PROMETRIC BASICS TIPS

MUTATION

FEMALE XX
MALE XY
X+X=FEMALE BABY
X+Y=MALE BABY
• Females typically have two of the same kind of
sex chromosome (XX), and are called the homogametic sex.
Males typically have two different kinds of sex chromosomes (XY),
and are called the heterogametic sex. ... More specifically, it is
the SRY gene located on the Y chromosome that is of importance
to male differentiation.
 Sickle cell disease/Achandroplacia/Hemophilia
If both parent have sickle cell disease ,100% of chance to get disease in first child
If one of the parent have sickle cell disease ,50% of chance to get disease in first
child
If the parent have sickle cell disease ,25% of chance to get disease in second child

Sickle Cell Trait

If the parent have sickle cell trait ,25% of chance to get disease in child
• The cord contains three blood vessels: two arteries and one vein. The vein carries
oxygen and nutrients from the placenta

• Ductus venosus - shunts a portion of umbilical vein blood flow directly to the inferior
vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver.

• Ductus arteriosus is a normal blood vessel that connects two major arteries (the aorta
and the pulmonary artery)

• Foramen ovale is a small hole located in the septum, which is the wall between the
two upper chambers of the heart (atria).
• COARCTATION OF THE AORTA
A narrowing of the large blood vessel (aorta) that
leads from the heart.
Difference in blood pressure of upper and lower
extremities

• PERSISTENT DUCTUS ARTERIOSUS {PDA}

Inj Indomethacin (Prostaglandin inhibitor) help to assist
closure of PDA
 Anterior fontanel
(Bregma)
Closed during 9 month
to 18 month

Posterior fontanel
(Lambda)
Closed during
1month to 2 month
 NEURAL TUBE DEFECT
Spina bifida a birth defect in which
babys spinal cord fails to develop or
close properly while in the womb.
• Check Alpha Fetoprotein in maternal venous blood
during 16 to 20 week of gestation
• Adequate intake of folic acid and multivitamin
supplements can prevent this defect
• Green leafy vegetables & Citrus fruits
• In case of Spina Bifida ,keep the baby on Prone
position
• Ask about latex allergy or pea nut allergy due to
pronged exposure of latex items like gloves and
Foleys catheter etc.[repeated surgical procedure &
hospitalization]
 Cleft Lip surgical correction at the age
of 3 to 6 months
 Before surgery Frequent burping &
upright position
 Use large holed, soft nipple (hole
under or side of the nipple)
 Use special feeders/obturator
Precaution after surgery
• Elbow restraint
• Avoid breast feeding/sucking
• Give feed in cup
• Avoid crying
• P/Surgery -Side lying position/supine
position
• Logan bow
Cleft Palate surgical correction by the
age of 12 – 18 month
 P/Surgery - Prone position
 PREVENT CLEFT LIP & PALATE

• Adequate intake of folic acid 400 IU

• Green leafy vegetables & Citrus fruits

 Hydrocephalus is caused by excessive production of CSF fluid from ventricle of the brain
Signs and symptoms are:-
 bulging of fontanells,
 head and feet flexed back position,,
 increased head circumference,
 high pitch cry
Management :- ventriculo-peritoneal shunt
ventricular tap in case of emergency situation
TRACHEO ESOPHAGEAL FISTULA (TEF)
ESOPHAGEAL ATRESIA
GASTROSTOMY FEEDING &
SURGICAL REPAIR
Projectile Vomiting
Left to right peristaltic waves
Palpable Mass On right side of
Abdomen -Olive like mass on
After feeding keep in infant seat
or upright position
 Poops stool /small stool
 Surgery Pyloromyotomy
 Position after surgery is prone
PROTEIN ENERGY MALNUTRITION
HEAT LOSS
 POLYDACTYLY

KOILONYCHIA
 MENTAL RETARDATION
Normal IQ >70
• Mild {Educable} 60-70
• Moderate {Trainable} 35-50
• Severe {Dependent Retarded} 20-25
• Profound {Life Support} <20
 Normal female pelvis gynecoid /male pelvis Android
12- 13 hours primi
Less than 2 hour
7 – 8 hours para

