MEDICAL-SURGICAL NURSING REVIEW

Course Outline

I. II. III.

Client in Pain Perioperative Nursing Care Alterations in Human Functioning a. Disturbances in Oxygenation: Respiratory & Cardiovascular Functions

IV. V.

Disturbances in usculos$eletal Functions Client in %iologic Crisis: &i'e t(reatening Conditions o' t(e Human %ody ) *(oc$ !mergency & Disaster ) First)aid and Cardiopulmonary *upport

b. c. d. e. f. g.

Disturbances in

etabolic and !ndocrine Functions

Disturbances in !limination: "astrointestinal Problems Disturbances in Fluids and !lectrolytes: Renal & "enitourinary Functions Disturbances in Cellular Functioning: Cancer and Hematologic Problems Disturbances in Auditory & #isual Functions

I.

-------------------------------------------------------------------------------------------------------------------------------------CLIENT IN PAIN

Pain + t(e 'i't( vital sign an unpleasant sensory and emotional experience associated ,it( actual or potential tissue damage%asic Categories o' Pain: 1. Acute Pain + sudden pain ,(ic( is usually relieved in seconds or a'ter a 'e, ,ee$s-

2. 3.

C(ronic Pain .Non) alignant/ + constant0 intermittent pain ,(ic( usually persists even a'ter (ealing o' t(e in1ured tissue Cancer)Related Pain) ay be acute or c(ronic2 may or may not be relieved by medications

Pain 3ransmission: 4- Nociceptors are called pain receptors- 3(ese are t(e 'ree nerve endings in t(e s$in t(at respond to intense0 potentially damaging stimuli5- Perip(eral Nervous *ystem 3. Central Nervous *ystem 6- Descending Control *ystem Factors 7n'luencing Pain Response 1. Past !xperience + e-g- trauma 5- Anxiety and Depression 3. Culture ) belie's

4. 5.
8-

Age + in'ants are more sensitive "ender Placebo !''ect

C(aracteristics o' Pain 1. 7ntensity +mild0 moderate0 excruciating

2.
9-

4. 5. 6. 7.

3iming + morning or evening0 duration may be longer or s(orter &ocation :uality + burning0 ac(ing0 stabbing Personal eaning to pain + tolerance to pain may be di''erent 'rom one person to t(e ot(er due to some personal reasons suc( as economic reasons0 ,or$ condition0 etcAggravating and Alleviating 'actors + patient;s environment Pain %e(aviors ) 'acial expressions ,it( pain

Pain Assessment 4- !valuate: Cause0 &ocation0 C(aracter and 7ntensity 2. Numeric Pain *cale + <)severe pain ) = + no pain 9- Descriptive Pain *cales + mild0 moderate0 severe 4. #isual Analogue *cales <- Faces Pain *cale Nurse;s Role in Pain anagement 4- 7denti'y goals 'or Pain management a- Decrease intensity0 duration or 're>uency b- Factors in identi'ying goals: i- *everity o' pain

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iiiii5-

Harm'ul e''ects o' pain to t(e client Duration o' t(e pain

3.

!stablis( Nurse)Patient Relations(ip and 3eac(ing a- Ac$no,ledge t(e verbali?ation o' pain by t(e client b- Relieve patient;s anxiety c- 3eac( measures (o, to relieve pain Provide P(ysical care a- 3eac( and assist in sel')care b- !nvironmental conditions c- Application o' ice@(eat on pain'ul area anage anxiety related to Pain a- 3eac( about t(e nature o' pain t(at may be 'elt by t(e client and reassure (im@(er b- 3eac( alternative measures to relieve pain c- *tay ,it( t(e client@ 're>uent communication ,it( t(e client Pain edications may be administered as: %alanced Anest(esia + given to avoid experiencing pain PRN + APro Re NataB + as needed Preventive + ta$en be'ore pain is 'elt 7ndividuali?ed Dosage Patient)Controlled Analgesia .PCA/ + patient ta$es medication i' pain 'elt is becoming intolerable

6-

5.

a.
b-

c.
d-

e.
8-

Non)p(armacologic 7nterventions a- Cutaneous *imulation and assage b- 7ce and (eat t(erapies c- 3ranscutaneous !lectrical Nerve *timulation d- Distraction e- Relaxation 3ec(ni>ues '- "uided 7magery g- Hypnosis

II.

PERIOPERATIVE CARE o P(ases o' Perioperative Nursing a-

b.
cA-

Pre)operative Nursing 7nraoperative Nursing Post)operative Nursing

Pre)operative Care Pre)admission and Admission 3est 4Psyc(ological support 5Client !ducation: a7mportance and practice o' breat(ing exercises b&ocation & support o' ,ound c7mportance o' early ambulation d. 7n'orm and practice leg exercises0 positioning0 turning eAnest(esia and analgesics '!ducate regarding drains and dressings to be received post)op gRecovery room policies and procedures 97n'ormed consent aAt least 4C years o' age b7n sound mind) ,it(out psyc(ologic disorder cNot under t(e in'luence o' drugs or alco(ol d7mmediate relative over 4C years old P(ysical Assessment and preparation a. P(ysical Preparation + NPO0 remove dentures0 1e,elries0 clot(esetc-

6-

b. c. d. e. f.

Nutritional & Fluid *tatus + s(ould be ,ell (ydrated Drug or alco(ol Dse + may experience delirium or intoxication to anest(etic drugs because ormal doses do not usually ta$e e''ect to t(ese patients and re>uire (eavier dose to ac(ieve anest(etic e''ectRespiratory *tatus ) teac( breat(ing exercises Cardiovascular *tatus + s(ould (ave controlled and stable cardiovascular 'unctioning be'ore operation to prevent intraoperative problems Hepatic & Renal Functions + normal 'unctioning is important in absorbing anest(etic drugs

116

g. h. i. j. 5. 6.
*emi)Fo,lers

!ndocrine Functions) important in monitoring to (ypo@(yperglycemia0 t(yrotoxicosis0 acidosis 7mmune Functions + allergies esp- to anest(etic drugs

prevent

Psyc(osocial Factors + emotional and psyc(ological preparation to ensure cooperation 'om t(e patient ,it( t(e procedures *piritual & Cultural %elie's ) blood trans'usions0 transplants0 ligation0 etc are against ot(er culture & religion-

Pre)operative drugs + given 5=)8= mins-pre)operative o a$es patient dro,sy0 $eep siderails up Proper positioning HO% elevated at 9= degrees HO% elevated at 6< degrees Head in1ury0 pot)op cranial surgery0 post)op cataract removal0 increased 7CP0 dyspneic patients Head in1ury0 pot)op cranial surgery2 post)op abdominal surgery2 post)op t(yroidectomy0 post)op cataract surgery0 increased 7CP2 dyspnea Pneumot(orax0 (iatus (ernia *pinal cord in1ury0 urinary cat(eteri?ation Amputation o' legs@'eet0 post lumbar puncture0 post myelogram0 post tonsillectomy & adenoidectomy .3&A/ Post)abominal surgery0 post tonsillectomy & adenoidectomy .3&A/0 post)liver biopsy . rig(t side do,n/0 post pyloric stenosis .rig(t/ Dnconscious client

Fo,lers

Hig()Fo,ler;s *upine@ Dorsal Recumbent

HO% elevated at E= degrees &ying on bac$ ,@ small pillo, under (ead &ying on abdomen ,it( (ead turned to t(e side

&ateral @ *ide lying

&ying on side0 ,eig(t on t(e lateral side0 t(e lo,er scapula and lo,er iliac&ying on side0 ,eig(t on t(e clavicle0 (umerus and anterior aspect o' t(e iliac&ying on bac$ ,it( $nees and legs bent and raised on a stir up

Perineal0 rectal & vaginal procedures

3rendelenburg Reverse 3redelenburg !levate extremity

Head & body lo,ered0 'eet elevated Head elevated 0 'eet lo,ered *upport ,it( pillo,s

*(oc$ Cervical traction Post)op surgical procedure on extremity0 cast0 edema0 t(rombop(lebitis

117

Prone *upine Lateral Recumbent

*im;s Position

Reverse 3rendelenburg

Hig()Fo,ler;s

Fac$)Gni'e

&it(otomy

%-

7ntra)operative Care

1.

!nsure sterility o' all instruments and supplies at t(e operating 'ield Principle: *3!R7&! 3O *3!R7&!0 C&!AN 3O C&!AN
Sterile objects touches only sterile surfaces/objects Clean objects touches only clean surfaces/objects

*terili?ation tec(ni>ues: o Autoclave + *team0 !t(yl Oxide ."as/ o "lutaralde(yde *olution) Cidex

2.
9-

!nsure sa'ety o' client in t(e operating table) prevent 'alls0 drape t(e patient properly0 provide ,armt( *tay ,it( t(e client to relieve anxiety and support during anest(esia Anesthesia Administration:

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abcd-

"eneral Anest(esia via 7n(alation "eneral Anest(eisia via 7ntravenous Regional Anest(esia ) local anest(esia Conduction %loc$s@ *pinal Anest(esia + !pidural & *pinal %loc$ ) 'or operation belo, t(e ,aist line ) patient is a,a$e during operation

6<8HC-

Per'orm sponge count0 instrument count and needle count Aseptic tec(ni>ue in (andling and preparing all instruments and supplies Applies grounding device to prevent electrical burn during use o' electrosurgical e>uipment Proper documentation Post)operative Care 1. 7mmediate assessment o' #*0 and Neuro #*0 drainages0 surgical dressing 5onitoring o' vital signs > 4<mins until stable 3. Post)operative positioning depending on t(e procedure per'ormed

4.
<8-

Deep breat(ing exercises !arly ambulation Healt( teac(ing 'or 7ndependent .sel'/ care upon disc(arge

III. ALTERATIONS IN HUMAN UNCTIONING

!. DISTUR"ANCES IN O#$GENATION Arterial "loo% Gas Nor&al Value 'H 'CO( easure o' acidity or al$alinity Partial pressure o' carbon dioxide parameter in'luenced by lungs only respiratory H-9< + H-6< 9< )6<

'O(

Partial pressure o' oxygen2 measure o' amount oxygen delivered to lungs %icarbonate0 metabolic parameter in'luenced only by metabolic 'actors

C=)4==

HCO)

55)58

Res'irator* A+i%osis 'H 'CO( Normal Compensation HCO)

Nor&al Value H-9< + H-6< 9< )6< 55)58

Res'irator* Al,alosis

Normal Compensation

a- Administer NaHco9 b- "et rid o' CO5 c- %ronc(odilators d- onitor A%"

Nursin- Inter.ention

a- %reat(e into paper bag or cupped (ands b- Oxygen

119

Meta/oli+ A+i%osis 'H Normal Compensation 'CO( HCO) a- 3reat underlying cause .*tarvation0 systemic in'ections0 renal 'ailure0 Diabetic acidosis0 Geratogenic diet0 diarr(ea0 excessive exercise/ b- Promote good air exc(ange c- "ive NAHCO9 via 7#

Nor&al Value H-9< + H-6<

Meta/oli+ Al,alosis

Normal Compensation 9< )6< 55)58 Restore 'luid loss ,(ic( may be cause by vomiting0 gastric suction0 al$ali ingestion0 excessive diuretic

Nursin- Inter.ention

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

A group o' conditions assoc- ,@ c(ronic obstruction o' air'lo, entering or leaving t(e lungs a1or diseases 4- Pulmonary !mp(ysema + air,ay is obstructed due to destroyed alveolar ,alls 5- C(ronic %ronc(itis) increased mucus production t(at obstructs air,ay 9- Ast(ma

Cause: 4596Clinical

Cigarette smo$ing C(ronic respiratory in'ections Family (istory o' COPD Air pollution ani'estations: Fe, ,ords bet,een breat(s Pursed)lip breat(ing Cyanosis Distended nec$ veins %arrel c(est + increased diameter o' t(orax Pulsus paradoxus + Clubbing o' 'ingers Nicotine *tains Pitting edema exertional dyspnea or dyspnea at rest !nlarged pulsating liver Coug() ,it( or ,it(out sputum production

edical 4596<8-

anagement: %ronc(odilators Anti(istamines *teroids Antibiotics !xpectorants Oxygen t(erapy at 5&P

+ use cautiously

Nursing anagement: 4- Administer meds and O5 as ordered 5- Promote ade>uate activities to en(ance cardiovascular 'itness 9- Ade>uate rests 6- Avoid allergens or ot(er irritants <- Psyc(ological *upport

CHRONIC BRONCHITIS Blue Bloater ) ) An in'lammation o' t(e bronc(i ,(ic( causes increased mucus production and c(ronic coug(C(ronic condition is diagnosed i' symptoms occur 'or 9 mont(s and 'or 5 consecutive years-

Cause: Cigarette *mo$ing0 in'ection0 pollution

Clinical

ani'estations: Productive coug( 3(ic$er0 more tenacious mucus *lig(t gynecomastia Petec(iae in midsternal area Dyspnea

120

 edical Nursing 4596<8-

Decreased exercise tolerance I(ee?es

anagement: see COPD anagement: Reduce or avoid irritants 7ncrease (umidity Administer medications as ordered C(est p(ysiot(erapy Postural drainage Promote %reat(ing tec(ni>ues EMPHYSEMA Pink Puffer

) )

A disorder ,(ere t(e alveolar ,alls are destroyed causing permanent distention o' air spaces.J/ dead areas in t(e lungs t(at do not participate in gas or blood exc(ange

Cause: Cigarette smo$ing0 Alp(a)anti)trypsin de'iciency .an en?yme in t(e alveolar ,alls/ Clinical 4596<8Hani'estations: Dyspnea on exertion 3ac(ypnea %arrel)c(est I(ee?es Pin$is( s$in color *(allo, rapid respirations Pursed lip breat(ing Nursing anagement: Position: *it up and lean 'or,ard Pulmonary toilet: Coug()K%reat(e deeply)KC(est p(ysiot(erapy)K turn & position Fre>uent rest periods Nebuli?ation 7PP% + 7ntermittent Positive Pressure %reat(ing .aerosoli?ed in(alation/ O5 M 5&P

Asthma )A condition ,(ere t(ere is an increase responsiveness and@or spasm o' t(e trac(ea and bronc(i due to various stimuli ,(ic( causes narro,ing o' air,ays Cause and Ris$ Factors: 4Family (istory o' ast(ma 5Allergens: dust0 pollens0 9*econdary smo$e in(alation 6Air pollution <*tress 3ypes:

1. 2.
9Clinical

7mmunologic ast(ma

occurs in c(ild(ood

Non)immunologic ast(ma ) occurs in adult(ood and assoc ,@ recurrent resp in'ections) usually K9< y@o ixed0 combined immunologic and non)immunologic ani'estations: 7ncreased tig(tness o' c(est0 dyspnea 3ac(ycardia0 tac(ypnea Dry0 (ac$ing0 persistent coug( .J/ ,(ee?es0 crac$les Pallor0 cyanosis0 diap(oresis Nursing anagement: Promote pulmonary ventilation Facilitate expectoration Healt( teac(ing %reat(ing tec(ni>ues *tress management Avoid allergens

1. 2.
9-

C(ronic barrel c(est0 elevated s(oulders distended nec$ veins ort(opnea 3enacious0 mucoid sputum

3reatment: 4- *teroids0 5- Antibiotics 9- %ronc(odilators0 expectorants 4. O50 nebuli?ation0 aerosol Complication: STATUS ASTHMATICUS - a li'e)t(reatening ast(matic attac$ in ,@c symptoms o' ast(ma continues and do not respond to treatment 77PAR!NCHL A& D7*ORD!R*:

121

PNEUMONIA - An in'lammatory process o' lung parenc(yma assoc- ,@ mar$ed increase in alveolar and interstitial 'luids !tiology: 4- %acterial @ #iral + streptococcus pneumoniae0 pseudomonas aeruginosa0 in'luen?a 5- Aspiration 9- 7n(alation o' irritating 'umes Ris$ 'actors: 4- Age: too young and elderly are most prone to develop 5- *mo$ing0 air pollution 9- DR37 6- Altered conciousness <- 3rac(eal intubation 6. Prolonged immobility: post)operative0 bed)ridden patients Clinical 459Nursing ani'estations: C(est pain0 irritability0 appre(ensiveness0 irritability0 restlessness0 nausea0 anorexia0 (x o' exposure Coug() productive 0 rusty@ yello,is(@greenis( sputum0 splinting o' a''ected side0 c(est retration CNR0 sputum culture0 %lood culture0 increased I%C0 elevated sedimentation rate anagement: Promote ade>uate ventilation) positioning0 C(est p(ysiot(erapy0 7PP% Provide rest and com'ort Prevent potential complications Healt( teac(ing: s$in care0 (ygiene Drug t(erapy: o Antibiotics: penicillin0 cep(alosp(orin0 tetracycline0 eryt(romycin o Coug( suppressants o !xpectorants Rest and ade>uate activity Proper Nutrition PULMONAR$ EDEMA ) o'ten occurs ,(en t(e le't side o' t(e (eart is distended and 'ails to pump ade>uately o Clinical ani'estation: Constant irritating coug(0 dyspnea0 crac$les0 cyanosis Pat(op(ysiology: Nursing Fluid accumulation in t(e alveolar sacs due to (ypovolemia0 'luid congestions in t(e lungs0 alveoli are congested

anagement: 4- Diuretics0 lo, sodium diet0 7&O 5- promote e''ective air,ay clearance0 breat(ing patterns and ventilation 9onitor #* 6- Psyc(ological support <- Administer medications TUBERCULOSIS

) A c(ronic lung in'ection t(at leads to consumption o' alveolar tissues !tiology: ycobacterium tuberculosis-

Ris$ Factors: Poor living conditions0 overcro,ded 4- Poor nutritional inta$e 5- Previous in'ection

122

Close contact ,it( in'ected person 6- 7nade>uate treatment o' primary in'ection Clinical ani'estations: Diagnostic 3ests: 4596<8HCEProductive coug( Hemoptysis Dypnea Rales alaise Nig(t *,eats Ieig(t loss Anorexia0 vomiting 7ndigestion0 pallor 459CNR *putum acid)'ast antoux 3est ) -4 ml o' PPD .Puri'ied Protein Derivative/ 2 Read a'ter 6C)H5 (rs7nduration: 4=mm + K positive exposure to 3% bacillus < + E mm )K doubt'ul0 may repeat t(e procedure K 6 mm )K Negative

3.

