The primary goal of therapy for the client with pulmonary edema or heart failure is increasing cardiac output.

Pulmonary edema is an acute medical emergency requiring immediate intervention. Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting to ascites. Weight gain due to retention of fluids and worsening heart failure causes exertional dyspnea in clients with mitral regurgitation. Nicotine (Nicotrol) is given in controlled and decreasing doses for the management of nicotine withdrawal syndrome. Raynauds disease is characterized by vasospasms of the small cutaneous arteries that involves fingers and toes. The lumen of the arteries can be assessed by cardiac catheterization. Angina is usually caused by narrowing of the coronary arteries. Myoclonic seizure is characterized by sudden uncontrollable jerking movements of a single or multiple muscle group. Decerebrate posturing is the extension of the extremities after a stimulus which may occur with upper brain stem injury. Perfusion can be best estimated by blood pressure, which is an indirect reflection of the adequacy of cardiac output. Ileostomy - Sudden decrease in drainage or onset of severe abdominal pain should be reported immediately to the physician because it could mean that obstruction has been developed. Urine testing provides an indirect measure that maybe influenced by kidney function while blood glucose testing is a more direct and accurate measure. The use of electronic toothbrush, irrigation device or dental floss may cause bleeding of gums, allowing bacteria to enter and increasing the risk of endocarditis. Most peptic ulcer is caused by Helicopter pylori which is a gram negative bacterium. Hodgkins disease - Assessing for an open airway is the priority. The procedure involves the neck, the anesthesia may have affected the swallowing reflex or the inflammation may have closed in on the airway leading to ineffective air exchange. Neutropenic client is at risk for infection especially bacterial infection of the gastrointestinal and respiratory tract. Common signs and symptoms of fracture include pain, deformity, shortening of the extremity, crepitus and swelling. Protamine Sulfate is used to prevent continuous bleeding in client who has undergone open heart surgery. Complications of acute appendicitis are peritonitis, perforation and abscess development.

Osmosis is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration. Streptomycin is an aminoglycoside and damage on the 8th cranial nerve (ototoxicity) is a common side effect of aminoglycosides. Wheat cereal has low sodium content. To maintain adequate oxygenation post op. Positioning the client laterally with the neck extended does not obstruct the airway so that drainage of secretions and oxygen and carbon dioxide exchange can occur. Hepatitis A : Clay colored stools( should be reported by physician) are indicative of hepatic obstruction The left side of the body will be affected in a right-sided brain attack. By the 2nd day of hospitalization after suffering a Myocardial Infarction, Clients are able to perform care without chest pain NGT - Semi-fowlers position will localize the spilled stomach contents in the lower part of the abdominal cavity. The most frequent side effects of Cascara Sagrada (Laxative) is abdominal cramps and nausea. When diuretics are taken in the morning, client will void frequently during daytime and will not need to void frequently at night. Administration of Intravenous Nitroglycerin infusion requires pump for accurate control of medication. Cholecystectomy : It may take 4 to 6 months to eat anything, but most people can eat anything they want. Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock. Cardiac Catheterization - Blood pressure is monitored to detect hypotension which may indicate shock or hemorrhage. Apical pulse is taken to detect dysrhythmias related to cardiac irritability. Seeing yellow spots and colored vision are common symptoms of digitalis toxicity. GERD After meal rest in sitting position. Gravity speeds up digestion and prevents reflux of stomach contents into the esophagus. Forearm muscle weakness is a probable sign of radial nerve injury caused by crutch pressure on the axillae. Excessive bubbling indicates an air leak which must be eliminated to permit lung expansion. Discomfort or pain is a problem that originates in the kidney. It is felt at the costovertebral angle on the affected side.

12 to 24 hours after subtotal gastrectomy gastric drainage is normally brown, which indicates digested food. Left sided heart failure causes fluid accumulation in the capillary network of the lung. Fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration. After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early. Typical signs and symptoms of hypovolemic shock includes systolic blood pressure of less than 90 mm Hg. Beta-carotene and Vitamin E are antioxidants which help to inhibit oxidation. Vitamin E is found in the following foods: wheat germ, corn, nuts, seeds, olives, spinach, asparagus and other green leafy vegetables. Food sources of beta-carotene include dark green vegetables, carrots, mangoes and tomatoes. Aspirin containing medications should not be taken 14 days before surgery to decrease the risk of bleeding. Metabolic acidosis is anaerobic metabolism caused by lack of ability of the body to use circulating glucose. Administration of insulin corrects this problem. A client with acute pancreatitis is prone to complications associated with respiratory system. Icteric Phase of viral hepatitis - Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Gastroscopy : Abdominal distension (complication) may be associated with pain, may indicate perforation, a complication that could lead to peritonitis. After eye surgery - Watching TV is permissible because the eye does not need to move rapidly with this activity, and it does not increase intraocular pressure. The constituents of CSF are similar to those of blood plasma. An examination for glucose content is done to determine whether a body fluid is a mucus or a CSF. A CSF normally contains glucose. Restlessness is an early indicator of hypoxia. The nurse should suspect hypoxia in unconscious client who suddenly becomes restless. Penile Implant : After 24 hours of surgery - Elevation increases lymphatic drainage, reducing edema and pain. Laryngectomy - Patent airway is the most priority; therefore removal of secretions is necessary. Progression stage is the change of tumor from the preneoplastic state or low degree of malignancy to a fast growing tumor that cannot be reversed.

When mitral stenosis is present, the left atrium has difficulty emptying its contents into the left ventricle because there is no valve to prevent back ward flow into the pulmonary vein, the pulmonary circulation is under pressure. Urine output provides the most sensitive indication of the clients response to therapy for hypovolemic shock. Urine output should be consistently greater than 30 to 35 mL/hr. The osmotic diuretic mannitol is contraindicated in the presence of inadequate renal function or heart failure because it increases the intravascular volume that must be filtered and excreted by the kidney Crutch with tripod gait : The palms should bear the clients weight to avoid damage to the nerves in the axilla. Aging process involves increased capillary fragility and permeability. Older adults have a decreased amount of subcutaneous fat and cause an increased incidence of bruise like lesions caused by collection of extravascular blood in loosely structured dermis. Good source of vitamin B12 are dairy products and meats. Tubercle bacillus is a drug resistant organism and takes a long time to be eradicated. Usually a combination of three drugs is used for minimum of 6 months and at least six months beyond culture conversion. Aplastic anemia decreases the bone marrow production of RBCs, white blood cells, and platelets. The client is at risk for bruising and bleeding tendencies. BPH : distention of the lower abdomen. This indicates that the bladder is distended with urine, therefore palpable. ARF - In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced. Tracheostomy tube has several potential complications including bleeding, infection and laryngeal nerve damage During blood transfusion, patient complains of lumbar pain: The blood must be stopped at once, and then normal saline should be infused to keep the line patent and maintain blood volume. In spinal shock, the bladder becomes completely atonic and will continue to fill unless the client is catheterized. RA (convalescent stage) - Active exercises, alternating extension, flexion, abduction, and adduction, mobilize exudates in the joints relieves stiffness and pain. 1st 24 hours thrombotic stroke - It is crucial to monitor the pupil size and papillary response to indicate changes around the cranial nerves

An increased in LDL cholesterol concentration has been documented at risk factor for the development of atherosclerosis. LDL cholesterol is not broken down into the liver but is deposited into the wall of the blood vessels. Disseminated Intravascular Coagulation (DIC) has not been found to respond to oral anticoagulants such as Coumadin. Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume, or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat. Early warning signs of laryngeal cancer can vary depending on tumor location. Hoarseness lasting 2 weeks should be evaluated because it is one of the most common warning signs. Epidural Anesthesia: after checking vital signs, assess for bladder distention. The last area to return sensation is in the perineal area, and the nurse in charge should monitor the client for distended bladder. An elective procedure is scheduled in advance so that all preparations can be completed ahead of time. The vital signs are the final check that must be completed before the client leaves the room so that continuity of care and assessment is provided for. Glucocorticoids (steroids) are used for their anti-inflammatory action, which decreases the development of edema. Trauma is one of the primary cause of brain damage and seizure activity in adults. Other common causes of seizure activity in adults include neoplasms, withdrawal from drugs and alcohol, and vascular disease. Menieres disease antihistamine, diuretic, antiemetics Acute Lymphocytic Leukemia (ALL) does not cause gastric distention. It does invade the central nervous system, and clients experience headaches and vomiting from meningeal irritation. In burn, the capillaries and small vessels dilate, and cell damage cause the release of a histamine-like substance. The substance causes the capillary walls to become more permeable and significant quantities of fluid are lost. Atropine sulfate is contraindicated with glaucoma patients because it increases intraocular pressure. Uremic Syndrome : Elevation of uremic waste products causes irritation of the nerves, resulting in flapping hand tremors. Intensity is the major indicative of severity of pain and it is important for the evaluation of the treatment. Detection of myoglobin is a diagnostic tool to determine whether myocardial damage has occurred.

