CONTENT REVIEW

PIH
Possible complication = seizure
RACE
Rescue, Alarm, Contain, Extinguish
Labs:
Na (135-145), K (3.5-5.0), Cl (85-115), HCO3 (22-26)
Diffusion
Movement of particles from high concentration to low concentration
Osmosis
Movement of fluid from low concentration to high concentration r/t to albumn
Fluid intake
1500mL/24 hours
Fluid output
60-70 ml/hour
Kayexalate enema
Sodium and potassium exchange enema = only in case of severe hyperkalemia
Fluids:
D5W 1000ml = 200 cal
NaCl or LR 1000ml = 0 cal
Acid-Base
pH (7.35-7.45), pCO2 (35-45), pO2 (80-100), pHCO3 (22-26)
Epidural
needle does not puncture the dura = no SF loss = decrease risk of HA
Spinal
needle puncture the dura = SF loss = HA
Eye, head, hernia surgergy
NO coughing, but encourage deep breath
Abd hysterectomy
Increase risk of thrombophlebitis
Post-op fever
Immediately r/t dehydration
24-48 hours r/t dehydration
48-72 hours r/t UTI
> 72 hors r/t wound infection
Autonomic Nervous System
SNS (adrenergic = Adrenalin) : fight or flight bear and the boy
PNS maintenance (cholinergic) = acetylcholine SLUG the pig colon
Lumbar puncture
Fluid should be clear, if +glucose CSF
Lateral recumbent position during procedure
After procedure = needs to lie supine 6-8 hours to prevent HA
Arteriogram (heart cath)
Bleeding at puncture site
Assess circulation distally
CAT/CT scan
X-ray, may use contrast dye for better image ASSESS food/med allergies
Other scans use radioactive isotope
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MRI
Interior vision of the body; question any metal??? Claustrophobic (+ may need sedation)???
PCWP (4-12, not >15); CVP (4-10, not >15)
ICP (0-10, concern >15)
Conditions that increase ICP hydrocephalus, brain tumor, head trauma
Sx: decrease pulse & respiration, increase pulse pressure, vomiting (pos. projectile), decrease LOC, no
pupil reaction (on same side injury), opposite side paralysis
Rx: AIRWAY, VS, neuro checks (pupil, hand grasps, wiggle toes), check glucose, HOB elevated 20-
30o, steroids, diurectic-Mannitol or Lasix, anticonvulsants
Hypothalamus produce ADH (damage to hypothalmamus, decrease ADH production = diurese)
Meningitis
Sx: nucchal rigidity, positive Kernigs/Brudzinkis/Opisthotomos (sideline position best)
Rx: private room/isolation until cause is define
Decrease noise, decrease light, calm & quite environment
If bacterial IV antibiotic
Encephalitis
Viral, inflammation of brain tissue
West Nile spread by mosquito; reservoir sick bird
Teaching: decrease risk by removing standing water, wear long sleeve when outside
CVA
Decrease cerebral blood flow & oxygen
Types: thrombolytic (2-3 hours window tx from onset, embolic, hemorrhagic (no anticoagulation,
increase risk w/ ASA, gingko, Vit E)
Sx: homonymous hemianopia cannot see from paralysis side; dyarthria (difficulty saying words),
asphasia (receptive blah blah blah, expressive eh eh eh), apraxia (inability to perform
previously learned act), agnosia (dont know what an object is for )
L hemiplagia difficulty with visual & spatial relation, impulsive, FALL risk
R hemiplagia speech and language deficits, slow cautious behavior
Frontal lob decrease learning, memory, thinking, attention span
TIA CVA as angina MI
Parkinsons
Sx: bent head, stoop tremors, mask-like face, drooling, rigidity, akenesia (muscle weakness), shuffling
gait (+smooth sole shoes)
Rx: levadopa/carbadopa, parladel (increase dopamine), artane/congentin (anticholinergic-decrease
acetylcholine), safety, constipation, as independent as long as possible
Multiple sclerosis (MS) - autoimmune
Demyelination of neuron
Rx: steroids, self cath
As disease progress decrease to absent motor ability, age of onset >40
Myasthenia Gravis (MG)
Antibodies inhibit acetylcholine receptor motor disorder muscular fatique
Sx: diplopia, dysphagia, muscle weakness, ptosis (eyelid droop), mask-like expression, weak voice,
