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MEDICAL-SURGICAL NURSING
REVIEW
Course Outline
I. Client in Pain
II.Perioperative Nursing Care
III.Alterations in Human Functioning
a. Disturbances in Oxygenation: Respiratory & Cardiovascular Functions
b. Disturbances in Metabolic and Endocrine Functions
c. Disturbances in Elimination: Gastrointestinal Problems
d. Disturbances in Fluids and Electrolytes: Renal & Genitourinary Functions
e. Disturbances in Cellular Functioning: Cancer and Hematologic Problems
f. Disturbances in Auditory & Visual Functions
g. Disturbances in Musculoskeletal Functions
IV. Client in Biologic Crisis: Life threatening Conditions of the Human Body
- Shock
V. Emergency & Disaster
- First-aid and Cardiopulmonary Support
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I. CLIENT IN PAIN
Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the skin that respond to intense,
potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System
Characteristics of Pain
1. Intensity –mild, moderate, excruciating
2. Timing – morning or evening, duration may be longer or shorter
3. Location
4. Quality – burning, aching, stabbing
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5. Personal Meaning to pain – tolerance to pain may be different from one person to the other due to some personal
reasons such as economic reasons, work condition, etc.
6. Aggravating and Alleviating factors – patient’s environment
7. Pain Behaviors - facial expressions with pain
Pain Assessment
1. Evaluate: Cause, Location, Character and Intensity
2. Numeric Pain Scale – 5-severe pain - 0 – no pain
3. Descriptive Pain Scales – mild, moderate, severe
4. Visual Analogue Scales
5. Faces Pain Scale
6. Non-pharmacologic Interventions
a. Cutaneous Simulation and Massage
b. Ice and heat therapies
c. Transcutaneous Electrical Nerve Stimulation
d. Distraction
e. Relaxation Techniques
f. Guided Imagery
g. Hypnosis
a. Pre-operative Nursing
b. Inraoperative Nursing
c. Post-operative Nursing
A. Pre-operative Care
Pre-admission and Admission Test
1. Psychological support
2. Client Education:
a. Importance and practice of breathing exercises
b. Location & support of wound
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c. Importance of early ambulation
d. Inform and practice leg exercises, positioning, turning
e. Anesthesia and analgesics
f. Educate regarding drains and dressings to be received post-op
g. Recovery room policies and procedures
3. Informed consent
a. At least 18 years of age
b. In sound mind- without psychologic disorder
c. Not under the influence of drugs or alcohol
d. Immediate relative over 18 years old
6. Proper positioning
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Prone
Supine Lateral Recumbent
Jack-Knife Lithotomy
B. Intra-operative Care
Sterilization techniques:
o Autoclave – Steam, Ethyl Oxide (Gas)
o Glutaraldehyde Solution- Cidex
2. Ensure safety of client in the operating table- prevent falls, drape the patient properly, provide warmth
3. Stay with the client to relieve anxiety and support during anesthesia
Anesthesia Administration:
a. General Anesthesia via Inhalation
b. General Anestheisia via Intravenous
c. Regional Anesthesia - local anesthesia
d. Conduction Blocks/ Spinal Anesthesia – Epidural & Spinal Block
- for operation below the waist line
- patient is awake during operation
C. Post-operative Care
1. Immediate assessment of VS, and Neuro VS, drainages, surgical dressing
2. Monitoring of vital signs q 15mins until stable
3. Post-operative positioning depending on the procedure performed
4. Deep breathing exercises
5. Early ambulation
6. Health teaching for Independent (self) care upon discharge
1. DISTURBANCES IN OXYGENATION
Normal Value
pH 7.35 – 7.45
pCO2 35 -45
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pH 7.35 – 7.45
Normal Compensation Normal Compensation
pCO2 35 -45
HCO3 22-26
- A group of conditions assoc. w/ chronic obstruction of airflow entering or leaving the lungs
Major diseases
1. Pulmonary Emphysema – airway is obstructed due to destroyed alveolar walls
2. Chronic Bronchitis- increased mucus production that obstructs airway
3. Asthma
CHRONIC BRONCHITIS
“Blue Bloater”
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- An inflammation of the bronchi which causes increased mucus production and chronic cough.
- Chronic condition is diagnosed if symptoms occur for 3 months and for 2 consecutive years.
Clinical Manifestations:
Slight gynecomastia
Productive cough
Thicker, more tenacious mucus Petechiae in midsternal area
Decreased exercise tolerance
Dyspnea
Wheezes
Nursing Management:
1. Reduce or avoid irritants
2. Increase humidity
3. Administer medications as ordered
4. Chest physiotherapy
5. Postural drainage
6. Promote Breathing techniques
EMPHYSEMA
“Pink Puffer”
- A disorder where the alveolar walls are destroyed causing permanent distention of air spaces.
- (+) dead areas in the lungs that do not participate in gas or blood exchange
Cause: Cigarette smoking, Alpha-anti-trypsin deficiency (an enzyme in the alveolar walls)
Asthma
-A condition where there is an increase responsiveness and/or spasm of the trachea and bronchi due to various stimuli which causes
narrowing of airways
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Types:
1. Immunologic asthma - occurs in childhood
2. Non-immunologic asthma - occurs in adulthood and assoc w/ recurrent resp infections.
- usually >35 y/o
3. Mixed, combined immunologic and non-immunologic
PNEUMONIA
- An inflammatory process of lung parenchyma assoc. w/ marked increase in alveolar and interstitial fluids
Etiology:
1. Bacterial / Viral – streptococcus pneumoniae, pseudomonas aeruginosa, influenza
2. Aspiration
3. Inhalation of irritating fumes
Risk factors:
1. Age: too young and elderly are most prone to develop
2. Smoking, air pollution
3. URTI
4. Altered conciousness
5. Tracheal intubation
6. Prolonged immobility: post-operative, bed-ridden patients
Clinical Manifestations:
Nursing Management:
PULMONARY EDEMA
- often occurs when the left side of the heart is distended and fails to pump adequately
Clinical Manifestation:
o Constant irritating cough, dyspnea, crackles, cyanosis
Pathophysiology:
Fluid accumulation in the alveolar sacs due to hypovolemia, fluid congestions in the lungs, alveoli are congested
Nursing Management:
1. Diuretics, low sodium diet, I&O
2. promote effective airway clearance, breathing patterns and ventilation
3. Monitor VS
4. Psychological support
5. Administer medications
TUBERCULOSIS
Risk Factors:
1. Productive cough
2. Hemoptysis 1. CXR
3. Dypnea
4. Rales 2. Sputum acid-fast
5. Malaise 3. Mantoux Test - .1 ml of PPD (Purified Protein Derivative) ;
6. Night Sweats
7. Weight loss Read after 48-72 hrs.
8. Anorexia, vomiting
Induration: 10mm – > positive exposure to TB
9. Indigestion, pallor
bacillus
5 – 9 mm -> doubtful, may repeat
Treatment:
1. Ethambutol
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2. Rifampicin
3. Isoniazid
4. Pyrazinamide
5. Streptomycin
Client Education:
1. TB is infectious but can be cured
2. Transmitted by droplet infection and not carried on articles like clothing or eating utensils
3. Individual is generally considered not infectious after 1- 2 weeks of medication.
4. Medication regimen should be continuous and uninterrupted
5. Regimen is usually 6 months.
6. Regular check-up to monitor progress should be done.
7. Sputum samples are obtained first before drug therapy is started.
8. Advise proper handwashing and use of mask for people in contact with infected persons who are not yet under treatment.
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CARDIOVASCULAR SYSTEM
THE HEART AND MAJOR VESSELS
A. DIAGNOSTIC PROCEDURES:
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1. Laboratory Tests a. Electrolytes – Na, K, Ca, Determines hyperkalemia, Hypernatremia, etc.
Chloride , Mg - determine the ability of the heart to affect circulation and
(see fluids & electrolytes) regulatory functions of fluids and electrolytes.
h. Enzymes:
> CPK – men- 55-170
- women- 30-135 - cardiac enzymes are present in high
( rises 3-6 hrs after M.I.) concentration in the myocardial tissues ;
determines tissue damage in the myocardium
> LDH – 150-450 u/ml
(rises 12 hrs after M.I.)
> SGOT – 5-40 u/ml
B. 1.ARTERIAL DISORDERS
HYPERTENSION
Persistent BP above 140 /90
Signs & Symptoms BP=140/90 ; headache, fatigue, weakness, dizziness, palpitations, flushing, blurred vision and
epistaxis
Treatment 1. Non-pharmacologic:
Weight reduction √ Sodium restriction
Diet modification √ Exercise
Alcohol & Smoking cessation √ Caffeine Restriction
Relaxation Techniques
Potassium, Calcium, Magnesium supplements (to balance sodium and other
electrolytes)
2. Pharmacologic:
Calcium Agonist: Nifedipine, Verapamil
Vasodilators: Hydralazine
Diuretics: Aldactone, hydrochlorothizide
Adrenergic inhibitors: Propanolol, Clonidine, Methyldopa
Nursing Interventions
1. BP monitoring
2. Correct cause: obesity, diet, stress, etc
3. Regular exercise
4. Salt restrictions
5. Administer medications
6. Teach risk factors
ARTERIOSCLEROSIS
“Obstruction”
- When the arteries become obstructed with plaque and cholesterol, they harden and constrict, and the circulation of
blood through the vessels becomes difficult, forcing the blood through narrower passageways. As a result, blood pressure
becomes elevated.
- Arteriosclerosis occurs when lipids in the blood, including cholesterol, accumulate inside the walls of blood vessels and
reduce the size of the veins or arteries through which blood flows.
ATHEROSCLEROSIS
“Thickening”
- A degenerative condition of the arteries characterized by thickening due to localized accumulation of fats, mainly
cholesterol. The term atherosclerosis refers to a condition in which fatty deposits build up in and on the artery walls,
interfering with the normal flow of blood and oxygen throughout the body. When this happens, the heart has to work harder
to pump blood through the narrowed blood vessels, and a heart attack or a stroke may result.
Predisposing factors:
cigarette smoking
high fat levels in the blood
high cholesterol
high blood pressure
obesity
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The symptoms of atherosclerosis depend on the part of the body where the condition is taking place. Sometimes there
aren't any noticeable symptoms until the condition has advanced to a very serious stage. When the arteries of the heart are
affected, one of the first symptoms is chest pain, often called angina. A person with clogged arteries of the heart may also
have occasional difficulty in breathing and may experience unusual fatigue after short periods of exertion.
Nursing Intervention:
a. Health Teaching
b. Reduce Risk Factors
c. Restore Blood Supply
d. Pre & Post-op Care for Surgical Patients
e.
AORTIC ANEURYSM
BUERGER’S DISEASE
a.k.a. Thromboangitis Obliterans (TAO)
Definition: Vasculitis of the veins and arteries in the upper & lower extremities
Risk Factors: Men -20-35 y/o, Heavy smokers, hypersensitivity to intradermal injections
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Treatment:
Calcium Channel Blockers to promote vasodilation
Rest, Pain Relievers, Avoid exposure to cold
Surgery: Amputation of extremity is delayed until conservative treatments fail to effect.
Nursing Intervention:
Health teaching on lifestyle modifications, spec. smoking
Ensure protection of extremities against cold
Administration of medications as ordered
Protect client from injury
Assessment of extremities
RAYNAUD’S DISEASE
Risk Factors: Women, heavy smokers, individuals spec. women with Systemic Lupus
Erythematosus (SLE) or rheumatoid arthritis
Treatment:
Nifedipine to decrease vasospasm
Avoid exposure to cold and keep hands warm
Avoid smoking
Nursing Intervention
Same as buerger’s disease
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B.2.VENOUS DISORDERS:
THROMBOPHLEBITIS
VARICOSE VEINS
Treatment:
Surgical Management: Sclerotherapy (injection of sclerosing agent to the
vein. Not a treatment, hence, for cosmetic purpose only)
Nursing Intervention
Elevate legs at least 30 mins. After prolonged standing
Wear thromoembolic stockings
Teach client o avoid prolong sitting or standing
Avoid cross-legs while sitting
Post-op Care after Sclerotherapy: a. Maintain firm elastic pressure over the whole limb
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IV.CARDIAC DISORDERS
ANGINA PECTORIS
Chest pain
Precipitating factor:
over exertion
eating
exposure to cold
emotional stress
Classification of Symptoms:
Class I – no limitations of physical activity (ordinary physical activity does not cause symptoms).
Class II – slight limitation of physical activity (ordinary physical activity does cause symptoms).
Class III – moderate limitation of activity (patient is comfortable at rest, but less than ordinary activity can
cause symptoms).
Class IV – unable to perform any physical activity without discomfort, therefore severe limitations (patient may
be symptomatic even at rest).
Nursing Interventions:
a. Assess pain – location, character, ECG (ST elevation), precipitating factors
b. Help client to adjust lifestyle to prevemt angina attack – avoid excessive activity in cold
weather, avoid overeating, avoid constipation, rest after meals, exercise
c.
