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Cardiovascular: Hyperkalemia can be a side effect of ACE inhibitors.

Confusion and restlessness are signs of lidocaine toxicity cerebrovascular accident is a common complication of atrial fibrillation. Cardiogenic shock occurs when myocardial contractility decreases and cardiac out put greatly decreases. The circulating blood volume is within normal limits or i ncreased. Raynaud's disease results from reduced blood flow to the extremities when expose d to cold or stress. It's commonly associated with connective tissue disorders s uch as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pai n, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branche s that interrupts blood flow to the legs and feet, causing pain and coolness. Bu erger's disease is an inflammatory, nonatheromatous occlusive disease that cause s segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs. Sumatriptan is contraindicated in clients with ischemic heart disease, such as a ngina, myocardial infarction, or coronary artery disease, because it is a vasoco nstrictor. a common complication of Buerger's disease is thrombus formation and potential o cclusion of the vessel. Because of its location near the xiphoid process, the liver is the organ most ea sily damaged from pressure exerted over the xiphoid process during CPR.

Enalapril maleate is an angiotensin-converting enzyme inhibitor that prevents co nversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasocons trictor and also contributes to aldosterone secretion. Thus, enalapril decreases blood pressure through systemic vasodilation. High pulmonary artery wedge pressures are diagnostic for left-sided heart failur e. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. Digoxin is a cardiac glycoside with positive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increa ses output of blood from the left ventricle. Preload is the volume in the left ventricle at the end of diastole. It's also re ferred to as end-diastolic volume. Preload is reduced by any condition that redu ces circulating volume, such as hemorrhage, sepsis, and anaphylaxis. Hemorrhage reduces circulating volume by loss of volume from the intravascular space. Sepsi s and anaphylaxis reduce circulating volume by increased capillary permeability. Diuresis, vasodilation, and third spacing also reduce preload. Preload increase s with fluid overload and heart failure. A history of aortic insufficiency contraindicates use of the IABP. Other contrai ndications for this therapy include aortic aneurysm, central or peripheral ather osclerosis, chronic end-stage heart disease, multisystemic failure, chronic debi

litating disease, bleeding disorders, and a history of emboli. Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increas es perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that dire ctly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct e ffect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic bloc ker that slows heart rate and lowers blood pressure, undesirable effects when tr eating cardiogenic shock. AAA rupture-severe back pain, Grey Turner's sign (flank brusing) , nausea, blood pressure of 90/40, heart rate 128 beats per minute and respirations 28 per minu te Digoxin toxicity may cause visual disturbances (such as, flickering flashes of l ight, colored or halo vision, photophobia, blurring, diplopia, and scotomata), c entral nervous system abnormalities (such as headache, fatigue, lethargy, depres sion, irritability and, if profound, seizures, delusions, hallucinations, and me mory loss), and cardiovascular abnormalities (abnormal heart rate and arrhythmia s). Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopr il, but they don't indicate that therapy is ineffective. Cardizem relaxes smooth muscles and improves peripheral perfusion, therefore re ducing finger numbness. Cardizem decreases heart rate and is used to treat atria l fibrillation, Antiembolism stockings prevent DVT by forcing blood into the deep venous system , instead of allowing blood to pool. Dobutamine increases cardiac output for clients with acute heart failure and th ose undergoing cardiopulmonary bypass surgery. Physicians may use epinephrine hy drochloride, another catecholamine agent, to treat sinus bradycardia. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension. As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adre nergic blockers, it increases peripheral vascular resistance at rest and with ex ercise. Atenolol may cause bradycardia

The most common side effect of nitroglycerin is a headache. Additional cardiovas cular side effects include tachycardia, hypotension, and dizziness. The nurse needs to assess neurologic status throughout the therapy. Altered sens orium or neurologic changes may indicate intracranial bleeding for the client wh o has received tissue plasminogen activator or alteplase. The nurse should caref ully check for bleeding every 15 minutes during the first hour of therapy, every 15 to 30 minutes during the next 9 hours, and at least every 4 hours during the duration of therapy. To maintain the best perfusion, it is recommended that compressions be given at a rate of 100 per minute in a 30 compression to 2 breath ratio for one rescuer C PR.

