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Terms in this set (202)
Anti-Anxiety,Anticonvulsant,Muscle Relaxer short acting, benzo USE: Anxiety, tension, alcohol withdrawal, convulsive disorders, pre-op
TEACHING: Routine liver funct, cross sen w/ benzos
SIDE EFFECTS: Dizzy, tired, blurred vision, rashes, resp dec, bradycardia
PRECAUTIONS: Dependency, Bed Rest observe for 3 hrs
Spironeolactone (Aldactone)- K sparing diuretic - Hyperkalemia, OH, hypotension - Monitor renal function, watch for hyperkalemia, avoid salt sub. that contain KaWarfarin (Coumadin)- Anticoagulant, Antiplatelet - Easy Bruising/Bleeding - Antidote: Vita K, limited Vita K diet, avoid leafy greens MONITOR: PT w INR -bleeding prec.Lisinopril (Prinivil)-ACE Inhibitor, Antihypertensive, SE- dry cough, hyperkalemia, angioedemaPhytonadione (Vitamin K)- Manmade Vita - Helps liver to produce blood clotting factors - SE: Decreased appetite - Warfarin reversal agent - May treat drug induced abns & disease of premisAminocaproic Acid (Amicar)- Antifibrinolytic - Helps control bleeding due to cond. where ur blood doesn't clot way normally should (fibrinolysis) - SE: Headache, n/v, stomach pain, unusual tirednessDextroamphetamine Sulfate (Dexadrine)- Stimulant - Used to treat ADHD & Narcolepsy - SE: Nausea, cramps, loss of appetite, dry mouth, trouble sleeping - Increased BPDigoxin Immune Fab (Digibind)- Tx of pot life threatening Digoxin Intox(not indicated for milder cases of digitalis tox) -Man of life threatening tox: VTAC, VFIB, Severe sinus bradycardia, or sec or third deg heart block not responsive to atropine. -HypokalemiaPhenytoin (Dilantin) Therpeutic Level10-20 seizure mng toxic >30 lethal >100Probenecid (Benemid)-used for reducing blood uric acid levels assoc w gout. -also block excretion by kidney of penicillin & related antibiotics&is used for increasing effectiveness when treating infections. -SE: headache,dizziness, n/v, skin rashValproic Acid (Depakene)- Used to treat seizure disorders, mental/mood conditions, prevent migraines - Restores balance of certain natural substances (neurotransmitters)(In the brain) - SE: Diahrrea, dizziness, drowsiness, hair loss, chg in periods, tinnitis, double visionSucralfate (Carafate)- Used to treat/prevent ulcers in intestines - Puts coating over ulcers - Take on empty stomach (hour prior to meal) - SE: Constipation, dry mouth, upset stomach, nausea, gasEpoetin (Epogen)- TX of anemia & ppl w long term serious kidney disease - SE: Headache, body ache, diarrhea, increased BPFolic Acid (Folvite)- Water soluble B Vita., effective for anemia, folvite deficiency, also kidney disease, high amounts homocystine, reduces s/e of methotrexate, neural tube defectsFerrous Sulfate (Feosol)- Iron sup. - Effective for Anemia caused by chronic disease or Iron deficiency - SE: Upset, N/V, - Should be taken on empty stomachCalcium Carbonate (Tums)- Don't exceed 15 tablets in 24 hrs. - AntacidDocusate Sodium (Colace)- Stool softner -SE: Stomach pain, Diarrhea, CrampingCaptopril (Capoten)- ACE inhibitor - TX of HTN - Take on empty stomach 1 hour prior to meals - SE: Dizziness, dry cough, light headednessFurosemide (Lasix)- Loop Diuretic -Hypokalemia, Dehydration -Monitor: I&O, wt, K levels - SE: Dizziness, light headedness, blurred visionAspirin- Drink full glass water, don't lie down at least 10 min after taking, don't crush or chew - Reduces fever/mild pain, prevents blood clots, reduces risk of stroke/heart attack - Blood thiner - SE: Upset stomach, heartburn, bleeding allergic reactionGlyburide (Micronase)- Used to treat Type 2 diabetes - SE: Nausea, heartburn, stomach fullness, weight gain - Take w first main meal of dayProventil (Albuterol)- Fast acting B2 antagonist -Rescue Inhaler (carry w pt ALL times) monitor HR - Treats wheezing/sob - Broncho dialator - SE: Nervousness, trimmers, headache, dizziness, increased BPIM Injections- Z Track Technique-dorsal gluteal site -mk sure bubble at end of med, identify