30 min – 1 hour
Pregnancy

Telangiectasia
• Pica :- Compulsive Eating Disorder In Which People Eat Nonfood Items

• Telangiectasia :- Dilated small blood vessels on the skin or mucous membranes,

anywhere in the body due to Increased Estrogen

• Leukorrhea:- Excessive Vaginal Discharge During Pregnancy Due To Increased

Estrogen

• Ptyalism:- Excessive Salivation During Pregnancy Due To Increased Estrogen

• Hyperemesis Gravidarum :- Excessive vomiting during pregnancy due to increased

Estrogen & HCG (human chorionic gonadotropin)
Management
Normal position recommended during
Hydration pregnancy left lateral position to avoid
caval compression
Intake output
 HYDATIDIFORM MOLE/ MOLAR PREGNANCY/
TROPHOBLASTIC DISEASE

CHECK UTERINE SIZE AND

ENLARGEMENT

Test for hydatidi form mole

 HCG
 USG
Pregnant client is making her first antepartum visit, she has a 2 year
old son born at 40 weeks, a 5 old daughter born at 38 weeks and 7
year old twin daughter born at 35 weeks. she had spontaneous
abortion 3years ago at 10 weeks. Using GTPAL format the nurse
should identify that the client is:- G5 T2 P1 A1 L4
 CARDIOTOCOGRAPHY(CTG)

 Cardiotocography is a technical means of

recording the fetal heartbeat and the uterine
contractions during pregnancy

 Accelerations are transient increases in FHR of

15bpm or more above the baseline and lasting 15
seconds.

 Decelerations are transient episodes of decrease of

FHR below the baseline of more than 15 bpm
lasting at least 15 seconds.

 Baseline rate is normal heart rate and should be

anywhere between 110 and 160 bpm.

 Variability is a fluctuation of fetal heart rate.

PLACENTAL PREVIA
 RH D Immunoglobulin to pregnant women at
28th weeks of gestation and within 72 hours of
delivery

 Abortion at 10 weeks of gestation –RH D

immunoglobulin within 72 hours

 In direct coombs test during pregnancy to rule

out risk of hemolytic disease

 RHD Immunoglobulin help to prevent maternal

antibody prevention
1 to 3 days

4 to 10 days

From 2 weeks
 Demand Feeding
 Formula of children weight

A 9-month child when he born his weight was 2.75kg what

is the accrue weight after 9 months? What is his weight
now?
• 7
• 9
• 11
• 13
 INFANT EXPECTED ORAL INTAKE CALCULATION FORMULA

Weight x 75

Q1.A 11 month old baby weight 8 kg has vomiting 7 times,

how many ML oral intake he can provide?
• 8x75=600 ml

Q2.A 9 month old baby weight about 9 kg, he has diarrhea

and how many ORS given per kilogram?
PERCENTILE
A 6 month old boy is admitted
with a diagnosis of failure to thrive.
According to the growth chart at
months of age the infant's weight
is in which percentile?
• 25 th
• 5 th
• 10 th
• Below 5
LANUGO VERNIX CASEOSA
GCS
RAMSAY SEDATION SCALE
 ABG

Drowning-respiratory
Gastric suction & vomiting- Colostomy irrigation & acidosis
metabolic alkalosis Diarrhea-metabolic acidosis Salt water drowning-
metabolic acidosis
Assessment steps

Inspection palpation Auscultation percussion FOOT EXAMINATION

Assessment if abdomen included: INSPECTION & PALPATION
Inspection – Auscultation – percussion – palpation
MASLOWS OF HIERARCHY
BURNS - RULE OF NINE
 DRUG CALCULATION
1gm=1000 mg
1000 mg=1gm

Convert gram to milligram = Gram x 1000

Convert milligram to gram =Milligram ÷ 1000
1.Standard Formula for Calculating a Medication Dosage
• D (desired) is the dosage that the health care provider prescribed.
• H (available in hand) is the dosage strength as stated on the medication label.
• Q (quantity) is the volume or form in which the dosage strength is available, such as
tablets, capsules, or milliliters.
D/H x Q
1.Physician prescribed quinidine 8.25mg/kg every 4th hourly for a patient who weighs 50
kg, the drug is available as a 275 mg tablet, the nurse should administer how many
tablets for each dose?
Ans:-8.25x50=412.5 is patient dose ,so 412.5/275=1.5 tablet

2.Prescribed Heparin 1000 IU, available in Vial 25000 IU/5 ml, how many ml should given
Calculation=1000/25000x5=0.2ml
2.Formulas for Intravenous Calculations
DROPS /MIN =T.VOLUME X DROP FACTOR
TIME IN MINUTE

Pediatric drip set= 15

IV Set=12
Q. 2000 ML of RL to be administered over 24 hours by IV set {drop factor 12}
How much is the drops/min?

