• Save
INTENSIVE FINAL COACHING - NP3
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

INTENSIVE FINAL COACHING - NP3

on

  • 1,576 views

NP3

NP3

Statistics

Views

Total Views
1,576
Views on SlideShare
1,308
Embed Views
268

Actions

Likes
0
Downloads
1
Comments
1

2 Embeds 268

http://virtualeli.net 224
http://virtualeli.me 44

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • hello..can you please send me a copy of your slides? I'll be taking exam this june...thanks..Calimlimanne@yahoo.com
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

INTENSIVE FINAL COACHING - NP3 Presentation Transcript

  • 1. Intensive final coaching NURSING PRACTICE 3
  • 2. 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
  • 3. 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
  • 4. ENDOCRINE SYSTEM
    • HORMONAL REGULATION
    •  
    • Hypothalamus
    • Pituitary Gland
    • Hormone
    • Target Cell/ Organ
    • Effect
  • 5. A P
  • 6.
    • ___________  promote longitudinal bone growth
    • _________  skin pigmentation
    • _________  promotes milk production
    • _________  maturity of ovary and teste
    • _________  T3 & T4 needed to  BMR Calcitonin
  • 7.
    • _______  stimulates the adrenal gland to produce its own hormone
    • _______  promotes milk ejaculation
    • contraction of uterus
    • _______  prevents formation of large volume of urine
  • 8. 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
  • 9. 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
  • 10. Mastery drill
    • ___________ cause proliferation of endometrial lining
    • ___________ increases vascularity in the uterus
    • ________ causes water retention
    • ________  cervical mucous production (+ spinnbarkeit)
  • 11. ACTH ADRENAL GLANDS
  • 12.
    • ________  regulates sodium secretion
      •  Needed for water retention
    • ________  development of secondary male characteristics
    •  responsible for  libIDO
  • 13. sympathetic
    • _______ V/S
    • _______ GU
    • _______ GI
    • Ejaculation or Erection
  • 14. Parasympathetic
    • ______ V/S
    • ______ GU
    • ______ GI
    • Erection or Ejaculation
  • 15. Sympha or Para
    • Dilated pupils
    • Decreased salivary secretion
    • Thirst and dryness of the mouth
    • Hypoventilation
    • Pallor
    • Cold and clammy skin
    • Diarrhea
    • Flatulence
    • Constipation
  • 16. Sympa or Para
    • Decreased peristalsis
    • Bronchodilation
    • Peripheral vasoconstriction
    • Urinary retention
    • Decreased secretion of insulin and pancreatic enzymes
    • Coronary vasodilation
    • Bronchoconstriction
  • 17. Summary of disturbances
    • GH
    • Increase ________________
    • Decrease _______________
    • 2. MSH
    • Increase ________________
    • Decrease _______________
  • 18.
    • 3. TSH
    • Increase ______________
    • Decrease _____________
    • 4. ACTH
    • Increase ______________
    • Decrease _____________
    • 5. Prolactin
    • Increase ______________
    • Decrease _____________
  • 19.
    • 6. FSH/LH
    • Increase _________________
    • Decrease ________________
    • 7. ADH
    • Increase _________________
    • Decrease ________________
    • 8. Oxytocin
    • Increase _________________
    • Decrease ________________
  • 20. Islet of langerhans
    • 1.
    • 2.
    • 3.
  • 21. Diagnostic Tests
      • 1___________ Measures 0 2 consumption of the cell
    • Preparation:
    • NPO _____
    • Night Sleep ___________
    • Normal Value __________
    • 2. PBI _______________
    • Preparation: ________________
    • .
  • 22.
    • 3. ___________ Deep tendon reflex
    • 4. T3 and T4 level
    • T3 NV ________________
    • T4 NV ________________
    • 5. VMA
    • NV: ___________
    • Specimen: _____________
    • Avoid foods: ____________
  • 23. Hypothyroidism or Hyperthyroidism
    • facial edema
    • protruding eyes
    • fine hand tremors
    • intolerance to heat
    • constipation
    • Myxedema
    • Cretinism
  • 24. Hypothyroidism or Hyperthyroidism
    • low calorie / low cholesterol
    • provide warm environment
    • cold intolerance
    • heat intolerance
    • synthroid
    • PTU
    • Cytomel
  • 25.
    • low calorie / low cholesterol
    • provide warm environment
    • cold intolerance
    • heat intolerance
    • synthroid
    • PTU
    • Cytomel
  • 26.
    • Hypercalcemia
    • Increased metabolic rate
    • Decrease Heat Production
    • Hypocalcemia
    • Hashimoto disease
    • Diarrhea
    • Hyperlipidemia
    • Obesity
  • 27.
    • Brittle nails
    • Pliable nails
    • Coarse,dry hair
    • Shiny Hair
    • Provide warm environment in cold climate
    • Low Calorie, High Fiber
    • cytomel (Liothyronine)  check _____?
    • synthroid (Levothyroxine)
  • 28.
    • Basedow’s Disorder
    • Grave’s Disorder
      •  appetite to eat
    • Anorexia
    • Weigh gain
    • Weight loss
    • Exopthalmus
    • Dalrymple’s sign
  • 29.
    • 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
  • 30. Hyperparathyroidism
    • _________ bone resorption
    • _________ serum calcium level
    • _________ phospate level
    • _________ neuromuscular irritability
  • 31. Hypothyroidism
    • _______ bone resorption
    • _______ serum calcium level
    • _______ phosphate level
    • _______ neuromuscular irritability
  • 32. Addison or Cushing
    • Truncal obesity
    • Hyponatremia
    • Hyperglycemia
    • Amenorrhea
    • Impotence
    • Hypernatremia
    • Poor wound healing
  • 33.
    • Hypernatremia
    • Hypokalemia
    • Hyponatremia
