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Albumin protein that causes blood to stay inside the vessel. (Osmotic Pressure)
1. Isotonic
a. zero pressure solution
b. or dehydrated patients
c. !"amples:
Plain #SS $ .% #SS
Plain &'
Plain I()
Plain solution
*. +ypertonic
a. increased pressured (shrin,$crenation)
b. increased solute- decreased solvent
c. !"amples:
1. +ypotonic
a. .ecreased pressured (s2ellin3)
b. .ecreased solute- increased solvent
c. !"amples:
!dema 6ormation hypertonic
+ypertonic and diuretic 3o hand in hand7
- sodium attracts 2ater
- 2ater retention
- Outside
- #ormal 9alue: 11/:14/ mmol$& or me;$&
- Inside
- Important or contraction
- #ormal 9alue: 1./:/.0 me;$&
- sodium secretion
- !"ample: aldosterone
- 3lucose
- !"ample: cortisol
6luid .isturbances:
1. 6luid 9olume
a. .e=cit .ecreased !>6
i. >auses:
1. Inade;uate inta,e$absorption o 2ater
*. Increased renal losses (diurectic- .iabetes)
1. Increased s,ins losses
4. Increased 3astrointestinal losses (vomitin3- diarrhea)
/. ?hird:spacin3 movement o @uid in the body 2here
normally no @uid accumulates (ascitis)
ii. Si3ns and Symptoms:
1. ?hirst early maniestation
*. Aei3ht loss acuteB *.* lbs$day
1. 'ou3h- dry ton3ue and it 2ill shrin,
4. Poor s,in tur3or ability o the s,in to return to its normal
appearance (abdominal area best site)
/. Oli3uria urine output o C400 ml$*4h
D. +emoconcentration ?est: Increased hematocrit
E. 6ever (late maniestation)
5. 'estlessness
%. Aea,ness
10. .ecreased &evel o >onsciousness &ethar3y: early
maniestation in decreased &O>
11. .ecreased >9P #ormal: 4:D mm+3 (>9P is the pressure
that monitors the 'i3ht Atrium)
1*. Increased )F# due to hemoconcentration
iii. (ana3ement:
1. 6luid replacement
*. !stablish a patent line and start 2ith isotonic solution
1. ?reat the underlyin3 cause
b. !"cess increased !>6
i. Si3ns and Symptoms:
ii. Si3ns and Symptoms: (Systemic)
1. Acute 2ei3ht 3ain
*. +ypertension (due to @uid overload)
1. +epatosplenome3aly
4. !n3or3e ton3ue
/. .ecreased hematocrit
D. Increased >9P (hypervolemia)
E. .istended nec, vein$ nec, vein en3or3ement elevate head
o bed at *0 de3rees an3leB G 4cm distended nec, vein
@uid volume e"cess
iii. Si3ns and Symptoms (Pulmonary)
1. >ou3h (cardinal si3n o 'espiratory Problem)
*. .yspnea
a. !"ertional .yspnea
b. Orthopnea dyspnea
c. Paro"ysmal nocturnal dyspnea
1. 'ales or crac,les
iv. (ana3ement:
6luid mi3rates to
pulmonary area
1. .ietary modi=cation (lo2 sodium diet)
*. 6luid restrictions (1000 to 1100 ml$day)
1. .iuretic ?herapy (most eHective)
v. #ursin3 Alerts
1. .iuretics
a. <iven in the mornin3
b. >losely monitor or I and #a
c. #ot allo2ed to ta,e ood or bevera3es that increase
*. 6luid 9olume Imbalances
a. .aily 2ei3hin3 best 2ay to assess @uid volume
*. Sodium Alterations
a. +yponatremia
i. .ecrease inta,e absorption o #a
ii. Increase inta,e (@uid volume e"cess)
iii. Si3ns and Symptoms
1. #ausea and vomitin3
*. +eadache
1. (uscle cramps
4. 'estlessness
/. Aea,ness
D. Irritable
E. .ecrease &O>
iv. (ana3ement
1. Increase #a diet
*. &imit 2ater inta,e
v. .ru3s
1. P#SS replace sodium
*. 6or severe .iuretic$+ypertonic
b. +ypernatremia
i. &ie threatenin3 condition cause intracranial bleedin3
ii. Si3ns and Symptoms
1. ?hirst
*. .ry- stic,y mucus membrance
1. 'ou3h- dry ton3ue
4. 6ever
/. Aea,ness
D. >ramps
E. .ecrease &O> due to intracranial bleedin3
5. Aater retention
iii. (ana3ement
1. .iet: .ecrease #a
*. 6luid replacement
1. Potassium Alterations
a. Potassium and +ydro3en are bestriends
b. Increase Potassium J Increase +ydro3en retention (decrease p+ acidosis)
c. .ecrease Potassium J +ydro3en elimination (Increase p+ al,alosis)
d. +ypo,alemia and +yper,alemia 2ill 3ive 2ea,ness
e. +ypo,alemia potentiates the eHect o di3o"in
i. A decrease in Potassium J Increase the eHect o di3o"in (leadin3 to
di3italis to"icity)
. +yper,alemia increases the ris, or cardiac arrest
3. Potassium chloride must not be 3iven in bolus or in hi3h concentration. I>l
2ill be incorporated 2ith P#SS. I>l J *0 m3$d& (ma"imum that you can
h. Increase Potassium$hyper,alemia 2ill increase sensitivity o insulin and
i. +KPOIA&!(IA
i. .ecrease potassium level
ii. >auses:
1. .ecrease inta,e$inade;uate absorption o I
*. Increase renal losses
1. Increase 3astrointestinal losses
4. 6re;uent 3astric suctionin3
/. .isorders (>ushin3Ls Syndrome)
iii. Si3ns and Symptoms
1. <eneralized 2ea,ness
*. >onstipation
1. Paralytic Ileus
4. 6ecal Impaction passin3 o a li;uid stool
/. .ysrrhythmia$arrhythmia dru3: &idocaine- "ylocaine
D. !>< chan3es prominent F 2ave
E. (uscle >ramps
iv. .iet
1. )anana- dried ood- meat- raisins- ruit Muice (oran3e Muice)-
3reen leay ve3etables (malun33ay iron- 9itamin >-
*. 1 banana J 100 m3
1. Potassium supplement oral or parenteral
M. +KP!'IA&!(IA
i. >auses:
1. Increase inta,e$absorption o potassium
*. 'enal ailure .ecrease potassium elimination Potassium
retention +yper,alemia
1. 'elease rom intracellular to e"tracellular (e.3. burns-
6re;uent )?)
ii. Si3ns and Symptoms
1. Aea,ness
*. .iarrhea
1. Irritability
4. Increased ris, or cardiac arrest
/. (uscle cramps
D. .ysrrhythmia$arrhythmia
E. !>< chan3es Pea,ed ? 2ave
iii. (ana3ement:
1. .iet: &o2 potassium diet
*. .ru3s: .iuretics$ O6I
1. Insulin and ./0 2ater
4. Sodium polystyrene Sulonate (,aye"alate) PO or enema
iv. Alert: Aatch or hypernatremia
4. >alcium Alterations
a. >alcium: #ormal J 5./ to 10./ m3$d&
i. )one ormation
ii. Stren3then bone
iii. >ontraction
iv. >lot ormation
b. +KPO>A&>!(IA
i. .ecrease in calcium level
ii. >auses:
1. .ecrease inta,e$absorption o calcium
*. Increase renal losses
1. .ecrease bone resorption
iii. Si3ns and Symptoms
1. #euromuscular Irritability
a. >hvoste,Ls Si3n
i. ?ap * to 1 cm anterior to the ear lobe- patient
develops muscle t2itchin3
b. ?rousseau si3n$>arpapedal Spasm
i. <et a )P cuH- in@ate at the arms o the patient
N 100 mm+3. Ater 10 minutes- the patient
=n3ers have spasms.
c. +yperre@e"ia
i. +yperactive re@e"es
*. Aea,ness
1. >ramps
4. .ysrrhythmia$arrhythmia
/. +ypertension
D. Irritability
iv. (ana3ement:
1. .iet: +i3h calcium
a. .iary products mil, (1 3lass o mil, J 100 m3 o
b. <reen leay ve3etables
c. 9itamin . (>alcieron) enhances calcium
d. >alcium:containin3 solutions
i. >alcium 3luconate
ii. >alcium chloride
iii. >alcium 3luceptate
c. +KP!'>A&>!(IA
i. ?oo much calcium
ii. >auses:
1. Increase inta,e$absorption o calcium
*. Increase bone resorption
1. .ecrease renal losses
iii. Si3ns and Symptoms
1. +ypore@e"ia
*. +ypoactive bo2el sound
1. +ypotension
4. Increase bone pain due to bone resorption
/. 6lan, pain due to ,idney stone ormation
a. (ost common orm o ,idney stone: >alcium Stones
iv. (ana3ement:
1. .iet: &o2 calcium
*. .ru3s: .iuretics- O6I- >alcitonin
Parathyroid 3land is
>a absorption
Promotes osteoclast activity (bone
1. Other .ru3s: )iphosphonate- Plicamycin- <allium #itrate
/. Phosphate and (a3nesium Alterations
a. Phosphate 6or:
b. (a3nesium !lectrical ?ransmission$#euronal ?ransmission
c. #ormal Phosphate J 1./ to 4./ m3$d&
d. #ormal (a3nesium J *.E m3$d&
e. +KPOP+OP+A?!(IA
i. >auses:
1. Impaired renal unction most common
*. Alcoholism : malnutrition
ii. Si3ns and Symptoms
1. Seizures$convulsions
*. .isorientation
1. Aea,ness
4. &ethar3y
/. Impaired A)> unction
D. Platelet dysunction
E. Anemia <DP. de=ciencies (hemolytic anemia) <lucose:D
Phosphate .ehydro3enase .e=ciency anemia
iii. (ana3ement:
1. .iet:
a. +i3h phosphate diet
b. .rin, mil,
i. 1 3lass J */0 m3
c. 6ish head
d. Phosphate supplements: PO- Parenteral
e. Phosphate is contraindicated in:
i. 'enal ailure
ii. +ypocalcemia
. +KP!'P+OSP+A?!(IA
Thyroid gland stimulated
"ecrease Ca a#sorption
Calcium deposition
$enal %ailure &hosphate limination &hosphate retention
Ca a#sorption Hypocalcemia Hyperphosphatemia
i. Increase phosphate in the blood
ii. >auses:
1. Acute phosphate overload
*. 'enal ailure
1. 'elease rom intracellular to e"tracellular
iii. Si3ns and Symptoms:
1. +yperphosphatemia 2ill decrease >a absorption leadin3 to
*. Si3ns and symptoms o hyperphosphatemia J hypocalcemia
a. #euromuscular Irritability
i. >hvoste,Ls Si3n
1. ?ap * to 1 cm anterior to the ear lobe-
patient develops muscle t2itchin3
ii. ?rousseau si3n$>arpapedal Spasm
1. <et a )P cuH- in@ate at the arms o the
patient N 100 mm+3. Ater 10
minutes- the patient =n3ers have
iii. +yperre@e"ia
1. +yperactive re@e"es
b. Aea,ness
c. >ramps
d. .ysrrhythmia$arrhythmia
e. +ypertension
. Irritability
iv. (ana3ement:
1. .iet: &o2 phosphate diet- +i3h >a diet
*. .ru3s:
a. .iuretics$Increase O
b. >a supplements
1. Severe: .ialysis
3. +KPO(A<#!S!(IA
i. >auses
1. !limination o ma3nesium (e". .iarrhea)
*. .ecrease inta,e$absorption o ma3nesium
ii. Si3ns and Symptoms
1. +ypertension
*. Seizures
1. #euromuscular irritability
4. Aea,ness
/. >ramps$Paresthesia (numbness or tin3lin3 sensation)
iii. (ana3ement:
1. <ive (a3nesium Sulate
a. >hec, .?'
b. >hec, )P (a3nesium
c. >hec, '' ?o"icity
d. >hec, FO
e. (a3nesium sulate to"icity$+yperma3nesemia
h. +KP!'(A<#!S!(IA
i. >auses
1. .ecrease elimination
*. Acute ma3nesium overload
ii. Si3ns and Symptoms
1. .iminished or absent re@e"es (earliest maniestation)
*. +ypotension
1. 'espiratory .epression
4. Oli3uria
/. Patient develops irritability
D. 6acial @ushin3
E. 'is, or cardiac arrest
iii. (ana3ement
1. Stop 3ivin3 ma3nesium
*. <ive calcium containin3 solution
1. Severe: .ialysis
Normal ABG Results
p+ E.1/ to E.4/
PO* 50 to 100 mm+3
P>O* 1/ to 4/ mm+3
+>O1 ** to *D m!;$&
88+>O1 neutralizes acidity
Interpretation of
pH Al,alosis
pH Acidosis
HC(3 Al,alosis
HC(3 Acidosis
&(2 +ypo"ia
(2 +ypo"ia
C(2 +ypercap
C(2 +ypocapn
#ursin3 Alerts
1. 'espiratory and urinary systems are systems that 2ill re3ulate acid:base.
*. 9asodilation is the common eHect o acidosis.
1. 9asoconstriction is the common eHect o al,alosis.
4. +yperventilation leads to respiratory al,alosis.
