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NERVOUS SYSTEM Overview of structures and functions: Central Nervous System 11 Brain 12 Spinal Cord Peripheral Nervous System 13 Cranial Nerves 14 Spinal Nerves Autonomic Nervous System 15 Sympathetic nervous system 16 Parasympathetic nervous system AUTONOMIC NERVOUS SYSTEM Sympathetic Nervous System (ADRENERGIC) - Involved in fight or aggression response. - Release of Norepinephrine (cathecolamines) from adrenal glands and causes vasoconstriction. - Increase all bodily activity except GIT EFFECTS OF SNS - Dilation of pupils(mydriasis) in order to be aware. - Dry mouth (thickened saliva). - Increase BP and Heart Rate. - Bronchodilation, Increase RR - Constipation. - Urinary Retention. - Increase blood supply to brain, heart and skeletal muscles. - SNS I. Adrenergic Agents - Give Epinephrine. Signs and Symptoms: - SNS Contraindication: - Contraindicated to patients suffering from COPD (Broncholitis, Bronchoectasis, Emphysema, Asthma). II. Beta-adrenergic Blocking Agents - Also called Beta-blockers. - All ending with "lol" Parasympathetic Nervous System (CHOLINERGIC, VAGAL, SYMPATHOLYTIC) - Involved in fight or withdrawal response. - Release of Acetylcholine. - Decreases all bodily activities except GIT. EFFECTS OF PNS - Constriction of pupils (meiosis). - Increase salivation. - Decrease BP and Heart Rate. - Bronchoconstriction, Decrease RR. - Diarrhea - Urinary frequency.
I. Cholinergic Agents - Mestinon, Neostigmine. Side Effects - PNS
II. Anti-cholinergic Agents - To counter cholinergic agents. - Atropine Sulfate
- Propranolol, Atenelol, Metoprolol. Effects of Beta-blockers B – roncho spasm E – licits a decrease in myocardial contraction. T – reats hypertension. A – V conduction slows down. q 1 Should be given to patients with Angina Pectoris, Myocardial Infarction, Hypertension. ANTI- HYPERTENSIVE AGENTS 1. Beta-blockers – "lol" 2. Ace Inhibitors – Angiotensin, "pril" (Captopril, Enalapril) 3. Calcium Antagonist – Nifedipine (Calcibloc) q1 In chronic cases of arrhythmia give Lidocaine(Xylocaine)
Side Effects - SNS
CENTRAL NERVOUS SYSTEM 17 Brain and Spinal Cord. I. CELLS A. NEURONS 18 Basic cells for nerve impulse and conduction. PROPERTIES Excitability – ability of neuron to be affected by changes in external environment. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another. Permanent Cell – once destroyed not capable of regeneration. TYPES OF CELLS BASED ON REGENERATIVE CAPACITY 1. Labile 19 Capable of regeneration. 20 Epidermal cells, GIT cells, GUT cells, cells of lungs. 2. Stable 21 Capable of regeneration with limited time, survival period. 22 Kidney cells, Liver cells, Salivary cells, pancreas. 3. Permanent 23 Not capable of regeneration. 24 Myocardial cells, Neurons, Bone cells, Osteocytes, Retinal Cells.
B. NEUROGLIA 25 Support and protection of neurons. TYPES 1. Astrocytes – maintains blood brain barrier semi-permeable.
26 Majority of brain tumors (90%) arises from called astrocytoma.
2. Oligodendria 3. Microglia 4. Epindymal SUBSTANCES THAT CAN PASS THE BLOOD-BRAIN BARRIER 1. Ammonia 27 Cerebral toxin 28 Hepatic Encephalopathy (Liver Cirrhosis) 29 Ascites 30 Esophageal Varices Early Signs of Hepatic Encephalopathy
31 asterixis (flapping hand tremors).
Late Signs of Hepatic Encephalopathy 32 Headache 33 Dizziness 34 Confusion
35 Fetor hepaticus (ammonia like breath)
36 Decrease LOC
MENINGITIS – Kernig's sign (leg pain). 27. CHOLERA – rice watery stool. 15. 7. PERNICIOUS ANEMIA – red beefy tongue. SLE – butterfly rashes. APPENDICITIS – rebound tenderness. (+) Grey turners spots. 6. LIVER CIRRHOSIS – spider like varices. DOWN SYNDROME – protruding tongue. Type 1 DM (IDDM) 40 Causes diabetic ketoacidosis. 3. PANCREATITIS – Cullen's sign (ecchymosis of umbilicus). 22. MALARIA – stepladder like fever with chills. PYLORIC STENOSIS – olive like mass. 28. PTB – low-grade afternoon fever. INTUSSUSCEPTION – sausage shaped mass 2. BULIMIA – chipmunk face. 3. 23. HYPERTHYROIDISM/GRAVE'S DISEASE – exopthalmus. PDA – machine like murmur. 17. Carbon Monoxide and Lead Poisoning 37 Can lead to Parkinson's Disease. 19. TETANY – HYPOCALCEMIA (+) Trousseau's sign/carpopedal spasm. 24. 13. DENGUE – petechiae or (+) Herman's sign. CUSHING'S SYNDROME – moon face appearance and buffalo hump. 14. ASTHMA – wheezing on expiration. PNEUMONIA – rusty sputum. 10. TYPHOID – rose spots in abdomen. LEPROSY – lioning face. Chvostek sign (facial spasm). 5. Brudzinski sign (neck pain). 2. 4.PATHOGNOMONIC SIGNS 1. 20. 11. 18. EMPHYSEMA – barrel chest. 9. TETANUS – risus sardonicus. 38 Epilepsy 39 Treat with ANTIDOTE: Calcium EDTA. 26. 8. 16. KAWASAKI SYNDROME – strawberry tongue. . ADDISON'S DISEASE – bronze like skin pigmentation. 25. 21. MEASLES – koplik's spots. DIPTHERIA – pseudo membrane formation 12.
41 And increases breakdown of fats. DEMYELINATING DISORDERS 1. 45 KUSSMAUL'S respiration. DRUG OF CHOICE: ARICEPT (taken at bedtime) and COGNEX. Apraxia – no recognition of objects function. MULTIPLE SCLEROSIS 57 Chronic intermittent disorder of CNS characterized by white patches of demyelination in brain and spinal cord. *Expressive aphasia 52 "motor speech center" 53 Broca's Aphasia *Receptive aphasia 54 inability to understand spoken words. 55 Wernicke's Aphasia 56 General Knowing Gnostic Area or General Interpretative Area. 50 Causing irreversible brain damage. Agnosia – no recognition of inanimate objects. c. ALZHEIMER'S DISEASE 51 Atrophy of brain tissues. Hepatitis 47 Signs of jaundice (icteric sclerae). 46 Which may lead to diabetic coma. Amnesia – loss of memory. 42 And free fatty acids 43 Resulting to cholesterol and (+) to Ketones (CNS depressant). Sign and Symptoms 4 A's of Alzheimer a. Bilirubin 49 Increase bilirubin in brain (Kernicterus). b. . 2. Aphasia – no speech (nodding). d. 4. 44 Resulting to acetone breath odor/fruity odor. 48 Caused by bilirubin (yellow pigment) 5. a rapid shallow respiration.
Impaired sensation 71 to touch. . saliva. Visual disturbances 68 blurring of vision (primary) 69 diplopia (double vision) 70 scotomas (blind spots) 2. Impaired cerebral function . Ig M – acute in inflammation. Mood swings 75 euphoria (sense of well being) 4. Ig A – present in all bodily secretions (tears. Ig D – for chronic inflammation. Impaired motor function 76 weakness 77 spasticity 78 paralysis 5. Ig E – for allergic reaction.Immediate action. heat and cold. pain. 72 tingling sensation 73 paresthesia 74 numbness 3. Signs and Symptoms 1. colostrums). .58 Characterized by remission and exacerbation. pressure.short term protection. 59 Women ages 15-35 are prone 60 Unknown Cause 61 Slow growing virus 62 Autoimmune disorders 63 Pernicious anemia 64 Myasthenia gravis 65 Lupus 66 Hypothyroidism 67 GBS Ig G – only antibody that pass placental circulation causing passive immunity. * Give palliative or supportive care.
ACTH (Adreno Corticotropic Hormone)/ Steroids for acute exacerbation to reduce edema at site of demyelination to prevent paralysis. Yoga 4. NURSING MANAGEMENT 1. Decrease sexual capacity DIAGNOSTIC PROCEDURE Nystagmus 80 CSF analysis (increase in IgG and Protein). Institute stress management techniques. b. c. d. 81 MRI (reveals site and extent of demyelination). 3. Baclofen (Dioresal)/ Dantrolene Sodium (Dantrene) – muscle relaxants. Increase fluid intake and increase fiber to prevent constipation. Deep breathing exercises b. 82 (+) Lhermitte's sign a continuous and increase contraction of spinal column. a. 5.79 scanning speech TRIAD SIGNS OF MS Ataxia (Unsteady gait. Interferons – alter immune response. Diuretics . Administer medications as ordered a. Maintain side rails to prevent injury related to falls. a. (+) Romberg's test) Intentional tremors 6. Urinary retention/incontinence 7. Catheterization to prevent retention. Constipation 8. Immunosupresants 2.
1-1 ½ inches) 89 poor perineal hygiene 90 vaginal environment is moist Nursing Management 91 avoid bubble bath (can alter Ph of vagina). prunes. 85 Monitor breath sounds 1 hour after subcutaneous administration. 92 avoid use of tissue papers 93 avoid using talcum powder and perfume. MACROPHAGE Microglia Monocytes Kupffers cells Histiocytes Alveolar Macrophage EPINDYMAL CELLS ORGAN Brain Blood Kidney Skin Lung 97 Secretes a glue called chemo attractants that concentrate the bacteria. COMMON CAUSE OF UTI Female 88 short urethra (3-5 cm. 8 inches) 95 urinate after intercourse MICROGLIA 96 stationary cells that carry on phagocytosis (engulfing of bacteria or cellular debris. pineapple.b. vitamin C and orange. Prophantheline Bromide (Promanthene) 86 Acid ash diet like cranberry juice. For Urinary Incontinence Anti spasmodic agent a. . eating). 87 To acidify urine and prevent bacterial multiplication. c. 84 Monitor side effects bronchospasm and wheezing. plums. pinocytosis (cell drinking). Bethanicol Chloride (Urecholine) Nursing Management 83 Only given subcutaneous. Male 94 Urethra (20 cm.
Brain Mass PARTS OF THE BRAIN 1. Limbic System (Rhinencephalon) 116controls smell and if damaged results to Anosmia (absence of smell). Functions of Cerebrum 103 integrative 104 sensory 105 motor Lobes of Cerebrum 1. Temporal 110 hearing 111 short term memory 3. Parietal 112 for appreciation 113 discrimination of sensory impulses to pain. pressure. 2.COMPOSITION OF BRAIN 98 80% brain mass 99 10% blood 100 10% CSF I. numbness. cold. Frontal 106 higher cortical thinking 107 controls personality 108 controls motor activity 109 Broca's Area (motor speech area) when damaged results to garbled speech. heat. 4. 117 controls libido 118 controls long term memory . Occipital 114 for vision Insula (Island of Reil) 115 visceral function activities of internal organ like gastric motility. touch. CEREBRUM 101 largest part 102 composed of the Right Cerebral Hemisphere and Left Cerebral Hemisphere enclosed in the Corpus Callosum.
2. BASAL GAGLIA 119 areas of grey matter located deep within each cerebral hemisphere. 120 release dopamine (controls gross voluntary movement. NEURO TRANSMITTER Acethylcholine Dopamine DECREASE Myasthenia Gravis Parkinson's Disease INCREASE Bi-polar Disorder Schizophrenia
3. MIDBRAIN/ MESENCEPHALON 121 acts as relay station for sight and hearing.
122size of pupil is 2 – 3 mm. 123equal size of pupil is isocoria. 124unequal size of pupil is anisocoria. 125hearing acuity is 30 – 40 dB.
126 positive PERRLA 4. INTERBRAIN/ DIENCEPHALON Parts of Diencephalon A. Thalamus 127 acts as relay station for sensation. B. Hypothalamus 128 controls temperature (thermoregulatory center). 129 controls blood pressure 130 controls thirst 131 appetite/satiety 132 sleep and wakefulness 133 controls some emotional responses like fear, anxiety and excitement. 134 controls pituitary functions
135androgenic hormones promotes secondary sex characteristics.
136 early sign for males are testicular and penile enlargement 137 late sign is deepening of voice. 138 early sign for females telarche and late sign is menarche. 5. BRAIN STEM 139 located at lowest part of brain Parts of Brain Stem 1. Pons
140 pneumotaxic center controls the rate, rhythm and depth of respiration. 2. Medulla Oblongata 141 controls respiration, heart rate, swallowing, vomiting, hiccup, vasomotor center (dilation and constriction of bronchioles).
3. Cerebellum 142 smallest part of the brain. 143 lesser brain. 144 controls balance, equilibrium, posture and gait. INTRA CRANIAL PRESSURE Monroe Kellie Hypothesis Skull is a closed container Any alteration or increase in one of the intracranial components Increase intra-cranial pressure (normal ICP is 0 – 15 mmHg) Cervical 1 – also known as ATLAS. Cervical 2 – also known as AXIS. Foramen Magnum Medulla Oblongata Brain Herniation Increase intra cranial pressure * Alternate hot and cold compress to prevent HEMATOMA 145 CSF cushions brain (shock absorber)
146Obstruction of flow of CSF will lead to enlargement of skull posteriorly called
hydrocephalus. 147 Early closure of posterior fontanels causes posterior enlargement of skull in
INCREASE INTRACRANIAL PRESSURE – increase in intra-cranial bulk brought about by an increase in one of the 3 major intra cranial components. Causes: q1 head trauma/injury 148 localized abscess 149 cerebral edema 150 hemorrhage 151 inflammatory condition (stroke) 152 hydrocephalus 153 tumor (rarely) Signs and Symptoms (Early) 154 decrease LOC 155 restlessness/agitation 156 irritability 157 lethargy/stupor 158 coma Signs and Symptoms (Late) 159 changes in vital signs
160blood pressure (systolic blood pressure increases but diastolic remains the
same). 161 widening of pulse pressure is neurologic in nature (if narrow cardiac in nature). 162 heart rate decrease 163 respiratory rate decrease 164 temperature increase directly proportional to blood pressure. 165 projective vomiting 166 headache
167papilledema (edema of optic disc)
168 abnormal posturing
169decorticate posturing (damage to cortex and spinal cord). 170decerebrate posturing (damage to upper brain stem that includes pons,
cerebellum and midbrain).
171unilateral dilation of pupils called uncal herniation 172bilateral dilation of pupils called tentorial herniation
173 resulting to mild headache
c. . maintain side rails. Elevate bed of client 30 – 35o angle with neck in neutral position unless contraindicated to promote venous drainage. Assist in mechanical ventilation 2.174 possible seizure activity Nursing Management 1. Before and after suctioning hyper oxygenate client 100% and done 10 – 15 seconds only. provide an comfortable and quite environment. Prevention of hypoxia and hypercarbia Early signs of hypoxia 175 restlessness 176 agitation 177 tachycardia Late signs of hypoxia 178Bradycardia 179Extreme restlessness 180Dyspnea 181Cyanosis HYPERCARBIA 182Increase CO2 (most powerful respiratory stimulant) retention. instruct client to avoid forms of valsalva maneuver like: 184 straining stool 185 excessive vomiting (use anti emetics) 186 excessive coughing (use anti tussive like dextromethorphan) 187 avoid stooping/bending 188 avoid lifting heavy objects e. avoid clustering of nursing activity together. 3. 4. Monitor strictly input and output and neuro check 5. Maintain patent and adequate ventilation by: a. d. b. Limit fluid intake to 1200 – 1500 ml/day (in force fluids 2000 – 3000 ml/day). Prevent complications of 6. c. avoid use of restraints. 183In chronic respiratory distress syndrome decrease O2 stimulates respiration. Prevent further increase ICP by: a. b.
