MEDICAL AND SURGICAL NURSING BULLETS

In a patient with hypokalemia (serum potassium level below 3.5 mEq/L), presenting signs an symptoms in!lu e mus!le weakness an !ar ia! arrhythmias. "uring !ar ia! arrest, i# an I.$. route is unavailable, epinephrine !an be a ministere en otra!heally. %erni!ious anemia results #rom the #ailure to absorb vitamin &'( in the )I tra!t an !auses primarily )I an neurologi! signs an symptoms. * patient who has a pressure ul!er shoul !onsume a high+protein, high+!alorie iet, unless !ontrain i!ate . ,he -.+/& isoen0yme level is use to assess tissue amage in myo!ar ial in#ar!tion. *#ter a '(+hour #ast, the normal #asting bloo glu!ose level is 12 to '(2 mg/ l. * patient who is e3perien!ing igo3in to3i!ity may report nausea, vomiting, iplopia, blurre vision, light #lashes, an yellow+green halos aroun images. *nuria is aily urine output o# less than '22 ml. In remittent #ever, the bo y temperature varies over a (4+hour perio , but remains elevate . 5isk o# a #at embolism is greatest in the #irst 41 hours a#ter the #ra!ture o# a long bone. It6s mani#este by respiratory istress. ,o help venous bloo return in a patient who is in sho!k, the nurse shoul elevate the patient6s legs no more than 45 egrees. ,his pro!e ure is !ontrain i!ate in a patient with a hea in7ury. ,he pulse e#i!it is the i##eren!e between the api!al an ra ial pulse rates, when taken simultaneously by two nurses. ,o re u!e the patient6s risk o# vomiting an aspiration, the nurse shoul s!he ule postural rainage be#ore meals or ( to 4 hours a#ter meals. &loo pressure !an be measure ire!tly by intra+arterial insertion o# a !atheter !onne!te to a pressure+monitoring evi!e. * positive .ernig6s sign, seen in meningitis, o!!urs when an attempt to #le3 the hip o# a re!umbent patient !auses pain#ul spasms o# the hamstring mus!le an resistan!e to #urther e3tension o# the leg at the knee. In a patient with a #ra!ture , islo!ate #emur, treatment begins with re u!tion an immobili0ation o# the a##e!te leg. 8erniate nu!leus pulposus (intervertebral isk) most !ommonly o!!urs in the lumbar an lumbosa!ral regions. Lamine!tomy is surgi!al removal o# the herniate portion o# an intervertebral isk. 9urgi!al treatment o# a gastri! ul!er in!lu es severing the vagus nerve (vagotomy) to re u!e the amount o# gastri! a!i se!rete by the gastri! !ells. $alsalva6s maneuver is #or!e e3halation against a !lose glottis, as when taking a eep breath, blowing air out, or bearing own. :hen mean arterial pressure #alls below ;2 mm 8g an systoli! bloo pressure #alls below 12 mm 8g, vital organ per#usion is seriously !ompromise . Li o!aine (<ylo!aine) is the rug o# !hoi!e #or re u!ing premature ventri!ular !ontra!tions. * patient is at greatest risk o# ying uring the #irst (4 to 41 hours a#ter a myo!ar ial in#ar!tion. "uring a myo!ar ial in#ar!tion, the le#t ventri!le usually sustains the greatest amage. ,he pain o# a myo!ar ial in#ar!tion results #rom myo!ar ial is!hemia !ause by ano3ia. =or a patient in !ar ia! arrest, the #irst priority is to establish an airway. ,he universal sign #or !hoking is !lut!hing the han to the throat. =or a patient who has heart #ailure or !ar iogeni! pulmonary e ema, nursing interventions #o!us on e!reasing venous return to the heart an in!reasing le#t ventri!ular output. ,hese interventions in!lu e pla!ing the patient in high =owler6s position an a ministering o3ygen, iureti!s, an positive inotropi! rugs as pres!ribe .

'

* positive tuber!ulin skin test is an in uration o# '2 mm or greater at the in7e!tion site. ,he signs an symptoms o# histoplasmosis, a !hroni! systemi! #ungal in#e!tion, resemble those o# tuber!ulosis. In burn vi!tims, the lea ing !ause o# eath is respiratory !ompromise. ,he se!on lea ing !ause is in#e!tion. ,he e3o!rine #un!tion o# the pan!reas is the se!retion o# en0ymes use to igest !arbohy rates, #ats, an proteins. * patient who has hepatitis * (in#e!tious hepatitis) shoul !onsume a iet that6s mo erately high in #at an high in !arbohy rate an protein, an shoul eat the largest meal in the morning. Esophageal balloon tampona e shoul n6t be in#late greater than (2 mm 8g. >verpro u!tion o# prola!tin by the pituitary glan !an !ause gala!torrhea (e3!essive or abnormal la!tation) an amenorrhea (absen!e o# menstruation). Intermittent !lau i!ation (pain uring ambulation or other movement that6s relieve with rest) is a !lassi! symptom o# arterial insu##i!ien!y in the leg. In bla er !ar!inoma, the most !ommon #in ing is gross, painless hematuria. %arenteral a ministration o# heparin so ium is !ontrain i!ate in patients with renal or liver isease, )I blee ing, or re!ent surgery or trauma? in pregnant patients? an in women ol er than age ;2. "rugs that potentiate the e##e!ts o# anti!oagulants in!lu e aspirin, !hloral hy rate, glu!agon, anaboli! steroi s, an !hlorampheni!ol. =or a burn patient, !are priorities in!lu e maintaining a patent airway, preventing or !orre!ting #lui an ele!trolyte imbalan!es, !ontrolling pain, an preventing in#e!tion. Elasti! sto!kings shoul be worn on both legs. *!tive immuni0ation is the #ormation o# antibo ies within the bo y in response to va!!ination or e3posure to isease. %assive immuni0ation is a ministration o# antibo ies that were pre#orme outsi e the bo y. * patient who is re!eiving igo3in (Lano3in) shoul n6t re!eive a !al!ium preparation be!ause o# the in!rease risk o# igo3in to3i!ity. -on!omitant use may a##e!t !ar ia! !ontra!tility an lea to arrhythmias. Intermittent positive+pressure breathing is in#lation o# the lung uring inspiration with !ompresse air or o3ygen. ,he goal o# this in#lation is to keep the lung open. :rist rop is !ause by paralysis o# the e3tensor mus!les in the #orearm an han . =oot rop results #rom e3!essive plantar #le3ion an is usually a !ompli!ation o# prolonge be rest. * patient who has gonorrhea may be treate with peni!illin an probene!i (&enemi ). %robene!i elays the e3!retion o# peni!illin an keeps this antibioti! in the bo y longer. In patients who have glu!ose+;+phosphate ehy rogenase ();%") e#i!ien!y, the re bloo !ells !an6t metaboli0e a equate amounts o# glu!ose, an hemolysis o!!urs. >n+!all me i!ation is me i!ation that shoul be rea y #or imme iate a ministration when the !all to a minister it6s re!eive .

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always point in the same ire!tionG p8 %a->( 8->3F H respiratory a!i osis !ompensate p8 %a->( 8->3F H respiratory alkalosis !ompensate p8 %a->( 8->3F H metaboli! a!i osis !ompensate p8 %a->( 8->3F H metaboli! alkalosis !ompensate . %olyuria is urine output o# (,522 ml or more within (4 hours. ,he presenting sign o# pleuritis is !hest pain that is usually unilateral an relate to respiratory movement. I# a patient has a gastri! rainage tube in pla!e, the nurse shoul e3pe!t the physi!ian to or er potassium !hlori e. *n in!rease pulse rate is one o# the #irst in i!ations o# respiratory i##i!ulty. It o!!urs be!ause the heart attempts to !ompensate #or a e!rease o3ygen supply to the tissues by pumping more bloo . In an a ult, a hemoglobin level below '' mg/ l suggests iron e#i!ien!y anemia an the nee #or #urther evaluation. ,he normal partial pressure o# o3ygen in arterial bloo is B5 mm 8g (plus or minus 5 mm 8g). $itamin - e#i!ien!y is !hara!teri0e by brittle bones, pinpoint peripheral hemorrhages, an #riable gums with loosene teeth. -lini!al mani#estations o# pulmonary embolism are variable, but in!rease respiratory rate, ta!hy!ar ia, an hemoptysis are !ommon. Iormally, intrao!ular pressure is '( to (2 mm 8g. It !an be measure with a 9!hiJt0 tonometer. In early hemorrhagi! sho!k, bloo pressure may be normal, but respiratory an pulse rates are rapi . ,he patient may report thirst an may have !lammy skin an piloere!tion (goose bumps). -ool, moist, pale skin, as o!!urs in sho!k, results #rom iversion o# bloo #rom the skin to the ma7or organs. ,o assess !apillary re#ill, the nurse applies pressure over the nail be until blan!hing o!!urs, qui!kly releases the pressure, an notes the rate at whi!h blan!hing #a es. -apillary re#ill in i!ates per#usion, whi!h e!reases in sho!k, thereby lengthening re#ill time. Iormal !apillary re#ill is less than 3 se!on s. E3!ept #or patients with renal #ailure, urine output o# less than 32 ml/hour signi#ies ehy ration an the potential #or sho!k.

I# gagging, nausea, or vomiting o!!urs when an airway is remove , the nurse shoul pla!e the patient in a lateral position with the upper arm supporte on a pillow. :hen a postoperative patient arrives in the re!overy room, the nurse shoul position the patient on his si e or with his hea turne to the si e an the !hin e3ten e . In the imme iate postoperative perio , the nurse shoul report a respiratory rate greater than 32, temperature greater than '22@ = (3A.1@ -) or below BA@ = (3;.'@ -), or a signi#i!ant rop in bloo pressure or rise in pulse rate #rom the baseline. Irreversible brain amage may o!!ur i# the !entral nervous system is eprive o# o3ygen #or more than 4 minutes. ,reatment #or poly!ythemia vera in!lu es a ministering o3ygen, ra ioisotope therapy, or !hemotherapy agents, su!h as !hlorambu!il an nitrogen mustar , to suppress bone marrow growth. * patient with a!ute renal #ailure shoul re!eive a high+!alorie iet that6s low in protein as well as potassium an so ium. * ison6s isease is !ause by hypo#un!tion o# the a renal glan an is !hara!teri0e by #atigue, anemia, weight loss, an bron0e skin pigmentation. :ithout !ortisol repla!ement therapy, it6s usually #atal. )lau!oma is manage !onservatively with beta+a renergi! blo!kers su!h as timolol (,imopti!), whi!h e!rease sympatheti! impulses to the eye, an with mioti! eye rops su!h as pilo!arpine (Isopto -arpine), whi!h !onstri!t the pupils. /ioti!s e##e!tively treat glau!oma by re u!ing intrao!ular pressure. ,hey o this by !onstri!ting the pupil, !ontra!ting the !iliary mus!les, opening the anterior !hamber angle, an in!reasing the out#low o# aqueous humor. :hile a patient is re!eiving heparin, the nurse shoul monitor the partial thromboplastin time. Crinary #requen!y, in!ontinen!e, or both !an o!!ur a#ter !atheter removal. In!ontinen!e may be mani#este as ribbling. :hen tea!hing a patient about !olostomy !are, the nurse shoul instru!t the patient to hang the irrigation reservoir '1D to ((D (45 to 55 !m) above the stoma, insert the !atheter (D to 4D (5 to '2 !m) into the stoma, irrigate the stoma with 'A to 34 o0 (523 to ',225 ml) o# water at a temperature o# '25@ to ''2@ = (42@ to 43@ -) on!e a ay, !lean the area aroun the stoma with soap an water be#ore applying a new bag, an use a prote!tive skin !overing, su!h as a 9tomahesive wa#er, karaya paste, or karaya ring, aroun the stoma. ,he #irst sign o# 8o gkin6s isease is painless, super#i!ial lympha enopathy, typi!ally #oun un er one arm or on one si e o# the ne!k in the !ervi!al !hain. ,o i##erentiate true !yanosis #rom eposition o# !ertain pigments, the nurse shoul press the skin over the is!olore area. -yanoti! skin blan!hes, but pigmente skin oesn6t. * patient who has a gastri! ul!er is most likely to report pain uring or shortly a#ter eating. :i ening pulse pressure is a sign o# in!reasing intra!ranial pressure. =or e3ample, the bloo pressure may rise #rom '(2/12 to ';2/;2 mm 8g. In a burn vi!tim, a primary goal o# woun !are is to prevent !ontamination by mi!roorganisms. ,o prevent e3ternal rotation in a patient who has ha hip nailing, the nurse pla!es tro!hanter rolls #rom the knee to the ankle o# the a##e!te leg. 9evere hip pain a#ter the insertion o# a hip prosthesis in i!ates islo gment. I# this o!!urs, be#ore !alling the physi!ian, the nurse shoul assess the patient #or shortening o# the leg, e3ternal rotation, an absen!e o# re#le3es. *s mu!h as A5E o# renal #un!tion is lost be#ore bloo urea nitrogen an serum !reatinine levels rise above normal. :hen !ompensatory e##orts are present in a!i +base balan!e, partial pressure o# arterial !arbon io3i e (%a->() an bi!arbonate (8->3F)

In el erly patients, the most !ommon #ra!ture is hip #ra!ture. >steoporosis weakens the bones, pre isposing these patients to #ra!ture, whi!h usually results #rom a #all. &e#ore angiography, the nurse shoul ask the patient whether he6s allergi! to the ye, shell#ish, or io ine an a vise him to take nothing by mouth #or 1 hours be#ore the pro!e ure. "uring myelography, appro3imately '2 to '5 ml o# !erebrospinal #lui is remove #or laboratory stu ies an an equal amount o# !ontrast me ia is in7e!te . *#ter angiography, the pun!ture site is !overe with a pressure ressing an the a##e!te part is immobili0e #or 1 hours to e!rease the risk o# blee ing. I# a water+base me ium was use uring myelography, the patient remains on be rest #or ; to 1 hours, with the hea o# the be elevate 32 to 45 egrees. I# an oil+base me ium was use , the patient remains #lat in be #or ; to (4 hours. ,he level o# amputation is etermine by estimating the ma3imum viable tissue (tissue with a equate !ir!ulation) nee e to evelop a #un!tional stump. 8eparin so ium is in!lu e in the ialysate use #or renal ialysis. %aro3ysmal no!turnal yspnea may in i!ate heart #ailure. * patient who takes a !ar ia! gly!osi e, su!h as igo3in, shoul !onsume a iet that in!lu es high+potassium #oo s. ,he nurse shoul limit tra!heobron!hial su!tioning to '2 to '5

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se!on s an shoul make only two passes. &e#ore per#orming tra!heobron!hial su!tioning, the nurse shoul ventilate an o3ygenate the patient #ive to si3 times with a resus!itation bag an '22E o3ygen. ,his pro!e ure is !alle bagging. 9igns an symptoms o# pneumothora3 in!lu e ta!hypnea, restlessness, hypotension, an tra!heal eviation. ,he !ar inal sign o# to3i! sho!k syn rome is rapi onset o# a high #ever. * key sign o# pepti! ul!er is hematemesis, whi!h !an be bright re or ark re , with the !onsisten!y o# !o##ee groun s. 9igns an symptoms o# a per#orate pepti! ul!er in!lu e su en, severe upper ab ominal pain? vomiting? an an e3tremely ten er, rigi (boar like) ab omen. -onstipation is a !ommon a verse rea!tion to aluminum hy ro3i e. =or the #irst (4 hours a#ter a myo!ar ial in#ar!tion, the patient shoul use a be si e !ommo e an then progress to walking to the toilet, bathing, an taking short walks. *#ter a myo!ar ial in#ar!tion, the patient shoul avoi overe3ertion an a a new a!tivity aily, as tolerate without yspnea. In a patient with a re!ent myo!ar ial in#ar!tion, #rothy, bloo +tinge sputum suggests pulmonary e ema. In a patient who has a!quire immuno e#i!ien!y syn rome, the primary purpose o# rugs is to prevent se!on ary in#e!tions. In a patient with a!quire immuno e#i!ien!y syn rome, suppression o# the immune system in!reases the risk o# opportunisti! in#e!tions, su!h as !ytomegalovirus, %neumo!ystis !arinii pneumonia, an thrush. * patient with a!quire immuno e#i!ien!y syn rome may have rapi weight loss, a sign o# wasting syn rome. I# the bo y oesn6t use glu!ose #or energy, it metaboli0es #at an pro u!es ketones. *ppro3imately (2E o# patients with )uillain+&arrK syn rome have resi ual e#i!its, su!h as mil motor weakness or iminishe lower e3tremity re#le3es. 8ypertension an hypokalemia are the most signi#i!ant !lini!al mani#estations o# primary hyperal osteronism. *#ter per!utaneous aspiration o# the bla er, the patient6s #irst voi is usually pink? however, urine with #rank bloo shoul be reporte to the physi!ian. * urine !ulture that grows more than '22,222 !olonies o# ba!teria per milliliter o# urine in i!ates in#e!tion. * patient who is un ergoing ialysis shoul take a vitamin supplement an eat #oo s that are high in !alories, but low in protein, so ium, an potassium. In a patient who has !hroni! obstru!tive pulmonary isease, the most e##e!tive ways to re u!e thi!k se!retions are to in!rease #lui intake to (,522 ml/ ay an en!ourage ambulation. ,he nurse shoul tea!h a patient with emphysema how to per#orm purse +lip breathing be!ause this slows e3piration, prevents alveolar !ollapse, an helps to !ontrol the respiratory rate. -lubbing o# the igits an a barrel !hest may evelop in a patient who has !hroni! obstru!tive pulmonary isease. * stroke (Lbrain atta!kM) isrupts the brain6s bloo supply an may be !ause by hypertension. In a patient who is un ergoing ialysis, esire out!omes are normal weight, normal serum albumin level (3.5 to 5.5 g/ l), an a equate protein intake ('.( to '.5 g/kg o# bo y weight aily). Intermittent peritoneal ialysis involves per#orming three to seven treatments that total 42 hours per week.

In a patient with !hroni! obstru!tive pulmonary isease, the best way to a minister o3ygen is by nasal !annula. ,he normal #low rate is ( to 3 L/ minute. Isoetharine (&ronkosol) !an be a ministere with a han hel nebuli0er or by intermittent positive+pressure breathing. &rain eath is irreversible !essation o# brain #un!tion. -ontinuous ambulatory peritoneal ialysis requires #our e3!hanges per ay, A ays per week, #or a total o# ';1 hours per week. ,he !lassi! a verse rea!tions to antihistamines are ry mouth, rowsiness, an blurre vision. &e!ause o# the risk o# paralyti! ileus, a patient who has re!eive a general anestheti! !an6t take anything by mouth until a!tive bowel soun s are hear in all ab ominal qua rants. ,he level o# alpha+#etoprotein, a tumor marker, is elevate in patients who have testi!ular germ !ell !an!er. -lini!al mani#estations o# or!hitis !ause by ba!teria or mumps in!lu e high temperature, !hills, an su en pain in the involve testis. ,he level o# prostate+spe!i#i! antigen is elevate in patients with benign prostati! hyperplasia or prostate !an!er. ,he level o# prostati! a!i phosphatase is elevate in patients with a van!e stages o# prostate !an!er. %henylephrine (Ieo+9ynephrine), a my riati!, is instille in a patient6s eye to ilate the eye. ,o promote #lui rainage an relieve e ema in a patient with epi i ymitis, the nurse shoul elevate the s!rotum on a s!rotal bri ge. =luores!ein staining is !ommonly use to assess !orneal abrasions be!ause it outlines super#i!ial epithelial e#e!ts. %resbyopia is loss o# near vision as a result o# the loss o# elasti!ity o# the !rystalline lens. ,ransient is!hemi! atta!ks are !onsi ere pre!ursors to strokes. * sign o# a!ute appen i!itis, /!&urney6s sign is ten erness at /!&urney6s point (about (D N5 !mO #rom the right anterior superior ilia! spine on a line between the spine an the umbili!us). :hen !aring #or a patient with )uillain+&arrK syn rome, the nurse shoul #o!us on respiratory interventions as the isease pro!ess a van!es. 9igns an symptoms o# !olon !an!er in!lu e re!tal blee ing, !hange in bowel habits, intestinal obstru!tion, ab ominal pain, weight loss, anore3ia, nausea, an vomiting. 9ymptoms o# prostatitis in!lu e #requent urination an ysuria.

* !han!re is a painless, ul!erative lesion that evelops uring the primary stage o# syphilis. "uring the tertiary stage o# syphilis, spiro!hetes inva e the internal organs an !ause permanent amage. In total parenteral nutrition, weight gain is the most reliable in i!ator o# a positive response to therapy. ,he nurse may a minister an I.$. #at emulsion through a !entral or peripheral !atheter, but shoul n6t use an in+line #ilter be!ause the #at parti!les are too large to pass through the pores. I# a patient who has a prostate!tomy is using a -unningham !lamp, instru!t him to wash an ry his penis be#ore applying the !lamp. 8e shoul apply the !lamp hori0ontally an remove it at least every 4 hours to empty his bla er to prevent in#e!tion. I# a woman has signs o# urinary tra!t in#e!tion uring menopause, she shoul be instru!te to rink si3 to eight glasses o# water per ay, urinate be#ore an a#ter inter!ourse, an per#orm .egel e3er!ises.

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I# a menopausal patient e3perien!es a Lhot #lash,M she shoul be instru!te to seek a !ool, bree0y lo!ation an sip a !ool rink. -heilosis !auses #issures at the angles o# the mouth an in i!ates a vitamin &(, ribo#lavin, or iron e#i!ien!y. ,etany may result #rom hypo!al!emia !ause by hypoparathyroi ism. * patient who has !ervi!al !an!er may e3perien!e vaginal blee ing #or ' to 3 months a#ter intra!avitary ra iation. *s!ites is the a!!umulation o# #lui , !ontaining large amounts o# protein an ele!trolytes, in the ab ominal !avity. It6s !ommonly !ause by !irrhosis. Iormal pulmonary artery pressure is '2 to (5 mm 8g. Iormal pulmonary artery we ge pressure is 5 to '( mm 8g. *#ter !ar ia! !atheteri0ation, the site is monitore #or blee ing an hematoma #ormation, pulses istal to the site are palpate every '5 minutes #or ' hour, an the patient is maintaine on be rest with the e3tremity e3ten e #or 1 hours. 8emophilia is a blee ing isor er that6s transmitte geneti!ally in a se3+linke (< !hromosome) re!essive pattern. *lthough girls an women may !arry the e#e!tive gene, hemophilia usually o!!urs only in boys an men. $on :illebran 6s isease is an autosomal ominant blee ing isor er that6s !ause by platelet ys#un!tion an #a!tor $III e#i!ien!y. 9i!kle !ell anemia is a !ongenital hemolyti! anemia that6s !ause by e#e!tive hemoglobin 9 mole!ules. It primarily a##e!ts bla!ks. 9i!kle !ell anemia has a homo0ygous inheritan!e pattern. 9i!kle !ell trait has a hetero0ygous inheritan!e pattern. %el+Ebstein #ever is a !hara!teristi! sign o# 8o gkin6s isease. =ever re!urs every #ew ays or weeks an alternates with a#ebrile perio s. )lu!ose+;+phosphate ehy rogenase ();%") e#i!ien!y is an inherite metaboli! isor er that6s !hara!teri0e by re bloo !ells that are e#i!ient in );%", a !riti!al en0yme in aerobi! gly!olysis. %re#erre sites #or bone marrow aspiration are the posterior superior ilia! !rest, anterior ilia! !rest, an sternum. "uring bone marrow harvesting, the onor re!eives general anesthesia an 422 to 122 ml o# marrow is aspirate . * butter#ly rash a!ross the bri ge o# the nose is a !hara!teristi! sign o# systemi! lupus erythematosus. 5heumatoi arthritis is a !hroni!, estru!tive !ollagen isease !hara!teri0e by symmetri! in#lammation o# the synovium that lea s to 7oint swelling. 9!reening #or human immuno e#i!ien!y virus antibo ies begins with the en0yme+linke immunosorbent assay. 5esults are !on#irme by the :estern blot test. ,he -.+/& isoen0yme level in!reases 4 to 1 hours a#ter a myo!ar ial in#ar!tion, peaks at '( to (4 hours, an returns to normal in 3 ays. E3!essive intake o# vitamin . may signi#i!antly antagoni0e the anti!oagulant e##e!ts o# war#arin (-ouma in). ,he patient shoul be !autione to avoi eating an e3!essive amount o# lea#y green vegetables. * lymph no e biopsy that shows 5ee +9ternberg !ells provi es a e#initive iagnosis o# 8o gkin6s isease. &ell6s palsy is unilateral #a!ial weakness or paralysis !ause by a isturban!e o# the seventh !ranial (#a!ial) nerve. "uring an initial tuber!ulin skin test, la!k o# a wheal a#ter in7e!tion o# tuber!ulin puri#ie protein erivative in i!ates that the test ose was in7e!te too eeply. ,he nurse shoul in7e!t another ose at least (D (5 !m) #rom the initial site. * tuber!ulin skin test shoul be rea 41 to A( hours a#ter a ministration. In rea ing a tuber!ulin skin test, erythema without in uration is usually not signi#i!ant. "eath !ause by botulism usually results #rom elaye respiratory !ompli!ations. iagnosis an

In a patient who has rabies, saliva !ontains the virus an is a ha0ar #or nurses who provi e !are. * #ebrile nonhemolyti! rea!tion is the most !ommon trans#usion rea!tion. 8ypokalemia (abnormally low !on!entration o# potassium in the bloo ) may !ause mus!le weakness or paralysis, ele!tro!ar iographi! abnormalities, an )I isturban!es. &eriberi, a serious vitamin &' (thiamine) e#i!ien!y, a##e!ts al!oholi!s who have poor ietary habits. It6s epi emi! in *sian !ountries where people subsist on unenri!he ri!e. It6s !hara!teri0e by the phrase LI !an6t,M in i!ating that the patient is too ill to o anything. E3!essive se ation may !ause respiratory epression. ,he primary postoperative !on!ern is maintenan!e o# a patent airway. I# !yanosis o!!urs !ir!umorally, sublingually, or in the nail be , the o3ygen saturation level (9ao () is less than 12E. * rapi pulse rate in a postoperative patient may in i!ate pain, blee ing, ehy ration, or sho!k. In!rease pulse rate an bloo pressure may in i!ate that a patient is e3perien!ing Lsilent painM (pain that !an6t be e3presse verbally, su!h as when a patient is re!overing #rom anesthesia). Li o!aine (<ylo!aine) e3erts antiarrhythmi! a!tion by suppressing automati!ity in the %urkin7e #ibers an elevating the ele!tri!al stimulation threshol in the ventri!les. -ullen6s sign (a bluish is!oloration aroun the umbili!us) is seen in patients who have a per#orate pan!reas. "uring the postoperative perio , the patient shoul !ough an breathe eeply every ( hours unless otherwise !ontrain i!ate (#or e3ample, a#ter !raniotomy, !atara!t surgery, or throat surgery). &e#ore surgery, a patient6s respiratory volume may be measure by in!entive spirometry. ,his measurement be!omes the patient6s postoperative goal #or respiratory volume. ,he postoperative patient shoul use in!entive spirometry '2 to '( times per hour an breathe eeply. &e#ore ambulating, a postoperative patient shoul angle his legs over the si e o# the be an per#orm eep+breathing e3er!ises. "uring the patient6s #irst postoperative ambulation, the nurse shoul monitor the patient !losely an assist him as nee e while he walks a #ew #eet #rom the be to a stea y !hair. 8ypovolemia o!!urs when '5E to (5E o# the bo y6s total bloo volume is lost. 9igns an symptoms o# hypovolemia in!lu e rapi , weak pulse? low bloo pressure? !ool, !lammy skin? shallow respirations? oliguria or anuria? an lethargy. *!ute peri!ar itis !auses su en severe, !onstant pain over the anterior !hest. ,he pain is aggravate by inspiration. 9igns an symptoms o# septi!emia in!lu e #ever, !hills, rash, ab ominal istention, prostration, pain, hea a!he, nausea, an iarrhea. 5o!ky /ountain spotte #ever !auses a persistent high #ever, nonpitting e ema, an rash. %atients who have un ergone !oronary artery bypass gra#t shoul sleep ; to '2 hours per ay, take their temperature twi!e aily, an avoi li#ting more than '2 lb (4.5 kg) #or at least ; weeks. -lau i!ation pain (pain on ambulation) is !ause by arterial insu##i!ien!y as a result o# atheromatous plaque that obstru!ts arterial

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bloo #low to the e3tremities. %a!emakers !an be powere by lithium batteries #or up to '2 years. ,he patient shoul n6t voi #or ' hour be#ore per!utaneous suprapubi! bla er aspiration to ensure that su##i!ient urine remains in the bla er to make the pro!e ure su!!ess#ul. Le#t+si e heart #ailure !auses pulmonary !ongestion, pink+tinge sputum, an yspnea. (5emember L #or le#t an lung.) ,he !urrent re!ommen e bloo !holesterol level is less than (22 mg/ l. :hen !aring #or a patient who is having a sei0ure, the nurse shoul #ollow these gui elinesG (') *voi restraining the patient, but help a stan ing patient to a lying position. (() Loosen restri!tive !lothing. (3) %la!e a pillow or another so#t ob7e!t un er the patient6s hea . (4) -lear the area o# har ob7e!ts. (5) "on6t #or!e anything into the patient6s mouth, but maintain a patent airway. (;) 5eassure an reorient the patient a#ter the sei0ure subsi es. )ingival hyperplasia, or overgrowth o# gum tissue, is an a verse rea!tion to phenytoin ("ilantin). :ith aging, most marrow in long bones be!omes yellow, but it retains the !apa!ity to !onvert ba!k to re . -lini!al mani#estations o# lymphe ema in!lu e a!!umulation o# #lui in the legs. *#terloa is ventri!ular wall tension uring systoli! e7e!tion. It6s in!rease in patients who have septal hypertrophy, in!rease bloo vis!osity, an !on itions that !ause blo!kage o# aorti! or pulmonary out#low. 5e bloo !ells !an be store #ro0en #or up to ( years? however, they must be use within (4 hours o# thawing. =or the #irst (4 hours a#ter amputation, the nurse shoul elevate the stump to prevent e ema. *#ter hystere!tomy, a woman shoul avoi se3ual inter!ourse #or 3 weeks i# a vaginal approa!h was use an ; weeks i# the ab ominal approa!h was use . %arkinson6s isease !hara!teristi!ally !auses progressive mus!le rigi ity, akinesia, an involuntary tremor. ,oni!+!loni! sei0ures are !hara!teri0e by a loss o# !ons!iousness an alternating perio s o# mus!le !ontra!tion an rela3ation. 9tatus epilepti!us, a li#e+threatening emergen!y, is a series o# rapi ly repeating sei0ures that o!!ur without intervening perio s o# !ons!iousness. ,he i eal onor #or ki ney transplantation is an i enti!al twin. I# an i enti!al twin isn6t available, a biologi!al sibling is the ne3t best !hoi!e. &reast !an!er is the lea ing !an!er among women? however, lung !an!er a!!ounts #or more eaths. ,he stages o# !ervi!al !an!er are as #ollowsG stage 2, !ar!inoma in situ? stage I, !an!er !on#ine to the !ervi3? stage II, !an!er e3ten ing beyon the !ervi3, but not to the pelvi! wall? stage III, !an!er e3ten ing to the pelvi! wall? an stage I$, !an!er e3ten ing beyon the pelvis or within the bla er or re!tum. >ne metho use to estimate bloo loss a#ter a hystere!tomy is !ounting perineal pa s. 9aturating more than one pa in ' hour or eight pa s in (4 hours is !onsi ere hemorrhaging. ,ransurethral rese!tion o# the prostate is the most !ommon pro!e ure #or treating benign prostati! hyperplasia. In a !hest rainage system, the water in the water+seal !hamber normally rises when a patient breathes in an #alls when he breathes out. 9pinal #usion provi es spinal stability through a bone gra#t, usually #rom the ilia! !rest, that #uses two or more vertebrae. * patient who re!eives any type o# transplant must take an immunosuppressant rug #or the rest o# his li#e. In!entive spirometry shoul be use 5 to '2 times an hour while the patient is awake.