ANS:- 2000 x 12
24x60
24000 = 16.6 (17)
1440
Number of Milliliters per Hour = TOTAL VOLUME IN ML
TOTAL NUMBER OF HOURS

Q1.1500 ML of NS to be administered over 12 hours ,what is the infusion rate?

1500 =125 ml
12
Q2. 75 ML/hour over 12 hours of NS to be administered, how many ML total to be
given?

75x12=900 ml
Sodium
lactate
 STEP ADULT PEDIATRICS INFANT
One Rescuer
CAROTID CAROTID OR FEMORAL BRACHIAL
CHECK PULSE & RESPIRATION
SIMULTANEOUSLY ( MINM 5 TO MAXM 10 SEC)

CHEST COMPRESSION 30: 2 30:2 30:2

VENTILATION RATIO

RATE 100-120 / MINUTE 100-120 / MINUTE 100-120 / MINUTE

DEPTH 2-2.5 INCHES ABOUT 2 INCHES 1.5 INCHES

CYCLES 5 CYCLES OF 5 CYCLES OF 30:2 5 CYCLES OF

30:2 IN 2 MINUTE. IN 2 MINUTE 30:2 IN 2 MINUTE

RE CHECK THE PULSE AND RE CHECK THE PULSE AND RESP RE CHECK THE PULSE AND RESP
RESP AFTER 2 MINUTE AFTER 2 MINUTE AFTER 2 MINUTE

RESPIRATORY ARREST ( WITH PULSE 1 BREATH 1 BREATH EVERY 1 BREATH EVERY

AND WITHOUT RESP) EVERY 5-6 SEC 5-6 SEC 5-6 SEC

2 RESCUER
No changes in adult
Pediatrics and infants instead of 30:2 it will be 15:2 ( 10 cycle in 2 minute )
ANTIDOTES
No MEDICINE ANTIDOT
1 ACETAMINOPHEN N-ACETYLCYSTEIN (MUCOMYST)
2 ANTICHOLINESTERASE ATROPIN
3 ANTICHOLINERGICS PHYSOSTIGMINE
4 DIPHENHYDRAMINE PHYSOSTIGMINE
5 BENZODIAZEPENS FLUMAZENIL / ACTIVATED
CHARCOAL
6 CALCIUM CHANNEL GLUCAGON, EPINEPHRINE
BLOCKERS
7 BETA BLOCKERS GLUCAGON , EPINEPHRINE
8 HYPOGYCEMIA GLUCAGON , EPINEPHRINE
9 HYPOGLYCEMIC AGENTS GLUCAGON , EPINEPHRINE
10 MAGNESIUM SULPHATE CALCIUM GLUCONATE
11 COUMADIN VIT.K ( PHYTONADION)

12 CYANIDE AMYL NITRITE , SODIUM NITRITE , SODIUM THIOSULFATE

13 CYCLOPHOSPHAMIDE MESNA
14 DOGOXIN DIGIBIND, DIGOXIN IMMUNE FAB
15 HEROIN NALOXONE ( NARCAN )
16 IRON DEFEROXAMINE
17 HEPARIN PROTAMINE SULFATE
18 LEAD DIMERCAPROL , SUCCIMER
19 POTTASIUM INSULIN+GLUCOSE or
KAYEXALATE/ Sodium Polystyrene Sulfonate
20 METHANOL FOLIC ACID
21 VALPORIC ACID L CARNITINE
22 SULFONYLUREAS OCTREOTIDE
23 ISONIAZIDE PYRIDOXIN HCL (VITAMINE B6)
24 SODIUM CHANNEL NaHCO3
BLOCKERS
25 CYCLIC NaHCO3
ANTIDEPRESSANTS

