POSITIONS Abdominal aneurysm surgery: Fowler position to prevent pressure on the graft.

Air embolism: Left side position and lower head of the bed to promote air to the right atrium and prevent to be carried to the systemic circulation. Appendicitis: Any position if unruptured, and semi fowler if ruptured. Asthma: Sitting position, leaning forward, to promote patient breathing Autonomic dysreflexia: High fowler. It will prevent patient from hypertension stroke. Bronchoscopy: Semi Fowler, to prevent aspiration after procedure. Broncholitis: Tripod position. Cast: elevate extremity to prevent edema. Cataract surgery: Semi fowler to prevent edema at the operative site. Cerebral aneurysm: Semi fowler. Cleft lip: Supine after operation, prevent pressure on the suture line. Cleft palate: Prone position. Congestive heart failure: High Fowler that improve oxygenation. Craniotomy: Semi fowler if supratentorial, and Flat if infratentorial that can promote drainage from the head. Cerebro vascular accident: Elevate the head to reduce intra cranial pressure. Dumping syndrome: Supine position after meal. It prevents rapid emptying or the stomach. Epistaxis: Leaning forward to prevent blood aspiration. Flail chest: Keep patient on affected side to promote expansion of the unaffected lung. Hemorroidectomy: Side lying. Hiatal hernia: Upright position after meals to prevent reflux of stomach contents. Hip surgery: Legs in abduction position that can prevent dislodge of the head of the femur from acetabulum. Hypophysectomy: Elevate head of the bed to prevent increase intracranial pressure Increased Intracranial Pressure (ICP): Elevate head of the bed. Laminectomy: Prevent twisting of the spine with keeping the back as straight as possible. Laryngectomy: Semi fowler for maintaining airway and reduce edema. Liver biopsy: Right side position post procedure to prevent patient from bleeding. Lobectomy: Semi fowler Lumbar puncture: Lateral side lying during procedure and flat after procedure. Mastectomy: Elevate the extremity of the affected side (on pillow) to prevent edema. Myelogram: Elevate the head if water based dye was used, and flat if oil based dye was used. Placenta previa: Sitting position that can minimize bleeding. Prolapse cord: Knee-chest Position to prevent pressure on the cord. Pulmonary edema: Fowler position. Pyloric stenosis: Right side lying position after meal, to facilitate entry of the stomach contents into the intestines. Radium implant in the cervix: Flat to prevent dislodge of the implant. Retinal detachment: The affected side toward the bed to help the detached retina to fall back in place. Seizure: Side lying position Shock: Modified trendelenburg to promote venous return. Spinal cord injury: Immobilize the patient Thoracentesis: Fowler position during procedure and any position after Thrombophlebitis: Bed rest and elevate the affected leg to promote circulation Thyroidectomy: Semi Fowler ad avoid hyperflexion and hyperextension of the neck. Tonsillectomy: Sidelying or prone Total Parenteral Nutrition: Trendelenburg during tube insertion to prevent air embolism Tracheoesophagel Fistula (TEF): Supine with the head elevated at least 30 degrees Varicose veins: elevate the legs above the level of heart Vein stripping and ligation: Legs are elevated to prevent venous stasis INITIAL S/S Acromegaly: coarsening of facial features Acute glomerulonephritis: edema Acute lympocytic leukemia: anemia Acute respiratory distress syndrome: rapid shallow breathing Alzeimer's disease: progressive memory loss

Anemia iron deficiency: fatigue Anemia pernicious: fatigue Anemia sickle cell: growth retardation Angina pectoris: chest pain Arthritis rheumatoid: morning stiffness Autonomic dysreflexia: hypertension Benign prostatic hypertrophy: reduction in size and force of urinary stream Bronchogenic carcinoma: changing cough Cancer bladder: painless hematuria Cancer breast: mass/lump/thickening Cancer cervix: bleeding Cancer esophagus: dysphagia after ingestion of solid foods. Cancer larynx: change in voices or hoarseness Cancer ovary: vague abdominal discomfort and dyspepsia Cancer testes: painless swelling Cataract: blurring of vision Congestive heart failure: dyspnea (if left side) and edema (if right side) Congenital hip dislocation: shorter of affected leg Crohn's disease: right lower quadrant pain Cystic fibrosis: meconium ileus Cystitis: burning on urination Diabetes mellitus: polyuria Dumping syndrome: dizziness, diarrhea, diaphoresis Guillain-bare syndrome: ascending weakness beginning in the lower extremities, clumsiness Hepatic encephalopathy: personality changes Hiatal hernia: heartburn 30 minutes after meals Hyperthyroidism: nervousness Hypocalcemia: tingling sensation around the lips and the fingers Hypokalemia: muscle weakness Hypovolemic shock: increased pulse rate Hypoxia: restlessness Increased ICP : widening pulse pressure , decreasing LOC Liver cirrhosis: hepatomegaly Lyme's disease: bull's eye rash Meniere's disease: vertigo Mengingitis: headache Multiple sclerosis: diplopia Myasthenia gravis: muscle weakness Nephrotic syndrome: periorbital edema Otitis media: pain Pancreatitis: periumbilical pain Parkinson's disease: unilateral pill rolling tremors Retinal detachment: visual floaters Retinoblastoma: cat's eye reflex Tardive dyskinesia: tongue twitching Thyroid crisis: increased temperature Ulcerative colitis: recurrent bloody diarrhea