hoarseness
Diagnostic test = Tensilon test
Rx: give med on time before meals with milk and crackers, check gag reflex and swallowing, check
respiratory function, do not take other CNS depressant, soft diet, thymectomy, plasmapheresis (remove
antibody)
MEDS (anticholinesterase/cholinergic increase acetylcholine): Prostigmin, Prednisone
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 Myasthenia crisis: under medicated, extreme weakness, tensilon relieves sx
Cholinergic crisis: over medicated muscle weakness, tensilon makes sx worse, ANTIDOTE: Atropine
Trigeminal Neuralgia 5th CN
Antiepileptic drugs; injury of never, avoid extreme temperatures (terrible pain, esp in cold temp),
surgery to protect eye
Bells palsy 7th CN (facial)
1 side of the face droops
Steroids, analgesics, protect, facial exercises, possible spontaneous recovery
Guillian Barre Syndrome (follow viral infection)
Ascending paralysis
Protect AIRWAY, ROM, prevent foot drop, warm blanket during plamaphoresis
Amyotrophic lateral sclerosis (Lou Gehrighs disease)
No cure, not communicable ; men > women
Motor neuron disease inability to move immobile respiratory arrest
SCI
Cervical upper body, C4-5 injury require mechanical ventilation keep diaphragm alive, quadriplegia,
no bowel and bladder function
Thoracic lower extremity, paraplegia, no bowel and bladder function
Lumbar (Leg)- lower extremity, paraplegia, no bowel and bladder function
Sacral decrease bowel and bladder function
Spinal shock also absences of reflexes, last 6 weeks 3 months, resolving when reflex returns
Immobilize head and spine, AIRWAY, intermittent cath, paralytic ileus VM care, skin care prevent
deformities
SCI (T6 & higher) notify MD of
o Autonomic dysreflexia/hyperreflexia
Increase BP, HA blurred vision, nausea, FULL BLADDER, fecal impaction
Immobilization
Halo traction skeletal traction
Crutchfield tongs skeletal traction & weight
Halo vest traction skeletal traction; broken neck, sleep in reclining chair
Stryker frame prone supine prone supine (position change Q2)
Cataracts (affect the lenses): OD (R eye), OS (L eye), OU (both eyes)
Surgery lenses implant
Sx: blurred vision, decreae acuity, photophobia, blindness
Analysis sensory-perceptual alteration, input deficit, increase risk for injury, increase risk for social
isolation
Pre-op: mydriatrics
Post-op: avoid laying on ooperative site: NO coughing, vomiting, shaving, teeth brushing, bending;
safety; teach poor depth perception if no implant in 3-4 months permanent glasses
Chronic glaucoma (open angle glaucoma)
Insidious onset
Sx: loss of peripheral vision, haloes around lights, reduced visual acuity (esp at night), tonometer
reading >22 (increased IOP), dilated pupils
Rx: miotics (eserine, pilocarpine, carbachol), timolol maleate, IV mannitol, and parenteral
acetazolamide, anticholinesterase (Humorsol), carbonic anhydrase inhibitor Diamox (decrease
aqueous humor)
Care: NO lifting, straining, coughing, excessive fluids, safety, DAILY EYE DROPS, regular eye exam

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Acute glaucoma (closed-angle)
Sx: causes excruciating unilateral pain and pressure, blurred vision, decreased visual acuity, haloes
around lights, diplopia, lacrimation, and N/V due to increase IOP
Amy be precipitated by dilating the pupils
Detached retina (separated from the blood supply)
Sx: curtain over filed of vision, flashes, floating particles
Preop - patch both eyes, bed rest, cycloplegics, mydriates
Postop NO reading 2-3 wks; bedrest, flat/low-fowlers, mydriatic, antibiotics, corticosteroids, eye patch
Mennierres disease
Inner problem, sx: ringing balance problem, smoking aggravates disease
Cardiovascular
ESR (sed rate) - + inflammation somewhere in the body
CRP = increase cardiovascular risk,
CPK/MB rise w/I hours
SGOT/AST transaminase
Total cholesterol < 200
