NCLEX-RN REVIEWER - KILLS BACTERIA

- EX: CLOSTRIDIUM DIFICILLE

- WOF: Explosive Diarrhea

GASTROINTESTINAL 1. OMEPRAZOLE
2. ESOMEPRAZOLE
3. PANTOPRAZOLE
PEPTIC ULCER DRUGS
WHEN TO TAKE?!
- WITHOUT MEAL
ANTACIDS - WITH APPLE JUICE ONLY
- NEUTRALIZE THE ACIDITY OF HCL
- INCREASE PH LEVEL UP TO 5PH AT RISK FOR OSTEOPOROSIS!
- PROVIDE ALKALINE ENVIRONMENT
- ALSO KNOWN AS PHOSPHATE SUCRALFATE
BINDERS - COATS THE ULCER
- GIVEN TO ESRD PATIENTS TO - BLOCKS ABSORPTION OF ORAL
DECREASE SERUM PHOSPHORUS DRUGS: esp: DIGOXIN, WARFARIN
LEVELS (COUMADIN)
- Give medications TWO HOURS APART
1. ALUMINUM- SE: Constipation
2. MAGNESIUM- (LAXATIVE)
1. CARAFATE
Aluminum + Magnesium= MAALOX
3. CALCIUM CARBONATE- WHEN TO TAKE?!
contraindicated to MILK, YOGURT, - AN HOUR BEFORE MEAL
VITAMIN D
Will lead to MILK ALKALINE
SYNDROME
MISOPROTOL (CYTOTEC)
4. SODIUM BICARBONATE - INCREASE NATURAL MUCUS
SECRETION BICARBONATE LAYER OF
WOF: METABOLIC ALKALOSIS!!! THE STOMACH
- CONTRAINDICATED TO
WHEN TO TAKE?! PREGNANCY causes ABORTION
- AFTER MEAL - EXPECTED PROBLEM: DIARRHEA
- 1-3 HR AFTER MEAL - INDICATED TO PEOPLE THAT USES
LONG TERM NSAIDS
H2 RECEPTOR ANTAGONIST WHEN TO TAKE?!
- DECREASE HCL PRODUCTION - WITH MEAL
- (HCL KILLS BACTERIA)

1. RANITIDINE NSAIDS
2. FAMOTIDINE - ULCERATIVE/ MAY CAUSE ULCER
3. CIMETIDINE- SE- Mild Diarrhea - DECREASES MUCUS PROTECTION
- Can cross BLOOD BRAIN BARRIER to - WOF: PEPTIC ULCER DISEASE
ELDER PATIENTS
- WOF: PSYCHOSIS 1. NAPROXEN
o DEPRESSION 2. IBUPROFEN
o ANXIETY 3. CELECOXIB (CELEBREX) – Not
ulcerative but can cause ANGINA
WHEN TO TAKE?!
- Saunders: without meal
- Kaplan: With meal
- NCLEX: WITH MEALS

PROTON PUMP INHIBITORS

- DECREASE HCL PRODUCTION

PATROLFUSRN23
 PROBANTHINE BETHANICOL - GASTRIC EMPYTING TIME: 2-3 HOURS
Anticholinergic Cholinergic AFTER MEAL
DECREASES: INCREASES:
SECRETION SECRETIONS S/SX:
URINE OUTPUT URINE OUTPUT 1. WEIGHT GAN
PERISTALSIS PERISTALSIS 2. MORE MELENA THAN HEMATEMESIS
DILATE PUPIL CONSTRICT PUPILS
PRIORITY!
 WOF BRIGHT RED HEMATEMESIS
(arterial hemorrhage)
 PERFORATION- PERITONITIS
GASTRIC ULCER DISEASE  COFFEE GROUND EMESIS (venous
- TRIGGER BY HCL hemorrhage)
RISK FACTORS: MOST COMMON DRUG:
- NSAIDS USER 1. METRONIDAZOLE
- STEROIDS - Teratogenic
- ASPIRIN - Disulfiram- avoid alcohol; liquior
- EMPTY STOMACH
DUMPING SYNDROME
S/SX: - NOT A DSE, A COMPLICATION
1. PAIN with food intake or 30 mins to 1 hour - CAUSE OF POST OPERATIVE
post meal GASTRECTOMY
2. WEIGHT LOSS - PASSAGE OF HYPEROSMOTIC FOOD
3. MORE HEMATEMESIS- decreases pain (Osmosis: movement of water from LOWER to
HIGHER CONCENTRATION)
PRIORITY!
 WOF BRIGHT RED HEMATEMESIS S/SX:
(arterial hemorrhage) EARLY MANIFESTATION:
 PERFORATION- PERITONITIS 1. HYPOTENSION- d/t plasma of blood goes
 COFFEE GROUND EMESIS (venous to hyperosmotic food hypovolemia
hemorrhage) 2. HYPOVOLEMIA
- PALE SKIN
MANAGEMENT: - DIAPHORESIS
1. PEPTIC ULCER DRUGS - COLD SKIN
2. PARTIAL GASTRECTOMY/ - PALPITATION
ANTHRECTOMY 3. INCREASE PERISTALSIS- DIARRHEA
(ANTHRUM=PYLORUS)
- Anthrum contains parietal cells which MNGT OF EARLY MANIFESTATIONS:
produces HCL and intrinsic factor that is 1. LOW NA DIET
responsible for VIT B12 ABSORPTION 2. NO SOFT FOODS, NO FLUIDS WITH
- SE: PERNICIOUS ANEMIA FOOD
- MOST COMMON COMPLICATION : 3. HIGH PROTEIN DIET- to decrease
DUMPING SYNDROME peristalsis
EX: 4. HIGH FAT- to decrease peristalsis
BILROTH I (DUODENUM) 5. AVOID UPRIGHT POSITION AFTER
BILROTH II (JEJUNUM) EATING, SUPINE AFTER EATING
(30MINS)
DUODENAL ULCER DISEASE
- ULCERATION BELOW THE LATE MANIFESTATION:
PYLORIC AREA 1. HYPOGLYCEMIA
- TOO MUCH HCL
RISK FACTORS: MNGT OF LATE MANIFESTATIONS:
- STRESS 1. LOW CARB DIET
- H. PYLORI BACTERIAL INFECTIONS 2. AVOID SUGAR (PREVENT)
3. DON’T EAT- to prevent insulin production

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INFLAMMATORY BOWEL DISEASE 2. STEROIDS
- AVOID STRESS TO PREVENT 3. AVOID STRESS
EXACERBATION
- UNKNOWN CAUSE GASTROESOPHAGEAL REFLUX
- LIFETIME DISEASE - OPEN/ INCOMPETENT LES
GOAL: INCREASE PERISTALSIS/ FASTER
1. CROHN’S DISEASE GASTRIC EMPTYING
- “REGIONAL ENTERITIS”
- AFFECT TERMINAL ILEUM, SMALL S/SX:
INTESTINE 1. HEARTBURN
- MALABSORPTION 2. ACID REFLUX
- WILL LEAD TO PERNICIOUS ANEMIA 3. DYSPHAGIA

S/SX: Avoid anticholinergics.

1. WEIGHT LOSS
2. STEATORRHEA- FATTY FOODS  PRIORITY: PREVENT EROSIVE
3. 5-6 SOFT STOOLS PER DAY ESOPHAGITIS!
4. RIGHT LOWER QUADRANT PAIN
(ILEUM PAIN) MNGT.
- NO CAFFEINE- increases HCL
 PRIORITY! PERFORATION- ALCOHOL- increases HCL
PERITONITIS SPICY- increases HCL
HIGH FAT- slows down peristalsis
- REMAIN UPRIGHT, 2-3 HOURS
AFTER GASTRIC EMPTYING
2. ULCERATIVE COLITIS - AVOID CONSTRICTIVE CLOTHING
- INFLAMMATION OF SIGMOID - ELEVATE HOB WHEN SLEEPING, USE
COLON 2-3 PILLOWS
- DEFICIENCY OF VIT K
- AVOID HEAVY LIFTING
- MAY LEAD TO IRON DEFICIENCY
ANEMIA MEDS:
1. CHOLINERGIC- INCREASE
S/SX: PERITALSIS
1. LEFT QUADRANT PAIN 2. PROKINETIC AGENTS-
2. 10-30 STOOLS PER DAY, WATERY, METOCLOPROMIDE (PLASIL,
BLOODY DEHYDRATION REGLAN)- INCREASE PERISTALSIS
3. PPI FOR 8WKS/2MOS IF EROSIVE
DRUGS ESOPHAGITIS OCCURS
1. IMMUNOSUPRESSANTS
- PREDNISONE (STEROIDS)
- MYCOPHENOLATE (CELLCEPT) GALLBLADDER DISEASE
- METHOTREXATE
GALLBLADDER:
MNGT FOR DIARRHEA: - BILE STORAGE
- ANTIDIARRHEAL - BILE- EMULSIFY FAT
- ANTICHOLINERGIC- to decrease
peristalsis PROBANTHINE FATTY FOOD RELEASE OF
- LOW FIBER DIET CHOLECYSTOKININ GB CONTRACTS
- LOW RESIDUE DIET, milk, pulps
MNGT FOR INFLAMMATION: RBC
1. DRUG OF CHOICE: SULFAZALINE - HEMOLYSIS AFTER 120 DAYS
(AZULFIDINE) - BYPRODUCT IS BILIRUBIN: DIRECT
- WOF: KIDNEY STONES (STOOL) AND INDIRECT
- SULFA BASED DRUGS, CRYTALIZE
- INCREASE ORAL FLUID INTAKE

PATROLFUSRN23
CHOLELITHIASIS 3. COUGHING EXERCISES AND DEEP
- STONE IN THE GALLBLADDER BREATHING
- STONE OBSTRUCTION
EXOCRINE FUNCTIONS OF PANCREAS
S/SX: - CHEMICAL ENZYMES/DIGESTIVE
1. ACHOLIC STOOL/PALE ENZYMES
COLORED/CLAY COLORED - AMYLASE & LIPASE
2. JAUNDICE- INREASED INDIRECT
BILIRUBIN ACUTE PANCREATITIS
3. DARK/TEA COLORED URINE - PANCREAS CAN EAT ITSELF=
4. STEATORRHEA- FAT AUTODIGESTION
MALABSORPTION - DESTRUCTS ITS OWN TISSUE
5. VIT ADEK DEFICIENCY- RF:
MALABSORPTION - CHOLELITHIASIS- CAN DESTROY
PANCREAS
CHOLECYSTITIS
- INFLAMMATION OF THE  PRIORITY IS CIRCULATION!!
GALLBLADDER
AUTODIGESTION:
S/SX: 1. SEVERE PAIN (MID EPIGASTRIC/LLQ
1. RIGHT UPPER QUADRANT PAIN RADIATING TO THE BACK)
2. PAIN 2-4 HOURS AFTER EATING 2. PAINFUL BREATHING- AT RISK FOR
FATTY MEAL PNEUMONIA
3. MURPHY’S SIGN- examiner palpates GB 3. BLEEDING- BLOOD LOSS, DECREASE
then ask to inhale, it will result to pain while BP
inhalation WOF: HYPOVOLEMIC SHOCK- IV
FLUIDS
 PRIORITY IS PNEUMONIA AND 4. CULLEN’S SIGN- BLUISH/ PURPLISH
ATELECTASIS DISCOLORATION OF ABDOMEN
- Painful breathing causes SHALLOW 5. TURNER’S SIGN- BLUISH/ PURPLISH
BREATING- @RISK DICOLORATION OF FLANK AREA
CULLEN AND TURNER’S SIGN INDICATIVE
MNGT. OF INTERNAL BLEEDING
1. PAIN MNGT 6. HYPOCALCEMIA
 DEMEROL - Paresthesia
 PROBANTHINE- DECREASES - Tetany
GB CONTRACTION - Muscle spasm
2. COUGH AND DEEP BREATHING - CHVOTEK’S SIGN- facial stimulation
EXERCISES gives facial spasm
3. LOW FAT DIET, AVOID GAS FORMING - TROUSSEAU’S SIGN- with use of BP
FOOD app, BP +20 systolic maintain inflated over
4. SURGERY: CHOLECYSTECTOMY 2-5mins will result to carpopedal spasm
7. STEATORRHEA- MALABSORPTION
CHOLECYSTECTOMY
- AFTER SURGERY, T-TUBE WILL BE CHRONIC PANCREATITIS
INSERTED TO DRAIN BILE - MAY LEAD TO DESTRUCTION OF
1. FIRST 24 HOURS, RED TO BROWN ENDOCRINE FUNCTION
300-500ML - DM
2. AFTER 24 HOURS, GREEN TO
BROWN 500-1000ML MNGT.
1. PAIN MNGT.
NSG MNGT. - DEMEROL
1. ELEVATE HOB - HYDROMORPHONE
2. ANALGESIC 2. COUGH AND DBE TO PREVENT
PNEUMONIA AND ATELECTASIS