+yperventilation >O* loss +ypocapnia p+ (al,alosis) 'espiratory
/. +ypoventilation leads to respiratory acidosis
+opoventilation >O* loss +ypercapnia p+ (acidosis) 'espiratory
D. 9omitin3 and re;uent 3astric suctionin3 leads to metabolic al,alosis
9omitin3 and re;uent 3astric suctionin3 3astric acid loss p+ (al,alosis)
E. .iarrhea leads to metabolic acidosis
.iarrhea @uid loss +ydro3en concentration p+ (acidosis) (etabolic
5. Severe vomitin3 leads to metabolic acidosis
Severe vomitin3 proound 3astric acid loss Stimulates: Parietal cells to
produce more +>l acid (compensation) p+ (acidosis) (etabolic
p" aCO
Fncompensated #

1. +yperventilation
a. 6actors:
i. An"iety
ii. ?oo much lau3hin3
iii. 6ever
iv. >#S inections
v. In3estion o to"ic substances$a3ent (Al,aseltzer)
*. +ypo,alemia
1. (etabolic Acidosis
Si3ns and Symptoms
1. Seizures
*. .eep- rapid breathin3
1. +yperventilation
4. >onusion
/. +ypo,alemia
D. &i3ht headedness
E. ?in3lin3 o e"tremities
1. )reath in a cuphand or paper ba3 re3ardless o the color
*. .ru3s:
a. Sedative (to correct an"iety)
b. An"iolytic
c. #arcotics
d. Antipyretic
1. ?reat inections
p" aCO
Fncompensated #

1. +ypoventilation
a. 6actors:
.ama3e: (edulla Oblon3ata (>enter or 'espiratory- )P- +')
'espiratory .isorders
>hest trauma
#eurolo3ic problem (>9A- Seizures- Alzheimers)
#euromuscular problem ((S- (<)
*. +yper,alemia
1. SuHocation
4. (etablic Al,alosis
Si3ns and Symptoms
1. +ypoventilation
*. 'apid- shallo2 breathin3
1. Increase )P
4. .yspnea
/. +yper,alemia
D. .isor3anization
E. Increase cardiac output
5. (uscle 2ea,ness
%. +ypo"emia
1. Acute
a. I9 Sodium )arcarbonate (#a+>O1) less than E.1/ p+
b. >hec, or patent line because it can cause 1
de3ree chemical burn
*. >hronic
a. PO Sodium )icarbonate (#a+>O1)
1. +oo, patient to a mechanical ventilator to aide the patient to breath
1 Alarms in the mechanical ventilator:
a. +i3h Alarm obstruction Suction Auscultate i suctionin3 is eHective
b. &o2 Pressure Alarm lea,a3e$loose connections correct the tubin3
c. Apnea Alarm #obody is hoo,ed at the ventilator
d. I you cannot =3ure out 2hat cause the alarm- do ba33in3 manually. <ive
the patient o"y3en vial ba33in3 (Ambuba3)
p" aCO
Fncompensated +

1. .iarrhea
*. Severe vomitin3
1. 'enal 6ailure .ecrease hydro3en elimination (etabolic Acidosis
4. Increase at metabolism (.()
6ats 6atty Acids Kields ,enones .IA (orm o metabolic acidosis)
Penetrate blood brain barrier .iabetic >oma
/. +yper,alemia
D. 'espiratory Al,alosis
Si3ns and Symptoms
1. +eadache
*. .isorientation
1. +yper,alemia
4. (uscle t2itchin3
/. >han3es in &O>
D. Iussmaul 'espiration
1. Acute: I9 #a+>O1
*. Severe: PO #a+>O1
1. Same mana3ement 2ith 'espiratory Acidosis
p" aCO
Fncompensated +

1. 9omitin3
*. 6re;uent 3astric suctionin3
1. Acute +>O* overload
4. +ypo,alemia
/. 'espiratory Acidosis (.ecrease p+)
Si3ns and Symptoms
1. 'estlessness ollo2ed by lethar3y
*. .ysrrhythmia
1. >ompensatory hypoventilation
4. .iarrhea
/. >onusion (decrease &O>)
D. #ausea and vomitin3
1. (ild: #a treatment
*. 9omitin3
a. <ive antiemetic as ordered
b. <ive I>l P P#SS (to replace 3astric losses)
1. Severe: <ive I9 ammonium chloride
#ursin3 Alert
a. >ontraindicated to hepatic or renal disorders
b. (ust not be 3iven I liter in 4 hours
4. .ru3s: Acetazolamide (.iuretic) promote e"cretion$elimination o +>O1 and
- 'eers to cell death or tissue death due to an e"treme heat caused by chemical-
3eothermal- radiation- =re and electricity
1. 6irst .e3ree Partial thic,ness burn
*. Second .e3ree
1. ?hird .e3ree 6ull thic,ness burn
4. 6ourth .e3ree
6irst !pidermis 'edness$!rythma
Second !pidemis P .ermis )listers$most painul
?hird S,in P Subcutaenous >harcoal$!dema and
6ourth S,in P Subcutaneous P
(uscles P )ones
6irst 1 to E days
Second Avera3e *1 days
?hird S,in 3ratin3 1 types:
8Auto3rat sel
8Qeno3rat$+etero3rat animal
8Allo3rat cadaver
6ourth S,in 3ratin3 and amputation
!schar tou3h coa3ulum o necrotic tissue (R,u3an3S)
>ompartment Syndrome 1
de3ree burn
Si3ns and Symptoms o >ompartment Syndrome
1. Pain
*. Pallor
1. Paralysis
4. Pulselessness
/. Paresthesia (numbness and tin3lin3 sensation)
D. Poi,ilothermia (coolness o the s,in surace)
#ursin3 Action:
1. !levate e"tremity or venous return
*. 'eport to doctor
?)SA (?otal )ody Surace Area)
- area o inMury
- 'ule o #ines
o +ead (includes nec,) %T
o Anterior ?run, 15T
o Posterior ?run, 15T
o !ach arm %T
o !ach le3 15T
o Perineum 1T
- (aMor )urn: (ore than */T
o Systemic complications arise i the patient sustained maMor burns
o Systemic >omplications o )urns:
+emodynamic instability (starts immediately)
?al,s about blood
)e3ins almost immediately 2ith inMury to capillaries
Problem 2ith blood circulationB poor perusion (secondary to
@uid shitin3 secondary to increased permeability)
)ecause o the burn- there is increased permeability. &eadin3
to shitin3 o plasma to interstitial @uid.
'espiratory dysunction
>ommon cause o death (carbon mono"ide poisonin3)
>arbon mono"ide has 3reater aUnity to hemo3lobin
>arbo"y hemo3lobin hemo3lobin =lled 2ith carbonB
decreased o"y3en carryin3 ability hypo"emia hypo"ia
o +eme 2here o"y3en binds
o <lobin 2here carbon dio"ide binds
+ypermetabolic 'esponse
.ue to the inMury sustained by the patient
As a nurse- 2hat is the implication i patient has
hypermetabolic response:
o Increased metabolism 2ould lead to increased
metabolic acid production metabolic acidosis
o Increased calorie re;uirement D-000 to 5-000
cal$day (#ormal: 1*00 to *000 cal$day)- thereore
?P# is important. .iet o patient should be hi3h
calorie- hi3h protein- hi3h carbohydrates.
Or3an .ysunction
.ue to shoc,- hemodynamic instability
Sepsis and Immune dysunction
A small brea, in s,in 2ould lead to inection
Patient is immunocompromised thereore put the patient in
reverse isolation
.octors 2ould prescribe antibiotic common dru3 3iven:
#ot topical- I( but I9?? route
Pain 3ive anal3esic ((orphine Sulate * m3$hr until pain 3oes
(orphine narcotic anal3esicB can cause addiction. Aatch
or respiratory depression and dru3 addiction. Antidote:
#alo"one (#arcan)
!motional trauma intervention: therapeutic communication (let
the patient verbalize ear) .o not start the ;uestion 2ith 2hy
In <eneral- i patient 3ot )F'# ( more than */T )- it 2ould 3ive 4
maMor problem:
>ell lysis
o >an cause release o potassium rom intracellular to
e"tracellular can cause hyper,alemia Increased
heart rate decreased cardiac output decreased
tissue perusion or3an dysunctions
Possible inhalation inMury
o ould lead to >arbo"y hemo3lobin decreased
o"y3en carryin3 ability +ypo"emia decreased
tissue perusion
)rea, in the physical barrier
o &ead to Increased inection and altered
Increased permeability
o &ead to @uid shitin3 (!Hects)
+emoconcentration (increased in +ct)
o )urn Shoc, (An e"ample o hypovolemic shoc,)
o )urn shoc, re;uires massive stress response
o (S' stimulates adrenal 3land$ 'elease o
o Simulation o adrenal 3land 2ould lead to ollo2in3
Increased metabolism
Aould lead to metabolic acidosis
Aould increase calorie re;uirements
Increased hydrochloric acid >urlin3Ls Flcer
?issue InMury (due to catecholamines releasedB
inection also 2ould lead to tissue inMury)
Increased heart rate decreased cardiac
- Sta3es o )F'#S
o !mer3ent Phase
Occurs 2henO Actual e"posure to e"treme heat

o Shoc, Phase
Occurs on the =rst *4:45 hours post burn (movement o @uid is
rom plasma to interstitial)
o .iuresis $ 6luid 'emobilization Phase
Occurs * to / days post burn
.urin3 this phase- movement o @uid is interstitial to plasma (there
2ill be hemodilution)- thereore- c3e ihi (diuresis) to prevent
Priority: Prevention o con3estion
o 'ehabilitation Phase $ >onvalescent Phase $ 'ecovery Phase
Aill only start i diuresis is completed
o 'esuscitative Phase a combination o emer3ent and shoc, phase
- 6luid and !lectrolyte >han3es .urin3 )urns
o !mer3ent Phase$Shoc,$'esuscitative Phase
<eneralized dehydration (plasma to interstitial)
'eduction o blood volume
.ecreased urine output
+yper,alemia (due to cell lysis)
+yponatremia (due to @uid shitin3)
(etabolic acidosis
+emoconcentration (elevated +ct)
o .iuresis Phase
+emodilution (decreased +ct)
Increased urine output compensation (because o hemodilution)
+yponatremia (due to dilution)
+ypo,alemia (early sta3e: +yper,alemia- hyponatremia.. &ater on:
+ypo,alemia- hyponatremia)
(etabolic acidosis (due to the inMury sustained by the patient)
o 'ehabilitation Phase
#o more imbalances
- Phases o )urn >are Priorities
o !mer3ent$Shoc, Phase
6irst aid saetyB prevent added inMury
Rescue the patient$'emove the patient to a sae place
Activate the alarm
Con=ne or contain the =re +o2: close the door- lo2er the
curtain- close the 2indo2s
E"tin3uish the =re
o ull the saety pin
o Aim the nozzle
o S;ueeze
o Aho to evacuate =rstO Aell patient
Prevention o shoc,$respiratory distress
.etection and treatment o inMuries
Aound assessment and care evaluate the de3ree o dama3eB
reassess the patient rom time to time
o .iuretic Phase or 6luid 'emobilization Phase
Aound care and closure
Prevention and treatment o complications
#utritional Support
o 'ehabilitation Phase
Prevention o scars and contractures
+o2 to prevent scarsO
o &et patient 2ear anti:scar stoc,in3
)est time to 2ear: must be 2orn a 2ee, ater
healin3 has completed
6or ho2 lon3: 1D to 15 months- ma"imum o *
+o2 oten: 2ear *1 hours$day
+o2 to prevent contractures (happens because you ail to
position the patient properly)
o Position: Anatomical position (!"tremities e"tended-
di3its abducted)
Physical- occupational and vocational rehabilitation
Start rehab upon admission
Ahen do rehab phase be3in: 2hen diuresis is completed
6unctional and cosmetic reconstruction
Psychosocial counselin3
- ?reatment:
o Soa, burned area in cool 2ater not more than 10 minutes. I more than 10
minutes- it 2ould cause severe vasoconstriction and 2ould impede normal
@o2 o blood.
o Prevent causal a3ent rom producin3 urther tissue dama3e 6I'S?
o !mer3ency care includes:
Stabilization 2ith I9 2hile maintainin3 cardiac and respiratory
o +ospital settin3
6luid replacement
(aintenance o nutritional demands (?P#)
o Antibiotic ?herapy
o (aintenance o cardiac and respiratory unction
o Pain mana3ement
o !motional support
o Prevention o complications
o S,in 3ratin3
o 'ehabilitation
- >ommon >omplications
o 'espiratory .ysunction
o Inection
o 6luids and electrolyte imbalances
o Pain
o .)? (.eep 9ein ?hrombosis)
o .I> (.isseminated Intravascular >oa3ulation) or )lood coa3ulopathy
o )ody ima3e disturbance
o >ompartment syndrome
(!scharotomyB !scharectomy) can be perormed on bedside
2ithout anesthesia
6asciotomy O' under 3eneral anesthesia
- reers to perusion o 3ases
- not only o"y3en- but also involves carbon dio"ide
- 1 systems involved:
o 'espiratory
o +emotopoesis
o >ardiovascular
Sneeze re@e" that clears upper respiratory tract
9ibriscae hair o the noseB =lter the air comin3 in
!pi3lottis division o upper and lo2er respiratory system
>ou3h re@e" that clears lo2er respiratory tract
9ocal cords
- one inMury: hoarseness o voice
- both are inMured: loss o voice
- paralysis:
Air2ay obstruction noisy breathin3
>omplete air2ay obstruction loss o voice
<lobet cells produce mucus
>arina anatomical landmar, or the tip o endotracheal tube
+erin3:)reuer 'e@e" re@e" that 3overn in@ation or de@ation process o alveoli
Intrathoracic ne3ative pressure
#ursin3 .ia3nosis:
1. Altered tissue perusion
a. Fsed i there is circulatory obstruction
b. .ili p2ede sa respiratory problems
c. !"ample: (I- .9?- Pulmonary !mbolism- An3ina Pectoris
*. Impaired <as !"chan3e
a. Fsed i the patient is havin3 alveolar problem or lun3 problem
b. !"ample: Patient havin3 emphysema : there is loss o lun3 elasticityB
patient havin3 or too much mucus productionB
1. IneHective )reathin3 Pattern
a. Fsed i the patient has hypoventilation or hyperventilation
4. IneHective Air2ay >learance
a. Fsed i patient has air2ay obstruction
b. !"ample: )ronchitis- Asthma
1. 'estrictive &un3 .isease
a. Are any process that limits lun3 e"pansion
b. &imits movement o air into the lun3s
c. Inspiratory problem
d. !"ample: Atelectasis- Inections (P?)- Pneumonia)- >hest ?rauma
(+emothora"- ?ension Pneumothora"- Pneumothora")
*. >OP.$>A& (>hronic Air2ay &imitation)
a. Any process that limits movement o air out rom the lun3s
b. !"piratory problem
c. Saest o"y3en @o2 rate: 1 to * &$min O#&K
d. D &$min the more it causes dyspneaB I o"y3en increases- carbon dio"ide
decreases- so there is hypocapneaB ,un3 2alay carbon dio"ide- 2alay
stimulator- so it 2ould lead to respiratory depression
e. (ost appropriate o"y3en device: 9enturi (as, ()ecause venturi mas, is
the only device that 2ould 3ive you the accurate o"y3en concentration)
#e"t: #asal >annula
. >roup ?ent important nursin3 intervention: tuc, the sides
3. (ost common cardiovascular or >OP.: >ardiome3aly (ri3ht ventricular
hypertrophy or cor pulmonale)
h. !"ample: !mphysema- )ronchitis- )ronchiectasis- Asthma
1. Pulmonary 9ascular .isorder
a. Any problem aHectin3 the vascular compartment o the pulmonary area
b. !"ample: >or Pulmonale- Pulmonary !mbolism
'estrictive &un3 .isorders
1. Atelectasis
a. .e=nition: >ollapse o a previously in@ated lun3 tissue
b. * (aMor ?ypes:
i. Primary a type o atelectasis brou3ht about by suractant
1. common amon3 premature babies (SI.S$A'.S)
betamethasone promotes lun3 maturity
ii. Secondary brou3ht about by compression or obstruction
1. compression: hemothora" and pneumothora"
*. obstruction: aspiration
c. Si3ns and Symptoms
i. .yspnea
ii. >ou3h
iii. +ypo"ia
iv. >hest pain
v. Asymmetrical lun3 e"pansion
vi. .ecreased breath sound on the aHected lun3 =eld
vii. 'estlessness
viii. >old- clammy s,in
d. Appropriate #ursin3 .ia3nosis:
i. Impaired <as !"chan3e
e. .ia3nostic ?est
i. >hest Q:ray con=rms collapsed &un3
ii. A)<
1. decreased P+
*. increased P>O*
1. decreased PO*
4. 'eadin3: 'espiratory acidosis- hypo"ia
. (ana3ement
i. .ru3s:
1. )ronchodilator
a. 9entolin- Aminophyline (3iven parenteral)-
?heophylline (3iven PO)
*. Anticholiner3ic .ru3 decreases spasm- decreases mucus
1. Antibiotic
4. Anticholiner3ic
ii. Speci=c #ursin3 (ana3ement:
1. Position: +i3h 6o2lerLs Position to promote lun3 e"pansion
*. <ive o"y3en supplement to correct hypo"ia
1. +oo, the patient in respiratory support
4. ?reat the underlyin3 cause$problem
/. .ecrease environment and physical stimuli to decrease
o"y3en demandB limit visitors
*. >hest ?rauma
a. >ommon cause: accident
b. ?ypes:
i. )lunt$#on:Penetratin3 >hest ?rauma
1. >ommon problem is 6&AI& >+!S? arise rom three or more
ractured ribs adMacent to each other $ multiple rib racture.