Administer medications like: a.7. 192 administered via side drip 193 regulated fast drip to prevent crystal formation. 199 given early morning 200immediate effect of 10 – 15 minutes. 191 monitor strictly input and output every 1 hour notify physician if output is less 30 cc/hr. b. 197 monitor strictly input and output every 1 hour notify physician if output is less 30 cc/hr. 201 maximum effect of 6 hours. Phenytoin) *CONGESTIVE HEART FAILURE Signs and Symptoms 207 dyspnea 208 orthopnea 209 paroxysmal nocturnal dyspnea 210 productive cough 211 frothy salivation 212 cyanosis 213 rales/crackles . c. Loop diuretic (Lasix. Nursing Management 196 Monitor vital signs especially BP (hypotension). Furosemide) 194 Drug of choice for CHF (pulmonary edema) 195 Loop of Henle in kidneys. Corticosteroids 202 Dexamethasone (Decadron) 203 Hydrocortisone 204 Prednisone (to reduce edema that may lead to increase ICP) 205 Mild Analgesics (Codeine Sulfate for respiratory depression) 206 Anti Convulsants (Dilantin. 198 administered IV push or oral. Osmotic diuretic (Mannitol) 189 for cerebral diuresis Nursing Management 190 monitor vital signs especially BP (hypotension).
4 – 5.214 bronchial wheezing 215 pulsus alternans 216 anorexia and general body malaise 217 PMI (point of maximum impulse/apical pulse rate) is displaced laterally 218 S3 (ventricular gallop) 219 Predisposing Factors/Mitral Valve RHD Aging TREATMENT Morphine Sulfate Aminophelline Digoxin Diuretics Oxygen Gases.5 meq/L Sign and Symptoms 231 weakness and fatigue 232 constipation . blood monitor RIGHT CONGESTIVE HEART FAILURE (Venous congestion) Signs and Symptoms 220 jugular vein distention (neck) 221 ascites 222 pitting edema 223 weight gain 224 hepatosplenomegaly 225 jaundice 226 pruritus 227 esophageal varices 228 anorexia and general body malaise Signs and Symptoms of Lasix in terms of electrolyte imbalances 1. Hypokalemia 229decrease potassium level 230normal value is 3.
Hypocalcemia/ Tetany VEGETABLES Asparagus Brocolli Carrots Spinach 236decrease calcium level 237normal value is 8. Oral Potassium Chloride) 235 increase intake of foods rich in potassium FRUITS Apple Banana Cantalop e Oranges 2.233 positive U wave on ECG tracing Nursing Management 234administer potassium supplements as ordered (Kalium Durule.5 – 11 mg/100 ml Signs and Symptoms 238 tingling sensation 239 paresthesia 240 numbness 241 (+) Trousseau's sign/ Carpopedal spasm 242 (+) Chvostek's sign Complications Arrhythmia Seizures Calcium Gluconate per IV slowly as ordered Nursing Management q * Calcium Gluconate toxicity – results to SEIZURE Magnesium Sulfate Magnesium Sulfate toxicity S/S BP Urine output Respiratory rate Patellar relfex absent DECREASE .
3. Hyponatremia
243decrease sodium level 244normal value is 135 – 145 meq/L
Signs and Symptoms 245 hypotension
246dehydration signs (Initial sign in adult is THIRST, in infant TACHYCARDIA)
247 agitation 248 dry mucous membrane 249 poor skin turgor 250 weakness and fatigue Nursing Management 251 force fluids
252administer isotonic fluid solution as ordered
4. Hyperglycemia
253normal FBS is 80 – 100 mg/dl
Signs and Symptoms 254 polyuria 255 polydypsia 256 polyphagia Nursing Management 257 monitor FBS 5. Hyperuricemia 258 increase uric acid (purine metabolism) 259 foods high in uric acid (sardines, organ meats and anchovies) 260 *Increase in tophi deposit leads to Gouty arthritis. Signs and Symptoms 261 joint pain (great toes) 262 swelling Nursing Management 263 force fluids 264 administer medications as ordered a. Allopurinol (Zyloprim) 265 Drug of choice for gout.
266Mechanism of action: inhibits synthesis of uric acid.
b. Colchecine 267 Acute gout
268Mechanism of action: promotes excretion of uric acid.
* KIDNEY STONES Signs and Symptoms 269 renal colic 270 Cool moist skin Nursing Management 271 force fluids 272 administer medications as ordered a. Narcotic Analgesic 273 Morphine Sulfate
274ANTIDOTE: Naloxone (Narcan) toxicity leads to tremors.
b. Allopurinol (Zyloprim) Side Effects 275 Respiratory depression (check for RR)
276Chronic progressive disorder of CNS characterized by degeneration of
dopamine producing cells in the SUBSTANCIA NIGRA of the midbrain and basal ganglia. Predisposing Factors 1. Poisoning (lead and carbon monoxide) 2. Arteriosclerosis 3. Hypoxia 4. Encephalitis
5. Increase dosage of the following drugs: a. Reserpine(Serpasil) b. Methyldopa(Aldomet) c. Haloperidol(Haldol) d. Phenothiazine AntipsychoticS AntihypertensiveS
SIDE EFFECTS RESERPINE Major depression leading to suicide Aloneness
Loss of spouse 277 direct approach towards the client 278 close surveillance is a nursing priority
Loss of Job
279 time to commit suicide is on weekends early morning Signs and Symptoms for Parkinson's 280 pill rolling tremors of extremities especially the hands. 281 bradykinesia (slowness of movement) 282 rigidity (cogwheel type) 283 stooped posture 284 shuffling and propulsive gait 285 over fatigue
286mask like facial expression with decrease blinking of the eyes.
287 difficulty rising from sitting position. 288 Monotone type speech 289 mood lability (in state of depression)
290increase salivation (drooling type)
291 autonomic changes a. increase sweating b. increase lacrimation c. seborrhea
Administer medications as ordered Anti Parkinsonian agents 292 Levodopa (L-dopa) short acting 293 Amantadine Hydrochloride (Symmetrel) 294 Carbidopa (Sinemet) Mechanism of Action 295 increase level of dopamine Side Effects 296 GIT irritation (should be taken with meals 297 orthostatic hypotension 298 arrhythmia 299 hallucinations Contraindications 300 clients with narrow angle closure glaucoma 301 clients taking MAOI's (no foods with triptophan and thiamine) 302 urine and stool may be darkened 303no Vitamin B6 (Pyridoxine) reverses the therapeutic effects of Levodopa * Increase Vitamin B when taking INH (Isoniazid).d.to relieve tremors Mechanism of Action 304 inhibits action of acethylcholine Side Effects 305 SNS Anti Histamine (Dipenhydramine Hydrochloride) Side Effects Adult: drowsiness Children: CNS excitement (hyperactivity) because blood brain barrier is not yet fully developed. Dopamine Agonist .relieves tremor rigidity Bromocriptene Hydrochloride (Parlodel) Side Effects 306 Respiratory depression . constipation e. Isonicotinic Acid Hydrazide Anti Cholinergic Agents (ARTANE and COGENTIN) . decrease sexual capacity Nursing Management 1.
2. Prevent complications of immobility 4.6 – 1. Decrease protein in morning and increase protein in afternoon to induce sleep 5. Encourage increase fluid intake and fiber. Assist in Stereotaxic Thalamotomy MAGIC 2's IN DRUG MONITORING DRUG Digoxin/ Lanoxin (Increase force of cardiac output) Lithium/ Lithane (Decrease level of Ach/NE/Serotonin) Aminophylline (Dilates bronchial tree) Dilantin/ Phenytoin Acetaminophen/Tylenol NORMAL RANGE .5 – 1. 6. Assist/supervise in ambulation 7.2 meq/L 10 – 19 mg/100 ml 10 – 19 mg/100 ml 10 – 30 mg/100 ml TOXICITY LEVEL 2 2 20 20 200 INDICATION CHF Bipolar COPD Seizures Osteo Arthritis CLASSIFICATION Cardiac Glycoside Anti-Manic Agents Bronchodilators Anti-Convulsant Non-narcotic Analgesic 1. Digitalis Toxicity Signs and Symptoms 307 nausea and vomiting 308 diarrhea 309 confusion 310 photophobia 311 changes in color perception (yellowish spots) Antidote: Digibind 2. Maintain side rails to prevent injury 3. Lithium Toxicity Signs and Symptoms 312 anorexia 313 nausea and vomiting 314 diarrhea .5 meq/L .
315 dehydration causing fine tremors 316 hypothyroidism Nursing Management 317 force fluids 318 increase sodium intake to 4 – 10 g% daily 3. irritability. agitation and restlessness) Nursing Management 322 only mixed with plain NSS or 0.9 NaCl to prevent development of crystals or precipitate. Aminophylline Toxicity Signs and Symptoms 319 tachycardia 320 palpitations 321 CNS excitement (tremors. Acetaminophen Toxicity Signs and Symptoms 332 hepatotoxicity (monitor for liver enzymes) 333 SGPT/ALT (Serum Glutamic Pyruvate Transaminace) 334 SGOT/AST (Serum Glutamic Oxalo-Acetil Transaminace) 335 nephrotoxicity monitor BUN (10 – 20) and Creatinine (.8 – 1) 336 hypoglycemia Tremors. 323 administered sandwich method 324 avoid taking alcohol because it can lead to severe CNS depression 325 avoid caffeine 4. Dilantin Toxicity Signs and Symptoms 326 gingival hyperplasia (swollen gums) 327 hairy tongue 328 ataxia 329 nystagmus Nursing Management 330 provide oral care 331 massage gums 5. tachycardia Irritability .
input and output and neuro check * monitor strength or motor grading scale 4. q if there is no effect there is damage to occipital lobe and midbrain and is negative for M. institute NGT feeding 6. depression Antidote: Acetylcisteine (mucomyst) prepare suction apparatus as bedside. airway 2. Incidence rate: women 20 – 40 years old Predisposing factors 338 unknown 339 autoimmune: it involves release of cholinesterase an enzyme that destroys Ach.Restlessness Extreme fatigue Diaphoresis. Anti Cholenisterase (Neostegmin) maintain patent airway and adequate ventilation . Cholinergic (Mestinon) b. maintain side rails to prevent injury related to falls 5. Signs and Symptoms 340initial sign is ptosis a clinical parameter to determine ptosis is palpebral fissure.G. aspiration 3. Nursing Management 1. administer medications as ordered a. 341 diplipia 342 mask like facial expression 343 dysphagia 344 hoarseness of voice 345 respiratory muscle weakness that may lead to respiratory arrest 346 extreme muscle weakness especially during exertion and morning Diagnostic Procedure 347Tensilon test (Edrophonium Hydrochloride) provides temporary relief of signs and symptoms for about 5 – 10 minutes and a maximum of 15 minutes. MYASTHENIA GRAVIS 337 neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction leading to descending muscle weakness. mmobility * assist in mechanical ventilation and monitor pulmonary function test * monitor strictly vital signs.
8.Mechanism of Action q increase level of Ach PNS Cortocosteroids suppress immune response monitor for 2 types of crisis: CHOLINERGIC CRISIS Cause: .PNS Treatment .under medication . for support and protection for nourishment blood supply LAYERS OF THE MENINGES 1. Arachnoid – middle layer 3. speak. swallow.The client is unable to see. Dura matter – outer layer 2.over medication Signs and Symptoms . . Prevent complications INFLAMMATORY CONDITIONS OF THE BRAIN MENINGITIS Meninges q q q q 3 fold membrane that covers brain and spinal cord.administer cholinergic agents as ordered 7.stress . Assist in surgical procedure known as thymectomy because it is believed that the thymus gland is responsible for M. CSF aspiration is done.infection Signs and Symptoms . Assist in plasma paresis and removing auto immune anti bodies 9.Administer anti cholinergic agents (Atropine Sulfate) Side Effects q q q MYASTHENIC CRISIS Causes: .G. Pia matter – inner layer q q subdural space between the dura and arachnoid subarachnoid space between the arachnoid and pia. breathe Treatment .
chills.causes adult meningitis 4. (+) cultured microorganism (confirms meningitis) CBC reveals . Nuchal rigidity or stiff neck b. (+) Kernig's sign (leg pain) d. Streptococcus . Pneumococcus 3. 4. Increase CHON and WBC 2.A. Decrease glucose 3. Increase CSF opening pressure (normal pressure is 50 – 100 mmHg) 4. Post Lumbar Puncture 1. Etiology 1. Mode of transmission 348 airborne transmission (droplet nuclei) C. Hemophilus Influenzae – causes pediatric meningitis B. Diagnostic Procedures 356 Lumbar puncture: a hollow spinal needle is inserted in the subarachnoid space between the L3 – L4 to L5. Encourage to arch back to clearly visualize L3-L4. Check punctured site for any discoloration. Signs and Symptoms 349 headache 350 photophobia 351 projectile vomiting 352 fever. CSF analysis reveals 1. Empty bladder and bowel to promote comfort. anorexia. general body malaise and weight loss 353 Possible increase in ICP and seizure activity 354 Abnormal posturing (decorticate and decerebrate) 355 Signs of meningeal irritation a. Force fluids 3. Assess for movement and sensation of extremities. Meningococcus – most dangerous 2. Nursing Management for LP Before Lumbar Puncture 1. (+) Brudzinski sign (neck pain) D. 2. Opisthotonus (arching of back) c. Place flat on bed 12 – 24 o 2. Secure informed consent and explain procedure. 3. drainage and leakage to tissues.
b. Provide client health care and discharge planning concerning: a. Enforce complete bed rest 2. Elevate head 30-45o 5. 363 2 most common cerebral artery affected by stroke a. Provide a comfortable and darkened environment. calories with small frequent feedings. Administer medications as ordered a. Rehabilitation for neurological deficit 360 mental retardation 361 delayed psychomotor development CVA (STROKE/BRAIN ATTACK/ ADOPLEXY/ CEREBRAL THROMBOSIS) 362 a partial or complete disruption in the brains blood supply. Institute strict respiratory isolation 24 hours after initiation of anti biotic therapy 4. CHON.1. Mild analgesics c. Institute measures to prevent increase ICP and seizure. Incidence Rate 364 men are 2-3 times high risk B. 7. Nursing Management 1. Maintain fluid and electrolyte balance. Maintain good diet of increase CHO. 8. Monitor strictly V/S. Prevent complications 357most feared is hydrocephalus 358hearing loss/nerve deafness is second complication 359consult audiologist c. Broad spectrum antibiotics (Penicillin. Increase wbc E. Internal Cerebral Artery – the 2 largest artery A. . Predisposing Factors 365 thrombus (attached) 366embolus (detached and most dangerous because it can go to the lungs and cause pulmonary embolism or the brain and cause cerebral embolism. 9. input and output and neuro check 6. Anti pyretics 3. Mid Cerebral Artery b. Tetracycline) b.
