NCLEX REVlEW - GAPUZ REVlEW CENTER NCLEX REVlEW - GAPUZ REVlEW CENTER

(31 ]ANUARY - 17 FEBRUARY 2005, PlCC, City of Manila)

DAY 1 (31 JANUARY 05)
STEPS lN PASSlNG
! Have a Rght Atttude
! THINK POSITIVELY . have a Fresh Start
! KNOW what YOU WANT and HOW TO GET IT
! OVERVIEW OF ESSENTIAL CONCEPT
! TRY OUT
! Focus assessment
! 7 habts of SUCCESSFUL EXAMINEE
MOSBY - growth and deveopment
LlPPlNCOTT - care of the Edery and Communcabe Dsease
DlGOXlN - montor the creatnne. " the TV DOESNT ook good to me"
(DIGOXIN TOXICITY - nausea/vomtng, abd cramps)
Ove = butter
CK - normaze 1 - 3 days after MI
LDH - 10 - 14 days
ATRIAL FLUTTER - SAW TOOTH
PROCESS OF ELlMlNATlON
! consder MASLOWs H of NEEDS
! consder the COMPLICATION whether ACUTE - ALWAYS prioritize
CHRONIC
! ABCs
! SAFETY FIRST
! NSG PROCESS
MMR VACClNE - only vaccine for HlV pt.
Pt on HEPARIN - APTT (N 30-40sec), therefore f INCREASE - beedng
POlSON - nursing action in order :
#1 CALL poson contro center
# 2 MINIMIZE EXPOSURE of pt to poson - pu hm/her away from the poson
# 3 IDENTIFY the poson
GENTAMYClN - s/e tnntus, vertgo, ototoxcty, ogura
LlTHlUM CARBONATE - for ELDERLY : N eve NOT more than 1.0meq/L
ADULT : N .5 - 1.2 meq/L
HEPA B diet : ow fat, ncrease CHON
DOWN SYNDROME - arge tongue - feedng probem - poor suckng (nfants)
SAFETY PRlNClPLE
1. when can a chd 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 - fas
3. SUPRATENTORlAL craniotomy - sem fowers poston
lNFRATENTORlAL - fat n bed
4. SCATTER RUGS - osteoporosis pts.
5. TRIAGE ; burns, open fx - "SHOCK"
Things NOT TO BE DELEGATED by RN:
Assessment, Teachngs, Evauaton
Pt 50y/o and - mammogram - once a year.
Pt with PKU - LOW PHENYLALAMINE DIET (NOT pheny FREE). -
therefore LOW CHON
Pt wth Rocky Mountan Fever - exposure to dog ticks
Lymes Dses - deer ticks
PSYCHE PATIENTS
1. remember to stck to unt rues/pocy - be consstent to pt.
2. encourage verbazaton - "te me how..."
3. sound knowedge of cutura dversty
- seek hep of nterpreter
4. acknowedge pt feengs - "t seems.."
"ths must be dffcut..."
5. emphatze wth your patentss feengs
" I understand how you fee..."
CATARACT - CAUSES - agng and trauma
MRSA (methcn resstant staphyccocus aureus)
- USE GLOVES AND GOWN WHEN W/ PT
DAY 2 ( 01 February 05)
T U B E S
1. GROSHONG CATHETER - 2 umen
HICKMAN - 3 umen
BROVIAC - 1 umen
ALL requres Centra Venous Access
- stes: cephac, bracha, basca and superor vena cava
PURPOSE: For TPN
Admnstraton of Chemo Agents,
Bood Products, Antbotcs
COMPLlCATlON:Thromboss and Beedng
2. CHEST TUBES - Water Seaed Dranage
Types: Anteror - w}c drains AlR
Posteror - w}c drains FLUlDS
Water Seaed Dranage : 1 botte, 2 botte and Three botte system
1 BOTTLE : 3 - 5cm of ony (ength of tube to be emerge)
2 BOTTLE : Frst botte - dranage botte (no tube emerge),
2
nd
botte - ong rod 3-5cm
3 bottle : FREOUENTLY USED
1
st
botte - drainage
2
nd
botte - water sealed
3
rd
botte - suction bottle control
COMPLlCATlONS: bubbng, breakage, bockage
Nsg ALERT:
! NORMAL : BUBBLING s N n the 3
rd
botte - t ndcates that sucton s
ADEOUATE
(f no bubbng STOPS n the 3
rd
botte, meanng - nadequate sucton)
! ABNORMAL : f bubbng occurs at the 2
nd
botte - ndcates LEAKAGE -
acton, check seaed at ar tght contaner and the pt and botte connecton.
In case there BREAKAGE, have extra botte and emerge tube ASAP to prevent entry of
ar and or may use forcep to camp tube temporary.
If pt. ambuates, keep botte LOWER than the patent.
ABSENCE of OSClLLATlON at the 2
nd
Bottle - ndcates bockage
TOWARDS THE BOTTLE - When MlLKlNG the tubings.
EMERGENCY EUlPMETS AT BEDSlDE: xtra bottle,clamp, gauze
3. TRACHEOSTOMY TUBE
- to mantan patent arway for pt w/ neuroogca probems and
muscuoskeeta dsorders.
nursing care:
1. Suctonng - 10-15seconds
- f (+) bradycarda, STOP
- f accdentay dsodge, nsert obturator to keep t open
2. AVOID: water sports - swmmng
3. In changng tes - nsert new one frst BEFORE REMOVING od te.
4. Rbbon or tes @ sde of the neck ony to avod pressure.
5. Before and After suctonng - hyperoxygenate the patent.
4. PTCA - enarge the passageway for boodfow.
probem: spasms that ead to arrhythma
C-STENT (cardac-stent) - aternatve to PTCA
Mantans patency of bd vesses
Probem: dsodge
lABP (Intra Aortc Baoon Pump)
- for Cardogenc Shock
probem: thrombus formaton, nfecton and arrhythma
5. PENROSE DRAlN
- wound dranage system
- doctors the one who removes ths.
- remove graduay
6. NASO GASTRlC TUBE - stomach and ntestne (duodenum)

Types:
! Levine Tube - for stomach
- 1 umen, for avage (ceanng) and gavage (feedng)
! Salem Sump - for stomach
- 2 umen (I for suctonng, I for avage/gavage)
- f pt (nfant) s havng enterc coated meds, request for
change n form of meds
! Miller Abbot - for ntestna (w/ mercury b4 n|ecton)
- 2 umen (nsert then n|ect the mercury)
! Cantor - for ntestna
- 1 umen
Nursing Care for NGT:
1. tp of nose to earobe to xyphod process (for stomach)
2. tp of nose to earobe to XP + 7-10 nches for intestinal NGT
3. accurate means to verfy correct pacement: ALWAYS consder Two checkng
crtera: ASPIRATION and Gurgng Sounds
Report the following:
If (-) or decrease dranage,
(+) nausea and vomtng
(+) abdm rgdty
Characterstc of Gastrc Resdua: more than 50 mo and coffee ground.
Before feedng check for pacement.

7. GASTROSTOMY TUBE (GT)
PEG
both for NUTRITIONAL PURPOSES
GT - ncson (abdomen to stomach)
- for pt (+) eson at esophagus
- nsg care : report s/s of nfecton, abd cramps, n/v
- provde adequate skn care
PEG - ncson at skn
- ong term therapy
8. T TUBE
- to dran excess be unt hearng occurs
- pace dranage bag at the eve of t-tube
(obstructon of t-tube - there w be excess dranage)
500 m - N dranage n 24hrs, f report ASAP.
9. HEMOVAC
]ACKSON-PRATTS (]P)
! BOTH used as cose wound dranage sucton system
! BOTH system functon on the system of (-) pressure.
|P - compress the contaner before attachng to the dranage.
WHEN TO EMPTY: when ts usuay 1/3 to fu then RECORD the amount.
10. THREE-WAY FOLEY
absence of cot - effectve
Characterstc of dranage - 2-3 days after surgery (boody to pnksh) - NO NEED TO
REPORT THIS
- t s expected
11. SUPRAPUBlC CATHETER - for gento urnary probem
- nserted drecty at the badder wa
- check f propery anchored
12. URETHRAL CATHETER
- to dran urne.
- never camp because t can ony hod 4-8 m of urne.
- keep open to dran urne from kdney pevs.
SENGSTAKEN BLAKEMORE TUBE
- 3 umen ( for esophagea baoon, gastrc baoon, for meds)
- for pt w/ esophagea varces
- baoon tamponade
- 48 hrs - keep baoon nfated for 10 mnutes to decrease beedng
LlNTON TUBE - 3 umen
MlNESOTTA TUBE - 4 umen
! SCISSORS - important EUlPMENT AT BEDSlDE FOR ALL TUBES.
! HEMOSTAT - mportant nstrument that shd be @ bedsde for water seaed
dranage.
! Persstent bubbng at water dranage botte - for botte #2 - check f tubng s
propery seaed.
! NGT IS REMOVED - f patent exhbts return of bowe sounds.
! BULB SYRINGE - use to cean the nares of pt wth NGT (chd)
! To factate remova of ar at ungs - purpose of water seaed chamber n 3 way
botte system.
THERAPEUTIC DIET
GENERAL CONSlDERATlON
! Know the DIAGNOSIS of the patent
! Identfy & ncorporate the pt. detary preferences
! Instruct pt on what to avod
! For pregnant pt, note detary changes:
a. addt caores (300 ca/day) average of 2400 - 2700
b. addt of 10gms/day for CHON
c. IRON : 15-30mg/day
d. CALCIUM : RDA s 1000 then +200mg/day (brocco,tuna,cheese)
e. Gaactogogues - ncrease producton of mk
! PEDlATRlC pt
- by 4-6 mos - START ron suppement due to ron depeton and (-)
extruson refex.
- cereas, fruts, vegetabes,meat and tabe foods
- egg yok (6mos), egg whte (1yr)
TRANSCULTURAL CONSlDERATlON
" CHlNESE - ke cod desserts after surgery for optmum heath
" ]EWS - "kosher det" (no meat and dary products at the same tme)
" EUROPEANS - man mea s served at md day foowed by espresso
" MUSLlM - "haa det" - no pork
" SDA - strcty vegs det (vt B6 and B12 defcency)
" MORMONS
- words of wsdom (no caffene, acoho and once a month fastng)
- the amount due for food s donated to the church
KEY POlNTS FOR NURSES
Sodum (Na) - source down the so
Potassum (K) - source up the tree
Low Na Det : AVOID processed foods, mk products and saty foods
KNOW the servng: CHO - 6-11 servngs
CHON - 2-3
FRUITS & Vegs - 3-4
FATS - sparngy
MOST COMMON DIET
! CLEAR LlUlD DlET (ght can pass thru t, meanng TRANSPARENT)
- gven to pt to reeve thrst, correct fd & eectroyte mbaance
- gven aso to pt post-op
ex: appe |uce, geatn (strawberry), popsce, candy
! RENAL DlET
- for kdney dsorder (rena faure, AGN, Nephrotc syndrome)
- to mantan fd & e mbaance
LOW CHON - avod poutry products
LOW Na - avod processed foods, mk products, & saty foods
Low K - avod fruts (anythng you see n a tree)
! LOW FAT}CHOLESTEROL RESTRlCTED DlET
- for ver dsorder, cardovascuar and rena dses
ALLOWED: ean meat, fruts, vegs and fsh
AVOlD : Sea foods, fred foods, preserved foods (cheese cake and custard)
! HlGH FlBER DlET
- to prevent constpaton, hemorrhods & dvertcuts
- vegs, fruts and gran products
! SOFT DlET
- for nfammatory condtons: esophagts, peptc ucer gastrts
- pureed foods/ benderzed foods
- soup
! PURlNE RESTRlCTED DlET
- for gouty arthrts
- ncrease fud ntake
- AVOID: preserved foods, sea foods, acoho,
organ meat (ver, gzzard)
! NA RESTRlCTED DlET
- for cardovascuar dses, rena, fd & e mbaance
- ALLOWED: fresh vegs
- AVOlD : processed foods, mk products and saty foods
! BLAND DlET
- for peptc ucer, nfammatory GI condtons
- AVOID: chemcay and mechancay rrtatng foods such as fred foods, fresh
and raw fruts & vegs (EXCEPT: avocado, banana & pnya) and spcy foods
wth preservatves
! HlGH PROTElN, HlGH CARBO DlET
- for burns (about 5000 ca/day)
- gran products and poutry - to ad the heang tssues
! AClD ASH DlET
- to decrease the ph of the urne
- ndcated for pt w/ akane stone ex struvte
- ex. 3 CS - cranberry, cheese, & corn
3 PS - prunes, pums & pastres
! ALKALlNE ASH DlET
- to ncrease ph of the urne
- ndcated for acd stone ( urc acd stone, cystne stone)
- ex. Mk
! GLUTEN-FREE DlET
- for ceac dses
- ALLOWED : rce, corn, cereas, soy beans
- AVOlD (LlFETlME): barey, rye, oats, wheat
! PHENYLALANlNE DlET
- for PKU, unt age 10 and adoescence ony
- AVOlD : CHON rch foods (meat products - uncheon meat)
! FULL LlUlD DlET
- opaque
- transtona det from qud
- ex : cream soup, ce cream, mk, eche fan, pumpkn cake
"ABGs" ATERlAL BLOOD GASES

Ph - 7.35 - 7.45
PCO2 - 35 - 35
HCO3 - 22 - 26 meq/L
Ph Compensatory Mechansm
Uncompensated abnorma no change
Partially compensated abnorma ncrease or decrease
Fully Compensated norma ncrease or decrease
Diarrhea - metaboc acdoss
Vomiting - metaboc akaoss
PRlORlTlZlNG of case:
Med.-Surg - "abc"
Psyche - safety frst
Fre - race
Trage - pt evauaton system (prortzng)
APGAR SCORlNG
0 1 2
Appearance paor acrocyanoss a pnk
Puse (-) <100 >100
Grmace (-) grmace vgorous
Actvty faccd some fexon fexon & extenson
Respratory (-) rreguar usty cry
T.R.l.A.G.E -prortzng
LEVEL 1 "emergency"
! severe shock, cardac arrest, cervca spne n|ury, arway compromse, atered
eve of conscousness, mutpe system trauma, ecampsa
LEVEL 2 "urgent (stabe)"
! can be deegated (fever, mnor burns, aceratons, dzzness)
LEVEL 3
! chronc/ mnor ness (can be deegated) - denta probems, routne medcatons
and chronc ow back pan
TlPS ON PRlORlTlZlNG
1. PT @ ER - sleeping pills overdose;
2. pt bp 80/30 & mother ded of CVA
1
st
priority : assess pt for addtl risk factor;
3. pt ask what procedure: Rn Action : notify the doctor
4. Ml attack - 1
st
action : report ASAP (esp. presence of vent. Fbraton)
5. pt on NGT - check patency of tube
DELEGATlON
- do not deegate Assessment, Teachng and Evauaton
- do not deegate meds preparaton, admnstraton, documentaton
CONCEPT OF DELEGATION
! consider the competence oI personnel
! 5 R`s in delegating (RIGHT task, person, circumstances, direction/communication supervision)
! RN may delegate Ieeding client, routine vital sign (pt w/ no complications)
and hygiene care
MI ATTACK enzymes to increase IN ORDER - #1 myoglobin
#2 troponin
#3 CK
#4 LDH
RISK FOR INJURY meniere`s dses
INEFFECTIVE BREATHING PATTERN myasthenia gravis
ALTERED TISSUE PERFUSION pt w/ complete heart block
INEFFECTIVE AIRWAY CLEARANCE pt w/ kussmaul`s breathing
D
DAY 3 ( 02 February 05)
POSITIONING FOR SPECIFIC SURGICAL CONDITION
Postonng - ndependent nsg functon
- know the purpose of the poston
a. to prevent or promote soothng;
b. what to prevent or promote;
c. know your anatomy & physoogy
Post Liver Biopsy - R sde yng - to prevent beedng
(durng the procedure - L sde yng).
Hiatal Hernia - uprght to prevent refux.
! AMPUTATlON
compcaton: hemorrhage (keep tournquet @ bedsde)

1
st
24hr - goa: to decrease edema - eevate the stump at foot part w/
the use of pow
AFTER 24hr - goa : to prevent contracture deformty (keep eg extended)
! APPENDlClTlS
Unruptured : any poston of comfort
Ruptured : sem to hgh fowers poston to prevent the upward
spread of nfecton
compcaton: pertonts
Ruptured appendcts ndcaton: pan decreases or go away.
(pt say, "I want to go home pan s gone")
! BURNS
Poston s FLAT or Modfed Trendeenburg - to prevent shock.
SHOCK occurs w/n 24-48hrs (mmedate post burn phase).
Compcaton: nfecton
! CAST, EXTREMlTY
Eevate the Extremty - to prevent edema (use rubber pow)
Nsg care:

a. capary ref - N 1-3 seconds ony (compcaton: atered crcuaton)
b. note for s/s of nfecton (when there s musty odor nsde the cast)
c. prurtus (n|ect ar usng bub syrnge)
d. bood staned - mark and note (f ncreasng n dameter - report ASAP)
e. tngng sensaton - ndcate nerve damage
! CRANlOTOMY
Types:
a. Supratentorial C - sem fowers orow fowers poston - to prevent
accumuaton of fud at surgca ste;
b. lnfratentorial C - fat or supne. Purpose: same
! FLAlL CHEST
(+) Traumatc In|ury - paradoxca chest movement - areas of chest GOES IN
nspraton and OUT on Expraton
poston: towards the affected sde to stabze the chest.
! GASTRlC RESECTlON
- to prevent dumpng syndrome - usuay for 10 mos ony NOT LIFETIME
dsorder (post gastrectomy)
- poston : LIE FLAT for 1-2hrs post mea
! HlATAL HERNlA
- there s damage to esophagea mucosa
- what to prevent: gastrc refux therefore FEEP PT IN UPRIGHT POSITION.
! HlP PROSTHESlS
Poston: to prevent suboxaton (KEEP LEG ABDUCTED) wth the
use of wedge pow or tranguar pow from pernum to
the knees.
dumping syndrome : "flat"
! LAMlNECTOMY
- "og-ro the patent" (3 nurses) - KEEP SPINE IN STRAIGHT
ALIGNMENT
- AVOID: hyperfexon, hyperextenson and prone - t causes
hyperextenson of the spne.
! LlVER BlOPSY
- before LB : supne or L sde yng to expose the part
- durng LB : - do-
- after LB : R sde yng w/ sma pow under the coasta margn to
prevent beedng.
! LOBECTOMY
- remova of Lobe (N R obe - 3, L obe - 2)
- poston : sem fowers poston - to promote ung expanson
! MASTECTOMY
- remova of breast
- eevate or extend affected arm to prevent ymp edema (or eevate hgher
that the eve of the heart.
AVOlD: venpuncture, specmen takng, bood pressure - ON THE AFFECTED
ARM coz there s no more ymph node w/c predspose pt to beedng.
Post mastectomy Exercises: squeezng exercses, fnger wa cmbng, fexon-
extenson (fodng of cothng, washng face,
vacuumng the house)
Due to remova of axary ymph node, avod aso gardenng and hand sewng
! PNEUMONECTOMY
- ether L or R ung. Poston pt on the AFFECTED SIDE to promote
ung expanson.
! RADlUM lMPLANT OF THE CERVlX
- keep pt on compete bed rest to prevent dsodge.
- AVOIDE SEX (may burn pens bec of the mpant nsde)
! RESPlRATORY DlSTRESS
Adut : Orthopnec poston - over bed tabe then ean forward
Peda : TRIPOD - ean forward and stck out tongue to maxmze the
Arfow
! RETlNAL DETACHMENT
- to prevent further detachment, pace pt on the AFFECTED SIDE.
Ex. If operaton s on the R outer of the R eye, pace pt on the R poston.
If operaton s on the L nner of the R eye, poston pt on the L sde
AVOID: sudden head movement.
! VElN STRlPPlNG
- keep extremtes extended then eevate the egs at eve of the heart to
promote venous return
T I P S

" liver biopsy s done on a pt. - durng 1
st
24hrs after the procedure, turn the pt
on hs abdomen w/ pow under the subcoasta area;
" when dranng the L ower obe of the ung - the pt shld be positioned on his R
side w} hip higher or slightly higher than the head;
" after tonsectomy - position: prone
" a pt s about to go on thoracenthess - how shd the nurse poston the pt? -
sitting w} a arms resting on the overbed table;
" to mantan the ntegrty of pt w/ hp prosthess - abduction splints
" mmedatey after supratentora cranotomy- fowler's position
" best poston for pt n shock - supine w} lower extremities elevated
THERAPEUTIC COMMUNICATION
1. DON'T ASK WHY this put pt on the defensive
2. AVOD PASSNG BACK " will refer you to..
3. DON'T GVE FAKE REASSURANCE "everything will be alright..
"you're in the hands of the best
4. AVOD NURSE CENTERED RESPONSE " felt same too.
" had the same feeling..
n GROUP DSCUSSON 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 soate nfecton transmsson
TYPE PRlVATE ROOM HAND WASHlNG GOWN GLOVE MASK
STRlCT
(airborne dses, direct contact-Diptheria)
RESPlRATORY OPTIONAL OPTIONAL
(AlRBORNE: BEYOND 3FT
DROPLET : W}lN 3FT)
TB OPTIONAL OPTIONAL
(negatve arfow room)
CONTACT
(direct contact - NOT AlRBORNE DSES)
eX SCABlES
ENTERlC X OPTIONAL OPTIONAL
(fecal contamination)
DlSCHARGE X OPTIONAL OPTIONAL
(dranage: pus ex burn pt)
UNlVERSAL X
(AlDS, HEPA b - TRANSMlTTED
BY BLD AND DODY FLUlDS)
TlPS:
! When mpementng unversa precauton, w/c nsg acton requre nterventon:
recappng the neede - this might prick your hand;
! When dscardng the contents of the bed pan use by a pt under enterc precauton
- GLOVE lS NECESSARY;
! A nurse s gvng heath teachng to the parents of chd wth scabes: family
member must be treated;
! Preventng pedcuoss n schoo age chdren: avoiding contact w} hair articles
of infected children like clips, head bands, hats - no sharing
! Patent wth fu bown AIDS s paced on soaton precauton - pt ask nurse why hs
vstors s wearng mask - response: it will help in the prevention of
infection;
! Essenta when a pt w/ menngts s kept n soaton: isolation precaution
remains until 24hrs after initiating antibiotic therapy
DIAGNOSTIC PROCEDURES
side notes:
pt for lVP : assess for allergy (cleansing enema b4 the procedure)
pt for KUB : no dye (don't assess for allergy)
schilling test : 24hr urine specimen
USG : no consent required
GENERAL CONSlDERATlON
EXPLAIN the procedure to the pt (nta nsg acton)
- f not ready nform the doctor;
- pt has the rght to refuse procedure;
- doctor the one who asked for consent
Check pt for CONSENT - f INVASIVE - WITH CONSENT
NON INVASIVE - NO CONSENT needed
CONTRAST MEDIUM - check for aergy
For procedure requrng anesthesia - KEEP PT NPO B4 PROCEDURE
When local anesthesia used - NPO, 1- 2HRS AFTER
General anesthesia - keep NPO at east 8hrd after
(check gag refex before meas)
PEDIATRIC PATIENT - use fash cards, games and pay to encourage
partcpaton
TRANSCULTURAL CONSlDERATlON
HlSPANlC PATlENT - women prefer same gender heath care provder
Obtan hep of interpreter when expanng procedures - (except or dont ask famy
members)
For muslim patient - they prefer same sex heath care provder however, f
procedures requre fe threatenng - they prefer to have
mae doctor.
- they ony want good news nformaton of ther condton
DELEGATlON and DOCUMENTATlON
Deegaton - assessment, montorng and evauaton of treatment
(cannot be deegated) BUT standard and changng procedures can
be deegated ex. - 24hr urne specmen and urne catheter
coecton.
Documentaton - type of treatment and any untoward reactons.
KEYPOlNTS FOR NURSES
! Prepare the patent;
! Montor for adverse reacton;
! Report compcaton to the doctor
FRAMEWORK - ncudes the Purpose, Speca Consderaton and Interpretaton
DIAGNOSTIC TESTS (to evaluate FETAL GROWTH AND WELL-BENG)
! DAILY FETAL MOVEMENT
Purpose : to determine fetal activity by counting fetal movements
usually perform by pt himself
N FetaI 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)
POSTVE result means, BABY is REACTVE (good condition) and no need for contraction stress
test/oxytocin challenge test coz baby is OK and doing well.
! CONTRACTION STRESS TEST (oxytocin chaIIenge 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. f (-) patient
is given Oxytocin onset is 20-30 minutes. Then check FHR and note the presence of
DECELERATON (slowing of FHR)
types of deceIeration
a. eary deceeraton - ndcates head compresson (MIRROR IMAGE)
b. ate deceeraton - ndcates pacenta nsuffcency (REVERSE MIRROR IMAGE)
mgt: L Latera Recumbent Poston, Admnster O2, Treat Hypotenson
c. varabe deceeraton - due to cord (mage: U or W shape) and sowng of FHR can occur
anytme.
If (+) CST, meanng there s deceeraton, baby s NOT OK coz there s decrease FHR and
durng abor he/she may stand the abor process.
! BIOPHYSICAL PROFILE
- to determine fetal well being w/ the use of 5 CRITERIA
fetaI breathing 2 points
movement 2 points
heart tone 2 points
reaction to NST 2 points
amniotic fId voIume 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
f pt ask if it is painful: NO PAN;
Pt shld have full bladder
CHORONC VLL SAMPLNG CVS
AMNOCENTESS AMNIO
PERCUTANEOUS UMBLCAL CORD BLOOD SAMPLNG PUBS
CVS AMNIO PUBS
Purpose: to detect chromosomal Purpose : same w/ CVS Purpose: to check chromosomal
Aberration aberrations, & presence of RH
(eg. Down syndrome, Trisomy 21) ncompatibility
Done in 1
st
trimester can be done on the 2
nd
wk (14-16 wk) Extract blood at umbilical cord
(can be done as early as 5
th
wk but - but not recommended bec. of danger then it is tested if it really comes
can be done on 8-10
th
wk) abortion (assess pt age of gestation) from the umbilical cord (can be
done on either 2
nd
or 3
rd
tri.

