BASIC NURSING NOTES MADE SIMPLE
BASIC NURSING NOTES MADE SIMPLE
Prepared by kachozom RN
1.ELECTROLYTES
• RBCs: 4.5 – 5.0 million
• WBCs: 5,000 – 10,000
• Platelets: 200,000 – 400,000
• Hemoglobin (Hgb): 12 – 16 gm (F); 14 – 18 gm(M).
• Hematocrit (Hct): 37 – 47 (F); 40 – 54 (M)
• Sodium: 135 – 145 mEq/L
• Potassium: 3.5 – 5.5 mEq/L
• Calcium: 8.5 – 10.9 mEq/LAa
• Chloride: 95 – 105 mEq/L
• Magnesium: 1.5 – 2.5 mEq/L - Mg(
• Phosphorus: 2.5 – 4.5 mEq/L
• Glucose: 70 – 110 mg/dL
• Specific Gravity: 1.010 – 1.030
• BUN: 7-22 mg/dL
• Serum creatinine: 0.6 – 1.35 mg/dL
• LDH: 100-190 U/L
• Protein: 6.2 – 8.1 g/dL
• Albumin: 3.4 – 5.0 g/dL
• Bilirubin: <1.0 mg/dL
• Total Cholesterol: 130 – 200 mg/dL
• Triglyceride: 40 – 50 mg/dL
• Uric acid: 3.5 – 7.5 mg/dL
• CPK: 21-232 U/L
learn Prefix
1.Hyperphosphatemia( muscle contraction + nerve ) same as prefix
= muscles excited,tetany s/s same like Hypocalcemia
*Hypophosphatemia =muscle weekend, decrease Resp ,seizure
- s/s same like Hypercalcemia
2.Hyperkalemia -think cardiac & Neuromuscular
s/s opp as Prefix in muscle(weak) & same prefix GI - /hyper BS, diarrhea
Prefex same cardiac in K+ (Tall T waves,Flat P waves,Prolong PR interval,widened QRS complexes ) Hyperkalemia and hypoxia are more likely to result in sinus bradycardia.
*HypoKalemia - ( ST depression, Flat or inverted T wave, U wave)-low Bp+Hr
3. Hypercalcemia- think Neuromuscular+parathyroid
s/s opposite Prefix - decrease muscle(Shorten ST and widen T wave)
*Hypocalcemia - Paresthesia (chvostek’s sign and Trousseau sign)
- excess muscle contraction, Prolong QT ,tetany,seizures
4. Hypernatremia- think Neuromuscular + fluid -
s/s opposite Prefix -N/V,dry,thirst,increase muscle tone,irritability
*Hyponatremia - (confusion, seizures and coma,Resp arrest)
5.Hypermagnesemia- think Muscles too relaxed
s/s Opposite Prefix ( Prolong PR interval,Wide QRS)
*Hypomagnesemia -muscles excited /tachycardia, seizures,
Tall T wave,ST depression -( like Hyperkalemia)
2.FLUIDS
1-Isotonic (equal fluid exchange) = healthy man
- learn Middle numbers like 0.9NS, D5w, RL
2-Hypertonic ( external fluid shift)= Skinny man
-learn Upper nos like 5% NS, 3%NS, D10W, D5LR, TPN,ALBUMIN
3-Hypotonic ( Internal fluid shift)= fat man
-learn lower nos like 0.45NS, 0.225NS, D25W
ABG(ACID BASE BALANCE) - learn s/s of each cause
• pH: 7.36 – 7.45
• HCO3: 24 – 26 mEq/L
• CO2: 35 – 45 mEq/L
• PaO2: 80% – 100%
• SaO2: >95
Learn ROME =Resp opposite and Metabolic equal.