Troponin, PT (11-15; tx 2-2..5x control), INR (1; tx 2-3); PTT (60-70 secs), aPTT (30-40; tx 1.5-3x
control); Coagulation time (5-15 min)
Stress test w/o thalium
NO heavy meals 4 hours before test; NO stimulant or smoking before and after test
Stress test w/ thalium
No caffeine 24 hours before, NPO after MN, MO smoking on the day of procedure
Cardiac catherization
R venous approach via the femoral or antecubital (AC) R atrium R ventricle pulmonary artery
L atrial approach via the brachial or femoral artery aorta L ventricle
o Detect coronary artery disease; more apt to bleed
Check for allergy to shellfish; void before procedure; conscious sedation
Check distal pulses from the puncture site (pedal pulses, radial pulses); check extremities/circulation;
monitor ECG and VS
Swan-Ganz Catheter
R atrium tricuspid R ventricle pulmonary artery
L-sided heart failure: distal port; measuring PCWP, PA pressure
R-sided heart failure: proximal port; measuring R atrial pressure (CVP)
PCWP (4-12); CVP (4-10); ICP (0-10) if any is > 15 trouble
Electrical conduction System
Heart beat starts at SA node atria AV node bundle of his bundle branches Purkinje fibers
ventricles beat
Sinus heart beat starts at SA node pacemaker
Atrial heart beat start at atria but outside the normal pathway/ectopic (PAC)
Ventricular heart beat start at ventricle but outside the normal pathway (PVC)
o Ventricular fibrillation (V-fib) is LIFE THREATENING 4-6 minutes before brain death occur
Fibrillation NO identifiable P-wave
Flutter sea-saw teeth
T wave related myocardial ischemia
1st degree block prolonged PR interval
2nd degree block more P-waves than QRS
3rd degree block complete AV block, possible pacemaker required

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Pacemaker
Check HR daily; no contact sport; avoid sources of electricity; stay away from microwaves/cell
phones/garage opener
NO MRI; usually have a set HR, if HR fall below the set value problem w/ pacemaker
Angina
Insufficient blood flow to myocardium
Triggers exhaustion, excitement, environment, eating, nicotine
Rx oxygen, vasodilator Nitrites/Nitrates, semi-high fowler, diet change, NO SMOKING; sit or lie
down before taking Nitro (r/t hypotension)
o NITRO SL Q5min x 3 if > 911: sensitive to light/heat/humidity short shell life (6-12 mos)
o NITRO patch/paste NO Viagra or cyalis
o Calcium blocking agent Nifedipine (Procardia), Verapamil (Isoptin, Calan)
MI
Death of myocardial cell r/t inadequate oxygentation crushing chest pain
Cardiogenic shock cool, clammy, ashen skin
After attack elevated temperature
Rx: oxygen, pain relief (morphine sulfate), IV line, monitor closely, bed rest, anticoagulant, semi-
fowler, stool softener, I/O
Thrombolytic
Alteplase (tPA) give w/I 6 hours of onset heparin Coumadin
Streptokinase (Kabikinase) & Urokinase (Abbokinase) heparin Coumadin
o Give w/I 6 hours of onset in MI
o Give w/I 3 hours of onset in PE or DVT
Anticoagulants
Heparin prolongs clotting time; antidote PROTAMINE SULFATE
Enoxaprin (Lovenox)
Coumadin (Wafarin) antidote VITAMIN K
Drugs treat Ventricular Dysrythmias
Qunidine sulfate (Qunidex)
Disopyramide (Norpace)
Lidocaine HCL (Xylocain) decrease PVCs
Phenytoin Na (Dilantin)
Bretylium (Bretylol)
Adenaside (Adenocard)
Amiodarone (Cardarone)
Digoxin in A-fib patient
CHF
L-sided failure Lung problem dyspnea
R-sided failure venous problem, distended neck veins, hepatomegally, pitting edema
Digoxin increase blood supply; loading dose maintenance: check POTASIUM level
o Therapeutic (0.8-2), toxic > 2 nausea; antidote DIGI-BIND
Diuretics:
o Thiazides (diuril) K wasting
o Lasix loop diuretic decrease Na & K increase K intake and monitor Na & K level
o Spironolactone K sparing, block aldosterone
Food high in K: watermelon, prune, lima bean, apricot, banana, oranges,

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Hypertension