26 SALICYLATES NaHCO3

27 ETHYLENE GLYCOL THIAMINE

28 HYDROFLUORIC ACID CaCL, CAL.GLUCONATE

29 HYPERMAGNISEMIA CaCL, CAL.GLUCONATE

30 STREPTOKINASE AMINOCARPORIC ACID

31 ALPHA AGONIST (CLONIDINE NALOXONE

)

32 CODEINE SULFATE NALOXONE

33 PETHEDINE NALOXONE

34 MORPHIN NALOXONE

35 FENTANYL NALOXONE

36 MEPEREDIN NALOXONE

37 ALL NARCOTICS NALOXONE

38 ARSENIC POISONING D PENICILLAMINE ( CUPRIMINE )

39 COPPER D PENICILLAMINE ( CUPRIMINE )

40 MERCURY D PENICILLAMINE ( CUPRIMINE )

41 LEAD D PENICILLAMINE ( CUPRIMINE )

42 LOCAL ANESTHETICS FAT EMULSIONS

 Needle gauge-26 – 27
 Tuberculin test,mauntox text, PPD(Purified
protein derivatives)
 Skin allergy test
 Needle gauge 23-25
 Rotate the site to prevent lumps formation
 Maximum 36 hours at one site
 2 inch away from umbilicus
 Intramuscular injection sites
1.Deltoid muscle of the arm.
The deltoid muscle is the site most typically
used for vaccines.
Maximum 1 ml given due to small muscle
2.Ventrogluteal muscle of the buttocks
Commonly used for Adult
3.Dorsogluteal muscle of the buttocks
Not recommended due to sciatic nerve
passed over this area (sciatic nerve
damage leads to paralysis)
4. Vastus lateralis muscle of the thigh.
Commonly used for small children's
5.Rectus femoris of the thigh
Not used for small children due to
underdeveloped muscle
Needle gauge 18 - 23
 SA NODE :- PACEMAKER OF THE HEART

POST PPI INSTRUCTION

 Check pulse rate every day (feel the

pulse for 10 second and multiplied by 6)

 Avoid MRI
 Avoid loud noise
 Avoid Airport metal detector

 Complication of PPI :- Pneumothorax

NT-proBNP
REGION OF ABDOMINAL CAVITY
AIRWAY OPENING
ABDOMINAL THRUST OR HEIMLICH MANEUVER
PURSEED LIP BREATHING
COPD PATIENT BEST TECHNIQUE
WOUND DEHISCENCE & EVISCERATION
 Health
Education
 Immunization

BSE,PAP
smear,Mamography
 Cranial nerves 12
One Of Our Trained Teacher Make A Famous Very Good Vada And Halwa
DABDA
•ONE TEASPOON =5 ML
•ONE TABLE SPOON= 15 ML
•ONE OUNCE =30 ML
•p.c = Post cibum (after meal)
•a.c = Ante cibum (before meal)
Dorsal recumbent position
AFTER CARDIAC SURGERY
SUPINE POSITION
LIVER BIOPSY
CLEFT LIP REPAIR
PRONE POSITION
NEURAL TUBE DEFECT/SPINA BIFIDA/MYOMENINGOCELE/MENINGOCELE
CLEFT PALATE REPAIR
POST TONSILECTOMY
VITRECTOMY
KNEE CHEST POSITION
TOF/CYANOTIC SPELL/CONGENITAL HEART DISEASE
TRENLENBURG POSITION
CVP LINE INSERTION
HYPOVOLEMIC SHOCK
LOWER ABDOMINAL SURGERY
TO CHECK HIP DISLOCATION
SEMI SITTING/SEMIFOWLERS POSITION
POST CRANIOTOMY/SUPRATENTORIAL SURGERY/HYPOPHYSECTOMY
PATIENT WITH BREATHING DIFFICULTY
FOWLERS POSITION/SITTING POSITION
NGT INSERTION
ABDOMOINAL PARACENTESIS
THORACENTESIS
NEBULIZATION
 BMI (Body max index)
BMI = Total body weight
(height)m2