1-Respiratory Alkalosis-(PH high+PCO2 low )
-cause Eg-Hyperventilating,Hypoxia,Hysteria
2-Respiratory Acidosis -( PH low + PCO2 high)
-cause Eg-Asthma,COPD, Emphysema, Pneumonia,Bronchitis
3-Metabolic Alkalosis-( PH high + HCO3 high)
-Cause Eg- Vomiting or GI suctioning
4-Metabolic Acidosis-( PH low + HCO3 low )
-Cause Eg-Intestinal secretion like Diarrhea,colostomy.
3.INFECTION CONTROL
1-AIRBORNE precautions( N95 respirator/Negative air room)
Learn My= measle,
Chicken =varicella / herpes zoster
has TB= Tuberculosis
when in room Nurse wear N95 mask
When patient is out of room patient wear surgical mask . Who is accompany wear N95 mask
2-CONTACT PRECAUTIONS (USE GOWN & NITRILE GLOVE)
* Herpes simplex ( open lesion )
* Draining abscess
* Diarrhea in young child
* MRSE ,VRSE
* Impetigo
* Conjunctivitis
* Head lice , scabies
* Clostridium
3- DROPLET PRECAUTION ( Mask & 30 feet distance)
learn PIMP my ride ( from tv show)
Pertussis
influenzae type b
* Mumps
* Neisseria
meningitis
* Haemophilia
* Rubella
* Diphtheria
* Viral influenza
* Streptococcus group a throat
4-STANDARD Precaution
Surgical mask and Disposable gown
Private room glove when in contact with fluid
Google shield in contact with body fluid when suction, wound care
4.EKG
*ST depression-(ischemia)
ST elevation-(Infarction)
Tall T waves-(Hyperkalemia)
U Wave (-HypoKalemia)
SINUS RHYTHM-Regular rhythm, 60-100 bts/min, Uniform P wave precedes QRS complex,
PR interval(0.12 to 0.20)secs , QRS (0.11secs or less)
1-Sinus Tachycardia-Atrial and ventricular,rhythms are regular. Rate > 100 bpm.Normal P wave preceding each QRS complex
2.Sinus Bradycardia-Regular atrial and ventricular rhythms.Rate < 60 bpm.Normal P wave preceding each QRS complex.
-Atrial flutter-Atrial rhythm regular, rate 250 to 400 bpm Ventricular rate variable, Saw-tooth shape ,
P wave not identified,QRS complexes often irregular
-Atrial Fibrillation-Atrial rhythm irregular, rate 400 to 600 bpm.Ventricular rhythm irregular,
No P waves, or P waves appear as erratic,irregular baseline fibrillatory waves,PR interval not measurable, QRS usually wide -cardioversion treatment
.-Ventricular Tachycardia -Ventricular rate 140 to 220 bpm, regular or irregular.
QRS complexes wide & bizarre, Mountain shape and independent of P waves P waves no discernible May start and stop suddenly.
Adenosine is the drug of choice!
*Monomorphic V-Tach- mono means one, rate 101-250,a rhythm regular ,NO P or PR interval,QRS wide
*Polymorphic V-Tach(TORSADES)- rate 150-300, Rhythm may be regular or irregular,
NO P or PR interval , QRS wide- GIVE Mgs04
-Ventricular Fibrillation -Ventricular rhythm and rate are rapid and can't identify . P,PR, QRS are not discernible.-DEFIBRILLATION treatment.
-Premature atrial contraction (PAC)-Premature, abnormal looking P waves that differ in configuration from normal P waves.QRS complexes after P Waves except in very early or blocked PACs.P wave often buried in the preceding T wave or identified in the preceding T wave.
-Premature ventricular contraction (PVC)-Atrial rhythm regular Ventricular rhythm irregular QRS complex premature, usually followed by a complete compensatory pause QRS complex wide and distorted, usually >0.14 second. Premature QRS complexes occurring singly, in pairs,or in threes; alternating with normal beats; focus from one or more sites. Ominous when clustered, multifocal, with R wave on T pattern.
-Paroxysmal Supraventricular Tachycardia-(PSVT)-is used to describe SVT that comes and ends suddenly.When a normal P wave is present, it’s called paroxysmal atrial tachycardia; when abnormal P wave isn’t present, it’s called paroxysmal junctional tachycardia.