In women, pelvi! in#lammatory isease is a !ommon !ompli!ation o# gonorrhea. 9!oliosis is lateral 9+shape !urvature o# the spine. 9igns an symptoms o# the se!on ary stage o# syphilis in!lu e a rash on the palms an soles, erosion o# the oral mu!osa, alope!ia, an enlarge lymph no es. In a patient who is re!eiving total parenteral nutrition, the nurse shoul monitor glu!ose an ele!trolyte levels. Cnless !ontrain i!ate , on a mission to the postanesthesia !are unit, a patient shoul be turne on his si e an his vital signs shoul be taken. E ema is treate by limiting #lui intake an eliminating e3!ess #lui . * patient who has ha spinal anesthesia shoul remain #lat #or '( to (4 hours. $ital signs an neuromus!ular #un!tion shoul be monitore . * patient who has maple syrup urine isease shoul avoi #oo !ontaining the amino a!i s leu!ine, isoleu!ine, an lysine. * severe !ompli!ation o# a #emur #ra!ture is e3!essive bloo loss that results in sho!k. ,o prepare a patient #or peritoneal ialysis, the nurse shoul ask the patient to voi , measure his vital signs, pla!e him in a supine position, an using asepti! te!hnique, insert a !atheter through the ab ominal wall an into the peritoneal spa!e. I# more than 3 L o# ialysate solution return uring peritoneal ialysis, the nurse shoul noti#y the physi!ian. 8emo ialysis is the removal o# !ertain elements #rom the bloo by passing heparini0e bloo through a semipermeable membrane to the ialysate bath, whi!h !ontains all o# the important ele!trolytes in their i eal !on!entrations. )angrene usually a##e!ts the igits #irst, an begins with skin !olor !hanges that progress #rom gray+blue to ark brown or bla!k. .i ney #un!tion is assesse by evaluating bloo urea nitrogen (normal range is 1 to (2 mg/ l) an serum !reatinine (normal range is 2.; to '.3 mg/ l) levels. * weight+bearing trans#er is appropriate only #or a patient who has at least one leg that6s strong enough to bear weight, su!h as a patient with hemiplegia or a single+leg amputation. >ver#low in!ontinen!e (voi ing o# 32 to ;2 ml o# urine every '5 to 32 minutes) is a sign o# bla er istention. ,he #irst sign o# a pressure ul!er is re ene skin that blan!hes when pressure is applie . Late signs an symptoms o# si!kle !ell anemia in!lu e ta!hy!ar ia, !ar iomegaly, systoli! an iastoli! murmurs, !hroni! #atigue, hepatomegaly, an splenomegaly. * me!hani!al ventilator, whi!h !an maintain ventilation automati!ally #or an e3ten e perio , is in i!ate when a patient !an6t maintain a sa#e %a>( or %a->( level. ,wo types o# me!hani!al ventilators e3istG negative+pressure ventilators, whi!h apply negative pressure aroun the !hest wall, an positive+pressure ventilators, whi!h eliver air un er pressure to the patient. *ngina pe!toris is !hara!teri0e by substernal pain that lasts #or ( to 3 minutes. ,he pain, whi!h is !ause by myo!ar ial is!hemia, may ra iate to the ne!k, shoul ers, or 7aw? is es!ribe as viselike, or !onstri!ting? an may be a!!ompanie by severe apprehension or a #eeling o# impen ing oom. ,he iagnosis o# an a!ute myo!ar ial in#ar!tion is base on the patient6s signs an symptoms, ele!tro!ar iogram tra!ings, troponin

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level, an !ar ia! en0yme stu ies. ,he goal o# treatment #or a patient with angina pe!toris is to re u!e the heart6s workloa , thereby re u!ing the myo!ar ial eman #or o3ygen an preventing myo!ar ial in#ar!tion. Iitrogly!erin e!reases the amount o# bloo that returns to the heart by in!reasing the !apa!ity o# the venous be . ,he patient shoul take no more than three nitrogly!erin tablets in a '5+minute perio . 8emo ialysis is usually per#orme (4 hours be#ore ki ney transplantation. 9igns an symptoms o# a!ute ki ney transplant re7e!tion are progressive enlargement an ten erness at the transplant site, in!rease bloo pressure, e!rease urine output, elevate serum !reatinine level, an #ever. *#ter a ra i!al maste!tomy, the patient6s arm shoul be elevate (with the han above the elbow) on a pillow to enhan!e !ir!ulation an prevent e ema. %ostoperative maste!tomy !are in!lu es tea!hing the patient arm e3er!ises to #a!ilitate lymph rainage an prevent shortening o# the mus!le an !ontra!ture o# the shoul er 7oint (#ro0en shoul er). *#ter ra i!al maste!tomy, the patient shoul help prevent in#e!tion by making sure that no bloo pressure rea ings, in7e!tions, or venipun!tures are per#orme on the a##e!te arm. =or a patient who has un ergone maste!tomy an is sus!eptible to lymphe ema, a program o# han e3er!ises !an begin shortly a#ter surgery, i# pres!ribe . ,he program !onsists o# opening an !losing the han tightly si3 to eight times per hour an per#orming su!h tasks as washing the #a!e an !ombing the hair. 9igns an symptoms o# theophylline to3i!ity in!lu e vomiting, restlessness, an an api!al pulse rate o# more than (22 beats/minute. ,he nurse shoul n6t in u!e vomiting in a person who has ingeste poison an is having sei0ures or is semi!ons!ious or !omatose. -entral venous pressure (-$%), whi!h is the pressure in the right atrium an the great veins o# the thora3, is normally ( to 1 mm 8g (or 5 to '( !m 8(>). -$% is use to assess right+si e !ar ia! #un!tion. -$% is monitore to assess the nee #or #lui repla!ement in seriously ill patients, to estimate bloo volume e#i!its, an to evaluate !ir!ulatory pressure in the right atrium. ,o prevent eep vein thrombosis a#ter surgery, the nurse shoul a minister 5,222 units o# heparin sub!utaneously every 1 to '( hours, as pres!ribe . >ral anti!oagulants, su!h as war#arin (-ouma in) an i!umarol, isrupt natural bloo !lotting me!hanisms, prevent thrombus #ormation, an limit the e3tension o# a #orme thrombus. *nti!oagulants !an6t issolve a #orme thrombus. *nti!oagulant therapy is !ontrain i!ate in a patient who has liver or ki ney isease or )I ul!ers or who isn6t likely to return #or #ollow+up visits. ,he nurse !an assess a patient #or thrombophlebitis by measuring the a##e!te an una##e!te legs an !omparing their si0es. ,he nurse shoul mark the measurement lo!ations with a pen so that the legs !an be measure at the same pla!e ea!h ay. "rainage o# more than 3,222 ml o# #lui aily #rom a nasogastri! tube may suggest intestinal obstru!tion. Pellow rainage that has a #oul o or may in i!ate small+bowel obstru!tion. %reparation #or sigmoi os!opy in!lu es a ministering an enema ' hour be#ore the e3amination, warming the s!ope in warm water or a sterili0er (i# using a metal sigmoi os!ope), an raping the patient to e3pose the perineum. ,reatment #or a patient with blee ing esophageal vari!es in!lu es a ministering vasopressin (%itressin), giving an i!e water lavage,

;
aspirating bloo #rom the stoma!h, using esophageal balloon tampona e, provi ing parenteral nutrition, an a ministering bloo trans#usions, as nee e . * trauma vi!tim shoul n6t be move until a patent airway is establishe an the !ervi!al spine is immobili0e . *#ter a maste!tomy, lymphe ema may !ause a #eeling o# heaviness in the a##e!te arm. * ying patient shoul n6t be tol e3a!tly how long he6s e3pe!te to live, but shoul be tol something more general su!h as L9ome people live 3 to ; months, but others live longer.M *#ter eye surgery, a patient shoul avoi using makeup until otherwise instru!te . *#ter a !orneal transplant, the patient shoul wear an eye shiel when engaging in a!tivities su!h as playing with !hil ren or pets. *#ter a !orneal transplant, the patient shoul n6t lie on the a##e!te site, ben at the waist, or have se3ual inter!ourse #or ' week. ,he patient must avoi getting soapsu s in the eye. * /ilwaukee bra!e is use #or patients who have stru!tural s!oliosis. ,he bra!e helps to halt the progression o# spinal !urvature by provi ing longitu inal tra!tion an lateral pressure. It shoul be worn (3 hours a ay. 9hort+term measures use to treat stomal retra!tion in!lu e stool so#teners, irrigation, an stomal ilatation. * patient who has a !olostomy shoul be a vise to eat a low+resi ue iet #or 4 to ; weeks an then to a one #oo at a time to evaluate its e##e!t. ,o relieve postoperative hi!!ups, the patient shoul breathe into a paper bag. I# a patient with an ileostomy has a blo!ke lumen as a result o# un igeste high+#iber #oo , the patient shoul be pla!e in the knee+ !hest position an the area below the stoma shoul be massage . "uring the initial interview an treatment o# a patient with syphilis, the patient6s se3ual !onta!ts shoul be i enti#ie . ,he nurse shoul n6t a minister morphine to a patient whose respiratory rate is less than '( breaths/minute. ,o prevent rying o# the mu!ous membranes, o3ygen shoul be a ministere with hy ration. =lavo3ate (Crispas) is !lassi#ie as a urinary tra!t spasmolyti!. 8ypotension is a sign o# !ar iogeni! sho!k in a patient with a myo!ar ial in#ar!tion. ,he pre ominant signs o# me!hani!al ileus are !ramping pain, vomiting, istention, an inability to pass #e!es or #latus. =or a patient with a myo!ar ial in#ar!tion, the nurse shoul monitor #lui intake an output meti!ulously. ,oo little intake !auses ehy ration, an too mu!h may !ause pulmonary e ema. Iitrogly!erin rela3es smooth mus!le, !ausing vaso ilation an relieving the !hest pain asso!iate with myo!ar ial in#ar!tion an angina. ,he iagnosis o# an a!ute myo!ar ial in#ar!tion is base on the patient6s signs an symptoms, ele!tro!ar iogram tra!ings, an serum en0yme stu ies. *rrhythmias are the pre ominant problem uring the #irst 41 hours a#ter a myo!ar ial in#ar!tion. -lini!al mani#estations o# malabsorption in!lu e weight loss, mus!le wasting, bloating, an steatorrhea. *sparaginase, an en0yme that inhibits the synthesis o# eo3yribonu!lei! a!i an protein, is use to treat a!ute lympho!yti! leukemia.

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,o relieve a patient6s sore throat that6s !ause by nasogastri! tube irritation, the nurse shoul provi e anestheti! lo0enges, as pres!ribe . =or the #irst '( to (4 hours a#ter gastri! surgery, the stoma!h !ontents (obtaine by su!tioning) are brown. *#ter gastri! su!tioning is is!ontinue , a patient who is re!overing #rom a subtotal gastre!tomy shoul re!eive a !lear liqui iet. ,he es!en ing !olon is the pre#erre site #or a permanent !olostomy. $alvular insu##i!ien!y in the veins !ommonly !auses vari!osity. * patient with a !olostomy shoul restri!t #at an #ibrous #oo s an shoul avoi #oo s that !an obstru!t the stoma, su!h as !orn, nuts, an !abbage. * patient who is re!eiving !hemotherapy is pla!e in reverse isolation be!ause the white bloo !ell !ount may be epresse . 9ymptoms o# mitral valve stenosis are !ause by improper emptying o# the le#t atrium. %ersistent blee ing a#ter open heart surgery may require the a ministration o# protamine sul#ate to reverse the e##e!ts o# heparin so ium use uring surgery. ,he nurse shoul tea!h a patient with heart #ailure to take igo3in an other rugs as pres!ribe , to restri!t so ium intake, to restri!t #lui s as pres!ribe , to get a equate rest, to in!rease walking an other a!tivities gra ually, to avoi e3tremes o# temperature, to report signs o# ,he nurse shoul !he!k an maintain the paten!y o# all !onne!tions #or a !hest tube. I# an air leak is ete!te , the nurse shoul pla!e one .elly !lamp near the insertion site. I# the bubbling stops, the leak is in the thora!i! !avity an the physi!ian shoul be noti#ie imme iately. I# the leak !ontinues, the nurse shoul take a se!on !lamp, work own the tube until the leak is lo!ate , an stop the leak. In two+person !ar iopulmonary resus!itation, the res!uers a minister ;2 !hest !ompressions per minute an ' breath #or every 5 !ompressions. /itral valve stenosis !an result #rom rheumati! #ever. *tele!tasis is in!omplete e3pansion o# lung segments or lobules (!lusters o# alveoli). It may !ause the lung or lobe to !ollapse. ,he nurse shoul instru!t a patient who has an ileal !on uit to empty the !olle!tion evi!e #requently be!ause the weight o# the urine may !ause the evi!e to slip #rom the skin. * patient who is re!eiving !ar iopulmonary resus!itation shoul be pla!e on a soli , #lat sur#a!e. &rain amage o!!urs 4 to ; minutes a#ter !ar iopulmonary #un!tion !eases. -lima!teri! is the transition perio uring whi!h a woman6s repro u!tive #un!tion iminishes an gra ually isappears. *#ter in#ratentorial surgery, the patient shoul remain on his si e, #lat in be . In a patient who has an ul!er, milk is !ontrain i!ate be!ause its high !al!ium !ontent stimulates se!retion o# gastri! a!i . * patient who has a positive test result #or human immuno e#i!ien!y virus has been e3pose to the virus asso!iate with a!quire immuno e#i!ien!y syn rome (*I"9), but oesn6t ne!essarily have *I"9. * !ommon !ompli!ation a#ter prostate!tomy is !ir!ulatory #ailure !ause by blee ing. In right+si e heart #ailure, a ma7or #o!us o# nursing !are is e!reasing the workloa o# the heart. 9igns an symptoms o# igo3in to3i!ity in!lu e nausea, vomiting, !on#usion, an arrhythmias. *n asthma atta!k typi!ally begins with whee0ing, !oughing, an in!reasing respiratory istress. In a patient who is re!overing #rom a tonsille!tomy, #requent swallowing suggests hemorrhage.

Ileostomies an 8artmann6s !olostomies are permanent stomas. Loop !olostomies an ouble+barrel !olostomies are temporary ones. * patient who has an ileostomy shoul eat #oo s, su!h as spina!h an parsley, be!ause they a!t as intestinal tra!t eo ori0ers. *n a renale!tomy !an e!rease steroi pro u!tion, whi!h !an !ause e3tensive loss o# so ium an water. &e#ore a ministering morphine ("uramorph) to a patient who is suspe!te o# having a myo!ar ial in#ar!tion, the nurse shoul !he!k the patient6s respiratory rate. I# it6s less than '( breaths/minute, emergen!y equipment shoul be rea ily available #or intubation i# respiratory epression o!!urs. * patient who is re!overing #rom supratentorial surgery is normally allowe out o# be '4 to 41 hours a#ter surgery. * patient who is re!overing #rom in#ratentorial surgery normally remains on be rest #or 3 to 5 ays. *#ter a patient un ergoes a #emoral+popliteal bypass gra#t, the nurse must !losely monitor the peripheral pulses istal to the operative site an !ir!ulation. *#ter a #emoral+popliteal bypass gra#t, the patient shoul initially be maintaine in a semi+=owler position to avoi #le3ion o# the gra#t site. &e#ore is!harge, the nurse shoul instru!t the patient to avoi positions that put pressure on the gra#t site until the ne3t #ollow+up visit. ># the #ive senses, hearing is the last to be lost in a patient who is entering a !oma. -holelithiasis !auses an enlarge , e ematous gallbla multiple stones an an elevate bilirubin level. er with

,he antiviral agent 0i ovu ine (5etrovir) su!!ess#ully slows repli!ation o# the human immuno e#i!ien!y virus, thereby slowing the evelopment o# a!quire immuno e#i!ien!y syn rome. 9evere rheumatoi arthritis !auses marke e ema an !ongestion, spin le+shape 7oints, an severe #le3ion e#ormities. * patient with a!quire immuno e#i!ien!y syn rome shoul a vise his se3ual partners o# his human immuno e#i!ien!y virus status an observe se3ual pre!autions, su!h as abstinen!e or !on om use. I# a ra ioa!tive implant be!omes islo ge , the nurse shoul retrieve it with tongs, pla!e it in a lea +shiel e !ontainer, an noti#y the ra iology epartment. * patient who is un ergoing ra iation therapy shoul pat his skin ry to avoi abrasions that !oul easily be!ome in#e!te . "uring ra iation therapy, a patient shoul have #requent bloo tests, espe!ially white bloo !ell an platelet !ounts. ,he nurse shoul a minister an aluminum hy ro3i e anta!i at least ' hour a#ter an enteri!+!oate rug be!ause it !an !ause premature release o# the enteri!+!oate rug in the stoma!h. *!i +base balan!e is the bo y6s hy rogen ion !on!entration, a measure o# the ratio o# !arboni! a!i to bi!arbonate ions (' part !arboni! a!i to (2 parts bi!arbonate is normal). *myotrophi! lateral s!lerosis !auses progressive atrophy an wasting o# mus!le groups that eventually a##e!ts the respiratory mus!les. /etaboli! a!i osis is !ause by abnormal loss o# bi!arbonate ions or e3!essive pro u!tion or retention o# a!i ions. 8emianopsia is e#e!tive vision or blin ness in one+hal# o# the visual #iel o# one or both eyes. 9ystemi! lupus erythematosus !auses early+morning 7oint sti##ness an #a!ial erythema in a butter#ly pattern. *#ter total knee repla!ement, the patient shoul remain in the semi+

MEDICAL AND SURGICAL NURSING BULLETS

=owler position, with the a##e!te leg elevate . In a patient who is re!eiving transpylori! #ee ings, the nurse shoul wat!h #or umping syn rome an hypovolemi! sho!k be!ause the stoma!h is being bypasse . I# a total parenteral nutrition in#usion must be interrupte , the nurse shoul a minister e3trose 5E in water at a similar rate. *brupt !essation !an !ause hypogly!emia. 9tatus epilepti!us is treate with I.$. ia0epam ($alium) an phenytoin ("ilantin). "isequilibrium syn rome !auses nausea, vomiting, restlessness, an twit!hing in patients who are un ergoing ialysis. It6s !ause by a rapi #lui shi#t. *n in i!ation that spinal sho!k is resolving is the return o# re#le3 a!tivity in the arms an legs below the level o# in7ury. 8ypovolemia is the most !ommon an #atal !ompli!ation o# severe a!ute pan!reatitis. In a patient with stomatitis, oral !are in!lu es rinsing the mouth with a mi3ture o# equal parts o# hy rogen pero3i e an water three times aily. In otitis me ia, the tympani! membrane is bright re an la!ks its !hara!teristi! light re#le3 (!one o# light). In patients who have peri!ar io!entesis, #lui is aspirate #rom the peri!ar ial sa! #or analysis or to relieve !ar ia! tampona e. Crti!aria is an early sign o# hemolyti! trans#usion rea!tion. "uring peritoneal ialysis, a return o# brown ialysate suggests bowel per#oration. ,he physi!ian shoul be noti#ie imme iately. *n early sign o# ketoa!i osis is polyuria, whi!h is !ause by osmoti! iuresis. %atients who have multiple s!lerosis shoul visually inspe!t their e3tremities to ensure proper alignment an #ree om #rom in7ury. *spirate re bone marrow usually appears rust+re , with visible #atty material an white bone #ragments. ,he "i!k test ete!ts s!arlet #ever antigens an immunity or sus!eptibility to s!arlet #ever. * positive result in i!ates no immunity? a negative result in i!ates immunity. ,he 9!hi!k test ete!ts iphtheria antigens an immunity or sus!eptibility to iphtheria. * positive result in i!ates no immunity? a negative result in i!ates immunity. ,he re!ommen e a ult osage o# su!ral#ate (-ara#ate) #or uo enal ul!er is ' g (' tablet) #our times aily ' hour be#ore meals an at be time. * patient with #a!ial burns or smoke or heat inhalation shoul be a mitte to the hospital #or (4+hour observation #or elaye tra!heal e ema. In a ition to patient tea!hing, preparation #or a !olostomy in!lu es withhol ing oral intake overnight, per#orming bowel preparation, an a ministering a !leansing enema. ,he physiologi! !hanges !ause by burn in7uries !an be ivi e into two stagesG the hypovolemi! stage, uring whi!h intravas!ular #lui shi#ts into the interstitial spa!e, an the iureti! stage, uring whi!h !apillary integrity an intravas!ular volume are restore , usually 41 to A( hours a#ter the in7ury. ,he nurse shoul !hange total parenteral nutrition tubing every (4 hours an the peripheral I.$. a!!ess site ressing every A( hours. * patient whose !arbon mono3i e level is (2E to 32E shoul be treate with '22E humi i#ie o3ygen. :hen in the room o# a patient who is in isolation #or tuber!ulosis, sta## an visitors shoul wear ultra#ilter masks. :hen provi ing skin !are imme iately a#ter pin insertion, the nurse6s primary !on!ern is prevention o# bone in#e!tion. *#ter an amputation, moist skin may in i!ate venous stasis? ry skin may in i!ate arterial obstru!tion. In a patient who is re!eiving ialysis, an internal shunt is working i# the nurse #eels a thrill on palpation or hears a bruit on aus!ultation.

In a patient with viral hepatitis, the paren!hymal, or .up##er6s, !ells o# the liver be!ome severely in#lame , enlarge , an ne!roti!. Early signs o# a!quire immuno e#i!ien!y syn rome in!lu e #atigue, night sweats, enlarge lymph no es, anore3ia, weight loss, pallor, an #ever. :hen !aring #or a patient who has a ra ioa!tive implant, health !are workers shoul stay as #ar away #rom the ra iation sour!e as possible. ,hey shoul remember the a3iom, LI# you ouble the istan!e, you quarter the ose.M * patient who has %arkinson6s isease shoul be instru!te to walk with a broa +base gait. ,he !ar inal signs o# %arkinson6s isease are mus!le rigi ity, a tremor that begins in the #ingers, an akinesia. In a patient with %arkinson6s isease, levo opa ("opar) is pres!ribe to !ompensate #or the opamine e#i!ien!y. * patient who has multiple s!lerosis is at in!rease risk #or pressure ul!ers. %ill+rolling tremor is a !lassi! sign o# %arkinson6s isease. =or a patient with %arkinson6s isease, nursing interventions are palliative. =at embolism, a serious !ompli!ation o# a long+bone #ra!ture, !auses #ever, ta!hy!ar ia, ta!hypnea, an an3iety. /etrorrhagia (blee ing between menstrual perio s) may be the #irst sign o# !ervi!al !an!er. /annitol is a hypertoni! solution an an osmoti! iureti! that6s use in the treatment o# in!rease intra!ranial pressure. ,he !lassi! sign o# an absen!e sei0ure is a va!ant #a!ial e3pression. /igraine hea a!hes !ause persistent, severe pain that usually o!!urs in the temporal region. * patient who is in a bla er retraining program shoul be given an opportunity to voi every ( hours uring the ay an twi!e at night. In a patient with a hea in7ury, a e!rease in level o# !ons!iousness is a !ar inal sign o# in!rease intra!ranial pressure. Ergotamine (Ergomar) is most e##e!tive when taken uring the pro romal phase o# a migraine or vas!ular hea a!he. ,reatment o# a!ute pan!reatitis in!lu es nasogastri! su!tioning to e!ompress the stoma!h an meperi ine ("emerol) #or pain. 9ymptoms o# hiatal hernia in!lu e a #eeling o# #ullness in the upper ab omen or !hest, heartburn, an pain similar to that o# angina pe!toris. ,he in!i en!e o# !holelithiasis is higher in women who have ha !hil ren than in any other group. *!etaminophen (,ylenol) over ose !an severely amage the liver. ,he prominent !lini!al signs o# a van!e !irrhosis are as!ites an 7aun i!e. ,he #irst symptom o# pan!reatitis is stea y epigastri! pain or le#t upper qua rant pain that ra iates #rom the umbili!al area or the ba!k. 9omnambulism is the me i!al term #or sleepwalking. Epinephrine (* renalin) is a vaso!onstri!tor. *n untreate liver la!eration or rupture !an progress rapi ly to

MEDICAL AND SURGICAL NURSING BULLETS

hypovolemi! sho!k. >bstipation is e3treme, intra!table !onstipation !ause by an intestinal obstru!tion. ,he e#initive test #or iagnosing !an!er is biopsy with !ytologi! e3amination o# the spe!imen. *rthrography requires in7e!tion o# a !ontrast me ium an !an i enti#y 7oint abnormalities. &rompton6s !o!ktail is pres!ribe to help relieve pain in patients who have terminal !an!er. * sar!oma is a malignant tumor in !onne!tive tissue. *luminum hy ro3i e (*mpho7el) neutrali0es gastri! a!i . 9ublu3ation is partial islo!ation or separation, with spontaneous re u!tion o# a 7oint. &arbiturates !an !ause !on#usion an who has an organi! brain isor er. elirium in an el erly patient

)raves6 isease (hyperthyroi ism) is mani#este by weight loss, nervousness, yspnea, palpitations, heat intoleran!e, in!rease thirst, e3ophthalmos (bulging eyes), an goiter. ,he #our types o# lipoprotein are !hylomi!rons (the lowest+ ensity lipoproteins), very+low+ ensity lipoproteins, low+ ensity lipoproteins, an high+ ensity lipoproteins. 8ealth !are pro#essionals use !holesterol level #ra!tionation to assess a patient6s risk o# !oronary artery isease. I# a patient who is taking amphoteri!in & (=ungi0one) bla er irrigations #or a #ungal in#e!tion has systemi! !an i iasis an must re!eive I.$. #lu!ona0ole ("i#lu!an), the irrigations !an be is!ontinue be!ause #lu!ona0ole treats the bla er in#e!tion as well. %atients with a ult respiratory istress syn rome !an have high peak inspiratory pressures. ,here#ore, the nurse shoul monitor these patients !losely #or signs o# spontaneous pneumothora3, su!h as a!ute eterioration in o3ygenation, absen!e o# breath soun s on the a##e!te si e, an !repitus beginning on the a##e!te si e. * verse rea!tions to !y!losporine (9an immune) in!lu e renal an hepati! to3i!ity, !entral nervous system !hanges (!on#usion an elirium), )I blee ing, an hypertension. >steoporosis is a metaboli! bone isor er in whi!h the rate o# bone resorption e3!ee s the rate o# bone #ormation. ,he hallmark o# ul!erative !olitis is re!urrent bloo y iarrhea, whi!h !ommonly !ontains pus an mu!us an alternates with asymptomati! remissions. 9a#er se3ual pra!ti!es in!lu e massaging, hugging, bo y rubbing, #rien ly kissing ( ry), masturbating, han +to+genital tou!hing, wearing a !on om, an limiting the number o# se3ual partners. Immunosuppresse patients who !ontra!t !ytomegalovirus (-/$) are at risk #or -/$ pneumonia an septi!emia, whi!h !an be #atal. Crinary tra!t in#e!tions !an !ause urinary urgen!y an #requen!y, ysuria, ab ominal !ramps or bla er spasms, an urethral it!hing. /ammography is a ra iographi! te!hnique that6s use to ete!t breast !ysts or tumors, espe!ially those that aren6t palpable on physi!al e3amination. ,o promote early ete!tion o# testi!ular !an!er, the nurse shoul palpate the testes uring routine physi!al e3aminations an en!ourage the patient to per#orm monthly sel#+e3aminations uring a warm shower. %atients who have thalassemia minor require no treatment. ,hose with thalassemia ma7or require #requent trans#usions o# re bloo !ells. * high level o# hepatitis & serum marker that persists #or 3 months or more a#ter the onset o# a!ute hepatitis & in#e!tion suggests !hroni! hepatitis or !arrier status. Ieurogeni! bla er ys#un!tion is !ause by isruption o# nerve transmission to the bla er. It may be !ause by !ertain spinal !or in7uries, iabetes, or multiple s!lerosis. >3ygen an !arbon io3i e move between the lungs an the bloo stream by i##usion. ,o gra e the severity o# yspnea, the #ollowing system is use G gra e ', shortness o# breath on mil e3ertion, su!h as walking up steps? gra e (, shortness o# breath when walking a short istan!e at a normal pa!e on level groun ? gra e 3, shortness o# breath with mil aily a!tivity, su!h as shaving? gra e 4, shortness o# breath when supine (orthopnea). * patient with -rohn6s isease shoul !onsume a iet low in resi ue, #iber, an #at, an high in !alories, proteins, an !arbohy rates. ,he patient also shoul take vitamin supplements, espe!ially vitamin .. In the three+bottle urine !olle!tion metho , the patient !leans the meatus an urinates '2 to '5 ml in the #irst bottle an '5 to 32 ml (mi stream) in the se!on bottle. ,hen the physi!ian per#orms prostati! massage, an the patient voi s into the thir bottle. =in ings in the three+bottle urine !olle!tion metho are interprete as #ollowsG pus in the urine (pyuria) in the #irst bottle in i!ates anterior urethritis? ba!teria in the urine in the se!on bottle in i!ate bla er in#e!tion? ba!teria in the thir bottle in i!ate prostatitis.