Positve Elisa and Western blot - These tests confirm the presence of HIV antibodies that occur in response to the presence of the human immunodeficiency virus (HIV). Uric acid has a low solubility, it tends to precipitate and form deposits at various sites where blood flow is least active, including cartilaginous tissue such as the ears. The peak incidence of Acute Lymphocytic Leukemia (ALL) is 4 years of age. It is uncommon after 15 years of age. Post Aortic Aneurysm Surgery - There is a potential alteration in renal perfusion manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross-clamping during the surgery. Pen like insulin delivery device - These devices are more accurate because they are easily to used and have improved adherence in insulin regimens by young people because the medication can be administered discreetly. After long leg cast removal : Elevate the leg when sitting for long periods of time. Elevation will help control the edema that usually occurs. To assess for damage to major blood vessels from the fracture tibia. Check for prolonged reperfusion of the toes after blanching. Damage to blood vessels may decrease the circulatory perfusion of the toes, this would indicate the lack of blood supply to the extremity. Myasthenia Gravis : immunosuppressive therapy - Steroids decrease the bodys immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction Flare up pruritus, cause of aggravation - The use of fragrant soap is very drying to skin hence causing the pruritus. Intermittent pain is the classic sign of renal carcinoma. It is primarily due to capillary erosion by the cancerous growth. CRF high biologic protein. One cup of cottage cheese contains approximately 225 calories, 27 g of protein, 9 g of fat, 30 mg cholesterol, and 6 g of carbohydrate. Proteins of high biologic value (HBV) contain optimal levels of amino acids essential for life Client under Spinal Surgery Assess for clients feet for sensation and circulation. Alteration in sensation and circulation indicates damage to the spinal cord, if these occurs notify physician immediately. The nurse most positive approach is to encourage the client with multiple sclerosis to stay active, use stress reduction techniques and avoid fatigue because it is important to support the immune system while remaining active.

Last to assess after induction of anesthesia Respiratory movement. There is no respiratory movement in stage 4 of anesthesia, prior to this stage, respiration is depressed but present. Nursing care after bone biopsy includes close monitoring of the punctured site for bleeding, swelling and hematoma formation. Temporary heterograft (burn patient) relieved pain and promote rapid epithelialization. The graft covers the nerve endings, which reduces pain and provides framework for granulation After right pneumonectomy. Position: Right side lying position or supine position permits ventilation of the remaining lung and prevent fluid from draining into sutured bronchial stump. Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure (ARF). most serious complication. 24 hours after colostomy, no drain d/t absence of intestinal motility. This is primarily caused by the trauma of intestinal manipulation and the depressive effects anesthetics and analgesics. Walking and swimming are very helpful in strengthening back muscles for the client suffering from lower back pain. Frequent flashing lights (detached retina) - This symptom is caused by stimulation of retinal cells by ocular movement. Hepatitis A is primarily spread via fecal-oral route. Sewage polluted water may harbor the virus. Restlessness indicates a lack of oxygen to the brain stem which impairs the reticular activating system. increasing ICP Signs and symptoms of infection under a casted area include odor or purulent drainage and the presence of hot spot which are areas on the cast that are warmer than the others. Sodium, which is concerned with the regulation of extracellular fluid volume, it is lost with vomiting. Chloride, which balances cations in the extracellular compartments, is also lost with vomiting, because sodium and chloride are parallel electrolytes, hyponatremia will accompany. Peritonitis (abdominal rigidity). With increased intraabdominal pressure, the abdominal wall will become tender and rigid. After surgery to correct a detached retina, prevention of increased intraocular pressure is the priority goal. Isoniazid (INH) interferes in the effectiveness of oral contraceptives and clients of childbearing age should be counseled to use an alternative form of birth control while taking this drug. Assessment of a client with Hodgkins disease most often reveals enlarged, painless lymph node, fever, malaise and night sweats.

Tonic clonic seizure: Priority (protect head form injury) - Rhythmic contraction and relaxation associated with tonic-clonic seizure can cause repeated banging of head. Typical signs of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, constipation and numbness. Hard candy will relieve thirst and increase carbohydrates but does not supply extra fluid. In preoperative period, the nurse should consult with the physician about withholding Warfarin Sodium to avoid occurrence of hemorrhage. Iatrogenic infection is caused by the heath care provider or is induced inadvertently by medical treatment or procedures. Fractured pain is generally described as sharp, continuous, and increasing in frequency. Jaundice may be present in acute pancreatitis owing to obstruction of the biliary duct. The adult with normal cerebrospinal fluid has no red blood cells. Bradykinesia is slowing down from the initiation and execution of movement. Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed. Otoscopic examnation in a client with mastoiditis reveals a dull, red, thick and immobile tymphanic membrane with or without perforation. It is a priority to hyperoxygenate the client before and after suctioning to prevent hypoxia and to maintain cerebral perfusion. Dark red to purple stoma indicates inadequate blood supply. Autotransfusion is acceptable for the client who is in danger of cardiac arrest. For the safety of all personnel, if the defibrillator paddles are being discharged, all personnel must stand back and be clear of all the contact with the client or the clients bed. After a pelvic surgery, there is an increased chance of thrombophlebitits owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Amylase concentration is high in the pancreas and is elevated in the serum when the pancreas becomes acutely inflamed and also it distinguishes pancreatitis from other acute abdominal problems. Deep breathing and coughing: Place hand on abdomen and feel it rise. Abdominal breathing improves lungs expansion

A Client with burns is very sensitive to temperature changes because heat is loss in the burn areas Meat provides proteins and the fruit proteins vitamin C that both promote wound healing. Constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer. Sudden, severe abdominal pain is the most indicative sign of perforation. When perforation of an ulcer occurs, the nurse maybe unable to hear bowel sounds at all. Liver biopsy, position on left side help stop bleeding if any occurs. Pressure applied in the puncture site indicates that a biliary vessel was puncture which is a common complication after liver biopsy. Client on seizure - Positioning the client on one side with head flexed forward allows the tongue to fall forward and facilitates drainage secretions therefore prevents aspiration Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis because of the loss of hydrochloric acid which is a potent acid in the body. Measuring the urine output to detect excess amount and checking the specific gravity of urine samples to determine urine concentration are appropriate measures to determine the onset of diabetes insipidus. Ulcerative colitis Bed rest (reduced intestinal motility). The rationale for activity restriction is to help reduce the hypermotility of the colon. Miotic agent constricts the pupil and contracts ciliary muscle. These effects widen the filtration angle and permit increased out flow of aqueous humor. After client eye has been anesthesized do not rub the eye for 15 20 minutes. One assessment for hypoglycemia feel the client and bed for dampness. Blood transfusion reaction stop the transfusion, disconnect the blood tubing and begin primary infusion of normal saline solution. Menieres disease Hydrochloride (hydro diuril) Acute pancreatitis steatorrhea, abdominal pain and fever Metformin (Glucophage) taken with meals Insulin enhance transport of glucose in cell wall. Suctioning through an ET tube the catheter is inserted to the point of resistant, and intermittent suction is applied during withdrawal.

