NURSING BULLETS _____________ ___________________________________________________________

FUNDAMENTALS OF NURSING
A blood pressure cuff thats too narrow can cause a falsely ele ated blood pressure read!n"# $hen prepar!n" a s!n"le !n%ect!on for a pat!ent who ta&es re"ular and neutral prote!n 'a"edorn !nsul!n( the nurse should draw the re"ular !nsul!n !nto the syr!n"e f!rst so that !t does not conta)!nate the re"ular !nsul!n# Rhonch! are the ru)bl!n" sounds heard on lun" auscultat!on# They are )ore pronounced dur!n" e*p!rat!on than dur!n" !nsp!rat!on# Ga a"e !s forced feed!n"( usually throu"h a "astr!c tube +a tube passed !nto the sto)ach throu"h the )outh,# Accord!n" to -aslows h!erarchy of needs( phys!olo"!c needs +a!r( water( food( shelter( se*( act! !ty( and co)fort, ha e the h!"hest pr!or!ty# The safest and surest way to er!fy a pat!ents !dent!ty !s to chec& the !dent!f!cat!on band on h!s wr!st# In the therapeut!c en !ron)ent( the pat!ents safety !s the pr!)ary concern# .lu!d osc!llat!on !n the tub!n" of a chest dra!na"e syste) !nd!cates that the syste) !s wor&!n" properly# The nurse should place a pat!ent who has a Sen"sta&en/Bla&e)ore tube !n se)!/.owler pos!t!on# The nurse can el!c!t Trousseaus s!"n by occlud!n" the brach!al or rad!al artery# 'and and f!n"er spas)s that occur dur!n" occlus!on !nd!cate Trousseaus s!"n and su""est hypocalce)!a# .or blood transfus!on !n an adult( the appropr!ate needle s!0e !s 12 to 34G# Intractable pa!n !s pa!n that !ncapac!tates a pat!ent and cant be rel!e ed by dru"s# In an e)er"ency( consent for treat)ent can be obta!ned by fa*( telephone( or other tele"raph!c )eans# 5ec!bel !s the un!t of )easure)ent of sound# Infor)ed consent !s re6u!red for any !n as! e procedure# A pat!ent who cant wr!te h!s na)e to "! e consent for treat)ent )ust )a&e an 7 !n the presence of two w!tnesses( such as a nurse( pr!est( or phys!c!an# The 8/trac& I#-# !n%ect!on techn!6ue seals the dru" deep !nto the )uscle( thereby )!n!)!0!n" s&!n !rr!tat!on and sta!n!n"# It re6u!res a needle thats 19 +3#: c), or lon"er# In the e ent of f!re( the acrony) )ost often used !s RA;E# +R, Re)o e the pat!ent# +A, Act! ate the alar)# +;, Atte)pt to conta!n the f!re by clos!n" the door# +E, E*t!n"u!sh the f!re !f !t can be done safely# A re"!stered nurse should ass!"n a l!censed ocat!onal nurse or l!censed pract!cal nurse to perfor) beds!de care( such as suct!on!n" and dru" ad)!n!strat!on# If a pat!ent cant o!d( the f!rst nurs!n" act!on should be bladder palpat!on to assess for bladder d!stent!on# The pat!ent who uses a cane should carry !t on the unaffected s!de and ad ance !t at the sa)e t!)e as the affected e*tre)!ty# To f!t a sup!ne pat!ent for crutches( the nurse should )easure fro) the a*!lla to the sole and add 39 +: c), to that )easure)ent#

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Assess)ent be"!ns w!th the nurses f!rst encounter w!th the pat!ent and cont!nues throu"hout the pat!ents stay# The nurse obta!ns assess)ent data throu"h the health h!story( phys!cal e*a)!nat!on( and re !ew of d!a"nost!c stud!es# The appropr!ate needle s!0e for !nsul!n !n%ect!on !s 3:G and :<=9 lon"# Res!dual ur!ne !s ur!ne that re)a!ns !n the bladder after o!d!n"# The a)ount of res!dual ur!ne !s nor)ally :4 to 144 )l# The f! e sta"es of the nurs!n" process are assess)ent( nurs!n" d!a"nos!s( plann!n"( !)ple)entat!on( and e aluat!on# Assess)ent !s the sta"e of the nurs!n" process !n wh!ch the nurse cont!nuously collects data to !dent!fy a pat!ents actual and potent!al health needs# Nurs!n" d!a"nos!s !s the sta"e of the nurs!n" process !n wh!ch the nurse )a&es a cl!n!cal %ud")ent about !nd! !dual( fa)!ly( or co))un!ty responses to actual or potent!al health proble)s or l!fe processes# >lann!n" !s the sta"e of the nurs!n" process !n wh!ch the nurse ass!"ns pr!or!t!es to nurs!n" d!a"noses( def!nes short/ter) and lon"/ter) "oals and e*pected outco)es( and establ!shes the nurs!n" care plan# I)ple)entat!on !s the sta"e of the nurs!n" process !n wh!ch the nurse puts the nurs!n" care plan !nto act!on( dele"ates spec!f!c nurs!n" !nter ent!ons to )e)bers of the nurs!n" tea)( and charts pat!ent responses to nurs!n" !nter ent!ons# E aluat!on !s the sta"e of the nurs!n" process !n wh!ch the nurse co)pares ob%ect! e and sub%ect! e data w!th the outco)e cr!ter!a and( !f needed( )od!f!es the nurs!n" care plan# Before ad)!n!ster!n" any ?as needed@ pa!n )ed!cat!on( the nurse should as& the pat!ent to !nd!cate the locat!on of the pa!n# Aeho ahs $!tnesses bel!e e that they shouldnt rece! e blood co)ponents donated by other people# To test !sual acu!ty( the nurse should as& the pat!ent to co er each eye separately and to read the eye chart w!th "lasses and w!thout( as appropr!ate# $hen pro !d!n" oral care for an unconsc!ous pat!ent( to )!n!)!0e the r!s& of asp!rat!on( the nurse should pos!t!on the pat!ent on the s!de# 5ur!n" assess)ent of d!stance !s!on( the pat!ent should stand 34B +2#1 ), fro) the chart# .or a "er!atr!c pat!ent or one who !s e*tre)ely !ll( the !deal roo) te)perature !s 22C to D2C . +1=#=C to 3E#EC ;,# Nor)al roo) hu)!d!ty !s F4G to 24G# 'and wash!n" !s the s!n"le best )ethod of l!)!t!n" the spread of )!croor"an!s)s# Hnce "lo es are re)o ed after rout!ne contact w!th a pat!ent( hands should be washed for 14 to 1: seconds# To perfor) catheter!0at!on( the nurse should place a wo)an !n the dorsal recu)bent pos!t!on#

A pos!t! e 'o)ans s!"n )ay !nd!cate thro)bophleb!t!s#

Electrolytes !n a solut!on are )easured !n )!ll!e6u! alents per l!ter +)E6<L,# A )!ll!e6u! alent !s the nu)ber of )!ll!"ra)s per 144 )!ll!l!ters of a solut!on# -etabol!s) occurs !n two phasesI anabol!s) +the construct! e phase, and catabol!s) +the destruct! e phase,#

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The basal )etabol!c rate !s the a)ount of ener"y needed to )a!nta!n essent!al body funct!ons# Its )easured when the pat!ent !s awa&e and rest!n"( hasnt eaten for 1E to 1= hours( and !s !n a co)fortable( war) en !ron)ent# The basal )etabol!c rate !s e*pressed !n calor!es consu)ed per hour per &!lo"ra) of body we!"ht# 5!etary f!ber +rou"ha"e,( wh!ch !s der! ed fro) cellulose( suppl!es bul&( )a!nta!ns !ntest!nal )ot!l!ty( and helps to establ!sh re"ular bowel hab!ts# Alcohol !s )etabol!0ed pr!)ar!ly !n the l! er# S)aller a)ounts are )etabol!0ed by the &!dneys and lun"s# >etech!ae are t!ny( round( purpl!sh red spots that appear on the s&!n and )ucous )e)branes as a result of !ntrader)al or sub)ucosal he)orrha"e# >urpura !s a purple d!scolorat!on of the s&!n thats caused by blood e*tra asat!on# Accord!n" to the standard precaut!ons reco))ended by the ;enters for 5!sease ;ontrol and >re ent!on( the nurse shouldnt recap needles after use# -ost needle st!c&s result fro) )!ssed needle recapp!n"# The nurse ad)!n!sters a dru" by I#J# push by us!n" a needle and syr!n"e to del! er the dose d!rectly !nto a e!n( I#J# tub!n"( or a catheter# $hen chan"!n" the t!es on a tracheosto)y tube( the nurse should lea e the old t!es !n place unt!l the new ones are appl!ed# A nurse should ha e ass!stance when chan"!n" the t!es on a tracheosto)y tube# A f!lter !s always used for blood transfus!ons# A four/po!nt +6uad, cane !s !nd!cated when a pat!ent needs )ore stab!l!ty than a re"ular cane can pro !de# A "ood way to be"!n a pat!ent !nter !ew !s to as&( ?$hat )ade you see& )ed!cal helpK@ $hen car!n" for any pat!ent( the nurse should follow standard precaut!ons for handl!n" blood and body flu!ds# >otass!u) +LM, !s the )ost abundant cat!on !n !ntracellular flu!d# In the four/po!nt( or alternat!n"( "a!t( the pat!ent f!rst )o es the r!"ht crutch followed by the left foot and then the left crutch followed by the r!"ht foot# In the three/po!nt "a!t( the pat!ent )o es two crutches and the affected le" s!)ultaneously and then )o es the unaffected le"# In the two/po!nt "a!t( the pat!ent )o es the r!"ht le" and the left crutch s!)ultaneously and then )o es the left le" and the r!"ht crutch s!)ultaneously# The !ta)!n B co)ple*( the water/soluble !ta)!ns that are essent!al for )etabol!s)( !nclude th!a)!ne +B1,( r!bofla !n +B3,( n!ac!n +BF,( pyr!do*!ne +B2,( and cyanocobala)!n +B13,# $hen be!n" we!"hed( an adult pat!ent should be l!"htly dressed and shoeless# Before ta&!n" an adults te)perature orally( the nurse should ensure that the pat!ent hasnt s)o&ed or consu)ed hot or cold substances !n the pre !ous 1: )!nutes# The nurse shouldnt ta&e an adults te)perature rectally !f the pat!ent has a card!ac d!sorder( anal les!ons( or bleed!n" he)orrho!ds or has recently under"one rectal sur"ery#

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In a pat!ent who has a card!ac d!sorder( )easur!n" te)perature rectally )ay st!)ulate a a"al response and lead to asod!lat!on and decreased card!ac output# $hen record!n" pulse a)pl!tude and rhyth)( the nurse should use these descr!pt! e )easuresI MF( bound!n" pulse +read!ly palpable and forceful,N M3( nor)al pulse +eas!ly palpable,N M1( thready or wea& pulse +d!ff!cult to detect,N and 4( absent pulse +not detectable,# The !ntraoperat! e per!od be"!ns when a pat!ent !s transferred to the operat!n" roo) bed and ends when the pat!ent !s ad)!tted to the postanesthes!a care un!t# Hn the )orn!n" of sur"ery( the nurse should ensure that the !nfor)ed consent for) has been s!"nedN that the pat!ent hasnt ta&en anyth!n" by )outh s!nce )!dn!"ht( has ta&en a shower w!th ant!)!crob!al soap( has had )outh care +w!thout swallow!n" the water,( has re)o ed co))on %ewelry( and has rece! ed preoperat! e )ed!cat!on as prescr!bedN and that !tal s!"ns ha e been ta&en and recorded# Art!f!c!al l!)bs and other prostheses are usually re)o ed# ;o)fort )easures( such as pos!t!on!n" the pat!ent( rubb!n" the pat!ents bac&( and pro !d!n" a restful en !ron)ent( )ay decrease the pat!ents need for anal"es!cs or )ay enhance the!r effect! eness# A dru" has three na)esI "ener!c na)e( wh!ch !s used !n off!c!al publ!cat!onsN trade( or brand( na)e +such as Tylenol,( wh!ch !s selected by the dru" co)panyN and che)!cal na)e( wh!ch descr!bes the dru"s che)!cal co)pos!t!on# To a o!d sta!n!n" the teeth( the pat!ent should ta&e a l!6u!d !ron preparat!on throu"h a straw# The nurse should use the 8/trac& )ethod to ad)!n!ster an I#-# !n%ect!on of !ron de*tran +I)feron,# An or"an!s) )ay enter the body throu"h the nose( )outh( rectu)( ur!nary or reproduct! e tract( or s&!n# In descend!n" order( the le els of consc!ousness are alertness( lethar"y( stupor( l!"ht co)a( and deep co)a# To turn a pat!ent by lo"roll!n"( the nurse folds the pat!ents ar)s across the chestN e*tends the pat!ents le"s and !nserts a p!llow between the)( !f neededN places a draw sheet under the pat!entN and turns the pat!ent by slowly and "ently pull!n" on the draw sheet# The d!aphra") of the stethoscope !s used to hear h!"h/p!tched sounds( such as breath sounds# A sl!"ht d!fference !n blood pressure +: to 14 )) '", between the r!"ht and the left ar)s !s nor)al# The nurse should place the blood pressure cuff 19 +3#: c), abo e the antecub!tal fossa# $hen !nst!ll!n" ophthal)!c o!nt)ents( the nurse should waste the f!rst bead of o!nt)ent and then apply the o!nt)ent fro) the !nner canthus to the outer canthus# The nurse should use a le" cuff to )easure blood pressure !n an obese pat!ent# If a blood pressure cuff !s appl!ed too loosely( the read!n" w!ll be falsely ele ated# >tos!s !s droop!n" of the eyel!d# A t!lt table !s useful for a pat!ent w!th a sp!nal cord !n%ury( orthostat!c hypotens!on( or bra!n da)a"e because !t can )o e the pat!ent "radually fro) a hor!0ontal to a ert!cal +upr!"ht, pos!t!on# To perfor) en!puncture w!th the least !n%ury to the essel( the nurse should turn the be el upward when the essels lu)en !s lar"er than the needle and turn !t downward when the lu)en !s only sl!"htly lar"er than the needle#

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To )o e a pat!ent to the ed"e of the bed for transfer( the nurse should follow these stepsI -o e the pat!ents head and shoulders toward the ed"e of the bed# -o e the pat!ents feet and le"s to the ed"e of the bed +crescent pos!t!on,# >lace both ar)s well under the pat!ents h!ps( and stra!"hten the bac& wh!le )o !n" the pat!ent toward the ed"e of the bed# $hen be!n" )easured for crutches( a pat!ent should wear shoes# The nurse should attach a restra!nt to the part of the bed fra)e that )o es w!th the head( not to the )attress or s!de ra!ls# The )!st !n a )!st tent should ne er beco)e so dense that !t obscures clear !sual!0at!on of the pat!ents resp!ratory pattern# To ad)!n!ster hepar!n subcutaneously( the nurse should follow these stepsI ;lean( but dont rub( the s!te w!th alcohol# Stretch the s&!n taut or p!c& up a well/def!ned s&!n fold# 'old the shaft of the needle !n a dart pos!t!on# Insert the needle !nto the s&!n at a r!"ht +O4/de"ree, an"le# .!r)ly depress the plun"er( but dont asp!rate# Lea e the needle !n place for 14 seconds# $!thdraw the needle "ently at the an"le of !nsert!on# Apply pressure to the !n%ect!on s!te w!th an alcohol pad# .or a s!")o!doscopy( the nurse should place the pat!ent !n the &nee/chest pos!t!on or S!)s pos!t!on( depend!n" on the phys!c!ans preference# -aslows h!erarchy of needs )ust be )et !n the follow!n" orderI phys!olo"!c +o*y"en( food( water( se*( rest( and co)fort,( safety and secur!ty( lo e and belon"!n"( self/estee) and reco"n!t!on( and self/actual!0at!on# $hen car!n" for a pat!ent who has a naso"astr!c tube( the nurse should apply a water/soluble lubr!cant to the nostr!l to pre ent soreness# 5ur!n" "astr!c la a"e( a naso"astr!c tube !s !nserted( the sto)ach !s flushed( and !n"ested substances are re)o ed throu"h the tube# In docu)ent!n" dra!na"e on a sur"!cal dress!n"( the nurse should !nclude the s!0e( color( and cons!stency of the dra!na"e +for e*a)ple( ?14 )) of brown )uco!d dra!na"e noted on dress!n"@,# To el!c!t Bab!ns&!s refle*( the nurse stro&es the sole of the pat!ents foot w!th a )oderately sharp ob%ect( such as a thu)bna!l# A pos!t! e Bab!ns&!s refle* !s shown by dors!fle*!on of the "reat toe and fann!n" out of the other toes# $hen assess!n" a pat!ent for bladder d!stent!on( the nurse should chec& the contour of the lower abdo)en for a rounded )ass abo e the sy)phys!s pub!s# The best way to pre ent pressure ulcers !s to repos!t!on the bedr!dden pat!ent at least e ery 3 hours# Ant!e)bol!s) stoc&!n"s deco)press the superf!c!al blood essels( reduc!n" the r!s& of thro)bus for)at!on# In adults( the )ost con en!ent e!ns for en!puncture are the bas!l!c and )ed!an cub!tal e!ns !n the antecub!tal space# Two to three hours before be"!nn!n" a tube feed!n"( the nurse should asp!rate the pat!ents sto)ach contents to er!fy that "astr!c e)pty!n" !s ade6uate# >eople w!th type H blood are cons!dered un! ersal donors# >eople w!th type AB blood are cons!dered un! ersal rec!p!ents# 'ert0 +'0, !s the un!t of )easure)ent of sound fre6uency#

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'ear!n" protect!on !s re6u!red when the sound !ntens!ty e*ceeds =E dB# 5ouble hear!n" protect!on !s re6u!red !f !t e*ceeds 14E dB# >rothro)b!n( a clott!n" factor( !s produced !n the l! er# If a pat!ent !s )enstruat!n" when a ur!ne sa)ple !s collected( the nurse should note th!s on the laboratory re6uest# 5ur!n" lu)bar puncture( the nurse )ust note the !n!t!al !ntracran!al pressure and the color of the cerebrosp!nal flu!d# If a pat!ent cant cou"h to pro !de a sputu) sa)ple for culture( a heated aerosol treat)ent can be used to help to obta!n a sa)ple# If eye o!nt)ent and eyedrops )ust be !nst!lled !n the sa)e eye( the eyedrops should be !nst!lled f!rst# $hen lea !n" an !solat!on roo)( the nurse should re)o e her "lo es before her )as& because fewer patho"ens are on the )as&# S&eletal tract!on( wh!ch !s appl!ed to a bone w!th w!re p!ns or ton"s( !s the )ost effect! e )eans of tract!on# The total parenteral nutr!t!on solut!on should be stored !n a refr!"erator and re)o ed F4 to 24 )!nutes before use# 5el! ery of a ch!lled solut!on can cause pa!n( hypother)!a( enous spas)( and enous constr!ct!on# 5ru"s arent rout!nely !n%ected !ntra)uscularly !nto ede)atous t!ssue because they )ay not be absorbed# $hen car!n" for a co)atose pat!ent( the nurse should e*pla!n each act!on to the pat!ent !n a nor)al o!ce# 5entures should be cleaned !n a s!n& thats l!ned w!th a washcloth# A pat!ent should o!d w!th!n = hours after sur"ery# An EEG !dent!f!es nor)al and abnor)al bra!n wa es# Sa)ples of feces for o a and paras!te tests should be del! ered to the laboratory w!thout delay and w!thout refr!"erat!on# The autono)!c ner ous syste) re"ulates the card!o ascular and resp!ratory syste)s# $hen pro !d!n" tracheosto)y care( the nurse should !nsert the catheter "ently !nto the tracheosto)y tube# $hen w!thdraw!n" the catheter( the nurse should apply !nter)!ttent suct!on for no )ore than 1: seconds and use a sl!"ht tw!st!n" )ot!on# A low/res!due d!et !ncludes such foods as roasted ch!c&en( r!ce( and pasta# A rectal tube shouldnt be !nserted for lon"er than 34 )!nutes because !t can !rr!tate the rectal )ucosa and cause loss of sph!ncter control# A pat!ents bed bath should proceed !n th!s orderI face( nec&( ar)s( hands( chest( abdo)en( bac&( le"s( per!neu)# To pre ent !n%ury when l!ft!n" and )o !n" a pat!ent( the nurse should pr!)ar!ly use the upper le" )uscles# >at!ent preparat!on for cholecysto"raphy !ncludes !n"est!on of a contrast )ed!u) and a low/fat e en!n" )eal# $h!le an occup!ed bed !s be!n" chan"ed( the pat!ent should be co ered w!th a bath blan&et to pro)ote war)th and pre ent e*posure# Ant!c!patory "r!ef !s )ourn!n" that occurs for an e*tended t!)e when the pat!ent real!0es that death !s !ne !table#

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The follow!n" foods can alter the color of the fecesI beets +red,( cocoa +dar& red or brown,( l!cor!ce +blac&,( sp!nach +"reen,( and )eat prote!n +dar& brown,# $hen prepar!n" for a s&ull 7/ray( the pat!ent should re)o e all %ewelry and dentures# The f!"ht/or/fl!"ht response !s a sy)pathet!c ner ous syste) response# Broncho es!cular breath sounds !n per!pheral lun" f!elds are abnor)al and su""est pneu)on!a# $hee0!n" !s an abnor)al( h!"h/p!tched breath sound thats accentuated on e*p!rat!on# $a* or a fore!"n body !n the ear should be flushed out "ently by !rr!"at!on w!th war) sal!ne solut!on# If a pat!ent co)pla!ns that h!s hear!n" a!d !s ?not wor&!n"(@ the nurse should chec& the sw!tch f!rst to see !f !ts turned on and then chec& the batter!es# The nurse should "rade hyperact! e b!ceps and tr!ceps refle*es as ME# If two eye )ed!cat!ons are prescr!bed for tw!ce/da!ly !nst!llat!on( they should be ad)!n!stered : )!nutes apart# In a postoperat! e pat!ent( forc!n" flu!ds helps pre ent const!pat!on# A nurse )ust pro !de care !n accordance w!th standards of care establ!shed by the A)er!can Nurses Assoc!at!on( state re"ulat!ons( and fac!l!ty pol!cy# The &!localor!e +&cal, !s a un!t of ener"y )easure)ent that represents the a)ount of heat needed to ra!se the te)perature of 1 &!lo"ra) of water 1C ;# As nutr!ents )o e throu"h the body( they under"o !n"est!on( d!"est!on( absorpt!on( transport( cell )etabol!s)( and e*cret!on# The body )etabol!0es alcohol at a f!*ed rate( re"ardless of seru) concentrat!on# In an alcohol!c be era"e( proof reflects the percenta"e of alcohol )ult!pl!ed by 3# .or e*a)ple( a 144/proof be era"e conta!ns :4G alcohol# A l! !n" w!ll !s a w!tnessed docu)ent that states a pat!ents des!re for certa!n types of care and treat)ent# These dec!s!ons are based on the pat!ents w!shes and !ews on 6ual!ty of l!fe# The nurse should flush a per!pheral hepar!n loc& e ery = hours +!f !t wasnt used dur!n" the pre !ous = hours, and as needed w!th nor)al sal!ne solut!on to )a!nta!n patency# Pual!ty assurance !s a )ethod of deter)!n!n" whether nurs!n" act!ons and pract!ces )eet establ!shed standards# The f! e r!"hts of )ed!cat!on ad)!n!strat!on are the r!"ht pat!ent( r!"ht dru"( r!"ht dose( r!"ht route of ad)!n!strat!on( and r!"ht t!)e# The e aluat!on phase of the nurs!n" process !s to deter)!ne whether nurs!n" !nter ent!ons ha e enabled the pat!ent to )eet the des!red "oals# Huts!de of the hosp!tal sett!n"( only the subl!n"ual and transl!n"ual for)s of n!tro"lycer!n should be used to rel!e e acute an"!nal attac&s# The !)ple)entat!on phase of the nurs!n" process !n ol es record!n" the pat!ents response to the nurs!n" plan( putt!n" the nurs!n" plan !nto act!on( dele"at!n" spec!f!c nurs!n" !nter ent!ons( and coord!nat!n" the pat!ents act! !t!es#

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The >at!ents B!ll of R!"hts offers pat!ents "u!dance and protect!on by stat!n" the respons!b!l!t!es of the hosp!tal and !ts staff toward pat!ents and the!r fa)!l!es dur!n" hosp!tal!0at!on# To )!n!)!0e o)!ss!on and d!stort!on of facts( the nurse should record !nfor)at!on as soon as !ts "athered# $hen assess!n" a pat!ents health h!story( the nurse should record the current !llness chronolo"!cally( be"!nn!n" w!th the onset of the proble) and cont!nu!n" to the present# $hen assess!n" a pat!ents health h!story( the nurse should record the current !llness chronolo"!cally( be"!nn!n" w!th the onset of the proble) and cont!nu!n" to the present# A nurse shouldnt "! e false assurance to a pat!ent# After rece! !n" preoperat! e )ed!cat!on( a pat!ent !snt co)petent to s!"n an !nfor)ed consent for)# $hen l!ft!n" a pat!ent( a nurse uses the we!"ht of her body !nstead of the stren"th !n her ar)s# A nurse )ay clar!fy a phys!c!ans e*planat!on about an operat!on or a procedure to a pat!ent( but )ust refer 6uest!ons about !nfor)ed consent to the phys!c!an# $hen obta!n!n" a health h!story fro) an acutely !ll or a"!tated pat!ent( the nurse should l!)!t 6uest!ons to those that pro !de necessary !nfor)at!on# If a chest dra!na"e syste) l!ne !s bro&en or !nterrupted( the nurse should cla)p the tube !))ed!ately# The nurse shouldnt use her thu)b to ta&e a pat!ents pulse rate because the thu)b has a pulse that )ay be confused w!th the pat!ents pulse# An !nsp!rat!on and an e*p!rat!on count as one resp!rat!on# Eupnea !s nor)al resp!rat!on# 5ur!n" blood pressure )easure)ent( the pat!ent should rest the ar) a"a!nst a surface# Us!n" )uscle stren"th to hold up the ar) )ay ra!se the blood pressure# -a%or( unalterable r!s& factors for coronary artery d!sease !nclude hered!ty( se*( race( and a"e# Inspect!on !s the )ost fre6uently used assess)ent techn!6ue# .a)!ly )e)bers of an elderly person !n a lon"/ter) care fac!l!ty should transfer so)e personal !te)s +such as photo"raphs( a fa or!te cha!r( and &n!c&&nac&s, to the persons roo) to pro !de a co)fortable at)osphere# >ulsus alternans !s a re"ular pulse rhyth) w!th alternat!n" wea& and stron" beats# It occurs !n entr!cular enlar"e)ent because the stro&e olu)e ar!es w!th each heartbeat# The upper resp!ratory tract war)s and hu)!d!f!es !nsp!red a!r and plays a role !n taste( s)ell( and )ast!cat!on# S!"ns of accessory )uscle use !nclude shoulder ele at!on( !ntercostal )uscle retract!on( and scalene and sternocle!do)asto!d )uscle use dur!n" resp!rat!on# $hen pat!ents use a*!llary crutches( the!r pal)s should bear the brunt of the we!"ht# Act! !t!es of da!ly l! !n" !nclude eat!n"( bath!n"( dress!n"( "roo)!n"( to!let!n"( and !nteract!n" soc!ally#

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NURSING BULLETS _____________ ___________________________________________________________

Nor)al "a!t has two phasesI the stance phase( !n wh!ch the pat!ents foot rests on the "round( and the sw!n" phase( !n wh!ch the pat!ents foot )o es forward# The phases of )!tos!s are prophase( )etaphase( anaphase( and telophase# The nurse should follow standard precaut!ons !n the rout!ne care of all pat!ents# The nurse should use the bell of the stethoscope to l!sten for enous hu)s and card!ac )ur)urs# The nurse can assess a pat!ents "eneral &nowled"e by as&!n" 6uest!ons such as ?$ho !s the pres!dent of the Un!ted StatesK@ ;old pac&s are appl!ed for the f!rst 34 to E= hours after an !n%uryN then heat !s appl!ed# 5ur!n" cold appl!cat!on( the pac& !s appl!ed for 34 )!nutes and then re)o ed for 14 to 1: )!nutes to pre ent refle* d!lat!on +rebound pheno)enon, and frostb!te !n%ury# The pons !s located abo e the )edulla and cons!sts of wh!te )atter +sensory and )otor tracts, and "ray )atter +refle* centers,# The autono)!c ner ous syste) controls the s)ooth )uscles# A correctly wr!tten pat!ent "oal e*presses the des!red pat!ent beha !or( cr!ter!a for )easure)ent( t!)e fra)e for ach!e e)ent( and cond!t!ons under wh!ch the beha !or w!ll occur# Its de eloped !n collaborat!on w!th the pat!ent# >ercuss!on causes f! e bas!c notesI ty)pany +loud !ntens!ty( as heard o er a "astr!c a!r bubble or puffed out chee&,( hyperresonance + ery loud( as heard o er an e)physe)atous lun",( resonance +loud( as heard o er a nor)al lun",( dullness +)ed!u) !ntens!ty( as heard o er the l! er or other sol!d or"an,( and flatness +soft( as heard o er the th!"h,# The opt!c d!s& !s yellow!sh p!n& and c!rcular( w!th a d!st!nct border# A pr!)ary d!sab!l!ty !s caused by a patholo"!c process# A secondary d!sab!l!ty !s caused by !nact! !ty# Nurses are co))only held l!able for fa!l!n" to &eep an accurate count of spon"es and other de !ces dur!n" sur"ery# The best d!etary sources of !ta)!n B2 are l! er( &!dney( por&( soybeans( corn( and whole/"ra!n cereals# Iron/r!ch foods( such as or"an )eats( nuts( le"u)es( dr!ed fru!t( "reen leafy e"etables( e""s( and whole "ra!ns( co))only ha e a low water content# ;ollaborat!on !s %o!nt co))un!cat!on and dec!s!on )a&!n" between nurses and phys!c!ans# Its des!"ned to )eet pat!ents needs by !nte"rat!n" the care re"!)ens of both profess!ons !nto one co)prehens! e approach# Bradycard!a !s a heart rate of fewer than 24 beats<)!nute# A nurs!n" d!a"nos!s !s a state)ent of a pat!ents actual or potent!al health proble) that can be resol ed( d!)!n!shed( or otherw!se chan"ed by nurs!n" !nter ent!ons# 5ur!n" the assess)ent phase of the nurs!n" process( the nurse collects and analy0es three types of dataI health h!story( phys!cal e*a)!nat!on( and laboratory and d!a"nost!c test data# The pat!ents health h!story cons!sts pr!)ar!ly of sub%ect! e data( !nfor)at!on thats suppl!ed by the pat!ent# The phys!cal e*a)!nat!on !ncludes ob%ect! e data obta!ned by !nspect!on( palpat!on( percuss!on( and auscultat!on# $hen docu)ent!n" pat!ent care( the nurse should wr!te le"!bly( use only standard abbre !at!ons( and s!"n each entry# The nurse should ne er destroy or atte)pt to obl!terate docu)entat!on or lea e acant l!nes#

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.actors that affect body te)perature !nclude t!)e of day( a"e( phys!cal act! !ty( phase of )enstrual cycle( and pre"nancy# The )ost access!ble and co))only used artery for )easur!n" a pat!ents pulse rate !s the rad!al artery# To ta&e the pulse rate( the artery !s co)pressed a"a!nst the rad!us# In a rest!n" adult( the nor)al pulse rate !s 24 to 144 beats<)!nute# The rate !s sl!"htly faster !n wo)en than !n )en and )uch faster !n ch!ldren than !n adults# Laboratory test results are an ob%ect! e for) of assess)ent data# The )easure)ent syste)s )ost co))only used !n cl!n!cal pract!ce are the )etr!c syste)( apothecar!es syste)( and household syste)# Before s!"n!n" an !nfor)ed consent for)( the pat!ent should &now whether other treat)ent opt!ons are a a!lable and should understand what w!ll occur dur!n" the preoperat! e( !ntraoperat! e( and postoperat! e phasesN the r!s&s !n ol edN and the poss!ble co)pl!cat!ons# The pat!ent should also ha e a "eneral !dea of the t!)e re6u!red fro) sur"ery to reco ery# In add!t!on( he should ha e an opportun!ty to as& 6uest!ons# A pat!ent )ust s!"n a separate !nfor)ed consent for) for each procedure# 5ur!n" percuss!on( the nurse uses 6u!c&( sharp tapp!n" of the f!n"ers or hands a"a!nst body surfaces to produce sounds# Th!s procedure !s done to deter)!ne the s!0e( shape( pos!t!on( and dens!ty of underly!n" or"ans and t!ssuesN el!c!t tendernessN or assess refle*es# Ballotte)ent !s a for) of l!"ht palpat!on !n ol !n" "entle( repet!t! e bounc!n" of t!ssues a"a!nst the hand and feel!n" the!r rebound# A foot cradle &eeps bed l!nen off the pat!ents feet to pre ent s&!n !rr!tat!on and brea&down( espec!ally !n a pat!ent who has per!pheral ascular d!sease or neuropathy# Gastr!c la a"e !s flush!n" of the sto)ach and re)o al of !n"ested substances throu"h a naso"astr!c tube# Its used to treat po!son!n" or dru" o erdose# 5ur!n" the e aluat!on step of the nurs!n" process( the nurse assesses the pat!ents response to therapy# Bru!ts co))only !nd!cate l!fe/ or l!)b/threaten!n" ascular d!sease# H#U# )eans each eye# H#5# !s the r!"ht eye( and H#S# !s the left eye# To re)o e a pat!ents art!f!c!al eye( the nurse depresses the lower l!d# The nurse should use a war) sal!ne solut!on to clean an art!f!c!al eye# A thready pulse !s ery f!ne and scarcely percept!ble# A*!llary te)perature !s usually 1C . lower than oral te)perature# After suct!on!n" a tracheosto)y tube( the nurse )ust docu)ent the color( a)ount( cons!stency( and odor of secret!ons# Hn a dru" prescr!pt!on( the abbre !at!on p#c# )eans that the dru" should be ad)!n!stered after )eals# After bladder !rr!"at!on( the nurse should docu)ent the a)ount( color( and clar!ty of the ur!ne and the presence of clots or sed!)ent#

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After bladder !rr!"at!on( the nurse should docu)ent the a)ount( color( and clar!ty of the ur!ne and the presence of clots or sed!)ent# Laws re"ard!n" pat!ent self/deter)!nat!on ary fro) state to state# Therefore( the nurse )ust be fa)!l!ar w!th the laws of the state !n wh!ch she wor&s# Gau"e !s the !ns!de d!a)eter of a needleI the s)aller the "au"e( the lar"er the d!a)eter# An adult nor)ally has F3 per)anent teeth# After turn!n" a pat!ent( the nurse should docu)ent the pos!t!on used( the t!)e that the pat!ent was turned( and the f!nd!n"s of s&!n assess)ent# >ERRLA !s an abbre !at!on for nor)al pup!l assess)ent f!nd!n"sI pup!ls e6ual( round( and react! e to l!"ht w!th acco))odat!on# $hen percuss!n" a pat!ents chest for postural dra!na"e( the nurses hands should be cupped# $hen )easur!n" a pat!ents pulse( the nurse should assess !ts rate( rhyth)( 6ual!ty( and stren"th# Before transferr!n" a pat!ent fro) a bed to a wheelcha!r( the nurse should push the wheelcha!rs footrests to the s!des and loc& !ts wheels# $hen assess!n" resp!rat!ons( the nurse should docu)ent the!r rate( rhyth)( depth( and 6ual!ty# .or a subcutaneous !n%ect!on( the nurse should use a :<=9 3:G needle# The notat!on ?AA Q H R F@ !nd!cates that the pat!ent !s awa&e( alert( and or!ented to person +&nows who he !s,( place +&nows where he !s,( and t!)e +&nows the date and t!)e,# .lu!d !nta&e !ncludes all flu!ds ta&en by )outh( !nclud!n" foods that are l!6u!d at roo) te)perature( such as "elat!n( custard( and !ce crea)N I#J# flu!dsN and flu!ds ad)!n!stered !n feed!n" tubes# .lu!d output !ncludes ur!ne( o)!tus( and dra!na"e +such as fro) a naso"astr!c tube or fro) a wound, as well as blood loss( d!arrhea or feces( and persp!rat!on# After ad)!n!ster!n" an !ntrader)al !n%ect!on( the nurse shouldnt )assa"e the area because )assa"e can !rr!tate the s!te and !nterfere w!th results# $hen ad)!n!ster!n" an !ntrader)al !n%ect!on( the nurse should hold the syr!n"e al)ost flat a"a!nst the pat!ents s&!n +at about a 1:/de"ree an"le,( w!th the be el up# To obta!n an accurate blood pressure( the nurse should !nflate the )ano)eter to 34 to F4 )) '" abo e the d!sappearance of the rad!al pulse before releas!n" the cuff pressure# The nurse should count an !rre"ular pulse for 1 full )!nute# A pat!ent who !s o)!t!n" wh!le ly!n" down should be placed !n a lateral pos!t!on to pre ent asp!rat!on of o)!tus# >rophyla*!s !s d!sease pre ent!on# Body al!"n)ent !s ach!e ed when body parts are !n proper relat!on to the!r natural pos!t!on# Trust !s the foundat!on of a nurse/pat!ent relat!onsh!p# Blood pressure !s the force e*erted by the c!rculat!n" olu)e of blood on the arter!al walls#

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-alpract!ce !s a profess!onals wron"ful conduct( !)proper d!schar"e of dut!es( or fa!lure to )eet standards of care that causes har) to another# As a "eneral rule( nurses cant refuse a pat!ent care ass!"n)entN howe er( !n )ost states( they )ay refuse to part!c!pate !n abort!ons# A nurse can be found ne"l!"ent !f a pat!ent !s !n%ured because the nurse fa!led to perfor) a duty that a reasonable and prudent person would perfor) or because the nurse perfor)ed an act that a reasonable and prudent person wouldnt perfor)# States ha e enacted Good Sa)ar!tan laws to encoura"e profess!onals to pro !de )ed!cal ass!stance at the scene of an acc!dent w!thout fear of a lawsu!t ar!s!n" fro) the ass!stance# These laws dont apply to care pro !ded !n a health care fac!l!ty# A phys!c!an should s!"n erbal and telephone orders w!th!n the t!)e establ!shed by fac!l!ty pol!cy( usually 3E hours# A co)petent adult has the r!"ht to refuse l!fesa !n" )ed!cal treat)entN howe er( the !nd! !dual should be fully !nfor)ed of the conse6uences of h!s refusal# Althou"h a pat!ents health record( or chart( !s the health care fac!l!tys phys!cal property( !ts contents belon" to the pat!ent# Before a pat!ents health record can be released to a th!rd party( the pat!ent or the pat!ents le"al "uard!an )ust "! e wr!tten consent# Under the ;ontrolled Substances Act( e ery dose of a controlled dru" thats d!spensed by the phar)acy )ust be accounted for( whether the dose was ad)!n!stered to a pat!ent or d!scarded acc!dentally# A nurse cant perfor) dut!es that !olate a rule or re"ulat!on establ!shed by a state l!cens!n" board( e en !f they are author!0ed by a health care fac!l!ty or phys!c!an# To )!n!)!0e !nterrupt!ons dur!n" a pat!ent !nter !ew( the nurse should select a pr! ate roo)( preferably one w!th a door that can be closed# In cate"or!0!n" nurs!n" d!a"noses( the nurse addresses l!fe/threaten!n" proble)s f!rst( followed by potent!ally l!fe/ threaten!n" concerns# The )a%or co)ponents of a nurs!n" care plan are outco)e cr!ter!a +pat!ent "oals, and nurs!n" !nter ent!ons# Stand!n" orders( or protocols( establ!sh "u!del!nes for treat!n" a spec!f!c d!sease or set of sy)pto)s# In assess!n" a pat!ents heart( the nurse nor)ally f!nds the po!nt of )a*!)al !)pulse at the f!fth !ntercostal space( near the ape*# The S1 heard on auscultat!on !s caused by closure of the )!tral and tr!cusp!d al es# To )a!nta!n pac&a"e ster!l!ty( the nurse should open a wrappers top flap away fro) the body( open each s!de flap by touch!n" only the outer part of the wrapper( and open the f!nal flap by "rasp!n" the turned/down corner and pull!n" !t toward the body# The nurse shouldnt dry a pat!ents ear canal or re)o e wa* w!th a cotton/t!pped appl!cator because !t )ay force ceru)en a"a!nst the ty)pan!c )e)brane# A pat!ents !dent!f!cat!on bracelet should re)a!n !n place unt!l the pat!ent has been d!schar"ed fro) the health care fac!l!ty and has left the pre)!ses#

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The ;ontrolled Substances Act des!"nated f! e cate"or!es( or schedules( that class!fy controlled dru"s accord!n" to the!r abuse potent!al# Schedule I dru"s( such as hero!n( ha e a h!"h abuse potent!al and ha e no currently accepted )ed!cal use !n the Un!ted States# Schedule II dru"s( such as )orph!ne( op!u)( and )eper!d!ne +5e)erol,( ha e a h!"h abuse potent!al( but currently ha e accepted )ed!cal uses# The!r use )ay lead to phys!cal or psycholo"!cal dependence# Schedule III dru"s( such as pare"or!c and butabarb!tal +But!sol,( ha e a lower abuse potent!al than Schedule I or II dru"s# Abuse of Schedule III dru"s )ay lead to )oderate or low phys!cal or psycholo"!cal dependence( or both# Schedule IJ dru"s( such as chloral hydrate( ha e a low abuse potent!al co)pared w!th Schedule III dru"s# Schedule J dru"s( such as cou"h syrups that conta!n code!ne( ha e the lowest abuse potent!al of the controlled substances# Act! !t!es of da!ly l! !n" are act!ons that the pat!ent )ust perfor) e ery day to pro !de self/care and to !nteract w!th soc!ety# Test!n" of the s!* card!nal f!elds of "a0e e aluates the funct!on of all e*traocular )uscles and cran!al ner es III( IJ( and JI# The s!* types of heart )ur)urs are "raded fro) 1 to 2# A "rade 2 heart )ur)ur can be heard w!th the stethoscope sl!"htly ra!sed fro) the chest# The )ost !)portant "oal to !nclude !n a care plan !s the pat!ents "oal# .ru!ts are h!"h !n f!ber and low !n prote!n( and should be o)!tted fro) a low/res!due d!et# The nurse should use an ob%ect! e scale to assess and 6uant!fy pa!n# >ostoperat! e pa!n ar!es "reatly a)on" !nd! !duals# >ost)orte) care !ncludes clean!n" and prepar!n" the deceased pat!ent for fa)!ly !ew!n"( arran"!n" transportat!on to the )or"ue or funeral ho)e( and deter)!n!n" the d!spos!t!on of belon"!n"s# The nurse should pro !de honest answers to the pat!ents 6uest!ons# -!l& shouldnt be !ncluded !n a clear l!6u!d d!et# $hen car!n" for an !nfant( a ch!ld( or a confused pat!ent( cons!stency !n nurs!n" personnel !s para)ount# The hypothala)us secretes asopress!n and o*ytoc!n( wh!ch are stored !n the p!tu!tary "land# The three )e)branes that enclose the bra!n and sp!nal cord are the dura )ater( p!a )ater( and arachno!d# A naso"astr!c tube !s used to re)o e flu!d and "as fro) the s)all !ntest!ne preoperat! ely or postoperat! ely# >sycholo"!sts( phys!cal therap!sts( and ch!ropractors arent author!0ed to wr!te prescr!pt!ons for dru"s# The area around a sto)a !s cleaned w!th )!ld soap and water# Je"etables ha e a h!"h f!ber content# The nurse should use a tubercul!n syr!n"e to ad)!n!ster a subcutaneous !n%ect!on of less than 1 )l#

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NURSING BULLETS _____________ ___________________________________________________________

.or adults( subcutaneous !n%ect!ons re6u!re a 3:G 19 needleN for !nfants( ch!ldren( elderly( or ery th!n pat!ents( they re6u!re a 3:G to 3DG S9 needle# Before ad)!n!ster!n" a dru"( the nurse should !dent!fy the pat!ent by chec&!n" the !dent!f!cat!on band and as&!n" the pat!ent to state h!s na)e# To clean the s&!n before an !n%ect!on( the nurse uses a ster!le alcohol swab to w!pe fro) the center of the s!te outward !n a c!rcular )ot!on# The nurse should !n%ect hepar!n deep !nto subcutaneous t!ssue at a O4/de"ree an"le +perpend!cular to the s&!n, to pre ent s&!n !rr!tat!on# If blood !s asp!rated !nto the syr!n"e before an I#-# !n%ect!on( the nurse should w!thdraw the needle( prepare another syr!n"e( and repeat the procedure# The nurse shouldnt cut the pat!ents ha!r w!thout wr!tten consent fro) the pat!ent or an appropr!ate relat! e# If bleed!n" occurs after an !n%ect!on( the nurse should apply pressure unt!l the bleed!n" stops# If bru!s!n" occurs( the nurse should )on!tor the s!te for an enlar"!n" he)ato)a# $hen pro !d!n" ha!r and scalp care( the nurse should be"!n co)b!n" at the end of the ha!r and wor& toward the head# The fre6uency of pat!ent ha!r care depends on the len"th and te*ture of the ha!r( the durat!on of hosp!tal!0at!on( and the pat!ents cond!t!on# >roper funct!on of a hear!n" a!d re6u!res careful handl!n" dur!n" !nsert!on and re)o al( re"ular clean!n" of the ear p!ece to pre ent wa* bu!ldup( and pro)pt replace)ent of dead batter!es# The hear!n" a!d thats )ar&ed w!th a blue dot !s for the left earN the one w!th a red dot !s for the r!"ht ear# A hear!n" a!d shouldnt be e*posed to heat or hu)!d!ty and shouldnt be !))ersed !n water# The nurse should !nstruct the pat!ent to a o!d us!n" ha!r spray wh!le wear!n" a hear!n" a!d# The f! e branches of phar)acolo"y are phar)aco&!net!cs( phar)acodyna)!cs( phar)acotherapeut!cs( to*!colo"y( and phar)aco"nosy# The nurse should re)o e heel protectors e ery = hours to !nspect the foot for s!"ns of s&!n brea&down# 'eat !s appl!ed to pro)ote asod!lat!on( wh!ch reduces pa!n caused by !nfla))at!on# A sutured sur"!cal !nc!s!on !s an e*a)ple of heal!n" by f!rst !ntent!on +heal!n" d!rectly( w!thout "ranulat!on,# 'eal!n" by secondary !ntent!on +heal!n" by "ranulat!on, !s closure of the wound when "ranulat!on t!ssue f!lls the defect and allows reep!thel!al!0at!on to occur( be"!nn!n" at the wound ed"es and cont!nu!n" to the center( unt!l the ent!re wound !s co ered# Lelo!d for)at!on !s an abnor)al!ty !n heal!n" thats character!0ed by o er"rowth of scar t!ssue at the wound s!te# The nurse should ad)!n!ster proca!ne pen!c!ll!n by deep I#-# !n%ect!on !n the upper outer port!on of the buttoc&s !n the adult or !n the )!dlateral th!"h !n the ch!ld# The nurse shouldnt )assa"e the !n%ect!on s!te# An ascend!n" colosto)y dra!ns flu!d feces# A descend!n" colosto)y dra!ns sol!d fecal )atter# A folded towel +scrotal br!d"e, can pro !de scrotal support for the pat!ent w!th scrotal ede)a caused by asecto)y( ep!d!dy)!t!s( or orch!t!s#

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$hen "! !n" an !n%ect!on to a pat!ent who has a bleed!n" d!sorder( the nurse should use a s)all/"au"e needle and apply pressure to the s!te for : )!nutes after the !n%ect!on# >latelets are the s)allest and )ost fra"!le for)ed ele)ent of the blood and are essent!al for coa"ulat!on# To !nsert a naso"astr!c tube( the nurse !nstructs the pat!ent to t!lt the head bac& sl!"htly and then !nserts the tube# $hen the nurse feels the tube cur !n" at the pharyn*( the nurse should tell the pat!ent to t!lt the head forward to close the trachea and open the esopha"us by swallow!n"# +S!ps of water can fac!l!tate th!s act!on#, .a)!l!es w!th lo ed ones !n !ntens! e care un!ts report that the!r four )ost !)portant needs are to ha e the!r 6uest!ons answered honestly( to be assured that the best poss!ble care !s be!n" pro !ded( to &now the pat!ents pro"nos!s( and to feel that there !s hope of reco ery# 5ouble/b!nd co))un!cat!on occurs when the erbal )essa"e contrad!cts the non erbal )essa"e and the rece! er !s unsure of wh!ch )essa"e to respond to# A non%ud")ental att!tude d!splayed by a nurse shows that she ne!ther appro es nor d!sappro es of the pat!ent# Tar"et sy)pto)s are those that the pat!ent f!nds )ost d!stress!n"# A pat!ent should be ad !sed to ta&e asp!r!n on an e)pty sto)ach( w!th a full "lass of water( and should a o!d ac!d!c foods such as coffee( c!trus fru!ts( and cola# .or e ery pat!ent proble)( there !s a nurs!n" d!a"nos!sN for e ery nurs!n" d!a"nos!s( there !s a "oalN and for e ery "oal( there are !nter ent!ons des!"ned to )a&e the "oal a real!ty# The &eys to answer!n" e*a)!nat!on 6uest!ons correctly are !dent!fy!n" the proble) presented( for)ulat!n" a "oal for the proble)( and select!n" the !nter ent!on fro) the cho!ces pro !ded that w!ll enable the pat!ent to reach that "oal# .!del!ty )eans loyalty and can be shown as a co))!t)ent to the profess!on of nurs!n" and to the pat!ent# Ad)!n!ster!n" an I#-# !n%ect!on a"a!nst the pat!ents w!ll and w!thout le"al author!ty !s battery# An e*a)ple of a th!rd/party payer !s an !nsurance co)pany# The for)ula for calculat!n" the drops per )!nute for an I#J# !nfus!on !s as followsI + olu)e to be !nfused R dr!p factor, T t!)e !n )!nutes U drops<)!nute Hn/call )ed!cat!on should be "! en w!th!n : )!nutes of the call# Usually( the best )ethod to deter)!ne a pat!ents cultural or sp!r!tual needs !s to as& h!)# An !nc!dent report or unusual occurrence report !snt part of a pat!ents record( but !s an !n/house docu)ent thats used for the purpose of correct!n" the proble)# ;r!t!cal pathways are a )ult!d!sc!pl!nary "u!del!ne for pat!ent care# $hen pr!or!t!0!n" nurs!n" d!a"noses( the follow!n" h!erarchy should be usedI >roble)s assoc!ated w!th the a!rway( those concern!n" breath!n"( and those related to c!rculat!on# The two nurs!n" d!a"noses that ha e the h!"hest pr!or!ty that the nurse can ass!"n are Ineffect! e a!rway clearance and Ineffect! e breath!n" pattern# A sub%ect! e s!"n that a s!t0 bath has been effect! e !s the pat!ents e*press!on of decreased pa!n or d!sco)fort#

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.or the nurs!n" d!a"nos!s 5ef!c!ent d! ers!onal act! !ty to be al!d( the pat!ent )ust state that hes ?bored(@ that he has ?noth!n" to do(@ or words to that effect# The )ost appropr!ate nurs!n" d!a"nos!s for an !nd! !dual who doesnt spea& En"l!sh !s I)pa!red erbal co))un!cat!on related to !nab!l!ty to spea& do)!nant lan"ua"e +En"l!sh,# The fa)!ly of a pat!ent who has been d!a"nosed as hear!n" !)pa!red should be !nstructed to face the !nd! !dual when they spea& to h!)# Before !nst!ll!n" )ed!cat!on !nto the ear of a pat!ent who !s up to a"e F( the nurse should pull the p!nna down and bac& to stra!"hten the eustach!an tube# To pre ent !n%ury to the cornea when ad)!n!ster!n" eyedrops( the nurse should waste the f!rst drop and !nst!ll the dru" !n the lower con%unct! al sac# After ad)!n!ster!n" eye o!nt)ent( the nurse should tw!st the )ed!cat!on tube to detach the o!nt)ent# $hen the nurse re)o es "lo es and a )as&( she should re)o e the "lo es f!rst# They are so!led and are l!&ely to conta!n patho"ens# ;rutches should be placed 29 +1:#3 c), !n front of the pat!ent and 29 to the s!de to for) a tr!pod arran"e)ent# L!sten!n" !s the )ost effect! e co))un!cat!on techn!6ue# Before teach!n" any procedure to a pat!ent( the nurse )ust assess the pat!ents current &nowled"e and w!ll!n"ness to learn# >rocess record!n" !s a )ethod of e aluat!n" ones co))un!cat!on effect! eness# $hen feed!n" an elderly pat!ent( the nurse should l!)!t h!"h/carbohydrate foods because of the r!s& of "lucose !ntolerance# $hen feed!n" an elderly pat!ent( essent!al foods should be "! en f!rst# >ass! e ran"e of )ot!on )a!nta!ns %o!nt )ob!l!ty# Res!st! e e*erc!ses !ncrease )uscle )ass# Iso)etr!c e*erc!ses are perfor)ed on an e*tre)!ty thats !n a cast# A bac& rub !s an e*a)ple of the "ate/control theory of pa!n# Anyth!n" thats located below the wa!st !s cons!dered unster!leN a ster!le f!eld beco)es unster!le when !t co)es !n contact w!th any unster!le !te)N a ster!le f!eld )ust be )on!tored cont!nuouslyN and a border of 19 +3#: c), around a ster!le f!eld !s cons!dered unster!le# A ?sh!ft to the left@ !s e !dent when the nu)ber of !))ature cells +bands, !n the blood !ncreases to f!"ht an !nfect!on# A ?sh!ft to the r!"ht@ !s e !dent when the nu)ber of )ature cells !n the blood !ncreases( as seen !n ad anced l! er d!sease and pern!c!ous ane)!a# Before ad)!n!ster!n" preoperat! e )ed!cat!on( the nurse should ensure that an !nfor)ed consent for) has been s!"ned and attached to the pat!ents record# A nurse should spend no )ore than F4 )!nutes per =/hour sh!ft pro !d!n" care to a pat!ent who has a rad!at!on !)plant# A nurse shouldnt be ass!"ned to care for )ore than one pat!ent who has a rad!at!on !)plant#

