HERBAL MEDS St. John's wort - antidepressant, photosensitive (C/I in SULFA drugs) Garlic - antihypertensive (avoid aspirin) Ginseng - Anti stress (C/I in coumadin) Green tea - antioxidant (check if risk for calculi-oxalates) Echinacea - immune stimulant (6-8 weeks only)(C/I in SANDIMMUNE-Immunosuppressant) Licorice - cough and cold Ginger root - antinausea (C/I in Coumadin) Ginkgo - improves circulation (C/I in anticoagulant, headache side effect - check PT) Ma huang - bronchodilator, stimulant (Ephedra) Digitalis Toxicity includes.. N - nausea A - anorexia V - vomiting D - diarrhea A - abdominal pain Drugs which can cause URINE DISCOLORATION Adriamycyn------ Reddish Rifabutin--------- Red orange Rifampicin------- Red orange Bactrim---------- Red orange Robaxin--------- Brown, Black or Greenish Azulfidine------ Orange yellow Flagyl------------ Brownish Dilantin---------- Pink tinged Anti Psychotic-- Pinkish to Red brown Early signs of hypoxia: R-restlessness A-anxiety T-Tachycardia Late signs of hypoxia: B-bradycardia E-extreme restlessness D-dyspnea In pediaF-feeding difficulty I-inspiratory stridor N-nares flare E-expiratory grunting S-sternal retractions Respiratory Patterns Kussmaul- fruity acetone breath odor Cheyne-stokes- near death breathing pattern
who suffer from summer depression. SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.
A sign of improvement from dehydration would be a decreased urine specific gravity and a decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the best answer of the two you had in you question. The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and volume) (different texts give a slightly different range). SG 1.025-1.030+ (concentrated urine) SG 1.001-1.010 (dilute urine) SG 1.001-1.018 in infants under 2 years of age Specific gravity is a measurement of the kidney's ability to concentra urine. The range of urine's SG depends on the state of hydration and varies with urine volume and the load of solids to be excreted under standardized conditions; when fluid intake is restricted or increased, measures the concentrating and diluting functions of the kidney. Los of these functions is an indication of renal dysfunction. SG values usually vary inversely with amounts of urine excreated (decrease in urine volume = increase in specific gravity). However in some conditions this is not the case. EYE ABBREVIATIONS OU- both eyes OR- right eye OS- left eye CUSHINGS (Hypersecretion of Adrenal Cortex Hormones) C = Check VS, particularly BP U = Urinary output & weight monitoring S = Stress Management H = High CHON diet I = Infection precaution N = Na+ restriction G = Glucose & Electrolytes Monitoring S = Spousal support ADDISON'S (Hyposecretion of Adrenal Cortex Hormones) Always Remember the 6 A's of Addison's disease 1.) Avoid Stress 2.) Avoid Strenuous 3.) Avoid Individuals with Infection 4.) Avoid OTC meds 5.) A lifelong Glucocorticoids Therapy 6.) Always wear medic alert bracelet
Hirschsprung\u2019s diagnosed with rectal biopsy looking for absen ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.
Intussusception common in kids with CF. Obstruction may cause feca emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is Seasonal Affective Disorder (SAD) may affect over 10 million obvious, with onset of bowel movements. Americans. The typical symptoms of SAD include depression, lack of energy, With omphalocele and gastroschisis (herniation of abdominal content increased need for sleep, a craving for sweets and weight gain.dress with loose saline dressing covered with plastic wrap, and keep Symptoms begin in the fall, peak in the winter and usually resolve eye on in temp. Kid can lose heat quickly. the spring. Some individuals experience great bursts of energy and After a hydrocele repair provide ice bags and scrotal support. creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may No with phenylalanine with a kid positive for PKU (no meat, no dairy, no experience SAD-type symptoms at any time of year. Some people SAD have mild or occasionally severe periods of mania during aspartame). the spring or summer. If the symptoms are mild, no treatment may be voided urine most accurate when testing for ketones and necessary. If they are problematic, then a mood stabilizer suchSecond as glucose. Lithium might be considered. There is a smaller group of individuals
B eside the nurse's station? At the end of the hallway? Single Room/Private Room? C hain of infection/circumstance Nephrotic syndrome is characterized by massive proteinuria (looks D iagnosis dark and frothy) caused by glomerular damage. Corticosteroids the E are nviroment (dim light, darkened, red nightlapm) mainstay. Generalized edema common. Sample Test Item: The best roommate for patient with LEUKEMIA is A positive Western blot in a child <18 months (presence of HIV O 1 A 9-year-old with ruptured appendix antibodies) indicates only that the mother is infected. Two or more O 2 A 12-year-old with chicken pox positive p24 antigen tests will confirm HIV in kids <18 months. O The 3 A 2-year-old with fever of unknown origin p24 can be used at any age. O 4 A 5-year-old with nephrotic syndrome Correct Answer: 4. A 5-year-old with nephrotic syndrome. For HIV kids avoid OPV and Varicella vaccinations (live), but give 1,2 & 3, manifest symptoms of infection. A client with leukemia is Pneumococcal and influenza. MMR is avoided only if the kid isimmunosuppressed and Patients with infection shouldn't be placed in severely immunocompromised. Parents should wear gloves forthis care, room. Since patient with nephrotic syndrome receives diuretics a not kiss kids on the mouth, and not share eating utensils. steroids, this child will also need immunocompromised host precautio Never give potassium if the patient is oliguric or anuric.
Hypotension and vasoconstricting meds may alter the accuracy of o2 INFECTION CONTROL: sats. Sample Test Item: 3. Which of the following methods should the RN utilize in patient wit An antacid should be given to a mechanically ventilated patient w/ an SALMONELLA? ng tube if the ph of the aspirate is <5.0. Aspirate should be checked O 1atAirborne Precautions least every 12 hrs. O 2 Droplet Precautions O 3 Neutropenic Precautions Ambient air (room air) contains 21% oxygen. O 4 Enteric Precautions The correct answer: 4. The first sign of ARDS is increased respirations. Later comes dyspnea, Salmonella mode of transmission is fecal oral (enteric) retractions, air hunger, cyanosis. Handwashing Gloves must be used in handling bedpan and diapers Normal PCWP is 8-13. Readings of 18-20 are considered high. Gown - if soiling is likely to happen. Source of infection: First sign of PE (pulmonary embolism) is sudden chest pain, followed Contaminated food and water. by dyspnea and tachypnea. Remember - Transmission Based precautions: A ir High potassium is expected with carbon dioxide narcosis (hydrogen B orne, small particles are dispersed in the air like MTB, varicella floods the cell forcing potassium out). Carbon dioxide narcosisCcauses ontact, drug-resistant microorganisms increased intracranial pressure. D roplet, large particles are dispersed into air, resp.infections except resp syncytial Pulmonary sarcoidosis leads to right sided heart failure. E nteric, fecal-oral like hepaA & salmonella
An NG tube can be irrigated with cola, and should be taught toAGE family APPROPRIATE GROWTH AND DEVELOPMENT when a client is going home with an NG tube. (HOPPING WITH ONE LEG) Sample test Item: PRIORITY QUESTIONS (WHO TO SEE FIRST) 4. Which of the following is NOT a characteristic of a preschooler? Sample Test Item: O 1 predominantly "parallel play" period 1. Which of the following clients should the nurse deal with FIRST? O 2 balances on 1 foot with eyes closed o 1 A client who needs his daily vitamin O 3 skips on alternate feet o 2 A client who needs to be suctioned O 4 jumps rope o 3 A client who needs diaper to be changed The correct answer is: 1. Parallel play is more common in o 4 A client who is being prepared for discharge TODDLERS. Correct Answer: 2. A client who needs to be suctioned Preschooler (3-6 years) PRIORITY (Use ABC) Gross motor development Obstruction in the airway \u2013 secretions HOPS ON ONE (1) FOOT BY 4 YEARS Need to be suctioned SKIPS & HOPS ON ALTERNATE FEET BY 5 YEARS 2. Delegation, RN, LVN, UAP, CNA PLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, Which of the following clients should the LPN be assigned to? SUPERHEROES (Remember the movie: Jingle All The way!) o 1 A newly diagnosed patient with MYASTHENIC CRISIS FEAR: Intrusive procedures, venipunctures, IM injections, body o 2 An immediate post-op client in PACU mutilation o 3 A client awaiting medication for vitamins o 4 A new admission for KIDNEY Transplant Patient Toxoplasmosis, where else you can contract this (thinking of cat litter Correct Answer: 3-stable, A client awaiting medication for vitamins but it aint there) Myasthenic Crisis \u2013 Unstable, Acute Respiratory Failure Sample test Item: Immediate Post \u2013 op \u2013 Unstable, Risk for Complications, 5. To which of the following pregnant clients will be risk for Kidney Transplant \u2013 Unstable, needs assessment for rejection TOXOPLASMOSIS? DELEGATION: Remember the 5R's, Right Task, Right Person, Right Select all that apply: Circumstance, Right Communication & Right Feedback) O 1 A pregnant client who eat raw meat. RN Least stable, unstable, central catheters (hickman, broviac), O 2 A pregnant client handling cat litter of infected cats. admission, discharge, health teachings, patient for transfer, blood O 3 A pregnant client gardening and cultivating soil exposed to cat transfusion (2RNs) feces. LPN Technical Doer, Stable, medications, wound dressing O 4 A pregnant client with low rubella titer CNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VS O 5 A pregnant client who have undergone external radiation. UAP turning q2H, conducting group activities, ambulation O 6 A pregnant client with draining, painful vesicles in the external For future USRNs genitalia. This is for you... from the purkinje fibers of my heart.... The correct answers: 1, 2 & 3. Room Assignment(Who to Share Room with) TOXOPLASMOSIS Check: How do people get toxoplasmosis? A ge A Toxoplasma infection occurs by:
Accidentally swallowing cat feces from a Toxoplasma-infected (female: cat that 190 to 420 mg/dL) is shedding the organism in its feces. This might happen if you were to accidentally touch your hands Insulin to your mouth after gardening, (Regular, Humulin R) cleaning a cat's litter box, or Type: Fast acting touching anything that has come into contact with cat feces. Onset: \u00bd -1 hr Eating contaminated raw or partly cooked meat, especially pork, Peak: lamb, 2-4 hr or venison; Duration: 6-8 hr Insulin by touching your hands to your mouth after handling undercooked (NPH, Humulin N) meat. Type: Intermediate acting Contaminating food with knives, utensils, cutting boards and other Onset: 2hr foods that have had contact with raw meat. Peak: 6-12hr Drinking water contaminated with Toxoplasma. Duration 18-26hr Insulin Receiving an infected organ transplant or blood transfusion, though (Ultralente, this Humulin U) is rare. Type: Slow acting (From the internet-Division of Parasitic Disease) Onset: 4hr Which of these statements by the nurse is incorrect if the nurse Peak: has the 8-20hr goal to reinforce information about cancers to a group of young Duration: adults? 24-36hr Insulin 1. \u201cYou can reduce your risk of this serious type of stomach (Humulin cancer70/30) by eating lots of fruits and vegetables, limiting all meat, and avoiding Type: Combination nitrate-containing foods.\u201d Onset: \u00bd hr 2. \u201cProstate cancer is the most common cancer in American Peak: men 2-12hr with results to threaten sexuality and life.\u201d Duration: 24hr 3. \u201cColorectal cancer is the second-leading cause of cancer-related deaths in the United States.\u201d Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm 4. \u201cLung cancer is the leading cause of cancer deaths in Central the United Hg = too much fluid States. Yet it's the most preventable of all cancers. Need to memorize for Nclex
