1. Health Infrastructures 10.

Other diseases of respiratory system

General Hospital - Provides a range of different sen ices
for patients of various age groups and with varying
disease conditions.
Specialized hospital - Patients suffering from a specific
disease or affection of one system, or reserved for the
diagnosis and treatment of conditions.
District first-level referral hospital- A hospital at the first
referral level that is responsible for a district or a
defined geographical area
Primary health-care center - A center that provides
services that are usually the first point of contact with a
health professional
2. Health Workforce
6 are non-communicable 4 major NCDs
CVD, cancers, COPD and diabetes mellitus.
PICOT format
 Patient population (i.e., age, gender, disorder)
 Intervention or issue of interest (i.e., exposure,
risk behavior, prognostic factor)
 Comparison intervention or group (ie., could be
placebo or usual care group)
 Outcome (i.e., risk of disease, accuracy of dx,
rate or occurrence
 Time frame (i.e., how long observed, time to
achieve outcome)

Physicians, Nurses, Midwives, Pharmacists, Dentist, Sample Clinical Scenario with clinical questions using
and Other Health Care Providers. PICOT format
Top 8 Most Common Health Issues in the World (WHO) Maria is a 50 year old female patient obese with type 2
diabetes has been trying to reduce weight for almost 2
1. Global influenza pandemic
years now. Over the years she has tried numerous diets
2. Fragile and vulnerable settings and exercise programs to reduce her weight, but has
not been very successful. She is worried that her
3. Antimicrobial resistance
diabetes puts her at risk for heart disease and is
4. Ebola and other high-threat pathogens frustrated that she cannot lose the necessary weight.
Her neighbor suggested to have her stomach stapled
5. Weak primary health care (Bariatric Surgery) not only to lose weight but also
6. Vaccine hesitancy "cured" her diabetes within a year than diet and
exercises program. She wants to know if this procedure
7. Dengue really works.
8. HIV Population = Female patient with Type 2 Diabetes and
obese

National: Health Issues affecting the Philippines in Intervention = Bariatric Surgery

2019 Comparison = Diet and Exercise Program
 Dengue Outcome = Lose weight and Cure Diabetes
 Diptheria
 Measles Time frame = Within 1 year
 Polio What is the clinical question?
Local: Top Leading Cause of Mortality in Zamboanga P In patients with type 2 diabetes and obesity, I does
City 2016 bariatric surgery C = compared to diet and program
1. Heart Disese exercises O = promote the management of diabetes and
weight loss T = within a year of surgery?
2. Diseases of the vascular system
Questions addressing the treatment of an illness or
3. Pneumonias disability.
4. Malignant neoplasms/cancers In(P), how does(I) compared to (C) affect(O) within(T)?
5. Tuberculosis ( all Forms) In(P), what is the effect of(I) on(O) compared with(C)
within(T)?
6. Accidents
In African American female adolescents with hepatitis B
7. COPD and allied conditions
(P), how does acetaminophen (I) compared to ibuprofen
8. Diabetes mellitus (C) affect liver function (O)? (Time is optional).
9. Nephritis/nephritic syndrome

Questions addressing the act or process of identifying or
determining the nature and cause of a disease or injury
through evaluation.
Questions addressing the causes or origin of disease,
the factors that produce or predispose toward a certain
disease or disorder.
Documentation
The act of writing that information down often used to
describe the gathering and compilation of information
from studies or research.
The process of providing proof for the things you write
about and naming the texts that you use.
The purpose of documentation is to:
-Describe the use. The operation, maintenance, or
design of software or hardware through the use of
manuals, listings, diagrams, and other hard- or soft-copy
written and graphic materials.
What is the advantage of documentation?
- Faster and more efficient document retrieval
- Can boost staff morale and increase client satisfaction.
- Document management solutions are scalable to
meet the changing needs of any enterprise.
- Proper document management systems can bring
many benefits to you and your office.
- Sen es as proof that something has been done.
NURSING PROCESS – Systematic guide to client-
centered care with 5 sequential steps. ADPIE
A – Assessment
D – Diagnosis
P- Planning
I – Implementation
E – Evaluation
Patient’s Bill of Rights
1. Right to Appropriate Medical Care and Humane
Treatment
2. Right to Informed Consent
3. Right To Privacy and Confidentiality
4. Right to Information
5. The Right To Choose Health Care Provider and
Facility
6. Right to Self-Determination
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right to Refuse Participation in Medical Research
11. Right to Correspondence and to Receive Visitors
12. Right to Express Grievances
13. Right to be Informed of His Rights and Obligations as
a Patient
HEALTHCARE ETHICS
Beneficence
Non-maleficence - Non-maleficence means non-
harming or inflicting the least harm possible to reach a
beneficial outcome.
• The principle of "non-maleficence" requires an
intention to avoid needless harm or injury that
can arise through act of commission or
omission.
• In common language, it can be considered
"negligence" if you impose a careless or
unreasonable risk of harm upon another.
Autonomy - In medicine, autonomy refers to the right
of the patient to retain control his or her body. A health
care professional can suggest or advise, but any action
or attempt to persuade or coerce patient into making a
choice are violations of this principle. In the end, the
patient must be allowed to make his or
her own decisions.
RA 9173 - or known as the Philippine nursing act of
2002 is an act that assumes to the responsibility for the
protection and improvement of the nursing profession
by instituting measures that will result in relevant
nursing education, humane working conditions better
career prospects and a dignified existence of our nurses
Article VI - section 28 titled as scope of nursing practice
covers,but not limited to, nursing care during
conception, labor, delivery, infancy, childhood, toddler,
preschool, school age, adolescence, adulthood, and old
Age.
It shall be the duty of the nurse to:
a) Provide nursing care through the utilization of
the nursing process. Nursing care includes, but
not limited to. traditional and innovative
approaches, therapeutic use of self, executing
health care techniques and procedures,
essential primary health care, comfort
measures, health teachings, and administration
of written prescription for treatment, therapies,
oral topical and parenteral medications, internal
examination during labour in the absence of
antenatal bleeding and delivery. In case of
suturing of perineal laceration, special training
shall be provided according to protocol
established;
b) Establish linkages with community resources
and coordination with the health team;
a) Provide health education to individuals,
families and communities;
b) Teach, guide and supervise students in
nursing education programs including the
administration of nursing services in varied
settings such as
hospitals and clinics; undertake consultation
services; engage in such activities that require
the utilization of knowledge and decision-
making skills of a registered nurse; and
e.) Undertake nursing and health human resource
development training and research, which shall include,
but not limited to, the development of advance nursing
practice.That this section shall not apply to nursing
students who perform nursing functions under the
direct supervision of a qualified faculty:
a.) Provided, further. That in the practice of nursing
in all settings, the nurse is duty-bound to
observe the Code of Ethics for nurses and
uphold the standards of safe nursing practice.
The nurse is required to maintain competence
by continual learning through continuing
professional education to be provided by the
accredited professional organization or any
recognized professional nursing organization.
b.) b.) Provided, finally, That the program and
activity for the continuing
c.) professional education shall be submitted to
and approved by the Board."
The JRRMMC Cancer Institute Department of
Radiotherapy offers:
• Tumor Localization & Simulation (CT Scanning)
A computerized tomography (CT) scan combines a
senes of X-ray images taken from different angles
around your body and uses computer processing to
create cross-sectional images (slices) of the bones,
blood vessels and soft tissues inside your body*. CTscan
images provide more-detailed information than plain X-
rays do
• High Dose Rate (HDR) Brachytherapy
It is a type of interna! radiotherapy. It involves inserting
thin tubes into the prostate gland.
• Cobalt Radiotherapy
Cobalt therapy is the medical use of gamma rays from
the radioisotope cobalt-60 to treat conditions such as
cancer.
What is R.A 4921?
• An Act Extending the Scope of the Cancer Detection
and Diagnostic Center of the Dr. Jose R. Reyes Memorial
Hospital to Include also Cancer Treatment and
Research, and Appropriating Funds Therefor
Republic Act No. 4921.
Advance Directive
* Is a written document by a competent person,
regarding their health care preference.
* Allow individual to provide directions about the kind
of medical care they do or do not want it they become
unable to make or communicate their decisions.
An Advance Directive may include a living will and/or a
durable power of attorney for health care.
Health Care Problems/Issues
1. Physical Activity and Nutrition
2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. HIV/AIDS
6. Mental Health
7. Injury and Violence
8. Environmental Quality
9. Immunization
10. Access to Health Care
 PREOPERATIVE PHASE 3. Curative - To treat the disease condition and
elimination or repair of a pathologic condition (e.g.
appendectomy)

3 Types of Curative Surgeries

a. Ablative - Involves removal of an organ suffix use "
ectomy * e.g. appendectomy
b. Constructive - Involves removal of ancongenital
defective organ suffix use" plasty, orrhaphy, pexy" e.g.
cheiloplasty, orchidopexy, herniorrhaphy,
c. Reconstructive - Involves repair of damage organ e.g.
plastic surgery for severe burns
d. Palliative - To relieve distressing S/S, not necessarily
to cure the disease e.g. Colostomy.
- alleviation of symptoms without cure (e.g. rhizotomy).
POSTOPERATIVE Removing the symptoms of pain but with no cure

According to degree of RISK/ MAGNITUDE / EXTEND

1. Major surgery - criteria involves high risk of
morbidity and mortality, extensive, large amount of
blood loss, vital organs are removed and great risk of
occurrence of complications e.g. TAH-BSO.
2. Minor surgery - criteria involves lesser risk procedure
is not prolonged and does not usually involve serious
complications.

According to Risk
 Risk deals with the probability of morbidity or death
from surgery.
 The risk period covers the entire perioperative phase
Risk factors Components
Age Extremely young Detailed assessment
Surgery - Also termed as operation, it is the branch of or old Initiate teaching
medicine performed for the purpose of Nutrition Obese or appropriate to px’s
emaciated needs
mechanically altering the human body by the incision or
Nutritional deficit Involve family during
destruction of tissues. (American College of Surgeons, Fluid & Dehydration interview & health
lifted July 4, 2020) Electrolyte Electrolyte teaching
- art & science of treating diseases, injuries and Balance imbalance Verify completion of
deformities by operation and instrumentation General Problems with preoperative diagnostic
health the: pulmo, testing
cardio, liver, Ensure px and fam
PREOPERATIVE – starts before the surgery (initial status
renal, metabolic understanding of
phase) disorders surgeon’s postop orders
- the phase where the professional bond is Infection Examine and review
established between the px and health team Medications Anticoagulant advanced directive
- px prepared physically and mentally Tranquilizers document
Antibiotics Initiates discharge
INTRAIOERATIVE – the surgery itself
Diuretics planning
- starts when the px is wheeled for surgery and Antihypetensives
ends w/ px wheeled for postop care Long term steroid
POSTOPERATIVE – period immediately after surgery
- mainly focused on monitoring and managing According to URGENCIES
the patient’s physiological health. 1. Emergency - The surgery is done immediately to save
the patient's life or limb.
Classification of Surgical Procedures - performed without delay (ASAP)
According to PURPOSE 2. Imperative or Urgent - The surgery must be done
1. Diagnostic - To confirm the presence of a disease within 24-48hrs.
condition, e.g. Biopsy - requires prompt attention (can be within hours)
- determination of the presence and extent of a 3. Planned Required - The procedure is necessary for
pathologic condition the well-being of the patient
2. Exploratory - To determine the nature pr extent of - px is stable but requires early intervention
the disease condition, e.g. exploratory laparotomy
4. Elective - The procedure is not absolutely necessary
for survival, delay will not cause adverse effect.
5. Optional - The procedure is required by the client
for aesthetic purposes.
SURGICAL SETTINGS
1. elective surgery – carefully planned event
2. emergency surgery – may arise with unexpected
urgency
3. ambulatory surgery – majority of the procedures are
performed as same-day or outpatient surgery.
GENERAL RISK FACTORS FOR SURGERY
• Aging
• Obesity
• Fluid electrolyte imbalance
• Presence of disease/s
• Concurrent or prior pharmacotherapy
Informed consent is the patient’s autonomous decision
about whether to undergo a surgical procedure.
Voluntary and written informed consent from the
patient is necessary before nonemergent surgery can be
performed in order to protect the patient from
unsanctioned surgery and protect the surgeon from
claims of an unauthorized operation
Pre-admission and Admission Test
1. Psychological support
2. Client Education:
- Importance and practice of breathing exercises
- Location & support of wound
- Importance of early ambulation
- Inform and practice leg exercises, positioning,
turning
- Anesthesia and analgesics
- Educate regarding drains and dressings to be
received post-op
- Recovery room policies and procedures
3. Informed consent
- At least 18 years of age
- In sound mind- without psychologic disorder
- Not under the influence of drugs or alcohol
- Immediate relative over 18 years old
4. Physical Assessment and preparation
- Physical Preparation – NPO, remove dentures,
jewelries, clothes etc.
- Nutritional & Fluid Status – should be well hydrated
- Drug or alcohol Use – may experience delirium or
intoxication to anesthetic drugs because normal
doses do not usually take effect to these patients
and require heavier dose to achieve anesthetic
effect.
- Respiratory Status - teach breathing exercises
- Cardiovascular Status – should have controlled
and stable cardiovascular functioning before
operation to prevent intraoperative problems
- Hepatic & Renal Functions – normal functioning is
important in absorbing anesthetic drugs
- Endocrine Functions- important in monitoring
to prevent hypo/hyperglycemia, thyrotoxicosis,
acidosis
- Immune Functions – allergies esp. to anesthetic
drugs
- Psychosocial Factors – emotional and psychological
preparation to ensure cooperation fom the patient
with the procedures
- Spiritual & Cultural Beliefs - blood transfusions,
transplants, ligation, etc are against other culture &
religion.
5. Pre-operative drugs – given 20-60 mins.pre-operative
o Makes patient drowsy, keep siderails up
PREOPERATIVE ASESSMENT
1. Identification of the patient - Using 2 identifiers
2. Physical, psychological and social state.
3. Functional Status (Ability to perform ADL)
4. Cardiovascular and Respiratory status
5. Skin Condition
6. Nutritional Status
7. Range of Motion
8. Any prothetics or corrective devices use
9. Pain, Anxiety
10. Sensory Impairments
11. Language barrier, cultural and spiritual needs
12. Previous surgeries and anesthesia exprience
13. Allergies
14. Medications, herbs, nutritional supplements and
drug abuse
15. Support System
Intra-operative Care
Intraop nursing responsibility:
- continue assessment of px physio and psycho status
- promotes safety and privacy
- prevent wound infection and promote heal
1. Ensure sterility of all instruments and supplies at the
operating field
Principle: STERILE TO STERILE, CLEAN TO CLEAN
Sterile objects touches only sterile surfaces/objects
Clean objects touches only clean surfaces/objects
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 - A loss of feeling, sensation of
pain and protective reflexes
Analgesia – absence of sensibility to pain
without loss of consciousness
Anesthesiology – branch of medicine, it is
the administration of medication or anesthetic
agents for the purpose relieving pain while
supporting physiologic
functions
 Anesthetics – drugs that produces local or PACU - Post Anesthesia Care Unit
general loss of sensibility - critical care unit where the patient's vital signs are
Primary consideration in providing anesthesia closely observed, pain management begins, and
- Low morbidity fluids are given. 
- Low mortality
- Lowest concentration Guidelines:
Anesthesia Administration: Respiratory – airway patency, rr, o2 sat; monitor
a. General Anesthesia via Inhalation oxygenation and ventilation
b. General Anestheisia via Intravenous Cardiovascular – monitor heart rate and bp and the ecg
c. Regional Anesthesia - local anesthesia Mental Status – alert and oriented vs. unresponsive
d. Conduction Blocks/ Spinal Anesthesia – Epidural & Pain – need for pain therapy
Spinal Block Hydration – iv fluid management and monitoring
- for operation below the waist line Urine – output and voiding assessment
- patient is awake during operation Drainage and bleeding – periodically assess to prevent
LEVEL OF SEDATION postop complications
- MIMIMAL- px remain responsive Advocacy – informing fam and so about the patient’s
- MODERATE – px remain responsive but won’t status and admission to PACU
remember after the procedure (eg. Regional anes.) Discharging patient from the PACU
- DEEP – depression of consciousness but respond - Most patients are discharged from the PACU at
purposefully after painful stimulation least one hour or until recovery from anesthesia
is ascertained by the nurse and concurred by the
STAGES anesthesiologist.
1 – Onset or Induction - Patient’s stability is ensured upon endorsement
2 - Excitement or delirium (drowsiness of px) (hand-off report) of the patient to the postop
3 – Surgical Stage (good for operation) nurse at the receiving (surgical) unit.
4 – Medullary or Danger stage
Most common postop complication (high fever occurs)
4. Perform sponge count, instrument count and needle Atelectasis (within the first 48hrs), wound infection (in
count 5-7days), Urinary infections (5-8 days),
5. Aseptic technique in handling and preparing all thrombophlebitis (7-14 days)
instruments and supplies
6. Applies grounding device to prevent electrical burn • Fluid and electrolyte balance
during use of electrosurgical • Infection
equipment • Renal function
7. Proper documentation • GIT function
• Liver function
Surgical Attire – reduce px risk for surgical site infection • Endocrine function
- reduces personal exposure to hazardous substance • Hematologic function
“TIME OUT” – Verbal agreement initiated by CN • Presence of trauma
- means where the endorsement happens with surgical
unit nurse and received by the CN to check correct px,
site, procedure, verify implant devices, or special
instructions from the physician, document time in and
out