app landmark, pull skin& subQ tiss's away from muscle, clean st while holding skin& subQ, insert needle, aspirate, inject drug slowly followd by inj of air bubble. -DONT MSG ST -given when severe iron def anemiaDelegation to an unlicensed AP"DONT delegate what you can E.A.T." Evaluate, Assess, or TeachProtecting victims of abuseensure safety, allow them to remain in controlSafe transfers of pt w R/L sided weaknessensure wheelchair on unaffected sideTrach care & suctioning-establish hand gesture -always preoxygenate, suction for no longer than 10-15sec, suction on way out not in, suction mouth last.Asthma SE of oral inhalation therapyTachycardia, uncontrollable shaking of part of body, headache, cough, throat irritationWhen taking bronchodilator & corticosteroid1st-bronchodialator(fast acting) 2nd- steriod 3rd- long actingO2 Therapy-no open flames/ combustion hazardsAdrenal Insufficiency (Addison's)-not enough glucocorticoids & mineralocorticoids(aka not enough steroids) -Anemic Adam -low Na high K -bronze skin, wt loss, hypoglycemia, dehydrated, irreg HR (^K) -watch for adisonian crisis -TX: Cortisol 2/3 am 1/3 pmAddisonian Crisis-life threatening event -need for cortisol & aldosterone is greater than availability -occurs in resp to stressful eventDiabetes MellitusPancreas doesn't produce insulin -Type1 & Type 2Type 1 Diabetes Mellitusautoimmune disorder n which beta cells r destroyed n a genetically susceptible personType 2 Diabetes Mellitusprogressive disorder n which pancreas makes less insulin over time related to insulin resistance, poor control of liver glucose output, & decreased beta cell func.; eventually leading to beta cell failure3 glucose related emergencies-DKA (diabetes ketoacidosis) -HHS (hyperglycemic-hyperosmolar state) -hypoglycemiaDKA (diabetes ketoacidosis)czd by lack of insulin& ketosis -sudden onset, precipitated by inf or inadequate insulin dose -Kussmaul Resp/fruity breath, nausea, and pain - >300mg/dL -TX: Insulin TherpayHHS (hyperglycemic-hyperosmolar state)czd by insulin def & profound dehydration -gradual onset, precipitated by inf or poor fluid intake -alt CNS funct w neurologic s/s - >600mg/dl -TX: FLUIDS & IV INSULINhypoglycemiafrom too much insulin or too little glucoseHbA1c-Gycosylated HemoglobinNorm Range 4-6% -levels any highr=poor glucose control -shows avg of glucose in body for 120daysHypothyroidism-hyposecretion of thyroid hormones -slow metabolism, intolerance to cold, weakness, fatigue, muscle aches, dry skin/hair, bradycardiaHypothyroidismAdmin. Synthroid as perscribed -T3 & T4 decreased, TSH elevated -Hashimoto disease assoc. wHyperparathyroidismhypersecretion of parathyroid hormone -Hypercalcemia & Hypophosphatemia (Ca/P interchangeable) -fatigue, muscle weakness, wt loss, HTN, cardiac dysrhythmiasHyperparathyroidismAdmin. Calcitonin *Ca is high P is low benign adenoma in glomuler epiphealelHypoparathyroidismhyposecretion of PTH -Hypocalcemia & Hyperphosphatemia -Positive Trousseau & Chvostek's sign -Hypotension, irritability, depressionHypoparathyroidismCa is low P is high -(CATS) Convulsions, Arrhythmias, Tetany, Stridor/Spasms -vita D def -removal of parathyroid?Gastritisinflammation in lining of stomach -excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs -H. Pylori, Pernicious anemia, bile refuxAddison's Diseasedeficiency from the posterior pituitary -sudden cessation of longterm high dose glucocorticoid therapy (low cortisol disease)Addison's Disease-Hypocortisolism (hypoglycemia, anorexia, wt loss) & Hypoaldosteronism (^K, dec NA, hypovolemia, hypotension) -MONITOR: diet, safety, cardiac dysrhythmias, seizure prec, glucose, I/Os, Daily wts -maintain fluid balance -severe hypotension, hypokalemia, irreg HR(^K)Addison's Disease MEDS-hydrocortisone -Florinef (replaces aldosterone)Acute pancreatitislife threatening inflammatory proc of pancreas, czd by premature activation of excessive pancreatic enzymes that destroy ductal tis & pancreatic