dlscrib.com_36190527-gapuz-notes-day-1-7.pdf

NCLEX REVIEW – GAPUZ REVIEW CENTER (31 JANUARY – 17 FEBRUARY 2005, PICC, Cit !" #$%i&$'

DAY 1 (31 JANUARY 05)

TEP IN PAING       

Have a Right Attitude  THINK POSITIVELY … have a Fresh Start KNOW what YOU WANT ad HOW TO !ET IT OVERVIEW OF ESSENTIAL "ON"EPT  TRY OUT F#$us assess%et & ha'its #( SU""ESSFUL E)A*INEE

#)BY + gr#wth ad deve,#-%et LIPPINC)TT + $are #( the E,der,. ad "#%%ui$a',e /isease

*IG)XIN + %#it#r the $reatiie… 0 the TV /OESN1T ,##2 g##d t# %e3 4/I!O)IN TO)I"ITY + ausea5v#%itig6 a'd, $ra%-s7 O,ive 8 'utter "K + #r%a,i9e : + ; da.s a(ter *I L/H < : := = + :> :> da.s ATRIAL FLUTTER + AW T))T+

PR)CE )F ELI#INATI)N  

    

$#sider *ASLOW1s H #( NEE/S $#sider the "O*PLI"ATION whether ACUTE "HRONI" A?"s SAFETY FIRST NS! PRO"ESS

– ALWAY -i!-iti./

##R VACCINE – !%& $i%/ "!- +IV t Pt # HEPARIN + APTT 4N ;=<>=se$76 there(#re i( IN"REASE + ',eedig

P)I)N  %4-i%6 %4-i%6 $ti!% $ti!% i% !-/- 8 @: "ALL -#is# $#tr#, $eter @  *INI*IBE E)POSURE #( -t t# -#is# + -u,, hi%5her awa. (r#% the -#is# @ ; I/ENTIFY the -#is# GENTA#YCIN + s5e tiitus6 vertig#6 #t#t#Ci$it.6 #,iguria LIT+IU# CARB)NATE + (#r EL/ERLY D N ,eve, NOT %#re tha :=%e5L

A/ULT D N G + : %e5L

+EPA B i/t D ,#w (at6 i$rease "HON

/OWN SYN/RO*E + ,arge t#gue + (eedig -r#',e% + -##r su$2ig 4i(ats7

AFETY PRINCIPLE : whe $a a $hi,d USE A/ULT SEAT ?ELT < i" t9/ i%"$%t i :0 &; $% :0 i%9/ i% 9/i69t

/$t ;/&t &!$ti!% i% $- D ?A"K "ENTER SEAT 2. T)**LER + (a,,s 3. UPRATENT)RIAL -$%i!t!<  + se%i (#w,er1s -#siti#

INFRATENT)RIA L + (,at i 'ed 4. S"ATTER RU!S + !t/!!-!i t 5.  TRIA!E  'urs6 #-e (C + =+)C>?

T9i%6 N)T T) BE *ELEGATE* ; RN D Assess%et6 Tea$higs6 Eva,uati#

Pt G=.5# ad

< <$<
Pt @it9 P>U + LOW PHENYLALA*INE /IET 4NOT -he., FREE7 + there(#re LOW "HON Pt with R#$2. *#utai Fever + eC-#sure t# !6 ti L.%e1s /ses + //- ti

PSYCHE PATIENTS : re%e%'er re%e%'er t# sti$2 sti$2 t# uit ru,es5 ru,es5-#,i$ -#,i$. . + 'e $#sistet $#sistet t# -t  e$#urage e$#urage ver'a, ver'a,i9ati i9ati# # + 0te, 0te, %e h#w… h#w…3 3 ; s#ud 2#w,edge 2#w,edge #( $u,tur $u,tura, a, divers diversit. it. < see2 see2 he, he,- #( #( it iter er-r -ret eter er > a$2#w,edge a$2#w,edge -t (ee,igs (ee,igs + 0it see%s…3 see%s…3 0this %ust 'e di((i$u,t…3 G e%-hati9e e%-hati9e with .#ur -atiets1s -atiets1s (ee,igs (ee,igs 0 I uderstad h#w .#u (ee,…3

CATARACT  + "AUSES + agig ad a d trau%a #RA 4%ethi$i,,i resistat sta-h.,i$$#$us aureus7 < USE !LOVES AN/ !OWN WHEN W5 PT

DAY 2 ( 01 February 05)

TUBES : GR)+)NG CAT+ETER HI"K*AN ?ROVIA"

<  ,u%e < ; ,u%e < : ,u%e

ALL reuires "etra, Ve#us A$$ess < sitesD sitesD $e-h $e-ha,i a,i$6 $6 'ra$h 'ra$hia, ia,66 'asi,i$ 'asi,i$a a ad su-er su-eri#r i#r vea vea $ava $ava PURPOSE D F#r TPN

Ad%iistrati# #( "he%# Agets6 ?,##d Pr#du$ts6 Ati'i#ti$s

C)#PLICATI)NDThr#%'#sis ad ?,eedig

 C+ET TUBE + Water Sea,ed /raiage  T.-esD Ateri#r + @ -$i% AIR P#steri#r < @ -$i% FLUI* Water Sea,ed /raiage D : '#tt,e6  '#tt,e ad Three '#tt,e s.ste%

1 B)TTLE D

3 – 5< #( #,. 4,egth #( tu'e t# 'e e%erge7

2 B)TTLE D

First '# '#tt,e + dr draiage '# '#tt,e 4 4# tu tu'e e% e%erge76 d  '#tt,e < ,#g r#d ;
%$3 ;!tt&/

FREJUENTLY USE/

D

:st '#tt,e + -$i%$6/ d '#tt,e + @$t/- /$&/ ;rd '#tt,e + 4ti!% ;!tt&/ !%t-!&

C)#PLICATI)N D

'u'',ig6 'rea2age6 ',#$2age

Nsg ALERTD 

N)R#AL  D ?U??LIN! is N i the ; rd '#tt,e + it idi$ates that su$ti# is A/EJUATE 4i( # 'u'',ig STOPS i the ;rd '#tt,e6 %eaig + iadeuate su$ti#7



ABN)R#AL  D i( 'u'',ig #$$urs at the d '#tt,e + idi$ates LEAKA!E + a$ti#6 $he$2 sea,ed at air tight $#taier ad the -t ad '#tt,e $#e$ti#

I $ase there BREA>AGE 6 have eCtra '#tt,e ad e%erge tu'e ASAP t# -revet etr. #( air ad #r %a. use (#r$e- t# $,a%- tu'e te%-#rari,. I( -t a%'u,ates6 2ee- '#tt,e LOWER tha the -atiet

ABENCE !" )CILLATI)N $t t9/ 2 % B!tt&/ + idi$ates ',#$2age T)WAR* T+E B)TTLE  W9/% #IL>ING t9/ t4;i%6 E#ERGENCY EUIP#ET EUIP#ET AT BE*I*E8 Dt-$ ;!tt&/,&$<, 6$4./

; TRAC+E)T)#Y TUBE < t# %ait %aitai ai -ate -atet t airw airwa. a. (#r (#r -t w5 eur eur#,# #,#gi$ gi$a, a, -r#', -r#',e%s e%s ad ad %us$u,#s2e,eta, dis#rders

%4-i%6 $-/8 : Su$ti#ig + Su$ti#ig + :=<:Gse$#ds < i( 47 'rad.$ardia6 STOP < i( a$$ideta,,. dis,#dge6 isert #'turat#r t# 2ee- it #-e  AVOI/D AVOI/D water  water s-#rts + swi%%ig ; I $hagig ties + isert ew #e (irst ?EFORE RE*OVIN! #,d tie > Ri''# #r ties  side #( the e$2 #,. t# av#id -ressure G ?e(#re ad A(ter su$ti#ig + su$ti#ig  + h.-er#C.geate the -atiet

> PTCA

 

+ e,arge the -assagewa. (#r ',##d(,#w -r#',e%D s-as%s that ,ead t# arrh.th%ia

CTENT 4$ardia$
G PENR)E *RAIN  w#ud draiage s.ste% < d#$t#rs the #e wh# re%#ves this < re%#ve gradua,,.

M NA) GATRIC TUBE + st#%a$h ad itestie 4du#deu%7 Types: 

Le! Le !"e "e Tube Tu be + (#r st#%a$h < : ,u%e6 (#r ,avage 4$,eaig7 ad gavage 4(eedig7



Sa#e Sa #e$ $ Su$% Su $% + (#r st#%a$h <  ,u%e 4I (#r su$ti#ig6 I (#r ,avage5gavage7 < i( -t 4i(at7 is havig eteri$ $#ated %eds6 reuest (#r $hage i (#r% #( %eds



&!##er Abb' + (#r itestia, 4w5 %er$ur. '> ie$ti#7 <  ,u%e 4isert the ie$t the %er$ur.7



Ca"'r + (#r itestia, < : ,u%e

N4-i%6 C$-/ "!- NGT8 1. ti- #( #se t# ear,#'e t# C.-h#id -r#$ess 4(#r st#%a$h7 2. ti- #( #se t# ear,#'e t# )P  &<:= i$hes (#r i%t/ti%$& NGT

; a$$urate %eas %eas t# veri(. $#rre$t $#rre$t -,a$e%etD -,a$e%etD ALWAYS ALWAYS $#sider Tw# $he$2ig $he$2ig $riteriaD ASPIRATION ad !urg,ig S#uds

R/!-t t9/ "!&&!@i%68

I( 4<7 #r de$rease draiage6 47 ausea ad v#%itig 47 a'd%, rigidit. "hara$teristi$ #( !astri$ Residua,D Residua,D %#re tha G= %# ad $#((ee gr#ud ?e(#re (eedig $he$2 (#r -,a$e%et

& GATR)T)#Y TUBE (GT'   PEG '#th (#r NUTRITIONAL PURPOSES •

!T + i$isi# 4a'd#%e t# st#%a$h7 < (#r (#r -t -t 47 47 ,esi ,esi# # at es#es#-ha hagu gus s < sg $are $are D re-#r re-#rtt s5s s5s #( i(e$t i(e$ti# i#66 a'd, a'd, $ra% $ra%-s6 -s6 5v < -r#v -r#vid ide e ade adeu uat ate e s2i s2i  $ar $are e PE! + i$isi# at s2i < ,#g ter% thera-.

 T TUBE < t# drai eC$ess 'i,e 'i,e uti, hearig #$$urs < -,a$e draiage 'ag at the ,eve, #( thrs6 >hrs6 i( i( re-#rt ASAP

 +E#)VAC JAC>)NPRATT JAC>)NPRA TT (JP'  

?OTH used as $,#se w#ud draiage su$ti# s.ste% ?OTH s.ste% (u$ti# # the s.ste% #( 4<7 -ressure

QP + $#%-ress the $#taier 'e(#re atta$hig t# the draiage WHEN TO E*PTYD whe its usua,,. :5; t#  (u,, the RE"OR/ the a%#ut

:= T+REEWAY F)LEY  a'se$e #( $,#t + e((e$tive "hara$teristi$ #( draiage + <; da.s a(ter surger. 4',##d. t# -i2ish7 + NO NEE/ TO REPORT THIS + it is eC-e$ted

CAT+ETER –  – (#r geit# uriar. -r#',e% :: UPRAPUBIC CAT+ETER  iserted dire$t,. dire$t,. at the ',adder wa,, wa,, < $he$2 i( -r#-er,. a$h#red

: URET+RAL CAT+ETER + t# drai urie < ever $,a%- 'e$ause it $a #,. h#,d >< %, #( urie < 2ee- #-e t# drai urie (r#% 2ide. -e,vis

ENGTA>EN BLA>E#)RE TUBE < ; ,u%e ,u%e 4 (#r (#r es#es#-hage hagea, a, 'a,, 'a,,## ##66 gastri$ gastri$ 'a,,## 'a,,##6 6 (#r (#r %eds7 %eds7 < (#r (#r -t -t w5 w5 es# es#-h -hag agea ea,, v var ari$ i$es es < 'a,, a,,## ta%-#ade ade < > hrs hrs + 2ee- 'a,, 'a,,## ## i(, i(,ate ated d (#r := := %iut %iutes es t# de$r de$reas ease e ',eedi ',eedig g

LINT)N TUBE + ; ,u%e #INE)TTA TUBE + > ,u%e

     

S"ISSORS + i<!-t$%t EUIP#ENT AT BE*I*E F)R ALL TUBE  S"ISSORS + HE*OSTAT + i%-#rtat istru%et that sh,d 'e  'edside (#r water sea,ed draiage Persistet 'u'',ig at water draiage '#tt,e + '#tt,e  + (#r '#tt,e @ + $he$2 i( tu'ig is -r#-er,. sea,ed N!T IS RE*OVE/ + i( -atiet eChi'its retur #( '#we, s#uds ?UL? SYRIN!E + use t# $,ea the ares #( -t with N!T 4$hi,d7  T# (a$i,itate re%#va, #( air at ,ugs + -ur-#se #( water sea,ed $ha%'er i ; wa. '#tt,e s.ste%

THERAPEUTIC DIET GENERAL C)NI*ERATI)N    



K#w the /IA!NOSIS #( the -atiet Ideti(.  i$#r-#rate the -t dietar. -re(ere$es Istru$t -t # what t# av#id F#r -regat -t6 #te dietar. $hagesD a addt, $a,#ri $a,#ries es 4;== 4;== $a,5da.7 $a,5da.7 average average #( #( >== < &== &== ' addt, addt, #( :=g% :=g%s5d s5da. a. (#r (#r "HON "HON $ IRON IRON D :G :G<; <;=% =%g5 g5da. da. d "AL"IU* "AL"IU* D R/A is :=== the ==%g5 ==%g5da. da. 4'r#$$#,i 4'r#$$#,i6tua6$ 6tua6$heese heese77 e !a,a$t#g#gu !a,a$t#g#gues es + i$rease i$rease -r#du$ti# -r#du$ti# #( #( %i,2 %i,2

PE*IATRIC t + '. >
TRANCULTURAL C)NI*ERATI)N 

C+INEE  + ,i2e $#,d desserts a(ter surger. (#r #-ti%u% hea,th



 JEW + 02#sher diet3 4# %eat ad diar. -r#du$ts at the sa%e ti%e7



EUR)PEAN  + %ai %ea, is served at %id da. (#,,#wed '. es-ress#



#ULI# + 0ha,a, diet3 + # -#r2



*A + stri$t,. vegs diet 4vit ?M ad ?: de(i$ie$.7



#)R#)N + w#rds w#rds #( wisd# wisd#% % 4# $a((e $a((eie ie66 a,$#h#, a,$#h#, ad ad #$e a %#th %#th (asti (astig7 g7 + the a%#ut a%#ut due (#r (##d (##d is d#a d#ated ted t# the the $hur $hur$h $h

>EY P)INT F)R NURE  S#diu% 4Na7 + s#ur$e d#w the s#i,  P#tassiu% 4K7 < s#ur$e u- the tree L#w Na /iet D AVOI/ -r#$essed (##ds6 %i,2 -r#du$ts ad sa,t. s a,t. (##ds KNOW the servigD

"HO < M<:: servigs "HON < <; FRUITS  Vegs < ;<> FATS < s-arig,.