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Lon"/handled forceps and a lead/l!ned conta!ner should be a a!lable !n the roo) of a pat!ent who has a rad!at!on !)plant# Usually( pat!ents who ha e the sa)e !nfect!on and are !n str!ct !solat!on can share a roo)# 5!seases that re6u!re str!ct !solat!on !nclude ch!c&enpo*( d!phther!a( and !ral he)orrha"!c fe ers such as -arbur" d!sease# .or the pat!ent who ab!des by Aew!sh custo)( )!l& and )eat shouldnt be ser ed at the sa)e )eal# $hether the pat!ent can perfor) a procedure +psycho)otor do)a!n of learn!n", !s a better !nd!cator of the effect! eness of pat!ent teach!n" than whether the pat!ent can s!)ply state the steps !n ol ed !n the procedure +co"n!t! e do)a!n of learn!n",# Accord!n" to Er!& Er!&son( de elop)ental sta"es are trust ersus )!strust +b!rth to 1= )onths,( autono)y ersus sha)e and doubt +1= )onths to a"e F,( !n!t!at! e ersus "u!lt +a"es F to :,( !ndustry ersus !nfer!or!ty +a"es : to 13,( !dent!ty ersus !dent!ty d!ffus!on +a"es 13 to 1=,( !nt!)acy ersus !solat!on +a"es 1= to 3:,( "enerat! !ty ersus sta"nat!on +a"es 3: to 24,( and e"o !nte"r!ty ersus despa!r +older than a"e 24,# $hen co))un!cat!n" w!th a hear!n" !)pa!red pat!ent( the nurse should face h!)# An appropr!ate nurs!n" !nter ent!on for the spouse of a pat!ent who has a ser!ous !ncapac!tat!n" d!sease !s to help h!) to )ob!l!0e a support syste)# 'yperpyre*!a !s e*tre)e ele at!on !n te)perature abo e 142C . +E1#1C ;,# -!l& !s h!"h !n sod!u) and low !n !ron# $hen a pat!ent e*presses concern about a health/related !ssue( before address!n" the concern( the nurse should assess the pat!ents le el of &nowled"e# The )ost effect! e way to reduce a fe er !s to ad)!n!ster an ant!pyret!c( wh!ch lowers the te)perature set po!nt# $hen a pat!ent !s !ll( !ts essent!al for the )e)bers of h!s fa)!ly to )a!nta!n co))un!cat!on about h!s health needs#

Ethnocentr!s) !s the un! ersal bel!ef that ones way of l!fe !s super!or to others#
$hen a nurse !s co))un!cat!n" w!th a pat!ent throu"h an !nterpreter( the nurse should spea& to the pat!ent and the !nterpreter# In accordance w!th the ?hot/cold@ syste) used by so)e -e*!cans( >uerto R!cans( and other '!span!c and Lat!no "roups( )ost foods( be era"es( herbs( and dru"s are descr!bed as ?cold#@ >re%ud!ce !s a host!le att!tude toward !nd! !duals of a part!cular "roup# 5!scr!)!nat!on !s preferent!al treat)ent of !nd! !duals of a part!cular "roup# Its usually d!scussed !n a ne"at! e sense# Increased "astr!c )ot!l!ty !nterferes w!th the absorpt!on of oral dru"s# The three phases of the therapeut!c relat!onsh!p are or!entat!on( wor&!n"( and ter)!nat!on# >at!ents often e*h!b!t res!st! e and challen"!n" beha !ors !n the or!entat!on phase of the therapeut!c relat!onsh!p# Abdo)!nal assess)ent !s perfor)ed !n the follow!n" orderI !nspect!on( auscultat!on( palpat!on( and percuss!on#

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$hen )easur!n" blood pressure !n a neonate( the nurse should select a cuff thats no less than one/half and no )ore than two/th!rds the len"th of the e*tre)!ty thats used# $hen ad)!n!ster!n" a dru" by 8/trac&( the nurse shouldnt use the sa)e needle that was used to draw the dru" !nto the syr!n"e because do!n" so could sta!n the s&!n# S!tes for !ntrader)al !n%ect!on !nclude the !nner ar)( the upper chest( and on the bac&( under the scapula# $hen e aluat!n" whether an answer on an e*a)!nat!on !s correct( the nurse should cons!der whether the act!on thats descr!bed pro)otes autono)y +!ndependence,( safety( self/estee)( and a sense of belon"!n"# $hen answer!n" a 6uest!on on the N;LE7 e*a)!nat!on( the student should cons!der the cue +the st!)ulus for a thou"ht, and the !nference +the thou"ht, to deter)!ne whether the !nference !s correct# $hen !n doubt( the nurse should select an answer that !nd!cates the need for further !nfor)at!on to el!)!nate a)b!"u!ty# .or e*a)ple( the pat!ent co)pla!ns of chest pa!n +the st!)ulus for the thou"ht, and the nurse !nfers that the pat!ent !s ha !n" card!ac pa!n +the thou"ht,# In th!s case( the nurse hasnt conf!r)ed whether the pa!n !s card!ac# It would be )ore appropr!ate to )a&e further assess)ents# Jerac!ty !s truth and !s an essent!al co)ponent of a therapeut!c relat!onsh!p between a health care pro !der and h!s pat!ent# Benef!cence !s the duty to do no har) and the duty to do "ood# Theres an obl!"at!on !n pat!ent care to do no har) and an e6ual obl!"at!on to ass!st the pat!ent# Non)alef!cence !s the duty to do no har)# .ryes AB;5E cascade pro !des a fra)ewor& for pr!or!t!0!n" care by !dent!fy!n" the )ost !)portant treat)ent concerns# A U A!rway# Th!s cate"ory !ncludes e eryth!n" that affects a patent a!rway( !nclud!n" a fore!"n ob%ect( flu!d fro) an upper resp!ratory !nfect!on( and ede)a fro) trau)a or an aller"!c react!on# B U Breath!n"# Th!s cate"ory !ncludes e eryth!n" that affects the breath!n" pattern( !nclud!n" hyper ent!lat!on or hypo ent!lat!on and abnor)al breath!n" patterns( such as Lorsa&offs( B!ots( or ;heyne/Sto&es resp!rat!on# ; U ;!rculat!on# Th!s cate"ory !ncludes e eryth!n" that affects the c!rculat!on( !nclud!n" flu!d and electrolyte d!sturbances and d!sease processes that affect card!ac output# 5 U 5!sease processes# If the pat!ent has no proble) w!th the a!rway( breath!n"( or c!rculat!on( then the nurse should e aluate the d!sease processes( "! !n" pr!or!ty to the d!sease process that poses the "reatest !))ed!ate r!s&# .or e*a)ple( !f a pat!ent has ter)!nal cancer and hypo"lyce)!a( hypo"lyce)!a !s a )ore !))ed!ate concern# E U E eryth!n" else# Th!s cate"ory !ncludes such !ssues as wr!t!n" an !nc!dent report and co)plet!n" the pat!ent chart# $hen e aluat!n" needs( th!s cate"ory !s ne er the h!"hest pr!or!ty# $hen answer!n" a 6uest!on on an N;LE7 e*a)!nat!on( the bas!c rule !s ?assess before act!on#@ The student should e aluate each poss!ble answer carefully# Usually( se eral answers reflect the !)ple)entat!on phase of nurs!n" and one or two reflect the assess)ent phase# In th!s case( the best cho!ce !s an assess)ent response unless a spec!f!c course of act!on !s clearly !nd!cated# Rule ut!l!tar!an!s) !s &nown as the ?"reatest "ood for the "reatest nu)ber of people@ theory# E"al!tar!an theory e)phas!0es that e6ual access to "oods and ser !ces )ust be pro !ded to the less fortunate by an affluent soc!ety# Act! e euthanas!a !s act! ely help!n" a person to d!e# Bra!n death !s !rre ers!ble cessat!on of all bra!n funct!on#

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>ass! e euthanas!a !s stopp!n" the therapy thats susta!n!n" l!fe# A th!rd/party payer !s an !nsurance co)pany# Ut!l!0at!on re !ew !s perfor)ed to deter)!ne whether the care pro !ded to a pat!ent was appropr!ate and cost/effect! e# A alue cohort !s a "roup of people who e*per!enced an out/of/the/ord!nary e ent that shaped the!r alues# Joluntary euthanas!a !s act! ely help!n" a pat!ent to d!e at the pat!ents re6uest# Bananas( c!trus fru!ts( and potatoes are "ood sources of potass!u)# Good sources of )a"nes!u) !nclude f!sh( nuts( and "ra!ns# Beef( oysters( shr!)p( scallops( sp!nach( beets( and "reens are "ood sources of !ron# Intrathecal !n%ect!on !s ad)!n!ster!n" a dru" throu"h the sp!ne# $hen a pat!ent as&s a 6uest!on or )a&es a state)ent thats e)ot!onally char"ed( the nurse should respond to the e)ot!on beh!nd the state)ent or 6uest!on rather than to whats be!n" sa!d or as&ed# The steps of the tra%ectory/nurs!n" )odel are as followsI Step 1I Ident!fy!n" the tra%ectory phase Step 3I Ident!fy!n" the proble)s and establ!sh!n" "oals Step FI Establ!sh!n" a plan to )eet the "oals Step EI Ident!fy!n" factors that fac!l!tate or h!nder atta!n)ent of the "oals Step :I I)ple)ent!n" !nter ent!ons Step 2I E aluat!n" the effect! eness of the !nter ent!ons

A '!ndu pat!ent !s l!&ely to re6uest a e"etar!an d!et# >a!n threshold( or pa!n sensat!on( !s the !n!t!al po!nt at wh!ch a pat!ent feels pa!n# The d!fference between acute pa!n and chron!c pa!n !s !ts durat!on# Referred pa!n !s pa!n thats felt at a s!te other than !ts or!"!n# Alle !at!n" pa!n by perfor)!n" a bac& )assa"e !s cons!stent w!th the "ate control theory# Ro)ber"s test !s a test for balance or "a!t# >a!n see)s )ore !ntense at n!"ht because the pat!ent !snt d!stracted by da!ly act! !t!es# Hlder pat!ents co))only dont report pa!n because of fear of treat)ent( l!festyle chan"es( or dependency# No por& or por& products are allowed !n a -usl!) d!et# Two "oals of 'ealthy >eople 3414 areI 'elp !nd! !duals of all a"es to !ncrease the 6ual!ty of l!fe and the nu)ber of years of opt!)al health El!)!nate health d!spar!t!es a)on" d!fferent se")ents of the populat!on# A co))un!ty nurse !s ser !n" as a pat!ents ad ocate !f she tells a )alnour!shed pat!ent to "o to a )eal pro"ra) at a local par&# If a pat!ent !snt follow!n" h!s treat)ent plan( the nurse should f!rst as& why#

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.alls are the lead!n" cause of !n%ury !n elderly people# >r!)ary pre ent!on !s true pre ent!on# E*a)ples are !))un!0at!ons( we!"ht control( and s)o&!n" cessat!on# Secondary pre ent!on !s early detect!on# E*a)ples !nclude pur!f!ed prote!n der! at! e +>>5,( breast self/e*a)!nat!on( test!cular self/e*a)!nat!on( and chest 7/ray# Tert!ary pre ent!on !s treat)ent to pre ent lon"/ter) co)pl!cat!ons# A pat!ent !nd!cates that hes co)!n" to ter)s w!th ha !n" a chron!c d!sease when he says( ?I) ne er "o!n" to "et any better#@ Hn not!c!n" rel!"!ous art!facts and l!terature on a pat!ents n!"ht stand( a culturally aware nurse would as& the pat!ent the )ean!n" of the !te)s# A -e*!can pat!ent )ay re6uest the !nter ent!on of a curandero( or fa!th healer( who !n ol es the fa)!ly !n heal!n" the pat!ent# In an !nfant( the nor)al he)o"lob!n alue !s 13 "<dl# The n!tro"en balance est!)ates the d!fference between the !nta&e and use of prote!n# -ost of the absorpt!on of water occurs !n the lar"e !ntest!ne# -ost nutr!ents are absorbed !n the s)all !ntest!ne# $hen assess!n" a pat!ents eat!n" hab!ts( the nurse should as&( ?$hat ha e you eaten !n the last 3E hoursK@ A e"an d!et should !nclude an abundant supply of f!ber# A hypoton!c ene)a softens the feces( d!stends the colon( and st!)ulates per!stals!s# .!rst/)orn!n" ur!ne pro !des the best sa)ple to )easure "lucose( &etone( p'( and spec!f!c "ra !ty alues# To !nduce sleep( the f!rst step !s to )!n!)!0e en !ron)ental st!)ul!# Before )o !n" a pat!ent( the nurse should assess the pat!ents phys!cal ab!l!t!es and ab!l!ty to understand !nstruct!ons as well as the a)ount of stren"th re6u!red to )o e the pat!ent# To lose 1 lb +4#: &", !n 1 wee&( the pat!ent )ust decrease h!s wee&ly !nta&e by F(:44 calor!es +appro*!)ately :44 calor!es da!ly,# To lose 3 lb +1 &", !n 1 wee&( the pat!ent )ust decrease h!s wee&ly calor!c !nta&e by D(444 calor!es +appro*!)ately 1(444 calor!es da!ly,# To a o!d shear!n" force !n%ury( a pat!ent who !s co)pletely !))ob!le !s l!fted on a sheet# To !nsert a catheter fro) the nose throu"h the trachea for suct!on( the nurse should as& the pat!ent to swallow# J!ta)!n ; !s needed for colla"en product!on# Hnly the pat!ent can descr!be h!s pa!n accurately# ;utaneous st!)ulat!on creates the release of endorph!ns that bloc& the trans)!ss!on of pa!n st!)ul!#

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>at!ent/controlled anal"es!a !s a safe )ethod to rel!e e acute pa!n caused by sur"!cal !nc!s!on( trau)at!c !n%ury( labor and del! ery( or cancer# An As!an A)er!can or European A)er!can typ!cally places d!stance between h!)self and others when co))un!cat!n"# The pat!ent who bel!e es !n a sc!ent!f!c( or b!o)ed!cal( approach to health !s l!&ely to e*pect a dru"( treat)ent( or sur"ery to cure !llness# ;hron!c !llnesses occur !n ery youn" as well as )!ddle/a"ed and ery old people# The tra%ectory fra)ewor& for chron!c !llness states that preferences about da!ly l!fe act! !t!es affect treat)ent dec!s!ons# E*acerbat!ons of chron!c d!sease usually cause the pat!ent to see& treat)ent and )ay lead to hosp!tal!0at!on# School health pro"ra)s pro !de cost/effect! e health care for low/!nco)e fa)!l!es and those who ha e no health !nsurance# ;olle"!al!ty !s the pro)ot!on of collaborat!on( de elop)ent( and !nterdependence a)on" )e)bers of a profess!on# A chan"e a"ent !s an !nd! !dual who reco"n!0es a need for chan"e or !s selected to )a&e a chan"e w!th!n an establ!shed ent!ty( such as a hosp!tal# The pat!ents b!ll of r!"hts was !ntroduced by the A)er!can 'osp!tal Assoc!at!on# Abandon)ent !s pre)ature ter)!nat!on of treat)ent w!thout the pat!ents per)!ss!on and w!thout appropr!ate rel!ef of sy)pto)s# Jalues clar!f!cat!on !s a process that !nd! !duals use to pr!or!t!0e the!r personal alues# 5!str!but! e %ust!ce !s a pr!nc!ple that pro)otes e6ual treat)ent for all# -!l& and )!l& products( poultry( "ra!ns( and f!sh are "ood sources of phosphate# The best way to pre ent falls at n!"ht !n an or!ented( but restless( elderly pat!ent !s to ra!se the s!de ra!ls# By the end of the or!entat!on phase( the pat!ent should be"!n to trust the nurse# .alls !n the elderly are l!&ely to be caused by poor !s!on# Barr!ers to co))un!cat!on !nclude lan"ua"e def!c!ts( sensory def!c!ts( co"n!t! e !)pa!r)ents( structural def!c!ts( and paralys!s# The three ele)ents that are necessary for a f!re are heat( o*y"en( and co)bust!ble )ater!al# Sebaceous "lands lubr!cate the s&!n# To chec& for petech!ae !n a dar&/s&!nned pat!ent( the nurse should assess the oral )ucosa# To put on a ster!le "lo e( the nurse should p!c& up the f!rst "lo e at the folded border and ad%ust the f!n"ers when both "lo es are on# To !ncrease pat!ent co)fort( the nurse should let the alcohol dry before "! !n" an !ntra)uscular !n%ect!on# Treat)ent for a sta"e 1 ulcer on the heels !ncludes heel protectors#

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Se enth/5ay Ad ent!sts are usually e"etar!ans#

Endorph!ns are )orph!ne/l!&e substances that produce a feel!n" of well/be!n"#

>a!n tolerance !s the )a*!)u) a)ount and durat!on of pa!n that an !nd! !dual !s w!ll!n" to endure#

MATERNAL & CHILD HEALTH NURSING

Unl!&e false labor( true labor produces re"ular rhyth)!c contract!ons( abdo)!nal d!sco)fort( pro"ress! e descent of the fetus( bloody show( and pro"ress! e efface)ent and d!lat!on of the cer !*# To help a )other brea& the suct!on of her breast/feed!n" !nfant( the nurse should teach her to !nsert a f!n"er at the corner of the !nfants )outh#

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Ad)!n!ster!n" h!"h le els of o*y"en to a pre)ature neonate can cause bl!ndness as a result of retrolental f!broplas!a# A)n!oto)y !s art!f!c!al rupture of the a)n!ot!c )e)branes# 5ur!n" pre"nancy( we!"ht "a!n a era"es 3: to F4 lb +11 to 1F#: &",# Rubella has a terato"en!c effect on the fetus dur!n" the f!rst tr!)ester# It produces abnor)al!t!es !n up to E4G of cases w!thout !nterrupt!n" the pre"nancy# I))un!ty to rubella can be )easured by a he)a""lut!nat!on !nh!b!t!on test +rubella t!ter,# Th!s test !dent!f!es e*posure to rubella !nfect!on and deter)!nes suscept!b!l!ty !n pre"nant wo)en# In a wo)an( a t!ter "reater than 1I= !nd!cates !))un!ty# $hen used to descr!be the de"ree of fetal descent dur!n" labor( float!n" )eans the present!n" part !snt en"a"ed !n the pel !c !nlet( but !s freely )o able +ballotable, abo e the pel !c !nlet# $hen used to descr!be the de"ree of fetal descent( en"a"e)ent )eans when the lar"est d!a)eter of the present!n" part has passed throu"h the pel !c !nlet# .etal stat!on !nd!cates the locat!on of the present!n" part !n relat!on to the !sch!al sp!ne# Its descr!bed as V1( V3( VF( VE( or V: to !nd!cate the nu)ber of cent!)eters abo e the le el of the !sch!al sp!neN stat!on V: !s at the pel !c !nlet# .etal stat!on also !s descr!bed as M1( M3( MF( ME( or M: to !nd!cate the nu)ber of cent!)eters !t !s below the le el of the !sch!al sp!neN stat!on 4 !s at the le el of the !sch!al sp!ne# 5ur!n" the f!rst sta"e of labor( the s!de/ly!n" pos!t!on usually pro !des the "reatest de"ree of co)fort( althou"h the pat!ent )ay assu)e any co)fortable pos!t!on# 5ur!n" del! ery( !f the u)b!l!cal cord cant be loosened and sl!pped fro) around the neonates nec&( !t should be cla)ped w!th two cla)ps and cut between the cla)ps# An Ap"ar score of D to 14 !nd!cates no !))ed!ate d!stress( E to 2 !nd!cates )oderate d!stress( and 4 to F !nd!cates se ere d!stress# To el!c!t -oros refle*( the nurse holds the neonate !n both hands and suddenly( but "ently( drops the neonates head bac&ward# Nor)ally( the neonate abducts and e*tends all e*tre)!t!es b!laterally and sy))etr!cally( for)s a ; shape w!th the thu)b and foref!n"er( and f!rst adducts and then fle*es the e*tre)!t!es# >re"nancy/!nduced hypertens!on +preecla)ps!a, !s an !ncrease !n blood pressure of F4<1: )) '" o er basel!ne or blood pressure of 1E4<O: )) '" on two occas!ons at least 2 hours apart acco)pan!ed by ede)a and albu)!nur!a after 34 wee&s "estat!on# >os!t! e s!"ns of pre"nancy !nclude ultrasound e !dence( fetal heart tones( and fetal )o e)ent felt by the e*a)!ner +not usually present unt!l E )onths "estat!on Goodells s!"n !s soften!n" of the cer !*# Pu!c&en!n"( a presu)pt! e s!"n of pre"nancy( occurs between 12 and 1O wee&s "estat!on# H ulat!on ceases dur!n" pre"nancy# Any a"!nal bleed!n" dur!n" pre"nancy should be cons!dered a co)pl!cat!on unt!l pro en otherw!se# To est!)ate the date of del! ery us!n" NW"eles rule( the nurse counts bac&ward F )onths fro) the f!rst day of the last )enstrual per!od and then adds D days to th!s date#

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At 13 wee&s "estat!on( the fundus should be at the top of the sy)phys!s pub!s# ;ows )!l& shouldnt be "! en to !nfants youn"er than a"e 1 because !t has a low l!nole!c ac!d content and !ts prote!n !s d!ff!cult for !nfants to d!"est# If %aund!ce !s suspected !n a neonate( the nurse should e*a)!ne the !nfant under natural w!ndow l!"ht# If natural l!"ht !s una a!lable( the nurse should e*a)!ne the !nfant under a wh!te l!"ht# The three phases of a uter!ne contract!on are !ncre)ent( ac)e( and decre)ent# The !ntens!ty of a labor contract!on can be assessed by the !ndentab!l!ty of the uter!ne wall at the contract!ons pea&# Intens!ty !s "raded as )!ld +uter!ne )uscle !s so)ewhat tense,( )oderate +uter!ne )uscle !s )oderately tense,( or stron" +uter!ne )uscle !s boardl!&e,# ;hloas)a( the )as& of pre"nancy( !s p!")entat!on of a c!rcu)scr!bed area of s&!n +usually o er the br!d"e of the nose and chee&s, that occurs !n so)e pre"nant wo)en# The "yneco!d pel !s !s )ost !deal for del! ery# Hther types !nclude platypello!d +flat,( anthropo!d +apel!&e,( and andro!d +)alel!&e,# >re"nant wo)en should be ad !sed that there !s no safe le el of alcohol !nta&e# The fre6uency of uter!ne contract!ons( wh!ch !s )easured !n )!nutes( !s the t!)e fro) the be"!nn!n" of one contract!on to the be"!nn!n" of the ne*t# J!ta)!n L !s ad)!n!stered to neonates to pre ent he)orrha"!c d!sorders because a neonates !ntest!ne cant synthes!0e !ta)!n L# Before !nternal fetal )on!tor!n" can be perfor)ed( a pre"nant pat!ents cer !* )ust be d!lated at least 3 c)( the a)n!ot!c )e)branes )ust be ruptured( and the fetuss present!n" part +scalp or buttoc&s, )ust be at stat!on V1 or lower( so that a s)all electrode can be attached# .etal alcohol syndro)e presents !n the f!rst 3E hours after b!rth and produces lethar"y( se!0ures( poor suc&!n" refle*( abdo)!nal d!stent!on( and resp!ratory d!ff!culty# Jar!ab!l!ty !s any chan"e !n the fetal heart rate +.'R, fro) !ts nor)al rate of 134 to 124 beats<)!nute# Accelerat!on !s !ncreased .'RN decelerat!on !s decreased .'R# In a neonate( the sy)pto)s of hero!n w!thdrawal )ay be"!n se eral hours to E days after b!rth# In a neonate( the sy)pto)s of )ethadone w!thdrawal )ay be"!n D days to se eral wee&s after b!rth# In a neonate( the card!nal s!"ns of narcot!c w!thdrawal !nclude coarse( flapp!n" tre)orsN sleep!nessN restlessnessN prolon"ed( pers!stent( h!"h/p!tched cryN and !rr!tab!l!ty# The nurse should count a neonates resp!rat!ons for 1 full )!nute# ;hlorpro)a0!ne +Thora0!ne, !s used to treat neonates who are add!cted to narcot!cs# The nurse should pro !de a dar&( 6u!et en !ron)ent for a neonate who !s e*per!enc!n" narcot!c w!thdrawal# In a pre)ature neonate( s!"ns of resp!ratory d!stress !nclude nostr!l flar!n"( substernal retract!ons( and !nsp!ratory "runt!n"# Resp!ratory d!stress syndro)e +hyal!ne )e)brane d!sease, de elops !n pre)ature !nfants because the!r pul)onary al eol! lac& surfactant#

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$hene er an !nfant !s be!n" put down to sleep( the parent or care"! er should pos!t!on the !nfant on the bac&# +Re)e)ber bac& to sleep#, The )ale sper) contr!butes an 7 or a X chro)oso)eN the fe)ale o u) contr!butes an 7 chro)oso)e# .ert!l!0at!on produces a total of E2 chro)oso)es( !nclud!n" an 7X co)b!nat!on +)ale, or an 77 co)b!nat!on +fe)ale,# The percenta"e of water !n a neonates body !s about D=G to =4G# To perfor) nasotracheal suct!on!n" !n an !nfant( the nurse pos!t!ons the !nfant w!th h!s nec& sl!"htly hypere*tended !n a ?sn!ff!n"@ pos!t!on( w!th h!s ch!n up and h!s head t!lted bac& sl!"htly# Hr"ano"enes!s occurs dur!n" the f!rst tr!)ester of pre"nancy( spec!f!cally( days 1E to :2 of "estat!on# After b!rth( the neonates u)b!l!cal cord !s t!ed 19 +3#: c), fro) the abdo)!nal wall w!th a cotton cord( plast!c cla)p( or rubber band# Gra !da !s the nu)ber of pre"nanc!es a wo)an has had( re"ardless of outco)e# >ara !s the nu)ber of pre"nanc!es that reached !ab!l!ty( re"ardless of whether the fetus was del! ered al! e or st!llborn# A fetus !s cons!dered !able at 34 wee&s "estat!on# An ectop!c pre"nancy !s one that !)plants abnor)ally( outs!de the uterus# The f!rst sta"e of labor be"!ns w!th the onset of labor and ends w!th full cer !cal d!lat!on at 14 c)# The second sta"e of labor be"!ns w!th full cer !cal d!lat!on and ends w!th the neonates b!rth# The th!rd sta"e of labor be"!ns after the neonates b!rth and ends w!th e*puls!on of the placenta# In a full/ter) neonate( s&!n creases appear o er two/th!rds of the neonates feet# >reter) neonates ha e heel creases that co er less than two/th!rds of the feet# The fourth sta"e of labor +postpartu) stab!l!0at!on, lasts up to E hours after the placenta !s del! ered# Th!s t!)e !s needed to stab!l!0e the )others phys!cal and e)ot!onal state after the stress of ch!ldb!rth# At 34 wee&s "estat!on( the fundus !s at the le el of the u)b!l!cus# At F2 wee&s "estat!on( the fundus !s at the lower border of the r!b ca"e# A pre)ature neonate !s one born before the end of the FDth wee& of "estat!on# >re"nancy/!nduced hypertens!on !s a lead!n" cause of )aternal death !n the Un!ted States# A hab!tual aborter !s a wo)an who has had three or )ore consecut! e spontaneous abort!ons# Threatened abort!on occurs when bleed!n" !s present w!thout cer !cal d!lat!on# A co)plete abort!on occurs when all products of concept!on are e*pelled# 'ydra)n!os +polyhydra)n!os, !s e*cess! e a)n!ot!c flu!d +)ore than 3(444 )l !n the th!rd tr!)ester,# Stress( dehydrat!on( and fat!"ue )ay reduce a breast/feed!n" )others )!l& supply# 5ur!n" the trans!t!on phase of the f!rst sta"e of labor( the cer !* !s d!lated = to 14 c) and contract!ons usually occur 3 to F )!nutes apart and last for 24 seconds#

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A nonstress test !s cons!dered nonreact! e +pos!t! e, !f fewer than two fetal heart rate accelerat!ons of at least 1: beats<)!nute occur !n 34 )!nutes# A nonstress test !s cons!dered react! e +ne"at! e, !f two or )ore fetal heart rate accelerat!ons of 1: beats<)!nute abo e basel!ne occur !n 34 )!nutes# A nonstress test !s usually perfor)ed to assess fetal well/be!n" !n a pre"nant pat!ent w!th a prolon"ed pre"nancy +E3 wee&s or )ore,( d!abetes( a h!story of poor pre"nancy outco)es( or pre"nancy/!nduced hypertens!on# A pre"nant wo)an should dr!n& at least e!"ht =/o0 "lasses +about 3(444 )l, of water da!ly# $hen both breasts are used for breast/feed!n"( the !nfant usually doesnt e)pty the second breast# Therefore( the second breast should be used f!rst at the ne*t feed!n"# A low/b!rth/we!"ht neonate we!"hs 3(:44 " +: lb = o0, or less at b!rth# A ery/low/b!rth/we!"ht neonate we!"hs 1(:44 " +F lb : o0, or less at b!rth# $hen teach!n" parents to pro !de u)b!l!cal cord care( the nurse should teach the) to clean the u)b!l!cal area w!th a cotton ball saturated w!th alcohol after e ery d!aper chan"e to pre ent !nfect!on and pro)ote dry!n"# Teena"e )others are )ore l!&ely to ha e low/b!rth/we!"ht neonates because they see& prenatal care late !n pre"nancy +as a result of den!al, and are )ore l!&ely than older )others to ha e nutr!t!onal def!c!enc!es# L!nea n!"ra( a dar& l!ne that e*tends fro) the u)b!l!cus to the )ons pub!s( co))only appears dur!n" pre"nancy and d!sappears after pre"nancy# I)plantat!on !n the uterus occurs 2 to 14 days after o u) fert!l!0at!on# >lacenta pre !a !s abnor)ally low !)plantat!on of the placenta so that !t encroaches on or co ers the cer !cal os# In co)plete +total, placenta pre !a( the placenta co)pletely co ers the cer !cal os# In part!al +!nco)plete or )ar"!nal, placenta pre !a( the placenta co ers only a port!on of the cer !cal os# Abrupt!o placentae !s pre)ature separat!on of a nor)ally !)planted placenta# It )ay be part!al or co)plete( and usually causes abdo)!nal pa!n( a"!nal bleed!n"( and a boardl!&e abdo)en# ;ut!s )ar)orata !s )ottl!n" or purple d!scolorat!on of the s&!n# Its a trans!ent aso)otor response that occurs pr!)ar!ly !n the ar)s and le"s of !nfants who are e*posed to cold# The class!c tr!ad of sy)pto)s of preecla)ps!a are hypertens!on( ede)a( and prote!nur!a# Add!t!onal sy)pto)s of se ere preecla)ps!a !nclude hyperrefle*!a( cerebral and !s!on d!sturbances( and ep!"astr!c pa!n# Hrtolan!s s!"n +an aud!ble cl!c& or palpable %er& that occurs w!th th!"h abduct!on, conf!r)s con"en!tal h!p d!slocat!on !n a neonate# The f!rst !))un!0at!on for a neonate !s the hepat!t!s B acc!ne( wh!ch !s ad)!n!stered !n the nursery shortly after b!rth# If a pat!ent )!sses a )enstrual per!od wh!le ta&!n" an oral contracept! e e*actly as prescr!bed( she should cont!nue ta&!n" the contracept! e# If a pat!ent )!sses two consecut! e )enstrual per!ods wh!le ta&!n" an oral contracept! e( she should d!scont!nue the contracept! e and ta&e a pre"nancy test#

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If a pat!ent who !s ta&!n" an oral contracept! e )!sses a dose( she should ta&e the p!ll as soon as she re)e)bers or ta&e two at the ne*t scheduled !nter al and cont!nue w!th the nor)al schedule# If a pat!ent who !s ta&!n" an oral contracept! e )!sses two consecut! e doses( she should double the dose for 3 days and then resu)e her nor)al schedule# She also should use an add!t!onal b!rth control )ethod for 1 wee&# Ecla)ps!a !s the occurrence of se!0ures that arent caused by a cerebral d!sorder !n a pat!ent who has pre"nancy/!nduced hypertens!on# In placenta pre !a( bleed!n" !s pa!nless and seldo) fatal on the f!rst occas!on( but !t beco)es hea !er w!th each subse6uent ep!sode# Treat)ent for abrupt!o placentae !s usually !))ed!ate cesarean del! ery# 5ru"s used to treat w!thdrawal sy)pto)s !n neonates !nclude phenobarb!tal +Lu)!nal,( ca)phorated op!u) t!ncture +pare"or!c,( and d!a0epa) +Jal!u),# Infants w!th 5own syndro)e typ!cally ha e )ar&ed hypoton!a( flopp!ness( slanted eyes( e*cess s&!n on the bac& of the nec&( flattened br!d"e of the nose( flat fac!al features( spadel!&e hands( short and broad feet( s)all )ale "en!tal!a( absence of -oros refle*( and a s!)!an crease on the hands# The fa!lure rate of a contracept! e !s deter)!ned by the e*per!ence of 144 wo)en for 1 year# Its e*pressed as pre"nanc!es per 144 wo)an/years# The narrowest d!a)eter of the pel !c !nlet !s the anteroposter!or +d!a"onal con%u"ate,# The chor!on !s the outer)ost e*trae)bryon!c )e)brane that "! es r!se to the placenta# The corpus luteu) secretes lar"e 6uant!t!es of pro"esterone# .ro) the =th wee& of "estat!on throu"h del! ery( the de elop!n" cells are &nown as a fetus# In an !nco)plete abort!on( the fetus !s e*pelled( but parts of the placenta and )e)brane re)a!n !n the uterus# The c!rcu)ference of a neonates head !s nor)ally 3 to F c) "reater than the c!rcu)ference of the chest# After ad)!n!ster!n" )a"nes!u) sulfate to a pre"nant pat!ent for hypertens!on or preter) labor( the nurse should )on!tor the resp!ratory rate and deep tendon refle*es# 5ur!n" the f!rst hour after b!rth +the per!od of react! !ty,( the neonate !s alert and awa&e# $hen a pre"nant pat!ent has und!a"nosed a"!nal bleed!n"( a"!nal e*a)!nat!on should be a o!ded unt!l ultrasono"raphy rules out placenta pre !a# After del! ery( the f!rst nurs!n" act!on !s to establ!sh the neonates a!rway# Nurs!n" !nter ent!ons for a pat!ent w!th placenta pre !a !nclude pos!t!on!n" the pat!ent on her left s!de for )a*!)u) fetal perfus!on( )on!tor!n" fetal heart tones( and ad)!n!ster!n" I#J# flu!ds and o*y"en( as ordered# The spec!f!c "ra !ty of a neonates ur!ne !s 1#44F to 1#4F4# A lower spec!f!c "ra !ty su""ests o erhydrat!onN a h!"her one su""ests dehydrat!on# The neonatal per!od e*tends fro) b!rth to day 3=# Its also called the f!rst E wee&s or f!rst )onth of l!fe#

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A wo)an who !s breast/feed!n" should rub a )!ld e)oll!ent crea) or a few drops of breast )!l& +or colostru), on the n!pples after each feed!n"# She should let the breasts a!r/dry to pre ent the) fro) crac&!n"# Breast/feed!n" )others should !ncrease the!r flu!d !nta&e to 3S to F 6t +3(:44 to F(444 )l, da!ly# After feed!n" an !nfant w!th a cleft l!p or palate( the nurse should r!nse the !nfants )outh w!th ster!le water# The nurse !nst!lls erythro)yc!n !n a neonates eyes pr!)ar!ly to pre ent bl!ndness caused by "onorrhea or chla)yd!a# 'u)an !))unodef!c!ency !rus +'IJ, has been cultured !n breast )!l& and can be trans)!tted by an 'IJ/pos!t! e )other who breast/feeds her !nfant# A fe er !n the f!rst 3E hours postpartu) !s )ost l!&ely caused by dehydrat!on rather than !nfect!on# >reter) neonates or neonates who cant )a!nta!n a s&!n te)perature of at least OD#2C . +F2#EC ;, should rece! e care !n an !ncubator +Isolette, or a rad!ant war)er# In a rad!ant war)er( a heat/sens!t! e probe taped to the neonates s&!n act! ates the heater un!t auto)at!cally to )a!nta!n the des!red te)perature# 5ur!n" labor( the rest!n" phase between contract!ons !s at least F4 seconds# Loch!a rubra !s the a"!nal d!schar"e of al)ost pure blood that occurs dur!n" the f!rst few days after ch!ldb!rth# Loch!a serosa !s the serous a"!nal d!schar"e that occurs E to D days after ch!ldb!rth# Loch!a alba !s the a"!nal d!schar"e of decreased blood and !ncreased leu&ocytes thats the f!nal sta"e of loch!a# It occurs D to 14 days after ch!ldb!rth# ;olostru)( the precursor of )!l&( !s the f!rst secret!on fro) the breasts after del! ery# The len"th of the uterus !ncreases fro) 3S9 +2#F c), before pre"nancy to 13S9 +F3 c), at ter)# To est!)ate the true con%u"ate +the s)allest !nlet )easure)ent of the pel !s,( deduct 1#: c) fro) the d!a"onal con%u"ate +usually 13 c),# A true con%u"ate of 14#: c) enables the fetal head +usually 14 c), to pass# The s)allest outlet )easure)ent of the pel !s !s the !ntertuberous d!a)eter( wh!ch !s the trans erse d!a)eter between the !sch!al tuberos!t!es# Electron!c fetal )on!tor!n" !s used to assess fetal well/be!n" dur!n" labor# If co)pro)!sed fetal status !s suspected( fetal blood p' )ay be e aluated by obta!n!n" a scalp sa)ple# In an e)er"ency del! ery( enou"h pressure should be appl!ed to the e)er"!n" fetuss head to "u!de the descent and pre ent a rap!d chan"e !n pressure w!th!n the )olded fetal s&ull# After del! ery( a )ult!parous wo)an !s )ore suscept!ble to bleed!n" than a pr!)!parous wo)an because her uter!ne )uscles )ay be o erstretched and )ay not contract eff!c!ently# Neonates who are del! ered by cesarean b!rth ha e a h!"her !nc!dence of resp!ratory d!stress syndro)e# The nurse should su""est a)bulat!on to a postpartu) pat!ent who has "as pa!n and flatulence# -assa"!n" the uterus helps to st!)ulate contract!ons after the placenta !s del! ered# $hen pro !d!n" phototherapy to a neonate( the nurse should co er the neonates eyes and "en!tal area#

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The narcot!c anta"on!st nalo*one +Narcan, )ay be "! en to a neonate to correct resp!ratory depress!on caused by narcot!c ad)!n!strat!on to the )other dur!n" labor# In a neonate( sy)pto)s of resp!ratory d!stress syndro)e !nclude e*p!ratory "runt!n" or wh!n!n"( sandpaper breath sounds( and seesaw retract!ons# ;erebral palsy presents as asy))etr!cal )o e)ent( !rr!tab!l!ty( and e*cess! e( feeble cry!n" !n a lon"( th!n !nfant# The nurse should assess a breech/b!rth neonate for hydrocephalus( he)ato)as( fractures( and other ano)al!es caused by b!rth trau)a# $hen a pat!ent !s ad)!tted to the un!t !n act! e labor( the nurses f!rst act!on !s to l!sten for fetal heart tones# In a neonate( lon"( br!ttle f!n"erna!ls are a s!"n of post)atur!ty# 5es6ua)at!on +s&!n peel!n", !s co))on !n post)ature neonates# A )other should allow her !nfant to breast/feed unt!l the !nfant !s sat!sf!ed# The t!)e )ay ary fro) : to 34 )!nutes# N!tra0!ne paper !s used to test the p' of a"!nal d!schar"e to deter)!ne the presence of a)n!ot!c flu!d# A pre"nant pat!ent nor)ally "a!ns 3 to : lb +1 to 3#: &", dur!n" the f!rst tr!)ester and sl!"htly less than 1 lb +4#: &", per wee& dur!n" the last two tr!)esters# Neonatal %aund!ce !n the f!rst 3E hours after b!rth !s &nown as patholo"!cal %aund!ce and !s a s!"n of erythroblastos!s fetal!s# A class!c d!fference between abrupt!o placentae and placenta pre !a !s the de"ree of pa!n# Abrupt!o placentae causes pa!n( whereas placenta pre !a causes pa!nless bleed!n"# Because a )a%or role of the placenta !s to funct!on as a fetal lun"( any cond!t!on that !nterrupts nor)al blood flow to or fro) the placenta !ncreases fetal part!al pressure of arter!al carbon d!o*!de and decreases fetal p'# >rec!p!tate labor lasts for appro*!)ately F hours and ends w!th del! ery of the neonate# -ethyler"ono !ne +-ether"!ne, !s an o*ytoc!c a"ent used to pre ent and treat postpartu) he)orrha"e caused by uter!ne atony or sub!n olut!on# As e)er"ency treat)ent for e*cess! e uter!ne bleed!n"( 4#3 )" of )ethyler"ono !ne +-ether"!ne, !s !n%ected I#J# o er 1 )!nute wh!le the pat!ents blood pressure and uter!ne contract!ons are )on!tored# Bra*ton '!c&s contract!ons are usually felt !n the abdo)en and dont cause cer !cal chan"e# True labor contract!ons are felt !n the front of the abdo)en and bac& and lead to pro"ress! e cer !cal d!lat!on and efface)ent# The a era"e b!rth we!"ht of neonates born to )others who s)o&e !s 2 o0 +1D4 ", less than that of neonates born to nons)o&!n" )others# ;uldoscopy !s !sual!0at!on of the pel !c or"ans throu"h the poster!or a"!nal forn!*# The nurse should teach a pre"nant e"etar!an to obta!n prote!n fro) alternat! e sources( such as nuts( soybeans( and le"u)es# The nurse should !nstruct a pre"nant pat!ent to ta&e only prescr!bed prenatal !ta)!ns because o er/the/counter h!"h/ potency !ta)!ns )ay har) the fetus#

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'!"h/sod!u) foods can cause flu!d retent!on( espec!ally !n pre"nant pat!ents# A pre"nant pat!ent can a o!d const!pat!on and he)orrho!ds by add!n" f!ber to her d!et# If a fetus has late decelerat!ons +a s!"n of fetal hypo*!a,( the nurse should !nstruct the )other to l!e on her left s!de and then ad)!n!ster = to 14 L of o*y"en per )!nute by )as& or cannula# The nurse should not!fy the phys!c!an# The s!de/ly!n" pos!t!on re)o es pressure on the !nfer!or ena ca a# H*ytoc!n +>!toc!n, pro)otes lactat!on and uter!ne contract!ons# Lanu"o co ers the fetuss body unt!l about 34 wee&s "estat!on# Then !t be"!ns to d!sappear fro) the face( trun&( ar)s( and le"s( !n that order# In a neonate( hypo"lyce)!a causes te)perature !nstab!l!ty( hypoton!a( %!tter!ness( and se!0ures# >re)ature( post)ature( s)all/for/"estat!onal/a"e( and lar"e/for/"estat!onal/a"e neonates are suscept!ble to th!s d!sorder# Neonates typ!cally need to consu)e :4 to :: cal per pound of body we!"ht da!ly# Because o*ytoc!n +>!toc!n, st!)ulates powerful uter!ne contract!ons dur!n" labor( !t )ust be ad)!n!stered under close obser at!on to help pre ent )aternal and fetal d!stress# 5ur!n" fetal heart rate )on!tor!n"( ar!able decelerat!ons !nd!cate co)press!on or prolapse of the u)b!l!cal cord# ;yto)e"alo !rus !s the lead!n" cause of con"en!tal !ral !nfect!on# Tocolyt!c therapy !s !nd!cated !n pre)ature labor( but contra!nd!cated !n fetal death( fetal d!stress( or se ere he)orrha"e# Throu"h ultrasono"raphy( the b!ophys!cal prof!le assesses fetal well/be!n" by )easur!n" fetal breath!n" )o e)ents( "ross body )o e)ents( fetal tone( react! e fetal heart rate +nonstress test,( and 6ual!tat! e a)n!ot!c flu!d olu)e# A neonate whose )other has d!abetes should be assessed for hyper!nsul!n!s)# In a pat!ent w!th preecla)ps!a( ep!"astr!c pa!n !s a late sy)pto) and re6u!res !))ed!ate )ed!cal !nter ent!on# After a st!llb!rth( the )other should be allowed to hold the neonate to help her co)e to ter)s w!th the death# -old!n" !s the process by wh!ch the fetal head chan"es shape to fac!l!tate )o e)ent throu"h the b!rth canal# If a wo)an rece! es a sp!nal bloc& before del! ery( the nurse should )on!tor the pat!ents blood pressure closely# If a wo)an suddenly beco)es hypotens! e dur!n" labor( the nurse should !ncrease the !nfus!on rate of I#J# flu!ds as prescr!bed# The best techn!6ue for assess!n" %aund!ce !n a neonate !s to blanch the t!p of the nose or the area %ust abo e the u)b!l!cus# 5ur!n" fetal heart )on!tor!n"( early decelerat!on !s caused by co)press!on of the head dur!n" labor# After the placenta !s del! ered( the nurse )ay add o*ytoc!n +>!toc!n, to the pat!ents I#J# solut!on( as prescr!bed( to pro)ote postpartu) !n olut!on of the uterus and st!)ulate lactat!on# >!ca !s a cra !n" to eat nonfood !te)s( such as d!rt( crayons( chal&( "lue( starch( or ha!r# It )ay occur dur!n" pre"nancy and can endan"er the fetus# A pre"nant pat!ent should ta&e fol!c ac!d because th!s nutr!ent !s re6u!red for rap!d cell d! !s!on#

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A wo)an who !s ta&!n" clo)!phene +;lo)!d, to !nduce o ulat!on should be !nfor)ed of the poss!b!l!ty of )ult!ple b!rths w!th th!s dru"# If needed( cer !cal sutur!n" !s usually done between 1E and 1= wee&s "estat!on to re!nforce an !nco)petent cer !* and )a!nta!n pre"nancy# The sutur!n" !s typ!cally re)o ed by F: wee&s "estat!on# 5ur!n" the f!rst tr!)ester( a pre"nant wo)an should a o!d all dru"s unless do!n" so would ad ersely affect her health# -ost dru"s that a breast/feed!n" )other ta&es appear !n breast )!l&# The .ood and 5ru" Ad)!n!strat!on has establ!shed the follow!n" f! e cate"or!es of dru"s based on the!r potent!al for caus!n" b!rth defectsI A( no e !dence of r!s&N B( no r!s& found !n an!)als( but no stud!es ha e been done !n wo)enN ;( an!)al stud!es ha e shown an ad erse effect( but the dru" )ay be benef!c!al to wo)en desp!te the potent!al r!s&N 5( e !dence of r!s&( but !ts benef!ts )ay outwe!"h !ts r!s&sN and 7( fetal ano)al!es noted( and the r!s&s clearly outwe!"h the potent!al benef!ts# A pat!ent w!th a ruptured ectop!c pre"nancy co))only has sharp pa!n !n the lower abdo)en( w!th spott!n" and cra)p!n"# She )ay ha e abdo)!nal r!"!d!tyN rap!d( shallow resp!rat!onsN tachycard!aN and shoc&# A pat!ent w!th a ruptured ectop!c pre"nancy co))only has sharp pa!n !n the lower abdo)en( w!th spott!n" and cra)p!n"# She )ay ha e abdo)!nal r!"!d!tyN rap!d( shallow resp!rat!onsN tachycard!aN and shoc&# The )echan!cs of del! ery are en"a"e)ent( descent and fle*!on( !nternal rotat!on( e*tens!on( e*ternal rotat!on( rest!tut!on( and e*puls!on# A probable s!"n of pre"nancy( -c5onalds s!"n !s character!0ed by an ease !n fle*!n" the body of the uterus a"a!nst the cer !*# A)enorrhea !s a probable s!"n of pre"nancy# A pre"nant wo)ans partner should a o!d !ntroduc!n" a!r !nto the a"!na dur!n" oral se* because of the poss!b!l!ty of a!r e)bol!s)# The presence of hu)an chor!on!c "onadotrop!n !n the blood or ur!ne !s a probable s!"n of pre"nancy# Rad!o"raphy !snt usually used !n a pre"nant wo)an because !t )ay har) the de elop!n" fetus# If rad!o"raphy !s essent!al( !t should be perfor)ed only after F2 wee&s "estat!on# A pre"nant pat!ent who has had rupture of the )e)branes or who !s e*per!enc!n" a"!nal bleed!n" shouldnt en"a"e !n se*ual !ntercourse# -!l!a )ay occur as p!npo!nt spots o er a neonates nose# The durat!on of a contract!on !s t!)ed fro) the )o)ent that the uter!ne )uscle be"!ns to tense to the )o)ent that !t reaches full rela*at!on# Its )easured !n seconds# The un!on of a )ale and a fe)ale "a)ete produces a 0y"ote( wh!ch d! !des !nto the fert!l!0ed o u)# The f!rst )enstrual flow !s called )enarche and )ay be ano ulatory +!nfert!le,# Sper)ato0oa +or the!r fra")ents, re)a!n !n the a"!na for D3 hours after se*ual !ntercourse# >rolact!n st!)ulates and susta!ns )!l& product!on# Strab!s)us !s a nor)al f!nd!n" !n a neonate#

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A postpartu) pat!ent )ay resu)e se*ual !ntercourse after the per!neal or uter!ne wounds heal +usually w!th!n E wee&s after del! ery,# A pre"nant staff )e)ber shouldnt be ass!"ned to wor& w!th a pat!ent who has cyto)e"alo !rus !nfect!on because the !rus can be trans)!tted to the fetus# .etal de)!se !s death of the fetus after !ab!l!ty# Resp!ratory d!stress syndro)e de elops !n pre)ature neonates because the!r al eol! lac& surfactant# The )ost co))on )ethod of !nduc!n" labor after art!f!c!al rupture of the )e)branes !s o*ytoc!n +>!toc!n, !nfus!on# After the a)n!ot!c )e)branes rupture( the !n!t!al nurs!n" act!on !s to assess the fetal heart rate# The )ost co))on reasons for cesarean b!rth are )alpresentat!on( fetal d!stress( cephalopel !c d!sproport!on( pre"nancy/ !nduced hypertens!on( pre !ous cesarean b!rth( and !nade6uate pro"ress !n labor# A)n!ocentes!s !ncreases the r!s& of spontaneous abort!on( trau)a to the fetus or placenta( pre)ature labor( !nfect!on( and Rh sens!t!0at!on of the fetus# After a)n!ocentes!s( abdo)!nal cra)p!n" or spontaneous a"!nal bleed!n" )ay !nd!cate co)pl!cat!ons# To pre ent her fro) de elop!n" Rh ant!bod!es( an Rh/ne"at! e pr!)!"ra !da should rece! e Rho+5, !))une "lobul!n +RhoGA-, after del! er!n" an Rh/pos!t! e neonate# If a pre"nant pat!ents test results are ne"at! e for "lucose but pos!t! e for acetone( the nurse should assess the pat!ents d!et for !nade6uate calor!c !nta&e# If a pre"nant pat!ents test results are ne"at! e for "lucose but pos!t! e for acetone( the nurse should assess the pat!ents d!et for !nade6uate calor!c !nta&e# Rubella !nfect!on !n a pre"nant pat!ent( espec!ally dur!n" the f!rst tr!)ester( can lead to spontaneous abort!on or st!llb!rth as well as fetal card!ac and other b!rth defects# A pre"nant pat!ent should ta&e an !ron supple)ent to help pre ent ane)!a# 5!rect ant!"lobul!n +d!rect ;oo)bs, test !s used to detect )aternal ant!bod!es attached to red blood cells !n the neonate# Nausea and o)!t!n" dur!n" the f!rst tr!)ester of pre"nancy are caused by r!s!n" le els of the hor)one hu)an chor!on!c "onadotrop!n# Before d!schar"!n" a pat!ent who has had an abort!on( the nurse should !nstruct her to report br!"ht red clots( bleed!n" that lasts lon"er than D days( or s!"ns of !nfect!on( such as a te)perature of "reater than 144C . +FD#=C ;,( foul/s)ell!n" a"!nal d!schar"e( se ere uter!ne cra)p!n"( nausea( or o)!t!n"# $hen !nfor)ed that a pat!ents a)n!ot!c )e)brane has bro&en( the nurse should chec& fetal heart tones and then )aternal !tal s!"ns# The durat!on of pre"nancy a era"es 3=4 days( E4 wee&s( O calendar )onths( or 14 lunar )onths# The !n!t!al we!"ht loss for a healthy neonate !s :G to 14G of b!rth we!"ht# The nor)al he)o"lob!n alue !n neonates !s 1D to 34 "<dl# ;rown!n" !s the appearance of the fetuss head when !ts lar"est d!a)eter !s enc!rcled by the ul o a"!nal r!n"#

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A )ult!para !s a wo)an who has had two or )ore pre"nanc!es that pro"ressed to !ab!l!ty( re"ardless of whether the offspr!n" were al! e at b!rth# In a pre"nant pat!ent( preecla)ps!a )ay pro"ress to ecla)ps!a( wh!ch !s character!0ed by se!0ures and )ay lead to co)a# The Ap"ar score !s used to assess the neonates !tal funct!ons# Its obta!ned at 1 )!nute and : )!nutes after del! ery# The score !s based on resp!ratory effort( heart rate( )uscle tone( refle* !rr!tab!l!ty( and color# Because of the ant!/!nsul!n effects of placental hor)ones( !nsul!n re6u!re)ents !ncrease dur!n" the th!rd tr!)ester# Gestat!onal a"e can be est!)ated by ultrasound )easure)ent of )aternal abdo)!nal c!rcu)ference( fetal fe)ur len"th( and fetal head s!0e# These )easure)ents are )ost accurate between 13 and 1= wee&s "estat!on# S&eletal syste) abnor)al!t!es and entr!cular septal defects are the )ost co))on d!sorders of !nfants who are born to d!abet!c wo)en# The !nc!dence of con"en!tal )alfor)at!on !s three t!)es h!"her !n these !nfants than !n those born to nond!abet!c wo)en# S&eletal syste) abnor)al!t!es and entr!cular septal defects are the )ost co))on d!sorders of !nfants who are born to d!abet!c wo)en# The !nc!dence of con"en!tal )alfor)at!on !s three t!)es h!"her !n these !nfants than !n those born to nond!abet!c wo)en# The pat!ent w!th preecla)ps!a usually has puff!ness around the eyes or ede)a !n the hands +for e*a)ple( ?I cant put )y wedd!n" r!n" on#@,# Le"el e*erc!ses re6u!re contract!on and rela*at!on of the per!neal )uscles# These e*erc!ses help stren"then pel !c )uscles and !)pro e ur!ne control !n postpartu) pat!ents# Sy)pto)s of postpartu) depress!on ran"e fro) )!ld postpartu) blues to !ntense( su!c!dal( depress! e psychos!s# The preter) neonate )ay re6u!re "a a"e feed!n"s because of a wea& suc&!n" refle*( uncoord!nated suc&!n"( or resp!ratory d!stress# Acrocyanos!s +blueness and coolness of the ar)s and le"s, !s nor)al !n neonates because of the!r !))ature per!pheral c!rculatory syste)# To pre ent ophthal)!a neonatoru) +a se ere eye !nfect!on caused by )aternal "onorrhea,( the nurse )ay ad)!n!ster one of three dru"s( as prescr!bed( !n the neonates eyesI tetracycl!ne( s!l er n!trate( or erythro)yc!n# Neonatal test!n" for phenyl&etonur!a !s )andatory !n )ost states# The nurse should place the neonate !n a F4/de"ree Trendelenbur" pos!t!on to fac!l!tate )ucus dra!na"e# The nurse )ay suct!on the neonates nose and )outh as needed w!th a bulb syr!n"e or suct!on trap# To pre ent heat loss( the nurse should place the neonate under a rad!ant war)er dur!n" suct!on!n" and !n!t!al del! ery/ roo) care( and then wrap the neonate !n a war)ed blan&et for transport to the nursery# The u)b!l!cal cord nor)ally has two arter!es and one e!n# $hen pro !d!n" care( the nurse should e*pose only one part of an !nfants body at a t!)e# L!"hten!n" !s settl!n" of the fetal head !nto the br!) of the pel !s# If the neonate !s stable( the )other should be allowed to breast/feed w!th!n the neonates f!rst hour of l!fe#

