Beruflich Dokumente
Kultur Dokumente
NERVOUS SYSTEM
Overview of structures and functions:
Central Nervous System
Brain
Spinal Cord
Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Autonomic Nervous System
Sympathetic nervous system
Parasympathetic nervous system
B. NEUROGLIA
Support and protection of neurons.
TYPES
1. Astrocytes – maintains blood brain barrier semi-permeable.
Majority of brain tumors (90%) arises from called astrocytoma.
2. Oligodendria
3. Microglia
4. Epindymal
Astrocites
Maintains integrity of blood brain barrier.
Oligodendria
Produces myelin sheath in CNS
DEMYELINATING
Act as insulator and facilitates DISORDERS
rapid nerve impulse transmission.
1. ALZHEIMER’S DISEASE
Atrophy of brain tissues.
Sign and Symptoms
4 A’s of Alzheimer
a. Amnesia – loss of memory.
b. Agnosia – no recognition of inanimate objects.
c. Apraxia – no recognition of objects function.
d. Aphasia – no speech (nodding).
*Expressive aphasia
“motor speech center”
Broca’s Aphasia
*Receptive aphasia
inability to understand spoken words.
Wernicke’s Aphasia
General Knowing Gnostic Area or General Interpretative Area.
DRUG OF CHOICE: ARICEPT (taken at bedtime) and COGNEX.
2. MULTIPLE SCLEROSIS
Chronic intermittent disorder of CNS characterized by white patches of demyelination in brain and
spinal cord.
Characterized by remission and exacerbation.
Women ages 15-35 are prone
Unknown Cause
Slow growing virus
Autoimmune disorders
Pernicious anemia
Myasthenia gravis
Lupus
Hypothyroidism
GBS
2. Impaired sensation
to touch, pain, pressure, heat and cold.
tingling sensation
paresthesia
numbness
3. Mood swings
euphoria (sense of well being)
4. Impaired motor function
weakness
spasticity
paralysis
5. Impaired cerebral function
scanning speech
TRIAD SIGNS OF MS
Ataxia
(Unsteady gait, (+) Romberg’s test)
CHARCOTS
TRIAD
IAN
6. Urinary retention/incontinence
7. Constipation
8. Decrease sexual capacity
DIAGNOSTIC PROCEDURE
CSF analysis (increase in IgG and Protein).
MRI (reveals site and extent of demyelination).
(+) Lhermitte’s sign a continuous and increase contraction of spinal column.
NURSING MANAGEMENT
1. Administer medications as ordered
a. ACTH (Adreno Corticotropic Hormone)/ Steroids for acute exacerbation to reduce edema at
site
of demyelination to prevent paralysis.
b. Baclofen (Dioresal)/ Dantrolene Sodium (Dantrene) – muscle relaxants.
c. Interferons – alter immune response.
d. Immunosupresants
2. Maintain side rails to prevent injury related to falls.
3. Institute stress management techniques.
15
a. Deep breathing exercises
b. Yoga
4. Increase fluid intake and increase fiber to prevent constipation.
MICROGLIA
stationary cells that carry on phagocytosis (engulfing of bacteria or cellular debris, eating),
pinocytosis (cell drinking).
MACROPHAGE ORGAN
Microglia Brain
Monocytes Blood
Kupffers cells Kidney
Histiocytes Skin
Alveolar Lung
Macrophage
EPINDYMAL CELLS
Secretes a glue called chemo attractants that concentrate the bacteria.
COMPOSITION OF BRAIN
80% brain mass
10% blood
10% CSF
I. Brain Mass
PARTS OF THE BRAIN
1. CEREBRUM
largest part 15
composed of the Right Cerebral Hemisphere and Left Cerebral Hemisphere enclosed in
the Corpus Callosum.
2. Temporal
hearing
short term memory
3. Parietal
for appreciation
discrimination of sensory impulses to pain, touch, pressure, heat, cold, numbness.
4. Occipital
for vision
Insula (Island of Reil)
visceral function activities of internal organ like gastric motility.
Limbic System (Rhinencephalon)
controls smell and if damaged results to Anosmia (absence of smell).
controls libido
controls long term memory
2. BASAL GAGLIA
areas of grey matter located deep within each cerebral hemisphere.
release dopamine (controls gross voluntary movement.
3. MIDBRAIN/ MESENCEPHALON
acts as relay station for sight and hearing.
size of pupil is 2 – 3 mm.
equal size of pupil is isocoria.
unequal size of pupil is anisocoria.
hearing acuity is 30 – 40 dB.
positive PERRLA
4. INTERBRAIN/ DIENCEPHALON
Parts of Diencephalon
A. Thalamus
acts as relay station for sensation.
B. Hypothalamus
15
controls temperature (thermoregulatory center).
controls blood pressure
controls thirst
5. BRAIN STEM
located at lowest part of brain
Parts of Brain Stem
1. Pons
pneumotaxic center controls the rate, rhythm and depth of respiration.
2. Medulla Oblongata
controls respiration, heart rate, swallowing, vomiting, hiccup, vasomotor center (dilation
and constriction of bronchioles).
3. Cerebellum
smallest part of the brain.
lesser brain.
controls balance, equilibrium, posture and gait.
Medulla Oblongata
Brain Herniation
15
CSF cushions brain (shock absorber)
Obstruction of flow of CSF will lead to enlargement of skull posteriorly called hydrocephalus.
Early closure of posterior fontanels causes posterior enlargement of skull in hydrocephalus.
Nursing Management
1. Maintain patent and adequate ventilation by:
a. Prevention of hypoxia and hypercarbia
Early signs of hypoxia
restlessness
agitation
tachycardia
Late signs of hypoxia
Bradycardia
Extreme restlessness
Dyspnea
Cyanosis
HYPERCARBIA
Increase CO2 (most powerful respiratory stimulant) retention.
15
In chronic respiratory distress syndrome decrease O2 stimulates respiration.
b. Before and after suctioning hyper oxygenate client 100% and done 10 – 15 seconds only.
c. Assist in mechanical ventilation
e Spinach
Oranges
Magnesium Sulfate
3. Hyponatremia
decrease sodium level
normal value is 135 – 145 meq/L
Signs and Symptoms
hypotension
dehydration signs (Initial sign in adult is THIRST, in infant TACHYCARDIA)
agitation
dry mucous membrane
poor skin turgor
weakness and fatigue
Nursing Management
force fluids
administer isotonic fluid solution as ordered
4. Hyperglycemia
normal FBS is 80 – 100 mg/dl
Signs and Symptoms
polyuria
polydypsia
15
polyphagia
Nursing Management
monitor FBS
Aloneness
Multiple loss
causes
suicide
15
3. Aminophylline Toxicity
Signs and Symptoms
tachycardia
palpitations
CNS excitement (tremors, irritability, agitation and restlessness)
Nursing Management
only mixed with plain NSS or 0.9 NaCl to prevent development of crystals or precipitate.
administered sandwich method
avoid taking alcohol because it can lead to severe CNS depression
avoid caffeine
4. Dilantin Toxicity
Signs and Symptoms
gingival hyperplasia (swollen gums)
hairy tongue
ataxia
nystagmus
Nursing Management
provide oral care
massage gums
5. Acetaminophen Toxicity
Signs and Symptoms
hepatotoxicity (monitor for liver enzymes)
SGPT/ALT (Serum Glutamic Pyruvate Transaminace)
SGOT/AST (Serum Glutamic Oxalo-Acetil Transaminace)
nephrotoxicity monitor BUN (10 – 20) and Creatinine (.8 – 1)
15
hypoglycemia
Tremors, tachycardia
Irritability
7. Assist in surgical procedure known as thymectomy because it is believed that the thymus gland is
responsible for M.G.
