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Want MORE VISIT NURSING NOTES http://www.nursingnotes.info/
SNS : Adrenergic Agents – Epinephrine (adrenaline)
Anticholinergic , Sympathomimetic, Parasympatholytic
-Atropine sulfate
PNS: Cholinergics, Beta Adrenergic blockers, Sympatholitic, Parasympathomimetic
Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’)– Blocks release of norepinephrine.– Decrease body activities except GIT (diarrhea)Ex. Propanolol, MetopanololSE:B – broncho spasm (bronchoconstriction)E – elicits a decrease in myocardial contractionT – treats HPN
A – AV conduction slows down
DEMYELLENATING DISEASE
1.)ALZHEIMER’S DISEASE– atrophy of brain tissue due to a deficiency of acetylcholine.
S&Sx:
A – amnesia – loss of memoryA – apraxia – unable to determine function & purpose of objectA – agnosia – unable to recognize familiar objectA – aphasia –- Expressive – brocca’s aphasia – unable to speak- Receptive – wernickes aphasia – unable to understand spoken wordsCommon to Alzheimer – receptive aphasiaDrug of choice – ARICEPT (taken at bedtime) & COGNEX.Mgt: Supportive & palliative.
Microglia – stationary cells, engulfs bacteria, engulfs cellular debris.
Bronchoscopyo AtSO4
Anticholinergic mimics SNR Decreases saliva dry mouth
o NPO 6 to 8 hourso Local anesthesia check gag reflex before feeding
ABGo Hyperventilation decreased CO2 increased blood pH respiratory alkalosiso Hypoventilation increased CO2 decreased blood pH respiratory acidosiso Diarrhea decreased HCO3 decreased blood pH metabolic acidosiso Vomiting gastric content decreased HCL increased blood pH metabolic alkalosiso Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid
decreased blood pH metabolic acidosiso Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosiso Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory
Alkalosiso Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic
acidosis
Cancer of the larynx CS, alcohol and over usage of voice (choir member)o A - nterior neck masso B – urning sensation with hot beverages / Bad breatho C - hange in the voice (hoarseness)o D – ysphagia/dyspnea
Chronic Obstructive Pulmonary Diseaseo Chronic Bronchitis
Blue bloater Excessive mucus production
o Asthma Periods of bronchospasm and bronchoconstriction
o Emphysema Disequilibrium of elastase and antielastase Pink puffer
o Manifestations A – LTERATION IN
LOC decreased O2 Thoracic anatomy over distention of alveoli TD = APD barrel chest Skin
o Temperature cool clammy skino Color pale to cyanotic
ABG Respiratory acidosis Increased CO2 B – reathing difficulty, purse lip expiration > inhalation removal of excess CO2
(diet low CHO) C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2
demand by rest and SFF) clubbing of the fingers and decreased TP to the kidneys causing polycythemia
D – ecreased Metabolism Anorexia weight loss (high calorie diet) fatigue weakness
Bronchodilatorso Theophylline and aminophylline
Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodilation
Side effect stimulates beta 1 receptors increases cardiac rate need not to notify the physician
Adverse effect hypotension monitor BP sign of toxicity Evaluation check breath sounds
Pulmonary embolismo Restlessness earliest sign
Water Seal Systemo Drainage Bottle marked the level every shifto Water seal bottle
Presence of fluctuation normal Absence of fluctuation lungs are fully expanded assess first patient (X ray
confirm) OR presence of obstruction Intermittent bubbling normal
Absent obstruction Continuous leakage
o Suction Control continuous bubbling normal
Risk factors for cardiovascular disorderso R – ace non modifiableo I – ncreased blood pressure modifiableo S – tress SNR increased BP and CR, vasoconstriction modifiableo K – nowing sedentary life style modifiableo F – at foods atherosclerosis modifiableo A – lcohol (modifiable) / Age above 40 (non modifiable)o C – igarette smoking vasoconstriction (nicotine) modifiable / Contraceptive pills clotting
of blood thrombus formationo T – ype A behavior (modifiable) competitiveness, perfectionist high stress levelo O – besityo R – esult of DM lipolysis increased fatty acids atherosclerosis
o S – ex gender males > female (before menopausal because estrogen decreases PVR) after menopausal female eversible}[inverted T wave] Injury [elevated ST segment] > male
Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart) decreased TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid PAIN management decreased O2 demand by rest and SFF
Angina o Pain relieved by rest and NTGo NTG
Vasodilation orthostatic hypotension move gradually Monitor BP Store in a dark and amber container Effective tingling sensation no need to notify physician Maximum of 3 tablets with 5 minute interval
MIo Pain relieved by Morphine SO4