or can be done on the 3
rd
wk (34-36 wk)
purpose: to detect fetal maturity (FLM)
Get sample at chorion (by 10-12wks thru monitoring of L/S Ratio N 2:1
The placenta matures, get some sample) (if mother is (+) DM LS ratio is 3:1)
This procedure also check level of alpha-feto
Protein if NCREASE spina befida;
f 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. infection
b. bleeding
c. abortion
d. fetal death
T I P S
EARLY DECELERATION expected in the fetal monitor when there is fetaI head
compression;
AMNIOCENTESIS was done @ 35 wks gestation purpose: to determine fetaI
Iung maturity;
A mother asked the nurse what wiII amniocentesis provide during pregnancy:
it will show as whether the baby Iungs are deveIoped enough for the baby to be born;
a nurse is preparing pt for Iower abdI 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 : bIeeding;
pt ask the nurse what deceIeration means it refers to sIowing of baby's
heart rate;
before Amniocentesis, what to check - USG DEVICE
DlAGNOSTlC TESTS (to evaIuate pediatric patients)
CARDlOPNEUMOGRAM
- use to dagnose apnea of nfancy
- assess HR, RR, nasa arfow and O2 saturaton - N 95-98%
beow 85 - report ASAP
GLUTEN CHALLENGE
- detect presence of Ceac Dsease (CD) - ntoerance to guten;
- pt s gven guten rch food for 3-4 months the observe s/s of CD
s/s of CD: abd cramps, steatorrhea, abd rgdty, abd dstenton
(f + for CD, guten free det w be for fe tme)
ORTOLANl'S TEST (OT) BARLOW'S MANUEVER (BM)
purpose: test deveopmenta dyspaca of the hp or purpose : same
congenta hp dsocaton
(+) f w/ cck sound (atera) (+) barows cck - press downward and w/ cck sound
POLYSOMNOGRAPHY or "seep test"
- EEG s connected to pt when he seeps
- Check the bran waves, check for apnea of nfancy
- preparaton : No Speca prep,
HOLD CAFFEINE FOOD - 2days b4 test

SCOLlOMETER
- measure the degree or ange of scooss
- check for: (+) scooss f uneven hemne
uneven wast
more promnent ac rest and scapua on one sde
presence of rb hump
test for pre-teen : "bend over test" - bend and touch the toe;
(+) scooss - f presence of rb hump, therefore x-ray then scoometer.
SlCKLEDEX TEST HGB ELECTROPOlSlS
Purpose: test for scke ce anema Purpose: test for scke ce anema
Specimen : Bood : (bood + souton, f (+) TURBID Specimen : Bood : bd + eectropoess, f sckng of RBC
Therefore TRAIT CARRIER (S or C shape RBC), therefore + for SC Dses
Test for TRAIT Test for Dsease
GUTHRlE CAPlLLARY BLOOD TEST (GCBT)
- to detect PKU
(n PKU there s absence of PHENYLALAMINE HYDROXYLASE- PH)
Phenyaamne hydroxyase - s an enzyme that converts PH to Tyroxne - the one that
gves coor to har, eyes and skn.
If absent PH, no one w convert PH to Tyroxne, therefore t w accumuates to bran
and can cause menta retardaton.
PH came from CHON rch food. At brth, t s usuay negatve, so gve CHON food frst for
3wks then retest.
Before test, gve chon rch food for 1-4 days before test. (adut)
N PH eve - >2mg/d
(f 4mg/d - indicative of PKU, 8mg/d - confirms PKU)
SWEAT CHLORlDE TEST
- to detect Cystic Fibrosis (n CF, the skn becomes mpermeabe to Na.
meanng cannot reabsorb Na and t accumuates outsde of the skn);
- Mother compan that her baby taste saty;
- PILOCARPINE - used n the test to nduce sweatng;
Types:
a. sweat chorde test - N 10-35 meq/L (above 40 meq/L- (+)
b. serum chorde test - N 90-110 meq/L (above 140 meq/L - (+)
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 chIoride
test;
! 9 yo pt has (+) result for sweat test this indicates possibIe dx of Cystic Fibrosis;
! piIocarpine drug used for pt undergoing seat chloride test;
! hgb electropoisis test for sickIe ceII dses
DAY 4 (3 Feb 2005)
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)
ABNORMALlTlES
a. atra fbraton - p waves "haos magkadkt.
(no dscernabe p waves)
b. atra futter - "saw tooth" futter waves
c. ventrcuar - check on ORS (N - .8-.12)
ANGINA - st segment eevaton, t wave nverson
MI - st segment eevaton or depresson, t wave nverson
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)
Addison's Dses: hyponatremia (dec Na), hyperkalemia (inc K) "FLD MBALANCE
Cushing Syndrome: hypernatremia, hypokalemia "FLD VOL. EXCESS
! POTASSIUM (3.5 5 meq/L)
Hyperkalemia : Addison's dses
Hypokalemia : Cushing Syndrome
nc or dec in K PT RSK of NJURY
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 M)
LDH2 17-27% (for heart check for M)
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
ncrease CPK 3-6hrs post M then it normalize 3-4 dyas
! AST (SGOT) SGPT (ALT)
- N 8-20 u/L N 8-20 u/L
- for liver (inc. for liver dses) 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 PTT APTT
(11-12 sec) (60-70 sec) (30-40 sec)
coumadin check pt heparin PTT
monitor pt 4 bleeding 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 : hemoconcentration (nsg dx: fld deficit dehydrated pt)
dec hct : hemodilution fld excess
DOPPLER USG
- to detect the patency of bld vessels arteries & veins esp of lower
extremities;
- painless, non invasive, NO SMOKNG 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
- vsuazaton of b. tree or arway passages;
- to gather specmen for bopsy;
- NPO b4 & after
- Gag refex return after 1-2hrs;
- Pt may expect a sore feeng (PINK STINGED SPUTUM)
- Report (+) strdor
! CHEST X-RAY
- to determne abnormates of ungs and thoracc cavty;
- no preparaton;
- ABSOLUTE CONTRAINDICATED TO PREGNANCY
- Check pt for radaton ndcator
- Determne effectveness of tx and whether pt s actve or
non-actve
! SPUTUM STUDlES
- to determne the gross characterstc of the sputum (refers
to the amount, coor, abnorma partces, consstency and
characterstc)
TYPE OF SPUTUM
PNEUMONIA - Viral thin & watery
Bacteria - rusty
TB - blood streaked
BRONCHITIS - gelatinous
CHF/ PULMONARY EDEMA - pink stinged
Sputum specimen sterile container
! THORACENTESlS
- aspraton of fd at thoracc cavty
(for dagnostc & therapeutc purpose)
position: DURING - sttng
AFTER - affected or unaffected sde
Nsg alert:
NO COUGHING & DEEP BREATHING - durng the procedure - coz
ths may cause puncture of the ungs;
Assess for breath sounds after;
Compcaton: beedng and pneumothorax
! PULMONARY FUNCTlON TEST
- thru the use of ncentve sprometer
- vta capacty (4-5 L of ar) - refers 2 N amt of ar that goes n
& out of ung after maxmum nspraton.
PROCEDURE: EXHALE then INSERT mouth pece, BREATH N, HOLD
then EXHALE
! LUNG SCAN
- to dentfy the presence of bockage n the pumonary bd
vesses;
- wth contrast medum;
- (+) consent;
- assess for rxn to aergy
! MANTOUX TEST
- test for POSSIBLE TB EXPOSURE;
- usng PPD (purfed chon dervatves)
- ange 10-15, BEVEL UP then read 48-72hrs after
5mm n duraton - (+) for HIV, mutpe sex, prevousy (+) pt;
10mm - (+) for mmgrants, chdren beow 3yo and for
pt w/ medca condton - DM & Acohosm
15mm - (+) for genera popuaton
! LUNG BlOPSY
- aspraton of tssues at ungs for dx of tumors, magnancy
- assess for beedng, breath sounds & report for s/s of dyspnea
III. NERVOUS
! EEG
- shampoo har B4 (to remove chemcas)
and AFTER to remove eectrode ge (shampoo or acetone)
- measures eectrca actvty of the bran (gray matter)
- non nvasve, (-) consent
- detect the ff: bran tumors, space occupyng essons
acoho bran waves and sezures
nursng aert:
# detary modfcaton: WITHOLD CAFFEINE - coffee and tea;
# WITHOLD 48hrs b4 the procedure : tranquzers, sedatves, ant-convusant, acoho
CT SCAN MRl PET
Use !"#$"%$&' to determne use ()(*%!&+",'(%$* .$()# use ,"++" !"/0 &! 1&0$%!&' ()(*%!&'
tssue densty to detect abnormaty of tssue densty to detect abnormaty of tssue densty;
(detect cancer and tumor) aso to detect O2 saturaton @ tssue;
physoogy of psychoss; and to evauate tx ke CA Tx
gve more detaed mpresson
(ex. Measurement of bocked artery)
NSG ALERT:
(w/ or w/out dye)
CONTRAlNDlCATlON CONTRAlNDlCATlON
(same w} ct scan BUT w} addtl)
a. pregnancy;
b. obese pt (more than 300 bs); NO METAL OB]ECTS
c. caustrophoba (gve ant-anxety b4) - |eweres, nsun pump,
d. pt w/ unstabe v/s (arrhythmc & HPN); pacemaker, hp repacement
e. pt w/ aergy to dye
"clicking sound" w be heard & e st durng the procedure lie still
e st durng the procedure and "thumping sound" w be heard
! CEREBRAL ANGlOGRAM
- nvoves vsuazaton of bd vesses @ ven w/ the use of
contrast medum.
CONTRAINDICATED IN:

pt w/ aergy; pregnant pt.; beedng
Nursing Alert:
a. keep pt NPO;
b. assess pt Ior allergy;
c. monitor Ior signs oI bldg;
d. inc oral Ild intake to excrete dye;
e. keep epinephrine and or benadryl at bedside Ior emergency
! LUMBAR PUNCTURE
- aspraton of CSF for assessment to check for nfecton or
hemorrhage
position:
DURING : feta or C-poston
AFTER : FLAT to prevent spna headache
Neede s nserted between L3 and L4 or L4 and L5
Increase fud ntake after.
! CSF ANALYSlS
- Assess for the characterstc of CSF.
- N amount: 100-200 m
- Characterstc : Cear w/ gucose, Na and H2O
If REDDISH - hemorrhage
If Yeowsh - nfecton
Ear ckng w/ fud - test f (+) gucose bec. CSF has gucose.
! MYELOGRAM
- test for presence of sp dsc or hernated nuceus
porposus (HNP).
ALERT:
Know the type of dye use:
a. water based - caed AMIPAOUE
b. o base - caed PANTOPAOUE
# type of dye w determne the poston of pt AFTER the procedure.
# If water based, the HEAD OF BED ELEVATED;
# If o based, FLAT after
Ratonae for both o and water based dye s TO PREVENT the upward dspersa of dye
w/c can cause eectrca menngts (s/s ncudes: (+) sezure, headache)
IV. EENT
TONOMETRY
- to measure IOP (N 12-21)
- paness but w/ oca anesthesa
ACUTE GLUACOMA : 50 yo and above
CHRONIC GALUCOMA : 25 yo
CALORlC STlMULATlON TEST
- test the presence of Mnerres Dses (nner ear)
- nvoves ntroducton of warm and cod water then NOTE
FOR NYSTAGMUS - |erky atera movement of the eye.
SEVERE NYSTAGMUS - NORMAL
MODERATE NYS - Mnerres Dses
NO NYSTAGMUS - Acoustc Neuroma
GONlOSCOPY
- to dfferentate OPEN and cose ange gaucoma;
- non-nvasve, paness
WEBER TEST RlNNE'S TEST
To determne aterazaton of sound; To determne ar and bone conducton
If pt hears vibration better in GOOD EAR, Pace tunng fork 2nches from the ear
Probem woud be SENSORlNEURAL LOSS; pace at mastod bone or n teeth then..
f pt hear better in POOR EAR, - refers to f AIR CONDUCTION s LONGER, therefore
CONDUCTlVE HEARlNG LOSS SENSORlNEURAL HEARlNG LOSS;
If BONE CONDUCTION IS LONGER, therefore
CONDUCTlVE HEARlNG LOSS
V. GASTRO INTESTINAL TRACT
! UPPER Gl SERlES (Barium Swallow)
- xray vsuazaton wth contrast medum
- Contrast Medum:

a. Gastrografn - water soube, use straw
b. Barum - swaow - mk shake ke (use feedng botte of pt)
- then pt s ask to assume dfferent postons to
dstrbute dye @ esophagus

purpose: to detect dsorders of esophagus
feces : "chaky-whte"
after: nstruct pt to take axatve to excrete dye
! BARlUM ENEMA (for Lower GIT)
- nvove recta nstaaton of barum;
- there s baoon catheter nserted @ anus then barum s nsted and pt s
asked to ro-over at dfferent poston then xray s taken to detect:
hemorrhods, dvercuoss, poyps and esons;
- after, gve axatve to excrete dye (bec dye s constpatng)
nstruct aso patent to nc ora fd ntake
! GUAlAC TEST
- to detect the presence of beedng and nfammatory bowe condton ke
CANCER;
specmen : stoo (ths can be refrgerated awatng aboratory)
AVOID the foowng 3 days B4 the test - bec t can yed to FALSE (+)
RESULT : Red Meat, Fsh and Horse Radsh
! CHOLANGlOGRAPHY
- vsuazaton of bary tree (ncudes, hepatc duct & common be duct) - same wth
CHOLECYSTOGRAPY - but medum gven oray;
- wth contrast medum w/s s gven thru IV
- ALERT: assess for aergy (epnephrne/benadry)
- Post procedure: nc. ora fd ntake - to factate excreton of dye
! GASTRlC ANALYSlS
- anayss of gastrc secreton ke HYDROCHLORIC ACID
- Lower Leve N : 2-5 meq/hr
- Upper Lmt N: 10-20 meq/hr
UPPER LlMlT YPES
a. WITHOUT TUBE (tubeess gastrc anayss)
- usng DlAGNEX BLUE (specmen: urne);

if urine colors turns BLUE, therefore (+) HCL Acid;
if urine (-) blue color, therefore (-) HCL Acid
- f (-) HCL Acd at stomach (achorhyda), therefore Gastrc CA;
- f Increase HCL Acd - therefore ZOLLlNGER-ELLlSON SYNDROME - (+) Gastric Tumor
b. WITH TUBE - wth the use of NGT then asprate
! ULTRASONOGRAPHY
- upper abd USG to detect abnormates n the upper abd area w/
ncudes bary tree and Upper GI;
- paness;
- ge at abdomen and pt s NPO
! LlVER BlOPSY
- aspraton of sampe tssue from the ver to detect: Hepatc CA and Crrhoss;
- ALERT: Check for Beedng Tme (N - 1-9 mns) and
Cottng Tme (N - 10-12 mns) - because ver s hghy
vascuar organ
- WHEN NEDDLE IS INSERTED te pt to:
Inhae then Exhae then Hod Breath - to stabze ver poston
- Poston after : R sde-yng poston
- Thngs to report: s/s of SHOCK - nc PR, dec BP
Check v/s
! ENDOSCOPlC RETROGRADE CHOLANGlOPANCREATOGRAPHY (ERCP)
- to vsuaze common be duct and pancreatc duct;
- nvasve - (+) consent;
- NPO - tube nserton;
- Te pt that tere w be feeng of soreness a wk after the procedure
! COLONOSCOPY
- vsuazaton of coon to detect:
nfammatory bowe condton
Chrons Dses
Dvertcuts
Hemmorhods
Tumor
Poyps
- (+) Consent
- NPO b4
- cear qud det - 2days b4 the procedure
poston: Latera or sde yng poston or L Latera Sms
VI. ENDOCRINE
! GLUCOSE TOLERANCE TEST
- to provde measure of bd sugar eve at bood;
- Inform pt to have hgh CHO det 2 days b4 the test;
- Instruct NPO a day b4 the test (npo post mdnoc);
- Inc sugar eve, therefore Dabetes
! ACTH STlMULATlON TEST
- to detect presence of Addsons Dses
- specmen: bood
- pt s gven dose of ACTH (not nore than 40ug/d)
- f st dec despte ACTH admnstraton, therefore Adrena Insuffcency -
Addsons Dses
! DEXAMETHASONE SUPRESSlON TEST
- to detect endogenous depresson - depresson resutng thru endocrne dsorder
- pt s gven dexa then 24hr urne specmen s coected;
- a dose of dexa w suppress the reease of adrena hormones;
- f despte dexa admnstraton st ncrease adrena hormones, therefore pt s
sufferng depresson
! 17 KETOSTEROlD & 170 HCS
- use to detect the presence of Addsons & Cushngs Dses.
Addsons - dec secreton of ketones
Cushngs - nce secreton of ketones
Specmen: 24 hr urne
! VANlLLYLMANDELlC AClD TEST - VMA Test
- b-product of CATHECHOLAMINE Metabosm

epnephrne norepnephrne


inc if there is TUMOR (pheocromocytoma) of Adrenal Medulla
N 2-7 mg/d / 24hrs - f nc, therefore tumor
AVOID: vana contanng food 3 days b4 test - ce cream, coffee, chocoates
! R A l U
- pt s gven odne 131 then after 24hr foowed by a thyrod scan
- nc ndcates hyperthyrodsm, dec hypothyrodsm
- AVOID: odne rch-food (sea foods, sea shes, sea weeds) 7-10 days b4 and to ncude
other dagnostc procedures that uses contrast medum ("NO" - angogram
test). - bec t may yed to fase (-) resut.
! SULKOWlTCH'S TEST
- detect amount of cacum excreted at urne;
- f to test for hypercacema and hyperthyrodsm - gather specmen b4 meas;
- to test for hypocacema and hypothyrodsm - gather after meas
VII. R E NA L
! URlNALYSlS
- examne the gross characterstc of the urne
urne amount : 30-60m/hr
coor : cear, amber
s. gravty : 1.010 - 1.025
abnormaty: ower than 1.005 - dabetc nspdus
hgher than 1.030 - dabetc metus
(+) gucose - nfecton, DM
(+) CHON - PIH, kdney dses.
Urne maybe refrgerated f watng to be examned.
! CULTURE & SENSlTlVlTY
- to detect nfecton
- prepare storage contaner
! K U B lVP
- xray of the kdneys, ureter and badder - xray of the kdneys, ureter and badder
- NO SPECIAL PREPARATION NEEDED - uses contrast medum/ dye
- assess for aergy, then nc. ora fd ntake after
- benadry or epnephrne at bedsde for aergc rxn
- NPO POST MIDNOC, ceansng enema n AM
! CYSTOSCOPY
- vsuazaton of urnary badder
- after : montor I & O;
- note for s/s of beedng
! RENAL BlOPSY
- aspraton of tssues at kdney for bopsy to detect:
a. magnancy/ Ca
b. magnant HPN
c. kdney dsorder
- note for s/s of beedng
! CYSTOURETROGRAM
- to check the patency of the ureter and badder;
- montor I & O
! CYSTOMETROGRAM
- to evauate the sensory and motor funx of badder;
- to check f badder respond to dstenton after nstaaton of fds;
- montor I & O
VIII. MUSCULO-SKELETAL
! ELECTROMYOGRAPHY
- to detect eectrca actvty of the musce;
- (+) consent;
- to aternatey contract and reease the musce as neede s nserted
- HOLD musce reaxant b4 the test
! ARTHROCENTESlS
- aspraton of fuds at synova space to detect abnormates;
- check for order of anagesc;
- appy cod pack
! ARTHROSCOPY
- vsuazaton of |onts
- KEEP TORNIOUET, ICE PACK and ANALGESIC at bedsde
! BONE SCAN
- detect rate of bone destructon or bone resorpton for pt w/ osteopoross;
- e st durng the procedure;
- PAINLESS AND NON INVASIVE
IX. MISCELLANEOUS
! BONE MARROW BlOPSY
- to check abnormates at the b. marrow (eg. Leukema)
- ste : ILEAC REST
- (+) consent
- assess for beedng
- sand bag at bedsde (post procedure) - for emergency use
! SCHlLLlNG'S TEST
- specmen: 24hr urne
- test for VIT B12 defcency;
- for pt w/ PERNICIOUS ANEMEIA;
- pt s gven ora VIT B12 then urne s coected, then NOTE for RATE of
EXCRETION of VIT B12 (N - ess than 40%);
eg. If 100mg Vt b was taken - 60mg shd retan at stomach and
40mg w be excreted.
! URlNE UROBlLlNOGEN
" to detect HEMOLYTIC DSES
" WITHOLD ALL MEDS - 24hrs b4 the test
! BENCE-]ONES PROTElN
" detect presence of MULTIPLE MYELOMA (magnancy of pasma ces);
" RELEASED by destroyed or damage bones
! ROMBERG'S TEST
" check FUNX of CEREBELLUM;
" stand erect, cose eyes, and observe for nabty to mantan posture (f pt s
Swayng, therefore TUMOR at cerebeum)
! ERYTHROCYTE FRAGlLlTY TEST
- use to detect the rate of RBC DESTRUCTION n a hypotonc
souton (RBC Lfespan: 120 days)
f fespan of RBC >120 days, therefore HEMOLYTIC ANEMIA (EX. SICKLE CELL)
! HETEROPHlL ANTlBODY TEST
- detect presence of IgM w/c s reated to Epsten Vrus nfecton
Epsten Vrus Infecton - causatve agent of nfectous mononuceouss ("kssng dses")

mgt: AVOID SHARING of utenss and gass
! LYMES DSES SEROLOGY
- detect presence of BORRELIA BURGDORFERI - causatve agent of ymes
dses.

Treatment: tetracycne
TlPS FOR DlAGNOSTlC PROCEDURE
" 2 moths od nfant suspected of brochots s treated wth oxygen therapy. Whch resut ndcates
that tx was effectve : 02 SATURATlON OF 98%.
" Pt s schedued for ver bopsy. What shd the nurse nstruct pt to do durng neede nserton? -
hold breath during the procedure upon insertion of the needle.
" Staff nurse s observng a nurse carng for pt w/ cvp. W/c acton of the nurse requre nterventon? -
touching the edge of the soiled dressing using clean gloves.
" Pt undergong ERCP - mportant prep for nurse to make woud be: keep pt NPO b4 the
procedure.
" Pt w/ coronary angogram, the catheter was nserted at the L femora artery. w/c nterventon s
approprate after the procedure: palpate the popliteal and pedal pulses.
" In expanng to the pt about cystoscopy the nurse shd say : the bladder lining will be visualize.
" A mantoux test s (+) - if the nurse assesses w}c of the following: in duration.
" w/c of the ff w yed an accurate readng of CVP: when the zero level of the manometer is at
the level of R atrium.
" w/c responses made by the pt ndcates that he understands the procedure to be done n a CT scan:
"a dye will be injected to me".
" A pt s to have an upper GI seres - whch statement shows that he understood the nstructon gven
: "l will drink the dye".
" After ver bopsy, a potenta compcaton: bleeding.
" MRl s the prmary dagnostc too for mutpe sceoss bec it promotes visualization of plaques
at the bran.
DAY 5 (8 Feb 2005)
PHARMACOLOGY
l. GENERAL CONSlDERATlONS
ONLY RNs are aowed to admnster (to ncude centra ne)
LPNs - perphera IV Lne route;
ELDERLY PT - provde wth memory ad
PEDIATRIC PT - do not mx w/ mk (dosage depends on wt, age and sze)
For SIDE EFFECTS - GI symptoms (mosty)
For AD. EFFECTS - aways consder bone marrow ("eukocytopena - a PENIA")
3 COMMON DRUGS - wth patents over 65 y/o
a. LITHIUM - f above 65 yo, dose shd not more than 1.0mEq
b. HALDOL - f above 65 yo, dose shd not more than 6mg/day
c. MEPERIDINE - f above 65 yo, shd not 50 mg
ll. TRANSCULTURAL
ASIANS - are stocsm atttude (they refuse meds f for the 1
st
tme)
MIDDLE EASTERNERS - they expect meds durng frst contact w/ hx care provder
|EWISH - no meds restrctons
|EHOVAHS WITNESS - do -
! ORIENTAL PAYLOAH (from mexco)
- treatment for darrhea;
- may cause ead toxcty
! ECHINECEA
- use to boost the mmune system;
- for pt. wth cancer
! ST |OHNS WORT
- ant-depressant (t funx ke MAO nhbtor);
- do not gve to pt takng MAO
! VALERIAN
- sedatve (used aso as ant-anxety agent)
- adverse effects - GI Irrtaton
! GINGCO BILOBA
- bood thnner;
- use to enhance bd crcuaton;
- for pt w/ azemers
- CONTRAINDICATED to pt wth beedng dsorders
COMMON CONTRAlNDlCATlONS for HERBAL MEDS:
! NO HERBAL MEDS for pregnant client;
! NO HERBAL to lactating pt;
! NO HERBAL for those with severe kidney and liver disorder
lV. THE CHECK PRlNClPLE
C - assfcaton (FOR WHAT?)
H - ow w you know that he meds f effectve (evauaton)
E - xacty what tme are you gong to gve t
C - ent teachng tps
K - eys to gvng t safey
! Lactuose - gven to pt wth hepatc enceph to dec ammona absorpton
- s/e : darrhea
! ANTABUSE (dzufram) - most approprate tme to take meds : after
12hrs of acoho free.
! COGENTIN - to prevent pseudoparknsonsm (by decreasng musce rgdty)
! TETRACYCLINE - can cause stanng of teeth,
Photosenstvty (use sunscreen when outdoors)
! LITHIUM - shd have nc. fud n the det
lll. DELEGATlON AND DOCUMENTATlON
Document a medca admn record: tme, route, dosage and untoward reacton;
The foowng CANNOT be deegated: treatment, admnstraton, documentaton of meds
PSYCHOTROPIC
I. ANTIPSYCHOTIC
- ma|or tranquzer;
- for SCHIZOPHRENIA (pt has EXCESS DOPAMINE);
- pays as treatment to the symptoms NOT CURE to schzo - meanng t modfy
the symptoms (target symptom: to decrease dopamne)
ex.
Hado
Chorpromazne
Cozapne (chozar)
Oanzapne (zyprexa)
Rsperdon
BETS TO GIVE: after meals
DOPAMINE - neurotransmtter (factate the transmsson of neurons)
In SCHIZO there n INCREASE NEUROTANSMITTER.
Signs & Symptoms:
a. DELUSION - "FALSE BELIEF"
b. HALUCINATION - hearng sounds
c. LOOSENES OF ASSOCIATION - shftng of topc
CLlENT TEACHlNGS:
! Report ADVERSE EFFECTS of ANTl-PSYCHOTlCS
- whch ndcates agranuocytoss
a. fever
b. body maase
c. sore throat
d. chs
! hyperpyrexa and musce rgdty
- ths ndcates NEUROLEPTlC MALlGNANT SYNDROME (NMS)
drug of choce: Parode, Dantrum
! Assess SlGNS and SYMPTOMS of PSEUDOPARKlNSONlSM
a. mask-ke face or expressoness face
b. p-rong tremors
c. cogwhees rgdty or ead ppe rgdty
AKATHESIA - "restess eg syndrome" (I fee as f I have ants n
my pants)
DYSTONIA
Avod drect sunght - because meds photosenstvty
Instruct pt to rse sowy - to avod orthostatc hypotenson
Check: CBC, BP, AST/ALT
To prevent pseudoparknsonsm, admnster ANTIPARKINSONIAN agents
lA. DOPAMlNERGlCS - ANTlPARKlNSONlAN
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-Carbdopa
! Effective f decrease n tremors and rgdty wthn 2-3 days;
! When to gve: AFTER MEALS;
! Health Teachings :
a. detary modfcaton: AVOID CHON and Vt B6
- bec t decreases drug absorpton
b. check for ORTHOSTATIC HYPOTENSION and PALPITATION;
c. check BP and PR
lB. ANTlCHOLlNERGlC
- decrease ACETYLCHOLINE
ex. Benadry
Cogentn
! effective: f decrease tremors and rgdty;
! when to gve: AFTER MEALS;
! Health Teachings:
a. sde effects: burred vson (no drvng);
b. dry mouth - suck on ce chps or hard candy;
c. paptatons - check PR;
d. constpaton - nc. roughage at det;
e. urnary retenton NOT urnary frequency
I. decrease BP - rse sowy
g. check BP, PR, ECG
II. ANTI-ANXIETY
- mnor tranquzer
- decrease Retcuar Actvty System - center of wakefuness
ex. Vaum, dazepam, Lbrum, Tranxene
! Effective: Decrease Anxety,
Decrease Musce Spasm (to pt w/ tracton)
Promote Seep
! B4 MEALS - because food deays absorpton
! HEALTH TEACHlNGS :
a. report ADVERSE EFFECT:
PARADOXICAL REACTION - opposte of sde effects
b. Danger of Dependency
c. AVOID:
Caffene, Acoho - t ncrease the depressant effect of the drug
d. check RR - t causes respratory depresson
e. admnster VALIUM separatey - because t s ncompatbe wth any drug -
use dfferent syrnge.
lll. ANTI-DEPRESSANT/MANIC
a. TRICYCLICS
b. MAO
c. STIMULANTS
d. SSRI
PATlENT with DEPRESSlON
- there s DECREASE norepinephrine and serotonin
A. TRlCYCLlCS - prevents the reabsorpton of norepnephrne.
Ex. Tofran, Eav
Effective: If adequate seep (8hrs ony)
Increase appette
Best given: AFTER MEALS
Hx Teachings:
! The INITIAL EFFECT 2-3 wks after
FULL THERAPEUTIC EFFCET 3-4 wks
ONSET EFFECT n a WK
! AVOID : |uce - because an acdc medum decrease absorpton of drugs
! REPORT PALPITATION and TACHYCARDIA and ARRYTHMIAS - adverse effects of
TRICYCLICS
! CHECK BP and ECG