8. Assist in plasma paresis and removing auto immune anti bodies
9. Prevent complications
A. Etiology
1. Meningococcus – most dangerous
2. Pneumococcus
3. Streptococcus - causes adult meningitis
4. Hemophilus Influenzae – causes pediatric meningitis
B. Mode of transmission
airborne transmission (droplet nuclei)
D. Diagnostic Procedures 15
Lumbar puncture: a hollow spinal needle is inserted in the subarachnoid space between the
L3 – L4 to L5.
CBC reveals
1. Increase wbc
E. Nursing Management
1. Enforce complete bed rest
2. Administer medications as ordered
a. Broad spectrum antibiotics (Penicillin, Tetracycline)
b. Mild analgesics
c. Anti pyretics
3. Institute strict respiratory isolation 24 hours after initiation of anti biotic therapy
4. Elevate head 30-45o
5. Monitor strictly V/S, input and output and neuro check
6. Institute measures to prevent increase ICP and seizure.
7. Provide a comfortable and darkened environment.
8. Maintain fluid and electrolyte balance.
9. Provide client health care and discharge planning concerning:
a. Maintain good diet of increase CHO, CHON, calories with small frequent feedings.
b. Prevent complications
most feared is hydrocephalus
hearing loss/nerve deafness is second complication
consult audiologist
c. Rehabilitation for neurological deficit
mental retardation
delayed psychomotor development
B. Predisposing Factors
thrombus (attached)
15
embolus (detached and most dangerous because it can go to the lungs and cause
pulmonary embolism or the brain and cause cerebral embolism.
C. Risk Factors
1. Hypertension, Diabetes Mellitus, Myocardial Infarction, Atherosclerosis, Valvular Heart Disease, Post
Cardiac Surgery (mitral valve replacement)
2. Lifestyle (smoking), sedentary lifestyle
3. Obesity (increase 20% ideal body weight)
4. Hyperlipidemia more on genetics/genes that binds to cholesterol
5. Type A personality
a. deadline driven
b. can do multiple tasks
c. usually fells guilty when not doing anything
6. Related to diet: increase intake of saturated fats like whole milk
7. Related stress physical and emotional
8. Prolong use of oral contraceptives promotes lypolysis (breakdown of lipids) leading to atherosclerosis that
will lead to hypertension and eventually CVA.
F. Nursing Management
1. Maintain patent airway and adequate ventilation by:
a. assist in mechanical ventilation
b. administrate O2 inhalation
2. Restrict fluids to prevent cerebral edema that might increase ICP
3. Elevate head 30 – 45o
4. Monitor strictly vitals signs, I & O and neuro check
5. Prevent complications of immobility by:
a. turn client to side
b. provide egg crate mattresses or water bed
c. provide sand bag or food board.
6. Assist in passive ROM exercise every 4 hours to promote proper bodily alignment and prevent contractures
7. Institute NGT feeding
8. Provide alternative means of communication
a. non verbal cues
b. magic slate
9. If positive to hemianopsia approach client on unaffected side
10. Administer medications as ordered
a. Osmotic Diuretics (Mannitol)
b. Loop Diuretics (Lasix, Furosemide)
c. Cortecosteroids
d. Mild Analgesics
15
e. Thrombolytic/Fibrinolytic Agents – dissolves thrombus
Streptokinase
Side Effect: Allergic Reaction
A. Predisposing Factors
1. Autoimmune
2. Antecedent viral infections such as LRT infections
B. Signs and Symptoms
1. Clumsiness (initial sign)
2. Dysphagia
3. Ascending muscle weakness leading to paralysis
4. Decreased of diminished deep tendon reflex
5. Alternate hypotension to hypertension
** ARRYTHMIA (most feared complication)
6. Autonomic symptoms that includes
a. increase salivation
b. increase sweating
c. constipation 15
C. Diagnostic Procedures
D. Nursing Management
1. Maintain patent airway and adequate ventilation by:
a. assist in mechanical ventilation
b. monitor pulmonary function test
2. Monitor strictly the following
a. vital signs
b. intake and output
c. neuro check
d. ECG
3. Maintain side rails to prevent injury related to fall
4. Prevent complications of immobility by turning the client every 2 hours
5. Institute NGT feeding to prevent aspiration
6. Assist in passive ROM exercise
7. Administer medications as ordered
a. Corticosteroids – suppress immune response
b. Anti Cholinergic Agents – Atrophine Sulfate
c. Anti Arrythmic Agents
Lidocaine, Zylocaine
Bretylium – blocks release of norepinephrine to prevent increase of BP
8. Assist in plasma pharesis (filtering of blood to remove autoimmune anti-bodies)
9. Prevent complications
a. Arrythmia
b. Paralysis or respiratory muscles/Respiratory arrest
A. Predisposing Factors
1. Head injury due to birth trauma
2. Genetics
3. Presence of brain tumor
4. Toxicity from
a. lead
15
b carbon monoxide
5. Nutritional and Metabolic deficiencies
6. Physical and emotional stress
C. Diagnostic Procedures
1. CT Scan – reveals brain lesions
2. EEG – reveals hyper activity of electrical brain waves
D. Nursing Management
1. Maintain patent airway and promote safety before seizure activity
a. clear the site of blunt or sharp objects
b. loosen clothing of client
c. maintain side rails
d. avoid use of restrains
e. turn clients head to side to prevent aspiration
f. place mouth piece of tongue guard to prevent biting or tongue
2. Avoid precipitating stimulus such as bright/glaring lights and noise
15
3. Administer medications as ordered
a. Anti convulsants (Dilantin, Phenytoin)
b. Diazepam, Valium
Conscious 15 – 14
Lethargy 13 – 11
Stupor 10 – 8
Coma 7
Deep Coma 3
I. LEVEL OF CONSCIOUSNESS
1. Conscious - awake
2. Lethargy – lethargic (drowsy, sleepy, obtunded)
3. Stupor
stuporous (awakened by vigorous stimulation)
15
generalized body weakness
decrease body reflex
4. Coma
CRANIAL NERVES
I. OLFACTORY S
II. OPTIC S
III OCCULOMOTOR M
IV. TROCHLEAR M
(Smallest)
V. TRIGEMINAL B
(Largest)
VI. ABDUCENSE M
VII. FACIAL B
VIII. ACOUSTIC S
IX. GLOSSOPHARYNGEAL B
X. VAGUS B
(Longest)
XI. SPINAL ACCESSORY M
XII. HYPOGLOSSAL M
CRANIAL NERVE I: OLFACTORY
sensory function for smell
Material Used
don’t use alcohol, ammonia, perfume because it is irritating and highly diffusible.
