Leadership

the process of influence in which the leader

influences others toward goal achievement
is the effort to envision and inspire changes
Leader
the one who leads, conducts or guides the process
A Leader is one others follow willingly and
voluntarily

Theories of Leadership
Great Man Theory
Argues that few people are born to be great leaders
who are well rounded & simultaneously instrumental
& supportive also of the premise that leaders are
born not made, which suggests that leadership
cannot be developed
Styles of Leadership
Autocratic
involves centralized decision making, with the
leader making the decision & using power to
command & control others
Democratic

 is participatory, with the authority delegated to

others, influential by having close and personal
relationship with the subordinates
Laissez-Faire
Is passive & permissive, nondirective, inactive.
Chaos is most likely to develop because
members may work independently

Management Process
Planning Organizing
Sources of Power
Expert power it is derived from the knowledge &
skills one possess
Legitimate power is derived from the position one
holds in a group & indicates authority but not
sufficient as ones only source of power
Referent power derived from respect & trust
coming from any individual group or organization
Reward power it comes from the ability to
recognize others for complying
Coercive power is based on fear of punishment if
one fails to conform
Connection power it comes from coalition &
interpersonal relationship

 Informational power it comes from knowledge &

access to information

Great Man
Leaders are born and not made
Great leaders will arise when there is a great need
Ex. King of Spain
Behavioral Theory
Successful leadership is based in definable, learnable
behavior
Situational theory
The best action of leader depends on range of
situational factors
*motivation
*capability of followers
performance of leader and follower
attitudes, needs and expectations
Frederick W. Taylor (1856 1917)
Father of Scientific Management
If workers could be taught the one best way to
accomplish a task, productivity would increase.
4 overriding principles of scientific management:
1. Replace rule-of-thumb work methods with methods
based on a scientific study of the tasks.

2.
Scientifically select, train, and develop each
employee rather than passively leaving them to train
themselves.
3. The spirit of cooperation between the management
and workers for accomplishing the job.
4.
Divide work equally between managers and
workers, so that the managers apply scientific
management principles to planning the work and the
workers actually perform the tasks.
Managers need to think of new ways to do traditional
tasks so that work is more efficient.
The amount of and effort each employee expends to
produce a unit of output can be reduced by
increasing specialization and the division of labor
Bureaucratic Model
Max Weber (1864 1920)
Stressed the need for a strictly defined hierarchy
governed by clearly defined regulations and lines of
authority
Studied large organizations to determine what made
some more efficient than the others
Saw the need for legalized, formal authority and
consistent rules and regulation for personnel in
different positions
Proposed bureaucracy as organizational design
Dimensions of Bureaucracy

1. Division of labor based on functional

specialization
2. A well-defined hierarchy of authority;
3. A system of rules covering the rights and duties of
position
4. A system of procedures for dealing with work
situations
5. An impersonality in interpersonal relations
6. A system of promotion and selection for employment
based on technical competence
Douglas McGregor
Theory X (classical)
Theory X managers believe that their employees are
basically lazy, need constant supervision and
direction, and are indifferent to organizational needs.
Theory Y (based on developments in social sciences)
employees want autonomy, job satisfaction,
responsibility, and will work hard when they are
appreciated
Theory Y required a change in management, not a
change in the worker or the workplace
Theory Y managers believe that their workers
enjoy their work, are self-motivated, and are
willing to work hard to meet personal and
organizational goals.

Performance Appraisal

The process of measuring an employees

performance on the job , comparing and recording
the results , and communicating the results to the
employees
Steps in Performance Appraisal
1- Manager measures an employees work and
compare it with established standards
2-Manager records the results
3-Manager communicates the results to the
employees in some form
Managers need to think of new ways to do traditional
tasks so that work is more efficient.

Propanolol (inderal)a beta-adrenergic blocker used as

antihypertensive; a beta-blocker that takes up beta-adrenergic
receptor sites, which prevents adrenaline from causing symptoms
and glycogenolysis. Inderal may mask symptoms of
hypoglycemia, removing the bodys early warning system.
Side effects: bronchospasm, bradycardia, depression. Take pulse
before administration and gradually decrease when discontinuing.
Do not give to asthmatic patients.
Glipizide (Glucotrol)an oral hypoglycemic that decreases
blood sugar by stimulating insulin release from the beta cells of
the pancreas; may cause aplastic anemia and photosensitivity.

Partial-thickness burn; only part of skin is damaged or

destroyed; large, thick-walled blisters develop; underlying tissue
is deep red, appears wet and shiny; painful with increased
sensitivity to heat; healing occurs by evolution of undamaged
basal cells, takes about 21-22 days. I.E., Redness and swelling
with fluid-filled vesicles noted on right arm or Blistering and
blanching of the skin noted on the back.
Full-thickness burn; all skin is destroyed and muscle and bone
may be involved; substance that remains is called eschar, dry to
touch, doesnt heal spontaneously, requires grafting. I.E.,
Charred, waxy, white appearance of skin on left leg.
Superficial burn; skin appears pink, increased sensitivity to
heat, some swelling, healing occurs without treatment. I.E.,
Reddened blotchy painful areas noted on the face.
Carbidopa/Levodopa (Sinemet)used to treat symptoms of
Parkinsons disease. Take immediately before meals and highprotein meals may impair effectiveness of medication. Reduces
rigidity and bradykinesis and facilitates clients mobility.

Signs of tardive dyskinesia include smacking lips, grinding of

teeth and "fly catching" tongue movements.

Signs/Symptoms of Digital Toxicity: first signs include abdominal

pain, anorexia, nausea, vomiting, visual disturbances,
bradycardia, and other arrhythmias. In infants and small children,
the first symptoms of overdose are usually cardiac arrhythmias.