?hese ractured ribs become loose ribs- piercin3 o2n lun3
tissue durin3 inspiration (Parado"ical 'espiration).
*. (ana3ement: +oo, the patient in mechanical ventilator- to
acilitate healin3 o the ractured rib.
ii. Penetratin3 >hest ?rauma
1. >ommon problems:
a. +emothora" reers to blood in pleural space
i. Accumulation o blood in the lo2er lobe
b. Pneumothora" air
i. Fpper lobe
c. +emoPneumothora"
i. 1 tube in the lo2er lobe
d. ?ension Pneumothora"
i. .urin3 inspiration- the hole opens allo2in3 air
to 3et inside. .urin3 e"piration- it closes. So
air is trapped inside the lun3s.
ii. (ediastinal shit common in pneumothora"-
i not corrected 2ould lead to cardio3enic
shoc, or atelectasis
*. ?horacentesis
c. ?horacentesis
i. A orm o invasive procedure that involves insertion o needle in the
pleural space to drain air or @uid or the purpose o dia3nosis or
ii. (ain 'eason: to restore a ne3ative pressured cavity
iii. #ursin3 responsibilities beore insertion:
1. >hec, .octorLs order
*. Aitness si3nin3 o consent
1. >hec, the vital si3ns o the patient pay attention on ''
4. >hec, chest ":ray result
/. ?each deep breathin3 e"ercises
iv. #ursin3 responsibility durin3 insertion
1. )est position: sittin3 position or hi3h:o2lerLs position-
leanin3 or2ard- arms supported on a hi3h:chair or arms
*. Ahat to instruct durin3 insertion: !"hale and close your
3lottis $ valsalvaLs maneuver hi3her intrathoracic pressure
preventin3 entry o air into the lun3s o the patient- prevents
1. !"act site:
a. .rain air: insertion is on the *
or 1
b. .rain @uid: insertion is on /
or D
intercostal spaces
v. #ursin3 responsibility ater insertion:
1. )est position: &yin3 on the 3ood side or unaHected side
*. >hec, the site o insertion
1. >hec, the vital si3ns o the patient particularly the '' o
4. >hec, tidalin3 or oscillation (@uctuation or the rise and all o
@uid in the tube durin3 respiration) this is normal. I 2alay
tidalin3- the needle is out or there is obstruction in the tube.
.urin3 inspiration- @uid rises. .urin3 e"piration- @uid alls.
vi. #ursin3 alerts:
1. Ieep collectin3 bottle belo2 the level o insertion
*. .o not clamp the tube or lon3 period o time. )ecause it
can cause tension pneumothora". >lamp the tube not more
than 10 minutes.
1. >lamp the tube as close to the patientLs body.
4. .o not mil, the tube. )ecause it creates pressure inside- it
causes suction and cause dama3e on the pleural tissue.
vii. Interpretation:
1. Intermittent )ubblin3
a. Indicates that the lun3 had ree"panded
*. >ontinuous )ubblin3
a. Indicates lea,a3e
1. #o draina3e comin3 out
a. Indicates resolution
viii. One:2ay bottle system
i". ?2o:2ay bottle system
". ?hree:2ay bottle system
88 Immersed *cm belo2
1. !mphysema
a. &oss o lun3 elasticity
b. Irreversible
c. >auses:
i. Smo,in3
ii. .e=ciency in antitrypsin an enzyme that causes destruction o the
alveolar 2all
iii. >hemical e"posure asbestos
d. Patholo3ic >han3es
i. &oss o lun3 elasticity
ii. 6ormation o )ulla$)ullae
iii. +yperin@ation o lun3 tissue : >ommon result o chest ":ray: )arrel
chest (increased AP .iameter) +yperresonant sound
iv. Small air trappin3 or collapse
e. ?ypes
i. Panlobular upper lobe
ii. >entrolobular common in central aspect o lun3 tissue
iii. Paraseptal .istal Acinar !mphysema distal part o lun3 tissue
. .ia3nostic ?est
i. >hest ":ray barrel chestB increased AP diameter
ii. .ecreased P+- increased P>O*- decreased PO*
iii. Pulmonary unction test
1. Incentive Spirometer #ormal: increased in the residual
volume and a decrease in the e"piratory reserved volume
3. Pin, PuHer
i. Increased >O* retention (pin,)
ii. #o cyanosis
iii. Purse lip breathin3
iv. .yspnea
v. IneHective cou3h
vi. +yperresonance on percussion
vii. Orthopneic
viii. )arrel chest
i". !"ertional dyspnea
". Prolon3ed e"piratory time
"i. Spea,s in short Mer,y sentences
"ii. An"ious
"iii. Fse o accessory muscles to breathe
"iv. ?hin appearance
h. (ana3ement:
i. .ru3s:
1. )ronchodilator
*. Antibiotic
1. Anticholiner3ic dru3
4. (ucolytic e"pectorant
ii. #ursin3 (ana3ement:
1. >essation o smo,in3
a. +o2 to convinceO ?ell the patient on the
conse;uences o his action.
*. O"y3en supplement
1. .iet o patient
a. +i3h calories
b. +i3h protein
c. +i3h =ber
4. Avoid pollutants or other irritatin3 substances
/. Assist or prepare the patient or sur3ery
a. Sur3ical procedures:
i. &obectomy part o a lun3
1. )est position post lobectomy: lyin3 on
3ood side
*. >hest tube inserted in patients lun3
ii. Pneumonectomy entire lun3
1. )est position post pneumonectomy:
lyin3 on the aHected or bad side. #e2
ans2er: lyin3 hi3h o2lerLs position
*. )ronchitis
a. 'eers to in@ammation o the bronchial area due to inhalation o no"ious
umes or irritatin3 substances
b. RSmo,erLs cou3hS
c. >ommon cause: Smo,in3 (same 2ith emphysema e"cept decreased in
d. ?he problem is in@ammation- too much mucus production 2hich leads to
e. 'eversible problem
. ?ermed as Rblue bloatersS
i. )lue because there is cyanosis
ii. )loaters due to edema ormation and clubbin3 o =n3ers (secondary
to chronic hypo"ia)
iii. !dema 'i3ht ventricular hypertrophy >+6
iv. Schamroth method method used to determine clubbin3 o =n3ers
v. #ormal de3ree an3le o nail: 1D0 de3rees
1. I C 1D0 but G 150 J early clubbin3
*. I6 C 150 J advanced clubbin3$ di3ital clubbin3
3. #ursin3 .ia3nosis: IneHective Air2ay >learance
h. >hronic )ronchitis R)lue )loatersS
i. >olor dus,y to cyanotic
ii. 'ecurrent cou3h and increased sputum production
iii. +ypo"ia
iv. +ypercapnia
v. Acidosis
vi. !dematous
vii. Increased respiratory rate
viii. !"ertional dyspnea
i". Increased incidence in heavy ci3arette smo,ers
". .i3ital clubbin3
i. .ia3nostic ?est
i. Q:ray constriction in the bronchial air2ay
1. increased mucus production
*. A)< same 2ith emphysema- respiratory acidosis and
1. Pulmonary unction test same 2ith emphysema
M. (ana3ement:
i. (ost important mana3ement is cessation o smo,in3
1. Perception o o2nLs behavior =rst ;uestion to be as,ed or
patientLs under rehabilitation
ii. >ommon dru3s
1. )ronchodilator
a. >losely monitor normal theophylline and
aminophylline level 2hich is 10 to *0 unit 3ram$d&
b. I C *0: theophylline or aminophylline to"icity
c. Indicators o aminophylline and theophylline to"icity
i. Patient develops nausea and vomitin3
ii. +eadache
iii. >hest pain
iv. Palpitations unpleasant a2areness o
v. ?remors or sha,iness
d. (eter .osed Inhaler
i. Instruction: Simultaneously s;ueeze and
inhale deeply to deliver the dru3 directly in
the respiratory system
*. >orticosteroids
a. Anti:in@ammatory
b. I patient is usin3 corticosteroids- corticosteroids
must not be ta,en or lon3 periods o time because it
causes immune suppression. So 2atch out or si3ns
and symptoms o inections.
c. It can also cause cushin3Ls syndrome or
d. .o not stop corticosteroid abruptly- it must be
e. >orticosteroids cause 3ynecomastia
1. Anticholiner3ic dru3
a. .ecreases mucus production
b. !"ample: atrophine sulate
c. Are also anti spasmodic
4. )eta bloc,ers
a. +elp dilate bronchial area
b. Ahat is the most lie:threatenin3 side eHect:
)'O#>+OSPAS(. ?hat is 2hy it is contraindicated to
asthmatic patient because the more it causes
c. )eta bloc,er may mas, the si3ns and symptoms o
shoc, and hypo3lycemia. So closely monitor blood
su3ar level.
d. Ahat is the =rst dru3 3iven to patientO
e. >orticosteroid =rst beore beta bloc,er to subside
in@ammation =rst- so that beta bloc,er can 3et
/. Antibiotic
a. Prophyla"is a3ainst inection
D. .iuretic
iii. #ursin3 (ana3ement
1. O"y3en supplement is important
*. Aatch or 2ater retention
1. +i3h o2lerLs position to relieve dyspnea
4. &imit visitors- decrease environment and physical stimuli
/. .iet is similar 2ith emphysema
1. )ronchiectasis
a. Permanent dilation
Smo,in3 and Increased >O*
Pin, puHers
- no cyanosis
- hypercapnia
)lood con3estion
Pulmonary 9ascular .isease
1. >or Pulmonale
a. 'eers to enlar3ement o the ri3ht ventricle due to constriction on the
pulmonary vessels secondary to respiratory disorders
b. (ana3ement: treat respiratory disorder
*. Pulmonary !mbolism
a. #arro2in3 or occlusion in one or more pulmonary vessel
b. >auses:
i. >lot
ii. >holesterol or at or lipid
iii. Amniotic @uid
iv. Air embolism
c. >ommon ;uestion
i. Ahat is the best position to patient suspected o pulmonary
embolismO ?rendelenber3 position (because i head is hi3her- air
2ill 3o to the head)
ii. Ahat position- ri3ht or let side lyin3 positionO &et side:lyin3
position (i ri3ht lun3 is on top- air bubbles 2ill 3et inside the ri3ht
lun3- then it 2ill be absorbed by the pulmonary arteries correctin3
pulmonary embolism)
d. Si3ns and symptoms
i. Acute chest pain
ii. .yspnea
iii. >ou3h
iv. #ausea and vomitin3
v. >old- clammy s,in
e. Si3ns and symptoms o shoc,
i. 'estlessness
ii. .iaphoresis
iii. Pleuritic pain there is pain 2hen you inhale deeply
. .ia3nostic test
i. >on=rmatory test: PF&(O#A'K A#<IO<'AP+K
1. a procedure that 2ill evaluate patency o blood vessel
*. doctors 2ill ma,e use o emoral line
1. In any orm o an3io3raphy assess peripheral or distal pulses
beore and ater procedure
4. I ater an3io3raphy- no pulses- dama3ed an3 artery.
?hereore- inorm the doctor immediately.
/. Post an3rio3raphy- increase O6I to acilitate elimination o
dye or contrasts.
3. #ursin3 .ia3nosis: Altered ?issue Perusion- Alteration in comort
h. .ru3s:
i. Anticoa3ulant prevents clot ormation
1. e"ample: Aspirin- +eparin- Aararin- >oumadin
*. )est dia3nostic test that 2ould evaluate eHectiveness o
+eparin: Partial ?hromboplastin ?ime (P??) or >lottin3 time
Antidote: Protamine Sulate
a. >an you 3ive +eparin to pre3nant mothersO K!S
because heparin cannot pass the placenta.
b. Protamine Sulate is still anticoa3ulant. )ut ,un3 ma3
meet sila sa +eparin- mahimo siya coa3ulant.
1. )est dia3nostic test that 2ould evaluate eHectiveness o
Aararin: P? Antidote: 9itamin I
4. Aatch or bleedin37
ii. ?hrombolytic .ru3
1. Strepto,inase
a. .issolves the blood
b. An enzyme that is rom a bacteria. ?hatLs 2hy do not
3ive to immunosuppressed.
c. .elivered throu3h I9 pump
d. 888 (ust be 3iven 2ithin D hours. )ut better i 3iven
2ithin 1 hours.
iii. Anal3esic
1. (orphine Sulate
i. #ursin3 (ana3ement
i. )est position: +i3h o2lerLs position to promote lun3 e"pansion
e"cept or air embolism
ii. O"y3en supplement is important
iii. I thereLs a need to hoo, the patient in respiratory support- do so.
iv. .ecrease environment and physical stimuli.
v. Prepare the patient or sur3ery. 'emoval o clot (!mbolectomy)
- important or the ollo2in3 reasons:
o transportation
o protection
o re3ulation
- Pluripotent a cell that 2ill subdivide into several types o cells
o (yloid ')>- A)>- Platelet
o &ymphoid ):&ymphocytes and ?:&ymphocytes
- ')> 4.5 to /.4 m$mm1
- A)> /000 to 10-000$mm1
- Platelet 1/0-000 to 4/0-000$mm1
o ?hrombocytopenia less than normal platelet
o ?hrombocytosis too much platelet
- )lood volume
o (ale : / to D liters
o 6emale : 4 to / liters
- )lood color
o O"y3enated blood bri3ht red
o .eo"y3enated blood dull red
- Ph o blood
o E.1/ to E.4/
o Sli3htly al,aline in nature
- #ormal ?emperature J 15 de3rees celsius
- ?aste: It has a metallic taste
- .iHerent )lood ?ypes
o ?ype A
>an transuse type A and O
o ?ype )
?ype ) and O
o ?ype O Fniversal .onor
?ype O
o ?ype A) Fniversal 'ecipient
A- )- A)- O
- 'h
o 'hP
a blood 2ith 'h anti3en
o 'h:
a blood 2ithout 'h anti3en
- O: : i you donLt ,no2 the blood type- type O can be 3iven. #e3ative because the
saest blood is a blood that has no 'h anti3en.
o Ideally an3 ihata3 nimo n3a blood or type O: n3a patient- is blood type O.
)ut in cases o emer3ency- p2ede ma3hata3 u3 type 0P provided that it is
his 6I'S? transusion. An3 succeedin3 na daun niya n3a transusion should
be O: throu3hout his lie. I ma3hata3 ,a u3 0P the *
time around- i:
destroy na pud to niya an3 daan n3a anti3en- resultin3 to hemolysis.