MOST COMMON DIET 

CLEAR CLE AR LIUI LI UI* * *IET *IE T 4,ight $a -ass thru it6 %eaig TRANSPARENT7 < give give t# -t t# re,ieve re,ieve thirst6 thirst6 $#rre$t (,d  e,e$tr#,.te e,e$tr#,.te i%'a,a$e < give a,s# t# -t -#st<#eCD a--,e ui$e6 ge,ati 4straw'err.76 -#-si$,e6 $ad.



RENA RE NAL L *I *IET ET < <

(#r 2ide 2ide. . dis#rde dis#rderr 4rea, 4rea, (ai,u (ai,ure6 re6 A!N6 A!N6 Ne-hr Ne-hr#ti #ti$ $ s.dr#% s.dr#%e7 e7 t# %ait aitai ai  ((,d ,d  e i%'a i%'a,a ,a$ $e e

LOW "HON + "HON + av#id -#u,tr. -r#du$ts LOW Na < av#id -r#$essed (##ds6 %i,2 -r#du$ts6  sa,t. (##ds L#w K  < av#id (ruits 4a.thig .#u see i a tree7



L)W FATC+)LET FATC +)LETER)L ER)L RETRICT RET RICTE* E* *IET

< (#r ,iver ,iver dis dis#rd #rder6 er6 $ardi# $ardi#vas vas$u, $u,ar ar ad ad rea rea,, dses dses ALL)WE* D ,ea %eat6 %eat6 (ruits6 vegs ad (ish AV)I* D Sea (##ds6 (ried (##ds6 -reserved (##ds 4$heese $a2e ad



+IG + FIBER +IG+ FI BER *I *IET ET < t# -reve -revet t $#st $#sti-a i-ati# ti#6 6 he%#rr he%#rrh#i h#ids ds  divert diverti$ i$u,i u,itis tis < vegs vegs66 (rui (ruits ts ad ad gra grai i -r#d -r#du$ u$ts ts



)FT ) FT *I *IET ET < < <



(#r -e-ti$ -e-ti$ u,$er u,$er66 i i(,a (,a%%a %%at#r t#r. . !I !I $#d $#diti iti#s #s AVOI/D AVOI/D $he%i$a, $he%i$a,,. ,. ad ad %e$hai$ %e$hai$a,,. a,,. irritati irritatig g (##ds (##ds su$h su$h as (ried (ried (##ds6 (##ds6 (resh (resh ad raw (ruits  vegs 4EXCEPT8 av#$ad#6 'aaa  -i.a7 ad s-i$. (##ds with -reservatives

+IG+ PR)TEI P R)TEIN, N, +IG+ +IG + CARB) CARB ) *IET *IE T < <



(#r $ardi# $ardi#vas$ vas$u,a u,arr dses6 dses6 rea, rea,66 (,d (,d  e i%'a,a i%'a,a$e $e ALL)WE*8  (resh vegs AV)I* D -r#$essed (##ds6 %i,2 -r#du$ts ad sa,t. (##ds

BLAN BL AN* * *IE * IET T < <

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(#r g# g#ut. ar arthritis i$ i$rease ease (,ui (,uid d it ita2 a2e e AVOI/D AVOI/D -reser -reserved ved (##ds6 (##ds6 sea (##ds6 (##ds6 a,$#h# a,$#h#,6 ,6 #rga %eat 4,iver6 gi99ard7

NA RETR RETRICTE ICTE* * *IET < < <

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(#r i(,a i(,a%%a %%at#r t#r. . $#diti $#diti#s #sDD es#-hagi es#-hagitis tis66 -e-ti$ -e-ti$ u,$er u,$er gastriti gastritis s -ure -ureed ed (##d (##ds5 s5 ',e ',ede deri ri9e 9ed d (##d (##ds s s #u-

PURINE PURI NE RETRI R ETRICTE* CTE* *IET < < <

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$ustard7

(#r (#r 'ur 'urs s 4a'# 4a'#ut ut G== G=== = $a, $a,5d 5da. a.77 grai grai -r#d r#du$t u$ts s ad -#u,tr -#u,tr. . + t# t# aid aid the the hea,i hea,ig g tissu tissues es

ACI* ACI * A+ A + *IE *IET T < < <

t# de$r de$rea ease se the the -h -h #( #( the the uri urie e idi$a idi$ated ted (#r -t w5 a,2a,i a,2a,ie e st#e st#e eC eC s stru truvi vite te eC eC ; "1S "1S + $ra' $ra'er err. r.66 $he $hees ese6 e6  $#r $#r  ; P1S < -rues6 -,u%s  -astries

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AL>ALI AL> ALINE NE A+ A + *IET *I ET < < <

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GLUTEN GLU TENF FREE REE *IET *I ET < < <

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(#r (#r PKU6 PKU6 ut uti, i, age age := := ad ad ad#, ad#,es es$e $e$ $e e #,. #,. AV)I* 8 "HON ri$h (##ds 4%eat -r#du$ts + ,u$he# %eat7

FULL FUL L LIUI LI UI* * *IET *I ET < < <

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(#r $e,ia$ dses ALL)WE*  D ri$e6 $#r6 $#r6 $erea,s6 s#. 'eas AV)I* (LIFETI#E'8 'ar,e.6 r.e6 #ats6 wheat wheat

P+ENYLA P+E NYLALAN LANINE INE *IET *IE T < <

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t# i$r i$rea ease se -h #( the the uri urie e idi$a idi$ated ted (#r a$id a$id st st#e #e 4 uri$ uri$ a$id a$id st# st#e6 e6 $.sti $.stie e st#e7 st#e7 eC *i,2

#-aue tra trasi siti ti# #a, a, die diett (r#% (r#% ,i ,iui uid d eC D $rea $rea% % s#u-6 s#u-6 i$e i$e $rea $rea%6 %6 %i, %i,26 26 ,e$he ,e$he (,a6 (,a6 -u%-2 -u%-2i i $a2e $a2e

ATERIAL BL))* GAE

Ph + &;G + &>G P"O P"O < ;G + ;G H"O; <  + M %e5L

Ph

"#%-esat#r. *e$hais%

U%!</%$t/ a'#r%a, P$-ti$&& !</%$t/ a'#r%a, F4&& C!</%$t/ #r%a,

# $hage i$rease #r de$rease i$rease #r de$rease

*i$--9/$ + %eta'#,i$ a$id#sis V!
PRI)RITIZING PRI)RITIZING !" $/8 *ed
APGAR C)RING

0 A--eara$e Pu,se !ri%a$e A$tivit. Res-irat#r.

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4<7 4<7 (,a$$id 4<7

2

a$r#$.a#sis :== :== gri%a$e vig#r#us s#%e (,eCi# irregu,ar ,ust. $r.

a,, -i2

(,eCi#  eCtesi#

TRIAGE <-ri#riti9ig LEVEL 1  0e%erge$.3 

severe sh#$26 $ardia$ arrest6 $ervi$a, s-ie iur.6 airwa. $#%-r#%ise6 a,tered ,eve, #( $#s$i#usess6 %u,ti-,e s.ste% trau%a6 e$,a%-sia

LEVEL 2 0urget 4sta',e73 

$a 'e de,egated 4(ever6 %i#r 'urs6 ,a$erati#s6 di99iess7

LEVEL 3 

$hr#i$5 %i#r i,,ess 4$a 'e de,egated7 + deta, -r#',e%s6 r#utie %edi$ati#s ad $hr#i$ ,#w 'a$2 -ai

TIP )N PRI)RITIZING 1. PT  ER + &//i%6 i&& !/-!/

 -t '- =5; =5;= =  %#ther %#ther died died #( #( "VA t 1  -i!-it 8 $/ t "!- $t& -i "$t!- 3. -t as2 what -r#$edureD R% Ati!% 8 %!ti" t9/ !t!-

Fi'ri,,ati#7 4. #I $tt$ – 1 t $ti!% 8 re-#rt ASAP 4es- -rese$e #( vet Fi'ri,,ati#7

5. -t # N!T + 9/ $t/% !" t4;/

*ELEGATI)N < <

d# #t de,egate Assess%et6 Tea$hig ad Eva,uati# d# #t de,ega de,egate te %eds %eds -re-ar -re-arati ati#6 #6 ad%ii ad%iistr strati ati#6 #6 d#$u%e d#$u%eta tati# ti# 

CONCEPT OF DELEGATION   

consider the competence of personnel 5 R’s in delegating (RIGHT task person circ!mstances direction"comm!nication s!per#ision$ R% ma& delegate ' feeding client ro!tine #ital sign (pt " no complications$ and h&giene care

MI ATTACK  '  ' en)&mes to increase I% *R+,R - 1 2 3 4

m&oglo m&og lo/i /in n troponin 0  +H

RI RI *R *R I%6 I%6R7 R7 ' meniere’s dses I%,,0TI8, 9R,:THI%G ;:TT,R% ' myasthenia ra!is :T,R,+ TI6, ;,R6I*% ' "t #$ %&m"'ete heart ('&%)  I%,,0TI8, :IR<:7 0,:R:%0, ' "t #$ )*ssma*'’s (reathin

D

DAY 3 ( 02 February 05)

POSITIONING FOR SPECIFIC SURGICAL CONDITION P#siti#ig + ide-edet sg (u$ti# < 2#w the 4-!/ #( the -#siti# a. t# -revet #r -r#%#te s##thig ' what what t# -reve -revet t #r -r#% -r#%#te #te c. 2#w .#ur aat#%.  -h.si#,#g. P!t Li/- Bi! + R side ,.ig + t# -revet ',eedig

4durig the -r#$edure + L side ,.ig7 +i$t$& +/-%i$ + u-right t# -revet re(,uC



A#PU A# PUTA TATI TI)N )N $#%-,i$ati#D he%#rrhage 42ee- t#uriuet  'edside7 :st >hr + g#a,D g#a,D t# de$rease ede%a + e,evate the stu%- at (##t -art w5 the use #( -i,,#w AFTER >hr + g#a, D t# -revet $#tra$ture de(#r%it. 42ee- ,eg eCteded7



APPEN* APP EN*ICI ICITI TI  Uru-tured D a. -#siti# #( $#%(#rt

Ru-tured D Ru-tured  D se%i t# high high (#w,er1s -#siti# -#siti# t# -revet -revet the u-ward s-read #( i(e$ti# $#%-,i$ati#D -erit#itis Ru-tured a--edi$itis a--edi$itis idi$ati#D -ai de$reases #r g# awa. 4-t sa.6 0I wat t# g# h#%e -ai is g#e37



BURN P#siti# is FLAT #r *#di(ied Trede,e'urg + t# -revet sh#$2

SHO"K #$$urs w5i ><>hrs 4i%%ediate -#st 'ur -hase7 "#%-,i$ati#D i(e$ti#



CAT, CA T, EXTRE EX TRE#IT #ITY Y E,evate the ECtre%it. + t# -revet ede%a 4use ru''er -i,,#w7

N6 $-/8 #,. 4$#%-,i$ati#D  4$#%-,i$ati#D a,tered $ir$u,ati#7 a. $a-i,,ar. re(i,, + N :<; se$#ds #,. ' $ d e

#te (#r s5s s5s #( i(e$ti# i(e$ti# 4whe 4whe there is %ust. %ust. #d#r iside iside the $ast7 $ast7 -ruritus -ruritus 4ie$t 4ie$t air air usig usig 'u,' s.rige7 s.rige7 ',##d staied staied + %ar2 %ar2 ad #te #te 4i( 4i( i$reasig i$reasig i dia%eter dia%eter < re-#rt re-#rt ASAP7 ASAP7 tig,ig tig,ig sesati sesati# # + idi$at idi$ate e erve erve da%age da%age



CRAN CR ANI) I)T) T)#Y #Y T/8

4-$t/%t!-i$&& C + se%i (#w,er1s #r,#w (#w,er1s -#siti# + t# -revet a. 4-$t/%t!-i$ a$$u%u,ati# #( (,uid at surgi$a, site  /. I%"-$t/%t!-i$& C < (,at #r su-ie Pur-#seD sa%e



FLAI FL AIL L C+E C+ ET T 47 Trau%ati$ Iur. + -arad#Ci$a, $hest %#ve%et + areas #( $hest !OES IN is-irati# ad OUT # EC-irati#

-#siti#D t#wards -#siti#D  t#wards the a((e$ted side t# sta'i,i9e the $hest



GATRIC GAT RIC REEC REECTI)N TI)N < <

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+IATAL +IA TAL +ER +ERNIA NIA < <

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t# -reve -revet t du%-i du%-ig g s.dr# s.dr#%e %e + usua, usua,,. ,. (#r (#r := %#s %#s #,. #,. NOT NOT LIFETI* LIFETI*E E dis#rder 4-#st gastre$t#%.7 -#si -#siti ti# # D LIE LIE FLAT FLAT (#r (#r :< :<hr hrs s -#st -#st %ea %ea,,

ther there e is is da% da%ag age e t# t# es# es#-h -hage agea, a, %u$# %u$#sa sa what t# -revetD -revetD gastri$ re(,uC there(#re FEEP PT IN UPRI!HT POSITION

+IP PR) PR)T+ T+EI EI  P#siti#D t# -revet -revet su',#Cati# 4KEEP LE! A?/U"TE/7 A?/U"TE/7 with the use #( wedge -i,,#w #r triagu,ar -i,,#w (r#% -eriiu% t# the 2ees 4<i%6 %-!


