFFEINE FOOD 2days b4 test

SCOLIOMETER measure the degree or angle of scoliosis check for: (+) scoliosis if uneven hemline uneven waist more prominent iliac rest and scapula on one side presence of rib hump

test for pre-teen : bend over test bend and touch the toe; (+) scoliosis if presence of rib hump, therefore x-ray then scoliometer. SICKLEDEX TEST
Purpose: test for sickle cell anemia Specimen : Blood : (blood + solution, if (+) TURBID Therefore TRAIT CARRIER Test for TRAIT

HGB ELECTROPOISIS
Purpose: test for sickle cell anemia Specimen : Blood : bld + electropoiesis, if sickling of RBC (S or C shape RBC), therefore + for SC Dses Test for Disease

GUTHRIE CAPILLARY BLOOD TEST (GCBT) - to detect PKU (in PKU there is absence of PHENYLALAMINE HYDROXYLASE- PH) Phenylalamine hydroxylase is an enzyme that converts PH to Tyroxine the one that gives color to hair, eyes and skin. If absent PH, no one will convert PH to Tyroxine, therefore it will accumulates to brain and can cause mental retardation. PH came from CHON rich food. At birth, it is usually negative, so give CHON food first for 3wks then retest. Before test, give chon rich food for 1-4 days before test. (adult) N PH level - >2mg/dl (if 4mg/dl indicative of PKU, 8mg/dl confirms PKU) SWEAT CHLORIDE TEST Types: a. sweat chloride test N 10-35 meq/L (above 40 meq/L (+) b. serum chloride test N 90-110 meq/L (above 140 meq/L (+) to detect Cystic Fibrosis (in CF, the skin becomes impermeable to Na. meaning cannot reabsorb Na and it accumulates outside of the skin); Mother complain that her baby taste salty; PILOCARPINE used in the test to induce sweating;

TIPS
pt w/ PKU would more likely to have (+) result in gluten capillary bld test if there is adequate CHON in the diet; mother complains that her baby taste salty which test is to be performed : sweat chloride test; 9 yo pt has (+) result for sweat test this indicates possible dx of Cystic Fibrosis; pilocarpine drug used for pt undergoing seat chloride test; hgb electropoisis test for sickle cell dses

DIAGNOSTIC PROCEDURES
I. CARDIOVASCULAR

A. ELECTROCARDIOGRAPHY records the electrical activity of the HEART P wave atrial depolarization QRS complex ventricular depolarization ST - repolarization Rhythm appearance of wave and distance Rate - N 60-100 bpm check on # of QRS then divide it by 300 (k)
ABNORMALITIES

a. atrial fibrillation p waves halos magkadikit. (no discernable p waves) b. atrial flutter saw tooth flutter waves c. ventricular check on QRS (N - .8-.12) ANGINA st segment elevation, t wave inversion MI - st segment elevation or depression, t wave inversion

B. CARDIAC CATHETERIZATION it determine the structural abnormalities in the heart either L or R sided catheterization site: antecubital, femoral, brachial

common complications: embolism, bleeding, arrythimia EBA nsg mgt : monitor distal pulses (if brachial site: check @ radial if femoral site : check @ dorsalis pedis) if weak or no pulse REPORT if (+) bleeding report (sandbag 10-20 lbs shld be at bedside)

C. STRESS TEST determines the ability of the heart to withstand stress equipment : threadmill & ECG nsg alert : check pulse and BP keep NPO an hr b4 the test NO Jewelries

D. CORONARY ARTERIOGRAPHY visualization of the bld vessels w/ contrast medium

nsg alert: (+)consent check allergy to contrast medium increase oral fluid intake after to excrete dye epinephrine shld be ready for any untoward reaction

E. SWAN-GANZ CATHETERIZATION 4 lumen for the ff CVP, Pulmonary Capillary Wedge Pressure (PCWP), Pulmonary Artery Pressure, Bld products, Balloon

CVP measure R side pressure of the heart PCWP L side of the heart N Pressure CVP: for R Atrium 0-12 for SVC 5-12 Nsg Alert : check pulse and s/s of bleeding

F. BLOOD CHEMISTRIES SODIUM (135 145 meq/L)

Addisons Dses: hyponatremia (dec Na), hyperkalemia (inc K) FLD IMBALANCE Cushing Syndrome: hypernatremia, hypokalemia FLD VOL. EXCESS

POTASSIUM (3.5 5 meq/L)

Hyperkalemia : Addisons dses Hypokalemia : Cushing Syndrome Inc or dec in K PT RISK of INJURY Pt w/ digitalis & diuretics monitor for arrhythmia

CALCIUM (4.5 5 meq/L or 9-10mg/dl)

Hyperthyroidism inc CA Renal Calculi Formation inc CA @ bld

GLUCOSE (80-120) Higher than 140 hyperglycemia (acidosis may lead to ineffective breathing pattern and airway is the main problem) below 50 hypoglycemia (pt prone to injury & altered thought process)

Creatinine (.5-1.5)
most sensitive index of kidney funx (increase BUN but N creatinine do not report to AP) increase creatinine kidney failure or renal disorder

BUN (10-20 mg/dl)

inc. if (+) kidney disorder

LDH (40 90 u/L)

LDH1 27-37% (for heart check for MI) LDH2 17-27% (for heart check for MI) LDH3 8-15% (for respiratory system) LDH4 3-8% (for liver & kidney) LDH5 0-5% (for liver & kidney)

LDH inc for MI for 3-4 days then it returns to N after 10-14 days

CPK or CK
Male 12-70 u/L Female - 10-55 u/L Increase CPK 3-6hrs post MI then it normalize 3-4 dyas

AST (SGOT)
- N 8-20 u/L - for liver (inc. for liver dses)

SGPT (ALT)
N 8-20 u/L more on HEART (inc for cardiac dses)

G. HEMATOLOGIC STUDIES RBC (4.5 5.5 million) - inc RBC polycythemia risk for injury complication CVA - dec RBC anemia activity intolerance

WBC (5-10 thousand) - to detect presence of infection, bld disorders like leukemia - dec WBC pt prone to infection - inc WBC hyperleukocytosis (+) to pt w/ leukemia risk for infxn

PLATELET (150,000-450,000) - spontaneous bleeding occurs when platelet dec (pt also prone to injury)

PT
(11-12 sec)

PTT
(60-70 sec)

APTT
(30-40 sec)

coumadin check pt monitor pt 4 bleeding

heparin PTT monitor pt 4 bleeding

HGB male : 14-18 mg/dl Female : 12-16 mg/dl

Dec hgb anemia (nsg dx: activity intolerance)

HCT - 35-45% - determine the adequacy of hydration and the ration of plasma to the cellular component blood inc hct dec hct : hemoconcentration (nsg dx: fld deficit dehydrated pt) : hemodilution fld excess

DOPPLER USG - to detect the patency of bld vessels arteries & veins esp of lower extremities; - painless, non invasive, NO SMOKING 30 min-1hr b4 the test

PULSE OXIMETRY - determines the O2 saturation at blood - N 95-98 attach to finger or earlobe (do not expose e light)

II.