Severe hypoperfusion to all vital organs results in failure of the vital functio ns and then circulatory collapse. Hypotension, anuria, respiratory distress, and acidosis are other symptoms associated with irreversible shock. This client's total cholesterol isn't within the recommended guidelines; it shou ld be less than 200 mg/dl. LDL should be less than 79 mg/dl, and HDL should be g reater than 40 mg/dl. T-wave inversion, ST-segment elevation, and a pathologic Q-wave are all signs of tissue hypoxia which occur during an MI. Ischemia results from inadequate blood supply to the myocardial tissue and is reflected by T-wave inversion. Injury re sults from prolonged ischemia and is reflected by ST-segment elevation. Q-waves may become evident when the injury progresses to infarction. A notched T-wave ma y indicate pericarditis in an adult client. The presence of a U-wave may or may not be apparent on a normal ECG; it represents repolarization of the Purkinje fi bers. A prolonged PR-interval is associated with first-degree atrioventricular b lock. Mitral stenosis causes a diastolic, rumbling, low-pitched murmur audible at the apex. A pansystolic, blowing, high-pitched murmur characterizes mitral insuffici ency. A systolic, harsh, crescendo-decrescendo murmur occurs with aortic stenosi s. A diastolic, blowing, decrescendo murmur accompanies aortic insufficiency. PTT 50-70s=therapeutic anticoagulation, NML=30-40 Activated clotting time 150-210= therapeutic, NML= 70-120s signs of cardiac tamponade= hypotension, distended neck veins, muffled heart sou nds metoprolol masks the common signs of hypoglycemia. Monitor glucose levels, heart block or bradycardia, blood pressure, masks signs of shock pneumothorax- diminshed breath sounds on affected side tracheal deviation in tension pneumothorax muffled or distant heart sounds in cardiac tamponade loop diuretic removes water, sodium, and potassium beta blockers work by blocking beta receptors in the myocardium, reducing the re sponse to catecholamines and sympatheric nreve stimulation. They decrease myocar dial oxygen demand Ca channel blockers reduce the hearts workload by decreasing the heart rate. Opiods reduce myocardial oxygen demand, promote vasodilation, and decrease anxie ty. Nitrates reduce myocardial oxtgen consumption by decresing preload and afterload frontal lobe- personality, memory, reasoning, concentration, motor control of sp eech temporal- hearing and speech

occipital- vision brain stem- vital functions for cardiac disorder, nurse should avoid rectal route for temp An average adult requires 20 to 35 calories per kilogram per day. russell traction- applied to a lower ext with the ext suspended sbove the bed an d a sling placed under the knee skeletal traction- applied to a lower ext is called 90-90 traction bucks- skin traction applied to an extended lower ext bryants- skin traction applied bilaterally to the lower ext croup- acute viral infection of the respiratory track that causes acute upper ai rway obstruction. characterized by stridor, barking cough that worsens at night, and hoarseness, low gradefever adensoine acts on the AV node to slow conduction, used for paroxysmal atrial tac hy atriopine for bradycardia digoxin to treat a-fib lidocaine to manage ventricular ectopy cardiogenic shock= low cardio output dopamine is used to tx cardiogenic shock- it increases perfusion pressure to imp rove myo contractility and blood flow ace-inbitors lower blood pressure beta blockers slows HR n lower BP dobutamine increases cardiac output epi for sinus brady epi, isoproterenol n norepi to tx acute hypotension homans sign for thrombus romberg for cerbellar fn phalen for carpal tunnel syn rinne to comapre air and bone conduction in the ears infective endocarditis occur when infectious agent enters the bloodstream from I V drug abuse or dental work. Assessment includes Osler nodes (red, painful nodul es on the finger and toes), splinter hemmorrhages, fever, joint pain abd pain, n ew murmur, and Janeways lesion (small hemorrhagic areas on the fingers, toes, ea rs, and nose) Pericarditis=inflammation of the pericardium, retrosternal pain worsens when sup

ine, pulsus paradoxus (decline in bp during inspiration), and pericardial fricti on rub htn pt restrict Na and saturated fats leads V3 and V4 reord septal region of L vent I, aVl, V5 V6 record lateral surface of L vent 2,3 and aVf record on inferior surface of L vent V1 and V2 record on anterior surface or R vent and L vent do not give heparin for hemorrhagic stroke, give dexamethasone to decrease erbr al edema and pressure, methyldopa to reduce bp, and phentoin to prevent seizures atropine- tx brady dobutamine- tx hf, low CO amiodarone- tc v-fib, unstable v-tach lidocaine- tx ventricular ectopy, v-tach, v-fib nitroprusside- increase BP antiembolism stockings prevent DVT by forcing blood into deep venous system, ins tead of allowing blood to pool prinzmental angina= unstable angina, attack during rest, indicated by ST segment elevation, results from coronary artery spasm ischemic MI cause elevated ST segment, an inverted Twave, and a pathological Q w ave prolonged PR for 1st degreee heart block widened QRS indicates a conduction delay in the His Purkinje system total cholesterol <200 LDL < 160 HDL >35 Triglyceride 100-200 cardiac arrhythmiasmay occur with digoxin toxicity before using a deibrillator to terminate v-fib, check the synchronizer switch is turned off synchronizer switch should be turned on when attempting to terminate arrhythmias that contain QRS complexes fixed S2 split= ASD right bundle branch block causes a wide S2 split thats louder on inspiration tha t on expiration left bundle branch block, aortic stenosis, and PDA cuase a paradoxical S2 split heard only on expiration and results from delayed aortic vavle closure