use coffee granules, vinegar, bar of soap, cigarette
Procedure 15
C. Diagnostic Procedures
15
1. Tonometry
2. Perimetry
3. Gonioscopy
E. Surgical Procedures
1. TRABECULECTOMY (Peripheral Indectomy) – drain aqueous humor
2. Cataract
Decrease opacity of lens
A. Predisposing Factor
1. Aging 65 years and above
2. Related to congenital
3. Diabetes Mellitus
4. Prolonged exposure to UV rays
C. Pathognomonic Signs
1. Blurring or hazy vision
2. Milky white appearance at center of pupils
3. Decrease perception to colors
Complication is blindness
D. Diagnostic Procedure
1. Opthalmoscopic exam
E. Treatment
1. Mydriatics (Mydriacyl) – constricts pupils
2. Cyclopegics (Cyclogyl) – paralyses cilliary muscle
F. Surgical Procedure
Extra Intra
Capsular Capsular
Cataract Cataract
Lens Lens
Extraction Extraction
- Partial removal - Total removal of cataract with its surrounding capsules
Most feared complication post op is RETINAL DETACHMENT
15
A. Predisposing Factors
1. Post Lens Extraction
2. Myopia (near sightedness)
C. Surgical Procedures
1. Scleral Buckling
2. Cryosurgery – cold application
3. Diathermy – heat application
4. Macular Degeneration
Degeneration of the macula lutea (yellowish spot at the center of retina)
Oculomotor
controls the size and response of pupil
15
normal pupil size is 2 – 3 mm
equal size of pupil: Isocoria
Unequal size of pupil: Anisocoria
ENDOCRINE SYSTEM
Overview of the structures and functions
1. Pituitary Gland (Hypophysis Cerebri)
o Located at base of brain particularly at sella turcica
o Master gland or master clock
o Controls all metabolic function of body
PARTS OF THE PITUITARY GLAND
1. Anterior Pituitary Gland
o called as adenohypophysis
2. Posterior Pituitary Gland
o called as neurohypophysis
o secretes hormones oxytocin -promotes uterine contractions preventing bleeding/
hemorrhage
o administrate oxytocin immediately after delivery to prevent uterine atony.
o initiates milk let down reflex with help of hormone prolactin
2. Antidiuretic Hormone
o Pitressin (Vasopressin)
o Function: prevents urination thereby conserving water
o Diabetes Insipidus/ Syndrome of Inappropriate Anti Diuretic Hormone
DIABETES INSIPIDUS
o Decrease production of anti diuretic hormone
A. Predisposing Factor
o Related to pituitary surgery
o Trauma
o Inflammation
o Presence of tumor
B. Signs and Symptoms
1. Polyuria
2. Signs of dehydration
a. Adult: thirst
b. Agitation
c. Poor Skin turgor
d. Dry mucous membrane
3. Weakness and fatigue
15
4. Hypotension
5. Weight loss
SIADH
o hypersecretion of anti diuretic hormone
A. Predisposing Factors
1. Head injury
2. Related to presence of bronchogenic cancer
o initial sign of lung cancer is non productive cough
o non invasive procedure is chest x-ray
3. Related to hyperplasia (increase size of organ brought about by increase of number of cells) of pituitary
gland.
C. Diagnostic Procedure
1. Urine specific gravity is increased
2. Serum Sodium is decreased
D. Nursing Management
1. Restrict fluid
2. Administer medications as ordered
a. Loop diuretics (Lasix)
b. Osmotic diuretics (Mannitol)
3. Monitor strictly vital signs, intake and output and neuro check
4. Weigh patient daily and assess for pitting edema
5. Provide meticulous skin care
6. Prevent complications 15
PINEAL GLAND
o secretes melatonin
o inhibits LH secretion
o it controls/regulates circadian rhythm (body clock)
THYROID GLAND
o located anterior to the neck
3 Hormones secreted
1. T3 (Tri iodothyronine) - 3 molecules of iodine (more potent)
2. T4 (tetra iodothyronine, Thyroxine)
o T3 and T4 are metabolic or calorigenic hormone
o promotes cerebration (thinking)
3. Thyrocalcitonin – antagonizes the effects of parathormone to promote calcium resorption.
HYPOTHYROIDISM
o all are decrease except weight and menstruation
o memory impairment 15
Signs and Symptoms
o there is loss of appetite but there is weight gain
HYPERTHYROIDISM
o all are increase except weight and menstruation
Signs and Symptoms
o increase appetite but there is weight loss
o amenorrhea
o exophthalmos
THYROID DISORDERS
SIMPLE GOITER
o enlargement of thyroid gland due to iodine deficiency
A. Predisposing Factors
1. Goiter belt area
a. places far from sea
b. Mountainous regions
2. Increase intake of goitrogenic foods
o contains pro-goitrin an anti thyroid agent that has no iodine.
o cabbage, turnips, radish, strawberry, carrots, sweet potato, broccoli, all nuts
o soil erosion washes away iodine
o goitrogenic drugs
a. Anti Thyroid Agent – Prophylthiuracil (PTU)
b. Lithium Carbonate
c. PASA (Aspirin)
d. Cobalt
e. Phenylbutazones (NSAIDs)
- if goiter is caused by
C. Diagnostic Procedures
1. Serum T3 and T4 – reveals normal or below normal
2. Thyroid Scan – reveals enlarged thyroid gland.
3. Serum Thyroid Stimulating Hormone (TSH) – is increased (confirmatory diagnostic test)
D. Nursing Management
1. Enforce complete bed rest
2. Administer medications as ordered
a. Lugol’s Solution/SSKI ( Saturated Solution of Potassium Iodine)
o color purple or violet and administered via straw to prevent staining of teeth. 15
o 4 Medications to be taken via straw: Lugol’s, Iron, Tetracycline, Nitrofurantoin (drug of choice
for pyelonephritis)
HYPOTHYROIDISM
o hyposecretion of thyroid hormone
o adults: MYXEDEMA non pitting edema
o children: CRETINISM the only endocrine disorder that can lead to mental retardation
A. Predisposing Factors
1. Iatrogenic Cause – disease caused by medical intervention such as surgery
2. Related to atrophy of thyroid gland due to trauma, presence of tumor, inflammation
3. Iodine deficiency
4. Autoimmune (Hashimotos Disease)
C. Diagnostic Procedures
1. Serum T3 and T4 is decreased
2. Serum Cholesterol is increased
3. RAIU (Radio Active Iodine Uptake) is decreased
D. Nursing Management
1. Monitor strictly vital signs and intake and output to determine presence of
o Myxedema coma is a complication of hypothyroidism and an emergency case
o a severe form of hypothyroidism is characterized by severe hypotension, bradycardia,
bradypnea, hypoventilation, hyponatremia, hypoglycemia, hypothermia leading to pregressive
stupor and coma.