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
Fluids - Approximately 60% of a typical adult’s weight
consists of fluid (water and electrolytes). Factors that
influence the amount of body fluid are age, gender, and
body fat.
Electrolytes - Electrolytes in body fluids are active
chemicals (cations, which carry positive charges, and
anions, which carry negative charges).
The major cations in body fluid are sodium, potassium,
calcium, magnesium, and hydrogen ions. The major
anions are chloride, bicarbonate, phosphate, sulfate,
and proteinate ions.
Remember (fluid electrolyte SHIFT)
WATER FLOWS WHERE SODIUM GOES
*basically sodium is the queen, it doesn’t follow water
Example: Aldosterone regulates Na+ and K+ (it is either
to keep or release sodium), when we talk directly to
SODIUM, WATER follows either by staying or leaving
with it.
In IV fluids, Isotonic – water and sodium are equal
Hypotonic – more water than sodium (basically water
will rush to the salty (sodium) cell)
Hypertonic – more salt than water (water will rush out
of the cell to meet sodium)
When we talk about WATER, SODIUM does NOT
FOLLOW (so when ADH tells water to stay or leave,
sodium does not follow coz Na doesn’t follow water)
SIADH and DI - is hormones release by ADH. ADH will
either tell kidneys to retain or get rid of water (but
remember that we talking directly to water and we are
not affecting SODIUM)
Composition of Body Fluids
Total body fluid 60% of body wt.
- Intracellular fluids – fluids within the cells (makeup
approximately 40-50% total body wt)
Composition: water, proteins and dissolved solutes –
electrolytes (an element or compound that helps body
to function properly but when dissolved in fluid, breaks
up into ions)
Primary component of electrolytes(cation)- POTASSIUM
Mangesium; Phosphate – high concentration of
negative charge (anion)
- Extracellular fluids
Interstitial fluids – 15% of body wt
Trancellular fluid (plasma) – fluid passes across the cell
Intravascular fluid (CSF) – blood plasma & lymph
Primary component of electrolytes(cation)- SODIUM
Calcium; Chloride – high concentration of negative
charge (anion)
FUNCTIONS OF ELECTROLYTE Affected by:
- Maintains pH IV fluids
- Maintains Homeostasis Food we eat
- Moves water to the body Medications
- Provides energy to the cells Blood Transfusion
- Contract Muscle
Values of the major electrolytes measured in EF Comp.
Magnesium (Mg) 1.5 - 2.5 mEq/L
Sodium (Na) 135 - 145 mEq/L
Phosphorus 2.5 – 4.5 mEq/L
Potassium (K) 3.5 – 5.0 mEq/L
Calcium (CA) 8.5 – 10.5 mEq/L
Chloride (Cl) 95 -105 mEq/L
Mechanisms of Regulating Fluid and Electrolyte
1. Thirst Center
The center of thirst is in the hypothalamus, it regulates
the desire of an individual to drink water or not.
Osmoreceptors cells in the hypothalamus responds to
changes in the osmolality of the ECF, it inhibits or
secretes ADH when there is a decrease or increase in
ECF osmolality.
2. Renal
The kidneys are the major regulators of sodium and
water balance in the ECF through two mechanisms
renin-angiotensin- aldosterone system and sodium-
potassium pump system.
3.Endocrine
Antidiuretic hormone (ADH) controls the amount of
water by increasing permeability of the distal renal
tubules in response to increase or low blood volume,
thus increasing the reabsorption of water.
4. Cardiovascular
The cardiovascular system regulates the volume of fluid,
blood pressure sensor, and atrial natriuretic factor
(ANF).
- Changes in blood volume directly affect atrial
blood pressure and urinary output.
- Arterial baroreceptors and low-pressure sensors
in aorta and carotid react to changes in blood
volume.
- ANF (hormone secreted by the cardiac atria).
Controls fluid volume by signaling the kidney to
decrease sodium reabsorption and by stretching
the wails of the blood vessels in times of fluid
overload.
ENDOCRINE SYSTEMS
Ductless glands – produce and secrete hormones
directly into the bloodstream.
Hypothalamus
- Part of the brain that has a vital role in controlling
many bodily functions including the release of
hormones from the pituitary gland.
- Hypothalamus works with the pituitary gland.
HORMONES
5. Gastrointestinal
Gl absorbs fluid and electrolyte through digestion. The
hormones and enzymes during digestion with active and
passive transport helps in fluid and electrolyte
regulation.
6. Pulmonary
Regulates fluid by controlling respirations:
hypoventilating or hyperventilating.
 Strictly Measure Intake and Output – report
output less than 30 ml/hr
 Assess the vital signs – Note for weak pulses,
hypotension and respiratory status.
 Assess tissue perfusion – Carefully assess skin
and mucous membrane and monitor SO2.
 Monitor Laboratory Values – Review electrolyte
levels, CBC, and urine specific-gravity.
 Weigh daily – Note for changes in weight. Take
weight before breakfast.
 Assess Neurologic Status – Check orientation,
reflexes, muscle strength, vision and hearing.
 Monitor closely and regulate isotonic IV
infusion.
 Monitor signs of shock – cool, moist, pale skin,
tachycardia, weak thready pulses, rapid shallow
respirations, hypotension, changes in LOC,
decrease UO and temperature.

Nursing Management
 Weigh daily – monitor abdominal girth
 Measure accurate input and output
 Assess cardiac, respiratory, and neurologic
status
 Assess skin for pitting edema. Provide good skin
and oral care.
 Strictly regulate IV fluids
 Administer Diuretic and monitor it carefully
 Restrict sodium and water intake
 Monitor laboratory values
 Monitor complications of: MOF
Nursing Management for Shock

ELECTROLYTE IMBALANCES
HYPONATREMIA
Imbalance – HYPONATREMIA: low levels of sodium in
the blood. Serum Sodium level below 135 mEq/L

Etiology – Decreased sodium intake or absorption.

Increased sodium excretion through GI suctioning
suctioning or diaphoresis. Adrenal insufficiency where
aldosterone levels are low. Syndrome of inappropriate
ADH (SIADH).

Causes - Remember “NO Na+”

o Na+ excretion increased with renal problems, NG

suction (GI system rich in sodium), vomiting, diuretics,
sweating, diarrhea, decreased secretion of aldosterone
(wasting sodium)
o Overload of fluid with congestive heart failure,
hypotonic fluids infusions, renal failure (dilutes sodium)
o Na+ intake low through low salt diets or nothing by
mouth
o Antidiuretic hormone over secreted **SIADH
(syndrome of inappropriate antidiuretic hormone
secretion…remembers retains water in the body and
this dilutes sodium)
Manifestations - Nauseas, vomiting, rapid thread pulse,
postural hypotension, shrunken tongue, abdominal
cramps, muscle twitching, headache, dizziness,
confusion, convulsion, coma
Laboratory & diagnostics: Serum Na above 145Urine
specific gravity > 1.015Serum osmolality > 295
mOsm/kg
Nursing Intervention - Provide foods high in salt.
Restrict or limit water Intake. Administer normal saline
solution IV (3% NSS with extreme caution), monitor
cardio-pulmonary status, and obtain BP lying down.
sitting, & standing, daily weighing, monitoring serum
sodium levels
HYPERNATREMIA
Imbalance - High sodium in the blood. Serum Sodium
level above 145 mEqL
Etiology - Excess/rapid administration of normal saline
Solution. Inadequate water intake, Kidney Disease.
Causes – Remember HIGH SALT
o Hypercortisolism (Cushing’s synd.), hyperventilation
o Increased intake of sodium (oral or IV route)
o GI feeding (tube) without adequate water supplement
o Hypertonic solutions
o Sodium excretion decreased (body keeping too much
sodium) and corticosteroids
o Aldosterone overproduction (Hyperaldosteronis)
o Loss of fluids (dehydrated) infection (fever), sweating,
diarrhea, and diabetes insipidus
o Thirst impairment
Manifestations - Thirst DIY, sticky mucous membrane,
rough dry tongue, flushed skin, decreased turgor,
tachycardia edema oliguria to anuria, hyperactive
reflexes, lethargy seizures. The main symptom of
hypernatremia is excessive thirst. Other symptoms are
lethargy, which is extreme fatigue and lack of energy,
and possibly confusion.
Laboratory/Diagnostics: Serum Na below 135Urine
specific gravity > 1.0 10 serum osmolality > 285
mOsmkg
Nursing Intervention - Daily weighing, strict I & O
recording, assess skin and degree of edema, measures
to prevent skin breakdown, Sodium -restricted diet.
vital signs & neurologic assessment, monitor laboratory
test.
HYPOKALEMIA (normal K levels – 3.6 – 5.2mmol/L)
Imbalance – low potassium levels in the blood. Serum
Potassium level below 3.5 mEq/L.
Etiology – inadequate intake or K such in anorexia &
alcoholism. Vomiting, diarrhea. GI suctioning. K wasting
medications such as thiazide, diuretic, laxative, steroid
therapy. Alkalotic state – hypertonic glucose
administration (hyperaldosteronism)
Manifestation –weak pulse (thready, rapid, irregular).
Faint heat sounds. Hypotension. Shallow respirations.
Decrease GI motility a& abnormal distension. Muscle
weakness and cramps. Hyporeflexia. Malaise.
Drowsiness, lethargy, coma, anemia, vomiting, weight
loss.
Try to remember everything is going to be SLOW and
LOW. Don’t forget potassium plays a role in muscle and
nerve conduction so muscle systems are going to be
messed up and effect the heart, GI, renal, and the
breathing muscles for the lungs.
Laboratory & diagnostics – ECG: depress ST segment,
flattened T waves. Serum: K levels below 3.5. pH:
elevated above 7.5. Decrease sodium bicarbonate level.
Elevated Glucose Level.
Nursing intervention:
Be extra cautious in giving drugs that waste K.
Administer KCL oral or IV to replace losses. Monitor ABG
for acid-base imbalances. Monitor pulse, respirations,
BP & ECG.
NURSING FAST FACT!
Assess urine output prior to giving K. IV potassium is
NEVER given IV PUSH. Should be reconstituted in 1 Liter
IV solution, shake to distribute K evenly into the
solution (follow hospital’s protocol). During infusion
check IV site, monitor ECG & serum K level. Monitor
early signs of hyperkalemia (indicate pending cardia
arrest). Oral potassium is given with orange juice.
HYPERKALEMIA
Imbalance - High potassium level in the blood. Serum K
level 5.0 mEq/L
Etiology - Renal insufficiency. Adrenocortical
insufficiency. Bowel obstruction. Use of K sparing
diuretics. Cellulose damage (burns, trauma &
chemotherapy). Infection. High potassium intake. Rapid
IV infusion of solutions with potassium
Manifestation - *Symptoms of hyperkalemia can be Laboratory & diagnostics –
fatal. Thready, slow pulse. Shallow or Kassmauls
 Serum calcium below 8.5
breathing. Nausea, vomiting, intestinal colic. Muscle
 Hyperphosphatemia
paralysis. Paresthesia. Confusion
 Hypomagnesemia
Laboratory & diagnostics - ECG: prolong P-R interval,  Albumin
wide QRS complex, tented T wave (tented T waves is an  Prolong PT, PTT
indication of eventual cardiac arrest).
Nursing intervention:
ABG show metabolic acidosis
 Administer oral calcium (calcium lactate), or IV
Nursing intervention: calcium (calcium gluconate or calcium chloride)
 Seizure precaution & Safety measures: pad side
 Administer Kayexalate as ordered
rails, bed free from sharp object, never leave
 Administer & monitor IV glucose & insulin infusion
patient unattended
 Anticipate hemodialysis if potassium levels become
 Provide diet rich in calcium
severe
 Institute bleeding precautions.
 Administer sodium bicarbonate with caution
 Monitor electrolyte levels
(calcium level drops with bicarbonate)
 Provide cardiac monitoring
 Discontinue any potassium IV or oral supplements
HYPOMAGNESIMIA

Imbalance - Low serum magnesium in the blood. Serum

HYPERCALCEMIA
Imbalance - High calcium levels in the blood.
Etiology - Too much of calcium intake.
Hyperparathyroidism. Thyrotoxicosis. Renal tubules
disorders. Increased vitamin D intake. Altered GI
metabolism. Hypophosphatemia. Bone disorder
(bone cancer, or osteoporosis). Immobility
Manifestation - Nausea, vomiting. Anorexia. Decrease
peristalsis leading to constipation. Headache. Change
in LOC: confusion, lethargy, stupor, or coma. Decreased
muscle tone (weakness/flaccid). Deep bone/ flank pain
Nursing intervention:
 Encourage mobilization
 Limit vitamin D & calcium intake
 Administer diuretics (Lasix)
 Administer IV normal saline
 Administer calcitonin
 Provide safety measures
 Monitor/review electrolyte levels
HYPOCALCEMIA
Imbalance - Low calcium levels in the blood. Calcium
below 8.5 mg/dl
Etiology - Acute pancreatitis. Diarrhea.
Hypoparathyroidism. Vitamin D deficiency.
Malabsorption of Ca. Long term steroid therapy.
Renal failure acute or chronic). Hypomagnesemia
magnesium below 1.3 mEq/L
Etiology - Low in magnesium diet. Malabsorption
syndrome. Prolong diarrhea. Massive diuresis.
hypoparathyroidism
Manifestation - Flushed face. Changes in LOC:
confusion, hallucinations, memory loss. Tetany.
Convulsion. Ataxia, tremors. Hyperactive reflexes.
Laryngeal stridor due to muscle spasm. Trousseau’s
and Chvostek’s sign
Laboratory & diagnostics - Serum magnesium below 1.3
Hypocalcemia
Hypokalemia
ECG: Prolong PR and T intervals, wide ME complexes,
depress ST segment, inverted T waves
Nursing intervention:
Provide dietary food rich of magnesium
Monitor cardiac & respiratory status
Monitor electrolyte levels
Administer magnesium replacement slowly and with
extreme caution
NURSING FAST FACT!
Rapid administration of magnesium can cause
cardiac arrest.Infuse 10% Mg at a rate no more than 1.5
ml/minute.
 Seizure precaution
 Assess for difficulty in swallowing