HEARTBLOCKS
*First-degree AV-block -rate 50, Atrial and ventricular rhythms regular, P wave regular,
PR interval > 0.20 second,(more then 5 blocks) .QRS complex normal
*Second-degree type I AV block -Mobitz I (Wenckebach)-Atrial rhythm regular, Ventricular rhythm irregular,P wave present and irregular,PR interval shorter to longer in cycle.QRS drops.
“Longer longer longer drops-thats called Wenckebach-type 1 be one)
*Second-degree type II AV block -Mobitz II (complex heart block-) rate slower than type I,
P waves regular, R waves irregular , QRS drops multiple
“Type 2, 2 beats and drops”
*Third degree AV block -P waves regular, R waves regular , Rate less then 40, PR interval is irregular,QRS complexes are wide and bizarre.
-Asystole-No atrial or ventricular,rate or rhythm.No discernible P waves,QRS complexes, or T waves
5.PATIENT POSITION
• Air/Pulmonary embolism – turn patient to left side and lower HOB.
• Asthma – Orthopneic position
• Above Knee Amputation – elevate for first 24hrs on pillow, position on prone daily for hip extension.
• Below Knee Amputation – foot of bed elevated for first 24 hrs, position prone daily for hip extension.
• Post Bronchoscopy –supine with head hyperextended.
• Cerebral Aneurysm – high Fowler’s
• Hemorrhagic Stroke – HOB elevated 30 degrees to reduce ICP
• Ischemic Stroke – HOB flat.
• Cardiac Catheterization – keep site extended, low fowler
• Tube feeding –position patient on right side ,HOB elevated to prevent aspiration.
• Postural Drainage – Lung segment to be drained should be in the uppermost position to allow gravity.
• Post Lumbar puncture – patient should lie flat in supine to prevent headache and leaking of CSF.
• Continuous Bladder Irrigation (CBI) – catheter should be taped to thigh so legs should be kept straight.
• After myringotomy – position on the side of affected ear after surgery (allows drainage of secretion).
• Post cataract surgery – patient will sleep on unaffected side with a night shield for 1-4 weeks.
• Detached retina – area of detachment should be in the dependent position.
• Post thyroidectomy – low or semi-Fowlers, support head, neck and shoulders.
• Thoracentesis – sitting on the side of the bed and leaning over the table (during procedure);
Affected side up (after procedure).
• Spina Bifida – position infant on prone so that sac does not rupture.
• Buck’s Traction – elevate foot of bed for countertraction.
• Post Total Hip Replacement –.abduction by separating thighs with pillows.
• Prolapsed cord – knee-chest position or Trendelenburg.
•Cleft-lip & Cleft-palate – supine, – not prone.While feeding, hold in upright position
.Hemorrhoidectomy – assist to lateral position.
• Hiatal Hernia – upright position.
• Dumping Syndrome – eat in reclining position, lie down after meals for 20-30 minutes
• Enema Administration – position patient in leftside lying (Sim’s position) with knees flexed.
• Post supratentorial surgery (incision behind hairline) – elevate HOB 30-45 degrees.
• Post infratentorial surgery (incision at nape of neck) – position patient flat and lateral on either side.
• Increased ICP – high Fowler’s.
• Laminectomy – back as straight as possible; log roll to move and sand bag on sides.
• Spinal Cord Injury – immobilize on spine board,with head in neutral position.
• Liver Biopsy – right side lying with pillow or small towel under puncture site for at least 3 hours.
• Paracentesis – flat on bed or sitting.
• Intestinal Tubes – place patient on right side to facilitate passage into duodenum.
• Nasogastric Tubes – elevate HOB 30 degrees to prevent aspiration. Maintain elevation for
continuous feeding or 1 hour after intermittent feedings.
• Rectal Exam – knee-chest position, Sim’s, or dorsal recumbent.
• During internal radiation – patient should be on bed rest while implant is in place.
