LETS DO SOME DRILLS

Complications
Diarrhea
Leukemia
Addisons
Cushings
Sickle cell anemia
Valvular disease
Cystic fibrosis
Gonorrhea
Herpes and HPV
Kissing disease
Meningitis
Pancreatitis
Phenylketonuria and cretinism
Polycythemia vera
PIH and Preeclampsia
vomiting

Dehydration and met acidosis
Infection and bleeding
Shock
Fluid overload (anasarca)
MI and CVD
CHF
Permanent sterility
Pelvic inflammatory disease
Cancer of the cervix
Spleenic rupture
Auditory damage
Destruction of beta cells
Mental retardation
MI and CVD
Abruptio placenta
Met alkalosis
Diets
AGN
Addisons
Cushings
Pernicious anemia
Sickle cell anemia
Angina
Gouty arthritis
ADHD and bipolar
Burns
Bedsores
DM
Dumping syndrome
Hepatic encephalopathy
Hepatitis
Liver cirrhosis



Low Na, Low CHON
High Na, low K
Low Na, high K
Vit B12 injections monthly
High fluids
Low cholesterol
Purine restricted
Finger foods
high CHON, high Cal, high vit
High CHON, high vit
Well balanced
Low CHO, dry diet
Low CHON
High CHON
Low CHON


Diets
Hyperthyroidism
Hypothyroidism
Hyperparathyroidim
Hypoparathyroidism
Menieres dse
Cholecystitis
Pancreatitis
Phenylketonuria
PIH
Renal Failure
Tonsillitis
High cal, low residu
Low cal, low chol
Low Ca
High Ca
Low Na
Low fat
Low fat
Low phenylalanine
High protein
Low CHON, Na, K
Soft diet

Bedside
Amputation
Autonomic dysreflexia
CTT
CVA
Parkinson's
Myasthenia gravis
Epiglotitis and Croup
Thyroidectomy
DVT and ascites
Radium implant
Sengstaken-blakemore
Tonsillectomy
Tracheostomy tube

Tourniquet
Catheter
Clamp, bottle, vasgauze
Suction
Suction
ET and tracheostomy
ET and tracheostomy
Tracheostomy, Ca
Tape measure
Lead container, forceps
Scissors
Flashlight
Obturator and hemostat
Positioning
AAA
Air embolism
Appendicitis, unruptured
Appendicitis ruptured
Asthma
Cardiac catheterization
Casting
Cleft lip
Cleft palate
CHF
CVA
Dumping syndrome
GERD
Epistaxis
Flail chest
Hemorroidectomy
Hip replacement
High fowlers
Trendelenburg, slightly left
Position of comfort
High fowlers
Orthopneic
Affected extremity extended
Elevate extremity
Opposite side or Supine
Prone
High fowlers
Elevate HOB or side lying
Supine after meals
Upright position after meals
Leaning forward
Affected side on bed
Side-lying
Abduction of legs


Positioning
Laminectomy, slip disk
Liver biopsy
Lobectomy
Pneumonectomy
Lumbar puncture
Mastectomy
Placenta previa bleed
Postural drainage
Prolapsed cord
Pulmonary edema
Pyloric stenosis
Seizure
Shock
Thrombophlebitis
Varicose veins
Thyroidectomy
Tracheoesophageal fistula
Keep as straight as possible
Left during, Right after
Unaffected side down
Affected side down
Knee-chest, flat on bed after
Elevate affected extremity
Bed rest
Segment to drain upwards
Knee-chest
High fowlers
Right side lying
Side lying or prone
Trendelenburg
Elevate extremity
Elevate extremity
No flexion or hyperextension
upright


Laboratory data
AGN
Leukemia
Addisons
Cushings
AIDS
Gouty arthritis
Rheumatoid arthritis
Prostate cancer
Colorectal cancer
Cystic fibrosis
DM
Hemophilia
Hepatic encephalopathy
Hyperthyroidism
hypothyroidism
High ASO titer, BUN, Crea
High WBC, low RBC & PLT
Low Na & glucose, high K
High Na & glucose, low K
(+) ELISA and western blot
High uric acid
High RF & ANA, high ESR
High PSA
High CEA
High NaCl on sweat
Hyperglycemia
Prolonged bleeding time
Elevated BUN
High T3, T4
Low T3, T4

