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INTENSIVE FINAL COACHING - NP3
 

INTENSIVE FINAL COACHING - NP3

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    INTENSIVE FINAL COACHING - NP3 INTENSIVE FINAL COACHING - NP3 Presentation Transcript

    • Intensive final coaching NURSING PRACTICE 3
    • Situation
      • Using of Intramuscular Analgesia in managing the pain during surgery gives longer effect than using patient controlled analgesia.
      • DEPENDENT or CRITERION
      • INDEPENDENT or TREATMENT
    • NOTES
      • T-test  to examine the DIFFERENCE of 2 groups
      • Chi-square  to examine the COMMONALITIES or RELATIONSHIP and COMPARE DATA in the form of percentages or frequencies
      • ANOVA  to examine the difference among 3 or more means
    • ENDOCRINE SYSTEM
      • HORMONAL REGULATION
      •  
      • Hypothalamus
      • Pituitary Gland
      • Hormone
      • Target Cell/ Organ
      • Effect
    • A P
      • ___________  promote longitudinal bone growth
      • _________  skin pigmentation
      • _________  promotes milk production
      • _________  maturity of ovary and teste
      • _________  T3 & T4 needed to  BMR Calcitonin
      • _______  stimulates the adrenal gland to produce its own hormone
      • _______  promotes milk ejaculation
      • contraction of uterus
      • _______  prevents formation of large volume of urine
    • Mastery drills
      • ______ hormone in Pineal gland
      • ______ hormone in thymus gland (T cell differentiation)
      • ______ hormone in kidney which stimulate bone marrow
      • ______ hormone of parathyroid that increases serum calcium
    • Estrogen Progesterone 1. inhibits FSH release 1. inhibits LH release 2. cause proliferation of endometrial lining 2. increases vascularity in the uterus 3.  cervical mucous production (+ spinnbarkeit) 3. maintains the course of pregnancy 4. causes water retention
    • Mastery drill
      • ___________ cause proliferation of endometrial lining
      • ___________ increases vascularity in the uterus
      • ________ causes water retention
      • ________  cervical mucous production (+ spinnbarkeit)
    • ACTH ADRENAL GLANDS
      • ________  regulates sodium secretion
        •  Needed for water retention
      • ________  development of secondary male characteristics
      •  responsible for  libIDO
    • sympathetic
      • _______ V/S
      • _______ GU
      • _______ GI
      • Ejaculation or Erection
    • Parasympathetic
      • ______ V/S
      • ______ GU
      • ______ GI
      • Erection or Ejaculation
    • Sympha or Para
      • Dilated pupils
      • Decreased salivary secretion
      • Thirst and dryness of the mouth
      • Hypoventilation
      • Pallor
      • Cold and clammy skin
      • Diarrhea
      • Flatulence
      • Constipation
    • Sympa or Para
      • Decreased peristalsis
      • Bronchodilation
      • Peripheral vasoconstriction
      • Urinary retention
      • Decreased secretion of insulin and pancreatic enzymes
      • Coronary vasodilation
      • Bronchoconstriction
    • Summary of disturbances
      • GH
      • Increase ________________
      • Decrease _______________
      • 2. MSH
      • Increase ________________
      • Decrease _______________
      • 3. TSH
      • Increase ______________
      • Decrease _____________
      • 4. ACTH
      • Increase ______________
      • Decrease _____________
      • 5. Prolactin
      • Increase ______________
      • Decrease _____________
      • 6. FSH/LH
      • Increase _________________
      • Decrease ________________
      • 7. ADH
      • Increase _________________
      • Decrease ________________
      • 8. Oxytocin
      • Increase _________________
      • Decrease ________________
    • Islet of langerhans
      • 1.
      • 2.
      • 3.
    • Diagnostic Tests
        • 1___________ Measures 0 2 consumption of the cell
      • Preparation:
      • NPO _____
      • Night Sleep ___________
      • Normal Value __________
      • 2. PBI _______________
      • Preparation: ________________
      • .