Fractures:
Immobilize joint above and below fracture
Cover open fracture with cleanest material available
Check temperature, color, sensation, capillary refill
distal to fracture
Close reductionmanually manipulate bone or use
traction
Bucks Traction
Use to relieve muscle spasm of leg and back
If used for muscles spasms only, they can turn to either side.
If used for fracture treatment, only can turn to unaffected
side.
Use 8-20 lbs of weight, if used for scoliosis will use 40 lbs of
weight.
Elevate head of bed for countertraction or foot bed
Place pillow below leg not under heel or behind knee.
Russells Traction

Sling is used
Check for popliteal pulse
Place pillow below lower leg and heel off the bed
Dont turn from waist down
Lift patient, not the leg

Cervical Tongs
Never lift the weights
No pillow under head during feedings
Balanced Suspension Traction
For femur realignment
Maintain weights hanging free and not on floor

 Maintain continuous pull

Halo Jacket
Maintain pin cleansing
Casts

Dont rest on hard surface

Dont cover until dry 48+ hours
Handle with palms of hands not with fingers
Keep above level of heart
Check for CSM

Fractured Hip
Assessments
Leg shortened
Adducted
Externally rotated
Implementation
Care after a total hip replacement
Abduction pillows
Crutch walking with 3-point gait
Dont sleep on operated side
Dont flex hip more than 45-60 degrees
Dont elevate head of the bed more than 45
degrees
Amputations
Guillotine (open)
Flap (closed)
Delayed prosthesis fitting
Residual limb covered with dressing and elastic
bandage (figure eight)

Figure-8 doesnt restrict blood flow, shaped to

reduce edema
Check for bleeding
Elevated 24 hours (AKA-pillow, BKA-foot of bed
elevated)
Position prone daily
Exercises, crutch walking
Phantom Pain: acknowledge feelings, that pain is
real for them.

Folic acidRBC formation; deficiency will cause anemia

Cyanocobalamin (B12)nerve function; deficiency cause
pernicious anemia

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

Parkinsons disease
- Activities should be scheduled for late morning when energy
level is highest and patient wont be rushed
- Symptoms: tremors, akinesia, rigidity, weakness, motorized
propulsive gait, slurred monotonous speech, dysphagia,
drooling, mask-like expression.

- Nursing care: encourage finger exercises. Administer

Artane, Congentin, L-Dopa, Parlodel, Sinemet, Symmetrel.
- Teach: ambulation modification
- Promote family understanding of disease
intellect/sight/hearing not impaired, disease progressive but
slow, doesnt lead to paralysis
Normal urine output (1200-1500 ccs/day or 50-63 cc/hr, normal
voiding pattern 5-6 times/day.
Green leafy vegetables contain vitamin K.

Labs
HbA1c (4.5-7.6%)
- indicates overall glucose control for the previous 120 days
Serum Amylase / Somogyl (60-160 u/dL)
- elevated in acute pancreatitis
Erythrocyte Sedimentation Rate (ESR)
-

Men (1-15)
Women (1-20)
Rate at which RBCs settle out of unclotted blood in one hour
Indicates inflammation/neurosis

Hematocrit (Hct)
- Men (40-45) u/mL
- Women (37-45) u/mL
- Relative volume of plasma to RBC

- Increased with dehydration

- Decreased with volume excess
Creatine Kinase (CK)
-

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

Serum Glucose
- 60-110 mg/dL
Sodium (Na+)
- 135-145 mEq/L
- Hypernatremia
o Dehydration and insufficient water intake
Chloride (Cl-)
- 95-105 mEq/L
Potassium (K+)
- 3.5-5.0 mEq/L
Bicarbonate (HCO3)
- 22-26 mEq/L
- Decreased levels seen with starvation, renal failure, diarrhea.
Blood, Urea, Nitrogen (BUN)
- 6-20 mg
- Elevated levels indicate rapid protein catabolism, kidney
dysfunction, dehydration

Creatinine Clearance Test

- normal 125 ml/min.
- Lower levels reflect renal insufficiency and may influence the
excretion of many drugs and toxins from the body.
Lithium
- targeted blood level: (1-1.5 mEq/L)
Tofranil and AnafranilOCD medications
Pick physical needs over psychosocial needs!!!!!!!!!!!!!!!
Focus on here and now!!!!!!!!!!!!!!!!!
Oculogyric crisis: uncontrollable rolling back of eyes: side effect of
Phenothiazines
Parkinsons disease
- Activities should be scheduled for late morning when energy
level is highest and patient wont be rushed
- Symptoms: tremors, akinesia, rigidity, weakness, motorized
propulsive gait, slurred monotonous speech, dysphagia,
drooling, mask-like expression.
- Nursing care: encourage finger exercises. Administer
Artane, Congentin, L-Dopa, Parlodel, Sinemet, Symmetrel.
- Teach: ambulation modification
- Promote family understanding of disease
intellect/sight/hearing not impaired, disease progressive but
slow, doesnt lead to paralysis

Normal urine output (1200-1500 ccs/day or 50-63 cc/hr, normal

voiding pattern 5-6 times/day.
Green leafy vegetables contain vitamin K.

Labs
HbA1c (4.5-7.6%)
- indicates overall glucose control for the previous 120 days
Serum Amylase / Somogyl (60-160 u/dL)
- elevated in acute pancreatitis
Erythrocyte Sedimentation Rate (ESR)
-

Men (1-15)
Women (1-20)
Rate at which RBCs settle out of unclotted blood in one hour
Indicates inflammation/neurosis

Hematocrit (Hct)
-

Men (40-45) u/mL

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

Creatine Kinase (CK)

- Men (12-70)
- Women (10-55)

- Enzyme specific to brain, myocardium, and skeletal muscles

- Indicates tissue necrosis or injury
Serum Glucose
- 60-110 mg/dL
Sodium (Na+)
- 135-145 mEq/L
- Hypernatremia
o Dehydration and insufficient water intake
Chloride (Cl-)
- 95-105 mEq/L
Potassium (K+)
- 3.5-5.0 mEq/L
Bicarbonate (HCO3)
- 22-26 mEq/L
- Decreased levels seen with starvation, renal failure, diarrhea.
Blood, Urea, Nitrogen (BUN)
- 6-20 mg
- Elevated levels indicate rapid protein catabolism, kidney
dysfunction, dehydration
Creatinine Clearance Test
- normal 125 ml/min.
- Lower levels reflect renal insufficiency and may influence the
excretion of many drugs and toxins from the body.

Lithium
- targeted blood level: (1-1.5 mEq/L)
Tofranil and AnafranilOCD medications
Pick physical needs over psychosocial needs!!!!!!!!!!!!!!!

