Medical Surgical Notes Review
Content
In a patient patient with with hypokal hypokalemi emiaa (serum (serum potass potassium ium level level belo below w 3.5 3.5 mEq/ mEq/L) L),, pres presen enti ting ng sign signss and and symptom symptomss inlud inludee musle musle weakne weakness ss and ardia ardia arrhythmias. During ardia arrest, i! an ".#. route is unavailable, epinephrine an be administered endotraheally. Pernicious anemia results !rom the !ailure to absorb vitamin $%& in the '" trat due to loss o! intrinsi !ator and auses primarily '" and neurologi signs and symptoms. A patient who has a pressure uler should onsume a highp hprotein ein, high halorie die diet, unless ontraindiated. The CK-MB CK-MB isoeny isoenyme me level level is used used to assess assess tissue damage in myoardial in!artion. %&hourr !ast, !ast, the normal !asting !asting blood After a %&hou gluose level is *+ to %&+ mg/dl. A patient who is eperiening digoin toiity may report report nausea, nausea, vomiting, vomiting, diplopia, diplopia, blurred blurred vision, vision, ligh lightt !las !lashe hes, s, and and yell yellow owg gre reen en halo haloss arou around nd images. % ++ ml. Anuria is daily urine output o! less than %++ "n remittent !ever, the body temperature varies over a &-hour period, but remains elevated. Risk Risk o! a !at embolism is greatest in the !irst -* hour hourss a!t a!ter the the !rat ratur uree o! a long ong bone bone.. "ts ts mani!ested by respiratory distress. patient who is in To help venous blood return in a patient shok, the nurse should elevate the patients legs no more than -5degrees. his proedure is ontraindiated in a patient with a head h ead in0ury. de!iitt is the di!!ere di!!erene ne betwee between n the The pulse pulse de!ii apial and radial dial pulse rates, when taken simultaneously by two nurses. the pati patient ents risk risk o! vomit vomitin ing g and and To reduce reduce the aspi aspira rati tion on,, the the nurse nurse shoul should d she shedul dulee postu postura rall drainage be!ore meals or & to -hours a!ter meals. Blood pressure an be measured diretly by intra arte arteri rial al inse insert rtio ion n o! a ath athet eter er onn onne ete ted d to a pressuremonitoring devie. A positive 1ernigs sign, seen in meningitis, ours when an attempt to !le the hip o! a reumbent patient auses pain!ul spasms o! the hamstring musle and resistane to !urther etension o! the leg at the knee. In a patie patient nt with with a !ratu !ratured red,, disloa disloated ted !emur !emur,, treatment begins with redution and immobiliation o! the a!!eted leg. Herniated Herniated nucleus pulposus (intervertebral disk) most omm ommonl only ours in the lumb umbar and lumbosaral regions. a!inecto!" is surgial removal o! the herniated portion o! an intervertebral disk. gastri ri uler uler inlud inludes es #urgical #urgical treat!ent treat!ent o! a gast severing the vagus nerve (vagotomy) to redue the amount o! gastri aid sereted by the gastri ells. $alsalva%s $alsalva%s !aneuver is !ored ehalation against a los losed ed glot glotti tis, s, as when when taki taking ng a deep deep brea breath th,, blowing air out, or bearing down. &hen !ean arterial pressure !alls below 2+ mm g and systoli blood pressure !alls below *+ mm g,
vital vital organ organ per!us per!usion ion is seriou seriously sly omprom ompromis ised. ed. idocaine idocaine '("locaine) '("locaine) is the drug o! hoie !or reduing premature ventriular ontrations. A patient is at greatest risk o! dying during the !irst &- to -* hours a!ter a myoardial in!artion. During a myoardial in!artion, the le!t ventrile usually sustains the greatest damage. The pain o! a myoardial in!artion results !rom myoardial ishemia aused by anoia. *or a patient in ardia arrest, the !irst priority is to establish an airway. The universal universal sign sign !or hoking hoking is luthin luthing g the hand to the throat. *or a patient who has heart !ailure or ardiogeni pulmonary edema, nursing interventions !ous on dereasing venous return to the heart and inreasing le!t ventriular output. hese interventions inlude plaing the patient in high 4owlers position and admin adminis iste teri ring ng oygen oygen,, diur diuret eti is, s, and and posi positi tive ve inotropi drugs as presribed. A positive tuberulin skin test is an induration o! %+ mm or greater at the in0etion site. and symp sympto toms ms o! hist histopl oplas asmo mosi sis, s, a Thee signs Th signs and hroni systemi !ungal in!etion, resemble those o! tuberulosis+ vitim ims, s, the the leadi leading ng ause ause o! deat death h is In ,urn vit respiratory ompromise. he seond leading ause is in!etion. !unti tion on o! the the pan panre reas as is the the The eocrin eocrinee !un seretion o! enymes used to digest arbohydrates, !ats, and proteins. A patient who has hepatitis (in!etious hepatitis) should onsume a diet thats moderately high in !at and high in arbohydrate and protein, and should eat the largest meal in the morning. tamponade de should shouldnt nt be .sophag .sophageal eal ,alloon ,alloon tampona in!lated greater than &+ mm g. /verproduction o! prolatin by the pituitary gland an an aus ausee gala galato torr rrhea hea (ee (eess ssiv ivee or abnor abnorma mall latation) and amenorrhea (absene o! menstruation). Inter!ittent claudication (pain during ambulation or other movement thats relieved with rest) is a lassi symptom o! arterial insu!!iieny in the leg. In ,ladder arinoma, the most ommon !inding is gross, painless hematuria. Parenteral ad!inistration o! heparin sodium is ont ontra rain indi diat ated ed in pati patien ents ts with with renal renal or live liver r disease, '" bleeding, or reent surgery or trauma6 in pregnant patients6 and in women older than age 2+. Drugs that potentiate the e!!ets o! antioagulants inlude aspirin, hloral hydrate, gluagon, anaboli steroids, and hlorampheniol. *or a ,urn patient, are priorities inlude maint aintai aini ning ng a pat patent ent air airway way, prev preven entting ing or orr orre eti ting ng !lui !luid d and and ele eletr trol oly yte imba imbala lan nes es,, ontrolling pain, and preventing in!etion. .lastic stockings should be worn on both legs. Active Active i!!uni0 i!!uni0atio ation n is the !ormation o! antibod bodies within hin the body body in response to vaination or eposure to disease.
Passive Passive i!!uni0 i!!uni0atio ation n is admin adminis istr trat atio ion n o! antibodies that were pre!ormed outside the body. A patient who is reeiving digoin (Lanoin) must have his 7 and 8otassium level heked beause o! the inreased risk o! dig digoin in toi oiity. 9onom 9onomita itant nt use may a!!et a!!et ardia ardia ontra ontratil tility ity and lead to arrhythmias. Inter!i Inter!itten ttentt positive positive-- pressure breathing is in!l in!lat atio ion n o! the the lung lung duri during ng insp inspir irat atio ion n with with ompressed air or oygen. he goal o! this in!lation is to keep the lung open. &ristdrop is aused by paralysis o! the etensor musles in the !orearm and hand. *ootdrop results results !rom eessive eessive plantar plantar !leion !leion and is usually a ompliation o! prolonged bed rest. A patient who has gonorrhea may be treated with peniillin and probeneid ($enemid). 8robeneid delays delays the eretion eretion o! peniil peniilli lin n and keeps keeps this this antibioti in the body longer. gluose2 e2ph phosp osphat hatee In pati patien ents ts who have gluos dehydrogenase dehydrogenase ('28:) de!iieny de!iieny,, the red blood ells ant metabolie adequate amounts o! gluose, and hemolysis ours. /n-call mediation is mediation that should be ready !or immediate administration when the all to administer its reeived. If gagging , nausea, or vomiting ours when an airw airway ay is remo remove ved, d, the the nurse nurse shoul should d pla plaee the the patient in a lateral position with the upper arm supported on a pillow. &hen a postoperative patient arrives in the reovery room, the nurse should position the patient on his side or with his head turned to the side and the hin etended. In the immediate postoperative period, the nurse should should report report a respir respirato atory ry rate rate greate greaterr than than 3+, temperature greater than%++; 4 (3<.*; 9) or below =<; =<; 4 (32. (32.%; %; 9), 9), or a sign signi! i!i ian antt drop drop in blood blood pressure or rise in pulse rate !rom the the baseline. Irreversi,le ,rain damage may our i! the entral nervous system is deprived o! oygen !or more than - minutes. !or poly polyy yth them emia ia ver vera inl nludes udes Treat!ent !or admini administe sterin ring g oygen oygen,, radioi radioisot sotope ope therapy therapy,, or hemoth hemothera erapy py agents agents,, suh suh as hloram hlorambui buill and nitrogen mustard, to suppress bone marrow growth. A patient with aute renal !ailure should reeive a highalorie diet thats low in protein as well as potassium and sodium. Addison%s disease is aused by hypo!untion o! the adre adrenal nal glan gland d and and is hara harat ter eri ied ed by !ati !atigue gue,, anemia, weight loss, and brone skin pigmentation. >ithout >ithout ortisol ortisol replaement replaement therapy, therapy, its its usually usually !atal. 1lauc 1lauco!a o!a is managed onservatively with beta adrener adrenergi gi bloker blokerss suh suh as timolol timolol (im (imopt opti) i),, whih derease sympatheti impulses to the eye, and and with with mioti mioti eyedr eyedrops ops suh suh as pilo piloar arpi pine ne ("sopto 9arpine), whih onstrit the pupils. Miotics e!!eti e!!etively vely treat treat glauom glauomaa by redui reduing ng intraoular pressure. hey do this by onstriting the pupil, pupil, ontrating ontrating theiliary theiliary musles, musles, opening opening
the the ante anteri rior or hamb hamber er angl angle, e, and and inr inrea easi sing ng the the out!low o! aqueous humor. patientt is reeiv reeiving ing hepari heparin, n, the nurse nurse &hi &hile le a patien should should monitor monitor the partial partial thromboplas thromboplastin tin time.ϖ ?rinary ?rinary !requeny !requeny,, inontinene, inontinene, or both an our a!te a!terr ath athet eter er remo remova val. l. "no "nont ntin inen ene e may be mani!ested as dribbling. &hen teaching a patient about olostomy are, the nurs nursee shou should ld inst instru rut t the the pati patien entt to hang hang the the irrigation reservoir %*@ to&&@ (-5 to 55 m) above the stoma, insert the atheter &@ to -@ (5 to %+ m) into the stoma, irrigate the stoma with %< to 3o(5+3 to %,++5 ml) o! water at a temperature o! %+5; to %%+; 4 (-+; to -3; 9) one a day, lean the area around the stoma with soap and water be!ore apply applyin ing g a new new bag, bag, and and use use a prot protet etiv ivee skin skin ove overi ring ng,, suh suh as a Atom Atomahe ahesi sive ve wa!e wa!er, r, kara karaya ya paste, or karaya ring, around the stoma. Thee first Th first sign sign o! odgkins disease is painless, super!iial lymphadenopathy, typially !ound under one arm or on one side o! the nek in the ervial hain. To differentiate true yanosis !rom deposition o! ertain pigments, the nurse should press the skin over the disolored area. 9yanoti skin blanhes, but pigmented skin doesnt. A patient who has a gastri uler is most likely to report pain during or shortly a!ter eating. &idening pulse pressure is a sign o! inreasing intr intra ara rani nial al pres pressu sure re.. 4or 4or eamp eample le,, the the blood blood pressure may rise !rom%&+/*+ to %2+/2+ mm g. In a ,urn vitim, a primary goal o! wound are is to prevent ontamination by miroorganisms. To prevent eternal rotation in a patient who has had hip nailin nailing, g, the nurse nurse plaes plaes trohan trohanter ter rolls rolls !rom !rom the the knee knee to the the ankl anklee o! the the a!!e a!!et ted ed leg. leg. #evere hip hip pai pain a!te a!terr the inse inserrtion tion o! a hip hip prosthesis indiates dislodgment. "! this ours, be!ore alling the physiian, the nurse should shou ld assess the the pati patient ent !or !or shor shorte teni ning ng o! the the leg, leg, ete etern rnal al rotation, and absene o! re!lees. As !uch as <5B o! renal !untion is lost be!ore blood urea nitrogen and serum reatinine levels rise above normal. &hen ompensatory e!!orts are present in aid base balane, partial pressure o! arterial arbon dioide (8a9C&) and biarbonate (9C3D) always point in the same diretion p 8a9C& 9C3D F resp respir irat ator ory y aid aidos osis is omp ompen ensa sate ted d p 8a9C 8a9C& & 9C3D 9C3D F respir respirato atory ry alkalo alkalosis sis ompens ompensate ated d p 8a9C& 9C3D F metaboli aidosis ompensated p 8a9C& 9C3D F metaboli alkalosis ompensated. Pol"uria is urine urine outpu outputt o! &,5++ &,5++ ml or more more within &- hours. The presenting sign o! pleuritis is hest pain that is usual usually ly unil unilat ater eral al and rela relate ted d to resp respir irat atory ory movement. If a patient has a gastri drainage tube in plae, the nurs nursee shoul hould d epe epet t the phy physii siian an to orde order r potassium hloride.
An increased pulse rate is one o! the !irst indiations o! respiratory di!!iulty. "t ours beause the heart attempts to ompensate !or a dereased oygen supply to the tissues by pumping more blood. In an adult , a hemoglobin level below %% mg/dl suggests iron de!iieny anemia and the need !or !urther evaluation. The nor!al partial pressure o! oygen in arterial blood is =5 mm g (plus or minus 5 mm g). $ita!in C de!iieny is harateried by brittle bones, pinpoint peripheral hemorrhages, and !riable gums with loosened Clinical !anifestations o! pulmonary embolism are variable, but inreased respiratory rate, tahyardia, and hemoptysisare ommon. 2or!all", intraoular pressure is %& to &+ mm g. "t an be measured with a AhiGt tonometer. In earl" hemorrhagi shok, blood pressure may be normal, but respiratory and pulse rates are rapid. he patient may report thirst and may have lammy skin and piloeretion (goose bumps). Cool3 !oist , pale skin, as ours in shok, results !rom diversion o! blood !rom the skin to the ma0or organs. To assess apillary re!ill, the nurse applies pressure over the nail bed until blanhing ours, quikly releases the pressure, and notes the rate at whih blanhing !ades. 9apillary re!ill indiates per!usion, whih dereases in shok, thereby lengthening re!ill time. Hormal apillary re!ill is less than 3 seonds. .cept !or patients with renal !ailure, urine output o! less than 3+ ml/hour signi!ies dehydration and the potential !or shok. In elderl" patients, the most ommon !rature is hip !rature. Csteoporosis weakens the bones, predisposing these patients to !rature, whih usually results !rom a !all. Before angiograph", the nurse should ask the patient whether hes allergi to the dye, shell!ish, or iodine and advise him to take nothing by mouth !or * hours be!ore the proedure. During myelography, approimately %+ to %5 ml o! erebrospinal !luid is removed !or laboratory studies and an equal amount o! ontrast media is in0eted. After angiography, the punture site is overed with a pressure dressing and the a!!eted part is immobilied !or * hours to derease the risk o! bleeding. If a 4ater-,ased medium was used during myelography, the patient remains on bed rest !or 2 to * hours, with the head o! the bed elevated 3+ to -5 degrees. "! an oilbased medium was used, the patient remains !lat in bed !or 2 to &- hours. The level o! amputation is determined by estimating the maimum viable tissue (tissue with adequate irulation) needed to develop a !untional stump. Heparin sodiu! is inluded in the dialysate used !or renal dialysis. Paro"s!al nocturnal dyspnea may indiate heart !ailure.
A patient who takes a ardia glyoside, suh as digoin, should onsume a diet that inludes high potassium !oods. The nurse should limit traheobronhial sutioning to %+ to %5 seonds and should make only two passes. Before perfor!ing traheobronhial sutioning, the nurse should ventilate and oygenate the patient !ive to si times with a resusitation bag and %++B oygen. his proedure is alled bagging. #igns and s"!pto!s o! pneumothora inlude tahypnea, restlessness, hypotension, and traheal deviation. The cardinal sign o! toi shok syndrome is rapid onset o! a high !ever. A ke" sign o! pepti uler is hematemesis, whih an be bright red or dark red, with the onsisteny o! o!!ee grounds. #igns and s"!pto!s o! a per!orated pepti uler inlude sudden, severe upper abdominal pain6 vomiting6 and an etremelytender, rigid (boardlike) abdomen. Constipation is a ommon adverse reation to aluminum hydroide. *or the !irst &- hours a!ter a myoardial in!artion, the patient should use a bedside ommode and then progress to walking to the toilet, bathing, and tak ing short walks. After a myoardial in!artion, the patient should avoid overeertion and add a new ativity daily, as tolerated without dyspnea. In a patient with a reent myoardial in!artion, !rothy, bloodtinged sputum suggests pulmonary edema. In a patient who has aquired immunode!iieny syndrome, the primary purpose o! drugs is to prevent seondary in!etions. In a patient with aquired immunode!iieny syndrome, suppression o! the immune system inreases the risk o! opportunisti in!etions, suh as ytomegalovirus, 8neumoystis arinii pneumonia, and thrush. A patient with aquired immunode!iieny syndrome may have rapid weight loss, a sign o! wasting syndrome. If the body doesnt use gluose !or energy, it metabolies !at and produes ketones. Approi!atel" 567 o! patients with 'uillain $arrI syndrome have residual de!iits, suh as mild motor weakness or diminished lower etremity re!lees. H"pertension and hypokalemia are the most signi!iant linial mani!estations o! primary hyperaldosteronism. After percutaneous aspiration o! the bladder, the patients !irst void is usually pink6 however, urine with !rank blood should be reported to the physiian. A urine ulture that grows more than %++,+++ olonies o! bateria per milliliter o! urine indiates in!etion.
A patient who is undergoing dialysis should take a vitamin supplement and eat !oods that are high in alories, but low in protein, sodium, and potassium. In a patient who has hroni obstrutive pulmonary disease, the most e!!etive ways to redue thik seretions are to inrease !luid intake to &,5++ ml/day and enourage ambulation. The nurse should teah a patient with emphysema how to per!orm pursedlip breathing beause this slows epiration, prevents alveolar ollapse, and helps to ontrol the respiratory rate. Clu,,ing of the digits and a barrel hest may develop in a patient who has hroni obstrutive pulmonary disease. A stroke '8,rain attack9) disrupts the brains blood supply and may be aused by hypertension. In a patient who is undergoing dialysis, desired outomes are normal weight, normal serum albumin level (3.5 to 5.5 g/dl),and adequate protein intake (%.& to %.5 g/kg o! body weight daily). Inter!ittent peritoneal dialysis involves per!orming three to seven treatments that total -+ hours per week. In a patient with hroni obstrutive pulmonary disease, the best way to administer oygen is by nasal annula. he normal !low rate is & to 3 L/ minute. Isoetharine 'Bronkosol) an be administered with a handheld nebulier or by intermittent positive pressure breathing. Brain death is irreversible essation o! brain !untion. Continuous a!,ulator" peritoneal dialysis requires !our ehanges per day, < days per week, !or a total o! %2* hours per week. The classic adverse reations to antihistamines are dry mouth, drowsiness, and blurred vision. Because of the risk o! paralyti ileus, a patient who has reeived a general anestheti ant take anything by mouth until ative bowel sounds are heard in all abdominal quadrants. The level o! alpha!etoprotein, a tumor marker, is elevated in patients who have testiular germ ell aner. Clinical !anifestations o! orhitis aused by bateria or mumps inlude high temperature, hills, and sudden pain in the involved testis. The level o! prostatespei!i antigen is elevated in patients with benign prostati hyperplasia or prostate aner. The level of prostati aid phosphatase is elevated in patients with advaned stages o! prostate aner. Phen"lephrine '2eo-#"nephrine)3 a mydriati, is instilled in a patients eye to dilate the eye. To pro!ote !luid drainage and relieve edema in a patient with epididymitis, the nurse should elevate the srotum on asrotal bridge. *luorescein staining is ommonly used to assess orneal abrasions beause it outlines super!iial epithelial de!ets. Pres,"opia is loss o! near vision as a result o! the loss o! elastiity o! the rystalline lens.
Transient ische!ic attacks are onsidered preursors to strokes. sign of acute appendiitis, J$urneys sign is tenderness at J$urneys point (about &@ K5 m !rom the right anterior superior ilia spine on a line between the spine and the umbilius). &hen caring !or a patient with 'uillain$arrI syndrome, the nurse should !ous on respiratory interventions as the disease proess advanes. #igns and s"!pto!s o! olon aner inlude retal bleeding, hange in bowel habits, intestinal obstrution, abdominalpain, weight loss, anoreia, nausea, and vomiting. #"!pto!s of prostatitis inlude !requent urination and dysuria. A chancre is a painless, ulerative lesion that develops during the primary stage o! syphilis. During the tertiar" stage o! syphilis, spirohetes invade the internal organs and ause permanent damage. In total parenteral nutrition, weight gain is the most reliable indiator o! a positive response to therapy. The nurse may administer an ".#. !at emulsion through a entral or peripheral atheter, but shouldnt use an inline !ilter beause the !at partiles are too large to pass through the pores. If a patient who has a prostatetomy is using a 9unningham lamp, instrut him to wash and dry his penis be!ore applying the lamp. e should apply the lamp horiontally and remove it at least every - hours to empty his bladder to prevent in!etion. If a woman has signs o! urinary trat in!etion during menopause, she should be instruted to drink si to eight glasses o! water per day, urinate be!ore and a!ter interourse, and per!orm 1egel eerises. If a !enopausal patient eperienes a Mhot !lash,N she should be instruted to seek a ool, breey loation and sip a ool drink. Cheilosis auses !issures at the angles o! the mouth and indiates a vitamin $&, ribo!lavin, or iron de!iieny. Tetan" may result !rom hypoalemia aused by hypoparathyroidism. A patient who has ervial aner may eperiene vaginal bleeding !or % to 3 months a!ter intraavitary radiation. Ascites is the aumulation o! !luid, ontaining large amounts o! protein and eletrolytes, in the abdominal avity. "ts ommonly aused by irrhosis. 2or!al pul!onar" artery pressure is %+ to &5 mm g. Hormal pulmonary artery wedge pressure is 5 to %& mm g. After cardiac atheteriation, the site is monitored !or bleeding and hematoma !ormation, pulses distal to the site are palpated every %5 minutes !or % hour, and the patient is maintained on bed rest with the etremity etended !or * hours. He!ophilia is a bleeding disorder thats transmitted genetially in a selinked (O hromosome) reessive pattern. lthough girls and women may
arry the de!etive gene, hemophilia usually ours only in boys and men. $on &ille,rand%s disease is an autosomal dominant bleeding disorder thats aused by platelet dys!untion and !ator #"""de!iieny. #ickle cell anemia is a ongenital hemolyti anemia thats aused by de!etive hemoglobin A moleules. "t primarily a!!ets blaks. #ickle cell anemia has a homoygous inheritane pattern. Aikle ell trait has a heteroygous inheritane pattern. Pel-.,stein !ever is a harateristi sign o! odgkins disease. 4ever reurs every !ew days or weeks and alternates witha!ebrile periods. 1lucose-:-phosphate dehydrogenase ('28:) de!iieny is an inherited metaboli disorder thats harateried by red blood ells that are de!iient in '28:, a ritial enyme in aerobi glyolysis. Preferred sites !or bone marrow aspiration are the posterior superior ilia rest, anterior ilia rest, and sternum. During ,one marrow harvesting, the donor reeives general anesthesia and -++ to *++ ml o! marrow is aspirated. A ,utterfl" rash aross the bridge o! the nose is a harateristi sign o! systemi lupus erythematosus. Rheu!atoid arthritis is a hroni, destrutive ollagen disease harateried by symmetri in!lammation o! the synoviumthat leads to 0oint swelling. #creening for human immunode!iieny virus antibodies begins with the enymelinked immunosorbent assay. 7esults areon!irmed by the >estern blot test. The CK-MB isoenyme level inreases - to * hours a!ter a myoardial in!artion, peaks at %& to &hours, and returns tonormal in 3 days. .cessive intake o! vitamin 1 may signi!iantly antagonie the antioagulant e!!ets o! war!arin (9oumadin). he patientshould be autioned to avoid eating an eessive amount o! lea!y green vegetables. A l"!ph node biopsy that shows 7eedAternberg ells provides a de!initive diagnosis o! odgkins disease. Bell%s pals" is unilateral !aial weakness or paralysis aused by a disturbane o! the seventh ranial (!aial) nerve. During an initial tuberulin skin test, lak o! a wheal a!ter in0etion o! tuberulin puri!ied protein derivative indiates thatthe test dose was in0eted too deeply. he nurse should in0et another dose at least &@ (5 m) !rom the initial site. A tu,erculin skin test should be read -* to <& hours a!ter administration. In reading a tu,erculin skin test, erythema without induration is usually not signi!iant. Death caused by botulism usually results !rom delayed diagnosis and respiratory ompliations. In a patient who has rabies, saliva ontains the virus and is a haard !or nurses who provide are.
