nurse

Final comprehansive notes

2011-02-22T04:27:00.000-08:00

Dilantin detoxified by liver.

The nurse cares for a client receiving IV antibiotics every 8 hours for the past 4 days. The antibiotic is mixed in D5W. The nurse determines that a post-infusion phlebitis has occurred if which of the following is observed?
1. Tenderness at the IV site.
2. Increased swelling at the insertion site.
3. Area around the IV site is reddened with red streaks.
4. Fluid is leaking around the IV catheter.
a. Tenderness occurs with phlebitis but is not specific to it.
b. May indicate either infiltration or phlebitis
c. CORRECT—reddened, warm area noted around insertion site or on path of vein; discontinue IV, apply warm, moist compresses, restart IV at new site
d. Not indicative of phlebitis

Ethacrynic Acid (Edecrin)—are considered loop diuretics and are potassium wasting; encourage client to increase intake of potassium-rich foods. Orange juice/Bananas, etc.

Aminophylline (Truphylline)—is a xanthine bronchodilator; major side effects: palpitations, nervousness, rapid pulse, dysrhythmias, nausea, and vomiting. Toxic effects: confusion, headache, flushing, tachycardia, and seizure.

Morphine Sulfate—decreases blood return to the right side of the heart, and decrease peripheral resistance. In other words, decreases preload and afterload pressures and cardiac workload; causes vasodilation and pooling of fluid in extremities; provides relief from anxiety.

Intropin (Dopamine)—vasoactive medication are given IV to restore BP in hypotensive states; Increases blood return to the right side of the heart, and increase peripheral resistance; side effects: headache, severe hypertension, dysrhythmias; check BP q2 minutes until stabilized, then q5 minutes

TPN—hang no longer than 24 hours; IV tubing and filters every 24 hours; site of catheter changed every 4 weeks.

Fluoxetine (Prozac)—a selective serotonin reuptake inhibitor (SSRI) used to treat depression and obsessive compulsive disorder. Side effects: postural hypotension, dry mouth, rapid heartbeat, anorexia, weight loss, severe headache. If dose is missed, omit dose and instruct client to return to regular dosing schedule.

Propanolol (inderal)—a beta-adrenergic blocker used as antihypertensive; Side effects: bronchospasm, bradycardia, depression, increase airway resistance. Take pulse and count respirations before administration and gradually decrease when discontinuing. Do not give to asthmatic patients.

Glipizide (Glucotrol)—an oral hypoglycemic that decreases blood sugar by stimulating insulin release from the beta cells of the pancreas; may cause aplastic anemia and photosensitivity.

Prednisone (Deltasone)—a corticosteroid. Side effects: hyperglycemia

Bethanechol (Urecholine)—a cholinergic or parasympathomimetic used to treat functional urinary retention; mimics action of acetylcholine.

Ventricular Tachycardia—causes chest pain, dizziness, and fainting.

1 grain = 60mg

Levothyroxine (Synthroid)—thyroid preparation should be administered at breakfast to prevent insomnia.

Carbamazepine (Tegretol)—interferes with action of hormonal contraceptives. Side effects: photosensitivity.

Aluminum Hydroxide (Amphojel)—an antacid; neutralizes hydrochloric acid and reduces pepsin activity; take one hour before and hour of sleep. Antacids most effective after digestion has started, but prior to the emptying of the stomach.

Isoniazid (INH)—Side effects: peripheral neuropathy (administer pyridoxine), rash, urticaria, and swelling of the face, lips, and eyelids.

Pyridoxine (Vitamin B6, Beesix, Doxine)—required for amino acid, carbohydrate, and lipid metabolism. Used in the transport of amino acids, formation of neurotransmitters, and sythesis of heme. Prevention of neuropathy.

Carbamazepine (Tegretol)—prevention of seizures and relief of pain in trigeminal neuralgia. Trigeminal neuralgia (Tic douloureux) is an agonizing pain that may result in severe depression and suicide.

Clonidine (Catapres-TTS)—is a centrally acting alpha-adrenergic used to treat hypertension; Side effects: drowsiness, sedation, orthostatic hypotension, heart failure. If patch used be cautious around microwaves results in burns, dispose of carefully, and heat will increase medication absorption leading to toxicity.

Phlebitis—tenderness, redness; remove iv, apply warm soaks to decrease inflammation, swelling, and discomfort.

Autologous blood—may give blood 5 weeks before surgery; can give 2 to 4 units of blood; may have to take iron pills

Partial-thickness burn; only part of skin is damaged or destroyed; large, thick-walled blisters develop; underlying tissue is deep red, appears wet and shiny; painful with increased sensitivity to heat; healing occurs by evolution of undamaged basal cells, takes about 21-22 days. I.E., Redness and swelling with fluid-filled vesicles noted on right arm or Blistering and blanching of the skin noted on the back.

Full-thickness burn; all skin is destroyed and muscle and bone may be involved; substance that remains is called eschar, dry to touch, doesn’t heal spontaneously, requires grafting. I.E., Charred, waxy, white appearance of skin on left leg.

Superficial burn; skin appears pink, increased sensitivity to heat, some swelling, healing occurs without treatment. I.E., Reddened blotchy painful areas noted on the face.

Carbidopa/Levodopa (Sinemet)—used to treat symptoms of Parkinson’s disease. Take immediately before meals and high-protein meals may impair effectiveness of medication. Reduces rigidity and bradykinesis and facilitates client’s mobility.

Doxycycline (Vibramycin)—a tetracycline that is taken at regular intervals but not within 1 hour of bedtime because it may cause esophageal irritation. Use another method of birth control, do not take antacids within 1-3 hours of taking medication, and may cause photosensitivity.

Albuterol (Proventil)—a bronchodilator. Side effects: tremors, headache, hyperactivity, tachycardia. Use first before steroid medication so opens up bronchioles for steroid to get in. Wait one minute between puffs of the inhalers for best effect.

Beclomethasone (Vanceril)—a steroid medication. Side effect: fungal infections, dry mouth, throat infections.

Insulin—NPH Onset: 1.5 hours Peak: 4-12 hours Regular Onset: 0.5 hours Peak: 2.5-5 hours
Topiramate (Topamax)—is an anticonvulsant. Should drink 2000-3000ml of fluid daily to prevent kidney stones. Side effects: orthostatic hypotension, ocular symptoms, blindness, and decrease effects of hormonal contraceptives.

Propranolol (Inderal)—a beta-blocker that takes up beta-adrenergic receptor sites, which prevents adrenaline from causing symptoms and glycogenolysis. Inderal may mask symptoms of hypoglycemia, removing the body’s early warning system.

Phenazopyridine (Pyridium)—acts on urinary tract mucosa to produce analgesic or local anesthetic effects. Side effects: bright orange urine, yellowish discoloration of skin or sclera indicates drug accumulation due to renal impairment.

Trimethoprim-sulfamethoxazole (Bactrim)—most common side effect mild to moderate rash (urticaria)
Aminoglycosides are ototoxic.

Butorphanol Tartrate (Stadol)—analgesic used for moderate to severe pain; Side effects include change in BP, bradycardia, respiratory depression.

Infant normal resting heart rate: 120-140

Salt substitutes contain potassium

When directing a UAP, the nurse must communicate clearly about each delegated task with specific instructions on what must be reported. Because the RN is responsible for all care-related decisions, only implementation tasks should be assigned because they do not require independent judgment.

When applying the nursing process, assessment is the first step in providing care. The 5 "Ps" of vascular impairment can be used as a guide (pain, pulse, pallor, paresthesia, paralysis)

READ THE QUESTIONS FIRST!!!!!
READ THE QUESTIONS FIRST!!!!!
DETERMINE THE QUESTION!!!!!!

Rash and blood dyscrasias are side effects of anti-psychotic drugs. A history of severe depression is a contraindication to the use of neuroleptics.

Children with celiac disease should eat a gluten free diet. Gluten is found mainly in grains of wheat and rye and in smaller quantities in barley and oats. Corn, rice, soybeans and potatoes are digestible in persons with celiac disease.
The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk because Decadron increases the production of hydrochloric acid, which may cause gastrointestinal ulcers.
The protest phase of separation anxiety is a normal response for a child this age (2 year-old hospitalized child). In toddlers, ages 1 to 3, separation anxiety is at its peak
Signs of tardive dyskinesia include smacking lips, grinding of teeth and "fly catching" tongue movements.
Verapamil, Bretylium, and Amiodarone increases serum dig levels, possibly causing Digitalis Toxicity

Signs/Symptoms of Digital Toxicity: first signs include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias. In infants and small children, the first symptoms of overdose are usually cardiac arrhythmias.

Restlessness, confusion, irritability and disorientation may be the first signs of fat embolism syndrome followed by a very high temperature.

A Neologism is a new word self invented by a person and not readily understood by another that is often associated with a thought disorder.

Pancreatic enzymes give before meals.
Clinical features of delusional disorder include extreme suspiciousness, jealousy, distrust, and belief that others intend to harm.
The UAP can be assigned to care for a client with a chronic condition after an initial assessment by the nurse. This client has no risk of instability of condition.

Never leave your patient. For example, Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician.

Tips for charting: don’t use inflammatory words, no nurse judgments, be as specific as possible. I.E.,
“Vital signs stable” is incorrect for of charting.

Restraint: frame of bed, quick release ties, document need for restraint Q4 hours

Never ask “WHY” questions in the NCLEX!

Gag Reflex: don’t assess gag reflex to a client that has an absent swallow reflex

Nifedipine (Procardia XL): do not crush

An RN that is not assigned to a patient does not have the authority to tell a nurse what to do. Refer it to nursing supervisor.

If doctor has orders it should carried out unless contraindicated in nurse’s decision.

Physical assessment: Inspection, Percussion, Palpation, Auscultation (Except for abdomen: Inspection, Auscultation, Percussion, Palpation)

Coronary artery bypass graft (CABG)—halt medications before surgery, can do 5 at a time; will be on mechanical ventilations after surgery; chest tubes

Acromegaly—monitor blood sugar, atrium—90 implant care (radioactive, nasally implanted, monitor vision)

Bone marrow Aspiration---done at iliac crest; painful

Postoperative care after Supratentorial surgery: maintain airway, elevate head 30-45

Position care after Infratentorial surgery: flat and lateral

Orange juice does not help acidify urine it makes it more alkaline.

Myelogram
• Water-soluble dye—elevate head of bed 30 degrees (not removed)
• Oil based dye—flat in bed (removed)
• Involves lumbar puncture w/ injection of contrast medium, allowing x-ray visualization of the vertebral canal.

Fractures:
 Immobilize joint above and below fracture
 Cover open fracture with cleanest material available
 Check temperature, color, sensation, capillary refill distal to fracture
 Close reduction—manually manipulate bone or use traction

Buck’s Traction
 Use to relieve muscle spasm of leg and back
 If used for muscles spasms only, they can turn to either side.
 If used for fracture treatment, only can turn to unaffected side.
 Use 8-20 lbs of weight, if used for scoliosis will use 40 lbs of weight.
 Elevate head of bed for countertraction or foot bed
 Place pillow below leg not under heel or behind knee.

Russell’s Traction
 Sling is used
 Check for popliteal pulse
 Place pillow below lower leg and heel off the bed
 Don’t turn from waist down
 Lift patient, not the leg

Cervical Tongs
 Never lift the weights
 No pillow under head during feedings

Balanced Suspension Traction
 For femur realignment
 Maintain weights hanging free and not on floor
 Maintain continuous pull

Halo Jacket
 Maintain pin cleansing

Casts
 Don’t rest on hard surface
 Don’t cover until dry 48+ hours
 Handle with palms of hands not with fingers
 Keep above level of heart
 Check for CSM

Fractured Hip
• Assessments
 Leg shortened
 Adducted
 Externally rotated
• Implementation
 Care after a total hip replacement
• Abduction pillows
• Crutch walking with 3-point gait
• Don’t sleep on operated side
• Don’t flex hip more than 45-60 degrees
• Don’t elevate head of the bed more than 45 degrees

Amputations
• Guillotine (open)
• Flap (closed)
• Delayed prosthesis fitting
 Residual limb covered with dressing and elastic bandage (figure eight)
• Figure-8 doesn’t restrict blood flow, shaped to reduce edema
 Check for bleeding
 Elevated 24 hours (AKA-pillow, BKA-foot of bed elevated)
 Position prone daily
 Exercises, crutch walking
 Phantom Pain: acknowledge feelings, that pain is real for them.

Thiamin (Vit. B1)—carbohydarte metabolism; deficiency will cause Beri-Beri

Pyridoxine (Vit. B6)—amino acid metabolism; deficiency will cause anemia, seizures

Folic acid—RBC formation; deficiency will cause anemia

Cyanocobalamin (B12)—nerve function; deficiency cause pernicious anemia

Calcium deficiency causes Rickett’s

Cultural Food Pattern’s
 Orthodox Jewish (Kosher)—milk and meat cannot be eaten at same meal
 Muslin—30 day fast during Ramadan
 Japanese—rice is basic food, tea is main beverage
 Greek—bread is served with every meal

Enteral feeding held if: 150 or > cc’s aspirated or 50% given in the hour is aspirated
 If cramping, vomiting occurs decrease rate of enteral feeding or keep it warm.

TPN—supply nutritions via intravenous route
 Peripherally or centrally
 Initial rate 50/hour and can be increased to 100-125ml/hour.
 A pump must be used to keep rate constant
 Prevent sepsis: maintain closed system,, don’t draw blood/infuse anything in line, dry sterile dressing
 Verify placement of line
 Monitor Glucose, acetone
 Change IV tubing/Filter Q24 hours
 Solution refrigerated then warmed
 If solution not available, start 10% in water.
 3/week check BUN, electrolytes (ca, mg)
 When TPN Dc’d taper patient off or else will get rebound hypoglycemia (use hypotonic to do this)

Specific gravity 1.010-1.030
Ph 4.5-8
1,000-1,500cc/day

Crede’s Manuever—push urine out

Pernicious Anemia
- monthly Vitamin B12 IM injections

Metered dose inhaler
- Beclomethasone (Vanceril)
- Albuterol (Proventil)

Guillain-Barre Syndrome
- GBS often preceded by a viral infection as well as immunizations/vaccinations
- Intervention is symptomatic
- Acute phase: Steroids, plasmapheresis, aggressive respiratory care; prevent hazards of immobility, maintain adequate nutrition; physical therapy; pain-reducing measures; eye care, prevention of complications (UTI, aspiration); psychosocial support

Organ Donation Criteria
- No history of significant, disease, process in organ/tissue to be donated
- No untreated sepsis
- Brain death of donor
- No history of extracranial malignancy
- Relative hemodynamic stability
- Blood group compatibility
- Newborn donors must be full term (more than 200g)
- Only absolute restriction to organ donation is documented case of HIV infection
- Family members can give consent
- Nurse can discuss organ donation with other death-related topics (funeral home to be used, autopsy request)

Accurate way to verify NG tube position is to aspirate for gastric contents and check pH.

Parkinson’s disease
- Activities should be scheduled for late morning when energy level is highest and patient won’t be rushed
- Symptoms: tremors, akinesia, rigidity, weakness, “motorized propulsive gait, slurred monotonous speech, dysphagia, drooling, mask-like expression.
- Nursing care: encourage finger exercises. Administer Artane, Congentin, L-Dopa, Parlodel, Sinemet, Symmetrel.
- Teach: ambulation modification
- Promote family understanding of disease intellect/sight/hearing not impaired, disease progressive but slow, doesn’t lead to paralysis

Normal urine output (1200-1500 cc’s/day or 50-63 cc/hr, normal voiding pattern 5-6 times/day.

Green leafy vegetables contain vitamin K.

Labs

HbA1c (4.5-7.6%)
- indicates overall glucose control for the previous 120 days

Serum Amylase / Somogyl (60-160 u/dL)
- elevated in acute pancreatitis

Erythrocyte Sedimentation Rate (ESR)
- Men (1-15)
- Women (1-20)
- Rate at which RBC’s settle out of unclottted blood in one hour
- Indicates inflammation/neurosis

Hematocrit (Hct)
- Men (40-45) u/mL
- Women (37-45) u/mL
- Relative volume of plasma to RBC
- Increased with dehydration
- Decreased with volume excess

Creatine Kinase (CK)
- Men (12-70)
- Women (10-55)
- Enzyme specific to brain, myocardium, and skeletal muscles
- Indicates tissue necrosis or injury

Serum Glucose
- 60-110 mg/dL

Sodium (Na+)
- 135-145 mEq/L
- Hypernatremia
o Dehydration and insufficient water intake

Chloride (Cl-)
- 95-105 mEq/L
Potassium (K+)
- 3.5-5.0 mEq/L

Bicarbonate (HCO3)
- 22-26 mEq/L
- Decreased levels seen with starvation, renal failure, diarrhea.

Blood, Urea, Nitrogen (BUN)
- 6-20 mg
- Elevated levels indicate rapid protein catabolism, kidney dysfunction, dehydration

Creatinine Clearance Test
- normal 125 ml/min.
- Lower levels reflect renal insufficiency and may influence the excretion of many drugs and toxins from the body.

Lithium
- targeted blood level: (1-1.5 mEq/L)

Tofranil and Anafranil—OCD medications

Pick physical needs over psychosocial needs!!!!!!!!!!!!!!!

Focus on here and now!!!!!!!!!!!!!!!!!

Oculogyric crisis: uncontrollable rolling back of eyes: side effect of Phenothiazines
Moribund means dying patient.

Don’t leave your patients. Stay with your patients.

Assess before implementation.

Manic patient: decrease stimuli and increase rest period and no competition.

Lithium helps control impulsive behaviors.

Fluphenazine (Prolixin): antipsychotic medication

Thiamine sources: organ meats, liver, whole grain, nuts, legume, egg, and milk.

Don’t document abuse. Report suspected abuse to nursing supervisor.

Never promise a patient “Not to tell.”
Tonometry—measures intraocular pressure; to rule out glaucoma
Myopia—nearsightedness (near clear, distance clear)

Hyperopia—farsightedness (distance is clear, near vision blurry)

Presbyopia—changes with aging

Blind client: address by name, introduce self, keep furniture arrangement consistent, open or close doors walk ½ step ahead, identify food location on tray.

Instilling ear drops lie patient on unaffected ear to absorb drops.

Position patient on affected ear to promote drainage.

Regular Insulin only given IV.

Sick day rules: take insulin as ordered, check blood glucose q3-4 hours, soft foods, liquids

Phenylketonuria—high blood phenylalanine (no enzyme), results in mental retardation; milk substitutes, low-protein diet

Celiac Disease (SPrue)—intestinal malabsorption, malnutrition (unable to digest wheat/rye/oats/barley); gluten-free diet

Hepatobiliary disease—decrease in ability of bile to absorb fat, fat malabsorption; low-fat high-protein diet, vitamins

Cystic fibrosis—absence of pancreatic enzymes, malabsorption of fat, lung disease, pancreatic enzyme replacement, high-protein, high-calorie diet, respiratory care/suction

Position right side to promote gastric emptying.

Dumping syndrome prevention: restrict fluid with meals, lie down after eating, small, frequent meals, low-carbohydrate, low-fiber diet

Sengstaken-Blakemore Tube—to treat pt. with esophageal varices.

Normal Vital Signs

1-4 year old

Normal Vital Signs

Newborn
• Pulse 120-140 bpm, increases with crying
• Respirations 30-50/min, diaphgramatic (abdomen moves), can be irregular
• BP 60/40 – 80/50 mmHg

• Pulse: 80-140
• Resp: 20-40
• BP: 90-60 – 99/65

5-12 year old
• Pulse: 70-115
• Resp: 15-25
• BP: 100/56 – 110/60

Adult
• Pulse: 60-100
• Resp: 12-20
• BP: 90/60-140/90

Hepatitis B Vaccine
Given IM to vastus lateralis or deltoid
Side effects: mild tenderness at site
• 1st shot – Birth to 3 months
• 2nd shot – 1 to 4 months
• 3rd shot – 6 to 18 months

DTaP (Diptheria, Tetanus, and Pertussis)
Given IM anterior or lateral thigh
Side effects: fever within 24-48 hours, swelling, redness, soreness
Don’t treat with aspirin, use other antipyretic.
• 1st shot – 2 months
• 2nd shot – 4 months
• 3rd shot – 6 months
• 4th shot – 15 to 18 months
• 5th shot – 4 to 6 years
• Only TD shot – 11 to 16 years

Hib (Influenza)
• 1st shot – 2months
• 2nd shot – 4months
• 3rd shot – 6 months
• 4th shot – 12 to 18 months

IPV (Inactive Polio Vaccine)
Given PO, Few side effects
• 1st shot – 2 months
• 2nd shot – 4 months
• 3rd shot – 6 to 18 months
• 4th shot – 4 to 6 years MMR (Mumps, Measles, and Rubella)
Given SC anterior or lateral thigh
Side effects: rash, fever, arthritis in 10 days to 2 weeks.
• 1st shot – 12 to 18 months
• 2nd shot – 4 to 6 years

Varicella (Chickenpox)
• 12 to 18 months

PCV (Pneumococcal)
• 1st shot – 2 months
• 2nd shot – 4 months
• 3rd shot – 6 months
• 4th shot – 12 to 18 months

TB
Given intradermal
Evaluated in 48 to 72 hours

TD
Given IM into anterior or lateral thigh
Repeated every 10 years

Live attenuated Rubella
Given once SC into anterior or lateral thigh
Given to antibody-negative women
Prevent pregnancy for 3 months after receiving immunization

Live attenuated mumps
Given once SC
Prevents orchitis

Aortic Valve: Right of Sternum at the 2nd intercostal space

Pulmonic Valve: Left of Sternum at the 2nd intercostal space

Tricuspid Valve: Immediately left of sternal border at the 5th Intercostal Space

Mitral Valve (Point of Maximal Impulse): Left of Sternum Mid-Clavicular Line at the 5th Intercostal Space

Erbb’s Point: Left of Sternum at the 3rd intercostal space

Infant (Point of Maximal Impulse): Lateral to sternum 4th intercostals space

Obese person choking use Chest Thrusts.