• Autonomic Dysreflexia – place client in sitting position (elevate HOB)
• Shock –modified Trendelenburg
• Head Injury – elevate HOB 30 degrees to decrease intracranial pressure.
• Peritoneal Dialysis –supine, turn patient side to side if checking for kinks
• Myelogram Water-based dye – semi Fowler’s for at least 8 hours.
• Myelogram Oil-based dye – flat on bed for at least 6-8 hours to prevent leakage of CSF.k
• Myelogram Air dye – Trendelenburg
--------------------------------------------------GOOD LUCK-------------------------------------------------------------
MEDSURG NOTES
1.CARDIAC
1. Hypertension (s/s-Headache,Blurry vision,Chest Pain,Nose bleeds,Ringing in the ears,Dizzy)
2.Myocardial Infarction (s/s-Radiating chest pain that goes to left arm, jaw and back chest pain unrelieved by nitroglycerin or rest,SOB,Increased HR or irregular HR or BP.
3.Heart failure is characterized by manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance.
a-signs and symptoms of Left-sided heart failure(think LUNG)
-Difficulty breathing,Rales,,Orthopnea,Weakness,Nocturnal, Paroxysmal dyspnea,
Increased heart rate,Nagging cough
b.Right-Sided Heart Failure:(think body Systems)
-Swelling of legs, hands, liver, abdomen,Weight gain,pitting edema,jugular venous distention , Lethargic,Irregular heart rate,Nocturia, increased Girth of abdomen
4.Coronary Artery Disease:(s/s-Chest pain during activity,Shortness of breath
5.Endocarditis(s/s -Petechiae,Anorexia,High Fever & Heart Failure,Embolic,Erythematous
*Osler’s Nodes( tender, red lesions on the hands and feet)
*Janeway Lesions (non-tender nodular lesions on the palms or soles of feet)
*Roth Spots (burst of blood vessels in the retinas with white centers)
*Splenomegaly (helps fight infection so it becomes enlarged)
5.Pericarditis s/s-Friction rub,Fever,Radiating substernal pain to left shoulder, neck or back,Chest pain that is stabbing,Trouble breathing when lying down,Inspiration or coughing makes pain worse,
ST segment elevation
*Types a.Acute: less than 6 weeks b.Chronic: lasts a long time about 6 months.
*Monitor for Cardiac Tamponade and Pulsus paradoxus
6.Aneurysms (Aortic/types)
S/s- pain extend left shoulder, neck or back,abdomen , difficulty swallowing ,syncope,Cyanosis,dyspnea)
7.Vascular disorder (DVT-Do not ambulated frequently during recovery face or else active and passive leg exercises should be performed to increase venous flow.
8.Cardiomyopathy- s/s- shortness of breath, fatigue, dizziness, edema of legs and feet.
9.Cardiogenic shock Confusion or lack of alertness,LOCs,rapid heartbeat,Sweating,Pale skin.
10.Myocardial Infarction s/s -Crushing chest pain, SOB,,Coughing.Nausea,Vomiting,Dizziness.
11.Aortic stenosis refers to the narrowing of the aortic valve. This causes reduced cardiac output and increased left ventricle pressure. Syncope is a hallmark sign of aortic stenosis.
12.Thromboangiitis obliterans (also called Buerger's disease) s/s inflammation and thrombosis of the vessels of the hands and feet. It is strongly associated with smoking.Ulceration is a common complication associated with thromboangiitis obliterans.
2.RESPIRATORY
*Breathing Retraining(Pursed lip breathing,Diaphragmatic Breath)
*Huff Coughing ( cough 3 times during exhale)
* Chest Physio (CPT) /Use of type of oxygen/
*Ventilators (High pressure-Congestion / Low Pressure-leak)
1.Rib Fracture /Flail chest - (direct Blunt chest Trauma)
*Flail chest-2 or more fracture(floating/paradoxical chest movement)
2.Pneumothorax ( accumulation of Air) -tracheal deviation in tension
3.Acute Resp. Failure / Acute Respiratory Distress Syndrome
Common s/s- Dyspnea, Headaches,Tachycardia,Decreased breath sounds Pulmonary, edema, pulmonary hypertension and severe acidosis.