)lood .isorders
1. A#!(IA it is not a disease but a condition 2here there is a decrease in ')> V
and a decrease in hemo3lobin mass
a. >ommon denominator amon3 Anemias: .ecreased o"y3en carryin3 ability
b. >ommon Si3ns and Symptoms
i. Pallor
ii. Aea,ness
iii. +eadache
iv. .izziness
v. 88!asy ati3ability or easy e"haustion is very common amon3
Iron:.e=ciency anemia.
vi. Patient develops pica cause o pica is un,no2nB common amon3
iron:de=ciency anemia
vii. #eurolo3ic .e=cits common amon3 patients 2ith pernicious
anemiaB priority is saety o patient
viii. )eey red ton3ue or sore in the ton3ue common to patients 2ith
pernicious anemia
1. 88Stra2berry ton3ue Ia2asa,i
*. 88'ed or 2hite stra2berry ton3ue Scarlet ever
c. >hronic maniestations o late anemia
i. Ioilonychia spoon:li,e nail because o hypo"ia
ii. An3ular >helliosis ulcer ormation on the side o the mouthB an
indication o chronic anemia
iii. +yperthyroidism common to patient 2ith iron:de=ciency anemia
because iron is important to the synthesis o ?1 and ?4
iv. >hronic inection
v. >ardiome3aly
vi. +eart ailure
vii. <eneralized edema
d. >lassi=cations o Anemia
i. Anemia secondary to blood loss anemia results rom bleedin3
1. Acute Anemia
a. Sudden
b. >onditions: +emorrha3e
*. >hronic Anemia
a. Occurs 3radually
b. >onditions: Peptic Flcer .isease- Flcerative >olitis-
)leedin3 hemorrhoids
c. (ana3ement:
i. )lood ?ransusion
ii. >orrect underlyin3 cause
ii. Anemia secondary to nutritional de=ciencies most common
anemia in the Philippines due to poverty
1. Iron:.e=ciency Anemia
a. Patient must have iron supplement
b. 6ood rich in iron:
i. <reen leay ve3etables
c. #ursin3 Alerts or Iron
i. Iron is best absorbed in an empty stomach
ii. Iron is 3astric irritant
iii. Iron must be ta,en 10 minutes beore meal or
an hour ater meal
iv. Iron must be ta,en to3ether 2ith vitamin >
vitamin c enhances iron absorption. E0 cc is
enou3h to enhance iron absorption.
v. Pediatric 2ith Iron .e=ciency Anemia. ?he
best indicator that iron supplement is
eHective: A chan3e in the stool
characteristics. Ahat is that chan3eO It
becomes a blac, tarry stool or 3reen stool.
d. .ru3 o choice a3ainst iron to"icity: 13m
.!6!'OQA(I#! (.esteral) 13m can neutralize E/
m3 o iron
e. Antidote o iron hypersensitivity: !PI#!P+'I#!
. Iron preparations
i. ?ablet
ii. &i;uid88 : i ta,en in li;uid orm- do not or3et
to use stra2 or medicine dropper because it
can cause permanent discoloration o the
teeth- 2hich is bro2n to blac, in color.
1. ?he most important nursin3 action
ater 3ivin3 iron in li;uid orm is Oral
iii. Parenteral
1. !"ample: .e"tran 6orte
*. .o not or3et- you have to 3ive deep
I( W:trac, techni;ue.
*. (e3aloblastic Anemia
a. 6olate$6olic Acid Anemia
i. 6olic Acid is important or .#A and '#A
synthesis o ')>. Also important to prevent
neural tube deects.
ii. As a result- the bone marro2 o the patient
2ill compensate. ?hat compensation is that
the bone marro2 produces lar3e cells.
iii. Implication:
iv. 6olic Acid dosa3e: 1m3$day
b. Pernicious Anemia
i. ?he problem is that you have a de=ciency in
9itamin )1*
ii. !ither there is no parietal cells or no intrinsic
iii. Aithout intrinsic actor- you cannot absorb
vitamin )1*
iv. )1* is absorbed in the Ileum part o the small
intestine. So mas,i naay intrinsic actor- but
2ala na an3 Ileum- naa Mapun ,a pernicious
v. +A&&(A'I: )eey red ton3ue or red beey
ton3ue or sore in the ton3ue
vi. >on=rmatory ?est: Schillin3Ls ?est
1. +ata3an u3 * ,a ,lase n3a )1* an3
patient- that is 'adioactive )1* (PO)
and #on:radioactive (I()
*. D to %T o the radioactive substances
2ill be eliminated throu3h urine 2ithin
*4 hours. ?hereore the most important
nursin3 action durin3 Schillin3Ls test- is
*4:hour urine collection.
1. I may radioactive substances an3
urine- ne3ative or pernicious anemia.
4. I there is no radioactive substance-
there is pernicious anemia.
/. An3 non:radioactive pan3 buHer lan3.
vii. &ielon3 administration o )1*
1. .osa3e: 1000 units o 9itamin )1*
*. 6re;uency: every month
1. 'oute: I(- vastus lateralis
1. <DP. .e=ciency Anemia
a. <lucose D Phosphate .ehydro3enase .e=ciency
b. <DP. is important or 3lucose metabolism.
c. ?here is hemolysis because o too much 3lucose-
because there is no metabolism o 3lucose due to the
de=ciency in <DP.
d. Added (aniestations
i. Aea,ness
ii. Petichae
iii. +epatosplenome3aly
iv. +emo3lobinuria
v. )loody urine
vi. 'enal shut do2n
e. (ana3ement:
i. .iet: hi3h phosphate diet
ii. )lood transusion
iii. )(? )one (arro2 ?ransplant (1 types)
1. Antolo3ous
a. ?he donor 2ill be the patient
b. Ahen do doctors harvest bone
marro2 o the patientO .urin3
period o 'emission. 'emission
is a time 2hen no laboratory
tests can identiy presence o
cancer cells or abnormal cells.
*. Allo3eneic
a. ?he donors are the siblin3s or
brothers or sisters. It must be
1. Syn3eneic
a. .onor is the identical t2in.
iii. Anemia secondary to Impaired ')> Production the problem here is
the bone marro2 o the patient. It is not producin3 suUcient or
mature blood cells.
1. Aplastic Anemia
a. A rare blood disorder characterized by a decrease in
the bone marro2 elements o un,no2n reason.
b. A precursor or leu,emia.
c. .ecreased bone marro2 elements- so decreased
')>- A)> (pancytopenia) and platelet.
d. Aplastic anemia and pancytopenia are the same.
e. Patients are immunocompromised so important an3
reverse isolation. Observe strict aseptic techni;ue.
. Platelet is decreased so bleedin3 is common. So no
invasive procedures and no aspirin.
3. .ru3 o choice: )one (arro2 Suppressant
(!?+O?'!QA?! or >ytosan
i. I:suppress an3 bone marro2 para ma3stop
siya u3 produce u3 immature blood cells.
ii. Antibiotic
iii. )?
iv. )(?
*. Sic,le >ell Anemia
a. A blood disorder characterized by production o a
deective hemo3lobin S
b. +emo3lobin S sic,lin3
c. Sic,le >ell >risis or vaso occlusive crisis common
cause: hypo"ia
d. 888O"y3en supplement to prevent hypo"ia
e. 888+ydrate- hydrate- hydrate the patient to prevent
clot ormation
. Inarction
3. !Hects o Sic,lin3
i. Spleen primary site o sic,lin3
1. So there is inarction decreased
spleen activity increased ris, or
ii. >#S inarction neurolo3ic de=cits (>9A)
iii. &un3s inarction increased pulmonary
pressure pulmonary hypertension
iv. &iver
v. Iidneys inarction 3lomerular dama3e
vi. )ones hypo"ia increase bone marro2
activity bone pain
vii. S,in$9ascular obstruction ulcer ormation
viii. Penis obstruction priapism necrosis
h. (ana3ement:
i. .ru3s
1. methotre"ate
*. antibiotics
1. thrombolitics
4. anticoa3ulant
/. anal3esic
ii. nursin3 (ana3ement:
1. o"y3en supplement
*. hydration
1. bone marro2 transplant
iv. Anemia secondary to 'enal 6ailure
1. Iidneys 2ill produce or release erythropoietin (a hormone
that stimulates bone marro2 activity. &eadin3 to increased
')> production.
*. (ana3ement:
a. .ru3s
i. Iron supplement
ii. !rythropoietin (!pre")
iii. )lood transusion
iv. Iidney transplant
*. Polycythema 9era
a. A chronic myeloprolierative disorder- involvin3 all bone marro2 elements.
?here is prolieration in myeloid cell. Increased ')>- A)> and platelet.
b. >ommon amon3 2omen compared to men.
c. >ause is un,no2n
d. Si3ns and Symptoms:
i. Increased ')>- A)>- platelet
ii. Plethoric appearance (rody appearance)
iii. +ypertension (because o increase in blood volume)
iv. +emoconcentration
v. Pain on the di3its because o increase in blood volume
vi. +epatsplenome3aly
vii. >ardiome3aly
viii. Increased clot ormation 8 : the most common cause o death
amont polycythema vera
e. 88Avoid hi3h altitude places because a hi3h altitude area has a decrease
o"y3en concentration. In the environment- the normal o"y3en saturation is
C*1T. In the body- o"y3en saturation is %/ to 100T. Once there is less
o"y3en saturation- it 2ould stimulate the ,idneys o the patient- releasin3
erythropoietin- causin3 an increase in ')> production.
. (ana3ement:
i. (edication:
1. Immune bone marro2 suppressant (!?+O?'!QA?!
*. 9asodilators
1. Anticoa3ulant
4. Antihypertensive dru3s
ii. #ursin3 (ana3ement:
#ursin3 .ia3nosis: 'is, or altered tissue perusion because o
circulatory obstruction
1. .eliver o"y3en
*. +ydrate patient to prevent clot ormation
1. )one marro2 transplant
4. Phlebotomy about /00 to *000 ml $ 2ee,
a. >annot be transused- because the blood is
considered to be deective.
1. ?hrombocytopenia
a. A decrease in platelet count
b. >auses:
i. .ru3s Alcohol- Aspirin- >hloramphenicol (dru3 o choice or
typhoid ever)- chemotherapy dru3- radiation e"posure-
anticoa3ulants- thrombolytics- ;uinolones- Phenobarbital
ii. Inection viral inection (tanan naay thrombocytopenia)- !bola
9iral Inection (most eared viral inection). !bola and den3ue viral
inection pareho naay ever and thrombocytopenia. )ut !bola
li;ueaction o internal or3an.
iii. .isorder leu,emia
c. (ana3ement:
i. Platelet concentrate transusion
d. #ursin3 Alerts
i. #o invasive procedures
ii. #o dar,:colored oods
iii. #o strenuous activities
iv. Avoid aspirin
v. Patient 2ith bleedin3 tendencies- best e"ercise: S2immin3 (less
physical contact)
vi. 6or pediatric patients- common presentation o bleedin3:
hemarthrosis (bleedin3 in the Moints). !arly indication o
hemarthrosis is reluctance to move a body part.
88#ursin3 Actions: Pad the Moint or e"tremities
vii. !nsure sae administration o blood product
* 9alves
1. A9 9alve
a. ?ricuspid 9alve
b. (itral 9alve
*. Semilunar 9alve
a. Pulmonary
b. Aortic
+eart sound is due to the closure o the valve.
S1 closure o A9 valve.
S* closure o the Semilunar valve.
Abnormal heart sounds murmursB S1 and S4
S1 heard ater S*B common cause is heart ailure
S4 heard beore S1B common cause is hypertension
!>< J !I<
1. P 2ave atrial depolarization (depolarization is contraction$stimulation)
*. X'S comple"
a. Atrial repolarization (repolarization is restin3$rela"ation)
b. 9entricular depolarization
1. ? 2ave ventricular repolarization
1* &eads o !><
: are the diHerent an3les or vie2 o the heart
1. >hest &eads
a. 91 ri3ht side
b. 9* ri3ht side
c. 91 septum
d. 94 septum
e. 9/ let side
. 9D let side
*. &imb &eads
a. I
b. II
c. III
d. I9
e. A9'
. A9&
3. A96
#ormal 'ate: D0 to 100 bpm
#ormal P:': 0.1* to 0.*0 seconds
#ormal X'S: 0.05 to 0.1* seconds
1 small bo" J 0.04 seconds
1 bi3 bo" (/Q/) J 0.*0 seconds
1/0- 1/0- 100- E/- D0- /0
!>< I#?!'P'!?A?IO#
1. Ischemia Inverted ? 2ave
*. InMury S? se3ment elevated
1. Inarction
a. Old patholo3ical X 2ave
b. #e2 S? se3ment elevation
4. +ypo,alemia prominent F 2ave
/. +yper,alemia pea, ? 2ave
>O'O#A'K A'?!'K .ISO'.!'S
- reers to perusion alteration
- coronary arteries is not allo2in3 blood to @o2 reely in the heart- most probably
because o obstruction
- the 3oal is to improve perusion by all means
1. Atherosclerosis
a. An abnormal accumulation o lipid- or atty- substances and =brous tissues
in the vessel 2all
b. >holesterol
i. &.& bad
1. as early as E years old- there is already at deposition
*. A)> and macropha3es modiy the &.&
1. durin3 modi=cation- there is inMury in the vessel
ii. +.& 3ood
iii. ?ri3lycerides increased ris, or >A.
*. Arteriosclerosis
a. 'eers to hardenin3 o the vessel 2alls
b. Ischemia disrupted blood @o2
'is, 6actors:
1. (odi=able
a. +i3h )lood Pressure
b. >i3arette Smo,in3
c. +i3h )lood >holesterol &evels
d. .iabetes (ellitus accelerates atherosclerosis
e. &ac, o estro3en in 2omen
. Physical inactivity
3. Obesity paired 2ith hypertension
*. #on (odi=able
a. 6amily +istory o >A.
b. Increasin3 a3e (// years old and above)
c. <ender common amon3 (ales- type A personality
d. 'ace Arican:American
#ormal ?otal Serum >holesterol J 1/0 to *40 m3$dl
+.& J *% to EE m3$dl
&.& D0 to 1D0 m3$dl
?ri3lycerides J 10 to 1%0 m3$dl
.esired &. levels:
1. 1 ris, actor or no ris, actor J G 1D0
*. * or more ris, actors J G 110
1. .ia3nosed 2ith >A. J G 100
A#<I#A P!>?O'IS
- reers to chest pain or chest discomort
- Rcho,ed chestS
- An3ina is due to myocardial ischemia (inability o the coronary arteries to supply
blood ade;uately)
- Speci=c causes:
o Atherosclerosis
o Arteriosclerosis
o 9asospasm common early in mornin3
o 9asocompression brou3ht about by in@ammatory processes
o .ru3s
.econ3estants all lead to myocardial ischemia
Adrener3ic dru3s
- ?ypes:
o Stable
A type o an3ina pectoris i patient is under stress or physical
e"ertion. Kou ,no2 2hen the attac, 2ill occur.
o Fnstable
!ven at rest may occur
Kou need to closely monitor patient- because may pro3ress to
myocardial inarction
Also ,no2n as Preinarction An3ina
(ost common cause: Atherosclerosis
o Silent
#o si3ns and symptoms (asymptomatic)
o 9ariant
#octurnal an3ina pectoris
P2ede mu3a2as early in the mornin3
AIA Prinzmetal An3ina
(ost common cause: 9asospasm
o Intractable$'eractory
?he patient 2ill not respond to common medications- that is 2hy
patient complains o severe pain.
o &ud2i3Ls An3ina
)rou3ht about by dru3s.