Teach patient how to cope with angina attack – nitroglycerin every 5 mins upto 3x, if still not
relieved go to the hospital
Diagnostic Assessment:
a. ECG
b. Stress Test
c. Radioisotope Imaging
d. Coronary Angiography
Medical Management:
MYOCARDIAL INFARCTION
The rapid development of myocardial necrosis caused by imbalance between the oxygen supply and
demand of the myocardium.
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Myocardial Infarction
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Pituitary Gland
Anterior Lobe Growth Hormone Stimulates growth of body tissues and bones
Gonadotropic hormones (LH & Affect growth, maturity and functioning of primary and
FSH) secondary sex organs
Anti-diuretic hormones (ADH, Promotes reabsorption of water by the distal tubules and
Posterior lobe vasopressin) collecting ducts of the kidney, thus decreasing urine
output
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Thyroid Gland Thyroxine (T4) Increases metabolic activity of almost all cells;
stimulates most aspects of fat, protein and carbohydrate
Triiodothyronine (T3) metabolism
Adrenal Cortex Glucocorticoids (primarily Promotes carbohydrate, protein and fat catabolism,
cortisol) -- Sugar increases tissue responsiveness to other hormones
Controls SSS:
SUGAR, SALT, Mineralcorticoids (Aldosterone) Tends to increase sodium retention and potassium
SEX -- Salt excretion
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Gigantism
Overgrowth of all body tissues and bones
Growth
Hormone
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Addison’s Disease 1. Malaise and general weakness 1. Pharmacology: Steroids (Prednisone,
2. Hypotension, hypovolemia dexamethasone)
3. Increased pigmentation of skin 2. Diet: high CHO, CHON diet
4. Anorexia, nausea, vomiting 3. Observe side effects of hormone replacement –
5. Electrolyte Imbalance Cushingoid Appearance
6. Weight loss 4. Monitor fluid & electrolyte
Glucocorticoids 7. Loss of libido 5. Teach importance of lifelong medications
Mineralcorticoids
8. Hypoglycemia (60-70) 4. WOF Signs of Addisonian Crisis:
9. Personality Changes
Addisonian Crisis:
STEROIDS:
Purpose: Anti-inflammatory and anti-allergy; Stress Tolerance
Medication:
a. Take at the same time everyday
b. Follow regime and do not stop abruptly
c. Causes gastric upset
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Pheochromocytom 1. HPN 1. Surgical Mgt: Removal o tumor
a 2. Increase Perspiration 2. Medical Management: Symptomatic (Treat
3.Apprehension symptoms as it occurs)
4.Palpitations 3. Nursing Mgt:
5. Nausea, Vomiting, Headache > High caloric diet
6. Tachycardia > Adequate Rest
7. Hyperglycema
d. Propanolol
THYROID STORM: 3. Radioiodine therapy
4. Nursing Mgt:
a. Fever a. Adequate Rest
b. High caloric, high protein,
b. Tachycardia carbohydrate, vitamins without
c. Delirium stimulants
c. Measure daily weights
d. Eye protection for xopthalmos
e. WOF: Thyroid Storm
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Cretinism 1. Physical & mental retardation
2. Sensitive to cold
3. Dry skin
T3, T4, 4. Poor appetite and constipated
Thyrocalcitonin
Treatment:
Hormone
Replacement
PANCREATIC PROBLEMS
DIABETES MELLITUS
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Type I Type II
Insulin Dependent DM Non-Insulin Dependent DM
(IDDM) (NIDDM)
Age of Onset
Before 30 years old but may occur at >35 y/o but can occur in children
any age
Onset
Abrupt Insidious
Incidence
10% 85-90%
Insulin production
Little or none Below normal
Normal or
Above normal
Insulin Injections
Required Necessary for only 20-30% of clients
Ketosis
May occur Unlikely to occur
Body weight at onset
Ideal body weight or thin Usually Obese
Management
Diet, exercise and insulin Diet, exercise, hypoglycemic agent or
insulin
Treatment:
Administration:
2. Insulin Injections:
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Short-Acting Clear - Regular Insulin 30 mins. – 1 hr. 2 – 4 hrs. 6 – 8 hrs.
Complications of DM:
a. Hypoglycemia
Nursing Interventions: Give candy, juice or softdrinks, let the patient eat
Check sugar level
b. Diabetic Ketoacidosis
Signs & Symptoms: Polyuria, thirst, Nausea, vomiting, dry mucous membranes, Kussmaul resp,
Coma, sunken eyesballs, acetone odor of breath, hypotension, abdominal
rigidity
c. Lipodystrophy
3. DISTURBANCES IN ELIMINATION
GASTRIC CANCER
Incidence:
f. Common in men than women
g. History or presence of Pernicious Anemia
h. Often develops with the occurrence of atrophic gastritis
i. Low-socio economic status; live in urban area
j. Exposure to radiation or trace metals in soil
Clinical Manifestations:
a. Palpable mass
b. Ascites
c. Weight loss
d. Dysphagia
e. Indigestion and anorexia
f. (+) high lactate dehydrogenase level in gastric juice
Nursing Intervention: Same as with patient’s with ulcer, emotional support, pre and post-operative health teaching
Risk Factors:
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o Poor food handling
o Poor sanitary conditions
o Overcrowding
o Food remaining on high temperature making organisms incubate and colonize easily.
Management:
o Replace fluid loss
o Anti-infective Agent (e.g. Metronidazole spec for amoebiasis, Bactrim)
Nursing Intervention:
o Measure intake and output
o Administer medications
o Replace fluids
APPENDICITIS
Cause: Fecalith (stone or calculus in the appendix) .-> Kinking of the appendix
Fibrous condition in the bowel wall -> Bowel adhesion
S/S: Pain starts in the epigastriium the shifts to the the right lower quadrant
Guarding of painful area
Keeps legs bent to relieve tension
May have vomiting, loss of apetite, low grade fever, coated tongue and halitosis
Treatment: Appendectomy
Nursing intervention:
Assess the VS and pain scale carefully
Observe for symptoms of peritonitis , Pre & post-operative care
PERITONITIS
o Medical Management:
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NGT: Lavage to relieve pressure in the abdomen
Fluid & electrolyte replacement
o Surgical Treatment:
Appendectomy or Exploration of the abdomen with drainage
o Nursing intervention:
Careful assessment of history, V/S, fluid & electrolytes
Pre & Post-operative Care
Pathology & Involves primarily the ileum & right Mucosal ulceration of lower colon
Anatomy colon and rectum
Distribution of d’se is segmental Distribution of d’se is continuous
Malignancy is rare Malignancy may occur after 10 years
Post-op intervention:
Observation of the stoma
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Teach client re: self-care
HERNIA
-An abnormal protrusion of an organ or tissue through the structure that contains it.