Manifestation - Painful muscle spasm of upper & lower

extremities. Facial spasm. Laryngospasm. Cardiac
dysrhythmias. Fatigue. Dyspnea. Convulsion.
Positive Trousseau’s and Chvostek’s sign. ECG: prolong
Q-T interval
HYPERMAGNESIMIA
Imbalance - High serum magnesium in the blood. Serum
magnesium above 2.1 mEq/L
Etiology - Renal insufficiency. Hypoadrenalism.
Dehydration. Excessive use of magnesium containing
antacids. Diabetic ketoacidosis
Manifestation - Cardiac arrhythmias. Decrease pulse &
RR. Vomiting. Weakness, depressed reflexes.
Lethargy, somnolence, confusion
Laboratory & diagnostics - Serum magnesium above 2.1
ECG: changes in PR interval, ME complex, and QT
interval
Nursing intervention:
 Withhold magnesium containing drugs and foods
 Increase fluid intake
 Administer calcium gluconate
 Neuromuscular assessment
 Monitor cardiac status
Nursing Assessment:
Vital signs; Dietary pattern- type of food/fluids, number
of meals a day; Food preferences & intake of protein,
carbohydrates, & fats; Loss of appetite; Nausea/
vomiting; Heart burn or indigestion; Weight, body built;
Skin turgor, condition of mucous membrane & teeth;
Elimination pattern; Presence of edema, crackles, or
wheezes; Jugular vein distension or flatness; Bowel
sounds m& abdominal girth; Pattern of elimination:
urine concentration and characteristics stools &
frequency of elimination.
Nursing Diagnosis
 Fluid Volume, Excess related to compromised
regulatory mechanism
 Fluid Volume, Deficit related to active fluid loss
 Altered Mucous Membrane related to dehydration
 Imbalanced Nutrition: less than/ more than body
requirements related to inability to ingest, digest, or
absorb nutrients
HOMEOSTATIC MECHANISMS
The body is equipped with remarkable homeostatic
mechanisms to keep the composition and volume of
body fluid within narrow limits of normal. Organs
involved in homeostasis include the kidneys, lungs,
heart, adrenal glands, parathyroid glands, and pituitary
gland.
Kidney Functions
Vital to the regulation of fluid and electrolyte balance,
the kidneys normally filter 170 L of plasma every day in
the adult, while excreting only 1.5 L of urine. They act
both autonomously and in response to blood-borne
messengers, such as aldosterone and antidiuretic
hormone (ADH). Major functions of the kidneys in
maintaining normal fluid balance include the following:
• Regulation of ECF volume and osmolality by selective
retention and excretion of body fluids
• Regulation of electrolyte levels in the ECF by selective
retention of needed substances and excretion of
unneeded substances
• Regulation of pH of the ECF by retention of hydrogen
ions
• Excretion of metabolic wastes and toxic substances
Heart and Blood Vessel Functions
The pumping action of the heart circulates blood
through the kidneys under sufficient pressure to allow
for urine formation. Failure of this pumping action
interferes with renal perfusion and thus with water and
electrolyte regulation.
Lung Functions
The lungs are also vital in maintaining homeostasis.
Through exhalation, the lungs remove approximately
300 mL of water daily in the normal adult. Abnormal
conditions, such as hyperpnea (abnormally deep
respiration) or continuous coughing, increase this loss;
mechanical ventilation with excessive moisture
decreases it. The lungs also have a major role in
maintaining acid–base balance. Changes from normal
aging result in decreased respiratory function, causing
increased difficulty in pH regulation in older adults with
major illness or trauma.
Pituitary Functions
The hypothalamus manufactures ADH, which is stored
in the posterior pituitary gland and released as needed.
ADH is sometimes called the water-conserving hormone
because it causes the body to retain water. Functions of
ADH include maintaining the osmotic pressure of the
cells by controlling the retention or excretion of water
by the kidneys and by regulating blood volume.
Adrenal Functions
Aldosterone, a mineralocorticoid secreted by the zona
glomerulosa (outer zone) of the adrenal cortex, has a
profound effect on fluid balance. Increased secretion of
aldosterone causes sodium retention (and thus water
retention) and potassium loss. Conversely, decreased
secretion of aldosterone causes sodium and water loss
and potassium retention.
Composition of Blood
ACID-BASE IMBALANCES a. Administer NaHco3 b. Get rid of CO2
- Is an abnormality of the human body's normal balance c. Bronchodilators d. Monitor ABG
of acids and bases that causes the plasma pH to deviate
out of normal range. Respiratory Alkalosis
(Absolute co2 deficit)
❖ Causes of Acid-Base Imbalances Occurs as a result of
• Respiratory = are due to a problem with the lungs. hyperventilation or excess
Acidosis and Alkalosis aspirin intact.
• Metabolic = are due to a problem with the kidneys. causes: hyperventilation
Acidosis and Alkalosis (kidney will excrete amount
of bicarb to lower ph) Note: pH ↑; pco2↓
Normal Values of ABG Analysis a. Breathe into paper bag (always note for buffer
• Blood pH = 7.35 -7.45 (measures acidity/alkalinity) or cupped hands system, bicarb)
• paO2 = 80-100 mmHg (measure amount of o2 b. Oxygen
delivered to the lungs
• paCO2 = 35-45 mmHg (co2 respi parameter Metabolic Acidosis
influenced by lungs only (Absolute bicarb deficit)
• HCO3 = 22 - 26 mEq/L (influenced by metabolic causes: DM, shock, renal failure
factors only) (lungs blow off CO2 to raise ph)
• 02 Saturation = 95-100% a. Treat underlying cause
(Starvation, systemic
infections, renal failure,
Diabetic acidosis, Keratogenic diet, diarrhea,
excessive exercise)
b. Promote good air exchange
c. Give NAHCO3 via IV
Note: pH↓; HCO3 ↓ (always note for buffer system,
pCO2)

Metabolic Alkalosis
(absolute hco3 excess)
causes: prolonged vomiting,
diuretic therapy w/o K, NaHCO3
ingestion
(lungs blow off CO2 to raise ph)
a. Restore fluid loss which may
be cause by vomiting, gastric
suction, alkali ingestion, excessive diuretic
Note: pH↑; HCO3 ↑ (always note for buffer system,
pCO2)

NMENOMICS: Better think about

Respiratory Acidosis –
(Absolute co2 excess)
Occurs when breathing is
Inadequate and PaCO2
builds up.
causes: respiratory depression
pneumothorax, atelectasis
(kidney will retain increased
amount of bicarb to increase
the ph)
R- Respiratory
O – Opposite
M- Metabolic
E – Equal
NOTE: If the pCO2 is affected it is ALWAYS,
RESPIRATORY
If HCO3 is affected it is ALWAYS, METABOLIC
UNCOMPENSATED: Co2 or HCo3 normal results.
PARTIALLY COMPENSATED: Nothing is normal
COMPENSATED: pH is normal (7-4 baseline/neutral
Note: pH↓; pco2↑;
(always note for buffer
system, bicarb)

Nursing Intervention:

PROBLEMS IN OXYGENATION
UPPER RESPIRATORY TRACT
- The upper respiratory tract known as the upper airway
warms and filters inspired air so that the lower
respiratory tract (lungs) can accomplish gas exchange.
• Nursing Care of Clients with upper airway disorders
- Upper airway includes four compartments
• Nose- Functional during nasopharyngeal breathing
• Mouth - Functional during oropharyngeal breathing.
• Pharynx or the throat
• Larynx or voice box - (upper part)
1. Oxygenation – Ventilation
The adding of oxygen to any system in the body
The act of normal spontaneous breathing
Process: Inhalation & Exhalation
Nursing Care of Clients with Upper Airway Disorders
- Rhinitis, Pharyngitis
- Tonsilitis, Laryngitis, Epistaxis, Nasal Obstruction
Nursing Care of Clients with Ventilation Disorders
- Acute Bronchitis
- Asthma / Status asthmaticus
2. Oxygenation- Transport
Oxygen is carried in the blood bound to hemoglobin and
dissolved in plasma (intracellular fluid)
Nursing Care with Client Problems in Oxygenation -
Transport
Hematologic Disorders
1. Platelet/Coagulation Disorder:
Platelet disorders are complications that occur when
the platelet count in the blood is either high or too low,
and the platelets do not operate correctly. Platelets are
microscopic blood cells generated in the bone marrow
from more giant cells. When there are injuries, platelets
produce a stopper, called a blood clot, to seal the
wound.
Blood clots assist halt or slow down bleeding.
1.1. Idiopathic thrombocytopenic pupura
Idiopathic thrombocytopenic purpura is a blood
condition characterized by an abnormally low platelet
count. A platelet reduction can cause superficial
bruising, gum, and internal bleeding. ITP may be acute
and resolve within six months, or it may be chronic and
persist for more than six months.
ETIOLOGY
Immune thrombocytopenia usually happens when your
immune system mistakenly attacks and destroys
platelets, which are cell fragments that help blood clot.
In adults, this may be triggered by infection with HIV ,
hepatitis or H. pylori — the type of bacteria that causes
stomach ulcers.
PATHOPHYSIOLOGY
The pathophysiology of ITP is complex and
abnormalities of both the B-cell and the T-cell
compartments have been identified. The mechanisms of
the thrombocytopenia involve both increased platelet
destruction and, in a significant proportion of cases,
impaired platelet production.
SIGNS AND SYMPTOMS
 Easy or excessive bruising.
 Superficial bleeding into the skin that appears
as pinpoint-sized reddish-purple spots
(petechiae) that look like a rash, usually on the
lower legs.
 Bleeding from the gums or nose.
 Blood in urine or stools.
 Unusually heavy menstrual flow.
MANAGEMENT
 Steroids
 Immune globulin
 Drugs that boost platelet production
1.2. Hemophilia
Hemophilia is often a hereditary condition characterized
by improper blood clotting. It can result in spontaneous
bleeding after injury or surgery. Blood includes
several proteins known as clotting factors that aid in
stopping bleeding
ETIOLOGY
Hemophilia is caused by a mutation or change, in one of
the genes, that provides instructions for making the
clotting factor proteins needed to form a blood clot.
This change or mutation can prevent the clotting
protein from working properly or to be missing
altogether. These genes are located on the X
chromosome.
PATHOPHYSIOLOGY
Hemophilia is a rare, inherited hemorrhagic disorder
that results from the deficiency or dysfunction of
coagulation protein factors. Factor VIII (FVIII) and factor
IX (FIX) deficiencies and dysfunctions are the
pathological basis of hemophilia A and hemophilia B,
respectively.
SIGNS AND SYMPTOMS
 Unexplained and excessive bleeding from cuts
or injuries, or after surgery or dental work.
 Many large or deep bruises.
 Unusual bleeding after vaccinations.
 Pain, swelling or tightness in your joints.
 Blood in your urine or stool.
 Nosebleeds without a known cause.
 In infants, unexplained irritability.
MANAGEMENT
The best way to treat hemophilia is to replace the
missing blood clotting factor so that the blood can clot
properly. This is typically done by injecting treatment
products, called clotting factor concentrates, into a
person's vein.
1.3.DIC
Disseminated intravascular coagulation (DIC) is an
uncommon but deadly disorder characterized by
irregular blood clotting throughout the blood arteries of
the
body. A person may develop DIC if an infection or injury
disrupts normal blood clotting within the body.
ETIOLOGY
The underlying cause is usually due to inflammation,
infection, or cancer. In some cases of DIC, small blood
clots form in the blood vessels. Some of these clots can
clog the vessels and cut off the normal blood supply to
organs such as the liver, brain, or kidneys.
PATHOPHYSIOLOGY
Bleeding into organs, along with microvascular
thromboses, may cause dysfunction and failure in
multiple organs. Delayed dissolution of fibrin polymers
by fibrinolysis may result in the mechanical disruption
of red blood cells, producing schistocytes and mild
intravascular hemolysis.
SIGNS AND SYMPTOMS
 Bleeding, from many sites in the body.
 Blood clots.
 Bruising.
 Drop in blood pressure.
 Shortness of breath.
 Confusion, memory loss or change of behavior.
 Fever.
MANAGEMENT
 Plasma transfusions to reduce bleeding. Plasma
transfusion replace blood clotting factors
affected by DIC.
 Transfusions of red blood cells and/or platelets.
 Anti-coagulant medication (blood thinners) to
prevent blood clotting.
2.Anemia
Anemia is a disorder in which there are insufficient
healthy red blood cells to transport sufficient oxygen to
the body's tissues. A person with anemia, known as low
hemoglobin, may experience fatigue and weakness.
Each type of anemia has its underlying etiology.
2.1. Iron deficiency
A lack of iron causes iron deficiency anemia. Without
sufficient iron, the body cannot make enough of a
protein that permits red blood cells to transport oxygen
(hemoglobin). Consequently, iron deficiency anemia can
cause fatigue and shortness of breath.
ETIOLOGY
The body stores of iron decreases as do the stores of
transferrin which binds and transports iron. This leads
to depletion of red blood cells, resulting in decreased
hemoglobin concentration and decreased oxygen-
carrying capacity of blood.
PATHOPHYSIOLOGY
Iron deficiency anemia develops when body stores of
iron drop too low to support normal red blood cell
(RBC) production. Inadequate dietary iron, impaired
iron absorption, bleeding, or loss of body iron in the
urine may be the cause.
SIGNS AND SYMPTOMS
 Dizziness or lightheadedness
 Extreme fatigue
 Weakness
 Pale skin
 Fast heartbeat
 Headache
 Cold hand and feet
 Inflammation or soreness of tongue
 Craving for non-nutritive substance such as ice.
 Poor appetite
MANAGEMENT
 Parental iron
 Iron supplementation
 Iron rich foods
2.2. Hemolytic/Sickle Cell
Sickle cell anemia is one of a group of inherited
disorders known as sickle cell disease. It affects the
shape of red blood cells, which carry oxygen to all parts
of the body. Red blood cells are usually round and
flexible, so they move easily through blood vessels. In
sickle cell anemia, some red blood cells are shaped like
sickles or crescent moons. These sickle cells also
become rigid and sticky, which can slow or block blood
flow.
ETIOLOGY
Sickle cell anemia is caused by a change in the gene that
tells the body to make the iron-rich compound in red
blood cells called hemoglobin. Hemoglobin enables red
blood cells to carry oxygen from the lungs throughout
the body.
PATHOPHYSIOLOGY
The pathophysiology of SCD is based on genetics, HbS
polymerization–dependent hemolysis and sickling, vaso-
occlusion–dependent ischemia-reperfusion injury,
endothelial dysfunction–dependent vasculopathy, and
sterile inflammation. These factors lead to multiorgan
complications.
SIGN AND SYMPTOMS
 Fatigue (feeling weak and unusually tired)
 Dizziness.
 Headaches.
 Cold hands and feet.
 Jaundice (yellow tinted skin or whites of eyes)
 Unusually pale skin and mucous membranes
(tissue inside the nose, mouth, and elsewhere
inside the body)
MANAGEMENT
Treatments might include medications and blood
transfusions. For some children and teenagers, a stem
cell transplant might cure the disease
2.3. Megaloblastic
Megaloblastic anemia is a condition in which the bone
marrow produces unusually large, structurally
abnormal, immature red blood cells (megaloblasts).
Bone marrow, the soft spongy material found inside
certain bones, produces the main blood cells of the
body -red cells, white cells, and platelets.
ETIOLOGY
The most common causes of megaloblastic anemia are
deficiency of either cobalamin (vitamin B12) or folate
(vitamin B9). These two vitamins serve as building
blocks and are essential for the production of healthy
cells such as the precursors to red blood cells.
PATHOPHYSIOLOGY
Megaloblastic anemia (MA) encompasses a
heterogeneous group of anemias characterized by the
presence of large red blood cell precursors called
megaloblasts in the bone marrow. This condition is due
to impaired DNA synthesis, which inhibits nuclear
division.
SIGNS AND SYMPTOMS
 Fatigue
 Nausea
 Occasional diarrhea
 Sore, swollen tongue
 Tingling feeling in toes
 Feeling of clumsiness
MANAGEMENT
• leafy green vegetables.
• peanuts.
• lentils.
• enriched grains.
• Parenteral
• Folic acid supplements
2.4. Aplastic
Aplastic anemia, or bone marrow failure, is more than
anemia. Aplastic anemia is a rare but serious blood
condition that occurs when the bone marrow cannot
make enough new blood cells for the body to work
typically. It can develop quickly or slowly and can be
severe or mild
ETIOLOGY
Aplastic anemia is caused by damage to stem cells
inside your bone marrow, which is the sponge-like
tissue within your bones. Many diseases and conditions
can damage the stem cells in bone marrow. As a result,
the bone marrow makes fewer red blood cells, white
blood cells, and platelets. The most common cause of
aplastic anemia is from your immune system attacking
the stem cells in your bone marrow.
PATHOPHYSIOLOGY
Aplastic anemia (AA) is characterized by bone marrow
(BM) hypocellularity, resulting in peripheral cytopenias.
An antigen-driven and likely auto-immune dysregulated
T-cell homeostasis results in hematopoietic stem cell
injury, which ultimately leads to the pathogenesis of the
acquired form of this disease.
SIGNS AND SYMPTOMS
 Fatigue.
 Shortness of breath.
 Rapid or irregular heart rate.
 Pale skin.
 Frequent or prolonged infections.
 Unexplained or easy bruising.
 Nosebleeds and bleeding gums.
 Prolonged bleeding from cuts.
MANAGEMENT
• Blood transfusions
• Bone marrow transplantation
• Immune-suppressing drugs
• Growth factors
• Antibiotics to fight infections
3. OXYGENATION- PERFUSION
Perfusion is the process of oxygenated blood being
delivered to the tissues of the body.
Nursing Care with Client Problems in Oxygenation -
Perfusion
o Hypertension
- Also known as high blood pressure, is blood
pressure that is higher than normal of which
according to the seventh report of the JNC on the
detection, prevention and treatment of high blood
pressure guideline.
• Normal - Systolic Pressure is less than 120 mmHg
and diastolic pressure less than 80 mmHg.
• At risk - (Prehypertension) Systolic: 120-139
mmHg; Diastolic: 80-89 mmHg
• High blood pressure (Hypertension) -
Systolic: 130 or higher
Diastolic: 80 and higher
o Coronary Artery Disease (CAD)
Coronary artery disease is caused by plaque buildup in
the wall of the arteries that supply blood to the heart
(called coronary arteries).
ETIOLOGY
Coronary artery disease is caused by plaque buildup in
the wall of the arteries that supply blood to the heart
(called coronary arteries). Plaque is made up of
cholesterol deposits. Plaque buildup causes the inside
of the arteries to narrow over time. This process is
called atherosclerosis.
PATHOPHYSIOLOGY
Atherosclerosis can be described as a low-grade
inflammatory state of the intima (inner lining) of
medium-sized arteries that is accelerated by the well-
known risk factors such as high blood pressure, high
cholesterol, smoking, diabetes, and genetics.
SIGNS AND SYMPTOMS
 Chest pain or discomfort (angina)
 Weakness, light-headedness, nausea (feeling
sick to your stomach), or a cold sweat.
 Pain or discomfort in the arms or shoulder.
 Shortness of breath.
MANAGEMENT
Coronary angioplasty is also performed as an
emergency treatment during a heart attack.
o Myocardial Infarction
Heart Attack (Myocardial Infarction) A heart attack
(medically known as a myocardial infarction) is a deadly
medical emergency where your heart muscle begins to
die because it isn't getting enough blood flow. This is
usually caused by a blockage in the arteries that supply
blood to your heart.
ETIOLOGY
Most myocardial infarctions are due to underlying
coronary artery disease, the leading cause of death in
the United States. With coronary artery occlusion, the
myocardium is deprived of oxygen. Prolonged
deprivation of oxygen supply to the myocardium can
lead to myocardial cell death and necrosis.
PATHOPHYSIOLOGY
In the clinical context, myocardial infarction is usually
due to thrombotic occlusion of a coronary vessel caused
by rupture of a vulnerable plaque. Ischemia induces
profound metabolic and ionic perturbations in the
affected myocardium and causes rapid depression of
systolic function.
SIGNS AND SYMPTOMS
The symptoms of MI include chest pain, which travels
from left arm to neck, shortness of breath, sweating,
nausea, vomiting, abnormal heart beating, anxiety,
fatigue, weakness, stress, depression, and other factors
MANAGEMENT
The immediate priority in managing acute myocardial
infarction is thrombolysis and reperfusion of the
myocardium, a variety of other drug therapies such as
heparin, β-adrenoceptor blockers, magnesium and
insulin might also be considered in the early hours.
o Angina Pectoris
Angina pectoris is the medical term for chest pain or
discomfort due to coronary heart disease. It occurs
when the heart muscle doesn't get as much blood as it
needs. This usually happens because one or more of the
heart's arteries is narrowed or blocked, also called
ischemia.
ETIOLOGY
Angina is caused by reduced blood flow to the heart
muscle. Blood carries oxygen, which the heart muscle
needs to survive. When the heart muscle isn't getting
enough oxygen, it causes a condition called ischemia.
The most common cause of reduced blood flow to the
heart muscle is coronary artery disease (CAD).
PATHOPHYSIOLOGY
Angina is caused by reduced blood flow to the heart
muscle. Blood carries oxygen, which the heart muscle
needs to survive. When the heart muscle isn't getting
enough oxygen, it causes a condition called ischemia.
The most common cause of reduced blood flow to the
heart muscle is coronary artery disease (CAD).
SIGNS AND SYMPTOMS
• A pressing, squeezing, or crushing pain, usually in the
chest under your breastbone.
• Pain may also occur in your upper back, both arms,
neck, or ear lobes.
• Pain radiating in your arms, shoulders, jaw, neck, or
back.
• Shortness of breath.
• Weakness and fatigue.
• Feeling faint.
MANAGEMENT
The most common form of nitrate used to treat angina
is nitroglycerin. The nitroglycerin pill is placed under the
tongue. Your health care provider might recommend
taking a nitrate before activities that typically trigger
angina (such as exercise) or on a long-term preventive
basis. Aspirin.
o Arthrosclerosis
Atherosclerosis is the buildup of fats, cholesterol and
other substances in and on the artery walls. This
buildup is called plaque. The plaque can cause arteries
to narrow, blocking blood flow. The plaque can also
burst, leading to a blood clot.
ETIOLOGY
Atherosclerosis happens when the endothelium
becomes damaged, due to factors such as smoking, high
blood pressure, or high levels of glucose, fat, and
cholesterol in the blood. This damage allows a
collection of substances, known as plaque, to build up in
the artery wall. These substances include fat and
cholesterol.
PATHOPHYSIOLOGY
Atherosclerosis mainly develops through the continuous
process of arterial wall lesions due to lipid retention by
trapping in the intima by a matrix (eg proteoglycans)
resulting in a modification which then aggravates
chronic inflammation vulnerable sites in the arteries.
SIGNS AND SYMPTOMS
• chest pain or angina.
• pain in your leg, arm, and anywhere else that
has a blocked artery.
• cramping in the buttocks while walking.
• shortness of breath.
• fatigue.
• confusion, which occurs if the blockage affects
circulation to your brain.
MANAGEMENT
Some medications used to treat atherosclerosis: Statins
and other cholesterol drugs. Aggressively lowering low-
density lipoprotein (LDL) cholesterol — the "bad"
cholesterol — can slow, stop or even reverse the
buildup of fatty deposits in the arteries.
o Congestive heart failure
Heart failure — sometimes known as congestive heart
failure — occurs when the heart muscle doesn't pump
blood as well as it should. When this happens, blood
often backs up and fluid can build up in the lungs,
causing shortness of breath.
ETIOLOGY
The most common cause of decompensated congestive
heart failure is inappropriate drug treatment, dietary
sodium restriction, and decreased physical activity.
Uncontrolled hypertension is the second most common
cause of decompensated heart failure.
PATHOPHYSIOLOGY
Congestive heart failure is a syndrome that can be
caused by a variety of abnormalities, including pressure
and volume overload, loss of muscle, primary muscle
disease or excessive peripheral demands such as high
output failure. In the usual form of heart failure, the
heart muscle has reduced contractility.
SIGNS AND SYMPTOMS
 Shortness of breath with activity or when lying
down.
 Fatigue and weakness.
 Swelling in the legs, ankles and feet.
 Rapid or irregular heartbeat.
 Reduced ability to exercise.
 Persistent cough or wheezing with white or pink
blood-tinged mucus.
 Swelling of the belly area (abdomen)
MANAGEMENT
Doctors usually treat heart failure with a combination of
medications. Depending on your symptoms, you might
take one or more medications, including: Angiotensin-
converting enzyme (ACE) inhibitors. These drugs relax
blood vessels to lower blood pressure, improve blood
flow and decrease the strain on the heart.
o Acute Coronary Syndrome (ACS)
Acute coronary syndrome is a term used to describe a
range of conditions associated with sudden, reduced
blood flow to the heart. One such condition is a heart
attack (myocardial infarction) — when cell death results
in damaged or destroyed heart tissue.
ETIOLOGY
Acute coronary syndrome usually results from the
buildup of fatty deposits (plaques) in and on the walls of
coronary arteries, the blood vessels delivering oxygen
and nutrients to heart muscles. When a plaque deposit
ruptures or splits, a blood clot forms. This clot blocks
the flow of blood to heart muscles.
PATHOPHYSIOLOGY
The underlying pathophysiology in ACS is decreased
blood flow to part of heart musculature which is usually
secondary to plaque rupture and formation of
thrombus. Sometimes ACS can be secondary to
vasospasm with or without underlying atherosclerosis.
SIGNS AND SYMPTOMS
 Chest pain (angina) or discomfort, often
described as aching, pressure, tightness or
burning.
 Pain spreading from the chest to the shoulders,
arms, upper abdomen, back, neck or jaw.
 Nausea or vomiting.
 Indigestion.
 Shortness of breath (dyspnea)
 Sudden, heavy sweating (diaphoresis)
MANAGEMENT
What is the immediate treatment for ACS?
Morphine (or fentanyl) for pain control, oxygen,
sublingual or intravenous (IV) nitroglycerin, soluble
aspirin 162-325 mg, and clopidogrel with a 300- to 600-
mg loading dose are given as initial treatment.
o Cardiogenic Shock
Cardiogenic shock, also known as cardiac shock,
happens when your heart cannot pump enough blood
and oxygen to the brain and other vital organs. This is a
life-threatening emergency. It is treatable if diagnosed
right away, so it's important to know the warning signs.
ETIOLOGY
Most often the cause of cardiogenic shock is a serious
heart attack. Other health problems that may lead to
cardiogenic shock include heart failure, which happens
when the heart can't pump enough blood to meet the
body's needs; chest injuries; and blood clots in the
lungs.
PATHOPHYSIOLOGY
The pathophysiology of cardiogenic shock involves a
vicious spiral circle: ischemia causes myocardial
dysfunction, which in turn aggravates myocardial
ischemia. Myocardial stunning and/or hibernating
myocardium can enhance myocardial dysfunction, thus,
worsening the cardiogenic shock.
SIGNS AND SYMPTOMS
• Rapid breathing.
• Severe shortness of breath.
• Sudden, rapid heartbeat (tachycardia)
• Loss of consciousness.
• Weak pulse.
• Low blood pressure (hypotension)
• Sweating.
• Pale skin.
MANAGEMENT
Medications to treat cardiogenic shock are given to
increase your heart's pumping ability and reduce the
risk of blood clots. Vasopressors. These medications are
used to treat low blood pressure. They include
dopamine, epinephrine (Adrenaline, Auvi-Q),
norepinephrine (Levophed) and others.
o Vascular Disorders
Vascular diseases affect the circulatory system. They
include hypertension, stroke, aneurysms, and
peripheral artery disease (PAD). Due to an aging
population, an increase in obesity and chronic
conditions like Type II diabetes, vascular diseases are a
growing epidemic.
ETIOLOGY
The most common cause of vascular disease is
atherosclerosis, which happens when a buildup of a
fatty substance called plaque inside the arteries causes
them to narrow, slowing or blocking the flow of blood.
PATHOHYSIOLOGY
The pathophysiology of atherosclerosis is a complex
inflammatory response with the involvement of various
vascular cells, thrombotic factors, and cholesterol and
inflammatory molecules. Atherosclerosis begins with
lipoprotein accumulation within the intimal layer of
large arteries.
SIGNS AND SYMPTOMS
• Wounds that won't heal over pressure points, such as
heels or ankles.
• Numbness, weakness, or heaviness in muscles.
• Burning or aching pain at rest, commonly in the toes
and at night while lying flat.
• Restricted mobility.
• Thickened, opaque toenails.
• Varicose veins.
MANAGEMENT
Types of treatments for vascular diseases include:
Lifestyle changes, such as eating a heart-healthy diet
and getting more exercise. Medicines, such as blood
pressure medicines, blood thinners, cholesterol
medicines, and clot-dissolving drugs.
- Thromboanginitis obliterans
ETIOLOGY
Thromboangiitis obliterans (Buerger disease) is caused
by small blood vessels that become inflamed and
swollen. The blood vessels then narrow or get blocked
by blood clots (thrombosis). Blood vessels of the hands
and feet are mostly affected. Arteries are more affected
than veins.
PATHOPHYSIOLOGY
In Buerger's disease — also called thromboangiitis
obliterans — your blood vessels become inflamed, swell
and can become blocked with blood clots (thrombi).
This eventually damages or destroys skin tissues and
may lead to infection and gangrene.
SIGNS AND SYMPTOMS
The most common symptoms of Buerger's disease are:
Fingers or toes that appear pale, red, or bluish. Cold
hands or feet. Pain in the hands and feet that may feel
like burning or tingling.
MANAGEMENT
1. Medications to dilate blood vessels, improve
blood flow or dissolve blood clots.
2. Intermittent compression of the arms and legs
to increase blood flow to your extremities.
3. Spinal cord stimulation.
4. Amputation, if infection or gangrene occurs.
- Peripheral vascular disease
Peripheral vascular disease (PVD) is a slow and
progressive circulation disorder. Narrowing, blockage,
or spasms in a blood vessel can cause PVD. PVD may
affect any blood vessel outside of the heart including
the arteries, veins, or lymphatic vessels.
ETIOLOGY
The most common cause of PVD is atherosclerosis, the
buildup of plaque inside the artery wall. Plaque reduces
the amount of blood flow to the limbs. It also decreases
the oxygen and nutrients available to the tissue.
PATHOPHYSIOLOGY
Peripheral vascular disease is primarily driven by
progressive atherosclerotic disease resulting in the
reduction of major organ blood flow and end-organ
ischemia. The process of atherosclerosis is complex,
with the involvement of numerous cells, proteins, and
pathways.
SIGNS AND SYMPTOMS
 Changes in the skin, including decreased skin
temperature, or thin, brittle, shiny skin on the
legs and feet.
 Weak pulses in the legs and the feet.
 Gangrene (dead tissue due to lack of blood
flow)
 Hair loss on the legs.
 Impotence.
MANAGEMENT
Medical management of peripheral artery disease
includes cholesterol reduction, antiplatelet therapy,
anticoagulation, peripheral vasodilators, blood pressure
control, exercise therapy, and smoking cessation, all of
which have the capacity to reduce mortality, symptoms,
and complications.
- Deep vein thrombosis
Deep vein thrombosis (DVT) is a medical condition that
occurs when a blood clot forms in a deep vein. These
clots usually develop in the lower leg, thigh, or pelvis,
but they can also occur in the arm.
ETIOLOGY
The main causes of deep vein thrombosis (DVT) are
damage to a vein from surgery or inflammation and
damage due to infection or injury.
PATHOPHYSIOLOGY
Deep venous thrombosis usually begins in venous valve
cusps. Thrombi consist of thrombin, fibrin, and red
blood cells with relatively few platelets (red thrombi);
without treatment, thrombi may propagate proximally
or travel to the lungs.
SIGNS AND SYMPTOMS
 throbbing or cramping pain in 1 leg (rarely both
legs), usually in the calf or thigh.
 swelling in 1 leg (rarely both legs)
 warm skin around the painful area.
 red or darkened skin around the painful area.
  swollen veins that are hard or sore when you Signs and symptoms
touch them. o pain, swelling and tenderness around your cheeks,
MANAGEMENT eyes or forehead,
Treatments include medications called anticoagulants o a blocked nose.
(blood thinners), compression stockings and elevating o a reduced sense of smell,
your affected leg(s) at different times throughout the o green or yellow mucus from your nose,
day. In a minority of cases, when the DVT is extensive, o a sinus headache
invasive treatments (catheter-based procedures) may
be required. Management/Treatment
Humidification, nasal wash, decongestants (topical or
COMMON RESPIRATORY SIGNS AND SYMPTOMS systemic) such as pseudoephedrine.
• Dyspnea or SOB Only start antibiotics if you strongly suspect
• Wheezing bacterial disease.
• Chest pain
• Cough Allergic Rhinitis
• Hemoptysis Etiology
• Sputum production Allergic Rhinitis is caused by an allergen such as pollen,
dust, mold or animal shedding.
COMMON DIAGNOSTIC EVALUATION Non-allergic rhinitis is usually caused by a viral infection,
• Pulmonary Function Test although it can also be caused by the oversensitive
• ABG blood vessels in the nose reacting to irritants, and the
• Sputum Analysis overuse of nasal decongestants.
• Pulse Oximetry
• Imaging Studies ( CXR, CT, MRI, etc.) Pathophysiology
Allergic rhinitis is induced after exposure to allergens via
MNEMONICS (SOCRATES) to assess chest pain IgE-mediated hypersensitivity reactions.
S – Site of pain Non-allergic rhinitis has the lack o f systemic allergic
O – Onset of pain sensation (negative skin testing and/or lack of serum-
C – Character of pain specific IgE) to the aeroallergens implicated in allergic
R – any Radiation rhinitis.
A – Associated Factors
T – Timing of pain Signs and Symptoms
E – Exacerbating / Alleviating Factors S&S of allergic rhinitis includes itching, sneezing, runny
S – Severity of pain using rating scale nose, stuffiness, and itchy, watery eyes. People may
have headaches and swollen eyelids and also may
Modifiable Risk Factors includes the ff: cough and wheeze
Smoking Dyslipidemia S&S of non-allergic rhinitis may consist of but are not
Obesity Poor diet limited to runny nose, sneezing, congestion, postnasal
Hypertension drip, cough, and a low-grade fever.