.ru3:induced an3ina
- Si3ns and Symptoms
o >hest pain (precipitated by the ollo2in3)
!nvironment (cold)
88 can be relieved by rest and or nitro3lycerin
88 chest pain is usually less than *0 minutes
88 (P) &evine si3n 3raspin3 anterior chest because o pain
88 ?he maMor diHerence o chest pain e"perienced by patient 2ith
an3ina and (I: >haracteristic o pain
o >hest discomort
o >hest ti3htness
- >ommon .ia3nostic ?est
o !>< inverted ? 2ave
o )lood analysis
&ipid pro=le
>ardiac enzymes (>PI:()- ?rop:?- &.+)
o ?halium Scan an invasive procedure
Identiy 2hat part o the heart 2ith hypo"ia
o >oronary An3io3raphy
All assess or distal and peripheral pulses
- (ana3ement
o .ru3s
9asodilator #itro3lycerin
#ursin3 Alerts:
#itro3lycerin is a vasodilator
#itro3lycerin comes in diHerent preparations
o tablet- spray ta,e sublin3uallyB store in a dar, dry
ti3htly capped container because it is photosensitive.
)urnin3 or tin3lin3 sensation 2hen ta,in3 the
dru3 best indicator that nitro3lycerin is
eHective or still resh
&i3htheadedness is a normal side eHect o
.iscard nitro3lycerin ater D months
nitro3lycerin starts to decline its potency on
the 4
#itro3lycerin must be ta,en 1 tab at a time or
one spray at a time- / minutes interval-
ma"imum o 1 tablets or 1 sprays
Ater 1 days- i pain is still present- consult
o Patch
do not touch the medicated surace
place on anterior chest
do not place on a hairy site shave site alon3
the direction o hair 3ro2th to decrease the
ris, or s,in brea,do2n
?o prevent nitro3lycerin tolerance- the nursin3
action is to establish a 1*:bour no
nitro3lycerin per day
Anal3esic i severe pain occurs
)eta bloc,ers to decrease myocardial o"y3en demand
o #ursin3 (ana3ement:
6irst nursin3 action i patient in your unit complains o chest pain:
<ive o"y3en supplement 1 to * &$minute
Position the patient in a Semi:6o2lerLs position to promote 3ood
lun3 e"pansion
(odiy the diet o the patient: &o2 sodium- lo2 at- hi3h protein-
hi3h potassium- hi3h =ber diet (to prevent constipation)
.ecrease environment and physical stimuli to decrease the
2or,load o the heart
Prepare the patient or sur3ery
P?>A (Percutaneous ?ransluminal >oronary An3ioplasty)
o )eore and ater- assess or peripheral and distal
>A)< (>oronary Artery )ypass <ratin3) ultimate choice
I not corrected- an3ina may pro3ress to (I
(KO>A'.IA& I#6A'>?IO#
- caused by coronary occlusion
- causes are same 2ith an3ina
- Patient may present 2ith the ollo2in3:
o .yspnea
o An"iety dyspnea- diaphoresis and nausea and vomitin3 are related to
o #ausea and vomitin3
o >hest pain $ crushin3 substernal pain not all patients 2ith (I have chest
pain- not common amon3 2omen. #ot also common to patient 2ith
diabetes mellitus- because they have diabetic neuropathy- so sira an3
nerve- so 2alay pain.
>hest pain is more than *0 minutes
>annot be relived by rest or nitro3lycerin
(P) or &evine si3n
>hest pain may radiate bac,- do2n the nec,- shoulder and on the
let arm. P2ede sa ri3ht but most common sa let arm. Ahy it
radiates on the let armO )ecause the nerve that supplies the heart
and the nerve that supplies the let arm ori3inated in the same
Aura : !pi3astric Pain. #3ano naa epi3astric painO Patient thou3ht it
2as an epi3astric pain- but instead- it is part o chest pain.
o !levated temperature
Ahy elevatedO Pa3 may occlusion- there is no o"y3en supply on
the cells- so they 2ill pursue an anaerobic circulation. Anaerobic
circulation increases the release o lactic acid- these acid causes
inMury to the vessels. .ue to inMury. InMury tri33ers release o cardiac
enzymes- and these enzymes activate pyro3ens 2hich causes and
elevated temperature.
#ormal >PI
o (ale / to 1/
o 6emale / to */
>PI rises 4 to 5 hours
Pea, o >PI is Y to 1 Y days
>PI normalizes 1 to 4 days ater the attac,
#ormal: 100 to 1%0 IF$&
'ises 1* to *4 hours ater the attac,
Pea, is * to D days ater
#ormal: #e3ative
Ielan lumalabas: immediately
Pea, is 4 to *4 hours
?rop:? normalizes 1 to 1 2ee,s ater the attac,
(ost reliable enzyme
o Palor
.ue to a decrease in cardiac output decrease tissue perusion
o Arrhythmia
Or dysrrhythmia a lie:threatenin3 complication o (I. I not
correct- not prevented- it 2ill lead to cardiac arrest. (&idocaine)
88Aatch or P9> (characteristics)
Aidenin3 o X'S comple"
D P9> in 1 minute is considered lie threatenin3
88 Aatch out or 9entricular ?achycardia a lie threatenin3
arrhythmia or dysrrhythmia
6irst dru3 3iven to patient 9asopressin
#e"t is 3ive &idocaine
Ater &idocaine- de=brillation ((a" Zoules: 100 Z)
#e"t- cardiac compression
o .iaphoresis
- Ahen is (I attac, commonO In the mornin3 durin3 2hen ta,in3 a bath because
3a startle man.
- .ia3nostic ?est
o Ischemia inverted ? 2ave
o Old inarction patholo3ical X 2ave
o #e2 inarction inverted S? se3ment
o )lood analysis
&ipid pro=le
>ardiac enzymes
&iver enzymes
)F# and >reatinine
o ?halium scan and coronary an3io3raphy
- (ana3ement:
o (orphine Sulate narcotic anal3esic- may cause respiratory depression
o O"y3en
o Aspirin
o #itrates a vasodilator
o Strepto,inase a thrombolytic dru3
o Sur3ery P?>A and >A)<
- #ursin3 .ia3nosis: Alteration in >omort: Pain
- #ursin3 Alerts:
o .iet: lo2 sodium- lo2 at- hi3h protein- hi3h =ber
o Position: Semi 6o2lerLs
o Avoid constipation
o .ecrease environment and physical stimuli
o 'esumption o physical activity 4 to D 2ee,s ater the attac, or i not-
patient can resume se"ual activity i patient can climb stairs more than 10
steps 2ithout chest pain
o Ahen is the best time to do se"ual activityOOO !arly in the mornin3
because the heart has 2ell rested
o Approach: Fse passive approach
o Ahere is the best place to do se"ual activityOO In a amiliar environment
to decrease an"iety
>O#<!S?I9! +!A'? 6AI&F'!
- inability o the heart to pump properly
- ?2o types
o 'i3ht:Sided >+6
Systemic maniestation
Increased peripheral venous pressure
!nlar3ed liver and spleen
.istended Mu3ular vein
Anore"ia and complaints o <I distress
S2ellin3 in hands and =n3er
.ependent edema
o &et:Sided >+6
Pulmonary maniestation
Paro"ysmal nocturnal dyspnea
!levated pulmonary capillary 2ed3e pressure
)lood tin3ed sputum
!"ertional dyspnea
- <oal in mana3ement: increase the orce o contraction 2ithout increasin3 heart
- Approach in mana3in3 >+6:
o Fpri3ht position to prevent pulmonary con3estion
o #itrates nitrates are vasodilator- to promote blood @o2
o &asi" a orm o diureticB to 3et rid o too much @uid inside the bodyB best
3iven in mornin3 and 2atch out or hypo,alemia. +ypo,alemia increases
the ris, o di3italis to"icity.
o O"y3en
o Aminophylline a bronchodilatorB dilates the bronchial area to relieve
o .i3o"in dru3 o choice or >+6. AhyO )ecause the action o di3o"in is the
3oal o the di3o"in and that is to increase the orce o contraction.
)eore 3ivin3 di3o"in : chec, heart rate and blood pressure-
because these are indications o di3italis to"icity or overdosa3e o
Ahat is the normal di3o"in levelO 0./ to *.0 micro3ram$d&
I more than *- di3italis to"icity. (si3ns)
#ausea and vomitin3
Kello2 to yello2:3reen halos around the li3ht
'is, or cardiac arrest
Antidote: .i3ibind or .i3o"in Immune 6ab or .i3i6ab
o 6luid restriction 1000 to 1100 ml$day or 1 to 1.1 &$day
o Ater load decrease
+o2 to decrease aterloadO
)ed rest
<ivin3 dru3s
o )eta bloc,ers
o A>! inhibitor dru3s endin3 in prilB common side
eHect is >OF<+
'otatin3 tourni;uet do not remove all tourni;uets at the
same time
o Sodium restriction because sodium attracts 2ater
o ?est or potassium and A)< because hypo,alemia potentiates the eHect
o A)<
'+!F(A?I> +!A'? .IS!AS!
- is a se;ualae or a complication o re;uent or untreated <A)S (<roup A
)etahemolytic Streptococcus) inection
- (aMor (aniestations:
o Pancarditis in@ammation on the three layers o the heart
o 9alvular deect$s must be prevented or corrected because this is
irreversible. (itral 9alve commonly aHected valve
o Subcutaneous nodules 88
Aould resolve even 2ithout medication
It does not re;uire treatment
o >horea St. 9itus .anceB
abnormal Mer,y movementB
common in upper e"tremities and Ma2 o patientB
it is sel:limitin3 lastin3 or 1 monthsB
a33ravated by loud music
- (inor (aniestations:
o >hest pain
o 6re;uent sore throat
o 6ever
o Aea,ness
o (yal3ia muscle pain
o !levated ASO titer Anti Streptolysin O (an antibody speci=c or
Streptolysin O)
- .ia3nostic ?est
o #o speci=c test
o .ia3nosin3 is based on assessment by ZoneLs >riteria
* maMor maniestations- 1 minor maniestation
1 maMor maniestation- * minor maniestations
o Other tests
?hroat culture
)lood analysis
- (ana3ement:
o .ru3
Penicillin dru3 o choice
<iven D to 5 years durin3 active inection stress the
importance o compliance
or !rythromycin
- #ursin3 Alerts:
o Stress the importance o 3ood oral hy3iene
o Inorm the doctor or dentist prior to dental 2or,:up or any invasive
o Stress the importance o compliance
o +ave yearly or annual physical e"amination- specially *.:echo to
evaluate cardiac abnormalities
A&?!'A?IO# I# +O'(O#A& '!<F&A?IO#
+ormonal 'e3ulation:
Pituitary <land (hypophysis)
?ar3et >ell$Or3an
Pituitary <land
1. Anterior
a. <ro2th +ormone
b. Prolactin
c. (elanocyte Stimulatin3 +ormone
d. 6ollicle Stimulatin3 +ormone
e. &eutinizin3 +ormone
. A>?+
3. ?hyroid Stimulatin3 +ormone
*. Posterior
a. Anti .iuretic +ormone $ 9asopressin
b. O"ytocin
A.'!#O>O'?I>O?'OPI> +O'(O#!
- tar3et cell or or3an: Adrenal <land (located above the ,idney) or Supra 'enal
- !Hect:
o Stimulate the adrenal 3land to produce itLs o2n hormone
o Adrenal >orte" (4 hormones)
>ortisol (most abundant hormone produced)
<lucocorticoid : because it has a direct eHect on 3lucose
(ineralocorticoid : because it has a direct eHect on mineral
Promotes 2ater retention
.evelopment o secondary male characteristics
Adrenal !stro3en
o Adrenal (edulla (* hormones)
!pinephrine (Adrenalin)
6or sympathetic reactions
?+K'OI. S?I(F&A?I#< +O'(O#!
- Stimulates thyroid 3land to produce itLs o2n hormone
- 1 hormones produced:
o ?1
.erived rom iodine
Important to increase the basal metabolic rate
o ?4
?etraiodothyronine or ?hyro"ine
.erived rom iodine
Important to increase the basal metabolic rate
o >alcitonin
.ecreases calcium level
A#?I.IF'!?I> +O'(O#! (9asopressin)
- tar3et cell or or3an: II.#!K
- Prevents ormation o lar3e volume o urine
Anterior Pituitary <land (E hormones)
1. <ro2th +ormone
a. +ypersecretion
i. Pedia 3iantism$3i3antism
ii. Adult : Acrome3aly
b. +yposecretion
i. .2ar=sm
*. (elanocyte Stimulatin3 +ormone
a. +ypersecretion dar,ens the s,in
b. +yposecretion : Albino
1. Prolactin
a. +ypersecretion lactation or mil, production
b. +yposecretion no lactation
4. 6S+
a. (enstrual .isorders
/. &+
a. (enstrual .isorders
D. A>?+
a. +ypersecretion >ushin3Ls Syndrome
b. +yposecretion AddisonLs .isease
E. ?S+
a. +ypersecretion +yperthyroidism$?hyroto"icosis (!"ample: <raveLs
b. +yposecretion +ypothyroidism
i. Pedia >retinism
ii. Adult : (y"edema
Posterior Pituitary <land
1. A.+
a. +yper SIA.+
b. +ypo .iabetes Insipidus
*. O"ytocin
a. +yper contraction or &et:do2n re@e" or (il, !Mection
b. +ypo muscle atony
?umor the most common cause
(ana3ement: Sur3ery removal o the tumor
+ypophysectomy removal o pituitary 3landB a orm o craniotomy
>ommon Problem post:op: Increased I>P elevate head o bed (10 to 4/ de3rees) to
promote venous return.
(idline position neutral position to prevent compression
- 1 approaches
o Supratentorial
Above the hair line
)est position: !levate head o bed $ +i3h 6o2lerLs Position $ &yin3 on
his bac, 2ith head o bed elevated $ +ead o bed elevated- lyin3 on
the side o the unaHected side
o Inratentorial
)est position: Side lyin3 position- head o bed elevated dependin3
on patientLs preerence ,un3 let or ri3ht
o ?ranssphenoidal
(ost common approach or hypophysectomy
Incision: beneath the upper lip o the patient to 3ain access on the
nasal cavity
)est position post:op: +i3h 6o2lerLs position $ &yin3 on his bac,
- #ursin3 Alerts
o Avoid blo2in3 the nose
o (aintain nasal pac,in3
o Avoid brushin3 the teeth and do not 3ar3le because the more it increases
I>P and bleedin3 episodes. Fse padded ton3ue depressor D to 10 days
o Aatch or 'hinorrhea >S6 lea,a3e sa nose.
6irst nursin3 action i you suspect 'hinorrhea: >hec, or the 3lucose
content because >S6 contains 3lucose /0 to 50 m3$d&.