MI

Implementation for MI

Chest pain radiating to

arms, jaw, neck (which
is unrelieved by rest or
nitroglycerin)
Dyspnea
Indigestion
Apprehension
Low grade fever
Elevated WBC (5-10,
ESR, CK-MB, LDH)

Increased ICP
Assessments
Altered LOC (Earliest Sign)
Glasgow coma scale <7
indicates coma
Confusion
Restlessness
Pupillary changes
Vital sign changes
WIDENING PULSE PRESSURE

Thrombolytic therapystreptokinase, t-PA

Bedrest
Beta-blockers, morphine
sulfate, dysrhythmics,
anticoagulants
Do not force fluids (will
give heart more to work
with)

Implementations

Monitor vital signs

Monitor Glasgow Coma Scale
Elevate head 30-45 degrees
Avoid neck flexion and head
rotation
Reduce environmental stimuli
Prevent Valsalva maneuver
Restrict fluids to 1200-1500
cc/day
Medications Osmotic diuretics,

corticosteroids

Electrolytes
Potassium:

3.5-5.0 mEq/L

Sodium:

135-145 mEq/L

Calcium:

4.5-5.2 mEq/L

Magnesium: 1.5-2.5 mEq/L

Hypokalemia
Assessments

Hypokalemia Implementations

K+ < 3.5 mEq/L

Muscle weakness
Paresthesias
Dysrhythmias
Increased sensitivity to
digitalis

Hyperkalemia Assessments
K+ >5.0 mEq/L
EKG changes
Paralysis
Diarrhea
Nausea

Potassium Supplements
Dont give > 40 mEq/L into
peripheral IV or without
cardiac monitor
Increase dietary intake
oranges, apricots, beans,
potatoes, carrots, celery,
raisins
Hyperkalemia Implementations
Restrict oral intake
Kayexalate
Calcium Gluconate and Sodium
Bircarbonate IV
Peritoneal or hemodialysis
Diuretics

Hyponatremia Assessments
Na+ < 135 mEq/L
Nausea
Muscle cramps
Confusion
Increased ICP

Hypernatremia Assessments
Na+ >145 mEq/L
Disorientation, delusion,
hallucinations
Thirsty, dry, swollen tongue
Sticky mucous membranes
Hypotension
Tachycardia
Hypocalcemia Assessments

Ca+ < 4.5 mEq/L

Tetany
Positive Trousseaus sign
Positive Chvosteks sign
Seizures
Confusion
Irritability, paresthesias

Hypercalcemia Assessments
Ca+> 5.2 mEq/L
Sedative effects on CNS
Muscle weakness, lack of
coordination
Constipation, abdominal pain

Hyponatremia Implementations
I&O
Daily weight
Increase oral intake of sodium rich
foods
Water restriction
IV Lactated Ringers or 0.9% NaCL
Hypernatremia Assessments
I&O
Daily Weight
Give hypotonic solutions:
0.45% NaCl or 5% Dextrose in
water IV

Hypocalcemia Implementations
Oral calcium supplements with
orange (maximizes absorption)
Calcium gluconate IV
Seizure precautions
Meet safety needs

Hypercalcemia Implementations
0.4% NaCl or 0.9% NaCl IV
Encourage fluids (acidic drinks:
cranberry juice)
Diuretics
Calcitonin

 Depressed deep tendon

reflexes
Dysrhythmias
Hypomagnesemia Assessments

Mg+< 1.5 mEq/L

Neuromuscular irritability
Tremors
Seizures
Tetany
Confusion
Dysphagia

Mobilize patient
Surgery for hyperparathyroidism

Hypomagnesemia
Implementations
Monitor cardiac rhythm and
reflexes
Test ability to swallow
Seizure precautions
Increase oral intakegreen
vegetables, nuts, bananas,
oranges, peanut butter,
chocolate

Hypermagnesemia Assessments Hypermagnesemia

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

Blue Bloaters
Pink Puffers
Weakness
Change in postured day and
hs (dont sleep laying down,
have to stay erect)
Use of accessory muscles of
breathing

COPD Implementations
Assess airway clearance
Listen to breath sounds
Administer low-flow oxygen (12 L, not too much because your
trying to prevent CO2 narcosis)
Encourage fluids
Small frequent feedings
Use metered dose inhalers

(MDI)

Dyspnea
Cough
Adventitious breath sounds

Left-Side CHF

Right-Side CHF

Dyspnea, orthopnea
Cough
Pulmonary edema
Weakness/Changes in mental
status

Dependent edema
Liver enlargement
Abdominal pain/Nausea/Bloating
Coolness of extremities

CHF Implementations

Administer digoxin, diuretics

Low-sodium, low-calorie, low-residue diet
Oxygen therapy
Daily weight
Teach about medications and diet

Anemia Assessments
(reduction in hemoglobin
amount/erythrocytes)

Palpitations
Dyspnea
Diaphoresis
Chronic fatigue
Sensitivity to cold

Iron Deficiency Anemia

Assessments
Fatigue
Glossitis

Anemia Implementations
Identify cause
Frequent rest periods
High protein, high iron,
high vitamin diet
Protect from infection

Iron Deficiency Anemia

Implementations
Increase iron-rich foods (liver,
green leafy vegetables)

 Spoon fingernails
Impaired cognition
Pernicious Anemia Assessments
(gastric mucosa fail to secrete
enough intrinsic factor for stomach
to absorb)

Vitamin B12IM
Rest of life cant be absorbed
PO

Schillings Test
Fatigue
Sore, red tongue
Paresthesia in hands and feet

Sickle Cell Anemia Assessments

Iron supplements (stains

teeth)
Pernicious Anemia Assessments

Pain /Swelling/Fever
Schlerae jaundiced
Cardiac murmurs
Tachycardia

Parkinsons Disease
Assessments
Deficiency of dopamine
Tremors, rigidity, propulsive
gait

Sickle Cell Anemia

Implementations
Check for signs of infection
(prevent crisis)
Check joint areas for pain and
swelling
Encourage fluids
Provide analgesics with PCA
pump c crisis

Parkinsons Disease
Implementations
Teach ambulation modification:
goose stepping walk
(marching), ROM exercises
MedicationsArtane, Cogentin,

L-Dopa, Parlodel, Sinemet,

Symmetrel

Monotonous speech
Mask like expression

O universal donor/AB universal recipient.

