Must Know***

thyroid stimulating hormone* def

- blood test to differentiate diagnosis of hypothyroidism - increase = hypothyroidism - decrease = hyperthyroidism or secondary education

sterile package list###

- means double wrapped package containing small sterile package * wash hand * put nonsterile-gloves * touch only outside wrapper * loosen the tape toward you 1. open top flap away from you 2. open right flap 3. open left flap 4. open bottom flap toward you * avoid crossing sterile package 1. open top away from you 2. right flap, left flap 3. bottom flap toward you Sterile technique 1. Never open sterile package in sterile site 2. 2inch border in sterile field is contaminated 3. Open package Going up

mole color

- mole changed to blue - melanoma - genital warts - cancer of cervix - dimpling skin - breast cancer - mole & round & smooth - normal

body fluid

- premature infant = 85% - fullterm infant = 55-70 - adult = 50-55

1. Peak Expiratory Flow Rate* def. values

- used in asthma, COPD, rejection of lung transplant - measures how fast a person can breathe out (exhale) air. - small handheld device w/ a mouthpiece at one end and scale with a moveable indicator (usually a small plastic arrow values 1. 80-100% • green zone • asthma is under control • normal 2. 50-79% • yellow zone • respi. airway narrowing & additional meds required 3. less than 50% • red zone • means medical emergency • severe airway narrowing & need emergency care • notify MD procedure 1. Breathe in as deeply as possible. 2. Blow into instrument's mouthpiece as hard and fast as possible. 3. Do this three times, and record the highest flow rate.

PT ( prothrombin time)

--- 10 to 12 sec. (started values) ----1.5 to 2 times from started values ----PT longer 25 sec. (Client risk for bleeding, hold warfarin dose)***•• - increaded intake of vit k(green vege) to SHORTEN the PT••• - used in warparin*** - used in lung biopsy

"""1.pharma formula

. . 1cup = 240 mL*** 1oz = 30 mL**** 1 g(gram) = 1,000mg** 1 gr(grain) = 60 mg** 1 kilo = 2.2(lb) pounds pounds (lbs) = = 16 oz 1 kilo weight = approx. 1 liter Units per cc = 120** 1 mg(milligram) = 1,000 mcg (microgram) 1 lbs = 3,500 calorie - not safe to lose more than 2lb/wk Tid = 3 times a day gr V = 5 grain Divided bid = divide by 2 8 lbs & 4 oz = 4 oz / 16 = .375 = 4 = 8.4 -----as long straight administer not total Dose per day Daily in 6 divided dose = Given divide by 4 then (no convert) Cross multiply everything Then convert Twice daily = straight answer Nclex notes math final Bigger to lower 1mg = 1,000 Gm (multiply) 1mg = 1,000mcg 1 mcg = 1,000ml - infution time • divide the given 125/hr to Order - 24hrs x 60 min = 1440 min - 12hrs x 60 = 720 min 1/6 Gr (grain = 60) - 1/6 x 60/1 = 60/6 = 10 - Result then divide 4 Divided dose Daily in 4 equal dose - Results then multiply • every 8hrs • tid, bid, qid - straight answer • per day • each dose - IGNORE • doctor order w/ added saline Or reconstitute • computation yolk of egg 4oz jar of baby food - INCLUDE • saline in available dosea

pulse grading or pulse strength

0 = absent +1 = weak +2 = nornal +3 = full +4 = bounding

*1. lab

. . . . . . . . . . . . Hematocrit Male...... .....42%--52% female.... ....35%---47% hemoglobin Male...... .....14-17 Female... ....12-15 BUN...... .....8-25 Clotting time --- 8 to 15 min. *** Creatine.... .....0.6---1.3 Urine specific gravity ........ 1.010-1.030 WBC....... ...4,500 --- 11,000 Platelet..... ...150,000 to 400,000 RBC........ ......4.5-6 million albumin..... .....3.5-5 pulse oximeter & oxygen saturation ......93% to 100% .......90% or less = critical Cholesterol ........ ...lower than 200 triglyceride .... ......lower than 150 LDL ........... ........ lower than 100 HDL ............... .....higher than 50 in women higher than 40 in men Blood glucose........... ..... 70-120 diabetes bp - 130/80 bp = normal - higher systolic or diatolic report to MD Cystic fibrosis - quantitative sweat chloride test - adult more than 60 = positive cystic - infant more than 40 = positive cystic Drink water ......3,000mL per day urine output .......30-50mL • Capillary refill ...Less than 3 sec. • ankle-brachial index - 0.65 = moderate arterial vascular dissease= need further evaluation • Goal of oxygen theraphy ..... PaO2 50-60 - lead poisoning • 10-14 = family lead education, follow up testing • 45 = oral chelation theraphy - PKU • serum phenylalanine 3 &7/100 (must maintain) • 10-15/100 = significant brain damage • if below 2/100 = growth retardation - folic serum • 1.8 - 9 - vit. b12 • 200-900 - sedimentation rate • 16 - normal both men & women • nonapecific test to detect the presence of inflammation pH - 7.35 to 7.45 PaCO2 or PaCO - 35 to 45 mmHg - carbon monoxide retension - 80 = Require possible mechanical ventillation To reduce PaCO level PaO2 - 80 to 100 mmHg - below is pt. = pt. experience hypoxia HCO3 - 22 to 26 mEq/L • glucoslyated hemoglobin/diabetes ....2.5 to 6.. • C-reactive protein - Less than 1.0 mg/L = normal (Lowest risk) - 1.0 to 3.0 mg/L = Average risk - More than 3.0 mg/L = Highest risk • Overdose drugs# - half life is 5 hrs = 25 hrs - if pt. like to lose one lbs / week one lbs. of body fat = 3,500 calorie 3,500 divide by 7days = 500/day • ICP ............ .....4 to 15<<<< (reliable than glascow coma scale) .. cerebral computation • ICP (minus) arterial pressure•• ..cerebral perfution 70-100 • Cvp (measure pressure in superior vena cava = blood return) - 5 to 10cm H2O - best indicator of lasix meds - high CVP seen in • increase blood volume • congested heart failure • pulmonary edema • cardiac tamponade - low CVP • decrease blood volume • hemorrhage, dehydration • postural hypotension • Digoxin .... .. .5 to 2.0 - check pulse before givin meds if in safe range*** • theophilline & dilantin.... 10 to 20 = normal values<< • cholesterol intake 250-300 mg/day!! peak explatory rate • 1. 80-100% • green zone • asthma is under control • normal 2. 50-79% • yellow zone • respi. airway narrowing & additional meds required 3. less than 50% • red zone • means medical emergency • severe airway narrowing & need emergency care • notify MD Co2 level - best measurement of respi Function for astma PaO2 is better of O2 = respi function

1. crutches types*

1. 2 point gait - move left crutch & right leg forward Move right crutch & left leg forward 2. 3 point gait - both crutches & weaker leg forward 3. 4 point gait - move left crutch forward & right leg forward 4. Swing theough gait - both crutches advanced simultaneously

1. grieving process* types

1. Denial, shock, disbelief - (Always priority- 1st expectation of grief process) ex. "I feel fine"; " "There must be some mistake." 2. Anger - pt. blaming others like doctor, Nurse, etc. - Why me? It's not fair!" 3. Bargaining: - "If only... then I'll...." 4. Depression - "What's the use, I'm going to die anyway." 5. acceptance - final stage - "It's going to be OK. I'm prepared to die." Guilt - pt. blaming himself

oxygen mask = level of oxygen

1. Nasal - 24 to 40% oxygen at a flow - 1-6 L per minute. - low oxygen 2. simple face mask - 40 to 60% - 10-12 L per minute. - moderate to high 3. partial rebreather mask - 70% to 90% -15 L per minute. - high oxygen. 4. Non-rebreather mask - 90% to 100% oxygen - 15 L per minute. - .high flow oxygen.