Prolong use of oral contraceptives promotes lypolysis (breakdown of lipids) leading to atherosclerosis that will lead to hypertension and eventually CVA. Yellow bone marrow are produced from the medullary cavity of the long bones and produces fat cells. Valvular Disease. Type A personality a. Myocardial Infarction.Signs and Symptoms of Pulmonary Embolism 367 Sudden sharp chest pain 368 Unexplained dyspnea 369 Tachycardia 370 Palpitations 371 Diaphoresis 372 Mild restlessness Signs and Symptoms of Cerebral Embolism 373 Headache and dizziness 374 Confusion 375 Restlessness 376 Decrease LOC Fat embolism is the most feared complications after femur fracture. Atherosclerosis. sedentary lifestyle 3. Diabetes Mellitus. Lifestyle (smoking). usually fells guilty when not doing anything 6. If there is bone fracture there is hemorrhage and there would be escape of the fat cells in the circulation. Risk Factors 1. Compartment syndrome (compression of arteries and nerves) C. can do multiple tasks c. D. Obesity (increase 20% ideal body weight) 4. Signs and Symptoms 377 dependent on stages of development Heart . Hypertension. Hyperlipidemia more on genetics/genes that binds to cholesterol 5. deadline driven b. Related stress physical and emotional 8. Post Cardiac Surgery (mitral valve replacement) 2. Related to diet: increase intake of saturated fats like whole milk 7.
Cerebral Arteriography 392 reveals the site and extent of malocclusion 393 uses dye for visualization 394 most of dye are iodine based 395 check for shellfish allergy 396 after diagnostic exam force fluids to release dye because it is nephro toxic 397 check for distal pulse (femoral) 398 check for hematoma formation F. TIA 378 Initial sign of stroke or warning sign Signs and Symptoms 379 headache and dizziness 380 tinnitus 381 visual and speech disturbances 382 paresis (plegia) 383 possible increase ICP 2. nausea and vomiting 389 dysphagia 390 (+) Kernig's sign and Brudzinski sign which may lead to hemorrhagic stroke 391 focal neurological deficits a. Stroke in evolution 384 progression of signs and symptoms of stroke 3. CT Scan – reveals brain lesions 2.1. Diagnostic Procedure 1. homonymous hemianopsia (loss of half of visual field) E. phlegia b. aphasia c. alexia (difficulty reading) e. agraphia (difficulty writing) f. Nursing Management . Complete stroke 385 resolution phase characterized by: Signs and Symptoms 386 headache and dizziness 387 Cheyne Stokes Respiration 388 anorexia. dysarthria (inability to articulate words) d.
Anti Coagulants 403 Heparin (short acting) 404 check for partial thromboplastin time if prolonged there is a risk for bleeding. provide sand bag or food board. Restrict fluids to prevent cerebral edema that might increase ICP 3. I & O and neuro check 5. non verbal cues b.1. If positive to hemianopsia approach client on unaffected side 10. Monitor strictly vitals signs. assist in mechanical ventilation b. Prevent complications of immobility by: a. Thrombolytic/Fibrinolytic Agents – dissolves thrombus 399 Streptokinase Side Effect: Allergic Reaction 400 Urokinase 401 Tissue Plasminogen Activating Factor 402 Side Effect: Chest Pain f. Elevate head 30 – 45o 4. Cortecosteroids d. administrate O2 inhalation 2. 405 give Protamine Sulfate 406 Comadin/ Warfarin (long acting) 407 give simultaneously because Coumadin will take effect after 3 days 408 check for prothrombin time if prolonged there is a risk for . Administer medications as ordered a. turn client to side b. Osmotic Diuretics (Mannitol) b. Furosemide) c. Assist in passive ROM exercise every 4 hours to promote proper bodily alignment and prevent contractures 7. 6. Maintain patent airway and adequate ventilation by: a. Provide alternative means of communication a. magic slate 9. Mild Analgesics e. Loop Diuretics (Lasix. Institute NGT feeding 8. provide egg crate mattresses or water bed c.
Dysphagia 3. Autoimmune 2. Autonomic symptoms that includes a. avoidance of modifiable risk factors (diet. K (Aqua Mephyton) g. prevent complication (subarachnoid hemorrhage is the most feared complication) c. Predisposing Factors 1. Anti Platelet 410 PASA (Aspirin) 411 Contraindicated for dengue. increase salivation b. Antecedent viral infections such as LRT infections B. exercise. ulcer and unknown cause of headache because it may potentiate bleeding 11. Clumsiness (initial sign) 2. smoking) b. dietary modification (decrease salt. Alternate hypotension to hypertension ** ARRYTHMIA (most feared complication) 6. Provide client health teachings and discharge planning concerning a.bleeding 409 give Vit. Decreased of diminished deep tendon reflex 5. importance of follow up care GUILLAIN BARRE SYNDROME 412 a disorder of the CNS characterized by bilateral symmetrical polyneuritis leading to ascending muscle paralysis. Signs and Symptoms 1. saturated fats and caffeine) d. increase sweating c. A. constipation . Ascending muscle weakness leading to paralysis 4.
Nursing Management 1. Monitor strictly the following a. monitor pulmonary function test 2. Assist in plasma pharesis (filtering of blood to remove autoimmune anti-bodies) 9. Prevent complications a. CONVULSIVE DISORDER/ CONVULSION 418 disorder of CNS characterized by paroxysmal seizure with or without loss of .C. vital signs b. Maintain side rails to prevent injury related to fall 4. Assist in passive ROM exercise 7. Anti Cholinergic Agents – Atrophine Sulfate c. Maintain patent airway and adequate ventilation by: a. Administer medications as ordered a. Diagnostic Procedures 1. CSF analysis reveals increase in IgG and protein D. neuro check d. intake and output c. Paralysis or respiratory muscles/Respiratory arrest * Sengstaken Blakemore Tube 415 for liver cirrhosis 416 to decompress bleeding esophageal verices (prepare scissor to cut tube incase of difficulty in breathing to release air in the balloon 417 for hemodialysis prepare bulldog clips to prevent air embolism. Prevent complications of immobility by turning the client every 2 hours 5. Arrythmia b. assist in mechanical ventilation b. ECG 3. Corticosteroids – suppress immune response b. Zylocaine 414 Bretylium – blocks release of norepinephrine to prevent increase of BP 8. Institute NGT feeding to prevent aspiration 6. Anti Arrythmic Agents 413 Lidocaine.
lead b carbon monoxide 5. tactile. Partial or Localized Seizure 1. Tonic contractions . Head injury due to birth trauma 2. Post ictal sleep – unresponsive sleep 2. Valium) B. olfactory.direct symmetrical extension of extremities Clonic contractions . loss of consciousness (5 – 10 seconds) II. blank stare b. Predisposing Factors 1. Epileptic cry – is characterized by fall and loss of consciousness for 3 – 5 minutes c. Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam. 419Seizure – first convulsive attack 420Epilepsy – second or series of attacks 421Febrile seizure – normal in children age below 5 years A. Generalized Seizure 1. Jacksonian Seizure (focal seizure) 423 Characterized by tingling and jerky movement of index finger and thumb that spreads to the shoulder and other side of the body. Physical and emotional stress 7.contraction of extremities d. twitching of mouth d. Genetics 3. Grand mal Seizure (tonic-clonic seizure) a. . Petit mal Seizure – absence of seizure common among pediatric clients characterized by a. Nutritional and Metabolic deficiencies 6. visual. decrease blinking of eyes c. Signs or aura with auditory. Signs and Symptoms 422 Dependent on stages of development or types of seizure I. Toxicity from a. Presence of brain tumor 4. sensory experience b.consciousness abnormal motor activity alternation in sensation and perception and changes in behavior.
place mouth piece of tongue guard to prevent biting or tongue 2. Status Epilepticus 424 A continuous uninterrupted seizure activity. avoid use of restrains e. Maintain patent airway and promote safety before seizure activity a. Administer medications as ordered a. loosen clothing of client c. onset and duration b. Phenobarbital. administer O2 inhalation b.2. Valium and Glucose C. duration of post ictal sleep may lead to status epilepticus d. clouding of consciousness – not in contact with environment c. Psychomotor Seizure (focal motor seizure) a. maintain side rails d. Diazepam. mild hallucinatory sensory experience III. assist in surgical procedure cortical resection . Phenytoin) b. provide suction apparatus 5. Anti convulsants (Dilantin. Institute seizure and safety precaution post seizure attack a. EEG – reveals hyper activity of electrical brain waves D. Luminal 4. Valium c. Document and monitor the following a. Carbamazepine (Tegretol) – Trigeminal neuralgia d. if left untreated can lead to hyperpyrexia and lead to coma and eventually death. Nursing Management 1. turn clients head to side to prevent aspiration f. Diagnostic Procedures 1. 425Drug of choice: Diazepam. automatism – stereotype repetitive and non propulsive behavior b. CT Scan – reveals brain lesions 2. Avoid precipitating stimulus such as bright/glaring lights and noise 3. types of seizures c. clear the site of blunt or sharp objects b.
sleepy. LOC b. Finger to nose test – positive result mean dimetria (inability of body to stop movement at desired point) c. Verbal response 3.awake 2. Test of memory 428 Levels of orientation 429 Cranial nerve assessment 430 Sensory nerve assessment 431 Motor nerve assessment 432 Deep tendon reflex 433 Autonimics 434 Cerebellar test a. obtunded) 3. Alternate supination and pronation – positive result mean dimetria I. Conscious . Lethargy – lethargic (drowsy.COMPREHENSIVE NEURO EXAM GLASGOW COMA SCALE 426 objective measurement of LOC sometimes called as the quick neuro check Components 1. Motor response 2. Romberg's test – 2 nurses. Eye opening 427 Survey of mental status and speech a. Stupor 435 stuporous (awakened by vigorous stimulation) . LEVEL OF CONSCIOUSNESS 1. positive for ataxia b.
TEST OF MEMORY 1. Person – second asked 3. Place – third asked CRANIAL NERVES CRANIAL NERVES I. Corneal or blinking reflex 441 Conscious client use a wisp of cotton 442 Unconscious client place 1 drop of saline solution II. OLFACTORY II. Coma 438 comatose 439 light coma (positive to all forms of painful stimulus) 440 deep coma (negative to all forms of painful stimulus) DIFFERENT PAINFUL STIMULATION 1. OPTIC III OCCULOMOTOR IV.436 generalized body weakness 437 decrease body reflex 4. Pressure on great toes 4. Orbital pressure 3. Short term memory 443 ask most recent activity 444 positive result mean anterograde amnesia and damage to temporal lobe 2. TRIGEMINAL FUNCTION S S M M (Smallest) B . Long term memory 445 ask for birthday and validate on profile sheet 446 positive result mean retrograde amnesia and damage to limbic system 447 consider educational background III. TROCHLEAR V. LEVELS OF ORIENTATION 1. Deep sternal stimulation/ deep sternal pressure 2. Time – first asked 2.
Hyposnia – decrease sensitivity to smell 2. ACOUSTIC IX. indicates distance by which the person normally can see letter in the chart. 460 . ammonia.20/200 indicates blindness 461 20/20 visual acuity if client is able to read letters above the red line. cigarette Procedure 451 test each nostril by occluding each nostril Abnormal Findings 1. 450 use coffee granules. may indicate inflammatory conditions (sinusitis) CRANIAL NERVE II: OPTIC 452 sensory function for vision or sight Functions 1. Anosmia – absence of smell Indicative of 1. SPINAL ACCESSORY M XII. Test visual acuity or central vision or distance 453use Snellen's Chart 454 Snellen's Alphabet chart: for literate clients 455 Snellen's E chart: for illiterate clients 456 Snellen's Animal chart: for pediatric clients 457 normal visual acuity 20/20 458 numerator is constant. bar of soap.VI. vinegar. HYPOGLOSSAL M CRANIAL NERVE I: OLFACTORY 448 sensory function for smell Material Used 449 don't use alcohol. 2. Test of visual field or peripheral vision . GLOSSOPHARYNGEAL X. Dysosmia – distorted sense of smell 3. 20 feet) 459 denominator changes. VAGUS (Largest) M B S B B (Longest) XI. ABDUCENSE VII. it is the distance of person from the chart (6 – 7 m. perfume because it is irritating and highly diffusible. FACIAL VIII. head injury damaging the cribriform plate of ethmoid bone where olfactory cells are located 2.
Headache. Loss of peripheral vision 469pathognomonic sign is tunnel vision 2. Miotics – constricts pupil a. Predisposing Factors 465 Common among 40 years old and above 466 Hereditary 467 Hypertension 468 Obesity B. Carbonic Anhydrase Inhibitors a. Perimetry 3. Inferiorly COMMON VISUAL DISORDERS 1. Nasally d. Tonometry 2. Signs and Symptoms 1. eye pain (halos around light) 470 steamy cornea 471 may lead to blindness C. Superiorly b. Acetazolamide (Diamox) – promotes increase outflow of aqueous humor or drainage 4. nausea. Treatment 1. Epinephrine eyedrops – decrease formation of aqueous humor 3. Glaucoma 462 increase IOP 463normal IOP is 12 – 21 mmHg 464 preventable but not curable A. Carbachol 2. Pilocarpine Sodium.a. Diagnostic Procedures 1. Timoptics (Timolol Maleate) E. vomiting. Gonioscopy D. Surgical Procedures . Bitemporaly c.
1. Opthalmoscopic exam E. Pathognomonic Signs 1. Decrease perception to colors 473 Complication is blindness D. Related to congenital 3. Milky white appearance at center of pupils 3. Cataract 472 Decrease opacity of lens A. Cyclopegics (Cyclogyl) – paralyses cilliary muscle F. Aging 65 years and above 2. Prolonged exposure to UV rays B. TRABECULECTOMY (Peripheral Indectomy) – drain aqueous humor 2. Diabetes Mellitus 4. Signs and Symptoms 1. Diagnostic Procedure 1. Treatment 1. Blurring or hazy vision 2. Mydriatics (Mydriacyl) – constricts pupils 2.Partial removal Intra Capsular Cataract Lens Extraction . Surgical Procedure Extra Capsular Cataract Lens Extraction . Predisposing Factor 1. Loss of central vision C.Total removal of cataract with its surrounding capsules 474Most feared complication post op is RETINAL DETACHMENT .
IV. ABDUCENS 477 Controls or innervates the movement of extrinsic ocular muscle (EOM) 478 6 muscles Superior Rectus Superior Oblique Lateral Rectus Medial Rectus . Scleral Buckling 2. Signs and Symptoms 1. Macular Degeneration 476Degeneration of the macula lutea (yellowish spot at the center of retina) A. Cryosurgery – cold application 3. Post Lens Extraction 2. Predisposing Factors 1. VI: OCULOMOTOR. Signs and Symptoms 1. TROCHLEAR. Retinal Detachment 475 Separation of epithelial surface of retina A. Surgical Procedures 1. Floaters C. Diathermy – heat application 4. Curtain veil like vision 2.3. Myopia (near sightedness) B. Black Spots CRANIAL NERVE III.
. teeth. refers to movement and orientation of the body in space. frown and if results are negative there is facial paralysis or Bell's Palsy and the primary cause is forcep delivery. anterior 2/3 of tongue 494 pinch of sugar and cotton applicator placed on tip of tongue 495 Motor: controls muscle of facial expression 496 instruct client to smile. soft palate and corneal reflex) 490 motor: controls the muscle of mastication or chewing 491 damage to CN V leads to trigeminal neuralgia/thickdolorum 492 medication: Carbamezapine(Tegretol) CRANIAL NERVE VII: FACIAL 493 Sensory: controls taste. mandibular 489 sensory: controls sensation of face. mucous membrane. CRANIAL NERVE VIII: ACOUSTIC/VESTIBULOCOCHLEAR 497Controls balance particularly kinesthesia or position sense.Inferior Oblique Inferior Rectus 479 trochlear controls superior oblique 480 abducens controls lateral rectus 481 oculomotor controls the 4 remaining EOM Oculomotor 482 controls the size and response of pupil 483 normal pupil size is 2 – 3 mm 484 equal size of pupil: Isocoria 485 Unequal size of pupil: Anisocoria 486 Normal response: positive PERRLA CRANIAL NERVE V: TRIGEMINAL 487 largest cranial nerve 488 consists of ophthalmic. maxillary.