LA#I LA #INE NECT CT)# )#Y Y <

0,#g
<



LIVER LIV ER BI) BI)P PY Y < < <

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'e(#re L? D su-ie #r L side ,.ig t# eC-#se the -art durig L? D < d#< a(ter L? D R side ,.ig w5 s%a,, -i,,#w uder the $#asta, %argi t# -revet ',eedig

L)BE L) BECT CT)# )#Y Y < <



AVOI/D h.-er(,eCi#6 AVOI/D  h.-er(,eCi#6 h.-ereCtesi# ad -r#e + it $auses h.-ereCtesi# #( the s-ie

re%# re%#va va,, #( #( L#'e L#'e 4N R ,#' ,#'e e + ;6 ;6 L ,#' ,#'e e + 7 7 -#siti# D se%i D se%i (#w,er1s -#siti# + t# -r#%#te ,ug eC-asi#

#AT #A TEC ECT) T)#Y #Y < <

re%#va, #( 'reast ast e,evate e,evate #r eCted eCted a((e$ted a((e$ted ar% t# t# -revet -revet ,.%- ede%a ede%a 4#r e,evate e,evate higher higher that the ,eve, #( the heart AV)I*8 vei-u$ture6 s-e$i%e s-e$i%e ta2ig6 ',##d ',##d -ressure + ON THE AFFE"TE/ AFFE"TE/ AR* $#9 there is # %#re ,.%-h #de w5$ -redis-#se -t t# ',eedig P!t <$t/t!< ED/-i/ D suee9ig eCer$ises6 (iger wa,, $,i%'ig6 (,eCi#<

eCtesi# 4(#,dig #( $,#thig6 washig (a$e6 va$uu%ig the h#use7 /ue t# re%#va, #( aCi,,ar. ,.%-h #de6 av#id a,s# gardeig ad had sewig



PNEU#) PNE U#)NEC NECT)# T)#Y Y <



RA*IU# RA*I U# I#PLANT I#P LANT )F ) F T+E CERVI C ERVIX X < <



eith either er L #r R ,u ,ug g P#s P#sit iti# i#  -t # the the AFFE"TE/ SI/E t# SI/E t# -r#%#te ,ug eC-asi#

2ee2ee- -t # $#%$#%-,et ,ete e 'ed 'ed rest rest t# -rev -revet et dis dis,#d ,#dge ge AVOI/E SE) 4%a. SE) 4%a. 'ur -eis 'e$ #( the i%-,at iside7

REPIRAT) REP IRAT)RY RY *IT *ITRE RE Adu,t D Orth#-ei$ -#siti# -#siti# + #ver 'ed ta',e the ,ea (#rward Pedia D TRIPO/ + ,ea (#rward (#rward ad sti$2 #ut t#gue t# %aCi%i9e the the Air(,#w



RETINA RET INAL L *ETAC+#E *ETAC +#ENT NT

<

t# -re -reve vett (urth (urther er det deta$h a$h%e %et6 t6 -,a$ -,a$e e -t # the the AFFE"TE/ SI/E SI/E

EC I( #-erati# #-erati# is is # the R #uter #( the R e.e6 -,a$e -t # the R -#siti# I( #-erati# is # the L ier #( the R e.e6 -#siti# -t # the L side AVOI/D sudde AVOI/D  sudde head %#ve%et



VEIN VEI N TRIP T RIPPI PING NG <

2ee- eCtre eCtre%iti %ities es eCtede eCteded d the the e,evate e,evate the ,egs ,egs at ,eve, ,eve, #( the the heart heart t# -r#%#te ve#us retur

TIPS 

&i/- ;i! is d#e # a -t + durig 1t 2:9- $"t/- t9/ -!/4-/6 tur the -t # his a'd#%e w5 -i,,#w uder the su'$#asta, area



whe draiig the L ,#wer ,#'e #( the ,ug + t9/ t 9& ;/ !iti!%/ !% 9i R i/ @ 9i 9i69/- !- &i69t& 9i69/- t9$% t9/ 9/$



a(ter t#si,,e$t#%. + !iti!%8 -!%/



a -t is a'#ut t# g# # th#ra$ethesis < h#w sh,d the urse -#siti# the -t + itti%6 @ $ $-< -/ti%6 !% t9/ !/-;/ t$;&/



t# %aitai the itegrit. #( -t w5 hi- -r#sthesis + $;4ti!% &i%t



i%%ediate,. a(ter su-ratet#ria, $rai#t#%.< "!@&/- !iti!%



/Dt-/
THERAPEUTIC COMMUNICATION WHY  – this put pt on the defensive 1. DON’T ASK WHY – PASSING SSING BACK BACK –  – I !i"" #efe# $ou to%&' 2.  AVOID PA 3. DON’T GIV( )AK( *(ASS+*ANC(  – eve#$thin, !i"" -e ."#i,ht%&' $ou’#e in the h.nds of the -est' N+*S( C(NT(*( C(NT(*(D D *(SPONS( *(SPONS( –  – I fe"t s./e too%' 4.  AVOID N+*S( I h.d the s./e fee"in,%&' In G*O+P DISC+SSION – DISC+SSION  – nu#se is 0ust . f.1i"it.to# – "et the ,#oup de1ide2 he3she 1h.nne" .#e 1on1e#n -.14 to the ,#oup& THERAPEUTIC PHRASES  – it see/s% see/s% $ou see/%& see/%& 5 open ended 6uestion 5 1"ose ended – fo# /.ni1 pt .nd pt in 1#isis 5 di#e1t 6uestion5 fo# sui1id." pt

ISOLATION PRECAUTIO PRECAUTION N Pur-#se D t# D t# is#,ate i(e$ti# tras%issi#

TYPE TYP E

PRIVA PR IVATE TE R) R))# )#

+AN* +AN * WA WA+I +ING NG

G)WN G)W N

GL)VE GL )VE

#A>  #A > 

TRICT ($i-;!-%/ /, i-/t !%t$t*it9/-i$'

REPIRAT)RY 

OPTIONAL

OPTIONAL

(AIRB)RNE8 BEY)N* 3FT *R)PLET 8 WIN 3FT'

TB

OPTIONAL

OPTIONAL

4egative air(,#w r##%7

C)NTACT (i-/t !%t$t – N)T AIRB)RNE *E' /X CABIE

ENTERIC

X

OPTIONAL

OPTIONAL

("/$& !%t$
*IC+ARGE X 4draiageD -us eC 'ur -t7 UNIVERAL

OPTIONAL

OPTIONAL

X

(AI*, +EPA ; – TRAN#ITTE* BY BL* AN* *)*Y FLUI*'

TIP8 

Whe i%-,e%etig uiversa, -re$auti#6 w5$ sg a$ti# reuire iterveti#D re$a--ig the eed,e + t9i


Whe dis$ardig the $#tets #( the 'ed -a use '. a -t uder eteri$ -re$auti# + GL)VE I NECEARY



A urse is givig hea,th tea$hig t# the -arets #( $hi,d with s$a'iesD "$


Prevetig -edi$u,#sis i s$h##, age $hi,dreD $!ii%6 !%t$t @ 9$i- $-ti&/ !" i%"/t/ 9i&-/% &i/ &i, 9/$ ;$%, 9$t – %! 9$-i%6



Patiet with (u,, ',#w AI/S is -,a$ed # is#,ati# -re$auti# + -t as2 urse wh. his visit#rs is wearig %as2 + -/!%/8 it @i&& 9/& i% t9/ -//%ti!% !" i%"/ti!%

Essetia, whe a -t w5 %eigitis is 2e-t i is#,ati#D i!&$ti!% -/$4ti!% -/<$i% 4%ti& 2:9- $"t/- i%iti$ti%6 $%ti;i!ti $%ti;i!ti t9/-$



DIAGNOSTIC PROCEDURES i/ %!t/8 t "!"!- IVP IVP t "!- >UB 9i&&i%6 t/t UG

8 8 8 8

$/ $/  "!"!- $&&/ $&&/-6 -6  (&/ (&/$% $%i i%6 %6 /%/< /%/<$ $ ;: t9/ t9/ -! -!/ /44-/' /' %! / (!%t $/ "!- $&&/-6' 2:9- 4-i%/ /i
GENERAL C)NI*ERATI)N •

< < < •

 E)PLAIN the -r#$edure t# the -t 4iitia, sg a$ti#7 i( #t #t re read. ad. ii( (#r #r% % the the d#$t d#$t#r #r -t has has the the righ rightt t# t# re( re(us use e -r# -r#$e $edu dure re d#$t d#$t#r #r the the #e #e wh# wh# as2 as2ed ed (#r (#r $# $#se set t "he$2 -t (#r "ONSENT + i( INVASIVE + WITH "ONSENT NON INVASIVE + NO "ONSENT eeded

•

"ONTRAST *E/IU* + $he$2 (#r a,,erg.

•

F#r -r#$edure reuirig $%/t9/i$ + KEEP PT NPO ?> PRO"E/URE

 

•

Whe &!$& $%/t9/i$ used + NPO6 :< HRS AFTER G/%/-$& $%/t9/i$ + 2ee- NPO at ,east hrd a(ter 4$he$2 gag re(,eC 'e(#re %ea,s7 PE/IATRI" PATIENT + use (,ash $ards6 $ards6 ga%es ad -,a. t# e$#urage e$#urage -arti$i-ati#

TRANCULTURAL C)NI*ERATI)N

+IPANIC PATIENT + w#%e -re(er sa%e geder hea,th $are -r#vider O'tai he,- #( i%t/--/t/- whe eC-,aiig eC-,aiig -r#$edures -r#$edures + 4eC$e-t 4eC$e-t #r d#1t as2 as2 (a%i,. %e%'ers7 F#r <4&i< $ti/%t < the. -re(er sa%e sa%e seC hea,th $are -r#vider h#wever6 h#wever6 i( -r#$edures reuire ,i(e threateig + the. -re(er t# have %a,e d#$t#r < the. #,. wat g##d ews i(#r%ati# #( their $#diti#

*ELEGATI)N $% *)CU#ENTATI)N

/e,egati# + assess%et6 %#it#rig ad eva,uati# #( treat%et 4$a#t 'e de,egated7 ?UT stadard ad $hagig -r#$edures $a 'e de,egated eC + >hr urie s-e$i%e ad urie $atheter

 

$#,,e$ti#

/#$u%etati# + t.-e #( treat%et ad a. ut#ward rea$ti#s

>EYP)INT F)R NURE   

Pre-are the -atiet *#it#r (#r adverse rea$ti# Re-#rt $#%-,i$ati# t# the d#$t#r

FRA#EW)R>  +  + i$,udes the Pur-#se6 S-e$ia, "#siderati# ad Iter-retati#

DIAGNOSTIC TESTS 7to ev."u.te )(TA8 G*OWTH AND W(885B(ING 9



DAILY FETAL MOVEM MOVEMENT ENT Pu#pose : to dete#/ine fet." .1tivit$ -$ 1ountin, fet." /ove/ents – usu.""$ pe#fo#/ -$ pt hi/se"f 

N Fetal Movement  ;<5;=



fo# ;= h# pe#iod 7.ve#.,e: ; /ove/ent3h# !ith .ve#.,e >f/3h#9

NON STRESS S TRESS TEST (NST)  – 1o##e".tes 1o##e".tes fet." fet." he.#t #.te #.te !3 fet." fet." /ove/ent

<

/onito# the -.se"ine )H* then indu1e fet." /ove/ents -$ 7HOW9 : .& #in, in, . -e"" e"" -& feed feed the the p.t p.tie ient nt

then 1he14 )H*2 NST is 7?9 if )H* in1#e.se .t "e.st ;@ -e.ts3/in th.n the -.se"ine& 7e& ;< )HB -.se"ine2 then .fte# 1h.""en,e it in1#e.se to ;@@9 POSITIV( #esu"t /e.ns2 BABY is *(ACTIV( 7,ood 1ondition9 .nd no need fo# 1ont#.1tion st#ess test3o$to1in 1h.""en,e test – 1o -.-$ is OK .nd doin, !e""&



CONTRACTION CONTRAC TION STRESS TEST (oxto!"n !#allen$e te%t)

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1o##e".tes )H* !ith ute#ine 1ont#.1tions pt on NPO ,et -.se"ine )H* then indu1e ute#ine 1ont#.1tion

HOW: Th#u -#e.st sti/u".tion – it t#i,,e#s the #e"e.se of o$to1in f#o/ pituit.#$ ,".nd% If 759 p.tient is ,iven O$to1in – onset is =<5>< /inutes& Then 1he14 )H* .nd note the p#esen1e of D(C(8(*ATION 7s"o!in, of )H*9 t&e% o' e!eleat"on de$e,erati#  + idi$ates head $#%-ressi# 4*IRROR I*A!E7 a. ear,. de$e,erati# +

 /. ,ate de$e,erati# + idi$ates -,a$eta, isu((i$ie$. 4REVERSE *IRROR I*A!E7 %gtD L Latera, Re$u%'et P#siti#6 Ad%iister O6 Treat H.-#tes#

c. varia',e de$e,erati# + de$e,erati#  + due t# $#rd 4i%ageD U #r W sha-e7 sha-e7 ad s,#wig #( FHR $a $a #$$ur a.ti%e

I( 47 "ST6 %eaig there is de$e,erati#6 'a'. is NOT OK $#9 there is de$rease FHR ad durig ,a'#r he5she %a. stad the ,a'#r -r#$ess



*IOPHYSICAL *IOPHY SICAL PROFILE

+

to dete#/ine fet." !e"" -ein, !3 the use of + CRITERIA

'etal ,eat#"n$ movement #eat tone ea!t"on to NST amn"ot"! 'l vol.me

- &o"nt% - &o"nt% - &o"nt% - &o"nt% - &o"nt% ;< points

s1o#e -e"o! 2 indi1.tes fet." 0eop.#d$



ULTR UL TRAS ASOU OUND ND 5 p#ovide d.t. on p".1ent. 7.,e .nd "o1.tion9 ,ende# of -.-$ st#u1tu#." .-no#/."ities  position of -.-$ 5 fo# p#e,n.nt: site is "o!e# .-do/in." +SG

t$pes: .& +ppe +ppe## +SG +SG – NPO NPO -& 8o!e 8o!e## +SG +SG 5 NP NPO < p#ep.#.tion: in1#e.se f"uid int.4e 7o#."9 NO 1onsent needed If pt .s4 if it is p.infu": NO PAINE Pt sh"d h.ve fu"" -".dde# 

CHO*IONIC VI88I SAFP8ING – CVS –  CVS  AFNIOC(NT(SIS  AFNIOC(NT(SIS – AMNIO P(*C+TAN(O+S +FBI8ICA8 CO*D B8OOD SAFP8ING – PU*S

CVS P.&o%e: P.&o%e: to dete1t 1h#o/oso/."  A-e##.tion 7e,& Do!n s$nd#o/e2 T#iso/$ =;9

Done in 0%t t"me%te  71.n -e done .s e.#"$ .s @ th !4 -ut 1.n -e done on 5;< th !49

Get s./p"e .t 1ho#ion 7-$ ;<5;=!4s – The p".1ent. /.tu#es2 ,et so/e s./p"e9

AMNIO P.&o%e : P.&o%e : s./e !3 CVS

PU*S P.&o%e/ to 1he14 1h#o/oso/." .-e##.tions2  p#esen1e p#esen1e of *H In1o/p.ti-i"it$

1.n -e done on the -n 12 7;5; !49 5 -ut not #e1o//ended -e1& of d.n,e# .-o#tion 7.ssess pt .,e of ,est.tion9

(t#.1t -"ood .t u/-i"i1." 1o#d then it is tested if it #e.""$ 1o/es f#o/ the u/-i"i1." 1o#d 71.n -e done on eithe# =nd o# >#d t#i&

o# 1.n -e done on the 3 12 7>5>  12 7>5> !49 &.&o%e: &.&o%e: to dete1t fet." /.tu#it$ 7)8F9 th#u /onito#in, of 83S *.tio N =:; 7if /othe# is 7?9 DF 8S #.tio is >:;9

This p#o1edu#e ."so 1he14 "eve" of ."ph.5feto P#otein – if INC*(AS( – spin. -efid.E If D(C*T(AS( – do!n s$nd#o/e

7?9 Consent – inv.sive

B".dde# : (/pt$

7?9 Consent

1onside# the Pt A,e of Gest.tion 7if .,e of ,est.tion :

7?9 Consent

is hi,he# th.n =
"O*PLI"ATIONS #( "VS6 A*NIO  PU?SD .& -& 1& d&

infe infe1 1tio tion -"eedin, .-o#tion fet. et." de de.th .th

TIPS EARLY DECELERATION – DECELERATION  – epe1ted in the fet." /onito# !hen the#e is 'etal #ea !om&e%%"on4 •

AMNIOCENTESIS – AMNIOCENTESIS  – !.s done 5 3+ 12% $e%tat"on  – pu#pose: to dete#/ine 'etal l.n$ mat."tE mat."t E •

 A /othe# .s4ed the nu#se 1#at 1"ll amn"o!ente%"% &ov"e  du#in, &e$nan!: &e$nan! : it !i"" sho! .s !hethe# the ,a, l.n$% ae evelo&e eno.$# 'o t#e ,a, to ,e ,on4

•

. nu#se is p#ep.#in, &t 'o lo1e a,l .%$  – !31 of the fo""o!in, done -$ the &t nee% '.t#e tea!#"n$ 6 &t vo"% ,7 t#e &o!e.e E