• BMI Weight Status

• Below 18.5 Underweight

• 18.5 – 24.9 Normal or Healthy Weight

• 25.0 – 29.9 Overweight

• 30.0 and Above Obese

 PARALYSIS –UNABLE TO
MOVE ACTIVE EXERCISE :-Doing by
PARASTHESIA-WEAKNESS self
OF BODY PART

HEMIPLEGIA-PARALYSIS
OF HALF OF THE BODY PASSIVE EXERCISE :-
PARAPLEGIA-PARALYSIS Doing by other
OF LOWER SIDE OF THE e.g :-Physiotherapy
BODY
 Cerebrum-cognitive function TETRAPLEGIA
 Brocas Area - Speech /QUADRIPLEGIA-ALL LIMBS
PARALYSED
 Medulla oblongata – respiration ISOMETRIC
EXERCISE for
 Hypothalamus-temperature regulation improving Muscle
Strength
 Thalamus-sensory center

 Cerebellum –balance and coordination

With in 15 minutes
of
transfusion…stop
immediately

After 15 minutes of
transfusion
…decrease the flow
rate (circulatory
overload)
Used for Infants ,Toddler ,non verbal Adult
Used for Young children
Used for adults
COLOSTOMY

Ileum located in
right lower
abdomen
 Colostomy irrigation/ Enema administration
 Reduce the flow rate if cramping occurs
(cramping is normal it indicate peristalsis
movement)
 Clamp the tubing is second option
 Reduce the height of the irrigation solution is third
option
 High protein diet
Positioning
Heel ulcer …free floating
 CRUTCHES

Stairs up
When you are going up, lead with your good foot,
keeping your injured foot raised behind you.

Stairs down
When you are going down, hold your injured foot up
in front, and hop down each step on your good foot.
Take it one step at a time.
 CANE / WALKING STICK

Walking
• Move cane and affected leg together
• To start, set your cane about one small stride ahead of you and step off on your
injured leg. Finish the step with your good leg.
Stairs
• To climb stairs, place your cane in the hand opposite your injured leg. With your
free hand, grasp the handrail. Step up on your good leg first, then step up on the
injured leg.
• To come down stairs, put your cane on the step first, then your injured leg and
then, finally, your good leg, which carries your body weight.
WALKER
 RESEARCH
&
EPIDEMIOLOGY
 Cause to
Disease
Lung cancer

Non
Smokers Lung
cancer

Lung cancer

Non
Non smokers Lung
cancer
Backward study ,disease already occurred and this study to find out the risk factors/Cause
 Forward study ,here
identify the risk factor
for disease and follow
them over long year
 Disease to Cause
Smokers

Non smokers
Lung
cancer
patient

Smokers

Non
lung
Non smokers cancer
patient
This study indicate to find out the present
problem through direct or indirect
method of data collection(survey,
telephonic interview)
E.g.:-collect information about 3 different
group of people using different water
supply source in order to find out the
cholera risk
Correlational Research
Equation of central tendancy calculation ?

• mode >median> mode

• mean>median<mode

• mean>median>mode

• mean<median<mode
Identify the range by the following numbers? 10,12,14,16

• Answer key is large number minus small number = range

16 is large number & 10 is small number so 16-10=??

• 2
• 4
• 6
• 5
How to calculate the mean by the following numbers?
4,10,6,8,14,12

• Answer key is Sum of total number /total number=mean

4+10+6+8+14+12=54/6=??

• 14
• 10
•6
•9
How to calculate median by the following numbers?
15,10,16,2,8

• Answer Key arrange in ascending order and take

middle number that is median 2,8,10,15,16
•
• 10
• 8
• 15
• 16
How to calculate mode by the following
numbers? 21,14,12,10,12,12,14,16,18

• Answer Key is repeated one

• 21
• 12
• 14
• 18
Which type of mode is following? 14,14,14,12,12,12

• Bi mode

• Uni mode

Which type of mode is following? 14,14,14,12,12,10,8

• Bimode

• Unimode
Study for 100 intern students' weights that recorded 75+-10
how much proportion between 65 kg and 85 kg?
34%
50%
95%
68%
Community a data year 2013,July population 254,316
• Death from maternal disease 15
• Deaths from cardiovascular diseases 3029
• Death ≤ year of age 23
• Death ≤ 28 day 8
• Registration cases of measles 79
• Total pneumonia exposed people 2593
• Total number of deaths in any case 10998
Referring to the giving data, what is the specific death rate caused from
cardiovascular disease?
• 28 / 100
• 28 / 100,000
• 1191 / 100,000
• 1198 / 100,000
 STOOL APPEARANCE