In a patient with arthritis, physi!al therapy is in i!ate to promote optimal #un!tioning. 9ome patients who have hepatitis * may be ani!teri! (without 7aun i!e) an la!k symptoms, but some have hea a!hes, 7aun i!e, anore3ia, #atigue, #ever, an respiratory tra!t in#e!tion. 8epatitis * is usually mil an won6t a van!e to a !arrier state. In the prei!teri! phase o# all #orms o# hepatitis, the patient is highly !ontagious. Enteri! pre!autions are require #or a patient who has hepatitis *. -hole!ystography is ine##e!tive in a patient who has 7aun i!e as a result o# gallbla er isease. ,he liver !ells !an6t transport the !ontrast me ium to the biliary tra!t. In a patient who has iabetes insipi us, ehy ration is a !on!ern be!ause iabetes !auses polyuria. In a patient who has a re u!ible hernia, the protru ing mass spontaneously retra!ts into the ab omen. ,o prevent purple glove syn rome, a nurse shoul n6t a minister I.$. phenytoin ("ilantin) through a vein in the ba!k o# the han , but shoul use a larger vessel. "uring stage III o# surgi!al anesthesia, un!ons!iousness o!!urs an surgery is permitte . ,ypes o# regional anesthesia in!lu e spinal, !au al, inter!ostal, epi ural, an bra!hial ple3us. ,he #irst step in managing rug over ose or rug to3i!ity is to establish an maintain an airway. 5espiratory paralysis o!!urs in stage I$ o# anesthesia (to3i! stage). In stage I o# anesthesia, the patient is !ons!ious an tranquil. "yspnea an sharp, stabbing pain that in!reases with respiration are symptoms o# pleurisy, whi!h !an be a !ompli!ation o# pneumonia or tuber!ulosis. $ertigo is the ma7or symptom o# inner ear in#e!tion or isease. Lou talking is a sign o# hearing impairment. * patient who has an upper respiratory tra!t in#e!tion shoul blow his nose with both nostrils open. * patient who has ha a !atara!t remove !an begin most normal a!tivities in 3 or 4 ays? however, the patient shoul n6t ben an li#t until a physi!ian approves these a!tivities. 9ymptoms o# !orneal transplant re7e!tion in!lu e eye irritation an e!reasing visual #iel .

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resume normal a!tivities, in!lu ing se3ual a!tivity.

'2

9igns an symptoms o# aorti! stenosis in!lu e a lou , rough systoli! murmur over the aorti! area? e3ertional yspnea? #atigue? angina pe!toris? arrhythmias? low bloo pressure? an emboli. Ele!tive surgery is primarily a matter o# !hoi!e. It isn6t essential to the patient6s survival, but it may improve the patient6s health, !om#ort, or sel#+esteem. 5equire surgery is re!ommen e by the physi!ian. It may be elaye , but is inevitable. Crgent surgery must be per#orme within (4 to 41 hours. Emergen!y surgery must be per#orme imme iately. *bout 15E o# arterial emboli originate in the heart !hambers. %ulmonary embolism usually results #rom thrombi islo ge #rom the leg veins. ,he !ons!ious interpretation o# pain o!!urs in the !erebral !orte3. ,o avoi inter#ering with new !ell growth, the ressing on a onor skin gra#t site shoul n6t be isturbe . * sequela is any abnormal !on ition that #ollows an is the result o# a isease, a treatment, or an in7ury. "uring si!kle !ell !risis, patient !are in!lu es be rest, o3ygen therapy, analgesi!s as pres!ribe , I.$. #lui monitoring, an thorough o!umentation o# #lui intake an output. * patient who has an ileal !on uit shoul maintain a aily #lui intake o# (,222 ml. In a !lose !hest rainage system, !ontinuous bubbling in the water seal !hamber or bottle in i!ates a leak. %alpitation is a sensation o# heart poun ing or ra!ing asso!iate with normal emotional responses an !ertain heart isor ers. =at embolism is likely to o!!ur within the #irst (4 hours a#ter a long+ bone #ra!ture. =oot rop !an o!!ur in a patient with a pelvi! #ra!ture as a result o# peroneal nerve !ompression against the hea o# the #ibula. ,o promote venous return a#ter an amputation, the nurse shoul wrap an elasti! ban age aroun the istal en o# the stump. :ater that a!!umulates in the tubing o# a ventilator shoul be remove . ,he most !ommon route #or the a ministration o# epinephrine to a patient who is having a severe allergi! rea!tion is the sub!utaneous route. ,he nurse shoul use =owler6s position #or a patient who has ab ominal pain !ause by appen i!itis. ,he nurse shoul n6t give analgesi!s to a patient who has ab ominal pain !ause by appen i!itis be!ause these rugs may mask the pain that a!!ompanies a rupture appen i3. ,he nurse shoul n6t give analgesi!s to a patient who has ab ominal pain !ause by appen i!itis be!ause these rugs may mask the pain that a!!ompanies a rupture appen i3. *s a last+ it!h e##ort, a barbiturate !oma may be in u!e to reverse unrelenting in!rease intra!ranial pressure (I-%), whi!h is e#ine as a!ute I-% o# greater than 42 mm 8g, persistent elevation o# I-% above (2 mm 8g, or rapi ly eteriorating neurologi! status. ,he primary signs an symptoms o# epiglotti itis are stri or an progressive i##i!ulty in swallowing. 9alivation is the #irst step in the igestion o# star!h. * patient who has a eman pa!emaker shoul measure the pulse rate be#ore rising in the morning, noti#y the physi!ian i# the pulse rate rops by 5 beats/minute, obtain a me i!al i enti#i!ation !ar an bra!elet, an

,ransverse, or loop, !olostomy is a temporary pro!e ure that6s per#orme to ivert the #e!al stream in a patient who has a!ute intestinal obstru!tion. Iormal values #or erythro!yte se imentation rate are 2 to '5 mm/hour #or men younger than age 52 an 2 to (2 mm/hour #or women younger than age 52. * -.+/& level that6s more than 5E o# total -. or more than '2 C/L suggests a myo!ar ial in#ar!tion. %ropranolol (In eral) blo!ks sympatheti! nerve stimuli that in!rease !ar ia! work uring e3er!ise or stress, whi!h re u!es heart rate, bloo pressure, an myo!ar ial o3ygen !onsumption. *#ter a myo!ar ial in#ar!tion, ele!tro!ar iogram !hanges (9,+ segment elevation, ,+wave inversion, an Q+wave enlargement) usually appear in the #irst (4 hours, but may not appear until the 5th or ;th ay. -ar iogeni! sho!k is mani#este by systoli! bloo pressure o# less than 12 mm 8g, gray skin, iaphoresis, !yanosis, weak pulse rate, ta!hy!ar ia or bra y!ar ia, an oliguria (less than 32 ml o# urine per hour). * patient who is re!eiving a low+so ium iet shoul n6t eat !ottage !heese, #ish, !anne beans, !hu!k steak, !ho!olate pu ing, Italian sala ressing, ill pi!kles, an bee# broth. 8igh+potassium #oo s in!lu e rie prunes, watermelon ('5.3 mEq/ portion), rie lima beans ('4.5 mEq/portion), soybeans, bananas, an oranges. .ussmaul6s respirations are #aster an eeper than normal respirations an o!!ur without pauses, as in iabeti! ketoa!i osis. -heyne+9tokes respirations are !hara!teri0e by alternating perio s o# apnea an eep, rapi breathing. ,hey o!!ur in patients with !entral nervous system isor ers. 8yperventilation !an result #rom an in!rease #requen!y o# breathing, an in!rease ti al volume, or both. *pnea is the absen!e o# spontaneous respirations. &e#ore a thyroi e!tomy, a patient may re!eive potassium io i e, antithyroi rugs, an propranolol (In eral) to prevent thyroi storm uring surgery. ,he normal li#e span o# re bloo !ells (erythro!ytes) is ''2 to '(2 ays. $isual a!uity o# (2/'22 means that the patient sees at (2R (; m) what a person with normal vision sees at '22R (32 m). Crinary tra!t in#e!tions are more !ommon in girls an women than in boys an men be!ause the shorter urethra in the #emale urinary tra!t makes the bla er more a!!essible to ba!teria, espe!ially Es!heri!hia !oli. %eni!illin is a ministere orally ' to ( hours be#ore meals or ( to 3 hours a#ter meals be!ause #oo may inter#ere with the rug6s absorption. /il rea!tions to lo!al anestheti!s may in!lu e palpitations, tinnitus, vertigo, apprehension, !on#usion, an a metalli! taste in the mouth. *bout ((E o# !ar ia! output goes to the ki neys. ,o ensure a!!urate !entral venous pressure rea ings, the nurse shoul pla!e the manometer or trans u!er level with the phlebostati! a3is. * patient who has lost (,222 to (,522 ml o# bloo will have a pulse rate o# '42 beats/minute (or higher), isplay a systoli! bloo pressure o# 52 to ;2 mm 8g, an appear !on#use an lethargi!. *rterial bloo is bright re , #lows rapi ly, an (be!ause it6s pumpe ire!tly #rom the heart) spurts with ea!h heartbeat. $enous bloo is ark re an ten s to oo0e #rom a woun . >rthostati! bloo pressure is taken with the patient in the supine,

MEDICAL AND SURGICAL NURSING BULLETS

sitting, an stan ing positions, with ' minute between ea!h rea ing. * '2+mm 8g e!rease in bloo pressure or an in!rease in pulse rate o# '2 beats/ minute suggests volume epletion. * pneumati! antisho!k garment shoul be use !autiously in pregnant women an patients with hea in7uries. *#ter a patient6s !ir!ulating volume is restore , the nurse shoul remove the pneumati! antisho!k garment gra ually, starting with the ab ominal !hamber an #ollowe by ea!h leg. ,he garment shoul be remove un er a physi!ian6s supervision. /ost hemolyti! trans#usion rea!tions asso!iate with mismat!hing o# *&> bloo types stem #rom i enti#i!ation number errors. :arming o# bloo to more than '2A@ = (4'.A@ -) !an !ause hemolysis. -ar ia! output is the amount o# bloo e7e!te #rom the heart ea!h minute. It6s e3presse in liters per minute. 9troke volume is the volume o# bloo e7e!te #rom the heart uring systole. ,otal parenteral nutrition solution !ontains e3trose, amino a!i s, an a itives, su!h as ele!trolytes, minerals, an vitamins. ,he most !ommon type o# neurogeni! sho!k is spinal sho!k. It usually o!!urs 32 to ;2 minutes a#ter a spinal !or in7ury. *#ter a spinal !or in7ury, peristalsis stops within (4 hours an usually returns within 3 to 4 ays. ,o3i! sho!k syn rome is mani#este by a temperature o# at least '2(@ = (31.1@ -), an erythematous rash, an systoli! bloo pressure o# less than B2 mm 8g. =rom ' to ( weeks a#ter the onset o# these signs, esquamation (espe!ially on the palms an soles) o!!urs. ,he signs an symptoms o# anaphyla3is are !ommonly !ause by histamine release. ,he most !ommon !ause o# septi! sho!k is gram+negative ba!teria, su!h as Es!heri!hia !oli, .lebsiella, an %seu omonas organisms. &ruits are vas!ular soun s that resemble heart murmurs an result #rom turbulent bloo #low through a isease or partially obstru!te artery. Crine p8 is normally 4.5 to 1.2. Crine p8 o# greater than 1.2 !an result #rom a urinary tra!t in#e!tion, a high+alkali iet, or systemi! alkalosis. Crine p8 o# less than 4.5 may be !ause by a high+protein iet, #ever, or metaboli! a!i osis. &e#ore a per!utaneous renal biopsy, the patient shoul be pla!e on a #irm sur#a!e an positione on the ab omen. * san bag is pla!e un er the ab omen to stabili0e the ki neys. Iephroti! syn rome is !hara!teri0e by marke proteinuria, hypoalbuminemia, mil to severe epen ent e ema, as!ites, an weight gain. Cn erwater e3er!ise is a #orm o# therapy per#orme in a 8ubbar tank. /ost women with tri!homoniasis have a malo orous, #rothy, greenish gray vaginal is!harge. >ther women may have no signs or symptoms. $oi ing !ystourethrography may be per#orme to ete!t bla er an urethral abnormalities. -ontrast me ium is instille by gentle syringe pressure through a urethral !atheter, an overhea <+ray #ilms are taken to visuali0e bla er #illing an e3!retion. -ystourethrography may be per#orme to i enti#y the !ause o# urinary tra!t in#e!tions, !ongenital anomalies, an in!ontinen!e. It also is use to assess #or prostate lobe hypertrophy in men. 8erpes simple3 is !hara!teri0e by re!urrent episo es o# blisters on the skin an mu!ous membranes. It has two variations. In type ', the blisters appear in the nasolabial region? in type (, they appear on the genitals, anus, butto!ks, an thighs.

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/ost patients with -hlamy ia tra!homatis in#e!tion are asymptomati!, but some have an in#lame urethral meatus, ysuria, an urinary urgen!y an #requen!y. ,he hypothalamus regulates the autonomi! nervous system an en o!rine #un!tions. * patient whose !hest e3!ursion is less than normal (3D to ;D NA.5 to '5 !mO) must use a!!essory mus!les to breathe. 9igns an symptoms o# to3i!ity #rom thyroi repla!ement therapy in!lu e rapi pulse rate, iaphoresis, irritability, weight loss, ysuria, an sleep isturban!e. ,he most !ommon allergi! rea!tion to peni!illin is a rash. *n early sign o# aspirin to3i!ity is eep, rapi respirations. ,he most serious an irreversible !onsequen!e o# lea poisoning is mental retar ation, whi!h results #rom neurologi! amage. ,o assess ehy ration in the a ult, the nurse shoul !he!k skin turgor on the sternum. =or a patient with a pepti! ul!er, the type o# iet is less important than in!lu ing #oo s in the iet that the patient !an tolerate. * patient with a !olostomy must establish an irrigation s!he ule so that regular emptying o# the bowel o!!urs without stomal is!harge between irrigations. :hen using rotating tourniquets, the nurse shoul n6t restri!t the bloo supply to an arm or leg #or more than 45 minutes at a time. * patient with iabetes shoul eat high+#iber #oo s be!ause they blunt the rise in glu!ose level that normally #ollows a meal. Sugular vein istention o!!urs in patients with heart #ailure be!ause the le#t ventri!le !an6t empty the heart o# bloo as #ast as bloo enters #rom the right ventri!le, resulting in !ongestion in the entire venous system. ,he lea ing !auses o# blin ness in the Cnite 9tates are iabetes mellitus an glau!oma. *#ter a thyroi e!tomy, the patient shoul remain in the semi+=owler position, with his hea neither hypere3ten e nor hyper#le3e , to avoi pressure on the suture line. ,his position !an be a!hieve with the use o# a !ervi!al pillow. %remenstrual syn rome may !ause ab ominal istention, engorge an pain#ul breasts, ba!ka!he, hea a!he, nervousness, irritability, restlessness, an tremors. ,reatment o# ehis!en!e (pathologi! opening o# a woun ) !onsists o# !overing the woun with a moist sterile ressing an noti#ying the physi!ian. :hen a patient has a ra i!al maste!tomy, the ovaries also may be remove be!ause they are a sour!e o# estrogen, whi!h stimulates tumor growth. *tropine blo!ks the e##e!ts o# a!etyl!holine, thereby obstru!ting its vagal e##e!ts on the sinoatrial no e an in!reasing heart rate. 9ali!ylates, parti!ularly aspirin, are the treatment o# !hoi!e in rheumatoi arthritis be!ause they e!rease in#lammation an relieve 7oint pain. "eep, intense pain that usually worsens at night an is unrelate to movement suggests bone pain. %ain that #ollows prolonge or e3!essive e3er!ise an subsi es with rest suggests mus!le pain. ,he ma7or hemo ynami! !hanges asso!iate with !ar iogeni! sho!k are e!rease le#t ventri!ular #un!tion an e!rease !ar ia! output. &e#ore thyroi e!tomy, the patient shoul be a vise that he may e3perien!e hoarseness or loss o# his voi!e #or several ays a#ter surgery.

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a##e!te si e to promote lung e3pansion on the una##e!te si e.

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*!!eptable a verse e##e!ts o# long+term steroi use in!lu e weight gain, a!ne, hea a!hes, #atigue, an in!rease urine retention. Cna!!eptable a verse e##e!ts o# long+term steroi use are i00iness on rising, nausea, vomiting, thirst, an pain. *#ter a !raniotomy, nursing !are in!lu es maintaining normal intra!ranial pressure, maintaining !erebral per#usion pressure, an preventing in7ury relate to !erebral an !ellular is!hemia. =oli! a!i an vitamin &'( are essential #or nu!leoprotein synthesis an re bloo !ell maturation. Imme iately a#ter intra!ranial surgery, nursing !are in!lu es not giving the patient anything by mouth until the gag an !ough re#le3es return, monitoring vital signs an assessing the level o# !ons!iousness (L>-) #or signs o# in!reasing intra!ranial pressure, an a ministering analgesi!s that on6t mask the L>-. -hest physiotherapy in!lu es postural rainage, !hest per!ussion an vibration, an !oughing an eep+breathing e3er!ises. -ushing6s syn rome results #rom e3!essive levels o# a reno!orti!al hormones an is mani#este by #at pa s on the #a!e (moon #a!e) an over the upper ba!k (bu##alo hump), a!ne, moo swings, hirsutism, amenorrhea, an e!rease libi o. ,o prevent an a isonian !risis when is!ontinuing long+term pre nisone ("eltasone) therapy, the nurse shoul taper the ose slowly to allow #or monitoring o# isease #lare+ups an #or the return o# hypothalami!+pituitary+a renal #un!tion. %ulsus para o3us is a pulse that be!omes weak uring inspiration an strong uring e3piration. It may be a sign o# !ar ia! tampona e. 9ubstan!es that are e3pelle through portals o# e3it in!lu e saliva, mu!us, #e!es, urine, vomitus, bloo , an vaginal an penile is!harges. * mi!roorganism may be transmitte ire!tly, by !onta!t with an in#e!te bo y or roplets, or in ire!tly, by !onta!t with !ontaminate air, soil, water, or #lui s. * postmenopausal woman who re!eives estrogen therapy is at an in!rease risk #or gallbla er isease an breast !an!er. ,he appro3imate o3ygen !on!entrations elivere by a nasal !annula are as #ollowsG ' L H (4E, ( L H (1E, 3 L H 3(E, 4 LH 3;E, an 5 L H 42E. -ar inal #eatures o# iabetes insipi us in!lu e poly ipsia (e3!essive thirst) an polyuria (in!rease urination to 5 L/(4 hours). * patient with low spe!i#i! gravity ('.22' to '.225) may have an in!rease esire #or !ol water. "iabeti! !oma !an o!!ur when the bloo glu!ose level rops below ;2 mg/ l. =or a patient with heart #ailure, the nurse shoul elevate the hea o# the be 1D to '(D ((2 to 32 !m), provi e a be si e !ommo e, an a minister !ar ia! gly!osi es an iureti!s as pres!ribe . ,he primary reason to treat strepto!o!!al sore throat with antibioti!s is to prote!t the heart valves an prevent rheumati! #ever. * patient with a nasal #ra!ture may lose !ons!iousness uring re u!tion. 8oarseness an !hange in the voi!e are !ommonly the #irst signs o# laryngeal !an!er. ,he lungs, !olon, an re!tum are among the most !ommon !an!er sites. ,he most !ommon preoperative problem in el erly patients is lower+ than+normal total bloo volume. /annitol (>smitrol), an osmoti! iureti!, is a ministere to re u!e intrao!ular or intra!ranial pressure. :hen a stroke is suspe!te , the nurse shoul pla!e the patient on the

=or a patient who has ha !hest surgery, the nurse shoul re!ommen sitting upright an per#orming !oughing an eep+breathing e3er!ises. ,hese a!tions promote e3pansion o# the lungs, removal o# se!retions, an optimal pulmonary #un!tioning. "uring every sleep !y!le, the sleeper passes through #our stages o# nonrapi +eye+movement sleep an one stage o# rapi +eye+movement sleep. * patient who is taking !al!i#e iol (-al erol) shoul avoi !on!omitant use o# preparations that !ontain vitamin ". * patient shoul begin an en a (4+hour urine !olle!tion perio with an empty bla er. =or e3ample, i# the physi!ian or ers urine to be !olle!te #rom 2122 ,hurs ay to 2122 =ri ay, the urine voi e at 2122 ,hurs ay shoul be is!ar e an the urine voi e at 2122 =ri ay shoul be retaine . In a patient who is re!eiving igo3in (Lano3in), a low potassium level in!reases the risk o# igo3in to3i!ity. &loo urea nitrogen values normally range #rom '2 to (2 mg/ l. =lura0epam ("almane) to3i!ity is mani#este by !on#usion, hallu!inations, an ata3ia. * silent myo!ar ial in#ar!tion is one that has no symptoms. * verse rea!tions to verapamil (Isoptin) in!lu e i00iness, hea a!he, !onstipation, hypotension, an atrioventri!ular !on u!tion isturban!es. ,he rug also may in!rease the serum igo3in level. :hen a re!tal tube is use to relieve #latulen!e or enhan!e peristalsis, it shoul be inserte #or no longer than (2 minutes. Pellowish green is!harge on a woun an shoul be !ulture . ressing in i!ates in#e!tion

9i!kle !ell !risis !an !ause severe ab ominal, thora!i!, mus!ular, an bone pain along with pain#ul swelling o# so#t tissue in the han s an #eet. >ral !an i iasis (thrush) is !hara!teri0e by !ream+!olore or bluish white pat!hes on the oral mu!ous membrane. ,reatment #or a patient with !ysti! #ibrosis may in!lu e rug therapy, e3er!ises to improve breathing an posture, e3er!ises to #a!ilitate mobili0ation o# pulmonary se!retions, a high+salt iet, an pan!reati! en0yme supplements with sna!ks an meals. %an!reati! !an!er may !ause weight loss, 7aun i!e, an intermittent ull+to+severe epigastri! pain. /etastasis is the sprea o# !an!er #rom one organ or bo y part to another through the lymphati! system, !ir!ulation system, or !erebrospinal #lui . ,he management o# pulmonary e ema #o!uses on opening the airways, supporting ventilation an per#usion, improving !ar ia! #un!tioning, re u!ing preloa , an re u!ing patient an3iety. =a!tors that !ontribute to the eath o# patients with *l0heimer6s isease in!lu e in#e!tion, malnutrition, an ehy ration. 8o gkin6s isease is !hara!teri0e by painless, progressive enlargement o# !ervi!al lymph no es an other lymphoi tissue as a result o# proli#eration o# 5ee +9ternberg !ells, histio!ytes, an eosinophils. 8untington6s isease (!horea) is a here itary isease !hara!teri0e by egeneration in the !erebral !orte3 an basal ganglia. * patient with 8untington6s isease may e3hibit sui!i al i eation. *t is!harge, an amputee shoul be able to emonstrate proper stump !are an per#orm stump+toughening e3er!ises. *!ute tubular ne!rosis is the most !ommon !ause o# a!ute renal #ailure.

MEDICAL AND SURGICAL NURSING BULLETS

the patient to !lose his eyes, o!!lu e one nostril, an i enti#y a nonirritating substan!e (su!h as peppermint or !innamon) by smell. ,hen the nurse shoul repeat the test with the patient6s other nostril o!!lu e . 9alk an 9abin intro u!e the oral polio va!!ine.

