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PERNICIOUS ANEMIA
- *without B12, brain can't work
- *s/s: numbness/tingling(paresthesia), bloody red tongue, mouth sores; psychosis & suicidal
- *test: Schilling's 24hr Urine Test (24hr urine=discard 1st & save last; if no B12 then its pos = B12 injections 4life)
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DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
- *cause: trauma r/t surgery , OB complication
- *s/s: BLEEDING
- *tx: Heparin, cryoprecipitate, IV fluids
- *clotting factors leave arteries & veins which causes more bleeding b/c clotting factors won't be available in area of injury
- *will need to move quickly to keep BP up
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HODGKIN'S LYMPHOMA
- *CA of the lymphatic system (nomoveable, painless masses)
- *dx test: Reed-Sternberg CA cells: Biopsy, CT, MRI
- *prednisone
- ***Interventions for pts receiving chemo: alopecia, antiematic, appearance of urine, mannitol (dieuretic which loses water so monitor output)
- ***common SE of chemo: anorexia, akopecia, N/V, ecchymosis
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SMOKING is a r/f for ... BOCELL !
- B = bladder
- O = oral
- C = cervical
- E = esophageal
- L = lung
- L= laryngeal
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PITUITARY GLAND (Cushing Vs. Addison's)
- *anytime brain surgery is done, P is placed on pit gland
- *if pt c/o excessive thirst/urination postop, check urine (sp. grav <1.010 = FVD so pt needs ADH (vasopressin, the "-pressins"))
- *lots of output = ADH (lack of ADH l/t diabetes insipidus)
- *no output = diuretics
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CUSHING SYNDROME (FVE = Metabolic Alkalosis) 
- *being on too much prednisone (moonface, buffalo hump; d/t steroid (sugar) long term use and storage)
- *too much cortisol
- *hypokalemia d/t sugar (increases HR) & hypernatremia d/t h2O retention
- *long term steroids = loss of Ca+ l/t osteoporosis
- *labs: check K+ 1st , electrolytes
- *meds: potassium sparing
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ADDISON'S (FVD = Metabolic Acidosis)
- *hypoTN, cyanosis is late sign
- *airway pts b/c sugar hormones needed to breath
- *inc melanocytes: bronze like skin
- *hypocortisolism: dec sugar, dec glucose level (PRIORITY : give sugar hormones = glucocorticosteroids)
- *hyponatremia (abd cramps, belly hurts, N/V)
- *hyperkalemia (bradycardia)
- *NO sedatives = can lose airway !
- *meds: decadron = cortisol
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HYPERTHYROIDISM (need to stop increasing HR or else will go to her "garve" = Grave's Disease)
*excess amount of thyroxine = hypermetabolism
- *put in a cool rm b/c pt is hot !
- *inc appetite = wt loss d/t hyperness
- *No caffeine , pt is already up !
- *give calories, sugar, proteins, carbs (she's burning cals fast & so she can continue to breathe)
- *don't give fine motor activity b/c she's to shaky !
- *** thyroid storm = medical emergency
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HYPOTHYROIDISM (adult=myxedema, infant=cretinism)
- *s/s: dec HR, BP, T ; edema on hands & feet, wt gain, fatigue & lethargy, hoarse cry in infants
- *prefers warm environment, high fiber diet d/t constipation
- *check P, >100 hold med !
- *NO sedatives, sleeping pills, Narcs !
- ***select all that apply = irritability, artificial tears, high carb diet
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HYPOPARATHYROIDISM (dec Ca+, inc P+)
- *s/s: carpopedal spasms,dry, scaly skin & thin hair, cavities, cataracts
- *hypocalcemia = CATS (Chvostek's sign (CN7 check ) , Arrythmia, Tetany , Tremors, Trousseau's sign (BP cuff on arm for tetany) , Seizures
- *tx: calcium gluconate (inc with VitD)
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HYPERPARATHYROIDISM (inc Ca+, dec P+)
*s/s: N/V, muscle weakness, osteoporosis, bone pain
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Air Embolism
turn pt on l side so air bubbles stay in r atrium
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Pneumonectomy
- lay on operative side
- don't lay on good side (organs will shift)
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DIGOXIN = CHF
- strengthens heart muscle contaraction
- has diuretic effect = helps dec volume but K+ wasting (Lasix)
- 0.5-2.0 range
- antidote : digibind
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Potassium Imbalance = PRIORITY***
- *dec K+=heart can't be controlled (tachycardia)
- *inc K+=stops heart (bradycardia) ***corporal punishment via IVP;
- *K+ always needs to be by IV pump
- *K+ supplements given with food
- *potatoes, peanuts
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Hypokalemia = Metabolic Alkalosis
- diuretics
- burns
- NG suctioning
- steroids
- Cushing = R alkalosis
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Hyperkalemia = Metabolic Acidosis
- NSAID's
- renal failure
- Addison's = R acidosis
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MI meds
- *aspirin (to begin anticoagulation)
- *morphine (vasodilates=opens up coronary arteries + reduces pain)
- *nitrates (nitroglycerin, restores circulation to occluded vessels)
- *wear gloves with patch & cream
- *DIET: no prepackaged, canned, smoked foods
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SODIUM
- **hypernatremia
- *s/s: dry, sticky mucuos, fever, confusion
- *metabolic alkalosis = diarrhea !