• Upper GI bleeding – black tarry stool

• Lower GI bleeding – bright red stool

• Barium study – chalky white colour stool

• Hepatitis – clay coloured stool Pyloric stenosis- Poops/small content

• Cholera- rice water stool Celiac disease-large pale foul

smelling stool
• Typhoid – pea soup stool

• Diverticulosis- coffee coloured stool

• Chron’s disease – diarrhoea with mucus and pus

• Ulcerative collitis – bloody diarrhoea

• Intussuseption – jelly like stool

• Hirschsprung’s disease – ribbon like stool

 EATING DISORDER
Commonly seen in TEENAGE GIRLS & YOUNG WOMEN
ANOREXIA NERVOSA
• Low BMI
• Not eating
• Vigorous Exercise
• Induce vomiting & Diarrhea

BULLIMIA NERVOSA
• Low or high BMI
• Excessive eating/binge eating
• Vigorous Exercise
• Induce vomiting & Diarrhea
 Drugs
Lithium (0.6 -1.2 mE/L)poly urea ,dehydration (diarrhea & vomitting),tremor,
muscle weakness, ringing of the ear (Tinnitus)
• Adequate sodium and hydration 2-3 L of water / day
Digoxin (0.8-2.0 ng/ml)hypokalemia, hypomagnessia, confusion, loss of appetite,
nausea ,vomitting and visual disturbance (halo ring )

QUINIDINE-Ringing sound in ear, prolonged QT interval

MGSO4 – Prolonged QT interval in low Mgso4 (Torsades De point)
_ Absence or slow deep tendon reflex in mgso4 toxicity
POTTASSIUM – Cramps, abdominal pain, nausea,vomiting,Diarrhea
CALCIUM – Muscle twitching and tingling
 Myopia-short sight
 Hyperopia-long site
Snellen chart
 Glaucoma-increased IOP(Intra ocular
pressure)
Surgery
 Sclerostomy
 Laser surgery
 Trabeculectomy
 Cataract:- opacity of the lens
 Laser surgery

Snellen chart
TONOMETRY To check visual
To check IOP acuity 20/20
normal
Children develop fibrous tissue formation behind
the lens due to Prolonged exposure to oxygen
therapy
To check hearing loss
Conductive or sensory
neural hearing loss
 2P
POLYUREA
POLYDIPSIA
DISEASES TYPE OF REQUIRED FOOD

1-Celiac disease Gluten- free

2-Cholecysestitis High protein, high carbohydrates, low fat

3-Cushing High k, low Na

4-Cystic fibrosis High calorie, high Na

5-Bed sore high protein

6-MI Low fat, low NA, lowcholesterol

7-Nephrotic syndrome Low NA, normalprotein, high

calorie

8-Burn High calorie, high protein

9-Renal failure Low protein, high carbohydrates , low NA

10-Hypothyroidism Low cholesterol, low calorie,low saturated fat

11-Hyperthyroid High calorie, high protein

12-Ricketts Food contain VID such as Fish

, liver , milk, eggs ,Oatmeal
HIGH PROTEIN DIET FOR
TISSUE REPAIR
BED SORE,FRACTURE
CASE,SURGERY CASE

VITAMINE C FOR
WOUND HEALING
 MOST
COMMON
EPIDEMIC SOURCE OF DISEASE

CONTAMINATED
WATER

CONTAMINATED AIR

CONTAMINATED
SOIL
Tuberculosis
• TB epidemic disease
• TB. Wear N95 mask
• TB. Preliminary Test Mantoux test / PPD TEST/Tuberculin test
• TB TEST WITHIN 48-72 Hours
• TB Confirmatory or accurate test sputum culture / ACID FAST BACILLI and to be done early
morning
• Isoniazid for TB side effect numbness , hepatitis symptoms , stomach upset ,rashes
• Rifampicin cause red orange colored secretion like sweat & urine
Meningitis
• Streptococcal pneumonia
• meningococcal vaccine. Hib
• Brudzinski sign ,Kerning sign & Nuchal rigidity (Neck rigidity ,fever, mental status changes)
• Droplet
• Turbid -Cloudy CSF
• Lumber puncture
• Surgical mask. No N95 mask
CT PULMONARY
D-DIMER
ANGIOGRAPHY
POST PLASTER CAST PRECAUTION
If patient complaints of pain --- ADMINISTER PAIN KILLER