Tracheostomy tube placement of cuff maintained to prevent aspiration
Care for patient first, equipment second
Signs for hypoxia: restlessness, tachycardia

CPR: Shake, shout, summon help, open airway, look, listen, feel for signs of breathing, pinch nose, give 2 full breaths (if no rise, reposition)

Adults 12/min check carotid, chest compressions 80-100/min 1.5 inches
Infants 20/min check brachial pulse, chest compression 100/min ½ - 1 inch

15:2 Adult 4 cycles
Infant 20 cycles
Reassess pulse and breathing

Continue CPR until:
• Victim responds
• Someone else takes over
• Victim is transferred
• Rescuer is unable to continue

MI
• Chest pain radiating to arms, jaw, neck (which is unrelieved by rest or nitroglycerin)
• Dyspnea
• Indigestion
• Apprehension
• Low grade fever
• Elevated WBC (5-10, ESR, CK-MB, LDH) Implementation for MI

• Thrombolytic therapy-streptokinase, t-PA
• Bedrest
• Beta-blockers, morphine sulfate, dysrhythmics, anticoagulants
• Do not force fluids (will give heart more to work with)

Defibrillation
• Start CPR first
• 1st attempt – 200 joules
• 2nd attempt – 200 to 300 joules
• 3rd attempt – 360 joules
• Check monitor between shocks for rhythm

Cardioversion
• Elective procedure, Informed Consent
• Valium IV
• Synchronizer on
• 25-360 joules
• Check monitor between rhythm

Epidural hematoma – short period of unconsciousness, ipsilateral papillary dilation, contralateral weakness of extremities

Subdural hematoma – decreased LOC, ipsilateral papillary dilation, contralateral weakness of extremities, personality changes

CSF leakage – good place to look is behind the ears.

Head Injury – elevate bed 30 degrees, barbiturate therapy, hypothermia, glucocorticoids (Decadron)

Flail Chest
Affected side goes down during inspiration and up during expiration Sucking Chest Wound
(Sucking Open Pneumothorax)
• Sucking sound with respiration
• Pain
• Decreased breath sounds
• Anxiety Pneumothorax
Collapse of lung due to alteration of air in intrapleural space
• Dyspnea
• Pleuritic pain
• Restricted movement on affected side
• Decreased/absent breath sounds
• Cough
• Hypotension Implementation
Monitor for shock
Humidified oxygen
Thoracentesis (aspiration of fluid from pleural space)
Chest Tubes

Cullen’s Sign – ecchymosis around umbilicus
Turner’s Sign – ecchymosis around either flank
Balance’s sign – resonance over spleen (+) means rupture of spleen
Shock Signs and Symptoms
• Cool, clammy skin
• Cyanosis
• Decreased alertness
• Tachycardia
• Hypotension
• Shallow, rapid respirations
• Oliguria

Hypovolemic
Decreased in intravascular volume Cardiogenic
Decreased cardiac output Distributive
Problem with blood flow to cells

Implementation for shock
• Monitor CVP: <3>11 too much fluid

Increased ICP
Assessments
• Altered LOC (Earliest Sign)
• Glasgow coma scale <7> 40 mEq/L into peripheral IV or without cardiac monitor
• Increase dietary intake – oranges, apricots, beans, potatoes, carrots, celery, raisins

Hyperkalemia Assessments
• K+ >5.0 mEq/L
• EKG changes
• Paralysis
• Diarrhea
• Nausea
Hyperkalemia Implementations
• Restrict oral intake
• Kayexalate
• Calcium Gluconate and Sodium Bircarbonate IV
• Peritoneal or hemodialysis
• Diuretics

Hyponatremia Assessments
• Na+ <>145 mEq/L
• Disorientation, delusion, hallucinations
• Thirsty, dry, swollen tongue
• Sticky mucous membranes
• Hypotension
• Tachycardia Hypernatremia Assessments
• I & O
• Daily Weight
• Give hypotonic solutions: 0.45% NaCl or 5% Dextrose in water IV

Hypocalcemia Assessments
• Ca+ <> 5.2 mEq/L
• Sedative effects on CNS
• Muscle weakness, lack of coordination
• Constipation, abdominal pain
• Depressed deep tendon reflexes
• Dysrhythmias Hypercalcemia Implementations
• 0.4% NaCl or 0.9% NaCl IV
• Encourage fluids (acidic drinks: cranberry juice)
• Diuretics
• Calcitonin
• Mobilize patient
• Surgery for hyperparathyroidism

Hypomagnesemia Assessments
 Mg+<> 2.5 mEq/L
 Hypotension
 Depressed cardiac impulse transmission
 Absent deep tendon reflexes
 Shallow respirations Hypermagnesemia Implementations
 Discontinue oral and IV magnesium
 Monitor respirations, cardiac rhythm, reflexes
 IV Calcium to antagonize cardiac depressant activity (helps to stimulate heart)

Burns Assessments
• Superficial partial thickness—pink to red, painful
• Deep partial thickness—red to white, blisters, painful
• Full thickness—charred, waxy, white, painless

Wound Care for Burns
 Never break blisters
 Isotonic fluids (Lactated Ringer’s)
 Closed method (Silvadene) covered with dressings
 Open method (Sulfamylon) that are not covered with dressings
 IV pain medication initially: not PO takes too long, not IM circulation impaired
 Medicate patient before wound care
 Silver nitrate (warn patient skin will turn black)
 High calorie, High carbohydrate, High protein diet
 Vitamin B,C, and Iron
 TPN maybe
 Prevent contractures

Addisson’s Disease Assessments
 Fatigue
 Weakness
 Dehydration
 Eternal tan
 Decreased resistance to stress
 Low Sodium
 Low Blood Sugar
 High Potassium Addisson’s Disease Implementations
 High protein, High carbohydrate, high Sodium, Low potassium diet
 Teach life-long hormone replacement
Addisonian Crisis Assessments
• Hypotension
• Extreme weakness
• Nausea vomiting
• Abdominal pain
• Severe hypoglycemia
• Dehydration Addisonian Crisis Implementations
• Administer NaCl IV, vasopressors, hydrocortisone
• Monitor vital signs
• Absolute bedrest

Cushing’s Syndrome Assessments
• Osteoporosis
• Muscle wasting
• Hypertension
• Purple skin striations
• Moon face
• Truncal obesity
• Decreased resistance to infection Cushing’s Syndrome Implementations
• Low Carbohydrate, Low Calorie, High Protein, High Potassium, Low sodium diet
• Monitor glucose level
• Postop care after adrenalectomy or hypophysectomy

Pheochromocytoma Assessments—hypersecretions of the catecholamines (epinephrine/norepinephrine)
• Persistent hypertension
• Hyperglycemia
• Pounding headache
• Palpitations
• Visual disturbances Pheochromocytoma Implementations
• Histamine Test, Regitine Test, 24- hour urine VMA test
• Avoid emotional and physical stress
• Encourage rest
• Avoid coffee and stimulating foods
• Postop care after adrenalectomy and medullectomy

COPD Assessments
• “Blue Bloaters”
• “Pink Puffers”
• Weakness
• Change in postured day and hs (don’t sleep laying down, have to stay erect)
• Use of accessory muscles of breathing
• Dyspnea
• Cough
• Adventitious breath sounds COPD Implementations
• Assess airway clearance
• Listen to breath sounds
• Administer low-flow oxygen (1-2 L, not too much because your trying to prevent CO2 narcosis)
• Encourage fluids
• Small frequent feedings
• Use metered dose inhalers (MDI)

Pneumonia Assessments
• Fever
• Leukocytosis
• Productive Cough (rust, green, yellow)
• Dyspnea
• Pleuritic pain
• Tachycardia Pneumonia Implementations
• Check breath sounds
• Cough and deep breath q 2 hours
• Chest physiotherapy
• Antibiotics
• Incentive spirometer
• Encourage fluids
• Suction PRN
• Provide oxygen
• Semi-Fowler’s position
• Bedrest
• Medications—mucolytics (Mucomyst), expectorants (Robitussin), Bronchodilators (Aminophylline), Antibiotics (Bacterim)

Acyanotic Congenital Heart Anomalies Assessments
• Normal Color
• Possible exercise intolerance
• Small stature
• Failure to thrive
• Heart murmur
• Frequent respiratory Infections

Cyanotic Congenital Heart Anomalies Assessments
• Cyanosis
• Clubbing of fingers
• Seizures
• Marked exercise intolerance
• Difficulty eating
• Squat to decrease respiratory distress
• Small stature
• Failure to thrive
• Characteristic murmur
• Frequent respiratory infections
Acyanotic Congenital Heart Anomalies Types:
• Ventricular Septal Defect (VSD)—abnormal opening between right/left ventricles; hole size of pinhole or absence of septum; hear a loud harsh murmur, at age of 3 hole may close otherwise surgery such as purse-string suture

• Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if defect is severe closure is done later in childhood)

• Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from the placenta to systemic circulation (which bypasses the lungs). Once the child is born that structure should close because it is no longer needed because blood passes through to lungs; vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical to divide or ligate the vessel.

• Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end-to-end anastomosis.

• Pulomonic Stenosis—narrowing at entrance to pulmonary artery; causes resistance to blood flow and right ventricular hypertrophy; surgery

• Aortic Stenosis—narrowing of aortic valve; causes decrease cardiac output; surgery

Cyanotic Congenital Heart Anomalies Types:
• Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee chest position to help breath; surgery needed

• Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle; oxygenated blood not going into systemic circulation
• Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either goes to the lungs or to the body; cyanosis, murmur, difficult intolerance
• Total anomalous venous return—absence of direct communication between pulmonary veins and left atria; pulmonary veins attach directly to right atria or drains to right atria

Congenital Heart Anomalies Compensatory Mechanisms
• Tachycardia
• Polycythemia (increase formation of RBC’s)
• Posturing—squatting, knee-chest position

Congenital Heart Anomalies Implementations
• Prevention
• Recognize early symptoms
• Monitor vital signs and heart rhythms
• Medications—digoxin, iron, diuretics, potassium
• Change feeding pattern

Left-Side CHF
• Dyspnea, orthopnea
• Cough
• Pulmonary edema
• Weakness/Changes in mental status Right-Side CHF
• Dependent edema
• Liver enlargement
• Abdominal pain/Nausea/Bloating
• Coolness of extremities

CHF Implementations
• Administer digoxin, diuretics
• Low-sodium, low-calorie, low-residue diet
• Oxygen therapy
• Daily weight
• Teach about medications and diet

Arterial Peripheral Vascular Disease
Assessments
• Rubor
• Cool shiny skin
• Ulcers
• Gangrene
• Intermittent Claudication (pain with exercise/walking relieved with rest)
• Impaired sensation
• Decreased peripheral pulses Arterial Peripheral Vascular Disease
Implementations
• Monitor Peripheral pulses
• Good foot care
• Stop smoking
• Regular exercise
• Medications—vasodilators, anticoagulants

Venous Peripheral Vascular Disease
Assessments
• Cool, brown skin
• Edema
• Normal or decreased pulses
• Positive Homan’s sign Venous Peripheral Vascular Disease
Implementations
• Monitor peripheral pulses
• Elastic stockings
• Medications—anticoagulants
• Elevate legs
• Warm, moist packs
• Bedrest 4-7 days (acute phase)

Anemia Assessments (reduction in hemoglobin amount/erythrocytes)
• Palpitations
• Dyspnea
• Diaphoresis
• Chronic fatigue
• Sensitivity to cold Anemia Implementations
• Identify cause
• Frequent rest periods
• High protein, high iron, high vitamin diet
• Protect from infection

Iron Deficiency Anemia Assessments
• Fatigue
• Glossitis
• Spoon fingernails
• Impaired cognition Iron Deficiency Anemia Implementations
• Increase iron-rich foods (liver, green leafy vegetables)
• Iron supplements (stains teeth)
Pernicious Anemia Assessments (gastric mucosa fail to secrete enough intrinsic factor for stomach to absorb)
• Schilling’s Test
• Fatigue
• Sore, red tongue
• Paresthesia in hands and feet Pernicious Anemia Assessments
• Vitamin B12—IM
• Rest of life can’t be absorbed PO

Sickle Cell Anemia Assessments
• Pain /Swelling/Fever
• Schlerae jaundiced
• Cardiac murmurs
• Tachycardia Sickle Cell Anemia Implementations
• Check for signs of infection (prevent crisis)
• Check joint areas for pain and swelling
• Encourage fluids
• Provide analgesics with PCA pump c crisis

Hemophilia Assessments (female to male gene transmission)
• Easy bruising
• Joint pain
• Prolonged bleeding Hemophilia Implementations
• Administer plasma or factor VIII
• Analgesics
• Cryoprecipitated antihemophilic factor (AHF)
• Teach about lifestyle changes
• Non contact sports

Cancer Implementation: External Radiotherapy
• Leave markings on skin
• Avoid use of creams, lotions (only vitamin A&D ointment)
• Check for redness, cracking
• Wear cotton clothing
• Administer antiemetics

Cancer Implementation: Internal radiation sealed source
• Lead container and long-handled forceps in room
• Save all dressings, bed linen until source removed
• Urine and feces not radioactive
• Don’t stand close or in line with source
• Patient on bed rest Cancer Implementation: Internal Radiation
• Time and distance important
• Private room sign on door
• Nurse wears dosimeter at all times
• Limit visitors and time spent in room
• Rotate staff
• Self-care when can do
Cancer Implementation: Internal radiation unsealed source
• All body fluids contaminated
• Greatest danger first 24-96 hours

Leukemia Assessments
• Ulcerations of mouth
• Anemia
• Fatigue
• Weakness
• Pallor Leukemia Implementations
• Monitor for signs of bleeding: petechiae, ecchymosis, thrombocytopenia
• Infections
• Neutropenia (private room/limit # people, wbc done daily, no fruit, no flowers/plotted plants, clean toothbrush with weak bleach solution
• Good mouth care
• High calorie, high Vitamin diet (avoid salads/raw fruit/pepper/don’t reuse cup/don’t change litter box/digging in garden

Intracranial Tumors Assessments
• Motor deficits
• Hearing or visual disturbances
• Dizziness
• Paresthesia
• Seizures
• Personality disturbances
• Changes in LOC Intracranial Tumors Implementations
• Preoperative: do neurological assessment, patient head shaved
• Postoperative: maintain airway, elevate head 30-45 after supratentorial surgery
• Flat and lateral after infratentorial surgery
• Monitor vital and neurological signs
• Glascow coma scale
Therapeutic Positions
 Supine—avoids hip flexion
 Dorsal recumbent—supine with knees flexed
 Prone—extension of hip joint(after amputation)
 Side lateral—drainage of oral secretions
 Knee-chest—visualization of rectal area
 Sim’s—decreases abdominal tension (side lying with legs bent)
 Fowler’s—increases venous return, lung expansion
 High Fowler’s—60-90
 Fowler’s—45-60
 Semi-Fowler’s—30-45
 Low Fowler’s—15-30
 Modified Trendelenburg—used for shock;Feet elevated 20 degrees, knees straight, trunk flat, head slightly elevated
 Elevation of extremity—increases blood to extremity and venous return
 Lithotomy—used for vaginal exam

4 point Gait
Weight bearing both legs
RC, LF, LC, RF 2 point Gait
Bearing both legs
RC/LF, LC/RF 3 point Gait
Bearing one leg
Weaker leg both crutches, then stronger leg Swing-to-swing through
Partial weight bearing both legs
Both crutches, one or two legs
Stairs
 Going up—“good” leg first, crutches, “bad” leg
 Going down—crutches with “bad” leg, then “good” leg
 “Up with the good, down with the bad”
Walker
• Flex elbows 20-30 degrees when hands are on grips
• Lift and move walker forward 8-10 inches
• Step forward with “bad” leg, support self on arms, follow with “good” leg
• Stand behind client holding onto gait belt

Myelogram—x-ray visualization of the spinal canal by injection of radiopaque dye.
• Hydration done 12 hours before procedure
• Cleansing enemas
• Avoid seizure-promoting medications Post-procedure
• Water-soluble dye—elevate head of bed 30 degrees (not removed)
• Oil based dye—flat in bed (removed)
• Bedrest 24 hours encourage fluids

Laminectomy—excision portion of lamina to expose area of affected disc
• Preopcare: moist heat
• Fowler’s position
• Isometric exercises for abdominal muscles
• Muscle relaxants, NSAIDs, Analgesics
• Traction, TENS Postoperative care:
• Assess circulation and sensation
• Log roll Q2 hours with pillow between leg
• Calf exercises, assist with ambulation keeping back straight
• Muscle relaxants, NSAIDS, analgesics, Teaching—daily exercises, firm mattress, avoid prone position and heavy lifting
• Avoid sitting long time

Dysplasia of the Hip Assessment
• Uneven gluteal folds and thigh creases
• Limited abduction of hip
• Ortolani’s sign—place infant on back with legs flexed, clicking sound with abduction of legs
• Shortened limb on affected side Dysplasia of the Hip Implementations
Newborn to 6 months
• Reduced by manipulation
• Pavlik harness for 3 to 6 months
6 to 18 months
• Bilateral Bryant’s traction
• Hip spica cast
Older child
• Open reduction
• Hip Spica cast

Scoliosis Assessments—lateral deviation of one or more of vertebrae accompanied by rotary motion of spine
• Uneven hips or scapulae
• Kyphosis lump on back
• Bend at waist to visualize deformity
• Structural (flexible deviation corrected with bending) or functional (permanent heredirary that is seen) Scoliosis Implementations
• Exercises to strengthen abdominal muscles (if functional)
• Surgery: spinal fusion insertion of Herrington Rod
• Milwaukee brace: used with curves 30-40 degrees
• Wear 4-6 years, worn 23 hours of the day, wear undershirt to prevent irritation, teach isometric exercises

Cerebral Palsy Assessments
• Voluntary muscles poorly controlled due to brain damage
• Spasticity, rigidity, ataxia, repetitive involuntary gross motor movements Cerebral Palsy Implementations
• Ambulation devices, PT and OT
• Muscle relaxants and anticonvulsants
• Feeding: place food at back of mouth with slight downward pressure. Never tilt head backward.
• High calorie diet

Muscular Dystrophy Assessments
Atrophy of voluntary muscles
Muscle weakness, lordosis, falls Braces to help ambulation
Balance activity and rest

Parkinson’s Disease Assessments
• Deficiency of dopamine
• Tremors, rigidity, propulsive gait
• Monotonous speech
• Mask like expression Parkinson’s Disease Implementations
• Teach ambulation modification: goose stepping walk (marching), ROM exercises
• Medications—Artane, Cogentin, L-Dopa, Parlodel, Sinemet, Symmetrel

Myasthenia Gravis Assessments
• Deficiency of acetylcholine
• Muscular weakness produced by repeated movement
• Dysphagia
• Respiratory distress Myasthenia Gravis Implementations
• Good eye care, restful environment
• Medications—anticholinesterases, corticosteroids, immunosuppressants
• Avoid crisis: infection
• Symptoms: sudden ability to swallow

Clear liquid
 No milk
 No juice with pulp Full liquid
 No jam
 No fruit
 No nuts Low-fat cholesterol restricted
 Can eat lean meat
 No avocado, milk, bacon, egg yolks butter Sodium restricted
 No cheese High roughage, high fiber
 No white bread without fiber Low-residue
 Minimize intestinal activity
 Buttered rice white processed food, no whole wheat corn bran
High protein diet
 Restablish anabolism to raise albumin levels
 Egg, roast beef sandwich,
 No junk food Renal
 Keeps protein, potassium and sodium low
 No beans, no cereals, no citrus fruits Low-phenylalanine diet
 Prevents brain damage from imbalance of amino acids
 Fats, fruits, jams allowed
 No meats eggs bread

Glomerulonephritis Assessment
• Fever, Chills
• Hematuria
• Proteinuria
• Edema
• Hypertension
• Abdominal or flank pain
• Occurs 10 days after beta hemolytic streptococcal throat infection Glomerulonephritis Implementation
• Antibiotics, corticosteroids
• Antihypertensives, immunosuppressive agents
• Restrict sodium and water intake
• Bedrest
• I&O
• Daily weight
• High Calorie, Low protein

Urinary Diversion: Assessments
• Done for: Bladder t umors, birth defects, neurogenic bladder, interstitial cystitis
• Ileal Conduit
• Koch Pouch Urinary Diversion Implementations
• Nephrostomy: flank incision and insertion of nephrostomy tube into renal pelvis; penrose drain after surgery; surgical dressing
• Ureterosigmoidostomy: urters detached from bladder and anastomosed to sigmoid colon; encourage voiding via rectum q 2-4 hours;no enemas or cathartics; complications—electrolyte imbalance, infection, obstruction; urine and stool evacuated towards anus.
• Cutaneous Ureterostomy: Stoma formed from ureters excised from bladder and brought to abdominal wall; stoma on right side below waist; assist with alteration in body image
• Illeal Conduit: Ureters replanted into portion of terminal ileum and brought to abdominal wall; check for obstruction; mucous threads in urine normal
• Koch Pouch (Continent Illeal Conduit): Ureters transplanted into pouch made from ileum with one-way valve; drainage of pouch by catheter under control of client; drain pouch at regular intervals

Acute Renal Failure Assessments: Oliguric Phase
• Output <400 chamber="air">11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician)
• Lowered<3,>50% residual from previous hour (adults) or >25% (children)
• Flush tube with water before and after feeding
• Use pump to control rate of tube feeding
• Administer fluid at room temperature
• Change bag Q8 hours for continuous feeding
• Elevate head of bed while feeding is running
• Check patency Q4 hours
• Good mouth care

NG Irrigation Tubing:
• Verify placement of tube
• Insert 30-50 cc of normal saline into tube
• If feel resistance, change patient position, check for kinks
• Withdraw solution or record amount as input
NG removal:
• Clamp tube
• Remove tape
• Instruct patient to exhale
• Remove tube with smooth, continuous pull

Intestinal Tubes (Cantor, Mill-Abbott, Harris)
• Implementations
o After tube is in stomach, have patient lie on right side, then back in Fowler’s position, then left side
o Gravity helps to position tube
o Coil excess tube loosely on bed, do not tape
o Position of tube verified by x-ray
o Measure drainage QShift
• Removal
o Clamp tube
o Remove tape
o Deflate balloon or aspirate contents of intestinal tube balloon
o Instruct patient to exhale
o Remove 6” every 10 min. until reaches the stomach, then remove completely with smooth, continuous pull

T-Tube: 500-1000 cc/day, bloody first 2 hours
Penrose: expect drainage on dressing

Enema Implementation
• Position on left side
• Use tepid solution
• Hold irrigation set no more than 18” above rectum
• Insert tube no more than 4”
• Do not use if abdominal pain, nausea, vomiting, suspected appendicitis

Catheter insertion: 2-3” into urethra then 1” after urine flows

Male catheter: insert 6-7”

Catheter Urine Drainage bag: do not remove more than 700 cc at one time, clamp prior to removal

Ileostomy: post-op has loose, dark green, liquid drainage from stoma

Tonsillectomy: post-op frequently swallowing indicates hemorrhage

External contact lenses: need fine motor movements (rheumatoid arthritis prevents this).

