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Monday, June 30, 2008

Medical Surgical Nursing: Sjögren's syndrome

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Sjögren's syndrome is an autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva. It is named after Swedish ophthalmologist Henrik Sjögren (1899-1986), who first described it. Sjögren's syndrome is also associated with rheumatic disorders such as rheumatoid arthritis, and it is rheumatoid factor positive in 90 percent of cases. The hallmark symptoms of the disorder are dry mouth and dry eyes (part of what are known as sicca symptoms). In addition, Sjögren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, and brain. Nine out of ten Sjögren's patients are women and the average age of onset is late 40s, although Sjögren's occurs in all age groups in both women and men. It is estimated to strike as many as 4 million people in the United States alone making it the second most common autoimmune rheumatic disease.

Treatment of Sjögren's syndrome

There is neither a known cure for Sjögren's syndrome nor a specific treatment to permanently restore gland secretion. Instead, treatment is generally symptomatic and supportive. Moisture replacement therapies such as artificial tears may ease the symptoms of dry eyes (some patients with more severe problems use goggles to increase local humidity or have punctal plugs inserted to help retain tears on the ocular surface for a longer time). Additionally, Cyclosporin (Restasis) is available by prescription to help treat chronic dry eye by suppressing the inflammation that disrupts tear secretion. Prescription drugs are also available that help to stimulate salivary flow, such as cevimeline and pilocarpine. Nonsteroidal anti-inflammatory drugs may be used to treat musculoskeletal symptoms. For individuals with severe complications, corticosteroids or immunosuppressive drugs may be prescribed. Also, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may be helpful.

Prognosis for Sjögren's syndrome

Sjögren's can damage vital organs of the body with symptoms that may plateau or worsen, but the disease does not go into remission as with other autoimmune diseases. Some people may experience only the mild symptoms of dry eyes and mouth, while others have symptoms of severe disease. Many patients are able to treat problems symptomatically. Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty in swallowing and eating. Debilitating fatigue and joint pain can seriously impair quality of life. Some patients can develop renal involvement (autoimmune tubulointerstitial nephritis) leading to proteinuria, urinary concentrating defect and distal renal tubular acidosis.

Patients with Sjögren's syndrome have a higher rate of non-Hodgkin lymphoma compared to both patients with other autoimmune diseases and healthy people.[2] About 5% of patients with Sjögren's syndrome will develop some form of lymphoid malignancy.[3] Patients with severe cases are much more likely to develop lymphomas than patients with mild or moderate cases.[4] The most common lymphomas are salivary extranodal marginal zone B cell lymphomas (MALT lymphomas in the salivary glands)[2] and diffuse large B-cell lymphoma.[4]


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Saturday, June 28, 2008

June 2008 NLE Nursing Board Exam Results

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More or less the June 2008 NLE Nursing Board Exam Results will be release around the 3rd week of August. Estimated date of the Release of the June 2008 is August 15, 2008.

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Osteoporosi and Smoking: How Smoking Affects Osteoporosis

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How Smoking Affects Osteoporosis

Smoking affects your bones. When you smoke, you put yourself at risk for a condition that causes loss of bone mass. The name of the condition is osteoporosis (OSS-tee-oh-por-OH-sis). When bones lose mass, they weaken, and weak bones can easily break (fracture).

Q: What makes bones strong?
A: Bone is a living organ made from several substances. Collagen (CALL-uh-jen) forms the framework of the bone. The mineral calcium is deposited into this framework. For bones to grow strong and stay strong, they need calcium. Inside our bones, a constant process of renewal
goes on. Some cells in the bone are called osteoclasts (OSS-tee-oh-klasts). Their job is to break down old bone. Just as fast, other cells use calcium to build up new bone. These cells are called osteoblasts (OSS-tee-oh blasts). This process of renewal helps to keep our bones healthy and strong.

Q: How does smoking affect my bones?
A: Smoking reduces the amount of calcium your bones absorb. Vitamin D helps bones to absorb calcium, but smoking interferes with how your body uses vitamin D. Less calcium is then available to build strong bones. As a result, your bones start to get brittle. Smoking lowers estrogen levels in both men and women. Estrogen is important because it helps the bones to hold calcium and other minerals that make them strong. At menopause, a woman’s body makes much less estrogen, and this puts her naturally at risk for osteoporosis. Smoking increases her risk even more. To hold calcium, the bones also need help from weight-bearing exercise, such as walking. Smokers, however, tend to get less exercise than non-smokers do. Smoking
is also toxic to osteoblasts (bone forming cells).

Q: How does smoking increase the risk of osteoporosis?
A: Smoking during your bone-building years makes your bone mass peak at a lower level. This puts you at risk for osteoporosis in later years. Smoking after age 30 speeds up your loss of bone mass — it occurs 1.5 to 2 times faster. Your whole body loses bone mass, but the hip, spine, and wrist are the most affected. The more you smoke, the greater your risk for osteoporosis.

Q: Do both male and female smokers increase their risk for osteoporosis?
A: Yes. Osteoporosis risk is 2.5 times greater for male and female smokers than for non-smokers. Both male and female smokers have lower bone mineral density than non-smokers of the same age and sex. The bone mineral content of female smokers is 15 to 30 percent less than that of non-smokers. The bone mineral content of male smokers is 10 to 20 percent less than that of non-smokers.

Q: Are any bones more at risk for a fracture among smokers?
A: Yes. The hips and spine are especially at risk for a fracture when you smoke. Smokers have 2 to 4 times more risk than non-smokers of a hip fracture linked to osteoporosis. Smokers also have greater risk for fractures of the spine.

Q: Can I smoke and use medicine to prevent osteoporosis?
A: If you take estrogen to increase your bone density to prevent osteoporosis, smoking will reduce the drug’s ability to work.

Q: Does second-hand smoke have any effect on my bones?
A: Breathing second-hand smoke affects your bones the same way that smoking does.

Q: If I quit smoking, will it help my bones?
A: You eliminate one of the causes of osteoporosis when you quit smoking


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Thursday, June 26, 2008

Kaplan NCLEX Trainer Notes 3

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Women need 1200-1500 kcal/day (men need 1500-1899 kcal/day); women need 15mg/day of iron (men need 10mg/day); with pregnancy 30mg required

Hemolytic reaction when tranfusing blood includes chills, headache, backache, dyspnea, cyanosis, chest pains, tachycardia, and hypotension.

Glycosylated Hemoglobin assay (BhA1c) test indates how well blood suger has been controlled during the past 6-8 weeks.

Primary goal of a reminiscing group for geriatric clients is to review and hsare their live experiences with the group members.

Symptoms associated with hypercalcemia are constipation, decreased reflexes, decreased muscle strength.

Miller-Abbott tube provides intestinal decompression; intestinal tube is often used for treatment of paralytic ileus

Promethazine hydrocloride (Phenergan) - nurse should check patency of the patient's vein; extravasation will cause necrosis.

Buerger's disease - digital sensitivity to cold; vasculitis of blood vessels in upper and lower extremities.

Continuous bladder irrigation (CBI) is necessary because it enables urine to keep flowing; prevents formation of clots that can lead to obstruction and spasm in the postoperative TURP client.
Pain related to a gastric ulcer occurs about one-half to one hour after a meal and rarely at night; is not helped by ingestion of food

To auscultate patient's right middle lobe (RML), RML is found in the right anterior chest between the fourth and sixth intercostal spaces.
Characteristics of Mania --- agitation, grandiose delusions, euphoria, difficulty concentrating

Characteristics of Sxhizonphrenia -- Paranoia, hallucinations, disturbed thought processes, hypervigilance.

Meniere's disease - Stand in front of the patient so that the client does not have to turn her head to see the nurse; by decreasing movement of the client's head, vertigo attacks may be decreased.

Use standard precautions is method of transmission is saliva, feces and blood; use contact isolation if fecal incontinence.

Play theraphy is suggested for children undergoing a stressful event because they have diffulty putting feelings into words; play is how they express themselves.

Normal PT 11-15 sec, normal Hgb male : 13.5-17.5 g/dl, female: 12-16 g/dl

Normal BUN 10-20 mg/dl, normal creatine 0.6-1.2 mg/dl

Normal Ca+ 4.5-5.3 mEq/L

Normal AST (SGOT) 8-20 U/L, normal ALT (SGPT) 8-20 U/L

Fluid challenge test is used to rule out dehydration as the cause of oliguria. Expected response after a fluid challenge on normally functioning kidneys is an increase in urine output; will occur if low urine output is due to dehydration; if it is due to acute renal failure, there will continue to be oliguria.

Normal specific gravitity is 1.010-1.030

Chlorpromazine (Thorazine) medication is contraindicated for the treatment of alcohol withdrawal symptoms; medication will lower client's seizure threshold and BP, causing potentially serious medical consequences.