•

a'te amn"o!ente%"% amn"o!ente%"% !31  !31 of the fo""o!in, /.nifest.tion if o-se#ved -$ the nu#se on the p.tient th.t nee% to ,e e&ote / ,lee"n$ E •

pt .s4 the the nu#se nu#se – 1#at e!eleat"on mean% – it #efe# #efe#s s to %lo1"n$ o' ,a,8%

•

#eat ate4 •

,e'oe Amn"o!ente%"%2 Amn"o!ente%"% 2 !h.t to !#e!2 6 USG DEVICE

*IAGN)TIC TET (to eval.ate &e"at"! &at"ent%) CAR*I)PNEU#)GRA# + us use e t# t# dia diag g#s #se e a- a-ea ea #( i(a i(a$. $. + assess assess HR6 HR6 RR6 asa, asa, air(,# air(,#w w ad O O satura saturati# ti#  + N G< G<  'e,#w G + re-#rt ASAP

GLUTEN C+ALLENGE < dete$t dete$t -res -rese$ e$e e #( "e,ia$ "e,ia$ /ise /isease ase 4"/7 4"/7 < it#,e it#,era ra$e $e t# g,ute g,ute  < -t is giv give e g,ute g,ute  ri$h ri$h (##d (##d (#r (#r ;<> ;<> %#th %#ths s the #'serv #'serve e s5s #( "/ s5s #( "/D

a'd, $ra%-s6 steat#rrhea6 a'd, rigidit.6 a'd, disteti# 4i(  (#r "/6 g,ute (ree diet wi,, 'e (#r ,i(e ti%e7

)RT)LANI TET  4OT7 4-!/D 4-!/D test deve,#-%eta, d.s-,a$ia #( the hi- #r $#geita, hi- dis,#$ati# 47 i( w5 $,i$2 s#ud 4,atera,7

BARL)W #ANUEVER 4?*7 4-!/ D 4-!/ D sa%e

47 'ar,#w1s $,i$2 + -ress d#wward ad w5 $,i$2 s#ud

P)LY) P)L Y)#N)G #N)GRAP RAP+Y +Y !- 0s,ee- test3 < < <

EE! EE! is is $# $#e e$t $ted ed t# -t whe whe he s,ee s,ee-s -s "he$2 "he$2 the the 'rai 'rai waves6 waves6 $he$2 $he$2 (#r a-ea a-ea #( #( i(a$ i(a$. . -re-re-ar arat ati# i#  D N# S-e$ S-e$ia ia,, -re-re-66 HOL/ "AFFEINE FOO/ + da.s '> test

C)LI)#ETER < <

%eas %easur ure e the the degr degree ee #r #r ag, ag,e e #( s$# s$#,i ,i#s #sis is $he$ $he$2 2 (#rD (#rD 47 47 s$ s$#, #,i# i#si sis s i( uev ueve e he%, he%,i ie e ueve waist %#re -r#%iet i,ia$ rest ad s$a-u,a # #e side -rese$e #( ri' hu%-

test (#r -re
IC>LE*EX TET

+GB ELECTR)P)II

P4-!/D P4-!/D test (#r si$2,e $e,, ae%ia

P4-!/D P4-!/D test (#r si$2,e $e,, ae%ia

/i
Test (#r /isease /isease

GUT+RIE CAPILLARY BL))* TET (GCBT' < t! /t/t P>U 4i PKU there is a'se$e #( PHENYLALA*INE HY/RO)YLASE< PH7 Phe.,a,a%ie h.dr#C.,ase + is a e9.%e that $#verts PH t# T.r#Cie + the #e that gives $#,#r t# hair6 e.es ad s2i I( a'set PH6 # #e wi,, $#vert PH t# T.r#Cie6 there(#re it wi,, a$$u%u,ates t# 'rai ad $a $ause %eta, retardati# PH $a%e (r#% "HON ri$h ri$h (##d At 'irth6 it is usua,,. egative6 egative6 s# give "HON (##d (irst (#r ;w2s the retest ?e(#re test6 give $h# ri$h (##d (#r :<> da.s 'e(#re test 4adu,t7 N PH ,eve, < %g5d, i%i$ti/ !" P>U6 %g5d, + !%"i-< P>U7 4i( >%g5d, + i%i$ti/

WEAT C+L)RI*E TET < < <

t# /t/t Cti Fi;-!i  4i "F6 the s2i 'e$#%es i%-er%ea',e t# Na %eaig $a#t rea's#r' Na ad it a$$u%u,ates #utside #( the s2i7 *#th *#ther er $#% $#%-, -,ai ai  that that her her 'a'. 'a'. taste taste sa,t sa,t. . PILO"A PILO"ARPI RPINE NE + used used i the test test t# t# idu$ idu$e e sweat sweatig ig

 T.-esD a. sweat $h,#ride test + N :=<;G %e5L 4a'#ve >= %e5L+ 47  /. seru% $h,#ride test + N =<::= %e5L 4a'#ve :>= %e5L + 47

 TIPS 

pt !3 PK+ !ou"d /o#e "i4e"$ to h.ve 7?9 #esu"t in ,"uten 1.pi"".#$ -"d test if the#e is – ae9.ate CHON "n t#e "et4



/othe# 1o/p".ins th.t he# -.-$ t.ste s."t$ – !hi1h test is to -e pe#fo#/ed : %1eat !#lo"e te%t4



 $o pt h.s 7?9 #esu"t fo# s!e.t test – t#"% "n"!ate% &o%%",le x o' C%t"! F",o%"% E



&"lo!a&"ne – &"lo!a&"ne  – d#u, used used fo# pt pt unde#,oin, unde#,oin, se.t se.t 1h"o#ide testE



h,- e"e1t#opoisis – te%t 'o %"!2le !ell %e%

DAY  (3 Feb 2005)

DIAGNOSTIC PROCEDURES I.

CARDIO CAR DIO+AS +ASCUL CULAR AR

A: ELECTROCARDIOGRAPHY ELECTROCARDIOGRAPHY 6  6 #e1o#ds the e"e1t#i1." .1tivit$ of the H(A*T P !.ve – .t#i." depo".#i.tion J*S 1o/p"e – vent#i1u".# depo".#i.tion ST 5 #epo".#i.tion *h$th/ – .ppe.#.n1e of !.ve .nd dist.n1e *.te 5 N <5;<< <5;<< -p/ – 1he14 1he14 on  of J*S then divide divide it -$ ><< 749 ABN)R#ALITIE

a atria, atria, (i'ri,,at (i'ri,,ati# i# + - waves waves 0ha,#s 0ha,#s %ag2adi %ag2adi2it 2it 4# dis$era',e - waves7 ' atria, atria, (,utter (,utter + 0saw 0saw t##th3 t##th3 (,utter (,utter waves waves $ vetri$u vetri$u,ar ,ar + $he$2 $he$2 # JRS 4N 4N < <:7 <:7

AN!INA + st seg%et e,evati#6 t wave iversi# iversi# *I < st seg%et e,evati# #r de-ressi#6 t wave iversi#

*: CARDIA CARDIAC C CATHETERI;ATION CATHETERI;ATION

< < <

it dete#/ine the st#u1tu#." .-no#/."ities in the he.#t eithe# 8 o# * sided 1.thete#i.tion site: .nte1u-it."2 fe/o#."2 -#.1hi."

1o//on 1o/p"i1.tions: e/-o"is/2 ,"eedin,2 a##$thi/i. (BA' ns, /,t :   

/onito# dist." pu"ses 7if -#.1hi." site: 1he14 L #.di." if fe/o#." site : 1he14 L do#s."is pedis9 if !e.4 o# no pu"se – *(PO*T if 7?9 -"eedin, – #epo#t 7s.nd-., ;<5=< "-s' – sh"d -e .t -edside9

C: STR STRESS ESS TEST TEST

< < <

dete#/ines the .-i"it$ of the he.#t to !ithst.nd st#ess e6uip/ent : th#e.d/i""  (CG ns, ."e#t : 1he14 pu"se .nd BP 4eep NPO .n h# - the test NO Me!e"#ies

D: CORONA CORONARY RY ARTERIOGRAPHY ARTERIOGRAPHY

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visu."i.tion of the -"d vesse"s !3 1ont#.st /ediu/ ns, ."e#t: 7?91onsent 1he14 .""e#,$ to 1ont#.st /ediu/ in1#e.se o#." f"uid int.4e .fte# to e1#ete d$e epineph#ine sh"d -e #e.d$ fo# .n$ unto!.#d #e.1tion

S
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 "u/en fo# the ff CVP2 Pu"/on.#$ C.pi"".#$ Wed,e P#essu#e 7PCWP92 Pu"/on.#$ A#te#$ P#essu#e2 B"d p#odu1ts2 B.""oon

CVP – /e.su#e * side p#essu#e of the he.#t PCWP – 8 side of the he.#t N P#essu#e CVP: fo# * At#iu/ – <5;=

fo# SVC – @5;= Ns, A"e#t : 1he14 pu"se .nd s3s of -"eedin,

F: *LO *LOOD OD CHEMIST CHEMISTRIES RIES



SODIUM 7;>@ SODIUM 7;>@ – ;@ /e6389 A"%on8% D%e%/ h$pon.t#e/i. 7de1 N.92 h$pe#4."e/i. 7in1 K9 – )8D IFBA8ANC(' C.%#"n$ Snome/ h$pe#n.t#e/i.2 h$po4."e/i. – )8D VO8& (C(SS'



POTASSIUM 7>&@ – @ /e6389 H$pe#4."e/i. : Addison’s dses H$po4."e/i. : Cushin, S$nd#o/e In1 o# de1 in K PT *ISK of INM+*Y Pt !3 di,it."is  diu#eti1s – /onito# fo# .##h$th/i.



CALCIUM 7&@ CALCIUM 7&@ – @ /e638 o# 5;






GLUCOSE 7<5;=<9

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Hi,he# th.n ;< – h$pe#,"$1e/i. 7.1idosis – /.$ "e.d to ineffe1tive -#e.thin, p.tte#n .nd .i#!.$ is the /.in p#o-"e/9

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-e"o! @< – h$po,"$1e/i. 7pt p#one to in0u#$  ."te#ed thou,ht p#o1ess9

Ceat"n"ne 7&@5;&@9 Ceat"n"ne  7&@5;&@9 <

/ost sensitive inde of 4idne$ fun 7in1#e.se B+N -ut N 1#e.tinine – do not #epo#t to AP9

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in1#e.se 1#e.tinine – 4idne$ f.i"u#e o# #en." diso#de# 

*UN 7;<5=< *UN 7;<5=< /,3d"9 <



in1& if 7?9 4idne$ diso#de# 

LDH 7< – < u389 8DH; – =5> 7fo# he.#t – 1he14 fo# FI9

8DH= – ;5= 7fo# he.#t he.#t – 1he14 fo# FI9 8DH> – 5;@ 7fo# 7fo# #espi#.to#$ s$ste/9 8DH – >5 7fo# "ive#  4idne$9 8DH@ – <5@ 7fo# "ive#  4idne$9

LDH inc for MI for 3-4 days then it returns to N after 10-14 days



CP> o C> F."e – ;=5< u38 )e/."e 5 ;<5@@ u38 In1#e.se CPK >5h#s post FI then it no#/."ie >5 d$.s



AST (SGOT)

SGPT (ALT)

5 N 5=< u38 5 fo# "ive# 7in1& fo# "ive# dses9

N 5=< u38 /o#e on H(A*T 7in1 fo# 1.#di.1 dses9

G: HEMATO HEMATOLOGIC LOGIC STUDIES STUDIES

R*C 7&@ – @&@ /i""ion9 5 in1 *BC – po"$1$the/i. – #is4 fo# in0u#$ – 1o/p"i1.tion CVA 5 de1 *BC – .ne/i. – .1tivit$ into"e#.n1e

  <*C 7@5;< thous.nd9 < to dete1t p#esen1e of infe1tion2 -"d diso#de#s "i4e "eu4e/i. < de1 WBC – pt p#one to infe1tion < in1 WBC – h$pe#"eu4o1$tosis – 7?9 to pt !3 "eu4e/i. – #is4 fo# infn

PLATELET 7;@<2<<<5@<2<<<9 < spont.neous -"eedin, o11u#s !hen p".te"et de1 7pt ."so p#one to in0u#$9

PT

PTT

APTT

7;;5;= se19

7<5< se19

7><5< se19

1ou/.din – 1he14 pt

hep.#in – PTT

/onito# pt  -"eedin,

/onito# pt  -"eedin,

HG* – /."e : ;5; /,3d" )e/."e : ;=5; /,3d" De1 h,- – .ne/i. 7ns, d: .1tivit$ into"e#.n1e9

HCT 5 >@5@ 5 dete#/ine the .de6u.1$ of h$d#.tion .nd the #.tion of p".s/. to the 1e""u".# 1o/ponent -"ood in1 h1t

: he/o1on1ent#.tion 7ns, d: f"d defi1it – deh$d#.ted pt9

de1 h1t h1t

: he/od /odi"ut i"utio ion n f"d e1ess

DOPPLER USG < to dete1t the p.ten1$ of -"d vesse"s – .#te#ies  veins esp of "o!e# et#e/itiesE < p.in"ess2 non inv.sive2 NO SFOKING >< /in5;h# - the test

PULSE O?IMETRY < dete#/ines the O= s.tu#.tion .t -"ood < N @5 – .tt.1h to fin,e# o# e.#"o-e 7do not epose e "i,ht9

II.

RESPI RES PIRAT RATOR, OR, 

BR)NC+)C)PY + + + + + +

visua, visua,i9a i9ati# ti#  #( ' tree tree #r airwa. airwa. -assage -assages s t# gathe gatherr s-e s-e$i $i%e %e  ((#r #r 'i#'i#-s. s. NPO '>  a(ter !ag !ag re( re(,e ,eC C ret retur ur  a(te a(terr :< :<hr hrs s Pt %a. %a. eC-e$ eC-e$tt a s#re s#re (ee, (ee,ig ig 4PIN 4PINK K STIN!E STIN!E/ / SPUTU SPUTU*7 *7 Re-#r e-#rtt 47 str strid#r d#r

C+E C+ ET T XRA X RAY Y



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t# deter%ie a'#r%a,ities #( ,ugs ad th#ra$i$ $avit. # -re-arati# A?SOLUTE "O "ONTRAIN/I"ATE/ TO TO PRE!NAN"Y "he$2 -t (#r radiati# idi$at#r /eter%ie e((e$tiveess #( tC ad whether -t is a$tive #r #
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PUTU P UTU# # TU*IE TU *IE  t# de deter%ie th the gr gr#ss $h $hara$teristi$ #( #( tth he s-utu% 4re(ers t# the a%#ut6 $#,#r6 a'#r%a, -arti$,es6 $#siste$. ad $hara$teristi$7 T,PE OF SPUTUM PNEUMONIA T.

' thin = ater& - 8iral 9acteria - r!st& - /lood streaked

.RONCHITIS - gelatino!s CHF$ PULMONAR, EDEMA - pink stinged

p!t!m specimen ' sterile container  

T+) RACENT T+)RAC ENTEI EI  < as-irati# #( (,d at th#ra$i$ th#ra$i$ $avit. $avit. 4(#r diag#sti$  thera-euti$ -ur-#se7

"&siti&n/

/URIN! + sittig AFTER < a((e$ted #r ua((e$ted side

Ns a'ert/

NO "OU!HIN!  /EEP ?REATHIN! + durig the -r#$edure + $#9 this %a. $ause -u$ture #( the ,ugs Assess (#r 'reath s#uds a(ter "#%-,i$ati#D ',eedig ad -eu%#th#raC



PUL#)NARY PUL#) NARY FUNCT FUNCTI)N I)N TET < thru the use #( i$etive s-ir#%eter < vita, $a-a$it. 4>
 #ut #( ,ug a(ter %aCi%u% is-irati#   PROCEDURE/



E)HALE the INSERT %#uth -ie$e6 ?REATH iN6 HOL/ the E)HALE

LUNG LU NG C CAN AN < t# ideti(. the -rese$e #( ',#$2age i the -u,%#ar. ',d vesse,s < with $#trast %ediu% < 47 $#set < assess (#r rC t# a,,erg.