RESPIRATORY
BRONCHOSCOPY visualization of b. tree or airway passages; to gather specimen for biopsy; NPO b4 & after Gag reflex return after 1-2hrs; Pt may expect a sore feeling (PINK STINGED SPUTUM) Report (+) stridor

CHEST X-RAY to determine abnormalities of lungs and thoracic cavity; no preparation; ABSOLUTE CONTRAINDICATED TO PREGNANCY Check pt for radiation indicator Determine effectiveness of tx and whether pt is active or non-active

SPUTUM STUDIES to determine the gross characteristic of the sputum (refers to the amount, color, abnormal particles, consistency and characteristic)
TYPE OF SPUTUM PNEUMONIA - Viral thin & watery Bacteria - rusty TB - blood streaked

BRONCHITIS - gelatinous CHF/ PULMONARY EDEMA - pink stinged

Sputum specimen sterile container

THORACENTESIS - aspiration of fld at thoracic cavity (for diagnostic & therapeutic purpose)

position:

DURING sitting AFTER - affected or unaffected side

Nsg alert:

NO COUGHING & DEEP BREATHING during the procedure coz this may cause puncture of the lungs; Assess for breath sounds after; Complication: bleeding and pneumothorax PULMONARY FUNCTION TEST - thru the use of incentive spirometer - vital capacity (4-5 L of air) refers 2 N amt of air that goes in & out of lung after maximum inspiration.
PROCEDURE:

EXHALE then INSERT mouth piece, BREATH iN, HOLD then EXHALE

LUNG SCAN - to identify the presence of blockage in the pulmonary bld vessels; - with contrast medium; - (+) consent; - assess for rxn to allergy MANTOUX TEST - test for POSSIBLE TB EXPOSURE; - using PPD (purified chon derivatives) - angle 10-15, BEVEL UP then read 48-72hrs after 5mm in duration (+) for HIV, multiple sex, previously (+) pt; 10mm - (+) for immigrants, children below 3yo and for pt w/ medical condition DM & Alcoholism 15mm - (+) for general population LUNG BIOPSY - aspiration of tissues at lungs for dx of tumors, malignancy - assess for bleeding, breath sounds & report for s/s of dyspnea

III.

NERVOUS
EEG shampoo hair B4 (to remove chemicals) and AFTER to remove electrode gel (shampoo or acetone) measures electrical activity of the brain (gray matter) non invasive, (-) consent detect the ff: brain tumors, space occupying lessions alcohol brain waves and seizures

nursing alert:
dietary modification: WITHOLD CAFFEINE coffee and tea; WITHOLD 48hrs b4 the procedure : tranquilizers, sedatives, anti-convulsant, alcohol

CT SCAN
Use radiation to determine tissue density (detect cancer and tumor)

MRI
use electromagnetic field to detect abnormality of tissue density

PET
use gamma rays or positron electron to detect abnormality of tissue density; also to detect O2 saturation @ tissue; physiology of psychosis; and to evaluate tx give more detailed impression (ex. Measurement of blocked artery)

like CA Tx

NSG ALERT: (w/ or w/out dye) CONTRAINDICATION a. b. c. d. e. CONTRAINDICATION (same w/ ct scan BUT w/ addtl)

pregnancy; obese pt (more than 300 lbs); claustrophobia (give anti-anxiety b4) pt w/ unstable v/s (arrhythmic & HPN); pt w/ allergy to dye

NO METAL OBJECTS - jewelries, insulin pump, pacemaker, hip replacement

clicking sound will be heard & lie still during the procedure

lie still during the procedure and thumping sound will be heard

lie still

CEREBRAL ANGIOGRAM - involves visualization of bld vessels @ vein w/ the use of contrast medium.
CONTRAINDICATED IN:
pt w/ allergy; pregnant pt.; bleeding

Nursing Alert: a. b. c. d. e. keep pt NPO; assess pt for allergy; monitor for signs of bldg; inc oral fld intake to excrete dye; keep epinephrine and or benadryl at bedside for emergency

LUMBAR PUNCTURE aspiration of CSF for assessment to check for infection or hemorrhage

position:

DURING : fetal or C-position AFTER : FLAT to prevent spinal headache

Needle is inserted between L3 and L4 or L4 and L5 Increase fluid intake after.

CSF ANALYSIS Assess for the characteristic of CSF. N amount: 100-200 ml Characteristic : Clear w/ glucose, Na and H2O

If REDDISH hemorrhage If Yellowish infection Ear licking w/ fluid test if (+) glucose bec. CSF has glucose.

MYELOGRAM test for presence of slip disc or herniated nucleus porposus (HNP).

ALERT:

Know the type of dye use: a. water based called AMIPAQUE b. oil base called PANTOPAQUE type of dye will determine the position of pt AFTER the procedure. If water based, the HEAD OF BED ELEVATED; If oil based, FLAT after Rationale for both oil and water based dye is TO PREVENT the upward dispersal of dye w/c can cause electrical meningitis (s/s includes: (+) seizure, headache)

IV. EENT
TONOMETRY - to measure IOP (N 12-21) - painless but w/ local anesthesia
ACUTE GLUACOMA : 50 yo and above CHRONIC GALUCOMA : 25 yo

CALORIC STIMULATION TEST - test the presence of Minierres Dses (inner ear) - involves introduction of warm and cold water then NOTE FOR NYSTAGMUS jerky lateral movement of the eye.
SEVERE NYSTAGMUS NORMAL MODERATE NYS - Minierres Dses NO NYSTAGMUS - Acoustic Neuroma

GONIOSCOPY - to differentiate OPEN and close angle galucoma; - non-invasive, painless WEBER TEST RINNES TEST

To determine lateralization of sound; To determine air and bone conduction If pt hears vibration better in GOOD EAR, Place tuning fork 2inches from the ear Problem would be SENSORINEURAL LOSS; place at mastoid bone or in teeth then. if pt hear better in POOR EAR, - refers to if AIR CONDUCTION is LONGER, therefore CONDUCTIVE HEARING LOSS SENSORINEURAL HEARING LOSS; If BONE CONDUCTION IS LONGER, therefore CONDUCTIVE HEARING LOSS

V.