Low intestinal obstruction, nurse would anticipate that the client's abdomen will be distended, nausea, vomiting; no stool, as motility distal to (below) the obstruction would cease

Why are we not using beef or pork insulin and only human insulin? Human insulin does nto cause the formation of antibodies because the protein structure is identical to your own.
Approx. 65% of AIDS clients demonstrate a progressive dementia staged according to severity of debilitation; late stage ois typified by cognitive confusion and disorientation.

Two major side effects of haloperidol (Haldol) is hematologic problems primarily blood syscrasia and extrapyramidal symptom (EPS)

Taken from Kaplan Nclex Trainer Explanation Test 2











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Wednesday, June 25, 2008

Medical Surgical Nursing: Autonomic Dysreflexia / Hyperreflexia

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Autonomic dysreflexia, also known as hyperreflexia, is a state that is unique to patients after spinal cord injury at a T-5 level and above. Patients with spinal cord injuries at Thoracic 5 (T-5) level and above are very susceptible. Patients with spinal cord injuries at Thoracic 6 - Thoracic 10 (T6-T10) may be susceptible. Patients with Thoracic 10 (T-10) and below are usually not susceptible. Also, the older the injury the less likely the person will experience autonomic dysreflexia.

Autonomic dysreflexia can develop suddenly, and is a possible emergency situation. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.

Autonomic dysreflexia means an over-activity of the Autonomic Nervous System. It can occur when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure. Nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain. The brain sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate. However, the brain cannot send messages below the level of injury, due to the spinal cord lesion, and therefore the blood pressure cannot be regulated.


Symptoms and Causes of Autonomic Dysreflexia

* Pounding headache (caused by the elevation in blood pressure)
* Goose Pimples
* Sweating above the level of injury
* Nasal Congestion
* Slow Pulse
* Blotching of the Skin
* Restlessness

There can be many stimuli that cause autonomic dysreflexia. Anything that would have been painful, uncomfortable, or physically irritating before the injury may cause autonomic dysreflexia after the injury.

The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder. The second most common cause is a bowel that is full of stool or gas. Any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia.

Other causes include skin irritations, wounds, pressure sores, burns, broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.

Treatment of autonomic dysreflexia must be initiated quickly to prevent complications.

Remain in a sitting position, but do a pressure release immediately. You may transfer yourself to bed, but always keep your head elevated.

Since a full bladder is the most common cause, check the urinary drainage system. If you have a Foley or suprapubic catheter, check the following:

Is your drainage full?
Is there a kink in the tubing?
Is the drainage bag at a higher level than your bladder?
Is the catheter plugged?

After correcting an obvious problem, and if your catheter is not draining within 2-3 minutes, your catheter must be changed immediately. If you do not have a Foley or suprapubic catheter, perform a catheterization and empty your bladder.

If your bladder has not triggered the episode of autonomic dysreflexia, the cause may be your Bowel. Perform a digital stimulation and empty your bowel. If you are performing a digital stimulation when the symptoms first appear, stop the procedure and resume after the symptoms subside.

If your bladder or bowel are not the cause, check to see if:

You have a pressure sore
You have an ingrown toenail
You have a fractured bone.



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Tuesday, June 24, 2008

Medical Surgical Nursing: Kawasaki Disease

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Kawasaki disease illness mucocutaneous lymph node syndrome



First identified in Japan in 1967, Kawasaki disease (also called mucocutaneous lymph node syndrome) affects young children, usually under the age of 5. It is believed to be caused by a noncontagious infection, although scientists are unsure of the exact cause.

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups.

Signs and Symptoms of Kawasaki Disease
Kawasaki disease can't be prevented, but usually has telltale symptoms and signs that appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever higher than 104° Fahrenheit (39° Celsius) and lasts for at least 5 days.

Other symptoms that typically develop include:

* severe redness in the eyes
* a rash on the stomach, chest, and genitals
* red, dry, cracked lips
* swollen tongue with a white coating and big red bumps
* sore, irritated throat
* swollen palms of the hands and soles of the feet with a purple-red color
* swollen lymph nodes


During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. The child also may experience joint pain, diarrhea, vomiting, or abdominal pain. If your child shows any of these symptoms, call your doctor.

Complications of Kawasaki Disease
Doctors can manage the symptoms of Kawasaki disease if they catch it early. Symptoms often disappear within just 2 days of the start of treatment. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop.

Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.

Diagnosis of of Kawasaki Disease
No one test can detect Kawasaki disease, so doctors usually diagnose it by evaluating the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

* redness in both eyes
* changes around the lips, tongue, or mouth
* changes in the fingers and toes, such as swelling, discoloration, or peeling
* a rash in the trunk or genital area
* a large swollen lymph node in the neck
* red, swollen palms of hands and soles of feet


If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.

Treatment for Kawasaki disease
Treatment should begin as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. The child also might be given a high dose of aspirin to reduce the risk of heart problems.


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Monday, June 23, 2008

Kaplan NCLEX Trainer Notes 2

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Hemophilia is a sex-linked disorder. A mother who is a carrier has a 50% chance of passing the faulty X chromosome to her daughter, while an affected father will always pass on the affected gene to his daughters. A son cannot inherit the defective gene from his father.

There are two main types of hemophilia. If you have hemophilia A, you have little to no clotting factor VIII (8). About 9 out of 10 people with hemophilia have type A. If you have hemophilia B, you’re missing or have low levels of clotting factor IX (9).

Pincher grasp present at nine months of age

Posterior fontanels closed by two to three months

Phobias involves projection and displacement.

An infant with fetal alcohol syndrome will have a small head circumference, low birth weight and underveloped cheekbones.
Hydromorphone hydrochloride (Dilaudid) is a narcotic analgesic used for moderate to severe pain, monitor vital signs frequently.

Chlorpromazine hydrocloride (Thorazine) extrapyramidal side effects includes akathisia (motor restlessness), dystonias (protrusio of tongue, abnormal posturing), pseudoparkinsonism (tremors, rigidity), dyskinesia (still neck, difficulty swallowing)

1 grain (gr) = 60mg

Right upper quadrant pain to diagnose cholecyctitis

Tremors, elevated temperature and pain symptoms are indicative of an alcohol-related problem

Long term use of ceftriaxone sodium (Rocephin) can cause overgrouth of organisms; monitoring of tongue and oral cavity is recommended.
Client with hypothyroidism are very sensitive to narcotics, barbiturates and anesthetics


When performing a Rinne tests, the stem of a vibrating tuning fork is held against the mastoid bone until the child indicates that she can no longer hear the sound. Then the tuning fork is moved in front of the auditory canal.

Clomiphene citrate (Clomid) induce ovulation by changing hormonal effects n the ovary. It alters estrogen and stimulating follicular growth to produce a mature ovum.

Naproxen sodium (Naprosyn) is an NSAID used as analgesic; side effects include headache, dizziness, GI distress, pruitus and rash. Assess the patient for fluid retention and dizziness.

Cortisol is responsible for converting proteins and fat into glucose; is also an antiflamatory agent.

Verapamil (Isoptin) is indicated for the treatment of supraventricular tachycardias, so the client's heart rate should be checked prior to administration

Breastfeeding mothers are advice to increase their caloric intake because milk productions requires an increase of 500 calories per day.

Digoxin increases the force of myocardial contraction.

Pacemaker increase the cardiac output; acts to regulate cardiac rhythm.

Quinidine prevent premature ventricular contractions (PVCs); antiarrhythmics

Lasiz prevent systemic overload; diuretics

With lead poisioning, milk provides a large amount of vitamin D; vitamin D optimizes depoosition of lead in the long bones; purpoase of the treatment is to remove lead from the blood and soft tissues.

An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses contrast material.

SIDS is a support group of parents who have had an infant die from sudden infant death syndrome

SHARE is a support group for parents who have lost a newborn or have experienced a miscaarriage

RESOLVE is a support group for infertile clients

CANDLELIGHTERS is a support group for families who have lost a child to cancer

Accurate intake and output is the best indicator for fluid status.

Taken from Kaplan NCLEX Training Explanation 1


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Saturday, June 21, 2008

Medical Surginal Nursing: CHOLECYCTITIS

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CHOLECYCTITIS

Background: Cholecystitis is defined as inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct from cholelithiasis. Ninety percent of cases involve stones in the cystic duct (ie, calculous cholecystitis), with the other 10% representing acalculous cholecystitis. Although bile cultures are positive for bacteria in 50-75% of cases, bacterial proliferation may be a result of cholecystitis and not the precipitating factor. Risk factors for cholecystitis mirror those for cholelithiasis and include increasing age, female sex, certain ethnic groups, obesity or rapid weight loss, drugs, and pregnancy.

Acalculous cholecystitis is related to conditions associated with biliary stasis, including debilitation, major surgery, severe trauma, sepsis, long-term total parenteral nutrition (TPN), and prolonged fasting. Other causes of acalculous cholecystitis include cardiac events; sickle cell disease; Salmonella infections; diabetes mellitus; and cytomegalovirus, cryptosporidiosis, or microsporidiosis infections in patients with AIDS.