Laboratory data
Hypoparathyroidism
Hyperparathyroidism
Liver cirrhosis
Multiple myeloma
MI
Pancreatitis
Polycythemia vera
Renal failure
Rheumatic heart dse
Met acidosis
Met alkalosis
Respi acidosis
Respi alkalosis
Low Ca
High Ca
High SGPT, SGOT
Low WBC, RBC, PLT, High Ca
High troponin, Ck, LDH, SGOT
Hyperglycemia, high amylase
High RBC
High BUN, Crea, Na, K low Ca
High ASO titer
Low pH, low bicarbonate
High pH, high bicarbonate
Low pH, high CO2
High pH, low CO2
History
AAA
AGN
AIDS or HIV
Breast cancer
Cervical cancer
Laryngeal cancer
Cystic fibrosis &
hirschprungs
Cholecystitis
Liver cirrhosis &
pancreatitis
PID
RHD

Hypertension
Sore throat
Multiple sexual partners
1
st
child after 35
Herpes or HPV infection
Smoking, teacher
Meconium ileus

Intolerance to fatty food
Alcoholism

STD
Sore throat
Initial manifestation
AGN
Alzeimers
Anemia
Sickle cell anemia
Angina
Arthritis
BPH
Bladder cancer
Breast cancer
Cervical cancer
Esophageal cancer
Laryngeal cancer
Cataract
CHF
Congenital hip dislocation

Edema & tea colored urine
Memory loss, forgetfulness
Fatigue
Growth retardation
Chest pain
Morning stiffness
Dec force & flow of urine
Painless hematuria
Lump or mass
Painless vaginal bleeding
Dysphagia
Hoarseness
Blurred vision, glare
Dyspnea or edema
Affected leg is shorter

Initial manifestation
Cystitis
DM
GBS
MS
MG
Liver failure
GERD
Hypocalcemia
Hypokalemia
Hypoxia
Increased ICP
Menieres dse
Parkinsons dse
Retinal detachment
Tardive dyskinesia
Burning upon urination
Polyuria, polydipsia
Clumsiness
Diplopia
Muscle weakness
Personality change, asterixis
Heartburn after eating
Tingling and muscle twitch
Parasthesia
Restlessness
Widening pulse pressure
Vertigo
Pill rolling movement
Visual floaters
Lip smacking

LETS INTEGRATE SIGN AND
SYMPTOMS
PAIN
Dull abdominal or low back pain associated with
a pulsating abd mass
Ans : AAA
Squeezing, burning, choking pain relieved by
rest or nitroglycerine
Ans: Angina
Squeezing, burning, choking pain relieved by
morphine
Ans : MI

PAIN
Rebound tenderness at Mcburneys point
Ans : Appendicitis
RUQ pain radiating to R shoulder,
associated with fat intake
Ans: Cholelithiasis
LUQ pain radiating to L shoulder
Ans : Spleenic rupture

PAIN
Gnawing, burning aching pain 3hrs after
eating relieved by food intake
Ans : duodenal ulcer
Gnawing, burning aching pain 30min after
eating relieved by vomiting
Ans: gastric ulcer
Sudden sharp knife like unilateral abd pain
Ans : ectopic pregnancy

Alopecia
Endocrine disorder

Cancer therapy
Hypothyroidism

Chemotherapy and
radiation therapy
amenorrhea
Endocrine disorder

Psychiatric d/o
Hypothyroidism

Anorexia nervosa and
bulimia nervosa
Amnesia
Psych d/o

Psych treatment

alcoholism
Alzheimer's(dementia)

ECT

Wernickes and
korsakoffs
Barrel chest
Absent bowel
sounds
Brudzinski & kernigs
Buffalo hump
Butterfly rash

Paradoxical chest
movement
Chvosteks &
trousseaus
Carpopedal spasm
Cogwheel rigidity
COPD
Paralytic Ileus
Meningitis, brain
hemorrhage
Cushings
SLE

Flail chest

Hypocalcemia

Hypocalcemia
Parkinson's
Diplopia
Vertigo (ear dse)
Absent Dolls eye
Exopthalmos
Halo vision
Green halo vision
Heat intolerance
Painless Hematuria
Hoarseness of voice
Hiccups
Hirsutism & virilism
Homans sign

MS and MG
Menieres
Brain stem damage
Hyperthyroidism
Glaucoma
Digitalis toxicity
Hyperthyroidism
Bladder cancer
Laryngeal cancer
Pacemaker failure
Cushings
DVT
Moon face
Night blindness
Nuchal rigidity

Orthostatic
hypotension
Chest retractions

Sunset eyes
Bossing sign

Cushings
Vit A deficiency
Meningitis and
encephalitis
Hypovolemia and
Addison's
Asthma, epiglottitis,
croup
Hydrocephalus
hydrocephalus
Intention tremors
Resting tremors or pill
rolling tremors
Flapping tremors
Trismus
Decreased caliber of
urine
Projectile vomiting