Tonometry: normal (10-21 mm Hg) PR Interval: normal (0.12-0.20 seconds) Serum Amylase: normal (25-151 units/dL) Serum Ammonia: normal (35 to 65 mcg/dL) Calcium: adult (8.6-10 mg/dL) child (8 to 10.5 mg/dL) term<1week (7 to 12 mg/dL)
Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL Magnesium: 1.5-2.5 mEq/L Chloride: 96-107 mEq/L Phosphorus: 2.7 to 4.5 mg/dL PR measurements: normal (0.12 to 0.20 second) QRS measurements: normal (0.04 to 0.10 second) Ammonia: 35 to 65 ug/dL Amylase:25 to 151 IV/L
Partial Thromboplastin Time (aPTT): normal (20-36 seconds) Lipase: 10 to 140 U/L therapeutic 1.5-2.5 Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3 seconds) Platelet Count: normal (150,000-400,000 cells/uL) Albumin level: normal (3.4 to 5 g/dL) Serum Osmolality: normal (285 to 295 mOsm/kg) high value indicates dehydration Safe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg) Serum Lithium: normal (1 to 1.5 mEq/L) acute mania (0.6 to 1.4 mEq/L) maintenance treatment Phenytoin (Dilantin): normal serum (10 to 20 mcg/mL) Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml) Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl)
Cholesterol: 140 to 199 mg/dL LDL: <130 mg/dL HDL: 30 to 70 mg/dL Triglycerides: <200 mg/dL Bilriubin \u2022 Direct: 0 to 0.3 mg/dL \u2022 Indirect: 0.1 to 1.0 mg/dL \u2022 Total: <1.5 mg/dL Protein: 6.0 to 8.0 g/dL Uric acid: Male 4.5 to 8 mg/dL Female 2.5 to 6.3 mg/dL Glycosylated Hemoglobin HbA1c: good control 7.5% or less Serum creatinine: 0.6 to 1.3 mg/dL
Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 BUN: 9-25 mg/dL Farenheit) Normal CK is 26-174 U/L WBC\u2019s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediate postpartum period, (maybe as high as Troponin I value: normal (<0.6 ng/mL) 25,000 to 30,000 cells/mm3) Troponin T >0.1 to 0.2 ng/mL = MI Stomach Capacity: Newborn infant (10 to 20 mL) 1-week-old (30 to 60 mL) 2-3-week-old infant (75 to 100 mL) 1-month-old infant (90 to 150 mL) Left Atrial Pressure: normal (1 to 10 mm Hg) Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and
Erythrocyte studies: 0-30 mm/hour Serum iron: Male 65-175 ug/dL Female 50-170 ug/dL RBC: Male 4.5 to 6.2 M/uL
Female 4.0 to 5.5 M/uL
Intimacy vs. isolation 25 – 50 Generativity vs. stagnation
Theophylline levels normal (10 to 20 mcg/dl)
MOTOR DEVELOPMENT Chin up 1 month Chest up 2 month Knee push and “swim” 6 month Sits alone/stands with help 7 month Crawls on stomach 8 month Stands holding on furniture 10 month Walks when led 11 month Stands alone 14 month Walks alone 15 month AT THE PLAY GROUND * * * * *
Stranger anxiety: 0 -1 year Separation anxiety: 1 - 3 years Solitary play: 0 – 1 year Parallel play: 2 – 3 years Group play: 3 – 4 years
PSYCHOLOGICAL DEVELOPMENT AGE ERIKSON FREUD PIAGET Infant 0 – 1.5 Trust vs. mistrust Oral (trust & dependence sensorimotor Toddler 1.5 -3 Autonomy vs. shame Anal (holding vs. letting out) preoperational Pre-school 3-6 Initiative vs. guilt Phallic (Oedipus complex) preoperational School age 6 - 11 Industry vs. inferiority latency Concrete operational 11 - 20 Identity vs. role confusion genital Formal operational 20 – 25
50 - ? Integrity vs.despair LABORATORY VALUES ELECTROLYTES Sodium (Na+): 135 – 145 meq/L (increase-dehydration; decrease overhydration) Potassium (K+): 3.5 - 5.0 meq/L Magnesium (Mg++): 1.5 – 2.5 meq/L Calcium (Ca++): 4.5 – 5.8 meq/L Neonate : 7.0 to 12 mg/dL Child: 8.0 to 10.5 mg/dL Phosphorus (PO4): 1.7 – 2.6 meq/L Chloride (Cl-): 96 – 106 meq/L COAGULATION STUDIES
Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used Prothrombin time(PT): male: 9.6 – 11.8 seconds Female: 9.5 – 11.3 seconds International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadi therapy 3.0 – 4.5 for high-dose Coumadin therapy Clotting time: 8 – 15 minutes Platelet count: 150,000 to 400,000 cells/Ul Bleeding time: 2.5 to 8 minutes SERUM GASTROINTESTINAL STUDIES Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 15 to 45 ug/dL Amylase: 50 – 180 Somogyi U/dL in adult 20 – 160 Somogyi U/dL in the older adult Bilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 – 1.0 mg/dL Total: less than 1.5 mg/dL Cholesterol: 120 – 200mg/dL Lipase: 31 -186 U/L Lipids: 400 – 800 mg/dL Triclycerides: Normal range: 10 – 190 mg/dL Borderline high: 200 – 400 mg/dL High: 400 – 1000mg/dL Very high: greater than 1000mg.dL Protien: 6.0 – 8.0 g/L Uric acid: male: 4.5 – 8 ng/dL Female: 2.5 – 6.2 ng/dL GLUCOSE STUDIES Fasting blood sugar: 70 – 105 mg/dL Glucose monitoring (capillary Blood): 60 – 110 mg/dL
RENAL FUNCTION TEST Creatinine: 0.6 – 1.3 mg/dL Blood urea nitrogen (BUN): 5 – 20 mg/dL ERYTROCYTES STUDIES
Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age Hemoglobin: male: 14 – 16.5 g/dL Female: 12 – 15 g/dL Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid
loss and dehydration) Female: 35% - 47% ( decreased in fluid retention) Red blood cell (RBC): male: 4.5 to 6.2 million/uL Female: 4 to 5.5 million/uL White blood cell (WBC): 4500 to 11,000/uL Erytrocyte Protoporthyrin (EP) : <9ug/dL Phenylalanine Level: <2 mg/dL PKU: >25 mg/dL CRANIAL NERVES MAJOR FUNCTIONS I. Olfactory (S) smell II. Optic (S) vision III. Oculomotor (M) IV. Trochlear (M) Eye movement V. Trigeminal (S-M) Facial sensation Jaw movement VI. Abducent (M) Eye movement VII. Facial (S-M) Taste Facial expression VIII. Acoustic (S) Hearing and balance
Decreased heart rate Bronchi dilation constriction GI tract Reduced motility Increased motility Rectum Allows filling Empties rectum Relaxes internal sphincter Bladder Allows filling Empties bladder Relaxes internal sphincter Erection Maintains erection Ejaculation Triggers ejaculation Pupils of eye Big (mydriasis) Small (miosis) Salivary glands Secretion Blood vessels Depends on receptors -a contrict -b dilates
IX. Glossopharyngeal (S-M) Taste Throat sensation Gag and swallow X. Vagus (S-M) Gag and swallow Parasympathetic activity XI. Spinal Accessory (M) Neck and back muscles XII. Hypoglossal (M) Tongue movement
FLOW OF BLOOD THROUGH THE HEART
Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle – pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle – aortic valve aorta – systemic circulation
CARDIAC IMPULSES On Old Olympus’ Towering Tops, A Finn And German Viewed Some Hops Sinoatrial (SA) node – right and left atria (atria contract) – Some Says Marry Money, But My Brother Says Bad Business Marry atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s Money fibers – ventricles contract. ARTERIAL BLOOD GAS (ABG) pH: 7.35 – 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base “RAMS”(Respiratory Alternate, Metabolic Same) GLASGOW COMA SCALE Eye opening response Motor response Verbal response AUTONOMIC NERVOUS SYSTEM SYMPATHETIC/ ADRENERGIC PARASYMPATHETIC/ CHOLINERGIC Heart Increased heart rate Increased conduction Increased force
Blood volume: 5000mL Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration) Pressure within the right atrium: 2 to 7 mmHg Capillary refill time: <3 seconds Normal sweat chloride: <40 mEq/L Normal pupil diameter: 3 to 5mm Normal ocular pressure: 10 to 21 mmHg Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg Normal cardiac output : 4 to 8 L/min. THERAPEUTIC SERUM MEDICATION LEVELS Acetaminopen (Tylenol) 10 – 20 ug/mL Amikacin (Amikin) 25 – 30 ug/mL Amitryptyline (Elavil) 120 -150 ng/mL Carbamazepine (Tegretol) 5 -12 ug/mL Chloramphenicol (Chloromycetin) 10 – 20 ug/mL Desipramine (Norpramin) 150 -300 ng/mL Digotoxin ( Crystodigin) 15- 25 ng/mL Digoxin ( Lanoxin) 0.5 – 2.0 ng/mL Disopyramide (Norpase) 2 -5 ug/mL Ethosuximide ( Zarontin) 40 – 100 ug/mL Gentamycin (Garamycin) 5 – 10 ug/mL
Imipramide (Tofranil) 150 – 300 ug/mL Lidocaine (Xylocaine) 1.5 – 5.0 ug/mL Lithium (Lithobid) 0.5 -1.5 ug/mL Magnesium sulphate 4 -7 mg/dL Nortriptyline (Aventyl) 50 – 150 ng/mL Phenobarbital (Luminal) 10 – 30 ug/mL Phenytoin (Dilantin) 10 -20 ug/mL Primidone (Myoline) 5 – 20 ug/mL Procainamide (Pronestryl) 4 – 10 ug/mL Propranolol (Inderal) 50 – 100 ng/mL Quinidine (Quinalaglute, Cardioquin) 2 – 5ug/mL Salisylate 100 -250 ug/mL Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL Tobramycin (Nebcin ) 5 -10 ug/mL Valproic acid (depakene) 50 -100 ug/mL
A
Formulas for Intravenous Calculations Flow Rates: Total volume x gtt factor = gtt per min Time in minutes Infusion Time: Total volume to infuse = Infusion time mL per hour being infused IMMUNIZATION
Birth Hepatitis B 1 months Hepatitis B 2 months OPV, DPT, HIB 4 months DPT, HIB, OPV Pulmonary capillary wedge pressure: 5 to 13 mmHg 6 months DPT, HIB, hepatitis B Pulmonary artery pressure: systolic: 16 to 30 mmHg 12 months HIB, OPV Diastolic: 0 to 7 mmHg 15 months MMR Spinal pressure: 70 to 200mmH2O 18 months DPT Morphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour 12 – 18 months Varicella vaccine 4 -6 years DPT, OPV, MMR 11 – 12 years MMR ( if not administered at 4 -6 years) SULFONYLUREAS 11 – 16 TD booster For treatment of NIDDM Sulfonylureas should not be given to patients with liver or kidney failure. SPINAL CORD INJURY Accummulation of drug will increase risk of hypoglycaemia. Cervical Injury: C2 to C3 injury usually fatal C4 is the major innervation to the diaphragm by th phrenic nerve Involvement above th C4 causes respiratory difficulty and DURATION paralysis of all the four extremities tolbutamide C5 or below client may have movement in the shoulder 8h Thoracic Level Injury: Glycburide, glipizide loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury 20 h, most potent Leg paralysis (paraplegia) Autonomic dysreflexia with lesions above T6 and in cervical chlorpropamide 48 h lesions Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, na Apothecary and Household System stuffiness, and gooseflesh Grain –gr 1 gr = 60 mg Dram – dr 5 gr = 300 mg Ounce –oz 15 gr = 1000mg or 1g Minim – min, M, m 1/150 gr =0.4 mg Quart – qt 1 oz = 30 mL Pint – pt 1 dr = 4 mL Drop – gtt 1 T = 15 mL or 3 tsp Tablespoon – T or tbs 1 min = 1 gtt Teaspoon – t or tsp 15 min = 1mL Pound – lb 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kg Fahrenheit to Celcius (F – 32) divide 1.8 = C
Lumbar and Sacral Level Injuries: loss of movement and sensation of the lower extremities. S2 and S3 center on micturation; therefore below this level, the bladder will contract but not empty (neurogenic bladder) Injury above S2 in males allows them to have an erection, but they are unable to ejaculate because of sympathetic nerve damage. Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection and ejaculation. RULE OF NINE Head and neck 9% Anterior trunk 18% Posterior trunk 18% Arms (9%) 18% Legs (18%) 36% Perineum 1%
Celcius to Fahrenheit 1.8 C + 32 = F Formula for Calculating a Medication Dosage D (desired ) = the dosage that the physician ordered A (available) =the dosage strength as stated on the medication label Q (quantity ) = the volume that the dosage strength is available in, such NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL as tablet, capsules, or mL DXQ=X
Neutrophils 56% or 18000 – 7800/uL
Bands 3% or 0 – 700/uL Eosinophils 2.7% or 0 – 450/uL Basophils 0.3% or 0 – 200/uL Lymphocytes 34% or 1000 – 4800/uL Monocytes 4% or 0 – 800/uL
Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders Hawtorn ( Crategus species) – CHF and related cardiovascular conditions Horebound (Marribium vulgare) – primary cough suppression and expectoration Horse Chestnut Seed (Aesculus hippocastanum) chronic venous THYROID STUDIES insufficiency Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease Thyroxine (T4): 5.0 to 12.0 ug/dL Kava ( piper methysticum) – mild psychoactive and antianxiety Thyroxine free (FT3) : 0.8 to 2.4 ng/dL property Triiodothyronine (T3): 80 to 230 ng/dL Lemon Balm (Melissa officinalis) – sedative and for dyspepsia Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and infections Melatonin – insomia, jet lag Normal Fribrinogen level: for men: 180 to 340mg/dL Milk Thistle – hepatitis, liver desease Women: 190 to 420mg/dL Mints (Mentha species) – minor calcium channel antagonists, used fo Fribrinogen is used up in the clotting process. upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritant Erythrocyte Protoporhyrin (EP): < 9ug/dL Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic Phenylalanine level: < 2mg/dL Papaya (Carica papaya) – digestive aid, dyspepsia, and for PKU: >25 mg/dL inflammatory, topically applied to wounds Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic Passion diabetes insipidus herb Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre Pokeroot (Phytolacca Americana) – inflammatory conditions also as an syndrome emetic/cathartic Normal CSF pressure: 5 – 15 mmHg Pygeum (Pygeum africanum) – mild symptoms of BPH Normal serum osmolality: 285 – 295 mOsmlkgH2O increase inRed Clover (Trifolium pratense) – used as a natural estrogen substitu dehydration; for women’s health Decrease in over hydration St. John’s Wort (Hypericum perforatum) – antidepressant effect Normal scalp pH: 7.26 and above Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial Borderline acidosis: 7.20 to 7.25 Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti Acidosis: < 7.15 cancer, and antioxidant Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic Yohimbe – erectile dysfunction
