verbals

• The nervous system consists of the brain, the spinal cord and peripheral nerves.
• The structure and organisation of its cells and tissues (neurones, nerves) enable rapid communication between different parts of the body through nerve impulses. The electrical stimuli, called “neurotransmitters” will send signal to the brain and the brain will respond by sending command to muscle/gland cells to contract/produce secretions.  Main function is working together with the endocrine system to regulate and maintain homeostasis, and the centre of all mental activities including thoughts, movement, decision making, learning and memory.

People with epilepsy has impaired the stability of the neuron cell membrane and such it triggers an abnormal electrical discharge that cause seizure and associated symptoms related to seizures. Two types of seizure: partial (begins on one side of the cerebral cortex) and generalized (abnormal electrical discharge spread to another side of hemisphere). 

• Confusion
• Loss of consciousness
• AgitationUncontrolled jerk movement of legs/arms

• Aura/sensation warning a patient that seizure is about to occur
• Headache
• Visual disturbance
• GI distress

EEG is useful to determine where in the brain the seizures start, its frequency, duration, and presence of subclinical seizures (asymptomatic). CT or MRI may indicate abnormalities in internal structures.  

• During seizure episode, clear the environment to keep the patient safe,  protect the patient from injury
• Turn the patient into a recovery position once the convulsion stops as this help accumulated saliva to drain from the mouth and avoid obstruction airway by this saliva.
• Observe the seizure activity and its clinical presentation (if repetitive seizures within 30mns and without a return of consciousness, need emergency call.), report to RN and document in progress notes because it is a scope of EN’s practice and relates to seizure management. Monitor vital signs to evaluate if the patient returns to consciousness after seizure.

Anticonvulsants  EG : Phenytoin ( Dilantin)

• Instruct the patient to recognize the aura, to care and to get safety if it occurs, such as lying down away from objects to prevent injury.
• Encourage patient to wear medical band or card to alert others to the presence of seizure disorder.
•  Educate patient to have regular dental care as essential if they take Phenytoin (Dilantin) because it provides side effects as gingival.
• Educate patient the medication prescribed, side effects (drowsiness and dizziness so avoid driving), avoid sudden discontinuance of medication. Educate the patient the important of regular blood test (checking therapeutic level to evaluate compliance with the medication regiment). Therapeutic blood levels help to prevent seizure (too low) and toxicity (too high).

• Digestive System extends from the mouth to the anus and consists of mouth, pharynx, oesophagus, stomach, small intestine, and colon.
•  It has five main functions such as ingestion (taking food into GI tract), propulsion (mixed and move content along GI tract), digestion (breaking down food into small molecules by gastric secretion), absorption (process of digested food absorbed into the blood for circulation and used by cells), and elimination (process of defecation).

Is the condition that the lining of upper GI tract (oesophagus, stomach, pylorus, or duodenum) is damaged by high concentration/activity of hydrochloric acid and pepsin. Damage mucosa is unable to secrete enough mucus to act as a barrier against the acidity. Some have more rapid gastric emptying and create a large amount of acid moving into duodenum resulting duodenal ulcer. Primary cause of PUD is infection by Helicobacter Pylori (H. Pylori), responsible for 80% of gastric ulcer and more than 90% of duodenal ulcer. This bacteria releases a toxin that promotes mucosal inflammation and ulceration.

• Pain at epigastria region
• Abdominal extensionHematemesis                                                                                              Melena

• Upper abdominal burning sensation after meal or with food.
•  Nausea/vomiting
• Weakness Weight loss

Upper GI endoscopy to confirm the ulcer and permit biopsy to rule out H. pylori or cancer. Complete blood count show anaemia or WBC elevated.

