Chest X ray painless procedure Bronchoscopy o AtSO4 Anticholinergic mimics SNR Decreases saliva dry mouth o NPO 6 to 8 hours

hours o Local anesthesia check gag re le! "e ore eeding ABG o #yperventilation decreased $O% increased "lood p# respiratory alkalosis o #ypoventilation increased $O% decreased "lood p# respiratory acidosis o Diarrhea decreased #$O& decreased "lood p# meta"olic acidosis o 'omiting gastric content decreased #$L increased "lood p# meta"olic alkalosis o 'omiting "lood decreased O% anaero"ic meta"olism ormation o lactic acid decreased "lood p# meta"olic acidosis o (lood p# normal )*&+ to )*4+ , increased alkalosis- , decreased acidosis o Partial $O% normal &+ to 4+ , increased Respiratory Acidosis- i decreased Respiratory Alkalosis o Partial #$O& normal %% to %6 , increased .eta"olic alkalosis- , decreased meta"olic acidosis Cancer of the larynx $S/ alcohol and over usage o voice 0choir mem"er1 o A 2 nterior neck mass o ( 3 urning sensation 4ith hot "everages 5 (ad "reath o $ 2 hange in the voice 0hoarseness1 o D 3 ysphagia5dyspnea Chronic Obstructive Pulmonary Disease o $hronic (ronchitis (lue "loater 6!cessive mucus production o Asthma Periods o "ronchospasm and "ronchoconstriction o 6mphysema Dise7uili"rium o elastase and antielastase Pink pu er o .ani estations

A 3 L86RA8,ON ,N
LO$ decreased O% 8horacic anatomy over distention o alveoli 8D 9 APD "arrel chest

Skin o 8emperature cool clammy skin o $olor pale to cyanotic A(: Respiratory acidosis ,ncreased $O%

iculty/ purse lip e!piration > inhalation removal o e!cess $O% 0diet lo4 $#O1 C 3 ough 0mucus production1- $hronic hypo!ia 0% to & lpm o O% therapy/ decreased O% demand "y rest and S;;1 clu""ing o the ingers and decreased 8P to the kidneys causing polycythemia D 3 ecreased .eta"olism Anore!ia 4eight loss 0high calorie diet1 atigue 4eakness Bronchodilators o 8heophylline and aminophylline Primary e ect stimulates "eta % receptors smooth muscle rela!ation "ronchodilation Side e ect stimulates "eta < receptors increases cardiac rate need not to noti y the physician Adverse e ect hypotension monitor (P sign o to!icity 6valuation check "reath sounds Acute Respiratory Distress yndrome o $auses

B 3 reathing di

A 3 spiration R 3 espiratory trauma 0em"olism1

racture em"olism ARDS

D 3 rug to!icity 0ASA1

3 epsis and shock 'omiting/ "leeding/ dehydration hypovolemia shock ARDS

o Syndrome Severe hypo!ia (ilateral in iltrates Dyspnea Pulmonary embolism o Restlessness earliest !ater eal ystem o Drainage (ottle marked the level every shi t o =ater seal "ottle Presence o luctuation normal

A"sence o luctuation lungs are ully e!panded assess first patient "X ray confirm# OR presence o o"struction ,ntermittent "u""ling normal A"sent o"struction $ontinuous leakage o Suction $ontrol continuous "u""ling normal Ris$ factors for cardiovascular disorders o R 3 ace non modi ia"le o o o o o o

% 3 ncresed "lood pressure modi ia"le

3 tress SNR increased (P and $R/ vasoconstriction modi ia"le

& 3 no4ing sedentary li e style modi ia"le ' 3 at oods atherosclerosis modi ia"le A 3 lcohol 0modi ia"le1 5 Age a"ove 4> 0non modi ia"le1 C 3 igarette smoking vasoconstriction 0nicotine1 modi ia"le 5 $ontraceptive

pills clotting o "lood throm"us ormation o ( 3 ype A "ehavior 0modi ia"le1 competitiveness/ per ectionist high stress level o O 3 "esity o o

R 3 esult o

D. lipolysis increased atty acids atherosclerosis

3 e! gender males ? emale 0"e ore menopausal "ecause estrogen decreases P'R1 a ter menopausal emale eversi"le@Ainverted 8 4aveB ,nCury Aelevated S8 segmentB ? male Decreased 8P in heart %schemia "An)ina# Dr necrosis "*%# Dirreversi"le@ Apathologic E 4ave5permanent in the 6$:B 6ating a heavy meal/ strenuous e!ercise/ se!/ e!posure to cold Decreased "lood lo4 0heart1 decreased 8P 0heart1 decreased O% 0heart1 anaero"ic respiration production o lactic acid PA%+ management decreased O% demand "y rest and S;; An)ina o Pain relieved "y rest and N8: o N8: 'asodilation orthostatic hypotention move gradually .onitor (P Store in a dark and am"er container 6 ective tingling sensation no need to noti y physician .a!imum o & ta"lets 4ith + minute interval *% o Pain relieved "y .orphine SO4