X: GLOSOPHARYNGEAL. contains the Organ of Corti (the true organ of hearing) 508 Let client repeat words uttered CRANIAL NERVE IX. Outer Ear 498 Pinna 499 Eardrum 2. VAGUS NERVE 509 Glosopharyngeal: controls taste. Inner Ear Malleus Incus Stapes 503Vestibule: Meinere's Disease 504 Cochlea 505 Mastoid Cells 506 Endolymph and Perilymph 507COCHLEA: controls hearing. Middle Ear 500Hammer 501Anvil 502Stirrup 3.Parts of the Ear 1. . posterior 1/3 of tongue 510 Vagus: controls gag reflex 511 Uvula should be midline and if not indicative of damage to cerebral hemisphere 512 Effects of vagal stimulation is PNS CRANIAL NERVE XI: SPINAL ACCESSORY 513 Innervates with sternocleidomastoid (neck) and trapezius (shoulder) CRANIAL NERVE XII: HYPOGLOSSAL 514 Controls the movement of tongue 515 Let client protrude tongue and it should be midline and if unable to do indicative of damage to cerebral hemisphere and/or has short frenulum.
Poor Skin turgor d. Anterior Pituitary Gland o o o o o called as adenohypophysis called as neurohypophysis secretes hormones oxytocin -promotes uterine contractions preventing administrate oxytocin immediately after delivery to prevent uterine atony. Pituitary Gland (Hypophysis Cerebri) o o o Located at base of brain particularly at sella turcica Master gland or master clock Controls all metabolic function of body PARTS OF THE PITUITARY GLAND 1. Adult: thirst b. Antidiuretic Hormone o o o Pitressin (Vasopressin) Function: prevents urination thereby conserving water Diabetes Insipidus/ Syndrome of Inappropriate Anti Diuretic Hormone DIABETES INSIPIDUS o Decrease production of anti diuretic hormone A. Predisposing Factor o o o o 1. initiates milk let down reflex with help of hormone prolactin 2. Signs and Symptoms . Polyuria 2. Posterior Pituitary Gland bleeding/ hemorrhage 2. Dry mucous membrane Related to pituitary surgery Trauma Inflammation Presence of tumor B.ENDOCRINE SYSTEM Overview of the structures and functions 1. Agitation c. Signs of dehydration a.
Nursing Management SIADH o hypersecretion of anti diuretic hormone A. Diagnostic Procedures 1. Predisposing Factors 1. Hypotension 5. Force fluids 2. Serum Sodium D.3. Water intoxication may lead to cerebral edema and lead to increase ICP – may lead to seizure activity initial sign of lung cancer is non productive cough non invasive procedure is chest x-ray 3. Edema c. Signs and Symptoms 1. Weakness and fatigue 4. Weight gain 2.015 – 1. If left untreated results to hypovolemic shock (sign is anuria) C. Urine Specific Gravity o o o 1. Related to presence of bronchogenic cancer o o pituitary gland. B.030 Ph 4 – 8 Increase resulting to hypernatremia 2. Administer medications as ordered a. Fluid retention a. Head injury 2. Weight loss 6. Hypertension b. Related to hyperplasia (increase size of organ brought about by increase of number of cells) of . Monitor strictly vital signs and intake and output 3. Prevent complilcations – HYPOVOLEMIC SHOCK is the most feared complication Normal value: 1. Pitressin (Vasopresin Tannate) – administered IM Z-tract 4.
Serum Sodium is decreased D. Monitor strictly vital signs. Lactogenic homone (Prolactin) . Diagnostic Procedure 1. intake and output and neuro check 4. Nursing Management 1. Weigh patient daily and assess for pitting edema 5. Osmotic diuretics (Mannitol) 3. Prevent complications ANTERIOR PITUITARY GLAND 516also called ADENOHYPOPHYSIS secretes 1. Administer medications as ordered a.C. Growth hormones (somatotropic hormone) 517 Promotes elongation of long bones 518Hyposecretion of GH among children results to Dwarfism 519Hypersecretion of GH results to Gigantism 520Hypersecretion of GH among adults results to Acromegaly (square face) 521Drug of choice: Ocreotide (Sandostatin) 2. Lead to blindness due to severe photophobia b. Prone to skin cancer o Hypersecretion of MSH results to Vitiligo 3. Adrenochorticotropic hormone (ACTH) o promotes development of adrenal cortex 4. Restrict fluid 2. Loop diuretics (Lasix) b. Urine specific gravity is increased 2. Provide meticulous skin care 6. Melanocyte Stimulating hormone o o o for skin pigmentation Hyposecretion of MSH results to Albinism Most feared complications of albinism a.
3 molecules of iodine (more potent) 2. Thyroxine) o o resorption. Thyrocalcitonin – antagonizes the effects of parathormone to promote calcium Signs and Symptoms HYPERTHYROIDISM o o o all are increase except weight and menstruation increase appetite but there is weight loss amenorrhea Signs and Symptoms . T3 (Tri iodothyronine) . Follicle stimulating hormone PINEAL GLAND o o o secretes melatonin inhibits LH secretion it controls/regulates circadian rhythm (body clock) THYROID GLAND o located anterior to the neck 3 Hormones secreted 1. T4 (tetra iodothyronine. Leutinizing hormone 6.o o o o promotes development of mammary gland with help of oxytocin it initiates milk let down reflex secretes estrogen secretes progesterone 5. HYPOTHYROIDISM o o o o o o all are decrease except weight and menstruation memory impairment there is loss of appetite but there is weight gain menorrhagia cold intolerance constipation T3 and T4 are metabolic or calorigenic hormone promotes cerebration (thinking) 3.
PASA (Aspirin) d. Goiter belt area a. Cobalt e. Mountainous regions 2. Nursing Management 1. Enforce complete bed rest 2. Administer medications as ordered a. Serum T3 and T4 – reveals normal or below normal 2. Phenylbutazones (NSAIDs) . strawberry. carrots. Lugol's Solution/SSKI ( Saturated Solution of Potassium Iodine) o color purple or violet and administered via straw to prevent staining of teeth.if goiter is caused by B. Predisposing Factors 1. Increase intake of goitrogenic foods o o o o contains pro-goitrin an anti thyroid agent that has no iodine. . sweet potato. Signs and Symptoms 1. 3. Diagnostic Procedures 1. Enlarged thyroid gland 2. Thyroid Scan – reveals enlarged thyroid gland.o exophthalmos THYROID DISORDERS SIMPLE GOITER o enlargement of thyroid gland due to iodine deficiency A. Lithium Carbonate c. cabbage. radish. Mild restlessness C. Serum Thyroid Stimulating Hormone (TSH) – is increased (confirmatory diagnostic test) D. places far from sea b. turnips. Anti Thyroid Agent – Prophylthiuracil (PTU) b. broccoli. all nuts soil erosion washes away iodine goitrogenic drugs a. Mild dysphagia 3.
inflammation 3. Signs and Symptoms . Assist in surgical procedure of subtotal thyroidectomy HYPOTHYROIDISM o o o hyposecretion of thyroid hormone adults: MYXEDEMA non pitting edema children: CRETINISM the only endocrine disorder that can lead to mental retardation A. Iron.o 4 Medications to be taken via straw: Lugol's. Monitor side effects o o o o o o o insomnia tachycardia and palpitations hypertension heat intolerance seaweeds seafood's like oyster. Iodine deficiency 4. Thyroid Hormones o o o Levothyroxine (Synthroid) Liothyronine (Cytomel) Thyroid Extracts Nursing Management when giving Thyroid Hormones 1. Nitrofurantoin (drug of choice for pyelonephritis) b. Iatrogenic Cause – disease caused by medical intervention such as surgery 2. Tetracycline. crabs. Monitor vital signs especially heart rate because drug causes tachycardia and palpitations 3. iodized salt. clams and lobster but not shrimps because it contains lesser amount of iodine. presence of tumor. Increase dietary intake of foods rich in iodine B. Predisposing Factors 1. Related to atrophy of thyroid gland due to trauma. Instruct client to take in the morning to prevent insomnia 2. Autoimmune (Hashimotos Disease) 4. best taken raw because it it is easily destroyed by heat 5.
Constipation (Late Signs) 1. Serum T3 and T4 is decreased 2. hypoventilation. Non pitting edema (Myxedema) 3. bradypnea. RAIU (Radio Active Iodine Uptake) is decreased D. hyponatremia. Force fluids 3. Weakness and fatigue 2. CNS changes o o o o lethargy memory impairment psychosis menorrhagia C. Nursing Management for Myxedema Coma 2. Dry skin 4. Cold intolerance 5. Decrease libido 5.(Early Signs) 1. Monitor strictly vital signs and intake and output to determine presence of o o Myxedema coma is a complication of hypothyroidism and an emergency case a severe form of hypothyroidism is characterized by severe hypotension. bradypnea. Administer isotonic fluid solution as ordered 4. Nursing Management 1. hypoglycemia. Brittleness of hair and nails 2. bradycardia. bradycardia. Decrease in all vital signs – hypotension. Loss of appetite but with weight gain which promotes lipolysis leading to atherosclerosis and MI 3. hypothermia 6. Diagnostic Procedures 1. hypothermia leading to pregressive stupor and coma. Serum Cholesterol is increased 3. Administer medications as ordered Assist in mechanical ventilation Administer thyroid hormones as ordered Force fluids . Hoarseness of voice 4.
narcotics. Provide client health teaching and discharge planning concerning a. All vital signs are increased 6. Predisposing Factors 1. hypovolemic shock hormonal replacement therapy for lifetime importance of follow up care increase in T3 and T4 Grave's Disease or Thyrotoxicosis developed by Robert Grave HYPERTHYROIDISM A. Avoid precipitating factors leading to myxedema coma o o o o o o o o o o stress infection cold intolerance use of anesthetics. CNS involvement a. Restlessness . Leothyronine c. Thyroid Extracts 5. Provide dietary intake that is low in calories 6. Irritability and agitation b. Signs and Symptoms 1. Heat intolerance 4. Provide meticulous skin care 8. Excessive iodine intake 3. and sedatives prevent complications (myxedema coma. Levothyroxine b.Thyroid Hormones a. Autoimmune – it involves release of long acting thyroid stimulator causing exopthalmus (protrusion of eyeballs) enopthalmus (late sign of dehydration among infants) 2. Provide comfortable and warm environment 7. Moist skin 3. Increase appetite (hyperphagia) but there is weight loss 2. Diarrhea 5. Related to hyperplasia (increase size) B.
Maintain side rails 7. POST OPERATIVELY. Prophythioracill (PTU) b. Assist in surgical procedures known as subtotal thyroidectomy ** Before thyroidectomy administer Lugol's Solution (SSKI) to decrease vascularity of the thyroid gland to prevent bleeding and hemorrhage. 4. Provide dietary intake that is increased in calories. Provide meticulous skin care 5. Insomnia e. Administer medications as ordered Anti Thyroid Agent a. Goiter 8. Tremors d. Amenorrhea C. Exopthalmus 9.reveals an enlarged thyroid gland D. RAIU (Radio Active Iodine Uptake) is increased 3. Watch out for signs of thyroid storm/ thyrotoxicosis . Hallucinations 7. Nursing Management 1. Methymazole (Tapazole) Side Effects of Agranulocytosis 522 increase lymphocytes and monocytes 523 fever and chills 524 sore throat (throat swab/culture) 525 leukocytosis (CBC) 3. Monitor strictly vital signs and intake and output 2. Thyroid Scan. Serum T3 and T4 is increased 2. 8.c. 1. Provide bilateral eye patch to prevent drying of the eyes. Diagnostic Procedures 1. Comfortable and cold environment 6.
Watch out for accidental Laryngeal damage which may lead to hoarseness of voice Nursing Management 533 encourage client to talk/speak immediately after operation and notify physician 4. Watch out for accidental removal of parathyroid gland that may lead to Hypocalcemia (tetany) Signs and Symptoms 530 (+) trousseau's sign 531 (+) chvostek sign 532 Watch out for arrhythmia. seizure give Calcium Gluconate IV slowly as ordered 3. Anti Pyretics b. Hormonal replacement therapy for lifetime 6. 5. Importance of follow up care PARATHYROID GLAND 535 A pair of small nodules behind the thyroid gland 536 Secretes parathormone .Agitation Hyperthermia 526 administer medications as ordered a. Beta-blockers 527 monitor strictly vital signs. 528 maintain side rails 529 offer TSB Tachycardia 2. input and output and neuro check. Signs of bleeding (feeling of fullness at incisional site) Nursing Management 534 Check the soiled dressings at the back or nape area.
positive trousseu's sign/carpopedal spasm f. arrhythmia 2. photophobia and cataract formation b. dysphagia e. Signs and Symptoms 1. seizure i. X-ray of long bones reveals a decrease in bone density 4. trauma B. laryngospasm/broncospasm h. paresthesia c.537 Promotes calcium reabsorption 538 Hypoparathyroidism 539 Hyperparathyroidism HYPOPARATHYROIDISM 540Decrease secretion of parathormone leading to hypocalcemia 541 Resulting to hyperphospatemia A. CT Scan – reveals degeneration of basal ganglia feared complications . Atrophy of parathyroid gland due to: a. agitation and memory impairment C.5 – 4. Serum Calcium is decreased (normal value: 8. tingling sensation b. Acute tetany a. Chronic tetany a. Predisposing Factors 1. Serum Phosphate is decreased (normal value: 2. Following subtotal thyroidectomy 2. Diagnostic Procedures 1. anorexia.5 – 11 mg/100 ml) 2. loss of tooth enamel c. tumor c. positive chvostek sign g. inflammation b.5 mg/100 ml) 3. nausea and vomiting d. numbness d.
Phosphate binder 542Aluminum Hydroxide Gel (Ampogel) 543 Side effect: constipation ANTACID A.D.C ▼ Aluminum Containing Antacids ▼ Aluminum Hydroxide Gel ▼ Side Effect: Constipation MAD ▼ Magnesium Containing Antacids ▼ Side Effect: Diarrhea 2. Administer medications as ordered such as: a. green turnips . anchovies b. Chronic Tetany Oral Calcium supplements Calcium Gluconate Calcium Lactate Calcium Carbonate c. salmon c. Acute Tetany Calcium Gluconate IV slowly b.A. Vitamin D (Cholecalciferol) for absorption of calcium CHOLECALCIFEROL ARE DERIVED FROM Drug (Calcitriol) Diet (Calcidiol) Sunlight d. Encourage increase intake of foods rich in calcium a. Nursing Management 1. Avoid precipitating stimulus such as glaring lights and noise 3.
Children: Ricketts b. Bone pain especially at back (bone fracture) 2. Diagnostic Procedures 1. Hormonal replacement therapy for lifetime 9. Serum Calcium is increased 2. nausea and vomiting 4. Prevent complications 8. Administer medications as ordered a. Importance of follow up care. HYPERTHYROIDISM 544 Decrease parathormone 545 Hypercalcemia: bone demineralization leading to bone fracture (calcium is stored 99% in bone and 1% blood) 546 Kidney stones A. Prepare trache set at bedside for presence of laryngo spasm 7. Over compensation of parathyroid gland due to vitamin D deficiency a. Signs and Symptoms 1. Hyperplasia of parathyroid gland 2. X-ray of long bones reveals bone demineralization D. Serum Phosphate is decreased 3. cool moist skin 3. renal cholic b. Adults: Osteomalacia B. Kidney stones a. Force fluids to prevent kidney stones 2. Morphine Sulfate (Demerol) 5. Institute seizure and safety precaution 5. Strain all the urine using gauze pad for stone analysis 3. Agitation and memory impairment C.4. Encourage increase intake of foods rich in phosphate but decrease in calcium . Provide warm sitz bath 4. 6. Nursing Management 1. Predisposing Factors 1. Encourage client to breathe using paper bag to produce mild respiratory acidosis result. Anorexia.