4.Asthma(early triggers and Late symptoms of continuous wheezing)
5.COPD(s/s Barrel chest,hypercapnia,hypoxia,Orthopnea,)
4.SARS(Severe Acute Resp Syndrome-Cause by coronavirus/avoid contact)
5.Pneumonia(s/s-Rhonchi,wheeze,Pleuritic pain, fever,chills,sputum)
6.Influenza(flu) / Legionnaires Disease (symptoms like flu)
7.Pleural effusion( Pleuritic pain,progressive dyspnea,dry,non productive cough)
8.Chronic Bronchitis( s/s Blue-Cyanotic,recurrent cough,Hypoxia,hypercapnia,^RR
9.Emphysema -air in tissue (s/s barrel chest,Hyperresonance on percussion, orthopnea,
pursed lip breathing,prolonged expiration)
10.Pleurisy(knife like pain or rough scratching sound,pleural friction rub cause from infection / *Empyema(pus within pleural cavity
11.Lung cancer s/s Hoarseness, worsening cough, SOB,Wheezing,Weakness and fatigue,
Loss of appetite and weight loss,Coughing up phlegm or blood,Muscle weakness,Nausea,Vomiting,
High blood pressure,High blood sugar,Confusion,Seizures.Coma
12.pulmonary embolism - Sudden chest pain is the most common initial symptom reported. Other symptoms include dyspnea, increased respiratory rate, blood-tinged sputum, tachycardia, anxiety, fever, and diaphoresis.
•Dyspnea can occur at rest or with exertion and has a sudden onset.
13.pleural effusion s/s pleuritic pain, dry nonproductive cough, dyspnea on exertion, tachycardia, and diminished breath sounds of the affected area.
14.Pleural friction rub s/s abnormal sounds heard during inspiration and expiration that range from squeaking to crackling, or grating, is a hallmark sign of pleural effusions
15.Simple silicosis: The patient was exposed to low concentrations of silica and is usually asymptomatic. Abnormalities are usually detected on x-ray.
3.NEURO
Myasthenia Gravis
-autoimmune condition where the body attacks the receptors that allow for voluntary muscle control, which leads to muscle weakness(Myelin Sheath breakdown)
s/s-difficulty swallowing, muscle Weakness,ptosis,no expression,No energy,strabismus
complication-Short of breath
-diagnosed by Edrophonium (Tensilon test):
*Cholinergic Crisis( too much meds)
s/s-Respiratory failure,Muscle weakness,GI issues,Low blood pressure and heart rate,Pupil constriction,Increase salivation and tear production, blurred vision and increase respiratory secretions,Muscle fasciculation/twitching, eventually paralysis
*Myasthenic Crisis(too less meds)
s/s-Respiratory failure,Muscle weakness,pupils dilated,tachycardia/HTN,aspiration,incontinence
Type of Strokes
–Ischemic-This limits the blood that can reach the brain cells.
-Embolism: The clot develops in the heart and travels to the brain, which stops blood flow.
-Thrombosis: Clot forms within the artery wall within the neck or brain.
–Hemorrhagic: there is bleeding in the brain due to a break in a blood vessel.
-TIA (transient ischemic attack) also called a mini-stroke.
s/s -“FAST”
Face: drooping or uneven smile
Arm: numbness, weakness, drift (raise both arms)
Speech: can’t repeat a phrase, slurred speech
Time: to call rapid response and note the time
Other s/s -Bowel and bladder incontinence or retention
Parkinson’s Disease
s/s-Tremors at rest,Pill-rolling,Stiffness of extremities,akinesia,Shuffling of gait ,
Cogwheel rigidity,Bradykinesia,drooling, Face mask expression,Coordination issues,
slurred speech, problems swallowing,Depression,Constipation
ICP(High BP,low Respiration)
Other s/s-Mental Status Changes,Irregular breathing
Late signs- double vision, swelling of optic nerve,pupil changes),abnormal doll’s eyes,oculocephalic reflex Post craniotomy -position for an infratentorial approach is to keep the head of bed flat and place a small pillow under the nape of the patient's neck to promote venous return and reduce ICP.