SBAR## def. ex

1. Situation 2. Background 3. Asessment 4. Recommendation 1. situation - Identify the person to whom you are speaking - Identify yourself, occupation and where you are calling from - Identify the patient by name, date of birth, age, sex, reason for admission 2. Background - Give the patient's presenting complaint - Give the patient's relevant past medical history - Brief summary of background 3. Assessment - Vital signs: heart rate, respiratory rate, blood pressure, temperature, oxygen saturation, pain scale, level of consciousness - List if any vital signs that are outside of parameters; what is your - clinical impression - Severity of patient, additional concern 4. Recommendation - Explanation of what you require, how urgent and when action needs to be taken - Make suggestions of what action is to be taken - Clarify what action you expect to be taken

reflex* types def

1. babinski - toes flare out when foot stroke - present at birth - dissapear at age of 2yrs old*** if not. CNS problem 2. plantar grasp = foot ]]]] - palmar grasp = palm of hand]] - finger or toes curl around object that stimulate the hand or foot. - palmar dissapear 3months**]]]] plantar dissapear at 10months]]]]] 3. parachute reflex - appear at 9 months to late adultshood - positive if infant extend his arms to prevent fall - absent of this reflex indicated severe dementia, motor disorder. 4. placing reflex ]]] - baby upright and the baby will lift the foot and place it on the table. - dissapear at 1.5months 5. tonic neck - fencing position - may or may not present at birth - dissapear 3-4month 6. moro reflex = startle reflex]]]]] - also known embrace reflex*** - dissapear 6 months*** 7. sucking reflex - dissapear at 4 months 8. rooting]]]] - turn head toward finger or nipple rub against cheek - present at birth - diaapear about 4 months]]]] 9. stepping reflex]]]] - gone in 2 months]]] --- 1.5 months - placing 2 months - stepping 3-4months - tonic - palmar grasp 4 months - sucking; rooting 6 months - moro - babinski - dissapear at 2 yrs - paracute - 9 months to persist - plantar dissapear 10 month

RN jobs* list

1. cannot delegate asessment, Teaching, evaluation, discharge, Nursing decision 2. Newly admitted 2. Newly diagnosed 3. Current alcohol withdrawal (current disease)

oxygen * types. def

1. nasal cannula or nasal prong - used to deliver oxygen w/ low flow, low or medium oxygen 25% - 40% oxygen at the flowrate at 1 to 6 liters/min. !!! - nasal care every shieft, *** mouth care every 2 hrs - Secure tubing in pt. clothes not in his bottom sheet - Keep humidification jar filled w/ distilled water • add humidication as order if flow rate is higher than 2L/min. • check water level & change humidifier as needed - Flow rates of 1-4L/min. • can be given upto 6L/pm but nasal dryness & or nasal bleeding can be uncomfortable (no more than 10L/min)** - ensure nasal prong is at the nares!! - asess skin integrity, pad tubing around the ears if needed - not used for acute phase of illness like COPD • COPD need venturi mask (control oxygen) - acute situations pt. may need higher concentration of oxygen and non-rebreathe mask or simple oxygen mask is often used. - used in pt. w/ hypoxemic w/ hypercapnia require 1-2L/min!!! advantage & disadvantage 1. advantages • possible to eat, drink and talk while using them; • they also reduce the risk of carbon dioxide rebreathing 2. disadvantage • nasal dryness ---------------------------- 2. SIMPLE FACE MASK - deliver 50-60% oxygen at flow rate of 8-12 - allow room air to enter in mask!! - used for short term oxygen theraphy or oxygen in emergency!!!! - poorly tolerated therefore not commonly used - make sure mask fit securely over nose & mouth cause poorly fitting reduce fraction of oxygen - check skin breakdown - facemask set 6L is ok = yes### -------------------------------------------- PARTIAL REBREATER - mask w/ reservoir bag - pt. rebreath 1/3 of exhaled tidal volume - make sure reservoir does not twist, kink, or become deflated - adjust flow rate to keep reservoirbag inflated 2/3 full during inspiration cause deflation result in decreased oxygen - is there deflate or inflate : yes### -------------------------------------------- 4. venturi mask - deliver 25-50% oxygen!!! at flow rate of 3-15 liters/min. - ideal for pt. w/ COPD!!!!!! since low flow rates can be set. - can replace mask at mealtime w/ nasal cannula - can used humidification - has adapter that is color coded for oxygen regulator; & to modify fraction of inspired oxygen!! - keep nasal cannula on stand by for meal!! - keep air in entrapment port for venturi for venturi adapter open & uncovered to ensure adequate oxygen delivery!! - asessfor dry mucous membraine; humidify or aerosol can be added -------------------------------------------- Non-rebreather mask - deliver 60-100% oxygen at flowrate of 6-15 liters/min. - used for sickiest pt. w/ deteriorating respi. status. !! - high concentration***!!! & highest percentage of O2 in any kind of mask!!! - mask w/ added reservoir bag, one way valve prevent pt. from exhaling back into the bag!!! - oxygen flowrate prevent collapse of bag during inhalation!!! - has oneway valve & mask cover mouth & nose & wrap around ear - contraindicated in pt. COPD!!! - remove mucos or saliva from mask - ensure valve & flap are intact & functional during each breath - valve should open during expiration & close during inspiration - suffucation can occur if reservoir bag kink or oxygen source disconnect - no need humidification if have reservoir bag - intervention • require close monitoring to the pt. • intubation may be needed!! • ensure reservoir bag does not completely collapse during peak inspiration !! • ensure pop-off valves on mask are not stuck & work properly! • ensure bag deflate slightly during pt. inhales & inflate during exhalation (if bag collapse at inspiration; increase liter flow to bag) • w/ water or no### - complication 1. claustrophobic 2. elastric strap may cause skin breakdown behind ear 3. need to remove mask when eating, taking meds --------------------------------------------

Types of prevention

A. Primary - avoid crises for recuring - health promotion & disease prevention - apply to person physically & emotionally healthy - ex. exercise, healthy diet B. secondary - reduce the intensity of crisis - early detection of illness - focus on person, who experiencing health problem & illness & who is risk for disease - activities is directed at diagnosis & treatment - ex. breast exam, cholesterol screen!! C. Tertiary - Reduce the amount of disability - prevent further disease & disability - occur when disability become permanent & irreversible - activities directed to rehabilitation!! - ex 1. find safe house after survivor 2. counselling & support 3. alcoholic anonymous!!!

acid base cause

A.) Respi. Alkalasois 1. increase respi***, fever, pain 2. hyperventilation, overventilation by mechanical vent. - hysteria, hypoxia 4. hypokalemia, hypocalcemia B.) Respiratory Acidosis 1. hypoventilation, brain trauma 2. RESPI PROBLEM - obstruction of airway COPD, asthma, atelectasis, emphysema, pnemonia, bronchitis pulmonary edema/emboli, 3. MEDS - CNS depressant(benzodiazephine, barbiturates, sedative drug) C.) Metabolic alkalosis 1. N & V, bulimia, Suction**** - hyperaldosteronism 3. excess • Antacid, ** • blood transfution • sodium bicarbonate • diuretic (for hypertension, potassium sparring diuretic) D.) Metabolic acid 1. diabetes, DKA, lactic acidosis, 2. MEDS - salicylate/aspirin (intoxication excess) 3. increase fat diet, decrease carbo. • starvation, malnutrition • ileostomy, diarrhea!!!••• 4. renal failure, shock 5. treat by sodium bicarbonate