+o2O <et a specimen and send to lab or analysis.
Or 3et a 2hite clean clothe or 3auze- 2ipe the @uid and let it dry. I
it leaves a yello2 mar,- then it is >S6.
.IS?F')A#>!S A66!>?I#< A>?+
1. AddisonLs .isease
a. .ecreased adrenal hormones
b. (aniestation:
i. .ecreased 3lucocorticoid hypo3lycemia
ii. .ecreased mineralocorticoid hyponatremia$hyper,alemia
iii. .ecreased andro3en abnormal hair distribution
c. Patho3nomonic Si3n: )ronze pi3mentation o the s,in or tannin3 o the
d. Other si3ns and symptoms
i. Aea,ness
ii. Postural hypotension or orthostatic hypotension
1. 888 Avoid sittin3 or standin3 ;uic,ly- it must be 3radual
iii. Abnormal distribution o body hair
e. #ursin3 .ia3nosis: 6luid 9olume .e=cit
i. 88.ehydration is the most common cause o Adrenal >risis or
Addisonian >risis
ii. Adrenal >risis or Addisonian >risis reers to critical de=ciency o
the adrenal hormones
iii. (ost common cause: .ehydration
iv. #ursin3 Implication: +o2 to prevent adrenal crisisO +ydrate the
v. Si3ns and Symptoms o Adrenal >risis
1. .ehydration
*. +yponatremia
1. +yper,alemia
4. 9ascular collapse
a. 888It is the most common cause o death
b. 9ascular collapse is due to @uid volume de=cit
/. 'enal shut do2n
vi. .ru3 o choice: +ydrocortisone
. .iet o the patient:
i. )eore steroids
1. +i3h carbohydrates
*. +i3h #a
1. &o2 I
4. +i3h protein
/. +i3h calorie
ii. .urin3 steroids steroids promote 2ater retention
1. &o2 #a
*. +i3h I
3. .ru3 that replaces 3lucocorticoid +ydrocortisone
h. .ru3 that replaces mineralocorticoid 6ludocortisone
i. Aath or: >ushin3Ls Syndrome
*. >ushin3Ls Sydnrome
a. 'eers to e"cessive adrenal hormone production
b. Increase in adrenal hormone (corte" >ortisol)
c. AIA +ypercorticolism
d. (aniestation
i. Increased 3lucocorticoid hyper3lycemia
ii. Increased mineralocorticoid hypernatremia $ hypo,alemia
iii. Increased andro3en +irsutism (applicable to emales)
e. #ursin3 .ia3nosis: 6luid 9olume !"cess
. Patho3nomonic Si3n:
i. (oon ace due to edema
ii. )uHalo hump or at deposition on the bac, due to edema and at
iii. ?runcal Obesity due to at deposition
iv. Aei3ht 3ain classic si3n 888
3. Other si3ns and symptoms
i. Poor 2ound healin3
ii. Inection or chronic inection admit under reverse isolation
iii. 6ra3ile s,in
iv. Acne
v. Amenorrhea
vi. !cchymosis
vii. .ecreased libido
viii. !nlar3ed clitoris
i". +ypertension
". (ood s2in3s irritable
h. .iet:
i. &o2 carbohydrates
ii. &o2 sodium
iii. +i3h potassium
iv. +i3h protein
v. &o2 calorie
i. .ru3s
i. .ru3 o choice: (etyrapone (adrenal suppressant)
ii. .iuretic
iii. Insulin anti diabetic a3ent
iv. I supplement
M. Sur3ery
i. Adrenalectomy removal o adrenal 3land
?S+ .IS?F')A#>!S
1. +yperthyroidism $ ?hyroto"icosis
a. !"ample: <raveLs .isease common i you ailed to eat iodine:rich ood
(e": seaoods)
b. 1 common eatures:
i. Increased ?1 and ?4
1. Increased basal metabolic rate
a. ?achycardia
b. Palpitation
c. Aei3ht loss
d. .iarrhea
e. 6ine sil,y strai3ht hair
. .iaphoresis
3. +ypertension
h. Increased systolic blood pressure
i. +yperactive
M. Amenorrhea
,. 6ine hand tremors
l. (uscle 2astin3
m. +yperactivity provide restul environment
*. Increased heat production
a. +eat intolerance
1. Increased calorie re;uirement
a. Polypha3ia
4. .iet: Increased calorie- increase carbohydrates- increase
ii. !"opthalmia bul3in3 o eyeballsB .alyrimple Si3n or thyroid stare
iii. <oiter enlar3ement o thyroidism
1. (ay be present also in hypothyroidism
*. >ause: hyperplasia
1. Assess or bruit or thrill over the thyroid
c. )est .ia3nostic ?est: ?S+
d. .ru3s:
i. Antithyroid a3ent
1. P?F PropylthiurazilB inhibits thyroid hormone synthesis
*. &u3olLs Solution also ,no2n as SSII (Stron3 Saturated
Potassium Iodide)
a. Action: .ecrease vascularity o thyroid 3land
Aatch or: +ypothyroidism7
ii. >orticosteroids help inhibit thyroid hormone synthesis
iii. )eta bloc,ers (:olol dru3s)
iv. .i3o"in
v. Iodine preparation (Iodotope)
e. Sur3ery:
i. ?hyroidectomy
ii. #ursin3 Alert:
1. )est position post:thyroidectomy 6o2lerLs position
*. Ieep tracheostomy tray on the bed side- specially on the
=rst *4 hours post:op because respiratory distress is
common on the =rst *4 hours
a. >auses o respiratory distress:
i. ?racheal collapse due to sur3ery
ii. ?rachea mucus accumulation
iii. &aryn3eal edema
iv. 9ocal cord paralysis can cause air2ay
v. +ypocalcemia accident removal o
parathyroid 3land. .ru3 o choice: >alcium
1. +oarseness and a 2ea, voice are normal and temporary
4. +o2 to assess or laryn3eal nerve unction: ability to s2allo2
or ability to tal, or spea,
/. Aatch or bleedin3: >hec, or blood in the nape o the
D. Aatch or thyroid storm a sudden increase in the ?1 and ?4
due to stimulation upon sur3ery. Si3ns o thyroid storm:
a. ?achycardia
b. 9omitin3
c. 6ever
d. +ypertension
e. +yper,inesis
*. +ypothyroidism
a. ?here is a decrease in ?1 and ?4
b. >ommon to 2omen than in men
c. (ost common cause: +ashimotoLs .isease
i. An autoimmune problem
ii. Our immune system 2ill destroy our o2n thyroid 3land
d. 1 problems
i. .ecreased )('
1. >onstipation
*. Amenorrhea
1. +air loss
4. )rittle nails and hair
/. >oarse- Scaly- dry s,in
D. &ethar3y
E. Anore"ia
5. 6ati3ue
ii. .ecreased heat production
1. >old intolerance
iii. .ecreased calorie re;uirements
iv. <oiter due to hypertrophy
e. 6or pedia >retinism
i. (entally retarded
ii. .2ar=sm
. Adult (y"edema
i. !dema ormation
ii. .epression
3. (y"edema >oma
i. A critical de=ciency in ?1 and ?4- leadin3 to severe depression
ii. (ost common cause: S?'!SS
iii. Si3ns and symptoms:
1. +ypothermia
*. )radycardia
1. &ethar3y pro3ressin3 to >oma
4. >ardiopulmonary arrest
iv. 888Priority: Air2ay o Patient
h. .I!?
i. &o2 calorie
ii. +i3h protein
iii. +i3h =ber
i. .'F<S
i. &iothyronine (>ytomel) replaces ?1
ii. &evothyro"ine (Synthroid) replaces ?4
#ursin3 Alert:
1. Ahen is the best time to 3ive >ytomel and Synthroid: In the
mornin3. #ot at ni3ht because it can cause insomnia.
*. Aatch or over dosa3e or over medication. Si3ns o over
a. ?achycardia
b. 'estlessness
c. #ervousness
d. Insomnia
iii. Stool Soteners: .O>FSA?! SO.IF( (>olace)
M. #ursin3 Alert:
i. Avoid sedative- narcotics and other >#S depressants the more it
causes depression
ii. Assess @uid volume because there is edema
iii. Provide a 2arm environment because there is cold intolerance
iv. Provide re;uent rest period
.IS?F')A#>!S >AFS!S A.+ (A#?I.IF'!?I> +O'(O#!)
1. Syndrome o Inappropriate Anti.iuretic +ormone
a. Increased A.+
b. 6luid volume e"cess because there is retention
c. Si3ns and symptoms:
i. .ecrease +ct (+emodilution)
ii. Increase Frine Speci=c <ravity urine is concentratedB #ormal:
1.010 to 1.0*/
1. 888)est ?est to evaluate A.+ abnormalities
d. .ru3s
i. .iuretics
*. .iabetes Insipidus
a. .ecrease in A.+
b. >ause: Ideopathic $ Fn,no2n
c. >losely related to patient 2ho under2ent brain sur3ery
d. #ursin3 .ia3nosis: 6luid 9olume .e=cit
e. Si3ns and Symptoms
i. Polydypsia 4 to 40 & per day
ii. Polyuria : C / &$day
iii. .ehydration
iv. Increased +ct
v. .ecreased Frine speci=c 3ravity
. .iet:
i. 'e3ular diet but avoid ood that e"ert diuretic eHect
3. .ru3s:
i. 9asopressin route: nasal spray or parenteral
1. .esmopressin
*. .esmoressin
1. Pitressin
4. &ypressin
1. .iabetes (ellitus
a. Siphonin3 o the blood because o too much su3ar
b. A orm o a metabolic disorder characterized by an elevation in blood su3ar
(hyper3lycemia)- resultin3 rom a deect in insulin production- action or
both action and production
c. ?he problem is the pancreas
i. Alpha >ells secrete 3luca3ons (increase 3lucose in the blood)
ii. )eta >ells insulin (decrease 3lucose)
d. ?est to evaluate unction o Pancreas: 6astin3 )lood Su3ar
e. ?ypes
i. ?ype 1
1. Also called Zuvenile .iabetes- Zuvenile:onset .iabetes-
Ietosis:prone .iabetes- )rittle .iabetes
*. appro"imately / to 10T o people 2ith diabetes
1. acute onset- usually beore a3e 10
4. re;uires inMection o insulin to control their blood 3lucose
/. #ormal 3lucose: 50 to 1*0
D. #ot enou3h production o insulin
E. .IA
ii. ?ype *
1. Adult:onset .iabetes- (aturity:onset .iabetes- Ietosis:
'esistant .iabetes- Stable .iabetes
*. +yper3lycemic- +yperosmolar- #on Ietosis (++#I)
1. %0 to %/T o people 2ith diabetes
4. onset is common to people older than 10 years and obese
/. #ot necessarily ma3 insulin
D. the problem is the action o insulin
. / Ps
i. Polydypsia e"cessive thirst
ii. Polyuria e"cessive urination
iii. Polypha3ia e"cessive hun3er
iv. Poor 2ound healin3
v. Proound 2ei3ht loss
3. Si3ns o hyper3lycemia
i. Polydipsia
ii. Polyuria
iii. Polypha3ia
iv. 6ever
v. Aarm s,in to touch
vi. 6ruity breath
h. Si3ns o +ypo3lycemia
i. Sha,iness or tremors
ii. +eadache
iii. #ausea
iv. >old- clammy s,in
v. .iaphoresis
vi. Irritability
i. 88 I the s,in is 2arm to touch- insulin is rush
M. 88 I the s,in is cold and clammy- 3ive candy
,. &ie:savin3 carbohydrates
i. 6ruit Muice Y cup mas o,ay sa hard candy because ruit Muice is
already in li;uid orm
ii. +ard candy
iii. 4 tsp o su3ar
iv. 1 tbsp honey or syrup
v. 5 ounces lo2 at mil, or s,im mil,
vi. 1 3raham crac,ers
l. (ana3ement:
i. #utritional (ana3ement
1. the basic oundation or diabetes control
*. 6actors:
a. #utrition
b. .iet
c. Aei3ht reduction
1. >aloric re;uirement: 1500 to *400 per day
a. >arbo /0 to D0T
b. 6ats *0 to 10T
c. Protein 10T
d. 888 .iabetic diet is a 2ell:balanced diet
ii. !"ercise
1. )ene=ts:
a. +elp decrease blood su3ar level +o2O )y increasin3
sensitivity o insulin receptors
b. +elps decrease ris, or cardiac abnormality
*. <eneral Precaution:
a. Fse proper oot 2ear durin3 e"ercise
b. Inspect eet daily ater e"ercise
c. Avoid e"ercise durin3 e"treme temperature
d. Avoid e"ercise durin3 periods o poor metabolic
iii. (onitorin3
1. essential to evaluate 2hether blood su3ar is 2ell re3ulated
*. 6)S (?hin3s to remember)
a. Place the patient on #PO 5 to 1* hours
1. +<?
a. Ahere to pric,O Side less nerve endin3s- so less
4. <lycosylated +emo3lobin ?est the best to evaluate 3lucose
in the blood or the past * to 1 months. ?hat is the best test
to evaluate eHectiveness o treatment. #ormal: G E./T
iv. Pharmacolo3ic therapy
1. ?hin3s to remember about insulin:
a. Insulin is a at:soluble hormone
b. Insulin must be 3iven subcutaneously do not
massa3e site- do not apply 2arm compress
c. Insulin must be stored in a cool environment re: 1
months- room temp: 1 month
d. )reasteedin3 2ill decrease insulin dosa3e
re;uirement breasteedin3 has an antidiabe3enic
e. Inection or illness 2ill not aHect insulin
. Ahen monitorin3 or hypo3lycemia- chec, or the
3. Ahen monitorin3 or the time- 2hen you 2ill see a
decrease in the blood su3ar- monitor or the onset or
chec, or the onset
h. 'e3ular insulin is short:actin3 insulin re3ular insulin
can be 3iven subcu and I9
i. #P+ (neutral protamine ha3edorn) intermediate
actin3 insulinB cloudy insulin
M. #P+ must be 3iven at 10 pm to prevent da2n
,. Ahen mi"in3 insulin- aspirate air =rst.
'e3ular insulin should be aspirated =rst.
l. Aatch or complications.
i. Acute hypo3lycemia
ii. Somo3yi eHect rebound hyper3lycemia
iii. &ipodystrophy hardenin3 o the ats due to
re;uent site o administration.