      • 3. ___________ Deep tendon reflex
      • 4. T3 and T4 level
      • T3 NV ________________
      • T4 NV ________________
      • 5. VMA
      • NV: ___________
      • Specimen: _____________
      • Avoid foods: ____________
    • Hypothyroidism or Hyperthyroidism
      • facial edema
      • protruding eyes
      • fine hand tremors
      • intolerance to heat
      • constipation
      • Myxedema
      • Cretinism
    • Hypothyroidism or Hyperthyroidism
      • low calorie / low cholesterol
      • provide warm environment
      • cold intolerance
      • heat intolerance
      • synthroid
      • PTU
      • Cytomel
      • low calorie / low cholesterol
      • provide warm environment
      • cold intolerance
      • heat intolerance
      • synthroid
      • PTU
      • Cytomel
      • Hypercalcemia
      • Increased metabolic rate
      • Decrease Heat Production
      • Hypocalcemia
      • Hashimoto disease
      • Diarrhea
      • Hyperlipidemia
      • Obesity
      • Brittle nails
      • Pliable nails
      • Coarse,dry hair
      • Shiny Hair
      • Provide warm environment in cold climate
      • Low Calorie, High Fiber
      • cytomel (Liothyronine)  check _____?
      • synthroid (Levothyroxine)
      • Basedow’s Disorder
      • Grave’s Disorder
        •  appetite to eat
      • Anorexia
      • Weigh gain
      • Weight loss
      • Exopthalmus
      • Dalrymple’s sign
      • Beta Blockers
          • propanolol (Inderal)
      • Calcium Channel Blockers
        • nifedipine (Adalat)
      • Iodides
          • ________________________
          • Inhibit the release of thyroid hormone
          • Mix with fruit juice ; glass of H20
          • Use straw
    • Hyperparathyroidism
      • _________ bone resorption
      • _________ serum calcium level
      • _________ phospate level
      • _________ neuromuscular irritability
    • Hypothyroidism
      • _______ bone resorption
      • _______ serum calcium level
      • _______ phosphate level
      • _______ neuromuscular irritability
    • Addison or Cushing
      • Truncal obesity
      • Hyponatremia
      • Hyperglycemia
      • Amenorrhea
      • Impotence
      • Hypernatremia
      • Poor wound healing
      • Hypernatremia
      • Hypokalemia
      • Hyponatremia
      • Hyperkalemia
      • Hypertension
      • Hypotension
    • Diabetes Mellitus Type 1 or Type 2
      • Juvenile
      • Unstable DM
      • Acute onset
      • Ketosis resistant
      • DKA
      • HHNC
      • Obese
      • Onset before 30 years old
      • IDDM
      • NIDDM
    • 5 P’s of DM
      • 1 st P
      • 2 nd P
      • 3 rd P
      • P
      • P
    • Caloric Requirement in DM
      • CHO _____ %
      • Fat ______ %
      • Protein ____ %
    • Hyper or Hypoglycemia
      • Increase thirst
      • hunger
      • Fruity breath
      • Fever
      • Shaking
      • Sweating
      • Pale cool clammy skin
      • irritability
    • INSULIN
      • Short-acting insulin – REGULAR
      • Onset ________
      • Peak _________
      • Duration ______
      • Note: Onset  time it takes effect
      • Peak  maximum effect of drug
      • Example: If rapid-acting insulin is administered at 8:00am hypoglycemia may possibly experienced at 10:00am
      • Intermediate acting – NPH
      • Onset ________
      • Peak _________
      • Duration ______
      • Long acting - Ultralente
      • Onset ________
      • Peak _________
      • Duration ______
    • NOTES
      • Fat soluble hormone
      • Route: ________
      • Massage ?
      • Regular insulin _______ (clear or cloudy)
      • Intermediate or NPH ___ (clear or cloudy)
      • When mixing insulin: draw NPH or REGULAR?
      • Refrigerate or not?
    • Foot care
      • Soak in water: Warm or cold?