Oxygenation Problems on Ventilation and Gas Management/Treatment

Exchange
Sinusitis
Etiology
Causes are a combination of environmental and host
factors. Those with atopy commonly get sinusitis, it can
be caused by allergens, irritants, viruses, fungi, and
bacteria.
Pathophysiology
Ciliary immobility can lead to increased mucus viscosity,
further blocking drainage. Bacteria are introduced into
the sinuses by coughing and nose blowing. Bacterial
sinusitis usually occurs after a viral upper respiratory
infection and worsening symptoms after 5 days, or
persistent symptoms after 10 days.
Treatment of allergic rhinitis include the use of
antihistamine, decongestant, and the use of nasal spray.
Treatment of non-allergic rhinitis include avoiding
triggers, the use of decongestant, and the use of nasal
sprays.
Rhinitis/Common Cold
- The common cold is a viral infection of your nose and
throat (upper respi tract). It’s usually harmless,
although it might not feel that way. Many types of
viruses can cause common cold.
Pharyngitis
PHARYNGITIS IS THE INFECTION OF THE PHARYNX.
There are 2 types of pharyngitis: Acute pharyngitis
(Acute pharyngitis is more common than chronic
pharyngitis. Treatment involves treating the symptoms,
and it usually goes away within 10 days) and
Chronic pharyngitis (Chronic pharyngitis lingers for
much longer — often for several weeks. There are many
different causes, and treatment involves addressing the
underlying problem)
Etiology
Virus - About 50% to 80% of pharyngitis, or sore throat,
symptoms are viral in origin and include a variety of
viral pathogens.
Bacteria - The most common bacterial infection is
Group A beta-hemolytic streptococci, which causes 5%
to 36% of cases of acute pharyngitis.
Pathophysiology
Bacteria and viruses can cause direct invasion of the
pharyngeal mucosa. Certain viruses like rhinovirus can
cause irritation secondary to nasal secretions. In almost
all cases, there is a local invasion of the pharyngeal
mucosa which also results in excess secretion and
edema.
Signs and Symptoms
- A cough
- A headache
- Fever
- Body aches
- Sneezing
- Congestion in the nasal passageways
Management/Treatment
Nursing management:
- Recommends avoidance of alcohol, tabacco,
secondhand smoke, and exposure to cold
environment and occupational pollutants
- Encourage the patient to have plenty of drinks or
fluids.
- Gargling with warm saline solution may relieve
throat discomfort.
Laryngitis
Acute laryngitis is an inflammation of the vocal fold
mucosa and larynx. When the etiology of acute
laryngitis is infectious, white blood cells remove
microorganisms during the healing process. The vocal
folds then become more edematous, and vibration is
adversely affected, thus eliciting hoarseness.
Etiology
The most common cause of infectious laryngitis is virus
infection such as rhinovirus and other causative viruses
including parainfluenza virus, respiratory syncytial virus,
influenza, and adenoviruses. Bacterial and fungal
infection can also be a cause of infectious laryngitis.
Non-infectious causes of laryngitis include irritant
laryngitis (e.g., due to toxic exposure), allergic,
traumatic, especially due to heavy vocal use.
Pathophysiology
In chronic laryngitis, the inflammatory process damages
the ciliated epithelium of the larynx, particularly in the
posterior wall. This impairs the important function of
moving the mucous flow out of the tracheobronchial
tree which results mucous stasis on the posterior wall of
the larynx and around the vocal cords provokes a
reactive cough.
Signs and Symptoms
- Hoarseness
- Weak voice or voice less
- Tickling sensation and rawness in your throat
- Sore throat
Management/Treatment
- Self-care measures such as voice rest, drinking fluids
and humidifying your air.
- Medications such as antibiotics and corticosteroids
are used in some cases
- Voice therapy
- In some cases, surgery may be needed.
Trancheitis
Tracheitis is an inflammation of the trachea. Although
the trachea is usually considered part of the lower
respiratory tract in ICD-10 tracheitis is classified under
"acute upper respiratory infections”
Etiology
Bacterial tracheitis is a bacterial infection of the trachea
and is capable of producing airway obstruction. One of
the most common causes is Staphylococcus aureus and
often follows a recent viral upper respiratory infection.
Bacterial tracheitis is a rare complication of influenza
infection. It is the most serious in young children,
possibly because of the relatively small size of the
trachea that gets easily blocked by swelling.
Pathophysiology
In bacterial tracheitis, pathogenic bacteria invade the
trachea and stimulate both local and systemic
inflammatory responses. Locally, this results in
production of thick, mucopurulent exudates, ulceration
and sloughing of the tracheal mucosa.
Signs and Symptoms
- Increasing deep or barking croup cough following a
recent upper respiratory infection
- Crowing sound when inhaling
- 'Scratchy' feeling in the throat
- Chest pain Signs and Symptoms
- Fever - chronic daily cough
- coughing up blood
MANAGEMENT/TREATMENT - abnormal sounds or wheezing in the chest with
In more severe cases, it is treated by administering breathing
intravenous antibiotics and may require admission to an - shortness of breath
intensive care unit (ICU) for intubation and supportive - chest pain
ventilation if the airway swelling is severe. - coughing up large amounts of thick mucus every
day

OXYGENATION PROBLEMS ON GAS EXCHANGE MANAGEMENT/TREATMENT

Lungs Alveoli Treatments includes antibiotics, mucus thinning
- COPD - Emphysema medication, airway clearance devices and clinical trials.
- PULMONARY EDEMA Management suggestions include: quitting smoking,
- CorPulmonale Bronchioles healthy diet, staying hydrated and stay updated on
- CHRONIC OBSTRUCTIVE - Bronchiectasis vaccinations.
- PULMONARY DISEASE
- Acute respiratory distress Pulmonary Edema
- syndrome (ARDS) Pulmonary edema is a condition caused by excess fluid
- RESPIRATORY FAILU in the lungs. This fluid collects in the numerous air sacs
- Atelectasis in the lungs, making it difficult to breathe.
- PNEUMOTHORAX
- Pleural effusion Etiology
If a heart problem causes the pulmonary edema, it's
called cardiogenic pulmonary edema. Most often, the
Bronchiectasis fluid buildup in the lungs is due to a heart condition.
Bronchiectasis can If pulmonary edema is not heart related, it's called
occur if the noncardiogenic pulmonary edema.
inflammation Sometimes, pulmonary edema can be caused by both a
permanently destroys heart problem and a non-heart problem.
the elastic-like tissue
and muscles Pathophysiology
surrounding the Pulmonary edema is often caused by congestive heart
bronchi (airways), failure. When the heart is not able to pump efficiently,
causing them to blood can back up into the veins that take blood
widen. The abnormal through the lungs. As the pressure in these blood
bronchi then become filled with excess mucus, which vessels increases, fluid is pushed into the air spaces
can trigger persistent coughing and make the lungs (alveoli) in the lungs.
more vulnerable to infection
Signs and symptoms
Etiology Difficulty breathing (dyspnea) or extreme shortness of
Bronchiectasis is caused by the airways of the lungs breath
becoming damaged and widened. This can be the result A feeling of suffocating or drowning that worsens when
of an infection or another condition, but sometimes the lying down
cause is not known. Bronchiectasis can occur if the A cough that produces frothy sputum
inflammation permanently destroys the elastic-like Wheezing or gasping for breath
tissue and muscles surrounding the bronchi (airways), Cold, clammy skin
causing them to widen.
MANAGEMENT/TREATMENT
Pathophysiology Diuretics. Doctors commonly prescribe diuretics, such
As bronchiectasis is an acquired disorder, its as furosemide (Lasix), to decrease the pressure caused
pathophysiology is commonly described as distinct by excess fluid in your heart and lungs. Morphine (MS
phases of infection and chronic inflammation. The Contin, Oramorph, others).
interaction between these phases establishes a vicious
circle in which the end result is the destruction of the
bronchi and the accompanying clinical symptoms.
CORPULMONALE
Corpulmonale is defined as an alteration in the
structure and function of the right ventricle (RV) of the
heart caused by a primary disorder of the respiratory
system.
Etiology
Causes are blood clots in the lungs, chronic obstructive
pulmonary disease. lung tissue damages. sleep apnea.
cystic fibrosis.
Pathophysiology
The pathophysiology of corpulmonale is a result of
increased right-sided filling pressures from pulmonary
hypertension that is associated with diseases of the
lung. The increased afterload leads to structural
alterations in the right ventricle (RV) Including RV
hypertrophy (RVH) which can be seen in chronic cor
pulmonale.
Signs and symptoms
Patients may report a combination of fatigue,
tachypnea, exertional dyspnea, and cough. Anginal
chest pain can also occur and may be due to right
ventricular ischemia or pulmonary artery stretching,
which typically do not respond to nitrates.
MANAGEMENT/TREATMENT
Treatment is aimed primarily at treating the underlying
condition; the aim is improving oxygenation and right
ventricular (RV) function by increasing RV contractility
and decreasing pulmonary vasoconstriction.
Chronic Obstructive Pulmonary Disease (COPD)
Etiology
COPD, or chronic obstructive pulmonary disease, is a
progressive disease that makes it hard to breathe.
Progressive means the disease gets worse over time.
There are 2 main causes of COPD:
- Smoking (and less often other inhalational exposures)
- Genetic factors
Pathophysiology
Inhalational exposures can trigger an inflammatory
response in airways and alveoli that leads to disease in
genetically susceptible people. The process is thought to
be mediated by an increase in protease activity and a
decrease in antiprotease activity.
Respiratory infection (which COPD patients are prone
to) may amplify progression of lung destruction.
Signs and symptoms
Symptoms usually progress quickly in patients who
continue to smoke and in those who have a higher
lifetime tobacco exposure. Morning headache develops
in more advanced disease and signals nocturnal
hypercapnia or hypoxemia.
MANAGEMENT/TREATMENT
For most people with COPD, short-acting bronchodilator
inhalers are the first treatment used. There are 2 types
of short-acting bronchodilator inhaler:
beta-2 agonists, such as salbutamol, salmeterol,
formoterol and vilanterol.
anticholinergics, such as ipratropium, tiotropium,
aclidinium and glycopyrronium.
CHRONIC BRONCHITIS “Blue Bloater”
- 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.
Cause: Cigarette Smoking, infection, pollution
Signs and Symptoms
Productive Cough Slight gynecomastia
Thicker, mor tenacious mucus Petechiae in midsternal
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)
Signs and Symptoms:
1. Dyspnea on exertion
2. Tachypnea
3. Barrel-chest
4. Wheezes
5. Pinkish skin color
6. Shallow rapid respirations
7. Pursed lip breathing
Nursing Management: Acute respiratory distress syndrome (ARDS)
 Position: Sit up and lean forward Etiology
 Pulmonary toilet: Underlying causes of ADS include:
 Cough->Breathe deeply->Chest physiotherapy-> Sepsis. The most common cause of ARDS is sepsis, a
turn & position serious and widespread infection of the bloodstream.
 Frequent rest periods Inhalation of harmful substances. Breathing high
 Nebulization concentrations of smoke or chemical fumes can result in
 IPPB – Intermittent Positive Pressure Breathing ARDS, as can inhaling (aspirating) vomit or near-
(aerosolized inhalation) drowning episodes.
 O2 @ 2LPM Severe pneumonia. Severe cases of pneumonia usually
affect all five lobes of the lungs.