B. MAO lNHlBlTOR (MonoAmne Oxdase)
- prevents the destructon of NEUROTRANSMITTERs
ex. Parnate, Nard and Marpan
Effective : f INCREASE SLEEP and APPETITE -
Gve 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 swss) ALLOWED: cheese - cottage and cream,
FRESH MEAT, VEGETABLES
COLA, CHICKEN LIVER
SOY SAUCE
RED WINE
PICKLES
! Check BP - the drug can cause HYPERTENSIVE CRISIS -
occpta headache - "my nape s achng"
! 2 WKS INTERVAL - when shftng ANTI DEPRESSANT
- to avod HYPERTENSIVE CRISIS
ex . after MAO - 2 wks rest then can gve ST |OHNS WORT
C. STlMULANTS
(Rtan, Dexedrne and Cyert)
- drecty stmuates the CNS.
Effective: Increase Appette and Adequate seep
Best to Gve: AFTER MEALS
- f b4 meas, t suppresses the appette;
- gve NOT BEYOND 2pm bec. t causes INSOMNIA - 6 Hrs b4 bedtme;
- shd be gven n the mornng - to avod INSOMNIA
COMPLlCATlONS: growth suppresson
Hx Teachings:
! provde ntervas or ntermttenty to avod growth suppresson;
! check BP and PR
D. SSRl (seectve serotonn reuptake nhbtor)
Ex. ZOLOFT, Prozac
Adverse effects: DECREASE LIBIDO and Impotence
s}e: GI
III.1 ANTIMANIC
# Lthum (thane, thobd, escath)
# Tegreto
# Depakne/ Depakote
A. LlTHlUM
- t aters eve of neurotransmtters
effectve f DECREASE HYPERACTIVITY
gve AFTER MEALS
Hx Teachngs:
! det:
Hgh Na (6-10 gms) and Hgh Fud (3-4L)
N Na - 3 gms, N fud ntake 3L
Bascay, Lthum s a sat
! Report the ff s/s (NAVDA)
- Nausea
- Anorexa
- Vomtng
- Darrhea
- Abd Cramps
Report aso:
FINE HAND TREMORS progressng to COARSE HAND TREMORS,
THIRST and ATAXIC - sgn of LITHIUM TOXICITY - Dug of choce: MANNITOL
DIAMOX
Hx Teachings:
Avod actvty that ncrease perspraton - Na & H2o;
Avod caffene;
Montor thum eve
(specmen: bood drawn n the mornng b4 breakfast or at east 12 hrs after the ast dose)
Frequency of Lthum montorng: ONCE A MONTH;
NORMAL LlTHlUM LEVEL:
ACUTE DOSE MAlNTENANCE DOSE
Beow 65 yo .5 - 1.5 mEq/L .5 - 1.2 mEq/L
Above 65 yo .6 - 1.0 mEq/L .4 - .8 mEq/L
Lthum s effectve wth 10 - 14 DAYS before t w reach ts therapeutc eve.
CONTRAlNDlCATlON OF LlTHlUM:
Pregnancy;
Lactatng;
Kdney dsorder
- f above s/s are (+) to patent, nstead of thum use TEGRETOL, DOPAKINE/ DEPAKOTE
tegretol - a/e : aopeca
dopakine} depakote - gngvts
ANTICONVULSANT (Tegreto and dantn)
- for sezures, wheren there s abnorma dscharge of mpuse n the bran
- acton : IT INHIBITS the sezure focus and dscharge
effectve: f (-) sezure
gven BEST AFTER MEALS (except for sedatves- ke vaum)
- MOST DRUGS THAT AFFECT CNS ARE BEST GIVEN AFTER MEALS TOO.
NSG ALERT:
Report GINGIVITIS;
Report S/S of Bone Marrow Depresson - pancytopenia
(dec RBC & WBC);
Instruct pt to use SOFT BRISTTLED TOOTHBRUSH;
Instruct pt to MASSAGE GUMS and frequent ora hygene
Check : CBC - due to pancytopena
RBC, WBC and Pateet abe
CHOLINESTERASE INHIBITORS
For MYASTHENlA GRAVlS : Prostgmn (ong actng) and Tenson (short actng)
For ALZElMER's DSES : Cognex (tacrne) and Arcept
Myasthenia Gravis - there s decrease or absence of Acethychone (ACTH)

ACTH s a neurotransmtter the devers the order ex. Bran to musce to contract/move.
Therefore, the drug s gven to nhbt chonesterase n destroyng ACTH
(so, f dec chonesterace and nc. ACTH, good musce contracton)
PROSTIGMIN - ong actng - for treatment
TENSILLON - short actng - ony for 5 mns. - t ncrease musce strength n 30 seconds
(therefore, f musce weakness dsappear wthn 30 seconds - t s MYASTHENIA GRAVIS)
Drug Action:
Increase musce strength (ex. Increase chewng abty or abe to chew food forcefuy)
GIVE B4 MEALS or any actvty;
Meds s FOR LIFE;
Report s/s of HEPATOXICITY - RUO pan of abdomen and |AUNDICE
Antdote: ATSO4 - t reverses the effect of antchonesterase
Check for LIVER FUNX TEST;
Keep at bedsde: endotrachea tube - for resp. probem
ANTICOAGULANT
HEPARIN COUMADIN LOVENOX
For ACUTE CASESof Manic Case FOR MANTENANCE or Chronic CASE Heparin Derivatives
Antidote: PROTAMNE SO4 Antidote: VT K Antidote same w/ Heparin
Given SubQ (Lower Abdl Fat) Oral
Onset: 2-5 days (mantenance case)
Check PT (N 11-13 sec and INR 24 sec)
Effectve f (-) cot
Gve same tme of day
Report s/s of beedng : Hemoptyss
Hematemess
HEPARIN: AVOID - green eafy vegetabes - bec t s rch n Vt K and w counteract the effect of ant coaguant.
Therefore, det of patent - no approprate.
NSG ALERT: monitor PTT (N 60-70 SEC, TIL INR of 175), f more than INR - HOLD
"INR" - refers to the upper mt of meds from N vaue to the maxmum dose
COAGULATlON PROCESS:
thrombopastn
Vtamn K dependent cottng factors PRO THROMBIN THROMBIN
COUMADIN FIBRINOGEN
HEPARIN
FIBRIN (CLOT)
COUMADlN - act as vt k dependent cottng factors
HEPARlN - converts PROTHROMBIN to THROMBIN and
FIBRINOGEN to FIBRIN
- RAPID ACTING :onset : 24 - 48 hrs
Coumadin and Heparin

- NOT to dssove cot
(ony as THROMBOLYTlC - meanng t prevents ENLARGEMENT and FORMATION of CLOTS)

- can be gven together
ANTIARRYTHIMICS
Ex. Quinidine (quinam)
Side notes:
Characteristics of HEART MUSCLE:
a. CONDUCTIVITY - abty to propagate mpuses;
b. AUTOMATICITY - abty of heart to ntate contracton;
c. REFRACTORINESS - abty of t heart to respond to stmuus whe n the state of contracton;
d. EXCITTABILITY - abty of the heart to be stmuated
Inotropc effect - force of contracton or strength of myocarda contracton;
Chromotropc Effect - conducton of mpuses;
CHRONOTROPIC Effect - rate of contracton
ANTlARRYTHMlC (qundex, pronesty)
- repoarzaton - restng phase (k goes out)
depoarzaton - stmuatng phase (Na goes n)
(therefore the depoarzaton and repoarzaton of heart musce depends on Na and K pump.)
K - once t ncrease or decrease, t affects the repo and depo of heart musce
whch causes arrhythma.
And so, to mantan the baance n the Na and K pump gve antarrythma because t
decreases the automatcty of the heart.
Antarrythma s effectve f (-) arrhythma;
Gve meds anytme;
Health teachings:
a. report CNS - confuson, ataxa and headache
GI - nausea, anorexa and vomtng
b. RASH - therefore SKIN TEST FIRST
c. REPORT s/s of OUINIDINE TOXICITY - tnntus, hearng oss and vsua dsturbances
d. check pt PR and ECG - waves, rate and rhythm
UlNlDlNE PROCAlNE LlDOCAlNE
Ventrcuar arrythma
For VENTRCULLAR & ATRAL Fibrillation
CARDIAC GLYCOSIDES
- ncrease force of contracton;
- affects the automatcty and exctabty of the heart musce;
- K - shd be montored when n ths meds therapy
(The heart contracton s reguated by Na and K pump. If K decreases, Cacum enters and t w resut to a
more ncrease force of contracton due to Na and Ca pump converson.)
Effects: (+) INOTROPIC - strengthen the force of contracton
(-) CHRONOTROPIC - decrease rate of contracton
DlGOXlN DlGlTOXlN
EFFECTIVE : t ncrease FORCE OF CONTRACTION same
ACTION : onset : 5 - 20 mns 30 mns - 2hrs
Gve after meas due to GI rrtaton same
CLlENT TEACHlNGS:
! Report s/s of TOXICITY : NAVDA
Xanthopsa - yeowsh vson or greensh haos;
Check PR - f BELOW 60/mn (adut) - HOLD next dose;
f BELOW 70/ mn (oder chd) - HOLD;
f BELOW 90- 110 (nfants) - HOLD next dose
EXCRETION
Dgoxn - kdney - montor rena funx test (BUN & Crea) - report f nc;
Dgtoxn - ver - AST/ ALT
DIGIBIND - antdote for digoxin (lanoxin)
THERAPEUTlC LEVEL:
a. Dgoxn : .5 - 2 ug/L
b. Dgtoxn : 14 - 26 ug/L
NITRATES (nitroglycerine)
- dont gve f pt takng VIAGRA - it will result to FETAL HYPOTENSlON

EFFECTS: dataton of coronary arteres and arteroes thereby resutng to
DECREASE IN PRELOAD & AFTERLOAD.
Decrease in Preload - decrease n the amount of bood that goes to the LV;
AFTERLOAD - amount of resstance offered by bood vesses that heart shd overcome
when pumpng bood
Effective if NEGATVE ANGNAL PAN;
Give BEFORE any activity;
Administered SUBLNGUALLY (+ burning sensation indicates drug is potent) NO WATER because it
will dilute the meds;
DOSES: 3 doses at 5mns nterva;
Report f there s persstence of pan;
Check BP and PR;
Keep meds n dark contaner (bec ght dec potency);
Once the botte s open, use the meds wthn 3-6 mos
DO NOT REPORT THE FF: (expected s/s)
Hypotension, Headache, facial flushing "why is my face red?
MUCOLYTICS (an antidote aIso 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
- f no sde effects, repeat dose n 1 hr
BRONCHODILATORS (ex. TERBUTALINE - brethne)
- dates the bronchoes or arways;
- effectve: f (-) bronchospasm;
- GIVEN n AM to decrease nsomna
- REPORT THE FF: insomnia, tachycardia, palpitation-PR, + NAV
Theophyne - N 10-20;
- for ACUTE ATTACK and PREVENTION of ASTMA
EXPECTORANT (robtussn)
- stmuates productve coughng;
- effectve : (+) COUGHING & SECRETIONS
- gve ANYTIME;
- sideffects: - NAV + DlZZlNESS or drowsiness - avod actvty
that requred aertness (ex. Drvng)
ANTIBIOTICS
- bactericidal;
- effective: (-) infection;
- give ON EMPTY STOMACH B4 MEALS;
- Hx teachings: REPORT rash, urticaria and "STRDOR indicates
airway obstruction;
- side effects: NAVDA + GI Irritation
l. PENlClLLlN : antdote s EPINIPHRINE
ll. AMlNOGLYCOSlDE (gentamycn)
- effectve: (-) nfecton - gve B4 meas;
- report the ff:
OTOTOXlClTY: "l hear ringing in my ear"
NEPHROTOXlClTY : "oliguria"
NEUROTOXlClTY : "seizures"
- check BUN, CREA (kdney funx test);
- check I & O (sgn of nephrotoxcty)
III. ANTlNEOPLASTlC (adramycn)
- for breast and ovaran CA;
- effectve: (-) tumor sze;
- GIVE IN ARM - to prevent HEMMORRHAGIC CYSTITIS
- Hx Teachngs:
a. nc ora fud ntake (2-3L/day) - cytotoxc preventon;
b. montor kdney funx - I & O;
THYROID AGENTS (synthroid, cytomel)
- for HYPOTHYROIDSM;
- effectve: f Inc n T3 and T4 and NORMAL SLEEP;
- pt aways seep, therefore gve meds n AM - to avod nsomna;
- REPORT HE FOLLOWING: nsomna, nervousness; paptatons
- Take meds LIFETIME (same w/ meds 4 neuro);
- Check HR, PR and kdney funx test;
ANTITHYROID (PTU, LUGOL`S SOLUTION)
- For GRAVES DISEASE or HYPERTHYROIDISM;
- Effectve: Decrease n T3 and T4 (n ab data);
- Gve round the cock;

Health Teachings:
a. Report sore throat, fever, chs, body maase because meds
cause AGRANULOCUYTOSIS;
b. Report ethargy, bradycarda, and INCREASE SLEEP - ndcates
that pt s havng HYPERTHYROIDISM;
c. Darrhea wth metac taste - sgn of IODINE TOXICITY
ANTIDIABETICS (INSULIN)
- effectve: N Bood sugar (80-120)
- for DM Type 1 (nsun dependent);
- gve n AM b4 meas;
- check:
a. nstruct S/S OF HYPOGLYCEMIA -
dzzness/ drowsness
dffcuty n probem sovng
decrease eve of conscouness
cod cammy skn
b. montor the bood sugar eve n eary AM and supper tme
! lN]ECT AlR FlRST to NPH then n|ect ar and WlTHDRAW FlRST with REGULAR.
! PEAK OF ACTlON (refers to - when patent becomes HYPOGLYCEMIA)
REGUALR INSULIN - unch tme
Intermedate - ate n the afternoon - B4 dnner
Long Actng - B4 Breakfast
SULFONYLUREAS (Orinase)
- for DM type 2;
- stmuate pancreas to produce nsun;
- effectve - N bd sugar eve;
- gve b4 meas reguary;
- teachngs:
a. s/s of hypogycema;
b. montor rena funx test;
c. antdote for hypogycema - ORANGE |UICE
ANTACIDS (amphoge, tagamet)
- ALUMINUM HYDROXIDE GEL - antacd and t aso dec phosphate eve n pt
rena faure;
- Effectve: dec phosphate
(-) pan
- gve on EMPTY STOMACH (1 hr b4 or 2hrs after meas);
- nstruct pt to REPORT: musce weakness n ower extremtes -
ndcates HYPOPHOSPATHEMIA
- admnster wth gass of water;
- check phosphate eve and rena funx test;
- assess for constpaton
LAXATIVES (ducoax)
Coace - stoo softener
Metamuc - buk formng
Ducoax - rapd actng
Lactuose - 15-30 mns
- effectve : (+) BM;
- gve AT HS (f NOT dagnostc procedure);
- gve AFTER MEALS -for dyspepsa;
- meds s gven n short duraton ony because of dependency
- teachngs:
a. be near or stay near CR;
b. s/e: darrhea;
c. NO actuose for pt w/ darrhea;
d. Causes hypokaema - therefore check eectroytes
e. Increase fd ntake - to avod dehydraton
DIURETICS
Target Organs
a. Damox - exerts effect at Proxma Convuuted Tubues;
b. Lasx - at Loop of Hene;
c. Dur - at Dstant Con. Tubues
LOOP DlURETlCS (lasix)
- effetctve: ncrase urne output;
- gve n mornng to prevent noctura;
- teachngs:
a. montor for hypokaema eve and I & O;
b. report musce weakness;
c. gve K rch food - banana, orange
THlAZlDE (diuril)
- gve n AM;
- montor for hypokaema;
- check I & O, K eve, PR and BP
K-SPARRlNG (triamterene, aldactone)
- effectve: nc. urne output;
- gve n AM;
- teachngs: montor for HYPERKALEMIA
check PR and K
ANTlGOUT
PROBENEClD COLCHlClNE ALLOPURlNOL
- URICOSURIC - for ACUTE GOUT - for CHRONIC GOUT
- promotes excreton of urc acd - has ant-nfammatory effect by - prevents or dec formaton
preventng deposton of u.acd of u. acd
@ |onts
- s/effects: NAV + - NAV + Bdg and Brusng - dzzness/drowsness
Hypersenstvty agranuocytoss (check CBC)
- ONSET: 8-12 wks - ONSET: 1-3 wks
TEACHINGS:
a. Increase ORAL FLUID INTAKE;
b. Montor urc acd eves;
MIOTICS (tmoptc, poca)
- DECREASE IOP (N12-21) for pt w/ gaucoma;
- Gve ANYTIME - but for LIFETIME;
- Teachngs:
a. t causes burrng of vson and brow pan;
b. admnster meds at ower con|unctva sac;
c. press the nner canthus for 1-2 mns to prevent systemc sde
effects (hypergycema and hypotenson)
MYDRIATRIC (AK-Date)
- effectve: pupary dataton;
- gve ANYTIME (but f pt for surgery, gve b4);
- teachngs: may cause burrng of vson
ower con|uctva sac
CARBONIC ANHYDRASE INHIBITORS (diamox)
- Ior GALAUCOMA liIetime;
- to decrease production oI acqueous humor;
- eIIective: N IOP and Inc. urine output;
- eIIective to pt with MENIERE`S DSES dec vertigo
- teachings:
a. check urine output;
b. report: s/s oI dehydration bec oI diuretic eIIect
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: Ietotoxic - thereIore check iI pt is pregnant;
- check iI pt has skin irritation may burn the skin
TOCOLYTICS (Yutopar, MgSO4)
- reax the uterus;
- drug of choce for pre-term abor;
- effectve: (-) pre-term or reaxed uterus;
- gve: ORAL - B4 meas and IV - anytme;
- teachngs:
a. sgns of Ca Intoxcaton:
hypotenson, hypotherma and hypocacema
b. check bd pressure; urne output (N 30m/hr)
c. check RR - at east 12/mn
d. check patear refex - shd be (+) knee |erk
HOLD f RR - 10/mn and urne output: 15m/hr
Antidote: Cacum Guconate
OXYTOXIC
PlTOClN METHERGlN
To nduce abor To prevent post partum hemorrhage
Effectve: Frm and Contracted Uterus
Gve anytme
If IV, use "pggy back"
Teachngs:
a. REPORT the ff: HYPOTENSION (due to nactvaton of ANS - neuroogca effect of drug);
b. Headache
c. Hypertenson (cardovascuar effect of the drug)
d. Check BP, Uterne Contracton - especay the duraton - N 30-90 sec
- report f beyond 90 sec - sgn of uterne hypertoncty
e. Check Force, Duraton and Frequency of Uterne Contracton
PROSTAGLANDIN (cytotec, E2ge)
- ant ucer drug to dec gastrc acdty;
- decrease rpenng of the cervx w/c eads to effacement then dataton then
aborton;
- gve after meas;
- assess for darrhea and gastrc rrtaton;
- check for pregnancy bec t may cause aborton
TlPS ON PHARMACOLOGY
! Patent recevng DIAZEPAM, the nurse notce that there s no change n patent
behavor. What shd the nurse do? - VERlFY THE PT DlET
! COGNEX - gven wth AZEIMERSS DSES - to increase mental functioning
! Pt w/ PVC : bedsde : XYLOCAlNE
! Pt w/ COMPLETE HEART BLOCK: gve ATSO4 - it increases HR
! Pt w/ DIVERTICULITIS (pt has darrhea) - the ff meds were gven: what meds the nurse
shd queston : LACTULOSE
! Morphne S04 gven to pt wth Pu. Edema - to decrease anxiety
! Pt ask the nurse on why she w take COUMADIN when shes aready takng HEPARIN -
Heparin is given for ACUTE CASES while Coumadin for maintenance
! Pt on CHEMOTHERAPY compans of nausea and vomtng, w/c meds can be gven -
ZOFRAN
! Expected sde effects of STEROIDS : wt gain, obesity and lnc appetite
! Pt s takng LEVODOPA - observe for URlNARY RETENTlON
! ADREAMYCIN - causes hemorrhagic cystitis
! DESMOPRESSIN ACETATE - administered lNTRANASALLY
! FESO4 - shld be given w} orange juice
! ASPIRIN I s gven to pt w/ TIA - to decrease platelet aggregation
! Pt takng ANCEF - observe for skin rashes
! Pt to receve NPH at 7:30am, the nurse shd expect for hypogycema - LATE n the
AFTERNOON
TYPES OF PRECAUTlON
P H GL GW M
AlDS (unversa) x yes yes yes yes
DlARRHEA (enterc) x yes yes x x
HEPA A (enterc) x yes yes x x
B (unversa) x yes yes yes yes
C (unversa) x yes yes yes yes
MRSA (contacts) yes yes yes yes yes
MENlNGlTlS}SEPTlC (enterc) x yes yes x x
SCABlES (contact) yes yes yes yes yes
TB (tb Precauton) yes yes x x yes
PEDlCULOSlS (contact) yes yes yes yes yes
P - private room
H - handwashing
GL - gloves
GW - gown
M - mask
AlDS - universal
Norwalk Virus - respiratory
Hepa A - contact
MRSA - contact
Scabies - contact

Day 6 (Feb 9, 05)
D.l.S.E.A.S.E.S
(MEDICAL-SURGICAL NURSING)
GENERAL CONSIDERATION
Prorty: Oxygenaton
The dsorders resut as ateraton n the functon of HEART (pump), BLOOD
(transport mechansm of oxygen, nutrents, hormones & CO2) and BLOOD
VESSELS (passageway).