      • Socks color: ________
      • Shoes: _____________
    • DKA or HHNK
      • Common in type 1
      • Ketosis
      • Fat metabolism
      • No acidosis
      • Metabolic acidosis
      • None ketotic
      • Kausmull’s breathing
    • Important notes
      • Polyuria  if >5L/day
      • Polydipsia  if 4-40 L/day
    • BULLETS (Authored from previous board exam questions)
      • Chest X ray  painless procedure
      • Bronchoscopy
        • AtSO4
          • Anticholinergic  mimics SNR
          • Decreases saliva  dry mouth
        • NPO 6 to 8 hours
        • Local anesthesia  check gag reflex before feeding
    • ABG
        • Hyperventilation  decreased CO2  increased blood pH  respiratory alkalosis
        • Hypoventilation  increased CO2  decreased blood pH  respiratory acidosis
        • Diarrhea  decreased HCO3  decreased blood pH  metabolic acidosis
        • Vomiting gastric content  decreased HCL  increased blood pH  metabolic alkalosis
        • Vomiting blood  decreased O2  anaerobic metabolism  formation of lactic acid  decreased blood pH  metabolic acidosis
        • Blood pH  normal 7.35 to 7.45  If increased  alkalosis; If decreased  acidosis
        • Partial CO2  normal 35 to 45  If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
        • Partial HCO3  normal 22 to 26  If increased Metabolic alkalosis; If decreased metabolic acidosis
      • Cancer of the larynx  CS, alcohol and over usage of voice (choir member)
        • A - nterior neck mass
        • B – urning sensation with hot beverages / Bad breath
        • C - hange in the voice (hoarseness)
        • D – ysphagia/dyspnea
    • Chronic Obstructive Pulmonary Disease
        • Chronic Bronchitis
          • Blue bloater
          • Excessive mucus production
        • Asthma
          • Periods of bronchospasm and bronchoconstriction
        • Emphysema
          • Disequilibrium of elastase and antielastase
          • Pink puffer
        • Manifestations
          • A – LTERATION IN
            • LOC  decreased O2
            • Thoracic anatomy  over distention of alveoli  TD = APD  barrel chest
            • Skin
              • Temperature  cool clammy skin
              • Color  pale to cyanotic
            • ABG  Respiratory acidosis  Increased CO2
          • B – reathing  difficulty, purse lip  expiration > inhalation  removal of excess CO2 (diet low CHO)
          • C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and SFF)  clubbing of the fingers and decreased TP to the kidneys causing polycythemia
          • D – ecreased Metabolism
            • Anorexia  weight loss (high calorie diet)  fatigue  weakness
    • Bronchodilators
        • Theophylline and aminophylline
          • Primary effect  stimulates beta 2 receptors  smooth muscle relaxation  bronchodilation
          • Side effect  stimulates beta 1 receptors  increases cardiac rate  need not to notify the physician
          • Adverse effect  hypotension  monitor BP  sign of toxicity
          • Evaluation  check breath sounds
    • Acute Respiratory Distress Syndrome
        • Causes
          • A – spiration
          • R – espiratory trauma (embolism)
            • fracture  embolism  ARDS
          • D – rug toxicity (ASA)
          • S – epsis and shock
            • Vomiting, bleeding, dehydration  hypovolemia  shock  ARDS
        • Syndrome
          • Severe hypoxia
          • Bilateral infiltrates
          • Dyspnea
    • Pulmonary embolism
        • Restlessness  earliest sign
    • Water Seal System
        • Drainage Bottle  marked the level every shift
        • Water seal bottle
          • Presence of fluctuation  normal
          • Absence of fluctuation  lungs are fully expanded  assess first patient (X ray  confirm) OR presence of obstruction
          • Intermittent bubbling  normal
            • Absent  obstruction
            • Continuous  leakage
        • Suction Control  continuous bubbling  normal
    • Risk factors for cardiovascular disorders
        • R – ace  non modifiable
        • I – ncreased blood pressure  modifiable
        • S – tress  SNR  increased BP and CR, vasoconstriction  modifiable
        • K – nowing sedentary life style  modifiable
        • F – at foods  atherosclerosis  modifiable
        • A – lcohol (modifiable) / Age  above 40 (non modifiable)
        • C – igarette smoking  vasoconstriction (nicotine)  modifiable / Contraceptive pills  clotting of blood  thrombus formation
        • T – ype A behavior (modifiable)  competitiveness, perfectionist  high stress level
        • O – besity
        • R – esult of DM  lipolysis  increased fatty acids  atherosclerosis
        • S – ex  gender  males > female (before menopausal because estrogen decreases PVR) after menopausal female eversible}[inverted T wave]  Injury [elevated ST segment]  > male
      • Decreased TP in heart  Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in the ECG]
      •  