A fe,rile nonhemolyti reation is the most ommon trans!usion reation. H"pokale!ia (abnormally low onentration o! potassium in the blood) may ause musle weakness or paralysis,eletroardiographi abnormalities, and '" disturbanes. Beri,eri , a serious vitamin $% (thiamine) de!iieny, a!!ets aloholis who have poor dietary habits. "ts epidemi insian ountries where people subsist on unenrihed rie. "ts harateried by the phrase M" ant,N indiating that the patientis too ill to do anything. .cessive sedation may ause respiratory depression. The pri!ar" postoperative onern is maintenane o! a patent airway. If c"anosis ours irumorally, sublingually, or in the nail bed, the oygen saturation level (Aao &) is less than *+B. A rapid pulse rate in a postoperative patient may indiate pain, bleeding, dehydration, or shok. Increased pulse rate and blood pressure may indiate that a patient is eperiening Msilent painN (pain that ant beepressed verbally, suh as when a patient is reovering !rom anesthesia). idocaine '("locaine) eerts antiarrhythmi ation by suppressing automatiity in the 8urkin0e !ibers and elevating theeletrial stimulation threshold in the ventriles. Cullen%s sign (a bluish disoloration around the umbilius) is seen in patients who have a per!orated panreas. During the postoperative period, the patient should ough and breathe deeply every & hours unless otherwiseontraindiated (!or eample, a!ter raniotomy, atarat surgery, or throat surgery). Before surger"3 a patients respiratory volume may be measured by inentive spirometry. his measurement beomes thepatients postoperative goal !or respiratory volume. The postoperative patient should use inentive spirometry %+ to %& times per hour and breathe deeply. Before a!,ulating , a postoperative patient should dangle his legs over the side o! the bed and per!orm deepbreathingeerises. During the patients !irst postoperative ambulation, the nurse should monitor the patient losely and assist him as neededwhile he walks a !ew !eet !rom the bed to a steady hair. H"povole!ia ours when %5B to &5B o! the bodys total blood volume is lost. #igns and s"!pto!s o! hypovolemia inlude rapid, weak pulse6 low blood pressure6 ool, lammy skin6 shallowrespirations6 oliguria or anuria6 and lethargy. Acute pericarditis auses sudden severe, onstant pain over the anterior hest. he pain is aggravated by inspiration. #igns and s"!pto!s o! septiemia inlude !ever, hills, rash, abdominal distention, prostration, pain, headahe, nausea,and diarrhea.
Rock" Mountain spotted !ever auses a persistent high !ever, nonpitting edema, and rash. Patients 4ho have undergone oronary artery bypass gra!t should sleep 2 to %+ hours per day, take their temperature twiedaily, and avoid li!ting more than %+ lb (-.5 kg) !or at least 2 weeks. Claudication pain (pain on ambulation) is aused by arterial insu!!iieny as a result o! atheromatous plaque that obstrutsarterial blood !low to the etremities. Pace!akers can be powered by lithium batteries !or up to %+ years. The patient shouldnt void !or % hour be!ore perutaneous suprapubi bladder aspiration to ensure that su!!iient urine remains in the bladder to make the proedure suess!ul. eft-sided heart failure auses pulmonary ongestion, pinktinged sputum, and dyspnea. (7emember L !or le!t and lung.) The current reommended blood holesterol level is less than &++ mg/dl. &hen caring !or a patient who is having a seiure, the nurse should !ollow these guidelines (%) void restraining thepatient, but help a standing patient to a lying position. (&) Loosen restritive lothing. (3) 8lae a pillow or another so!t ob0etunder the patients head. (-) 9lear the area o! hard ob0ets. (5) :ont !ore anything into the patients mouth, but maintain apatent airway. (2) 7eassure and reorient the patient a!ter the seiure subsides. 1ingival h"perplasia , or overgrowth o! gum tissue, is an adverse reation to phenytoin (:ilantin). &ith aging3 most marrow in long bones beomes yellow, but it retains the apaity to onvert bak to red. Clinical !anifestations o! lymphedema inlude aumulation o! !luid in the legs. Afterload is ventriular wall tension during systoli e0etion. "ts inreased in patients who have septal hypertrophy,inreased blood visosity, and onditions that ause blokage o! aorti or pulmonary out!low. Red ,lood cells an be stored !roen !or up to & years6 however, they must be used within &- hours o! thawing. *or the !irst &- hours a!ter amputation, the nurse should elevate the stump to prevent edema. After h"sterecto!" , a woman should avoid seual interourse !or 3 weeks i! a vaginal approah was used and 2 weeks i! the abdominal approah was used. Parkinson%s disease harateristially auses progressive musle rigidity, akinesia, and involuntary tremor. Tonic-clonic seiures are harateried by a loss o! onsiousness and alternating periods o! musle ontration andrelaation. #tatus epilepticus3 a li!ethreatening emergeny, is a series o! rapidly repeating seiures that our without intervening periods o! onsiousness.
The ideal donor !or kidney transplantation is an idential twin. "! an idential twin isnt available, a biologial sibling is thenet best hoie. Breast cancer is the leading aner among women6 however, lung aner aounts !or more deaths. The stages of cervical aner are as !ollows stage +, arinoma in situ6 stage ", aner on!ined to the ervi6 stage "",aner etending beyond the ervi, but not to the pelvi wall6 stage """, aner etending to the pelvi wall6 and stage "#,aner etending beyond the pelvis or within the bladder or retum. /ne !ethod used to estimate blood loss a!ter a hysteretomy is ounting perineal pads. Aaturating more than one pad in %hour or eight pads in &hours is onsidered hemorrhaging. Transurethral resetion o! the prostate is the most ommon proedure !or treating benign prostati hyperplasia. In a chest drainage system, the water in the water seal hamber normally rises when a patient breathes in and !alls when hebreathes out. #pinal fusion provides spinal stability through a bone gra!t, usually !rom the ilia rest, that !uses two or more vertebrae. A patient who reeives any type o! transplant must take an immunosuppressant drug !or the rest o! his li!e. Incentive spiro!etr" should be used 5 to %+ times an hour while the patient is awake. In 4o!en3 pelvi in!lammatory disease is a ommon ompliation o! gonorrhea. #coliosis is lateral Ashaped urvature o! the spine. #igns and s"!pto!s o! the seondary stage o! syphilis inlude a rash on the palms and soles, erosion o! the oral muosa,alopeia, and enlarged lymph nodes. In a patient who is reeiving total parenteral nutrition, the nurse should monitor gluose and eletrolyte levels. ;nless contraindicated3 on admission to the postanesthesia are unit, a patient should be turned on his side and his vitalsigns should be taken. .de!a is treated by limiting !luid intake and eliminating eess !luid. A patient who has had spinal anesthesia should remain !lat !or %& to &- hours. #ital signs and neuromusular !untionshould be monitored. A patient who has maple syrup urine disease should avoid !ood ontaining the amino aids leuine, isoleuine, and lysine. A severe ompliation o! a !emur !rature is eessive blood loss that results in shok. To prepare a patient !or peritoneal dialysis, the nurse should ask the patient to void, measure his vital signs, plae him in asupine position, and using asepti tehnique, insert a atheter through the abdominal wall and into the peritoneal spae. If !ore than 3 L o! dialysate solution return during peritoneal dialysis, the nurse should noti!y the physiian.
He!odial"sis is the removal o! ertain elements !rom the blood by passing heparinied blood through a semipermeablemembrane to the dialysate bath, whih ontains all o! the important eletrolytes in their ideal onentrations. 1angrene usuall" a!!ets the digits !irst, and begins with skin olor hanges that progress !rom grayblue to dark brown orblak. Kidne" function is assessed by evaluating blood urea nitrogen (normal range is * to &+ mg/dl) and serum reatinine(normal range is +.2 to %.3 mg/dl) levels A 4eight-,earing trans!er is appropriate only !or a patient who has at least one leg thats strong enough to bear weight,suh as a patient with hemiplegia or a singleleg amputation. /verflo4 incontinence (voiding o! 3+ to 2+ ml o! urine every %5 to 3+ minutes) is a sign o! bladder distention. The first sign o! a pressure uler is reddened skin that blanhes when pressure is applied. ate signs and s"!pto!s o! sikle ell anemia inlude tahyardia, ardiomegaly, systoli and diastoli murmurs, hroni!atigue, hepatomegaly, and splenomegaly. A !echanical ventilator, whih an maintain ventilation automatially !or an etended period, is indiated when a patientant maintain a sa!e 8aC& or 8a9C& level. T4o t"pes o! mehanial ventilators eist negativepressure ventilators, whih apply negative pressure around the hestwall, and positivepressure ventilators, whih deliver air under pressure to the patient. Angina pectoris is harateried by substernal pain that lasts !or & to 3 minutes. he pain, whih is aused by myoardial ishemia, may radiate to the nek, shoulders, or 0aw6 is desribed as viselike, or onstriting6 and may be aompanied bysevere apprehension or a !eeling o! impending doom. he diagnosis o! an aute myoardial in!artion is based on the patients signs and symptoms, eletroardiogram traings,troponin level, and ardia enyme studies. The goal o! treatment !or a patient with angina petoris is to redue the hearts workload, thereby reduing the myoardialdemand !or oygen and preventing myoardial in!artion. 2itrogl"cerin dereases the amount o! blood that returns to the heart by inreasing the apaity o! the venous bed. The patient should take no more than three nitroglyerin tablets in a %5minute period. He!odial"sis is usually per!ormed &- hours be!ore kidney transplantation. #igns and s"!pto!s o! aute kidney transplant re0etion are progressive enlargement and tenderness at the transplant site,inreased blood pressure, dereased urine output, elevated serum reatinine level, and !ever. After a radical mastetomy, the patients arm should be elevated (with the hand above the elbow)
on a pillow to enhane irulation and prevent edema. Postoperative !astecto!" are inludes teahing the patient arm eerises to !ailitate lymph drainage and preventshortening o! the musle and ontrature o! the shoulder 0oint (!roen shoulder). After radical mastetomy, the patient should help prevent in!etion by making sure that no blood pressure readings,in0etions, or venipuntures are per!ormed on the a!!eted arm. *or a patient who has undergone mastetomy and is suseptible to lymphedema, a program o! hand eerises an beginshortly a!ter surgery, i! presribed. he program onsists o! opening and losing the hand tightly si to eight times per hourand per!orming suh tasks as washing the !ae and ombing the hair. #igns and s"!pto!s o! theophylline toiity inlude vomiting, restlessness, and an apial pulse rate o! more than &++beats/minute. The nurse shouldnt indue vomiting in a person who has ingested poison and is having seiures or is semionsious oromatose. Central venous pressure 'C$P)3 whih is the pressure in the right atrium and the great veins o! the thora, is normally & to* mm g (or 5 to %& m &C). 9#8 is used to assess rightsided ardia !untion. C$P is monitored to assess the need !or !luid replaement in seriously ill patients, to estimate blood volume de!iits, and irulatory pressure in the right atrium. To prevent deep vein thrombosis a!ter surgery, the nurse should administer 5,+++ units o! heparin subutaneously every *to %& hours, as presribed. /ral anticoagulants , suh as war!arin (9oumadin) and diumarol, disrupt natural blood lotting mehanisms, prevent thrombus !ormation, and limit the etension o! a !ormed thrombus. Anticoagulants ant dissolve a !ormed thrombus. Anticoagulant therap" is ontraindiated in a patient who has liver or kidney disease or '" ulers or who isnt likely to return !or !ollowup visits. The nurse an assess a patient !or thrombophlebitis by measuring the a!!eted and una!!eted legs and omparing their sies. he nurse should mark the measurement loations with a pen so that the legs an be measured at the same plae eah day. Drainage o! more than 3,+++ ml o! !luid daily !rom a nasogastri tube may suggest intestinal obstrution. Pellow drainagethat has a !oul odor may indiate smallbowel obstrution. !or sigmoidosopy inludes Preparation administering an enema % hour be!ore the eamination, warming the sope inwarm water or a sterilier (i! using a metal sigmoidosope), and draping the patient to epose the perineum. Treat!ent for a patient with bleeding esophageal varies inludes administering vasopressin (8itressin), giving an ie water lavage, aspirating blood !rom the stomah, using esophageal balloon
tamponade, providing parenteral nutrition, and administering blood trans!usions, as needed. A trau!a vitim shouldnt be moved until a patent airway is established and the ervial spine is immobilied. After a !astecto!" , lymphedema may ause a !eeling o! heaviness in the a!!eted arm. A d"ing patient shouldnt be told eatly how long hes epeted to live, but should be told something more general suh as MAome people live 3 to 2 months, but others live longer.N After e"e surger", a patient should avoid using makeup until otherwise instruted. After a corneal transplant, the patient should wear an eye shield when engaging in ativities suh as playing with hildren or pets. After a orneal transplant, the patient shouldnt lie on the a!!eted site, bend at the waist, or have seual interourse !or %week. he patient must avoid getting soapsuds in the eye. A Mil4aukee ,race is used !or patients who have strutural soliosis. he brae helps to halt the progression o! spinal urvature by providing longitudinal tration and lateral pressure. "t should be worn &3 hours a day. #hort-ter! measures used to treat stomal retration inlude stool so!teners, irrigation, and stomal dilatation. A patient who has a olostomy should be advised to eat a lowresidue diet !or - to 2 weeks and then to add one !ood at a time to evaluate its e!!et. To relieve postoperative hiups, the patient should breathe into a paper bag. If a patient with an ileostomy has a bloked lumen as a result o! undigested high!iber !ood, the patient should be plaed in the kneehest position and the area below the stoma should be massaged. During the initial interview and treatment o! a patient with syphilis, the patients seual ontats should be identi!ied. The nurse shouldnt administer morphine to a patient whose respiratory rate is less than %& breaths/minute. To prevent drying o! the muous membranes, oygen should be administered with hydration. *lavoate ';rispas) is lassi!ied as a urinary trat spasmolyti. H"potension is a sign o! ardiogeni shok in a patient with a myoardial in!artion. The predo!inant signs o! mehanial ileus are ramping pain, vomiting, distention, and inability to pass !ees or !latus. *or a patient with a myoardial in!artion, the nurse should monitor !luid intake and output metiulously. oo little intake auses dehydration, and too muh may ause pulmonary edema. 2itrogl"cerin relaes smooth musle, ausing vasodilation and relieving the hest pain assoiated with myoardialin!artion and angina. The diagnosis o! an aute myoardial in!artion is based on the patients signs and symptoms,
eletroardiogram traings ,and serum enyme studies. Arrh"th!ias are the predominant problem during the !irst -* hours a!ter a myoardial in!artion. Clinical !anifestations o! malabsorption inlude weight loss, musle wasting, bloating, and steatorrhea. Asparaginase3 an enyme that inhibits the synthesis o! deoyribonulei aid and protein, is used to treat aute lymphoyti leukemia. To relieve a patients sore throat thats aused by nasogastri tube irritation, the nurse should provide anestheti loenges, as presribed. *or the first %& to &- hours a!ter gastri surgery, the stomah ontents (obtained by sutioning) are brown. After gastric sutioning is disontinued, a patient who is reovering !rom a subtotal gastretomy should reeive a lear liquid diet. The descending olon is the pre!erred site !or a permanent olostomy. $alvular insufficienc" in the veins ommonly auses variosity. A patient with a olostomy should restrit !at and !ibrous !oods and should avoid !oods that an obstrut the stoma, suh asorn, nuts, and abbage. A patient who is reeiving hemotherapy is plaed in reverse isolation beause the white blood ell ount may be depressed. #"!pto!s o! mitral valve stenosis are aused by improper emptying o! the le!t atrium. Persistent ,leeding a!ter open heart surgery may require the administration o! protamine sul!ate to reverse the e!!ets o! heparin sodium used during surgery. The nurse should teah a patient with heart !ailure to take digoin and other drugs as presribed, to restrit sodium intake, to restrit !luids as presribed, to get adequate rest, to inrease walking and other ativities gradually, to avoid etremes o! temperature, to report signs o! The nurse should hek and maintain the pateny o! all onnetions !or a hest tube. "! an air leak is deteted, the nurse should plae one 1elly lamp near the insertion site. "! the bubbling stops, the leak is in the thorai avity and the physiian should be noti!ied immediately. "! the leak ontinues, the nurse should take a seond lamp, work down the tube until the leak is loated, and stop the leak. In t4o-person ardiopulmonary resusitation, the resuers administer 2+ hest ompressions per minute and % breath !orevery 5 ompressions. Mitral valve stenosis an result !rom rheumati !ever. Atelectasis is inomplete epansion o! lung segments or lobules (lusters o! alveoli). "t may ause the lung or lobe toollapse. The nurse should instrut a patient who has an ileal onduit to empty the olletion devie !requently beause the weight o!the urine may ause the devie to slip !rom the skin.
A patient who is reeiving ardiopulmonary resusitation should be plaed on a solid, !lat sur!ae. Brain da!age ours - to 2 minutes a!ter ardiopulmonary !untion eases. Cli!acteric is the transition period during whih a womans reprodutive !untion diminishes and gradually disappears. After infratentorial surgery, the patient should remain on his side, !lat in bed. In a patient who has an uler, milk is ontraindiated beause its high alium ontent stimulates seretion o! gastri aid. A patient who has a positive test result !or human immunode!iieny virus has been eposed to the virus assoiated with aquired immunode!iieny syndrome (":A), but doesnt neessarily have ":A. A co!!on ompliation a!ter prostatetomy is irulatory !ailure aused by bleeding. In right-sided heart failure, a ma0or !ous o! nursing are is dereasing the workload o! the heart. #igns and s"!pto!s o! digoin toiity inlude nausea, vomiting, on!usion, and arrhythmias. An asth!a attack typially begins with wheeing, oughing, and inreasing respiratory distress. In a patient who is reovering !rom a tonsilletomy, !requent swallowing suggests hemorrhage. Ileosto!ies and Hart!ann%s colosto!ies are permanent stomas. Loop olostomies and double barrel olostomies are temporary ones. A patient who has an ileostomy should eat !oods, suh as spinah and parsley, beause they at as intestinal tratdeodoriers. An adrenalecto!" an derease steroid prodution, whih an ause etensive loss o! sodium and water. Before ad!inistering !orphine (:uramorph) to a patient who is suspeted o! having a myoardial in!artion, the nurse should hek the patients respiratory rate. "! its less than %& breaths/minute, emergeny equipment should be readily available !or intubation i! respiratory depression ours. A patient who is reovering !rom supratentorial surgery is normally allowed out o! bed %- to -* hours a!ter surgery. patient who is reovering !rom in!ratentorial surgery normally remains on bed rest !or 3 to 5 days. After a patient undergoes a !emoralpopliteal bypass gra!t, the nurse must losely monitor the peripheral pulses distal to theoperative site and irulation. After a fe!oral-popliteal bypass gra!t, the patient should initially be maintained in a semi4owler position to avoid !leion o! the gra!t site. $e!ore disharge, the nurse should instrut the patient to avoid positions that put pressure on the gra!t siteuntil the net !ollowup visit. /f the five senses, hearing is the last to be lost in a patient who is entering a oma.
Cholelithiasis auses an enlarged, edematous gallbladder with multiple stones and an elevated bilirubin level. The antiviral agent idovudine (7etrovir) suess!ully slows repliation o! the human immunode!iieny virus, therebyslowing the development o! aquired immunode!iieny syndrome. #evere rheu!atoid arthritis auses marked edema and ongestion, spindleshaped 0oints, and severe !leion de!ormities. A patient with aquired immunode!iieny syndrome should advise his seual partners o! his human immunode!iienyvirus status and observe seual preautions, suh as abstinene or ondom use. If a radioactive implant beomes dislodged, the nurse should retrieve it with tongs, plae it in a leadshielded ontainer, and noti!y the radiology department. A patient who is undergoing radiation therapy should pat his skin dry to avoid abrasions that ould easily beome in!eted. During radiation therap" , a patient should have !requent blood tests, espeially white blood ell and platelet ounts. The nurse should administer an aluminum hydroide antaid at least % hour a!ter an enteri oated drug beause it an ause premature release o! the enterioated drug in the stomah. Acid-,ase ,alance is the bodys hydrogen ion onentration, a measure o! the ratio o! arboni aid to biarbonate ions (%part arboni aid to &+ parts biarbonate is normal). A!"otrophic lateral sclerosis auses progressive atrophy and wasting o! musle groups that eventually a!!ets the respiratory musles. Meta,olic acidosis is aused by abnormal loss o! biarbonate ions or eessive prodution or retention o! aid ions. He!ianopsia is de!etive vision or blindness in onehal! o! the visual !ield o! one or both eyes. #"ste!ic lupus er"the!atosus auses early morning 0oint sti!!ness and !aial erythema in a butter!ly pattern. After total knee replace!ent , the patient should remain in the semi4owler position, with the a!!eted leg elevated. In a patient who is reeiving transpylori !eedings, the nurse should wath !or dumping syndrome and hypovolemi shokbeause the stomah is being bypassed. If a total parenteral nutrition in!usion must be interrupted, the nurse should administer detrose 5B in water at a similarrate. brupt essation an ause hypoglyemia. #tatus epilepticus is treated with ".#. diaepam (#alium) and phenytoin (:ilantin). auses nausea, Dise<uili,riu! s"ndro!e vomiting, restlessness, and twithing in patients who are undergoing dialysis. "tsaused by a rapid !luid shi!t.
An indication that spinal shok is resolving is the return o! re!le ativity in the arms and legs below the level o! in0ury. H"povole!ia is the most ommon and !atal ompliation o! severe aute panreatitis. In a patient with stomatitis, oral are inludes rinsing the mouth with a miture o! equal parts o! hydrogen peroide andw ater three times daily. In otitis !edia , the tympani membrane is bright red and laks its harateristi light re!le (one o! light). In patients who have periardioentesis, !luid is aspirated !rom the periardial sa !or analysis or to relieve ardiatamponade. ;rticaria is an early sign o! hemolyti trans!usion reation. During peritoneal dial"sis3 a return o! brown dialysate suggests bowel per!oration. he physiian should be noti!iedimmediately. An earl" sign o! ketoaidosis is polyuria, whih is aused by osmoti diuresis. Patients 4ho have multiple slerosis should visually inspet their etremities to ensure proper alignment and !reedom !romin0ury. Aspirated red ,one marrow usually appears rust red, with visible !atty material and white bone !ragments. The Dick test detets sarlet !ever antigens and immunity or suseptibility to sarlet !ever. positive result indiates noimmunity6 a negative result indiates immunity. The #chick test detets diphtheria antigens and immunity or suseptibility to diphtheria. positive result indiates no immunity6 a negative result indiates immunity. The reco!!ended adult dosage o! sural!ate (9ara!ate) !or duodenal uler is % g (% tablet) !our times daily % hour be!oremeals and at bedtime. A patient with !aial burns or smoke or heat inhalation should be admitted to the hospital !or &- hour observation !or delayed traheal edema. In addition to patient teahing, preparation !or a olostomy inludes withholding oral intake overnight, per!orming bowel preparation, and administering a leansing enema. The ph"siologic changes aused by burn in0uries an be divided into two stages the hypovolemi stage, during whih intravasular !luid shi!ts into the interstitial spae, and the diureti stage, during whih apillary integrity and intravasularvolume are restored, usually -* to <& hours a!ter the in0ury. The nurse should hange total parenteral nutrition tubing every &- hours and the peripheral ".#. aess site dressing every<& hours. A patient whose arbon monoide level is &+B to 3+B should be treated with %++B humidi!ied oygen. &hen in the roo! o! a patient who is in isolation !or tuberulosis, sta!! and visitors should wear ultra!ilter masks.
&hen providing skin are immediately a!ter pin insertion, the nurses primary onern is prevention o! bone in!etion. After an a!putation, moist skin may indiate venous stasis6 dry skin may indiate arterial obstrution. In a patient who is reeiving dialysis, an internal shunt is working i! the nurse !eels a thrill on palpation or hears a bruit on ausultation. In a patient with viral hepatitis, the parenhymal, or 1up!!ers, ells o! the liver beome severely in!lamed, enlarged, andneroti. .arl" signs o! aquired immunode!iieny syndrome inlude !atigue, night sweats, enlarged lymph nodes, anoreia, weightloss, pallor, and !ever. &hen caring !or a patient who has a radioative implant, health are workers should stay as !ar away !rom the radiation soure as possible. hey should remember the aiom, M"! you double the distane, you quarter the dose.N A patient who has 8arkinsons disease should be instruted to walk with a broadbased gait. The cardinal signs o! 8arkinsons disease are musle rigidity, a tremor that begins in the !ingers, and akinesia. In a patient 4ith Parkinson%s disease , levodopa (:opar) is presribed to ompensate !or the dopamine de!iieny. A patient who has multiple slerosis is at inreased risk !or pressure ulers. Pill-rolling tre!or is a lassi sign o! 8arkinsons disease. *or a patient with 8arkinsons disease, nursing interventions are palliative. *at e!,olis!3 a serious ompliation o! a long bone !rature, auses !ever, tahyardia, tahypnea, and aniety. Metrorrhagia ',leeding ,et4een !enstrual periods) may be the !irst sign o! ervial aner.ϖ Jannitol is a hypertoni solution and an osmoti diureti thats used in the treatment o! inreased intraranial pressure. The classic sign o! an absene seiure is a vaant !aial epression. Migraine headaches ause persistent, severe pain that usually ours in the temporal region. A patient who is in a bladder retraining program should be given an opportunity to void every & hours during the day andtwie at night. In a patient with a head in0ury, a derease in level o! onsiousness is a ardinal sign o! inreased intraranial pressure. .rgota!ine '.rgo!ar) is most e!!etive when taken during the prodromal phase o! a migraine or vasular headahe. Treat!ent of acute pancreatitis inludes nasogastri sutioning to deompress the stomah and meperidine (:emerol) !orpain. #"!pto!s of hiatal hernia inlude a !eeling o! !ullness in the upper abdomen or hest, heartburn, and pain similar to that o!angina petoris.