- Frequently a congenital occurrence or acquired weakness of the abdominal muscles
Types:
1. Indirect Inguinal Hernia
2. Direct Inguinal Hernia
3. Femoral Hernia
4. Umbilical Hernia
5. Incisional Hernia
Medical Treatment: Use of TRUSS if hernia is not strangulated or incarcerated.
DIVERTICULUM
Diverticulum – an outpouching of intestinal mucosa through the muscular coat of the large
intestine (most commonly the sigmoid colon)
Diverticulosis – refers to the presence of non-inflamed out pouching of the intestine
Diverticulitis – inflammation of a diverticulum
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Indications Nursing Intervention
e. Hemorrhoids
S/S: Internal – bleeding and renal prolapse, bleeding and rectal itching
External – enlarged mass at the anus
Present symptoms in both internal & external: Bright red (blood) stain in
stool or tissue, Pain
Medical Intervention: a. Treat constipation
b. Relieve pain through heat application / Sith’s bath
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Surgical Intervention: Hemorrhoidectomy, Sclerotheraphy, Rubber band ligation, Laser
Surgery, cryosurgery
f. Fistula-in-ano
Tiny, tubular fibrous tract that extends into the anal canal
May develop from trauma, fissures or regional enteritis
Fistulectomy is recommended.
Cause fluids exceeds the normal volume fluids and/or electrolytes are
the body needs loss
- physiologic or over hydration as physiologic or dehydration
in IV therapy
Illness:
Renal Disease Renal Disease
Neurologic Diseases Diarrhea
Congestive Heart Failure Post-operative conditions
Addison’s Disease Burns
Trauma
GIT Suction/Drainage
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Clinical Manifestations Weight gain Weight loss
Edema Dry skin and mucous
Flushed skin Membrane
Tachycardia Tachycardia (same w/ excess)
Increased BP, RR Poor skin turgor
Rales Decreased urine output
Neck Vein distention Decreased Central Venous
Increased Central Venous Pressure
Pressure Increased hematocrit
Decreased Hct Urine output: < 30 cc/hr
Urine output: > 1,500 ml/day ( Normal Urine Output =30 cc/hr)
Sources of Electrolytes:
Nursing Considerations:
a. Collect urine for testing
b. Antibiotic treatment, as ordered
c. Force fluids
d. Good hygiene
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Hematuria, proteinuria, fever, chills, weakness, nausea, vomiting
Edema
Oliguria
HPN
Headache
Increased Urea Nitrogen
Flank Pain
Anemia
Nursing Considerations:
a. Penicillin, as ordered
b. Proper dietary intake
c. Sodium & fluid restriction
d. Bed rest
4.1.4. Nephrotic Sydrome – glomeruli disorder due to other diseases like DM, SLE, etc.
Nursing Considerations:
a. bed rest
b. high calorie, high protein, low sodium
c. Monitor I & O
d. Protect from infection
e. Administer meds as ordered: Diuretics, Steroids, Immunosuppresiove agents,
anticoagulants
Nursing Considerations:
a. Force fluids: at least 3L of water in a day
b. Strain Urine for stones
c. Administer meds as ordered
4.1.6. Acute Renal Failure –sudden and reversible malfunction of the kidney due to trauma, allergies, stones or
benign Prostatic hyperplasia
Nursing Intervention:
a. Treat cause of sudden occurrence
b. Maintain Fluid & electrolyte balance
c. Prevent hypokalemia
d. Administer insulin or IV glucose as ordered to promote potassium absorption
e. Proper diet :
Oliguric – low CHON, High CHO, high fat, less potassium
Diuresis – high CHON, high calorie, less fluid
f. Weigh daily
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g. Monitor I & O
h. Dialysis if indicated
i. Psychological & emotional support
4.1.7. Chronic Renal Failure – progressive failure of kidney function which may result to death, caused
by chronic gomerulonephritis (CGN), pyelopnephritis, DM, uncontrolled HPN
Treatment:
Dialysis
Renal Transplant
Nursing Considerations:
a. Maintain fluid & electrolyte balance
b. Bedrest
c. Diet: low protein, low sodium, high CHO and vitamins
d. Control HPN
e. WOF cerebral irritation
4.1.8. Benign Prostatic Hyperplasia – enlargement of the prostate with unknown etiology usually in
older males
Signs & Symptoms:
Difficulty in urinating
Nocturia, hematuria, dribbling sensation
Surgical Treatment:
Prostatectomy
b. Peritoneal Dialysis
Use of peritoneum via a catheter for proper exchange of fluids and electrolytes and drainage of
fluids
Catheter inserted just below the umbilicus with small incision
Nursing Interventions:
a. Weigh daily
b. Monitor vital signs
c. Maintain asepsis at all times
d. Record intake and output
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e. Monitor for complications: Bleeding, peritonitis, abdominal pain, dyspnea, bowel
perforation
2. Urinary Tract Surgery
a. Transurethral Removal of the Prostate
b. Prostatectomy
Nursing Interventions:
Weigh daily , monitor I&O
Monitor vital signs
Maintain asepsis at all times
Monitor for complications: Bleeding, peritonitis, abdominal pain, dyspnea, bowel
Replace fluids
Proper irrigation
3. Kidney Transplant
2. Increase awareness of signs & symptoms of kidney disease as edema and HPN
5.1. CANCER
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Cancer in the Philippines:
o Ranks third in leading cause of morbidity and mortality
o 75% of cancers occur at age 50 y/o
Staging of Tumors
a. Extent of tumor
T= primary tumor
N= regional nodes
M= metastasis
b. Extent of Malignancy
T0 = no evidence of primary tumor
TIS= Carcinoma in Situ
T1, T2, T3, T4 = progressive tumor in size and involvement
TX = tumor cannot be assessed
d. Metastatic Development
MO= no evidence of distant metastasis
M1, M2, M3 = increasing degree of distant metastasis
C Change in bowel or bladder habits Ex. Gastric Ca, Colon Ca, Rectal Ca ,
Renal Ca, Prostate Ca
A A sore that does not heal Ex. Laryngeal Ca
U Unusual bleeding or discharge Ex. Uterine Ca
T Thickening or lump in breast or Ex. Breast Ca, Hodgkin’s Lymphoma
elsewhere
I Indigestion or difficulty in Ex. Esophageal Ca
swallowing
O Obvious change in wart or mole Ex. Melanoma, Squamous cell Ca
N Nagging cough or hoarseness Ex. Lung Ca
U Unexplained Anemia
S Sudden uexplained weight loss Most Ca conditions
Risk Factors
Age Health Habits
Sex Family History
Race Socio-Economic Status
Occupation Lifestyle
Cancer Therapy
a. Surgery
b. Chemotherapy – chemical/ medication
c. Radiation Therapy – electromagnetic rays destroys cancer cells
d. Palliative/ Supportive Care- for end-stage or terminal stage
- given if chemo, surgery or radiation therapy cannot assure treatment of
the patient ; it is a holistic care for the patient and family
- management o f care is geared towards a symptom-free individual with