      • Eating a heavy meal, strenuous exercise, sex, exposure to cold  Decreased blood flow (heart)  decreased TP (heart)  decreased O2 (heart)  anaerobic respiration  production of lactic acid  PAIN  management decreased O2 demand by rest and SFF
    • Angina
        • Pain relieved by rest and NTG
        • NTG
          • Vasodilation  orthostatic hypotension  move gradually  Monitor BP
          • Store in a dark and amber container
          • Effective  tingling sensation  no need to notify physician
          • Maximum of 3 tablets with 5 minute interval
    • MI
        • Pain relieved by Morphine SO4
          • Narcotic analgesic
          • Can cause respiratory depression  monitor RR and O2 saturation
          • Antidote  narcan
      • Cardioversion  synchronous
      • Defibrillation  unsynchronous
      • Buerger’s disease  CS  vasoconstriction  stop CS  common in men
      • Raynaud’ s  stress and cold  vasoconstriction  common in female
    • Congestive heart failure
        • Left sided  pulmonary
          • Dyspnea
          • Crackles
          • Polycythemia  due to decrease O2 to the kidneys
          • Clubbing of the fingers  due to prolonged hyxia
          • Orthopnea
        • Right sided  systemic
          • Hepatomegaly
          • Distended neck veins
          • Edema
          • Portal hypertension
          • Ascites  weight gain
          • Varicose veins
        • Digoxin
          • Cardiac glycoside
          • Positive inotrophic effect  increased strength of myocardial contraction
          • Negative chronotrophic effect  decreased cardiac rate  monitor CR  never give if CR below 60 bpm
          • Adverse effect
            • V – omitting
            • A – norexia
            • N – ausea
            • D – iarrhea
            • A – bdominal pain
            • REMEMBER : earliest  GI; late  halo vision
            • Antidote  Digibind
      • Decreased RBC  Activity in tolerance, Fatigue, provide rest, Anemia 
      • Decreased Platelets  Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high risk for injury
      • Decreased WBC  prone to infection, reverse isolation 
      • Increased WBC  presence of infection
      • First Day/Newly diagnosed  Knowledge deficit
      • Diuretic
        • D – iet  high K diet except aldactone
        • I – input and Output  expected increased output
        • U – ndesirable effect electrolyte imbalance (K)
        • R – ecord weight  expected decreased weight
        • E – lderly  special precaution
        • T – ake in AM and with food
        • I – ncreased orthostatic hypotension  monitor BP and move gradually
        • C – ancel alcohol because of mild diuretic effect
      • Heparin  anticoagulant  prevent further enlargement of clot not dissolve them  monitor APTT/PTT  antidote protamine SO4
      • Coumadin  anticoagulant  prevent further enlargement of clot not dissolve it  monitor PT  vitamin K is the antidote
      • Urokinase/Streptoase  dissolves the clot  
      • Pernicious anemia  absence of intrinsic factor (gastric surgery)  problem in absorption of Vitamin B12  beefy red tongue schilling’s test  definitive test  24 hour urine collection  life long Vitamin B12
      • Gastritis  LUQ pain
      • Gastric ulcer  affected area stomach  pain (precipitated by food intake  increased HCl)  pain relieved by antacids
      • Duodenal ulcer  affected area duodenum  pain (2 hour after eating)  pain relieved by food 
      • Ulcers  bleeding  (+) occult blood test (guiac)  high fiber diet, avoid red meat, iron, steroids, NSAIDs, indomethacin
      • Vagotomy  resection of vagus nerve  decreased cholinergic stimulation  decreased HCl and gastric movement
      • Dumping syndrome  tachycardia and weakness  3 D’s (diarrhea, diaphoresis and dizziness)  fluids after meals, lie down after meals and SFF 
      • Appendicitis  RLQ pain  avoid heat pads  cause rupture  signs of ruptured appendix  sudden cessation of pain, elevation of temperature and WBC
      • Diverticulitis  LLQ pain  low fiber diet
      • Diverticulosis  high fiber diet 
      • Ulcerative colitis  bloody diarrhea 15 to 20 times a day  fluid volume deficit, anemia
      • Liver cirrhosis  alcohol and malnutrition (laennec’s) , infection and drugs (post necrotic) , RSCHF (cardiac) and biliary obstruction (biliary)
        • Portal hypertention can lead to
          • Blood shifted to the different collateral
            • Esophageal varices
            • Spider angioma (face and neck)
            • Caput medusae (abdomen)
            • Hemorrhoids (rectal)
            • Management avoid rupture  avoid shouting, valsalva maneuver
          • Increased hydstatic pressure  fluid shifting  ascites
      • Liver cirrhosis  alcohol and malnutrition (laennec’s) , infection and drugs (post necrotic) , RSCHF (cardiac) and biliary obstruction (biliary)
        • Portal hypertention can lead to
          • Blood shifted to the different collateral