Nursing Management for Myxedema Coma
Assist in mechanical ventilation
Administer thyroid hormones as ordered
Force fluids
2. Force fluids
3. Administer isotonic fluid solution as ordered
4. Administer medications as ordered
Thyroid Hormones
a. Levothyroxine
b. Leothyronine
c. Thyroid Extracts
5. Provide dietary intake that is low in calories
6. Provide comfortable and warm environment
7. Provide meticulous skin care
8. Provide client health teaching and discharge planning concerning
a. Avoid precipitating factors leading to myxedema coma
o stress
o infection
o cold intolerance
o use of anesthetics, narcotics, and sedatives
o prevent complications (myxedema coma, hypovolemic shock
o hormonal replacement therapy for lifetime
o importance of follow up care
HYPERTHYROIDISM
o increase in T3 and T4
o Grave’s Disease or Thyrotoxicosis
o developed by Robert Grave
A. Predisposing Factors
1. Autoimmune – it involves release of long acting thyroid stimulator causing exopthalmus (protrusion
of eyeballs) enopthalmus (late sign of dehydration among infants)
15
2. Excessive iodine intake
3. Related to hyperplasia (increase size)
C. Diagnostic Procedures
1. Serum T3 and T4 is increased
2. RAIU (Radio Active Iodine Uptake) is increased
3. Thyroid Scan- reveals an enlarged thyroid gland
D. Nursing Management
1. Monitor strictly vital signs and intake and output
2. Administer medications as ordered
Anti Thyroid Agent
a. Prophythioracill (PTU)
b. Methymazole (Tapazole)
Side Effects of Agranulocytosis
o increase lymphocytes and monocytes
o fever and chills
o sore throat (throat swab/culture)
o leukocytosis (CBC)
3. Provide dietary intake that is increased in calories.
4. Provide meticulous skin care
5. Comfortable and cold environment
6. Maintain side rails
7. Provide bilateral eye patch to prevent drying of the eyes.
8. Assist in surgical procedures known as subtotal thyroidectomy
** Before thyroidectomy administer Lugol’s Solution (SSKI) to decrease vascularity of the thyroid
gland to prevent bleeding and hemorrhage.
POST OPERATIVELY,
1. Watch out for signs of thyroid storm/ thyrotoxicosis
TRIAD SIGNS
15
Agitation
2. Watch out for accidental removal of parathyroid gland that may lead to
Hypocalcemia (tetany)
Signs and Symptoms
o (+) trousseau’s sign
o (+) chvostek sign
o Watch out for arrhythmia, seizure give Calcium Gluconate IV slowly as ordered
3. Watch out for accidental Laryngeal damage which may lead to hoarseness of voice
Nursing Management
o encourage client to talk/speak immediately after operation and notify physician
PARATHYROID GLAND
o A pair of small nodules behind the thyroid gland
o Secretes parathormone
o Promotes calcium reabsorption
o Hypoparathyroidism
o Hyperparathyroidism
HYPOPARATHYROIDISM
o Decrease secretion of parathormone leading to hypocalcemia
o Resulting to hyperphospatemia
A. Predisposing Factors
1. Following subtotal thyroidectomy
2. Atrophy of parathyroid gland due to:
15
a. inflammation
b. tumor
C. Diagnostic Procedures
1. Serum Calcium is decreased (normal value: 8.5 – 11 mg/100 ml)
2. Serum Phosphate is decreased (normal value: 2.5 – 4.5 mg/100 ml)
3. X-ray of long bones reveals a decrease in bone density
4. CT Scan – reveals degeneration of basal ganglia
D. Nursing Management
1. Administer medications as ordered such as:
a. Acute Tetany
Calcium Gluconate IV slowly
b. Chronic Tetany
Oral Calcium supplements
Calcium Gluconate
Calcium Lactate
Calcium Carbonate
c. Vitamin D (Cholecalciferol) for absorption of calcium
d. Phosphate binder
Aluminum Hydroxide Gel (Ampogel)
Side effect: constipation
ANTACID
15
A.A.C MAD
▼ ▼
Aluminum Containing Magnesium Containing
HYPERTHYROIDISM
o Decrease parathormone
o Hypercalcemia: bone demineralization leading to bone fracture (calcium is stored 99% in bone and 1%
blood)
o Kidney stones
A. Predisposing Factors
1. Hyperplasia of parathyroid gland
2. Over compensation of parathyroid gland due to vitamin D deficiency
a. Children: Ricketts
b. Adults: Osteomalacia
B. Signs and Symptoms
1. Bone pain especially at back (bone fracture)
2. Kidney stones
a. renal cholic
b. cool moist skin
3. Anorexia, nausea and vomiting
4. Agitation and memory impairment
C. Diagnostic Procedures
1. Serum Calcium is increased
2. Serum Phosphate is decreased
3. X-ray of long bones reveals bone demineralization
D. Nursing Management
1. Force fluids to prevent kidney stones
2. Strain all the urine using gauze pad for stone analysis
3. Provide warm sitz bath
4. Administer medications as ordered 15
ADRENAL GLAND
o Located atop of each kidney
o 2 layers of adrenal gland
a. Adrenal Cortex – outermost
b. Adrenal Medulla – innermost (secretes catecholamines a power hormone)
2 Types of Catecholamines
o Epinephrine and Norepinephrine (vasoconstrictor)
o Pheochromocytoma (adrenal medulla)
o Increase secretion of norepinephrine
o Leading to hypertension which is resistant to pharmacological agents leading to CVA
o Use beta-blockers
ADRENAL CORTEX
3 Zones/Layers
1. Zona Fasciculata
- secretes glucocortocoids (cortisol)
- function: controls glucose metabolism
- Sugar
2. Zona Reticularis
- secretes traces of glucocorticoids and androgenic hormones
- function: promotes secondary sex characteristics
- Sex
3. Zona Glumerulosa
- secretes mineralocorticoids (aldosterone)
- function: promotes sodium and water reabsorption and excretion of potassium
- Salt
ADDISON’S DISEASE
o Hyposecretion of adreno cortical hormone leading to
a. metabolic disturbance – Sugar
b. fluid and electrolyte imbalance – Salt
c. deficiency of neuromuscular function – Salt/Sex
A. Predisposing Factors 15
1. Related to atrophy of adrenal glands
2. Fungal infections
C. Diagnostic Procedures
1. FBS is decreased (normal value: 80 – 100 mg/dl)
2. Plasma Cortisol is decreased
3. Serum Sodium is decrease (normal value: 135 – 145 meq/L)
4. Serum Potassium is increased (normal value: 3.5 – 4.5 meq/L)
D. Nursing Management
1. Monitor strictly vital signs, input and output to determine presence of Addisonian crisis (complication of
addison’s disease)
o Addisonian crisis results from acute exacerbation of addison’s disease characterized by
a. severe hypotension
b. hypovolemic shock
c. hyponatremia leading to progressive stupor and coma
Nursing Management for Addisonian Crisis
1. Assist in mechanical ventilation,
- administer steroids as ordered
- force fluids
2. Administer isotonic fluid solution as ordered
3. Force fluids
4. Administer medications as ordered
Corticosteroids
a. Dexamethasone (Decadrone)