ABO BLOOD TYPE

COMPATIBILITY
Blood Type

Can Receive from:

Can donate to:

O,A,B,AB

A,O

A,AB

B,O

B,AB

AB

O,A,B,AB

AB

Autologous Transfusion:
Collected 4-6 weeks before surgery
Contraindicatedinfection, chronic disease, cerebrovascular
or cardiovascular
disease

Hypotonic
Solution
NS
(0.45%
Saline)

Isotonic Solution

Hypertonic Solution

0.9% NaCl
(Normal Saline)
5% D/W
(Dextrose in
Water)
Lactated Ringers
5% D/ NS (5%
Dextrose in
0.225% Saline )

10% D/W (10% Dextrose in

water)
D15W
5% D/NS (5% Dextrose in
0.9% Saline)
5% D/ NS (5% Dextrose in
0.45% Saline)
3% NaCl

 5% Sodium Bicarbonate

Anti-Depressants
Monoamine
Oxidase Inhibitors
(MAO)
Action:
Causes
increases
concentration of
neurotransmitter
s
Used for:

AntiDepressants
(Monoamine
Oxidase
Inhibitors)
Medications:
Marplan
Nardil
Parnate

Depression
Chronic pain

Anti-Depressants
Selective
Serontonin

Anti-Depressants
(Monoamine Oxidase
Inhibitors)
Side effects:
Hypertensive Crisis
(Sudden headache,
diaphoretic, palpitations,
stiff neck, intracranial
hemorrhage) with food
that contain Tyramine
Nursing Considerations:
Avoid foods containing
Tyramine: Aged cheese,
liver, yogurt, herring, beer
and wine, sour cream,
bologna, pepperoni,
salami, bananas, raisins,
and pickled products
Monitor output
Takes 4 weeks to work
Dont combine with
sympathomometics
vasoconstrictors, and cold
medications

AntiDepressants
Selective

Anti-Depressants
Selective Serontonin
Reuptake Inhibitors (SSRI)

Reuptake
Inhibitors (SSRI)

Serontonin
Reuptake
Inhibitors
(SSRI)

Action:
Inhibits CNS
uptake of
serotonin
Used for:

Medications:
Paxil
Prozac
Zoloft

Depression
ObsessiveCompulsive
Disorder
Bulimia
Anti-Depressants
(Tricyclics)

AntiDepressants
(Tricyclics)

Action:
Inhibits
reuptake of
neurotransmitter
s
Used for:

Medications:
Norpramin
Elavil
Tofranil

Depression
Sleep apnea

Antipsychotic
Agents

Side effects:
Anxiety
GI upset
Change in appetite and
bowel function
Urinary retention
Nursing Considerations:
Suicide precautions
Takes 4 weeks for full effect
Take in a.m.
May urine to pinkish-red or
Pinkish-brown
Can be taken with meals
Anti-Depressants
(Tricyclics)
Side Effects:
Sedation/Confusion
Anticholinergics affects
Postural Hypotension
Urinary retention
Nursing Considerations:
Suicide precautions/2-6
weeks to work
Take at hs/Dont
abruptly halt
Avoid alcohol/OTC
/Photosensitivity

Antipsychotic

Antipsychotic

Action:

Agents

Agents

Blocks
dopamine
receptors in
basal ganglia
Used for:

Medications:

Side Effects:

Acute and
Chronic
psychoses

Haldol
Thorazine
Mellaril
Stelazine

Akathisia
(inability to
sit still)
Dyskinesia
Dystonias
Parkinsons
syndrome
Tardive
dyskinesias
Leukopenia
Nursing
Considerations:
Check CBC
Monitor vital
signs
Avoid alcohol
and caffeine

Atypical
Antipsychotic
Agents
Action:
Interferes
with binding
of dopamine
in the brain
Used for:
Acute and
Chronic
psychoses

Atypical
Antipsychotic

Atypical
Antipsychotic

Medications:

Side Effects:

Clozaril
Risperdal

Extrapyramida
l effects
Anticholinergic
Sedative
Orthostatic
hypotension
Nursing
Considerations:
Monitor blood
Change

positions
slowly
Use sunscreen

Cardiac
Glycosides

Cardiac
Glycosides

Action:

Medication:

Increases
Lanoxin
force of
myocardial (Digoxin)
contraction,
slows rate
Used for:
Left-sided
CHF

Cardiac Glycosides
Side Effects:

Bradycardia
Nausea
Vomiting
Visual
disturbances
Nursing
Considerations:
Take apical pulse
Notify physician
if adult <60,
child <90-110,
<70 in older
children
Monitor
potassium level
Dose: 0.5-1
milligram IV or
PO over 24 hr
period
Average: 0.25
mg

Hyperkalemia on Electrocardiogram:
Tall, peaked T waves; prolonged PR interval;
widening QRS complex

Hypokalemia on Electrocardiogram: ST segment depression;

Flat T wave
First-Degree Heart Block: Prolonged P-R interval
Bundle Branch Block: Widened QRS complex
Myocardial Necrosis in Area: Q waves present
Ventricular Fibrillation: No visible P waves or QRS
complexes, no measurable rate. Irregular, chaotic
undulations of varying amplitudes.
HypoCalcemia: Prolonged Q-T interval
Myocardial Ischemia: ST segment elevation or depression
Premature Ventricular Contractions: absence of P waves,
wide and bizarre QRS complexes, and premature beats
followed by a compensatory pause
Ventricular Tachycardia: absence of P waves, wide QRS
complexes, rate between 100 and 250 impulses per
minute. Regular rhythm
Atrial Fibrillation: no P waves; instead there are wavy
lines, no PR interval. QRS duration is WNL and irregular
ventricular rate can range from 60-160 beats/minute.
FOODS HIGH IN WATER-SOLUBLE VITAMINS
A. Vitamin C - citrus fruits, cabbage, tomatoes, strawberries,
broccoli
B. Thiamine (B1) - lean meat, legumes,unrefined or enriched
grains and cereals
C. Riboflavin (B2) - enriched grains, milk, organ meats, poultry,
fish