Pathophysiology: Acute calculous cholecystitis is caused by obstruction of the cystic duct, leading to distention of the gallbladder. As the gallbladder becomes distended, blood flow and lymphatic drainage are compromised, leading to mucosal ischemia and necrosis. A study by Cullen et al (2000) demonstrated the ability of endotoxin to cause necrosis, hemorrhage, areas of fibrin deposition, and extensive mucosal loss, consistent with an acute ischemic insult. Endotoxin also abolished the contractile response to cholecystokinin (CCK), leading to gallbladder stasis.

Although the exact mechanism of acalculous cholecystitis is unclear, a couple of theories exist. Injury may be the result of retained concentrated bile, an extremely noxious substance. In the presence of prolonged fasting, the gallbladder never receives a CCK stimulus to empty; thus, the concentrated bile remains stagnant in the lumen.

Frequency:

In the US: An estimated 10-20% of Americans have gallstones, and as many as one third of these people develop acute cholecystitis. Cholecystectomy for either recurrent biliary colic or acute cholecystitis is the most common major surgical procedure performed by general surgeons, resulting in approximately 500,000 operations annually.

Mortality/Morbidity:

Most patients with acute cholecystitis have a complete remission within 1-4 days. However, 25-30% of patients either require surgery or develop some complication.
Patients with acalculous cholecystitis have a mortality rate ranging from 10-50%, which far exceeds the expected 4% mortality rate observed in patients with calculous cholecystitis. Emphysematous cholecystitis has a mortality rate approaching 15%.
Perforation occurs in 10-15% of cases.
Race:



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Medical Surgical Nursing: Understanding Hemophilia

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What Is Hemophilia?

Hemophilia (heem-o-FILL-ee-ah) is a rare, inherited bleeding disorder in which your blood doesn’t clot normally. If you have hemophilia, you may bleed for a longer time than others after an injury. You also may bleed internally, especially in your knees, ankles, and elbows. This bleeding can damage your organs or tissues and, sometimes, be fatal.

The effects of this sex-linked, X chromosome disorder are manifested almost entirely in males, although the gene for the disorder is inherited from the mother. Females have two X chromosomes while males have only one, lacking a 'back up' copy for the defective gene. Females are therefore almost exclusively carriers of the disorder, and may have inherited it from either their mother or father. In about 30% of cases of Hemophilia B, however, there is no family history of the disorder and the condition is the result of a spontaneous gene mutation[2]. A mother who is a carrier has a 50% chance of passing the faulty X chromosome to her daughter, while an affected father will always pass on the affected gene to his daughters. A son cannot inherit the defective gene from his father.


People born with hemophilia have little to none of a protein needed for normal blood clotting. The protein is called a clotting factor. There are several types of clotting factors, and they work together with platelets to help the blood clot. Platelets are small pieces of blood cells that are formed in the bone marrow. They play a major role in blood clotting.

When blood vessels are injured, clotting factors help the platelets stick together to plug cuts and breaks at the site of the injury to stop the bleeding. Without clotting factors, normal blood clotting can’t take place. Sometimes people with hemophilia need injections of a clotting factor or factors to stop bleeding.

There are two main types of hemophilia. If you have hemophilia A, you have little to no clotting factor VIII (8). About 9 out of 10 people with hemophilia have type A. If you have hemophilia B, you’re missing or have low levels of clotting factor IX (9).

Hemophilia can be mild, moderate, or severe, depending on how much clotting factor is in the blood. About 7 out of 10 people who have hemophilia A have the severe form of the disorder. People who don’t have hemophilia have a factor VIII activity of 100 percent; people who have severe hemophilia A have a factor VIII activity of less than 1 percent.

In addition to being inherited, hemophilia also can be acquired, which means that you can develop it during your lifetime. It can develop if your body forms antibodies to the clotting factors in your bloodstream. The antibodies can block the clotting factors from working. Only inherited hemophilia is discussed in this article.

About 18,000 people in the United States have hemophilia. Each year, about
400 babies are born with the disorder. Hemophilia usually occurs only in males (with very rare exceptions).


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Friday, June 20, 2008

Arterial Blood Gas Analysis Made Easy

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PH
7.34-7.45

PaCO2
35 to 45mm Hq

HCO3
22-26mEq/L

Step 1:
Look at the PH firse. Draw an arrow if it is alow or high.An arrpw indocating low means acidosis. An arrow indicating high means alkalosis.
Next, loook at the resporatory indicator (PaCO2). Draw an arrowif it is low or high.

Step 2:
If the arrows are in the opposite direction, the problem is respiratory in nature-either resp.acidosis or resp.alkalosis.
Next, look at the metabolic indicator (HCO3). Draw an arrow if it is low or high.

Step 3:
If the pH arrow and the metabolic arrow are in the same direction, the problem is of metabolic in nature-either metab.acidosis or metab alkalosis.

Step 4:
Compensation is present if the arrows of PaCO2 and HCO3 are opposite.Partial compensation is present if the arrows of PaCO2 and HCO3 point in the same direction.




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Thursday, June 19, 2008

Pharmacology Mnemonics - Drugs Made Easy To Remember

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Morphine: side-effects MORPHINE:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention)
Nausea
Emesis


Tricyclic antidepressants: members worth knowing
"I have to hide, the CIA is after me":
Clomipramine Imipramine Amitrptyline
· If want the next 3 worth knowing, the DNDis also after me:
Desipramine Norrtriptyline Doxepin

Patent ductus arteriosus: treatment
"Come In and Close the door": INdomethacin is used to Close PDA

SIADH-inducing drugs ABCD:
Analgesics: opioids, NSAIDs
Barbiturates
Cyclophosphamide/ Chlorpromazine/ Carbamazepine
Diuretic (thiazide)

Vir-named drugs: use"-vir at start, middle or end means for virus": · Drugs:
Abacavir,
Acyclovir,
Amprenavir,
Cidofovir,
Denavir,
Efavirenz,
Indavir,
Invirase,
Famvir,
Ganciclovir,
Norvir,
Oseltamivir,
Penciclovir,
Ritonavir,
Saquinavir,
Valacyclovir,
Viracept,
Viramune,
Zanamivir,
Zovirax.

Phenobarbitone: side effects
Children are annoying (hyperkinesia, irritability, insomnia, aggression).
Adults are dosy (sedation, dizziness, drowsiness).

Thrombolytic agents USA:
Urokinase Streptokinase Alteplase (tPA)



Narcotic antagonists
The Narcotic Antagonists are NAloxone and NAltrexone. · Important clinically to treat narcotic overdose.


Routes of entry: most rapid ways meds/toxins enter body
"Stick it, Sniff it, Suck it, Soak it":
Stick = Injection
Sniff = inhalation
Suck = ingestion
Soak = absorption

Anticholinergic side effects
"Know the ABCD'S of anticholinergic side effects":
Anorexia
Blurry vision
Constipation/ Confusion
Dry Mouth
Sedation/ Stasis of urine


Atropine use: tachycardia or bradycardia
"A goes with B": Atropine used clinically to treat Bradycardia.


Aspirin: side effects ASPIRIN:
Asthma
Salicyalism
Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA
Intestinal blood loss
Reye's syndrome
Idiosyncracy
Noise (tinnitus)


Morphine: effects at mu receptor PEAR:
Physical dependence
Euphoria
Analgesia
Respiratory depression

Beta-1 vs Beta-2 receptor location "You have 1 heart and 2 lungs":
Beta-1 are therefore primarily on heart. Beta-2 primarily on lungs.

SSRIs: side effects SSRI:
Serotonin syndrome
Stimulate CNS
Reproductive disfunctions in male
Insomnia


Warfarin: action, monitoring WePT:
Warfarin works on the extrinsic pathway and is monitored by PT.


Propranolol and related '-olol' drugs: usage"olol" is just two backwards lower case b's. Backward b's stand for "beta blocker". · Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol.


Depression: 5 drugs causing it PROMS:
Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids

Lead poisoning: presentation ABCDEFG:
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)


Cholinergics (eg organophosphates): effects
If you know these, you will be "LESS DUMB":
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction

Benzodiazepines: actions
"Ben SCAMs Pam into seduction not by brain but by muscle":
Sedation
anti-Convulsant
anti-Anxiety
Muscle relaxant
Not by brain: No antipsychotic activity.