Assist/supervise in ambulation 8. Importance of follow up care ADRENAL GLAND 547 Located atop of each kidney 548 2 layers of adrenal gland a. Maintain side rails 9.function: controls glucose metabolism . Adrenal Cortex – outermost b.function: promotes sodium and water reabsorption and excretion of potassium . Assist in surgical procedure known as parathyroidectomy 11.secretes glucocortocoids (cortisol) .6. Adrenal Medulla – innermost (secretes catecholamines a power hormone) 2 Types of Catecholamines 549 Epinephrine and Norepinephrine (vasoconstrictor) 550 Pheochromocytoma (adrenal medulla) 551 Increase secretion of norepinephrine 552 Leading to hypertension which is resistant to pharmacological agents leading to CVA 553 Use beta-blockers ADRENAL CORTEX 3 Zones/Layers 1. Zona Glumerulosa .secretes mineralocorticoids (aldosterone) .Sex 3.Sugar 2. Hormonal replacement therapy for lifetime 12. Prevent complications (seizure and arrhythmia) 10.function: promotes secondary sex characteristics . Zona Reticularis .secretes traces of glucocorticoids and androgenic hormones . Zona Fasciculata . Provide acid ash in the diet to acidify urine and prevent bacterial growth 7.
Bronze like skin pigmentation C.arrhythmia 5. FBS is decreased (normal value: 80 – 100 mg/dl) 2. Plasma Cortisol is decreased 3. Nursing Management 1. fluid and electrolyte imbalance – Salt c..diarrhea .5 meq/L) D.agitation .Salt ADDISON'S DISEASE 554 Hyposecretion of adreno cortical hormone leading to a. Diagnostic Procedures 1.signs of dehydration . Predisposing Factors 1. Monitor strictly vital signs.weight loss 4. Signs and Symptoms 1. Decrease libido 6. Serum Sodium is decrease (normal value: 135 – 145 meq/L) 4. Hypoglycemia – TIRED 2.5 – 4. input and output to determine presence of Addisonian crisis (complication of addison's disease) 555Addisonian crisis results from acute exacerbation of addison's disease characterized . metabolic disturbance – Sugar b. Serum Potassium is increased (normal value: 3. Fungal infections B. Loss of pubic and axillary hair 7. Hyponatremia . Decrease tolerance to stress 3. deficiency of neuromuscular function – Salt/Sex A.hypotension . Related to atrophy of adrenal glands 2. Hyperkalemia .
moon face appearance 4. Monitor side effects a. Administer isotonic fluid solution as ordered 3. hypovolemic shock c. Taper dose (withdraw gradually from drug) 3.hypovolemic shock c. hyponatremia leading to progressive stupor and coma Nursing Management for Addisonian Crisis 1. protein but decrease in potassium 6. prevent complications . Provide dietary intake.administer steroids as ordered . Mineralocorticoids (Flourocortisone) 5.infection . hypertension b.sudden withdrawal to steroids b. Provide meticulous skin care 7. Provide client health teaching and discharge planning a. increase susceptibility to infection e.stress . increase calories. avoid precipitating factor leading to addisonian crisis leading to . Prednisone c. Instruct client to take 2/3 dose in the morning and 1/3 dose in the afternoon to mimic the normal diurnal rhythm 2. Hydrocortisone (Cortison) Nursing Management when giving steroids 1. Dexamethasone (Decadrone) b. Force fluids 4. severe hypotension b. edema c. .addisonian crisis . carbohydrates. Administer medications as ordered Corticosteroids a. hirsutism d. hormonal replacement for lifetime .by a.force fluids 2. Assist in mechanical ventilation.
U wave upon ECG (T wave hyperkalemia) 5. Serum Potassium is decreased C. thin extremities 4. moon face appearance and buffalo hump e. obese trunk f. Nursing Management . Hypernatremia a. importance of follow up care CUSHING SYNDROME 556 Hypersecretion of adenocortical hormones A. constipation c. Predisposing Factors 1 Related to hyperplasia of adrenal gland 2. Increase masculinity among females B. FBS is increased 2. Hypokalemia a. Plasma Cortisol is increased 3. pendulous abdomen g. Hirsutism 6. Diagnostic Procedures 1. edema c. hypertension b. Acne and striae 7. weakness and fatigue b.d. Increase susceptibility to infections 3. Easy bruising 8. weight gain d. Serum Sodium is increased 4.
Measure abdominal girth daily and notify physician 4. Monitor strictly vital signs and intake and output 2.Consist of acinar cells which secretes pancreatic juices that aids in digestion thus it is an exocrine gland . Diabetes Mellitus 3.Located behind the stomach . Prevent complications (DM) 8. Restrict sodium intake 5. Weigh patient daily and assess for pitting edema 3. protein and fat metabolism CLASSIFICATION OF DM Type 1 (IDDM) . Provide meticulous skin care 6.Obese over 40 years old . Importance of follow up care PANCREAS .Delta cells secretes somatostatin (function: antagonizes the effects of growth hormones) 3 Main Disorders of Pancreas 1.Beta cells secretes insulin (function: hypoglycemia) .Consist of islets of langerhans .Juvenile onset type .metabolic disorder characterized by non utilization of carbohydrates.Has alpha cells that secretes glucagons (function: hyperglycemia) .Mixed gland (exocrine and endocrine) . Hormonal replacement for lifetime 10. Pancreatic Tumor/Cancer 2.Adult onset .1. Administer medications as ordered a.Maturity onset type . Assist in surgical procedure (bilateral adrenoraphy) 9. Pancreatitis DIABETES MELLITUS .Brittle disease Type 2 (NIDDM) . Spinarolactone – potassium sparring diuretics 7.
A. Exercise E. Ketotic 5. Incidence Rate . Osmolar 3. Steroids 4. Anorexia. Polyphagia 4. Polyuria 3. Predisposing Factors 1. Related to viruses 3. Lasix b. Treatment 1. nausea and vomiting 7.90% of general population has type 2 DM B. Polydypsia 3. Hyper 2. Insulin therapy 2. Weight loss 6. Exercise E. Signs and Symptoms 1. Treatment 1. Glucosuria 5. Obesity – because obese persons lack insulin receptor binding sites C. Polyuria 2. Signs and Symptoms 1. Complications 1. Diabetic Ketoacidosis A. Incidence Rate . Increase susceptibility to infection 9. Complication 1. Blurring of vision 8. Predisposing Factors 1. Diet 3. Polydypsia 4. Coma . Hereditary (total destruction of pancreatic cells) 2. Non 4. Polyphagia 5. Related to carbon tetrachloride toxicity C.10% general population has type 1 DM B. Weight gain D. Delayed/poor wound healing D. Glucosuria 6. Usually asymptomatic 2. Drugs a. Oral Hypoglycemic agents 2. Diet 3.
MAIN FOODSTUFF 1.Ketones HYPERGLYCEMIA Increase osmotic diuresis Glycosuria Cellular starvation – weight loss Stimulates the appetite/satiety center (Hypothalamus) Polyphagia Polyuria Cellular dehydration Stimulates the thirst center (Hypothalamus) Polydypsia * Liver has glycogen that undergo glycogenesis/ glycogenolysis GLUCONEOGENESIS Formation of glucose from non-CHO sources Increase protein formation ▼ Negative Nitrogen balance ▼ Tissue wasting (Cachexia) ▼ INCREASE FAT CATABOLISM ▼ Free fatty acids Cholesterol ▼ Ketones ▼ .Cholesterol . Protein 3. Carbohydrates 2. Fats ANABOLISM CATABOLISM Glucose Amino Acids Fatty Acids Glycogen Nitrogen Free Fatty Acids .
Signs and Symptoms 1. Acetone breath odor .Acute complication of type 1 DM due to severe hyperglycemia leading to severe CNS depression A. Predisposing Factors 1. Polydypsia 3. nausea and vomiting 7. Hyperglycemia 2. Glucosuria 5. Infection B.Atherosclerosis ▼ Hypertension Respiration odor MI CVA Diabetic Keto Acidosis Acetone Breath Kussmaul's Death Diabetic Coma DIABETIC KETOACIDOSIS . Polyphagia 4. Anorexia. Polyuria 2. Blurring of vision 8. Weight loss 6. Stress – number one precipitating factor 3.
Assist in mechanical ventilation 2. Creatinine (normal value: . Kussmaul's Respiration (rapid shallow breathing) 10 CNS depression leading to coma C. Signs and Symptoms 1. Assist in mechanical ventilation 2. Monitor strictly vital signs.45 NaCl (hypotonic solutions) to counteract dehydration and shock 3. Administer 0. Administer medications as ordered a.for DKA use rapid acting insulin . Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 – 4 hours) b. Monitor strictly vital signs. Restlessness 3. BUN (normal value: 10 – 20) 3. Decrease LOC – diabetic coma B. Administer 0.8 – 1) 4. Antibiotics to prevent infection HYPER OSMOLAR NON KETOTIC COMA . Administer medications as ordered a.Non ketotic: absence of lypolysis (no ketones) A.45 NaCl (hypotonic solutions) to counteract dehydration and shock 3.Hyperosmolar: increase osmolarity (severe dehydration) . Hct (normal value: female 36 – 42. male 42 – 48) due to severe dehydration D. intake and output and blood sugar levels 4. Nursing Management 1. Diagnostic Procedures 1. Seizure activity 4. intake and output and blood sugar levels 4. Headache and dizziness 2. Nursing Management 1.9 NaCl followed by .9. Insulin therapy (regular acting insulin peak action of 2 – 4 hours) . FBS is increased 2. Sodium Bicarbonate to counteract acidosis c.9 NaCl followed by .
Sources of Insulin 1. Monitor for signs of local complications such as a. Animal sources . Intermediate Acting Insulin (cloudy) . No need to aspirate upon injection 7. When mixing 2 types of insulin aspirate first the clear insulin before cloudy to prevent contaminating the clear insulin and promote proper calibration.Ultra Lente . Rotate insulin injection sites to prevent development of lipodystrophy 8. Antibiotics to prevent infection INSULIN THERAPY A.Peak action is 8 – 16 hours 3. Types of Insulin 1. Human Sources . Administer insulin either 45o – 90o depending on amount of clients tissue deposit 6. Nursing Management for Insulin Injections 1.Frequently used type because it has less antigenicity property thus less allergic reaction 3. Artificially Compound Insulin B.Peak action is 2 – 4 hours 2.Derived from beef and pork 2. Most accessible route is abdomen 9. Administer at room temperature to prevent development of lipodystrophy (atrophy.Peak action is 16 – 24 hours C. Long Acting Insulin (cloudy) . Use gauge 25 – 26 needle 5. 10.Rarely used because it can cause severe allergic reaction . Rapid Acting Insulin (clear) .Non Protamine Hagedorn Insulin (NPH) .Regular acting insulin (IV only) .b. Allergic reactions . hypertrophy of subcutaneous tissues) 2. Place in refrigerator once opened 3. Avoid shaking insulin vial vigorously instead gently roll vial between palm to prevent formation of bubbles 4.
Administer insulin and OHA therapy as ordered 3.Stimulates the pancreas to secrete insulin A. Diabeta (Micronase) Nursing Management when giving OHA 1.for hypoglycemia (cold and clammy skin) give simple sugars .administer simple sugars . Chlorpropamide (Diabenase) b. Somogyis Phenomenon – rebound effect of insulin characterized by hypoglycemia to hyperglycemia ORAL HYPOGLYCEMIC AGENTS . First Generation Sulfonylureas a. Alpha Glycosylated Hemoglobin is increased C. polydypsia. Tolamazide (Tolinase) 2. Glipzide (Glucotrol) b.for hyperglycemia (dry and warm skin) 5. Instruct the client to avoid taking alcohol because it can lead to severe hypoglycemia reaction or Disulfiram (Antabuse) toxicity symptoms B. Classsification 1. Random Blood Sugar is increased 3. intake and output and blood sugar levels 4. Monitor strictly vital signs. Lipodystrophy c. protein 30% and fats 20% or offer alternative food substitutes 6. Instruct client to exercise best after meals when blood glucose is rising . Monitor for signs of hypoglycemia and hyperglycemia . Tolbutamide (Orinase) c. FBS is increased (3 consecutive times with signs or polyuria. Second Generation Sulfonylureas a. Provide nutritional intake of diabetic diet that includes: carbohydrates 50%. Oral glucose tolerance test is increased – most sensitive test 4. Diagnostic Procedures 1.b. polyphagia and glucosuria confirmatory for DM) 2. Nursing Management 1. Instruct the client to take it with meals to lessen GIT irritation and prevent hypoglycemia 2. Monitor for peak action of insulin and OHA and notify physician 2.
Blindness KIDNEY -RECURRENT PYELONEPHRITIS . instruct client to avoid walking barefooted b. Veins III.diarrhea/constipation . Instruct client to have an annual eye and kidney exam 10. Blood Forming Plasma CHON (formed in liver) 1. Assist in surgical procedure HEMATOLOGICAL SYSTEM I. Prothrombin and Fibrinogen 1. Lymph Nodes 6. assist in surgical wound debriment (give analgesics 15 – 30 mins prior) 9. encourage client to apply lanolin lotion to prevent skin breakdown e. Arteries 2. MI. Spleen 4. CVA) b. Monitor for signs of DKA and HONKC 11. Institute foot care management a. HPN and DM major cause of renal failure d. Gangrene formation e. Lymphoid Organ 5. instruct client to avoid wearing constrictive garments d. instruct client to cut toenails straight c. Atherosclerosis (HPN.sexual impotence 8.Largest and numerous plasma CHON .peripheral neuropathy . Blood Vessels 1. Bone Marrow ALBUMIN .Maintains osmotic pressure preventing edema . Albumin 2. Shock due to dehydration .7.Renal failure c. Blood Organs 55% Plasma Serum 45% Formed II. Globulins 3. Liver 3. Microangiopathy (affects small minute blood vessels of eyes and kidneys) EYES -PREMATURE CATARACT . Monitor signs for complications a.
iron c. vitamin c d.normal value: 5000 – 10000/mm3 A. WBC (LEUKOCYTES) .biconcave discs . vitamin b12 (cyanocobalamin) e.only unnucleated cell . folic acid b.GLOBULINS . vitamin b6 (pyridoxine) f.60 – 70% of WBC .hemoglobin: normal value female 12 – 14 gms% male 14 – 16 gms% .Alpha globulins . prothrombin and fibrinogen clotting factors FORMED ELEMENTS 1.consist of molecules of hgb (red pigment) bilirubin (yellow pigment) biliverdin (green pigment) hemosiderin (golden brown pigment) .responsible for the release of chemical mediation for inflammation . Polymorpho Neutrophils .substances needed for maturation of RBC a.transports and carries oxygen to tissues . RBC (ERYTHROCYTES) .for parasite infections . anti-bodies and immunoglobulins b. Granulocytes 1.transport steroids.normal value: 4 – 6 million/mm3 .Normal life span of RBC is 80 – 120 days and is killed in red pulp of spleen 2.hematocrit red cell percentage in wholeblood . Polymorphonuclear Basophils . bilirubin and hormones .Gamma globulins a.normal value: female 36 – 42% male 42 – 48% .involved in short term phagocytosis for acute inflammation 2.Beta globulins – iron and copper . intrinsic factor .
anti viral and anti tumor property HIV .western blot opportunistic .Consist of immature or baby platelets or megakaryocytes which is the target of dengue virus .ELISA .bone marrow .000/mm3 . Monocytes .involved in long term phagocytosis for chronic inflammation 2.thymus for immunity Natural killer cell . Petechiae 2. Kaposi's Sarcoma 2.for allergic reaction B. Polymorphonuclear Eosinophils .Normal value: 150.000 – 450.macrophage in blood . Echhymosis 3. Platelets (THROMBOCYTES) .Normal life span of platelet is 9 – 12 days Signs of Platelet Dysfunction 1. Non Granulocytes 1.6 months window period .drug of choice AZT (Zidon Retrovir) 2 Common fungal opportunistic infection in AIDS 1. Pneumocystis Carinii Pneumonia 3.Promotes hemostasis (prevention of blood loss) . Oozing of blood from venipunctured site BLOOD DISORDERS Iron Deficiency Anemia .largest WBC .6 months – 5 years incubation period . Lymphocytes B-cell T-cell .3.