MS
Parkinsons

Asterixis
Tetanus & rabies
BPH

Inc ICP & pyloric
stenosis
Stool
Clay or gray colored
Steatorrhea
Currant jelly
Ribbon like
Hematochezia
Melena
Alternating diarrhea
and constipation

Biliary dse
Pancreatitis
Intussuception
hirshprungs
Lower GI bleed
Upper GI bleed
CA of the colon
LETS COMBINE EVERYTHING
Abdominal aortic aneurism
Problem:
Pulsating abdominal mass
S/S:
Pulsating abd mass on palpation
Best Lab:
UTZ
Intervention: Dont perform?
Abd palpation

Abruptio placenta
Problem:
Premature separation of the placenta
S/S:
Dark red vaginal bleeding, peritonitis
Best Lab:
UTZ
Complication:
Shock and DIC

Diarrhea
Problem:
Increased passage of liquid stools
S/S:
Loose watery stools
Lab:
Met acidosis
Intervention:
Fluid replacement (pedialyte and Oresol)

AGN
Problem:
Damage to kidneys filtering system
S/S:
Cola urine, edema
Lab:
High crea, BUN, ASO titer
Interventions:
Infection and injury precautions
Diet:
Low CHON, Low Na
DOC:
Steroids

Leukemia
Problem:
Carcinoma of the WBC
S/S:
Fatigue, bruising, freq infxn
Best Lab:
Biopsy of bone marrow (WBC high)
Interventions:
Infection and bleeding precautions

AIDS
Problem:
Degeneration of the immune system
S/S:
Non-specific catarrhal symptoms for 1 month
Lab:
ELISA and Western blot, CD4 counts
Intervention:
Infection precautions, Safe sex

Addisons disease
Problem:
Hypo functioning of the adrenal glands
S/S:
Thin, hypovolemia, bronze discoloration of skin
Lab:
Low Na and glucose, high K
Intervention:
Prevention of shock, infection precautions, fluids
and electrolytes, hypotension
DIET:
High Na, Low K
Cushings disease
Problem:
Hyper functioning of the adrenal glands
S/S:
Edema, hypervolemia, buffalo hump, moon face
Lab:
high Na and glucose, low K
Intervention:
Infection and injury precautions, Hypertension
DIET:
low Na, high K
Alzheimer's
Problem:
Progressive degeneration of cerebral cortex
S/S:
Forgetfulness, confusion, confabulation, sun
downing
Lab:
No specific (ACTH high)
Intervention:
5Cs: clock, calendar, color, caregiver, cognex
Angina
Problem:
Ischemia of myocardium
S/S:
Squeezing, crushing chest pain relieved by rest
or nitroglycerine, last for no more than 30min
ECG:
ST segment depression
DOC:
Nitroglycerine
DIET:
Low cholesterol
Appendicitis
Problem:
Inflammation of the appendix
S/S:
Rebound tenderness, RLQ pain, Mcburneys
point
Position:
Before rupture - Position of comfort
After rupture - High fowlers
NO:
pain relievers, laxatives, enema, warm compress
Asthma
Problem:
Hyperactivity of the bronchial airway
S/S:
Dyspnea and wheezing
Lab:
Respiratory acidosis
Intervention:
Orthopneic position, pursed-lip breathing
Drugs:
Bronchodilator 1
st
then corticosteroids
BPH
Problem:
Overgrowth of prostate (benign)
S/S:
Decreased caliber of urine
Lab:
High acid phosphatase
surgery:
TURP No incision
Post-op:
Cystoclysis: OUT must always be more than IN
BURNS
Problem:
Thermal, electric, chemical injury to skin
S/S:
1
st
degree: pink and red
2
nd
degree: vesicles
3
rd
degree: charred, white, with eschar
Lab:
Initially Inc K & dec Na then becomes both dec K & Na
Intervention:
Fluid resuscitation (rule of 9s), Pain control, infxn,
contractures
DIET:
High cal, CHON, Vit
Cataract
Problem:
Opacity of the lens
S/S:
Blurring of vision, glare
Lab: (slit-lamp)
Red reflex absent
Intervention:
Injury precautions
Surgery:
PECLE or PHACO : prevent inc IOP
CVA
Problem:
Disruption of blood supply to the brain
(hemorrhagic or thrombotic)
S/S:
Hemiplegia, hemi paresis, speech
problems, hemianopsia
Positioning:
ICP : Elevate HOB
Aspiration : Side-lying
Chicken pox
Problem:
Infection by varicella zoster
S/S:
Fever, fluid filled vesicles
Intervention:
Isolate for 2 weeks, treat pruritus
DRUGS: Never give
aspirin
Cholecystitis
Problem:
Inflammation of the gall bladder
S/S:
Pain in the RUQ radiates to shoulder ass with fat
intake
Steatorrhea and jaundice if severe obstruction
Surgery:
Cholecystectomy: high abd incision
DIET:
Pre-op: Low fat
Post-op: No more fat restriction
Chronic bronchitis
Problem:
Copious mucus secretion on the bronchioles
(smoking number 1 risk factor)
S/S:
Blue bloater
Lab:
Respiratory acidosis
Intervention:
Max O2 at 4L/min
Purse lip breathing, chest physiotherapy
CHF
Problem:
Cardiac pump failure due to cardiomegaly
S/S:
RSHF: systemic
LSHF: Pulmonary
Lab:
Elevated CVP, PAWP
Positioning:
High fowlers position
DOC:
Digitalis (+)inotropic, (-)chronotropic
Croup
Problem:
Inflammation of the airway
(laryngotracheobronchitis)
S/S:
Barking cough, inspiratory stridor
Intervention:
Mist inhalation
Bedside:
ET and tracheostomy