The incidence o! holelithiasis is higher in women who have had hildren than in any other group.ϖ etaminophen (ylenol) overdose an severely damage the liver. The pro!inent linial signs o! advaned irrhosis are asites and 0aundie. The first s"!pto! o! panreatitis is steady epigastri pain or le!t upper quadrant pain that radiates !rom the umbilial areaor the bak. #o!na!,ulis! is the medial term !or sleepwalking. .pinephrine 'Adrenalin) is a vasoonstritor.ϖ n untreated liver laeration or rupture an progress rapidly to hypovolemi shok. /,stipation is etreme, intratable onstipation aused by an intestinal obstrution. The definitive test !or diagnosing aner is biopsy with ytologi eamination o! the speimen. Arthrograph" requires in0etion o! a ontrast medium and an identi!y 0oint abnormalities. Bro!pton%s cocktail is presribed to help relieve pain in patients who have terminal aner. A sarco!a is a malignant tumor in onnetive tissue. Alu!inu! h"droide 'A!pho=el) neutralies gastri aid. #u,luation is partial disloation or separation, with spontaneous redution o! a 0oint. Bar,iturates an ause on!usion and delirium in an elderly patient who has an organi brain disorder. In a patient with arthritis, physial therapy is indiated to promote optimal !untioning. #o!e patients who have hepatitis may be aniteri (without 0aundie) and lak symptoms, but some have headahes,0aundie, anoreia, !atigue, !ever, and respiratory trat in!etion. Hepatitis A is usually mild and wont advane to a arrier state. In the preicteric phase o! all !orms o! hepatitis, the patient is highly ontagious. .nteric precautions are required !or a patient who has hepatitis . Cholec"stograph" is ine!!etive in a patient who has 0aundie as a result o! gallbladder disease. he liver ells ant transport the ontrast medium to the biliary trat. In a patient who has diabetes insipidus, dehydration is a onern beause diabetes auses polyuria. In a patient who has a reduible hernia, the protruding mass spontaneously retrats into the abdomen. To prevent purple glove syndrome, a nurse shouldnt administer ".#. phenytoin (:ilantin) through a vein in the bak o! the hand, but should use a larger vessel. During stage III o! surgial anesthesia, unonsiousness ours and surgery is permitted. T"pes of regional anesthesia inlude spinal, audal, interostal, epidural, and brahial pleus. The first step in managing drug overdose or drug toiity is to establish and maintain an airway.
Respirator" paral"sis ours in stage "# o! anesthesia (toi stage). In stage I o! anesthesia, the patient is onsious and tranquil. D"spnea and sharp , stabbing pain that inreases with respiration are symptoms o! pleurisy, whih an be a ompliation o!pneumonia or tuberulosis. $ertigo is the ma0or symptom o! inner ear in!etion or disease. oud talking is a sign o! hearing impairment. A patient who has an upper respiratory trat in!etion should blow his nose with both nostrils open. A patient who has had a atarat removed an begin most normal ativities in 3 or - days6 however, the patient shouldnt bend and li!t until a physiian approves these ativities. #"!pto!s of orneal transplant re0etion inlude eye irritation and dereasing visual !ield. 1raves% disease (hyperthyroidism) is mani!ested by weight loss, nervousness, dyspnea, palpitations, heat intolerane,inreased thirst, eophthalmos (bulging eyes), and goiter. The four t"pes o! lipoprotein are hylomirons (the lowestdensity lipoproteins), verylowdensity lipoproteins, lowdensity lipoproteins, and high density lipoproteins. ealth are pro!essionals use holesterol level !rationation to assess apatients risk o! oronary artery disease. If a patient who is taking amphoteriin $ (4ungione) bladder irrigations !or a !ungal in!etion has systemi andidiasis and must reeive ".#. !luonaole (:i!luan), the irrigations an be disontinued beause !luonaole treats the bladderin!etion as well. Patients with adult respiratory distress syndrome an have high peak inspiratory pressures. here!ore, the nurse should monitor these patients losely !or signs o! spontaneous pneumothora, suh as aute deterioration in oygenation, absene o! breath sounds on the a!!eted side, and repitus beg inning on the a!!eted side. Adverse reactions to ylosporine (Aandimmune) inlude renal and hepati toiity, entral nervous system hanges(on!usion and delirium), '" bleeding, and hypertension. /steoporosis is a metaboli bone disorder in whih the rate o! bone resorption eeeds the rate o! bone !ormation. The hall!ark o! ulerative olitis is reurrent bloody diarrhea, whih ommonly ontains pus and muus and alternates with asymptomati remissions. #afer seual praties inlude massaging, hugging, body rubbing, !riendly kissing (dry), masturbating, handtogenital touhing, wearing a ondom, and limiting the number o! seual partners. I!!unosuppressed patients who ontrat ytomegalovirus (9J#) are at risk !or 9J# pneumonia and septiemia, whih an be !atal.
;rinar" tract infections an ause urinary urgeny and !requeny, dysuria, abdominal ramps or bladder spasms, and urethral ithing. Ma!!ograph" is a radiographi tehnique thats used to detet breast ysts or tumors, espeially those that arent palpable on physial eamination. To pro!ote early detetion o! testiular aner, the nurse should palpate the testes during routine physial eaminations and enourage the patient to per!orm monthly sel!eaminations during a warm shower. Patients who have thalassemia minor require no treatment. hose with thalassemia ma0or require !requent trans!usions o! red blood ells. A high level o! hepatitis $ serum marker that persists !or 3 months or more a!ter the onset o! aute hepatitis $ in!etion suggests hroni hepatitis or arrier status. 2eurogenic ,ladder dys!untion is aused by disruption o! nerve transmission to the bladder. "t may be aused by ertain spinal ord in0uries, diabetes, or multiple slerosis. /"gen and car,on dioide move between the lungs and the bloodstream by di!!usion. To grade the severity o! dyspnea, the !ollowing system is used grade %, shortness o! breath on mild eertion, suh aswalking up steps6 grade &, shortness o! breath when walking a short distane at a normal pae on level ground6 grade 3,shortness o! breath with mild daily ativity, suh as shaving6 grade -, shortness o! breath when supine (orthopnea). A patient 4ith Crohn%s disease should onsume a diet low in residue, !iber, and !at, and high in alories, proteins, andarbohydrates. he patient also should take vitamin supplements, espeially vitamin 1. In the three-,ottle urine olletion method, the patient leans the meatus and urinates %+ to %5 ml in the !irst bottle and %5to 3+ ml (midstream) in the seond bottle. hen the physiian per!orms prostati massage, and the patient voids into the third bottle. *indings in the threebottle urine olletion method are interpreted as !ollows pus in the urine (pyuria) in the !irst bottle indiates anterior urethritis6 bateria in the urine in the seond bottle indiate bladder in!etion6 bateria in the third bottle indiate prostatitis. #igns and s"!pto!s o! aorti stenosis inlude a loud, rough systoli murmur over the aorti area6 eertional dyspnea6!atigue6 angina petoris6 arrhythmias6 low blood pressure6 and emboli. .lective surger" is primarily a matter o! hoie. "t isnt essential to the patients survival, but it may improve the patientshealth, om!ort, or sel!esteem. Re<uired surger" is reommended by the physiian. "t may be delayed, but is inevitable. ;rgent surger" must be per!ormed within &- to -* hours. .!ergenc" surger" must be per!ormed immediately.
A,out >?7 o! arterial emboli originate in the heart hambers. Pul!onar" e!,olis! usually results !rom thrombi dislodged !rom the leg veins. The conscious interpretation o! pain ours in the erebral orte. To avoid interfering with new ell growth, the dressing on a donor skin gra!t site shouldnt be disturbed. A se<uela is any abnormal ondition that !ollows and is the result o! a disease, a treatment, or an in0ury. During sickle cell crisis3 patient are inludes bed rest, oygen therapy, analgesis as presribed, ".#. !luid monitoring, and thorough doumentation o! !luid intake and output. A patient who has an ileal onduit should maintain a daily !luid intake o! &,+++ ml. In a closed chest drainage system, ontinuous bubbling in the water seal hamber or bottle indiates a leak. Palpitation is a sensation o! heart pounding or raing assoiated with normal emotional responses and ertain heart disorders. *at e!,olis! is likely to our within the !irst &hours a!ter a longbone !rature. *ootdrop can our in a patient with a pelvi !rature as a result o! peroneal nerve ompression against the head o! the !ibula. To pro!ote venous return a!ter an amputation, the nurse should wrap an elasti bandage around the distal end o! the stump. &ater that aumulates in the tubing o! a ventilator should be removed. The !ost co!!on route !or the administration o! epinephrine to a patient who is having a severe allergi reation is the subutaneous route. The nurse should use 4owlers position !or a patient who has abdominal pain aused by appendiitis. The nurse shouldnt give analgesis to a patient who has abdominal pain aused by appendiitis beause these drugs may mask the pain that aompanies a ruptured appendi. The nurse shouldnt give analgesis to a patient who has abdominal pain aused by appendiitis beause these drugs may mask the pain that aompanies a ruptured appendi. As a last-ditch e!!ort, a barbiturate oma may be indued to reverse unrelenting inreased intraranial pressure ("98),whih is de!ined as aute "98 o! greater than -+ mm g, persistent elevation o! "98 above &+ mm g, or rapidly deteriorating neurologi status. The pri!ar" signs and symptoms o! epiglottiditis are stridor and progressive di!!iulty in swallowing. #alivation is the !irst step in the digestion o! starh. A patient who has a demand paemaker should measure the pulse rate be!ore rising in the morning, noti!y the physiian i! the pulse rate drops b y 5 beats/minute, obtain a medial identi!iation ard
and braelet, and resume normal ativities,inluding seual ativity. Transverse , or loop, olostomy is a temporary proedure thats per!ormed to divert the !eal stream in a patient who has aute intestinal obstrution. 2or!al values !or erythroyte sedimentation rate are + to %+ ells/hour A CK-MB level thats more than 5B o! total 91 or more than %+ ?/L suggests a myoardial in!artion. Propranolol 'Inderal) bloks sympatheti nerve stimuli that inrease ardia work during eerise or stress, whih redues heart rate, blood pressure, and myoardial oygen onsumption. After a !"ocardial infarction , eletroardiogram hanges (Asegment elevation, wave inversion, and Qwave enlargement) usually appear in the !irst &- hours, but may not appear until the 5th or 2th day. Cardiogenic shock is mani!ested by systoli blood pressure o! less than *+ mm g, gray skin, diaphoresis, yanosis, weak pulse rate, tahyardia or bradyardia, and oliguria (less than 3+ ml o! urine per hour). A patient who is reeiving a lowsodium diet shouldnt eat ottage heese, !ish, anned beans, huk steak, hoolate pudding, "talian salad dressing, dill pikles, and bee! broth. High-potassiu! !oods inlude dried prunes, watermelon (%5.3 mEq/ portion), dried lima beans (%-.5 mEq/portion),soybeans, bananas, and oranges. Kuss!aul%s respirations are !aster and deeper than normal respirations and our without pauses, as in diabeti ketoaidosis. Che"ne-#tokes respirations are harateried by alternating periods o! apnea and deep, rapid breathing. hey our inpatients with entral nervous system disorders. H"perventilation an result !rom an inreased !requeny o! breathing, an inreased tidal volume, or both. Apnea is the absene o! spontaneous respirations.ϖ $e!ore a thyroidetomy, a patient may reeive potassium iodide, antithyroid drugs, and propranolol ("nderal) to prevent thyroid storm during surgery. The nor!al life span o! red blood ells (erythroytes) is %%+ to %&+ days. $isual acuit" o! &+/%++ means that the patient sees at &+ (2 m) what a person with normal vision sees at %++ (3+ m). ;rinar" tract infections are more ommon in girls and women than in boys and men beause the shorter urethra in the !emale urinary trat makes the bladder more aessible to bateria, espeially Esherihia oli. Penicillin is administered orally % to & hours be!ore meals or & to 3 hours a!ter meals beause !ood may inter!ere with the drugs absorption. Mild reactions to loal anesthetis may inlude palpitations, tinnitus, vertigo, apprehension, on!usion, and a metalli taste in the mouth
A,out 567 o! ardia output goes to the kidneys. To ensure accurate entral venous pressure readings, the nurse should plae the manometer or transduer level with the phlebostati ais. patient 4ho has lost &,+++ to &,5++ ml o! blood will have a pulse rate o! %-+ beats/minute (or higher), display a systoli blood pressure o! 5+ to 2+ mm g, and appear on!used and lethargi. Arterial ,lood is bright red, !lows rapidly, and (beause its pumped diretly !rom the heart) spurts with eah heartbeat. $enous ,lood is dark red and tends to ooe !rom a wound. /rthostatic ,lood pressure is taken with the patient in the supine, sitting, and standing positions, with % minute between eah reading. %+mm g derease in blood pressure or an inrease in pulse rate o! %+ beats/ minute suggests volume depletion. A pneu!atic antishock garment should be used autiously in pregnant women and patients with head in0uries. After a patient%s irulating volume is restored, the nurse should remove the pneumati antishok garment gradually, starting with the abdominal hamber and !ollowed by eah leg. he garment should be removed under a physiians supervision. Most he!ol"tic trans!usion reations assoiated with mismathing o! $C blood types stem !rom identi!iation number errors. &ar!ing of ,lood to more than %+<; 4 (-%.<; 9) an ause hemolysis. Cardiac output is the amount o! blood e0eted !rom the heart eah minute. "ts epressed in liters per minute. #troke volu!e is the volume o! blood e0eted !rom the heart during systole. Total parenteral nutrition solution ontains detrose, amino aids, and additives, suh as eletrolytes, minerals, and vitamins. The !ost co!!on type o! neurogeni shok is spinal shok. "t usually ours 3+ to 2+ minutes a!ter a spinal ord in0ury. After a spinal cord in=ur" , peristalsis stops within &- hours and usually returns within 3 to - days. Toic shock s"ndro!e is mani!ested by a temperature o! at least %+&; 4 (3*.*; 9), an erythematous rash, and systoli blood pressure o! less than =+ mm g. 4rom % to & weeks a!ter the onset o! these signs, desquamation (espeially on the palms and soles) ours. The signs and s"!pto!s o! anaphylais are ommonly aused by histamine release. The !ost co!!on ause o! septi shok is gram negative bateria, suh as Esherihia oli, 1lebsiella, and 8seudomonas organisms. Bruits are vascular sounds that resemble heart murmurs and result !rom turbulent blood !low through a diseased or partially obstruted artery. ;rine pH is normally -.5 to *.+.ϖ ?rine p o! greater than *.+ an result !rom a urinary trat in!etion, a highalkali diet, or systemi alkalosis.
;rine pH o! less than -.5 may be aused by a high protein diet, !ever, or metaboli aidosis. Before a percutaneous renal biopsy, the patient should be plaed on a !irm sur!ae and positioned on the abdomen. sandbag is plaed under the abdomen to stabilie the kidneys. 2ephrotic s"ndro!e is harateried by marked proteinuria, hypoalbuminemia, mild to severe dependent edema, asites, and weight gain. ;nder4ater eercise is a !orm o! therapy per!ormed in a ubbard tank. Most 4o!en with trihomoniasis have a malodorous, !rothy, greenish gray vaginal disharge. Cther women may have no signs or symptoms. $oiding c"stourethrograph" may be per!ormed to detet bladder and urethral abnormalities. 9ontrast medium is instilled by gentle syringe pressure through a urethral atheter, and overhead Oray !ilms are taken to visualie bladder !illing anderetion. C"stourethrograph" may be per!ormed to identi!y the ause o! urinary trat in!etions, ongenital anomalies, and inontinene. "t also is used to assess !or prostate lobe hypertrophy in men. Herpes si!ple is harateried by reurrent episodes o! blisters on the skin and muous membranes. "t has two variations. "n type %, the blisters appear in the nasolabial region6 in type &, they appear on the genitals, anus, buttoks, and thighs. Most patients with 9hlamydia trahomatis in!etion are asymptomati, but some have an in!lamed urethral meatus,dysuria, and urinary urgeny and !requeny. The h"pothala!us regulates the autonomi nervous system and endorine !untions. A patient whose hest eursion is less than normal (3@ to 2@ K<.5 to %5 m) must use aessory musles to breathe. #igns and s"!pto!s o! toiity !rom thyroid replaement therapy inlude rapid pulse rate, diaphoresis, irritability, weight loss, dysuria, and sleep disturbane. The !ost co!!on allergi reation to peniillin is a rash. An earl" sign o! aspirin toiity is deep, rapid respirations. The !ost serious and irreversible onsequene o! lead poisoning is mental retardation, whih results !rom neurologidamage. To assess deh"dration in the adult, the nurse should hek skin turgor on the sternum. *or a patient with a pepti uler, the type o! diet is less important than inluding !oods in the diet that the patient an tolerate. A patient with a olostomy must establish an irrigation shedule so that regular emptying o! the bowel ours withoutstomal disharge between irrigations.
&hen using rotating tourni<uets , the nurse shouldnt restrit the blood supply to an arm or leg !or more than -5 minutes at a time. A patient with diabetes should eat high!iber !oods beause they blunt the rise in gluose level that normally !ollows a meal. @ugular vein distention ours in patients with heart !ailure beause the le!t ventrile ant empty the heart o! blood as !ast as blood enters !rom the right ventrile, resulting in ongestion in the entire venous system. The leading auses o! blindness in the 8hilippines are diabetes mellitus and glauoma. After a th"roidecto!"3 the patient should remain in the semi4owler position, with his head neither hyperetended nor hyper!leed, to avoid pressure on the suture line. his position an be ahieved with the use o! a ervial pillow. Pre!enstrual s"ndro!e may ause abdominal distention, engorged and pain!ul breasts, bakahe, headahe, nervousness,irritability, restlessness, and tremors. Treat!ent of dehiscence (pathologi opening o! a wound) onsists o! overing the wound with a moist sterile dressing and noti!ying the physiian. &hen a patient has a radial mastetomy, the ovaries also may be removed beause they are a soure o! estrogen, whih stimulates tumor growth. Atropine ,locks the e!!ets o! aetylholine, thereby obstruting its vagal e!!ets on the sinoatrial node and inreasing heartrate. #alic"lates3 partiularly aspirin, are the treatment o! hoie in rheumatoid arthritis beause they derease in!lammation and relieve 0oint pain. Deep3 intense pain that usually worsens at night and is unrelated to movement suggests bone pain. Pain that follo4s prolonged or eessive eerise and subsides with rest suggests musle pain. The !a=or hemodynami hanges assoiated with ardiogeni shok are dereased le!t ventriular !untion and dereasedardia output. Before th"roidecto!" , the patient should be advised that he may eperiene hoarseness or loss o! his voie !or several days a!ter surgery. Accepta,le adverse e!!ets o! longterm steroid use inlude weight gain, ane, headahes, !atigue, and inreased urineretention. ;naccepta,le adverse e!!ets o! longterm steroid use are diiness on rising, nausea, vomiting, thirst, and pain. After a cranioto!" , nursing are inludes maintaining normal intraranial pressure, maintaining erebral per!usion pressure, and preventing in0ury related to erebral and ellular ishemia. *olic acid and vitamin $%& are essential !or nuleoprotein synthesis and red blood ell maturation. I!!ediatel" a!ter intraranial surgery, nursing are inludes not giving the patient anything by mouth until the gag and ough re!lees return, monitoring vital signs and assessing the level o! onsiousness
(LC9) !or signs o! inreasing intraranial pressure, and administering analgesis that dont mask the LC9. Chest ph"siotherap" inludes postural drainage, hest perussion and vibration, and oughing and deepbreathingeerises. Cushing%s s"ndro!e results !rom eessive levels o! adrenoortial hormones and is mani!ested by !at pads on the !ae(moon !ae) and over the upper bak (bu!!alo hump), ane, mood swings, hirsutism, amenorrhea, and dereased libido. To prevent an addisonian risis when disontinuing longterm prednisone (:eltasone) therapy, the nurse should taper thedose slowly to allow !or monitoring o! disease !lareups and !or the return o! hypothalamipituitaryadrenal !untion. Pulsus paradous is a pulse that beomes weak during inspiration and strong during epiration. "t may be a sign o! ardia tamponade. #u,stances that are epelled through portals o! eit inlude saliva, muus, !ees, urine, vomitus, blood, and vaginal andpenile disharges. A !icroorganis! may be transmitted diretly, by ontat with an in!eted body or droplets, or indiretly, by ontat with ontaminated air, soil, water, or !luids. A post!enopausal woman who reeives estrogen therapy is at an inreased risk !or gallbladder disease and breast aner. The approi!ate oygen onentrations delivered by a nasal annula are as !ollows % L F &-B, & L F &*B, 3 L F 3&B, -LF 32B, and 5 L F -+B. Cardinal features o! diabetes insipidus inlude polydipsia (eessive thirst) and polyuria (inreased urination to 5 L/&-hours). A patient 4ith low spei!i gravity (%.++% to %.++5) may have an inreased desire !or old water. Dia,etic co!a an our when the blood gluose level drops below 2+ mg/dl. *or a patient with heart !ailure, the nurse should elevate the head o! the bed *@ to %&@ (&+ to 3+ m), provide a bedside ommode, and administer ardia glyosides and diuretis as presribed. The pri!ar" reason to treat streptooal sore throat with antibiotis is to protet the heart valves and prevent rheumati !ever. A patient with a nasal !rature may lose onsiousness during redution. Hoarseness and change in the voie are ommonly the !irst signs o! laryngeal aner. The lungs3 colon3 and retum are among the most ommon aner sites. The !ost co!!on preoperative problem in elderly patients is lowerthannormal total blood volume. Mannitol '/s!itrol) , an osmoti diureti, is administered to redue intraoular or intraranial pressure. &hen a stroke is suspeted, the nurse should plae the patient on the a!!eted side to promote lung epansion on the una!!eted side. *or a patient who has had hest surgery, the nurse should reommend sitting upright and per!orming
oughing and deepbreathing eerises. hese ations promote epansion o! the lungs, removal o! seretions, and optimal pulmonary!untioning. During ever" sleep yle, the sleeper passes through !our stages o! nonrapideyemovement sleep and one stage o! rapideyemovement sleep. A patient who is taking ali!ediol (9alderol) should avoid onomitant use o! preparations that ontain vitamin :. A patient should begin and end a &-hour urine olletion period with an empty bladder. 4or eample, i! the physiian orders urine to be olleted !rom +*++ hursday to +*++ 4riday, the urine voided at +*++ hursday should be disarded and the urine voided at +*++ 4riday should be retained. In a patient who is reeiving digoin (Lanoin), a low potassium level inreases the risk o! digoin toiity. Blood urea nitrogen values normally range !rom %+ to &+ mg/dl. *lura0epa! 'Dal!ane) toiity is mani!ested by on!usion, halluinations, and ataia. A silent !"ocardial infarction is one that has no symptoms. Adverse reactions to verapamil ("soptin) inlude diiness, headahe, onstipation, hypotension, and atrioventriular ondution disturbanes. he drug also may inrease the serum digoin level. &hen a rectal tu,e is used to relieve !latulene or enhane peristalsis, it should be inserted !or no longer than &+ minutes. ello4ish green disharge on a wound dressing indiates in!etion and should be ultured. #ickle cell crisis an ause severe abdominal, thorai, musular, and bone pain along with pain!ul swelling o! so!t tissuein the hands and !eet. /ral candidiasis 'thrush) is harateried by reamolored or bluish white pathes on the oral muous membrane. Treat!ent for a patient with ysti !ibrosis may inlude drug therapy, eerises to improve breathing and posture, eerises to !ailitate mobiliation o! pulmonary seretions, a highsalt diet, and panreati enyme supplements with snaks and meals. Pancreatic cancer may ause weight loss, 0aundie, and intermittent dulltosevere epigastri pain. Metastasis is the spread o! aner !rom one organ or body part to another through the lymphati system, irulation system, or erebrospinal !luid. The !anage!ent o! pulmonary edema !ouses on opening the airways, supporting ventilation and per!usion, improving ardia !untioning, reduing preload, and reduing patient aniety. *actors that ontribute to the death o! patients with lheimers disease inlude in!etion, malnutrition, and dehydration. Hodgkin%s disease is harateried by painless, progressive enlargement o! ervial lymph nodes and other lymphoid tissueas a result o! proli!eration
o! 7eedAternberg ells, histioytes, and eosinophils. Huntington%s disease 'chorea) is a hereditary disease harateried by degeneration in the erebral orte and basalganglia. A patient with untingtons disease may ehibit suiidal ideation. At discharge3 an amputee should be able to demonstrate proper stump are and per!orm stump toughening eerises. Acute tu,ular nerosis is the most ommon ause o! aute renal !ailure. Co!!on co!plications o! ie water lavage are vomiting and aspiration. *oods high in vita!in D inlude !orti!ied milk, !ish, liver, liver oil, herring, and egg yolk. *or a pelvic eamination, the patient should be in the lithotomy position, with the buttoks etending &R@ (2.- m) past theend o! the eamination table. If a patient ant assume the lithotomy position !or a pelvi eamination, she may lie on her le!t side. A !ale eaminer should have a !emale assistant present during a vaginal eamination !or the patients emotional om!ortand the eaminers legal protetion. Cervical secretions are lear and strethy be!ore ovulation and white and opaque a!ter ovulation. heyre normallyodorless and dont irritate the muosa. A patient with an ileostomy shouldnt eat orn beause it may obstrut the opening o! the pouh. iver d"sfunction a!!ets the metabolism o! ertain drugs. .de!a that aompanies burns and malnutrition is aused by dereased osmoti pressure in the apillaries. H"ponatre!ia is most likely to our as a ompliation o! nasogastri sutioning. In a !an who has omplete spinal ord separation at A-, eretion and e0aulation arent possible. The earl" signs o! pulmonary edema (dyspnea on eertion and oughing) re!let interstitial !luid aumulation and dereased ventilation and alveolar per!usion. Meth"lprednisolone '#olu-Medrol) is a !irstline drug used to ontrol edema a!ter spinal ord trauma. *or the patient who is reovering !rom an intraranial bleed, the nurse should maintain a qu iet, rest!ul environment !or the!irst !ew days. 2euros"philis is assoiated with widespread damage to the entral nervous system, inluding general paresis, personalityhanges, slapping gait, and blindness. A 4o!an who has had a spinal ord in0ury an still beome pregnant. In a patient who has had a stroke, the most serious ompliation is inreasing intraranial pressure. A patient with an intraranial hemorrhage should undergo arteriography to identi!y the site o! the bleeding. *actors that a!!et the ation o! drugs inlude absorption, distribution, metabolism, and eretion.