2. Addison disease# info. cause. diagnosis. sign. care

Addison's disease - occurs when the client does not produce enough steroids from the adrenal cortex. - caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. *This results in loss of extracellular fluid and dangerously low blood volume.; Glucocorticoids must be administered to reverse hypotension. *Preventing infection is not an appropriate goal of care in this life-threatening situation. * Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring. - Primary Addison's disease cause by problem in the gland itself that results from idiopathic atrophy of the adrenal glands. ( Oversecretion of the adrenal medulla is not cause by addison) - The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). - Hyposecretion of glucocorticoids, aldosterone, and androgens occur with Addison's disease. - Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. adrenal cortex secrete too little ACTH-adrenocorticotropic hormone - decrease secretion of other adrenal product (mineralocorticoid, glucocorticoid, & sex hormone) - can be primary or secondary - relatively rare •••• - addisonean crisis is life threatening - Caused & avoid 1. stress, trauma 2. infection, surgery 3. autoimmune adrenalitis•••• - sign addison disease - early sign 1. lethargy and depression as early symptoms. - mood changes, emotional lability, irritability, - fatigue 2. weight loss, 2. muscle weakness not muscle spasm, 3. nausea, and vomiting. loss of appetite. 4. Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. - The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to the sun, such as the nipples, genitalia, tongue, and knuckles, become bronze-colored. - Treatment of Addison's disease usually reverses the hyperpigmentation. - sign adrenal crisis (addisonian crisis) - can cause profound physiologic changes. 1. severe pain ex. - headache, abdominal pain, back pain, or pain in the extremities). 2. hypoglycemia, hyposodium - all hypo except • Hyperpotassium & calcium • hyperpigmentation of skin• (darken skin pigmentation)•••• not a jaundice•••• 3. impaired sodium retention causes fluid deficit 4. fluid volume. Edema would not be expected. 5. Gastrointestinal disturbances ex. - includ-ing nausea and vomiting; not hunger 6. fatigue, personality change••• 3. muscle weakness•• 4. anorexia, N & V•• 2. women: menstrual change men: impotence - sign - addisonian crisis (acute adrenal insufficiency) 1. severe hypotension•••• severe headache/back pain 2. generalized muscle weaknes 3. diarrhea, constipation• 4. confution, lethargy• 5. circulatory collapse• - diagnosis 1. ACTH stimulation test = low cortisol level•• • used to differentiatePrimary & secondary addison disease*** 2. 24 hrs urine collection - decreased level of free cortisol - care 1. Priority - lifetime hormone replacement theraphy••• (strict to follow)* 2. Increase sodium/protein/carbo. •• 3. meds - glucocorticoid replacement theraphy (hydrocortisone)•••• - mineralocorticoid theraphy (florine)••• - Cortisone or cortisol treatment 4. in addisonian crisis - emergency intervention for circulatory collapse•• - administer iv hydrocortisone 1. client and family teaching plan - Lifetime steroid replacement is needed. - The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. - Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. - A medical identification bracelet should be worn - the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. - Dental work, infections, and surgery commonly require an adjusted dosage of steroids. - Fatigue, weakness, dizziness, and mood changes need to be reported to the physician. - The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease. 1. The nurse is instructing a young adult with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which of the following situations? - Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. - In these situations, glucocorticoid and mineralocorticoid dosages are increased. -Weight loss, not gain, occurs with adrenal insuffciency. Psychological stress has less effect on corticosteroid need than physical stress. 2. priority for a client in addisonian crisis? - Preventing irreversible shock. 3. A client with Addison's disease is admitted to the medical unit. The client has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which of the following fluids would be most appropriate? - Bouillon and juice. * Salted bouillon and fruit juices provide glucose and sodium to replenish * avoid Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium. 4. After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to: - Use relaxation techniques such as music. - Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. - - Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress. 4. most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? - The importance of watching for signs of hyperglycemia. - Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. *Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. * A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise, insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism resulting in a crisis situation of acute hypotension, not increased blood pressure. - Addison's disease is a disease of inadequate adrenal hormone and therefore the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia - Taking less medication than was prescribed can trigger Addisonian crisis state which is a medical emergency manifested by signs of shock. 5. The client with Addison's disease is taking glucocorticoids at home. Which of the following statements indicate that the client understands how to take the medication? - "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." - The need for glucocorticoids changes with circumstances. * The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. - Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. -They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 8 AM and the remainder at about 4 PM. This schedule approximates the diurnal pattern of nor-mal secretion, with highest levels between 4 and 6 AM and lowest levels in the evening. 6. priority outcome for the client with Addison's disease? - Maintenance of medication compliance. * Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the gluco-corticoid dose in response to the normal and unex-pected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress.

2. Cushing syndrome# sign. info. treatment

Cushing's disease - sign classic 1. Skin bruising from increased skin and blood vessel fragility - Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids 2. Fluid retention causes hypertension, (polyurea - is not sign)<<< - hyperglycemia - hypernatremia - hypercalcemia - hyperplenty except<<< Hypokalemia, hypocalcemia 3. Muscle wasting occurs in the extremities. - muscle mass is DECREASED - musculoskeletal changes, and the client may be at risk for injury and falls. - The skin becomes thin and fragile and the client is also at risk for infection - muscle weakness - fatigability<< 4. Hair on the head thins, while body hair increases. 5. - hypokalemia, - Sodium retention is typically accompanied by potassium depletion. - Increased cortisol levels do not cause fluid deficit 5.There is excessive protein catabolism causing muscle wasting, decreased inflammatory response, and potential for delayed healing and infection 6. edema 7. heart failure may result from the hypersecretion of aldosterone. 8. moon face, buffalo hump - weight gain 9. osteoporosis<<<< 10. metabolic acidosis• 7. impotence••• women: ammenorrhia, menstrual irregularities, ••• 8. acne or hyperpigmentation•• - diagnostic 1. 3 standard case detection test • 24 hr urine free cortisol • late-night salivary cortisol • 1-mg overnight dexamethasone suppression test 2. dexamethasone suppression test. - Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. * When Cushing's syndrome is suspected a 24-hour urine collection for free cortisol is performed. * Levels of 50 to 100 mcg/day in adults indicate Cushing's syndrome. If these results are borderline a high-dose dexamethasone suppression test is done. * The Dexamethasone is given at 11 PM to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 8 AM. Normal cortisol level less than 5 mcg/dL indicates normal adrenal response. - complication 1. Bone resorption * Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. - prevention: Regular daily weight-bearing exercise (eg, brisk walking) is an effective way to drive calcium back into the bones. - The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. -Vitamin D is needed to aid in the absorption of calcium. - avoid Isometric exercises condition muscle tone but do not build bones. - treatment 1. Adrenalectomy**** - surgery to remove adrenal or pituitary tumor••• 2 .Restrict sodium, high protein 3. Monitor sign of infection****** 4. irraditation••• 5. need lifelong treatment - care 1. 1. sign abnormal - Crackles in lungs (excess water & sodium)••• 2. body changes may reverse but may take months to year 3. surgical treatment may cause • adrenal insuffiency or pituitary insufficiency 1. A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for: - Bruised areas on the skin. 2. diet - increasing protein, - restrict sodium, thereby reducing fluid retention. - Increased protein * catabolism results in loss of muscle mass and necessitates supplemental protein intake. - restrict total calories to reduce weight. - Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended. * reduce fat to 10% - is wrong

erickson* list

Middle adulthood - pt. concern at time in his life by Reevalute life goal - pt. very aware to time left to live - know true men death Younger adults - carrier selection - leisure time activities of focus - settle down

pulmonary artery & pulmonary vein* def

Pulmonary vein - carry oxygenated blood Pulmonary artery - carry deoxygenated blood

ROME - respi opposite, Metabolic equal

Respi alka = ph up, co2/hco3 down Respi acid = ph down, co2/hco3 up Meta alka = ph up, co2/hco3 up Meta acid = ph down, co2/hco3 down - right • paCO2 & HcO3 - goes in same direction = compensated • opposie direction = uncompensated - wrong compensated = normal ph uncompensated = abnormal ph

sensible & insensible fluid loss*

SENSIBLE LOSSESS - measurable losess like wound drainage, gastrointestinal losess & urine output INSENSIBLE LOSSES - losses that cannot be measured cause they occur through skin & lungs - they occur in daily basis w/o pt. awareness

point of maximal impulse_adult & infant

adult = mitral infant = lateral to nipple

2. calcium hyper# cause. sign. care

cause 1. {hyperparathyroidism}<<< 2. Paget disease 3. Fractures 4. {bone malignancies}<<< 5. {prolonged immobilization}<<< 6. {renal failure} 7. {meds - thiazide diuretic}<<< - lithium - excess calcium/vit. D - sign 1. polyurea<< - increase urine calcium<< 2. flank pain nex to urinary calculi<< - bone pain<<<< 3. decrease deep reflex/ motility<< or depressed reflex<< - hypoactive bowel sound <<< 4. confusion<<< decreased memory< 3. constipation<< N&V<<< - increase fluid & fiber< 4. {hypertension, tachycardia} - ventricular dysrhymias<< 4. HYPOPHOSPHATEMIA - care 1. avoid thiazide diuretic & replace w/ diuretic that enhance excretion of calcium 2. {med increase calcium - phosphurus meds( it increase calcium} - calcitonin<< - biphosphonate<< 3. dialysis if meds dont work 4. calcium embalance risk for pathological fracture & must move carefully

1. posture Decerebrate##

extention or extensor - indicate brainstem lesion

brain definition types

frontal *SOCIAL BEHAVIOR/ PERSONALITY {BROCA SPEECH} **HIGHER INTELLECTUAL FUNCTION - {moral, reasoning, judgement!! } - {personality, emotion, concentration & abstraction} - dysfunction lead to! 1. change in personality!! 2. emotional lability! 3. inattentiveness! 4. flat affect! 5. inapropriate behavior!! Parietal ** SENSATION - {pain, pressure, paresthesia taste, touch, temp. } Temporal - {HEARING} - {wernicke area for sensory & speech} Occipital - vision**** Medula - respiratory center Limbic system - {learning & memory - emotional & visceral pattern for survival} brainstem - pons • contain respi. center & regulate breathing

2. Phosphurus hypo# sign. cause. care

sign 1. weakness • due to malnutrition & not enough rest • decrease deep tendon reflex 2. {bone fracture } 3. increased bleeding - cause 1. alcohol withdrawal 2. respi. alkalosis 2. {malignancy} 3. {hyperglycemia} 4. fluid loss, 5. {malnutrition-starvation} 6. {hyperparathyroidism.} - Interventions 1. administer phosphurus orally w/ vit. D suppliment

2. magnesium hyper# sign. care

sign 1. {hypercalcemia/hyperkalemia} 2. {hypotension!!'bradycardia} -{ peripheral vasodilation} 3. {decrease deep tendon reflex} = decrease nerve impulse transmission} - {decreaced LOC} - {hyporeflexia}### - lethargy<< drowsiness<< - N & V<<< 5. {respi. depression} - dysrhymias!! intervention 1. give {loop diuretic like lasix} 2. give calcium if due to cardiac problem 1. increase fluid 2. if patellar reflex is absent. notify MD 3. more than 7 mEQ/L risk for cardiac & respi arrest 4. {calcium gluconate/chloride is antidote for magnessium overdose} 4. { avoid meds contain magnessium} - {laxative. & antacid} - {enema} 5. diuretic are prescribed to increase renal excretion of magnessium 5. diagnosis - priority - Ineffective breathing pattern related to muscle weakness • Monitor pulse oximetry and respiratory effort. • Monitor telemetry, neuro checks at least every two hours.