Asthma Pathophysiology
-A condition where there is an increase responsiveness The pathophysiology of acute respiratory distress
and/or spasm of the trachea and bronchi due to various syndrome involves fluid accumulation in the lungs not
stimuli which causes narrowing of airways explained by heart failure (noncardiogenic pulmonary
Cause and Risk Factors: edema). It is typically provoked by an acute injury to the
1. Family history of asthma lungs that results in flooding of the lungs' microscopic
2. Allergens: dust, pollens, air sacs responsible for the exchange of gases such as
3. Secondary smoke inhalation oxygen and carbon dioxide with capillaries in the lungs.
4. Air pollution
5. Stress Signs and symptoms
Types: - Severe shortness of breath
1. Immunologic asthma - occurs in childhood - Labored and unusually rapid breathing
2. non-immunologic asthma - occurs in adulthood and - Low blood pressure
assoc w/ recurrent resp infections. Usually >35 y/o - Confusion and extreme tiredness
3. Mixed, combined immunologic and non-immunologic
MANAGEMENT/TREATMENT
Signs and Symptoms - Oxygen
 Increased tightness of chest, dyspnea - Management of fluids
 Tachycardia, tachypnea - Management of fluid intake is another ARDS
 Dry, hacking, persistent cough treatment strategy. This can help ensure an
 (+) wheezes, crackles adequate fluid balance.
 Pallor, cyanosis, diaphoresis - Medication
 Chronic barrel chest, elevated shoulders
 distended neck veins
 orthopnea
 Tenacious, mucoid sputum Respiratory Failure
Nursing Management: Respiratory failure is a condition in which your blood
1. Promote pulmonary ventilation doesn't have enough oxygen or has too much carbon
2. Facilitate expectoration dioxide. Sometimes, you can have both.
3. Health teaching
 Breathing techniques Etiology
 Stress management Potential causes include: disorder of the spine, such as
 Avoid allergens scoliosis, inhalation injuries, such as inhaling smoke
Treatment: from fires or fumes. Lung-related conditions, such as
1. Steroids, acute respiratory distress syndrome (ARDS), cystic
2. Antibiotics fibrosis, chronic obstructive pulmonary disease (COPD),
3. Bronchodilators, expectorants pneumonia, or a pulmonary embolism.
4. O2, nebulization, aerosol
Pathophysiology
Hypoventilation: in which PaCO2 and PaO2 and
alveolar-arterial PO2 gradient are normal.
Depression of CNS from drugs is an example of this
condition.
V/P mismatch: this is the most common cause of
hypoxemia. Administration of 100% 02 eliminates
hypoxemia.
Signs and symptoms Etiology
- Dyspnea The most common causes of transudative (watery fluid)
- Tachypnoea pleural effusions include:
- Restlessness - Heart failure, Pulmonary embolism.
- Confusion - Cirrhosis.
- Anxiety - Post open heart surgery

MANAGEMENT/TREATMENT
This includes supportive measures and treatment of the
underlying cause. Supportive measures which depend
on depending on airways management to maintain
adequate ventilation and correction of the blood gases
Abnormalities.
Pathophysiology
The accumulation of fluid in the pleural space is due to
the rate of pleural fluid production exceeding the rate
of reabsorption. Effusion of exudative type occurs when
filtration rate exceeds maximum lymph flow, resulting
in an effusion with higher than usual protein content.

Signs and symptoms

Atelectasis
Etiology
The primary cause of acute or chronic atelectasis is
bronchial obstruction by the following:
- Plugs of tenacious sputum
- Foreign bodies
- Endobronchial tumors
- Tumors, a lymph node, or an aneurysm
compressing the bronchi and bronchial distortion
Pathophysiology
The pathophysiology of atelectasis is not fully
understood. However, current theories suggest that
airway collapse is due to a combination of airway
compression, alveolar gas resorption intra-operatively,
and impairment of surfactant production.
- Chest pain
- Dry, nonproductive cough
- Dyspnea (shortness of breath, or difficult, labored
breathing)
- Orthopnea (the inability to breathe easily unless
the person is sitting up straight or standing erect)
MANAGEMENT/TREATMENT
A minor pleural effusion often goes away on its own
without treatment. In other cases, doctors may need to
treat the condition that is causing the pleural effusion.
For example, you may get antibiotics to treat
pneumonia. Or you could get other medicines to treat
heart failure.

Signs and symptoms

- Difficulty breathing PNEUMOTHORAX
- Rapid, shallow breathing
- Wheezing
- Cough

MANAGEMENT/TREATMENT
The most effective treatments for atelectasis are deep
breathing exercises and chest physiotherapy. This
ensures that the airways are opened maximally and Etiology
coughing can be performed effectively. As an adjunct, Primary spontaneous pneumothorax occurs in patients
ensure that the patient has adequate pain control to without underlying pulmonary disease, classically in tall,
allow them to deep breathe thin young men in their teens and 20s. It is thought to
be due to spontaneous rupture of subpleural apical
blebs or bullae that result from smoking or that are
inherited.
PLEURAL EFFUSION
Pleural effusion, Pathophysiology
sometimes referred Intrapleural pressure is normally negative (less than
to as "water on the atmospheric pressure) because of inward lung and
lungs, is the build- outward chest wall recoil. In pneumothorax, air enters
up of excess fluid the pleural space from outside the chest or from the
between the layers lung itself via mediastinal tissue planes or direct pleural
of the pleura perforation. Intrapleural pressure increases, and lung
outside the lungs. volume decreases.
Signs and symptoms
Small pneumothoraces are occasionally asymptomatic.
Symptoms of pneumothorax include dyspnea and
pleuritic chest pain. Dyspnea may be sudden or gradual
in onset depending on the rate of development and size
of the pneumothorax.

MANAGEMENT/TREATMENT
- Immediate needle decompression for tension
pneumothoraces
- Observation and follow-upx-ray
- Catheter aspiration for large or symptomatic
primary spontaneous pneumothoraces
- Tube thoracostomy for secondary and traumatic
pneumothoraces

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:
1. Chest pain, irritability, apprehensiveness, irritability,
restlessness, nausea, anorexia, hx of exposure
2. Cough- productive , rusty/ yellowish/greenish
sputum, splinting of affected side, chest retration
3. CXR, sputum culture, Blood culture, increased WBC,
elevated sedimentation rate

Nursing Management:
 Promote adequate ventilation- positioning,
Chest physiotherapy, IPPB
 Provide rest and comfort
 Prevent potential complications
 Health teaching: skin care, hygiene
 Drug therapy:
o Antibiotics: penicillin, cephalosphorin,
tetracycline, erythromycin
o Cough suppressants
o Expectorants
 Rest and adequate activity
 Proper Nutrition
Catheter Care, Urology Surgery, & Urinary Diversion.
• Breaks in the catheter tubing or collection bag
• Contamination of the catheter tubing or collection bag
• Entry during insertion
• Bacteria movement up the catheter
Gloves play a key role in preventing hand contamination
—but do NOT replace hand hygiene
Perform hand hygiene and wear gloves immediately
before—
• Accessing the drainage system
• Emptying the drainage bag
• Collecting a urine sample
Remove gloves and perform hand hygiene immediately
after—
• Handling an indwelling catheter
• Accessing the drainage system
• Emptying the drainage bag
• Collecting a urine sample
• Only trained staff should empty the urine collection
bag and rinse/store containers
• Follow manufacturer's instructions on use
• Empty drainage bags regularly (at least once per shift)
• Stabilize the catheter tubing and drainage bag
• Keep drainage bag below level of bladder and off the
floor at all times
• Consider where to place the drainage bag during
resident's daily activity
 Wheelchair
 Walker (clamp or hook)
 Bed
 Dining/activity area
 Lounge/reading chair (peg on side)
Leg Bags and Bath Basins
• Residents sometimes prefer leg bags, which can
improve mobility and dignity
• Leg bag care and changing should be done per your
facility's policy
• The outside of the leg bag and the leg straps should
be—
 Wiped down during routine, daily bathing care
 Rinsed and promptly dried
 Do not allow prolonged skin-to-skin contact with
wet/damp materials
Bath Basins
• Clean and disinfect basins after each bathing
procedure
• Keep bath basins clean and dry when not in use, and
stored upside down to prevent airborne
contamination
• Replace basins if damaged
• A resident identifier should be clearly displayed
*Disclaimer: A multidisciplinary team reviewed the
literature, and while there is a general lack of research
and evidence surrounding leg bag and bath basin care,
this team was able to make general recommendations.
Please remember to follow your facility's policy and
direct any questions to your supervisor.
The DO's of Indwelling Urinary Catheter Care
• Do perform peri-care using only soap and water
• Do keep the catheter and tubing from kinking and
becoming obstructed
• Do keep catheter systems closed when using urine
collection bags or leg bags
• Do replace catheters and collection bags that become
disconnected
• Do ensure the resident's identifier/implementation
date is on their urine collection containers
• Do make sure to disinfect the sampling port before
obtaining a sample
The DON'Ts of Indwelling Urinary Catheter Care
• Don't change catheters or drainage bags at routine,
fixed intervals
• Don't administer routine antimicrobial prophylaxis
• Don't use antiseptics to cleanse the periurethral area
while a catheter is in place
• Don't clean the periurethral area vigorously
• Don't irrigate the bladder with antimicrobials
• Don't instill antiseptic or antimicrobial solutions into
drainage bags
• Don't routinely screen for asymptomatic bacteriuria
• Don't contaminate the catheter outlet valve during
collection bag emptying
URETHRAL CATHETER
Signs and Symptoms
• Inability to pass urine for the last 8 hours
• Tender palpable bladder midway between the pubic
symphysis and umbilicus
• Large distended bladder as well as a pelvic mass
• Presence of a large posterior uterine wall mass
• Anterior displacement of the urinary bladder
• Mild (grade I) bilateral hydronephrosis/hydroureter
Nursing Management
• Determine need for catheterization, but HCP must
order
• Choose appropriate type and size of catheter
• Insert catheter in patient with urethral trauma, pain,
or obstruction
• Develop plan of care to decrease risk for infection in
patient with indwelling catheter
• Teach catheter care to the patient, particularly one
who is ambulatory
• Use a sterile, close drainage system in short-term
catheterization
Medical Management
• Gonadotropin-releasing hormone (GnRH) agonists.
Decrease estrogen production and are most helpful
when given preoperatively to reduce fibroid and uterine
volume, making surgery
technically more feasible and reducing blood loss during
surgery. In general, these drugs should not be used in
the long term because rebound growth to pretreatment
size within 6 months
is common and bone demineralization may occur.
• Exogenous progestins. Partially suppress estrogen
stimulation of uterine fibroid growth. Progestins can
decrease uterine bleeding but may not shrink fibroids as
much as GnRH agonists.
• Danazol. An androgenic agonist, can suppress fibroid
growth but has a high rate of adverse effects (eg, weight
gain, acne, hirsutism, edema, hair loss, deepening of the
voice, flushing,
sweating, vaginal dryness) and is thus often less
acceptable to patients.
• Tranexamic acid (Lysteda, Cyklokapron). This
nonhormonal medication is taken to ease heavy
menstrual periods. It's taken only on heavy bleeding
days.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Used
to treat pain but probably do not decrease bleeding.
NEPHROSTOMY TUBE
• A nephrostomy tube is a thin catheter placed into the
kidney to drain urine. A patient can have one tube in a
kidney or two tubes, one in each kidney. The
urine collects in a bag attached to the tube. In most
cases, the bag is attached to the leg.
• A nephrostomy is an opening between the kidney and
the skin. A nephrostomy tube is a thin plastic tube that
is passed from the back, through the skin
and then through the kidney, to the point where the
urine collects. Its job is to temporarily drain the urine
that is blocked.
• It is used if a person has kidney stones, pelvic tumors,
damage to the urinary systems or prostate cancer.
Purpose of Nephrostomy Tube
- To provide urinary drainage through a tube inserted
into the renal pelvis
- Tub exits from the flank and is attached to extension
tubing which drains to a leg bag
- Designed to divert the drainage away from a partial or
complete obstruction of the urinary tract
Indications for Insertion of a Nephrostomy Tube
- To remove renal calculi.
- To decompress an obstructed system and to maintain
or improve renal function following ureteric obstruction
- To obtain access to the renal pelvis for radiological
procedures. e.g. insertion of ante grade stent
Nursing Management:
- Check nephrostomy is on free drainage
- Ensure fluid-balance chart is in progress, with urine
measurements taken once or twice an hour; if urine
output is <30ml/hour, inform member of medical
team
- Ensure nephrostomy tube is secured at exit site with
suture and drain fixation dressing
- Place transparent film dressing over site for extra
security/water resistance
- Monitor dressings for strike-through at least twice
daily
- Make observations every 30 minutes for two hours,
then once every hour for two hours (including blood
pressure, pulse, temperature, respiration, and
oxygen monitoring)
- Advise bed rest for 4-6 hours
Medical Management
- Nil by mouth six hours prior to the procedure
- Confirm with the healthcare provider regarding the
administration or withholding of anticoagulants and
other medication
- Most patient should receive broad-spectrum
parenteral antibiotics
- Insulin dependent diabetic patients must have insulin
dextrose infusion and hourly BSL checked unless
otherwise stated by healthcare provider.
- If drugs are administered, it is recommended to use
cephalosporin or combination of penicillin and
aminoglycoside prior to the procedure, depending on
the patient’s allergies
SUPRAPUBIC CATHETERS
Signs and Symptoms
• 24 hours of (chronic) urinary retention
• Strong pain in the lower abdomen
• Prostate w/5cm in breadth
• Distended bladder (palpable half-way to the
umbilicus)
Medical History
• Previously diagnosed with the following;
➢ Benign Prostatic Hyperplasia (BPH)
➢ Alcoholic Hepatitis
➢ Lumbar Strain
• Has not taken any medication or using recreational
drugs.
 Medical Management
• Diphenhydramine (Benadryl).
• Pseudoephedrine (Sudafed
• Narcotics
• Oxybutynin (Ditropan).
• Tamsulosin (Flomax).
Nursing Management
• Teach catheter care to patients especially to one who
is ambulatory, if not, to the significant others.
• Utilize a sterile, closed drainage system in short-term
catheterization.
• Use sterile technique whenever the collecting system
is open. If frequent irrigations are necessary in short-
term catheterization to maintain catheter patency, a
triple-lumen catheter may be preferable, permitting
continuous irrigations within a closed system.
• Place a pectin-base skin barrier on the insertion site to
protect the skin around the area from breakdown.
IDWELLING DRAINAGE SYSTEM
An indwelling urinary catheter (IUC), generally referred
to as a “Foley” catheter, is a closed sterile system with a
catheter and retention balloon that is inserted either
through the urethra or suprapubically to allow for
bladder drainage.
External collecting devices (e.g. drainage tubing and
bag) are connected to the catheter for urine collection
Indwelling urinary catheters are recommended only for
short-term use, defined as less than 30 days (EAUN
recommends no longer than 14 days.) The catheter is
inserted for continuous drainage of the bladder for two
common bladder dysfunction: urinary incontinence (UI)
and urinary retention.
Two Types of Indwelling Catheters
Indwelling urinary catheters are either inserted:
• Transurethrally
• Suprapubically
In practice, transurethral catheterization is the typical
approach because the procedure can be organized and
managed by nurses whereas suprapubic catheterization
requires a more complex procedure. However, if in
place long-term, defined as more than 30 days, the
insertion, changing and management are done by
nurses (registered nurses, licensed practical nurses).
PERITONIAL DIALYSIS
a way to remove waste products from your blood when
your kidneys can't adequately do the job any longer.
This procedure filters the blood in a different way than
does the more common blood-filtering procedure called
hemodialysis
You need dialysis if your kidneys no longer function well
enough. Kidney damage generally progresses over a
number of years as a result of long-term conditions,
such as:
 Diabetes
 High blood pressure
 Kidney inflammation (glomerulonephritis)
 Multiple cysts in the kidneys (polycystic kidney
disease)
HEMODIALYSIS
In hemodialysis, a machine filters wastes, salts and fluid
from your blood when your kidneys are no longer
healthy enough to do this work adequately.
Hemodialysis (he-moe-die-AL-uh-sis) is one way to treat
advanced kidney failure and can help you carry on an
active life despite failing kidneys.
With hemodialysis, you'll need to:
 Follow a strict treatment schedule
 Take medications regularly
 Make changes in your diet
Hemodialysis is a serious responsibility, but you don't
have to shoulder it alone. You'll work closely with your
health care team, including a kidney specialist and other
professionals with experience managing hemodialysis.
You may be able to do hemodialysis at home.
UROLOGY SURGERY PROCEDURES
1. Vasectomy
Vasectomy is a surgical procedure used for permanent
male birth control. During the procedure, the doctor
cuts off the supply of sperm to the semen by cutting
and sealing the vas deferens, which carries sperm from
the testicles. It is an out-patient procedure that only
takes about 10-30 minutes.
2. Vasectomy Reversal
If a man who has had a vasectomy decides he wants to
try and father children again, a vasectomy reversal can
be performed
3. Cystoscopy
A cystoscopy is a urology procedure that allows a
urologist to examine the lining of the bladder and the
urethra. This procedure is commonly used to diagnose
and treat bladder conditions. It can also be used to
diagnose an enlarged prostate.
4. Prostate Procedures
Urologists may perform a number of procedures to
diagnose and treat prostate conditions. These include:
 Prostate biopsy
 UroLift
 Transurethral needle ablation (TUNA)
 Transurethral resection of the prostate (TURP)
 Transurethral incision of the prostate (TUIP)
5. Ureteroscopy
Ureteroscopy is a procedure used to diagnose and treat
kidney stones. Small stones can be removed whole,
while larger stones need to be broken up. The
procedure used to break up the stones is called
lithotripsy.
6. Lithotripsy
Lithotripsy is a urology procedure that uses shock waves
or a laser to break down stones in the kidney, bladder,
or ureter.
7. Orchiopexy
Orchiopexy is a surgical procedure performed to repair
an undescended testicle.
8. Penile Plication
Penile plication is a surgical urology procedure that is
used to treat curvature of the penis caused
by Peyronie’s disease.
9. Penile Implants & Prosthesis
Penile implants or prostheses are devices placed inside
the penis to allow men with erectile dysfunction (ED) to
get an erection.
10. Male circumcision
Circumcision is a surgical procedure in which the skin
covering the tip of the penis (foreskin) is removed. It is a
procedure commonly performed on newborn boys in
different places around the world.
Disorders of Urinary Elimination.
LEIOMYOMAS
ETIOLOGY
Although the initiator or initiators of fibroids are
unknown, several predisposing factors have been
identified, including age (late reproductive years),
African-American ethnicity, nulliparity, and obesity.
Nonrandom cytogenetic abnormalities have been found
in about 40% of tumors examined.
PATHOPHYSIOLOGY
Fibroids are a result of the inappropriate growth of
uterine smooth muscle tissue or myometrium. Their
growth is dependent on estrogen and progesterone
levels. The underlying pathophysiology is uncertain.
SIGNS AND SYMPTOMS
 Heavy menstrual bleeding.
 Menstrual periods lasting more than a week.
 Pelvic pressure or pain.
 Frequent urination.
 Difficulty emptying the bladder.
 Constipation.
 Backache or leg pains.
MANAGEMENT
Surgery has traditionally been the gold standard for the
treatment of uterine leiomyomas and has typically
consisted of either hysterectomy or myomectomy.
BENIGN PROSTATIC HYPERPLASIA
Benign prostatic hyperplasia (BPH) — also called
prostate gland enlargement — is a common condition
as men get older. An enlarged prostate gland can cause
uncomfortable urinary symptoms, such as blocking the
flow of urine out of the bladder. It can also cause
bladder, urinary tract or kidney problems.
ETIOLOGY
The etiology of BPH is influenced by a wide variety of
risk factors in addition to direct hormonal effects of
testosterone on prostate tissue. BPH arises as a result of
the loss of homeostasis between cellular proliferation
and cell death, resulting in an imbalance favoring
cellular proliferation.
PATHOPHYSIOLOGY
Prostatic enlargement depends on the potent androgen
dihydrotestosterone (DHT). In the prostate gland, type II
5-alpha-reductase metabolizes circulating testosterone
into DHT, which works locally, not systemically. DHT
binds to androgen receptors in the cell nuclei,
potentially resulting in BPH.
SIGNS AD SYMPTOMS
 Frequent or urgent need to urinate.
 Increased frequency of urination at night
(nocturia)
 Difficulty starting urination.
 Weak urine stream or a stream that stops and
starts.
 Dribbling at the end of urination.
 Inability to completely empty the bladder.
MANAGEMENT • Pregnancy
Treatment for BPH has long been medications and • Age (older adults and young children are more likely
procedures, such as lasers or an electric loop, which to get UTIs)
burn the prostate from the inside out. But, now, a • Structural problems in the urinary tract, such as
relatively new convective water therapy treatment uses enlarged prostate
steam to make the prostate smaller. • Poor hygiene, for example, in children who are potty-
training