Before prescri,ing a drug !or a woman o! hildbearing age, the presriber should ask !or the date o! her last menstrual period and ask i! she may be pregnant. Acidosis may ause insulin resistane. A patient with gluose2phosphate dehydrogenase de!iieny may have aute hemolyti anemia when given asul!onamide. The five basi ativities o! the digestive system are ingestion, movement o! !ood, digestion, absorption, and de!eation. #igns and s"!pto!s o! aute panreatitis inlude epigastri pain, vomiting, bluish disoloration o! the le!t !lank ('reyurners sign), bluish disoloration o! the periumbilial area (9ullens sign), lowgrade !ever, tahyardia, and hypotension. A patient 4ith a gastri uler may have gnawing or burning epigastri pain. To test the !irst ranial nerve (ol!atory nerve), the nurse should ask the patient to lose his eyes, olude one nostril, and identi!y a nonirritating substane (suh as peppermint or innamon) by smell. hen the nurse should repeat the test with the patients other nostril oluded. #alk and #a,in introdued the oral polio vaine. A patient 4ith a disease o! the erebellum or posterior olumn has an atai gait thats harateried by staggering and inability to remain steady when standing with the !eet together. "n trauma patients, improved outome is diretly related to early resusitation, aggressive management o! shok, andappropriate de!initive are. To check !or leakage o! erebrospinal !luid, the nurse should inspet the patients nose and ears. "! the patient an sit up,the nurse should observe him !or leakage as the patient leans !orward. ocked-in s"ndro!e is omplete paralysis as a result o! brain stem damage. Cnly the eyes an be moved voluntarily. 2eck dissection , or surgial removal o! the ervial lymph nodes, is per!ormed to prevent the spread o! malignant tumors o! the head and nek. A patient with holeystitis typially has right epigastri pain that may radiate to the right sapula or shoulder6 nausea6 and vomiting, espeially a!ter eating a heavy meal. Atropine is used preoperatively to redue seretions. #eru! calciu! levels are normally -.5 to 5.5 mEq/L. #uppressor T ells regulate overall immune response. #eru! levels o! aspartate aminotrans!erase and alanine aminotrans!erase show whether the liver is adequately detoi!ying drugs. #eru! sodiu! levels are normally %35 to %-5 mEq/L. #eru! potassiu! levels are normally 3.5 to 5.+ mEq/L.
A patient who is taking prednisone (:eltasone) should onsume a saltrestrited diet thats rih in potassium and protein. &hen perfor!ing ontinuous ambulatory peritoneal dialysis, the nurse must use sterile tehnique when handling the atheter, send a peritoneal !luid sample !or ulture and sensitivity testing every &- hours, and report signs o! in!etion and!luid imbalane. &hen 4orking with patients who have aquired immunode!iieny syndrome, the nurse should wear goggles and a mask only i! blood or another body !luid ould splash onto the nurses !ae. Blood spills that are in!eted with human immunode!iieny virus should be leaned up with a %%+ solution o! sodiumhypohlorite 5.&5B (household bleah). Ra"naud%s pheno!enon is intermittent ishemi attaks in the !ingers or toes. "t auses severe pallor and sometimes paresthesia and pain. Intussusception (prolapse o! one bowel segment into the lumen o! another) auses sudden epigastri pain, sausageshapedabdominal swelling, passage o! muus and blood through the retum, shok, and hypotension. Bence @ones protein ours almost elusively in the urine o! patients who have multiple myeloma. 1aucher%s disease is an autosomal disorder thats harateried by abnormal aumulation o! gluoerebrosides (lipidsubstanes that ontain gluose) in monoytes and maroytes. "t has three !orms ype % is the adult !orm, type & is thein!antile !orm, and type 3 is the 0uvenile !orm. A patient with olon obstrution may have lower abdominal pain, onstipation, inreasing distention, and vomiting. Colchicine 'Colsalide) relieves in!lammation and is used to treat gout. #o!e people have gout as a result o! hyperuriemia beause they ant metabolie and erete purines normally. A nor!al sper! ount is &+ to %5+ million/ml. A first-degree ,urn involves the stratum orneum layer o! the epidermis and auses pain and redness. #heehan%s s"ndro!e is hypopituitarism aused by a pituitary in!art a!ter postpartum shok and hemorrhage. &hen caring !or a patient who has had an asthma attak, the nurse should plae the patient in 4owlers or semi4owlersposition. In elderl" patients , the inidene o! nonompliane with presribed drug therapy is high. Jany elderly patients have diminished visual auity, hearing loss, or !orget!ulness, or need to tak e multiple drugs. Tu,erculosis is a reportable ommuniable disease thats aused by in!etion with Jyobaterium tuberulosis (an aid!ast baillus). *or right-sided ardia atheteriation, the physiian passes a multilumen atheter through the superior or in!erior venaava.
After a fracture3 bone healing ours in these stages hematoma !ormation, ellular proli!eration and allus !ormation, andossi!iation and remodeling. A patient who is sheduled !or positron emission tomography should avoid alohol, tobao, and a!!eine !or &- hoursbe!ore the test. In a stroke3 dereased oygen destroys brain ells. A patient with glauoma shouldnt reeive atropine sul!ate beause it inreases intraoular pressure. The nurse should instrut a patient who is hyperventilating to breathe into a paper bag. During inter!ittent positivepressure breathing, the patient should bite down on the mouthpiee, breathe normally, and let the mahine do the work. !ter inspiration, the patient should hold his breath !or 3 or - seonds and ehale ompletely through the mouthpiee. *leion contractures o! the hips may our in a patient who sits in a wheelhair !or a long time. 2"stag!us is rapid horiontal or rotating eye movement. After !"elograph" , the patient should remain reumbent !or &- hours. The treat!ent o! sprains and strains onsists o! applying ie immediately and elevating the arm or leg above heart level. An anticholinesterase agent shouldnt be presribed !or a patient who is taking morphine beause it an potentiate the e!!et o! morphine and ause respiratory depression. M"opia is nearsightedness. H"peropia and pres,"opia are two types o! !arsightedness. The !ost e!!etive ontraeptive method is one that the woman selets !or hersel! and uses onsistently. To perfor! &e,er%s test !or bone ondution, a vibrating tuning !ork is plaed on top o! the patients head at midline. hepatient should pereive the sound equally in both ears. "n a patient who has ondutive hearing loss, the sound is heard in(lateralies to) the ear that has ondutive loss. In the Rinne test , bone ondution is tested by plaing a vibrating tuning !ork on the mastoid proess o! the temporal boneand air ondution is tested by holding the vibrating tuning !ork R@ (%.3 m) !rom the eternal auditory meatus. hese testsare alternated, at di!!erent !requenies, until the tuning !ork is no longer heard at one position. After an a!putation3 the stump may shrink beause o! musle atrophy and dereased subutaneous !at. A patient 4ho has deep vein thrombosis is given heparin !or < to %+ days, !ollowed by %& weeks o! war!arin (9oumadin)therapy. After pneu!onecto!"3 the patient should be positioned on the operative side or on his bak, with his head slightlyelevated. To reduce the possibility o! !ormation o! new emboli or epansion o! eisting emboli, a patient with deep vein thrombosisshould reeive heparin.
Atherosclerosis is the most ommon ause o! oronary artery disease. "t usually involves the aorta and the !emoral,oronary, and erebral arteries. Pul!onar" e!,olis! is a potentially !atal ompliation o! deep vein thrombosis. Chest pain is the most ommon symptom o! pulmonary embolism. The nurse should in!orm a patient who is taking phenaopyridine (8yridium) that this drug olors urine orange or red. Pneu!othora is a serious ompliation o! entral venous line plaement6 its aused by inadvertent lung punture. Pneu!oc"stis carinii pneu!onia isnt onsidered ontagious beause it only a!!ets patients who have a suppressed immune system. To enhance drug absorption, the patient should take regular erythromyin tablets with a !ull glass o! water % hour be!ore or& hours a!ter a meal or should take enterioated tablets with !ood. he patient should avoid taking either type o! tablet with!ruit 0uie. Tris!us3 a sign o! tetanus (lok0aw), auses pain!ul spasms o! the mastiatory musles, di!!iulty opening the mouth, nekrigidity and sti!!ness, and dysphagia. The nurse should plae the patient in an upright position !or thoraentesis. "! this isnt possible, the nurse should positionthe patient on the una!!eted side. If gravit" !low is used, the nurse should hang a blood bag 3 (% m) above the level o! the planned venipunture site. The nurse should plae a patient who has a losed hest drainage system in the semi4owler position. If ,lood isnt trans!used within 3+ minutes, the nurse should return it to the blood bank beause the re!rigeration !ailitieson a nursing unit are inadequate !or storing blood produts. Blood that%s disolored and ontains gas bubbles is ontaminated with bateria and shouldnt be trans!used. 4i!ty perent o! patients who reeive ontaminated blood die. *or !assive3 rapid blood trans!usions and !or ehange trans!usions in neonates, blood should be warmed to =*.<; 4 (3<;9). A chest tu,e permits air and !luid to drain !rom the pleural spae. A handheld resusitation bag is an in!latable devie that an be attahed to a !ae mask or an endotraheal or traheostomytube. "t allows manual delivery o! oygen to the lungs o! a patient who ant breathe independently. Mechanical ventilation arti!iially ontrols or assists respiration. The nurse should enourage a patient who has a losed hest drainage system to ough !requently and breathe deeply to help drain the pleural spae and epand the lungs. Tracheal suction removes seretions !rom the trahea and bronhi with a sution atheter.
During colosto!" irrigation, the irrigation bag should be hung %*@ (-5.< m) above the stoma. The 4ater used !or olostomy irrigation should be %++; to %+5; 4 (3<.*; to -+.2; 9). An arterial embolism may ause pain, loss o! sensory nerves, pallor, oolness, paralysis, pulselessness, or paresthesia in the a!!eted arm or leg. Respirator" alkalosis results !rom onditions that ause hyperventilation and redue the arbon dioide level in the arterialblood. Mineral oil is ontraindiated in a patient with appendiitis, aute surgial abdomen, !eal impation, or intestinalobstrution. &hen using a Ptype administration set to trans!use paked red blood ells (7$9s), the nurse an add normal salinesolution to the bag to dilute the 7$9s and make them less visous. Autotransfusion is olletion, !iltration, and rein!usion o! the patients own blood. Prepared I+$+ solutions !all into three general ategories isotoni, hypotoni, and hypertoni. "sotoni solutions have asolute onentration thats similar to body !luids6 adding them to plasma doesnt hange its osmolarity. ypotoni solutionshave a lower osmoti pressure than body !luids6 adding them to plasma dereases its osmolarity. ypertoni solutions have ahigher osmoti pressure than body !luids6 adding them to plasma inreases its osmolarity. #tress incontinence is involuntary leakage o! urine triggered by a sudden physial strain, suh as a ough, sneee, or quik movement. Decreased renal function makes an elderly patient more suseptible to the development o! renal aluli. The nurse should onsider using shorter needles to in0et drugs in elderly patients beause these patients eperiene subutaneous tissue redistribution and loss in areas, suh as the buttoks and deltoid musles. ;rge incontinence is the inability to suppress a sudden urge to urinate. Total incontinence is ontinuous, unontrollable leakage o! urine as a result o! the bladders inability to retain urine. Protein3 vita!in3 and mineral needs usually remain onstant as a person ages, but alori requirements derease. *our valves keep blood !lowing in one diretion in the heart two atrioventriular valves (triuspid and mitral) and twosemilunar valves (pulmoni and aorti). An elderl" patient%s height may derease beause o! narrowing o! the intervertebral spaes and eaggerated spinalurvature. Constipation most ommonly ours when the urge to de!eate is suppressed and the musles assoiated with bowelmovements remain ontrated. 1out develops in !our stages asymptomati, aute, interritial, and hroni.
Co!!on postoperative ompliations inlude hemorrhage, in!etion, hypovolemia, septiemia, septi shok, ateletasis,pneumonia, thrombophlebitis, and pulmonary embolism. An insulin pu!p delivers a ontinuous in!usion o! insulin into a seleted subutaneous site, ommonly in the abdomen. A co!!on s"!pto! o! saliylate (aspirin) toiity is tinnitus (ringing in the ears). A frost,itten etremity must be thawed rapidly, even i! de!initive treatment must be delayed. A patient with 7aynauds disease shouldnt smoke igarettes or other tobao produts. Ra"naud%s disease is a primary arteriospasti disorder that has no known ause. 7aynauds phenomenon, however, isaused by another disorder suh as sleroderma. To re!ove a foreign body !rom the eye, the nurse should irrigate the eye with sterile normal saline solution. &hen irrigating the eye, the nurse should diret the solution toward the lower on0untival sa. .!ergenc" care !or a orneal in0ury aused by a austi substane is !lushing the eye with opious amounts o! water !or &+to 3+ minutes. De,ride!ent is mehanial, hemial, or surgial removal o! neroti tissue !rom a wound. #evere pain a!ter atarat surgery indiates bleeding in the eye. A ,ivalve cast is ut into anterior and posterior portions to allow skin inspetion. After ear irrigation, the nurse should plae the patient on the a!!eted side to permit gravity to drain !luid that remains in the ear. If a patient with an indwelling atheter has abdominal disom!ort, the nurse should assess !or bladder distention, whih may be aused by atheter blokage. Continuous ,ladder irrigation helps prevent urinary trat obstrution by !lushing out small blood lots that !orm a!ter prostate or bladder surgery. The nurse should remove an indwelling atheter when bladder deompression is no longer needed, when the atheter is obstruted, or when the patient an resume voiding. he longer a atheter remains in plae, the greater the risk o! urinary trat in!etion. In an adult3 the etent o! a burn in0ury is determined by using the 7ule o! Hines the head and nek are ounted as =B6 eah arm, as =B6 eah leg, as %*B6 the bak o! the trunk, as %*B6 the !ront o! the trunk, as %*B6 and the perineum, as %B. A deep partial-thickness burn a!!ets the epidermis and dermis. In a patient who is having an asthma attak, nursing interventions inlude administering oygen and bronhodilators as presribed, plaing the patient in the semi4owler position, enouraging diaphragmati breathing, and helping the patient torela. Prostate cancer is usually !atal i! bone metastasis ours.
A strict vegetarian needs vitamin $%& supplements beause animals and animal produts are the only soure o! this vitamin. Regular insulin is the only type o! insulin that an be mied with other types o! insulin and an be given ".#. If a patient pulls out the outer traheostomy tube, the nurse should hold the traheostomy open with a surgial dilator until the physiian provides appropriate are. The !edulla o,longata is the part o! the brain that ontrols the respiratory enter. *or an unconscious patient , the nurse should per!orm passive rangeo!motion eerises every & to - hours. A ti!ed-release drug isnt reommended !or use in a patient who has an ileostomy beause it releases the drug at di!!erentrates along the '" trat. The nurse isn%t required to wear gloves when applying nitroglyerin paste6however, she should wash her hands a!ter applying this drug. Before ecretor" urography, a patients !luid intake is usually restrited a!ter midnight. A sodiu! pol"st"rene sulfonate 'Ka"ealate) enema, whih ehanges sodium ions !or potassium ions, is used to derease the potassium level in a patient who has hyperkalemia. If the color o! a stoma is muh lighter than when previously assessed, dereased irulation to the stoma should be suspeted. Massage is ontraindiated in a leg with a blood lot beause it may dislodge the lot. The first plae a nurse an detet 0aundie in an adult is in the slera. @aundice is aused by eessive levels o! on0ugated or unon0ugated bilirubin in the blood. M"driatic drugs are used primarily to dilate the pupils !or intraoular eaminations. After e"e surger" , the patient should be plaed on the una!!eted side. &hen assigning tasks to a liensed pratial nurse, the registered nurse should delegate tasks that are onsidered bedside nursing are, suh as taking vital signs, hanging simple dressings, and giving baths. :eep al! pain on dorsi!leion o! the !oot is a positive omans sign, whih suggests venous thrombosis or thrombophlebitis. ;ltra-short-acting ,ar,iturates , suh as thiopental (8entothal), are used as in0etion anesthetis when a short duration o! anesthesia is needed suh as outpatient surgery. Atropine sulfate may be used as a preanestheti drug to redue seretions and minimie vagal re!lees. *or a patient with in!etious mononuleosis, the nursing are plan should emphasie strit bed rest during the aute !ebrile stage to ensure adequate rest. During the aute phase o! in!etious mononuleosis, the patient should urtail ativities to minimie the possibility o! rupturing the enlarged spleen.
Dail" application o! a longating, transdermal nitroglyerin path is a onvenient, e!!etive way to prevent hroni angina. The nurse !ust wear a ap, gloves, a gown, and a mask when providing wound are to a patient with thirddegree burns. The nurse should epet to administer an analgesi be!ore bathing a burn patient. The passage o! blak, tarry !ees (melena) is a ommon sign o! lower '" bleeding, but also may our in patients who haveupper '" bleeding. A patient 4ho has a gastri uler should avoid taking aspirin and aspirinontaining produts beause they an irritate thegastri muosa. &hile ad!inistering hemotherapy agents with an ".#. line, the nurse should disontinue the in!usion at the !irst sign o!etravasation. A lo4-fi,er diet may ontribute to the development o! hemorrhoids. A patient 4ho has abdominal pain shouldnt reeive an analgesi until the ause o! the pain is determined. If surger" requires hair removal, the reommendation o! the 9enters !or :isease 9ontrol and 8revention is that a depilatory be used to avoid skin abrasions and uts. *or nasotracheal sutioning, the nurse should set wall sution at 5+ to =5 mm g !or an in!ant, =5 to %%5 mm g !or a hild, or *+ to %&+ mm g !or an adult. After a !"ocardial infarction , a hange in pulse rate and rhythm may signal the onset o! !atal arrhythmias. Treat!ent of epistais inludes nasal paking, ie paks, autery with silver nitrate, and pressure on the nares. Palliative treat!ent relieves or redues the intensity o! unom!ortable symptoms, but doesnt ure the ausative disorder. Placing a postoperative patient in an upright position too quikly may ause hypotension. $erapa!il 'Calan) and diltiaem (9ardiem) slow the in!low o! alium to the heart, thereby dereasing the risk o! supraventriular tahyardia. After cardiopul!onar" bypass gra!t, the patient will per!orm turning, oughing, deep breathing, and wound splinting, andwill use assistive breathing devies. A patient who is eposed to hepatitis $ should reeive +.+2 ml/kg ".J. o! immune globulin within <& hours a!ter eposure and a repeat dose at &* days a!ter eposure. The nurse should advise a patient who is undergoing radiation therapy not to remove the markings on the skin made by theradiation therapist beause they are landmarks !or treatment. The !ost ommon symptom o! osteoarthritis is 0oint pain thats relieved by rest, espeially i! the pain ours a!ter eeriseor weight bearing. In adults, urine volume normally ranges !rom *++ to &,+++ ml/day and averages between %,&++ and %,5++ ml/day.
Directl" applied moist heat so!tens rusts and eudates, penetrates deeper than dry heat, doesnt dry the skin, and is usuallymore om!ortable !or the patient. Tetrac"clines are seldom onsidered drugs o! hoie !or most ommon baterial in!etions beause their overuse has led to the emergene o! tetraylineresistant bateria. Because light degrades nitroprusside (Hitropress), the drug must be shielded !rom light. 4or eample, an ".#. bag that ontains nitroprusside sodium should be wrapped in !oil. Cephalosporins should be used autiously in patients who are allergi to peniillin. hese patients are more suseptible to hypersensitivity reations. If chlora!phenicol and peniillin must be administered onomitantly, the nurse should give the peniillin % or more hours be!ore the hlorampheniol to avoid a redution in peniillins bateriidal ativity. The er"throc"te sedimentation rate measures the distane and speed at whih erythroytes in whole blood !all in a vertial tube in % hour. he rate at whih they !all to the bottom o! the tube orresponds to the degree o! in!lammation. &hen teaching a patient with myasthenia gravis about pyridostigmine (Jestinon) therapy, the nurse should stress theimportane o! taking the drug eatly as presribed, on time, and in evenly spaed doses to prevent a relapse and maimie the e!!et o! the drug. If an anti,iotic must be administered into a peripheral heparin lok, the nurse should !lush the site with normal saline solution a!ter the in!usion to maintain ".#. pateny. The nurse should instrut a patient with angina to take a nitroglyerin tablet be!ore antiipated stress or eerise or, i! the angina is noturnal, at bedtime. Arterial ,lood gas analysis evaluates gas ehange in the lungs (alveolar ventilation) by measuring the partial pressures o! oygen and arbon dioide and the p o! an arterial sample. The nor!al seru! magnesium level ranges !rom %.5 to &.5 mEq/L. Patient preparation !or a total holesterol test inludes an overnight !ast and abstinene !rom alohol !or &- hours be!ore the test. The fasting plas!a gluose test measures gluose levels a!ter a %& to %-hour !ast. 2or!al ,lood p ranges !rom <.35 to <.-5. blood p higher than <.-5 indiates alkalemia6 one lower than <.35 indiates aidemia. During an acid per!usion test, a small amount o! weak hydrohlori aid solution is in!used with a nasoesophageal tube. positive test result (pain a!ter in!usion) suggests re!lu esophagitis. 2or!all"3 the partial pressure o! arterial arbon dioide (8a9C&) ranges !rom 35 to -5 mm g. 8a9C& greater than -5mm g indiates aidemia as a result o! hypoventilation6 one less than 35 mm g indiates alkalemia as a result o! hyperventilation.
Red cell indies aid in the diagnosis and lassi!iation o! anemia. 2or!all" , the partial pressure o! arterial oygen (8ao &) ranges !rom *+ to %++ mm g. 8ao & o! 5+ to *+ mm gindiates respiratory insu!!iieny. 8ao & o! less than 5+ mm g indiates respiratory !ailure. The 4hite ,lood cell '&BC) di!!erential evaluates >$9 distribution and morphology and provides more spei!iin!ormation about a patients immune system than the >$9 ount. An eercise stress test (treadmill test, eerise eletroardiogram) ontinues until the patient reahes a predetermined targetheart rate or eperienes hest pain, !atigue, or other signs o! eerise intolerane. Altera,le risk !ators !or oronary artery disease inlude igarette smoking, hypertension, high holesterol or triglyeridelevels, and diabetes. The !ediastinu! is the spae between the lungs that ontains the heart, esophagus, trahea, and other strutures. Ma=or co!plications o! aute myoardial in!artion inlude arrhythmias, aute heart !ailure, ardiogeni shok,thromboembolism, and le!t ventriular rupture. The sinoatrial node is a luster o! hundreds o! ells loated in the right atrial wall, near the opening o! the superior venaava. *or one-person ardiopulmonary resusitation, the ratio o! ompressions to ventilations is %5&.4or twoperson ardiopulmonary resusitation, the ratio o! ompressions to ventilations is 5%.