            • Esophageal varices
            • Spider angioma (face and neck)
            • Caput medusae (abdomen)
            • Hemorrhoids (rectal)
            • Management avoid rupture  avoid shouting, valsalva maneuver
          • Increased hydstatic pressure  fluid shifting  ascites
      • Hepatitis A  fecal oral  prone plumber
      • Hepatitis B  body secretion  prone working in a dialysis
      • Cholecystitis  5 F’s (fair, female, fat, fertile and forty)  RUQ pain  after ingestion of fatty food  demerol to relieved pain
      • Cholecystectomy  T tube  level of the incision site  drain excess bile 
      • Pancreatitis  alcohol  autodigestion  LUQ pain
    • Anterior Pituitary gland
        • Growth hormone
          • Increased before the closure of the epiphysis of the long bones  gigantism  tall
          • Increased after the closure of the epiphysis  acromegaly  big hands (big gloves), big feet (big shoes) and big head (big hat)
          • Decreased  dwarfism
        • Prolactin
          • Increased  galactorrhea
          • Decreased  decreased milk production
        • ACTH
          • Increased  secondary cushing’s
          • Decreased  secondary addison’s
        • TSH
          • Increased  secondary hypethyroidism
          • Decreased  secondary hypothyroidism
    • Posterior pituitary gland
        • ADH
          • Increased  water retention  oliguria  edema (fluid volume excess) and weight gain  concentrated urine  increased urine specific gravity
          • Decreased  water excretion  polyuria  dehydration (fluid volume deficit and weight loss)  diluted urine  decreased urine specific gravity
    • Parathyroid gland
        • Parathormone
          • Increased  increased calcium in the blood and decrease calcium in the bones  stone formation and decreased bone mass  osteoporosis  management increased water intake
          • Decreased  hypocalcemia  calcium supplement
    • Thyroid Gland
        • Increased (hyperthyroidism)
          • T3 and T4  increased BMR  hyperactive  inability to focus  insomia  increased catabolism  weight loss  increased appetite  increased peristalsis  Diarrhea  fluid volume deficit  Increased CR and RR (due to increased BMR)
            • Increased T3  heat intolerance
          • Calcitonin  decreased calcium in the blood  tetany  compensatory  calcium withdraws from the bones  bone destruction (complication)
          • PTU  decreased synthesis of TH  watch out for SE (similar to signs and symptoms of hypothyroidism)  watch out for agrunulocytosis (fever, skin rash and sore throat)
          • Lugol’s solution  decreased released of TH  before thyroidectomy  decreased vascularity of the thyroid gland
        • Decreased (hypothyroidism)
          • T3 and T4  decreased BMR  hypoactive  sleeps a lot  decreased metabolism  weight gain  anorexia  decreased peristalsis  constipation  decreased CR and RR due to decreased BMR
          • T3  cold intolerance
          • Calcitonin  hypercalcemia  stone formation
          • Synthroid and Proloid  increased TH
    • Adrenal Gland
        • Incresead (cushing’s)
          • Glucocorticoids  hyperglycemia and decrease wound healing
          • Mineral corticoids  increased aldosterone  sodium retention and potassium excretion  hypernatremia and hypokalemia
            • Hypernatremia  water retention  oliguria  edema (moon face,buffalohump, fluid volume excess and weight gain)  concentrated urine  increased urine specific gravity  low sodium diet
            • Hypokalemia  weakness  Prominent U wave  high potassium diet
            • Epinephrine and Norepinephrine  Increased BP and CR
          • Sex hormones
            • Males  gynecomastia and falling of hair
            • Females  hirsutism and deepening of the voice
        • Decreased (addisons)
          • Glucocorticoids  hypoglycemia and inability to cope with stress
          • Mineralcorticoids  decreased aldosterone  sodium excretion and potassium retention  hyponatremia and hyperkalemia
            • Hyponatremia  water excretion  polyuria (dehydration, fluid volume deficit and weight loss)  diluted urine --. Decreased urine specific gravity  increased fluids and Na
            • Hyperkalemia  weakness  tall or peaked T waves  low K diet
          • Epinephrine and Norepinephrine  decreased BP and CR
    • Diabetes Mellitus
        • Type I  absolutely no insulin  thin  insulin
        • Type II  insufficient insulin  obese  OHA
        • Diet  50% CHO, 30% Fats, 20% CHON
        • Exercise  Increased uptake of glucose  Decreased insulin requirement
        • Oral hypoglycemic agent (OHA)
          • Stimulates pancreas to produce insulin
        • Insulin
          • SC; IV if DKA
          • Never massage the area
          • Never administer cold insulin
          • Rotate the site of injection
            • PREVENTS LIPODYSTROPHY
          • Mix
            • Aspirate clear first
            • Inject air to cloudy first