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The nurse should chec& the neonates te)perature e ery 1 to 3 hours unt!l !ts )a!nta!ned w!th!n nor)al l!)!ts# At b!rth( a neonate nor)ally we!"hs : to O lb +3 to E &",( )easures 1=9 to 339 +E:#: to :2 c), !n len"th( has a head c!rcu)ference of 1FS9 to 1E9 +FE to F:#: c),( and has a chest c!rcu)ference thats 19 +3#: c), less than the head c!rcu)ference# In the neonate( te)perature nor)ally ran"es fro) O=C to OOC . +F2#DC to FD#3C ;,( ap!cal pulse rate a era"es 134 to 124 beats<)!nute( and resp!rat!ons are E4 to 24 breaths<)!nute# The d!a)ond/shaped anter!or fontanel usually closes between a"es 13 and 1= )onths# The tr!an"ular poster!or fontanel usually closes by a"e 3 )onths# In the neonate( a stra!"ht sp!ne !s nor)al# A tuft of ha!r o er the sp!ne !s an abnor)al f!nd!n"# >rosta"land!n "el )ay be appl!ed to the a"!na or cer !* to r!pen an unfa orable cer !* before labor !nduct!on w!th o*ytoc!n +>!toc!n,# Supernu)erary n!pples are occas!onally seen on neonates# They usually appear alon" a l!ne that runs fro) each a*!lla( throu"h the nor)al n!pple area( and to the "ro!n# -econ!u) !s a )ater!al that collects !n the fetuss !ntest!nes and for)s the neonates f!rst feces( wh!ch are blac& and tarry# The presence of )econ!u) !n the a)n!ot!c flu!d dur!n" labor !nd!cates poss!ble fetal d!stress and the need to e aluate the neonate for )econ!u) asp!rat!on# To assess a neonates root!n" refle*( the nurse touches a f!n"er to the chee& or the corner of the )outh# Nor)ally( the neonate turns h!s head toward the st!)ulus( opens h!s )outh( and searches for the st!)ulus# 'arle6u!n s!"n !s present when a neonate who !s ly!n" on h!s s!de appears red on the dependent s!de and pale on the upper s!de# -on"ol!an spots can ran"e fro) brown to blue# The!r color depends on how close )elanocytes are to the surface of the s&!n# They )ost co))only appear as patches across the sacru)( buttoc&s( and le"s# -on"ol!an spots are co))on !n non/wh!te !nfants and usually d!sappear by a"e 3 to F years# Jern!* caseosa !s a cheesel!&e substance that co ers and protects the fetuss s&!n !n utero# It )ay be rubbed !nto the neonates s&!n or washed away !n one or two baths# ;aput succedaneu) !s ede)a that de elops !n and under the fetal scalp dur!n" labor and del! ery# It resol es spontaneously and presents no dan"er to the neonate# The ede)a doesnt cross the suture l!ne# Ne us fla))eus( or port/w!ne sta!n( !s a d!ffuse p!n& to dar& blu!sh red les!on on a neonates face or nec&# The Guthr!e test +a screen!n" test for phenyl&etonur!a, !s )ost rel!able !f !ts done between the second and s!*th days after b!rth and !s perfor)ed after the neonate has !n"ested prote!n# To assess coord!nat!on of suc&!n" and swallow!n"( the nurse should obser e the neonates f!rst breast/feed!n" or ster!le water bottle/feed!n"# To establ!sh a )!l& supply pattern( the )other should breast/feed her !nfant at least e ery E hours# 5ur!n" the f!rst )onth( she should breast/feed = to 13 t!)es da!ly +de)and feed!n",# To a o!d contact w!th blood and other body flu!ds( the nurse should wear "lo es when handl!n" the neonate unt!l after the f!rst bath !s "! en#

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If a breast/fed !nfant !s content( has "ood s&!n tur"or( an ade6uate nu)ber of wet d!apers( and nor)al we!"ht "a!n( the )others )!l& supply !s assu)ed to be ade6uate# In the sup!ne pos!t!on( a pre"nant pat!ents enlar"ed uterus !)pa!rs enous return fro) the lower half of the body to the heart( result!n" !n sup!ne hypotens! e syndro)e( or !nfer!or ena ca a syndro)e# Tocolyt!c a"ents used to treat preter) labor !nclude terbutal!ne +Breth!ne,( r!todr!ne +Xutopar,( and )a"nes!u) sulfate# A pre"nant wo)an who has hypere)es!s "ra !daru) )ay re6u!re hosp!tal!0at!on to treat dehydrat!on and star at!on# 5!aphra")at!c hern!a !s one of the )ost ur"ent neonatal sur"!cal e)er"enc!es# By co)press!n" and d!splac!n" the lun"s and heart( th!s d!sorder can cause resp!ratory d!stress shortly after b!rth# ;o))on co)pl!cat!ons of early pre"nancy +up to 34 wee&s "estat!on, !nclude fetal loss and ser!ous threats to )aternal health# .etal e)bod!)ent !s a )aternal de elop)ental tas& that occurs !n the second tr!)ester# 5ur!n" th!s sta"e( the )other )ay co)pla!n that she ne er "ets to sleep because the fetus always "! es her a thu)p when she tr!es# J!sual!0at!on !n pre"nancy !s a process !n wh!ch the )other !)a"!nes what the ch!ld shes carry!n" !s l!&e and beco)es ac6ua!nted w!th !t# 'e)od!lut!on of pre"nancy !s the !ncrease !n blood olu)e that occurs dur!n" pre"nancy# The !ncreased olu)e cons!sts of plas)a and causes an !)balance between the rat!o of red blood cells to plas)a and a resultant decrease !n he)atocr!t# -ean arter!al pressure of "reater than 144 )) '" after 34 wee&s of pre"nancy !s cons!dered hypertens!on# The treat)ent for sup!ne hypotens!on syndro)e +a cond!t!on that so)et!)es occurs !n pre"nancy, !s to ha e the pat!ent l!e on her left s!de# A contr!but!n" factor !n dependent ede)a !n the pre"nant pat!ent !s the !ncrease of fe)oral enous pressure fro) 14 )) '" +nor)al, to 1= )) '" +h!"h,# 'yperp!")entat!on of the pre"nant pat!ents face( for)erly called chloas)a and now referred to as )elas)a( fades after del! ery# The hor)one rela*!n( wh!ch !s secreted f!rst by the corpus luteu) and later by the placenta( rela*es the connect! e t!ssue and cart!la"e of the sy)phys!s pub!s and the sacro!l!ac %o!nt to fac!l!tate passa"e of the fetus dur!n" del! ery# >ro"esterone )a!nta!ns the !nte"r!ty of the pre"nancy by !nh!b!t!n" uter!ne )ot!l!ty# Lad!ns s!"n( an early !nd!cat!on of pre"nancy( causes soften!n" of a spot on the anter!or port!on of the uterus( %ust abo e the uterocer !cal %uncture# 5ur!n" pre"nancy( the abdo)!nal l!ne fro) the sy)phys!s pub!s to the u)b!l!cus chan"es fro) l!nea alba to l!nea n!"ra# In neonates( cold stress affects the c!rculatory( re"ulatory( and resp!ratory syste)s# Hbstetr!c data can be descr!bed by us!n" the .<T>AL syste)I .<TI .ull/ter) del! ery at F= wee&s or lon"er >I >reter) del! ery between 34 and FD wee&s AI Abort!on or loss of fetus before 34 wee&s LI Nu)ber of ch!ldren l! !n" +!f a ch!ld has d!ed( further e*planat!on !s needed to clar!fy the d!screpancy !n nu)bers,#

>ar!ty doesnt refer to the nu)ber of !nfants del! ered( only the nu)ber of del! er!es#

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$o)en who are carry!n" )ore than one fetus should be encoura"ed to "a!n F: to E: lb +1:#: to 34#: &", dur!n" pre"nancy# The reco))ended a)ount of !ron supple)ent for the pre"nant pat!ent !s F4 to 24 )" da!ly# 5r!n&!n" s!* alcohol!c be era"es a day or a s!n"le ep!sode of b!n"e dr!n&!n" !n the f!rst tr!)ester can cause fetal alcohol syndro)e# ;hor!on!c !llus sa)pl!n" !s perfor)ed at = to 13 wee&s of pre"nancy for early !dent!f!cat!on of "enet!c defects# In percutaneous u)b!l!cal blood sa)pl!n"( a blood sa)ple !s obta!ned fro) the u)b!l!cal cord to detect ane)!a( "enet!c defects( and blood !nco)pat!b!l!ty as well as to assess the need for blood transfus!ons# The per!od between contract!ons !s referred to as the !nter al( or rest!n" phase# 5ur!n" th!s phase( the uterus and placenta f!ll w!th blood and allow for the e*chan"e of o*y"en( carbon d!o*!de( and nutr!ents# In a pat!ent who has hyperton!c contract!ons( the uterus doesnt ha e an opportun!ty to rela* and there !s no !nter al between contract!ons# As a result( the fetus )ay e*per!ence hypo*!a or rap!d del! ery )ay occur# Two 6ual!t!es of the )yo)etr!u) are elast!c!ty( wh!ch allows !t to stretch yet )a!nta!n !ts tone( and contract!l!ty( wh!ch allows !t to shorten and len"then !n a synchron!0ed pattern# 5ur!n" crown!n"( the present!n" part of the fetus re)a!ns !s!ble dur!n" the !nter al between contract!ons# Uter!ne atony !s fa!lure of the uterus to re)a!n f!r)ly contracted# The )a%or cause of uter!ne atony !s a full bladder# If the )other w!shes to breast/feed( the neonate should be nursed as soon as poss!ble after del! ery# A s)ac&!n" sound( )!l& dr!pp!n" fro) the s!de of the )outh( and suc&!n" no!ses all !nd!cate !)proper place)ent of the !nfants )outh o er the n!pple# Before feed!n" !s !n!t!ated( an !nfant should be burped to e*pel a!r fro) the sto)ach# -ost author!t!es stron"ly encoura"e the cont!nuat!on of breast/feed!n" on both the affected and the unaffected breast of pat!ents w!th )ast!t!s# Neonates are nears!"hted and focus on !te)s that are held 149 to 139 +3: to F4#: c), away# In a neonate( low/set ears are assoc!ated w!th chro)oso)al abnor)al!t!es such as 5own syndro)e# -econ!u) !s usually passed !n the f!rst 3E hoursN howe er( passa"e )ay ta&e up to D3 hours# Boys who are born w!th hypospad!as shouldnt be c!rcu)c!sed at b!rth because the fores&!n )ay be needed for construct! e sur"ery# In the neonate( the nor)al blood "lucose le el !s E: to O4 )"<dl# 'epat!t!s B acc!ne !s usually "! en w!th!n E= hours of b!rth# 'epat!t!s B !))une "lobul!n !s usually "! en w!th!n 13 hours of b!rth# 'ELL> +he)olys!s( ele ated l! er en0y)es( and low platelets, syndro)e !s an unusual ar!at!on of pre"nancy/!nduced hypertens!on#

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NURSING BULLETS _____________ ___________________________________________________________

-aternal seru) alpha/fetoprote!n !s detectable at D wee&s of "estat!on and pea&s !n the th!rd tr!)ester# '!"h le els detected between the 12th and 1=th wee&s are assoc!ated w!th neural tube defects# Low le els are assoc!ated w!th 5own syndro)e# An arrest of descent occurs when the fetus doesnt descend throu"h the pel !c ca !ty dur!n" labor# Its co))only assoc!ated w!th cephalopel !c d!sproport!on( and cesarean del! ery )ay be re6u!red# A late s!"n of preecla)ps!a !s ep!"astr!c pa!n as a result of se ere l! er ede)a# In the pat!ent w!th preecla)ps!a( blood pressure returns to nor)al dur!n" the puerperal per!od# To obta!n an estr!ol le el( ur!ne !s collected for 3E hours# An estr!ol le el !s used to assess fetal well/be!n" and )aternal renal funct!on!n" as well as to )on!tor a pre"nancy thats co)pl!cated by d!abetes# A pre"nant pat!ent w!th a"!nal bleed!n" shouldnt ha e a pel !c e*a)!nat!on# In the early sta"es of pre"nancy( the f!nd!n" of "lucose !n the ur!ne )ay be related to the !ncreased shunt!n" of "lucose to the de elop!n" placenta( w!thout a correspond!n" !ncrease !n the reabsorpt!on capab!l!ty of the &!dneys# A pat!ent who has pre)ature rupture of the )e)branes !s at s!"n!f!cant r!s& for !nfect!on !f labor doesnt be"!n w!th!n 3E hours# Infants of d!abet!c )others are suscept!ble to )acroso)!a as a result of !ncreased !nsul!n product!on !n the fetus# To pre ent heat loss !n the neonate( the nurse should bathe one part of h!s body at a t!)e and &eep the rest of the body co ered# A pat!ent who has a cesarean del! ery !s at "reater r!s& for !nfect!on than the pat!ent who "! es b!rth a"!nally# The occurrence of thrush !n the neonate !s probably caused by contact w!th the or"an!s) dur!n" del! ery throu"h the b!rth canal# The nurse should &eep the sac of )en!n"o)yelocele )o!st w!th nor)al sal!ne solut!on# If fundal he!"ht !s at least 3 c) less than e*pected( the cause )ay be "rowth retardat!on( )!ssed abort!on( trans erse l!e( or false pre"nancy# .undal he!"ht that e*ceeds e*pectat!ons by )ore than 3 c) )ay be caused by )ult!ple "estat!on( polyhydra)n!os( uter!ne )yo)ata( or a lar"e baby# A )a%or de elop)ental tas& for a wo)an dur!n" the f!rst tr!)ester of pre"nancy !s accept!n" the pre"nancy# Unl!&e for)ula( breast )!l& offers the benef!t of )aternal ant!bod!es# Spontaneous rupture of the )e)branes !ncreases the r!s& of a prolapsed u)b!l!cal cord# A cl!n!cal )an!festat!on of a prolapsed u)b!l!cal cord !s ar!able decelerat!ons# 5ur!n" labor( to rel!e e sup!ne hypotens!on )an!fested by nausea and o)!t!n" and paleness( turn the pat!ent on her left s!de# If the o u) !s fert!l!0ed by a sper)ato0oon carry!n" a X chro)oso)e( a )ale 0y"ote !s for)ed#

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I)plantat!on occurs when the cellular walls of the blastocyte !)plants !tself !n the endo)etr!u)( usually D to O days after fert!l!0at!on# I)plantat!on occurs when the cellular walls of the blastocyte !)plants !tself !n the endo)etr!u)( usually D to O days after fert!l!0at!on# 'eart de elop)ent !n the e)bryo be"!ns at 3 to E wee&s and !s co)plete by the end of the e)bryon!c sta"e# -ether"!ne st!)ulates uter!ne contract!ons# The ad)!n!strat!on of fol!c ac!d dur!n" the early sta"es of "estat!on )ay pre ent neural tube defects# $!th ad anced )aternal a"e( a co))on "enet!c proble) !s 5own syndro)e# $!th early )aternal a"e( cephalopel !c d!sproport!on co))only occurs# In the early postpartu) per!od( the fundus should be )!dl!ne at the u)b!l!cus# A rubella acc!ne shouldnt be "! en to a pre"nant wo)an# The acc!ne can be ad)!n!stered after del! ery( but the pat!ent should be !nstructed to a o!d beco)!n" pre"nant for F )onths# A 12/year/old "!rl who !s pre"nant !s at r!s& for ha !n" a low/b!rth/we!"ht neonate# The )others Rh factor should be deter)!ned before an a)n!ocentes!s !s perfor)ed# -aternal hypotens!on !s a co)pl!cat!on of sp!nal bloc&# After del! ery( !f the fundus !s bo""y and de !ated to the r!"ht s!de( the pat!ent should e)pty her bladder# Before pro !d!n" a spec!)en for a sper) count( the pat!ent should a o!d e%aculat!on for E= to D3 hours# The hor)one hu)an chor!on!c "onadotrop!n !s a )ar&er for pre"nancy# >a!nless a"!nal bleed!n" dur!n" the last tr!)ester of pre"nancy )ay !nd!cate placenta pre !a# 5ur!n" the trans!t!on phase of labor( the wo)an usually !s !rr!table and restless# Because wo)en w!th d!abetes ha e a h!"her !nc!dence of b!rth ano)al!es than wo)en w!thout d!abetes( an alpha/ fetoprote!n le el )ay be ordered at 1: to 1D wee&s "estat!on# To a o!d punctur!n" the placenta( a a"!nal e*a)!nat!on shouldnt be perfor)ed on a pre"nant pat!ent who !s bleed!n"# A pat!ent who has postpartu) he)orrha"e caused by uter!ne atony should be "! en o*ytoc!n as prescr!bed# Lacerat!on of the a"!na( cer !*( or per!neu) produces br!"ht red bleed!n" that often co)es !n spurts# The bleed!n" !s cont!nuous( e en when the fundus !s f!r)# 'ot co)presses can help to rel!e e breast tenderness after breast/feed!n"# The fundus of a postpartu) pat!ent !s )assa"ed to st!)ulate contract!on of the uterus and pre ent he)orrha"e# A )other who has a pos!t! e hu)an !))unodef!c!ency !rus test result shouldnt breast/feed her !nfant# 5!noprostone +;er !d!l, !s used to r!pen the cer !*#

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Breast/feed!n" of a pre)ature neonate born at F3 wee&s "estat!on can be acco)pl!shed !f the )other e*presses )!l& and feeds the neonate by "a a"e# If a pre"nant pat!ents rubella t!ter !s less than 1I=( she should be !))un!0ed after del! ery# The ad)!n!strat!on of o*ytoc!n +>!toc!n, !s stopped !f the contract!ons are O4 seconds or lon"er# .or an e*tra)ural del! ery +one that ta&es place outs!de of a nor)al del! ery center,( the pr!or!t!es for care of the neonate !nclude )a!nta!n!n" a patent a!rway( support!n" efforts to breathe( )on!tor!n" !tal s!"ns( and )a!nta!n!n" ade6uate body te)perature# Sub!n olut!on )ay occur !f the bladder !s d!stended after del! ery# The nurse )ust place !dent!f!cat!on bands on both the )other and the neonate before they lea e the del! ery roo)# Erythro)yc!n !s "! en at b!rth to pre ent ophthal)!a neonatoru)# >el !c/t!lt e*erc!ses can help to pre ent or rel!e e bac&ache dur!n" pre"nancy# Before perfor)!n" a Leopold )aneu er( the nurse should as& the pat!ent to e)pty her bladder#

MEDICAL SURGICAL NURSING

In a pat!ent w!th hypo&ale)!a +seru) potass!u) le el below F#: )E6<L,( present!n" s!"ns and sy)pto)s !nclude )uscle wea&ness and card!ac arrhyth)!as# 5ur!n" card!ac arrest( !f an I#J# route !s una a!lable( ep!nephr!ne can be ad)!n!stered endotracheally# >ern!c!ous ane)!a results fro) the fa!lure to absorb !ta)!n B13 !n the GI tract and causes pr!)ar!ly GI and neurolo"!c s!"ns and sy)pto)s# A pat!ent who has a pressure ulcer should consu)e a h!"h/prote!n( h!"h/calor!e d!et( unless contra!nd!cated# The ;L/-B !soen0y)e le el !s used to assess t!ssue da)a"e !n )yocard!al !nfarct!on# After a 13/hour fast( the nor)al fast!n" blood "lucose le el !s =4 to 134 )"<dl# A pat!ent who !s e*per!enc!n" d!"o*!n to*!c!ty )ay report nausea( o)!t!n"( d!plop!a( blurred !s!on( l!"ht flashes( and yellow/"reen halos around !)a"es# Anur!a !s da!ly ur!ne output of less than 144 )l# In re)!ttent fe er( the body te)perature ar!es o er a 3E/hour per!od( but re)a!ns ele ated# R!s& of a fat e)bol!s) !s "reatest !n the f!rst E= hours after the fracture of a lon" bone# Its )an!fested by resp!ratory d!stress# To help enous blood return !n a pat!ent who !s !n shoc&( the nurse should ele ate the pat!ents le"s no )ore than E: de"rees# Th!s procedure !s contra!nd!cated !n a pat!ent w!th a head !n%ury# The pulse def!c!t !s the d!fference between the ap!cal and rad!al pulse rates( when ta&en s!)ultaneously by two nurses#

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To reduce the pat!ents r!s& of o)!t!n" and asp!rat!on( the nurse should schedule postural dra!na"e before )eals or 3 to E hours after )eals# Blood pressure can be )easured d!rectly by !ntra/arter!al !nsert!on of a catheter connected to a pressure/)on!tor!n" de !ce# A pos!t! e Lern!"s s!"n( seen !n )en!n"!t!s( occurs when an atte)pt to fle* the h!p of a recu)bent pat!ent causes pa!nful spas)s of the ha)str!n" )uscle and res!stance to further e*tens!on of the le" at the &nee# In a pat!ent w!th a fractured( d!slocated fe)ur( treat)ent be"!ns w!th reduct!on and !))ob!l!0at!on of the affected le"# 'ern!ated nucleus pulposus +!nter ertebral d!s&, )ost co))only occurs !n the lu)bar and lu)bosacral re"!ons# La)!necto)y !s sur"!cal re)o al of the hern!ated port!on of an !nter ertebral d!s&# Sur"!cal treat)ent of a "astr!c ulcer !ncludes se er!n" the a"us ner e + a"oto)y, to reduce the a)ount of "astr!c ac!d secreted by the "astr!c cells# Jalsal as )aneu er !s forced e*halat!on a"a!nst a closed "lott!s( as when ta&!n" a deep breath( blow!n" a!r out( or bear!n" down# $hen )ean arter!al pressure falls below 24 )) '" and systol!c blood pressure falls below =4 )) '"( !tal or"an perfus!on !s ser!ously co)pro)!sed# L!doca!ne +7yloca!ne, !s the dru" of cho!ce for reduc!n" pre)ature entr!cular contract!ons# A pat!ent !s at "reatest r!s& of dy!n" dur!n" the f!rst 3E to E= hours after a )yocard!al !nfarct!on# 5ur!n" a )yocard!al !nfarct!on( the left entr!cle usually susta!ns the "reatest da)a"e# The pa!n of a )yocard!al !nfarct!on results fro) )yocard!al !sche)!a caused by ano*!a# .or a pat!ent !n card!ac arrest( the f!rst pr!or!ty !s to establ!sh an a!rway# The un! ersal s!"n for cho&!n" !s clutch!n" the hand to the throat# .or a pat!ent who has heart fa!lure or card!o"en!c pul)onary ede)a( nurs!n" !nter ent!ons focus on decreas!n" enous return to the heart and !ncreas!n" left entr!cular output# These !nter ent!ons !nclude plac!n" the pat!ent !n h!"h .owlers pos!t!on and ad)!n!ster!n" o*y"en( d!uret!cs( and pos!t! e !notrop!c dru"s as prescr!bed# A pos!t! e tubercul!n s&!n test !s an !ndurat!on of 14 )) or "reater at the !n%ect!on s!te# The s!"ns and sy)pto)s of h!stoplas)os!s( a chron!c syste)!c fun"al !nfect!on( rese)ble those of tuberculos!s# In burn !ct!)s( the lead!n" cause of death !s resp!ratory co)pro)!se# The second lead!n" cause !s !nfect!on# The e*ocr!ne funct!on of the pancreas !s the secret!on of en0y)es used to d!"est carbohydrates( fats( and prote!ns# A pat!ent who has hepat!t!s A +!nfect!ous hepat!t!s, should consu)e a d!et thats )oderately h!"h !n fat and h!"h !n carbohydrate and prote!n( and should eat the lar"est )eal !n the )orn!n"# Esopha"eal balloon ta)ponade shouldnt be !nflated "reater than 34 )) '"# H erproduct!on of prolact!n by the p!tu!tary "land can cause "alactorrhea +e*cess! e or abnor)al lactat!on, and a)enorrhea +absence of )enstruat!on,# Inter)!ttent claud!cat!on +pa!n dur!n" a)bulat!on or other )o e)ent thats rel!e ed w!th rest, !s a class!c sy)pto) of arter!al !nsuff!c!ency !n the le"#

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In bladder carc!no)a( the )ost co))on f!nd!n" !s "ross( pa!nless he)atur!a# >arenteral ad)!n!strat!on of hepar!n sod!u) !s contra!nd!cated !n pat!ents w!th renal or l! er d!sease( GI bleed!n"( or recent sur"ery or trau)aN !n pre"nant pat!entsN and !n wo)en older than a"e 24# 5ru"s that potent!ate the effects of ant!coa"ulants !nclude asp!r!n( chloral hydrate( "luca"on( anabol!c stero!ds( and chlora)phen!col# .or a burn pat!ent( care pr!or!t!es !nclude )a!nta!n!n" a patent a!rway( pre ent!n" or correct!n" flu!d and electrolyte !)balances( controll!n" pa!n( and pre ent!n" !nfect!on# Elast!c stoc&!n"s should be worn on both le"s# Act! e !))un!0at!on !s the for)at!on of ant!bod!es w!th!n the body !n response to acc!nat!on or e*posure to d!sease# >ass! e !))un!0at!on !s ad)!n!strat!on of ant!bod!es that were prefor)ed outs!de the body# A pat!ent who !s rece! !n" d!"o*!n +Lano*!n, shouldnt rece! e a calc!u) preparat!on because of the !ncreased r!s& of d!"o*!n to*!c!ty# ;onco)!tant use )ay affect card!ac contract!l!ty and lead to arrhyth)!as# Inter)!ttent pos!t! e/pressure breath!n" !s !nflat!on of the lun" dur!n" !nsp!rat!on w!th co)pressed a!r or o*y"en# The "oal of th!s !nflat!on !s to &eep the lun" open# $r!stdrop !s caused by paralys!s of the e*tensor )uscles !n the forear) and hand# .ootdrop results fro) e*cess! e plantar fle*!on and !s usually a co)pl!cat!on of prolon"ed bed rest# A pat!ent who has "onorrhea )ay be treated w!th pen!c!ll!n and probenec!d +Bene)!d,# >robenec!d delays the e*cret!on of pen!c!ll!n and &eeps th!s ant!b!ot!c !n the body lon"er# In pat!ents who ha e "lucose/2/phosphate dehydro"enase +G2>5, def!c!ency( the red blood cells cant )etabol!0e ade6uate a)ounts of "lucose( and he)olys!s occurs# Hn/call )ed!cat!on !s )ed!cat!on that should be ready for !))ed!ate ad)!n!strat!on when the call to ad)!n!ster !ts rece! ed# If "a""!n"( nausea( or o)!t!n" occurs when an a!rway !s re)o ed( the nurse should place the pat!ent !n a lateral pos!t!on w!th the upper ar) supported on a p!llow# $hen a postoperat! e pat!ent arr! es !n the reco ery roo)( the nurse should pos!t!on the pat!ent on h!s s!de or w!th h!s head turned to the s!de and the ch!n e*tended# In the !))ed!ate postoperat! e per!od( the nurse should report a resp!ratory rate "reater than F4( te)perature "reater than 144C . +FD#=C ;, or below ODC . +F2#1C ;,( or a s!"n!f!cant drop !n blood pressure or r!se !n pulse rate fro) the basel!ne# Irre ers!ble bra!n da)a"e )ay occur !f the central ner ous syste) !s depr! ed of o*y"en for )ore than E )!nutes# Treat)ent for polycythe)!a era !ncludes ad)!n!ster!n" o*y"en( rad!o!sotope therapy( or che)otherapy a"ents( such as chlora)buc!l and n!tro"en )ustard( to suppress bone )arrow "rowth# A pat!ent w!th acute renal fa!lure should rece! e a h!"h/calor!e d!et thats low !n prote!n as well as potass!u) and sod!u)# Add!sons d!sease !s caused by hypofunct!on of the adrenal "land and !s character!0ed by fat!"ue( ane)!a( we!"ht loss( and bron0e s&!n p!")entat!on# $!thout cort!sol replace)ent therapy( !ts usually fatal# Glauco)a !s )ana"ed conser at! ely w!th beta/adrener"!c bloc&ers such as t!)olol +T!)opt!c,( wh!ch decrease sy)pathet!c !)pulses to the eye( and w!th )!ot!c eyedrops such as p!locarp!ne +Isopto ;arp!ne,( wh!ch constr!ct the pup!ls# -!ot!cs effect! ely treat "lauco)a by reduc!n" !ntraocular pressure# They do th!s by constr!ct!n" the pup!l( contract!n" the

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c!l!ary )uscles( open!n" the anter!or cha)ber an"le( and !ncreas!n" the outflow of a6ueous hu)or# $h!le a pat!ent !s rece! !n" hepar!n( the nurse should )on!tor the part!al thro)boplast!n t!)e# Ur!nary fre6uency( !ncont!nence( or both can occur after catheter re)o al# Incont!nence )ay be )an!fested as dr!bbl!n"# $hen teach!n" a pat!ent about colosto)y care( the nurse should !nstruct the pat!ent to han" the !rr!"at!on reser o!r 1=9 to 339 +E: to :: c), abo e the sto)a( !nsert the catheter 39 to E9 +: to 14 c), !nto the sto)a( !rr!"ate the sto)a w!th 1D to FE o0 +:4F to 1(44: )l, of water at a te)perature of 14:C to 114C . +E4C to EFC ;, once a day( clean the area around the sto)a w!th soap and water before apply!n" a new ba"( and use a protect! e s&!n co er!n"( such as a Sto)ahes! e wafer( &araya paste( or &araya r!n"( around the sto)a# The f!rst s!"n of 'od"&!ns d!sease !s pa!nless( superf!c!al ly)phadenopathy( typ!cally found under one ar) or on one s!de of the nec& !n the cer !cal cha!n# To d!fferent!ate true cyanos!s fro) depos!t!on of certa!n p!")ents( the nurse should press the s&!n o er the d!scolored area# ;yanot!c s&!n blanches( but p!")ented s&!n doesnt# A pat!ent who has a "astr!c ulcer !s )ost l!&ely to report pa!n dur!n" or shortly after eat!n"# $!den!n" pulse pressure !s a s!"n of !ncreas!n" !ntracran!al pressure# .or e*a)ple( the blood pressure )ay r!se fro) 134<=4 to 124<24 )) '"# In a burn !ct!)( a pr!)ary "oal of wound care !s to pre ent conta)!nat!on by )!croor"an!s)s# To pre ent e*ternal rotat!on !n a pat!ent who has had h!p na!l!n"( the nurse places trochanter rolls fro) the &nee to the an&le of the affected le"# Se ere h!p pa!n after the !nsert!on of a h!p prosthes!s !nd!cates d!slod")ent# If th!s occurs( before call!n" the phys!c!an( the nurse should assess the pat!ent for shorten!n" of the le"( e*ternal rotat!on( and absence of refle*es# As )uch as D:G of renal funct!on !s lost before blood urea n!tro"en and seru) creat!n!ne le els r!se abo e nor)al# $hen co)pensatory efforts are present !n ac!d/base balance( part!al pressure of arter!al carbon d!o*!de +>a;H3, and b!carbonate +';HFV, always po!nt !n the sa)e d!rect!onI p' >a;H3 ';HFV U resp!ratory ac!dos!s co)pensated p' >a;H3 ';HFV U resp!ratory al&alos!s co)pensated p' >a;H3 ';HFV U )etabol!c ac!dos!s co)pensated p' >a;H3 ';HFV U )etabol!c al&alos!s co)pensated# >olyur!a !s ur!ne output of 3(:44 )l or )ore w!th!n 3E hours# The present!n" s!"n of pleur!t!s !s chest pa!n that !s usually un!lateral and related to resp!ratory )o e)ent# If a pat!ent has a "astr!c dra!na"e tube !n place( the nurse should e*pect the phys!c!an to order potass!u) chlor!de# An !ncreased pulse rate !s one of the f!rst !nd!cat!ons of resp!ratory d!ff!culty# It occurs because the heart atte)pts to co)pensate for a decreased o*y"en supply to the t!ssues by pu)p!n" )ore blood# In an adult( a he)o"lob!n le el below 11 )"<dl su""ests !ron def!c!ency ane)!a and the need for further e aluat!on# The nor)al part!al pressure of o*y"en !n arter!al blood !s O: )) '" +plus or )!nus : )) '",# J!ta)!n ; def!c!ency !s character!0ed by br!ttle bones( p!npo!nt per!pheral he)orrha"es( and fr!able "u)s w!th loosened teeth# ;l!n!cal )an!festat!ons of pul)onary e)bol!s) are ar!able( but !ncreased resp!ratory rate( tachycard!a( and he)optys!s are

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co))on# Nor)ally( !ntraocular pressure !s 13 to 34 )) '"# It can be )easured w!th a Sch!Yt0 tono)eter# In early he)orrha"!c shoc&( blood pressure )ay be nor)al( but resp!ratory and pulse rates are rap!d# The pat!ent )ay report th!rst and )ay ha e cla))y s&!n and p!loerect!on +"oose bu)ps,# ;ool( )o!st( pale s&!n( as occurs !n shoc&( results fro) d! ers!on of blood fro) the s&!n to the )a%or or"ans# To assess cap!llary ref!ll( the nurse appl!es pressure o er the na!l bed unt!l blanch!n" occurs( 6u!c&ly releases the pressure( and notes the rate at wh!ch blanch!n" fades# ;ap!llary ref!ll !nd!cates perfus!on( wh!ch decreases !n shoc&( thereby len"then!n" ref!ll t!)e# Nor)al cap!llary ref!ll !s less than F seconds# E*cept for pat!ents w!th renal fa!lure( ur!ne output of less than F4 )l<hour s!"n!f!es dehydrat!on and the potent!al for shoc&# In elderly pat!ents( the )ost co))on fracture !s h!p fracture# Hsteoporos!s wea&ens the bones( pred!spos!n" these pat!ents to fracture( wh!ch usually results fro) a fall# Before an"!o"raphy( the nurse should as& the pat!ent whether hes aller"!c to the dye( shellf!sh( or !od!ne and ad !se h!) to ta&e noth!n" by )outh for = hours before the procedure# 5ur!n" )yelo"raphy( appro*!)ately 14 to 1: )l of cerebrosp!nal flu!d !s re)o ed for laboratory stud!es and an e6ual a)ount of contrast )ed!a !s !n%ected# After an"!o"raphy( the puncture s!te !s co ered w!th a pressure dress!n" and the affected part !s !))ob!l!0ed for = hours to decrease the r!s& of bleed!n"# If a water/based )ed!u) was used dur!n" )yelo"raphy( the pat!ent re)a!ns on bed rest for 2 to = hours( w!th the head of the bed ele ated F4 to E: de"rees# If an o!l/based )ed!u) was used( the pat!ent re)a!ns flat !n bed for 2 to 3E hours# The le el of a)putat!on !s deter)!ned by est!)at!n" the )a*!)u) !able t!ssue +t!ssue w!th ade6uate c!rculat!on, needed to de elop a funct!onal stu)p# 'epar!n sod!u) !s !ncluded !n the d!alysate used for renal d!alys!s# >aro*ys)al nocturnal dyspnea )ay !nd!cate heart fa!lure# A pat!ent who ta&es a card!ac "lycos!de( such as d!"o*!n( should consu)e a d!et that !ncludes h!"h/potass!u) foods# The nurse should l!)!t tracheobronch!al suct!on!n" to 14 to 1: seconds and should )a&e only two passes# Before perfor)!n" tracheobronch!al suct!on!n"( the nurse should ent!late and o*y"enate the pat!ent f! e to s!* t!)es w!th a resusc!tat!on ba" and 144G o*y"en# Th!s procedure !s called ba""!n"# S!"ns and sy)pto)s of pneu)othora* !nclude tachypnea( restlessness( hypotens!on( and tracheal de !at!on# The card!nal s!"n of to*!c shoc& syndro)e !s rap!d onset of a h!"h fe er# A &ey s!"n of pept!c ulcer !s he)ate)es!s( wh!ch can be br!"ht red or dar& red( w!th the cons!stency of coffee "rounds# S!"ns and sy)pto)s of a perforated pept!c ulcer !nclude sudden( se ere upper abdo)!nal pa!nN o)!t!n"N and an e*tre)ely tender( r!"!d +boardl!&e, abdo)en# ;onst!pat!on !s a co))on ad erse react!on to alu)!nu) hydro*!de# .or the f!rst 3E hours after a )yocard!al !nfarct!on( the pat!ent should use a beds!de co))ode and then pro"ress to wal&!n" to the to!let( bath!n"( and ta&!n" short wal&s#

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After a )yocard!al !nfarct!on( the pat!ent should a o!d o ere*ert!on and add a new act! !ty da!ly( as tolerated w!thout dyspnea# In a pat!ent w!th a recent )yocard!al !nfarct!on( frothy( blood/t!n"ed sputu) su""ests pul)onary ede)a# In a pat!ent who has ac6u!red !))unodef!c!ency syndro)e( the pr!)ary purpose of dru"s !s to pre ent secondary !nfect!ons# In a pat!ent w!th ac6u!red !))unodef!c!ency syndro)e( suppress!on of the !))une syste) !ncreases the r!s& of opportun!st!c !nfect!ons( such as cyto)e"alo !rus( >neu)ocyst!s car!n!! pneu)on!a( and thrush# A pat!ent w!th ac6u!red !))unodef!c!ency syndro)e )ay ha e rap!d we!"ht loss( a s!"n of wast!n" syndro)e# If the body doesnt use "lucose for ener"y( !t )etabol!0es fat and produces &etones# Appro*!)ately 34G of pat!ents w!th Gu!lla!n/BarrZ syndro)e ha e res!dual def!c!ts( such as )!ld )otor wea&ness or d!)!n!shed lower e*tre)!ty refle*es# 'ypertens!on and hypo&ale)!a are the )ost s!"n!f!cant cl!n!cal )an!festat!ons of pr!)ary hyperaldosteron!s)# After percutaneous asp!rat!on of the bladder( the pat!ents f!rst o!d !s usually p!n&N howe er( ur!ne w!th fran& blood should be reported to the phys!c!an# A ur!ne culture that "rows )ore than 144(444 colon!es of bacter!a per )!ll!l!ter of ur!ne !nd!cates !nfect!on# A pat!ent who !s under"o!n" d!alys!s should ta&e a !ta)!n supple)ent and eat foods that are h!"h !n calor!es( but low !n prote!n( sod!u)( and potass!u)# In a pat!ent who has chron!c obstruct! e pul)onary d!sease( the )ost effect! e ways to reduce th!c& secret!ons are to !ncrease flu!d !nta&e to 3(:44 )l<day and encoura"e a)bulat!on# The nurse should teach a pat!ent w!th e)physe)a how to perfor) pursed/l!p breath!n" because th!s slows e*p!rat!on( pre ents al eolar collapse( and helps to control the resp!ratory rate# ;lubb!n" of the d!"!ts and a barrel chest )ay de elop !n a pat!ent who has chron!c obstruct! e pul)onary d!sease# A stro&e +?bra!n attac&@, d!srupts the bra!ns blood supply and )ay be caused by hypertens!on# In a pat!ent who !s under"o!n" d!alys!s( des!red outco)es are nor)al we!"ht( nor)al seru) albu)!n le el +F#: to :#: "<dl,( and ade6uate prote!n !nta&e +1#3 to 1#: "<&" of body we!"ht da!ly,# Inter)!ttent per!toneal d!alys!s !n ol es perfor)!n" three to se en treat)ents that total E4 hours per wee&# In a pat!ent w!th chron!c obstruct! e pul)onary d!sease( the best way to ad)!n!ster o*y"en !s by nasal cannula# The nor)al flow rate !s 3 to F L< )!nute# Isoethar!ne +Bron&osol, can be ad)!n!stered w!th a handheld nebul!0er or by !nter)!ttent pos!t! e/pressure breath!n"# Bra!n death !s !rre ers!ble cessat!on of bra!n funct!on# ;ont!nuous a)bulatory per!toneal d!alys!s re6u!res four e*chan"es per day( D days per wee&( for a total of 12= hours per wee&# The class!c ad erse react!ons to ant!h!sta)!nes are dry )outh( drows!ness( and blurred !s!on# Because of the r!s& of paralyt!c !leus( a pat!ent who has rece! ed a "eneral anesthet!c cant ta&e anyth!n" by )outh unt!l act! e bowel sounds are heard !n all abdo)!nal 6uadrants#

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The le el of alpha/fetoprote!n( a tu)or )ar&er( !s ele ated !n pat!ents who ha e test!cular "er) cell cancer# ;l!n!cal )an!festat!ons of orch!t!s caused by bacter!a or )u)ps !nclude h!"h te)perature( ch!lls( and sudden pa!n !n the !n ol ed test!s# The le el of prostate/spec!f!c ant!"en !s ele ated !n pat!ents w!th ben!"n prostat!c hyperplas!a or prostate cancer# The le el of prostat!c ac!d phosphatase !s ele ated !n pat!ents w!th ad anced sta"es of prostate cancer# >henylephr!ne +Neo/Synephr!ne,( a )ydr!at!c( !s !nst!lled !n a pat!ents eye to d!late the eye# To pro)ote flu!d dra!na"e and rel!e e ede)a !n a pat!ent w!th ep!d!dy)!t!s( the nurse should ele ate the scrotu) on a scrotal br!d"e# .luoresce!n sta!n!n" !s co))only used to assess corneal abras!ons because !t outl!nes superf!c!al ep!thel!al defects# >resbyop!a !s loss of near !s!on as a result of the loss of elast!c!ty of the crystall!ne lens# Trans!ent !sche)!c attac&s are cons!dered precursors to stro&es# A s!"n of acute append!c!t!s( -cBurneys s!"n !s tenderness at -cBurneys po!nt +about 39 [: c)\ fro) the r!"ht anter!or super!or !l!ac sp!ne on a l!ne between the sp!ne and the u)b!l!cus,# $hen car!n" for a pat!ent w!th Gu!lla!n/BarrZ syndro)e( the nurse should focus on resp!ratory !nter ent!ons as the d!sease process ad ances# S!"ns and sy)pto)s of colon cancer !nclude rectal bleed!n"( chan"e !n bowel hab!ts( !ntest!nal obstruct!on( abdo)!nal pa!n( we!"ht loss( anore*!a( nausea( and o)!t!n"# Sy)pto)s of prostat!t!s !nclude fre6uent ur!nat!on and dysur!a# A chancre !s a pa!nless( ulcerat! e les!on that de elops dur!n" the pr!)ary sta"e of syph!l!s# 5ur!n" the tert!ary sta"e of syph!l!s( sp!rochetes !n ade the !nternal or"ans and cause per)anent da)a"e# In total parenteral nutr!t!on( we!"ht "a!n !s the )ost rel!able !nd!cator of a pos!t! e response to therapy# The nurse )ay ad)!n!ster an I#J# fat e)uls!on throu"h a central or per!pheral catheter( but shouldnt use an !n/l!ne f!lter because the fat part!cles are too lar"e to pass throu"h the pores# If a pat!ent who has a prostatecto)y !s us!n" a ;unn!n"ha) cla)p( !nstruct h!) to wash and dry h!s pen!s before apply!n" the cla)p# 'e should apply the cla)p hor!0ontally and re)o e !t at least e ery E hours to e)pty h!s bladder to pre ent !nfect!on# If a wo)an has s!"ns of ur!nary tract !nfect!on dur!n" )enopause( she should be !nstructed to dr!n& s!* to e!"ht "lasses of water per day( ur!nate before and after !ntercourse( and perfor) Le"el e*erc!ses# If a )enopausal pat!ent e*per!ences a ?hot flash(@ she should be !nstructed to see& a cool( bree0y locat!on and s!p a cool dr!n&# ;he!los!s causes f!ssures at the an"les of the )outh and !nd!cates a !ta)!n B3( r!bofla !n( or !ron def!c!ency# Tetany )ay result fro) hypocalce)!a caused by hypoparathyro!d!s)# A pat!ent who has cer !cal cancer )ay e*per!ence a"!nal bleed!n" for 1 to F )onths after !ntraca !tary rad!at!on# Asc!tes !s the accu)ulat!on of flu!d( conta!n!n" lar"e a)ounts of prote!n and electrolytes( !n the abdo)!nal ca !ty# Its co))only caused by c!rrhos!s#

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Nor)al pul)onary artery pressure !s 14 to 3: )) '"# Nor)al pul)onary artery wed"e pressure !s : to 13 )) '"# After card!ac catheter!0at!on( the s!te !s )on!tored for bleed!n" and he)ato)a for)at!on( pulses d!stal to the s!te are palpated e ery 1: )!nutes for 1 hour( and the pat!ent !s )a!nta!ned on bed rest w!th the e*tre)!ty e*tended for = hours# 'e)oph!l!a !s a bleed!n" d!sorder thats trans)!tted "enet!cally !n a se*/l!n&ed +7 chro)oso)e, recess! e pattern# Althou"h "!rls and wo)en )ay carry the defect! e "ene( he)oph!l!a usually occurs only !n boys and )en# Jon $!llebrands d!sease !s an autoso)al do)!nant bleed!n" d!sorder thats caused by platelet dysfunct!on and factor JIII def!c!ency# S!c&le cell ane)!a !s a con"en!tal he)olyt!c ane)!a thats caused by defect! e he)o"lob!n S )olecules# It pr!)ar!ly affects blac&s# S!c&le cell ane)!a has a ho)o0y"ous !nher!tance pattern# S!c&le cell tra!t has a hetero0y"ous !nher!tance pattern# >el/Ebste!n fe er !s a character!st!c s!"n of 'od"&!ns d!sease# .e er recurs e ery few days or wee&s and alternates w!th afebr!le per!ods# Glucose/2/phosphate dehydro"enase +G2>5, def!c!ency !s an !nher!ted )etabol!c d!sorder thats character!0ed by red blood cells that are def!c!ent !n G2>5( a cr!t!cal en0y)e !n aerob!c "lycolys!s# >referred s!tes for bone )arrow asp!rat!on are the poster!or super!or !l!ac crest( anter!or !l!ac crest( and sternu)# 5ur!n" bone )arrow har est!n"( the donor rece! es "eneral anesthes!a and E44 to =44 )l of )arrow !s asp!rated# A butterfly rash across the br!d"e of the nose !s a character!st!c s!"n of syste)!c lupus erythe)atosus# Rheu)ato!d arthr!t!s !s a chron!c( destruct! e colla"en d!sease character!0ed by sy))etr!c !nfla))at!on of the syno !u) that leads to %o!nt swell!n"# Screen!n" for hu)an !))unodef!c!ency !rus ant!bod!es be"!ns w!th the en0y)e/l!n&ed !))unosorbent assay# Results are conf!r)ed by the $estern blot test# The ;L/-B !soen0y)e le el !ncreases E to = hours after a )yocard!al !nfarct!on( pea&s at 13 to 3E hours( and returns to nor)al !n F days# E*cess! e !nta&e of !ta)!n L )ay s!"n!f!cantly anta"on!0e the ant!coa"ulant effects of warfar!n +;ou)ad!n,# The pat!ent should be caut!oned to a o!d eat!n" an e*cess! e a)ount of leafy "reen e"etables# A ly)ph node b!opsy that shows Reed/Sternber" cells pro !des a def!n!t! e d!a"nos!s of 'od"&!ns d!sease# Bells palsy !s un!lateral fac!al wea&ness or paralys!s caused by a d!sturbance of the se enth cran!al +fac!al, ner e# 5ur!n" an !n!t!al tubercul!n s&!n test( lac& of a wheal after !n%ect!on of tubercul!n pur!f!ed prote!n der! at! e !nd!cates that the test dose was !n%ected too deeply# The nurse should !n%ect another dose at least 39 +: c), fro) the !n!t!al s!te# A tubercul!n s&!n test should be read E= to D3 hours after ad)!n!strat!on# In read!n" a tubercul!n s&!n test( erythe)a w!thout !ndurat!on !s usually not s!"n!f!cant# 5eath caused by botul!s) usually results fro) delayed d!a"nos!s and resp!ratory co)pl!cat!ons# In a pat!ent who has rab!es( sal! a conta!ns the !rus and !s a ha0ard for nurses who pro !de care#

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A febr!le nonhe)olyt!c react!on !s the )ost co))on transfus!on react!on# 'ypo&ale)!a +abnor)ally low concentrat!on of potass!u) !n the blood, )ay cause )uscle wea&ness or paralys!s( electrocard!o"raph!c abnor)al!t!es( and GI d!sturbances# Ber!ber!( a ser!ous !ta)!n B1 +th!a)!ne, def!c!ency( affects alcohol!cs who ha e poor d!etary hab!ts# Its ep!de)!c !n As!an countr!es where people subs!st on unenr!ched r!ce# Its character!0ed by the phrase ?I cant(@ !nd!cat!n" that the pat!ent !s too !ll to do anyth!n"# E*cess! e sedat!on )ay cause resp!ratory depress!on# The pr!)ary postoperat! e concern !s )a!ntenance of a patent a!rway# If cyanos!s occurs c!rcu)orally( subl!n"ually( or !n the na!l bed( the o*y"en saturat!on le el +Sao 3, !s less than =4G# A rap!d pulse rate !n a postoperat! e pat!ent )ay !nd!cate pa!n( bleed!n"( dehydrat!on( or shoc&# Increased pulse rate and blood pressure )ay !nd!cate that a pat!ent !s e*per!enc!n" ?s!lent pa!n@ +pa!n that cant be e*pressed erbally( such as when a pat!ent !s reco er!n" fro) anesthes!a,# L!doca!ne +7yloca!ne, e*erts ant!arrhyth)!c act!on by suppress!n" auto)at!c!ty !n the >ur&!n%e f!bers and ele at!n" the electr!cal st!)ulat!on threshold !n the entr!cles# ;ullens s!"n +a blu!sh d!scolorat!on around the u)b!l!cus, !s seen !n pat!ents who ha e a perforated pancreas# 5ur!n" the postoperat! e per!od( the pat!ent should cou"h and breathe deeply e ery 3 hours unless otherw!se contra!nd!cated +for e*a)ple( after cran!oto)y( cataract sur"ery( or throat sur"ery,# Before sur"ery( a pat!ents resp!ratory olu)e )ay be )easured by !ncent! e sp!ro)etry# Th!s )easure)ent beco)es the pat!ents postoperat! e "oal for resp!ratory olu)e# The postoperat! e pat!ent should use !ncent! e sp!ro)etry 14 to 13 t!)es per hour and breathe deeply# Before a)bulat!n"( a postoperat! e pat!ent should dan"le h!s le"s o er the s!de of the bed and perfor) deep/breath!n" e*erc!ses# 5ur!n" the pat!ents f!rst postoperat! e a)bulat!on( the nurse should )on!tor the pat!ent closely and ass!st h!) as needed wh!le he wal&s a few feet fro) the bed to a steady cha!r# 'ypo ole)!a occurs when 1:G to 3:G of the bodys total blood olu)e !s lost# S!"ns and sy)pto)s of hypo ole)!a !nclude rap!d( wea& pulseN low blood pressureN cool( cla))y s&!nN shallow resp!rat!onsN ol!"ur!a or anur!aN and lethar"y# Acute per!card!t!s causes sudden se ere( constant pa!n o er the anter!or chest# The pa!n !s a""ra ated by !nsp!rat!on# S!"ns and sy)pto)s of sept!ce)!a !nclude fe er( ch!lls( rash( abdo)!nal d!stent!on( prostrat!on( pa!n( headache( nausea( and d!arrhea# Roc&y -ounta!n spotted fe er causes a pers!stent h!"h fe er( nonp!tt!n" ede)a( and rash# >at!ents who ha e under"one coronary artery bypass "raft should sleep 2 to 14 hours per day( ta&e the!r te)perature tw!ce da!ly( and a o!d l!ft!n" )ore than 14 lb +E#: &", for at least 2 wee&s#