FOUR STRATEGIES: 1. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would Aloe vera Gel – abrasionsand dermatologic conditions next? American Ginseng (Panax quinquefolius) – boost energy, relievebe stress, 2. If the question asks what the client needs. Use maslow’s hierarchy to improve concentration and enhance physical or cognitive performance. determine which need to address. Ashwagandha (Withania somnifera) – stress arthritis 3. If the question indicates that the client doesn’t have urgent Asian gingseng (Panax ginseng) – enhance health and combat stress physiologic need, focus on the patient safety. and disease Bilberry (Vaccinium myrtillus) – vision and peripheral vascular 4. If the question involves communicating with a patient. Use principles of therapeutic communication. disorders and as antioxidant Black Cohosh (Cimicifuga racemosa) – menopausal REMEMBER: Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS) anti-inflammatory, rheumatoid arthritis Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment The nurse in primary care clinic is caring for a 50-year-old woman. Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, History reveals that she had experienced on and off chest pain. After colic, or dyspepsia and anxiety Chaste tree (Vitex agnus-castus) – menstrual related disorders,series PMS, of cardiac tests (EKG & Blood Chem), the doctor orders for THALLIUM STRESS TEST. Which of the following medications cyclical mastalgia should the RN prepare if the patient needs an alternative exercise in Chodroitin – osteoarthritis thallium test? Coenzyme Q10 – antioxidant 1.Nitroglycerin Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders 2.Morphine Cranberry (Vaccinium macrocarpon) – UTI 3.Aminophylline Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and 4.Persantin analgesic The correct answer is #4. Persantin (dipyridamole) Echinacea (Echinacea spp.) – acute viral URI symptoms Persantin is use as an alternative to exercise in thallium myocardial Ederberry (Sanbacus nigra) – respiratory tract infection perfusion imaging for the evaluation of CAD in those who cannot Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and exercise adequately. pseudoephedrine Purpose: to determine myocardial wall viability Evening Primrose Oil (Oenothera biennis) – eczema, breast pain Other names: associated with PMS and inflammatory condition 1. Cardiac pooling Fenugreek (Trigonella foenum-graecum) – lowering blood glucose 2. MUGA-multigated radionuclide angiographic scanning Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis 3. nurclear scan Garlic (Allium sativaum)- help prevent cardiovascular disease and 4. sestamibi test cancer Ginger (Zingiber officinale) –nausea and motion sickness, anti- 5. thallium scan 6. dipyridamole or persantin stress test inflammatory 7. In short, heart scan :) Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitus Loving NCLEX-RN URC Glucosamine – osteoarthritis 09178364589 Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic HERBAL MEDICINE
Posted by Anaski from IP 203.131.183.186 on August 23, 2005 M at-marplan N-nardil 21:44:00: P-parnate For Future USRN's: Cervical Cancer Etiology: Hypertensive crisis within several hours of ingestion of tyramine * Early age of sexual intercourse containing foods * Multiple sexual partners Tyramine foods: * Sexually Transmitted Disease (Venereal Wart) aged cheese, beer, ale, red wine, pickled foods, smoked or pickled fish * Virus - HPV beef or chopped liver, avocado of figs. Cancer Carcinoma in SITU - only in epithelial linings Situ sounds like Ziru - Stage 0 ANTI-DEPRSSION Tumor marker - CEA Signs and Symptoms (3 P's) A- asendin POST COITAL BLEEDING N-norpramin T- tofranil PAINFUL INTERCOURSE S-sinequan PROFUSE (PERIOD IRREGULARITIEs - menorrhagia and A-anafranil metrorrhagia) - aventyl V-vivactil Management: E-Elavil P-paxil U - pera (Surgery HYSTERECTOMY) Z-zoloft R - radiation (intracavitary cessium - remember STD - shielding, timing and distance)) C - chemotherapy to destroy the DNA,RNA & CHON synthesis.D-riving is contraindicated E-ffect has a delayed onset of 7-21 days P-regnancy consult with your physician R-elieves symptoms but never cure Psychiatric Drugs E- valuate vital sign S-toppind drug abruptly is Out! ANTI PARKINSON'S S-afety measures I-nstruct to report undesirable side effect C- cogentin O-bserve for suicidal tendencies A- artane N-o alcohol or CNS depressants P- parlodel A- akineton ANTI-MANIC DRUGS B- benadryl L- larodopa Lithium- Eskalith E- Eldepryl S- symmetril Increase risk of toxicity when given with: thiazide diuretics, methyldopa, and NSAIDs Increase protein and give B6 Decrease lithium levels with excess sodium and antacids. Akathisia Increase CNS toxicity with Haloperidol Dystonia Tardive Dysinesia 0.6-1.2 -meq/l Therapeutic Effect Neuroleptic Malignant Syndrome > 1.5 meq/l Toxic 2.0 meq/l lethal ANTI-ANXIETY L- evel - therapeutic 0.6-1.2 meq/l I-ncreased Urination V-valium T-hirst Increased L-librium H-eadaches and Tremors A-ativan I-ncreased fluids S-serax U-nsteady T-tranxene M-orton's Salt -adequate intake M-miltown E- equanil V-vistaril Hepatotoxic Drugs ( liver) A-taxene I-Inderal * ACE inhibitors B-buspar * acetaminophen * alcohol * iron overdose * erythromycins A- void abrupt discontinuation after prolonged use * estrogens N- Not give if BP is up, hepatic/renal dysfunction or history of drug * fluconazole (Difulcan) abuse * isoanazid (INH) X-xanax, ativan, serax is also an anti-anxiety meds * itraconazole (Sporanox) I-increase in 3D's- drowsiness, dizziness, decreased BP * phenothiazines Enhances action of GABA * phenytoin (Dilantin) T-teach client to rise slowly from supine position * rifampin (Rifadin) Y-es alcohol should also be avoided. * sulfonamids Tolerance develop until seven days
MAOI Drugs
CRCL = creatinine clearance CRF = chronic renal failure • acetaminophen (high doses, acute) CRT = capillary refill time * acyclovir; parenteral (zovirax) CSF = cerebrospinal fluid * aminoglycocides CT = computerized tomography * amphotericin B CVA = cerebral vascular accident, costovertebral angle * ciprofloxacin CVP = central venous pressure * cisplatin (platinol) D5W = 5% dextrose in water * methotrexate (high doses) DAT = diet as tolerated * nonsteriodal anti-inflamatory drugs (NSAIDS) DC = (dc) discontinue * rifampicin DIC = disseminated intravascular coagulopathy * sulfonamides DKA = diabetic ketoacidosis * tetracyclines ( exceptions are doxycycline and minocycline) DM = diabetes mellitus * vancomycin DNA = deoxyribonucleic acid DNR = do not resuscitate • DOA = dead on arrival DOE = dyspnea on exertion Basic Nursing Abbreviations DPT = diphtheria, pertussis, tetanus A /G = albumin/globulin ratio DTR = deep tendon reflexes ABG = arterial blood gases DVT = deep venous thrombosis AC = before eating DX = diagnosis ACE = angiotensin converting enzyme EAA = essential amino acids ACL = anterior cruciate ligament EBL = estimated blood loss ACLS = advanced cardiac life support EBV = Epstein-Barr Virus ACTH = adrenocorticotropic hormone ECF = extracellular fluid, extended care facility ad lib = as much as needed ECG = electrocardiogram ADH = anti-diuretic hormone ECT = electroconvulsive therapy ADL = activities of daily living EENT = eye, ear, nose and throat AFB = acid-fast bacilli EFAD = essential fatty acid deficiency AFP = alpha-fetoprotein EMG = electromyogram AGA = appropriate for gestational age EMV = eyes, motor, verbal response (Glasgow coma scale) AI = aortic insufficiency ENT = ears, nose, and throat AIDS = acquired immune deficiency syndrome EOM = extraocular muscles AKA = above knee amputation ESR = erythrocyte sedimentation rate ALD = alcoholic liver disease ESRD = end stage renal disease ALL = acute lymphocytic leukemia ET = endotracheal tube ALP = alkaline phosphatase ETT = endotracheal tube ALT = alanine transaminase, alanine aminotransferase EUA = examination under anesthesia ATN = acute tubular necrosis FBS = fasting blood sugar AU = both ears FDA = Food & Drug Administration AV = atrioventricular FEV = forced expiratory volume B.S. = Bachelor of Science FFP = fresh frozen plasma B/K = below knee FNP = Family Nurse Practitioner BM = bowel movement or breast milk GB = gallbladder BX = biopsy GC = gonorrhea c = with GERD = gastroesophageal reflux disease C/O = complaining of GFR = glomerular filtration rate CA = calcium, cancer, carcinoma GI = gastrointestinal CAA = crystalline amino acids GSW = gun shot wound CABG = coronary artery bypass graft GTT = glucose tolerance test CAD = coronary artery disease GU = genitourinary CAPD = continuous ambulatory peritoneal dialysis HB = hemoglobin CAT = computerized axial tomography HBP = high blood pressure CBC = complete blood count HCG = human chorionic gonadotropin CBD = common bile duct HCO3 = bicarbonate CBG = capillary blood gas HCT = hematocrit CBI = continuous bladder irrigation HD = hemodialysis CBS = capillary blood sugar HDL = high density lipoprotein CC = chief complaint HEENT = head, eyes, ears, nose, throat CCK = cholecystokinin CCPD = continuous cyclic peritoneal dialysis CCU = clean catch urine or cardiac care unit Caring for the Patient on a Ventilator CCV = critical closing volume CF = cystic fibrosis The nurse must be able to do the following: CHF = congestive heart failure CHO = carbohydrate 1. Identify the indications for mechanical ventilation. CI = cardiac index 2. List the steps in preparing a patient for intubation. CLT = Clinical Laboratory Technician 3. Determine the FIO2, tidal volume, rate and mode of ventilation on a CML = chronic myelogenous leukemia given CN = cranial nerves ventilator. CNS = central nervous system 4. Describe the various modes of ventilation and their implications. CO = cardiac output 5. Describe at least two complications associated with patient’s COPD = chronic obstructive pulmonary disease response to mechanical ventilation and their signs and symptoms. CP = chest pain, cleft palate 6. Describe the causes and nursing measures taken when troubleCPD = cephalo-pelvic disproportion shooting ventilator alarms. CPK = creatinine phosphokinase 7. Describe preventative measures aimed at preventing selected other CPP = cerebral perfusion pressure complications related to endotracheal intubation. CPR = cardiopulmonary resuscitation Drugs That Can Cause Nephrotoxicity