GASTRO INTESTINAL TRACT

UPPER GI SERIES (Barium Swallow) - xray visualization with contrast medium - Contrast Medium: a. Gastrografin water soluble, use straw b. Barium - swallow milk shake like (use feeding bottle of pt) - then pt is ask to assume different positions to distribute dye @ esophagus purpose: to detect disorders of esophagus feces : chalky-white after: instruct pt to take laxative to excrete dye

BARIUM ENEMA (for Lower GIT)

involve rectal installation of barium; there is balloon catheter inserted @ anus then barium is instilled and pt is asked to rollover at different position then xray is taken to detect: hemorrhoids, diverculosis, polyps and lesions; after, give laxative to excrete dye (bec dye is constipating) instruct also patient to inc oral fld intake

GUAIAC TEST to detect the presence of bleeding and inflammatory bowel condition like CANCER;
(this can be refrigerated awaiting laboratory)

specimen : stool

AVOID the following 3 days B4 the test bec it can yield to FALSE (+) RESULT : Red Meat, Fish and Horse Radish

CHOLANGIOGRAPHY
-

visualization of biliary tree

medium given orally;

(includes, hepatic duct & common bile duct) same with CHOLECYSTOGRAPY but

with contrast medium w/s is given thru IV ALERT: assess for allergy (epinephrine/benadryl) Post procedure: inc. oral fld intake
to facilitate excretion of dye

GASTRIC ANALYSIS analysis of gastric secretion like HYDROCHLORIC ACID Lower Level N : 2-5 meq/hr Upper Limit N: 10-20 meq/hr
UPPER LIMIT YPES a. WITHOUT TUBE (tubeless gastric analysis) using DIAGNEX BLUE (specimen: urine); if urine colors turns BLUE, therefore (+) HCL Acid; if urine (-) blue color, therefore (-) HCL Acid b. if (-) HCL Acid at stomach (achlorhydia), therefore Gastric CA; if Increase HCL Acid therefore ZOLLINGER-ELLISON SYNDROME (+) Gastric Tumor

WITH TUBE with the use of NGT then aspirate

ULTRASONOGRAPHY upper abdl USG to detect abnormalities in the upper abdl area w/ includes biliary tree and Upper GI; painless; gel at abdomen and pt is NPO

LIVER BIOPSY aspiration of sample tissue from the liver to detect: Hepatic CA and Cirrhosis; ALERT: Check for Bleeding Time (N 1-9 mins) and Clotting Time (N 10-12 mins) because liver is highly vascular organ WHEN NEDDLE IS INSERTED tell pt to: Inhale then Exhale then Hold Breath to stabilize liver position Position after : R side-lying position Things to report: s/s of SHOCK inc PR, dec BP Check v/s

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) to visualize common bile duct and pancreatic duct; invasive (+) consent; NPO tube insertion; Tell pt that tere will be feeling of soreness a wk after the procedure

COLONOSCOPY visualization of colon to detect: inflammatory bowel condition Chrons Dses Diverticulitis Hemmorhoids Tumor Polyps

- (+) Consent - NPO b4 - clear liquid diet 2days b4 the procedure position: Lateral or side lying position or L Lateral Sims

VI. ENDOCRINE
GLUCOSE TOLERANCE TEST to provide measure of bld sugar level at blood; Inform pt to have high CHO diet 2 days b4 the test; Instruct NPO a day b4 the test (npo post midnoc); Inc sugar level, therefore Diabetes

ACTH STIMULATION TEST to detect presence of Addisons Dses specimen: blood pt is given dose of ACTH (not nore than 40ug/dl) if still dec despite ACTH administration, therefore Adrenal Insufficiency Addisons Dses

DEXAMETHASONE SUPRESSION TEST

-

to detect endogenous depression depression resulting thru endocrine disorder pt is given dexa then 24hr urine specimen is collected; a dose of dexa will suppress the release of adrenal hormones; if despite dexa administration still increase adrenal hormones, therefore pt is suffering depression

17 KETOSTEROID & 170 HCS use to detect the presence of Addisons & Cushings Dses.

Addisons dec secretion of ketones Cushings ince secretion of ketones Specimen: 24 hr urine

VANILLYLMANDELIC ACID TEST VMA Test bi-product of CATHECHOLAMINE Metabolism

epinephrine norepinephrine

inc if there is TUMOR (pheocromocytoma) of Adrenal Medulla

N 2-7 mg/dl / 24hrs if inc, therefore tumor AVOID: vanilla containing food 3 days b4 test RAIU pt is given iodine 131 then after 24hr followed by a thyroid scan inc indicates hyperthyroidism, dec hypothyroidism AVOID: iodine rich-food (sea foods, sea shells, sea weeds) 7-10 days b4 and to include other diagnostic procedures that uses contrast medium (NO - angiogram test). bec it may yield to false (-) result.
ice cream, coffee, chocolates

SULKOWITCHS TEST detect amount of calcium excreted at urine; if to test for hypercalcemia and hyperthyroidism - gather specimen b4 meals; to test for hypocalcemia and hypothyroidism gather after meals

VII. R E NA L
URINALYSIS examine the gross characteristic of the urine

urine amount : 30-60ml/hr color : clear, amber s. gravity : 1.010 1.025

abnormality: lower than 1.005 diabetic insipidus higher than 1.030 diabetic mellitus (+) glucose infection, DM (+) CHON - PIH, kidney dses. Urine maybe refrigerated if waiting to be examined.