Teratogenic drugs "W/ TERATOgenic":
Warfarin
Thalidomide
Epileptic drugs: phenytoin, valproate, carbamazepine
Retinoid
ACE inhibitor
Third element: lithium
OCP and other hormones (eg danazol)

Gynaecomastia-causing drugs DISCOS:
Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol

Osmotic diuretics: members GUM:
Glycerol
Urea
Mannitol


Antibiotics contraindicated during pregnancy MCAT:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline


Lithium: side effects LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism



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Wednesday, June 18, 2008

Nurse Abbreviation Guide

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ABG arterial blood gases
ACE angiotensin converting enzyme
ACL anterior cruciate ligament
ACTH adrenocorticotropic hormone
ADA American Diabetes Association
ADH antidiuretic hormone
ADL activities of daily living
AFB acid-fast bacilli
AFP alpha-fetoprotein
AGA appropriate for gestational age
AIDS acquired immune deficiency syndrome
AKA above knee amputation
ALP alkaline phosphatase
ALT alanine transaminase, alanine aminotransferase
AMA against medical advice
AMI acute myocardial infarction
AODM adult onset diabetes mellitus
AP apical pulse
APSGN acute poststreptococcal glomerulonephritis
ARF acute renal failure
ASD atrial septal defect
AST aspartate aminotransferase
ATN acute tubular necrosis
AU both ears
AVB atrio-ventricular block
A.A. Associate of Arts
A.A.S. Associate in Applied Science
A.D. Associate Degree
A.D.N. Associate Degree in Nursing
A.S. Associate of Science

BBS bilateral breath sounds
BE barium enema
BG blood glucose
BI brain injury
BID twice a day
BILAT bilateral
B/K below knee
BM bowel movement or breast milk
BP blood pressure
BPH benign prostatic hypertrophy
BRM biologic response modifiers
BRP bathroom privileges
BS bowel sounds
BSA body surface area
BSE breast self examination
BT bowel tones
BUN blood urea nitrogen
B.A. Bachelor of Arts
B.S. Bachelor of Science
B.S.N. Bachelor of Science in Nursing


C&S culture and sensitivity
CA calcium, cancer, carcinoma
CABG coronary artery bypass graft
CAD coronary artery disease
CAPD continuous ambulatory peritoneal dialysis
CAT computerized tomography scan
CBC complete blood count
CBD common bile duct
CBE clinical breast examination
CBG capillary blood glucose
CBI continuous bladder irrigation
CBS capillary blood sugar
CC chief complaint
CCK cholecystokinin
CCPD continuous cyclic peritoneal dialysis
CEA cultured epithelial autograft
CFT complement-fixation test
CIN cervical intraepithelial neoplasm
CL cleft lip
CMS circulation, motion, sensation
CO cardiac output
COPD chronic obstructive pulmonary disease
CP chest pain, cleft palate
CPAP continuous positive airway pressure
CPD cephalo-pelvic disproportion
CPP cerebral perfusion pressure
CPPD chest percussion and post drainage
CRF chronic renal failure
CRRT continuous renal replacement therapy
CRT capillary refill time
CSF cerebrospinal fluid, colony stimulating factors
CT chest tube, computed tomography
CVA cerebral vascular accident, costovertebral angle
CVP central venous pressure
CX cancel, cervix
CXR chest x-ray
CDA Certified Dental Assistant
CLS Clinical Laboratory Scientist
CLT Clinical Laboratory Technician
CMA Certified Medical Assistant
CNMT Certified Nuclear Medical Technologist
COTA Certified Occupational Therapy Assistant
CRTT Certified Respiratory Therapy Technician


DAT diet as tolerated
DC (dc) discontinue
DCCT Diabetes Control and Complication Trials
DEX (DXT) blood sugar
DIC disseminated intravascular coagulation
DKA diabetic ketoacidosis
DNA deoxyribonucleic acid
DNR do not resuscitate
DTR deep tendon reflex
DVT deep vein thrombosis
DX diagnosis
D.M.D Doctor of Dental Medicine
DDS Doctor of Dental Surgery
DVM Doctor of Veterinary Medicine


EBV Epstein-Barr Virus
ECF extracellular fluid, extended care facility
EENT eye, ear, nose and throat
EMC ensephalomyocarditis
EMG electromyogram
ERCP endoscopic retrograde cholangiopancreatography
ESRD end stage renal disease
ET endotracheal tube
EMT-B Emergency Medical Technician-Basic
EMT-I Emergency Medical Technician-Intermediate
EMT-P Emergency Medical Technician-Paramedic


F & R force and rhythm
FA fatty acid
FBS fasting blood sugar
FD fatal dose, focal distance
FDA Food & Drug Administration
FX fracture
FUO fever of unknown origin
FVD fluid volume deficit
FNP Family Nurse Practitioner


GB gallbladder
GERD gastroesophageal reflux disease
GFR glomerular filtration rate
GGT gamma-glutamyl transferase
GI gastrointestinal
GOT glutamic oxalic transaminase
GU genitourinary
GVHD graft-versus-host-disease


HA headache
HB hemoglobin
HCG human chorionic gonadotropin
HCO3 bicarbonate
HCT hematocrit
HD hemodialysis
HDL high density lipoprotein
HEENT head, eye, ear, nose and throat
HGB hemoglobin
HIV human immunodeficiency virus
HRT hormone replacement therapy
HS bedtime
HX history


IBC iron binding capacity
IBD inflammatory bowel disease
IBS irritable bowel syndrome
IBW ideal body weight
ICCE intracapsular cataract extraction
ICF imtermediate care facility
ICP intracranial pressure
ICS intercostal space
ICT inflammation of connective tissue
ICU intensive care unit
IDM infant of diabetic mother
IDDM insulin dependent diabetes mellitus
IE inspiratory exerciser
IH infectious hepatitis
IHD ischemic heart disease
IIP implantable insulin pump
IM intramuscular
IMV intermittent mandatory ventilation
INR international normalization ratio
IPD intermittent peritoneal dialysis
IPPB intermittent positive pressure breathing
ITP immune thrombocytopenic purpura
IV intravenous
IVF in vitro fertilization
IVP intravenous pyelography


JAMA Journal of the American Medical Association
JVP jugular venous pressure


K potassium
KCl potassium chloride
KI potassium iodide
KUB kidney, ureter, bladder
KVO keep vein open


L & A light and accommodation
LAD left anterior descending artery
LB large bowel
LDL low density lipoprotein
LE lupus erythematosus
LFTs liver function tests
LIJ left internal jugular
LLQ left lower quadrant
LMP last menstrual period
LP lumbar puncture
LSC left subclavian
LUQ left upper quadrant
LPN Licensed Practical Nurse


MAP mean arterial pressure
MAR medication administration record
MCL modified chest lead
MDI multiple daily vitamin
MI myocardial infarction
MLC midline catheter
MM mucous membrane
MOABS monoclonal antibodies
MOM Milk of Magnesia
MRDD mental retarded/developmentally disabled
MRI magnetic resonance imaging
MRM modified radical mastectomy
MS multiple sclerosis, morphine sulfate
M.B.A. Master of Business Administration
M.D. Doctor of Medicine
M.H.E. Master of Health Education
M.N. Master of Nursing
M.P.A. Master of Public Administration
M.P.H. Master of Public Health
M.P.T. Master of Physical Therapy
M.S. Master of Science
M.S.N. Master of Science in Nursing
M.S.W. Master of Social Work
MD Medical Doctor
MLT Medical Laboratory Technician
MT Medical Technologist


NA sodium
NACL sodium chloride
NED no evidence of disease
NICU neonatal intensive care unit
NIDDM noninsulin dependent diabetes mellitus
NKA no known allergies
NKDA non-ketotic diabetic acidosis
NKMA no known medcation allergies
NPD nightly peritoneal dialysis
NPO nothing by mouth
NSAID nonsteroidal anti-inflammatory drug
NTD neural tube defect
NV nausea & vomiting
NYD not yet diagnosed


OD right eye
OGTT oral glucose tolerance test
ORIF open reduction internal fixation
OS left eye
OU both eyes
OTR Occupational Therapist-Registered


PABA para-aminobenzoic acid
PC after meals
PCA patient controlled analgesia, posterior communicating artery
PCN penicillin, primary care nurse
PCV packed cell volume
PD peritoneal dialysis
PDA patent ductus arteriosus, posterior descending artery
PDD pervasive development disorder
PDR physician’s desk reference
PEG percutaneous endoscopic gastrostomy
PEJ percutaneous endoscopic jejunostomy
PERL pupils equal, react to light
PERRLA pupils equal, round, react to light, accommodation
PET positron emission tomography
PFT pulmonary function test
PG prostaglandin
PH past history
PI present illness
PICC peripherally inserted central venous catheter
PID pelvic inflammatory disease
PMI point of maximal impulse
PNH paroxysmal nocturnal hemoglobinuria
PO by mouth
PRBC packed red blood cells
PS pyloric stenosis
PSA prostate specific antigen
PT prothrombin time
PTT partial thromboplastin time
PUD peptic ulcer disease
PVD peripheral vascular disease
PX pneumothorax
Ph.D. Doctor of Philosophy
Pharm.D. Doctor of Pharmacy
PT Physical Therapist
PTA Physical Therapy Assistant


QD everyday
QID four times a day
QNS quantity not sufficient
QOD every other day
QS quantity sufficient, quantity required