Risk factor: African American, Hispanic American, Native American, obesity, smoking, stress, high Na
intake, high fat diet, sedentary lifestyle, age
Rx: ACE-I (pril) blocks angiotensin I angiotensin II; Beta-blockers (olol); Alpha-blockers
(zosin)
Arterioschlerosis obliterans (atherosclerosis)
Intermittent claudication
Sx: tingling and numbness of toes, poor circulation
Rx: STOP smoking, low fat-high fiber diet, legs straight then down
o antilipemic Questran concerns with bleeding
o statin; Niacin B vitamin (toxic to liver, vasodilation effect)
Buergers disease
Inflammation of arteries and veins; STOP smoking; vasodilators & anticoagulants; leg exercises (U,D,F)
Raynauds phenomenon
Cold, painful hands; STOP SMOKING, protect from cold, mittens
AAA (abdominal aortic aneurysm)
Assess pulses on bilateral legs
Thromboplebitis
Leg exercise
Varicose veins
Surgery ligation & stripping; ACE bandaids
Amputation
Elevate stump during 1st 24 hours only to decrease edema
Keep tourniquet @ bedside; Wrap stump to help shape for prosthesis
Check stump for skin break down, leave stump open to air promote healing; lie prone prevent hip
flexion
CANCER
SE: bone marrow suppression (decrease RBC, Plt, WBC), alopecia, increase uric acid increase risk of
Gout on Alopurenol push fluids
Cytoxan may cause cystitis push fluid & empty bladder frequently
External radiation: daily x 4-6 weeks, DO NOT remove mark, NO powder/deodorant (corn starch only);
pat dry, check diarrhea, VS, CBC, avoid direct sun light and crowds
Internal radiation: bed rest, no visitors, TIME (limit), DISTANCE (increase), shielding (lead-lined
protection)
Bleeding precaution
Neutropenic or reverse precaution
o NO flower, plant, fruit, vegetables; NO visitor with infection, NO rectal temperature or
suppostitory, NO enamas or foley
o STRICT handwashing, mask & gloves, check for sx of infection, use soft toothbrush
Blood tests
Universal recipient = AB +
Universal donor = O
Rhogam w/I 1st 72 hours of 2nd delivery (if expose to Rh conflict)
Rhogam w/I 28 weeks of gestation, after abortion or miscarriage
Rhogam to prevent development of antibody against Moms Rh factor
2 units of RBC 1 unit of whole blood < 4 hours of infusion
FFP thaw in warm water infuse quickly
Blood with NS only, large G needle 18-19 G
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Iron Deficiency Anemia
Sx: fatigue, cold sensitivity, palpitations, dizziness, pallor, brittle hair and nails
Tx: rest, iron replacement, check for blood loss
Vit C enhance Fe absorption; milk blocks Fe absorption
Give Fe PO use straw, with meals to decrease GI upset, with Vit C (spinach/brocholli)
Give Fe IM via deep Z-trac
Pernicious Anemia
Common cause r/t lack of intrinsic factor blocks Vit B12 absorption
Sx: sore mouth, beefy red tongue
Tx: monthly Vit B12 injection
Blood test or Schilling test PO radioactive Vit B12 24 hour urine collection
Folic Acid Anemia
May cause neural tube defect (encephalopathy, minengocele)
Increase green leafy vegetable, liver / organ meat
Aplastic Anemia
Bone marrow depression (decrease RBC, WBC, PLT)
Neutropenic or bleeding precaution
Serious life threatening
Sickle Cell Anemia
Recessive transmitted anemia
o If both parents are carriers: with each pregnancy 25% w/ disease, 50% carrier, 25% normal
Precipitating factor: dehydrated, high altitude
By product of RBC bilirubin convert to bile in liver store as bile in gallbladder
Sx: liver damage, jaundice, decrease circulation, thrombosis distally ischemia, kidney damage, leg
ulcer, stroke, blind, VASO-OCCLUSIVE CRISIS
PRIORITY: fluid administration, oxygenation, NO ASA, report and get help if child is N/V, has fever
At greatest risk: African background, Middle East descendent
Idiopathic Thrombocytopenia Purpura (ITP)
Decrease PLT bleeding precaution, on steroids; possible splenectomy
Classic hemophylia
Sons has disease; daughters are carrier from MOM
X-linked transmitted