cells, resulting n autodigestion & fibrosis of pancreasAcute pancreatitisLABS: ^amylase ^lipase CT w contrast MAN: severe constant abd pain- LUQ/epigastric, pain worse wn lying, wt loss from N/vAcute pancreatitisCOMP: DIC, Septic Shock, resp failure, DIABETES MELITUS, total TPN, hospitalized very sick Onset by alcohol binging, hypovolemia(bc of^bleeding/hemmorage), kidney failure, pleural effusion, multisyst organ failureNephrotic Syndromecond of increased glomerular permeability that allows larger molecules to pass thru the membraneACUTE Renal Failure-sudden onset, 50% nephron involv, duration 2-4wks, prog is gd for return of renal func w supportive care -S/S czd by retention of wastes& fluids, & inability of kidneys to regulate electrolytesHIV (AIDS)transmitted by needlestick, blood, body fluids -Elisa&Western Blot test to confirm -AIDS is when CD4T Cells go under 200 or if acquire Opportunistic inf.Hiatal Herniastomach bulges up into the chest through the hiatus (opening in the diaphragm) 2main types: sliding and paraesophageal (next to the esophagus).Pernicious Anemiaanemia that occurs when the stomach lacks a naturally occurring substance needed to properly absorb and digest vitamin B12Lyme Diseaseczd by spirochete Borrelia burgdorferi resulting frm bite of infected deer tick -flu like s/s, rash, pain/stiffness in muscles & joints TX: doxyxycline/ amoxil during uncomplicated stageGlomerulonephritiskidney disorders characterized by inflammatory injuries in the glomerulus, most of which are czd by immunological reaction, loss of kidney func develops. -2-3 weeks after strep infCOPDcan't get Co2 out -barrel chest, clubbed nails, tripod pos, space out ADLS, cool roomGoutform of arthritis wen urate crystals deposits in joints & other body it causing inflammation -limit proteins, avoid trigger foods, plenty fluids, low purine dietGastrectomysurgical removal of a part or the whole of the stomachGERDA digestive disease in which stomach acid or bile irritates the food pipe lining(LES). -preggos, hiatal hernias -diet&lifestyle changes; severe-meds & surgeryDVT-formation of a blood clot (thrombus) w in a deep vein,(legs). -s/s: pain, swelling, redness, warmness, and engorged superficial veins. -Pulmonary embolism, a potentially life-threatening complication czd by detachment (embolization) of a clot that travels to the lungs. -prevention: exercise, anticoagulants, aspirin, graduated compression stockings, and intermittent pneumatic compression.Endocarditisinflammation of the (endocardium)inner layer of heart -Dx tests: echo ,blood cultures, ECG -S/S: fever, chills, sweating, malaise, weakness, anorexia, weight loss, splenomegaly, flu like feeling, cardiac murmur, HF, petechia of anterior trunk **Rheumatic fever -IV antibioticsRF for CADsmoking, obesity, sedentary lifestyle -diabetes, high cholesterol, & HTNEffects of Hypokalemia on ECGTachycardiaNA levels135-145K levels3.5-5Hyponatremiaconfusion, muscle weakness, dec DTR *check resp. status increased GI motilityHypernatremiaseizures, muscle twitching, dec cardiac contractility *Seizure precHypokalemia*dig toxicity, heart dysrhythmias, constipation *check resp. status OHEffects of Hyperkalemia on EKGTall peaked T wavs, wide QRS, diarrheaFoods high in Kdark leafy veg, potatoes, squash, yogurt, fish, avocados, bananasFoods high in Nacanned veggies, processes meats, chz, picklesAcid Base ImbalanceNORM PH: Acidic 7.35-7.45 Alkalosis CO2(PACO2) represents Resp: Alk 35-45 Acid HCO3 BICARB represents metabolic: Acid 21-28 AlkLow K =Alkalosisshallow resp, irritability, confusion, tachycardia, thready pulseHigh K =Acidosismuscles twitches, hypotension, EKG changes, abd cramping, diarrheaResp Acidosis-teach breathing exercises (pursed lip breathing) -any type airway obstruction -retention of CO2 COPD, asthma, hypoventilation dec. rate /depth of respirations -broken ribsResp Alkalosishypervenilation, mechanical ventilation, anxiety , fear -teach pt to slow rt of breathing -breathe in bag to rebreathe CO2Metabolic AcidosisStarvation, fasting, DKA, excess of alcohol/aspirin, seizure act, prolonged diarrhea "ass-idosis" - inc. rate/depth of resp. -S/S:Kussmauls Resp, warm flushed skinMetabolic Alkalosistoo much fluids coming out of me -prolonged vomiting "alk-alosis", prolonged ng tube suction, overuse of antacids dec. rate/depth of resp.Airborne Precautionsneg airflow room required to prevent spread of microbes, HEPA filter -TB, measles, chickenpox -N95 MASKContact Precautionsknown/suspected infs transmitted by direct contact or contact w items in environment -MRSA, Pediculosis(Lice), scabies, RSV, Cdiff -PPE's &HANDWASHINGDroplet Precautionsprotect from droplets that may travel 3 ft but aren't suspended for long pers. -influenza, mumps, pertussis, miningitis -SURGICAL MASKBest practices for hearing lossspeak clearly and slowly, sit in front of them, avoid yes/no questions. -dont use hairsprays while hearing aide is in ear -turn off & remove batt when not in useOsteoporosis RFolder age, estrogen/androgen deficiency, smoking, high alcohol intake, lack of physical exercise or prolonged immobilityPulmonary Embolidue to prolonged immobility, obesity, central venous catheters, hist of embolus. -INTERV: ROM for immobilized pts, TED hose, improve lung perfusion, antiplatlet therapy, O2 therapyBucks Extension Tractionskin traction in which application of a pulling force is to a part of the body to provide reduction, alignment, rest. -Never remove wts, should b freely hanging, inspect skin from pin sites to prevent inf. -pin site care =aseptic(sterile), treat each pin as one dressingAbove the Knee AmputationFlexion contractures can occur so treat by proper positioning& acive ROM -Elevate for 24 hrs& put in prone pos to prevent contractures& ROM on hip -phantom limb pain?treat accordingly (its real) -Cymbalta Tx of painCast Care-too tight=cut it off -assess distal for skin color, temp, movement, sensation, pulse, capillary refill, pain. -handle w palmsCompartment Syndromeserious cond czd by increased press w in 1 or more compartments reduces circulation to the area -edema, pain, pallor, cyanosis, tingling/numbnessNephrotic Syndrome-massive proteinuria -edema -decresase plasma albumin -hyperlypidemia -renal insufficiency -alt liver act may occur resulting n ^lipid production&hyperlipidemiaNephrotic Syndrome Tx-ACE Inhibitors: dec protein loss in urine -Cholesterol lowering drugs: improve blood lipid levels -Heparin: reduce protein&renal isufficiencyNephrotic Syndrome-mild diuretics & Na restriction my be needed to control edema & HTN -asses hydration status bc vascular dehydration is common (worsen renal probs)Most Common Cz of Nephrotic Syndromeimmune or inflammatory processesNephrotic Syndrome Diet ChangesGFR Norm =dietary intake of protein is needed GFR decreased =dietary protein must be decreasedACUTE Renal Failure Causes-conditions dec blood flow to kidneys (shock, HF) -actual physical, chemical, hypoxic, or immunologic tiss damage -obstruction of the urine collecting syst (kidney stones)ACUTE Renal FailureNephrotoxic substances- antibiotics are common drugs w nephrotoxic SE -combining 2 or more of these drugs ^the risk for acute renal failureCHRONIC Renal Failure-transplant -diet, fluid rest, dialysis, drug therapy,ACUTE Renal Failure Manifestations-azotemia(build up of nitrogenous wastes) -oliguria or anuria -CARDIAC: HTN, tachycardia, JVT, ECG changes(Tall T waves) -RESP: SOB, rales, crackles, pulmonary edema, orthopnea -GI: anorexia, N/V, flank pain -NEURO: lethargy, headache, tremors, confusion -GEN: gen edema & wt gainPhases of Oliguric ARFOnset-precipitating event& cons until oliguria (hrs-days) Oliguric-dec UO that doesn't respond to fluid changes or diuretics(1-3 wks) Diuretic-urin flow^ rapidly over a per of sev days(>10L of salute urine/day Recovery-return norm levels act. complete rec ~12mosInterventions for ARFmonitor for life threating FE changes, nitrogen retention ,FE replace is key, peritoneal dialysis, hemodialysis, hemofiltration -Lasix to promote fluid loss -diet ^in proteinChronic Kidney Disease RF/Causes-Vascular disease of the kidney IE: renal art stenosis- proc affecting the renal art. which severely narrows the lumen & greatly dec blood flow to kidneys -Inf IE: pyelonephritis: bacterial (UTI) in kidney&renal pelvis -Metabolic Renal Disease IE: Gout=hyperuricemic or diabetic nephropathy -Inherited or genetic conditions IE: polycystic kidney diseaseChronic Kidney Disease-Kidney changes: abn urine production, poor water excretion, electrolyte imbalance -Metabolic changes: ^urea & creatine, risk for hyponatremia, hyperkalemia which leads to cardiac dysrhythimas, acid base disturbances, hypocalcemia, hyperphospatemia -Cardiac Changes: HTN, Fluid overload, hyperlipidemia, anemiaChronic Kidney Disease Prevention/Health Promotion-control DM & HTN -pts adhere to drug&diet therapies -exercise -CBGs in normal range -Blood monitoring: BUN, Cr, Albumin -Na & K restrictions -BP daily & daily wts -avoid infections, urinary catheters, injury -alt pers of rest&actGlomerulonephritis causesimmunological disease, autoimmune diseases, STREP, hist of pharyngitis/tonsilitis 2-3wks before onset of s/sGlomerulonephritis S/SCLOUDY SMOKY BROWN URINE, periorbital edema, oliguria, pallor, irritability, HTN, anorexia, hematuria, azotemia, abd/flank pain, headaches, ^ASO titer, dysuria, proteinuria,Glomerulonephritis interventions-MONITOR: VS, wt, I/Os, charc's of urine, for compications -limit act high quality nutrient food(foods high in K restricted during per of oliguria, protein rest at times, moderate Na/fluid rest) -administer diuretics, antihypertensives,&antibiotics as Rx -seizure prec -pt report s/s of bloody urine, headache, edemaCADArteries fill w plaque &narrow, atherosclerosis occurs. -heart can't get enough O2 to funct properlyCardioversion to treat atrial fibrillationelectric current used to reset the heart's rhythm back to its regular pattern (normal sinus rhythm). The low-voltage electric current enters the body through metal paddles or patches applied to the chest wall. Before: meds to control pain and cause relaxation.Defibrillation for ventricular tachycardiaAntiarrhythmic medications Implantable cardioverter-defibrillator (ICD), Catheter ablation -cardioversion, epe, lidocaineMastectomy-mng of pain:vicodin -JP drains -dont remove steri strips or stitches -may shower 1day after the drains out and if have a plastic dressing -no heavy liftingRF for pneumoniasmokin, copd, excessive alcohol, take PPI, Cold /flu, older than 65, weakened immune systOrgan donation contraindicationsAge >85 • Any cancer with evidence of spread outside affected organ (including lymph nodes) within 3 years of donation (however, localised prostate, thyroid, in situ cervical cancer and non-melanotic skin cancer are acceptable) • Melanoma (except completely excised Stage 1 cancers) • Choriocarcinoma • Active haematological malignancy (myeloma, lymphoma, leukaemia) • Definite, probable or possible case of human TSE, including CJD and vCJD, individuals whose blood relatives have had familial CJD, other neurodegenerative diseases associated with infectious agents • TB: active and untreated • HIV disease (but not HIV infection)Care of venous stasis ulcerscompression therapy, local wound care (debridement), dressings, topical or systemic antibiotics for infected wounds, other pharmacologic agents, surgery, and adjunctive therapy.hydrocolloid dressing for VSUwater type of dressing that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant outer layer. complication: assesment is hard, avoid w diabetic pts, may curlwet to dry dressings for VSUplacing moist saline gauze onto the wound bed, allowing it to dry& adhere to tissue in wound bed. Once the gauze is dry,remove gauze. -repeated every 4 to 6 hours. - harms good tiss & removes necrotic tiss -keeps wound bed cool temperature and it at risk for