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;laud!cat!on pa!n +pa!n on a)bulat!on, !s caused by arter!al !nsuff!c!ency as a result of athero)atous pla6ue that obstructs arter!al blood flow to the e*tre)!t!es# >ace)a&ers can be powered by l!th!u) batter!es for up to 14 years# The pat!ent shouldnt o!d for 1 hour before percutaneous suprapub!c bladder asp!rat!on to ensure that suff!c!ent ur!ne re)a!ns !n the bladder to )a&e the procedure successful# Left/s!ded heart fa!lure causes pul)onary con"est!on( p!n&/t!n"ed sputu)( and dyspnea# +Re)e)ber L for left and lun"#, The current reco))ended blood cholesterol le el !s less than 344 )"<dl# $hen car!n" for a pat!ent who !s ha !n" a se!0ure( the nurse should follow these "u!del!nesI +1, A o!d restra!n!n" the pat!ent( but help a stand!n" pat!ent to a ly!n" pos!t!on# +3, Loosen restr!ct! e cloth!n"# +F, >lace a p!llow or another soft ob%ect under the pat!ents head# +E, ;lear the area of hard ob%ects# +:, 5ont force anyth!n" !nto the pat!ents )outh( but )a!nta!n a patent a!rway# +2, Reassure and reor!ent the pat!ent after the se!0ure subs!des# G!n"! al hyperplas!a( or o er"rowth of "u) t!ssue( !s an ad erse react!on to phenyto!n +5!lant!n,# $!th a"!n"( )ost )arrow !n lon" bones beco)es yellow( but !t reta!ns the capac!ty to con ert bac& to red# ;l!n!cal )an!festat!ons of ly)phede)a !nclude accu)ulat!on of flu!d !n the le"s# Afterload !s entr!cular wall tens!on dur!n" systol!c e%ect!on# Its !ncreased !n pat!ents who ha e septal hypertrophy( !ncreased blood !scos!ty( and cond!t!ons that cause bloc&a"e of aort!c or pul)onary outflow# Red blood cells can be stored fro0en for up to 3 yearsN howe er( they )ust be used w!th!n 3E hours of thaw!n"# .or the f!rst 3E hours after a)putat!on( the nurse should ele ate the stu)p to pre ent ede)a# After hysterecto)y( a wo)an should a o!d se*ual !ntercourse for F wee&s !f a a"!nal approach was used and 2 wee&s !f the abdo)!nal approach was used# >ar&!nsons d!sease character!st!cally causes pro"ress! e )uscle r!"!d!ty( a&!nes!a( and !n oluntary tre)or# Ton!c/clon!c se!0ures are character!0ed by a loss of consc!ousness and alternat!n" per!ods of )uscle contract!on and rela*at!on# Status ep!lept!cus( a l!fe/threaten!n" e)er"ency( !s a ser!es of rap!dly repeat!n" se!0ures that occur w!thout !nter en!n" per!ods of consc!ousness# The !deal donor for &!dney transplantat!on !s an !dent!cal tw!n# If an !dent!cal tw!n !snt a a!lable( a b!olo"!cal s!bl!n" !s the ne*t best cho!ce# Breast cancer !s the lead!n" cancer a)on" wo)enN howe er( lun" cancer accounts for )ore deaths# The sta"es of cer !cal cancer are as followsI sta"e 4( carc!no)a !n s!tuN sta"e I( cancer conf!ned to the cer !*N sta"e II( cancer e*tend!n" beyond the cer !*( but not to the pel !c wallN sta"e III( cancer e*tend!n" to the pel !c wallN and sta"e IJ( cancer e*tend!n" beyond the pel !s or w!th!n the bladder or rectu)# Hne )ethod used to est!)ate blood loss after a hysterecto)y !s count!n" per!neal pads# Saturat!n" )ore than one pad !n 1 hour or e!"ht pads !n 3E hours !s cons!dered he)orrha"!n"# Transurethral resect!on of the prostate !s the )ost co))on procedure for treat!n" ben!"n prostat!c hyperplas!a#

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In a chest dra!na"e syste)( the water !n the water/seal cha)ber nor)ally r!ses when a pat!ent breathes !n and falls when he breathes out# Sp!nal fus!on pro !des sp!nal stab!l!ty throu"h a bone "raft( usually fro) the !l!ac crest( that fuses two or )ore ertebrae# A pat!ent who rece! es any type of transplant )ust ta&e an !))unosuppressant dru" for the rest of h!s l!fe# Incent! e sp!ro)etry should be used : to 14 t!)es an hour wh!le the pat!ent !s awa&e# In wo)en( pel !c !nfla))atory d!sease !s a co))on co)pl!cat!on of "onorrhea# Scol!os!s !s lateral S/shaped cur ature of the sp!ne# S!"ns and sy)pto)s of the secondary sta"e of syph!l!s !nclude a rash on the pal)s and soles( eros!on of the oral )ucosa( alopec!a( and enlar"ed ly)ph nodes# In a pat!ent who !s rece! !n" total parenteral nutr!t!on( the nurse should )on!tor "lucose and electrolyte le els# Unless contra!nd!cated( on ad)!ss!on to the postanesthes!a care un!t( a pat!ent should be turned on h!s s!de and h!s !tal s!"ns should be ta&en# Ede)a !s treated by l!)!t!n" flu!d !nta&e and el!)!nat!n" e*cess flu!d# A pat!ent who has had sp!nal anesthes!a should re)a!n flat for 13 to 3E hours# J!tal s!"ns and neuro)uscular funct!on should be )on!tored# A pat!ent who has )aple syrup ur!ne d!sease should a o!d food conta!n!n" the a)!no ac!ds leuc!ne( !soleuc!ne( and lys!ne# A se ere co)pl!cat!on of a fe)ur fracture !s e*cess! e blood loss that results !n shoc&# To prepare a pat!ent for per!toneal d!alys!s( the nurse should as& the pat!ent to o!d( )easure h!s !tal s!"ns( place h!) !n a sup!ne pos!t!on( and us!n" asept!c techn!6ue( !nsert a catheter throu"h the abdo)!nal wall and !nto the per!toneal space# If )ore than F L of d!alysate solut!on return dur!n" per!toneal d!alys!s( the nurse should not!fy the phys!c!an# 'e)od!alys!s !s the re)o al of certa!n ele)ents fro) the blood by pass!n" hepar!n!0ed blood throu"h a se)!per)eable )e)brane to the d!alysate bath( wh!ch conta!ns all of the !)portant electrolytes !n the!r !deal concentrat!ons# Gan"rene usually affects the d!"!ts f!rst( and be"!ns w!th s&!n color chan"es that pro"ress fro) "ray/blue to dar& brown or blac&# L!dney funct!on !s assessed by e aluat!n" blood urea n!tro"en +nor)al ran"e !s = to 34 )"<dl, and seru) creat!n!ne +nor)al ran"e !s 4#2 to 1#F )"<dl, le els# A we!"ht/bear!n" transfer !s appropr!ate only for a pat!ent who has at least one le" thats stron" enou"h to bear we!"ht( such as a pat!ent w!th he)!ple"!a or a s!n"le/le" a)putat!on# H erflow !ncont!nence + o!d!n" of F4 to 24 )l of ur!ne e ery 1: to F4 )!nutes, !s a s!"n of bladder d!stent!on# The f!rst s!"n of a pressure ulcer !s reddened s&!n that blanches when pressure !s appl!ed# Late s!"ns and sy)pto)s of s!c&le cell ane)!a !nclude tachycard!a( card!o)e"aly( systol!c and d!astol!c )ur)urs( chron!c fat!"ue( hepato)e"aly( and spleno)e"aly# A )echan!cal ent!lator( wh!ch can )a!nta!n ent!lat!on auto)at!cally for an e*tended per!od( !s !nd!cated when a pat!ent cant )a!nta!n a safe >aH3 or >a;H3 le el#

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Two types of )echan!cal ent!lators e*!stI ne"at! e/pressure ent!lators( wh!ch apply ne"at! e pressure around the chest wall( and pos!t! e/pressure ent!lators( wh!ch del! er a!r under pressure to the pat!ent# An"!na pector!s !s character!0ed by substernal pa!n that lasts for 3 to F )!nutes# The pa!n( wh!ch !s caused by )yocard!al !sche)!a( )ay rad!ate to the nec&( shoulders( or %awN !s descr!bed as !sel!&e( or constr!ct!n"N and )ay be acco)pan!ed by se ere apprehens!on or a feel!n" of !)pend!n" doo)# The d!a"nos!s of an acute )yocard!al !nfarct!on !s based on the pat!ents s!"ns and sy)pto)s( electrocard!o"ra) trac!n"s( tropon!n le el( and card!ac en0y)e stud!es# The "oal of treat)ent for a pat!ent w!th an"!na pector!s !s to reduce the hearts wor&load( thereby reduc!n" the )yocard!al de)and for o*y"en and pre ent!n" )yocard!al !nfarct!on# N!tro"lycer!n decreases the a)ount of blood that returns to the heart by !ncreas!n" the capac!ty of the enous bed# The pat!ent should ta&e no )ore than three n!tro"lycer!n tablets !n a 1:/)!nute per!od# 'e)od!alys!s !s usually perfor)ed 3E hours before &!dney transplantat!on# S!"ns and sy)pto)s of acute &!dney transplant re%ect!on are pro"ress! e enlar"e)ent and tenderness at the transplant s!te( !ncreased blood pressure( decreased ur!ne output( ele ated seru) creat!n!ne le el( and fe er# After a rad!cal )astecto)y( the pat!ents ar) should be ele ated +w!th the hand abo e the elbow, on a p!llow to enhance c!rculat!on and pre ent ede)a# >ostoperat! e )astecto)y care !ncludes teach!n" the pat!ent ar) e*erc!ses to fac!l!tate ly)ph dra!na"e and pre ent shorten!n" of the )uscle and contracture of the shoulder %o!nt +fro0en shoulder,# After rad!cal )astecto)y( the pat!ent should help pre ent !nfect!on by )a&!n" sure that no blood pressure read!n"s( !n%ect!ons( or en!punctures are perfor)ed on the affected ar)# .or a pat!ent who has under"one )astecto)y and !s suscept!ble to ly)phede)a( a pro"ra) of hand e*erc!ses can be"!n shortly after sur"ery( !f prescr!bed# The pro"ra) cons!sts of open!n" and clos!n" the hand t!"htly s!* to e!"ht t!)es per hour and perfor)!n" such tas&s as wash!n" the face and co)b!n" the ha!r# S!"ns and sy)pto)s of theophyll!ne to*!c!ty !nclude o)!t!n"( restlessness( and an ap!cal pulse rate of )ore than 344 beats<)!nute# The nurse shouldnt !nduce o)!t!n" !n a person who has !n"ested po!son and !s ha !n" se!0ures or !s se)!consc!ous or co)atose#

;entral enous pressure +;J>,( wh!ch !s the pressure !n the r!"ht atr!u) and the "reat e!ns of the thora*( !s nor)ally 3 to = )) '" +or : to 13 c) '3H,# ;J> !s used to assess r!"ht/s!ded card!ac funct!on# ;J> !s )on!tored to assess the need for flu!d replace)ent !n ser!ously !ll pat!ents( to est!)ate blood olu)e def!c!ts( and to e aluate c!rculatory pressure !n the r!"ht atr!u)# To pre ent deep e!n thro)bos!s after sur"ery( the nurse should ad)!n!ster :(444 un!ts of hepar!n subcutaneously e ery = to 13 hours( as prescr!bed# Hral ant!coa"ulants( such as warfar!n +;ou)ad!n, and d!cu)arol( d!srupt natural blood clott!n" )echan!s)s( pre ent thro)bus for)at!on( and l!)!t the e*tens!on of a for)ed thro)bus#

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Ant!coa"ulants cant d!ssol e a for)ed thro)bus# Ant!coa"ulant therapy !s contra!nd!cated !n a pat!ent who has l! er or &!dney d!sease or GI ulcers or who !snt l!&ely to return for follow/up !s!ts# The nurse can assess a pat!ent for thro)bophleb!t!s by )easur!n" the affected and unaffected le"s and co)par!n" the!r s!0es# The nurse should )ar& the )easure)ent locat!ons w!th a pen so that the le"s can be )easured at the sa)e place each day# 5ra!na"e of )ore than F(444 )l of flu!d da!ly fro) a naso"astr!c tube )ay su""est !ntest!nal obstruct!on# Xellow dra!na"e that has a foul odor )ay !nd!cate s)all/bowel obstruct!on# >reparat!on for s!")o!doscopy !ncludes ad)!n!ster!n" an ene)a 1 hour before the e*a)!nat!on( war)!n" the scope !n war) water or a ster!l!0er +!f us!n" a )etal s!")o!doscope,( and drap!n" the pat!ent to e*pose the per!neu)#

Treat)ent for a pat!ent w!th bleed!n" esopha"eal ar!ces !ncludes ad)!n!ster!n" asopress!n +>!tress!n,( "! !n" an !ce water la a"e( asp!rat!n" blood fro) the sto)ach( us!n" esopha"eal balloon ta)ponade( pro !d!n" parenteral nutr!t!on( and ad)!n!ster!n" blood transfus!ons( as needed# A trau)a !ct!) shouldnt be )o ed unt!l a patent a!rway !s establ!shed and the cer !cal sp!ne !s !))ob!l!0ed# After a )astecto)y( ly)phede)a )ay cause a feel!n" of hea !ness !n the affected ar)# A dy!n" pat!ent shouldnt be told e*actly how lon" hes e*pected to l! e( but should be told so)eth!n" )ore "eneral such as ?So)e people l! e F to 2 )onths( but others l! e lon"er#@ After eye sur"ery( a pat!ent should a o!d us!n" )a&eup unt!l otherw!se !nstructed# After a corneal transplant( the pat!ent should wear an eye sh!eld when en"a"!n" !n act! !t!es such as play!n" w!th ch!ldren or pets# After a corneal transplant( the pat!ent shouldnt l!e on the affected s!te( bend at the wa!st( or ha e se*ual !ntercourse for 1 wee&# The pat!ent )ust a o!d "ett!n" soapsuds !n the eye# A -!lwau&ee brace !s used for pat!ents who ha e structural scol!os!s# The brace helps to halt the pro"ress!on of sp!nal cur ature by pro !d!n" lon"!tud!nal tract!on and lateral pressure# It should be worn 3F hours a day# Short/ter) )easures used to treat sto)al retract!on !nclude stool softeners( !rr!"at!on( and sto)al d!latat!on# A pat!ent who has a colosto)y should be ad !sed to eat a low/res!due d!et for E to 2 wee&s and then to add one food at a t!)e to e aluate !ts effect# To rel!e e postoperat! e h!ccups( the pat!ent should breathe !nto a paper ba"# If a pat!ent w!th an !leosto)y has a bloc&ed lu)en as a result of und!"ested h!"h/f!ber food( the pat!ent should be placed !n the &nee/chest pos!t!on and the area below the sto)a should be )assa"ed# 5ur!n" the !n!t!al !nter !ew and treat)ent of a pat!ent w!th syph!l!s( the pat!ents se*ual contacts should be !dent!f!ed# The nurse shouldnt ad)!n!ster )orph!ne to a pat!ent whose resp!ratory rate !s less than 13 breaths<)!nute# To pre ent dry!n" of the )ucous )e)branes( o*y"en should be ad)!n!stered w!th hydrat!on# .la o*ate +Ur!spas, !s class!f!ed as a ur!nary tract spas)olyt!c#

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'ypotens!on !s a s!"n of card!o"en!c shoc& !n a pat!ent w!th a )yocard!al !nfarct!on# The predo)!nant s!"ns of )echan!cal !leus are cra)p!n" pa!n( o)!t!n"( d!stent!on( and !nab!l!ty to pass feces or flatus# .or a pat!ent w!th a )yocard!al !nfarct!on( the nurse should )on!tor flu!d !nta&e and output )et!culously# Too l!ttle !nta&e causes dehydrat!on( and too )uch )ay cause pul)onary ede)a# N!tro"lycer!n rela*es s)ooth )uscle( caus!n" asod!lat!on and rel!e !n" the chest pa!n assoc!ated w!th )yocard!al !nfarct!on and an"!na# The d!a"nos!s of an acute )yocard!al !nfarct!on !s based on the pat!ents s!"ns and sy)pto)s( electrocard!o"ra) trac!n"s( and seru) en0y)e stud!es# Arrhyth)!as are the predo)!nant proble) dur!n" the f!rst E= hours after a )yocard!al !nfarct!on# ;l!n!cal )an!festat!ons of )alabsorpt!on !nclude we!"ht loss( )uscle wast!n"( bloat!n"( and steatorrhea# Aspara"!nase( an en0y)e that !nh!b!ts the synthes!s of deo*yr!bonucle!c ac!d and prote!n( !s used to treat acute ly)phocyt!c leu&e)!a# To rel!e e a pat!ents sore throat thats caused by naso"astr!c tube !rr!tat!on( the nurse should pro !de anesthet!c lo0en"es( as prescr!bed# .or the f!rst 13 to 3E hours after "astr!c sur"ery( the sto)ach contents +obta!ned by suct!on!n", are brown# After "astr!c suct!on!n" !s d!scont!nued( a pat!ent who !s reco er!n" fro) a subtotal "astrecto)y should rece! e a clear l!6u!d d!et# The descend!n" colon !s the preferred s!te for a per)anent colosto)y# Jal ular !nsuff!c!ency !n the e!ns co))only causes ar!cos!ty# A pat!ent w!th a colosto)y should restr!ct fat and f!brous foods and should a o!d foods that can obstruct the sto)a( such as corn( nuts( and cabba"e# A pat!ent who !s rece! !n" che)otherapy !s placed !n re erse !solat!on because the wh!te blood cell count )ay be depressed# Sy)pto)s of )!tral al e stenos!s are caused by !)proper e)pty!n" of the left atr!u)# >ers!stent bleed!n" after open heart sur"ery )ay re6u!re the ad)!n!strat!on of prota)!ne sulfate to re erse the effects of hepar!n sod!u) used dur!n" sur"ery# The nurse should teach a pat!ent w!th heart fa!lure to ta&e d!"o*!n and other dru"s as prescr!bed( to restr!ct sod!u) !nta&e( to restr!ct flu!ds as prescr!bed( to "et ade6uate rest( to !ncrease wal&!n" and other act! !t!es "radually( to a o!d e*tre)es of te)perature( to report s!"ns of The nurse should chec& and )a!nta!n the patency of all connect!ons for a chest tube# If an a!r lea& !s detected( the nurse should place one Lelly cla)p near the !nsert!on s!te# If the bubbl!n" stops( the lea& !s !n the thorac!c ca !ty and the phys!c!an should be not!f!ed !))ed!ately# If the lea& cont!nues( the nurse should ta&e a second cla)p( wor& down the tube unt!l the lea& !s located( and stop the lea&# In two/person card!opul)onary resusc!tat!on( the rescuers ad)!n!ster 24 chest co)press!ons per )!nute and 1 breath for e ery : co)press!ons# -!tral al e stenos!s can result fro) rheu)at!c fe er# Atelectas!s !s !nco)plete e*pans!on of lun" se")ents or lobules +clusters of al eol!,# It )ay cause the lun" or lobe to

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collapse# The nurse should !nstruct a pat!ent who has an !leal condu!t to e)pty the collect!on de !ce fre6uently because the we!"ht of the ur!ne )ay cause the de !ce to sl!p fro) the s&!n# A pat!ent who !s rece! !n" card!opul)onary resusc!tat!on should be placed on a sol!d( flat surface# Bra!n da)a"e occurs E to 2 )!nutes after card!opul)onary funct!on ceases# ;l!)acter!c !s the trans!t!on per!od dur!n" wh!ch a wo)ans reproduct! e funct!on d!)!n!shes and "radually d!sappears# After !nfratentor!al sur"ery( the pat!ent should re)a!n on h!s s!de( flat !n bed# In a pat!ent who has an ulcer( )!l& !s contra!nd!cated because !ts h!"h calc!u) content st!)ulates secret!on of "astr!c ac!d#

A pat!ent who has a pos!t! e test result for hu)an !))unodef!c!ency !rus has been e*posed to the !rus assoc!ated w!th ac6u!red !))unodef!c!ency syndro)e +AI5S,( but doesnt necessar!ly ha e AI5S# A co))on co)pl!cat!on after prostatecto)y !s c!rculatory fa!lure caused by bleed!n"# In r!"ht/s!ded heart fa!lure( a )a%or focus of nurs!n" care !s decreas!n" the wor&load of the heart# S!"ns and sy)pto)s of d!"o*!n to*!c!ty !nclude nausea( o)!t!n"( confus!on( and arrhyth)!as# An asth)a attac& typ!cally be"!ns w!th whee0!n"( cou"h!n"( and !ncreas!n" resp!ratory d!stress# In a pat!ent who !s reco er!n" fro) a tons!llecto)y( fre6uent swallow!n" su""ests he)orrha"e# Ileosto)!es and 'art)anns colosto)!es are per)anent sto)as# Loop colosto)!es and double/barrel colosto)!es are te)porary ones# A pat!ent who has an !leosto)y should eat foods( such as sp!nach and parsley( because they act as !ntest!nal tract deodor!0ers# An adrenalecto)y can decrease stero!d product!on( wh!ch can cause e*tens! e loss of sod!u) and water# Before ad)!n!ster!n" )orph!ne +5ura)orph, to a pat!ent who !s suspected of ha !n" a )yocard!al !nfarct!on( the nurse should chec& the pat!ents resp!ratory rate# If !ts less than 13 breaths<)!nute( e)er"ency e6u!p)ent should be read!ly a a!lable for !ntubat!on !f resp!ratory depress!on occurs#

A pat!ent who !s reco er!n" fro) supratentor!al sur"ery !s nor)ally allowed out of bed 1E to E= hours after sur"ery# A pat!ent who !s reco er!n" fro) !nfratentor!al sur"ery nor)ally re)a!ns on bed rest for F to : days# After a pat!ent under"oes a fe)oral/popl!teal bypass "raft( the nurse )ust closely )on!tor the per!pheral pulses d!stal to the operat! e s!te and c!rculat!on# After a fe)oral/popl!teal bypass "raft( the pat!ent should !n!t!ally be )a!nta!ned !n a se)!/.owler pos!t!on to a o!d fle*!on of the "raft s!te# Before d!schar"e( the nurse should !nstruct the pat!ent to a o!d pos!t!ons that put pressure on the "raft s!te unt!l the ne*t follow/up !s!t#

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Hf the f! e senses( hear!n" !s the last to be lost !n a pat!ent who !s enter!n" a co)a# ;holel!th!as!s causes an enlar"ed( ede)atous "allbladder w!th )ult!ple stones and an ele ated b!l!rub!n le el# The ant! !ral a"ent 0!do ud!ne +Retro !r, successfully slows repl!cat!on of the hu)an !))unodef!c!ency !rus( thereby slow!n" the de elop)ent of ac6u!red !))unodef!c!ency syndro)e# Se ere rheu)ato!d arthr!t!s causes )ar&ed ede)a and con"est!on( sp!ndle/shaped %o!nts( and se ere fle*!on defor)!t!es# A pat!ent w!th ac6u!red !))unodef!c!ency syndro)e should ad !se h!s se*ual partners of h!s hu)an !))unodef!c!ency !rus status and obser e se*ual precaut!ons( such as abst!nence or condo) use# If a rad!oact! e !)plant beco)es d!slod"ed( the nurse should retr!e e !t w!th ton"s( place !t !n a lead/sh!elded conta!ner( and not!fy the rad!olo"y depart)ent# A pat!ent who !s under"o!n" rad!at!on therapy should pat h!s s&!n dry to a o!d abras!ons that could eas!ly beco)e !nfected# 5ur!n" rad!at!on therapy( a pat!ent should ha e fre6uent blood tests( espec!ally wh!te blood cell and platelet counts# The nurse should ad)!n!ster an alu)!nu) hydro*!de antac!d at least 1 hour after an enter!c/coated dru" because !t can cause pre)ature release of the enter!c/coated dru" !n the sto)ach# Ac!d/base balance !s the bodys hydro"en !on concentrat!on( a )easure of the rat!o of carbon!c ac!d to b!carbonate !ons +1 part carbon!c ac!d to 34 parts b!carbonate !s nor)al,# A)yotroph!c lateral scleros!s causes pro"ress! e atrophy and wast!n" of )uscle "roups that e entually affects the resp!ratory )uscles# -etabol!c ac!dos!s !s caused by abnor)al loss of b!carbonate !ons or e*cess! e product!on or retent!on of ac!d !ons# 'e)!anops!a !s defect! e !s!on or bl!ndness !n one/half of the !sual f!eld of one or both eyes# Syste)!c lupus erythe)atosus causes early/)orn!n" %o!nt st!ffness and fac!al erythe)a !n a butterfly pattern# After total &nee replace)ent( the pat!ent should re)a!n !n the se)!/.owler pos!t!on( w!th the affected le" ele ated# In a pat!ent who !s rece! !n" transpylor!c feed!n"s( the nurse should watch for du)p!n" syndro)e and hypo ole)!c shoc& because the sto)ach !s be!n" bypassed# If a total parenteral nutr!t!on !nfus!on )ust be !nterrupted( the nurse should ad)!n!ster de*trose :G !n water at a s!)!lar rate# Abrupt cessat!on can cause hypo"lyce)!a# Status ep!lept!cus !s treated w!th I#J# d!a0epa) +Jal!u), and phenyto!n +5!lant!n,# 5!se6u!l!br!u) syndro)e causes nausea( o)!t!n"( restlessness( and tw!tch!n" !n pat!ents who are under"o!n" d!alys!s# Its caused by a rap!d flu!d sh!ft# An !nd!cat!on that sp!nal shoc& !s resol !n" !s the return of refle* act! !ty !n the ar)s and le"s below the le el of !n%ury# 'ypo ole)!a !s the )ost co))on and fatal co)pl!cat!on of se ere acute pancreat!t!s# In a pat!ent w!th sto)at!t!s( oral care !ncludes r!ns!n" the )outh w!th a )!*ture of e6ual parts of hydro"en pero*!de and water three t!)es da!ly# In ot!t!s )ed!a( the ty)pan!c )e)brane !s br!"ht red and lac&s !ts character!st!c l!"ht refle* +cone of l!"ht,#

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In pat!ents who ha e per!card!ocentes!s( flu!d !s asp!rated fro) the per!card!al sac for analys!s or to rel!e e card!ac ta)ponade# Urt!car!a !s an early s!"n of he)olyt!c transfus!on react!on# 5ur!n" per!toneal d!alys!s( a return of brown d!alysate su""ests bowel perforat!on# The phys!c!an should be not!f!ed !))ed!ately# An early s!"n of &etoac!dos!s !s polyur!a( wh!ch !s caused by os)ot!c d!ures!s# >at!ents who ha e )ult!ple scleros!s should !sually !nspect the!r e*tre)!t!es to ensure proper al!"n)ent and freedo) fro) !n%ury# Asp!rated red bone )arrow usually appears rust/red( w!th !s!ble fatty )ater!al and wh!te bone fra")ents# The 5!c& test detects scarlet fe er ant!"ens and !))un!ty or suscept!b!l!ty to scarlet fe er# A pos!t! e result !nd!cates no !))un!tyN a ne"at! e result !nd!cates !))un!ty# The Sch!c& test detects d!phther!a ant!"ens and !))un!ty or suscept!b!l!ty to d!phther!a# A pos!t! e result !nd!cates no !))un!tyN a ne"at! e result !nd!cates !))un!ty# The reco))ended adult dosa"e of sucralfate +;arafate, for duodenal ulcer !s 1 " +1 tablet, four t!)es da!ly 1 hour before )eals and at bedt!)e# A pat!ent w!th fac!al burns or s)o&e or heat !nhalat!on should be ad)!tted to the hosp!tal for 3E/hour obser at!on for delayed tracheal ede)a# In add!t!on to pat!ent teach!n"( preparat!on for a colosto)y !ncludes w!thhold!n" oral !nta&e o ern!"ht( perfor)!n" bowel preparat!on( and ad)!n!ster!n" a cleans!n" ene)a# The phys!olo"!c chan"es caused by burn !n%ur!es can be d! !ded !nto two sta"esI the hypo ole)!c sta"e( dur!n" wh!ch !ntra ascular flu!d sh!fts !nto the !nterst!t!al space( and the d!uret!c sta"e( dur!n" wh!ch cap!llary !nte"r!ty and !ntra ascular olu)e are restored( usually E= to D3 hours after the !n%ury# The nurse should chan"e total parenteral nutr!t!on tub!n" e ery 3E hours and the per!pheral I#J# access s!te dress!n" e ery D3 hours# A pat!ent whose carbon )ono*!de le el !s 34G to F4G should be treated w!th 144G hu)!d!f!ed o*y"en# $hen !n the roo) of a pat!ent who !s !n !solat!on for tuberculos!s( staff and !s!tors should wear ultraf!lter )as&s# $hen pro !d!n" s&!n care !))ed!ately after p!n !nsert!on( the nurses pr!)ary concern !s pre ent!on of bone !nfect!on# After an a)putat!on( )o!st s&!n )ay !nd!cate enous stas!sN dry s&!n )ay !nd!cate arter!al obstruct!on#

In a pat!ent who !s rece! !n" d!alys!s( an !nternal shunt !s wor&!n" !f the nurse feels a thr!ll on palpat!on or hears a bru!t on auscultat!on# In a pat!ent w!th !ral hepat!t!s( the parenchy)al( or Lupffers( cells of the l! er beco)e se erely !nfla)ed( enlar"ed( and necrot!c# Early s!"ns of ac6u!red !))unodef!c!ency syndro)e !nclude fat!"ue( n!"ht sweats( enlar"ed ly)ph nodes( anore*!a( we!"ht loss( pallor( and fe er#

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$hen car!n" for a pat!ent who has a rad!oact! e !)plant( health care wor&ers should stay as far away fro) the rad!at!on source as poss!ble# They should re)e)ber the a*!o)( ?If you double the d!stance( you 6uarter the dose#@ A pat!ent who has >ar&!nsons d!sease should be !nstructed to wal& w!th a broad/based "a!t# The card!nal s!"ns of >ar&!nsons d!sease are )uscle r!"!d!ty( a tre)or that be"!ns !n the f!n"ers( and a&!nes!a# In a pat!ent w!th >ar&!nsons d!sease( le odopa +5opar, !s prescr!bed to co)pensate for the dopa)!ne def!c!ency# A pat!ent who has )ult!ple scleros!s !s at !ncreased r!s& for pressure ulcers# >!ll/roll!n" tre)or !s a class!c s!"n of >ar&!nsons d!sease# .or a pat!ent w!th >ar&!nsons d!sease( nurs!n" !nter ent!ons are pall!at! e# .at e)bol!s)( a ser!ous co)pl!cat!on of a lon"/bone fracture( causes fe er( tachycard!a( tachypnea( and an*!ety# -etrorrha"!a +bleed!n" between )enstrual per!ods, )ay be the f!rst s!"n of cer !cal cancer#

-ann!tol !s a hyperton!c solut!on and an os)ot!c d!uret!c thats used !n the treat)ent of !ncreased !ntracran!al pressure# The class!c s!"n of an absence se!0ure !s a acant fac!al e*press!on# -!"ra!ne headaches cause pers!stent( se ere pa!n that usually occurs !n the te)poral re"!on# A pat!ent who !s !n a bladder retra!n!n" pro"ra) should be "! en an opportun!ty to o!d e ery 3 hours dur!n" the day and tw!ce at n!"ht# In a pat!ent w!th a head !n%ury( a decrease !n le el of consc!ousness !s a card!nal s!"n of !ncreased !ntracran!al pressure# Er"ota)!ne +Er"o)ar, !s )ost effect! e when ta&en dur!n" the prodro)al phase of a )!"ra!ne or ascular headache# Treat)ent of acute pancreat!t!s !ncludes naso"astr!c suct!on!n" to deco)press the sto)ach and )eper!d!ne +5e)erol, for pa!n# Sy)pto)s of h!atal hern!a !nclude a feel!n" of fullness !n the upper abdo)en or chest( heartburn( and pa!n s!)!lar to that of an"!na pector!s# The !nc!dence of cholel!th!as!s !s h!"her !n wo)en who ha e had ch!ldren than !n any other "roup# Aceta)!nophen +Tylenol, o erdose can se erely da)a"e the l! er# The pro)!nent cl!n!cal s!"ns of ad anced c!rrhos!s are asc!tes and %aund!ce# The f!rst sy)pto) of pancreat!t!s !s steady ep!"astr!c pa!n or left upper 6uadrant pa!n that rad!ates fro) the u)b!l!cal area or the bac&# So)na)bul!s) !s the )ed!cal ter) for sleepwal&!n"# Ep!nephr!ne +Adrenal!n, !s a asoconstr!ctor# An untreated l! er lacerat!on or rupture can pro"ress rap!dly to hypo ole)!c shoc&#

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Hbst!pat!on !s e*tre)e( !ntractable const!pat!on caused by an !ntest!nal obstruct!on# The def!n!t! e test for d!a"nos!n" cancer !s b!opsy w!th cytolo"!c e*a)!nat!on of the spec!)en# Arthro"raphy re6u!res !n%ect!on of a contrast )ed!u) and can !dent!fy %o!nt abnor)al!t!es# Bro)ptons coc&ta!l !s prescr!bed to help rel!e e pa!n !n pat!ents who ha e ter)!nal cancer# A sarco)a !s a )al!"nant tu)or !n connect! e t!ssue# Alu)!nu) hydro*!de +A)pho%el, neutral!0es "astr!c ac!d# Sublu*at!on !s part!al d!slocat!on or separat!on( w!th spontaneous reduct!on of a %o!nt# Barb!turates can cause confus!on and del!r!u) !n an elderly pat!ent who has an or"an!c bra!n d!sorder# In a pat!ent w!th arthr!t!s( phys!cal therapy !s !nd!cated to pro)ote opt!)al funct!on!n"# So)e pat!ents who ha e hepat!t!s A )ay be an!cter!c +w!thout %aund!ce, and lac& sy)pto)s( but so)e ha e headaches( %aund!ce( anore*!a( fat!"ue( fe er( and resp!ratory tract !nfect!on# 'epat!t!s A !s usually )!ld and wont ad ance to a carr!er state# In the pre!cter!c phase of all for)s of hepat!t!s( the pat!ent !s h!"hly conta"!ous# Enter!c precaut!ons are re6u!red for a pat!ent who has hepat!t!s A# ;holecysto"raphy !s !neffect! e !n a pat!ent who has %aund!ce as a result of "allbladder d!sease# The l! er cells cant transport the contrast )ed!u) to the b!l!ary tract# In a pat!ent who has d!abetes !ns!p!dus( dehydrat!on !s a concern because d!abetes causes polyur!a# In a pat!ent who has a reduc!ble hern!a( the protrud!n" )ass spontaneously retracts !nto the abdo)en# To pre ent purple "lo e syndro)e( a nurse shouldnt ad)!n!ster I#J# phenyto!n +5!lant!n, throu"h a e!n !n the bac& of the hand( but should use a lar"er essel# 5ur!n" sta"e III of sur"!cal anesthes!a( unconsc!ousness occurs and sur"ery !s per)!tted# Types of re"!onal anesthes!a !nclude sp!nal( caudal( !ntercostal( ep!dural( and brach!al ple*us# The f!rst step !n )ana"!n" dru" o erdose or dru" to*!c!ty !s to establ!sh and )a!nta!n an a!rway# Resp!ratory paralys!s occurs !n sta"e IJ of anesthes!a +to*!c sta"e,# In sta"e I of anesthes!a( the pat!ent !s consc!ous and tran6u!l# 5yspnea and sharp( stabb!n" pa!n that !ncreases w!th resp!rat!on are sy)pto)s of pleur!sy( wh!ch can be a co)pl!cat!on of pneu)on!a or tuberculos!s# Jert!"o !s the )a%or sy)pto) of !nner ear !nfect!on or d!sease# Loud tal&!n" !s a s!"n of hear!n" !)pa!r)ent# A pat!ent who has an upper resp!ratory tract !nfect!on should blow h!s nose w!th both nostr!ls open#

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A pat!ent who has had a cataract re)o ed can be"!n )ost nor)al act! !t!es !n F or E daysN howe er( the pat!ent shouldnt bend and l!ft unt!l a phys!c!an appro es these act! !t!es# Sy)pto)s of corneal transplant re%ect!on !nclude eye !rr!tat!on and decreas!n" !sual f!eld# Gra es d!sease +hyperthyro!d!s), !s )an!fested by we!"ht loss( ner ousness( dyspnea( palp!tat!ons( heat !ntolerance( !ncreased th!rst( e*ophthal)os +bul"!n" eyes,( and "o!ter# The four types of l!poprote!n are chylo)!crons +the lowest/dens!ty l!poprote!ns,( ery/low/dens!ty l!poprote!ns( low/dens!ty l!poprote!ns( and h!"h/dens!ty l!poprote!ns# 'ealth care profess!onals use cholesterol le el fract!onat!on to assess a pat!ents r!s& of coronary artery d!sease# If a pat!ent who !s ta&!n" a)photer!c!n B +.un"!0one, bladder !rr!"at!ons for a fun"al !nfect!on has syste)!c cand!d!as!s and )ust rece! e I#J# flucona0ole +5!flucan,( the !rr!"at!ons can be d!scont!nued because flucona0ole treats the bladder !nfect!on as well# >at!ents w!th adult resp!ratory d!stress syndro)e can ha e h!"h pea& !nsp!ratory pressures# Therefore( the nurse should )on!tor these pat!ents closely for s!"ns of spontaneous pneu)othora*( such as acute deter!orat!on !n o*y"enat!on( absence of breath sounds on the affected s!de( and crep!tus be"!nn!n" on the affected s!de# Ad erse react!ons to cyclospor!ne +Sand!))une, !nclude renal and hepat!c to*!c!ty( central ner ous syste) chan"es +confus!on and del!r!u),( GI bleed!n"( and hypertens!on# Hsteoporos!s !s a )etabol!c bone d!sorder !n wh!ch the rate of bone resorpt!on e*ceeds the rate of bone for)at!on#

The hall)ar& of ulcerat! e col!t!s !s recurrent bloody d!arrhea( wh!ch co))only conta!ns pus and )ucus and alternates w!th asy)pto)at!c re)!ss!ons# Safer se*ual pract!ces !nclude )assa"!n"( hu""!n"( body rubb!n"( fr!endly &!ss!n" +dry,( )asturbat!n"( hand/to/"en!tal touch!n"( wear!n" a condo)( and l!)!t!n" the nu)ber of se*ual partners# I))unosuppressed pat!ents who contract cyto)e"alo !rus +;-J, are at r!s& for ;-J pneu)on!a and sept!ce)!a( wh!ch can be fatal# Ur!nary tract !nfect!ons can cause ur!nary ur"ency and fre6uency( dysur!a( abdo)!nal cra)ps or bladder spas)s( and urethral !tch!n"# -a))o"raphy !s a rad!o"raph!c techn!6ue thats used to detect breast cysts or tu)ors( espec!ally those that arent palpable on phys!cal e*a)!nat!on# To pro)ote early detect!on of test!cular cancer( the nurse should palpate the testes dur!n" rout!ne phys!cal e*a)!nat!ons and encoura"e the pat!ent to perfor) )onthly self/e*a)!nat!ons dur!n" a war) shower# >at!ents who ha e thalasse)!a )!nor re6u!re no treat)ent# Those w!th thalasse)!a )a%or re6u!re fre6uent transfus!ons of red blood cells# A h!"h le el of hepat!t!s B seru) )ar&er that pers!sts for F )onths or )ore after the onset of acute hepat!t!s B !nfect!on su""ests chron!c hepat!t!s or carr!er status# Neuro"en!c bladder dysfunct!on !s caused by d!srupt!on of ner e trans)!ss!on to the bladder# It )ay be caused by certa!n sp!nal cord !n%ur!es( d!abetes( or )ult!ple scleros!s# H*y"en and carbon d!o*!de )o e between the lun"s and the bloodstrea) by d!ffus!on#

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To "rade the se er!ty of dyspnea( the follow!n" syste) !s usedI "rade 1( shortness of breath on )!ld e*ert!on( such as wal&!n" up stepsN "rade 3( shortness of breath when wal&!n" a short d!stance at a nor)al pace on le el "roundN "rade F( shortness of breath w!th )!ld da!ly act! !ty( such as sha !n"N "rade E( shortness of breath when sup!ne +orthopnea,# A pat!ent w!th ;rohns d!sease should consu)e a d!et low !n res!due( f!ber( and fat( and h!"h !n calor!es( prote!ns( and carbohydrates# The pat!ent also should ta&e !ta)!n supple)ents( espec!ally !ta)!n L# In the three/bottle ur!ne collect!on )ethod( the pat!ent cleans the )eatus and ur!nates 14 to 1: )l !n the f!rst bottle and 1: to F4 )l +)!dstrea), !n the second bottle# Then the phys!c!an perfor)s prostat!c )assa"e( and the pat!ent o!ds !nto the th!rd bottle# .!nd!n"s !n the three/bottle ur!ne collect!on )ethod are !nterpreted as followsI pus !n the ur!ne +pyur!a, !n the f!rst bottle !nd!cates anter!or urethr!t!sN bacter!a !n the ur!ne !n the second bottle !nd!cate bladder !nfect!onN bacter!a !n the th!rd bottle !nd!cate prostat!t!s# S!"ns and sy)pto)s of aort!c stenos!s !nclude a loud( rou"h systol!c )ur)ur o er the aort!c areaN e*ert!onal dyspneaN fat!"ueN an"!na pector!sN arrhyth)!asN low blood pressureN and e)bol!# Elect! e sur"ery !s pr!)ar!ly a )atter of cho!ce# It !snt essent!al to the pat!ents sur ! al( but !t )ay !)pro e the pat!ents health( co)fort( or self/estee)# Re6u!red sur"ery !s reco))ended by the phys!c!an# It )ay be delayed( but !s !ne !table# Ur"ent sur"ery )ust be perfor)ed w!th!n 3E to E= hours# E)er"ency sur"ery )ust be perfor)ed !))ed!ately# About =:G of arter!al e)bol! or!"!nate !n the heart cha)bers# >ul)onary e)bol!s) usually results fro) thro)b! d!slod"ed fro) the le" e!ns# The consc!ous !nterpretat!on of pa!n occurs !n the cerebral corte*# To a o!d !nterfer!n" w!th new cell "rowth( the dress!n" on a donor s&!n "raft s!te shouldnt be d!sturbed# A se6uela !s any abnor)al cond!t!on that follows and !s the result of a d!sease( a treat)ent( or an !n%ury# 5ur!n" s!c&le cell cr!s!s( pat!ent care !ncludes bed rest( o*y"en therapy( anal"es!cs as prescr!bed( I#J# flu!d )on!tor!n"( and thorou"h docu)entat!on of flu!d !nta&e and output# A pat!ent who has an !leal condu!t should )a!nta!n a da!ly flu!d !nta&e of 3(444 )l# In a closed chest dra!na"e syste)( cont!nuous bubbl!n" !n the water seal cha)ber or bottle !nd!cates a lea&# >alp!tat!on !s a sensat!on of heart pound!n" or rac!n" assoc!ated w!th nor)al e)ot!onal responses and certa!n heart d!sorders# .at e)bol!s) !s l!&ely to occur w!th!n the f!rst 3E hours after a lon"/bone fracture# .ootdrop can occur !n a pat!ent w!th a pel !c fracture as a result of peroneal ner e co)press!on a"a!nst the head of the f!bula# To pro)ote enous return after an a)putat!on( the nurse should wrap an elast!c banda"e around the d!stal end of the stu)p# $ater that accu)ulates !n the tub!n" of a ent!lator should be re)o ed#

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The )ost co))on route for the ad)!n!strat!on of ep!nephr!ne to a pat!ent who !s ha !n" a se ere aller"!c react!on !s the subcutaneous route# The nurse should use .owlers pos!t!on for a pat!ent who has abdo)!nal pa!n caused by append!c!t!s# The nurse shouldnt "! e anal"es!cs to a pat!ent who has abdo)!nal pa!n caused by append!c!t!s because these dru"s )ay )as& the pa!n that acco)pan!es a ruptured append!*# The nurse shouldnt "! e anal"es!cs to a pat!ent who has abdo)!nal pa!n caused by append!c!t!s because these dru"s )ay )as& the pa!n that acco)pan!es a ruptured append!*# As a last/d!tch effort( a barb!turate co)a )ay be !nduced to re erse unrelent!n" !ncreased !ntracran!al pressure +I;>,( wh!ch !s def!ned as acute I;> of "reater than E4 )) '"( pers!stent ele at!on of I;> abo e 34 )) '"( or rap!dly deter!orat!n" neurolo"!c status# The pr!)ary s!"ns and sy)pto)s of ep!"lott!d!t!s are str!dor and pro"ress! e d!ff!culty !n swallow!n"# Sal! at!on !s the f!rst step !n the d!"est!on of starch# A pat!ent who has a de)and pace)a&er should )easure the pulse rate before r!s!n" !n the )orn!n"( not!fy the phys!c!an !f the pulse rate drops by : beats<)!nute( obta!n a )ed!cal !dent!f!cat!on card and bracelet( and resu)e nor)al act! !t!es( !nclud!n" se*ual act! !ty# Trans erse( or loop( colosto)y !s a te)porary procedure thats perfor)ed to d! ert the fecal strea) !n a pat!ent who has acute !ntest!nal obstruct!on# Nor)al alues for erythrocyte sed!)entat!on rate are 4 to 1: ))<hour for )en youn"er than a"e :4 and 4 to 34 ))<hour for wo)en youn"er than a"e :4# A ;L/-B le el thats )ore than :G of total ;L or )ore than 14 U<L su""ests a )yocard!al !nfarct!on# >ropranolol +Inderal, bloc&s sy)pathet!c ner e st!)ul! that !ncrease card!ac wor& dur!n" e*erc!se or stress( wh!ch reduces heart rate( blood pressure( and )yocard!al o*y"en consu)pt!on# After a )yocard!al !nfarct!on( electrocard!o"ra) chan"es +ST/se")ent ele at!on( T/wa e !n ers!on( and P/wa e enlar"e)ent, usually appear !n the f!rst 3E hours( but )ay not appear unt!l the :th or 2th day# ;ard!o"en!c shoc& !s )an!fested by systol!c blood pressure of less than =4 )) '"( "ray s&!n( d!aphores!s( cyanos!s( wea& pulse rate( tachycard!a or bradycard!a( and ol!"ur!a +less than F4 )l of ur!ne per hour,# A pat!ent who !s rece! !n" a low/sod!u) d!et shouldnt eat cotta"e cheese( f!sh( canned beans( chuc& stea&( chocolate pudd!n"( Ital!an salad dress!n"( d!ll p!c&les( and beef broth# '!"h/potass!u) foods !nclude dr!ed prunes( water)elon +1:#F )E6< port!on,( dr!ed l!)a beans +1E#: )E6<port!on,( soybeans( bananas( and oran"es# Luss)auls resp!rat!ons are faster and deeper than nor)al resp!rat!ons and occur w!thout pauses( as !n d!abet!c &etoac!dos!s# ;heyne/Sto&es resp!rat!ons are character!0ed by alternat!n" per!ods of apnea and deep( rap!d breath!n"# They occur !n pat!ents w!th central ner ous syste) d!sorders# 'yper ent!lat!on can result fro) an !ncreased fre6uency of breath!n"( an !ncreased t!dal olu)e( or both# Apnea !s the absence of spontaneous resp!rat!ons#

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NURSING BULLETS _____________ ___________________________________________________________

Before a thyro!decto)y( a pat!ent )ay rece! e potass!u) !od!de( ant!thyro!d dru"s( and propranolol +Inderal, to pre ent thyro!d stor) dur!n" sur"ery# The nor)al l!fe span of red blood cells +erythrocytes, !s 114 to 134 days# J!sual acu!ty of 34<144 )eans that the pat!ent sees at 34B +2 ), what a person w!th nor)al !s!on sees at 144B +F4 ),# Ur!nary tract !nfect!ons are )ore co))on !n "!rls and wo)en than !n boys and )en because the shorter urethra !n the fe)ale ur!nary tract )a&es the bladder )ore access!ble to bacter!a( espec!ally Escher!ch!a col!# >en!c!ll!n !s ad)!n!stered orally 1 to 3 hours before )eals or 3 to F hours after )eals because food )ay !nterfere w!th the dru"s absorpt!on# -!ld react!ons to local anesthet!cs )ay !nclude palp!tat!ons( t!nn!tus( ert!"o( apprehens!on( confus!on( and a )etall!c taste !n the )outh# About 33G of card!ac output "oes to the &!dneys# To ensure accurate central enous pressure read!n"s( the nurse should place the )ano)eter or transducer le el w!th the phlebostat!c a*!s# A pat!ent who has lost 3(444 to 3(:44 )l of blood w!ll ha e a pulse rate of 1E4 beats<)!nute +or h!"her,( d!splay a systol!c blood pressure of :4 to 24 )) '"( and appear confused and lethar"!c# Arter!al blood !s br!"ht red( flows rap!dly( and +because !ts pu)ped d!rectly fro) the heart, spurts w!th each heartbeat# Jenous blood !s dar& red and tends to oo0e fro) a wound#

Hrthostat!c blood pressure !s ta&en w!th the pat!ent !n the sup!ne( s!tt!n"( and stand!n" pos!t!ons( w!th 1 )!nute between each read!n"# A 14/)) '" decrease !n blood pressure or an !ncrease !n pulse rate of 14 beats< )!nute su""ests olu)e deplet!on# A pneu)at!c ant!shoc& "ar)ent should be used caut!ously !n pre"nant wo)en and pat!ents w!th head !n%ur!es# After a pat!ents c!rculat!n" olu)e !s restored( the nurse should re)o e the pneu)at!c ant!shoc& "ar)ent "radually( start!n" w!th the abdo)!nal cha)ber and followed by each le"# The "ar)ent should be re)o ed under a phys!c!ans super !s!on# -ost he)olyt!c transfus!on react!ons assoc!ated w!th )!s)atch!n" of ABH blood types ste) fro) !dent!f!cat!on nu)ber errors# $ar)!n" of blood to )ore than 14DC . +E1#DC ;, can cause he)olys!s# ;ard!ac output !s the a)ount of blood e%ected fro) the heart each )!nute# Its e*pressed !n l!ters per )!nute# Stro&e olu)e !s the olu)e of blood e%ected fro) the heart dur!n" systole# Total parenteral nutr!t!on solut!on conta!ns de*trose( a)!no ac!ds( and add!t! es( such as electrolytes( )!nerals( and !ta)!ns# The )ost co))on type of neuro"en!c shoc& !s sp!nal shoc&# It usually occurs F4 to 24 )!nutes after a sp!nal cord !n%ury# After a sp!nal cord !n%ury( per!stals!s stops w!th!n 3E hours and usually returns w!th!n F to E days#

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To*!c shoc& syndro)e !s )an!fested by a te)perature of at least 143C . +F=#=C ;,( an erythe)atous rash( and systol!c blood pressure of less than O4 )) '"# .ro) 1 to 3 wee&s after the onset of these s!"ns( des6ua)at!on +espec!ally on the pal)s and soles, occurs# The s!"ns and sy)pto)s of anaphyla*!s are co))only caused by h!sta)!ne release# The )ost co))on cause of sept!c shoc& !s "ra)/ne"at! e bacter!a( such as Escher!ch!a col!( Llebs!ella( and >seudo)onas or"an!s)s# Bru!ts are ascular sounds that rese)ble heart )ur)urs and result fro) turbulent blood flow throu"h a d!seased or part!ally obstructed artery# Ur!ne p' !s nor)ally E#: to =#4# Ur!ne p' of "reater than =#4 can result fro) a ur!nary tract !nfect!on( a h!"h/al&al! d!et( or syste)!c al&alos!s# Ur!ne p' of less than E#: )ay be caused by a h!"h/prote!n d!et( fe er( or )etabol!c ac!dos!s# Before a percutaneous renal b!opsy( the pat!ent should be placed on a f!r) surface and pos!t!oned on the abdo)en# A sandba" !s placed under the abdo)en to stab!l!0e the &!dneys# Nephrot!c syndro)e !s character!0ed by )ar&ed prote!nur!a( hypoalbu)!ne)!a( )!ld to se ere dependent ede)a( asc!tes( and we!"ht "a!n# Underwater e*erc!se !s a for) of therapy perfor)ed !n a 'ubbard tan&# -ost wo)en w!th tr!cho)on!as!s ha e a )alodorous( frothy( "reen!sh "ray a"!nal d!schar"e# Hther wo)en )ay ha e no s!"ns or sy)pto)s# Jo!d!n" cystourethro"raphy )ay be perfor)ed to detect bladder and urethral abnor)al!t!es# ;ontrast )ed!u) !s !nst!lled by "entle syr!n"e pressure throu"h a urethral catheter( and o erhead 7/ray f!l)s are ta&en to !sual!0e bladder f!ll!n" and e*cret!on#

;ystourethro"raphy )ay be perfor)ed to !dent!fy the cause of ur!nary tract !nfect!ons( con"en!tal ano)al!es( and !ncont!nence# It also !s used to assess for prostate lobe hypertrophy !n )en# 'erpes s!)ple* !s character!0ed by recurrent ep!sodes of bl!sters on the s&!n and )ucous )e)branes# It has two ar!at!ons# In type 1( the bl!sters appear !n the nasolab!al re"!onN !n type 3( they appear on the "en!tals( anus( buttoc&s( and th!"hs# -ost pat!ents w!th ;hla)yd!a tracho)at!s !nfect!on are asy)pto)at!c( but so)e ha e an !nfla)ed urethral )eatus( dysur!a( and ur!nary ur"ency and fre6uency# The hypothala)us re"ulates the autono)!c ner ous syste) and endocr!ne funct!ons# A pat!ent whose chest e*curs!on !s less than nor)al +F9 to 29 [D#: to 1: c)\, )ust use accessory )uscles to breathe# S!"ns and sy)pto)s of to*!c!ty fro) thyro!d replace)ent therapy !nclude rap!d pulse rate( d!aphores!s( !rr!tab!l!ty( we!"ht loss( dysur!a( and sleep d!sturbance# The )ost co))on aller"!c react!on to pen!c!ll!n !s a rash# An early s!"n of asp!r!n to*!c!ty !s deep( rap!d resp!rat!ons# The )ost ser!ous and !rre ers!ble conse6uence of lead po!son!n" !s )ental retardat!on( wh!ch results fro) neurolo"!c da)a"e#

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To assess dehydrat!on !n the adult( the nurse should chec& s&!n tur"or on the sternu)# .or a pat!ent w!th a pept!c ulcer( the type of d!et !s less !)portant than !nclud!n" foods !n the d!et that the pat!ent can tolerate#