A patient 4ho has pulseless ventriular tahyardia is a andidate !or ardioversion. .chocardiograph" , a noninvasive test that direts ultrahigh!requeny sound waves through the hest wall and into theheart, evaluates ardia struture and !untion and an show valve de!ormities, tumors, septal de!ets, periardial e!!usion,and hypertrophi ardiomyopathy. Ataia is impaired ability to oordinate movements. "ts aused by a erebellar or spinal ord lesion. /n an electrocardiogra! strip, eah small blok on the horiontal ais represents +.+- seond. Eah large blok (omposedo! !ive small bloks) represents +.& seond. #tarling%s la4 states that the !ore o! ontration o! eah heartbeat depends on the length o! the musle !ibers o! the heartwall. The therapeutic blood level !or digoin is +.* to &.+ ng/ml. Pancrelipase 'Pancrease) is used to treat ysti !ibrosis and hroni panreatitis. Treat!ent !or mild to moderate variose veins inludes antiembolism stokings and an eerise program that inludeswalking to minimie venous pooling. An intoicated patient isnt onsidered ompetent to re!use required medial treatment and shouldnt be allowed to hekout o! a hospital against medial advie. The pri!ar" di!!erene between the pain o! angina and that o! a myoardial in!artion is its duration.
vital vital organ organ per!us per!usion ion is seriou seriously sly omprom ompromis ised. ed. idocaine idocaine '("locaine) '("locaine) is the drug o! hoie !or reduing premature ventriular ontrations. A patient is at greatest risk o! dying during the !irst &- to -* hours a!ter a myoardial in!artion. During a myoardial in!artion, the le!t ventrile usually sustains the greatest damage. The pain o! a myoardial in!artion results !rom myoardial ishemia aused by anoia. *or a patient in ardia arrest, the !irst priority is to establish an airway. The universal universal sign sign !or hoking hoking is luthin luthing g the hand to the throat. *or a patient who has heart !ailure or ardiogeni pulmonary edema, nursing interventions !ous on dereasing venous return to the heart and inreasing le!t ventriular output. hese interventions inlude plaing the patient in high 4owlers position and admin adminis iste teri ring ng oygen oygen,, diur diuret eti is, s, and and posi positi tive ve inotropi drugs as presribed. A positive tuberulin skin test is an induration o! %+ mm or greater at the in0etion site. and symp sympto toms ms o! hist histopl oplas asmo mosi sis, s, a Thee signs Th signs and hroni systemi !ungal in!etion, resemble those o! tuberulosis+ vitim ims, s, the the leadi leading ng ause ause o! deat death h is In ,urn vit respiratory ompromise. he seond leading ause is in!etion. !unti tion on o! the the pan panre reas as is the the The eocrin eocrinee !un seretion o! enymes used to digest arbohydrates, !ats, and proteins. A patient who has hepatitis (in!etious hepatitis) should onsume a diet thats moderately high in !at and high in arbohydrate and protein, and should eat the largest meal in the morning. tamponade de should shouldnt nt be .sophag .sophageal eal ,alloon ,alloon tampona in!lated greater than &+ mm g. /verproduction o! prolatin by the pituitary gland an an aus ausee gala galato torr rrhea hea (ee (eess ssiv ivee or abnor abnorma mall latation) and amenorrhea (absene o! menstruation). Inter!ittent claudication (pain during ambulation or other movement thats relieved with rest) is a lassi symptom o! arterial insu!!iieny in the leg. In ,ladder arinoma, the most ommon !inding is gross, painless hematuria. Parenteral ad!inistration o! heparin sodium is ont ontra rain indi diat ated ed in pati patien ents ts with with renal renal or live liver r disease, '" bleeding, or reent surgery or trauma6 in pregnant patients6 and in women older than age 2+. Drugs that potentiate the e!!ets o! antioagulants inlude aspirin, hloral hydrate, gluagon, anaboli steroids, and hlorampheniol. *or a ,urn patient, are priorities inlude maint aintai aini ning ng a pat patent ent air airway way, prev preven entting ing or orr orre eti ting ng !lui !luid d and and ele eletr trol oly yte imba imbala lan nes es,, ontrolling pain, and preventing in!etion. .lastic stockings should be worn on both legs. Active Active i!!uni0 i!!uni0atio ation n is the !ormation o! antibod bodies within hin the body body in response to vaination or eposure to disease.
Passive Passive i!!uni0 i!!uni0atio ation n is admin adminis istr trat atio ion n o! antibodies that were pre!ormed outside the body. A patient who is reeiving digoin (Lanoin) must have his 7 and 8otassium level heked beause o! the inreased risk o! dig digoin in toi oiity. 9onom 9onomita itant nt use may a!!et a!!et ardia ardia ontra ontratil tility ity and lead to arrhythmias. Inter!i Inter!itten ttentt positive positive-- pressure breathing is in!l in!lat atio ion n o! the the lung lung duri during ng insp inspir irat atio ion n with with ompressed air or oygen. he goal o! this in!lation is to keep the lung open. &ristdrop is aused by paralysis o! the etensor musles in the !orearm and hand. *ootdrop results results !rom eessive eessive plantar plantar !leion !leion and is usually a ompliation o! prolonged bed rest. A patient who has gonorrhea may be treated with peniillin and probeneid ($enemid). 8robeneid delays delays the eretion eretion o! peniil peniilli lin n and keeps keeps this this antibioti in the body longer. gluose2 e2ph phosp osphat hatee In pati patien ents ts who have gluos dehydrogenase dehydrogenase ('28:) de!iieny de!iieny,, the red blood ells ant metabolie adequate amounts o! gluose, and hemolysis ours. /n-call mediation is mediation that should be ready !or immediate administration when the all to administer its reeived. If gagging , nausea, or vomiting ours when an airw airway ay is remo remove ved, d, the the nurse nurse shoul should d pla plaee the the patient in a lateral position with the upper arm supported on a pillow. &hen a postoperative patient arrives in the reovery room, the nurse should position the patient on his side or with his head turned to the side and the hin etended. In the immediate postoperative period, the nurse should should report report a respir respirato atory ry rate rate greate greaterr than than 3+, temperature greater than%++; 4 (3<.*; 9) or below =<; =<; 4 (32. (32.%; %; 9), 9), or a sign signi! i!i ian antt drop drop in blood blood pressure or rise in pulse rate !rom the the baseline. Irreversi,le ,rain damage may our i! the entral nervous system is deprived o! oygen !or more than - minutes. !or poly polyy yth them emia ia ver vera inl nludes udes Treat!ent !or admini administe sterin ring g oygen oygen,, radioi radioisot sotope ope therapy therapy,, or hemoth hemothera erapy py agents agents,, suh suh as hloram hlorambui buill and nitrogen mustard, to suppress bone marrow growth. A patient with aute renal !ailure should reeive a highalorie diet thats low in protein as well as potassium and sodium. Addison%s disease is aused by hypo!untion o! the adre adrenal nal glan gland d and and is hara harat ter eri ied ed by !ati !atigue gue,, anemia, weight loss, and brone skin pigmentation. >ithout >ithout ortisol ortisol replaement replaement therapy, therapy, its its usually usually !atal. 1lauc 1lauco!a o!a is managed onservatively with beta adrener adrenergi gi bloker blokerss suh suh as timolol timolol (im (imopt opti) i),, whih derease sympatheti impulses to the eye, and and with with mioti mioti eyedr eyedrops ops suh suh as pilo piloar arpi pine ne ("sopto 9arpine), whih onstrit the pupils. Miotics e!!eti e!!etively vely treat treat glauom glauomaa by redui reduing ng intraoular pressure. hey do this by onstriting the pupil, pupil, ontrating ontrating theiliary theiliary musles, musles, opening opening
the the ante anteri rior or hamb hamber er angl angle, e, and and inr inrea easi sing ng the the out!low o! aqueous humor. patientt is reeiv reeiving ing hepari heparin, n, the nurse nurse &hi &hile le a patien should should monitor monitor the partial partial thromboplas thromboplastin tin time.ϖ ?rinary ?rinary !requeny !requeny,, inontinene, inontinene, or both an our a!te a!terr ath athet eter er remo remova val. l. "no "nont ntin inen ene e may be mani!ested as dribbling. &hen teaching a patient about olostomy are, the nurs nursee shou should ld inst instru rut t the the pati patien entt to hang hang the the irrigation reservoir %*@ to&&@ (-5 to 55 m) above the stoma, insert the atheter &@ to -@ (5 to %+ m) into the stoma, irrigate the stoma with %< to 3o(5+3 to %,++5 ml) o! water at a temperature o! %+5; to %%+; 4 (-+; to -3; 9) one a day, lean the area around the stoma with soap and water be!ore apply applyin ing g a new new bag, bag, and and use use a prot protet etiv ivee skin skin ove overi ring ng,, suh suh as a Atom Atomahe ahesi sive ve wa!e wa!er, r, kara karaya ya paste, or karaya ring, around the stoma. Thee first Th first sign sign o! odgkins disease is painless, super!iial lymphadenopathy, typially !ound under one arm or on one side o! the nek in the ervial hain. To differentiate true yanosis !rom deposition o! ertain pigments, the nurse should press the skin over the disolored area. 9yanoti skin blanhes, but pigmented skin doesnt. A patient who has a gastri uler is most likely to report pain during or shortly a!ter eating. &idening pulse pressure is a sign o! inreasing intr intra ara rani nial al pres pressu sure re.. 4or 4or eamp eample le,, the the blood blood pressure may rise !rom%&+/*+ to %2+/2+ mm g. In a ,urn vitim, a primary goal o! wound are is to prevent ontamination by miroorganisms. To prevent eternal rotation in a patient who has had hip nailin nailing, g, the nurse nurse plaes plaes trohan trohanter ter rolls rolls !rom !rom the the knee knee to the the ankl anklee o! the the a!!e a!!et ted ed leg. leg. #evere hip hip pai pain a!te a!terr the inse inserrtion tion o! a hip hip prosthesis indiates dislodgment. "! this ours, be!ore alling the physiian, the nurse should shou ld assess the the pati patient ent !or !or shor shorte teni ning ng o! the the leg, leg, ete etern rnal al rotation, and absene o! re!lees. As !uch as <5B o! renal !untion is lost be!ore blood urea nitrogen and serum reatinine levels rise above normal. &hen ompensatory e!!orts are present in aid base balane, partial pressure o! arterial arbon dioide (8a9C&) and biarbonate (9C3D) always point in the same diretion p 8a9C& 9C3D F resp respir irat ator ory y aid aidos osis is omp ompen ensa sate ted d p 8a9C 8a9C& & 9C3D 9C3D F respir respirato atory ry alkalo alkalosis sis ompens ompensate ated d p 8a9C& 9C3D F metaboli aidosis ompensated p 8a9C& 9C3D F metaboli alkalosis ompensated. Pol"uria is urine urine outpu outputt o! &,5++ &,5++ ml or more more within &- hours. The presenting sign o! pleuritis is hest pain that is usual usually ly unil unilat ater eral al and rela relate ted d to resp respir irat atory ory movement. If a patient has a gastri drainage tube in plae, the nurs nursee shoul hould d epe epet t the phy physii siian an to orde order r potassium hloride.
An increased pulse rate is one o! the !irst indiations o! respiratory di!!iulty. "t ours beause the heart attempts to ompensate !or a dereased oygen supply to the tissues by pumping more blood. In an adult , a hemoglobin level below %% mg/dl suggests iron de!iieny anemia and the need !or !urther evaluation. The nor!al partial pressure o! oygen in arterial blood is =5 mm g (plus or minus 5 mm g). $ita!in C de!iieny is harateried by brittle bones, pinpoint peripheral hemorrhages, and !riable gums with loosened Clinical !anifestations o! pulmonary embolism are variable, but inreased respiratory rate, tahyardia, and hemoptysisare ommon. 2or!all", intraoular pressure is %& to &+ mm g. "t an be measured with a AhiGt tonometer. In earl" hemorrhagi shok, blood pressure may be normal, but respiratory and pulse rates are rapid. he patient may report thirst and may have lammy skin and piloeretion (goose bumps). Cool3 !oist , pale skin, as ours in shok, results !rom diversion o! blood !rom the skin to the ma0or organs. To assess apillary re!ill, the nurse applies pressure over the nail bed until blanhing ours, quikly releases the pressure, and notes the rate at whih blanhing !ades. 9apillary re!ill indiates per!usion, whih dereases in shok, thereby lengthening re!ill time. Hormal apillary re!ill is less than 3 seonds. .cept !or patients with renal !ailure, urine output o! less than 3+ ml/hour signi!ies dehydration and the potential !or shok. In elderl" patients, the most ommon !rature is hip !rature. Csteoporosis weakens the bones, predisposing these patients to !rature, whih usually results !rom a !all. Before angiograph", the nurse should ask the patient whether hes allergi to the dye, shell!ish, or iodine and advise him to take nothing by mouth !or * hours be!ore the proedure. During myelography, approimately %+ to %5 ml o! erebrospinal !luid is removed !or laboratory studies and an equal amount o! ontrast media is in0eted. After angiography, the punture site is overed with a pressure dressing and the a!!eted part is immobilied !or * hours to derease the risk o! bleeding. If a 4ater-,ased medium was used during myelography, the patient remains on bed rest !or 2 to * hours, with the head o! the bed elevated 3+ to -5 degrees. "! an oilbased medium was used, the patient remains !lat in bed !or 2 to &- hours. The level o! amputation is determined by estimating the maimum viable tissue (tissue with adequate irulation) needed to develop a !untional stump. Heparin sodiu! is inluded in the dialysate used !or renal dialysis. Paro"s!al nocturnal dyspnea may indiate heart !ailure.
A patient who takes a ardia glyoside, suh as digoin, should onsume a diet that inludes high potassium !oods. The nurse should limit traheobronhial sutioning to %+ to %5 seonds and should make only two passes. Before perfor!ing traheobronhial sutioning, the nurse should ventilate and oygenate the patient !ive to si times with a resusitation bag and %++B oygen. his proedure is alled bagging. #igns and s"!pto!s o! pneumothora inlude tahypnea, restlessness, hypotension, and traheal deviation. The cardinal sign o! toi shok syndrome is rapid onset o! a high !ever. A ke" sign o! pepti uler is hematemesis, whih an be bright red or dark red, with the onsisteny o! o!!ee grounds. #igns and s"!pto!s o! a per!orated pepti uler inlude sudden, severe upper abdominal pain6 vomiting6 and an etremelytender, rigid (boardlike) abdomen. Constipation is a ommon adverse reation to aluminum hydroide. *or the !irst &- hours a!ter a myoardial in!artion, the patient should use a bedside ommode and then progress to walking to the toilet, bathing, and tak ing short walks. After a myoardial in!artion, the patient should avoid overeertion and add a new ativity daily, as tolerated without dyspnea. In a patient with a reent myoardial in!artion, !rothy, bloodtinged sputum suggests pulmonary edema. In a patient who has aquired immunode!iieny syndrome, the primary purpose o! drugs is to prevent seondary in!etions. In a patient with aquired immunode!iieny syndrome, suppression o! the immune system inreases the risk o! opportunisti in!etions, suh as ytomegalovirus, 8neumoystis arinii pneumonia, and thrush. A patient with aquired immunode!iieny syndrome may have rapid weight loss, a sign o! wasting syndrome. If the body doesnt use gluose !or energy, it metabolies !at and produes ketones. Approi!atel" 567 o! patients with 'uillain $arrI syndrome have residual de!iits, suh as mild motor weakness or diminished lower etremity re!lees. H"pertension and hypokalemia are the most signi!iant linial mani!estations o! primary hyperaldosteronism. After percutaneous aspiration o! the bladder, the patients !irst void is usually pink6 however, urine with !rank blood should be reported to the physiian. A urine ulture that grows more than %++,+++ olonies o! bateria per milliliter o! urine indiates in!etion.
A patient who is undergoing dialysis should take a vitamin supplement and eat !oods that are high in alories, but low in protein, sodium, and potassium. In a patient who has hroni obstrutive pulmonary disease, the most e!!etive ways to redue thik seretions are to inrease !luid intake to &,5++ ml/day and enourage ambulation. The nurse should teah a patient with emphysema how to per!orm pursedlip breathing beause this slows epiration, prevents alveolar ollapse, and helps to ontrol the respiratory rate. Clu,,ing of the digits and a barrel hest may develop in a patient who has hroni obstrutive pulmonary disease. A stroke '8,rain attack9) disrupts the brains blood supply and may be aused by hypertension. In a patient who is undergoing dialysis, desired outomes are normal weight, normal serum albumin level (3.5 to 5.5 g/dl),and adequate protein intake (%.& to %.5 g/kg o! body weight daily). Inter!ittent peritoneal dialysis involves per!orming three to seven treatments that total -+ hours per week. In a patient with hroni obstrutive pulmonary disease, the best way to administer oygen is by nasal annula. he normal !low rate is & to 3 L/ minute. Isoetharine 'Bronkosol) an be administered with a handheld nebulier or by intermittent positive pressure breathing. Brain death is irreversible essation o! brain !untion. Continuous a!,ulator" peritoneal dialysis requires !our ehanges per day, < days per week, !or a total o! %2* hours per week. The classic adverse reations to antihistamines are dry mouth, drowsiness, and blurred vision. Because of the risk o! paralyti ileus, a patient who has reeived a general anestheti ant take anything by mouth until ative bowel sounds are heard in all abdominal quadrants. The level o! alpha!etoprotein, a tumor marker, is elevated in patients who have testiular germ ell aner. Clinical !anifestations o! orhitis aused by bateria or mumps inlude high temperature, hills, and sudden pain in the involved testis. The level o! prostatespei!i antigen is elevated in patients with benign prostati hyperplasia or prostate aner. The level of prostati aid phosphatase is elevated in patients with advaned stages o! prostate aner. Phen"lephrine '2eo-#"nephrine)3 a mydriati, is instilled in a patients eye to dilate the eye. To pro!ote !luid drainage and relieve edema in a patient with epididymitis, the nurse should elevate the srotum on asrotal bridge. *luorescein staining is ommonly used to assess orneal abrasions beause it outlines super!iial epithelial de!ets. Pres,"opia is loss o! near vision as a result o! the loss o! elastiity o! the rystalline lens.
Transient ische!ic attacks are onsidered preursors to strokes. sign of acute appendiitis, J$urneys sign is tenderness at J$urneys point (about &@ K5 m !rom the right anterior superior ilia spine on a line between the spine and the umbilius). &hen caring !or a patient with 'uillain$arrI syndrome, the nurse should !ous on respiratory interventions as the disease proess advanes. #igns and s"!pto!s o! olon aner inlude retal bleeding, hange in bowel habits, intestinal obstrution, abdominalpain, weight loss, anoreia, nausea, and vomiting. #"!pto!s of prostatitis inlude !requent urination and dysuria. A chancre is a painless, ulerative lesion that develops during the primary stage o! syphilis. During the tertiar" stage o! syphilis, spirohetes invade the internal organs and ause permanent damage. In total parenteral nutrition, weight gain is the most reliable indiator o! a positive response to therapy. The nurse may administer an ".#. !at emulsion through a entral or peripheral atheter, but shouldnt use an inline !ilter beause the !at partiles are too large to pass through the pores. If a patient who has a prostatetomy is using a 9unningham lamp, instrut him to wash and dry his penis be!ore applying the lamp. e should apply the lamp horiontally and remove it at least every - hours to empty his bladder to prevent in!etion. If a woman has signs o! urinary trat in!etion during menopause, she should be instruted to drink si to eight glasses o! water per day, urinate be!ore and a!ter interourse, and per!orm 1egel eerises. If a !enopausal patient eperienes a Mhot !lash,N she should be instruted to seek a ool, breey loation and sip a ool drink. Cheilosis auses !issures at the angles o! the mouth and indiates a vitamin $&, ribo!lavin, or iron de!iieny. Tetan" may result !rom hypoalemia aused by hypoparathyroidism. A patient who has ervial aner may eperiene vaginal bleeding !or % to 3 months a!ter intraavitary radiation. Ascites is the aumulation o! !luid, ontaining large amounts o! protein and eletrolytes, in the abdominal avity. "ts ommonly aused by irrhosis. 2or!al pul!onar" artery pressure is %+ to &5 mm g. Hormal pulmonary artery wedge pressure is 5 to %& mm g. After cardiac atheteriation, the site is monitored !or bleeding and hematoma !ormation, pulses distal to the site are palpated every %5 minutes !or % hour, and the patient is maintained on bed rest with the etremity etended !or * hours. He!ophilia is a bleeding disorder thats transmitted genetially in a selinked (O hromosome) reessive pattern. lthough girls and women may
arry the de!etive gene, hemophilia usually ours only in boys and men. $on &ille,rand%s disease is an autosomal dominant bleeding disorder thats aused by platelet dys!untion and !ator #"""de!iieny. #ickle cell anemia is a ongenital hemolyti anemia thats aused by de!etive hemoglobin A moleules. "t primarily a!!ets blaks. #ickle cell anemia has a homoygous inheritane pattern. Aikle ell trait has a heteroygous inheritane pattern. Pel-.,stein !ever is a harateristi sign o! odgkins disease. 4ever reurs every !ew days or weeks and alternates witha!ebrile periods. 1lucose-:-phosphate dehydrogenase ('28:) de!iieny is an inherited metaboli disorder thats harateried by red blood ells that are de!iient in '28:, a ritial enyme in aerobi glyolysis. Preferred sites !or bone marrow aspiration are the posterior superior ilia rest, anterior ilia rest, and sternum. During ,one marrow harvesting, the donor reeives general anesthesia and -++ to *++ ml o! marrow is aspirated. A ,utterfl" rash aross the bridge o! the nose is a harateristi sign o! systemi lupus erythematosus. Rheu!atoid arthritis is a hroni, destrutive ollagen disease harateried by symmetri in!lammation o! the synoviumthat leads to 0oint swelling. #creening for human immunode!iieny virus antibodies begins with the enymelinked immunosorbent assay. 7esults areon!irmed by the >estern blot test. The CK-MB isoenyme level inreases - to * hours a!ter a myoardial in!artion, peaks at %& to &hours, and returns tonormal in 3 days. .cessive intake o! vitamin 1 may signi!iantly antagonie the antioagulant e!!ets o! war!arin (9oumadin). he patientshould be autioned to avoid eating an eessive amount o! lea!y green vegetables. A l"!ph node biopsy that shows 7eedAternberg ells provides a de!initive diagnosis o! odgkins disease. Bell%s pals" is unilateral !aial weakness or paralysis aused by a disturbane o! the seventh ranial (!aial) nerve. During an initial tuberulin skin test, lak o! a wheal a!ter in0etion o! tuberulin puri!ied protein derivative indiates thatthe test dose was in0eted too deeply. he nurse should in0et another dose at least &@ (5 m) !rom the initial site. A tu,erculin skin test should be read -* to <& hours a!ter administration. In reading a tu,erculin skin test, erythema without induration is usually not signi!iant. Death caused by botulism usually results !rom delayed diagnosis and respiratory ompliations. In a patient who has rabies, saliva ontains the virus and is a haard !or nurses who provide are.
A fe,rile nonhemolyti reation is the most ommon trans!usion reation. H"pokale!ia (abnormally low onentration o! potassium in the blood) may ause musle weakness or paralysis,eletroardiographi abnormalities, and '" disturbanes. Beri,eri , a serious vitamin $% (thiamine) de!iieny, a!!ets aloholis who have poor dietary habits. "ts epidemi insian ountries where people subsist on unenrihed rie. "ts harateried by the phrase M" ant,N indiating that the patientis too ill to do anything. .cessive sedation may ause respiratory depression. The pri!ar" postoperative onern is maintenane o! a patent airway. If c"anosis ours irumorally, sublingually, or in the nail bed, the oygen saturation level (Aao &) is less than *+B. A rapid pulse rate in a postoperative patient may indiate pain, bleeding, dehydration, or shok. Increased pulse rate and blood pressure may indiate that a patient is eperiening Msilent painN (pain that ant beepressed verbally, suh as when a patient is reovering !rom anesthesia). idocaine '("locaine) eerts antiarrhythmi ation by suppressing automatiity in the 8urkin0e !ibers and elevating theeletrial stimulation threshold in the ventriles. Cullen%s sign (a bluish disoloration around the umbilius) is seen in patients who have a per!orated panreas. During the postoperative period, the patient should ough and breathe deeply every & hours unless otherwiseontraindiated (!or eample, a!ter raniotomy, atarat surgery, or throat surgery). Before surger"3 a patients respiratory volume may be measured by inentive spirometry. his measurement beomes thepatients postoperative goal !or respiratory volume. The postoperative patient should use inentive spirometry %+ to %& times per hour and breathe deeply. Before a!,ulating , a postoperative patient should dangle his legs over the side o! the bed and per!orm deepbreathingeerises. During the patients !irst postoperative ambulation, the nurse should monitor the patient losely and assist him as neededwhile he walks a !ew !eet !rom the bed to a steady hair. H"povole!ia ours when %5B to &5B o! the bodys total blood volume is lost. #igns and s"!pto!s o! hypovolemia inlude rapid, weak pulse6 low blood pressure6 ool, lammy skin6 shallowrespirations6 oliguria or anuria6 and lethargy. Acute pericarditis auses sudden severe, onstant pain over the anterior hest. he pain is aggravated by inspiration. #igns and s"!pto!s o! septiemia inlude !ever, hills, rash, abdominal distention, prostration, pain, headahe, nausea,and diarrhea.