Chronic diarrhea b. Common among tropical zones 3. Chronic blood loss due to trauma a.Stomatitis . Predisposing Factors 1. Subtotal gastrectomy 4. Incidence Rate 1. Atropic Glossitis (inflammation of tongue) . Iron is decreased 5. fresh blood per rectum is called hematochezia 2.Dysphagia 9. RBC is decreased 2. Heavy menstruation b.A chronic microcytic anemia resulting from inadequate absorption of iron leading to hypoxemic tissue injury A. High cereal intake with low animal protein digestion d. Palpitations 7. Common among developed countries 2. Reticulocyte is decreased PLUMBER VINSON'S SYNDROME . Hct is deceased 4. Dyspnea 6. Related to malabsorption syndrome c. Signs and Symptoms 1. Brittleness of hair and spoon shape nails (koilonychias) 8. PICA (abnormal appetite or craving for non edible foods D. Related to poor nutrition B. Pallor and cold sensitivity 5. Usually asymptomatic 2. Related to GIT bleeding resulting to hematemesis and melena (sign for upper GIT bleeding) c. Inadequate intake of iron due to a. Diagnostic Procedures 1. Headache and dizziness 4.. Weakness and fatigue (initial signs) 3. Hgb is decreased 3. Common among women 15 – 35 years old 4. Related to improper cooking of foods C.
Anorexia b. Melena 5. stool and GIT 2.6. Nuts 4. Legumes g. IV) b. Sorbitex (IM) Nursing Management when giving parenteral iron preparations . Ferrous Sulfate b. Nausea and vomiting c. Dried fruits f. Monitor for signs of bleeding of all hema test including urinw. Egg (yolk) c. Ferritin is decreased E. Administer medications as ordered Oral Iron Preparations a. Administer with Vitamin C or orange juice for absorption 4. Diarrhea/constipation e. Ferrous Fumarate c. Instruct client to take foods rich in iron a. Instruct the client to avoid taking tea and coffee because it contains tannates which impairs iron absorption 5. When diluting it in liquid iron preparations administer with straw to prevent staining of teeth Medications administered via straw . Sweet potatoes e. Instruct client to take with meals to lessen GIT irritation 2.Nitrofurantoin (Macrodentin) 3. Raisin d. Iron Dextran (IM.Lugol's solution . Nursing Management 1.Iron . Monitor and inform client of side effects a. Abdominal pain d. If client cant tolerate/no compliance administer parenteral iron preparation a.300 mg/day Nursing Management when taking oral iron preparations 1. Enforce CBR so as not to over tire client 3. Organ meat b.Tetracycline . Ferrous Gluconate .
Strictly vegetarian diet STOMACH ▼ Pareital cells/ Argentaffin or Oxyntic cells Produces intrinsic factors acid ▼ Promotes reabsorption of Vit B12 ▼ Promotes maturation of RBC B. Headache and dizziness ▼ Aids in digestion Secretes hydrochloric . Subtotal gastrectomy 2. Pain at injection site b. Avoid massaging the injection site instead encourage to ambulate to facilitate absorption 3. Autoimmune 5. Pruritus/orticaria g. Monitor side effects a. Predisposing Factors 1. Lymphadenopathy d. Signs and Symptoms 1. Administer Z tract technique to prevent discomfort. Fever and chills e. Skin rashes f. Weakness and fatigue 2. Hypotension (anaphylactic shock) PERNICIOUS ANEMIA . discoloration and leakage to tissues 2.1. Localized abscess c.Chronic anemia characterized by a deficiency of intrinsic factor leading to hypochlorhydria (decrease hydrochloric acid secretion) A. Hereditary factors 3. Inflammatory disorders of the ileum 4.
tingling sensation b. protein. positive to Romberg's test – damage to cerebellum resulting to ataxia e.No side effects 3.Site of injection for Vitamin B12 is dorsogluteal and ventrogluteal . Dyspnea and palpitations as part of compensation 5. GIT changes that includes a. Pallor and cold sensitivity 4. indigestion/dyspepsia d. Provide a dietary intake that is high in carbohydrates.3. Enforce CBR 2. mouth sore b. result to psychosis C. Diagnostic Procedure Schilling's Test – reveals inadequate/decrease absorption of Vitamin B12 D. numbness c. paresthesia d. CNS changes a. vitamin c and iron 4. Instruct client to avoid irritating mouth washes instead use soft bristled toothbrush 5. Avoid heat application to prevent burns APLASTIC ANEMIA . weight loss e. jaundice 6. Administer Vitamin B12 injections at monthly intervals for lifetime as ordered . Nursing Management 1.Never given orally because there is possibility of developing tolerance .Stem cell disorder leading to bone marrow depression leading to pancytopenia PANCYTOPENIA Decrease RBC Platelet Decrease WBC Decrease . red beefy tongue c.
Weakness and fatigue b. Diagnostic Procedures 1. Signs and Symptoms 1.(anemia) (thrombocytopenia) A. Pallor and cold sensitivity d. Immunologic injury 4. Headache and dizziness c. Chloramphenicol (Sulfonamides) Chemotherapeutic Agents a. Nursing Management 1. Methotrexate (Alkylating Agent) b. Bone marrow biopsy/aspiration (site is the posterior iliac crest) – reveals fat necrosis in bone marrow D. Oozing of blood from venipunctured sites C. Anemia a. Drugs Broad Spectrum Antibiotics a. Ecchymosis c. Petechiae (multiple petechiae is called purpura) b. Thrombocytopenia (leucopenia) a. CBC reveals pancytopenia 2. Removal of underlying cause 2. Predisposing Factors 1. Dyspnea and palpitations 2. Institute BT as ordered . Vincristine (Plant Alkaloid) c. Increase susceptibility to infection 3. Chemicals (Benzine and its derivatives) 2. Leukopenia a. Related to irradiation/exposure to x-ray 3. Nitrogen Mustard (Antimetabolite) Phenylbutazones (NSAIDS) B.
Massive trauma 4. Administer oxygen inhalation 4. Signs and Symptoms 1.3. Ecchymosis 3. Septecemia 6. Oliguria (late sign) . cough 7. Massive burns 3. Monitor for signs of infection a. Neoplasia (new growth of tissue) 7. fever b. Administer medications as ordered a. Anaphylaxis 5. Enforce CBR 5. Hemoptysis 6. Immunosuppressants Anti Lymphocyte Globulin ▼ Given via central venous catheter ▼ Given 6 days to 3 weeks to achieve Maximum therapeutic effect of drug DISSEMINATED INTRAVASCULAR COAGULATION Acute hemorrhagic syndrome characterized by wide spread bleeding and thrombosis due to a deficiency of prothrombin and fibrinogen A. Oozing of blood from punctured sites 4. Pregnancy B. venipunctured sites 8 Instead provide heparin lock 9. Avoid IM. Petechiae (widespread and systemic) eye. subcutaneous. Institute reverse isolation 6. Instruct client to use electric razor when shaving 10. Related to rapid blood transfusion 2. Corticosteroids – caused by immunologic injury b. lungs and lower extremities 2. Predisposing Factors 1.
Institute NGT decompression by performing gastric lavage by using ice or cold saline solution of 500 – 1000 ml 8. Administer isotonic fluid solution as ordered 3. Prevent bleeding if there is platelet deficiency Principles of blood transfusion . Prevent infection in there is a decrease in WBC 4. Pitressin/ Vasopresin to conserve fluids c. Anuria – late sign BLOOD TRANSFUSION Goals/Objectives 1. Monitor NGT output 9. Opthamoscopic exam reveals sub retinal hemorrhages D. Monitor for signs of bleeding of all hema test including stool and GIT 2. Administer oxygen inhalation 4. Vitamin K b. Diagnostic Procedures 1. Prevent complication a. Heparin/Coumadin is ineffective 6. Force fluids 5. CBC reveals decreased platelets 2. Stool occult blood positive 3. Administer medications as ordered a. Provide heparin lock 7. Hypovolemic shock b. Increase the oxygen carrying capacity of blood 3. ABG analysis reveals metabolic acidosis 4. Replace circulating blood volume 2. Nursing Management 1.C.
Isotonic solution (0. Allergic reaction c. Proper refrigeration . BT should be completed less than 4 hours because blood that is exposed at room temperature more than 2 hours causes blood deterioration that can lead to BACTERIAL CONTAMINATION 7. Regulate BT 10 – 15 gtts/min or KVO rate or equivalent to 100 cc/hr to prevent circulatory overload 9. Expiration date d.9 NaCl/plain NSS) to prevent hemolysis 4. during and after BT especially every 15 minutes for first hour because majority of transfusion reaction occurs during this period a. Pyrogenic reaction d. .Expiration of packed RBC is 3 – 6 days . Check the blood unit for bubbles cloudiness. Avoid mixing or administering drugs at BT line to prevent HEMOLYSIS 8.1. Instruct another RN to re check the following a. Monitor strictly vital signs before. Type AB – universal recipient c. Gauge 18 – 19 needle c. Proper typing and cross matching a. Air embolism f. Blood typing and cross matching c.Never warm blood as it may destroy vital factors in blood. Aseptically assemble all materials needed for BT a.Warming is only done during emergency situation and if you have the warming device . 6. Client name b. 85% of population is RH positive 3. Serial number 5. Hemolytic reaction b. Filter set b. Type O – universal donor b. Circulatory overload e.Emergency rapid BT is given after 30 minutes and let natural room temperature warm the blood. sediments and darkness in color because it indicates bacterial contamination .Expiration of platelet is 3 – 5 days 2. Thrombocytopenia .
Send the blood unit to blood bank for re examination 6. Notify physician 3. Flush with plain NSS 4. Administer isotonic fluid solution to prevent shock and acute tubular necrosis 5. Stop BT 2. Urine is color red/ portwine urine Nursing Management 1. Diarrhea/Constipation 4. Flushed skin 6. Hyperkalemia (caused by expired blood) Signs and Symptoms of Hemolytic reaction 1. Skin rashes 5. Monitor vital signs and intake and output SIGNS AND SYMPTOMS OF ALLERGIC REACTION 1. Obtain urine and blood sample and send to laboratory for re examination 7. Laryngospasm and Broncospasm Nursing Management .g. Broncial wheezing 4. Urticaria 6. Hypotension 5. Fever 2. Lumbasternal/ Flank pain 7. Dyspnea 3. Headache and dizziness 2. Dyspnea 3. Cytrate intoxication h.
Antibiotic 5. Tachycardia 4. Notify physician 3. Diaphoresis 6. Stop BT 2. Dyspnea Nursing Management 1. Administer medications as ordered a. Obtain urine and blood sample and send to laboratory for re examination 7.if positive to hypotension. Fever and chills 2. Send the blood unit to blood bank for re examination 6. Headache 3. Flush with plain NSS 4. Send the blood unit to blood bank for re examination 6. Exertional discomfort Nursing Management 1. Monitor vital signs and intake and output 8. Anti Histamine (Benadryl) . Stop BT 2. Dyspnea 3. Stop BT 2. Notify physician . Rales/Crackles upon auscultation 4. Render TSB SIGNS AND SYMPTOMS OF CIRCULATORY REACTION 1. Palpitations 5. Flush with plain NSS 4. Administer medications as ordered a. Notify physician 3. anaphylactic shock treat with Epinephrine 5. Obtain urine and blood sample and send to laboratory for re examination 7.1. Monitor vital signs and intake and output SIGNS AND SYMPTOMS PYROGENIC REACTIONS 1. Orthopnea 2. Antipyretic b.
Right atrium has decreased pressure which is 60 – 80 mmHg C.3.In order to propel blood to the systemic circulation . Visceral – inner layer . pericarditis.Muscular pumping organ of the body. Atria 2.Weighs approximately 300 – 400 grams . Atrioventricular Valves – guards opening between a.Prevent pericardial friction rub . Myocardium – middle layer 3. Valves . .Common among MI. Endocardium – inner layer . Chambers of the Heart 1. Loop diuretic (Lasix) CARDIOVASCULAR SYSTEM OVERVIEW OF THE STRUCTURE AND FUNCTIONS OF THE HEART HEART .Located on the left mediastinum . Lower Chamber (contracting or pumping) a. Parietal – outer layer b. Upper Chamber (connecting or receiving) a. Cardiac tamponade A.Myocarditis can lead to cardiogenic shock and rheumatic heart disease B.In between is the pericardial fluid which is 10 – 20 cc . tricuspid valve . Administer medications as ordered a.To promote unidimensional flow or prevent backflow 1.Resemble like a close fist . Layers of Heart 1. Epicardium – outer layer 2.Covered by a serous membrane called the pericardium 2 layers of pericardium a.Left ventricle has increased pressure which is 120 – 180 mmHg . Ventricles .
aortic .Located at the walls of the ventricles for ventricular contraction . Sino – Atrial Node (SA or Keith Flack Node) . Semi – lunar Valves a. Bundle of His .Left Main Bundle of His . Left Main Coronary Artery . pulmonic b. Atrio – Ventricular Node (AV or Tawara Node) .Acts as primary pacemaker of the heart . Right Main Coronary Artery 2.b.Right Main Bundle of His .Located at the interventricular septum 4. S4 – atrial gallop usually seen in Myocardial Infarction and Hypertension D.08 milliseconds to allow ventricular filling 3. Cardiac Conduction System 1.Supplies the myocardium E.Closure of AV valves give rise to first heart sound (S1 "lub") 2.Delay of electrical impulse for about . Purkinje Fibers .Located at the junction of superior vena cava and right atrium . mitral valve . S3 – ventricular gallop usually seen in Left Congestive Heart Failure 2.Located at the inter atrial septum . Coronary Arteries .Closure of SV valve give rise to second heart sound (S2 "dub") Extra Heart Sounds 1.Arises from base of the aorta Types of Coronary Arteries 1.Initiates electrical impulse of 60 – 100 bpm 2.
Myocardial Injury .Atherosclerosis . Peak T wave – Hyperkalemia 3.PURKINJE FIBERS . Positive U wave . Widening of QRS complexes – Arrythmia CARDIAC DISORDERS Coronary Arterial Disease/ Ischemic Heart Disease Stages of Development of Coronary Artery Disease 1.P WAVE (atrial depolarization) contraction . ST segment depression – Angina Pectoris 4. ST segment elevation – Myocardial Infarction 5.QRS WAVE (ventricular depolarization) .T WAVE (ventricular repolarization) Insert pacemaker if there is complete heart block Most common pacemaker is the metal pacemaker and lasts up to 2 – 5 years ABNORMAL ECG TRACING 1. T wave inversion – Myocardial Infarction 6.Hypokalemia 2.