avoid MRI with pacemaker, vigorous arm movement for 6 wks, stay 5ft away from mi crowaves procainamide- montor QRS duration Amiodarone- monitor pulmonary fn bcit can cause pul fibrosis diltizaem may cause increased PR interval or bradycardia monitor BGL in pts with T2 DM who are taking beta blockers, they may mask signs of hypoglycemia aortic stenosis murmur is loud and rough during systole aortic insufficiency murmur is high pitched and blowing heard at 3rd or 4th inte rcostal space at left sternal border mitral stenosis has a low pitched rumbling murmur heard at the apex mitral insufficency has a high pitched blowing murmur at apex complications of diltiazem are hypotension, AV block, hf, and elevated liver enz ymes. Diltiazem works during phase 0. procainamide may cause increased QRS complexes and QT intervals beta blockers may cause increased PR interval and bradycardia assess responsiveness, activate EMS, call for a defibrillator, assess breathing, adminster 2 breaths, assess pulse, compression renal failure is a major complication of AAA resection hemorrhage and shock are complications before AAA resection procainamide to tx a-fib synchronized cardioversion to tx v-tach----avoid t wAVE bc may cause v-fib SE of nitro- ha, hypotension, dizziness, n flushing SE of Beta-blocker- N/V, depression, fatigue, impotence SE of morphine- sedation, N/V, constipation, respiratory depression SE of nifedipine (Ca channel blocker)- flushing, dizziness, ha, pedal edema PE- shortness of breath, pleuritic chest pain, hemoptysis, fever Cardiac tamponade- muffled heart sounds, hypotension, elevated CVP tension pneumothorax- deviated trachea, absent breath sounds, dyspnea, JVD digoxin toxicity- N/V/D, abd cramp, visual disturbances high PAWP are dx for L side hf t inversion, st elevation, q wave during MI

ischemia- t inversion injury- st elevation percarditis- motched t wave 1st AV block- prolonged PR interval DVT- unilateral edema, skin color changes, calf pain stress induces the release of vasoactive carecholamines morphine- eliminates pain, reduces venous return, reduces resistance, reduces ca rdiac workload, reduces oxygen demand ace inhibitors SE- dizziness, HA, hypotension, diarrhea pericarditis Sx- fever, chest discomfort, NSTE, elevated ESR, pericardial fricti on rub atenolol decreases Co and BP, it increases peripheral vascular resistance, howev er unlike other B-blockers, it can cause bradcardia Pacemaker ID code- 1st letter stands for heart chamber being paced (atrium, vent ricle, both(D)), the 2nd letter stands for the chamber being sensed (atrium, ven t, both, none (o)), 3rd stands for the pacemakers response (inhibited, triggered , both, none) extra pacemaker spikes that dont precede a beat may indicate failure to capture, in whcih the pacemaker fires but the heart doesnt conduct the beat in failure to pace, the pacemaker doesnt fire when it should, this cuases hypote nsion. low cardiac output, bradycardia in failure to sense, the pacemaker cant sense the clients intrinsic heartbeat, s pikes may fall on t wave intra aortic ballon pump- decrease the hearts workload and increase the supply o f blood to the coranary arteries and increase cardiac output, indicated for pts with cardiogenic shock min orthostatic hypotension- flec calf muscles, avoid alcohol and straining, cha nge postion slowly, eat high protein snack at night, wear elastic stockings, hol d onto stationary object s3 sound- rapid filling of the vent causes vasodilation, decreased vent myocardi al contracility s4- incresaed atrial ctx or systemic hypertension, failure of the vent to eject all blood during systole d/t increased resistance nitro causes orthostatic hypotension, and dizziness preload- volume in the L vent at the end of diastole (end disatolic volume), dec reases with hemorrhage, sepsis, anaphylaxis, diuresis, vasodilation, third spaci ng preload increases with fluid overload and hf after Mi- hear pericardial friction rub