8. Give rationale for selected nursing interventions in the plan2. ofSymptoms care – may result in pneumothorax, pneumomediastinum, for the ventilated patient. pneumoperitoneum, or subcutaneous emphysema. 9. Complete the care of the ventilated patient checklist. 3. Treatment - aimed at reducing TV, cautious use of PEEP, and 10. Complete the suctioning checklist. avoidance of high airway pressures resulting in development of autoPEEP in high risk patients (patients with obstructive lung diseases 1. To review indications for and basic modes of mechanical ventilation, (asthma, bronchospasm), unevenly distributed lung diseases (lobar possible complications that can occur, and nursing observations and pneumonia), or hyperinflated lungs (emphysema). procedures to detect and/or prevent such complications. 2. To provide a systematic nursing assessment procedure to ensure C. Nosocomial Pneumonia early detection of complications associated with mechanical 1. Cause – invasive device in critically ill patients becomes colonized ventilation. with pathological bacteria within 24 hours in almost all patients. 2060% of these, develop nosocomial pneumonia. Indication for Intubation 2. Treatment – aimed at prevention by the following: 1. Acute respiratory failure evidenced by the lungs inability to maintain Avoid cross-contamination by frequent handwashing arterial oxygenation or eliminate carbon dioxide leading to tissue Decrease risk of aspiration (cuff occlusion of trachea, positioning, use hypoxia in spite of low-flow or high-flow oxygen delivery devices. of small-bore NG tubes) (Impaired gas exchange, airway obstruction or ventilation-perfusion Suction only when clinically indicated, using sterile technique abnormalities). Maintain closed system setup on ventilator circuitry and avoid poolin 2. In a patient with previously normal ABGs, the ABG results will as ofbe condensation in the tubing follows: Ensure adequate nutrition PaO2 > 50 mm Hg with pH < 7.25 Avoid neutralization of gastric contents with antacids and H2 blocker PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, D. Positive Water Balance anxiety, tachypnea, tachycardia, and diaphoresis 1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), vagal stretch receptors in right atrium sensing a decrease in venous cyanosis (late), and LOC (late) 3. Neuromuscular or neurogenic loss of respiratory regulation. return and see it as hypovolemia, leading to a release of ADH from th posterior pituitary gland and retention of sodium and water. Treatme (Impaired ventilation) aimed at decreasing fluid intake. 4. Usual reasons for intubation: Airway maintenance, Secretioniscontrol, 2. Decrease of normal insensible water loss due to closed ventilator Oxygenation and Ventilation. circuit preventing water loss from lungs. This fluid overload evidence Types of intubation: Orotracheal, Nasotracheal, Tracheostomyby decreased urine specific gravity, dilutional hyponatremia, increase Preparing for Intubation heart rate and BP. 1. Recognize the need for intubation. E. Decreased Renal Perfusion – can be treated with low dose dopami 2. Notify physician and respiratory therapist. Ensure consent obtained therapy. if not emergency. 3. Gather all necessary equipment: F. Increased Intracranial Pressure (ICP) – reduce PEEP a. Suction canister with regulator and connecting tubing b. Sterile 14 Fr. suction catheter or closed in-line suction catheter G. Hepatic congestion – reduce PEEP c. Sterile gloves d. Normal saline H. Worsening of intracardiac shunts –reduce PEEP e. Yankuer suction-tip catheter and nasogastric tube f. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, Water soluble lubricant, 2. Associated with ventilator malfunction: A. Alarms turned off or nonfunctional – may lead to apnea and Cetacaine spray respiratory arrest g. Endotracheal attachment device (E-tad) or tape Troubleshooting Ventilator Alarms h. Get order for initial ventilator settings Low exhaled volume: Cuff leak, Tubing disconnect, Patient i. Sedation prn disconnected j. Soft wrist restraints prn k. Call for chest x-ray to confirm position of endotracheal tube Evaluate cuff; reinflate prn; if ruptured, tube will need to be replaced connections; tighten or replace as needed; check ETT l. Provide emotional support as needed/ ensure family notified Evaluate of placement, Reconnect to ventilator change in condition. High pressure: Secretions in airway, Patient biting tubing, Tube kinke Intubation Cuff herniation, Increased airway resistance/decreased lung complia (caused by bronchospasm, right mainstem bronchus intubation, Types of Ventilators pneumothorax, pneumonia), Patient coughing and/or fighting the Ventilator Settings ventilator; anxiety; fear; pain. Modes of Mechanical Ventilation Suction patient, Insert bite block, Reposition patient’s head/neck; che Complications of Mechanical Ventilation all tubing lengths, Deflate and reinflate cuff, Auscultate breath sound 1. Associated with patient’s response to mechanical ventilation:Evaluate compliance and tube position; stabilize tube, Explain all procedures to patient in calm, reassuring manner, Sedate/medicate a A. Decreased Cardiac Output necessar 1. Cause - venous return to the right atrium impeded by the Low oxygen pressure: Oxygen malfunction dramatically increased intrathoracic pressures during inspiration from Disconnect patient from ventilator; manually bag with ambu; call R.T positive pressure ventilation. Also reduced sympatho-adrenal 3. Other stimulation leading to a decrease in peripheral vascular resistance and complications related to endotracheal intubation. A. Sinusitis and nasal injury – obstruction of paranasal sinus drainag reduced blood pressure. necrosis of nares 2. Symptoms – increased heart rate, decreased blood pressurepressure and 1. Prevention: avoid nasal intubations; cushion nares from tube and perfusion to vital organs, decreased CVP, and cool clammy skin. tape/ties. 3. Treatment – aimed at increasing preload (e.g. fluid administration) 2. Treatment: remove all tubes from nasal passages; administer and decreasing the airway pressures exerted during mechanical antibiotics. ventilation by decreasing inspiratory flow rates and TV, or using other methods to decrease airway pressures (e.g. different modes ofB. Tracheoesophageal fistula – pressure necrosis of posterior trachea wall resulting from overinflated cuff and rigid nasogastric tube ventilation). 1. Prevention: inflate cuff with minimal amount of air necessary; B. Barotrauma monitor cuff pressures q. 8 h. 1. Cause – damage to pulmonary system due to alveolar rupture 2. from Treatment: position cuff of tube distal to fistula; place gastrostomy excessive airway pressures and/or overdistention of alveoli. tube for enteral feedings; place esophageal tube for secretion cleara
proximal to fistula. These signs may indicate hypoxia. C. Mucosal lesions – pressure at tube and mucosal interface . Observe skin color and capillary refill. 1. Prevention: Inflate cuff with minimal amount of air necessary; Determine adequacy of blood flow needed to carry oxygen to tissues. monitor cuff pressure q. 8 h.; use appropriate size tube. . 2. Treatment: may resolve spontaneously; perform surgical Monitor CBC. interventions. Indicates the oxygen carrying capacity available. D. Laryngeal or tracheal stenosis – injury to area from end of tube or cuff, resulting in scar tissue formation and narrowing of airway. Administer oxygen as ordered. 1. Prevention: inflate cuff with minimal amount of air necessary; Decreases work of breathing and supplies supplemental oxygen. monitor cuff pressure q. 8.h.; suction area above cuff frequently. . 2. Treatment: perform tracheostomy; place laryngeal stint; perform Observe for tube obstruction; suction prn; ensure adequate surgical repair. humidification. E. Cricoid abcess – mucosal injury with bacterial invasion May result in inadequate ventilation or mucous plug. 1. Prevention: inflate cuff with minimal amount of air necessary; . monitor cuff pressure q. 8 h.; suction area above cuff frequently. Reposition patient q. 1-2 h. 2. Treatment: perform incision and drainage of area; administer Repositioning helps all lobes of the lung to be adequately perfused an antibiotics. ventilated. 4. Other common potential problems related to mechanical ventilation: Aspiration, GI bleeding, Inappropriate ventilation (respiratory Potential acidosis altered nutritional status: less than body requirements r/t N or alkalosis, Thick secretions, Patient discomfort due to pullingstatus or Monitor lymphocytes and albumin. jarring of ETT or tracheostomy, High PaO2, Low PaO2, Anxiety and Indicates adequate visceral protein. fear, Dysrhythmias or vagal reactions during or after suctioning, Incorrect PEEP setting, Inability to tolerate ventilator mode. . Provide nutrition as ordered, e.g. TPN, lipids or enteral feedings. PLAN OF CARE FOR THE VENTILATED PATIENT Calories, minerals, vitamins, and protein are needed for energy and Patient Goals: tissue repair. Patient will have effective breathing pattern. . Obtain nutrition consult. Patient will have adequate gas exchange. Provides guidance and continued surveillance. Patient’s nutritional status will be maintained to meet body needs. Potential for pulmonary infection r/t compromised tissue integrity. Patient will not develop a pulmonary infection. Secure airway and support ventialtor tubing. Patient will not develop problems related to immobility. mucosal damage. Patient and/or family will indicate understanding of the purposePrevent for . mechanical ventilation. Provide good oral care q. 4 h.; suction when need indicated using Nursing Diagnosis sterile technique; handwashing with antimicrobial for 30 seconds Nursing Interventions before and after patient contact; do not empty condensation in tubin Rationale back into cascade. Ineffective breathing pattern r/t ____________________________. Measures aimed at prevention of nosocomial infections. Observe changes in respiratory rate and depth; observe for SOB . and Use disposable saline irrigation units to rinse in-line suction; ensure use of accessory muscles. An increase in the work of breathing will add to fatigue; may indicate ventilator tubing changed q. 7 days, in-line suction changed q. 24 h.; patient fighting ventilator. ambu bags changes between patients and whenever become soiled. . IAW Infection Control Policy and Respiratory Therapy Standards of Observe for tube misplacement- note and post cm. Marking atCare for CCNS. lip/teeth/nares after x-ray confirmation and q. 2 h. Potential for complications r/t immobility. Indicates correct position to provide adequate ventilation. Assess for psychosocial alterations. . Dependency on ventilator with increased anxiety when weaning; Prevent accidental extubation by taping tube securely, checking q.2h.; ability to communicate; social isolation/alteration in family decreased restraining/sedating as needed. dynamics. Avoid trauma from accidental extubation, prevent inadequate . ventilation and potential respiratory arrest. Assess for GI problems. Preventative measures include relieving anxiety, antacids or H2 receptor antagonist therapy, adequate sleep . cycles, adequate communication system. Inspect thorax for symmetry of movement. Determines adequacy of breathing pattern; asymmetry may indicate Most serious is stress ulcer. May develop constipation. hemothorax or pneumothorax. . Observe skin integrity for pressure ulcers; preventative measures . Measure tidal volume and vital capacity. include turning patient at least q. 2 h.; keep HOB < 30 degrees with Indicates volume of air moving in and out of lungs. 30 degree side-lying position; use pressure relief mattress or turning . bed if indicated; follow prevention of pressure ulcers plan of care; Asses for pain maintain nutritional needs. Pain may prevent patient from coughing and deep breathing. Patient is at high risk for developing pressure ulcers due to immobili . and decreased tissue perfusion. Monitor chest x-rays . Shows extent and location of fluid or infiltrates in lungs. Maintain muscle strength with active/active-assistive/passive ROM a . prevent contractures with use of span-aids or splints. Maintain ventilator settings as ordered. Patient is at risk for developing contractures due to immobility, use o Ventilator provides adequate ventilator pattern for the patient.paralytics and ventilator related deficiencies. . Knowledge deficit r/t intubation and mechanical ventilation Elevate head of bed 60-90 degrees. Explain purpose/mode/and all treatments; encourage patient to relax This position moves the abdominal contents away from the diaphragm, and breath with the ventilator; explain alarms; teach importance of d which facilitates its contraction. breathing; provide alternate method of communication; keep call bel within reach; keep informed of results of studies/progress; demonstra Impaired gas exchange r/t alveolar-capillary membrane changes confidence. Monitor ABG’s. Reduce anxiety, gain cooperation and participation in plan of care. Determines acid-base balance and need for oxygen. . Assess LOC, listlessness, and irritability.