D. Niacin - peanuts, peas, beans, meat, poultry

E. Pyridoxine (B6) - kidneys, liver, meats, corn, wheat, eggs,
poultry, fish
F. Cyanocobalamin (B12) - kidneys, lean meats,liver, dairy
products, egs
G. Folic acid - liver, eggs, leafy green vegetables, fruits,
enriched grain products
FOODS CONTAINING FAT-SOLUBLE VITAMINS
A. Vitamin A - fruits, green and yellow vegetables, butter, milk,
eggs, liver
B. Vitamin D - milk, fish
C. Vitamin E - green vegetables, vegetables oils, wheat germ,
nuts
D. Vitamin K - liver, cheese, leafy green vegetables, milk, green
tea

THE LAW
This defines the minimum ethical standards in a given area of practice. For
example, deceptive advertising is illegal and violators of this law are liable to large
fines, to arrest and / loss of good will.
TYPE OF LAWS:
Nursing practices subject to:1. Statutory laws. (Nurse Practice Act)
2. Regulatory laws. ( PNC pass Rules & Regulation and administrator laws)
3. Common laws. ( Informed Consent, Clients Rights To Refuse treatment)
4. Criminal laws.
(On Server Offense Imprisonment or Death)
5. Civil laws.
(Protect Individual)
ELEMENTS OF THE CODE

1. NURSES AND PEOPLE

The nurses primary professional responsibility is to people requiring nursing
care.
In providing care, the nurse promotes an environment in which the human rights,
values, customs and spiritual beliefs of the individual, family and community are
respected.
The nurse ensures that the individual receives sufficient information on which
to base consent for care and related treatment.
The nurse holds in confidence personal information and uses judgment in sharing
this information.
The nurse shares with society the responsibility for initiating and supporting
action to meet the health and social needs of the public, in particular those of
vulnerable populations.
The nurse also shares responsibility to sustain and protect the natural
environment from depletion, pollution, degradation and destruction.
2. NURSES AND PRACTICE
The nurse carries personal responsibility and accountability for nursing
practice, and for maintaining competence by continual learning.
The nurse maintains a standard of personal health such that the ability to
provide care is not compromised.
The nurse uses judgement regarding individual competence when accepting and
delegating responsibility.
The nurse at all times maintains standards of personal conduct which reflect
well on the profession and enhance public confidence.
The nurse, in providing care, ensures that use of technology and scientific
advances are compatible with the safety, dignity and rights of people.
3. NURSES AND THE PROFESSION
The nurse assumes the major role in determining and implementing acceptable
standards of clinical nursing practice, management, research and education.
The nurse is active in developing a core of research-based professional
knowledge.
The nurse, acting through the professional organisation, participates in creating
and maintaining safe, equitable social and economic working conditions in
nursing.
4. NURSES AND CO-WORKERS

 The nurse sustains a co-operative relationship with co-workers in nursing and

other fields.
The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a coworker or any other
person.
Cushing's Triad = Late signs of Increased ICP
I - rregular RR
C ardiac Rate Decreases
P ulse pressure widens.

Decorticate positioning in response to pain = Cortex involvement. Decerebrate in response to pain =

Cerebellar, brain stem involvement

Delegations
PCAs
-skin care, feeding, toileting, vital signs (not initials), height, weight, IOs, ROM exercises,
ambulation, transporting, grooming, and hygiene meaures of stable clients.
EANs
-physiologically stable clients with predictable outcomes
-dressings, suctionings, urinary catheterization, med administrations (only oral, subcutaneous, and
intramuscular), no rectal or IV meds
RNs
-assessment/planning care, initiating teaching, IV meds
RN can not delegate these tasks:
-initial assessments of clients
-evaluation of client data
-nursing judgement
-client/family educatoin/evaluation
-nsg diagnosis

ACID/BASE BALANCE
pH- 7.35-7.45
PCO2- 35-45 mmHg
PO2- 80-100 mmHg
HCO3 22-27 mEq/L
ACIDOSIS
-decrease pH
-Potassium increases
AKALOSIS
-increase pH
-Potassium decreases
ROME
respiratory oppossite metabolic equals
-----------------------------------------------------------------------

RESPIRATORY ACIDOSIS
Causes of Respiratory Acidosis (mostly airways/lungs related)
-Asthma: spasms causing the brochioles to constrict
-Atelectasis: excess mucus collection
-Brain trauma: excessive pressure on the respirtory center
-Bronchiectasis: bronchi become dilated as a result of inflammation
-COPD
-Emphysema: loss of elasticity of alveolar sacs, restricting airflow
-Hypoventilation: Carbon dioxide is retained
-Pulmonary Edema: accumulation of fluid in acute CHF
-Medications
Assessment for Respiratory Acidosis
-headache
-restlessness
-drowiness/confusion
-visual disturbances
-diaphoresis
-cyanosis as the hypoxia become acute
-hyperkalemia
-rapid, irregular pulse
-dysrhythmias leading to VFib.
Interventions for Respiratory Acidosis

-monitor signs of respiratory distress

-administer oxygen as prescribed
-semi-fowler
-encourage and assist the client to turn, cough, and breathe deeply
-hydration to thin secretions unless contraindicated
-suction airway if necessary
-monitor for potassium (because it is high in acidosis already)
-administer meds (antibiotics) and NOT meds that would place the client in more respiratory
depression
-----------------------------------------------------------------------

RESPIRATORY ALKALOSIS
Causes of Respiratory Alkalosis
-Fever (increases metabolism)
-Hyperventilation
-Hypoxia
-Hysteria
-Overventilation by mechanical ventilators
-Pain
-Aspirin
Clinical Manifestations of Respiratory Alkalosis/Assessment
-headache
-tachypnea (initial but decreases) (abnormal rapid respiration)
-paresthesias (tingling of fingers and toes)
-tetany
-vertigo
-convulsions
-hypokalemia
-hypocalcemia
Interventions for Respiratory Alkalosis
-encourage appropriate breathing patterns
-assist with breathing techniques and breathing aids as prescribed (voluntary holding of breath, use
of rebreathing mask, carbon dioxide breaths)
-no deep breathing???? (not sure but please look it up in your book and let me know)
-administer calicum gluconate for tetany as prescribed.
-----------------------------------------------------------------------

METABOLIC ACIDOSIS
Causes of Metabolic Acidosis
-Diabetes Mellitus or Diabetic Ketoacidosis

-Excessive ingestion of acetylsalicylic (aspirin)