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 3.SAVE THE PANCREAS! NO ENZYME HEPATIC ENCEPHALOPATHY
PRODUCTION
 NPO, STOP AUTODIGESTION STAGE 1: IMPAIRED HAND WRITING
 NGT SUCTION STAGE 2: ASTEREXIS- FLAPPING TREMORS
 H2 RECEPTOR ANTAGONIST CONFUSION/ DISORIENTATION
 PPI STAGE 3: ALTERED LOC
 ANTICHOLINERGIC STAGE 4: COMA
4. FOOD INTAKE
- FOOD + PANCREATIC ENZYME DIET: LOW PROTEIN DIET 15-30G/DAY to
REPLACEMENT EACH MEAL prevent muscle destruction
EX: PANCREALIPASE, PANCREATIN FROM HIGH BIOLOGICAL VALUE PROTEIN
complete AMINO ACIDS EX: chicken breast
GOAL TO DECREASE STEATORRHEA LOW FAT DIET (NO BILE)
HIGH CARBS, HIGH CALORIE for energy
CIRRHOSIS
- DESTRUCTION OF THE LIVER MED MNGT.
1. LACTULOSE- OSMOTIC LAXATIVE
CAUSES: TYPES: - ACID- Which binds to ammonia
ALCOHOLISM LAENNEC’S - Excrete ammonia in the feces
BILE OBSTRUCTION BILIARY
CONGESTIVE HF CARDIAC GOAL: IMPROVE LOC
DESTRUCTION POST NECROTIC BOWEL 2-3 TIMES PER DAY

1. DRUG: ACETAMINOPHEN MNGT. (DESTROY COLONIC BACTERIA)

- NEED: MILK THISTLE (SILYMARINE) 1. ANTIBIOTICS
- ACETYLCYSTEINE - METRONIDAZOLE
2. HEPATITIS C, B, D - NEOMYCIN- OTOTOXIC,
NEPHROTOXIC
FUNCTIONS OF THE LIVER:
1. DETOXIFY BLOOD- KUPPFER CELLS PORTAL HYPERTENSION
REMOVE BILIRUBIN - ACCUMULATION OF BLOOD IN THE
2. PRODUCE ALBUMIN ESOPHAGEAL VEINS
3. INCHARGE IN HORMONES 1. SPLEENOMEGALY
4. VIT K SYNTHESIS- CLOT FORMATION 2. HEMORRHOIDS
3. ASCITES- IV ALBUMIN, K SPARRING
S/SX: DIURETICS (AMILORIDE)
1. ANOREXIA- TOXINS OF THE BLOOD MNGT. PARACENTESIS, ELEVATE
2. JAUNDICE HOB
3. CLAY COLORED STOOLS 4. ESOPHAGEAL VARICES
4. EDEMA- DECREASE ALBUMIN (PRIORITY!!)
5. MALE: GYNECOMASTIA
FEMALE: VIRILISM ESOPHAGEAL VARICES
6. DECREASE CLOT FORMATION - BLOOD IN THE ESOPHAGEAL VEINS
7. HEPATOMEGALY – EARLY SIGN - DILATED
8. SHRINK LIVER- LATE SIGN - ANYTIME CAN RUPTURE
- PAINLESS, NON-STOP BLEEDING
COMPLICATIONS: (DEFICIENCY IN VIT K)
1. Hepatic Encephalopathy - WILL LEAD TO HYPOVOLEMIA,
2. Esophageal Varices HEMATEMESIS, MELENA= SHOCK
3. Portal Hypertension
4. Ascites
5. Bleeding MNGT.
1. VASOPRESSIN IV- PRODUCE
VASOCONSTRICTION
2. AMINOCAPROIC ACID- TO CLOT/
STOP THE BLEEDING

PATROLFUSRN23
 3. SENGSTAKEN- BLAKEMORE TUBE- 3 MNGT.
WAY 1. AVOID ANYTHING THAT
o GASTRIC SUCTION INCREASES PERISTALSIS
o GASTRIC BALLOON PRIORITY!!!
o ESOPHAGEAL BALLOON
4. MINNESOTA TUBE- 4 WAY 2. AVOID HEAT, WILL LEAD TO
o GASTRIC SUCTION VASODILATION- RUPTURE
o GASTRIC BALLOON 3. AVOID ENEMA
o ESOPHAGEAL BALLOON 4. AVOID LAXATIVES
o ESOPHAGEAL SUCTION 5. NO PAIN MEDS- WILL MASK
RUPTURE
MNGT FOR TUBES: 6. NPO
1. ELEVATE HOB 7. IV LINE
2. SCISSORS, FOR RESPI DISTRESS, TO
CUT TUBES, REMOVE NGT S/SX:
3. LABEL TUBES 1. LOW GRADE FEVER
2. SEVERE PAIN
DIVERTICULAR DISEASE 3. NAUSEA
- UNKNOWN CAUSE 4. ANOREXIA
- OUTPOUCHING IN SIGMOID COLON 5. PSOAS’ SIGN- Pain in HIP EXTENSION
- LIFETIME DSE 6. BLOOMBERG’S SIGN- AKA
RF: “REBOUND TENDERNESS”
- LOW FIBER DIET 7. ROVSING’S SIGN- PALPATE @LEFT,
- AGING FEELS PAIN @RIGHT
8. ABDOMINAL GUARDING- ABD SPASM
DIVERTICULOSIS
-NO S/SX
MNGT
DIET: HIGH FIBER DIET
AVOID NUTS, SEEDS, STRAINING

DIVERTICULITIS
S/SX:
- LEFT LOWER QUADRANT PAIN
- LOW GRADE FEVER
- ALTERNATING CONSTIPATION AND
DIARRHEA
- BLOODY STOOL

MNGT.
- LOW FIBER DIET
- ANTICHOLINERGIC- TO DECREASE
PERISTALSIS

 PRIORITY: RUPTURE= PERITONITIS

(PAIN IN ALL QUADRANTS)

APPENDICITIS
- UNKNOWN CAUSE
- ENEMY: PERISTALSIS- IT WILL
INCREASE PRESSURE IN THE
APPENDIX
- THEORY: FECALITH

PATROLFUSRN23
 RESPIRATORY CHRONIC: (PREVENTS ATTACK)
1. MAST CELLS STABILIZERS
2. ANTI-LEUKOTRINE
ASTHMA
- HYPERSENSITIVITY REACTION
- TRIGGERED BY:
BRONCHODILATOR
 ALLERGENS
- RELAXES SMOOTH MUSCLE/ DECREASE
SMOOTH MUSCLE CONTRACTION
 DUST - HAVE SNS EFFECT
 MOLDS o INCREASED BP HPN
 STRESS o INCREASED HR TACHYCARDIA
 SMOKE o INCREASED GLUCOSE HYPERGLY
- CONTRAINDICATED TO: STIMULANTS:
 MEDICATION o Avoid: COFFEE, TEA, COLA AND
- ACE INHIBITORS CHOCOLATE
- BETA BLOCKERS TYPES: BETA AGONISTS & XANTHINES
- NSAIDS
- ASPIRIN BETA AGONIST
- FIRST LINE DRUGS
TRIGGERS WILL LEAD TO ASTHMA EX: epinephrine
ATTACK! Albuterol
Metaproterenol
1. SMOOTH MUSCLE CONTRACTION Isoproterenol
2. AIRWAY EDEMA
3. INCREASED MUCUS SECRETION XANTHINES
EX: theophylline
S/SX: Aminophylline-
1. EXPIRATORY WHEEZING- Partial Obstruction THERAPEUTIC LEVEL 10-20MCG/DL
2. DYSPNEA- INCREASED RR
3. EARLY ABG: RESPIRATORY ALKALOSIS
4. SUDDEN DIMINISHED WHEEZING-
COMPLETE OBSTRUCTION
STEROIDS
5. EXHAUSTION - DECEREASE AIRWAY INFLAMMATION
6. LATE ABG: RESPIRATORY ACIDOSIS d/t - RELIEVES AIRWAY EDEMA
close airway increased CO2 - DO NOT STOP ABRUPTLY, TAPER THE
DOSE
DX: -EX: triamcinolone
1. PEAK FLOW METER Methylprednisone
- USED AS DAILY BASIS - TAKEN VIA METERED DOSE INHALER
- INCREASED WOF
- USED TO MEASURE FORCE EXPIRATORY
VOLUME (FEV) SALT HYPERNATREMIA
- STEPS: SUGAR HYPERGLYCEMIA
o TAKE A DEEP BREATH OR INHALE SEX SECONDARY SEX CHR.
COMPLETELY
o BLOW OUT HARD AND FAST STEROIDS:
o RECORD THE READING ON THE - EXCRETE CALCIUM: prone to FRACTURE
METER: (record the 3rd time!) - HYDROGEN: prone to METABOLIC
80-100%- GREEN, GOOD ALKALOSIS
<80%- YELLOW, TAKE MEDICATIONS - RETAIN FATS- Buffalo hump; truncal obesity
<60% RED, EMERGENCY - OSTEOPOROSIS- d/t excretion of Ca
- IMMUNOSUPPRESSION- decreased activity of
immune system; prone to infections
ASTHMA DRUGS
- DELAYED WOUND HEALING
- SEVERE MUSCLE WASTING- thin extremities
ACUTE: (During attack)
1. BRONCHODILATOR
2. STEROIDS
3. ANTICHOLINERGIC

PATROLFUSRN23
METERED DOSE INHALER 2. INCREASE SIZE OF GOBLET CELLS-
- S/E: ORAL THRUSH/ ORAL FUNGAL increased mucus; THICK, medium for infection
INFECTIONS 3. DYSFUNCTIONAL CILIA

MNGT. MNGT.
1. RINSE THE MOUTH AFTER USING 1. INCREASE FLUIDS
2. SUCTION
STEPS ON HOW TO USE MDI: 3. VACCINES; ANTIBIOTICS
1. Remove cover and shake 4. POSTURAL DRAINAGE
2. Exhale and extend the neck 5. EXPECTORANTS
3. One to 2 inches away if without spacer 6. CHEST PHYSIOTHERAPY
4. Press during inhalation
5. Exhale after 10 seconds EMPHYSEMA
6. Next dose: 1 min apart if SAME DRUG - PINK PUFFER- d/t increase CO2, vasodilate,
5 min apart if DIFF DRUG erythema
- PATHO:
ANTICHOLINERGIC 1. DECREASED ALPHA 1 ANTIRYPSIN
- DECREASE MUCUS SECRETIONS 2. DAMAGE IN THE ALVEOLAR WALL
- DECREASE PERISTALSIS, UO AND PUPIL 3. NOT ELASTIC, NOT PASSIVE EXHALATION
DILATION
-S/E: CONSTIPATION- Increase fiber; fluid intake - BARREL CHEST- hyperinflation of the lungs;
and activities increased anterior posterior diameter
- CONTRAINDICATED TO: BPH! In XRAY will see FLAT DIAPHRAGM

MAST CELL STABILIZERS MNGT.