3reatment: 4- !t(ambutol 5- Ri'ampicin 9- 7sonia?id 6- Pyra?inamide <- *treptomycin Client !ducation: 4- 3% is in'ectious but can be cured 5- 3ransmitted by droplet in'ection and not carried on articles li$e clot(ing or eating utensils 9- 7ndividual is generally considered not in'ectious a'ter 4) 5 ,ee$s o' medication6edication regimen s(ould be continuous and uninterrupted <- Regimen is usually 8 mont(s8- Regular c(ec$)up to monitor progress s(ould be doneH- *putum samples are obtained 'irst be'ore drug t(erapy is startedC- Advise proper (and,as(ing and use o' mas$ 'or people in contact ,it( in'ected persons ,(o are not yet under treatment-------------------------------------------------------------------------------------------------------------------------------------------------------CARDIOVASCULAR S$STEM 3H! H!AR3 AND AFOR #!**!&* I. Dia-nosti+ Pro+e%ure &aboratory 3est !lectrocardiogram !c(ocardiograp(y Central #enous Pressure Pulmonary Artery Pressure@ *,an)"an? Cardiac Cat(eteri?ation 77- Diseases o1 t2e Vas+ular S*ste&: Arterial Disorders: 4- Hypertension 5- Arteriosclerosis 9- At(erosclerosis 6- Aortic Aneurysm <- %uerger;s Disease .3(romboangitis Obliterans/ 8- Raynaud;s Disease A. DIAGNOSTIC PROCEDURES0 Pro+e%ure 4- &aboratory 3ests Values 3 Des+ri'tion a- !lectrolytes + Na0 G0 Ca0 C(loride 0 g .see 'luids & electrolytes/ b- P33 + 48)6= secc- P3 + E)45 secd- Clotting time + 4= minse- C(olesterol + 4<=)5<= mg@dl ) determines ability o' t(e blood to 'orm clot or t(rombus Pur'ose Determines (yper$alemia0 Hypernatremia0 etc) determine t(e ability o' t(e (eart to a''ect circulation and regulatory 'unctions o' 'luids and electrolytesVenous Disor%ers0 453(rombop(lebitis #aricose #eins

Car%ia+ Disor%ers ab7n'arction cFailure de'Angina Pectoris yocardial Congestive (eart #alvular *tenosis A# Heart %loc$ Pacema$ers

123

'- 3riglyceride + <=)5<= mg@dl K &D& .bad c(olesterol/ + 8=)4C= mg@dl K HD& .good c(olesterol/ + 9=)C= mg@dl g- %DN + 8)5= mg@dl ) determines t(e development o' at(erosclerosis ,(ic( causes coronary artery disease

) test o' renal 'unction2 determines ade>uacy o' circulation 'rom t(e (eart to t(e $idneys and its ability to excrete protein and urea

(- !n?ymes: K CPG + men) <<)4H= ) ,omen) 9=)49< . rises 9)8 (rs a'ter -7-/ K &DH + 4<=)6<= u@ml .rises 45 (rs a'ter K *"O3 + <)6= u@ml i- !*R) =)9=-+ also rises a'ter 5- !lectrocardiogram P) contraction o' t(e atrium :R* complex) contraction o' t(e ventricles 3) Resting state o' t(e ventricles PR interval) contraction o' atrium until t(e beginning o' t(e contraction o' ventricles *3) ventricles moves to a resting state Values 3 Des+ri'tion Dltrasound o' t(e (eart 7 -7-/

) cardiac en?ymes are present in (ig( concentration in t(e myocardial tissues 2 determines tissue damage in t(e myocardium

Determines t(e electrical impulse o' t(e (eart Normal impulses ensures ade>uate circulation to all body organs and tissues

Pro+e%ure 9- 5)Dimensional !c(ocardiograp(y .5D !c(o/

Pur'ose Determines valvular de'ormities0 t(ic$ening o' myocardium0 pericardial e''usion0etc *erves as guide 'or 'luid replacement onitor pressures in t(e rig(t atrium and central veins

6- Central #enous Pressure .C#P/ Normal O < + 4= cm Iater

easures t(e rig(t atrial pressure or t(e pressure o' t(e greater veins ,it(in t(e t(orax by t(reading a cat(eter into a large central vein) *ubclavian ) Fugular ) edian ) %asilic ) Femoral !nd o' cat(eter or 3ip + positioned at t(e rig(t atrium or upper portion superior vena cava .'or 'emoral insertion0 tip is at t(e in'erior vena cava/

Administer blood products0 3PN0 drug t(erapy Obtain venous access ,(en perip(eral veins are inade>uate 3o insert a temporary pacema$er Obtain central venous samples onitor pressure in t(e '': Rig(t ventricle Pulmonary artery e. Distal branc(es o' t(e pulmonary artery 3(ermodilution Obtain blood 'or O5 saturation d-

<- *,an)"an? Cat(eter @ Pulmonary Artery Pressure .PAP/

easures t(e level o' pressure in t(e le't atrium 6 Ports: a- 3(ermodilution port b- %alloon Port 'or in'lating balloon used 'or placement o' cat(eter c- Rig(t atrium Port d- Pulmonary atrium port

c.

124

8- Cardiac Cat(eteri?ation

Cat(eter inserted into t(e rig(t or le't side o' t(e (eart and vessels and a dye is introduced Dsed to determine details on t(e structure and per'ormance o' t(e valves0 (eart and circulation

a-

easure O5 concentration0 saturation0 tension and pressure in t(e c(ambers o' t(e (eart

b- Detect s(unts c- 3o get blood samples d- Determine cardiac output & pulmonary 'lo, e- Determine need 'or bypass surgery

T2ree t*'es o1 "loo% Vessels0 459Arteries ) carries oxygenated blood #eins ) carries unoxygenated blood Capillaries + allo,s t(e delivery o' nutrients0 oxygen and 'luids to t(e tissues

%- DISEASES O THE VASCULAR S$STEM:

%- 4-AR3!R7A& D7*ORD!R*
HYPERTENSION persistent %P above 46= @E= 3ypes o' Hypertension !tiology: !ssential (ypertension un$no,n etiology ) most common ) may be caused by an increase in cardiac output or increase in perip(eral resistance !ssential (ypertension "enetic Obesity *tress &oss o' elastic tissues Arteriosclerosis o' aorta *econdary (ypertension caused by ot(er p(ysiologic problems

3ypes o' Hypertension Ris$ Factors

*econdary (ypertension Renal problems + Renal Failure0 Nep(ritis !ndocrine problems + 3(yroid problem0 D Neurologic Disorders + %rain tumors0 3rauma Pregnancy)7nduced HPN any ot(ers

*igns & *ymptoms 3reatment

%PO46=@E= 2 (eadac(e0 'atigue0 ,ea$ness0 di??iness0 palpitations0 'lus(ing0 blurred vision and epistaxis Non)p(armacologic:

Ieig(t reduction Diet modi'ication Alco(ol & *mo$ing cessation Relaxation 3ec(ni>ues Potassium0 Calcium0 electrolytes/

P *odium restriction P !xercise P Ca''eine Restriction

agnesium supplements .to balance sodium and ot(er

P(armacologic: Calcium Agonist: Ni'edipine0 #erapamil #asodilators: Hydrala?ine Diuretics: Aldactone0 (ydroc(lorot(i?ide Adrenergic in(ibitors: Propanolol0 Clonidine0 Nursing 7nterventions %P monitoring Correct cause: obesity0 diet0 stress0 etc Regular exercise *alt restrictions Administer medications 3eac( ris$ 'actors

et(yldopa

125

ARTERIOSCLEROSIS Obstruction ) I(en t(e arteries become o/stru+te% 4it2 'la5ue an% +2olesterol0 t(ey (arden and constrict0 and t(e circulation o' blood t(roug( t(e vessels becomes di''icult0 'orcing t(e blood t(roug( narro,er passage,aysAs a result0 blood pressure becomes elevated) Arteriosclerosis occurs ,(en lipids in t(e blood0 including c(olesterol0 accumulate inside t(e ,alls o' blood vessels and reduce t(e si?e o' t(e veins or arteries t(roug( ,(ic( blood 'lo,sATHEROSCLEROSIS Thickening ) A degenerative condition o' t(e arteries c(aracteri?ed /* t2i+,enin- %ue to lo+ali6e% a++u&ulation o1 1ats7 &ainl* +2olesterol- 3(e term at(erosclerosis re'ers to a condition in ,(ic( 'atty deposits build up in and on t(e artery ,alls0 inter'ering ,it( t(e normal 'lo, o' blood and oxygen t(roug(out t(e body- I(en t(is (appens0 t(e (eart (as to ,or$ (arder to pump blood t(roug( t(e narro,ed blood vessels0 and a (eart attac$ or a stro$e may result-

Pre%is'osin- 1a+tors0 cigarette smo$ing (ig( 'at levels in t(e blood (ig( c(olesterol (ig( blood pressure obesity Si-ns an% s*&'to&s0 3(e symptoms o' at(erosclerosis depend on t(e part o' t(e body ,(ere t(e condition is ta$ing place*ometimes t(ere arenQt any noticeable symptoms until t(e condition (as advanced to a very serious stageI(en t(e arteries o' t(e (eart are a''ected0 one o' t(e 'irst symptoms is c(est pain0 o'ten called angina- A person ,it( clogged arteries o' t(e (eart may also (ave occasional di''iculty in breat(ing and may experience unusual 'atigue a'ter s(ort periods o' exertion-

abcd-

e.
abcde-

Me%i+al 8 Sur-i+al Inter.entions 1or At2ero an% Arterios+lerosis0 &i'estyle odi'ication 2 Reduce Ris$ Factors Coronary Artery %ypass "ra't .CA%" Percutaneous 3ransluminal Coronary Angioplasty .P3CA/ Directional Coronary At(erectomy .DCA/ 7ntracoronary *tents Nursin- Inter.ention0 Healt( 3eac(ing Reduce Ris$ Factors Restore %lood *upply Pre & Post)op Care 'or *urgical Patients AORTIC ANEURYSM 3ypes o' Aneurysm: 3(oracic or Abdominal Aortic Aneurysm Ris$ Factors: Presence o' At(erosclerosis0 7n'ections or a Congenital abnormality *igns & *ymptoms: 3(oracic Aortic Aneurysm Dyspnea Dysp(agia voice (oarseness 3reatment: 3(oracic@c(est pain coug( Abdominal Aortic Aneurysm .AAA/ Abdominal Pain &o, bac$ pain Pulsating Abdominal

ass

*urgical Removal o' Aneurysm abPsyc(ological support onitor patient 'or signs o' rupture o' aneurysm

Nursing 7ntervention:

126

3riad o' mani'estations 'or ruptured abdominal aneurysm: 4- Abdominal pain 5- %ac$ or Flan$ pain .scrotal pain may also occur/ 9- *(oc$: %pO K4== systolic2 Pulse Rate K4==bpm c- Pre)operative preparation d- Post)operative care: monitor perip(eral circulation BUERGERS DISEASE a-$-a- 3(romboangitis Obliterans .3AO/ De1inition0 Ris, a+tors0 bcde#asculitis o' t(e veins and arteries in t(e upper & lo,er extremities Men -5=)9< y@o0 Heavy smo$ers0 (ypersensitivity to intradermal in1ections

Si-ns 8 S*&'to&s: a- pain in legs relieved by immobility0 numbness and tingling o' toes sensitivity to cold Iea$ or absent pulsations at t(e dorsalis pedis0 posterior tibial Reddis( or Cyanotic extremity ,(ic( may progress to ulceration or gangrene Treat&ent0 Calcium C(annel %loc$ers to promote vasodilation Rest0 Pain Relievers0 Avoid exposure to cold *urgery: Amputation o' extremity is delayed until conservative treatments 'ail to e''ectNursin- Inter.ention0 Healt( teac(ing on li'estyle modi'ications0 spec- smo$ing !nsure protection o' extremities against cold Administration o' medications as ordered Protect client 'rom in1ury Assessment o' extremities RAYNAUDS DISEASE De'inition: Ris$ Factors: Cause: *igns & *ymptoms: #asospasm o' arteries in t(e (ands .upper extremities only/ Wo&en7 (eavy smo$ers0 individuals spec- ,omen ,it( *ystemic &upus !ryt(ematosus .*&!/ or r(eumatoid art(ritis (ypersensitivity o' 'ingers to colds0 congenital vasospasm0 *erotonin release Cyanosis@pallor o' t(e 'ingers ,(en exposed to cold environment or emotional stimuli Numbness and occasional pain %ilateral or symmetrical involvement

3reatment: Ni'edipine to decrease vasospasm Avoid exposure to cold and $eep (ands ,arm Avoid smo$ing Nursing 7ntervention *ame as buerger;s disease

%-5-#!NOD* D7*ORD!R*:
THROMBOPHLEBITIS De'inition: Ris$ Factors: *igns & *ymptoms: Clot disorder in t(e vein usually at t(e lo,er extremity 3rauma o' t(e blood vessels0 stasis0 7ncreased coagulability !dema o' t(e extremity0 redness0 pain0 local induration0 .J/ Homan;s sign ) cal' pain upon dorsi'lexion o' 'oot

Nursing 7ntervention: a- Dse o' t(romboembolytic .3!D/ stoc$ings

127

b- !levate legs c- Heparin t(erapy0 as ordered d- %ed rest e- Iarm compress VARICOSE VEINS De'inition: Cause: Ris$ Factors: *igns & *ymptoms: 3reatment: Ac(ing Heaviness oderate s,elling !nlarged0 tortuous veins in t(e legs distention0 lengt(ening and totuosity o' veins loss o' valvular competence and constant elevation o' venous pressure most commonly in t(e veins o' t(e legsProlonged standing0 obesity0 pregnancy

*urgical

anagement: *clerot(erapy .in1ection o' sclerosing agent to t(e vein- Not a treatment0 (ence0 'or cosmetic purpose only/

Nursing 7ntervention !levate legs at least 9= mins- A'ter prolonged standing Iear t(romoembolic stoc$ings 3eac( client o avoid prolong sitting or standing Avoid cross)legs ,(ile sitting Post)op Care a'ter *clerot(erapy: a- aintain 'irm elastic pressure over t(e ,(ole limb b- Regular but care'ul exercise o' t(e legs to promote circulation + ambulate 'or s(ort periods 56)6C (rs post)op c- Assess'or complications suc( as bleeding0 in'ection0 nerve damage

7#-CARD7AC D7*ORD!R*
ANGINA PECTORIS Chest ain insu''icient coronary blood 'lo, inade>uate oxygen exc(ange in t(e (eart causing intermittent c(est pain can be relieved ,it( rest7t lasts only 'or 4)< minutes and ta$ing up o' nitroglycerine ,ill be bene'icial 'or t(e client-

Si-ns an% s*&'to&s0 Patient experiences retrosternal c(est discom'ort Pressing0 (eaviness0 s>uee?ing0 burning and c(o$ing sensationPain in t(e epigastrium0 bac$ nec$ 1a, or in t(e s(ouldersRadiation o' pain in t(e arms0 s(oulders and t(e nec$-

Pre+i'itatin- 1a+tor0 over exertion eating exposure to cold emotional stress Classi'ication o' *ymptoms: Class I + no limitations o' p(ysical activity .ordinary p(ysical activity does not cause symptoms/Class II + slig(t limitation o' p(ysical activity .ordinary p(ysical activity does cause symptoms/Class III + moderate limitation o' activity .patient is com'ortable at rest0 but less t(an ordinary activity can cause symptoms/Class IV + unable to per'orm any p(ysical activity ,it(out discom'ort0 t(ere'ore severe limitations .patient may be symptomatic even at rest/-

128

Nursin- Inter.entions0 a. Assess pain + location0 c(aracter0 !C" .*3 elevation/0 precipitating 'actors bcHelp client to ad1ust li'estyle to prevemt angina attac$ + avoid excessive activity in cold ,eat(er0 avoid overeating0 avoid constipation0 rest a'ter meals0 exercise

3eac( patient (o, to cope ,it( angina attac$ + nitroglycerin every < mins upto 9x0 i' still not relieved go to t(e (ospital Dia-nosti+ Assess&ent0 a- !C" b- *tress 3est c- Radioisotope 7maging d- Coronary Angiograp(y Me%i+al Mana-e&ent0 abcOpiate Analgesic + o*o6 #asidilators + Nitroglygcerin0 7sosorbide ononitrate@Dinitrate Calcium C(annel %loc$ers + Dlitia?em0 Ni'edipine %eta %loc$ing Agents +Propanolol MYOCARDIAL INFARCTION

d.