Calcium chloride emergency medication for tetany Sickle cell crisis Priority: hydration oxygenation, pain management. Myringotomy promote drainage from the ear. DIC administer Fresh Frozen Plasma (FFP) Comatose and Hypoglycemic administer 50% glucoe IV Exercise for diabetic patient during exercise the body will use CHO for energy production, which in turn will decrease the need for insulin. SIADH hyponatremia and low serum osmolality. Stapedectomy ensure safety. Implement fall precautions. Levothyroxine (syntroid) HT: call the physician for onset of palpitations or nervousness (signals hyperthyroidism) Hearing aid amplifies sound buy does not improve ability to hear. There may be a genetic factor with glaucoma, children over 30 should be screen yearly. Exopthalmos fluid edema in the retro orbital tissues which force the eyes to protrude. Diaphoresis early sign of insulin reaction (hypoglycemia) Polycythemia vera headaches, dyspnea, claudication Client experiencing vertigo assist in sitting or lying position. ET tube leaking Sign: client is able to speak Central obesity long term effect of steroids Coldness around the insertion site best sign of infiltration Non narcotic analgesic : inhibits prostaglandin synthesis Stage 2, pressure ulcer moisture vapor permeable dressing When the client ask for her chart to be viewed ask her if he/she has concerns about his/her care. Trendelenburg position increase pressure in diaphragm To prevent internal rotation of the legs use a trochanter roll alongside the clients upper thigh. TPN monitor for hyperglycemia and hypokalemia 90 F water temperature for tepid sponge bath Burning pain upon IM injection apply warm compress to dilate blood vessels

Maxillary sinus palpate below the cheekbones Before placing an MVA patient in modified trendelenburg position, assess for head injury Fracture of the neck of femur desirable position, internal rotation with extension of the knee Neostigmine (Prostigmin) blocking the action of cholinesterase Knee amputation (prone position) prevents flexion contractures Exsanguination most serious problem in external shunt Antihypertensive drugs S/E: delayed ejaculation Undescended testicle risk for testicular cancer Intramedullary nailing fracture of shaft of the femur Urine specimen for ketones should be removed from a clients retention catheter, using a sterile syringe to remove it from clamped, cleansed catheter Angina bleeding oral ulcerations TENS (transcutaneous electrical nerve stimulation) Adjust the TENS dial until the client perceives pain relief and comfort Vaginal Irrigation (Douche) nozzle is inserted downward and backward within the vagina Ear surgery inability to wrinkle the forehead (early response that may be associated with possible damage to the motor branch of the facial nerve) Scleroedema autoimmunity Prostatectomy: to limit painful bladder spasm - encourage client not to contract his muscle as if he were voiding. Testicular carcinoma high incidence of early metastasis Myasthenia Gravis decrease functioning ACE receptor sites Cystectomy view of urethra and bladder Psoriasis shiny, scaly lesions (Treatment: topical application of steroids) Jaundice light amber urine, dark brown stools, yellow skin CBI following prostate surgery keep drainage to light pink Stationary thrombus leg cramps During peritoneal dialysis the nurse observes that drainage of dialysate from the peritoneal cavity has ceased before the required amount has drained out. The nurse should assist the client to turn from side to side. After BMA, briefly apply pressure over the aspiration site.

A client with full-thickness burns on the chest has a skin graft. During the 1st 24 hours after a skin graft, care of the donor site includes immediately reporting, small amount of yellowish green oozing. Special application with drug (Vaginal Suppository) ask client to void prior to inserting suppository Fractured rib paradoxical respiration Vaginitis intensive vaginal and perineal itching Pemphigus vulgaris skin lesions Ovarian cancer early symptoms of cancer of the ovary are vague Bilateral lumbar sympathectomy sudden drop in BP & no signs of bleeding (d/t reallocation of blood supply) Fluid overload moist rates RA stiff, sore joints (1st symptom that leads to seeking healthcare) Mafenide (Sulfamylon) Disadvantage: causes lactic acidosis Pelvic traction level with iliac crest Acute MI may have a normal ECG. Which is why a normal ECG alone cannot be relied upon to rule out an MI. Chest pain does not always accompany an MI. This is especially true of patients with diabetes. A targeted history is often crucial in making the diagnosis of acute MI. The chest pain associated with an acute MI is often described as heavy, crushing pressure, 'like an elephant sitting on my chest.' CN8, the acoustic nerve or vestibulocochlear nerve, is the most commonly affected CN in acoustic neuroma although as the tumor progresses CN5 and Ventricular fibrillation is 15 times more likely to occur during the first hour of an acute MI than the following twelve hours which is why it is vital to decrease the delay between onset of chest pain and arrival at a medical facility. First degree heart block is not a lethal arrhythmia. A pinguecula (yellow plaque deposited in conjunctiva), which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age. Migraine headaches dilation of cerebral arteries: The vascular theory best explains migraine and often diagnosis is confirmed through a trial of ergotamine, which constricts the dilated, pulsating vesels. An oropharyngeal airway should be used in an unconscious patient. In a conscious or semiconscious patient its use may cause laryngospasm or vomiting. An oropharyngeal airway that is too long may push the epiglottis into a position that obstructs the airway. It is often use with an ETT to prevent biting and occlusion.

It is usually inserted upside down and then rotated into the correct orientation as it approaches full insertion. S1 is caused by mitral and tricuspid valve closure, S2 (2nd ICS, LICS @ LSB) is caused by the aortic and pulmonic valve closure; S3 and S4 are generally considered abnormal heat sounds in adults and are best heard at the apex. MVP pain may be cause by papillary muscle ischemia and dysfunction. Visual field loss is a common side effect of CVA. In right-handed persons the speech center (Brocas area) is most commonly in the left brain; because of the crossover of the motor fibers, a CVA in the left brain will produce a right-sided hemiplegia. Thus, Mr. Liberatore will probably have some speech disturbance and rightsided paralysis. Often bladder control is diminished following CVA. Slit lamp is most often used to detect corneal lesions; Snellen test is a test for visual acuity using snellens chart; fluorescein stain is used to focus on layers of the cornea and lens looking for opacities and inflammation. Tonometry for glaucoma Many factors may contribute to migraine. Usually the client comes from a family that has migrated, which may have been called sick headache due to accompanying nausea and vomiting. Often there is an aura. Stress, diet, hormonal changes, and fatigue may all be implicated in migraine. dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea pulmonary HTN. Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms. The left ventricle does not hypertrophy in mitral stenosis; right heart failure would cause abdominal discomfort and peripheral edema; pericardial thickening does not occur. The PMI is the impulse at the apex of the heart caused by the beginning of ventricular systole. It is generally located in the 5th left ICS, 7-9 cm from the MSL or at, or just medial to, the MCL. Wedge resection is removal of part of a segment of the lung; decortication is the removal of a fibrous membrane that develops over the visceral pleura; and thoracoplasty is the removal of ribs or sections of ribs. Pneumonectomy is removal of entire lung. EOA (esophageal obturator airway) should not be used with a conscious person, pediatric, or patient who have swallowed caustic substance. EOA insertion should only be attempted by persons highly proficient in their use. Moreover, since visualization is not required the EOA may be very useful in patients when intubation is contraindicated or not possible. Vomiting and aspiration are possible complications of insertion and removal of an EOA. Ventricular irritability is common in the early post-MI period, which predisposes the client to ventricular arrhythmias. Heart block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common.