- FOR LONG TERM ASTHMA 1. PURSED LIP BREATHING- use of diaphragm to
EX: Chromolyb expel CO2
Medocromyl - uses effort= WEIGHT LOSS
- WITH AN UNPLEASANT TASTE DIET: INCREASE CALORIE; INCREASE
- GIVE WITH SIPS OF WATER PROTEIN; DECREASE CARBS!
- GIVE 30 MINUTES BEFORE EXPOSURE * bcoz carbohydrates have end product of carbon
dioxide
ANTILEUKOTRINE
- EX: zafirlukast S/SX:
Montelukast- HEPATOTOXIC (check liver - CHRONIC COUGH/ SMOKERS COUGH
enzymes) - PRODUCTIVE MUCUS
- GIVEN ONE HOUR BEFORE MEAL - DYSPNEA ON EXERTION (expected)
- CLUBBING OF FINGERS
-02 SAT OF 88-91% (expected)
- 1-2L/min of o2 only
COPD
-RF: They can have: POLYCYTHEMIA VERA
o SMOKING - INCREASE RBC d/t DECREASE 02
o INDUSTRIAL CHEMICALS
o POLLUTION Patho:
- TYPES: BRONCHITIS& EMPHYSEMA 1. KIDNEY STILL PRODUCES
ERYTHROPOIETIN
BRONCHITIS 2. BONE MARROW FORMS RBC
-INFLAMMATION 3. INCREASE BLOOD VISCOSITY
- BLUE BLOATERS 4. CLOT FORMATION
5. THROMBUS--- EMBOLI
GOAL IS TO EXPEL MUCUS
MNGT.
-PATHO: 1. HIGH FOWLERS- achieve maximum lung
1. NARROW AIRWAY expansion
2. O2 BY MASK

PATROLFUSRN23
 3. CORRECT THE UNDERLYING CAUSE - ASYMMETRICAL BREATHING
4. PREPARE FOR INTUBATION, - (-) BREATH SOUNDS ON THE
MECHANICAL VENTILATION AFFECTED SIDE
- CHEST PAIN, PLEURITIC PAIN
- DYSPNEA
MECHANICAL VENTILATION
- BRING OXYGEN REACH PLEURAL EFFUSION
ALARMS: PNEUMOTHORAX NO LUNG LUNG
 HIGH PRESSURE ALARM: kinks, HEMOTHORAX EXPANSION. COLLAPS
obstruction, secretions
 LOW PRESSURE ALARM: removal from
the client, leak, pt has NO SPONTANEOUS CHEST TUBE
BREATHING - RESTORE NEGATIVE PRESSURE
Never turn off the alarm!! INSIDE THE LUNGS
MODES: - POSITION: ORTHOPNEIC
1. CONTROLLED VENTILATION- pt has no - DRAINED BY GRAVITY
spontaneous breathing - 2ND-3RD ICS AIR
2. ASSISTED VETILATION- pt is preparing - 4TH-5TH ICS FLUID
for weaning
3. SYNCRONIZED INTERMITTENT
MANDATORY VENTILATION (SIMV)-
pt is preparing for extubation
COMPLICATION!
- ATELECTASIS HAPPENS DURING
EXHALATION
DB WS SCB
SETTINGS:
CPAP PEEP DRAINAGE
CONTINUOS POSITIVE END - N= <100ML PER HOUR
POSITIVE AIRWAY EXPIRATORY - >100ML, BRIGHT RED= ACTIVE
PRESSURE PRESSURE BLEEDING; NOTIFY PHYSICIAN
STABLE CONDITION UNSTABLE WATER SEAL
COMPLICATION: - N= GENTLE INTERMITENT BUBBLING
PNEUMOTHORAX - DURING EXHALATION AND
DX. XRAY COUGHING
- TIDALLING/ FLUCTUATING/
PNEUMOTHORAX OSCILLATING/ INHALATION
SUCTION CONTROL
OPEN TENSION - REGULATES THE AMOUNT OF
hole outside air enters Increase pressure, air SUCTION APPLIED
pleural space enters the pleural space - GENTLE CONTINUOS BUBBLING
with each inhalation
and no exit during MNGT.
inhalation 1. ACCIDENTAL REMOVAL FROM THE
CLIENT
COMPLICATIONS: - Put occlusive dressing; sterile vaselinized
1. MEDIASTINAL SHIFTING gauze; 3 TAPES ONLY then inform
 PRIORITY physician
- Because of TRACHEAL DEVIATION- 2. ACCIDENTAL REMOVAL FROM THE
AIRWAY OBSTRUCTION! SYSTEM
- COMPRESSES SUPERIOR VENA CAVA - Dip into the sterile NSS
which increases CVP: DECREASED CO; REMOVAL
BP; EXTREMITIES FULL OF BLOOD 1. CHECK FIRST FOR TIDALING/
will lead to DISTENDED NECK VEINS BUBBLING
2. POSITION PT, CTT, IF STILL NO
ASSESSMENT: TIDALING

PATROLFUSRN23
 3. AUSCULTATE: BILATERAL! INCREASE VISCOSITY COMPLICATION:
4. CHECK TIME ALWAYS 1. THROMBUS FORMATION- EMBOLI
5. EXHALES OR BEAR DOWN/ @RISK FOR stroke and MI
VALSALVA MANUEVER Increased CO, BP= HPN, HA, RUDDY
6. CLOSES THE MOUTH AND BLOW COMPLEXION
7. PUT OCCLUSIVE DRESSING- GAUZE- 4 NSG DX:
TAPES  RISK FOR CLOT FORMATION
 RISK FOR BLEEDING
CYSTIC FIBROSIS MNGT.
- AUTOSOMAL RECESSIVE DISORDER 1. PHLEBOTOMY
- BOTH PARENT CARRIES GENES OF 2. INCREASE FLUID- DECREASE BLOOD
C.F. VISCOSITY
- CHROMOSOMAL TRANSFER 3. ANTICOAGULANT
- EXOCRINE GLAND DISORDER- with
ducts IRON DEFICIENCY ANEMIA
SWEAT GLAND - CAUSES:
PANCREAS o BLOOD LOSS
SEX GLAND o DIET
MUCUS GLAND o GI ABSORPTION
SWEAT GLAND
- IRON BINDS HEMOGLOBIN TO CARRY
02
- CHLORIDE SWEAT TEST- UP TO
DX: DECREASE HBG; HCT
60MEQ/L N=40MEQ/L
MICROCYTIC; HYPOCHROMIC
- SALTY SWEAT- DEHYDRATION AND
S/SX:
HYPONATREMIA so INCREASE
- PALE
FLUIDS AND SALT
- FATIGUE CLASSIC SIGN
PANCREAS
- DYSPNEA
- PRODUCES THICK ENZYME
- INCREASED HR
- NO CHEMICAL DIGESTION
- SPOON SHAPED NAILS
- MALABSORPTION= STEATORRHEA
“KOILONYCHIA”
(foul smelling, bulky stools)
- PICA (INGESTION OF INEDIBLE FOOD)
Mngt.
- ANGULAR CHLEOSIS- ULCER IN THE
1. ARTIFICIAL ENZYMES-
CORNER OF THE MOUTH
PANCREALIPASE WITH EACH MEAL
- PLUMMBER VINSON’S TRIAD
SEX GLAND
: STOMATITIS
Female= thick secretions; no sperm entry
: ATROPIC GLOSITTIS
Male= thick sperm; no sperm exit
: DYSPHAGIA
DIFFICULTY OF CONCEIVING
MUCUS GLAND
MNGT.
- INCREASE SECRETIONS
1. MNGT.
- AIRWAY OBSTRUCTION
- DIET: HIGH IN IRON= bread, beans,
Mngt.
cereals, dried fruits, citrus fruits, egg yolk,
1. POSTURAL DRAINAGE
legumes, mollusks, molasses, nuts, oatmeal,
2. EXPECTORANT
potato with skin, tofu
3. ANTIBIOTICS
- IRON SUPPLEMENTS
S/E CONSTIPATION; DARK STOOL
HEMATOLOGY (FOUL AFTER TASTE syrup)
 INCREASES ABSORPTION
POLYCYTHEMIA VERA - Empty stomach
- UNKNOWN CAUSE - With vit c
- STEM CELL DISORDER - Orange/tomato juice
(REGENERATING CELLS)  DECREASE ABSORPTION
RBC - Milk
WBC INCREASE BLOOD - Antacid
PLATELET VISCOSITY ORAL IRON: use with straw or spoon- IT STAINS

PATROLFUSRN23
IV IRON: stains skin INFECTION, ACIDOSIS,
IM= Z TRACT DEHYDRATION

PERNICIOUS ANEMIA INCREASED VISCOSITY

- VIT B12 DEFICIENCY
- “MEGALOBLASTIC ANEMIA”
- BEEFY RED TONGUE AFFECTS BLOOD FLOW
B12= Nerve Functions; maturation of RBCs
ISCHEMIA NECROSIS
Causes: (decrease tissue perfusion)
1. GASTRECTOMY- DECREASE
PARIETAL CELLS THAT RELEASES
INTRINSIC FACTOR SEVERE PAIN in any parts of the body
2. CROHN’S DSE- INFLAMMATION OF
ILEUM, TIRED OF ABSORPTION MNGT.
S/SX: 1. HYDRATION
- PALE 2. OXYGEN
- FATIGUE 3. PAIN MEDICATION
- DYSPNEA DOC: MORPHINE
- INCOORDINATION AVOID DEMEROL bcoz INDUCES
- PARESTHESIA SEIZURES AND ACIDOSIS
- SMOOTH BEEFY RED TONGUE

Normal Physiology: THALASSEMIA MAJOR

B12 ERYTHROBLAST (ERYTHROCYTES) - AUTOSOMAL RECESSIVE DISORDER
UNDERGO DNA SYNTHESIS CELL - DECREASE LIFESPAN OF RBCs,
DIVISION MATURATION (with help of B12) HEMOLYSIS
- HEME GLOBIN
DX:
-
BLOOD SMEAR = MACROCYTIC;
OVAL; MEGALOBLASTIC IRON BILIRUBIN
CONFIRMATORY TEST- SCHILLING’S TEST
 To check the absorption of B12 SPLEENOMEGALY JAUNDICE
 SPECIMEN IS URINE (24 HOUR (prone to rupture)
URINE COLLECTION)
 (-) B12URINE (+) B12 STOOL (+) MNGT.
PERNICIOUS ANEMIA 1. AVOID CONTACT SPORTS
2. SPLEENOMECTOMY
MNGT. RISK FOR INFECTION (bcoz spleen is
1. VIT B12- Intramuscular part of immune system)
- MONTHLY, LIFETIME IF S/P
GASTRECTOMY PROBLEM: IRON OVERLOAD

SICKLE CELL ANEMIA

- AUTOSOMAL RECESSIVE DISORDER
(25% chance)
- DECREASE LIFE SPAN OF RBC
10-12 DAYS ONLY THEN
DESTRUCTION OCCURS (n- 120DAYS)
- VASOOCCCLUSIVE CRISIS/ SICKLE
CELL CRISIS/ PAIN CRISIS=
Sickle shape: when exposed to trigger such
as, HYPOXIA, HIGH ALTITUDE,
TISSUE DAMAGE
Mngt. CHELATION THERAPY (will bind to iron,
will be excreted out to urine; RED URINE IS
EXPECTED
EX: DESFERAL- OTOTOXIC S/SX tinnitus
DEFEROXAMINE

PATROLFUSRN23
ENDOCRINE - GRADUAL ABSORPTION OF
COMPLEX CARBOHYDRATES (rice,
pasta, bread)
ORAL HYPOGLYCEMIC AGENTS - SLOW ABSORPTION WILL DECREASE
(OHA) INSULIN
- ONLY GIVEN TO TYPE II DM ONLY - TAKE WITH FIRST BITE OF FOOD

1. SULFONYLUREAS EX:
- STIMULATE BETA CELLS IN GLYSET
PANCREASE TO INCREASE INSULIN ACARBOSE
PRODUCTION
- RISK FOR HYPOGLYCEMIA  ALWAYS CARRY SIMPLE
S/E: weight gain d/t other glucose will go to SUGAR OF DEXTROSE
adipose tissue TABLETS
EX:
GLIPIZIDE 5. MEGLITINIDE
GLYBURIDE - INCREASES INSULIN PRODUCTION
CHLORPROPAMIDE (B CELLS)
TOLBUTAMIDE - HAS SHORT TERM EFFECT
COMPARED TO SULFONYLUREAS
 PRIORITY - WOF: HYPOGLYCEMIA
HYPOGLYCEMIA
DISULFIRAM EFFECT- avoid alcohol EX:
intake STARLIX
PRANDIN
2. THIAZOLIDINEDIONES
- INCREASE CELL SENSIVITY TO INSULIN
INSULIN
- HEPATOTOXIC INSULIN ONSE PEAK DURATI
T ON
 PRIORITY RAPID Within 1 hour 2-4 hrs
CHF ACTING ex: 15
Humalog; mins
EX: Novolog
AVANDIA FAST ACTING 30 2-4 4-6 hrs
ACTOS ex: Regular; mins hrs
Humulin R,
3. BIGUANIDES Novolin R
- STOP LIVER GLYCOGENOLYSIS
- CONTRAINDICATED TO CONTRAST INTERMEDIA 2-4 hrs 6- 24hrs
MEDIUM bcoz it will result to LACTIC TE ex: NPH; 12hrs
ACIDOSIS; (don’t combine 2 nephrotoxic LENTE
drugs)
- S/E: MILD DIARRHEA (EXPECTED0
LONG Gradu Gradu 24hrs
ACTING ex: al al
 PRIORITY
lantus; ultralente
LACTIC ACIDOSIS- MUSCLE PAIN
MIXED 30 2- 24hrs
NEPHROTOXIC- RENAL FAILURE
ex: 30% regular mins 12hrs
(oliguria, increased Creatinine and BUN)
70% NPH
Normal= Crea 0.6-1.3mg/dl
BUN 8-25mg/dl
Urine 30-60ml/hr