• Elevating the head of bed at 30-45˚ is for the supratentorial approach.
4.RENAL
1.Stages of Chronic Kidney Disease
1.Stages of Chronic Kidney Disease
Stage 1: GFR >90 ml/min but with proteinuria (3 months or more)
Stage 2: GFR 60-89 ml/min with proteinuria (3 months or more)
Stage 3: Mild-to-severe loss of renal function, GFR 30-59 mL/min
Stage 4: Severe loss renal function ,GFR 15-29 mL/min
Stage 5: end stage renal disease, GFR less 15 mL/min
s/s-Uremia ,Hypervolemia, Proteinuria and Hematuria,Oliguria,Anuria
(Electrolyte Imbalances: hyperkalemia, hypocalcemia, hyperphosphatemia,hypermagnesemia
2.Stages of Acute Kidney Injury
*cause by pre kidney like heart , In the Nephron and post kidney like Urinary system
-Initiation: This stage lasts a few hours to several days.
-diuresis stage-some patients skip this stage
-Oliguric:output less than 400
3.Acute Glomerulonephritis- is a type of Nephritic syndrome often occurs after streptococcal glomerulonephritis.
S/S-ASO antistreptolysin titer positive,Decreased GFR,Swelling in face/eyes,Tea-colored urine,,Elevated BUN and creatinine, mild Proteinuria,Hypertension,hematuria, azotemia, oliguria, Decreased urine specific gravity
4.Nephrotic Syndrome:• s/s-proteinuria, hypoalbuminemia, and hyper lipids, edema.
5.Nephritic syndrome- I- mild loss of rbc & protein urea VS Nephrotic syndrome-O - no loss of rbc but massive loss proteinuria: n that they both involve increased permeability of the glomerulus, leading to proteinuria, hypoalbuminemia, and hyperlipidemia.
• When differentiating these two diagnoses, hematuria is noted only in nephritic syndrome.
6.Renal Calculi- s/s-Pain can change as the stone moves through the urinary system , odorous urine
Watch for *Renal colic: stone in the renal pelvis dull, deep aching in the flank or costovertebral area -murphy's sign punch
*Ureteral colic: stone residing in the ureter ,.intense, sharp, radiating, wavelike pain to the genitalia.
*Urinary retention: especially if stone is stuck in neck of bladder…this makes it extremely hard to completely pass all the urine in the bladder…
7.POLYCYSTIC KIDNEY DISEASE PKD is an inherited condition characterized by the formation of cysts. It is progressive and difficult to treat.
• Cyst formation on the kidneys leads to scar tissue, damage to the nephrons and carries a poor prognosis.
6.GASTRO
COMMON GI CONDITIONS
(learn risk and Management. Diet(protein) and NSAID caution )
1.GERD= Heartburn(gas reflux, regurgitate while lying & dry cough in night )
2-PEPTIC ULCER =abdominal pain that is severe with a sudden onset.Heartburn with bleeding
due to ulcers.(melena)GI sound may be absent when perforation occurs
3-DUMPING SYNDROME(dumping so fast) precaution of fluid shift s/s tachy,decrease insulin)
4-DUODENAL ULCER Up to 90% of duodenal ulcers are caused by the bacteria Helicobacter pylori
(H. pylori). Treatment consists of 1 or 2 antibiotics, a proton pump inhibitor, and bismuth.
• Stress, NSAID use, and alcohol can lead to gastric, not duodenal ulcers.
( feed the Dude- pain subsides after feeding)
5-GASTRIC ULCER (starve and pain subsides when starving)
6-CROHN’S DISEASE( non bloody stool,5-6 per day) lying with leg flexed.
