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Airborne:

Measels
Chicken pox/ varicella
Herpes zoster/ shingles
TB
Bird flu
Private room, negative pressure, 6-12 air exhanges per hour with HEPA filter, respiratory protetion
devie !"#$ %al& minimum, wet mas& doesn't protet$
Droplet:
Scarlet Fever
Streptoccocal Pharngitis
Pne!"onia
Pert!ssis
(nfluen)a
Diptheria
*espiratory sunytial virus
#!bella
Meningicocal $isease
M!"ps
Private room or ohort lient, mas& or respirator re+uired
Contact:
M#SA
#S%
%#&
C D'FF
Scabies
Hep A if pooping
Herpes simplex
,almonella
,higellosis
,taph
Private room or ohort lients, gloves, gowns
Stan$ar$:
H(-
HEP B
HEP .
*otavirus
Protective &nviro"ent
!eutropeni patients
Private room , positive pressure with 12 or more air exhanges per hour, HEPA filtration, respirator
mas& gloves and gowns
/on't delegate what you an EA% 0Evaluate, asses, teah1
P-/- *emem2er DA%&- Dependent Arterial, %enous &levated
( gra" o) $iaper *eight+ (", o) )l!i$
3ultiply weight in &ilograms 2y 45 to get the amount of fluid people need daily
B3(6 17$#-2# is normal
,terile proedure- open away from 2ody first
,urgial asepsis- sru2 nails 1# stro&es and fingers with 15 stro&es per side$ *inse from finger to el2ow
8ash hands and rinse for 1# seonds in warm water
9opli& spots- small red spots with 2lue enter$ 3easles$
Anthrax- tx with a2x x 65 days
3ag ,ulfate- monitor :;, don't give 2hr 2efore delivery
Postpartum- %emp elevated x2<hrs, H* dereased x1 w&
=oreps- an lead to hematoma
BPP- he&s 2reathing, 2ody movements, fetal tone, reative =H*, Amnioti fluid volume
Amnioentesis- .he& for fetal anomalies 0down syndrome, %risomy 14>171, =etal maturity and ?,
ration to assess fetal lung
maturity$ @ive rhogam if pt *h negative
.horioni -illi ,ampling- he& for fetal anomalies and geneti defets an 2e done at 17w&s
3aternal Alphafetoprotein ,amplin- ?ow levelsA /own ,yndrome, HighA !eural tu2e defets$ /one
at 16-27 wee&s gestation
.ontrations should 2e 2-4min apart for 65 se$ (f B 2-4 min and C"5 se dD P(% all dr$
Birth weight dou2les 2y 6 months and triples 2y 1 year
Physiologial Eaundie- o& noted after 2#hrs, pea&s on day #
Pathologial Eaundie- 2ad- noted 2efore 2<hrs after 2irth
Hyper2iliru2enia6 A is a level C12mgDd?
!eonate =B, levels6 <5-65 first 2<hr, then #5-"5 after 2#hrs$
!? :; for infant- 1-2mlD&gDhr
Aute infetious diarrhea 0infetious gastroenteritis1- is a result of various 2aterial, viral, andDor
parasiti infetions$ %he onset of gastroenteritis is often a2rupt with rapid loss of fluids and eletrolytes
from persistent vomiting and diarrhea
(nfant 2orn with */, at rDf pneumothorax, give Exosurf 0surfatant1 to prevent
*eyes syndrome- aute enephalopathy- /x with liver 2x$ ?in&ed to aspirin in hildren$
,pinal 2ifida- neural tu2es didn't lose$ !o diapers, prone position
Baterial meningitis- loudy .,= with inreased protein and dereased gluose$
@oodells sign- softening of ervix
.hadwi&s- purpleish olor of vagina
=etal H* P3(- 2reeh6 a2ove BB midline$ .ephali and =ae presentation6 lt or rt side of uterus 2elow
BB$ %ransverse6 2elow
BB midline$ -ertex near symphysis pu2is
,aturate 1 pad per hourA hemorrhage
Epiglottitis- seondary to flu or strep$ A2rupt onset$ 3edial emergeny$ 9id drools$ %ripod position$
Put !othing in mouth$ @ive ool moist oxygen
?aryngotraheo2ronhitis- *,-$ gradual onset, ool vapori)er$
.ysti fi2rosis- resp failure$ /efiient in -it A,/,E,9$ give lots of alories and protein
*heumati fever- preeded 2y strep
,tatus epiliptius- hild may need intu2ation
,oliosis- gradual urvature hange of the verte2rae that may go unnotied 2y parents$
.P%- in hildren should 2e done 1hr 2efore meals$ @ive al2uterol 2efore doing it$
*u2ella virus- an ause left lip
.left lip- sution stuff at 2edside$ El2ow restraints post op
%ransesophageal fistula- 4 's6 ho&ing, oughing, yanosis$ =rothy saliva$ *Df A,P(*A%(;!$ !P;$
(- fluid
Hypertrophi pylori stenosis- visi2le peristalsis$ ProEetile vomiting$ ;live mass on right side$