Common Syndromes
* Red rash followed by desquamation
DOWN SYNDROME: Trisomy 21. Mental retardation, characteristic facial features, Simeon CARPAL-TUNNEL SYNDROME: Compression of Median Nerve crease in hand. through the Carpal Tunnel - pain and parasthesia over distribution of Median N. MARFAN SYNDROME: Connective Tissue disorder * Arachnodactyly: Abnormally long digits and extremities * Subluxation of lens * Dissecting aortic aneurism SUDDEN INFANT DEATH SYNDROME: Unexplained death in sleeping infants. TURNER'S SYNDROME: XO monosomy. * Dwarfism * Webbed neck * Valgus of elbow. * Amenorrhea
HORNER'S SYNDROME: Loss or lesion of cervical sympathetic ganglion * Ptosis, miosis, anhydrosis * Enophthalmos (caved in eyes) KORSAKOFF SYNDROME: Loss of short-term memory in chronic alcoholism, caused by degeneration of mamillary bodies.
MALABSORPTION SYNDROME: Impaired absorption of dietary substance - diarrhea, weakness, weight loss, or symptoms from speci deficiencies.
RESTLESS LEGS SYNDROME: Need to stretch legs at night before WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading going to sleep; twitch in legs causing insomnia. to buildup of copper mental retardation, cirrhosis, hepatolenticular degeneration. Herbal Plants
AMENNORRHEA-GALACTORRHEA SYNDROME: Non1) ALOE VERA physiologic lactation, resulting from endocrinologic causes or from a Aloe vera syn. A. barbadensis (Liliaceae) pituitary disorder. The clear gel found inside the plant's leaf contains aloin, are both use for medicinal and cosmetic purposes. It is a effective healer of wound and burns, speeding up the rate of healing and reducing the risk of CUSHING'S SYNDROME: Hypersecretion of cortisol secondary infection. The brownish part containing aloin is a strong laxative, symptoms and characteristics: useful for short-term constipation. Aloe is present in many cosmetic's * Fatness of face and trunk with wasting of extremities formulae because its emollient and scar preventing properties. * Buffalo hump * Bone decalacification MAIN PROPERTIES: Heals wounds, emollient, laxative. * Corticoid diabetes * Hypertension 2) ANGELICA Angelica arcangelica (Umbelliferae) Angelica has been used to reduce muscular spasms in asthma and PREMENSTRUAL SYNDROME: Abnormal sensation in breasts, bronchitis. It has also been shown to ease rheumatic inflammation, to abdominal pain, thirst, headache, pelvic congestion, nervous irritability. regulate menstrual flow and as an appetite stimulant. The stems are candied for culinary use. Ocassionally nausea and vomiting. MAIN PROPERTIES: Antispasmodic, promotes menstrual flow.
GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown 3) ANISE cause. Pimpinella anisum (Umbelliferae) It has been used as a flavoring spice in recipes and as a diuretic, to tr digestive problems and to relieve toothache. Anise seeds are known f REYE'S SYNDROME: Loss of consciousness and seizures in kids, their ability to reduce flatulence and colic, to settle the digestion, to after a viral infection treated by aspirin. relieve colic, and to ease nausea and indigestion. It also has an expectorant and antispasmodics action that is helpful in countering period pain, asthma, whooping cough and bronchitis. The mild REITER'S SYNDROME: Symptom cluster. Etiology is thought to be hormonal action of anise seeds may explain its ability to increase Chlamydial or post-chlamydial. breast-milk production and its reputation for easing childbirth and Urethritis treating impotence and frigidity. Anise essential oil is used externally Iridocyclitis (Conjunctivitis) treat lice and scabies. Arthritis Skin lesions like karatoderma blenorrhagicum MAIN PROPERTIES: Reduces colic and flatulence, promotes Also can see fatty liver or liver necrosis. digestion, antispasmodic STEVENS-JOHNSON SYNDROME: Erythema Multiforme complication. Large areas of skin slough, including mouth and anogenital membranes. Mucous membranes: stomatitis, urethritis, conjunctivitis. Headache, fever, malaise.
4) ARNICA Arnica montana (Compositae) Arnica improves the local blood supply and accelerates healing. It is anti-inflammatory and increases the rate of re-absorption of internal bleeding. The internal use of arnica is restricted to homeopathic dosages as it is potentially toxic.
MAIN PROPERTIES: Anti-inflammatory, germicide, muscular soreness, pain reliever. TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons. Infection with Staph Aureus and subsequent toxicity of exotoxin TSST 5) ARROWROOT systemic anaphylaxis. Maranta arundinacea (Marantaceae) * Fever, vomiting, diarrhea
Its root is used as a poultice for smallpox sores, and as an infusiondistillates for are used extensively in perfumery. Orange flower water is a urinary infections. It helps to relieve acidity, indigestion and colic, by-product and of distillation and is used in perfumery and to flavor sweets is mildly laxative. It may be applied as an ointment or poultice mixed and biscuits, as well as being used medicinally to reduce heart rate and with some other antiseptic herbs such as comfrey. palpitations, to encourage sleep and calm the digestive tract.
MAIN PROPERTIES: Anti-inflammatory, digestive, antiseptic. MAIN PROPERTIES: Anti-inflammatory, antifungal, antibacterial, digestive. 6) ARTEMISIA, WORMWOOD Artemisia absinthium (Compositae) 12) BOLDO Wormwood has a marked tonic effect on the stomach, the gallbladder Peumus boldus (Umbelliferae) and in adjusting weak digestive problems. It is used to expel It activates the secretion of saliva and gastric juices. Boldine, one of roundworms and threadworms. By improving the functions of constituents, the induces the flow of bile as well as the total amount of digestive system it helps in many conditions, including anaemia. It isthat it excretes. Its protective action over the hepatic cells has solids also a muscle relaxant occasionally used to treat rheumatism. been The demonstrated "in vitro" and "in vivo". Boldo stimulates liver leaves of wormwood have antiseptic properties which may derive fromand bile flow and is chiefly valued as a remedy for gallstones activity the azulenes that the plant contains. and liver or gallbladder pain. It is normally taken for a few weeks at time, either as a tincture or infusion. Boldo also has antiseptic MAIN PROPERTIES: Bitter, carminative, muscle relaxant, antiseptic. properties which help in combating cystitis.
7) BASIL, HOLY BASIL MAIN PROPERTIES: Bile and liver activity stimulant, digestive. Ocimum sanctum (Labiatae) The herb has very important medicinal properties - notably its 13) ability to CALENDULA, MARIGOLD reduce blood sugar levels. It also prevents peptic ulcers and other stress officinallis (Compositae) Calendula related conditions like hypertension, colitis and asthma. Basil is also Marigold is one of the best herbs for treating local skin problems. used to treat cold and reduce fever, congestion and joint pain. Infusions Due to itsor decoctions of Calendula petals decrease the inflammatio anti-bacterial and fungicide action, basil leaves are used on itching of sprains, stings, varicose veins and other swellings and also soothes skin, insect biting and skin affections. burns, sunburns, rashes and skin irritations. These remedies are excellent for inflamed and bruised skin, their antiseptic and healing MAIN PROPERTIES: Lowers blood sugar levels, antispasmodic,properties helping to prevent the spread of infection and accelerate t analgesic, lowers blood pressure, reduces fever, fungicidal, anti-healing. Marigold is also a cleansing and detoxifying herb, and the inflammatory. infusion and tincture are used to treat chronic infections. Taken internally, it has been used traditionally to promote the draining of 8) BELLADONA, DEADLY NITIGHTSHADE swollen lymph glands such as tonsillitis. Atropa belladonna (Solanaceae) MAIN PROPERTIES: Anti-inflammatory, astringent, heals wounds, Herba bella dona, or "herb of the beautiful lady" is known for its antiseptic, detoxifying. poisonous effects (belladonna increases heartbeat and can lead to death), like many other plants it is an important and beneficial remedy 14) CAM PHOR when used correctly. Belladonna contains atropine used in conventional Cinnamomum camphora syn. Laurus camphora (Lauraceae) medicine to dilate the pupils for eye examinations and as an anesthetic. crystals have strong antiseptic, stimulant and antispasmod In herbal medicine, deadly nightshade is mainly prescribed to Camphor relieve properties and are applied externally as unguents or balms as a coun intestinal colic, to treat peptic ulcers and to relax distended organs, and analgesic liniment to relieve arthritic and rheumatic pain especially the stomach and intestine. Deadly nightshade is alsoirritant used as neuralgia and back pain. It may also be applied to skin problems, suc an anaesthetic in conventional medicine. as cold sores and chilblains, and used as a chest rub for bronchitis an MAIN PROPERTIES: Smooth muscle, antispasmodic, narcotic,other chest infections. reduces sweating, sedative. MAIN PROPERTIES: Antiseptic, antispasmodic, analgesic, expectorant. 9) BENZOIN GUM Styrax benzoin (Styraceae) 15) CARD AMOM Its trunk exudes a gum well known for its strong astringent and Elettaria cardamomum (Zingiberaceae) antiseptic action. For this reason it is used externally to fight tissue Cardamom is an excellent remedy for many digestive problems, inflammation and disinfection of wounds. When taken internally, benzoin gum acts to settle griping pain, to stimulate coughing,helping and to to soothe indigestion, dyspepsia, gastralgia, colon spasms an flatulence. It has an aromatic and pungent taste and combines well w disinfect the urinary tract. Benzoin gum is widely used in cosmetics as other an antioxidant in oils, as a fixative in perfumes and as an additive to herbs and helps to disguise the less pleasant taste of other her soaps. When steam inhaled, it helps healing sore throats, head and chest MAIN PROPERTIES: Eases stomach pain, carminative, aromatic, colds, asthma and bronchitis. antispasmodic. MAIN PROPERTIES: Antiseptic, astringent, anti-inflammatory. 16) CARDUS, MILK THISTLE, MARY THISTLE 10) BERGAMOT Carduus marianus syn. Silybum marianum (Compositae) Citrus bergamia syn. C. aurantium var. bergamia (Rutaceae) Milk thistle has been in use as a remedy for liver problems for Bergamot oil, expressed from the peel, assists in avoiding infectious hundreds, if not thousands, of years. It is used in a whole range of liv diseases. In cosmetics it is used in preventing oily skin, acne, psoriasis and bladder conditions including hepatitis and cirrhosis. Recent and acne. The oil (or constituents of it) is sometimes added to research sunhas confirmed that the herb has a remarkable ability to prot tanning oils. Bergamot oil is also used to relieve tension, relaxthe muscle liver from damage resulting from alcoholic and other types of spasms and improve digestion. poisoning. Today, milk thistle is widely used in the West for the treatment of a range of liver conditions. MAIN PROPERTIES: Disinfectant, muscle relaxant. MAIN PROPERTIES: Digestive, liver tonic, stimulates secretion of bile, increases breast-milk production, antidepressant. 11) BITTER ORANGE Citrus aurantium (Rutaceae) 17) CELERY, SMALLAGE Its oil contains flavonoids which are anti-inflammatory, antibacterial Apium graveolens (Umbelliferae) and antifungal. Bitter orange juice is rich in vitamin C which helps Morethe familiar as a vegetable than as a medicine, celery find its main immune system. As an infusion, it helps to relieve fever, sootheuse in the treatment of rheumatism, arthritis and gout. Containing ap headaches and lower fever. It yields neroli oil from its flowers,the andseeds the are also used as a urinary antiseptic. Celery is a good oil known as petitgrain from its leaves and young shoots. Bothcleansing, diuretic herb, and the seeds are used specifically for arthr
complaints where there is an accumulation of waste products. 24) The CYMBOPOGON, LEMON GRASS seeds also have a reputation as a carminative with a mild tranquilizing Cymbopogon citratus (Gramineae) effect. The stems are less significant medicinally. Its oil is used as a culinary flavoring, a scent and medicine. Lemon grass is principally taken as a tea to remedy digestive problems MAIN PROPERTIES: Anti-rheumatic, antispasmodic, diuretic, urinary diarrhea and stomach ache. It relaxes the muscles of the stomach an antiseptic. gut, relieves cramping pains and flatulence and is particularly suitab for children. In the Caribbean, lemon grass is primarily regarded as a 18) CHAMOMILE, GERMAN CHAMOMILE fever-reducing herb. It is applied externally as a poultice or as dilute Chamomilla recutita syn. Matricaria recutita (Compositae) essential oil to ease pain and arthritis. Its flowers help to ease indigestion, nervousness, depressions and headaches, being ideal for emotion related problems such as peptic MAIN PROPERTIES: Digestive, antispasmodic, analgesic. ulcers, colitis, spastic colon and nervous indigestion. Chamomile's essential oil have anti-inflammatory, anti-spasmodic and anti-microbial 25) DAMIA NA activity. It is an excellent herb for many digestive disorders and Turnera for diffusa syn. T. diffusa var. aphrodisiaca (Turneraceae) nervous tension and irritability. Externally, it is used for sore skin andan ancient reputation as an aphrodisiac and is an excellent It has eczema. Roman chamomile (Chamaemelum nobile) is a close relation, remedy for the nervous system acting as a stimulant and tonic in case used in a similar way. of mild depression. Damiana has a strongly aromatic, slightly bitter taste. The leaves are used to flavor liqueurs and are taken in Mexico MAIN PROPERTIES: Anti-inflammatory, antispasmodic, relaxant, a substitute for tea. carminative, bitter, nervine. MAIN PROPERTIES: Nerve tonic, antidepressant, urinary antiseptic. 19) CHICORY Cicorium intybus (Compositae) 26) DANDELION As a tea or extract, chicory root is a bitter digestive tonic that Taraxacum also officinale (Compositae) increases bile flow and decrease inflammation. Its roasted rootKnown is principally as a weed, dandelion has an astonishing range of commonly used as a coffee substitute. Chicory is an excellent mild health benefits. The leaves, which can be eaten in salads, are a power bitter tonic for the liver and digestive tract. The root is therapeutically diuretic. The roots act as a "blood purifier" that helps both kidneys an similar to dandelion root supporting the action of the stomach the andliver liverto remove impurities from the blood. This effect seems to be and cleansing the urinary tract. Chicory is also taken for rheumatic due to its potassium content. It also acts like a mild laxative and conditions and gout, and as a mild laxative, one particularly appropriate improves appetite and digestion. for children. An infusion of the leaves and flowers also aids the MAIN PROPERTIES: Diuretic, digestive, antibiotic, bitter. digestion.