Narcotic analgesic $an cause respiratory depression monitor RR and O% saturation Antidote narcan Cardioversion synchronous Defibrillation unsynchronous Buer)er,s disease $S vasoconstriction stop $S common in men Raynaud,s stress and cold vasoconstriction common in emale Con)estive heart failure o Le t sided pulmonary Dyspnea $rackles Polycythemia due to decrease O% to the kidneys $lu""ing o the ingers due to prolonged hy!ia Orthopnea o Right sided systemic #epatomegaly Distended neck veins 6dema Portal hypertension Ascites 4eight gain 'aricose veins o Digo!in $ardiac glycoside Positive inotrophic e ect increased strength o myocardial contraction Negative chronotrophic e ect decreased cardiac rate monitor $R never give i $R "elo4 6> "pm Adverse e ect - 3 omitting A 3 nore!ia + 3 ausea D 3 iarrhea A 3 "dominal pain R.*.*B.RF earliest :,- late halo vision Antidote Di)ibind Decreased RBC Activity in tolerance/ 'ati)ue/ provide rest/ Anemia Decreased Platelets Prone to bleedin)/ avoid parenteral in0ection/ appl pressure on in0ection site/ hi)h ris$ for in0ury Decreased !BC prone to infection/ reverse isolation %ncreased !BC presence of infection 'irst Day1+e2ly dia)nosed &no2led)e deficit

Diuretic

o o o o o o o o

D 3 iet high G diet e!cept aldactone % 3 input and Output e!pected increased output 3 3 ndesira"le e ect electrolyte im"alance 0G1 R 3 ecord 4eight e!pected decreased 4eight . 3 lderly special precaution ( 3 ake in A. and 4ith ood % 3 ncreased orthostatic hypotension monitor (P and move gradually C 3 ancel alcohol "ecause o mild diuretic e ect

4eparin anticoagulant prevent urther enlargement o clot not dissolve them monitor AP885P88 antidote protamine SO4 Coumadin anticoagulant prevent urther enlargement o clot not dissolve it monitor P8 vitamin G is the antidote 3ro$inase1 treptoase dissolves the clot Pernicious anemia a"sence o intrinsic actor 0gastric surgery1 pro"lem in a"sorption o 'itamin (<% "ee y red tongue schillingHs test de initive test %4 hour urine collection li e long 'itamin (<% Gastritis LIE pain Gastric ulcer a ected area stomach pain 0precipitated "y ood intake increased #$l1 pain relieved "y antacids Duodenal ulcer a ected area duodenum pain 0% hour a ter eating1 pain relieved "y ood 3lcers "leeding 0J1 occult "lood test 0guiac1 high i"er diet/ avoid red meat/ iron/ steroids/ NSA,Ds/ indomethacin -a)otomy resection o vagus nerve decreased cholinergic stimulation decreased #$l and gastric movement Dumpin) syndrome tachycardia and 4eakness & DHs 0diarrhea/ diaphoresis and diKKiness1 luids a ter meals/ lie do4n a ter meals and S;; Appendicitis RLE pain avoid heat pads cause rupture signs o ruptured appendi! sudden cessation o pain/ elevation o temperature and =($ Diverticulitis LLE pain lo4 i"er diet Diverticulosis high i"er diet 3lcerative colitis "loody diarrhea %> to &> times a day luid volume de icit 5iver cirrhosis alcohol and malnutrition "laanec,s#/ in ection and drugs "post necrotic#/ RS$#; "cardiac# and "iliary o"struction "biliary# o Portal hypertention can lead to (lood shi ted to the di erent collateral 6sophageal varices Spider angioma 0 ace and neck1 $aput medusae 0a"domen1 #emorrhoids 0rectal1 .anagement avoid rupture avoid shouting/ valsalva maneuver