DIETS Acne : low fat Acute gastroenteritis : clear liquid Acute glomerulonephritis : low Natrium, low Protein Addison disease : high Natrium, Low kalium Anemia - iron deficiency : high iron Anemia - pernicious : high protein, vitamin B

Anemia sickle cell : high fluid Angina pectoris : low cholesterol Arthritis gout : purine restricted Attention Deficit Hyperactivity Disorder (ADHD) : finger foods Bipolar disorder : finger foods Burn : high calorie, high protin Celiac's disease : gluten free Cholecystitis : high protein, high carbohydrate, low fat Congestive heart failure : low natrium, low cholesterol Congestive heart failure : low natrium, low cholesterol Cretinism : high protein, high calcium Crohn disease : high protein, high carbohydrate, low fat Cushing disease : high kalium, low natrium Cystic fibrosis : high calorie, high natrium Cystitis : acid ash (for alkaline stones) and alkaline ash( for acid stones) Decubitus ulcer : high protein, high vitamin C Diabetes mellitus : well balanced diet Diarrhea : high kalium, high natrium Diverticulitis : low residue Diverticulosis : high residue with no seeds Dumping syndrome : high fat, high protein, dry food Hepatic encephalopathy : low protein Hepatitis : hight protein, high calorie Hirschsprung disease : high calorie, low residue, high protein Hyperparathyroidism : low calcium Hypertension : salt restricted Hyperthyroidism : high calorie, high protein Hypoparathyroidism : high calcium, low phosphorus Hypthyroidism : low calorie, low cholesterol, low saturated fat Kawasakis' disease : clear liquid Liver cirrhosis : low protein Meniere's disease : low natrium Myocardial infarction : low fat, low cholesterol, low natrium Nephritic syndrome : low natrium, high protein, high calorie Osteoporosis : high calcium, high vitamin D Pancreatitis : low fat Peptic ulcer : high fat, high carbohydrate, low protein Phenylketonuria : low protein/phenylalanine Pregnancy induced hypertension : high protein Renal colic : low sodium, low protein Renal failure acute : low protein, high carbohydrate, low natrium (oliguric phase), high protein, high calorie, restricted fluid (diuretic phase) Renal failure chronic : low protein, low natrium, low kalium Tonsillitis : clear liquid MAJOR DIETARY SOURCES: CARBOHYDRATE Bread, Cereal, Crackers, Corn, Potatoes PROTEIN Beef, Pork, Fish, Cheese FAT SOURCE Margarine, Avocado, Nuts, Olives, Peanut, MayonnaisE

DEVELOPMENT INFANT (0-1 YEAR) Immunization schedule: Hepatitis B is given at birth, at two months, and at six months. OPV at 2, 4, 15 months, DPT at 2, 4, 6 months. Iron supplement starts at 4-6 months No choking hazards. Fear of stranger at 8 months. Allow to use pacifier if in NPO. Note the weight: doubles at 6 months, triples at 1 year, and quadruples at 2.5 years. Trust vs. mistrust. Solitary play. TODDLER (1-3 YEARS) Talk to child in simple terms Offer choices to provide some control. Do not leave alone near the swimming pool or bathtub. Doubt and shame vs. autonomy Learns about death beginning at 3 years Elimination pattern: toilet training begins at 18 months. Rituals and routine. PRE-SCHOOLER (3-6 YEARS) Play is associative cooperative Regression is common. Explain every procedure. Same age group for room assignment Curious Highly imaginative Imaginary playmate Observe for initiative vs. guilt Off limits to the kitchen because of risk for poisoning and burns. Loss of body part (mutilation) is a common fear. SCHOOLER (6-12 YEARS) Same sex stage. Competitive play Hero-worship, realistic and universal concept of death: age 9-10 age. Observe for industry vs. inferiority. Off limits to vehicles because of risk for accidents. Loss of control is a common fear. Explain procedures. Regression is common. DISEASES & COMPLICATIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Acute gastroenteritis : dehydration Acute lymphcytic leukemia : bleeding Addison's disease : shock Anemia-pernicious : peripheral neuritis Anemia-sickle cell : cerebrovascular accident Cardia vulvular disorder congestive heart failure Cystic fibrosis : male to be sterility, female to be difficulty conceiving Cholelithiasis : cholecystitis Complete heart block : congestive heart failure Gonorrhea : pelvic inflammatory disease (PID) Herpes : cervical cancer Hypertension : cerebrovascular accident

13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Infectious mononucleosis : splenic rupture Lyme's disease : pralysis Lead poisoning : mental retardation Meningitis : hearing impairment Mitral valve stenosis : acute glomerulonephritis Mycardiacl infarction : premature ventricular contraction (PVC) Pancreatitis : hypocalcemia / hyperglycemia Phenylkenounia (PKU) : mental retardation Polycyethemia vera : cerebrovascular accident Pre-eclampsia : abruption placenta Septicemia : shock Sexually transmitted disease (STD) : pelvic inflammatory disease (female) Sore throat : rheumatic heart disease, mitral valve stenosis, acute glomerulonephritis