.elia disease- give iron, foli aid, vit A/E9
Appendiitis- pain in *?F$ PerforatedA relief of pain then more pain$ !; HEA%G .an rupture
Appendetomy- post op- no pain meds or heat and no enema or laxative$ Apply ie only$ ?ay on * side$
!P; until B, return
Hirshprung a&a megaolon- watery explosive diarrhea$ *i22ony stools$ !o meonium$ @ive low fi2er$
.hrons- no 2leeding$ Pt needs diet high in protein and alories and low in fi2er
/9A- rehydration with !,G
@lomerolunephritis- ,%*EPG .loudy, smo&y, 2rown urine$
!ephroti- massive proteinuria$ /on't give salt$
,i&le ell anemia- !; /E3E*;?G @ive morphine or dilaudid$ %reat risis with ;2, hydration, pain
med and rest
Aplasti anemia- 2one marrow not ma&ing 8B.'s, platelets, andDor *B.'s$ sDs6 hypoxia, fatigue,
pallor, inreased infetion, hemorrhage, ehymosis, petehiae, Panytopenia$ @ive
immunosuppressive 0prednisone and ylosporine, or .ytoxan1 and 2one marrow transplant$ Protetive
isolation$
Perniious anemia- -it B12 defiieny$ /iagnosed through a ,hillings test, measures :; of -it B12$
8ill get -it B12 shot one a a wee& for 1 month then monthly for life$
Hemophilia- give fator -(((
Hodg&ins disease- reed stren2erg ells$ Painless node near lavile first sign$
8ilms tumor- measure a2dominal girth daily$ !o palpation
,pider 2ite- ie
,na&e- no ie$ ?evel 2elow heart$ !o movement of extremity
Burns- low !a and High 9 ours$ ,D, sho&$ =ast H* low BP and ?ow .;$ Ht high initially$ 8ill
gain 25l2s the first 4 days$ Antaids daily$ 8t +d$ :se sterile sheets
.ellulitis- warm ompresses
Brahytherapy- pt emits radiation to others
.aner- high temp is always seriousGG
3astetomy- pt should wear gloves on the affeted side $
3ultiple myeloma- a2n plasma invades 2one marrow$ Produe a2normal anti2ody alled 2ene Eones
protein$ High uri aid and .a lead to renal failure$ @et osteoporosis$ @ive fluids$ 3ove arefuly$
%umor lysis syndrome- tumor ells destroyed and uri aid and 9 lea& into 2lood$ @ive (- fluids and
diuretis$ @ive allopurinol$
@ive insulin and gluose to treat hyper&alemia$ EmergenyG ?eads to eletrolyte im2alane and renal
failureG
Aldosterone- always thin& ,odium and 8ater
A/H- thin& water only
Adrenoortiotropin Hormones 0A.%H1 and ortisolA same thing$ Hormones of adrenal ortex$
Addisons- too little Aldosterone, pt has low sugar and !a with high 9 and .a$ Aldosterone ma&es you
retain !a and 8ater 2ut they don't have any so they're loosing !a and H2;H fatigue, musle pain,
wea&ness, Eoint pain, hroni diarrhea, !>-, diminished li2ido, hyperpigmentation, low BP, Pt is fluid
volume defiient$ At ris& for anemia need lifelong gluoortioids0=lorinef1$ High protein > ar2$
Addisonian risis-severe hypotension and vasular ollapse$ ,udden extreme wea&ness, severe a2d,
2a&, > leg pain, hyperpyrexia, oma, death$ ,eondary to infetion, trauma, surgery, stress, P@$ goal
is to prevent irreversi2le sho& and severe hypotension$ 3ay re+uire (- steroids and respiratory
support$
.ushings- too muh aldosterone$ pt has high sugar and !a with low 9 and .a$ Pt has H%!, upper 2ody
o2esity, thin extremities, moon fae, 2uffalo hump, ne& fat, hirsutism, ammenorhae, high triglyerides,
=ragile s&in with purple striae, 2ruise easily osteoporosis$ 3eds6 parlodel, ?ysodren, .ytadren$ High
protein, low ar2$ Put in +uiet environment$
Hyperpititurism- too muh @H$a&a- aromegaly$ Pt has lg hands, feet, deep voie$ ;ily s&in$ !eed
transphenoidal hyposphetomy$ 3eds6 sandostatin, somavert, or permax$ ?ower @H$
%ransphenoidal Hyphospetomy- removal of pituitary tumor$ .he& for ,(A/H post op
/ia2etes (nsipidus-fluid volume defiit on vassopresors for life$ .ant onentrate urine$ have very
onentrated 2lood$
,(A/H- sDs fluid over load$ %hey have ?ow !a$ give hypertoni solution$ Have onentrated urine >
/iluted 2lood$ *estrit fluids$ ,ei)ure preautions$ ,odium infusions, loop or osmoti diuretis$ 3eds6
vasopressin reeptor antagonist6s (= !A B12# - onivaptan, %olvaptan$