psychologic and spiritual support
Oral Cancer Avoid Smoking tobacco, Betel Thorough dental check-up each year
quid “Nganga” chewing,
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Proper cavity and dental
chewing
Breast No conclusive evidence for Monthly self-exam and annual exam with
early prevention physician;
Mammography:
o Initially at age 40 and then 1-2 yrs
thereafter
o High risk women- should consult a
doctor before age 40
Uterine / Cervix Clean, safe sex Regular pap smear: Once sexually active then
Single partner reduces risk every 3 years if findings are normal
Colon and Maintenance of a high fiber Regular medical check-up after 40 years,
Rectum and low fat diet yearly occult blood tests in stools, rectal exams
and sigmoidoscopy
Nursing Intervention
a. Assist the patient in maintaining self-dignity and integrity by continued and sustained communication
and contact
b. Allow patient to ventilate feelings such as fear, anger, indifference
c. Make arrangements for spiritual consolation
d. Assist in rehabilitation even before treatment and until she recovers and adjust to the society
e. Collaborate with other health workers for the patient’s holistic needs
f. Home visits and education about the client’s condition, course of treatment and alternatives
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Hct - hematocrit Female: 36 – 48%
Male: 40 -52%
5.2.1. ANEMIA
Causes:
a. Sudden or Chronic blood loss
b. Abnormal bone marrow function
c. RBC fails to mature adequately
Types of Anemia:
Clinical Manifestations:
Hypoxia
Prone to infection
Fatigue
Easy bruising
Nursing Intervention:
Proper nutrition
Psychological support
Protect against infection and injury
Pernicious Anemia – Vit. B12 and Folic acid deficiency in gastric juice
Clinical Manifestations:
Paresthesia
Tingling or numbness of extremities
Gait disturbances
Behavioral Disturbances
Nursing Intervention:
Intake of Vit. B12 following this regimen:
o 3x a week for 2 weeks, then
o 2 x a week for 2 weeks, then
o Once a month
Protect lower extremities
Rest in non-stimulating environment
c. Hemolytic Anemia
Sickle Cell Anemia- defective hemoglobin, turns to sickle cell when oxygen in venous
blood is low
Thalassemia
Glucose-6 Phosphate Dehydrogenase Deficiency
Clinical Manifestations:
Thalassemia & G6PD – usually asymptomatic
Sickle Cell Anemia:
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o Severe Pain
o Swelling
o Fever
o Jaundice
o Prone to infection
Nursing Intervention:
Proper oxygenation
Hydration
Analgesics
Adequate Rest
Refer to genetic counseling
Avoid cold places to prevent sickle cell proliferation
Leukemia - proliferation of neoplastic white blood cells in the bone marrow affecting the
different tissues and organs in the body
Clinical Manifestations:
Fever
Prone to Infection
Pain
Weight Loss
Fatigue
Nursing Interventions:
Energy conservation
Reverse Isolation
Blood Transfusion
Nursing Interventions:
Emotional Support
Reverse isolation
Adequate Rest and Nutrition
Strict Medication Regimen
Nursing Interventions:
NEUROLOGIC DISTURBANCES
I. Central Nervous System:
a. Brain
b. Spinal Cord
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IX Glossopharyngeal Gag Response
X Vagus Ability to speak clearly
XI Spinal Accessory Shoulder’s ability to resist against
pressure
XII Hypoglossal Tongue at midline
Neurologic Status:
- An assessment tool measuring the individual’s neurologic status specifically the spontaneity of the client’s eye
movement , speaking ability and motor abilities in response to a stimuli.
Perfect score is 15 points - Spontaneous/ Normal eye, motor and verbal response
Lowest score is 3 points - No response
Points
a. Spontaneous 4
Eye b. To speech 3
Opening c. To pain 2
Response d. No response 1
a. Oriented 5
Best verbal b. Able to Converse 4
response c. Inappropriate speech 3
d. Makes incomprehensible sound 2
e. No response 1
Example:
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GCS Scoring: GCS Scoring:
o A sudden disruption of blood supply to the brain which may lead to temporary or permanent
dysfunction.
2. Cerebral thrombosis
- a blood clot (thrombus) forms in an artery (blood vessel) supplying blood to the brain.
- brain cells are starved of oxygen.
3. Cerebral embolism
- blood clot that forms and then travel to the brain.
4. Cerebral hemorrhage
- occurs when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a hemorrhage,
extra damage is done to the brain tissue by the blood that seeps into it.
Nursing Interventions:
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Definition: A damage in the nerve structure causing dysfunction resulting to paralysis, sensory loss and altered
activity.
Cause:
Vehicular accidents, Violence, Falls,
Sports, Infection, Tumor
Etiology:
1. Spinal Shock (Areflexia)
2. Autonomic Hyperreflexia
- Injury in T6 and above
- Life-threatening
C1 Head & Neck Paralysis below neck; impaired breathing, bowel & bladder
Cervical C2 incontinence, sexual dysfunction
Nerve C3
C4
Injury C5 Diaphragm Shoulder elevation possible, ventilation support
causes C6 Deltoid, biceps
Quadriplegia C7 Wrist Extenders Elbow, upper arm, wrist movement
/ Tetraplegia C8 Triceps
Thoracic T1 Hand
Nerve T2 Loss of hand control, Paralysis below waist
T3
Injury T4
causes T5 Chest Muscles
Paraplegia T6
T7
T8 Abdominal Trunk and Abdominal control
T9 Muscles
T10
T11
T12
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L1
Lumbar Nerve
L2
S1
S2
Bladder & Bowel control Bladder/Bowel Incontinence,etc
Sacral Nerve S3
S4 Sexual Control Decrease sensation in the peineum
Sexual, Bladder
S5
& Bowel conrol
PARKINSON’S DISEASE
PARKINSON’S DISEASE
Definition: A disorder affecting control and regulation of movement
- Unilateral flexion of arms, shuffling gait, difficulty in walking, weakness, disability
Clinical Manifestations:
a. Rigidity
b. Involuntary body tremors
c. Hips and knees flexion
d. Masklike facial expression
e. Slurred speech
f. Drooling
g. Constipation
h. Depression
i. Retropulsion, propulsion
Nursing Interventions:
a. Rehabiltation – exercise
b. Speech therapy
c. Diet: Low CHIN in am, high CHON in PM
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d. High fiber foods to promote bowel elimination
e. Prevent Injury – fall, etc
MYASTHENIA GRAVIS
Clinical Manifestation:
1. Mask-like facial expression
2. Diplopia- double-vision
3. Ptosis- difficulty opening of the eye
4. Dyphagia
Management:
a. Pyridostigmine Bromine (mestinon)
b. Ambenomium Chloride
c. Steroids –Prednisone
d. Atrophine Sulfate
Nursing Interventions: Avoid fatigue, Administer meds as ordered, Avoid neomycin and morphine
CATARACT
Clinical Manifestations:
2. Gradual visual loss.
3. Hazy vision / Yellowish haze
4. Whitish to yellowish eyelense.
Drug: Vision
Vision w/
w/ Cataract
Cataract
1. Mydriatrics - causes dilation of pupils; increases intraocular pressure (IOP)
a. Atrophine Sulfate
b. Phenylephrine Hydrochloride
Nursing Intervention:
1. Monitor BP; avoid use to patients with HPN
2. Teach client that blurring of vision may be experienced.
3. Post-op intervention:
keep eye covered
head of bed elevated at 30-45 degreed, supine position
Avoid bending or lifting heavy objects, coughing and sneezing as it may further increase
IOP
GLAUCOMA
2 types of Glaucoma:
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1. Acute or Closed- Angle Glaucoma
a. Rainbow around lights
b. Pain around the eye
c. Cloudy and blurred vision
d. Nausea & vomiting
e. Dilation of pupils
Drugs:
Miotics – causes constriction of pupils
Nursing Intervention:
1. Administer drugs as ordered
2. Teach client that glaucoma can be controlled but not curable (even surgery can’t cure the disease)
3. Encourage moderate exercise
4. Avoid straining of bowel
5. Encourage low residue, high fiber diet
6. MUSCULOSKELETAL DISTURBANCES
Kinds of Joints Cervical, finger joints, ulnar, can also be Weight-bearing joints: knees, hips, spine
involved:heart and lung (as in rheumatic heart
disease)
Management Rest, exercise, ASA, NSAIDs, Steroids, heat Balanced rest and activity, heat packs,
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steroids in joist only
Nursing Intervention Maintain body alignment, Balance rest and exercise, proper diet
Clinical Manifestations A salt of uric acid (Urate) crystallizes in soft and bony tissues causing local inflammation and
irritation.
Severe pain, usually in great toe
Red, painful and swollen joints
Tophi (crystal formation in joints) are palapated around great toes, fingers,
earlobes
Drugs: Allopurinol
NSAID’s – Ibubrofen , Indomethacin
Probenecid
Colchicine
Sulfinpyrazone
Nursing Management:
a. Bedrest during attacks
b. Heat or cold compress
c. Increase fluid intake to flush out uric acid
d. Avoid eating organ meats, shellfish, sardines - - - food with high purine / uric acid content
Definition: Diffuse connective tissue disease affecting skin, joints, kidney, serous membranes of the heart and
lungs, lymph nodes and GI tract.
Clinical Manifestations: “Butterfly rash” in the face ( across both cheeks and nose)
Manifests symptoms same as that of arthritis and Raynaud’s
Management: NSAID’s
Steroids
Cytotoxic drugs - Azathioprine, Cyclophosphamide
Nursing Intervenions:
a. Avoid exposure to sunlight because symptoms aggravate symptoms or wear hats, umbrella or
sunscreen
b. Adequate nutrition, rest and exercise
c. Stress management, if possible avoid stress
Fractures
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Definition: A break in the continuity of the bones
Clinical Manifestations:
Pain Edema
Loss of function Spasm
Deformity Crepitus
False motion Hematoma around skin
Breaks for penetrating bone fragments
Management:
Closed Reduction - external manipulation such as manually aligning bones by pulling. For patients
who have lower pain tolerance (elderly, children) reduction may be done under
sedation anesthesia.
Internal Fixation - surgically applying screws, plates, pins, nails to align bones (opening of the
skin and exposing bones affected); skin is closed after the procedure.
External Fixation - applying nails and metal screws to bones through the skin surface
Nursing Management:
1. Mainatin positioning
2. For tractionL maintaing weights and countertraction
3. Clean wounds to prevent infection
4. Assess for VASCULAR OCCLUSION
7. INTEGUMENTARY DISTURBANCES
Burn
Depth of Injury Manifestation Level of Skin Affected
Second-degree Pain, pink to red, with blisters Epidermis and dermis hair follicle Superficial partial
(fluid formation) intact thickness; Deep
partial thickness
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Third- degree Reddish, brownish or whitish, Epidermis, dermis, subcutaneous Full thickness
painless, eschar formation tissue
(Leather-like skin)
Rule of Nines:
a. Head and Neck - 9%
b. Anterior Truck - 18%
c. Posterior Trunk - 18%
d. Arms - 9% each = 18%
e. Legs - 18% each = 36%
f. Perineum - 1%
100%
Rule of
Nine’s
Management:
First-Aid:
1. Burning person: Ask person to stop, drop and roll ( lie down and roll)
2. Burning person: Stop burning process such as wrapping the burning part with wet towel or blanket
3. Check airway
4. First-degree burn: Run cool water to affected area for 10 minutes
Hospital Interventions:
1. Check ABC, give oxygen and IV fluids
2. Assess client’s data, history of injury (time, cause,etc)
3. Maintain asepsis- burn patients are very prone to infections
4. Medical – Surgical Management:
a. Tetanus toxoid
b. Topical Anti-microbial agent: Silver Nitrate, Silver Sulfadiazine, Gentamicin Sulfate, Mafenide acetate
c. Debridement
SHOCK
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•Failure of the circulatory system to maintain adequate perfusion of vital organs.