A pat!ent w!th a colosto)y )ust establ!sh an !rr!"at!on schedule so that re"ular e)pty!n" of the bowel occurs w!thout sto)al d!schar"e between !rr!"at!ons# $hen us!n" rotat!n" tourn!6uets( the nurse shouldnt restr!ct the blood supply to an ar) or le" for )ore than E: )!nutes at a t!)e# A pat!ent w!th d!abetes should eat h!"h/f!ber foods because they blunt the r!se !n "lucose le el that nor)ally follows a )eal# Au"ular e!n d!stent!on occurs !n pat!ents w!th heart fa!lure because the left entr!cle cant e)pty the heart of blood as fast as blood enters fro) the r!"ht entr!cle( result!n" !n con"est!on !n the ent!re enous syste)# The lead!n" causes of bl!ndness !n the Un!ted States are d!abetes )ell!tus and "lauco)a# After a thyro!decto)y( the pat!ent should re)a!n !n the se)!/.owler pos!t!on( w!th h!s head ne!ther hypere*tended nor hyperfle*ed( to a o!d pressure on the suture l!ne# Th!s pos!t!on can be ach!e ed w!th the use of a cer !cal p!llow# >re)enstrual syndro)e )ay cause abdo)!nal d!stent!on( en"or"ed and pa!nful breasts( bac&ache( headache( ner ousness( !rr!tab!l!ty( restlessness( and tre)ors# Treat)ent of deh!scence +patholo"!c open!n" of a wound, cons!sts of co er!n" the wound w!th a )o!st ster!le dress!n" and not!fy!n" the phys!c!an# $hen a pat!ent has a rad!cal )astecto)y( the o ar!es also )ay be re)o ed because they are a source of estro"en( wh!ch st!)ulates tu)or "rowth# Atrop!ne bloc&s the effects of acetylchol!ne( thereby obstruct!n" !ts a"al effects on the s!noatr!al node and !ncreas!n" heart rate# Sal!cylates( part!cularly asp!r!n( are the treat)ent of cho!ce !n rheu)ato!d arthr!t!s because they decrease !nfla))at!on and rel!e e %o!nt pa!n# 5eep( !ntense pa!n that usually worsens at n!"ht and !s unrelated to )o e)ent su""ests bone pa!n# >a!n that follows prolon"ed or e*cess! e e*erc!se and subs!des w!th rest su""ests )uscle pa!n# The )a%or he)odyna)!c chan"es assoc!ated w!th card!o"en!c shoc& are decreased left entr!cular funct!on and decreased card!ac output# Before thyro!decto)y( the pat!ent should be ad !sed that he )ay e*per!ence hoarseness or loss of h!s o!ce for se eral days after sur"ery# Acceptable ad erse effects of lon"/ter) stero!d use !nclude we!"ht "a!n( acne( headaches( fat!"ue( and !ncreased ur!ne retent!on# Unacceptable ad erse effects of lon"/ter) stero!d use are d!00!ness on r!s!n"( nausea( o)!t!n"( th!rst( and pa!n# After a cran!oto)y( nurs!n" care !ncludes )a!nta!n!n" nor)al !ntracran!al pressure( )a!nta!n!n" cerebral perfus!on pressure( and pre ent!n" !n%ury related to cerebral and cellular !sche)!a#

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.ol!c ac!d and !ta)!n B13 are essent!al for nucleoprote!n synthes!s and red blood cell )aturat!on# I))ed!ately after !ntracran!al sur"ery( nurs!n" care !ncludes not "! !n" the pat!ent anyth!n" by )outh unt!l the "a" and cou"h refle*es return( )on!tor!n" !tal s!"ns and assess!n" the le el of consc!ousness +LH;, for s!"ns of !ncreas!n" !ntracran!al pressure( and ad)!n!ster!n" anal"es!cs that dont )as& the LH;#

;hest phys!otherapy !ncludes postural dra!na"e( chest percuss!on and !brat!on( and cou"h!n" and deep/breath!n" e*erc!ses# ;ush!n"s syndro)e results fro) e*cess! e le els of adrenocort!cal hor)ones and !s )an!fested by fat pads on the face +)oon face, and o er the upper bac& +buffalo hu)p,( acne( )ood sw!n"s( h!rsut!s)( a)enorrhea( and decreased l!b!do# To pre ent an add!son!an cr!s!s when d!scont!nu!n" lon"/ter) predn!sone +5eltasone, therapy( the nurse should taper the dose slowly to allow for )on!tor!n" of d!sease flare/ups and for the return of hypothala)!c/p!tu!tary/adrenal funct!on# >ulsus parado*us !s a pulse that beco)es wea& dur!n" !nsp!rat!on and stron" dur!n" e*p!rat!on# It )ay be a s!"n of card!ac ta)ponade# Substances that are e*pelled throu"h portals of e*!t !nclude sal! a( )ucus( feces( ur!ne( o)!tus( blood( and a"!nal and pen!le d!schar"es# A )!croor"an!s) )ay be trans)!tted d!rectly( by contact w!th an !nfected body or droplets( or !nd!rectly( by contact w!th conta)!nated a!r( so!l( water( or flu!ds# A post)enopausal wo)an who rece! es estro"en therapy !s at an !ncreased r!s& for "allbladder d!sease and breast cancer# The appro*!)ate o*y"en concentrat!ons del! ered by a nasal cannula are as followsI 1 L U 3EG( 3 L U 3=G( F L U F3G( E LU F2G( and : L U E4G# ;ard!nal features of d!abetes !ns!p!dus !nclude polyd!ps!a +e*cess! e th!rst, and polyur!a +!ncreased ur!nat!on to : L<3E hours,#

A pat!ent w!th low spec!f!c "ra !ty +1#441 to 1#44:, )ay ha e an !ncreased des!re for cold water# 5!abet!c co)a can occur when the blood "lucose le el drops below 24 )"<dl# .or a pat!ent w!th heart fa!lure( the nurse should ele ate the head of the bed =9 to 139 +34 to F4 c),( pro !de a beds!de co))ode( and ad)!n!ster card!ac "lycos!des and d!uret!cs as prescr!bed# The pr!)ary reason to treat streptococcal sore throat w!th ant!b!ot!cs !s to protect the heart al es and pre ent rheu)at!c fe er# A pat!ent w!th a nasal fracture )ay lose consc!ousness dur!n" reduct!on# 'oarseness and chan"e !n the o!ce are co))only the f!rst s!"ns of laryn"eal cancer# The lun"s( colon( and rectu) are a)on" the )ost co))on cancer s!tes# The )ost co))on preoperat! e proble) !n elderly pat!ents !s lower/than/nor)al total blood olu)e# -ann!tol +Hs)!trol,( an os)ot!c d!uret!c( !s ad)!n!stered to reduce !ntraocular or !ntracran!al pressure#

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$hen a stro&e !s suspected( the nurse should place the pat!ent on the affected s!de to pro)ote lun" e*pans!on on the unaffected s!de# .or a pat!ent who has had chest sur"ery( the nurse should reco))end s!tt!n" upr!"ht and perfor)!n" cou"h!n" and deep/ breath!n" e*erc!ses# These act!ons pro)ote e*pans!on of the lun"s( re)o al of secret!ons( and opt!)al pul)onary funct!on!n"# 5ur!n" e ery sleep cycle( the sleeper passes throu"h four sta"es of nonrap!d/eye/)o e)ent sleep and one sta"e of rap!d/ eye/)o e)ent sleep# A pat!ent who !s ta&!n" calc!fed!ol +;alderol, should a o!d conco)!tant use of preparat!ons that conta!n !ta)!n 5# A pat!ent should be"!n and end a 3E/hour ur!ne collect!on per!od w!th an e)pty bladder# .or e*a)ple( !f the phys!c!an orders ur!ne to be collected fro) 4=44 Thursday to 4=44 .r!day( the ur!ne o!ded at 4=44 Thursday should be d!scarded and the ur!ne o!ded at 4=44 .r!day should be reta!ned# In a pat!ent who !s rece! !n" d!"o*!n +Lano*!n,( a low potass!u) le el !ncreases the r!s& of d!"o*!n to*!c!ty# Blood urea n!tro"en alues nor)ally ran"e fro) 14 to 34 )"<dl# .lura0epa) +5al)ane, to*!c!ty !s )an!fested by confus!on( halluc!nat!ons( and ata*!a# A s!lent )yocard!al !nfarct!on !s one that has no sy)pto)s# Ad erse react!ons to erapa)!l +Isopt!n, !nclude d!00!ness( headache( const!pat!on( hypotens!on( and atr!o entr!cular conduct!on d!sturbances# The dru" also )ay !ncrease the seru) d!"o*!n le el# $hen a rectal tube !s used to rel!e e flatulence or enhance per!stals!s( !t should be !nserted for no lon"er than 34 )!nutes# Xellow!sh "reen d!schar"e on a wound dress!n" !nd!cates !nfect!on and should be cultured# S!c&le cell cr!s!s can cause se ere abdo)!nal( thorac!c( )uscular( and bone pa!n alon" w!th pa!nful swell!n" of soft t!ssue !n the hands and feet# Hral cand!d!as!s +thrush, !s character!0ed by crea)/colored or blu!sh wh!te patches on the oral )ucous )e)brane#

Treat)ent for a pat!ent w!th cyst!c f!bros!s )ay !nclude dru" therapy( e*erc!ses to !)pro e breath!n" and posture( e*erc!ses to fac!l!tate )ob!l!0at!on of pul)onary secret!ons( a h!"h/salt d!et( and pancreat!c en0y)e supple)ents w!th snac&s and )eals# >ancreat!c cancer )ay cause we!"ht loss( %aund!ce( and !nter)!ttent dull/to/se ere ep!"astr!c pa!n# -etastas!s !s the spread of cancer fro) one or"an or body part to another throu"h the ly)phat!c syste)( c!rculat!on syste)( or cerebrosp!nal flu!d# The )ana"e)ent of pul)onary ede)a focuses on open!n" the a!rways( support!n" ent!lat!on and perfus!on( !)pro !n" card!ac funct!on!n"( reduc!n" preload( and reduc!n" pat!ent an*!ety# .actors that contr!bute to the death of pat!ents w!th Al0he!)ers d!sease !nclude !nfect!on( )alnutr!t!on( and dehydrat!on# 'od"&!ns d!sease !s character!0ed by pa!nless( pro"ress! e enlar"e)ent of cer !cal ly)ph nodes and other ly)pho!d t!ssue as a result of prol!ferat!on of Reed/Sternber" cells( h!st!ocytes( and eos!noph!ls#

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'unt!n"tons d!sease +chorea, !s a hered!tary d!sease character!0ed by de"enerat!on !n the cerebral corte* and basal "an"l!a# A pat!ent w!th 'unt!n"tons d!sease )ay e*h!b!t su!c!dal !deat!on# At d!schar"e( an a)putee should be able to de)onstrate proper stu)p care and perfor) stu)p/tou"hen!n" e*erc!ses# Acute tubular necros!s !s the )ost co))on cause of acute renal fa!lure# ;o))on co)pl!cat!ons of !ce water la a"e are o)!t!n" and asp!rat!on# .oods h!"h !n !ta)!n 5 !nclude fort!f!ed )!l&( f!sh( l! er( l! er o!l( herr!n"( and e"" yol&# .or a pel !c e*a)!nat!on( the pat!ent should be !n the l!thoto)y pos!t!on( w!th the buttoc&s e*tend!n" 3S9 +2#E c), past the end of the e*a)!nat!on table# If a pat!ent cant assu)e the l!thoto)y pos!t!on for a pel !c e*a)!nat!on( she )ay l!e on her left s!de# A )ale e*a)!ner should ha e a fe)ale ass!stant present dur!n" a a"!nal e*a)!nat!on for the pat!ents e)ot!onal co)fort and the e*a)!ners le"al protect!on# ;er !cal secret!ons are clear and stretchy before o ulat!on and wh!te and opa6ue after o ulat!on# Theyre nor)ally odorless and dont !rr!tate the )ucosa# A pat!ent w!th an !leosto)y shouldnt eat corn because !t )ay obstruct the open!n" of the pouch# L! er dysfunct!on affects the )etabol!s) of certa!n dru"s# Ede)a that acco)pan!es burns and )alnutr!t!on !s caused by decreased os)ot!c pressure !n the cap!llar!es# 'yponatre)!a !s )ost l!&ely to occur as a co)pl!cat!on of naso"astr!c suct!on!n"# In a )an who has co)plete sp!nal cord separat!on at SE( erect!on and e%aculat!on arent poss!ble# The early s!"ns of pul)onary ede)a +dyspnea on e*ert!on and cou"h!n", reflect !nterst!t!al flu!d accu)ulat!on and decreased ent!lat!on and al eolar perfus!on# -ethylpredn!solone +Solu/-edrol, !s a f!rst/l!ne dru" used to control ede)a after sp!nal cord trau)a#

.or the pat!ent who !s reco er!n" fro) an !ntracran!al bleed( the nurse should )a!nta!n a 6u!et( restful en !ron)ent for the f!rst few days# Neurosyph!l!s !s assoc!ated w!th w!despread da)a"e to the central ner ous syste)( !nclud!n" "eneral pares!s( personal!ty chan"es( slapp!n" "a!t( and bl!ndness# A wo)an who has had a sp!nal cord !n%ury can st!ll beco)e pre"nant# In a pat!ent who has had a stro&e( the )ost ser!ous co)pl!cat!on !s !ncreas!n" !ntracran!al pressure# A pat!ent w!th an !ntracran!al he)orrha"e should under"o arter!o"raphy to !dent!fy the s!te of the bleed!n"# .actors that affect the act!on of dru"s !nclude absorpt!on( d!str!but!on( )etabol!s)( and e*cret!on# Before prescr!b!n" a dru" for a wo)an of ch!ldbear!n" a"e( the prescr!ber should as& for the date of her last )enstrual per!od and as& !f she )ay be pre"nant#

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Ac!dos!s )ay cause !nsul!n res!stance# A pat!ent w!th "lucose/2/phosphate dehydro"enase def!c!ency )ay ha e acute he)olyt!c ane)!a when "! en a sulfona)!de# The f! e bas!c act! !t!es of the d!"est! e syste) are !n"est!on( )o e)ent of food( d!"est!on( absorpt!on( and defecat!on# S!"ns and sy)pto)s of acute pancreat!t!s !nclude ep!"astr!c pa!n( o)!t!n"( blu!sh d!scolorat!on of the left flan& +Grey Turners s!"n,( blu!sh d!scolorat!on of the per!u)b!l!cal area +;ullens s!"n,( low/"rade fe er( tachycard!a( and hypotens!on# A pat!ent w!th a "astr!c ulcer )ay ha e "naw!n" or burn!n" ep!"astr!c pa!n#

To test the f!rst cran!al ner e +olfactory ner e,( the nurse should as& the pat!ent to close h!s eyes( occlude one nostr!l( and !dent!fy a non!rr!tat!n" substance +such as pepper)!nt or c!nna)on, by s)ell# Then the nurse should repeat the test w!th the pat!ents other nostr!l occluded# Sal& and Sab!n !ntroduced the oral pol!o acc!ne# A pat!ent w!th a d!sease of the cerebellu) or poster!or colu)n has an ata*!c "a!t thats character!0ed by sta""er!n" and !nab!l!ty to re)a!n steady when stand!n" w!th the feet to"ether# In trau)a pat!ents( !)pro ed outco)e !s d!rectly related to early resusc!tat!on( a""ress! e )ana"e)ent of shoc&( and appropr!ate def!n!t! e care# To chec& for lea&a"e of cerebrosp!nal flu!d( the nurse should !nspect the pat!ents nose and ears# If the pat!ent can s!t up( the nurse should obser e h!) for lea&a"e as the pat!ent leans forward# Loc&ed/!n syndro)e !s co)plete paralys!s as a result of bra!n ste) da)a"e# Hnly the eyes can be )o ed oluntar!ly# Nec& d!ssect!on( or sur"!cal re)o al of the cer !cal ly)ph nodes( !s perfor)ed to pre ent the spread of )al!"nant tu)ors of the head and nec&# A pat!ent w!th cholecyst!t!s typ!cally has r!"ht ep!"astr!c pa!n that )ay rad!ate to the r!"ht scapula or shoulderN nauseaN and o)!t!n"( espec!ally after eat!n" a hea y )eal# Atrop!ne !s used preoperat! ely to reduce secret!ons# Seru) calc!u) le els are nor)ally E#: to :#: )E6<L# Suppressor T cells re"ulate o erall !))une response#

Seru) le els of aspartate a)!notransferase and alan!ne a)!notransferase show whether the l! er !s ade6uately deto*!fy!n" dru"s# Seru) sod!u) le els are nor)ally 1F: to 1E: )E6<L# Seru) potass!u) le els are nor)ally F#: to :#4 )E6<L# A pat!ent who !s ta&!n" predn!sone +5eltasone, should consu)e a salt/restr!cted d!et thats r!ch !n potass!u) and prote!n# $hen perfor)!n" cont!nuous a)bulatory per!toneal d!alys!s( the nurse )ust use ster!le techn!6ue when handl!n" the catheter( send a per!toneal flu!d sa)ple for culture and sens!t! !ty test!n" e ery 3E hours( and report s!"ns of !nfect!on and flu!d !)balance#

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$hen wor&!n" w!th pat!ents who ha e ac6u!red !))unodef!c!ency syndro)e( the nurse should wear "o""les and a )as& only !f blood or another body flu!d could splash onto the nurses face# Blood sp!lls that are !nfected w!th hu)an !))unodef!c!ency !rus should be cleaned up w!th a 1I14 solut!on of sod!u) hypochlor!te :#3:G +household bleach,# Raynauds pheno)enon !s !nter)!ttent !sche)!c attac&s !n the f!n"ers or toes# It causes se ere pallor and so)et!)es paresthes!a and pa!n# Intussuscept!on +prolapse of one bowel se")ent !nto the lu)en of another, causes sudden ep!"astr!c pa!n( sausa"e/shaped abdo)!nal swell!n"( passa"e of )ucus and blood throu"h the rectu)( shoc&( and hypotens!on# Bence Aones prote!n occurs al)ost e*clus! ely !n the ur!ne of pat!ents who ha e )ult!ple )yelo)a#

Gauchers d!sease !s an autoso)al d!sorder thats character!0ed by abnor)al accu)ulat!on of "lucocerebros!des +l!p!d substances that conta!n "lucose, !n )onocytes and )acrocytes# It has three for)sI Type 1 !s the adult for)( type 3 !s the !nfant!le for)( and type F !s the %u en!le for)# A pat!ent w!th colon obstruct!on )ay ha e lower abdo)!nal pa!n( const!pat!on( !ncreas!n" d!stent!on( and o)!t!n"# ;olch!c!ne +;olsal!de, rel!e es !nfla))at!on and !s used to treat "out# So)e people ha e "out as a result of hyperur!ce)!a because they cant )etabol!0e and e*crete pur!nes nor)ally# A nor)al sper) count !s 34 to 1:4 )!ll!on<)l# A f!rst/de"ree burn !n ol es the stratu) corneu) layer of the ep!der)!s and causes pa!n and redness# Sheehans syndro)e !s hypop!tu!tar!s) caused by a p!tu!tary !nfarct after postpartu) shoc& and he)orrha"e# $hen car!n" for a pat!ent who has had an asth)a attac&( the nurse should place the pat!ent !n .owlers or se)!/.owlers pos!t!on# In elderly pat!ents( the !nc!dence of nonco)pl!ance w!th prescr!bed dru" therapy !s h!"h# -any elderly pat!ents ha e d!)!n!shed !sual acu!ty( hear!n" loss( or for"etfulness( or need to ta&e )ult!ple dru"s# Tuberculos!s !s a reportable co))un!cable d!sease thats caused by !nfect!on w!th -ycobacter!u) tuberculos!s +an ac!d/fast bac!llus,# .or r!"ht/s!ded card!ac catheter!0at!on( the phys!c!an passes a )ult!lu)en catheter throu"h the super!or or !nfer!or ena ca a#

After a fracture( bone heal!n" occurs !n these sta"esI he)ato)a for)at!on( cellular prol!ferat!on and callus for)at!on( and oss!f!cat!on and re)odel!n"# A pat!ent who !s scheduled for pos!tron e)!ss!on to)o"raphy should a o!d alcohol( tobacco( and caffe!ne for 3E hours before the test# In a stro&e( decreased o*y"en destroys bra!n cells# A pat!ent w!th "lauco)a shouldnt rece! e atrop!ne sulfate because !t !ncreases !ntraocular pressure# The nurse should !nstruct a pat!ent who !s hyper ent!lat!n" to breathe !nto a paper ba"#

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5ur!n" !nter)!ttent pos!t! e/pressure breath!n"( the pat!ent should b!te down on the )outhp!ece( breathe nor)ally( and let the )ach!ne do the wor&# After !nsp!rat!on( the pat!ent should hold h!s breath for F or E seconds and e*hale co)pletely throu"h the )outhp!ece# .le*!on contractures of the h!ps )ay occur !n a pat!ent who s!ts !n a wheelcha!r for a lon" t!)e# Nysta")us !s rap!d hor!0ontal or rotat!n" eye )o e)ent# After )yelo"raphy( the pat!ent should re)a!n recu)bent for 3E hours# The treat)ent of spra!ns and stra!ns cons!sts of apply!n" !ce !))ed!ately and ele at!n" the ar) or le" abo e heart le el# An ant!chol!nesterase a"ent shouldnt be prescr!bed for a pat!ent who !s ta&!n" )orph!ne because !t can potent!ate the effect of )orph!ne and cause resp!ratory depress!on# -yop!a !s nears!"htedness# 'yperop!a and presbyop!a are two types of fars!"htedness# The )ost effect! e contracept! e )ethod !s one that the wo)an selects for herself and uses cons!stently# To perfor) $ebers test for bone conduct!on( a !brat!n" tun!n" for& !s placed on top of the pat!ents head at )!dl!ne# The pat!ent should perce! e the sound e6ually !n both ears# In a pat!ent who has conduct! e hear!n" loss( the sound !s heard !n +lateral!0es to, the ear that has conduct! e loss# In the R!nne test( bone conduct!on !s tested by plac!n" a !brat!n" tun!n" for& on the )asto!d process of the te)poral bone and a!r conduct!on !s tested by hold!n" the !brat!n" tun!n" for& S9 +1#F c), fro) the e*ternal aud!tory )eatus# These tests are alternated( at d!fferent fre6uenc!es( unt!l the tun!n" for& !s no lon"er heard at one pos!t!on# After an a)putat!on( the stu)p )ay shr!n& because of )uscle atrophy and decreased subcutaneous fat# A pat!ent who has deep e!n thro)bos!s !s "! en hepar!n for D to 14 days( followed by 13 wee&s of warfar!n +;ou)ad!n, therapy# After pneu)onecto)y( the pat!ent should be pos!t!oned on the operat! e s!de or on h!s bac&( w!th h!s head sl!"htly ele ated# To reduce the poss!b!l!ty of for)at!on of new e)bol! or e*pans!on of e*!st!n" e)bol!( a pat!ent w!th deep e!n thro)bos!s should rece! e hepar!n# Atheroscleros!s !s the )ost co))on cause of coronary artery d!sease# It usually !n ol es the aorta and the fe)oral( coronary( and cerebral arter!es# >ul)onary e)bol!s) !s a potent!ally fatal co)pl!cat!on of deep e!n thro)bos!s# ;hest pa!n !s the )ost co))on sy)pto) of pul)onary e)bol!s)# The nurse should !nfor) a pat!ent who !s ta&!n" phena0opyr!d!ne +>yr!d!u), that th!s dru" colors ur!ne oran"e or red# >neu)othora* !s a ser!ous co)pl!cat!on of central enous l!ne place)entN !ts caused by !nad ertent lun" puncture# >neu)ocyst!s car!n!! pneu)on!a !snt cons!dered conta"!ous because !t only affects pat!ents who ha e a suppressed !))une syste)# To enhance dru" absorpt!on( the pat!ent should ta&e re"ular erythro)yc!n tablets w!th a full "lass of water 1 hour before or 3 hours after a )eal or should ta&e enter!c/coated tablets w!th food# The pat!ent should a o!d ta&!n" e!ther type of tablet w!th fru!t %u!ce# Tr!s)us( a s!"n of tetanus +loc&%aw,( causes pa!nful spas)s of the )ast!catory )uscles( d!ff!culty open!n" the )outh( nec&

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r!"!d!ty and st!ffness( and dyspha"!a# The nurse should place the pat!ent !n an upr!"ht pos!t!on for thoracentes!s# If th!s !snt poss!ble( the nurse should pos!t!on the pat!ent on the unaffected s!de# If "ra !ty flow !s used( the nurse should han" a blood ba" FB +1 ), abo e the le el of the planned en!puncture s!te# The nurse should place a pat!ent who has a closed chest dra!na"e syste) !n the se)!/.owler pos!t!on# If blood !snt transfused w!th!n F4 )!nutes( the nurse should return !t to the blood ban& because the refr!"erat!on fac!l!t!es on a nurs!n" un!t are !nade6uate for stor!n" blood products# Blood thats d!scolored and conta!ns "as bubbles !s conta)!nated w!th bacter!a and shouldnt be transfused# .!fty percent of pat!ents who rece! e conta)!nated blood d!e# .or )ass! e( rap!d blood transfus!ons and for e*chan"e transfus!ons !n neonates( blood should be war)ed to O=#DC . +FDC ;,#

A chest tube per)!ts a!r and flu!d to dra!n fro) the pleural space# A handheld resusc!tat!on ba" !s an !nflatable de !ce that can be attached to a face )as& or an endotracheal or tracheosto)y tube# It allows )anual del! ery of o*y"en to the lun"s of a pat!ent who cant breathe !ndependently# -echan!cal ent!lat!on art!f!c!ally controls or ass!sts resp!rat!on# The nurse should encoura"e a pat!ent who has a closed chest dra!na"e syste) to cou"h fre6uently and breathe deeply to help dra!n the pleural space and e*pand the lun"s# Tracheal suct!on re)o es secret!ons fro) the trachea and bronch! w!th a suct!on catheter# 5ur!n" colosto)y !rr!"at!on( the !rr!"at!on ba" should be hun" 1=9 +E:#D c), abo e the sto)a# The water used for colosto)y !rr!"at!on should be 144C to 14:C . +FD#=C to E4#2C ;,# An arter!al e)bol!s) )ay cause pa!n( loss of sensory ner es( pallor( coolness( paralys!s( pulselessness( or paresthes!a !n the affected ar) or le"# Resp!ratory al&alos!s results fro) cond!t!ons that cause hyper ent!lat!on and reduce the carbon d!o*!de le el !n the arter!al blood# -!neral o!l !s contra!nd!cated !n a pat!ent w!th append!c!t!s( acute sur"!cal abdo)en( fecal !)pact!on( or !ntest!nal obstruct!on# $hen us!n" a X/type ad)!n!strat!on set to transfuse pac&ed red blood cells +RB;s,( the nurse can add nor)al sal!ne solut!on to the ba" to d!lute the RB;s and )a&e the) less !scous#

Autotransfus!on !s collect!on( f!ltrat!on( and re!nfus!on of the pat!ents own blood# >repared I#J# solut!ons fall !nto three "eneral cate"or!esI !soton!c( hypoton!c( and hyperton!c# Isoton!c solut!ons ha e a solute concentrat!on thats s!)!lar to body flu!dsN add!n" the) to plas)a doesnt chan"e !ts os)olar!ty# 'ypoton!c solut!ons ha e a lower os)ot!c pressure than body flu!dsN add!n" the) to plas)a decreases !ts os)olar!ty# 'yperton!c solut!ons ha e a h!"her os)ot!c pressure than body flu!dsN add!n" the) to plas)a !ncreases !ts os)olar!ty# Stress !ncont!nence !s !n oluntary lea&a"e of ur!ne tr!""ered by a sudden phys!cal stra!n( such as a cou"h( snee0e( or 6u!c&

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)o e)ent# 5ecreased renal funct!on )a&es an elderly pat!ent )ore suscept!ble to the de elop)ent of renal calcul!# The nurse should cons!der us!n" shorter needles to !n%ect dru"s !n elderly pat!ents because these pat!ents e*per!ence subcutaneous t!ssue red!str!but!on and loss !n areas( such as the buttoc&s and delto!d )uscles# Ur"e !ncont!nence !s the !nab!l!ty to suppress a sudden ur"e to ur!nate# Total !ncont!nence !s cont!nuous( uncontrollable lea&a"e of ur!ne as a result of the bladders !nab!l!ty to reta!n ur!ne# >rote!n( !ta)!n( and )!neral needs usually re)a!n constant as a person a"es( but calor!c re6u!re)ents decrease# .our al es &eep blood flow!n" !n one d!rect!on !n the heartI two atr!o entr!cular al es +tr!cusp!d and )!tral, and two se)!lunar al es +pul)on!c and aort!c,# An elderly pat!ents he!"ht )ay decrease because of narrow!n" of the !nter ertebral spaces and e*a""erated sp!nal cur ature#

;onst!pat!on )ost co))only occurs when the ur"e to defecate !s suppressed and the )uscles assoc!ated w!th bowel )o e)ents re)a!n contracted# Gout de elops !n four sta"esI asy)pto)at!c( acute( !ntercr!t!cal( and chron!c# ;o))on postoperat! e co)pl!cat!ons !nclude he)orrha"e( !nfect!on( hypo ole)!a( sept!ce)!a( sept!c shoc&( atelectas!s( pneu)on!a( thro)bophleb!t!s( and pul)onary e)bol!s)# An !nsul!n pu)p del! ers a cont!nuous !nfus!on of !nsul!n !nto a selected subcutaneous s!te( co))only !n the abdo)en# A co))on sy)pto) of sal!cylate +asp!r!n, to*!c!ty !s t!nn!tus +r!n"!n" !n the ears,# A frostb!tten e*tre)!ty )ust be thawed rap!dly( e en !f def!n!t! e treat)ent )ust be delayed# A pat!ent w!th Raynauds d!sease shouldnt s)o&e c!"arettes or other tobacco products# Raynauds d!sease !s a pr!)ary arter!ospast!c d!sorder that has no &nown cause# Raynauds pheno)enon( howe er( !s caused by another d!sorder such as scleroder)a# To re)o e a fore!"n body fro) the eye( the nurse should !rr!"ate the eye w!th ster!le nor)al sal!ne solut!on# $hen !rr!"at!n" the eye( the nurse should d!rect the solut!on toward the lower con%unct! al sac# E)er"ency care for a corneal !n%ury caused by a caust!c substance !s flush!n" the eye w!th cop!ous a)ounts of water for 34 to F4 )!nutes#

5ebr!de)ent !s )echan!cal( che)!cal( or sur"!cal re)o al of necrot!c t!ssue fro) a wound# Se ere pa!n after cataract sur"ery !nd!cates bleed!n" !n the eye# A b! al e cast !s cut !nto anter!or and poster!or port!ons to allow s&!n !nspect!on# After ear !rr!"at!on( the nurse should place the pat!ent on the affected s!de to per)!t "ra !ty to dra!n flu!d that re)a!ns !n the ear#

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If a pat!ent w!th an !ndwell!n" catheter has abdo)!nal d!sco)fort( the nurse should assess for bladder d!stent!on( wh!ch )ay be caused by catheter bloc&a"e# ;ont!nuous bladder !rr!"at!on helps pre ent ur!nary tract obstruct!on by flush!n" out s)all blood clots that for) after prostate or bladder sur"ery# The nurse should re)o e an !ndwell!n" catheter when bladder deco)press!on !s no lon"er needed( when the catheter !s obstructed( or when the pat!ent can resu)e o!d!n"# The lon"er a catheter re)a!ns !n place( the "reater the r!s& of ur!nary tract !nfect!on# In an adult( the e*tent of a burn !n%ury !s deter)!ned by us!n" the Rule of N!nesI the head and nec& are counted as OGN each ar)( as OGN each le"( as 1=GN the bac& of the trun&( as 1=GN the front of the trun&( as 1=GN and the per!neu)( as 1G# A deep part!al/th!c&ness burn affects the ep!der)!s and der)!s# In a pat!ent who !s ha !n" an asth)a attac&( nurs!n" !nter ent!ons !nclude ad)!n!ster!n" o*y"en and bronchod!lators as prescr!bed( plac!n" the pat!ent !n the se)!/.owler pos!t!on( encoura"!n" d!aphra")at!c breath!n"( and help!n" the pat!ent to rela*#

>rostate cancer !s usually fatal !f bone )etastas!s occurs# A str!ct e"etar!an needs !ta)!n B13 supple)ents because an!)als and an!)al products are the only source of th!s !ta)!n# Re"ular !nsul!n !s the only type of !nsul!n that can be )!*ed w!th other types of !nsul!n and can be "! en I#J# If a pat!ent pulls out the outer tracheosto)y tube( the nurse should hold the tracheosto)y open w!th a sur"!cal d!lator unt!l the phys!c!an pro !des appropr!ate care# The )edulla oblon"ata !s the part of the bra!n that controls the resp!ratory center# .or an unconsc!ous pat!ent( the nurse should perfor) pass! e ran"e/of/)ot!on e*erc!ses e ery 3 to E hours# A t!)ed/release dru" !snt reco))ended for use !n a pat!ent who has an !leosto)y because !t releases the dru" at d!fferent rates alon" the GI tract# The nurse !snt re6u!red to wear "lo es when apply!n" n!tro"lycer!n pasteN howe er( she should wash her hands after apply!n" th!s dru"# Before e*cretory uro"raphy( a pat!ents flu!d !nta&e !s usually restr!cted after )!dn!"ht# A sod!u) polystyrene sulfonate +Laye*alate, ene)a( wh!ch e*chan"es sod!u) !ons for potass!u) !ons( !s used to decrease the potass!u) le el !n a pat!ent who has hyper&ale)!a# If the color of a sto)a !s )uch l!"hter than when pre !ously assessed( decreased c!rculat!on to the sto)a should be suspected#

-assa"e !s contra!nd!cated !n a le" w!th a blood clot because !t )ay d!slod"e the clot# The f!rst place a nurse can detect %aund!ce !n an adult !s !n the sclera# Aaund!ce !s caused by e*cess! e le els of con%u"ated or uncon%u"ated b!l!rub!n !n the blood# -ydr!at!c dru"s are used pr!)ar!ly to d!late the pup!ls for !ntraocular e*a)!nat!ons#

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After eye sur"ery( the pat!ent should be placed on the unaffected s!de# $hen ass!"n!n" tas&s to a l!censed pract!cal nurse( the re"!stered nurse should dele"ate tas&s that are cons!dered beds!de nurs!n" care( such as ta&!n" !tal s!"ns( chan"!n" s!)ple dress!n"s( and "! !n" baths# 5eep calf pa!n on dors!fle*!on of the foot !s a pos!t! e 'o)ans s!"n( wh!ch su""ests enous thro)bos!s or thro)bophleb!t!s# Ultra/short/act!n" barb!turates( such as th!opental +>entothal,( are used as !n%ect!on anesthet!cs when a short durat!on of anesthes!a !s needed such as outpat!ent sur"ery# Atrop!ne sulfate )ay be used as a preanesthet!c dru" to reduce secret!ons and )!n!)!0e a"al refle*es# .or a pat!ent w!th !nfect!ous )ononucleos!s( the nurs!n" care plan should e)phas!0e str!ct bed rest dur!n" the acute febr!le sta"e to ensure ade6uate rest# 5ur!n" the acute phase of !nfect!ous )ononucleos!s( the pat!ent should curta!l act! !t!es to )!n!)!0e the poss!b!l!ty of ruptur!n" the enlar"ed spleen# 5a!ly appl!cat!on of a lon"/act!n"( transder)al n!tro"lycer!n patch !s a con en!ent( effect! e way to pre ent chron!c an"!na# The nurse )ust wear a cap( "lo es( a "own( and a )as& when pro !d!n" wound care to a pat!ent w!th th!rd/de"ree burns# The nurse should e*pect to ad)!n!ster an anal"es!c before bath!n" a burn pat!ent# The passa"e of blac&( tarry feces +)elena, !s a co))on s!"n of lower GI bleed!n"( but also )ay occur !n pat!ents who ha e upper GI bleed!n"# A pat!ent who has a "astr!c ulcer should a o!d ta&!n" asp!r!n and asp!r!n/conta!n!n" products because they can !rr!tate the "astr!c )ucosa# $h!le ad)!n!ster!n" che)otherapy a"ents w!th an I#J# l!ne( the nurse should d!scont!nue the !nfus!on at the f!rst s!"n of e*tra asat!on# A low/f!ber d!et )ay contr!bute to the de elop)ent of he)orrho!ds# A pat!ent who has abdo)!nal pa!n shouldnt rece! e an anal"es!c unt!l the cause of the pa!n !s deter)!ned# If sur"ery re6u!res ha!r re)o al( the reco))endat!on of the ;enters for 5!sease ;ontrol and >re ent!on !s that a dep!latory be used to a o!d s&!n abras!ons and cuts# .or nasotracheal suct!on!n"( the nurse should set wall suct!on at :4 to O: )) '" for an !nfant( O: to 11: )) '" for a ch!ld( or =4 to 134 )) '" for an adult# After a )yocard!al !nfarct!on( a chan"e !n pulse rate and rhyth) )ay s!"nal the onset of fatal arrhyth)!as# Treat)ent of ep!sta*!s !ncludes nasal pac&!n"( !ce pac&s( cautery w!th s!l er n!trate( and pressure on the nares# >all!at! e treat)ent rel!e es or reduces the !ntens!ty of unco)fortable sy)pto)s( but doesnt cure the causat! e d!sorder#

>lac!n" a postoperat! e pat!ent !n an upr!"ht pos!t!on too 6u!c&ly )ay cause hypotens!on# Jerapa)!l +;alan, and d!lt!a0e) +;ard!0e), slow the !nflow of calc!u) to the heart( thereby decreas!n" the r!s& of supra entr!cular tachycard!a#

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After card!opul)onary bypass "raft( the pat!ent w!ll perfor) turn!n"( cou"h!n"( deep breath!n"( and wound spl!nt!n"( and w!ll use ass!st! e breath!n" de !ces# A pat!ent who !s e*posed to hepat!t!s B should rece! e 4#42 )l<&" I#-# of !))une "lobul!n w!th!n D3 hours after e*posure and a repeat dose at 3= days after e*posure# The nurse should ad !se a pat!ent who !s under"o!n" rad!at!on therapy not to re)o e the )ar&!n"s on the s&!n )ade by the rad!at!on therap!st because they are land)ar&s for treat)ent# The )ost co))on sy)pto) of osteoarthr!t!s !s %o!nt pa!n thats rel!e ed by rest( espec!ally !f the pa!n occurs after e*erc!se or we!"ht bear!n"# In adults( ur!ne olu)e nor)ally ran"es fro) =44 to 3(444 )l<day and a era"es between 1(344 and 1(:44 )l<day# 5!rectly appl!ed )o!st heat softens crusts and e*udates( penetrates deeper than dry heat( doesnt dry the s&!n( and !s usually )ore co)fortable for the pat!ent# Tetracycl!nes are seldo) cons!dered dru"s of cho!ce for )ost co))on bacter!al !nfect!ons because the!r o eruse has led to the e)er"ence of tetracycl!ne/res!stant bacter!a# Because l!"ht de"rades n!tropruss!de +N!tropress,( the dru" )ust be sh!elded fro) l!"ht# .or e*a)ple( an I#J# ba" that conta!ns n!tropruss!de sod!u) should be wrapped !n fo!l#

;ephalospor!ns should be used caut!ously !n pat!ents who are aller"!c to pen!c!ll!n# These pat!ents are )ore suscept!ble to hypersens!t! !ty react!ons# If chlora)phen!col and pen!c!ll!n )ust be ad)!n!stered conco)!tantly( the nurse should "! e the pen!c!ll!n 1 or )ore hours before the chlora)phen!col to a o!d a reduct!on !n pen!c!ll!ns bacter!c!dal act! !ty# The erythrocyte sed!)entat!on rate )easures the d!stance and speed at wh!ch erythrocytes !n whole blood fall !n a ert!cal tube !n 1 hour# The rate at wh!ch they fall to the botto) of the tube corresponds to the de"ree of !nfla))at!on# $hen teach!n" a pat!ent w!th )yasthen!a "ra !s about pyr!dost!")!ne +-est!non, therapy( the nurse should stress the !)portance of ta&!n" the dru" e*actly as prescr!bed( on t!)e( and !n e enly spaced doses to pre ent a relapse and )a*!)!0e the effect of the dru"# If an ant!b!ot!c )ust be ad)!n!stered !nto a per!pheral hepar!n loc&( the nurse should flush the s!te w!th nor)al sal!ne solut!on after the !nfus!on to )a!nta!n I#J# patency# The nurse should !nstruct a pat!ent w!th an"!na to ta&e a n!tro"lycer!n tablet before ant!c!pated stress or e*erc!se or( !f the an"!na !s nocturnal( at bedt!)e# Arter!al blood "as analys!s e aluates "as e*chan"e !n the lun"s +al eolar ent!lat!on, by )easur!n" the part!al pressures of o*y"en and carbon d!o*!de and the p' of an arter!al sa)ple# The nor)al seru) )a"nes!u) le el ran"es fro) 1#: to 3#: )E6<L# >at!ent preparat!on for a total cholesterol test !ncludes an o ern!"ht fast and abst!nence fro) alcohol for 3E hours before the test#

The fast!n" plas)a "lucose test )easures "lucose le els after a 13/ to 1E/hour fast#

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Nor)al blood p' ran"es fro) D#F: to D#E:# A blood p' h!"her than D#E: !nd!cates al&ale)!aN one lower than D#F: !nd!cates ac!de)!a# 5ur!n" an ac!d perfus!on test( a s)all a)ount of wea& hydrochlor!c ac!d solut!on !s !nfused w!th a nasoesopha"eal tube# A pos!t! e test result +pa!n after !nfus!on, su""ests reflu* esopha"!t!s# Nor)ally( the part!al pressure of arter!al carbon d!o*!de +>a;H3, ran"es fro) F: to E: )) '"# A >a;H3 "reater than E: )) '" !nd!cates ac!de)!a as a result of hypo ent!lat!onN one less than F: )) '" !nd!cates al&ale)!a as a result of hyper ent!lat!on# Red cell !nd!ces a!d !n the d!a"nos!s and class!f!cat!on of ane)!a# Nor)ally( the part!al pressure of arter!al o*y"en +>ao 3, ran"es fro) =4 to 144 )) '"# A >ao 3 of :4 to =4 )) '" !nd!cates resp!ratory !nsuff!c!ency# A >ao 3 of less than :4 )) '" !nd!cates resp!ratory fa!lure# The wh!te blood cell +$B;, d!fferent!al e aluates $B; d!str!but!on and )orpholo"y and pro !des )ore spec!f!c !nfor)at!on about a pat!ents !))une syste) than the $B; count# An e*erc!se stress test +tread)!ll test( e*erc!se electrocard!o"ra), cont!nues unt!l the pat!ent reaches a predeter)!ned tar"et heart rate or e*per!ences chest pa!n( fat!"ue( or other s!"ns of e*erc!se !ntolerance# Alterable r!s& factors for coronary artery d!sease !nclude c!"arette s)o&!n"( hypertens!on( h!"h cholesterol or tr!"lycer!de le els( and d!abetes#

The )ed!ast!nu) !s the space between the lun"s that conta!ns the heart( esopha"us( trachea( and other structures# -a%or co)pl!cat!ons of acute )yocard!al !nfarct!on !nclude arrhyth)!as( acute heart fa!lure( card!o"en!c shoc&( thro)boe)bol!s)( and left entr!cular rupture# The s!noatr!al node !s a cluster of hundreds of cells located !n the r!"ht atr!al wall( near the open!n" of the super!or ena ca a# .or one/person card!opul)onary resusc!tat!on( the rat!o of co)press!ons to ent!lat!ons !s 1:I3# .or two/person card!opul)onary resusc!tat!on( the rat!o of co)press!ons to ent!lat!ons !s :I1# A pat!ent who has pulseless entr!cular tachycard!a !s a cand!date for card!o ers!on# Echocard!o"raphy( a non!n as! e test that d!rects ultra/h!"h/fre6uency sound wa es throu"h the chest wall and !nto the heart( e aluates card!ac structure and funct!on and can show al e defor)!t!es( tu)ors( septal defects( per!card!al effus!on( and hypertroph!c card!o)yopathy# Ata*!a !s !)pa!red ab!l!ty to coord!nate )o e)ents# Its caused by a cerebellar or sp!nal cord les!on# Hn an electrocard!o"ra) str!p( each s)all bloc& on the hor!0ontal a*!s represents 4#4E second# Each lar"e bloc& +co)posed of f! e s)all bloc&s, represents 4#3 second# Starl!n"s law states that the force of contract!on of each heartbeat depends on the len"th of the )uscle f!bers of the heart wall# The therapeut!c blood le el for d!"o*!n !s 4#: to 3#: n"<)l#

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>ancrel!pase +>ancrease, !s used to treat cyst!c f!bros!s and chron!c pancreat!t!s# Treat)ent for )!ld to )oderate ar!cose e!ns !ncludes ant!e)bol!s) stoc&!n"s and an e*erc!se pro"ra) that !ncludes wal&!n" to )!n!)!0e enous pool!n"# An !nto*!cated pat!ent !snt cons!dered co)petent to refuse re6u!red )ed!cal treat)ent and shouldnt be allowed to chec& out of a hosp!tal a"a!nst )ed!cal ad !ce# The pr!)ary d!fference between the pa!n of an"!na and that of a )yocard!al !nfarct!on !s !ts durat!on# Gyneco)ast!a !s e*cess! e )a))ary "land de elop)ent and !ncreased breast s!0e !n boys and )en# ;lass!c sy)pto)s of Gra es d!sease are an enlar"ed thyro!d( ner ousness( heat !ntolerance( we!"ht loss desp!te !ncreased appet!te( sweat!n"( d!arrhea( tre)or( and palp!tat!ons# General!0ed )ala!se !s a co))on sy)pto) of !ral and bacter!al !nfect!ons and depress! e d!sorders# J!ta)!n ; and prote!n are the )ost !)portant nutr!ents for wound heal!n"# A pat!ent who has portal hypertens!on should rece! e !ta)!n L to pro)ote act! e thro)b!n for)at!on by the l! er# Thro)b!n reduces the r!s& of bleed!n"# The nurse should ad)!n!ster a sedat! e caut!ously to a pat!ent w!th c!rrhos!s because the da)a"ed l! er cant )etabol!0e dru"s effect! ely# Beta/he)olyt!c streptococcal !nfect!ons should be treated a""ress! ely to pre ent "lo)erulonephr!t!s( rheu)at!c fe er( and other co)pl!cat!ons# The )ost co))on nosoco)!al !nfect!on !s a ur!nary tract !nfect!on# The nurse should !)ple)ent str!ct !solat!on precaut!ons to protect a pat!ent w!th a th!rd/de"ree burn thats !nfected by Staphylococcus aureus# A pat!ent who !s under"o!n" e*ternal rad!at!on therapy shouldnt apply crea) or lot!on to the treat)ent s!te# The )ost co))on ascular co)pl!cat!on of d!abetes )ell!tus !s atheroscleros!s# Insul!n def!c!ency )ay cause hyper"lyce)!a# S!"ns of >ar&!nsons d!sease !nclude drool!n"( a )as&l!&e e*press!on( and a propuls! e "a!t# I#J# cholan"!o"raphy !s contra!nd!cated !n a pat!ent w!th hyperthyro!d!s)( se ere renal or hepat!c da)a"e( tuberculos!s( or !od!ne hypersens!t! !ty# -!rrors should be re)o ed fro) the roo) of a pat!ent who has d!sf!"ur!n" wounds such as fac!al burns# A pat!ent who has "outy arthr!t!s should !ncrease flu!d !nta&e to pre ent calcul! for)at!on# An*!ety !s the )ost co))on cause of chest pa!n# A pat!ent who !s follow!n" a low/salt d!et should a o!d canned e"etables# Bananas are a "ood source of potass!u) and should be !ncluded !n a low/salt d!et for pat!ents who are ta&!n" a loop d!uret!c such as furose)!de +Las!*,# The nurse should encoura"e a pat!ent who !s at r!s& for pneu)on!a to turn fre6uently( cou"h( and breathe deeply# These

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act!ons )ob!l!0e pul)onary secret!ons( pro)ote al eolar "as e*chan"e( and help pre ent atelectas!s# The nurse should not!fy the phys!c!an whene er a pat!ents blood pressure reaches 1=4<144 )) '"# Buc&s tract!on !s used to !))ob!l!0e and reduce spas)s !n a fractured h!p# .or a pat!ent w!th a fractured h!p( the nurse should assess neuroc!rculatory status e ery 3 hours# $hen car!n" for a pat!ent w!th a fractured h!p( the nurse should use p!llows or a trochanter roll to )a!nta!n abduct!on# Hrthopnea !s a sy)pto) of left/s!ded heart fa!lure# Althou"h a f!ber"lass cast !s )ore durable and dr!es )ore 6u!c&ly than a plaster cast( !t typ!cally causes s&!n !rr!tat!on# In an !))ob!l!0ed pat!ent( the )a%or c!rculatory co)pl!cat!on !s pul)onary e)bol!s)# To rel!e e ede)a !n a fractured l!)b( the pat!ent should &eep the l!)b ele ated# I#J# ant!b!ot!cs are the treat)ent of cho!ce for a pat!ent w!th osteo)yel!t!s# Blue dye !n c!)et!d!ne +Ta"a)et, can cause a false/pos!t! e result on a fecal occult blood test such as a 'e)occult test# The nurse should suspect elder abuse !f wounds are !ncons!stent w!th the pat!ents h!story( )ult!ple wounds are present( or wounds are !n d!fferent sta"es of heal!n"# I))ed!ately after a)putat!on( pat!ent care !ncludes )on!tor!n" dra!na"e fro) the stu)p( pos!t!on!n" the affected l!)b( ass!st!n" w!th e*erc!ses prescr!bed by a phys!cal therap!st( and wrapp!n" and cond!t!on!n" the stu)p# A pat!ent who !s prone to const!pat!on should !ncrease h!s bul& !nta&e by eat!n" whole/"ra!n cereals and fresh fru!ts and e"etables#

In the pel !c e*a)!nat!on of a se*ual assault !ct!)( the speculu) should be lubr!cated w!th water# ;o))erc!al lubr!cants retard sper) )ot!l!ty and !nterfere w!th spec!)en collect!on and analys!s# .or a ter)!nally !ll pat!ent( phys!cal co)fort !s the top pr!or!ty !n nurs!n" care# 5ors!fle*!on of the foot pro !des !))ed!ate rel!ef of le" cra)ps# After card!ac sur"ery( the pat!ent should l!)!t da!ly sod!u) !nta&e to 3 " and da!ly cholesterol !nta&e to F44 )"# Bleed!n" after !ntercourse !s an early s!"n of cer !cal cancer# Hral ant!d!abet!c a"ents( such as chlorpropa)!de +5!ab!nese, and tolbuta)!de +Hr!nase,( st!)ulate !nsul!n release fro) beta cells !n the !slets of Lan"erhans of the pancreas# $hen !s!t!n" a pat!ent who has a rad!at!on !)plant( fa)!ly )e)bers and fr!ends )ust l!)!t the!r stay to 14 )!nutes# J!s!tors and nurses who are pre"nant are restr!cted fro) enter!n" the roo)# ;o))on causes of a"!nal !nfect!on !nclude us!n" an ant!b!ot!c( an oral contracept! e( or a cort!costero!dN wear!n" t!"ht/ f!tt!n" panty hoseN and ha !n" se*ual !ntercourse w!th an !nfected partner# A pat!ent w!th a rad!at!on !)plant should re)a!n !n !solat!on unt!l the !)plant !s re)o ed# To )!n!)!0e rad!at!on e*posure(

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wh!ch !ncreases w!th t!)e( the nurse should carefully plan the t!)e spent w!th the pat!ent# A)on" cultural "roups( Nat! e A)er!cans ha e the lowest !nc!dence of cancer# The &!dneys f!lter blood( select! ely reabsorb substances that are needed to )a!nta!n the constancy of body flu!d( and e*crete )etabol!c wastes# To pre ent stra!n!n" dur!n" defecat!on( docusate +;olace, !s the la*at! e of cho!ce for pat!ents who are reco er!n" fro) a )yocard!al !nfarct!on( rectal or card!ac sur"ery( or postpartu) const!pat!on# After prostate sur"ery( a pat!ents pr!)ary sources of pa!n are bladder spas)s and !rr!tat!on !n the area around the catheter# To*oplas)os!s !s )ore l!&ely to affect a pre"nant cat owner than other pre"nant wo)en because cat feces !n the l!tter bo* harbor the !nfect!n" or"an!s)# Good food sources of fol!c ac!d !nclude "reen leafy e"etables( l! er( and le"u)es# The Glas"ow ;o)a Scale e aluates erbal( eye( and )otor responses to deter)!ne the pat!ents le el of consc!ousness# The nurse should place an unconsc!ous pat!ent !n low .owlers pos!t!on for !nter)!ttent naso"astr!c tube feed!n"s# La]nnecs +alcohol!c, c!rrhos!s !s the )ost co))on type of c!rrhos!s# In decort!cate postur!n"( the pat!ents ar)s are adducted and fle*ed( w!th the wr!sts and f!n"ers fle*ed on the chest# The le"s are e*tended st!ffly and rotated !nternally( w!th plantar fle*!on of the feet# ;and!dates for sur"ery should rece! e noth!n" by )outh fro) )!dn!"ht of the day before sur"ery unless cleared by a phys!c!an# -eper!d!ne +5e)erol, !s an effect! e anal"es!c to rel!e e the pa!n of nephrol!th!as!s +ur!nary calcul!,# An !n%ured pat!ent w!th thro)bocytopen!a !s at r!s& for l!fe/threaten!n" !nternal and e*ternal he)orrha"e# The Trendelenbur" test !s used to chec& for un!lateral h!p d!slocat!on# As soon as poss!ble after death( the pat!ent should be placed !n the sup!ne pos!t!on( w!th the ar)s at the s!des and the head on a p!llow# Jascular res!stance depends on blood !scos!ty( essel len"th and( )ost !)portant( !ns!de essel d!a)eter# A below/the/&nee a)putat!on lea es the &nee !ntact for prosthes!s appl!cat!on and allows a )ore nor)al "a!t than abo e/the/ &nee a)putat!on# ;erebrosp!nal flu!d flows throu"h and protects the four entr!cles of the bra!n( the subarachno!d space( and the sp!nal canal# Sod!u) re"ulates e*tracellular os)olal!ty# The heart and bra!n can )a!nta!n blood c!rculat!on !n the early sta"es of shoc&# After l!)b a)putat!on( narcot!c anal"es!cs )ay not rel!e e ?phanto) l!)b@ pa!n# A pat!ent who rece! es )ult!ple blood transfus!ons !s at r!s& for hypocalce)!a# Syph!l!s !n!t!ally causes pa!nless chancres +s)all( flu!d/f!lled les!ons, on the "en!tals and so)et!)es on other parts of the body#