Object in eye: never remove visible glass; apply loose cover and remain quiet.

Retina detached: sleep prone with affected side down; avoid jarring movements; avoid pin point movement with eye (sewing); high fluid and roughage (prevents constipation=no straining); make light sufficient for needs (75watt+); no hairwashing

Glaucoma medications: Epinephrine hydrochloride (Adrenalin Chloride) and Pilocarpine Hydrochloride (Pilocar): give Pilocar (therapeutic) first then wait 2-10minutes and instill adrenalin to increase absorption of adrenalin).

Tympanoplasty: remain in bed 24 hours position flat in bed with the affected ear up (helps to promote insertion).

Triglycerides elevation can falsely elevate glycosalated hemoglobin test.

Laparoscopic Cholecystectomy post: encourage to walk to eliminate acute right shoulder pain.

Impetigo: 2 year old; honey-colored crusts, vesicles, and reddish macules around mouth; don’t need to isolate; watch contact precautions.

Only patient we use distractions on the NCLEX are manic patients and toddlers not for pain.

Rhinoplasty (nose surgery) position post-op: want to promote drainage of oral secretions is to position on her right side.

1 cup= 240cc
Pregnancy is a contraindication to an MRI.

Raynaud’s disease have decreased vascularity in the extremities.

Post-Parecentesis most important assessment is to obtain the blood pressure, weight the client, measure the client’s abdominal girth, and check dressing in that order.

Tracheostomy tube: use pre-cut/pre-made gauze pads.

Suction is always intermittent never continuous.

O universal donor/AB universal recipient.

ABO BLOOD TYPE COMPATIBILITY
Blood Type Can Receive from: Can donate to:
O O O,A,B,AB
A A,O A,AB
B B,O B,AB
AB O,A,B,AB AB

Autologous Transfusion:
• Collected 4-6 weeks before surgery
• Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular
disease

Hypotonic Solution
• ½ NS (0.45% Saline) Isotonic Solution
• 0.9% NaCl (Normal Saline)
• 5% D/W (Dextrose in Water)
• Lactated Ringer’s
• 5% D/ ¼ NS (5% Dextrose in 0.225% Saline ) Hypertonic Solution
• 10% D/W (10% Dextrose in water)
• D15W
• 5% D/NS (5% Dextrose in 0.9% Saline)
• 5% D/ ½ NS (5% Dextrose in 0.45% Saline)
• 3% NaCl
• 5% Sodium Bicarbonate

Change tubing Q72 hours

Change bottle Q24 hours
Infiltration
• Assessment: cool skin, swelling, pain, decrease in flow rate
• Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site
IV Phlebitis, Thrmobophlebitis
• Assessment—redness, warm, tender, swelling, leukocytosis
• Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity
Hematoma
• Assessment—ecchymosis, swelling, leakage of blood
• Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity

IV Clotting
• Assessment—decreased flow rate, back flow of blood into tubing
• Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate cannula, inject Urokinase, D/C and start on other site.

Insertion of Percutaneous Central Catheters:
• Placed supine in head-low position
• Turn head away from procedure
• Perform Valsalva maneuver
• Antibiotic ointment and transparent sterile dressing
• Verify position with x-ray
• Change tubing Q24 hours
• Nurse/patient both wear mask when dressing change 2-3x/week

Adrenergics
Actions:
• Stimulate the sympathetic nervous system: increase in peripheral resistance, increase blood flow to heart, bronchodilation, increase blood flow to skeletal muscle, increase blood flow to uterus
• Stimulate beta-2 receptors in lungs
• Use for cardiac arrest and COPD Adrenergic Medications
• Levophed
• Dopamine
• Adrenalin
• Dobutrex Adrenergics Side effects:
• Dysrhythmias
• Tremors
• Anticholinergic effects
Adrenergics Nursing Considerations:
• Monitor BP
• Monitor peripheral pulses
• Check output

Anti-Anxiety
Action:
• Affect neurotransmitters
Used for:
• Anxiety disorders, manic episodes, panic attacks Anti-Anxiety
Medications:
• Librium, Xanax, Ativan, Vistaril, Equanil
Anti-Anxiety
Side effects:
• Sedation
• Confusion
• Hepatic dysfunction
Anti-Anxiety
Nursing Considerations:
• Potention for addiction/overdose
• Avoid alcohol
• Monitor Liver Function AST/ALT
• Don’t discontinue abruptly, wean off
• Smoking/caffeine decreases effectiveness
Antacids
Actions:
• Neutralize gastric acids
Used for:
• Peptic ulcer
• Indigestion, reflex esophagitis Antacids Medications
• Amphojel
• Milk of Magnesia
• Maalox Antacids
Side effects:
• Constipation
• Diarrhea
• Acid rebound
Antacids
Nursing Considerations:
• Interferes with absorption of antibiotics, iron preps, INH, Oral contraceptives
• Monitor bowel function
• Give 1-2 hours after other medications
• 1-3 hours after meals and at HS
• Take with fluids

Antiarrhythmics
Action:
• Interfere with electrical excitability of heart
Used for:
• Atrial fibrillation and flutter
• Tachycardia
• PVCs Antiarrhythmics
Medications:
• Atropine sulfate
• Lidocaine
• Pronestyl
• Quinidine
• Isuprel Antiarrhythmics
Side effects:
• Lightheadedness
• Hypotension
• Urinary retention
Antiarrhythmics
Nursing Considerations:
• Monitor vital signs
• Monitor cardiac rhythm

Aminoglycosides (Antibiotics)
Action:
• Inhibits protein synthesis in gram-negative bacteria
Used for:
• Pseudomonas, E.Coli Aminoglycosides (Antibiotics)
Medications:
• Gentamycin
• Neomycin
• Streptomycin
• Tobramycin Aminoglycosides (Antibiotics)
Side effects:
• Ototoxicity and Nephrotoxicity
• Anorexia
• Nausea
• Vomiting
• Diarrhea
Aminoglycosides (Antibiotics)
Nursing Considerations:
• Harmful to liver and kidneys
• Check 8th cranial nerve (hearing)
• Check renal function
• Take for 7-10 days
• Encourage fluids
• Check peak/trough level

Allergy: 1st symptom SOB

Cephalosporins (Antibiotics)
Action:
• Inhibits synthesis of bacterial cell wall
Used for:
• Tonsillitis, otitis media, peri-operative prophylaxis
• Meningitis Cephalosporins (Antibiotics)
Medications:
• Ceclor
• Ancef
• Keflex
• Rocephin
• Cefoxitin Cephalosporins (Antibiotics)
Side effects:
• Bone marrow depression: caution with anemic, thrombocytopenic patients
• Superinfections
• Rash
Nursing Considerations:
• Take with food
• Cross allergy with PCN
• Avoid alcohol
• Obtain C&S before first dose: to make sure medication is effective against disease/bacteria
• Can cause false-positive for proteinuria/glycosuria

Fluoroquinolones (Antibiotics)
Action:
• Interferes with DNA replication in gram-negative bacteria
Used for:
• E.Coli, Pseudomonas, S. Aureus Fluoroquinolones
(Antibiotics)
Medications:
• Cipro Fluroquinolones
(Antibiotics)
Side effects:
• Diarrhea
• Decreased WBC and Hematocrit
• Elevated liver enzymes (AST, ALT)
• Elevated alkaline phosphatase
Nursing Considerations:
• C&S before starting therapy
• Encourage fluids
• Take 1 hour ac or 2 hour pc (food slows absorption)
• Don’t give with antacids or iron preparation
• Maybe given with other medications (Probenicid: for gout)

Macrolide (Antibiotics)
Action:
• Binds to cell membrane and changes protein function
Used for:
• Acute infections
• Acne
• URI
• Prophylaxis before dental procedures if allergic to PCN Macrolide (Antibiotics)
Medications:
• Erythromycin
• Clindamycin Macrolide (Antibiotics)
Side effects:
• Diarrhea
• Confusion
• Hepatotoxicity
• Superinfections
Nursing Considerations:
• Take 1hr ac or 2-3 hr pc
• Monitor liver function
• Take with water (no fruit juice)
• May increase effectiveness of: Coumadin and Theophylline (bronchodilator)

Penicillin
Action:
• Inhibits synthesis of cell wall
Used for:
• Moderate to severe infections
• Syphilis
• Gonococcal infections
• Lyme disease Penicillin
Medications:
• Amoxicillin
• Ampicillin
• Augmentin Penicillin
Side effects:
• Stomatitis
• Diarrhea
• Allergic reactions
• Renal and Hepatic changes
Nursing Considerations:
• Check for hypersensitivity
• Give 1-2 hr ac or 2-3 hr pc
• Cross allergy with cephalosporins

Sulfonamides (Antibiotics)
Action:
• Antagonize essential component of folic acid synthesis
Used for:
• Ulcerative colitis
• Crohn’s disease
• Otitis media
• UTIs Sulfonamides (Antibiotics)
Medications:
• Gantrisin
• Bactrim
• Septra
• Azulfidine Sulfonamides (Antibiotics)
Side effects:
• Peripheral Neuropathy
• Crystalluria
• Photosensitivity
• GI upset
• Stomatitis
Nursing Considerations:
• Take with meals or foods
• Encourage fluids
• Good mouth care
• Antacids will interfere with absorption

Tetracyclines
(Antibiotics)
Action:
• Inhibits protein sythesis
Used for:
• Infections
• Acne
• Prophylaxis for opthalmia neonatorum TEtracyclines
(Antibiotics)
Medications:
• Vibramycin
• Panmycin Tetracyclines (Antibiotics)
Side effects:
• Discoloration of primary teeth if taken during pregnancy or if child takes at young age
• Glossitis
• Rash
• Phototoxic reactions
Nursing considerations:
• Take 1 hr ac or 2-3 hr pc
• Do not take with antacids, milk, iron
• Note expiration date
• Monitor renal function
• Avoid sunlight

UTIs
• Medication:
o Furadantin
• Action:
o Anti-infective
• Side effects:
o Asthma attacks
o Diarrhea
• Nursing Considerations:
o Give with food or milk
o Monitor pulmonary status

UTIs
• Medication
o Mandelamine
• Action:
o Anti-infective
• Side effects:
o Elevated liver enzymes
• Nursing Considerations:
o Give with cranberry juice to acidify urine
o Limit alkaline foods: vegetables, milk, almonds, coconut

UTIs
• Medication
o Pyridium
• Side effects:
o Headache
o Vertigo
• Action
o Urinary tract analgesic
• Nursing Consideration
o Tell patient urine will be orange

Anticholinergics
Action:
• Inhibits action of acethylcholine and blocks parasympathetic nerves (affects heart, eyes, respiratory tract, GI tract and the bladder)
• Dilates pupil, causes bronchodilation and decreased secretions
• Decrease GI motility secretions
Used for:
• Opthalmic exam
• Motion sickness
• Pre-operative Anticholinergic Medications:
• Pro-Banthine
• Atropine
• Scopolamine Anticholinergic
Side Effects:
• Blurred vision
• Dry mouth
• Urinary retention
• Chage in heart rate
Nursing Consideration:
• Monitor output
• Contraindicated with glaucoma
• Give 30 min ac, hs, or 2hr pc
• Contraindicated: paralytic ileus, BPH

Anticoagulants
Action:
• Blocks conversion of prothrombin to thrombin
Used for:
• Pulmonary embolism
• Venous thrombosis
• Prophylaxis after acute MI Anticoagulants
Medications:
• Heparin Anticoagulants (Heparin)
Side Effects:
• Hematuria
• Tissue irritation
Nursing Considerations:
• Monitor clotting time or Partial Thromboplastin Time (PTT)
• Normal 20-45 sec
• Therapeutic level 1.5-2.5 times control
• Antagonist—Protamine Sulfate
• Give SC or IV

Anticoagulant
Action:
• Interferes with synthesis of vitamin K-dependent clotting factors
Used for:
• Pulmonary embolism
• Venous thrombosis
• Prophylaxis after acute MI Anticoagulant
Medication:
• Coumadin Anticoagulant (Coumadin)
Side Effects:
• Hemorrhage, Alopecia
Nursing Considerations:
• Monitor Prothrombin Test (PT)
• Normal 9-12 sec
• Therapeutic level 1.5 times control
• Antagonist—Vitamin K (AquaMEPHYTON)
• Monitor for bleeding
• Give PO

Anticonvulsants
Action:
• Decreases flow of calcium and sodium across neuronal membranes
Used for:
• Seizures Anticonvulsant
Medications:
• Dilantin
• Luminal
• Depakote
• Tegretol
• Klonopin Anticonvulsant
Side effects:
• Respiratory depression
• Aplastic anemia
• Gingival hypertrophy
• Ataxia
Nursing Considerations:
• Don’t discontinue abruptly
• Monitor I&O
• Caution with use of medications that lower seizure threshold: MAO inhibitors & anti-psychotics
• Good mouth care
• Take with food
• May turn urine pinkish-red/pinkish-brown

Anti-Depressants Monoamine Oxidase Inhibitors (MAO)
Action:
• Causes increases concentration of neurotransmitters
Used for:
• Depression
• Chronic pain
Anti-Depressants
(Monoamine Oxidase Inhibitors)
Medications:
• Marplan
• Nardil
• Parnate
Anti-Depressants
(Monoamine Oxidase Inhibitors)
Side effects:
• Hypertensive Crisis (Sudden headache, diaphoretic, palpitations, stiff neck, intracranial hemorrhage) with food that contain Tyramine
Nursing Considerations:
• Avoid foods containing Tyramine: Aged cheese, liver, yogurt, herring, beer and wine, sour cream, bologna, pepperoni, salami, bananas, raisins, and pickled products
• Monitor output
• Takes 4 weeks to work
• Don’t combine with sympathomometics vasoconstrictors, and cold medications

Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)
Action:
• Inhibits CNS uptake of serotonin
Used for:
• Depression
• Obsessive-Compulsive Disorder
• Bulimia Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)
Medications:
• Paxil
• Prozac
• Zoloft Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)
Side effects:
• Anxiety
• GI upset
• Change in appetite and bowel function
• Urinary retention
Nursing Considerations:
• Suicide precautions
• Takes 4 weeks for full effect
• Take in a.m.
• May urine to pinkish-red or Pinkish-brown
• Can be taken with meals
Anti-Depressants (Tricyclics)
Action:
• Inhibits reuptake of neurotransmitters
Used for:
• Depression
• Sleep apnea Anti-Depressants (Tricyclics)
Medications:
• Norpramin
• Elavil
• Tofranil Anti-Depressants (Tricyclics)
Side Effects:
• Sedation/Confusion
• Anticholinergics affects
• Postural Hypotension
• Urinary retention
Nursing Considerations:
• Suicide precautions/2-6 weeks to work
• Take at hs/Don’t abruptly halt
• Avoid alcohol/OTC /Photosensitivity

Insulin
(Regular, Humulin R)
Type: Fast acting
Onset: ½ -1 hr
Peak: 2-4 hr
Duration: 6-8 hr Insulin
(NPH, Humulin N)
Type: Intermediate acting
Onset: 2hr
Peak: 6-12hr
Duration 18-26hr Insulin
(Ultralente, Humulin U)
Type: Slow acting
Onset: 4hr
Peak: 8-20hr
Duration: 24-36hr Insulin
(Humulin 70/30)
Type: Combination
Onset: ½ hr
Peak: 2-12hr
Duration: 24hr

Antidiabetic Agents
Action:
• Stimulates insulin release from beta cells in pancreas
Used for:
• Type 2 diabetes (NIDDM) Antidiabetic Agents
Medications:
• Diabinese
• Orinase
• Dymelor
• Micronase Antidiabetic Agents
Side Effects:
• Hypoglycemia
• Allergic skin reactions
• GI upset
Nursing Considerations:
• Take before breakfast
• Monitor glucose levels
• Avoid alcohol, sulfonamides, Oral Contraceptives, (MAO), aspirin because they help to make drug work better

Hypoglycemic Agent
Action:
• Stimulates liver to change glycogen to glucose
Used for:
• Hypoglycemia Hypoglycemic Agent
Medication:
• Glucagon Hypoglycemic Agent
Side Effects:
• Hypotension
• Bronchospasm
Nursing Considerations:
• May repeat in 15min
• Give carbohydrates orally to prevent secondary hypoglycemic reactions

Antidiarrheals
Action:
• Slows peristalsis
• Increases tone of sphincters
Used for:
• Diarrhea Antidiarrheals
Medications:
• Kaopectate
• Lomotil
• Imodium
• Paregoric Antidiarrheals
Side Effects:
• Constipation
• Anticholinergic effects (urinary retention, dry mouth)
Nursing Considerations:
• Do not use with abdominal pain
• Monitor for urinary retention
• Give 2hr before or 3 hr after other meds

Antiemetics
Action:
• Increases GI motility
• Blocks effect of dopamine in chemoreceptor trigger zone
Used for:
• Vomiting Antiemetics
Medications:
• Tigan
• Compazine
• Torecan
• Reglan
• Antivert
• Dramamine Antiemetics
Side Effects:
• Sedation
• Anticholinergic effects
Nursing Considerations:
• Used before chemotherapy
• When used with viral infections may cause Reye’s syndrome (Toxic Encephalopathy)

Antifungals
Action:
• Impairs cell membrane
Used for:
• Candidiasis
• Oral thrush
• Histoplasmosis Antifungals
Medications:
• Amphotericin B
• Nystatin Antifungals
Side Effects:
• Hepatotoxicity
• Thrombocytopenia
• Leukopenia
• Pruritis
Nursing Considerations:
• Give with food
• Monitor liver function
• Good oral hygiene

Antigout Agents
Action:
• Decreases production and resorption of uric acid
Used for:
• Gout Antigout Agents
Medications:
• Colchicine
• Probenecid
• Zyloprim Antigout Agents
Side Effects:
• Agranulocytosis
• GI upset
• Renal calculi
Nursing Considerations:
• Monitor for renal calculi
• Give with food, milk, antacids

Antihistamines
Action:
• Block effects of histamine
Used for:
• Allergic rhinitis
• Allergic reactions to blood Antihistamines
Medications:
• Chlor-Trimeton
• Benadryl
• Phenergan Antihistamines
Side Effects:
• Drowsiness
• Dry mouth
• Photosensitivity
Nursing Considerations:
• Give with food
• Use sunscreen
• Avoid alcohol

Antihyperlipidemic Agents
Action:
• Inhibits cholesterol and triglyceride synthesis
Used For:
• Elevated cholesterol
• Reduce incidence of cardiovascular disease Antihyperlipidemic Agents
Medications:
• Questran
• Lipid Antihyperlipidemic Agents
Side Effects:
• Constipation
• Fat-soluble vitamin deficiency
Nursing Considerations:
• Take at hs or 30 min ac
• Administer 1hr before or 4-6 hr after other meds

Antihypertensives
Types: ACE Inhibitors
Action:
• Blocks ACE in lungs
Used for:
• Hypertension
• CHF Antihypertensives
(ACE Inhibitors)
Medications:
• Capoten
• Vasotec Antihypertensives
(ACE Inhibitors)
Side Effects:
• GI upset
• Orthostatic hypotension
• Dizziness
Nursing Considerations:
• Give 1hr ac or 3hr pc
• Change position slowly

Antihypertensives
Type: Beta-Adrenergic Blockers
Action:
• Blocks Beta-Adrenergic Receptors
• Decrease excitability/workload of heart, oxygen consumption
• Decrease
Used for:
• Hypertension
• Angina
• SVT Antihypertensives
Type: Beta-Adrenergic
Medications;
• Nadolol
• Propranolol
• Tenormin
• Timoptic Antihypertensives
Type: Beta-Adrenergic
Side Effects:
• Changes in heart rate
• Hypotension
• Bronchospasm
Nursing Considerations:
• Masks signs of shock and hypoglycemia
• Take with meals
• Do not discontinue abruptly

Antihypertensives
Type: Calcium Channel Blockers
Action:
• Inhibits movement of calcium across cell membranes
• Slow impulse conduction and depresses myocardial contractility
• Causes dilation of coronary arteries and decreases cardiac workload and energy consumption
Used for:
• Angina
• Hypertension
• Interstitial cystitis Antihypertensives
Type: Calcium Channel Blockers
Medications:
• Procardia
• Calan
• Cardizem Antihypertensives
Type: Calcium Channel Blockers
Side Effects:
• Hypotension
• Dizziness
• GI distress
Nursing Consideration:
• Monitor vital signs
• Do not chew or divide sustained-release tablets

