The document provides information on various medical procedures, tests, diseases, and medications. It discusses chest X-rays, bronchoscopies, arterial blood gases, cancer of the larynx, chronic obstructive pulmonary disease, bronchodilators, acute respiratory distress syndrome, pulmonary embolism, water seal systems, cardiovascular risk factors, decreased tissue perfusion in the heart, angina, myocardial infarction, cardioversion, defibrillation, Raynaud's phenomenon, congestive heart failure, digoxin, decreased blood cells, newly diagnosed patients, diuretics, anticoagulants, peptic ulcers, gastrointestinal surgeries, appendicitis, diverticulitis, liver diseases, hepatitis,

1. BULLETS
(Authored from previous board exam questions)
 Chest X ray  painless procedure
 Bronchoscopy
o AtSO4
 Anticholinergic  mimics SNR
 Decreases saliva  dry mouth
o NPO 6 to 8 hours
o Local anesthesia  check gag reflex before feeding
 ABG
o Hyperventilation  decreased CO2  increased blood pH  respiratory alkalosis
o Hypoventilation  increased CO2  decreased blood pH  respiratory acidosis
o Diarrhea  decreased HCO3  decreased blood pH  metabolic acidosis
o Vomiting gastric content  decreased HCL  increased blood pH  metabolic alkalosis
o Vomiting blood  decreased O2  anaerobic metabolism  formation of lactic acid 
decreased blood pH  metabolic acidosis
o Blood pH  normal 7.35 to 7.45  If increased  alkalosis; If decreased  acidosis
o Partial CO2  normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory
Alkalosis
o 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)
o A - nterior neck mass
o B – urning sensation with hot beverages / Bad breath
o C - hange in the voice (hoarseness)
o D – ysphagia/dyspnea
 Chronic Obstructive Pulmonary Disease
o Chronic Bronchitis
 Blue bloater
 Excessive mucus production
o Asthma
 Periods of bronchospasm and bronchoconstriction
o Emphysema
 Disequilibrium of elastase and antielastase
 Pink puffer
o Manifestations
 A – LTERATION IN
• LOC  decreased O2
• Thoracic anatomy  over distention of alveoli  TD = APD  barrel chest
• Skin
o Temperature  cool clammy skin
o 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
o 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

2.  Adverse effect  hypotension  monitor BP  sign of toxicity
 Evaluation  check breath sounds
 Acute Respiratory Distress Syndrome
o Causes
 A – spiration
 R – espiratory trauma (embolism)
• fracture  embolism  ARDS
 D – rug toxicity (ASA)
 S – epsis and shock
• Vomiting, bleeding, dehydration hypovolemia  shock  ARDS
o Syndrome
 Severe hypoxia
 Bilateral infiltrates
 Dyspnea
 Pulmonary embolism
o Restlessness  earliest sign
 Water Seal System
o Drainage Bottle → marked the level every shift
o 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
o Suction Control → continuous bubbling → normal
 Risk factors for cardiovascular disorders
o R – ace  non modifiable
o I – ncreased blood pressure  modifiable
o S – tress  SNR  increased BP and CR, vasoconstriction  modifiable
o K – nowing sedentary life style  modifiable
o F – at foods atherosclerosis  modifiable
o A – lcohol (modifiable) / Age  above 40 (non modifiable)
o C – igarette smoking  vasoconstriction (nicotine)  modifiable / Contraceptive pills  clotting
of blood  thrombus formation
o T – ype A behavior (modifiable)  competitiveness, perfectionist  high stress level
o O – besity
o R – esult of DM  lipolysis  increased fatty acids  atherosclerosis
o 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
o Pain relieved by rest and NTG
o NTG
 Vasodilation  orthostatic hypotension  move gradually  Monitor BP
 Store in a dark and amber container

3.  Effective  tingling sensation  no need to notify physician
 Maximum of 3 tablets with 5 minute interval
 MI
o 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
o Left sided  pulmonary
 Dyspnea
 Crackles
 Polycythemia  due to decrease O2 to the kidneys
 Clubbing of the fingers  due to prolonged hyxia
 Orthopnea
o Right sided  systemic
 Hepatomegaly
 Distended neck veins
 Edema
 Portal hypertension
 Ascites  weight gain
 Varicose veins
o 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
o D – iet  high K diet except aldactone
o I – input and Output  expected increased output
o U – ndesirable effect electrolyte imbalance (K)