Destruction o' myocardial tissue due to reduced coronary blood 'lo,3(e rapid development o' myocardial necrosis caused by imbalance bet,een t(e oxygen supply and demand o' t(e myocardiumResults 'rom pla>ue rupture ,it( t(rombus 'ormation in a coronaryvessel0 resulting in an acute reduction o' blood supply to a portion o' t(e myocardium-

Causes0 4- At(erosclerotic (eart 5- Coronary Artery !mbolism Si-ns an% s*&'to&s0 4- c(est pain + (eavy .viseli$e0 crus(ing0 s>uee?ing/ usually across t(e anterior pericardium typically is described as tig(tness0 pressure0 or s>uee?ing-

Pain may radiate to t(e 1a,0 nec$0 arms0 bac$0 and epigastrium- 3(e le't arm is
a''ected more 're>uently2 (o,ever0 a patient may experience pain in bot( arms-

2. 3. 4.
<-

Dyspnea0 Ort(opnea + sense o' su''ocation Nausea and@or abdominal pain) gas pains around t(e (eart Anxiety0 Appre(ension &ig(t (eadedness ,it( or ,it(out syncope Coug( 0 I(ee?ing Nausea ,it( or ,it(out vomiting Cold diap(oresis0 gray 'acial color0 Iea$ness and altered mental status + common in elderly patients-

6.
H-

8.
E-

10. Rales + may be present in congestive (eart 'ailure11. Nec$ vein distention + represents rig(t pump 'ailure45- Dysryt(mias ) an irregular (eart beat or pulse0 usually tac(ycardic49- Oliguria + urine less t(an 9= ml@(r Ris, 1a+tors0

129

 Age 0 ale gender0 *mo$ing0 D 0 Family (istory0 *edentary li'estyle0 obesity0 diet0 stress0 (ypertension0 3ype A personality DIAGNOSTICS0 La/ stu%ies0

Creatine $inase+ % .CG) %/ yoglobin C%C 0 3rponin Potassium and magnesium level Creatinine level C + Reactive protein .CRP/ !ryt(rocyte sedimentation rate .!*R/ *erum lactate de(ydrogenase .&DH/

I&a-in- stu%ies0 C(est radiograp(y or c(est x)ray + reveals pulmonary edema secondary to (eart 'ailureC3 scan Radionuclide 7maging Positron !mission 7maging 3ransesop(ageal !c(ocardiograp(y agnetic resonance imaging . R7/ ) can identi'y ,all t(inning0 scar0 delayed en(ancement .in'arction/0 and ,all motion abnormalities .isc(emia/!lectrocardiogram .!C"/ ) *3)segment elevation greater t(an 4 mm- t(e presence o' ne, : ,avesintermediate probability o' 7 are *3)segment depression0 3),ave inversion0 and ot(er nonspeci'ic *3)3 ,ave abnormalitiesI&&e%iate e&er-en+* inter.ention0

7# access + t(rombolytic agents e-g- (eparin supplemental oxygen pulse oximetry + maintain oxygen saturation at KE=R 7mmediate administration o' aspirin en route Nitroglycerin 'or active c(est pain0 given sublingually or by spray !C"

Treat&ent is ai&e% at0 Restoration o' balance bet,een oxygen supply and demand to prevent 'urt(er isc(emiaC(est Pain relie' Prevention and treatment o' complicationsDru- o1 +2oi+e 1or 'atient 4it2 MI0 Antit(rombotic agents ) prevent t(e 'ormation o' t(rombus and in(ibit platelet 'unction.as irin! "he arin# #asodilators ) Opposes coronary artery spasm0 ,(ic( augments coronary blood 'lo, and reduces cardiac ,or$ by decreasing preload and a'terload ) can be administered sublingually by tablet or spray0 topically0 or 7#$nitroglycerine# %eta)adrenergic bloc$ers ) reduce blood pressure0 ,(ic( decreases myocardial oxygen demand- .meto rolol# Platelet aggregation in(ibitors + in(ibits platelet aggregation clo idogrel $ la%i&# Analgesics + reduce pain ,(ic( decreases sympat(etic stress .mor hine sulfate#

130

Angiotensin converting en?yme .AC!/ in(ibitors + prevents conversion o' angiotensin 7 to angiotensin 770 a potent vasoconstrictor- )ca to ril$ca oten# Co&'li+ations o1 MI0 Dysr(ytmias Cardiogenic *(oc$ Heart Failure Pulmonary !dema Pulmonary !mbolism Recurrent 7 Complications due to Necrosis + #*D0 rupture o' t(e (eart0 ruptured papillary muscles Pericarditis Re+o&&en%ations0 - All 7 patients s(ould be admitted in t(e 7CDPatient s(ould remain on complete bed rest during (is stay in t(e (ospital and avoid straining activitiesNursin- inter.entions 1or MI 4abcde'!arly 3reat arryt(mias promptly + lidocaine "ive analgesic) morp(ine Provide p(ysical rest Administer O5 via cannula Fre>uent #* Ni'edipine Propanolol HC& !motional *upport &ater

g.
(5abcde-

"ive stool so'tener Provide lo, 'at0 lo, c(olesterol0 lo, sodium diet0 so't 'ood Commode *el')care Plan 'or re(abilitation !xercise program *tress management 3eac( ris$ 'actors 'Psyc(ological support g&ong)term drug t(erapy Antiarry(tmics) >uinidine0 lidocaine Anticoagualnt + (eparin0 aspirin Anti(ypertensives + propanolol0 c(lorat(ia?ide

TRANSIENT ISCHEMIC ATTACK (TIA) temporary episode o' neurological dys'unction lasting only a 'e, minutes or seconds .in a day@ 56(rs/ due to decreased blood 'lo, to t(e brainA ,arning sign o' stro$e especially in 'irst 6 ,ee$s a'ter 37A Causes: 4- At(erosclerosis 5icroemboli 'rom at(erosclerotic pla>ue ani'estations: 4- *udden loss o' visual 'unction 5- *udden loss o' sensory 'unction 9- *udden loss o' motor 'unction anagement: ) *urgical Carotid !ndarterectomy .bypass/ 4Post)op 'ocus + assess neurologic de'icits2 avoid 'lexing nec$ 7nability to s,allo,0 move tongue0 raise arm0 smile may indicate problem in t(e speci'ic cranial nerveAnticoagulant t(erapy: aspirin0 etcCONGESTIVE HEART FAILURE (CHF) De'inition: inability o' t(e (eart to meet oxygen and metabolic needs o' t(e body

5-

131

Causes: 4- Abnormal loading conditions ) Congenital de'ects0 ventricular @ atrial septal de'ect0 Patent Ductus Arteriosus0 #alvular stenosis0 HPN0 Hig( Perip(eral #ascular Resistance

2. 3.

Abnormal muscle 'unction ) yocardial 7n'arction0 myocarditis0 cardiomyopat(y0 ventricular aneurysm Diseases t(at exacerbate or precipitate (eart 'ailure + *tress0 dysr(yt(mia0 in'ection0 anemia0 t(yroid disorders0 pregnancy0 nutritional de'iciency0 pulmonary disease0 (ypervolemia

&e't #entricular Failure *igns & *ymptoms Causes Pulmonary Congestion: apnea byne;s *tro$e Dys C(e

Rig(t #entricular Perip(eral edema #enous congestion o' organs Hepatomegaly Cyanosis o' t(e nail beds assive s,elling o' t(e legs0 genitals and trun$ .Anasarca/ '- Anxiety0 'ear and depression '-

Cou g(0 Rales0 ,(ee?ing dOrt( opnea ePar oxysmal Nocturnal Dyspnea 'Pul monary !dema gCer ebral (ypoxia (Fati gue &muscular ,ea$ness i- Renal C(anges0 Nocturia

c.

anagement: Positioning + Hig( 'o,ler;s position to reduce pulmonary congestion O5 Administration P(armacology: Digitalis0 Dopamine & Dobutamine0 AC! in(ibitors Digitalis: increases ventricular contractility 7ncreases ventricular emptying 7ncrease Cardiac output Iatc( out 'or Digitalis toxicity Si-ns o1 Di-italis To9i+it*0 a- !yes: b- "astrointestinal 3ract: c- Cardiovascular: d- Central Nervous *ystem: Halo around lig(ts Diarr(ea0 anorexia0 vomiting0 abdominal cramps %radycardia0 're>uent P#C;s Headac(e 0 Fatigue0 &et(argy

Nursing 7ntervention: 4- *odium restriction 5- Reduce pain and anxiety 3. 7mprove oxygenation: proper positioning0 O5

4.

Reduce congestion and edema: meds0 positioning

132

VALVULAR STENOSIS De'inition: *igns & *ymptoms: 3reatment: Narro,ing o' valve ,(ic( prevents blood 'lo, or impaired closure o' t(e valves causing regurgitation urmurs0 decreased cardiac output0 (eart 'ailure Heart valve replacement0 mitral commisurotomy P(armacology: Anti)coagulant) Coumadin anagement: lo, sodium0 lo, c(olesterol diet *tenosed

Nursing 7ntervention: same as CHF

AV HEART BLOCK De'inition: D !" Altered transmission o' impulse 'rom *A node t(roug( A# node #$ B%#&' D s&"()t(#* delayed transmission o' impulse to A# node not all impulses pass t(roug( A# node No impulse pass t(roug( A# node PACEMAKERS De'inition: 3ypes: !lectronic device .battery) operated/ t(at produce electrical stimuli to t(e (eart and controls (eart rate a- 3emporary Pacema$ers ) +t "*al0 device can be (eld in a beltT" atm *t None

First)degree A# %loc$

*econd)degree A# %loc$

Atrop(ine 7soproterenol #entricular Pacema$er

3(ird)degree A# %loc$

) used 'or emergency purposes0 temporary pacing ) inserted trans t(oracic0 transvenous0 transesop(ageal0 transcutaneous0 transesop(ageal b- Permanent Pacema$ers , (*t "*a%0 device0 sutured ,it(in t(e subcutaneous tissueNursing 7ntervention: abcdC(ec$ 'or signs o' in'ection on t(e site: 'ever0 (eat0 pain0 s$in brea$do,n Avoid (ig()energy radar0 television0 micro,ave: i' di??iness or tac(ycardia occur0 as$ patient to move 6)8 'eet a,ay 'rom sourceRemind to ,ear 7D)in'ormation bracelet at all times esp- ,(en traveling Care o' *ite: K ,ear loose)'itting around pace)ma$er K !ncourage bat( tubs rat(er t(an s(o,er to protect incision site 'or t(e 'irst 4= days K !xplain t(at (ealing ta$es place ,it(in 9 mont(s

133

))) !xternal Pacema$er 7nternal Pacema$er .sutured subcutaneously/ Appearance o' a person ,@ internal pacema$er

-------------------------------------------------------------------------------------------------------------------------------------------------------------Co&'arison o1 C2est Pain An-ina Pe+toris M*o+ar%ial In1ar+tion *udden0 severe0 crus(ing0 (eavy0 tig(tness *ubsternal0 radiates to one or bot( arms0 1a,0 nec$ K9= minsOxygen0 narcotics0 not relieved by rest & nitroglycerin

3ype &ocation

s>uee?ing0 pressing0 burning Retrosternal0 substernal0 le't o' sternum0 radiates to t(e le't arm Dsually 9)< mins duration S9= mins rest0 nitroglycerin

Duration Relie'

Co&'arison o1 ot2er si-ns 8 s*&'to&s An-ina Pe+toris M*o+ar%ial In1ar+tion Transient Is+2e&i+ Atta+,

134

*ub1ective Data: Dyspnea Palpitation Di??iness Faintness

*ub1ective Data: *(ortness o' breat( Appre(ens ion0 'ear o' impending deat( Nausea Ob1ective Data: *ymptoms o' s(oc$ Cyanosis0 diap(oresis

*udden loss o': #isual 'xn *ensory 'xn otor 'xn

Ob1ective Data: 3ac(ycardia Pallor Diap(oresis

Restless

Ob1ective Data: &oss o' 'unctioning about and returns normal

'or to

Nursin- Care Mana-e&ent A"t "(#s&% "#s(s A*!(*a P &t#"(s T"a*s( *t Is&h m(& Atta&'

!. (.

Li1est*le Mo%i1i+ation Diet0 stress mgt0 (abits Restore /loo% su''l* Anti)embolic stoc$ings0 anti)coagulants Pre 8 'ost-o' +are CA%"0P3CA0 *tents Healt2 tea+2inodi'ications0 diet0etc-

1.

). :.

Pro.i%e relie1 1ro& 'ain0 Rest Nitroglycerin &i'estyle modi'ication #ital signs Assist ,@ ambulation Pro.i%e e&otional su''ort Healt2 tea+2inPain di''erentiation edication Dx test Diet0 exercise0 CA%"

45-

Assess neurologic status Administer meds

(. ).

Nursin- Care Mana-e&ent M*o+ar%ial In1ar+tion

1.

Re%u+e 'ain 8 %is+o&1ort: Narcotics0 O50 *emi)'o,ler;s position to improve ventilation battery) operated 2. Maintain a%e5uate +ir+ulationonitor #*0 Drine Output & !C" eds: Anti)arryt(mics & anticoagulants C(ec$ 'or edema0 cyanosis0 dyspnea0 coug(0 crac$les C#P: normalO <)4<cm H5= RO 0 anti)embolic stoc$ings ). De+rease o9*-en %e&an%3 Pro&ote o9*-enation O50 %edrest .56)6C (rs/0 rest periods *emi)'o,ler;s position Anticipate needs o' client: call lig(t0 ,ater eds: vasodilators0 vasopressors0 Cal-C-%loc$ers

:.

Maintain 1lui% 8 ele+trol*te /alan+e 3 Nutrition Geep 7# open2 C#P0 #*0 DO &ab data: NaJ49<)46<2 G 9-<)<-= m!>@& !C" Diet: lo, calorie0 lo, sodium0 lo, c(olesterol0 lo, 'at a+ilitate 1e+al eli&ination stool so'tener0 avoid #alsalva0 mout( breat(ing0 bedside commode Pro.i%e e&otional su''ort Pro&ote se9ual 1un+tionindiscuss concerns include partner resume <)C ,$s a'ter uncomplicated

5.

;. <.

=. Healt2 tea+2in-

(. Glan%

DISTUR"ANCES IN META"OLIC 8 ENDOCRINE UNCTIONING Hor&one un+tions

135

Pituitary "land Anterior &obe

"ro,t( Hormone Prolactin 3(yrotropic (ormone .3*H/ "onadotropic (ormones .&H & F*H/ Adrenocorticotropic (ormone .AC3H/ elanocyte)stimulating Hormone . *H/ Anti)diuretic (ormones .ADH0 vasopressin/ Oxytocin

*timulates gro,t( o' body tissues and bones *timulates mammary tissue gro,t( & lactation *timulates t(yroid gland A''ect gro,t(0 maturity and 'unctioning o' primary and secondary sex organs *timulates steroid production by adrenal cortex ay stimulate adrenal cortex2 may a''ect pigmentation

Posterior lobe

Promotes reabsorption o' ,ater by t(e distal tubules and collecting ducts o' t(e $idney0 t(us decreasing urine output *timulates e1ection o' mil$ 'rom mammary alveoli into t(e ducts: stimulates uterine contractions may possibly be involved in t(e transport o' sperm in t(e reproductive tract o' t(e 'emale 7ncreases metabolic activity o' almost all cells2 stimulates most aspects o' 'at0 protein and carbo(ydrate metabolism &o,ers serum calcium levels and elevates p(osp(ate level2 opposite e''ect 'rom t(at o' P3H 7ncreases calcium levels and decreases p(osp(ate levels2 increases resorption o' bones Promotes carbo(ydrate0 protein and 'at catabolism0 increases tissue responsiveness to ot(er (ormones 3ends to increase sodium retention and potassium excretion "overns certain secondary sex c(aracteristics2 all corticoids are important 'or de'ense against stress or in1ury !levates blood pressure0 converts glycogen to glucose ,(en needed by muscles 'or energy2 increases (eart rate2 increases cardiac contractility2 dilates bronc(ioles *timulate development o' secondary sex c(aracteristics0 e''ect repair o' t(e endometrium a'ter menstruation !ssential 'or normal 'unctioning o' male reproductive organs2 stimulates development o' secondary sex c(aracteristics Promotes metabolism o' carbo(ydrates0 protein and 'at t(us decreasing blood glucose obili?es glycogen stores0 t(us raising blood glucose levels Decreases secretion o' insulin0 glucagons0 gro,t( (ormone and several gastrointestinal (ormones. gastrin0 secretin/

3(yroid "land

3(yroxine .36/ 3riiodot(yronine .39/ 3(ryrocalcitonin

Parat(yroid Adrenal Cortex Controls SSS: *D"AR0 *A&30 *!N

Parat(ormone .P3H/ "lucocorticoids .primarily cortisol/ )) *ugar ineralcorticoids .Aldosterone/ )) *alt Androgens .male (ormones/ )) *ex

edulla

!pinep(rine .Adrenalin/)C=R Norepinep(rine) 5=R

Ovaries

!strogens and progesterone

3estes

3estosterone

Pancreas 7slets o' &anger(ans

7nsulin "lucagon *omatostatin

PITUITARY GLAND PROBLEMS

136

Clini+al Mani1estations A+ro&e-al* "ro,t( Hormone 7N ADD&3* 4- !nlarged extremities 5- Protrusion o' 1a, and orbit 9- No increase in (eig(t and ,eig(t but (ands and 'eet become bigger 6- 7ncreased perspiration <- #isual problems 8- Hyperglycemia@calcemia

Mana-e&ent 4- 7rradiation o' pituitary ,it( "ro&o+ri'tine to decrease secretion o' gro,t( (ormone 5- *urgery: Hypop(ysectomy)removal o' t(e pituitary gland 9- Post)op Care: a- Assess 7CP b- !levate (ead o' bed .HO%/ 9= degrees c- Avoid coug(ing0 snee?ing0 blo,ing nose

Gi-antis& Overgro,t( o' all body tissues and bones "ro,t( Hormone
7n CH7&DR!N

D4ar1is& "ro,t( Hormone 7n CH7&DR!N

4- Retarded p(ysical gro,t( 5- Premature body aging 9- *lo, intellectual development

4- Removal o' cause : tumor 5- Human "ro,t( Hormone 7n1ection 9- *ame as acromegaly & gigantism

Dia/etes Insi'i%us Anti) diuretic Hormone

4- Polyuria 5- Polydipsia 9- De(yration

4- P(armacology: a- Desmopressin Acetate nasal spray b- #asopressin 3annate + 7 in1ections c- Hypressin Nasal *pray 5- Nursing 7nterventions2 a- aintain ade>uate 'luids b- *odium Restriction c- 7nta$e & Output monitoring d- 3eac( sel')in1ection tec(ni>ues e- Daily ,eig(ts '- *peci'ic gravity

SIADH > S*n%ro&e o1 Ina''ro'riate se+retion o1 ADH

4- Hyponatremia 5- ental con'usion 9- Personality c(anges 6- &et(argy0 ,ea$ness0 (eadac(e <- Ieig(t gain 8- Abdominal cramping H- Anorexia0 nausea0 vomiting

4- Fluid restriction 5- 3reat underlying causes 9- P(arma: a- Demeclocycline administration as ordered b- &it(ium Carbonate c- %utorp(anol 3atrate

ADRENAL GLAND PROBLEMS

137

Clini+al Mani1estations A%%ison?s Disease 4- alaise and general ,ea$ness 5- Hypotension0 (ypovolemia 9- 7ncreased pigmentation o' s$in 6- Anorexia0 nausea0 vomiting <- !lectrolyte 7mbalance 8- Ieig(t loss H- &oss o' libido C- Hypoglycemia .8=)H=/ E- Personality C(anges

Mana-e&ent 4- P(armacology: *teroids .Prednisone0 dexamet(asone/ 5- Diet: (ig( CHO0 CHON diet 9- Observe side e''ects o' (ormone replacement + Cus(ingoid Appearance 6- onitor 'luid & electrolyte <- 3eac( importance o' li'elong medications 6- IOF *igns o' Addisonian Crisis: Addisonian Crisis' *udden pro'ound ,ea$ness *evere abdominal0 bac$ and leg pain Hyperpyrexia 'ollo,ed by (ypot(ermia Perip(eral vascular collapse *(oc$ Renal *(utdo,n )K Deat(

"lucocorticoids ineralcorticoids *ex Hormones

Cus2in-?s S*n%ro&e

"lucocorticoids

4596<8HCE4=-

3(in scalp oon Face Acne 7ncreased body (air %u''alo (ump Obesity Hyperpigmentation 3(in extremities !asy %ruising ood s,ings0 male c(aracteristics appear in ,omen 44- Hypo$alemia0 Hyperglycemia0 HPN 45- Amenorr(ea 49- Osteoporosis

