1. Signs and symptoms of Digitalis Toxicity: 0-8-2ng/ml -fatigue -nausea/vomiting, -changes in heart rate and rhythm -loss of appetite (anorexia) (anorexia) -diarrhea -visual disturbances (yellow or green halos around obects) -confusion -di!!iness -nightmares -agitation and/or depression, as well as a higher acute sense of sensual activities. -"ypersalivation #. Signs and symptoms of Magnesium Sulfate Toxicity: -$xcess magnesium sulfate results in magnesium sulfate toxicity, toxicity, which results in both respiratory respiratory depression and a loss of deep tendo ten don n re%exes re %exes (hypore hyp ore%exi %exia a). -visual disturbances and facial %ushing. -nasal stu&ness and chest pain. -gastrointestinal upset. '. Side eects of Nitroglycerine (oxic $ect)* -tingling sensation -di!!iness, headache, light-headedness, worsened angina pain and %ushing. -+are itroglycerin itroglycerin side eects may include dry mouth, diarrhea, fainting, heart pounding, low blood pressure, pressure, nausea, vomiting, pallor, restlessness, restlessness, severe allergic reactions, rash, sweating, vertigo, fatigue, and numbness. . Signs and symptoms of Thyrotoxic Crisis: -uncontrolled fever, increased , 0ncreased +/"+ . Signs and symptoms of Angina ectoris: -chest pain/discomfort characteri!ed by pressure, pressure, heaviness, tightness, s2uee!ing, burning, or cho3ing sensation. -4part from chest discomfort, anginal pains may also be experienced experienced in the e!igastrium (upper central abdomen), bac3, nec3 area, aw, or shoulders. -ain may be accompanied by breathlessness, sweating and nausea
"y!o#alemia: $%&-'%( 5. Signs and Symptoms of "y!o#alemia: -muscle wea3ness, muscle aches, and muscle cramps.
-palpitations (irregular heartbeats) may be experienced by the patient. 0n severe cases, hypo3alemia can lead to dangerous disturbances in heart rhythm (arrhythmias).
6. Signs and symptoms "y!er#alemia: $xtreme hyper3alemia is a me)ical emergency due to the ris3 of potentially fatal abnormal heart rhythms (arrhythmia ). - Symptoms are fairly nonspeci7c and generally include malaise, !al!itations and muscle *ea#ness8 mild hyperventilation may meta+olic aci)osis , which indicate a compensatory response to is one of the possible causes of hyper3alemia. 9ften, however, the problem is detected during screening +loo) tests for a medical disorder, or it only comes to medical attention after complications have developed, such as car)iac arrhythmia or su))en )eath. :. osition of atient after ,ier .io!sy: -lace the patient on right lateral position and place folded towel on the punctured site for at least ' hours to provide pressure on the site and prevent bleeding. ;. "ow to reduce odor from Colonosco!y - diet modi7cation 1<. =omplication ost Thyroi)ectomy: ->onitor for respiratory distress -"ave a tracheostomy set, oxygen, and suction at the bedside. ->onitor surgical site for edema and for signs of bleeding8 chec3 dressing anteriorly and the bac3 of the nec3. -?imit client tal3ing, and asess level of hoarseness. ->onitor for laryngeal nerve damage, as evidenced by respiratory obstruction, dysphonia, high-pitched voice, stridor, dysphagia, and restlessness. ->onitor for signs of hypocalcemia and tetany, which can be due to trauma to the parathyroid gland -repare to administer calcium gluconate as prescribed for tetany. ->onitor for thyroid storm -$levated temperature -achycardia -Systolic hypertension -ausea, vomiting, and diarrhea -4gitation, tremors, anxiety -0rritability, agitation, restlessness, confusion, and sei!ures as the condition progresses
-@elirium and coma 11. ursing management for enous ,eg 1lcer: -=ompression and elevation of aected leg 1#. Dee! ein Throm+osis - is the formation of a blood clot (AthrombusA) in a deep vein. 0t is a form of thrombophlebitis (in%ammation of a vein with clot formation). - Anticoagulation is the usual treatment for @B. 0n general, patients are initiated on a brief course (i.e., less than a wee3) of he!arin treatment while they start on a '- to 5month course of *arfarin (or related itamin inhibitors). 1'. 4pproach to patient on Manic State: -give 7nger foods 1. Chat is the by-product of rotein )igestion -Drea and Dric 4cid 1. Chy you should not administer oxygen on high concentration for patients with =9@E -so as not to reverse the "ypoxic drive for breathing 15. >anagement of patient after 3S4, 53xtracor!oreal shoc# *ae lithotri!sy6: - $xtracorporeal shoc3 wave lithotripsy ($SC?) uses shoc3 waves to stone into small pieces that can more easily travel brea3 a #i)ney through the urinary tract and pass from the body. - 0t may ta3e a few days or wee3s for all the stone fragments to pass from your body. Fou may have mild pain as the small fragments pass through the urinary tract. - =omplications of $SC? include* • •
ain caused by the passage of stone fragments. loc3ed urine %ow as a result of stone fragments becoming stuc3 in the urinary tract. he fragments may then need to be removed with a ureteroscope.