#ANT)U #AN T)UX X TE TET T < test (#r POSSI?LE T? E)POSURE < usig PP/ 4-uri(ied $h# derivatives7 < ag,e :=<:G6 ?EVEL UP the read ><&hrs a(ter G%% i durati# + 47 (#r HIV6 %u,ti-,e seC6 -revi#us,. -revi#us,. 47 -t :=%% < 47 (#r i%%igrats6 $hi,dre 'e,#w ;.# ad (#r -t w5 %edi$a, $#diti# + /*  A,$#h#,is% :G%% < 47 (#r geera, -#-u,ati#



LUNG LU NG BI) B I)P PY Y < as-irati# #( tissues at ,ugs (#r dC #( tu%#rs6 tu%#rs6 %a,iga$. < assess (#r ',eedig6 'reath s#uds  re-#rt (#r s5s #( d.s-ea

III.

NER+OUS



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EEG sha%-## hair ?> 4t# re%#ve $he%i$a,s7 ad AFTER t# re%#ve e,e$tr#de ge, 4sha%-## #r a$et#e7 %easures e,e$tri$a, a$tivit. #( the 'rai 4gra. %atter7 # ivasive6 4<7 $#set dete$t th the (( ((D 'r 'rai tu tu%#rs6 ss-a$e #$ #$$u-.ig ,,e essi#s a,$#h#, 'rai waves ad sei9ures ursig a,ertD  

CT CAN

dietar. %#di(i$ati#D WITHOL/ "AFFEINE + $#((ee ad tea WITHOL/ >hrs '> the -r#$edure D traui,i9ers6 traui,i9er s6 sedatives6 ati<$#vu,sat6 a,$#h#,

#RI

PET

Use radiation t# deter%ie use electromagnetic field   use gamma rays or positron electron tissue desit. t# dete$t a'#r%a,it. a'#r%a,it. #( tissue desit. t# dete$t a'#r%a,it. a'#r%a,it. #( tissue desit. 4dete$t $a$er ad tu%#r7 a,s# t# dete$t O saturati#  tissue

-h.si#,#g. #( -s.$h#sis ad t# eva,uate tC give %#re detai,ed i%-ressi#  4eC *easure%et #( ',#$2ed arter.7 NG ALERTD ALERT D 4w5 #r w5#ut d.e7 C)NTRAIN*ICATI)N a

 /. c. d. e

C)NTRAIN*ICATI)N ($
-rega$. #'ese -t 4%#re tha ;== ,'s7 $,austr# $,austr#-h#' -h#'ia ia 4give ati7

N) #ETAL )BJECT < ewe,rie ewe,ries6 s6 isu,i isu,i -u%-6 -u%-6

-t w5 usta',e v5s 4arrh.th%i$  HPN7 -t w5 a,,e a,,erg rg. . t# t# d.e d.e

-a$e%a2er6 -a$e%a2er6 hi- re-,a$e%et re-,a$e%et

=&ii%6 !4%? wi,, !4%? wi,, 'e heard &i/ ti&& heard  ,ie sti,, durig durig the -r#$edure -r#$edure ,ie sti,, durig the -r#$edure ad =t94<i%6 !4%? wi,, 'e heard



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CEREBRAL CERE BRAL ANGI) ANGI)GRA# GRA# iv#,ves v viisua,i9ati ati# #( #( ' ',,d ve vesse,s  vei w5 w5 the us use #( #( $#trast %ediu% CONTRAINDICATED IND -t w5 a,,erg. -regat -t ',eedig

N*rsin A'ert/

a.  /. c. d. e.

keep pt %;*> assess pt for allerg&> allerg&> moni monito torr for for sign signss of of /ld /ldg> g> inc oral oral fld fld intak intakee to to e?cr e?crete ete d&e> d&e> keep epinephrin epinephrinee and or /enadr /enadr&l &l at /edside /edside for for emerg emergenc& enc&

LU#BAR LU# BAR PUN PUNCTU CTURE RE



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as-irati# #( "SF (#r assess%et t# $he$2 (#r i(e$ti# #r he%#rrhage "&siti&n/

/URIN! D (eta, #r "<-#siti# AFTER

D FLAT t# -revet s-ia, heada$he

Need,e is iserted 'etwee L; ad L> #r L> ad LG I$rease (,uid ita2e a(ter



CF ANA ANALY LYI I < < <

Assess Asse ss (#r (#r the the $ha $hara ra$t $ter eris isti ti$ $ #( #( "SF "SF N a% a%#utD := :==< <= == %, %, "hara$t "hara$teri eristi sti$ $ D ",ear ",ear w5 g,u$#s g,u$#se6 e6 Na ad HO HO

,i2e "A TC

I( RE//ISH + he%#rrhage I( Ye,,#wish + i(e$ti# Ear ,i$2ig w5 (,uid + test i( 47 g,u$#se 'e$ "SF has g,u$#se

#YEL #Y EL)G )GRA RA# #



<

test (#r -rese$e #( s,i- dis$ #r heriated u$,eus -#r-#sus 4HNP7

ALERT/

K#w the t.-e #( d.e useD a water water 'ased 'ased + $a,, $a,,ed ed A*IP A*IPAJU AJUE E ' #i, 'ase 'ase + $a,, $a,,ed ed PANTO PANTOPAJ PAJUE UE 

t.-e #( d.e wi,, deter%ie the -#siti# #( -t AFTER the -r#$edure



I( water 'ased6 the HEA/ OF ?E/ ELEVATE/ I( #i, 'ased6 FLAT a(ter



Rati#a,e (#r '#th #i, ad water 'ased d.e is TO PREVENT the u-ward dis-ersa, #( d.e w5$ $a $ause e,e$tri$a, %eigitis 4s5s i$,udesD 47 sei9ure6 s ei9ure6 heada$he7

I8. •

<

EENT

 T)N)#ETRY  t# %easure IOP 4N :<:7 < -ai,ess 'ut w5 ,#$a, aesthesia A"UTE !LUA"O*A D G= .# ad a'#ve "HRONI" !ALU"O*A D G .#

•

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CAL)RI CAL )RIC C TI TI#UL #ULATI ATI)N )N TET test the -rese$e #( *iierre1s /ses 4i 4ier ear7 iv#,ves itr#du$ti# #( #( war% ad ad $#,d water the NOTE FOR NYSTA!*US +  er2. ,atera, ,atera, %#ve%et %#ve%et #( the e.e SEVERE NYSTA!*US + NOR*AL *O/ERATE NYS < *iierre1s /ses NO NYSTA!*US < A$#usti$ Neur#%a

•

<

G)NI)C)PY t# di((eretiate OPEN ad $,#se ag,e ga,u$#%a

<

#
WEBER TET

RINNE TET

 T# deter%ie deter%ie ,atera,i9ati# ,atera,i9ati# #( s#ud s#ud T# deter%ie deter%ie air ad ad '#e $#du$ti# $#du$ti# EAR6 I( -t 9/$- i;-$ti!% ;/tt/- i% G))* EAR6 P,a$e tuig (#r2 i$hes (r#% the ear Pr#',e% w#u,d 'e EN)RINEURAL L) -,a$e at %ast#id '#e #r i teeth the… EAR 6 < re(ers i( -t 9/$- ;/tt/- i% P))R EAR6 re(ers t# i( AIR "ON/U"TI "ON/U"TION ON is LON!ER6 LON!ER6 there(#re there(#re C)N*UCTIVE +E +EARING L) L) EN)RINEURAL +E +EARING L) L) I( ?ONE "ON/U"TION IS LON!ER6 there(#re C)N*UCTIVE +EARING L)

8. 

GASTRO INTESTINAL TRACT UPPER UPPE R GI ERIE ERI E (B$-i4< (B$- i4< @$&&!@ @ $&&!@''

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Cra. visua,i9ati# with $#trast %ediu% < "#trast *ediu%D a !astr#gra(i + water s#,u',e6 use straw ' ?ariu% < swa,,#w + %i,2 sha2e ,i2e 4use (eedig '#tt,e #( -t7 < the -t is as2 t# assu%e di((eret -#siti#s -#siti#s t# distri'ute d.e  es#-hagus -ur-#seD t# dete$t dete$t dis#rders dis#rders #( es#-hagus (e$es D 0$ha,2.




BARIU# ENE#A 4(#r L#wer !IT7 <

iv# iv#,v ,ve e re$t re$ta, a, is ista ta,, ,,at ati# i#  #( 'ari 'ariu% u%

<

there is 'a,,## 'a,,## $athet $atheter er isert iserted ed  aus the the 'ariu% 'ariu% is is isti,,e isti,,ed d ad -t is as2ed t# r#,,<#ver at di((eret -#siti# the Cra. is ta2e t# dete$tD he%#rrh#ids6 diver$u,#sis6 -#,.-s ad ,esi#s

<

a(ter6 a(ter6 give give ,aCat ,aCative ive t# t# eC$re eC$rete te d.e d.e 4'e$ 4'e$ d.e is $#st $#sti-a i-ati tig7 g7 istru$t a,s# -atiet t# i$ #ra, (,d ita2e

GUAIA GU AIAC C TE TET T <

t# dete$t dete$t the -rese$e -rese$e #( ',eedi ',eedig g ad i(,a%%at# i(,a%%at#r. r. '#we, '#we, $#diti# $#diti# ,i2e ,i2e "AN"ER

s-e$i%e D st##,

4this $a 'e re(rigerated awaitig ,a'#rat#r.7

AVOI/ the (#,,#wig ; da.s ?> the test + 'e$ it $a .ie,d t# FALSE 47 RESULT D Red *eat6 Fish ad H#rse Radish



C+)LAN C+) LANGI GI)GR )GRAP+ AP+Y Y



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visu visua, a,i9 i9at ati# i#  #( 'i,i 'i,iar ar. . tree tree

<

with with $# $#tr trast ast %edi %ediu% u% w5s w5s is is give give  thru thru IV IV

<

ALERTD ALERTD assess assess (#r (#r a,,er a,,erg. g. 4e-i 4e-iee-hri hrie5 e5'e 'eadr adr., .,77

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P#st P#st -r# -r#$e $edu dure reDD i$ i$ #ra #ra,, (,d (,d ita ita2e 2e + t# (a$i,itate eC$reti# #( d.e

4i$,udes6 he-ati$ du$t  $#%%# 'i,e du$t7 + sa%e with "HOLE"YSTO!RAPY + 'ut %ediu% give #ra,,.

GATR GA TRIC IC ANALY ANA LYI I < < <

aa,.si aa,.sis s #( gast gastri ri$ $ se$re se$reti# ti#  ,i ,i2e 2e HY/R HY/RO"H O"HLOR LORI" I" A"I/ A"I/ L#we L#werr Leve Leve,, N D 
a

WITHOUT WITHOUT TU?E TU?E 4tu'e,ess 4tu'e,ess gastri$ gastri$ aa,.sis aa,.sis77

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BLUE 4s-e$i%eD urie7 usig *IAGNEX BLUE 4s-e$i%eD i" 4-i%/ !&!- t4-% BLUE, t9/-/"!-/ (H' +CL Ai i" 4-i%/ (' ;&4/ !&!-, t9/-/"!-/ (' +CL Ai

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i( 4<7 4<7 H"L A$id A$id at at st#%a$ st#%a$h h 4a$h,# 4a$h,#rh rh.di .dia76 a76 the there( re(#r #re e !astri !astri$ $ "A "A

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Z)LLINGERELLI)N YN*R)#E – (H' G$t-i T4
WITH TU?E TU?E + with with the use use #( #( N!T N!T the the as-ira as-irate te

ULTRA ULT RA)N) )N)GRA GRAP+Y P+Y < < <



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u--er u--er a'd, a'd, US! US! t# dete$ dete$tt a'#r% a'#r%a,i a,itie ties s i the the u--er u--er a'd, a'd, area area w5 i$,udes 'i,iar. tree ad U--er !I -ai,ess ge, ge, at at a'd a'd#% #%e e ad ad -t -t is NPO NPO

LIVER LIV ER BI) BI)P PY Y <

as-irati# as-irati# #( #( sa%-,e sa%-,e tissue tissue (r#% the the ,iver ,iver t# dete$t dete$tDD He-ati$ He-ati$ "A ad "irrh#sis "irrh#sis

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ALERTD ALERTD "he$2 "he$2 (#r ?,eed ?,eedig ig Ti%e Ti%e 4N + :< %is7 %is7 ad ",#ttig Ti%e 4N + :=<: %is7 + 'e$ause ,iver is high,. vas$u,ar #rga

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WHEN WHEN NE// NE//LE LE IS INSE INSERT RTE/ E/ te,, te,, -t t#D t#D Iha,e the ECha,e the H#,d ?reath + t# sta'i,i9e ,iver -#siti#

< <

P#si P#siti ti# # a(t a(ter er D R sid side< e<,. ,.i ig g -#si -#siti ti# # Thigs Thigs t# re-#r re-#rtD tD s5s #( SHO"K SHO"K + i$ i$ PR6 PR6 de$ de$ ?P "he$2 v5s

EN*)C)PIC RETR)GRA*E C+)LANGI)PANCREA C+)LANGI)PANCREAT)GRAP+Y T)GRAP+Y (ERCP' < <

t# visu visua,i a,i9e 9e $#%% $#%%# # 'i,e 'i,e du$t du$t ad ad -a$r -a$reat eati$ i$ du$t du$t iva ivas sive ive + 47 47 $# $#s set et

< <



NPO NPO + tu'e u'e is ser erti ti# # Te,, -t that that tere tere wi,, wi,, 'e 'e (ee,ig (ee,ig #( s#re s#reess ess a w2 a(ter the -r#$edur -r#$edure e

C)L) C) L)N) N)C C)P )PY Y <

visu visua, a,i9 i9at ati# i#  #( #( $#, $#,# # t# dete dete$t $tDD i(,a%%at#r. '#we, $#diti# "hr#1s /ses /iverti$u,itis He%%#rh#ids  Tu%#r P#,.-s

< 47 "#set < NPO '> < $,ear ,iuid diet + da.s '> the -r#$edure -#siti#D Latera, #r side side ,.ig -#siti# -#siti# #r L Latera, Si%s

8I. 