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-ommon !ompli!ations o# i!e water lavage are vomiting an aspiration. =oo s high in vitamin " in!lu e #orti#ie milk, #ish, liver, liver oil, herring, an egg yolk. =or a pelvi! e3amination, the patient shoul be in the lithotomy position, with the butto!ks e3ten ing (TD (;.4 !m) past the en o# the e3amination table. I# a patient !an6t assume the lithotomy position #or a pelvi! e3amination, she may lie on her le#t si e. * male e3aminer shoul have a #emale assistant present uring a vaginal e3amination #or the patient6s emotional !om#ort an the e3aminer6s legal prote!tion. -ervi!al se!retions are !lear an stret!hy be#ore ovulation an white an opaque a#ter ovulation. ,hey6re normally o orless an on6t irritate the mu!osa. * patient with an ileostomy shoul n6t eat !orn be!ause it may obstru!t the opening o# the pou!h. Liver ys#un!tion a##e!ts the metabolism o# !ertain rugs. E ema that a!!ompanies burns an malnutrition is !ause by e!rease osmoti! pressure in the !apillaries. 8yponatremia is most likely to o!!ur as a !ompli!ation o# nasogastri! su!tioning. In a man who has !omplete spinal !or separation at 94, ere!tion an e7a!ulation aren6t possible. ,he early signs o# pulmonary e ema ( yspnea on e3ertion an !oughing) re#le!t interstitial #lui a!!umulation an e!rease ventilation an alveolar per#usion. /ethylpre nisolone (9olu+/e rol) is a #irst+line rug use to !ontrol e ema a#ter spinal !or trauma. =or the patient who is re!overing #rom an intra!ranial blee , the nurse shoul maintain a quiet, rest#ul environment #or the #irst #ew ays. Ieurosyphilis is asso!iate with wi esprea amage to the !entral nervous system, in!lu ing general paresis, personality !hanges, slapping gait, an blin ness. * woman who has ha a spinal !or in7ury !an still be!ome pregnant. In a patient who has ha a stroke, the most serious !ompli!ation is in!reasing intra!ranial pressure. * patient with an intra!ranial hemorrhage shoul un ergo arteriography to i enti#y the site o# the blee ing. =a!tors that a##e!t the a!tion o# rugs in!lu e absorption, istribution, metabolism, an e3!retion. &e#ore pres!ribing a rug #or a woman o# !hil bearing age, the pres!riber shoul ask #or the ate o# her last menstrual perio an ask i# she may be pregnant. *!i osis may !ause insulin resistan!e. * patient with glu!ose+;+phosphate ehy rogenase e#i!ien!y may have a!ute hemolyti! anemia when given a sul#onami e. ,he #ive basi! a!tivities o# the igestive system are ingestion, movement o# #oo , igestion, absorption, an e#e!ation. 9igns an symptoms o# a!ute pan!reatitis in!lu e epigastri! pain, vomiting, bluish is!oloration o# the le#t #lank ()rey ,urner6s sign), bluish is!oloration o# the periumbili!al area (-ullen6s sign), low+gra e #ever, ta!hy!ar ia, an hypotension. * patient with a gastri! ul!er may have gnawing or burning epigastri! pain. ,o test the #irst !ranial nerve (ol#a!tory nerve), the nurse shoul ask

* patient with a isease o# the !erebellum or posterior !olumn has an ata3i! gait that6s !hara!teri0e by staggering an inability to remain stea y when stan ing with the #eet together. In trauma patients, improve out!ome is ire!tly relate to early resus!itation, aggressive management o# sho!k, an appropriate e#initive !are. ,o !he!k #or leakage o# !erebrospinal #lui , the nurse shoul inspe!t the patient6s nose an ears. I# the patient !an sit up, the nurse shoul observe him #or leakage as the patient leans #orwar . Lo!ke +in syn rome is !omplete paralysis as a result o# brain stem amage. >nly the eyes !an be move voluntarily. Ie!k isse!tion, or surgi!al removal o# the !ervi!al lymph no es, is per#orme to prevent the sprea o# malignant tumors o# the hea an ne!k. * patient with !hole!ystitis typi!ally has right epigastri! pain that may ra iate to the right s!apula or shoul er? nausea? an vomiting, espe!ially a#ter eating a heavy meal. *tropine is use preoperatively to re u!e se!retions. 9erum !al!ium levels are normally 4.5 to 5.5 mEq/L. 9uppressor , !ells regulate overall immune response. 9erum levels o# aspartate aminotrans#erase an alanine aminotrans#erase show whether the liver is a equately eto3i#ying rugs. 9erum so ium levels are normally '35 to '45 mEq/L. 9erum potassium levels are normally 3.5 to 5.2 mEq/L. * patient who is taking pre nisone ("eltasone) shoul !onsume a salt+ restri!te iet that6s ri!h in potassium an protein. :hen per#orming !ontinuous ambulatory peritoneal ialysis, the nurse must use sterile te!hnique when han ling the !atheter, sen a peritoneal #lui sample #or !ulture an sensitivity testing every (4 hours, an report signs o# in#e!tion an #lui imbalan!e. :hen working with patients who have a!quire immuno e#i!ien!y syn rome, the nurse shoul wear goggles an a mask only i# bloo or another bo y #lui !oul splash onto the nurse6s #a!e. &loo spills that are in#e!te with human immuno e#i!ien!y virus shoul be !leane up with a 'G'2 solution o# so ium hypo!hlorite 5.(5E (househol blea!h). 5aynau 6s phenomenon is intermittent is!hemi! atta!ks in the #ingers or toes. It !auses severe pallor an sometimes paresthesia an pain. Intussus!eption (prolapse o# one bowel segment into the lumen o# another) !auses su en epigastri! pain, sausage+shape ab ominal swelling, passage o# mu!us an bloo through the re!tum, sho!k, an hypotension. &en!e Sones protein o!!urs almost e3!lusively in the urine o# patients who have multiple myeloma. )au!her6s isease is an autosomal isor er that6s !hara!teri0e by abnormal a!!umulation o# glu!o!erebrosi es (lipi substan!es that !ontain glu!ose) in mono!ytes an ma!ro!ytes. It has three #ormsG ,ype ' is the a ult #orm, type ( is the in#antile #orm, an type 3 is the 7uvenile #orm. * patient with !olon obstru!tion may have lower ab ominal pain, !onstipation, in!reasing istention, an vomiting. -ol!hi!ine (-olsali e) relieves in#lammation an is use to treat gout.

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9ome people have gout as a result o# hyperuri!emia be!ause they !an6t metaboli0e an e3!rete purines normally. * normal sperm !ount is (2 to '52 million/ml. * #irst+ egree burn involves the stratum !orneum layer o# the epi ermis an !auses pain an re ness. 9heehan6s syn rome is hypopituitarism !ause by a pituitary in#ar!t a#ter postpartum sho!k an hemorrhage. :hen !aring #or a patient who has ha an asthma atta!k, the nurse shoul pla!e the patient in =owler6s or semi+=owler6s position. In el erly patients, the in!i en!e o# non!omplian!e with pres!ribe rug therapy is high. /any el erly patients have iminishe visual a!uity, hearing loss, or #orget#ulness, or nee to take multiple rugs. ,uber!ulosis is a reportable !ommuni!able isease that6s !ause by in#e!tion with /y!oba!terium tuber!ulosis (an a!i +#ast ba!illus). =or right+si e !ar ia! !atheteri0ation, the physi!ian passes a multilumen !atheter through the superior or in#erior vena !ava. *#ter a #ra!ture, bone healing o!!urs in these stagesG hematoma #ormation, !ellular proli#eration an !allus #ormation, an ossi#i!ation an remo eling. * patient who is s!he ule #or positron emission tomography shoul avoi al!ohol, toba!!o, an !a##eine #or (4 hours be#ore the test. In a stroke, e!rease o3ygen estroys brain !ells. * patient with glau!oma shoul n6t re!eive atropine sul#ate be!ause it in!reases intrao!ular pressure. ,he nurse shoul instru!t a patient who is hyperventilating to breathe into a paper bag. "uring intermittent positive+pressure breathing, the patient shoul bite own on the mouthpie!e, breathe normally, an let the ma!hine o the work. *#ter inspiration, the patient shoul hol his breath #or 3 or 4 se!on s an e3hale !ompletely through the mouthpie!e. =le3ion !ontra!tures o# the hips may o!!ur in a patient who sits in a wheel!hair #or a long time. Iystagmus is rapi hori0ontal or rotating eye movement. *#ter myelography, the patient shoul remain re!umbent #or (4 hours. ,he treatment o# sprains an strains !onsists o# applying i!e imme iately an elevating the arm or leg above heart level. *n anti!holinesterase agent shoul n6t be pres!ribe #or a patient who is taking morphine be!ause it !an potentiate the e##e!t o# morphine an !ause respiratory epression. /yopia is nearsighte ness. 8yperopia an presbyopia are two types o# #arsighte ness. ,he most e##e!tive !ontra!eptive metho is one that the woman sele!ts #or hersel# an uses !onsistently. ,o per#orm :eber6s test #or bone !on u!tion, a vibrating tuning #ork is pla!e on top o# the patient6s hea at mi line. ,he patient shoul per!eive the soun equally in both ears. In a patient who has !on u!tive hearing loss, the soun is hear in (laterali0es to) the ear that has !on u!tive loss. In the 5inne test, bone !on u!tion is teste by pla!ing a vibrating tuning #ork on the mastoi pro!ess o# the temporal bone an air !on u!tion is teste by hol ing the vibrating tuning #ork TD ('.3 !m) #rom the e3ternal au itory meatus. ,hese tests are alternate , at i##erent #requen!ies, until the tuning #ork is no longer hear at one position. *#ter an amputation, the stump may shrink be!ause o# mus!le atrophy an e!rease sub!utaneous #at. * patient who has eep vein thrombosis is given heparin #or A to '2 ays, #ollowe by '( weeks o# war#arin (-ouma in) therapy.

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*#ter pneumone!tomy, the patient shoul be positione on the operative si e or on his ba!k, with his hea slightly elevate . ,o re u!e the possibility o# #ormation o# new emboli or e3pansion o# e3isting emboli, a patient with eep vein thrombosis shoul re!eive heparin. *theros!lerosis is the most !ommon !ause o# !oronary artery isease. It usually involves the aorta an the #emoral, !oronary, an !erebral arteries. %ulmonary embolism is a potentially #atal !ompli!ation o# eep vein thrombosis. -hest pain is the most !ommon symptom o# pulmonary embolism. ,he nurse shoul in#orm a patient who is taking phena0opyri ine (%yri ium) that this rug !olors urine orange or re . %neumothora3 is a serious !ompli!ation o# !entral venous line pla!ement? it6s !ause by ina vertent lung pun!ture. %neumo!ystis !arinii pneumonia isn6t !onsi ere !ontagious be!ause it only a##e!ts patients who have a suppresse immune system. ,o enhan!e rug absorption, the patient shoul take regular erythromy!in tablets with a #ull glass o# water ' hour be#ore or ( hours a#ter a meal or shoul take enteri!+!oate tablets with #oo . ,he patient shoul avoi taking either type o# tablet with #ruit 7ui!e. ,rismus, a sign o# tetanus (lo!k7aw), !auses pain#ul spasms o# the masti!atory mus!les, i##i!ulty opening the mouth, ne!k rigi ity an sti##ness, an ysphagia. ,he nurse shoul pla!e the patient in an upright position #or thora!entesis. I# this isn6t possible, the nurse shoul position the patient on the una##e!te si e. I# gravity #low is use , the nurse shoul hang a bloo bag 3R (' m) above the level o# the planne venipun!ture site. ,he nurse shoul pla!e a patient who has a !lose !hest rainage system in the semi+=owler position. I# bloo isn6t trans#use within 32 minutes, the nurse shoul return it to the bloo bank be!ause the re#rigeration #a!ilities on a nursing unit are ina equate #or storing bloo pro u!ts. &loo that6s is!olore an !ontains gas bubbles is !ontaminate with ba!teria an shoul n6t be trans#use . =i#ty per!ent o# patients who re!eive !ontaminate bloo ie. =or massive, rapi bloo trans#usions an #or e3!hange trans#usions in neonates, bloo shoul be warme to B1.A@ = (3A@ -). * !hest tube permits air an #lui to rain #rom the pleural spa!e. * han hel resus!itation bag is an in#latable evi!e that !an be atta!he to a #a!e mask or an en otra!heal or tra!heostomy tube. It allows manual elivery o# o3ygen to the lungs o# a patient who !an6t breathe in epen ently. /e!hani!al ventilation arti#i!ially !ontrols or assists respiration. ,he nurse shoul en!ourage a patient who has a !lose !hest rainage system to !ough #requently an breathe eeply to help rain the pleural spa!e an e3pan the lungs. ,ra!heal su!tion removes se!retions #rom the tra!hea an bron!hi with a su!tion !atheter. "uring !olostomy irrigation, the irrigation bag shoul be hung '1D (45.A !m) above the stoma. ,he water use #or !olostomy irrigation shoul be '22@ to '25@ = (3A.1@ to 42.;@ -). *n arterial embolism may !ause pain, loss o# sensory nerves, pallor, !oolness, paralysis, pulselessness, or paresthesia in the a##e!te arm or leg. 5espiratory alkalosis results #rom !on itions that !ause

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hyperventilation an re u!e the !arbon io3i e level in the arterial bloo . /ineral oil is !ontrain i!ate in a patient with appen i!itis, a!ute surgi!al ab omen, #e!al impa!tion, or intestinal obstru!tion. :hen using a P+type a ministration set to trans#use pa!ke re bloo !ells (5&-s), the nurse !an a normal saline solution to the bag to ilute the 5&-s an make them less vis!ous. *utotrans#usion is !olle!tion, #iltration, an rein#usion o# the patient6s own bloo . %repare I.$. solutions #all into three general !ategoriesG isotoni!, hypotoni!, an hypertoni!. Isotoni! solutions have a solute !on!entration that6s similar to bo y #lui s? a ing them to plasma oesn6t !hange its osmolarity. 8ypotoni! solutions have a lower osmoti! pressure than bo y #lui s? a ing them to plasma e!reases its osmolarity. 8ypertoni! solutions have a higher osmoti! pressure than bo y #lui s? a ing them to plasma in!reases its osmolarity. 9tress in!ontinen!e is involuntary leakage o# urine triggere by a su en physi!al strain, su!h as a !ough, snee0e, or qui!k movement. "e!rease renal #un!tion makes an el erly patient more sus!eptible to the evelopment o# renal !al!uli. ,he nurse shoul !onsi er using shorter nee les to in7e!t rugs in el erly patients be!ause these patients e3perien!e sub!utaneous tissue re istribution an loss in areas, su!h as the butto!ks an eltoi mus!les. Crge in!ontinen!e is the inability to suppress a su en urge to urinate.

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"ebri ement is me!hani!al, !hemi!al, or surgi!al removal o# ne!roti! tissue #rom a woun . 9evere pain a#ter !atara!t surgery in i!ates blee ing in the eye. * bivalve !ast is !ut into anterior an posterior portions to allow skin inspe!tion. *#ter ear irrigation, the nurse shoul pla!e the patient on the a##e!te si e to permit gravity to rain #lui that remains in the ear. I# a patient with an in welling !atheter has ab ominal is!om#ort, the nurse shoul assess #or bla er istention, whi!h may be !ause by !atheter blo!kage. -ontinuous bla er irrigation helps prevent urinary tra!t obstru!tion by #lushing out small bloo !lots that #orm a#ter prostate or bla er surgery. ,he nurse shoul remove an in welling !atheter when bla er e!ompression is no longer nee e , when the !atheter is obstru!te , or when the patient !an resume voi ing. ,he longer a !atheter remains in pla!e, the greater the risk o# urinary tra!t in#e!tion. In an a ult, the e3tent o# a burn in7ury is etermine by using the 5ule o# IinesG the hea an ne!k are !ounte as BE? ea!h arm, as BE? ea!h leg, as '1E? the ba!k o# the trunk, as '1E? the #ront o# the trunk, as '1E? an the perineum, as 'E. * eep partial+thi!kness burn a##e!ts the epi ermis an ermis.

,otal in!ontinen!e is !ontinuous, un!ontrollable leakage o# urine as a result o# the bla er6s inability to retain urine. %rotein, vitamin, an mineral nee s usually remain !onstant as a person ages, but !alori! requirements e!rease. =our valves keep bloo #lowing in one ire!tion in the heartG two atrioventri!ular valves (tri!uspi an mitral) an two semilunar valves (pulmoni! an aorti!). *n el erly patient6s height may e!rease be!ause o# narrowing o# the intervertebral spa!es an e3aggerate spinal !urvature. -onstipation most !ommonly o!!urs when the urge to e#e!ate is suppresse an the mus!les asso!iate with bowel movements remain !ontra!te . )out evelops in #our stagesG asymptomati!, a!ute, inter!riti!al, an !hroni!. -ommon postoperative !ompli!ations in!lu e hemorrhage, in#e!tion, hypovolemia, septi!emia, septi! sho!k, atele!tasis, pneumonia, thrombophlebitis, an pulmonary embolism. *n insulin pump elivers a !ontinuous in#usion o# insulin into a sele!te sub!utaneous site, !ommonly in the ab omen. * !ommon symptom o# sali!ylate (aspirin) to3i!ity is tinnitus (ringing in the ears). * #rostbitten e3tremity must be thawe rapi ly, even i# e#initive treatment must be elaye . * patient with 5aynau 6s isease shoul n6t smoke !igarettes or other toba!!o pro u!ts. 5aynau 6s isease is a primary arteriospasti! isor er that has no known !ause. 5aynau 6s phenomenon, however, is !ause by another isor er su!h as s!lero erma. ,o remove a #oreign bo y #rom the eye, the nurse shoul irrigate the eye with sterile normal saline solution. :hen irrigating the eye, the nurse shoul the lower !on7un!tival sa!. ire!t the solution towar

In a patient who is having an asthma atta!k, nursing interventions in!lu e a ministering o3ygen an bron!ho ilators as pres!ribe , pla!ing the patient in the semi+=owler position, en!ouraging iaphragmati! breathing, an helping the patient to rela3. %rostate !an!er is usually #atal i# bone metastasis o!!urs. * stri!t vegetarian nee s vitamin &'( supplements be!ause animals an animal pro u!ts are the only sour!e o# this vitamin. 5egular insulin is the only type o# insulin that !an be mi3e with other types o# insulin an !an be given I.$. I# a patient pulls out the outer tra!heostomy tube, the nurse shoul hol the tra!heostomy open with a surgi!al ilator until the physi!ian provi es appropriate !are. ,he me ulla oblongata is the part o# the brain that !ontrols the respiratory !enter. =or an un!ons!ious patient, the nurse shoul per#orm passive range+ o#+motion e3er!ises every ( to 4 hours. * time +release rug isn6t re!ommen e #or use in a patient who has an ileostomy be!ause it releases the rug at i##erent rates along the )I tra!t. ,he nurse isn6t require to wear gloves when applying nitrogly!erin paste? however, she shoul wash her han s a#ter applying this rug. &e#ore e3!retory urography, a patient6s #lui intake is usually restri!te a#ter mi night. * so ium polystyrene sul#onate (.aye3alate) enema, whi!h e3!hanges so ium ions #or potassium ions, is use to e!rease the potassium level in a patient who has hyperkalemia. I# the !olor o# a stoma is mu!h lighter than when previously assesse , e!rease !ir!ulation to the stoma shoul be suspe!te . /assage is !ontrain i!ate in a leg with a bloo !lot be!ause it may islo ge the !lot. ,he #irst pla!e a nurse !an ete!t 7aun i!e in an a ult is in the s!lera. Saun i!e is !ause by e3!essive levels o# !on7ugate or un!on7ugate bilirubin in the bloo . /y riati! rugs are use primarily to ilate the pupils #or intrao!ular e3aminations.

Emergen!y !are #or a !orneal in7ury !ause by a !austi! substan!e is #lushing the eye with !opious amounts o# water #or (2 to 32 minutes.

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be!ause they are lan marks #or treatment. ,he most !ommon symptom o# osteoarthritis is 7oint pain that6s relieve by rest, espe!ially i# the pain o!!urs a#ter e3er!ise or weight bearing.

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*#ter eye surgery, the patient shoul be pla!e on the una##e!te si e. :hen assigning tasks to a li!ense pra!ti!al nurse, the registere nurse shoul elegate tasks that are !onsi ere be si e nursing !are, su!h as taking vital signs, !hanging simple ressings, an giving baths. "eep !al# pain on orsi#le3ion o# the #oot is a positive 8omans6 sign, whi!h suggests venous thrombosis or thrombophlebitis. Cltra+short+a!ting barbiturates, su!h as thiopental (%entothal), are use as in7e!tion anestheti!s when a short uration o# anesthesia is nee e su!h as outpatient surgery. *tropine sul#ate may be use as a preanestheti! rug to re u!e se!retions an minimi0e vagal re#le3es. =or a patient with in#e!tious mononu!leosis, the nursing !are plan shoul emphasi0e stri!t be rest uring the a!ute #ebrile stage to ensure a equate rest. "uring the a!ute phase o# in#e!tious mononu!leosis, the patient shoul !urtail a!tivities to minimi0e the possibility o# rupturing the enlarge spleen. "aily appli!ation o# a long+a!ting, trans ermal nitrogly!erin pat!h is a !onvenient, e##e!tive way to prevent !hroni! angina. ,he nurse must wear a !ap, gloves, a gown, an a mask when provi ing woun !are to a patient with thir + egree burns. ,he nurse shoul e3pe!t to a minister an analgesi! be#ore bathing a burn patient. ,he passage o# bla!k, tarry #e!es (melena) is a !ommon sign o# lower )I blee ing, but also may o!!ur in patients who have upper )I blee ing. * patient who has a gastri! ul!er shoul avoi taking aspirin an aspirin+!ontaining pro u!ts be!ause they !an irritate the gastri! mu!osa. :hile a ministering !hemotherapy agents with an I.$. line, the nurse shoul is!ontinue the in#usion at the #irst sign o# e3travasation. * low+#iber iet may !ontribute to the evelopment o# hemorrhoi s. * patient who has ab ominal pain shoul n6t re!eive an analgesi! until the !ause o# the pain is etermine . I# surgery requires hair removal, the re!ommen ation o# the -enters #or "isease -ontrol an %revention is that a epilatory be use to avoi skin abrasions an !uts. =or nasotra!heal su!tioning, the nurse shoul set wall su!tion at 52 to B5 mm 8g #or an in#ant, B5 to ''5 mm 8g #or a !hil , or 12 to '(2 mm 8g #or an a ult. *#ter a myo!ar ial in#ar!tion, a !hange in pulse rate an rhythm may signal the onset o# #atal arrhythmias. ,reatment o# epista3is in!lu es nasal pa!king, i!e pa!ks, !autery with silver nitrate, an pressure on the nares. %alliative treatment relieves or re u!es the intensity o# un!om#ortable symptoms, but oesn6t !ure the !ausative isor er. %la!ing a postoperative patient in an upright position too qui!kly may !ause hypotension. $erapamil (-alan) an iltia0em (-ar i0em) slow the in#low o# !al!ium to the heart, thereby e!reasing the risk o# supraventri!ular ta!hy!ar ia. *#ter !ar iopulmonary bypass gra#t, the patient will per#orm turning, !oughing, eep breathing, an woun splinting, an will use assistive breathing evi!es. * patient who is e3pose to hepatitis & shoul re!eive 2.2; ml/kg I./. o# immune globulin within A( hours a#ter e3posure an a repeat ose at (1 ays a#ter e3posure. ,he nurse shoul a vise a patient who is un ergoing ra iation therapy not to remove the markings on the skin ma e by the ra iation therapist

In a ults, urine volume normally ranges #rom 122 to (,222 ml/ ay an averages between ',(22 an ',522 ml/ ay. "ire!tly applie moist heat so#tens !rusts an e3u ates, penetrates eeper than ry heat, oesn6t ry the skin, an is usually more !om#ortable #or the patient. ,etra!y!lines are sel om !onsi ere rugs o# !hoi!e #or most !ommon ba!terial in#e!tions be!ause their overuse has le to the emergen!e o# tetra!y!line+resistant ba!teria. &e!ause light egra es nitroprussi e (Iitropress), the rug must be shiel e #rom light. =or e3ample, an I.$. bag that !ontains nitroprussi e so ium shoul be wrappe in #oil.

-ephalosporins shoul be use !autiously in patients who are allergi! to peni!illin. ,hese patients are more sus!eptible to hypersensitivity rea!tions. I# !hlorampheni!ol an peni!illin must be a ministere !on!omitantly, the nurse shoul give the peni!illin ' or more hours be#ore the !hlorampheni!ol to avoi a re u!tion in peni!illin6s ba!teri!i al a!tivity. ,he erythro!yte se imentation rate measures the istan!e an spee at whi!h erythro!ytes in whole bloo #all in a verti!al tube in ' hour. ,he rate at whi!h they #all to the bottom o# the tube !orrespon s to the egree o# in#lammation. :hen tea!hing a patient with myasthenia gravis about pyri ostigmine (/estinon) therapy, the nurse shoul stress the importan!e o# taking the rug e3a!tly as pres!ribe , on time, an in evenly spa!e oses to prevent a relapse an ma3imi0e the e##e!t o# the rug. I# an antibioti! must be a ministere into a peripheral heparin lo!k, the nurse shoul #lush the site with normal saline solution a#ter the in#usion to maintain I.$. paten!y. ,he nurse shoul instru!t a patient with angina to take a nitrogly!erin tablet be#ore anti!ipate stress or e3er!ise or, i# the angina is no!turnal, at be time. *rterial bloo gas analysis evaluates gas e3!hange in the lungs (alveolar ventilation) by measuring the partial pressures o# o3ygen an !arbon io3i e an the p8 o# an arterial sample. ,he normal serum magnesium level ranges #rom '.5 to (.5 mEq/L. %atient preparation #or a total !holesterol test in!lu es an overnight #ast an abstinen!e #rom al!ohol #or (4 hours be#ore the test. ,he #asting plasma glu!ose test measures glu!ose levels a#ter a '(+ to '4+hour #ast. Iormal bloo p8 ranges #rom A.35 to A.45. * bloo p8 higher than A.45 in i!ates alkalemia? one lower than A.35 in i!ates a!i emia. "uring an a!i per#usion test, a small amount o# weak hy ro!hlori! a!i solution is in#use with a nasoesophageal tube. * positive test result (pain a#ter in#usion) suggests re#lu3 esophagitis. Iormally, the partial pressure o# arterial !arbon io3i e (%a->() ranges #rom 35 to 45 mm 8g. * %a->( greater than 45 mm 8g in i!ates a!i emia as a result o# hypoventilation? one less than 35 mm 8g in i!ates alkalemia as a result o# hyperventilation. 5e !ell in i!es ai in the iagnosis an !lassi#i!ation o# anemia. Iormally, the partial pressure o# arterial o3ygen (%ao () ranges #rom 12 to '22 mm 8g. * %ao ( o# 52 to 12 mm 8g in i!ates respiratory insu##i!ien!y. * %ao ( o# less than 52 mm 8g in i!ates respiratory #ailure. ,he white bloo !ell (:&-) i##erential evaluates :&- istribution

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an morphology an provi es more spe!i#i! in#ormation about a patient6s immune system than the :&- !ount. *n e3er!ise stress test (trea mill test, e3er!ise ele!tro!ar iogram) !ontinues until the patient rea!hes a pre etermine target heart rate or e3perien!es !hest pain, #atigue, or other signs o# e3er!ise intoleran!e. *lterable risk #a!tors #or !oronary artery isease in!lu e !igarette smoking, hypertension, high !holesterol or trigly!eri e levels, an iabetes.