Hyperaldosteronism a&a .;!!,- too muh aldosterone$ Pt has ?ow 9 and high !a$ give Aldatone
and (nspra$
Parathyroids- serete P%H whih pulls alium from 2ones to put it in the 2lood$
Hypoparathyroidism- low alium and high phosphorus$ sDs parasthesia, musle ramps, alopeia, dry
2rittle hair and nails,
hovste&s, trosseaus painful menstruation$ 9eep in +uiet environment$ @ive (- alium gluonate$ ;r
oral alium salt s and vitamin /
Hyperparathyroidism- high alium and low phosphorus$ 9idney stones and hyperuriemia,
osteoporosis, polyuria, polydipsia, H%!$ =ore fluids, prevent onstipation, strain urine$ @ive
Pliamyin or alitonin, give ?asix
Hypothyroidism- low %4 and %< high %,H an lead to 3yxedema oma-an our due to rapid
withdrawal of thyroid meds 0synthroid, proloid, ytomel1$ Pt has low BP, sugar, !a, H*$ ?eads to oma
and resp failure
Hyperthyroidism- high %4>%<- thyroid hormones gives us energy, pt has too muh energy$ 0@raves
disease1- the linial manifestations are &nown as thyrotoxiosis$ @ive P%:, Propail, %apa)ole to stop
ma&ing %H's$ @ive (nderal $ Pt irrita2le with soft s&in and hair, &eep in +uiet environment$
%hyroid storm- life threatening$ sDs hyperpyrexia, tahyardia, systoli hypertension$ @ive P%:, 2eta
2lo&ers$ ,,9( 2efore surgery to prevent this from happening$
%hyroidetomy- need lifetime levothyroxine and alium$ 9eep trah tray, sution and ;2 and (-
alium gluonate at 2ed side$
%halassemia- pt has low Hg2$ @ive 2lood transfusion$ Pt is greenDyellow$ Has wide set eyes$ Big
forehead
Polyythemia vera- too many *B.'s$ thi& 2lood$ rDf stro&e$ @ive fluids
*egular insulin- is the only insulin that an 2e give (-$
/9A- B, C455$ @ive (- regular insulin$ ,tart with a 2olus first then a drip$ 8ath 9, it will drop$
Hyperosmolar hyperglyemi non&etoi syndrome- B,C755$ !, alone may treat it$
Pheoromoytoma- 2enign tumor of adrenal medulla$ %he adrenal medulla produes atheolamines
epi and norepi, with this tumor pt is produing too muh whih leads to- H%!G$ /o 2<hr urine to dx
alled -anylmandeli %est, no offee or exerise 2efore test$ /on't palpate tumorDa2domen$ Fuiet
environment$
Esophageal varies- due to portal H%!$ .an &ill if ruptured$
Panreatitis- !P;$ Put in lying &nee-hest position$
:lerative olitis- -it 9 defiient$ !o mil&, fi2er or fruits$ Patient 2leeds$
/ivertiulitis- give low fi2er
Eviseration- put in semi fowlers position with &nees 2ent, over with !, gau)e, all dr statG
/umping syndrome- early signs sweaty and pallor$ Avoid sugar, salt, mil&$ Eat protein and fat > low
ar2$
Hepati enephalopathy- eat low protein$ And high al and ar2$
Barium swallow dye- auses 2owel o2strution$ @ive lax and fluid$ .hal&y poop$
@astri lavage- patient put on left side
!@ insertion- pt put on high fowlers position
!@ deompression or feedings- ,emi fowlers position
Paraentisis- pt voids 2efore proedure, don't want to punture 2ladder$
?iver 2x- put on left side during$ he& P%, P%% and platelets 2efore 2x$ Post put on right side$
.irrhosis- limit exerise$ ?imit sodium inta&e
!onre2reather- gives highest onentration of ;2$ =or pt needing ventilation$
-enturi mas&- most preise
PEEP- greater than 1# an ause 2arotrauma or tension pneumothorax
3ehanial ventilator- pt at ris& for infetion esp pneumonia
A*/,- fluid in alveoli$ .ardinal sign is HIP;JE3(A$ treat the ause$ restrit fluids$ @ive ;2 and
diuretis
Patient have ,evere hypoxemia despite administration of 155K oxygen A systemi inflammatory
response inEures the alveolar-apillary mem2rane$ (t 2eomes permea2le to large moleules, and the
lung spae is filled with fluid$ A redution in surfatant wea&ens the alveoli, whih auses ollapse or
filling of fluid leading to worsening edema$
.;P/- AB@'s show respiratory aidosis$ 3ax ;2 is 2lDmin$ give high al and protein and lots of fluid$
,ever aute resp syndrome- aused 2y oronavirus$ .ontagious$
Air Em2olism- treat with (- heparin
=at em2olism- early symptom6 onfusion$ ?ate6 petehiae over ne&, upper 2ody, hest and a2domen$
treat with heparin