stenosed valve- high pitched snap in diastole hear graham steell murmur (high pitched blowing murmure with a decresendo patter n) indicates pulmonary hypertension, or congenital pulmonary vavle defect hear ejection click associated with MVP or calcifies aortic vavle mitral stenosis caauses a diastolic, rumbling low pitch murmur mitral insufficiency causes a pansystolic, blowing, high pitched murmur aortic stenosis causes a systolic harsh cresendo-decresendo murmur aortic insufficieny causes a distolic blowing decresendo murmur Orem- self care deficits Dorothy Johnson- behavioral systems theory Virginia Henderson- client basic needs Martha Rogers- unitary human being theory vagus nerve- vasodilation and bradycardia osler's nodes(red, painful nodules on fingers and toes), splinter hemorrhages, f ever, diaphoresis, joint pain, weakness, abd pain, new heart murmur, Janeway les ions(small hemorrhagic areas on the fingers) are signs of infective endocarditis retrosternal pain that worsens when pt is supine, pulsus paradoxus (decline in b p during inspiration),and pericardial friction rub are common in pericarditis in acute respiratory failure adminstering O2 elevates PaO2 in ARDS, elevation of the PaO2 require PEEP dizziness, headache, and hypotension are common SE of ACE inhibitors Respiratory: isoniazid se- peripheral neuropathy, nausea COPD susceptible to respiratory infection, encouraged to receive influenza and p neumococcal vaccines FiO2 greater than 0.5 can be toxic in pts with hf, fluid intake shouldnt exceed 1.5 L moblize secretions include drinking 2 L of fluid, pursed lip breathing, engage i n moderate activity in pts with COPD cystic fibrosis- inherited disorder of the exocrine gland that affects multiple organ systems, causing pul dse, pancreatic deficiency, sweat gland dysfunction, malabsorption, and liver obstruction. goals of cystic fibrosis are promoting secretion clearance, controlling infectio n, and providing adequate nutrition pleural effusions- fluid accumulates in the pleural space, decreased breath soun ds

crackels with atelectasis, fibrosis, LS-HF rhonchi=secretions wheezes result from narrow airways, such as in asthma, COPD, and bronchitis Resp alkalosis is caused nt extreme anxiety, fever, hf, injury to brain, overve ntilation, PE, early salicylate intoxication corticosteriod SE: hypergylcemia, glycosuria, GI bleeding, resetlessness, seizur es theophylline makes the resp center more sensitive to CO2 and stimulate respirato ry drive PEEP reduces CO constant bubbling in the water seal chamber indicates an air leak flumazenil reverses the effects of benzodiazepines dextromethorphan is the most widely used antitussive in the US pneumonia is the most common complication of influenza in acute resp failure. admin supplemntal oxy elevates PaCO2 in resp distree syn, elevationof PaO2 requires PEEP pursed lip breathing prevents early airway collapse NML inspiratory:expiratory ration is 1:2 naso, oro, and endotracheal tubes increase the risk of pneumonia bc of the risk of aspirations from improperly placed tubes venturi mask is a high flow oxygen delivery device that allows for exact titrati on of the fraction of inspired oxygen delivered. resonant sounds (low pitch, hollow siunds) in asthma hyperresonnat in emphysema and pneumothorax consolidation- dull sounds over dense lung tissue albuterol may cause nervousness, insomnia, hypokalemia, tremor, dizzi, HA, tachc ardia, palpiations, heartburn, N/V, muscle cramps to prevent tracheal dilation, a min leak technique should be used and the pressu re should be kept at less than 25 cm hupotension, hypothermia, and vasoconstriction, alter pulse ox valves nonrebreather mask deliver levels of FiO2 as high as 100% conditions that trigger high pressure alarm include kinking, bronchospasm, PE, m ucus plug, water in the tube, coughing or biting on the ET tube a disconnected tube or an ET cuff leak would trigger the low pressure alarm

Pul HTN- dyspnea, weakness, hekoptysis, RS HF COPD- cough, dyspnea on exertion, sputum production TB- low grade fever, night sweata, fatigue, cough, weight loss acute resp failure- hypercapnia, hypoventilation, hypoxemia resp acidosis complictions- shock and cardiac arrest resp alkalosis complications seizures in non-vent pts, water level in the water seal chamber rises with inspiration an d drops with expiration. In vent pts, water level drops with inspiration and ris es with expiration. tidaling decreases when a large air leak is present, when the lung has reexpande d, or when PEEP is used GI: Ranitidine blocks secretion of hydrochloric acid. Clients who take only one dail y dose of ranitidine are usually advised to take it at bedtime to inhibit noctur nal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular ( not as needed) doses of an antacid are needed to treat peptic ulcer disease Clients with hepatitis A commonly experience fatigue and altered nutrition due to anorexia and nausea. Because of the severe fatigue associated with hepatitis, clients are encouraged to rest and restrict activity during the active phase of the disease. It is important that frequent rest periods be planned throughout t he day. Clients may experience nausea and vomiting; thus, providing relief is im portant. Small, frequent meals help clients manage the anorexia associated with hepatitis. An exercise program is not appropriate due to the need for rest. Clie nts with hepatitis do not experience pain. All medications administered to clien ts with hepatitis need to be evaluated for their potential for hepatotoxicity. Fresh frozen plasma and cryoprecipitate have the most clotting factors pneumovax 23 admin prophylactically to prevent pneumococcal sepsis that sometime s occur after plenectomy recombivax HB vaccine for hep B attenuvax is a live attenuated vac for immunization against measles increase PT, which indicates clotting time, increases the risk of bleeding phytonadine= vit k sigmoid colostomy, the feces are solid,the pt may eventually gain enough control that he would not need to wear a colostomy bag descending the feces are semi-mushy tranverse colonostmy the feces are mushy