b. Prednisone
c. Hydrocortisone (Cortison)
Nursing Management when giving steroids
1. Instruct client to take 2/3 dose in the morning and 1/3 dose in the afternoon to mimic the normal diurnal
rhythm
2. Taper dose (withdraw gradually from drug)
3. Monitor side effects
a. hypertension
15
b. edema
c. hirsutism
d. increase susceptibility to infection
CUSHING SYNDROME
o Hypersecretion of adenocortical hormones
A. Predisposing Factors
1 Related to hyperplasia of adrenal gland
2. Increase susceptibility to infections
3. Hypernatremia
a. hypertension
b. edema
c. weight gain
d. moon face appearance and buffalo hump
e. obese trunk
f. pendulous abdomen
g. thin extremities
4. Hypokalemia
a. weakness and fatigue
b. constipation
c. U wave upon ECG (T wave hyperkalemia)
5. Hirsutism
6. Acne and striae
7. Easy bruising
8. Increase masculinity among females
B. Diagnostic Procedures
1. FBS is increased
2. Plasma Cortisol is increased
15
3. Serum Sodium is increased
4. Serum Potassium is decreased
PANCREAS
- Located behind the stomach
- Mixed gland (exocrine and endocrine)
- Consist of acinar cells which secretes pancreatic juices that aids in digestion thus it is an exocrine gland
- Consist of islets of langerhans
- Has alpha cells that secretes glucagons (function: hyperglycemia)
- Beta cells secretes insulin (function: hypoglycemia)
- Delta cells secretes somatostatin (function: antagonizes the effects of growth hormones)
DIABETES MELLITUS
- metabolic disorder characterized by non utilization of carbohydrates, protein and fat metabolism
CLASSIFICATION OF DM
Type 1 (IDDM) Type 2 (NIDDM)
- Juvenile onset type - Adult onset
- Brittle disease - Maturity onset type
- Obese over 40 years old
A. Incidence Rate A. Incidence Rate
- 10% general population has type 1 DM - 90% of general population has type 2 DM
B. Predisposing Factors B. Predisposing Factors
1. Hereditary (total destruction of pancreatic cells) 1. Obesity – because obese persons lack insulin
2. Related to viruses receptor binding sites
3. Drugs
a. Lasix
b. Steroids
4. Related to carbon tetrachloride toxicity
15
E. Complication E. Complications
1. Diabetic Ketoacidosis 1. Hyper
2. Osmolar
3. Non
4. Ketotic
5. Coma
HYPERGLYCEMIA
Increase osmotic diuresis
Glycosuria Polyuria
Cholesterol Ketones
▼ ▼
Atherosclerosis Diabetic Keto Acidosis
▼
Hypertension
Acetone Breath Kussmaul’s Respiration
odor
MI CVA
DIABETIC KETOACIDOSIS
- Acute complication of type 1 DM due to severe hyperglycemia leading to severe CNS depression
A. Predisposing Factors
1. Hyperglycemia
2. Stress – number one precipitating factor
3. Infection
C. Diagnostic Procedures
1. FBS is increased
2. BUN (normal value: 10 – 20)
3. Creatinine (normal value: .8 – 1)
4. Hct (normal value: female 36 – 42, male 42 – 48) due to severe dehydration
D. Nursing Management
1. Assist in mechanical ventilation
2. Administer 0.9 NaCl followed by .45 NaCl (hypotonic solutions) to counteract dehydration and shock
3. Monitor strictly vital signs, intake and output and blood sugar levels
4. Administer medications as ordered
a. Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 – 4 hours)
b. Sodium Bicarbonate to counteract acidosis
c. Antibiotics to prevent infection
B. Nursing Management
1. Assist in mechanical ventilation
2. Administer 0.9 NaCl followed by .45 NaCl (hypotonic solutions) to counteract dehydration and shock
3. Monitor strictly vital signs, intake and output and blood sugar levels
4. Administer medications as ordered
a. Insulin therapy (regular acting insulin peak action of 2 – 4 hours)
- for DKA use rapid acting insulin
b. Antibiotics to prevent infection
INSULIN THERAPY
A. Sources of Insulin
1. Animal sources
- Rarely used because it can cause severe allergic reaction
- Derived from beef and pork
2. Human Sources
- Frequently used type because it has less antigenicity property thus less allergic reaction
3. Artificially Compound Insulin
15
B. Types of Insulin
1. Rapid Acting Insulin (clear)
B. Diagnostic Procedures
1. FBS is increased (3 consecutive times with signs or polyuria, polydypsia, polyphagia and glucosuria
confirmatory for DM)
2. Random Blood Sugar is increased
15
3. Oral glucose tolerance test is increased – most sensitive test
4. Alpha Glycosylated Hemoglobin is increased
EYES KIDNEY
-PREMATURE CATARACT -RECURRENT PYELONEPHRITIS
- Blindness - Renal failure
HEMATOLOGICAL SYSTEM
1. Arteries 1. Liver
55% Plasma 45% Formed 2. Veins 3. Spleen
4. Lymphoid Organ
Serum Plasma CHON 5. Lymph Nodes
(formed in liver) 6. Bone Marrow
1. Albumin
2. Globulins
3. Prothrombin and Fibrinogen
ALBUMIN
- Largest and numerous plasma CHON 15
- Maintains osmotic pressure preventing edema
FORMED ELEMENTS
1. RBC (ERYTHROCYTES)
- normal value: 4 – 6 million/mm3
- only unnucleated cell
- biconcave discs
- consist of molecules of hgb (red pigment) bilirubin (yellow pigment) biliverdin (green pigment) hemosiderin
(golden brown pigment)
- transports and carries oxygen to tissues
- hemoglobin: normal value female 12 – 14 gms% male 14 – 16 gms%
- hematocrit red cell percentage in wholeblood
- normal value: female 36 – 42% male 42 – 48%
- substances needed for maturation of RBC
a. folic acid
b. iron
c. vitamin c
d. vitamin b12 (cyanocobalamin)
e. vitamin b6 (pyridoxine)
f. intrinsic factor
- Normal life span of RBC is 80 – 120 days and is killed in red pulp of spleen
2. WBC (LEUKOCYTES)
- normal value: 5000 – 10000/mm3
A. Granulocytes
1. Polymorpho Neutrophils
- 60 – 70% of WBC
- involved in short term phagocytosis for acute inflammation
2. Polymorphonuclear Basophils
- for parasite infections
- responsible for the release of chemical mediation for inflammation
3. Polymorphonuclear Eosinophils
- for allergic reaction
B. Non Granulocytes
1. Monocytes
- macrophage in blood
- largest WBC
- involved in long term phagocytosis for chronic inflammation
2. Lymphocytes
3. Platelets (THROMBOCYTES)
- Normal value: 150,000 – 450,000/mm3
- Promotes hemostasis (prevention of blood loss)
- Consist of immature or baby platelets or megakaryocytes which is the target of dengue virus
- Normal life span of platelet is 9 – 12 days
BLOOD DISORDERS
Iron Deficiency Anemia
- A chronic microcytic anemia resulting from inadequate absorption of iron leading to hypoxemic tissue injury
A. Incidence Rate
1. Common among developed countries
2. Common among tropical zones
3. Common among women 15 – 35 years old
4. Related to poor nutrition
B. Predisposing Factors
1. Chronic blood loss due to trauma