bacterial invasion, as bacteria can penetrate up 64 lyrs of gauze -PAINFUlCharacteristic pain of gastric and duodenal ulcersEpigastric pain(LUQ) is the most common s/sPeptic ulcer disease:-occurs in the stomach and proximal duodenum. -predominant causes: infec w H. pylori& use of nonsteroidal anti-inflammatory drugs(pain killers). S/S: epigastric discomfort (specifically, pain relieved by food intake or antacids and pain that causes awakening at night or that occurs between meals), loss of appetite, & wt lossSigns of Perforation in Peptic Ulcer Disease-acid contents stomach floods peritoneum gives sudden agonizing pain. -constant pain, spreads across entire upper abdomen&later all over, worsened by deep breathing/movement. -pt lies still in excruciating pain, breathes shallowly w out moving abd -pale, sweating, hypotensive, fast pulse , norm temp, & nondistended stomach -board-like rigid abd -After 3 -6 hrs pain&rigidity lessen, feels better& a ''silent interval' begins. Then, ~6 hos, s/s of diffuse peritonitis develop, accompanied by abd distension &absent bowel sounds.Complications of Peptic Ulcer Diseasebleeding, perforation, penetration, or obstruction.Most important RF for COPDemphysema & chronic bronchitis **CIG SMOKINGDuodenal ulcersFood or antacids relieve the pain of this ulcerphlebitisinflammation in the walls of the veininfiltrationoccurs when I.V. fluid leaks into surrounding tissueinfiltration S/Sswelling, discomfort, burning, tightness, cool skin, blanchingprevention of cystitishydration, freq urination, Wipe from front to back after a bowel movement, showers not baths, Avoid using deodorant sprays or feminine products in the genital area, urinate asap after sex,treatment of cystitisdepends on underlying cause, 1st antibioticscystitiscaused by bacterial infection is generally treated with antibioticss/s fluid vol overloadSOB, Edema, Crackles upon auscultation, increase bounding pulse, JVT, HTN, Ascites, 3rd heart sound, moist skin, dypsneas/s fluid vol defecitcold, clammy skin, paleness, rapid breathing and heart rate, weakness, decreased or absent urine output, sweating, anxiety, confusion, and unconsciousness low bpUse of incentive spirometer-Exhale normally, Put the mouthpiece in your mouth and close your lips tightly around it. Do not block the mouthpiece with your tongue. -Inhale slowly and deeply through the mouthpiece to raise the indicator. Try to make the indicator rise up to the level of the goal marker. When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 3 seconds. Exhale normally. Repeat these steps 10 to 12 times every hour when you are awake, or as often as directed.continous bladder irrigation-irrigation is done until return flow is clear -if blood, contact physician, -color should be yellow with red sediment -check I/OsprostectomyProstatectomy usually requires general anesthesia and a hospital stay of 2 to 4 days. A catheter is usually left in bladder to drain urine for 1 to 3 weeks. Dr will give instructions to care for catheter at home. Poor bladder control afterwards.Prevention of female reproductive tract infections-urinate after sex -avoid baths -avoid douches -practice safe sex/abstinence -no multiple sexual partnersfoods high in Ka-bananas -OJ -milk -fish -squash -yogurtfoods high is Na-canned foods -processed foods -fried foodRF for fluid volume deficit-decreased oral intake associated with anorexia, fatigue, and nausea if present; -increased insensible fluid loss associated with diaphoresis and hyperventilation if present; -excessive loss of fluid associated with vomiting and/or diarrhea if present with initial infection or as a side effect of antimicrobial therapy.Who SHOULD get the flu shot?All persons ages 6 months and older are recommended for annual vaccination, with rare exception. -(6mo-4yrs) -health care personal -immunocompromised -(50yrs & >) -long term facility pts -preggosHow often should you get the flu shot?as soon as vaccine becomes available, if possible by October.who should NOT get the flu shot?