If pain persist after pain medication administration

Check pedal pulse, if not getting use Doppler device

to check pulse because peripheral pulse difficult to
palpate by hand, notify the physician immediately if
no pulse

Check capillary refill ,if more than 3 second

need immediate notification to physician
 Group A streptococcus
Pharyngitis
↓
Tonsillitis
↓
Sore Throat
↓
Upper Respiratory Infections
↓
Glomerulonephritis
↓
Patient got above mentioned any one of the problem and found
streptococcal infection after few days of discharge patient again get
signs of infection physician can directly check for jones Criteria to
detect Rheumatic fever (ECG)
 Benzathine penicillin- severe anaphylactic reactions/
 Erythromycin
 Complication of hyperthyroidism
Cretinism – congenital hypothyroidism in children Graves disease, exophthalmos goiter, thyroid
Myxedema– advanced hypothyroidism in adults storm, thyrotoxicosis
Hypercalcemia

Osteoporosis
Twitching of the muscle
• Accountability : Responsibility
Delirium:- loss of present memory and has ;past memory ,confusion,
hallucination

vegetative state:-like coma but sometimes open the eyes

 Thick secretion
↓
Nebulization
↓
Physiotherapy
↓
Hydration to liquefy the secretions
↓
Albuterol nebulization
↓
Check heart rate
↓
Give pancreatic enzyme with meal
 Provide safe environment
Post ictal stage sleepiness
/exhausted in tonic clonic Tonic clonic seizure along with loss of
seizure consciousness
 TOTAL PARENTERAL NUTRITION
↓
SUPINE POSITION
↓
2ND HOURLY SUGAR CHECKING
↓
DAILY WEIGHT CHECKING
↓
24 HOURS OF FEEDING
↓
AFTER 24 HOURS DISPOSE THE TPN SOLUTION
↓
IF ANY BREATHING TROUBLE STOP THE INFUSION
IMMEDIATRELY DUE TO HIGH RISK OF PULMONARY
EMBOLISM
↓
WEEKLY TARGET WEIGHT RANGES FROM 0.45 – 0.91%
 GONORRHEA
↓
MILKY VAGINAL DISCHARGE
↓
CEPHALOSPORIN IS DRUG OF CHOICE
↓
CEFTRIAXONE FOR PREGNANT WOMEN WITH GONORRHEA

TRICHOMONIASIS
↓
YELLOWISH/GREENISH FOUL SMELLING DISCHARGE
↓
METRONIDAZOLE & TINIDAZOLE IS DRUG OF CHOICE
Autocratic
 IMMUNIZATION
6 MONTH VACCINE - DTP
9 MONTH VACCINE - MEASLES,MENINGOCOCCAL
CONJUGATED VACCINE(MCV)
MEASLES NOT GIVEN AT 6 MONTH
MEASLES GIVEN SUBCUTANEOUS NOT INTRAMUSCULAR
1 YEAR VACCINE -MMR,PNEUMOCOCCAL
4 YEAR VACCINE – MMR,VARICELLA
PREGNANT WOMEN VACCINE- TT
ADULT VACCINE -INFLUENZA
Post AmPutated patient
PRE AMPUTATION POST AMPUTATION

WITNESSING THE CONSENT ELEVATE THE RESIDUAL LIMB WITH PILLOW

PREOPERATIVE EDUCATION AND COUNSELLING MASSAGE THE LIMB FOR PROSTHESIS

INVOLVE THE PATIENT IN SITE MARKING SHAPE: Cone shaped

TALK ABOUT PHANTOM LIMB SENSATION

DISTORTED BODY IMAGE/BODY IMAGE DISTURBANCE

 POST AMPUTATION
 COLOSTOMY
 MASTECTOMY
 BURNS
 SURGICAL SCAR ON FACE