COMPLICATIONS
UTI When treated promptly and properly, lower urinary
DEFINITION tract infections rarely lead to complications. But left
A urinary traction untreated, UTIs can cause serious health problems.
infection (UTI) is a very Complications of a UTI may include:
common type of infection • Repeated infections, which means you have two or
in your urinary system. A more UTIs within six months or three or more within a
UTI can involve any part year. Women are especially prone to having
of your urinary system, repeated infections.
including the urethra, • Permanent kidney damage from a kidney infection
ureters, bladder, and due to an untreated UTI.
kidneys. Symptoms typically include needing to urinate • Delivering a low birth weight or premature infant
often, having pain when urinating and feeling pain in when a UTI occurs during pregnancy.
your side or lower back. Most UTIs can be treated with • A narrowed urethra in men from having repeated
an antibiotic. infections of the urethra.
• Sepsis, a potentially life-threatening complication of
SIGNS AND SYMPTOMS an infection. This is a risk especially if the infection
A urinary tract infection causes the lining of the urinary travels up the urinary tract to the kidneys.
tract to become red and irritated (inflammation), which
may produce some of the following symptoms: MANAGEMENT
• Pain in the side (flank), abdomen or pelvic area. • Symptomatic UTI: antibiotic therapy
• Pressure in the lower pelvis. • Asymptomatic UTI: no treatment required except in
• Frequent need to urinate (frequency), urgent need to special situations.
urinate (urgency) and Incontinence (urine leakage). • Non-specific therapy: more water intake and maintain
• Painful urination (dysuria) and blood in the urine. acidity of urine by fluid like
• The need to urinate at night. cranberry juice or use of ascorbic acid.
• Abnormal urine color (cloudy urine) and strong or TREATMENT
foul-smelling urine. Antibiotics usually are the first treatment for urinary
tract infections. Your health and the type of bacteria
Other symptoms that may be associated with a urinary found in your urine determine which medicine is used
tract infection include: and how long you need to take it.
• Pain during sex. Simple infection
• Penis pain. Medicines commonly used for simple UTIs include:
• Flank (side of the body) pain or lower back pain. • Trimethoprim and sulfamethoxazole (Bactrim, Bactrim
• Fatigue. DS)
• Fever (temperature above 100 degrees Fahrenheit) • Fosfomycin (Monurol)
and chills. • Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
• Vomiting. • Cephalexin
• Mental changes or confusion. • Ceftriaxone

RISK FACTORS
Some people are at higher risk of getting a UTI. UTIs are
more common in females because their urethras are
shorter and closer to the rectum. This makes it easier
for bacteria to enter the urinary tract.
Other factors that can increase the risk of UTIs:
• A previous UTI
• Sexual activity
• Changes in the bacteria that live inside the vagina, or
vaginal flora. For example, menopause or the use of
spermicides can cause these bacterial changes.
NEUROGENIC BLADDER diverting urine away from the bladder, a "urinary
Neurogenic Bladder or diversion")
also known as TREATMENT:
Neurogenic lower Treatment for neurogenic bladder includes emptying
Urinary Tract the bladder with a catheter at regular times.
dysfunction. Neurogenic Preventive antibiotics to reduce infection.
bladder is the term for Placing an artificial cuff around the neck of the bladder
what happens when which can be inflated to hold urine and deflated to
neurological (nervous system) conditions affect the way release it, surgeries and medicine.
your bladder works You may pee too much or too little.
Neurogenic bladder is the name given to a number of Medicine for neurogenic bladder include:
urinary conditions in people who lack bladder control -Medicines that relax the bladder (oxybutynin,
due to a brain, spinal cord or nerve problem. This nerve tolterodine, or propantheline)
damage can be the result of diseases such as multiple -Medicines that make certain nerves more active
sclerosis (MS), Parkinson's disease or diabetes. (bethanechol)
There are two types of neurogenic bladder -Botulinum toxin.
dysfunction: -GABA supplements.
Overactive bladder causes you to have little or no -Antiepileptic drugs
control over your urination. It can also cause you to feel
a sudden or frequent need to urinate.
Underactive bladder occurs when your bladder muscles
lose their ability to hold your urine.

SIGNS AND
Symptoms may Kidney Disorder
include: Chronic Renal Failure
UTI , Kidney stones Chronic kidney
Urinary incontinence disease, also
(unable to control called chronic
urine) Leaking urine, kidney failure,
passing urine involves a gradual
often ,Urine dribbles loss of kidney
function. It is a
RISK FACTORS: condition in which
Factors that increase your chance of the kidneys are
neurogenic bladder include: damaged and cannot filter blood as well as they should.
Nerve or spinal cord conditions present since birth, such Because of this, excess fluid and waste from blood
as spina bifida or spinal cord tumor, Diabetes, Stroke, remain in the body and may cause other health
Other causes of brain injury such as infection or trauma problems, such as heart disease and stroke.
Chemotherapy Ovarian cancer/tumor
Signs and Symptoms
MANAGEMENT: - Nausea - Vomiting
 Bladder training - Loss of appetite - Fatigue and weakness
 Plan urination schedules for their patients - Sleep problems - Urinating more or less
 Provide care appropriate to treatment options - Decreased mental sharpness - Muscle cramps
 Monitor possible complications and supervise - Swelling of feet and ankles - Dry, itchy skin
pelvic floor exercises - High blood pressure (hypertension) that's difficult
to control
Damage or changes in the nervous system and infection can - Shortness of breath, if fluid builds up in the lungs
cause neurogenic bladder. Treatment is aimed at - Chest pain, if fluid builds up around the lining of the
preventing kidney damage. It may include medicine, heart.
urinary catheters, antibiotics to reduce the chance of
infection, and, in severe cases, surgery. Risk Factors
● Diabetes
Surgery for Neurogenic Bladder ● High blood pressure
Artificial sphincter. Electrical device implanted near the ● heart disease
bladder nerves to stimulate the bladder muscles. ● Obesity
Sling surgery. Creation of an opening (stoma) in ● Family history of CKD
which urine flows into a special pouch (this may include