Antihypertensives
Type: Centrally acting alpha-adrenergics
Action:
• Stimulates alpha receptors in medulla which causes a reduction in sympathetic in the heart
Used for:
• Hypertension Antihypertensives
Type: Centrally acting alpha-adrenergics
Medications:
• Aldomet
• Catapres Antihypertensives
Type: Centrally acting alpha-adrenergics
Side Effects:
• Sedation
• Orthostatic Hypotension
Nursing Considerations:
• Don’t discontinue abruptly
• Monitor for fluid retention
• Change position slowly
Antihypertensives
Type: Direct-acting vasodilators
Action:
• Relaxes smooth muscle
Used for:
• Hypertension Antihypertensives
Medications
• Hydralazine
• Minoxidil Antihypertensives
Side Effects:
• Tachycardia
• Increase in body hair
Nursing Considerations:
• Teach patient to check pulse

Antihypertensives
Type: Peripheral-acting alpha-adrenergic blockers
Action:
• Depletes stores of norepinephrine in sympathetic nerve endings
Used for:
• Hypertension Antihypertensives
Medications:
• Reserpine Antihypertensives
Side Effects:
• Depression
• Orthostatic Hypotension
• Brachycardia
Nursing Considerations:
• Give with meals or milk
• Change position slowly

Bipolar Disorder
Action:
• Reduces catecholamine release
Used for:
• Manic episodes Bipolar Disorder Medications:
• Lithium (1-1.5meq/L)
• Tegretol
• Depakote Bipolar Disorder
Side Effects:
• GI upset
• Tremors
• Polydipsia
• Polyuria
Nursing Considerations:
• Monitor serum levels
• Give with meals
• Increase fluid intake

Antineoplastic Agents
Type: Alkylating Agents
Action:
• Interferes with rapidly reproducing DNA
Used for:
• Leukemia
• Multiple myeloma Antineoplastic Agents
Medications:
• Cisplatin
• Myleran
• Cytoxan Antineoplastic Agents
Side Effects:
• Hepatotoxicity
• Ecchymosis
• Alopecia
• Epitaxis
• Infertility
• Bone Marrow Suppression
• Stomatitis
• GI disturbances: Anorexic, N/V, diarrhea
Nursing Considerations:
• Check hematopoietic (reproduction of RBC’s by bone marrow) function
• Force fluids
• Good mouth care

Antineoplastic Agents
Type: Antimetabolites
Action:
• Inhibits DNA polymerase
Used for:
• Acute lymphatic leukemia
• Cancer of colon, breast, pancreas Antineoplastic Agents
Antimetabolites Medications:
• 5-FU
• Methotrexate
• Hydrea Antineoplastic Agents
Antimetabolites
Side Effects:
• Nausea
• Vomiting
• Oral ulceration
• Bone marrow suppression
• Alopecia
Nursing Considerations:
• Monitor hematopoietic function
• Good mouth care
• Discuss body image changes

Antineoplastic Agents
Type: Antitumor Antibiotics
Action:
• Interferes with DNA and RNA synthesis
Used for:
• Cancer Antineoplastic Agents
Antitumor Antibiotics
Medications:
• Adriamycin
• Actinomycin D
• Bleomycin Antineoplastic Agents
Antitumor Antibiotics
Side Effects:
• Bone marrow suppression
• Alopecia
• Stomatitis
Nursing Considerations:
• Monitor vital signs
• Give antiemetic medications before therapy

Antineoplastic Agents
Type: Hormonal Agents
Action:
• Changes hormone input into sensitive cells
Used for:
• Cancer Antineoplastic Agents
Type: Hormonal Agents
Medications:
• Diethylstilbestrol
• Tamoxifen
• Testosterone Antineoplastic Agents
Type: Hormonal Agents
Side Effects:
• Leukpenia
• Bone pain
• Hypercalcemia
Nursing Considerations:
• Check CBC
• Monitor serum calcium

Antineoplastic Agents
Type: Vinca Alkaloids
Action:
• Interferes with cell division
Used for:
• Cancer Antineoplastic Agents
Type: Vinca Alkaloids
Medications:
• Oncovin
• Velban Antineoplastic Agents
Type: Vinca Alkaloids
Side Effects:
• Stomatitis
• Alopecia
• Loss of reflexes
• Bone marrow suppression
Nursing Considerations:
• Give antiemetic before administration
• Check reflexes
• Given with Zyloprim to decrease uric acid

Antiparkinson Agents
Action:
• Converted to Dopamine
• Stimulates postsynaptic Dopamine receptors
Used for:
• Parkinson’s disease Antiparkinson Agents
Medications:
• Artane
• Cogentin
• L-Dopa
• Parlodel
• Sinemet
• Symmetrel Antiparkinson Agents
Side Effects:
• Dizziness
• Ataxia
• Atropine-like effects: dry mouth, urinary retention
Nursing Considerations:
• Monitor for urinary retention
• Large doses of vitamin B6 reverse effects
• Avoid use of CNS depressants
Antiplatelet Agents
Action:
• Interferes with platelet aggregation
Used for:
• Venous thrombosis
• Pulmonary embolism Antiplatelet Agents
Medications:
• Aspirin
• Persantine Antiplatelet Agents
Side Effects:
• Hemorrhage
• Thrombocytopenia
Nursing Considerations:
• Check for signs of bleeding
• Give with food or milk

Antipsychotic Agents
Action:
• Blocks dopamine receptors in basal ganglia
Used for:
• Acute and Chronic psychoses Antipsychotic Agents
Medications:
• Haldol
• Thorazine
• Mellaril
• Stelazine Antipsychotic Agents
Side Effects:
• Akathisia (inability to sit still)
• Dyskinesia
• Dystonias
• Parkinson’s syndrome
• Tardive dyskinesias
• Leukopenia
Nursing Considerations:
• Check CBC
• Monitor vital signs
• Avoid alcohol and caffeine

Atypical Antipsychotic Agents
Action:
• Interferes with binding of dopamine in the brain
Used for:
• Acute and Chronic psychoses Atypical Antipsychotic
Medications:
• Clozaril
• Risperdal Atypical Antipsychotic
Side Effects:
• Extrapyramidal effects
• Anticholinergic
• Sedative
• Orthostatic hypotension
Nursing Considerations:
• Monitor blood
• Change positions slowly
• Use sunscreen

Antipyretic Agents
Action:
• Antiprostaglandin activity in hypothalamus
Used for:
• Fever Antipyretic Agents
Medications:
• Tylenol (Acetaminophen) Antipyretic Agents
Side Effects:
• GI irritation
Nursing Considerations:
• Monitor liver function
• Aspirin contraindicated for younger than 21 years old due to risk of Reye’s syndrome

Antithyroid Agents
Action:
• Reduce vascularity of thyroid
• Inhibits release of thyroid into circulation
Used for:
• Hyperthyroidism Antithyroid Agents
Medications:
• Tapazole
• SSKI Antithyroid Agents
Side Effects:
• Leukopenia
• Rash
• Thrombocytopenia
Nursing Considerations:
• Bitter taste
• May cause burning in mouth
• Give with meals
• Check CBC

Thyroid Replacement Agents
Action:
• Increases metabolic rate
Used for:
• Hypothyroidism Thyroid Replacement
Medications
• Synthroid
• Cytomel Thyroid Replacement
Side Effects:
• Nervousness
• Tachycardia
• Weight loss
Nursing Considerations:
• Monitor pulse and BP
• Monitor weight
• Take in a.m.
• Enhance action of anticoagulants, antidepressants, decrease action of insulin and digitalis

Antitubercular Agents
Action:
• Inhibits cell and protein synthesis
Used for:
• Tuberculosis
• To prevent disease in person exposed to organism

Antitubercular Agents
Medications:
• INH
• Ethambutol
• Streptomycin
• PAS
• PYZ
Antitubercular Agents
Side Effects:
• Hepatitis
• Peripheral Neuritis
Nursing Considerations:
• Check liver function tests
• Vitamin B6 given for peripheral neuritis (Pyridoxine)
• Used in combination
Antivirals
Action:
• Inhibits DNA and RNA replication
Used for:
• Recurrent HSV
• HIV infection Antivirals
Medications:
• Zovirax
• AZT
• Videx
• Famvir
• Cytovene Antivirals
Side Effects:
• Headache
• Dizziness
• GI symptoms
Nursing Considerations:
• Encourage fluids
• Not a cure, but relieves symptoms

Attention Disorder Agents
Action:
• Increases level of catecholamines
Used for:
• ADDH
• Narcolepsy Attention Disorder Agents
Medications:
• Ritalin
• Cylert
• Dexedrine Attention Disorder Agents
Side Effects:
• Restlessness
• Insomnia
• Tachycardia
• Palpitations
Nursing Considerations:
• Monitor growth rate
• Monitor liver enzymes
• Give in A.M.

Bronchodilators
Action:
• Decreases activity of phosphodiesterase
Used for:
• COPD
• Preterm labor (Terbutaline) Bronchodilators
Medications:
• Aminophylline
• Atrovent
• Brethine
• Proventil
• Primatene Bronchodilators
Side Effects:
• Tachcyardia
• Dysrhythmias
• Palpitations
• Anticholinergic effects
Nursing Considerations:
• Monitor BP and HR
• When used with steroid inhaler, use bronchodilator first
• May aggravate diabetes

Cardiac Glycosides
Action:
• Increases force of myocardial contraction, slows rate
Used for:
• Left-sided CHF Cardiac Glycosides
Medication:
• Lanoxin
(Digoxin) Cardiac Glycosides
Side Effects:
• Bradycardia
• Nausea
• Vomiting
• Visual disturbances
Nursing Considerations:
• Take apical pulse
• Notify physician if adult <60,>9micrograms = toxic), Erythrocyte protoporphyrin (EP), X-ray long bones (lead deposits in long bones)
 Children engage in PICA (ingesting nonfood substances)
 Lead blocks formation of hemogloblin and toxic to kidneys.
 Nursing care: identify source, chelating agents, teaching parents
What are nursing care goals for Hazardous wastes?  Decontaminate individual
 Prevent spread of contamination
 Clean and remove contaminuated source
 Monitor personnel exposed
What are nursing care for Hazardous wastes?  If chemical poses threat to caregiver, decontaminate patient first.
 If chemical poses no threat or patient has been decontaminated, begin care.
 If immediate threat to life, put on protective garments and provide care to stabilize patient.
What type of play do infants (0-12months) use?  Solitary play. Game is one sided. Like to play with body parts.
 Birth-3months: smile/squeal
 3-6months: rattles/soft stuff toys
 6-12 months: begin imitation, peek-a-boo, patty-cake
What type of play do toddlers (1-3years) use?  Parallel play.
What type of play do pre-schoolers (3-6years) use?  Associative play. Dress up/imitating play. Talking on telephone/kitchen/tool belt
What type of play do school age (6-12years) use?  Cooperative play. Conformed/organized play.
According to Erikson’s Developmental Task, explain the Infancy stage.  Birth-18 months.
 Trust vs. Mistrust
 Positive outcome---trusts self
 Negative outcome---withdrawn
According to Erikson’s Developmental Task, explain the Toddler stage.  18months – 3 years
 Autonomy vs. Shame and Doubt
 Positive outcome---exercise self-control
 Negative outcome---defiant and negative
According to Erikson’s Developmental Task, explain the Preschool stage.  3-6 years
 Initiative vs. Guilt
 Children develop conscience at this age.
 Positive Outcome---learns limits
 Negative Outcome---fearful, pessimistic
According to Erikson’s Developmental Task, explain the School age stage.  6-12years
 Industry vs. Inferiority
 Positive---sense of confidence
 Negative---self doubt, inadequate
According to Erikson’s Developmental Task, explain the Adolescence stage.  12-20 years
 Identity vs. Role diffusion
 Positive outcome---coherent sense of self
 Negative outcome---lack of identity
According to Erikson’s Developmental Task, explain the young adult stage.  20-45 years
 Intimacy vs. Isolation
 Positive outcome---intimate relationships/careers formed
 Negative outcome---avoidance of intimacy
According to Erikson’s Developmental Task, explain the middle adulthood stage.  45-65 years
 Generativity vs. Stagnation
 Positive Outcome---creative and productive
 Negative Outcome---self centered
According to Erikson’s Developmental Task, explain the Late adulthood stage.  65+ years
 Integrity vs. Despair
 No regrets in life or Regrets
 Positive outcome---seems life as meaningful
 Negative outcome---life lacks meaning
At what month does the head sag?  1 month
At what month do you see closing of posterior fontanelle, turn from side to back, and see a social smile?  2 months
What toys do you give for a 2 month old?  Mobiles, wind up infant swings, soft clothes, and blankets.
At what month does a child bring objects to mouth and head erect?  3 months
What toys do you give for a 4 month old?  Rattles, cradle gym, and stuffed animals
Which age does birth weight double?  5 months
At what age does teething occur?  6 months
What toys do you give for a 6 month old?  Brightly colored, small enough to grasp, large enough for safety, teething toys
What age for fears of strangers? When is fear strongest?  7 months
 8 months is stronger
Which month able to play peek-a-boo?  7 months
What toys do you give for 7-8months?  Large colored, bricks, jack in the box
What month can a child say “DADA?  9 month
What month can a child crawl well?  10 months
What month can a child stand erect with support?  11 months
What happens in the 12th month of the child?  Birth weight triples.
 Eats with fingers.
 Anterior Fontanelle almost close.
 Babinski reflex disappears.
 Toys: books with large pictures, push pull toys, teddy bears, a large ball, or sponge toys.
Explain introduction of solid foods.  One food at a time.
 Begin with least allergenic foods first.
 Cereal is usually first. (Do not use cow’s milk/whole milk. After six months of age cereal can be mixed with fruit juices. Fruit juices should be offered in a cup to prevent dental carries.)
 Vegetables
 Fruits
 Potatoes
 Meats
 Eggs
 Orange Juice
 By 12 months children should be eating table food. Don’t give honey under 12 because of botulism.
What does a toddler do at 15 months?  Walks alone.
 Throws object.
 Holds spoon.
 Say 4-6 words. Understand simple commands.
What does a toddler do at 18 months?  Anterior fontanelle closes.
 Climbs stairs.
 Sucks thumb.
 Say 10 + words.
 Temper Tantrums.
What does a toddler do at 24 months?  300 world vocabulary.
 Obeys easy commands.
 Go up/down stairs alone.
 Build towers.
 Turn doorknobs/unscrew lids.
 Increase independence.
What does a toddler do at 30 months?  Walk tip toe.
 Stand on one foot balance.
 Has control for sphincter training.
 Birth weight quadrupled.
 State first/last name.
 Give simple commands.
What type of toys are included for Toddlers?  Cooking utensils, Dress-up clothes, rocking horses, finger paints, phonographs, cd players.
How do you avoid negativism during toddler ages?  Don’t ask no/yes questions.
 Offer them choices.
 Make a game out of the tasks.
What can a 3 year old do?  Rides tricycle.
 Undresses without help.
 May invent imaginary friend.
 Vocabulary 900 words.
 Egocentric in thoughts/behaviors.
What can a 4 year old do?  Laces shoes
 Brushes teeth
 Throws overhand
 Uses sentences.
 Independent
What can a 5 year old do?  Runs well/Dresses without help.
 Beginning cooperative play.
 Gender-specific behavior.
What toys are used for preschool (3-5)?  Playground materials, Housekeeping toys, Coloring books, tricycle with helmet.
Which age groups has greatest number of fears?  Preschool age children.
 Death is temporary and gradual
What would you expect with a 6 year old?  Self-centered, show off, rude
 Sensitive to criticism
 Begins loosing temporary teeth
 Tends to lie.
What would you expect with a 7 year old?  Team games/sports.
 Concept of time.
 Playing with same sex child.
 Death is a punishment for his/her action.
What would you expect with a 8 year old?  Seeks out friends.
 Writing replaces printing.
What would you expect with a 9 year old?  Conflicts between peer groups and parents.
 Conflicts between independence and dependence.
 Likes school.
 Able to take on job duties (housework).
 Death is inevitable and irreversible.
What toys are used for school age child?  Construction toys, Pets, Games, Electronic games, reading, books, bicycles with helmets.
School age potential problems include:  Anuresis (encourage before bed time)
 Encopresis
 Head lice
What are symptoms/indications of a fetal alcohol syndrome in a child?  Thin upper lip, vertical ridge in upper lip, short up turned nose, mental retardation, motor retardation, hearing disorders, microcephaly.
 Avoid alcohol 3 months before conception and throughout pregnancy.
What happens with amniocentesis? What does it do?  16th week detects genetic abnormality
 30th week detects L/S ratio: lung maturity
 Void before procedure
 Ultrasound given to determine position of placenta and fetus.
 Complications: premature labor, infection, Rh isommunization (if client Rh negative, will be given Rhogam)
What happens with an ultrasound?  5th week confirms pregnancy
 Determines position of fetus, placenta, and # of fetuses.
 Client must drink a lot of fluid before procedure for full bladder to have a clear image.
What happens with a non-stress test?  At 28th week records FHR and fetal movement.
 Favorable result: 2+ FHR accelerates by 15bpm and last 15seconds in 20 minutes.
What happens with a contraction stress test?  Determines placenta’s response to labor.
 Done after 28th week.
 Fowler/Semi-Fowler.
 Given Oxytocin or Pitocin.
 Results:
 Positive: Late decelerations indicates potential risk to fetus.
Negative: No late decelerations.
What does Torch stand for? And their importance?  Diseases that cross placenta or other events. Produce significant deformities or infant born with infectious process.
 Toxoplasmosis: no litter box changed, no gardening, no under cooked meats.
 Rubella: 1-16 titer immune for rubella, titer <1-8>160 in >10minutes
 Late sign: fetal bradycardia <110> 10 minutes
What things should you know about the Informed Consent form?  Nurse can witness patient sign form.
 Patient has to be age of capacity/adult and confident. No confused patient/drinking/already received preoperative medications.
 Consent must be given voluntarily and information understandable. Nurse must make sure questions are answered and form is attached to chart.
What is early deceleration?  Decrease in HR before peak of contraction. Indication of head compression.
What are interventions for late decelerations?  Position mother left side/trendenlenberg/knee chest
 Increase rate of IV
 Administer Oxygen 7-10 l/min
 DC Oxytocin
What do variable decelerations indicate?  Cord compression.
 Change maternal position.
 Administer oxygen.
 DC Oyxtocin/Pitocin
What are signs of “True Labor”?  Regular contractions increasing in frequency, duration, intensity
 Discomfort radiates from back
 Contractions do not decrease with rest
 Cervix progressively effaced and dilated.
What are characteristics of a “False Labor”?  Irregular contractions, no change in frequency, duration, intesityDiscomfort is abdominal
 Contractions decrease with rest or activity
 No cervical changes
Prior to Lumbar Epidural block what should the patient do?  Void
What should be implemented during the delivery of a newborn?  Establish airway
 Check Apgar at 1 and 5 minutes
 Clamp umbilical cord
 Maintain Warmth
 Place ID band on mother and infant
What are the types of Lochia?  Rubra-bloody, day 1-3
 Serosa-pink-brown, day 4-9
 Alba-yellow-white, 10+ days
If fundus is displaced not centrally and off to the sides means?  Bladder distended.
If client soaks pad in 15 minutes or pooling of blood?  Check for hemorrhage
What are assessments and implementations for an “Ectopic Pregnancy”?  Unilateral lower quadrant pain.
 Rigid, tender abdomen
 Low Hct and hCG levels
 Bleeding
 Monitor for shock
 Administer RhoGAM
 Provide support
What are assessments and implementations for “Placenta Previa”?  A placenta that’s implanted in the lower uterine segment near cervical os, during pregnancy placenta is torn away causing:
 First and second trimester spotting
 Third and trimester painless, profuse bleeding
 Bedrest side-lying or trendelenburg position, ultrasound to locate placenta, no vaginal or rectal exams, amniocentesis for lung maturity, daily Hgb, Hct, Monitor bleeding
What are the assessments and implementation for “Abruptio Placentae”?  The premature separation of a placenta that is implanted in a correct position.
 Painful vaginal bleeding
 Abdomen tender, painful, tense
 Possible fetal distress/Contractions
 Monitor for maternal and fetal distress
 Prepare for immediate delivery
 Monitor for complications: DIC, pulmonary emboli
What are assessments and implementations for Gestational Diabetes Mellitus (GDM)?  Hyperglycemia after 20 weeks
 Usually controlled by diet
 Oral hypoglycemic medications contraindicated
 Test for diabetes at 24-28 weeks on all women with average risk 20.
 Frequent monitoring of mother/fetus during pregnancy.
 Teach to eat prescribed amount of food daily at same times
 Home glucose monitoring
 Teach about change in insulin requirements
What are assessments and implementation for a Hydatidiform Mole?  Elevated hCG
 Uterine size larger than expected for dates
 No FHT
 Minimal dark red/brown vaginal bleeding with grape like clusters
 Nausea and vomiting
 Associated with PIH
 Curettage to remove tissue
 Pregnancy discouraged for 1 year
 Do not use IUD
 hCG levels monitored for 1 year
What are the newborn vital signs?  Temp. 97.7-99.7
 HR sleep 100, awake 120-140, 180 crying
 Resp 30-60
 BP arm/calf 65/41
What are assessments and implementation for Hyperbilirubinemia?  Caused by immature hepatic function
 Physiological Jaundice (No treatment required)
 Seen after 24 hours
 Peaks at 72 hours
 Lasts 5-7 days
 Breast-Feeding Associated Jaundice (Frequent breast feeding)
 Caused by poor milk intake
 Onset 2-3 days
 Peaks 2-3 days
 Breast Milk Jaundice (discontinue breast feeding for 24 hours)
 Caused by factor in breast milk
 Onset 4-5 days
 Peak 10-15 days
 Hemolytic Disease (Phototherapy then exchange transfusion)
 Caused by blood antigen incompatibility (Rh or ABO incompatibility)
 Onset first 24 hours
 Peak variable
What are assessments and implementations for a Narcotic-Addicted infant?  Assessments
 High-pitched cry (Hallmark sign)
 Hyperreflexia
 Decreased sleep
 Tachypnea (>60/min)
 Frequent sneezing and yawning
 Seen at 12-24 hours of age, up to 7-10 days
 Implementation
 Reduce environmental stimuli
 Administer Phenobarbital, chlorpromazine, diazepam, paregoric
 Wrap snugly, rock, and hold tightly
 Assess muscle tone, irritability, vital signs.
What are the assessments and implementations of Toxic Shock Syndrome?  Sudden-onset fever
 Vomiting, diarrhea
 Hypotension
 Erythematous rash on palms and soles
 Administer antibiotics
 Educate about use of tampons (change tampon Q3-Q6 hours)
What are contraindications to Immunizations?  Immunization is a primary prevention
 Severe febrile illness
 Altered immune system
 Previous allergic response
 Recently acquired passive immunity
What are assessments and implementations for a “Latex Allergy”?  Assessment
 Urticaria, rash
 Wheezing, Rhinitis, Conjunctivitis, Bronchospasms
 Anaphylactic shock
 Implementation
 Screen for sensitivity
 Avoid latex products: gloves, catheters, brown ace bandages, band aid dressing, elastic pressure stockings, balloons, condoms
What are implementations for Croup syndromes at home?  Steamy shower
 Exposure to cold air
 Cool, humidified air

Universal Donor Blood: Packed red blood cells (help oxygen deliver to tissue, if you use whole blood there will be a risk for fluid overload), type O, Rh-negative

5% Sodium Bicarbonate—metabolic alkalosis solution

Older adults are asymptomatic when they have an infection and can lead to confusion.