CULTURE & SENSITIVITY KUB xray of the kidneys, ureter and bladder - NO SPECIAL PREPARATION NEEDED -

to detect infection prepare storage container IVP

xray of the kidneys, ureter and bladder uses contrast medium/ dye assess for allergy, then inc. oral fld intake after benadryl or epinephrine at bedside for allergic rxn NPO POST MIDNOC, cleansing enema in AM

CYSTOSCOPY visualization of urinary bladder after : monitor I & O; note for s/s of bleeding

RENAL BIOPSY aspiration of tissues at kidney for biopsy to detect: a. malignancy/ Ca b. malignant HPN c. kidney disorder note for s/s of bleeding

CYSTOURETROGRAM to check the patency of the ureter and bladder; monitor I & O

CYSTOMETROGRAM to evaluate the sensory and motor funx of bladder; to check if bladder respond to distention after installation of flds; monitor I & O

VIII. MUSCULO-SKELETAL
ELECTROMYOGRAPHY to detect electrical activity of the muscle; (+) consent; to alternately contract and release the muscle as needle is inserted HOLD muscle relaxant b4 the test

ARTHROCENTESIS aspiration of fluids at synovial space to detect abnormalities; check for order of analgesic; apply cold pack

ARTHROSCOPY - visualization of joints - KEEP TORNIQUET, ICE PACK and ANALGESIC at bedside BONE SCAN detect rate of bone destruction or bone resorption for pt w/ osteoporosis; lie still during the procedure; PAINLESS AND NON INVASIVE

IX. MISCELLANEOUS
BONE MARROW BIOPSY to check abnormalities at the b. marrow (eg. Leukemia) site : ILEAC REST (+) consent assess for bleeding sand bag at bedside (post procedure) for emergency use

SCHILLINGS TEST specimen: 24hr urine test for VIT B12 deficiency; for pt w/ PERNICIOUS ANEMEIA; pt is given oral VIT B12 then urine is collected, then NOTE for RATE of EXCRETION of VIT B12 (N less than 40%);
eg. If 100mg Vit b was taken 60mg shld retain at stomach and 40mg will be excreted.

URINE UROBILINOGEN to detect HEMOLYTIC DSES WITHOLD ALL MEDS 24hrs b4 the test BENCE-JONES PROTEIN detect presence of MULTIPLE MYELOMA (malignancy of plasma cells); RELEASED by destroyed or damage bones

ROMBERGS TEST check FUNX of CEREBELLUM; stand erect, close eyes, and observe for inability to maintain posture
TUMOR at cerebellum)

(if pt is Swaying, therefore

ERYTHROCYTE FRAGILITY TEST use to detect the rate of RBC DESTRUCTION in a hypotonic solution (RBC Lifespan: 120 days)

if lifespan of RBC >120 days, therefore HEMOLYTIC ANEMIA (EX. SICKLE CELL)

HETEROPHIL ANTIBODY TEST detect presence of IgM w/c is related to Epstein Virus infection

Epstein Virus Infection causative agent of infectious mononucleousis (kissing dses) mgt: AVOID SHARING of utensils and glass

LYMES DSES SEROLOGY

-

detect presence of BORRELIA BURGDORFERI

causative agent of lymes dses. Treatment: tetracycline

TIPS FOR DIAGNOSTIC PROCEDURE

2 moths old infant suspected of brocholitis is treated with oxygen therapy. Which result indicates that tx was effective : 02 SATURATION OF 98%. Pt is scheduled for liver biopsy. What shld the nurse instruct pt to do during needle insertion? - hold breath during the procedure upon insertion of the needle. Staff nurse is observing a nurse caring for pt w/ cvp. W/c action of the nurse require intervention? touching the edge of the soiled dressing using clean gloves . Pt undergoing ERCP important prep for nurse to make would be: keep pt NPO b4 the procedure. Pt w/ coronary angiogram, the catheter was inserted at the L femoral artery. w/c intervention is appropriate after the procedure: palpate the popliteal and pedal pulses. In explaining to the pt about cystoscopy the nurse shld say : the bladder lining will be visualize. A mantoux test is (+) if the nurse assesses w/c of the following: in duration. w/c of the ff will yield an accurate reading of CVP: when the zero level of the manometer is at the level of R atrium. w/c responses made by the pt indicates that he understands the procedure to be done in a CT scan: a dye will be injected to me. A pt is to have an upper GI series which statement shows that he understood the instruction given : I will drink the dye. After liver biopsy, a potential complication: bleeding. MRI is the primary diagnostic tool for multiple scelosis bec it promotes visualization of plaques at the brain.

PHARMACOLOGY
I. GENERAL CONSIDERATIONS

ONLY RNs are allowed to administer (to include central line) LPNs peripheral IV Line route; ELDERLY PT provide with memory aid PEDIATRIC PT do not mix w/ milk (dosage depends on wt, age and size) For SIDE EFFECTS GI symptoms (mostly) For AD. EFFECTS always consider bone marrow (leukocytopenia all PENIA) 3 COMMON DRUGS with patients over 65 y/o a. LITHIUM if above 65 yo, dose shld not more than 1.0mEq b. HALDOL if above 65 yo, dose shld not more than 6mg/day c. MEPERIDINE if above 65 yo, shld not 50 mg

II. TRANSCULTURAL ASIANS are stoicism attitude MIDDLE EASTERNERS (they refuse meds if for the 1st time)

they expect meds during first contact w/ hx care provider

JEWISH no meds restrictions

JEHOVAHS WITNESS do ORIENTAL PAYLOAH (from mexico) - treatment for diarrhea; - may cause lead toxicity ECHINECEA - use to boost the immune system; - for pt. with cancer ST JOHNS WORT - anti-depressant (it funx like MAO inhibitor); - do not give to pt taking MAO VALERIAN - sedative (used also as anti-anxiety agent) - adverse effects GI Irritation GINGCO BILOBA - blood thinner; - use to enhance bld circulation; - for pt w/ alzeimers - CONTRAINDICATED to pt with bleeding disorders

COMMON CONTRAINDICATIONS for HERBAL MEDS:

NO HERBAL MEDS for pregnant client; NO HERBAL to lactating pt; NO HERBAL for those with severe kidney and liver disorder

IV.