-High-fat diet (a high intake of fat causes a much too rapid accumulation of the waste products of
fat metabolism, leading to a buildup of ketones and acids.
-insufficient metabolism of carbohydrates
-malnutrition
-renal insufficiency or renal failure
-severe diarrhea
-enteric dranage tubes/ileostomy
-gastrointestinal disorder
Clinical manifestations of metabolic acidosis/ assessments
-hyperpnea with kussmaul's repirations
-headache
-nausea/vomitting/ diarrhea
-fruitty smelling breath resulting from improper fat metabolism
-CNS depression (mental dullness, drowiness, stupor, and coma)
-twitching and convulsions
-hyperkalemia
Interventions for Metabolic Acidosis
-give insulin as precribed
-dialysis as prescribed
-Diet: low in protein and high in calories will decrease the amouth of protien waste products (which
will lessen the acidosis)
-----------------------------------------------------------------------

METABOLIC ALKALOSIS
Causes of Metabolic Alkalosis
-diuretics
-excessive vomitting or gastrointestinal suctioning
-hyperaldosteronism: increased rental tubular reabsorption of sodium occurs, with the resultant
loss of hydrogen ions.
-ingestion of excess sodium bicarbonate/antacids
-massive transfusion of whole blood
Assessment of Metabolic Alkalosis
-nausea, vomiting, diarrhea
-restlessness
-numbness and tingling in the extremities
-twitching in the extremities
-hypokalemia
-hypocalcemia
-dysrhythmias: tachycarida

Interventions for Metabolic Alkalosis

-monitor potassium and calcium
-institute safety precautions (not sure of the safety precautions, please look this up in your book
and let me know)
-prepare to administer medications as prescribed to promote the kidney excretion of bicarbonate.
-replace potassium chloride
Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?

PATHOPHYSIOLOGY OF ENDOMETRIOSIS
RISK FACTORS:

ETIOLOGY:

UNKNOWN

Family History One or

more relatives (The
THEORIES:
mother, aunt, sister) had
Hormonal
endometriosis
influence
Early menarche
Retrograde
Short menstrual cycles (<
Menstruation
27 days)
Lymphatic or
Heavy bleeding during
Vascular spread
menses
Immunological
Delayed childbearing
Infertility

If Shedding
the egg is of
not
Thickening
of
the
MENSTRUAL
CYCLE:
fertilized,lining
it
endometrial
endometrial
lining
Regurgitation
disintegrates
the
form
offor
ESTROGEN
in in
preparation
Levels
fromofthe
causing
the
menstrual
blood
LEVEL
the
fertilization
of
Estrogen
and
fallopian
tubes
hormones
to
drop

RETROGRADE
HORMONAL
MENSTRUATION
INFLUENCE

Vascular
/
dissemination
of
the endometrial
tissue

LYMPHATIC OR
VASCULAR SPREAD

Endometrial cells
deposited outside
the uterus implant
on structures within
the cavity

Endometrium
build up
Continuously
responds to
menstrual cycle
stimulation
More cells attach
to pelvic
structures

BLEEDING

INFLAMMATION

SCARRING

ADHESION

PHARMACOLOGIC
MNGT:

Nonsteroidal antiinflammatory
drugs or NSAIDs
Gonadotropinreleasing hormone
analogs (GnRH
analogs)
Danazol (Danocrine)

PAIN
S/SX:

Dysmenorrhea
Chronic pelvic
pain
Dyspareunia
Dysuria

Infertility

Florence

Nightingaless Environmental Theory

Defined Nursing: The act of utilizing the environment of

the patient to assist him in his recovery.

Focuses on changing and manipulating

in order to put

the environment

the patient in the best possible

conditions for nature to act.

Identified

Considered a clean, well-ventilated, quiet environment essential for

recovery.

Deficiencies in these 5 factors produce illness or lack of health, but

with a nurturing environment, the body could repair itself.

5 environmental factors: fresh air, pure water, efficient

drainage, cleanliness/sanitation and light/direct sunlight.

Dorothea Orems Self-Care Theory

Defined Nursing: The act of assisting others in the provision

and management of self-care to maintain/improve human
functioning at home level of effectiveness.

Focuses on activities that adult individuals perform on their own behalf

to maintain life, health and well-being.

Has a strong health promotion and maintenance focus.

Identified 3 related concepts:

1. Self-care - activities an Individual performs independently

throughout life to promote and maintain personal well-being.
2. Self-care deficit - results when self-care agency (Individuals
ability) is not adequate to meet the known self-care needs.
3. Nursing System - nursing

interventions needed

when Individual is unable to perform the necessary self-care

activities:
1. Wholly compensatory - nurse provides entire self-care
for the client.

Example: care of a new born, care of client

recovering from surgery in a post-anesthesia care
unit

2. Partial compensatory - nurse and client perform care,

client can perform selected self-care activities, but also
accepts care done by
the nurse for needs
the client cannot meet independently.

Example: Nurse can assist post operative client to

ambulate, Nurse can bring a meal tray for client who
can feed himself

3. Supportive-educative - nurses actions are to help the

client develop/learn their own self-care abilities through
knowledge, support and encouragement.
1.
1.

Example: Nurse guides a mother how to breastfeed

her baby, Counseling a psychiatric client on more
adaptive coping strategies.

Virginia Hendersons Definition of the Unique Function of

Nursing

Defined Nursing: Assisting the individual, sick or well, in the

performance of those activities contributing to health or its
recovery (or to peaceful death) that an individual would
perform unaided if he had the necessary strength, will or
knowledge.

Identified 14 basic needs :

1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal range
8. Keeping the body clean and well-groomed
9. Avoiding dangers in

the environment

10.

Communicating with others

11.

Worshipping according to ones faith

12.
Working in such a way that one feels a sense of
accomplishment
13.

Playing/participating in various forms of recreation

14.
Learning, discovering or satisfying the curiosity that leads
to normal development and health and using available health
facilities.

Madeleine Leiningers Transcultural Care Theory and Ethnonursing

Nursing is a learned humanistic and scientific profession and discipline

which is focused on human care phenomena and activities in order to
assist, support, facilitate, or enable individuals or groups to maintain or
regain their well being (or health) in culturally meaningful and
beneficial ways, or to help people face handicaps or death.