4- *urgical gt: Adrenalectomy 5- C(emot(erapy: "ro&o+ri'tine 9- Diet: (ig( CHON0 lo, CHO0 lo, Na diet 0 potassium supplement 6- Nursing gt: K protect 'rom in'ection K protect 'rom accidents K (ealt( teac(ing on sel')medication

*3!RO7D*: Purpose: Anti)in'lammatory and anti)allergy2 *tress 3olerance edication: a. 3a$e at t(e same time everyday b- Follo, regime and do not stop abruptly c- Causes gastric upset *ide e''ects: Cus(ingoid Appearance Conn?s S*n%ro&e 3 Al%osteronis& 4- HPN 5- Hypo$alemia 4- *urgery: Removal o' tumor 5- Potassium replacement 9- 3reatment o' (ypertension 6- Nursing gt: onitor %P0 administer meds0 provide >uiet environment

ineralcorticoids .Aldosterone/

P2eo+2ro&o+*to&a

!pinep(rine@ Norepinep(rine

4- HPN 5- 7ncrease Perspiration 9-Appre(ension 6-Palpitations <- Nausea0 #omiting0 Headac(e 8- 3ac(ycardia H- Hyperglycema

4- *urgical gt: Removal o tumor 5- edical anagement: *ymptomatic .3reat symptoms as it occurs/ 9- Nursing gt: K Hig( caloric diet K Ade>uate Rest

THYROID GLAND PROBLEMS

138

Clini+al Mani1estations Gra.e?s Disease 3 H*'ert2*roi%is&3 T2*roto9i+osis 4- !xopt(almos) protrusion o' eyes 5- !nlargement o' t(e t(yroid gland 9- 7ncrease metabolism: ,eig(t loss0 diarr(ea0 diap(oresis 6- Personality c(anges <- Cardiac Arryt(mias 8- !asy 'atigability H- uscle ,ea$ness C- HPN E- Anxiety0 7nsomnia

Mana-e&ent 4- *urgery: 3(yroidectomy 5- Drug 3(erapy: a- et(ima?ole b- Propyl) 3(yracil c- 7odides: &ugol;s solution + strains teet(0 drin$ ,@ stra, *aturated *olution o' Potassium 7odide .**G7/ d- Propanolol 9- Radioiodine t(erapy 6- Nursing gt: a- Ade>uate Rest b- Hig( caloric0 (ig( protein0 carbo(ydrate0 vitamins ,it(out stimulants c- easure daily ,eig(ts d- !ye protection 'or xopt(almos e- IOF: 3(yroid *torm

390 360 3(yrocalcitonin

TH$ROID STORM0 a- Fever b- 3ac(ycardia c- Delirium d- 7rritability

Cretinis&
390 360 3(yrocalcitonin IN ANTS

4- P(ysical & mental retardation 5- *ensitive to cold 9- Dry s$in 6- Poor appetite and constipated 3reatment: Hormone Replacement

M*9e%e&a
390 360 3(yrocalcitonin ADULT

4- anorexia and constipation 5- intolerance to cold 9- *lo, metabolism: decreased s,eating0 edema 6- Dry s$in <- !nlarged t(yroid

4- Drug 3(erapy: a- &evot(yroxine b- 3(yroid Replacement .Desiccated t(yroid/ TT ta$en in empty stomac( TT (eart rate less t(an 4== bpm )o$

PARATHYROID GLAND PROBLEMS Clini+al Mani1estations H*'o'arat2*roi%

Parat(ormone

Mana-e&ent 4- Drug t(erapy: &evot(yroxine0 &iot(yronine *odium 5- Avoid stimulus

%radycardia 0 !asy bruising Fluid retention0 Constipation Dry0 coarse s$in0 Fatigue0 let(argy Decreased libido0 enorr(agia0 irregular menses

139

H*'ert2*roi%

Parat(ormone

3ac(ycardia Palpitations 7ncreased persitalsis ,eig(t loss Heat intolerance Decreased libido Amenorr(ea

4- Drug t(erapy: Prop(ylt(iuracil et(ima?ole0 *aturated solution o' Potassium 7odide0 Radioactive 7odine 5- Diet: lo, calcium0 (ig( 'iber 9- Force 'luid

PANCREATIC PROBLEMS DIABETES MELLITUS

T*'e I Insulin De'en%ent DM @IDDMA Ot(er Name Age o' Onset %e'ore 9= years old but may occur at any age Onset Abrupt 7ncidence 4=R 7nsulin production &ittle or none 7nsulin 7n1ections Re>uired Getosis ay occur %ody ,eig(t at onset 7deal body ,eig(t or t(in anagement Diet0 exercise and insulin Fuvenile D

T*'e II Non-Insulin De'en%ent DM @NIDDMA Adult D K9< y@o but can occur in c(ildren 7nsidious C<)E=R %elo, normal Normal or Above normal Necessary 'or only 5=)9=R o' clients Dnli$ely to occur Dsually Obese Diet0 exercise0 (ypoglycemic agent or insulin

Car%inal Si-ns 8 S*&'to&s: 1. Polydipsia

) excessive t(irst ) 're>uent urination

2. 3.
6Treat&ent0 !. Oral 2*'o-l*+e&i+s0 a- "lipi?ide b- "lyburide c- 3olbutamide d- 3ola?amide e- Aceto(examide '- C(lorpropamide

Polyuria

Polyp(agia ) excessive (unger Ieig(t &oss ) 'or 7DD

*ide e''ects: a- Hypoglycemia b- *$in ras(es c- "7 disturbances d- Flus(ing e- Nausea0 vomiting Administration: K usually administered 9= mins- be'ore meals to promote 'aster absorption o' t(e meds

140

(. Insulin InBe+tions0 Action Appearance) Preparation Onset o1 E11e+t *(ort)Acting Clear Cloudy 7ntermediate Acting &ong)Acting Cloudy Cloudy Cloudy Cloudy Pre) ixed ) Regular 7nsulin ) *emilente ) NPH ) &ente ) Protamine ?inc ) Dltralente 9= mins- + 4 (r9= mins- + 4 (r4 + 5 (rs4 + 9 (rs6 + 8 (rs6 + 8 (rs9= minsPea, 5 + 6 (rs5 + C (rs8 + 45 (rs8 + 45 (rs4C + 56 (rs46 + 56 (rs5 )45 (rsDuration o1 E11e+t 8 + C (rsC + 48 (rs 4C )58 (rs4C )58 (rs5C + 98 (rs98 (rs4C) 56 (rs-

Cloudy ) H=R NPH ) 9=R regular

Complications o' D : a. H*'o-l*+e&ia Cause: *igns & *ymptoms: Nursing 7nterventions: Hunger0 less dietary inta$e0 excessive insulin Diap(oresis0 3ac(ycardia0 tremors0 ,ea$ness0 irritability0 con'usion "ive candy0 1uice or so'tdrin$s0 let t(e patient eat C(ec$ sugar level

/.

Dia/eti+ Cetoa+i%osis Cause: *igns & *ymptoms: &ac$ o' insulin 0 7n'ection0 *tress Polyuria0 t(irst0 Nausea0 vomiting0 dry mucous membranes0 Gussmaul resp0 Coma0 sun$en eyesballs0 acetone odor o' breat(0 (ypotension0 abdominal rigidity "ive regular insulin

Nursing 7nterventions: +. Li'o%*stro'2* Cause: *igns & *ymptoms: Nursing 7nterventions: %.

7ndurated areas on s$in due to in1ections *$in indurations 3eac( client to rotate sites o' in1ection

H*'er-l*+e&i+ H*'eros&olar Non,etoti+ Co&a @HHNCA Cause: *igns & *ymptoms: !xtremely (ig( glucose0 no $etosis Polyp(agia0 polydipsia0 polyuria0 glucosuria0 de(ydration0 abdominal discom'ort0 (yperpyrexia0 (yperventilation0 c(anges in sensorium0 coma0 (ypotension0 s(oc$ Fluid & electroluyte replacement0 7nsulin

Nursing 7nterventions:

141

:.

DISTUR"ANCES IN ELIMINATION -./. I*$%ammat#"0 a*1 N #)%ast(& D(s#"1 "s a- Acute "astritis b- C(ronic "astritis c- Duodenal Dlcer d- "astric Dlcer e- "astric Cancer A+ute Gastritis C2roni+ Gastritis o *ame in Acute "astritis Treat&ent edical anagement: a- Antacids b- *mall 're>uent meals c- %land diet d- ay prescribe antic(olinergics in c(ronic gastritis Nursing 7nterventions@ Healt( 3eac(ing: )Avoid spicy 'oods )Avoid alco(ol inta$e )Fre>uent small meals

In+i%en+e0

o Common in age <=)8= years

old o Fre>uent in male t(an 'emale o "reater incidents in (eavy drin$ers and smo$ers

Cause0

Helicobacter Pylori edicines: Aspirin0 N*A7D*0 c(emo drugs0 steroids Food: Alco(ol0 co''ee0 spicy 'oods

o History o' or presence o' peptic ulcer disease o Previous gastric surgery o *ame as acute gastritis

Prolonged o ay be asymptomatic o Ot(er symptoms include: o Dyspepsia0 belc(ing0 vague epigastric pain0 N@#0 intolerance to spicy or 'atty 'oods No increase in (ydroc(loric acid

Duration0 Clini+al Mani1estations0

*(ort !pigastric discom'ort0 Abdominal pain0 cramping0 severe nausea0 vomiting and sometimes (ematemesis 7ncreased (ydroc(loric acid-

A+i% 'ro%u+tion:

Duo%enal Ul+er O++urren+e0 o 5<)<= yrs- old o 3ype A personality .leaders0 executives/2 o Dsually in a ,ell) nouris(ed individual

Gastri+ Ul+er Nursin- Inter.ention: K <= yrs- old a- Relaxation tec(ni>ues

ost common in persons li$e 'armers0 construction ,or$ers o Dsually a''ects malnouris(ed individuals !xcessive smo$ing0 salicylates inta$e Normal to (yposecretion &esser curvature o !xperienced U to 4 (our a'ter meal o 7ngestion o' FOOD DO!* NO3 R!&7!#! PA7N

b- !liminate ca''eine0 cigarette smo$ing0 alco(ol inta$e and spicy 'oods c- Hig( 'at0 (ig( carbo(ydrate Me%i+al Treat&ent0 Antacids ) avoid administration ,it(in 4)5 (r o' ot(er oral meds ) 're>uent administration + ac0 pc0 (s H5 Antagonists ) ,it( meals@pc Antic(olinergics Prostaglandin Analogs ) TTmisoprostolTT & AC7D PD P 7NH7%73OR* ) TTin(ibits t(e en?yme t(at produces gastric acid H Pylori + etronida?ole Omepra?ole 3etraycline@Clarit(romycin Cytoprotective + binds ,it(

Cause0 A+i% 'ro%u+tion0 Lo+ation o1 Ul+er Pain0

*tress0 Poor 'ood (abit Hypersecretion Pylorus o !xperienced 5)9 (rs a'ter meal o 7ngestion o' FOOD R!&7!#!* PA7N

142

"lee%in-

elena is more common t(an (ematemesis Not possible

diseased tissue and provides a protective barrier to acid Hematemesis is more common t(an melena Sur-i+al Treat&ent 4- #agotomy 5- "astric Resection) "astroduodenostomy2 "astro1e1unostomy

Mali-nan+*0

Possible

GASTRIC CANCER 7ncidence: 'g(i1Common in men t(an ,omen History or presence o' Pernicious Anemia O'ten develops ,it( t(e occurrence o' atrop(ic gastritis &o,)socio economic status2 live in urban area !xposure to radiation or trace metals in soil

Cause: Helicobacter Pylori Clinical ani'estations: a- Palpable mass b- Ascites c. Ieig(t loss d- Dysp(agia e. 7ndigestion and anorexia '- .J/ (ig( lactate de(ydrogenase level in gastric 1uice

Diagnosis: "73 x)ray0 gastroscopy 3reatment: C(emot(erapy0 radiation t(erapy0 gastric resection Nursing 7ntervention: *ame as ,it( patient;s ,it( ulcer0 emotional support0 pre and post)operative (ealt( teac(ing -.2. D(s#"1 "s #$ th La"! a*1 Sma%% B#3 % VIRAL AND "ACTERIAL GASTROENTERITIS3 D$SENTER$ "astroenteritis ) 7n'lammation o' stomac( and intestine usually t(e small bo,elS3S0 abdominal cramps0 diarr(ea0 vomiting0 'ever0 severe 'luid and electrolyte loss0 mild to severe temperature Cause: #iral Dysentery ) 7n'lammation in t(e colon S3S0 severe bloody diarr(ea and abdominal cramping0 severe 'luid and electrolyte loss0 mild to severe temperature Cause0 %acterial . !-coli nd@or s(igella0 salmonella0 Clostriduum di''icile 'rom antibiotics/ o o o o Ris$ Factors: Poor 'ood (andling Poor sanitary conditions Overcro,ding Food remaining on (ig( temperature ma$ing organisms incubate and coloni?e easily-

anagement: o Replace 'luid loss o Anti)in'ective Agent .e-gNursing 7ntervention: o easure inta$e and output o Administer medications o Replace 'luids

etronida?ole spec 'or amoebiasis0 %actrim/

APPENDICITIS o 7n'lammation o' t(e vermi'orm appendix 7ncidence: Common bet,een 5=)9= yrs- old

143

Cause:

Fecalit( .stone or calculus in t(e appendix/ Fibrous condition in t(e bo,el ,all

-)K Gin$ing o' t(e appendix )K %o,el ad(esion

*@*: Pain starts in t(e epigastriium t(e s(i'ts to t(e t(e rig(t lo,er >uadrant "uarding o' pain'ul area Geeps legs bent to relieve tension ay (ave vomiting0 loss o' apetite0 lo, grade 'ever0 coated tongue and (alitosis Diagnosis: 7ncreased I%C0 .J/ pain at 3reatment: Appendectomy Nursing intervention: Assess t(e #* and pain scale care'ully Observe 'or symptoms o' peritonitis 0 Pre & post)operative care PERITONITIS o o 7n'lammation o' t(e peritoneal membrane Cause: "angrenous c(olecystitis Ruptured gallbladder Per'orated gastric cancer Per'orated Peptic ulcer Ruptured spleen Acute pancreatitis Penetrating ,ound Dlcerative colitis "angrenous obstruction o' t(e bo,el Per'orated diverticulum o c %urney;s point .R&:/

7leitis Appendicitis ,it( per'oration Ruptured retroperitoneal abscess *trangulated (ernia *alpingitis *eptic Abortion Ruptured bladder Puerperal in'ection 7atrogenic Cause

*igns and *ymptoms: &ocali?ed pain Abdominal rigidity 7ncreased pain upon movement Nausea0 vomiting .N@#/ Absence o' bo,el sounds *(allo, respirations 7ncreased I%C 0 dilation and edema o' intestines revealed in "73 x)ray edical anagement: N"3: &avage to relieve pressure in t(e abdomen Fluid & electrolyte replacement *urgical 3reatment: Appendectomy or !xploration o' t(e abdomen ,it( drainage Nursing intervention: Care'ul assessment o' (istory0 #@*0 'luid & electrolytes Pre & Post)operative Care

o o

+. In1la&&ator* "o4el Disease0 ULCERATIVE COLITIS 8 CHRON?S DISEASE CHRON?S DISEASE Pat2olo-* 8 Anato&* 7nvolves primarily t(e ileum & rig(t colon Distribution o' d;se is segmental alignancy is rare ay be genetic Dsually in t(e 9=;s Remissions and relapses Course o1 Disease *lo,ly progressive Common ULCERATIVE COLITIS ucosal ulceration o' lo,er colon and rectum Distribution o' d;se is continuous alignancy may occur a'ter 4= years ay be caused by in'ection or alteration in immunity Loung adults .5=)6=/ Onset

Etiolo-*

144

Re+tal /lee%inAnore+tal 1istula Ot2er S3S0

Occasional Rare Common Abdominal pain Ieig(t loss Diarr(ea + so't or semi)li>uid Pain in R&:0 cramping0 tenderness0 'latulence0 nausea .mimics Appendicitis/ Replacement o' 'luid loss Anti)diarr(eal: Dip(enoxylate HC& .&omotil/ 2 &operamide HC& .7modium/ 3otal Parenteral Nutrition %o,el Resection0 7leostomy Rectal bleeding0 diarr(ea .5= stools@day or more/2 *tools may occur ,it( blood or pus0 ,eig(t loss Drgency0 cramping0 Pain &&:0 abdominal distention0 emotional stress*ame as C(ron;s D;se

Me%i+al Treat&ent

Sur-i+al Treat&ent Nursininter.entions0

%o,el Resection0 7leostomy Assess 7nta$e and output0 ,eig(t !motionla support Client teac(ing regarding surgery Post)op intervention: Observation o' t(e stoma 3eac( client re: sel')care *ame as C(ron;s D;se

HERNIA )An abnormal protrusion o' an organ or tissue t(roug( t(e structure t(at contains it) Fre>uently a congenital occurrence or ac>uired ,ea$ness o' t(e abdominal muscles 3ypes: 7ndirect 7nguinal Hernia 5- Direct 7nguinal Hernia 9- Femoral Hernia 6- Dmbilical Hernia <- 7ncisional Hernia edical 3reatment: Dse o' 3RD** i' (ernia is not strangulated or incarcerated*urgical 3reatment: Herniorr(ap(y

1.

Nursing 7ntervention: Pre & Post)operative Care Post"o Care: aa$e sure t(e client voids a'ter surgery0 urinary retention is common a'ter (erniorr(ap(y b- Resume diet as tolerated by t(e patient c- 7ce pac$ over t(e incisional site to control pain and s,elling d- 7nstruct patient to avoid (eavy li'ting 'rom 6)8 ,ee$s post surgery

DIVERTICULUM Diverticulum + an outpouc(ing o' intestinal mucosa t(roug( t(e muscular coat o' t(e large intestine .most commonly t(e sigmoid colon/ Diverticulosis + re'ers to t(e presence o' non)in'lamed out pouc(ing o' t(e intestine Diverticulitis + in'lammation o' a diverticulum 7ncidence: !tiology: K 6< yrs- old 2 ale & Female

&o,er 'iber diet ,(ic( causes bul$ in stools ,(ic( may cause intraluminal pressure in t(e bo,el causing diverticula C(ronic Constipation Anorexia &o, grade 'ever

Ris$ 'actors: *@*:

&e't :uadrant Pain 7ncreased 'latus

145

.J/ rectal mass on digital rectal examination edical 7ntervention: Hig()'iber diet and laxatives N"3 insertion to relieve pressure Control in'lammation t(roug( antibiotics and advise patient to: aAvoid activities t(at may increase abdominal pressure .bending0 li'ting0 etc/ b7nta$e o' 8)C glasses o' ,ater a day cReduce ,eig(t i' obese 7ndicated 'or t(ose ,(o developed complications as mani'ested by (emorr(age0 abscess0 per'oration and obstructiono Colon resection ,it( colostomy 7ndications Colosto&* o 7nvolves t(e large bo,el .colon/ o stool is semi)'ormed 7n'lammatory @ obstructive process o' t(e lo,er intestinal tract 3rauma Rectal or sigmoid cancer Diverticulum o C(ron;s Disease Dlcerative Colitis Nursing 7ntervention 4- !motional support 5- Psyc(ological *upport 9- Heat( !ducation regarding: a-surgery .ileostomy@colostomy/ b- *el')care

*urgical 7ntervention:

Ileosto&* o 7nvolves t(e small bo,el .ileum/ o stool is in li>uid 'orm

o o

d.