.ompartment- 6P's pain, pressure, paralysis, pallor, pulselessnes, paresthesia$ 3eds don't help$
%B- treatment for 2-4w& then no longer ontagious$
(sonia)id (!H- not given to pt with liver pro2lems
*u2eolaDmeasles- 4.'s ory)a, ough, onEuntivitis$ ,mall red spots with 2lue enter$ Air2orne pt$
*u2ella D@erman measles- &eep away from P@ women$ Air2orne preautions
3umps- parotid glandular swelling$ /ropletDontat pt
/iptheria- 2ullne&-lymphadenitis$ Humidified oxygen$
3ononuleosis- monitor for spleni rupture
.-P6 normal #-15A pressure in right atrium$ High .-PA hypervolemia low .-PA hypovolemia$ %o
measure pt needs to 2e supine on high fowlers$ Iou an measure .-P on patients that are reeiving
2olus fluids to ensure you're not over loading them with fluid$
PA8P- !? <-12$ 3easure right atrial pressure$ Elevations may indiate left ventriular failure or mitral
regurgitation, intraardial shunt, or hypervolemia$ /ereased means hypovolemia$
3AP- must 2e at least 65 for ade+uate organ perfusion$- ,BPL2/BPD4
Pulmonary apillary wedge pressure6 !? 6-12$ measured when 2alloon inflates$ (ndiates ?eft
ventriular end-diastoli pressure$ High means hypervolemia or left ventriular failure and low means
hypovolemia$
,inus 2radyardia- give atropine if it doesn't wor& transutaneous paema&er$ /on't give too muh
atropine 2eause pt will get tahyardia
,inus tahyardia- H* 155-175 rhythm normal$ Eliminate ause$
./<D%<- normal levels 755-1255$ #55 o& in H(- patients$ B#55 is 2ad$ B255 A A(/,$
&C- #&AD'.-S:
P wave- 5$56-5$12
P* interval- 5$12-5$25
F*, interval- B5$12
,% segment- 5$12
% wave- 5$16
F% interval- 5$4<-5$<<
.;- thin& left ventrile$
.AB@- post op restrit fluids to 1#55-2555Dd$
.oartation of aorta- BP higher in :E than ?E$ .ool ?E
Hyperianoti spells- put in &nee hest$ @ive 155 ;2, give morphine sulfate and (- fluids$ (n alm
plae$
P-.- due to affeine, stress or low ;2 0hypoxemia1 or low 9$ give;2, ?idoaine , monitor
potassium$:ntreated P-.'san lead to -=i2
- %ah- H* 1<5-2#5, dereased .;$ an lead to ardia arrest$ %x6 if pt has pulse and no sDs of
dereased .;6 give ;2$ (f pt has pulse and sDs of dereased .; give ;2 and prepare for ardioversion,
as& patient to ough hard every 1-4 seonds for ough .P*$ (f patient has !o pulse6 defi2rillate and
.P*$ @ive Amiodarone or ?ido
- =i2- is fatal if not treated within 4-# minutes, pt has no pulse, BP, heart sound or respirations$ ;2,
.P* and defi2rillation
A fi2- disorgani)ed impulses at 4#5-6552pm$ an lead throm2i formation ausing stro&e or heart
failure$ !o P wave visi2le$ F*, is visi2le$ %x 6 ;xygen, .ardioversion, 2eta 2lo&er, digoxin and
warfarin
3(- E.@ shows ,% elevation and % wave inversion$ Permanent a2normal F wave$
*ight ventriular failure- avoid ,t Mohns 8orth and ?iorie
.ardioversion- pt on heparin <-6 w&s pre$ ,ynhroni)ed to * wave$
/efi2rillating- turn of ;2 firstG
AsynhronousDfixed paema&er- for asystole or severely 2radyardi pts$
?eft ventriular failure- leads to pulmonary failure- emergenyG
.ardiogeni sho&- failure of the heart to pump ade+uately$ Pts BP will 2e lower than "5 systoli and
:; B45$ %ahy, old lammy s&in, poor peripheral pulses$ @ive /o2utamine, morphine, diuretis,
nitrates$ ,8A! @ans insertion$ *eading will show inreased pulmonary apillary wedge pressure and
dereased .;$ maintain transduer at level of right atrium$
,8A! @an)- ompliations6 air em2oli or pulmonary infartion
,ystemi (ntra-Arterial ?ine- measures BP ontinuously$
Hypovolemi sho&- dereased irulating 2lood volume
/istri2utive- vasogeni sho&$ 0 !eurogeni, Anaphylati, septi1
,epti sho&- systemi vasodilation due to infetion$ (nitially warm, flushed s&in and fever$
Anaphylati- hypersensitivity reation
!eurogeni- inreased si)e of vasular 2ed due to loss of vasular tone
,ho& manifestations6 are due to dereased tissue perfusion$ %ahyardia with hypotension$ %ahypnea,
;liguria, .old moist s&in, olor ashen and pallor, meta2oli aidosis, dereased ?;.$ Position in