RA rheumatoid arthritis
RAD reactive airway disease
RAI radioactive iodine
RAIU radioactive iodine uptake
RCA right coronary artery
RDW red cell distribution width
REEDA redness, edema, ecchymosis, drainage, approximation
RHD rheumatic heart disease, relative hepatic dullness
RIJ right internal jugular
RLQ right lower quadrant
RM respiratory movement
ROM range of motion
ROS review of systems
RSC right subclavian
RUQ right upper quadrant
RX prescription, pharmacy
RD Registered Dietician
Registration Abbreviations
RHIA Registered Health Information Administrator
RHIT Registered Health Information Technician
RN Registered Nurse
RRA Registered Record Administrator
RRT Registered Respiratory Therapist
RT Radiologic Technologist
RTN Registered Technician of Nuclear Medicine


S/S signs & symptoms
SAB spontaneous abortion
SAST serum aspartate aminotransferase
SB spina bifida
SBO small bowel obstruction
SGPT serum glutamic-pyruvic transaminase
SLE systemic lupus erythematosus
SNF skilled nursing facility
SOB short of breath
SR sedimentation rate
SS social services
STD sexually transmitted disease
STH somatotropic hormone
STM short term memory
SUI stress urinary incontinence
SVR systemic vascular resistance


T3 triiodothyronine
T4 thyroxine
TBSA total body surface area
TCDB turn, cough, deep breathe
TED (hose) thrombo-embolism deterrent
TEP transesophageal puncture
THR total hip replacement
TIA transient ischemic attack
TIBC total iron binding capacity
TID three times a day
TIL tumor infiltrating lymphocytes
TKR total knee replacement
TNF tumor necrosis factor
TNM tumor, node, metastases
TNTC too numerous to mention
TP tuberculin precipitation
TPN total parenteral nutrition
TTN transient tachypnea of the newborn
TTP thrombotic thrombocytopenia purpura
TUPR trans-urethral prostatic resection
TUR (or TURP) trans-urethral resection of the prostate
TWB touch weight bear
TWE tap water enema
TX treatment, traction


UA urinalysis
UAO upper airway obstruction
UBW usual body weight
UGI upper gastrointestinal
UPJ ureteropelvic junction
URI upper respiratory infection
US ultrasonic
UTI urinary tract infection
UVJ ureterovesical junction


VA visual acuity
VBAC vaginal birth after caeserean
VF ventricular fibrillation
VLDL very low density lipoprotein
VMA vanillylmandelic acid
VSD ventricular septal defect
VT ventricular tachycardia
VW vessel wall


W/C wheelchair
WBC white blood cell
WD well developed
WHO World Health Organization
WN well nourished
WNL within normal limits


XR x-ray


YO years old


Z zero





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Tuesday, June 17, 2008

Glasgow Coma Scale

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A neurologic assessment scale that provides objective measurement of level of consciousness, pupil reaction,and motor activity. The total of the three scores can range from 3 to 15. A client who is oriented, opens the eyes spontaneously, and follows commands scores a 15. A client in a deep coma would score a 3. The first GCS score becomes the baselin. Future scores indicate trends or changes in nureologic status.



Eye response

*opens spontaneously -----------------------------------4
*opens to verbal command ------------------------------ 3
*opens to pain ------------------------------------------ 2
*opens response ---------------------------------------- 1



Motor response

*react to verbal command ------------------------------ 6
*reacts to painful stimuli -------------------------------- 5
*flexes and withdraws --------------------------------- 4
*assumes flexor posture -------------------------------- 3
*assumes extensor posture ----------------------------- 2
*no response ------------------------------------------- 1



Verbal response

*is oriented and converses ------------------------------ 5
*isdisoriented but converses ---------------------------- 4
*uses inappropriate words ------------------------------ 3
*makes unintelligible sounds ---------------------------- 2
*no response ------------------------------------------- 1


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Monday, June 16, 2008

IV fluid tonicity

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0.9% NaCl (normal saline) ---------------------------- Isotonic
0.25% NaCl ----------------------------------------- Hypotonic
0.45% NaCl ----------------------------------------- Hypotonic
2.5% dextrose --------------------------------------- Hypotonic
Lactated Ringer's solution --------------------------- Isotonic
D5W (acts as a hypotonic solution in body) ----------- Isotonic
D5 NaCl --------------------------------------------- Hypertonic
D5 in Lactated Ringer's ------------------------------ Hypertonic
D5 0.45% NaCl -------------------------------------- Hypertonic




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Sunday, June 15, 2008

Adventitious Lung Sounds

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Crackles
Characteristics:
popping,crackling,bubbling, moist sound on insporation

LUNG PROBLEM:
pneumoina,pulmonary edema, pulmonary fibrosis

-----------------------------------------------------------
Rhonchi
Characteristics:
rumbling sound on expiration

LUNG PROBLEM:
pneumonia,emphysema,bronchitis,
bronchiectasis

-----------------------------------------------------------
Wheezes
Characteristics:
high-pitched musical sound during both inspiration ans expiration (lounder)

LUNG PROBLEM:
emphysema,asthma,
foreign bodies

-----------------------------------------------------------
Pleural Friction Rub
Characteristics:
dry,grationg sound on both inspiration and expiration

LUNG PROBLEM:
pleurisy,pneumonia,
pleural infarct


Listen to these different lung sounds at http://www.cvmbs.colostate.edu/clinsci/callan/breath_sounds.htm



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Saturday, June 14, 2008

Binay orders closure of Ospital ng Makati neonatal ICU

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Hospital says deaths caused by neonatal sepsis

By Thea Alberto, Katherine Evangelista
INQUIRER.net
First Posted 15:41:00 06/06/2008


MANILA, Philippines -- (UPDATE) Amid concern over the reportedly growing incidence of infant deaths, Makati Mayor Jejomar Binay ordered the neonatal intensive care unit (ICU) of the Ospital ng Makati (Osmak) closed while an investigation is conducted.

Osmak immediately complied with the order, with assistant medial director Dr. Ramoncito Coronel saying they are closing down not just the neonatal ICU but also their delivery rooms.

However, he said the hospital would continue accepting emergency cases that they cannot turn away since it could prove fatal to both mother and infant.

He advised non-emergency cases to seek admission in other hospitals or lying-in clinics so Osmak can undertake extra precautionary measures.

Coronel acknowledged that there had been 25 infant deaths from neonatal sepsis, a bacterial infection, in May, more than half of the 45 cases recorded. Osmak delivered a total of 275 deliveries last month.

Neonatal sepsis is a bacterial infection, Dr. Enrique Tayag, director of the National Epidemiology Center of the Department of Health, said.

Tayag explained that neonatal sepsis is not uncommon and that as many as six to seven out of ten infants infected die of the infection. Nevertheless, Coronal admitted that the sudden surge of infant mortalities in May had caused alarm.

Binay said a fact-finding team of medical practitioners will be created to look into the reported deaths at the government-run hospital and recommend the appropriate measures. The mayor has asked the Department of Health (DoH) to assist the investigation.

Joey Salgado, Makati public information officer chief, said Binay will ask former health secretary Dr. Jaime Galvez-Tan to head the investigating body.

Tayag sad the DoH has also formed a team, headed by Anthony San Juan, regional epidemiologist of the Center for Health Development, to conduct separate investigations.

"We look forward to working with the DoH, in the light of information that these cases are not limited only to Osmak but in other public hospitals as well. We hope that we can do our share in assisting the national government address this issue concretely," Binay said.

Earlier, Binay ordered Osmak director Dr. Julius Drilon to submit a report and all relevant documents on the reported deaths at the facility within three days.

"The Ospital ng Makati is city-owned and any decision would have to come from the [local] government," said Salgado, adding that the neonatal ICU will remain closed until Drilon submits his report.

READ MORE AT http://newsinfo.inquirer.net/breakingnews/metro/view/20080606-141171/Binay-orders-closure-of-Ospital-ng-Makati-neonatal-ICU





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Stages of Pressure Sore with Illustration

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StageI:
Nonblanchable erythema that remains red 30 min. after pressure has been relieve.Epidermis remains intace.

StageII:
Epidermis is broken, lesion is superficial and there is partial-thickness skin loss.

StageIII:
Full-thickness skin loss down through the dermis which may include subcutaneous tissue.

StageIV:
Full-thickness skin loss extending into supportive structures, such as muscle, tendon, and bone.


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Friday, June 13, 2008

Human Anatomy Online

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Welcome to inner exploration of Human Anatomy. Each topic has animations, 100’s of graphics, and thousands of descriptive links. Study the anatomy of the human body. It’s fun, interactive, and an ideal reference site for students or those who just want to know more about the medical descriptions used by doctors and nurses.