,ncreased hydstatic pressure luid shi ting ascites o Decreased al"umin decreased oncotic 5 colloidal osmotic pressure luid shi ting ascites mana)ement hi)h protein diet o $#ON meta"olism "y product ammonia liver cannot convert to urea increased level o ammonia in the "rain Alteration o LO$ and changes o "ehavior and astere!is hepatic encephalopathy mana)ement lo2 C4O+ diet and lactulose for removal of ammonia 4epatitis A ecal oral prone plum"er 4epatitis B "ody secretion prone 4orking in a dialysis Cholecystitis + ;Hs 0 air/ emale/ at/ ertile and orty1 R36 pain a ter ingestion o atty ood demerol to relieved pain Cholecystectomy 8 tu"e level o the incision site drain e!cess "ile Pancreatitis alcohol autodigestion 536 pain Anterior Pituitary )land o :ro4th hormone ,ncreased "e ore the closure o the epiphysis o the long "ones gigantism tall ,ncreased a ter the closure o the epiphysis acromegaly "ig hands 0"ig gloves1/ "ig eet 0"ig shoes1 and "ig head 0"ig hat1 Decreased d4ar ism o Prolactin ,ncreased galactorrhea Decreased decreased milk production o A$8# ,ncreased secondary cushingHs Decreased secondary addisonHs o 8S# ,ncreased secondary hypethyroidism Decreased secondary hypothyroidism

Posterior pituitary )land o AD# ,ncreased 4ater retention oliguria edema 0 luid volume e!cess1 and 4eight gain concentrated urine increased urine speci ic gravity Decreased 4ater e!cretion polyuria dehydration 0 luid volume de icit and 4eight loss1 diluted urine decreased urine speci ic gravity Parathyroid )land o Parathormone ,ncreased increased calcium in the "lood and decrease calcium in the "ones stone ormation and decreased "one mass osteoporosis management increased 4ater intake Decreased hypocalcemia calcium supplement

 (hyroid Gland o ,ncreased 0hyperthyroidism1 8& and 84 increased (.R hyperactive ina"ility to ocus insomia increased cata"olism 4eight loss increased appetite increased peristalsis Diarrhea luid volume de icit ,ncreased $R and RR 0due to increased (.R1 ,ncreased 8& heat intolerance $alcitonin decreased calcium in the "lood tetany compensatory calcium 4ithdra4s rom the "ones "one destruction 0complication1 P8I decreased synthesis o 8# 4atch out or S6 0similar to signs and symptoms o hypothyroidism1 4atch out or agrunulocytosis 0 ever/ skin rash and sore throat1 LugolHs solution decreased released o 8# "e ore thyroidectomy decreased vascularity o the thyroid gland o Decreased 0hypothyroidism1 8& and 84 decreased (.R hypoactive sleeps a lot decreased meta"olism 4eight gain anore!ia decreased peristalsis constipation decreased $R and RR due to decreased (.R 8& cold intolerance $alcitonin hypercalcemia stone ormation Synthroid and Proloid increased 8# Adrenal Gland o ,ncresead 0cushingHs1 :lucocorticoids hyperglycemia and decrease 4ound healing .ineral corticoids increased aldosterone sodium retention and potassium e!cretion hypernatremia and hypokalemia #ypernatremia 4ater retention oliguria edema 0moon ace/"u alohump/ luid volume e!cess and 4eight gain1 concentrated urine increased urine speci ic gravity lo4 sodium diet #ypokalemia 4eakness Prominent I 4ave high potassium diet 6pinephrine and Norepinephrine ,ncreased (P and $R Se! hormones .ales gynecomastia and alling o hair ;emales hirsutism and deepening o the voice o Decreased 0addisons1 :lucocorticoids hypoglycemia and ina"ility to cope 4ith stress .ineralcorticoids decreased aldosterone sodium e!cretion and potassium retention hyponatremia and hyperkalemia

#yponatremia 4ater e!cretion polyuria 0dehydration/ luid volume de icit and 4eight loss1 diluted urine 22* Decreased urine speci ic gravity increased luids and Na #yperkalemia 4eakness tall or peaked 8 4aves lo4 G diet 6pinephrine and Norepinephrine decreased (P and $R Diabetes *ellitus o 8ype , a"solutely no insulin thin insulin o 8ype ,, insu icient insulin o"ese O#A o Diet +>L $#O/ &>L ;ats/ %>L $#ON o 6!ercise ,ncreased uptake o glucose Decreased insulin re7uirement o Oral hypoglycemic agent 0O#A1 Stimulates pancreas to produce insulin o ,nsulin S$- ,' i DGA Never massage the area Never administer cold insulin Rotate the site o inCection .i! Aspirate clear irst ,nCect air to cloudy irst PR.-.+( 5%POD7 (ROP47