modified trandelen2urgs, large (- 16-17 gauge, ;2, -, +#min, monitor :;
.hroni onstritive periarditis- give a2x, diuretis and digoxin
.ardia tamponade- pt has M-/ and lear lungs
Prostheti valve- lifetime antioagulants
%hrom2ophle2itis- elevate extremity a2ove level of heart
-enous insuffiieny- elevate$ .lean wounds wit !, !;% 2etadine or hydrogen peroxide, destroys
tissue
Buergers disease- inflammation of veinsDarteries auses vasoonstrition$ extremity red and old when
in dependent position$ %x6 stop smo&ing, hydration, avoid old
%hrom2olity therapy- ontraindiated in severe H%!$
Aute renal failure- reversi2le$ 3onitor (>; +hr and wt +d$ ?ow protein$ !o 9 or !a in diet
;liguri- lasts 7-1# days$ no pee$ sDs =-E$ 9ussmauls$ High 9$ give ?asix
/iureti- pees more$ <-#? daily$ @ive fluids
*eovery- lasts 2-4 yrs$ Pees normal$ 3emory improves
.hroni renal failure- ardia monitor due to high 9$ don't give Aldatone or /yrenium they retain 9$
/ise+uili2rium syndrome- derease stimuli$ @ive hypertoni sol or al2umin$ ,low or stop infusion$
/ialysis enepholapathy- give aluminum helating agents
Bladder trauma- pt has pain 2ellow um2ilius that radiated to shoulder
@lauoma- entral visual field unaffeted$ %hey lose peripheral vision, its painful$ %a&e meds0miotis1
whole life$ 3eds ause pain and 2lurred vision$
Primary open angle glauoma- painless, slow vision hanges, Ntunnel visionO
Primary angle losure glauoma- 2lurred vision, halos, oular erythema$
Aute angle losure glauoma- medial emergeny$ Pt has !>- and pain
.atarat extration- severe pain reported to 3/ statG means hemorrhagi 2leeding
*etinal detahment- pt see flashes of light and floaters, Nurtain drawn over eyeO$ Painless$
.ondutive hearing loss- external or middle ear o2strution$ Hearing aids
,ensorineural hearing loss- pathologial proess of the inner ear$ :sually permanent$ .ohlear
implants$ %he hearing aids only ma&e the sound louder not learer
Pres2yusis- a sensorinueral hearing loss that happens with age$ Pts hear mum2ling$
3enieres- don't give fluid or sodium$ @ive niain
?P- ontradited in pt with ((.P
(.P- early sign is altered ?;.$ /on't flex legs or &nees$
Head inEury- elevate H;B to prevent ((.P
,pinal sho&- pt has paraliti ileus
Autonomi dysreflexia- ours after spinal sho&$ An emergenyG sDs HA, H%!, stuffy nose, flushing$
&levate H/B, loosen lothing, he& for 2ladder distention$ @ive H%! meds$ %o prevent hypertensive
stro&eG
*ight .-A- pt has left sided neglet
.-A- &eep BP at 1#5D155 for purfusion$
3yasthenia gravis- monitor for aspiration$
%ensilon test- puts pt at rDf -fi2 or ardia arrest$ Have atropine at 2ed side$
Par&inson disease- depleted dopamine$ *o& 2a& and forth to move$ ?ay prone with pillow$ Avoid vit
B6
%rigeminal neuralgia- fae pain$ Avoid extreme temps of food$
@uillian 2arre- asending paralysis$ ,ensitive to pain$ 3onitor 2reathingG- resp arrest is possi2ility$
?ou gerrighs- involves motor system$ !o mental hanges$ !o ure$ ?eads to paralysis then *esp arrest
then death$
((.P- sDs High temp and BP, low ** and H*
Halo devies- no driving at all$
@oodpasteurs- involve lung and &idneys
!ephrostomy tu2e- never lamped$ *eport :; B45Dhr ,%A%
%raheostomy- /eflate uff 2efore inserting deannulation plug or pt will dieG
Hemodyalisis- the exess removal of fluid an ause hypernatremia$ 3onitor !a$
%onsilletomy- post op lay on side, no mil& produts$
%rahea-innominate artery fistula-trah pulsating with heart$ *emove statG medial emergeny$
.ane- held on good side 0.;A?- ane opposite affeted leg1
?E amputation- 1
st
2< hr elevate to redue edema, 2ed flat to prevent ontrature$ After 2<hr put prone
to extendDstreth and no elevation to prevent ontrature$
,prain- *(.E 1
st
2<hrs then heat
Arthrosopi surgery- nurse an apply ie post op
*adiation- delayed until 7yo
=loater *! ats as ?-!
/-%- warm moist ompresses, promotes 2lood flow$
Pulse ;x is not aurate in .; poisoning ases 2eause it ant distinguish 2etween .; vs oxygen
attahed to Hg2
%otal protein- 6-7gmDd?