'A
!irrhosis be!ause the amage liver !an6t metaboli0e rugs e##e!tively. &eta+hemolyti! strepto!o!!al in#e!tions shoul be treate aggressively to prevent glomerulonephritis, rheumati! #ever, an other !ompli!ations. ,he most !ommon noso!omial in#e!tion is a urinary tra!t in#e!tion. ,he nurse shoul implement stri!t isolation pre!autions to prote!t a patient with a thir + egree burn that6s in#e!te by 9taphylo!o!!us aureus. * patient who is un ergoing e3ternal ra iation therapy shoul n6t apply !ream or lotion to the treatment site. ,he most !ommon vas!ular !ompli!ation o# iabetes mellitus is atheros!lerosis. Insulin e#i!ien!y may !ause hypergly!emia. 9igns o# %arkinson6s isease in!lu e rooling, a masklike e3pression, an a propulsive gait. I.$. !holangiography is !ontrain i!ate in a patient with hyperthyroi ism, severe renal or hepati! amage, tuber!ulosis, or io ine hypersensitivity. /irrors shoul be remove #rom the room o# a patient who has is#iguring woun s su!h as #a!ial burns. * patient who has gouty arthritis shoul in!rease #lui intake to prevent !al!uli #ormation. *n3iety is the most !ommon !ause o# !hest pain. * patient who is #ollowing a low+salt iet shoul avoi !anne vegetables. &ananas are a goo sour!e o# potassium an shoul be in!lu e in a low+salt iet #or patients who are taking a loop iureti! su!h as #urosemi e (Lasi3). ,he nurse shoul en!ourage a patient who is at risk #or pneumonia to turn #requently, !ough, an breathe eeply. ,hese a!tions mobili0e pulmonary se!retions, promote alveolar gas e3!hange, an help prevent atele!tasis. ,he nurse shoul noti#y the physi!ian whenever a patient6s bloo pressure rea!hes '12/'22 mm 8g. &u!k6s tra!tion is use to immobili0e an re u!e spasms in a #ra!ture hip. =or a patient with a #ra!ture hip, the nurse shoul assess neuro!ir!ulatory status every ( hours. :hen !aring #or a patient with a #ra!ture hip, the nurse shoul use pillows or a tro!hanter roll to maintain ab u!tion. >rthopnea is a symptom o# le#t+si e heart #ailure. *lthough a #iberglass !ast is more urable an ries more qui!kly than a plaster !ast, it typi!ally !auses skin irritation. In an immobili0e patient, the ma7or !ir!ulatory !ompli!ation is pulmonary embolism. ,o relieve e ema in a #ra!ture limb, the patient shoul keep the limb elevate . I.$. antibioti!s are the treatment o# !hoi!e #or a patient with osteomyelitis. &lue ye in !imeti ine (,agamet) !an !ause a #alse+positive result on a #e!al o!!ult bloo test su!h as a 8emo!!ult test. ,he nurse shoul suspe!t el er abuse i# woun s are in!onsistent with the patient6s history, multiple woun s are present, or woun s are in i##erent stages o# healing. Imme iately a#ter amputation, patient !are in!lu es monitoring rainage #rom the stump, positioning the a##e!te limb, assisting with

,he me iastinum is the spa!e between the lungs that !ontains the heart, esophagus, tra!hea, an other stru!tures. /a7or !ompli!ations o# a!ute myo!ar ial in#ar!tion in!lu e arrhythmias, a!ute heart #ailure, !ar iogeni! sho!k, thromboembolism, an le#t ventri!ular rupture. ,he sinoatrial no e is a !luster o# hun re s o# !ells lo!ate in the right atrial wall, near the opening o# the superior vena !ava. =or one+person !ar iopulmonary resus!itation, the ratio o# !ompressions to ventilations is '5G(. =or two+person !ar iopulmonary resus!itation, the ratio o# !ompressions to ventilations is 5G'. * patient who has pulseless ventri!ular ta!hy!ar ia is a !an i ate #or !ar ioversion. E!ho!ar iography, a noninvasive test that ire!ts ultra+high+#requen!y soun waves through the !hest wall an into the heart, evaluates !ar ia! stru!ture an #un!tion an !an show valve e#ormities, tumors, septal e#e!ts, peri!ar ial e##usion, an hypertrophi! !ar iomyopathy. *ta3ia is impaire ability to !oor inate movements. It6s !ause by a !erebellar or spinal !or lesion. >n an ele!tro!ar iogram strip, ea!h small blo!k on the hori0ontal a3is represents 2.24 se!on . Ea!h large blo!k (!ompose o# #ive small blo!ks) represents 2.( se!on . 9tarling6s law states that the #or!e o# !ontra!tion o# ea!h heartbeat epen s on the length o# the mus!le #ibers o# the heart wall. ,he therapeuti! bloo level #or igo3in is 2.5 to (.5 ng/ml. %an!relipase (%an!rease) is use to treat !ysti! #ibrosis an !hroni! pan!reatitis. ,reatment #or mil to mo erate vari!ose veins in!lu es antiembolism sto!kings an an e3er!ise program that in!lu es walking to minimi0e venous pooling. *n into3i!ate patient isn6t !onsi ere !ompetent to re#use require me i!al treatment an shoul n6t be allowe to !he!k out o# a hospital against me i!al a vi!e. ,he primary i##eren!e between the pain o# angina an that o# a myo!ar ial in#ar!tion is its uration. )yne!omastia is e3!essive mammary glan in!rease breast si0e in boys an men. evelopment an

-lassi! symptoms o# )raves6 isease are an enlarge thyroi , nervousness, heat intoleran!e, weight loss espite in!rease appetite, sweating, iarrhea, tremor, an palpitations. )enerali0e malaise is a !ommon symptom o# viral an ba!terial in#e!tions an epressive isor ers. $itamin - an protein are the most important nutrients #or woun healing. * patient who has portal hypertension shoul re!eive vitamin . to promote a!tive thrombin #ormation by the liver. ,hrombin re u!es the risk o# blee ing. ,he nurse shoul a minister a se ative !autiously to a patient with

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e3er!ises pres!ribe by a physi!al therapist, an wrapping an !on itioning the stump. * patient who is prone to !onstipation shoul in!rease his bulk intake by eating whole+grain !ereals an #resh #ruits an vegetables In the pelvi! e3amination o# a se3ual assault vi!tim, the spe!ulum shoul be lubri!ate with water. -ommer!ial lubri!ants retar sperm motility an inter#ere with spe!imen !olle!tion an analysis. =or a terminally ill patient, physi!al !om#ort is the top priority in nursing !are. "orsi#le3ion o# the #oot provi es imme iate relie# o# leg !ramps. *#ter !ar ia! surgery, the patient shoul limit aily so ium intake to ( g an aily !holesterol intake to 322 mg. &lee ing a#ter inter!ourse is an early sign o# !ervi!al !an!er. >ral anti iabeti! agents, su!h as !hlorpropami e ("iabinese) an tolbutami e (>rinase), stimulate insulin release #rom beta !ells in the islets o# Langerhans o# the pan!reas. :hen visiting a patient who has a ra iation implant, #amily members an #rien s must limit their stay to '2 minutes. $isitors an nurses who are pregnant are restri!te #rom entering the room. -ommon !auses o# vaginal in#e!tion in!lu e using an antibioti!, an oral !ontra!eptive, or a !orti!osteroi ? wearing tight+#itting panty hose? an having se3ual inter!ourse with an in#e!te partner. * patient with a ra iation implant shoul remain in isolation until the implant is remove . ,o minimi0e ra iation e3posure, whi!h in!reases with time, the nurse shoul !are#ully plan the time spent with the patient. *mong !ultural groups, Iative *meri!ans have the lowest in!i en!e o# !an!er. ,he ki neys #ilter bloo , sele!tively reabsorb substan!es that are nee e to maintain the !onstan!y o# bo y #lui , an e3!rete metaboli! wastes. ,o prevent straining uring e#e!ation, o!usate (-ola!e) is the la3ative o# !hoi!e #or patients who are re!overing #rom a myo!ar ial in#ar!tion, re!tal or !ar ia! surgery, or postpartum !onstipation. *#ter prostate surgery, a patient6s primary sour!es o# pain are bla er spasms an irritation in the area aroun the !atheter. ,o3oplasmosis is more likely to a##e!t a pregnant !at owner than other pregnant women be!ause !at #e!es in the litter bo3 harbor the in#e!ting organism. )oo #oo sour!es o# #oli! a!i in!lu e green lea#y vegetables, liver, an legumes. ,he )lasgow -oma 9!ale evaluates verbal, eye, an motor responses to etermine the patient6s level o# !ons!iousness. ,he nurse shoul pla!e an un!ons!ious patient in low =owler6s position #or intermittent nasogastri! tube #ee ings. LaUnne!6s (al!oholi!) !irrhosis is the most !ommon type o# !irrhosis. In e!orti!ate posturing, the patient6s arms are a u!te an #le3e , with the wrists an #ingers #le3e on the !hest. ,he legs are e3ten e sti##ly an rotate internally, with plantar #le3ion o# the #eet. -an i ates #or surgery shoul re!eive nothing by mouth #rom mi night o# the ay be#ore surgery unless !leare by a physi!ian. /eperi ine ("emerol) is an e##e!tive analgesi! to relieve the pain o# nephrolithiasis (urinary !al!uli). *n in7ure patient with thrombo!ytopenia is at risk #or li#e+ threatening internal an e3ternal hemorrhage. ,he ,ren elenburg test is use to !he!k #or unilateral hip islo!ation. *s soon as possible a#ter eath, the patient shoul be pla!e in the supine position, with the arms at the si es an the hea on a pillow. $as!ular resistan!e epen s on bloo vis!osity, vessel length an , most important, insi e vessel iameter. * below+the+knee amputation leaves the knee inta!t #or prosthesis appli!ation an allows a more normal gait than above+the+knee amputation.

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-erebrospinal #lui #lows through an prote!ts the #our ventri!les o# the brain, the subara!hnoi spa!e, an the spinal !anal. 9o ium regulates e3tra!ellular osmolality. ,he heart an brain !an maintain bloo !ir!ulation in the early stages o# sho!k. *#ter limb amputation, nar!oti! analgesi!s may not relieve Lphantom limbM pain. * patient who re!eives multiple bloo trans#usions is at risk #or hypo!al!emia. 9yphilis initially !auses painless !han!res (small, #lui +#ille lesions) on the genitals an sometimes on other parts o# the bo y. E3posure to a ra ioa!tive sour!e is !ontrolle by time (limiting time spent with the patient), istan!e (#rom the patient), an shiel (a lea apron). Saun i!e is a sign o# ys#un!tion, not a isease. 9evere 7aun i!e !an !ause brain stem ys#un!tion i# the un!on7ugate bilirubin level in bloo is elevate to (2 to (5 mg/ l. ,he patient shoul take !imeti ine (,agamet) with meals to help ensure a !onsistent therapeuti! e##e!t. :hen !aring #or a patient with 7aun i!e, the nurse shoul relieve pruritus by provi ing a soothing lotion or a baking so a bath an shoul prevent in7ury by keeping the patient6s #ingernails short. ,ype & hepatitis, whi!h is usually transmitte parenterally, also !an be sprea through !onta!t with human se!retions an #e!es. Insulin is a naturally o!!urring hormone that6s se!rete by the beta !ells o# the islets o# Langerhans in the pan!reas in response to a rise in the bloo glu!ose level. "iabetes mellitus is a !hroni! en o!rine isor er that6s !hara!teri0e by insulin e#i!ien!y or resistan!e to insulin by bo y tissues. * iagnosis o# iabetes mellitus is base on the !lassi! symptoms (polyuria, polyphagia, weight loss, an poly ipsia) an a ran om bloo glu!ose level o# more than (22 mg/ l or a #asting plasma glu!ose level o# more than '42 mg/ l when teste on two separate o!!asions. * patient with nonFinsulin+ epen ent (type () iabetes mellitus pro u!es some insulin an normally oesn6t nee e3ogenous insulin supplementation. /ost patients with this type o# iabetes respon well to oral anti iabeti! agents, whi!h stimulate the pan!reas to in!rease the synthesis an release o# insulin. * patient with insulin+ epen ent (type ') iabetes mellitus !an6t pro u!e en ogenous insulin an requires e3ogenous insulin a ministration to meet the bo y6s nee s. 5api +a!ting insulins are !lear? interme iate+ an long+a!ting insulins are turbi (!lou y). 5api +a!ting insulins begin to a!t in 32 to ;2 minutes, rea!h a peak !on!entration in ( to '2 hours, an have a uration o# a!tion o# 5 to '; hours. ,he best times to test a iabeti! patient6s glu!ose level are be#ore ea!h meal an at be time. Interme iate+a!ting insulins begin to a!t in ' to ( hours, rea!h a peak !on!entration in 4 to '5 hours, an have a uration o# a!tion o# (( to (1 hours. Long+a!ting insulins begin to a!t in 4 to 1 hours, rea!h a peak

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!on!entration in '2 to 32 hours, an have a uration o# a!tion o# 3; hours or more. I# the results o# a non#asting glu!ose test show above+normal glu!ose levels a#ter glu!ose a ministration, but the patient has normal plasma glu!ose levels otherwise, the patient has impaire glu!ose toleran!e. Insulin requirements are in!rease by growth, pregnan!y, in!rease #oo intake, stress, surgery, in#e!tion, illness, in!rease insulin antibo ies, an some rugs. Insulin requirements are e!rease by hypothyroi ism, e!rease #oo intake, e3er!ise, an some rugs. 8ypogly!emia o!!urs when the bloo glu!ose level is less than 52 mg/ l. *n insulin+resistant patient is one who requires more than (22 units o# insulin aily. 8ypogly!emia may o!!ur ' to 3 hours a#ter the a ministration o# a rapi +a!ting insulin, 4 to '1 hours a#ter the a ministration o# an interme iate+a!ting insulin, an '1 to 32 hours a#ter the a ministration o# a long+a!ting insulin. :hen the bloo glu!ose level e!reases rapi ly, the patient may e3perien!e sweating, tremors, pallor, ta!hy!ar ia, an palpitations. >b7e!tive signs o# hypogly!emia in!lu e slurre spee!h, la!k o# !oor ination, staggere gait, sei0ures, an possibly, !oma. * !ons!ious patient who has hypogly!emia shoul re!eive sugar in an easily igeste #orm, su!h as orange 7ui!e, !an y, or lump sugar. *n un!ons!ious patient who has hypogly!emia shoul re!eive an 9.-. or I./. in7e!tion o# glu!agon as pres!ribe by a physi!ian or 52E e3trose by I.$. in7e!tion. * patient with iabetes mellitus shoul inspe!t his #eet aily #or !alluses, !orns, an blisters. 8e shoul also use warm water to wash his #eet an trim his toenails straight a!ross to prevent ingrown toenails. ,he early stage o# ketoa!i osis !auses polyuria, poly ipsia, anore3ia, mus!le !ramps, an vomiting. ,he late stage !auses .ussmaul6s respirations, sweet breath o or, an stupor or !oma. *n allergen is a substan!e that !an !ause a hypersensitivity rea!tion. * !orre!tive lens #or nearsighte ness is !on!ave. -hroni! untreate hypothyroi ism or abrupt with rawal o# thyroi me i!ation may lea to my3e ema !oma. 9igns an symptoms o# my3e ema !oma are lethargy, stupor, e!rease level o# !ons!iousness, ry skin an hair, elaye eep ten on re#le3es, progressive respiratory !enter epression an !erebral hypo3ia, weight gain, hypothermia, an hypogly!emia. Iearsighte ness o!!urs when the #o!al point o# a ray o# light #rom an ob7e!t that6s (2R (; m) away #alls in #ront o# the retina. =arsighte ness o!!urs when the #o!al point o# a ray o# light #rom an ob7e!t that6s (2R away #alls behin the retina. * !orre!tive lens #or #arsighte ness is !onve3. 5e#ra!tion is !lini!al measurement o# the error in eye #o!using. * hesions are ban s o# granulation an s!ar tissue that evelop in some patients a#ter a surgi!al in!ision. ,he nurse shoul moisten an eye pat!h #or an un!ons!ious patient be!ause a ry pat!h may irritate the !ornea. * patient who has ha eye surgery shoul n6t ben over, !omb his hair vigorously, or engage in a!tivity that in!reases intrao!ular pressure. :hen !aring #or a patient who has a penetrating eye in7ury, the nurse shoul pat!h both eyes loosely with sterile gau0e, a minister an oral antibioti! (in high oses) an tetanus in7e!tion as pres!ribe , an re#er the patient to an ophthalmologist #or #ollow+up.

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9igns an symptoms o# !olore!tal !an!er in!lu e !hanges in bowel habits, re!tal blee ing, ab ominal pain, anore3ia, weight loss, malaise, anemia, an !onstipation or iarrhea. :hen !limbing stairs with !rut!hes, the patient shoul lea with the uninvolve leg an #ollow with the !rut!hes an involve leg. :hen es!en ing stairs with !rut!hes, the patient shoul lea with the !rut!hes an the involve leg an #ollow with the uninvolve leg. :hen surgery requires eyelash trimming, the nurse shoul apply petroleum 7elly to the s!issor bla es so that the eyelashes will a here to them. %ain a#ter a !orneal transplant may in i!ate that the ressing has been applie too tightly, the gra#t has slippe , or the eye is hemorrhaging. * patient with retinal eta!hment may report #loating spots, #lashes o# light, an a sensation o# a veil or !urtain !oming own. Imme iate postoperative !are #or a patient with retinal eta!hment in!lu es maintaining the eye pat!h an shiel in pla!e over the a##e!te area an observing the area #or rainage? maintaining the patient in the position spe!i#ie by the ophthalmologist (usually, lying on his ab omen, with his hea parallel to the #loor an turne to the si e)? avoi ing bumping the patient6s hea or be ? an en!ouraging eep breathing, but not !oughing. * patient with a !atara!t may have vision isturban!es, su!h as image istortion, light glaring, an gra ual loss o# vision. :hen talking to a hearing+impaire patient who !an lip+rea , the nurse shoul #a!e the patient, speak slowly an enun!iate !learly, point to ob7e!ts as nee e , an avoi !hewing gum. -lini!al mani#estations o# venous stasis ul!er in!lu e hemosi erin eposits (visible in #air+skinne in ivi uals)? ry, !ra!ke skin? an in#e!tion. ,he #luores!ent treponemal antibo y absorption test is a spe!i#i! serologi! test #or syphilis. ,o re u!e #ever, the nurse may give the patient a sponge bath with tepi water (12@ to B3@ = N(;.A@ to 33.B@ -O). :hen !ommuni!ating with a patient who has ha a stroke, the nurse shoul allow ample time #or the patient to speak an respon , #a!e the patient6s una##e!te si e, avoi talking qui!kly, give visual !lues, supplement spee!h with gestures, an give instru!tions !onsistently. ,he ma7or !ompli!ation o# &ell6s palsy is keratitis (!orneal in#lammation), whi!h results #rom in!omplete eye !losure on the a##e!te si e. Immunosuppressants are use to !ombat tissue re7e!tion an help !ontrol autoimmune isor ers. *#ter a unilateral stroke, a patient may be able to propel a wheel!hair by using a heel+to+toe movement with the una##e!te leg an turning the wheel with the una##e!te han . =irst+morning urine is the most !on!entrate an most likely to show abnormalities. It shoul be re#rigerate to retar ba!terial growth or, #or mi!ros!opi! e3amination, shoul be sent to the laboratory imme iately. * patient who is re!overing #rom a stroke shoul align his arms an legs !orre!tly, wear high+top sneakers to prevent #oot rop an !ontra!ture, an use an egg !rate, #lotation, or pulsating mattress to help prevent pressure ul!ers. *#ter a #ra!ture o# the arm or leg, the bone may show !omplete union (normal healing), elaye union (healing that takes longer than e3pe!te ), or nonunion (#ailure to heal). ,he most !ommon !ompli!ation o# a hip #ra!ture is thromboembolism, whi!h may o!!lu e an artery an !ause the area it supplies to be!ome !ol an !yanoti!. -hloral hy rate suppositories shoul be re#rigerate . -ast appli!ation usually requires two persons? it shoul n6t be attempte alone.

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* plaster !ast rea!hes ma3imum strength in 41 hours? a syntheti! !ast, within 32 minutes be!ause it oesn6t require rying. 9evere pain in i!ates the evelopment o# a pressure ul!er within a !ast? the pain e!reases signi#i!antly a#ter the ul!er evelops. In i!ations o# !ir!ulatory inter#eren!e are abnormal skin !oolness, !yanosis, an rubor or pallor. "uring the postoperative phase, in!reasing pulse rate an e!reasing bloo pressure may in i!ate hemorrhage an impen ing sho!k. >rthope i! surgi!al woun s blee more than other surgi!al woun s. ,he nurse !an e3pe!t (22 to 522 ml o# rainage uring the #irst (4 hours an less than 32 ml ea!h 1 hours #or the ne3t 41 hours. * patient who has ha hip surgery shoul n6t a u!t or #le3 the a##e!te hip be!ause #le3ion greater than B2 egrees may !ause islo!ation. ,he 8oyer li#t, a hy rauli! evi!e, allows two persons to li#t an move a nonambulatory patient sa#ely. * patient with !arpal tunnel syn rome, a !omple3 o# symptoms !ause by !ompression o# the me ian nerve in the !arpal tunnel, usually has weakness, pain, burning, numbness, or tingling in one or both han s. ,he nurse shoul instru!t a patient who has ha heatstroke to wear light+!olore , loose+#itting !lothing when e3pose to the sun? rest #requently? an rink plenty o# #lui s. * !ons!ious patient with heat e3haustion or heatstroke shoul re!eive a solution o# T teaspoon o# salt in '(2 ml o# water every '5 minutes #or ' hour. *n I.$. line inserte uring an emergen!y or outsi e the hospital setting shoul be !hange within (4 hours. *#ter a tepi bath, the nurse shoul prevent !hills. ry the patient thoroughly to

,he nurse shoul assess a patient who has limb restraints every 32 minutes to ete!t signs o# impaire !ir!ulation. ,he -enters #or "isease -ontrol an %revention re!ommen s using a nee leless system #or piggyba!king an I.$. rug into the main I.$. line. I# a gown is require , the nurse shoul put it on when she enters the patient6s room an is!ar it when she leaves. :hen !hanging the ressing o# a patient who is in isolation, the nurse shoul wear two pairs o# gloves. * isposable be pan an urinal shoul remain in the room o# a patient who is in isolation an be is!ar e on is!harge or at the en o# the isolation perio . /y!oses (#ungal in#e!tions) may be systemi! or eep (a##e!ting the internal organs), sub!utaneous (involving the skin), or super#i!ial (growing on the outer layer o# skin an hair). ,he night be#ore a sputum spe!imen is to be !olle!te by e3pe!toration, the patient shoul in!rease #lui intake to promote sputum pro u!tion. * sample o# #e!es #or an ova an parasite stu y shoul be !olle!te ire!tly into a waterproo# !ontainer, !overe with a li , an sent to the laboratory imme iately. I# the patient is be ri en, the sample !an be !olle!te into a !lean, ry be pan an then trans#erre with a tongue epressor into a !ontainer. :hen obtaining a sputum spe!imen #or testing, the nurse shoul instru!t the patient to rinse his mouth with !lean water, !ough eeply #rom his !hest, an e3pe!torate into a sterile !ontainer. ,onometry allows in ire!t measurement o# intrao!ular pressure an ai s in early ete!tion o# glau!oma. %ulmonary #un!tion tests (a series o# measurements that evaluate ventilatory #un!tion through spirometri! measurements) help to iagnose pulmonary ys#un!tion. *#ter a liver biopsy, the patient shoul lie on the right si e to !ompress the biopsy site an e!rease the possibility o# blee ing. * patient who has !irrhosis shoul #ollow a iet that restri!ts so ium, but provi es protein an vitamins (espe!ially &, -, an ., an #olate). I# '( hours o# gastri! su!tion on6t relieve bowel obstru!tion, surgery is in i!ate . ,he nurse !an pun!ture a ni#e ipine (%ro!ar ia) !apsule with a nee le, with raw its liqui , an instill it into the bu!!al pou!h. :hen a ministering whole bloo or pa!ke re bloo !ells (5&-s), the nurse shoul use a '; to (2) nee le or !annula to avoi 5&hemolysis. 8irsutism is e3!essive bo y hair in a mas!uline istribution. >ne unit o# whole bloo or pa!ke re bloo !ells is a ministere over ( to 4 hours. 9!urvy is asso!iate with vitamin - e#i!ien!y. * vitamin is an organi! !ompoun that usually !an6t be synthesi0e by the bo y an is nee e in metaboli! pro!esses. %ulmonary embolism !an be !ause when thromboembolism o# #at, bloo , bone marrow, or amnioti! #lui obstru!ts the pulmonary artery. *#ter ma3illo#a!ial surgery, a patient whose man ible an ma3illa have been wire together shoul keep a pair o# s!issors or wire !utters rea ily available so that he !an !ut the wires an prevent aspiration i# vomiting o!!urs. 5api instillation o# #lui ab ominal !ramping. uring !oloni! irrigation !an !ause

,he nurse shoul take the patient6s temperature 32 minutes a#ter !ompleting a tepi bath. 9hower or bath water shoul n6t e3!ee '25@ = (42.;@ -). "ilatation an !urettage is wi ening o# the !ervi!al !anal with a ilator an s!raping o# the uterus with a !urette. :hen not in use, all !entral venous !atheters must be !appe with a aptors a#ter #lushing. -are a#ter ilatation an !urettage !onsists o# be rest #or ' ay, mil analgesi!s #or pain, an use o# a sterile pa #or as long as blee ing persists. I# a patient #eels #aint uring a bath or shower, the nurse shoul turn o## the water, !over the patient, lower the patient6s hea , an summon help. * patient who is taking oral !ontra!eptives shoul n6t smoke be!ause smoking !an intensi#y the rug6s a verse !ar iovas!ular e##e!t. ,he use o# so#t restraints requires a physi!ian6s or er an assessment an o!umentation o# the patient an a##e!te limbs, a!!or ing to #a!ility poli!y. * vest restraint shoul be use !autiously in a patient with heart #ailure or a respiratory isor er. ,he restraint !an tighten with movement, #urther limiting respiratory #un!tion. ,o ensure patient sa#ety, the least amount o# restraint shoul be use . I# a piggyba!k system be!omes islo ge , the nurse shoul repla!e the entire piggyba!k system with the appropriate solution an rug, as pres!ribe . ,he nurse shoul n6t se!ure a restraint to a be 6s si e rails be!ause they might be lowere ina vertently an !ause patient in7ury or is!om#ort.

* !ollaborative relationship between health !are workers helps

MEDICAL AND SURGICAL NURSING BULLETS

shorten the hospital stay an in!reases patient satis#a!tion. =or el erly patients in a health !are #a!ility, pre i!table ha0ar s in!lu e nighttime !on#usion (sun owning), #ra!tures #rom #alling, immobility+in u!e pressure ul!ers, prolonge !onvales!en!e, an loss o# home an support systems. 5espiratory tra!t in#e!tions, espe!ially viral in#e!tions, !an trigger asthma atta!ks. >3ygen therapy is use in severe asthma atta!ks to prevent or treat hypo3emia. "uring an asthma atta!k, the patient may pre#er nasal prongs to a $enturi mask be!ause o# the mask6s smothering e##e!t. -hroni! obstru!tive pulmonary isease usually evelops over a perio o# years. In B5E o# patients, it results #rom smoking. *n early sign o# !hroni! obstru!tive pulmonary isease (->%") is slowing o# #or!e e3piration. * healthy person !an empty the lungs in less than 4 se!on s? a patient with ->%" may take ; to '2 se!on s. -hroni! obstru!tive pulmonary isease eventually lea s to stru!tural !hanges in the lungs, in!lu ing over isten e alveoli an hyperin#late lungs. -ellulitis !auses lo!ali0e heat, re ness, swelling an , o!!asionally, #ever, !hills, an malaise. $enous stasis may pre!ipitate thrombophlebitis. ,reatment o# thrombophlebitis in!lu es leg elevation, heat appli!ation, an possibly, anti!oagulant therapy. * su!tioning ma!hine shoul remain at the be si e o# a patient who has ha ma3illo#a!ial surgery. =or a be ri en patient with heart #ailure, the nurse shoul !he!k #or e ema in the sa!ral area. In passive range+o#+motion e3er!ises, the therapist moves the patient6s 7oints through as #ull a range o# motion as possible to improve or maintain 7oint mobility an help prevent !ontra!tures. In resistan!e e3er!ises, whi!h allow mus!le length to !hange, the patient per#orms e3er!ises against resistan!e applie by the therapist. In isometri! e3er!ises, the patient !ontra!ts mus!les against stable resistan!e, but without 7oint movement. /us!le length remains the same, but strength an tone may in!rease. Impetigo is a !ontagious, super#i!ial, vesi!opustular skin in#e!tion. %re isposing #a!tors in!lu e poor hygiene, anemia, malnutrition, an a warm !limate. *#ter !ar iopulmonary resus!itation (-%5) begins, it shoul n6t be interrupte , e3!ept when the a ministrator is alone an must summon help. In this !ase, the a ministrator shoul per#orm -%5 #or ' minute be#ore !alling #or help. ,he tongue is the most !ommon airway obstru!tion in an un!ons!ious patient. =or a ult !ar iopulmonary resus!itation, the !hest !ompression rate is 12 to '22 times per minute. * patient with ul!ers shoul avoi be time sna!ks be!ause #oo may stimulate no!turnal se!retions. In angioplasty, a bloo vessel is ilate with a balloon !atheter that6s inserte through the skin an the vessel6s lumen to the narrowe area. >n!e in pla!e, the balloon is in#late to #latten plaque against the vessel wall. * #ull liqui iet supplies nutrients, #lui s, an !alories in simple, easily igeste #oo s, su!h as apple 7ui!e, !ream o# wheat, milk, !o##ee, straine !ream soup, high+protein gelatin, !ranberry 7ui!e, !ustar , an i!e !ream. It6s pres!ribe #or patients who !an6t tolerate a regular iet. * puree iet meets the patient6s nutritional nee s without in!lu ing #oo s that are i##i!ult to !hew or swallow. =oo is blen e to a semisoli !onsisten!y.

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* so#t, or light, iet is spe!i#i!ally esigne #or patients who have i##i!ulty !hewing or tolerating a regular iet. It6s nutritionally a equate an !onsists o# #oo s su!h as orange 7ui!e, !ream o# wheat, s!ramble eggs, enri!he toast, !ream o# !hi!ken soup, wheat brea , #ruit !o!ktail, an mushroom soup. * regular iet is provi e #or patients who on6t require ietary mo i#i!ation. * blan iet restri!ts #oo s that !ause gastri! irritation or pro u!e a!i se!retion without provi ing a neutrali0ing e##e!t. * !lear liqui iet provi es #lui an a gra ual return to a regular iet. ,his type o# iet is e#i!ient in all nutrients an shoul be #ollowe #or only a short perio . %atients with a gastri! ul!er shoul avoi al!ohol, !a##einate beverages, aspirin, an spi!y #oo s. In a!tive assistan!e e3er!ises, the patient per#orms e3er!ises with the therapist6s help. %eni!illinase is an en0yme pro u!e by !ertain ba!teria. It !onverts peni!illin into an ina!tive pro u!t, in!reasing the ba!teria6s resistan!e to the antibioti!. &attle6s sign is a bluish is!oloration behin the ear in some patients who sustain a basilar skull #ra!ture.

-ra!kles are nonmusi!al !li!king or rattling noises that are hear uring aus!ultation o# abnormal breath soun s. ,hey are !ause by air passing through #lui +#ille airways. *ntibioti!s aren6t e##e!tive against viruses, proto0oa, or parasites. /ost peni!illins an !ephalosporins pro u!e their antibioti! e##e!ts by !ell wall inhibition. :hen assessing a patient with an inguinal hernia, the nurse shoul suspe!t strangulation i# the patient reports severe pain, nausea, an vomiting. %himosis is tightness o# the prepu!e o# the penis that prevents retra!tion o# the #oreskin over the glans. *minogly!osi es are natural antibioti!s that are e##e!tive against gram+negative ba!teria. ,hey must be use with !aution be!ause they !an !ause nephroto3i!ity an ototo3i!ity. >n s!rotal e3amination, vari!o!eles an tumors on6t transilluminate, but spermato!eles an hy ro!eles o. * hor eolum (eyeli stye) is an in#e!tion o# one or more seba!eous glan s o# the eyeli . * !hala0ion is an eyeli mass that6s !ause by !hroni! in#lammation o# the meibomian glan . "uring ophthalmos!opi! e3amination, the absen!e o# the re re#le3 in i!ates a lens opa!ity (!atara!t) or a eta!he retina. 5espiratory a!i osis is asso!iate with !on itions su!h as rug over ose, )uillain+&arrK syn rome, myasthenia gravis, !hroni! obstru!tive pulmonary isease, pi!kwi!kian syn rome, an kyphos!oliosis. &ullets 5espiratory alkalosis is asso!iate with !on itions su!h as high #ever, severe hypo3ia, asthma, an pulmonary embolism. /etaboli! a!i osis is asso!iate with su!h !on itions as renal #ailure, iarrhea, iabeti! ketosis, an la!ti! ketosis, an with high oses o# a!eta0olami e ("iamo3). )astre!tomy is surgi!al e3!ision o# all or part o# the stoma!h to remove a !hroni! pepti! ul!er, stop hemorrhage in a per#orate ul!er, or remove a malignant tumor.