•
Drinary tract infection.
•
leeding around the outside of the 3idney.
16. riority ursing >anagement for Sic#le Cell Crisis:
- sic3le cell disease results from mutation, or change, of certain types of hemoglobin chains in red blood cells (the beta hemoglobin chains). he changes in the building of normal hemoglobin result in the abnormal hemoglobin of sic3le cell disease. hese mutated molecules do not have the smooth motion needed for oxygenation and deoxygenation. Chen the oxygen concentration in the blood is reduced, the red blood cell assumes the characteristic sic3le shape. his causes the red blood cell to be sti and rigid, and stops the smooth passage of the red blood cells through the narrow blood vessels. -eople with sic3le cell disease often suer from vaso-occlusive crisis. 0t is caused when the abnormal red blood cells begin to restrict blood %ow to the organs and obstruct capillaries. 4 person suering from vaso-occlusive crisis experiences intense pain, ischemia, and most of the time, organ damage. Sometimes the condition is called Gpainful crisisH, with the fre2uency and severity of the crisis periods varying from time to time. - ainful crises are treated symptomatically with analgesics8 pain management re2uires opioid administration at regular intervals until the crisis has settled. Ior milder crises, a subgroup of patients manage on S40@s (such as diclofenac or naproxen). Ior more severe crises, most patients re2uire inpatient management for intravenous opioids8 patientcontrolled analgesia (=4) devices are commonly used in this setting. @iphenhydramine is also an eective agent that is fre2uently prescribed by doctors in order to help control any itching associated with the use of opioids.
1:. "ow to approach patient with Al7heimers Disease -establish routine activities, reorient the patient, reinforce/identify retained s3ills. 1;. Signs and symptoms of Congestie "eart 9ailure 5C"96: - =ongestive heart failure (="I) is a condition in which the heartJs function as a pump is inade2uate to deliver oxygen rich blood to the body. =ongestive heart failure can be caused by* 1. diseases that wea3en the heart muscle, #. diseases that cause stiening of the heart muscles, or '. diseases that increase oxygen demand by the body tissue beyond the capability of the heart to deliver ade2uate oxygen-rich blood. -Signs and Symptoms*
- 4n early symptom of congestive heart failure is fatigue. - 4s the body becomes overloaded with %uid from congestive heart failure, swelling (edema) of the an3les and legs or abdomen may be noticed. his can be referred to as Aright sided heart failureA as failure of the right sided heart chambers to pump venous blood to the lungs to ac2uire oxygen results in buildup of this %uid in gravity-dependent areas such as in the legs. -in addition, %uid may accumulate in the lungs, thereby causing shortness of breath, particularly during exercise and when lying %at. 0n some instances, patients are awa3ened at night, gasping for air. - he extra %uid in the body may cause increased urination, particularly at night. - 4ccumulation of %uid in the liver and intestines may cause nausea, abdominal pain, and decreased appetite. #<. ursing >anagement after Car)iac Catheteri7ation: -prevent bleeding on the open wound (catheter port), apply pressure. -monitor cardiac rate -bed restKfor upper extremity until B/S are stable, for lower extremity for # hours. #1. ursing +esponsibility in Delegation: -the delegator delegates the tas3, not the responsibility ##. 0mmediate action when you hear two employees tal3ing about patientLs condition* -call their attention, remember patientLs con7dentiality #'. 0mmediate action when you saw an employee ta3ing patientLs meds from medication cabinet* -call the employeeLs attention