PEDIATRIC CONSIDERATION
a. a factors necessary for approprate cardovascuar functonng are
present at brth EXCEPT VIT. K (w/c s produced by ntestna mucosa);
b. there are structures whch are present at brth that may ater the route of bood
crcuaton (present at brth: foramen ovae, ductus arterosus, ductus venosus)
c. note the CARDIAC RATE of pedatrc pt (mnmum $ y. chdren - 90-110, oder c. - 70)
REPORTABLE S/S FOR ADULT
Paptaton, Pan and Paroxysma Nocturna Dyspnea
For pedatrc patent: observe for PALLOR - f (+) ndcates ANEMIA for baby
Nocturna dyspnea - dff. of breathng at nght
Paroxysma ND - when pt fees as f hes drownng
HEART SOUNDS:
S1 - norma - "ubb"
S2 - -do- - "dub"
- n assessng S1 & S2 use BELL of steth
S3 - N for Pedatrc pt (ABNORMAL for adult pt - t ndcates CHF or Aortc Stenoss)
Steth - BELL - for LOW PITCH SOUND (ex. Murmur)
Daphragm - for HIGH PITCH SOUND
SHOCK
mp: decrease in circulating blood volume
TYPES
! CARDIOGENIC - pump faure (CHF, MI, Atherosceross Heart Dses, Mtra Vave Dses)
! HYPOVOLEMIC - reated to fud oss (pt w/ open wound, traumatc n|ury, burn)
! ANAPHYLACTIC - cause by aergc reacton (aB procedure w/ dye, asthma, poson)
! NEUROGENIC - caused by vasomotor coapse
(vasomotor - ocated @ medua obongata w/c s responsbe for dataton & constrcton of bd vesses)
! SEPTIC - due to systemc nfecton (ex. Septcema)
TRlAD SYMPTOMS OF SHOCK
a. Atered eve of conscousness (dec bd crcuaton - resut to dec o2 n the bran);
b. Hypotenson;
c. Tachycarda and Tachypnea
Patent n shock- there s aso (+) paor and
(+) ogura - due to dec bd crcuaton & narrowng of bd vesses
Lab Data (to check bd voume crcuaton) - check HEMATOCRIT (N-35-45%)
- check Urne Output
- check CVP
Nsg Dx: FLD VOLUME DEFICIT re to dec n Crc Vo.
Prorty Interventon: Fd repacement (D5Lr, NSS. Bd Trans - for |ehovas use pasma expander)
ANEMlA
MP: Decrease RBC due to decrease producton or ncrease destructon
Rsk Factors:
Age
Gender
Surgery
Secondary to exstng medca condton (ex. Rena Faure)
Kdney - produce erythropoten that stmuates bone marrow to produce RBC
TYPES:
a. Iron Defcency Anema (IDA)
b. Perncous Anema (PA)
c. Foc Acd Defcency Anema (FADA)
d. Scke Ce Anema (SCA)
e. Apastc/ Fancons Anema (AA)
f. Taasema Anema (TA)
lRON DEFlClENCY ANEMlA
- common n nfants and chdren;
- characterstc of patent: chubby but pae
- they are aso caed "mk babes"
- those baby 5 yo but st takng mk
(mk are poor source of ron)
MP: Nutrtona Defcency
S}S : Fatgue
Fantng
Forgetfuness
Paor, cod cammy skn
Dyspnea (due to dec RBC)
Lab data:
Decrease n HgB (N mae: 14-18, Femae: 12-16)
Characterstc of RBC: HYPOCHROMIC & MICROCYTIC
Nsg Dx: Actvty Intoerance
Priority lntervention:

a. Correct the defcency - by admnsterng ron suppements,
- IRON RDA - 15-30 mgs/ day
eg. Ora FeSO4 (take w/ orange |uce)
f ELIXIR - use straw to avod stanng of teeth
f IM (nferon) - "Z" track method
(for Z track IM - PULL SKIN LATERALLY, deep IM,
wat 10 seconds before pung the neede)
FeSO4 - evauate AFTER 4 weeks to check the effect
b. Det: ron rch food - (organ meat, dred foods, "egg yok" - ron, "egg whte" - CHON);
c. provde patent wth BED REST - due to fatgue
PERNlClOUS ANEMlA
- common n edery;
- common n POST GATRIC SURGERY
Main Problem: Lack of INTRINSIC FACTOR at the stomach
(ntrnsc factor - the one that absorb vt b12)
In edery, there s that GASTRIC ATROPHY w/c eads to dec n the Intrnsc factor
S}S:
3F (fatgue, fantng, forgetfuness)
Beefy Red Tongue or gossts
Perphera Neuropathy (tngng sensaton at ower extremtes - usuay both egs are affected)
Lab Data:
a. check Hgb
b. SCHILLINGS TEST (24hr urne)
c. RBC characterstc : MACROCYTIC & HYPERCHROMIC
Nsg Dx: Actvty Intoerance
Rsk for In|ury due to p. neuropathy
Prorty Interventon:
a. Correct the defcency - gve Vt B12 (IM, Once a month for fetme);
b. Bed rest - due to fatgue
FOLlC AClD DEFlClENCY ANEMlA
- common n nfants, adoescents, pregnant, actatng and overcooked food;
Main Problem: Defcency n Foc Acd or VIT B9 or FOLACIN
S}S: a symptoms of perncous anema EXCEPT P. NEUROPATHY
Lab Data: HgB
Foc Acd eve (N 4mg/day) - green eafy veg. (spnach)
Nsg Dx:
Actvty Intoerance (NO RISK FOR IN|URY coz NO P. NEUROPATHY)
Pl: Inc. foc acd n the det - g. eafy;
Bed Rest
SlCKLE CELL ANEMlA
- autosoma recessve
- heredtary
- presence of "S or C" shape Hgb due to dec O2 (SICKLING OF RBC)
STATUS N TRAlT TRANS DSES TRANS
! 1 PARENT W/ TRAIT 50% 50% 0
! BOTH PARENTS w/ TRAIT 25% 50% 25%
! I parent TRAIT, 1 DSES 0 50% 50%
! BOTH parents w/ Dsease 0 0 100%
Risk Factors:
Dehydraton (dec n crc bd voume - resut n sckng of RBC);
Infectons
Condtons that ead to SHOCK
S}S:
3Fs + Fever (due to dehydraton) + Pan + |aundce Hepatomegay
Complications:
a. Vasoccusve Crss (hallmark of the dses)
- bd vesses obstructon by rgd and tanged ces w/c causes tssue anoxa and possbe necross
b. Speenc Sequestraton Crss - massve entrapment of red ces n the speen & ver
c. Apastc/ Megaobastc Crss
- bone marrow depresson w/c resuted to DEC RBC, WBC & PLATELET
Lab Data: Sickledex Test
(+) Turbd Souton
Nsg Dx: Actvty Intoerance
Fd Voume Defct
Pan - due to vasoccusve crss
Pl: Hydraton and reef of pan (nc ora fd ntake)
Prevent dehydraton
Meds for Pan - Morphne SO4, acetamnophen
Snce HEREDITARY - refer to gentcst
APLASTlC ANEMlA
MP: Heredtary (there s DECREASE IN RBC, WBC & PLATELET)
Autosoma Recessve
S}S: 3Fs + Paor + Dyspnea
Rsk for Infecton (dec n RBC)
Beedng (dec n Pateet)
Lab Data: HgB, CBC, Cottng Factors Pateet, Beedng & Cottng tme
Nsg Dx: Actvty Intoerance (dec n RBC)
Rsk for In|ury (dec n WBC and Pateet)
Pl: Bd transfuson;
Reverse Isoaton;
Genetc Counseng;
Bed rest
THALASEMlA
Risk Factors:
Common n Backs, Itaan, Greeks, Chnese, Indans
MP: Heredtary
Autosoma Domnant - common n femae and mae
There s a defect n poypeptde
Chan of HgB - ALPA and ETA Chan - there s RBC destructon
Types:
a. Mnor Thaasema Anema - md anema: 3Fs
b. Intermeda TA - more severe anema + Speenomegay
|aundce
(nc deposton of ron @ tssue) Hemosdoross
c. Ma|or TA - severe anema + Speenomegay
Lab Data:
HgB
Cottng and Beedng Tme
Nsg Dx: Actvty Intoerance
Rsk for In|ury
Pl : Bd Transfuson,
IVF
Detary suppements of Foc Acd and Iron
Surgery (ast resort)
LEUKEMlA
MP: proferaton of mmature WBC
Characterzed by Remsson and Exacerbaton
Types:
a. LYMPHOCYTIC - common n young chdren (proferaton of ymphocytes)
b. MYELOGENOUS - adoescent and adut (proferaton of granuocytes)
TRAID S/S:
Anema (nta) + 3Fs
Beedng
Infecton
Lab Data:
WBC - hypereukocytoss (150 - 500,000K) - expected
NDx: Rsk for In|ury
Actvty Intoerance
Rsk for nfecton
Pl: Bed rest
Avod Contact Sports
Reverse Isoaton
Bood transfuson
Bone marrow transpant
lDlOPATHlC THROMBOCYTOPENlC PURPURA (lTP) or
WERLHOF'S DSES
- common n BLACKS;
- cause: dopathc
unknown (vra and autommune)
s/s: petechae
ecchymoss
hemorrhage
(a sgns of beedng)
ab data: Pateet Count of ess than 20,000 (spontaneous bdg)
(N 150,000 - 450,000)
Nsg Dx: Rsk for In|ury
Fd Vo. Defct (due to bdg)
PI : SAFETY -prevent beedng
Gve pt pateet, IVF and Bd Transfuson
Cortcosterods - "wonder drugs"
HEMOPHlLlA
- nherted - bdg dsorder
TYPES:
a. Hemo. A - defcency n factor 8
b. Hemo. B - defcency n Factor 9
c. Von Webrands Dses - common n mae and femae
HEMPPHILIA A and B - Autosoma Recessve Lnk (from mother to mae)
Von W Dses - Autosoma Domnant - Mother and Father

S/S:
Hemarthross - bdg between |onts that usuay affects anke, knee and ebow |onts;
Hematoma
Hematura
Hematemess
(above mentoned are sgns of HEMORRHAGE)
Lab Data : PROLONGED CLOTTING TIME
Nsg Dx : Rsk for In|ury
PI : SAFETY then RICE (REST, IMMOBILIZE, COLD COMPRESS, ELEVATE)
For |EHOVAHS - use pasma expander (cryoprecptate) nstead
TIPS FOR BLOOD DISORDERS
! If a of the ff data were obtaned by the nurse, w/c one s MOST SUGGESTIVE of
CARDIOGENIC SHOCK - lnc. HRate from 84 to 122 bpm;
! The nurse admtted a 4 yo chd wth SICKLE CELL DSES - the priority for the
patient is - HYDRATlON;
! w/c of the ff s TYPICAL for patent w/ ANEMIA - SHORTNESS OF BREATH ON
EXERTlON;
! common manfestaton of LYMPHOCYTIC LEUKEMIA s - PETECHlAE;
! a mother of 15 mos od chd wth IDA makes the ff comment. w/c one s reated to
chd condton - "MY CHlLD DRlNKS 2 UARTS OF MlLK}DAY";
! a 7 yo boy wth HEMOPHILIA was admtted. w/c of the ff s EXPECTED
MANIFESTATION - HEMARTHROSlS;
! pt w/ IDA has NSG DX of ALTERED NUTRITION LESS THAN BODY REOUIREMENTS.
w/c of the ff shd the nurse nstruct the pt to do - lNCLUDE VEGS. AND MEAT in
your diet at least 1 meal a day;
! w/c of the ff s the prorty nterventon for pt w/ IDA - PROVlDE BED REST
ALTERNATlNG w} activities;
! w/c of the ff s ndcatve of thrombocytopena - HEMATURlA

CARDlOVASCULAR PEDlATRlCS
FETAL ClRCULATlON
3 FETAL STRUCTRUES
PLACENTA UMBILICAL VEIN DUCTUS VENUSUS LIVER
(functonay, coses at brth)
Vena Cava
UMBILICAL ARTERIES

Rght Atrum FORAMEN OVALE
(functonay, coses at brth)
AORTA
R Ventrce LA

LV
LUNGS
L VENTRICLE

DUCTUS ARTERlOSUS (functionally closes by 3-4 days at birth)
L ATRIUM P. ARTERY AORTA
Therefore, f these 3 feta structures w not cose, CONGENITAL HEART DISEASE

CONGENlTAL HEART DlSEASE
ACYANOTlC HEART DSES CYANOTlC HEART DlSEASE
Dec Pumonary Bd fow Obstructve CHD Decrease Pumonary
Vent. Septa Defect (most common) Pumonary Stenoss Tetraogy of Faot (most common)
Atra Septa Defect Aortc Stenoss Transposton of the Great Ven
Patent Ductus Arterosus Coarctaton of the Aorta Truncus Arterosus
Trcuspd Atresa
Usually due to:
- Materna Infecton - meases, c. pox
- Age 40 and above
- Medca Condtons - DM
- Acohosm
Signs and Symptoms:
! Dffcuty feedng
! Retarded Growth
! Tachypnea/Tachycarda
! Frequent URTI
! ANS - brow seatng
Complication: CH Faure (check for "murmur") CVA (due to pycythema - Inc RBC)
Lab Data: 2 D Echo
Nsg Dx: Atered Tssue Perfuson
Pl : Oxygenaton
Surgery

lf < 2yrs old prepare the patent the moment the dagnoss was confrmed/ determned;
For 2-7 yrs old - surgery s equa to chd age ( ex 3yo, therefore prepare the chd 3 days pror to surgery)
lf > 7yo - parents decson
PATENT DUCTUS ARTERlOSUS
- connecton probem : P Artery and Aorta
- "machinery-like murmur"
- (+) brow seatng
(+) retarded growth
(+) tachycarda/ tachypnea
LAB DATA : 2 D-Echo
CVP
PExam
Nsg Dx : Atered Tssue Perfuson
Pl : Oxygenaton
INDOMETHACIN
ACYANOTIC POSITION: ORTHOPNEIC (poston for CHF) then SURGERY
TETRALOGY OF FALLOT
- pumonary stenoss, coarctaton of aorta, rght vent. Hypertrophy, vent
septa defect
- "boot-shape heart"
- tet spe - squattng w/ cyanoss
LAB DATA : 2 D-echo

Complication : CVA - check for RBC Count
Nsg Dx : Rsk for In|ury
Pl : Oxygenaton
Position the Pt. : SUATTlNG
Surgery
COARCTATlON OF AORTA
- Hgher BP n the Upper Extremtes and Lower BP n the Lower Ext.
Lab Data : BP, 2 D-Echo
Pl : Oxygenaton
Position the patient: Orthopneic or semi - fowler's position
KAWASAKl'S DlSEASE
- due to acute vascuts (nfammaton of bd vesses) of the heart;
- especay to |APANESE chdren and todder 5yo and beow
S}S : Hgh Spkng Fever for 5 Days
Lymphadenopathy
Strawberry Tongue
Pamar and Feet Desquamaton
Lab Data : No Specfc Dagnostc test
Check ECG
Nsg Dx : Atered Tssue Perfuson
Atered Thermoreguaton
Atered Skn Integrty
Diet : Hgh CHON
TlPS FOR CARDlOVASCULAR - PEDlA
! w/ of the ff s an OUTSTANDING SYMPTOM OF CARDIOVASCULAR PROBLEM n
chdren - difficulty in feeding;
! w/c of the ff s an approprate nterventon for a chd who keeps on squattng
because of Tetraogy of Faot - f LESS THAN 1 yo - flex lower extremities
towards the abodomen;
! a chd who was brought n to a we baby cnc turns cyanotc whe cryng -
REFER to the physician;
! the BLD VESSELS INVOLVE n PATENT DUCTUS ARTERIOSUS - pulmonary artery
and aorta;
! w/c of the ff data n mother heath hstory ndcates a rsk factor for congenta
heart dsease - ADVANCE AGE;
! when admttng a pt w/ suspected congenta heart dsease, w/c nterventon s
prorty - decreasing the metabolic demand of the heart
CORONARY ARTERY DlSEASE (CAD)
Main Problem : NARROWING and OBSTRUCTION of Coronary Arteres whch
coud ead to HYPOXIA - reversbe (whch coud further progress to ANGINA)
and or ISCHEMIA - rreversbe (that coud progress aso to devt. of SCAR
FORMATION that can ead to MI).
Risk Factors:
Famy Hstory
Atherosceross
Smokng
Eevated Choestero
HPN
Obesty
Physca Inactvty
Stress
CAD
HYPOXIA ISCHEMIA
NECROSIS

ANGINA
Myocarda Infarcton - " |aw pan"
ths eads to decrease O2 - and w resut to the converson of aerobc metabosm to
anerobc thereby resutng to the producton of LACTIC ACID - that w stmuate the nerve endng of the
heart w/ w produce/ resut to PAIN that s precptated by:
EATING
Emnaton - due to vasava manuever
Exercse/effort/ exerton
Emoton
Extreme Temperature - "coo temp" - vasoconstrcton
sEx
PAlN
MTOCARDlAL lNFACRTlON ANGlNA
Precptated by 6Es Pan confned at sterna area
Pan that resembes "ndgeston", crushng, excruxatng Pan that resembes "pressure"
Pan radates to the L |aw, L arm, L shouder
Reeved by SO4 Opods (MORPHINE) Reeved by rest & NITROGLYCERIN
Pan occurs AFTER MEAL (post cebum) or AFTER ACTIVITY SAME
S/S of above mentoned + SHOCK s/s - esp to CARDIOGENIC
SHOCK w/c s due to PUMP Faure - that eads to dec cardac
Output that eads further to CHF.
ECG - nta change s ST SEGMENT DEPRESSION w/ SAME
T WAVE INVERSION
lncrease CHOLESTEROL SAME
HDL - "good" or Heathy - ver for metabosm - 30-80
LDL - "bad" - perphera vascuar system - bd vesses- 60-80
CARDlAC ENZYMES #1 Myogobn SAME
Troponn
CK - wthn 2-3 days
LDH 1&2 - wthn 10-14 days
Nsg Dx : PAIN
Atered Tssue Perfuson
Impared Gas Exchange
Prorty : Arway (Oxygenaton)
Goa of CARE
a. To decrease oxygen metaboc demand
- poston : SEMI-FOWLERS
- admnster O2 as ordered
- admnster meds:
Ml : Morphine SO4 - montor RR, effectve : (-) pan,
ANTIDOTE : Naoxone HCL - Narcan
ANGlNA : Nitroglycerine - dark contaner
gve b4 actvty
maxmum of 3 doses, 5 mns nterva
effectve: tngng sensaton, subngua
provde rest - due to pan
b. Det : Low Na and Low Choestero
HEALTH TEACHlNGS:
! Identfy types of Angna:

Stabe Angna - predctabe - angna that occurs w/ actvty;
Unpredctabe - reeved by Ntrogycern;
Varant/ Prnzmeta - severe form of Angna;
Nocturna Angna - occurs at nght;
Decubtus Angna - when pt s yng down
Intractabe Angna - unresponsve to tx
Post MI Angna
! For patent wth MI - focus on compcatons :
a. PVC or PVBeats - defbraton/ cardoverson
b. Ventrcuar Fbraton - Ldocane - s/e "rashes"
CARDIOVERSION DEFIBRILLATION
- synchronze - unsynchronzed
- esp. for VTACH w/ PULSE - for VTACH w/o PULSE
! SEX - for pt w} Ml - resume f pt toerate 2-3 pghts of star w/o pan;
- take meds b4 sex;
- poston durng sex : passve - et the gr do her share
! ACTIVITY - advsed pt to have frequent rest perod;
! DIET : avod PROCESSED FOODS;
MILK
Saty
Sea Foods
Pastres - esp. yeow cake
! FOR ANGINA APIN - nstruct patent to report pan that ast more than 2o mnutes (ndcatve of MI);
! Weak or absent PULSE - ndcatve of VENTRICULLAR FIBRILLATION
! Report NECK VEIN DISTENTION - ndcatve of CHF compcaton
! Report BLEEDINGs - especay to pt on THROMBOLYTICS - t-PA and Streptoknase
CONGESTlVE HEART FAlLURE
main problem : PUMP FAILURE - nabty of the heart to pump an adequate
amount of bood to meet the metaboc
demands of the body
how will the heart compensate7
The HEART w pump harder- Inc HR (tachycarda) - that w resut to enargement
of the heart musce (hypertrophy) - w/c can ead to dataton and congeston of the
cardac musces - thereby resutng to decrease n the cardac output.
PUMP FAILURE EFFECTS:
! Backward Effects : backfow of bood - systemc congeston;
! Forward Effects : decrease cardac output - dec n tssue O2
perfuson - that eads to overwork respratory
system
LEFT HEART FAILURE - eary sgns of CHF
Therefore, Rght Heart Faure - w be the ate sgns of CHF as
compcaton of LHF
Risk Factors to Heart Failure:
- Arrythmas
- Coronary Dses & HPN
- Rena Faure
LEFT SIDED HF - dyspnea and other "pumonary s/s" - "crackes"
RIGHT SIDED HF - systemc effect - dstended |uguar ven
Anke edema
Asctes
Hepatomegay
LEFTS SlDED HF RlGHT SlDED HF
Lab Data : Swan Ganz CVP (N R - 0-12, V Cava - 5-12)
PAP (N 20-30)
PCWP (N 8-13)
X-ray X-ray
Nsg Dx : Atered Tssue Perfuson
Ineffectve Breathng Pattern - for LHF
Fd Voume Excess - for RHF
PRlORlTY : Oxygenaton
Poston: Sem-Fowers
Admnster: Dgoxn - absorb n GI
Vasodators
Duretcs
Morphne - for CHF - t causes pherpera vasodaton by
Decreasng the amount bood gong back to the heart.
DlET : LOW Na - NO PMS
HEALTH TEACHlNGS :
a. Actvty - rest
b. detary counseng - NO PMS
c. report s/s of compcatons
! DIGITALIS - D. Toxcty: yeow vson;
! Musce weakness (hypokaema) - that can ead to arrythma
! Dyspnea - s/s of pumonary edema;
HYPERTENSION PREGNANCY INDUCED HPN
MP : blood pressure higher than Elevation of BP that occurs after 20-24
140/90 (hypertensive state) (5 mos- age of viability) wks of gestation

pre hypertensve phase
120/80, therefore N BP : 110/70 f BP eevated B4 20-24 wks & cont after devery - CHRONIC
HPN
Risk Factors: Levels of PlH
! Common n BLACKS; a. HYPERTENSIVE DISORDER OF PREGNANCY
! Obesty - INC. BP + EDEMA & Protenura (s/s of PRE-ECLAMPSlA)
! Stress
! Smokng b. PRE-ECLAMPSIA S/S + convuson,
Abd pan & Headache - ECLAMPSIA
PHASE
c. ECLAMPSIA + Beedng = HELP SYNDROME
TYPES:
a. ESSENTIAL HPN - cause - unknown
b. BENIGN - usuay of ong duraton, onset s CHRONIC
c. MALIGNANT - acute or abrupt onset, short n duraton
d. SECONDARY - reated to exstng medca condton
HPN IN PREGNANCY - usuay reated to generazed spasm of the arteres
PRE-ECLAMPSlA TYPES:
a. MILD BP 140/90, PROTENURIA s <5mg/hr (N - .5-1GM)
b. SEVERE BP 160/90, PROTENURIA s >5mg/hr
HEADACHE and ABDOMINAL PAIN - s/s of ECLAMPSIA, ndcatve of mpendng convuson.
ECLAMPSIA + BLEEDING = HELP SYNDROME

H - emoyss
E - evated Lver Enzyme
L - ow
P- ateet
(A are sgns of beedng)
S}S of HPN:
Headache
Retna Hemorrhage
Edema
- above s/s can further ead to compcatons: Coronary artery dses
CHF
Chronc Rena Faure
CVA
LAB DATA:
Bood Pressure
Eevated Choestero
For PIH : (+) Protenura, Inc BP and Inc Choestero
Nsg Dx:
Atered Heath Mantenance
Rsk for In|ury
PlORlTY: Stabze BP
How?
I. Non-Pharmacoogc Features
! Stress Management
! Deep breathng
! Det : Low Na/ Choestero
! Poston : f nc BP - supne poston
II. PHARMACOLOGIC MEASURES
! Anthypertensve
! Duretcs
! Asprn
! Antpmc - smvastatn & ovastatn - gve after mea nghttme
! Montor ver Funx test - meds above are hepatotoxc
Pts w/ PIH meds:
a. MgSo4 - antdote s CAguconate
b. Darkened room - to dec stmuus thereby preventng convuson
PERIPHERAL VASCULAR DISEASE
Artera Obstructon Venous Obstructon
Coor paor ruddy
Edema (-) or md (+) & severe
Nas brtte nas N
Pan ntermttent caudcaton homans sgn (pan @ gastrocnemeus area)
Puse (-) (+)
Temperature cod warm
Ucer dry & necrotc wet
TYPES:
BURGERS DSES RAYNAUDS ARTERIOSCLEROSIS OBLITERANS
(THROMBO ANGITIS OBLITERANS)
common : MALE FEMALE MALE
AREA Lower Ext. Upper Ext - 97% Upper & Lower Ext
AFFECTED : 3% - ower ext
Affects arteres Arteres ONLY Arteres ONLY
and vens
MP : "Angts" - nfam. of Spasm of Arteres Hardenng of arteres due to fatty deposts
Arteres & vens of ower ext of Upper & ower
ACUTE INTERMITTENT CHRONIC - (+) pan usuay reated to
- (+) pan that narrowng of bood vesses.
accompaned by coor changes: PALLOR that
progresses to CYANOSIS then REDNESS &
aggravated by exposure to cod - NO
SHOVELlNG OF SNOW & COLD BATH & exposure to cold - wear goves
S/S: Outstandng s/s
s INTERMITTENT CLAUDICATION - pan that worsens w/ actvty or pan that s reeved by rest.
- aggravated by smoking - causes further narrowng of bd vesses
LAB DATA : Inc WBC & ESR DOPPLER USG Inc Choestero and Ca
Nsg Dx: Atered Tssue Perfusonsame same
Pan -do- -do-
PI : Reef of Pan -do- -do-
MEDS : (for a types)
! Antcoaguants
! Vasodators (papavern - pavabd)
! Anthypertensve
DIET : Low Choestero
VARICOSE VEIN THROBOPHLEBITIS PHLEBOTHROMBOSIS

weakenng of venous vaves; CLOT + Infammaton Cot
|ob reated (proong sttng/standng)
pregnancy
heredtary
secondary to exstng medca condton
s}s : dated tortous ven
draggng sensaton "heavness"
edema (unatera/ batera) - tape measure to montor eg crcumference
Pan
Lab data:
1. conservatve test - TRENDELENBURG TEST - pt e down, eevate/ rase the egs then
stand up and observe for bugng of ven;
2. DOPPLER USG
Nsg Dx : PAIN
Atered Tssue Perfuson
Hx Teachings :
Eevate the egs above the heart;
Use support stockngs;
Surgery - ven gaton & strppng
Scero therapy - n|ecton of scerosng agents to make wa stronger
thereby preventng vens to buge.
NO MASSAGE - coz t may dsodge the cots;
KNEE HIGH STOCKINGS;
COLD COMPRESS
ABDOMlNAL AORTlC ANEURYSM (AAA)
- weakenng of porton of abd aorta - eadng to daton;
- coud be reated to agng and HPN
TYPES:

Fusform - entre wa s affected
Dssectng - part of nner ntma and meda was dssected w/c ead to the pushng
of tunca adventta to buge
Saccuar
S}S:
Pusatng Abd Mass
Low Back Pan
Hgher BP n Upper Extremtes
If RUPTURE occurs - coud ead to SHOCK
LAB DATA : Atered Tssue Perfuson
Rsk for In|ury
PRlORlTY : NO ABDOMINAL PALPATION
bec t may ead to rupture - PLACE WARNING AT THE DOOR OF THE PT.
Prepare pt for Surgery
CARDlO-PULMONARY RESUSClTATlON (CPR)
- ndcated for cardac arrest when pt s BREATHLESS
and PULSELESS;
! shake the pt - are you ok? If breathess & puseess then;
! ACTIVATE the EMS - Hep!
! CPR (1 or 2 rescuer : 15 : 2)
! In 1 mnute, there w be 80 compresson and
15 - 20 rescue breaths
Depth of Compresson : 11/2" - 2"
If too deep - t may fx the ver
Effect of CPR : #1 (+) Puse;
#2 skn coor