•Critically severe deficiency in nutrients, oxygen and electrolytes delivered to body tissues, plus deficiency in removal of cellular
wastes, resulting to cardiac failure
I. Stages of Shock
- Body compensates
2Progressive Stage
- blood flow to the heart is not adequate thus heart begins to deteriorate
3. Irreversible Stage
- Inadequate tissue perfusion
- Cellular ischemia & necrosis lead to organ failure
Cause Etiology
Hypovolemic Shock due to inadequate circulating blood Blood loss: Massive Trauma, GI
volume Bleeding, Ruptured Aortic Aneurysm,
Surgery, Erosion of Vessesl due to lesion,
tubes or other devices, Disseminated
Intravascular Coaguation
Cardiac Dysrhtymias:
Tachyarrhythmias, Bradyarrythmias,
Electromechanical dissociation
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3. Distributive Shock
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•Neuroendocrine System Stage of resistance
o ADH is released causing kidneys to retain
sodium and water
o Increase in adrenocorticoid mineralcorticoid
hormones
V. FIRST AID
2. Don't move the joint. Splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it
back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.
3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of
fluids in and around the injured joint.
Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to avoid infection
or other complications. These guidelines can help you care for simple wounds:
1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle
pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes. Don't keep checking
to see if the bleeding has stopped because this may damage or dislodge the fresh clot that's forming and cause
bleeding to resume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance.
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2. Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to keep it out of the
actual wound. If dirt or debris remains in the wound after washing, use tweezers cleaned with alcohol to remove
the particles. If debris remains embedded in the wound after cleaning, see your doctor. Thorough wound cleaning
reduces the risk of tetanus. To clean the area around the wound, use soap and a washcloth. There's no need to
use hydrogen peroxide, iodine or an iodine-containing cleanser. These substances irritate living cells. If you
choose to use them, don't apply them directly on the wound.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as
Neosporin or Polysporin to help keep the surface moist. The products don't make the wound heal faster, but they
can discourage infection and allow your body's healing process to close the wound more efficiently. Certain
ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has
healed enough to make infection unlikely, exposure to the air will speed wound healing.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If you're allergic to
the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze held in place with paper
tape, gauze roll or a loosely applied elastic bandage. These supplies generally are available at pharmacies.
6. Get stitches for deep wounds. A wound that cuts deeply through the skin or is gaping or jagged-edged and has
fat or muscle protruding usually requires stitches. A strip or two of surgical tape may hold a minor cut together, but
if you can't easily close the mouth of the wound, see your doctor as soon as possible. Proper closure within a few
hours minimizes the risk of infection.
7. Watch for signs of infection. See your doctor if the wound isn't healing or you notice any redness, drainage,
warmth or swelling.
8. Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty
and your last shot was more than five years ago, your doctor may recommend a tetanus shot booster. Get the
booster within 48 hours of the injury
For minor burns, including second-degree burns limited to an area no larger than 2 to 3 inches in diameter, take the
following action:
Cool the burn. Hold the burned area under cold running water for at least 5 minutes, or until the pain subsides. If
this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces
swelling by conducting heat away from the skin. Don't put ice on the burn.
Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze
loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and
protects blistered skin.
Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve)
or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may
be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever,
swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year
old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.
Caution
Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
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Don't break blisters. Broken blisters are vulnerable to infection.
Third-degree burn
The most serious burns are painless and involve all layers of the skin. Fat, muscle and even bone may be affected. Areas
may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning or other toxic
effects may occur if smoke inhalation accompanies the burn.
For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:
1. Don't remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering
materials or exposed to smoke or heat.
2. Don't immerse severe large burns in cold water. Doing so could cause shock.
3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of
circulation, begin cardiopulmonary resuscitation (CPR).
4. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.
1. Remove the cause of the burn by flushing the chemicals off the skin surface with cool, running water for 15
minutes or more. If the burning chemical is a powder-like substance such as lime, brush it off the skin before
flushing.
3. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.
The victim has signs of shock, such as fainting, pale complexion or breathing in a notably shallow manner.
The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn covers an area
more than 2 to 3 inches in diameter.
The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint.
An electrical burn may appear minor or not show on the skin at all, but the damage can extend deep into the tissues
beneath your skin. If a strong electrical current passes through your body, internal damage, such as a heart rhythm
disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the electrical burn can cause you to be
thrown or to fall, resulting in fractures or other associated injuries.
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Dial 911 or call for emergency medical assistance if the person who has been burned is in pain, is confused, or is
experiencing changes in his or her breathing, heartbeat or consciousness.
While helping someone with an electrical burn and waiting for medical help, follow these steps:
1. Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may
pass the current through you.
2. Turn off the source of electricity if possible. If not, move the source away from both you and the injured
person using a nonconducting object made of cardboard, plastic or wood.
3. Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary
resuscitation (CPR) immediately.
4. Prevent shock. Lay the person down with the head slightly lower than the trunk and the legs elevated.
5. Cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze bandage, if
available, or a clean cloth. Don't use a blanket or towel. Loose fibers can stick to the burns.
Domestic pets cause most animal bites. Dogs are more likely to bite than cats. Cat bites, however, are more likely to
cause infection. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is more
common in raccoons, skunks, bats and foxes than in cats and dogs. Rabbits, squirrels and other rodents rarely carry
rabies. If an animal bites you or your child, follow these guidelines:
For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a minor wound.
Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover the bite
with a clean bandage.
For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding,
apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.
For infection. If you notice signs of infection such as swelling, redness, increased pain or oozing, see your doctor
immediately.
For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies — any bite from a
wild or domestic animal of unknown immunization status — see your doctor immediately.
Doctors recommend getting a tetanus shot every 10 years. If your last one was more than five years ago and your wound
is deep or dirty, your doctor may recommend a booster. You should have the booster within 48 hours of the injury.
Falls put you at risk of serious injury. Prevent falls with these fall-prevention measures.
Your odds of falling each year after age 65 are about one in three. Fortunately, most of these falls aren't serious. Still, falls
are the leading cause of injury and injury-related death among older adults. You're more likely to fall as you get older
because of common, age-related physical changes and medical conditions — and the medications you take to treat such
conditions.
You needn't let the fear of falling rule your life. Many falls and fall-related injuries are preventable with fall-prevention
measures. Here's a look at six fall-prevention approaches that can help you avoid falls.
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Fall-prevention step 1: Make an appointment with your doctor
Begin your fall-prevention plan by making an appointment with your doctor. You and your doctor can take a
comprehensive look at your environment, your health and your medications to identify situations when you're vulnerable to
falling. In order to devise a fall-prevention plan, your doctor will want to know:
What medications are you taking? Include all the prescription and over-the-counter medications you take, along
with the dosages. Or bring them all with you. Your doctor can review your medications for side effects and
interactions that may increase your risk of falling. To help with fall prevention, he or she may decide to wean you off
certain medications, especially those used to treat anxiety and insomnia.