        • Hypoglycemia
          • W – eakness
          • H – unger pangs
          • A – alteration of LOC
          • T – achycardia and tremors
          • A – bdominal pain
          • B – blurring of vision
          • C – ool clammy skin
          • D – iaphoresis
          • Give  orange juice (simple sugars)
        • DKA  increased lipolysis increased ketones
        • Hyperglycemia  polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria and warm flush skin
        • Glycosylated hemoglobin  reflect BSL for the past 3 to 4 months  most accurate
        • Foot care
          • Podiatrist
          • Avoid removing corns and calluses
          • Cut toe nails straight across
          • Avoid walking bare foot
      • Hepatitis A  fecal oral
      • Hepatitis B  body and bloody secretions (hemodialysis)
      • Peritoneal Dialysis
        • Diasylate output is decreased  turn patient from side to side
        • Complication  infection  monitor WBC and temperature, diasylate is cloudy  boardlike and rigid abdomen  peritonitis
        • Don’t include diasylate solution in the output of the client
        • Expected  decreased weight  monitor weight before and after  decreased createnine and BUN
      • Heart block  decreased tissue perfusion
      • Parkinson’s diasease
        • Decreased dopamine in the basal ganglia  levodopa to increased dopamine  avoid Vit B6 foods
        • Cardinals signs  tremors (non intentional)  muscle rigidity  bradykinesia
        • Pill rolling
        • Microphonia  ask your client to speak aloud to be aware
        • Artane and Cogentin  anticholinergic  decreased muscle rigidity
    • Myasthenia Gravis
        • Tensilon test  confirmatory test
        • Decreased Acetylcholine and increased cholinesterase
        • Muscle weakness  priority airway
        • NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
        • Cholinergics (mestinon)  increased muscle strength  antidote ATSO4
          • Undermedication  myasthenic crisis  give cholinergics
          • Over medication  cholinergic crisis  give ATSO4
    • Multiple Sclerosis
        • Demyelinization of the myelin sheath
        • Charcoat’s triad
          • Intentional tremors
          • Scanning of speech
          • Nystagmus
        • Visual disturbances  diplopia
      • Pancreatitis  autodigestion  alcohol  bleeding  shock
        • Elevated amylase
    • Rheumatoid Arthritis
        • No specific diagnostic test
        • NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
        • Synovitis  Pannus formation  fibrous ankylosis (limited joint movement)  Bony ankylosis (joint fixation)
        • Avoid flexion and promote prone position
      • Gouty Arthritis
        • Increased uric acid  allopurinol and avoid organ meats (liver)  tophi (ears)
      • Osteoarthritis
        • Most common  related with aging
        • Pain after weight bearing exercise or activity  rest to relieved pain  weight reduction
      • Diverticulitis  LLQ pain and low fiber diet
      • Cyclophosphamide (Cytoxan)  can cause hemorrhagic cystitis  to avoid increased fluid intake
      • Vincristine (Oncovin)  increased fiber in the diet  
      • Iron supplement  When is the best time to take (empty stomach), How is best taken (with orange juice)
    • Steroids and NSAID’s
        • DEATH  inflammation
        • BIRTH  side effects
          • B – one marrow depression  prone to infection  monitor temperature and WBC
          • I – ncreased gastric irritation  take it with food or after meals
          • R – enal toxicity
          • T – innitus
          • H – epato toxic
      • Cataract  common cause is aging (senile)  opacity of the lens  position on the unaffected side
      • Glaucoma  increased IOP  decreased of peripheral vision first  halo, tunnel and gun barrel vision  miotics (constricts pupils)  avoid ATSO4 (dilates pupil)
      • Retinal detachment  trauma  blood clots  floating spots  dependent position  scleral buckling
      • Avoid Increased Intraocular pressure  PRIORITY
        • Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
      • Meniere’s  Triad  tinnitus, impaired hearing loss and vertigo  low Na diet
        • Vertigo  imbalance  high risk for injury  decreased vertigo by focusing on one side of the room  assume a flat or reclining position
      • ASA  8 th cranial nerve damage  tinnitus, impaired hearing loss and vertigo
      • Antibiotics  allergic reactions
    • Normal Values
        • BUN = 10 – 20 mg/dl
        • Calcium = 9 to 10.5 mg/dl
        • Creatinine = 5 to 1.5 mg/dl
        • GTT = 70 to 115 mg/dl
        • O2 sat = 97 to 98%
    • Signs and Symptoms of Increased Intracranial Pressure
        • B – lood pressure and temperature are elevated
        • R – espiratory and cardiac rate are decreased
        • A – lteration of LOC
        • I – rritability
        • N – ote for projectile vomiting
        • S – eizure