TIPS FOR CARDIOVASCULAR - ADULT
A nurse s assgned to a pt wth artera dses of ower extremtes, w/c of the ff s
expected - calf pain after short walking (ntermttent caudcaton);
A pt was dagnosed w/ MI deveop atra fbraton - ths may possby ead to -
CEREBRAL EMBOLlSM;
A pt w/ CHF was admtted exhbtng confuson, dsorentaton, vsua dsorders &
haucnaton - the nurse best acton s to - CALL THE PHYSlClAN;
A nurse s assessng a pt w/ MI - w/c of the ff s the characterstc of PAIN - pain
radiates to the jaw;
In utzng mnd over body prncpe for pt w/ HPN - w/c nterventon s approprate
- relaxation and stress mgt;
Pt exhbts ntermttent caudcaton - another sgn of perphera dses s w/c of the
ff - tropic skin changes;
Ff MI, when sha I resume sexua actvty? - when you can climb 2 plights of
stairs w}o shortness of breath then sexual activity is safe;
A pt has R sded CHF, w/c of the ff s expected - hepatomegally;
Apt w/ CHF who s takng duretcs exhbts the ff, w/c requres further nvestgaton
(not expected to pt) - wt gain of 3 lbs in 2 days;
In addton to assessng a pt w/ Burgers Dses, w/c of the ff data supports the Dx. -
smoking;
A pt wth R sded HF w manfest - distended jugular vein
R E S P I R A T O R Y
GeneraI Consideration:
! use the DIAPHRAGM of the steth when assessng breath sounds;
! use steth drecty on pt. skn - because cothng my nterfere w/ auscutaton;
! when the pt chest s hary, wet the har w/ dump coth - because dry har nterfere
w/ auscutaton
Consideration w/ Pediatric Patient:
! when assessing pediatric pt, RR is affected when therefore check RR FRST;
! Note for chest indrawing (if +, may indicate Pneumonia) and rapid breathing
ReportabIe Signs and Symptoms : common TO ALL RESPRATORY DSORDERS
"RE TACHY TACHY D C
! RETRACTONS - #1 or Early sign for respiratory distress;
! Tachycardia
! Tachypnea
! Dyspnea
! Cyanosis late sign of respiratory Distress
Key Points for Assessment - note for abnormalities in RATE, RHYTHM & DEPTH
Common CHARACTERSTC in Breathing
! BOTS increase in depth followed by apnea; - pt w/ neuro impairement
! Cheyne-Stroke increase in rate and depth of breathing followed by apnea; - nero case
! Kussmauls deep rapid breathing;
! Apneustic forceful inspiration followed by slow expiration dying patient
At birth, the child can maintain temperature by burning brown fat and increase burning bi products
is ncrease fatty acids that will cause acidosis that can worsen the Resp. Distress Syndrome a
group of symptoms (mgt: maintain temperature).
HYPOVENTLATON
Cause: Lack of O2 Effect: ACIDOSIS
HYPERVENTILATION
ALKALOSIS

Cause : ack of CO2 - the pt w decrease rate of breathng to save CO2.
co2 then combne wth H2O to form carbonc acd - f nc, can
ead to acdoss - and the bran w compensate by
hyperventatng - and ncrease emnaton of CO2 w cause
ALKALOSIS.
APNEA OF lNFANCY SlDS} CRlB DEATH
Occurs n Fu Term Baby (37wks onwards) Usuay occurs n Pre-term
s}s : epsodes of APNEA, TACHYCARDIA Rsk Factors:
and Cyanoss
a. Pre-Term;
b. Those w/ epsodes of Apparent Lfe Threatenng Events
c. Sbngs of those who ded w/ SIDS
(usuay 2-3 ss/ bro - ded)
d. Hypoventaton
Dx Procedures:
Cardoneumogram - measures O2
Poysonography
ABG Anayss
Tx :
Admnster Theophyne (N 10-20 mg/m) S/Effects: NAV and Insoma
Caffene
Assst mother threu grevng process
Hx Teaching : Teach parents CPR (esp to Apnea of Infancy)
ASTHMA
MP : Infammaton of bronchoes that eads to excessve mucus producton that resuted to
narrowng and obstructon.
Risk Factors : Envronmenta factors
Emoton
Effort/ Exercse
S}S : WHEEZING sound - due to obstructon
Orthopnea
Whtsh Sputum
Lab Data : Pumonary Funx test
Incentve Sprometer
Nsg Dx : Ineffectve arway Cearance
Pl : AIRWAY
lntervention :
Bronchodators - theophyne
Rest
Oxygen - ow fow (1-2 /mn) - hgher than ths w resut to decrease n the stmuus for breathng -
w/c s CO2
Nebuzaton
Chest Physotherapy - b4 meas or at bed tme
Hgh Fowers
lntermttent Postve Pressure Breathng
Aeroso
Lbera Fud Intake
Meds : Amnophyne
Sterods
Theophyne
Hstamne Antagonst
Mucoytc
Antbotcs
Hx Teachings :
! Approprate rest;
! Actvty - avod those that w expose pt to aergens;
! AVOID PROPANOLOL and ASPIRIN - causes BRONCHOSPASM;
! Exercse - "bowng exercses" - bubbes, trumpet
CYSTlC FlBROSlS
- mut system dses (GI and Respratory System) characterzed by excessve
mucus producton by exocrne gands.
Respiratory Gl
Heredtary Autosoma Recessve
For each pregnancy - TRAIT TRANSMISSION - 50%
Chance for DISEASE TRANSMISSION - 25%
S}S : MECONIUM ILEUS - wthn the 1st 24-36 hrs - f baby fa to defecate - suspect for CF;
ABDL DISTENTION
Maabsorpton Syndrome - STEATORRHEA - fou-smeng stoo w/ Inc Fats & Buky
Saty to Kss - bec skn becomes mpermeabe to Na
Common Complications: because of thck mucus pug
MALE - Asperma - ow sperm count
Sterty
FEMALE - Dffcuty n concevng
Nsg Dx : Knowedge Defct
Atered Emnaton
Atered Sexua Functonng
Lab Data : Sweat Chorde Test - N (f sweat) 10 - 35 mg/d - INCREASE IF (+) CF
(f serum) 90 - 110 mg/d - -do-
Pl : snce two system are affected:
Respratory Therapy - bowng of trumpet, Increase Fud Intake;
GI Therapy - Admnster Pancreatc Enzyme (pancreatn, pancrease, vocase)
GIVEN WITH EACH MEALS
Effectve : f (-) fat at stoo
Hx Teachng : Refer parents to GENETICIST
CROUP DlSORDER
ACUTE LARYNGlTlS LTB RSV} BRONCHlOLlTlS
(Laryngotrachea Bronchts) (Respratory Syncta Vrus)
common n TODDLER INFANTS & TODDLER INFANTS usuay (ess than 6 mos)
VIRAL VIRAL or BACTERIAL VIRAL
Infammaton of LARYNX Infam. of LARYNX & TRACHEA Infam. Of BRONCHIOLES
"barkng-metac cough" "harsh-brassy cough" "paroxysma-hackng cough"
(-) FEVER (+) FEVER-ow grade (+) FEVER-moderate
(+) STRIDOR (+) STRIDOR (+) WHEEZING
STRIDOR - s present when the affected part s LARYNX.
Lab data: P Exam -do- ELIZA
ABGs -do-
Nsg Dx : INEFFECTIVE AIRWAY CLEARANCE
PI : Arway - Endotrachea Tube (Tracheostomy Set - #1) - to factate arway;
Humdty - pace nfant n MIST TENT or CROUPETTE

Nsg care:
! change cothng frequenty coz mst w dampen chd cothngs;
! TOYS whe nsde the tent: PLASTIC TOYS
! "no battery operated & no frcton whee toys"
! at HOME: we can use NIGHT or MOIST ar outsde
and hot shower mst at the comfort room - for chd to nhae
Antbotcs - Antvra - Rbavrn
Hx Teachngs :
SYRUP OF IPECAC - for Croup - t nduces vomtng- bec t w stop the spam thereby preventng
further coughng.
Chronic Obstructive Pulmonary Disease (COPD)
MP : group of dsorders of respratory system that ead to obstructon or
narrowng of arways.

EMPHYSEMA BRONCHlTlS ASTHMA
Over dstenton of Aveo Infammaton of Bronchus
Geatnous sputum + "RE TACHY TACHY D C"
Risk Factors:
(+) Aergy
(+) Envronmenta factors
(+) Poen
(+) Eevated Immunogobun E (IgE)
(+) Smokng (esp to passve smokers)
S}S: RE TACHY TACHY D C + "barre-shape test" - there s an INCREASE n ANTERIOR and POSTERIOR
DIAMETER of the chest
Lab Data : ABGs - to check for respratory acdoss
CXrays
Nsg Dx : #1 Ineffectve Arway Cearance - due to narrowng & obstructon
#2 Ineffectve Breathng Pattern
Pl :
! AIRWAY 1-2 L/mn;
! Meds: Bronchodator - Atrovent
! Exercse: Bowng;
! Rest perods n between actvtes
Durng ACUTE attack, the POSITION OF CHOICE : ORTHOPNEIC
PNEUMOTHORAX
MP : parta or tota coapse of ungs due to:
Types :
Open Pneumothorax - TRAUMA
Spontaneous Pneumothorax - due to rupture of BLEB - over dstenton of aveo
Tenson Pneumothorax - due to INCREASE IN TENSION
S}S : Dmnshed Breath Sounds - (-) b. sounds to area auscutated;
(+) Dyspnea;
(+) Restessness
Nsg Dx : Impared Gas Exchange
Ineffectve Breathng Pattern
Pl : Chest Tube Dranage System - restores the (-) pressure wthn the thoracc cavty
Anteror chest tube - drans the AIR
Posteror chest tube - drans FLUIDS
PNEUMONlA (PNA)
MP : there s INFLAMMATION of ALVEOLAR SPACES that eads to
exudaton and consodaton of the ungs.
LEGIONARES DSES - acute bronchopneumona n edery, acohoc &
Immunosuppressed pt
- management same w/ pna
VlRAL PNA BACTERlAL PNA
Fever : (+) ow-moderate (+) fever moderate-hgh
Cough : (+) Non productve - "thn-watery" (+) Productve - "rusty"
WBC : No change or sght Eevated
Lab Data : Xray and ABGs
Nsg Dx : Impared Gas Exchange - due to exudaton and consodaton of Aveo
PI :
Arway - O2
Poston : Sem-fowers or Orthopnec
Bed Rest
Inc Ora fud ntake
Antbotcs
TCDB (turnng, coughng, & deep breathng)
TB HlSTOPLASMOSlS MYCOBACTERlUM
AVlUM COMPLEX
Bactera Funga (from HISTOPLASMA CAPSULATUM) Bactera
from BIRD MANURE - so & transmtted thru
nhaaton
Dropets & Arborne Dropets & Arborne Dropets & Arborne
Rsk Factors:
ASIAN IMMIGRANT
IMMUNOSUPPRESSION
MALNUTRITION
S}S : same: a to e + FOREST RELATED ACTIVITY same wth TB
Ask cent f came from AVIARY

a. ntay asymptomatc;
b. ow grade fever that occurs n the afternoon;
c. body maase or weakness;
d. coughng w/ bd streaked sputum;
e. weght oss
Lab Data : Hstopasmne Skn Test - for Hstopasmoss
Mantoux Test
Xray - confrmatory test
Sputum - @ east 2 (-) to be effectve
Nsg Dx :
Infecton;
Ineffectve Breathng Pattern
PROPHYLACTIVE TREATMENT OF TB - INH for TWO WKS (take Vt B6 to avod NEUROPATHY)
MEDS : Antiviral Meds Antibiotics
Rfampcn
lNH
Streptomycn
Ethambuto
- take above meds for 6-12 moths to avod resstance
TlPS FOR RESPlRATORY
! you observed a nurse carng for a chd n a CROUPETTE, f you are the nurse n-
charge, what woud be your #1 PRIORITY? - changing the linens & clothings to
keep child always dry;
! whch data n the past medca hstory of the pt. supports a dx of cystc fbross -
MECOMlUM lLEUS in the neonate;
! the prmary goa of care for pt w/ bronchots s to - minimize oxygen
expenditure;
! w/c of the ff nterventon beng carred out by LPN woud requre mmedate
nterventon - suctioning the pt for 20 seconds;
! a cent w/ TB w experence - low grade fever;
! a pt s dagnosed w/ emphysema - w/ of the ff s/s woud the nurse expect to have -
barrel shape chest;
! a nurse carng for a pt w R Lower Lobe PNA shd put the pt n w/c of the ff poston
to enhance postura dranage - L Lateral w} the Head Lower than the Trunk
DAY 7 (Feb 10, 2005)
ENDOCRINE
General Consideration
Expan to the pt the MOST COMMON METHOD of assessment:
a. Drect methods - specmen : bood and urne
b. Expan the methods of gatherng the specmen
Consideration for PEDlATRlC PATlENT
a. Invove the parents of the chd;
b. Incorporate food preferences
2 servngs of popcorn - HOW MANY RICE TO GIVE UP = 1
f sandwch = 1 rce
c. sef nsun admnstraton - aowed to chd 9 yo and above
Reportable S}S :
! skn changes - "have you notced any change n your skn coor"
("bronze skn pgmentaton - addsons dses)
! Inc. temperature
! S/S of Shock
Keypoints : Specmen characterstc s usuay affected by STREE, DIET and
Norma Body Rhythm
PKU
- AUTOSOMAL RECESSIVE PATTERN of transmsson (nherted)
MP :
There s Absence of Phenyaamne Hydroxyase (the one that converts
Phenyaamne to Thyroxne ( a precursor to Meann).
Therefore (-) PH eads to accumuaton of phenyaanne at the bran that eads to
Menta Retardaton.
S}S :
Intay - asymptomatc
For OLDER CHILDREN : Darrhea
Anorexs
Lethargy
Anema
Skn Rashes and sezure
Musty odor of urne (due to pheny pyruvc acd)
Snce (-) meanne: har : bonde
Eyes: bue
Far Skn
Lab Data :
! GUTHRIE CAPILLARY BLD TEST - nta screenng - done after the nfant has ngested CHON
for a mnmum of of 24 hrs.
! Secondary screenng : done when the nfant s about 6wks od - test fresh urne w/
PHENISTIX - WHICH CHANGE COLOR
! Phenyaanne eve greater than 8mg/d - dagnostc of PKU (4mg/d - ndcatve)
Nsg Dx :
Knowedge Defct
Atered Thought Process
Rsk For In|ury
Pl : Detary Modfcaton : LOW CHON and Low Phenyaanne Det unt
adoescent or t 10 yo - bec b4 ths tme the bran mature
MEDS : Lofenaac - 20-30mg/kg/day
Hx Teachings :
! Inform parents of the foods to be avoded; - prepare speca educaton to parents
! Provde st of foods aowed;- prepare speca educaton to parents
! Refer to genetcst
Untreated PKU can resut n faure to thrve, vomtng and eczema - and by about 6 mos,
sgns of bran nvovement appear.
LYMPHOCYTlC THYROlDlTlS or
]UVENlLE HYPOTHYROlDlSM
Cause : Autommune or genetcs
MP : Decrease n T3 and T4
S}S : Dysphaga
Enarge thyrod
A s/s of hypothyrodsm (decrease metabosm)
Nsg Dx : Knowedge Defct
Actvty Intoerance
Pl : no tx because t regresses (ony temporary) spontaneousy
CRETENlSM or CONGENlTAL HYPOTHYROlDlSM
- dsorders reated to absent or non-functonng thyrod;
- newborns are supped wth materna thyrod hormones that ast up to 3 mos;
- ntay asymptomatc
s/s begns 2 - 3 months
behavora s/s physca s/s - arge tongue & protrudes
- apathy - "we behave" from mouth
- retarded growth
- ntoerance to cod
menta retardaton
! Preventon: neonata screenng bood test;
! Wthout treatment, menta retardaton and deveopmenta deay w occur after age 3 mos;
Lab Data : Decrease T3 and T4
Nsg Dx : Knowedge Defct
Rsk for In|ury
Meds : Snge mornng dose of Synthrod for "LIFE" - ora thyroxne and Vt D as
ordered to prevent M. retardaton
(adverse effect of meds : nsomna, tachycarda, and nervousness - REPORT ASAP)
Pl : correct the defcency
Hx Teachings :
! Warm envronment (bec there s Hypotherma w/ coo extremtes);
! Low caore det : snce there s decrease metabosm;
! Speca educaton
ENDOCRlNE GLANDS
- 8 gands (ductess)- they secrete the hormone drecty to bd stream
1. Pnea Gand
2. Ptutary Gand
3. Thyrod Gand
4. Parathyrod Gand
5. Thymus Gand
6. Pancreas
7. Adrenas
8. Gonads (testes & ovares)
Glands UNDER OVER
PITUITARY Dabetes Inspdus SIADH
THYROID Hypothrodsm Hyperthyrodsm
(Myxedema) (Graves, Basedows, Parrys)
PARATHYROID Hypo Hyper
Pancreas DM
ADRENALS Addsons Dses Cushngs
Conns
PANCREAS
Apha Ces BETA CELLS
Isets of Langerhans
Gucagon Insun (responsbe for Decrease n bood sugar)
Responsbe n the ncrease Bood Sugar
Absence Defcency
(DM Type l) (DM Type ll)
IDDM NIDDM

! |uvene Onset - B4 age of 30 Maturty Onset - After age of 30;
! Adoescence to Eary Adut Stage Pt s Obese
! Pt s THIN
! Pt s KETOSIS PRONE NON-KETOSIS PRONE
MODY - DM lll
- combnes features of DM Type I & 2;
- Maturty Onset that occurs n young adut;
- OBESE, b4 age of 30
- Non-Ketoss Prone
GESTATlONAL DlABETES - occurs durng pregnancy
Types Accordng to WHITES Cassfcaton
TYPE ONSET DURATION
A CHEMICAL DIABETES (+) Increase Bd Sugar
B After the age of 20 10 years
C Bet 10 - 19 yrs od 10-19 years
D Before 10 yrs od More than 20 yrs
D1 Before 10 yrs od
D2 >20 yrs
D3 Begnnng Retnopathy
D4 w/ cacfcaton of arteres
D5 DM w/ HPN
E w/ cacfcaton of Pevc Arteres
F w/ nephropathy (Dabetes Nephropathy)
H Dabetes Cardopathy
R Dabetes Retnopathy
T w/ Transpant of the Kdney
DlABETES MELLlTUS
MP : Defcency n INSULIN - ether absence or defcency of nsun that eads
to ateraton n the metabosm of CHO, CHON
and FATS.
Cause: unknown
R. factors : Autommune
Genetc
Stress
S}S : Poydpsa
Poyura
Poyphaga - the stave ces send message to the bran to eat more
Wt oss
Nsg Dx : Knowedge Defct
Atered Nutrton
Pl :
Correct the defcency- HOW?
! Det : we baance det - CHO - 50-70% (man source of energy and sugar for DM pt.)
! lnsun - for Type 1

Hypoglycemia Most Approximately to Occur
RAPID Reguar Insun - BEFORE LUNCH
INTERMEDIATE NPH - LATE IN THE AFTERNOON/ AFTERNOON
SLOW Protamne Znc - DURING NIGHT
Utraente
INSULIN: Best Ste s ABDOMEN bec t s a NEUTRAL AREA
SUBO - 90 degree ange for nsun syrnge
40 degree ange f non-nsun syrnge
Compcaton of INSULIN ADMINISTRATION:
! Lpodystropy
! Dawns Phenomenon - hypergycema that occurs at dawn - Eary AM
- due to over secreton growth hormone
treatment: GIVE INSULIN - NPH at 10 PM to prevent hypergycema at eary AM
! SOMOGYI Phenomenon - rebound hypergycema (tx: admnster nsun)
! Antdabetc Agent;
! Bood Sugar Montorng - n AM and supper tme (2x a day);
! Ensure adequate food ntake;
! Transpant of Pancreatc Ces;
! Exercse - t w decrease nsun requrement (n pregnancy/stress - Increase nsun req)
! Scrupuous foot care - check up w/ podatrst
- foot powder, snugy fttng shoes, cut toe na straght across
- cut toe na across
- avod gong barefoot
- aways dry n between toes
Modification for Pregnant Pt with DM
+300Kca;
Insun Requrement (dose w be ad|usted on 2
nd
& 3
rd
Trmester);
AM Dose: 2:1 for Reguar to NPH
PM Dose: 1:1 for R:NPH
EFFECTS
MOTHER BABY
Macrosomia
Hyperglycemia Hypoglycemia
Therefore pre-term brth RDS
Complication: Uterine Atony Congenital Defects
COMPLlCATlON

1. Hypogycema Hypergycema (bd sugar eve above 120)
(Insun Reacton) (Dabetc Coma)
- BLD SUGAR BELOW 50
DKA HHNK
Risk Factors :
! Mssed meas; Overeatng
! Increase or Overdose of Insun; Decrease Insun
! Too much Actvty Inactvty
Stress
Infecton
S}S :
Dzzness
Drowsness
Dffcuty Probem Sovng
Decrease Leve of Conscousness
+ Cod Cammy Skn, Daphoress
Lab Data : Beow 50 Bood Sugar Leve
Pl : Admnster Smpe Sugar (fructose-frut |uce)
Hard Candy (not chocoate - t s compex sugar)
If unconscous - D50
DKA (Type 1) HHNK (Type 2)
(Hypergycemc Hyperosmoar Nonketotc Coma)
S}S : 3 Ps + Sgns of Dehydraton - thrst & warm skn
Hypergycema More pronounced GI Dsturbances
"Kussmau Breathng + 3Ps
Thrst and warm skn
Lab Data : Increase Bd Sugar
Pl : #1 AIRWAY
#2 Fud
Reguar Insun
Nsg Dx : Rsk for In|ury
2. MlCROANGlOPATHY - destructon of sma bood vesses;
3. ATHEROSCLEROSlS - hardenng of arteres;
4. NEPHROPATHY - kdney damage;
5. OPTHALMOPATHY - w/c eads to cataract (eye exam annuay);
6. Peripheral Neuropathy or Autonomic Neuropathy
- there s poor nerve mpuse transmsson
- common manfestaton : mpotence
DlABETES lNSlPlDUS
(Ptutary Gands - 3 obes)
ANTERlOR POSTERlOR MlDDLE
Secrete Tropc Hormones Store Ony (does not excrete) MSH (skn coor)
! FSH OXYTOCIN
(foce stmuatng Hormone) ADH
! ACTH
(adrenocortcotropc hormone)
! LH (utenzng hormone);
! GH (growth hormone);
! Prolactin
PlTUlTARY GLAND
ADH (ant Duretc Hormone) - retan h20 or fds
Deficiency: ead to D. INSIPIDUS Excess : SIADH
(Syndrome of Inapproprate Ant Duretc Hormone Secreton)
Due to or reated to:
Ptutary Tumor
Head Trauma
In|ures
MP : Defcency n ADH eads to fld excretion, therefore s/s same wth DM EXCEPT : POLYPHAGIA
! Poyura - 21 L/day
! Poydypsa
LAB DATA :
a. urne - decrease n specfc gravty (N 1.010 - 1.025) - n DI ts <1.005;
b. FLUID DEPRIVATION Test - pt on NPO 24hrs B4;
Nsg Dx : FLUID VOLUME DEFICIT
Pl : Admnster IV Fuds
Meds - Synthetc ADH - Vasopressn - IM
Desmopressn - INTRANASALLY- one hoe of nose ony
Lypressn - -do-
How : Gven as pt exhae to the mouth then
nhae thru the nose then EXHALE to the
mouth then gve meds.
Evaluate the effect of meds :
! Check Specfc Gravty of Urne;
! Montor I & O;
! Montor V/S : assess for hypovoemc shock

SlADH
- excess ADH;
MP : Fud Retenton - resut to DILUTIONAL HYPONATREMIA or H2O INTOXICATION
S}S : due to DECREASE NA - ths coud ead to the ff:
! convuson;
! sezure;
! HPN
Above s/s coud ead to decrease LOC
LAB DATA : Decrease Na Leve (<120 mEq/L) - hyponatrema
Nsg Dx : FLUID VOLUME EXCESS
Pl : FLUID RESTRICTION
Drugs - DIURETICS + ANTIHPN - f cause by TUMOR - PREPARE PT FOR SURGERY
IF after surgery - POLYURIA - report ASAP - sgn of DI
PlTUlTARY
GROWTH HORMONE
DEFlClENCY EXCESS
DWARFlSM B4 Cosure of Growth Pate
- "congenta" - "gigantism"
ex. MAHAL - ong, sender extremtes and Inc. n Heght
ex. Maro Aquno

NANU'S SYNDROME (heredtary)
After the Coser of Growth Pate
- "acromegally"
- there s coarsenng of faca features +
enargement of the dgts (nc. shoe sze)
ex. Bangt
Lab Data : INCREASE HUMAN GROWTH HORMONE
Increase Bood Sugar
Nsg Dx : Rsk for In|ury
Pl : Safety
Meds - Parode - decrease secreton of growth hormone
If reated to tumor : surgery
GlGANTlSM
(ong sender extremty)
MARFAN SYNDROME KLINEFELTERS
(heredtary) (chromosoma aberratons)
MP : Cardo & Eye dsorder (compcaton) MP : XXY Pattern (an extra X chromosome)
Scooss X chromosome - FEMALE COMPONENT
of HUMAN BODY
Probem s NON-DEVELOPMENT of SEX ORGAN
ADRENAL}SUPRARENAL
CORTEX (OUTER) MEDULLA (INNER)
RESPONSIBLE FOR SECRETION OF: SECRETES THE FF:
GLUCOCORTICOIDS MINERALOCORTICOIDS EPINEPHRINE NOREPINEPHRINE
(ALDOSTERONE)
GLUCONEOGENESlS STRESS RESPONSE - "fight or flight"
- formaton of sugar from Responsible for Na Retention
new sources and K Excretion
! DEFlClENCY lN GLUCO & MlNERALO : ADDlSON'S Dses
! EXCESS of GLUCO & MlNERALO : CUSHlNG'S Dses} syndrome
! EXCESS of MlNERALOCORTlCOlDS ONLY : CONN'S SYNDROME
ADDlSON'S CUSHlNG CONN'S
MP : Underactivity of the Adrena Gands Overactivity of A. Gands lNC. MINERALOCORTICOIDS
(there s DEC G, M & SEX HORMONES) (there s INCREASE G & M) - w/c cause K EXCRETION &
ADRENOCORTICAL INSUFFICIENCY Na RETENTION
Excessve SECRETION of Excessve ALDOSTERONE
- cotcosterods especay the Secreton from A. Cortex
GLUCOCORTICOID CORTISOL
Common: Mae and Femae Femae (bet. Age 30-60) Femae (30-50)
RF : Coud be reated to Surgery - remova Reated to Tumors Reated to Tumor
Of Adrena Gand and or
Auto Immune Reacton
S}S: Dec Bd Sugar (hypogycema) INC BP, NA ALL S/S OF CUSHINGS
Dec Na (hyponatrema) DEC K + EXCEPT HYPERGLYCEMIA
Dec BP Moonface, Hrsutsm,
INC K (hyperkaema) Buffao Hump, Penduous Abdomen Hypertenson
Labty of Mood (mood swngs) Poyura, Poydpsa
Depresson Cardac Arrythmas - due
COMPENSATORY of MSH - Inc w/c Trunka Obesty / thn Extremtes to dec K
Leads to "Bronze-Lke Skn Pgmentaton" Hypertenson
Decrease Resstance to Infxn
Hypotenson, Weak Puse
Weght oss, Fatgue, Musce weakness
Nausea, Anorexa, Vomtng
Hx of frequent Hypogycemc Rxn