• Pain assessment because the patient has acute pain related to gastric mucosa erosion and prompt assessment can lead to timely intervention and relief pain.
• Ask about factors precipitating and relieving pain because PUD pain may be relieved by food, antacids or others.
• Administer antiulcer medications as order (it reduces amount of gastric acid production and antacids neutralize gastric acid to help relieve pain. Monitor the vital signs because server blood loss (bleeding or hematemesis) can cause hypovolemic shock

Antiulcer Agent- e.g:Ranitidine (Zantac or Rani2)

• Educate patient the medication prescribed ( 1 table at bedtime), and side effects (constipation, bradycardia, headache, and increased liver enzymes). Take Antacids 1 hour before or 2hs after Zantac to avoid interaction.
• Educate patient to avoid over counter medications such as aspirin, asprin and NSAID unless GP prescribed.
• Educate patient to avoid irritation food, caffeine and alcohol intake during exacerbation.
• Provide small frequent meals four to 6 times a day because they can dilute and neutralize gastric acid. Encourage non-acidic fluids between meals because it decreases irritation to gastric mucosa.

Respiratory system: it is the one of the main system of the body which helps the person for effective exchange of gasses .The primary function of the respiratory system is O2 intake & CO2 expulsion. The respiratory system is divided into the upper (structures not within the chest) and lower (structures within the chest) respiratory tracts. The structures of the respiratory system are: The mouth and nose, the trachea, the lungs, bronchi, bronchioles, alveoli & diaphragm

It is characterized as inflammation of mucosal lining of the bronchial tree and spasm of the bronchial smooth muscles (bronchospasm) It is due to mucosal oedema and thickened secretion blocked the airways. inflammation occurs in part because asthma triggers cause release of inflammatory substances such as histamines and leukotrienes

• Difficulty in breathing (dyspnoea)
• Lethargy
• Wheezing
• Cyanosis Use of accessory respiratory muscles

• Tightness in the chest
• Cough
• Difficulty in breathing Production of sticky mucus

• Lung function test may show the decreased peak flow and forced expiratory volume in 1 second
• Skin testing may show specific allergens

• Place the patient in high fowler position to maintain the patient ‘s airways so that patient can breathe easily
• Monitor patient’s peak  expiratory flow rate and chart the reading on the asthma action plan so that the result may indicate the onset of asthma before the patient experience any symptoms

Bronchodilators

• Educate the patient do not stop any medication without doctor’s advice
• If symptoms are uncontrolled seek medical advice
• Advice the patient to avoid the triggers of asthma
• Educate the patient about the effective coughing techniquesIf two types of medication are used at same time, instruct the patient which to take first and which is second

• If symptoms are uncontrolled seek medical advice
• Advice the patient to avoid the triggers of asthma
• Educate the patient about the effective coughing techniquesIf two types of medication are used at same time, instruct the patient which to take first and which is second

• Endocrine system: this system consists of glands and hormones. Gland is a group of cells that produces and secretes chemical in the body. Those chemicals are called hormones. Glands are of two types: Exocrine - salivary, sweat, sebaceous, pancreas
• Endocrine - Pituitary, thyroid, thymus, adrenal, testis and ovaries 

• Main functions are:
• Growth
• Repair
• Sexual reproduction
• Digestion Homeostasis

• Pancreas produces not enough insulin and the body is resitent to the insulin that is produced.
• Insulin receptors are less sensitive
• Amount of insulin produced is not enough to meet the bodies needs.

• Weight gain or obesity
• Fatigue
• Darker skin areas
• Slow healing sores Dry and itchy skin

• polydipsia
• feeling hungry
• polyuria
• headache
• Blurred Vision

• Fasting blood sugar test. A blood sample will be taken after an overnight fast
• Random blood sugar test. A blood sample will be taken at a random time Oral glucose tolerance test. For this test, which is rarely used anymore, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

Monitor the bgl of the patient for good diabetes controlsEncourage the patient to adapt a healthy lifestyle to maintain the diabetes such as cessation of smoking, healthy diet

Oral hypoglycaemic agents

• Educate the patient about the medication when to take and how to take
• Educate the patient how to monitor bgl
• Educate the patient about the foot care
• Encourage fluid intake to avoid dehydration
• Educate the patient about  diet and exercise programs to reduce weight

• Pancreas produces little to no insulin and as a result blood glucose levels rise
• Without insulin glucose cannot enter cells and be used for energy and remains in the blood
• The body takes food and breaks it down into fat protein and carbohydrates for energy
• Carbohydrates are broken down into glucose which is absorbed into bloodstream.
• insulin helps cells absorb glucose in blood to be used as energy