4#55aloriesA 1 l2 of weight
8hen pt starts on 2eta 2lo&er sx of .H= will initially get worse that's o&$ (e ra&les, fatigue, wt gain
.;P/- aused 2y emphysema or hroni 2ronhitis$ ?ow ;2 via !. 2?Dmin$
9- is exreted 2y the &idneys so if the &idneys aren't wor&ing the 9 ant get out so pt gets
hyper&alemia
.alitonin dereases alium 2y gra2ing it and putting it 2a& in the 2ones
:se weight to measure fluid volume ade+uay, exept with 2urns, youll measure (>;
%etanus toxoid ta&es 2-<w&s to develop anti2odies, the immunoglo2ulin provides immediate
protetion$
Hyper&alemia happens after 2urns 2eause the ells ruptured and 9 spills out$ 3onitor ptG
Eletrial inEury- put patient in heart monitor immediatelyG Pt at rDf Afi2
?o2etomy- surgial side up so left over lo2es an expand
Pneumonetomy- surgial side down so left over lung wont fill with water
%otal laryngetomy- removal of voal hords, epiglottis, and thyroid artilage$ Pt will have a
traheostomy$ Position in semi fowlers and provide !@ feedings$ Have o2turater at 2edside$ 8ath for
arotid artery ruptureG A&a innominate artery, youll see the trah pulsating at the heart 2eat rhythm, a
medial emergenyG
%raheostomy are- sutioning is sterile and hyperoxygenate 2efore and after$ (ntermittent sution on
the way out, sution for 15 seonds with 65 seonds in 2etween times$ %he vagus nerve is stimulated so
the H* drops, monitor for 2radyardia$
.olon aner- diagnosed with olonosopy$ 3ost ommon signs are retal 2leeding, hanges in 2owel
ha2its and anemia
Prostate aner- most pts will initially have sDs of BPH$ %he most ommon sign is painless hematuria$
.he& P,A, should 2e B<ngDml$ diagnose with 2iopsy$ /r may do Nwathful waitingO
BPH signs are no =:!6 Fre+ueny, 0rgeny, .oturia
-entilator alarms6 H/,D
High pressure6 /2strution due to inreased seretions in airways, 2ronhospasms, E% tu2e
displaement, pt fighting ventilator, pt gagging, oughing or 2itting tu2e
,ow pressure6 Disonnetion or lea& in the ventilator or in the pts airway uff or pt stops 2reathingG
/evelopmental
2-4 months6 turns head side to side
<-# months6 grasps, swith and roll
6-P months6 sits at 6 and waves 2ye 2ye
7-" months6 stands straight at eight
15-11 months6 2elly to 2utt
12-14 months6 tweleve and !p drin& from a c!p
Autonomy Q the right to self-determination
Benefiene Q ta&ing positive ations to help others
!onmalefiene Q avoidane of harm or hurt
Mustie Q fairness
=idelity Q agreement to &eep promises
-eraity in general means auray or onformity to truth
%hia)ides- not for pt with renal failure or allergies to sulfa drugs
!iotini aid- to lower holesterol $ auses flushing$ @ive !,A(/ 45 min 2efore to redue it$
%P!- used for6 panreatitis, ulerative olitis, hrons disease, 2urn inEury, aner, A(/,, starvation$ (ts
maintained in the fridge when not in use$ Hypertoni solution that should 2e weaned off, never sha&e it,
and room to warm temp priori to use
;xa)epam- Ben)odiasepine given to pt with alohol withdrawal symptoms$
AmphoEel- auses onstipation and tastes hal&y
Amphotheriin B- nephrotoxi
Adenosine- (-P 6mg =A,% flush with !,$ Brief asystole ;9$ =or paroxysmal ,-%
Benadryl- an 2e give to patients with par&insons for tremors
?evodopa with 3A;(A hypertensive risis
Antiholinergis- ontradited in pt with glauoma
Antionvulsants- not ta&en with food or antaids
/ilantin- dereases ontraeptive effet$ !? level 15-25$ /on't give faster than 2#-#5mgDmin$ auses
?eu&openiaG 3onitor 8B.'s
Allopurinol and olhiine- not ta&en with aspirin$ %a&e lots of fluid
,ynthroid- inreases effets of antioagulants
/opamine- for sho& and heart failure$ (nreases .; and renal perfusion$ Pt will pee more$
?i2rium- given for alohol withdrawal
3ethadone- used to detoxify naroti addits$
,,9(- given pre thyroidetomy to derease vasularity$ @ive in mil& or Euie and use a straw $
*adioative (odine- for hyperthyroidism$ @iven in 1 dose$ ,tay away from 2a2ies J2<hr$ wath for
thyroid storm as it ould 2e a re2ound effet from iodine
%etrayline- avoid sun exposure, don't ta&e with mil&$
.ar2ama)epine 0%egretol1- toxi levels ause diplopia, HA, and vertigo
3etformin with aloholA lati aidosis
@luoortioids- ta&en with meals or antaids, may ause ulers
=urosemide- auses ototoxiity
Prisoline- auses severe hypotension
Haldol, thor)ine, mellaril are typial antipsyhotis
Ryprexa, ,ero+uel, a2ilify, lo)aril are atypial antypsyhotis
;ral potassium should never 2e ta&en on an empty stomah
(- 9 should never exeed 25 mE+Dhr$ don't give 9 if pt has low :;$
@entamyin- ototoxi, do vesti2ular he& <w&s after disontinuation
!itroglyerin- auses dereased preload and afterload$ Pt will get a HA- give %ylenol$
Parnate- not given with /emerol
Byetta- auses panreatitis
(sonia)id for %B should 2e ta&en for 6months
/oxyyline- should 2e avoided in pregnany 2eause it stains the neonates teeth
,almeterol- is a maintenane drug for asthma$
.lo)apine0lo)aril1- auses severe tahyardia dont give if H* C1<5$ .auses H%! and hyperglyemia$
.auses agranuloytosis so monitor 8B.'s
/iltia)em- (-P over 2min, an repeat in 1# min$ for Afi2 or Aflutter
/epo-provera inEetion in women an ause depression if theyre already depressed
!afillin 0:nipen1- AE's-vomitting, diarrhea, sore mouth, fever
3ethima)oleD%apa)ole- for thyroid storm$ !o more than 7 w&s$ .auses agranuloytosis he& .B.'s$
Pentamidine 0pentam1- auses =A%A? hypoglyemia
(nterferon alfa 2-a- for hep . ause flu li&e symptoms in the 2eginning$
/igoxin 0in hildren1- don't mix with food or fluids$ ,igns of toxiity A poor feeding, vomiting
,andostatinDoreotide- for aromegaly$ @( upset and gallstones$
3%J toxiity- treat with ?euovorin 0wellovorin1
?evothyroxine- on an empty stomah in the A3$
.o2alaminD -it B12- dose is 1555mg (m +d x2 w&s, then wee&ly when Ht is o& then monthly for life
-ariella Roster immunoglo2in an prevent variella on immunoompromised pts$ :sually given$
Atrovent or ,piriva not given to pts with peanut allergies$
Antioagulants are high alert meds that need to 2e dou2le he&ed 2y other nurses
Pro)a doses greater then <5mg should 2e divided in two doses
/efroxamine- antidote for iron poisoning
Pheno2ar2ital6 15-45mgDm?