Transcultural nursing as a learned subfield or branch of nursing which

focuses upon the comparative study and analysis of cultures with
respect to nursing and health-illness caring practices, beliefs and
values with the goal to provide meaningful and efficacious nursing care
services to people according to their cultural values and health-illness
context.

Focuses on the fact that different cultures have different caring

behaviors and different health and illness values, beliefs, and patterns
of behaviors.

Awareness of the differences allows

culture-specific nursing

the nurse to design

interventions.

Calixta Roys Adaptation Theory

Viewed humans as Biopsychosocial beings constantly interacting with a

changing environment and who cope with their environment through
Biopsychosocial adaptation mechanisms.

Focuses on the ability of Individuals., families, groups, communities, or

societies to adapt to change.

The degree of internal or external environmental change and the

persons ability to cope with that change is likely to determine the
persons health status.

Nursing

interventions are aimed at promoting

physiologic, psychologic, and social functioning or adaptation.

Martha Rogers Concept of Science of Unitary Human Beings, and Principles

of Homeodynamics

Nursing is an art and science that is humanistic and humanitarian. It is

directed toward the unitary human and is concerned with the nature
and direction of human development. The goal of nurses is to
participate in the process of change..

Nursing interventions seek to promote harmonious interaction between

persons and their environment, strengthen the wholeness of the
Individual and redirect human and environmental patterns or
organization to achieve maximum health.

5 basic assumptions:

1.
1. The human being is a unified whole, possessing individual
integrity and manifesting characteristics that are more than and
different from the sum of parts.
2. The individual and

the environment are

continuously exchanging matter and energy with each other

3. The life processes of human beings evolve irreversibly and
unidirectionally along a space-time continuum
4. Patterns identify human being and reflect their innovative
wholeness
5. The individual is characterized by the capacity for abstraction
and imagery, language and thought, sensation and emotion

Hildegard Peplaus Interpersonal Relations Theory

Defined Nursing: An interpersonal process of therapeutic interactions

between an Individual who is sick or in need of health services and a
nurse especially educated to recognize, respond to the need for help.

Nursing is a maturing force and an educative instrument

Identified 4 phases of

the Nurse - Patient

relationship:
1. Orientation - individual/family has a felt need and seeks
professional assistance from a nurse (who is a stranger). This is
the problem identification phase.
2. Identification - where the patient begins to have feelings of
belongingness and a capacity for dealing with the problem,
creating an optimistic attitude from which inner strength ensues.
Here happens the selection of appropriate professional
assistance.
3. Exploitation -

the nurse uses communication tools

to offer services to

the patient, who is expected to

take advantage of all services.

4. Resolution - where patients needs have already been met by the
collaborative efforts between
the patient and the
nurse.

Therapeutic relationship is terminated and the links are

dissolved, as patient drifts away from identifying with
the nurse as the helping person.

Jean Watsons The Philosophy and Science of Caring

Nursing is concerned with promotion health, preventing illness, caring

for the sick, and restoring health.

Nursing is a human science of persons and human health-illness

experiences that are mediated by professional, personal, scientific,
esthetic and ethical human care transactions

She defined caring as a nurturant way or responding to a valued client

towards whom the nurse feels a personal sense of commitment and
responsibility. It is only demonstrated interpersonally that results in the
satisfaction of certain human needs. Caring accepts the person as
what he/she may become in a caring environment

Carative Factors:

1.
1. The promotion of a humanistic-altruistic system of values
2. Instillation of faith-hope
3. The cultivation of sensitivity to ones self and others
4. The development and acceptance of the expression of positive
and negative feelings.
5. The systemic use of the scientific problem-solving method for
decision making
6. The promotion of interpersonal teaching-learning
7. The provision for supportive, protective and corrective mental,
physical, socio-cultural and spiritual environment
8. Assistance with the gratification of human needs
9. The allowance for existential phenomenological forces

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally
contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in
the thin membrane that naturally lines the inside of the cavity

A hernia is an abnormal protrusion of part of the intestines through a weak part of the
abdomen, that is, part of the guts is poking through the abdominal wall. Normally, the front of
the abdomen has several layers comprising of skin then fat then muscles and broad

ligaments.Underneath all these lie the intestines (guts). If, for any reason, there is a weak point in
the muscles or ligaments, part of the intestines push through. You can then feel a soft lump under
the skin.

TYPE

Femoral hernia : The femoral canal is the path through which the femoral artery, vein, and nerve
leave the abdominal cavity to enter the thigh.
Umbilical hernia : These common hernias (10%-30%) are often noted at birth as a protrusion at
the bellybutton (the umbilicus). This is caused when an opening in the abdominal wall, which
normally closes before birth, doesn't close completely
Incisional hernia : Abdominal surgery causes a flaw in the abdominal wall. This flaw can create
an area of weakness in which a hernia may develop.
Spigelian hernia : This rare hernia occurs along the edge of the rectus abdominus muscle, which
is several inches to the side of the middle of the abdomen.
Obturator hernia : This extremely rare abdominal hernia develops mostly in women. This hernia
protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen).
Epigastric hernia : Occurring between the navel and the lower part of the rib cage in the midline
of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain
intestine.
Inguinal hernia is An a condition in which intra-abdominal fat or part of the small intestine, also
called the small bowel, bulges through a weak area in the lower abdominal muscles.

CAUSES
Although abdominal hernias can be present at birth, others develop later in life. Some
involve pathways formed during fetal development, existing openings in the abdominal cavity, or
areas of abdominal-wall weakness.
Any condition that increases the pressure of the abdominal cavity may contribute to the
formation or worsening of a hernia. Examples include

obesity,

heavy lifting,

coughing,

straining during a bowel movement or urination,

chronic lung disease, and

fluid in the abdominal cavity.