-allergy to eggs -ever had Guillane Barre Syndromeparaplegiaparalysis in lower extremitiesparaplegia- Tx of spasticity of leg muscles-Muscle relaxants i.e. baclofen (Lioresal), clonazepam (Klonopin), diazepam (Valium), -OT & PT -muscle stretching & ROM exercises -sometimes use of braces may help prevent tendon shortening. Rehab may help to reduce or stabilize the severity of s/s & to improve functional performance.S/E of corticosteroids-Na & fluid to be retained in the body and cause weight gain or edema -HBP -Loss of Ka -Headache -Muscle weakness -Puffiness of the face (moon face) -Facial hair growth -Thinning and easy bruising of the skin -Slow wound healing -Glaucoma -Cataracts -Ulcers in the stomach and duodenum -Loss of diabetes control -Menstrual irregularity -"Buffalo hump," a condition described as a rounding of the upper backcare of NG tube to suction post abd surgery-Assess position and patency of NG tube, connecting it to low suction. Gently irrigate with sterile normal saline if tube becomes clogged. -Assess color, amount, and odor of gastric drainage, noting any changes in these parameters or the presence of clots or bright bleeding. Initial drainage is bright red. It becomes dark, then clear or greenish-yellow over the first 2 to 3 days. A change in the color, amount, or odor may indicate a complication such as hemorrhage, intestinal obstruction, or infection. -Monitor bowel sounds and abd distention Bowel sounds indicate resumption of peristalsis. Increasing distention may indicate third-spacing, obstruction or infection. -encourage ambulationtheophylline inhalersbronchodilator. It works by relaxing muscles in the lungs and chest, making the lungs less sensitive to allergens and other causes of bronchospasm.Patient teaching for theophylline inhalers-treat symptoms such as wheezing or shortness of breath caused by asthma, bronchitis, emphysema, and other breathing problems -Do not take theophylline in larger or smaller amounts or for longer than recommended. Theophylline overdose can occur if you accidentally take too much at one time, or if your daily doses are too high. To be sure you are using the correct dose, your blood will need to be tested often. -Do not start or stop smoking without first talking to your doctor. Smoking changes the way your body uses theophylline, and you may need to use a different dose.patient teaching for metered dose inhalersRemove the cap from the MDI and shake well for 5 seconds. Breathe out all the way. Keep your chin up. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it. As you start to breathe in slowly, press down on the canister one time. Keep breathing in slowly to completely fill your lungs. (It should take about 5 to 7 seconds for you to completely breathe in.) Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs. Replace the cap on the MDI when finished. rinse moth after use.factors that increase the risk of electrolytes being depleted or in excess-alcoholism and cirrhosis of the liver -CHF -eating disorder -kidney disease -trauma (such as severe burns or broken bones) -thyroid and parathyroid disordersinterventions for children with Diabetes Mellitus-dont smoke -Keep track of carbohydrates (sugar and starchy foods) -Give low-fat and low-sodium foods -give high fiber foods -Go to all follow-up appointments -encourage kid to exercise(DONT IF blood sugar level is high and he has ketones in his urine or blood.) -help maintain healthy weight -Check feet each day for sores -Give instructions to your child's school -ask about vaccinesintravenous pyelography-teach exposed to low level radiation -check for allergies, particularly to iodine or shellfish -check if pregnant or think you might be pregnant -check if had a previous severe reaction to X-ray dyes. You may need to avoid eating and drinking for a certain amount of time before an intravenous pyelogram.bronchoscopy teaching-1ST THING: CHECK