-anomyin- not mixed with other mediations
!eupogen- inreases neutrophils 8B.'s in patients undergoing hemo$
=luoro+uinulones- given with lots of water to prevent rystalluria
Autane- he& triglyerides 2eause it elevates them$ (t's a vit A derivative so avoid food with vit A
.ytoxan- give without food and lots of fluids to prevent ystitis
Hypo&alemia E.@ hanges- ,% depression, (nverted % wave, prominent : wave
A/H- A9A vasopressin
/itropan- give for 2ladders spasms
/E=E.%, 8(%H (!.*EA,E/ P:?3;!A*I B?;;/ =?;8- .H(?/ ,H;8, ,I3P%;3, ;=
.H=
Atrial septal defet- opening 2etween atria, auses too muh oxygenated 2lood to go to rt side$ ,o rt
atrium and ventrile get enlarged$ .lose with ardia ath$
Atrioventriular anal defet- ommon in down syndrome$ .hild get yanoti whit rying$ 3urmur
present$ .hild develops .H=$
Patent dutus arteriosus- failure for the artery onneting the aorta and pulmonary artery to lose$
3ahinery li&e murmur, wide pulse pressure and 2ounding pulse present$ @ive (ndomethainD (ndoin
to lose it$ ;r with ardia ath$
-entriular ,eptal /efet- a2n opening 2etween lt and rt ventriles$ 3urmur present$ .lose on its own$
;B,%*:.%(-E /E=E.%,- .H(?/ ,H;8, ,I3P%;3, ;= .H=
Aorti stenosis- the narrowing doesn't let the 2lood from the lt ventrile pass through the aorta$ *esults
in dereased .;, lt ventriular hypertrophy and pulmonary vasular ongestion$ sDs of exerise
intolerane, hest pain and di))iness when standing for long$ /ilation during ath or valve replaement$
.oartation of aorta- narrowing near dutus arteriosus$ BP higher in :E$ sDs of .H= and dereased .;$
also headahes, di))iness, fainting, and epistaxis from H%!$ *esetion of oarted portion with
anastomosis or Ballon angioplasty$ *estenosis an reour$
Pulmonary stenosis- narrow entrane of pulmonary artery$ .auses right ventriular hypertrophy$ !B are
yanoti$ /ilataion of the artery with ardia ath$
/E=E.%, 8(%H /E.*EA,E/ P:?3;!A*I B?;;/ =?;8
%etralogy of fallot- -,/, pulmonary stenosis, overriding aorta, right ventriular hypertrophy$ (nfants
are yanoti at 2irth and progresses the 1sr year of life$ %hey have hyperyanoti 2lue spells Ntet spellsO
when they ry, feed, or poop$ 8ith inreasing yanosis s+uatting, lu22ing of fingers, and poor growth
may our$ %x with palliative shunt, 3orphine$ ;r omplete repair after 1yo$
%riuspid artresia- no triuspid valve, so no ommuniation 2etween rt atrium and rt ventrile$
3(JE/ /E=E.%,
Hypoplasti left heart syndrome- :nderdevelopment of lt side of heart$ =atal if not treated$ 3ay need
heart transplant$
*heumati =ever- autoimmune inflammatory disease$ Proeeds strep A infetion$ .an ause rheumati
heart disease whih affets ardia valves partiularly the mitral valve$ Mones riteria diagnoses *=$
3aEor riteria6 arditis, arthralgia, horea, erythema marginatum, su2F nodules$ 3inor .riteria6 =ever,
arthralgia, high E,*, positive .*P level $ Assessment6 low grade fever that spi&es in the P3$ High
E,*, L.*P, Ashoff 2odies, L antistreptolysin ; titer$ @ive A2x and sei)ure preautions$
9awasa&i disease- a&a muoutaneous lymph node syndrome$ (ts an aute systemi inflammatory
disease$ .ause un&nown$ Affets the heart, aneurysms an develop$ sDs A.:%E6 fever, red throat, red
eye, swollen hands, lg lymph nodes$ ,:BA.:%E6 ra&ling lips, peeling fingers and toes, Eoint pain,
thm2oytosis$ .;!-A?E,.E!% stage6 hild appears nl 2ut signs of inflammation present$ @ive fluids
that are not too hot or old$ 8t daily$ 3onitor (>;$ passive *;3$ (- immunoglo2ulin$ Avoid 33*
and variella for 11 months after (g@ therapy$ Put in +uiet environment$ %hey are very irrita2le$
Early signs of .H=6 tahyardia, espeially at rest and slight exertions$ %ahypnea, salp diaphoresis,
fatigue, irrita2ility, sudden weight gain, respiratory distress$ Q =or all these heart pro2s - P#/%'D&
#&ST1
Hemolyti-uremi syndrome6 toxins, hemials, viruses ause aute renal failure in hildren 6mos to
#yo$ ,D,6 triad of anemia, throm2oytopenia, renail failure, proteinuria, hematuria, urinary asts,
elevated B:! and reatnine and dereased Hg2 and Ht$ /o hemodyalisi or peritoneal dialysis$
Bladder Exstrophy- 2ladder outside the 2ody through defet in lower a2dominal wall$ .over 2ladder