Mononucleosis: complication enlarged spleen; concerned for trauma if child plays dangerous sport.

Lyme disease:found mainly in mid alantic states (Connecticut)

Pottery is unglazed can lead to “Lead Toxicity”

Apgar Score: normal 7-10
WBC after pregnancy?

Ampicillin decreases oral contraceptives efficiency.

Tricuspid area: 5th intercostals space in the left sternum area

Tracheostomy care: no powder, suction trachea first then mouth, use pre-cut gauze.

Hip-Flexion: causes increased intra-abdominal/thoracic pressure.

Injury C3 and above need respiratory ventilation.

SIADH causes: lung cancer, Cisplatin (Platinol)

Chest Tubes
 Fill water-seal chamber with sterile water to 2 cm (middle chamber)
 Fill suction control chamber with sterile water to 20 cm (chamber all the way to the right)
 Air-leak if bubbling in water-seal chamber (middle chamber)
 Obstruction: “milk” tube in direction of drainage
 Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly, apply occlusive dressing
 Dislodged: apply tented dressing
 Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert
 Tube becomes disconnected from drainage system, immerse in 2cm of water

Jackson-pratt: Notify physician if drainage increases or becomes bright red

Penrose: Expect drainage on dressing

Tracheostomy Tube Cuff
 Prevents aspiration of fluids/separates upper and lower airways
 Inflated during continuous mechanical ventilation
 Inflated during and after eating
 Inflated during and 1 hour after tube feeding
 Inflated when patient cannot handle oral secretions

• NCLEX-RN exam is a “here and now” test; take care of problem now to prevent harm to client.
• Do not ask “why” on the licensure exam
• Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi; Meperidine is drug of choice.
• Normal Intraocular Pressure is 10-21 mm Hg
• Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates retroperitoneal bleeding

The parenteral form of Chlorpheniramine Maleate is use to relieve symptoms of anaphylaxis allergic reactions to blood or plasma.

Herbs: Toxicities and Drug Interactions

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress.
Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic

Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.")
Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin.

Feverfew

Uses: Most commonly used for migraine headaches.
Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba

Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking.
Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital.

Ginseng

Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.")
Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis.

Ginger

Uses: Ginger has been used as a treatment for nausea and bowel spasms.
Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Saw Palmetto

Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections.
Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")
Black Cohosh

Claims, Benefits: A natural way to treat menopausal symptoms.
Bottom Line: Little is known about its benefits and its risks.

A child with celiac disease mustn’t consume foods containing gluten and therefore should avoid prepared puddings, commercially prepared ice cream, malted milk, and all food and beverages containing wheat, rye, oats, or barley.
The infant of a diabetic mother may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increases glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the newborn coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia
Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity.
A platypelloid pelvis has a flat shape. A gynecoid pelvis is a normal female pelvis. An anthropoid pelvis has an oval shape, and an android pelvis has a heart shape.
The pulse is the earliest indicator of new decreases in fluid volume.
Adult Rickets: deficiency in vitamin D.
Chronic Pain: normal blood pressure, heart rate, and respiratory rate. Normal pupils and dry skin.
Acute pain: causes increased blood pressure, increased pulse, and respiratory rate, dilated pupils, and perspiration.
The tip of the endotracheal tube lies 1 cm above the carina. This is positioned above the bifurcation of the right and left mainstem bronchi.
Creatine Phosphokinase (CPK) is a cellular enzyme that can be fractionated into three isoenzymes.
 MB band reflects CPK from CARDIAC MUSCLE (This is the level that elevates with an MI.)
 MM band reflects CPK from SKELETAL MUSCLE
 BB band reflects CPK from the BRAIN
ALKYLATING AGENTS: affect ALL PHASES of the reproductive cell cycle (i.e., Cyclophosphamide [Cytoxan])
ANTIMETABOLITES: are cell cycle phase-specific and affect the S PHASE
(i.e., Cytarabine [Cytosar])
VINCA ALKALOIDS: are cell cycle phase-specific and act on the M PHASE
Bell’s Palsy: is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown. Possible causes include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of these items.
McBURNEY’S POINT: is midway between the right anterior superior iliac crest and the umbilicus. This is usually the location of greatest pain in the child with appendicitis.
MMR: administered SQ in the outer aspect of the upper arm.
Watch for absolute words “NOT” and “ONLY”
AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg position. Lying on the left side may prevent air from flowing into the pulmonary veins. The trendelenburg position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during inspiration.
Trigeminal neuralgia pain medication: Use Carbamazepine (Tegretol) and Phenytoin (Dilantin). Narcotic analgesics (Meperidine Hydrochloride [Demerol], Codeine Sulfate , and Oxycodone) are not effective in controlling pain caused by trigeminal neuralgia.
Grapefruit juice can raise cyclosporine (Sandimmune) levels by 50% to 100%, risk for toxicity.
Fomepizole (Antizol): an antidote given IV to a client with Ethylene Glycol (Antifreeze) intoxication
Phenotolamine (Regitine): antidote for hypertensive crisis
Bromocriptine (Parlodel): an antiparkinsonian prolactin inhibitor, is used to treat NMS.
Biophysical profile: assesses five parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume. In a biophysical profile, each of the five parameters contributes 0 to 2 points with a score of 8 being considered normal and a score of 10 perfect.

G T P A L
Gravidity, the number of pregnancies.

Term births, the number born at term (40 weeks). Preterm births, the number born before 40 weeks’ gestation. Abortions/miscarriages
• Included in gravida if before 20 weeks’ gestation
• Included in parity if past 20 weeks’ gestation Live births, the number of live births or living children
Therefore a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.

Probable signs of pregnancy:
• Uterine enlargement
• Hegar’s sign (Softening and thinning of the lower uterine segment that occurs about week 6)
• Goodell’s sign (softening of the cervix that occurs at the beginning of the second month)
• Chadwick’s sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs about week 6)
• Ballottement (rebounding of the fetus against the examiner’s fingers on palpation)
• Braxton Hicks contractions
• A positive pregnancy test measuring for human chorionic gonadotropin
Positive signs of pregnancy:
• Fetal heart rate detected by electronic device (Doppler transducer) at 8-12 weeks and by nonelectronic device (Fetoscope) at 20 weeks of gestation
• Active fetal movements palpable by examiner
• An outline of fetus via radiography or ultrasound
Acetazolamide (Diamox): used for management of glaucoma is a carbonic anyhdrase inhibitor that has sulfonamide properties.
Watch out for absolute words “ALL” and “ALWAYS”
Before NG removal: bowel sounds have to be present.
Hyperkalemia on Electrocardiogram:
Tall, peaked T waves; prolonged PR interval; widening QRS complex
Hypokalemia on Electrocardiogram: ST segment depression; Flat T wave
First-Degree Heart Block: Prolonged P-R interval
Bundle Branch Block: Widened QRS complex
Myocardial Necrosis in Area: Q waves present
Ventricular Fibrillation: No visible P waves or QRS complexes, no measurable rate. Irregular, chaotic undulations of varying amplitudes.
HypoCalcemia: Prolonged Q-T interval
Myocardial Ischemia: ST segment elevation or depression
Premature Ventricular Contractions: absence of P waves, wide and bizarre QRS complexes, and premature beats followed by a compensatory pause
Ventricular Tachycardia: absence of P waves, wide QRS complexes, rate between 100 and 250 impulses per minute. Regular rhythm
Atrial Fibrillation: no P waves; instead there are wavy lines, no PR interval. QRS duration is WNL and irregular ventricular rate can range from 60-160 beats/minute.

ANGINA
Stable Unstable Variant Intractable
Triggered by a predictable amount of effort or emotion. Triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Triggered by coronary artery spasm; the attacks tend to occur early in the day and at rest. Chronic and incapacitating and is refractory to medical therapy.

Cardiac Conduction System: Sinoatrial NodeInternodal/Interatrial pathwaysAV nodeBundle of HisR/L Bundle BranchesPurkinje fibers
Pulse rate is the earliest indicator of decrease in fluid volume.
A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated
A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation.
B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction, and contractility.
B2: Arterial and bronchial walls and cause vasodilation and bronchodilation.
PULSE PRESENT = NO DEFIBRILLATION
Myxedema (a.ka. Hypothyroidism)
Suggested toys
a. birth to six months - mobiles, unbreakable mirrors, music boxes, rattles
b. six to 12 months - blocks, nesting boxes or cups, simple take apart toys, large ball, large puzzles, jack in the box, floating toys, teething toys, activity box, push-pull toys
c. Solitary play
Toddlerhood (one year to three years)
Play is parallel
• Suggested toys: push-pull toys, finger paints, thick crayons, riding toys, balls, blocks, puzzles, simple tape recorder, housekeeping toys, puppets, cloth picture books, large beads to string, toy telephone, water toys, sand box, play dough or clay, chalk and chalkboard
Preschool age (three years to six years)
• Preschool play is associative and cooperative.
• dress-up
• fantasy play
• imaginary playmates
• Suggested toys: tricycle, gym and sports equipment, sandboxes, blocks, books, puzzles, computer games, dress-up clothes, blunt scissors, picture games, construction sets, musical instruments, cash registers, simple carpentry tools

School age (six years to 12 years)
Play is cooperative.
1. sports and games with rules
2. fantasy play in early years
3. clubs
4. hero worship
5. cheating
6. Suggested toys/activities: board or computer games, books, collections, scrapbooks, sewing, cooking, carpentry, gardening, painting
Tympany: Drumlike, loud, high pitch, moderate duration; usually found over spaces containing air such as the stomach
Resonance:Hollow sound of moderate to loud intensity; low pitch, long duration; Usually heard over lungs
Hyperresonance: Booming sound of very loud intensity; very low pitch, long duration; Usually heard in the presence of trapped air (such as emphysematous lung)Flatness:
Flat sound of soft intensity; high pitch; short duration; Usually heard over muscle
Dullness:Thud-like sound of soft intensity; high pitch; moderate duration; Usually heard over solid organs (such as heart, liver)
body temperature
o range: 36 to 38 degrees Celsius (98.6 to 100.4 degrees Fahrenheit)
St. John's wort - antidepressant
Garlic - antihypertensive
Ginseng - Anti stress
Green tea - antioxidant
Echinacea - immune stimulant (6-8 weeks only)
Licorice - cough and cold
Ginger root - antinausea
Ginkgo - improves circulation
Ma huang - bronchodilator, stimulant
Anatomical Landmarks of the HEART
i. second right intercostal space - aortic area
ii. second left intercostal space - pulmonic area
iii. third left intercostal space - Erb's point
iv. fourth left intercostal space - tricuspid area
v. fifth left intercostal space - mitral (apical) area
vi. epigastric area at tip of sternum
Range of Normal Blood Pressure
i. child under age two weighing at least 2700g: use flush technique,30-60mg Hg
ii. child over age two: 85-95/50-65 mm Hg
iii. school age: 100-110/50-65 mm Hg
iv. adolescent: 110-120/65-85 mm Hg
v. adult: <130 mm Hg Systolic / <85 mm Hg diastolic
Normal Range of Peripheral Pulses
• infants: 120 to 160 beats/minutes
• toddlers: 90 to 140 beats/minutes
• preschool/school-age: 75 to 110 beats/ minute
• adolescent/adult: 60 to 100 beats/minute

Normal Rates of Respirations
• newborn: 35 to 40 breaths/minute
• infant: 30 to 50 breaths/minute
• toddler: 25 to 35 breaths/minute
• school age: 20 to 30 breaths/minute
• adolescent/adult: 14 to 20 breaths/minute
• adult: 12 to 20 breaths/minute
CRANIAL NERVE FUNCTION
1. Olfactory (CN I)
• Can identify variety of smells
• Deviation: Inability to identify aroma
2. Optic (CN II)
• Has visual acuity and full visual fields
• Fundoscopic exam reveals no pathology
• Deviation: Inability to identify full visual fields - total or partial blindness of one or both eyes
3, 4, 6. Oculomotor (CN III), trochlear (CN IV), and abducens (CN VI)
• Follows up to six cardinal positions of gaze
• Pupils are unremarkable
• Exhibits no nystagmus and no ptosis
• Deviation: one or both eyes will deviate from its normal position
5. Trigeminal (CN V)
• Clenches teeth with firm bilateral pressure
• Has no lateral jaw deviation with mouth open
• Feels a cotton wisp touched to forehead, cheek and chin
• Differentiates sharp and dull sensations on face
• Corneal reflex; blinks when cotton is touched to each cornea
• Deviation: Absent or one-sided blinking of eyelids
7. Facial (CN VII)
• Has facial symmetry with and without a smile
• Can raise the eyebrows symmetrically and grimace
• Can shut eyes tightly
• Can identify sweet, sour, salt or bitter on the anterior tongue
• Deviation: Irregular and unequal facial movements
• Deviation: Inability to taste or identify taste
• Deviation: Inability to taste or identify salt, sweet, sour, or bitter substances on the anterior two-thirds of the tongue
• Deviation: Inability to smile symmetrically
8. Acoustic (CN VIII)
• Can hear a whisper at 1-2 feet
• Can hear a watch tick at 1-2 feet
• Does not lateralize the Weber test
• Can hear AC (air conduction) better than BC (bone conduction) in the Rinne test
• Deviation: Inability to hear spoken word
9, 10. Glossopharyngeal (CN IX) and Vagus (CN X)
• Swallows and speaks without hoarseness
• Palate and uvula rise symmetrically when patient says "ah"
• Bilateral gag reflex
• Can identify taste on the posterior tongue
• Deviation: Unequal or absent rise of uvula and soft palate as the client says, "ah"
• Deviation: Absent gag reflex
• Deviation: inability to taste or identify taste on the posterior tongue
11. Spinal accessory (CN XI)
• Resists head turning
• Can shrug against resistance
• Deviation: Weak or absent shoulder and neck movement
12. Hypoglossal (CN XII)
• Can stick tongue out and move it from side to side
• Can push tongue strongly against resistance
• Deviation: Tongue deviates to side
Types of Coping Mechanisms
1. Compensation - extra effort in one area to offset real or imagined lack in another area
o Example: Short man becomes assertively verbal and excels in business.
2. Conversion - A mental conflict is expressed through physical symptoms
o Example: Woman becomes blind after seeing her husband with another woman.
3. Denial - treating obvious reality factors as though they do not exist because they are consciously intolerable
o Example: Mother refuses to believe her child has been diagnosed with leukemia. "She just has the flu."
4. Displacement - transferring unacceptable feelings aroused by one object to another, more acceptable substitute
o Example: Adolescent lashes out at parents after not being invited to party.
5. Dissociation - walling off specific areas of the personality from consciousness
o Example: Adolescent talks about failing grades as if they belong to someone else; jokes about them.
6. Fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction
o Example: A student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest.
7. Fixation - becoming stagnated in a level of emotional development in which one is comfortable
o Example: A sixty year old man who dresses and acts as if he were still in the 1960's.
8. Identification - subconsciously attributing to oneself qualities of others
o Example: Elvis impersonators.
9. Intellectualization - use of thinking, ideas, or intellect to avoid emotions
o Example: Parent becomes extremely knowledgeable about child's diabetes.
10. Introjection - incorporating the traits of others
o Example: Husband's symptoms mimic wife's before she died.
11. Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others
o Example: Woman who is jealous of another woman's wealth accuses her of being a gold-digger.
12. Rationalization - justifying behaviors, emotions, motives, considered intolerable through acceptable excuses
o Example: "I didn't get chosen for the team because the coach plays favorites."
13. Reaction Formation - expressing unacceptable wishes or behavior by opposite overt behavior
o Example: Recovered smoker preaches about the dangers of second hand smoke.
14. Regression - retreating to an earlier and more comfortable emotional level of development
o Example: Four year old insists on climbing into crib with younger sibling.
15. Repression - unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts
o Example: Adolescent "forgets" appointment with counselor to discuss final grades.
16. Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable areas.
o Example: Young woman who hated school becomes a teacher.

Elizabeth Kubler-Ross: Five Stages
1. Denial
a. Unconscious avoidance which varies from a brief period to the remainder of life
b. Allows one to mobilize defenses to cope
c. Positive adaptive responses - verbal denial; crying
d. Maladaptive responses - no crying, no acknowledgement of loss
2. Anger
a. Expresses the realization of loss
b. May be overt or covert
c. Positive adaptive responses - verbal expressions of anger
d. Maladaptive responses - persistent guilt or low self esteem, aggression, self destructive ideation or behavior
3. Bargaining
a. An attempt to change reality of loss; person bargains for treatment control, expresses wish to be alive for specific events in near future
b. Maladaptive responses - bargains for unrealistic activities or events in distant future
4. Depression and Withdrawal
a. Sadness resulting from actual and/or anticipated loss
b. Positive adaptive response - crying, social withdrawal
c. Maladaptive responses - self-destructive actions, despair
5. Acceptance
a. Resolution of feelings about death or other loss, resulting in peaceful feelings
b. Positive adaptive behaviors - may wish to be alone, limit social contacts, complete personal business
FOODS HIGH IN WATER-SOLUBLE VITAMINS
A. Vitamin C - citrus fruits, cabbage, tomatoes, strawberries, broccoli
B. Thiamine (B1) - lean meat, legumes,unrefined or enriched grains and cereals
C. Riboflavin (B2) - enriched grains, milk, organ meats, poultry, fish
D. Niacin - peanuts, peas, beans, meat, poultry
E. Pyridoxine (B6) - kidneys, liver, meats, corn, wheat, eggs, poultry, fish
F. Cyanocobalamin (B12) - kidneys, lean meats,liver, dairy products, egs
G. Folic acid - liver, eggs, leafy green vegetables, fruits, enriched grain products
FOODS CONTAINING FAT-SOLUBLE VITAMINS
A. Vitamin A - fruits, green and yellow vegetables, butter, milk, eggs, liver
B. Vitamin D - milk, fish
C. Vitamin E - green vegetables, vegetables oils, wheat germ, nuts
D. Vitamin K - liver, cheese, leafy green vegetables, milk, green tea

mucomyst: acetaminophen toxicity

-end-

2009-02-19T21:51:00.000-08:00

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Results of November 2008 Nurses Licensure Exam

2009-02-19T21:43:00.000-08:00

Nursing Names 20090220

Publish at Scribd or explore others: Academic Work Exams & Quizzes exam nursing

2009-02-15T17:22:00.000-08:00

Hospitals fight to stop new nurses from quitting

1 in 5 leaves within a year, study says; Many say they're overwhelmed

MIAMI - Newly minted nurse Katie O'Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who'd had seizures. She was told he was stable and to check him in a few minutes, but O'Bryan decided not to wait. She found he had stopped breathing and was turning blue.

"If I hadn't gone right away, he probably would have died," O'Bryan said. "I couldn't do it anymore."

Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

That turnover rate is a major contributor to the nation's growing shortage of nurses. But there are expanding efforts to give new nursing grads better support. Many hospitals are trying to create safety nets with residency training programs.

"It really was, 'Throw them out there and let them learn,'" said University of Portland nursing professor Diane Vines. The university now helps run a yearlong program for new nurses.

"This time around, we're a little more humane in our treatment of first-year grads, knowing they might not stay if we don't do better," she said.

Nursing shortage could reach half million

The national nursing shortage could reach 500,000 by 2025, as many nurses retire and the demand for nurses balloons with the aging of baby boomers, according to Peter Buerhaus of Vanderbilt University Medical Center. The nursing professor is the author of a book about the future of the nursing work force.

Nursing schools have been unable to churn out graduates fast enough to keep up with the demand, which is why hospitals are trying harder to retain them.

Medical school grads get on-the-job training during formal residencies ranging from three to seven years. Many newly licensed nurses do not have a similar protected period as they build their skills and get used to a demanding environment.

Some hospitals have set up their own programs to help new nurses make the transition. Often, they assign novices to more experienced nurses, whom they shadow for a few weeks or months while they learn the ropes. That's what O'Bryan's hospital did, but for her, it wasn't enough.

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who washed out is about $50,000, personnel experts estimate.

NOVEMBER NURSING BOARD EXAM RESULT

2009-01-14T05:34:00.000-08:00

VIVA PIT SENYOR CEBU

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Philippines suffers from
hemorrhage of nurses

Rose Gonzalez, a nursing graduate turned public relations practitioner for seven years, is leaving in a few weeks to work at the Johns Hopkins University Hospital in Maryland, USA.

Having returned to her original profession, she is one of the scores of Filipinas who find that nursing is now the “sure” ticket for a better-paying job abroad—and the shortest route to immigrant status.

Government figures report that some 2,908 Filipino nurses left for 21 countries in the first quarter of 2002. In the previous year, some 13,536 Filipino nurses left for 31 countries. Major destinations were the United Kingdom, Saudi Arabia and Ireland.

The Philippine Overseas Employment Administration (POEA) said only 304 nurses left for the US in 2001. This figure, however, is “grossly underreported.”