The sound created by closure of the tricuspid valve is heard at the 5th LICS at the LSB. Pulmonic closure is best heard at the 2nd LICS, LSB. Aortic closure is best heard at the 2nd RICS, RSB. Mitral valve closure is best heard at the PMI landmark (apex) Macular area - a small yellowish central area of the retina that is rich in cones and that mediates clear detailed vision. Intubation, when auscultated only the right lung has breath sounds. Pull the tube back and listen again. Most likely you have a right main stem bronchus intubation. Pulling the tube back a few centimeters may be all you need to do. The warning sign or aura is associated with migraine although not everyone with migrane has an aura. Migraine is usually unilateral and described as pounding. If the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and the physician consulted. Serum potassium levels should be monitored periodically in clients on digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias. However the client cannot do this at home. Daily weights may make the client alert to fluid accumulation, an early sign of CHF. Blood pressure measurement is also helpful; providing the client has the right size cuff and he or she and/or significant other understand the technique and can interpret the results meaningfully. Gliomas are malignant tumors. Weakness and anorexia are due to progressive renal damage; pruritus is secondary to presence of urea in the perspiration. Fruity smelling breath is found in diabetic ketoacidosis. Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria is seen in chronic renal failure. The skin is more sallow or brown as renal failure continues. Tension headache feeling of tightness bitemporally, occipitally, or in the neck & bandlike tightness around the neck. Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug. Thus alteration in drug schedule and dosage is necessary for safe care. As ICP increases, the pulse rate decreases and the BP rise. However, as ICP continues to rise, vital signs may vary considerably. Postoperatively clients who have undergone craniotomy usually have their heads elevated to decrease local edema and also decrease ICP MI CK peaks (12 24 hours), SGOT (24 36 hours), LDH (3 -4 days) Verapamil usually decreases blood pressure, which is why it is sometimes used as an antihypertensive agent. Verapamil may be lethal if given to a patient with V-tach, therefore it should not be given to a tachycardic patient with a wide complex QRS.

Verapamil is a calcium channel blocker and may actually cause PEA if given too fast intravenously or if given in excessive amounts. The specific antidote for overdose from verapamil, or any other calcium channel blocker, is calcium. Verapamil may cause hypotension. BVM - Cricoid pressure may prevent gastric inflation during ventilations and may also prevent regurgitation by compressing the esophagus. There are many possible causes for a childhood seizure. These include fever, central nervous system conditions, trauma, metabolic alterations and idiopathic (unknown). Domestic violence victims may be immobilized by a variety of affective responses, one being self-blame. The victim believes that a change in their behavior will cause the abuser to become nonviolent, which is a myth. Administering stool softeners every day will prevent straining on defecation which causes the Valsalva maneuver. If constipation occurs then laxatives would be necessary to prevent straining. If straining on defecation produced the valsalva maneuver and rhythm disturbances resulted then antidysrhythmics would be appropriate. Explaining illness to 10 years old able to think logically in organizing facts. The child in the concrete operations stage, according to Piaget, is capable of mature thought when allowed to manipulate and organize objects. Adolescent - The isolation may occur gradually resulting in a loss of all meaningful social contacts. Isolation can be self imposed or can occur as a result of the inability to express feelings. At this stage of development it is important to achieve a sense of identity and peer acceptance. Clients with contraindications to heparin, recurrent PE (pulmonary embolism) or those with complications related to the medical therapy may require vena caval interruption by the placement of a filter device in the inferior vena cava. A filter can be placed transvenously to trap clots before they travel to the pulmonary circulation When using a warming device the neonates temperature should be continuously monitored for undesired elevations. The use of heat lamps is not safe as there is no way to regulate their temperature. Warming medications and fluids is not indicated. While touching with cold hands can startle the infant it does not pose a safety risk. Shortening of a leg is a sign of developmental dysplasia of the hip. A.L.S. is a chronic progressive disease that involves degeneration of the anterior horn of the spinal cord as well as the corticospinal tracts. When the intercostal muscles and diaphragm become involved, the respirations become shallow and coughing is ineffective.

During the working phase alternative behaviors and techniques are explored. The nurse and the client discuss the meaning behind the behavior. In Eriksons theory of development, toddlers struggle to assert independence. They often use the word no even when they mean yes. This stage is called autonomy versus shame and doubt. Mobility reduces the risk of deep vein thrombosis in the postsurgical client and the adult at risk. The main general objectives in the treatment of a sickle cell crisis is bed rest, hydration, electrolyte replacement, analgesics for pain, blood replacement and antibiotics to treat any existing infection. Assertive communication respects the rights and responsibilities of both parties. This statement is an honest expression of concern for safe practice and a request for clarification without selfdepreciation. It reflects the right of the professional to give and receive information. The nurse should instruct the client on isometric exercises for the muscles of the casted extremity, i.e., instruct the client to alternately contract and relax muscles without moving the affected part. The client should also be instructed to do active range of motion exercises for every joint that is not immobilized at regular and frequent intervals Bronchopulmonary dysplasia is an iatrogenic disease caused by therapies such as use of positive-pressure ventilation used to treat lung disease. Any activity that involves straining should be avoided in clients with glaucoma. Such activities would increase intraocular pressure. Clients with chronic obstructive pulmonary disease have difficulty exhaling fully as a result of the weak alveolar walls from the disease process . Alveolar collapse can be avoided with the use of pursed-lip breathing. This is the major reason to use it. The other options are secondary effects of purse-lip breathing The non-rebreather mask has a one-way valve that prevents exhales air from entering the reservoir bag and one or more valves covering the air holes on the face mask itself to prevent inhalation of room air but to allow exhalation of air. When a tight seal is achieved around the mask up to 100% of oxygen is available. Polycythemia occurs as a physiological reaction to chronic hypoxemia which commonly occurs in clients with Tetralogy of Fallot. Polycythemia and the resultant increased viscosity of the blood increase the risk of thromboembolic events. Cerebrovascular accidents may occur. Signs and symptoms include sudden paralysis, altered speech, extreme irritability or fatigue, and seizures. Membranes ruptured over 24 hours prior to birth greatly increases the risk of infection to both mother and the newborn.

The guidelines of the American Academy of Pediatrics recommend that one new food be introduced at a time, beginning with strained cereal Prickling sensation is an indication of compartment syndrome and requires immediate action by the nurse. AGN is generally accepted as an immune-complex disease in relation to an antecedent streptococcal infection of 4 to 6 weeks prior, and is considered as a noninfectious renal disease. As the adolescent gains weight, there is a lessening sense of self esteem and poor body image The higher pitched a sound is, the more narrow the airway. Therefore, the obstruction has increased or worsened. With no evidence of secretions no support exists to indicate the need for suctioning. Batterers are usually physically or psychologically abused as children or have had experiences of parental violence. Batterers are also manipulative, have a low self-esteem, and have a great need to exercise control or power-over partner. Intraocular pressure becomes elevated which slowly produces a progressive loss of the peripheral visual field in the affected eye along with rainbow halos around lights. Intraocular pressure becomes elevated from the microscopic obstruction of the trabeculae meshwork. If left untreated or undetected blindness results in the affected eye. PTCA - Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow. PTCA is performed to improve coronary artery blood flow in a diseased artery. It is performed during a cardiac catheterization. Aorta coronary bypass Graft is the surgical procedure to repair a diseased coronary artery. The purpose of play for the 7 year-old is cooperation. Rules are very important. Logical reasoning and social skills are developed through play. The nurse should help the parents see the negativism as a normal growth of autonomy in the toddler. They can best handle the negative toddler by using patience and humor. Kawasaki Disease (mucocutaneous lymph node syndrome) involves all the small and medium-sized blood vessels. There is progressive inflammation of the small vessels which progresses to the medium-sized muscular arteries, potentially damaging the walls and leading to coronary artery aneurysms. IVF - Bowel prep is important because it will allow greater visualization of the bladder and ureters. Stimulation of the breast during nursing releases oxytocin, which contracts the uterus. This contraction is especially important following hemorrhage.