Narcotic analgesic Can cause respiratory depression monitor RR and O2 saturation Antidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Buerger’s disease CS vasoconstriction stop CS common in men
Raynaud’s stress and cold vasoconstriction common in female
Congestive heart failureo Left sided pulmonary
Dyspnea Crackles Polycythemia due to decrease O2 to the kidneys Clubbing of the fingers due to prolonged hyxia Orthopnea
o Right sided systemic Hepatomegaly Distended neck veins Edema Portal hypertension Ascites weight gain Varicose veins
o Digoxin Cardiac glycoside Positive inotrophic effect increased strength of myocardial contraction Negative chronotrophic effect decreased cardiac rate monitor CR never give if
CR below 60 bpm Adverse effect
V – omitting A – norexia N – ausea D – iarrhea A – bdominal pain REMEMBER: earliest GI; late halo vision Antidote Digibind
Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia
Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high risk for injury
Decreased WBC prone to infection, reverse isolation
Increased WBC presence of infection
First Day/Newly diagnosed Knowledge deficit
Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT antidote protamine SO4
Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PT vitamin K is the antidote
Urokinase/Streptoase dissolves the clot
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of Vitamin B12 beefy red tongue schilling’s test definitive test 24 hour urine collection life long Vitamin B12
Gastritis LUQ pain
Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) pain relieved by antacids
Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids, NSAIDs, indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and gastric movement
Dumping syndrome tachycardia and weakness 3 D’s (diarrhea, diaphoresis and dizziness) fluids after meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix sudden cessation of pain, elevation of temperature and WBC
Diverticulitis LLQ pain low fiber diet
Diverticulosis high fiber diet
Ulcerative colitis bloody diarrhea 15 to 20 times a day fluid volume deficit, anemia
Liver cirrhosis alcohol and malnutrition (laennec’s), infection and drugs (post necrotic), RSCHF (cardiac) and biliary obstruction (biliary)
o Portal hypertention can lead to Blood shifted to the different collateral
Esophageal varices Spider angioma (face and neck) Caput medusae (abdomen) Hemorrhoids (rectal) Management avoid rupture avoid shouting, valsalva maneuver
Increased hydstatic pressure fluid shifting asciteso Decreased albumin decreased oncotic / colloidal osmotic pressure fluid shifting ascites
management high protein dieto CHON metabolism by product ammonia liver cannot convert to urea increased level of
ammonia in the brain Alteration of LOC and changes of behavior and asterexis hepatic encephalopathy management low CHON diet and lactulose for removal of ammonia
Hepatitis A fecal oral prone plumber
Hepatitis B body secretion prone working in a dialysis
Cholecystitis 5 F’s (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food demerol to relieved pain
Cholecystectomy T tube level of the incision site drain excess bile
Pancreatitis alcohol autodigestion LUQ pain
Anterior Pituitary glando Growth hormone
Increased before the closure of the epiphysis of the long bones gigantism tall Increased after the closure of the epiphysis acromegaly big hands (big gloves), big
feet (big shoes) and big head (big hat) Decreased dwarfism
o Prolactin Increased galactorrhea Decreased decreased milk production
o ACTH Increased secondary cushing’s Decreased secondary addison’s
o TSH Increased secondary hypethyroidism Decreased secondary hypothyroidism
Posterior pituitary gland o ADH
Increased water retention oliguria edema (fluid volume excess) and weight gain concentrated urine increased urine specific gravity
Decreased water excretion polyuria dehydration (fluid volume deficit and weight loss) diluted urine decreased urine specific gravity
Parathyroid glando Parathormone
Increased increased calcium in the blood and decrease calcium in the bones stone formation and decreased bone mass osteoporosis management increased water intake
Decreased hypocalcemia calcium supplement
Thyroid Glando Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increased catabolism weight loss increased appetite increased peristalsis Diarrhea fluid volume deficit Increased CR and RR (due to increased BMR)
Increased T3 heat intolerance Calcitonin decreased calcium in the blood tetany compensatory calcium
withdraws from the bones bone destruction (complication) PTU decreased synthesis of TH watch out for SE (similar to signs and symptoms
of hypothyroidism) watch out for agrunulocytosis (fever, skin rash and sore throat) Lugol’s solution decreased released of TH before thyroidectomy decreased