streptokinase-injection, Kabikinase, Streptase

USES: This medication is an enzyme which works to break up and dissolve
blood clots which can block arteries. It is used in the treatment of
heartattack or lung blood clots (pulmonary embolism) as well as leg blood
clots
(deep venous thrombosis-DVT).
HOW TO USE: This medication is given by injection by a health care
professional. It is important this medication be used as prescribed. It is
mosteffective when administered as soon as possible (within 6 hours after
symptoms (e.g., chest pain) appear.
SIDE EFFECTS: Nausea, dizziness, low blood pressure or mild fever mayoccur.
It can also cause nerve damage. If any of these effects persist or worsen,
notify your doctor promptly. Notify your doctor promptly if you
develop: easy bruising, headache, flushing, rapid or abnormal
heartbeat,chest pain. A serious allergic reaction to this drug is unlikely, but
seek immediate medical attention if it occurs. Symptoms of a serious allergic
reaction include: rash, itching, swelling, severe dizziness, trouble
breathing.Immediately report any signs of bleeding to your doctor. If you
notice othereffects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Tell your doctor if you have: bleeding disorders, high blood
pressure, endocarditis, recent biopsy or surgery, recent injury, any allergies.
Use extra caution to avoid injury and trauma (e.g., carefully brush teeth)
while using this medication due to the increased risk of bleeding. This
medication should be used only if clearly needed during pregnancy. Discuss
the risks and benefits with your doctor. It is not known if this medication
appears in breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Tell your doctor of any over-the-counter or prescription
medication you may take, including: blood thinners (e.g., warfarin), NSAID

(e.g., ibuprofen, naproxen), aspirin. Drugs that can reverse effects of

streptokinase include: aminocaproic acid, aprotinin, tranexamic acid. Do not
start or stop any medicine without doctor or pharmacist approval.
NOTES: Laboratory tests will be done frequently while using this medication
to monitor its effects and to prevent side effects.

Elizabeth Kubler-Ross: Five Stages

1. Denial
a. Unconscious avoidance which varies from a brief period
to the remainder of life
b. Allows one to mobilize defenses to cope
c. Positive adaptive responses - verbal denial; crying
d. Maladaptive responses - no crying, no
acknowledgement of loss
2. Anger
a. Expresses the realization of loss

b. May be overt or covert

c. Positive adaptive responses - verbal expressions of
anger
d. Maladaptive responses - persistent guilt or low self
esteem, aggression, self destructive ideation or
behavior
3. Bargaining
a. An attempt to change reality of loss; person bargains
for treatment control, expresses wish to be alive for
specific events in near future
b. Maladaptive responses - bargains for unrealistic
activities or events in distant future
4. Depression and Withdrawal
a. Sadness resulting from actual and/or anticipated loss
b. Positive adaptive response - crying, social withdrawal
c. Maladaptive responses - self-destructive actions,
despair
5. Acceptance
a. Resolution of feelings about death or other loss,
resulting in peaceful feelings
b. Positive adaptive behaviors - may wish to be alone,
limit social contacts, complete personal business
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in
choices about her health care. It originates from the legal and ethical right the patient
has to direct what happens to her body and from the ethical duty of the physician to
involve the patient in her health care.

What are the elements of full informed consent?

The most important goal of informed consent is that the patient have an opportunity to
be an informed participant in his health care decisions. It is generally accepted that
complete informed consent includes a discussion of the following elements:
the nature of the decision/procedure
reasonable alternatives to the proposed intervention
the relevant risks, benefits, and uncertainties related to each alternative
assessment of patient understanding
the acceptance of the intervention by the patient

Nursing
Interventions
1. Verify
doctors
order.
Inform the
client and
explain
the
purpose of
the
procedure.
2. Check for cross matching and typing. To ensure compatibility
3. Obtain and record baseline vital signs
4. Practice strict asepsis
5. At least 2 licensed nurse check the label of the blood transfusion. Check the following:
o Serial number

o Blood component
o Blood type
o Rh factor
o Expiration date
o Screening test (VDRL, HBsAg, malarial smear) this is to ensure that the blood
is free from blood-carried diseases and therefore, safe from transfusion.
6. Warm blood at room temperature before transfusion to prevent chills.
7. Identify client properly. Two Nurses check the clients identification.
8. Use needle gauge 18 to 19 to allow easy flow of blood.
9. Use BT set with special micron mesh filter to prevent administration of blood clots and
particles.
10. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes. Adverse
reaction usually occurs during the first 15 to 20 minutes.
11. Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp,
increase in respiratory rate)
12. Do not mix medications with blood transfusion to prevent adverse effects. Do not
incorporate medication into the blood transfusion. Do not use blood transfusion lines for
IV push of medication.
13. Administer 0.9% NaCl before; during or after BT. Never administer IV fluids with
dextrose. Dextrose based IV fluids cause hemolysis.
14. Administer BT for 4 hours (whole blood, packed RBC). For plasma, platelets,
cryoprecipitate, transfuse quickly (20 minutes) clotting factor can easily be destroyed.
15. Observe for potential complications. Notify physician.

CARDIAC ARRYTHMIAS
1. Terminology
a. QRS depolarization always refer to ventricular (not atrial,
junctional, or nodal)
b. P wave refers to atrial
2. Six rhythms tested on NCLEX

a. Asystole
i. A lack of QRS depolarizations (a straight line)
b. Atrial flutter
i. Rapid Pwave
depolarizations in a sawtooth
(flutter)
c. Atrial fibrillation
i. Chaotic Pwave
depolarizations (lacks any discernable
pattern)
d. Ventricular fibrillation
i. Chaotic QRS depolarizations
e. Ventricular tachycardia
i. Wide, bizarre QRSs
ii. Tachy is always discernable repeating pattern
f. Premature ventricular contractions (PVC)
i. Periodic wide, bizarre QRSs
ii. Generally low to moderate priority. unless everyone else has
a normal rhythm
iii. Be concerned, if:
1. More than 6 per minute
2. 6 in a row
3. PVC falls of T-wave of previous beat
3. Lethal arrhythmias
a. Asystole
b. Vfib
4. Potentially life threatening arrhythmia: V-tach
a. Pulseless vtach
same as asystole and v. fib and would depend on
how long down
b. After 8 mins consider dead
5. Treatment
a. PVCs
i. Lidocaine (Ventricular, lasts longer) , Amiodorone
b. V Tach
i. Lidocaine
c. Supraventricular arrhythmias
i. Adenosine (push fast IV push usually 8s or faster)
ii. Beta-Blockers (lol)
iii. Calcium Channel Blockers
iv. Digoxin (Digitalis) Lanocin
d. VFib
i. Best treatment electrically
ii. Shock = 200 Defibrillate
e. Asystole
i. Epinephrine

ii. Atropine
iii. S/E anticholinergics