Even if mild hypospadias is suspected, circumcision is not done in order to save the foreskin for surgical repair, if needed. During normal development, fear of strangers becomes prominent beginning around age 6-8 months. Such behaviors include clinging to parent, crying, and turning away from the stranger. These fears/behaviors extend into the toddler period and may persist into preschool While parents should report any of the observations, they need to call the health care provider immediately if the level of alertness changes. This indicates anoxia, which may lead to death. The structural defects associated with Tetralogy of Fallot include pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy and overriding of the aorta. Surgery is often delayed, or may be performed in stages. Anxiety is triggered by change that threatens the individuals sense of security. In response to anxiety in clients, the nurse should remain calm, minimize stimuli, and move the client to a calmer, more secure/safe setting. The use of oral contraceptives in a pregnant woman who smokes increases her risk of cardiovascular problems, such as thromboembolic disorders. Heartburn is a burning sensation caused by regurgitation of gastric contents that is best relieved by sleeping position, eating small meals, and not eating before bedtime. Separation anxiety if most evident from 6 months to 30 months of age. It is the greatest stress imposed on a toddler by hospitalization. If separation is avoided, young children have a tremendous capacity to withstand other stress. Lithium - Nausea, metallic taste and fine hand tremors are common side effects that usually subside within days. CHF - Sitting in a chair or resting in a bed in high Fowler''s position decreases the cardiac workload and facilitates breathing. Hip cast - The child should be turned every 2 hours, with surface exposed to the air. Oculogyric Crisis involuntary muscle spasm of the eye. Suppression is willfully putting an unacceptable thought or feeling out of ones mind. A deliberate exclusion "voluntary forgetting" is generally used to protect ones own self esteem. Nephrotoxicity is a common side effect of calcium disodium edetate, in addition to lead poisoning in general. Conservative management in herniated disk C.I. muscle relaxant Yellow urine with mucus normal for a client with ileal conduit Spinal anesthesia assess the degree of response to pinpricks in the legs or toes (whether the client is recovering or not).

Theophylline ethylenediamide (COPD) relax bronchial smooth muscle. Sclera buckling for a detached retina avoid abrupt movements of the head. Hodgkins (young adults : 21 40 years old)

Disorientation organic psychosis (bizarre behavior) 6 12 months after most hazardous period for development of clinical disease (TB) TB maintenance phase treatment 4 months NGT irrigate tube with saline as ordered

Comparing equality of hand grasps best to assist motor strength in a neurologically injured patient Cholecystitis/cholelithiasis nausea after ingestion of high fat foods. Menieres disease feeling of ear fullness (before an attack). Diet: Low Sodium, restricted fluid intake Postural hypotension common SE of Levodopa Lomotil report for urinary incontinence Liquid iron dilutes the medication and drink with straw Hypocalcemia depressed reflexes Nitroglycerin ointment remove previously applied ointment

Hip fracture leg shortened, adducted & externally rotated 10 mm induration (+) for TB Mantoux test not routinely done in the Philippines because almost all Filipinos will test positive for Mantoux Test. Levodopa increase dopamine availability Ethambutol not likely given during maintenance phase Normal IOP: 8 21 mmHg Instilled a cold water in the clients right ear and he noticed that nystagmus occurred towards the left ear- This indicates an intact and working vestibular branch of CN VIII Cane hold 6 inches at lateral side of the foot

Pterygium - primarily caused by exposure to dust Aqueous humor produces in ciliary body Foreign body protruding in the eye irrigate with NSS timolol [timoptic] - Reduce production of Aquesous Humor Chalazion - Sterile chronic granulomatous inflammation of the meibomian gland Hyperopia convex lens Retinal detachment floating spots before the eyes, progressive constriction of vision in one area, flashes of lights, & least likely to experience pain In acute glaucoma, the obstruction to the flow of aqueous humor is caused by displacement of the iris. Characterized by irreversible blindness. Rinnes test compare air conduction with bone conduction Otosclerosis - Replacement of normal bones by spongy and highly-vascularized bones and the stapes become fixed with the oval window Presbyopia - lessening of the effective powers of accommodation Cataract contact MD if experiencing pain. Primary problem: blurring vision Enucleation removal of the eyeball The primary reason for performing iridectomy after cataract extraction is to prevent secondary glaucoma. Brick red normal color of stoma Colostomy irrigation - Suspend the irrigant 45 cm above the stoma. Insert tube 3 4 inches. 18 inches (maximum height of irrigation solution) Probantheline Bromide (Probanthine) Reduces secretion of the glandular organ of the body. Avoid hot weather to prevent heat strokes. PUD - disease would Probanthine exert the much needed action for control or treatment . Expressive aphasia is prominent on clients with right sided weakness Acute close angle glaucoma Pain Open angle glaucoma no pain Wall unit suction 100 120 mmHg Portable suction - 10 -15 mmHg The main difference between chronic and organic brain syndrome is that the former is progressive and irreversible. 10 seconds maximum time for suctioning At risk for osteoporosis cushings disease, furosemide & phenytoin, hyperthyroidism, and ESRD.

During colostomy irrigation, when patient experience cramping stop the irrigation by clamping the tube. Alcohol not compatible when taking probanthine Atropine Sulfate - drug should always be available in any case systemic toxicity occurs while patient is under Pilocarpine. Beet greens and parsley lessen the odor of colostomy Tonometry measures IOP Pilocarpine contract the ciliary muscle Webers test - if one side of the ear hears louder than the other ear, the louder ear might have a sensory hearing loss and the other side with conductive hearing loss. Levodopa - CI: Vitamin B6 rich food Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations dont cause metabolic acidosis. Esophageal varices - Increased pressure within the portal veins (portal HTN) causes them to bulge, leading to rupture and bleeding into the lower esophagus. Any hole, no matter how small, will destroy the odor-proof seal of a drainage bag. Removing the bag or unclamping it is the only appropriate method for relieving gas. A turning schedule with a signing sheet will help ensure that the client gets turned and thus, help prevent pressure ulcers. Turning should occur every 1-2 hoursnot every 8 hoursfor clients who are in bed for prolonged periods. The nurse should apply lotion to keep the skin moist but should avoid vigorous massage, which could damage capillaries. When moving the client, the nurse should lift rather than slide the client to void shearing. Continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate or longacting insulins Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushings syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is

undersecretion of glucocorticoids resulting hypoglycemia, hypovolemia, and hypotension.

in

profound

Testicular cancer commonly occurs in men between ages 20 and 30. A male client should be taught how to perform testicular selfexamination before age 20, preferably when he enters his teens According to the ACS guidelines, Women older than age 40 should perform breast selfexamination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesteronedependent. TIA may be a warning that the client will experience a CVA, or stroke, in the near future. TIA aymptoms last no longer than 24 hours and clients usually have complete recovery after TIA. The most common symptom of TIA is sudden, painless loss of vision lasting up to 24 hours. The nurse should instill the eyedrop into the conjunctival sac where absorption can best take place. The pupil permits light to enter the eye. The sclera maintains the eyes shape and size. The vitreous humor maintains the retinas placement and the shape of the eye. When clients gag reflex is absent, elevating the head of the bed to 30 degrees helps minimize the clients risk of aspiration. Checking the stools, performing ROM exercises, and keeping the skin clean and dry are important, but preventing aspiration through positioning is the priority. Eccrine glands are associated with body temperature regulation. Sebaceous glands lubricate the skin and hairs, and apocrine glands are involved in bacteria decomposition. Endocrine glands secrete hormones responsible for the regulation of body processes, such as metabolism and glucose regulation Excessive of aldosterone in the adrenal cortex is responsible for the clients hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the cathecolaminesepinephrine and norepinephrine. The parathyroids secrete parathyroid hormone Holding a cane on the uninvolved side distributes weight away from the involved side. Holding the cane close to the body prevents leaning. Use of a cane wont maintain stride length or prevent edema. Leukemia is manifested by an abnormal overpopulation of immature leukocytes in the bone marrow. Neisseria meningitides droplet precaution The portion of the cerebrum that controls speech and hearing is the temporal lobe. Injury to the frontal lobe causes personality changes, difficulty speaking, and disturbance in memory, reasoning, and concentration. Injury to the parietal lobe causes