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E*posure to a rad!oact! e source !s controlled by t!)e +l!)!t!n" t!)e spent w!th the pat!ent,( d!stance +fro) the pat!ent,( and sh!eld +a lead apron,# Aaund!ce !s a s!"n of dysfunct!on( not a d!sease# Se ere %aund!ce can cause bra!n ste) dysfunct!on !f the uncon%u"ated b!l!rub!n le el !n blood !s ele ated to 34 to 3: )"<dl# The pat!ent should ta&e c!)et!d!ne +Ta"a)et, w!th )eals to help ensure a cons!stent therapeut!c effect# $hen car!n" for a pat!ent w!th %aund!ce( the nurse should rel!e e prur!tus by pro !d!n" a sooth!n" lot!on or a ba&!n" soda bath and should pre ent !n%ury by &eep!n" the pat!ents f!n"erna!ls short# Type B hepat!t!s( wh!ch !s usually trans)!tted parenterally( also can be spread throu"h contact w!th hu)an secret!ons and feces# Insul!n !s a naturally occurr!n" hor)one thats secreted by the beta cells of the !slets of Lan"erhans !n the pancreas !n response to a r!se !n the blood "lucose le el# 5!abetes )ell!tus !s a chron!c endocr!ne d!sorder thats character!0ed by !nsul!n def!c!ency or res!stance to !nsul!n by body t!ssues# A d!a"nos!s of d!abetes )ell!tus !s based on the class!c sy)pto)s +polyur!a( polypha"!a( we!"ht loss( and polyd!ps!a, and a rando) blood "lucose le el of )ore than 344 )"<dl or a fast!n" plas)a "lucose le el of )ore than 1E4 )"<dl when tested on two separate occas!ons# A pat!ent w!th nonV!nsul!n/dependent +type 3, d!abetes )ell!tus produces so)e !nsul!n and nor)ally doesnt need e*o"enous !nsul!n supple)entat!on# -ost pat!ents w!th th!s type of d!abetes respond well to oral ant!d!abet!c a"ents( wh!ch st!)ulate the pancreas to !ncrease the synthes!s and release of !nsul!n# A pat!ent w!th !nsul!n/dependent +type 1, d!abetes )ell!tus cant produce endo"enous !nsul!n and re6u!res e*o"enous !nsul!n ad)!n!strat!on to )eet the bodys needs# Rap!d/act!n" !nsul!ns are clearN !nter)ed!ate/ and lon"/act!n" !nsul!ns are turb!d +cloudy,# Rap!d/act!n" !nsul!ns be"!n to act !n F4 to 24 )!nutes( reach a pea& concentrat!on !n 3 to 14 hours( and ha e a durat!on of act!on of : to 12 hours# The best t!)es to test a d!abet!c pat!ents "lucose le el are before each )eal and at bedt!)e# Inter)ed!ate/act!n" !nsul!ns be"!n to act !n 1 to 3 hours( reach a pea& concentrat!on !n E to 1: hours( and ha e a durat!on of act!on of 33 to 3= hours# Lon"/act!n" !nsul!ns be"!n to act !n E to = hours( reach a pea& concentrat!on !n 14 to F4 hours( and ha e a durat!on of act!on of F2 hours or )ore# If the results of a nonfast!n" "lucose test show abo e/nor)al "lucose le els after "lucose ad)!n!strat!on( but the pat!ent has nor)al plas)a "lucose le els otherw!se( the pat!ent has !)pa!red "lucose tolerance# Insul!n re6u!re)ents are !ncreased by "rowth( pre"nancy( !ncreased food !nta&e( stress( sur"ery( !nfect!on( !llness( !ncreased !nsul!n ant!bod!es( and so)e dru"s# Insul!n re6u!re)ents are decreased by hypothyro!d!s)( decreased food !nta&e( e*erc!se( and so)e dru"s# 'ypo"lyce)!a occurs when the blood "lucose le el !s less than :4 )"<dl# An !nsul!n/res!stant pat!ent !s one who re6u!res )ore than 344 un!ts of !nsul!n da!ly#

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'ypo"lyce)!a )ay occur 1 to F hours after the ad)!n!strat!on of a rap!d/act!n" !nsul!n( E to 1= hours after the ad)!n!strat!on of an !nter)ed!ate/act!n" !nsul!n( and 1= to F4 hours after the ad)!n!strat!on of a lon"/act!n" !nsul!n# $hen the blood "lucose le el decreases rap!dly( the pat!ent )ay e*per!ence sweat!n"( tre)ors( pallor( tachycard!a( and palp!tat!ons# Hb%ect! e s!"ns of hypo"lyce)!a !nclude slurred speech( lac& of coord!nat!on( sta""ered "a!t( se!0ures( and poss!bly( co)a#

A consc!ous pat!ent who has hypo"lyce)!a should rece! e su"ar !n an eas!ly d!"ested for)( such as oran"e %u!ce( candy( or lu)p su"ar# An unconsc!ous pat!ent who has hypo"lyce)!a should rece! e an S#;# or I#-# !n%ect!on of "luca"on as prescr!bed by a phys!c!an or :4G de*trose by I#J# !n%ect!on# A pat!ent w!th d!abetes )ell!tus should !nspect h!s feet da!ly for calluses( corns( and bl!sters# 'e should also use war) water to wash h!s feet and tr!) h!s toena!ls stra!"ht across to pre ent !n"rown toena!ls# The early sta"e of &etoac!dos!s causes polyur!a( polyd!ps!a( anore*!a( )uscle cra)ps( and o)!t!n"# The late sta"e causes Luss)auls resp!rat!ons( sweet breath odor( and stupor or co)a# An aller"en !s a substance that can cause a hypersens!t! !ty react!on# A correct! e lens for nears!"htedness !s conca e# ;hron!c untreated hypothyro!d!s) or abrupt w!thdrawal of thyro!d )ed!cat!on )ay lead to )y*ede)a co)a# S!"ns and sy)pto)s of )y*ede)a co)a are lethar"y( stupor( decreased le el of consc!ousness( dry s&!n and ha!r( delayed deep tendon refle*es( pro"ress! e resp!ratory center depress!on and cerebral hypo*!a( we!"ht "a!n( hypother)!a( and hypo"lyce)!a# Nears!"htedness occurs when the focal po!nt of a ray of l!"ht fro) an ob%ect thats 34B +2 ), away falls !n front of the ret!na# .ars!"htedness occurs when the focal po!nt of a ray of l!"ht fro) an ob%ect thats 34B away falls beh!nd the ret!na# A correct! e lens for fars!"htedness !s con e*# Refract!on !s cl!n!cal )easure)ent of the error !n eye focus!n"# Adhes!ons are bands of "ranulat!on and scar t!ssue that de elop !n so)e pat!ents after a sur"!cal !nc!s!on# The nurse should )o!sten an eye patch for an unconsc!ous pat!ent because a dry patch )ay !rr!tate the cornea# A pat!ent who has had eye sur"ery shouldnt bend o er( co)b h!s ha!r !"orously( or en"a"e !n act! !ty that !ncreases !ntraocular pressure# $hen car!n" for a pat!ent who has a penetrat!n" eye !n%ury( the nurse should patch both eyes loosely w!th ster!le "au0e( ad)!n!ster an oral ant!b!ot!c +!n h!"h doses, and tetanus !n%ect!on as prescr!bed( and refer the pat!ent to an ophthal)olo"!st for follow/up# S!"ns and sy)pto)s of colorectal cancer !nclude chan"es !n bowel hab!ts( rectal bleed!n"( abdo)!nal pa!n( anore*!a( we!"ht loss( )ala!se( ane)!a( and const!pat!on or d!arrhea# $hen cl!)b!n" sta!rs w!th crutches( the pat!ent should lead w!th the un!n ol ed le" and follow w!th the crutches and

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!n ol ed le"# $hen descend!n" sta!rs w!th crutches( the pat!ent should lead w!th the crutches and the !n ol ed le" and follow w!th the un!n ol ed le"# $hen sur"ery re6u!res eyelash tr!))!n"( the nurse should apply petroleu) %elly to the sc!ssor blades so that the eyelashes w!ll adhere to the)# >a!n after a corneal transplant )ay !nd!cate that the dress!n" has been appl!ed too t!"htly( the "raft has sl!pped( or the eye !s he)orrha"!n"#

A pat!ent w!th ret!nal detach)ent )ay report float!n" spots( flashes of l!"ht( and a sensat!on of a e!l or curta!n co)!n" down# I))ed!ate postoperat! e care for a pat!ent w!th ret!nal detach)ent !ncludes )a!nta!n!n" the eye patch and sh!eld !n place o er the affected area and obser !n" the area for dra!na"eN )a!nta!n!n" the pat!ent !n the pos!t!on spec!f!ed by the ophthal)olo"!st +usually( ly!n" on h!s abdo)en( w!th h!s head parallel to the floor and turned to the s!de,N a o!d!n" bu)p!n" the pat!ents head or bedN and encoura"!n" deep breath!n"( but not cou"h!n"# A pat!ent w!th a cataract )ay ha e !s!on d!sturbances( such as !)a"e d!stort!on( l!"ht "lar!n"( and "radual loss of !s!on# $hen tal&!n" to a hear!n"/!)pa!red pat!ent who can l!p/read( the nurse should face the pat!ent( spea& slowly and enunc!ate clearly( po!nt to ob%ects as needed( and a o!d chew!n" "u)# ;l!n!cal )an!festat!ons of enous stas!s ulcer !nclude he)os!der!n depos!ts + !s!ble !n fa!r/s&!nned !nd! !duals,N dry( crac&ed s&!nN and !nfect!on# The fluorescent trepone)al ant!body absorpt!on test !s a spec!f!c serolo"!c test for syph!l!s# To reduce fe er( the nurse )ay "! e the pat!ent a spon"e bath w!th tep!d water +=4C to OFC . [32#DC to FF#OC ;\,# $hen co))un!cat!n" w!th a pat!ent who has had a stro&e( the nurse should allow a)ple t!)e for the pat!ent to spea& and respond( face the pat!ents unaffected s!de( a o!d tal&!n" 6u!c&ly( "! e !sual clues( supple)ent speech w!th "estures( and "! e !nstruct!ons cons!stently# The )a%or co)pl!cat!on of Bells palsy !s &erat!t!s +corneal !nfla))at!on,( wh!ch results fro) !nco)plete eye closure on the affected s!de# I))unosuppressants are used to co)bat t!ssue re%ect!on and help control auto!))une d!sorders# After a un!lateral stro&e( a pat!ent )ay be able to propel a wheelcha!r by us!n" a heel/to/toe )o e)ent w!th the unaffected le" and turn!n" the wheel w!th the unaffected hand# .!rst/)orn!n" ur!ne !s the )ost concentrated and )ost l!&ely to show abnor)al!t!es# It should be refr!"erated to retard bacter!al "rowth or( for )!croscop!c e*a)!nat!on( should be sent to the laboratory !))ed!ately# A pat!ent who !s reco er!n" fro) a stro&e should al!"n h!s ar)s and le"s correctly( wear h!"h/top snea&ers to pre ent footdrop and contracture( and use an e"" crate( flotat!on( or pulsat!n" )attress to help pre ent pressure ulcers# After a fracture of the ar) or le"( the bone )ay show co)plete un!on +nor)al heal!n",( delayed un!on +heal!n" that ta&es lon"er than e*pected,( or nonun!on +fa!lure to heal,# The )ost co))on co)pl!cat!on of a h!p fracture !s thro)boe)bol!s)( wh!ch )ay occlude an artery and cause the area !t suppl!es to beco)e cold and cyanot!c#

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;hloral hydrate suppos!tor!es should be refr!"erated# ;ast appl!cat!on usually re6u!res two personsN !t shouldnt be atte)pted alone# A plaster cast reaches )a*!)u) stren"th !n E= hoursN a synthet!c cast( w!th!n F4 )!nutes because !t doesnt re6u!re dry!n"# Se ere pa!n !nd!cates the de elop)ent of a pressure ulcer w!th!n a castN the pa!n decreases s!"n!f!cantly after the ulcer de elops# Ind!cat!ons of c!rculatory !nterference are abnor)al s&!n coolness( cyanos!s( and rubor or pallor# 5ur!n" the postoperat! e phase( !ncreas!n" pulse rate and decreas!n" blood pressure )ay !nd!cate he)orrha"e and !)pend!n" shoc&# Hrthoped!c sur"!cal wounds bleed )ore than other sur"!cal wounds# The nurse can e*pect 344 to :44 )l of dra!na"e dur!n" the f!rst 3E hours and less than F4 )l each = hours for the ne*t E= hours# A pat!ent who has had h!p sur"ery shouldnt adduct or fle* the affected h!p because fle*!on "reater than O4 de"rees )ay cause d!slocat!on# The 'oyer l!ft( a hydraul!c de !ce( allows two persons to l!ft and )o e a nona)bulatory pat!ent safely# A pat!ent w!th carpal tunnel syndro)e( a co)ple* of sy)pto)s caused by co)press!on of the )ed!an ner e !n the carpal tunnel( usually has wea&ness( pa!n( burn!n"( nu)bness( or t!n"l!n" !n one or both hands# The nurse should !nstruct a pat!ent who has had heatstro&e to wear l!"ht/colored( loose/f!tt!n" cloth!n" when e*posed to the sunN rest fre6uentlyN and dr!n& plenty of flu!ds# A consc!ous pat!ent w!th heat e*haust!on or heatstro&e should rece! e a solut!on of S teaspoon of salt !n 134 )l of water e ery 1: )!nutes for 1 hour# An I#J# l!ne !nserted dur!n" an e)er"ency or outs!de the hosp!tal sett!n" should be chan"ed w!th!n 3E hours# After a tep!d bath( the nurse should dry the pat!ent thorou"hly to pre ent ch!lls# The nurse should ta&e the pat!ents te)perature F4 )!nutes after co)plet!n" a tep!d bath# Shower or bath water shouldnt e*ceed 14:C . +E4#2C ;,# 5!latat!on and curetta"e !s w!den!n" of the cer !cal canal w!th a d!lator and scrap!n" of the uterus w!th a curette# $hen not !n use( all central enous catheters )ust be capped w!th adaptors after flush!n"# ;are after d!latat!on and curetta"e cons!sts of bed rest for 1 day( )!ld anal"es!cs for pa!n( and use of a ster!le pad for as lon" as bleed!n" pers!sts# If a pat!ent feels fa!nt dur!n" a bath or shower( the nurse should turn off the water( co er the pat!ent( lower the pat!ents head( and su))on help# A pat!ent who !s ta&!n" oral contracept! es shouldnt s)o&e because s)o&!n" can !ntens!fy the dru"s ad erse card!o ascular effect# The use of soft restra!nts re6u!res a phys!c!ans order and assess)ent and docu)entat!on of the pat!ent and affected l!)bs( accord!n" to fac!l!ty pol!cy# A est restra!nt should be used caut!ously !n a pat!ent w!th heart fa!lure or a resp!ratory d!sorder# The restra!nt can t!"hten

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w!th )o e)ent( further l!)!t!n" resp!ratory funct!on# To ensure pat!ent safety( the least a)ount of restra!nt should be used# If a p!""ybac& syste) beco)es d!slod"ed( the nurse should replace the ent!re p!""ybac& syste) w!th the appropr!ate solut!on and dru"( as prescr!bed# The nurse shouldnt secure a restra!nt to a beds s!de ra!ls because they )!"ht be lowered !nad ertently and cause pat!ent !n%ury or d!sco)fort# The nurse should assess a pat!ent who has l!)b restra!nts e ery F4 )!nutes to detect s!"ns of !)pa!red c!rculat!on#

The ;enters for 5!sease ;ontrol and >re ent!on reco))ends us!n" a needleless syste) for p!""ybac&!n" an I#J# dru" !nto the )a!n I#J# l!ne# If a "own !s re6u!red( the nurse should put !t on when she enters the pat!ents roo) and d!scard !t when she lea es# $hen chan"!n" the dress!n" of a pat!ent who !s !n !solat!on( the nurse should wear two pa!rs of "lo es# A d!sposable bedpan and ur!nal should re)a!n !n the roo) of a pat!ent who !s !n !solat!on and be d!scarded on d!schar"e or at the end of the !solat!on per!od# -ycoses +fun"al !nfect!ons, )ay be syste)!c or deep +affect!n" the !nternal or"ans,( subcutaneous +!n ol !n" the s&!n,( or superf!c!al +"row!n" on the outer layer of s&!n and ha!r,# The n!"ht before a sputu) spec!)en !s to be collected by e*pectorat!on( the pat!ent should !ncrease flu!d !nta&e to pro)ote sputu) product!on# A sa)ple of feces for an o a and paras!te study should be collected d!rectly !nto a waterproof conta!ner( co ered w!th a l!d( and sent to the laboratory !))ed!ately# If the pat!ent !s bedr!dden( the sa)ple can be collected !nto a clean( dry bedpan and then transferred w!th a ton"ue depressor !nto a conta!ner# $hen obta!n!n" a sputu) spec!)en for test!n"( the nurse should !nstruct the pat!ent to r!nse h!s )outh w!th clean water( cou"h deeply fro) h!s chest( and e*pectorate !nto a ster!le conta!ner# Tono)etry allows !nd!rect )easure)ent of !ntraocular pressure and a!ds !n early detect!on of "lauco)a# >ul)onary funct!on tests +a ser!es of )easure)ents that e aluate ent!latory funct!on throu"h sp!ro)etr!c )easure)ents, help to d!a"nose pul) onary dysfunct!on# After a l! er b!opsy( the pat!ent should l!e on the r!"ht s!de to co)press the b!opsy s!te and decrease the poss!b!l!ty of bleed!n"# A pat!ent who has c!rrhos!s should follow a d!et that restr!cts sod!u)( but pro !des prote!n and !ta)!ns +espec!ally B( ;( and L( and folate,# If 13 hours of "astr!c suct!on dont rel!e e bowel obstruct!on( sur"ery !s !nd!cated# The nurse can puncture a n!fed!p!ne +>rocard!a, capsule w!th a needle( w!thdraw !ts l!6u!d( and !nst!ll !t !nto the buccal pouch# $hen ad)!n!ster!n" whole blood or pac&ed red blood cells +RB;s,( the nurse should use a 12 to 34G needle or cannula to a o!d RB; he)olys!s#

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'!rsut!s) !s e*cess! e body ha!r !n a )ascul!ne d!str!but!on# Hne un!t of whole blood or pac&ed red blood cells !s ad)!n!stered o er 3 to E hours# Scur y !s assoc!ated w!th !ta)!n ; def!c!ency# A !ta)!n !s an or"an!c co)pound that usually cant be synthes!0ed by the body and !s needed !n )etabol!c processes# >ul)onary e)bol!s) can be caused when thro)boe)bol!s) of fat( blood( bone )arrow( or a)n!ot!c flu!d obstructs the pul)onary artery# After )a*!llofac!al sur"ery( a pat!ent whose )and!ble and )a*!lla ha e been w!red to"ether should &eep a pa!r of sc!ssors or w!re cutters read!ly a a!lable so that he can cut the w!res and pre ent asp!rat!on !f o)!t!n" occurs# Rap!d !nst!llat!on of flu!d dur!n" colon!c !rr!"at!on can cause abdo)!nal cra)p!n"#

A collaborat! e relat!onsh!p between health care wor&ers helps shorten the hosp!tal stay and !ncreases pat!ent sat!sfact!on# .or elderly pat!ents !n a health care fac!l!ty( pred!ctable ha0ards !nclude n!"htt!)e confus!on +sundown!n",( fractures fro) fall!n"( !))ob!l!ty/!nduced pressure ulcers( prolon"ed con alescence( and loss of ho)e and support syste)s# Resp!ratory tract !nfect!ons( espec!ally !ral !nfect!ons( can tr!""er asth)a attac&s# H*y"en therapy !s used !n se ere asth)a attac&s to pre ent or treat hypo*e)!a# 5ur!n" an asth)a attac&( the pat!ent )ay prefer nasal pron"s to a Jentur! )as& because of the )as&s s)other!n" effect# ;hron!c obstruct! e pul)onary d!sease usually de elops o er a per!od of years# In O:G of pat!ents( !t results fro) s)o&!n"# An early s!"n of chron!c obstruct! e pul)onary d!sease +;H>5, !s slow!n" of forced e*p!rat!on# A healthy person can e)pty the lun"s !n less than E secondsN a pat!ent w!th ;H>5 )ay ta&e 2 to 14 seconds# ;hron!c obstruct! e pul)onary d!sease e entually leads to structural chan"es !n the lun"s( !nclud!n" o erd!stended al eol! and hyper!nflated lun"s# ;ellul!t!s causes local!0ed heat( redness( swell!n" and( occas!onally( fe er( ch!lls( and )ala!se# Jenous stas!s )ay prec!p!tate thro)bophleb!t!s# Treat)ent of thro)bophleb!t!s !ncludes le" ele at!on( heat appl!cat!on( and poss!bly( ant!coa"ulant therapy# A suct!on!n" )ach!ne should re)a!n at the beds!de of a pat!ent who has had )a*!llofac!al sur"ery# .or a bedr!dden pat!ent w!th heart fa!lure( the nurse should chec& for ede)a !n the sacral area# In pass! e ran"e/of/)ot!on e*erc!ses( the therap!st )o es the pat!ents %o!nts throu"h as full a ran"e of )ot!on as poss!ble to !)pro e or )a!nta!n %o!nt )ob!l!ty and help pre ent contractures# In res!stance e*erc!ses( wh!ch allow )uscle len"th to chan"e( the pat!ent perfor)s e*erc!ses a"a!nst res!stance appl!ed by the therap!st# In !so)etr!c e*erc!ses( the pat!ent contracts )uscles a"a!nst stable res!stance( but w!thout %o!nt )o e)ent# -uscle len"th re)a!ns the sa)e( but stren"th and tone )ay !ncrease#

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I)pet!"o !s a conta"!ous( superf!c!al( es!copustular s&!n !nfect!on# >red!spos!n" factors !nclude poor hy"!ene( ane)!a( )alnutr!t!on( and a war) cl!)ate# After card!opul)onary resusc!tat!on +;>R, be"!ns( !t shouldnt be !nterrupted( e*cept when the ad)!n!strator !s alone and )ust su))on help# In th!s case( the ad)!n!strator should perfor) ;>R for 1 )!nute before call!n" for help# The ton"ue !s the )ost co))on a!rway obstruct!on !n an unconsc!ous pat!ent# .or adult card!opul)onary resusc!tat!on( the chest co)press!on rate !s =4 to 144 t!)es per )!nute# A pat!ent w!th ulcers should a o!d bedt!)e snac&s because food )ay st!)ulate nocturnal secret!ons# In an"!oplasty( a blood essel !s d!lated w!th a balloon catheter thats !nserted throu"h the s&!n and the essels lu)en to the narrowed area# Hnce !n place( the balloon !s !nflated to flatten pla6ue a"a!nst the essel wall#

A full l!6u!d d!et suppl!es nutr!ents( flu!ds( and calor!es !n s!)ple( eas!ly d!"ested foods( such as apple %u!ce( crea) of wheat( )!l&( coffee( stra!ned crea) soup( h!"h/prote!n "elat!n( cranberry %u!ce( custard( and !ce crea)# Its prescr!bed for pat!ents who cant tolerate a re"ular d!et# A pureed d!et )eets the pat!ents nutr!t!onal needs w!thout !nclud!n" foods that are d!ff!cult to chew or swallow# .ood !s blended to a se)!sol!d cons!stency# A soft( or l!"ht( d!et !s spec!f!cally des!"ned for pat!ents who ha e d!ff!culty chew!n" or tolerat!n" a re"ular d!et# Its nutr!t!onally ade6uate and cons!sts of foods such as oran"e %u!ce( crea) of wheat( scra)bled e""s( enr!ched toast( crea) of ch!c&en soup( wheat bread( fru!t coc&ta!l( and )ushroo) soup# A re"ular d!et !s pro !ded for pat!ents who dont re6u!re d!etary )od!f!cat!on# A bland d!et restr!cts foods that cause "astr!c !rr!tat!on or produce ac!d secret!on w!thout pro !d!n" a neutral!0!n" effect# A clear l!6u!d d!et pro !des flu!d and a "radual return to a re"ular d!et# Th!s type of d!et !s def!c!ent !n all nutr!ents and should be followed for only a short per!od# >at!ents w!th a "astr!c ulcer should a o!d alcohol( caffe!nated be era"es( asp!r!n( and sp!cy foods# In act! e ass!stance e*erc!ses( the pat!ent perfor)s e*erc!ses w!th the therap!sts help# >en!c!ll!nase !s an en0y)e produced by certa!n bacter!a# It con erts pen!c!ll!n !nto an !nact! e product( !ncreas!n" the bacter!as res!stance to the ant!b!ot!c# Battles s!"n !s a blu!sh d!scolorat!on beh!nd the ear !n so)e pat!ents who susta!n a bas!lar s&ull fracture#

;rac&les are non)us!cal cl!c&!n" or rattl!n" no!ses that are heard dur!n" auscultat!on of abnor)al breath sounds# They are caused by a!r pass!n" throu"h flu!d/f!lled a!rways# Ant!b!ot!cs arent effect! e a"a!nst !ruses( proto0oa( or paras!tes# -ost pen!c!ll!ns and cephalospor!ns produce the!r ant!b!ot!c effects by cell wall !nh!b!t!on# $hen assess!n" a pat!ent w!th an !n"u!nal hern!a( the nurse should suspect stran"ulat!on !f the pat!ent reports se ere pa!n( nausea( and o)!t!n"#

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>h!)os!s !s t!"htness of the prepuce of the pen!s that pre ents retract!on of the fores&!n o er the "lans# A)!no"lycos!des are natural ant!b!ot!cs that are effect! e a"a!nst "ra)/ne"at! e bacter!a# They )ust be used w!th caut!on because they can cause nephroto*!c!ty and ototo*!c!ty# Hn scrotal e*a)!nat!on( ar!coceles and tu)ors dont trans!llu)!nate( but sper)atoceles and hydroceles do# A hordeolu) +eyel!d stye, !s an !nfect!on of one or )ore sebaceous "lands of the eyel!d# A chala0!on !s an eyel!d )ass thats caused by chron!c !nfla))at!on of the )e!bo)!an "land# 5ur!n" ophthal)oscop!c e*a)!nat!on( the absence of the red refle* !nd!cates a lens opac!ty +cataract, or a detached ret!na# Resp!ratory ac!dos!s !s assoc!ated w!th cond!t!ons such as dru" o erdose( Gu!lla!n/BarrZ syndro)e( )yasthen!a "ra !s( chron!c obstruct! e pul)onary d!sease( p!c&w!c&!an syndro)e( and &yphoscol!os!s# Bullets

Resp!ratory al&alos!s !s assoc!ated w!th cond!t!ons such as h!"h fe er( se ere hypo*!a( asth)a( and pul)onary e)bol!s)# -etabol!c ac!dos!s !s assoc!ated w!th such cond!t!ons as renal fa!lure( d!arrhea( d!abet!c &etos!s( and lact!c &etos!s( and w!th h!"h doses of aceta0ola)!de +5!a)o*,# Gastrecto)y !s sur"!cal e*c!s!on of all or part of the sto)ach to re)o e a chron!c pept!c ulcer( stop he)orrha"e !n a perforated ulcer( or re)o e a )al!"nant tu)or# -etabol!c al&alos!s !s assoc!ated w!th naso"astr!c suct!on!n"( e*cess! e use of d!uret!cs( and stero!d therapy# J!t!l!"o +a ben!"n( ac6u!red s&!n d!sease, !s )ar&ed by star& wh!te s&!n patches that are caused by the destruct!on and loss of p!")ent cells# H erdose or acc!dental o er!n"est!on of d!sulf!ra) +Antabuse, should be treated w!th "astr!c asp!rat!on or la a"e and support! e therapy# The causes of abdo)!nal d!stent!on are represented by the s!* .sI flatus( feces( fetus( flu!d( fat( and fatal +)al!"nant, neoplas)# A pos!t! e -urphys s!"n !nd!cates cholecyst!t!s# S!"ns of append!c!t!s !nclude r!"ht abdo)!nal pa!n( abdo)!nal r!"!d!ty and rebound tenderness( nausea( and anore*!a# Asc!tes can be detected when )ore than :44 )l of flu!d has collected !n the !ntraper!toneal space# .or a pat!ent w!th or"an!c bra!n syndro)e or a sen!le d!sease( the !deal en !ron)ent !s stable and l!)!ts confus!on#

In a pat!ent w!th or"an!c bra!n syndro)e( )e)ory loss usually affects all spheres( but be"!ns w!th recent )e)ory loss# 5ur!n" card!ac catheter!0at!on( the pat!ent )ay e*per!ence a thudd!n" sensat!on !n the chest( a stron" des!re to cou"h( and a trans!ent feel!n" of heat( usually !n the face( as a result of !n%ect!on of the contrast )ed!u)# Sl!"ht bubbl!n" !n the suct!on colu)n of a thorac!c dra!na"e syste)( such as a >leur/e ac un!t( !nd!cates that the syste) !s wor&!n" properly# A lac& of bubbl!n" !n the suct!on cha)ber !nd!cates !nade6uate suct!on# Nutr!t!onal def!c!ency !s a co))on f!nd!n" !n people who ha e a lon" h!story of alcohol abuse#

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In the pat!ent w!th ar!cose e!ns( "raduated co)press!on elast!c stoc&!n"s +F4 to E4 )) '", )ay be prescr!bed to pro)ote enous return# Non !ral hepat!t!s usually results fro) e*posure to certa!n che)!cals or dru"s# Substant!al ele at!on of the seru) transa)!nase le el !s a sy)pto) of acute hepat!t!s# Nor)al card!ac output !s E to 2 L<)!nute( w!th a stro&e olu)e of 24 to D4 )l# E*cess! e o)!t!n" or re)o al of the sto)ach contents throu"h suct!on can decrease the potass!u) le el and lead to hypo&ale)!a# As a hepar!n anta"on!st( prota)!ne !s an ant!dote for hepar!n o erdose# If a pat!ent has a pos!t! e react!on to a tubercul!n s&!n test( such as the pur!f!ed prote!n der! at! e test( the nurse should suspect current or past e*posure# The nurse should as& the pat!ent about a h!story of tuberculos!s +TB, and the presence of early s!"ns and sy)pto)s of TB( such as low/"rade fe er( we!"ht loss( n!"ht sweats( fat!"ue( and anore*!a# S!"ns and sy)pto)s of acute rheu)at!c fe er !nclude chorea( fe er( card!t!s( )!"ratory polyarthr!t!s( erythe)a )ar"!natu) +rash,( and subcutaneous nodules# Before under"o!n" any !n as! e dental procedure( the pat!ent who has a h!story of rheu)at!c fe er should rece! e prophylact!c pen!c!ll!n therapy# Th!s therapy helps to pre ent conta)!nat!on of the blood w!th oral bacter!a( wh!ch could )!"rate to the heart al es# After a )yocard!al !nfarct!on( )ost pat!ents can resu)e se*ual act! !ty when they can cl!)b two fl!"hts of sta!rs w!thout fat!"ue or dyspnea# Elderly pat!ents are suscept!ble to orthostat!c hypotens!on because the baroreceptors beco)e less sens!t! e to pos!t!on chan"es as people a"e# .or the pat!ent w!th suspected renal or urethral calcul!( the nurse should stra!n the ur!ne to deter)!ne whether calcul! ha e been passed# The nurse should place the pat!ent w!th asc!tes !n the se)!/.owler pos!t!on because !t per)!ts )a*!)u) lun" e*pans!on# .or the pat!ent who has !n"ested po!son( the nurse should sa e the o)!tus for analys!s# The earl!est s!"ns of resp!ratory d!stress are !ncreased resp!ratory rate and !ncreased pulse rate# In adults( "astroenter!t!s !s co))only self/l!)!t!n" and causes d!arrhea( abdo)!nal d!sco)fort( nausea( and o)!t!n"# ;ard!ac output e6uals stro&e olu)e )ult!pl!ed by the heart rate per )!nute# In pat!ents w!th acute )en!n"!t!s( the cerebrosp!nal flu!d prote!n le el !s ele ated# $hen a pat!ent !s suspected of ha !n" food po!son!n"( the nurse should not!fy publ!c health author!t!es so that they can !nter !ew pat!ents and food handlers and ta&e sa)ples of the suspected conta)!nated food# The pat!ent who !s rece! !n" a potass!u)/wast!n" d!uret!c should eat potass!u)/r!ch foods# A pat!ent w!th chron!c obstruct! e pul)onary d!sease should rece! e low/le el o*y"en ad)!n!strat!on by nasal cannula +3 to F L<)!nute, to a o!d !nterfer!n" w!th the hypo*!c dr! e# In )etabol!c ac!dos!s( the pat!ent )ay ha e Luss)auls resp!rat!ons because the rate and depth of resp!rat!ons !ncrease to ?blow off@ e*cess carbon!c ac!ds#

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In wo)en( "onorrhea affects the a"!na and fallop!an tubes# After trau)at!c a)putat!on( the "reatest threats to the pat!ent are blood loss and hypo ole)!c shoc&# In!t!al !nter ent!ons should control bleed!n" and replace flu!d and blood as needed# Ep!nephr!ne !s a sy)patho)!)et!c dru" that acts pr!)ar!ly on alpha( beta1( and beta3 receptors( caus!n" asoconstr!ct!on# Ep!nephr!nes ad erse effects !nclude dyspnea( tachycard!a( palp!tat!ons( headaches( and hypertens!on# A card!nal s!"n of pancreat!t!s !s an ele ated seru) a)ylase le el# '!"h colon!c !rr!"at!on !s used to st!)ulate per!stals!s and reduce flatulence# Bleed!n" !s the )ost co))on postoperat! e proble)# The pat!ent can control so)e colosto)y odors by a o!d!n" such foods as f!sh( e""s( on!ons( beans( and cabba"e and related e"etables# $hen paralys!s or co)a !)pa!rs or erases the corneal refle*( fre6uent eye care !s perfor)ed to &eep the e*posed cornea )o!st( pre ent!n" ulcerat!on and !nfla))at!on# Inter ent!ons for the pat!ent w!th ac6u!red !))unodef!c!ency syndro)e !nclude treat!n" e*!st!n" !nfect!ons and cancers( reduc!n" the r!s& of opportun!st!c !nfect!ons( )a!nta!n!n" ade6uate nutr!t!on and hydrat!on( and pro !d!n" e)ot!onal support to the pat!ent and fa)!ly# S!"ns and sy)pto)s of chla)yd!al !nfect!on are ur!nary fre6uencyN th!n( wh!te a"!nal or urethral d!schar"eN and cer !cal !nfla))at!on# ;hla)yd!al !nfect!on !s the )ost pre alent se*ually trans)!tted d!sease !n the Un!ted States# The p!tu!tary "land !s located !n the sella turc!ca of the spheno!d bone !n the cran!al ca !ty# -yasthen!a "ra !s !s a neuro)uscular d!sorder thats character!0ed by !)pulse d!sturbances at the )yoneural %unct!on# -yasthen!a "ra !s( wh!ch usually affects youn" wo)en( causes e*tre)e )uscle wea&ness and fat!"ab!l!ty( d!ff!culty chew!n" and tal&!n"( strab!s)us( and ptos!s# 'ypother)!a !s a l!fe/threaten!n" d!sorder !n wh!ch the bodys core te)perature drops below O:C . +F:C ;,# S!"ns and sy)pto)s of hypop!tu!tar!s) !n adults )ay !nclude "onadal fa!lure( d!abetes !ns!p!dus( hypothyro!d!s)( and adrenocort!cal !nsuff!c!ency# Re!ters syndro)e causes a tr!ad of sy)pto)sI arthr!t!s( con%unct! !t!s( and urethr!t!s# .or pat!ents who ha e had a part!al "astrecto)y( a carbohydrate/restr!cted d!et !ncludes foods that are h!"h !n prote!n and fats and restr!cts foods that are h!"h !n carbohydrates# '!"h/carbohydrate foods are d!"ested 6u!c&ly and are read!ly e)pt!ed fro) the sto)ach !nto the duodenu)( caus!n" d!arrhea and du)p!n" syndro)e# A wo)an of ch!ldbear!n" a"e who !s under"o!n" che)otherapy should be encoura"ed to use a contracept! e because of the r!s& of fetal da)a"e !f she beco)es pre"nant# >ern!c!ous ane)!a !s !ta)!n B13 def!c!ency thats caused by a lac& of !ntr!ns!c factor( wh!ch !s produced by the "astr!c )ucosal par!etal cells# To perfor) pursed/l!p breath!n"( the pat!ent !nhales throu"h the nose and e*hales slowly and e enly a"a!nst pursed l!ps

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wh!le contract!n" the abdo)!nal )uscles# A pat!ent who !s under"o!n" che)otherapy should consu)e a h!"h/calor!e( h!"h/prote!n d!et# Ad erse effects of che)otherapy !nclude bone )arrow depress!on( wh!ch causes ane)!a( leu&open!a( and thro)bocytopen!aN GI ep!thel!al cell !rr!tat!on( wh!ch causes GI ulcerat!on( bleed!n"( and o)!t!n"N and destruct!on of ha!r foll!cles and s&!n( wh!ch causes alopec!a and der)at!t!s# The he)o"lob!n electrophores!s test d!fferent!ates between s!c&le cell tra!t and s!c&le cell ane)!a# The ant!b!ot!cs erythro)yc!n( cl!nda)yc!n( and tetracycl!ne act by !nh!b!t!n" prote!n synthes!s !n suscept!ble or"an!s)s# The nurse ad)!n!sters o*y"en as prescr!bed to the pat!ent w!th heart fa!lure to help o erco)e hypo*!a and dyspnea# S!"ns and sy)pto)s of s)all/bowel obstruct!on !nclude decreased or absent bowel sounds( abdo)!nal d!stent!on( decreased flatus( and pro%ect!le o)!t!n"# The nurse should use both hands when ent!lat!n" a pat!ent w!th a )anual resusc!tat!on ba"# Hne hand can del! er only E44 cc of a!rN two hands can del! er 1(444 cc of a!r# 5osa"es of )ethyl*anth!ne a"ents( such as theophyll!ne +Theo/5ur, and a)!nophyll!ne +A)!nophyll!n,( should be !nd! !dual!0ed based on seru) dru" le el( pat!ent response( and ad erse react!ons# The pat!ent should apply a transder)al scopola)!ne patch +Transder)/Scop, at least E hours before !ts ant!e)et!c act!on !s needed# Early !nd!cat!ons of "an"rene are ede)a( pa!n( redness( dar&en!n" of the t!ssue( and coldness !n the affected body part# Ipecac syrup !s the e)et!c of cho!ce because of !ts effect! eness !n e acuat!n" the sto)ach and relat! ely low !nc!dence of ad erse react!ons# Hral !ron +ferrous sulfate, )ay cause "reen to blac& feces# >olycythe)!a era causes prur!tus( pa!nful f!n"ers and toes( hyperur!ce)!a( plethora +redd!sh purple s&!n and )ucosa,( wea&ness( and easy fat!"ab!l!ty# Rheu)at!c fe er !s usually preceded by a "roup A beta/he)olyt!c streptococcal !nfect!on( such as scarlet fe er( ot!t!s )ed!a( streptococcal throat !nfect!on( !)pet!"o( or tons!ll!t!s# A thyro!d stor)( or cr!s!s( !s an e*tre)e for) of hyperthyro!d!s)# Its character!0ed by hyperpyre*!a w!th a te)perature of up to 142C . +E1#1C ;,( d!arrhea( dehydrat!on( tachycard!a of up to 344 beats<)!nute( arrhyth)!as( e*tre)e !rr!tab!l!ty( hypotens!on( and del!r!u)# It )ay lead to co)a( shoc&( and death# Tard! e dys&!nes!a( an ad erse react!on to lon"/ter) use of ant!psychot!c dru"s( causes !n oluntary repet!t! e )o e)ents of the ton"ue( l!ps( e*tre)!t!es( and trun&# Asth)a !s bronchoconstr!ct!on !n response to aller"ens( such as food( pollen( and dru"sN !rr!tants( such as s)o&e and pa!nt fu)esN !nfect!onsN weather chan"esN e*erc!seN or "astroesopha"eal reflu*# In the Un!ted States( about :G of ch!ldren ha e chron!c asth)a# Blood cultures help !dent!fy the cause of endocard!t!s# An !ncreased wh!te blood cell count su""ests bacter!al !nfect!on# In a pat!ent who has acute aort!c d!ssect!on( the nurs!n" pr!or!ty !s to )a!nta!n the )ean arter!al pressure between 24 and 2: )) '"# A asod!lator such as n!tropruss!de +N!tropress, )ay be needed to ach!e e th!s "oal# .or a pat!ent w!th heart fa!lure( one of the )ost !)portant nurs!n" d!a"noses !s decreased card!ac output related to altered

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)yocard!al contract!l!ty( !ncreased preload and afterload( and altered rate( rhyth)( or electr!cal conduct!on# .or a pat!ent rece! !n" per!toneal d!alys!s( the nurse )ust )on!tor body we!"ht and blood urea n!tro"en( creat!n!ne( and electrolyte le els# An"!otens!n/con ert!n" en0y)e !nh!b!tors( such as captopr!l +;apoten, and enalapr!l +Jasotec,( decrease blood pressure by !nterfer!n" w!th the ren!n/an"!otens!n/aldosterone syste)# A pat!ent who has stable entr!cular tachycard!a has a blood pressure and !s consc!ousN therefore( the pat!ents card!ac output !s be!n" )a!nta!ned( and the nurse )ust )on!tor the pat!ents !tal s!"ns cont!nuously# An"!otens!n/con ert!n" en0y)e !nh!b!tors !nh!b!t the en0y)e that con erts an"!otens!n I !nto an"!otens!n II( wh!ch !s a potent asoconstr!ctor# Throu"h th!s act!on( they reduce per!pheral arter!al res!stance and blood pressure#

In a pat!ent who !s rece! !n" a d!uret!c( the nurse should )on!tor seru) electrolyte le els( chec& !tal s!"ns( and obser e for orthostat!c hypotens!on# Breast self/e*a)!nat!on !s one of the )ost !)portant health hab!ts to teach a wo)an# It should be perfor)ed 1 wee& after the )enstrual per!od because thats when hor)onal effects( wh!ch can cause breast lu)ps and tenderness( are reduced# >ost)enopausal wo)en should choose a re"ular t!)e each )onth to perfor) breast self/e*a)!nat!on +for e*a)ple( on the sa)e day of the )onth as the wo)ans b!rthday,# The d!fference between acute and chron!c arter!al d!sease !s that the acute d!sease process !s l!fe/threaten!n"# $hen prepar!n" the pat!ent for chest tube re)o al( the nurse should e*pla!n that re)o al )ay cause pa!n or a burn!n" or pull!n" sensat!on# Essent!al hypertens! e renal d!sease !s co))only character!0ed by pro"ress! e renal !)pa!r)ent# -ean arter!al pressure +-A>, !s calculated us!n" the follow!n" for)ula( where S U systol!c pressure and 5 U d!astol!c pressureI -A> U [+5 R 3, M S\ T F Sy)pto)s of sup!ne hypotens!on syndro)e are d!00!ness( l!"ht/headedness( nausea( and o)!t!n"# An !))unoco)pro)!sed pat!ent !s at r!s& for Lapos!s sarco)a# 5olls eye )o e)ent !s the nor)al la" between head )o e)ent and eye )o e)ent# Th!rd spac!n" of flu!d occurs when flu!d sh!fts fro) the !ntra ascular space to the !nterst!t!al space and re)a!ns there# ;hron!c pa!n !s any pa!n that lasts lon"er than 2 )onths# Acute pa!n lasts less than 2 )onths# The )echan!s) of act!on of a phenoth!a0!ne der! at! e !s to bloc& dopa)!ne receptors !n the bra!n# >at!ents shouldnt ta&e b!sacodyl( antac!ds( and da!ry products all at the sa)e t!)e# Ad !se the pat!ent who !s ta&!n" d!"o*!n to a o!d foods that are h!"h !n f!ber( such as bran cereal and prunes# A pat!ent who !s ta&!n" d!uret!cs should a o!d foods that conta!n )onosod!u) "luta)ate because !t can cause t!"hten!n" of the chest and flush!n" of the face# .urose)!de +Las!*, should be ta&en 1 hour before )eals# A pat!ent who !s ta&!n" "r!seoful !n +Gr!so !n .>, should )a!nta!n a h!"h/fat d!et( wh!ch enhances the secret!on of b!le#

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>at!ents should ta&e oral !ron products w!th c!trus dr!n&s to enhance absorpt!on# Ison!a0!d should be ta&en on an e)pty sto)ach( w!th a full "lass of water# .oods that are h!"h !n prote!n decrease the absorpt!on of le odopa# A pat!ent who !s ta&!n" tetracycl!ne shouldnt ta&e !ron supple)ents or antac!ds# A pat!ent who !s ta&!n" warfar!n +;ou)ad!n, should a o!d foods that are h!"h !n !ta)!n L( such as l! er and "reen leafy e"etables# The nor)al alue for cholesterol !s less than 344 )"<dl# The nor)al alue for low/dens!ty l!poprote!ns !s 24 to 1=4 )"<dlN for h!"h/dens!ty l!poprote!ns( !ts F4 to =4 )"<dl# The nor)al card!ac output for an adult who we!"hs 1:: lb +D4#F &", !s : to 2 L<)!nute# A pul)onary artery pressure catheter +Swan/Gan0, )easures the pressure !n the card!ac cha)bers# Se ere chest pa!n thats a""ra ated by breath!n" and !s descr!bed as ?sharp(@ ?stabb!n"(@ or ?&n!fel!&e@ !s cons!stent w!th per!card!t!s# $ater/ha))er pulse !s a pulse thats loud and bound!n" and r!ses and falls rap!dly# It can be caused by e)ot!onal e*c!te)ent or aort!c !nsuff!c!ency# >atholo"!c spl!tt!n" of S3 !s nor)ally heard between !nsp!rat!on and e*p!rat!on# It occurs !n r!"ht bundle/branch bloc&# >!n&( frothy sputu) !s assoc!ated w!th pul)onary ede)a# .ran& he)optys!s )ay be assoc!ated w!th pul)onary e)bol!s)# An aort!c aneurys) can be heard %ust o er the u)b!l!cal area and can be detected as an abdo)!nal pulsat!on +bru!t,# 'eart )ur)urs are "raded accord!n" to the follow!n" syste)I "rade 1 !s fa!nt and !s heard after the e*a)!ner ?tunes !n@N "rade 3 !s heard !))ed!atelyN "rade F !s )oderately loudN "rade E !s loudN "rade : !s ery loud( but !s heard only w!th a stethoscopeN and "rade 2 !s ery loud and !s heard w!thout a stethoscope# ;lot for)at!on dur!n" card!ac catheter!0at!on !s )!n!)!0ed by the ad)!n!strat!on of E(444 to :(444 un!ts of hepar!n# -ost co)pl!cat!ons that ar!se fro) card!ac catheter!0at!on are assoc!ated w!th the puncture s!te# Aller"!c sy)pto)s assoc!ated w!th !od!ne/based contrast )ed!a used !n card!ac catheter!0at!on !nclude urt!car!a( nausea and o)!t!n"( and flush!n"# To ensure that blood flow hasnt been co)pro)!sed( the nurse should )ar& the per!pheral pulses d!stal to the cutdown s!te to a!d !n locat!n" the pulses after the procedure# The e*tre)!ty used for the cutdown s!te should re)a!n stra!"ht for E to 2 hours# If an antecub!tal essel was used( an ar)board !s needed# If a fe)oral artery was used( the pat!ent should re)a!n on bed rest for 2 to 13 hours# If a pat!ent e*per!ences nu)bness or t!n"l!n" !n the e*tre)!ty after a cutdown( the phys!c!an should be not!f!ed !))ed!ately# After card!ac catheter!0at!on( flu!d !nta&e should be encoura"ed to a!d !n flush!n" the contrast )ed!u) throu"h the &!dneys# In a pat!ent who !s under"o!n" pul)onary artery catheter!0at!on( r!s&s !nclude pul)onary artery !nfarct!on( pul)onary e)bol!s)( !n%ury to the heart al es( and !n%ury to the )yocard!u)# >ul)onary artery wed"e pressure !s a d!rect !nd!cator of left entr!cular pressure# >ul)onary artery wed"e pressure "reater than 1= to 34 )) '" !nd!cates !ncreased left entr!cular pressure( as seen !n left/

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s!ded heart fa!lure# $hen )easur!n" pul)onary artery wed"e pressure( the nurse should place the pat!ent !n a sup!ne pos!t!on( w!th the head of the bed ele ated no )ore than 3: de"rees# >ul)onary artery pressure( wh!ch !nd!cates r!"ht and left entr!cular pressure( !s ta&en w!th the balloon deflated# >ul)onary artery systol!c pressure !s the pea& pressure "enerated by the r!"ht entr!cle# >ul)onary artery d!astol!c pressure !s the lowest pressure !n the pul)onary artery# Nor)al adult pul)onary artery systol!c pressure !s 1: to 3: )) '"# Nor)al adult pul)onary artery d!astol!c pressure !s = to 13 )) '"# The nor)al o*y"en saturat!on of enous blood !s D:G# ;entral enous pressure !s the a)ount of pressure !n the super!or ena ca a and the r!"ht atr!u)# Nor)al adult central enous pressure !s 3 to = )) '"( or F to 14 c) '3H# A decrease !n central enous pressure !nd!cates a fall !n c!rculat!n" flu!d olu)e( as seen !n shoc&# An !ncrease !n central enous pressure !s assoc!ated w!th an !ncrease !n c!rculat!n" olu)e( as seen !n renal fa!lure# In a pat!ent who !s on a ent!lator( central enous pressure should be ta&en at the end of the e*p!ratory cycle# To ensure an accurate basel!ne central enous pressure read!n"( the 0ero po!nt of the transducer )ust be at the le el of the r!"ht atr!u)# A blood pressure read!n" obta!ned throu"h !ntra/arter!al pressure )on!tor!n" )ay be 14 )) '" h!"her than one obta!ned w!th a blood pressure cuff# In -^nc&eber"s scleros!s( calc!u) depos!ts for) !n the )ed!al layer of the arter!al walls# The sy)pto)s assoc!ated w!th coronary artery d!sease usually dont appear unt!l pla6ue has narrowed the essels by at least D:G# Sy)pto)s of coronary artery d!sease appear only when there !s an !)balance between the de)and for o*y"enated blood and !ts a a!lab!l!ty# >ercutaneous translu)!nal coronary an"!oplasty !s an !n as! e procedure !n wh!ch a balloon/t!pped catheter !s !nserted !nto a bloc&ed artery# $hen the balloon !s !nflated( !t opens the artery by co)press!n" pla6ue a"a!nst the arterys !nt!)al layer# Before percutaneous translu)!nal coronary an"!oplasty !s perfor)ed( an ant!coa"ulant +such as asp!r!n, !s usually ad)!n!stered to the pat!ent# 5ur!n" the procedure( the pat!ent !s "! en hepar!n( a calc!u) a"on!st( or n!tro"lycer!n to reduce the r!s& of coronary artery spas)s# 5ur!n" coronary artery bypass "raft sur"ery( a bloc&ed coronary artery !s bypassed by us!n" the saphenous e!n fro) the pat!ents th!"h or lower le"# $hen a e!n !s used to bypass an artery( the e!n !s re ersed so that the al es dont !nterfere w!th blood flow# 5ur!n" a coronary artery bypass "raft procedure( the pat!ents heart !s stopped to allow the sur"eon to sew the new essel !n place# Blood flow to the body !s )a!nta!ned w!th a card!opul)onary bypass# 5ur!n" an an"!nal attac&( the cells of the heart con ert to anaerob!c )etabol!s)( wh!ch produces lact!c ac!d as a waste

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product# As the le el of lact!c ac!d !ncreases( pa!n de elops# >a!n thats descr!bed as ?sharp@ or ?&n!fel!&e@ !s not cons!stent w!th an"!na pector!s# An"!nal pa!n typ!cally lasts for : )!nutesN howe er( attac&s assoc!ated w!th a hea y )eal or e*tre)e e)ot!onal d!stress )ay last 1: to 34 )!nutes# A pattern of ?e*ert!on/pa!n/rest/rel!ef@ !s cons!stent w!th stable an"!na# Unl!&e stable an"!na( unstable an"!na can occur w!thout e*ert!on and !s cons!dered a precursor to a )yocard!al !nfarct!on# A pat!ent who !s scheduled for a stress electrocard!o"ra) should not!fy the staff !f he has ta&en n!trates# If he has( the test )ust be rescheduled#

E*erc!se e6u!p)ent( such as a tread)!ll or an e*erc!se b!&e( !s used for a stress electrocard!o"ra)# Act! !ty !s !ncreased unt!l the pat!ent reaches =:G of h!s )a*!)u) heart rate# In pat!ents who ta&e n!tro"lycer!n for a lon" t!)e( tolerance often de elops and reduces the effect! eness of n!trates# A 13/ hour dru"/free per!od !s usually )a!nta!ned at n!"ht# Beta/adrener"!c bloc&ers( such as propranolol +Inderal,( reduce the wor&load on the heart( thereby decreas!n" o*y"en de)and# They also slow the heart rate# ;alc!u) channel bloc&ers !nclude n!fed!p!ne +>rocard!a,( wh!ch !s used to treat an"!naN erapa)!l +;alan( Isopt!n,( wh!ch !s used pr!)ar!ly as an ant!arrhyth)!cN and d!lt!a0e) +;ard!0e),( wh!ch co)b!nes the effects of n!fed!p!ne and erapa)!l w!thout the ad erse effects# A pat!ent who has an"!nal pa!n that rad!ates or worsens and doesnt subs!de should be e aluated at an e)er"ency )ed!cal fac!l!ty# ;ard!ac cells can w!thstand 34 )!nutes of !sche)!a before cell death occurs# 5ur!n" a )yocard!al !nfarct!on( the )ost co))on s!te of !n%ury !s the anter!or wall of the left entr!cle( near the ape*# After a )yocard!al !nfarct!on( the !nfarcted t!ssue causes s!"n!f!cant P/wa e chan"es on an electrocard!o"ra)# These chan"es re)a!n e !dent e en after the )yocard!u) heals# The le el of ;L/-B( an !soen0y)e spec!f!c to the heart( !ncreases E to 2 hours after a )yocard!al !nfarct!on and pea&s at 13 to 1= hours# It returns to nor)al !n F to E days# >at!ents who sur ! e a )yocard!al !nfarct!on and ha e no other card!o ascular patholo"y usually re6u!re 2 to 13 wee&s for a full reco ery# After a )yocard!al !nfarct!on( the pat!ent !s at "reatest r!s& for sudden death dur!n" the f!rst 3E hours# After a )yocard!al !nfarct!on( the f!rst 2 hours !s the cruc!al per!od for sal a"!n" the )yocard!u)# After a )yocard!al !nfarct!on( !f the pat!ent cons!stently has )ore than three pre)ature entr!cular contract!ons per )!nute( the phys!c!an should be not!f!ed# After a )yocard!al !nfarct!on( !ncreas!n" ascular res!stance throu"h the use of asopressors( such as dopa)!ne and le arterenol( can ra!se blood pressure#