• Shaking
• Sweating
• Flushed face
• Weight loss

• Sweating
• Flushed face
• Weight loss

• Polydipsia
• Polyuria
• Felling hungry
• Headache

Fasting blood sugar test. A blood sample will be taken after an overnight fastRandom blood sugar test. A blood sample will be taken at a random time

• Monitor the bgl for good diabetes control
• administer medication as ordered by the doctor to prevent the complication and to maintain blood glucose level

Insulin

• CARDIOVASCULAR/ NERVOUS SYSTEM.
• The cardiovascular system is divided into two main parts the heart which ensures constant circulation of the blood and the blood vessels which forms a network through which blood flows it supplies a continuous flow to all body cells, when the flow is interrupted or becomes inadequate tissue damage or cell death may follow.
•  The nervous system consists of the brain, spinal cord and peripheral nerves and enables communication between the different parts of the body.

When blood flow is interrupted the oxygen and glucose needed are not available to meet the brains metabolic needs. If the supply of oxygen and glucose is stopped, the brain tissue dies. The particular vessels involved determine the area of the brain affected and therefore the symptoms that result. There are two types: Ischemic stroke caused by embolism or thrombosis and Haemorrhagic Stroke caused by the rupture of a cerebral blood vessel.

• Sudden weakness numbness of face, arm, or leg. Hemiplegia
• Trouble speaking
• Trouble walkingTrouble talking

• Headache
• Dizziness
• Trouble seeing one or both eyes
• Unexplained fall

• Dizziness
• Trouble seeing one or both eyes
• Unexplained fall

• Look for signs of facial droop or symmetry of the face.
• ECT for presence of heart disease and increase risk of thrombosis.
• CT is to identify if the symptoms are caused by a haemorrhagic stroke, cause of action will be different than ischemic strokes

• Maintain airway to promote adequate oxygenation.
• Administer oxygen as ordered to maintain oxygen saturation greater than 90% and ensure adequate tissue perfusion.
• Knee-high anti-embolism stockings to help stop formation of clots while patient is resting in bed.

• Administer oxygen as ordered to maintain oxygen saturation greater than 90% and ensure adequate tissue perfusion.
• Knee-high anti-embolism stockings to help stop formation of clots while patient is resting in bed.

Anti- platelet agents eg. Aspirin Calcium channel blocker eg. Nimodipine

• Educate patient on risk factors associated with stroke, diet, smoking and lack of exercise.
• Educate patient and family on stroke warning signs FAST and to get treatment within 3 hrs don’t avoid warning signs.
• Educate patient with dysphagia to sit up straight when eating.
• Educate patient that embolism may be prevented with warfarin.
• Educate family and make use of community resources like RDN’s , meals on wheels, support groups.

NOSE, PHARYNX, LARYNX, TRACHEA, TWO BRONCHI (ONE BRONCHUS TO EACH LUNG AND SMALLER AIR PASSAGES TWO LUNGS, PLEURA,INTERCOSTAL AND DIAPHRAM MUSCLES.Gaseous exchange takes place between the capillaries and alveoli, we inhale air, oxygen is then passed to the capillaries and carbon dioxide is expelled from the capillaries the oxygenated blood is then transported to all parts of the body and cells.  

It is the accumulation of fluid in the alveoli and the interstitial spaces of the lungs, the fluid collects in the numerous air-sacs in the lungs making it difficult to breath, and there is insufficient gaseous exchange.

• Excessive sweating
• Pale skin
• Cough that produces frothy sputum that may be tinged with blood
• Wheezing/Dyspnoea

• Fatigue
• Insomnia
• Inability to lie down due to breathlessness
• Weight gain when caused by congestive heart failure.Increased lung congestion

• Chest x-ray
• Arterial blood gases

• Administer oxygen as ordered because there is insufficient gaseous exchange in the lungs and this will increase amounts.
• Place patient in high semi-fowlers position to enhance lung expansion.Reduce movement of patient to decrease oxygen demands.