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/etaboli! alkalosis is asso!iate with nasogastri! su!tioning, e3!essive use o# iureti!s, an steroi therapy. $itiligo (a benign, a!quire skin isease) is marke by stark white skin pat!hes that are !ause by the estru!tion an loss o# pigment !ells. >ver ose or a!!i ental overingestion o# isul#iram (*ntabuse) shoul be treate with gastri! aspiration or lavage an supportive therapy. ,he !auses o# ab ominal istention are represente by the si3 =6sG #latus, #e!es, #etus, #lui , #at, an #atal (malignant) neoplasm. * positive /urphy6s sign in i!ates !hole!ystitis. 9igns o# appen i!itis in!lu e right ab ominal pain, ab ominal rigi ity an reboun ten erness, nausea, an anore3ia. *s!ites !an be ete!te when more than 522 ml o# #lui has !olle!te in the intraperitoneal spa!e. =or a patient with organi! brain syn rome or a senile isease, the i eal environment is stable an limits !on#usion. In a patient with organi! brain syn rome, memory loss usually a##e!ts all spheres, but begins with re!ent memory loss. "uring !ar ia! !atheteri0ation, the patient may e3perien!e a thu ing sensation in the !hest, a strong esire to !ough, an a transient #eeling o# heat, usually in the #a!e, as a result o# in7e!tion o# the !ontrast me ium. 9light bubbling in the su!tion !olumn o# a thora!i! rainage system, su!h as a %leur+eva! unit, in i!ates that the system is working properly. * la!k o# bubbling in the su!tion !hamber in i!ates ina equate su!tion. Iutritional e#i!ien!y is a !ommon #in ing in people who have a long history o# al!ohol abuse. In the patient with vari!ose veins, gra uate !ompression elasti! sto!kings (32 to 42 mm 8g) may be pres!ribe to promote venous return. Ionviral hepatitis usually results #rom e3posure to !ertain !hemi!als or rugs. 9ubstantial elevation o# the serum transaminase level is a symptom o# a!ute hepatitis. Iormal !ar ia! output is 4 to ; L/minute, with a stroke volume o# ;2 to A2 ml. E3!essive vomiting or removal o# the stoma!h !ontents through su!tion !an e!rease the potassium level an lea to hypokalemia. *s a heparin antagonist, protamine is an anti ote #or heparin over ose. I# a patient has a positive rea!tion to a tuber!ulin skin test, su!h as the puri#ie protein erivative test, the nurse shoul suspe!t !urrent or past e3posure. ,he nurse shoul ask the patient about a history o# tuber!ulosis (,&) an the presen!e o# early signs an symptoms o# ,&, su!h as low+gra e #ever, weight loss, night sweats, #atigue, an anore3ia. 9igns an symptoms o# a!ute rheumati! #ever in!lu e !horea, #ever, !ar itis, migratory polyarthritis, erythema marginatum (rash), an sub!utaneous no ules. &e#ore un ergoing any invasive ental pro!e ure, the patient who has a history o# rheumati! #ever shoul re!eive prophyla!ti! peni!illin therapy. ,his therapy helps to prevent !ontamination o# the bloo with oral ba!teria, whi!h !oul migrate to the heart valves. *#ter a myo!ar ial in#ar!tion, most patients !an resume se3ual a!tivity when they !an !limb two #lights o# stairs without #atigue or yspnea. El erly patients are sus!eptible to orthostati! hypotension be!ause the barore!eptors be!ome less sensitive to position !hanges as people age. =or the patient with suspe!te renal or urethral !al!uli, the nurse shoul strain the urine to etermine whether !al!uli have been passe . ,he nurse shoul pla!e the patient with as!ites in the semi+=owler position be!ause it permits ma3imum lung e3pansion.

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=or the patient who has ingeste poison, the nurse shoul save the vomitus #or analysis. ,he earliest signs o# respiratory istress are in!rease respiratory rate an in!rease pulse rate. In a ults, gastroenteritis is !ommonly sel#+limiting an !auses iarrhea, ab ominal is!om#ort, nausea, an vomiting. -ar ia! output equals stroke volume multiplie by the heart rate per minute. In patients with a!ute meningitis, the !erebrospinal #lui protein level is elevate . :hen a patient is suspe!te o# having #oo poisoning, the nurse shoul noti#y publi! health authorities so that they !an interview patients an #oo han lers an take samples o# the suspe!te !ontaminate #oo . ,he patient who is re!eiving a potassium+wasting iureti! shoul eat potassium+ri!h #oo s. * patient with !hroni! obstru!tive pulmonary isease shoul re!eive low+level o3ygen a ministration by nasal !annula (( to 3 L/minute) to avoi inter#ering with the hypo3i! rive. In metaboli! a!i osis, the patient may have .ussmaul6s respirations be!ause the rate an epth o# respirations in!rease to Lblow o##M e3!ess !arboni! a!i s. In women, gonorrhea a##e!ts the vagina an #allopian tubes. *#ter traumati! amputation, the greatest threats to the patient are bloo loss an hypovolemi! sho!k. Initial interventions shoul !ontrol blee ing an repla!e #lui an bloo as nee e . Epinephrine is a sympathomimeti! rug that a!ts primarily on alpha, beta', an beta( re!eptors, !ausing vaso!onstri!tion. Epinephrine6s a verse e##e!ts in!lu e yspnea, ta!hy!ar ia, palpitations, hea a!hes, an hypertension. * !ar inal sign o# pan!reatitis is an elevate serum amylase level. 8igh !oloni! irrigation is use to stimulate peristalsis an re u!e #latulen!e. &lee ing is the most !ommon postoperative problem. ,he patient !an !ontrol some !olostomy o ors by avoi ing su!h #oo s as #ish, eggs, onions, beans, an !abbage an relate vegetables. :hen paralysis or !oma impairs or erases the !orneal re#le3, #requent eye !are is per#orme to keep the e3pose !ornea moist, preventing ul!eration an in#lammation. Interventions #or the patient with a!quire immuno e#i!ien!y syn rome in!lu e treating e3isting in#e!tions an !an!ers, re u!ing the risk o# opportunisti! in#e!tions, maintaining a equate nutrition an hy ration, an provi ing emotional support to the patient an #amily. 9igns an symptoms o# !hlamy ial in#e!tion are urinary #requen!y? thin, white vaginal or urethral is!harge? an !ervi!al in#lammation. -hlamy ial in#e!tion is the most prevalent se3ually transmitte isease in the Cnite 9tates. ,he pituitary glan is lo!ate in the sella tur!i!a o# the sphenoi bone in the !ranial !avity. /yasthenia gravis is a neuromus!ular isor er that6s !hara!teri0e by impulse isturban!es at the myoneural 7un!tion. /yasthenia gravis, whi!h usually a##e!ts young women, !auses e3treme mus!le weakness an #atigability, i##i!ulty !hewing an talking, strabismus, an ptosis. 8ypothermia is a li#e+threatening isor er in whi!h the bo y6s !ore temperature rops below B5@ = (35@ -). 9igns an symptoms o# hypopituitarism in a ults may in!lu e gona al

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#ailure, iabetes insipi us, hypothyroi ism, an a reno!orti!al insu##i!ien!y. 5eiter6s syn rome !auses a tria o# symptomsG arthritis, !on7un!tivitis, an urethritis. =or patients who have ha a partial gastre!tomy, a !arbohy rate+ restri!te iet in!lu es #oo s that are high in protein an #ats an restri!ts #oo s that are high in !arbohy rates. 8igh+!arbohy rate #oo s are igeste qui!kly an are rea ily emptie #rom the stoma!h into the uo enum, !ausing iarrhea an umping syn rome. * woman o# !hil bearing age who is un ergoing !hemotherapy shoul be en!ourage to use a !ontra!eptive be!ause o# the risk o# #etal amage i# she be!omes pregnant. %erni!ious anemia is vitamin &'( e#i!ien!y that6s !ause by a la!k o# intrinsi! #a!tor, whi!h is pro u!e by the gastri! mu!osal parietal !ells. ,o per#orm purse +lip breathing, the patient inhales through the nose an e3hales slowly an evenly against purse lips while !ontra!ting the ab ominal mus!les. * patient who is un ergoing !hemotherapy shoul !onsume a high+ !alorie, high+protein iet. * verse e##e!ts o# !hemotherapy in!lu e bone marrow epression, whi!h !auses anemia, leukopenia, an thrombo!ytopenia? )I epithelial !ell irritation, whi!h !auses )I ul!eration, blee ing, an vomiting? an estru!tion o# hair #olli!les an skin, whi!h !auses alope!ia an ermatitis. ,he hemoglobin ele!trophoresis test i##erentiates between si!kle !ell trait an si!kle !ell anemia. ,he antibioti!s erythromy!in, !lin amy!in, an tetra!y!line a!t by inhibiting protein synthesis in sus!eptible organisms. ,he nurse a ministers o3ygen as pres!ribe to the patient with heart #ailure to help over!ome hypo3ia an yspnea. 9igns an symptoms o# small+bowel obstru!tion in!lu e e!rease or absent bowel soun s, ab ominal istention, e!rease #latus, an pro7e!tile vomiting. ,he nurse shoul use both han s when ventilating a patient with a manual resus!itation bag. >ne han !an eliver only 422 !! o# air? two han s !an eliver ',222 !! o# air. "osages o# methyl3anthine agents, su!h as theophylline (,heo+"ur) an aminophylline (*minophyllin), shoul be in ivi uali0e base on serum rug level, patient response, an a verse rea!tions. ,he patient shoul apply a trans ermal s!opolamine pat!h (,rans erm+9!op) at least 4 hours be#ore its antiemeti! a!tion is nee e . Early in i!ations o# gangrene are e ema, pain, re ness, arkening o# the tissue, an !ol ness in the a##e!te bo y part. Ipe!a! syrup is the emeti! o# !hoi!e be!ause o# its e##e!tiveness in eva!uating the stoma!h an relatively low in!i en!e o# a verse rea!tions. >ral iron (#errous sul#ate) may !ause green to bla!k #e!es. %oly!ythemia vera !auses pruritus, pain#ul #ingers an toes, hyperuri!emia, plethora (re ish purple skin an mu!osa), weakness, an easy #atigability. 5heumati! #ever is usually pre!e e by a group * beta+hemolyti! strepto!o!!al in#e!tion, su!h as s!arlet #ever, otitis me ia, strepto!o!!al throat in#e!tion, impetigo, or tonsillitis. * thyroi storm, or !risis, is an e3treme #orm o# hyperthyroi ism. It6s !hara!teri0e by hyperpyre3ia with a temperature o# up to '2;@ = (4'.'@ -), iarrhea, ehy ration, ta!hy!ar ia o# up to (22 beats/minute, arrhythmias, e3treme irritability, hypotension, an elirium. It may lea to !oma, sho!k, an eath. ,ar ive yskinesia, an a verse rea!tion to long+term use o# antipsy!hoti! rugs, !auses involuntary repetitive movements o# the tongue, lips, e3tremities, an trunk.

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*sthma is bron!ho!onstri!tion in response to allergens, su!h as #oo , pollen, an rugs? irritants, su!h as smoke an paint #umes? in#e!tions? weather !hanges? e3er!ise? or gastroesophageal re#lu3. In the Cnite 9tates, about 5E o# !hil ren have !hroni! asthma. &loo !ultures help i enti#y the !ause o# en o!ar itis. *n in!rease white bloo !ell !ount suggests ba!terial in#e!tion. In a patient who has a!ute aorti! isse!tion, the nursing priority is to maintain the mean arterial pressure between ;2 an ;5 mm 8g. * vaso ilator su!h as nitroprussi e (Iitropress) may be nee e to a!hieve this goal. =or a patient with heart #ailure, one o# the most important nursing iagnoses is e!rease !ar ia! output relate to altere myo!ar ial !ontra!tility, in!rease preloa an a#terloa , an altere rate, rhythm, or ele!tri!al !on u!tion. =or a patient re!eiving peritoneal ialysis, the nurse must monitor bo y weight an bloo urea nitrogen, !reatinine, an ele!trolyte levels. *ngiotensin+!onverting en0yme inhibitors, su!h as !aptopril (-apoten) an enalapril ($asote!), e!rease bloo pressure by inter#ering with the renin+angiotensin+al osterone system. * patient who has stable ventri!ular ta!hy!ar ia has a bloo pressure an is !ons!ious? there#ore, the patient6s !ar ia! output is being maintaine , an the nurse must monitor the patient6s vital signs !ontinuously. *ngiotensin+!onverting en0yme inhibitors inhibit the en0yme that !onverts angiotensin I into angiotensin II, whi!h is a potent vaso!onstri!tor. ,hrough this a!tion, they re u!e peripheral arterial resistan!e an bloo pressure. In a patient who is re!eiving a iureti!, the nurse shoul monitor serum ele!trolyte levels, !he!k vital signs, an observe #or orthostati! hypotension. &reast sel#+e3amination is one o# the most important health habits to tea!h a woman. It shoul be per#orme ' week a#ter the menstrual perio be!ause that6s when hormonal e##e!ts, whi!h !an !ause breast lumps an ten erness, are re u!e . %ostmenopausal women shoul !hoose a regular time ea!h month to per#orm breast sel#+e3amination (#or e3ample, on the same ay o# the month as the woman6s birth ay). ,he i##eren!e between a!ute an !hroni! arterial isease is that the a!ute isease pro!ess is li#e+threatening. :hen preparing the patient #or !hest tube removal, the nurse shoul e3plain that removal may !ause pain or a burning or pulling sensation. Essential hypertensive renal isease is !ommonly !hara!teri0e by progressive renal impairment. /ean arterial pressure (/*%) is !al!ulate using the #ollowing #ormula, where 9 H systoli! pressure an " H iastoli! pressureG /*% H N(" V () W 9O X 3 9ymptoms o# supine hypotension syn rome are i00iness, light+ hea e ness, nausea, an vomiting. *n immuno!ompromise patient is at risk #or .aposi6s sar!oma. "oll6s eye movement is the normal lag between hea movement an eye movement. ,hir spa!ing o# #lui o!!urs when #lui shi#ts #rom the intravas!ular spa!e to the interstitial spa!e an remains there. -hroni! pain is any pain that lasts longer than ; months. *!ute pain lasts less than ; months. ,he me!hanism o# a!tion o# a phenothia0ine erivative is to blo!k opamine re!eptors in the brain. %atients shoul n6t take bisa!o yl, anta!i s, an the same time. airy pro u!ts all at

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* vise the patient who is taking igo3in to avoi #oo s that are high in #iber, su!h as bran !ereal an prunes. * patient who is taking iureti!s shoul avoi #oo s that !ontain monoso ium glutamate be!ause it !an !ause tightening o# the !hest an #lushing o# the #a!e. =urosemi e (Lasi3) shoul be taken ' hour be#ore meals. * patient who is taking griseo#ulvin ()risovin =%) shoul maintain a high+#at iet, whi!h enhan!es the se!retion o# bile. %atients shoul take oral iron pro u!ts with !itrus rinks to enhan!e absorption. Isonia0i shoul be taken on an empty stoma!h, with a #ull glass o# water. =oo s that are high in protein e!rease the absorption o# levo opa. * patient who is taking tetra!y!line shoul n6t take iron supplements or anta!i s. * patient who is taking war#arin (-ouma in) shoul avoi #oo s that are high in vitamin ., su!h as liver an green lea#y vegetables. ,he normal value #or !holesterol is less than (22 mg/ l. ,he normal value #or low+ ensity lipoproteins is ;2 to '12 mg/ l? #or high+ ensity lipoproteins, it6s 32 to 12 mg/ l. ,he normal !ar ia! output #or an a ult who weighs '55 lb (A2.3 kg) is 5 to ; L/minute. * pulmonary artery pressure !atheter (9wan+)an0) measures the pressure in the !ar ia! !hambers. 9evere !hest pain that6s aggravate by breathing an is es!ribe as Lsharp,M Lstabbing,M or Lkni#elikeM is !onsistent with peri!ar itis. :ater+hammer pulse is a pulse that6s lou an boun ing an rises an #alls rapi ly. It !an be !ause by emotional e3!itement or aorti! insu##i!ien!y. %athologi! splitting o# 9( is normally hear between inspiration an e3piration. It o!!urs in right bun le+bran!h blo!k. %ink, #rothy sputum is asso!iate with pulmonary e ema. =rank hemoptysis may be asso!iate with pulmonary embolism. *n aorti! aneurysm !an be hear 7ust over the umbili!al area an !an be ete!te as an ab ominal pulsation (bruit). 8eart murmurs are gra e a!!or ing to the #ollowing systemG gra e ' is #aint an is hear a#ter the e3aminer Ltunes inM? gra e ( is hear imme iately? gra e 3 is mo erately lou ? gra e 4 is lou ? gra e 5 is very lou , but is hear only with a stethos!ope? an gra e ; is very lou an is hear without a stethos!ope. -lot #ormation uring !ar ia! !atheteri0ation is minimi0e by the a ministration o# 4,222 to 5,222 units o# heparin. /ost !ompli!ations that arise #rom !ar ia! !atheteri0ation are asso!iate with the pun!ture site. *llergi! symptoms asso!iate with io ine+base !ontrast me ia use in !ar ia! !atheteri0ation in!lu e urti!aria, nausea an vomiting, an #lushing. ,o ensure that bloo #low hasn6t been !ompromise , the nurse shoul mark the peripheral pulses istal to the !ut own site to ai in lo!ating the pulses a#ter the pro!e ure. ,he e3tremity use #or the !ut own site shoul remain straight #or 4 to ; hours. I# an ante!ubital vessel was use , an armboar is nee e . I# a #emoral artery was use , the patient shoul remain on be rest #or ; to '( hours. I# a patient e3perien!es numbness or tingling in the e3tremity a#ter a !ut own, the physi!ian shoul be noti#ie imme iately. *#ter !ar ia! !atheteri0ation, #lui intake shoul be en!ourage to ai in #lushing the !ontrast me ium through the ki neys.

(4
In a patient who is un ergoing pulmonary artery !atheteri0ation, risks in!lu e pulmonary artery in#ar!tion, pulmonary embolism, in7ury to the heart valves, an in7ury to the myo!ar ium. %ulmonary artery we ge pressure is a ire!t in i!ator o# le#t ventri!ular pressure. %ulmonary artery we ge pressure greater than '1 to (2 mm 8g in i!ates in!rease le#t ventri!ular pressure, as seen in le#t+si e heart #ailure. :hen measuring pulmonary artery we ge pressure, the nurse shoul pla!e the patient in a supine position, with the hea o# the be elevate no more than (5 egrees. %ulmonary artery pressure, whi!h in i!ates right an le#t ventri!ular pressure, is taken with the balloon e#late . %ulmonary artery systoli! pressure is the peak pressure generate by the right ventri!le. %ulmonary artery iastoli! pressure is the lowest pressure in the pulmonary artery. Iormal a ult pulmonary artery systoli! pressure is '5 to (5 mm 8g. Iormal a ult pulmonary artery iastoli! pressure is 1 to '( mm 8g. ,he normal o3ygen saturation o# venous bloo is A5E. -entral venous pressure is the amount o# pressure in the superior vena !ava an the right atrium. Iormal a ult !entral venous pressure is ( to 1 mm 8g, or 3 to '2 !m 8(>. * e!rease in !entral venous pressure in i!ates a #all in !ir!ulating #lui volume, as seen in sho!k. *n in!rease in !entral venous pressure is asso!iate with an in!rease in !ir!ulating volume, as seen in renal #ailure. In a patient who is on a ventilator, !entral venous pressure shoul be taken at the en o# the e3piratory !y!le. ,o ensure an a!!urate baseline !entral venous pressure rea ing, the 0ero point o# the trans u!er must be at the level o# the right atrium. * bloo pressure rea ing obtaine through intra+arterial pressure monitoring may be '2 mm 8g higher than one obtaine with a bloo pressure !u##. In /Yn!keberg6s s!lerosis, !al!ium eposits #orm in the me ial layer o# the arterial walls. ,he symptoms asso!iate with !oronary artery isease usually on6t appear until plaque has narrowe the vessels by at least A5E. 9ymptoms o# !oronary artery isease appear only when there is an imbalan!e between the eman #or o3ygenate bloo an its availability. %er!utaneous transluminal !oronary angioplasty is an invasive pro!e ure in whi!h a balloon+tippe !atheter is inserte into a blo!ke artery. :hen the balloon is in#late , it opens the artery by !ompressing plaque against the artery6s intimal layer. &e#ore per!utaneous transluminal !oronary angioplasty is per#orme , an anti!oagulant (su!h as aspirin) is usually a ministere to the patient. "uring the pro!e ure, the patient is given heparin, a !al!ium agonist, or nitrogly!erin to re u!e the risk o# !oronary artery spasms. "uring !oronary artery bypass gra#t surgery, a blo!ke !oronary artery is bypasse by using the saphenous vein #rom the patient6s thigh or lower leg. :hen a vein is use to bypass an artery, the vein is reverse so that the valves on6t inter#ere with bloo #low. "uring a !oronary artery bypass gra#t pro!e ure, the patient6s heart is stoppe to allow the surgeon to sew the new vessel in pla!e. &loo #low to the bo y is maintaine with a !ar iopulmonary bypass. "uring an anginal atta!k, the !ells o# the heart !onvert to anaerobi!

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metabolism, whi!h pro u!es la!ti! a!i as a waste pro u!t. *s the level o# la!ti! a!i in!reases, pain evelops. %ain that6s es!ribe as LsharpM or Lkni#elikeM is not !onsistent with angina pe!toris. *nginal pain typi!ally lasts #or 5 minutes? however, atta!ks asso!iate with a heavy meal or e3treme emotional istress may last '5 to (2 minutes. * pattern o# Le3ertion+pain+rest+relie#M is !onsistent with stable angina. Cnlike stable angina, unstable angina !an o!!ur without e3ertion an is !onsi ere a pre!ursor to a myo!ar ial in#ar!tion. * patient who is s!he ule #or a stress ele!tro!ar iogram shoul noti#y the sta## i# he has taken nitrates. I# he has, the test must be res!he ule . E3er!ise equipment, su!h as a trea mill or an e3er!ise bike, is use #or a stress ele!tro!ar iogram. *!tivity is in!rease until the patient rea!hes 15E o# his ma3imum heart rate. In patients who take nitrogly!erin #or a long time, toleran!e o#ten evelops an re u!es the e##e!tiveness o# nitrates. * '(+hour rug+#ree perio is usually maintaine at night. &eta+a renergi! blo!kers, su!h as propranolol (In eral), re u!e the workloa on the heart, thereby e!reasing o3ygen eman . ,hey also slow the heart rate. -al!ium !hannel blo!kers in!lu e ni#e ipine (%ro!ar ia), whi!h is use to treat angina? verapamil (-alan, Isoptin), whi!h is use primarily as an antiarrhythmi!? an iltia0em (-ar i0em), whi!h !ombines the e##e!ts o# ni#e ipine an verapamil without the a verse e##e!ts. * patient who has anginal pain that ra iates or worsens an oesn6t subsi e shoul be evaluate at an emergen!y me i!al #a!ility. -ar ia! !ells !an withstan (2 minutes o# is!hemia be#ore !ell eath o!!urs. per#orme .

(5

&e#ore the nurse puts antiembolism sto!kings ba!k on the patient, the patient shoul lie with his #eet elevate ;D ('5.( !m) #or (2 minutes. "ressler6s syn rome is known as late peri!ar itis be!ause it o!!urs appro3imately ; weeks to ; months a#ter a myo!ar ial in#ar!tion. It !auses peri!ar ial pain an a #ever that lasts longer than ' week. In phase I a#ter a myo!ar ial in#ar!tion, #or the #irst (4 hours, the patient is kept on a !lear liqui iet an be rest with the use o# a be si e !ommo e. In phase I a#ter a myo!ar ial in#ar!tion, on the se!on ay, the patient gets out o# be an spen s '5 to (2 minutes in a !hair. ,he number o# times that the patient goes to the !hair an the length o# time he spen s in the !hair are in!rease epen ing on his en uran!e. In phase II, the length o# time that the patient spen s out o# be an the istan!e to the !hair are in!rease . *#ter trans#er #rom the !ar ia! !are unit, the post+myo!ar ial in#ar!tion patient is allowe to walk the halls as his en uran!e in!reases. 9e3ual inter!ourse with a known partner usually !an be resume 4 to 1 weeks a#ter a myo!ar ial in#ar!tion. * patient un er !ar ia! !are shoul avoi rinking al!oholi! beverages or eating be#ore engaging in se3ual inter!ourse. ,he ambulation goal #or a post+myo!ar ial in#ar!tion patient is ( miles in ;2 minutes. * post+myo!ar ial in#ar!tion patient who oesn6t have a strenuous 7ob may be able to return to work #ull+time in 1 or B weeks. 9troke volume is the amount o# bloo e7e!te #rom the heart with ea!h heartbeat. *#terloa is the #or!e that the ventri!le must e3ert uring systole to e7e!t the stroke volume. ,he three+point position (with the patient upright an leaning #orwar , with the han s on the knees) is !hara!teristi! o# orthopnea, as seen in le#t+si e heart #ailure. %aro3ysmal no!turnal yspnea in i!ates a severe #orm o# pulmonary !ongestion in whi!h the patient awakens in the mi le o# the night with a #eeling o# being su##o!ate . -lini!al mani#estations o# pulmonary e ema in!lu e breathlessness, nasal #laring, use o# a!!essory mus!les to breath, an #rothy sputum. * late sign o# heart #ailure is e!rease !ar ia! output that !auses e!rease bloo #low to the ki neys an results in oliguria. * late sign o# heart #ailure is anasar!a (generali0e e ema). "epen ent e ema is an early sign o# right+si e heart #ailure. It6s seen in the legs, where in!rease !apillary hy rostati! pressure overwhelms plasma protein, !ausing a shi#t o# #lui #rom the !apillary be s to the interstitial spa!es. "epen ent e ema, whi!h is most noti!eable at the en o# the ay, usually starts in the #eet an ankles an !ontinues upwar . =or the re!umbent patient, e ema is usually seen in the presa!ral area. 9igns o# urinary tra!t in#e!tion in!lu e #requen!y, urgen!y, an ysuria. In tertiary+intention healing, woun !losure is elaye be!ause o# in#e!tion or e ema. * patient who has ha supratentorial surgery shoul have the hea o# the be elevate 32 egrees. *n a!i +ash iet a!i i#ies urine. $itamin - an !ranberry 7ui!e a!i i#y urine. * patient who takes probene!i (-olbenemi ) #or gout shoul be instru!te to take the rug with #oo .

"uring a myo!ar ial in#ar!tion, the most !ommon site o# in7ury is the anterior wall o# the le#t ventri!le, near the ape3. *#ter a myo!ar ial in#ar!tion, the in#ar!te tissue !auses signi#i!ant Q+wave !hanges on an ele!tro!ar iogram. ,hese !hanges remain evi ent even a#ter the myo!ar ium heals. ,he level o# -.+/&, an isoen0yme spe!i#i! to the heart, in!reases 4 to ; hours a#ter a myo!ar ial in#ar!tion an peaks at '( to '1 hours. It returns to normal in 3 to 4 ays. %atients who survive a myo!ar ial in#ar!tion an have no other !ar iovas!ular pathology usually require ; to '( weeks #or a #ull re!overy. *#ter a myo!ar ial in#ar!tion, the patient is at greatest risk #or su en eath uring the #irst (4 hours. *#ter a myo!ar ial in#ar!tion, the #irst ; hours is the !ru!ial perio #or salvaging the myo!ar ium. *#ter a myo!ar ial in#ar!tion, i# the patient !onsistently has more than three premature ventri!ular !ontra!tions per minute, the physi!ian shoul be noti#ie . *#ter a myo!ar ial in#ar!tion, in!reasing vas!ular resistan!e through the use o# vasopressors, su!h as opamine an levarterenol, !an raise bloo pressure. -lini!al mani#estations o# heart #ailure in!lu e isten e ne!k veins, weight gain, orthopnea, !ra!kles, an enlarge liver. 5isk #a!tors asso!iate with embolism are in!rease bloo vis!osity, e!rease !ir!ulation, prolonge be rest, an in!rease bloo !oagulability. *ntiembolism sto!kings shoul be worn aroun the !lo!k, but shoul be remove twi!e a ay #or 32 minutes so that skin !are !an be

MEDICAL AND SURGICAL NURSING BULLETS

patient who is suspe!te o# having epiglottitis. 5o!ky /ountain spotte #ever is sprea through the bite o# a ti!k harboring the 5i!kettsia organism. * patient who has a!quire immuno e#i!ien!y syn rome shoul n6t share ra0ors or toothbrushes with others, but there are no spe!ial pre!autions #or innerware or laun ry servi!es.