Hirs+2'run-?s Disease an% Me-a+olon Congenital absence o' parasympat(etic ganglion Clinical ani'estations: o N% 'ail to pass meconium 56 (rs a'ter birt( o Older c(ild + recurrent abdominal distention0 c(ronic constipation0 ribbon)li$e stool0 diarr(ea0 emesis ,@ bile stain 3reatment: a- Colostomy b- %o,el Resection c- Cleansing !nema Post)op Nursing 7ntervention2 a- 3eac( colostomy care) c(ec$ color o' stoma .s(ould be brig(t leg/ b- C(ec$ dressing conitor inta$e & output d- Avoid incision by $eeping diapers lo, e- 4=)44 yr- old c(ild can already ta$e care o' (is@(er o,n stoma-

e. He&orr2oi%s o Peri)anal varicosities ,(ic( is eit(er internal or external

3ypes: a- 7nternal + varicosities above t(e mucocutaneous border covered by t(e mucous membrane-

146

b- !xternal Hemorr(oids) + varicosities belo, t(e mucocutaneous border covered by t(e anal s$in7ncidence: Ris$ 'actors: *@*: %ot( male and 'emale aged 5=)<= y@oPregnancy0 CHF0 Prolonged sitting or standing0 portal (ypertension 7ncreased abdominal pressure0 constipation0 straining during bo,el ovement 7nternal + bleeding and renal prolapse0 bleeding and rectal itc(ing !xternal + enlarged mass at t(e anus

Present symptoms in bot( internal & external: %rig(t red .blood/ stain in stool or tissue0 Pain edical 7ntervention: a- 3reat constipation b- Relieve pain t(roug( (eat application @ *it(;s bat( *urgical 7ntervention: Hemorr(oidectomy0 *clerot(erap(y0 Rubber band ligation0 &aser *urgery0 cryosurgery

1. istula-in-ano 3iny0 tubular 'ibrous tract t(at extends into t(e anal canal ay develop 'rom trauma0 'issures or regional enteritis Fistulectomy is recommended--.-. A41#m(*a% T"a5ma :

a. b.
D.

%lunt 3rauma + in1ury li$e ve(icular accident Penetrating Abdominal 3rauma + stab ,ound

DISTUR"ANCES IN LUIDS AND ELECTROL$TES Fluid Content in t(e Human %ody : a- Iomen ) b- en ) c- 7n'ant ) d- !lderly ) !lectrolytes in t(e Human %ody: a- *odium .Na/ b- Potassium .G/ c- C(loride .Cl/ d- %icarbonate .HCO9 / <=)<<R o' body ,eig(t is ,ater 8=)H=R o' body ,eig(t is ,ater H<) C=R o' body ,eig(t is ,ater 6HR o' body ,eig(t is ,ater ) ) )
)

49<)46< m!>@& 9-< + <-< m!>@& C<)44< m!>@& 55)5E m!>@&

Functions o' t(e Fluid & !lectrolytes in t(e Human %ody: a- Regulates acid)base balance in t(e body baintains 'luid volume c- Regulates exc(ange o' ,ater bet,een 'luid compartments abcActions o' t(e Fluids & !lectrolytes Di''usion + 'luids move 'rom area o' (ig(er concentration to an area o' lo,er concentration Osmosis ) 'luids move 'rom an area o' lesser concentration to a (ig(er concentration Filtration + 'luids and substances moves 'rom (ig(er (ydrostatic pressure to lesser (ydrostatic pressure7ntravenous *olutions Dsed to correct imbalance: e. 7sotonic + =-E N**0 D<I '- Hypertonic + (as greater concentration o' solis substances t(an t(e 'luid substances e-g-3otal Parenteral Nutrition0 D<= g. Hypotonic + (as 'e,er solid and (as (ig(er 'luid content0 e-g- =-6< NaCl *ystem o' Fluid %alance in t(e body: a- Gidneys + responsible in controlling t(e balance o' 'luid & electrolytes b- &ungs) controls t(e Carbondioxide levels in t(e body and ,ater vapor c- *$in + means o' elimination o' 'luid in t(e body t(roug( perspiration d. !ndocrine +Controls (ormones ,(ic( regulates normal 'unctioning o' systems 7mbalances in Fluids & !lectrolytes lui% Volu&e E9+ess Cause 'luids exceeds t(e normal volume t(e body needs ) p(ysiologic or over (ydration as lui% Volu&e De1i+it 'luids and@or electrolytes are loss p(ysiologic or de(ydration

147

in 7# t(erapy 7llness: Renal Disease Neurologic Diseases Congestive Heart Failure Addison;s Disease Renal Disease Diarr(ea Post)operative conditions %urns 3rauma "73 *uction@Drainage Ieig(t loss Dry s$in and mucous embrane 3ac(ycardia .same ,@ excess/ Poor s$in turgor Decreased urine output Decreased Central #enous Pressure 7ncreased (ematocrit Drine output: S 9= cc@(r
. Normal Drine Output O9= cc@(r/

Clinical

ani'estations

Ieig(t gain !dema Flus(ed s$in 3ac(ycardia 7ncreased %P0 RR Rales Nec$ #ein distention 7ncreased Central #enous Pressure Decreased Hct Drine output: K 40<== ml@day onitor vital signs onitor 7 & O Fluid restriction &o, sodium diet Ieig(t daily Prevent s$in brea$do,n) s$in is 'ragile Geep client in *emi)'o,ler;s position to establis( good gas ex(ange Administer Diuretics as ordered) &asix .Furosemide/

Nursing 7nterventions

onitor vital signs onitor 7 & O Replace 'luids0 Re(ydration Ieig(t daily Administer medications as ordered . depending on electrolytes loss/ !ncourage proper nutrition an 'luid inta$e

*ources o' !lectrolytes: Ele+trol*te Potassium *odium agnesium Calcium oo% sour+e %ananas0 peac(es0 melon0 prunes0 raisins0 apricots0 tomato0 nuts & vegetables0 red meat0 tur$ey 7odi?ed or table *alt Peas0 beans0 nuts0 'ruits il$0 c(eese0 sardines0 'is(

4.1

Genitourinar* 8 Renal Pro/le&s Renal Function 3ests Normal #alues: a%lood Drea Nitrogen .%DN/ + 4=)5= mg@dl b*erum Creatinine) =)4 mg@d& cCreatinine Clearance + 4==)45= ml@ minute .56 (r- urine collection/ d*erum Dric Acid )9-< )H-C mg@d& eDrine Dric Acid + 5<=)H<= mg@ 56 (rs- .56 (r- urine collection/ 6-4-5- Cystitis @ Dret(ritis@ Drinary 3ract 7n'ection +usually caused by !-Coli *igns & *ymptoms a- Fre>uency & Drgency o' urination b- Dysuria c- *uprapubic pain d- Hematuria e- Fever0 c(ills '- Cloudy urine Nursing Considerations: a- Collect urine 'or testing b- Antibiotic treatment0 as ordered c- Force 'luids d- "ood (ygiene

4.1.3.

"lomerulonep(ritis + in'lammatory damage o' t(e glomeruli + usually *treptococcus

*igns & *ymptoms: Hematuria0 proteinuria0 'ever0 c(ills0 ,ea$ness0 nausea0 vomiting !dema Oliguria

148

HPN Headac(e 7ncreased Drea Nitrogen Flan$ Pain Anemia Nursing Considerations: a- Penicillin0 as ordered b- Proper dietary inta$e c- *odium & 'luid restriction d- %ed rest 6-4-6- Nep(rotic *ydrome + glomeruli disorder due to ot(er diseases li$e D 0 *&!0 etc*igns & *ypmtoms: a- Proteinuria b- Hypoalbunimemia c- Hyperbilirubinemia d- !dema Nursing Considerations: a- bed rest b- (ig( calorie0 (ig( protein0 lo, sodium c- onitor 7 & O d- Protect 'rom in'ection e- Administer meds as ordered: Diuretics0 *teroids0 7mmunosuppresiove agents0 anticoagulants 6-4-<- Drolit(iasis ) stones in t(e urinary system *igns & *ymptoms: a- Dull ac(ing pain b- Nausea0 vomiting0 diarr(ea c- Hematuria d- D37 symptoms Nursing Considerations: a- Force 'luids: at least 9& o' ,ater in a day b- *train Drine 'or stones c- Administer meds as ordered 6-4-8- Acute Renal Failure +sudden and reversible mal'unction o' t(e $idney due to trauma0 allergies0 stones or benign Prostatic (yperplasia *igns & *ymptoms: 9 P(ases a- Oliguric P(ase + sudden 0 .J/ edema ) urine is less t(an 6== cc in 56 (rsb- Period o' Diuresis + urine is 4=== ml in 56 (rs and is diluted c- Recovery Period Nursing 7ntervention: a- 3reat cause o' sudden occurrence baintain Fluid & electrolyte balance c- Prevent (ypo$alemia d- Administer insulin or 7# glucose as ordered to promote potassium absorption e- Proper diet : Oliguric + lo, CHON0 Hig( CHO0 (ig( 'at0 less potassium Diuresis + (ig( CHON0 (ig( calorie0 less 'luid '- Ieig( daily gonitor 7 & O (- Dialysis i' indicated iPsyc(ological & emotional support 6-4-H- C(ronic Renal Failure + progressive 'ailure o' $idney 'unction ,(ic( may result to deat(0 caused by c(ronic gomerulonep(ritis .C"N/0 pyelopnep(ritis0 D 0 uncontrolled HPN *igns & *ymptoms: a- 'atigue b- Headac(e c- "astrointestinal symptoms d- HPN e- 7rritability '- Convulsions

149

g- Anemia (- !levated %DN0 crea0 sodium0 potassium 3reatment: Dialysis Renal 3ransplant abcdNursing Considerations: aintain 'luid & electrolyte balance %edrest Diet: lo, protein0 lo, sodium0 (ig( CHO and vitamins Control HPN IOF cerebral irritation

e. 4.1.8.

%enign Prostatic Hyperplasia + enlargement o' t(e prostate ,it( un$no,n etiology usually in older males *igns & *ymptoms: Di''iculty in urinating Nocturia0 (ematuria0 dribbling sensation

*urgical 3reatment: Prostatectomy Post)operative Nursing Consideration: a- Observe 'or s(oc$ and (emorr(age b- %ladder Drainage2 monitor bladder irrigation c- Avoid li'ting (eavy ob1ects x 8 ,ee$s and avoid strenuous activities d- 7ncrease 'luid inta$e e- Decrease pain0 administer meds as odered 3R!A3 !N3 FOR "!N73ODR7NARL PRO%&! *: 4- Dialysis a- Hemodialysis Process o' cleansing t(e blood o' ,aste products ,(ic( t(e "D3 is unable to eliminate Cat(et(er inserted via a small incision on t(e nec$ .intra1ugular/0 arms or at t(e 'emoral areabPeritoneal Dialysis Dse o' peritoneum via a cat(eter 'or proper exc(ange o' 'luids and electrolytes and drainage o' 'luids Cat(eter inserted 1ust belo, t(e umbilicus ,it( small incision Continuous Ambulatory Peritoneal Dialysis

cabcde5-

Nursing 7nterventions: Ieig( daily onitor vital signs aintain asepsis at all times Record inta$e and output onitor 'or complications: %leeding0 peritonitis0 abdominal pain0 dyspnea0 bo,el per'oration Drinary 3ract *urgery a- 3ransuret(ral Removal o' t(e Prostate b- Prostatectomy Nursing 7nterventions: Ieig( daily 0 monitor 7&O onitor vital signs aintain asepsis at all times onitor 'or complications: %leeding0 peritonitis0 abdominal pain0 dyspnea0 bo,el Replace 'luids Proper irrigation

9-

Gidney 3ransplant

CIDNE$ DISEASE IN THE PHILIPPINE HEALTH SITUATION 80=== ne, cases o' renal disease per year A''ects all ages Adult: !nd)*tage Renal Disease .!*RD/

150

C(ildren and young: C(ronic "lomrulonep(ritis Causes: 4- C(ronic "lomerulonep(ritis + 6HR 5- C(ronic Pyelopnep(ritis + 4HR 9- Diabetes ellitus) 49R 6- Hypertensive Nep(rosclerosis) <R Gidney Disease Prevention: "ood Nutrition Clean !nvironment !arly detection o' o' t(e disease 3(oroug( urinary screening o' asymptomatic c(ildren 7ncrease case'inding and treatment 'or c(ronic glomerulonep(ritis "ood glycemic control .,@ D / Optimum %lood Pressure Control Nursing Healt( !ducation: 4- 7ncrease a,areness and prevent renal disease: Ade>uate ,ater inta$e %alanced diet "ood personal (ygiene Regular exercise Regular %P c(ec$)up Complete immuni?ation 'or in'ants and c(ildren Proper management o' t(roat and s$in in'ections Learly urinalysis 5- 7ncrease a,areness o' signs & symptoms o' $idney disease as edema and HPN ;. ;.!. 9- Routine screening 'or D370 diabetes and $idney disease DISTUR"ANCES IN CELLULAR UNCTIONING

CANCER o Abnormal gro,t( o' tissues a- Carcinoma ) epit(elial cells lining t(e internal and external sur'aces o' t(e bodyb- &eu$emia ) cancer 'rom blood)'orming organs c- &ymp(oma + cancer 'rom reticulo)endot(elial lymp( node organs d- *acrcoma) cancer 'rom connective tissues

o o

Cancer in t(e P(ilippines: Ran$s t(ird in leading cause o' morbidity and mortality H<R o' cancers occur at age <= y@o *taging o' 3umors a- !xtent o' tumor 3O primary tumor NO regional nodes O metastasis b!xtent o' alignancy 3= O no evidence o' primary tumor 37*O Carcinoma in *itu 340 350 390 36 O progressive tumor in si?e and involvement 3N O tumor cannot be assessed 7nvolvement o' Regional Nodes NO O regional lymp( nodes not abnormal N40 N50N90 N6 O increasing degree o' abnormal regional lymp( nodes etastatic Development OO no evidence o' distant metastasis 40 50 9 O increasing degree o' distant metastasis ines by the *O(#

c-

d-

Clinical ani'estations o' 3umor Presence $based on Community (ealth )ursing Ser%ices in the Phili C A U T I C(ange in bo,el or bladder (abits A sore t(at does not (eal Dnusual bleeding or disc(arge 3(ic$ening or lump in breast or else,(ere 7ndigestion or di''iculty in

!x- "astric Ca0 Colon Ca0 Rectal Ca 0 Renal Ca0 Prostate Ca !x- &aryngeal Ca !x- Dterine Ca !x- %reast Ca0 Hodg$in;s &ymp(oma !x- !sop(ageal Ca

151

O N U S

s,allo,ing Obvious c(ange in ,art or mole Nagging coug( or (oarseness Dnexplained Anemia *udden uexplained ,eig(t loss

!x- elanoma0 *>uamous cell Ca !x- &ung Ca ost Ca conditions

Ris$ Factors Age Healt( Habits *ex Family History Race *ocio)!conomic *tatus Occupation &i'estyle Cancer 3(erapy a- *urgery b. C(emot(erapy + c(emical@ medication

c.
d-

Radiation 3(erapy + electromagnetic rays destroys cancer cells Palliative@ *upportive Care) 'or end)stage or terminal stage ) given i' c(emo0 surgery or radiation t(erapy cannot assure treatment o' t(e patient 2 it is a (olistic care 'or t(e patient and 'amily ) management o ' care is geared to,ards a symptom)'ree individual ,it( psyc(ologic and spiritual support

Cancer Prevention & !arly Detection T*'e o1 Can+er Oral Cancer Earl* Pre.ention Avoid *mo$ing tobacco0 %etel >uid ANgangaB c(e,ing0 Proper cavity and dental c(e,ing No conclusive evidence 'or early prevention Earl* Dete+tion 3(oroug( dental c(ec$)up eac( year

%reast

ont(ly sel')exam and annual exam ,it( p(ysician2 ammograp(y: o 7nitially at age 6= and t(en 4)5 yrs t(erea'ter o Hig( ris$ ,omen) s(ould consult a doctor be'ore age 6=

&ung Dterine @ Cervix

Avoid smo$ing Clean0 sa'e sex *ingle partner reduces ris$ Hepa- vaccine0 inimal alco(ol inta$e0 Avoid moldy 'oods aintenance o' a (ig( 'iber and lo, 'at diet Avoid excessive sun exposure No conclusive evidence 'or early prevention

Annual c(ec$)up Regular pap smear: Once sexually active t(en every 9 years i' 'indings are normal None

&iver

Colon and Rectum *$in Prostate

Regular medical c(ec$)up a'ter 6= years0 yearly occult blood tests in stools0 rectal exams and sigmoidoscopy *el' s$in assessment Rectal !xam

Nursing 7ntervention abcdeAssist t(e patient in maintaining sel')dignity and integrity by continued and sustained communication and contact Allo, patient to ventilate 'eelings suc( as 'ear0 anger0 indi''erence a$e arrangements 'or spiritual consolation Assist in re(abilitation even be'ore treatment and until s(e recovers and ad1ust to t(e society Collaborate ,it( ot(er (ealt( ,or$ers 'or t(e patient;s (olistic needs

152

'-

Home visits and education about t(e client;s condition0 course o' treatment and alternatives

Priorities 'or Healt( *upervision: a- Ne,ly diagnosed cases b- Post)operative Cases c- 7ndigent Cases d- 3erminal Cases ;.(. HEMATOLOGIC PRO"LEMS Normal #alues to Remember: "loo% Co&'onent R%C + red blood cells Hgb ) (emoglobin Hct ) (ematocrit Female: ale: Female: ale: Female: ale: Nor&al Values 6-5 + <-6 x 4=8 6-H + 8-4 x 4=8 44-< + 4<-< g@d& 49-< + 4H-< g@d& 98 + 6CR 6= )<5R

I%C + ,(ite blood cells PC) ;.(.!. abANEMIA Platelet count

60<== + 440===@ mm9 4<=0 === + 6==0=== @ mm9

Causes: *udden or C(ronic blood loss Abnormal bone marro, 'unction c- R%C 'ails to mature ade>uately *igns & *ymptoms: Fatigue0 Iea$ness0 Di??iness0 Pallor0 Decreased R%C0 (emoglobin & (ematocrit T0) s #$ A* m(a6

a.