THE CHECK PRINCIPLE C HECKlassification (FOR WHAT?) ow will you know that he meds if effective (evaluation) xactly what time are you going to give it lient teaching tips eys to giving it safely

Lactulose given to pt with hepatic enceph to dec ammonia absorption - s/e : diarrhea ANTABUSE (dizulfiram) most appropriate time to take meds : after 12hrs of alcohol free. COGENTIN to prevent pseudoparkinsonism
(by decreasing muscle rigidity)

TETRACYCLINE - can cause staining of teeth, Photosensitivity (use sunscreen when outdoors) LITHIUM shld have inc. fluid in the diet

III. DELEGATION AND DOCUMENTATION Document all medical admin record:

time, route, dosage and untoward reaction;

The following CANNOT be delegated:

treatment, administration, documentation of meds

PSYCHOTROPIC
I. ANTIPSYCHOTIC
ex. Haldol Chlorpromazine Clozapine (chlozaril) Olanzapine (zyprexa) Risperdon BETS TO GIVE: after meals DOPAMINE neurotransmitter (facilitate the transmission of neurons) In SCHIZO there in INCREASE NEUROTANSMITTER. Signs & Symptoms: a. DELUSION FALSE BELIEF b. HALUCINATION - hearing sounds c. LOOSENES OF ASSOCIATION shifting of topic CLIENT TEACHINGS: Report ADVERSE EFFECTS of ANTI-PSYCHOTICS which indicates agranulocytosis a. fever b. body malaise c. sore throat d. chills hyperpyrexia and muscle rigidity
-

major tranquilizer; for SCHIZOPHRENIA (pt has EXCESS DOPAMINE); plays as treatment to the symptoms NOT CURE to schizo meaning it modify the symptoms (target symptom: to decrease dopamine)

this indicates NEUROLEPTIC MALIGNANT SYNDROME (NMS)

drug of choice: Parlodel, Dantrium

Assess SIGNS and SYMPTOMS of PSEUDOPARKINSONISM

a. mask-like face or expressionless face b. pill-rolling tremors c. cogwheels rigidity or lead pipe rigidity

DYSTONIA

AKATHESIA restless leg syndrome (I feel as if I have ants in my pants)

Avoid direct sunlight because meds photosensitivity

Instruct pt to rise slowly to avoid orthostatic hypotension

Check: CBC, BP, AST/ALT To prevent pseudoparkinsonism, administer ANTIPARKINSONIAN agents

IA. DOPAMINERGICS - ANTIPARKINSONIAN

in schizo there is increase dopamine, therefore give antipsychotic to dec dopamine then dec dopamine causes pseudoparkinsonism. Therefore give dopaminergic.

ex.

L-Dopa Levodopa Levodopa-Carbidopa

Effective if decrease in tremors and rigidity within 2-3 days; When to give: AFTER MEALS; Health Teachings: a. dietary modification: AVOID CHON and Vit B6 - bec it decreases drug absorption b. check for ORTHOSTATIC HYPOTENSION and PALPITATION; c. check BP and PR

IB. ANTICHOLINERGIC
decrease ACETYLCHOLINE

ex. Benadry Cogentin effective: if decrease tremors and rigidity; when to give: AFTER MEALS;
Health Teachings:

a. b. c. d. e. f. g.

side effects: blurred vision (no driving); dry mouth suck on ice chips or hard candy; palpitations check PR; constipation inc. roughage at diet; urinary retention NOT urinary frequency decrease BP rise slowly check BP, PR, ECG

II. ANTI-ANXIETY
minor tranquilizer decrease Reticular Activity System center of wakefulness

ex. Valium, diazepam, Librium, Tranxene

Effective:

Decrease Anxiety, Decrease Muscle Spasm

(to pt w/ traction)

Promote Sleep
B4 MEALS

because food delays absorption

HEALTH TEACHINGS:

a. report ADVERSE EFFECT: PARADOXICAL REACTION opposite of side effects b. Danger of Dependency c. AVOID: Caffeine, Alcohol it increase the depressant effect of the drug d. check RR it causes respiratory depression e. administer VALIUM separately because it is incompatible with any drug use different syringe.

III. ANTI-DEPRESSANT/MANIC
a. b. c. d. TRICYCLICS MAO STIMULANTS SSRI

PATIENT with DEPRESSION there is DECREASE norepinephrine and serotonin

A. TRICYCLICS

prevents the reabsorption of norepinephrine.

Ex. Tofranil, Elavil

Effective:

If adequate sleep (8hrs only) Increase appetite AFTER MEALS

Best given:

Hx Teachings:

The INITIAL EFFECT 2-3 wks after FULL THERAPEUTIC EFFCET 3-4 wks ONSET EFFECT in a WK AVOID : juice because an acidic medium decrease absorption of drugs REPORT PALPITATION and TACHYCARDIA and ARRYTHMIAS adverse effects of TRICYCLICS CHECK BP and ECG

B.

MAO INHIBITOR (MonoAmine Oxidase)

prevents the destruction of NEUROTRANSMITTERs ex. Parnate, Nardil and Marplan
Effective

: if INCREASE SLEEP and APPETITE

Give AFTER MEALS

Hx Teachings:

AVOID TYRAMINE CONTAINING FOOD

(1 day before FIRST DOSE and 14 days AFTER LAST DOSE)

Avocado, banana, cheese (cheddar, aged and swiss) COLA, CHICKEN LIVER SOY SAUCE RED WINE PICKLES

ALLOWED: cheese cottage and cream, FRESH MEAT, VEGETABLES

Check BP the drug can cause HYPERTENSIVE CRISIS

occipital headache my nape is aching

2 WKS INTERVAL when shifting ANTI DEPRESSANT

to avoid HYPERTENSIVE CRISIS ex . after MAO 2 wks rest then can give ST JOHNS WORT

C.

STIMULANTS
(Ritalin, Dexedrine and Cylert)

directly stimulates the CNS.

Effective:

Increase Appetite and Adequate sleep

if b4 meals, it suppresses the appetite; give NOT BEYOND 2pm bec. it causes INSOMNIA 6 Hrs b4 bedtime; shld be given in the morning to avoid INSOMNIA

Best to Give: AFTER MEALS

COMPLICATIONS:

growth suppression

Hx Teachings:

provide intervals or intermittently to avoid growth suppression; check BP and PR

D.