a. Heavy menstruation
b. Related to GIT bleeding resulting to hematemesis and melena (sign for upper GIT bleeding)
c. fresh blood per rectum is called hematochezia
2. Inadequate intake of iron due to
a. Chronic diarrhea
b. Related to malabsorption syndrome
c. High cereal intake with low animal protein digestion
d. Subtotal gastrectomy
4. Related to improper cooking of foods
C. Signs and Symptoms
1. Usually asymptomatic
2. Weakness and fatigue (initial signs)
3. Headache and dizziness
15
4. Pallor and cold sensitivity
5. Dyspnea
6. Palpitations
PERNICIOUS ANEMIA
- Chronic anemia characterized by a deficiency of intrinsic factor leading to hypochlorhydria (decrease
hydrochloric acid secretion)
A. Predisposing Factors
1. Subtotal gastrectomy
2. Hereditary factors
3. Inflammatory disorders of the ileum
4. Autoimmune
5. Strictly vegetarian diet
STOMACH
▼
Pareital cells/ Argentaffin or Oxyntic cells
D. Nursing Management
1. Enforce CBR
2. Administer Vitamin B12 injections at monthly intervals for lifetime as ordered
- Never given orally because there is possibility of developing tolerance
- Site of injection for Vitamin B12 is dorsogluteal and ventrogluteal
- No side effects
3. Provide a dietary intake that is high in carbohydrates, protein, vitamin c and iron
4. Instruct client to avoid irritating mouth washes instead use soft bristled toothbrush
5. Avoid heat application to prevent burns
APLASTIC ANEMIA
- Stem cell disorder leading to bone marrow depression leading to pancytopenia
PANCYTOPENIA
A. Predisposing Factors
1. Chemicals (Benzine and its derivatives)
2. Related to irradiation/exposure to x-ray
3. Immunologic injury
4. Drugs
Broad Spectrum Antibiotics
a. Chloramphenicol (Sulfonamides)
Chemotherapeutic Agents
a. Methotrexate (Alkylating Agent)
b. Vincristine (Plant Alkaloid)
c. Nitrogen Mustard (Antimetabolite)
Phenylbutazones (NSAIDS)
D. Nursing Management
1. Removal of underlying cause
2. Institute BT as ordered
3. Administer oxygen inhalation
4. Enforce CBR
5. Institute reverse isolation
6. Monitor for signs of infection
a. fever
b. cough
7. Avoid IM, subcutaneous, venipunctured sites
8 Instead provide heparin lock
9. Instruct client to use electric razor when shaving
10. Administer medications as ordered
a. Corticosteroids – caused by immunologic injury
b. Immunosuppressants
A. Predisposing Factors
1. Related to rapid blood transfusion
2. Massive burns
3. Massive trauma
4. Anaphylaxis
5. Septecemia
6. Neoplasia (new growth of tissue)
7. Pregnancy
C. Diagnostic Procedures
15
1. CBC reveals decreased platelets
2. Stool occult blood positive
D. Nursing Management
1. Monitor for signs of bleeding of all hema test including stool and GIT
2. Administer isotonic fluid solution as ordered
3. Administer oxygen inhalation
4. Force fluids
5. Administer medications as ordered
a. Vitamin K
b. Pitressin/ Vasopresin to conserve fluids
c. Heparin/Coumadin is ineffective
6. Provide heparin lock
7. Institute NGT decompression by performing gastric lavage by using ice or cold saline solution of 500 – 1000
ml
8. Monitor NGT output
9. Prevent complication
a. Hypovolemic shock
b. Anuria – late sign
BLOOD TRANSFUSION
Goals/Objectives
1. Replace circulating blood volume
2. Increase the oxygen carrying capacity of blood
3. Prevent infection in there is a decrease in WBC
4. Prevent bleeding if there is platelet deficiency
15
SIGNS AND SYMPTOMS OF ALLERGIC REACTION
1. Fever
2. Dyspnea
A. Layers of Heart
1. Epicardium – outer layer
2. Myocardium – middle layer
3. Endocardium – inner layer
- Myocarditis can lead to cardiogenic shock and rheumatic heart disease
C. Valves
- To promote unidimensional flow or prevent backflow
D. Coronary Arteries
- Arises from base of the aorta
Types of Coronary Arteries
1. Right Main Coronary Artery
2. Left Main Coronary Artery
15
- Supplies the myocardium
E. Cardiac Conduction System
1. Sino – Atrial Node (SA or Keith Flack Node)
3. Bundle of His
- Right Main Bundle of His
- Left Main Bundle of His
- Located at the interventricular septum
4. Purkinje Fibers
- Located at the walls of the ventricles for ventricular contraction
SA NODE
AV NODE
BUNDLE OF HIS
JLJLJLJJLJLJL
PURKINJE FIBERS
ATHEROSCLEROSIS
ATHEROSCLEROSIS ARTERIOSCLEROSIS
- narrowing of artery - hardening of artery
- lipid or fat deposits - calcium and protein deposits
- tunica intima - tunica media
A. Predisposing Factors
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
6. sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet – increased saturated fats
10. Type A personality
C. Treatment
Percutaneous Transluminal Coronary Angioplasty
Objectives of PTCA
1. Revascularize myocardium
2. To prevent angina
3. Increase survival rate
- Done to single occluded vessels
- If there is 2 or more occluded blood vessels CABG is done
Coronary Arterial Bypass And Graft Surgery
3 Complications of CABG
1. Pneumonia – encourage to perform deep breathing, coughing exercise and use of incentive spirometer
2. Shock
3. Thrombophlebitis
B. Precipitating Factors
4 E’s of Angina Pectoris
1. Excessive physical exertion – heavy exercises
2. Exposure to cold environment
3. Extreme emotional response – fear, anxiety, excitement
4. Excessive intake of foods rich in saturated fats – skimmed milk
D. Diagnostic Procedure
1. History taking and physical exam
2. ECG tracing reveals ST segment depression
3. Stress test – treadmill test, reveal abnormal ECG
4. Serum cholesterol and uric acid is increased
E. Nursing Management
1. Enforce complete bed rest
2. Administer medications as ordered
a. Nitroglycerine (NTG) – when given in small doses will act as venodilator, but in large doses will
act as vasodilator
- Give first dose of NTG (sublingual) 3 – 5 minutes
- Give second dose of NTG if pain persist after giving first dose with interval of 3 - 5 minutes
- Give third and last dose of NTG if pain still persist at 3 – 5 minutes interval
Nursing Management when giving NTG
- Keep the drug in a dry place, avoid moisture and exposure to sunlight as it may inactivate the drug
- Monitor side effects
o Orthostatic hypotension
15
o Transient headache and dizziness
- Instruct the client to rise slowly from sitting position
b. Beta-blockers
- Propanolol - side effects PNS
- Not given to COPD cases because it causes bronchospasm
c. ACE Inhibitors
- Enalapril
d. Calcium Antagonist
- NIfedipine
MYOCARDIAL INFARCTION
Heart attack
Terminal stage of coronary artery disease characterized by malocclusion, necrosis and scarring.