ascending colostony the feces are fluid hypovolemic shock from fluid shift is a major factor in acute pancratitis when preparing a pt for hemorrhoidectomy, the nurse should adminster an enema deficient fluid volume is the primary nsg dx for bowel obstruction Paregoric helps decrease peristalsis and disrrhea caused by muscle spasms clindamycin may enhance the action of neuromuscular blocking agents GU: nml urine pH=4.5-8 dialysis equilibrium syndrome causes confusion, a dec LOC, HA, and seizures acute bone pain and confusion are associated with aluminum intoxication mumps affects male fertility kayexalate is a sodium exchange resin. The pt will gain sodium as potassium is l ost in the bowel. Pt should have diarrhea dopamine increase renal perfusion, ctxility, and vasodilation fluid depletion before excretory urograph is contraindicated in pts with multipl e myeloma, DM, and uric acid nephropathy glomerulonephritis s/sx: periorbital edema, hematuria, proteinuris, htn, oliguri a Neuro: jacksonian seizure is a localized motor seizure SE of dantrolene is muscle weakness, depress liver fn, hepatitis. Dantrolene red uces muscle spaciticty phenytoin toxicity: problems walking, coordination, lethargy, diplopia, nystagmu s with ICP increases, Cushings triad may develop whcih involves bradycardia, brady pnea, and hypertension. shock: tachcardia, tachypnea, hypotension vit A is important for night vision conductive hearing loss results from unterference wuth the conduction of sound w aves from the trmpanic membrane to the inner ear sensorineureal hearing loss affects the inner ear and involves the cochlea and e ighth CN anticholinesterase agents are contraindicatedin pts with mechanical obstruction of the intestines, n peritonitis NML ICP= 10-20 phenyroin SE: gingival hyperplasia, hypotension, visual disturbances

cerebral hemorrhage warning signs: tinnitus, vomiting, change in LOC, localized seizures MUSCLO: scolosis can progress and impinge on the lung and affect pulmonary fn hip fracture the affected leg is shorter, aducted, and externally rotated herniated lumbar disk S/Sx: severe lower back pain, which radiates to the buttoc ks, legs, feet, usually unilaterally. colchine for acute gout allopurinol for chronic gout Endocrine: control hypogycemia with consuming low cards, high protein, and avoid fasting Spironolactone can cause menstrual irregularities, decreased libio, gynecosmasti a, impotence, diarrhea, hyponatremia, hyperkalemia glucagon interacts adversly only with oral anticoagulants increasing their effec ts chronic renal failure cant convert vit D, the serum calcium level declines, may contriute to hyperparathyrodism phentolamine is used t oreduce blood pressure in pheochromocytoma dopamine vasopressor thyroid crisi occurs in the first 23 hrs afyrt thyroidectomy and causes exaggera ted signs of hyperthyroidism continuous sub q insulin regimen uses a basal rate and boluses of short acting i nsulin 10-15g of simple carbs hyperkalemia SE: muscle weakness, bradycardia, diarrhea, paresthesia corticotropin secreting pit adenoma is the most common cause of Cushings in wome n ectopic corticotropin secreting tumor is more common in older men Oncology: The most common reaction of the skin to radiation therapy is redness of the surf ace tissues. Dryness, tanning, and capillary dilation are also common. Squamous cell carcinomas are malignant lesions that are generally found on areas of sun-damaged skin. They can develop from normal skin or a preexisting lesion. Basal cell carcinomas are small, waxy nodules with translucent borders. Maligna nt melanoma is usually characterized by a flat, irregular border that may be tan , brown, or black. Environmental factors include place of residence, nutrition, occupation, person al habits, iatrogenic factors, and physical environment. Gender, immunologic sta tus, and age are individual factors.