SSRI (selective serotonin reuptake inhibitor)

Ex. ZOLOFT, Prozac
Adverse effects: s/e:

DECREASE LIBIDO and Impotence

GI

III.1 ANTIMANIC
Lithium (lithane, lithobid, escalith) Tegretol Depakine/ Depakote

A. LITHIUM
-

it alters level of neurotransmitters

effective if DECREASE HYPERACTIVITY give AFTER MEALS Hx Teachings: diet: High Na (6-10 gms) and High Fluid (3-4L)
N Na 3 gms, N fluid intake 3L Basically, Lithium is a salt

Report the ff s/s (NAVDA) Nausea Anorexia Vomiting Diarrhea Abdl Cramps

Report also:

FINE HAND TREMORS progressing to COARSE HAND TREMORS, THIRST and ATAXIC - sign of LITHIUM TOXICITY Dug

of choice: MANNITOL DIAMOX

Hx Teachings:

(specimen: blood drawn in the morning b4 breakfast or at least 12 hrs after the last dose)

Avoid activity that increase perspiration Na & H2o; Avoid caffeine; Monitor lithium level

Frequency of Lithium monitoring: ONCE A MONTH;

NORMAL LITHIUM LEVEL:

ACUTE DOSE Below 65 yo Above 65 yo .5 1.5 mEq/L .6 1.0 mEq/L

MAINTENANCE DOSE
.5 1.2 mEq/L .4 - .8 mEq/L

Lithium is effective with 10 14 DAYS before it will reach its therapeutic level.

CONTRAINDICATION OF LITHIUM: Pregnancy; Lactating; Kidney disorder

- if above s/s are (+) to patient, instead of lithium use TEGRETOL, DOPAKINE/ DEPAKOTE tegretol a/e : alopecia

dopakine/ depakote - gingivitis

ANTICONVULSANT (Tegretol and dilantin)

for seizures, wherein there is abnormal discharge of impulse in the brain action : IT INHIBITS the seizure focus and discharge

effective: if (-) seizure given BEST AFTER MEALS

(except for sedatives- like valium) MOST DRUGS THAT AFFECT CNS ARE BEST GIVEN AFTER MEALS TOO.

NSG ALERT:

Check :

Report GINGIVITIS; Report S/S of Bone Marrow Depression pancytopenia (dec RBC & WBC); Instruct pt to use SOFT BRISTTLED TOOTHBRUSH; Instruct pt to MASSAGE GUMS and frequent oral hygiene CBC due to pancytopenia RBC, WBC and Platelet label

CHOLINESTERASE INHIBITORS
For MYASTHENIA GRAVIS For ALZEIMERs DSES

: Prostigmin (long acting) and Tensillon : Cognex (tacrine) and Aricept

(short acting)

Myasthenia Gravis there is decrease or absence of Acethylcholine (ACTH)

ACTH is a neurotransmitter the delivers the order ex. Brain to muscle to contract/move.

Therefore, the drug is given to inhibit cholinesterase in destroying ACTH

(so, if dec cholinesterace and inc. ACTH, good muscle contraction)

PROSTIGMIN long acting for treatment TENSILLON short acting only for 5 mins.
it increase muscle strength in 30 seconds (therefore, if muscle weakness disappear within 30 seconds it is MYASTHENIA GRAVIS)

Drug Action: Increase muscle strength (ex. Increase chewing ability or able to chew food forcefully) GIVE B4 MEALS or any activity; Meds is FOR LIFE; Report s/s of HEPATOXICITY RUQ pain of abdomen and JAUNDICE

Antidote: ATSO4 it reverses the effect of anticholinesterase Check for LIVER FUNX TEST; Keep at bedside: endotracheal tube for resp. problem

ANTICOAGULANT
HEPARIN
For ACUTE CASES of Manic Case Antidote: PROTAMINE SO4 Given SubQ (Lower Abdl Fat) Effective if (-) clot Give same time of day Report s/s of bleeding : Hemoptysis Hematemesis HEPARIN: AVOID green leafy vegetables bec it is rich in Vit K and will counteract the effect of anti coagulant. Therefore, diet of patient no appropriate. NSG ALERT: monitor PTT (N 60-70 SEC, TIL INR of 175), if more than INR - HOLD INR refers to the upper limit of meds from N value to the maximum dose

COUMADIN
FOR MAINTENANCE or Chronic CASE Antidote: VIT K Oral Onset: 2-5 days (maintenance case) Check PT (N 11-13 sec and INR 24 sec)

LOVENOX
Heparin Derivatives Antidote same w/ Heparin

COAGULATION PROCESS: Vitamin K dependent clotting factors PRO THROMBIN thromboplastin THROMBIN

COUMADIN HEPARIN

FIBRINOGEN

FIBRIN (CLOT)

COUMADIN act as vit k dependent clotting factors HEPARIN

converts PROTHROMBIN to THROMBIN and FIBRINOGEN to FIBRIN

- RAPID ACTING :onset : 24 48 hrs

Coumadin and Heparin

NOT to dissolve clot (only as THROMBOLYTIC meaning it prevents ENLARGEMENT and FORMATION of CLOTS) can be given together

ANTIARRYTHIMICS
Ex. Quinidine (quinam)

Side notes:

Characteristics of HEART MUSCLE:

a. CONDUCTIVITY ability to propagate impulses; b. AUTOMATICITY - ability of heart to initiate contraction; c. REFRACTORINESS ability of t heart to respond to stimulus while in the state of contraction; d. EXCITTABILITY - ability of the heart to be stimulated
Inotropic effect Chromotropic Effect CHRONOTROPIC Effect - force of contraction or strength of myocardial contraction; conduction of impulses; - rate of contraction

ANTIARRYTHMIC (quinidex, pronestyl) repolarization resting phase (k goes out) depolarization stimulating phase (Na goes in)

(therefore the depolarization and repolarization of heart muscle depends on Na and K pump.)
K once it increase or decrease, it affects the repo and depo of heart muscle which causes arrhythmia. And so, to maintain the balance in the Na and K pump give antiarrythmia because it decreases the automaticity of the heart. Antiarrythmia is effective if (-) arrhythmia; Give meds anytime;

Health teachings: a. report CNS confusion, ataxia and headache GI - nausea, anorexia and vomiting b. RASH therefore SKIN TEST FIRST c. REPORT s/s of QUINIDINE TOXICITY tinnitus, hearing loss and visual disturbances d. check pt PR and ECG waves, rate and rhythm

QUINIDINE

PROCAINE

LIDOCAINE
Ventricular arrythmia

For VENTRICULLAR & ATRIAL Fibrillation

CARDIAC GLYCOSIDES
increase force of contraction; affects the automaticity and excitability of the heart muscle; K shld be monitored when in this meds therapy

(The heart contraction is regulated by Na and K pump. If K decreases, Calcium enters and it will result to a more increase force of contraction due to Na and Ca pump conversion.)