o Mom carrier & Dad normal: 50% girls carriers, 50% boys disease
o Mom normal & Dad disease: 100% girls carriers, 100% boys normal
R/T decrease clotting factor VIII
Parents tend to become over protective; child need Med ID, regular dental checkups
Hemearthrosis (bleeding into the joint) use of bed cradle device prevent the sheets from touching
the lower extremities
Rx: give factor VIII, costly management, may swim, NO contact sport
DIC (disseminated (wide spread) intravascular (into the vessels) clotting)
Possible precipitating factor SEPSIS
Cause excessive production of clot in microcirculation clotting in the wrong places that used up
clotting factor (underlying problem)
Sx: hemorrhage and bleeding profusely, decrease urine output, decrease BP, prolong PT
Tx: heparin (to stop clotting in the wrong places) & supportive care
LIFE THREATENING

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Infectious mononucleosis Mono/kissing disease
Viral infection caused by Epstein-Barr via droplet contact (saliva)
Diagnostic test: heterophil antibody test, monospot test
Sx: sever sore throat, swollen lymph node, sever fatigue
Tx: REST, rarely hospitalized
Leukemia
Anemia, fatigue, bleeding, immunocompromised (decrease WBC, RBC, PLT)
Over production of immature WBC
Neutropenic and bleeding precaution
Tx: CA therapeutic drugs induce remission, bone marrow transplant (autologous-self; donor-
compatable; multiple marrow biopsy from donor, recipient go under radiation)
Hodgkins Lymphoma
CA of the lymphatic system (lymph node)
Single PAINLESS, enlarged lymph node swelling
Sx: severe itching; high survival if diagnose early unless metastasize to surrounding organs
Nonhogkins Lymphoma
Poor prognosis
AIDS
Virus attacks T-cell lymphocytes become immunosuppressed
Test: Elissa test or Western Assay test + for antibodies; HIV+ until T cell < 200 (AIDS)
BODY FLUID PRECAUTIONS
NO cure: DRUGS nucleosides & nonnucleoside (vir, AZT), combinations, may pills
Multiple Myeloma
CA of bone marrow (decrease WBC-immunocompromised, RBC-anemic, PLT-bleeding)
Bone destruction-holes in the bone, CA of bone, multiple fractures (pathological no traumatic cause),
vertebral compression fracture (decrease height), increase serum Ca (risk of kidney stones)
PAINFUL disease, poor prognosis
Drugs: thylidamide (cause severe birth defects)
Respiratory assessment
ABG, arterial blood samples (keep cool-on ice)
Sputum culture best in AM, rinse mouth with water only
Thoracentesis can be done at bedside, upright sitting position
Bronchoscopy NPO after MN, NPO after procedure until gag reflex returns
TB skin test (Mantoux, PPD) intradermal (15o create a wheal; read 48-72 hours if > 10 cm induration
indicates positive antibodies chest x-ray sputum culture x 3
Pneumothorax
Air in pleural cavity with stabbed wound collapsed lungs cover would w/ air vent dressing
Must remove air water sealed chest tube intermittent bubbling (air leaving the pleural cavity); if
no bubbling in water seal may indicate lung has inflated or obstruction in tubing
Suction control tube continuous bubbling if not check suction if it is on, or check for air leak
Hemopneumothorax
PLEURA-EVAC 3 chambers chest tube: collection, water seal, suction control
Petroleum or air occlusive dressing; hold breath or hmmm when D/C chest tube
NO milking or stripping of chest tube
If chamber broken put tube in a glass of water or sterile NS
Chest physiotherapy
Loosen secretion with postural drainage (position and scheduling AM, between meals & HS)
Percussion w/ cupped hand), vibration (vest)
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Mechanical ventilation
When alarm goes off check PATIENT 1st
Humidify oxygen if > 4L
COPD
Obstruction of air flow
Barrel chest, hx of smoking; emphysema, bronchitis, bronchiecstais, asthma
Emphysema
o Excessive inflation of the air spaces; decrease CO2 and O2 exchange; CO2 trapped in alveoli