4. o R – ecord weight  expected decreased weight
o E – lderly  special precaution
o T – ake in AM and with food
o I – ncreased orthostatic hypotension  monitor BP and move gradually
o 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)
o 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
o Decreased albumin  decreased oncotic / colloidal osmotic pressure  fluid shifting  ascites
 management high protein diet
o CHON metabolism  by product ammonia  liver cannot convert to urea  increased level of
ammonia in the brain  Alteration of LOC and changes of behavior and asterexis hepatic
encephalopathy  management low CHON diet and lactulose for removal of ammonia
 Hepatitis A  fecal oral  prone plumber

5.  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
o 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
o Prolactin
 Increased  galactorrhea
 Decreased  decreased milk production
o ACTH
 Increased  secondary cushing’s
 Decreased  secondary addison’s
o TSH
 Increased  secondary hypethyroidism
 Decreased  secondary hypothyroidism
 Posterior pituitary gland
o 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
o 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
o 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
o 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
o Incresead (cushing’s)
 Glucocorticoids  hyperglycemia and decrease wound healing

6.  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
o 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
o Type I  absolutely no insulin  thin  insulin
o Type II  insufficient insulin  obese  OHA
o Diet  50% CHO, 30% Fats, 20% CHON
o Exercise  Increased uptake of glucose  Decreased insulin requirement
o Oral hypoglycemic agent (OHA)
 Stimulates pancreas to produce insulin
o 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
o 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)
o DKA → increased lipolysis increased ketones
o Hyperglycemia  polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria
and warm flush skin
o Glycosylated hemoglobin  reflect BSL for the past 3 to 4 months  most accurate
o Foot care
 Podiatrist
 Avoid removing corns and calluses
 Cut toe nails straight across
 Avoid walking bare foot

7.  Hepatitis A → fecal oral
 Hepatitis B → body and bloody secretions (hemodialysis)
 Peritoneal Dialysis
o Diasylate output is decreased → turn patient from side to side
o Complication → infection → monitor WBC and temperature, diasylate is cloudy → boardlike and
rigid abdomen → peritonitis
o Don’t include diasylate solution in the output of the client
o Expected → decreased weight → monitor weight before and after → decreased createnine and
BUN
 Heart block → decreased tissue perfusion
 Parkinson’s diasease
o Decreased dopamine in the basal ganglia → levodopa to increased dopamine → avoid Vit B6
foods
o Cardinals signs → tremors (non intentional) → muscle rigidity → bradykinesia
o Pill rolling
o Microphonia → ask your client to speak aloud to be aware
o Artane and Cogentin → anticholinergic → decreased muscle rigidity
 Myasthenia Gravis
o Tensilon test → confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness → priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) → increased muscle strength → antidote ATSO4
 Undermedication → myasthenic crisis → give cholinergics
 Over medication → cholinergic crisis → give ATSO4
 Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoat’s triad
 Intentional tremors
 Scanning of speech
 Nystagmus
o Visual disturbances → diplopia
 Pancreatitis → autodigestion → alcohol → bleeding → shock
o Elevated amylase
 Rheumatoid Arthritis
o No specific diagnostic test
o NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis → Pannus formation → fibrous ankylosis (limited joint movement) → Bony ankylosis
(joint fixation)
o Avoid flexion and promote prone position
 Gouty Arthritis
o Increased uric acid → allopurinol and avoid organ meats (liver) → tophi (ears)
 Osteoarthritis
o Most common → related with aging
o Pain after weight bearing exercise or activity → rest to relieved pain → weight reduction

8.  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
o DEATH → inflammation
o 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
o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
 Meniere’s → Triad → tinnitus, impaired hearing loss and vertigo → low Na diet
o Vertigo → imbalance → high risk for injury → decreased vertigo by focusing on one side of the
room → assume a flat or reclining position
 ASA → 8th cranial nerve damage → tinnitus, impaired hearing loss and vertigo
 Antibiotics → allergic reactions
 Normal Values
o BUN = 10 – 20 mg/dl
o Calcium = 9 to 10.5 mg/dl
o Creatinine = 5 to 1.5 mg/dl
o GTT = 70 to 115 mg/dl
o O2 sat = 97 to 98%
 Signs and Symptoms of Increased Intracranial Pressure
o B – lood pressure and temperature are elevated
o R – espiratory and cardiac rate are decreased
o A – lteration of LOC
o I – rritability
o N – ote for projectile vomiting
o S – eizure