Cystic fibrosis
Problem:
genetic disorder of the exocrine glands
S/S:
Sweat glands: high NaCl
Respi glands: copious sputum
Digestive glands: steatorrhea
Reproductive: permanent sterility
Lab:
Sweat chloride test (40meq/L or higher)
DIET:
Low fat, high cal, high Na
Cystitis
Problem:
Inflammation of the urinary bladder
S/S:
Dysuria, urgency, frequency
Lab:
High WBC, ESR (culture : E.Coli)
Intervention:
EOF, Acidify urine
NO:
Tight fitting underwear, bubble baths
Diabetes insipidus
Problem:
Hyposecretion of ADH
S/S:
Polyuria and polydipsia, hypotension
Lab:
Low urine spec. grav
Intervention:
EOF, monitor for shock
DOC:
Desmopressin
NSG DX:
Fluid volume deficit
Sleep pattern disturbance
SIADH
Problem:
Hypersecretion of ADH
S/S:
Edema, anasarca, hypertension
Lab:
high urine spec. grav
Intervention:
monitor for fluid overload
DOC:
Demeclocycline (furosemide may also be used)
NSG DX:
Fluid volume excess
Risk for injury
Dumping syndrome
Problem:
Rapid entry of carbohydrate rich chyme to
duodenum
Long term complication of billroth(gastrectomy)
S/S:
Shock like symptoms, diaphoresis
Intervention:
Supine position after meals
DIET:
Small frequent feedings, Low CHO, dry
Ectopic pregnancy
Problem:
Implantation outside the uterus (fallopian tubes)
S/S:
Sharp, stabbing, unilateral abd pain with
spotting
Lab:
UTZ
Intervention:
Prepare client for surgery

Emphysema
Problem:
Loss of alveolar elasticity thus trapping of air
S/S:
Pink puffer, barrel chest
Labs:
Respiratory acidosis
Interventions:
Breathing technique: Pursed lip
Position: Orthopneic
Max oxygen: 2-4L/min

Epiglotitis
Problem:
Complete airway obstruction due to infxn of
epiglotis
S/S:
sore throat
Positioning
Tripod position
Bedside:
ET and tracheostomy