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;l!n!cal )an!festat!ons of heart fa!lure !nclude d!stended nec& e!ns( we!"ht "a!n( orthopnea( crac&les( and enlar"ed l! er# R!s& factors assoc!ated w!th e)bol!s) are !ncreased blood !scos!ty( decreased c!rculat!on( prolon"ed bed rest( and !ncreased blood coa"ulab!l!ty# Ant!e)bol!s) stoc&!n"s should be worn around the cloc&( but should be re)o ed tw!ce a day for F4 )!nutes so that s&!n care can be perfor)ed# Before the nurse puts ant!e)bol!s) stoc&!n"s bac& on the pat!ent( the pat!ent should l!e w!th h!s feet ele ated 29 +1:#3 c), for 34 )!nutes# 5resslers syndro)e !s &nown as late per!card!t!s because !t occurs appro*!)ately 2 wee&s to 2 )onths after a )yocard!al !nfarct!on# It causes per!card!al pa!n and a fe er that lasts lon"er than 1 wee&# In phase I after a )yocard!al !nfarct!on( for the f!rst 3E hours( the pat!ent !s &ept on a clear l!6u!d d!et and bed rest w!th the use of a beds!de co))ode#

In phase I after a )yocard!al !nfarct!on( on the second day( the pat!ent "ets out of bed and spends 1: to 34 )!nutes !n a cha!r# The nu)ber of t!)es that the pat!ent "oes to the cha!r and the len"th of t!)e he spends !n the cha!r are !ncreased depend!n" on h!s endurance# In phase II( the len"th of t!)e that the pat!ent spends out of bed and the d!stance to the cha!r are !ncreased# After transfer fro) the card!ac care un!t( the post/)yocard!al !nfarct!on pat!ent !s allowed to wal& the halls as h!s endurance !ncreases# Se*ual !ntercourse w!th a &nown partner usually can be resu)ed E to = wee&s after a )yocard!al !nfarct!on# A pat!ent under card!ac care should a o!d dr!n&!n" alcohol!c be era"es or eat!n" before en"a"!n" !n se*ual !ntercourse# The a)bulat!on "oal for a post/)yocard!al !nfarct!on pat!ent !s 3 )!les !n 24 )!nutes# A post/)yocard!al !nfarct!on pat!ent who doesnt ha e a strenuous %ob )ay be able to return to wor& full/t!)e !n = or O wee&s# Stro&e olu)e !s the a)ount of blood e%ected fro) the heart w!th each heartbeat# Afterload !s the force that the entr!cle )ust e*ert dur!n" systole to e%ect the stro&e olu)e# The three/po!nt pos!t!on +w!th the pat!ent upr!"ht and lean!n" forward( w!th the hands on the &nees, !s character!st!c of orthopnea( as seen !n left/s!ded heart fa!lure# >aro*ys)al nocturnal dyspnea !nd!cates a se ere for) of pul)onary con"est!on !n wh!ch the pat!ent awa&ens !n the )!ddle of the n!"ht w!th a feel!n" of be!n" suffocated# ;l!n!cal )an!festat!ons of pul)onary ede)a !nclude breathlessness( nasal flar!n"( use of accessory )uscles to breath( and frothy sputu)# A late s!"n of heart fa!lure !s decreased card!ac output that causes decreased blood flow to the &!dneys and results !n ol!"ur!a# A late s!"n of heart fa!lure !s anasarca +"eneral!0ed ede)a,# 5ependent ede)a !s an early s!"n of r!"ht/s!ded heart fa!lure# Its seen !n the le"s( where !ncreased cap!llary hydrostat!c pressure o erwhel)s plas)a prote!n( caus!n" a sh!ft of flu!d fro) the cap!llary beds to the !nterst!t!al spaces# 5ependent ede)a( wh!ch !s )ost not!ceable at the end of the day( usually starts !n the feet and an&les and cont!nues upward#

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.or the recu)bent pat!ent( ede)a !s usually seen !n the presacral area# S!"ns of ur!nary tract !nfect!on !nclude fre6uency( ur"ency( and dysur!a# In tert!ary/!ntent!on heal!n"( wound closure !s delayed because of !nfect!on or ede)a# A pat!ent who has had supratentor!al sur"ery should ha e the head of the bed ele ated F4 de"rees# An ac!d/ash d!et ac!d!f!es ur!ne# J!ta)!n ; and cranberry %u!ce ac!d!fy ur!ne# A pat!ent who ta&es probenec!d +;olbene)!d, for "out should be !nstructed to ta&e the dru" w!th food# If wound deh!scence !s suspected( the nurse should !nstruct the pat!ent to l!e down and should e*a)!ne the wound and )on!tor the !tal s!"ns# Abnor)al f!nd!n"s should be reported to the phys!c!an# 8oster !))une "lobul!n !s ad)!n!stered to st!)ulate !))un!ty to ar!cella#

The )ost co))on sy)pto)s assoc!ated w!th co)part)ental syndro)e are pa!n thats not rel!e ed by anal"es!cs( loss of )o e)ent( loss of sensat!on( pa!n w!th pass! e )o e)ent( and lac& of pulse# To help rel!e e )uscle spas)s !n a pat!ent who has )ult!ple scleros!s( the nurse should ad)!n!ster baclofen +L!oresal, as orderedN "! e the pat!ent a war)( sooth!n" bathN and teach the pat!ent pro"ress! e rela*at!on techn!6ues# A pat!ent who has a cer !cal !n%ury and !)pa!r)ent at ;: should be able to l!ft h!s shoulders and elbows part!ally( but has no sensat!on below the cla !cle# A pat!ent who has cer !cal !n%ury and !)pa!r)ent at ;2 should be able to l!ft h!s shoulders( elbows( and wr!sts part!ally( but has no sensat!on below the cla !cle( e*cept a s)all a)ount !n the ar)s and thu)b# A pat!ent who has cer !cal !n%ury and !)pa!r)ent at ;D should be able to l!ft h!s shoulders( elbows( wr!sts( and hands part!ally( but has no sensat!on below the )!dchest# In%ur!es to the sp!nal cord at ;F and abo e )ay be fatal as a result of loss of !nner at!on to the d!aphra") and !ntercostal )uscles# S!"ns of )en!n"eal !rr!tat!on seen !n )en!n"!t!s !nclude nuchal r!"!d!ty( a pos!t! e Brud0!ns&!s s!"n( and a pos!t! e Lern!"s s!"n# Laboratory alues that show pneu)o)en!n"!t!s !nclude an ele ated cerebrosp!nal flu!d +;S., prote!n le el +)ore than 144 )"<dl,( a decreased ;S. "lucose le el +E4 )"<dl,( and an !ncreased wh!te blood cell count# Before under"o!n" )a"net!c resonance !)a"!n"( the pat!ent should re)o e all ob%ects conta!n!n" )etal( such as watches( underw!re bras( and %ewelry# Usually food and )ed!c!ne arent restr!cted before )a"net!c resonance !)a"!n"# >at!ents who are under"o!n" )a"net!c resonance !)a"!n" should &now that they can as& 6uest!ons dur!n" the procedureN howe er( they )ay be as&ed to l!e st!ll at certa!n t!)es# If a contrast )ed!u) !s used dur!n" )a"net!c resonance !)a"!n"( the pat!ent )ay e*per!ence d!ures!s as the )ed!u) !s

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flushed fro) the body# The T0anc& test !s used to conf!r) herpes "en!tal!s# 'epat!t!s ; !s spread pr!)ar!ly throu"h blood +for e*a)ple( dur!n" transfus!on or !n people who wor& w!th blood products,( personal contact and( poss!bly( the fecal/oral route# The best )ethod for soa&!n" an open( !nfected( dra!n!n" wound !s to use a hot/)o!st dress!n"# Sputu) culture !s the conf!r)at!on test for tuberculos!s# 5e*a)ethasone +5ecadron, !s a stero!dal ant!/!nfla))atory thats used to treat adrenal !nsuff!c!ency# S!"ns of !ncreased !ntracran!al pressure !nclude alterat!on !n le el of consc!ousness( restlessness( !rr!tab!l!ty( and pup!llary chan"es# The pat!ent who has a lower l!)b a)putat!on should be !nstructed to assu)e a prone pos!t!on at least tw!ce a day# 5ur!n" the f!rst 3E hours after a)putat!on( the res!dual l!)b !s ele ated on a p!llow# After that t!)e( the l!)b !s placed flat to reduce the r!s& of h!p fle*!on contractures#

A tourn!6uet should be !n full !ew at the beds!de of the pat!ent who has an a)putat!on# An e)er"ency tracheosto)y set should be &ept at the beds!de of a pat!ent who !s suspected of ha !n" ep!"lott!t!s# Roc&y -ounta!n spotted fe er !s spread throu"h the b!te of a t!c& harbor!n" the R!c&etts!a or"an!s)# A pat!ent who has ac6u!red !))unodef!c!ency syndro)e shouldnt share ra0ors or toothbrushes w!th others( but there are no spec!al precaut!ons for d!nnerware or laundry ser !ces# Because ant!fun"al crea)s )ay sta!n cloth!n"( pat!ents who use the) should use san!tary nap&!ns# An ant!fun"al crea) should be !nserted h!"h !n the a"!na at bedt!)e# A pat!ent who !s ha !n" a se!0ure usually re6u!res protect!on fro) the en !ron)ent onlyN howe er( anyone who needs a!rway )ana"e)ent should be turned on h!s s!de# Status ep!lept!cus !s treated w!th I#J# d!phenylhydanto!n# A *eno"raft !s a s&!n "raft fro) an an!)al# The ant!dote for )a"nes!u) sulfate !s calc!u) "luconate 14G# Aller"!c react!ons to a blood transfus!on are flush!n"( whee0!n"( urt!car!a( and rash# A pat!ent who has a h!story of basal cell carc!no)a should a o!d sun e*posure# $hen potent( n!tro"lycer!n causes a sl!"ht st!n"!n" sensat!on under the ton"ue# A pat!ent who appears to be ?f!"ht!n" the ent!lator@ !s hold!n" h!s breath or breath!n" out on an !nsp!ratory cycle#

An ant!neoplast!c dru" thats used to treat breast cancer !s ta)o*!fen +Nol ade*,#

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Ad erse effects of !ncr!st!ne +Hnco !n, are alopec!a( nausea( and o)!t!n"# Increased ur!ne output !s an !nd!cat!on that a hypertens! e cr!s!s !s nor)al!0!n"# If a pat!ent who !s rece! !n" I#J# che)otherapy has pa!n at the !nsert!on s!te( the nurse should stop the I#J# !nfus!on !))ed!ately# E*tra asat!on !s lea&a"e of flu!d !nto surround!n" t!ssue fro) a e!n thats be!n" used for I#J# therapy# ;l!n!cal s!"ns of prostate cancer are dr!bbl!n"( hes!tancy( and decreased ur!nary force# ;ard!ac "lycos!des !ncrease card!ac contract!l!ty# Ad erse effects of card!ac "lycos!des !nclude headache( hypotens!on( nausea and o)!t!n"( and yellow/"reen halos around l!"hts# A T tube should be cla)ped dur!n" pat!ent )eals to a!d !n fat d!"est!on# A T tube usually re)a!ns !n place for 14 days# 5ur!n" a ert!"o attac&( a pat!ent who has -Zn!_res d!sease should be !nstructed to l!e down on h!s s!de w!th h!s eyes closed# $hen )a!nta!n!n" a Aac&son/>ratt dra!na"e syste)( the nurse should s6uee0e the reser o!r and e*pel the a!r before recapp!n" the syste)# The )ost co))on sy)pto) assoc!ated w!th sleep apnea !s snor!n"# '!sta)!ne !s released dur!n" an !nfla))atory response#

$hen deal!n" w!th a pat!ent who has a se ere speech !)ped!)ent( the nurse should )!n!)!0e bac&"round no!se and a o!d !nterrupt!n" the pat!ent# .e er and n!"ht sweats( hall)ar& s!"ns of tuberculos!s( )ay not be present !n elderly pat!ents who ha e the d!sease# A su!table dress!n" for wound debr!de)ent !s wet/to/dry# 5r!n&!n" war) )!l& at bedt!)e a!ds sleep!n" because of the natural sedat! e effect of the a)!no ac!d tryptophan# The !n!t!al step !n pro)ot!n" sleep !n a hosp!tal!0ed pat!ent !s to )!n!)!0e en !ron)ental st!)ulat!on# Before )o !n" a pat!ent( the nurse should assess how )uch e*ert!on the pat!ent !s per)!tted( the pat!ents phys!cal ab!l!ty( and h!s ab!l!ty to understand !nstruct!on as well as her own stren"th and ab!l!ty to )o e the pat!ent# A pat!ent who !s !n a restra!nt should be chec&ed e ery F4 )!nutes and the restra!nt loosened e ery 3 hours to per)!t ran"e of )ot!on e*erc!ses for the e*tre)!t!es# Ant!b!ot!cs that are "! en four t!)es a day should be "! en at 2 a#)#( 13 p#)#( 2 p#)#( and 13 a#)# to )!n!)!0e d!srupt!on of sleep# Sundowner syndro)e !s seen !n pat!ents who beco)e )ore confused toward the e en!n"# To counter th!s tendency( the nurse should turn a l!"ht on# .or the pat!ent who has so)na)bul!s)( the pr!)ary "oal !s to pre ent !n%ury by pro !d!n" a safe en !ron)ent#

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.or the pat!ent who has so)na)bul!s)( the pr!)ary "oal !s to pre ent !n%ury by pro !d!n" a safe en !ron)ent# Nalo*one +Narcan, should be &ept at the beds!de of the pat!ent who !s rece! !n" pat!ent/controlled anal"es!a# 'ypnot!c dru"s decrease rap!d eye )o e)ent sleep( but !ncrease the o erall a)ount of sleep# A sudden wa e of o erwhel)!n" sleep!ness !s a sy)pto) of narcolepsy# A d!abet!c pat!ent should be !nstructed to buy shoes !n the afternoon because feet are usually lar"est at that t!)e of day# If sur"ery !s scheduled late !n the afternoon( the sur"eon )ay appro e a l!"ht brea&fast# A hear!n" a!d !s usually left !n place dur!n" sur"ery to per)!t co))un!cat!on w!th the pat!ent# The operat!n" roo) tea) should be not!f!ed of !ts presence# The nurse should )on!tor the pat!ent for central ner ous syste) depress!on for 3E hours after the ad)!n!strat!on of n!trous o*!de# In the postanesthes!a care un!t( the proper pos!t!on of an adult !s w!th the head to the s!de and the ch!n e*tended upward# The S!)s pos!t!on also can be used unless contra!nd!cated# After a pat!ent !s ad)!tted to the postanesthes!a care un!t( the f!rst act!on !s to assess the patency of the a!rway# If a pat!ent !s ad)!tted to the postanesthes!a care un!t w!thout the pharyn"eal refle*( hes pos!t!oned on h!s s!de# The nurse stays at the beds!de unt!l the "a" refle* returns# In the postanesthes!a care un!t( the pat!ents !tal s!"ns are ta&en e ery 1: )!nutes rout!nely( or )ore often !f !nd!cated( unt!l the pat!ent !s stable# In the postanesthes!a care un!t( the T tube should be uncla)ped and attached to a dra!na"e syste)# After the pat!ent rece! es anesthes!a( the nurse )ust obser e h!) for a drop !n blood pressure or e !dence of labored breath!n"# If a pat!ent be"!ns to "o !nto shoc& dur!n" the postanesthes!a assess)ent( the nurse should ad)!n!ster o*y"en( place the pat!ent !n the Trendelenbur" pos!t!on( and !ncrease the I#J# flu!d rate accord!n" to the phys!c!ans order or the pol!cy of the postanesthes!a care un!t# Types of ben!"n tu)ors !nclude )y*o)a( f!bro)a( l!po)a( osteo)a( and chondro)a# -al!"nant tu)ors !nclude sarco)a( basal cell carc!no)a( f!brosarco)a( osteosarco)a( )y*osarco)a( chondrosarco)a( and adenocarc!no)a# .or a cancer pat!ent( pall!at! e sur"ery !s perfor)ed to reduce pa!n( rel!e e a!rway obstruct!on( rel!e e GI obstruct!on( pre ent he)orrha"e( rel!e e pressure on the bra!n and sp!nal cord( dra!n abscesses( and re)o e or dra!n !nfected tu)ors# A pat!ent who !s under"o!n" rad!at!on !)plant therapy should be &ept !n a pr! ate roo) to reduce the r!s& of e*posure to others( !nclud!n" nurs!n" personnel# After total &nee replace)ent sur"ery( the &nee should be &ept !n )a*!)u) e*tens!on for F days# >art!al we!"ht bear!n" !s allowed appro*!)ately 1 wee& after total &nee replace)ent# $e!"ht bear!n" to the po!nt of pa!n !s allowed at 3 wee&s# S%^"rens syndro)e !s a chron!c !nfla))atory d!sorder assoc!ated w!th a decrease !n sal! at!on and lacr!)at!on# ;l!n!cal )an!festat!ons !nclude dryness of the )outh( eyes( and a"!na# Nor)al alues of cerebrosp!nal flu!d !nclude the follow!n"I prote!n le el( 1: to E: )"<144 )lN fast!n" "lucose( :4 to =4

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)"<144 )lN red blood cell count( 4N wh!te blood cell count( 4 to :<`lI p'( D#FN potass!u) !on alue( 3#O ))ol<LN chlor!de( 134 to 1F4 )E6<L# The follow!n" )ne)on!c de !ce can be used to !dent!fy whether a cran!al ner e !s a )otor ner eI I So)e a II Say a III -arry a IJ -oney( a J but a JI -y a JII Brother a JII Says a I7 Bad a 7 Bus!ness a 7I -arry a 7II -oney# To !nterpret the )ne)on!c de !ceI If the word be"!ns w!th an S( !ts a sensory ner eN !f !t starts w!th an -( !ts a )otor ner eN and !f !t starts w!th a B( !ts both a sensory and a )otor ner e# The Glas"ow ;o)a Scale e aluates le el of consc!ousness( pup!l react!on( and )otor act! !ty# A score between F and 1: !s poss!ble# $hen assess!n" a pat!ents pup!ls( the nurse should re)e)ber that an!socor!a( une6ual pup!ls of 1 )) or lar"er( occurs !n appro*!)ately 1DG of the populat!on# 'o)ony)ous he)!anops!a !s a !sual defect !n wh!ch the pat!ent sees only one/half of the !sual f!eld w!th each eye# Therefore( the pat!ent sees only one/half of a nor)al !sual f!eld# >ass! e ran"e/of/)ot!on e*erc!ses are co))only started 3E hours after a stro&e# Theyre perfor)ed four t!)es per day# In treat!n" a pat!ent w!th a trans!ent !sche)!c attac&( the "oal of )ed!cal )ana"e)ent !s to pre ent a stro&e# The pat!ent !s ad)!n!stered ant!hypertens! e dru"s( ant!platelet dru"s or asp!r!n and( !n so)e cases( warfar!n +;ou)ad!n,# A pat!ent who has an !ntraper!toneal shunt should be obser ed for !ncreased abdo)!nal "!rth# 5!"est!on of carbohydrates be"!ns !n the )outh# 5!"est!on of fats be"!ns !n the sto)ach( but occurs predo)!nantly !n the s)all !ntest!ne# 5!etary sources of )a"nes!u) are f!sh( "ra!ns( and nuts# A rou"h est!)ate of seru) os)olar!ty !s tw!ce the seru) sod!u) le el# In deter)!n!n" ac!dVbase proble)s( the nurse should f!rst note the p'# If !ts abo e D#E:( !ts a proble) of al&alos!sN !f !ts below D#F:( !ts a proble) of ac!dos!s# The nurse should ne*t loo& at the part!al pressure of arter!al carbon d!o*!de +>a;H3,# Th!s !s the resp!ratory !nd!cator# If the p' !nd!cates ac!dos!s and the >a;H3 !nd!cates ac!dos!s as well +"reater than E: )) '",( then theres a )atch( and the source of the proble) !s resp!rat!on# Its called resp!ratory ac!dos!s# If the p' !nd!cates al&alos!s and the >a;H3 also !nd!cates al&alos!s +less than F: )) '",( then theres a )atch( and the source of the proble) !s resp!rat!on# Th!s !s called resp!ratory al&alos!s# If the >a;H3 !s nor)al( then the nurse should loo& at the b!carbonate +';HFV,( wh!ch !s the )etabol!c !nd!cator( and note whether !ts ac!d!c +less than 33 )E6<L, or al&al!ne +"reater than 32 )E6<L,# 5eter)!ne wh!ch alue the p' )atchesN !t w!ll deter)!ne whether the proble) !s )etabol!c ac!dos!s or )etabol!c al&alos!s# If both the >a;H3 and ';HFV are abnor)al( then the body !s co)pensat!n"# If the p' has returned to nor)al( the body !s !n full co)pensat!on# The Tens!lon +edrophon!u) chlor!de, test !s used to conf!r) )yasthen!a "ra !s# A )as&l!&e fac!al e*press!on !s a s!"n of )yasthen!a "ra !s and >ar&!nsons d!sease# Albu)!n !s a collo!d that a!ds !n )a!nta!n!n" flu!d w!th!n the ascular syste)# If albu)!n were f!ltered out throu"h the &!dneys and !nto the ur!ne( ede)a would occur# Ede)a caused by water and trau)a doesnt cause p!tt!n"# 5ehydrat!on !s water loss onlyN flu!d olu)e def!c!t !ncludes all flu!ds !n the body#

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The pr!)ary act!on of an o!l retent!on ene)a !s to lubr!cate the colon# The secondary act!on !s soften!n" the feces# A pat!ent who uses a wal&er should be !nstructed to )o e the wal&er appro*!)ately 139 +F4#: c), to the front and then ad ance !nto the wal&er# Brady&!nes!a !s a s!"n of >ar&!nsons d!sease# Lordos!s !s bac&ward arch!n" cur ature of the sp!ne# Lyphos!s !s forward cur ature of the sp!ne# In a pat!ent w!th anore*!a ner osa( a pos!t! e response to therapy !s susta!ned we!"ht "a!n# The dru" !n d!alysate !s hepar!n# An auto"raft !s a "raft thats re)o ed fro) one area of the body for transplantat!on to another# S!"ns of cer !cal cancer !nclude )!d)enses bleed!n" and postco!tal bleed!n"# After prostatecto)y( a catheter !s !nserted to !rr!"ate the bladder and &eep ur!ne straw/colored or l!"ht p!n&( to put d!rect pressure on the operat! e s!de( and to )a!nta!n a patent urethra# If a rad!at!on !)plant beco)es d!slod"ed( but re)a!ns !n the pat!ent( the nurse should not!fy the phys!c!an# The best )ethod to reduce the r!s& for atelectas!s !s to encoura"e the pat!ent to wal&# Atelectas!s usually occurs 3E to E= hours after sur"ery# >at!ents who are at the "reatest r!s& for atelectas!s are those who ha e had h!"h abdo)!nal sur"ery( such as cholecystecto)y# A pers!stent decrease !n o*y"en to the &!dneys causes erythropo!es!s# Rhonch! and crac&les !nd!cate !neffect! e a!rway clearance# $hee0!n" !nd!cates bronchospas)s# ;l!n!cal s!"ns and sy)pto)s of hypo*e)!a are restlessness +usually the f!rst s!"n,( a"!tat!on( dyspnea( and d!sor!entat!on# ;o))on ad erse effects of op!o!ds are const!pat!on and resp!ratory depress!on# 5!suse osteoporos!s !s caused by de)!neral!0at!on of calc!u) as a result of prolon"ed bed rest# The best way to pre ent d!suse osteoporos!s !s to encoura"e the pat!ent to wal&# A cane should be carr!ed on the unaffected s!de and ad anced w!th the affected e*tre)!ty# Stero!ds shouldnt be used !n pat!ents who ha e ch!c&enpo* or sh!n"les because they )ay cause ad erse effects# Serocon ers!on occurs appro*!)ately F to 2 )onths after e*posure to hu)an !))unodef!c!ency !rus# Therapy w!th the ant! !ral a"ent 0!do ud!ne !s !n!t!ated when the ;5EM T/cell count !s :44 cells<`l or less# In a l!"ht/s&!nned person( Lapos!s sarco)a causes a purpl!sh d!scolorat!on of the s&!n# In a dar&/s&!nned person( the d!scolorat!on !s dar& brown to blac&#

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After an esopha"eal balloon ta)ponade !s !n place( !t should be !nflated to 34 )) '"# A pat!ent who has Lapos!s sarco)a should a o!d ac!d!c or h!"hly seasoned foods# The treat)ent for oral cand!d!as!s !s a)photer!c!n B +.un"!0one, or flucona0ole +5!flucan,# A s!"n of resp!ratory fa!lure !s !tal capac!ty of less than 1: )l<&" and resp!ratory rate of "reater than F4 breaths<)!nute or less than = breaths< )!nute# .or left/s!ded card!ac catheter!0at!on( the catheter !s threaded throu"h the descend!n" aorta( aort!c arch( ascend!n" aorta( aort!c al e( and left entr!cle# .or r!"ht/s!ded card!ac catheter!0at!on( the catheter !s threaded throu"h the super!or ena ca a( r!"ht atr!u)( r!"ht entr!cle( pul)onary artery( and pul)onary cap!llar!es# Ane)!a can be d! !ded !nto four "roups accord!n" to !ts causeI blood loss( !)pa!red product!on of red blood cells +RB;s,( !ncreased destruct!on of RB;s( and nutr!t!onal def!c!enc!es# Asp!r!n( !buprofen( phenobarb!tal( l!th!u)( colch!c!ne( lead( and chlora)phen!col can cause aplast!c ane)!a# After a pat!ent under"oes bone )arrow asp!rat!on( the nurse should apply d!rect pressure to the s!te for F to : )!nutes to reduce the r!s& of bleed!n"# .resh fro0en plas)a !s thawed to O=#2C . +FDC ;, before !nfus!on# S!"ns of thro)bocytopen!a !nclude petech!ae( ecchy)oses( he)atur!a( and "!n"! al bleed!n"# A pat!ent who has thro)bocytopen!a should be tau"ht to use a soft toothbrush and use an electr!c ra0or# S!"ns of flu!d o erload !nclude !ncreased central enous pressure( !ncreased pulse rate( d!stended %u"ular e!ns( and bound!n" pulse#

A pat!ent who has leu&open!a +or any other pat!ent who !s at an !ncreased r!s& for !nfect!on, should a o!d eat!n" raw )eat( fresh fru!t( and fresh e"etables# To pre ent a se ere "raft/ ersus/host react!on( wh!ch !s )ost co))only seen !n pat!ents older than a"e F4( the donor )arrow !s treated w!th )onoclonal ant!bod!es before transplantat!on# The four )ost co))on s!"ns of hypo"lyce)!a reported by pat!ents are ner ousness( )ental d!sor!entat!on( wea&ness( and persp!rat!on# >rolon"ed attac&s of hypo"lyce)!a !n a d!abet!c pat!ent can result !n bra!n da)a"e# Act! !t!es that !ncrease !ntracran!al pressure !nclude cou"h!n"( snee0!n"( stra!n!n" to pass feces( bend!n" o er( and blow!n" the nose# Treat)ent for bleed!n" esopha"eal ar!ces !ncludes asopress!n( esopha"eal ta)ponade( !ced sal!ne la a"e( and !ta)!n L# 'epat!t!s ; +also &nown as blood/transfus!on hepat!t!s, !s a parenterally trans)!tted for) of hepat!t!s that has a h!"h !nc!dence of carr!er status# The nurse should be concerned about flu!d and electrolyte proble)s !n the pat!ent who has asc!tes( ede)a( decreased ur!ne output( or low blood pressure#

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The nurse should be concerned about GI bleed!n"( low blood pressure( and !ncreased heart rate !n a pat!ent who !s he)orrha"!n"# The nurse should be concerned about "eneral!0ed )ala!se( cloudy ur!ne( purulent dra!na"e( tachycard!a( and !ncreased te)perature !n a pat!ent who has an !nfect!on#

In a pat!ent who has ede)a or asc!tes( the seru) electrolyte le el should be )on!tored# The pat!ent also should be we!"hed da!lyN ha e h!s abdo)!nal "!rth )easured w!th a cent!)eter tape at the sa)e locat!on( us!n" the u)b!l!cus as a chec&po!ntN ha e h!s !nta&e and output )easuredN and ha e h!s blood pressure ta&en at least e ery E hours# Endo"enous sources of a))on!a !nclude a0ote)!a( GI bleed!n"( catabol!s)( and const!pat!on# E*o"enous sources of a))on!a !nclude prote!n( blood transfus!on( and a)!no ac!ds# The follow!n" h!stolo"!c "rad!n" syste) !s used to class!fy cancersI "rade 1( well/d!fferent!atedN "rade 3( )oderately well/ d!fferent!atedN "rade F( poorly d!fferent!atedN and "rade E( ery poorly d!fferent!ated# The follow!n" "rad!n" syste) !s used to class!fy tu)orsI T4( no e !dence of a pr!)ary tu)orN TIS( tu)or !n s!tuN and T1( T3( TF( and TE( accord!n" to the s!0e and !n ol e)ent of the tu)orN the h!"her the nu)ber( the "reater the !n ol e)ent# >heochro)ocyto)a !s a catechola)!ne/secret!n" neoplas) of the adrenal )edulla# It causes e*cess! e product!on of ep!nephr!ne and norep!nephr!ne# ;l!n!cal )an!festat!ons of pheochro)ocyto)a !nclude !sual d!sturbances( headaches( hypertens!on( and ele ated seru) "lucose le el# The pat!ent shouldnt consu)e any caffe!ne/conta!n!n" products( such as cola( coffee( or tea( for at least = hours before obta!n!n" a 3E/hour ur!ne sa)ple for an!llyl)andel!c ac!d# A pat!ent who !s ta&!n" ;olBene)!d +probenec!d and colch!c!ne, for "out should !ncrease h!s flu!d !nta&e to 3(444 )l<day# A )!ot!c such as p!locarp!ne !s ad)!n!stered to a pat!ent w!th "lauco)a to !ncrease the outflow of a6ueous hu)or( wh!ch decreases !ntraocular tens!on# The dru" thats )ost co))only used to treat streptococcal pharyn"!t!s and rheu)at!c fe er !s pen!c!ll!n# A pat!ent w!th "out should a o!d pur!ne/conta!n!n" foods( such as l! er and other or"an )eats# A pat!ent who under"oes )a"net!c resonance !)a"!n" l!es on a flat platfor) that )o es throu"h a )a"net!c f!eld# Laboratory alues !n pat!ents who ha e bacter!al )en!n"!t!s !nclude !ncreased wh!te blood cell count( !ncreased prote!n and lact!c ac!d le els( and decreased "lucose le el# -ann!tol !s a hyperton!c os)ot!c d!uret!c that decreases !ntracran!al pressure# The best )ethod to debr!de a wound !s to use a wet/to/dry dress!n" and re)o e the dress!n" after !t dr!es# The "reatest r!s& for resp!ratory co)pl!cat!ons occurs after chest wall !n%ury( chest wall sur"ery( or upper abdo)!nal sur"ery# Secondary )ethods to pre ent postoperat! e resp!ratory co)pl!cat!ons !nclude ha !n" the pat!ent use an !ncent! e sp!ro)eter( turn!n" the pat!ent( ad !s!n" the pat!ent to cou"h and breathe deeply( and pro !d!n" hydrat!on#

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A character!st!c of aller"!c !nsp!ratory and e*p!ratory whee0!n" !s a dry( hac&!n"( nonproduct! e cou"h# The !ncubat!on per!od for Roc&y -ounta!n spotted fe er !s D to 1E days# -!cona0ole +-on!stat, a"!nal suppos!tory should be ad)!n!stered w!th the pat!ent ly!n" flat# The nurse should place the pat!ent who !s ha !n" a se!0ure on h!s s!de# S!"ns of h!p d!slocat!on are one le" thats shorter than the other and one le" thats e*ternally rotated# Ant!chol!ner"!c )ed!cat!on !s ad)!n!stered before sur"ery to d!)!n!sh secret!on of sal! a and "astr!c %u!ces# E*trapyra)!dal syndro)e !n a pat!ent w!th >ar&!nsons d!sease !s usually caused by a def!c!ency of dopa)!ne !n the substant!a n!"ra# In a burn pat!ent( the order of concern !s a!rway( c!rculat!on( pa!n( and !nfect!on# 'yper&ale)!a nor)ally occurs dur!n" the hypo ole)!c phase !n a pat!ent who has a ser!ous burn !n%ury# Blac& feces !n the burn pat!ent are co))only related to ;url!n"s ulcer# In a pat!ent w!th burn !n%ury( !))ed!ate care of a full/th!c&ness s&!n "raft !ncludes co er!n" the s!te w!th a bul&y dress!n"# The donor s!te of a s&!n "raft should be left e*posed to the a!r# Lea&!n" around a T tube should be reported !))ed!ately to the phys!c!an# A pat!ent who has -Zn!_res d!sease should consu)e a low/sod!u) d!et# In any postoperat! e pat!ent( the pr!or!ty of concern !s a!rway( breath!n"( and c!rculat!on( followed by self/care def!c!ts# The sy)pto)s of )yasthen!a "ra !s are )ost l!&ely related to ner e de"enerat!on# Sy)pto)s of sept!c shoc& !nclude cold( cla))y s&!nN hypotens!onN and decreased ur!ne output# N!nety/f! e percent of wo)en who ha e "onorrhea are asy)pto)at!c# An ad erse s!"n !n a pat!ent who has a Ste!n)anns p!n !n the fe)ur would be erythe)a( ede)a( and pa!n around the p!n s!te# S!"ns of chron!c "lauco)a !nclude halos around l!"hts( "radual loss of per!pheral !s!on( and cloudy !s!on# S!"ns of a detached ret!na !nclude a sensat!on of a e!l +or curta!n, !n the l!ne of s!"ht# To*!c le els of strepto)yc!n can cause hear!n" loss# A lon"/ter) effect of rheu)at!c fe er !s )!tral al e da)a"e# Laboratory alues noted !n rheu)at!c fe er !nclude an ant!streptolys!n/H t!ter( the presence of ;/react! e prote!n( leu&ocytos!s( and an !ncreased erythrocyte sed!)entat!on rate# ;ra)py pa!n !n the r!"ht lower 6uadrant of the abdo)en !s a cons!stent f!nd!n" !n ;rohns d!sease# ;ra)py pa!n !n the left lower 6uadrant of the abdo)en !s a cons!stent f!nd!n" !n d! ert!cul!t!s#

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In the !cter!c phase of hepat!t!s( ur!ne !s a)ber( feces are clay/colored( and the s&!n !s yellow# S!"ns of osteo)yel!t!s !nclude patholo"!c fractures( shorten!n" or len"then!n" of the bone( and pa!n deep !n the bone# The laboratory test that would best reflect flu!d loss because of a burn would be he)atocr!t# A pat!ent who has acute pancreat!t!s should ta&e noth!n" by )outh and under"o "astr!c suct!on to deco)press the sto)ach# A )!st tent !s used to !ncrease the hydrat!on of secret!ons# A pat!ent who !s rece! !n" le odopa should a o!d foods that conta!n pyr!do*!ne + !ta)!n B2,( such as beans( tuna( and beef l! er( because th!s !ta)!n decreases the effect! eness of le odopa# A pat!ent who has a transact!onal !n%ury at ;F re6u!res pos!t! e ent!lat!on# The act!on of phenyto!n +5!lant!n, !s potent!ated when "! en w!th ant!coa"ulants# ;erebral palsy !s a nonpro"ress! e d!sorder that pers!sts throu"hout l!fe# A co)pl!cat!on of ulcerat! e col!t!s !s perforat!on# $hen a pat!ent who has )ult!ple scleros!s e*per!ences d!plop!a( one eye should be patched# A dan"er s!"n after h!p replace)ent !s lac& of refle*es !n the affected e*tre)!ty# A cl!n!cal )an!festat!on of a ruptured lu)bar d!s& !ncludes pa!n that shoots down the le" and ter)!nates !n the popl!teal space# The )ost !)portant nutr!t!onal need of the burn pat!ent !s I#J# flu!d w!th electrolytes# The pat!ent who has syste)!c lupus erythe)atosus should a o!d sunsh!ne( ha!r spray( ha!r color!n" products( and dust!n" powder# The best pos!t!on for a pat!ent who has low bac& pa!n !s s!tt!n" !n a stra!"ht/bac&ed cha!r# ;l!n!cal s!"ns of ulcerat! e col!t!s !nclude bloody( purulent( )uco!d( and watery feces# A pat!ent who has a prote!n syste)!c shunt )ust follow a l!felon" prote!n/restr!cted d!et# A pat!ent who has a h!atal hern!a should )a!nta!n an upr!"ht pos!t!on after eat!n"# A suct!on apparatus should be &ept at the beds!de of a pat!ent who !s at r!s& for status ep!lept!cus# The lead!n" cause of death !n the burn pat!ent !s resp!ratory co)pro)!se and !nfect!on# In pat!ents who ha e herpes 0oster( the pr!)ary concern !s pa!n )ana"e)ent# The treat)ent for Roc&y -ounta!n spotted fe er !s tetracycl!ne# Strawberry ton"ue !s a s!"n of scarlet fe er# If a pat!ent has he)!anops!a( the nurse should place the call l!"ht( the )eal tray( and other !te)s !n h!s f!eld of !s!on# The best pos!t!on for the pat!ent after a cran!oto)y !s se)!/.owler# S!"ns of renal trau)a !nclude flan& pa!n( he)ato)a and( poss!bly( blood !n the ur!ne and decreased ur!ne output#

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.lan& pa!n and he)ato)a !n the bac& !nd!cate renal he)orrha"e !n the trau)a pat!ent# Natural d!uret!cs !nclude coffee( tea( and "rapefru!t %u!ce# ;entral enous pressure of 1= c) '3H !nd!cates hyper ole)!a# Sal)onellos!s can be ac6u!red by eat!n" conta)!nated )eat such as ch!c&en( or e""s# Good sources of )a"nes!u) !nclude f!sh( nuts( and "ra!ns# >at!ents who ha e low blood urea n!tro"en le els should be !nstructed to eat h!"h/prote!n foods( such as f!sh and ch!c&en# The nurse should )on!tor a pat!ent who has Gu!lla!n/BarrZ syndro)e for resp!ratory co)pro)!se# A heat!n" pad )ay pro !de co)fort to a pat!ent who has pel !c !nfla))atory d!sease# After supratentor!al sur"ery( the pat!ent should be placed !n the se)!/.owler pos!t!on# To pre ent deep e!n thro)bos!s( the pat!ent should e*erc!se h!s le"s at least e ery 3 hours( ele ate the le"s abo e the le el of the heart wh!le ly!n" down( and a)bulate w!th ass!stance# After bronchoscopy( the pat!ents "a" refle* should be chec&ed# In a pat!ent w!th )ononucleos!s( abdo)!nal pa!n and pa!n that rad!ates to the left shoulder )ay !nd!cate a ruptured spleen# .or a s&!n "raft to ta&e( !t )ust be autolo"ous# Untreated ret!nal detach)ent leads to bl!ndness# A pat!ent who has f!brocyst!c breast d!sease should consu)e a d!et thats low !n caffe!ne and salt# A foul odor at the p!n s!te of a pat!ent who !s !n s&eletal tract!on !nd!cates !nfect!on# A )uscle rela*ant thats ad)!n!stered w!th o*y"en )ay cause )al!"nant hyperther)!a and resp!ratory depress!on# >a!n that occurs on )o e)ent of the cer !*( to"ether w!th adne*al tenderness( su""ests pel !c !nfla))atory d!sease# The "oal of cr!s!s !nter ent!on !s to restore the person to a precr!s!s le el of funct!on!n" and order# Nephrot!c syndro)e causes prote!nur!a( hypoalbu)!ne)!a( and ede)a( and so)et!)es he)atur!a( hypertens!on( and a decreased "lo)erular f!ltrat!on rate#

Bowel sounds )ay be heard o er a hern!a( but not o er a hydrocele# S1 !s decreased !n f!rst/de"ree heart bloc&# S3 !s decreased !n aort!c stenos!s# Gas !n the colon )ay cause ty)pany !n the r!"ht upper 6uadrant( obscure l! er dullness( and lead to falsely decreased est!)ates of l! er s!0e# In ata*!a caused by loss of pos!t!on sense( !s!on co)pensates for the sensory loss# The pat!ent stands well w!th the eyes open( but loses balance when theyre closed +pos!t! e Ro)ber" test result,# Inab!l!ty to reco"n!0e nu)bers when drawn on the hand w!th the blunt end of a pen su""ests a les!on !n the sensory corte*#

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5ur!n" the late sta"e of )ult!ple )yelo)a( the pat!ent should be protected a"a!nst patholo"!cal fractures as a result of osteoporos!s# Tr!cycl!c ant!depressants such as a)!tr!ptyl!ne +Ela !l, shouldnt be ad)!n!stered to pat!ents w!th narrow/an"le "lauco)a( ben!"n prostat!c hypertrophy( or coronary artery d!sease# >ul)onary e)bol!s) !s character!0ed by a sudden( sharp( stabb!n" pa!n !n the chestN dyspneaN decreased breath soundsN and crac&les or a pleural fr!ct!on rub on auscultat!on# ;l!n!cal )an!festat!ons of card!ac ta)ponade are hypotens!on and %u"ular e!n d!stent!on# To a o!d further da)a"e( the nurse shouldnt !nduce o)!t!n" !n a pat!ent who has swallowed a corros! e che)!cal( such as o en cleaner( dra!n cleaner( or &erosene# A br!ll!ant red refle* e*cludes )ost ser!ous defects of the cornea( a6ueous cha)ber( lens( and !treous cha)ber# Hral hypo"lyce)!c a"ents st!)ulate the !slets of Lan"erhans to produce !nsul!n# To treat wound deh!scence( the nurse should help the pat!ent to l!e !n a sup!ne pos!t!onN co er the protrud!n" !ntest!ne w!th )o!st( ster!le( nor)al sal!ne pac&sN and chan"e the pac&s fre6uently to &eep the area )o!st# $h!le a pat!ent !s rece! !n" an I#J # n!tro"lycer!n dr!p( the nurse should )on!tor h!s blood pressure e ery 1: )!nutes to detect hypotens!on# Any type of flu!d loss can tr!""er a cr!s!s !n a pat!ent w!th s!c&le cell ane)!a# The pat!ent should r!nse h!s )outh after us!n" a cort!costero!d !nhaler to a o!d stero!d res!due and reduce oral fun"al !nfect!ons# A pat!ent w!th low le els of tr!!odothyron!ne and thyro*!ne )ay ha e fat!"ue( lethar"y( cold !ntolerance( const!pat!on( and decreased l!b!do# 5ur!n" a s!c&le cell cr!s!s( treat)ent !ncludes pa!n )ana"e)ent( hydrat!on( and bed rest# A pat!ent who !s hyper ent!lat!n" should rebreathe !nto a paper ba" to !ncrease the retent!on of carbon d!o*!de# ;horea !s a )a%or cl!n!cal )an!festat!on of central ner ous syste) !n ol e)ent caused by rheu)at!c fe er# ;horea causes constant %er&y( uncontrolled )o e)entsN f!d"et!n"N tw!st!n"N "r!)ac!n"N and loss of bowel and bladder control# Se ere d!arrhea can cause electrolyte def!c!enc!es and )etabol!c ac!dos!s# To reduce the r!s& of hypercalce)!a !n a pat!ent w!th )etastat!c bone cancer( the nurse should help the pat!ent a)bulate( pro)ote flu!d !nta&e to d!lute ur!ne( and l!)!t the pat!ents oral !nta&e of calc!u)#

>a!n assoc!ated w!th a )yocard!al !nfarct!on usually !s descr!bed as ?pressure@ or as a ?hea y@ or ?s6uee0!n"@ sensat!on !n the )!dsternal area# The pat!ent )ay report that the pa!n feels as thou"h so)eone !s stand!n" on h!s chest or as thou"h an elephant !s s!tt!n" on h!s chest# ;alc!u) and phosphorus le els are ele ated unt!l hyperparathyro!d!s) !s stab!l!0ed# The pa!n assoc!ated w!th carpal tunnel syndro)e !s caused by entrap)ent of the )ed!an ner e at the wr!st#

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>ancreat!c en0y)e replace)ent enhances the absorpt!on of prote!n# La)!necto)y w!th sp!nal fus!on !s perfor)ed to rel!e e pressure on the sp!nal ner es and stab!l!0e the sp!ne# A transect!on !n%ury of the sp!nal cord at any le el causes paralys!s below the le el of the les!on# .or pulseless entr!cular tachycard!a( the pat!ent should be def!br!llated !))ed!ately( w!th 344 %oules( F44 %oules( and then F24 %oules "! en !n rap!d success!on# >leural fr!ct!on rub !s heard !n pleur!sy( pneu)on!a( and plural !nfarct!on# $hee0es are heard !n e)physe)a( fore!"n body obstruct!on( and asth)a# Rhonch! are heard !n pneu)on!a( e)physe)a( bronch!t!s( and bronch!ectas!s# ;rac&les are heard !n pul)onary ede)a( pneu)on!a( and pul)onary f!bros!s# The electrocard!o"ra) of a pat!ent w!th heart fa!lure shows entr!cular hypertrophy# A decrease !n the potass!u) le el decreases the effect! eness of card!ac "lycos!des( !ncreases the poss!b!l!ty of d!"o*!n to*!c!ty( and can cause fatal card!ac arrhyth)!as# A 13/lead electrocard!o"ra) read!n" should be obta!ned dur!n" a )yocard!al !nfarct!on or an an"!nal attac&# The pr!)ary d!fference between an"!na and the sy)pto)s of a )yocard!al !nfarct!on +-I, !s that an"!na can be rel!e ed by rest or n!tro"lycer!n ad)!n!strat!on# The sy)pto)s of an -I arent rel!e ed w!th rest( and the pa!n can last F4 )!nutes or lon"er# ;alc!u) channel bloc&ers !nclude erapa)!l +;alan,( d!lt!a0e) hydrochlor!de +;ard!0e),( n!fed!p!ne +>rocard!a,( and n!card!p!ne hydrochlor!de +;ardene,# After a )yocard!al !nfarct!on( electrocard!o"raph chan"es !nclude ele at!ons of the P wa e and ST se")ent# Ant!arrhyth)!c a"ents !nclude 6u!n!d!ne "luconate +Pu!na"lute,( l!doca!ne hydrochlor!de( and proca!na)!de hydrochlor!de +>ronestyl,# An"!otens!n/con ert!n" en0y)e !nh!b!tors !nclude captopr!l and enalapr!l )aleate +Jasotec,# After a )yocard!al !nfarct!on( the pat!ent should a o!d stressful act! !t!es and s!tuat!ons( such as e*ert!on( hot or cold te)peratures( and e)ot!onal stress# Ant!hypertens! e dru"s !nclude hydrala0!ne hydrochlor!de +Apresol!ne, and )ethyldopa +Aldo)et,# Both parents )ust ha e a recess! e "ene for the offspr!n" to !nher!t the "ene# A do)!nant "ene !s a "ene that only needs to be present !n one parent to ha e a :4V:4 chance of affect!n" each offspr!n"# Bronchod!lators d!late the bronch!oles and rela* bronch!olar s)ooth )uscle# The pr!)ary funct!on of aldosterone !s sod!u) reabsorpt!on# The "oal of pos!t! e end/e*p!ratory pressure !s to ach!e e ade6uate arter!al o*y"enat!on w!thout us!n" a to*!c le el of !nsp!red o*y"en or co)pro)!s!n" card!ac output# .urose)!de +Las!*, !s a loop d!uret!c# Its onset of act!on !s F4 to 24 )!nutes( pea& !s ach!e ed at 1 to 3 hours( and durat!on !s 2 to = hours for the I#-# or oral route# >re"nancy( )yocard!al !nfarct!on( GI bleed!n"( bleed!n" d!sorders( and he)orrho!ds are contra!nd!cat!ons to )anual re)o al

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of fecal !)pact!on# A)bulat!on !s the best )ethod to pre ent postoperat! e atelectas!s# Hther )easures !nclude !ncent! e sp!ro)etry and turn!n"( cou"h!n"( and breath!n" deeply# The blood urea n!tro"en test and the creat!n!ne clearance test )easure how effect! ely the &!dneys e*crete these respect! e substances# The f!rst s!"n of resp!ratory d!stress or co)pro)!se !s restlessness# The ant!dote for )a"nes!u) sulfate o erdose !s calc!u) "luconate 14G# The ant!dote for hepar!n o erdose !s prota)!ne sulfate# An aller"!c react!on to a blood transfus!on )ay !nclude flush!n"( urt!car!a( whee0!n"( and a rash# If the pat!ent has any of these s!"ns of a react!on( the nurse should stop the transfus!on !))ed!ately( &eep the e!n open w!th nor)al sal!ne( and not!fy the phys!c!an# A pat!ent ta&!n" d!"o*!n and furose)!de +Las!*, should call the phys!c!an !f he e*per!ences )uscle wea&ness# A pat!ent w!th basal cell carc!no)a should a o!d e*posure to the sun dur!n" the hottest t!)e of day +between 14 a#)# and F p#)#,# A cl!n!cal )an!festat!on of acute pa!n !s d!aphores!s# Gardnerella a"!n!t!s !s a type of bacter!al a"!nos!s that causes a th!n( watery( )!l&l!&e d!schar"e that has a f!shy odor# A pat!ent who !s ta&!n" .la"yl +)etron!da0ole, shouldnt consu)e alcohol!c be era"es or use preparat!ons that conta!n alcohol because they )ay cause a d!sulf!ra)/l!&e react!on +flush!n"( headache( o)!t!n"( and abdo)!nal pa!n,# 5ur!n" the ad)!n!strat!on of transcutaneous electr!cal ner e st!)ulat!on( the pat!ent feels a t!n"l!n" sensat!on# In pat!ents w!th "lauco)a( the head of the bed should be ele ated !n the se)!/.owler pos!t!on or as ordered after sur"ery to pro)ote dra!na"e of a6ueous hu)or# >ostoperat! e care after per!pheral !r!decto)y !ncludes ad)!n!ster!n" dru"s +stero!ds and cyclople"!cs, as prescr!bed to decrease !nfla))at!on and d!late the pup!ls# Ret!nopathy refers to chan"es !n ret!nal cap!llar!es that decrease blood flow to the ret!na and lead to !sche)!a( he)orrha"e( and ret!nal detach)ent# Le"el e*erc!ses are reco))ended after sur"ery to !)pro e the tone of the sph!ncter and pel !c )uscles# Hne of the treat)ents for tr!cho)on!as!s a"!nal!s !s )etron!da0ole +.la"yl,( wh!ch )ust be prescr!bed for the pat!ent and the pat!ents se*ual partner# A co))on sy)pto) after cataract laser sur"ery !s blurred !s!on# A pat!ent w!th acute open/an"le "lauco)a )ay see halos around l!"hts# An As!an pat!ent w!th d!abetes )ell!tus usually can dr!n& "!nsen" tea# To pre ent ot!t!s e*terna( the pat!ent should &eep the ears dry when bath!n"# >at!ents who rece! e prolon"ed h!"h doses of I#J# furose)!de +Las!*, should be assessed for t!nn!tus and hear!n" loss# The treat)ent for to*!c shoc& syndro)e !s I#J# flu!d ad)!n!strat!on to restore blood olu)e and pressure and ant!b!ot!c therapy to el!)!nate !nfect!on#

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In pat!ents w!th "lauco)a( beta/adrener"!c bloc&ers fac!l!tate the outflow of a6ueous hu)or# A )an who loses one test!cle should st!ll be able to father a ch!ld# Nat! e A)er!cans are part!cularly suscept!ble to d!abetes )ell!tus# Blac&s are part!cularly suscept!ble to hypertens!on# $o)en w!th the "reatest r!s& for cer !cal cancer are those whose )others had cer !cal cancer( followed by those whose fe)ale s!bl!n"s had cer !cal cancer# A post)enopausal wo)an should perfor) breast self/e*a)!nat!on on the sa)e day each )onth( for e*a)ple( on the sa)e day of the )onth as her b!rthday# -!ddle/ear hear!n" loss usually results fro) otoscleros!s# After test!cular sur"ery( the pat!ent should use an !ce pac& for co)fort# A pat!ent w!th chron!c open/an"le "lauco)a has tunnel !s!on# The nurse )ust be careful to place !te)s d!rectly !n front of h!) so that he can see the)# ;l!n!cal s!"ns of bacter!al pneu)on!a !nclude sha&!n"( ch!lls( fe er( and a cou"h that produces purulent sputu)# ;l!n!cal )an!festat!ons of fla!l chest !nclude parado*!cal )o e)ent of the !n ol ed chest wall( dyspnea( pa!n( and cyanos!s# R!"ht/s!ded card!ac funct!on !s assessed by e aluat!n" central enous pressure# A pat!ent w!th a pace)a&er should !))ed!ately report an !ncrease !n the pulse rate or a slow!n" of the pulse rate of )ore than E to : beats<)!nute# 5!00!ness( fa!nt!n"( palp!tat!on( h!ccups( and chest pa!n !nd!cate pace)a&er fa!lure# Leu&e)!a causes easy fat!"ab!l!ty( "eneral!0ed )ala!se( and pallor# After card!ac catheter!0at!on( the puncture( or cutdown( s!te should be )on!tored for he)ato)a for)at!on# Luss)auls breath!n" !s assoc!ated w!th d!abet!c &etoac!dos!s# If the nurse not!ces water !n a ent!lator tube( she should re)o e the water fro) the tube and reconnect !t# Ta)o*!fen !s an ant!neoplast!c dru" thats used to treat breast cancer# The ad erse effects of !ncr!st!ne +Hnco !n, !nclude alopec!a( nausea( and o)!t!n"# E)physe)a !s character!0ed by destruct!on of the al eol!( enlar"e)ent of the d!stal a!r spaces( and brea&down of the al eolar walls# To &eep secret!ons th!n( the pat!ent who has e)physe)a should !ncrease h!s flu!d !nta&e to appro*!)ately 3#: L<day# The cl!n!cal )an!festat!ons of asth)a are whee0!n"( dyspnea( hypo*e)!a( d!aphores!s( and !ncreased heart and resp!ratory rate# E*tr!ns!c asth)a !s an ant!"enVant!body react!on to aller"ens( such as pollen( an!)al( dander( feathers( foods( house dust( or )!tes#