Rock" Mountain spotted !ever auses a persistent high !ever, nonpitting edema, and rash. Patients 4ho have undergone oronary artery bypass gra!t should sleep 2 to %+ hours per day, take their temperature twiedaily, and avoid li!ting more than %+ lb (-.5 kg) !or at least 2 weeks. Claudication pain (pain on ambulation) is aused by arterial insu!!iieny as a result o! atheromatous plaque that obstrutsarterial blood !low to the etremities. Pace!akers can be powered by lithium batteries !or up to %+ years. The patient shouldnt void !or % hour be!ore perutaneous suprapubi bladder aspiration to ensure that su!!iient urine remains in the bladder to make the proedure suess!ul. eft-sided heart failure auses pulmonary ongestion, pinktinged sputum, and dyspnea. (7emember L !or le!t and lung.) The current reommended blood holesterol level is less than &++ mg/dl. &hen caring !or a patient who is having a seiure, the nurse should !ollow these guidelines (%) void restraining thepatient, but help a standing patient to a lying position. (&) Loosen restritive lothing. (3) 8lae a pillow or another so!t ob0etunder the patients head. (-) 9lear the area o! hard ob0ets. (5) :ont !ore anything into the patients mouth, but maintain apatent airway. (2) 7eassure and reorient the patient a!ter the seiure subsides. 1ingival h"perplasia , or overgrowth o! gum tissue, is an adverse reation to phenytoin (:ilantin). &ith aging3 most marrow in long bones beomes yellow, but it retains the apaity to onvert bak to red. Clinical !anifestations o! lymphedema inlude aumulation o! !luid in the legs. Afterload is ventriular wall tension during systoli e0etion. "ts inreased in patients who have septal hypertrophy,inreased blood visosity, and onditions that ause blokage o! aorti or pulmonary out!low. Red ,lood cells an be stored !roen !or up to & years6 however, they must be used within &- hours o! thawing. *or the !irst &- hours a!ter amputation, the nurse should elevate the stump to prevent edema. After h"sterecto!" , a woman should avoid seual interourse !or 3 weeks i! a vaginal approah was used and 2 weeks i! the abdominal approah was used. Parkinson%s disease harateristially auses progressive musle rigidity, akinesia, and involuntary tremor. Tonic-clonic seiures are harateried by a loss o! onsiousness and alternating periods o! musle ontration andrelaation. #tatus epilepticus3 a li!ethreatening emergeny, is a series o! rapidly repeating seiures that our without intervening periods o! onsiousness.
The ideal donor !or kidney transplantation is an idential twin. "! an idential twin isnt available, a biologial sibling is thenet best hoie. Breast cancer is the leading aner among women6 however, lung aner aounts !or more deaths. The stages of cervical aner are as !ollows stage +, arinoma in situ6 stage ", aner on!ined to the ervi6 stage "",aner etending beyond the ervi, but not to the pelvi wall6 stage """, aner etending to the pelvi wall6 and stage "#,aner etending beyond the pelvis or within the bladder or retum. /ne !ethod used to estimate blood loss a!ter a hysteretomy is ounting perineal pads. Aaturating more than one pad in %hour or eight pads in &hours is onsidered hemorrhaging. Transurethral resetion o! the prostate is the most ommon proedure !or treating benign prostati hyperplasia. In a chest drainage system, the water in the water seal hamber normally rises when a patient breathes in and !alls when hebreathes out. #pinal fusion provides spinal stability through a bone gra!t, usually !rom the ilia rest, that !uses two or more vertebrae. A patient who reeives any type o! transplant must take an immunosuppressant drug !or the rest o! his li!e. Incentive spiro!etr" should be used 5 to %+ times an hour while the patient is awake. In 4o!en3 pelvi in!lammatory disease is a ommon ompliation o! gonorrhea. #coliosis is lateral Ashaped urvature o! the spine. #igns and s"!pto!s o! the seondary stage o! syphilis inlude a rash on the palms and soles, erosion o! the oral muosa,alopeia, and enlarged lymph nodes. In a patient who is reeiving total parenteral nutrition, the nurse should monitor gluose and eletrolyte levels. ;nless contraindicated3 on admission to the postanesthesia are unit, a patient should be turned on his side and his vitalsigns should be taken. .de!a is treated by limiting !luid intake and eliminating eess !luid. A patient who has had spinal anesthesia should remain !lat !or %& to &- hours. #ital signs and neuromusular !untionshould be monitored. A patient who has maple syrup urine disease should avoid !ood ontaining the amino aids leuine, isoleuine, and lysine. A severe ompliation o! a !emur !rature is eessive blood loss that results in shok. To prepare a patient !or peritoneal dialysis, the nurse should ask the patient to void, measure his vital signs, plae him in asupine position, and using asepti tehnique, insert a atheter through the abdominal wall and into the peritoneal spae. If !ore than 3 L o! dialysate solution return during peritoneal dialysis, the nurse should noti!y the physiian.
He!odial"sis is the removal o! ertain elements !rom the blood by passing heparinied blood through a semipermeablemembrane to the dialysate bath, whih ontains all o! the important eletrolytes in their ideal onentrations. 1angrene usuall" a!!ets the digits !irst, and begins with skin olor hanges that progress !rom grayblue to dark brown orblak. Kidne" function is assessed by evaluating blood urea nitrogen (normal range is * to &+ mg/dl) and serum reatinine(normal range is +.2 to %.3 mg/dl) levels A 4eight-,earing trans!er is appropriate only !or a patient who has at least one leg thats strong enough to bear weight,suh as a patient with hemiplegia or a singleleg amputation. /verflo4 incontinence (voiding o! 3+ to 2+ ml o! urine every %5 to 3+ minutes) is a sign o! bladder distention. The first sign o! a pressure uler is reddened skin that blanhes when pressure is applied. ate signs and s"!pto!s o! sikle ell anemia inlude tahyardia, ardiomegaly, systoli and diastoli murmurs, hroni!atigue, hepatomegaly, and splenomegaly. A !echanical ventilator, whih an maintain ventilation automatially !or an etended period, is indiated when a patientant maintain a sa!e 8aC& or 8a9C& level. T4o t"pes o! mehanial ventilators eist negativepressure ventilators, whih apply negative pressure around the hestwall, and positivepressure ventilators, whih deliver air under pressure to the patient. Angina pectoris is harateried by substernal pain that lasts !or & to 3 minutes. he pain, whih is aused by myoardial ishemia, may radiate to the nek, shoulders, or 0aw6 is desribed as viselike, or onstriting6 and may be aompanied bysevere apprehension or a !eeling o! impending doom. he diagnosis o! an aute myoardial in!artion is based on the patients signs and symptoms, eletroardiogram traings,troponin level, and ardia enyme studies. The goal o! treatment !or a patient with angina petoris is to redue the hearts workload, thereby reduing the myoardialdemand !or oygen and preventing myoardial in!artion. 2itrogl"cerin dereases the amount o! blood that returns to the heart by inreasing the apaity o! the venous bed. The patient should take no more than three nitroglyerin tablets in a %5minute period. He!odial"sis is usually per!ormed &- hours be!ore kidney transplantation. #igns and s"!pto!s o! aute kidney transplant re0etion are progressive enlargement and tenderness at the transplant site,inreased blood pressure, dereased urine output, elevated serum reatinine level, and !ever. After a radical mastetomy, the patients arm should be elevated (with the hand above the elbow)
on a pillow to enhane irulation and prevent edema. Postoperative !astecto!" are inludes teahing the patient arm eerises to !ailitate lymph drainage and preventshortening o! the musle and ontrature o! the shoulder 0oint (!roen shoulder). After radical mastetomy, the patient should help prevent in!etion by making sure that no blood pressure readings,in0etions, or venipuntures are per!ormed on the a!!eted arm. *or a patient who has undergone mastetomy and is suseptible to lymphedema, a program o! hand eerises an beginshortly a!ter surgery, i! presribed. he program onsists o! opening and losing the hand tightly si to eight times per hourand per!orming suh tasks as washing the !ae and ombing the hair. #igns and s"!pto!s o! theophylline toiity inlude vomiting, restlessness, and an apial pulse rate o! more than &++beats/minute. The nurse shouldnt indue vomiting in a person who has ingested poison and is having seiures or is semionsious oromatose. Central venous pressure 'C$P)3 whih is the pressure in the right atrium and the great veins o! the thora, is normally & to* mm g (or 5 to %& m &C). 9#8 is used to assess rightsided ardia !untion. C$P is monitored to assess the need !or !luid replaement in seriously ill patients, to estimate blood volume de!iits, and irulatory pressure in the right atrium. To prevent deep vein thrombosis a!ter surgery, the nurse should administer 5,+++ units o! heparin subutaneously every *to %& hours, as presribed. /ral anticoagulants , suh as war!arin (9oumadin) and diumarol, disrupt natural blood lotting mehanisms, prevent thrombus !ormation, and limit the etension o! a !ormed thrombus. Anticoagulants ant dissolve a !ormed thrombus. Anticoagulant therap" is ontraindiated in a patient who has liver or kidney disease or '" ulers or who isnt likely to return !or !ollowup visits. The nurse an assess a patient !or thrombophlebitis by measuring the a!!eted and una!!eted legs and omparing their sies. he nurse should mark the measurement loations with a pen so that the legs an be measured at the same plae eah day. Drainage o! more than 3,+++ ml o! !luid daily !rom a nasogastri tube may suggest intestinal obstrution. Pellow drainagethat has a !oul odor may indiate smallbowel obstrution. !or sigmoidosopy inludes Preparation administering an enema % hour be!ore the eamination, warming the sope inwarm water or a sterilier (i! using a metal sigmoidosope), and draping the patient to epose the perineum. Treat!ent for a patient with bleeding esophageal varies inludes administering vasopressin (8itressin), giving an ie water lavage, aspirating blood !rom the stomah, using esophageal balloon
tamponade, providing parenteral nutrition, and administering blood trans!usions, as needed. A trau!a vitim shouldnt be moved until a patent airway is established and the ervial spine is immobilied. After a !astecto!" , lymphedema may ause a !eeling o! heaviness in the a!!eted arm. A d"ing patient shouldnt be told eatly how long hes epeted to live, but should be told something more general suh as MAome people live 3 to 2 months, but others live longer.N After e"e surger", a patient should avoid using makeup until otherwise instruted. After a corneal transplant, the patient should wear an eye shield when engaging in ativities suh as playing with hildren or pets. After a orneal transplant, the patient shouldnt lie on the a!!eted site, bend at the waist, or have seual interourse !or %week. he patient must avoid getting soapsuds in the eye. A Mil4aukee ,race is used !or patients who have strutural soliosis. he brae helps to halt the progression o! spinal urvature by providing longitudinal tration and lateral pressure. "t should be worn &3 hours a day. #hort-ter! measures used to treat stomal retration inlude stool so!teners, irrigation, and stomal dilatation. A patient who has a olostomy should be advised to eat a lowresidue diet !or - to 2 weeks and then to add one !ood at a time to evaluate its e!!et. To relieve postoperative hiups, the patient should breathe into a paper bag. If a patient with an ileostomy has a bloked lumen as a result o! undigested high!iber !ood, the patient should be plaed in the kneehest position and the area below the stoma should be massaged. During the initial interview and treatment o! a patient with syphilis, the patients seual ontats should be identi!ied. The nurse shouldnt administer morphine to a patient whose respiratory rate is less than %& breaths/minute. To prevent drying o! the muous membranes, oygen should be administered with hydration. *lavoate ';rispas) is lassi!ied as a urinary trat spasmolyti. H"potension is a sign o! ardiogeni shok in a patient with a myoardial in!artion. The predo!inant signs o! mehanial ileus are ramping pain, vomiting, distention, and inability to pass !ees or !latus. *or a patient with a myoardial in!artion, the nurse should monitor !luid intake and output metiulously. oo little intake auses dehydration, and too muh may ause pulmonary edema. 2itrogl"cerin relaes smooth musle, ausing vasodilation and relieving the hest pain assoiated with myoardialin!artion and angina. The diagnosis o! an aute myoardial in!artion is based on the patients signs and symptoms,
eletroardiogram traings ,and serum enyme studies. Arrh"th!ias are the predominant problem during the !irst -* hours a!ter a myoardial in!artion. Clinical !anifestations o! malabsorption inlude weight loss, musle wasting, bloating, and steatorrhea. Asparaginase3 an enyme that inhibits the synthesis o! deoyribonulei aid and protein, is used to treat aute lymphoyti leukemia. To relieve a patients sore throat thats aused by nasogastri tube irritation, the nurse should provide anestheti loenges, as presribed. *or the first %& to &- hours a!ter gastri surgery, the stomah ontents (obtained by sutioning) are brown. After gastric sutioning is disontinued, a patient who is reovering !rom a subtotal gastretomy should reeive a lear liquid diet. The descending olon is the pre!erred site !or a permanent olostomy. $alvular insufficienc" in the veins ommonly auses variosity. A patient with a olostomy should restrit !at and !ibrous !oods and should avoid !oods that an obstrut the stoma, suh asorn, nuts, and abbage. A patient who is reeiving hemotherapy is plaed in reverse isolation beause the white blood ell ount may be depressed. #"!pto!s o! mitral valve stenosis are aused by improper emptying o! the le!t atrium. Persistent ,leeding a!ter open heart surgery may require the administration o! protamine sul!ate to reverse the e!!ets o! heparin sodium used during surgery. The nurse should teah a patient with heart !ailure to take digoin and other drugs as presribed, to restrit sodium intake, to restrit !luids as presribed, to get adequate rest, to inrease walking and other ativities gradually, to avoid etremes o! temperature, to report signs o! The nurse should hek and maintain the pateny o! all onnetions !or a hest tube. "! an air leak is deteted, the nurse should plae one 1elly lamp near the insertion site. "! the bubbling stops, the leak is in the thorai avity and the physiian should be noti!ied immediately. "! the leak ontinues, the nurse should take a seond lamp, work down the tube until the leak is loated, and stop the leak. In t4o-person ardiopulmonary resusitation, the resuers administer 2+ hest ompressions per minute and % breath !orevery 5 ompressions. Mitral valve stenosis an result !rom rheumati !ever. Atelectasis is inomplete epansion o! lung segments or lobules (lusters o! alveoli). "t may ause the lung or lobe toollapse. The nurse should instrut a patient who has an ileal onduit to empty the olletion devie !requently beause the weight o!the urine may ause the devie to slip !rom the skin.
A patient who is reeiving ardiopulmonary resusitation should be plaed on a solid, !lat sur!ae. Brain da!age ours - to 2 minutes a!ter ardiopulmonary !untion eases. Cli!acteric is the transition period during whih a womans reprodutive !untion diminishes and gradually disappears. After infratentorial surgery, the patient should remain on his side, !lat in bed. In a patient who has an uler, milk is ontraindiated beause its high alium ontent stimulates seretion o! gastri aid. A patient who has a positive test result !or human immunode!iieny virus has been eposed to the virus assoiated with aquired immunode!iieny syndrome (":A), but doesnt neessarily have ":A. A co!!on ompliation a!ter prostatetomy is irulatory !ailure aused by bleeding. In right-sided heart failure, a ma0or !ous o! nursing are is dereasing the workload o! the heart. #igns and s"!pto!s o! digoin toiity inlude nausea, vomiting, on!usion, and arrhythmias. An asth!a attack typially begins with wheeing, oughing, and inreasing respiratory distress. In a patient who is reovering !rom a tonsilletomy, !requent swallowing suggests hemorrhage. Ileosto!ies and Hart!ann%s colosto!ies are permanent stomas. Loop olostomies and double barrel olostomies are temporary ones. A patient who has an ileostomy should eat !oods, suh as spinah and parsley, beause they at as intestinal tratdeodoriers. An adrenalecto!" an derease steroid prodution, whih an ause etensive loss o! sodium and water. Before ad!inistering !orphine (:uramorph) to a patient who is suspeted o! having a myoardial in!artion, the nurse should hek the patients respiratory rate. "! its less than %& breaths/minute, emergeny equipment should be readily available !or intubation i! respiratory depression ours. A patient who is reovering !rom supratentorial surgery is normally allowed out o! bed %- to -* hours a!ter surgery. patient who is reovering !rom in!ratentorial surgery normally remains on bed rest !or 3 to 5 days. After a patient undergoes a !emoralpopliteal bypass gra!t, the nurse must losely monitor the peripheral pulses distal to theoperative site and irulation. After a fe!oral-popliteal bypass gra!t, the patient should initially be maintained in a semi4owler position to avoid !leion o! the gra!t site. $e!ore disharge, the nurse should instrut the patient to avoid positions that put pressure on the gra!t siteuntil the net !ollowup visit. /f the five senses, hearing is the last to be lost in a patient who is entering a oma.
Cholelithiasis auses an enlarged, edematous gallbladder with multiple stones and an elevated bilirubin level. The antiviral agent idovudine (7etrovir) suess!ully slows repliation o! the human immunode!iieny virus, therebyslowing the development o! aquired immunode!iieny syndrome. #evere rheu!atoid arthritis auses marked edema and ongestion, spindleshaped 0oints, and severe !leion de!ormities. A patient with aquired immunode!iieny syndrome should advise his seual partners o! his human immunode!iienyvirus status and observe seual preautions, suh as abstinene or ondom use. If a radioactive implant beomes dislodged, the nurse should retrieve it with tongs, plae it in a leadshielded ontainer, and noti!y the radiology department. A patient who is undergoing radiation therapy should pat his skin dry to avoid abrasions that ould easily beome in!eted. During radiation therap" , a patient should have !requent blood tests, espeially white blood ell and platelet ounts. The nurse should administer an aluminum hydroide antaid at least % hour a!ter an enteri oated drug beause it an ause premature release o! the enterioated drug in the stomah. Acid-,ase ,alance is the bodys hydrogen ion onentration, a measure o! the ratio o! arboni aid to biarbonate ions (%part arboni aid to &+ parts biarbonate is normal). A!"otrophic lateral sclerosis auses progressive atrophy and wasting o! musle groups that eventually a!!ets the respiratory musles. Meta,olic acidosis is aused by abnormal loss o! biarbonate ions or eessive prodution or retention o! aid ions. He!ianopsia is de!etive vision or blindness in onehal! o! the visual !ield o! one or both eyes. #"ste!ic lupus er"the!atosus auses early morning 0oint sti!!ness and !aial erythema in a butter!ly pattern. After total knee replace!ent , the patient should remain in the semi4owler position, with the a!!eted leg elevated. In a patient who is reeiving transpylori !eedings, the nurse should wath !or dumping syndrome and hypovolemi shokbeause the stomah is being bypassed. If a total parenteral nutrition in!usion must be interrupted, the nurse should administer detrose 5B in water at a similarrate. brupt essation an ause hypoglyemia. #tatus epilepticus is treated with ".#. diaepam (#alium) and phenytoin (:ilantin). auses nausea, Dise<uili,riu! s"ndro!e vomiting, restlessness, and twithing in patients who are undergoing dialysis. "tsaused by a rapid !luid shi!t.
An indication that spinal shok is resolving is the return o! re!le ativity in the arms and legs below the level o! in0ury. H"povole!ia is the most ommon and !atal ompliation o! severe aute panreatitis. In a patient with stomatitis, oral are inludes rinsing the mouth with a miture o! equal parts o! hydrogen peroide andw ater three times daily. In otitis !edia , the tympani membrane is bright red and laks its harateristi light re!le (one o! light). In patients who have periardioentesis, !luid is aspirated !rom the periardial sa !or analysis or to relieve ardiatamponade. ;rticaria is an early sign o! hemolyti trans!usion reation. During peritoneal dial"sis3 a return o! brown dialysate suggests bowel per!oration. he physiian should be noti!iedimmediately. An earl" sign o! ketoaidosis is polyuria, whih is aused by osmoti diuresis. Patients 4ho have multiple slerosis should visually inspet their etremities to ensure proper alignment and !reedom !romin0ury. Aspirated red ,one marrow usually appears rust red, with visible !atty material and white bone !ragments. The Dick test detets sarlet !ever antigens and immunity or suseptibility to sarlet !ever. positive result indiates noimmunity6 a negative result indiates immunity. The #chick test detets diphtheria antigens and immunity or suseptibility to diphtheria. positive result indiates no immunity6 a negative result indiates immunity. The reco!!ended adult dosage o! sural!ate (9ara!ate) !or duodenal uler is % g (% tablet) !our times daily % hour be!oremeals and at bedtime. A patient with !aial burns or smoke or heat inhalation should be admitted to the hospital !or &- hour observation !or delayed traheal edema. In addition to patient teahing, preparation !or a olostomy inludes withholding oral intake overnight, per!orming bowel preparation, and administering a leansing enema. The ph"siologic changes aused by burn in0uries an be divided into two stages the hypovolemi stage, during whih intravasular !luid shi!ts into the interstitial spae, and the diureti stage, during whih apillary integrity and intravasularvolume are restored, usually -* to <& hours a!ter the in0ury. The nurse should hange total parenteral nutrition tubing every &- hours and the peripheral ".#. aess site dressing every<& hours. A patient whose arbon monoide level is &+B to 3+B should be treated with %++B humidi!ied oygen. &hen in the roo! o! a patient who is in isolation !or tuberulosis, sta!! and visitors should wear ultra!ilter masks.
&hen providing skin are immediately a!ter pin insertion, the nurses primary onern is prevention o! bone in!etion. After an a!putation, moist skin may indiate venous stasis6 dry skin may indiate arterial obstrution. In a patient who is reeiving dialysis, an internal shunt is working i! the nurse !eels a thrill on palpation or hears a bruit on ausultation. In a patient with viral hepatitis, the parenhymal, or 1up!!ers, ells o! the liver beome severely in!lamed, enlarged, andneroti. .arl" signs o! aquired immunode!iieny syndrome inlude !atigue, night sweats, enlarged lymph nodes, anoreia, weightloss, pallor, and !ever. &hen caring !or a patient who has a radioative implant, health are workers should stay as !ar away !rom the radiation soure as possible. hey should remember the aiom, M"! you double the distane, you quarter the dose.N A patient who has 8arkinsons disease should be instruted to walk with a broadbased gait. The cardinal signs o! 8arkinsons disease are musle rigidity, a tremor that begins in the !ingers, and akinesia. In a patient 4ith Parkinson%s disease , levodopa (:opar) is presribed to ompensate !or the dopamine de!iieny. A patient who has multiple slerosis is at inreased risk !or pressure ulers. Pill-rolling tre!or is a lassi sign o! 8arkinsons disease. *or a patient with 8arkinsons disease, nursing interventions are palliative. *at e!,olis!3 a serious ompliation o! a long bone !rature, auses !ever, tahyardia, tahypnea, and aniety. Metrorrhagia ',leeding ,et4een !enstrual periods) may be the !irst sign o! ervial aner.ϖ Jannitol is a hypertoni solution and an osmoti diureti thats used in the treatment o! inreased intraranial pressure. The classic sign o! an absene seiure is a vaant !aial epression. Migraine headaches ause persistent, severe pain that usually ours in the temporal region. A patient who is in a bladder retraining program should be given an opportunity to void every & hours during the day andtwie at night. In a patient with a head in0ury, a derease in level o! onsiousness is a ardinal sign o! inreased intraranial pressure. .rgota!ine '.rgo!ar) is most e!!etive when taken during the prodromal phase o! a migraine or vasular headahe. Treat!ent of acute pancreatitis inludes nasogastri sutioning to deompress the stomah and meperidine (:emerol) !orpain. #"!pto!s of hiatal hernia inlude a !eeling o! !ullness in the upper abdomen or hest, heartburn, and pain similar to that o!angina petoris.