27) DILL MAIN PROPERTIES: Digestive, liver tonic, anti-rheumatic, mild Anethum graveolens syn. Peucedanum graveolens (Umbelliferae) laxative. Dill has always been considered a remedy for the stomach, relieving 20) CINNA MON wind and calming the digestion. Dill's essential oil relieves intestinal Cinnamomum verum syn. C. zeylanicum (Lauraceae) spasms and griping and helps to settle colic, hence it is often used in The infusion or powder is used for stomach pains and cramps. gripe water mixtures. Chewing the seeds improves bad breath. Dill Traditionally, the herb was taken for colds, flu and digestive problems. makes a useful addition to cough, cold and flu remedies, and is a mild diuretic. Dill increases milk production, and when taken regularly by MAIN PROPERTIES: Warming stimulant, carminative, antispasmodic, nursing mothers, helps to prevent colic in their babies. antiseptic, anti-viral. MAIN PROPERTIES: Digestive, antibacterial, antispasmodic, diuretic 21) CLOVE Eugenia caryophyllata syn. Syzgium aromaticum (Myrtaceae) 28) EUCALYPTUS, BLUE GUM Eucalyptus globulus (Myrtaceae) The dried flower buds, clove, are extensively used as spice. The buds, Eucalyptus is a powerful antiseptic used all over the world for relievi leaves and stems are used for the extractions of clove's oil. The oil coughs contains eugenol, a strong anesthetic and antiseptic substance. Clovesand colds, sore throats and other infections. The leaves cool t body and relive fever. Inhaling the vapors of the essential oils heated are also well known for their antispasmodic and stimulant properties. water, clears sinus and bronchial congestions. Eucaliptol, one of the MAIN PROPERTIES: Antiseptic, mind and body stimulant, analgesic, substances found in the essential oil, is one of the main constituents antibacterial, carminative. the many existing commercial formulas of chest rubs for colds. The essential oil has also strong anti-biotic, anti-viral and anti-fungal acti 22) COMFREY, KNITBONE Eucalyptus is a common ingredient in many over-the-counter cold Symphytum officinale (Boraginaceae) remedies. Comfrey leaves and roots contain allantoin, a cell multiplication agent MAIN PROPERTIES: Antiseptic, expectorant, stimulates local blood that increases the healing of wounds. Today, it is still highly regarded flow, anti-fungal. for its healing properties. Externally it is used for rashes, wounds, inflammations and skin problems. Internally, comfrey has action over 29) FEN NEL the digestive tract helping to cure ulcers and colitis. It is also used for a Foeniculum vulgare (Umbelliferae) variety of respiratory problems. The primary use of fennel seeds is to relieve flatulence, but they also MAIN PROPERTIES: Digestive problems, anti-inflammatory, wound settle colic, stimulate the appetite and digestion. Fennel is also diure healing, astringent. and anti-inflammatory. Like anise (Pimpinella anisum) and caraway (Carum carvi), it has a calming effect on bronchitis and coughs. An 23) CORIANDER infusion of the seeds may be taken as a gargle for sore throats and as Coriandrum sativum (Umbelliferae) mild expectorant. Fennel increases breast-milk production and the he It aids digestion, reduce flatulence and improves appetite. It helps is still used as an eye wash for sore eyes and conjunctivitis. Essential relieving spasms within the gut and counters the effects of nervous oil from the sweet variety is used for its digestive and relaxing tension. Coriander is also chewed to sweeten the breath, especially after properties. consumption of garlic (Allium sativum). It is applied externally as a lotion for rheumatic pain. Coriander essential oil is used in theMAIN PROPERTIES: Digestive, antispasmodic, anti-inflammatory. manufacture of perfumes, cosmetics and dentifrices. 30) GARLIC MAIN PROPERTIES: Digestive, antispasmodic, anti-rheumatic.Allium sativum (Liliaceae) Recognized for its pungent odor and taste, garlic is a powerful home
medicine for the treatment for a host of health problems. It is one Crataegus of the oxyacantha & C. monogyna (Rosaceae) most effective anti-biotic plants available, acting on bacteria, viruses It has been shown that its effects are only present when a whole plan and alimentary parasites. It counters many infections, including preparation those is used. Its applications are: the loss of cardiac function, of the nose, throat and chest. Garlic is also known to reduce feelings of congestions and oppression in the hearth region. Western cholesterol, helps circulatory disorders, such as high blood pressure, herbalists consider it literally to be a "food for the heart", increasing and lower blood sugar levels, making it useful in cases of late-onset blood flow to the heart muscles and restoring normal heart beat. Rec diabetes. research has confirmed the validity of these uses. MAIN PROPERTIES: Antibiotic, expectorant, diaphoretic, hypotensive, antispasmodic, expels worms.
MAIN PROPERTIES: Cardiotonic, diuretic, astringent, dilates blood vessels, relaxant, antioxidant.
31) GENTIAN 38) HYSSOP Gentiana lutea (Gentianaceae) Hyssopus officinalis (Labiatae) Gentian is a powerful bitter that stimulates appetite and promotes Currently an undervalued medicinal herb, hyssop is potentially usefu digestion through the increased production of saliva, gastric juices as it is and both calming and tonic. It has a large spectrum of uses which bile. It also decreases gastric inflammation and kill worms. Gentian due toisits anti-spasmodic action. It is used in coughs, bronchitis, tigh also used to treat liver and spleen problems and to promote chestedness, respiratory catarrh, sore throat and common cold. As a menstruation. Medicinally, gentian strengthens a weak or under-active sedative, hyssop is a useful remedy against asthma in both children a digestive system. adults, especially where the condition is exacerbated by mucus congestion. MAIN PROPERTIES: Bitter, digestive stimulant, eases stomach pain. MAIN PROPERTIES: Anti-spasmodic, expectorant, diaphoretic, antiinflammatory, hepatic. 32) GIN GER Zingiber officinali (Zingiberaceae) 39) JASMINE The Chinese consider ginger as an important drug to treat cold and Jasminum grandiflorum (Oleaceae) encourage sweating. Ginger brings relief to digestion, stimulates Jasmine flowers make a calming and sedative infusion, taken to reliev circulation, reduce headaches and kill intestinal parasites. tension. The oil is considered antidepressant and relaxing. It is used MAIN PROPERTIES: Diaphoretic, carminative, circulatory stimulant, externally to soothe dry and sensitive skin. inhibits coughing, anti-inflammatory, antiseptic. MAIN PROPERTIES: Aromatic, anti-spasmodic, expectorant. 33) GIN KGO Ginkgo biloba (Ginkgoaceae) 40) JUNIPER Traditionally known as an anti-microbial and anti-tubercular action, it communis (Cupressaceae) Juniperus has now been shown that ginkgo as a profound activity on brain It is a valuable remedy for cystitis, and helps relieve fluid retention, b function and cerebral circulation. This action is useful to prevent should be avoided in cases of kidney disease. In the digestive system, dizziness, tinnitus, short-term memory loss, depression and other juniper is warming and settling, easing colic and supporting the symptoms related to poor brain circulation. Its effect on poor function of the stomach. Taken internally or applied externally, junipe circulation also used to treat other related disorders like diabetes, is helpful in the treatment of chronic arthritis, gout and rheumatic hemorrhoids and varicose veins. Ginkgo is also valuable for asthma. conditions. Applied externally as a diluted essential oil, it has a slight warming effect on the skin and is thought to promote the removal of MAIN PROPERTIES: Circulatory stimulant and tonic, anti-asthmatic, waste products from underlying tissues. antispasmodic, anti-allergenic, anti-inflammatory. MAIN PROPERTIES: Diuretic, anti-microbial, carminative, antirheumatic. 34) GINSENG Panax ginseng (Araliaceae) 57)toRADISH Ginseng increases mental and physical efficiency and resistance Raphanus sativus (Cruciferae) stress and disease. It often shows a dual response like sedating or Radish stimulating the central nervous system according to the condition it isstimulates the appetite and the digestion. The juice of the bla radish is drunk to counter gassy indigestion and constipation. Black being taken to treat. In the West, ginseng is regarded as a life-enhancing radish juice has a tonic and laxative action on the intestines, and tonic. indirectly stimulates the flow of bile. Consuming radish generally MAIN PROPERTIES: Tonic, stimulant, physical and mental results in improved digestion, but some people are sensitive to its enhancement. acridity and strong action. In China, radish is eaten to relieve abdominal distention. 35) GUMPLANT Grindelia camporum syn. G. robusta var. rigida (Compositae) MAIN PROPERTIES: Digestive, mild laxative. Its anti-spasmodic, expectorant and hypotensive actions find applications in treating heart conditions, asthmatic and bronchial 58) RAUVOLFIA, INDIAN SNAKEROOT conditions. It has been employed in the treatment of wooping cough, Rauvolfia serpentina (Apocynaceae) hay fever and cystitis. Externally in relieves and heals skin irritations Indian snakeroot contains reserpine, a substance now widely used to and burns. lower blood pressure and lessen some symptoms of mental illness. Th MAIN PROPERTIES: Anti-spasmodic, expectorant, hypotensive. root has a pronounced sedative and depressant effect on the sympathetic nervous system. By reducing the system's activity, the he brings about the lowering of blood pressure. It may also be used to tr 36) HAMAMELIS, WITCH HAZEL Hamamamelis virginiana (Hamamelidaceae) anxiety and insomnia, as well as more serious mental health problem such as Witch hazel acts mostly on the veins and circulation. For this reason it psychosis. has been used to decrease the inflammation and pain of bruises, sore muscles, bleeding, hemorrhoids, varicose veins, phlebitis, and MAIN insect PROPERTIES: Antidepressant, lowers blood pressure. bites. American indians used poultices soaked in a decoction of bark to CHINESE RHUBARB treat tumors and inflammations, especially of the eye, and took59) theRHUBARB, herb Rheum palmatum (Polysonaceae) internally for hemorrhaging and heavy menstrual bleeding. Its main use is as a laxative safe even for young children due to its MAIN PROPERTIES: Astringent, anti-inflammatory, stops external gentle action. It is also extremely effective in the treatment for many and internal bleeding. digestive problems. Paradoxically, it is a laxative when taken in large doses but has a constipating effect in small measures. The rhizome h 37) HAWTHORN an astringent, unpleasant taste.