1. BMI - measurement

underweight = less than 18.5 normal weight = 18.5 - 25*** overweight = 26 - 29.9 obesity = more than 30 extreme obesity = more than 40

1. posture Decorticate##

{flexion or flexor} - indicate nonfunctioning cortex

1. crutch walking* upstair,downstair, stair

•up stairs 1. "good leg" goes up 1st then crutches move w/ "bad leg" •down stair 1. "bad leg" goes down 1st •stair 1. use 1 crutch & stair rail (if stair stable & there someone to carry the other crutches) 2. use 2 crutch (if no stair rail) 3. use 2 crutch in one side of arm & use railing = normal

1. insulin mix* nph reminders

* draw regular 1st then cloudy * NPH is only suiable for mixing short acting insulin Such as "novolog" Always mixed frequently**

2. exudate# def

- Any fluid or semisolid that has exuded out of a tissue or its capillaries, - more specifically because of injury or inflammation (for example, peritoneal pus in peritonitis, or the exudate ccthat forms a scab over a skin abrasion) in which case it is characteristically high in protein and white blood cells. - Purulent exudate indicates infection<<

Pregnancy notes

- Chills and shaking are common after birth<<< ______________________ - 1st trimester - 2nd trimester - 3rd trimester 1. ectopic pregnancy or trophoblastic disease (hydatidiform mole) is not seen in the third trimester.

Heimlich maneuver} def. procedure

- Choking because of an obstructed airway is a leading cause of accidental death. - If a choking person is not coughing or is unable to speak, that's your cue to perform the Heimlich maneuver asap. 1. If a victim is coughing strongly or able to talk, let the person try to expel the foreign body using his or her own efforts. 2. If the choking victim displays a weak or ineffective cough, this indicates that air exchange is minimal and that you should start the Heimlich maneuver.. - To avoid breaking bones, never place your hands on the victim's breastbone or lower rib cage when performing the Heimlich maneuver.

Car seat

- rear facing • under 1yrs old & less than 20lbs - front facing • more than 1yrs old & 20-40 lbs - booster set 40-80lbs - car seat • until 4 yrs old - safe location in car • middle back seat - least safe or not safe front seat w/ or w/o airbag - 12yrs & up = front seat 11yrs below = back seat

2. phosphurus hyper# def. sign. goal. care

- Most common contributing factor is renal failure. - most body system tolerate increase serum phosphurus well. - sign 1. {always accompanied by hypocalcium }<<< {other sign: sign of hypocalcium} -{ this lead to stimulation of parathyroid hormone causing bone demineralization} - cause 1. tumor lysis syndrome 2. decreased renal excretion resulting from renal failure 3. hypoparathyroidism Interventions 1. same care w/ hypocalcium 1. {give phosphate binders, like TUMS, phoslo, renagel} w/ meal to lower phosphurs - give stool softner cause phosphate binders effect is constipating 2. avoid aluminum hydroxide preparation to bind phosphate cause they are associated w/ dementia & osteomalacia} 2. Diagnosis - Urinary elimination altered related to increased phosphorus levels 3. will have at least 30 ml/ hour of urine output. • report if less 30mL 4. report tetany or palpitation

2. magnessium hypo# def. sign.care

- act as depressant Sign - associated w/ {hypokalemia!! & hypocalcemia} 1. {Dysrhymias}{confution<<< 2. {hyperactive reflex/deep tendon << reflex} 3. {respi paralysis} 2. {tachycardia•• hypertension} 3. muscle weakness**••• • {positive chovoster/trosseau} tetany, 4. tremor<<< 5. seizures<<< intervention 1. monitor pt. for laryngeal stridor** & cardiac rhythm/ respi** 2. check - neurological checks, ( priority) • decreased deep tendon reflexes (check frequently it means hypermagnessium during meds given to increase magnessium)•• 3. {hypo magnessium always accompanied by hypocalcium - care should also increase magnessium & calcium} 4. meds - magnessium sulfate iv in severe case (cause IM cause pain & tissue danage) -

1. Cpr* list to do

- adult : adolescence to older adult - infant : less than 1yrs old - child : 1yr to onset of puberty (12-14yrs old) - priority list 1. Check unresponsiveness • yell the pt. !! • shake gently!! • gasping breath = still no breath 2. Call emergency responce team 3. Asess open airway - by head tilt-chin lift (while pushing back the forehead use the other hand to lift the chin forward) - use jaw-thrust • if trauma is evident or spinal injury is suspected) 4. check breathing first - look at the chest - listen & feel (for breathing) - if pt. have breathing; • position in recovery position - if pt. have no breathing • give 2 rescue breath at one sec. per breath • assess breath go into the lungs by chest movement; • if chest dont rise after 1st breath, perform head tilt-chin lift a second time before giving second breath • avoid giving too many breath or breath that is too large or forcefull • keep denture secure if loosen; remove it. 5. check pulse - dont spent 10sec. checking pulse - if no pulse in 10 sec. • Begin CPR w/o pause!!!! • use of critoid pressure is not recommended - adult or older child - neck - carotid - child - carotid or femoral - infant - brachial or femoral 6. begin chest compression - if pulse is absent - child/infant if heart rate less than 60 • w/ poor sign perfusion - make sure pt. on firm surface 7. chest compression - hand position • at breast bone sternum - adult/older child: at center of chest between nipples, two hands w/ heel of one hand & the other one is on top - child - one hand w/ use of heel of hands - infant - just below the nipple line!! - one rescuer uses two finger or two rescuer uses two thumbs encircling hand around chest - pressure of pushing comes in shoulder!! - arms straight - push hard & push fast for compression - allow chest to recoil - minimize interuption, keep at 10 sec. or less 4. activate emergency response system 5. use AED (defibrillator) • send someone to do so 7. compression 1st b4 breath CPR sequence ( CAB RATHER ABC) - 30 compression and 2 ventillation - 8-10 breath for min. - adult & older child = 30:2!!!!! for 1 or 2 rescuer - child to infant = 1 rescuer = 30:2 2 rescuer = 15:2 8. compression rate - at least 100/min - in all ages!!!! 9. compression depth - {adult 1.5" - 2"} {best is 2" rather than 1.5} - infant 1.5" or 1-2 to 1/3 depth of chest - intervention 1. rescuer not trained - compression only 2. if pt. successfully resuscitated - initial action is check • hourly urine output** 3. if have advanced airway consideration - laryngeal mask airway; esophageal- tracheal tube or endotracheal tube) - give breath at rate of 1 breath every 6-8 sec. (approx. 8-10 breath per min. ) when advance airway is in place during 2 person CPR to victim for all ages - there should no pause in chest compression for delivery of breath 4. american heart association support - compression only CPR w/o mouth to mouth!! 5. lay rescuer - do not need to assess pulse or sign of circulation for unresponsive victim!! 3. if pt is unresponsive • for child to adult - priority is call emergency responce team • infant to child - provide ONE MIN. CPR before activating the emergency responce team

1. Eardrops & Ear notes

- adult = pinna up & down - child = pinna down & up * check for age of child - can use in also in otoscopic exam - medication should be warned to body temp. - when instilling meds • pt. lie on side w/ affected ear upward - when doing ear irrigation • tilt head down toward affected ear - notes 1. changes in barometric pressure will affect person w/ ear disorder 2. hearing loss • can be partial or total • affect one ear or both ear • occur in low, medium or high frequency • hearing loss of 22.5% usually affect social functionality & require hearing aid • if talking to pt. w/ hearing loss - speak slowly and face them • noise exposure is the major cause of hearing loss in U.S. 3. in erderly the loss of high freqency sound may require special smoke detector w/ low frequency sound 4. to gain pt. attention - raise hand or touch pt. arm•• 5. speak in a lower tone when talking to elderly 6. speaking toward the pt. good ear is recommended. • speaking louder will not increase the chance of hearing