(;

I# woun ehis!en!e is suspe!te , the nurse shoul instru!t the patient to lie own an shoul e3amine the woun an monitor the vital signs. *bnormal #in ings shoul be reporte to the physi!ian. Zoster immune globulin is a ministere to stimulate immunity to vari!ella. ,he most !ommon symptoms asso!iate with !ompartmental syn rome are pain that6s not relieve by analgesi!s, loss o# movement, loss o# sensation, pain with passive movement, an la!k o# pulse. ,o help relieve mus!le spasms in a patient who has multiple s!lerosis, the nurse shoul a minister ba!lo#en (Lioresal) as or ere ? give the patient a warm, soothing bath? an tea!h the patient progressive rela3ation te!hniques. * patient who has a !ervi!al in7ury an impairment at -5 shoul be able to li#t his shoul ers an elbows partially, but has no sensation below the !lavi!le. * patient who has !ervi!al in7ury an impairment at -; shoul be able to li#t his shoul ers, elbows, an wrists partially, but has no sensation below the !lavi!le, e3!ept a small amount in the arms an thumb. * patient who has !ervi!al in7ury an impairment at -A shoul be able to li#t his shoul ers, elbows, wrists, an han s partially, but has no sensation below the mi !hest. In7uries to the spinal !or at -3 an above may be #atal as a result o# loss o# innervation to the iaphragm an inter!ostal mus!les. 9igns o# meningeal irritation seen in meningitis in!lu e nu!hal rigi ity, a positive &ru 0inski6s sign, an a positive .ernig6s sign. Laboratory values that show pneumomeningitis in!lu e an elevate !erebrospinal #lui (-9=) protein level (more than '22 mg/ l), a e!rease -9= glu!ose level (42 mg/ l), an an in!rease white bloo !ell !ount. &e#ore un ergoing magneti! resonan!e imaging, the patient shoul remove all ob7e!ts !ontaining metal, su!h as wat!hes, un erwire bras, an 7ewelry. Csually #oo an me i!ine aren6t restri!te be#ore magneti! resonan!e imaging. %atients who are un ergoing magneti! resonan!e imaging shoul know that they !an ask questions uring the pro!e ure? however, they may be aske to lie still at !ertain times. I# a !ontrast me ium is use uring magneti! resonan!e imaging, the patient may e3perien!e iuresis as the me ium is #lushe #rom the bo y. ,he ,0an!k test is use to !on#irm herpes genitalis. 8epatitis - is sprea primarily through bloo (#or e3ample, uring trans#usion or in people who work with bloo pro u!ts), personal !onta!t an , possibly, the #e!al+oral route. ,he best metho #or soaking an open, in#e!te , raining woun is to use a hot+moist ressing. 9putum !ulture is the !on#irmation test #or tuber!ulosis. "e3amethasone ("e!a ron) is a steroi al anti+in#lammatory that6s use to treat a renal insu##i!ien!y. 9igns o# in!rease intra!ranial pressure in!lu e alteration in level o# !ons!iousness, restlessness, irritability, an pupillary !hanges. ,he patient who has a lower limb amputation shoul be instru!te to assume a prone position at least twi!e a ay. "uring the #irst (4 hours a#ter amputation, the resi ual limb is elevate on a pillow. *#ter that time, the limb is pla!e #lat to re u!e the risk o# hip #le3ion !ontra!tures. * tourniquet shoul be in #ull view at the be si e o# the patient who has an amputation. *n emergen!y tra!heostomy set shoul be kept at the be si e o# a

&e!ause anti#ungal !reams may stain !lothing, patients who use them shoul use sanitary napkins. *n anti#ungal !ream shoul be inserte high in the vagina at be time. * patient who is having a sei0ure usually requires prote!tion #rom the environment only? however, anyone who nee s airway management shoul be turne on his si e. 9tatus epilepti!us is treate with I.$. iphenylhy antoin. * 3enogra#t is a skin gra#t #rom an animal. ,he anti ote #or magnesium sul#ate is !al!ium glu!onate '2E. *llergi! rea!tions to a bloo trans#usion are #lushing, whee0ing, urti!aria, an rash. * patient who has a history o# basal !ell !ar!inoma shoul avoi sun e3posure. :hen potent, nitrogly!erin !auses a slight stinging sensation un er the tongue. * patient who appears to be L#ighting the ventilatorM is hol ing his breath or breathing out on an inspiratory !y!le. *n antineoplasti! rug that6s use to treat breast !an!er is tamo3i#en (Iolva e3). * verse e##e!ts o# vin!ristine (>n!ovin) are alope!ia, nausea, an vomiting. In!rease urine output is an in i!ation that a hypertensive !risis is normali0ing. I# a patient who is re!eiving I.$. !hemotherapy has pain at the insertion site, the nurse shoul stop the I.$. in#usion imme iately. E3travasation is leakage o# #lui into surroun ing tissue #rom a vein that6s being use #or I.$. therapy. -lini!al signs o# prostate !an!er are ribbling, hesitan!y, an e!rease urinary #or!e. -ar ia! gly!osi es in!rease !ar ia! !ontra!tility. * verse e##e!ts o# !ar ia! gly!osi es in!lu e hea a!he, hypotension, nausea an vomiting, an yellow+green halos aroun lights. * , tube shoul be !lampe igestion. uring patient meals to ai in #at

* , tube usually remains in pla!e #or '2 ays. "uring a vertigo atta!k, a patient who has /Kni[re6s isease shoul be instru!te to lie own on his si e with his eyes !lose . :hen maintaining a Sa!kson+%ratt rainage system, the nurse shoul squee0e the reservoir an e3pel the air be#ore re!apping the system. ,he most !ommon symptom asso!iate with sleep apnea is snoring. 8istamine is release uring an in#lammatory response.

:hen ealing with a patient who has a severe spee!h impe iment, the nurse shoul minimi0e ba!kgroun noise an avoi interrupting the patient. =ever an night sweats, hallmark signs o# tuber!ulosis, may not be present in el erly patients who have the isease. * suitable ressing #or woun ebri ement is wet+to+ ry.

MEDICAL AND SURGICAL NURSING BULLETS

(A
=or a !an!er patient, palliative surgery is per#orme to re u!e pain, relieve airway obstru!tion, relieve )I obstru!tion, prevent hemorrhage, relieve pressure on the brain an spinal !or , rain abs!esses, an remove or rain in#e!te tumors. * patient who is un ergoing ra iation implant therapy shoul be kept in a private room to re u!e the risk o# e3posure to others, in!lu ing nursing personnel. *#ter total knee repla!ement surgery, the knee shoul be kept in ma3imum e3tension #or 3 ays. %artial weight bearing is allowe appro3imately ' week a#ter total knee repla!ement. :eight bearing to the point o# pain is allowe at ( weeks. 97Ygren6s syn rome is a !hroni! in#lammatory isor er asso!iate with a e!rease in salivation an la!rimation. -lini!al mani#estations in!lu e ryness o# the mouth, eyes, an vagina. Iormal values o# !erebrospinal #lui in!lu e the #ollowingG protein level, '5 to 45 mg/'22 ml? #asting glu!ose, 52 to 12 mg/'22 ml? re bloo !ell !ount, 2? white bloo !ell !ount, 2 to 5/\lG p8, A.3? potassium ion value, (.B mmol/L? !hlori e, '(2 to '32 mEq/L. ,he #ollowing mnemoni! evi!e !an be use to i enti#y whether a !ranial nerve is a motor nerveG I 9ome ] II 9ay ] III /arry ] I$ /oney, ] $ but ] $I /y ] $II &rother ] $II 9ays ] I< &a ] < &usiness ] <I /arry ] <II /oney. ,o interpret the mnemoni! evi!eG I# the wor begins with an 9, it6s a sensory nerve? i# it starts with an /, it6s a motor nerve? an i# it starts with a &, it6s both a sensory an a motor nerve. ,he )lasgow -oma 9!ale evaluates level o# !ons!iousness, pupil rea!tion, an motor a!tivity. * s!ore between 3 an '5 is possible. :hen assessing a patient6s pupils, the nurse shoul remember that aniso!oria, unequal pupils o# ' mm or larger, o!!urs in appro3imately 'AE o# the population. 8omonymous hemianopsia is a visual e#e!t in whi!h the patient sees only one+hal# o# the visual #iel with ea!h eye. ,here#ore, the patient sees only one+hal# o# a normal visual #iel . %assive range+o#+motion e3er!ises are !ommonly starte (4 hours a#ter a stroke. ,hey6re per#orme #our times per ay. In treating a patient with a transient is!hemi! atta!k, the goal o# me i!al management is to prevent a stroke. ,he patient is a ministere antihypertensive rugs, antiplatelet rugs or aspirin an , in some !ases, war#arin (-ouma in). * patient who has an intraperitoneal shunt shoul be observe #or in!rease ab ominal girth. "igestion o# !arbohy rates begins in the mouth. "igestion o# #ats begins in the stoma!h, but o!!urs pre ominantly in the small intestine. "ietary sour!es o# magnesium are #ish, grains, an nuts. * rough estimate o# serum osmolarity is twi!e the serum so ium level.

"rinking warm milk at be time ai s sleeping be!ause o# the natural se ative e##e!t o# the amino a!i tryptophan. ,he initial step in promoting sleep in a hospitali0e patient is to minimi0e environmental stimulation. &e#ore moving a patient, the nurse shoul assess how mu!h e3ertion the patient is permitte , the patient6s physi!al ability, an his ability to un erstan instru!tion as well as her own strength an ability to move the patient. * patient who is in a restraint shoul be !he!ke every 32 minutes an the restraint loosene every ( hours to permit range o# motion e3er!ises #or the e3tremities. *ntibioti!s that are given #our times a ay shoul be given at ; a.m., '( p.m., ; p.m., an '( a.m. to minimi0e isruption o# sleep. 9un owner syn rome is seen in patients who be!ome more !on#use towar the evening. ,o !ounter this ten en!y, the nurse shoul turn a light on. =or the patient who has somnambulism, the primary goal is to prevent in7ury by provi ing a sa#e environment. =or the patient who has somnambulism, the primary goal is to prevent in7ury by provi ing a sa#e environment. Ialo3one (Iar!an) shoul be kept at the be si e o# the patient who is re!eiving patient+!ontrolle analgesia. 8ypnoti! rugs e!rease rapi eye movement sleep, but in!rease the overall amount o# sleep. * su en wave o# overwhelming sleepiness is a symptom o# nar!olepsy. * iabeti! patient shoul be instru!te to buy shoes in the a#ternoon be!ause #eet are usually largest at that time o# ay. I# surgery is s!he ule late in the a#ternoon, the surgeon may approve a light break#ast. * hearing ai is usually le#t in pla!e uring surgery to permit !ommuni!ation with the patient. ,he operating room team shoul be noti#ie o# its presen!e. ,he nurse shoul monitor the patient #or !entral nervous system epression #or (4 hours a#ter the a ministration o# nitrous o3i e. In the postanesthesia !are unit, the proper position o# an a ult is with the hea to the si e an the !hin e3ten e upwar . ,he 9ims6 position also !an be use unless !ontrain i!ate . *#ter a patient is a mitte to the postanesthesia !are unit, the #irst a!tion is to assess the paten!y o# the airway. I# a patient is a mitte to the postanesthesia !are unit without the pharyngeal re#le3, he6s positione on his si e. ,he nurse stays at the be si e until the gag re#le3 returns. In the postanesthesia !are unit, the patient6s vital signs are taken every '5 minutes routinely, or more o#ten i# in i!ate , until the patient is stable. In the postanesthesia !are unit, the , tube shoul be un!lampe an atta!he to a rainage system. *#ter the patient re!eives anesthesia, the nurse must observe him #or a rop in bloo pressure or evi en!e o# labore breathing. I# a patient begins to go into sho!k uring the postanesthesia assessment, the nurse shoul a minister o3ygen, pla!e the patient in the ,ren elenburg position, an in!rease the I.$. #lui rate a!!or ing to the physi!ian6s or er or the poli!y o# the postanesthesia !are unit. ,ypes o# benign tumors in!lu e my3oma, #ibroma, lipoma, osteoma, an !hon roma. /alignant tumors in!lu e sar!oma, basal !ell !ar!inoma, #ibrosar!oma, osteosar!oma, my3osar!oma, !hon rosar!oma, an a eno!ar!inoma.

In etermining a!i Fbase problems, the nurse shoul #irst note the p8. I# it6s above A.45, it6s a problem o# alkalosis? i# it6s below A.35, it6s a problem o# a!i osis. ,he nurse shoul ne3t look at the partial pressure o# arterial !arbon io3i e (%a->(). ,his is the respiratory in i!ator. I# the p8 in i!ates a!i osis an the %a->( in i!ates a!i osis as well (greater than 45 mm 8g), then there6s a mat!h, an the sour!e o# the problem is respiration. It6s !alle respiratory a!i osis. I# the p8 in i!ates alkalosis an the %a->( also in i!ates alkalosis (less than 35 mm 8g), then there6s a mat!h, an the sour!e o# the problem is respiration. ,his is !alle respiratory alkalosis. I# the %a->( is normal, then the nurse shoul look at the bi!arbonate (8->3F), whi!h is the metaboli! in i!ator, an note whether it6s a!i i! (less than (( mEq/L) or alkaline (greater than (; mEq/L). "etermine whi!h value the p8 mat!hes? it will etermine whether the problem is metaboli! a!i osis or metaboli!

MEDICAL AND SURGICAL NURSING BULLETS

alkalosis. I# both the %a->( an 8->3F are abnormal, then the bo y is !ompensating. I# the p8 has returne to normal, the bo y is in #ull !ompensation. ,he ,ensilon (e rophonium !hlori e) test is use to !on#irm myasthenia gravis. * masklike #a!ial e3pression is a sign o# myasthenia gravis an %arkinson6s isease. *lbumin is a !olloi that ai s in maintaining #lui within the vas!ular system. I# albumin were #iltere out through the ki neys an into the urine, e ema woul o!!ur. E ema !ause by water an trauma oesn6t !ause pitting. "ehy ration is water loss only? #lui volume e#i!it in!lu es all #lui s in the bo y. ,he primary a!tion o# an oil retention enema is to lubri!ate the !olon. ,he se!on ary a!tion is so#tening the #e!es. * patient who uses a walker shoul be instru!te to move the walker appro3imately '(D (32.5 !m) to the #ront an then a van!e into the walker. &ra ykinesia is a sign o# %arkinson6s isease. Lor osis is ba!kwar ar!hing !urvature o# the spine. .yphosis is #orwar !urvature o# the spine. In a patient with anore3ia nervosa, a positive response to therapy is sustaine weight gain. ,he rug in ialysate is heparin. *n autogra#t is a gra#t that6s remove #rom one area o# the bo y #or transplantation to another. 9igns o# !ervi!al !an!er in!lu e mi menses blee ing an post!oital blee ing. *#ter prostate!tomy, a !atheter is inserte to irrigate the bla er an keep urine straw+!olore or light pink, to put ire!t pressure on the operative si e, an to maintain a patent urethra. I# a ra iation implant be!omes islo ge , but remains in the patient, the nurse shoul noti#y the physi!ian. ,he best metho to re u!e the risk #or atele!tasis is to en!ourage the patient to walk. *tele!tasis usually o!!urs (4 to 41 hours a#ter surgery. %atients who are at the greatest risk #or atele!tasis are those who have ha high ab ominal surgery, su!h as !hole!yste!tomy. * persistent e!rease in o3ygen to the ki neys !auses erythropoiesis. 5hon!hi an !ra!kles in i!ate ine##e!tive airway !learan!e. :hee0ing in i!ates bron!hospasms. -lini!al signs an symptoms o# hypo3emia are restlessness (usually the #irst sign), agitation, yspnea, an isorientation. -ommon a verse e##e!ts o# opioi s are !onstipation an respiratory epression. "isuse osteoporosis is !ause by eminerali0ation o# !al!ium as a result o# prolonge be rest. ,he best way to prevent isuse osteoporosis is to en!ourage the patient to walk. * !ane shoul be !arrie on the una##e!te si e an a van!e with the a##e!te e3tremity. 9teroi s shoul n6t be use in patients who have !hi!kenpo3 or shingles be!ause they may !ause a verse e##e!ts.

(1

9ero!onversion o!!urs appro3imately 3 to ; months a#ter e3posure to human immuno e#i!ien!y virus. ,herapy with the antiviral agent 0i ovu ine is initiate when the -"4W ,+!ell !ount is 522 !ells/\l or less. In a light+skinne person, .aposi6s sar!oma !auses a purplish is!oloration o# the skin. In a ark+skinne person, the is!oloration is ark brown to bla!k. *#ter an esophageal balloon tampona e is in pla!e, it shoul be in#late to (2 mm 8g. * patient who has .aposi6s sar!oma shoul avoi a!i i! or highly seasone #oo s. ,he treatment #or oral !an i iasis is amphoteri!in & (=ungi0one) or #lu!ona0ole ("i#lu!an). * sign o# respiratory #ailure is vital !apa!ity o# less than '5 ml/kg an respiratory rate o# greater than 32 breaths/minute or less than 1 breaths/ minute. =or le#t+si e !ar ia! !atheteri0ation, the !atheter is threa e through the es!en ing aorta, aorti! ar!h, as!en ing aorta, aorti! valve, an le#t ventri!le. =or right+si e !ar ia! !atheteri0ation, the !atheter is threa e through the superior vena !ava, right atrium, right ventri!le, pulmonary artery, an pulmonary !apillaries. *nemia !an be ivi e into #our groups a!!or ing to its !auseG bloo loss, impaire pro u!tion o# re bloo !ells (5&-s), in!rease estru!tion o# 5&-s, an nutritional e#i!ien!ies. *spirin, ibupro#en, phenobarbital, lithium, !ol!hi!ine, lea , an !hlorampheni!ol !an !ause aplasti! anemia. *#ter a patient un ergoes bone marrow aspiration, the nurse shoul apply ire!t pressure to the site #or 3 to 5 minutes to re u!e the risk o# blee ing. =resh #ro0en plasma is thawe to B1.;@ = (3A@ -) be#ore in#usion. 9igns o# thrombo!ytopenia in!lu e pete!hiae, e!!hymoses, hematuria, an gingival blee ing. * patient who has thrombo!ytopenia shoul be taught to use a so#t toothbrush an use an ele!tri! ra0or. 9igns o# #lui overloa in!lu e in!rease !entral venous pressure, in!rease pulse rate, isten e 7ugular veins, an boun ing pulse. * patient who has leukopenia (or any other patient who is at an in!rease risk #or in#e!tion) shoul avoi eating raw meat, #resh #ruit, an #resh vegetables. ,o prevent a severe gra#t+versus+host rea!tion, whi!h is most !ommonly seen in patients ol er than age 32, the onor marrow is treate with mono!lonal antibo ies be#ore transplantation. ,he #our most !ommon signs o# hypogly!emia reporte by patients are nervousness, mental isorientation, weakness, an perspiration. %rolonge atta!ks o# hypogly!emia in a iabeti! patient !an result in brain amage. *!tivities that in!rease intra!ranial pressure in!lu e !oughing, snee0ing, straining to pass #e!es, ben ing over, an blowing the nose. ,reatment #or blee ing esophageal vari!es in!lu es vasopressin, esophageal tampona e, i!e saline lavage, an vitamin .. 8epatitis - (also known as bloo +trans#usion hepatitis) is a parenterally transmitte #orm o# hepatitis that has a high in!i en!e o# !arrier status. ,he nurse shoul be !on!erne about #lui an ele!trolyte problems in the patient who has as!ites, e ema, e!rease urine output, or low bloo pressure.

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(B

,he nurse shoul be !on!erne about )I blee ing, low bloo pressure, an in!rease heart rate in a patient who is hemorrhaging. ,he nurse shoul be !on!erne about generali0e malaise, !lou y urine, purulent rainage, ta!hy!ar ia, an in!rease temperature in a patient who has an in#e!tion. In a patient who has e ema or as!ites, the serum ele!trolyte level shoul be monitore . ,he patient also shoul be weighe aily? have his ab ominal girth measure with a !entimeter tape at the same lo!ation, using the umbili!us as a !he!kpoint? have his intake an output measure ? an have his bloo pressure taken at least every 4 hours. En ogenous sour!es o# ammonia in!lu e a0otemia, )I blee ing, !atabolism, an !onstipation. E3ogenous sour!es o# ammonia in!lu e protein, bloo trans#usion, an amino a!i s. ,he #ollowing histologi! gra ing system is use to !lassi#y !an!ersG gra e ', well+ i##erentiate ? gra e (, mo erately well+ i##erentiate ? gra e 3, poorly i##erentiate ? an gra e 4, very poorly i##erentiate . ,he #ollowing gra ing system is use to !lassi#y tumorsG ,2, no evi en!e o# a primary tumor? ,I9, tumor in situ? an ,', ,(, ,3, an ,4, a!!or ing to the si0e an involvement o# the tumor? the higher the number, the greater the involvement. %heo!hromo!ytoma is a !ate!holamine+se!reting neoplasm o# the a renal me ulla. It !auses e3!essive pro u!tion o# epinephrine an norepinephrine. -lini!al mani#estations o# pheo!hromo!ytoma in!lu e visual isturban!es, hea a!hes, hypertension, an elevate serum glu!ose level. ,he patient shoul n6t !onsume any !a##eine+!ontaining pro u!ts, su!h as !ola, !o##ee, or tea, #or at least 1 hours be#ore obtaining a (4+hour urine sample #or vanillylman eli! a!i . * patient who is taking -ol&enemi (probene!i an !ol!hi!ine) #or gout shoul in!rease his #lui intake to (,222 ml/ ay. * mioti! su!h as pilo!arpine is a ministere to a patient with glau!oma to in!rease the out#low o# aqueous humor, whi!h e!reases intrao!ular tension. ,he rug that6s most !ommonly use to treat strepto!o!!al pharyngitis an rheumati! #ever is peni!illin. * patient with gout shoul avoi purine+!ontaining #oo s, su!h as liver an other organ meats. * patient who un ergoes magneti! resonan!e imaging lies on a #lat plat#orm that moves through a magneti! #iel . Laboratory values in patients who have ba!terial meningitis in!lu e in!rease white bloo !ell !ount, in!rease protein an la!ti! a!i levels, an e!rease glu!ose level. /annitol is a hypertoni! osmoti! iureti! that e!reases intra!ranial pressure. ,he best metho to ebri e a woun is to use a wet+to+ ry ressing an remove the ressing a#ter it ries. ,he greatest risk #or respiratory !ompli!ations o!!urs a#ter !hest wall in7ury, !hest wall surgery, or upper ab ominal surgery. 9e!on ary metho s to prevent postoperative respiratory !ompli!ations in!lu e having the patient use an in!entive spirometer, turning the patient, a vising the patient to !ough an breathe eeply, an provi ing hy ration. * !hara!teristi! o# allergi! inspiratory an e3piratory whee0ing is a ry, ha!king, nonpro u!tive !ough. ,he in!ubation perio #or 5o!ky /ountain spotte #ever is A to '4 ays. /i!ona0ole (/onistat) vaginal suppository shoul be a ministere with the patient lying #lat.

,he nurse shoul pla!e the patient who is having a sei0ure on his si e. 9igns o# hip islo!ation are one leg that6s shorter than the other an one leg that6s e3ternally rotate . *nti!holinergi! me i!ation is a ministere be#ore surgery to iminish se!retion o# saliva an gastri! 7ui!es. E3trapyrami al syn rome in a patient with %arkinson6s isease is usually !ause by a e#i!ien!y o# opamine in the substantia nigra. In a burn patient, the or er o# !on!ern is airway, !ir!ulation, pain, an in#e!tion. 8yperkalemia normally o!!urs uring the hypovolemi! phase in a patient who has a serious burn in7ury. &la!k #e!es in the burn patient are !ommonly relate to -urling6s ul!er. In a patient with burn in7ury, imme iate !are o# a #ull+thi!kness skin gra#t in!lu es !overing the site with a bulky ressing. ,he onor site o# a skin gra#t shoul be le#t e3pose to the air. Leaking aroun a , tube shoul be reporte imme iately to the physi!ian. * patient who has /Kni[re6s isease shoul !onsume a low+so ium iet. In any postoperative patient, the priority o# !on!ern is airway, breathing, an !ir!ulation, #ollowe by sel#+!are e#i!its. ,he symptoms o# myasthenia gravis are most likely relate to nerve egeneration. 9ymptoms o# septi! sho!k in!lu e !ol , !lammy skin? hypotension? an e!rease urine output. Iinety+#ive per!ent o# women who have gonorrhea are asymptomati!. *n a verse sign in a patient who has a 9teinmann6s pin in the #emur woul be erythema, e ema, an pain aroun the pin site. 9igns o# !hroni! glau!oma in!lu e halos aroun lights, gra ual loss o# peripheral vision, an !lou y vision. 9igns o# a eta!he retina in!lu e a sensation o# a veil (or !urtain) in the line o# sight. ,o3i! levels o# streptomy!in !an !ause hearing loss. * long+term e##e!t o# rheumati! #ever is mitral valve amage. Laboratory values note in rheumati! #ever in!lu e an antistreptolysin+> titer, the presen!e o# -+rea!tive protein, leuko!ytosis, an an in!rease erythro!yte se imentation rate. -rampy pain in the right lower qua rant o# the ab omen is a !onsistent #in ing in -rohn6s isease. -rampy pain in the le#t lower qua rant o# the ab omen is a !onsistent #in ing in iverti!ulitis. In the i!teri! phase o# hepatitis, urine is amber, #e!es are !lay+!olore , an the skin is yellow. 9igns o# osteomyelitis in!lu e pathologi! #ra!tures, shortening or lengthening o# the bone, an pain eep in the bone. ,he laboratory test that woul best re#le!t #lui loss be!ause o# a burn woul be hemato!rit. * patient who has a!ute pan!reatitis shoul take nothing by mouth an un ergo gastri! su!tion to e!ompress the stoma!h. * mist tent is use to in!rease the hy ration o# se!retions. * patient who is re!eiving levo opa shoul avoi #oo s that !ontain

MEDICAL AND SURGICAL NURSING BULLETS

pyri o3ine (vitamin &;), su!h as beans, tuna, an bee# liver, be!ause this vitamin e!reases the e##e!tiveness o# levo opa. * patient who has a transa!tional in7ury at -3 requires positive ventilation. ,he a!tion o# phenytoin ("ilantin) is potentiate when given with anti!oagulants. -erebral palsy is a nonprogressive isor er that persists throughout li#e. * !ompli!ation o# ul!erative !olitis is per#oration. :hen a patient who has multiple s!lerosis e3perien!es iplopia, one eye shoul be pat!he . * anger sign a#ter hip repla!ement is la!k o# re#le3es in the a##e!te e3tremity. * !lini!al mani#estation o# a rupture lumbar isk in!lu es pain that shoots own the leg an terminates in the popliteal spa!e. ,he most important nutritional nee o# the burn patient is I.$. #lui with ele!trolytes. ,he patient who has systemi! lupus erythematosus shoul avoi sunshine, hair spray, hair !oloring pro u!ts, an usting pow er. ,he best position #or a patient who has low ba!k pain is sitting in a straight+ba!ke !hair. -lini!al signs o# ul!erative !olitis in!lu e bloo y, purulent, mu!oi , an watery #e!es. * patient who has a protein systemi! shunt must #ollow a li#elong protein+restri!te iet. * patient who has a hiatal hernia shoul maintain an upright position a#ter eating. * su!tion apparatus shoul be kept at the be si e o# a patient who is at risk #or status epilepti!us. ,he lea ing !ause o# eath in the burn patient is respiratory !ompromise an in#e!tion. In patients who have herpes 0oster, the primary !on!ern is pain management. ,he treatment #or 5o!ky /ountain spotte #ever is tetra!y!line. 9trawberry tongue is a sign o# s!arlet #ever. I# a patient has hemianopsia, the nurse shoul pla!e the !all light, the meal tray, an other items in his #iel o# vision. ,he best position #or the patient a#ter a !raniotomy is semi+=owler. 9igns o# renal trauma in!lu e #lank pain, hematoma an , possibly, bloo in the urine an e!rease urine output. =lank pain an hematoma in the ba!k in i!ate renal hemorrhage in the trauma patient. Iatural iureti!s in!lu e !o##ee, tea, an grape#ruit 7ui!e. -entral venous pressure o# '1 !m 8(> in i!ates hypervolemia. 9almonellosis !an be a!quire by eating !ontaminate meat su!h as !hi!ken, or eggs. )oo sour!es o# magnesium in!lu e #ish, nuts, an grains. %atients who have low bloo urea nitrogen levels shoul be instru!te to eat high+protein #oo s, su!h as #ish an !hi!ken. ,he nurse shoul monitor a patient who has )uillain+&arrK syn rome #or respiratory !ompromise. * heating pa may provi e !om#ort to a patient who has pelvi! in#lammatory isease.