Smoking 4. Diet – increased saturated fats 10. Increase survival rate . Myocardial Ischemia – Angina Pectoris 3.calcium and protein deposits .Done to single occluded vessels . Chest pain 2.tunica intima A. Obesity 5. coughing exercise and use of incentive ARTERIOSCLEROSIS . Hyperlipidemia 6. Type A personality B. Duaphoresis C. To prevent angina 3.tunica media . Sex – male 2. Race – black 3. Diabetes Mellitus 8. Treatment Percutaneous Transluminal Coronary Angioplasty Objectives of PTCA 1. Revascularize myocardium 2. Myocardial Necrosis – Myocardial Infarction ATHEROSCLEROSIS ATHEROSCLEROSIS .If there is 2 or more occluded blood vessels CABG is done Coronary Arterial Bypass And Graft Surgery 3 Complications of CABG 1.lipid or fat deposits .narrowing of artery .hardening of artery . Tachycardia 4. Predisposing Factors 1. sedentary lifestyle 7. Hypothyroidism 9. Palpitations 5. Pneumonia – encourage to perform deep breathing. Dyspnea 3. Signs and Symptoms 1.2.
sedentary lifestyle 7. Smoking 4. Predisposing Factors 1. Excessive intake of foods rich in saturated fats – skimmed milk C. axilla and jaw muscles. Shock 3. anxiety. Thrombophlebitis ANGINA PECTORIS (SYNDROME) Clinical syndrome characterized by paroxysmal chest pain that is usually relieved by rest or nitroglycerine due to temporary myocardial ischemia A. Hypothyroidism 9. Diet – increased saturated fats 10. Diagnostic Procedure . Precipitating Factors 4 E's of Angina Pectoris 1. Levine's Sign – initial sign that shows the hand clutching the chest 2. excitement 4. Dyspnea 4. Type A personality B. Sex – male 2. Signs and Symptoms 1. Chest pain characterized by sharp stabbing pain located at sub sterna usually radiates from back. Diaphoresis D. Obesity 5.spirometer 2. Exposure to cold environment 3. Race – black 3. arms. Palpitations 6. Hyperlipidemia 6. shoulder. Extreme emotional response – fear. usually relieved by rest or taking nitroglycerine 3. Excessive physical exertion – heavy exercises 2. Diabetes Mellitus 8. Tachycardia 5.
Serum cholesterol and uric acid is increased E. Stress test – treadmill test.Give first dose of NTG (sublingual) 3 – 5 minutes . but in large doses will act as vasodilator .5 minutes .NIfedipine .Enalapril d. Nursing Management 1. Calcium Antagonist . avoid moisture and exposure to sunlight as it may inactivate the drug 558 Monitor side effects o o Orthostatic hypotension Transient headache and dizziness 559 Instruct the client to rise slowly from sitting position 560 Assist or supervise in ambulation 561When giving nitrol or transdermal patch o o o Avoid placing near hairy areas as it may decrease drug absorption Avoid rotating transdermal patches as it may decrease drug absorption Avoid placing near microwave ovens or duting defibrillation as it may lead to burns (most important thing to remember) b. ACE Inhibitors . ECG tracing reveals ST segment depression 3. History taking and physical exam 2. Beta-blockers . Nitroglycerine (NTG) – when given in small doses will act as venodilator. reveal abnormal ECG 4.Give third and last dose of NTG if pain still persist at 3 – 5 minutes interval Nursing Management when giving NTG 557 Keep the drug in a dry place. Enforce complete bed rest 2.Propanolol .side effects PNS .Give second dose of NTG if pain persist after giving first dose with interval of 3 .1.Not given to COPD cases because it causes bronchospasm c. Administer medications as ordered a.
Hyperlipidemia 6. necrosis and scarring. Diet – increased saturated fats 10. Transmural Myocardial Infarction – most dangerous type characterized by occlusion of both right and left coronary artery 2. Diabetes Mellitus 8. Place client on semi fowlers position 5. Subendocardial Myocardial Infarction – characterized by occlusion of either right or left coronary artery B. Predisposing Factors 1. Provide client health teachings and discharge planning a.3. Sex – male 2. The importance of follow up care MYOCARDIAL INFARCTION Heart attack Terminal stage of coronary artery disease characterized by malocclusion. Type A personality . Instruct client to take medication before indulging into physical exertion to achieve the maximum therapeutic effect of drug d. intake and output and ECG tracing 6. sedentary lifestyle 7. Administer oxygen inhalation 4. Prevent complication (myocardial infarction) c. The Most Critical Period Following Diagnosis of Myocardial Infarction ** 6 – 8 hours because majority of death occurs due to arrhythmia leading to PVC's C. Smoking 4. Monitor strictly vital signs. Provide decrease saturated fats sodium and caffeine 7. Types 1. Race – black 3. A. Obesity 5. Hypothyroidism 9. Avoidance of 4 E's b.
Increase in blood pressure (initial sign) 4. Pericardial friction rub b. Hyperthermia 5. Cardiac Enzymes a. Mild restlessness and apprehension 7. Troponin Test – is increased 3. Signs and Symptoms 1. jaw and abdominal muscles (abdominal ischemia) . shoulder. Occasional findings a. CPK – MB . Ashen skin 6. Nursing Management Goal: Decrease myocardial oxygen demand . viselike pain located at substernal and rarely in precordial . 12 – 24 hours b.Excruciating visceral. Serum Cholesterol and uric acid are both increased 5. axilla. arms. Diagnostic Procedure 1. Widening of QRS complexes indicates that there is arrhythmia in MI 4. T wave inversion c. S4 or atrial gallop E. Chest pain . Rales/Crackles upon auscultation d. CBC – increased WBC F. SGPT – Serum glutamic pyruvate transaminase is increased d.Creatinine phosphokinase is increased . Split S1 and S2 c. ST segment elevation b.Heart only.Not usually relieved by rest or by nitroglycerine 2. LDH – Lactic acid dehydroginase is increased c.Usually radiates from back. SGOT – Serum glutamic oxal-acetic transaminase is increased 2. Dyspnea 3. ECG tracing reveals a.D.
Thrombolytics/ Fibrinolytic Agents . Enforce CBR without bathroom privileges a. Calcium Antagonist f.Side Effects of Naloxone Toxicity is tremors 2.Side Effects: respiratory depression .Brutylium c.Side Effects: confusion and dizziness . Monitor strictly vital signs.Administer narcotic analgesic/morphine sulfate .Lidocaine (Xylocane .Antidote: Narcan/Naloxone . sodium and caffeine 8. Administer medication as ordered a. Place client on semi fowlers position 6. Encourage client to take 20 – 30 cc/week of wine.Urokinase . Isodil) sublingual b. Using bedside commode 4.Side Effects: chest pain . Provide a general liquid to soft diet that is low in saturated fats. Vasodilators . pruritus .Nitroglycerine .Monitor for bleeding time .TIPAF (tissue plasminogen activating factor) . whisky and brandy to induce vasodilation 9.ISD (Isosorbide Dinitrate. intake and output and ECG tracing 7. Beta-blockers d. Instruct client to avoid forms of valsalva maneuver 5.1. Administer oxygen low inflow to prevent respiratory arrest at 2 – 3 L/min 3. ACE Inhibitors e.Side Effects: allergic reaction.Streptokinase . Decrease myocardial workload (rest heart) . Anti Arrythmic Agents .
client is resistant to pharmacological agents. Stroke/CVA f. Strict compliance to mediation and importance of follow up care .arrhythmia (caused by premature ventricular contraction) b.Anti thrombotic effect .instruct client to assume a non weight bearing position . Anti Coagulant .000 – 450. Provide client health teaching and discharge planning concerning a. Anti Platelet .Side Effects of Aspirin 562 Tinnitus 563 Heartburn 564 Indigestion/Dyspepsia .g. Left Congestive Heart Failure d.Antidote: protamine sulfate .Heparin (check for partial thrombin time) . administer 150.000 units of streptokinase as ordered g.client can resume sexual intercourse if can climb staircase .dietary modification h. Post MI Syndrome/Dressler's Syndrome . post CABG and instruct to .Contraindication 565 Dengue 566 Peptic Ulcer Disease 567 Unknown cause of headache 10. Thrombophlebitis .homan's sign e.Coumadin/ Warfarin Sodium (check for prothrombin time) .late sign is oliguria c.make sex as an appetizer rather than dessert .Antidote: Vitamin K h. Avoidance of modifiable risk factors .PASA (Aspirin) . Cardiogenic shock . Resumption of ADL particularly sexual intercourse is 4 – 6 weeks post cardiac rehab.
S3 – ventricular gallop C. Aging 2. Cyanosis 7. Rales/Crackles 8. PAP (pulmonary arterial pressure) – measures pressure in right ventricle or cardiac status .ASO Titer (Anti streptolysin O titer) .Common among children . Predisposing Factors 1. Diagnostic Procedure 1. A beta-hemolytic streptococcus . Productive cough with blood tinged sputum 5. Frothy salivation 6. There is anorexia and generalized body malaise 12. Orthopnea – use 2 – 3 pillows when sleeping or place in high fowlers 4.Penicillin . Myocardial Infarction 3. LEFT SIDED HEART FAILURE A. 90% is mitral valve stenosis due to a. Aortic valve stenosis B. Ischemic heart disease 4. Dyspnea 2. Bronchial wheezing 9. PMI is displaced laterally due to cardiomegaly 11. RHD – inflammation of mitral valve due to invasion of Grp. Chest x-ray – reveals cardiomegaly 2.Aspirin b. Pulsus Alternans – weak pulse followed by strong bounding pulse 10.Formation of aschoff bodies in the mitral valve .CONGESTIVE HEART FAILURE Inability of the heart to pump blood towards systemic circulation Types of Heart Failure 1. Hypertension 5. Paroxysmal nocturnal dyspnea – client is awakened at night due to difficulty of breathing 3. Signs and Symptoms 1.
If CVP is more than 10 cm of water hypervolemic shock . RIGHT SIDED HEART FAILURE A. Predisposing Factors 1. ABG – reveals PO2 is decreased (hypoxemia). Pulmonary embolism 3. Ecocardiography – enlarged heart chamber (cardiomyopathy).CVP fluid status measure . Ascites 4.Do the fluid challenge (increase IV flow rate) . Central venous pressure (CVP) . Hepatosplenomegaly 6.Upon insertion place client in trendelendberg position to promote ventricular filling and . Esophageal varices C. Tricuspid valve stenosis 2. Pruritus 8. Weight gain 5. Pitting edema 3. Left sided heart failure B. Signs and Symptoms (venous congestion) 1. PCO2 is increased (respiratory acidosis) 2.If CVP is less than 4 cm of water hypovolemic shock .PCWP (pulmonary capillary wedge pressure) – measures end systolic and dyastolic pressure 568 both are increased 569done by cardiac catheterization (insertion of swan ganz catheter) 3.Measure pressure in right atrium (4 – 10 cm of water) .When reading CVP patient should be flat on bed . Related to COPD 4. Neck/jugular vein distension 2. Jaundice 7. dependent on extent of heart failure 4. Pulmonic valve stenosis 5. Chest x-ray – reveals cardiomegaly 2. Anorexia 9. Diagnostic Procedures 1.Administer loop diuretics as ordered .
Thrombophlebitis .Right ventricular hypertrophy . Vasodilators . Administer medications as ordered a. cholesterol and caffeine 8. Liver enzymes – SGPT and SGOT is increased D. Provide meticulous skin care 9.Shock . 3 – 4 L/min. intake and output and ECG tracing 6. rotated clockwise every 15 minutes to promote decrease venous return 10.Increase force of cardiac contraction .MI .If heart rate is decreased do not give b.Nitroglycerine f. Assist in bloodless phlebotomy – rotating tourniquet.Lasix (Furosemide) c. High fowlers position 5. Administer oxygen inhalation with high inflow.Arrythmia . Ecocardiography – reveals enlarged heart chambers (cardiomyopathy 4. Nursing Management Goal: increase cardiac contractility thereby increasing cardiac output (3 – 6 L/min) 1. Prevent complications . Monitor strictly vital signs. Anti Arrhythmic .Digoxin (Lanoxin) . Provide a dietary intake of low sodium. Bronchodilators d. Narcotic analgesics . delivered via nasal cannula 4.Morphine Sulfate e. Cardiac glycosides .prevent pulmonary embolism 3. Enforce CBR 2. Provide client health teaching and discharge planning a. Loop Diuretics .Lidocaine (Xylocane) 3. Measure abdominal girth daily and notify physician 7.
Doppler UTZ – decrease blood flow to the affected extremity 3. Smoking B. Predisposing Factors 1. cyanosis then rubor) 3. Thrombophlebitis (deep vein thrombosis) THROMBOANGITIS OBLITERANS Acute inflammatory disorder usually affecting the small medium sized arteries and veins of the lower extremities A. walking 3 – 4 times a day . Strict compliance to medications PERIPHERAL VASCULAR DISORDER Arterial Ulcer I. Decreased peripheral pulses 4. Cold sensitivity and changes in skin color (pallor. Encourage a slow progressive physical activity a. Ulceration 6. Angiography – reveals site and extent of malocclusion D. Oscillometry – decrease in peripheral pulses 2. Nursing Management 1. Trophic changes 5. Signs and Symptoms 1.b. Dietary modification c. Diagnostic Procedures 1. Varicose Veins 2. High risk groups – men 30 years old and above 2. Thrombo Angitis Obliterans 570 Burger's Disease 571 Reynaud's Disease Venous Ulcer 1. Gangrene formation C. Intermittent claudication – leg pain upon walking 2.
Anti coagulants 3. Intermittent claudication – leg pain upon walking 2. Signs and Symptoms 1. Excessive typing c. cyanosis then rubor) 3. Assist in surgical procedure – bellow knee amputation REYNAUD'S DISEASE Disorder characterized by acute episodes of arterial spasm involving the fingers or digits of the hands A. Piano playing b. Smoking 3. Predisposing Factors 1. Analgesics b. Trophic changes 4. Ulceration 5. Direct hand trauma a.b. Gangrene formation C. Instruct client to avoid smoking and exposure to cold environment 5. Administer medications as ordered a. Diagnostic Procedures 1. Angiography – reveals site and extent of malocclusion . Cold sensitivity and changes in skin color (pallor. Collagen diseases a. Doppler UTZ – decrease blood flow to the affected extremity 2. out of bed 3 – 4 times a day 2. Rheumatoid Arthritis 4. Operating chainsaw B. High risk group – female 40 years old and above 2. SLE (butterfly rash) b. Institute foot care management 4. Vasodilators c.
Predisposing Factors 1. Encourage to wear gloves 3. Pregnancy 6. Signs and Symptoms 1. Instruct client on importance of cessation of smoking and exposure to cold environment VARICOSITIES Abnormal dilation of veins of lower extremities and trunks due to Incompetent valve resulting to Increased venous pooling resulting to Venous stasis causing Decrease venous return A. Heaviness in legs C. Cardiac disorder 5. Analgesics b. Measure the circumference of leg muscle to determine if swollen 3. Obesity 7. Congenital weakness of veins 3. Wear anti embolic stockings .D. Prolonged standing or sitting B. Trendelenburg's Test .veins distends quickly in less than 35 seconds D. Pain after prolonged standing 2. Nursing Management 1. Administer medications as ordered a. Vasodilators 2. Thrombophlebitis 4. Dilated tortuous skin veins 3. Hereditary 2. Elevate legs above heart level to promote increased venous return by placing 2 – 3 pillows under the legs 2. Warm to touch 4. Nursing Management 1. Venography 2. Diagnostic Procedure 1.
4. Post cannulation – insertion of various cardiac catheter 11. Administer medications as ordered a. Analgesics 5. Post op complication 10. Venography 2. Smoking 3. Nursing Management . Angiography D. B. Prolong use of oral contraceptives – promotes lipolysis 6. Dilated tortuous skin veins 4. Obesity 2. Diagnostic Procedure 1. Pain at affected extremity 2. Congestive heart failure 8. Positive Hpman's Signs – pain at the calf or leg muscle upon dorsi flexion of the foot C. Sclerotherapy – can recur and only done in spider web varicosities and danger of thrombosis (2 – 3 years for embolism) THROMBOPHLEBITIS Deep vein thrombosis Inflammation of the veins with thrombus formation A. Signs and Symptoms 1. Diabetes mellitus 7. Increase in saturated fats in the diet. Myocardial infarction 9. Warm to touch 3. Chronic anemia 5. Vein stripping and ligation (most effective) b. Predisposing Factors 1. Related to pregnancy 4. Assist in surgical procedure a.