The client is exhibiting signs of extravasation, which occurs when the medicati on leaks into the surrounding tissues and causes swelling, burning, or pain at t he injection site A client with suspected cervical cancer is undergoing a colposcopy with conizati on.The client should be informed that her next two or three periods could be hea vy and prolonged. Because external radiation commonly causes skin irritation, the nurse should wa sh the irradiated area with water only and leave the area open to air. Colorectal polyps are common with colon cancer. The client with a cervical implant is kept on strict bed rest, flat in bed. Limi tation of movement is designed to prevent accidental displacement or dislodgment of the implant. Client knowledge and understanding are critical to compliance w ith these restrictions. The client will not be allowed out of bed while the impl ant is in. Assuming various positions while in bed can dislodge the implant. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and el ectrolyte imbalances. A class V finding in a Pap test suggests probable cervical cancer; the client sh ould have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to mod erate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible. Tamoxifen may cause bisual changes=bad A client with a cerebellar brain tumor may suffer injury from impaired balance a s well as disturbed gait and incoordination bleeding disorder contraindicated for thoracentesis A mammogram can detect a lesion the size of a pinhead, and a lump is about 2 cm before it can be detected by a BSE. The American Cancer Society guidelines reco mmend a mammogram yearly after age 40. The American Cancer Society recommends an annual digital examination after age 4 0 for the purpose of detecting colorectal cancer. The CEA test is performed on c lients who have already been treated for colorectal cancer. It helps monitor a c lient's response to treatment as well as detect metastasis or recurrence. Procto sigmoidoscopy is recommended every 3 to 5 years for people older than age 50. myelosuppression is reduxed RBC, WBC, and platelets radiation of the head and neck commonly produces dry mouth (xerostomia), irritat ion of the oral mucous membranes (stomatitis), and dimished sense of taste (dysg eusia) multiple myeloma dx: presence of Bence Jones protein in the urine, increased cre atinine, increased serum calcium, increased serum protein breast ca tumors are fixed, hard, and poorly delinetaed with irregular edges. A mobile mass that is soft and easily delinated is most commonly a fluid filled be nign cyst

nipple retraction is a sign of ca Asymmetry, border irregularity, color variation, diameter leucovorin is administered with methotrxate to protect nml cells horner's syn, which occurs when a lung tumor invades the ribs and affects the sy mpathetic nerve ganglia, is characterized by miosis, partial eyelid ptosis, anih idrosis on the affected side of the face. Pancosast tumor, a lung tumor involving the first thoracic and 8th CN within the brachial plexus, causes arm and shoulder pain and atrophy of the arm metoclopramide=antiemetic dexamethasone=antiinflammatory sigmoidoscopy and protoscopy confirm dx of colorectal ca a bleeding disorder is contraindicated for thoracentesis kaposi sarcoma is the most common ca associated with AIDS lymph node dissection provides prognostic information lung, brain, bone,liver, lymph nodes are the five most common ca metastasis site s vit E can increase the rsik of bleeding during a surgical procedure mammogram yarly for women age 40 and older. Its recommemded that women between a ges 20 and 39 have a professional breast exam every 3 yrs SKIN: scabies is caused by a tiny mite that burrows under the skin. it is transmitted by close person to person contact or contact with ifected linens. it causes seve re itching at night in addition to a papular rash vit A,C,K are necessary for wound healing vit D, calcium are necessary for bone healing cont compression wraps helps skin healing with min hypertropied tissue tretinon fo acne vulgris minoxidl for hair growth zinc oxide gelatin for statsis dermatitis fluorouracil for basal cell carcinoma acyclovir may cause diarrhea impetigo is a contagious superfical skin infection characterized by small red ma cule that turns inti a vescile becoming pustular with a honey colored crust contact dermatitis is inflammation of the skin caued by contact with chemical or allergen dermatophyrosis is ringworm characterized by erytgmatous patches and scaling vesicles are elevated sharply defined that are <0.5 and contain serous fluid: bl ister, chickenpox, herpes