The incidence o! holelithiasis is higher in women who have had hildren than in any other group.ϖ etaminophen (ylenol) overdose an severely damage the liver. The pro!inent linial signs o! advaned irrhosis are asites and 0aundie. The first s"!pto! o! panreatitis is steady epigastri pain or le!t upper quadrant pain that radiates !rom the umbilial areaor the bak. #o!na!,ulis! is the medial term !or sleepwalking. .pinephrine 'Adrenalin) is a vasoonstritor.ϖ n untreated liver laeration or rupture an progress rapidly to hypovolemi shok. /,stipation is etreme, intratable onstipation aused by an intestinal obstrution. The definitive test !or diagnosing aner is biopsy with ytologi eamination o! the speimen. Arthrograph" requires in0etion o! a ontrast medium and an identi!y 0oint abnormalities. Bro!pton%s cocktail is presribed to help relieve pain in patients who have terminal aner. A sarco!a is a malignant tumor in onnetive tissue. Alu!inu! h"droide 'A!pho=el) neutralies gastri aid. #u,luation is partial disloation or separation, with spontaneous redution o! a 0oint. Bar,iturates an ause on!usion and delirium in an elderly patient who has an organi brain disorder. In a patient with arthritis, physial therapy is indiated to promote optimal !untioning. #o!e patients who have hepatitis may be aniteri (without 0aundie) and lak symptoms, but some have headahes,0aundie, anoreia, !atigue, !ever, and respiratory trat in!etion. Hepatitis A is usually mild and wont advane to a arrier state. In the preicteric phase o! all !orms o! hepatitis, the patient is highly ontagious. .nteric precautions are required !or a patient who has hepatitis . Cholec"stograph" is ine!!etive in a patient who has 0aundie as a result o! gallbladder disease. he liver ells ant transport the ontrast medium to the biliary trat. In a patient who has diabetes insipidus, dehydration is a onern beause diabetes auses polyuria. In a patient who has a reduible hernia, the protruding mass spontaneously retrats into the abdomen. To prevent purple glove syndrome, a nurse shouldnt administer ".#. phenytoin (:ilantin) through a vein in the bak o! the hand, but should use a larger vessel. During stage III o! surgial anesthesia, unonsiousness ours and surgery is permitted. T"pes of regional anesthesia inlude spinal, audal, interostal, epidural, and brahial pleus. The first step in managing drug overdose or drug toiity is to establish and maintain an airway.
Respirator" paral"sis ours in stage "# o! anesthesia (toi stage). In stage I o! anesthesia, the patient is onsious and tranquil. D"spnea and sharp , stabbing pain that inreases with respiration are symptoms o! pleurisy, whih an be a ompliation o!pneumonia or tuberulosis. $ertigo is the ma0or symptom o! inner ear in!etion or disease. oud talking is a sign o! hearing impairment. A patient who has an upper respiratory trat in!etion should blow his nose with both nostrils open. A patient who has had a atarat removed an begin most normal ativities in 3 or - days6 however, the patient shouldnt bend and li!t until a physiian approves these ativities. #"!pto!s of orneal transplant re0etion inlude eye irritation and dereasing visual !ield. 1raves% disease (hyperthyroidism) is mani!ested by weight loss, nervousness, dyspnea, palpitations, heat intolerane,inreased thirst, eophthalmos (bulging eyes), and goiter. The four t"pes o! lipoprotein are hylomirons (the lowestdensity lipoproteins), verylowdensity lipoproteins, lowdensity lipoproteins, and high density lipoproteins. ealth are pro!essionals use holesterol level !rationation to assess apatients risk o! oronary artery disease. If a patient who is taking amphoteriin $ (4ungione) bladder irrigations !or a !ungal in!etion has systemi andidiasis and must reeive ".#. !luonaole (:i!luan), the irrigations an be disontinued beause !luonaole treats the bladderin!etion as well. Patients with adult respiratory distress syndrome an have high peak inspiratory pressures. here!ore, the nurse should monitor these patients losely !or signs o! spontaneous pneumothora, suh as aute deterioration in oygenation, absene o! breath sounds on the a!!eted side, and repitus beg inning on the a!!eted side. Adverse reactions to ylosporine (Aandimmune) inlude renal and hepati toiity, entral nervous system hanges(on!usion and delirium), '" bleeding, and hypertension. /steoporosis is a metaboli bone disorder in whih the rate o! bone resorption eeeds the rate o! bone !ormation. The hall!ark o! ulerative olitis is reurrent bloody diarrhea, whih ommonly ontains pus and muus and alternates with asymptomati remissions. #afer seual praties inlude massaging, hugging, body rubbing, !riendly kissing (dry), masturbating, handtogenital touhing, wearing a ondom, and limiting the number o! seual partners. I!!unosuppressed patients who ontrat ytomegalovirus (9J#) are at risk !or 9J# pneumonia and septiemia, whih an be !atal.
;rinar" tract infections an ause urinary urgeny and !requeny, dysuria, abdominal ramps or bladder spasms, and urethral ithing. Ma!!ograph" is a radiographi tehnique thats used to detet breast ysts or tumors, espeially those that arent palpable on physial eamination. To pro!ote early detetion o! testiular aner, the nurse should palpate the testes during routine physial eaminations and enourage the patient to per!orm monthly sel!eaminations during a warm shower. Patients who have thalassemia minor require no treatment. hose with thalassemia ma0or require !requent trans!usions o! red blood ells. A high level o! hepatitis $ serum marker that persists !or 3 months or more a!ter the onset o! aute hepatitis $ in!etion suggests hroni hepatitis or arrier status. 2eurogenic ,ladder dys!untion is aused by disruption o! nerve transmission to the bladder. "t may be aused by ertain spinal ord in0uries, diabetes, or multiple slerosis. /"gen and car,on dioide move between the lungs and the bloodstream by di!!usion. To grade the severity o! dyspnea, the !ollowing system is used grade %, shortness o! breath on mild eertion, suh aswalking up steps6 grade &, shortness o! breath when walking a short distane at a normal pae on level ground6 grade 3,shortness o! breath with mild daily ativity, suh as shaving6 grade -, shortness o! breath when supine (orthopnea). A patient 4ith Crohn%s disease should onsume a diet low in residue, !iber, and !at, and high in alories, proteins, andarbohydrates. he patient also should take vitamin supplements, espeially vitamin 1. In the three-,ottle urine olletion method, the patient leans the meatus and urinates %+ to %5 ml in the !irst bottle and %5to 3+ ml (midstream) in the seond bottle. hen the physiian per!orms prostati massage, and the patient voids into the third bottle. *indings in the threebottle urine olletion method are interpreted as !ollows pus in the urine (pyuria) in the !irst bottle indiates anterior urethritis6 bateria in the urine in the seond bottle indiate bladder in!etion6 bateria in the third bottle indiate prostatitis. #igns and s"!pto!s o! aorti stenosis inlude a loud, rough systoli murmur over the aorti area6 eertional dyspnea6!atigue6 angina petoris6 arrhythmias6 low blood pressure6 and emboli. .lective surger" is primarily a matter o! hoie. "t isnt essential to the patients survival, but it may improve the patientshealth, om!ort, or sel!esteem. Re<uired surger" is reommended by the physiian. "t may be delayed, but is inevitable. ;rgent surger" must be per!ormed within &- to -* hours. .!ergenc" surger" must be per!ormed immediately.
A,out >?7 o! arterial emboli originate in the heart hambers. Pul!onar" e!,olis! usually results !rom thrombi dislodged !rom the leg veins. The conscious interpretation o! pain ours in the erebral orte. To avoid interfering with new ell growth, the dressing on a donor skin gra!t site shouldnt be disturbed. A se<uela is any abnormal ondition that !ollows and is the result o! a disease, a treatment, or an in0ury. During sickle cell crisis3 patient are inludes bed rest, oygen therapy, analgesis as presribed, ".#. !luid monitoring, and thorough doumentation o! !luid intake and output. A patient who has an ileal onduit should maintain a daily !luid intake o! &,+++ ml. In a closed chest drainage system, ontinuous bubbling in the water seal hamber or bottle indiates a leak. Palpitation is a sensation o! heart pounding or raing assoiated with normal emotional responses and ertain heart disorders. *at e!,olis! is likely to our within the !irst &hours a!ter a longbone !rature. *ootdrop can our in a patient with a pelvi !rature as a result o! peroneal nerve ompression against the head o! the !ibula. To pro!ote venous return a!ter an amputation, the nurse should wrap an elasti bandage around the distal end o! the stump. &ater that aumulates in the tubing o! a ventilator should be removed. The !ost co!!on route !or the administration o! epinephrine to a patient who is having a severe allergi reation is the subutaneous route. The nurse should use 4owlers position !or a patient who has abdominal pain aused by appendiitis. The nurse shouldnt give analgesis to a patient who has abdominal pain aused by appendiitis beause these drugs may mask the pain that aompanies a ruptured appendi. The nurse shouldnt give analgesis to a patient who has abdominal pain aused by appendiitis beause these drugs may mask the pain that aompanies a ruptured appendi. As a last-ditch e!!ort, a barbiturate oma may be indued to reverse unrelenting inreased intraranial pressure ("98),whih is de!ined as aute "98 o! greater than -+ mm g, persistent elevation o! "98 above &+ mm g, or rapidly deteriorating neurologi status. The pri!ar" signs and symptoms o! epiglottiditis are stridor and progressive di!!iulty in swallowing. #alivation is the !irst step in the digestion o! starh. A patient who has a demand paemaker should measure the pulse rate be!ore rising in the morning, noti!y the physiian i! the pulse rate drops b y 5 beats/minute, obtain a medial identi!iation ard
and braelet, and resume normal ativities,inluding seual ativity. Transverse , or loop, olostomy is a temporary proedure thats per!ormed to divert the !eal stream in a patient who has aute intestinal obstrution. 2or!al values !or erythroyte sedimentation rate are + to %+ ells/hour A CK-MB level thats more than 5B o! total 91 or more than %+ ?/L suggests a myoardial in!artion. Propranolol 'Inderal) bloks sympatheti nerve stimuli that inrease ardia work during eerise or stress, whih redues heart rate, blood pressure, and myoardial oygen onsumption. After a !"ocardial infarction , eletroardiogram hanges (Asegment elevation, wave inversion, and Qwave enlargement) usually appear in the !irst &- hours, but may not appear until the 5th or 2th day. Cardiogenic shock is mani!ested by systoli blood pressure o! less than *+ mm g, gray skin, diaphoresis, yanosis, weak pulse rate, tahyardia or bradyardia, and oliguria (less than 3+ ml o! urine per hour). A patient who is reeiving a lowsodium diet shouldnt eat ottage heese, !ish, anned beans, huk steak, hoolate pudding, "talian salad dressing, dill pikles, and bee! broth. High-potassiu! !oods inlude dried prunes, watermelon (%5.3 mEq/ portion), dried lima beans (%-.5 mEq/portion),soybeans, bananas, and oranges. Kuss!aul%s respirations are !aster and deeper than normal respirations and our without pauses, as in diabeti ketoaidosis. Che"ne-#tokes respirations are harateried by alternating periods o! apnea and deep, rapid breathing. hey our inpatients with entral nervous system disorders. H"perventilation an result !rom an inreased !requeny o! breathing, an inreased tidal volume, or both. Apnea is the absene o! spontaneous respirations.ϖ $e!ore a thyroidetomy, a patient may reeive potassium iodide, antithyroid drugs, and propranolol ("nderal) to prevent thyroid storm during surgery. The nor!al life span o! red blood ells (erythroytes) is %%+ to %&+ days. $isual acuit" o! &+/%++ means that the patient sees at &+ (2 m) what a person with normal vision sees at %++ (3+ m). ;rinar" tract infections are more ommon in girls and women than in boys and men beause the shorter urethra in the !emale urinary trat makes the bladder more aessible to bateria, espeially Esherihia oli. Penicillin is administered orally % to & hours be!ore meals or & to 3 hours a!ter meals beause !ood may inter!ere with the drugs absorption. Mild reactions to loal anesthetis may inlude palpitations, tinnitus, vertigo, apprehension, on!usion, and a metalli taste in the mouth
A,out 567 o! ardia output goes to the kidneys. To ensure accurate entral venous pressure readings, the nurse should plae the manometer or transduer level with the phlebostati ais. patient 4ho has lost &,+++ to &,5++ ml o! blood will have a pulse rate o! %-+ beats/minute (or higher), display a systoli blood pressure o! 5+ to 2+ mm g, and appear on!used and lethargi. Arterial ,lood is bright red, !lows rapidly, and (beause its pumped diretly !rom the heart) spurts with eah heartbeat. $enous ,lood is dark red and tends to ooe !rom a wound. /rthostatic ,lood pressure is taken with the patient in the supine, sitting, and standing positions, with % minute between eah reading. %+mm g derease in blood pressure or an inrease in pulse rate o! %+ beats/ minute suggests volume depletion. A pneu!atic antishock garment should be used autiously in pregnant women and patients with head in0uries. After a patient%s irulating volume is restored, the nurse should remove the pneumati antishok garment gradually, starting with the abdominal hamber and !ollowed by eah leg. he garment should be removed under a physiians supervision. Most he!ol"tic trans!usion reations assoiated with mismathing o! $C blood types stem !rom identi!iation number errors. &ar!ing of ,lood to more than %+<; 4 (-%.<; 9) an ause hemolysis. Cardiac output is the amount o! blood e0eted !rom the heart eah minute. "ts epressed in liters per minute. #troke volu!e is the volume o! blood e0eted !rom the heart during systole. Total parenteral nutrition solution ontains detrose, amino aids, and additives, suh as eletrolytes, minerals, and vitamins. The !ost co!!on type o! neurogeni shok is spinal shok. "t usually ours 3+ to 2+ minutes a!ter a spinal ord in0ury. After a spinal cord in=ur" , peristalsis stops within &- hours and usually returns within 3 to - days. Toic shock s"ndro!e is mani!ested by a temperature o! at least %+&; 4 (3*.*; 9), an erythematous rash, and systoli blood pressure o! less than =+ mm g. 4rom % to & weeks a!ter the onset o! these signs, desquamation (espeially on the palms and soles) ours. The signs and s"!pto!s o! anaphylais are ommonly aused by histamine release. The !ost co!!on ause o! septi shok is gram negative bateria, suh as Esherihia oli, 1lebsiella, and 8seudomonas organisms. Bruits are vascular sounds that resemble heart murmurs and result !rom turbulent blood !low through a diseased or partially obstruted artery. ;rine pH is normally -.5 to *.+.ϖ ?rine p o! greater than *.+ an result !rom a urinary trat in!etion, a highalkali diet, or systemi alkalosis.
;rine pH o! less than -.5 may be aused by a high protein diet, !ever, or metaboli aidosis. Before a percutaneous renal biopsy, the patient should be plaed on a !irm sur!ae and positioned on the abdomen. sandbag is plaed under the abdomen to stabilie the kidneys. 2ephrotic s"ndro!e is harateried by marked proteinuria, hypoalbuminemia, mild to severe dependent edema, asites, and weight gain. ;nder4ater eercise is a !orm o! therapy per!ormed in a ubbard tank. Most 4o!en with trihomoniasis have a malodorous, !rothy, greenish gray vaginal disharge. Cther women may have no signs or symptoms. $oiding c"stourethrograph" may be per!ormed to detet bladder and urethral abnormalities. 9ontrast medium is instilled by gentle syringe pressure through a urethral atheter, and overhead Oray !ilms are taken to visualie bladder !illing anderetion. C"stourethrograph" may be per!ormed to identi!y the ause o! urinary trat in!etions, ongenital anomalies, and inontinene. "t also is used to assess !or prostate lobe hypertrophy in men. Herpes si!ple is harateried by reurrent episodes o! blisters on the skin and muous membranes. "t has two variations. "n type %, the blisters appear in the nasolabial region6 in type &, they appear on the genitals, anus, buttoks, and thighs. Most patients with 9hlamydia trahomatis in!etion are asymptomati, but some have an in!lamed urethral meatus,dysuria, and urinary urgeny and !requeny. The h"pothala!us regulates the autonomi nervous system and endorine !untions. A patient whose hest eursion is less than normal (3@ to 2@ K<.5 to %5 m) must use aessory musles to breathe. #igns and s"!pto!s o! toiity !rom thyroid replaement therapy inlude rapid pulse rate, diaphoresis, irritability, weight loss, dysuria, and sleep disturbane. The !ost co!!on allergi reation to peniillin is a rash. An earl" sign o! aspirin toiity is deep, rapid respirations. The !ost serious and irreversible onsequene o! lead poisoning is mental retardation, whih results !rom neurologidamage. To assess deh"dration in the adult, the nurse should hek skin turgor on the sternum. *or a patient with a pepti uler, the type o! diet is less important than inluding !oods in the diet that the patient an tolerate. A patient with a olostomy must establish an irrigation shedule so that regular emptying o! the bowel ours withoutstomal disharge between irrigations.
&hen using rotating tourni<uets , the nurse shouldnt restrit the blood supply to an arm or leg !or more than -5 minutes at a time. A patient with diabetes should eat high!iber !oods beause they blunt the rise in gluose level that normally !ollows a meal. @ugular vein distention ours in patients with heart !ailure beause the le!t ventrile ant empty the heart o! blood as !ast as blood enters !rom the right ventrile, resulting in ongestion in the entire venous system. The leading auses o! blindness in the 8hilippines are diabetes mellitus and glauoma. After a th"roidecto!"3 the patient should remain in the semi4owler position, with his head neither hyperetended nor hyper!leed, to avoid pressure on the suture line. his position an be ahieved with the use o! a ervial pillow. Pre!enstrual s"ndro!e may ause abdominal distention, engorged and pain!ul breasts, bakahe, headahe, nervousness,irritability, restlessness, and tremors. Treat!ent of dehiscence (pathologi opening o! a wound) onsists o! overing the wound with a moist sterile dressing and noti!ying the physiian. &hen a patient has a radial mastetomy, the ovaries also may be removed beause they are a soure o! estrogen, whih stimulates tumor growth. Atropine ,locks the e!!ets o! aetylholine, thereby obstruting its vagal e!!ets on the sinoatrial node and inreasing heartrate. #alic"lates3 partiularly aspirin, are the treatment o! hoie in rheumatoid arthritis beause they derease in!lammation and relieve 0oint pain. Deep3 intense pain that usually worsens at night and is unrelated to movement suggests bone pain. Pain that follo4s prolonged or eessive eerise and subsides with rest suggests musle pain. The !a=or hemodynami hanges assoiated with ardiogeni shok are dereased le!t ventriular !untion and dereasedardia output. Before th"roidecto!" , the patient should be advised that he may eperiene hoarseness or loss o! his voie !or several days a!ter surgery. Accepta,le adverse e!!ets o! longterm steroid use inlude weight gain, ane, headahes, !atigue, and inreased urineretention. ;naccepta,le adverse e!!ets o! longterm steroid use are diiness on rising, nausea, vomiting, thirst, and pain. After a cranioto!" , nursing are inludes maintaining normal intraranial pressure, maintaining erebral per!usion pressure, and preventing in0ury related to erebral and ellular ishemia. *olic acid and vitamin $%& are essential !or nuleoprotein synthesis and red blood ell maturation. I!!ediatel" a!ter intraranial surgery, nursing are inludes not giving the patient anything by mouth until the gag and ough re!lees return, monitoring vital signs and assessing the level o! onsiousness
(LC9) !or signs o! inreasing intraranial pressure, and administering analgesis that dont mask the LC9. Chest ph"siotherap" inludes postural drainage, hest perussion and vibration, and oughing and deepbreathingeerises. Cushing%s s"ndro!e results !rom eessive levels o! adrenoortial hormones and is mani!ested by !at pads on the !ae(moon !ae) and over the upper bak (bu!!alo hump), ane, mood swings, hirsutism, amenorrhea, and dereased libido. To prevent an addisonian risis when disontinuing longterm prednisone (:eltasone) therapy, the nurse should taper thedose slowly to allow !or monitoring o! disease !lareups and !or the return o! hypothalamipituitaryadrenal !untion. Pulsus paradous is a pulse that beomes weak during inspiration and strong during epiration. "t may be a sign o! ardia tamponade. #u,stances that are epelled through portals o! eit inlude saliva, muus, !ees, urine, vomitus, blood, and vaginal andpenile disharges. A !icroorganis! may be transmitted diretly, by ontat with an in!eted body or droplets, or indiretly, by ontat with ontaminated air, soil, water, or !luids. A post!enopausal woman who reeives estrogen therapy is at an inreased risk !or gallbladder disease and breast aner. The approi!ate oygen onentrations delivered by a nasal annula are as !ollows % L F &-B, & L F &*B, 3 L F 3&B, -LF 32B, and 5 L F -+B. Cardinal features o! diabetes insipidus inlude polydipsia (eessive thirst) and polyuria (inreased urination to 5 L/&-hours). A patient 4ith low spei!i gravity (%.++% to %.++5) may have an inreased desire !or old water. Dia,etic co!a an our when the blood gluose level drops below 2+ mg/dl. *or a patient with heart !ailure, the nurse should elevate the head o! the bed *@ to %&@ (&+ to 3+ m), provide a bedside ommode, and administer ardia glyosides and diuretis as presribed. The pri!ar" reason to treat streptooal sore throat with antibiotis is to protet the heart valves and prevent rheumati !ever. A patient with a nasal !rature may lose onsiousness during redution. Hoarseness and change in the voie are ommonly the !irst signs o! laryngeal aner. The lungs3 colon3 and retum are among the most ommon aner sites. The !ost co!!on preoperative problem in elderly patients is lowerthannormal total blood volume. Mannitol '/s!itrol) , an osmoti diureti, is administered to redue intraoular or intraranial pressure. &hen a stroke is suspeted, the nurse should plae the patient on the a!!eted side to promote lung epansion on the una!!eted side. *or a patient who has had hest surgery, the nurse should reommend sitting upright and per!orming
oughing and deepbreathing eerises. hese ations promote epansion o! the lungs, removal o! seretions, and optimal pulmonary!untioning. During ever" sleep yle, the sleeper passes through !our stages o! nonrapideyemovement sleep and one stage o! rapideyemovement sleep. A patient who is taking ali!ediol (9alderol) should avoid onomitant use o! preparations that ontain vitamin :. A patient should begin and end a &-hour urine olletion period with an empty bladder. 4or eample, i! the physiian orders urine to be olleted !rom +*++ hursday to +*++ 4riday, the urine voided at +*++ hursday should be disarded and the urine voided at +*++ 4riday should be retained. In a patient who is reeiving digoin (Lanoin), a low potassium level inreases the risk o! digoin toiity. Blood urea nitrogen values normally range !rom %+ to &+ mg/dl. *lura0epa! 'Dal!ane) toiity is mani!ested by on!usion, halluinations, and ataia. A silent !"ocardial infarction is one that has no symptoms. Adverse reactions to verapamil ("soptin) inlude diiness, headahe, onstipation, hypotension, and atrioventriular ondution disturbanes. he drug also may inrease the serum digoin level. &hen a rectal tu,e is used to relieve !latulene or enhane peristalsis, it should be inserted !or no longer than &+ minutes. ello4ish green disharge on a wound dressing indiates in!etion and should be ultured. #ickle cell crisis an ause severe abdominal, thorai, musular, and bone pain along with pain!ul swelling o! so!t tissuein the hands and !eet. /ral candidiasis 'thrush) is harateried by reamolored or bluish white pathes on the oral muous membrane. Treat!ent for a patient with ysti !ibrosis may inlude drug therapy, eerises to improve breathing and posture, eerises to !ailitate mobiliation o! pulmonary seretions, a highsalt diet, and panreati enyme supplements with snaks and meals. Pancreatic cancer may ause weight loss, 0aundie, and intermittent dulltosevere epigastri pain. Metastasis is the spread o! aner !rom one organ or body part to another through the lymphati system, irulation system, or erebrospinal !luid. The !anage!ent o! pulmonary edema !ouses on opening the airways, supporting ventilation and per!usion, improving ardia !untioning, reduing preload, and reduing patient aniety. *actors that ontribute to the death o! patients with lheimers disease inlude in!etion, malnutrition, and dehydration. Hodgkin%s disease is harateried by painless, progressive enlargement o! ervial lymph nodes and other lymphoid tissueas a result o! proli!eration
o! 7eedAternberg ells, histioytes, and eosinophils. Huntington%s disease 'chorea) is a hereditary disease harateried by degeneration in the erebral orte and basalganglia. A patient with untingtons disease may ehibit suiidal ideation. At discharge3 an amputee should be able to demonstrate proper stump are and per!orm stump toughening eerises. Acute tu,ular nerosis is the most ommon ause o! aute renal !ailure. Co!!on co!plications o! ie water lavage are vomiting and aspiration. *oods high in vita!in D inlude !orti!ied milk, !ish, liver, liver oil, herring, and egg yolk. *or a pelvic eamination, the patient should be in the lithotomy position, with the buttoks etending &R@ (2.- m) past theend o! the eamination table. If a patient ant assume the lithotomy position !or a pelvi eamination, she may lie on her le!t side. A !ale eaminer should have a !emale assistant present during a vaginal eamination !or the patients emotional om!ortand the eaminers legal protetion. Cervical secretions are lear and strethy be!ore ovulation and white and opaque a!ter ovulation. heyre normallyodorless and dont irritate the muosa. A patient with an ileostomy shouldnt eat orn beause it may obstrut the opening o! the pouh. iver d"sfunction a!!ets the metabolism o! ertain drugs. .de!a that aompanies burns and malnutrition is aused by dereased osmoti pressure in the apillaries. H"ponatre!ia is most likely to our as a ompliation o! nasogastri sutioning. In a !an who has omplete spinal ord separation at A-, eretion and e0aulation arent possible. The earl" signs o! pulmonary edema (dyspnea on eertion and oughing) re!let interstitial !luid aumulation and dereased ventilation and alveolar per!usion. Meth"lprednisolone '#olu-Medrol) is a !irstline drug used to ontrol edema a!ter spinal ord trauma. *or the patient who is reovering !rom an intraranial bleed, the nurse should maintain a qu iet, rest!ul environment !or the!irst !ew days. 2euros"philis is assoiated with widespread damage to the entral nervous system, inluding general paresis, personalityhanges, slapping gait, and blindness. A 4o!an who has had a spinal ord in0ury an still beome pregnant. In a patient who has had a stroke, the most serious ompliation is inreasing intraranial pressure. A patient with an intraranial hemorrhage should undergo arteriography to identi!y the site o! the bleeding. *actors that a!!et the ation o! drugs inlude absorption, distribution, metabolism, and eretion.