1. abdomen pina,a mabilis ma3 absorb
nan3 insulin
*. arms
1. thi3h
iv. .a2n phenomenon a condition in 2hich the
patient re;uires hi3h dose o insulin in the
mornin3 due to an eHect o 3ro2th hormone
and adrenal hormone
m. ?ypes o Insulin
i. 'apid Actin3
1. A3ent &ispro (+umalo3)B Aspart
*. Onset: 10 to 1/ minutes
1. Pea,: 1 hour
4. .uration: 1 hours
ii. Short:Actin3
1. A3ent: 'e3ular InsulinB +umalo3 'B
#ovolin 'B Iletin II 'e3ular
*. Onset: Y to 1 hour
1. Pea,: * to 1 hours
4. .uration: 4 to D hours
iii. Intermediate:actin3
1. A3ent: #P+B +umulin #B Iletin II &enteB
Iletin II #P+B #ovolin (&ente)B #ovolin #
*. Onset: * to 4 hours
1. Pea,: D to 1* hours
4. .uration: 1D to *0 hours
/. #ote: <iven at 10 pm to prevent .a2n
Phenomenon . 1 am is the best time to
chec, su3ar level or .a2n
iv. &on3:Actin3 Insulin
1. A3ent: Fltralente (F&)
*. Onset: D to 5 hours
1. Pea,: 1* to 1D hours
4. .uration: *0 to 10 hours
v. 9ery &on3:Actin3
1. A3ent: <lar3ine (&antus)
*. Onset: 1 hour
1. Pea,: >ontinous
4. .uration: *4 hours
v. !ducation
1. Proper eet care
a. Ieep your eet dry at all times
b. Kou may apply moisturizer on the eet- e"cept on the
toes or bet2een the toes. A moist area attracts
c. Pat 2hen dryin3 the eet.
d. ?rim your o2n nails. trim strai3ht acrossB do not let
a Podiatrist or manicurist trim your nails
e. .o not soa, your eet on e"treme temperature
. .o not 2al, bareooted
3. 'e3ularly chan3e your soc,s. )est soc, a cotton
=ber soc, because it is absorbent.
h. Fse a 2ell:=tted oot2ear. #ot too ti3ht- not too
loose. )est shoes 2al,in3 on the beach: a canvass
D!A ""N!
>ommon to ?ype 1 >ommon to ?ype *
?here is sli3ht elevation in the blood su3ar
)lood su3ar is hi3hly elevated (E00m3$d&)
Acidosis #o acidosis
+yperventilation or >osmos 'espiration #o hyperventilation or cosmos respiration
?here is ,etone breath #o ,etone breath
#ormal or sli3htly elevated blood osmolality
(normal blood osmolality *D0 to *%0)
+yper osmolar blood (111 osmolality)
+ypernatremia and hypo,alemia +ypernatremia and hypo,alemia
.ue to increase at metabolism .ue to hyper3lycemia and @uid loss-
leadin3 to dehydration- hypernatremia
and hypo,alemia
.ia3nostic ?est: A)<
1. 6irst anticipated action is @uid
replacement. ?he =rst solution to be
used is Isotonic Solution. ?o be ollo2ed
by +ypotonic Solution. #ever use
*. <ive insulin
1. <ive potassium supplement
4. <ive sodium bicarbonate
1. <ive potassium supplement
Sodium +ypochlorite : Active component o .a,inLs Solution
(FS>F&OSI!&!?A& .ISO'.!'S
1. Arthritis
a. In@ammation o Moint
b. Zoint reers to connection o t2o bones or mobility
c. 1 (aMor ?ypes:
i. 'heumatoid Arthritis
ii. Osteoarthritis
iii. <outy Arthritis
A'?+'I?IS '+!F(A?OI. OS?!OA'?+'I?IS <OF?K
.escription Systemic (all Moints)
8 Synovial
#on:systemic (speci=c
or 2ei3ht bearin3 Moint
and Moint in the
interphalan3eal area)
#ot systemic or not
non:systemic- it is a
purine metabolism
>ommon Moint aHected:
)i3 toe$an,les
>ause Idiopathic: )ut said to
be auto:immune
>losely related to 1
- Inection
- +ormonal
- &iestyle
(ost common orm o
>ause: Idiopathic- but
said to be
de3enerative type
'elated to 1 6actors:
- A3in3
- ?rauma
- Obesity
- 6amilial
Increase uric acid level
>ommon Aomen (1/ to /0 yo) )oth se"es (en
Si3ns and
8#ursin3 Action: Apply cold compress
Pain aspirin
StiHness in the Moint
8#ursin3 action: ?a,e a 2arm sho2er bath
Si3n and
Increase synovial @uid
&eadin3 to structural

&eadin3 to physical
#ode ormation:
- +eberdenLs
#ode seen on
distal Moints
(most common)
- )ouchardLs
#ode seen on
pro"imal Moints
Frate crystal
deposition- reerred to
as ?ophi
removal o sinovial
d. .ia3nostic ?ests
i. Qray
ii. >)> (anemia) : common to rheumatoid arthritis because it is an
autoimmune disease
iii. Increased !S' indicates chronic or systemic in@ammation
iv. (P) 'heumatoid 6actor
v. Increased serum uric acid level
vi. I6 ne3ative sa rheumatoid actor and normal uric acid level- tapos
naay in@ammation dia3nosis: Osteoarthritis
e. #ursin3 Alerts:
i. I in@ammation occurs- apply cold compress.
ii. I stiHness occurs- apply 2arm compress or ta,e 2arm sho2er bath.
iii. Supply li3ht:2ei3ht cups- utensils- easy to open bevera3es or
1. type o utensil to oHer: a plastic spoon and or,
*. 6racture
a. 'eers to a brea, in the continuity o the bone
b. (ost common cause: ?rauma
c. * (aMor ?ypes:
i. Open$>ompound a brea, in the bone and the bone is e"posed to
the environment
ii. >losed$Simple A brea, in the bone- but the s,in is intact
1. >omminuted 6racture ra3mented
*. ?ransverse brea, is transversely done
1. Obli;ue slanted brea,
4. Spiral
/. <reenstic, common to pediatricB common site: ulna and
D. .epressed common in s,ull
E. >ompressed common in e"tremities
d. Si3ns and symptoms
i. Pain a33ravated by movement
1. 6irst nursin3 action: immobilize
ii. .evelops in@ammation8
iii. !dema ormation8
1. in@ammation and edema increase the ris, or compartment
iv. Asymmetry
v. +ematoma or discoloration
vi. >omplaints o pain
vii. 8Patient 2ith lon3 bone racture or multiple racture is at ris, to
develop at embolism. at embolism is common on the =rst *4 to
45 hours. And the most common presentation: 'espiratory diUculty.
viii. 8I the patient sustained anterior cranial racture- patient develops
rhinorrhea and raccoonLs eye (discoloration o the periorbital area
or periorbital hematoma).
i". I the patient sustained basilar racture- common presentation is
otorrhea and )attleLs si3n.
e. .ia3nostic ?est
i. Q:ray
. (ana3ement:
i. ?he =rst nursin3 action is to immobilize the patient. Advanta3es:
1. Promote bone healin3
*. .ecreases bleedin3 episodes
1. .ecreases paint
4. .ecreases ris, or urther inMury
(ethods o Immobilization:
1. Splint application
*. >ast application
1. ?raction application
ii. Sur3ery
1. reduction reali3nment o the bone
1. open
*. closed
*. amputation
iii. Fsin3 o assistive device or 2al,in3
1. crutches
*. 2al,er
1. cane
* ?ypes:
1. Plaster o Paris
#ursin3 Alert
a. *4 to E* hours to dry
b. Avoid 2ater
c. .ry the cast but turnin3 the patient every * hours to promote dryin3 o the
cast. Arap the cast on a cotton =ber to promote dryness.
d. !lectric an in dryin3 Plaster o Paris.
e. Ahen carin3 or the cast- use your palm- not your =n3ertips.
. Si3ns o a dry cast 2hite- hard- shiny and resistant
3. Support the cast on a plastic- protected by pillo2 or rubber underneath.
h. .o not cover the cast until it is dry.
*. Synthetic >ast (6iber3lass)
#ursin3 Alert
a. Perorm neurovascular status o the patient
i. #euro 2arm- hot- sharp
ii. 9ascular chec, the capillary re=ll time G 1 seconds
b. Aatch out or >ompartment Syndrome
i. !levate the e"tremity
ii. 'eport to the physician
iii. Prepare the patient or removal o cast
c. It is normal or the patient to eel heat sensation. Ahen it dries- heat must
d. (aintain 3ood s,in inte3rity instruct patient to do isometric e"ercises
i. Isotonic movement contraction and de3ree o @e"ion
ii. Isometric movement contraction
e. >hec, or hot spots
i. +ot spots indicate in@ammation under the cast
. #ote any odor rom the cast inection
3. .o not insert anythin3 under the cast
h. I itchy
i. Scratch the opposite side
ii. <et stra2 and blo2
iii. Pour alcohol
iv. Apply cold compress on top o the cast
v. ?ap the cast on top
vi. .rin, anti:histamine as ordered
vii. Prepare to remove the cast
* ?ypes
1. S,in traction
a. Pullin3 only the s,in
b. Short:term$Intermittent traction
c. Pedia
d. / to 5 pounds (*./ to 1./ ,3)
e. ?ypes o S,in ?raction
i. )uc,s ?raction
1. Patient 2ith racture hip
*. !"erts pull in the e"tremities
1. Priority: Prevention o oot drop. Put some oot plate but
never allo2 to rest the oot on the board
4. Shoc, bloc, 2ill prevent the client rom allin3 the bed and
provides counter traction
/. +o2 to ?urn to sideO
a. >lient may turn to2ards the unaHected side
b. Place pillo2 bet2een the le3s and client can turn
to2ards the unaHected side
ii. 'ussellLs ?raction
1. Fsed to patient 2ith ractured emoral shat
*. Inee bent- suspended in a slin3- attach to rope and pullin3
on a )al,an 6rame
1. Priority: Prevention o s,in brea,do2n in the popliteal area.
4. +o2 to turn the patientO
a. Patient can turn sli3htly rom side to side 2ithout
turnin3 the body belo2 the 2aist
iii. >ervical ?raction
1. Fsed by patient 2ho develops spinal cord inMury- speci=cally
cervical inMury
*. 6irst priority: (aintain head- nec,- spin ali3nment
1. Second priority: Pad the chin- protect the ears.
4. .o not turn the patient. I it is a must to turn the patient- use
lo3 rollin3 techni;ue.
iv. Pelvic ?raction
1. Fsed 2hen the patient develops lo2 bac, pain
*. )est position: Semi:o2lerLs position 2ith ,nee bent
1. Priority: ?o prevent s,in brea,do2n on the lumbo:sacral area
4. ?urn to sideO #O- instead tell the patient to hold the trapeze-
then pull the body
v. )ryantLs ?raction
1. >ommon to pedia
*. Fsed to patient 2ith hip dislocation and racture in the lo2er
1. )oth lo2er e"tremities are raise up$above the mattress
4. Priority: (aintain le3 at %0 de3ree an3le and elevate the
buttoc, above the mattress at 1 inches
*. S,eletal ?raction
a. .octors insert ton3s- pin
b. #ursin3 Priority: Prevention o Inection
Inection Osteomyelitis >A: Staphylococcus Aureus
c. Si3ns and Symptoms
i. In@ammation
ii. 'edness
iii. ?enderness
iv. Pain on the site
v. 6oul smellin3
vi. .ischar3es comin3 rom the site
vii. 6ever
d. #ursin3 Actions
i. Observe or proper pin care sur3ical asepsis
ii. +o2 oten is the pin careO !very 5 hours
e. #ursin3 Alert
i. Perorm neurovascular chec,
ii. Aatch out or compartment syndrome
iii. Instruct the patient to 2i33le toes or =n3ers to promote 3ood
iv. Instruct the patient to do plantar$dorsi@e"ion
v. 'opes must be ali3n and 2ei3hts must be han3 reely
vi. ?he line o traction must be alone the lon3 a"is o the bone
vii. ?here should be no PAI# 2hile on traction pain means not in
proper positionB best nursin3 action is to reposition the patient
>erebral >orte" decorticate
)roca motor speech ormationB speech aphasia
Aernic,e sensory speech understandin3B receptive aphasia
+ypothalamus thirst- limbs
>overin3$Protection o the )rain
1. Scalp
*. S,ull
1. (anin3es
Si3ns o (enin3eal Irritation
a. #uchal ri3idity (stiH nec,)
b. )rudzins,iLs Si3n
c. Ierni3Ls Si3n
d. Opisthotonos
4. >S6
a. Produced by the choroids ple"us
b. Absorbed by arachnoid villi
c. #ormal volume: 1/0 m&
d. #ormal characteristics:
i. >olor: clear and colorless cloudy >S6 means inection
ii. Protein in >S6 normal: 1/ to 4/ m3$d&
Increase protein in >S6 bacterial inection- demyelination
iii. <lucose in >S6 #ormal: /0 to 50 m3$d&
Increase 3lucose hyper3lycemiaB promotes inection
.ecrease 3lucose : hypo3lycemia
iv. <ama <lobulin in >S6 1 to 1* T
1. Increased <ama <lobulin inection
*. Increased I3< demyelination ((S- <)S)
1. Increased I3< (S
4. Increased I3<- Increase >+O# <)S
v. A)> in the >S6 0 to / mm1
1. Increased A)> inection
vi. ')> in the >S6 ne3ative
e. &umbar ?ap
i. Side:lyin3- ,nee chest position- etal position- shrimp position- >
position to 2iden vertebral dis,
ii. &1 and &4
iii. 9oid beore procedure because distended bladder cause headache
iv. Post procedure
1. 6lat on bed 5 to 1* hours to prevent lea,a3e
*. Prone * to 1 hours
1. Post procedure headache increased O6I
v. >ontraindication
1. Increased I>P sudden release o pressure cerebral
herniationB #ormal pressure is / to 1/ mm+3
vi. 1 6actors
1. >S6 9olume 1/0 m&
*. )lood 9olume 1/0 m&
1. )rain 9olume 1-400 m&
88I6 increased- it can cause increased I>P
Si3ns and Symptoms o Increased I>P (Adult)
1. +eadache
*. 9omitin3
1. .ecrease sensory and motor unction
4. Impaired eye movement
/. Fne;ual size o pupils
D. >ushin3 triad increase systolic (2idenin3 pulse pressure)B
decrease diastolicB decrease pulse rate
E. Seizure
5. 'espiratory depression
Si3ns and Symptoms Increased I>P (Pedia)
1. +i3h pitch cry
*. Increase head circumerence
1. )ul3in3 o ontanels
4. >ranial suture separation
/. .ru3s:
a. (annitol : osmotic diuretic
b. >orticosteroid decrease in@ammation
c. Anticonvulsant: Phenytoin (.ilantin) cause 3in3ival
hyperplasia provide oral care and use a sot bristle
tooth bruth 3ive in small amount because it can
cause vasoconstriction and vascular collapse
d. Acetazolamide decrease >S6
D. #ursin3 (ana3ement
a. Position patient: head o the bed elevated and in
neutral position
b. .iet: &o2 #a- 6luid restricted diet- +i3h =ver to
prevent constipation
c. Avoid cou3hin3- sneezin3- bendin3 body belo2 the
2aist- combin3 the hair- brushin3 the teeth
- a disruption in the normal @o2 o blood 3oin3 to the brain
- ?ype
o Ischemic$?hromboembolic
>lot ormation