Lab Data : Decrease Cortso Leve Increase Cortso Leve Hypokaema - due
Hyponatrema Hypernatrema metaboc Akaoss
Hypogycema Hypergycema Inc Urnary Adosterone Leve
Hyperkaema Hypokaema Decrease K
Nsg Dx :
Fud Vo. Defct Fd Vo. Excess Rsk for In|ury
Fd & E mbaance Fd & E mbaance Fd & E Imbaance
ADDlSON'S CUSHlNGS CONN'S
Pl :
! Correct the mbaance - IV Correct the mbaance Check BP - gve antHPN
! Det: Inc Na Dec K - mt fd ntake
! Admnster Sterods (Fudocortsone)
DIET : Low n Caores & Na Lmt the fds
Admn. Hormone Repacement Therapy Hgh n CHON, K, Ca
Cortsone - gve 2/3 of dose n AM & Vt D
1/3 n afternoon
! Meds are FOR LIFE Prevent accdent & Fas Det : Low Na, Inc K
! Prevent exposure to Infxn Protect cent exposure to Infxn
! Provde rest perods - prevent fatgue Mnmze stress n envronment Admnster SPIRONOLACTONE
! Montor I & O, wegh Day MIO & wegh Day (adactone) & K suppements
As Rx
! Provde sma, frequent feedng hgh n Montor V/S, observe for HPN &
CHO, Na and CHON to prevent edema
Hypogycema & Hyponatrema
! Use of Tabe sat tabets (f Rx) or ngeston Surgery - prepare pt f cause
Of saty foods (potato chps) by ptutary tumor or hyperpasa
f experencng Inc. sweatng
Post Surgery:
poor wound heang;
report s/s of Addsonan Crss -
severe HYPOTENSION

! Avodance of strenuous exercse esp Meds: FOR LIFE
n HOT WEATHER Gucocortcods Synthess Inhbtors
- Lysodren and Cytodren
- prevents formaton of Guco.
ADDlSONlAN CRlSlS
- severe exacerbaton of Addsons dses caused by acute adrena nsuffecency
causes: strenuous actvty, nfecton, trauma, stress, faure to take RX Meds
s/s: severe generazed musce weakness
severe hypotenson
hypovoema, shock
PI : admnster fds to treat vascuar coapse
IV gucocortcods - Sou-Cortef and Vasopressors
Mantan strct bed rest and emnate a forms of stressfu stmu
MIO and wegh day
Protect cent from Infxn
Other Hx teachngs: same wth Addsons

THYROlD
T3 & T4 Cactonn
- responsbe for mantenance of METABOLlSM - depost Ca @ bones

DEFICIENCY EXCESS
HYPOTHYROlDlSM HYPERTHYROlDlSM
Adut: Myxedema Graves Dsease, Basedows or Parrys Dses
Chdren: Cretensm
Main Problem:
Sowng of metaboc process caused by hypofuncton of the Secreton of excessve amount of Thyrod Thyrod Gand
wth decrease thyrod hormone secreton (T3 & T4) Hormone n the bood causes n the INC
Of metaboc process
DEFICIENCY n T3 and T4 Excess n T3 and T4
Causes:
! congenta genetc
! surgery autommune
! autommune tumor
S}S :
FACIAL EDEMA EXOPTHALMUS
INTOLERANCE to COLD (+) Goter
DECREASE v/s Hypermetaboc State
DECREASE GI Motty - constpaton INTOLERANCE to HEAT
HYPOactvty Inc V/S
Increase Seep - hypersomna INC GI Motty - DIARRHEA
Wt Gan n the presence of Dec Appette Insomna
Dry scay skn, dry sparse har, brtte nas HYPERactvty
WT LOSS even INC Appette
Warm smooth skn, fne soft har
Pabe nas
Irrtabty, restessness, agtaton
LAB DATA :
Check TSH (ncrease) DECREASE TSH
DECREASE T3 & T4 INCREASE T3 & T4
DECREASE RAIU (131) INCREASE RAIU
INCREASE Serum Choestero Leve
RADlOACTlVE lODlNE UPTAKE (RAlU) - admnstraton of 123I or 131I oray;
- performed to determne thyrod functon (ncrease uptake - ndcated
hyperthyrodsm, mnma uptake may ndcate - hypothyrodsm);
nsg consderaton : take a thorough hstory - thyrod meds must be D/C 7-10 days b4 the test - meds contanng odne
cough preparatons, and ntake of odne rch foods and test usng odne - eg IVP can nvadate the test
NSG DX :
Actvty Intoerance - due to Fatgue Rsk for In|ury (bec of hyper)
(fatgue - due to hypometabosm)
Pl :
Promote a EUTHYROID STATE same
HOW : a. THYROID SUPPLEMENT Admn AntThyrod Meds - for LIFE
Synthrod, Cytome - fetme ex. PTU & Lugos
s/e: nsomna, paptaton
nervousness
b. DIET: ow caore Assgn to prvate room away from excessve actvty
c. Mantan vta funx: correct hypotherma - mantan Oute & reaxng Actvty
adequate ventaton
d. Provde comfortabe, warm envronment Provde a COOL ENVIRONMENT
e. Increase fds and hgh fber foods to prevent
constpaton,. Admn stoo softener as Rx DIET : Hgh n CHO, CHON, CALORIES
f. Meds: thyrod hormone repacement - take day Vt & Mneras w/ suppementa
dose n AM to avod nsomna feedngs bet meas & at HS
Montor THYROTOXlCOSlS - tachycarda NO STIMULANTS
Paptatons, nausea, vomtng, darrhea,
Sweatng, tremors, dyspnea Protect eyes w/ dark gasses & artfca
tears
Montor for AGRANULOCYTOSIS (fever,
Sore throat & skn rashes) - f takng
antthyrod meds.
Prepare pt for surgery - 2wks before
SURGERY gve LUGOLS SOLUTION
- t decrease sze and vascuarty of thyrod gand;
- gve w/ straw to avod stanng teeth;
- can be duted w/ H2O or orange/ appe |uce;
- report darrhea & metac state
Meds: a. Antthyrod Drugs - Prophythourac and Tapazoe
- bock synthess of thyrod hormone;
- toxc effect ncude AGRANULOCYTOSIS
b. Radoactve Isotope of Iodne (131) - Radoactve Iodne Thrapy
- gven to destroy the thyrod gand thereby decreasng
Thyrod hormone producton
COMPLlCATlONS OF THYROlD SURGERY:
! MEMORRHAGE - whether the dressng s dry or ntact - ts not a confrmatory that there
s no beedng.
To check, sp your hands at the back of the neck (bec of prncpe of gravty)
! Damage Laryngea Nerve - to assess, ask pt to tak past surgery and f pt has APHONIA - provde
communcaton ads - paper and penc
! LARYNGOSPASM - accdenta remova of parathyrod gand - therefore w ead to dec
parathormones - w/c ead to dec Cacum and aryngospasm - KEEP TRACHEO SET at bedsde.
! TETANY - due to decrease n CA - characterzed by:
a. tngng sensaton - fngers & ps
b. Chvosteks Sgn - faca musce twtchng on percusson of faca nerve
c. Trousseau Sgn - carpopeda spasm
THYROID CRISIS - due to rebound hyperthyrodsm
Increase thyrod hormone
Increase HRate/paptaton
Inc Temp - hypertherma
PARATHYROlD
Parathormone

Deficiency lnc CA in the Blood EXCESS
HYPOPARATHYROIDISM wthdraws Ca @ bone to the bd HYPERPARATHYROIDISM
MP : Dec Ca (hypocacema) maybe heredtary, Increased secreton of PTH that resut
Or caused by accdenta damage to or remova n atered state of Ca, Phospate & bone
Of parathyrod gands durng surgery eg thyrodectomy metabosm
S}S :
Inta S/S: Bone Pan (esp Back Bone)
- Tngng ps & Fngers Kdney Dsorder - kdney stones
- Chvosteks rena coc
- Trousseau NAV, Constpaton
Late S/S
- personaty changes
- cardac arrythmas
- musce pans
Lab Data : Decrease Ca Inc Ca (N 4.5-5.5 mg/d)
Serum Phospate Inc Dec Serum Phospate Leve
Skeeta Xray - revea Inc Bone densty xray -revea Bone Demnerazaton
Nsg Dx : RISK FOR IN|URY same
Pl : a. Safety same
b. Keep Ca suppement at Bedsde Inc Ora Fd ntake - due to rena
c. Det: Inc Ca - spnach, sardnes, seafoods cacu of havng INC Ca
d. Tracheo set - deu to dec Ca - Laryngospasm Det; Low Ca
Surgery - f due to tumor
TlPS FOR ENDOCRlNE
! a chd w/ PKU was admtted, w/c of the ff statements made by the mother
ndcates a need for further nstructon - "my child loves to drink milkshakes"
- chon- w}c has lNCREASE Phenylalanine;
! w/c of the ff f manfested by a chd coud be ndcatve of dabetes - bed
wetting;
! a common manfestaton of HYPOGLYCEMIA - shaky tremors;
! a pt post thyrodectomy deveops tetany, the nurse antcpates that the doctor w
most key order - Ca Gluconate;
! rapd & deep breathng that occurs n dabetc pt s ndcatve of - KETOAClDOSlS
! a pt s to receve NPH Insun at 8AM, when shd the nurse expect to have
hypogycema - in the late afternoon;
! to determne the effect of PTU, the expected outcome s - Dec HR;
! what woud be the queston to support the Dx of Hypothyrodsm - do you tire
easily7;
! w/c of the ff statements made by the dabetc pt woud ndcate the need for
further teachng - "l will be hypoglycemic if l experience emotional stress".
GENlTO-URlNARY
General Consideration
! when performng assessment of Gento-urnary system, use open-ended queston- bec some pt are
not comfortabe takng gentas;
! expan the meanng of termnooges;
! ask the patent what symptoms bother hm/her the most;
Consideration for Pediatric Patient
! assess for hstory of sorethroat;
! badder capacty ncrease wth age
nfants - about 65m
todder - 300-400 m
schoo age - 800 - 1000 m
! nfants are unabe to concentrate urne unt the age of 1 - therefore - adequate mk ntake f baby
has 6-8 dapers /day;
! badder sphncter contro deveop at around 2 yo (therefore, badder trng comes after bowe trng -
15-18 mos of age)
S}S common to all Disorders of GU:
a. frequency
b. urgency
c. hestancy
Reportable s}s :
! per orbta edema
! BP
! Ogura
! Hematura - Eary Stream Hematura - ndcate eson at Urethra
Late Stream - ndcate eson at badder
Key points :
a. check for wt gan

f >1b/day - ndcatve of fd retenton
b. characterstc of urne: coor N - amber
f pnksh - bdg
brownsh - fagy
orange - rfampcn
c. s. gravty (N 1.010 - 1.025) - f INCREASE - D. Inspdus
DECREASE - D. Metus
d. Increase gucose - UTI
e. Eevated CHON - Nephrotc Syndrome or PIH
Epspadas - openng at DORSAL porton
Hypospadas - openng at VENTRAL porton
WlLM'S TUMOR
- congenta tumor at the kdney
- common n L Kdney and
chdren beow 5 yo
S}S : Unatera Abdm Mass
Hematura
HPN
Lab Data :
CT Scan
IVP
NO INAVSIVE LAB/ Procedure
NO BIOPSY
Nsg Dx : Knowedge Defct
Rsk for In|ury
Pl : AVOID/ NO ABDOMINAL PALPATION
Prepare pt for Surgery and Chemotherapy
NEPHROTlC SYNDROME AGN
MP : Atered Kdney Funx reated to nabty to retan CHON Destructon of Kdney Tssues reated
(therefore there s PROTEINURAI) to Group A Beta Hemoytc Streptococus
causes: Autommune sorethroat
congenta
S}S
EDEMA: Per-orbta Edema but subsde Perorbta but progresses to generazed
at the end of the day at the end of the day
BP : Decrease or N INCREASE BP
URINE : Frothy Tea coored or Coa coored or Smoky
LAB DATA
(+) Protenura, severe - >10mg n 24 hrs (+) Protenura - <10 mg/ 24hrs urne
Nsg Dx : Fd Voume Excess
Impared Skn Integrty
Pl :
Check BP
Mantan Fd Baance
Meds : NO Anthypertensve Anthypertensve
(+) Sterods Duretcs
(+) Antbotcs
DlET :
INCREASE CHON, Low Na LOW CHON and Na
POSlTlONlNG :
Turn Patent frequenty - because pt w/ edema are prone to skn ntegrty ke pressure sore formaton
CYSTlTlS
- Infecton of the badder
- Ascendng nfecton caused by E. Co (from feces) or Pseudomonas
RF :
Wearng sk underwear (does not absorb most); - use COTTON
Bubbe bath
Proong drvng
Common n FEMALE - due to sze (short) urethra
S/S:
FREOUENCY, URGENCY & HESISTANCY + Burnng sensaton on urnaton (dysura)
LAB DATA : Urnayss - to check for mcroorgansm
Nsg Dx : Atered Emnaton Pattern
Infecton
PI : Treat for Infecton - antbotcs for 10-15 days
Badder Anagesc (ex. PYRIDIUM - ch can cause ORANGE COLORED URINE, effectve : (-) pan)
Det : ACID-ASH DIET - gve emon |uce or VIT C
Hx Teachngs: Avod bubbe Bath
No Sk underwear
Inc. Fd Intake
RENAL FAlLURE
ACUTE CHRONlC
MP Sudden or Acute, Usuay Reversbe oss of IRREVERSIBLE kdney damage that
Kdney Funx eads to scar formaton
There s nabty of kdney to mantan fd & E baance
Causes PHASES :
! Pre-rena Factors - those that dec bd crcuatng vo. - SHOCK;Phase l: RENAL lNSUFFlClENCY
! Intra-Rena - dses condton of the kdney eg. AGN
! Post-Rena - those that causes obstructon eg. Kdney stones Poyura
Noctura
Poydpsa
Phases of ARF
PHASE ll : MlLD RENAL DAMAGE
OLlGURlC PHASE
- decrease urne output that s ess than 400 m/24hr (OLIGURIA) There w be INC BUN & Crea
- Dec NA & Inc K
RENAL FAlLURE
DlURETlC PHASE
- Inc urne output (4-5L/day) A s/s + Anema & HPN
- Dec Na & K
ESRD
RECOVERY PHASE
- rena funx normazes (1-2 yrs) Azotema & Urema -
accumuaton
of waste products
"uremc frost" - skn prurtus
LAB DATA
Increase BUN and same
Crea - most senstve Index
Nsg Dx
Fd and E Imbaance Fd & E Imbaance
Actvty Intoerance
Pl : TO CORRECT THE IMBALANCE
A. Fud restrcton; Fd restrcton
B. Meds : Duretcs Amphoge - to promote excreton of
Cardac Gycosdes - Dgtas Phospate
Anthypertensve Epogen - Inc RBC synthess
Duretcs
AntHPN
C. DIET : Low CHON - NO PMS Det: same
DlALYSlS
PERlTONEAL HEMODlALYSlS
Sem-permeabe membrane: Abdomen (pertoneum) Dayzng machne
Use of Tenchkoff Catheter Use of fstua or shunt
Teachngs: anastomoss of artery & ven (nterna access) - ess prone to nfxn
! Report Infxn (abdomen: rgd, Souton : coudy)
! Check BT and CT externa access
! Check Temp of dayzng souton (more prone to nfxn)
Compcatons of dayss (report ASAP):
1. DISEOUILIBRIUM SYNDROME - due to rapd remova of soutes (eectroytes and CHON)
s/s:
GI - nausea, vomtng, headache
CNS - convuson, sezures
2. DIALYSIS ENCEPHALOPATHY - due to aumnum toxcty
s/s:
(+) dementa
musce abnormates - twtchng
sezures
RENAL TRANSPLANT - s/s of compcaton : FLANK PAIN, FEVER, TENDERNESS, HPN - REPORT
BPH
- ganduar enargement of the prostrate
- common n maes above 40 yrs od
S/S :
Decrease sze and force of urnary stream
Noctura
Frequency, hestancy and urgency
LAB DATA:
Dgta recta exam - once a yr for pt 40yo and above
goves, ky |ey
poston: Sms
Nsg Dx : Atered Emnaton Pattern
PI : Prepare pt for surgery
! TURP - no ncson
! Suprapubc Prostatectomy
! Retropubc -do-
! Pernea -do- - common compcaton: IMPOTENCE due to
nerve damage
"I am eager to have sex agan" - cannot be bec pt s mpotence
nsgcare : CBR for 2-3 days post surgery;
NO LONG DRIVE/ SITTING;
Ff up check up (f INC ACID PHOSPATASE: Prostate CA)
TlPS FOR GENlTOR-URlNARY
! A common sgn of ARF - OLlGURlA;
! After pertonea dayss, w/c of the ff s approprate acton - turn pt to side;
! To prevent cystts, w/c of the ff the nurse must nstruct to the pt to do - take a
bath using the shower rather than bubble bath;
! For eary detecton of prostrate CA the nurse shd emphaszed - digital rectal
exam annually to screen for prostrate CA in men 40 yo and above;
! In a pt wth BPH, the nurse shd expect that the pt w probaby have the
symptoms - residual urine of more than 50 ml;
! A mae pt has an arterovenous fstua n hs L forearm, w/c behavor woud ndcate
that the pt needs further nstructon n sef care - he wears a watch on his L
wrist;
! w}c of the ff indicates complication of peritoneal dialysis - coudy daysate
DAY 8 (Feb 11, 2005)
EENT
General Consideration
! Expan to the patent there there w be no or tte dscomfort when performng EENT exam;
! Expan the methods of assessment to the patent;
Consideration to Pediatric Patients
! Obtan feedng hstory (bec the type & technques dffers)
! Obtan the det hx of the pt and hx to URTI
! Invove the parents n the assessment of the baby
Reportable Signs and Symptoms
! TINNITUS - rngng, buzzng or sea she sound n the ear
! VERTIGO - Ob|ectve - "the room s spnnng"
Sub|ectve - "I fee that I am revovng/rotatng"
! Hearng Loss
! Pan - f pan subsde or (-) - rupture of ear drum
Keypoints for Assessment
! Note for abnorma fndngs
! Document the sub|ectve and ob|ectve compants
OTlTlS MEDlA
- nfecton of the mdde ear
RF :
Fauty feedng practces
Swmmng n drty waters
Upper Resp. Tract Infecton
S/S :
PAIN - Pung
Tuggng
Cryng when yng on the affected ear
Absence of pan ndcates rupture of Tympanc Membrane - ear drum
Lab Data :
OTOSCOPY - reveaed - reddened, bugng tympanc membrane
Nsg Dx : Infecton
Sensory - Percepton Ateraton
PI : Treat Infecton (antbotcs - 7-10 days) - f does not hea - possbe MYRINGOTOMY
Hx Teachng : RIGHT POSITION whe feedng
RETlNOBLASTOMA
- congenta tumor of the retna;
- genetcay transmtted;
- autosoma domnant (common n MALE and FEMALE)
S/S :
LEUKOCORIA - "cats eye refex"
- whtsh or graysh dscooraton of the pup
Dpopa and or Strabsmus
LAB DATA : PE
Opthamoscopy
Nsg Dx : Knowedge Defct
Tx : Surgery - Inocuaton - done b4 age of 3 (chemotherapy - after surgery)
Gentcst
RETlNAL DETACHMENT GLAUCOMA CATARACT
RF:
Agng (above 40) Agng (above 40) Agng (above 70)
Reated to trauma Common n Backs Reated to Trauma
Fama Predsposton Re. to Dabetes
Re. to Sterods
Re. to Chromosoma Abberaton
- those wth D. Syndrome are prone
RETlNAL DETACHMENT
MP : There s separaton of sensory and pgment porton of the retna - therefore t w aow fuds to go n
between whch gve rse to OUSTANDING manfestaton as:

VISUAL FLOATERS - pt says: "I see ght structures
Curtan ke
Foatng spots
Cobwebs"
S}S : NO Pan
Burrng of vson - because of foaters
Lab Data : Opthamoscopy
Nsg Dx : Rsk for In|ury
Pl : Immedate Bed rest - AFFECTED SIDE TOWARDS THE BED - to aow the connecton of
DETACHED PART
NO SUDDEN HEAD MOVEMENT
AVOID readng (TV - ALLOWED)
Prepare Pt for Surgery: SCLERAL BUCKLING - use of aser to reduce nfammaton and
when nfammaton subsde, the
detached retna porton w be attached
thru scar formaton.
POST SURGERY :
! AVOID actvty that requres BENDING, LIFTING, COUGHING;
(No Bowng & shampoong of har at snk)
! REPORT SUDDEN eye pan - ndcatve of beedng/ hemorrhage
GLAUCOMA
MP : INCRASE IOP due to obstructon n the outfow of acqeous humor or coud be reated to
forward dspacement of the rs.
TREATABLE but NOT CURABLE
If Obstructon reated : coud ead to CHRONIC OPEN ANGLE.
If due to Forward dspacement: can ead to ACUTE CLOSE ANGLE
S}S :
TUNNEL or Gun Barre Vson - wheren there s oss of Perphera Vson
Haos around ghts - rounded rngs around eyes
CLOSED ANGLE GLAUCOMA - (+) pan
OPEN ANGLE GLAUCOMA - mnma or (-) pan
LAB DATA:
! Tonometry - measures IOP (N12-21) - PAINLESS
ACUTE G - as hgh as 25;
Chronc G - as hgh as 50
! Gonoscopy
! Opthamoscopy
! Permetry - measures vsua fed
Nsg Dx : Rsk for In|ury
Pl : TO DECREASE IOP
How:
a. Admnster MIOTICS (Pocarpne, Tomoo, Damox) - for LIFE
- t decrease the producton of ACOEOUS HUMOR - admn. At ower con|unctva sac
b. Prepare pt for Surgery : TRABECULOPLASTY - a new pathway was created for the passage of
the bocked fuds;
- Out-patent ony (use of aser ony)
TRABECULECTOMY - requres hospta admsson for 1-2 days
Hx Teachings : same w/ retna detachment
CATARACT
MP : Opacty of the Crystane Lense
S}S : Burred Vson (Poor Coor Percepton)
NO PAIN
LAB DATA:
a. SLIT LAMP TEST - test for red ght refex
(ths refex s absent n cataract pt due to presence of mky whte ens)
b. Opthamoscopy
Nsg Dx : Rsk for In|ury
Pl : Prepare for SURGERY
! CATARACT EXTRACTION - Extra Capsuar Cataract Extracton (ECCE)
Intra Capsuar Cataract Extracton (ICCE)
ECCE - remova of anteror part
ICCE - remova of entre capsue
! PHACOEMULSIFICATION - neede s nserted to ens and send vbraton thereby crushng
the cataract then sucton t out
! PERIPHERAL IRIDECTOMY - a whoe s created then suctonng
Post Cataract Surgery - NO SEX for 4-6 weeks
Heath teachngs - same w/ R. Detachment
MENlERE'S DSES OTOSCLEROSlS
(hardenng of the ears)
RF : Hgh attudes Agng
Agng
Ototoxc Drugs
MP : Cause by an mbaance of Endo- Overgrowth of the stapes
Lymphatc Fuds n the nner ear
Sensor-neura hearng oss - snce Conductve Hearng Loss
Inner ear was affected - snce mdde ear was affected
S}S : Tnntus same
Hearng Loss + same
VERTIGO (ony for M. DSES)
Lab Data: Caorc Stmuant test
Webers test - aterazaton of sound
Rnnes - bone conducton
Audometry
(above test - use of TUNING FORK)
Nsg Dx : Rsk for In|ury Sensory Perceptuaateraton
Pl : SAFETY Estabsh Communcaton
(to prevent pt from fang:
bedrest or supne - danger of fas) Surgery : STAPEDECTOMY - mobzaton of
stape
DlET : LOW NA (AVOID - Acoho & Caffene contanng food)
Meds : AntVertgo - Damox, Bonamne Post Surgery Hx Teachngs:
Effective : (-) Vertgo/ Fas AVOID - dvng
Sma arpane
Coughng
AVOID - drvng Bowng of Nose
PMS Bendng
Sudden Head Movement
TlPS FOR EENT
! A pt who underwent cataract surgery w/ ntraocuar mpantaton s schedued for
dscharge, the nurse shd nstruct the pt to do w/c of the ff when pan occurs -
notify the AP;
! w/c Nsg Dx s consdered a prorty for a pt wth Meneres Dses - Risk for lnjury
! a Tonometer s used for the purpose - to determine lOP;
! Post Cataract Extracton : how shd the nurse poston the pt - UNAFFECTED SlDE
to minimize edema;
! w/c of the ff s a common manfestaton of Retnobastoma - Cat's Eye Reflex;
! The parents of the pt w/ retnobastoma must be referred to - GENETlClST
GASTROlNTESTlNAL
GENERAL CONSlDERATlON
! Provde prvacy
! Ask the pt when he 1
st
notce the S/S
Eg. LIVER CIRRHOSIS - when dd you notce that your eyes turns yeow?
PEDlATRlC CONSlDERATlON
! Introducton of FOOD: (shd be n order)
Cereas
Fruts
Vegetabes
Meat
Tabe foods
Obtan chd Detary Hstory
Assess for over-ntake of mk - poor source of ron (IDA)
REPORTABLE S}S
Vomtng
Abd Pan (f more than 6hrs) - R/O rupture of the bowe
Tarry Stoo - ndcates bdg (upper GI)
Fever, Tachycarda, Dehydraton - ndcatve of SHOCK
Hypotenton
KEPOlNTS.
Bowe Sounds (check a 4 quadrants- N 5-35 bowe sounds/mn)
- to assess, use DIAPHRAGM of Steth - to sten for norma sounds
- BELL part of Steth - to sten for abnorma bowe sound
Ex. "brut" - abnorma vascuar sound w/c ndcate abdm aortc aneurysm
DlARRHEA} AGE
- usuay asso w/ NORWALK (common n shp), ROTAVIRUS and CLOSTRIDIUM DEFFICELE
MP : Passage of watery and oose stoos (BEST |udge n the consstency)
S}S :
Frequent stoos
Sgn of DHN - sunken fontannes
Poor Skn Turgor
Absence of Tears (for more than 2 MONTHS od nfant)
Check for compcaton : Metaboc Acdoss
If excess fud oss, t w progress to shock - due to K oss (hypokaema)
LAB DATA :
Stoo Exam - to check for bactera
Nsg Dx :
Darrhea
Fud Voume Defct
Pl : Pace pt on ENTERIC ISOLATION PRECAUTION (handwashng & goves ONLY)
- whe watng for ab resut
CHALASlA GERD
CONGENITAL WEAKNESS OF THE CARDIAC SPHINCTER
S}S: vomtng - NON-BILE-STAINED Hear-burn due to Refux of Acd
Complication :
" METABOLIC Acdoss same
" BARRETTS ESOPHAGUS same
- damage to mucosa nng of ower esophagea mucosa w/c can ead to esophagea CA
LAB DATA :
Upper GI Seres (Ba Swaow) do
Gastroscopy do
Esophagoscopy do
Nsg Dx : Atered Nutrton Less Than Body Requrement
Fds & E Imbaance
Pl : Insure Adequate Nutrton
! Poston: Pace pt n UPRIGHT - to avod vomtng
(f BABY: use HARNESS or PRONE w/ HEAD UP POSITION)
! Admnster fds
! Antbotcs/ Antdarrheas ( dosage: f ess than 10 kg, therefore X100)
! Heath teachngs - crackers, |uce, water
! Feedng : Thckened
! Prepare pt for surgery : NISSINFUNDOPLICATION - part of fundus w be sutured to
esophagea area to tghten
! Effectve: f (-) vomtng and(-) refux and heartburn
POlSONlNG
lNTERVENTlON:
a. CALL poson contro center;
b. MINIMIZE EXPOSURE - remove pt from the scene
c. IDENTIFY the type of poson
"f unknown substance was taken" - brng botte or fo for proper dentfcaton
TYPES:
! CORROSIVE - "DO NOT lNDUCE VOMlTlNG"
Management: NEUTRALIZE the poson
If STRONG ACID - gve WEAK BASE (eg. ACID - gve MILK)
IF STRONG BASE - use weak ACID by usng vnegar
! NON-CORROSIVE - nduce vomtng by stmuatng GAG REFLEX
How:
a. Use fngers or tongue bade
b. Syrup of Ipecac - admnster w/ gass of H2O - make sure that a taken w be
vomted - bec t s cardotoxc (after 1hr - can repeat)
dosage: CHILDREN - 15 ML
ADULT - 30 ML
CLEFT
LlP PALATE
MP: Non-fuson of faca process Non-fuson of Paatve Processess (soft & hard)
(congenta) (congenta)
Nsg Dx : Atered Nutrton
Rsk for Aspraton
Body Image Dsturbance
Pl : Nutrton
Safety
Prepare for Surgery
Surgery :
Chiloplasty Palate Uranoplasty
- for 10wks od - f chd s 15-18 mos
10 bs
10gms/hgb
10,000 WBC
Post Surgery:
! CRYING shd be mnmze - bec t w put pressure at suture ne;
! LOGAN BAR/ BOW - t decrease tenson at suture ne;
! ELBOW RESTRAINT - prevent chd from touchng the suture ne;
! FEEDING DEVICE - C CLIP - use dropper, C PALATE - use Breck Feeder/ cup
! Refer pt to: SPEECH THERAPIST, AUDIOLOGIST & PSYCHOLOGIST