- **hyponatremia
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*cool, moist skin, h/a, low BP, cramps - *metabolic acidosis = vomiting !
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CELIAC DISEASE (G.I disorder = small intestine)
- *intolerance to gluten
- *s/s: steatorrhea, abd distention
- *gluten=wheat, oat, barley
- *gluten free=grains with corn, rice
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METABOLIC ALKALOSIS
- hypernatremia
- hypocalcemia
- hypokalemia
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METABOLIC ACIDOSIS
- hyponatremia
- hypercalcemia
- hyperkalemia
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RENAL FAILURE = Metabolic Acidosis b/c pt are not making urine
- in urine = NH3 (high=confusion & G.I bleed)
- pt should be right by nurse's station/leave light on
- 3 D's of options : dialysis, donor, death
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BENIGN PROSTATIC HYPERTHROPHY (BPH)
- *enlargement of prostate can obstruct the vesicle neck or prostate urethra, leading to incomplete emptying of the bladder & urinary retention
- *s/s: nocturia, frequency, urgency, dysuria
- *tx: TURP= check for hemorhage
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DIVERTICULITIS
- *prevent rupture = peritonitis = death
- *inc fluid to prevent constipation
- *s/s: irregular bowel, intervals of diarrhea, LLQ pain, low-grade fever
- *tx: increase dietary intake of soft fiber foods (a low fiber diet is used during the acute episode)
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APLASTIC ANEMIA = dec bone marrow
- *cells are replaced with fat
- *s/s: dec erythrocytes, leukopenia, thrombocytopenia
- *tx: bone marrow transplant
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SICKLE CELL ANEMIA = abnormal RBC l/t impaired tissue perfusion
- ***HHOP
- H= HEAT
- H= HYDRATION
- O= O2
- P= PAIN RELIEF
- *avoid contact sports and take frequent rest periods
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HEMOPHILIA = abnormal clotting
*s/s: bleeding & bruising easily, nose bleeds
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POLYCYTHEMIA VERA =thick blood
- *s/s: enlarged spleen, burning sensation in fingers and toes, dizziness, tinnitus
- *tx: phlebotomy, hydration, anticoagulant therapy
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Chronic Liver Pts
- ***ONLY chronic liver pts get ascites. A pt can have cirrhosis of the liver & not have ascites ,
- *Ascites Test: push on belly - if a wave of fluid appears = ascites if it jiggles = fat !
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Gallbladder
- Gall Stones = prone (4F's:forty, fertile, feamle, fat)
- Bile Duct Stones = supine
- ** no morphine , DEMEROL !
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OSTEOMYELITIS = bone infection
- *@risk: malnourished, elderly, overwt
- *s/s: fever, tachycardia, swelling, tenderness, pain
- *tx: antibiotics & pain meds
- *interventions: immobilize body part, diet high in protein & vitC
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GOUT = uric acid --> big toe !
- *s/s: painful joint & tophi (growths of urate crystals )
- *tx: low purine diet = cheese, eggs, fats, milk, gelatin, cherries
- * AVOID: fish, liver, lobster, spinach, mussels
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GULLAIN-BARRE = ascending progressive paralysis or weakness
- *s/s: diminished or absent tendon reflexes, low-grade fever
- *frequently develops 1-3wks following upper respiratory or G.I infection
- *Nsg Care: AIRWAY -> encourage incentive spirometer
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PAGET'S DISEASE
- inc skull size
- inc head circumference
- hard of hearing
- long arms & bowed legs
- wadding gait
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CROHN'S DISEASE
- *inflammation of segments of the bowel = l/t swelling, thickening, & abscess formation
- *s/s: abd pain, diarrhea*
- *dx: string sign
- *tx: low residue diet, vits and Fe supp
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ULCERATIVE COLITIS
- *inflammation of colon & rectum
- *s/s: bloody diarrhea, fever, vomiting, abd cramping
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INFANT
- 1-3 mos = RECLINER
- 3-6 mos = SITTER
- 6-9 mos = BOUNCER/CRAWLER
- 9-12 mos= CRALWER/CRUISER
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TODDLER (1-3yrs) = PRAISE
- P = push-pull toys; parallel play
- R= rituals & routines; regression
- A= autonomy vs. shame & doubt; accidents
- I= involve parents
- S= separation anxiety
- E= elimination & explore
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PRESCHOOLER (3-5yrs) = MAGIC
- M= mutilation
- A= associative play & abandonment
- G= guilt
- I= initiative, imaginary friend, imagination
- C= curious
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SCHOOL AGE (6-12yrs) = DIMPLE
- D= death
- I= industry vs inferiority
- M= modesty
- P= peers
- L= loss of control
- E= explanation procedures
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ADOLESCENCE (12-18yrs) = PAIRS
- P= peer group
- A=altered body image
- I= identity
- R= role confusion
- S= separation from peers
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