4. ALPHA GLUCOSIDASE INHIBITOR

PATROLFUSRN23
 - WOF: INSULIN REACTION= D. INJECT AIR FIRST
HYPOGLYCEMIA @ NPH then @ Regular
- N= 70-110mg/dl E. ASPIRATE FIRST
@Regular then @NPH (N-R-R-N)
MILD MODERATE SEVERE F. USE IN 5 MINS
Adrenaline
response will DIABETIC MELLITUS TYPE 1
activate
- INSULIN DEPENDENT
stress “fight
or flight” - JUVENILE ONSET
Hunger Decrease Unconsciousness - RAPID ONSET
Tremors brain Coma - UNKNOWN CAUSE; AUTOIMMUNE
Cold skin function Seizure - DESTRUCTION OF PANCREATIC BETA
Diaphoresis Drowsiness CELLS= NO INSULIN (wt. loss)
Anxiety Slurring of - DOC: INSULIN
Tachycardia speech
(palpitations) Incoordiation PATHO:
<60 <40 <20 CELL STARVATION

LOOK FOR ENERGY

1. NEED TO ROTATE SIGNS OF

ADMINISTRATION GLYCOGENOLYSIS
- To prevent lipodystrophy/ abnormal
insulin reaction
2. STORAGE GLUCONEOGENESIS
- VIAL: one month room temp 28C
o After a month: refrigerator
o For 7 days in UPRIGHT FATS (LIPOLYSIS) WT LOSS
POSITION
o But never store mixed insulin at KETOGENESIS
ref (another source of energy)
3. LANTUS
- Not mixed with any other insulin
4. IV INSULIN: REGULAR INSULIN DKA
ONLY - HYPERGLYCEMIA = DEHYDRATION
- Emergency
5. NO EXTREME TEMP (sunlight, freezer) S/SX:
- Avoid shaking d/t produces bubbles 1. HYPERGLYCEMIA- >180mg/dl
- Avoid giving cold insulin, will induce pain 2. GLYCOSURIA- >RENAL THRESHOLD
- Fast absorbed in the abd area 3. OSMOTIC DIURESIS:
6. SUB-Q; 27-29; HALF INCH NEEDLE - POLYURIA
7. HOW TO ROTATE? - POLYDIPSIA
- Choose one anatomical site 2 weeks - POLYPHAGIA d/t cell starvation
- Injects 1-1 ½ inches apart or 2.5cm
8. MIXTURE Trigger: DM patient no insulin and no eating!
30% REGULAR clear
70% NPH cloudy
DIABETIC KETOACIDOSIS
- STEPS: - DM 1 PT
A. WASH HAND - 300-800mg/dl
B. ROLL, ROTATE VIAL FOR ONE - INCREASE KETONES @ BLOOD
MINUTE (ketonemia; ketonuria; acetone breath/
C. ALCOHOL SPONGE FOR VIAL frothy odor)

PATROLFUSRN23
 - Ketone strips: COLOR PURPLE (+) HYPERGLYCEMIC HYPEROSMOLAR
- METABOLIC ACIDOSIS- decrease pH, NON KETOTIC SYNDROME
decrease HCO3, decrease CO2: it will
trigger KUSSMAUL’S RESP (deep, rapid,
- HYPERGLYCEMIA OF 600-2000mg/dl
breathing; expelling acid) - HYPEROSMOLAR- INCREASE
- May trigger vomiting OSMOLALITY >350 (N= 285-295)
- HYPERKALEMIA - DEADLIER THAN DKA
- (too much insulin= hypokalemia) - DEHYDRATION (mental confusion)- prone to
HHNS
 PRIORITY DEHYDRATION
 CIRCULATION Mngt.
1. HYDRATION
Mngt. 2. INSULIN- regular IV (optional)
1. HYDRATION
2. INSULIN- IV REGULAR ONLY, BOLUS VIA MORNING HYPERGLYCEMIA
INFUSION PUMP
3. POTASSIUM REPLACEMENT SOMOGYI EFFECT
4. ADD D5W UNTIL NEGATIVE KETONURIA to - MORNING INSULIN
prevent INCREASED ICP (brain loves glucose) - DECREASE EVENING INSULIN
But maintain 250mg/dl of glucose blood - HYPOGLYCEMIA AT 2AM

STRESS (RELEASE OF ADRENALINE)

DIABETES MELLITUS TYPE 2
- INSULIN SENSITIVITY (decreased insulin)
- d/t OBESITY IN AM HYPERGLYCEMIA
- NON INSULIN DEPENDENT
- OHAs ARE GIVEN MNGT.
- INSULIN are only for EMERGENCY 1. BEDTIME SNACK
- GRADUAL ONSET >30YRS OLD 2. DECREASE EVENING INSULIN
 EXERCISE
 DIET are needed
DAWN PHENOMENON
Patho: - NOCTURNAL GROWTH HORMONE RELEASE
HYPERGLYCEMIA >180
MNGT.
GLYCOSURIA 1. NPH @ BEDTIME 10PM
OSMOTIC DIURETICS
CHRONIC COMPLICATIONS
POLYURIA POLYDIPSIA - DAMAGE BLOOD VESSELS
CELL STARVATION Kidney- NEPROPATHY
Eyes- RETINOPATHY microvascular blood
Nerves- NEUROPATHY vessels
POLYPHAGIA
PERIPHERAL VASCULAR DISEASE
GLUCONEOGENESIS CAD macro
CVA vascular
GLYCOGENOLYSIS
(no lipolysis; no DKA)
Mngt.
 PRIORITY: HHNS 1. CONTROL BLOOD SUGAR
2. NO SMOKING, CONTROL BP

PATROLFUSRN23
 MICROVASCULAR PERIPHERAL VASCULAR DISEASE
NEPHROPATHY - SLOW HEALING ULCER
- STRESS FILTRATION MECHANISM
- ASYMPTOMATIC (DM FOOT CARE!!!)
 DON’T GO BAREFOOT OR EXPOSE
DX: URINALYSIS- MICROALBUMINURIA FEET
 DON’T WEAR FITFLOPS
S/SX:  MOISTURIZER/ LOTION BUT NOT IN
1. PROTEINURIA- foamy urine BETWEEN THE TOES
 FOOT IS NUMB PLUS SLOWED
DOC: HEALING, ULCERATIONS
1. ACE INHIBITORS- VASODILATOR  OBSERVE FEET DAILY
Ex: captopril, enalapril  OBTAIN PROPER FITTING OF SHOES,
BUY IN PM, AND WITH HALF INCH
RETINOPATHY ALLOWANCE
- MICROANEURYSM  TOE NAILS SHOULD BE CUT
- PRONE TO RUPTURE CAN CAUSE STRAIGHT ACROSS, AFTER BATH
HEMORRHAGE BUT IF TO HARD GO TO PODIATRIST
- WILL CAUSE BLURRING OF VISION THAT
WILL LEAD TO BLINDNESS CONN’S SYNDROME
- PRIMARY HYPERALDOSTERONISM
NEUROPATHY - INCREASE ALDOSTERONE
AUTONOMIC NEUROPATHY
1. AFFECTED URINATION- Neurogenic Anterior Pituitary Gland- controls adrenal cortex that
Bladder= NO URINE OUTPUT secretes steroids (also adrenocorticotropic hormone
2. BP- HYPOTENSION ACTH)
3. MALE ERECTION- IMPOTENCE
PERIPHERAL NEUROPATHY
- NERVE DAMAGE STEROIDS
- EARLY STAGE:

PARASTHESIA ALDOSTERONE (also called)

“Mineralocorticoid”
ALDOSTERONE
PAINFUL/BURNING SENSATION - SODIUM AND WATER RETENTION= RETAIN
BLOOD PRESSURE
- EXCRETE POTASSIUM, CALCIUM,
NUMBNESS HYDROGEN (ACID)
 INCREASED SALT
Mngt.  INCREASED H2O RETENTION
1. TRYCYLIC ANTIDEPRESSANTS (TCA)  INCREASED BP
- GIVEN TO NERVE PAINS  HYPOKALEMIA
- ex: doxepin, imipramine, amitriptyline  HYPOCALCEMIA
 DECREASED HYDROGEN
MACROVASCULAR (METABOLIC ALKALOSIS)
ATHEROSCLEROSIS  PRIORITY: CHF
- PLAQUE FORMATION IN THE ARTERY  WOF: CRACKLES/RALES
- PLAQUE OBSTRUCTION WILL LEAD TO
ISCHEMIA MNGT.
FOOT= PVD 1. Na RESTRICTION
MYOCARDIUM= CAD 2. FLUID RESTRICITON
BRAIN= CVA 3. POTASSIUM. CALCIUM REPLACEMENT
4. DIURETICS (K SPARRING DIURETICS)
EX: spironolactone/ aldactone; amiloride; triamterene

PATROLFUSRN23
C/I TO POTASSIUM WASTING: furosemide INCREASED TESTOSTERONE
- FEMALE: VIRILISM (VOICE); HIRSUTISM
TUMOR AT ADRENALS (FACIAL HAIR)
1. SURGERY
ADRENALECTOMY= HYPOTENSION; Mngt.
HYPOVOLEMIC SHOCK 1. AVOID SALT
1. lifetime steroid replacement 2. FLUID RESTRICTION
3. K SPARRING DIURETICS
TUMOR AT APG 4. CALCIUM SUPPLEMENTS
1. SURGERY 5. PRIVATE ROOM
TRANSPHENOIDAL HYPOPYSECTOMY 6. DIET: ADD PROTEIN
POSITION: semi- fowlers to PREVENT 7. SURGERY
INCREASED ICP - ADRENALECTOMY
- TRANSPHENOIDAL HYPOPYSECTOMY
Aldosterone is MINERALOCORTICOID (salt) *purpose of natural steroids is to fight long term
Cortisol is GLUCOCORTICOID (sugar) stress*
Testosterone is ANDROGEN (sex)
ADDISSON’S DISEASE
CUSHING’S SYNDROME - DECREASED STEROIDS
- INCREASED ALDOSTERONE, CORTISOL - COMMON CAUSE: S/P
AND ANDROGEN ADRENALECTOMY
CAUSES:
1. APG TUMOR OR ADRENAL CORTEX TUMOR DECREASED DECREASED DECREASED
2. LONG TERM STEROID REPLACEMENT ALDOSTERONE CORTISOL TESTOSTERONE

INCREASE ALDOSTERONE Decreased Na, H2o Hypoglycemia Impotence

- INCREASE H2O AND NA
- INCREASE BP Decreased BP, WT
- WT. AND EDEMA
- DECREASED POTASSIUM, CALCIUM, DEHYDRATION
HYDROGEN- METABOLIC ALKALOSIS

PRIORITY: CHF
WOF: CRACKLES/ RALES APG- OVER COMPENSATE: increased ACTH that
will produce increased MELANOCYTE
INCREASED CORTISOL
- FAT DEPOSITS: HYPERGLYCEMIA
- MOBILIZES PROTEIN: MUSCLE WASTING- SKIN: DARK BRONZE SKIN
MUSCLE WEAKNESS (immunosuppressed) *they
should be in neutropenic precautions* MEDS:
-OSTEOPOROSIS 1. LIFETIME STEROID TREATMENT
- FRAGILE SKIN/ FRAGILE HAIR - PREDNISONE (stress fighter)
- EASY BRUISING - Given 2/3 in MORNING 1/3 IN THE
- MOON FACE AFTERNOON (bcoz pt is
- BUFFALO HUMP immunocompromised many ppl will visit in
- TRUNCAL OBESITY the morning compared to night)
- THIN EXTREMITIES 2. FLUDROCORTISONE
- PURPLE STRIAE - EVERY MORNING
- INCREASE SALT NO SUGAR EFFECT

NSG MNGT.
1. SALT
2. FLUIDS
3. AVOID POTASSIUM, CALCIUM
4. CARBOHYDRATES

PATROLFUSRN23
EXPOSURE TO STRESS: EX: DIBENZYLINE- for prevention
PHENTOLAMINE- for emergency: to
ADDISSONIAN CRISIS treat hypertensive crisis
 PRIORITY 5. SURGERY- ADRENALECTOMY
 LIFE THREATENING SITUATION - MONITOR BP AS ALWAYS
 EX OF TRIGGER IS INFECTION

S/SX: HYPOTHAMALUS (PRODUCES ADH)

1. MUSCLE PAIN
2. HYPOTENSION
3. HYPOVOLEMIC SHOCK POSTERIOR PITUITARY GLAND
(STORAGE)
Mngt.
- AVOID STRESS ADH DIURESIS
- IV STEROIDS
- SALTY FOODS TO INCREASE SODIUM URINE PRODUCTION
- IV EMERGENCY KIT
 STEROIDS
 MEDIC ALERT BRACELET SIADH
- ONCOLOGIC EMERGENCY (ESP. LUNG
PHEOCHROMOCYTOMA CA)
- BENIGN TUMOR AT ADRENAL - TOO MUCH ADH= decreased urine
MEDULLA production
- ADRENAL MEDULLA RELEASES
CATHECOLAMINES: NOREPI AND EPI S/SX:
- (NATURAL STIMULANTS OF THE 1.URINE SPECIFIC GRAVITY
BODY) 2.URINE OSMOLALITY
NOREPINEPHRI EPINEPHRINE 3.WATER RETENTION
NE - Increased BP
(SYMPATHETIC) - Weight gain
- Increased BP - Hemodilution- decreased serum osmolality:
- Increased sugar decreased HCT, BUN, DILUTIONAL
s/sx: HYPONATREMIA= CEREBRAL EDEMA
- HPN
- HYPERGLY
- HEAT
INTOLERANCE OSMOSIS
- HYPERDIAPHOR
ESIS
- HYPERMETABOL CEREBRAL EDEMA
ISM
 PRIORITY IS
DEVELOPMENT SEIZURE/ ALTERED LOC
OF HPN CRISIS

DX TEST: VANILLYL MANDELIC ACID  PRIORITY IS INCREASED ICP!!!