sensory alterations and problems with spatial relationships. Damage to the occipital lobe causes vision disturbances. Coup - least serious form of brain trauma, characterized by a brief loss of consciousness and period of confusion. Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. Nipple retraction not eversionmay be a sign of cancer. A mobile mass that is soft and easily delineated is most often a fluid-filled benigned cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. In Parkinsons crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client who is confined to bed during a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, ineffective airway clearance is the priority diagnosis for this client. Although imbalanced nutrition:less than body requirements, impaired urinary elimination and risk for injury also are appropriate diagnoses for this client, they arent immediately lifethreatening and thus are less urgent. As a rule of practice, if intermittent catheterization for urine retention typically yields 500 ml or more, the frequency of catheterization should be increased. Indwelling catheterization is less preferred because of the risk of urinary tract infection and the loss of bladder tone. Severe pressure-like pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulites. Erythema, leukocytosis, and swelling are present in both cellulites and necrotizing fasciitis. he third cranial nerve (oculomotor) is responsible for pupil constriction. A heart valve prosthesis, such as a mitral valve replacement, is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, IV drug abuse, and immunosuppression Ottorrhea and rhinorrhea are classic signs of basilar skull fracture. Injury to the dura commonly occurs with this fracture, resulting in cerebrospinal fluid (CSF) leaking through the ears and nose. Any fluid suspected of being CSF should be checked for glucose or has a halo test done. Glipizide (Glucotrol) may cause adverse skin reactions, such as pruritus, and photosensitivity. PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vit D to its active form: 1 , 25 dihydroxy vitamin D. Percutaneous lithotripsy - The client should report the presence of foulsmelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to

flush the kidneys. Sand-like debris is normal because of residual stone products. Hematuria is common after lithotripsy. When the mechanical stressors of weight bearing are absent, diffuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented Peripheral edema is a sign of fluid volume overload and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but the dont indicate that therapy isnt effective. Autonomy ascribes the right of the individual to make his own decisions. Because thrombocytopenia impairs blood clotting, the nurse should assess the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. Before weaning a client from mechanical ventilation, its most important to have a baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. HCG is one of the tumor markers for testicular cancer. Crackles result from air moving through airways that contain fluid. Heard during inspiration and expiration, crackles are discrete sounds that vary in pitch and intensity. Theyre classified as fine, medium, or coarse. Pleural friction rubs have a distinctive grating sound. As the name indicates, these breath sounds result when inflamed pleurae rub together. Continuous, highpitched, musical squeaks, called wheezes, result when air moves rapidly through airways narrowed by asthma or infection or when an airway is partially obstructed by a tumor or foreign body. Wheezes, like gurgles, occur on expiration and sometimes on inspiration. Loud, coarse, low-pitched sounds resembling snoring are called gurgles. These sounds develop when thick secretions partially obstruct airflow through the large upper airways. CPP is derived by subtracting the ICP from the mean arterial pressure (MAP). For adequate cerebral perfusion to take place, the minimum goal is 70 mmHg. The MAP is derived using the following formula: MAP = ((diastolic blood pressure x 2) + systolic blood pressure) / 3 MAP = ((60 x2) + 90) / 3 MAP = 70 mmHg To find the CPP, subtract the clients ICP from the MAP. A universal concern in the care of donor sites for burn care is to keep the site away from sources of pressure. Caffeine is a stimulant, which can exacerbate palpitations and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps in increase cardiac output and decrease heart rate. Protein-rich foods arent restricted but high calorie foods are.

Regular follow-up care for the client with Graves disease is critical because most cases eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the clients ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Daily walks relieve symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may exacerbate these symptoms. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat foods that raise HDL levels. Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates leading to metabolic acidosis. CSF = 50 - 180 / 70 200 mmH2o. The presence of glucose is an expected finding in CSF, and RBCs typically occur in the first specimen tube from the trauma caused by the procedure. Gastric decompression is typically low pressure and intermittent. The nurse can gently irrigate the tube but must take care not to reposition it. Repositioning can cause bleeding. Suction should be applied continuously, not every hour. The NG tube shouldnt be clamped postoperatively because secretions and gas will accumulate, stressing the suture line. A scale is the characteristic secondary lesion occurring in psoriasis HHNS - Regardless of the clients medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly prescribed fluids include dextran (in case of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution. For clients with increased intracranial pressure (ICP), the head of the bed is elevated to promote venous outflow. A wet-to-dry saline dressing should always keep the wound moist. Tight packing or dry packing can cause tissue damage and pain. A dry gauze not a plastic-sheet-type dressingshould cover the wet dressing. In chronic bronchitis, the diaphragmatic is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air

trapping. Diaphragmatic increases lung expansion.

breathingnot

chest

breathing

Tenting of chest skin when pinched indicates decreased skin elasticity due to dehydration. Hand veins fill slowly with dehydration, not rapidly. A pulse that isnt easily obliterated and neck vein distention indicate fluid overload, not dehydration. Glipizide begins to act in 15 to 30 minutes. To help prevent airway obstruction and reduce the risk of aspiration, the nurse should position a client with hemiparesis on the affected side. Although performing ROM exercises, providing pillows for support, and applying antiembolism stockings can be appropriate for a client with CVA, the first concern is to maintain a patent airway. When clients are on mechanical ventilation, the artificial airway impairs the gag and cough reflexes that help keep organisms out of the lower respiratory tract. The artificial airway also prevents the upper respiratory system from humidifying and heating air to enhance mucociliary clearance. Manipulations of the artificial airway sometimes allow secretions into the lower airways. The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent positionnot a supine position when lying down to reduce the risk of aspiration. Encourage the client to wear properly fitted dentures to enhance his chewing ability. Thickened liquids, not thin liquids, decrease aspiration risk. The light-colored spots attached to the hair shafts are nits, which are the eggs of head lice. They cant be brushed off the hair shaft like dandruff. Scabies is a contagious dermatitis caused by the itch mite, Sacoptes scabiei, which lives just beneath the skin. Tinea capitis, or ringworm, causes patchy hair loss and circular lesions with healing centers. Impetigo is an infection caused by Staphylococcus or Sterptococcus, manifested by vesicles or pustules that form a thick, honey-colored crust. Anyone with psoriasis vulgaris who reports joint pain should be evaluated for psoriaic arthritis. Approximately 15% to 20% of individuals with psoriasis will also develop psoriatic arthritis, which can be painful and cause deformity. Because celiac disease destroys the absorbing surface of the intestine, fat isnt absorbed but is passed in the stool. Steatorrhea is bulky, fatty stools that have a foul odor. Individuals who are tuberculin skin test converters should begin a 6-month regimen of an antitubercular drug such as INH, and they should never have another skin test. After an individual has a positive tuberculin skin test, subsequent skin tests will cause severe skin reactions but wont provide new information about the clients TB status. The client doesnt have active TB, so cant transmit, or spread, the bacteria. Therefore, she shouldnt be quarantined or asked for information about recent contacts.

Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. According to family theory, any change in a family member, such as illness, produces role changes in all family members and affects the entire family, even if the client eventually recovers completely. An enterostomal nurse therapist is a registered nurse who has received advance education in an accredited program to care for clients with stomas. The enterostomal nurse therapist can assist with selection of an appropriate stoma site, teach about stoma care, and provide emotional support External fixator maintains reduction and overall hand function. Endotracheal suctioning secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and incentive spirometry improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldnt be affected. High pulmonary artery wedge pressures are diagnostic for leftsided heart failure. With leftsided heart failure, pulmonary edema can develop causing pulmonary crackles. In leftsided heart failure, hypotension may result and urine output will decline. When performing a nutritional assessment, one of the first things the nurse should do is to assess what the client typically eats. The client shouldnt be permitted to eat as desired. Weighing the client daily, placing her on I & O status, and drawing blood to determine electrolyte level arent part of a nutritional assessment. With a brain injury such as an epidural hematoma (a diagnosis that is most likely based on this clients symptoms), the initial sign of increasing ICP is a change in the level of consciousness. As neurologic deterioration progresses, manifestations involving pupillary symmetry, breathing patterns, and posturing will occur. When someone in a group of persons sharing a home contracts scabies, each individual in the same home needs prompt treatment whether hes symptomatic or not. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop. Third-degree burn may appear white, red, or black and are dry and leathery with no blisters. There may be little pain because nerve endings have been destroyed. First-degree burns are superficial and involve the epidermis only. There is local pain and redness but no blistering. Second-degree burns appear red and moist with blister formation and are painful. Fourth-degree burns involve underlying muscle and bone tissue. Cognitive appraisal - refers to the process through which an event is evaluated with respect to what is at stake and what might and can be done. The outcome of cognitive appraisal is identification of the situation as either stressful or non-stressful.