A. Types
1. Transmural Myocardial Infarction – most dangerous type characterized by occlusion of both right and left
coronary artery
2. Subendocardial Myocardial Infarction – characterized by occlusion of either right or left coronary artery
C. Predisposing Factors
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
15
6. sedentary lifestyle
7. Diabetes Mellitus
E. Diagnostic Procedure
1. Cardiac Enzymes
a. CPK – MB
- Creatinine phosphokinase is increased
- Heart only, 12 – 24 hours
b. LDH – Lactic acid dehydroginase is increased
c. SGPT – Serum glutamic pyruvate transaminase is increased
d. SGOT – Serum glutamic oxal-acetic transaminase is increased
2. Troponin Test – is increased
3. ECG tracing reveals
a. ST segment elevation
b. T wave inversion
c. Widening of QRS complexes indicates that there is arrhythmia in MI
4. Serum Cholesterol and uric acid are both increased
5. CBC – increased WBC
F. Nursing Management
Goal: Decrease myocardial oxygen demand
d. ACE Inhibitors
e. Calcium Antagonist
g. Anti Coagulant
- Heparin (check for partial thrombin time)
- Antidote: protamine sulfate
- Coumadin/ Warfarin Sodium (check for prothrombin time)
- Antidote: Vitamin K
h. Anti Platelet
- PASA (Aspirin)
- Anti thrombotic effect
- Side Effects of Aspirin
Tinnitus
Heartburn
Indigestion/Dyspepsia
- Contraindication
Dengue
Peptic Ulcer Disease
Unknown cause of headache
15
10. Provide client health teaching and discharge planning concerning
a. Avoidance of modifiable risk factors
A. Predisposing Factors
1. 90% is mitral valve stenosis due to
a. RHD – inflammation of mitral valve due to invasion of Grp. A beta-hemolytic streptococcus
- Formation of aschoff bodies in the mitral valve
- Common among children
- ASO Titer (Anti streptolysin O titer)
- Penicillin
- Aspirin
b. Aging
2. Myocardial Infarction
3. Ischemic heart disease
4. Hypertension
5. Aortic valve stenosis
B. Signs and Symptoms
1. Dyspnea
2. Paroxysmal nocturnal dyspnea – client is awakened at night due to difficulty of breathing
3. Orthopnea – use 2 – 3 pillows when sleeping or place in high fowlers
4. Productive cough with blood tinged sputum
5. Frothy salivation
6. Cyanosis
7. Rales/Crackles
8. Bronchial wheezing
15
9. Pulsus Alternans – weak pulse followed by strong bounding pulse
10. PMI is displaced laterally due to cardiomegaly
11. There is anorexia and generalized body malaise
D. Nursing Management
Goal: increase cardiac contractility thereby increasing cardiac output (3 – 6 L/min)
15
1. Enforce CBR
2. Administer medications as ordered
a. Cardiac glycosides
3. Administer oxygen inhalation with high inflow, 3 – 4 L/min, delivered via nasal cannula
4. High fowlers position
5. Monitor strictly vital signs, intake and output and ECG tracing
6. Measure abdominal girth daily and notify physician
7. Provide a dietary intake of low sodium, cholesterol and caffeine
8. Provide meticulous skin care
9. Assist in bloodless phlebotomy – rotating tourniquet, rotated clockwise every 15 minutes to promote
decrease venous return
10. Provide client health teaching and discharge planning
a. Prevent complications
- Arrythmia
- Shock
- Right ventricular hypertrophy
- MI
- Thrombophlebitis
b. Dietary modification
c. Strict compliance to medications
Venous Ulcer
1. Varicose Veins
2. Thrombophlebitis (deep vein thrombosis)
THROMBOANGITIS OBLITERANS
Acute inflammatory disorder usually affecting the small medium sized arteries and veins of the lower
extremities
A. Predisposing Factors
15
1. High risk groups – men 30 years old and above
2. Smoking
C. Diagnostic Procedures
1. Oscillometry – decrease in peripheral pulses
2. Doppler UTZ – decrease blood flow to the affected extremity
3. Angiography – reveals site and extent of malocclusion
D. Nursing Management
1. Encourage a slow progressive physical activity
a. walking 3 – 4 times a day
b. out of bed 3 – 4 times a day
2. Administer medications as ordered
a. Analgesics
b. Vasodilators
c. Anti coagulants
3. Institute foot care management
4. Instruct client to avoid smoking and exposure to cold environment
5. Assist in surgical procedure – bellow knee amputation
REYNAUD’S DISEASE
Disorder characterized by acute episodes of arterial spasm involving the fingers or digits of the hands
A. Predisposing Factors
1. High risk group – female 40 years old and above
2. Smoking
3. Collagen diseases
a. SLE (butterfly rash)
b. Rheumatoid Arthritis
4. Direct hand trauma
a. Piano playing
b. Excessive typing
c. Operating chainsaw
C. Diagnostic Procedures
D. Nursing Management
1. Administer medications as ordered
a. Analgesics
b. Vasodilators
2. Encourage to wear gloves
3. Instruct client on importance of cessation of smoking and exposure to cold environment
VARICOSITIES
Abnormal dilation of veins of lower extremities and trunks due to
Incompetent valve resulting to
Increased venous pooling resulting to
Venous stasis causing
Decrease venous return
A. Predisposing Factors
1. Hereditary
2. Congenital weakness of veins
3. Thrombophlebitis
4. Cardiac disorder
5. Pregnancy
6. Obesity
7. Prolonged standing or sitting
D. Nursing Management
1. Elevate legs above heart level to promote increased venous return by placing 2 – 3 pillows under the legs
2. Measure the circumference of leg muscle to determine if swollen
3. Wear anti embolic stockings
4. Administer medications as ordered
a. Analgesics
5. Assist in surgical procedure
a. Vein stripping and ligation (most effective)
b. Sclerotherapy – can recur and only done in spider web varicosities and danger of thrombosis (2 – 3
years for embolism)
15
THROMBOPHLEBITIS
Deep vein thrombosis
A. Predisposing Factors
1. Obesity
2. Smoking
3. Related to pregnancy
4. Chronic anemia
5. Prolong use of oral contraceptives – promotes lipolysis
6. Diabetes mellitus
7. Congestive heart failure
8. Myocardial infarction
9. Post op complication
10. Post cannulation – insertion of various cardiac catheter
11. Increase in saturated fats in the diet.
C. Diagnostic Procedure
1. Venography
2. Angiography
D. Nursing Management
1. Elevate legs above heart level to promote increase venous return
2. Apply warm moist pack – to reduce lymphatic congestion
3. Measure circumference of leg muscle to determine if swollen
4. Encourage to wear anti embolic stockings or knee elastic stockings
5. Administer medications as ordered
a. Analgesics
b. Anti Coagulant
- Heparin
6. Monitor for signs of complications
Embolism
a. Pulmonary
- Sudden sharp chest pain
- Unexplained dyspnea
- Tachycardia
- Palpitations
- Diaphoresis
- Restlessness
b. Cerebral
- Headache
15
- Dizziness
- Decrease LOC
RESPIRATORY SYSTEM
OVERVIEW OF THE STRUCTURES AND FUCNTIONS OF THE RESPIRATORY SYSTEM
I. Upper Respiratory System
1. Filtering of air
2. Warming and moistening of air
3. Humidification
A. Nose
- Cartillage
- Right nostril
- Left nostril
- Separated by septum
- Consist of anastomosis of capillaries known as Keissel Rach Plexus (the site of nose bleeding)
B. Pharynx/Throat
- Serves as a muscular passageway for both food and air
C. Larynx
- For phonation (voice production)
- For cough reflex
Glottis
- Opening of larynx
- Opens to allow passage of air
- Closes to allow passage of food going to the esophagus
- The initial sign of complete airway obstruction is the inability to cough
A. Precipitating Factors
1. Malnutrition
2. Overcrowded places
3. Alcoholism
4. Over fatigue
5. Ingestion of an infected cattle with mycobacterium bovis
6. Virulence (degree of pathogenecity) of microorganism
B. Mode of Transmission
1. Airborne transmission via droplet nuclei