Effects: (+) INOTROPIC strengthen the force of contraction (-) CHRONOTROPIC decrease rate of contraction
DIGOXIN
EFFECTIVE : ACTION : it increase FORCE OF CONTRACTION onset : 5 20 mins

DIGITOXIN
same 30 mins 2hrs

Give after meals due to GI irritation

same

CLIENT TEACHINGS: Report s/s of TOXICITY : NAVDA

Xanthopsia

yellowish vision or greenish halos;

Check PR if BELOW 60/min (adult) HOLD next dose; if BELOW 70/ min (older child) HOLD; if BELOW 90- 110 (infants) HOLD next dose EXCRETION Digoxin kidney monitor renal funx test (BUN & Crea) report if inc; Digitoxin liver AST/ ALT

DIGIBIND antidote for digoxin (lanoxin)

THERAPEUTIC LEVEL:

a. Digoxin b. Digitoxin

: .5 2 ug/L : 14 26 ug/L

NITRATES (nitroglycerine)
EFFECTS:

dont give if pt taking VIAGRA it will result to FETAL HYPOTENSION dilatation of coronary arteries and arterioles thereby resulting to DECREASE IN PRELOAD & AFTERLOAD.

Decrease in Preload decrease in the amount of blood that goes to the LV; AFTERLOAD amount of resistance offered by blood vessels that heart shld overcome
when pumping blood

Effective if NEGATIVE ANGINAL PAIN; Give BEFORE any activity; Administered SUBLINGUALLY (+ burning sensation indicates drug is potent) NO WATER because it
will dilute the meds;

DOSES: 3 doses at 5mins interval; Report if there is persistence of pain; Check BP and PR; Keep meds in dark container (bec light dec potency); Once the bottle is open, use the meds within 3-6 mos

DO NOT REPORT THE FF: (expected s/s) Hypotension, Headache, facial flushing why is my face red?

MUCOLYTICS (an antidote also for ACETAMINOPHEN TOXICITY)

Ex. Mucomyst

it decreases the viscosity of secretion; give meds anytime; client teaching: meds can be diluted w/ NSS or cola;

Side effects: NAV + Rashes

if no side effects, repeat dose in 1 hr

BRONCHODILATORS (ex. TERBUTALINE brethine)

-

dilates the bronchioles or airways; effective: if (-) bronchospasm; GIVEN in AM to decrease insomnia REPORT THE FF: insomnia, tachycardia, palpitation-PR, + NAV

Theophylline - N 10-20; - for ACUTE ATTACK and PREVENTION of ASTMA

EXPECTORANT
-

(robitussin)

stimulates productive coughing; effective : (+) COUGHING & SECRETIONS give ANYTIME; sideffects: NAV + DIZZINESS or drowsiness avoid activity that required alertness (ex. Driving)

ANTIBIOTICS
bactericidal; effective: (-) infection; give ON EMPTY STOMACH B4 MEALS; Hx teachings: REPORT rash, urticaria and STRIDOR indicates airway obstruction; side effects: NAVDA + GI Irritation

I. PENICILLIN : antidote is EPINIPHRINE II. AMINOGLYCOSIDE (gentamycin) effective: (-) infection give B4 meals; report the ff:
OTOTOXICITY: I hear ringing in my ear NEPHROTOXICITY : oliguria NEUROTOXICITY : seizures

III. -

check BUN, CREA (kidney funx test); check I & O (sign of nephrotoxicity) ANTINEOPLASTIC (adriamycin) for breast and ovarian CA; effective: (-) tumor size; GIVE IN ARM to prevent HEMMORRHAGIC CYSTITIS Hx Teachings: a. inc oral fluid intake (2-3L/day) cytotoxic prevention;

b. monitor kidney funx I & O;

THYROID AGENTS (synthroid, cytomel)

for HYPOTHYROIDSM; effective: if Inc in T3 and T4 and NORMAL SLEEP; pt always sleep, therefore give meds in AM to avoid insomnia; REPORT HE FOLLOWING: insomnia, nervousness; palpitations Take meds LIFETIME (same w/ meds 4 neuro); Check HR, PR and kidney funx test;

ANTITHYROID
-

(PTU, LUGOLS SOLUTION)

For GRAVES DISEASE or HYPERTHYROIDISM; Effective: Decrease in T3 and T4 (in lab data); Give round the clock; a. Report sore throat, fever, chills, body malaise because meds cause AGRANULOCUYTOSIS; b. Report lethargy, bradycardia, and INCREASE SLEEP indicates that pt is having HYPERTHYROIDISM; c. Diarrhea with metallic taste sign of IODINE TOXICITY

Health Teachings:

ANTIDIABETICS
-

(INSULIN)

effective: N Blood sugar (80-120) for DM Type 1 (insulin dependent); give in AM b4 meals; check: a. instruct S/S OF HYPOGLYCEMIA dizziness/ drowsiness difficulty in problem solving decrease level of consciouness cold clammy skin b. monitor the blood sugar level in early AM and supper time

INJECT AIR FIRST to NPH then inject air and WITHDRAW FIRST with REGULAR. PEAK OF ACTION (refers to when patient becomes HYPOGLYCEMIA) REGUALR INSULIN Intermediate Long Acting - lunch time - late in the afternoon B4 dinner - B4 Breakfast

SULFONYLUREAS
-

(Orinase)

for DM type 2; stimulate pancreas to produce insulin; effective N bld sugar level; give b4 meals regularly; teachings: a. s/s of hypoglycemia;

b. monitor renal funx test; c. antidote for hypoglycemia ORANGE JUICE

ANTACIDS
-

(amphogel, tagamet)

ALUMINUM HYDROXIDE GEL antacid and it also dec phosphate level in pt renal failure; Effective: dec phosphate (-) pain give on EMPTY STOMACH (1 hr b4 or 2hrs after meals); instruct pt to REPORT: muscle weakness in lower extremities indicates HYPOPHOSPATHEMIA administer with glass of water; check phosphate level and renal funx test; assess for constipation