Diuretic  (Loop Diurectic) eg Frusemide

• Life style changes educate patient on the effects of Smoking, Alcohol, Cholesterol.
• Educate patient about early onset and when to see a doctor e.g. shortness of breath, fatigue, dry cough.
• Educate patient to take sodium reduced diet to decrease fluid overload.
• Teach patient to take slow deep breaths to increase oxygenation.Educate patient on signs of weight gain and the implication with this condition.

Cardiovascular system, functions are to pump oxygen and nutrient rich blood around the body to the organs and extremities and elimination of wastes, providing the body the required amount to function properly. The structures consist of the heart, arteries and veinsHINT-The CV system means cardio=heart, vascular= blood vessels, the heart’s pumping action ensures constant circulation of the blood, the blood vessels, form a lengthy network through which the blood flows.

Arterie/s become narrowed and hardened due to an excessive build up of plaque around the artery wall. The plaque clogs up the artery, disrupting the flow of blood around the body. This potentially causes blood clots that can result in life-threatening conditions such as heart attack, stroke and other cardiovascular diseases.

The signs & symptoms of atherosclerosis vary depending on the affected artery. coronary arteries- Angina, coughing, vomiting, Arrhythmiasperipheral arteries- redness, hair loss, numbness, weakness, infectionrenal arteries- oedema of the hands and feet,  impaired concentrationcarotid arteries- Altered level of consciousness. Paralysis, facial numbness, impaired vision

Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as a stroke or heart attackSymptoms also depend on the sight of the atherosclerosis- Coronary Artery- chest pain, discomfort, pressure, indigestion, sleep problems ( if coronary microvascular atherosclerosis)Carotid artery- Sudden weakness, Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body, Confusion, Trouble speaking or understanding speech, Trouble seeing in one or both eyes, Problems breathing, sudden severe headache.Peripheral arteries- numbness, pain, redness, hair lossRenal arteries-  tiredness, change in urination,  loss of appetite, nausea, swelling of the hands and feet,

Cholesterol and triglycerides levels- blood serum test-Dopler ultrasound-MRI-ECG-Ankle brachial index-The ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm, discrepancies can indicate PAD or PVD-A computed tomography (CT) scan- creates computer-generated pictures of the heart, brain, or other areas of the body. The test can show hardening and narrowing of large arteries.

Monitoring of blood pressure- to detect the need to  implement any blood pressure control mechanisms like medication-Diet, low fat, low cholesterol-Administer medications as orderd

Lipid regulating agents ie- crestor (Statins)

A healthy lifestyle including good nutrition, exercise, cholesterol screening, frequent check-ups and medications are helpful in controlling atherosclerosis.Encourage patients on the importance of cessation of smokingEducation to patients about the risks of smoking and the exposure to second hand smoke is important.Educate patients on the importance of reducing cholesterol with diet, exercise and medications.Educate patients about the importance of maintaining their medication regimeEducate patients on the most important signs to report to their doctor or nurse, ie Angina, SOB, signs of stroke (FACE)

RespiratoryThe respirator y system is an important part of the human anatomy that enables the effective exchange of gasses in the lungs providing the body with the right amounts of O2 & CO2. The primary function of the respiratory system is O2 intake & CO2 expulsion. The respiratory system is divided into the upper (structures not within the chest) and lower (structures within the chest) respiratory tracts. The structures of the respiratory system are: The mouth and nose, the trachea, the lungs, bronchi, bronchioles, alveoli & diaphragm

Inflammation associated with the release of enzymes from the lung cells, causing irreversible abnormal enlargement of the airspaces of the bronchioles. This enlargement leads to the destruction of the alveolar walls breaking down their elasticity, ie their expansion. –HINT- Passive expiration is impaired and air is trapped in the alveoli. (Impaired alveolar expansion means impaired gaseous exchange leading to insufficient oxygenation)

• SOB
• Exertional dyspnoea
• Cough Barrel chest
• cyanosis

• Chronic cough
• weight loss
• grunting with respirations
• Physical discomfort

• Chest x-ray
• Pulmonary function test

Provide frequent rest periods-To allow the patient to conserve energy and maintain adequate levels of oxygenationAdminister O2 if ordered-with the aim of having the patient saturate at around 90% to 94%- continuous o2 therapy (more than 15 hours a day) is proven to be a treatment that can prolong survival.Assist with Pts dietary intake- Pt may tire easily when eating, offer small frequent meals and consider using o2 via nasal cannula during mealsDB&C- to assist with airway clearance(Deep Breathing & Coughing)