View Human Anatomy Illustration at http://www.innerbody.com/index.html



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Thursday, June 12, 2008

NLE / CGFNS / Nclex Review Materials 3

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41. DIC
• Bruising, purpura
• Presence of occult blood
• Low fibrinogen level, hct, platelet
• Increased PT, PTT
• Complication: RENAL FAILURE

42. PERIPHERAL ARTERIAL DISEASE
• Dry scaly skin on lower extremities
• Rest Pain, at night
• Intermittent claudication/
• Thickened toenails
• Cold & gray-blue color of skin
• Decreased or absent peripheral pulses
• Instruct pt. to walk to point of claudication, stop & rest & walk a little farther

43. THROMBOPHLEBITIS
• Avoid pressure behind legs
• Avoid prolonged sitting
• Avoid constrictive clothing
• Avoid crossing the legs
• Avoid massaging the legs

44. SYPHILIS
Painless chancre fades after 6 weeks
Low grade fever
Copper-colored rash on palms and soles of feet
Spread by contact of mucous membranes
Treat with Penicillin G IM
If patient has penicillin allergy, will use erythromycin for 10-15 days.
After treatment, patient must be retested to make sure disease is gone

45. POLYCYTHEMIA VERA
• Increased RBC
• Leukocytosis / Thrombocytosis
• Angina
• Intermittent claudication
• Dyspnea /HPN
• Lethargy / Syncope / Paresthesia

46. PRIMARY HPN
Risk Factors:
• Aging
• Black race
• Chronic stress
• Family Hx
• Obesity
• Smoking
• Men

47. CHOLECYSTITIS
Sx:
• N & V
• Belching
• Indigestion
• Flatulence
• Epigastric pain that radiates to the scapula 2 hrs. after eating fatty food
• Pain localized in RLQ
• Guarding, rigidity & rebound tenderness
• Cannot take a deep breath when fingers are pressed below hepatic margin (Murphy’s Sign)

II. COMPUTATION
1. Dopamine
2. Dobutamine drip: Order is 2.5mcg/kg/min, patient weights 176 lbs.
Stock is 500mg in 500ml of NSS,
Compute for ml/hr?

Formula: Stock (mg) x 1000 mcg/mg
Quantity (ml)
Flow rate: Dose (mcg/kg/min) x wt (kg) x
60 min/hr
Concentration
(mcg/ml)

Answer: 12ml/hr

3. Md with IV order for patient 3,000ml in 24 hrs., get the rate at ml per hour.
Solution: 3000/24 = 125 ml/hr

4. Tablets : Dose of 20 mg per dose in stock dose of 5 mg per tablet, how many
tablets?
Solution: 20/5 x 1 = 4 tablets


III. TOPICS
1. SAFETY INFECTION CONTROL

AIRBORNE : Hepa Filter Mask / N95

Particulate MASK
PTB
Measles / Rubella
Chicken Pox/
Varicella
SARS
Anthrax

CONTACT : GGG
(gown,gloves,goggles)
Conjunctivitis
Open wounds /drainage
Lesions
MRSA / VRSA /
CDAD
RSV/ VRE

DROPLET : Surgical Mask
Scarlett Fever
Diphtheria
Meningitis
Strep. Pharyngitis
Pneumonia

ENTERIC: Gown , Gloves
Diarrhea
Hep. A
Salmonella
Acute Gastroenteritis
Peptic H. Pylori
Shigella / Rotavirus Giardiasis /
Cryptosporidium Muris

FROTECTIVE:
Blood dyscrasias
Aplastic anemia
Leukemia
Major burns (50%)
Organ transplant
Aids
Multiple Myeloma
Prolong Steroid Therapy


Concepts:
1. Infection control:
a. clean with clean for example patients with CVA, DM, Cardio disease

2. Same precaution techniques:
a. Universal precaution: Hep B,D, AIDS

2. PRIORITIZATION
Remember the rule of stable vs. unstable. Although you consider the client unstable but if it expected in him, this is stable. Example. Asthma with wheezing- you consider this unstable.
ABC, unstable , first think EXPECTED in asthma so this will be considered stable.

3. DELEGATION
RN - Newly admitted, needs assessment, pre op teaching and post op, nsg. Judgment & discharge planning ,IV meds, BT.

LPN-Can give meds except IV, sterile techniques like wound dressing, catheterization, insertion of NG tube, remove sutures. Stable expected outcome.

NA/ UAP/CN/ Senior nursing student - All “-ing” ex bathing, reading v/s in long term pt. Testing occult blood, BS, monitoring, soap sud enema, testing occult blood,
-Isolation precautions, basic hygiene ADL, Input & Output, Finger stick with gestational diabetes, urinalysis, TSB, turning unconscious patient, change perineal pad, assist in ambulation,
discharge tomorrow,
-Stable v/s, pulse oximetry, reading,
terminally ill because of comfort only
needed.
- Routinary Procedure

4. Patient Hx C/I for MRI :
• Mitral Valve Replacement

5. Glaucoma :
• Halos around light

6. U waves :
• Hypokalemia

7. Patient with arterial insufficiency
• Elevate the affected leg

8. Patient with Dumping Syndrome:
• Avoid cheese

9. Adverse Effect of Anti-metabolite 5FU
• Stomatitis

10. Obtaining sputum specimen from pt. with tracheostomy:
• Instruct pt. to cough prior to obtaining sputum

11. Post-hypophysectomy pt. Report if:
• Specific Gravity of 1.005

12. Diet for Hypothyroidism
• Low sodium, High K

13. Patient with CHF cor pulmonale S & S
• Jugular vein distention & peripheral edema

14. Circumcision of a new infant:
• Diaper fasted loosely

15. Acute Pancreatitis
• Increase lipase/amylase

16. Short-term goal for anti-social patient
• Follow unit rules

17. Use of walker
• Partial weight bearing
• Stand in front, walk unto walker

18. Borderline patient
• Splitting

19. Neonates in nursery developed diarrhea
• Meconium stool study w/in 24 hrs.

20. Nsg. Action in pt. post cardiac catherization
• Check pulse in lower extremities

21. Diet for Diverticulitis
Avoid high-fiber foods when inflammation occurs, only low residue
• Introduce soft high-fiber foods when inflammation has resolved

22. Low iron.WBC & albumin, what type?
• Nutritional deficit (malnutrition)

23. What will you ask on pt for cardiac stress test (Thallium stress test)?
• Is he on beta-blocker? (if with radionuclide already, Persantine, then invasive & shld.
avoid caffeine, calcium channel blockers, b-blockers, theophylline)

24. Highest risk of accident
• 9 month infant eating grapes & apricot

25. Pancrease in Cystic Fibrosis
• Give with meals, dilute in applesauce

26. Client post-CVA, diet teaching
• Low salt, low fat

27. Client passing stones with calcium, diet teaching:
• Should be acid-ash diet & avoid oxalate rich & Ca rich food such as tea, almonds, rhubarbs beans, spinach, cocoa, vegetables, fruits
• Give cranberries, prunes, plums, tomatoes, cereals, corn, legumes I

28. Paget’s Disease
• Bowing of bones

29. Side Effect of Ansef (Cefazolin)
• Antibiotic (RTI,URTI)
• Diarrhea, Nausea
• Oral candidiasis
• Pancythopenia

30. Peptic ulcer disease
• Avoid stressful situation to prevent exacerbation

31. Schilling’s Test
• For pernicious anemia

32. Prior To MUGA SCAN:
• Informed consent
• Allergy not a concern

33. Action of Aquamephyton
• Prevention of hypoprothrobinemia

34. Action of Lipitor
• Anti-lipimec

35. Positioning of Hip Spica Cast in children
Maintain flexion, abduction & external rotation

36. Fear of 3 y/o child
• Injury (abandonment, castration)

37. To prevent ureteral stones
• Increase fluids

38. MDI
• Hold breath

39. Frostbite
• Soak in warm water

40. Normal respiratory changes in elderly
• Decreased cough reflex

41. Patient w/ DM & HPN, question if
• Given beta-blocker (causes bronchospasm )

42. Maximum injection on 10 month old infant
• 1 ml

43. Pt. with endometriosis takes Danocrine, action of the drug?
• Suppress menstruation/ ovulation

44. Post NSD with epidural anesthesia with bladder distension
• Offer bedpan

45. Apmhotericin B, side effect?
• Headache
• Hypokalemia
• Hypotension

46. PT. with angina unrelieved by 3 nitroglycerin
• Administer O2

47. Patient on Halo Vest
• Tape the wrench to the vest (Torque screw)

48. Pre-menopausal syndrome experiencing hot flashes
• Black Cohosh for menoposh

49. Abdominal Assessment
• Inspection
• Auscultation
• Percussion
• Palpation

50. Sclerotherapy
• Application of pressure dressing for 12-48 hrs.



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Wednesday, June 11, 2008

NLE / CGFNS / Nclex Review Materials 2

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11. ESRD DIET
• Restricted protein intake
• Increase CHO
• Low K, P
• Restrict Na

12. NORMAL IN 8 MONTH OLD CHILD
- can sit with out support
- can roll from front to back
- can hold a bottle
- closure of ant. fontanel
- can say mama and dada
- 2 teeth present

13. SUPERIOR VENA CAVA OCCLUSION
• Sx occur in the morning
• Edema of face, eyes & tightness of shirt/ (Stoke’s sign)
• Late sx: edema of arms, hands,
dyspnea, erythema, epistaxis