2. thyroid -hypo# def.sign. care

- affect more women • 30 to 50yrs old •• - cause 1. thyroid surgery 2. treatment of hyperthyroid condition 3. overdose of thyroid meds 4. deficiency of iodine diet••• - sign -sign 1. decrease T3 & T4 • decrease metabolic rate•• 2. Cold intolerance - dry skin<<< 3. Metrorrhagia - blood loss between menstrual periods • Menorrhagia, - excessive bleeding during menstrual periods - menstrual change••• increase menstrual flow••• 5. Hypotension,Bradycardia - hypoglycemia?? 6. fatigue and lethargy - lethargy, personality changes, generalized edema 7. memory problems - slowed speech - slow growth 8. Fluid retension= weight gain, <<< 9. coarse/sparse hair only not Fine thin hair <<<<<< - brittle/thick nails - hair loss - dry skin 10. constipation not diarrhea<<<<<< - Anorexia< 11. apathy, 12. numbness and tingling in the fingers. 13. sleppiness<<<<<<<<< 14. decreased levels of thyroxine and triiodothyronine and increased TSH. - presence of antithyroid antibodies - elevation of the creatine phosphokinase (CPK-MM) level. - Hypothyroidism has a metabolic effect on skeletal muscle. Muscle injury results, causing the CPK-MM to spill out of the damaged cells and into the bloodstream. 15. 10. retardation if low T4 at birth & tyroid replacement is not started •• 11. if sign develop after 2-3 yrs •• • when brain has grown • no mental retardation 16. posible goiter<<< • myxedema - generalized puffiness around eye & face - large tongue •• - types 1. cretinism•• • hypothyroidism in children • lead to mental retardation - child low growth & weight = should screen for hypothyroidism 2. Myxedema • affect adult • most severe type of hypothyroidism • potentially life threatening•• • trigger by stress • sign hypothermia, bradycardia, hypoventillation altered LOC lead to coma • treatment iv fluid, correct hypothermia•• synthroid, cytomel 3. hypothyroidism w/ myxedema • severe thyroid failure • usually seen in older adults 4. hypothyroidism w/o myxedema • mild thyroid failure - treatment 1. synthroid, cytomel 2. other meds - controversial • liotrix, armour thyroid (not typically prescribed) - intervention 1. Maintain patent airway** • provide restfull environment • protect pt. from cold 2. pt. must change position slowly* cause of hypotention* 3. avoid sedative & opiod 3. increase fluid 3. check for thyrotoxicosis (tachycardia, sweating) 4. check sign of myxedema•••• 4. Increased mobility,Avoid Bedrest (bedrest is when pt. have fatigue) 5. teach pt. to conserve energy••• & excersice when able•• 6. lifelong theraphy•• - must monitor administration cant be increased to fast•• 6. avoid or manage stress•••

1. fluid deficit*sign.care. risk. cause

- also known hypovolemia!!! sign 1. {flat neck vein} thirst/weightloss!!! 2. decresed bowel/sounds decrease motility - decrease CVP 3. dry skin & mucous membraine<< • tenting of skin/poor skin turgor<< 5. {oliguria} concentrated urine<< -increased specific gravity!!! - increased BUN/creatinine - increased RBC count/hematocrit<< 6. weak thready pulse<<< - {tachycardia??? - tachypnea & hypotention}<<< ( Cause if fluid deficit result to hypoxia & increased respi in attempt to maintain oxygen delivery) - {diminished peripheral pulse} - cause 1. isotonic dehydration - fluid deficit 2. fluid shieft in compartment 3. hypertonic dehydration due to - excessive perspiration - ketoacidosis, diabetes insipidus - prolonged fever, diarrhea - hyperventillation 4. hypotonic dehydration due to - excessive fluid replacement of hypotonic dehydration risk 1. 1. infant - high risk <<<< - rather than elderly 1. ileostomy 2. draining abdominal wound 3. NG tube placement intervention 1. treatment - isotonic dehydration • treated w/ isotonic fluid - hypotonic dehydration • treated w/ hypertonic - hypertonic dehydration • treated w/ hypotonic 1. increase oral & iv fluids • frequently offered pt. fluid especially if pt. is "disoriented " (avoid leave water next to her bed) 3. if pt. experiencing cardiac & cerebral symtomps • to increase pt. comfort (elevate head of bed) (to decrease venous return in lower body; (dont gave oxygen need order if question ask increase pt. comfort)

Stool* types. color

- brown = normal - black = associated w/ upper gastrointestinal bleeding - clay colored = biliary obstruction - green = infection or large amount of bile

LPN

- can Auscultate breath sounds.<< • like capable of gathering data and observations including breath sounds - can Administer prescribed << aerosolized medications. - Check oxygen saturation << using pulse oximetry. - complete the assessment sheet << and care for the client before surgery - LPN not allowed administer IV push even insulin - new born bath-initial needs to be done by an RN or LPN who understand the principles of thermodynamics that relate to the newborn- avoid assigning in nursing assistant - can do continues bladder irrigation - can help pt. wearing prostethic Limp- but cannot do teaching - can gave meds - can do reinforcement of teaching after RN do initial teaching before discharge - scope 1. Can attached cardiac monitor lead 2. Obtain 1 lead ECG 3. Oral meds** subcu** 3. Cannot gave heparin & morphine Cause its high alert meds 4. Check oxygen using pulse oximetry 4. Mouth care Remind mouthwash Observe lips n tongue Encourage mouth rinse 5. Listeb lungs sounds & check for edema 6. Subcu. Injection 7. Can setup oxygen & suction 8. Observe & document seizure activity 9. Checking for therapeutic effect & side effect 10. Can check & observe for sign of infection 11. Can check snellen test 12. Review handwashing 13. Teach cleanse eyelid & remove crusting 14. Irrigate ear canal 15. Remind not to blow in nose in tympanoplasty 16. Assist only in planning. 17. Assist phycian in incision 18. Nausea vomiting in chemotheraphy 19. Administer insulin 20. Cannot delegate new admitted pt. & Discharge pt. & Post operative pt. 21. Can collect data in responce to medication 22. Can listen & provide emotional support for pt. Who sexually assault 23. Can asess bleeeding in catheter insertion site 25. Nebulizer not for LPN 26. Can increase oxygen in nasal canula 27. Insert Catheter 28. Feeding tubes 29. Apply restrain 30. Can monitor iv theraphy 31. Can so drain 32. Can assigned to laminectomy

Nursing assistant* jobs

- can do oropharyngeal suction - Not allowed change dressings<< - Reposition the client every 2 hr.<< is priority than Obtain vital signs every hour. - intake and output recordings - sterile procedure is not in there Job description - can observe if pt. have respi. Depress - avoid assining initial assessment like taking Vital sign in pt. that newly out in surgical room** - can Set up the room for client who just delivered vaginally - can Encourage client to practice use of incentive spirometer*** - can do transferring pt. - never administer meds even its Advil(over the counter meds) - can do unsterile dressing change - can collect urine specimen!! - can orient pt. to room!! - cannot do observe & documentation responce to ambulation!! - can do routine vital sign!! Nursing assistant - can do obsessive compulsive disorder - avoid delegate pt. in severe Depression!! - can do remove & apply new rectal pouch for pt. - cannot do monitoring for range of motion exercise - can do stool for occult blood & urine for glucose w/ report of results - can measure or empty drainage in collection bag!! • but not in surgical dressing!!! 1. bathing & feeding*** 2. take vital sign for stable pt*** 1. Measurement of ankle-brachial index is calculated 2. Weight pt. ** 3. Stool specimen 4. Assist reposition pt 5. Reaply compression boots 6. Can disconect the suction to allow ambulation Reconect must be done by nurse 7. Monitor apical pulse 8. Cannot do draw blood for thyroid 9. Cannot report superinfection 10. Can perform chest compression 11. Not alowed for tipid sponge bath 12. Assist in postmortem 13. Pulse oxitemeter for expirenced CNA 14. Can do blood glucose finger sticks 15. Dont administer fleet enema 16. Can obtain stool specimen 17. Administer soap suds & tap water enema 18. Can assigned chest xray