• Bronchodialotors
• Anticholenergics
• Oxygen- 2-3 lts should be sufficient AntibioticsMucolytics

The importance of when to notify the nurse or physician….Avoidance of smoking… or smoking cessationCoughing and deep breathing exercising….Correct use of hand held inhalers….Signs and symptoms of a spontaneous pneumothoraxto alert nurse or Dr if patient experiences sudden worsening of dyspnoea, sharp pluretic chest pain worsened by chest movement, breathing or coughing.

• Musculoskeletal System.
• The musculoskeletal system consists of the bones of the skeleton and its joints, muscles, ligaments and tendons.
•  
• Function is to:
• Protect and support internal structures and organs of the body
• Allow movement of the body
• Produce blood cells
• Store calcium and phosphorus
• Produce heat

Rate of bone resorption accelerates as the rate of bone formation decelerates.Decreased bone mass results and bones become porous and brittle.

• Swelling of joints
• Redness of joints
• Stooping
• Reduced mobility

• Pain
• Stiffness
• Muscle weakness
• Cracking sounds in joints (crepitus)

Bone Mineral Density Scan-measures density of bonesBone Scan-shows injured or diseased areas

• Administer medication for pain as ordered.
• To provide pain relief and comfort.
•  
• Perform active or passive ROM exercises to all extremities.To encourage muscle strength and tone and maintain joint mobility.

(NSAID’s) Non-steroidal anti-inflammatory drugs e.g. Celebrex

• Advise patient to take medication with food or milk.
• Educate patient about eating a diet rich in calcium.
• Educate patient about exercise to help strengthen bones.
• Educate patient about increasing exposure to sun (at safe times) to boost vitamin D.Educate patient about reducing intake of caffeine and alcohol-interferes with ability to absorb calcium.

• Educate patient about eating a diet rich in calcium.
• Educate patient about exercise to help strengthen bones.
• Educate patient about increasing exposure to sun (at safe times) to boost vitamin D.Educate patient about reducing intake of caffeine and alcohol-interferes with ability to absorb calcium.

• The Urinary System
• The urinary system plays an important part in maintaining homeostasis of water and electrolyte concentrations within the body and is the main excretory system.
•  
• Structures: 2 Kidneys, 2 ureter, urinary bladder, urethra
•  
• Functions:
• Kidneys: Formation and secretion or urine, Production and secretion of the hormone erythropoietin which stimulates formation of red blood cells, Production and secretion of the enzyme which is important in the control of blood pressure.
• Ureters: Convey urine from kidneys to the urinary bladder.
• Urinary Bladder: Where urine collects and is temporarily stored.Urethra: Through which urine passes from the bladder to the exterior.

• Nephron destruction eventually causes irreversible damage.
• Glomerular filtration rate and filtrate volumes are greatly reduced and reabsorption of water is impaired. Reduced glomerular filtration leads to accumulation of waste substances in the blood.

• Dyspnoea
• Pruritus
• Pale, yellowish skin
• Vomiting

• Change in taste
• Nausea
• Fatigue
• Muscle cramps

• Renal biopsy
• MRI
• Kidney Ultrasound

• Monitor vital signs at least 4 hourly.
• Changes may indicate altered fluid or electrolyte status.
•  
• Monitor intake, output and urine specific gravity at least 4 hourly.Intake greater than output and elevated specific gravity may indicate fluid retention or overload

Diuretics (Loop Diuretics) e.g. Frusemide (Lasix)

• If patient is diabetic, encourage monitoring blood glucose levels more frequently (Goal is to avoid further damage to kidneys)
• Educate patient about restricted sodium intake which will minimize sodium and fluid retention.
• Educate patient on restricted fluid intake to prevent overload.
• Educate patient about maintaining skin integrity to protect against infection.Educate patient about dialysis site care as appropriate.