bullae r elevates fluid filled lesions >0.5 cysts are elevates thick walled lesions containing fluid or semisoild matter pustules are elevated lesions <0.1 containing purulent material; impetigo, acne lesions aminoglycosides SE: ototoxicity and nephrotoxicity severe pressurelike pain distinguished necrostizing fascitis from cellulitis. er thyema, leukocytosis, and swelling are present in both Blood: ANC= total WBC (neuto + bands)/100, >1000 no risk for infection, <1000 significa nt, <500 high, <100 almost certain SLE affects predominatly black women btwn 15-40 RA has periods of excerbation and remission hyperacute rejection is not treatable and the organ must be removed Dx of sickle cell crisis: low mean corpuslar hemoglobin, positve metabisulfate t est, postive howell-jolly test, presence of HbSS SLE Dx: above nml anti-DNA test, + ANA test, + lupus cell test, decreased serum complement Antepartum: blurred vision may indicate htn or preeclampsia episiotomy- 1 lac involves the fourchette, skin, 2 lac extends into the fasciae and muscle, 3 lac anal sphincter, 4 lac anal canal breast sensitivity is the only sign assessed within the first 4 eks iron deficieny anemia is a complication of adolescent pregancies triple screen (15-20wks) detects chromosomal abnormalities indirect coombs tests sceeens maternal blood for RBC antibodies aminocentesis (16-18, 35) to assess lung maturity, n detect fetal abnormalities castor oil can intiate premature ut ctx, used for constripation 1 tri, the mother copes with the common discomforts and changes 2 tri, mother image development, coping with body image and sexuality changes, a nd prenatal bonding 3 tri, overcome fears that women may have about the unknown, labor pain, loss of self esteem, loss of control, death older than 35, increase risk for gestational htn implantation occurs at the end of the firs wk after fertilization ortho hypo doesnt occur until late in pregnancy

cepahlic, FHR asculated btn the sym pubis and umbilicus breech, FHR ausculated above umblicus a pregnant minor is emancipated from her parents true labor- dialtion, effecament, regular ctx, discomfort that moves from back t o front of the abd false labor- irregular ctx felt in the abd n groin relieved by walking, inc feta l movement, no change in E n D amniocentesis at 15 wks detects chromosomal and NTD, determine sex, in the last tri it can evaluate fetal lung maturity ultrsound used to determine polyhydraminos, amnio to tx polyhydra iron def anemia- Hb <12, hct <33% terbutaline may cause tachycardia cerclage complications- ROM, infection, painful regular ctx, active bleeding preeclampsi sx- HA, blurred vision, epigastric pain, severe N&V amniotomy increases risk of umblical cord prolapse, infection, pain relief WIC assists women and infants who are at nutritional risk high AFP=SB, Ntd loe AFP= downs syn BPP is an ultrasound assessment includes nonstress test, fetal tone, fetal breth ing, fetal motion, and quanitity of amniotic fluid high hcg= hydatiform mole braxton hicks ctx btn 23-27, fetal rebound 18-22, fetal outline 28-31, B/H incre ase 32-35 ideal weight gain=25-35 lb placenta priduce estrogen, progesterone, detoxifies drugs, and exchange nutrient s a sustolic ejection murmur over the pulmonic area is a common finding in pregnan cy head- hard round mass sacral- softer round mass hands n feet- smll irregular shapes back- long firm mass for amniocentesis ask pt to void ectopic pregnancy sx- amenorrhea, adnexal fullness and tenderness, N/V, vaginal spotting, unilateral dull abdominal pain 1st accept the pregananc as a biologcal fact, if not pt will unlikely to seek pr

enatal care fetal movement- identify fetus as separate assuming caretaker role occur postpartum hCG is responsbile for maintaing pregnancy until the placenta is in place indirect coombs test measures maternal ab against fetal rh positive factor infertility is based on age. younger than 30, infertility is defined as failure to conceive after 2 year of unprotected intercourse. older than 30, the time per iod is reduced to 6mo of unprotected intercourse insulin acts as a growrg hormne on the fetus concomitant adminstration of prednisone and terbutaline may cause pilmonary edem a inuslin dec 1 tri and inc 2 n3 tri oligohhydramnios is associated with renal malformations gest htn sx- ha, double vision, edema (sudden weight gain), proteinuria mag sulfate toxicity- depressed DTR, respiatory depression, dec UOP, inc mag lev els gestational trphoblastic disease=hydaitoform mole sx- N/V, ut enlargement beyond expected, absense of EHR, vag spotting, grape like vesicales doppler FHR at 11wks, stethoscope btn 17-20 nitrazine paper turns blue with alkaline substances like amniotic fluid. nml vag discharge and urine are acidic n turns pink BPP nml=8-10, <6 is at risk for asphyxia and premature birth fetal well being is determined during a nonstress test by two accels occuring wi thin 20min that demonstate a rise in HR of at least 15 beats Intrapartum: latent phase- desires personal touch and responds to teaching active phase- withdrawn, irritable, and resistant to touch bromocriptine is used to inhibit lactation in post partum shallow chest breathing is used during the peak of ctx deep breathing can cause hyperventilation chest panting may be used to prevent a woman from pushing before the cervix is d ialted SE of lumbar puncture= hypotension primigravida will efface then dilate multigravida will efface and dilate at the same time