the wood is used to soothe rashes and itchy skin. In China, sandalwo MAIN PROPERTIES: Laxative, constipating, astringent, eases is stomach held to be useful for chest and abdominal pain. pain, antibacterial. MAIN PROPERTIES: Antiseptic, aromatic. 60) ROSE 66) SARSAPARILLA Rosa gallica (Rosaceae) Smilax The essential oil, called "attar of rose", is used in aromatherapy as a spp. (Liliaceae) is anti-inflammatory and cleansing, and can bring relief mildly sedative, antidepressant and anti-inflammatory remedy.Sarsaparilla Rose skin problems such as eczema, psoriasis and general itchiness, and h petals and their preparations have a similar action. They also reduce treat high cholesterol levels. Rosewater is mildly astringent and makes a rheumatism, rheumatoid, arthritis and gout. Sarsaparilla also h progesterogenic action, making it beneficial in pre-menstrual problem valuable lotion for inflamed and sore eyes. and menopausal conditions such as debility and depression. MAIN PROPERTIES: Aromatic, antidepressant,, sedative, antiinflammatory. MAIN PROPERTIES: Diuretic, anti-inflammatory, anti-rheumatic.
61) ROSEMARY 67) SCOTS PINE Rosmarinus officinalis (Labiatae) Pinus sylvestris (Pinaceae) Rosemary is a well-known and greatly valued herb that is native Itsto oil, extracted from the leaves, is added to disinfectants and other southern Europe. It has been used since antiquity to improve and preparations. Scots pine leaves, taken internally, have a mildly strengthen the memory. Rosemary leaves increase circulation,antiseptic reduce effect within the chest, and may also be used for arthritic a headaches and have anti-bacterial and fungal properties. Rosemary rheumatic problems. Essential oil from the leaves may be taken for improves food absorbtion by stimulating digestion, the liver, the asthma, bronchitis and other respiratory infections, and for digestive intestinal tract, and the gallbladder. It also is used in antisepticdisorders gargles such as wind. Scots pine branches and stems yield a thick for sore throats, gum problems and canker sores. Rosemary has resin, a longwhich is also antiseptic within the respiratory tract. The seeds standing reputation as a tonic, invigorating herb, imparting a zest yieldfor an essential oil with diuretic and respiratory-stimulant properti life that is to some degree reflected in its distinctive aromatic taste. MAIN PROPERTIES: Antiseptic, diuretic and anti-rheumatic. MAIN PROPERTIES: Tonic, stimulant, astringent, nervine, antiinflammatory, carminative. 68) SESAME Sesamum indicum (Pedaliaceae) 62) RUE The seeds are prescribed for problems such as dizziness, tinnitus Ruta graveolens (Rutaceae) (ringing in the ears), and blurred vision. Owing to their lubricating The rutin contained in the plant helps to strengthen fragile blood effect within the digestive tract, the seeds are also considered a reme vessels and alleviates varicose veins. Rue is also used due to its for constipation. Sesame seed oil benefits the skin and is used as a ba antispasmodic properties, especially in the digestive system where it for cosmetics. A decoction of the root is used in various traditions to eases griping and bowel tension. The easing of spasms gives ittreat a role in coughs and asthma. the stopping of spasmodic coughs. In European herbal medicine, rue MAIN PROPERTIES: Digestive, aromatic, antispasmodic. has also been taken to treat conditions as varied as hysteria, epilepsy, vertigo, colic, intestinal worms, poisoning and eye problems. The latter 69) ST JOHN'S WORT use is well founded, as an infusion used as an eyewash brings quick Hypericum perforatum (Guttiferae) relief to strained and tired eyes, and reputedly improves the eyesight. St. John's wort flowers at the time of the summer solstice, and in medieval Europe it was considered to have powerful magical propert MAIN PROPERTIES: Antispasmodic, increases peripheral blood circulation, relieves eye tension. that enabled it to repel evil. The most well-known action of St. John's wort is in repairing nerve damage and reducing pain and inflammatio 63) SAGE, CLARY CLARY SAGE It is taken to relieve the pain of menstrual cramps, sciatica and arthr Salvia sclarea (Labiatae) The oil is applied to inflammations, sprains, bruises and varicose vein Clary sage has been perceived both as a weaker version of its St. close John's wort is also used to treat circulation problems, bronchitis a relative, sage (S. officinalis), and as a significant herb in its own right. gout. Since the seeds were once commonly used to treat eye problems, it was MAIN PROPERTIES: Antidepressant, antispasmodic, astringent, also known as "clear eye". An antispasmodic and aromatic plant, clary sedative, sage is used today mainly to treat digestive problems such as wind and relieves pain, anti-viral. indigestion. It is also regarded as a tonic, calming herb that helps 70) TARRAGON relieve period pain and premenstrual problems. Owing to its estrogenArtemisia stimulating action, it is most effective when levels of this hormone are dracunculus (Compositae) low. Tarragon is widely used as a herb in cooking. In French, it is sometim known as herbe au dragon, because of its reputed ability to cure serp MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, bites. While tarragon stimulates the digestion, it is reputed to be a m estrogenic, reduces sweating, tonic. sedative and has been taken to aid sleep. With its mild menstruationinducing properties, it is taken if periods are delayed. The root has 64) SAGE traditionally been applied to aching teeth. Salvia officinalis (Labiatae) MAIN PROPERTIES: Anti-inflammatory, digestive. Its leaves are a well-known cold germ and flu fighter. It has been found to be very effective to reduce many physical emissions like sweating TEA TREE and is an excellent remedy for sore throats, poor digestion and71) irregular Malaleuca alternifolia (Myrtaceae) periods. It is also taken as a gently stimulating tonic. It has a slightly Tea tree, and in particular its essential oil, is one of the most importa warm, noticeably bitter and astringent taste. natural antiseptics. Useful for stings, burns, wounds and skin infectio MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, of all kinds, the herb merits a place in every medicine chest. Its estrogenic, reduces sweating, tonic. therapeutic properties were first researched during the 1920s and it now widely used in Europe and the US, as well as in Australia. 65) SANDALWOOD Santalum album (Santalaceae) MAIN PROPERTIES: Antiseptic, antibacterial, anti-fungal, anti-viral. The heartwood is most often used in perfumery, but it has also been taken as a remedy in China since around AD 500. Sandalwood72) andTHYME its essential oil are used for their antiseptic properties in treatingThymus genito- vulgaris (Labiatae) urinary conditions such as cystitis and gonorrhea. In India, a paste of medicinal application is in treating coughs and clearing Its main
congestion. Many current formulas for mouth washes and vapor rubsPROPERTIES: Antiseptic, anti-fungal, antispasmodic. MAIN contain thymol, one of the constituents found in thyme. It also improves digestion, destroys intestinal parasites and is an excellent 79) YARROW antiseptic and tonic. Achillea millefolium (Compositae) It has long been taken as a strengthening bitter tonic and all kinds of MAIN PROPERTIES: Antiseptic, tonic, relieves muscle spasm, bitter drinks have been made from it. Yarrow helps recovery from col expectorant. and flu and is beneficial for hay fever. It is also helpful for menstrual problems and circulatory disorders. 73) TURMERIC MAIN PROPERTIES: Antispasmodic, astringent, bitter tonic, increase Curcuma longa syn. C. domestica (Zingiberaceae) lowers blood pressure, reduces fever, mild diuretic and Best known for its bright yellow color and spicy taste to loverssweating, of Indian food, its medicinal value is not so well known. However,urinary recent antiseptic. research has confirmed the effects traditionally associated in ancient YLANG practices in the treatment of digestive and liver problems. The80) herb has -YLANG also been shown to inhibit blood-clotting, relieve inflammatoryCanananga odorata syn. Canangium odoratum (Annonaceae) Their scent is thought to have aphrodisiac qualities. The flowers and conditions and help lower cholesterol levels. essential oil are sedative and antiseptic. The oil has a soothing effect MAIN PROPERTIES: Stimulates secretion of bile, anti-inflammatory, and its main therapeutic uses are to slow an excessively fast heart ra and to lower blood pressure. With its reputation as an aphrodisiac, eases stomach pain, antioxidant, antibacterial. ylang-ylang may be helpful in treating impotence. 74) VALERIAN MAIN PROPERTIES: Antiseptic, aromatic, regulates blood pressure. Valeriana officinalis (Valerianaceae) Valerian root is a general tranquilizer used for relieving nervous tension, insomnia and headaches. Valerian decreases muscular spasm, being useful in cases of nervous digestion, bowel syndrome, stomach Preventing Clogged Feeding Tubes and menstrual cramps. Valerian helps relieve stress and has become an increasingly popular remedy in recent decades. It is a safe, non- Going with the flow. (preventing clogged feeding tubes) addictive relaxant that reduces nervous tension and anxiety andAuthor/s: Karen Brennan Krupp promotes restful sleep. Issue: April, 1998
MAIN PROPERTIES: Sedative, relaxant, relieves muscle spasm, Find out what problems to anticipate-- and how a few simple steps ca relieves anxiety, lowers blood pressure. head them off.
75) VERBENA A clogged enteral feeding tube that can't be cleared must be replaced Verbena officinalis (Verbenaceae) an unwelcome prospect for you and your patient. At the very least, Verbena is used in mouth washes for infected gums and as a poultice he'll miss getting some of the fluid and nutrition he needs. At for hemorrhoids. A tea has been used as a nerve tonic, to treat insomnia worst, if he's homebound or a nursing home resident, he'll need to and to help digestion. It has tonic, restorative properties, and is used traveltoto an appropriate facility for tube reinsertion and X-ray relieve stress and anxiety, and to improve digestive function. confirmation of placement. The expression An ounce of prevention is worth a pound of cure could have been coined by a nurse managing MAIN PROPERTIES: Nervine, tonic, mild sedative, stimulates feeding bile tubes. secretion, mild bitter. In this article, we'll describe two simple ways you can keep feeding 76) WHITE WILLOW tubes patent: pump-assisted infusion of enteral formulas and frequen Salix alba (Salicaceae) tube flushing. But first, let's review factors that can increase the White willow is an excellent remedy for arthritic and rheumatic pain, risk of a clogged feeding tube. affecting the joints like knees and hips. Problems in the pipeline MAIN PROPERTIES: Anti-inflammatory, analgesic, reduces fever, anti-rheumatic, astringent. Feeding tubes can become clogged for one of these reasons:
77) WORMWOOD * calorically dense formulas. When a dense formula is delivered in a Artemisia absinthium (Compositae) slow, uneven infusion (as by gravity drip), formula coagulation and Wormwood leave's primary uses is to stimulate the gallbladder,tube helpocclusion are more likely. prevent and release stones, and to adjust digestive malfunctions. It also increases bile secretion and is useful in expelling intestinal worms. It is * small-bore feeding tubes. Small-bore tubes are more flexible and taken in small doses and sipped, the intensely bitter taste playing lessan irritating to patients and can be left in place longer than important part in its therapeutic effect. In the past, wormwoodlarger was one ones. But their smaller lumens make them more likely to clog. of the main flavorings of vermouth (whose name derives from the German for wormwood). * gravity drip. An imprecise roller clamp adjustment may increase or decrease the amount of formula delivered by as much as 50%. When MAIN PROPERTIES: Aromatic bitter, stimulates secretion of bile, formula flows slowly, residue clings to the wall of the tube, anti-inflammatory, eliminates worms, eases stomach pains, mild creating a buildup that eventually clogs the tube. antidepressant. A slow or stopped flow of formula also causes gastric pH to decrease 78) WILD THYME because there's less nutritional liquid to dilute the stomach acid. Thymus serpyllum (Labiatae) This excess acid may then flow into the tube, causing the formula to Like its close relative thyme (Thymus vulgaris), wild thyme is strongly clump. antiseptic and anti-fungal. It may be taken as an infusion or syrup to treat flu and colds, sore throats, coughs, whooping cough, chest * medications. Bulk-forming agents such as psyllium (Metamucil), infections, and bronchitis. Wild thyme has anti-catarrhal properties and and medications that haven't been properly crushed or antacids, helps clear a stuffy nose, sinusitis, ear congestion and related reconstituted can also clog a tube. The combination of crushed complaints. It has been used to expel thread worms and roundworms in medications and a small-bore feeding tube is a common cause of children, and is used to settle wind and colic. Wild thyme's slowed antispasmodic action makes it useful and is used to settle windorand blocked formula flow. Whenever possible, administer the liquid colic. Wild thyme is also used in herbal baths and pillows. formulation of a medication rather than creating a mixture from crushed tablets.