vascularity of the thyroid glando Decreased (hypothyroidism)
T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight gain anorexia decreased peristalsis constipation decreased CR and RR due to decreased BMR
T3 cold intolerance Calcitonin hypercalcemia stone formation Synthroid and Proloid increased TH
Adrenal Glando Incresead (cushing’s)
Glucocorticoids hyperglycemia and decrease wound healing Mineral corticoids increased aldosterone sodium retention and potassium excretion
hypernatremia and hypokalemia Hypernatremia water retention oliguria edema (moon face,buffalohump,
fluid volume excess and weight gain) concentrated urine increased urine specific gravity low sodium diet
Hypokalemia weakness Prominent U wave high potassium diet Epinephrine and Norepinephrine Increased BP and CR Sex hormones
Males gynecomastia and falling of hair Females hirsutism and deepening of the voice
o Decreased (addisons) Glucocorticoids hypoglycemia and inability to cope with stress
Mineralcorticoids decreased aldosterone sodium excretion and potassium retention hyponatremia and hyperkalemia
Hyponatremia water excretion polyuria (dehydration, fluid volume deficit and weight loss) diluted urine --. Decreased urine specific gravity increased fluids and Na
Hyperkalemia weakness tall or peaked T waves low K diet Epinephrine and Norepinephrine decreased BP and CR
Diabetes Mellituso Type I absolutely no insulin thin insulino Type II insufficient insulin obese OHAo Diet 50% CHO, 30% Fats, 20% CHONo Exercise Increased uptake of glucose Decreased insulin requiremento Oral hypoglycemic agent (OHA)
Stimulates pancreas to produce insulin
o Insulin SC; IV if DKA Never massage the area Never administer cold insulin Rotate the site of injection
PREVENTS LIPODYSTROPHY Mix
Aspirate clear first Inject air to cloudy first
o DKA increased lipolysis increased ketoneso Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria
and warm flush skino Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurateo Foot care
Podiatrist Avoid removing corns and calluses Cut toe nails straight across Avoid walking bare foot
Hepatitis A fecal oral
Hepatitis B body and bloody secretions (hemodialysis)
Peritoneal Dialysiso Diasylate output is decreased turn patient from side to sideo Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and
rigid abdomen peritonitiso Don’t include diasylate solution in the output of the cliento Expected decreased weight monitor weight before and after decreased createnine and
BUN
Heart block decreased tissue perfusion
Parkinson’s diaseaseo Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6
foodso Cardinals signs tremors (non intentional) muscle rigidity bradykinesiao Pill rollingo Microphonia ask your client to speak aloud to be awareo Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Graviso Tensilon test confirmatory testo Decreased Acetylcholine and increased cholinesteraseo Muscle weakness priority airwayo NO tranquilizer, Morphine SO4, Muscle relaxant and neomycino Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics Over medication cholinergic crisis give ATSO4
Multiple Sclerosiso Demyelinization of the myelin sheatho Charcoat’s triad
Intentional tremors Scanning of speech Nystagmus
o Visual disturbances diplopia
Pancreatitis autodigestion alcohol bleeding shocko Elevated amylase
Rheumatoid Arthritis o No specific diagnostic testo NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis
(joint fixation)o Avoid flexion and promote prone position
Gouty Arthritiso Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritiso Most common related with agingo Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Diverticulitis LLQ pain and low fiber diet
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
Vincristine (Oncovin) increased fiber in the diet
Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice)
Steroids and NSAID’so DEATH inflammationo BIRTH side effects
B – one marrow depression prone to infection monitor temperature and WBC I – ncreased gastric irritation take it with food or after meals R – enal toxicity T – innitus H – epato toxic
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision miotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
Avoid Increased Intraocular pressure PRIORITYo Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
Meniere’s Triad tinnitus, impaired hearing loss and vertigo low Na dieto Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the
room assume a flat or reclining position
ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Antibiotics allergic reactions
Normal Valueso BUN = 10 – 20 mg/dlo Calcium = 9 to 10.5 mg/dlo Creatinine = 5 to 1.5 mg/dlo GTT = 70 to 115 mg/dlo O2 sat = 97 to 98%