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After endoscopy !s perfor)ed( the nurse should assess the pat!ent for he)optys!s# Increased ur!ne output !s an !nd!cat!on that a hypertens! e cr!s!s has resol ed# After rad!cal )astecto)y( the pat!ent should be pos!t!oned w!th the affected ar) on p!llows w!th the hand ele ated and al!"ned w!th the ar)# After pneu)onecto)y( the pat!ent should perfor) ar) e*erc!ses to pre ent fro0en shoulder# BulletsBullets Left/s!ded heart fa!lure causes crac&les( cou"h!n"( tachycard!a( and fat!"ab!l!ty# +Th!n& of L to re)e)ber Left and Lun"s#, Bullets ;ard!ac "lycos!des !ncrease contract!l!ty and card!ac output# R!"ht/s!ded heart fa!lure causes ede)a( d!stended nec& e!ns( noctur!a( and wea&ness# Ad erse effects of card!ac "lycos!des !nclude card!ac d!sturbance( headache( hypotens!on( GI sy)pto)s( blurred !s!on( and yellow/"reen halos around l!"hts# A pat!ent who !s rece! !n" ant!coa"ulant therapy should ta&e aceta)!nophen +Tylenol, !nstead of asp!r!n for pa!n rel!ef# Ade6uate hu)!d!f!cat!on !s !)portant after laryn"ecto)y# At ho)e( the pat!ent can use pans of water or a cool )!st apor!0er( espec!ally !n the bedroo)# Late sy)pto)s of renal cancer !nclude he)atur!a( flan& pa!n( and a palpable )ass !n the flan&# 'epar!n !s "! en subcutaneously( usually !n the lower abdo)!nal fat pad# In a pat!ent w!th s!c&le cell ane)!a( war) pac&s should be used o er the e*tre)!t!es to rel!e e pa!n# ;old pac&s )ay st!)ulate asoconstr!ct!on and cause further !sche)!a# The e*tre)!t!es should be placed on p!llows for co)fort# S!c&le cell cr!s!s causes seps!s +fe er "reater than 143C . [F=#OC ;\( )en!n"eal !rr!tat!on( tachypnea( tachycard!a( and hypotens!on, and aso/occlus! e cr!s!s +se ere pa!n, w!th hypo*!a +part!al pressure of arter!al o*y"en of less than D4 )) '",# Ad erse effects of d!"o*!n !nclude headache( wea&ness( !s!on d!sturbances( anore*!a( and GI upset# To perfor) a tuberculos!s test( a 32/"au"e needle !s used w!th a 1/)l syr!n"e# Resp!ratory fa!lure occurs when )ucus bloc&s the al eol! or the a!rways of the lun"s# The pat!ent should be !nstructed not to cou"h dur!n" thoracentes!s# The pat!ent should be !nstructed not to cou"h dur!n" thoracentes!s# A pat!ent who has thro)bophleb!t!s should be placed !n the Trendelenbur" pos!t!on# Sy)pto)s of >neu)ocyst!s car!n!! pneu)on!a !nclude dyspnea and nonproduct! e cou"h# To counteract !ta)!n B1 def!c!ency( a pat!ent who has pern!c!ous ane)!a should eat )eat and an!)al products# A pat!ent who !s on a ent!lator and beco)es restless should under"o suct!on!n"# Autolo"ous bone )arrow transplantat!on doesnt cause "raft/ ersus/host d!sease# A pat!ent who has )!ld thro)bophleb!t!s !s l!&ely to ha e )!ld cra)p!n" on e*ert!on# If the f!rst atte)pt to perfor) colosto)y !rr!"at!on !s unsuccessful( the procedure !s repeated w!th nor)al sal!ne solut!on#

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Breast enlar"e)ent( or "yneco)ast!a( !s an ad erse effect of estro"en therapy# In a pat!ent who has leu&e)!a( a low platelet count )ay lead to he)orrha"e# After rad!cal nec& d!ssect!on( the !))ed!ate concern !s resp!ratory d!stress as a result of tracheal ede)a# After rad!cal )astecto)y( the pat!ents ar) should be ele ated to pre ent ly)phede)a# 'ypo ent!lat!on causes resp!ratory ac!dos!s# The h!"h .owler pos!t!on !s the best pos!t!on for a pat!ent who has orthopnea# A trans!ent !sche)!c attac& affects sensory and )otor funct!on and )ay cause d!plop!a( dyspha"!a( aphas!a( and ata*!a# After )astecto)y( the pat!ent should s6uee0e a ball w!th the hand on the affected s!de# ;holestyra)!ne +Puestran,( wh!ch !s used to reduce the seru) cholesterol le el( )ay cause const!pat!on# Glucocort!co!d( or stero!d( therapy )ay )as& the s!"ns of !nfect!on# -elano)a !s )ost co))only seen !n l!"ht/s&!nned people who wor& or spend t!)e outdoors# A pat!ent who has a pace)a&er should ta&e h!s pulse at the sa)e t!)e e ery day# A pat!ent who has sto)at!t!s should r!nse h!s )outh w!th )outhwash fre6uently# An ad erse effect of theophyll!ne ad)!n!strat!on !s tachycard!a# The treat)ent for laryn"otracheobronch!t!s !ncludes postural dra!na"e before )eals# After rad!cal nec& d!ssect!on( a h!"h pr!or!ty !s pro !d!n" a )eans of co))un!cat!on# A h!"h/fat d!et that !ncludes red )eat !s a contr!but!n" factor for colorectal cancer# After a )od!f!ed rad!cal )astecto)y( the pat!ent should be placed !n the se)!/.owler pos!t!on( w!th the ar) placed on a p!llow# Ln!fel!&e( stabb!n" pa!n !n the chest )ay !nd!cate pul)onary e)bol!s)# Esopha"eal cancer !s assoc!ated w!th e*cess! e alcohol consu)pt!on# A pat!ent who has pancytopen!a and !s under"o!n" che)otherapy )ay e*per!ence he)orrha"e and !nfect!on# A "rade I tu)or !s encapsulated and "rows by e*pans!on# ;ancer of the pancreas causes anore*!a( we!"ht loss( and %aund!ce# >rolon"ed "astr!c suct!on!n" can cause )etabol!c al&alos!s# To )easure the a)ount of res!dual ur!ne( the nurse perfor)s stra!"ht catheter!0at!on after the pat!ent o!ds# 5e*a)ethasone +5ecadron, !s a stero!dal ant!/!nfla))atory a"ent thats used to treat bra!n tu)ors# Lon"/ter) reduct!on !n the del! ery of o*y"en to the &!dneys causes an !ncrease !n erythropo!es!s#

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A pat!ent who subs!sts on canned foods and canned f!sh !s at r!s& for sod!u) !)balance +hypernatre)!a,# ;l!n!cal s!"ns and sy)pto)s of hypo*!a !nclude confus!on( d!aphores!s( chan"es !n blood pressure( tachycard!a( and tachypnea# Red )eat can cause a false/pos!t! e result on fecal occult blood test# ;arbon )ono*!de replaces he)o"lob!n !n the red blood cells( decreas!n" the a)ount of o*y"en !n the t!ssue# Al&al!ne ur!ne can result !n ur!nary tract !nfect!on# Bladder retra!n!n" !s effect! e !f !t len"thens the !nter als between ur!nat!on# ;he!los!s !s caused by r!bofla !n def!c!ency# The concentrat!on of o*y"en !n !nsp!red a!r !s reduced at h!"h alt!tudes# As a result( dyspnea )ay occur on e*ert!on# A pat!ent who !s rece! !n" enter!c feed!n" should be assessed for abdo)!nal d!stent!on# Th!a)!ne def!c!ency causes neuropathy# A pat!ent who has abdo)!nal d!stent!on as a result of flatus can be treated w!th a car)!nat! e ene)a +'arr!s flush,# >ern!c!ous ane)!a !s caused by a def!c!ency of !ta)!n B13( or cobala)!n# After a bar!u) ene)a( the pat!ent !s "! en a la*at! e# The appropr!ate I#J# flu!d to correct a hypo ole)!c( or flu!d olu)e( def!c!t !s nor)al sal!ne solut!on# Seru) albu)!n def!c!ency co))only occurs after burn !n%ury# Before "! !n" a "astrosto)y feed!n"( the nurse should !nspect the pat!ents sto)a# The )ost co))on !ntest!nal bacter!a !dent!f!ed !n ur!nary tract !nfect!on !s Escher!ch!a col!# 'yponatre)!a )ay occur !n a pat!ent who has a h!"h fe er and dr!n&s only water# .ol!c ac!d def!c!ency causes )uscle wea&ness as a result of hypo*e)!a# 5ehydrat!on causes !ncreased resp!rat!on and heart rate( followed by !rr!tab!l!ty and fuss!ness# Glucocort!co!ds can cause an electrolyte !)balance# A decrease !n potass!u) le el decreases the effect! eness of card!ac "lycos!des( !ncreases poss!ble d!"o*!n to*!c!ty( and can cause fatal card!ac arrhyth)!as# 5!ures!s can cause decreased absorpt!on of !ta)!ns A( 5( E( and L# >rote!n deplet!on causes a decrease !n ly)phocyte count# To pre ent paraph!)os!s after the !nsert!on of a .oley catheter( the nurse should replace the prepuce# Loop d!uret!cs( such as furose)!de +Las!*,( decrease plas)a le els of potass!u) and sod!u)# After pyelo"raphy( the pat!ent should dr!n& plenty of flu!ds to pro)ote the e*cret!on of dye#

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>otass!u) should be ta&en w!th food and flu!ds# >roper )easure)ent of a naso"astr!c tube !s fro) the corner of the )outh to the ear lobe to the t!p of the sternu)# .ull a"on!st anal"es!cs !nclude )orph!ne( code!ne( )eper!d!ne +5e)erol,( propo*yphene +5ar on,( and hydro)orphone +5!laud!d,# Buprenorph!ne +Buprene*, !s a part!al a"on!st anal"es!c# >oor s&!n tur"or !s a cl!n!cal )an!festat!on of d!abetes !ns!p!dus# A pat!ent who has Add!sons d!sease and !s rece! !n" cort!costero!d therapy )ay be at r!s& for !nfect!on# To assess a pat!ent for he)orrha"e after a thyro!decto)y( the nurse should roll the pat!ent onto h!s s!de to e*a)!ne the s!des and bac& of the nec&# A pat!ent who !s rece! !n" hor)one therapy for hypothyro!d!s) should ta&e the dru" at the sa)e t!)e each day# 'yperprote!ne)!a )ay contr!bute to the de elop)ent of hepat!c encephalopathy# To )!n!)!0e bleed!n" !n a pat!ent who has l! er dysfunct!on( s)all/"au"e needles are used for !n%ect!ons# A pat!ent who has c!rrhos!s of the l! er and asc!tes should follow a low/sod!u) d!et# Before an e*cretory uro"raphy( the nurse )ust as& the pat!ent whether hes aller"!c to !od!ne or shellf!sh# A buffalo hu)p !s an abnor)al d!str!but!on of ad!pose t!ssue that occurs !n ;ush!n"s syndro)e# Le othyro*!ne +Synthro!d, !s used as replace)ent therapy !n hypothyro!d!s)# Le othyro*!ne +Synthro!d, treats( but doesnt cure( hypothyro!d!s) and )ust be ta&en for the pat!ents l!fet!)e# It shouldnt be ta&en w!th food because food )ay !nterfere w!th !ts absorpt!on# I)!pra)!ne +Tofran!l, w!th conco)!tant use of barb!turates )ay result !n enhanced ;NS depress!on# A pat!ent who !s rece! !n" le othyro*!ne +Synthro!d, therapy should report tachycard!a to the phys!c!an# The s!"ns and sy)pto)s of hyper&ale)!a !nclude )uscle wea&ness( hypotens!on( shallow resp!rat!on( apathy( and anore*!a# In a pat!ent w!th well/controlled d!abetes( the 3/hour postprand!al blood su"ar le el )ay be 1FO )"<dl# A pat!ent who has d!abetes )ell!tus should wash h!s feet da!ly !n war) water and dry the) carefully( espec!ally between the toes# Acute pancreat!t!s causes constant ep!"astr!c abdo)!nal pa!n that rad!ates to the bac& and flan& and !s )ore !ntense !n the sup!ne pos!t!on# 5!abet!c neuropathy !s a lon"/ter) co)pl!cat!on of d!abetes )ell!tus# >ortal e!n hypertens!on !s assoc!ated w!th l! er c!rrhos!s# After thyro!decto)y( the nurse should assess the pat!ent for laryn"eal da)a"e )an!fested by hoarseness# The pat!ent w!th hypoparathyro!d!s) has hypocalce)!a#

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A pat!ent who has chron!c pancreat!t!s should consu)e a bland( low/fat d!et# A pat!ent w!th hepat!t!s A should be on enter!c precaut!ons to pre ent the spread of hepat!t!s A# The pat!ent who has l! er d!sease !s l!&ely to ha e %aund!ce( wh!ch !s caused by an !ncreased b!l!rub!n le el# An ad erse effect of phenyto!n +5!lant!n, ad)!n!strat!on !s hyperplas!a of the "!n"! a# 'e)ate)es!s !s a cl!n!cal s!"n of esopha"eal ar!ces# .at destruct!on !s the che)!cal process that causes &etones to appear !n ur!ne# The "lucose tolerance test !s the def!n!t! e d!a"nost!c test for d!abetes# Atelectas!s and deh!scence are postoperat! e cond!t!ons assoc!ated w!th re)o al of the "allbladder# After l! er b!opsy( the pat!ent should be pos!t!oned on h!s r!"ht s!de( w!th a p!llow placed underneath the l! er border# ;ate"or!0ed Bullets Lu"ols solut!on !s used to de ascular!0e the "land before thyro!decto)y# ;holecyst!t!s causes low/"rade fe er( nausea and o)!t!n"( "uard!n" of the r!"ht upper 6uadrant( and b!l!ary pa!n that rad!ates to the r!"ht scapula# Early sy)pto)s of l! er c!rrhos!s !nclude fat!"ue( anore*!a( ede)a of the an&les !n the e en!n"( ep!sta*!s( and bleed!n" "u)s# The cl!n!cal )an!festat!ons of d!abetes !ns!p!dus !nclude polyd!ps!a( polyur!a( spec!f!c "ra !ty of 1#441 to 1#44:( and h!"h seru) os)olal!ty# The cl!n!cal )an!festat!ons of d!abetes !ns!p!dus !nclude polyd!ps!a( polyur!a( spec!f!c "ra !ty of 1#441 to 1#44:( and h!"h seru) os)olal!ty# 'ypertens!on !s a s!"n of re%ect!on of a transplanted &!dney# Lactulose !s used to pre ent and treat portal/syste)!c encephalopathy# E*tracorporeal and !ntracorporeal shoc& wa e l!thotr!psy !s the use of shoc& wa es to perfor) non!n as! e destruct!on of b!l!ary stones# Its !nd!cated !n the treat)ent of sy)pto)at!c h!"h/r!s& pat!ents who ha e few noncalc!f!ed cholesterol stones# 5ecreased consc!ousness !s a cl!n!cal s!"n of an !ncreased a))on!a le el !n a pat!ent w!th &!dney fa!lure or c!rrhos!s of the l! er# The pa!n )ed!cat!on thats "! en to pat!ents who ha e acute pancreat!t!s !s )eper!d!ne +5e)erol,# >rochlorpera0!ne +;o)pa0!ne,( )ecl!0!ne( and tr!)ethoben0a)!de +T!"an, are used to treat the nausea and o)!t!n" caused by cholecyst!t!s# Hbese wo)en are )ore suscept!ble to "allstones than any other "roup# -etabol!c ac!dos!s !s a co))on f!nd!n" !n acute renal fa!lure# .or a pat!ent who has acute pancreat!t!s( the )ost !)portant nurs!n" !nter ent!on !s to )a!nta!n h!s flu!d and electrolyte balance# After thyro!decto)y( the pat!ent !s )on!tored for hypocalce)!a#

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In end/sta"e c!rrhos!s of the l! er( the pat!ents a))on!a le el !s ele ated# In a pat!ent who has l! er c!rrhos!s( abdo)!nal "!rth !s )easured w!th the super!or !l!ac crest used as a land)ar&# The sy)pto)s of Al0he!)ers d!sease ha e an !ns!d!ous onset# .racture of the s&ull !n the area of the cerebellu) )ay cause ata*!a and !nab!l!ty to coord!nate )o e)ent# Seru) creat!n!ne !s the laboratory test that pro !des the )ost spec!f!c !nd!cat!on of &!dney d!sease# A pat!ent who has b!lateral adrenalecto)y )ust ta&e cort!sone for the rest of h!s l!fe# >ortal e!n hypertens!on causes esopha"eal ar!ces# S!"ns and sy)pto)s of hypo*!a !nclude tachycard!a( shortness of breath( cyanos!s( and )ottled s&!n# The three types of e)bol!s) are a!r( fat( and thro)bus# Assoc!at!ons for pat!ents who ha e had laryn"eal cancer !nclude the Lost ;ord ;lub and the New Jo!ce ;lub# Before d!schar"e( a pat!ent who has had a total laryn"ecto)y )ust be able to perfor) tracheosto)y care and suct!on!n" and use alternat! e )eans of co))un!cat!on# The un! ersal blood donor !s H ne"at! e# The un! ersal blood rec!p!ent !s AB pos!t! e# -ucus !n a colosto)y ba" !nd!cates that the colon !s be"!nn!n" to funct!on# After a asecto)y( the pat!ent !s cons!dered ster!le !f he has no sper) cells# .at!"ue !s an ad erse effect of rad!at!on therapy# To pre ent du)p!n" syndro)e( the pat!ents consu)pt!on of h!"h/carbohydrate foods and l!6u!ds should be l!)!ted# ;ryoprec!p!tate conta!ns factors JIII and 7III and f!br!no"en and !s used to treat he)oph!l!a# Inso)n!a !s the )ost co))on sleep d!sorder# Bru*!s) !s "r!nd!n" of the teeth dur!n" sleep# Elderly pat!ents are at r!s& for osteoporos!s because of a"e/related bone de)!neral!0at!on# The cl!n!cal )an!festat!ons of local !nfect!on !n an e*tre)!ty are tenderness( loss of use of the e*tre)!ty( erythe)a( ede)a( and war)th# ;l!n!cal )an!festat!ons of syste)!c !nfect!on !nclude fe er and swollen ly)ph nodes# An !))ob!le pat!ent !s pred!sposed to thro)bus for)at!on because of !ncreased blood stas!s# Urea !s the ch!ef end product of a)!no ac!d )etabol!s)# -orph!ne and other op!o!ds rel!e e pa!n by b!nd!n" to the ner e cells !n the dorsal horn of the sp!nal cord#

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Tr!cho)onas and ;and!da !nfect!ons can be ac6u!red nonse*ually# >resbycus!s !s pro"ress! e sensor!neural hear!n" loss that occurs as part of the a"!n" process#

PSYCHIATRIC NURSING
Accord!n" to Lbbler/Ross( the f! e sta"es of death and dy!n" are den!al( an"er( bar"a!n!n"( depress!on( and acceptance# .l!"ht of !deas !s an alterat!on !n thou"ht processes thats character!0ed by s&!pp!n" fro) one top!c to another( unrelated top!c# La belle !nd!ffZrence !s the lac& of concern for a profound d!sab!l!ty( such as bl!ndness or paralys!s that )ay occur !n a pat!ent who has a con ers!on d!sorder# -oderate an*!ety decreases a persons ab!l!ty to perce! e and concentrate# The person !s select! ely !nattent! e +focuses on !))ed!ate concerns,( and the perceptual f!eld narrows# A pat!ent who has a phob!c d!sorder uses self/protect! e a o!dance as an e"o defense )echan!s)#

In a pat!ent who has anore*!a ner osa( the h!"hest treat)ent pr!or!ty !s correct!on of nutr!t!onal and electrolyte !)balances# A pat!ent who !s ta&!n" l!th!u) )ust under"o re"ular +usually once a )onth, )on!tor!n" of the blood l!th!u) le el because the )ar"!n between therapeut!c and to*!c le els !s narrow# A nor)al laboratory alue !s 4#: to 1#: )E6<L# Early s!"ns and sy)pto)s of alcohol w!thdrawal !nclude an*!ety( anore*!a( tre)ors( and !nso)n!a# They )ay be"!n up to = hours after the last alcohol !nta&e# Al/Anon !s a support "roup for fa)!l!es of alcohol!cs#

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The nurse shouldnt ad)!n!ster chlorpro)a0!ne +Thora0!ne, to a pat!ent who has !n"ested alcohol because !t )ay cause o ersedat!on and resp!ratory depress!on# L!th!u) to*!c!ty can occur when sod!u) and flu!d !nta&e are !nsuff!c!ent( caus!n" l!th!u) retent!on# An alcohol!c who ach!e es sobr!ety !s called a reco er!n" alcohol!c because no cure for alcohol!s) e*!sts#

Accord!n" to Er!&son( the school/a"e ch!ld +a"es 2 to 13, !s !n the !ndustry/ ersus/!nfer!or!ty sta"e of psychosoc!al de elop)ent# $hen car!n" for a depressed pat!ent( the nurses f!rst pr!or!ty !s safety because of the !ncreased r!s& of su!c!de# Echolal!a !s parrotl!&e repet!t!on of another persons words or phrases#

Accord!n" to psychoanalyt!c theory( the e"o !s the part of the psyche that controls !nternal de)ands and !nteracts w!th the outs!de world at the consc!ous( preconsc!ous( and unconsc!ous le els# Accord!n" to psychoanalyt!c theory( the supere"o !s the part of the psyche thats co)posed of )orals( alues( and eth!cs# It cont!nually e aluates thou"hts and act!ons( reward!n" the "ood and pun!sh!n" the bad# +Th!n& of the supere"o as the ?supercop@ of the unconsc!ous#, Accord!n" to psychoanalyt!c theory( the !d !s the part of the psyche that conta!ns !nst!nctual dr! es# +Re)e)ber ! for !nst!nctual and d for dr! e#, 5en!al !s the defense )echan!s) used by a pat!ent who den!es the real!ty of an e ent#

In a psych!atr!c sett!n"( seclus!on !s used to reduce o erwhel)!n" en !ron)ental st!)ulat!on( protect the pat!ent fro) self/!n%ury or !n%ury to others( and pre ent da)a"e to hosp!tal property# Its used for pat!ents who dont respond to less restr!ct! e !nter ent!ons# Seclus!on controls e*ternal beha !or unt!l the pat!ent can assu)e self/control and helps the pat!ent to re"a!n self/control# Tyra)!ne/r!ch food( such as a"ed cheese( ch!c&en l! er( a ocados( bananas( )eat tender!0er( sala)!( bolo"na( ;h!ant! w!ne( and beer )ay cause se ere hypertens!on !n a pat!ent who ta&es a )onoa)!ne o*!dase !nh!b!tor# A pat!ent who ta&es a )onoa)!ne o*!dase !nh!b!tor should be we!"hed b!wee&ly and )on!tored for su!c!dal tendenc!es# If the pat!ent who ta&es a )onoa)!ne o*!dase !nh!b!tor has palp!tat!ons( headaches( or se ere orthostat!c hypotens!on( the nurse should w!thhold the dru" and not!fy the phys!c!an# ;o))on causes of ch!ld abuse are poor !)pulse control by the parents and the lac& of &nowled"e of "rowth and de elop)ent# The d!a"nos!s of Al0he!)ers d!sease !s based on cl!n!cal f!nd!n"s of two or )ore co"n!t! e def!c!ts( pro"ress! e worsen!n" of )e)ory( and the results of a neuropsycholo"!cal test# -e)ory d!sturbance !s a class!c s!"n of Al0he!)ers d!sease# Thou"ht bloc&!n" !s loss of the tra!n of thou"ht because of a defect !n )ental process!n"#

A co)puls!on !s an !rres!st!ble ur"e to perfor) an !rrat!onal act( such as wal&!n" !n a cloc&w!se c!rcle before lea !n" a roo) or wash!n" the hands repeatedly# A pat!ent who has a chosen )ethod and a plan to co))!t su!c!de !n the ne*t E= to D3 hours !s at h!"h r!s& for su!c!de#

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The therapeut!c seru) le el for l!th!u) !s 4#: to 1#: )E6<L#

>hob!c d!sorders are treated w!th desens!t!0at!on therapy( wh!ch "radually e*poses a pat!ent to an an*!ety/produc!n" st!)ulus# 5ysfunct!onal "r!e !n" !s absent or prolon"ed "r!ef#

5ur!n" phase I of the nurse/pat!ent relat!onsh!p +be"!nn!n"( or or!entat!on( phase,( the nurse obta!ns an !n!t!al h!story and the nurse and the pat!ent a"ree to a contract# 5ur!n" phase II of the nurse/pat!ent relat!onsh!p +)!ddle( or wor&!n"( phase,( the pat!ent d!scusses h!s proble)s( beha !oral chan"es occur( and self/defeat!n" beha !or !s resol ed or reduced# 5ur!n" phase III of the nurse/pat!ent relat!onsh!p +ter)!nat!on( or resolut!on( phase,( the nurse ter)!nates the therapeut!c relat!onsh!p and "! es the pat!ent pos!t! e feedbac& on h!s acco)pl!sh)ents# Accord!n" to .reud( a person between a"es 13 and 34 !s !n the "en!tal sta"e( dur!n" wh!ch he learns !ndependence( has an !ncreased !nterest !n )e)bers of the oppos!te se*( and establ!shes an !dent!ty# Accord!n" to Er!&son( the !dent!ty/ ersus/role confus!on sta"e occurs between a"es 13 and 34#

Tolerance !s the need for !ncreas!n" a)ounts of a substance to ach!e e an effect that for)erly was ach!e ed w!th lesser a)ounts# Su!c!de !s the th!rd lead!n" cause of death a)on" wh!te teena"ers# -ost teena"ers who &!ll the)sel es )ade a pre !ous su!c!de atte)pt and left telltale s!"ns of the!r plans#

In Er!&sons sta"e of "enerat! !ty ersus despa!r( "enerat! !ty +!n est)ent of the self !n the !nterest of the lar"er co))un!ty, !s e*pressed throu"h procreat!on( wor&( co))un!ty ser !ce( and creat! e endea ors# Alcohol!cs Anony)ous reco))ends a 13/step pro"ra) to ach!e e sobr!ety#

S!"ns and sy)pto)s of anore*!a ner osa !nclude a)enorrhea( e*cess! e we!"ht loss( lanu"o +f!ne body ha!r,( abdo)!nal d!stent!on( and electrolyte d!sturbances# A seru) l!th!u) le el that e*ceeds 3#4 )E6<L !s cons!dered to*!c#

>ubl!c Law OE/3ED +;h!ld Abuse and Ne"lect Act of 1ODF, re6u!res report!n" of suspected cases of ch!ld abuse to ch!ld protect!on ser !ces# The nurse should suspect se*ual abuse !n a youn" ch!ld who has blood !n the feces or ur!ne( pen!le or a"!nal d!schar"e( "en!tal trau)a that !snt read!ly e*pla!ned( or a se*ually trans)!tted d!sease# An alcohol!c uses alcohol to cope w!th the stresses of l!fe# The hu)an personal!ty operates on three le elsI consc!ous( preconsc!ous( and unconsc!ous# As&!n" a pat!ent an open/ended 6uest!on !s one of the best ways to el!c!t or clar!fy !nfor)at!on# The d!a"nos!s of aut!s) !s often )ade when a ch!ld !s between a"es 3 and F# 5efense )echan!s)s protect the personal!ty by reduc!n" stress and an*!ety#

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Suppress!on !s oluntary e*clus!on of stress/produc!n" thou"hts fro) the consc!ousness#

In psychodra)a( l!fe s!tuat!ons are appro*!)ated !n a structured en !ron)ent( allow!n" the part!c!pant to recreate and enact scenes to "a!n !ns!"ht and to pract!ce new s&!lls# >sychodra)a !s a therapeut!c techn!6ue thats used w!th "roups to help part!c!pants "a!n new percept!on and self/ awareness by act!n" out the!r own or ass!"ned proble)s# A pat!ent who !s ta&!n" d!sulf!ra) +Antabuse, )ust a o!d !n"est!n" products that conta!n alcohol( such as cou"h syrup( fru!tca&e( and sauces and soups )ade w!th coo&!n" w!ne# A pat!ent who !s ad)!tted to a psych!atr!c hosp!tal !n oluntar!ly loses the r!"ht to s!"n out a"a!nst )ed!cal ad !ce#

?>eople who l! e !n "lass houses shouldnt throw stones@ and ?A roll!n" stone "athers no )oss@ are e*a)ples of pro erbs used dur!n" a psych!atr!c !nter !ew to deter)!ne a pat!ents ab!l!ty to th!n& abstractly# +Sch!0ophren!c pat!ents th!n& !n concrete ter)s and )!"ht !nterpret the "lass house pro erb as ?If you throw a stone !n a "lass house( the house w!ll brea&#@, S!"ns of l!th!u) to*!c!ty !nclude d!arrhea( tre)ors( nausea( )uscle wea&ness( ata*!a( and confus!on# A lab!le affect !s character!0ed by rap!d sh!fts of e)ot!ons and )ood# A)nes!a !s loss of )e)ory fro) an or"an!c or !nor"an!c cause#

A person who has borderl!ne personal!ty d!sorder !s de)and!n" and %ud")ental !n !nterpersonal relat!onsh!ps and w!ll atte)pt to spl!t staff by po!nt!n" to d!screpanc!es !n the treat)ent plan# 5!sulf!ra) +Antabuse, shouldnt be ta&en concurrently w!th )etron!da0ole +.la"yl, because they )ay !nteract and cause a psychot!c react!on# In rare cases( electrocon uls! e therapy causes arrhyth)!as and death#

A pat!ent who !s scheduled for electrocon uls! e therapy should rece! e noth!n" by )outh after )!dn!"ht to pre ent asp!rat!on wh!le under anesthes!a# Electrocon uls! e therapy !s nor)ally used for pat!ents who ha e se ere depress!on that doesnt respond to dru" therapy# .or electrocon uls! e therapy to be effect! e( the pat!ent usually rece! es 2 to 13 treat)ents at a rate of 3 to F per wee&# 5ur!n" the )an!c phase of b!polar affect! e d!sorder( nurs!n" care !s d!rected at slow!n" the pat!ent down because the pat!ent )ay d!e as a result of self/!nduced e*haust!on or !n%ury# .or a pat!ent w!th Al0he!)ers d!sease( the nurs!n" care plan should focus on safety )easures# After se*ual assault( the pat!ents needs are the pr!)ary concern( followed by )ed!cole"al cons!derat!ons#

>at!ents who are !n a )a!ntenance pro"ra) for narcot!c abst!nence syndro)e rece! e 14 to E4 )" of )ethadone +5oloph!ne, !n a s!n"le da!ly dose and are )on!tored to ensure that the dru" !s !n"ested# Stress )ana"e)ent !s a short/ran"e "oal of psychotherapy#

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The )ood )ost often e*per!enced by a pat!ent w!th or"an!c bra!n syndro)e !s !rr!tab!l!ty# ;reat! e !ntu!t!on !s controlled by the r!"ht s!de of the bra!n#

-ethohe*!tal +Bre !tal, !s the "eneral anesthet!c thats ad)!n!stered to pat!ents who are scheduled for electrocon uls! e therapy# The dec!s!on to use restra!nts should be based on the pat!ents safety needs# 5!phenhydra)!ne +Benadryl, rel!e es the e*trapyra)!dal ad erse effects of psychotrop!c dru"s#

In a pat!ent who !s stab!l!0ed on l!th!u) +Es&al!th, therapy( blood l!th!u) le els should be chec&ed = to 13 hours after the f!rst dose( then two or three t!)es wee&ly dur!n" the f!rst )onth# Le els should be chec&ed wee&ly to )onthly dur!n" )a!ntenance therapy# The pr!)ary purpose of psychotrop!c dru"s !s to decrease the pat!ents sy)pto)s( wh!ch !)pro es funct!on and !ncreases co)pl!ance w!th therapy# -an!pulat!on !s a )aladapt! e )ethod of )eet!n" ones needs because !t d!sre"ards the needs and feel!n"s of others# If a pat!ent has sy)pto)s of l!th!u) to*!c!ty( the nurse should w!thhold one dose and call the phys!c!an#

A pat!ent who !s ta&!n" l!th!u) +Es&al!th, for b!polar affect! e d!sorder )ust )a!nta!n a balanced d!et w!th ade6uate salt !nta&e# A pat!ent who constantly see&s appro al or ass!stance fro) staff )e)bers and other pat!ents !s de)onstrat!n" dependent beha !or# Alcohol!cs Anony)ous ad ocates total abst!nence fro) alcohol# -ethylphen!date +R!tal!n, !s the dru" of cho!ce for treat!n" attent!on def!c!t hyperact! !ty d!sorder !n ch!ldren# Sett!n" l!)!ts !s the )ost effect! e way to control )an!pulat! e beha !or# J!olent outbursts are co))on !n a pat!ent who has borderl!ne personal!ty d!sorder# $hen wor&!n" w!th a depressed pat!ent( the nurse should e*plore )ean!n"ful losses# An !llus!on !s a )!s!nterpretat!on of an actual en !ron)ental st!)ulus# An*!ety !s nonspec!f!cN fear !s spec!f!c# E*trapyra)!dal ad erse effects are co))on !n pat!ents who ta&e ant!psychot!c dru"s#

The nurse should encoura"e an an"ry pat!ent to follow a phys!cal e*erc!se pro"ra) as one of the ways to ent!late feel!n"s# 5epress!on !s cl!n!cally s!"n!f!cant !f !ts character!0ed by e*a""erated feel!n"s of sadness( )elancholy( de%ect!on( worthlessness( and hopelessness that are !nappropr!ate or out of proport!on to real!ty# .ree/float!n" an*!ety !s an*!ousness w!th "eneral!0ed apprehens!on and pess!)!s) for un&nown reasons# In a pat!ent who !s e*per!enc!n" !ntense an*!ety( the f!"ht/or/fl!"ht react!on +alar) refle*, )ay ta&e o er# ;onfabulat!on !s the use of !)a"!nary e*per!ences or )ade/up !nfor)at!on to f!ll )!ss!n" "aps of )e)ory#

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$hen start!n" a therapeut!c relat!onsh!p w!th a pat!ent( the nurse should e*pla!n that the purpose of the therapy !s to produce a pos!t! e chan"e# A bas!c assu)pt!on of psychoanalyt!c theory !s that all beha !or has )ean!n"# ;athars!s !s the e*press!on of deep feel!n"s and e)ot!ons#

Accord!n" to the pleasure pr!nc!ple( the psyche see&s pleasure and a o!ds unpleasant e*per!ences( re"ardless of the conse6uences# A pat!ent who has a con ers!on d!sorder resol es a psycholo"!cal confl!ct throu"h the loss of a spec!f!c phys!cal funct!on +for e*a)ple( paralys!s( bl!ndness( or !nab!l!ty to swallow,# Th!s loss of funct!on !s !n oluntary( but d!a"nost!c tests show no or"an!c cause# ;hlord!a0epo*!de +L!br!u), !s the dru" of cho!ce for treat!n" alcohol w!thdrawal sy)pto)s#

.or a pat!ent who !s at r!s& for alcohol w!thdrawal( the nurse should assess the pulse rate and blood pressure e ery 3 hours for the f!rst 13 hours( e ery E hours for the ne*t 3E hours( and e ery 2 hours thereafter +unless the pat!ents cond!t!on beco)es unstable,# Alcohol deto*!f!cat!on !s )ost successful when carr!ed out !n a structured en !ron)ent by a support! e( non%ud")ental staff# The nurse should follow these "u!del!nes when car!n" for a pat!ent who !s e*per!enc!n" alcohol w!thdrawalI -a!nta!n a cal) en !ron)ent( &eep !ntrus!ons to a )!n!)u)( spea& slowly and cal)ly( ad%ust l!"ht!n" to pre ent shadows and "lare( call the pat!ent by na)e( and ha e a fr!end or fa)!ly )e)ber stay w!th the pat!ent( !f poss!ble# The therapeut!c re"!)en for an alcohol!c pat!ent !ncludes fol!c ac!d( th!a)!ne( and )ult! !ta)!n supple)ents as well as ade6uate food and flu!ds# A pat!ent who !s add!cted to op!ates +dru"s der! ed fro) poppy seeds( such as hero!n and )orph!ne, typ!cally e*per!ences w!thdrawal sy)pto)s w!th!n 13 hours after the last dose# The )ost se ere sy)pto)s occur w!th!n E= hours and decrease o er the ne*t 3 wee&s# React! e depress!on !s a response to a spec!f!c l!fe e ent# >ro%ect!on !s the unconsc!ous ass!"n!n" of a thou"ht( feel!n"( or act!on to so)eone or so)eth!n" else# Subl!)at!on !s the channel!n" of unacceptable !)pulses !nto soc!ally acceptable beha !or#

Repress!on !s an unconsc!ous defense )echan!s) whereby unacceptable or pa!nful thou"hts( !)pulses( )e)or!es( or feel!n"s are pushed fro) the consc!ousness or for"otten# 'ypochondr!as!s !s )orb!d an*!ety about ones health assoc!ated w!th ar!ous sy)pto)s that arent caused by or"an!c d!sease# 5en!al !s a refusal to ac&nowled"e feel!n"s( thou"hts( des!res( !)pulses( or e*ternal facts that are consc!ously !ntolerable# React!on for)at!on !s the a o!dance of an*!ety throu"h beha !or and att!tudes that are the oppos!te of repressed !)pulses and dr! es# 5!splace)ent !s the transfer of unacceptable feel!n"s to a )ore acceptable ob%ect# Re"ress!on !s a retreat to an earl!er de elop)ental sta"e#

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Accord!n" to Er!&son( an older adult +a"e 2: or older, !s !n the de elop)ental sta"e of !nte"r!ty ersus despa!r#

.a)!ly therapy focuses on the fa)!ly as a whole rather than the !nd! !dual# Its )a%or ob%ect! e !s to reestabl!sh rat!onal co))un!cat!on between fa)!ly )e)bers# $hen car!n" for a pat!ent who !s host!le or an"ry( the nurse should atte)pt to re)a!n cal)( l!sten !)part!ally( use short sentences( and spea& !n a f!r)( 6u!et o!ce# R!tual!s) and ne"at! !s) are typ!cal toddler beha !ors# They occur dur!n" the de elop)ental sta"e !dent!f!ed by Er!&son as autono)y ersus sha)e and doubt# ;!rcu)stant!al!ty !s a d!sturbance !n assoc!ated thou"ht and speech patterns !n wh!ch a pat!ent "! es unnecessary( )!nute deta!ls and d!"resses !nto !nappropr!ate thou"hts that delay co))un!cat!on of central !deas and "oal ach!e e)ent# Idea of reference !s an !ncorrect bel!ef that the state)ents or act!ons of others are related to oneself#

Group therapy pro !des an opportun!ty for each "roup )e)ber to e*a)!ne !nteract!ons( learn and pract!ce successful !nterpersonal co))un!cat!on s&!lls( and e*plore e)ot!onal confl!cts# Lorsa&offs syndro)e !s bel!e ed to be a chron!c for) of $ern!c&es encephalopathy# Its )ar&ed by halluc!nat!ons( confabulat!on( a)nes!a( and d!sturbances of or!entat!on# A pat!ent w!th ant!soc!al personal!ty d!sorder often en"a"es !n confrontat!ons w!th author!ty f!"ures( such as pol!ce( parents( and school off!c!als# A pat!ent w!th parano!d personal!ty d!sorder e*h!b!ts susp!c!on( hyper !"!lance( and host!l!ty toward others# 5epress!on !s the )ost co))on psych!atr!c d!sorder#

Ad erse react!ons to tr!cycl!c ant!depressant dru"s !nclude tachycard!a( orthostat!c hypotens!on( hypo)an!a( lowered se!0ure threshold( tre)ors( we!"ht "a!n( proble)s w!th erect!ons or or"as)s( and an*!ety# The -!nnesota -ult!phas!c >ersonal!ty In entory cons!sts of ::4 state)ents for the sub%ect to !nterpret# It assesses personal!ty and detects d!sorders( such as depress!on and sch!0ophren!a( !n adolescents and adults# Hr"an!c bra!n syndro)e !s the )ost co))on for) of )ental !llness !n elderly pat!ents# A person who has an IP of less than 34 !s profoundly retarded and !s cons!dered a total/care pat!ent# Refra)!n" !s a therapeut!c techn!6ue thats used to help depressed pat!ents to !ew a s!tuat!on !n alternat! e ways#

.luo*et!ne +>ro0ac,( sertral!ne +8oloft,( and paro*et!ne +>a*!l, are seroton!n reupta&e !nh!b!tors used to treat depress!on# The early sta"e of Al0he!)ers d!sease lasts 3 to E years# >at!ents ha e !nappropr!ate affect( trans!ent parano!a( d!sor!entat!on to t!)e( )e)ory loss( careless dress!n"( and !)pa!red %ud")ent# The )!ddle sta"e of Al0he!)ers d!sease lasts E to D years and !s )ar&ed by profound personal!ty chan"es( loss of !ndependence( d!sor!entat!on( confus!on( !nab!l!ty to reco"n!0e fa)!ly )e)bers( and nocturnal restlessness# The last sta"e of Al0he!)ers d!sease occurs dur!n" the f!nal year of l!fe and !s character!0ed by a blan& fac!al e*press!on( se!0ures( loss of appet!te( e)ac!at!on( !rr!tab!l!ty( and total dependence# Threaten!n" a pat!ent w!th an !n%ect!on for fa!l!n" to ta&e an oral dru" !s an e*a)ple of assault# Ree*a)!nat!on of l!fe "oals !s a )a%or de elop)ental tas& dur!n" )!ddle adulthood#

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Acute alcohol w!thdrawal causes anore*!a( !nso)n!a( headache( and restlessness and escalates to a syndro)e thats character!0ed by a"!tat!on( d!sor!entat!on( ! !d halluc!nat!ons( and tre)ors of the hands( feet( le"s( and ton"ue# In a hosp!tal!0ed alcohol!c( alcohol w!thdrawal del!r!u) )ost co))only occurs F to E days after ad)!ss!on#

;onfrontat!on !s a co))un!cat!on techn!6ue !n wh!ch the nurse po!nts out d!screpanc!es between the pat!ents words and h!s non erbal beha !ors# .or a pat!ent w!th substance/!nduced del!r!u)( the t!)e of dru" !n"est!on can help to deter)!ne whether the dru" can be e acuated fro) the body# Treat)ent for alcohol w!thdrawal )ay !nclude ad)!n!strat!on of I#J# "lucose for hypo"lyce)!a( I#J# flu!d conta!n!n" th!a)!ne and other B !ta)!ns( and ant!an*!ety( ant!d!arrheal( ant!con ulsant( and ant!e)et!c dru"s# The alcohol!c pat!ent rece! es th!a)!ne to help pre ent per!pheral neuropathy and Lorsa&offs syndro)e# Alcohol w!thdrawal )ay prec!p!tate se!0ure act! !ty because alcohol lowers the se!0ure threshold !n so)e people# >araphras!n" !s an act! e l!sten!n" techn!6ue !n wh!ch the nurse restates what the pat!ent has %ust sa!d#

A pat!ent w!th Lorsa&offs syndro)e )ay use confabulat!on +)ade up !nfor)at!on, to co er )e)ory lapses or per!ods of a)nes!a# !t# >eople w!th obsess! e/co)puls! e d!sorder real!0e that the!r beha !or !s unreasonable( but are powerless to control

$hen w!tness!n" psych!atr!c pat!ents who are en"a"ed !n a threaten!n" confrontat!on( the nurse should f!rst separate the two !nd! !duals# >at!ents w!th anore*!a ner osa or bul!)!a )ust be obser ed dur!n" )eals and for so)e t!)e afterward to ensure that they dont pur"e what they ha e eaten# Transse*uals bel!e e that they were born the wron" "ender and )ay see& hor)onal or sur"!cal treat)ent to chan"e the!r "ender# .u"ue !s a d!ssoc!at! e state !n wh!ch a person lea es h!s fa)!l!ar surround!n"s( assu)es a new !dent!ty( and has a)nes!a about h!s pre !ous !dent!ty# +Its also descr!bed as ?fl!"ht fro) h!)self#@, In a psych!atr!c sett!n"( the pat!ent should be able to pred!ct the nurses beha !or and e*pect cons!stent pos!t! e att!tudes and approaches# $hen establ!sh!n" a schedule for a one/to/one !nteract!on w!th a pat!ent( the nurse should state how lon" the con ersat!on w!ll last and then adhere to the t!)e l!)!t# Thou"ht broadcast!n" !s a type of delus!on !n wh!ch the person bel!e es that h!s thou"hts are be!n" broadcast for the world to hear# L!th!u) should be ta&en w!th food# A pat!ent who !s ta&!n" l!th!u) shouldnt restr!ct h!s sod!u) !nta&e#

A pat!ent who !s ta&!n" l!th!u) should stop ta&!n" the dru" and call h!s phys!c!an !f he e*per!ences o)!t!n"( drows!ness( or )uscle wea&ness#

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The pat!ent who !s ta&!n" a )onoa)!ne o*!dase !nh!b!tor for depress!on can !nclude cotta"e cheese( crea) cheese( yo"urt( and sour crea) !n h!s d!et# Sensory o erload !s a state !n wh!ch sensory st!)ulat!on e*ceeds the !nd! !duals capac!ty to tolerate or process !t#

Sy)pto)s of sensory o erload !nclude a feel!n" of d!stress and hyperarousal w!th !)pa!red th!n&!n" and concentrat!on# In sensory depr! at!on( o erall sensory !nput !s decreased#

A s!"n of sensory depr! at!on !s a decrease !n st!)ulat!on fro) the en !ron)ent or fro) w!th!n oneself( such as daydrea)!n"( !nact! !ty( sleep!n" e*cess! ely( and re)!n!sc!n"# The three sta"es of "eneral adaptat!on syndro)e are alar)( res!stance( and e*haust!on# A )aladapt! e response to stress !s dr!n&!n" alcohol or s)o&!n" e*cess! ely# 'yperalertness and the startle refle* are character!st!cs of posttrau)at!c stress d!sorder# A treat)ent for a phob!a !s desens!t!0at!on( a process !n wh!ch the pat!ent !s slowly e*posed to the feared st!)ul!#

Sy)pto)s of )a%or depress! e d!sorder !nclude depressed )ood( !nab!l!ty to e*per!ence pleasure( sleep d!sturbance( appet!te chan"es( decreased l!b!do( and feel!n"s of worthlessness# ;l!n!cal s!"ns of l!th!u) to*!c!ty are nausea( o)!t!n"( and lethar"y#

As&!n" too )any ?why@ 6uest!ons y!elds scant !nfor)at!on and )ay o erwhel) a psych!atr!c pat!ent and lead to stress and w!thdrawal# Re)ote )e)ory )ay be !)pa!red !n the late sta"es of de)ent!a#

Accord!n" to the 5S-/IJ( b!polar II d!sorder !s character!0ed by at least one )an!c ep!sode thats acco)pan!ed by hypo)an!a# The nurse can use s!lence and act! e l!sten!n" to pro)ote !nteract!ons w!th a depressed pat!ent# A psych!atr!c pat!ent w!th a substance abuse proble) and a )a%or psych!atr!c d!sorder has a dual d!a"nos!s# $hen a pat!ent !s read)!tted to a )ental health un!t( the nurse should assess co)pl!ance w!th )ed!cat!on orders# Alcohol potent!ates the effects of tr!cycl!c ant!depressants# .l!"ht of !deas !s )o e)ent fro) one top!c to another w!thout any d!scern!ble connect!on# ;onduct d!sorder !s )an!fested by e*tre)e beha !or( such as hurt!n" people and an!)als# 5ur!n" the ?tens!on/bu!ld!n"@ phase of an abus! e relat!onsh!p( the abused !nd! !dual feels helpless#

In the e)er"ency treat)ent of an alcohol/!nto*!cated pat!ent( deter)!n!n" the blood/alcohol le el !s para)ount !n deter)!n!n" the a)ount of )ed!cat!on that the pat!ent needs# S!de effects of the ant!depressant fluo*et!ne +>ro0ac, !nclude d!arrhea( decreased l!b!do( we!"ht loss( and dry )outh#

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Before electrocon uls! e therapy( the pat!ent !s "! en the s&eletal )uscle rela*ant succ!nylchol!ne +Anect!ne, by I#J# ad)!n!strat!on# $hen a psychot!c pat!ent !s ad)!tted to an !npat!ent fac!l!ty( the pr!)ary concern !s safety( followed by the establ!sh)ent of trust# An effect! e way to decrease the r!s& of su!c!de !s to )a&e a su!c!de contract w!th the pat!ent for a spec!f!ed per!od of t!)e# A depressed pat!ent should be "! en suff!c!ent port!ons of h!s fa or!te foods( but shouldnt be o erwhel)ed w!th too )uch food# The nurse should assess the depressed pat!ent for su!c!dal !deat!on# 5elus!onal thou"ht patterns co))only occur dur!n" the )an!c phase of b!polar d!sorder# Apathy !s typ!cally obser ed !n pat!ents who ha e sch!0ophren!a# -an!pulat! e beha !or !s character!st!c of a pat!ent who has pass! eV a""ress! e personal!ty d!sorder#

$hen a pat!ent who has sch!0ophren!a be"!ns to halluc!nate( the nurse should red!rect the pat!ent to act! !t!es that are focused on the here and now# $hen a pat!ent who !s rece! !n" an ant!psychot!c dru" e*h!b!ts )uscle r!"!d!ty and tre)ors( the nurse should ad)!n!ster an ant!par&!nson!an dru" +for e*a)ple( ;o"ent!n or Artane, as ordered# A pat!ent who !s rece! !n" l!th!u) +Es&al!th, therapy should report d!arrhea( o)!t!n"( drows!ness( )uscular wea&ness( or lac& of coord!nat!on to the phys!c!an !))ed!ately# The therapeut!c seru) le el of l!th!u) +Es&al!th, for )a!ntenance !s 4#2 to 1#3 )E6<L# Hbsess! e/co)puls! e d!sorder !s an an*!ety/related d!sorder# Al/Anon !s a self/help "roup for fa)!l!es of alcohol!cs# 5esens!t!0at!on !s a treat)ent for phob!a( or !rrat!onal fear# After electrocon uls! e therapy( the pat!ent !s placed !n the lateral pos!t!on( w!th the head turned to one s!de# A delus!on !s a f!*ed false bel!ef#

G! !n" away personal possess!ons !s a s!"n of su!c!dal !deat!on# Hther s!"ns !nclude wr!t!n" a su!c!de note or tal&!n" about su!c!de# A"oraphob!a !s fear of open spaces# A person who has parano!d personal!ty d!sorder pro%ects host!l!t!es onto others#

To assess a pat!ents %ud")ent( the nurse should as& the pat!ent what he would do !f he found a sta)ped( addressed en elope# An appropr!ate response !s that he would )a!l the en elope# After electrocon uls! e therapy( the pat!ent should be )on!tored for post/shoc& a)nes!a#

A )other who cont!nues to perfor) card!opul)onary resusc!tat!on after a phys!c!an pronounces a ch!ld dead !s show!n" den!al#

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Trans est!s) !s a des!re to wear clothes usually worn by )e)bers of the oppos!te se*#

Tard! e dys&!nes!a causes e*cess! e bl!n&!n" and unusual )o e)ent of the ton"ue( and !n oluntary suc&!n" and chew!n"# Tr!he*yphen!dyl +Artane, and ben0trop!ne +;o"ent!n, are ad)!n!stered to counteract e*trapyra)!dal ad erse effects#

To pre ent hypertens! e cr!s!s( a pat!ent who !s ta&!n" a )onoa)!ne o*!dase !nh!b!tor should a o!d consu)!n" a"ed cheese( caffe!ne( beer( yeast( chocolate( l! er( processed foods( and )onosod!u) "luta)ate# E*trapyra)!dal sy)pto)s !nclude par&!nson!s)( dyston!a( a&ath!s!a +?ants !n the pants@,( and tard! e dys&!nes!a#

Hne theory that supports the use of electrocon uls! e therapy su""ests that !t ?resets@ the bra!n c!rcu!ts to allow nor)al funct!on# A pat!ent who has obsess! e/co)puls! e d!sorder usually reco"n!0es the senselessness of h!s beha !or but !s powerless to stop !t +e"o/dyston!a,# In help!n" a pat!ent who has been abused( phys!cal safety !s the nurses f!rst pr!or!ty# >e)ol!ne +;ylert, !s used to treat attent!on def!c!t hyperact! !ty d!sorder +A5'5,#

;lo0ap!ne +;lo0ar!l, !s contra!nd!cated !n pre"nant wo)en and !n pat!ents who ha e se ere "ranulocytopen!a or se ere central ner ous syste) depress!on# Repress!on( an unconsc!ous process( !s the !nab!l!ty to recall pa!nful or unpleasant thou"hts or feel!n"s# >ro%ect!on !s sh!ft!n" of unwanted character!st!cs or shortco)!n"s to others +scape"oat,# 'ypnos!s !s used to treat psycho"en!c a)nes!a# 5!sulf!ra) +Antabuse, !s ad)!n!stered orally as an a ers!on therapy to treat alcohol!s)#

In"est!on of alcohol by a pat!ent who !s ta&!n" d!sulf!ra) +Antabuse, can cause se ere react!ons( !nclud!n" nausea and o)!t!n"( and )ay endan"er the pat!ents l!fe# I)pro ed concentrat!on !s a s!"n that l!th!u) !s ta&!n" effect#

Beha !or )od!f!cat!on( !nclud!n" t!)e/outs( to&en econo)y( or a reward syste)( !s a treat)ent for attent!on def!c!t hyperact! !ty d!sorder# .or a pat!ent who has anore*!a ner osa( the nurse should pro !de support at )ealt!)e and record the a)ount the pat!ent eats# A s!"n!f!cant to*!c r!s& assoc!ated w!th clo0ap!ne +;lo0ar!l, ad)!n!strat!on !s blood dyscras!a#

Ad erse effects of haloper!dol +'aldol, ad)!n!strat!on !nclude drows!nessN !nso)n!aN wea&nessN headacheN and e*trapyra)!dal sy)pto)s( such as a&ath!s!a( tard! e dys&!nes!a( and dyston!a# 'yper !"!lance and dZ%c u are s!"ns of posttrau)at!c stress d!sorder +>TS5,# A ch!ld who shows d!ssoc!at!on has probably been abused# ;onfabulat!on !s the use of fantasy to f!ll !n "aps of )e)ory#

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