Epilepsy/seizure
Problem:
Excessive electrical discharge in the brain
S/S:
rapid flexion and extension of skeletal muscles,
aura and prodrome
Labs:
EEG
Goals:
During seizure: Safety
After seizure: Aspiration
Glaucoma
Problem:
Increased IOP
S/S:
PAIN, tunnel vision, permanent vision loss
Labs:
Tonometry = 25mmHg and up
Interventions:
Prevent inc IOP
Eye gtts: Miototics
Guillain-barre syndrome
Problem:
Inflammation of motor neurons
S/S:
Paralysis = Ascending
Complication: Respiratory failure
-Prevent Respi infxn
-Suction and Tracheostomy at bedside
Hemophilia
Problem:
X-linked recessive d/o of clotting
S/S:
bruising, abnormal bleeding
Labs:
prolonged INR (PT,PTT, bleeding time)
Risk for:
bleeding use RICE
Question on PUNNET SQUARE
Hepatic encephalopathy
Problem:
progressive loss of consciousness due to
nitrogenous waste
S/S:
asterixis, personality changes, dec level of
consciousness
Labs:
inc BUN
diet:
low CHON
DOC to dec ammonia levels in GIT:
-Neomycin and lactulose
Hip Fracture
Problem:
break in continuity of hip bone
S/S:
pain, shortening and external rotation of leg
Complication:
fat embolus
TTT:
Splint and immobilize
surgery ORIF
post-op goal:
maintain leg in alignment
Abduction pillow-to keep head of femur inside
Acetabulum
Trochanter rolls-to prevent external rotation
Hirschsprung's dse
problem:
no nerve innervations on colon
S/S:
meconium ileus, constipation, ribbon like
stool
Diet:
low residue
TTT:
Surgery (rectal pull through)
Hydatidiform mole
AKA: Gestational Mole
Problem:
abN number of chromosomes in
fertilization
S/S:
rapid growing uterus, passage of grape fruit like
vesicles, no fetal movement or heart beat
TTT:
surgery (D and C)
Complication:
choriocarcinoma - levels of HCG will be
monitored for 2yrs
Hydrocephalus
Problem:
excessive CSF in the brain. Can be
communicating or non-communicating
S/S:
bulging fontanels, sunset eyes, inc ICP
Position:
elevate HOB
TTT: A-V shunt; watch for:
shunt failure dilated scalp veins
infxn temp and foul drainage
Shock
Problem:
decreased circulating blood volume
leading to inadequate tissue perfusion
S/S:
dec BP, inc PR, RR, dec CVP
Position:
trendelenburg
Increased intracranial pressure
Problem:
ICP greater than 15mmHg
S/S:
inc BP (widening pulse pressure), dec PR,
RR, projectile vomiting
Position:
elevate HOB
TTT:
Strongest diuretic - mannitol
Strongest anti-inflam - steroid
Surgery - craniotomy
Infectious mononucleosis
Problem:
infxn of lymphatic system by Epstein Barr
virus
S/S: lymph edema, sore throat, fatigue
Transmission:
saliva no sharing of kitchen utensils
Complication:
splenic rupture (pain at LUQ)
Meniere's dse
Problem:
over production of endolymph in inner ear
S/S:
vertigo, tinnitus, hearing loss
Risk for:
injury
Diet:
low Na
Position:
Supine on attack
Multiple myeloma
Problem:
Carcinoma of plasma cells which invade bone marrow
S/S:
Bone pain, myelosuppresion
Labs:
dec rbc, wbc, plt, inc Ca
Confirmatory:
Bone marrow biopsy
Risk for:
bleeding, infxn, fracture, kidney stones
Interventions:
EOF, prevent immobility
Parkinson's Dse
Problem:
degeneration of substancia nigra leading to
diminished dopamine levels
S/S:
mask like face, bradykinesia, shuffling gait,
drooling, resting tremors, constipation
Risk for:
injury and aspiration
DOC: levodopa
CHON and vit B6 antagonize levodopa
Bedside: Suction
Polycythemia Vera
Problem:
overproduction of rbc
Labs:
inc rbc, inc plasma osmolarity
S/S:
hypervolemia, hypertension
Complication:
thrombus formation - CVA, MI
PIH
Problem:
hypertension after 1st trimester of pregnancy
(inc in 30-50% of BV)
Triad S/S:
inc BP, proteinuria, edema
NSG:
limit environmental stimulation, monitor for
epigastric pain, seizure precautions
DOC:
MgSO4 -CNS depressant, assess: DTR
Pyloric stenosis

Problem:
hypertrophy of pylorus
S/s:
projectile Vomiting
Position:
R side lying
Retinal detachment

Problem:
separation of the retina from the pigment
layer
S/S:
visual floaters, curtain falling down,
painless
Emergency TTT:
patch both eyes

Reye's syndrome
Problem:
degeneration of brain, liver, and kidneys due to
concurrent viral infxn and aspirin use
S/S:
inc ICP, elevated SGPT SGOT, dec urine output
Monitor for worsening of dse:
dec LOC, crushing's triad, RUQ pain, Jaundice,
Oliguria
SKIN TRACTION ASSESS
THE PATIENT
Head Halter
Bryants Traction
Bucks Extension
Dunlops Traction
Pelvic Belt
Pelvic Sling
Russells Traction
head, ears, chin and neck
both legs
one or both legs
arm and forearm
Lower back and abdomen
Back and abdomen
Lower limbs