ENDOCRINE

GLUC)E GLUC )E T)LER T)LERANCE ANCE TET < < < <



ACT+ TI# TI#ULAT ULATI)N I)N TET < < < <



t# det dete$ e$tt -re -rese se$ $e e #( #( Add Addis is# #1s 1s /ses /ses s-e$i%eD ',##d -t is is give give d#se d#se #( #( A"TH A"TH 4#t 4#t #re #re tha tha >=ug >=ug5d, 5d,77 i( sti,, sti,, de$ de$ des-it des-ite e A"TH A"TH ad%ii ad%iistrat strati#6 i#6 there there(#re (#re Adrea, Adrea, Isu((i Isu((i$ie $ie$. $. + Addis#1s /ses

*EXA#ET+A *EXA #ET+A)NE )NE UPREI UPR EI)N )N TET < < < <



t# -r# -r#vid vide e %eas %easure ure #( ',d sugar sugar ,eve ,eve,, at at ' ',## ,##d d I(#r% I(#r% -t t# have have high high "HO "HO diet diet  da.s da.s '> the test test Istru$ Istru$tt NPO NPO a da. '> the test test 4-# 4-# -#st -#st %id# %id#$7 $7 I$ I$ suga sugarr ,ev ,eve, e,66 the there re(# (#re re /ia /ia'e 'ete tes s

t# dete dete$t $t ed# ed#ge ge# #us us de-r de-res essi si# # + de-ressi# resu,tig thru ed#$rie dis#rder -t is giv give e deCa deCa the the >hr >hr urie urie s-e$i s-e$i%e %e is $#,, $#,,e$t e$ted ed a d#se d#se #( deC deCa a wi,, wi,, su--r su--ress ess the the re,e re,ease ase #( #( adrea, adrea, h#r%# h#r%#es es i( des-ite des-ite deCa ad%iistr ad%iistrati# ati# sti,, sti,, i$rease i$rease adrea adrea,, h#r%#es h#r%#es66 there(#re there(#re -t is su((erig de-ressi#

17 >ET)T > ET)TER)I ER)I* *  170 17 0 +C <

use t# dete$t dete$t the -rese -rese$e $e #( Addis# Addis#1s 1s  "ush "ushig ig1s 1s /ses /ses

Addis#1s + de$ se$reti# #( 2et#es "ushig1s + i$e se$reti# #( 2et#es S-e$i%eD > hr urie



VANILLYL#A VANI LLYL#AN*ELI N*ELIC C ACI* TET T ET – V#A T/t T/ t <

'i<'i<-r# r#du du$t $t #( "ATH "ATHE" E"HO HOLA LA*I *INE NE *eta *eta'# '#,i ,is% s%

e-ie-hrie

#re-ie-hrie

i% i" t9/-/ i TU#)R (9/!-!
N <& %g5d, 5 >hrs + i( i$6 there(#re tu%#r AVOI/D vai,,a $#taiig (##d ; da.s '> test + 

i$e $rea%6 $#((ee6 $h#$#,ates

RAIU < < <



-t is give give i#di i#die e :;: :;: the the a(ter a(ter >hr >hr (#,, (#,,#we #wed d '. a th.r#i th.r#id d s$a i$ idi$a idi$ates tes h.-ert h.-erth.r h.r#id #idis% is%66 de$ h.-#th h.-#th.r# .r#idi idis% s% AVOI AV OI/D /D i#di i#die e ri$h ri$h<( <(## ##d d 4sea (##ds6 sea she,,s6 sea weeds7  &<:= da.s '> ad t# i$,ude #ther diag#sti$ -r#$edures that uses $#trast %ediu% 40NO3 < agi#gra% test7 + 'e$ it %a. .ie,d t# (a,se 4<7 resu,t UL>)WITC UL>) WITC+ + TET < < <

dete$t dete$t a%#ut a%#ut #( $a,$ $a,$iu% iu% eC$re eC$reted ted at urie urie i( t# test test (#r (#r h.-er$ h.-er$a,$e% a,$e%ia ia ad h.-erth.r h.-erth.r#idis% #idis% < gather gather s-e$i% s-e$i%e e '> %ea,s %ea,s t# test test (#r h.-#$ h.-#$a,$ a,$e%i e%ia a ad h.-#t h.-#th.r h.r#id #idis% is% + gathe gatherr a(ter a(ter %ea,s %ea,s

8II. R E NA L 

URIN UR INAL ALY YI I <

eCa%i eCa%ie e the gr#ss gr#ss $har $hara$t a$teri eristi sti$ $ #( #( the the urie urie

urie a%#ut D ;=
,#wer tha :==G + dia'eti$ isi-idus higher tha :=;= + dia'eti$ %e,,itus 47 g,u$#se + i(e$ti#6 /* 47 "HON < PIH6 2ide. dses

Urie %a.'e re(rigerated re(rigerated i( waitig t# 'e eCa%ied



CULTURE CULT URE  ENITI EN ITIVITY VITY < <

t# de dete$t i i(e$ti# -re-re-ar are e st#r st#rag age e $#t $#tai aie err



>UB <

Cra. #( the 2ide.s6 ureter ad ',adder < NO NO SPE"IAL PREPARATION NEE/E/





visu visua, a,i9 i9at ati# i#  #( #( uri uriar ar. . ',add ',adder er a(t a(ter D %# %#it#r I  O O #te #te (#r (#r s5 s5s #( #( ', ',eedi eedig g

RENA RE NAL L BI)P BI) PY Y <

as-irat as-irati# i# #( #( tissu tissues es at at 2ide 2ide. . (#r (#r 'i#-s 'i#-s. . t# dete$t dete$tDD a. %a,iga$.5 "a  /. %a,igat HPN c. 2ide. dis#rder

<

#te #te (#r (#r s5 s5s #( #( ', ',eedi eedig g

CYT)U CY T)URET RETR)G R)GRA# RA# < <



< Cra. #( the 2ide.s6 ureter ad ',adder < uses $#trast %ediu%5 d.e < assess (#r a,,erg.6 the i$ #ra, (,d ita2e a(ter < 'eadr., #r e-ie-hrie at 'edside (#r a,,ergi$ rC < NPO POST *I/NO"6 $,easig ee%a i A*

CYT CY T) )C) C)PY PY < < <



IVP

t# $he$ $he$2 2 the the -ate -ate$. $. #( the ureter ureter ad ',adde ',adder r %#it#r I  O

CYT)# CY T)#ETR ETR)GR )GRA# A# < < <

t# eva, eva,uat uate e the the ses ses#r. #r. ad %#t#r %#t#r (uC (uC #( ',ad ',adder der t# $he$2 $he$2 i( ',add ',adder er res-# res-#d d t# diste disteti ti# # a(ter a(ter ista, ista,,at ,ati# i# #( #( (,ds (,ds %#it#r I  O

8III. MUSCULO-SKELET MUSCULO-SKELETAL AL



ELECTR ELE CTR)#Y )#Y)GR )GRAP+ AP+Y Y < < < <



t# dete dete$t $t e,e$tr e,e$tri$a i$a,, a$ti a$tivi vit. t. #( the %us$,e %us$,e 47 $#set t# a,terat a,terate,. e,. $#tra$t $#tra$t ad ad re,ease re,ease the %us$,e %us$,e as eed,e eed,e is iserted iserted HOL/ HOL/ %us$ %us$,e ,e re,a re,aCa Cat t '> the the test test

ART+R) ART +R)CEN CENTE TEI I < < <

as-irat as-irati# i# #( (,uid (,uids s at s.#vi s.#via, a, s-a$e s-a$e t# dete dete$t $t a'#r% a'#r%a,i a,itie ties s $he$ $he$2 2 (#r (#r #rde #rderr #( #( aa aa,g ,ges esi$ i$ a--,. $# $#,d -a -a$2



ART+ AR T+R) R)C C)P )PY Y < visua,i9ati# #( #its < KEEP TORNIJUET6 TORNIJUET6 I"E PA"K ad ANAL!ESI" at 'edside



B)NE B) NE C CAN AN < < <

I@. 

MISCELLANEOUS

B)NE B)N E #ARR)W #AR R)W BI)P B I)PY Y < < < < <



dete$t dete$t rate rate #( #( '#e destru$ti destru$ti# # #r '#e res#r-ti res#r-ti# # (#r -t w5 #ste#-#r#si #ste#-#r#sis s ,ie ,ie sti, sti,,, duri durig g the the -r#$ -r#$ed edur ure e PAIN PA INLE LESS SS AN/ AN/ NON NON INVA INVASI SIVE VE

t# $he$ $he$2 2 a'#r% a'#r%a,i a,itie ties s at the the ' ' %arr %arr#w #w 4eg 4eg Leu2e% Leu2e%ia7 ia7 site D ILEA" REST 47 $#set ass assess (# (#r ', ',eedig sad 'ag at at 'edsi 'edside de 4-#s 4-#stt -r#$e -r#$edur dure7 e7 + (#r e%erge e%erge$. $. use

C+ILL C+ ILLING ING  TET TE T < < < <

s-e$i%e s-e $i%eD D >hr uri urie test test (#r (#r VIT VIT ?: ?:  de( de(i$ i$ie ie$ $. . (#r (#r -t -t w5 w5 PER PERNI NI"I "IOU OUS S ANE ANE*E *EIA IA -t is give give #ra, #ra, VIT VIT ?: ?: the the urie urie is $#,, $#,,e$t e$ted6 ed6 the the NOTE NOTE (#r (#r RATE RATE #( E)"RETION #( VIT ?: 4N + ,ess tha >=7 eg I( :==%g Vit ' was ta2e + M=%g sh,d retai at st#%a$h ad >=%g wi,, 'e eC$reted



URINE URI NE UR)BILIN UR)BI LIN)GE )GEN N  



BENCEJ) BENCE J)NE NE PR)TE PR)TEIN IN  



t# dete$t HE*OLYTI" /SES WITHOL/ ALL *E/S + >hrs '> the test

dete$t -rese$e #( *ULTIPLE *YELO*A 4%a,iga$. #( -,as%a $e,,s7 RELEASE/ '. destr#.ed #r da%age '#es

R)#BER R)# BERG G  TET TE T  

$he$2 FUN) #( "ERE?ELLU* stad ere$t6 $,#se e.es6 ad #'serve (#r ia'i,it. t# %aitai -#sture Swa.ig6 there(#re TU*OR at $ere'e,,u%7



ERYT+R)CYT ERYT+ R)CYTE E FRAGILI FRA GILITY TY TET TE T <

use t# dete$ dete$tt the the rate rate #( #( R?" R?" /ESTR /ESTRU"T U"TION ION i i a h.-#t h.-#t#i #i$ $

4i( -t is

 

s#,uti#

4R?" Li(es-aD := da.s7

i( ,i(es-a #( R?" := da.s6 there(#re HE*OLYTI" ANE*IA 4E) SI"KLE "ELL7



+ETER)P+I +ETER )P+IL L ANTIB)* ANT IB)*Y Y TET TE T <

dete$t dete$t -res -rese$ e$e e #( Ig* Ig* w5$ w5$ is re,at re,ated ed t# E-st E-stei ei  Virus Virus i(e$ i(e$ti# ti# 

E-stei Virus I(e$ti# + $ausative aget #( i(e$ti#us %##u$,e#usis 402issig dses37 %gtD AVOI/ SHARIN! #( utesi,s ad g,ass



LY#E *E ER)L ER)L)GY )GY <

dete$t dete$t -rese -rese$e $e #( ?ORRE ?ORRELIA LIA ?UR!/O ?UR!/ORFE RFERI RI +

$ausative aget #( ,.%e1s

dses  Treat%etD tetra$.$,ie tetra$.$,ie

TIP F)R *IAGN)TIC PR)CE*URE   %#ths #,d i(at sus-e$ted #( 'r#$h#,itis is treated with #C.ge thera-. thera-. Whi$h resu,t idi$ates idi$ates

that tC was e((e$tive D 02 ATURATI)N )F K  Pt is s$hedu,ed (#r ,iver 'i#-s. What sh,d the urse istru$t istru$t -t t# d# durig eed,e iserti# iserti# <

9!& ;-/$t9 4-i%6 t9/ -!/4-/ 4!% i%/-ti!% !" t9/ %//&/  Sta(( urse is #'servig a urse $arig $arig (#r -t w5 $v- W5$ a$ti# #( the urse reuire iterveti# iterveti# +

t!49i%6 t9/ /6/ !" t9/ !i&/ -/i%6 4i%6 &/$% 6&!/   Pt uderg#ig ER"P + i%-#rtat -re- (#r urse t# %a2e w#u,d 'eD // t NP) ;: t9/

-!/4-/ -!/4-/  Pt w5 $#r#ar. agi#gra%6 the $atheter was iserted at the L (e%#ra, arter. w5$ iterveti# is

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ONLY RN1s are a,,#wed t# ad%iister 4t# i$,ude $etra, ,ie7 LPN1s + -eri-hera, IV Lie r#ute EL/ERLY PT + -r#vide with %e%#r. aid PE/IATRI" PT + d# #t %iC w5 %i,2 4d#sage de-eds # wt6 age ad si9e7 F#r SI/E EFFE"TS + !I s.%-t#%s 4%#st,.7 F#r A/ EFFE"TS + a,wa.s $#sider '#e %arr#w 40,eu2#$.t#-eia + a,, PENIA37 ; "O**ON /RU!S + with -atiets #ver MG .5# a LITHIU* + i( a'#ve MG .#6 d#se sh,d #t %#re tha :=%E ' HAL/OL + i( a'#ve MG .#6 d#se sh,d #t %#re tha M%g5da. $ *EPERI/INE + i( a'#ve MG .#6 sh,d #t G= %g

II TRANCULTURAL ASIANS + are st#i$is% attitude *I//LE EASTERNERS < EASTERNERS <

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C)##)N C)NTRAIN*ICATI)N "!- +ERBAL #E*8   

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T+E C+EC> PRINCIP IPL LE

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 TETRA"Y"LINE <  TETRA"Y"LINE  < $a $ause staiig #( teeth6 Ph#t#sesitivit. 4use sus$ree whe #utd##rs7 LITHIU* + sh,d have i$ (,uid i the diet

III *ELEGATI)N AN* *)CU#ENTATI)N /#$u%et a,, %edi$a, ad%i re$#rdD

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eC Ha,d#, "h,#r-r#%a9ie ",#9a-ie 4$h,#9ari,7 O,a9a-ie 49.-reCa7 Ris-erd# ?ETS TO !IVED $"t/-
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Assess IGN $% Y#PT)# !" PEU*)PAR>IN)NI# a %as2<,i2 %as2<,i2e e (a$e (a$e #r #r eC-res eC-ressi# si#,ess ,ess (a$e ' -i,, -i,,
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"he$2D "?"6 ?P6 AST5ALT  T# -revet -seud#-ar2is#is%6 ad%iister ad%iister ANTIPARKINSONIAN agets

IA *)PA#INERGIC  ANTIPAR>IN)NIAN in schizo there is increase dopamine, therefore give antipsychotic to dec dopamine then dec dopamine causes  pseudoparkinsonism.  pseudoparkinsonism. Therefore Therefore give give dopaminergic. dopaminergic.