2. thyroid hyper# def. sign. treatment. care

- cause graves disease, also known••• as toxic diffuse goiter(Exothalmia) - clinical sign manifestation is tyrotoximusis•••• - cause 1. autoimmune 2. more on women 30-50yrs old -Sign 1. Hypertension and tachycardia<<< - hyperactivity 2. heat intolerance 3. weight loss, despite a good appetite and adequate caloric intake - hyperphagia- increase appetite<< - hypermetabolism - diarrhea<<<, 4. Excess energy throughout the day - perspiring through the day - Incomplete closure of the eyelids - insomia 7. moist flushed skin<<<< - thin brittle hair - pliable nail (plummers nail)••• 8. exophthalmus(protruding eye)•••• - accelerated linear growth & Bone age is accelerated<< 8. short attention span • palpitation< increased anxiety<< • difficulty concentrating•• • increased nervousness•• • reduced tolerance to stress••• 9. Myopathy 8. poor school performance - diagnosis 1. palpable goiter 2. radioactive iodine - increased 3. thyroid stimulating hormone - decreased - Treatment 1. Antithyroid drug 2. Thyroidectomy (Removal of thyroid gland) - partial or total removal - check voice post op•• 3. radioactive iodine theraphy to destroy thyroid cell 4. meds. • sodium 131 • antithyroid - PTU • iodides - usefull to deacrease vascularity of thyroid pre-surgical removal 5. diet • high calorie/protein/ carbohydrates (to make pt. fat)••• intervention 1.Tracheostomy kit, oxygen, suction* 2. rest, & rest voice, sedative** • avoid stimulant 3. administer inderal for tachycardia 4. check • vital sign especially bp & heart rate • behavior pattern before & after giving meds•• 5. provide quit & cool environment•• 6. gave extra fluid 7. gave moisturizing eye drop for exothalmia••• 7. post of. after surgery • assess laryngeal nerve damage•• • assess excessive swallowing•• or pooling of blood behind neck = hemorrhage••• • report sign of hypocalcemia or•• changes of voice••• • avoid fowlers position due to strain on incision••• 8. 1. Hypothyroidism may contribute to sadness and depression. - It is good practice for clients with newly diagnosed depression to be monitored for hypothyroidism by checking serum thyroid hormone and thyroid-stimulating hormone levels. - This client needs to know that these feelings may be related to her low thyroid hormone levels and may improve with treatment. - Replacement therapy does not cause depression. - Depression may accompany chronic illness, but it is not "normal.

Ear drop*

- child over 3yrs old/ adult • pinna up & back - child under 3yrs old • pinna down & back

2. calcium hypo# sign.cause. care

- chvostek sign • contraction of facial muscle in response to light tap over facial nerve in front of ear - trousaaeu sign • carpal spasm induced by inflating bp cuff sign- CADPIS-cramping### 1. OLIGORIA<<< 1. positive - chvostek sign (facial nerve twitching) - Troussaeu sign (carpopedal spasm) 2. tetany, paresthesia<< - numbness & tingling around mouth & extremities = early sign<<< 3. confusion<< seizure<< 3. {hypo. brady.}<<< - diminished pherepheral pulse 4. {hyperphosphatemia = cause} 5. {hyperactive deep tendon reflex • increase motility & bowel sound} cause 1. {Hypoparathyroidism}<<< 2. malabsorption<<< 3. decrease albumin<<< 4. decrease calcium<<< 8. {pancreatitis}<<<< 3. respi. alkalosis<<< 4. chronic renal failure <<<< 5. meds: lasix, , steroids, INH<<< 1. {immobility} 2. Thyroidectomy 5. {diarrhea-steatorehea} 5. calcium chelators/binders 6. hypomagnesimia 7. {hyperphosphatemia}<<<<< abuse of phosphate containing antacid 9. {hyperproteinemia} 1. {lactose intolerance} 2. {chrohn disease, celiac disease} - intervention 1. gave calcium gluconate<< 2. {give aluminum hydroxide - it increase calcium level while reduces serum phosphurus} 3. vit D - increase absorption of calcium in intestinsl tract

brain types

- coup = brain damage directly to site of impact - contrecoup = brain damage opposite the side Of impact - acceleration & deceleration = movement inside head

INR---International normalized ratio

- detect swelling - if INR is below recommended range • warfarin dose increase • if INR is high, warfarin dose decrease 2 to 3 (standard warfarin theraphy) • appropriate for most pt. 3 to 4.5(high dose warfarin)*** • recomended for pt. w/ mechanical heart valve 6 or higher = bleeding 8 = blood is too thin

erickson stages* list. not

- development task - young adult • develop relatioship to others • deficiency: social isolation & loneliness - middle adult • add more lesiesure time - young older adult • be active in community - older adult • stay in touch w/ family note: - adult • the diagnosis of a newly acquired disability in a variety of ways

pitting edema scale*

- edema if fluid accumulation & its not nornally present - to check edema, nurse will imprint his thumb firmly against the ankle or tibia - normal = skin surface is smooth - if pressure leaves a dent in skin = pitting edema is present scale 1+ mild pitting • slight indentation • no swelling of leg 2+ moderate pitting • indentation subsides rapidly 3+ deep pitting • indentation remain for short time • leg looks swollen 4+ very deep pitting • indentation last long time • leg is very swollen

1. Glascow coma scale* def. results def

- eye 4 Motor 6 Verbal 5 *total = 15 * 0 = no movement Results - less than 8 or equal = coma or severe • 8 = critical score, • less than 8 or equal = 50% die - more than 9 or equal = not in coma 1. Withdrawal of his hand Score of 4 indicates normal flexion* - 15 points; • most mild injury, - 3 points • being a vegetative state

2. parathyroid hyper# info. sign. care

- increased parathyroid result to# increased calcium & low phosphurus# & development of kidney stone!!!•• - diagnosis reveal demineralization of bone - cause 1. benign growth in parathyroid 2. secondary hyperparathyroid due to kidney disease or osteomalacia 3. occur at any sexes at age 50 - sign 1. hypercalcium • hypophosphatemia** 2. bone/Joint pain••• • demineralization•••• • pathological fracture•• 3. polyuria- renal stones•• 4. N & V••anorexia•• - weightloss, constipation•• 5. fatigur; irritability•• • muscle weakness••• intervention 1. priority is • risk for injury** 2. increase fluid to dilute calcium level in blood & urine) 1. lasix, diuretic, & acid-ash juices 2. check renal stones & renal involvement • evaluate & strain urine•• • evaluate back pain 3. decrease potassium & increase phosphurus diet 4. surgical removal of parathyroid • parathyroidectomy•• 5. post op care after surgery • monitor sign hypocalcemia•• • monitot laryngeal damage (change of voice & hoarseness) • eat high in calcium••

2. parathyroid Hypo# def. sign. care

- low parathyroid result to low # hypocalcemia & high phosphurus# - cause 1. autoimmune 2. surgical removal of parathyroid - sign 1. • tetany, carpopedal spasm • laryngospasm • muscle weakness or cramping • paresthesia 2. dry scaly skin; hairloss 4. abdominal cramping diagnosis 1. positive chvostek sign - facial muscle twitching when cheek is stroked on facial nerve infront of ear••• 2. positive troussaeau sign - carpopedal spasm as inflated bp cuff. is released 3. chvostek & trossaeau sign - test for neuromuscular irritability - result to hyperirritability•• - either of these indicate hypocalcemia & hypomagnessium•• - treatment 1. calcium replacement theraphy 2. calcium rich food & low phosphurus food•••• 3. vit. D intervention 1. monitor carefully for tetany••• • have calcium gluconate & syringe at bedside (administer if pt. have show sign of tetany, positive chovostek & troussaeu sign post op) • trachesotomy set, oxygen, suction at bedside•• 2. seizure precaution••• 3. report sign of vit D toxicity 4.

2. potassium hyper# cause,sign*,care,def

- more than 6 risk for cardiac arrest sign 1. {increase GI/reflex<< hyperactive bowel sound} 2. {dysrhymias} <<<< 3. muscle weakness & flaccid paralysis< 4. intestinal colic, diarrhea<<< - oliguria!! - hypotension; slow heart rate - Cause 1. Addison disease<<<< 3. kidney disease<<< 4. burn<< 4. Severe trauma or crush injuries<< (tissue damage)<<< 5. metabolic acidosis<<< - intervention 1. avoid salt & potassium suppliment for kidney disease<<< 2. if renal is impared - administer kayelante <<< (it increase sodium & decrease potassium level) 3. give iv hypertonic glucose w/<<< regular insulin to move excess potassium into cell 3. emergency give • sodium bicarbonate iv!!! • calcium gluconate iv<<<<< then kayelante 3. increase fluid 4. if pt. comes in hospital w/ high<<< potassium - inorder - Start an IV access site. • in case the client has respiratory or cardiac arrest - Attach the client to a cardiac monitor.