- 24 HOUR URINE
MEDS:
- 14mcg/ml urine catecholamine
1. DEMECLOMYCIN
- DIURETIC
Mngt:
- FLUID RESTRICTION
1. AVOID CAFFEINATED- COFFEE, TEA,
- SEIZURE PRECAUTION
COLA, CHOCOLATES
2. AVOID ABDOMINAL PALPATION
3. NO FULL BLADDER
4. ADRENERGIC BLOCKERS:

PATROLFUSRN23
 DIABETES INSIPIDUS HYPERTHYROIDISM HYPOTHYROIDISM
- POST OP TRANSPHENOIDAL Increased T3, T4, Calcitonin Decreased
HYPOPHYSECTOMY
- ONCOLOGIC EMERGENCY EVERYTHING IS INCREASED EVERYTHING IS
- URINE IS UP TO 24L/DAY EXCEPT wt. mens & calcium DECREASED EXCEPT wt.
- DECREASED ADH men, & calcium
- POLIURIA Early
- POLYDIPSIA CNS: FINE TREMORS LETHARGY
- GIVEN: SULFONYLUREAS ENERGY: IRRITABILITY WEAKNESS
CHLORPROMIDE TEMP: HEAT INTOLERANCE COLD INTOLERANCE
- DILUTED URINE IS DECREASED IN
BP: INCREASED DECREASED
SPECIFIC GRAVITY; URINE
OSMOLALITY HR: “ “
PERISTALIS: DIARRHEA CONSTIPATION
*FLUID DEFICIT: DECREASED BP; WEIGHT
LOSS URINE: INCREASED DECREASED
- HEMOCONCENTRATION INSOMNIA
- INCREASED SERUM OSMOLALITY
SMOOTH SILKY HAIR, SKIN, DRY SKIN, BRITTLE
- INCREASED BUN
NAILS NAILS
- INCREASED HEMATOCRIT
- INCREASED SERUM NA WEIGHT LOSS WEIGHT GAIN
OLIGOMENORRHEA MENORRHAGIA
 PRIORITY IS DEHYRATION HYPOCALCEMIA HYPERCALCEMIA
 WOF: MENTAL CONFUSION
INCREASED
Mngt. CHOLESTEROL:
1. SULFONYLUREAS ECG: Atrial Fibrillation
2. FLUID REPLACEMENT Cause: AUTOIMMUNE (graves Cause: AUTOIMMUNE (
3. ADH- VASOPRESSIN/ DESMOPRESSIN dse) hashimoto’s dse)
REPLACEMENT OVERDOSE= SIADH EXOPTHALMOS- permanent MYXEDEMA- AROUND
THE EYES
Mngt. Mngt.
THYROID DISORDER SAFETY 1. LEVOTHYROXINE
- APG- TSH- THYROID GLAND - USE DAYTIME 2. LIOTHYONINE
GLASSES - TH Replacement
TRIODOTHYRONINE THYROXINE CALCITONIN - TAPE EYES WHEN - Lifetime
T3 T4 SLEEPING - Increased
METABOLISM BODY HEAT STRONG - ARTIFICIAL TEARS metabolism, energy
BONE ANTITHYROID - ALWAYS TAKE
AIDS CA TO - THIOAMIDES: BEFORE
ENTER THE METHIMAZOLE/ BREAKFAST
BONES TAPAZOLE - EFFECTIVITY: If
Converts calories to Affect: Affect: PRIORITY IS with improve CNS
energy CNS PERISTALSIS AGRANULOCYTOSIS or urine output
ENERGY URINE stop the drug - Overdose: FINE
HEAT HAIR, SKIN PROPHYTHIOURACIL TREMORS
BP SWEAT - WOF: OVERDOSE
HR NAILS - LUGOL’S SOLUTION-
strong iodine (saturated
solution K iodide
PRIORITY IODISM)
 METALLIC
TASTE IN THE
TONGUE stop
the drug.

PATROLFUSRN23
 THYROID STORM MYXEDEMA COMA HYPOPARATHYROIDISM HYPOCALCEMIA
Trigger: STRESS Trigger: STRESS  PRIORITY IS - TETANY
(INFECTION) (INFECTION) LARYNGOSPASM!! (MUSCLE
FATAL: TOO MUCH  PRIORITY IS  WOF STRIDOR! SPASM)
ENERGY= SAFETY (INSPIRATORY) - AT RISK FOR
EXHAUSTION SEIZURES
S/SX: S/SX: - LARYNGOSPASM
DELIRIUM DECREASING VS - TROUSSEAU’S
INCREASED TEMP DECREASED GLUCOSE SIGN
INCREASED DECREASED - CHVOSTEK SIGN
SYSTOLIC HPN CONSCIOUSNESS - PARASTHESIA
INCREASED HR Mngt. -
(130bpm) atenolol is MNGT. 1. TRACHEOSTOMY
given, vasodilator, 1. IV SET
decrease HR LEVOTHYROXINE 2. CALCIUM
*avoid aspirin it will 2. GLUCOSE CARBONATE IV
cause thyroid to increase REPLACEMENT 3. CALCIUM
hormones* REPLACEMENT
4. PHOSPHATE
BINDERS= calcium
carbonate
N levels= Ca 8.6-10mg/dl
Phosphorus= 2.5-4.5mg/dl

Parathormone (from parathyroid gland) delivers

calcium from bone marrow to blood
increases

HYPERPARATHYROIDIS HYPERCALCEMIA
M
S/SX: MUSCLE WEAKNESS
WEAK BONES DYSRYTHMMIAS
PATHOLOGIC FRACTURE BOUNDING PULSE
(PREVENT FRACTURE) INCREASED HR (fast
QT interval 0.32-0.4 secs
shortened ST segment)
HYPERMAGNESEMI
A
Mgnt. CAUSES:
1. HYDRATION - Excessive intake
2. FUROSEMIDE- of ca or vit D
LOOP DIURETICS- - Renal failure
excretes calcium - Use of thiazide
C/I: thiazide diuretics
diuretics= will cause - Meds such as
retention of Ca glucocorticoids
3. CALCITONIN: acid and lithium
ash diet to prevent carbonate
(Nephrolithiasis) - DHN
4. PROTECT BONES -

 PRIORITY
CIRCULATION

PATROLFUSRN23
 NEURO 3. PLASMAPHERESIS
BLOOD TO CELL SEPARATOR=
REMOVES ACH ANTIBODIES
MYASTHENIA GRAVIS 4. THYMECTOMY
- DECREASED ACETYLCHOLINE
- WEAKNESS S/SX:
- ACETYLCHOLINE= excitatory muscle 1. WEAKNESS WORST IN THE
contraction AFTERNOON
- WITH CHOLINERGIC EFFECT: 2. WORST AFTER REST
 UO 3. PTOSIS
 SECRETION 4. DIPLOPIA
 PERISTALSIS 5. BLANK FACIAL EXPRESSION
 PUPIL CONSTRICT 6. OPEN MOUTH
ACETYLCHOLINE
WEAKNESS IS EXPECTED BUT NOT A
PRIORITY!!!
ACETYLCHOLINE RECEPTOR
(promotes contraction)  PRIORITY IS AIRWAY AND
BREATHING
CHOLINESTERASE 1. RISK FOR ASPIRATION- PROVIDE
(relaxation) THICK LIQUID NO THIN LIQUID
- FLEX THE NECK WHEN SWALLOWING
Acetylcholine + Cholinesterase = Muscle
Contraction and relaxation 2. BREATHING
- PNEUMONIA
- “MYASTHENIA” pure muscle relaxation - ATELECTASIS
GRAVIS (GRAVE) - RESP ARREST
- DEADLY MUSCLE WEAKNESS - RESP ACIDOSIS
- UNKNOWN CAUSE
- THEORY: AUTOIMMUNE ENDOPHRONIUM CHLORIDE
- MYONEURAL PROBLEM - TENSILON TEST
- C/I: MUSCLE RELAXANTS - SHORT ACTING- LAST 5 MINS
- FAST ACTING- WITHIN 60 SECS
Patho:
THYMUS DISORDER
(PRODUCES ANTIBODIES)

ATTACKS ACETYLCHOLINE NEOSTIGMINE

PYRIDOSTIGMINE increase muscle strength
AMBENONIUM cholinergic effect
CHOLINESTERASE DESTROY - GIVEN ON TIME
ACETYLCHOLINE - BEFORE EATING, BUT IF WITH GI
PROBLEM GIVE WITH SMALL
Mngt. SNACK
1. ANTICHOLINESTERASE – GIVEN CHOLINERGIC MYASTHENIA
BEFORE EATING CRISIS CRISIS
- NEOSTIGMINE
OVERDOSE UNDERDOSE
- PYRIGOSTIGMINE
STRESS, INFECTION
- AMBEONIUM
- ENDROPHRONIUM CHLORIDE- short WEAKNESS WEAKNESS
and fast acting; for TENSILON TEST (dx Increased secretions; Decreased secretion;
procedure) BP; HR HR; BP= adrenergic
2. AVOID HOT BATHS effect

PATROLFUSRN23
 Tensilon test= Tensilon test= CARDIAC
WORSEN IMPROVE DYSRYTHM
ANTIDOTE: MEDS= A.C. MIAS
ANTICHOLINERGIC DVT
atrophine sulfate

GUILLAN BARRE’ SYNDROME RECOVERY IS 6 MOS-2YRS!

- UNKNOWN CAUSE DESCENDING RECOVERY!!
- THEORY: AUTOIMMUNE
- TRIGGER: VIRAL INFECTION EX:
DIARRHEA, RESPI MULTIPLE SCLEROSIS
- ASCENDING PARALYSIS - DEMYELINATION IN CNS
- LIFETIME PROBLEM
- REMISSION AND EXACERBATION
GBS DEMYELINATION IN - UNKNOWN CAUSE
PERIPHERAL NERVOUS SYSTEM - COMMON TO 20-40 YRS OLD WOME
- THEORY IS AUTOIMMUNE
- AVOID TRIGGERS:
STRESS
DECREASE MYELIN SHEATH INFECTION
(myelin sheath produces faster impulses) EXTREME
TEMP ENVIRONMENT
HUMID
PHYSICAL
DECREASE IMPULSES IN PNS EMOTIONAL
(SLOWER)
CNS PNS ANS
CENTRAL PERIPHERAL AUTONOMI Patho:
(BRAIN AND CRANIAL C DEMYELINATION
SPINAL NERVES NS CNS
CORD) SPINAL NERVES
CRANINAL SENSORY/AFFE HR
NERVE 9 RENT URINE
(glossopharyng FECAL SLOWER IMPULSES IN CNS
eal) CONSTIPAT
PARASTHESIA ION
NEUROGEN
MOTOR/EFFERE IC
Difficulty NT BLADDER BRAIN SPINAL CORD
Of swallowing
BRAIN
ASCENDING A. CRANIAL II (OPTIC)
Dysphagia FLACCID EARLIEST: VISUAL DISTURBANCE
Mngt. PARALYSIS EX: DIPLOPIA
PRIORITY Mngt. SCOTOMA (BLIND SPOTS)
ASPIRATION FLEX THE NECK
r/t dysphagia WHEN B. CRANIAL 9 (GLOSSOPHARYNGEAL)
BREATHING- SWALLOWING DYSPHAGIA
pneumonia NO THIN Mngt.
atelectasis LIQUIDS FLEX THE NECK
RESP NO THIN LIQUIDS
ACIDOSIS RISK FOR ASPIRATION