· Specific plan * gastric residuals. When you check gastric residuals through ·aSocial support system feeding tube, gastric acid mixes with the formula in the tube and · DO NOT make “ suicide contract”! causes formula coagulation, which can lead to tube clogging. This problem is more common when small-bore feeding tubes are used to For Anxious clients aspirate gastric residuals. · Convey interest and care · Don’t “force” client An ounce of prevention · Help client identify source of anxiety · Suggest relaxation techniques Now let's look at the two steps you can take to prevent feeding tubes For Violent clients from clogging. · Remain calm and in control of the situation A pump-assisted infusion is especially helpful for administering· Give a client space, avoid sudden movements calorically dense formula. The slight degree of pump-generated · Encourage verbal expression of anger pressure means the formula is delivered in a continuous, even · Restrain or seclude if necessary infusion, avoiding the problems associated with an uneven For Compulsive clients administration rate. · Allow client to engage in rituals (these are used to cover up anxiety Regular tube flushing with water is, the simplest way to prevent tube · Gradually limit length of time for rituals. clogging--and the most often neglected. The most common practice is to instill 50 to 100 ml of water every 4 hours; before, after, andFor Manipulative clients · Set clear limits between multiple doses of medications; and when stopping and starting · Hold client responsible for behavior a feeding. If you flush the tube consistently, you can clear even viscous enteral formulas from the tube lumen. Also flush before and For Dependent clients after you check gastric residuals. · Don’t reward dependent behavior Continued from page 1 · Client should share responsibility for treatment
For Paranoid clients Cranberry juice, carbonated beverages, meat tenderizers, enzymatic · Don’t argue with client (simply state that you don’t share his beliefs solutions ... over the years, nurses have tried all sorts of remedies · Be reliable and consistent for clogged enteral tubes. But researchers who've studied various preventive irrigants have learned something surprising: Nothing beats For Delusional clients plain water. In fact, acidic colas and cranberry juice can actually · Stay with client cause an obstruction by promoting formula coagulation. · Don’t argue about the reality of delusions The bottom line? Flushing the tube regularly with water remains · Orient the frequently to reality (place, situation) most effective and practical way to prevent enteral, feeding tube · Assess potential for self harm clogs. For Somatization clients · Respect client and his problems (client is not faking) Making it automatic · Rule out physical basis for symptoms A heavy nursing workload and lack of written policies and procedures · Help client express anxiety for tube flushing can lead to inconsistency in tube flushing. So some enteral pumps also have an automatic flush feature, which delivers a DEFENSE MECHANISMS: preprogrammed amount of fluid, typically water, every hour. This 1. Conversion: A college student develops diarrhea on day of exam simulates the flushing action of a syringe and helps minimize residue 2. Regression: Returning to immature ways of dealing with stress: buildup. crying, tantrums… Automatic flushing doesn't just save nursing time--it's also more 3. Repression: Blocking of unacceptable urges and feelings from effective. Two studies found clogging in 75% of gastrostomy tubes awareness. in the manually flushed group, compared with only 5% in the 4. Denial: Blocking of unacceptable information or perceptions from automatically flushed group. The results were even more dramatic awarness. for nasogastric tubes: 91% in the manually flushed group clogged;5.none Dissociation of affect: A girl laughs when telling about her failed clogged in the automatic flush group. exam 6. Rationalization: Substituting an acceptable motive for attitudes or Smooth sailing behavior for an unacceptable motive 7. Reaction formation: you want to “kick your bosses ass” but end up By knowing which, factors predispose an enteral tube to clogging andit. kissing taking a few preventive measures, you can keep your patient 8. Identification: A teenager dresses like Madonna and mimics her comfortable- -and save yourself some time. behavior. 9. Projection: “ you are acting like a teenager, not I” 10. Introjection: A boy yells at his dog like his father does him 11. Displacement: Client is upset about disease and yells at nurse. Psyche Nursing Nurse gets upset and yells at nursing assistant 12. Undoing: “ magic,” For Withdrawn clients · Allow client to set pace SIGNS AND SYMPTOMS · Encourage social activities or games For Depressed client · Assess suicide potential · Let client talk about personal problems · Do not leave alone
Aphasia Receptive (Wernicke =difficulty to comprehend language) or expressive (Broca = difficulty to find “the right word” language disorder
For Suicidal clients Crisis intervention to assess suicide protential. · Communicate intent “ are you tired of living?” · Previous attempts
Apraxia Failure to do, despite intact motor function Agnosia
Failure to recognize Dementia Gradual impairment of cognitive functions, memory · Alzheimer dementia: early memory loss · Multi infarct dementia: step like decline Delirium Acute, organic, short lasting Clouded consciousness Confusion, disorientation, anxiety Sometimes hallucinations Delusions Persistent false belief despite invalidating evidence Grandeur Paranoia Somatic delusions illusions Misperception of external stimuli
5. Confabulation: invents stories to fill memory gaps: Korsakoff encephalopathy. DELIRIUM Ø Acute onset Ø Fluctuating consciousness Ø Disorientation Ø Optical hallucinations DEMENTIA Ø Gradual onset Ø No impairment of consciousness Ø Loss of intellectual functions: memory, orientation, language. ALZHEIMER’S
ASSESSMENT: § Progressive memory loss § Declining mental, social, and self care abilities ANALYSIS: § Risk of injury due to cognitive deficits § Family/caregiver burnout
Hallucinations Perception without external stimuli
IMPLEMENTATION: § Support family caregivers TERMS: § Provide safe and familiar environment 1. Neologisms: invents new words: Schizophrenia § Support client’s attempts at independence 2. Echolalia: echoes words or sentences: Schizophrenia § Continually orient client to time, date and person 3. Word Salad: jumble of words without meaning: Schizophrenia 4. Flight of ideas: rapid switching from topic to topic: Mania § Advance directive should be drafted as early as possible
GRIEF
DEPRESSION
Initial: shock/ denial
Feeling of hopelessness
Illusions/hallucinations may occur
Feeling of worthlessness
Low risk of suicide
High risk of suicide
PERSONALITY DISORDERS:
Behavior is inflexible across a broad range of situations Behavior is markedly deviant from cultural norms Significant distress and impairment of functioning DEPENDENT
Afraid of being helpless Need to be cared for
COMPULSIVE
Fear of loss of control Tries to control physician
PASSIVE-AGGRESSIVE
Appears willing but is not compliant
HISTRIONIC
Dramatic, emotional May display inappropriate sexual behavior
NARCISSISTIC
Feels better than others Perfect self image is threatened by disease
PARANOID
May blame nurse or others for disease
SCHIZOID
Anxious, withdrawn
(doesn’t want close relationships) BORDERLINE
Severe disorder! Intense unstable relationships Paranoia and suicidal behavior Features of psychoses
ANXIETY DISORDERS:
Clients are distressed and know that their symptoms are irrational. PHOBIA
Persistent excessive of specific objects or situations. Patient knows that his fear is unrealistic
PANIC ATTACK
Abrupt onset, peak within 10 min. Palpitations, tachycardia Sweating, trembling, shaking Fear of dying Derealization: feeling of unreality of the external world. Depersonalization: feeling of being detached from oneself
AGORAPHOBIA
Hx of panic attacks Patient avoids places where panic attack might occur (especially public places)
OBSESSSIVE COMPULSIVE
Obsessions: recurrent thoughts Compulsions: repetitive behavior
POSTRAUMATIC STRESS DISORDER
Traumatic event in client’s history May occur any time after event Persists for > 1 month
HYPOCHONDRIASIS & MALINGERING: HYPOCHONDRIASIS
Unrealistic interpretation of body signs Client believes to have serious disease that is unrecognized by family and physicians
FACTITIOUS DISORDER
Intentional feigning of symptoms Motivation: to assume the sick role: external incentives such as economic gain or avoiding legal responsibilities are absent
MALINGERING
Intentional feigning of symptoms Motivation: economic gain
Avoiding leagal responsibilities
MAJOR DEPRESSION ASSESSMENT:
Feeling of worthlessness Thoughts of death or suicide Lethargy Slow, muted speech Anorexia, weight loss Early morning awakening ANALYSIS:
Risk of suicide IMPLEMENTATION:
Assess suicidal risk ( ask client directly) Remove potentially harmful objects Encourage verbal expression of feelings Encourage participation in group activities MEDICATIONS:
Antidepressants (require several weeks for full effect) Watch for anticholinergic side effects: Blurred vision
Dry mouth Constipation Urinary retention
BIPOLAR DISORDER: Manic episodes alternate with episodes of major depression. Some clients have only manic episodes, no depressive episodes.
ASSESSMENT:
Euphoria Grandiose ideas Uninhibited sexuality Buying sprees Psychomotor agitation IMPLEMENTATION:
Low stimulus environment Provide frequent small meals, snacks Encourage physical activity as a means to “act out” MEDICATION:
Lithium Watch for signs of toxicity Abdominal pain, nausea
Hand tremor Ataxia, nystagmus Slurred speech Monitor serum levels closely
Not to exceed 1 mEq/L
SCHIZOPHRENIA:
ASSESSMENT:
Defect in reality testing Affect incongruent ( does not match thoughts) Thought form: tangential, circumstantial, loose associations “POSITIVE SYMPTOMS”
Delusions Hallucinations “NEGATIVE SYMPTOMS”
Flat affect Loss of interest Ambivalence Autism CATATONIA:
Waxy rigidity of muscles Client maintains bizarre positions IMPLEMENTAION:
Establish trusting, honest relationship Maintain calm, consistent manner Don’t challenge client’s thought content Decrease environmental stimuli MEDICATION:
Neuroleptics: monitor for signs of tardive dyskinesia Choreoathetosis
Lateral movements of jaw Tongue protrusion CLIENT EDUCATION:
Stress importance to comply with follow up visits Encourage family support
DRUG ABUSE:
Abuse: recurrent use of drugs resulting in social failures at home, school or work, legal problems or hazardous situations. Dependence: Tolerance (needs larger doses to achieve effect). Withdrawal symptoms.
ALCOHOL
INTOXICAITON
WITHDRAWAL
Euphoria
Nausea
Disorientaion
Delusions, hallucinations
Unsteady gait
Delirium Tremor, seizures
BARBITURATES
Sedation
Delirium Epilepsy Coma, death
BENZODIAZEPINES
Antianxiety
Anxiety
Sedation
Irritability insomnia
AMPHETAMINES, COCAINE Arousal
OPIOIDS
Fatigue
Euphoria
Dysphoria
Euphoria
Nausea, vomiting
Apathy
Sweating, fever Muscle aches
LSD
Hallucinations Anxiety Paranoid ideas
NONE