Figures from the International Union of Nurses said that close to 10,000 Filipino nurses were directly hired by US-based hospitals in 2001 through various nursing job fairs held in the Philippines. Nurses who leave on immigrant visas are not processed by the POEA.

The annual outflow of Filipino nurses is now three times greater than the annual production of licensed nurses, said Dr. Jaime Z. Galvez-Tan, vice chancellor for research at the University of the Philippines in Manila, and executive director of the National Institutes of Health Philippines.

The Professional Regulation Commission (PRC), through the Board of Nursing, issues licenses to only 6,500 to 7,000 nurses a year.

“Sadly, this is no longer brain drain, but more appropriately, brain hemorrhage of our nurses,” he said. “Very soon, the Philippines will be bled dry of nurses.”

For some, like Dr. Teresita I. Barcelo, that situation is already here. Barcelo is vice chancellor for academic affairs of the UP-Open University, and a professor at the UP College of Nursing.

Global need

Tan said the shortage of nurses in the developed countries would not just be for a year or two, but for at least the next 10 to 15 years.

“It will no longer be the roller-coaster demand for foreign graduate nurses that was seen in the last 35 years. This time, it will be a persistent, chronic need.”

He explains: The developed countries are experiencing a longer lifespan and the “graying of their population.” But their youth population is not interested in the nursing profession because of the difficult and risky work conditions such as evening duties, taking care of the chronically ill and exposure to HIV/AIDS. More options are also available to them to take on other professions that offer better pay and working conditions.

The solution for these countries: hire foreign nurses to do the job. Based on statements made by their respective governments, the US would need around 10,000 nurses a year, while the UK, Ireland, the Netherlands and other European countries would need another 10,000 nurses a year.

Austria and Norway also announced their need for foreign nurses this year and Japan, a new market, is expected to open its doors to foreign nurses this year.

Local shortage?

Here in the Philippines, experts qualify their answers on whether there is a shortage of nurses here.

Dr. Marilyn E. Lorenzo, director of the Institute of Health Policy and Development Studies and a professor at the UP College of Public Health, said “in absolute terms, there is no shortage. There are enough warm bodies here, but there is a shortage in terms of quality.”

The ones who have left are the skilled and experienced nurses. Most of those who are still here are relatively unskilled and inexperienced, and this poses serious implications on the quality of health care that they provide.

“Most people think there is a shortage because of the high staff turnover in hospitals. The truth is, nurses are now more mobile, because they have more options,” observed Nesie B. Dionisio, member of the Board of Nursing of the PRC.

Where are the nurses then? They move to urban areas—where there is higher pay, and better chances to be hired. After they get enough experience, say, one to two years, they leave the country to work abroad.

Dionisio adds: “The government contributes to the artificial shortage because it has not opened new positions. And the ones who left have not been replaced.”

The government is the single biggest employer of nurses here. While nurses prefer to work in government hospitals because of the higher pay than in private hospitals, there are no openings, said Dionisio.

Health does not seem a priority, and the government has yet to increase the health budget. Because most hospitals are understaffed, working conditions are far from ideal—average nurse-patient ratios range from 1:30 to 1:60.

Source

2009-01-05T23:14:00.000-08:00

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US demand for nurses to rise in ’14
MANILA, Philippines—The United States will need 1.2 million new nurses by 2014 to meet the growing demands of its aging population and to fill in for retiring health workers, a recruitment consultant
said over the weekend.

Citing a report from the US Department of Health and Human Services, recruitment consultant Emmanuel Geslani said the US will need 500,000 nurses to replace those leaving the service and 700,000 more to take care of the aging baby boomers in the coming years.

Geslani, however, said Filipino nurses should not pin all their hopes on the American market.

According to Geslani, who works for the Federated Association of Manpower Exporters (FAME), an umbrella group of recruiters, the US States Citizenship and Immigration Service (USCIS) has yet to adopt rules that would expedite the processing of visas for foreign nurses.

There have been proposals to the USCIS to have a dedicated lane and category for foreign nurses to fast track their visa applications. Geslani said the USCIS is still studying the proposal and it may take the agency sometime to reach a decision on the matter.

“The nursing shortage in the US may not be solved in the immediate future as policy recommendations will have to be approved and the red tape involved in the processing of nurses visas will have to be resolved without the CIS letting up on its safeguards in setting up standards for foreign nurses qualifications,” he said.

Geslani and FAME urged Filipino nurses not to wait for the US market to open up. They noted that they could apply to health facilities in the Middle East. Although the pay in Middle East is lower than in the US, Filipino nurses do not have to wait for years before getting a job there, Geslani said.

Source:
Filed Under: Nursing matters, Healthcare Providers, Overseas Employment

Nursing industry desperate to find new hires

MILWAUKEE (AP) — Please, please accept a high-paying job with us. In fact, just swing by for an interview and we'll give you a chance to win cash and prizes.

Sounds too good to be true, especially in an economy riddled with job cuts in nearly every industry. But applicants for nursing jobs are still so scarce that recruiters have been forced to get increasingly inventive.

One Michigan company literally rolled out a red carpet at a recent hiring event. Residential Home Health, which provides in-home nursing for seniors on Medicare, lavished registered nurses and other health care workers with free champagne and a trivia contest hosted by game-show veteran Chuck Woolery. Prizes included a one-year lease for a 2009 SUV, hotel stays and dinners.

"We're committed to finding ways to creatively engage with passive job seekers," said David Curtis, president of the Madison Heights-based company.

Recruiters like Curtis may have little choice. The long-standing U.S. nurse shortage has led to chronic understaffing that can threaten patient care and nurses' job satisfaction, and the problem is expected to worsen.

The shortage has been operating since World War II on an eight- to 10-year cycle, industry experts say. Each time the number of nurses reaches a critical low, the government adds funding and hospitals upgrade working conditions. But as the deficit eases, those retention efforts fade and eventually the old conditions return, often driving nurses into other professions.

"We recently had a hiring event where, for experienced nurses to interview — just to interview — we gave them $50 gas cards," said Tom Zinda, the director of recruitment at Wheaton Franciscan Healthcare in the Milwaukee-area city of Glendale. "We really try to get as creative as we can. It's a tough position to fill."

Recruiters across the country have tried similar techniques, offering chair massages, lavish catering and contests for flat-screen TVs, GPS devices and shopping sprees worth as much as $1,000.

Even strong salaries aren't doing the trick. Registered nurses made an average of $62,480 in 2007, ranging from a mean of $78,550 in California to $49,140 in Iowa, according to government statistics. Including overtime, usually abundantly available, the most experienced nurses can earn more than $100,000.

The U.S. Bureau of Labor Statistics predicts about 233,000 additional jobs will open for registered nurses each year through 2016, on top of about 2.5 million existing positions. But only about 200,000 candidates passed the Registered Nurse licensing exam last year, and thousands of nurses leave the profession each year.

Several factors are in play: a lack of qualified instructors to staff training programs, lack of funding for training programs, difficult working conditions and the need for expertise in many key nursing positions.

Cheryl Peterson, the director of nursing practice and policy for the American Nurses Association in Silver Spring, Md., said employers must raise salaries and improve working conditions.

"The wages haven't kept up with the level of responsibility and accountability nurses have," said Peterson, whose organization represents nurses' interests. Chronic understaffing means nurses are overworked, she said, and as burned-out nurses leave the situation spirals for the colleagues they leave behind.

Some hospital departments where experience is vital, such as the emergency room or intensive-care unit, simply cannot hire newly minted nurses. So managers in those areas have even fewer staffing choices.

Nurses qualified to teach aspiring nurses are scarce chiefly because they can make at least 20 percent more working at a hospital, experts said.

"It can be hard to turn down that extra money," said Robert Rosseter, the associate executive director of the American Association of Colleges of Nursing in Washington, D.C.

Many recruiters have looked for employees overseas, and about one-fourth of the nurses who earned their licenses in 2007 were educated internationally, most in the Philippines and India.

Some health organizations go out of their way to recruit as many nurses as possible even when they're overstaffed.

Residential Home Health, the home-nursing company in Michigan, is always looking to hire, Curtis said. Even with 375 clinical professionals on staff, his recruiters are eager to sign up as many as 50 more nurses and therapists, hence the Chuck Woolery event.

Zinda, the Milwaukee-area recruiter, said creative recruiting helps to introduce nurses to his hospital. Besides offering interviewees $50 gas cards, he has provided $100 gift cards to the local mall, and created a Facebook page to target younger nurses.

Attracting good candidates is about offering good working conditions, he said, but creative recruiting goes a long way in generating a buzz.

"Bottom line, you need to get people excited about what you're offering," he said. "If you don't, they can easily go elsewhere."

Japan set to admit caregivers

THE Philippines starts deploying the first 200 nurses and 300 caregivers to Japan from April to June to train for work there following the signing of the Japan-Philippines Economic Partnership Agreement.

Around $6.9 billion worth of Philippine products now also enjoy duty-free status in Japan as a result of the treaty.

“This is the express lane for trade and investment… that is the inherent nature of the agreement,” Trade Undersecretary Thomas Aquino said.

“With the [treaty] in place, we have an edge over our competitors in the region in terms of selling our goods to Japan.”

Under the treaty, 1,000 nurses and caregivers will be trained over the next two years to make them eligible to work there. The numbers could have been bigger, but Tokyo’s facilities could accommodate only 500 a year, Aquino said.

The treaty says Filipino nurses and caregivers must first pass certification exams in Nihongo before they could be accepted. Nursing applicants must also be licensed in the Philippines and a three-year work experience.

Japan is badly in need of nurses and caregivers as a result of its aging population. Estimates indicate there are now about 36 million old Japanese or 30 percent of Japan’s 120-million population.

The Philippine Chamber of Commerce and Industry says 150,000 Filipino workers would also benefit from the treaty, and mainly because of the job opportunities it will create as a result of the zero tariff on selected Philippine products.

“We in the business sector can now focus our energies on working towards enhancing our competitiveness with our Asean neighbors who have secured their respective bilateral and economic partnership agreements with Japan,” said special envoy Donald Dee.

Oversupply of Nurses Plagues Philippines
Gloria Esguerra Melencio, Arab News

MANILA, 3 April 2008 — The Philippines has oversupply of nurses this year as “world-class schools” continue to graduate thousands of nurses and some diploma mill schools churn out countless of practical nurses.

University of the Philippines College of Nursing Dean Dr. Josefina Tuazon and Philippine Nurses Association National President Leah Paquiz, disclosed that the oversupply of nurses is fast becoming the country’s problem even as deployment abroad may be the “first choice” for these graduates.

Tuazon explained that due to the numerous nursing graduates this year at 67, 728, hospitals have to get volunteer nurses — a lot better because they are not paid — to accommodate the fresh graduates.

High number of graduates of Practical Nursing, a two-year course that focuses on the basics of nursing, aggravate the unemployment problem at present, Tuazon stressed.

“There is no local demand or positions for practical nurses within the Philippine Health Care Delivery system particularly in the light of the oversupply of nurses and subsequent unemployment of graduate nurses,” PNA’s Paquiz revealed in a written statement distributed to the media recently.

Schools offering Practical Nursing have mushroomed in the country overnight as they promise overseas employment that may await the graduates of this two-year non-degree course. The promise of work abroad, however, is not true as foreign employers prefer the four-year college-degree nurses who passed the Licensure Board Exams, Paquiz added.

The farthest thing that these practical nurses can reach is become nurse assistants, Tuazon noted.

The PNA likewise asked the Commission on Higher Education (CHEd) of the Department of Education to put a stop to other schools’ offering the Practical Nursing program.

The PNA “strongly objects to the institution of the Practical Nursing program and vehemently rejects the proposed ladderization of the nursing curriculum,” the PNA statement said.

The PNA president also disclosed that United States, almost home to 250,000 Filipino nurses in the past years, stopped issuing work visas this year because the quota requirement for migrant workers has already been reached. There were 21,000 Filipino nurses seeking employment in the US in 2007.

The Philippine Overseas Employment Administration deployed a total of 13, 525 licensed nurses around the world in 2006. Of this number, 12, 263 are females and 1, 261 are males.

Saudi Arabia employed some 5,600 Filipino nurses, the highest so far of all Middle East countries in 2006.

Japan has 1.1 million Filipino nurses and licensed caregivers in 2005.

Heart Block

2009-01-05T03:20:00.000-08:00

Heart Block
(Atrioventricular [AV] Block)
Definition
The heart is comprised of four chambers: two upper chambers (atria) and two lower chambers (ventricles). The sinoatrial (SA) node, located near the top of the right atrium, produces electrical signals that are sent to the atrioventricular (AV) node. The AV node, also located in the right atrium, then sends the signals to the ventricles, which are the primary pumping chambers of the heart. When the heart is functioning well, the electrical signals are transmitted smoothly from the atria to the ventricles, causing rhythmic muscle contractions that pump blood to the rest of the body.
Heart block occurs when the electrical signals from the sinoatrial node are too slow (bradycardia). (Heart block does NOT mean that blood is being literally blocked from the heart.)
There are three types of heart block, ranging from mild to serious:
• First-degree heart block: This is the mildest form of heart block. In this case, the electrical signals from the SA node move more slowly than normal to the AV node, but all signals reach the ventricles. There are usually no symptoms, and heartbeat and rhythm are normal. This type of heart block is often found in well-trained athletes.
• Second-degree heart block: A second-degree heart block means that some of the electrical signals are not reaching the ventricles. This causes “dropped beats.” There are two types of second-degree heart block:
o Type I second-degree heart block: (also called Mobitz Type I or Wenckebach’s AV block) The electrical signals become increasingly delayed with each heartbeat, ultimately causing a beat to be missed.
o Type II second-degree heart block : (also called Mobitz Type II) In this type of heart block, some of the electrical signals do not reach the ventricles. This is less common, but more serious.
• Third-degree, or complete, heart block: This is the most serious type of heart block. In this condition, no electrical signals are able to reach the ventricles. The ventricles compensate by contracting on their own, but at a much slower rate than is safe for the heart to maintain full function.
Third-degree heart block is extremely serious and requires immediate care from your doctor. First- and second-degree heart block should be diagnosed by your physician, who will help you determine the best course of treatment, if any.
Anatomy of the Heart

Causes
Heart block often occurs when there is underlying heart disease. The causes of heart block include:
• History of heart disease (myocardial infarction, congestive heart failure, valvular problems, endocarditis)
• Hereditary heart defect
• Use of certain types of medications, such as:
o Beta blockers (eg, propanolol)
o Calcium channel blockers (eg, verapamil, diltiazem)
o Digitalis
Risk Factors
The following factors increase your chance of developing heart block. If you have any of these risk factors, tell your doctor:
• History of heart disease
• Use of medications such as beta blockers, calcium channel blockers, or digitalis
Symptoms
If you experience any of these symptoms, do not assume it is due to heart block. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Dizziness or lightheadedness
• Fainting (syncope)
• Chest pain
• Shortness of breath
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. He or she may also refer you to a cardiologist or arrhythmia specialist.
Tests may include the following:
• Electrocardiogram (ECG): a test that records the heart's activity by measuring electrical currents through the heart muscle
• Echocardiogram: a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
Treatment
The course of treatment will depend on the type of heart block you have. Generally, treatment is not necessary for first-degree heart block.
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
• Pacemaker: A pacemaker may be inserted for some cases of second-degree heart block, and all cases of third-degree heart block. A pacemaker is a device that generates electrical signals to stimulate heart muscle contractions.
.
Prevention
To help reduce your chances of getting heart block, take the following steps:
• Obtain treatment for any underlying heart problems or heart disease. This will help prevent heart block.
• If possible, avoid medications that can cause heart block, such as beta blockers, calcium channel blockers, and digitalis.
• Maintain a healthy weight and lifestyle. Get regular exercise, eat a heart-healthy diet, and minimize stress.
• Avoid excessive consumption of alcohol and caffeine.
• Stop smoking.

Heart Attack

2009-01-05T03:17:00.000-08:00

Heart Attack
(Myocardial Infarction)
Definition
A heart attack occurs when blood flow to the heart muscle is interrupted. This deprives the heart muscle of oxygen, causing tissue damage or tissue death.
Heart Attack

Causes
A heart attack may be caused by:
• Thickening of the walls of the arteries feeding the heart muscle (coronary arteries)
• Accumulation of fatty plaques in the coronary arteries
• Narrowing of the coronary arteries
• Spasm of the coronary arteries
• Development of a blood clot in the coronary arteries
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Sex: male
• Increased age
• Obesity
• Smoking
• High blood pressure
• Sedentary lifestyle
• High blood cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
• High blood triglycerides
• Diabetes
• Stress
• Family members with heart disease
Symptoms
Symptoms include:
• Squeezing, heavy chest pain, especially with:
o Exercise or exertion
o Emotional stress
o Cold weather
o A large meal
• Pain in the left shoulder, left arm, or jaw
• Shortness of breath
• Sweating, clammy skin
• Nausea
• Weakness
• Loss of consciousness
• Anxiety, especially feeling a sense of doom or panic without apparent reason
Unusual symptoms of heart attack (may occur more frequently in women):
• Stomach pain
• Back and shoulder pain
• Confusion
• Fainting
Diagnosis
If you think you are having a heart attack, call 911 immediately. You need emergency medical care.
Tests may include:
Blood Tests – to look for certain enzymes found in the blood within hours or days after a heart attack. Blood tests will be repeated every 6-8 hours to track the enzymes’ progressive elevation that indicates heart muscle damage.
Urine Tests – to look for certain substances found in the urine within hours or days after a heart attack
Electrocardiogram (EKG) – records the heart's activity by measuring electrical currents through the heart muscle. Certain abnormalities in the EKG occur when there is significant blockage of the coronary arteries and/or damage to the heart muscle. The EKG will be repeated to track the progression of these changes.
Echocardiogram – uses high-frequency sound waves (ultrasound) to examine the size, shape, function, and motion of the heart
Stress Test – records the heart's electrical activity under increased physical demand. A stress test can also be combined with an echocardiography. Patients who cannot exercise may be given a medication intravenously that simulates the effects of physical exertion. A stress test is done usually days or weeks after the heart attack.
Nuclear Scanning – Radioactive material (such as thalium) is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow, and therefore uptake of the radioactive material, show up as dark spots on the scan.
Electron-beam CT scan (coronary calcium scan, heart scan, CT angiography ) – a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan measures the amount of calcium deposits in the coronary arteries, and based on that and other health information, attempts to determines the risk of heart disease, including heart attacks. The American Heart Association (AHA) published guidelines in 2006 indicating that heart scans are not for everyone and those most likely to benefit from the procedure are patients at intermediate risk of coronary artery disease.
Coronary Angiography – X-rays are taken after a dye is injected into the arteries to look for abnormalities (narrowing, blockage) in the coronary arteries
Treatment
Treatment may include:
• Oxygen
• Pain-killing medications (such as morphine)
• Nitrate medications
• Antiplatelet agents
• Beta-blockers
• Aspirin
• Beta-blocking and/or ACE inhibitor medications
• Anti-anxiety medications
• Clot-busting agents: Within the first six hours after a heart attack, you may be given medications to break up blood clots in the coronary arteries.
• Other medicines that may be given along with clot-busting agents (called platelet IIb/IIIa receptor blockers)
• Cholesterol-lowering medications
• Anti-anxiety medications
• ACE inhibitors are also frequently given
There are many different medications that may be given in a combination dependent on a patient’s specific situation. Your doctors will determine which ones are the best for you
Surgery
Surgeries for people with severe blockages in their coronary arteries may include:
• Coronary artery bypass surgery
• Atherectomy
• Balloon angioplasty with or without stenting
Physical or Rehabilitative Therapy
During recovery from a heart attack, you may need physical or rehabilitative therapy to help you regain your strength.
Psychotherapy or Antidepressant Medication
Some people have depression after suffering a heart attack. If you do, psychotherapy and/or antidepressant medications may help relieve depression.
Prevention
Preventing or treating coronary artery disease may help prevent a heart attack.
• Maintain a healthy weight .
• Begin a safe exercise program with the advice of your doctor.
• If you smoke, quit .
• Eat a healthful diet , one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• Appropriately treat high blood pressure and/or diabetes .
• Manage stress .
• Ask your doctor about taking a small, daily dose of aspirin. It has been shown to decrease the risk of heart attack.
• Ask your doctor about taking cholesterol-lowering medications.
• Ask your doctor about taking medication to improve heart function or prevent future heart attacks, such as:
o Beta-blockers
o ACE-inhibitors
o Blood thinning medications
Please remember than when you are taking aspirin, certain painkillers (eg, ibuprofen), if taken together with aspirin, may put you at high risk for gastrointestinal bleeding and also diminish the effectiveness of aspirin.