H0)#)"#%($ "at(#* A* m(a + bone marro, 'ails to produce ade>uate blood cells a. 7ron De'iciency Anemia + nutritional de'iciency0 blood loss

b.
c-

Aplastic Anemia ) due to radiation0 drugs0 toxin Anemia due to Renal Disease ani'estations: Hypoxia Prone to in'ection Fatigue !asy bruising

Clinical

Nursing 7ntervention: Proper nutrition Psyc(ological support Protect against in'ection and in1ury

b.
or atrop(y o' t(e

M !a%#4%ast(& A* m(a + due to previous gastric surgery0 malabsorption gastric mucosa

Pernicious Anemia + #it- %45 and Folic acid de'iciency in gastric 1uice Clinical ani'estations: Parest(esia 3ingling or numbness o' extremities "ait disturbances %e(avioral Disturbances

Nursing 7ntervention: 7nta$e o' #it- %45 'ollo,ing t(is regimen: o 9x a ,ee$ 'or 5 ,ee$s0 t(en

153

 &.

o 5 x a ,ee$ 'or 5 ,ee$s0 t(en o Once a mont( Protect lo,er extremities Rest in non)stimulating environment

H m#%0t(& A* m(a *ic$le Cell Anemia) de'ective (emoglobin0 turns to sic$le cell ,(en oxygen in venous blood is lo, 3(alassemia "lucose)8 P(osp(ate De(ydrogenase De'iciency Clinical ani'estations: 3(alassemia & "8PD + usually asymptomatic *ic$le Cell Anemia: o *evere Pain o *,elling o Fever o Faundice o Prone to in'ection Nursing 7ntervention: Proper oxygenation Hydration Analgesics Ade>uate Rest Re'er to genetic counseling Avoid cold places to prevent sic$le cell proli'eration

6.2.2.

LEUCOC$TOSIS 8 LEUCEMIA &eu$ocytosis &eu$emia Clinical + increase level o' I%C0 persistent increased can be malignant ) proli'eration o' neoplastic ,(ite blood cells in t(e bone marro, a''ecting t(e di''erent tissues and organs in t(e body Acute & C(ronic yeloid &eu$emia .A & @ C &/ Acute & C(ronic &ymp(ocytic &eu$emia .A&& @ C &/ Angiogenic yeloid etaplasia .A /

ani'estations: Fever Prone to 7n'ection Pain Ieig(t &oss Fatigue

Nursing 7nterventions: !nergy conservation Reverse 7solation %lood 3rans'usion

6.2.3.

POL$C$THEMIA > neoplasm o' myeloid cells Clinical ani'estations: Di??iness0 (eadac(e0 tinnitus0 'atige0 parest(esia0 blurred vision0 at(erosclerosis THROM"OC$TOPHENIA ) 7ncreased %leeding 3endencies L$MPHOMAS > neoplasm o' lymp(atic cells Hodg$in;s &ymp(oma Non)Hodg$in;s &ymp(oma

6.2.4. 6.2.5.

ultiple

yeloma

3(rombocytop(enia + lo, platelet 0 bleeding

anagement: C(emot(erapy0 %lood 3rans'usions0 Reverse 7solation0 Radiation t(erapy0 *teroids Nursing 7nterventions: !motional *upport Reverse isolation Ade>uate Rest and Nutrition *trict edication Regimen

154

D.(.;. "LOOD TRANS USION 4593ypes o' %lood Components 3rans'used I(ole %lood Pac$ed Red %lood Cells Fres( Fro?en Plasma@ Plasma Concentrate 3rans'usion Complications Non)(emolytic reaction) Fever Hemolytic Reaction) li'e t(reatening: 'ear0 c(ills0 bac$pain0 nausea0 c(est tig(tness0 dyspnea and anxiety Allergic reaction +urticaria0 'lus(ing0 itc(ing Hypervolemia + nec$ vein distention0 dyspnea0 ort(opnea0 tac(ycardia0 sudden anxiety Diseases 3ransmitted t(roug( %lood 3rans'usion Hepatitis % or C 0 A7D* @ H7#0 Cytomegalovirus Nursing 7nterventions: 4596C(ec$ name0 7D0 blood type0 expiration0 serial V 3a$e baseline vitals signs %lood pac$ s(ould be at room temperature onitor 'or trans'usion reaction Allergic .pruritus0 respiratory distress0 urticaria/ Hemolytic .lo, bac$ pain0 'ever0 c(ills/ 3reat trans'usion reaction0 i' present + symptomatic treatment

5.

155

7.

NEUROLOGIC DISTUR"ANCES 7- Central Nervous *ystem:

%rain *pinal Cord 77- Perip(eral Nervous *ystem abCranial Nerves + 45 pairs *pinal Nerves + 94 pairs Cervical + C 3(oracic + 45 &umbar + < *acral + < Coccygeal ) 4 c- Autonomic Nervous *ystem *ympat(etic Nervous *ystem Parasympat(etic Nervous *ystem 3(e Cranial Nerves:

O(0 O(0 O(0 To Touc( And

I II III IV V VI VII VIII I# # #I #II

eel

A Girls Veil So Heaven

*mell #isual Acuity Pupil constriction and dilation !ye movement: 7n'erior and medial Fa, muscles !ye movement: &ateral directions *ymmetrical 'acial movement0 Client identi'ies taste0 !yelid reaction to stimulus Hearing Acuity "ag Response Ability to spea$ clearly *(oulder;s ability to resist against pressure 3ongue at midline

Ol'actory Optic Oculomotor Troc(lear Trigeminal Abducens

acial

Auditory Glossop(aryngeal Vagus Spinal Accessory Hypoglossal

Neurologic *tatus: a-

b. c. d.

Conscious) alert0 attentive0 and 'ollo,s command &et(argic) dro,sy but a,a$ens2 'ollo,s command0 but slo,ly and inattentively *tuporous ) arouses to vigorous and continuous stimulation )response may be an attempt to remove t(e pain'ul stimulusComa- + no sounds0 no movement
THE GLASGOW COMA SCALE

An assessment tool measuring t(e individual;s neurologic status speci'ically t(e spontaneity o' t(e client;s eye movement 0 spea$ing ability and motor abilities in response to a stimuliPer'ect score is 4< points ) *pontaneous@ Normal eye0 motor and verbal response &o,est score is 9 points ) No response

E*e O'eninRes'onse

a- *pontaneous b- 3o speec( c- 3o pain d- No response a- Obeys verbal commands b- &ocali?es pain c- Flexion: no ,it(dra,al d- Flexion: abnormal .decorticate/ e- !xtension: abnormal .decerebrate/ '- No response to pain on any limb

Points 6 9 5 4 8 < 6 9 5 4

Moto r Res'onse

156

"est .er/al res'onse

a- Oriented b- Able to Converse c- 7nappropriate speec( d- a$es incompre(ensible sound e- No response

< 6 9 5 4

!xample:

Patient s conscious0 co(erentCan tell ,(ere (e is0 can loo$ at surroundings0 can raise (ands ,(en as$ed to0 and can express sel' t(roug( ,ords0 ans,er >uestions appropriately"C* *coring: !ye opening otor Response #erbal Response GCS S+ore O 6 O 8 O < E !D

!ye slig(tly opens ,(en name is called 2 No movement@response ,(en s$in is Pinc(ed 2 I(en calling t(e nurse: can only say AneW-eWe-B sound "C* *coring: !ye opening otor Response #erbal Response GCS S+ore O 9 O 4 O 5 E ;

CERE"ROVASCULAR ACCIDENT @CVAA StrokeF

A sudden disruption o' blood supply to t(e brain ,(ic( may lead to temporary or permanent dys'unctionHPN0 Obesity0 perip(eral vascular disease0 obesity0 aneurysm *igns & *yptoms: a- *peec( problem @ Ap(asia ) a loss or impairment o' t(e ability to produce and@or compre(end language b- Hemiparesis) ,ea$ness o' one side o' t(e body c. Hemiplegia ) total paralysis o' t(e arm0 leg and trun$ on t(e same side ' t(e bodyd- Decreased a,areness o' body space

Ris$s Factors:

3ypes o' stro$e0 4- Transient +schaemic Attack $T+A) s(ort)term stro$e t(at lasts 'or less t(an 56 (ours . seconds or minutes in a day/ oxygen supply to t(e brain is restored >uic$ly transient stro$e needs prompt medical attention as it is a ,arning o' serious ris$ o' a ma1or stro$e(. Cerebral t(rombosis ) a blood clot .t(rombus/ 'orms in an artery .blood vessel/ supplying blood to t(e brain) brain cells are starved o' oxygen9- Cerebral embolism ) blood clot t(at 'orms and t(en travel to t(e brain6- Cerebral (emorr(age ) occurs ,(en a blood vessel bursts inside t(e brain and bleeds .(aemorr(ages/- Iit( a (emorr(age0 extra damage is done to t(e brain tissue by t(e blood t(at seeps into itNursing 7nterventions: 459aintain ade>uate air,ay onitor neuro vital signs: #ital signs and "lasgo, coma scale including inta$e and output aintain 'luid & electrolyte balance

) )

157

SPINAL CORD INGUR$

De1inition0 A damage in t(e nerve structure causing dys'unction resulting to paralysis0 sensory loss and altered activityCause0 #e(icular accidents0 #iolence0 Falls0 *ports0 7n'ection0 3umor T2e S'inal Ner.es: 4- Cervical Nerve 5- 3(oracic Nerve 9- &umbar Nerve 6- *acral Nerve Etiolo-*0 4- *pinal *(oc$ .Are'lexia/ 5- Autonomic Hyperre'lexia 7n1ury in 38 and above &i'e)t(reatening Nursin- Inter.entions: 4- 7mmobili?ation specially a'ter in1ury or trauma 5aintain respiratory 'unction0 A%C 9- %ladder & bo,el management 6- Re(abilitation

Ner.es

Le.el C4 C5 C9 C6 C< C8 CH CC 34 35 39 36 3< 38 3H 3C 3E 34= 344 345 &4 &5 &9 &6 &< *4 *5 *9 *6 *<

"o%* 'art a11e+te% Head & Nec$

S'inal Cor% InBur* E11e+t Paralysis belo, nec$2 impaired breat(ing0 bo,el & bladder incontinence0 sexual dys'unction

C "7(&a% N "7 7n1ury causes :uadriplegia@ 3etraplegia

Diap(ragm Deltoid0 biceps Irist !xtenders 3riceps Hand

*(oulder elevation possible0 ventilation support !lbo,0 upper arm0 ,rist movement

Th#"a&(& N "7 7n1ury causes Paraplegia

&oss o' (and control0 Paralysis belo, ,aist

C(est

uscles 3run$ and Abdominal control

Abdominal uscles

Lu&/ar Ner.e Paralysis o' legs2 loss o' bladder and bo,el control Sa&"a% N "7 *exual0 %ladder & %o,el conrol

Hip adduction impaired &eg muscles Gnee and an$le movement impaired

%ladder & %o,el control *exual Control

%ladder@%o,el 7ncontinence0etc Decrease sensation in t(e peineum

158

PARCINSON?S DISEASE

De1inition0

A disorder a''ecting control and regulation o' movement Dnilateral 'lexion o' arms0 s(u''ling gait0 di''iculty in ,al$ing0 ,ea$ness0 disability

Clini+al Mani1estations0 Rigidity 7nvoluntary body tremors Hips and $nees 'lexion as$li$e 'acial expression *lurred speec( Drooling Constipation Depression Retropulsion0 propulsion Me%i+al Mana-e&ent0 Sur-i+al Mana-e&ent0 Nursin- Inter.entions0 abcdeRe(abiltation + exercise *peec( t(erapy Diet: &o, CH7N in am0 (ig( CHON in P Hig( 'iber 'oods to promote bo,el elimination Prevent 7n1ury + 'all0 etc Anti)par$insonian Agent: Anti)c(olinergic: &evodopa Cogentin

*tereotaxic 3(alamotomy + surgery o' t(e t(alamus to treat disorder

M$ASTHENIA GRAVIS De1inition0 *evere ,ea$ness o' one or ore groups o' s$eletal muscles2 *evere ,ea$ness o' t(e neuro 'unctions most commonly a''ecting t(e *event( cranial nerve) Facial Nerve Clini+al Mani1estation0 4as$)li$e 'acial expression 5- Diplopia) double)vision 9- Ptosis) di''iculty opening o' t(e eye 6- Dyp(agia Mana-e&ent0 bcda- Pyridostigmine %romine .mestinon/ Ambenomium C(loride *teroids +Prednisone Atrop(ine *ul'ate

Nursin- Inter.entions0 Avoid 'atigue Administer meds as ordered Avoi neomycin and morp(ine CATARACT De1inition0 ) t(e eye lenses becomes t(ic$ and unclear or yello,is(Clini+al Mani1estations0 59"radual visual lossHa?y vision @ Lello,is( (a?e I(itis( to yello,is( eyelense-

4.
S5"!(&a% T" atm *t6

Cataract extraction

Dru-0 4- M*%riatri+s ) causes dilation o' pupils2 increases intraocular pressure .7OP/ a- Atrop(ine *ul'ate b. P(enylep(rine Hydroc(loride

#ision #ision ,@ ,@ Cataract Cataract

159

5- Cyclopegics + decreases ciliary muscle accomodation *ide e''ects: blurred vision0 increase %P Nursin- Inter.ention:

2.
96-

onitor %P2 avoid use to patients ,it( HPN 3eac( client t(at blurring o' vision may be experiencedPost)op intervention: $eep eye covered (ead o' bed elevated at 9=)6< degreed0 supine position

Avoid bending or li'ting (eavy ob1ects0 coug(ing and snee?ing as it may 'urt(er increase 7OP

GLAUCOMA non)curable condition o' t(e eye due to increase in intraocular pressure causing deterioration o' t(e optic nerve( t*'es o1 Glau+o&a0 4- Acute or Closed" Angle ,laucoma a- Rain/o4 aroun% li-2ts b- Pain around t(e eye c- Cloudy and blurred vision d- Nausea & vomiting e- Dilation o' pupils 5- Chronic or O en"Angle ,laucoma a- Halo aroun% li-2ts b- Progressive loss o' vision c- 3ired 'eeling in t(e eye d- *lo,ly diminis(ing perip(eral vision Sur-i+al Mana-e&ent: 4- 3rabeculectomy 5- 3(ermosclerectomy 9- 7ridenclesis Dru-s0 Mioti+s + causes constriction o' pupils

)A

#ision ,@ "laucoma

1.
596-

Pilocarpine (ydroc(loride ) Drains a>ueous (umor Aceta?olamide + decreases production o' a>ueous (umor annitol + reduces 7OP 7sosorbid + also decreases production o' a>ueous (umor

Nursin- Inter.ention0 4- Administer drugs as ordered 2. 3eac( client t(at glaucoma can be controlled but not curable .even surgery can;t cure t(e disease/ 9- !ncourage moderate exercise 6- Avoid straining o' bo,el <- !ncourage lo, residue0 (ig( 'iber diet =. MUSCULOSCELETAL DISTUR"ANCES RHEUMATOID ARTHRITIS A systemic in'lammatory disorder o' +onne+ti.e tissues an%3 or Boints c(aracteri?ed by exacerbation & remissionCervical0 'inger 1oints0 ulnar0 can also be involved:(eart and lung .as in r(eumatic (eart disease/ C(ronic disease2 early to mid)adult(ood0 common in ,omen ani'estations OSTEOARTHRITIS Degeneration o' t(e arti+ular +artila-e Iear & 3ear o' 1oints Ieig(t)bearing 1oints: $nees0 (ips0 spine

GOINT DISORDERS De'inition

Ginds o' Foints

7ncidence Clinical

Older ,omen Pain 'elt a'ter activity

*ynovitis Pain relieved ,it( rest

160

7ntermittent bone pain0 s,elling0 redness0 ,arm 'eeling due to vasodialtion and increased blood 'lo, Pannus 'ormation) granulation o' tissue causing destruction o' ad1acent cartilage0 1oints and bones 'atigue0 anorexia0 malaise0 ,eig(t loss anagement Rest0 exercise0 A*A0 N*A7Ds0 *teroids0 (eat %alanced rest and activity0 (eat pac$s0 steroids in 1oist only Drug: *teroid0 A*A0 7ndomet(acin0 P(enylbuta?one Nursing 7ntervention aintain body alignment0 %alance rest and exercise0 proper diet

Gout 3 Gout* Art2ritis

De1intion0 Ris, a+tors0 Clini+al Mani1estations pain'ul metabolic disorder due to in'lammation o' t(e Boints due to (ig( uri+ a+i% Hereditary0 most common in men A salt o' uric acid .Drate/ crystalli?es in so't and bony tissues causing local in'lammation and irritation*evere pain0 usually in great toe Red0 pain'ul and s,ollen 1oints 3op(i .crystal 'ormation in 1oints/ are palapated around great toes0 'ingers0 earlobes Allopurinol N*A7D;s + 7bubro'en 0 7ndomet(acin Probenecid Colc(icine *ul'inpyra?one

Dru-s0

Nursin- Mana-e&ent0 a- %edrest during attac$s b- Heat or cold compress c- 7ncrease 'luid inta$e to 'lus( out uric acid d- Avoid eating organ meats0 s(ell'is(0 sardines ) ) ) 'ood ,it( (ig( purine @ uric acid content S*ste&i+ Lu'ous Er*t2e&atosus @SLEA

De1inition0 Ris, 1a+tors0

Di''use connective tissue disease a''ecting s$in0 1oints0 $idney0 serous membranes o' t(e (eart and lungs0 lymp( nodes and "7 tractC(ildren0 middle)aged and elderly2 (ereditary

Clini+al Mani1estations0 A"utter1l* ras2F in t(e 'ace . across bot( c(ee$s and nose/ ani'ests symptoms same as t(at o' art(ritis and Raynaud;s Mana-e&ent0 N*A7D;s *teroids Cytotoxic drugs abc-

) A?at(ioprine0 Cyclop(osp(amide

Nursin- Inter.enions0 Avoid exposure to sunlig(t because symptoms aggravate symptoms or ,ear (ats0 umbrella or sunscreen Ade>uate nutrition0 rest and exercise *tress management0 i' possible avoid stress

ra+tures De1inition0 A brea$ in t(e continuity o' t(e bones

Clini+al Mani1estations0

161

Pain &oss o' 'unction De'ormity False motion

!dema *pasm Crepitus Hematoma around s$in %rea$s 'or penetrating bone 'ragments

Mana-e&ent0 First Aid 459aintain air,ay and circulation 7mmobili?e 1oints t(at may be a''ected2 *plint limb %ring to nearest (ospital@medical institution

3raction Closed Reduction

)balanced pulling o' t(e musculos$eletal structure to align bones2 re>uires countertraction ) external manipulation suc( as manually aligning bones by pulling- For patients ,(o (ave lo,er pain tolerance .elderly0 c(ildren/ reduction may be done under sedation anest(esia) internal manipulation o' bones re>uiring surgical operation ) surgically applying scre,s0 plates0 pins0 nails to align bones .opening o' t(e s$in and exposing bones a''ected/2 s$in is closed a'ter t(e procedure) applying nails and metal scre,s to bones t(roug( t(e s$in sur'ace

Open Reduction 7nternal Fixation !xternal Fixation Casts

)a rigid mold used to immobili?e an in1ured structure to promote (ealing

Nursin- Mana-e&ent0 4596ainatin positioning For traction& maintaing ,eig(ts and countertraction Clean ,ounds to prevent in'ection Assess 'or #A*CD&AR OCC&D*7ON

D P?s0

< signs o' #ascular Occlusion due to extremely tig(t casts @ traction a- Pain b- Pallor c- Pulselessness d- PArest(esia e- Paralysis

H.