7- ULCERATIVE COLITIS ( bloody stool,10-20 per day)
8-DIVERTICULITIS & DIVERTICULOSIS (LLQ pain)
Itis (inflammation) & losis (outpouching) at Diverticulum
-in acute diverticulitis avoid high fiber as to prevent strain on inflammation
9-IBS (IRRITABLE BOWEL SYMPTOMS)
-Combination of Diarrhea and constipation
10-TYPES OF HERNIA ( learn its location for s/s)
eg-Hiatal hernia ( cause heartburn), Inguinal (groin)
11-APPENDICITIS ( RL Quadrant pain)
-rebound tenderness, risk for perforation when complaint of pain.
12-CHOLECYSTITIS (GALLBLADDER)
-RUQ Pain, pain after eating , Clay colored stool
CELIAC DISEASE( Gluten free diet-BROW)
13-HEPATITIS TYPES /JAUNDICE( yellow colour)
14-CIRRHOSIS( gynecomastia, spider angioma) /
15-PORTAL HYPERTENSION ( Esophageal Varices/Hepatosplenomegaly)
16-LIVER OR HEPATIC ENCEPHALOPATHY (asterixis, altered mental status,coma)
17-LIVER CANCER(bleeding precaution, osteoporosis,fluid overload)
18. Peritonitis( Blumberg's sign is the presence of rebound tenderness in the abdomen
7.MUSKULOSKELETAL
1.Gout (s/s increased uric acid levels, swollen, red, hot or painful joints.
-Acute gout attacks(sudden swelling, redness and pain in a joint,may have flu-like like symptom,body aches)
-Chronic gout attack(:uric high acid levels constantly stay elevated which leads to repeated acute attacks,Joints become permanently damaged)
s/s-Outgrowths on Hands: Nodes (bony outgrowths) on fingers from bone spurs:
2.Osteoarthritis-(cartilage affected) s/s-Sunrise Stiffness (morning time) Less than 30 minutes
Tenderness,crepitus,
3.Rheumatoid Arthritis-(Synovium affected)
s/s morning stiffness greater than 30 minutes),Soft, tender, and warm in joint,Swelling in the joint
• Septic arthritis is characterized by invasion of the joint by microbes, leading to arthritis and destruction of the joint
4.Osteoporosis:s/s-Fracture,Rounding of the upper back Dowager’s Hump,Asymptomatic until fracture
Inches of height lost overtime since a young adult (2-3 inches),Low back pain, neck or hip pain
5.Bone fracture(crack in a bone)
s/s-Bruising over the site,pain that is sharp and continuous.Reduced movement of extremity or muscle,Crackling sounds Edema and erythema at the site.
6.Below the knee amputation(BKA) and Above the knee amputation(AKA)
-keep a pillow under stump for 24 hours post surgery, next day instruct to lie in prone position as tolerated at least twice a day. Caution against keeping pillow under lower-extremity stump or allowing BKA limb to hang dependently over side of bed or chair.
7.DVT ( deep vein thrombosis)s/s-Edema,massively swollen, tense, painful,cool to the touch.Tenderness.
In some cases, s/s of a pulmonary embolism are the first indication of DVT.
8.Buck's traction provides longitudinal pressure with the purpose of immobilizing, positioning, and aligning the lower extremity., providing a trapeze and footboard reduces friction and shear on the skin by facilitating independent movement and allowing the patient to lift the pelvis to reposition with the trapeze and the unaffected leg.
9. Cast Infection under a cast is suspected with the presence of a hot spot, foul or musty odor, or purulent drainage. .
10.total hip replacement, the patient should not stay in the same position for more than 1 hour. Frequent standing, stretching, and movement is encouraged.• Keeping a pillow between the legs will promote abduction of the hips.• Hips should not be flexed greater than 90 degrees, such as in low squatting.
11. Paget disease of bone (PDB) is a bone disease of unknown origin, s/s excessive breakdown and formation of bone. Bones become deformed and weak due to overactivity of osteoclasts and osteoblasts.