Monitor for signs of complications Embolism a.Tachycardia . Analgesics b.Restlessness b.Right nostril . Anti Coagulant .Consist of anastomosis of capillaries known as Keissel Rach Plexus (the site of nose bleeding) .Left nostril .Dizziness .Diaphoresis .1. Upper Respiratory System 1.Headache . Humidification A. cholecystitis characterized by pain at the right upper quadrant with tenderness RESPIRATORY SYSTEM OVERVIEW OF THE STRUCTURES AND FUCNTIONS OF THE RESPIRATORY SYSTEM I. Filtering of air 2. Elevate legs above heart level to promote increase venous return 2.Cartillage . Pulmonary . Apply warm moist pack – to reduce lymphatic congestion 3. Cerebral .Heparin 6.Palpitations . Encourage to wear anti embolic stockings or knee elastic stockings 5.Sudden sharp chest pain . Administer medications as ordered a. Warming and moistening of air 3. Measure circumference of leg muscle to determine if swollen 4.Decrease LOC 572MURPHY'S SIGN is seen in clients with cholelithiasis. Nose .Separated by septum .Unexplained dyspnea .
Opens to allow passage of air .The initial sign of complete airway obstruction is the inability to cough II.Left lung (consist of 2 lobes.Diffusion (Dalton's law of partial pressure of gases) Respiratory Distress Syndrome .For cough reflex Glottis .Serous membranes Pleural Cavity 573 Pareital 574 Pleural fluid 575 Visceral With Pleuritic Friction Rub a.Site of gas exchange (CO2 and O2) .Consist of cartilaginous rings .Serves as passageway of air going to the lungs .Site of tracheostomy B. 8 segments) . 10 segments) . Pharynx/Throat .For gas exchange A.For phonation (voice production) .Closes to allow passage of food going to the esophagus .B. Bronchus . Pleural effusion c. Hydrothorax (air and blood in pleural space Alveoli .Right lung (consist of 3 lobes. Larynx . Lower Respiratory System .Opening of larynx . Lungs .Right main bronchus .Left main bronchus C.Serves as a muscular passageway for both food and air C. Trachea/Windpipe . Pneumonia b.
generalized body malaise 4. Precipitating Factors 1.Decrease surface tension . Chest pain 7. Mode of Transmission 1.In premature infants 1:2 . PTB/Pulmonary Tuberculosis (Koch's Disease) . Productive cough (yellowish sputum) 3.Decrease oxygen stimulates breathing . Over fatigue 5. Low grade afternoon fever.Increase carbon dioxide is a powerful stimulant for breathing Type II Cells of Alveoli .. Malnutrition 2.Normal L/S ratio is 2:1 . Signs and Symptoms 1. night sweats 2.An acid fast. Alcoholism 4. Virulence (degree of pathogenecity) of microorganism B. gram negative.Prevent collapse of alveoli .Composed of lecithin and spingomyelin . Overcrowded places 3. Airborne transmission via droplet nuclei C.Infection of lung tissue caused by invasion of mycobacterium tuberculosis or tubercle bacilli . Anorexia. aerobic and easily destroyed by heat or sunlight A. Dyspnea 6. Ingestion of an infected cattle with mycobacterium bovis 6.retinopathy/blindness in prematurity Disorders of Respiratory System 1.L/S ratio to determine lung maturity .Give oxygen of less 40% in premature to prevent atelectasis and retrolental fibroplasias . Hemoptysis (chronic) . Weight loss 5.Secretes surfactant .
Institute strict respiratory isolation 3. taken before meals to facilitate absorption .INH and Rifampicin is given for 4 months.DOH 8 – 10 mm induration. 48 – 72 hours . Mantoux Test (skin test) . Enforce CBR 2.Reveals increase WBC E.PZA is given for 2 months. Intensive phase .INH (Isonicotinic Acid Hydrazide) . Chest X-ray . Sputum Acid Fast Bacillus .Rifampicin (Rifampin) . CBC .Side Effect INH: peripheral neuritis/neuropathy (increase intake of Vitamin . Diagnostic Procedure 1. taken after meals to facilitate absorption . Force fluids to liquefy secretions 5. Place client on semi fowlers position to promote expansion of lungs 6.D.WHO 10 – 14 mm induration. Encourage deep breathing and coughing exercise 7.Positive to cultured microorganism 3.Given everyday simultaneously to prevent resistance . Nursing Management 1. Nebulize and suction when needed 8. 48 – 72 hours .Purified protein derivative .PZA (Pyrazinamide) . Institute short course chemotherapy a.Positive Mantoux test (previous exposure to tubercle bacilli but without active TB) 2. Administer oxygen inhalation 4. Comfortable and humid environment 9.Reveals pulmonary infiltrates 4.
Strict compliance to medications d. protein. military tuberculosis) PTB .Kanamycin . Standard phase . hepatotoxicity. Avoidance of precipitating factors b.Amikacin . nephrotoxicity .Side Effect: tinnitus. Prevent complications (atelectasis.Bones (potts) .Meninges . heartburn 10.Side Effect Rifampicin: all bodily secretions turn to red orange color . Etiologic Agents 1.Side Effect PZA: allergic reaction.Injection of streptomycin (aminoglycoside) . vitamin C and calories 11.Eyes .Skin . Provide increase carbohydrates. Streptococcus Pneumonae – causing pneumococal pneumonia 2. Hemophylus Influenzae – causing broncho pneumonia . Importance of follow up care PNEUMONIA Inflammation of the lung parenchyma leading to pulmonary consolidation as the alveoli is filled with exudates A.Nephrotoxicity check for BUN and Creatinine .Neomycin .Adrenal gland c. dyspepsia.Side Effect: .Ototoxicity damage to the 8th cranial nerve resulting to tinnitus leading to hearing loss .B6/Pyridoxine) .Side Effect Ethambutol: optic neuritis b. Provide client health teaching and discharge planning a.PZA can be replaced by Ethambutol .Gentamycin .Give aspirin if there is fever .
Pseudomonas B. Elderly C. High Risk Groups 1.Initial sign is non productive cough . chills. Cyanosis 8. Dyspnea with prolong expiratory grunt 3. Air pollution 3.3. Aspiration of food causing aspiration pneumonia D. Productive cough with greenish to rusty sputum 2. Signs and Symptoms 1. Immuno compromised a. Fever. anorexia and general body malaise 4.Chest x-ray confirms lung cancer 4. Related to prolonged immobility (CVA clients).Drug of choice is Retrovir b. AIDS . Rales/crackles 6. Bronchogenic Cancer . Diplococcus Pneumoniae 4. Children below 5 years old 2. Abdominal distention leading to paralytic ileus (absence of peristalsis) . Bronchial wheezing 7.Pneumocystic carini pneumonia . Klebsella Pneumoniae 5. causing hypostatic pneumonia 5. Pleuritic friction rub 9. Weight loss 5. Smoking 2. Chest pain 10. Escherichia Pneumoniae 6. Predisposing Factors 1.
Turning and reposition 7. Contraindicated with . Diagnostic Procedure 1. Nebulize and suction as needed 8. Administer bronchodilators 15 – 30 minutes before procedure e.Chest physiotherapy . Administer oxygen inhalation low inflow 3.E. ABG analysis – reveals decrease PO2 4. erythrocyte sedimentation rate is increased F. Institute pulmonary toilet (tends to promote expectoration) . Assist in postural drainage .Deep breathing exercises . Place on semi fowlers position 6. Monitor vital signs c.Drain uppermost area of lungs . Enforce CBR 2. Encourage client deep breathing exercises d. Provide oral care after procedure g.Coughing exercises . Force fluid 5. Stop if client cannot tolerate procedure f. CBC – reveals increase WBC. Chest x-ray – reveals pulmonary consolidation 3. Administer medications as ordered Broad Spectrum Antibiotic 576 Penicillin 577 Tetracycline 578 Microlides (Zethromax) 579Azethromycin (Side Effect: Ototoxicity) 580 Antipyretics 581 Mucolytics/Expectorants 582 Analgesics 4.Placed on various position Nursing Management for Postural Drainage a. Nursing Management 1. Best done before meals or 2 – 3 hours to prevent gastro esophageal reflux b. Sputum Gram Staining and Culture Sensitivity – positive to cultured microorganisms 2.
Hemoptysis 6.Clients with increase intra ocular pressure (Normal IOP 12 – 21 mmHg) . protein and vitamin C 10. Fever.Increase ICP 9. Importance of follow up care HISTOPLASMOSIS Acute fungal infection caused by inhalation of contaminated dust or particles with histoplasma capsulatum derived from birds manure A. hydrocephalus) c.Meningitis (nerve deafness. chills.Atelectasis . ABG analysis PO2 decrease C. Provide increase carbohydrates.Unstable vital signs . Nursing Management 1. Administer oxygen inhalation 3. Histoplasmin Skin Test – positive 2. general body malaise 4. Administer medications as ordered .Hemoptysis .. Health teaching and discharge planning a. Dyspnea 3. Regular adherence to medications d. Productive cough 2. Signs and Symptoms PTB or Pneumonia like 1. calories. Chest and joint pains B. Diagnostic Procedures 1. anorexia. Enforce CBR 2. Avoid smoking b. Cyanosis 5. Prevent complications .
Scattered rales/ronchi 6. Antifungal . Prolonged expiratory grunt 4. Predisposing Factors 1. Prevent the spread of infection by spraying of breeding places COPD (Chronic Obstructive Pulmonary/Lung Disease) Chronic Bronchitis Inflammation of bronchus resulting to hypertrophy or hyperplasia of goblet mucous producing cells leading to narrowing of smaller airways A. Smoking 2. Prevent complications – bronchiectasis 7.Amphotericin B . Hypokalemia) b. check for BUN and Creatinine. Dyspnea on exertion 3.a. Diagnostic Procedure ABG analysis – reveals PO2 decrease (hypoxemia). Antipyretics 4. Mucolytics d. Predisposing Factors (Depending on Types) . Peripheral edema b. Signs and Symptoms 1.Fungizone (Nephrotoxicity. Cyanosis 7. Cor Pulmonale (right ventricular hypertrophy) C. Productive cough (consistent to all COPD) 2. Air pollution B. PCO2 increase. Anorexia and generalized body malaise 5. Pulmonary hypertension a. pH decrease Bronchial Asthma Reversible inflammatory lung condition due to hypersensitivity to allergens leading to narrowing of smaller airways A. Force fluids to liquefy secretions 5. Steroids c. Nebulize and suction as needed 6.
milk. apply direct pressure to ulnar and radial artery to determine presence of collateral circulation . Danders g.Before ABG test for positive Allens Test. Furs h. Cyanosis 5. Wheezing on expiration 4. Pollen b. ABG analysis – PO2 decrease . penicillin. Intrinsic Asthma (Non atopic/Non allergic) Causes a. Food additives (nitrates) e. Mixed Type 90 – 95% B. eggs. Signs and Symptoms 1. air pressure and humidity f. Diaphoresis C. Diagnostic Procedure 1. Hereditary b. Pulmonary Function Test . Foods (seafoods. palpitations 7. Dust c. Drugs (aspirin.Incentive spirometer reveals decrease vital lung capacity 2. Physical and emotional stress 3. Fumes d.1. Dyspnea 3. Lints 2. Tachycardia. Extrinsic Asthma ( Atopic/ Allergic ) Causes a. chicken d. beta blocker) c. Gases f. Smoke e. Sudden change in temperature. Cough that is non productive 2. Mild Stress/apprehension 6. chocolates.
Mucomysts (acetylceisteine) d. Nebulize and suction when needed 7. Enforce CBR 2.D. Chest trauma 3. Administer medications as ordered a. Dyspnea .Emphysema . Regular adherence to medications to prevent development of status asthmaticus d.Status Asthmaticus (give drug of choice) . Mucolytics/expectorants e.Steroids . Force fluids 5. Provide client health teachings and discharge planning concerning a. Related to presence of tumor B. Prevent complications . Steroids – decrease inflammation c.Epinephrine . Congenital defects 4. Nursing Management 1. Avoidance of precipitating factor b.Bronchodilators c. Importance of follow up care BRONCHIECTASIS Abnormal permanent dilation of bronchus leading to destruction of muscular and elastic tissues of alveoli A. Anti histamine 4. Semi fowlers position 6. Predisposing Factors 1. Productive cough 2. with low inflow of 2 – 3 L/min 3. Signs and Symptoms 1. Recurrent lower respiratory tract infections 2. Oxygen inhalation. Bronchodilators – given via inhalation or metered dose inhalaer or MDI for 5 minutes b.
Unaffected lobectomy facilitate drainage EMPHYSEMA Irreversible terminal stage of COPD characterized by a. may cause irritation 3. 1 lung is removed and position on affected side) 2. Cyanosis 4. Monitor vital signs and breath sound POST Bronchoscopy 1. Anorexia and generalized body malaise 5. Secure inform consent and explain procedure to client 2. Surgery (pneumonectomy . Segmental Wedge Lobectomy (promote re expansion of lungs) . Monitor for signs of gross 4. coughing and smoking. Over distention of thoracic cavity (barrel chest) A. Inelasticity of alveoli b. Monitor for signs of laryngeal spasm – prepare tracheostomy set D. Predisposing Factors 1. Treatment 1. Avoid talking. Bronchoscopy – direct visualization of bronchus using fiberscope Nursing Management PRE Bronchoscopy 1.3. Feeding initiated upon return of gag reflex 2. Diagnostic Procedure 1. Air trapping c. Maldistribution of gases d. ABG – PO2 decrease 2. Hemoptysis (only COPD with sign) C. Maintain NPO 6 – 8 hours prior to procedure 3. Smoking .
Dyspnea at rest 3. Resonance to hyperresonance 6. "Pink Puffers") . Rales or ronchi 9. Panacinar/ centriacinar .Increase ph . High risk: elderly 5. Panlobular/ centrilobular .Respiratory acidosis b. Prolong expiratory grunt 4.Increase PO2 (hyperaxemia. Air pollution 3. Flaring of alai nares 12. Barrel chest 11. Purse lip breathing to eliminates excess CO2 (compensatory mechanism) C. Productive cough 2. Allergy 4. Nursing Management 1. Decrease tactile fremitus 7.2. Diagnostic Procedure 1.Respiratory alkalosis D.Decrease ph . Decrease or diminished breath sounds 8.Increase PCO2 . Anorexia and generalized body malaise 5. ABG analysis reveals a. "Blue Bloaters") . Enforce CBR . Pulmonary Function Test – reveals decrease vital lung capacity 2.Decrease PO2 (hypoxemia leading to chronic bronchitis. Bronchial wheezing 10. for recoil of alveoli) B.Decrease PCO2 . Signs and Symptoms 1. Hereditary – it involves deficiency of ALPHA-1 ANTI TRYPSIN (needed to form Elastase.
Steroids c. calories. Avoid smoking b.CO2 narcosis may lead to coma .Pneumothorax c. Provide comfortable and humid environment 10. Antibiotics d. Nebulize and suction when needed 8. Institute pulmonary toilet 7. Force fluids 6. High fowlers position 5. Strict compliance to medication d. Provide high carbohydrates. Prevent complications . protein. Health teachings and discharge planning concerning a. Administer oxygen inhalation via low inflow 3. vitamins and minerals 11. Bronchodilators b. Importance of follow up care .Atelectasis .2. Administer medications as ordered a.Cor Pulmonale . Institute PEEP (positive end expiratory pressure) in mechanical ventilation promotes maximum alveolar lung expansion 9. Mucolytics/expectorants 4.
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