ü Risk factors for cardiovascular disorders
o R – ace à non modifiable
o I – ncresed blood pressure à modifiable
o S – tress à SNR à increased BP and CR, vasoconstriction à modifiable
o K – nowing sedentary life style à modifiable
o F – at foodsà atherosclerosis à modifiable
o A – lcohol (modifiable) / Age à above 40 (non modifiable)
o C – igarette smoking à vasoconstriction (nicotine) à modifiable / Contraceptive pills à clotting of blood à thrombus formation
o T – ype A behavior (modifiable) à competitiveness, perfectionist à high stress level
o O – besity
o R – esult of DM à lipolysis à increased fatty acids à atherosclerosis
o S – ex àgender à males > female (before menopausal because estrogen decreases PVR) after menopausal female eversible}[inverted T wave] à Injury [elevated ST segment] à> male
ü Decreased TP in heart à Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in the ECG]
ü Eating a heavy meal, strenuous exercise, sex, exposure to cold à Decreased blood flow (heart)à decreased TP (heart)à decreased O2 (heart)à anaerobic respiration à production of lactic acid à PAIN à management decreased O2 demand by rest and SFF
ü Angina
o Pain relieved by rest and NTG
o NTG
§ Vasodilation à orthostatic hypotention à move gradually à Monitor BP
§ Store in a dark and amber container
§ Effective à tingling sensation à no need to notify physician
§ Maximum of 3 tablets with 5 minute interval
ü MI
o Pain relieved by Morphine SO4
§ Narcotic analgesic
§ Can cause respiratory depression à monitor RR and O2 saturation
§ Antidote à narcan
ü Cardioversion à synchronous
ü Defibrillation à unsynchronous
ü Buerger’s disease à CS à vasoconstriction à stop CS à common in men
ü Raynaud’s à stress and cold à vasoconstriction à common in female
ü Congestive heart failure
o Left sided à pulmonary
§ Dyspnea
§ Crackles
§ Polycythemia à due to decrease O2 to the kidneys
§ Clubbing of the fingers à due to prolonged hyxia
§ Orthopnea
o Right sided à systemic
§ Hepatomegaly
§ Distended neck veins
§ Edema
§ Portal hypertension
§ Ascites à weight gain
§ Varicose veins
o Digoxin
§ Cardiac glycoside
§ Positive inotrophic effect à increased strength of myocardial contraction
§ Negative chronotrophic effect à decreased cardiac rate à monitor CR à never give if CR below 60 bpm
§ Adverse effect
· V – omitting
· A – norexia
· N – ausea
· D – iarrhea
· A – bdominal pain
· REMEMBER: earliest à GI; late à halo vision
· Antidote à Digibind
ü Decreased RBC ® Activity in tolerance, Fatigue, provide rest, Anemia
ü Decreased Platelets ® Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high risk for injury
ü Decreased WBC ® prone to infection, reverse isolation
ü Increased WBC ® presence of infection
ü First Day/Newly diagnosed ® Knowledge deficit
ü Diuretic
o D – iet à high K diet except aldactone
o I – input and Output à expected increased output
o U – ndesirable effect electrolyte imbalance (K)
o R – ecord weight à expected decreased weight
o E – lderly à special precaution
o T – ake in AM and with food
o I – ncreased orthostatic hypotension à monitor BP and move gradually
o C – ancel alcohol because of mild diuretic effect
ü Heparin à anticoagulant à prevent further enlargement of clot not dissolve them à monitor APTT/PTT à antidote protamine SO4
ü Coumadin à anticoagulant à prevent further enlargement of clot not dissolve it à monitor PT à vitamin K is the antidote
ü Urokinase/Streptoase ® dissolves the clot
ü Pernicious anemia à absence of intrinsic factor (gastric surgery)à problem in absorption of Vitamin B12 à beefy red tongue schilling’s test à definitive test à 24 hour urine collection à life long Vitamin B12
ü Gastritis à LUQ pain
ü Gastric ulcer à affected area stomach à pain (precipitated by food intake à increased HCl) à pain relieved by antacids
ü Duodenal ulcer à affected area duodenum à pain (2 hour after eating) à pain relieved by food
ü Ulcers à bleeding à (+) occult blood test (guiac)à high fiber diet, avoid red meat, iron, steroids, NSAIDs, indomethacin
ü Vagotomy à resection of vagus nerve à decreased cholinergic stimulation à decreased HCl and gastric movement
ü Dumping syndrome à tachycardia and weakness à 3 D’s (diarrhea, diaphoresis and dizziness) à fluids after meals, lie down after meals and SFF
ü Appendicitis à RLQ pain à avoid heat pads à cause rupture à signs of ruptured appendix à sudden cessation of pain, elevation of temperature and WBC
ü Diverticulitis à LLQ pain ® low fiber diet
ü Diverticulosis ® high fiber diet
ü Ulcerative colitis à bloody diarrhea 20 to 30 times a day à fluid volume deficit