with non-adhering plasti wrap$ ,urgery done$
-on 8ille2rands disease- hereditary$ Bleeding from muous mem2ranes$ %x similar to hemophilia$
S/S o) ''CP: !? (.PA #-1#
Altered ?;.- first sign
Headahe
A2normal respirations
*ise in BP with widening pulse pressure
,lowing of pulse
Elevated temperature
-omiting
Pupil hanges
,ate Signs: 0ushings triad- 2radyardia, H%!, wide pulse pressure1
(nreased systoli BP
8idened pulse pressure A increased systolic and low diastolic
,lowed heart rate
!on- reative pupils
Positive Ba2ins&i reflex-stro&e side of foot and 2ig toe dorsiflexes and others extend
/eortiate or deer2rate posturing
,ei)ures
/on't give morphine sulfate$ 3ehanial ventilation to maintain Pao2 at 45-4#mm Hg will result in
vasoonstrition of the ere2ral 2lood vessels, dereased 2lood flow, and therefore derease (.P$
3aintain BP$ Prevent shivering$ /erease stimuli$ ?imit fluid inta&e$ Avoid oughing and stuff$ Elevate
H;B$ /o a ventriuloperitoneal shunt$ H;B no more then 45 degrees elevation 2eause the hip flexion
auses an inrease in (.P$
'CP increases *ith:
,utioning
.oughing
,nee)ing
,training
=re+uent positioning
9nees flexed
!e& flexion
C%A
#ight si$e:
?eft side paralysis 0hemiplegia1
?eft side neglet
,patial-pereptual defiits
,hort attentions span
(mpaired Eudgment
,e)t Si$e:
Paraly)ed on right side
(mpaired speehDlanguage-aphasias
,low performane
/epression
Plae patient in +uiet environment to avoid an ((.P$
Hypertensive disease in pregnany is divided into linial su2sets of the disease 2ased on end-organ
effets and progresses along a ontinuum from mild gestational hypertension, mild and severe
preelampsia, elampsia, and hemolysis, elevated liver en)ymes, and low platelets 0HE??P1 syndrome$
-asospasm ontri2uting to poor tissue perfusion is the underlying mehanism for the signs and
symptoms of pregnany hypertensive disorders$
@estational hypertension 0@H1, whih 2egins after the 25th wee& of pregnany, desri2es hypertensive
disorders of pregnany where2y the woman has an elevated 2lood pressure at 1<5D"5 mm Hg or
greater, or a systoli inrease of 45 mm Hg or a diastoli inrease of 1# mm Hg from the prepregnany
2aseline$ %here is no proteinuria or edema$ %he lient's 2lood pressure returns to 2aseline 2y 12 wee&s
postpartum$
3ild preelampsia is @H with the addition of proteinuria of 1 to 2L and a weight gain of more than 2
&g 0<$< l21 per wee& in the seond and third trimesters$ 3ild edema will also 2egin to appear in the
upper extremities or fae$
,evere preelampsia onsists of 2lood pressure that is 165D155 mm Hg or greater, proteinuria 4 to <L,
oliguria, elevated serum reatinine greater than 1$2 mgDd?, ere2ral or visual distur2anes 0headahe
and 2lurred vision1, hyperreflexia with possi2le an&le lonus, pulmonary or ardia involvement,
extensive peripheral edema, hepati dysfuntion, epigastri and right upper-+uadrant pain, and
throm2oytopenia$
Elampsia is severe preelampsia symptoms along with the onset of sei)ure ativity oroma$ Elampsia
is usually preeded 2y headahe, severe epigastri pain, hyperreflexia, andhemoonentrations, whih
are warning signs of pro2a2le onvulsions$
HE??P syndrome is a variant of @H in whih hematologi onditions oexist with severe
preelampsia involving hepati dysfuntion$ HE??P syndrome is diagnosed 2y la2oratory
tests, not linially$
H Q hemolysis resulting in anemia and Eaundie
E? Q elevated liver en)ymes resulting in elevated alanine aminotransferase 0A?%1 or aspartate
transaminase 0A,%1, epigastri pain, and nausea and vomiting
?P Q low platelets 0B 155,555Dmm41, resulting in throm2oytopenia, a2normal 2leeding and lotting
time, 2leeding gums, petehiae, and possi2ly /(.
@estational hypertensive disease and hroni hypertension may our simultaneously @estational
hypertensive diseases are assoiated with plaental a2ruption, aute renal failure, hepati rupture,
preterm 2irth, and fetal and maternal death
Administer (- magnesium sulfate, whih is the mediation of hoie for prophylaxis or treatment$ (t
will lower 2lood pressure and depress the .!,$
Plae the lient on fluid restrition of 155 to 12# m?Dhr, and maintain a urinary output of 45 m?Dhr or
greater$

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