Analysis of data is included as part of the assessment. Elderly people frequently have one or more chronic illnesses that are managed with numerous medications and complicated by periodic acute episodes, making adherence difficult Cognitively intact patients who have stress or urge incontinence may gain bladder control through biofeedback Cultural blindness results in bias and stereotyping. Inability of a person to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies . Tertiary preventive nursing care, focusing on rehabilitation and restoring maximum health function, is a goal for home care nurses. PPOs (preferred provider organization) usually contract to provide health care to subscribers, usually businesses, for a negotiated fee that often is discounted. When a pair of chromosomes fails to separate completely and creates a sperm or oocyte that contains two copies of a particular chromosome (nondisjunction) Down syndrome results from three number 21 chromosomes. Collaborative problems are physiologic complications that nurses monitor to detect onset or changes and manage through the use of physician-prescribed and nursing-prescribed interventions to minimize the complications of events. Experiential readiness refers to past experiences that influence a persons ability to learn. To calculate the ideal body weight of a woman, the nurse allows 100 pounds for 5 feet of height and adds 5 pounds for each additional inch over 5 feet The history of the present illness is the single most important factor in assisting the health professional in arriving at a diagnosis or determining the persons needs. In the case of delayed PTSD, there may be up to a 6-month period of time that elapses between the trauma and the manifestation of symptoms. A mental device (something on which to focus the attention) relaxation techniques of progressive muscle relaxation, relaxation with guided imagery, and the Benson Relaxation Response. Similar elements also include a quiet environment, a comfortable position, and a passive attitude. Beneficence is the duty to do good and the active promotion of benevolent acts Mental disorder - a group of behavioral or psychological symptoms or a pattern that manifests itself in significant distress, impaired functioning, or accentuated risk of enduring severe suffering or possible death

Predictions regarding the time of their onset, their extent and eventual severity as well as which treatments or medications are likely to be most effective or harmful are the focus of genomic medicine. The naturalist or holistic perspective believes that health exists when all aspects of a persona are in perfect balance or harmony. Additionally, higher mortality rates in hospitalized patients and community-dwelling elderly are associated with individuals who have low BMI. (below 24) Stable cells have a latent ability to regenerate if they are damaged or destroyed and are found in the kidney, liver, and pancreas, among other body organs. An individual who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome of a pair. Both genders are affected in vertical pattern. Although some people take on a sick role identity, most people with chronic conditions do not consider themselves sick or ill and try to live as normal a life as is possible. Expression of the BRCA1 gene is an example of inheritance in the development of breast cancer. (Ashkanazi Jewish) A trochanter roll, properly placed, provides resistance to the external rotation of the hip. The leading health problems of elementary school children are injuries, infections, malnutrition, dental disease, and cancer. Hepatitis B is transmitted through contact with infected blood or plasma. Some Native Americans stare at the floor during conversations, conveying respect and indicating that the listener is paying close attention to the speaker. The stages include: denial, anger, bargaining, depression, and acceptance The reasons case management has gained such prominence can be traced to the decreased cost of care associated with decreased length of hospital stay, coupled with rapid and frequent inter-unit transfers from specialty to standard care units. Oncotic pressure is a pulling pressure exerted by proteins, such as albumin. Older adult increase residual volume, as a result, patient experience fatigue and breathlessness with sustained activity. Patients with orthopnea are placed in a high Fowlers position to facilitate breathing Septic shock is associated with immunosuppression, extremes of age, malnourishment, chronic illness, and invasive procedures.

Chloride is a major anion found in extracellular fluid. Stress incontinence - associated with weakened perineal muscles that permit leakage of urine when intra-abdominal pressure is increased In compensatory shock, the patients blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150. Bereavement is the period of time during which mourning a loss takes place. Emergency surgery means that the patient requires immediate attention and the disorder may be life-threatening.surgery without delay. 2nd intention healing - method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulations. When wounds dehisce, they will be allowed to heal by secondary intention. Individuals demonstrating ageism base their beliefs and attitudes about older people based upon chronological age without consideration of functional capacity. Signs of alcohol withdrawal delirium Up to 72 hours after alcohol withdrawal Presbyopia - refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away Tolerance is characterized by the need for increasing dose requirements to maintain the same level of pain relief. Perioperative period includes the preoperative, intraoperative, and postoperative phases. Mu opiods stimulation, then depression (RR). It also cause bradycardia, hypothermia, and constipation. Palliation is the goal for care in terminal cancer patients. Relief of symptoms associated with cancer. Antimetabolites are cellcycle-specific (S phase). In mutual pretense awareness, the patient, the family and the health care professionals are aware that the patient is dying but all pretend otherwise Physical tolerance usually occurs in the absence of addiction. Nitroprusside (nipride) - vasoactive drugs used in treating shock results in reduced preload and afterload, reducing oxygen demand of the heart. A disadvantage of nitroprusside is that it causes hypotension. Distributive or vasogenic shock results from displacement of blood volume, creating a relative hypovolemia

Clean-contaminated cases are those with a potential, limited source for infection, the exposure to which, to a large extent, can be controlled The living will is a type of advance medical directive in which the individual of sound mind documents treatment preferences. Fentanyl (Sublimaze) neuroleptanalgesic. Fentanyl is 75-100 times more potent than morphine and has about 25% of the duration of morphine (IV). Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. In the progressive stage of shock, the mechanisms that regulate blood pressure can no longer compensate, and the mean arterial pressure falls below normal limits. Stage III surgical anesthesia As the oxygen supply to the brain decreases, the patient may become restless (signs of approaching death). Potassium is a major cation that affects cardiac muscle functioning. Albumin (rapidly expand plasma volume) is a colloid that requires human donors, is limited in supply, and can cause congestive heart failure. Tachycardia is often the earliest sign of malignant hyperthermia. COPD barrel chest QRS complex - ECG waveforms characterizes conduction of an electrical impulse through the left ventricle. Ventricular depolarization. Angina pectoris is a symptom of myocardial ischemia. Legionnaires disease accounts for 15% of community-acquired pneumonias. High occurrence during summer or fall. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patients serum potassium level is low. Pigeon chest (displacement of the sternum) may occur with rickets, Marfans syndrome, or severe kyphoscoliosis. HSV : 2 12 days incubation period. COPD - Stage III patients demonstrate FEV1 < 30% with respiratory failure or clinical signs of right heart failure. Stage II patients demonstrate FEV1 between > 30% and 80%. Stage I is mild COPD with FEV1 < 70%.Stage O is characterized by normal spirometry.

Paroxysmal atrial tachycardia - characterized by abrupt onset, abrupt cessation, and a QRS of normal duration. PAT is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. *arterial insufficiency) TNR (transmyocardial laser revascu;arization) procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some blood flows into the channels, decreasing the ischemia directly. Within the next few days to months, the channels close as a result of the bodys inflammatory process of healing a wound and new blood vessels form as a result of the inflammatory process. (induces angiogenesis) Unstable angina - experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur. (crescendo or pre-infarction angina and indicates the need for a change in treatment.) Clergymans sore throat chronic granular pharyngitis. The pharynx is characterized by numerous swollen lymph follicles. The 60 minute interval is known as door to balloon time for performance of PTCA on a diagnosed MI patient. Stroke volume (amount of blood ejected per heartbeat) is determined by preload, afterload, and contractility. Mantoux test redness and induration Adenocarcinoma - most prevalent carcinoma of the lung for both men and women.

Normally, in the absence of disease of the vasculature, there is a

difference of no more than 5 mm Hg between arm pressures. A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Bizarre, abnormal QRS complex. When PVCs occur at a rate of more than six per minute they indicate increasing ventricular irritability and are considered forerunners of ventricular tachycardia (VT). Urine output of less than 25 ml/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume. Automaticity - ability of the heart to initiate an electrical impulse. Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Cricoids cartilage - the only complete cartilaginous ring in the larynx. Located below the thyroid cartilage. Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.

Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and at more than 20 cm water pressure to prevent aspiration. (20 25 mmHg) CVP assess in right atrium. Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Heart rate increases during inspiration and decreases during expiration. In general, the nurse should apply suction no longer than 10-15 seconds because hypoxia and dysrhythmias may develop, leading to cardiac arrest. Usually, no drains are used for the pneumonectomy patient because the accumulation of fluid in the empty hemithorax prevents mediastinal shift. Obstructive sleep apnea is characterized by lack of airflow due to pharyngeal occlusion. Occurs usually in men, especially those who are older and overweight 3rd degree AV block - no atrial impulse is conducted through the AV node into the ventricles. In third degree heart block, two impulses stimulate the heartone stimulates the ventricles and one stimulates the atria. Patient who has undergone laryngectomy suffers wound breakdown is high risk for carotid artery hemorrhage. The carotid artery lies close to the stoma and may rupture from erosion if the wound does not heal properly. Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Pleural friction rub - harsh and cracking, sounding like two pieces of leather being rubbed together, A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid. Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Consolidation - lung tissue that has become more solid in nature due to a collapse of alveoli or infectious process Hypermagnesemia - vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression. Untreated hypomagnesemia may result in coma, apnea, cardiac arres. Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change of form of medication is required by patients with tube feedings.

Persistent cough may indicate an onset of left-heart failure. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Normal bowel sounds are heard every 5-20 seconds Mitral valve prolpase is a deformity that usually produces no symptoms and has been diagnosed more frequently in recent years, probably as a result of improved diagnostic methods. Prazosin HCl - Minipress is a peripheral vasodilator acting directly on the blood vessel. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic. Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. To ensure patency of central venous line ports, dilute heparin flushes daily when not in use. Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Dysphagia - most common symptom of esophageal disease Intrinsic factor combines with vitamin B12. Leukoplakia is characterized by white patches, usually on the buccal mucosa. Scaling, crust formation, and fissures. Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Patients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Stem cell - primitive cell, capable of self-replication and differentiation. Stem cells may differentiate into myeloid or lymphoid stem cells. Acute lymphadenitis is demonstrated by enlarged, red and tender lymph nodes. High risk for infective endocarditis - patient who has complex cyanotic congenital malformations. Pulmonary artery wedge pressure - When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured. When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary arty until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure. The border of an ulcer caused by arterial insufficiency is circular. In venous insufficiency the border is irregular. Generally, when anxiety begins to increase, the patient will be less likely to want to discuss prognosis.

Classic sign of cardiogenic shock - Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation). Because the diverticula may retain decomposed food, halitosis and a sour taste in the mouth are frequent complaints. Many oral cancers produce no symptoms in the early stages. As the cancer progresses, the patient may complain of tenderness or difficulty in chewing, swallowing, or speaking. Sialolithiasis - Salivary stones are formed mainly from calcium phosphate. Contrast phlebography - diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot. When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein. Non tunneled catheter - venous access devices can be used for no more than 30 days in patients requiring parenteral nutrition. Most nasoenteric tubes use mercury to carry the tube by gravity to its desired location. The 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements, as it is more accurate in assessment of circulating oxygen. Regional enteritis (Transmural thickeneing) is an early pathologic change of Crohns disease. Later pathology results in deep, penetrating granulomas. After liver biopsy right side lying position. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Omeprazole (Prilosec) decreases gastric acid by slowing the hydrogen-potassium-adenosine-triphosphatase pump on the surface of the parietal cells. Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually two to three hours Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. The presence of mucus and pus in the stools suggests inflammatory colitis or enteritis. Alcoholic cirrhosis - scar tissue surrounds the portal areas. Pyelonephritis (renal pelvis) is an upper urinary tract inflammation, which may be acute or chronic.

Sulfonyureas - exert their primary action by directly stimulating the pancreas to secrete insulin. The onset of action of rapid-acting Humalog is within 10-15 minutes. With a sigmoid colostomy, the feces are solid. Anticholinergic agents are considered first-line medications for urge incontinence. Borborygmus is the term used to refer to intestinal rumbling which accompanies diarrhea. Celiac sprue Mucosal disorders causing generalized malabsorption. In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. The Roux-en-Y gastric bypass is the recommended procedure for long-term weight loss. In this procedure, a horizontal row of staples creates a stomach pouch with a 1-cm stoma that is anastomosed with a portion of distal jejunum, creating a gastroenterostomy. Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in the menopausal women. The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Excess somatotropin. Choledocholithotomy refers to incision of the common bile duct for the removal of stones (liths). Cylindruria cast in the urine. Casts may be identified through microscopic examination of the urine sediment after centrifuging. Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Adhesions (most common cause of bowel obstruction) are scar tissue that forms as a result of inflammation and infection. Urine that is orange may be caused by intake of Dilantin or other medications. Orange to amber colored urine may also indicate concentrated urine due to dehydration or fever. Digestion of cholesterol is aided by amylase. Secretory diarrhea is usually high volume diarrhea and is caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen. Anal fissure - longitudinal tear or ulceration in the lining of the anal canal

Saline agents (Milk of Magnesia) - draw water into the intestines by osmosis. Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption. Antibiotics and bismuth salts are given to eradicate H. pylori. Nausea is typically associated with appendicitis with or without vomiting. The nurse must never clamp a nephrostomy tube because it could cause obstruction and resultant pyelonephritis. A right angle straightens the urethra and makes it easier to insert the catheter. Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa. Cytomegalovirus is a species-specific herpes virus. Known to cause retinitis in HIV/AIDS A Pap smear is recommended for women aged 19-39 years, as well as for women aged 40 and older. Although specific therapies vary, treatment of HIV infection for an individual patient is based on three factors: the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load). Cytotoxic T cells - lyse cells infected with virus. Play a role in graft rejection Pagets disease - thickening, scaling, and erosion of the nipple and areola. Early signs of erythema of nipple and areola. Symptoms of prostatism include increased frequency of urination, nocturia, urgency, dribbling, and a sensation that the bladder has not completely emptied. A negative test result indicates that antibodies to the AIDS virus are not present in the blood at the time the blood sample for the test is drawn. The introitus is the vaginal orifice. Ductal lavage - women at higher risk for benign proliferative breast disease. Performed in the doctors office, a microcatheter is inserted through the nipple while instilling saline and retrieving the fluid for analysis. It has been shown to identify atypical cells in this population and has been found to be adept at detecting cellular changes within the breast tissue. Management in mild and moderate cases of OHSS (ovarian hyperstimulation syndrome) consists of decreased activity, monitoring of urine output and frequent office visits as designated by the reproductive endocrinologist.

Agammaglobulinemia (Brutons disease ) is a sex-linked disease that results in infants born with the disorder suffering severe infections soon after birth. The stem cell is known as a precursor cell that continually replenishes the bodys entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells. Proliferation - stage of the immune response does the circulatinglymphocyte containing the antigenic message return to the nearest lymph node Once in the node, the sensitized lymphocyte stimulates some of the resident dormant T and B lymphocytes to enlarge, divide, and proliferate. Laparoscopic myomectomy is the removal of fibroids through a laparoscope inserted through a small abdominal incision. BSE is best performed after menses, when less fluid is retained. On day 5 to day 7, counting the first day of menses as day 1. Primary immunodeficiencies - develop early in life after protection from maternal antibodies decreases. A vesicovaginal fistula (opening between bladder and vagina) may occur because of tissue injury sustained during surgery, vaginal delivery, or a disease process. K-Y jelly is water-based and will provide lubrication while not damaging the condom. Luteinizing hormone is released by the pituitary gland. Stimulate production of progesterone. Levofloxacin, a floroquinolone, is a good choice for short-course therapy of uncomplicated, mild to moderate UTI. Clinical trial data show high patient compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%) The viral set point is the balance between the amount of HIV in the body and the immune response. Interferons are biologic response modifiers with nonspecific viricidal proteins. Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system Peyronies disease (buildup of fibrous plaques in the sheath of the corpus cavernosum causing curvature of the penis when it is erect) may require surgical removal of the plaques when the disease makes sexual intercourse painful, difficult, or impossible. Stereotactic biopsy (use for nonpalpable lesion) utilizes computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue for pathologic examination.

When eosinophils make up 50-90% of white cell count, the patient is demonstrating severe eosinophilia. Indicative of idiopathic hypereosinophilic syndrome.