ü Liver cirrhosis à alcohol and malnutrition (laanec’s), infection and drugs (post necrotic), RSCHF (cardiac) and biliary obstruction (biliary)
o Portal hypertention can lead to
§ Blood shifted to the different collateral
· Esophageal varices
· Spider angioma (face and neck)
· Caput medusae (abdomen)
· Hemorrhoids (rectal)
· Management avoid rupture à avoid shouting, valsalva maneuver
§ Increased hydstatic pressure à fluid shifting à ascites
o Decreased albumin à decreased oncotic / colloidal osmotic pressure à fluid shifting à ascites à management high protein diet
o CHON metabolism à by product ammonia à liver cannot convert to urea à increased level of ammonia in the brain à Alteration of LOC and changes of behavior and asterexis àhepatic encephalopathy à management low CHON diet and lactulose for removal of ammonia
ü Hepatitis A à fecal oral à prone plumber
ü Hepatitis B à body secretion à prone working in a dialysis
ü Cholecystitis à 5 F’s (fair, female, fat, fertile and forty) à RUQ pain à after ingestion of fatty food à demerol to relieved pain
ü Cholecystectomy à T tube à level of the incision site à drain excess bile
ü Pancreatitis à alcohol à autodigestion à LUQ pain
ü Anterior Pituitary gland
o Growth hormone
§ Increased before the closure of the epiphysis of the long bones à gigantism à tall
§ Increased after the closure of the epiphysis à acromegaly à big hands (big gloves), big feet (big shoes) and big head (big hat)
§ Decreased à dwarfism
o Prolactin
§ Increased à galactorrhea
§ Decreased à decreased milk production
o ACTH
§ Increased à secondary cushing’s
§ Decreased à secondary
o TSH
§ Increased à secondary hypethyroidism
§ Decreased à secondary hypothyroidism
ü Posterior pituitary gland
o ADH
§ Increased à water retention à oliguria à edema (fluid volume excess) and weight gain à concentrated urine à increased urine specific gravity
§ Decreased à water excretion à polyuria à dehydration (fluid volume deficit and weight loss) à diluted urine à decreased urine specific gravity
ü Parathyroid gland
o Parathormone
§ Increased à increased calcium in the blood and decrease calcium in the bones à stone formation and decreased bone mass à osteoporosis à management increased water intake
§ Decreased à hypocalcemia à calcium supplement
ü Thyroid Gland
o Increased (hyperthyroidism)
§ T3 and T4 à increased BMR à hyperactive à inability to focus à insomia à increased catabolism à weight loss à increased appetite à increased peristalsis à Diarrhea à fluid volume deficit à Increased CR and RR (due to increased BMR)
· Increased T3 à heat intolerance
§ Calcitonin à decreased calcium in the blood à tetany à compensatory à calcium withdraws from the bones à bone destruction (complication)
§ PTU à decreased synthesis of TH à watch out for SE (similar to signs and symptoms of hypothyroidism) à watch out for agrunulocytosis (fever, skin rash and sore throat)
§ Lugol’s solution à decreased released of TH à before thyroidectomy à decreased vascularity of the thyroid gland
o Decreased (hypothyroidism)
§ T3 and T4 à decreased BMR à hypoactive à sleeps a lot à decreased metabolism à weight gain à anorexia à decreased peristalsis à constipation à decreased CR and RR due to decreased BMR
§ T3 à cold intolerance
§ Calcitonin à hypercalcemia à stone formation
§ Synthroid and Proloid à increased TH
ü Adrenal Gland
o Incresead (cushing’s)
§ Glucocorticoids à hyperglycemia and decrease wound healing
§ Mineral corticoids à increased aldosterone à sodium retention and potassium excretion à hypernatremia and hypokalemia
· Hypernatremia à water retention à oliguria à edema (moon face,buffalohump, fluid volume excess and weight gain) à concentrated urine à increased urine specific gravity à low sodium diet
· Hypokalemia à weakness à Prominent U wave à high potassium diet
§ Epinephrine and Norepinephrine à Increased BP and CR
§ Sex hormones
· Males à gynecomastia and falling of hair
· Females à hirsutism and deepening of the voice
o Decreased (
§ Glucocorticoids à hypoglycemia and inability to cope with stress
§ Mineralcorticoids à decreased aldosterone à sodium excretion and potassium retention à hyponatremia and hyperkalemia
· Hyponatremia à water excretion à polyuria (dehydration, fluid volume deficit and weight loss) à diluted urine --. Decreased urine specific gravity à increased fluids and Na
· Hyperkalemia à weakness à tall or peaked T waves à low K diet
§ Epinephrine and Norepinephrine à decreased BP and CR
ü Diabetes Mellitus
o Type I à absolutely no insulin à thin à insulin
o Type II à insufficient insulin à obese à OHA
o Diet à 50% CHO, 30% Fats, 20% CHON