GAG REFLEX - sleepy and confused when you wake up from general anesthesia or sedation -spend time in recover room -chest xray wil be done after procedure, may be told to cough up secretions into basin for testing -may experience throat sourness afterwards -Using throat lozenges or gargle may help w discomfort.Prep for EGD- stop taking meds such as aspirin and other blood-thinning agents for several days before the test. -not able to eat anything for 6 to 12 hours before the test. People who wear dentures will be asked to remove them for the test. As for all medical test and procedures, you'll be asked to sign an informed consent form before undergoing the procedure.intravenous pyelography teaching-A feeling of warmth or flushing -A metallic taste in the mouth -Nausea -Itching -Hivesintravenous pyelography complications-allergic reaction (anaphylactic shock) -cardiac arrest - Extremely low blood pressurebronchoscopy complications-Bleeding -Infection -Hole in the airway (bronchial perforation) -Irritation of the airways (bronchospasm) -Irritation of the vocal cords (laryngospasm) -Air in the space between the lung covering (pleural space) that causes the lung to collapse (pneumothorax)call healthcare provider after bronchoscopy IF-Fever of 100.4°F (38°C) or higher -Redness or swelling of the IV site -Blood or other fluid leaking from the IV site -Coughing up blood -Chest pain -Severe hoarseness -Trouble breathingEGD complicationssmall chance endoscope will cause a small hole in your esophagus, stomach, or small intestine. There's also a small risk of prolonged bleeding from the site of the biopsy. -difficulty breathing -low BP -slow heartbeat -excessive sweating -a spasm of the larynxEGD teachingA nurse will observe you for about an hour following the test to make sure that the anesthetic has worn off and you're able to swallow without difficulty or discomfort. -CHECK GAG REFLEX 1st -slightly bloated -slight cramping or a sore throat. relieved within24 hours. Wait to eat or drink until you can swallow comfortably. Once you do begin eating, start with a light snack.relieving bronchial secretions-decongestant -increase fluid intake -cool-mist humidifier in your bedroom -hot teas &soups -incentive spirometry -Forced expiratory maneuvers / Cough assist -cough & deep breathing exercises -Manual suction -resp therapy/ physical therapy -Percussion and vibration -DO NOT TAKE COUGH SUPPRESANTSassaultVERBALLY feel threatenedBatteryPHYSICALLY touch one without consentDroplet precaution-influenza, mumps, pertussis, meningitis -in my personal space 3-5ft = surgical maskAirborne precaution-TB , measles, chicken pox -N95 mask, negative pressure room, HEPA filterdiagnosing AIDS1st- HIV 2nd- CD4 T cell count below 200 OR opportunistic infectioncolon & prostate annual cancer screenings & follow upsmen older than 50 -every 10 yearsmammogram annual cancer screenings & follow upswomen older than 40pap annual cancer screenings & follow upsevery year after having sexTURP surgery for prostate removalFollowing surgery, a catheter is used to remove urine and blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and be discharged. Strenuous activity, constipation, and sexual activity should be avoided for about 4 to 6 weeks. S/S such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery. But they should ease during the first 6 weeks.CA levels8.5-10Magnesium level1.5-2.5Creatinine (specific for kidneys)0.6-1.2Cholesterol level<200Glucose level70-100Lithium level0.6-1.2Lanoxin (Digoxin) level0.5-2 apical pulse must be 60Platelets150,000 - 400,000WBC5,000- 10,000RBC4million- 6 millionTriglycerides<150Phosphorus3 - 4.5Hmg12-16Hct36- 48TroponinCK-MBglycosolated Hmg (Hmg A1C)120 days <5 = okaypH7.35 - 7.45PaCo235- 45HCO321-28earliest S/S of dig toxanorexia & nausealate S/S of dig toxbradycardia visual disturbances(green halo)Hyperkalemiacardiac dysrhythmias muscles weakness bradycardia increased GI motility increased excitable tissues