Head Lice

2009-01-05T03:14:00.001-08:00

Head Lice
(Pediculosis)
Definition
Head lice are tiny, barely visible insect-like animals (“arthropods”) that may live on the head and cause itching. ("Lice" is plural; the singular is "louse"). Head lice may also live in the eyebrows, eyelashes, and beard, but sometimes infestations in these areas are from a related species called pubic lice.
Head Lice

Causes
Head lice spread by personal contact and by sharing combs, brushes, hats, and other personal items.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Age: childhood
• Sharing combs, brushes, hats, and other personal items
• Personal contact with people who may have lice
Symptoms
Symptoms include:
• Extreme itchiness
• Skin breaks and possible infection (caused by scratching)
• Swollen lymph nodes
• Bacterial infection (if scratching causes open areas on the scalp)
• Some persons with head lice do not have symptoms
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine your head and scalp for lice and lice eggs (called "nits").
Do not self-diagnose and self-treat head lice. Some treatments can cause irritation and should only be used by people who have the infestation.
Treatment
Treating head lice involves removing eggs and killing lice so that they can't continue to lay eggs. Treatment may be difficult because in some regions lice have become resistant to many of the commonly used medications. Some experts recommend that treatment be given only when live adult lice are seen.
Methods include:
• Applying over-the-counter shampoo containing the insecticide, permethrin – It is very important to use medications as directed. Retreatment at 7-10 days is usually required to kill any lice that hatch from unremoved eggs.
• Removing lice on the eyelashes, which may be difficult – Tweezers can be used to pick them off. Vaseline may be used to coat the eyelashes and kill the lice.
• Unless instructed otherwise, removing eggs manually with specially designed combs – Eggs stick firmly to hair. Products such as “Clear," which loosen the eggs, may assist in removal.
In areas with high levels of resistance to permethrin, other prescription medications may be used, including malathion and lindane.
Lindane, a second line treatment, should only be prescribed to patients who are unable to take other medications or who have not responded to them. According to the Food and Drug Administration’s warning, lindane can rarely cause serious side effects, including seizure and death. Those especially susceptible are infants, the elderly, children and adults weighing under 110 lbs, and individuals with other skin conditions. Lindane is toxic and should not be overused. Patients are given small amounts (1-2 oz) of the shampoo or lotion and instructed to apply a very thin layer and not to reapply. For more information, visit the Center for Drug Evaluation and Research website.
Prevention
Lice are common, especially in children. While no records are kept for accurate counts, some estimates are that as many as 10-15 million persons annually develop head lice in the United States. To prevent outbreaks of head lice:
• Watch for signs of head lice, such as frequent head scratching.
• Don't share combs, brushes, hats, or other personal items with people who may have lice.
• Avoid close personal contact with people who may have lice.
• If you or your children have head lice, thoroughly wash and dry combs, brushes, hats, clothing, bedding, and stuffed animals, and vacuum carpeting and car seats.
• If your children get head lice, notify their school, camp, daycare provider, and their friends' parents.
• Check all family members for lice and eggs at least once a week.

Gynecomastia

2009-01-05T03:11:00.000-08:00

Gynecomastia
Pronounced: gi-ne-KOH-mast-e-ah
Definition
Gynecomastia is enlargement of the breasts in men. It is relatively common, occurring in about one third of adult men.
About 65% of boys develop some degree of breast enlargement during puberty. This is normal and usually goes away by age 18.
The breast tissue is firm in men with gynecomastia. In contrast, the breast tissue is soft in men with fat on their chests, hence looking like enlarged breasts (fatty enlargement of the breasts).
Gynecomastia

Causes
Men normally produce much more male hormones (androgens) than female hormones (estrogens). Gynecomastia is caused by an imbalance in the female and male hormones. The hormone imbalance can be caused by:
• Aging
• Testosterone deficiency
• Certain medications, such as digoxin (a heart medication), spironolactone (a diuretic), cimetidine (a medication for stomach conditions), and many others
• Anabolic steroids used to enhance athletic performance in sports
• Marijuana use
• Liver or kidney failure
• Chronic kidney disease
• Hyperthyroidism (overactive thyroid gland)
• Tumors of the testicles, lung, stomach, liver, kidney, or pituitary gland
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
By definition, only adult men can get gynecomastia.
Risk factors:
• Age: over 50
• Obesity
• Excess alcohol consumption leading to liver cirrhosis
• Chronic liver or kidney disease
• Presence of a condition or medication that decreases androgen or estrogen production
• Family history
Symptoms
Symptoms of gynecomastia include:
• Enlargement of the breasts with firm tissue, usually on both sides
• Tenderness
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may need to be referred to a doctor who specializes in hormone disorders (an endocrinologist).
Your doctor will be especially interested in other symptoms you have had and your use of medications. He or she will focus on your weight, breast exam, testicular exam, and any other signs of a hormone problem.
Diagnostic tests may include:
• Blood Sample – to check the function of your liver, thyroid, and kidneys, as well as other hormone levels
• Ultrasound – a test that uses sound waves to examine the breasts
• CT Scan– a type of x-ray that uses a computer to make pictures of the breasts
• Biopsy – If the diagnosis or cause remains unclear, a sample of breast tissue may be removed and sent to a pathology laboratory for evaluation.
Treatment
Usually treatment for gynecomastia is not needed. However, it is important to find and treat the underlying cause of the gynecomastia. For example, if you are taking a medication that causes gynecomastia, your doctor will ask you to discontinue it or change to a different medication if possible. It is particularly important to exclude tumors as a cause of gynecomastia, and, if one is found to be present, to treat it.
If treatment of gynecomastia is needed, medications are sometimes used, though they can produce unwanted side effects. On rare occasions, surgery is used to remove breast tissue.
Prevention
Prevention of gynecomastia requires avoiding known risk factors. Thus, avoiding excessive alcohol consumption, avoiding steroids, and refraining from marijuana use will prevent gynecomastia from those sources.

Hernia (Groin)

2009-01-05T03:08:00.000-08:00

Groin Hernia
(Inguinal Hernia)
Definition
A groin hernia is an external bulge in the groin area that contains fat, connective tissue, and/or a portion of intestine. There are two main types of groin hernias:
Inguinal Hernia – occurs when there is a weak spot in the area where the abdomen meets the thigh on both sides (most common type)
Femoral Hernia – occurs much less frequently and is located in the upper thigh
A groin hernia that pushes through the abdominal wall can become trapped. This may lead to dangerous complications such as intestinal obstruction or strangulation. Both require immediate surgery.
Inguinal Hernias

Causes
Anything that causes weakness or tears in the abdominal wall can cause a groin hernia, including:
• Defects at birth
• Prolonged wear and tear such as lifting, straining, or coughing
• Age-related weakness of the abdominal wall
• History of previous surgery in the area
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Advancing age
• Sex: male (Groin hernias are about 10 times more common in men, but the less common type, femoral hernias, are more common in women.)
• Lack of exercise
• Increased pressure within the abdominal cavity due to:
o Lifting heavy objects
o Straining to urinate or pass stools
o Severe or prolonged coughing
o Obesity
o Pregnancy
Symptoms
Symptoms include:
• A bulge in the groin area when standing or straining
• Pain in the groin area when straining
• A bulge that may extend into the scrotum in men
• Pain, a heavy feeling, or discomfort in the groin (Sometimes there is no pain.)
More serious symptoms associated with a groin hernia that may require immediate medical care include:
• Severe pain in the groin or abdomen
• Fever
• Rapid heart beat
• Abdominal swelling
• Nausea
• Vomiting
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Treatment
Most inguinal hernias eventually require surgery. For small hernias that can be pushed back into place, a truss or external pad against the weak spot may temporarily provide support. If the hernia bulge can be pushed back in place, surgery may not be needed right away. However, even small hernias eventually need to be repaired. After surgery, hernias sometimes recur in the same place or on the opposite side. Hernia repair can cause irritation of inguinal nerves leading to pain post-surgery. This complication causes significant disruption in quality of life, but is fortunately rare.
Surgeries include:
Herniorrhaphy – to repair the defect in the abdominal wall

Hernioplasty – to reinforce the weak area with steel mesh or wire
Bowel Resection – to remove a section of the intestine. This procedure may be used when part of the intestine becomes twisted or blocked or turns gangrenous and dies.
Laparoscopic Hernia Repair – surgery done through several tiny incisions in the groin or abdomen. Recovery may be faster and patients can often resume physical activity earlier.
Prevention
The following strategies may help to prevent a groin hernia:
• Lose weight, if you are overweight.
• Exercise regularly.
• Warm up before exercising to avoid straining your muscles.
• Learn to lift properly and ask for assistance with heavy weights.
• Always wear a protective belt when lifting heavy weights or moving heavy objects.
• Eat more fiber to prevent constipation.
• Stop smoking, especially if you have a chronic cough.
• Seek medical care if you:
o Strain when passing stools or urine.
o Cough or sneeze a lot.

Gout

2009-01-05T03:05:00.000-08:00

Gout
(Gouty Arthritis)
Definition
Gout is recurrent attacks of joint inflammation caused by a build-up of uric acid crystals. If the crystals accumulate in the kidneys, kidney stones may result.
Causes
Gout typically occurs in people with high levels of uric acid in their blood (hyperuricemia). However, most people with hyperuricemia do not develop gout. Conversely, people with normal blood uric acid levels can have gout.
Uric acid is derived from the breakdown of purines. Uric acid is metabolized in the liver and eliminated by the kidneys via the urine. Levels of uric acid build up when:
• The body produces too much uric acid
• The kidneys do not eliminate enough uric acid
Most patients with gout and hyperuricemia do not eliminate enough uric acid from their bodies.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. All causes of hyperuricemia are risk factors for gout.
Risk factors include:
• Obesity or sudden weight gain or very rapid weight loss
• Age: over 40 years old
• Sex: Male
• Family members with gout
• Diuretics, such as hydrochlorothiazide
• Certain medications, such as aspirin
• A purine-rich diet including:
o Liver and other organ meats
o Dried beans and peas
o Anchovies
o Gravies
• Alcohol consumption, especially binge drinking
• Certain types of cancer or cancer treatments (eg, cytotoxic drugs)
• Medications (such as antiseizure, anti-rejection medications and others)
• Dehydration
• Hypercholesterolemia
• Kidney disease
Symptoms
Symptoms include:
Acute Gouty Arthritis
• Sudden onset of severe pain in an inflamed joint, usually starting in the big toe
• Joints that are red, hot, swollen, and very tender
• Increased pain 24-36 hours after the onset of symptoms
Gout of the Big Toe

Recurrent Gouty Arthritis
Most gout suffers will have a recurrent attack within two years, which can affect many different joints. Recurrent gout can lead to the development of tophi, which are chalky deposits of uric acid that most commonly occur in the elbows and earlobes.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, the doctor may take a sample of fluid from the affected joint. This fluid will be tested for uric acid crystals.
Other tests may include:
• Blood and Urine Tests–to measure the level of uric acid in your blood and to assess kidney function and involvement
• X-rays–to check for joint destruction, which may complicate recurrent cases
Treatment
Treatment depends on whether the gout is acute or recurrent.
Acute Gouty Arthritis
In general, the sooner treatment begins for an acute attack, the more effective it is. Treatment depends on:
• Onset of symptoms
• Number of joints affected
• Previous responses to treatment
• Overall health
General Measures
Putting a warm pad or an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help.
Medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help:
o Indomethacin
o Ibuprofen
o Naproxen
• Aspirin is not recommended because it can increase uric acid levels.
• Corticosteroids–may be used if NSAIDs are not effective or not recommended (taken orally, injected into a muscle, or injected into the affected joint)
• Colchicine–also used to prevent attacks of gout. Seldom it is used as a treatment for an acute attack. Note: This drug is associated with many adverse effects, so it is rarely used first.
Recurrent Gout
General measures
• Consume a low-purine diet.
• Avoid alcohol.
• Lose weight if overweight. But do not lose weight rapidly and without the advice of your doctor since rapid weight loss can precipitate a gout attack.
• Discontinue or avoid medications that increase uric acid levels.
• Stay well-hydrated.
Medications
• For recurrent gouty arthritis, or an initial attack with persistent hyperuricemia, you may be given medication to either:
o Lower the production of uric acid (allopurinol); or
o Increase the excretion of uric acid by the kidneys (probenecid or sulfinpyrazone)
• Under some circumstances, low dose colchicine may also be used to prevent recurrent attacks.
Prevention
To reduce your chance of getting gout:
• Consume a diet low in purines if you have hyperuricemia or family members with gout.
• Limit your intake of alcohol, especially binge drinking.
• Avoid dehydration.
• Lose weight if you are overweight. But do not lose weight rapidly and without the advice of your doctor since rapid weight loss can precipitate a gout attack.
• Gout is also associated with high blood pressure and heart attacks. Speak to your doctor about reducing your risk factors for these complications.

Glaucoma

2009-01-04T05:15:00.000-08:00

Glaucoma
Pronounced: glaw-KOH-ma
Definition
Glaucoma is a group of diseases that can damage the eye's optic nerve and result in blindness. One type of glaucoma, called open-angle glaucoma, is often associated with increased pressure inside your eye. This can lead to vision loss or even blindness. This fact sheet focuses on open-angle glaucoma, the most common form of the disease.
Normal Anatomy of the Eye

Causes
At the front of the eye, there is a small space called the anterior chamber, which lies between the lens and the cornea. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues and to keep the eye properly formed. In some cases of glaucoma, for still uncertain reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye, leading to vision loss.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for glaucoma include, but are not limited to:
• Age: over 40 years old
• Race: Black or Hispanic
• Family members with glaucoma
• Having diabetes
Note: Risk factors for other forms of glaucoma may differ from these.
Symptoms
At first, glaucoma usually causes no visual symptoms. Vision stays normal, and there is no pain. However, as the disease progresses, peripheral vision gradually begins failing. That is, objects in front may still be seen clearly, but objects to the side may be missed. As the disease worsens, the field of vision narrows and complete blindness can result. Glaucoma is usually a slowly progressive disease, causing damage over many years before obvious symptoms occur.
Diagnosis
An ophthalmologist or optometrist can often detect glaucoma during an eye examination. One important part of an eye examination to check for glaucoma and other diseases is to dilate your pupils. To accomplish this, drops are put into your eyes during the exam to enlarge your pupils. This allows the eye care professional to see more of the inside of the eye.
To detect glaucoma, your eye care professional will do the following tests:
Visual Acuity – measures how well you see at various distances
Visual Field – measures your side (peripheral) vision
Tonometry – determines fluid pressure inside the eye
Pupil Dilation – provides a better view of the optic nerve to check for signs of damage
Treatment
Although open-angle glaucoma cannot be cured, it can often be controlled.
Treatments may include:
Medications
These may be eye drops, eye ointments, or pills. Some drugs are designed to reduce pressure by slowing the production of fluid into the eye. Others help improve fluid drainage.
For most people with glaucoma, regular use of medications will control the progression of damage by lowering eye pressure, but these drugs may stop working over time, may cause side effects, or may not be effective enough to control the progression of damage. If a problem occurs, your eye care professional may select other drugs, change the dose, or suggest other ways to deal with the problem.
Common glaucoma medications include:
• Drugs that decrease the production of intraocular fluid:
o Beta-blockers – Betimol, Betagan, Ocupress, Istalol, Timoptic
o Carbonic anhydrase inhibitors (CAI) – Diamox, Neptazane, Azopt, Trusopt
o Combination CAI/beta-blocker – Cosopt
• Drugs that increase the drainage of intraocular fluid:
o Miotics – (rarely used) Isopto Carbachol, Ocusert Akarpine, E-Pilo
o Prostaglandin – Lumigan, Xalatan, Travatan
• Drugs that may decrease production and increase drainage of intraocular fluid:
o Sympathomimetic alpha-adrenergic agonist – Alphagan, Iopidine
o Sympathomimetic nonselective – (rarely used) Epinal, Glaucon, Propine
Laser Surgery
During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. This can help fluid exit the eye. Over time, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma drugs.
Conventional Surgery
Surgery also can help fluid escape from the eye and thereby reduce pressure. However, surgery is usually reserved for patients who continue to progress despite maximum therapy with eye drops, pills, or laser surgery.
Observation
In some cases, the patient and physician may decide not to treat glaucoma. Since glaucoma is a very variable disease, treatment decisions are made on an individual basis. It is also difficult to diagnose glaucoma; many people have some signs of the disease, but do not necessarily have the disease. Therefore, some physicians decide to monitor patients as “glaucoma suspects” instead of committing them to treatments.
Prevention
There are no guidelines for preventing glaucoma. Early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. Since vision loss is gradual and begins only in peripheral vision, most patients don't notice any visual changes until significant damage has been done. Everybody should have regular eye examinations, including having your pupils dilated. This is especially important if you are at high risk for glaucoma.

Gonorrhea

2009-01-02T03:57:00.000-08:00

Gonorrhea
Definition
Gonorrhea is a common sexually transmitted disease (STD).
Causes
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which is transmitted during vaginal, oral, or anal sexual intercourse.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Multiple sex partners
• Age: 15-29
• Sexual intercourse with a partner who has a history of any STD
• Having sex without a condom
• History of having a sexually transmitted disease
Symptoms
Symptoms of gonorrhea range from absent to severe. If symptoms develop, they usually appear within 2-10 days after sexual contact with an infected partner. However, in some cases, symptoms do not occur for up to a month after exposure.
People with gonorrhea may experience some, all, or none of the following symptoms:
Men
• Discharge from the penis
• Burning sensation while urinating
• Tender or swollen testicles
Women
• Burning sensation while urinating
• Abnormal vaginal discharge
• Abdominal pain
• Unusual vaginal bleeding
Men and Women
• Anal itching
• Soreness
• Bleeding
• Painful bowel movements
• Eye infections
• Blood infections
Diagnosis
Three tests are commonly used to diagnose gonorrhea:
Gram Stain – A smear of the discharge from the penis or cervix is placed on a slide and stained with a dye. A doctor examines it under a microscope for the presence of bacteria. This test is more accurate for men than women.
Nucleic Acid Probe Test – Discharge or urine is tested for substances called nucleic acids that specifically identify gonorrhea.
Laboratory Analysis – A smear of the discharge is taken and sent to the lab for culture. After two days, the culture is checked for growth of the bacteria that causes gonorrhea.
Treatment
If you have gonorrhea, your doctor may prescribe one of the following antibiotics:
• Ceftriaxone
• Cefixime
• Ciprofloxacin
• Ofloxacin
• Levofloxacin
It is important to take all of the medication as prescribed. All of your sexual partners should be tested and treated.
If Gonorrhea Is Left Untreated
If gonorrhea is not treated, the consequences can be serious for both men and women, and can affect the following areas:
In Men
• Testicles: Gonorrhea may cause epididymitis, a painful condition of the testicles that may lead to infertility.
• Prostate: The prostate may be affected if gonorrhea is left untreated.
• Urethra: Gonorrhea can cause scarring on the inside of the urethra, which can create difficulty while urinating.
In Women
Reproductive organs: Gonorrhea can cause pelvic inflammatory disease (PID), a serious infection that can affect fertility. PID causes scar tissue to form in the fallopian tubes.
Female Reproductive System Organs

Prevention
The most effective way to prevent gonorrhea is sexual abstinence. Other preventive measures include:
• Always use latex condoms during sexual activity.
• Have sex with only one partner (who has sex only with you).
• Have regular checkups for sexually transmitted diseases.
Use of other barrier methods of contraception, such as a diaphragm, may also partially prevent gonorrhea.

Glomerulonephritis

2009-01-02T03:54:00.001-08:00

Glomerulonephritis
(Glomerular Disease)
Pronounced: glom-air-u-lo-nuh-FRI-tis
Definition
Glomerulonephritis is a kidney condition that involves damage to the glomeruli. Glomeruli are the tiny structures within the kidney that filter blood.
The kidneys are bean-shaped organs located in the back just below the rib cage. Each kidney is about the size of a fist. The two kidneys filter blood, catch needed substances and return them to the circulation, and dispose of wastes in the urine. If the kidneys don’t filter properly, wastes build up in the blood.
There are two types of glomerulonephritis:
• Acute glomerulonephritis begins suddenly.
• Chronic glomerulonephritis develops gradually over several years.
In some cases, glomerulonephritis leads to kidney failure. Kidney failure is a severe kidney disease that must be treated with dialysis or kidney transplant.
Anatomy of the Kidney

Causes
Causes of glomerulonephritis include:
• Streptococcal infection of the throat (strep throat) or skin (impetigo)
• Hereditary diseases
• Immune diseases, such as lupus
• Type 1 diabetes and Type 2 diabetes
• High blood pressure
• Vasculitis (inflammation of the blood vessels)
• Viruses – human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus
• Endocarditis (infection of the valves of the heart)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for glomerulonephritis include:
• Family history of glomerulonephritis
• The presence of a known cause of glomerulonephritis (see “Causes”)
Symptoms
Glomerulonephritis sometimes causes no symptoms and is discovered during a routine urine test. When present, the symptoms of acute and chronic glomerulonephritis differ from one another.
The symptoms of acute glomerulonephritis may include:
• Blood in urine (red, brown, or tea-colored urine)
• Foamy appearance of urine
• Less frequent urination
• Swelling in the morning, especially in the face, feet, hands, and abdomen
Chronic glomerulonephritis can lead to kidney failure, which may cause these symptoms:
• Feeling tired
• Dry, itchy skin
• Nausea
• Vomiting
• Poor appetite
• Muscle cramps at night
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to a doctor who specializes in kidney disease for further diagnostic testing and treatment (nephrologist).
Tests may include:
Urinalysis – test to look for blood, protein, bacteria, and other evidence of kidney damage in the urine
Blood Tests – tests to check how well the kidneys are functioning and to look for medical conditions that may be causing glomerulonephritis
Ultrasound – a test that uses sound waves to create images of the kidneys
Abdominal CT Scan – a type of x-ray test that uses a computer to create detailed images of the structures inside the abdomen, including the kidneys
Kidney Biopsy – removal of a sample of kidney tissue with a needle to test for glomerulonephritis
Treatment
Treatment will depend on the underlying cause of glomerulonephritis. For example, control of blood pressure and blood sugar with medications would be important in the treatment glomerulonephritis related to hypertension and diabetes. In addition, the following steps may be taken to aid kidney function or reduce further damage:
Medications
• Diuretics to reduce fluid retention
• Medications to suppress the immune system
Lifestyle Changes
• Restrict salt and water intake.
• Restrict intake of potassium, phosphorous, and magnesium.
• Cut down on protein in the diet.
• Maintain a healthy weight through diet and exercise.
• Take calcium supplements.
Dialysis and Transplant
If the kidneys are unable to remove sufficient waste from the blood, dialysis may be required. Temporary dialysis may be sufficient for acute glomerulonephritis. If it leads to permanent kidney failure, chronic glomerulonephritis will require long-term dialysis or kidney transplant.
Prevention
The following steps may decrease your risk of glomerulonephritis:
• Seek a doctor promptly if you have a sore throat that might be due to strep.
• To reduce the risk of getting viral infections, including HIV, use safer sex practices, and avoid intravenous drug use.
• If you have diabetes or high blood pressure, see your doctor about keeping these conditions in check.