o Exercise à Increased uptake of glucose à Decreased insulin requirement
o Oral hypoglycemic agent (OHA)
§ Stimulates pancreas to produce insulin
o Insulin
§ SC; IV if DKA
§ Never massage the area
§ Never administer cold insulin
§ Rotate the site of injection
· PREVENTS LIPODYSTROPHY
§ Mix
· Aspirate clear first
· Inject air to cloudy first
o Hypoglycemia
§ W – eakness
§ H – unger pangs
§ A – alteration of LOC
§ T – achycardia and tremors
§ A – bdominal pain
§ B – blurring of vision
§ C – ool clammy skin
§ D – iaphoresis
§ Give à orange juice (simple sugars)
o DKA ® increased lipolysis increased ketones
o Hyperglycemia à polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria and warm flush skin
o Glycosylated hemoglobin à reflect BSL for the past 3 to 4 months à most accurate
o Foot care
§ Podiatrist
§ Avoid removing corns and calluses
§ Cut toe nails straight across
§ Avoid walking bare foot
ü Hepatitis A ® fecal oral
ü Hepatitis B ® body and bloody secretions (hemodialysis)
ü Peritoneal Dialysis
o Diasylate output is decreased ® turn patient from side to side
o Complication ® infection ® monitor WBC and temperature, diasylate is cloudy ® boardlike and rigid abdomen ® peritonitis
o Don’t include diasylate solution in the output of the client
o Expected ® decreased weight ® monitor weight before and after ® decreased createnine and BUN
ü Heart block ® decreased tissue perfusion
ü Parkinson’s diasease
o Decreased dopamine in the basal ganglia ® levodopa to increased dopamine ® avoid Vit B6 foods
o Cardinals signs ® tremors (non intentional) ® muscle rigidity ® bradykinesia
o Pill rolling
o Microphonia ® ask your client to speak aloud to be aware
o Artane and Cogentin ® anticholinergic ® decreased muscle rigidity
ü Myasthenia Gravis
o Tensilon test ® confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness ® priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) ® increased muscle strength ® antidote ATSO4
§ Undermedication ® myasthenic crisis ® give cholinergics
§ Over medication ® cholinergic crisis ® give ATSO4
ü Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoat’s triad
§ Intentional tremors
§ Scanning of speech
§ Nystagmus
o Visual disturbances ® diplopia
ü Pancreatitis ® autodigestion ® alcohol ® bleeding ® shock
o Elevated amylase
ü Rheumatoid Arthritis
o No specific diagnostic test
o NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis ® Pannus formation ® fibrous ankylosis (limited joint movement) ® Bony ankylosis (joint fixation)
o Avoid flexion and promote prone position
ü Gouty Arthritis
o Increased uric acid ® allopurinol and avoid organ meats (liver) ® tophi (ears)
ü Osteoarthritis
o Most common ® related with aging
o Pain after weight bearing exercise or activity ® rest to relieved pain ® weight reduction
ü Diverticulitis ® LLQ pain and low fiber diet
ü Cyclophosphamide (Cytoxan) ® can cause hemorrhagic cystitis ® to avoid increased fluid intake
ü Vincristine (Oncovin) ® increased fiber in the diet
ü Iron supplement ®When is the best time to take (empty stomach), How is best taken (with orange juice)
ü Steroids and NSAID’s
o DEATH ® inflammation
o BIRTH ® side effects
§ B – one marrow depression ® prone to infection ® monitor temperature and WBC
§ I – ncreased gastric irritation ® take it with food or after meals
§ R – enal toxicity
§ T – innitus
§ H – epato toxic
ü Cataract ® common cause is aging (senile) ® opacity of the lens ® position on the unaffected side
ü Glaucoma ® increased IOP ® decreased of peripheral vision first ® halo, tunnel and gun barrel vision ® miotics (constricts pupils) ® avoid ATSO4 (dilates pupil)
ü Retinal detachment ® trauma ® blood clots ® floating spots ® dependent position® scleral buckling
ü Avoid Increased Intraocular pressure ® PRIORITY
o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
ü Meniere’s ® Triad ® tinnitus, impaired hearing loss and vertigo ® low Na diet
o Vertigo ® imbalance ® high risk for injury ® decreased vertigo by focusing on one side of the room ® assume a flat or reclining position
ü ASA ® 8th cranial nerve damage ® tinnitus, impaired hearing loss and vertigo
ü Antibiotics ® allergic reactions
ü Normal Values
o BUN = 10 – 20 mg/dl
o Calcium = 9 to 10.5 mg/dl
o Creatinine = 5 to 1.5 mg/dl
o GTT = 70 to 115 mg/dl
o O2 sat = 97 to 98%
ü Signs and Symptoms of Increased Intracranial Pressure
o B – lood pressure and temperature are elevated
o R – espiratory and cardiac rate are decreased
o A – lteration of LOC
o I – rritability
o N – ote for projectile vomiting
o S – eizure
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