14. ULCERATIVE COLITIS
Sx:
• Severe diarrhea with blood & mucus
• Abdominal tenderness & cramping
• Anorexia
• Wt. Loss
• Vit. K deficiency
• Anemia
• Dehydration
• Electrolyte imbalance
• Low residue & high protein diet

15. DILANTIN
• do not floss throughout the day
• do not use hard bristled toothbrush
• Gingivitis S/E

16. ANAPHYLACTIC REACTION
(steps)
• Stop medication
• Maintain airway
• Notify MD
• Maintain IV access of 0.9 NSS
• Place in supine position with legs elevated
• Monitor VS
• Administer prescribed emergency drugs

17. BLADDER CA
Risk Factors:
• Hx of smoking
• Exposure to radiation
• Working in industrial Factory

18. S/S OF DKA
• Fruity breath Odor
• Oliguria
• Kusmaull'’s (deep & nonlabored)

19. SITE FOR IM INJECTION ADULT
• Deltoid
• Ventrogluteal
• Vastus Lateralis
• Gluteus Maximus

20. S/S OF BACTERIAL MENINGITIS
• N & V
• Seizures
• Stiff Neck
• Photophobia

21. TB
• Waking up sweating at night
• Low grade fever
• Dull aching chest pain
• Cough streaked with blood
• Weight loss
• Anorexia
• Fatigue

22. LIVER CIRRHOSIS
• N & V
• Edema
• Ascites

23. PULMONARY EMBOLISM
Sx:
• Blood-tinged sputum
• Distended neck vein
• Chest Pain / Hypotension / Cyanosis
• Cough / Shallow respirations
• Rales on auscultation
• Tachypnea / Tachycardia

24. COLON CA
Risk Factors:
• Family HX
• Age above 50
• Jewish
• Male

25. DIGOXIN THERAPY
• Do not administer in infants if S/S OF CAD
• Chest Pain
• Palpitations
• Dyspnea / Syncope
• Hemoptysis
• Excessive Fatigue

27. COPD
• Rhythmic, diaphragmatic breathing
• If restless, perform purse-lip breathing not more than 1 minute
• Perform deep breathing with mouth held together during expiration

28. SEEN IN 15 MONTH OLD CHILD
• Speaks 6 words
• Sits w/o support
• Builds a tower of 5 blocks
• Strong palmar grasp

29. CUSHING’S SYNDROME
• Osteoporosis
• Muscle wasting
• Hypertension
• Purple skin striations
• Moon face
• Truncal obesity
• Decreased resistance to infection
• Low Carbohydrate, Low Calorie, High Protein, High K, Low sodium
• Monitor glucose level
• Check for color of stool, cortisol increase secretion of gastric acid – Peptic ulcer & GI bleeding
• C/I to Aspirin, increased bleeding

30. ADDISONS DISEASE
Fatigue
Weakness
Dehydration
Eternal tan
Decreased resistance to stress
Low Sodium
Low Blood Sugar
High Potassium

High protein, carbohydrate, Sodium, Low potassium diet

Teach life-long hormone replacement
• Glucocorticoids (sugar) - Solu- Medrol (succinate) to prevent addisonian crisis
• Mineralocorticoids (salt) – Florinef

6 A's of Addison's disease
1.) Avoid Stress
2.) Avoid Strenuous
3.) Avoid Individuals with Infection
4.) Avoid OTC meds
5.) A lifelong Glucocorticoids Therapy
6.) Always wear medic alert bracelet

Addisonian Crisis
• Hypotension
• Extreme weakness
• Nausea vomiting
• Abdominal pain /
• Severe hypoglycemia
• Dehydration
• Administer NaCl IV, vasopressors, hydrocortisone
• Monitor VS /Absolute bedrest

31. PLACENTA PREVIA
• Check Hematocrit level
• External fetal monitor not internal
• No vaginal examination
• Assess for bleeding
• Improperly implanted placenta at
lower uterine
• Painless bright red, vaginal
bleeding
• Soft, relaxed, nontender uterus
• Fundal height greater than
expected

32. ABRUPTIO PLACENTA
• Premature separation of placenta from uterine wall
• Painful dark red bleeding
• Uterine rigidity
• Severe abdominal pain
• Maternal shock
• Fetal distress

33. HEMODIALYSIS
• Palpate for a bruit or thrill
• Weigh client daily, before, during & after
• Hold antihypertensive drugs b4 dialysis
• Check for thrill and bruit q 8 hours
• Don’t use extremity for BP, finger stick
• Monitor vital signs, weight, breath sounds
• Monitor for hemorrhage

34. PERITONEAL DIALYSIS
• Weight before and after treatment
• Monitor BP
• Monitor breath sounds
• Use sterile technique
• If problem w/ outflow, reposition client
• Side effects: constipation

35. TYPE 1 IDDM
• Test blood glucose every 4 hrs if no feeling well
• Eat fruit or cheese sandwich before exercise
• Do not exercise if blood glucose is >250mg/dl & urinary ketones present
• Administer regular insulin 30 minutes before meals

36. COMPARTMENT SYNDROME
• Increased pain & swelling
• Pain with passive motion
• Loss of sensation
• Inability to move joints
• Pulselessness

37. CARDIAC CATHETERIZATION
• NPO 6-8 hrs. & no liquid for 4 hrs. prior to prevent vomiting & aspiration
• Feel a flush, warm, fluttery feeling, desire to cough, palpitations in introduction of dye
• Shave & Clean insertion site with antiseptic solution

38. PERNICIOUS ANEMIA
• Severe pallor
• Smooth, beefy red tongue
• Slight jaundice
• Paresthisias of hands & feet
• Disturbances with gait & balance

39. DUMPING SYNDROME
Occurs 30 minutes after eating
• Abdominal fullness & cramping
• Diarrhea
• Tachycardia
• Perspiration
• Weakness / dizziness
Borborygmi sound

40. TPN COMPLICATIONS
• Air Embolism
• Fluid Overload
• Hyperglycemia
• Hypoglycemia
• Infection
• Pneumothorax




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Tuesday, June 10, 2008

NLE / CGFNS / Nclex Review Materials 1

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1. CERVICAL CANCER
Risk Factors:
• African- American/ Native women
• Behavior (Sexual promiscuity)
• Chronic instrumentation of cervix
• Disease –STD
• Early age of Sex
• High Parity
• Poor Hygiene
• Low economic status
• Multiple sexual partners
• Partner with Prostate CA

Sx:
• Post-coital bleeding
• Painful sex
• Menstrual irregularities

2. OVARIAN CANCER
Risk factors:
• Ovarian dysfunction
• Vaginal use of talcum powder
• Alcohol
• Race - White women & family history
• Infertility
• Age - Peak=5th decade of life
• Nulliparity
• Genetic predisposition

3. DM FOOT CARE
• Meticulous care to feet
• Wash feet with warm water not hot & dry
• Can use lotion but No lotion in between toes
• Wear socks to keep feet warm
• Avoid thermal baths, heating pads
• Do not soak feet
• Inspect feet daily
• Do not treat corns, blisters
• Wear loose socks and no barefoot
• Change into clean cotton socks daily
• Break in new shoes gradually
• Use emery board
• Do not smoke
• Do not wear same pair of shoes 2 days in a row
• Check shoes for cracks before using

4. BLOOD TRANSFUSION REACTION
• Transfusion Reactions, Hemolytic Reaction, Allergic Reaction
• Circulatory Overload
• Septicemia
• Iron Overload
• Hypocalcemia
• Disease Transmission
• Hyperkalemia
• Citrate Intoxication


5. HYPERTHYROIDISM
• Soft smooth skin & hair
• Mood swings
• HPN
• Diaphoresis
• Intolerance to heat
• PTU drug to block thyroid synthesis

6. LUNG CA
• Bronchogenic Carcinoma
• 1st leading cause of death
• From asbestos, bacterial invasion,
cigarette
• Sx: Nagging cough, hoarseness of
voice, dyspnea, diminished breath
sounds

7. SX OF PARKINSONS
• Tremors, akinesia, rigidity
• Weakness, “motorized propulsive gait
• Slurred speech, dysphagia, drooling
• Monotonous speech
• Mask like expression
• Teach ambulation modification: goose stepping walk (marching), ROM exercises
• Meds—Artane, Cogentin, L-Dopa, Parlodel, Sinemet, Symmetrel
• Activities should be scheduled for late morning when energy level is highest
• Encourage finger exercises.
• Promote family understanding of disease intellect/sight/ hearing not impaired,

8. ACUTE PANCREATITIS
• Abdominal Pain severe –acute sx
• Complication : Shock,Hypovolemia
• Limited fat & protein intake

9. CAST CARE
Don’t rest on hard surface
Don’t cover until dry 48+ hours
Handle with palms of hands not with fingers
Keep above level of heart
Check for CSM