Atrial @utter- atrial =brillation 2ill lead to clot ormation
Increased I>P
<radual ?IA abrupt neurolo3ic de=cit lastin3 less than 1 hour but
not e"ceedin3 *4 hours
o +emorrha3ic
1 problems:
Increase I>P
Sudden ?IA
1. 9isual 6ield
a. +omonymous hemi
i. )lindness or visual @uid de=cit o either ri3ht or let visual =eld o
both eyes
ii. +ornerLs Syndrome
iii. Priority:
1. Saety o the patient
*. Aal, on the side o the patient that is blind
1. Stay 2ith the unaHected visual =eld
b. &oss o peripheral vision R?unnel 9isionS
i. #ursin3 Implication: Scan the loss visual =eld
c. .iplopia
i. .ouble vision
ii. #ursin3 Implication
1. >over each eye alternately each day
*. Place thin3s o the patient on its proper place and do not
or3et to tell the ;uantity o the obMect
*. (otor .e=cits
a. +emiparesis 2ea,ness
b. +emipla3ia paralysis
i. ?urn patient to side every * hours
ii. AHected side *0 minutes
iii. 'i3ht side on the headboard thin3s 2ill be placed i ri3ht
hemispheric stro,e
iv. 'i3ht hemispheric stro,e AmbulateO &et side approach
v. ImmobilityO Passive 'O(
c. Ata"ia raise side rails
d. .ysarthria diUculty in ormin3 2ordsB use other ormsB .ru3: Piracetam
e. .yspha3ia diUculty s2allo2in3
i. #ursin3 alert: Avoid thin li;uid increase ris, o aspiration
elevate head o bed
1. Sensory .e=cits
a. Paresthesia tin3lin3 sensation- unny eelin3
4. 9isual .e=cits
a. !"pressive Aphasia
b. 'eceptive Aphasia
c. <lobal Aphasia
/. >o3nitive .e=cits
a. (emory loss
b. .ecrease attention span
c. Altered Mud3ment
D. !motional .e=cits
a. .epression motivation: Positive 'einorcement let the patient eel little
b. Aithdra2al
c. .ecrease tolerance to stressul situation
i. 6ormulate short term 3oal
ii. Adhere to the plan- inorm the patient o the plan o care
E. .ia3nostic ?est
a. >? Scan non contrast type
b. ('I no metals allo2ed
c. !I<$!>< dysrhthmia$arrhythmia
d. >erebral An3io3raphy assess or peripheral distal
5. (ana3ement:
a. ?hromboembolic$Ischemic Stro,e
i. <oal: Salva3e brain unction
ii. .ru3s:
1. ?hrombolyic .ru3s
*. Anticoa3ulant
1. Piracetam
iii. (easure to decrease I>P
iv. Sur3ery
v. )est indication or ambulation: .ecrease in I>P
b. +emorrha3ic Stro,e
i. <oal:
1. ?o control bleedin3
*. ?o prevent rebleedin3 common on the 1
* 2ee,s ater
intial bleedin3
1. >orrect or prevent complication
a. 'e:bleedin3 (common)
b. >erebral vasospasm anti choliner3ic Atropine
c. Acute hydrocephalus
d. Seizure$convulsions$epilepsy
4. Speci=c (ana3ement:
a. >omplete bed rest 2ith sedation
b. .ru3s: Anti choliner3ic du3 Piracetam
c. (easures to decrease I>P
d. Sur3ery
e. )est indication or ambulation: #o si3ns o active
- Abnormal sensory- motor- autonomic psychic unctions due to e"cessive =rin3 o
- >auses:
o Idiopathic
.evelopmental deect on the =rst trimester
o Ac;uired
Aller3ic reaction
(etato"ic- metabolic to"ic conditions
)rain tumor$inMury
>#S inections
6ever 6ebrile seizure is 1 months to E years old
- * ?ypes
o Partial e"cessive =rin3 o neurons is 3enerated by part o the brain
Simple Partial conscious- repetitive distal to pro"imal
>omple" Partial unconscious- repetitive distal to pro"imal
Secondary <eneralized Partial unconscious
o <eneralized e"cessive =rin3 o the neurons is 3enerated by the entire
?onic >lonic (<rand:(al)
>ombined 2ith tonic and clonic seizure
?onic is a purposeul body movement$ri3idity lastin3 or 10
to *0 seconds
>lonic is a period o contraction- rela"ation
Absence Seizure (Petit (al)
>haracterized by blan, stares
>ommon to children
&astin3 or less than *0 seconds
A,inetic$Atonic (.rop Attac,)
>haracterized by sudden loss o muscle tone
- .ia3nostic ?est
o !!<
?est that records electrical activity o the brain
&ast or 4/ to D0 minutes
#ursin3 action: Increase chance o seizure
Ahile on !!<
.eprive patient i enou3h rest a ni3ht prior test
- (ana3ement
o .ru3s
Phenytoin (.ilantin)
9alproic Acid (.epa,ene)
o #ursin3 (ana3ement:
#urses maMor role beore and durin3 seizure
Observe and record the event
.uration o seizure
?ype o movement
>ircumstance Must beore the seizure
?he =rst thin3 the patient does beore the seizure
!pileptic cry =rst sound heard Must beore the seizure
Occurrence o aura common aura: epi3astric pain
#ursin3 care durin3 seizure
Provide privacy
Priority: saety
!ase the patient to the @oor
I in bed- raise the side rails- remove the pillo2s and remove
the blan,et to prevent suHocation
Protect the head 2ith a pad
Push aside any urniture
)est time to insert oral air2ay: .urin3 aura
)est position: Side lyin3 position
.o not attempt to restrain the patient durin3 seizure
#urses maMor role ater seizure
)est position: Side lyin3 position 2ith head @e"ed or2ard to
acilitate draina3e o secretion
'e:orient the patient
Allo2 the patient to ta,e the rest. )est approach i the
patient is a3itated or an"ious ater seizure is to use a calm
persuasion and a 3entle restrain.
- a slo2ly pro3ressive neurolo3ic movement disorder
- decrease dopamine (inhibitory)
- ?riad Symptoms
o 'estin3 tremors
+ead o the patient and hand o the patient
+ead side to side
..W+and pill rollin3
o )rady,inesia
Slo2 movement
.ecrease blin,in3 re@e"- loss o acial e"pression (muscle:ace)
&oss o normal arm s2in3 2hile 2al,in3
o (uscle 'i3idity
Increase resistance to passive movement
- Other si3ns and symptoms
o Paro"ysmal @ushin3
o <astric and urinary retention
o Shu[e 3ait
o Stoop posture
o Se"ual dysunction
- .ia3nostic ?est
o #o speci=c test
o P!? Scan (Position !mission ?omo3raphy)
Invasive procedure
Structure and cellular activity
- .ru3s
o &evodopa
Precursor or dopamine
.ecrease vitamin )D because it can inhibit absorption o &evodopa
o Anti:histamine
o (AOI
o .opamin A3onist
o Anti:9iral
- Sur3ery
o Sterotactic Sur3ery it 2ill limit the syndrome (triad)
o ?halamotomy incision o thalamus
o Pallidotomy incision o pallidum
- #ursin3 Alert
o Saety is the primary concern
o )est chairO 'oc,in3 chair
o +un3ry and 2ants to eat utensilsO Provide steel spoon and or,
o 'aise the bedside commode or chair o the patient
o Install hand rails in the >'
- >ommon sites: >/- >D- >E- ?1* and &1
- Si3ns and Symptoms
o >1 >5 (atlas and a"is)
.evelops ;uadriple3ia
'espiratory 6ailure
)ladder- bo2el dysunction
o ?1 &4
)ladder and bo2el dysunction
o Spinal >ord InMury above ?D- Increases the ris, o Autonomic .ysre@e"ia
(autonomic hyperre@e"ia)
Si3ns and Symptoms
(otor de=cits o the upper e"tremities F!
)o2el$bladder dysunction
&oss o pain- touch- temperature sensation- P motor de=cits &!
Ipsilateral Paralysis
- .ia3nostic ?est
o Q:ray
o >? Scan
o ('I careul or patients 2ith claustrophobia
- .ru3
o >orticosteroid to decrease in@ammation
- Speci=c (ana3ement
o Immobilize the patient
o PriorityO (aintain nec, and spine ali3nment
o Fsin3 o devices:
?raction and +alo vest drivin3 is contraindicated
o Sur3ery
- #ursin3 Alert
o (aintain 3ood s,in inte3rity
o (aintain urinary elimination
Frinary elimination distended urinary bladder autonomic dysre@e"ia
o Promote ade;uate breathin3 and air2ay clearance
o (onitor or complications
Orthostatic hypotension$postural hypotension
9ircho2s ?riad
o 9enous Stasis
o +ypercoa3ulopathy
Increase platelet
o )lood vessel 2all inMury
Si3ns and Symptoms
Positive +omanLs Si3n
Pain or tenderness on the site common: lo2er pelvis or cal
.istention o super=cial veins
Aarm s,in to touch
)ed rest minimum o 1 days
Improve venous return
o AHected &imb do not massa3e- no passive 'O(- do
not apply compression- no e"ercise- do not put pillo2
under the ,nee
o FnaHected limbs promote passive 'O(
o Anti:emboli stoc,in3 best time is early in the
mornin3 beore raisin3 up rom bed
o Aarm compress 2arm compress siteO &o2er part o
the abdomen
Autonomic .ysre@e"ia
Abnormal sympathetic reaction that arises ater spinal shoc,
>ommon to S>I above ?D
Spinal Shoc, an abrupt loss in spinal cord unction
o .istended visceral or3an urinary bladder
o Physical stimuli constipation
Si3ns and Symptoms
o Severe headache
o Severe hypertension
(ost common cause o death
+ead o the bed elevated
o 6acial @ushin3
o .iaphoresis orehead o the patient
o Pallor belo2 the lesion
o 6irst #ursin3 Action:
Promote urinary elimination
I catheter is attached- chec, or obstruction
o .ecrease physical stimuli
.ru3 o >hoice
o Apressolin (+ydralazine)
o Other hypertensive dru3s
- Autoimmune problem aHectin3 myoneural Munction causin3 varyin3 de3ree o
2ea,ness o the ace- throat and other voluntary muscles due to production o
antibodies speci=c or acetylcholine
- >ommon: Aomen (*0 to 40 years old)
(en (D0 to E0 years old)
- Idiopathic
- Si3ns and Symptoms
o Ptosis and .iplopia early maniestation
o <eneralized 2ea,ness
<eneralized 2ea,ness respiratory ailure death
o #asal Smile : +allmar,
- .ia3nostic ?est
o ?ensilon ?est
Anti:cholinesterase test
?ensilon !drophonium +>lB inhibits Ach brea,do2n
* m3 N a time J 10 m3
10 seconds post administration
#e3ative 2ea,ness$ptosis or 1 to / minutes positive tensilon
10 m3 3iven N chetine >holiner3ic >risis
>holiner3ic >risis
Si3ns and Symptoms
>rampin3 and Aea,ness
Antidote: Atropine Sulate 0.4 m3
(estinon (Prydostimine )romide) and Prosti3mine
(#eosti3mine )romide)
o (ust be 3iven beore meal to improve motor activity
o >leansin3 o the blood to remove circulatory
o 'emoval o thymus ?hymectomy
o 1 >ommon Problems
(yasthenia crisis
Aea,ness respiratory ailure
>holiner3ic >risis overdose
?est to diHerentiate ?ensilon ?est
)rittle crisis
88(yasthenic positive sli3ht increase muscle
88>holiner3ic e"acerbate 2ea,ness
o (ana3ement:
(yasthenia >risis 3ive ?ensilon
>holiner3ic >risis stop ?ensilon and 3ive
atropine sulate
)rittle crisis : plasmapheresis
(I pain radiates N let arm
Spleen pain radiates N let shoulder
<allbladder pain radiates N ri3ht shoulder
Frinary bladder pain radiates on shoulders ri3ht and let
'enal >alculi
1. Iidney stones- urolithiasis
*. (ost common cause o upper urinary tract inection
1. Stones
a. >alcium Stones due to hypercalcemia
b. Frate Stones due to increase uric acid level (Purine metabolism disorder)
c. >ystine Stones rare (Amino acid metabolism disorder)
d. (a3nessium Ammonium Phosphate Stone sta3horn$struvite (F?I)
4. Si3ns and Symptoms
a. Pain classic symptom o 'enal >alculi (costovertebral an3le)
i. 'enal colic brou3ht about by over stretchin3 o the ureter or other
collectin3 systemB deep dull ache and e"a33erated by drin,in3
lar3e volume o li;uid
ii. #on colic,y Pain due to pressure on the renal pelvisB
hydronephrosis increase in pressure causes pain
/. .ia3nostic ?est
a. Frinarlysis
i. +ematuria- F?I- crystals ormation
ii. (ost important nursin3 action: Strain the urine o the patient usin3
several layer o 3auze.
iii. Send to laboratory or analysis
b. 'adio3raph
i. Qray
ii. Fltrasound
iii. )ladder is ull prior to the test
c. )lood analysis
i. Increase A)> F?I
ii. Increase uric acid
iii. Increase calcium
D. (ana3ement
a. .ru3s
i. Anal3esic
ii. .iuretic
iii. Antibiotic
iv. Anti:3out
v. Anti:in@ammatory
vi. Alpha:bloc,ers bloc, alpha receptors to rela" smooth muscle
vii. .o"azosin- ?era"osin
viii. >alcitonin or hypercalcemia
b. .ietary (odi=cation
c. Sur3ery
i. Percutaneous #ephrolithotomy
ii. &ithotripsy
1. #ursin3 alert: Post lithotripsy Increase O6I to @ush stones
d. Speci=c (ana3ement
i. >alcium Stones
1. Increase O6I
*. .iuretics
1. &o2 calcium diet
4. >alcitonin
ii. Frate Stones
1. Increase O6I (* to 1 &$day)
*. .ecrease purine diet
1. .ru3s Allopurinol- >olchicine
4. Al,alanization o urine al,aline:ash dietB drin, mil, and
citrus Muice
iii. >ystine Stones
1. Increase O6I
*. .iuretic
1. Al,alinization o urine
iv. (a3nesium Ammonium Phosphate Stone
1. Increase O6I
*. .ru3s: >ipro@o"acin /00 m3 ?I. " E days
'ocephin 1 3m I( sin3le dose
.o"ycycline 1000m3 )I. " E days
1. Acidiy the urine acid:ash dietB drin, cranberry Muice
- !nlar3ement o the prostate narro2in3 o ureter
- >ause
o F,no2n
o 'elated: A3in3 above D0 years old and Andro3en hormone imbalance
- Si3ns and Symptoms
o Frinary re;uency
o .ribblin3 urine
o +ematuria
o Frinary stasis
o Obstructive voidin3 syndrome
.iUculty startin3 urination
Frinary hesitancy
.ecrease urine stream orce
6eelin3 o incomplete voidin3
- .ia3nostic ?est
o (ost de=nitive test: >ystouretheroscopy
o Frinalysis
o .'! (.i3ital 'ectal !"am) evaluate the size o the prostate
Prostate sot )P+
Prostate =rm prostate >A
o )lood analysis
)F#$>reatinine ('6)
PSA &evel #ormal: 4 to 10 m3$m&)
- (ana3ement:
o .ru3s
Alpha bloc,ers
Andro3en hormone inhibitor
!"ample: Proscar
o >atheterization
o Sur3ery
(ost eHective: Prostatectomy removal o the prostate
o &ead to impotence
?ransurethral (?F'P)
o Post procedure continuous bladder irri3ation
(cystoclysis$murphyLs drip$>)I)

- #ursin3 Alert