placental separation- lengthening of cord, a sudden gush of dark blood, a change in ut shape, inc ctx, inc vag bleeding oxytocin admin causes stronger, more uncomfortable ctx, whih peak more abruptly than spontaneous ctx 2 stage labor for primigravida= 1hr after placental del, the fundus is 1-2 fingerbraths above the umblicius oxytocin SE- tetanic ctx (high risk for hypoxia), pul edema, inc bp port wine color in abruption placentae painful intercourse (prolonged dyspareunia) with episiotomy if infection interfe rs PROM sx- fernlike pattern (high sodium and protein) that occurs when vaginal flu id is placed on a glass slide and allowed to dry, presence of amniotic fluid, al kaline pH transiton to 2 stage is marked by inc urge to push, inc bloody show, grunting, g aping of the anus, involuntry defacation, loss over cntl over breathing, N/V Inc risk of DIC- intraut fetl death, abruptio placentae, septic shock, amniotic fluid embolism determin duration- time the peiod from the onset of ut tightening to ut relaxat ion steady trickle of blood on the perineal pad may indicate vaginal laceration Postpartum: taking-in= the pt is exhausted and dependent on others, meeting mothers need fir st, looking at neonate, talking about neonate taking hold= pt vacillates btn seeking nurturing and acceptance for herself and seeking to resume an independent role, kissing, embracing, and caring for the ne onate letting go=begins to accept the neonate as an individual who is separate from he rself ut involution= 7-9 days hot showers n warm compresses stimulate trigger milk production and prolonging d iscomfort of engorgement fq feeding keeps the breast empty n dec engorgement diaphragm must be used with spermicidal jelly kegel exercises, col application, and sitz baths are intervention for a 4th degr ee laceration ergovine can cause hypertension bethanechol (used to tx urine retention)will increae GI motility, hypotension, d ec HR

retinopathy of prematurity associated with high o2 adminastration, prematurity, blood transufusion, apnea transient tachypnea associated with incomplete removal of fetal lung fluid neonatal asphyxia is associated with hypoxemia, inc co2, dec ph PE- suddnen dyspnea, diaphoresis, confusion, hypotension help releive nipple soreness- lubricating nipples with expressed milk, applying ice compresses, leeting the nipple air dry, avoiding soap in non-lactating mother, menstruation resumes 6-10 wks after birth ergovine and methergine tx postpartum hemorrhage and may increase bp oxytocin is responsible for the milk letdown reflex prolacti stimulates lactation estrogen stimulates development of ducts progesterone acts to inc lobes and alveoli in the breasts primdone dec the efficacy of hc women taking progrstin only pills have a higher incidence of tubal or ectopic pr egnancies to relieve mastitis, adivse pt to massage affected area during breat feeding, ap ply waem wet washcloth before feeding, avoid wearing a brassiere when breat feed ing to determine fertile period, the pt should subtract 18 days from hershortest and 11 days from her longest weight gain nml=2-5 during 1 tri, then 1 lb weekly during 2 n 3 tri mag sulfate Se= oliguria Guthrie blood test evaluates neonate for PKU. Lefenalac formula is low in phenyl alanine. manual pump, heat, n massage encourage milk flow ped: 7yo see death as a punishment 9yo see death as irreversible preschool see death as temporary adolescent see death based on past epereinces permethrin used for scabies griseofulvin and tolnafate used for ringworm thiabendazole used for hookworm and roundworm 10mo object permanence

breast fed- soft bright yello stool formula fed- pale yellow semiformed stool push toys at 10mo mobile at 4 mo rattles and blocks btn 4-8 mo fear of pain in school age hyperactivity. shrill cry, fq yawning and sneezing, and jitteriness= drug depend ecy hypoglycemia=hypothermia, muscle twitching, diaphoresis, respiratory distress neonatal sepsis= abd distention postterm=abdunat subq fat, long hair, absent vernix caseosa, cracked skin, long nails preterm= absent plantar creases, abundant lanugo, patchy fine hair heroin withdrawal= irritability, poor sucking, and restlessness croup- barking cough, low grade fever, gradual onset, hoarseness, inspiratory st ridor viral meningitis- fever, nucal rigidity, irritabilty, ohotophobia toddlers fear separation from parents, dark, loud noises, injury, strangers infants fear strangers, heights school age fear supernatural, storms, things een on television adolescents fear social prformance, seuality, drugs, gossip preschoolers view illness as a punishment fear of daeth in school age and sadolescent productive cough with bronchilitis gastric lavage or activeated charcoal for acetaminphen poisoing Psych: cocaine withdrawal- severe cravings, depression, fatigue, hypersomnia Amphetamine withdrawal- depression, distrubed sleep, restlessness, disorientatio n barbiturate withdrawal- n/v, tachycardia, trmors, seizures Narcotic withdrwal- like symtoms of flu, runny nose, yawning, fever, mucle and j oint pain, diarrhea