Pulmonary arterial wedge pressure

- normal 4 to 12. (same like CVP) - increase = hypervolemia (rales in chest) - decrease = hypovolemia(decrease bp,dry mucous)

1. bed pan* steps* inserting

- nornal insert 1. insert bed pan 2. raise head of bed; then pt. void 3. lower head of bed 4. remove bed pan -nclex 1. high bed position 2. insert(pt move side to side) 2. high bed 3. sitting position 4. low bed position

Urine color for bladder irrigation

- pale pink • bladder irrigation is infusing at sufficient rate - dark pink or punch colored • need increased in irrigation - bright red • means slow

1. posture flaccid* def

- pt. display no motor response in extremity

1. fluid overload*sign.care. risk

- serious complication of IV therapy< or iv infution is fluid overload. sudden onset of Noisy respirations = pulmonary congestion. - isotonic fluid overload • also known hypervolemia • caused by longterm corticosteroid theraphy - hypertonic fluid overload • cause by excess sodium or sodium bicarbonate theraphy - hypotonic fluid overload • alson known water intoxication • cause by early renal failure; SIADH, irrigation of wounds w/ hypotonic fluid sign 1. S3 heart sound-common!!! - crackles<< dyspnea<< - jugular vein/distended neck • {pale cool skin}< 2. {pitting edema in feet}<<< • cerebral/tissue edema<< • periorbital sacral & {watch}<< peripheral edema {watch}<< • {liver enlargement; ascitis} 3. {tachycardia, hypertension}<<< bounding pulse<<< 4. increase urine/diluted urine•• - {increase CVP} - {increased motility in GI} - output exceeds intake, - {visual affected} - {paresthesia} 4. sign early<<< - Hypertention & tachypnea<< - Weight gain<<<< risk 1. congested heart failure - 1st risk•• 1. pt. w/ renal failure 2. heart failure 3. liver disorder 4. excessive use of hypotonic iv fluid 6. excessive ingestion of TABLE SALT intervention 1. Gave lasix 1st. B4 any intervention* - {osmotic diuretic typicall prescribed} 2. {restric fluid & sodium} 3. avoid - antacid, cold remidies or other product contain sodium bicarbonate 4. avoid giving large amount if water 1. Avoid<<< - sweet & dry = may result to increase thrist 1. In clients w/ excess fluid volume<< sodium restriction may be necessary to promote fluid loss. - Restricting fluid intake will not<< reduce retained fluids; - increased fluids will increase urine< output and promote improved fluid balance

2. sodium hyper# sign*. care. cause,risk

- sign 1. {oligoria}thirsty<<< - {increased urine specific gravity} - dry/sticky mouth<<< 2. Flushed skin<< - altered cerebral function<<< - restlessness, seizures<<< 3. increased reflex<<< 4. infant sign!!! - irritability & depressed fontanel - cause 1. excessive sodium intake 2. decrease water intake*** 3. increased water loss due to (fever, increase metabolism, fever; hyperventillatio, infection, excessive diaphoresis, diarrheaa) 4. Heat stroke 5. Cushing syndrome*** 6. corticosteroid*** 7. Diabetes insipidus***<<< 8. water loss from osmotic diuresis<< 8. iv infution of hypertonic solution 9. renal failure*** 10. hyperaldosteronism** Risk - infant, elderly, comatose, - pt. on NPO - intervention 1. D5W is mostly used to treat pt.<< with fluid loss, dehydration, or hypernatremia (too much sodium.) When D5W is initially infused, - it is an isotonic solution, but when the dextrose is metabolized, the solution actually becomes hypotonic, a solution where osmotic pressure causes fluid to shift into cells. - D5W is not good for patients with renal failure or cardiac problems since it could cause fluid overload. Also, patients at risk for intracranial pressure should not receive D5W since it could increase cerebral edema (swelling.) 2. pt. would need Lactated Ringer's Solution to treat sudden blood loss, dehydration, burns, and fluid loss in the lower gastrointestinal tract (sigmoid colon, rectum.) - Lactated Ringer's solution has an electrolyte concentration similar to serum, but without magnesium. Patients with renal failure should also not receive Lactated Ringer's solution because it contains potassium and you want to avoid potassium overload (hyperkalemia.) - Lactated Ringer's solution should also not be used in patients with a pH level above 7.5 (alkalosis.) 3. Normal saline solution has some of most uses when giving IV therapy. - Normal saline solutions are used for patients with hypercalcemia (too much calcium) or hyponatremia (too little sodium), for patients who are in shock, for patients receiving a blood transfusion, and for patients in metabolic alkalosis (blood pH level over 7.45.) When normal saline solution is infused, it initially stays in the veins and expands vascular volume. Therefore, patients w/ hypernatremia, heart failure, or edema should not be given normal saline since it could cause fluid overload. 2. if caused by hypovolemia - increase water intake*(normal) - administer iv infusion 2. if caused by hypervolemia • restrict fluid*** 3. if caused by inadequate renal<< excretion of sodium - give diuretic that promote sodium loss

2. sodium hypo# sign.intervention.cause

- sign - 1. {increased urine} {decreased specific gravity} {decreased serum osmolality} - {increased motility/bowel sounds} - finger printing in sternum 2. increased ICP <<<< (papilledema, headache, confution, <<<< seizures)< 2. weakness, muscle cramps<<< -------------- - intervention 1. give hypertonic fluids### or 1. Decrease fluid intake*!!!! • to restore fluid & electrolyte balance 2. used normal saline(isotonic)<<< • For gastrointestinal or urinary irrigation • avoid sterile or tapwater • used hypertonic saline<< 3. avoid • 2-gram & 4 gram sodium diet (both dont increase serum sodium) • loop diuretic 4. if hyponatremia accompanied by fluid deficit - give iv sodium chloride to restore sodium & fluid volume 5. if hyponatremia accompanied by fluid overload - give osmotic diuretic to promote excretion of water rather than sodium 6. if caused by SIADH - give antidiuretic hormone 7. {if pt. taking lithium; - monitor lithium level cause hyponatremia can cause diminished lithium excretion resulting to toxicity} - caused 1. {Pt. runner cause pt. consume plenty} - {they loss sodium while they drink lots of fluids}<<< - it lead to water intoxication<< 2. increased sodium excreation - excessive diaphoresis<<< - pt on diuretic<<< (it secrete sodium, potassium, water)< - vomiting & diarrhea<<< - gastric suction<<< - wound drainage; especially<< gastrointestinal - renal disease<<< - SIADH<<< - adrenal insufficiency<< 3. dilute of serum sodium - rena failure - fresh water drowning - excessive ingestion of hypotonic fluids or irrigation w/ hypotonic fluids - hyperglycemia - congested heart failure

PTT

---Activated partial thromboplastin time ----20 to 35 sec.*** ----1.5 & 2.5 times normal**** -----30 to 88 seconds normal**** -----longer 90 sec. (Client risk for bleeding)** - used to monitor heparin, lovenox, •• dalteparin***

Chromosome

--sperm carry x or y chromosome** XY for male , XX for female** - duchenne dystrophy = x chromosome of mother - klinefelters syndrome = x chromosome of father

''''' antidote

. . . . . .. . . -Heparin- •protamine sulfate -Coumadin/oral anticoagulant •vitamin K -Magnesium sulfate & Hypocalcemia - tetany •calcium gluconate -Morphine/Narcotic/opiod/ • Narcan - Narcotic dependence & prevent withdrawal symtoms • Methadone -Anaphylactic reaction/IV globulin • epinephrine = adrenalin -Tensilon / prostigmine & cholinergic crisis/ anticholinesterace••• • atropine sulfate - atropine sulfate • Bethanicol - acetaminophen (tylenol & paracetamol) • acetylcysteine = mucolytics -Benzodiazapines - zepham & zolem • romazicon - iron poisoning • dexoferin - lead poisoning • EDTA/chelation theraphy or demercaprol - drug overdose • charcoal or ipecac - digoxin • digoxin immune fab - striptokina/Urokinase • amicar - doxorubicin • zinecard - CNS hyperactivity due to amphetamine overdose • diazepam - parasympathetic drug • anticholinergic - sodium bicarbonate•••• ex. baking soda • aspirin poisoning • metabolic acidosis • severe hyperkalemia - Alcoholic abuse • antabuse, * acute alcohol • librium * revia or revix (naltrexone) • lower craving for alcohol or treat alchoholism - methotrexate, trimetrexate • leucoverin (leukeran for cancer) - extravasion antidote••• • stop infution & remove iv • give phentolamine subQ into affected tissue•••