Chronic bronchitis
o Excessive mucus production with cough @ least for 3 mos/year x 2 consecutive years
Asthma
o Bronchospasm & airway obstruction; inflammatory process, like breathing through pinched
straw; beta-blockers are contraindicated
Bronchioecstasis
o Chronic abnormal dilation of bronchi & destruction of bronchial walls
CARE:
o bronchodilators (SE tachycardia), mucolytics (increase water intake contraindicated if +
right-sided heart failure), expectorant, pursed lip breathing prolong expiratory phase,
diaphragmic breather, HIGH calorie (frequent small meals) & HIGH protein diet
Normally stimulus to breathe is high CO2
COPD stimulus to breathe is low O2 DO NOT give high concentration oxygen may shut off the
drive to breath
TB
Sx: PM, low grade fever, night sweats, chest pain, anorexia and weight loss
Most conclusive test: positive sputum test AFB X 3
Tx: with antibiotic
o INH SE: peripheral neuritis Vit B6 for prevention, liver damage
o Rifampin turn body fluid red/orange and affect PO contraceptives
o Streptomycin (IM) SE ototoxicity & nephrotoxicity
o PAS PO w/ food
o Ethambutol eye & color blind (red-green color blindness)
NEGATIVE pressure room (respiratory isolation airborne precaution) until 3 sputum reconvert to (-)
Histoplasmosis
Caused by fungus grows in bird and bat manure (high risk farmer and city dweller)
Similar to TB; skin test
Amphotericin B SE: local phlebitis, fever, bone marrow depression, anaphylactic, fever, renal
damage
o Give Tylenol, Steroids & Benadryl to decrease SE
Pneumonia
Inflammation of alveolar spaces consolidation increase secretion
Sx: shallow respiration, nasal flaring, rib retraction
Rx: semi-fowler, oxygen, hydration, antipyretic, analgesic, Codein (use cautiously if +productive cough)
Pneumonectomy
Observe tracheal position (midiastinal shift)
Semi-fowler NOT far from either side, midline best
Lobectomy
Position on unaffected side increase lung expansion

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Shoulder Ankyllosis (growing together)
Problem following thoracotomy: on day of surgery passive ROM; 1 day after active ROM
Laryngectomy (CA of Larynx)
Risk factor smoking
Rest voice for several weeks voice may become raspy when speak again
Stoma in the neck-air enters via stoma, no longer have epiglottis, become neck breather, change smell
and taste function, temporary NG
Immediate post-op: write to communicate, picture board, signals (best-foot signal), artificial larynx,
Esophageal speech swallow air and talk on a burp (referral to OT)
Stoma covering filtering and warmth the air; NO water sport, tub bath is safer
GI diagnostic
Barium swallow NPO before procedure, laxative after procedure
EGD NPO before procedure, check gag reflex after procedure before eating and drinking
Sigmoidoscopy full bowel prep laxative (GoLYTELY) clear liquid diet 1 day before procedure,
NO red liquid
Barium Enema bowel prep (x-ray)
Liver biopsy clotting studies, left side during procedure, right side lying after procedure
Paracentesis (r/t ascites) void before procedure, check BP after r/t to removal of fluid
Enemas (often for fecal impaction)
Cleansing: use 500-1000 mL
Oil retention: 150-200 mL (use oil retention 1st then cleansing enema to flush away fecal content)
NG intubation
Check placement by aspirating content and check for pH < 4
Turn on right side immediately after passing NG tube for the 1st hour after procedure)
Enteral Nutrition
Absorb by GI tract; short term NG; long term gastrostomy, enterostomy
TPN via central vein catheter dump into right atrium check blood glucose; dressing change
3x/week, NO piggy back
Bismuth turns tongue or stool black
Hiatal hernia
Sx: dramatic heart burn
Rx: sit up after meal, small frequent meals, NO gas forming/carbonated beverages/caffeine/tea/chocolate
Peptic ulcer (acid related ulcer)