10. HYDROCEPHALUS
• Anterior fontanel bulges & nonpulsating
• Bones of head separated (cracked pot sound)
• Check for sun-setting eyes
• D’ Increase ICP
• Evidence of Frontal Bossing
• Failure to thrive
• Irritability
• High-pitched cry



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Monday, June 9, 2008

NLE / CGFNS / Nclex Review Materials 4

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51. RSV
• Droplet precaution

52. SIADH
• Sodium 128 only (Normal: 135-145)

53. Dementia of Alzheimer Type
• Check what the pt. is taking

54. PEG

55. What medicine if given shld be monitored for bleeding
• Indomethacin (NSAID)

56. GBS, priority nursing diagnosis
• Aspiration

57. Discharge teaching for Bell’s Palsy
• Provide eye care at bedtime

58. Sign of Scoliosis
• Asymmetry of the iliac crest

59. Normal for a 3 day old infant
• Describe normal tonic neck reflex

60. Manifestation of Paranoid Schizophrenia
• Inappropriate anxiety with delusion

61. Sign of Alcohol withdrawal
• Feeling of euphoria in 1st 24 hrs.

62. Activity for Alzheimer disease
• Reading magazine

63. Type 1 IDDM post renal test 48 hrs ago, watch out for:
• Hematuria

64. Correct understanding of antidepressant
• Anti-depressant takes effect after 1 week

65. DUROGESIC PATCH / FENTANYL
• For chronic pain lasts 3 days
• Maybe worn while bathing, showering, swimming
• Apply to flat, nonirritated, nonirradiated area like chest, flank, upper arm, back
• Overdose : difficulty in breathing

66. Signs of increase ICP in pt. with close head injury
• Increase systolic pressure & weak bounding pulse

67. Positive outcome for Calcium Channel blockers
Decrease chest pain

68. Obsessive Compulsive Behavior
• To alleviate anxiety

69. Patient with back pain, proper body mechanics
• Sit with knees higher than hips

70. What to check prior administration of EPOETEN
• BP
• S/E : HPN, Seizures

71.

72. Patient with pancreatitis if developing ascites would manifest:
Cullen’s Sign (bluish discoloration of abdomen or peri-umbilical hematoma)
Turner’s Sign (gray-blue discoloration of flank)
• Shallow, rapid breathing
• Abdominal pain
• Dyspnea & difficulty eating
• Orthopnea

73. Digitalis + Lasix = Weight Loss

74. Side effect of Garamycin
• Ototoxicity
• Nephrotoxic
• Hypomagnesimea
• Muscular paralysis
• Hypersensitivity

75. Side Effect of Theophylline
• Tremors & tachycardia
• Insomnia

76. Nsg. Management for cleft palate infant
• Enlarged nipple for feeding
• Stimulate sucking
• Swallow
• Rest
• Burp frequently

77. Patient with expressive aphasia, best communication:
• Use picture language

78. Diet for patient with colostomy
• DAT
• Low residue food 1-2 days postopt
• Avoid gas-forming foods

79. Patient allergic to Pseudoephedrine,
What is contraindicated?
• Patient taking Ma Huang

80. Patient with testicular cancer, correct understanding?
• Testicular CA is painless

81. 1st intervention in prolapsed cord
• Positioning – knee chest/trendelenberg

82. 2nd Stage of labor
• Cervical dilatation to delivery of
baby

83. Thiazide diuretic, what to watch out for?
• Potassium

84. Manic pt. taking lithium
• Watch out for sodium serum

85. Diet for patient with ileostomy
• Post opt 4 wks -- LOW FIBER
non-irritant diet to decrease fast movement of liquid stool, after can tolerate high fiber diet
already
• Foods that thicken stool like boiled rice, low fat cheese should be given
• Low fat diet
• Normal stool is liquid

86. G & D of a 2 y/o
• Combines 2 words
• Kicks a ball
• 50 word vocabulary

87. ALS
• Decreased sensation of touch
• Muscle weakness
• Excess glutamate

88. S/S of Kawasaki
• Desquamation of skin
• Joint pain
• Mucocutaneous lymph node syndrome

89. Watch out for in lumbar puncture
• Increased ICP
• Brain Herniation

90. S/S of DVT
• Edema
• Calf or groin tenderness
• Pain with or w/o swelling
• + Homan’s Sign
• Warm skin

91. Developmental Milestone of 10 month old
• Pincer grasp

92. Risk for breast CA
• 38 y/o female on oral contraceptive

93. Need to consider anti-coagulant therapy
• If taking Gingko Biloba

94. Check 1st before tonsillectomy
• Bleeding time

95. Complication of CAST
• Compartment syndrome
• Fat embolism
• Shock
• Avascular necrosis

96.

97. Physician orders beta-blockers, for w/c pt. should the nurse question the order:
• Patient on insulin (B-blockers may mask signs of hypoglycemia)

98. Patient hypersensitivity
• Give macrolides like erythromycin,azithromycin (Penicillin & Cephalosporins the same)

99. Patient with autonomic dysreflexia
• Pounding headache , piloerection

100. Pt. with carafate & antacids order, select the schedule.
• Carafate 1 hr. before meals &
antacids after meals

101. Increasing pulse pressure
• Widening pulse pressure (late sign)
• Decreased LOC, restlessness
(Early)

102. Pt. with Hemophilia & Leukemia
• Can lead to DIC

103. Effective teaching to DM patient
• Peak of NPH insulin 8 hrs.

104. Mg SO4 given to PIH pt. Nurse should watch out for?
• Epigastric pain & headache

105. Pt. with calcium oxalate stones
• Diet with fig & wheat germs

106. Cancer & Sepsis can lead to DIC
• low platelet count

107. Pt. in labor with crusted popular eruption, priority?
• Eye prophylaxis of the newborn

108. Heroin addicted mother in labor, nursing action?
• Avoid withdrawal in active stage

109. Signs of Heroin intoxication?
Euphoria
• Decrease response to pain
• Respiratory depression
• Apathy

110.

111. Scarlett Fever isolation precaution
• Respiratory precaution
• droplet until 24 hrs. start of
treatment

112. Laryngectomy
• Avoid swimming, showering, using aerosol sprays
• Teach client clean suction technique

113. External irradiation therapy
• Time & distance shielding

114. Pt. with anorexia nervosa, signs
• Tachycardia

115. Brain injury
• Decorticate rigidity

116. Signs of renal failure
• Urine output less than 100ml/hr

117. Post-thyroidectomy patient, WOF
• Tingling sensation in the cheek
(complication)

118. Ventricular Fibrillation
• Do chest compression

119. Pt. in crutches, nurse should check
• Check armpits to see if there is pressure secondary to crutch
(Pressure shld be on the hands not on the axilla)

120. Influenza Vaccine indicated for:
• Anyone 50 y/o & above annually
• Age 6 months & up with risk like asthma
• Immunocompromised patients
• Pts with cardiac & pulmonary
disease

121. Herpes Simplex I & II
• 2 strains of herpes virus family

• HSV I – cold blisters / fever blisters
• HSV II – in STD /Genital Herpes/Shingles & varicella zoster infection same with chicken pox

122. Above the knee amputation, patient shld
• Prevent internal or external rotation of the limb
• Place sandbag or rolled towel along side of thigh to prevent rotation

123. HIV suspect patient
• Hairy tongue and leukoplakia
(Leukoplakia, pre-malignant lesion)

124. DVT on Heparin therapeutic goal
• Ambulate ASAP
( Prevent thrombus formation)

125. Esophageal varices, refer pt if
• Cold clammy skin ( sx of shock)

126. Pregnant 39 weeks, knows true labor if
• Contractions from back going to abdomen

127. Bipolar manic patients, what to do?
• Limit group activities

128. Multiple Myeloma, care
• Force fluid from 3 - 4 L/day to offset hypercalcemia, hyperurecemia
• Encourage ambulation to prevent renal stones

129. Post pace maker transplant, correct understanding
• Patient CAN USE electricc blankets, cell phones <3 watts,microwave ovens, metal
detectors

130. Patient taking garlic supplements should take precaution when on aspirin therapy

131. DKA patient, what to administer 1st?
• Start IV line 0.9 NaCl

132. Hearing aid, correct teaching:
• Turn off & remove battery when not in use
• Avoid excessive wetting of hearing aid, keep dry
• Ear mold is the only part that may be washed w/ soap & water
• Cannula is cleaned with small
pipe cleaner device or toothpick

133. PEEP

134. 18 day old infant, how to assess trunk curvature
• Place in prone position & stroke spinal colum, see if infant’s body move towards the stimulated
area

135. Postural drainage, correct understanding:
• Position—lung segment to be
drained is uppermost
• Drink a glass of water before PD to loosen secretions
136. Sign of Abdominal Aortic Aneurysm
Pulsation between umbilicus & pubis

137. Echinacea
• To boost immune system
• Use only up to 8 weeks

138. Action of PILOCARPINE
• Increase outflow of aqueous humor
• For OPEN ANGLE GLAUCOMA


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