o #ypoglycemia ! 3 eakness 4 3 unger pangs A 3 alteration o LO$ ( 3 achycardia and tremors A 3 "dominal pain B 3 "lurring o vision C 3 ool clammy skin D 3 iaphoresis :ive orange Cuice "simple su)ars# D&A increased lipolysis increased ketones #yperglycemia polyuria/ polydipsia/ polyphagia/ kussmaul "reathing/ glycosuria/ ketonuria and 4arm lush skin :lycosylated hemoglo"in re lect (SL or the past & to 4 months most accurate ;oot care

o o o o

Podiatrist Avoid removing corns and calluses $ut toe nails straight across Avoid 4alking "are oot 4epatitis A ecal oral 4epatitis B "ody and "loody secretions 0hemodialysis1 Peritoneal Dialysis o Diasylate output is decreased turn patient rom side to side o $omplication in ection monitor =($ and temperature/ diasylate is cloudy "oardlike and rigid a"domen peritonitis o DonHt include diasylate solution in the output o the client o 6!pected decreased 4eight monitor 4eight "e ore and a ter decreased createnine and (IN 4eart bloc$ decreased tissue perfusion Par$inson,s diasease o Decreased dopamine in the "asal ganglia levodopa to increased dopamine avoid 'it (6 oods o $ardinals signs tremors 0non intentional1 muscle rigidity "radykinesia o Pill rolling o .icrophonia ask your client to speak aloud to "e a4are o Artane and $ogentin anticholinergic decreased muscle rigidity *yasthenia Gravis o 8ensilon test con irmatory test o Decreased Acetylcholine and increased cholinesterase o .uscle 4eakness priority air4ay o NO tran7uiliKer/ .orphine SO4/ .uscle rela!ant and neomycin o $holinergics 0mestinon1 increased muscle strength antidote A8SO4 Indermedication myasthenic crisis give cholinergics Over medication cholinergic crisis give A8SO4 *ultiple clerosis o DemyeliniKation o the myelin sheath o $harcoatHs triad ,ntentional tremors Scanning o speech Nystagmus o 'isual distur"ances diplopia Pancreatitis autodigestion alcohol "leeding shock o 6levated amylase Rheumatoid Arthritis o No speci ic diagnostic test o NSA,DHs and A A "antipyretic/ anal)esic and anti8inflammatory#

o Synovitis Pannus ormation i"rous ankylosis 0limited Coint movement1 (ony ankylosis 0Coint i!ation1 o Avoid le!ion and promote prone position Gouty Arthritis o ,ncreased uric acid allopurinol and avoid organ meats 0liver1 tophi 0ears1 Osteoarthritis o .ost common related 4ith aging o Pain a ter 4eight "earing e!ercise or activity rest to relieved pain 4eight reduction Diverticulitis LLE pain and lo4 i"er diet Cyclophosphamide "Cytoxan# can cause hemorrhagic cystitis to avoid increased luid intake -incristine "Oncovin# increased i"er in the diet %ron supplement =hen is the "est time to take 0empty stomach1/ #o4 is "est taken 04ith orange Cuice1 teroids and + A%D,s o D.A(4 inflammation o B%R(4 side effects B 3 one marro4 depression prone to in ection monitor temperature and =($ % 3 ncreased gastric irritation take it 4ith ood or a ter meals R 3 enal to!icity ( 9 innitus 4 3 epato to!ic Cataract common cause is aging 0senile1 opacity o the lens position on the una ected side Glaucoma increased ,OP decreased o peripheral vision irst halo/ tunnel and gun "arrel vision miotics 0constricts pupils1 avoid A8SO4 0dilates pupil1 Retinal detachment trauma "lood clots loating spots dependent position scleral "uckling Avoid %ncreased %ntraocular pressure PR%OR%(7 o Avoid vomiting/ coughing/ valsalva maneuver/ li ting heavy o"Cects/ "ending/ crying *eniere,s 8riad tinnitus/ impaired hearing loss and vertigo lo4 Na diet o 'ertigo im"alance high risk or inCury decreased vertigo "y ocusing on one side o the room assume a lat or reclining position A A 8th cranial nerve damage tinnitus/ impaired hearing loss and vertigo Antibiotics allergic reactions +ormal -alues o (IN 9 <> 3 %> mg5dl o $alcium 9 M to <>*+ mg5dl o $reatinine 9 + to <*+ mg5dl

o :88 9 )> to <<+ mg5dl o O% sat 9 M) to M8L i)ns and ymptoms of %ncreased %ntracranial Pressure o B 3 lood pressure and temperature are elevated o R 3 espiratory and cardiac rate are decreased o A 3 lteration o LO$ o % 3 rrita"ility o + 3 ote or proCectile vomiting o 3 eiKure