#. Cerer+oascular Acci)ent* interruption of blood supply to any part of the brain, causing the brain cells to die. 4lso called .rain Stro#e;% - he bloc3age of an artery in the brain by a clot (thrombosis) is the most common cause of a stro3e. he part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. 4s a result of the deprived blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops wor3ing. -Symptoms of Stro3e* - Sudden numbness or wea3ness of the face, arm or leg, especially on one side of the body. he loss of voluntary
movement and/or sensation may be complete or partial. here may be an associated tingling sensation in the aected area. - Sudden confusion or trouble spea3ing or understanding. Sometimes wea3ness in the muscles of the face can cause drooling. - Sudden trouble seeing in one or both eyes - Sudden trouble wal3ing, di!!iness, loss of balance or coordination - Sudden, severe headache with no 3nown cause. #. Menieres Disease- aects the inner ear. -is a disorder of the inner ear that can aect hearing and balance to a varying degree. 0t is characteri!ed by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear -due to imbalance of endolymphatic %uids -+is3 factors * increased altitudes, pilots, deep sea diving #5. ar#insons Disease: - 4 generative disease caused by the depletion of dopamine, which interferes with the inhibition of excitatory impulses. -+esults in a dysfunction of the extrapyramidal system. -Slow progressive disease that results in a crippling disability. -he debilitation can result in falls, self-care de7cits, failure of body systems, and depression. ->ental deterioration occurs late in the disease. 4ssessment* -rady3inesia - abnormal slowness of movement, and sluggishness of physical and mental responses. -43inesia M inability to initiate movements ->onotonous speech -"andwriting that becomes progressively smaller -remors in hands and 7nger at rest (pill rolling) -remors increasing when fatigued and decreasing with purposeful activity or sleep -+igidity with er3y interrupted movements -+estlessness and pacing -lan3 facial expression-mas3 li3e face -@rooling -@i&culty in swallowing and spea3ing -?oss of coordination and balance. -ShuNing steps, stooped position, and propulsive gait 0ntervention* -4ssess neurological status -4ssess ability to swallow and chew
-rovide high calorie, high protein, high 7ber, soft diet with small fre2uent feedings. -0ncrease %uid inta3e to #?/day ->onitor constipation -romote independence along with safety measures -4void rushing the client with activities -4ssist in ambulation and provide assistive devices -4dminister anticholinergic medication to treat tremors and rigidity and to inhibit action of acetylcholine -4dminister antipar3insonian meds to increase the dopamine in the =S -4void vitamin 5 and monoamine oxidase inhibitors. #6. =ommon complication of using ,aryngosco!e * -ro3en tooth #:. $arly Signs and symptoms of
•
olyuria - fre2uent urination
•
lurred vision
•
Iatigue (sleepiness)
•
Ceight loss
•
oor wound healing (cuts, scrapes, etc.)