Before prescri,ing a drug !or a woman o! hildbearing age, the presriber should ask !or the date o! her last menstrual period and ask i! she may be pregnant. Acidosis may ause insulin resistane. A patient with gluose2phosphate dehydrogenase de!iieny may have aute hemolyti anemia when given asul!onamide. The five basi ativities o! the digestive system are ingestion, movement o! !ood, digestion, absorption, and de!eation. #igns and s"!pto!s o! aute panreatitis inlude epigastri pain, vomiting, bluish disoloration o! the le!t !lank ('reyurners sign), bluish disoloration o! the periumbilial area (9ullens sign), lowgrade !ever, tahyardia, and hypotension. A patient 4ith a gastri uler may have gnawing or burning epigastri pain. To test the !irst ranial nerve (ol!atory nerve), the nurse should ask the patient to lose his eyes, olude one nostril, and identi!y a nonirritating substane (suh as peppermint or innamon) by smell. hen the nurse should repeat the test with the patients other nostril oluded. #alk and #a,in introdued the oral polio vaine. A patient 4ith a disease o! the erebellum or posterior olumn has an atai gait thats harateried by staggering and inability to remain steady when standing with the !eet together. "n trauma patients, improved outome is diretly related to early resusitation, aggressive management o! shok, andappropriate de!initive are. To check !or leakage o! erebrospinal !luid, the nurse should inspet the patients nose and ears. "! the patient an sit up,the nurse should observe him !or leakage as the patient leans !orward. ocked-in s"ndro!e is omplete paralysis as a result o! brain stem damage. Cnly the eyes an be moved voluntarily. 2eck dissection , or surgial removal o! the ervial lymph nodes, is per!ormed to prevent the spread o! malignant tumors o! the head and nek. A patient with holeystitis typially has right epigastri pain that may radiate to the right sapula or shoulder6 nausea6 and vomiting, espeially a!ter eating a heavy meal. Atropine is used preoperatively to redue seretions. #eru! calciu! levels are normally -.5 to 5.5 mEq/L. #uppressor T ells regulate overall immune response. #eru! levels o! aspartate aminotrans!erase and alanine aminotrans!erase show whether the liver is adequately detoi!ying drugs. #eru! sodiu! levels are normally %35 to %-5 mEq/L. #eru! potassiu! levels are normally 3.5 to 5.+ mEq/L.
A patient who is taking prednisone (:eltasone) should onsume a saltrestrited diet thats rih in potassium and protein. &hen perfor!ing ontinuous ambulatory peritoneal dialysis, the nurse must use sterile tehnique when handling the atheter, send a peritoneal !luid sample !or ulture and sensitivity testing every &- hours, and report signs o! in!etion and!luid imbalane. &hen 4orking with patients who have aquired immunode!iieny syndrome, the nurse should wear goggles and a mask only i! blood or another body !luid ould splash onto the nurses !ae. Blood spills that are in!eted with human immunode!iieny virus should be leaned up with a %%+ solution o! sodiumhypohlorite 5.&5B (household bleah). Ra"naud%s pheno!enon is intermittent ishemi attaks in the !ingers or toes. "t auses severe pallor and sometimes paresthesia and pain. Intussusception (prolapse o! one bowel segment into the lumen o! another) auses sudden epigastri pain, sausageshapedabdominal swelling, passage o! muus and blood through the retum, shok, and hypotension. Bence @ones protein ours almost elusively in the urine o! patients who have multiple myeloma. 1aucher%s disease is an autosomal disorder thats harateried by abnormal aumulation o! gluoerebrosides (lipidsubstanes that ontain gluose) in monoytes and maroytes. "t has three !orms ype % is the adult !orm, type & is thein!antile !orm, and type 3 is the 0uvenile !orm. A patient with olon obstrution may have lower abdominal pain, onstipation, inreasing distention, and vomiting. Colchicine 'Colsalide) relieves in!lammation and is used to treat gout. #o!e people have gout as a result o! hyperuriemia beause they ant metabolie and erete purines normally. A nor!al sper! ount is &+ to %5+ million/ml. A first-degree ,urn involves the stratum orneum layer o! the epidermis and auses pain and redness. #heehan%s s"ndro!e is hypopituitarism aused by a pituitary in!art a!ter postpartum shok and hemorrhage. &hen caring !or a patient who has had an asthma attak, the nurse should plae the patient in 4owlers or semi4owlersposition. In elderl" patients , the inidene o! nonompliane with presribed drug therapy is high. Jany elderly patients have diminished visual auity, hearing loss, or !orget!ulness, or need to tak e multiple drugs. Tu,erculosis is a reportable ommuniable disease thats aused by in!etion with Jyobaterium tuberulosis (an aid!ast baillus). *or right-sided ardia atheteriation, the physiian passes a multilumen atheter through the superior or in!erior venaava.
After a fracture3 bone healing ours in these stages hematoma !ormation, ellular proli!eration and allus !ormation, andossi!iation and remodeling. A patient who is sheduled !or positron emission tomography should avoid alohol, tobao, and a!!eine !or &- hoursbe!ore the test. In a stroke3 dereased oygen destroys brain ells. A patient with glauoma shouldnt reeive atropine sul!ate beause it inreases intraoular pressure. The nurse should instrut a patient who is hyperventilating to breathe into a paper bag. During inter!ittent positivepressure breathing, the patient should bite down on the mouthpiee, breathe normally, and let the mahine do the work. !ter inspiration, the patient should hold his breath !or 3 or - seonds and ehale ompletely through the mouthpiee. *leion contractures o! the hips may our in a patient who sits in a wheelhair !or a long time. 2"stag!us is rapid horiontal or rotating eye movement. After !"elograph" , the patient should remain reumbent !or &- hours. The treat!ent o! sprains and strains onsists o! applying ie immediately and elevating the arm or leg above heart level. An anticholinesterase agent shouldnt be presribed !or a patient who is taking morphine beause it an potentiate the e!!et o! morphine and ause respiratory depression. M"opia is nearsightedness. H"peropia and pres,"opia are two types o! !arsightedness. The !ost e!!etive ontraeptive method is one that the woman selets !or hersel! and uses onsistently. To perfor! &e,er%s test !or bone ondution, a vibrating tuning !ork is plaed on top o! the patients head at midline. hepatient should pereive the sound equally in both ears. "n a patient who has ondutive hearing loss, the sound is heard in(lateralies to) the ear that has ondutive loss. In the Rinne test , bone ondution is tested by plaing a vibrating tuning !ork on the mastoid proess o! the temporal boneand air ondution is tested by holding the vibrating tuning !ork R@ (%.3 m) !rom the eternal auditory meatus. hese testsare alternated, at di!!erent !requenies, until the tuning !ork is no longer heard at one position. After an a!putation3 the stump may shrink beause o! musle atrophy and dereased subutaneous !at. A patient 4ho has deep vein thrombosis is given heparin !or < to %+ days, !ollowed by %& weeks o! war!arin (9oumadin)therapy. After pneu!onecto!"3 the patient should be positioned on the operative side or on his bak, with his head slightlyelevated. To reduce the possibility o! !ormation o! new emboli or epansion o! eisting emboli, a patient with deep vein thrombosisshould reeive heparin.
Atherosclerosis is the most ommon ause o! oronary artery disease. "t usually involves the aorta and the !emoral,oronary, and erebral arteries. Pul!onar" e!,olis! is a potentially !atal ompliation o! deep vein thrombosis. Chest pain is the most ommon symptom o! pulmonary embolism. The nurse should in!orm a patient who is taking phenaopyridine (8yridium) that this drug olors urine orange or red. Pneu!othora is a serious ompliation o! entral venous line plaement6 its aused by inadvertent lung punture. Pneu!oc"stis carinii pneu!onia isnt onsidered ontagious beause it only a!!ets patients who have a suppressed immune system. To enhance drug absorption, the patient should take regular erythromyin tablets with a !ull glass o! water % hour be!ore or& hours a!ter a meal or should take enterioated tablets with !ood. he patient should avoid taking either type o! tablet with!ruit 0uie. Tris!us3 a sign o! tetanus (lok0aw), auses pain!ul spasms o! the mastiatory musles, di!!iulty opening the mouth, nekrigidity and sti!!ness, and dysphagia. The nurse should plae the patient in an upright position !or thoraentesis. "! this isnt possible, the nurse should positionthe patient on the una!!eted side. If gravit" !low is used, the nurse should hang a blood bag 3 (% m) above the level o! the planned venipunture site. The nurse should plae a patient who has a losed hest drainage system in the semi4owler position. If ,lood isnt trans!used within 3+ minutes, the nurse should return it to the blood bank beause the re!rigeration !ailitieson a nursing unit are inadequate !or storing blood produts. Blood that%s disolored and ontains gas bubbles is ontaminated with bateria and shouldnt be trans!used. 4i!ty perent o! patients who reeive ontaminated blood die. *or !assive3 rapid blood trans!usions and !or ehange trans!usions in neonates, blood should be warmed to =*.<; 4 (3<;9). A chest tu,e permits air and !luid to drain !rom the pleural spae. A handheld resusitation bag is an in!latable devie that an be attahed to a !ae mask or an endotraheal or traheostomytube. "t allows manual delivery o! oygen to the lungs o! a patient who ant breathe independently. Mechanical ventilation arti!iially ontrols or assists respiration. The nurse should enourage a patient who has a losed hest drainage system to ough !requently and breathe deeply to help drain the pleural spae and epand the lungs. Tracheal suction removes seretions !rom the trahea and bronhi with a sution atheter.
During colosto!" irrigation, the irrigation bag should be hung %*@ (-5.< m) above the stoma. The 4ater used !or olostomy irrigation should be %++; to %+5; 4 (3<.*; to -+.2; 9). An arterial embolism may ause pain, loss o! sensory nerves, pallor, oolness, paralysis, pulselessness, or paresthesia in the a!!eted arm or leg. Respirator" alkalosis results !rom onditions that ause hyperventilation and redue the arbon dioide level in the arterialblood. Mineral oil is ontraindiated in a patient with appendiitis, aute surgial abdomen, !eal impation, or intestinalobstrution. &hen using a Ptype administration set to trans!use paked red blood ells (7$9s), the nurse an add normal salinesolution to the bag to dilute the 7$9s and make them less visous. Autotransfusion is olletion, !iltration, and rein!usion o! the patients own blood. Prepared I+$+ solutions !all into three general ategories isotoni, hypotoni, and hypertoni. "sotoni solutions have asolute onentration thats similar to body !luids6 adding them to plasma doesnt hange its osmolarity. ypotoni solutionshave a lower osmoti pressure than body !luids6 adding them to plasma dereases its osmolarity. ypertoni solutions have ahigher osmoti pressure than body !luids6 adding them to plasma inreases its osmolarity. #tress incontinence is involuntary leakage o! urine triggered by a sudden physial strain, suh as a ough, sneee, or quik movement. Decreased renal function makes an elderly patient more suseptible to the development o! renal aluli. The nurse should onsider using shorter needles to in0et drugs in elderly patients beause these patients eperiene subutaneous tissue redistribution and loss in areas, suh as the buttoks and deltoid musles. ;rge incontinence is the inability to suppress a sudden urge to urinate. Total incontinence is ontinuous, unontrollable leakage o! urine as a result o! the bladders inability to retain urine. Protein3 vita!in3 and mineral needs usually remain onstant as a person ages, but alori requirements derease. *our valves keep blood !lowing in one diretion in the heart two atrioventriular valves (triuspid and mitral) and twosemilunar valves (pulmoni and aorti). An elderl" patient%s height may derease beause o! narrowing o! the intervertebral spaes and eaggerated spinalurvature. Constipation most ommonly ours when the urge to de!eate is suppressed and the musles assoiated with bowelmovements remain ontrated. 1out develops in !our stages asymptomati, aute, interritial, and hroni.
Co!!on postoperative ompliations inlude hemorrhage, in!etion, hypovolemia, septiemia, septi shok, ateletasis,pneumonia, thrombophlebitis, and pulmonary embolism. An insulin pu!p delivers a ontinuous in!usion o! insulin into a seleted subutaneous site, ommonly in the abdomen. A co!!on s"!pto! o! saliylate (aspirin) toiity is tinnitus (ringing in the ears). A frost,itten etremity must be thawed rapidly, even i! de!initive treatment must be delayed. A patient with 7aynauds disease shouldnt smoke igarettes or other tobao produts. Ra"naud%s disease is a primary arteriospasti disorder that has no known ause. 7aynauds phenomenon, however, isaused by another disorder suh as sleroderma. To re!ove a foreign body !rom the eye, the nurse should irrigate the eye with sterile normal saline solution. &hen irrigating the eye, the nurse should diret the solution toward the lower on0untival sa. .!ergenc" care !or a orneal in0ury aused by a austi substane is !lushing the eye with opious amounts o! water !or &+to 3+ minutes. De,ride!ent is mehanial, hemial, or surgial removal o! neroti tissue !rom a wound. #evere pain a!ter atarat surgery indiates bleeding in the eye. A ,ivalve cast is ut into anterior and posterior portions to allow skin inspetion. After ear irrigation, the nurse should plae the patient on the a!!eted side to permit gravity to drain !luid that remains in the ear. If a patient with an indwelling atheter has abdominal disom!ort, the nurse should assess !or bladder distention, whih may be aused by atheter blokage. Continuous ,ladder irrigation helps prevent urinary trat obstrution by !lushing out small blood lots that !orm a!ter prostate or bladder surgery. The nurse should remove an indwelling atheter when bladder deompression is no longer needed, when the atheter is obstruted, or when the patient an resume voiding. he longer a atheter remains in plae, the greater the risk o! urinary trat in!etion. In an adult3 the etent o! a burn in0ury is determined by using the 7ule o! Hines the head and nek are ounted as =B6 eah arm, as =B6 eah leg, as %*B6 the bak o! the trunk, as %*B6 the !ront o! the trunk, as %*B6 and the perineum, as %B. A deep partial-thickness burn a!!ets the epidermis and dermis. In a patient who is having an asthma attak, nursing interventions inlude administering oygen and bronhodilators as presribed, plaing the patient in the semi4owler position, enouraging diaphragmati breathing, and helping the patient torela. Prostate cancer is usually !atal i! bone metastasis ours.
A strict vegetarian needs vitamin $%& supplements beause animals and animal produts are the only soure o! this vitamin. Regular insulin is the only type o! insulin that an be mied with other types o! insulin and an be given ".#. If a patient pulls out the outer traheostomy tube, the nurse should hold the traheostomy open with a surgial dilator until the physiian provides appropriate are. The !edulla o,longata is the part o! the brain that ontrols the respiratory enter. *or an unconscious patient , the nurse should per!orm passive rangeo!motion eerises every & to - hours. A ti!ed-release drug isnt reommended !or use in a patient who has an ileostomy beause it releases the drug at di!!erentrates along the '" trat. The nurse isn%t required to wear gloves when applying nitroglyerin paste6however, she should wash her hands a!ter applying this drug. Before ecretor" urography, a patients !luid intake is usually restrited a!ter midnight. A sodiu! pol"st"rene sulfonate 'Ka"ealate) enema, whih ehanges sodium ions !or potassium ions, is used to derease the potassium level in a patient who has hyperkalemia. If the color o! a stoma is muh lighter than when previously assessed, dereased irulation to the stoma should be suspeted. Massage is ontraindiated in a leg with a blood lot beause it may dislodge the lot. The first plae a nurse an detet 0aundie in an adult is in the slera. @aundice is aused by eessive levels o! on0ugated or unon0ugated bilirubin in the blood. M"driatic drugs are used primarily to dilate the pupils !or intraoular eaminations. After e"e surger" , the patient should be plaed on the una!!eted side. &hen assigning tasks to a liensed pratial nurse, the registered nurse should delegate tasks that are onsidered bedside nursing are, suh as taking vital signs, hanging simple dressings, and giving baths. :eep al! pain on dorsi!leion o! the !oot is a positive omans sign, whih suggests venous thrombosis or thrombophlebitis. ;ltra-short-acting ,ar,iturates , suh as thiopental (8entothal), are used as in0etion anesthetis when a short duration o! anesthesia is needed suh as outpatient surgery. Atropine sulfate may be used as a preanestheti drug to redue seretions and minimie vagal re!lees. *or a patient with in!etious mononuleosis, the nursing are plan should emphasie strit bed rest during the aute !ebrile stage to ensure adequate rest. During the aute phase o! in!etious mononuleosis, the patient should urtail ativities to minimie the possibility o! rupturing the enlarged spleen.
Dail" application o! a longating, transdermal nitroglyerin path is a onvenient, e!!etive way to prevent hroni angina. The nurse !ust wear a ap, gloves, a gown, and a mask when providing wound are to a patient with thirddegree burns. The nurse should epet to administer an analgesi be!ore bathing a burn patient. The passage o! blak, tarry !ees (melena) is a ommon sign o! lower '" bleeding, but also may our in patients who haveupper '" bleeding. A patient 4ho has a gastri uler should avoid taking aspirin and aspirinontaining produts beause they an irritate thegastri muosa. &hile ad!inistering hemotherapy agents with an ".#. line, the nurse should disontinue the in!usion at the !irst sign o!etravasation. A lo4-fi,er diet may ontribute to the development o! hemorrhoids. A patient 4ho has abdominal pain shouldnt reeive an analgesi until the ause o! the pain is determined. If surger" requires hair removal, the reommendation o! the 9enters !or :isease 9ontrol and 8revention is that a depilatory be used to avoid skin abrasions and uts. *or nasotracheal sutioning, the nurse should set wall sution at 5+ to =5 mm g !or an in!ant, =5 to %%5 mm g !or a hild, or *+ to %&+ mm g !or an adult. After a !"ocardial infarction , a hange in pulse rate and rhythm may signal the onset o! !atal arrhythmias. Treat!ent of epistais inludes nasal paking, ie paks, autery with silver nitrate, and pressure on the nares. Palliative treat!ent relieves or redues the intensity o! unom!ortable symptoms, but doesnt ure the ausative disorder. Placing a postoperative patient in an upright position too quikly may ause hypotension. $erapa!il 'Calan) and diltiaem (9ardiem) slow the in!low o! alium to the heart, thereby dereasing the risk o! supraventriular tahyardia. After cardiopul!onar" bypass gra!t, the patient will per!orm turning, oughing, deep breathing, and wound splinting, andwill use assistive breathing devies. A patient who is eposed to hepatitis $ should reeive +.+2 ml/kg ".J. o! immune globulin within <& hours a!ter eposure and a repeat dose at &* days a!ter eposure. The nurse should advise a patient who is undergoing radiation therapy not to remove the markings on the skin made by theradiation therapist beause they are landmarks !or treatment. The !ost ommon symptom o! osteoarthritis is 0oint pain thats relieved by rest, espeially i! the pain ours a!ter eeriseor weight bearing. In adults, urine volume normally ranges !rom *++ to &,+++ ml/day and averages between %,&++ and %,5++ ml/day.
Directl" applied moist heat so!tens rusts and eudates, penetrates deeper than dry heat, doesnt dry the skin, and is usuallymore om!ortable !or the patient. Tetrac"clines are seldom onsidered drugs o! hoie !or most ommon baterial in!etions beause their overuse has led to the emergene o! tetraylineresistant bateria. Because light degrades nitroprusside (Hitropress), the drug must be shielded !rom light. 4or eample, an ".#. bag that ontains nitroprusside sodium should be wrapped in !oil. Cephalosporins should be used autiously in patients who are allergi to peniillin. hese patients are more suseptible to hypersensitivity reations. If chlora!phenicol and peniillin must be administered onomitantly, the nurse should give the peniillin % or more hours be!ore the hlorampheniol to avoid a redution in peniillins bateriidal ativity. The er"throc"te sedimentation rate measures the distane and speed at whih erythroytes in whole blood !all in a vertial tube in % hour. he rate at whih they !all to the bottom o! the tube orresponds to the degree o! in!lammation. &hen teaching a patient with myasthenia gravis about pyridostigmine (Jestinon) therapy, the nurse should stress theimportane o! taking the drug eatly as presribed, on time, and in evenly spaed doses to prevent a relapse and maimie the e!!et o! the drug. If an anti,iotic must be administered into a peripheral heparin lok, the nurse should !lush the site with normal saline solution a!ter the in!usion to maintain ".#. pateny. The nurse should instrut a patient with angina to take a nitroglyerin tablet be!ore antiipated stress or eerise or, i! the angina is noturnal, at bedtime. Arterial ,lood gas analysis evaluates gas ehange in the lungs (alveolar ventilation) by measuring the partial pressures o! oygen and arbon dioide and the p o! an arterial sample. The nor!al seru! magnesium level ranges !rom %.5 to &.5 mEq/L. Patient preparation !or a total holesterol test inludes an overnight !ast and abstinene !rom alohol !or &- hours be!ore the test. The fasting plas!a gluose test measures gluose levels a!ter a %& to %-hour !ast. 2or!al ,lood p ranges !rom <.35 to <.-5. blood p higher than <.-5 indiates alkalemia6 one lower than <.35 indiates aidemia. During an acid per!usion test, a small amount o! weak hydrohlori aid solution is in!used with a nasoesophageal tube. positive test result (pain a!ter in!usion) suggests re!lu esophagitis. 2or!all"3 the partial pressure o! arterial arbon dioide (8a9C&) ranges !rom 35 to -5 mm g. 8a9C& greater than -5mm g indiates aidemia as a result o! hypoventilation6 one less than 35 mm g indiates alkalemia as a result o! hyperventilation.
Red cell indies aid in the diagnosis and lassi!iation o! anemia. 2or!all" , the partial pressure o! arterial oygen (8ao &) ranges !rom *+ to %++ mm g. 8ao & o! 5+ to *+ mm gindiates respiratory insu!!iieny. 8ao & o! less than 5+ mm g indiates respiratory !ailure. The 4hite ,lood cell '&BC) di!!erential evaluates >$9 distribution and morphology and provides more spei!iin!ormation about a patients immune system than the >$9 ount. An eercise stress test (treadmill test, eerise eletroardiogram) ontinues until the patient reahes a predetermined targetheart rate or eperienes hest pain, !atigue, or other signs o! eerise intolerane. Altera,le risk !ators !or oronary artery disease inlude igarette smoking, hypertension, high holesterol or triglyeridelevels, and diabetes. The !ediastinu! is the spae between the lungs that ontains the heart, esophagus, trahea, and other strutures. Ma=or co!plications o! aute myoardial in!artion inlude arrhythmias, aute heart !ailure, ardiogeni shok,thromboembolism, and le!t ventriular rupture. The sinoatrial node is a luster o! hundreds o! ells loated in the right atrial wall, near the opening o! the superior venaava. *or one-person ardiopulmonary resusitation, the ratio o! ompressions to ventilations is %5&.4or twoperson ardiopulmonary resusitation, the ratio o! ompressions to ventilations is 5%.
A patient 4ho has pulseless ventriular tahyardia is a andidate !or ardioversion. .chocardiograph" , a noninvasive test that direts ultrahigh!requeny sound waves through the hest wall and into theheart, evaluates ardia struture and !untion and an show valve de!ormities, tumors, septal de!ets, periardial e!!usion,and hypertrophi ardiomyopathy. Ataia is impaired ability to oordinate movements. "ts aused by a erebellar or spinal ord lesion. /n an electrocardiogra! strip, eah small blok on the horiontal ais represents +.+- seond. Eah large blok (omposedo! !ive small bloks) represents +.& seond. #tarling%s la4 states that the !ore o! ontration o! eah heartbeat depends on the length o! the musle !ibers o! the heartwall. The therapeutic blood level !or digoin is +.* to &.+ ng/ml. Pancrelipase 'Pancrease) is used to treat ysti !ibrosis and hroni panreatitis. Treat!ent !or mild to moderate variose veins inludes antiembolism stokings and an eerise program that inludeswalking to minimie venous pooling. An intoicated patient isnt onsidered ompetent to re!use required medial treatment and shouldnt be allowed to hekout o! a hospital against medial advie. The pri!ar" di!!erene between the pain o! angina and that o! a myoardial in!artion is its duration.