PATROLFUSRN23
 C. CEREBELLUM BROMOCRIPTINE
BALANCE ROPINIROLE
INCOORDINATION PIRAMIPEXOLE
EX: ATAXIC GAIT SELEGILINE
Mngt.
WIDE BASE OF SUPPORT 2. CONT INHIBITORS- preserve existing
FEET PART dopamine
RISK FOR INJURY (CAPONE)
S/SX: ENTACAPONE
1. CHARCOLS TRIAD: TOLCAPONE
SCANNING SPEECH (syllabic)
INTENTIONAL TREMORS 3. LEVODOPA- actual dopamine replacement
NYSTAGMUS in brain; improve the symptoms
- Given with decarboxylase to convert
SPINAL CORD levodopa to dopamine
A. SENSORY - CARBIDOPA- inactivate decarboxylase to
NUMBNESS increase levodopa into brain
Mngt. - Ex: levodopa + carbidopa= SINEMET
AVOID HOT BATH given in combination
AVOID HOT COMPRESS - S/E: DARK URINE- anticholinergic effect,
RISK FOR BURN orthostatic hypotension EXPECTED
- COMPLICATION: HALLUCINATION
B. MOTOR (PSYCHOSIS); DYSKENESIA
CHRONIC FATIGUE AND WEAKNESS ABNORMAL MOVEMENT EX:
MUSCLE SPASM SPASMODIC WINKING

4. ANTICHOLINERGIC
CONTRACTURES
Mngt. DOPAMINE DRUG (stimulate the heart;
1. EXERCISE AS TOLERATED
2. MUSCLE RELAXANTS
contract the heart) IS NOT GIVEN TO PD
- BACLOFEN CAN CROSS BBB; CARDIOGENIC SHOCK
- DANTROLENE
- FLEXERIL (CYCLOBENZAPINE) S/SX:
- SOMA 1. BRADYKINESIA- SLOW
MOVEMENT/AKINESIA
C. CONSTIPATION Mngt.
D. NEUROGENIC BLADDER HARD SURFACE
RISK FOR UTI ROCK BACK AND FOURTH
2. COGWHEEL RIGIDITY- SPASTIC WITH
PARKINSON’S DISEASE PASSIVE MOVEMENT
- DECREASE DOPAMINE 3. RESTING TREMORS
- DESTRUCTION OF DOPAMINE PILL ROLLING
PRODUCING CELLS Rest- tremors
- SUBSTANCIA NIGRA @ BASAL Movement- no tremors
GANGLIA 4. POSTURE
- DECREASE DOPAMINE & INCREASE - FLEXED POSTURE/ STOOPED
ACETYLCHOLINE they should be equal 5. GAIT
- DOPAMINE- adrenergic; inhibitory - SHUFFLING
neurotransmitter - SWAYING ARMS
- ACETYLCHOLINE- cholinergic; excitatory - SMALL PROPULSIVE GAIT
neurotransmitter - FESTINATING
MEDICATION - DRAGGING OF THE FOOT
1. DOPAMINERGIC DRUGS- increase 6. DYSPHAGIA
production of dopamine 7. DROOLING
EX: AMANTIDINE 8. CONSTIPATION

PATROLFUSRN23
 9. MICROGRAPHIC MIGRAINE DISORDER
Mngt. - GIVEN TRIPTAN DRUGS
Risk for Aspiration (VASOCONSTRICTORS) ISCHEMIA
Diet: HIGH FIBER DIET - UNKNOWN CAUSE
*IF TAKING LEVODOPA - THEORY: ABNORMAL SEROTONIN
 NO MAOI STOP 14 DAYS BEFORE METABOLISM- NATURAL
LEVODOPA will cause HPN CRISIS VASOCONSTRICTOR
 AVOID FOOD RICH IN TYRAMINE - TRIGGERS: HORMONAL, STRESS,
EX: AGED CHEESE, RED WINE ODOR, TYRAMINE
 MAINTAIN LOW PROTEIN DIET- will EX OF MEDS:
increase levodopa absorption 1. SUMATRIPTAN TWICE A DAY
 AVOID EXCESSIVE VIT B6 AVOID 2. ALMOTRIPTAN PER 24
DECARBOXYLASE ex: supplement 3. PROVATRIPTAN- 3X A DAY
4. ERGOTAMINE- vasoconstrictor; abortive
AMYOTROPHIC LATERAL SCLEROSIS therapy
- ALSO KNOWN AS LOU GEHRIG’S DSE
- FATAL PREVENTIVE ABORTIVE
- MUSCLE DISORDER Vasodilators- Vasoconstrictors
- UNKNOWN CAUSE NIFEDIPINE
- DESCENDING
- COGNITION IS INTACT Patho:
- ABSENCE OF MUSCLE GROWTH TRIGGER
- THEORY: NEUROTRANSMITTER:
GLUTAMATE
RELEASE OF SEROTONIN

EXCITATORY
VASOCONSTRICTION @ BRAIN

DESTRUCTION OF UPPER AND

LOWER MOTOR NEURONS

DOC: GLUTAMATE ANTAGONIST DEPLETION OF SEROTONIN VISUAL DISTUR

EX: RILUTEK, RILUZOLE (warning sign)

S/SX: CEREBRAL VASODILATION

DYSPHAGIA
NASAL TONE OF SPEECH
TETRAPHLEGIA/ QUADRIPHLEGIA— HEADACHE
ATROPHY (ALS)

Possible cause of death: STARTS AT LEFT SIDE 1. AURA

1. ASPIRATION - N/V MED:
2. BREATHING: DIAPHRAGM; pneumonia, - PHOTOPHOBIA VASODILATOR
atelectasis, resp arrest, resp acidosis MED:
VASOCONSTRICTOR
Mngt. (Supportive)
1. ADVANCE DIRECTIVES
EX: LIVING WILL, DNR SPINAL CORD INJURY
1. HYPERFLEXION SCI
2. HYPEREXTENSION SCI
3. COMPRESSION SCI

SHOCK:
1. NEUROGENIC SHOCK (ABOVE T6)-
decreased HR

PATROLFUSRN23
 2. SPINAL SHOCK: PARALYSIS d/t spinal Patho:
cord injury- decreased HR, bradycardia TRIGGER
- BP
- HR
- PERISTALSIS ANS
- UO
FLACCID BELOW LEVEL OF INJURY
SNS PNS= decreased HR
SHOCK= HYPO HYPO+ TACHY TACHY
Hypotension, Hypothermia, Vasoconstriction
Tachycardia, Tachypnea Increased BP

SPINAL CORD S/SX:

ta
CERVICAL C1-C7 1. FACIAL FLUSHING
*C4 DIAPHRAGM 2. SEVERE THROBBING/POUNDING HA
*C5 3. NASAL CONGESTION/ STUFFINESS
*C6 ARMS AND HANDS
*C7 ASSESS: FACIAL FLUSHING; INCREASED BP
*T1 AND DECREASED HR
THORACIC T1-T12 Mngt.
*T2 1. POSITION IN A HIGH FOWLER’S
*T3 POSITION, 90 DEGREE
*T4 2. REMOVE NOXIOUS STIMULI ex: check
*T5 CHEST catheter kinks
*T6 3. NOTIFY MD
*T7 4. PRESCRIBED HPN DRUG
*T8
*T9 CRANIAL NERVES
*T10 OLFACTORY SMELL SENSOR
*T11 ABDOMINAL Y
*T12 OPTIC VISION SENSOR
LUMBAR L1-L5= LEGS Y
SACRAL= SEX, BOWEL, BLADDER OCCULOMOTOR MOTOR OF MOTOR
THE EYE Test: pupil
EX: SCI T6= T6 AND BELOW PARALYSIS constrict,
SCI C5= C4 IS OKAY C5 TO SACRAL IS open eyes,
PARALYZED eye
movement
 PRIORITY TROCHLEAR EYE
 AUTONOMIC DYSREFLEXIA MOVEMEN
 INCREASED INTRACRANIAL T
PRESSURE TRIGEMINAL SENSORY SENSOR
OF THE Y
AUTONOMIC DYSREFLEXIA FACE, MOTOR
- AUTONOMIC HYPERREFLEXIA MOTOR OF Test:
- MEDICAL EMERGENCY THE chewing
- HX: SCI ABOVE T6 MOUTH
- TRIGGER: BLADDER DISTENTION ABDUCENS EYE LATERA
(most common: catheter kinks) MOVEMEN L EYE
BOWEL INCAPACITY T MOVEME
COLD DRAFT NT
SKIN PRESSURE (wrinkled FACIAL FACIAL SENSOR
bed sheets) EXPRESSIO Y
- Trigger= noxious stimuli; stressors N; CLOSE MOTOR
EYE

PATROLFUSRN23
 ACOUSTIC HEARING SENSOR BELL’S PALSY
AND Y - CN 7
BALANCE - UNILATERAL INFLAMMATION
GLOSSOPHARYN TASTE SENSOR - HALF PARALYSIS OF THE FACE
GEAL SWALLOW Y - TEMPORARY, FULL RECOVERY IN A
ING MOTOR FEW WEEKS
VAGUS SWALLOW SENSOR - ONE SIDE: NO FACIAL EXPRESSION,
ING Y NO AFFECTED SIDE CHEWING, NO
PNS MOTOR CLOSURE OF THE EYE (PRIORITY),
SPINAL SHOULDER MOTOR NO EYE LACRIMATION
ACCESSORY SHRUG  PRIORITY IS TO PREVENT
HYPOGLOSSAL TONGUE MOTOR CORNEAL ABRASION
MOVEMEN
T Mngt.
- FACIAL EXERCISES
- MASSAGE IF NO PAIN
TRIGEMINAL NEURALGIA - ORAL CARE
- TIC DOULOREX (dolourex is pain) - PREVENT CORNEAL ABRASION: USE
- SENSORY OF THE FACE GLASSES, EYE PATCH
- TRIGGER: - ARTIFICIAL TEARS
EXTREME TEMP FOOD - DOC: STEROIDS, PREDNISONE
HARD FOOD
PRESSURE ON THE FACE (WIND) CVA/STROKE
TOUCHING OF THE FACE ISCHEMIA HEMORRHA
GIC
Patho: THROMBU CEREBRAL
INCREASE IMPULSES S ANEURYSM
OBSTRUCT RUPTURE
ION
CNS HPN CRISIS
EMBOLI
OBSTRUCT ARTERIOVEN
SENSORY OF THE FACE ION OUS
MALFORMAT
S/SX: ION- <30 yrs
1. EXCRUCIATING FACIAL PAIN- old
UNILATERAL *worst HA I
FACIAL GRIMACE WILL LEAD TO ever had
EXHAUSTION- altered nutrition GIVE ANTIPLATEL NO
Mngt. ET
1. DIET: SOFT, WARM, HIGH CALORIES GIVE ANTICOAGU NO
2. CNS DEPRESSANT/ LANT
ANTICONVULSANT/ ANTISEIZURE GIVE THROMBOLY NO
DOC: TEGRETOL/CARBAMAZEPINE TIC (within 3
DIAZEPAM hours of onset)
DILANTIN
3. TRYCYCLIC ANTIDEPRESSANT- HEMORRHAGIC
NERVE PAIN - DOC: AMINO CAPROIC ACID
IMIPRANINE
4. DIRECT INJECTION: ANESTHESIA, Mngt. For Ischemic CVA
GLYCEROL 1. POSITION FLAT ON BED
5. SURGERY: RHIZOTOMY- TO CUT CNS 2. PERMISSIVE HYPERTENSION- MAX
CRANIAL 5 OF 150/100 MAX NOT UNTIL 220/120 to
maintain BP to enter the brain
Mngt. For Hemorrhagic CVA

PATROLFUSRN23
 1. POSITION: SEMI FOWLERS TRANSIENT ISCHEMIC ATTACKS

RIGHT
- JUDGEMENT CAROTID STENOSIS
- SPATIAL
LEFT
- INTELLECT ISCHEMIA
- LANGUAGE
- DEPRESSION NEUROLOGICAL DEFICITS

S/SX: NEUROLOGICAL DEFICITS

RIGHT LEFT RECOVER IN 24 HOURS
- IMPULSIVE - DEPRESSION
- DENIAL - APHASIA:
- SPATIAL EXPRESSIVE- *IF ISCHEMIA MORE THAN 10MINS THEN
DEFICIT difficulty to express WILL BE PERMANENT STROKE*
language
Mngt.
1. PICTURE INCREASING INTRACRANIAL
POINTING PRESSURE
RECEPTIVE - N= 0-20mm/Hg
APHASIA- difficulty in - CAUSES:
comprehension of HEAD INJURY
language CRANIOTOMY
Mngt. BRAIN TUMOR
1. TALK CALM - CEREBRAL PERFUSION PRESSURE-
2. USE MIME N=50-100mm/Hg
AND - CPP=MAP-ICP
GESTURES 𝑆𝑌𝑆𝑇𝑂𝐿𝐼𝐶+2(𝐷𝐼𝐴𝑆𝑇𝑂𝐿𝐸)
- 𝑀𝐴𝑃 =
GLOBAL- both 3

- HALF WEAKNESS OF FACE- Patho:

UNILATERAL NEGLECT INCREASE ICP
- HORNER’S SYNDROME- INABILITY
TO DILATE PUPIL
- PTOSIS CSF DISPLACEMENT
- DYSPHAGIA- give thick liquids and flex
the neck swallowing
- DYSORTHIA- DAMAGE IN CN12 DECREASE BV
- AGNOSIA- INABILITY TO RECOGNIZE
OBJECTS
- HOMONYMOUS HEMIANOPSIA- scan BRAIN HERNIATION- FIXED
the environment; put things at good side DILATED PUPIL N SIZE= 3-5mm
- HEMIPHLEGIA- HALF PARALYSIS (in emergency nursing color BLACK)
R CVA- AFFECTED IS LEFT SIDE
SHOULDER= INTERAL ROTATION
HIP= EXTERNAL ROTATION Put ARTERIAL BLOOD SUPPLY
trochanter roll - DECREASE SUPPLY
- INCREASE CARBON DIOXIDE=
HAND INCREASE ICP
FINGER FLEXION - HYPERVENTILATION= ALKALOSIS
ELBOW (DECREASE O2)
KNEE - NOMORPHINE= DECREASED RR=
ACIDOSIS- VASODILATION-
INCREASED ICP
- DOC: CODEINE FOR PAIN

PATROLFUSRN23
 - NO RESP DEPRESSION VERBAL-5
- WEAK NARCOTIC ANALGESICS MOTOR-6
- FLUID RESTRICTION 1.2L/DAY
- DEXAMETHASONE TO DECREASE EYE
CEREBRAL EDEMA 4= SPONTANEOUS EYE MOVEMENT
- HIGH FOWLERS WILL HERNIATE 3= OBEY TO COMMANDS
THE BRAIN 2= OPEN TO PAIN
1= CLOSE EYES
VENOUS DRAINAGE
- INCREASE DRAINAGE VERBAL (DO YOU KNOW WHERE YOU
- SEMI FOWLERS ARE?)
- MANNITOL- (OSMOTIC DIURETIC) 5= ORIENTED TO PLACE (HOSPITAL)
- WOF: PULMO EDEMA, CRACKLES 4= DISORIENTED (HOUSE)
3=INAPPROPRIATE ANSWER (CHICKEN)
EFFECTIVE MANNITOL: 2= SOUNDS ANSWER (GRRR)
- IMPROVE THE LOC 1= NONE

NO VALSALVA MANEUVER MOTOR

AVOID COUGHING, SNEEZING, STRAINING, 6=OBEY
AVOID SUCTIONING 5=LOCALIZE PAIN
AVOID VIGOROUS MOVEMENT 4=WITHDRAWAL
DO DEEP BREATHING BUT NO COUGHING 3=DECORTICATE
EXERCISES 2=DECEREBRATE
1=NONE
MEDS:
1. CODEINE HEAD INJURY
NO RESPIRATORY DEPRESSION CONCUSSION
WEAK NARCOTIC - DECREASE CONSCIOUSNESS
COUGH SUPPRESSANT - RETROGRADE AMNESIA
CONSTIPATION- BAD IT WILL - HA
INCREASE ICP give stool softener CONTUSION
- BRAIN BRUISE
S/SX: COUP CONTRE COUP PHENOMENON
EARLY: - FRONTAL & OCCIPITAL DAMAGE
1. BLURRY VISION
2. RESTLESS FRONT PARIET OCCIPIT TEMPOR
3. ALTERED LOC AL AL AL AL
4. INCREASING CONFUSION Broca’s Sensation Vision Hearing
5. NOTE HEADACHE motor
INCREASING ICP: Intellect
1. HYPER-BRADY
2. INCREASING TEMP EPIDURAL HEMATOMA
3. CUSHING’S TRIAD: - TEMPORAL LOBE INJURY
INCREASE BP - MENINGES
DECREASE HR DURA
DECREASE RR ARACHNOID
4. CHEYNE’S STOKE RESPIRATION PIA MATER
5. PULSE PRESSURE RESPIRATION - BLEEDING ABOVE DURA
6. PAPILLEDEMA- edema of the optic disks SUBDURAL HEMATOMA
7. PHOTOPHOBIA - BLEEDING BELOW DURA
8. PROJECTILE VOMITING - VENOUS- SLOW BLEEDING
9. SEIZURE BASILAR SKULL FRACTURE
10. DECREASED GCS- PRIORITY - BASE
- OTORRHEA & RHINORRHEA
GLASGOW COMA SCALE - RACOON’S SIGN
EYE-4 Mngt.

PATROLFUSRN23
 1. CSF LEAK, INCREASING ICP 1. INFUSION SHOULD BE MORE
HALO SIGN THAN 1 HOUR
GLUCOSE STRIPS 4. STABLE AFTER 24 HOURS

BRAIN SURGERY SEIZURE

TRANSPHENOIDAL HYPOPHYSECTOMY - EPILEPSY- RECCURENT SEIZURE
- PITUITARY GLAND
- ABSENCE- NO TONIC, CLONIC
ONLY BLANK STARES 5-10
POST MNGT.
SECS
1. AVOID TOOTHNRUSH
CHILDREN
2. NO STRAW
 PRIORITY
- GRANDMAL- AURA (WARNING SIGN)
 DIABETES INSIPIDUS
- AURA: FLASHES OF LIGHT
 CSF LEAK
o EPIGASTRIC PAIN
 INCREASE ICP
o UNUSUAL TASTE AND SMELL
SUPRATENTORIAL
- TRIGGER: FLASHES; STOP
- INCREASE ICP
CONVULSANT
- SEMIFOWLER

INTRATENTORIAL
CONSCIOUS
- FLAT ON BED

MENINGITIS GENERALIZED TONIC-CLONIC

- BACTERIAL: STREPTOCOCAL (WHOLE BODY)
PNEUMONIAE- most common  TONIC- muscle contraction
NEISSERIA MENINGGITIDIS- deadly,
 CLONIC- muscle jerking
petechaie
 DROOLING
- VIRAL: COXACKIE VIRUS (ENTERIC)
 DYSPNEA
- INFLAMMATION OF THE BRAIN,
SPINAL CORD & MENINGES  BOWEL-BLADDER
- PIA MATER, ARACHNOID INCONTINENCE

S/SX: POST ICTAL:

CSF: CLOUDY - DISORIENTED
WBC - EXHAUSTED
INCREASE PROTEIN
DECREASE GLUCOSE MNGT. PUBLIC AREA
SPINAL CORD: - FLOOR
NUCCHAL RIGIDITY (STIFF NECK) - LIE ON THE SIDE
BRUDZINSKI’S SIGN- active flexion hip and knee - OBSERVE THE HEAD FOR
KERNIG’S sign- hamstring spasm pain, cannot PROTECTION
extend knee - ON A SOFT OBJECT
- INCREASE ICP - REMOVE NEARBY OBJECT
MGNT. HOSPITAL SETTING
Mngt. - PAD SIDERAILS
1. ISOLATION: DROPLET PREC - REMOVE THE PILLOW
2. CSF SAMPLE - PREPARE EQUIPMENT, SUCTION, O2-
3. ANTIBIOTICS: AFTER SEIZURE
CEFTRIAXONE - LOOSEN CLOTHING
VANCOMYCIN- OTOTOXIC AND - ADJUST BED TO LOWEST POSITION
NEPHROTOXIC - USE PRIVACY
WOF: RED MAN SYNDROME - TURN THE PT TO THE SIDE
- D/T TOO FAST INFUSION, HISTAMINE - IF POSSIBLE FLEX THE NECK
WILL BE ACTIVATED - ON BEDSIDE, IV LORAZEPAM,
Mngt. DIAZEPAM

PATROLFUSRN23
 - NO INSERTION IN THE MOUTH

ANTICONVULSANTS- CNS DEPRESSANTS

(TRANQUILIZERS)
1. VALPROIC ACID-DIVALPROEX
2. ZEPAM, DIAZEPAM, LORAZEPAM
3. BARBI: BARBITURATES,
LAMOBARBITAL, AMOBARBITAL,
PHENOBARBITAL
4. PHENYTOIN: DILANTIN
5. FOS PHENYTOIN
6. OTHERS: TEGRETOL, LAMICTAL
(LAMOTRIGENE)

PHENYTOIN= N 10-20MCG/ML
WOF!!!
DENTAL PROBLEM: GINGIVAL
HYPERPLASIA
INFECTION AND BLEEDING
LESS SEDATING: TOXICITY: ATAXIA
ABNORMAL ESTROGEN METABOLISM-
DECREASE EFFECTIVENESS OF PILLS
NORMAL BROWN URINE
TERATOGENIC CLEFT PALATE
INCREASE BLOOD GLUCOSE LEVEL:
HYPERGLYCEMIA
NSS ONLY FOR IV ADMINISTRATION

PATROLFUSRN23
ORTHO
BONES: FRAMEWORK
STRONG BONES- MINERAL: CALCIUM,
PHOSPHORUS, MAGNESIUM
WEIGHT: EXERCISE
MUSCLES: HEAT PRODUCTION,
MOVEMENT
STRONG- EXERCISE
LIGAMENTS: CONNECT BONES TOGETHER
TENDONS: CONNECT THE MUSCLE TO THE
BONE
TYPES OF INJURY
SPRAIN
- LIGAMENT TEAR D/T TWISTING
MOVEMENTS
- S/SX: INFLAMMATION
 SWELLING
 REDNESS
 WARTHM
 PAINFUL
 LIMITATION OF MOTION
STRAIN
- PULLED MUSCLE D/T
OVERSTRETCHING
- S/SX: INFLAMMATION
 SWELLING
 REDNESS
 WARTHM
 PAINFUL/ TENDERNESS
 LIMITATION OF MOTION
- GOAL: MOVEMENT
MNGT.
1. REST- WITHIN 12 HRS
- TO PREVENT FURTHER INJURY
- PROMOTES HEALING
2. ICE APPLICATION
- TO DECREASE SWELLINH
- 15-30MINS
- REAPPLY, WAIT FOR 60 MINS
- TO PREVENT REBOUND
PHENOMENON
3. COMPRESSIVE DRESSING
- USE: ACE WRAP/ ACE BANDAGES/
ADHESIVE BANDAGES/ ELASTIC
BANDAGES
- TO DECREASE SWELLING
4. ELEVATE- ABOVE THE LEVEL OF
THE HEART, USE PILLOWS
AFTER 24 HOURS
1. HOT APPLICATION
PATROLFUSRN23
- VASODILATION
- APPLY: 20-30 MINS
- ASSESS: 10-15MINS WOF BURN
- C/I: LINIMENTS (MENTHOL)
2. EXERCISES
A. PASSIVE- NURSE (NO MUSCLE
CONTRACTION) INCREASE
RANGE OF MOTION
B. ACTIVE- PATIENT (MUSCLE
CONTRACTION); INCREASE
MUSCLE TONE
C. RESISTIVE EXERCISES- TO
INCREASE POWER AND
ENDURANCE; FROM THE NURSE;
WITH WEIGHT
D. ISOMETRIC EXERCISE- there will no
joint movement but there will be muscle
contraction
Ex: STRESS BALL- TO PREVENT
ATROPHY OF THE MUSCLE
FRACTURES
- A BREAK IN THE CONTINUITY IN
THE BONE
1. SIMPLE: CLOSE
2. COMPOUND: OPEN
CLASSIFICATION
1. OBLIQUE- AN ANGLE
2. SPIRAL- DOUBLE ANGLE
3. TRANSVERSE- PERPENDICULAR
4. COMMUNITED- BONY FRAGMENTS
5. GREENSTICK- one side is broken but
the opposite side is bended; common to
children
RF:
 TRAUMA
 CERTAIN DSES: OSTEOPOROSIS,
OSTEOMYELITIS; BONE TUMORS;
 CERTAIN MEDS: STEROIDS
 S/SX:
BLEEDING/ BRUISING/ BONE
PROTRUSION
RANGE OF MOTION IS DECREASED
EDEMA
ACHING PAIN- CONTINUOS
CREPITUS
MNGT. (2 PRINCIPLES)
1. REDUCTION- REDUCE FRACTION
A. CLOSED- MANUAL
B. OPEN- SURGERY
2. IMMOBILIZE
A. CAST
B. TRACTION
CAST- CORRECT DEFORMITIES 5. MAINTAIN SKIN INTEGRITY
- ALIGNMENT - PETALLING TECHNIQUE (PUT
- SUPPORT/ STABILIZATION ADHESIVE/ TAPES/MOLESKIN AT THE
- TREAT FRACTURE EDGE OF THE CAST)
6. EDEMA CONTROL
TYPES: - ELEVATE ABOVE THE LEVEL OF THE
TRADITIONAL NON- HEART
TRADITIIONAL - ABOVE 2 PILLOWS
PLASTIC OF PARI FIBER GLASS 7. REMOVE: CAST CUTTER
(SYNTHETIC CAST) - PRODUCES A MACHINE-SOUND BUT
24-72 HRS WEIGHT BEARING THERE WILL BE NO DISCOMFORT
ASAP - BIVALVING- LONGDITUDINAL CUT
HEAVIER, NON LIGHTER, STRONG,
WATER RESISTANT DURABLE WATER
RESISTANT COMPLICATION:
WARM WATER WARM WATER COMPARTMENT SYNDROME
FOR ACTIVATION FOR ACTIVATION - INCREASING PRESSURE INSIDE
CRYSTALIZATION CRYSTALIZATION - S/SX:
SETTING: 20 MINS 20 MINS PAIN UNRELIEVED BY MEDS
PAIN UNRELIEVED BY ELEVATION
WET CAST: EDEMA UNRELIEVED BY
- COLOR: GRAY ELEVATION
- SOUND: DULL PALLOR
- FEET: DAMP, HOT, WARM PARESTHESIA
DRY CAST: POOR CAPILLARY REFILL
- COLOR: WHITE/ SHINNY PULSELESSNESS
- SOUND: RESONANT PARALYSIS
- FEET: FIRM, COLD MNGT.
- ODOR: NO ODOR 1. NOTIFY MD!!!
2. REMOVE CAST
MNGT. 3. SURGERY: FASCIOTOMY
1. PREVENT PRESSURE: USE PALMS
UPON APPLICATION. DON’T USE
FINGERTIPS TRACTION
A. PREVENT INFECTION; WINDOW - TWO OPPOSITE FORCES
TECHNIQUE (HOT SPOT, WARM SPOT) SKIN
B. PREVENT ATROPHY: ISOMETRIC PULL SKIN
EXERCISES - TREAT FRACTURES
2. LEAVE THE CAST CLEAN AND DRY - BEFORE SURGERY
HOW TO CLEAN: DAMP CLOTH - DECREASE MUSCLE SPASM
CLEANSER 1. CONTINUOS SKIN TRACTION
TO DRY: AIR DRY (BLOWER) 2. INTERMITTENT SKIN TRACTION
Q2 TURNING (COOL SETTING)
FAN CONTINUOUS
3. ASSESS THE CMS 1. BRYANS- BOTH FEET OF THE CLIENT
- CIRCULATION- CAPILLARY REFILL- SUSPENDED ON A SLING
N= LESS THAN 3 SECS - BUTTOCKS LIFTED OFF THE BED
- POSITIVE PULSE AT DISTAL  USUALLY CHILDREN- LESS
- MOVEMENT- DIGITS (FINGERS AND THAN 2 YRS OLD/ 30LBS
TOES)  TREAT: CONGENITAL HIP
- SENSATION- WARM TO TOUCH, DISLOCATION
NEGATIVE PARASTHESIA,  KNEES: SLIGHTY FLEXED
NUMBNESS, TINGLING SENSATION  COMPLICATION:
4. SUPPORT HYPEREXTENSION INJURY
- RIGID- FIBERGLASS 2. BUCKS- BOOTIE ON THE AFFECTED
- NON-RIGID- SYNTHETHIC, PILLOWS LEG