•
@ry mouth
•
@ry or itchy s3in
•
ingling in feet or heels
•
$rectile dysfunction
•
+ecurrent infections external ear infections (swimmerJs ear)
•
=ardiac arrhythmia
•
Stupor
•
=oma
'1. Signs and symptoms of "y!oglycemia: Sha3iness, anxiety, nervousness alpitations, tachycardia • •
•
Sweating, feeling of warmth (although sweat glands have muscarinic receptors, thus Aadrenergic manifestationsA is not entirely accurate)
•
allor, coldness, clamminess
•
@ilated pupils (mydriasis)
•
Ieeling of numbness Apins and needlesA (paresthesia)
•
4bnormal mentation, impaired udgment
•
onspeci7c dysphoria, moodiness, depression, crying, exaggerated concerns
•
egativism, irritability, belligerence, combativeness, rage
•
ersonality change, emotional lability
•
Iatigue, wea3ness, apathy, lethargy, daydreaming, sleep
•
=onfusion, amnesia, di!!iness, delirium
•
Staring, AglassyA loo3, blurred vision, double vision
•
Ilashes of light in the 7eld of vision
•
4utomatic behavior, also 3nown as automatism
•
@i&culty spea3ing, slurred speech
•
4taxia, incoordination, sometimes mista3en for Adrun3ennessA
•
Iocal or general motor de7cit, paralysis, hemiparesis
•
aresthesia, headache
•
Stupor, coma, abnormal breathing
•
Oenerali!ed or focal sei!ures
'#. Signs and Symptoms of Myocar)ial
. 4nesthetic complications 5. 0nfection 6. Stitch granuloma :. "aemorrhage/"ematoma o
his may compress the airway, becoming life-threatening. 4 suture removal 3it should be 3ept at the bedside throughout the postoperative hospital stay.
;. Surgical scar/3eloid ->angement*
• •
• •
•
• •
->onitor for respiratory distress "ave a tracheostomy set, oxygen, and suction at the bedside. >onitor surgical site for edema and for signs of bleeding8 chec3 dressing anteriorly and the bac3 of the nec3. ?imit client tal3ing, and asess level of hoarseness. >onitor for laryngeal nerve damage, as evidenced by respiratory obstruction, dysphonia, high-pitched voice, stridor, dysphagia, and restlessness. >onitor for signs of hypocalcemia and tetany, which can be due to trauma to the parathyroid gland repare to administer calcium gluconate as prescribed for tetany. >onitor for thyroid storm $levated temperature achycardia Systolic hypertension ausea, vomiting, and diarrhea 4gitation, tremors, anxiety 0rritability, agitation, restlessness, confusion, and sei!ures as the condition progresses @elirium and coma
'. ursing >anagement for =e))ene) s#in surface: '. 4pproach on De!resse) atient* '5. Chat is the focus of nursing management on an infant on actie sei7ure
-Safety '6. Chat ?aboratory test determines the therapeutic level of Couma)in 54arfarin6 -, 0+ (tQ;.5-11.:) (0+Q1.'-#) ':. asic
s Syn)rome 4shermanJs syndrome is a rare complication of a @R=. he syndrome involves scarring and adhesions in the uterus that can cause fertility problems and further miscarriages.
<. Chere is the A!ical !ulse locatedE -heard at the apex of the heart using a sthetoscope.
1. @rug of =hoice for ?ral Thrush: -4nti-fungals (@i%ucan, i!oral, >ycostatin, etc.) #. ursing intervention for ost Coronary Angiogram: - 4n angiogram is an -ray image of blood vessels after they are 7lled with a contrast material. 4n angiogram of the heart, a coronary angiogram, is the Agold standardA for the evaluation of coronary artery disease (=4@). 4 coronary angiogram can be used to identify the exact location and severity of =4@. '. ,eu#emia: - is a type of cancer of the blood or bone marrow characteri!ed by an abnormal increase of white blood cells. -=hec3 == . Anemia: - is a decrease in number of red blood cells (+=s) or less than the normal 2uantity of hemoglobin in the blood. -=hec3 == . =are for patient with Chest Tu+e:
b. c.
d.
e.
f.
4ssess patient for respiratory distress and chest pain, breath sounds over aected lung area, and stable vital signs 9bserve for increase respiratory distress 9bserve the following* (1) =hest tube dressing, ensure tubing is patent (#) ubing 3in3s, dependent loops or clots (') =hest drainage system, which should be upright and below level of tube insertion rovide two shodded hemostats for each chest tube, attached to top of patientLs bed with adhesive tape. =hest tubes are only clamped under speci7c circumstances* (1) o assess air lea3 (#) o 2uic3ly empty or change collection bottle or chamber8 performed by soldier medic who has received training in procedure (') o change disposable systems8 have new system ready to be connected before clamping tube so that transfer can be rapid and drainage system reestablished () o change a bro3en water-seal bottle in the event that no sterile solution container is available () o assess if patient is ready to have chest tube removed (which is done by physicianLs order)8 the solider medic must monitor patient for recreation of pneumothorax osition the patient to permit optimal drainage (1) Semi-IlowerLs position to evacuate air (pneumothorax) (#) "igh IlowerLs position to drain %uid (hemothorax) >aintain tube connection between chest and drainage tubes intact and taped
(1) (#) g. h.