32
*#ter supratentorial surgery, the patient shoul be pla!e in the semi+ =owler position. ,o prevent eep vein thrombosis, the patient shoul e3er!ise his legs at least every ( hours, elevate the legs above the level o# the heart while lying own, an ambulate with assistan!e. *#ter bron!hos!opy, the patient6s gag re#le3 shoul be !he!ke . In a patient with mononu!leosis, ab ominal pain an pain that ra iates to the le#t shoul er may in i!ate a rupture spleen. =or a skin gra#t to take, it must be autologous. Cntreate retinal eta!hment lea s to blin ness. * patient who has #ibro!ysti! breast isease shoul !onsume a iet that6s low in !a##eine an salt. * #oul o or at the pin site o# a patient who is in skeletal tra!tion in i!ates in#e!tion. * mus!le rela3ant that6s a ministere with o3ygen may !ause malignant hyperthermia an respiratory epression. %ain that o!!urs on movement o# the !ervi3, together with a ne3al ten erness, suggests pelvi! in#lammatory isease. ,he goal o# !risis intervention is to restore the person to a pre!risis level o# #un!tioning an or er. Iephroti! syn rome !auses proteinuria, hypoalbuminemia, an e ema, an sometimes hematuria, hypertension, an a e!rease glomerular #iltration rate. &owel soun s may be hear over a hernia, but not over a hy ro!ele. 9' is e!rease in #irst+ egree heart blo!k. 9( is e!rease in aorti! stenosis. )as in the !olon may !ause tympany in the right upper qua rant, obs!ure liver ullness, an lea to #alsely e!rease estimates o# liver si0e. In ata3ia !ause by loss o# position sense, vision !ompensates #or the sensory loss. ,he patient stan s well with the eyes open, but loses balan!e when they6re !lose (positive 5omberg test result). Inability to re!ogni0e numbers when rawn on the han with the blunt en o# a pen suggests a lesion in the sensory !orte3. "uring the late stage o# multiple myeloma, the patient shoul be prote!te against pathologi!al #ra!tures as a result o# osteoporosis. ,ri!y!li! anti epressants su!h as amitriptyline (Elavil) shoul n6t be a ministere to patients with narrow+angle glau!oma, benign prostati! hypertrophy, or !oronary artery isease. %ulmonary embolism is !hara!teri0e by a su en, sharp, stabbing pain in the !hest? yspnea? e!rease breath soun s? an !ra!kles or a pleural #ri!tion rub on aus!ultation. -lini!al mani#estations o# !ar ia! tampona e are hypotension an 7ugular vein istention. ,o avoi #urther amage, the nurse shoul n6t in u!e vomiting in a patient who has swallowe a !orrosive !hemi!al, su!h as oven !leaner, rain !leaner, or kerosene. * brilliant re re#le3 e3!lu es most serious e#e!ts o# the !ornea, aqueous !hamber, lens, an vitreous !hamber. >ral hypogly!emi! agents stimulate the islets o# Langerhans to pro u!e insulin. ,o treat woun ehis!en!e, the nurse shoul help the patient to lie in a supine position? !over the protru ing intestine with moist, sterile, normal saline pa!ks? an !hange the pa!ks #requently to keep the area moist. :hile a patient is re!eiving an I.$. nitrogly!erin rip, the nurse shoul monitor his bloo pressure every '5 minutes to ete!t hypotension.

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*ny type o# #lui loss !an trigger a !risis in a patient with si!kle !ell anemia. ,he patient shoul rinse his mouth a#ter using a !orti!osteroi inhaler to avoi steroi resi ue an re u!e oral #ungal in#e!tions. * patient with low levels o# triio othyronine an thyro3ine may have #atigue, lethargy, !ol intoleran!e, !onstipation, an e!rease libi o. "uring a si!kle !ell !risis, treatment in!lu es pain management, hy ration, an be rest. * patient who is hyperventilating shoul rebreathe into a paper bag to in!rease the retention o# !arbon io3i e. -horea is a ma7or !lini!al mani#estation o# !entral nervous system involvement !ause by rheumati! #ever. -horea !auses !onstant 7erky, un!ontrolle movements? #i geting? twisting? grima!ing? an loss o# bowel an bla er !ontrol. 9evere iarrhea !an !ause ele!trolyte e#i!ien!ies an metaboli! a!i osis. ,o re u!e the risk o# hyper!al!emia in a patient with metastati! bone !an!er, the nurse shoul help the patient ambulate, promote #lui intake to ilute urine, an limit the patient6s oral intake o# !al!ium. %ain asso!iate with a myo!ar ial in#ar!tion usually is es!ribe as LpressureM or as a LheavyM or Lsquee0ingM sensation in the mi sternal area. ,he patient may report that the pain #eels as though someone is stan ing on his !hest or as though an elephant is sitting on his !hest. -al!ium an phosphorus levels are elevate until hyperparathyroi ism is stabili0e . ,he pain asso!iate with !arpal tunnel syn rome is !ause by entrapment o# the me ian nerve at the wrist. %an!reati! en0yme repla!ement enhan!es the absorption o# protein. Lamine!tomy with spinal #usion is per#orme to relieve pressure on the spinal nerves an stabili0e the spine. * transe!tion in7ury o# the spinal !or at any level !auses paralysis below the level o# the lesion. =or pulseless ventri!ular ta!hy!ar ia, the patient shoul be e#ibrillate imme iately, with (22 7oules, 322 7oules, an then 3;2 7oules given in rapi su!!ession. %leural #ri!tion rub is hear in pleurisy, pneumonia, an plural in#ar!tion. :hee0es are hear in emphysema, #oreign bo y obstru!tion, an asthma. 5hon!hi are hear in pneumonia, emphysema, bron!hitis, an bron!hie!tasis. -ra!kles are hear in pulmonary e ema, pneumonia, an pulmonary #ibrosis. ,he ele!tro!ar iogram o# a patient with heart #ailure shows ventri!ular hypertrophy * e!rease in the potassium level e!reases the e##e!tiveness o# !ar ia! gly!osi es, in!reases the possibility o# igo3in to3i!ity, an !an !ause #atal !ar ia! arrhythmias. * '(+lea ele!tro!ar iogram rea ing shoul be obtaine myo!ar ial in#ar!tion or an anginal atta!k. uring a *#ter a myo!ar ial in#ar!tion, ele!tro!ar iograph !hanges in!lu e elevations o# the Q wave an 9, segment. *ntiarrhythmi! agents in!lu e quini ine glu!onate (Quinaglute), li o!aine hy ro!hlori e, an pro!ainami e hy ro!hlori e (%ronestyl). *ngiotensin+!onverting en0yme inhibitors in!lu e !aptopril an enalapril maleate ($asote!).

3'

*#ter a myo!ar ial in#ar!tion, the patient shoul avoi stress#ul a!tivities an situations, su!h as e3ertion, hot or !ol temperatures, an emotional stress. *ntihypertensive rugs in!lu e hy rala0ine hy ro!hlori e (*presoline) an methyl opa (*l omet). &oth parents must have a re!essive gene #or the o##spring to inherit the gene. * ominant gene is a gene that only nee s to be present in one parent to have a 52F52 !han!e o# a##e!ting ea!h o##spring. &ron!ho ilators ilate the bron!hioles an rela3 bron!hiolar smooth mus!le. ,he primary #un!tion o# al osterone is so ium reabsorption. ,he goal o# positive en +e3piratory pressure is to a!hieve a equate arterial o3ygenation without using a to3i! level o# inspire o3ygen or !ompromising !ar ia! output. =urosemi e (Lasi3) is a loop iureti!. Its onset o# a!tion is 32 to ;2 minutes, peak is a!hieve at ' to ( hours, an uration is ; to 1 hours #or the I./. or oral route. %regnan!y, myo!ar ial in#ar!tion, )I blee ing, blee ing isor ers, an hemorrhoi s are !ontrain i!ations to manual removal o# #e!al impa!tion. *mbulation is the best metho to prevent postoperative atele!tasis. >ther measures in!lu e in!entive spirometry an turning, !oughing, an breathing eeply. ,he bloo urea nitrogen test an the !reatinine !learan!e test measure how e##e!tively the ki neys e3!rete these respe!tive substan!es. ,he #irst sign o# respiratory istress or !ompromise is restlessness. ,he anti ote #or magnesium sul#ate over ose is !al!ium glu!onate '2E. ,he anti ote #or heparin over ose is protamine sul#ate. *n allergi! rea!tion to a bloo trans#usion may in!lu e #lushing, urti!aria, whee0ing, an a rash. I# the patient has any o# these signs o# a rea!tion, the nurse shoul stop the trans#usion imme iately, keep the vein open with normal saline, an noti#y the physi!ian. * patient taking igo3in an #urosemi e (Lasi3) shoul !all the physi!ian i# he e3perien!es mus!le weakness. * patient with basal !ell !ar!inoma shoul avoi e3posure to the sun uring the hottest time o# ay (between '2 a.m. an 3 p.m.). * !lini!al mani#estation o# a!ute pain is iaphoresis. )ar nerella vaginitis is a type o# ba!terial vaginosis that !auses a thin, watery, milklike is!harge that has a #ishy o or. * patient who is taking =lagyl (metroni a0ole) shoul n6t !onsume al!oholi! beverages or use preparations that !ontain al!ohol be!ause they may !ause a isul#iram+like rea!tion (#lushing, hea a!he, vomiting, an ab ominal pain). "uring the a ministration o# trans!utaneous ele!tri!al nerve stimulation, the patient #eels a tingling sensation. In patients with glau!oma, the hea o# the be shoul be elevate in the semi+=owler position or as or ere a#ter surgery to promote rainage o# aqueous humor. %ostoperative !are a#ter peripheral iri e!tomy in!lu es a ministering rugs (steroi s an !y!loplegi!s) as pres!ribe to e!rease in#lammation an ilate the pupils.

,he primary i##eren!e between angina an the symptoms o# a myo!ar ial in#ar!tion (/I) is that angina !an be relieve by rest or nitrogly!erin a ministration. ,he symptoms o# an /I aren6t relieve with rest, an the pain !an last 32 minutes or longer. -al!ium !hannel blo!kers in!lu e verapamil (-alan), iltia0em hy ro!hlori e (-ar i0em), ni#e ipine (%ro!ar ia), an ni!ar ipine hy ro!hlori e (-ar ene).

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3(
,amo3i#en is an antineoplasti! rug that6s use to treat breast !an!er. ,he a verse e##e!ts o# vin!ristine (>n!ovin) in!lu e alope!ia, nausea, an vomiting. Emphysema is !hara!teri0e by estru!tion o# the alveoli, enlargement o# the istal air spa!es, an break own o# the alveolar walls. ,o keep se!retions thin, the patient who has emphysema shoul in!rease his #lui intake to appro3imately (.5 L/ ay. ,he !lini!al mani#estations o# asthma are whee0ing, yspnea, hypo3emia, iaphoresis, an in!rease heart an respiratory rate. E3trinsi! asthma is an antigenFantibo y rea!tion to allergens, su!h as pollen, animal, an er, #eathers, #oo s, house ust, or mites. *#ter en os!opy is per#orme , the nurse shoul assess the patient #or hemoptysis. In!rease urine output is an in i!ation that a hypertensive !risis has resolve . *#ter ra i!al maste!tomy, the patient shoul be positione with the a##e!te arm on pillows with the han elevate an aligne with the arm. *#ter pneumone!tomy, the patient shoul per#orm arm e3er!ises to prevent #ro0en shoul er. &ullets&ullets Le#t+si e heart #ailure !auses !ra!kles, !oughing, ta!hy!ar ia, an #atigability. (,hink o# L to remember Le#t an Lungs.) &ullets -ar ia! gly!osi es in!rease !ontra!tility an !ar ia! output. 5ight+si e heart #ailure !auses e ema, isten e ne!k veins, no!turia, an weakness. * verse e##e!ts o# !ar ia! gly!osi es in!lu e !ar ia! isturban!e, hea a!he, hypotension, )I symptoms, blurre vision, an yellow+green halos aroun lights. * patient who is re!eiving anti!oagulant therapy shoul take a!etaminophen (,ylenol) instea o# aspirin #or pain relie#. * equate humi i#i!ation is important a#ter larynge!tomy. *t home, the patient !an use pans o# water or a !ool mist vapori0er, espe!ially in the be room. Late symptoms o# renal !an!er in!lu e hematuria, #lank pain, an a palpable mass in the #lank. 8eparin is given sub!utaneously, usually in the lower ab ominal #at pa . In a patient with si!kle !ell anemia, warm pa!ks shoul be use over the e3tremities to relieve pain. -ol pa!ks may stimulate vaso!onstri!tion an !ause #urther is!hemia. ,he e3tremities shoul be pla!e on pillows #or !om#ort. 9i!kle !ell !risis !auses sepsis (#ever greater than '2(@ = N31.B@ -O, meningeal irritation, ta!hypnea, ta!hy!ar ia, an hypotension) an vaso+ o!!lusive !risis (severe pain) with hypo3ia (partial pressure o# arterial o3ygen o# less than A2 mm 8g). * verse e##e!ts o# igo3in in!lu e hea a!he, weakness, vision isturban!es, anore3ia, an )I upset. ,o per#orm a tuber!ulosis test, a (;+gauge nee le is use with a '+ml syringe. 5espiratory #ailure o!!urs when mu!us blo!ks the alveoli or the airways o# the lungs. ,he patient shoul be instru!te not to !ough uring thora!entesis. ,he patient shoul be instru!te not to !ough uring thora!entesis.

5etinopathy re#ers to !hanges in retinal !apillaries that e!rease bloo #low to the retina an lea to is!hemia, hemorrhage, an retinal eta!hment. .egel e3er!ises are re!ommen e a#ter surgery to improve the tone o# the sphin!ter an pelvi! mus!les. >ne o# the treatments #or tri!homoniasis vaginalis is metroni a0ole (=lagyl), whi!h must be pres!ribe #or the patient an the patient6s se3ual partner. * !ommon symptom a#ter !atara!t laser surgery is blurre vision. * patient with a!ute open+angle glau!oma may see halos aroun lights. *n *sian patient with iabetes mellitus usually !an rink ginseng tea. ,o prevent otitis e3terna, the patient shoul keep the ears ry when bathing. %atients who re!eive prolonge high oses o# I.$. #urosemi e (Lasi3) shoul be assesse #or tinnitus an hearing loss. ,he treatment #or to3i! sho!k syn rome is I.$. #lui a ministration to restore bloo volume an pressure an antibioti! therapy to eliminate in#e!tion. In patients with glau!oma, beta+a renergi! blo!kers #a!ilitate the out#low o# aqueous humor. * man who loses one testi!le shoul still be able to #ather a !hil . Iative *meri!ans are parti!ularly sus!eptible to iabetes mellitus. &la!ks are parti!ularly sus!eptible to hypertension. :omen with the greatest risk #or !ervi!al !an!er are those whose mothers ha !ervi!al !an!er, #ollowe by those whose #emale siblings ha !ervi!al !an!er. * postmenopausal woman shoul per#orm breast sel#+e3amination on the same ay ea!h month, #or e3ample, on the same ay o# the month as her birth ay. /i le+ear hearing loss usually results #rom otos!lerosis. *#ter testi!ular surgery, the patient shoul use an i!e pa!k #or !om#ort. * patient with !hroni! open+angle glau!oma has tunnel vision. ,he nurse must be !are#ul to pla!e items ire!tly in #ront o# him so that he !an see them. -lini!al signs o# ba!terial pneumonia in!lu e shaking, !hills, #ever, an a !ough that pro u!es purulent sputum. -lini!al mani#estations o# #lail !hest in!lu e para o3i!al movement o# the involve !hest wall, yspnea, pain, an !yanosis. 5ight+si e !ar ia! #un!tion is assesse by evaluating !entral venous pressure. * patient with a pa!emaker shoul imme iately report an in!rease in the pulse rate or a slowing o# the pulse rate o# more than 4 to 5 beats/minute. "i00iness, #ainting, palpitation, hi!!ups, an !hest pain in i!ate pa!emaker #ailure. Leukemia !auses easy #atigability, generali0e malaise, an pallor. *#ter !ar ia! !atheteri0ation, the pun!ture, or !ut own, site shoul be monitore #or hematoma #ormation. .ussmaul6s breathing is asso!iate with iabeti! ketoa!i osis. I# the nurse noti!es water in a ventilator tube, she shoul remove the water #rom the tube an re!onne!t it.

* patient who has thrombophlebitis shoul be pla!e in the ,ren elenburg position. 9ymptoms o# %neumo!ystis !arinii pneumonia in!lu e yspnea an

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nonpro u!tive !ough. ,o !ountera!t vitamin &' e#i!ien!y, a patient who has perni!ious anemia shoul eat meat an animal pro u!ts. * patient who is on a ventilator an be!omes restless shoul un ergo su!tioning. *utologous bone marrow transplantation oesn6t !ause gra#t+versus+ host isease. * patient who has mil thrombophlebitis is likely to have mil !ramping on e3ertion. I# the #irst attempt to per#orm !olostomy irrigation is unsu!!ess#ul, the pro!e ure is repeate with normal saline solution. &reast enlargement, or gyne!omastia, is an a verse e##e!t o# estrogen therapy. In a patient who has leukemia, a low platelet !ount may lea to hemorrhage. *#ter ra i!al ne!k isse!tion, the imme iate !on!ern is respiratory istress as a result o# tra!heal e ema. *#ter ra i!al maste!tomy, the patient6s arm shoul be elevate to prevent lymphe ema. 8ypoventilation !auses respiratory a!i osis. ,he high =owler position is the best position #or a patient who has orthopnea. * transient is!hemi! atta!k a##e!ts sensory an motor #un!tion an may !ause iplopia, ysphagia, aphasia, an ata3ia. *#ter maste!tomy, the patient shoul squee0e a ball with the han on the a##e!te si e. -holestyramine (Questran), whi!h is use to re u!e the serum !holesterol level, may !ause !onstipation. )lu!o!orti!oi , or steroi , therapy may mask the signs o# in#e!tion. /elanoma is most !ommonly seen in light+skinne people who work or spen time out oors. * patient who has a pa!emaker shoul take his pulse at the same time every ay. * patient who has stomatitis shoul rinse his mouth with mouthwash #requently. *n a verse e##e!t o# theophylline a ministration is ta!hy!ar ia. ,he treatment #or laryngotra!heobron!hitis in!lu es postural rainage be#ore meals. *#ter ra i!al ne!k isse!tion, a high priority is provi ing a means o# !ommuni!ation. * high+#at iet that in!lu es re meat is a !ontributing #a!tor #or !olore!tal !an!er. *#ter a mo i#ie ra i!al maste!tomy, the patient shoul be pla!e in the semi+=owler position, with the arm pla!e on a pillow. .ni#elike, stabbing pain in the !hest may in i!ate pulmonary embolism. Esophageal !an!er is asso!iate with e3!essive al!ohol !onsumption. * patient who has pan!ytopenia an is un ergoing !hemotherapy may e3perien!e hemorrhage an in#e!tion. * gra e I tumor is en!apsulate an grows by e3pansion. -an!er o# the pan!reas !auses anore3ia, weight loss, an 7aun i!e. %rolonge gastri! su!tioning !an !ause metaboli! alkalosis.

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,o measure the amount o# resi ual urine, the nurse per#orms straight !atheteri0ation a#ter the patient voi s. "e3amethasone ("e!a ron) is a steroi al anti+in#lammatory agent that6s use to treat brain tumors. Long+term re u!tion in the elivery o# o3ygen to the ki neys !auses an in!rease in erythropoiesis. * patient who subsists on !anne #oo s an !anne #ish is at risk #or so ium imbalan!e (hypernatremia). -lini!al signs an symptoms o# hypo3ia in!lu e !on#usion, iaphoresis, !hanges in bloo pressure, ta!hy!ar ia, an ta!hypnea. 5e meat !an !ause a #alse+positive result on #e!al o!!ult bloo test. -arbon mono3i e repla!es hemoglobin in the re bloo !ells, e!reasing the amount o# o3ygen in the tissue. *lkaline urine !an result in urinary tra!t in#e!tion. &la er retraining is e##e!tive i# it lengthens the intervals between urination. -heilosis is !ause by ribo#lavin e#i!ien!y. ,he !on!entration o# o3ygen in inspire air is re u!e at high altitu es. *s a result, yspnea may o!!ur on e3ertion. * patient who is re!eiving enteri! #ee ing shoul be assesse #or ab ominal istention. ,hiamine e#i!ien!y !auses neuropathy. * patient who has ab ominal istention as a result o# #latus !an be treate with a !arminative enema (8arris #lush). %erni!ious anemia is !ause by a e#i!ien!y o# vitamin &'(, or !obalamin. *#ter a barium enema, the patient is given a la3ative. ,he appropriate I.$. #lui to !orre!t a hypovolemi!, or #lui volume, e#i!it is normal saline solution. 9erum albumin e#i!ien!y !ommonly o!!urs a#ter burn in7ury. &e#ore giving a gastrostomy #ee ing, the nurse shoul inspe!t the patient6s stoma. ,he most !ommon intestinal ba!teria i enti#ie in urinary tra!t in#e!tion is Es!heri!hia !oli. 8yponatremia may o!!ur in a patient who has a high #ever an only water. =oli! a!i e#i!ien!y !auses mus!le weakness as a result o# hypo3emia. "ehy ration !auses in!rease respiration an heart rate, #ollowe by irritability an #ussiness. )lu!o!orti!oi s !an !ause an ele!trolyte imbalan!e. * e!rease in potassium level e!reases the e##e!tiveness o# !ar ia! gly!osi es, in!reases possible igo3in to3i!ity, an !an !ause #atal !ar ia! arrhythmias. "iuresis !an !ause e!rease absorption o# vitamins *, ", E, an .. %rotein epletion !auses a e!rease in lympho!yte !ount. ,o prevent paraphimosis a#ter the insertion o# a =oley !atheter, the nurse shoul repla!e the prepu!e. Loop iureti!s, su!h as #urosemi e (Lasi3), e!rease plasma levels o# potassium an so ium. *#ter pyelography, the patient shoul promote the e3!retion o# ye. rink plenty o# #lui s to rinks

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%otassium shoul be taken with #oo an #lui s. %roper measurement o# a nasogastri! tube is #rom the !orner o# the mouth to the ear lobe to the tip o# the sternum. =ull agonist analgesi!s in!lu e morphine, !o eine, meperi ine ("emerol), propo3yphene ("arvon), an hy romorphone ("ilau i ). &uprenorphine (&uprene3) is a partial agonist analgesi!. %oor skin turgor is a !lini!al mani#estation o# iabetes insipi us. * patient who has * ison6s isease an is re!eiving !orti!osteroi therapy may be at risk #or in#e!tion. ,o assess a patient #or hemorrhage a#ter a thyroi e!tomy, the nurse shoul roll the patient onto his si e to e3amine the si es an ba!k o# the ne!k. * patient who is re!eiving hormone therapy #or hypothyroi ism shoul take the rug at the same time ea!h ay. 8yperproteinemia may !ontribute to the evelopment o# hepati! en!ephalopathy. ,o minimi0e blee ing in a patient who has liver ys#un!tion, small+ gauge nee les are use #or in7e!tions. * patient who has !irrhosis o# the liver an as!ites shoul #ollow a low+so ium iet. &e#ore an e3!retory urography, the nurse must ask the patient whether he6s allergi! to io ine or shell#ish. * bu##alo hump is an abnormal istribution o# a ipose tissue that o!!urs in -ushing6s syn rome. Levothyro3ine (9ynthroi ) is use as repla!ement therapy in hypothyroi ism. Levothyro3ine (9ynthroi ) treats, but oesn6t !ure, hypothyroi ism an must be taken #or the patient6s li#etime. It shoul n6t be taken with #oo be!ause #oo may inter#ere with its absorption. Imipramine (,o#ranil) with !on!omitant use o# barbiturates may result in enhan!e -I9 epression. * patient who is re!eiving levothyro3ine (9ynthroi ) therapy shoul report ta!hy!ar ia to the physi!ian. ,he signs an symptoms o# hyperkalemia in!lu e mus!le weakness, hypotension, shallow respiration, apathy, an anore3ia. In a patient with well+!ontrolle iabetes, the (+hour postpran ial bloo sugar level may be '3B mg/ l. * patient who has iabetes mellitus shoul wash his #eet aily in warm water an ry them !are#ully, espe!ially between the toes. *!ute pan!reatitis !auses !onstant epigastri! ab ominal pain that ra iates to the ba!k an #lank an is more intense in the supine position. "iabeti! neuropathy is a long+term !ompli!ation o# iabetes mellitus. %ortal vein hypertension is asso!iate with liver !irrhosis. *#ter thyroi e!tomy, the nurse shoul assess the patient #or laryngeal amage mani#este by hoarseness. ,he patient with hypoparathyroi ism has hypo!al!emia. * patient who has !hroni! pan!reatitis shoul !onsume a blan , low+ #at iet. * patient with hepatitis * shoul be on enteri! pre!autions to prevent the sprea o# hepatitis *. ,he patient who has liver isease is likely to have 7aun i!e, whi!h is !ause by an in!rease bilirubin level. *n a verse e##e!t o# phenytoin ("ilantin) a ministration is hyperplasia o# the gingiva.

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8ematemesis is a !lini!al sign o# esophageal vari!es. =at estru!tion is the !hemi!al pro!ess that !auses ketones to appear in urine. ,he glu!ose toleran!e test is the e#initive iagnosti! test #or iabetes. *tele!tasis an ehis!en!e are postoperative !on itions asso!iate with removal o# the gallbla er. *#ter liver biopsy, the patient shoul be positione on his right si e, with a pillow pla!e un erneath the liver bor er. -ategori0e &ullets Lugol6s solution is use to evas!ulari0e the glan be#ore thyroi e!tomy. -hole!ystitis !auses low+gra e #ever, nausea an vomiting, guar ing o# the right upper qua rant, an biliary pain that ra iates to the right s!apula. Early symptoms o# liver !irrhosis in!lu e #atigue, anore3ia, e ema o# the ankles in the evening, epista3is, an blee ing gums. ,he !lini!al mani#estations o# iabetes insipi us in!lu e poly ipsia, polyuria, spe!i#i! gravity o# '.22' to '.225, an high serum osmolality. ,he !lini!al mani#estations o# iabetes insipi us in!lu e poly ipsia, polyuria, spe!i#i! gravity o# '.22' to '.225, an high serum osmolality. 8ypertension is a sign o# re7e!tion o# a transplante ki ney. La!tulose is use to prevent an treat portal+systemi! en!ephalopathy. E3tra!orporeal an intra!orporeal sho!k wave lithotripsy is the use o# sho!k waves to per#orm noninvasive estru!tion o# biliary stones. It6s in i!ate in the treatment o# symptomati! high+risk patients who have #ew non!al!i#ie !holesterol stones. "e!rease !ons!iousness is a !lini!al sign o# an in!rease ammonia level in a patient with ki ney #ailure or !irrhosis o# the liver. ,he pain me i!ation that6s given to patients who have a!ute pan!reatitis is meperi ine ("emerol). %ro!hlorpera0ine (-ompa0ine), me!li0ine, an trimethoben0ami e (,igan) are use to treat the nausea an vomiting !ause by !hole!ystitis. >bese women are more sus!eptible to gallstones than any other group. /etaboli! a!i osis is a !ommon #in ing in a!ute renal #ailure.

=or a patient who has a!ute pan!reatitis, the most important nursing intervention is to maintain his #lui an ele!trolyte balan!e. *#ter thyroi e!tomy, the patient is monitore #or hypo!al!emia. In en +stage !irrhosis o# the liver, the patient6s ammonia level is elevate . In a patient who has liver !irrhosis, ab ominal girth is measure with the superior ilia! !rest use as a lan mark. ,he symptoms o# *l0heimer6s isease have an insi ious onset. =ra!ture o# the skull in the area o# the !erebellum may !ause ata3ia an inability to !oor inate movement. 9erum !reatinine is the laboratory test that provi es the most spe!i#i! in i!ation o# ki ney isease. * patient who has bilateral a renale!tomy must take !ortisone #or the rest o# his li#e. %ortal vein hypertension !auses esophageal vari!es. 9igns an symptoms o# hypo3ia in!lu e ta!hy!ar ia, shortness o# breath, !yanosis, an mottle skin.

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,he three types o# embolism are air, #at, an thrombus. *sso!iations #or patients who have ha laryngeal !an!er in!lu e the Lost -or -lub an the Iew $oi!e -lub. &e#ore is!harge, a patient who has ha a total larynge!tomy must be able to per#orm tra!heostomy !are an su!tioning an use alternative means o# !ommuni!ation. ,he universal bloo onor is > negative.

,he universal bloo re!ipient is *& positive. /u!us in a !olostomy bag in i!ates that the !olon is beginning to #un!tion. *#ter a vase!tomy, the patient is !onsi ere sterile i# he has no sperm !ells. =atigue is an a verse e##e!t o# ra iation therapy. ,o prevent umping syn rome, the patient6s !onsumption o# high+ !arbohy rate #oo s an liqui s shoul be limite . -ryopre!ipitate !ontains #a!tors $III an <III an #ibrinogen an is use to treat hemophilia. Insomnia is the most !ommon sleep isor er. &ru3ism is grin ing o# the teeth uring sleep. El erly patients are at risk #or osteoporosis be!ause o# age+relate bone eminerali0ation. ,he !lini!al mani#estations o# lo!al in#e!tion in an e3tremity are ten erness, loss o# use o# the e3tremity, erythema, e ema, an warmth. -lini!al mani#estations o# systemi! in#e!tion in!lu e #ever an swollen lymph no es. *n immobile patient is pre ispose to thrombus #ormation be!ause o# in!rease bloo stasis. Crea is the !hie# en pro u!t o# amino a!i metabolism. /orphine an other opioi s relieve pain by bin ing to the nerve !ells in the orsal horn o# the spinal !or . ,ri!homonas an -an i a in#e!tions !an be a!quire nonse3ually. %resby!usis is progressive sensorineural hearing loss that o!!urs as part o# the aging pro!ess.