D. Diagnostic Procedure
1. Mantoux Test (skin test)
15
- Purified protein derivative
- DOH 8 – 10 mm induration, 48 – 72 hours
- WHO 10 – 14 mm induration, 48 – 72 hours
3. Chest X-ray
- Reveals pulmonary infiltrates
4. CBC
- Reveals increase WBC
E. Nursing Management
1. Enforce CBR
2. Institute strict respiratory isolation
3. Administer oxygen inhalation
4. Force fluids to liquefy secretions
5. Place client on semi fowlers position to promote expansion of lungs
6. Encourage deep breathing and coughing exercise
7. Nebulize and suction when needed
8. Comfortable and humid environment
9. Institute short course chemotherapy
a. Intensive phase
- INH (Isonicotinic Acid Hydrazide)
- Rifampicin (Rifampin)
- PZA (Pyrazinamide)
- Given everyday simultaneously to prevent resistance
- INH and Rifampicin is given for 4 months, taken before meals to facilitate absorption
- PZA is given for 2 months, taken after meals to facilitate absorption
- Side Effect INH: peripheral neuritis/neuropathy (increase intake of Vitamin B6/Pyridoxine)
- Side Effect Rifampicin: all bodily secretions turn to red orange color
- Side Effect PZA: allergic reaction, hepatotoxicity, nephrotoxicity
- PZA can be replaced by Ethambutol
- Side Effect Ethambutol: optic neuritis
b. Standard phase
- Injection of streptomycin (aminoglycoside)
- Kanamycin
- Amikacin
- Neomycin
- Gentamycin
- Side Effect:
- Ototoxicity damage to the 8th cranial nerve resulting to tinnitus leading to hearing loss
- Nephrotoxicity check for BUN and Creatinine
- Give aspirin if there is fever
- Side Effect: tinnitus, dyspepsia, heartburn
10. Provide increase carbohydrates, protein, vitamin C and calories
15
11. Provide client health teaching and discharge planning
a. Avoidance of precipitating factors
b. Prevent complications (atelectasis, military tuberculosis)
PNEUMONIA
Inflammation of the lung parenchyma leading to pulmonary consolidation as the alveoli is filled with exudates
A. Etiologic Agents
1. Streptococcus Pneumonae – causing pneumococal pneumonia
2. Hemophylus Influenzae – causing broncho pneumonia
3. Diplococcus Pneumoniae
4. Klebsella Pneumoniae
5. Escherichia Pneumoniae
6. Pseudomonas
C. Predisposing Factors
1. Smoking
2. Air pollution
3. Immuno compromised
a. AIDS
- Pneumocystic carini pneumonia
- Drug of choice is Retrovir
b. Bronchogenic Cancer
- Initial sign is non productive cough
- Chest x-ray confirms lung cancer
4. Related to prolonged immobility (CVA clients), causing hypostatic pneumonia
5. Aspiration of food causing aspiration pneumonia
F. Nursing Management
1. Enforce CBR
2. Administer oxygen inhalation low inflow
3. Administer medications as ordered
Broad Spectrum Antibiotic
a. Penicillin
b. Tetracycline
c. Microlides (Zethromax)
- Azethromycin (Side Effect: Ototoxicity)
- Antipyretics
- Mucolytics/Expectorants
- Analgesics
4. Force fluid
5. Place on semi fowlers position
6. Institute pulmonary toilet (tends to promote expectoration)
- Deep breathing exercises
- Coughing exercises
- Chest physiotherapy
- Turning and reposition
7. Nebulize and suction as needed
8. Assist in postural drainage
- Drain uppermost area of lungs
- Placed on various position
Nursing Management for Postural Drainage
a. Best done before meals or 2 – 3 hours to prevent gastro esophageal reflux
b. Monitor vital signs
c. Encourage client deep breathing exercises
d. Administer bronchodilators 15 – 30 minutes before procedure
e. Stop if client cannot tolerate procedure
f. Provide oral care after procedure
g. Contraindicated with
- Unstable vital signs
- Hemoptysis
- Clients with increase intra ocular pressure (Normal IOP 12 – 21 mmHg)
- Increase ICP
9. Provide increase carbohydrates, calories, protein and vitamin C
10. Health teaching and discharge planning
15
a. Avoid smoking
b. Prevent complications
- Atelectasis
HISTOPLASMOSIS
Acute fungal infection caused by inhalation of contaminated dust or particles with histoplasma capsulatum
derived from birds manure
B. Diagnostic Procedures
1. Histoplasmin Skin Test – positive
2. ABG analysis PO2 decrease
C. Nursing Management
1. Enforce CBR
2. Administer oxygen inhalation
3. Administer medications as ordered
a. Antifungal
- Amphotericin B
- Fungizone (Nephrotoxicity, check for BUN and Creatinine, Hypokalemia)
b. Steroids
c. Mucolytics
d. Antipyretics
4. Force fluids to liquefy secretions
5. Nebulize and suction as needed
6. Prevent complications – bronchiectasis
7. Prevent the spread of infection by spraying of breeding places
A. Predisposing Factors
1. Smoking
15
2. Air pollution
B. Signs and Symptoms
1. Productive cough (consistent to all COPD)
Bronchial Asthma
Reversible inflammatory lung condition due to hypersensitivity to allergens leading to narrowing of smaller
airways
C. Diagnostic Procedure
1. Pulmonary Function Test
D. Nursing Management
1. Enforce CBR
2. Oxygen inhalation, with low inflow of 2 – 3 L/min
3. Administer medications as ordered
a. Bronchodilators – given via inhalation or metered dose inhalaer or MDI for 5 minutes
b. Steroids – decrease inflammation
c. Mucomysts (acetylceisteine)
d. Mucolytics/expectorants
e. Anti histamine
4. Force fluids
5. Semi fowlers position
6. Nebulize and suction when needed
7. Provide client health teachings and discharge planning concerning
a. Avoidance of precipitating factor
b. Prevent complications
- Emphysema
- Status Asthmaticus (give drug of choice)
- Epinephrine
- Steroids
- Bronchodilators
c. Regular adherence to medications to prevent development of status asthmaticus
d. Importance of follow up care
BRONCHIECTASIS
Abnormal permanent dilation of bronchus leading to destruction of muscular and elastic tissues of alveoli
A. Predisposing Factors
1. Recurrent lower respiratory tract infections
2. Chest trauma
3. Congenital defects
4. Related to presence of tumor
C. Diagnostic Procedure
1. ABG – PO2 decrease
15
2. Bronchoscopy – direct visualization of bronchus using fiberscope
POST Bronchoscopy
1. Feeding initiated upon return of gag reflex
2. Avoid talking, coughing and smoking, may cause irritation
3. Monitor for signs of gross
4. Monitor for signs of laryngeal spasm – prepare tracheostomy set
D. Treatment
1. Surgery (pneumonectomy , 1 lung is removed and position on affected side)
2. Segmental Wedge Lobectomy (promote re expansion of lungs)
- Unaffected lobectomy facilitate drainage
EMPHYSEMA
Irreversible terminal stage of COPD characterized by
a. Inelasticity of alveoli
b. Air trapping
c. Maldistribution of gases
d. Over distention of thoracic cavity (barrel chest)
A. Predisposing Factors
1. Smoking
2. Air pollution
3. Allergy
4. High risk: elderly
5. Hereditary – it involves deficiency of ALPHA-1 ANTI TRYPSIN (needed to form Elastase, for recoil of
alveoli)
C. Diagnostic Procedure
D. Nursing Management
1. Enforce CBR
2. Administer oxygen inhalation via low inflow
3. Administer medications as ordered
a. Bronchodilators
b. Steroids
c. Antibiotics
d. Mucolytics/expectorants
4. High fowlers position
5. Force fluids
6. Institute pulmonary toilet
7. Nebulize and suction when needed
8. Institute PEEP (positive end expiratory pressure) in mechanical ventilation promotes maximum alveolar lung
expansion
9. Provide comfortable and humid environment
10. Provide high carbohydrates, protein, calories, vitamins and minerals
11. Health teachings and discharge planning concerning
a. Avoid smoking
b. Prevent complications
- Atelectasis
- Cor Pulmonale
- CO2 narcosis may lead to coma
- Pneumothorax
c. Strict compliance to medication
d. Importance of follow up care
15