Assess lung

1. Inspection-asessment 2. Auscultation-bruit 3. Palpate 4. Percussion

Cranial nerve asessment

1. Olfactory - sence of smell*** - detect various odor in each nostrils - smell nonirritating substance like coffee or tobacco 2. Optic - sence of vision**** - snellen eye chart for far vision*** - read news paper for near vision - ophthalmoscopic exam 3. Oculomotor - eye movement***** - pupil constriction & raising eyelids - pupil equally in size & equally reactive to light*** - Pt. Look up & down - pt. Look in your finger 4. Trochlear - eye movement** - downward & inward movement of eye 5. Trigeminal - jaw movement & sensation of face & neck*** - pt. Able to clench & relax jaw - pt. Can diffirentiate various stimuli touching Face & neck - pt. Test forehead, cheek & face w/ pin & wisp Of cotton**** - pt. Open jaw, bite down*** Use tongue blade & bite & remove** 6. Abducen - lateral movement of eye - pt. Able to move eye in all direction 7. Facial - facial muscle movement & taste two-third Of tongue (sweet & salty) - pt. Able to smile, whistle 8. Acoustic - sence of hearing & bone balance - pt. Walk in balanced w/ eye closed - weber & rinne test - used tunning fork & audiometer 9. Glossophargeal - pharyngeal movement & swallowing - taste one third of tongue(bitter & sour) - pt. Gag reflex & swallow 10. Vagus - speaking - observe ovula for midline position 11. Spinal acessory - flexion & rotation of head - shugging of shoulders - inspect sternocleidomastoid & trapezius Muscle 12. Hypoglosal - tongue movement

2. potassium hypo# cause* def.sign.care.risk

1. less than 3 & more than 5.1 = life threatening 2. risk for dig toxicity - cause 1. all diuretic & corticosteroid<< 2. cushing syndrome<<<< 3. diabetes DKA<<< 3. Loss of electrolytes from the gastrointestinal tract through vomiting, diarrhea, or nasogastric suction 5. starvation<<< 5. wound drainage 5. excessive diaphoresis 6. water intoxication risk 1. Hydrochlorothuazide (HCTZ) - sign 1. decrease GI/reflex<<<< hypo active bowel sounds<<< 2. muscle weakness, soft & flabby muscles, 3. fatigue,malaise <<< 3. confution may lead to coma<<< 4. ventri. dysrhymias<<< 5. nausea, vomiting, and paralytic ileus, 6. {variable pulse rate, weak irregular thready pulse<, and the pedal pulses are difficult to palpitate when hypokalemia is present} - intervention 1. client who has been vomiting for 2 days has a nasogastric tube inserted. - The nurse notes that over the past 10 hours the tube has drained 2 L of fluid. - The nurse should further assess the client for: hypokalemia 2. Iv potassium- avoid bolus or iv push or subQ or IM (may result to cardiac arrthmias) Must be diluted to central or peripheral • dilution on more than 1mEQ/10 mL is recomended • after adding potassium to iv solution; rotate & invert bag to ensure potassium distributed eventy • given w/ cardiac monitor** 3. If pt. have hypokalemia when he arrive to hospital - Apply cardiac monitor(priority)** To assess dysrhymias - then attached ECG monitor 4. oral potassium may cause N&V & must taken in empty stomach - if pt. complain abdominal pain; diarrhea, GI bleeding, must discontiue meds 5. liquid potassium chloride has unpleasant taste & should taken w/ juice or another liquid 6. client has severe diarrhea that has lasted for 2 days. The nurse should now assess the client for - arrthytmias = hypokalemia

1. health screening

1. mammogram - • 40yrs old annualy • if have 1st degree relative then 5-10yrs before relative was diagnosed 2. clinical breast exam - 20-39yrsold every 3 yrs 3. breast self exam - monthly** 2. pap smear • annualy at 21 for high risk** (until 3 negative result) (3 paptest normal. Dont need exam) • every 3 yrs for low risk 3. clamydia screening - 25yrs old or younger 2. prostate antigen & digital rectal • over 50 • or 40 high risk(black & inherited) • digital rectal exam for men** 3. physical/pelvic/breast exam • 20-39 yrs old (every 3 yrs) • 40 & up (yearly) 4. testicular self exam • montly self exam • annual screening at 15 yrs old** • common cancer between 20-35 5. fecal occult blood test (guiaic) & sigmoidoscopy or barium enema • start 50 yrs old @ every 1 or 5 yrs 6. colonoscopy - 50 at every 10 yrs 7. cholesterol test - 20 & up every 5 years 8. tuberculosis - skin test, if positive need xray 9. diabetes - fasting plasma glucose (ideally 8-12hrs fasting) 10. vision - regular check up 11. dental - regular & cleaning every 6months 12. hearing - every 10yrs & every 3yrs after age of 50yrs old 13. well child care - birth to 6yrs old 14. sciolosis - onset of adolescence

cpr child* list

1. shout & tap child shoulder 2. no response: position on his back. 3. open airway using head tilt lifting of chin • do not hyperextend the neck • use jaw thrust method if cervical injury is suspected 4. placed in sniffing position*** 5. place ear near child mouth/nose • check chest to asess breathing 6. if not breathing give 2 small breath breath 7. check brachial & femoral pulse** • if pulse absent, begin compression at 100/min 7. position your 3rd & 4th finger in center of chest half inch below nipples • for infant both thumbs may used w/ finger encircling chest 8. ratio breath to compress is 30:2 9. after 1 min. call 911 & continue giving breath & compression

iv fluid* types. def.

A.) Isotonic fluid - same concentration as body fluids - increase extracellular fluid volume - do not enter the cell because of osmotic force exists to shieft the fluids - frequently used iv - ex. • .9% sodium chloride (normal saline) (good for dehydration)•• • D5W = 5% dextrose in water • D5W / 1/4NS = 5% dextrose in 0.225% NS • {lactated ringer solution}<<< (more electrolyte that pt. serum)•• • given to pt. w/ hypernatremia, • D5LR - 5% Ringer's solution has sugar and it opposes the effect of salinity. - Normal saline • its isotonic • contain water, sodium, chloride • its does not provide nutrition B.) Hypotonic solution - administered when pt. restrict their salt intake like hypernatremia•• - cause fluids to shift out of blood vessels and into the intestinal space, causing ECF volume depletion - are more dilute solution & have lower osmolality than body fluids - cause movement of water into cell by osmosis - should administered slowly to prevent cellular edema - used in parenteral nutrition -ex. • .45% sodium chloride = 1/2 NS • .33% sodium chloride = 1/3 NS • tap water is hypotonic in bowel & it will increased fluid in area avoid using tapwater enema until clear<< - C.) Hypertonic solution - have higher osmolality than body fluids & more concentrated solution - ex. • D10W = 10% dextrose in water<< • D10W in 45 NS • 3% NS • 5% NA • 5% dextrose in .9% NS • 5% dextrose in .45 NS • 5% dextrose in lactated ringer d.) colliod ex. - also known plasma expanders - used to increase vascular volume rapidly like hemorrhage.or severe hypovolemia - ex. • dextran • albumin d.) hyperosmotic - parenteral nutrition e.) Dextrose iv - given to pt. after evaluation of ABC, If pt. unresponsive but breathing, diaphoresis

spinal cord injury* list

C3 & above - it control diaphram, risk respi*** • unable to control muscle breathing** - ventillatory support - unable ADL C4 - no upper extremity function - movement of trapezious, sterno... - minimal respi. function*** check breath sound - unable ADL, feed powder(depend) C5 - neck movement - partial strength of shoulder, biceps C6 - muscle function in C5 level - partial strength in pectoralis - can drive electric wheelchair, - can feed self w/ powered device C7 - muscle function in C6 level - no finger muscle power - can dress lower extremities - minimal assistance needed - independent in wheelchair or car C8 - finger muscle have power - muscle function in C7 - activities easier, same w/ C7 T1-T4 - good upper extremity strength - can do wheel chair T5-L2 - balance difficulties - require wheelchair - limited ambulation T5 above - hypotension & bradycardia due to massive vasodilation L3-L5 - may use crutches or cane for ambulation - truck-pelvis intact L5-S3 - waddling gait - ambulation

1. fire safety## care

R - rescue (choose 1st than other like alarm) - (like move pt. In central Corridor = means away from Window A - alarm C - confine (closed window/door) E - evacuate (ambulatory pt. then wheelchair, last bedridden) - RACE= used even in tornado 1. fire safety at home • have a smoke detector** (it activate before appearance of open flames) 1st choice than sprinkler system, fire extinguishers) 2. turn off all oxygen in the area of fire!!! 3. never use elevator