INTEGUMENTAR$ DISTUR"ANCES "urn

De't2 o1 InBur* First)degree *econd)degree

Mani1estation Pain'ul0 pin$ to reddis(0 subsides >uic$ly Pain0 pin$ to red0 ,it( blisters .'luid 'ormation/ Reddis(0 bro,nis( or ,(itis(0 painless0 esc(ar 'ormation .&eat(er)li$e s$in/

Le.el o1 S,in A11e+te% !pidermis and part o' dermis !pidermis and dermis (air 'ollicle intact !pidermis0 dermis0 subcutaneous tissue !pidermis0 dermis0 subcutaneous tissue2 'at0 'ascia0 muscle and bone *uper'icial *uper'icial partial t(ic$ness2 Deep partial t(ic$ness Full t(ic$ness

3(ird) degree

Fourt()degree Rule o1 Nines0 a- Head and Nec$ b- Anterior 3ruc$

Full t(ic$ness

) )

ER 4CR

162

c- Posterior 3run$ d- Arms e- &egs '- Perineum

) ) ) )

4CR ER eac( O 4CR 4CR eac( O 98R 4R 4==R

Mana-e&ent0 irst-Ai%0 4-

Rule o1 Nine?s
%urning person: As$ person to stop0 drop and roll . lie do,n and roll/ %urning person: *top burning process suc( as ,rapping t(e burning part ,it( ,et to,el or blan$et C(ec$ air,ay First)degree burn: Run cool ,ater to a''ected area 'or 4= minutes

2. 3.
6-

Hos'ital Inter.entions0 4- C(ec$ A%C0 give oxygen and 7# 'luids 5- Assess client;s data0 (istory o' in1ury .time0 cause0etc/ 9aintain asepsis) burn patients are very prone to in'ections 6edical + *urgical anagement: a- 3etanus toxoid b- 3opical Anti)microbial agent: *ilver Nitrate0 *ilver *ul'adia?ine0 "entamicin *ul'ate0 c- Debridement

a'enide acetate

SHOCC

Failure o' t(e circulatory system to maintain ade>uate per'usion o' vital organsCritically severe de'iciency in nutrients0 oxygen and electrolytes delivered to body tissues0 plus de'iciency in removal o' cellular ,astes0 resulting to cardiac 'ailure I. Sta-es o1 S2o+, )on" rogressi%e Stage ) Cardiac output is slig(tly decreased ) %ody compensates Progressi%e Stage ) Compensatory mec(anism is not ade>uate ) blood 'lo, to t(e (eart is not ade>uate t(us (eart begins to deteriorate -. +rre%ersible Stage ) 7nade>uate tissue per'usion ) Cellular isc(emia & necrosis lead to organ 'ailure II. T0) s #$ Sh#&' Cause !tiology

Hypovolemic *(oc$

due to inade>uate circulating blood volume

%lood loss: assive 3rauma0 "7 %leeding0 Ruptured Aortic Aneurysm0 *urgery0 !rosion o' #essesl due to lesion0 tubes or ot(er devices0 Disseminated 7ntravascular Coaguation Plasma loss: %urns0 Accumulation o' intra) abdominal 'luid0 malnutrition0 severe dermatitis0 D7C Crystalloid loss: De(ydration0 Protracted #omiting0 Diarr(ea0 nasogastric suction

Cardiogenic *(oc$

due to (*a1 85at )5m)(*! a&t(#* #$ th h a"t because o' primary cardiac muscle dys'unction or mec(anical obstruction o' blood 'lo, caused by 7 or valvular insu''iciency

yocardial disease: Acute 70 yocardial Contusion Cardiomypat(ies #alvular Disease or in1ury: Ruptured Aortic Cusp0 Ruptured Papillary muscle0 %all t(rombus

163

!xternal Pressure on t(e Heart inter'eres ,it( (eart 'illing or emptying: Pericardial 3amponade due to 3rauma0 aneurysm0 cardiac surgery0 pericarditis0 massive pulmonary embolus0 tension pneumot(orax Cardiac Dysr(tymias: 3ac(yarr(yt(mias0 %radyarryt(mias0 !lectromec(anical dissociation 9- Distributive *(oc$ aNeurogenic *(oc$

inter'erence ,it( * "7#5s s0st m control o' t(e blood vessels

*pinal:

*pinal anest(esia0 spinal cord in1ury #aso)vagal reaction: *evere pain0 severe emotional stress Allergy to 'ood0 medicines0 dye0 insect bites or stings

b-

Anap(ylactic *(oc$

)severe h0) "s *s(t(7(t0 reaction resulting in massive systemic vasodilation

c-

*eptic *(oc$

) systemic reaction vasodilation due to (*$ &t(#*

"ram)negative septicemia but also caused by ot(er organisms

III. Si-ns o1 S2o+, Anxiety Restlessness Di??iness 3(irst Fainting Pale s$in0 urticaria in anap(ylactic s(oc$ Oliguria0 *lo, capillary re'ill %P) (ypotension Pulse + tac(ycardia0 t(ready0 irregular .Cardio-*(oc$/ Respiration: increased dept(0 tac(ypnea0 ,(ee?ing .anap(ylactic s(oc$/ 3emperature: cold clammy s$in0 elevated in anap(ylactic &OC ) could be alert0 oriented0 unresponsive C#P + belo, < cm H5= .(ypovolemic/ ) above 4< cms .cardio & septic/

IV. Nursin- Care Mana-e&ent GOAL0 Pro&ote .enous return7 +ir+ulator* 'er1usion Position: Feet elevated ,it( (ead slig(tly elevated also #entilation: loosen restrictive clot(ing0 O50 monitor respiration Fluids: 7#0 administer blood@plasma as ordered . stop blood immediately in anap(ylactic s-/ #ital signs: C#P0 !C"0 D-O-0*,an "an? edications .depends on type/ Anti(ypotensive .epinep(rine0 norepinep(rine0 dopamine/ Anti)arryt(mics0 Cardiac "lycosides0 Antibiotics0 Adrenocorticoids #asodilators .nitroprusside/0 %eta)adrenergic .dobutamine/ ec(anical support : ilitary Anti)s(oc$ 3rousers. A*3/

E11e+ts o1 S2o+, in Di11erent Or-ans

Respiratory *ystem Cardiovascular *ystem Neuroendocrine *ystem

Hypoxia &actic acid accumulates tissue necrosis yocardial deterioration Disseminated 7ntravascular Coagulation *tage o' resistance o ADH is released causing $idneys to retain sodium and ,ater o 7ncrease in adrenocorticoid mineralcorticoid (ormones

164

7mmune *ystem

acrop(ages in bloodstream and tissues are depressed 7ncreased susceptibility to s(oc$ "73 vagal stimulation stops@slo, do,n no peristalsis &iver + ability to detoxi'y is lost2 blood is pooled in t(e liver or portal bed Altered capillary blood pressure and glomerular 'iltration Renal isc(emia

"7 *ystem

Renal *ystem

IV.

IRST AID *** FIRST AID: Details from www.redcross.org Dislo+ation0 irst ai%JJJ

4- "et medical (elp immediately-

2. DonIt &o.e t2e Boint. *plint t(e a''ected 1oint into its 'ixed position- DonQt try to move a dislocated
1oint or 'orce it bac$ into place- 3(is can damage t(e 1oint and its surrounding muscles0 ligaments0 nerves or blood vessels-

3. Put i+e on t2e inBure% Boint. 3(is can (elp reduce s,elling by controlling internal bleeding and t(e
buildup o' 'luids in and around t(e in1ured 1ointCuts an% s+ra'es0 irst ai%JJJ

inor cuts and scrapes usually donQt re>uire a trip to t(e emergency room- Let proper care is essential to avoid in'ection or ot(er complications- 3(ese guidelines can (elp you care 'or simple ,ounds:

1. Sto' t2e /lee%in-. inor cuts and scrapes usually stop bleeding on t(eir o,n- 7' t(ey donQt0 apply
gentle pressure ,it( a clean clot( or bandage- Hold t(e pressure continuously 'or 5= to 9= minutesDonQt $eep c(ec$ing to see i' t(e bleeding (as stopped because t(is may damage or dislodge t(e 'res( clot t(atQs 'orming and cause bleeding to resume- 7' t(e blood spurts or continues to 'lo, a'ter continuous pressure0 see$ medical assistance-

2. Clean t2e 4oun%. Rinse out t(e ,ound ,it( clear ,ater- *oap can irritate t(e ,ound0 so try to
$eep it out o' t(e actual ,ound- 7' dirt or debris remains in t(e ,ound a'ter ,as(ing0 use t,ee?ers cleaned ,it( alco(ol to remove t(e particles- 7' debris remains embedded in t(e ,ound a'ter cleaning0 see your doctor- 3(oroug( ,ound cleaning reduces t(e ris$ o' tetanus- 3o clean t(e area around t(e ,ound0 use soap and a ,as(clot(- 3(ereQs no need to use (ydrogen peroxide0 iodine or an iodine)containing cleanser- 3(ese substances irritate living cells- 7' you c(oose to use t(em0 donQt apply t(em directly on t(e ,ound-

3. A''l* an anti/ioti+. A'ter you clean t(e ,ound0 apply a t(in layer o' an antibiotic cream or
ointment suc( as Neosporin or Polysporin to (elp $eep t(e sur'ace moist- 3(e products donQt ma$e t(e ,ound (eal 'aster0 but t(ey can discourage in'ection and allo, your bodyQs (ealing process to close t(e ,ound more e''iciently- Certain ingredients in some ointments can cause a mild ras( in some people- 7' a ras( appears0 stop using t(e ointment-

4. Co.er t2e 4oun%. %andages can (elp $eep t(e ,ound clean and $eep (arm'ul bacteria out- A'ter
t(e ,ound (as (ealed enoug( to ma$e in'ection unli$ely0 exposure to t(e air ,ill speed ,ound (ealing-

5. C2an-e t2e %ressin-. C(ange t(e dressing at least daily or ,(enever it becomes ,et or dirty- 7'
youQre allergic to t(e ad(esive used in most bandages0 s,itc( to ad(esive)'ree dressings or sterile gau?e (eld in place ,it( paper tape0 gau?e roll or a loosely applied elastic bandage- 3(ese supplies generally are available at p(armacies-

165

6. Get stit+2es 1or %ee' 4oun%s. A ,ound t(at cuts deeply t(roug( t(e s$in or is gaping or 1agged)
edged and (as 'at or muscle protruding usually re>uires stitc(es- A strip or t,o o' surgical tape may (old a minor cut toget(er0 but i' you canQt easily close t(e mout( o' t(e ,ound0 see your doctor as soon as possible- Proper closure ,it(in a 'e, (ours minimi?es t(e ris$ o' in'ection-

7. Wat+2 1or si-ns o1 in1e+tion. *ee your doctor i' t(e ,ound isnQt (ealing or you notice any redness0
drainage0 ,armt( or s,elling-

8. Get a tetanus s2ot. Doctors recommend you get a tetanus s(ot every 4= years- 7' your ,ound is
deep or dirty and your last s(ot ,as more t(an 'ive years ago0 your doctor may recommend a tetanus s(ot booster- "et t(e booster ,it(in 6C (ours o' t(e in1ury "urns0 irst ai%JJJ or &inor /urns0 including second)degree burns limited to an area no larger t(an 5 to 9 inc(es in diameter0 ta$e t(e 'ollo,ing action: Cool t2e /urn. Hold t(e burned area under cold running ,ater 'or at least < minutes0 or until t(e pain subsides- 7' t(is is impractical0 immerse t(e burn in cold ,ater or cool it ,it( cold compressesCooling t(e burn reduces s,elling by conducting (eat a,ay 'rom t(e s$in- DonQt put ice on t(e burn Co.er t2e /urn 4it2 a sterile -au6e /an%a-e. DonQt use 'lu''y cotton0 ,(ic( may irritate t(e s$inIrap t(e gau?e loosely to avoid putting pressure on burned s$in- %andaging $eeps air o'' t(e burned s$in0 reduces pain and protects blistered s$in Ta,e an o.er-t2e-+ounter 'ain relie.er. 3(ese include aspirin0 ibupro'en .Advil0 otrin0 ot(ers/0 naproxen .Aleve/ or acetaminop(en .3ylenol0 ot(ers/- Never give aspirin to c(ildren or teenagersinor burns usually (eal ,it(out 'urt(er treatment- 3(ey may (eal ,it( pigment c(anges0 meaning t(e (ealed area may be a di''erent color 'rom t(e surrounding s$in- Iatc( 'or signs o' in'ection0 suc( as increased pain0 redness0 'ever0 s,elling or oo?ing- 7' in'ection develops0 see$ medical (elp- Avoid re)in1uring or tanning i' t(e burns are less t(an a year old X doing so may cause more extensive pigmentation c(anges- Dse sunscreen on t(e area 'or at least a yearCaution DonIt use i+e. Putting ice directly on a burn can cause 'rostbite0 'urt(er damaging your s$in DonIt /rea, /listers. %ro$en blisters are vulnerable to in'ectionT2ir%-%e-ree /urn 3(e most serious burns are painless and involve all layers o' t(e s$in- Fat0 muscle and even bone may be a''ected- Areas may be c(arred blac$ or appear dry and ,(ite- Di''iculty in(aling and ex(aling0 carbon monoxide poisoning or ot(er toxic e''ects may occur i' smo$e in(alation accompanies t(e burnor &aBor /urns0 dial E44 or call 'or emergency medical assistance- Dntil an emergency unit arrives0 'ollo, t(ese steps:

1. DonIt re&o.e /urnt +lot2in-. Ho,ever0 do ma$e sure t(e victim is no longer in contact ,it(
smoldering materials or exposed to smo$e or (eat-

2. DonIt i&&erse se.ere lar-e /urns in +ol% 4ater. Doing so could cause s(oc$3. C2e+, 1or si-ns o1 +ir+ulation @/reat2in-7 +ou-2in- or &o.e&entA. 7' t(ere is no breat(ing or
ot(er sign o' circulation0 begin cardiopulmonary resuscitation .CPR/-

4. Co.er t2e area o1 t2e /urn. Dse a cool0 moist0 sterile bandage2 clean0 moist clot(2 or moist to,els7' a C2e&i+al /urns0 irst ai%JJJ c(emical burns t(e s$in0 'ollo, t(ese steps:

1. Re&o.e t2e +ause o1 t2e /urn by 'lus(ing t(e c(emicals o'' t(e s$in sur'ace ,it( cool0 running
,ater 'or 4< minutes or more- 7' t(e burning c(emical is a po,der)li$e substance suc( as lime0 brus( it o'' t(e s$in be'ore 'lus(ing-

166

2. Re&o.e +lot2in- or Be4elr* t(at (as been contaminated by t(e c(emical3. Wra' t2e /urne% area loosel* ,it( a dry0 sterile dressing or a clean clot(inor c(emical burns usually (eal ,it(out 'urt(er treatment-

See, e&er-en+* &e%i+al assistan+e i10 3(e victim (as signs o' s(oc$0 suc( as 'ainting0 pale complexion or breat(ing in a notably s(allo, manner 3(e c(emical burn penetrated t(roug( t(e 'irst layer o' s$in0 and t(e resulting second)degree burn covers an area more t(an 5 to 9 inc(es in diameter 3(e c(emical burn occurred on t(e eye0 (ands0 'eet0 'ace0 groin or buttoc$s0 or over a ma1or 1oint7' youQre unsure ,(et(er a substance is toxic0 call t(e poison centerEle+tri+al /urns0 irst ai%JJJ

An electrical burn may appear minor or not s(o, on t(e s$in at all0 but t(e damage can extend deep into t(e tissues beneat( your s$in- 7' a strong electrical current passes t(roug( your body0 internal damage0 suc( as a (eart r(yt(m disturbance or cardiac arrest0 can occur- *ometimes t(e 1olt associated ,it( t(e electrical burn can cause you to be t(ro,n or to 'all0 resulting in 'ractures or ot(er associated in1uriesDial E44 or call 'or emergency medical assistance i' t(e person ,(o (as been burned is in pain0 is con'used0 or is experiencing c(anges in (is or (er breat(ing0 (eartbeat or consciousnessW2ile 2el'in- so&eone 4it2 an ele+tri+al /urn an% 4aitin- 1or &e%i+al 2el'7 1ollo4 t2ese ste's0

1. Loo, 1irst. DonIt tou+2. 3(e person may still be in contact ,it( t(e electrical source- 3ouc(ing t(e
person may pass t(e current t(roug( you-

2. Turn o11 t2e sour+e o1 ele+tri+it* i1 'ossi/le. 7' not0 move t(e source a,ay 'rom bot( you and t(e
in1ured person using a nonconducting ob1ect made o' cardboard0 plastic or ,ood-

3. C2e+, 1or si-ns o1 +ir+ulation @/reat2in-7 +ou-2in- or &o.e&entA. 7' absent0 begin
cardiopulmonary resuscitation .CPR/ immediately-