Have you fallen before? Write down the details, including when, where and how you fell. Be prepared to discuss
instances when you almost fell but managed to grab hold of something just in time or were caught by someone.
Could your health conditions cause a fall? Your doctor likely wants to know about eye and ear disorders that
may increase your risk of falls. Be prepared to discuss these and to tell him or her how you walk — describe any
dizziness, joint pain, numbness or shortness of breath that affects your walk. Your doctor may then evaluate your
muscle strength, balance and individual walking style (gait).
If you aren't already getting regular physical activity, consider starting a general exercise program as part of your fall-
prevention plan. Consider activities such as walking, water workouts or tai chi — a gentle exercise that involves slow and
graceful dance-like movements. Such activities reduce your risk of falls by improving your strength, balance, coordination
and flexibility. Be sure to get your doctor's OK first, though.
If you avoid exercise because you're afraid it will make a fall more likely, bring this concern to your doctor. He or she may
recommend carefully monitored exercise programs or give you a referral to a physical therapist who can devise a custom
exercise program aimed at improving your balance, muscle strength and gait. To improve your flexibility, the physical
therapist may use techniques such as electrical stimulation, massage or ultrasound. If you have inner ear problems that
affect your balance, he or she may also teach you balance retraining exercises (vestibular rehabilitation) — which involve
specific head and body movements to correct loss of balance.
Consider changing your footwear as part of your fall-prevention plan. High heels, floppy slippers and shoes with slick
soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead:
Have your feet measured each time you buy shoes, since your size can change.
Buy properly fitting, sturdy shoes with nonskid soles.
Avoid shoes with extra-thick soles.
Choose lace-up shoes instead of slip-ons, and keep the laces tied.
Select footwear with fabric fasteners if you have trouble tying laces.
Shop in the men's department if you're a woman who can't find wide enough shoes.
If bending over to put on your shoes puts you off balance, consider a long shoehorn that helps you slip your shoes on
without bending over.
As part of your fall-prevention measures, take a look around you — your living room, kitchen, bedroom, bathroom,
hallways and stairways may be filled with booby traps. Clutter can get in your way, but so can the decorative accents you
add to your home. To make your home safer, you might try these tips:
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Remove boxes, newspapers, electrical cords and phone cords from walkways.
Move coffee tables, magazine racks and plant stands from high-traffic areas.
Store clothing, dishes, food and other household necessities within easy reach.
As you get older, less light reaches the back of your eyes where you sense color and motion. So keep your home brightly
lit with 100-watt bulbs or higher to avoid tripping on objects that are hard to see. Don't use bulbs that exceed the wattage
rating on lamps and lighting fixtures, however, since this can present a fire hazard. Also:
Place a lamp near your bed and within reach so that you can use it if you get up at night.
Make light switches more easily accessible in rooms. Make a clear path to the switch if it isn't right near the room
entrance. Consider installing glow-in-the-dark or illuminated switches.
Turn on the lights before going up or down stairs. This might require installing switches at the top and bottom of
stairs.
Your doctor might recommend using a cane or walker to keep you steady. Other assistive devices can help, too. All sorts
of gadgets have been invented to make everyday tasks easier. Some you might consider:
Grab bars mounted inside and just outside your shower or bathtub.
A raised toilet seat or one with armrests to stabilize yourself.
A sturdy plastic seat placed in your shower or tub so that you can sit down if you need to. Buy a hand-held shower
nozzle so that you can shower sitting down.
Handrails on both sides of stairways.
Nonslip treads on bare-wood steps.
Ask your doctor for a referral to an occupational therapist who can help you devise other ways to prevent falls in your
home. Some solutions are easily installed and relatively inexpensive. Others may require professional help and more of
an investment. If you plan on staying in your home for many more years, an investment in safety and fall prevention now
may make that possible.
Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin. The venom
triggers an allergic reaction. The severity of your reaction depends on your sensitivity to the insect venom or substance.
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Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling
that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. You might
experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of
people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include facial
swelling, difficulty breathing and shock.
Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from mosquitoes,
ticks, biting flies and some spiders also can cause reactions, but these are generally milder.
Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the
affected area with soap and water. Don't try to pull out the stinger; doing so may release more venom.
To reduce pain and swelling, apply a cold pack or cloth filled with ice.
Apply 0.5 percent or 1 percent hydrocortisone cream, calamine lotion or a baking soda paste — with a ratio of 3
teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day until your symptoms subside.
Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate
(Chlor-Trimeton, Teldrin).
Allergic reactions may include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches in diameter at
the site. See your doctor promptly if you experience any of these signs and symptoms.
Severe reactions may progress rapidly. Dial 911 or call for emergency medical assistance if the following signs or
symptoms occur:
Difficulty breathing
Swelling of your lips or throat
Faintness
Dizziness
Confusion
Rapid heartbeat
Hives
Nausea, cramps and vomiting
Take these actions immediately while waiting with an affected person for medical help:
1. Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-
injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-
injector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10
seconds to enhance absorption.
2. After administering epinephrine, have the person take an antihistamine pill if he or she is able to do so without
choking.
3. Have the person lie still on his or her back with feet higher than the head.
4. Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.
5. If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
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http://www.redcross.org
RESPIRATORY ARREST
CAUSES:
1. Strangulation
2. Poisoning-Injection, Ingestion, Inhalation
Injection- Snakebite, Rabies, Scorpions, bees, jellyfish, spiders
3. Severe Bleeding
4. Drowning
5. Electrocution
6. Suffocation
7. Choking: Universal Sign of Choking- palms guarding throat
8. Disease
With Good Air Exchange Victim can still TALK Observe the victim as he cough out
obstruction
With Poor Air Exchange Victim produces wheezing sound Abdominal Thrust / Heimlich
Maneuver
5. Artificial Respiration 2X if
effective
First Aid: Artificial Respiration (AR) – Giving of artificial air only either through a blow or ambubag
- chest compression not indicated because there is pulse rate
Rate of Blows 1 Blow every 5 secs 1 Blow every 4 secs 1 Blow every 3 seconds
12 blows per min 15 blows per min 20 blows per min
WHEN TO STOP
CARDIAC ARREST
CAUSES
All causes of Respiratory Arrest, Heart Attack, Stroke Danger of Failure to revive Patient:
Rate 15 ECC/2 blows 4X/min 5ECC/1 blow 15X/min 5ECC/1 blow 20X/min
DON’T’S IN CPR:
SEQUENCE:
66