LAXATIVES (dulcolax)
Colace Metamucil Dulcolax Lactulose stool softener - bulk forming - rapid acting - 15-30 mins

effective : (+) BM; give AT HS (if NOT diagnostic procedure); give AFTER MEALS for dyspepsia; meds is given in short duration only because of dependency teachings: a. b. c. d. e. be near or stay near CR; s/e: diarrhea; NO lactulose for pt w/ diarrhea; Causes hypokalemia therefore check electrolytes Increase fld intake to avoid dehydration

DIURETICS
Target Organs a. Diamox exerts effect at Proximal Convuluted Tubules; b. Lasix at Loop of Henle; c. Diuril at Distant Con. Tubules LOOP DIURETICS (lasix) - effetctive: incrase urine output; - give in morning to prevent nocturia; - teachings: a. monitor for hypokalemia level and I & O; b. report muscle weakness;

c. give K rich food banana, orange THIAZIDE (diuril) give in AM; monitor for hypokalemia; check I & O, K level, PR and BP

K-SPARRING (triamterene, aldactone) effective: inc. urine output; give in AM; teachings: monitor for HYPERKALEMIA check PR and K

ANTIGOUT
PROBENECID
- URICOSURIC - promotes excretion of uric acid - s/effects: NAV + Hypersensitivity

COLCHICINE
- for ACUTE GOUT - has anti-inflammatory effect by preventing deposition of u.acid @ joints - NAV + Bldg and Bruising - ONSET: 8-12 wks

ALLOPURINOL
- for CHRONIC GOUT - prevents or dec formation of u. acid - dizziness/drowsiness agranulocytosis (check CBC) - ONSET: 1-3 wks

TEACHINGS: a. Increase ORAL FLUID INTAKE; b. Monitor uric acid levels;

MIOTICS (timoptic, piloca)

DECREASE IOP (N12-21) for pt w/ glaucoma; Give ANYTIME but for LIFETIME; Teachings: a. it causes blurring of vision and brow pain; b. administer meds at lower conjunctival sac; c. press the inner canthus for 1-2 mins to prevent systemic side effects (hyperglycemia and hypotension)

MYDRIATRIC
-

(AK-Dilate)

effective: pupillary dilatation; give ANYTIME (but if pt for surgery, give b4); teachings: may cause blurring of vision
lower conjuctival sac

CARBONIC ANHYDRASE INHIBITORS (diamox)

for GALAUCOMA lifetime; to decrease production of acqueous humor; effective: N IOP and Inc. urine output; effective to pt with MENIERES DSES dec vertigo teachings: a. check urine output;

b. report: s/s of dehydration bec of diuretic effect c. blurred vision d. monitor I & O and IOP

ANTI-ACNE (acutane, retin-a)

decrease sebaceous gland size; given in AM to prevent insomnia; avoid sunlight: photosensitivity pregnancy: fetotoxic - therefore check if pt is pregnant; check if pt has skin irritation may burn the skin

TOCOLYTICS (Yutopar, MgSO4)

-

relax the uterus; drug of choice for pre-term labor; effective: (-) pre-term or relaxed uterus; give: ORAL B4 meals and IV anytime; teachings: a. signs of Ca Intoxication: hypotension, hypothermia and hypocalcemia b. check bld pressure; urine output (N 30ml/hr) c. check RR at least 12/min d. check patellar reflex shld be (+) knee jerk

HOLD if RR 10/min and urine output: 15ml/hr Antidote: Calcium Gluconate

OXYTOXIC
PITOCIN METHERGIN

To induce labor To prevent post partum hemorrhage Effective: Firm and Contracted Uterus Give anytime If IV, use piggy back Teachings: a. REPORT the ff: HYPOTENSION (due to inactivation of ANS neurological effect of drug); b. Headache c. Hypertension (cardiovascular effect of the drug) d. Check BP, Uterine Contraction especially the duration N 30-90 sec - report if beyond 90 sec sign of uterine hypertonicity e. Check Force, Duration and Frequency of Uterine Contraction

PROSTAGLANDIN (cytotec, E2gel)

anti ulcer drug to dec gastric acidity; decrease ripening of the cervix w/c leads to effacement then dilatation then abortion; give after meals; assess for diarrhea and gastric irritation; check for pregnancy bec it may cause abortion

TIPS ON PHARMACOLOGY
Patient receiving DIAZEPAM, the nurse notice that there is no change in patient behavior. What shld the nurse do? VERIFY THE PT DIET COGNEX given with AZEIMERSS DSES to increase mental functioning Pt w/ PVC : bedside : XYLOCAINE Pt w/ COMPLETE HEART BLOCK: give ATSO4 it increases HR Pt w/ DIVERTICULITIS (pt has diarrhea) the ff meds were given: what meds the nurse shld question : LACTULOSE Morphine S04 given to pt with Pul. Edema to decrease anxiety Pt ask the nurse on why she will take COUMADIN when shes already taking HEPARIN Heparin is given for ACUTE CASES while Coumadin for maintenance Pt on CHEMOTHERAPY complains of nausea and vomiting, w/c meds can be given ZOFRAN Expected side effects of STEROIDS : wt gain, obesity and Inc appetite Pt is taking LEVODOPA observe for URINARY RETENTION ADREAMYCIN causes hemorrhagic cystitis DESMOPRESSIN ACETATE administered INTRANASALLY FESO4 shld be given w/ orange juice ASPIRIN I s given to pt w/ TIA to decrease platelet aggregation Pt taking ANCEF observe for skin rashes Pt to receive NPH at 7:30am, the nurse shld expect for hypoglycemia LATE in the AFTERNOON

TYPES OF PRECAUTION
P AIDS
(universal) x

H
yes

GL
yes

GW
yes

M
yes

DIARRHEA HEPA A B C MRSA

(enteric)

yes

yes

(enteric) (universal) (universal)

x x x

yes yes yes

yes yes yes

x yes yes

x yes yes

(contacts) (enteric)

yes x

yes yes

yes yes

yes x

yes x

MENINGITIS/SEPTIC SCABIES TB
(contact)

yes

yes

yes

yes

yes

(tb Precaution)

yes

yes

yes

PEDICULOSIS
P private room H handwashing GL - gloves GW gown M - mask

(contact)

yes

yes

yes

yes

yes

AIDS universal Norwalk Virus respiratory Hepa A contact MRSA contact Scabies contact