PYLORlC STENOSlS
- congenta
- hypertrophy ("kumapa") of the pyorc sphncter (bet stomach & ntestne)
S}S :
PRO|ECTILE VOMITING (INITIALLY, NON-BILE STAINED but eventuay t PROGRESSESS TO be-staned)
If sttng : 4-5 ft
If yng down : 1 foot
Feedng shoud be thckened then AFTER FEEDING, pace to RIGHT SIDE LYING SEATED
at car seat - to factate the entry of food from stomach to duodenum
OLIVE-SHAPE MASS
VISCIBLE PERISTALTIC MOVEMENT - usuay from L to R of the abdomen - w/c can ead to DHN
LAB DATA :
Ba Swaow - (+) "strng sgn"
NSg Dx : Atered Nutrton
Fud Vo Defct
Fd and E mbaance
Pl : Nutrton
Surgery - FREDET-RAMSTEDT or PYLOROMYOTOMY - ncson at pyorc sphncter
CELlAC DlSEASE
- GLUTEN -INDUCED ENETEROPATHY
- Genetc predsposton
- Lfe-tme dsorder
MP : Intoerance to GLUTEN
OUTSTANDlNG S}S : Maabsorpton Syndrome-crss
Abd Enargement - ths can be trggered by lNFECTlON & Fld and E imbalance
Anorexa
Anema
- there w be SEVERE DHN
LAB DATA : Dagnostc Test : GLUTEN CHALLENGE - 3-4 mos - gve guten rch food
And f there s maabsorpton, therefore (+) CDses
Nsg Dx : Atered Nutrton
Pl : Detary Modfcaton : AVOID GLTUEN RICH FOOD : Barey, rce, oats, wheat
ALLOWED : Rce, cereas, corn, soy beans
Commercay prepared cakes are made of wheat - AVOID
Ok or aowed: f pt say "I w prepare a homemade cake"
AVOID : spaghett, macaron, sausage, uncheon meat, hotdog
HlRSCHPRUNG'S DlSEASE (AGANGLlONlC MEGACOLON)
MP : Absence of parasympathetc nerve fbers n a porton of a coon daton, abdomna
dstenton and peet-ke or rbbon-ke stoo.
Patient - meconium ileus & constipation - HALLMARK SlGN
LAB DATA : BA Enema
Nsg Dx : Atered Emnaton
Diet : Hgh Fber
Increase fuds
Tx : Gve Enema
Meds : Laxatve
Surgery - SOAVE Surgery - resecton wth end to end pu through
lNTUSSUCEPTlON
MP : There s teescopng of a part of a coon whch eads to nfammaton and edema
S}S : "sausage-shape mass"
Abdomna dstenton
"Dance sgn" - the R ower porton of the coon becomes empty
Vomtng : BILE-STAINED
Constpaton
LAB DATA : Ba Enema: f for DIAGNOSTIC : t outnes the area nvove
f for THERAPEUTIC : t reduces ntussucepton by means of hydrostatc pressure
Nsg Dx : Constpaton
Atered Emnaton
Diet : Inc. Fds.
Hgh Fber
Tx : wonder drugs - sterod
surgery
TRACHEOESOPHAGEAL FlSTULA (TEF)
MP : Faure of the esophagus to deveop as a contnous process
Types :
! AF1 - esophagus NOT connected w/ abdomen/stomach
! AF2 - esophagus attached to trachea (when pt eat, t goes to the ungs)
! AF3 - stomach connects w/ trachea
! AF4 - stomach & esophagus connected
! AF5 - stomach, eso and trachea are connected
! AF6 - separated propery
Atresa - "narrowng"
Fstua - connecton
S}S : Excessve Droong - danger n aspraton
(avod gucose water as nta feedng - use stere H2O nstead.)
Coughng, Chockng
Cyanoss
LAB DATA : Latera Neck Xray - to check the esophagus
Nsg Dx : Rsk for Aspraton
PI : Safety
Arway
Keep chd NPO - |ust gve pacfer (f feedng OK - use stere H2o nstead NOT GLUCOSE)
Tx : Surgery
TlPS FOR GASTRO - PEDlA
! w/c of the ff sgns f manfested by a chd post tonsectomy needs to be reported
- FREUENT SWALLOWlNG;
! a chd who has had severa epsodes of darrhea s key to deveop - metabolic
acidosis;
! n reaton to dx of p. stenoss, w/c of the ff actons of the nurse s mportant -
weighing pt daily for wt loss;
! w/c of the ff w the nurse expect to observe n a chd who oss fud due to
darrhea - flushed dry skin;
! the most approprate feedng devce for a chd post ceft paate - paper cup;
! the prorty nsg care for a chd on NPO s - offer a pacifier regularly;
! a common manfestaton of pyorc stenoss s - visible peristaltic wave;
! the prorty nsg dx for a pt w/ rotavrus nfecton s - diarrhea;
! w/c of the ff s expected n a chd sufferng from ceac dses - intolerance to
gluten
PEPTlC ULCER
RF : Stress
Smokng
Sacyates or NSAIDS
Hecobacter Pyor
Zonger-Eson Syndrome (gastnoma) - tumor of the stomach - due to ncrease HCL acd
GASTRlC ESOPHAGEAL DUODENAL
RF : same same
MP : Weakened Mucosa Excessve HCL Acd
Common n Femae Common n Mae
Beow 65 65 yo & above
Inc rsk for CA
OUSTANDING S/S: PAIN - achng, burnng, gnawng
PAIN - 30mns - 1hr post mea 2-3hrs after mea
PAIN at daytme Nghtme
Pan reeved by vomtng Pan reeved by eatng
Aso reated as hyperacdty
HEMATEMESIS (vomtng of bood)
- severe beedng - "shock"
LAB DATA :
GASTRIC Anayss (damox bue - urne)
Gastroscopy
BA Swaow
HgB
Hct
Nsg Dx : PAIN
Pl : Reef of Pan
Meds : ANTACIDS: Maaox - t NEUTRALIZE HCL Acd;
RANITIDINE - t DECREASE HCL Acd;
SUCRALFATE - t COATS the GIT
NO ASPIRIN
Diet : BLAND DIET - NO SPICY, fred, raw fruts and vegetabes
(EXCEPT: avocado, banana & pneappe)
GASTRlC SURGERY
! VAGOTOMY
! PARTIAL GATRECTOMY - Broth I (BI) and Broth II (BII)
! TOATAL GASTRECTOMY
BI - gastrodoudenostmy - duodenum and stomach
BII - gastro|e|unostomy - stomach and |e|unum
COMPLlCATlONS:
" PERNlClOUS ANEMlA - due to decrease lNTRlNSlC FACTOR w}c came from stomach;
" DUMPlNG SYNDROME (occur usually for 10-12 mos post surgery)
- due to rapd emptyng of the stomach and stmuaton of gastro-coc refex
GASTRO-COLlC REFLEX - s usuay due to ncrease CHO INTAKE n the det
- NO PANCAKE, NO UPRIGHT SITTING AFTER MEALS
S}S OF Dumping Syndrome : Darrhea
Daphoress
Dzzness/drowsness
Management: NO FLUIDS after meas - nstead n between meas
DIET: Hgh Fats - because t deays the emptyng of the stomach
LOW CHO
Le down - after eatng
lNFLAMMATORY BOWEL CONDlTlON
ULCERATlVE COLlTlS DlVERTlCULlTlS CROHN'S DSES
(Regona Enterts)
RF : Wth fama Predsposton Common n those LOW FIBER Det Reated to Genetcs
Smokng as Protectve Effect Common n Agng
Common n Obsessve-Compusve
Or Stress Reated or to "perfectonst"
MP :
lnflammation @ large lntestine lnflam @ L lntes. - lnflam of small &
Specifically @ recto-sigmoid colon at DlVERTlCULUM large intestine
S}S : same same
DIARRHEA (15-20x/day) darrhea & constpaton 3-4x/day
boody mucod
FEVER (+) (+) (+)
CRAMPY ABDL PAIN LLO LLO RLO
(Rgdty (REPORT ASAP) -sgn of coon rupture)
LAB DATA: BA ENEMA
Colonoscopy
Stool Exam
Nsg Dx : PAlN
Altere Elimination: Diarrhea
Pl : Relieve Pain
Meds: Steroids
Anticholinergic
Antidiarrheals
Antispasmodic
DlET : Low Fiber and Low Residue - for Ulcerative and Chron's
Diverticulosis - High Fiber}residue - allowed: vegetables
Low residue - (no vegetables)
SURGERY : Colostomy - irrigate
lleostomy - no need for irrigation
Characteristic of N Colostomy - REDDISH or PINKISH
EDEMATOUS
MOIST
N eevaton from skn: 2.5 cm
Dameter : 5cm
When to empty coostomy: when 1/3 - fu (EMPTY DO NOT CHANGE)
When to change C. Bag : 48hrs or 3x a wk
BEST TIME TO DO COLOSTOMY CARE - at home, whe n the bathroom
STOP coostomy rrgaton f patent (+) ABDOMINAL CRAMPS
HEMORRHOlDS
MP Varicosities of the ANAL SPlNCHTER
RF
PREGNANCY
PROLONGED STANDING
PORTAL HPN - hepatc enceph and ver crrhoss
GRADE
I Sma Area
II Large Area - reduces spontaneousy
III Entre Area - manua reducton
IV Entre Area - rreducbe
TYPES
lNTERNAL H - above the spinchter
EXTERNAL H - below the spinchter
S}S Pruritus
Pain
Bleeding
LAB DATA Sigmoidoscopy
Proctoscopy
P Exam
Nsg Dx Altered Elimination
Pl Diet : High Fiber
Avoid Spicy
PAlN - use SlTZ BATH (48 degree C - temp of H2o)
- emerge up to pelvic area with ice pack at head to prevent dizziness
STOOL SOFTENER
SURGERY
PANCREATlTlS
- AUTODESTRUCTION OR AUTODIGESTION of the pancreas
RF #1 Acohosm
#2 autommune
Hgh Fat Det
Bary Dses
SS PAIN @ per-umbca area or epgastrc that radates to per-umbca area
GREY TURNER SIGN - pan w/ bush dscooraton at fank area;
CULLENS SIGN - pan w/ bush dscooraton @ umbcus
NAUSEA & VOMITING
SHOCK - as compcaton
LAB DATA Eevated Serum Amyase (N56-190 u/L that normaze n 2 wks)
Nsg Dx PAIN
PI Reeve PAIN
Meds: DEMEROL - DRUG OF CHOICE
AVOlD MORPHlNE - t causes more pan bec t w causes spasm to the spnchter of odd
DlET LOW FAT
AVOID acoho
CHOLELlTHlASlS CHOLECYSTlTlS
Combine or usually come together in a pt
Stone n ga badder Infammaton of the G. badder
RF Fat same
Femae
Ferte
Forty
fatuence
S}S R UO Pan radatng to R shouder or R Scapua - usuay precptated by FATTY INTAKE
GI S/S - NAV darrhea and |aundce
URINE: dark coored
STOOL : "cay-coored" or graysh - acohoc stoo
LAB DATA lncrease AMYLASE, WBC, FATS
lncrease Liver Fnx test
USG
Nsg Dx PAlN
Pl Relief of Pain
meds : DEMEROL
diet: LOW FAT
surgery : 1) LAP. CHOLE - 4 small incision, CO2 insufflation
2-3 days after - discharge pt and back to ADL
1 WK after - pt can lift weight
2) CHOLECYSTECTOMY - R SUBCOASTAL
- complication: "Pneumonia"
- report rusty-colored sputum
hx teaching: TURNING, COUGHING, DEEP BREATHING
HEPATlTlS
MP Infammaton of the Lver
TYPES
A B C D E
Infectous SERUM POST TRANSFUSION DELTA HEPA ENTERICALLY-TRANSMITTED
Feca-ora bd, body fds Non A & B Post Hepa B Feca-ora
(Hepa A & B Combnaton
2-6 wks 6wks-6mos 70-80 days 6wks-6mos
STAGES OF HEPA B
! PRE-ICTERIC - 1-2 days : S/S NAVDA - NO |aundce yet;
! ICTERIC - 2-4 wks w/ |aundce;
! POST ICTERIC - 2-4 mos s/s subsde
Lab data Increase Lver Funx Test (Inc AST/ ALT)
Hepa A - Inc HaV
Hepa B - HbsAg
Nsg Dx Infecton
At Skn Integrty
Body Image Dsturbance
Pl Tx for Infecton
a. Meds : HEPATOPROTECTORS
DIURETICS
b. Det : Hgh Caore
Low Fat
Isoaton : A & E - Enterc
B, C, D - Unversa
COMPLlCATlON Lver Crrhoss
LlVER ClRRHOSlS
- scarrng of ver tssues
TYPES
LAENNES BILIARY CARDIAC POST NECROTIC
Due to acohosm Due to bary Dsorder due to CHF due to Hepatts
S}S - are related to 3 FUNXs of the LlVER
! MANUFACTURES : be, mmunogubon, & cottng factors
! METABOLlZES: CHO, Fats, CHON, Acoho and Drugs
! STORES : Vtamns & Mneras
Signs and symptoms
a. pt prone to beedng;
b. manutrton - no cho metaboze
c. edema - due to fd retenton (bec of dec abumn)
d. Fds & e mbaance
LAB DATA Increase Lver Funx Test
Lver Bopsy
Nsg Dx Risk for lnjury
Fld & E imbalance
Fld Vol Excess
Altered Nutrition
PI SAFETY
HOW7
! Meds: Diuretics - due to fld retention
ANTlHPN - due to portal HPN
Clotting factors : Coagulants - give Vit K (to avoid bleeding)
! Diet : LOW CHON or CHON to Tolerance
Or High Biologic Value CHON - good quality CHON (eg poutry products)
! SURGERY : Liver Transplant
COMPLlCATlONS:
a. HEPATIC EBCEPHALOPATHY - accumuaton of ammona - toxc to bran
s/s: PERSONALITY CHANGES
DECREASE LOC or rrtabty/ restessness
DRUG OF CHOICE : Neomycn, Lactuose
- factate excreton of ammona by acdfyng the coon
- common s/e : DIARRHEA

b. ASCITIS - accumuaton of fuds at the abdomen

s/s : wt gan
Increase abd grth - "I cannot button my pants anymore"
(fuds)
management: abdomna paracentess - aspraton of fuds from the pertoneum
- compcaton: chance for nfecton & shock
pt preparaton: #1 nstruct pt to vod;
#2 poston: sttng the evauate the WEIGHT, ABDL GIRTH & REPSIRATION
effectve f : Pt decrease wt of 5 bs and decrease or N RR
c. BLEEDING ESOPHAGEAL VARICES - DUE TO porta HPN
Lab data Sengstaken Bakemore Tube - 48 hrs nfated, scssors at bed sde
(Baoon Tamponade) - effectve f (-) hematemess
TlPS GASTRO - ADULT
" A pt w/ appendcts was admtted, of ALL the ff wrtten orders, w/c shd the nurse
prortze - Administration of Antibiotics;
" w/c statement f made by a pt w/ crrhoss s a rsk factor for havng the dsease -
"l drink 2 glasses of alcohol }day";
" whch of the ff ndcates a ruptured appendx - absence of pain;
" ff subtota gastrectomy, the nurse shd expect gastrc dranage for the 1
st
12 hrs to
be - reddish brown;
" the prorty nsg care post common be duct exporaton - preventing hypostatic
PNA;
" w/c queston durng nsg assessment woud confrm the Dx of L Crrhoss
- how long have you noticed the white in your eyes turns yellow;
" the prorty nsg dx for a pt w/ Hepa B - altered Nutrition
" the prorty nsg dx for for pt w/ acute pancreatts - Altered nutrition less
than body requirements
NEUROLOGY
DECORTICATE - abnorma FLEXION
DECEREBRATE - abnorma EXTENSION
Opstotonous - "back archng"
GENERAL CONSlDERATlON
When assessng the neurological system, pay attenton to the ff:
! #1 LEVEL OF CONSCIOUSNESS
! #2 BEHAVIOR
! #3 REFLEX
When assessng MUSCULO SYSTEM:
! #1 Range of Moton
! #2 |ont Stffness
! #3 POSTURES
PEDlATRlC CONSlDERATlON
a. Check for bowe and badder funx - ndcates neuroogca maturty
15-18 months - START BOWEL TRAINING
2 yo - start badder tranng
b. Assess for ther habts
"securty bankets" - ex. Stuff toys, mother waet
Associate mother's time w} child activity (chdren has NO DEFINITE TIME)
Ex. Your mom w be back after you have eaten your unch.
c. Assess for presence of URTI - coud be sgn of Menngts, Hemophus nfuenza, Otts Meda
d. Assess chd for S/S of anxety
- bed wettng
- na btng (N up to 4 yo)
- head bangng
- excessve thumb suckng
e. CONTUSSION - more severe, fata and coud even ead to death

CONCUSSION - |arrng of the bran, "na-aog" w/c coud ead to s/s of LOC n 24-48 hrs
DECORTlCATE - abnorma fexon whch ndcates damage to the cortex

s/s : #1 Decrease LOC
#2 wdenng puse pressure (ncrease systoc BUT dastoe s N)
#3 Convuson & sezures
ABOVE ARE S/S OF INCREASE ICP.
DECEREBRATE - more serious
- abnorma extenson w/c ndcates damage to bran stem
GLASGOW COMA SCALE
EYE OPENlNG (4) VERBAL RESPONSE (5) MOTOR (6)
6 - OBEYS COMMAND
5 - ORIENTED 5 - LOCALIZES PAIN
4 - OPEN SPONTANEOUSLY 4 - CONFUSED 4 - WITHDRAWS FROM PAIN
3 - OPENS TO VERBAL COMMAND 3 - INAPPROPRIATE 3 - DECORTICATE RIGIDITY
2 - OPEN TO PAIN 2 - INCOMPREHENSIBLE 2 - DECEREBRATE RIGIDITY
1 - NO RESPONSE 1 - NO RESPONSE 1 - NO RESPONSE
SCORE OF 3 : NO response (DEAD) - Doctor w the one to pronounce
SCORE OF 15 : pt s awake
Score of 8 : 50-50, MONITOR THE PT
7 and BELOW : pt s COMA
CRANlAL NERVES
I. OLFACTORY : SENSORY : smell - Abnoxious smell
Anosmia - no smell
Perfume
II . OPTIC : SIGHT - snellen's chart - 20/20 usually by age 3-6 yo
III. OCCULOMOTOR
IV. TROCHLEAR Eye movement - 6 cardinal direction of gaze
VI. ABDUCENS (if abnormal look for DIPLOPIA)
V. TRlGEMlNAL : SENSORY : responsible for FAClAL SENSATlON
(to check, use cotton & neede and run across the cheek)
AND MOTOR : abty of pt to chew

Refex: CORNEAL REFLEX - (+) f both eyes can bnk
VII. FAClAL : SENSORY : sense of taste @ anterior 2}3 of the tongue
and MOTOR : Facial Expression
VIII. ACOUSTlC or VESTlBULOCOCHLEAR - Sense of hearing and balance
TEST : ROMBERG'S TEST - stand erect, close eyes, observe for balance
IX. GLOSSOPHARYNGEAL
X. VAGUS SENSORY - Posterior Taste 1}3 Of The Tongue
MOTOR - swallowing and gag reflex
XI. SPlNAL ACCESSORY - motor movement of shoulder muscle
Xll. HYPOGLOSSAL - TONGUE MOVEMENT
DUCHENE'S MUSCULAR DYSTROPHY (DMD)
X -nked RECESSIVE (ony mother transmt to SON)
(-) Father Mother (+ carrer) Son - 50% chance
Daughter as Carrer - 25% chance
DMD Erb Duchenne's Paralysis (EDP) Klumpke Palsy (KP)
Reated to Brth In|ures affectng the BRACHIAL PLEXUS - nerves at axa porton
HEREDITARY EDP - upper plexus
KP - lower plexus w/c eads to parayss.
Prognosis : compete recovery n 3 months
Treatment : spnt and cast for 3 mos - eads to nerve
regeneraton
X-linked RECESSlVE DlRORDER
MP characterized by progressive muscle atrophy
w}c apparent in male at the age of 3
S}S a) GOWER'S SlGN - inability to stand up
- use arms to brace the body
b) WADDLlNG GAlT - duck-like gait
c) impaired mobility
d) difficulty in running and climbing
COMPLlCATlONs Respiratory Paralysis - for young children
Cardio-Resp. Arrest - for adolescent
LAB DATA Muscle Biopsy
PExam
Nsg Dx lneffective Breathing Pattern
lmpaired Physical Mobility
Pl AlRWAY
(keep TRACHEO at bedsde)
TX
a. Supportive - leg brace, crutches
b. Refer parents to geneticist
Target: Mothers or FEMALES - bec they are the source of transmission
Ex. Aunt, Femae Sbng, mothers, femae members of the famy - (bec transmsson: X nked recessve)
CEREBRAL PALSY
- Permanent, Fix (non-progressve) neuromuscular disorder characterized by abnormal
muscle movement.
Cause Unknown
S}S Exaggerated Reflexes
Protrusion of the tongue or tongue thrusting
Early pattern of hand dominance
Back Arching
Scissors-gait
LAB DATA Neurological Assessment
PExam
Nsg Dx Risk for lnjury
lmpaired Physical Mobility
Pl SAFETY
a. Leg braces
b. Meds : Anticunvulsants, Muscle Relaxants
c. Prepare child for SURGERY - release of TENDON OF ACHlLLES - to promote mobility
d. Refer child to : PT - for gross motor movement - wakng
OT - for fine motor - to open a botte of soft drnks
HYDROCEPHALUS