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E""/ti/ i( de$rease i tre%#rs ad rigidit. withi <; da.s Whe t# giveD AFTER #EAL

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eC Va,iu%6 dia9e-a%6 Li'riu%6 TraCee 

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III ANTI-DEPRESSANT$MANIC a ' $ d

TRI" TRI"Y" Y"L LI"S I"S *AO STI*ULA LAN NTS SSRI

PATIENT @it9 *EPREI)N + the there is /E"R /E"REA EASE SE %!-/i%/9-i%/ ad /-!t!%i%

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TRIC TR ICYC YCLI LIC C +

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EC T#(rai,6 E,avi, 4hrs #,.7 #,.7 E""/ti/D I( adeuate s,ee- 4hrs I$rease a--etite  B/t 6i/%D AFTER *EALS +D T/$9i%6 D 

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AVOI/ + TYRA*INE "ONTAININ! FOO/ 4: da. 'e(#re FIRST /OSE ad :> da.s AFTER LAST /OSE7

Av#$ad#6 'aaa6 $heese 4$heddar6 aged ad swiss7

ALLOWE/D $heese + $#ttage ad $rea%6 FRESH *EAT6 VE!ETA?LES

"OLA6 "HI"KEN LIVER SOY SAU"E RE/ WINE PI"KLES 

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4se,e$tive ser#t#i reu-ta2e ihi'it#r7 EC BOLOFT6 Pr#9a$

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III02 ANTIMANIC Lithiu% 4,ithae6 ,ith#'id6 es$a,ith7   Tegret#,  /e-a2ie5 /e-a2#te 

A LIT+I LIT+IU# U# <

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dietD High Na 4M<:= g%s7 ad High F,uid 4;<>L7 N Na + ; g%s6 N (,uid ita2e ;L ?asi$a,,.6 Lithiu% is a sa,t

Re-#rt the (( s5s (NAV*A' Nausea A#reCia V#%itig /iarrhea A'd, "ra%-s 

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FINE HAN/ TRE*ORS -r#gressig t# "OARSE HAN/ TRE*ORS6  THIRST ad ATA)I" ATA)I" < sig #( LITHIU* TO)I"ITY + TO)I"ITY + /ug #( $h#i$eD *ANNITOL

 

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4s-e$i%eD ',##d draw i the %#rig '> 'rea2(ast #r at ,east : hrs a(ter the ,ast d#se7 •

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G + :G %E5L M + := %E5L

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Lithiu% is e((e$tive with := + :> /AYS 'e(#re it wi,, rea$h its thera-euti$ ,eve, ,eve,

C)NTRAIN*ICATI)N )F LIT+IU# D • • •

Prega$. La$tatig Kide. dis#rder

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ANTICON+ULSANT < <

( Tegret#, ad di,ati7  Tegret#, di,ati7

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e((e$tiveD i( 4<7 sei9ure give ?EST AFTER *EALS +

4eC$e-t (#r sedatives< ,i2e va,iu%7 *OST /RU!S /RU!S THAT THAT AFFE"T AFFE"T "NS ARE ?EST !IVEN !IVEN AFTER AFTER *EALS *EALS TOO TOO

NS! ALERTD • •

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"he$2 D

Re-#rt !IN!IVITIS Re-#rt S5S #( ?#e *arr#w /e-ressi# + $%t!/%i$ 4de$ R?"  W?"7 Istru$t -t t# use SOFT ?RISTTLE/ TOOTH?RUSH Istru$t -t t# *ASSA!E !U*S ad (reuet #ra, h.giee "?" + due t# -a$.t#-eia R?"6 W?" ad P,ate,et ,a'e,

CHOLINESTERASE CHOLINESTERAS E INHI.ITORS F!- #YAT+ENIA GRAVI D Pr#stig%i  4,#g a$tig7 ad Tesi,,# 4sh#rt a$tig7 F!- ALZEI#ER *E

D "#geC 4ta$rie7 ad Ari$e-t

#$t9/%i$ G-$i + there is de$rease #r a'se$e #( A$eth.,$h#,ie 4A"TH7 A"TH is a eur#tras%itter the de,ivers the #rder eC ?rai t# %us$,e t# $#tra$t5%#ve

 There(#re6 the drug is give t# ihi'it ihi'it $h#,iesterase i destr#.ig destr#.ig A"TH 4s#6 i( de$ $h#,iestera$e ad i$ A"TH6 g##d %us$,e $#tra$ti#7

PROSTI!*IN + ,#g a$tig + (#r treat%et  TENSILLON + sh#rt a$tig + #,. (#r G %is + it i$rease %us$,e stregth i ;= se$#ds  4there(#re6 i( %us$,e wea2ess disa--ear withi ;= se$#ds + it is *YASTHENIA !RAVIS7

*-46 Ati!%8 • • • •

I$rease %us$,e stregth 4eC I$rease $hewig a'i,it. #r a',e t# $hew (##d (#r$e(u,,.7 !IVE ?> *EALS #r a. a . a$tivit. *eds is FOR LIFE Re-#rt s5s #( HEPATO)I"ITY + RUJ -ai #( a'd#%e ad QAUN/I"E

Atid#teD ATSO> + it reverses the e((e$t #( ati$h#,iesterase • •

"he$2 (#r LIVER FUN) TEST Kee- at 'edsideD ed#tra$hea, tu'e + (#r res- -r#',e%

ANTICOAGULANT HEPARIN

COUMADIN

)o# AC+T( CAS(S of o f F.ni1 C.se

)O* FAINT(NANC( o# Ch#oni1 CAS(

Ant"ote: Ant"ote: P*OTAFIN( SO

Ant"ote: Ant"ote: VIT K

Given Su-J 78o!e# A-d" ).t9

O#."

LOVENO? Hep.#in De#iv.tives Antidote s./e !3 Hep.#in

OsetD  se$7 E((e$tive i( 4<7 $,#t !ive sa%e ti%e #( da. Re-#rt s5s #( ',eedig D He%#-t.sis   He%ate%esis HEPARIND AVOI/ + gree ,ea(. vegeta',es + 'e$ it is ri$h i Vit K ad wi,, $#utera$t the e((e$t #( ati $#agu,at  There(#re6  There(#re6 diet #( -atiet -atiet + # a--r#-riate a--r#-riate NS! ALERTD
C)AGULATI)N PR)CE8   thr#%'#-,asti PRO THRO*?IN

Vita%i K de-edet $,#ttig (a$t#rs

"OU*A/IN  

THRO*?IN

FI?RINO!EN HEPARIN FI?RIN 4"LOT7

C)U#A*IN  + a$t as vit 2 de-edet $,#ttig (a$t#rs +EPARIN  +

$#verts PROTHRO*?IN t# THRO*?IN ad FI?RINO!EN t# FI?RIN

< RAPI/ A"TIN! D#set D > + > hrs

C!4<$i% $% +/$-i% N)T t# diss#,ve $,#t + N)T t#  4#,. as T+R)#B)LYTIC as T+R)#B)LYTIC +  + %eaig it -revets ENLAR!E*ENT ad FOR*ATION #( "LOTS7 <

$a 'e 'e gi give t# t#gether

ANTIARR,THIMICS Juinidine 76uin./9

,?.

i/ %!t/8

C#aa!te"%t"!% o' HEART MUSCLE D

a "ON/U"TI "ON/U"TIVITY VITY + a'i,it. a'i,it. t# t# -r#-aga -r#-agate te i%-u,se i%-u,ses s ' AUTO*ATI AUTO*ATI"ITY "ITY < a'i,it. a'i,it. #( heart heart t# iitia iitiate te $#tr $#tra$ti a$ti# # c. REFRA"TORINESS + a'i,it. #( t heart t# res-#d t# sti%u,us whi,e i the state #( $#tra$ti#  d E)"ITTA?I E)"ITTA?ILITY LITY < a'i,it. a'i,it. #( the the heart heart t# 'e 'e sti%u, sti%u,ated ated I#tr#-i$ e((e$t < (#r$e #( $#tra$ti# #r stregth #( %.#$ardia, %.#$ardia, $#tra$ti# $#tra$ti# "hr#%#tr#-i$ E((e$t + $#du$ti# #( i%-u,ses "HRONOTROPI" E((e$t < rate #( $#tra$ti#

ANTIARRYT+#IC 4uiideC6 -r#est.,7 <

re-# re-#,a ,ari ri9a 9ati ti# # + rest resti ig g -hase -hase 42 g#e g#es s #ut7 #ut7

de-#,ari9ati# + sti%u,atig -hase 4Na g#es i7  4there(#re the de-#,ari9ati# ad re-#,ari9ati# #( heart %us$,e de-eds # Na ad K -u%-7 K + #$e it i$rease #r de$rease6 de$rease6 it a((e$ts the re-# ad de-# #( heart %us$,e whi$h $auses arrh.th%ia Ad s#6 t# %aitai the 'a,a$e i the Na ad K -u%- give atiarr.th%ia atiarr.th%ia 'e$ause it de$reases de$reases the aut#%ati$it. aut#%ati$it. #( the heart Atiarr.th%ia Atiarr.th%ia is e((e$tive i( 4<7 arrh.th%ia arrh.th%ia !ive %eds a.ti%e

+/$&t9 t/$9i%68 a re-#rt "NS + $#(usi#6 ataCia ataCia ad heada$he heada$he !I < ausea6 a#reCia ad v#%itig ' RASH + there(#re SK SKIN TE TEST FI FIRST c. REPORT s5s #( JUINI/INE TO)I"ITY + tiitus6 hearig ,#ss ad visua, distur'a$es d $he$2 -t -t PR ad E"! + waves6 waves6 rate ad rh.th% rh.th%

UINI*INE

PR)CAINE

LI*)CAINE Vetri$u,ar arr.th%ia

)o# V(NT*IC+88A*  AT*IA8 )i-#i"".tion

CARDIAC GL,COSIDES < < <

i$r i$rea ease se (#r (#r$e $e #( #( $#t $#tra ra$t $ti# i#  a((e$ts a((e$ts the the aut#%at aut#%ati$i i$it. t. ad eC$i eC$ita' ta'i, i,it. it. #( the the heart heart %us$ %us$,e ,e K + sh,d sh,d ' 'e e %#i %#it#r t#red ed whe whe ii  tthis his %eds %eds ther thera-. a-.

4The heart $#tra$ti# is regu,ated '. Na ad K -u%- I( K de$reases6 "a,$iu% eters ad it wi,, resu,t t# a %#re i$rease (#r$e #( $#tra$ti# due t# Na ad "a -u%- $#versi#7

E""/t8 47 INOTROPI" + stregthe the (#r$e #( $#tra$ti# 4<7 "HRONOTROPI" + de$rease rate #( $#tra$ti# *IG)XIN EFFE"TIVE D EFFE"TIVE  D A"TION

*IGIT)XIN

it i$rease FOR"E OF "ONTRA"TION D

sa%e

#set D G + = %is

;= %is + hrs

!ive a(ter %ea,s due t# !I irritati#

sa%e

CLIENT TEAC+INGD TEAC+INGD 

Re-#rt s5s #( TO)I"ITY #(  TO)I"ITY D NAV/A

)ath#-sia +

.e,,#wish visi# #r greeish ha,#s

"he$2 PR + i( ?ELOW M=5%i M=5%i 4adu,t7 + HOL/ HOL/ eCt d#se i( ?ELOW &=5 %i 4#,der $hi,d7 + HOL/ i( ?ELOW =< ::= 4i(ats7 + HOL/ eCt d#se E)"RETION /ig#Ci + 2ide. + %#it#r rea, (uC test 4?UN  "rea7 + re-#rt i( i$

/igit#Ci + ,iver + AST5 ALT /I!I?IN/ + atid#te (#r i6!Di% (&$%!Di%7 (&$%!Di% 7

T+ERAPEUTIC LEVEL8

a /ig# /ig#Ci Ci  ' /igi /igit# t#Ci Ci 

D G +  ug5L ug5L D :> + M ug5L ug5L

NITRATES (nitrogl&cerine$ <

d#1 d#1tt give give i( -t ta2i ta2ig g VIA! VIA!RA RA + it @i&& -/4&t t! FETAL +YP)TENI)N di,atati# #( $#r#ar. arteries ad arteri#,es arteri#,es there'. resu,tig t# t# DECREASE IN PRELOAD @ AFTERLOAD 

EFFECT8

Decrease in Preload + Preload  + de$rease de$rease i the a%#ut a%#ut #( ',##d that g#es t# the LV  AFTER!AD +  AFTER!AD + a%#ut #( resista$e #((ered '. ',##d vesse,s that heart sh,d #ver$#%e whe -u%-ig ',##d • • •

(ffe1tive if N(GATIV( ANGINA8 PAINE Give B()O*( .n$ .1tivit$E sensatio n indi1.tes d#u, is potent9 – NO WAT(* -e1.use it  Ad/iniste#ed  Ad/iniste#ed S+B8ING+A88 S+B8ING+A88Y Y (+ burning sensation !i"" di"ute the /edsE

• • • • •

/OSESD ; d#ses at a t G%is iterva, Re-#rt i( there is -ersiste$e #( -ai -a i "he$2 ?P ad PR Kee- %eds i dar2 $#taier 4'e$ ,ight de$ -#te$.7 O$e the '#tt,e is #-e6 use the %eds withi ;
DO NOT *(PO*T TH( )): )) : 7epe1ted s3s9 H$potension2 He.d.1he2 f.1i." f"ushin, !h$ is /$ f.1e #edQ'

MUCOL,TICS

(an ant"ote al%o 'o ACETAMINOPHEN TO?ICITY)

(& Fu1o/$st

< < <

it de1#e.ses the vis1osit$ of se1#etionE ,ive /eds .n$ti/eE 1"ient te.1hin,: /eds 1.n -e di"uted !3 NSS o# 1o".E

S"e e''e!t%/ e''e!t%/ NAV  Ra%#e%

<

i( # sid side e e(( e((e$ e$ts ts66 rere-ea eatt d#se d#se i : hr hr

.RONCH .RO NCHODI ODILAT LATORS ORS < < <

4eC TER?UTALINE + 'rethie7

di,a di,ate tes s the the 'r# 'r#$h $hi# i#,e ,es s #r airw airwa. a.s s e((e e((e$t $tiv iveD eD i( 4<7 4<7 'r# 'r#$h $h#s #s-a -as% s% !IVE !IVEN N i i A* A* t# t# de$ de$re rease ase is# is#% %ia ia

<

REPORT THE FFD i%!<%i$, t$9$-i$, $&it$ti!%PR, $&it$ti!%PR, H NAV

 The#-h.,,ie < N :=<= < (#r (#r A"U A"UTE TE ATT ATTA" A"K K ad ad PREV PREVENT ENTIO ION N #( AST AST*A *A

E1PECTORANT   4r#'itussi7 < < < <

sti%u sti%u,a ,ate tes s -r# -r#du du$t $tiv ive e $#u $#ugh ghi ig g e((e e((e$t $tiv ive e D 47 47 "OU "OU!H !HIN IN! !  SE" SE"RE RETI TION ONS S give ANYTI*E i/""/t8 – NAV H *IZZINE *IZZINE !- -!@i%/ + av#id a$tivit. that reuired a,ertess 4eC /rivig7

ANTI.IOTICS < < < < <

-.1te#i1id."E effe1tive: 759 infe1tionE ,ive ON (FPTY STOFACH – B F(A8SE H te.1hin,s: REPORT #.sh2 REPORT #.sh2 u#ti1.#i. .nd ST*IDO*' – indi1.tes .i#!.$ o-st#u1tionE side effe1ts: NAVDA  GI I"tat"on

I PENICILLIN D atid#te is EPINIPHRINE

II A#IN)GLYC)I*E 4geta%.$i7 < <

e((e e((e$t $tiv iveD eD 4<7 4<7 i( i(e$ e$ti ti# # + give give ?> ?> %ea, %ea,s s re-#rt the ((D )T)T)XICITY8 =I 9/$- -i%6i%6 i% < /$-? )T)T)XICITY8 =I NEP+R)T)XICITY 8 ?!&i64-i$? 8 ?!&i64-i$? NEUR)T)XICITY 8 =/i.4-/? 8 =/i.4-/?