Complications
● Anemia. This happens when your kidneys don’t make
enough erythropoietin (EPO), which affects their ability
to make red blood cells. You may also have anemia due
to low levels of iron, vitamin B12, or folic acid. Anemia
can deprive vital organs and tissues of oxygen.
● Bone weakness. When your kidneys aren’t working
well, it can lead to low calcium and high phosphorus
levels (hyperphosphatemia), weakening your bones.
This increases the risk of bone fractures.
● Fluid retention. This is when your body hangs on to
excess fluids. This can lead to swelling of the limbs
(edema), high blood pressure, or fluid in the lungs.
● Gout. This is a type of arthritis caused by buildup of
uric acid in your joints. Uric acid is filtered through the
kidneys, linking the two conditions.
● Heart disease. This affects your heart or blood
vessels. When your kidneys aren’t functioning properly,
it can lead to heart concerns.
● High blood pressure (hypertension). This happens
when the force of the blood pumping through your
blood vessels is too high. Hypertension can lead to
worsening kidney function, which leads to fluid
retention and worsening hypertension.
● Hyperkalemia. This is a sudden rise in potassium
levels that may affect heart function.
● Metabolic acidosis. When there’s too much acid in
your bodily fluids that your kidneys don’t filter out, it
disturbs the pH balance. This can worsen kidney disease
and lead to issues like bone or muscle loss, as well as
endocrine disorders.
● Uremia. This is a buildup of waste products in your
blood, signaling kidney damage. It can cause a variety of
symptoms such as fatigue, nausea, restless legs, and
sleep disturbances.
Nursing Management
Nursing Priorities
● Maintain homeostasis.
● Prevent complications.
● Provide information about disease process/prognosis
and treatment needs.
● Support adjustment to lifestyle changes.
Nursing Interventions
● Nursing care is directed towards the following:
● Fluid status. Assess fluid status and identify potential
sources of imbalance.
● Nutritional intake. Implement a dietary program to
ensure proper nutritional intake within the limits of the
treatment regimen.
● Independence. Promote positive feelings by
encouraging increased self-care and greater
independence.
● Protein. Promote intake of high-biologic –value
protein foods: eggs, dairy products, meats.
● Medications. Alter schedule of medications so that
they are not given immediately before meals.
● Rest. Encourage alternating activity with rest.
Treatment
Depending on the cause, some types of kidney disease
can be treated. Often, though, chronic kidney disease
has no cure. Treatment usually consists of measures to
help control signs and symptoms, reduce complications,
and slow progression of the disease. If your kidneys
become severely damaged, you might need treatment
for end-stage kidney disease.
Treating Complications
High blood pressure medications. Your doctor might
recommend medications to lower your blood pressure
— commonly angiotensin-converting enzyme (ACE)
inhibitors or angiotensin II receptor blockers — and to
preserve kidney function. High blood pressure
medications can initially decrease kidney function and
change electrolyte levels, so you might need frequent
blood tests to monitor your condition. Your doctor may
also recommend a water pill (diuretic) and a low-salt
diet.
Medications to relieve swelling. Medications called
diuretics can help maintain the balance of fluids in your
body.
Medications to treat anemia. Supplements of the
hormone erythropoietin, sometimes with added iron,
help produce more red blood cells. This might relieve
fatigue and weakness associated with anemia.
Medications to lower cholesterol levels. Your doctor
might recommend medications called statins to lower
your cholesterol. People with chronic kidney disease
often have high levels of bad cholesterol, which can
increase the risk of heart disease.
Medications to protect your bones. Calcium and
vitamin D supplements can help prevent weak bones
and lower your risk of fracture. You might also take
medication known as a phosphate binder to lower the
amount of phosphate in your blood and protect your
blood vessels from damage by calcium deposits
(calcification).
A lower protein diet to minimize waste products in
your blood. As your body processes protein from foods,
it creates waste products that your kidneys must filter
from your blood. To reduce the amount of work your
kidneys must do, your doctor might recommend eating
less protein.
Treatment for end-stage kidney disease
If your kidneys can't keep up with waste and fluid
clearance on their own and you develop complete or
near-complete kidney failure, you have end-stage
kidney disease. At that point, you need dialysis or a
kidney transplant.
● Dialysis. Dialysis artificially removes waste products
and extra fluid from your blood when your kidneys can
no longer do this. In hemodialysis, a machine filters
waste and excess fluids from your blood.
In peritoneal dialysis, a thin tube inserted into your
abdomen fills your abdominal cavity with a dialysis
solution that absorbs waste and excess fluids.
After a time, the dialysis solution drains from your body,
carrying the waste with it.
● Kidney transplant. A kidney transplant involves
surgically placing a healthy kidney from a donor into
your body. Transplanted kidneys can come from
deceased or living donors. After a transplant, you'll
need to take medications for the rest of your life to
keep your body from rejecting the new organ. You don't
need to be on dialysis to have a kidney transplant.
 Care for clients with Burn  Sensation – the nerve endings in the skin
Burns – are tissue damage that results from heat, identify touch, heat, cold, pain, and light
overexposure to the sun or other radiation, or chemical pressure.
or electrical contact. Burns can be minor medical  Heat regulation – the skin regulate the body
problems or life-threatening emergencies. temperature by sweating to cool the body down
 The treatment of burns depends on the location when it overheats and shivering creating ‘goose
and severity of the damage. Sunburns and small bumps’ when it is cold. Shivering closes the
scalds can usually be treated at home. Deep or pores. The tiny hair that stands on end traps
widespread burns need immediate medical warm air and thus helps keep the body warm.
attention. Some people need treatment at  Absorption – absorption of ultraviolet rays from
specialized burn centers and monthslong the sun helps to form Vitamin D in the body,
follow-up care. which is vital for bone formation. Some creams,
Functions of the skin: essential oils and medicines (such as HRT, anti-
smoking patches) can also be absorbed through
the skin into the blood stream.
 Protection – the skin protects the body from
ultraviolet lights – too much of it is harmful to
the body – by producing a pigment called
melanin. It also protects us from the invasion of
bacteria and germs by forming an acid mantle
(formed by the skin sebum and sweat). This
barrier also prevents moisture loss.
 Excretion – waste products and toxins are
eliminated from the body through the sweat
glands. It is very important function which helps
to keep the body ‘clean’ from the inside.
 Secretion – sebum and sweat are secreted onto
the skin surface. The sebum keeps the skin
lubricated and soft, and the sweat combines
with the sebum to form an acid mantle which
creates the right pH balance for the skin to fight
off infection.
CARE OF CLIENTS WITH BURNS
Burns are characterized by severe skin damage that
causes the affected skin cells to die.
Most people can recover from burns without serious
health consequences, depending on the cause and
degree of injury.
Most serious burns require immediate emergency
medical care to prevent complications and death.
Burns are caused by a transfer of energy from a heat
source to the body.
 High level of knowledge about the physiologic
changes that occur after a burn
 Assessment skills to detect changes in the
patient’s condition
 Provide sensitive, compassionate care to
patients
 Able to communicate effectively with burn
patients
This will ensure quality care, which increases the
likelihood of the patient’s survival and promotes
optimal quality of LIFE.
Most burn injuries occur at home:
 Improper use of electrical appliances around
water sources
 Careless cooking is one of the leading causes of
household fires
 Burns can also occur from work-related injuries
  Chemicals and chemical products and increasing
awareness of the potential for injuries caused
by hot objects and substances
Many substances can cause burns, including:
 Fire
 Hot liquid or stream
 Hot metal, glass or other objects
 Electrical currents
 Radiation from x-rays or radiation therapy to
treat cancer
 Sunlight or ultraviolet light from a sunlamp of
tanning bed
 Chemicals such as strong acids, dye, paint
thinner or gasoline
A detailed history and physical examination is the first
step. The physician will evaluate the type, duration, and
timing of the burn; the burn location and severity; and
associated dehydration, disfigurement, and infection.
Fires in enclosed spaces should raise the suspicion for
smoke-inhalation injury.
Causes of Burns:
 Directly from burning fire
 Sunburns
 Therapeutic burns resulting from an operation
or laser treatment
 Due to electricity
 Burns caused from inflammable liquid or gas
 Chemical burn
Scalding – 34%; Contact burns – 9%; Electrical burns –
4%; Chemical burns – 4%; Fire or flame – 43%
Categories of Burn Injury
1. Thermal Burns (most common)
- Caused by: Contact with flames, hot liquids, semiliquid
(steam), hot objects, or automobile accidents
2. Chemical Burns
- Caused by: physical contact or ingestion with strong
acids, alkalines, organic compounds (household
cleaning objects)
3. Electrical Burns
- Caused by: heat that is generated by electrical energy
(faulty wiring, high voltage power lines lighting)
4. Radiation
- Caused by: exposure to radioactive source, sunburn, or
ultraviolet resources
BURN WOUND ASSESSMENT
Classified according to:
 Depth of injury
 First-degree burn (superficial burn)
 Second-degree burn (partial thickness)
 Third-degree burn (full thickness)
 Fourth-degree burn (deep full thickness)
 Extent of body surface area involved
 Rule of nines
Classification according to burn depth:
1. First degree burn – this minor burn affects only the
outer layer of the skin (epidermis)
- skin appears pink or red, dry and no blisters
- it causes redness and pain; usually resolves with
first-aid measures within several days to a week
Treatment:
 Cool burn. Hold burned skin under cool (not
cold) running water or immerse in cool
water until pain subsides.
 Protect burn. Cover with sterile, non-
adhesive bandage or clean cloth.
 Take acetaminophen or ibuprofen for pain
relief.
 Apply lidocaine (an anesthetic) with aloe
vera gel or cream to soothe skin.
 Use an antibiotic ointment and loose gauze
to protect the affected area.
2. Second-degree burn – these burns affect both the
epidermis and the second layer of the skin (dermis)
- redness, pain, and swelling
- looks wet or moist and shiny
- large thick blisters may develop covering the
burn area
- pain can be severe
- appears red with exudates, need skin grafting
- deep second-degree burns can cause scarring
- heals in 21-28 days or 2-3 weeks
Treatment depends on the severity of the burn and may
include the following:
 Antibiotic ointments
 Dressing changes one or two times a day
depending on the severity of the burn
 Daily cleaning of the wound to remove dead
skin
 Possibly systemic antibiotics
 Would cleaning and dressing changes may
be painful. In these cases, an analgesic
(pain reliever) may need to be given.
 Any blisters that have formed should not be
burst.
Second-degree burns are more serious because the
damage extends beyond the top layer of the skin.
This type of burn causes the skin to blister and become
extremely red and sore. Some blisters pop open, giving
the burn a wet or weeping appearance.
Over time, thick, soft, scab-like tissue called fibrinous
exudate may develop over the wound.
Keeping the area clean and bandaging it properly is
required to prevent infection. This also helps the burn
heal quicker.
3. Third-degree burn – burns that reach into the fat
layer beneath the dermis, subcutaneous tissue, muscle
and bone
- The skin may appear stiff, waxy white, leathery
or tan, dark brown
- Can destroy nerves, causing numbness
- Little or no pain
- Deep red, white or black, charred
- Appears dry, edema
- Hair follicles and sweat glands are destroyed
Treatment:
  May require process of skin grafting or the
use of synthetic skin.
 Intravenous antibiotics to prevent infection
or IV fluids to replace fluids lost when the
skin was burned.
 Managing burn pain. Burn pain can be one
of the most intense and prolonged types of
pain.
4. Fourth-degree burn – involves past the three layers
down to the bone and/or organs
- Damage to the bones, tendons, muscles, blood
vessels, and nerves
- Charring
- Electrical burns most common
- Extensive skin grafting required
- Patient might survive and/or limb might be
saved
Treatment:
Once the patient has been transported to a medical
facility, physicians can begin treating the burns and
resolving complications from the burns.
The patient may receive intravenous fluids to prevent
dehydration and antibiotics to prevent infection.
Physicians will often use skin grafts or other surgical
procedures to recreate the protective layer or skin that
was burned.
Calculation of Burned Body Surface Area
 Head and neck = 9%
 Each upper extremity(arms) = 9%
 Each lower extremity (legs) = 18%
 Anterior trunk = 18%
 Posterior trunk = 18%
 Genitalia (perineum) = 1%
First Aid for Burns and Scalds (ACT AT ONCE – DELAY IS
SERIOUS)
1. Immediately immerse the affected area in (or pour
over cold running water for at least 10 minutes or until
the pain is relieved.
2. In the event of swelling, remove anything that may
cause constriction i.e. belt, shoes, rings, etc.
3. Cover affected area with a dry sterile dressing.
4. Seek medical attention.
Emergency Medical Management
 The patient is transported to the nearest
emergency department.
 The hospital and physician are alerted that
the patient is enroute to the emergency
department so that life-saving measures
can be initiated immediately by a trained
team.
 Initial priorities in the emergency
department remain airway, breathing, and
circulation.
 For mild pulmonary injury, inspired air is
humidified and the patient is encouraged to
cough so that secretions can be removed by
suctioning.
Nursing Interventions: Curative
A. On the scene (first aid) – immediately treatment
 Extinguish flames from clothes on
fire, stop, dropping, rolling the
patient on the floor, smoother the
flame with blanket, rug
 Avoid standing, victim will breathe
the flame and smoke
 Avoid running
 Soak burn area with cold water
briefly
 Remove jewelry to prevent
construction secondary to edema
formation.
 Cover wound with sterile dressing
or clean cloth to minimize
contamination and decrease pain
from air current.
 Avoid ointments
 Rush to nearby hospitals.
 If chemical burn, irrigate with
running water.
B. Emergency room
 ABC – airway, breathing, circulation
 Assess breathing, suction to clear airway
 Administer 100% oxygen
 Assess circulation
 Assess degree of burn.
C. Prevention of shock
 IV therapy to prevent shock (Lactated Ringer’s
solution infusing at the rate required to
maintain a urine output of at least 30 ml per
hour).
 NPO, keep side lying position
 Maintain O2 and patent airway
 Pulmonary care: deep breathing, turning,
suctioning
 Proper positioning for optimal chest expansion
 Monitor VS, I&O, daily weight
 Foley catheter as prescribed, maintain urine
output
 Insert NGT, prevent vomiting, reduce risk for
aspiration
 For more severe situations, it is necessary to
remove secretions by bronchial suctioning and
 to administer bronchodilators and mucolytic
agents.
 If the edema of the airway develops,
endotracheal intubation may be necessary.
 Continuous positive airway pressure and
mechanical ventilation may also be required to
achieve adequate oxygenation.
- What continuous positive airway pressure
machines do is gently blow pressurized air
through your airway at a constant pressure that
keeps the throat from collapsing.
- It uses a machine to help a person who has
obstructive sleep apnea(OSA) breathe more
easily during sleep.
- Mechanical ventilation, in the healthcare setting
or home, helps patients breathe by assisting the
inhalation of oxygen into the lungs and the
exhalation of carbon dioxide.
- Depending on the patient’s condition,
mechanical ventilation can help support or
completely control breathing.
Topical antimicrobial therapy:
 Silver sulfadiazine (Silvadene)
 Silver nitrate solution
 Take an over-the-counter pain reliever. These
include aspirin, ibuprofen (Advil, Motrin,
others), naproxen (Aleve) or acetaminophen
(Tylenol, others)
 Caution: Don’t use ice. Putting ice directly on a
burn can cause a person’s body to become too
cold and cause further damage to the wound.
 Don’t break blisters. Broken blisters are more
vulnerable to infection.
 Don’t remove burned clothing. However, do
make sure the victim is no longer in contact
with smoldering materials or exposed to smoke
or heat.
 Don’t immerse large severe burns in cold water.
Doing so could cause a drop in body
temperature (hypothermia) and deterioration
of blood pressure and circulation (shock).
 Elevate the burned body part or parts to
prevent edema. Raise above heart level, when
possible.
 Prevent contractures/deformities. ROM
exercise, positioning
- When skin is burned, the surrounding skin
begins to pull together, resulting in a
contracture.
- Provide early and aggressive physical and
occupational therapy.
- Support patient if surgery is needed to achieve
full range of motion.
Nursing diagnoses for burn injuries include:
1. Impaired gas exchange related to carbon monoxide
poisoning, smoke inhalation, and upper airway
obstruction
2. Ineffective airway clearance related to edema and
effects of smoke inhalation
3. Fluid volume deficit related to increased capillary
permeability and evaporative losses from burn wound
4. Hypothermia related to loss of skin microcirculation
and open wounds
5. Pain related to tissue and nerve injury
6. Anxiety related to fear and the emotional impact of
burn injury
Others:
 Skin integrity, impaired
 Infection, high risk for
 Altered nutrition
 Pain, acute(with partial thickness burns)
 Fluid volume deficit
 Anxiety
 Coping, ineffective individual
 Body image disturbance
 Knowledge deficit
 Mobility, impaired
 Self-care deficit
Goals of treatment:
 Maintenance of adequate tissue oxygenation.
 Maintenance of patent airway and adequate
airway clearance.
 Restoration of optimal fluid and electrolyte
balance and perfusion of vital organs.
 Maintenance of adequate body temperature.
 Control of pain.
 Minimization of patient’s and family’s anxiety.
Nursing Priorities:
1. Maintain patent airway/respiratory function.
2. Restore hemodynamic stability/circulation volume.
3. Alleviate pain.
4. Prevent complications.
5. Provide emotional support for patient/signigicant
other.
6. Provide information about condition, prognosis, and
treatment.
STAGES OF BURNS
1. Emergent – Initial phase; begins at the time of injury
- Fluid shift, edema formation occurs within 24-
48 hours post burn
- Low blood volume, oliguria
- Hyponatremia – loss of sodium with fluid
- Hyperkalemia – damaged cells release K
 - Characterized by fluid loss, edema formation,
reduced blood fluid (fluid and electrolyte shifts
continues until diuresis occurs
Goals:
 Secure airway
 Support circulation by fluid replacement
 Keep the client comfortable with analgesics.
 Prevent infection through wound care
 Maintain body temperature
 Provide emotional support
2. Acute Intermediate Phase (weeks to months)
- Fluid mobilization occurs approximately, 48-72
hours after burn injury
- Fluid begins to shift interstitial spaces back into
bloodstream or intravascular space
- Diuresis occurs
- Wound healing begins, wound coverage is
initiated
Nursing interventions:
 Wound cleaning
 Topical antibacterial therapy
 Wound dressing
 Dressing changes
 Wound debridement and wound grafting
 Pain management
 Nutritional support
 Measure vital signs frequently
 Respiratory and fluid status remains highest
priority
Parkland formula: for calculating amount of
intravenous fluids to give in burn patients: total body
surface area % burned x kg x 4ml: ½ in first 8 hours,
second ½ given next 16 hours.
Example: pt weight = 75 kg and burned 25%
4ml x 75 x 25 =7500 ml/24 hours
50% 1st 8 hours = 3750 ml
25% 2nd 8 hours = 1875 ml
25% 3rd 8 hours = 1875 ml
Diagnosis: Anxiety related to loss of skin and pain
Nursing interventions:
 Allow verbalization of loss
 Explain all procedures
 Edema will subside in 2-4 days
 IV analgesics not IM
 Elevate burned arms on pillows
 Give pain meds 30 minutes prior to
treatments.
 Wound debridement – removal of debris
accumulates on the wound surface
- Done with forceps and curved scissor or
through hydrotherapy (application of water for
treatment)
- Only loose eschar removed
- Blisters are left alone to serve as a protector
Goals:
 To remove tissue contaminated by bacteria and
foreign bodies, thereby protecting the patient
from invasion of bacteria
 To remove devitalized tissue or burn eschar in
preparation for grafting and wound healing
 Sofra-tulle – This medication is a gauze dressing
impregnated with the antibiotic framycetin
sulfate. Framycetin sulfate belongs to a group
of medications known as antibiotics.
 Skin graft – It Is a surgical procedure that
involves removing the skin from one area of the
body and moving it, or transplanting it, to a
different area of the body. This surgery may be
done if a part of your body has lost its
protecting covering of skin due to burns, injury,
or illness.
Goals of treatment:
 Prevent complications (contractures)
 Vital signs hourly
 Assess respiratory function
 Tetanus booster
 Anti-infective
 Analgesics
 No aspirin
 Strict surgical asepsis
 Turn every 2 hours to prevent contractures
 Emotional support

Preventive measures you can take at home:
 Keep children out of the kitchen while cooking.
 Turn pot handles toward the back of the stove.
 Place a fire extinguisher in or near the kitchen.
 Measure bath water temperature before use.
 Lock up matches and lighters.
 Install electrical outlet covers.
 Check and discard electrical cords with exposed
wires.
 Keep chemicals out of reach, and wear gloves
during chemical use.
 Wear sunscreen every day, and avoid peak
sunlight.
 Ensure all smoking products are stubbed out
completely.
Nursing management:
 Collaborate with dietitian to plan a protein and
calorie-rich diet acceptable to patient
 Encourage family to bring nutritious and
patient’s favourite foods.
 Provide nutritional and vitamin and mineral
supplements if prescribed.
 Insert feeding tube if caloric goals cannot be
met by oral feeding
 Weight patient daily and graph weights
 Promoting skin integer
 Assess wound status
 Assess burn for size, color, odor, eschar,
exudate, bleeding, and the condition of the
surrounding skin; report any significant
changes to the physician.
 Assist, instruct, support, and encourage patient
and family to take part in dressing changes and
wound care.
 Early on, assess strengths of patient and family
in preparing for discharge and home care.
 Relieving pain and discomfort.
 Teach patient relaxation techniques
 Use guided imagery and distraction to alter
patient’s perceptions and responses to pain.
 Prevent complications of immobility
(atelectasis, pneumonia, edema, pressure
ulvers, and contractures by deep breathing,
turning, and proper repositioning.
 Apply splints or functional devices to
extremities for contracture control.