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 - UNAFFECTED LEG- ALLOWED TO
MOVE
NSG INTERVENTIONS:
- PILLOW BETWEEN THE LEGS
- CHECK FOR PRESSURE SORES
- KEEP THE WEIGHTS HANGING
FREELY
VINKE TONGS
CRUTCHFIELD TONGS
HALO TRACTION- WHOLE SPINE
THOMAS SPLINT WITH PEARSON
ATTACHMENT; FEMORAL FRACTURE
BALANCED SUSPENSION TRACTION-
3 FORCES

3. RUSSEL- ROPES AND PULLEYSIN A MNGT.

BALKAN FRAME (BED) 1. ASSESS CMS
- USUALLY KNEE SUSPENDED ON A 2. ASSESS BLADDER/ BOWEL
SLING FUNCTION
- KNEE IS SUPPORTED ON A SLING 3. CHANGE POSITION FREQUENTLY:
- ASSESS FOR DVT! USE OVERHEAD TRAPEZE
- S/SX: 4. DRESSING CARE: PIN SITES
CALF TENDERNESS USE: CHLORHEXIDINE SOLUTION 4X
WARTHM A DAY WITH COTTON APPLICATOR
REDNESS N- CRUSTING FORMATION
SWELLING UNILATERAL N- SEROUS SANGINOUS (RED)
INCREASED LEG CIRCUMFERENCE DRAINAGE
POSITIVE HOMAN’S SIGN- pain in the 5. NOTIFY MD IF LOOSE PINS
leg in doing dorsiflexion 6. PREVENT FOOT DROP: USE FOOT
- LEG ELEVATED BOARD
- LEAVE THE WEIGHTS HANGING
FREELY COMPLICATION: FAT EMBOLISM
- NOTIFY THE DOCTOR IF WEIGHTS - FIRST 48-72 HOURS AFTER THE
ARE ON THE FLOOR, NURSES ARE INJURY
NOT ALLOWED TO PUT BACK THE - COMMON: LONG BONE FRACTURE
WEIGHTS!!!) (FEMUR) D/T STEM CELL
PRODUCTION
INTERMITTENT YELLOW BONE MARROW (FAT
- DECREASE MUSCLE SPASMS GLOBULES, FAT DEPOSITS
1. CERVICAL TRACTION
- HEAD HALTER
 POSITION; SITTING OR SEMI
FOWLERS NO MANIFESTATION OF THE
 WIGHT 7-10LBS AFFECTED LEG
 20-30 MINS DURATION
 WOF: PAIN MANIFESTATIONS:
2. LUMBAR TRACTION BRAIN
- PELVIC HARNESS (ILIAC CREST) - ALTERED MENTAL STATUS
 POSITION: DORSAL - RESTLESSNESS
RECUMBENT, SUPINE WITH - IRRITABILITY
KNEES IN FLEXION - DECREASE LOC
 15-25LBS - HA
 WOF: PAIN LUNGS
- CHEST PAIN
 DURATION: 20-30 MINS
- SOB
- DOB
SKELETAL TRACTION: PULLS BONE
- CRACKLES/RALES/ PETECHIAE
- CONTINOUS TRACTION
FORMATION ON THE UPPER CHEST
- SURGERY
AND AXILLAE, NECK
- EQUIPMENTS:
- TACHYCARDIA
KISCHNER WIRES
- HYPOTENSION
STEINMANN PINS
- HYPERTHERMIA
GARDNER WELLS

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DX. TEST
1. ARTHROSCOPY- ENDOSCOPE FOR
VISUALIZATION
- ENDOSCOPE FOR VISUALIZATION
- PRE: ASSESS JOINT FLEXION-
INCREASED TO 50%
- EX: KNEE JOINT-180 DEGREE
90 DEGREE
- ASSESS S/SX: INFECTION
- POST PROCEDURE: R.I.C.E
(EXTENDED)
- N 1-4 DAYS UNCOMFORTABLE JOINT
- AMBULATE WITH CRUTCHES
- NOTIFY MD: HEMATHROSIS
i. FEVER/ PAIN FOR 3
DAYS
2. ARTHROGRAPHY/ ARTHROGRAM
- USE CONTRAST MEDIUM
- PRE: ASSESS: ALLERGIES
PREGNANCY
KIDNEY FUNCTION
- POST: RICE
- N- 1-2 DAYS: CLICKING SOUND/
CREPITUS
- NOTIFY MD: FEVER/PAIN X 2 DAYS
- HT: INCREASE OFI TO EXCRETE DYE
CHRONIC
HERNIATED NUCLEUS PULPOSUS
- RF:
DEGENERATION
AGE
OBESITY
HEAVY LIFTERS
- S/SX:
- CERVICAL AREA C5-C6/ C6-C7
S: PAIN RADIATES UE/ PARATHESIA/
NUMBNESS/ TINGLING SENSATION
M: MUSCLE SPASM, MUSCLE
WEAKNESS, PARALYSIS
- LUMBAR: L4-L5/L5-S4
S: PAIN RADIATE LE/ PARESTHESIA/
NUMBNESS/ TINGLING SENSATION
M: MUSCLE SPASMS, MUSCLE
WEAKNESS, PARALYSIS, NEGATIVE
ACHILLES TENDON REFLEX,
POSITIVE SLR TEST
DX. TEST
1. ELECTROMYOGRAPHY
- OSCILLATING MACHINE
- USES NEEDLE ELECTRODE
- EXPECTATIONS: PAINFUL,
UNCOMFORTABLE, DISCOMFORTING
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- AVOID: USE OF STIMULANTS,
SEDATIVE 24 HRS BEFORE
- AVOID USE OF CREAM/ LOTION ON
THE SITE
- POST PROCEDURE: S/SX OF
BLEEDING; PUT ADHESIVE TAPES/
STERILE STRIPS
- EXPECTED: BRUISING
2. MYELOGRAM/ MYELOGRAPHY
- USE: CONTRAST MEDIUM @
SUBARACHNOID SPACE
- PRE: ASSESS FOR ALLERIES,
PREGNANCY, KIDNEY FUNCTION
- POST: ASSESS NEUROVASCULAR,
INCREASE FLUID INTAKE
- WATER BASED DYE: AMIPAQUE DYE
- POSITION: SEMI FOWLERS POSITION;
- OIL BASED DYE: PANTOPAQUE DYE
- POSITION: FLAT ON BED
MNGT.
1. BED REST- USE FIRM MATTRESS
2. IMMOBILIZERS
A. BRACES
- CERVICAL BRACE
- PHILIDEPHIA COLLAR
- HALO BRACE- upper thoracic vertebrae
- JEWETT BRACE- lower thoracic upper
lumbar
- CHAIRABACK BRACE: lower lumbar
B. INTERMITTENT SKIN TRACTION
- CERVICAL TRACTION- head halter
- LUMBAR TRACTION- pelvic hardness
MEDICATIONS:
1. MUSCLE RELAXANTS
CYLCOBENZAPINE (FLEXERIL)
C/I: CARDIAC PROBLEM
METHOCARBAMOL (ROBAXIN)-
CHECK BP
S/E: DIZZINESS, DROWSINESS,
HYPOTENSION
- HT: AVOID ACTIVITIES THAT
INCREASE ALERTNESS
SURGERY:
AMPUTATION EYES: CONJUCTIVITIS
1. SURGICAL- UNHEALTHY/ LOWER LUNGS: PLEURISY/ PLEURITIS
EXTREMITIES HEART: PERICARDITIS
2. TRAUMATIC- HEALTHY/ UPPER SPLEEN: SPLEENOMEGALY
EXTREMETIES
3. BONES: OSTEOPOROSIS
TWO PRINCIPLES: LIGAMENTS: LAXITY
1. GOOD CIRCULATION- LE TENDONS: MUSCLE WEAKNESS
2. FUNCTIONALITY- UE RHEUMATOID NODULE- PAINLESS
MOVABLE NODULE SEEN ON FLEXED
(USES TRANSRADIAL CUT) JOINT (ELBOW)

 GOAL: MAINTAIN HEALTHY STUMP 4. (+) RHEUMATOID FACTOR

(RESIDUAL LIMB) - LABORATORY TOOL: INCREASED ESR

MANAGEMENT: 5. SYMMENTRICAL INVOLVEMENT (2

1. HANDLE STUMP GENTLY SIDES)
- Wash with mild soap and water, pat dry 6. SWAN NECK DEFORMITY- excessive
- Avoid creams/ lotion/ powders/ ointment flexion (DIP) Digital Inter Phalanges joints
bcoz it can irritate skin 7. BOUTONNIEVE DEFORMITY- excessive
- Protect: woolen stump socks extension (PIP) Proximal Inter Phalangeal
2. EDEMA CONTROL joint
- Use elastic bandage 8. ULNAR DEFORMITIES/ DRIFT
- Use figure of 8s
- Elevate the stump above the level of the MEDS:
heart (ELEVATE FOOT OF THE BED NO
PILLOWS) (because of hip contractures)
3. ASEPTIC TECHNIQUE
4. LIMB; CONICAL SHAPE
5. INTAKE OF PAIN MEDS
6. NO POSITION: HIP FLEXION, HIP
ABDUCTION, LEG DANGLING
7. EXERCISE: RESISTIVE EXERCISES
8. AMBULATE: 3 PT GAIT CRUTCHES

ARTHRITIS
RHEUMATOID ATHRITIS
- CHRONIC SYTEMIC, AUTOIMMUNE
DISORDER

IMMUNE SYSTEM

ANTIBODY

ATTACKS COLLAGEN

S/SX:
1. JOINTS:
INFLAMMATION/ SYNOVITIS
EARLY MORNING STIFFNESS
2. ORGANS

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