    • Hyperkalemia
    • Hypertension
    • Hypotension
  • 34. Diabetes Mellitus Type 1 or Type 2
    • Juvenile
    • Unstable DM
    • Acute onset
    • Ketosis resistant
    • DKA
    • HHNC
    • Obese
    • Onset before 30 years old
    • IDDM
    • NIDDM
  • 35. 5 P’s of DM
    • 1 st P
    • 2 nd P
    • 3 rd P
    • P
    • P
  • 36. Caloric Requirement in DM
    • CHO _____ %
    • Fat ______ %
    • Protein ____ %
  • 37. Hyper or Hypoglycemia
    • Increase thirst
    • hunger
    • Fruity breath
    • Fever
    • Shaking
    • Sweating
    • Pale cool clammy skin
    • irritability
  • 38. 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
  • 39.
    • Intermediate acting – NPH
    • Onset ________
    • Peak _________
    • Duration ______
    • Long acting - Ultralente
    • Onset ________
    • Peak _________
    • Duration ______
  • 40. 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?
  • 41. Foot care
    • Soak in water: Warm or cold?
    • Socks color: ________
    • Shoes: _____________
  • 42. DKA or HHNK
    • Common in type 1
    • Ketosis
    • Fat metabolism
    • No acidosis
    • Metabolic acidosis
    • None ketotic
    • Kausmull’s breathing
  • 43. Important notes
    • Polyuria  if >5L/day
    • Polydipsia  if 4-40 L/day
  • 44. BULLETS (Authored from previous board exam questions)
  • 45.
    • 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
  • 46. 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
  • 47.
      • 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
  • 48.
    • 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
  • 49. 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
  • 50.
      • 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
  • 51.
        • 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
  • 52. 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
  • 53. 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
  • 54. Pulmonary embolism
      • Restlessness  earliest sign
  • 55. 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
  • 56. 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
  • 57.
    • 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
  • 58. 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
  • 59. MI
      • Pain relieved by Morphine SO4
        • Narcotic analgesic
        • Can cause respiratory depression  monitor RR and O2 saturation
        • Antidote  narcan
  • 60.
    • Cardioversion  synchronous
    • Defibrillation  unsynchronous
    • Buerger’s disease  CS  vasoconstriction  stop CS  common in men
    • Raynaud’ s  stress and cold  vasoconstriction  common in female
  • 61. 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
  • 62.
      • 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
  • 63.
    • 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
  • 64.
    • 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
  • 65.
    • 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
  • 66.
    • 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
  • 67.
    • 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
  • 68.
    • Diverticulitis  LLQ pain  low fiber diet
    • Diverticulosis  high fiber diet 
    • Ulcerative colitis  bloody diarrhea 15 to 20 times a day  fluid volume deficit, anemia
  • 69.
    • 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
  • 70.
    • 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
  • 71.
    • 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
  • 72. 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
  • 73.
      • ACTH
        • Increased  secondary cushing’s
        • Decreased  secondary addison’s
      • TSH
        • Increased  secondary hypethyroidism
        • Decreased  secondary hypothyroidism
  • 74. 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
  • 75. 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
  • 76. 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)
  • 77.
        • 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
  • 78.
      • 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
  • 79. 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
  • 80.
        • Sex hormones
          • Males  gynecomastia and falling of hair
          • Females  hirsutism and deepening of the voice
  • 81.
      • 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
  • 82. 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
  • 83.
      • 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
  • 84.
      • 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)
  • 85.
      • 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
  • 86.
      • Foot care
        • Podiatrist
        • Avoid removing corns and calluses
        • Cut toe nails straight across
        • Avoid walking bare foot
  • 87.
    • 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
  • 88.
    • 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
  • 89. 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
  • 90. 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
  • 91. 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
  • 92.
    • 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
  • 93.
    • 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)
  • 94. 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
  • 95.
    • 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
  • 96.
    • 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
  • 97. 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%
  • 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