8.INTEGUMENTARY
1.Sjögren's syndrome is a systemic autoimmune disease that affects exocrine glands. This causes a deficiency in saliva, tears, skin lubrication, and other exocrine secretions.
• Offering frequent drinks of water or sugar-free soda helps wet the mouth. Chewing sugar-free gum also helps make more saliva.
• A dry mouth is more prone to oral infections. It is important to assess the oral mucosa daily for reddened or white patches.
2.Spider angioma is a form of telangiectasia, or dilated capillaries found on the skin. These lesions are benign and can be removed via laser treatment.
3.Impetigo is a bacterial skin infection that is very contagious and is generally caused by staph or strep infections. It is transmitted by direct contact. Red raised papules eventually dry and scab over with a brown, gold, or yellow crust. Lesions are treated by cleansing gently with wet cloth to loosen crusts, patting dry, and applying topical antibiotic ointment. More involved infections may require systemic antibiotics.
4.Psoriasis treatment includes moisturizers, coal tar, ultraviolet therapy, vitamin D, ointments, retinoids, and topical corticosteroids.
• Systemic corticosteroids are generally not used to treat psoriasis due to side effects and rebound psoriasis.
5. Post Burn Skin graft sites should be immobilized to promote adherence and healing for the first 3-7 days.• After skin graft adherence is accomplished, range of motion and physical therapy is needed to prevent contractures.
9. ENDOCRINE
1.Hypoparathyroidism- Paresthesia occurs from an alteration in nerve conduction due to hypocalcemia.
• Other common signs and symptoms include muscle cramps and spasms, fatigue, bone pain, abdominal pain, and insomnia.
2.Addison's disease also causes hyperkalemia, hypercalcemia, hyponatremia , hypoglycemia, and hyperpigmentation.
3.Cushing's syndrome). Hirsutism, edema, weight gain, and fragile skin are associated with excessive cortisol secretion
4.Thyroid storm are to decrease thyroid hormone synthesis, prevent thyroid hormone release, decrease the action of circulating thyroid hormone to reduce heart rate, and to treat the condition that brought on the thyroid storm.
5.Hyperaldosteronism (Conn's syndrome) is characterized by excessive aldosterone secretion. The main effects of aldosterone are sodium retention and potassium and hydrogen ion excretion. Thus, the symptoms of hyperaldosteronism are hypertension and hypokalemic metabolic alkalosis.
-post thyroidectomy -risk for hypocalcemia/Hypothriodism (signs of loss of sensation )
DM--
1- Type I DM ( deficiency of Insulin production), has Ketones (DKA)-
-insulin infusion (5%D or 10%D),carb diet and count.
2- Type II DM (lack of Insulin production), has no ketones (HHNK)>800
- fluid replacement(NS) & maintain diet & exercise
3-Hypoglycemia-(PIT)-TIRED
• Tachycardia
• Irritability
• Restlessness
• Excessive Hunger
• Diaphoresis
Rhyme
Cold and clammy, need some candy-Palpitation,irritability,tremor
Othres s/s are Shakiness/Diaphoresis / pallor/Anxiety/Restlessness
-If hypoglycemic <70- give 1 sugar + 1 starch(crackers), recheck in 15mins
-If hypoglycemic client is unconscious give Glucagon + IV Dextrose
4-Hyperglycemia >250 - S/S-(3Ps) - Polyuria,Polyphagia,polydipsia
-If hyperglycemic-give insulin
5-foot care- do not use cream between toes or cut toenails.
6-complication of insulin- rotate site to prevent ,local allergy,
-Lipodystrophy(loss of sc fat/dimpling)-Lipohypertrophy(development of fatty mass )
Caution using Insulin before and after surgery, dialysis pt.
10.ONCOLOGY
CANCER CAUTION-
CANCER CAUTION-
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or a lump in the breasts, testicles, or elsewhere
Indigestion or difficulty in swallowing
Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
Nagging cough or hoarseness
--------------------------------------------------GOOD LUCK-------------------------------------------------------------
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