NOT A DISEASE but a manfestaton of an exstng dsorder
Related to ARNOLD CHlARl MALFORMATlON DANDY WALKER SYNDROME
- there s ELONGATION of the BRAIN STEM or Medua - characterzed by ATRESIA of
and t protrudes to Foramen magnum Foramen of Luschka & Magende
SlDE NOTES: FLOW OF CSF (N amt : 100- 200 ml) - rich in glucose
From Lateral Ventricle t goes to Foramen of Munroe then to 3
rd
Ventricle then to Aqueduct of Sylvius then t moves
to F. of Luschka and Magendie gong to 4
th
Ventricle then t goes back to subarachnoid spaces of brain.
S}S OF HYDROCEPHALUS
! PRO]ECTlLE VOMlTlNG
! lRRlTABlLlTY
! ENLARGED HEAD - N Head Circumference : 33-35 cm (chest circum: 31-35 cm)
! SEPARATlON OF SKULL BONES
! SElZURES
! SUNKEN EYES - Can Progress To Bossing Sign
! MACEWEN SlGN - crack pot sound upon knocking the head
LAB DATA CT Scan
MRl
PExam - focus on head circumference
(tape measure - at bedside to measure H Circumference)
NSG DX Risk for lnjury
Pl SAFETY
Position Semi Fowler's - to prevent increase in lCP
Meds Diuretics
Anticonvulsants
Surgery Ventriculo-Peritoneal Shunt - progressive procedures
(AS CHILD AGE PROGRESSES, the surgery s revsed)
SPlNA BlFlDA - faure of a PORTION of spna cord to fuse
TYPES
SB OCULTA SB CYSTlCA
NO SAC W} SAC
W} DlMPLE or TUFT OF HAlR
SUB TYPES:
Meningocele - w/ sac that contans CSF and mennges;
Meningomyelocele - CSF, mennges and porton of
spna nerves
LAB DATA Amniocetesis - test for ALFA FETO CHON - if lNCREASE - Neural Tube Defect
lf DECREASE - Down Syndrome
CT SCAN
PExam
NSG DX Risk for lnjury
Pl Protect the sac
a. Position: Prone or side lying (NEVER SUPlNE);
b. Wet sterile gauze to cover the skin;
c. DOUGHNUT ring
SURGERY WlTHlN 24-48 HRS
COMPLlCATlON Badder and Bowe Probem
Parayss of Lower Extremtes
Post Surgery Complication Hydrocephaus (tape measure- at bed sde)
lNCREASE lCP
! ICP above 15mmhg (N 0-10)
! Md eevaton : 11 - 20
Moderate : 21 - 30
Severe : 31 and above
Wth the use of INTRAVENTRICULAR or SUBDURAL MONITORING DEVICE to montor ICP
RF Hydrocephaus
Space Occupyng Lessons
Bran Tumor
Trauma
S}S
1. INITIAL: Behavora Changes - rrtabty,
restessness,
decrease LOC - drowsness or pt becomes seepy
2. Vta Sgns Changes - wdenng puse pressure
DECREASE RR and PR
INCREASE temperature
3. Vomtng
4. Montor Abnormates - decortcate, decerebrate
Nsg Dx Rsk for n|ury
Pl To decrease ICP
! Head of Bed ELEVATED
! Evauate Neuro Status - Gasgow
! AIRWAY
! Dscharge Meds Instructon
Antconvusants, Sterods, Duretcs (mannto - to dec amt of cerebra edema)
! Sezure precauton - DARKENED ROOM
MENlNGlTlS MENlNGlSMUS
Infammaton of mennges w/c coud be reated to Infammaton of mennges but WITHOUT
the presence of bactera esp the H. Infuenza, and nfecton
Nessera Menngtds Usuay accompany w/ resp.
dsorder
S}S of lNC lCP + Kerngs Sgn - pan on extenson of ower extremtes
+ Brudznks - fexon of neck woud ead to fexon of ower ext.
- sgn of MENINGEAL IRRITATION
LAB DATA Lumbar Puncture
CSF Anayss
Nsg Dx Infecton
Rsk For In|ury
Pl Safety
Sezure Precauton
Tx the Infecton
Type of lnfcetion:
a. Bactera Menngts - respratory of dropet precauton
b. Vra Menngts - enterc precauton
MEDS Antbotcs
! For Bacterial Meningitis - may cause hearing impairment - refer
to AUDlOLOGlST
REYE'S SYNDROME
Non nfammatory, non recurrng but TOXIC ENCEPHALOPATY and HEPATOPATHY
(CNS) (LIVER)
RF Presence of Vra Infecton
Use of Asprn
TRlAD S}S Fever
Impared Lver Funx
Impared Conscousness w/c coud ead to convuson
STAGES I pt becomes ethargc
II confuson
III decortcate rgdty
IV decerebrate rgdty
V sezure or coma
LAB DATA Beedng and Cottng Tme
Lver Bopsy
Neuroogca Assessment
Nsg DX Rsk for In|ury
Atered Thought Process
Atered Thermoreguaton
Impared Physca Mobty
Pl Treatment - symptomatc - assess neuro status
Beedng - gve Vt K
AVOID ASPIRIN when there s VIRAL INFECTION
CVA} STROKE
MP Decrease Oxygen to bran ces
TYPES
THROMBOSIS
EMBOLISM
HEMORRHAGE
INFARCTION
RF
atherosceross
hpn
obesty
smokng
stress
age/ gender
SlGNS & SYMPTOMS:
1. DEPENDS ON THE PROGRESSION
a. TIA - bref perod of neuroogc dysfuncton that ast ess than 24 hrs (between epsode, pt s
N);
b. STROKE IN EVOLUTION - there s/s ke: faca parayss
Musce weakness
- above s/s coud ast 2-3 days
c. COMPLETE STROKE - there s FOCAL s/s
f R sde of Bran Affected - L Eye - R Face - L Body
f L Bran - R Eye - L face - R body
2. RELATED TO LOBES
FRONTAL - f affected - PERSONALITY CHANGES - BROCAS AREA (expressve aphasa - mouth
openng);
TEMPORAL - memory dsturbances -
WERNICKS LANGUAGE AREA (choce of words, understandng - RECEPTlVE APHASlA);
PARlETAL - DISORIENTATION - especay SPATIAL orentaton;
OCClPlTAL - VISUAL dsturbances
3. SIGNS AND SYMPTOMS INDICATIVE OF COMPLICATIONS
Hemanopsa oss of haf of the vsua fed (eg. Pt consumes haf of the food at pate);
Hemphega parayss of one sde of the body;
Emotona Labty "mood swng"
Aphasa Expressve - nabty to fnd rght words to say (damage to Brockas Area);
- pt can say rght words - mgt: pcture board

and Receptve - nabty to understand spoken words (Werncks area)
mgt: tak to pt sowy
Dysphaga nstruct the pt to swaow twce to prevent aspraton
LAB DATA Increase Choestero
Diagnostic Test CT Scan
MRI
EEG
Nsg DX Unatera Negect - nabty to care haf of the body
Impared Physca Mobty
Rsk for In|ury
Pl SAFETY
Poston Sem-fowers
Eevated
Meds Anthypertensve
Duretcs
Antpmc Agents
Antconvusants
Thromboytcs - f (+) thrombus - to dssove cots
DIET Low Na and Choestero
Actvty Range of Moton Exercses
Surgery Cranotomy
Infratentora Crano - FLAT
Supratentora - Sem-fowers
DlSEASES OF NEUROMUSCULAR: Guan Barre Syndrome (GBS)
Myastena Gravs (MG)
Mutpe Sceross (MS)
Amyotrophc Latera Sceross (ALS)
GBS MG
Descendng parayss - start @ upper ext. Common n Mae and Femae
NO gender reated factor but coud be reated to vra nfxn Eary onset : 20-30 yo (Femae)
Reversbe Eary onset : above 50 yo (mae)
MP Infammaton that eads to destructon of Perphera Nerves Defcency n ACTH Receptor Stes -
90%
w/c eads to: ASCENDING GBS Or Def. n ACTH -
"neurotransmtter"
DESCENDING GBS
Mxed Type GBS
ASCENDING GBS - #1 Cumsness that eventuay ead to S/S Musce weakness w/c begns at
face
musce weakness & resp. depresson therefore, Dpopa and Ptoss -
whch
progresses to MASK-LIKE face whch ead
to
respratory depresson
(descendng parayss - start at face - "NO
teebabad")
LAB DATA CSF - Increase CHON TENSILLON TEST - 5 mns
(to all neuromusco disorders)
Nsg Dx Ineffectve Breathng Pattern (ALL) same
Pl AIRWAY (tracheostomy - bed sde) - ALL same
MEDS Steroids Neostgmne - ATSO4 - antdote
Avoid crowded areas : viral infection
Refer to NEUROLOGlST, PULMOLOGlST and PT
MYASTHENlA GRAVlS
COMPLlCATlONS
Myasthenia Crisis (MC) - due to under medication or lack of meds;
Cholinergic Crisis (CC) - due to over medication - overdose
Signs and symptoms of above complication:
MUSCLE WEAKNESS - in MC due to ACTH Deficiency while in
CC due to or as adverse effect of the drug
Treatment : TENSlLLON - effective in MC - it lNCREASE MUSCLE STRENGTH

Effect in CC - it worsens muscle weakness once given - give ATSO4

NEOSTlGMlNE - for MC as TREATMENT
MULTlPLE SCLEROSlS
Common among women - especay whte
There s destructon of MYELIN SHEET at CNS , therefore generazed musce
weakness
Eg. "l know l will be eventually confined in the wheelchair
s}s of generalized muscle weakness: FACIAL - dpopa
Impared Cerebear Funx
Ataxc Gat - "asng"
lmpaired Sensation - NO HOT/COLD BATH
lmpaired Sensory Funx - mpotence
LAB DATA #1 MRI - specfc test for MS - t ocazes the area of paque formaton or the area of
dyemnaton
#2 CT SCAN
NSG DX same wth GBS & MG
DRUGS STEROIDS
Antconvusants - dantn
Musce reaxant - Bacofen
Badder Stmuants - Urechone (bethanco)
HX TEACHlNGS AVOID : HOT COLD SHOWER
Refer to PT: ROM Exercses
AMYOTHROPlC LATERAL SCLEROSlS
(LON GAHRlG'S DlSEASE)
MP Destructon of Upper and Lower Motor Neurons;
Genetcay Transmtted: AUTOSOMAL DOMINANT - common n Mae & Femae
More Pronounce s DYSPHAGlA
The muscle weakness - will eventually lead to RESPlRATORY DEPRESSlON
LABDATA CSF - Increase CHON
EMG - "contract and reax" - neede nserton
Musce bopsy
NSG DX Ineffectve Breathng Pattern
Pl AIRWAY (tracheostomy)
SUPPORTIVE
Refer to Genetcst
SIDE NOTES:
A Recessive : Cystc Fbro, Scke Ce, Apastc/Fancons - either or both parents are (+) for trait NOT
DSES
A Dominant : Retnobastoma, ALS - either father or mother (+) for disease or trait
X Link Recessive : Hemopha, Coor Bndness, Duchennes Muscuar, G6PD Dses - mother (+) trait NOT DSES
and transmit to SON
SPlNAL CORD lN]URY
Destructon of S. Cord reated to TRAUMA
TYPES
CERVICAL 8 - most serous - quadrphega
THORACIC 12
LUMBAR 5
SACRAL 5
COCCYGEAL 1
Pl SAFETY - mmobze, surgery
LUMBOSACRAL AREA - f affected, therefore PARAPHLEGIA - bowe and badder probem
THORACIC - paraphega + bowe and badder probem
CERVICAL c1 - c4 - ncompete or parta quadrphega
C5 - C8 - Compete quadrphega
LAB DATA Myeogram
CT Scan
Xray
Nsg Dx Rsk for In|ury
Impared Physca Mobty
Pl SAFETY
a. lmmobilize the spine - side lying w} pillows bet legs
b. Surgery
COMPLlCATlONS OF SPlNAL lN]URY : AUTONOMlC DYSREFLXlA - due to fu badder and bowe
s/s : #1 INITIAL : HPN
#2 Daphoress
#3 sght fever
what to keep at bedsde: CATHETER - TO KEEP THE BLADDER EMPTY, BEC IF FULL IT WILL TRIGGER THE ANS
TlPS FOR NEURO
A 10 yo s to undergo EEG, w/c comment made by a pt demonstrate that she
understands the procedure - "l will wash my hair after the procedure";
A pt w/ tumor of the fronta obe w most key manfest - difficulty in
concentrating;
A pt w/ M. Sceross has urnary ncontnence. To acheve vodng, w/c nsg
care shd the nurse gve - establishing regular voiding sked;
Whe ntervewng a pt. w/ Myasthena gravs, w/c of the ff statements
confrm the dx - "l have difficulty in swallowing";
A mae pt w/ CVA s observed by the nurse to have consumed haf of hs
mea, the PRIORITY Nsg Dx - Unilateral Neglect;
When takng care of pt w/ C4 Spna In|ury, w/c equpment shd the nurse
keep @ the b.sde - Urinary Catheterization Set;
The PRIORITY NSG DX for pt w/ Myasthenc Crss - lneffective Breathing
Pattern
MUSCULO
CLUBFOOT DEFORMITY
MP Congenta
Foot twsted out of pace
Types
Tapes Varus - "nverson"
Tapes Vagus - "everson"
Tapes Equnus - "tptoe"
LAB DATA PE
Xray
Nsg Dx Impared Physca Mobty
Pl Promote Mobty
#1 MANUAL MANIPULATION
#2 SEREAL CASTING - every 1-2 wks t poston normazes
#3 DENNIS BROWN SPLINT - 2-3 months
CAST : assess for s/s of neurological damage: Capary ref - if more than 3 sec. -
REPORT
EDEMA
Skn Coor/ nabed
CONGENITAL HIP DISLOCATION
MP Madeveopment of the Hps - that nvoves the acetabuum, head of femur or both
S}S Extra Gutea Fod - at affected sde;
Ortoons Sgn - (+) Cck
Trendeenburg Sgn or Pevc Droppng - when chd stand n one foot toward the affected sde,
then there s change n ength
As Sgn or Gaeazs Sgn - shortenng of the affected eg
LAB DATA PExam
Barows Manuever - press eg downward - (+) cck
Ortoans - abduct eg sdeward - (+) cck
Nsg Dx Impared Physca Mobty
Pl #1 Doube or trpe daper - to keep egs n abducted poston;
#2 PAVLIK Harness - for 2-3 mos
#3 Hp Spca Cast LAST RESORT
NO ADDUCTION OF LEGS!
FRACTURES
MP Break in the continuity of the bone
TYPES Open (compound) - bone tears the skin - therefore open: risk for infection
CLOSE - skin intact
AVULSION - tear in the tendon
COMMINUTED - fragmented
COMPRESSED - crushed
IMPACTED - driven to each other
DEPRESSED - pressed
SPIRAL - goes around the bone
GREENSTICK - incomplete
S/S #1 Deformity
#2 Pain
#3 Edema
#4 CREPITUS - sound created when two bone surface rob each other
NSG DX Impaired Physical Mobility
PI MOBILITY - immobilize the fx
a. Splinting;
b. Casting - check for edema - elevate the affected areas;
- check skin color - capillary refill time
- check for presence of blood stained
c. After cast, - CRUTCH WALKING
" 2 point gait - indicated if both lower extremities has partial wt bearing;
" 4 point gait - indicated for partial wt bearing;
" 3 point gait - indicated if 1 leg is allowed partial wt bearing and
the other one is N;
" swing through - when both legs need to moved past the level of the crutches
" swing to - when both legs need to be moved AT THE LEVEL OF THE CRUTHES
going upstairs - unaffected then crutch (goodleg - crutch - bad)
going down - crutch then bad leg - then good leg
SCOLIOSIS
MP Lateral Deviation of the Spine
RF STRUCTURAL - non correctible
FUNCTIONAL - correctible
OUSTANDING S/S
# Uneven Hemline;
# Uneven waistline;
# Uneven shoulder
# (+) Rib Hump
# Prominent Iliac Crest
LAB DATA Bend Over test - instruct to touch the toes and note for rib hump
Xray
Nsg Dx Impaired Physical Mobility - child
Body Image Disturbance - adolesence
TX a. To decrease curvature - wear BOSTON or MILWAUKEE Brace
- for 23 hrs/day except bathing
b. SURGERY - HARRINGTON ROD
- LUQUE
HX Teaching
Avoid : Bending
Jumping Rope
Playing Tennis
Trampoline
Allowed: Brisk Walking
Swimming
Cheer Leading
OSTEOPOROSIS/ HUNGRY BONE
MP Loss of Bone Density
RF #1 smoking
AGING
IMMOBILITY
MENOPAUSE - decrease Estrogen
Secondary to Existing Condition - as secondary Hyperparathyroidism
S/S PAIN
Dowagers Hump
Short Stature
Progressive Decrease in Height
LAB DATA Decrease in Calcium
Bone Densinometry
Bone Scan
Xray
Nsg Dx SAFETY
How?
# DIET : High Ca especially 4 those with - OSTEOPOROSIS
- spinnach
- seafoods
- sardines
# ACTIVITY : Partial Weight Bearing (NO SWIMMING)
- jumping rope
- bicycle reading
- brisk walking
# MEDS : Ca Supplement - alendronate
Fosomax - SIT UPRIGHT AFTER
ARTHRITIS
RHEUMATOID GOUTY OSTEOARTHRITIS
Common FEMALE MALE MALE/FEMALE
Affected Part Upper Extremities Lower Extremities wt bearing joint
MP
Chronic, systemic inflammation of connective tissues
Synovial joints and joints of Upper extremities
S/S PAIN
Inflammation
Morning Stifness
Stages of Rheumatoid A.
# STAGE 1 - no Disability
# STAGE 2 - with Interference To ADL
# STAGE 3 - with major compromise of funx
# STAGE 4 - incapacitation
ULNAR DRIFT SWAN NECK DEFORMITY
LAB DATA Decrease HgB
Increase ESR
Nsg Dx PAIN
Impaired Physical Mobility
PI Relief of Pain
a. Warm Bath;
b. MEDS : ASA - Antiinflammatory
STREROIDS
c. exercise: ROM
GOUTY ARTHRITIS
MP Metabolic disorder of purine w/c leads to deposition or uric acid at joints
site: THE GREAT BIG TOE
S/S (+) PAIN - usually aggravated by pressure
(+) Inflammation
- above s/s affects the LOWER EXTREMITIES
LAB DATA Increase Uric Acid
NSG DX PAIN
Impaired Physical Mobility
PI Relief of PAIN
Meds : Allupurinol, Probenecid
Diet : Low Purine/ Purine Restricted: AVOID : Organ Meats
SEAFOODS
Alcohol
ALLOWED: Cheese (EXCEPT fermented and Aged)
Increase ORAL Fluid Intake
OSTEOARTHRITIS
A degenerative joint disease that involves the weight bearing joints - elbows & knees
S/S PAIN - NO inflammation
Bouchards Nodes (distal)
Heberdenes Node (proximal)
LAB DATA
xRAY
Nsg Dx PAIN
Impaired Physical Mobility
PI Weight Control
Health Teaching Hot or Cold Compress
ASA
Trunk Assistive Device (cane)
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Autoimmune multi system dses characterized by inflammation of connective tissues
JOINT : (+) pain, (+) morning stiffness;
CARDIOVASCULAR : (+) chest pain;
CNS : (+) s/s of dec LOC, Irritability, Headache
OUTSTANDING S/S BUTTERFLY RASH (also present in pt in PROCAINAMIDE TOXICITY)
LAB DATA Increase ESR
Nsg Dx PAIN
Altered Tissue Perfusion
Risk For Injury
TX Symptomatic/ Supportive - meaning, treat available s/s
Drugs Steroids
TRACTION
PRINCIPLES T - rapeze bar
R - equires free hanging weights
A - nalgesic
C - iculation monitoring
T - emperature monitoring
I - nfection prevention
O - utput and input monitoring
N - utrition
S - kin Assessment
TIPS FOR MUSCULO
! the prorty nsg care for the pt w/ bucks extension traction shd be - ensure that
the tracton apped to the affected eg s aways attached to the weght;
! pt n russel's traction s beng taken cared of by the nurse, t woud be necessary
for the nurse to ntervene f - the pt feet are pressed aganst the foot board;
! a pt s usng CRUTCHES for the frst tme, w/c acton refects a need for further
nstructon - the pt bears hs/her wt wth hs/her axa;
! a pt on bucks tracton of the R femur ask the nurse how he can possby move
around. What can the nurse advse the pt - you can hold on to the trapeze bar
while moving;
! w/c of the ff can possby ndcate the presence of abnormality in an
adolescent - uneven hemne - scoliosis;
! when assessng an nfant, w/c of the ff needs to be reported - extra gluteal folds;
! post spna fuson -ROBAXIN -s gven for w/c of the ff purpose - to decrease
muscle spasm;
! a chd has hp spca cast upon dscharge, w/c statement of the father ndcates
further nstructon - " l will hold on to the bar bet his legs to help move
him"
lNTEGUMENTARY SYSTEM
Burn - trage : face and perneum (prorty)
BURNS
Traumatc n|ury to the skn brought about by : FIRE
CHEMICALS
PROLONGED EXPOSURE TO SUN
ELECTRICAL CURRENT
HOT H2O
CLASSSlFlCATlON:
Accordng to Damage
! PARTIAL THICKNESS - FlRST DEGREE 2
ND
DEGREE
! EPIDERMIS EPIDERMIS & PART OF DERMIS
! Pan Redness
! Redness Bster Formaton
! Eg sunburn pan
! FULL THICKNESS
THlRD DEGREE 4
TH
DEGREE
! SUB O FATS SUB O FATS
! MUSCLES MUSCLES & BONES
! LEATHERY APPEARANCE CHARRED APPEARANCE
! NO Pan No Pan
MlNOR MODERATE MA]OR
PARTIAL TICKNESS ess than 15% 15-25% 25%
FULL THICKNESS NONE <10% >10%
RULE OF 9 - CHECK NOTE day 9 page115
BURN TRlAGE
Priority : Burns of FACE
PERIMEUM
UPPER & LOWER EXT
Burn reated to Chd Abuse
Chemca - Fre
THlNK: R escue
A arm
C onfne the Fre
E xtngush the Fre
PRlNClPLES OF NSG CARE FOR BURN PTS :
! B - reathng - Arway
! U - rne output montorng
! R - esusctaton of Fuds
! N - utrton
! S - vadene Ontment
DlET DAT (Hgh CHON, Ca, Vt C)
Complication FIRST 24HRS - SHOCK
72Hrs - INFECTION
Pt Preparation :Bed Cradde
LYME'S DlSEASE Rocky Mountain
Fever

caused by BORRELIA BURGDORFERI (deer ticks) Dermacentor/ Varabs -
dog ticks
3-30 days or Dermacentor Andersor (wood)
2-3 wks

s/s : Fever, Pan, Chs, Rashes
RASHES: Bus Eye Rash or Rounder Rngs Generazed rashes
At most body parts
Complications
Cardo, Muscuoskeeta and CNS
- whch can ead to parayss
TX Avod wooded area - "have you been to the woods?"
Pl Vaccnaton
Use ong seeve
Remove tcks w/ twzers - upward straght moton
Meds Choramphenco
Tetracycne
DERMATlTlS
DlAPER (contact) ATOPlC ECZEMA (adut)
Peak : Durng nfancy - 9-12 mos Cause : Heredtary
Due to proonged exposure to urne, soap & excreta Prone to asthmatc
patents
S/S : RASH RASH + scang,
Crustng
Prurtus or tchng
Vscces
Management: Hydrate the skn w/ cod compress
Meds: Benadry (anthstamne)
ROSEOLA RUBEOLA RUBELLA
Exanthem MEASLES GERMAN MEASLES
Causative Agent Herpez Vrus Mease Vrus Rubea Vrus
lNC PERlOD Unknown 10 -20 days 14 -21 days
s/s FEVER and RASH
RASH Non Pruritic Begins w} face & downwards Face & downwards
Rose pink - begins w} trunk
Progressing outward
With KOPLlCK'S SPOTS + same
3 C's : Coryza
Cough
Conjuctivitis
MANAGEMENT: (to all types)
Bed rest
Antibiotics
Antipyretic
SYPHYLLlS GONORRHEA HERPEZ
C Agent T Pallidum N Gonorrhea Zoster Simplex
l. Period 10-13 wks 2-7 days
Vercea Zoster Vrus Herpes Smpex Vruz
Abdomna Ora Herpez
Genta H
2-12 days vesce
Sterods
Around the mouth Inner thgh
Buttocks
Gentas
Acycovr
Cervca Ca - compcaton of
Herpez
Annua pap smear
TRlCHOMONlASlS MONlLlASlS}CANDlDlASlS
Caused by TRICHOMONAS Vagnas Abcans
Both are STDs
Charac of dscharge : Greensh/ Yeowsh WHITISH-CHEESELIKE dscharge
Wth FOUL ODOR
Inc Perod 4 - 20 days 2 - 5 days
Druf pf Choce Fagy Amphotercn
TlPS
! A nurse admts 8yo brought by her mother. Upon assessment, the nurse fnds
rounded rngs of rash. Ths s ndcatve of - ymes dses;
! Durng the mmedate 24hrs pot burn, w/c of the ff s the prorty - admnstraton
of fus;
! A pt tes the nurse that he notce sma bsters on hs prvate parts. Ths s
ndcatve of - HERPEZ
! A pt wth CA of the cervx was admtted wth the ff data: w/c one ndcates a
possbe rsk factor - prevous tx for herpes;
! w/c of the ff ndcates effectve tx of gonorrhea - (-) puruent dscharge;
! a pt s dagnosed w/ herpes zoster, w/c of the ff s the prorty nsg dx - PAIN;
! w/c of the ff s ndcatve of CHLAMYDIASIS - burnng on urnaton
CANCER
Cause Unknown Theory of USE - Overuse, Underuse, and Abuse
RF Smokng : Lung, Badder and Laryngea or Ora CA
RACE : |ewsh - Breast
Backs - Cervx and Prostrate
Whtes - Testes
PARITY : Nuparty - breast havng baby after 35 yo
Mutparty - cervx
DIET : Hgh Fat and Low Fber - CA of Coon
Spcy - Ca of Prostrate
Raw - Ca of Stomach
LABDATA Screenng Exams
Male:
a. Testcuar Sef Exam - mothy - begns age 16 yo- target are hgh schoo
Female:
a. Pap smear - at age of 18 (f sexuay actve) - anuay
b. Breast sef exam - begnnng age 20 - monthy
c. Mamography - basene : 35-40 yo : AFTER 40 yo - once every 2years
After age 50 - annuay
BOTH MALE AND FEMALE
! Dgta Recta Exam 40 and above - ANUALLY
! Sgmodoscopy ANUALLY after age 50yo
! STOOL FOR OCCULT BLD Annuay after age 50 yo
Nsg Dx Inta : Knowedge defct
If pt s TERMINALLY ILL : HOPELESSNESS
If pt has some wshes or
Unfufed needS : Poweressness
Nsg Care Principles :
C hemotherapy - target ces : those rapdy dvdng ces;
A sess Body Image
N tuton/det : hgh CHON, we baance
C auton pt on s/s
E xercse
R est
COMMON S}S
LARYNX change n VOICE or Hoarseness
LUNGS changng cough or smokers cough (productve)
STOMACH dyspepsa
BREAST a ump or a dscharge
OVARIAN compans feeng of funess or ndgeston
CERVICAL "beedng"
PROSTRATE eevated acd phosphatase, noctura
COLON change n bowe habts
Hodgkns Dses paness enargement of ymph nodes
TESTICULAR crytorchdsm, spongy testes or ump (N - smooth unequa)
TlPS FOR CANCER
! w/c nsg dx s a prorty for a pt undergong chemotherapy - SOClAL lSOLATlON;
! when undergong chemotheraphy, w/c souton s used for mouth care -
HYDROGEN PEROXlDE;
! w/c of the ff s an approprate det for pt undergong chemo - bland diet;
! the most common sgn of Breast Ca s n - upper outer quadrant;
! pt w/ CA of esophagus w manfest - DYSPHAGlA
TlPS FOR PSYCHE
! A pt w/ chronc depresson s to undergo ECT, the purpose is to - relieve the
symptoms of depression;
! A nurse shd assess the pt w/ ALZEIMERS DSES for possbe change n -
orientation;
! A pt w/ bpoar epsodes s ready for dscharge when - she can comply with
units activities;
! The nurse woud suspect that the chd s a vctm of abuse f he - keeps quiet
while an lV is inserted;
! w/c of the ff stuatons refects an ncrease n sef-esteem of an abuse chd - when
he ask the nurse for a plastic cup to drink;
! the nta care pan for a pt wth Anorexa Nervosa woud requre the pt to -
remain in public place 1 hour after meals;
! where shd the nurse put the pt on eary acohoc wthdrawa - well-lighted room
near nurses station
TlPS FOR OB-GYNE
! A Mother Is Cryng Besdes her baby, she sad "I fee so sorry I coudnt hod her" -
let her stroke the baby;
! 6wks pregnant woman ask the nurse about the sgns of pregnancy - w/c one s
expected at ths tme - frequent urination;
! the nurse notes mrror mage n the feta montor - this could be related to
FETAL HEAD COMPRESSlON;
! whch of the ff s reated to trauma - ABRUPTlO PLACENTA;
! A nurse s carng for a woman n frst stage of abor, she s tmng the duration of
contraction - she s correct when she tmes t from the beginning of one
contraction to the end of same contraction
TlPS PEDlA
! w/c of the ff s expected by 6mos of age - sits w} minimal support;
! the most approprate toy for 18 mos od chd - carriage w} a doll;
! the approprate room mate for an 8yo gr w/ eukema s - 6 yo with hemophilia;
! n a 3yo chd - w/c of the ff shd the nurse assess durng admsson - special
words used for objects and routines;
! w/c of the ff s approprate way of admnsterng pre-op meds to 4 yo chd - ask
the child where she would like the injecvtion to be given
Parayss of Lower