4. Pre.ent s2o+,. &ay t(e person do,n ,it( t(e (ead slig(tly lo,er t(an t(e trun$ and t(e legs
elevated-

5. Co.er t2e a11e+te% areas. 7' t(e person is breat(ing0 cover any burned areas ,it( a sterile gau?e
bandage0 i' available0 or a clean clot(- DonQt use a blan$et or to,el- &oose 'ibers can stic$ to t(e burnsAni&al /ites0 irst ai%JJJ Domestic pets cause most animal bites- Dogs are more li$ely to bite t(an cats- Cat bites0 (o,ever0 are more li$ely to cause in'ection- %ites 'rom nonimmuni?ed domestic animals and ,ild animals carry t(e ris$ o' rabies- Rabies is more common in raccoons0 s$un$s0 bats and 'oxes t(an in cats and dogs- Rabbits0 s>uirrels and ot(er rodents rarely carry rabies- 7' an animal bites you or your c(ild0 'ollo, t(ese guidelines: or &inor 4oun%s. 7' t(e bite barely brea$s t(e s$in and t(ere is no danger o' rabies0 treat it as a minor ,ound- Ias( t(e ,ound t(oroug(ly ,it( soap and ,ater- Apply an antibiotic cream to prevent in'ection and cover t(e bite ,it( a clean bandage or %ee' 4oun%s. 7' t(e animal bite creates a deep puncture o' t(e s$in or t(e s$in is badly torn and bleeding0 apply pressure ,it( a clean0 dry clot( to stop t(e bleeding and see your doctor or in1e+tion. 7' you notice signs o' in'ection suc( as s,elling0 redness0 increased pain or oo?ing0 see your doctor immediately-

167

 or sus'e+te% ra/ies. 7' you suspect t(e bite ,as caused by an animal t(at mig(t carry rabies X any bite 'rom a ,ild or domestic animal o' un$no,n immuni?ation status X see your doctor immediatelyDoctors recommend getting a tetanus s(ot every 4= years- 7' your last one ,as more t(an 'ive years ago and your ,ound is deep or dirty0 your doctor may recommend a booster- Lou s(ould (ave t(e booster ,it(in 6C (ours o' t(e in1uryall 're.ention0 ; 4a*s to re%u+e *our 1allin- ris,JJJ alls 'ut *ou at ris, o1 serious inBur*. Pre.ent 1alls 4it2 t2ese 1all-'re.ention &easures. Lour odds o' 'alling eac( year a'ter age 8< are about one in t(ree- Fortunately0 most o' t(ese 'alls arenQt serious- *till0 'alls are t(e leading cause o' in1ury and in1ury)related deat( among older adults- LouQre more li$ely to 'all as you get older because o' common0 age)related p(ysical c(anges and medical conditions X and t(e medications you ta$e to treat suc( conditionsLou neednQt let t(e 'ear o' 'alling rule your li'e- any 'alls and 'all)related in1uries are preventable ,it( 'all) prevention measures- HereQs a loo$ at six 'all)prevention approac(es t(at can (elp you avoid 'allsall-'re.ention ste' !0 Ma,e an a''oint&ent 4it2 *our %o+tor %egin your 'all)prevention plan by ma$ing an appointment ,it( your doctor- Lou and your doctor can ta$e a compre(ensive loo$ at your environment0 your (ealt( and your medications to identi'y situations ,(en youQre vulnerable to 'alling- 7n order to devise a 'all)prevention plan0 your doctor ,ill ,ant to $no,: W2at &e%i+ations are *ou ta,in-K 7nclude all t(e prescription and over)t(e)counter medications you ta$e0 along ,it( t(e dosages- Or bring t(em all ,it( you- Lour doctor can revie, your medications 'or side e''ects and interactions t(at may increase your ris$ o' 'alling- 3o (elp ,it( 'all prevention0 (e or s(e may decide to ,ean you o'' certain medications0 especially t(ose used to treat anxiety and insomnia Ha.e *ou 1allen /e1oreK Irite do,n t(e details0 including ,(en0 ,(ere and (o, you 'ell- %e prepared to discuss instances ,(en you almost 'ell but managed to grab (old o' somet(ing 1ust in time or ,ere caug(t by someone Coul% *our 2ealt2 +on%itions +ause a 1allK Lour doctor li$ely ,ants to $no, about eye and ear disorders t(at may increase your ris$ o' 'alls- %e prepared to discuss t(ese and to tell (im or (er (o, you ,al$ X describe any di??iness0 1oint pain0 numbness or s(ortness o' breat( t(at a''ects your ,al$- Lour doctor may t(en evaluate your muscle strengt(0 balance and individual ,al$ing style .gait/all-'re.ention ste' (0 Cee' &o.in7' you arenQt already getting regular p(ysical activity0 consider starting a general exercise program as part o' your 'all)prevention plan- Consider activities suc( as ,al$ing0 ,ater ,or$outs or tai c(i X a gentle exercise t(at involves slo, and grace'ul dance)li$e movements- *uc( activities reduce your ris$ o' 'alls by improving your strengt(0 balance0 coordination and 'lexibility- %e sure to get your doctorQs OG 'irst0 t(oug(7' you avoid exercise because youQre a'raid it ,ill ma$e a 'all more li$ely0 bring t(is concern to your doctorHe or s(e may recommend care'ully monitored exercise programs or give you a re'erral to a p(ysical t(erapist ,(o can devise a custom exercise program aimed at improving your balance0 muscle strengt( and gait- 3o improve your 'lexibility0 t(e p(ysical t(erapist may use tec(ni>ues suc( as electrical stimulation0 massage or ultrasound- 7' you (ave inner ear problems t(at a''ect your balance0 (e or s(e may also teac( you balance retraining exercises .vestibular re(abilitation/ X ,(ic( involve speci'ic (ead and body movements to correct loss o' balanceall-'re.ention ste' )0 Wear sensi/le s2oes Consider c(anging your 'oot,ear as part o' your 'all)prevention plan- Hig( (eels0 'loppy slippers and s(oes ,it( slic$ soles can ma$e you slip0 stumble and 'all- *o can ,al$ing in your stoc$ing 'eet- 7nstead: Have your 'eet measured eac( time you buy s(oes0 since your si?e can c(ange %uy properly 'itting0 sturdy s(oes ,it( nons$id soles-

168

Avoid s(oes ,it( extra)t(ic$ solesC(oose lace)up s(oes instead o' slip)ons0 and $eep t(e laces tied*elect 'oot,ear ,it( 'abric 'asteners i' you (ave trouble tying laces*(op in t(e menQs department i' youQre a ,oman ,(o canQt 'ind ,ide enoug( s(oes-

7' bending over to put on your s(oes puts you o'' balance0 consider a long s(oe(orn t(at (elps you slip your s(oes on ,it(out bending over-

all-'re.ention ste' :0 Re&o.e 2o&e 2a6ar%s As part o' your 'all)prevention measures0 ta$e a loo$ around you X your living room0 $itc(en0 bedroom0 bat(room0 (all,ays and stair,ays may be 'illed ,it( booby traps- Clutter can get in your ,ay0 but so can t(e decorative accents you add to your (ome- 3o ma$e your (ome sa'er0 you mig(t try t(ese tips: Remove boxes0 ne,spapers0 electrical cords and p(one cords 'rom ,al$,ays ove co''ee tables0 maga?ine rac$s and plant stands 'rom (ig()tra''ic areas-

*ecure loose rugs ,it( double)'aced tape0 tac$s or a slip)resistant bac$ing Repair loose0 ,ooden 'loorboards and carpeting rig(t a,ay *tore clot(ing0 dis(es0 'ood and ot(er (ouse(old necessities ,it(in easy reac( 7mmediately clean spilled li>uids0 grease or 'ood Dse nons$id 'loor ,ax Dse nonslip mats in your bat(tub or s(o,erall-'re.ention ste' D0 Li-2t u' *our li.in- s'a+e As you get older0 less lig(t reac(es t(e bac$ o' your eyes ,(ere you sense color and motion- *o $eep your (ome brig(tly lit ,it( 4==),att bulbs or (ig(er to avoid tripping on ob1ects t(at are (ard to see- DonQt use bulbs t(at exceed t(e ,attage rating on lamps and lig(ting 'ixtures0 (o,ever0 since t(is can present a 'ire (a?ard- Also: Place a lamp near your bed and ,it(in reac( so t(at you can use it i' you get up at nig(t a$e lig(t s,itc(es more easily accessible in rooms- a$e a clear pat( to t(e s,itc( i' it isnQt rig(t near t(e room entrance- Consider installing glo,)in)t(e)dar$ or illuminated s,itc(es Place nig(t lig(ts in your bedroom0 bat(room and (all,ays 3urn on t(e lig(ts be'ore going up or do,n stairs- 3(is mig(t re>uire installing s,itc(es at t(e top and bottom o' stairs *tore 'las(lig(ts in easy)to)'ind places in case o' po,er outagesall-'re.ention ste' ;0 Use assisti.e %e.i+es Lour doctor mig(t recommend using a cane or ,al$er to $eep you steady- Ot(er assistive devices can (elp0 too- All sorts o' gadgets (ave been invented to ma$e everyday tas$s easier- *ome you mig(t consider: "rab bars mounted inside and 1ust outside your s(o,er or bat(tub A raised toilet seat or one ,it( armrests to stabili?e yoursel' A sturdy plastic seat placed in your s(o,er or tub so t(at you can sit do,n i' you need to- %uy a (and)(eld s(o,er no??le so t(at you can s(o,er sitting do,n Handrails on bot( sides o' stair,ays Nonslip treads on bare),ood stepsAs$ your doctor 'or a re'erral to an occupational t(erapist ,(o can (elp you devise ot(er ,ays to prevent 'alls in your (ome- *ome solutions are easily installed and relatively inexpensive- Ot(ers may re>uire

169

pro'essional (elp and more o' an investment- 7' you plan on staying in your (ome 'or many more years0 an investment in sa'ety and 'all prevention no, may ma$e t(at possibleInse+t /ites an% stin-s0 irst ai%JJJ

*igns and symptoms o' an insect bite result 'rom t(e in1ection o' venom or ot(er substances into your s$in3(e venom triggers an allergic reaction- 3(e severity o' your reaction depends on your sensitivity to t(e insect venom or substanceost reactions to insect bites are mild0 causing little more t(an an annoying itc(ing or stinging sensation and mild s,elling t(at disappear ,it(in a day or so- A delayed reaction may cause 'ever0 (ives0 pain'ul 1oints and s,ollen glands- Lou mig(t experience bot( t(e immediate and t(e delayed reactions 'rom t(e same insect bite or sting- Only a small percentage o' people develop severe reactions .anap(ylaxis/ to insect venom- *igns and symptoms o' a severe reaction include 'acial s,elling0 di''iculty breat(ing and s(oc$%ites 'rom bees0 ,asps0 (ornets0 yello, 1ac$ets and 'ire ants are typically t(e most troublesome- %ites 'rom mos>uitoes0 tic$s0 biting 'lies and some spiders also can cause reactions0 but t(ese are generally milderor &il% rea+tions0 ove to a sa'e area to avoid more stings-

*crape or brus( o'' t(e stinger ,it( a straig(t)edged ob1ect0 suc( as a credit card or t(e bac$ o' a $ni'e- Ias( t(e a''ected area ,it( soap and ,ater- DonQt try to pull out t(e stinger2 doing so may release more venom 3o reduce pain and s,elling0 apply a cold pac$ or clot( 'illed ,it( ice Apply =-< percent or 4 percent (ydrocortisone cream0 calamine lotion or a ba$ing soda paste X ,it( a ratio o' 9 teaspoons ba$ing soda to 4 teaspoon ,ater X to t(e bite or sting several times a day until your symptoms subside 3a$e an anti(istamine containing dip(en(ydramine .%enadryl0 3ylenol *evere Allergy/ or c(lorp(eniramine maleate .C(lor)3rimeton0 3eldrin/Allergic reactions may include mild nausea and intestinal cramps0 diarr(ea or s,elling larger t(an 5 inc(es in diameter at t(e site- *ee your doctor promptly i' you experience any o' t(ese signs and symptomsor se.ere rea+tions0 *evere reactions may progress rapidly- Dial E44 or call 'or emergency medical assistance i' t(e 'ollo,ing signs or symptoms occur: Di''iculty breat(ing *,elling o' your lips or t(roat Faintness Di??iness Con'usion Rapid (eartbeat Hives Nausea0 cramps and vomiting

3a$e t(ese actions immediately ,(ile ,aiting ,it( an a''ected person 'or medical (elp: 4- C(ec$ 'or special medications t(at t(e person mig(t be carrying to treat an allergic attac$0 suc( as an auto)in1ector o' epinep(rine .'or example0 !piPen/- Administer t(e drug as directed X usually by pressing t(e auto)in1ector against t(e personQs t(ig( and (olding it in place 'or several secondsassage t(e in1ection site 'or 4= seconds to en(ance absorption5- A'ter administering epinep(rine0 (ave t(e person ta$e an anti(istamine pill i' (e or s(e is able to do so ,it(out c(o$ing9- Have t(e person lie still on (is or (er bac$ ,it( 'eet (ig(er t(an t(e (ead-

170

6- &oosen tig(t clot(ing and cover t(e person ,it( a blan$et- DonQt give anyt(ing to drin$<- 7' t(ereQs vomiting or bleeding 'rom t(e mout(0 turn t(e person on (is or (er side to prevent c(o$ing8- 7' t(ere are no signs o' circulation .breat(ing0 coug(ing or movement/0 begin CPR-

htt '/////.redcross.org

RESPIRATORY ARREST
Respiratory Arrest .)/ RR .J/ PR-

A condition o' t(e victim ,(erein t(ere is no breat(ing but pulse continues

CAD*!*: 4596<8*trangulation Poisoning)7n1ection0 7ngestion0 7n(alation 7n1ection) *na$ebite0 Rabies0 *corpions0 bees0 1elly'is(0 spiders *evere %leeding Dro,ning !lectrocution *u''ocation C(o$ing: Dniversal *ign o' C(o$ing) palms guarding t(roat Disease

7.
C-

3HR!! .9/ G7ND* OF A7RIAL O%*3RDC37ON Cin% O Air4a* O/stru+tion Iit( "ood Air !xc(ange Iit( Poor Air !xc(ange 3otal Air,ay Obstruction ,it( No Air !xc(ange Si-ns #ictim can still 3A&G #ictim produces ,(ee?ing sound Dnconscious irst Ai% Observe t(e victim as (e coug( out obstruction Abdominal 3(rust @ Heimlic( aneuver 4- Abdominal 3(rust 4=N %lind Finger s,eep 'or adults 5- Arti'icial Respiration .AR/ 5N 9- C(ec$ i' Air is going bac$) &oo$0 &isten & Feel .&&F/ 6- Repeat blind 'inger s,eep <- Arti'icial Respiration 5N i' e''ective First Aid: Arti'icial Respiration .AR/ + "iving o' arti'icial air only eit(er t(roug( a blo, or ambubag ) c(est compression not indicated because t(ere is pulse rate !3HOD* 7N "7#7N" AR37F7C7A& R!*P7RA37ON

1. 2. 3. 4.
<8-

out( to out( to

out( ) usual met(od out( & Nose + used in in'ants

out( to Nose ) i' mout( is obstructed out( to *toma ) li$e 'or patients ,it( trac(eostomy out( to as$ Ambu %ag to out( & Nose Ambu %ag) a device used 'or arti'icial mec(anical breat(ing unit

171

ADD&3 !3HOD anner o' %reat(ing Rate o' %lo,s out( 3O out(

CH7&D out( 3O out(

7NFAN3 out( 3O out( & Nose Pu'' 4 %lo, every 9 seconds 5= blo,s per min

Full and *lo, 4 %lo, every < secs 45 blo,s per min

Regulated 4 %lo, every 6 secs 4< blo,s per min

*3AR3 I73H A %&OI AND !ND I73H A %&OI IH!N 3O *3OP 459I(en t(e rescuer is ex(austed I(en t(e victim is breat(ing on (is o,n I(en t(e service o' t(e p(ysician is available I(en t(e pulse disappears2 arti'icial respiration is stopped and cardiopulmonary rescucitation begins I(en anot(er 'irst aider ta$es over

4.
<-

CARDIAC ARREST
Condition o' t(e victim ,(en t(e pulse and breat(ing is absent-

7ntervention 'or Cardiac Arrest: CPR CPR) Cardio Pulmonary Resuscitation ) A combination o' external c(est compression and arti'icial ventilations to revive t(e (eart and t(e lungs CAD*!* All causes o' Respiratory Arrest0 Heart Attac$0 *tro$e &ocation O' C(est Compressions Danger o' Failure to revive Patient: 4- C&7N7CA& D!A3H) may occur i' (eart rate is not revived ,it(in 6)8 minutes 5- %7O&O"7CA& D!A3H) usually occurs a'ter 6)8 mins o' cardiac arrest

1.
5-

ADD&3) 9 'ingers above mid xip(oid 7NFAN3) along nipple line

ADULT et(od Dept( Rate *peed 5 Heels o' 5 Hands 4 U;) 5B 4< !CC@5 blo,s 6N@min 8=)C= !CC@min 45N@min 5 R!*CD!R* DON;3;* 7N CPR: 4596<8Don;t be a double crosser Don;t be a roc$er Don;t be a 1er$er Don;t be a render Don;t be a bouncer Don;t be a massager

CHILD 4 Heel o' 4 (and 4B) 4 UB <!CC@4 blo, 4<N@min C=)4== !CC@min

IN ANT 5 Fingers .ring and mid 'inger/ UB + 4B <!CC@4 blo, 5=N@min 4==)45= !CC@min

< !CC@4 blo,

CPR) start ,it( 5 blo,s end ,it( 5 blo,s

172

*!:D!NC!: 4596<8HC*urvey t(e scene A t(e scene is sa'eB C(ec$ 'or responsiveness A Hey 5N0 R D O$ayB Position t(e victim Open and Clear t(e air,ay .(ead tilt c(in li't/ A out( is clearB C(ec$ breat(ing 'or 9)< seconds .&&F/ 4==40 4==50 etc- A%reat(lessB 7' %reat(less0 give 5 blo,s C(ec$ 'or Pulse: Carotid <)4= seconds *tate t(e condition o' t(e victim A#ictim is breat(less ,it( pulseB or A#ictim is breat(less & pulse lessB E- Activate medical assistance AArrange trans'er 'acilities and 7;ll doWAR or CPRB 4=- A'ter eac( cycle0 c(ec$ pulse 'or < sec- t(en deliberate 44- Recovery Position

173