< <

$he$ $he$2 2 ?UN ?UN66 " "RE REA A 42i 42id de. e. (uC (uC test test7 7 $he$ $he$2 2 I  O 4si 4sig g #( ee-hr hr#t #t#C #Ci$ i$it it.7 .7

ANTINE)PLATIC 4adria%.$i7

III0

< < < <

(#r (#r 'rea 'reast st ad ad #var #varia ia  "A "A e((e e((e$t $tiv iveD eD 4<7 4<7 ttu% u%#r #r si9e si9e !IVE !IVE IN AR* + t# -reve -revet t HE** HE**OR ORRHA RHA!I" !I" "YSTIT "YSTITIS IS HC Te Tea$higsD a i$ #ra, (,uid (,uid ita2e ita2e 4<;L5da.7 4<;L5da.7 + $.t#t#C $.t#t#Ci$ i$ -reveti# -reveti# ' %#it# %#it#rr 2ide 2ide. . (uC (uC + I  O O

TH,ROI TH, ROID D AGENT AGE NTS S 7s$nth#oid2 1$to/e"9 < < < < < <

(#r HY HYPOTHYRO YROI/S I/S* e((e$t e((e$tiv iveD eD i( i( I$ I$ i T; ad T> ad NOR*AL NOR*AL SLEEP SLEEP -t a,wa.s a,wa.s s,ees,ee-66 there there(#r (#re e give give %eds %eds i A* A* + t# av#id av#id is# is#%i %ia a REPORT REPORT HE FOLLOW FOLLOWIN! IN!DD is#% is#%ia6 ia6 erv#u erv#use sess ss -a,-it -a,-itati ati#s #s Ta2e Ta2e %ed %eds s LIFE LIFETI TI*E *E 4sa 4sa%e %e w5 w5 %eds %eds > eur eur#7 #7 "he$ "he$2 2 HR6 HR6 PR ad ad 2id 2ide. e. (uC (uC test test

ANTITH,ROID

(;T6 6G*’ *6TI*%$

< < <

F#r F#r !RAV !RAVE1 E1S S /ISEA /ISEASE SE #r HYP HYPER ERTH THYR YROI OI/I /IS* S* E((e$t E((e$tive iveDD /e$re /e$rease ase i T; ad T> 4i ,a' data7 data7 !ive !ive r#ud #ud the $,#$2 ,#$2

+/$&t9 T/$9i%68

a

Re-#rt Re-#rt s#r s#re e thr#at thr#at66 (ever6 (ever6 $hi,,s $hi,,s66 '#d. '#d. %a,ais %a,aise e 'e$au 'e$ause se %eds %eds $ause A!RANULO"UYTOSIS ' Re-#rt Re-#rt ,etharg ,etharg.6 .6 'rad.$ar 'rad.$ardia6 dia6 ad ad IN"REASE IN"REASE SLEEP + idi$ates idi$ates that -t is havig HYPERTHYROI/IS* $ /iarrhea /iarrhea with with %eta,,i$ %eta,,i$ taste + sig #( IO/INE IO/INE TO)I"I TO)I"ITY TY

ANTIDIA.ETICS < < < <

(I%6I%$

e((e e((e$t $tiv iveD eD N ?,# ?,##d #d sugar sugar 4=< 4=<: :=7 =7 (#r (#r /* /* T.T.-e e : 4is 4isu, u,i i de-e de-ed de et7 t7 give i A* '> %ea,s $he$2D a istru istru$t $t S5S S5S OF HYPO HYPO!LY !LY"E* "E*IA IA + di99iess5 dr#wsiess di((i$u,t. i -r#',e% s#,vig de$rease ,eve, #( $#s$i#uess $#,d $,a%%. s2i ' %#it#r %#it#r the ',##d ',##d sugar sugar ,eve, ,eve, i ear,. ear,. A* ad su--er su--er ti%e ti%e



INJECT AIR FIRT t# FIRT t# NP+ the NP+ the ie$t air ad WIT+*RAW FIRT @it9 REGULAR REGULAR 



PEA> )F ACTI)N 4re(ers ACTI)N 4re(ers t# + whe -atiet 'e$#%es HYPO!LY"E*IA7 HYPO!LY"E*IA7 RE!UALR RE!UALR INSULIN INSULIN < ,u$h ,u$h ti%e Iter%ediate < ,a ,ate i the a(ter## + ?> dier L#g A$tig < ?> ?rea2(ast

SULFON,LUREAS < < < < <

(#r /* t.-e  sti%u sti%u,a ,ate te -a$ -a$re reas as t# t# -r#d -r#du$ u$e e isu, isu,i i e((e e((e$t $tiv ive e + N ',d ',d sug sugar ar ,eve ,eve, , give give '> %ea, %ea,s s regu regu,a ,ar, r,. . tea$higsD a s5s #( h.-#g, h.-#g,.$e .$e%ia %ia ' %#it# %#it#rr rea, rea, (uC (uC test test $ atid#te atid#te (#r (#r h.-#g,. h.-#g,.$e%i $e%ia a + ORAN!E ORAN!E QUI"E

ANTA AN TACI CIDS DS < < < < < < <

(*rinase$

4a%-h#ge,6 taga%et7

ALU*IN ALU*INU* U* HY/RO HY/RO)I/ )I/E E !EL + ata$i ata$id d ad it a,s# a,s# de$ de$ -h#s-hat -h#s-hate e ,eve, ,eve, i -t rea, (ai,ure E((e E((e$t $tiv iveD eD de$ de$ -h#s -h#s-h -hat ate e 4<7 -ai give # E*PTY STO*A"H STO*A"H 4: hr '> #r hrs a(ter %ea,s7 istru$t -t t# REPORTD REPORTD %us$,e wea2ess i ,#wer eCtre%ities eCtre%ities + idi$ates HYPOPHOSPATHE*IA HYPOPHOSPATHE*IA ad%i ad%iis iste terr with with g,as g,ass s #( #( wate water r $he$ $he$2 2 -h#s-h#s-ha hate te ,ev ,eve, e, ad ad re rea, a, (uC (uC tes test t asse assess ss (# (#r $# $#st stii-at -ati# i#

LA1A LA 1ATI TI+E +ES S 4du,$#,aC7 "#,a$e *eta% *eta%u$i u$i,, /u,$#,aC La$t a$tu,#se < < < < <

+ st##, s#(teer < 'u,2 'u,2 (#r%i (#r%ig g < ra ra-id a$ a$tig < :G :G<;= <;= %i %is

e((e$tive D 47 ?* give give AT AT HS 4i( 4i( NOT NOT dia diag g#s #sti ti$ $ -r#$ -r#$ed edur ure7 e7 give give AFTE AFTER R *EAL *EALS S +(#r +(#r d.sd.s-ee-si sia a %eds %eds is give give  i sh#r sh#rtt durati durati# # #,. #,. 'e$au 'e$ause se #( de-ed de-ede$ e$. . tea$higsD a ' $ d e

'e ear ear #r sta. sta. ear ear "R "R s5eD s5eD diar diarrh rhea ea NO ,a$t ,a$tu,# u,#se se (#r (#r -t w5 w5 diarr diarrhea hea "auses "auses h.-#2a,e%ia h.-#2a,e%ia + there(#re there(#re $he$2 $he$2 e,e$tr e,e$tr#,.t #,.tes es I$rease I$rease (,d (,d ita2e ita2e + t# av#id deh.drati# deh.drati# 

DIURETICS  Target Orgas a /ia%#C /ia%#C + eCerts e((e$t e((e$t at Pr#Ci% Pr#Ci%a, a, "#vu,uted "#vu,uted Tu'u,es Tu'u,es ' LasiC LasiC + at L##L##- #( He,e He,e $ /iuri, /iuri, + at /ist /istat at "# "# Tu'u Tu'u,es ,es

L))P *IURETIC (&$iD' < e((e e((et$ t$ti tive veDD i$ i$ra rase se uri urie e #ut #ut-u -ut t < give give i %#r %#ri ig g t# -rev -reve ett #$ #$tu turi ria a < tea$higsD a %#it#r %#it#r (#r (#r h.-#2a,e% h.-#2a,e%ia ia ,eve, ,eve, ad I  O ' re-#rt re-#rt %us$, %us$,e e wea2 wea2es ess s $ give give K ri$h ri$h (##d (##d + 'aa 'aaa6 a6 #rage #rage T+IAZI*E (i4-i&' < < <

give i A* %#i %#it# t#rr (#r (#r h.-# h.-#2a 2a,e ,e%i %ia a $he$ $he$2 2 I  O6 O6 K ,eve ,eve,6 ,6 PR ad ad ?P ?P

>PARRING (t-i$PARRING  (t-i$
e((e e((e$t $tiv iveD eD i$ i$ uri urie e #ut#ut-ut ut give i A* tea$ tea$hi hig gsD sD %#i %#it# t#rr (#r (#r HYPE HYPERK RKAL ALE* E*IA IA $he$2 PR ad K 

ANTIG)UT

PR)BENECI*

C)LC+ICINE

ALL)PURIN)L

< URI"OSURI" < (#r A"UTE !OUT < (#r "HRONI" !OUT < -r#%# -r#%#te tes s eC$r eC$ret eti# i#  #( uri$ uri$ a$id a$id < has ati ati
< ONSETD :<; w2s

 TEA"HIN!SD a I$rea I$rease se ORAL ORAL FLUI FLUI/ / INTAK INTAKE E ' *#it# *#it#rr uri$ uri$ a$id a$id ,ev ,eve,s e,s

MIOT MI OTIC ICS S 4ti%#-ti$6 -i,#$a7 < < <

/E"R /E"REA EASE SE IOP IOP 4N: 4N:< <: :77 (#r (#r -t w5 w5 g,au$ g,au$#% #%a a !ive !ive ANY ANYTI TI*E *E + 'ut 'ut (#r (#r LIF LIFET ETI* I*E E Tea$higsD a it $auses $auses ',urr ',urrig ig #( visi# visi# ad 'r#w 'r#w -ai ' ad%iister ad%iister %eds at at ,#wer ,#wer $#u$t $#u$tiva, iva, sa$ sa$ $ -ress the the ier ier $athus $athus (#r :< :< %is t# -reve -revet t s.ste%i$ s.ste%i$ side side e((e$ts 4h.-erg,.$e%ia ad h.-#tesi#7

M,DRIATRIC < < <

4AK
e((e e((e$t $tiv iveD eD -u-i -u-i,, ,,ar ar. . di, di,at atati ati# # give give ANYT ANYTI*E I*E 4'ut 4'ut i( i( -t -t (#r (#r surg surger. er.66 give give '>7 '>7 tea$ tea$hi hig gsD sD %a. %a. $aus $ause e ',ur ',urri rig g #( visi visi# # ,#wer $#u$tiva, sa$

CAR.ONIC ANH,DRASE INHI.ITORS < < < < <

(diamo?$

for G::60*A: ' lifetime> to decrease prod!ction of acB!eo!s h!mor> effecti#eC % I*; and Inc. !rine o!tp!t> effecti#e to pt ith A,%I,R,’ +, ' dec #ertigo teachingsC a. chec check k !ri !rine ne o!tp o!tp!t !t>>  /. reportC s"s of deh&dration /ec of di!retic effect c. /l!r /l!rrred #is #ision ion d. moni monito torr I = * and and I*; I*;

ANTI-ACNE

(ac!tane retin-a$

< decrease se/aceo!s gland si)e> < gi#en in :A to pre#ent insomnia> < a#oid s!nlightC photosensiti#it& <  pregnanc&C fetoto?ic - therefore check if pt is pregnant> < check if pt has skin irritation ' ma& /!rn the skin

TOCOL, TOC OL,TIC TICS S (7!topar Ag*4$ < < <

re,aC the uterus drug drug #( $h#i $h#i$e $e (#r (#r -re -re
< <

give giveDD ORA ORAL L + ?> ?> %ea %ea,s ,s ad ad IV IV + a. a.ti ti%e %e tea$higsD a sig sigs s #( #( "a It# It#Ci$ Ci$ati ati#D #D h.-#tesi#6 h.-#ther%ia ad h.-#$a,$e%ia ' $he$2 ',d ',d -ressure -ressure urie urie #ut-ut #ut-ut 4N ;=%,5h ;=%,5hr7 r7 $ $he$2 $he$2 RR RR + at ,eas ,eastt :5% :5%i i d. $he$2 -ate,,ar re(,eC + sh,d 'e 47 2ee er2

+)L* i( +)L* i( RR + :=5%i :=5%i ad urie urie #ut-utD :G%,5hr :G%,5hr A%ti!t/D A%ti!t/D "a,$iu% !,u$#ate

O1,TO1IC PIT)CIN

#ET+ERGIN

 T# idu$e ,a'#r T# -revet -#st -artu% -artu% he%#rrhage he%#rrhage E((e$tiveD Fir% ad "#tra$ted Uterus !ive a.ti%e I( IV6 use 0-igg. 'a$23  Tea$higsD a. REPORT the ((D HYPOTENSION 4due t# ia$tivati# #( ANS + eur#,#gi$a, e((e$t #( drug7  ' Heada$he 4$ardi#vas$u,ar e((e$t #( the drug7 c. H.-ertesi# 4$ardi#vas$u,ar d "he$2 ?P6 ?P6 Uterie Uterie "#tra$ti "#tra$ti# # + es-e$ia,, es-e$ia,,. . the durati# durati# + N ;=<= ;=<= se$ < re-#rt i( 'e.#d = se$ + sig #( uterie h.-ert#i$it. e "he$2 F#r$e6 F#r$e6 /urati# /urati# ad ad Freue$. Freue$. #( Uterie "#tra$ti#

PROSTAGLANDIN 4$.t#te$6 Ege,7 < < < < <

ati ati u u,$ ,$er er drug drug t# t# de$ de$ gastr gastri$ i$ a$id a$idit it. . de$rease de$rease ri-ei ri-eig g #( the the $erviC $erviC w5$ ,eads ,eads t# t# e((a$e%e e((a$e%et t the the di,atati di,atati# # the a'#rti# give a(t a(ter %ea,s a,s assess assess (#r diarr diarrhea hea ad gastri gastri$ $ iirr rrita itati# ti#  $he$2 $he$2 (#r -rega -rega$. $. 'e$ it %a. $ause $ause a'#rt a'#rti# i#

TIP )N P+AR#AC)L)GY  Patiet re$eivig /IABEPA*6 the urse #ti$e that there is # $hage i -atiet 'ehavi#r What sh,d the urse d# + VERIFY T+E PT *IET





"O!NE) + give with ABEI*ERS1S /SES – t! i%-/$/


Pt w5 PV" D 'edside D XYL)CAINE



Pt w5 "O*PLETE HEART ?LO"KD give ATSO> + it i%-/$/ +R



Pt w5 /IVERTI"ULITIS 4-t has diarrhea7 + the (( %eds were giveD what %eds the urse sh,d uesti# D LACTUL)E



*#r-hie S=> give t# -t with Pu, Ede%a + t! /-/$/ $%Di/t



Pt as2 the urse # wh. she wi,, ta2e "OU*A/IN whe shes a,read. ta2ig HEPARIN – +/$-i% i 6i/% "!- ACUTE CAE @9i&/ C!4<$i% "!- <$i%t/%$%/



Pt # "HE*OTHERAPY $#%-,ais #( ausea ad v#%itig6 w5$ %eds $a 'e give + Z)FRAN



EC-e$ted side e((e$ts #( STEROI/S D @t 6$i%, !;/it $% I% $/tit/



Pt is ta2ig LEVO/OPA + !;/-/ "!- URINARY RETENTI)N



A/REA*Y"IN + $4/ 9/

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