ISOLATION STRICT ISOLATION It is practiced for highly transmissible diseases by direct contact and airborne routes. It requires: private room, gown, mask, glove, hand washing, and double bagged for soiled articles. Diseases: Diptheria-pharyngeal, herpes zoster, pneumonia, varicella. RESPIRATORY ISOLATION It is practiced for droplet transmission. It requires: private room, mask, hand washing, and labeled plastic bags for soiled articles. Patient with same organism may share room. Diseases: H. influenza, measles, mumps, N. meningitis. TUBERCULOSIS / AFB ISOLATION It is practiced for suspected or active tuberculosis. It requires: mask, hand washing, and private room with negative pressure (room air vented to outside). Disease: Tuberculosis CONTACT ISOLATION It is practiced for infectious diseases or multiple resistant micro organism that are spread by close or direct contact. It requires: private room, mask, gown, and glove. Diseases: Diptheria-cutaneous, herpes simplex, MRSA, pediculosis, scabies, syphilis. ENTERIC PRECAUTION It is practiced for infectious diseases that transmitted through direct or indirect contact with infected feces. It requires: private room, hand washing, gloves, and gowns. Gowns are worn only when contact any object contaminated with feces. Diseases: Aseptic meningitis, diarrhea, gastroenteritis, hepatitis A, typhoid fever. DRAINAGE / SECRETION PRECAUTION It is practiced for patient with wound drainage (infected wound). It requires: gloves and gowns. Disease: Burns UNIVERSAL BLOOD AND BODY FLUID PRECAUTION It is practiced when possibly contact with blood-borne and body fluids pathogens (blood, semen, vaginal secretion, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, CSF, and tissue. It requires: gloves, masks, protective eye gears, and gowns. Used / contaminated needle should never recapped. Used needles and other sharp items are kept in a puncture resistant container (sharp box container). Diseases: AIDS, hepatitis B, hepatitis C.

DIABETES/INSULIN Basic Types of Insulin The goal of insulin therapy is strict blood glucose control. Rapid Acting Humalog, Novolog Onset-15 mins Peak- 1 hour Duration- 3 hours Client Teaching-Give with meals Short Acting Humalog R, Novolin R Onset-1 hour Peak- 2 hours Onset- 4 hours Client Teaching- Clear appearance Only type that can be given IV Intermediate Acting NPH, Humulin N Onset-4 hours Peak-8 hours Duration- 12 hours Client Teaching- Cloudy appearance When mixing insulin draw Regular before Intermediate Think "clear before cloudy" Long Acting Lantus Onset 1 hour Peak- No peak (continuous) Duration- 24 hours Client Teaching- Taken at bedtime General Insulin Teaching Inject subcutaneously-do not aspirate Do not massage site after injection Rotate injection site May need to decrease insulin after exercise to prevent hypoglycemia Oral Antidiabetic Agents (Metformin, Byetta, Glucophage, Avandia) Must be used in conjunction with diet and exercise comes in tablet form give 30 minutes before meals used to treat type 2 diabetes only Do not give to type 1 diabetics Side Effects: GI disturbance (diarrhea, nausea, etc.) Headache Weight gain Client Teaching:-Several medications interfere with Oral antidiabetics: Coumadin Oral Contraceptives Corticosteriods Symptoms of hyper/hypoglycemia

1. Answer B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia. 2. Answer A. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesnt accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isnt associated with tetany. 3. Answer D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the clients care. The nurse doesnt normally provide sex counseling. 4. Answer B. Diabetic clients must exercise at least three times a week to meet the goals of planned exercise lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldnt achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement. 5. Answer B. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter). 6. Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options arent associated with levothyroxine. 7. Answer D. Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they dont have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria. 8. Answer A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus. 9. Answer D. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation. 10. Answer C. The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesnt require a fasting period before blood is drawn. The nurse cant conclude that the result occurs from poor dietary management or inadequate insulin coverage. 11. Answer A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation arent seen in hyperkalemia. 12. Answer A. ADH is the hormone clients with diabetes insipidus lack. The clients TSH, FSH, and LH levels wont be affected. 13. Answer B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia. 14. Answer C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance. 15. Answer D. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isnt associated with the other options. 16. Answer C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the clients already heightened fluid load. 17. Answer A. This clients serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseaus sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegars sign (softening of the uterine isthmus) and Goodells sign (cervical softening) are probable signs of pregnancy. 18. Answer A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasnt been effective.

19. Answer A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isnt associated with hyperglycemia, nor is growth hormone deficiency. 20. Answer D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldnt help control hypoglycemia. 21. Answer C. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimotos thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role. 22. Answer B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents arent effective in type 1 diabetes. Pregnant and lactating women arent prescribed oral antidiabetic agents because the effect on the fetus is uncertain. 23. Answer A. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesnt cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia. 24. Answer B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldnt be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. 25. Answer D. To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesnt affect swallowing.