Duodenum relieved by food, pain 2-4 hours meal, during middle of the night
Gastric more acidic, not does not relieve by food, pain occur much soon after meal 1-2 hours AC
Causative agent H. pylori (test breath test or blood test)
Rx: triple therapy - Metronidazole (Flagyl) NO alcohol; Amoxacillin or Tetracycline; antacid -
Omeprazole (Prilosec) or Ranitidine (Zantac); Peptobismol tx 1-2 weeks
Diet: bland food, frequent meals; NO caffeine, alcohol, spices, smoking, stress may aggravates ulcer
Histamine or H2 Antagonists (idine)
SE: confusion, dizziness, dry mouth, no smoking
Cimetidine (Tagamet) given WITH MEALS
Antacid (Take AFTER MEALS)
Magnesium base (Milk of Magnesia) SE: diarrhea
Aluminum (Amphogel) SE: constipation, bind phosphates (appropriate for renal failure pts), long term
use osteoporosis
Combination (Riopan); Sodium Carbonate: retain sodium and fluid
Calcium Carbonate (TUMS) can be Ca supplement
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GI Anticholinergic
Belladonna, Banthine, Probanthine slows peristalsis
Indications: ulcers, irritable bowel, Crohns, ulcerative colitis
SE: Red, Hot, Dry, Blind, Mad (confuse)
Antisecretory
Omeprazole Prilosec give before meals, not safe for nursing mothers
Sucralfate & Carafate
Binds to the ulcers, coats stomach lining allowing healing
Binds w/ other medications give 2 hours apart from other meds; give BEFORE MEALS
Meds given before meals
Sucralfate (Carafate) & Omeprazole (Prilosec)
Meds given with meals
Cimetidine (Tagamet)
Meds given after meals
antacids
Gastric Surgery
Concern DUMPING SYNDROME
o Immediately after meals: nausea and dizziness
o 2 hours after eating: cold, clammy, irritable (hypoglycemia sx r/t pancrease increase secretion of
insulin)
Diet low sodium, decrease simple carbohydrate, increase complex carbohydrates and proteins
Lie down after meals, NO fluid with meals
Hernias
Abnormal protrusion of an organ through the structures normally containing it
Reducible (can manually replaced) vs irreducible (cannot be replaced)
Strangulated hernia irreducible w/ obstruction of blood supply surgical emergency; use scrotal
support, NO coughing post-op, NO insertion of indwelling catheter
Crohns disease
Chronic inflammatory bowel disease; heredity predisposition more pronounce in Eastern/European
Frequent stool; affect proximal colon and ileum; scaring and narrowing of bowel
Banthine; steroid; antimicrobial, ileostomy-proximal colon is common
Ulcerative colitis
Chronic inflammatory bowel disease ulcers in the colon bloody mucusy stool
Affect distal bowel and rectum
Banthine (anticholinergic) decrease peristaltic activity, decrease # of loose stools
Steroids (sones); antimicrobial
Possible colostomy-distal colon/ileostomy
Diverticulosis out pouching
Chronic constipation, NO SEEDed food
Diverticulitis inflammation of the pouches
No SEEDS; painful; low residue diet (NO skin, seeds, or leaves; avoid MILK) until the itis has healed
Ostomies
Ileostomy - proximal bowel most loose stool
Colostomy (most formed drainage) distal bowel if irrigate at the same time QD, hold solution at
18 high or at should height sit up right position or sit in toilet
Hemorrhoidectomy
Cold therapy on day of surgery, sitz bath 1 day after

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Liver functions
Coverts bilirubin bile gallbladder store bile to digest fat; when fail jaundice (in eye icterus)
Detoxifies poisons; when fail change drug metabolism toxicity
Metabolize carbohydrates store excess glucose convert to glycogen PRN; when fail fatigue
Deactivates amino acids excretes ammonia; when fail confusion, hepatic coma
Makes plasma proteins (albumin) osmotic balance; when fail ascites
Makes prothombin; when fail bleeding & bruising
Makes cholesterol
Stores Vit K, D, B12, iron
Diet: high carb, high protein; in hepatic failure HIGH carb, LOW PROTEIN

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