Cater-seal vent must be without occlusion Suction-control chamber vent must be without occlusion when suction is used =oil excess tubing on mattress next to patient. Secure with rubber band and safety pin or systemLs clamp 4dust tubing to hang in straight line from top of mattress to drainage chamber. 0f chest tube is draining %uid, indicate time (e.g., <;<<) that drainage was begun on drainage bottleLs adhesive tape or on write-on surface of disposable commercial system (1) Strip or mil3 chest tube only per >@/4 orders only (#) Iollow local policy for this procedure.
5. "ow to prevent Dum!ing Syn)rome - is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. 0t happens when the upper end of the small intestine, the duodenum, expands too 2uic3ly due to the presence of hyperosmolar (substances with increased osmolarity) food from the stomach. - @umping syndrome is largely avoidable by avoiding certain foods that are li3ely to cause it, therefore having a balanced diet is important. reatment includes changes in eating habits and medication. eople who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, avoiding simple sugars, and should drin3 li2uids between meals, not with them. Iiber delays gastric emptying and reduces insulin pea3s. 6. .reast Mastectomy Me)ications * -ain management :. osition of atient after =enal .io!sy: - 4fter the test, patients lie on their bac3s in the hospital for a few hours. atients who have a transplanted 3idney lie on their stomachs. @uring this time, the sta will monitor blood pressure and pulse and ta3e blood samples to assess for blood loss. 9n rare occasions when bleeding does not stop on its own, a transfusion may be necessary to replace lost blood. >ost patients leave the hospital the same day. atients may notice some blood in their urine for # hours after the test. 4 rare complication is infection from the biopsy. atients should tell their doctors or nurses if they have any of these problems*
•
bloody urine more than # hours after the test inability to urinate
•
fever
•
worsening pain in the biopsy site
•
faintness or di!!iness
•
;. A)erse 3@ect of =is!eri)al* - is an atypical antipsychotic drug often prescribed for treatment of schi!ophrenia and the psychotic features of bipolar disorder and other mental illnesses.
Dro*siness @rowsiness and increased need for sleep are common side eects of +isperdal. 0f these side eects become bothersome, discuss what options are available to you with your physician. .la))er Control 0ncontinence occurs in some individuals that ta3e +isperdal. 0f this occurs, contact your physician about alternatives that are available. 4eight ain Ceight gain can occur when ta3ing +isperdal. 0ncreased appetite is commonly reported among individuals ta3ing +isperdal. $ating a balanced diet and regular exercise can help lessen the severity of weight gain. Dia+etes +is3 of developing diabetes increases when ta3ing +isperdal. eing overweight and having a family history of diabetes increase this ris3. =lose monitoring of diabetes is necessary for diabetics ta3ing this medication. Tar)ie Dys#inesia ardive @ys3inesia (@) is a side eect that involves involuntary muscle movement. 0f you experience this side eect, contact your physician immediately, since it can become permanent. Neurole!tic Malignant Syn)rome 4ntipsychotic medications, including +isperdal, are associated with development of euroleptic >alignant Syndrome (>S). >S symptoms include fever, muscle rigidity, high blood o
o
o
o
o
o
pressure, confusion, and tremors. 4lthough rare, >S can be fatal. <. Delirium - (acute confusional state) is a common and severe neuropsychiatric syndrome with core features of acute onset and %uctuating course, attentional de7cits and generali!ed severe disorgani!ation of behavior. 0t typically involves other cognitive de7cits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual de7cits, altered sleep-wa3e cycle, and psychotic features such as hallucinations and delusions.
1. Com!utations: -'P solution in 5<