Gingivitis

2009-01-02T03:51:00.000-08:00

Gingivitis
(Gum Disease)
Definition
Gingivitis is a mild, often reversible form of gum disease. In gingivitis, there is inflammation of the gum tissue, which surrounds the teeth. If left untreated, gingivitis can progress to the support tissue and bone, a serious condition called periodontitis.
Gingivitis

Causes
Gingivitis is caused by a substance that forms on teeth called plaque. Plaque is a sticky material, composed of bacteria, mucus, food, and other substances. It hardens to form tartar. When plaque is left on the teeth for an extended period of time, it can lead to gingivitis. Toxins produced by bacteria in dental plaque irritate the gum tissue and cause infection, inflammation, and pain.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for gingivitis include:
• Inadequate brushing and flossing
• Stress
• Clenching teeth together or grinding teeth
• Poor nutrition
• Diabetes
• Breathing through the mouth
• HIV infection
• Improper bite
• Advancing age
• Pregnancy
• Birth control pills
• Family members with gum disease
• Sex: male
• Poorly fitting dentures
• Some medications taken for high blood pressure, heart disease, and depression
• Some seizure medications
• Drinking alcohol
• Smoking
• Down syndrome
Symptoms
Gingivitis is often painless with symptoms developing when it becomes worse.
Symptoms may include:
• Swollen, puffy gums
• Tender gums
• Redness in the gums or around the teeth
• Bleeding gums during brushing or eating
• Gum tissue that recedes or changes shape
• Persistent bad breath
Diagnosis
The dentist will examine your teeth and gums, assessing for swelling and areas where the tissue is pulling away from the teeth, forming a pocket. Early diagnosis of the problem enables prompt treatment and the possibility of reversing the condition. It is important to see your dentist every six months for a cleaning because gingivitis may have no symptoms in the early stages.
Treatment
Gingivitis therapy aims to remove the irritating plaque and prevent its return.
Treatment includes:
• Regular dental check ups and good oral hygiene
• Careful and frequent brushing and flossing
• A healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables
Self-care
Brushing
Thoroughly brush and floss your teeth. Use a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet. An electronic toothbrush may make brushing easier for patients with physical limitations. Replace the brush when the bristles become bent or frayed. Move the brush in small circular movements along the gumline and chewing surfaces of your teeth.
Flossing
Brushing removes bacteria from the teeth, but the brush cannot reach everywhere. Flossing helps rid food and bacteria between teeth. Hold the floss tight. Gently bring it down between the teeth. Do not pop the floss against the gum. Curve the floss around the tooth and rub up and down. Adjust the floss, so you use a fresh section for each tooth, including the back side of the last tooth, left and right, upper and lower.
Other Self-care
The dentist may recommend additional self-care treatments, such as massaging the gums with a rubber tip. Rinses to fight bacteria and plaque build-up may help some patients.
Dental Care
Dental health professionals check for gingivitis and remove plaque that has built up on teeth. A visit every six months is usually considered adequate. Patients with gingivitis may need more frequent cleanings. If the disease progresses and plaque builds up below the gum line, the area must be scraped off and smoothed with dental tools. Otherwise, accumulated plaque and tartar buildup make it easier for bacteria to grow.
If an area has progressed to periodontal disease, surgery or medication may be required. Treating an underlying medical problem may improve the health of your gums.
In patients with recurring gingivitis, the dentist will evaluate whether some other condition may be contributing to the gum disease.
Prevention
Strategies to prevent gingivitis include:
• Good dental habits:
o Brushing teeth twice daily. There is some data that rotating oscillating electric toothbrushes are more effective in controlling gingivitis than “normal” brushing by hand.
o Flossing at least once a day
o Visiting the dentist's office for a cleaning at least every six months
• Eating balanced, nutritious meals
• Not smoking
• Avoiding alcohol

Gestational Diabetes

2009-01-02T03:48:00.000-08:00

Gestational Diabetes
Definition
Gestational diabetes is a disorder in which the body does not make enough insulin or is unable to use all of the insulin needed during pregnancy. Insulin is a hormone that helps the body convert food into energy. Without insulin, glucose (sugar) from the food you eat cannot enter cells and glucose builds up in the blood. Body tissue becomes starved for energy. The excess sugar in the blood can cross the placenta and cause problems for the baby. By definition, this condition occurs in women with no history of diabetes.
A Woman With Gestational Diabetes

Causes
The reason some women develop gestational diabetes is unknown. Contributing factors include:
• Hormones needed for the baby's growth interfere with and block insulin's performance.
• Excess weight increases insulin resistance.
• Insulin resistance prevents the body from effectively using the insulin that is produced.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Obesity or being overweight
• Family members with diabetes
• Age: 25 or older
• Race: Hispanic, African-American, Native-American, Asian-American, Indigenous Australian, or a Pacific Islanders
• Gestational diabetes in a previous pregnancy
• Previous delivery of a large baby
• Previous stillbirth or too much fluid surrounding a baby during pregnancy
• Glucose in urine
Symptoms
Gestational diabetes may not cause any symptoms. If symptoms occur, they may include:
• Increased urination
• Thirst
• Hunger
• Recurring vaginal or urinary tract infections
• Weakness
Screening and Diagnosis
If you are at high risk of developing gestational diabetes (eg, very obese, prior history of gestational diabetes, glucose in your urine, or a strong family history of diabetes), your doctor may recommend that you undergo glucose testing as soon as possible. If your initial test is not positive, you should be retested between 24-28 weeks of gestation.
Women who are of average risk should be given the 50-gram glucose screening test between 24-28 weeks of gestation.
Newer guidelines do not require glucose testing for low-risk women, but to be low risk you must meet all of the following criteria:
• Less than 25 years of age
• Normal weight before and during pregnancy
• Member of an ethnic group with a low risk of gestational diabetes
• No known diabetes in any siblings or parents
• No history of abnormal glucose tolerance
• No history of poor obstetric outcomes
The screening test involves:
• Drinking a liquid high in sugar
• Taking a blood sample to measure the level of sugar in the blood
• A longer glucose-tolerance test if the initial screening test shows an above normal sugar level
Treatment
Gestational diabetes treatment aims to return blood sugar levels to normal.
Treatment includes:
Diet
• Eat a balanced diet, generally between 2,000-2,400 calories.
• Eat plenty of fruits, vegetables, and fiber.
• Limit the amount of fat you eat.
• Eat adequate amounts of protein and low-fat dairy products.
• Avoid foods high in sugar.
• Eat moderate portions of food at each meal.
• Eat a bedtime snack with protein and a starchy food.
• Do not gain more than the recommended amount of weight during pregnancy.
• Keep a record of your food intake to help a dietitian or a doctor revise your nutritional needs.
Exercise
Physical activity helps the body use blood sugar. The insulin you produce will be more effective. Follow your doctor's recommendations for activity levels and restrictions.
Blood Sugar Testing
Check your blood sugar levels during the day with an easy-to-use monitor. Keep a record of the results and show the doctor at prenatal visits.
Insulin
If your blood sugars remain above normal, despite exercise and diet, you may need one or two injections of insulin each day.
Follow-up
After delivery, blood sugar levels usually return to normal. You will need a glucose tolerance test 6-8 weeks after delivery. Exercise, breastfeeding, and weight loss in the weeks following childbirth help reduce the risk of developing type 2 diabetes.
Prevention
The following lifestyle changes may help you to avoid gestational diabetes:
• Maintain normal weight gain during pregnancy.
• Eat a healthy diet, one that is low in saturated fat and rich in fruits, vegetables, and whole grains.
• Exercise regularly. Do not start an exercise program until you check with the doctor.

Gastritis

2009-01-02T03:44:00.000-08:00

Gastritis
Definition
Gastritis is an inflammation of the stomach lining. In some cases, gastritis can lead to ulcers in the lining of the stomach.
Acute gastritis comes on suddenly and lasts briefly. Chronic gastritis is either longer lasting or recurrent.
Causes
Causes of gastritis include:
• Drugs (such as aspirin and other nonsteroidal anti-inflammatory medications [NSAIDs], as well as steroid drugs)
• Alcohol
• Smoking
• Severe stress, which can occur from:
o Surgery
o Burns
o Liver or kidney disease
o Shock
o Respiratory failure
o Head injury
o Sepsis
• Viral infection (for example, herpes, or cytomegalovirus)
• Bacterial infection, such as helicobacter pylori
• Fungal infection
• Injury to the blood vessels that bring blood to the stomach
• Excess production of stomach acid
• Reflux of bile into the stomach, especially after surgery of the bile system
• Crohn's disease
• Atrophy of the lining of the stomach (atrophic gastritis), usually associated with older age
• Pernicious anemia (causes autoimmune gastritis)
• Syphilis
• Sarcoidosis
• Radiation treatment
• Swallowing caustic substances
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Age 60 and older
• NSAID use
• Heavy alcohol use
• Pernicious anemia
• Diseases of the lymph system
• Severe stress, such as can occur with:
o Surgery
o Head injury
o Respiratory failure
o Kidney failure
o Liver failure
Symptoms
Symptoms include:
• Stomach pain
• Indigestion
• Burping
• Hiccuping
• Loss of appetite
• Nausea and vomiting
• Bloody or black vomit
• Dark black, tarry stools
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
Upper GI Series (Barium Swallow) – a series of x-rays of the upper digestive system taken after drinking a barium solution.
Endoscopy – a thin, lighted tube inserted down the throat and into the stomach to examine the inside of the stomach.
Upper GI Endoscopy

Biopsy – removal of a sample of stomach tissue to examine in a lab.
Blood, Breath, or Stool Tests – to check for infection with the bacteria Helicobacter pylori
Treatment
Treatment may include:
Medications
These include:
• Antacids
• H2 blockers
• Proton pump inhibitors
• Antibiotics to treat Helicobacter pylori infection
Prevention
To help prevent gastritis:
• Avoid alcohol.
• Do not smoke.
• Ask your doctor if any of the medications you are taking might be irritating your stomach. You might need to change medications. Or, you might need to take another medication to coat and protect your stomach lining.
• If you notice that certain foods (spicy foods, for example) are irritating, stop eating them. Some people feel better when they eat a bland diet.

Genital Herpes

2008-12-31T22:32:00.000-08:00

Genital Herpes
Herpes Simplex (HSV) – Types 1 and 2
Definition
Genital herpes is an infection that causes small, painful, fluid-filled blisters on the genitals, buttocks, or thighs. These blisters break open leaving an indented sore or ulcer. These blisters and/or ulcers may occur on other parts of the body, including the mouth, face, or eyes.
Genital Herpes

Causes
Genital herpes is caused by the herpes simplex virus. Although it was previously believed that type 1 was responsible for lesions from the waist up and type 2 for those from the waist down, this has been shown to be incorrect. Genital lesions may be of either type 1 or type 2, and some sources report that currently up to 40% of newly acquired cases of genital herpes are from type 1 virus. The virus enters the body through a break in the skin or through mucous membranes. After the first outbreak of genital herpes, the virus migrates to nerve endings at the base of the spine, and lies dormant until the next outbreak.
The virus is spread through:
• Sexual contact, including intercourse and oral and anal sex
• Fluid from herpes blisters that gets on other parts of the body
• An infected mother passing it on to her child during pregnancy or childbirth
The virus is most contagious when blisters are present. It is also contagious during the "shedding" stage, before blisters or sores are visible. The virus may also spread when inactive between outbreaks.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The strongest risk factor for getting the herpes simplex virus is unprotected sexual contact with a partner infected with the virus.
Once the herpes simplex virus is present in the body, other risk factors can trigger the blisters to form. Often, the exact cause of an outbreak of genital herpes is unknown.
Risk factors for an outbreak of genital herpes in people already infected with the virus include:
• Fever
• Illness or infection
• Stress
• Weakened immune system
• Menstruation
• Long periods of exposure to sunlight
Symptoms
Symptoms vary depending on whether this is the patient’s first (primary) episode or a recurrent episode. The virus remains dormant between outbreaks. During this period, the patient may not have any noticeable symptoms but may still be shedding (releasing) the virus and able to spread it to a sexual partner. When the virus is active, symptoms also vary and some people still have no symptoms. The frequency of genital herpes outbreaks varies from person to person. Most people have outbreaks at least once per year.
Primary Infection – This occurs in a patient who is newly exposed to HSV. Although there may not be any noticeable symptoms (asymptomatic), many people experience a flu-like syndrome, which includes fever and muscle aches. The lesions may be genital and/or present on other areas of the body, including the mouth, lips, and tongue. Additionally, the lesions are usually larger in size and number than those occurring in repeat or recurrent episodes. The primary infection usually resolves within two weeks unless the patient gets a second infection with a skin bacteria or fungus, in which case, the lesions may persist for up to six weeks.
Recurrent Infection – This represents a reactivation of the herpes virus. The recurrence will vary from patient to patient in terms of severity, duration, and amount of virus shed. In general though, recurrences tend to result in fewer, smaller ulcers which usually last only 3-7 days. Symptoms are usually limited to the area around the blister or ulcer. It is important to remember that viral shedding can occur with or without visible lesions and that asymptomatic (no symptoms or sores) lesions are currently responsible for over 50% of new infections.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam, particularly of the blisters and/or ulcers. Herpes lesions may look like other infections and may not be immediately visible if inside the urinary tract, vagina, or cervix. The doctor may need to open a blister to swab it and send it to the lab or may take a blood sample for testing.
Treatment
Treatments to ease pain include:
• Nonprescription pain relief drugs
• Antiviral creams and ointments
• Cool cloths placed on blisters or sores
• Lukewarm baths
• Wearing loose-fitting clothes
Treatments to speed healing include:
• Oral antiviral medications
• Keeping blisters/sores dry when not bathing
Treatments for bacterial infection of the blisters/sores include:
• Antibiotic medications
Prevention
To prevent the spread of the herpes simplex virus:
• Avoid sexual contact with an infected partner from the time the partner feels initial symptoms until blisters/sores have completely healed.
• If your partner is infected, use latex condoms during sex when your partner shows symptoms of genital herpes.
• Avoid oral sex if your partner has herpes blisters on the mouth or genital area.
• Avoid touching blisters to prevent spreading to other parts of the body.
• If you are pregnant and infected with the herpes virus, tell your doctor. Medication given to newborns immediately after birth can decrease the chance that they will be infected. If you have active herpes blisters when it is time to deliver your baby, the doctor may recommend that you deliver by Cesarean section.

Generalized Anxiety Disorder

2008-12-31T22:30:00.001-08:00

Generalized Anxiety Disorder (GAD)
Definition
Generalized anxiety disorder (GAD) causes chronic, exaggerated worrying and anxiety about everyday life. Everyone worries at times, but people with GAD can never relax and usually anticipate the worst; the intensity and pervasiveness of their worry interferes with normal functioning at school, work, and in their relationships. The worrying is often not related to anything in particular. Instead, each day provokes tension and anxiety.
People with GAD often worry excessively about health, family, work, or money. The worry is so severe that it interferes with their ability to live their lives. The anxiety can also progress to the point where people "worry about worrying." GAD usually starts in childhood or adolescence, but can also start in early adulthood. It is not unusual for GAD to start after age 20.
Causes
The exact cause of GAD is unknown. Researchers think it may be related to chemical imbalances in the brain.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for GAD include:
• Sex: female
• Family member with an anxiety disorder
• Long-term exposure to abuse, poverty, or violence
• Low-self esteem
• Poor coping skills
• Smoking or other substance abuse
• Increase in stress
Symptoms
Symptoms of GAD usually build up slowly. People with GAD often have both psychological and physical symptoms of anxiety.
Psychological symptoms include:
• Excessive ongoing worrying and tension
• Feeling tense or edgy
• Irritability, overly stressed
• Difficulty concentrating, mind going "blank"
• Stress
Physical symptoms include:
• Fatigue
• Muscle tension
• Headaches
• Trembling
• Difficulty sleeping
• Shortness of breath
• Sweating
• Stomach ache (abdominal pain)
• Diarrhea
• Nausea
People with GAD often have other anxiety disorders, depression, and/or problems with abusing alcohol or drugs.
Diagnosis
Your doctor will ask you about your symptoms and medical history, and perform a physical exam. Your doctor will also look for other medical conditions that may be causing your symptoms (eg, an overactive thyroid). You will be asked about any medications you are taking, including over-the-counter and herbal medications. Some medications can cause side effects similar to the symptoms of GAD. Your doctor will also ask about addictive substances you may be using. These can include nicotine, caffeine, street drugs, prescription medications, and alcohol.
To make a diagnosis of GAD, symptoms must be:
• Present more days than not
• Present for at least six months
• Interfering with your life (causing you to miss work or school, for example)
Treatment
If you have a mild form of GAD, your doctor will probably first have you try therapy to learn to manage anxious thoughts.
Therapies include:
Cognitive Behavioral Therapy
Your therapist will work with you to change your patterns of thinking. This will allow you to notice how you react to situations that cause anxiety. You will then learn to change your thinking so you can react differently. This can decrease the symptoms of anxiety.
Behavioral Therapy
Your therapist will teach you relaxation techniques. Learning ways to relax can help you gain control over anxiety. Instead of reacting with worry and tension, you can learn to remain calm. Your therapist may also slowly expose you to the situation that is causing the worry and tension. This can allow you to reduce your anxiety in a safe environment.
Medication
Medication can be prescribed for symptoms that are severe and make it difficult to function. Medications can help relieve symptoms so you can concentrate on getting better.
Medications may include:
• Benzodiazepines – to relax your body and keep it from tensing in response to anxious thoughts
o These medications need to be monitored closely because they may cause dependence.
• Buspirone (BuSpar) – an antianxiety medicine that does not cause dependence
• Antidepressant medications (most commonly selective serotonin re-uptake inhibitors, “SSRIs”) – to help control anxious thoughts
o Note: On March 22, 2004, the US Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
Prevention
There are no guidelines for preventing GAD. Early diagnosis and treatment can help symptoms from becoming debilitating.

Gangrene

2008-12-31T22:12:00.000-08:00

Gangrene
Definition
Gangrene is the death of an organ or body tissue. When the blood supply is cut off, the tissue doesn't get enough oxygen; it begins to die. If the gangrene is widespread, generalized shock may occur.
There are three main types:
Dry gangrene - The lack of blood supply causes the tissue to dry up and slough off.
Wet gangrene - The tissue becomes moist and decomposes. Wet gangrene usually occurs when the tissue is infected with bacteria.
Gas gangrene - This is a particular type of bacteria (Clostridia) that produces gas bubbles in the tissue.
Causes
Causes of gangrene include:
• Infection, especially after surgery or injury
• Diabetes
• Any condition that may block the blood flow to the tissues (such as atherosclerosis)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for gangrene include:
• Smoking
• Drinking alcohol
• Traumatic injury, especially crushing injuries
• Wound infection after surgery
• Frostbite
• Burns
• Atherosclerosis
• Diabetes
• Raynaud's disease
• Blood clots
• Ruptured appendix
• Hernia
• Intravenous drug use
Symptoms
Symptoms of gangrene may include:
• Swelling
• Pain, followed by numbness when the tissue is dead
• Sloughing off of skin
• Color changes, ranging from white, to red, to black
• Shiny appearance to skin
• Frothy, clear, watery discharge
• Fever and chills
• Nausea and vomiting
Gangrene of the Foot

Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
• Blood Tests
• Tests of the discharge and tissue from the gangrenous area
• X-rays of the area
• CT Scan – a type of x-ray that uses a computer to make pictures of the inside of the body
• MRI Scan – a test that uses magnetic waves to make pictures of the inside of the body
Treatment
Treatment of gangrene includes the following:
Antibiotics – These medications are given in a very potent form, through an IV.
Blood thinners – These drugs are given to prevent blood clots.
Debridement – This is a surgical procedure to cut away dead and dying tissue. It is done to try to avoid the spread of gangrene.
Amputation – If an entire toe, finger, hand, foot, leg, or arm is severely affected by gangrene, this body part may need to be removed.
Hyperbaric oxygen treatment – This therapy involves exposing the affected tissue to oxygen at high pressure.
Prevention
To help prevent gangrene:
• Patients with diabetes need to take very good care of their hands and feet.
• Surgical patients may be given antibiotics to help prevent infection (especially after intestinal surgery).

Ganglion Cyst

2008-12-31T22:10:00.000-08:00

Ganglion Cyst
Definition
A ganglion cyst is a fluid-filled sac that is usually attached to either a tendon sheath or a joint lining. Ganglion cysts usually appear on the back of the wrist, although they may be on the underside of the wrist, the hand, the fingers, or the feet. Ganglion cysts are always benign.
Ganglion Cyst

Causes
The cause of ganglion cysts is unknown.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a ganglion cyst include:
• Sex: Female
• Age: 20-50 years old
• Participating in gymnastics
Symptoms
Symptoms include:
• Appearance of a soft bump, usually on the back of the wrist
• Pain or tenderness at the site of the bump
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Most ganglion cysts are easily diagnosed based on their location and appearance. The doctor may use a small needle to remove some of the cyst's fluid for testing.
Other tests may include:
X-ray – a test that uses radiation to take a picture of structures inside the body, especially bones
MRI Scan – a test that uses magnetic waves to make pictures of structures inside the affected area
Treatment
Some ganglion cysts go away without treatment. If the cyst is very tender or unsightly, you may request treatment from your doctor. Even with treatment, ganglion cysts very often return.
Treatments include:
Home Treatment
• Ice
• Ibuprofen (Advil, Motrin) or aspirin to relieve pain and swelling
Note: Do not attempt to smash the cyst with a heavy object (a traditional home remedy). This is unlikely to get rid of the cyst and more likely to injure you.
Immobilization
Your doctor may suggest that you wear a splint on your wrist. Ganglion cysts usually get smaller with less activity and larger with more activity.
Aspiration
A needle is put into the cyst to drain the fluid.
Corticosteroid Injection
A steroid solution is injected into the cyst. This is usually done just after aspiration.
Surgery
Surgery can be performed to remove the cyst. This is done when cysts are large and unsightly or painful. They may return even after properly performed surgery.
Prevention
There are no guidelines for preventing a ganglion cyst.